Risk Insider: Marilyn Rivers

The Paralysis of the Political Season

By: | August 31, 2015 • 3 min read
Marilyn Rivers is director of risk and safety for the City of Saratoga Springs. She chairs the PRIMA Institute for the Public Risk Management Association and is chairperson of the RIMS Standards and Practice Council. She was named Public Risk Manager of the Year by PRIMA in 2007. She can be reached at [email protected]

It’s political high season – those few months before the primaries and the elections when candidates across the country vie for a headline or a moment on the news.

Candidate commercials are rampant during the dinner hour and rhetoric is at an all time high. There appears to be an inordinate amount of interest as to whether hair is real, what a candidate ate for lunch and how many babies can get kissed within range of the camera.

A colleague of mine likens politics to putting lipstick on a pig to make it sexy.

Public risk professionals and those that insure them are battening down the hatches, measuring their resources and preparing for the inconceivable shot across the bow. Inevitably there will be that one case file you’ve worked hard to contain that beckons like a shiny bauble for a political sound bite and unwanted attention from a candidate who wouldn’t know the truth if it hit them square in the forehead.

The political sound bite from a candidate, who should know better, often sends ripples within a governance structure and sends its insurer into anaphylactic shock.

What better way to call attention to your candidacy than by preying on the unknown because the issue is sexy and the press eager to get the scoop. The political sound bite from a candidate, who should know better, often sends ripples within a governance structure and sends its insurer into anaphylactic shock.

Have you ever polled a public risk professional during election season? Many will comment that they have working populations split between apathy, undermining, open warfare or a weary acceptance that not a lot is going to get done while the rhetoric flies.

A paralysis seems to envelop ordinary tasks and strategic goals. Incumbents and prospective candidates often spar over the most trivial of issues that somehow made their way into the workplace causing concern, strife or heated arguments.

Public governance requires stamina and endurance regardless of the political season’s veiled threats and promises. Let’s be clear folks. Public employees, regardless of the season, have a responsibility to ensure governments run, offices are open for business, licenses and permits are issued, and the public is served.

Making that happen amidst the carnival sideshow, the empty promises and the campy atmosphere of “it’s a mess out there that needs a-changing” is a true testament to the public servants who keep the peace, clean the streets and manage the processes to ensure our economy is successful.

It’s a thankless job with no pictures or press or glory.

Although we believe we’ve seen and heard it all, we need to find solace and humor in the ridiculous lack of reality the political season brings.

As the potential onslaught looms, find strength in knowing your risk programming and your partnerships can withstand the potential threat of words.  Gather your troops and shout “Ooh Rah” like a Marine as loud as your voice will carry. There are no knights in shining armor, only jesters who beg the attention of the crowd.

Public risk management is more than an issue. It’s a legacy that will more than withstand the test of time.

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Risk Insider: Patty Hostine

Managing Change Requires Introspection

By: | August 3, 2015 • 3 min read
Patricia Hostine, MA, MBA, LPC, CRC, MSCC, CWCP, has more than 20 years’ experience in workers’ compensation from both the vendor and corporate perspectives. She is the former Director of US Disability Management for The Flex N Gate Group of Companies.

If we’re lucky, every experience changes who we are and how we react to things both familiar and new. Our memories of outcomes, positive and negative, are intended to act as signposts for future decisions.

If we do not utilize those signs we have failed to learn from the past — and then, oh, what a waste those experiences were along the way.

In claims, sometimes we say it was instinct that we saw a claim start to unravel or that person has a great “gut” for knowing which claims to watch; claim-dar, if you please. I say it is merely watching the signposts and remembering. Along the way, you hope for continuous improvement toward a mutual goal.

Whether that goal is process improvement, return-to-work or recovery focused it is all just continuous improvement to maximum potential (MMI).

As we go along building new experiences to add to our toolbox of signposts, we use both positive and negative experiences to become the best at whatever it is we are attempting to attain or achieve. Sometimes, “Well, that didn’t work” is just as important as success in moving forward.

The only failure in improvement is stalling — choosing not to improve. Change is hard, it takes work, cajoling, introspection and honesty.

Sometimes, “Well, that didn’t work” is just as important as success in moving forward. The only failure in improvement is stalling — choosing not to improve.

I suspect introspection is the hardest, we think we know what we are about, but then when an obstacle comes along … do we go forward, stop, side-step or back away? I believe it all depends upon your convictions — how committed are you to success, to your philosophy or to your goals?

Now, I know there are far more questions here than answers, but that is the part that is so introspective and interesting.

Knowing risk is managing risk, which can be said in regard to most things we attempt. The risk of going out on a limb is always going to be that the limb could break.

The question then becomes, is it worth the break or worth the risk?

Change for the sake of change is not necessarily a bad thing but change in hope of improvement should be good for the human condition. Continuous improvement should always be the goal and it is not a new thing. It may have taken on a business-process meaning but from the time we are little, people tell us things to move us forward, to improve.

From Finding Nemo’s “Keep swimming” to “if you want to bake a cake, you have to break some eggs,” (a favorite of my mom’s) it is all about moving forward, improving, growing and learning.

Hopefully, as change comes you will continue to strive for continuous improvement; if you “keep swimming” you might just get “cake”!

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Sponsored: Healthcare Solutions

Specialty Drugs Show No Signs of Slowing Down

The emergence of specialty drugs in the workers' comp market comes with a new set of complexities and a hefty price tag.
By: | August 31, 2015 • 4 min read
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A decade ago, high-cost specialty drugs were commonly referred to as “injectable drugs” and were used to treat conditions not typically covered in workers’ compensation, such as cancer, rheumatoid arthritis and multiple sclerosis.

“Today, however, new specialty drugs are emerging that will be used to treat other chronic and inflammatory conditions,” said Joe Boures, president and CEO of Healthcare Solutions, an Optum company providing specialized pharmacy benefit management services to the workers’ compensation market.

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Joe Boures, President and CEO, Healthcare Solutions

“Payers in the workers’ comp market are just beginning to feel the cost impact of greater utilization of these drugs, which come with expensive price tags.”

Specialty drugs are often manufactured using biologic rather than chemical methods, and they are no longer just administered by injections. New specialty drugs can also be inhaled or taken orally, likely contributing to the rise in their utilization.

“There isn’t a standard definition of specialty drugs, but they are generally defined as being complex to manufacture, costly, require specialty handling and distribution, and they difficult for patients to take without ongoing clinical support or may require administration by a health care provider,” said Boures.

In 2014, more than a quarter of all new therapies that the FDA approved were through its biologics division. Biologics, and similar therapies, are representative of a future trend in prescription drug spend.

“As the fastest growing costs in health care today, specialty drugs have the potential to change the way prescription benefits are provided in the future,” said Jim Andrews, executive vice president of pharmacy for Healthcare Solutions.

Workers’ Compensation payers may not recognize how specialty drugs are affecting their drug spend.

Specialty drugs like Enbrel®, Humira® and Synvisc® can be processed in conjunction with other medical procedures and, therefore, not recognized by payers as a pharmacy expense.

This leaves payers with little visibility into the costs of these medications within their book of business and a lack of tools to control these costs.

Due to the high costs of specialty medications, special due diligence should be utilized when claimants receive these medications, up to and including utilization review, said Andrews.

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Jim Andrews, Executive Vice President of Pharmacy, Healthcare Solutions

“Healthcare Solutions recommends that claimants using specialty drugs are monitored for proper medication handling and that the medication is administered appropriately, as well as monitoring the claimant to determine whether the medication is having its desired results and if there are any side effects,” he said.

“At $1,000 per pill for some of these specialty medications, making sure a claimant can tolerate the side effects becomes vital to making sure the claimant achieves the desired outcomes.”

Hepatitis C drugs have made their way to the workers’ compensation market, largely through coverage of healthcare workers, who have exposure to the disease.

“Traditional drug treatments that began in the 1990’s had a success rate of 6% and costs ranging from $1,800 to over $88,000,” said Andrews.

“The new Hepatitis C specialty medications have a treatment success rate of 94-100%, but cost between $90,000 and $226,000.”

Although the new treatments include higher drug costs, the payer’s overall medical costs may actually decrease if the Hep C patient would have required a liver transplant as part of the course of treatment without the drugs.

While the release of new Hepatitis C medications in 2014 demonstrated the potential impact specialty medications can have on workers’ compensation payers, there are some specialty medications under development that target more common conditions in workers’ compensation.

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Pfizer Inc. and Eli Lilly and Company are currently developing tanezumab, a new, non-narcotic medication to treat chronic pain, which is common in workers’ compensation claims.

Tanezumab has demonstrated benefits of reducing pain in clinical trials and may provide non-addictive pain relief to claimants in the future.  This may change how pain management is treated in the future.

Healthcare Solutions has a specialty medication program that provides payers discounted rates and management oversight of claimants receiving specialty medications.

Through the paper bill process, Healthcare Solutions aids payers in identifying specialty drugs and works with adjusters and physicians to move claimants into the specialty network.

A central feature of the program is that claimants are assigned to a clinical pharmacist or a registered nurse with specialty pharmacy training for consistent care with one-on-one consultations and ongoing case management.

The program provides patients with education and counseling, guidance on symptoms related to their medical conditions and drug side effects, proactive intervention for medication non-adherence, and prospective refill reminder and follow-up calls.

“The goal is to improve patient outcomes and reduce total costs of care,” said Boures.

This article was produced by Healthcare Solutions and not the Risk & Insurance® editorial team.



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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