ACES Technologies Claims Profiling Software Cuts Workers' Compensation Costs, Now is Web-based
PROVIDENCE, March 30, 1999 - It is commonly appreciated that a rather small subgroup of cases is associated with a majority of cost and expense. Identifying this subgroup of cases is not all that difficult once the claim has begun to show signs of "delayed recovery". Unfortunately, this discovery often occurs too late in the claim life and successful recovery can be quite frustrating and costly. Likewise, a protocol defined by a more hypersensitive approach can also result in unnecessary overspending of time and resources. New "claims profiling" techniques have now been developed to help organizations accurately identify potential "delayed recovery" claims early in the claim cycle.
For the past three years, ACES Technologies, LLC has been developing and refining decision-support software to assist insurance adjusters in identifying those claims which are in need of advanced intervention such as nurse case management. The name of this new claims profiling software is ACES which stands for Accelerated Case/Claim Evaluation System. "Think of it as automated triage," says Cesare. "We have basically captured the logic and deduction skills of a seasoned adjuster and put it into our smart software. By using ACES, an adjuster with one year of experience can make the same decisions as a 10-year veteran.
ACES software was developed over several years by first identifying common characteristics of poor-outcome claims called "modifiers". According to Steven Lucci, P.T., Vice President Operations, "over 117 claim modifiers were originally identified and weighted according to a propensity to cause delayed recovery. However, continued "confidence" analysis of the data allowed us to narrow the modifiers list to the 28 currently being used today."
Using the ACES Technologies Website, adjusters can simply answer a series of yes/no questions at the time of the claim set-up and receive immediate feedback in the form of an ACES Index. The ACES Index is a quotient ranging from 1-100 and is further delineated into Level 1, Level 2 and Level 3 Claims indicating both severity and prioritization. Level 1 claims present a low predisposition to delayed recovery, while Level 3 claims require more intensive intervention such as case management activity or workplace analysis.
Current ACES users, both in the US and Canada, are realizing significant savings by early triaging of claims and selectively allocating resources to the appropriate cases. Approximately 25-30 % of "loss time" claims fall into the Level 3 category, according to Dr. Cesare. He continues to explain that 17 % of Level 3 claims are "medical only" claims which may suggest an under-involvement in this subgroup of cases. In addition, he adds that up to 22 % of "lost time" claims are in a Level 1 category which represents a significant over-involvement and unnecessary resource expenditure for many organizations. Further, ACES parallel database capabilities combines demographic, medical, therapeutic, ergonomics, and outcome information to create a variety of reporting tools. Such tools include provider profiling and superior integration with Loss Prevention activities. By profiling claims early, retrieving workplace information, and communicating effectively with providers, ACES users are experiencing up to 25 % reduction in total claim costs.
ACES Technologies has recently completed building a new and efficient "browser-based" delivery format which allows users to Profile claims either through the internet or an intranet. " Adjusters, case mangers, and supervisors can now use a PC with internet connection to go to our secure website which will serve as a Profiling Management Center, " explains Roseann Robinson, Account Manager. "New claims can be easily and quickly profiled while open claims are continuously monitored and re-profiled. Also, supervisors will have access to multiple reporting capabilities generated by our data warehouse." Robinson reports.
ACES Technologies will assist clients with customized quarterly administrative reports. All data can be downloaded to the client organization on a regular schedule if desired.