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"I grew up in South Dakota with an ancestry stemming from 1870s - 1880's era German immigrant homesteaders.  My family instilled in me a drive to look beyond the horizon & ask what's over there? From that history, I learned not to shy away from challenging expectations and norms as such risks are central to innovation and progress."

Jim's Bio

Jim Schlueter was raised in South Dakota and received his undergraduate and graduate degrees from the University of South Dakota.  His graduate work in the late 70's focused on organizational development.  Specifically, on how to create healthy communities and workplaces by moving beyond disease avoidance and traditional management methodologies. 

 

Jim became a healthcare administrator upon receiving his graduate degree in 1980.  He served the Presentation Health Systems (SD), Allen Memorial Hospital (WaterLoo, IA), and the Saint Raphael Health System (New Haven, CT).  At 30 years old, he was the youngest individual ever to rise to the position of COO within the Saint Raphael Health System. 

 

He launched his own company (OHMR) in 1989 in response to the ineffective practices he witnessed in the management of workers' compensation claims while an executive at St. Raphael's.  Before the term "medical management" came into being, he launched an innovative consulting company that hired Intensive Care and ER nurses to work as peers alongside claim adjusters.  The nurse's jobs were to identify and resolve the medical issues keeping a claim open so the adjusters could close the claim administratively. Within two years, OHMR's consulting services were employed nationally by over 40 Fortune 500 companies serving business operations across the United States. 

 

Following his exit from OHMR in 2000, he took some time to travel.  He landed in CA in early 2003, where he began doing turnaround work for the insurance and medical management industry.  It was through this experience that he witnessed the ineffectiveness of the UR triage process in California.  Subsequently, he created Smart-UR, which was a technology designed to automate and streamline the triage process for UR claims. 

 

As the technologies associated with Smart-UR evolved, he rebranded the company to Effective Health Systems.  Today EHS serves several of the leading insurance and medical management companies.  EHS has led the industry with innovative applications designed to automate workflows and augment the intelligence of claims and medical professionals.

Jim's most recent innovation is GIGI.   GIGI is a multi-variate, ML-supported predictive algorithm that predicts the likelihood of a medical request being certified if submitted to a full UR.  GIGI has demonstrated a 92.5% accuracy level, and the false positives can be largely corrected via business rules. GIGI is the most significant advance to the science of triage in workers' comp since Jim launched Smart-UR over a decade ago.  GIGI serves as an important supplement to existing triage tools by providing guidance to the UR professional regarding the potential outcome of sending a request to formal UR.

 

Jim has also served as an adjunct professor at the University of South Dakota, University of Northern Iowa, and the University of Southern CT.  He also lectured at Yale University School of Management on innovation and entrepreneurship.