december 17, 2023 – Michael Marsh
The concept of Creative Design is rarely discussed in the context of workers' compensation claims processes and procedures. The industry needs to look further than, well beyond, the trendy concepts of AI, patient engagement and work-from-home. Industry leaders that embrace the concept of Creative Design will help bring our industry into the strong, respected future that it has earned.
What is Creative Design? From the experts at https://www.perfectlancer.com :
Prelude–Creative design explained
You can’t describe creative design as a sole concept. Just like creativity can be found everywhere, wherever a human exists and has a soul, you can find it in design and arts, too. Generally speaking, creative design is the process of combining artistic elements and innovative thinking to produce visually appealing and impactful designs. It involves utilizing various techniques, such as typography, color theory, and layout, to effectively communicate a message or evoke emotions (mostly for marketing purposes).
My reading and review of Creative Design in the context of business process redesign led me to believe that there is a place for it at the business table. Creative Design brings together elements into the study process that heretofore were rarely in the same room together, let alone equal contributors. Nearly every organization trots out over and over as why they are an 'industry leader' with their business process design of the week/month/year. However, has there actually been any truly remarkable trend setting changes through the last several decades? My work as a consultant and expert litigation witness on topic of the claims process has not found there to be. Perhaps true industry leading organizations can bring the concept of Creative Design to the table to fashion and implement revised processes that move the needle in a substantive way.
When following a path using Creative Design, thinking differently about creation of the artistic works, evaluating components that make up visual or multi-sense artistic presentations and how the interaction between human beings and the 'subject' are more than simply the colors or type of paint is central. There is a human soul in every interaction between the presentation and the human being. Not acknowledging and planning for these interactions may actually lead to processes that are antithetical to 'best practices'. Few things are more important that the concept of acknowledging the human spiritual component in the management of workers' compensation claims.
In workers' compensation claims, we as the claims handlers are directly responsible for the interaction(s) of the recovering worker and the "system". Not embracing that fact is to not acknowledge a significant true driver of the workers' compensation claims system.
Sure, there are literally hundreds of important considerations, from state-specific statutes to legal precedents, from *insert name* financial investment firm requirements for ROI to client handling instructions. Nearly every claims operation in insurance companies, captive insurance, state-based quasi-insurance, and self-funded programs have contracts and procedures, that include internally created policies such as the much parroted concept of best practices, Every organization needs a unifying, cohesive set of guidelines. But unfortunately, far too often the folks involved use the guidelines as the end result measure...when in fact they should be called the lowest common denominator guidelines.
We as an industry can do better. The efforts of the fabulous people at https://www.workcompcollege.com are doing that. If you have not heard of their efforts, or would like to look at the national and state-specific content, go to their website. The expanse of topics to achieve certification are beyond the lowest common denominator issues. Even the change from calling the worker who was injured at work is referred to as the recovering work, throwing out the commonly used term claimant. Some organizations are all in.
WorkCompCollege is a perfect example of implementation of Creative Design in reconsidering how we handle workers' compensation claims. The human element is considered at every level. The many early graduate of the full program have wonderful things to say about the depth and breadth of the program. Check out the WorkCompCollege LinkedIn page for more information.
Looking at using Creative Design, we have to reexamine every step in the claims process. For example, when training our employers, many who have never had a workplace injury in their company, how do we prepare them for an injurious incident. Do we have the computer send a download of the policy documents to the producing agent...with a nice flyer with the phone number or website address to be used when there is an injury? And that is the full extent of our investment in employer training? Or do we have human to human contact with the employer to describe the process and what steps the state statutes and case law require of us when an injury takes place...when the policy is issued or renewed?
Do we describe the benefits of an effective, impactful and realistic return to work program while the recovering worker is healing? Or do we just order a report from a physician and/or a voc rehab person and assign someone to tell the recovering worker that they will be converted to TPD 'if' the employer can accommodate their temporary restrictions? Do either the employer or the employee even know what temporary restrictions are?
One of the most important steps in the claims process is the initial contact with the worker. After an injury, have we trained the employer on what the best things are to say? How important immediate notice to the claims professionals is? Where to send the person for care or who to call to ask for assistance at that critical 'it just happened' point in time? And what medical information that they can expect o have access to? The FROI process is a perfect area for organizations to begin use of Creative Design to evaluate the existing processes. While many that read laugh at this challenge, we have implemented it...and IT WORKS. Have you considered offering to coordinate a face-to-face meeting with the newly injured worker, their family and the claims professional? I'll repeat....IT WORKS.
IT WORKS to significantly increase the connection and trust between the worker/family and the claims professional. Workers that have this increased trust tend to focus upon their healing over other temptations. Workers that focus upon their healing heal faster and more completely. RTW days are decreased. Permanent impairments are decreased. Litigation costs are decreased. And for our financial folks, the ROI by investing in the front costs of claim handling pays many times more on the ultimate claim cost...including staff and infrastructure costs. My TPA has been doing this since 2001. The lower costs as compared to state averages have been demonstrated on our website and presented to our Legislature multiple times.
Creative Design as a concept in workers' compensation claims allows for multiple levels of folks to have input at every step as the detail of the process is examined. Each of the levels in a claims operation has an impact upon each of the other levels. If the medical bill review process is looked at, does the processor have input of the reason for delays or unwarranted numbers of provider challenges? How does this impact upon the formulation of the original bill review external provider contract? Or is the contract typically done from the top down through the Procurement Department? Is the process creating a higher number of medical liens that might otherwise exist? Is there an impact upon claim flow and resolution that might be improved upon by modifications to the bill review process?
These are simple examples of the beginning level questions that can be asked and studied when using a Creative Design approach to the claims process. The process allows for questions and study of each detail in our processing, investigation and evaluation of claims. Importantly, it brings in all levels of those who are involved in each step of the process.
Takeaway: Creative design is a powerful tool that can be used in the process of retooling the workers' compensation claims process.