The Benefits and Challenges of Profiling Providers in Workers Compensation

This paper provides a general overview of ways in which provider profiling can be used in developing, maintaining, and evaluating workers compensation managed care programs. It discusses some of the practical challenges that actuaries in actually developing such profiles and using them. Specifics covered include determining the types of statistics one might want to review, creating the appropriate database needed to do the analysis, and adjusting and segmenting data so that differences in the types of claims providers handle are taken into account. Provider profiling in WC is relatively new to the managed care world. This intent of this paper is to introduce actuaries to provider profiling.