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Infographic: The Risk List

7 Construction Risks

Construction challenges may come from unexpected places. Presented by Travelers.
By: | November 13, 2014 • 2 min read
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The Risk List is presented by:

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The R&I Editorial Team may be reached at riskletters@lrp.com.
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Risk Scenario

Midnight Blitz

On Cyber Monday, skilled hackers diminish an online retailer's credibility in mere minutes.
By: | November 13, 2014 • 8 min read
Risk Scenarios are created by Risk & Insurance editors along with leading industry partners. The hypothetical, yet realistic stories, showcase emerging risks that can result in significant losses if not properly addressed.

Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.

The Citadel

The October 2015 cover of the trade publication Retailer’s World featured a picture of Paul Vitez, general counsel for cloud host Va-Voom!, which rewrote the book on online shopping, making a billionaire of its founder, Teddy Houck.

Scenario_MidnightBlitz

In glowing prose, the author of the Retailer’s World cover story related Vitez’ impressive academic record at Haverford College, his background in finance and his role in earning for Va-Voom! the nickname of “The Citadel” for its innovative, committed approach to cyber security.

Employing the “prison, not a castle” approach to cyber security, Vitez and Va-Voom! created “honey- pots” within the Va-Voom! system, decoys which looked like they contained important data but were not actually part of the internal network.

Moving much more swiftly than its competitors, Va-Voom! also spent millions to implement chip and pin credit card technology on its credit cards, a much more secure way to store sensitive financial and personal information than the traditional magnetic strip.

Again with an eye toward short-term investment in operations and a goal of long-term success, Vitez was given carte blanche by Teddy Houck and the Va-Voom! board of directors to spend top dollar for information technology talent that had honed their skills in the high-stakes environments of the CIA and the Department of Defense.

Partner

Partner

From an information technology policy perspective, Va-Voom! was a demanding place to work. Under Vitez’ direction, the use of data encryption was heavily enforced. It also had a strict company policy barring employees from connecting personal devices to any computer equipment owned by Va-Voom! or to its network.

In 2014 and 2015, one by one, major retailers — even banking institutions — were hit by cyber attacks that undermined the public’s faith in those companies, doing serious mid- to long-term damage to their reputations. Retailers that learned only too well the degree to which they were vulnerable to attack found in Va-Voom! a business partner they felt they could trust.

Rather than being dampened by cyber fears, the trend of cyber attacks in 2014 and early 2015 actually increased the number of retailers that wanted to do business with Va-Voom!

The company’s insurance program was something of an anomaly, considering its position in the industry. Starting with a substantial retention, Va-Voom! carried property and professional liability coverage for its employees.

The company considered but never purchased coverage that would substantially indemnify the hundreds of retailers and other service providers that used its services, were Va-Voom! to be the victim of a cyber-security incident. It carried third-party liability insurance, but not as much as you would think a company of its size would carry.

“Really?” Vitez memorably said during a meeting with Steve Francis, the company’s chief risk officer and company CFO Maribel Kelly, when the subject of cyber security indemnification was broached by Va-Voom!’s broker, himself no slouch when it came to these matters.

With an eye to the merciless whims of stock market investors, Vitez and Kelly sided against Steve Francis when he argued that the cost of the premium, though it would put a slight dent in the company’s bottom line on a quarterly basis, was well worth the expense.

“Nobody manages this risk better than we do,” Vitez said, crossing his arms across his chest.

“We can and do own this risk,” he said.

Steve Francis looked at Vitez across the table but didn’t say what he was thinking. What he was thinking was, “You just bit off way more than you can chew, Mr. Haverford.”

Poll Question

Has your company conducted a cyber-security assessment of is information technology infrastructure?

View Results

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The Blitz

Just before midnight on Nov. 30, 2015, the Monday after Thanksgiving, known in retailing as Cyber Monday, a highly sophisticated and well-coordinated cyber-attack began, erasing Va-Voom!’s considerable credibility in a matter of minutes.

Scenario_MidnightBlitz

Here’s how it unfolded.

At five minutes to midnight, the websites of 10 of the largest retailers that sold on the Va-Voom! site went down. The retailers were so in the dark about what had happened to them that it took hours to put together that the source of the attack was coming from within Va-Voom!’s vaunted information technology system.

Precisely at midnight, unidentified hackers used the stolen e-mail addresses of the 10 retailers’ customers to send Trojan Horses to the personal computers of millions of online shoppers.

The customers didn’t need to click on the e-mails or download attachments to empower the Trojan Horses. After a mere half hour in their inboxes, the e-mails activated a cyber-locking mechanism that shut the users out of their own computers. The only visible content on their screen was the logo of the retailer whose customer information was stolen.

Angry consumers, shut out of their personal computers, pick up their handheld devices to vent their frustration in instant messages and Tweets aimed at the retailers whose logos were frozen on their now-useless computer screens.




Several of the affected companies went public within hours with their conviction that the Trojan Horses that caused so much havoc emanated from the Va-Voom! network.

“Are you seeing this?” said David Cohen, the equally miffed general counsel for one of the retailers, on a phone call with his law school buddy Paul Vitez, as they tried to sort out the hell that had broken loose.

“Yes I’m seeing it,” said Vitez.

Vitez, normally a man of action, but temporarily flummoxed, became as passive as any teenager with a handheld device in their hand as he sat, scrolling through the Tweets and Facebook posts that were savaging the retailers and Va-Voom!

“What are you doing?” Cohen said impatiently when Vitez fell silent.

“Are you playing with your iPhone? We have a serious situation here, Paul!” Cohen said.

“I’m not playing with my iPhone!” Vitez shouted back before putting down his mobile device and trying to regain control of his emotions.

“I know we have a problem David, I know we do,” Vitez said.

But all Vitez could do beyond that was run his hands through his hair, temporarily at a loss as to exactly what to do next.

On the afternoon of December 1, the New York Times published an online story, featuring quotes attributed to Wall Street analysts from the technology and retail sectors, estimating that damage to home computers and lost online retail sales from the coordinated and ongoing cyber attack could potentially exceed $1 billion.

Poll Question

Does your company have in place a crisis management and response plan in the event of a cyber-attack?

View Results

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Poll Question

If yes, how often is the plan tested?

View Results

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Black Monday and Beyond

In the aftermath of what history and newspaper editors and writers would record as “Black Monday,” Vitez and the rest of the Va-Voom! team tried to take stock of their losses and rally themselves into a recovery. They had a very hard and very expensive road ahead of them.

Scenario_MidnightBlitz

Paul Vitez had used the millions accorded to him to create Va-Voom’s “prison, not a castle” approach to cyber defense and he had employed that money in an admirable and innovative fashion.

But it was in a meeting with chief risk officer Steve Francis, CFO Marabel Kelly and Va-Voom!’s technology and general liability broker Brandon Fikes that Paul Vitez came to a better, albeit painful understanding about the best allocation of capital in the quest to manage risk.

The most immediate pain that Va-Voom! was feeling were notices from five attorneys general that investigations into the Black Monday breach were underway.

‘Well, the good news is that your regulatory defense is covered, as is your first party business interruption,” Fikes said.

“Great,” Vitez said. “What else?”

Steve Francis glanced at Vitez out of one corner of his eye. He felt the pain of the losses to the company as badly as anyone, but he couldn’t help but take a bit of perverse pleasure in the discomfort of Vitez, whose arrogance, in Francis’ estimation, was going to have significant consequences, consequences that could be measured in millions of dollars.

“The rest is somewhat of a mixed bag, unfortunately,” Fikes said.

“Go on,” said Vitez who shot Francis a quick sharp look, causing Francis to turn away quickly, lest his inner thoughts become outwardly visible.

“You had some third party liability coverage, but I don’t think it’s going to be enough to cover the losses of your business partners, not to mention the shoppers whose personal computers were damaged by this event,” Fikes said.

“How much …” Vitez managed to get out before Steve Francis stepped in.

“We could have multiples of millions in exposure here, Paul,” Francis said.

Vitez shot Francis another look but Francis diplomatically kept his mouth shut.

“I don’t think we’re ever going to get to the bottom of where this attack came from and who launched it,” said the CFO, Marabel Kelly.

“What’s your advice, Brandon, about spending money on forensics?” she asked.

“I think you spend it for a couple of reasons,” Fikes said.

“One, the cost is covered by insurance. But that’s not the best reason. The best reason is that you can use forensics to learn from the event and hopefully prevent anything else as bad as this going forward,” he said.

“All right,” Kelly said. “What else?”

“There’s reputation,” Steve Francis offered.

“Some say you can put a price on it, some say you can’t,” said Fikes.

“But one thing is for sure,” he said. “You had no coverage in place for that in any event.”

There was a pause, as the significance of that statement sunk in. In the extended, painfully awkward silence, Marabel Kelly shuffled the paperwork in front of her and shifted in her seat, visibly perturbed.

Within two weeks of that difficult conversation, the pain intensified for Paul Vitez and Va-Voom! Class action lawsuits were filed on behalf of the millions of home-computer owners who alleged pain and suffering in connection with the hassle of credit card replacement and property loss from their now-useless computers.

The 10 retailers affected, now known colloquially and to their ongoing irritation as the Black Monday Ten, also filed suit.

With Va-Voom!’s uninsured losses building from the millions to the tens of millions, Paul Vitez, once a magazine cover boy, resigned his position.

Poll Question

How much thought have you given to the third-party liability consequences of a cyber-attack on your system or on the systems of one of your business partners?

View Results

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Bar-Lessons-Learned---Partner's-Content-V1b

Risk & Insurance® partnered with XL Group to produce this scenario. Below are XL Group’s recommendations on how to prevent the losses presented in the scenario. These “Lessons Learned” are not the editorial opinion of Risk & Insurance®.

1. Have a crisis management response plan in place – The consequences of a cyber-attack are too expensive and too damaging for companies not to have a clear idea how they are going to respond in the event their services, or the services of their business partners are interrupted.

2. Understand your risk profile – Different companies have different cyber-risk profiles depending on their industry. Understanding your cyber-risk profile and working in conjunction with an agent and underwriter to map out the best coverage is a crucial step in avoiding being underinsured or paying too much for coverage you don’t need.

3. You are next – The realm of cyber-security and cyber-attacks is one area where an “it can’t happen here” mentality could be catastrophic. The chilling fact of the matter is that the most well-financed companies with the most sophisticated cyber defenses are vulnerable.

4. Get help – Whether it be through your insurance coverage or some other funding mechanism, find and connect with the consultants you need to help you understand the threat and how you can protect yourself. This risk environment is changing day by day and no one can afford to be content with the status quo.

5. Enforce your IT policies – Having sensible IT policies in place to minimize the potential for an attack is not enough. Companies must be proactive in seeing that employees take seriously company rules and standards on data encryption, and the use of personal devices in the workplace or in connection with company networks.

Additional Partner Resources

XL Group Cyber Product Sheet

John Coletti, Underwriting Manager of Cyber Liability, discusses cyber coverage options.


Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at dreynolds@lrp.com.
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Sponsored: Healthesystems

Changing the WC Medical Care Mindset

Having a holistic, comprehensive strategy is critical in the ongoing battle to control medical care costs.
By: | November 3, 2014 • 6 min read
SponsoredContent_HES

Controlling overall workers’ compensation medical costs has been an elusive target.

Yet, according to medical experts from Healthesystems, the Tampa, Fla.-based specialty provider of innovative medical cost management solutions for the workers’ compensation industry, payers today have more powerful options for both offering the highest quality medical care and controlling costs, but they must be more thoroughly and strategically executed.

Specifically as it relates to optimizing patient outcomes and controlling pharmacy costs, the key, say those experts, is to look beyond the typical clinical pharmacy history review and to incorporate a more holistic picture of the entire medical treatment plan. This means when performing clinical reviews, taking into account more comprehensive information such as lab results, physician notes and other critical medical history data which often identifies significant treatment plan concerns but frequently aren’t effectively monitored in total.

Healthesystems’ Dr. Robert Goldberg, chief medical officer, and Dr. Silvia Sacalis, vice president of clinical services, recently weighed in on how using a more holistic, comprehensive strategy can make the critical difference in the ongoing medical care cost control battle.

Fragmentation, Complexity Obscure the Patient Picture

According to Dr. Goldberg, fragmentation remains one of the biggest obstacles to controlling overall healthcare costs and ensuring the most successful treatment in workers’ compensation.

Robert Goldberg, MD, discusses obstacles to controlling overall medical costs and ensuring the best treatment in workers’ compensation.

“There are several hurdles, but they all relate to the fact that healthcare in workers’ comp is just not very well coordinated,” he said. “For the most part, there is poor communication between all parties involved, but especially between the payer and the provider. Unfortunately, it’s rare that all the stakeholders have a clear, complete picture of what’s happening with the patient.”

Dr. Goldberg explains that health care generally has become a more complex landscape, and workers’ comp adds another level of complexity. Physicians have less time to spend with patients due to work loads and other economic factors, and frequently there isn’t adequate time to develop a patient specific treatment strategy.

“Often we don’t have physicians properly incentivized to do a complete job with patients” he said, adding that extra paperwork and similar hurdles limit communication among payers, nurse case managers and other players.

In fact, Dr. Sacalis emphasized that it’s not only the payer, but often the healthcare provider who is not getting a complete picture. For example, a treating doctor may not be the primary care physician and therefore they may not have access to the total healthcare picture for the injured worker.

SponsoredContent_HES“Most of all, payers need to adopt a more collaborative approach in their relationships with physicians, employers and patients, as well as networks involved. It will result in getting people back to work through appropriate medical care and moving the case along to a prompt closure.”
– Robert Goldberg, MD, FACOEM, Chief Medical Officer, Healthesystems

“It’s often difficult for multiple physicians to communicate and collaborate about what’s happening because they may not be aware of each-others involvement in that patient’s care,” she said. “Data sharing is lacking, even in integrated healthcare systems where doctors are in the same group.”

Done Right, Technology Can Bridge the Treatment Strategy Gap

Dr. Sacalis explained the role technology advancements can play in creating a more holistic picture of not only an injured workers’ post-accident state or pace of recovery, but also their overall health history. However, the workers’ comp industry by and large is not there yet.

“Today’s technology can be very useful in providing transparency, but to date the data is still very fragmented,” she said. “With technology advancements, we can get a more holistic patient view. However, it is important that the data is both meaningful and actionable to promote effective clinical decision support.”

Silvia Sacalis, PharmD, explains the role that technology advancements can play in creating a more holistic picture of an injured worker’s overall health.

Healthesystems, for example, offers an advanced clinical solution that incorporates a comprehensive analysis of all relevant data sources including pharmacy, medical and lab data as part of a drug therapy analysis. So, for example, the process could uncover co-morbidities – such as diabetes – that may be unrelated to a workplace injury but should be considered in the overall treatment strategy.

“Healthcare professionals must ensure there are no interactions with any
co-morbidities that may limit or affect the treatment plan,” Dr. Sacalis said.

In the majority of cases where Healthesystems has performed advanced clinical analysis, information gathered from the various sources has uncovered critical information that significantly impacted the overall treatment recommendations. Technology and analytics enable the implementation of best practices.

She cites another example of how a physician may order a urine drug screen (UDS), yet the results indicating the presence of a non prescribed drug were not reflected in the treatment regimen as evidenced by the lack of modification in therapy.

“Visibility and transparency will help with facilitating a truly effective treatment plan,” she said, “Predictive analytics are necessary tools for proactive monitoring and detection of trends as well as early identification of cases for intervention.”

Speaking of Best Practices …

Dr. Goldberg highlighted that the most important overall best practice needed to secure the optimal outcome is centered around getting the right care to the right patient at the right time. To him, that means identifying patients who need adjustments in care and then determining medical necessity during the entire case trajectory.

“It means using evidence-based medical treatment guidelines that are coordinated,” he said.

“You must look at the whole patient, which means avoiding the typical barriers in the workers’ comp treatment system, issues such as delays in authorizations, lengthy UR processes or similar scenarios that are well intentioned but if not performed effectively they can get in the way of expedited care.”

Dr. Goldberg and Silvia Sacalis provide recommendations for critical steps payers should take to achieve the best outcomes for everyone.

Dr. Goldberg noted that seeking out the most effective doctors available in geographic locations is another critical best practice. That requires collecting data on physician performance, patient satisfaction and medical outcomes, so payers and networks can identify and incentivize them accordingly.

“This way, you are getting an alignment of incentives with all parties,” Dr. Goldberg said, adding that it also means removing outlier physicians, those whose tendencies are to over-treat, dispense drugs from their office or order unnecessary durable medical equipment, for example.

SponsoredContent_HES“Visibility and transparency will help with facilitating a truly effective treatment plan. Predictive analytics are necessary tools for proactive monitoring and detection of trends as well as early identification of cases for intervention.”
– Silvia Sacalis, PharmD, Vice President of Clinical Services, Healthesystems

“Most of all, payers need to adopt a more collaborative approach in their relationships with physicians, employers and patients, as well as networks involved,” he said. “It will result in getting people back to work through appropriate medical care and moving the case along to a prompt closure.”

Dr. Sacalis added that from a pharmacy perspective, another best practice is becoming more patient-centric, using a customized and flexible approach to help payers optimize outcomes for each patient.

“Focus on patient safety first, and that will naturally drive cost containment,” she said. “Focusing on cost alone can actually drive results in the wrong direction.”

Additional Insights 

Dr. Goldberg explains how consolidation in the health care and WC markets can impact the landscape and quality of care.

Dr. Goldberg and Silvia Sacalis discuss if injured workers today are getting better treatment than they were twenty years ago.

SponsoredContent

BrandStudioLogo

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Healthesystems. The editorial staff of Risk & Insurance had no role in its preparation.


Healthesystems is a leading provider of Pharmacy Benefit Management (PBM) & Ancillary Benefits Management programs for the workers' compensation industry.
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