Advanced Workers’ Compensation Predictive Analytics Tools Provide Insightful Decision Making
ODG-based Tools (reserve calculator, comorbidity calculator, and risk assessment scoring) have been incorporated into Equian’s Predictive Analytics payment integrity model as the basis of the data to assist in forecasting medical, indemnity, and administrative costs, as well as time off work, and the magnitude and volatility of claims. The database used for cost forecasting includes 2.5M claims and $20B in paid costs in state detail. The database behind the lost-time forecasting includes 10 million bill review cases from three sources—CDC National Health Survey, Bureau of Labor Statistics Survey of Occupational Injuries and Illness, and over 3 Million medical records from actual workers’ compensation claims from national workers’ compensation carriers, TPAs, and self-insured employers. Finally, a risk assessment score is paired with financial reserve and comorbidity historical factors to calculate magnitude and volatility of any case.