Ventiv Technology

1 4 | 360º Aon eSolutions "For example in workers' compensation, we were one of the first pools to institute a structured return-to-work (RTW) program. Today we perform utilization review in-house with our own medical director, and we utilize triage nurses to contain costs from the onset of a claim" said McKay. "Our nurses are the first point of contact for injured workers. They perform an initial injury evaluation and, when appropriate, provide first aid guidelines over the phone. In addition, they collect all necessary initial claims information and input it directly into iVOS." "Another big change we made years ago was to empower our claims staff by substantially reducing their average caseload. In this way, they would have more time to strategize the best resolution on claims," said McKay. "Our claims examiners like using iVOS; it offers a lot of practical functionality," said Jenkins. "Another beautiful feature is its configurability. iVOS offers a lot of fields and screens, so we've had the flexibility to capture additional information and track a special type of indemnity claim called 'medical-only RTW' in order to handle these claims differently from medical-only or indemnity claims." In addition, SIA deployed the MMSEA (Medicare, Medicaid, and SHIP Extension Action) reporting module. "Medicare compliance could have been a real nightmare, with penalties of up to $1,000 a day per claim that isn't reported appropriately. Achieving compliance with this module has been a huge relief for me," said Jenkins. IntegratIng rIskconsole "Our latest initiative will be to utilize RiskConsole to enhance our data analysis and reporting capabilities, which have become vital to our risk management strategy," said McKay. SIA was dealing with three issues that RiskConsole will help address. First, SIA wants to better manage member contacts, and also track member participation in various programs. "Second, we wanted to be able to easily consolidate data and reduce our reliance on spreadsheets," said McKay. "We have a lot of information silos and must coordinate multiple, complex spreadsheets in order to pull data. The process can be time consuming and prone to error. Third, we want to be able to take exposure data and marry it with our claims information, as well as pull in external data sources, such as California state normative information." "Currently we perform a regimen of monthly analytics, but if we have a special inquiry, it can take weeks to pull and organize data," said "We view iVOS and RiskConsole as true complements," said Paul McKay. "What iVOS does best is claims administration and data capture. RiskConsole gives us the added advantage of a full risk management information system (RMIS) with powerful capabilities to perform data integration, analysis and reporting." the recIpe for success "Our objective is to provide risk coverage and risk management services at the lowest possible premium costs to members," said McKay. "A combination of smart program design, excellent claims administration and thoughtful data analysis—all performed by highly competent professionals—is, in essence, our recipe for success." "Our primary objective is to contain claims costs; often that doesn't represent doing things differently, but rather, doing different things," said Rick Jenkins. "Technology helps us to 'follow the money' to prevent claims from occurring, and when they do occur to minimize costs. Through analysis, trial and error, and program adoption, we continually evolve to meet members' needs." reengIneerIng claIms SIA purchased iVOS as part of reengineering its claims operations. "We needed a system that would allow us to efficiently administer claims and effectively capture information, so we could understand what was driving our claims costs," said McKay. "Once iVOS was in place, we implemented other initiatives to improve outcomes." In California, school districts face tightening budgets—along with rising insurance costs. Schools Insurance Authority (SIA) offers an effective option: school districts pooling together for the purpose of self-insurance, risk management and loss control. Since its formation in 1974, SIA has helped its members save premium dollars and stabilize coverage costs. SIA continues its mission by partnering with members to prevent workplace injuries and property losses, as well as to maintain safe school environments for students and employees. We spoke with Paul McKay, director of finance and operations, and Rick Jenkins, IT supervisor, regarding SIA's use of iVOS to reengineer its claims process and the organization's recent decision to also implement RiskConsole for a comprehensive, integrated solution.

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