Cover Story

Raising the Costa Concordia

Insurance foots the bill for the largest marine recovery project in history.
By: | September 1, 2013 • 13 min read
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The plan to raise the Costa Concordia — the largest and most expensive wreck removal operation in maritime history — is a marine engineering marvel. But a successful outcome is far from assured and the cost is approaching $1 billion.

When the massive Costa Concordia passenger ship ran aground on Jan. 13, 2012, claiming 32 lives, it entered the marine insurance record books.

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Hull insurance on the vessel, at more than $500 million, is now paid off by insurers, which include XL, Generali and RSA.

But the removal of the wreck of the Costa Concordia, the largest such project ever attempted, is driving costs onto additional insurers that could reach $1 billion. Those carriers include P&I (protection and indemnity) clubs, which are, in essence, marine mutual insurers owned by ship owners and related interests.

Those charged with righting the decaying ship and plucking it off the reef are in a bind. Each day on the reef weakens the ship’s hull. Magnifying the ship recovery risk is the size of the Costa Concordia. The ship measures about the length of three football fields and weighs 114,500 gross tons.

By far, the biggest complication is the fact that the ship is wrecked in the environmentally sensitive Tuscan Archipelago National Park, a protected coral reef as well as a popular tourist destination.

The wreck must be removed whole in order to avoid releasing a swamp of debris and pollutants into the waters. For this reason, the Italian government is paying close attention to the project.

The need to remove the wreck in one piece left only the most expensive recovery option open: parbuckling and re-floating. Parbuckling, which refers to the process of rolling the ship back up to an upright position, is not a new invention. After the bombing of Pearl Harbor in 1941, the U.S. military recovered the capsized USS Oklahoma in much the same way. For the Concordia though, the costs involved in such an undertaking would be extraordinary.

“The instructions are ‘Get it off [the reef] and we’ll worry about costs later,’ which is the worst thing for an underwriter to hear,” said Steven Weiss, vice president, Marine Engineering and Project Cargo with Liberty International Underwriters.

Just as troubling as the cost, the shadow hanging over the plan is that a parbuckling operation has never been attempted on a ship anywhere near the size of the Costa Concordia. Even now, some still have doubts about whether it can really be done.

Getting Ready To Roll

From the moment the Costa Concordia came to rest on the reef, the race was on to avoid an environmental catastrophe. The ship was still carrying 2,300 tons of diesel fuel.

Dutch salvor Smit Salvage was brought in to pump out Concordia’s 17 fuel tanks — not as straightforward a task as it might seem. Draining the tanks would shift the vessel’s equilibrium, likely causing it to topple off the reef and sink, hemorrhaging fuel in its wake.

Smit used a process called hot-tapping, a painstaking method of pumping hot water into the vessel at the exact same rate that fuel is being pumped out, in order to keep the weight constant.

The fuel removal process alone took a team of 100 experts from around the world, with the aid of 20 platforms, tugs, transport ships, crane barges, tankers and oil spill response vessels. However, the 31-day operation was just a warm-up for the work that would soon begin.

Concordia

The contract to remove the wreck was awarded to a team comprised of Florida-based salvor Titan Salvage and Italian marine engineer Micoperi. The Titan-Micoperi plan has engaged 450-plus crewmen and divers from 19 countries, working around the clock for more than a year, with a menagerie of least 25 marine vessels and crafts operating at any given time.

“The number of engineers and amount of computing time they’ve used on this was probably equivalent to the first moon landing,” said John Phillips, vice president, Marine Hull, Liability & Cargo, Liberty International Underwriters.

That’s probably not far from the mark — it took three supercomputers running for weeks to model the wreck removal plan.

Work on the project began in June 2012, but parbuckling remained a distant goal. Every day that the ship lay on its underwater perch, it remained in danger of sliding down the steep seabed and sinking into 230-foot deep water, likely breaking apart in the process. Divers spent months stabilizing the vessel, securing it with chains, cables and anchor blocks to prevent it from becoming dislodged prematurely.

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About 65 percent of the ship lies beneath the water, its interior almost completely flooded. Therefore, the ship can’t float on its own and it will need a stable floor to support it before it can be refloated. Titan and Micoperi constructed a six-part subsea platform, aligned precisely so that the Concordia will land squarely on it once its rotation is complete.

Simultaneously, enormous airtight boxes called sponsons are being welded to the exposed side of the ship. The 15 sponsons, most around 10 stories high and weighing up to 500 tons, will be filled with seawater initially. They will act as a cantilever, adding weight and assisting in the rotation.

The main event — the parbuckle — will be a slow and tense operation, lasting at least two days. With a network of strong cables, the team must apply enough force to rotate the vessel, while being careful not to put too much stress on the hull.

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“There are a couple of big assumptions you’ve got to make,” explained Capt. Rich Habib, vice president and managing director of Titan Salvage.

“The amount of force you have to apply depends on the weight of the thing you’re going to rotate, where it’s going to pivot, and the center of gravity. It’s a simple physics problem if you knew all of the variables … but you don’t always know.”

The more force, the more risk. And for a ship that’s been languishing in the water this long, the risks are intensified. The Concordia’s hull is now covered in rust and is significantly weaker than it was 20 months ago.

“The water that it’s in is relatively warm temperature and that leads to more rapid corrosion,” said LIU’s Weiss. “The hull integrity of the vessel would become even more compromised.”

There’s no question that the parbuckling will be a nail-biter of an event. The ship is already in a stressed condition, lying in a position that the designers didn’t intend it for, said Habib.

“Now I’m going to add force to it. So I’m going to have a lot of distortions and things breaking and popping and so forth. It’s not a clean operation.”

After the ship has been rotated, most of it will be underwater. A matching set of 15 sponsons will be welded to the other side of the ship.

Hydraulic pumps will be used to force the seawater out of the sponsons and fill them with air, displacing water to create enough external buoyancy to lift the ship.

Slowly, the Costa Concordia will rise. But even then, a high degree of risk remains. The “what ifs” abound, said Michael Brown, area executive vice president, Marine, at Arthur J. Gallagher and Co.

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“The wreck could slide off the table while they try to pump air into the sponsons, or a sponson could fail or come loose, and it could sink.”

If that were to happen in deep water, some might consider it a blessing. But if it re-sank in shallow water, it would be a whole new ball game.

Either way, this operation is getting expensive, very expensive.

“With a lot of salvage events, the contract is bid with a [fixed] number. In a situation like this, it’s an open ended cost — there’s not an upper limit on it,” said Weiss.

“Because of the restrictions being placed by the government, the bottom line is they’ve got to remove the wreck. It doesn’t matter how much it costs, they’ve got to get it out of there.”

Salvors will continue to attempt the removal of the wreck until the limits of liability of the clubs is reached, said Brown.

And there’s the rub: “It’s an interesting fact that P&I clubs usually write vessels with unlimited liability except in the case of pollution,” said Brown. “So we’re talking mega potential loss. It could get worse or it could start all over again.”

The Titan-Micoperi plan has been vetted repeatedly, but challenges, or worse, surprises, may remain.

“We refloat things all the time, but we may not know the extent of the damage 100 percent beforehand so we have risk there too,” said Habib.

The team will have people and equipment in place “to ensure that once we float it, we can hold it.”

A Foundation That Flexes to Fit

Every salvage project, from a small capsized craft to a shipwrecked luxury cruise liner, carries its own unique circumstances and set of risks. Salvors need to rely on insurance programs that allow them to adapt to whatever comes their way.

Titan Salvage executives are keenly aware that their insurance program is the difference maker, giving the company the security it needs to operate in a risky industry. But it goes deeper than that. A dynamic insurance program gives salvors the freedom they need to be able to bid on any project quickly. It also becomes part of the overall value that the salvor has to offer its clients. Habib said the strength of the company’s insurance program helps set Titan apart.

“My insurance covers are not a cost to me; they’re a tool that I use to do my business. My underwriters are my partners,” said Habib.

Dwight Menard is vice president, risk management for Crowley Maritime Corp., the parent company of Titan Salvage.

“Crowley relies heavily on its core insurance program that is both well established, but also very flexible,” said Menard. “It has the ability to quickly respond to either a $1,000 job or a multimillion dollar job. Salvors’ insurance is a different animal — it’s unique and very specialized.”

Salvors’ protection and indemnity coverage must be broadly worded to cover regularly assigned employees as well as additional crew that may be hired for any given job. It also has to adapt to the intricacies of employment classifications.

“Salvage jobs may occur anywhere in the world, so you could have jurisdictional issues — are salvage workers seamen? Are they considered longshore and harbor workers? Or do they fall under a foreign employment scheme for injuries on the job? The P&I coverage for the salvage crew is extremely broad and allows the flexibility to cover any of those scenarios should an injury occur on a salvage job. It’s a very unique but absolutely essential type of cover for us.”

Salvors’ liability covers the operations of the salvor while undertaking the salvage project. In a situation like the Costa Concordia’s, where the vessel has already been declared a constructive total loss, the issue of damage to the vessel is moot. But a salvor still requires cover for damage to third parties, or any legal damages that may occur as a result of the operations of removing the wreck.

“Usually those types of covers are obtained at relatively low limits — low levels being $5 million — for a primary layer,” explained Menard. “So, in addition we have a very well structured bumbershoot and excess liability program to conceivably respond to much larger exposures and liabilities.”

Large scale salvage projects tend to be equipment intensive, but it’s not always possible to have equipment readily available when incidents occur in isolated parts of the world. That’s why some salvors find it more prudent to lease equipment locally, which typically means the salvor will have to provide cover for any physical damage to the equipment — some of it highly specialized as well as high priced.

Menard said that Crowley uses a captive to manage much of its equipment exposure.

“That’s included in the type of risk that we either self insure in the captive, or else cover through reinsurance for values in excess of aggregate deductibles. If it’s an extraordinarily high risk or an unusual piece of equipment, then specialized cover might be the best method of dealing with it. But for the most part, we’re able to cover these exposures through our captive and reinsurance program.”

Size in Perspective

The meter is still running on the financial toll of the Concordia wreck.

The ship’s safe removal remains the concern of The Standard Club and The Steamship Mutual, the lead P&I insurers for the ship, and the rest of the clubs in the International Group of P&I Clubs.

The vessel is reinsured through the International Group’s pooling system and reinsurance program with the London and international reinsurance markets. Costs from intense governmental oversight and the engineering required to safely remove the ship from the reef have pushed the P&I loss reserve to $1.17 billion.

Such eye-popping numbers for the wreck of a single ship have left some questioning whether marine vessels are simply getting too big — big enough for underwriters to start asking at what point a vessel is too risky to insure.

The Costa Concordia, put in service in 2006, was the first of five Concordia-class vessels, built for $570 million and measuring in at 114,500 GT (gross tonnage). But the Concordia’s sister ships are no longer the biggest behemoths afloat. Costa launched the Carnival Dream in 2009, a $741 million, 128,000 GT vessel. There are three Dream-class vessels currently in service, and a fourth 132,500 GT vessel being built.

But of course, the bigger they are, the harder they fall. Or sink, as the case may be.

It seems logical to ask if there might be a tipping point — the point at which the size of the vessel would make a salvage operation so expensive that insuring it would become too big a risk.

“It’s a valid question,” said Tim Donney, global head of Allianz Risk Consulting, Marine. “The truth is the international maritime salvage industry may not be able to keep up with the requirements of disasters such as the Costa Concordia.”

But Titan’s Habib is circumspect on the subject. Contrary to what the perception may be about the Concordia, he said, the project is actually moving at a brisk pace.

“Here, you have the largest passenger vessel in history, by weight — the largest salvage job ever accomplished, and we’re ready to parbuckle it in 14 months. I could name 10 projects that went on for two years or more — five years in one case — and you wouldn’t know one of those names if I rattled them off. There’s this perception that these large vessels are vastly more complex in the way that they have to be done. But it’s still a salvage job and it still has all the risks and variables of floating a 600-foot tanker.”

Bigger doesn’t necessarily change the equation, said Habib. Projects are more expensive for a variety of reasons — and they’re not all related to size.

“The salvor’s tool bag hasn’t changed much over the years,” he said. “What we’re doing on [the Concordia] is bigger than what’s been done before, but we’re using standard techniques. It’s really the requirements being placed on us from the outside that are driving the costs up.

“There’s a spotlight on the job, and that brings to bear all kinds of complications. The bigger the job, the more that’s perceived to be at stake, the more the underwriters and the consultants and the authorities want certainty. That drives the price up exponentially. Certainty comes at a pretty high price in salvage.”

Barring unforeseen disruptions, the Concordia will be parbuckled in late September. Any delay at this point could hurt the odds of a successful removal.

“The longer the job goes on, the greater the risk,” said Habib. “Time is our enemy. Always is, always has been, always will be.”

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at mkerr@lrp.com
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Workers' Comp

Putting a Cap on Physician Dispensing

States are increasing regulation to limit physician distributed prescriptions.
By: | September 1, 2013 • 9 min read
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“If someone told you, as a physician, you could earn an extra $75,000 to $200,000 per year without having to see any additional patients, work more hours or increase your overhead, wouldn’t you like to know how?”

So begins an ad from MedX Sales Ltd., designed to create interest in MedX’s prescription repackaging and workers’ comp medical dispensing program. The four-minute ad goes on to state that some physicians handling workers’ compensation who sell MedX’s prepackaged generic and name brand medications to patients directly have “literally doubled their income” as a result.

Sound seductive? It is.

And yet, these sorts of promises from prescription drug repackagers are like most things that sound too good to be true, according to industry experts representing workers’ compensation payers including insurers, self-insured employers, TPAs and state workers’ compensation funds.

They fail to explain that when physicians sell prescription drugs to comp claimants directly, employers, insurers and other payers can expect to receive bills that are 100 percent to 700 percent more than invoices for identical medications dispensed by retail pharmacies like Walgreens and CVS. So said Joe Paduda, president of CompPharma, LLC, a consortium of the nation’s leading pharmacy benefit managers that are active in workers’ compensation, headquartered in Madison, Conn.

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In total, Paduda estimated that physician dispensing adds a billion dollars to employers’ workers’ comp premiums annually.

The issue is most pronounced in workers’ compensation, since “workers’ comp is basically dealing with pain, inflammation and so on,” with physicians often dispensing simple and inexpensive drugs like ibuprofen — possibly dispensing them at a factor of three to 10 times the price of over the counter, said Jacob Lazarovic, M.D., senior vice president and chief medical officer with Broadspire, a TPA to employers and insurers, based in Sunrise, Fla.

“The dispensing physicians can have a very small menu of 10 to 15 drugs including generally less potent opioids including the generic versions of Vicodin and Percocet, and that’s all they need to dispense drugs to all their compensation patients so it’s a very simple process,” said Lazarovic.

To address these kinds of problems — as well as safety issues that have emerged when doctors take on the role of pharmacists without the same kinds of information about patient histories and drug interactions — many states have adopted rules restricting or banning physician-dispensed medications.

PBM Map

California, for instance, first amended its fee schedule regarding physician-dispensed drugs in March 2007. The guidelines in question required that the relevant fee schedule for physician-dispensed drugs be based on the original manufacturer National Drug Code (NDC) for the drug — the very same rule that applies to pharmacies. Such rules override a loophole in national regulations set by the Federal Drug Administration, wherein a repackager is a manufacturer able to set its own NDC code and can price prescription drugs at the average wholesale price of its choosing.

The results have been staggering. Alex Swedlow, president of the California Workers’ Compensation Institute (CWCI), observed in a February 2013 report that from 2002 though 2006 — prior to the reform — physician-dispensed repackaged drugs climbed to nearly 60 percent of California’s total workers’ compensation prescription drug payments.

Today, the figure is less than 2 percent, Swedlow said. In the past, “it was not unusual to see a 1,000 percent difference for the same prescription” sold directly by doctors versus pharmacies, but today that extreme profit incentive no longer exists, he emphasized.

So far, states that have followed California’s lead in equalizing reimbursement rates include Arizona (October 2009), Georgia (April 2011), South Carolina (December 2011) and Tennessee (August 2012).

In California, meanwhile, the Swedlow study found that during the pre-reform period, when physician-repackaged drugs represented more than half of all drugs prescribed in California workers’ compensation, paid medical benefits on physician-dispensed repackaged drugs averaged $5,524, or 16.4 percent more than the $4,747 average for claims without them. Even after the March 2007 reforms, paid medical benefits on claims involving physician-repackaged drugs averaged $7,297 — 37.3 percent more than the $5,316 average for claims without these drugs.

In addition, the study found that comp claims with physician-dispensed repackaged drugs had a higher average number of paid temporary disability (TD) days. “Combining the pre- and post-reform results shows that from 2002 through 2011, claims with repackaged drugs averaged 44.1 paid TD days; 8.9 percent more than the average of 40.5 days for claims without repackaged drugs.

This finding challenges a critical statement often heard from repackagers — that the convenience of obtaining prescriptions from doctors should reduce the cost of medical care and facilitate quicker return to work.

“We found the opposite,” said Swedlow.

Reforms Reduce Opioid Use

Another state that has set its own standard as far as prescription drug repackaging is concerned is Florida. The state’s ban on physician dispensing of certain “stronger opioids” went into effect July 1, 2011. A study from the Workers’ Compensation Research Institute (WCRI) released this past July found that the Florida law reduced the overall use of opioids prescribed for injured workers in the state.

Apparently, the average Florida physician-dispenser continued to dispense pain medications after the ban, but increased the use of less addictive pain medications like ibuprofen and tramadol.

“The physician-dispensers could have continued to prescribe the stronger opioids (e.g., hydrocodone-acetaminophen), but would have been required to send the patients to pharmacies,” WCRI stated when it released the findings. The study reported no material change in the percentage of patients who received stronger opioids from pharmacies.

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Paduda observed that before the Florida changes, 5.7 percent of the prescriptions dispensed by doctors were opioids that fell under the ban. “After? 0.6 percent, and almost all of those were dispensed by docs outside of Florida for Florida claimants. Moreover, there was no appreciable increase in the volume of opioids dispensed by retail pharmacies, implying that the physicians who were prescribing and dispensing strong opioids stopped doing so when they could no longer dispense the medications from their own offices.”

A serious concern with drug repackaging and direct sales by physicians is the risk it poses for patient safety and potential drug interactions.

“Many times prescribing physicians will ask patients, ‘Are you taking other medications?’ and patients don’t know exactly what drugs they are taking,” said Robert Bonner, M.D., vice president of medical practices and medical director with The Hartford.

“The pharmacist has an automated system to check for potential drug interactions,” Bonner observed, whereas individual doctors do not.

One problem, he said, concerns patients who receive “second or third line drugs” that were once popularly prescribed but are no longer the drug of choice for a particular condition.

For example, a muscle relaxer known as Carisoprodol, marketed under the name Soma, and first developed in the 1950s, “is not used much anymore but is fairly common with physician dispensing,” said Bonner.

Often the process of drug repackaging and physician sales leads to patients receiving questionable medications, one source suggested. A 2006 study by CWCI found that acid blocker Ranitidine (the generic version of Zantac) also had one of the highest mark-ups when dispensed by physicians at the time, at $2.97 per pill when pharmacies were paid 18 cents — a 1,700 percent differential. Ranitidine was the most physician-dispensed drug at the time of the report.

“Usually, physicians would prescribe this drug for patients if they had trouble tolerating ibuprofen or aspirin,” said Bonner. But some doctors were automatically dispensing Ranitidine, prompting questions of whether the drug was medically indicated or precipitated by a profit motive.

Fighting Back

Paduda of CompPharma pointed to a few remedies being used for the repackaged drug problem:

* A number of payers are directing injured workers to go to physicians who don’t dispense their own drugs. This has been happening in California, Florida and Connecticut.
* Where critics are questioning the medical necessity of a particular drug a physician is dispensing, utilization review regulations may be used to contest the use of the dispensed medication.
* In many states, insurers are declining to pay bills where doctors are dispensing medications, requiring physicians who wish to contest the practice to take their complaint to an administrative law judge.

Broadspire has begun a pilot program, contacting physicians in Georgia and Pennsylvania who are dispensing drugs and telling them why the practice is questionable, said Lazarovic. Aiding Broadspire with the effort is HealthCare Solutions, Broadspire’s PBM.

“The preliminary result after one quarter’s worth of data is that physician-dispensed drug costs have declined by 9 percent” among those doctors who were part of the pilot, Lazarovic said.

Janet Aschkenasy is a freelance financial writer based in New York. She can be reached at riskletters@lrp.com.
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Sponsored: Healthcare Solutions

The Promise of Technology

A roundtable in Philadelphia explores the power of technology in WC and its potential to take us where we have never been before.
By: | December 10, 2014 • 7 min read

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The field of workers’ compensation claims management seems ideally suited as a proving place for the power of technology.

Predictive analytics in the hands of pharmacy and medical management experts can give claims managers the data they need to intervene in troublesome claims. Wearables and other mobile technologies have the potential to give healthcare providers “real-time” reports on the medical condition of injured workers.

Never before have the goals of quick turnaround and transparency in managing claims appeared so tantalizingly achievable.

In the effort to learn more about technology’s potential, in September, Risk & Insurance® partnered with Duluth, Ga.-based Healthcare Solutions to convene an information technology executive roundtable in Philadelphia.

The goal of the roundtable was to explore technology’s promise and to gauge how advancements are serving the industry’s ultimate purpose, getting injured workers safely back to work.

 

Big Data, Transparency and the Economies of Scale

Integration is a word often heard in connection with workers’ compensation claims management. On one hand, it refers to industry consolidation, as investors and larger service providers seek to combine a host of services through mergers and acquisitions.

In another way, integration applies to workers’ compensation data management. As companies merge, technology is allowing previously siloed stores of data to be combined. Access to these new supersets of data, which technology professionals like to call “Big Data,” present a host of opportunities for payers and service providers.

Through accessible exchange systems that give both providers and payers better access to the internal processes of vendors, a service provider can show the payer the status of the claim across a much broader spectrum of services.

SponsoredContent_HCS“One of the things I see with all of this data starting to exchange is the ability to use analytics to predict outcomes, and to implement workflows to intervene.”
–Matthew Landon, Vice President of Analytics, Bunch CareSolutions.

“Any time that we can integrate with a payer across multiple products such as pharmacy, specialty and PPO services, what it does is gives us a better picture of the claim and that helps us to drive better outcomes,” said roundtable participant Chuck Cavaness, chief information officer for Healthcare Solutions.

Integration across multiple product lines also produces economies of scale for the payer, he said.

Big Data, according to the roundtable participants, also provides claims managers an unparalleled perspective on the cases they manage.

“One of the things that excites us as more data is exchanged is the ability to use analytics to predict outcomes, and to implement workflows to intervene,” said roundtable participant Matthew Landon, vice president of analytics with Lakeland, Fla.-based Bunch CareSolutions, A Xerox Company.

Philadelphia roundtable participant Mike Cwynar, vice president of Irvine, Calif.-based Mitchell International, agrees with Landon.

Jerry Poole, President and Chief Executive Officer, Acrometis

Jerry Poole, President and Chief Executive Officer, Acrometis

“We are utilizing technology to consolidate all of the data, to automate as many tasks as we can, and to provide exception-based processing to flag unusual activity where claims professionals can add value,” Cwynar said.

Technology is also enabling the claims management industry to have more productive interactions with medical providers, long considered one of the Holy Grails of better case management.

Philadelphia roundtable participant Jerry Poole, president and CEO of Malvern, Pa-based claims management company Acrometis, said more uniform and accessible information exchange systems are giving medical providers access to see how bills are moving through the claims manager’s process.

“The technology is enabling providers to call in or to visit a portal to figure out what’s happening in the process,” Poole said.

More efficient data storage and communication is also resulting in quicker turnaround times, which is shortening the duration of claims and driving down the overall cost of risk, according to Cwynar.

 

Going Mobile

Another area where technology is moving the industry forward, according to the Philadelphia technology roundtable participants, is mobile technology, which is being used to support adjustors and case managers and is also contributing to quicker return to work and lower costs for payers.

The ability to take a digital tablet to a meeting with an injured worker or a health care provider is allowing case managers to enter data and give feedback on a patient’s condition in real time.

“Our field-based case managers have mobile connectivity to our claims systems that they use while they’re out of the office attending doctor’s appointments, and can enter the data right there into the system, so they’re not having to wait until they are back at the office to enter critical clinical documentation,” said Landon.

Injured workers that use social media, e-mail and the texting function on their mobile phones are staying in better touch with those that are charged with insuring that they are in compliance with their treatment plans.

Wearable devices that provide in-the-moment information about an injured workers’ condition have the potential to recreate what is known in aviation as the “black box,” a device that will record and store the precise physical state of an employee when they were injured. Such a device could also monitor their recovery process.

But as with many technologies, worker and patient privacy also needs to be observed.

“At the end of the day, we need to make sure that we approach technology enhancement that demonstrates value to the client, while ensuring patient advocacy,” Landon said.

Consolidation

As payers and claims managers set out to harness the power of computing in assessing an injured worker’s condition and response to treatment, the cycle of investment in companies that serve the workers’ compensation space is currently playing a significant role.

The trend of private equity investing in companies that can establish one-stop shopping for such services as medical case management, bill review, pharmacy benefit management and fraud forensics has huge potential.

SponsoredContent_HCS“Any time that we can integrate with a payer across multiple products such as pharmacy, specialty and PPO services, what it does is gives us a better picture of the claim and that helps us to drive better outcomes.”
— Chuck Cavaness, Chief Information Officer, Healthcare Solutions.

The challenge now facing the industry, one the information technology roundtable participants are confident it can meet, is integrating those systems. But doing so won’t happen overnight.

“There’s a lot of specialization in the industry today,” said Jerry Poole of Acrometis.

Years ago there was a PT network. Now there’s a surgical implant guy, there’s specialized negotiations, there’s special investigations, said Poole.

The various data needs to be integrated into an overall data set to be used by the carriers to help lower the cost of risk.

“Consolidating all these providers will take standardization of communication pathways and it will likely be led by the vendors,” Poole said.

 

Securing Sensitive Information

Long before hackers turned the cyber defenses of major national retailers inside out, claims management professionals have focused increased attention on the protection of data shared across multiple partners.

Information security safeguards are changing and apply to what technology pros refer to “data at rest,” data that is stored on a particular company’s servers, and “data in flight,” data that is transferred from one user to another.

Michael Cwynar

Michael Cwynar, Vice President, Mitchell International

Mitchell’s Cwynar said carriers want certification that every company their data is being sent to needs to have that information and that both data at rest and data in flight is encrypted.

The roundtable participants agreed that the industry is in a conundrum. Carriers want more help in predictive analytics but are less willing to share the data needed to make those predictions.

And as crucial as avoiding cyber exposures and the corresponding reputational damage is for large, multinational corporations, it is even more acute for smaller companies in the workers’ compensation industry.

Healthcare Solutions’ Cavaness said the millions in loss notification and credit monitoring costs that impact a Target or a Home Depot in the case of a large data theft would devastate many a workers’ compensation service vendor.

“They’d be done in a minute,” Cavaness said.

The barriers to entry in this space are higher now than ever before, continued Cavaness, and companies wishing to do business with large carriers have the burden of proving that its security standards are uncompromising.

In Reality

Workers’ compensation risk management in the United States is by its very nature, complex and demanding. But keep in mind that those charged with managing that risk get better results year after year.

Technology has a proven capability to iron out the system’s inherent complications and take its more mundane tasks off of the shoulders of case adjustors.

The roundtable members agreed that the business goals of a lower cost of risk and an even more productive workforce will follow.
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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Healthcare Solutions. The editorial staff of Risk & Insurance had no role in its preparation.




Healthcare Solutions serves as a health services company delivering integrated solutions to the property and casualty markets, specializing in workers’ compensation and auto liability/PIP.
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