ICTA Nomination: Benchmark IME Applies Document Management/Workflow to the Accident Benefits Business

Posted on: January 1, 2015

The ‘ExpeFlow’ product is being used company-wide by every employee of Benchmark Independent Medical Examinations. ExpeFlow truly is Benchmark’s workflow platform and is used in every facet of the business. Administrative staff use the system to handle the core IME business processes, clinical staff use the system to ensure timelines are met and final edits are complete and sales/marketing/management use the system for reporting and an overall barometer of how Benchmark is performing. All information, processes, and workflow are captured, archived, and available for reporting purposes on the system which generates a tremendous amount of accountability among all users of the system since every action is tracked, date stamped, logged, and there is no concept of user anonymity on the system.

ExpeFlow was developed from inception as a single platform self-contained IME/AB system which is far superior to using multiple independent systems (even if each one is best-of-breed for its particular task) and all Benchmark users remain within the confines of this custom designed application specific system for the duration of their work day. This also has the added benefit of promoting internal and external collaboration in real-time with none of the pitfalls experienced when utilizing multiple software tools and relying on integrations and/or manual shifting between programs to create, manipulate, and share information.

ExpeFlow has been in use internally at Benchmark since early September, 2014 and now that the initial testing and internal processes are completed it will be rolled out to all participants involved in completing an IME file including: insurance companies, practitioners, lawyers, etc.

The goal of ExpeFlow is not just greatly expediting Benchmark’s processes, but also equally enabling all the participants on an IME file based on the premise that the easier Benchmark makes it to send, receive, and manipulate quality information the faster and more efficient it is to deliver quality results to clients. Quality data sent/received makes it far easier to deliver high quality results with much less administrative effort and burden among all parties involved in an IME file.

Essential Features of the Technology

• Technical Features:

Security is becoming a larger and larger challenge and compliance with governmental regulations such as PIPEDA and PHIPA and the associated privacy concerns are becoming much more visible and regulated than they were even two years ago. ExpeFlow is hosted in a Tier III facility with fully redundant hardware beginning right from the connectivity, power supplies, firewalls, switches, and ending with the servers.

All users connect through the application server in the business layer and end users never connect directly to the database server in any capacity.

In addition, ExpeFlow is hosted in a VMware environment configured to High Availability mode and, as a result, if there are ever any difficulties with the production server it will automatically vMotion over to another fully functioning server until the production server is back on-line. Currently 100% of Fortune 100 companies rely upon this technology and Benchmark wanted to ensure that it went with the industry standard for security, performance, and reliability.

• Operational Features:

An accident benefits claim and the corresponding IME are often complex, data intensive (voluminous amounts of text), time sensitive, and result in very costly claim payouts; particularly if not handled in the most strategic manner possible. The cornerstone of Benchmark’s approach has always been to utilize a standardized, systemized, redundant approach and ExpeFlow was expressly built to further enhance this quality based approach to an IME.

As soon as the initial referral is received on the ExpeFlow system it begins to track all aspects of the file with the automated business rules engine based on the type of IME that has been selected by the referral source. To further enhance this process, a referral tree has been built to walk the referral source (i.e. adjuster) through the process and it even drills down to an automated approach for selecting the issue in dispute and only displays the appropriate practitioner types that can be selected to handle the issue and then presents customized questions as provided by the referral source.

As part of the standardized approach, Benchmark attempts to collect as much data as possible in various templates and ExpeFlow now houses all the templates including the important Letters of Direction to the practitioners and their Report Templates. These documents are pre-loaded into ExpeFlow and automatically populate to create an “Automated Package” for the practitioners, and all the administrative staff has to do is select the pre-loaded documents. Based on these selections, the system automatically inserts the document list (with the pre-determined dates already calculated), the insurer’s questions, and all the pertinent data (date of exam, assessor credentials, signature, etc.) into the correct fields and also saves the documents into a PDF complete with bookmarks so that the practitioner receives an accurate, organized, and comprehensive package allowing them to immediately begin their job in a more efficient and organized manner. Since it is all systemized there is less potential for error on behalf of either the Benchmark administrative staff and/or the practitioner.

In order to ensure adherence to all performance standards an online Tracking Sheet allows ExpeFlow to track all files and corresponding deliverables in an automated business rules based fashion and even automate escalation to supervisorial staff if necessary. The automated tracking sheet replaces Benchmark’s previous manual quality control methodology and creates a proactive process as opposed to one that was manually triggered and now automatically prompts users to review tasks and deadlines based on the business rules with no human intervention.

The single platform design allows all internal Benchmark users and external file participants to collaborate on the files in real-time and this secure sharing of the file not only greatly decreases the cycle time of the file but it also enhances security and decreases the challenges of large files because all data files are uploaded to the system and keyword searches and other filters can be used to compare notes that might otherwise have been missed.

Benefits

ExpeFlow automates many of the previous manual processes that were required to fulfill Benchmark’s ISO certified double edit process. This results in not only a tremendous efficiency gain, but also in quality improvement because increasing the systemization and reducing manual processes inherently increases accuracy.

Benchmark has found that while all aspects of the IME process have been expedited the greatest improvement has been in the fundamental mechanics of the IME workflow between practitioner and Benchmark. Time studies have consistently revealed more than a 66% internal efficiency gain for Benchmark which is a radical improvement, especially when coupled with increased accuracy.