EHR Data Helped A Global Insurer Improve Disability Claims Management

Business Objective

Our client is a Fortune 500 company providing life and disability insurance to more than 100 million customers across 50 countries.

The current process of referring claims to clinicians is sub-optimal due to the lack of visibility of member’s healthcare journey before being disabled. The client wanted to augment claims data with external electronic health records to better understand triggers for the underlying disability condition. The key objectives include

  • Mapping healthcare touchpoints to disability claim events to create an integrated claims journey of participants
  • Understanding triggers for improving/deteriorating health conditions
  • Building claimant personas to create differentiated intervention strategies to help manage Return to Work (RTW)
  • Lack of metadata/medical taxonomies to aid in classification
  • Limited sample of participant’s health data

Solution Methodology
  • Built robust processes, including a set of APIs to gather external metadata, such as RxNorm and VA Health system, to aid in taxonomy creation.
  • Created treatment progression pathways (Sankey flow charts) that provided a view of the type of medication pathways of claimants.
  • Created specific personas that helped to understand how combinations of health and lifestyle factors impact Return to Work, such as anti-depressant drug usage, specialist visits, therapy usage, obesity prevalence.
  • Identified STD and LTD journey maps that gave a good understanding of leading and lagging indicators (therapies/comorbidities/surgery, etc.) of disability claims.
Business Impact
  • The insights helped frame inputs for a Clinical Recommendation Engine that is being developed to inform intervention strategies to help claimants return to work

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