Podcast: Technocracy and the Fate of the Expert

Transcription

Cory: 00:02 Hello, welcome back to the California work comp report. This is your host, Cory Oleson. Today is Tuesday, September 10th, 2019 our guest is Dr John Alchemy here to discuss technocracy and the fate of the expert. This episode of the California Work comp report is about technocrats in a data-driven future. We’re looking at technocracy is right now and what a technocracy is and what technocrats are. It’s a, it’s a form of government and what we’re talking about, it doesn’t necessarily apply to say the United States government, but more of the hierarchical structure of an institution, say like the medical field or even zooming in from that workers comp technocracy is made up of technically skilled elites in a field as opposed to an elected official who isn’t, who is an expert in something that we say, oh, that person’s an expert. I trust their opinion. As trends kind of go along as we are being able to gather more and more data based off of the way that consumers are, the way that relevant to RateFast.

Cory: 01:07 The way that injuries heal, things that we can measure and gathered data off of. People tend to now trust the data more than they trust the opinion of an expert. Before we had all the data that we were kind of almost inundated with now, but before all the data that we could gather, look at it and determine trends, determine, make educated guesses about future outcomes, about certain things. We could only really trust somebody who has internalized that sort of data themselves and say, well what do you think? And now the proof is in the pudding as they say. So now as that applies to workers’ compensation, we’re now able to use data to determine things about injuries and workers comp that we were never able to before. So we can use this data to help us do things like speed up claims, which are constantly being contested between a, the insurance adjuster and the doctor for example, or the attorney and the insurance adjuster, the attorney in the, and the doctor. And that inevitably will help speed up the way that workers’ comp claims are done. John, can you shed a little more light as to how it, how technocrats in a technocracy would work to benefit a workers comp as it is now?

Dr. Alchemy: 02:22 Hi, Cory. Sure. no problem. Now, I do a primary treating is as well as a owner and in lead developer of a RateFast and alchemy logic systems, which is the company that owns RateFast. And for many, many years, the issue has been that there’s been a contested issue in a claim and it has to go to a quote unquote expert. The more years the expert’s been doing, the more credible their opinion. The expert provides, an answer, to the parties and ultimately it’s accepted that, that is the truth. That’s, that’s how it’s worked many years in workers’ compensation. To some extent, it still works that way. But as a automation has gone forward and we are getting better at not only collecting data but harnessing it for the knowledge and figuring out systems that can use that data in a meaningful way to actually give us an output or to answer a question or a variety of questions.

Dr. Alchemy: 03:24 That’s really what we want to talk today about. And that’s the rise of the technocrats in workers’ compensation or impairment rating. We have seen in other areas of technology with the tech giants like Google and Twitter, Facebook, et Cetera, a very rapid shift in what I’m talking about and basically a concentration of the technical knowledge and it becomes very concentrated very quickly once a platform can get these methods in place and start utilizing them in a way that captures the meaningfulness in the data, if that makes sense. So when we talk about technocrats and impairment rating, we’re talking about a very select few group or group of individuals that have access to the platform. And that can take very confusing and laborious datasets and quickly organize them and give them some type of sense. And value and that’s really what we want to talk about today.

Cory: 04:26 There’s definitely a shift in perspective, which happens when you begin to look at things from a level of data as well. There’s, there’s an anecdote that I recently read about a mathematician who actually became a wine critic by way of analyzing the way that the rainfall was and how hot the summer was in a particular year in a particular region of, I think it was France, and essentially he was able to tell how a vintage was going to turn out by the weather patterns of that year and those who he was sort of in leagues with as a wine critic were, were, were bashing him and saying, Oh, you can’t judge how good a vintages by by all of these things. It takes an expert to know we have the tastes. We’ve been in this for years. It turns out that that which is characterized to make all the best flavors and wine were a result of all of the things that happen to make these vintages.

Cory: 05:20 The ones that were the most expensive, the ones that were rated the most flavorful, the best. What happened in those years with the rainfall and the in the sun and everything were all concurrent. And so he was able to tell right when the grapes were harvested, how, how, this vintage is going to be versus waiting for it all to age B, and to taste it and everything. So that’s actually, I believe that is how wine is rated now. That’s sort of the way of it now versus trusting the opinion of an expert. So that’s one very firm example of how what we’re talking about plays out.

Dr. Alchemy: 05:55 Yeah, I think so. And the, the parallels between that and if we, drill down into, impairment rating and or case management, it’s very, very similar, up, up until now. and, and still now, cases are put in front of, quote unquote experts in the expert makes some kind of opinion. There’s a lot of mysticism around that. There’s a lot of variance around that, not only on the outcome but how each, provider, looks at a data set that the things that they have in their physical exam that the next Dr. May or may not do and their physical exam and, and so there’s, there’s a lot of variants and everyone has their own perspective on how they would like the case to outcome with regards to, rating value or apportionment, a monetary value, et cetera. And, and it just leads to a lot of confusion and a lot of delay when we try to have these essential elements decided by a subjective individual.

Cory: 06:57 I feel like somebody that’s an expert that’s been in a field for a long time is powered by positive reinforcement and knowing that their expert opinion is constantly correct. We were talking about the fact that a lot of these people that are experts in fields, whether it be wine or whether it be a doctor or whether it be anything else, if your entire career is based off in this positive enforcement, that reinforcement that you’re correct the entire time you’re later on in your career. Suddenly things like the medical field, there’s suddenly the way that technology is treated. It’s almost like the, the view about your opinion that you get to other people as an expert becomes sort of this dog mode while the actual field that you’re working in is sort of changing fluid and slipping away from that of the expert. The nice thing about things being data-driven and being able to observe trends as things actually are, there’s no real allegiance to a dogma if if things are changing, new data’s brought into light. If there is a new method of making wine, for example, it’s, it’s, it’s impartial to all of that. It’s just another number that kind of gets thrown into the calculation. So we’re able to more accurately observe certain trends while things are changing.

Dr. Alchemy: 08:05 Yeah. And there’s also this whole issue of scalability and cost and delay. I mean currently if you have a complicated case, they’ll send a, the, the, the chart to this doctor and the doctoral maybe spend, two or three hours going through the chart and then they’ll, interview the patient, and do a physical exam and then they write this up and this is like, eight hours. if this whole thing evaluated and, and the frustrating thing about it is all this time and money is being spent and we’re not really even sure the outcome is going to be fair and equitable. that’s the real frustrating thing is the waste that goes on with this system. And as the algorithms get better, more inclusive of, of more data, the, the time compression and the quality of the opinions improved dramatically.

Dr. Alchemy: 08:58 Currently the, the time for when, when we first started the platform, all the manually review and do what we call a retrospective impairment review. I look at a case that’s already been written up and then I have to write up a summary and, and outline it for what’s correct and what’s incorrect, with regards to the standards of the rule set. And that might’ve taken me, maybe two to three hours, that, a very long time and that’s not really scalable. that the time element is not scalable. The cost element is not scalable and, and my knowledge base is not scalable cause very, very difficult to transfer this knowledge to another individual because it’s, it’s all based on experience and so forth. But once you start creating this and have the database, start managing the data searches and the inputs, the calculations, it becomes a very, very different exercise.

Dr. Alchemy: 09:56 And you can start to have the data input by, lesser trained individuals who know what they’re looking for with the computer, basically driving the process, telling them what to search for and whether it’s present or not in the report in a very, very consistent outcome, with regards to the determinations. And that to me is the biggest benefit that we have here. Because now I can sit down and with the benefit of the platform, I can come up with all the elements of the rating in about 15 minutes. So when you look at that two hours, to 15 minutes, that’s an incredible time compression and the opinions are much, much more consistent. So yeah, so, so I can write it up and say, well this rating is x because of elements a, B and C and elements e F and g weren’t present at all. or the quality of the data was, this value and here’s why. these are things that we’ve never had any insight into before. And that’s why technocrats will ultimately take over injury pricing, injury management, and ultimately make determinations on systems efficiency. Because you can only do that when you have a data set experience to draw upon.

Cory: 11:13 For All the critics that are listening right now, I would just like to pose this one question with you.

Cory: 11:19 Would you do with an extra hour and 45 minutes of your day? The more that you’re able to sort of have an accurate look at what it is that you’re trying to determine and there will always be anomalies because as we know about the scientific method and we know about there is a scientific theory cannot be proven right. It can only be proven wrong, but when you have such a large sample size to work off of, it’s invariably going to be a lot more accurate than if you’re sort of just grasping at straws or if you say, I’ve seen this before and this is how it’s going to go. One of the, one of the things that re-pass Kinda has currently in our arsenal, it’s a handy little tool. It’s the RateFast and in my calculator and it tells you when a claim is going to reach maximum medical improvement based off of some of the items that you input into it and it calculates it and that’s what it is and the calculations are made using data that’s been collected from the past, from work comp claims that you John have experienced and other such things.

Cory: 12:17 Actually, I’m curious, how was the data collected to determine how the MMI calculator would work? And again, the NMI calculator, it tells it tells the doctor or whoever is using it, when the patient is expected to recover as best as they’re going to get. How was the MMI calculator made and the calculations put in and everything.

Dr. Alchemy: 12:37 Yeah, the, the ray fast MMI calculator too, which, which lives at the address by the way, a RateFast mmi.com and it’s accessible to anyone who wants to check it out. was a tool, born out of statistical averages on turnaround times for a visit decisions. So imagine that you’re a patient, you go in, the doctor puts in a request for an MRI on your shoulder and if the doctor puts that request in on the MRI in your shoulder, and let’s say that we replicate that exact office visit over like let’s say 200 similar events, except there are 200 different clinics, 200 different doctors and maybe a 40 insurance companies. And all of those systems have their own delays in them, such as what is the doctors average time for getting the request out to the insurance company after the patient walks out of the office.

Dr. Alchemy: 13:37 is it three days? Is it one day? Is it two weeks? What is the turnaround time for the insurance company or adjuster to get that request to the Utilization Review Service? Is it one day? Is it three days, is the two weeks? And then what is the turnaround time for the utilization review to make their determination, including successful and unsuccessful peer-to-peer calls or writing up that report, getting it back to the doctor’s office and then back in front of the doctor’s eyes so the doctor knows if it was approved or not. Okay. Those are a lot of variables there. And what we do with the MMI tool is we look at those variables and we build them in to the estimated time that it’s going to take to process that particular request to the point where the doctor can make another decision on it. Now, it’s, it’s very, very interesting to know that currently in California, the case closure time, according to the DWC, the division of Workers’ comp is 60 months, five years, five years.

Dr. Alchemy: 14:46 Now, everyone listening to this, to this podcast is going to say, no, it’s not five years. I can maybe 18 months, two years, et Cetera, et cetera. But what the, what the DWC counts as a closed case is the actual final sign off by everyone on the case that they are, content with the outcome or at least agreeing to it. And the case is done done because primary treating clinic might call a case done, but it may have an afterlife with an attorney or occula me or an AME or all kinds of things can happen. So just because a clinic says a case is done and rated and complete, does definitely not mean that that case is done and rated and complete. So, so 60 months is actually how long it takes. I get letters, to my own practice from time to time, from adjusters saying, you legally, you don’t have to see this patient back for six weeks.

Dr. Alchemy: 15:46 Why are you seeing them back in two weeks? And it’s kind of, it’s kind of an amazing question. If you could see someone back in two weeks and make a, make a decision on the next treatment step, why would you wait six weeks? Really? You know? And so, if we have a process like the MMI tool that is going to look at that and follow up and tell you when to, to see the case back, why wouldn’t you use it? why would you, treat one case in your practice and see them back in six months and the other one back in two weeks. there’s just no consistency to that. Yes. And the MMI tool is just a great example of a, of a driver of a data-driven driver, that stakeholders can use to make sure that everyone gets what the system is supposed to deliver, which is accurately consistency and timeliness. that’s, those are the main things that, that the system is supposed to deliver. Unfortunately, the way that it’s traditionally been structured, it delivers everything, but that

Cory: 16:51 I’m still shocked that it takes five years to close out a claim. I’m sure. I’m sure that you’ve been approached with paperwork before and you said, I like, who is this patient? It’s like, Oh, you saw that five years ago. How am I supposed to remember that? anybody would probably say that unless you,

Dr. Alchemy: 17:09 I have a photographic memory, which we just had a case brought into the practice that transferred in, a couple of weeks ago, date of injury, 2005 amazing durations of time and delay. Like, it’s like, how, how does this happen? how can this happen? I, it’s, it’s amazing, but that’s why we do what we do. Yeah.

Cory: 17:36 When did that person still alive? Even at, no, I’m kidding about that.

Speaker 2: 17:39 No, they’re definitely alive. Yeah.

Cory: 17:44 Well, so we had mentioned a few minutes ago that the MMI calculator and everything, and actually in a certain way, and you had mentioned earlier in the podcast, the, the RateFast injury mapping and, and in a certain way in a very, very exaggerated way are the injury mapping is a, is, can be compared to the MMI calculator. And so far that it is, it is data-driven. it is a, it is a way of mapping and injuries so that the, all of the stakeholders in the claim know how the injury is going based off of the data from similar injuries before it. and that, that is certainly an example of, of, of Tech Tech, no Craddick technology at work. and is there anything additional that you would like to say about how injury mapping plays along with, with a technocracy and such?

Dr. Alchemy: 18:44 Oh, absolutely. I mean, industry mapping, for those of you that haven’t heard the previous podcast, it’s basically a tool, that completely maps the injury from the day they’re hurt until the day, that they get rated in the case closed. And it’s, it’s like the MMI calculator on steroids. But he, but even better, the great and interesting thing about the injury mapping, tool and concept is that when that algorithm runs, it not only maps out, when things are supposed to be done, but when they’ve actually been done. And now you can see gaps in delays consistently in areas of treatment that that can be improved upon. So for instance, if, if I’m injury mapping and I, put in that this patient was ordered for physical therapy today and the injury map is going to say great based on the existing best experience, that person should be at their first visit of physical therapy.

Dr. Alchemy: 19:48 Okay, no later than 18 days from today. And, and that’s assuming that the internal system and the vendors are on their game. Because if the vendor drops, the ball doesn’t call the patient or the patient drops the ball and doesn’t pick up the phone or the therapy department drops the ball and doesn’t schedule or doesn’t call the patient or doesn’t try to make a second call, that patient falls through the cracks. So the next time that patient comes in via two weeks or four weeks, the injury map was going to want to know, did this person start their physical therapy? The answer is no. The first thing that the injury maps is gonna want to know is why. And now we’re 10 days behind the expected, delivery date of that first therapy evaluation. And it not only calculates the delay, but it also changes it into a loss because it now becomes a functional expensive loss.

Dr. Alchemy: 20:47 The claim has now remained open unnecessarily and money has to be spent to continue to support that open claim. So the injury map keeps track of all these things and it becomes very obvious and often very embarrassing about how long, delays are in certain aspects of the case. And I’m not just blaming the insurance company or their vendors, that the doctors and the doctor’s offices are also, to have some blame here too because maybe the patient doesn’t show up and it doesn’t get picked up in the case, just stays open or maybe, their callback policy for no-shows is poor, all of these individual things that happen at the grassroots level of case management and it all adds up to tremendous delay and a lot of expense for people.

Cory: 21:35 John, is there anything else that you would like to say to tie up the conversation about technocrats and technocracy?

Dr. Alchemy: 21:41 Well, how would just cap off on what I was saying at the beginning of the interview and that’s that this type of knowledge with this particular specific type of platform is going to transfer, a very highly detailed, knowledge base to a very few individuals who will control it. And those who are able to control this information and understand where the problems are and the inefficiencies in the system and can and can more quickly and cheaply understand the true answers that are being asked by the stake holders are going to ultimately become the winners and control the knowledge and the outcome of Worker’s compensation in this case, while the others are going to be left to the old system to languish with estimates and dealing with the variety of quote broad exports. So it’s basically, in my opinion, going to become a very, very two tiered system where you’re going to have one system that’s consistent and, and continually improving and sharpening the sword, if you will. And the other system that just sort of gets through the day each day and continues to make the same errors in the same delay day after day because there’s just nothing in place that’s been created as an infrastructure to monitor the consistency and the efficiency of what’s being done.

Cory: 23:05 You could look at the data, it being part of a data-driven technocracy, almost like one could look at the spice from Frank Herbert’s Dune. The he who controls the spice controls the universe. And this Weiss must flow. Yes, absolutely. Take that out. but I want to think, I want to thank you again, John for this today and hopefully we’ll have some very big exciting news coming up very soon about about things like injury mapping. And, in the meantime, make sure to check out the RateFast and in my calculator I will leave. I will be the link at the end of the podcast as well as leaving the link in the relevant description of the podcast, so make sure to check that out. Excellent. Thanks Corey. Thanks, John.

Cory: 23:56 To learn more about technocracy in the ever changing field of worker’s compensation, visit our blog@blogdotrate-fast.com and give rate. Fast to spin. Visit us@rate-fast.com [inaudible] [inaudible].

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