Universities Cancel Classes in Israel
Amid the turmoil in the Middle East, a number of major American colleges and universities have cancelled fall semester undergraduate study programs in Israel.
Although a cease fire was recently announced, UMass Amherst had already cancelled all study for undergraduates in Israel for the fall semester, due to the fighting in the Gaza Strip, university officials announced.
The university said its International Risk Management Committee made the decision based on advice from the U.S. State Department, insurance companies, risk management consultants and other sources.
Insurance companies cover students for health, accidents, security and even evacuation, for some colleges.
New York University suspended its Tel Aviv program for the fall semester after being approached by some students and their families who expressed concern about the situation in the region.
“The safety of these 10 students was our foremost concern in our deliberations about whether or not to disrupt the academic program,” the university said. “We look forward to resuming classes at the Tel Aviv site in January.”
Other schools that have suspended programs in Israel or the West Bank include Trinity College in Hartford, the University of Iowa, the University of Michigan, Michigan State, Claremont McKenna College in California, and Penn State, according to the Associated Press.
Colleges told the AP that security was the top concern.
“The State Department recommends that U.S. citizens consider the deferral of non-essential travel to Israel and the West Bank,” according to the department’s latest travel advisory for the region.
“Israel is certainly on our list for civil unrest” at Middleburg, Va.-based Wallach & Co. Inc., providers of international travel insurance, said Belinda Smallwood, office manager.
“Basically, there are certain countries that go on the civil unrest list and underwriters can choose whether they want to add more war risk coverage,” she said.
John W. Cook, president of East Hartford, Conn.-based QuoteWright.com, said coverage for travel to Israel is still available, but the following exclusions are common to all travel insurance policies: declared or undeclared war, or any act of war; and any government regulations or prohibitions.
“So cancellations or interruptions caused either directly or indirectly by the military action will probably not be covered,” said Cook, whose firm’s website allows consumers to compare, review and buy travel insurance.
Thomas R. Petersen, vice president of Valencia, Calif.-based Petersen International Underwriters, said his firm has noticed that Israel has made an “incredibly strong push to say how safe it is to be in Israel.”
“When you get rockets lobbed near to the airport, it’s getting awfully close, but that doesn’t seem to penetrate a lot of people’s thinking,” said Petersen, whose firm is a Lloyd’s of London cover-holder that handles all forms of special risk insurance administration.
Petersen said his firm has not seen a decrease in sales of travel medical policies for Israel. “What we have seen is an increase in inquiries in war and terrorism coverage,” he said.
“I would say compared to normal it’s probably, on average, a 500 percent greater amount [of inquiries] compared to last year,” Petersen said. “Is that 50 more inquiries? Probably. I know it’s a significantly higher number of people asking about war and terrorism coverage than they ever have in the past.”
Indications are the same number of people in general still plan to travel and they don’t fear it, Petersen said. “They may be more cautious as opposed to scared,” he added.
Petersen noted that many of the requests his firm receives for travel medical policies are from fairly young people.
“A lot of them in theory have to be students, because a lot of them stay for six months or nine months or a year at a time,” he said. “I mean they’re not going just to see the Wailing Wall and then getting back here. They’ll be spending time there.”
Wallach & Co.’s Smallwood said the firm’s global health care plan for undergraduate students studying abroad lasts up to six months.
“You purchase it by the week and it’s $250,000 in coverage with a $100 deductible per illness or injury,” Smallwood said. “It covers accident and sickness coverage, which includes medical evacuation and repatriation.”
The standard rate would be $9 per week. In Israel, Wallach would have to know where a student was going to be located to determine a quote, Smallwood said.
Israeli educational programs are not the only victims of civil unrest. UMass Amherst also suspended programs in Syria, and St. Lawrence University in New York called off its program in Kenya, citing a State Department travel advisory.
Risk Management Is the Natural Owner of Compliance
With the adoption of Enterprise Risk Management (ERM), many organizations have already begun to include compliance risks as part of their organization’s risk management portfolio. However, even if the organization has not yet climbed aboard the ERM bandwagon, risk managers should be actively supporting, if not directing, their organization’s compliance efforts in several key areas, namely, interdepartmental risks.
After all, the compliance challenges in most organizations will not be those that land neatly in one department. Dining services managers will be on top of sanitation regulations; comptrollers will file their taxes.
No, the greatest compliance challenges are those that cross division and department lines.
Take a look at some of the compliance requirements that prove challenging to institutions of higher education.
• Title IX: Which prohibits discrimination on the basis of sex, covers not only equity in sports but also sexual assault and misconduct. Consequently, this impacts nearly every division of the institution.
• Americans with Disabilities Act (ADA): Its related laws and regulations impact academics, student life, facilities, IT, human resources, admissions, athletics and a multitude of other departments.
• Export Controls: A mishmash of laws that similarly effects any department involved with academics, research, technology, and travel.
• Records Retention Policy: Required under the tax form 990, covers every division and department and has additional privacy and security implications.
“…the compliance challenges in most organizations will not be those that land neatly in one department.”
Institutions traditionally find it difficult to manage compliance requirements such as these because there is no natural “owner” of the requirement. It is here that risk managers are ideally situated to help their institutions by gathering together individuals from the affected departments into a committee or task force.
Together, they can begin to create a shared management process for the institution. In the absence of hierarchical authority, committees and task forces can wield significant influence, especially if appointed by the president or board.
Furthermore, many compliance requirements are a natural fit within a risk management portfolio because they address insured risks. Compliance with anti-discrimination laws (like Title IX and ADA) is a perfect example, as acts of discrimination may be insured through educators’ or employers’ legal liability policies.
Other compliance matters may directly affect the essential identity of the institution. For instance, if an institution violates the regulations on political speech, it could lose its non-profit status and suffer reputational damages.
While it is impractical for a risk manager to be on top of every regulation that an institution is required to be in compliance with (they number in the hundreds) it is important that the risk manager be a leader in compliance matters that, when not addressed, can directly impact insurance and claims.
Offer to help organize a compliance effort. Make sure to (successfully) follow though.
You don’t have to be a subject expert to do this! Your results can showcase risk management services in the institution, reduce risk, and create a template for your next compliance project.
Medication Monitoring Achieves Better Outcomes
There are approximately three million workplace injuries in any given year. Many, if not the majority, involve the use of prescription medications and a significant portion of these medications is for pain. In fact, prescription medications are so prevalent in workers’ compensation that they account for 70% of total medical spend, with roughly one third being Schedule II opioids (Helios; NCCI; WCRI; et al.). According to the U.S. Drug Enforcement Administration (DEA), between the years of 1997 and 2007, the daily milligram per person use of prescription opioids in the United States rose 402%, increasing from an average of 74 mg to 369 mg. The Centers for Disease Control and Prevention (CDC) reports that, in 2012, health care providers wrote 259 million prescriptions—enough for every American adult to have a bottle of pills—and 46 people die every day from an overdose of prescription painkillers in the US. Suffice to say, the appropriate use of opioid analgesics continues to be a serious issue in the United States.
Stakeholders throughout the workers’ compensation industry are seeking solutions to bend the curve away from misuse and abuse and these concerning statistics. Change is happening: The American College of Occupational and Environmental Medicine (ACOEM) and the Work Loss Data Institute have published updated guidelines to promote more clinically appropriate use of opioids in the treatment of occupational injuries. State legislatures are implementing and enhancing prescription drug monitoring programs (PDMPs). The Food and Drug Association (FDA) is rescheduling medications. Pharmaceutical manufacturers are creating abuse-deterrent formulations. Meanwhile payers, generally in concert with their pharmacy benefit manager (PBM), are expending considerable effort to build global medication management programs that emphasize proactive utilization management to ensure injured workers are receiving the right medication at the right time.
A variety of factors can still influence the outcome of a workers’ compensation claim. Some are long-recognized for their affect on a claim; for example, body part, nature of injury, state of jurisdiction, and regulatory policy. In contrast, prescribing practices and physician demographics are perhaps a bit unexpected given the more contemporary data analysis showing their influence on outcomes. Such is the case for medication monitoring. Medication monitoring tools promote patient safety, confirm adherence, and identify potential high-risk, high-cost claims. Three of the more common medication monitoring tools include:
- Urine Drug Testing (UDT) is an analysis of the injured worker’s urine that detects the presence or absence of a specified drug. Although it is not a diagnosis, UDT results are generally a reliable indicator of what is present (and what is not) in the injured body worker’s system. The knowledge gained through the testing helps to minimize risks for undesired consequences including misuse, abuse, and diversion of opioids. With this information in hand, adjustments to the medication therapy regimen or other intervention activities can occur. UDT can also be an agent of positive change, as monitoring often leads to behavior modification, whether in direct response to an unexpected testing result or from the sentinel effect of knowing that medication use is being monitored.
- Medication Agreements or “Pain Contracts” signed by the injured worker and their prescribing doctor serve as a detailed and well-documented informed consent describing the risks and benefits associated with the use of prescription pain medications. Medication agreements help the prescribing doctor set expectations regarding the patient’s adherence to the prescribed medication therapy regimen. They serve as a means to facilitate care and provide for a way to document mutual understanding by clearly delineating the roles, responsibilities, and expectations of each party. Research also suggests that medication agreements promote safety and education as injured workers learn more about their therapy regimen, its risks, and benefits.
- Pill Counts quantify adherence by comparing the number of doses remaining in a pill bottle with the number of doses that should remain based on prescription instructions. Most often, physicians request pill counts at random intervals or the physician may ask the injured worker to bring their medication to all appointments. As a monitoring tool, pill counts can be useful in confirming proper use, or conversely, diversion activities.
On a stand-alone basis, these tools rank high on individual merit. When used together as part of a consolidated medication management approach, their impact escalates quite favorably. The collective use of UDT, Medication Agreements, and pill counts enhance decision-making, eliminating gaps in understanding. Their use raises awareness of potential high-risk, high-cost situations. Moreover, when used in concert with a collaborative effort on the part of the payer, PBM, physician, and injured worker, they can improve communication and align objectives to mitigate misuse or abuse situations throughout the life of a claim.
Medication monitoring can achieve better outcomes
The vast majority of injured workers use medications as directed. Unfortunately, situations of misuse and abuse are far too common. Studies show a growing trend of discrepancies between the medication prescription and actual medication-regimen adherence when it comes to claimants on opioid therapy (Health Trends: Prescription Drug Monitoring Report, 2012). In response, payers, working alongside with their PBM and other stakeholders, are deploying medication monitoring tools with greater frequency to verify the injured worker is appropriately using their medications, particularly opioid analgesics. The good news is these efforts are working. Forty-five percent of patients with previously demonstrated aberrant drug-related behaviors were able to adhere to their medication regimens after management with drug testing or in combination with signed treatment agreements and multispecialty care (Laffer Associates and Millennium Research Institute, October 2011).
In our own studies, we have similarly found that clinical interventions performed in conjunction with medication monitoring tools such as UDT reduces utilization of high-risk medications in injured workers on chronic opioid therapy. Results showed there was a decrease in all measures of utilization, driven primarily by opioids (32% decrease) and benzodiazepines (51% decrease), as well as a 26% reduction in total utilization of all medications, regardless of drug class. This is proof positive that medication monitoring can be useful in achieving better outcomes.