Cira Health Solutions’ Digital Transformation for IME Processing

2017 ICTA Nomination. Technology by DC Pro and AquaTrip Canada.

Effective Independent Medical Evaluations (IMEs) must be transparent and accurate, and have the ability to deliver results quickly for insurers. The management of timelines is a critical component of any successful IME system. The business is also rooted in managing risk for clients and is predicated on its services being defensible in court. Cira Medical Services leans on iAssess™ technology to ensure service speed, and to adopt clinical oversight with a high level of visibility and detail to ensure defensibility.

Four years ago, Cira Medical Services recognized the needs of the IME industry had changed and the company wanted better control over the IME workflow process to remain competitive. Many current systems were limited by way of data retrieval, management, and analysis. IMEs and insurers were also using multiple platforms to manage referrals at various stages of the IME file cycle. The result was a myriad of data points residing within different systems.

As a result, Cira Medical Services started the process of change leading to the development and launch of iAssess™, a new proprietary IME technology platform. Developed in-house, and backed by a 34-member technology department, the system provides change that has been long overdue in the IME industry. iAssess™ began as a concept in 2013, was introduced in 2014, and then rolled out completely in September 2015.

The system revolutionizes both the kind of data that can be stored and the management of medical file progression with secure 24/7 national access for all Cira employees, clients, and medical assessors. Prior to iAssess™, Cira Medical Services was using third-party resources which had limitations in flexibility. It also did not allow for proper transparency over the end-to-end process. High levels of precision and certainty was unachievable in terms of whether service delivery (the final IME report) was on target for delivery. iAssess™, on the other hand, allows Cira to determine if the file is on target for delivery or if there is a need to escalate procedures.

Specifically, iAssess™ impacts workflows by moving files quickly and automatically through the process. Cira can pull files through the service delivery process and show a date-time stamp of where file referrals are received and where they are moving through the system. A secure interface and unique portal for each stakeholder group (Cira employees, medical assessors, and adjusters/claims administrators) enables any authorized user to track the file’s progress with complete transparency at any time resulting in better communication between stakeholders, improved workflow efficiency, reduced administrative time, and more timely IME reports.

Moreover, risk mitigation is a natural outcome of this centralized system and workflow tracking, an important factor for court/arbitration challenges and for internal auditing purposes. Elements such as the default tracking of ‘micro’-drafts of all medical reports and documents allows Cira to review at which exact point any new documentation was added to a file or any edits made to a report.

iAssess™ has the ability to:

  • easily and automatically retrieve information from standard Ontario Claims Forms.
  • access an improved medical chart system with hyperlinks to all test results and information leading to easier understanding of charts, and less chance of an assessor missing a critical piece of information.
  • integrate with Health Claims for Auto Insurance (HCAI) for synchronization of information on medical professionals, assessments, treatments, and billing information.
  • directly interface with a leading Telemedicine platform, including scheduling and automatic connection to the service.
  • manage medical assessors’ schedules and assessment booking 24/7 online, reducing risk of no shows and scheduling conflicts.
  • upload and download medical files securely and quickly.
  • quickly understand and easily manage claimant appointment information including any special needs.
  • submit new claimant referrals quickly, at any time.
  • manage payment schedules.
  • manage and track all file document drafts, which in turn supports internal auditing and preparedness for court/arbitration.

This sophisticated technology also organizes and manages claimant files with clear and simple file categories for easy file identification. There is no limit to the number of documents that can be uploaded and managed.

From a cost-management standpoint, insurers naturally incur additional cost until they determine the root cause of a claimant’s medical issue. So, by managing timelines proactively and maintaining visibility, Cira remains highly competitive because client decision making is achieved sooner. Ultimately, the claim is settled more quickly, resulting in dollar savings. Cira also improves their own bottom line by being able to work more efficiently. From beginning to end, iAssess™ supports Cira’s key performance metrics.

In addition, IME providers like Cira Medical Services are interested in data that pinpoints a number of different file scenarios. The more data points you have and the more centralized the system is, the more robust and accurate is the outcome of any data analysis. It is expected that iAssess™ data will be used in the future to drive management decisions in a different way by bringing insurers, IMEs, and medical assessors together for new perspectives on claims handling.

iAssess™ complies with the security and privacy requirements of the Commission on Accreditation of Rehabilitation Facilities (CARF).

Business Impact

iAssess™ represents a huge improvement in the way IMEs do business. Since the initial launch, there’s been more than 200% growth in its user base. The new system has automated the previously manual, labour intensive processing of 678,000 PDF files, representing millions of pages of documents. Since integrating with Health Claims for Auto Insurance (HCAI), 93% of services now connect to HCAI automatically for synchronization of information. The iAssess™ Assessor Portal also connects with over 4,000 medical professionals to support service delivery. In 2015, Cira Medical Services processed 56,000 services. In 2016, it’s on track to process close to 100,000 services. There is no limit to the number of service requests the system is able to manage.

About Cira Health Solutions

Cira Medical Services has 30 years of experience supporting accident benefit insurers in the independent assessment and diagnosis of claimant medical conditions. Our services are essential to an adjuster’s decision making to determine accident benefits.

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SOURCE: Cira Health Solutions

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