Workers' Compensation Utilization Review Benchmarking

This technical report outlines a benchmarking study focused on utilization review within Michigan's auto no-fault insurance sector. The report identifies the challenges faced by payers in controlling medical expenses while ensuring efficient claims processing, particularly following the 2019 no-fault reforms. It details the approach taken by a leading Michigan auto payer in collaboration with Enlyte to benchmark performance and implement a more active clinical trigger methodology. The findings reveal that by adopting proven strategies from a peer program, the payer achieved significant improvements, with a reported 12.5x increase in average monthly treatment reductions and an additional $250,000 in monthly cost containment. The report emphasizes the importance of continuous improvement and stakeholder engagement in optimizing utilization review processes. It concludes by suggesting that this methodology could be beneficial for other Michigan auto payers seeking to reduce medical spending without increasing litigation risks.