Can ‘Ebola-mania’ Give Way to a National Reset?
Ebola is not a new contagion and it is one for which the United States has been preparing for since at least post-9/11 heightened bioterrorism concerns.
While some may be critical of the care provided to the first patient with Ebola in Dallas, as well as resulting communication issues involving hospital and medical officials, clearly all involved intended to do their very best under uniquely stressful conditions that rarely any American hospital had faced before.
In what will surely be a repeating pattern in the near-term, American hospitals, clinics and doctors, as well as employers and other entities will continue to periodically encounter individuals that have acquired the Ebola virus and require treatment. The country will also have periods where there may be no known cases.
As of Nov. 11, and for the first time in 41 days since the initial U.S. patients, there were no known cases of Ebola in the U.S. That was short-lived as within days thereafter a surgeon who had contracted the Ebola virus in West Africa was transferred to the United States for treatment, but unfortunately the patient died.
I believe we should attempt a national “reset” to manage this public health issue in America — based on science and evidence.
In order to do so, it is important to understand the causative factors leading to the arguably explicable initial national panic surrounding Ebola. In the early moments of a risk crisis, leaders get limited chances to establish credibility and trust. The populace and media want to know the risk is understood and under control.
Early slips in Dallas failed this test, as I mention in my first article on this subject.
While some may feel on edge with regard to changing CDC guidance, in fact, the CDC is adjusting to new information and changing their guidelines appropriately; not dissimilar to how managers of risk adjust to any hazard exposure.
As managers of risk, we should be assessing the risks Ebola presents.
Ebola is really no different than other significant risks (e.g., terrorism post-9/11, Y2K, swine flu, grounding of certain airplanes).
There is a common pattern that moves from initial organic obsession to an easing, understanding, and respect of the risk that becomes balanced with other important considerations such as civil liberties, promoting international health, and maintaining world economic balance, for examples in the context of contagion risks.
For the emerging risk of Ebola in America, we are at a pivotal point to learn from the recent past and venture forward with the best of science and evidence-based risk management.
Will America press the reset? As risk managers, we stand in an influential position within our organizations to utilize the proven methods and tools of managing enterprise risks, including contagion risk.
As such, risk managers are in a unique position to lead with others; to reset the response to the Ebola virus in our unique national microcosm and move to a balanced American view appropriately and respectfully managing our interests while simultaneously attending to world health risk issues, especially in West Africa.
Read all of Jeff Driver’s Risk Insider articles.
A Failure of Trust
‘Ebola-mania’ is my term for significant reactions to known public health and risk management issues associated with the Ebola virus.
The arrival of Ebola in the United States has been marked by fever-pitch reactions of alarm that ranged from cries for international travel bans, school closings, state-required quarantines of individuals, airport passenger health screenings, and even calls for national nursing union labor strikes over claimed unsafe hospital working conditions.
Now, let’s take a big collective national breath. Could it be that what first appeared to be a public health crisis turned out to be more of a significant crisis in public confidence?
Could it be that for America, Ebola is not as significant a risk as it is for the far less advanced medical systems in West Africa where over 5,000 people have died after contracting the virus?
But this fall, in different ways, U.S. hospitals, the Centers for Disease Control and Prevention, as well as state and federal governments arguably failed to fully establish credibility with a hungry media and scared public, exacerbating what should have been a manageable Ebola outbreak.
A trifecta of public confidence shaking moves occurred when missteps were made in treating the first U.S. Ebola patient, accurately communicating with the public, and protecting treating medical providers from contracting the virus.
First, a patient with a history of fever and travel from West Africa was discharged from a hospital back into the community. Then, information about the patient’s temperature being no greater than the CDC threshold of 101.5 degrees to trigger a serious Ebola concern had to be corrected; and once the patient was readmitted, officials failed to clearly explain delays in blood transfusion from an Ebola survivor and the administration of an experimental drug (Brincidofovir), both which had shown promise in treating Ebola.
Perhaps most alarming, the involved hospital has not been able to explain how two of its nurses contracted the virus, instead seeming to point the finger at the CDC for frequently changing protective gear guidelines and “frustrating” hospital employees and management.
Subsequent blows to public confidence stemmed from uncertainties around CDC guidelines on personal protective equipment (PPE) for health care workers and the 21-day quarantine guideline for individuals exposed to the Ebola virus.
First, with regard to PPE: After two nurses in Dallas tested positive for the Ebola virus, the CDC changed PPE guidelines to ensure there would be no ambiguity about leaving no skin exposure. It detailed step-by-step instructions to put on and take off the equipment safely, as well as the necessity of having a trained monitor to supervise the process.
Then, there are the still unresolved questions surrounding the necessity of a 21-day quarantine for individuals potentially exposed to the Ebola virus.
The several different approaches to contain the virus from individual states, the CDC and the military have not been resolved, and the current interim CDC recommendations at this point are based on transmission risk assessment.
In part II of this article on Ebola, I will focus on the way risk managers should reset the response to Ebola.
Read all of Jeff Driver’s Risk Insider articles.
Healthcare: The Hardest Job in Risk Management
Radically changing cost and reimbursement models.
Rapidly evolving service delivery approaches.
It is difficult to imagine an industry more complex and uncertain than healthcare. Providers are being forced to lower costs and improve efficiencies on a scale that is almost beyond imagination. At the same time, quality of care must remain high.
After all, this is more than just a business.
The pressure on risk managers, brokers and CFOs is intense. If navigating these challenges wasn’t stress inducing enough, these professionals also need to ensure continued profitability.
“Healthcare companies don’t hide the fact that they’re looking to reduce costs and improve efficiencies in practically every facet of their business. Insurance purchasing and financing are high on that list,” said Leo Carroll, who heads the healthcare professional liability underwriting unit for Berkshire Hathaway Specialty Insurance.
But it’s about a lot more than just price. The complexity of the healthcare system and unique footprint of each provider requires customized solutions that can reduce risk, minimize losses and improve efficiencies.
“Each provider is faced with a different set of challenges. Therefore, our approach is to carefully listen to the needs of each client and respond with a creative proposal that often requires great flexibility on the part of our team,” explained Carroll.
Creativity? Flexibility? Those are not terms often used to describe an insurance carrier. But BHSI Healthcare is a new type of insurer.
The Foundation: Financial Strength
Berkshire Hathaway is synonymous with financial strength. Leveraging the company’s well-capitalized balance sheet provides BHSI with unmatched capabilities to take on substantial risks in a sustainable way.
For one, BHSI is the highest rated paper available to healthcare providers. Given the severity of risks faced by the industry, this is a very important attribute.
But BHSI operationalizes its balance sheet in many ways beyond just strong financial ratings.
For example, BHSI has never relied on reinsurance. Without the need to manage those relationships, BHSI is able to eliminate a significant amount of overhead. The result is an industry leading expense ratio and the ability to pass on savings to clients.
“The impact of operationalizing our balance sheet is remarkable. We don’t impose our business needs on our clients. Our financial strength provides us the freedom to genuinely listen to our clients and propose unique, creative solutions,” Carroll said.
Keeping Things Simple
Healthcare professional liability policy language is often bloated and difficult to decipher. Insurers are attempting to tackle complex, evolving issues and account for a broad range of scenarios and contingencies. The result often confuses and contradicts.
Carroll said BHSI strives to be as simple and straightforward as possible with policy language across all lines of business. It comes down to making it easy and transparent to do business with BHSI.
“Our goal is to be as straightforward as we can and at the same time provide coverage that’s meaningful and addresses the exposures our customers need addressed,” Carroll said.
Claims: More Than an After Thought
Complex litigation is an unfortunate fact of life for large healthcare customers. Carroll, who began his insurance career in medical claims management, understands how important complex claims management is to the BHSI value proposition.
In fact, “claims management is so critical to customers, that BHSI Claims contributes to all aspects of its operations – from product development through risk analysis, servicing and claims resolution,” said Robert Romeo, head of Healthcare and Casualty Claims.
And as part of the focus on building long-term relationships, BHSI has made it a priority to introduce customers to the claims team as early as possible and before a claim is made on a policy.
“Being so closely aligned automatically delivers efficiency and simplicity in the way we work,” explained Carroll. “We have a common understanding of our forms, endorsements and coverage, so there is less opportunity for disagreement or misunderstanding between what our underwriters wrote and how our claims professionals interpret it.”
Responding To Ebola: Creativity + Flexibility
The recent Ebola outbreak provided a prime example of BHSI Healthcare’s customer-centric approach in action.
Almost immediately, many healthcare systems recognized the need to improve their infectious disease management protocols. The urgency intensified after several nurses who treated Ebola patients were themselves infected.
BHSI Healthcare was uniquely positioned to rapidly respond. Carroll and his team approached several of their clients who were widely recognized as the leading infectious disease management institutions. With the help of these institutions, BHSI was able to compile tools, checklists, libraries and other materials.
These best practices were immediately made available to all BHSI Healthcare clients who leveraged the information to improve their operations.
At the same time, healthcare providers were at risk of multiple exposures associated with the evolving Ebola situation. Carroll and his Healthcare team worked with clients from a professional liability and general liability perspective. Concurrently, other BHSI groups worked with the same clients on offerings for business interruption, disinfection and cleaning costs.
Ever vigilant, the BHSI chief underwriting officer, David Fields, created a point of central command to monitor the situation, field client requests and execute the company’s response. The results were highly customized packages designed specifically for several clients. On some programs, net limits exceeded $100 million and covered many exposures underwritten by multiple BHSI groups.
“At the height of the outbreak, there was a lot of fear and panic in the healthcare industry. Our team responded not by pulling back but by leaning in. We demonstrated that we are risk seekers and as an organization we can deploy our substantial resources in times of crisis. The results were creative solutions and very substantial coverage options for our clients,” said Carroll.
It turns out that creativity and flexibly requires both significant financial resources and passionate professionals. That is why no other insurer can match Berkshire Hathaway Specialty Insurance.
To learn more about BHSI Healthcare, please visit www.bhspecialty.com.
Berkshire Hathaway Specialty Insurance (www.bhspecialty.com) provides commercial property, casualty, healthcare professional liability, executive and professional lines, surety, travel, programs, and homeowners insurance. It underwrites on the paper of Berkshire Hathaway’s National Indemnity group of insurance companies, which hold financial strength ratings of A++ from AM Best and AA+ from Standard & Poor’s. Based in Boston, Berkshire Hathaway Specialty Insurance has regional underwriting offices in Atlanta, Boston, Chicago, Los Angeles, New York, San Francisco, Toronto, Hong Kong, Singapore and New Zealand. For more information, contact email@example.com.
The information contained herein is for general informational purposes only and does not constitute an offer to sell or a solicitation of an offer to buy any product or service. Any description set forth herein does not include all policy terms, conditions and exclusions. Please refer to the actual policy for complete details of coverage and exclusions.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Berkshire Hathaway Specialty Insurance. The editorial staff of Risk & Insurance had no role in its preparation.