Transforming Data into Actionable Intelligence

By Jamie LaPaglia, RN, CCM

Implementation Manager & Clinical Educator
ODG an MCG Health Company

While it may seem that our industry lags in the technology race, a closer look reveals that we are closing critical gaps by focusing on the information these technologies generate. Machine learning and artificial intelligence (AI) generate a lot of buzz, but the true innovation is in understanding how to leverage data for more effective claims management, better outcomes, and reduced disability cost.

Data is no longer just a reporting element; it is the foundation for decision support tools (DSTs) such as claims automation, predictive modeling, and risk scoring tools. These tools transform data into actionable intelligence for more proactive management of claims and more strategic use of resources.

Imagine predicting the number of days a claimant will be off work on the day the claim is filed. Or knowing the likelihood it will go to the end of benefit (EOB) and transition to long-term disability (LTD). Consider the value of being able to quickly identify which claims are receiving the most appropriate treatments, and which can be automatically paid and closed, or “auto-adjudicated.”

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