Why Wikinomics?

The following was posted at the Wikinomics Blog (http://www.wikinomics.com/blog/index.php/2007/11/26/all-bugs-are-shallow/#comment-64060)

"There are two groups; those that ‘get it’ and those that do not. Efficiency is the name of the game in business and those who cling to structure-the tangible- have ‘insecurity’ written all over their faces. I have begun to give the book “Wikinomics” to those who yearn to work smarter and quicker."

Would You Pay $330 for a $1 Pill?

If you are involved in the management of Workers' Compensation or 3rd Party BI claims it is important to understand what drives the cost of these claims. The medical portion (charges) is something that Carom finds is not regarded with enough scrutiny. So, we offer you the following information that we hope will cause you to question every line of every bill from every hospital.

A midwest health insurance provider recently sent me a letter explaining why certain charges from our local hospital were not covered for blood work done for my Wife. The letter went on to say that the insurance company analyzes charges from all hospitals and sees the markups that are billed. They wanted to let me know that "Based on the most recent public data, ______ Hospital marks up their prices, on average, by 330% times cost."

Enough said.

We Bring It On Ourselves

Here is yet another example of how our Cost of Risk is not being managed. This is both a Workers' Compensation example as well as an Auto example:

Truck Driver (company driver, not an Independent Operator) reports to his company that his truck was hit in a truck stop and he was injured. Adjuster in Trucking Company's Risk Dept instructs the Driver to seek medical attention and to call back with a diagnosis (first of many mistakes). Driver calls several days later and reports that HIS doctor is recommending a referral to an orthopedic surgeon. Fast forward 18 months and the Driver is still off work. In spite of a lien letter being sent by the Trucking Company the trucking company that hit the truck in the lot settled the 3rd Party BI claim with the Driver for $40,000.

When we asked the Adjuster in the Risk Dept just what sort of accident this was we encountered a blank stare. You see, no one, not the insured (self administered) trucking company or the 3rd party truck line ever bothered to look into just what this accident was all about. The handling Adjuster, upon learning that the settlement was made for the $40,000, advised that the impact resulted in a dent the size of a quarter in the bumper of the truck.

This is the norm, unfortunately, where we are focused on quickly paying the WC benefits and not taking the time to investigate the loss. Secondarily, the 3rd party truck line also never conducted an investigation nor challenged the legitimacy of the impact and allegation of injuries being related to such a minor event.

Our desire to find a better way has resulted in Carom developing a relationship with an engineering firm that produces a $360 Force Analysis that is used to effectively challenge these types of claims. They key is to quickly conduct the investigation and present the Analysis to the Claimant, the attending physician and plaintiff counsel. Often times the word "fraud" can be woven into the conversation and the end result is a diminished claim value.

Primacy Case Management; Primacy Event Management

Carom has applied to trademark its Primacy Case Management and Primacy Event Managment.

Deep Risk Smarts; Collaboration

Question for the day: What will cause the insurance industry to be efficient? Will they ever understand the power of Collaboration and an open source approach or will the every growing sense of Mediation continue to dominate their thinking? For those who have not been exposed to "Wikinomics" I strongly suggest you cuddle up with this book and then consider the impact it can have on outcomes; the cost of claims and service to the policyholder. There IS a better way!