Secure system cuts costs of independent medical examinations

By Sally Praskey

As insurers know all too well, managing independent medical examinations (IMEs) can be a costly and time-consuming chore.

Enter IME Workflow, founded in 2004 to provide insurers and vendors with a secure system for transmitting IME-related documents electronically. In 2010, the company introduced an enhanced version of the system, which streamlines workflow, increases productivity, and saves time and money in the process. Version 2 allows all communication to be documented, tracked, and time- and date-stamped for full transparency.

“The big advantage to us is the secure transfer of documents,” says Marlene Buckley, claims manager, Motors Insurance Corp., Thornhill, Ont., which has been using the IME Workflow system since the company’s inception, and Version 2 since its launch. She also cites the elimination of the laborious manual processes and expenses associated with paperwork.

“It’s allowed us to go paperless in this process, while before we were photocopying, faxing, couriering, and mailing,” agrees Lisa Fazzari, claims technical advisor for accident benefits, corporate claims, at The Economical Insurance Group, Waterloo, Ont., which also started using Version 2 last year. “It’s a lot more efficient, and there’s a huge cost savings associated with that.”

One insurer, for example, tracked operational savings at $72 per file, says IME Workflow COO Judith Kay. This calculation included courier charges, paper, photocopying and toner costs, telephone and long-distance charges, the labour involved for all of these tasks, plus initial file referral, call-backs for missing documentation, reassigned files, rescheduled appointments, additional questions or instructions, and duplication of the process for a follow-up IME request. Vendors and adjusters can realize similar savings.

Judith Kay, IME Workflow COO

The system also allows insurers to manage and monitor the performance of their vendors and adjusters, both in-house and independent. “Prior to initiation of a system like this, it was very difficult to compare apples to apples when you were looking at vendors, and I think this allows us to do that,” says Fazzari. “It really segregates those good vendors from the poor vendors. If you’re meeting timelines, meeting those service standards, and meeting the costs that you say you proposed, it becomes very clear. It’s easy to pull that information.” After all, the longer a file stays open, the more it costs the insurer. Now the insurer can have that important information at its fingertips.

Buckley, too, appreciates the ability to track vendor performance, along with the real-time updates and progress reports the system provides. “You’re able to track between your vendors the cost-effectiveness, to see how many are meeting our time requests,” she notes. “All of those different reports provide very valuable information.”

With the introduction of Version 2, independent adjusters were able to join the program, using the system to view the progress of their files, update status or documentation, and access past referrals. “We use it to transfer our documents to the IE companies and to get our reports,” says Shannon Hoyt, vice-president accident benefits, for ClaimsPro, Barrie, Ont. “It also tells us the date and time of the assessment, so it encompasses the whole IE process.” Prior to implementing the system, she explains, all the correspondence was done by telephone, so it couldn’t be tracked. Now, she adds, “we can see every step of the way. It’s a streamlined process.” And whether the file is handled in-house or externally, the insurance company can capture all of the data. Similarly, independent adjusters can use the system across multiple insurers.

With IME Workflow V2, insurers can track IME vendor performance

Because the system is rotational, it does not favour any particular vendor. To ensure that all the vendors with whom an insurer has contracted get an equal share of the work, the system automatically generates the next vendor on the list to get the file, rather than the adjuster having to make that decision.

“It’s completely equal. Everybody gets the same amount and it’s a complete rotation,” says Maria Maheras, director of operations, at vendor A.R.S. Inc., Toronto. “So it becomes a lot fairer to all the vendors who are on the same type of system.”

Maheras says vendors can upload all of their doctors’ information into the system. “So when we’re submitting a notice of assessment, the adjuster will automatically have that information, as opposed to having to request it.” Version 2 is a full-service system, she adds, that allows vendors not only to upload documents, but also incorporate pricing. “Everything can be built in, and it allows the insurance company to pull very detailed reports about how long it has taken for a vendor to book an assessment, or how long it’s taken them to submit the report back. It can give the insurers a billing option, so they can see exactly how much a vendor has billed.” Likewise, Maheras has the same type of information available at the click of a mouse, so she can track how her own departments are performing. “So it gives me an opportunity to audit internally in the same format that an insurance company could audit us.”

Every time a document is uploaded, the vendor receives an e-mail notification indicating to which file it has been sent, says Maheras. Then it’s as simple as clicking to take the vendor directly to the file. No more waiting for couriers and creating the file electronically themselves, she adds.

The Ontario Hospital Alliance of Assessment Providers (OHAAP) reports similar benefits. OHAAP is somewhat unique in that it consists of a group of Ontario hospitals that offer independent medical assessment services. Although it comprises a series of independent hospitals, OHAAP presents itself to customers as a single organization, explains Christine Pook, OHAAP central administrator. All the profits that the organization generates go back to the individual hospitals. “So there are a lot of unique challenges for us from a data management perspective, which is where IME Workflow comes in,” she says. “Our head office is in Hamilton, and it allows us to distribute the files to all our other hospital sites, quickly and efficiently, and in a secure manner.”

The system also helps the group present itself as a single unit through the standardized letters that it creates, says Dr. Sue O’Grady, clinical coordinator and OHAAP account manager. Like Maheras, she says it helps them monitor the performance of each of the nine hospitals in the group. “So not only is the insurance company using that information to monitor between vendors; we’re using it as part of our quality-assurance process,” says Pook, to help the hospitals determine as a group how they can reduce the amount of time it takes to respond to a request for an assessment.

IME Workflow also helps insurers identify trends in accident benefits. “Complete online tracking and data collection allows insurers to immediately respond to accident benefit trends as they happen, and incorporate business behaviour into their file handling and decision-making processes,” says Kay. The company regularly adds new features and benefits in response to rapidly changing environments and trends.

There are no hidden costs to insurers; transactional fees are paid by the vendors, who pay only for what they use, levelling the playing field for firms of all sizes. Recognizing that insurers and their workflow processes differ, the system is fully customizable to specific insurer needs. “The one-size-fits-all, out-of-the-box solution doesn’t work in my closet, and it certainly doesn’t work for insurers,” says Kay.

IME Workflow, however, may be just what the doctor ordered. Visit www.imeworkflow.com