By 2019, some insurance experts predict that medical care will make up two-thirds of workers compensation claim costs. Comorbid conditions such as obesity and diabetes, along with growing prescriptions for opioids can further complicate WC claims. When these injuries occur, however, the way a claim is managed, from the day of the injury to the day the claim is closed, can impact whether the injured employee quickly recovers and returns to work or requires treatment for months, even years.
By gaining a thorough understanding of the value nurses deliver, knowing which claims will benefit most from a nurse’s involvement, and learning which skills a nurse really needs to make that involvement count, Liberty Mutual says it can achieve better outcomes. Intuitively, insurance carriers and third-party administrators understand the connection between a nurse’s involvement in a claim and a favorable claim outcome. But Liberty wanted to quantify that impact and calculate the “N Factor.”
It looked at medical billing and claims data for 42,000 claims across four categories. The company was able to leverage a claimant’s behavioral or psychosocial characteristics, which are captured as part of a claim screening function. Nurses record information such as the claimant’s expectations, experience with injuries, and attitudes toward work and rehabilitation, all of which play a role in better outcomes.
The study, “The N Factor: How Nurses Add Value to Workers Compensation Claims,” showed that nurses deliver a number of significant benefits when involved on a claim. Medical and total loss dollars were reduced by double-digit percentages and injured employees returned to work sooner, which contributes to significant cost savings, increased productivity, and improvements in morale.
“When we analyzed a homogeneous set of claims, we saw that a nurse’s involvement made a difference in the claim cost as well as returning the injured employee to work sooner,” the study states. “But that doesn’t mean that involving a nurse in the treatment of every type of claim is going to produce the same results.”
Liberty created a decision-support model to identify claims where a nurse would be beneficial. This model leverages 25 to 30 data variables within its claims system.