Is it possible to settle claims with better outcomes faster using big data and predictive models? If you have old claims to close, keep reading!
The foundation for these questions was the beginning of Care Bridge International’s 10-year journey, a quest to validate conventional methods used to forecast medical exposure for claims and determine if a better solution might exist to answer the question about lifetime medicals and targeted care coordination for more successful claim settlements.
Research and Analysis of the Accuracy/ Validity of Conventional Methods
In 2013 we conducted an analysis of one hundred Medicare Set Asides (MSAs) submitted to CMS for review and approval and compared the CMS future care results to actual treatment rendered, two-year post settlement. Upon review of the medical records, we identified that ninety-four of the one hundred claimants treated less frequently and received less prescription drugs than what was allocated. Of the remaining six claims which closely mirrored the Medicare Set Asides forecasts, we identified that what these six claims all had in common is that they involved catastrophic or chronic, progressive conditions i.e., spinal cord injuries, chronic obstructive pulmonary disease (COPD) related to respiratory exposures and/ or debilitating rheumatoid arthritis. We could not ignore that the overwhelming majority of Medicare Set Asides did not resemble the care forecasted in the first two years post settlement.
In 2014, we performed claimant interviews, medical record reviews and an analysis of seventeen Life Care Plans and compared the actual treatment rendered, ten-years post settlement, involving Medicare beneficiaries living in the Bradenton/ Sarasota, Florida region. The results were a non-starter upon identifying that only one out of the seventeen beneficiaries knew they had a Life Care Plan. This single beneficiary was aware of the existence of a Life Care Plan, did not have a copy of the original plan of care, and therefore did not follow the medical recommendations that intended to maximize his functional independence and wellness.
Following an exhaustive quest to validate Life Care Planning methodology with post settlement measurements, we concluded that no empirical evidence exists to support the methodology of Life Care Planning is valid. Members of the Life Care Planning community defend the lack of validation by stating that the practice itself defines a Life Care Plan as a “dynamic document,” a process characterized by constant change or activity, and therefore no claims are made as to the accuracy of the forecasts.
After multiple pilot studies we learned that claim handlers typically under-value medical exposure by 30% and Clinical professionals over-value medical exposure by 40%. For the past five years our data analytics platform has allowed our customers to settle claims six (6) to eight (8) months faster than conventional methods. As a technology platform that is actuary approved and endorsed, faster and more accurate medical forecasts are possible, including the forecasting of surgical probability and weaning of prescription medications. Our platform results save our clients 70% or more!
In comparing the approaches (as shown below) it is clear the use of Care Bridge International’s Analytic-Powered Claims Database© provides a valid and reliable foundation from which to forecast medical care compared to conventional methods and/ or vendors.
Legacy Claims Express: With Care Bridge International’s Legacy Claims Express program, you will receive:
- Comprehensive predictive models and data analytics that deliver medical forecasts for reserves and MSAs in minutes instead of weeks!
- Reduced litigation expense and long-term financial security for people involved in personal injury claims through personalized settlement consulting services.
- Service beyond the basic Medicare compliance duties, to include personal contact with all parties and the provision of comprehensive services.
- Expert consulting, from large scale improvement programs to small, targeted projects that save money in the short term.
Actual Results Legacy Claims Express Settlement involving a Sample of 12 Claims:
Client’s Medical Exposure prior to Settlement = $2,482,532.68
Client’s Medical Exposure Post Legacy Claims Express Program = $196,929.72
Total Savings: $1,609,879.23
Interested in Learning More about how Care Bridge can help you achieve your settlement goals in 2021?
Contact us Toll-Free: 888-434-9326
Email: Bob@carebridgeinc.com , Chief Client Officer, to schedule a phone call or demonstration
About Care Bridge International
Using data intelligence, Care Bridge International offers integrated technology-based solutions for future medical valuations, medical reserve setting, claim settlements, litigation, care coordination, and Medicare Secondary Payer compliance.
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