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Risk Insider: Grace Crickette

ERM and the Art of War: Tactics

By: | November 17, 2014 • 3 min read
Grace Crickette, senior vice president of risk services with AAA Northern California, Nevada and Utah, is writing a series on how to gracefully transform your risk management program through enterprise risk management and change management techniques. She can be reached at Grace.Crickette@goaaa.com.
Topics: ERM | Risk Insider

Part IV of a series exploring phrases and tactics from Sun Tzu’s* The Art of War to develop strategies for implementing ERM programs. This installment delves into Chapter IV: Tactics.

MAKE ERM, NOT WAR

rainbow peace sign copy

Chapter IV: Tactics

  • What is our current reputation?
  • Do we have weaknesses in our current program?
  • Do we have good news we can publish?

Art of War Key Principal: Inherent Advantages and Disadvantages: Understand, and guard against, the inherent disadvantage in every advantageous situation. (If it sounds too good to be true it probably is).  Likewise, be alert to capitalizing on advantages that occur in distressed situations (Never waste a crisis).

If it sounds too good to be true it probably is, even if it is your own truth. We can be so impassioned about our ERM program, that we don’t recognize that it might have flaws and that our approach might be harming our reputation. What is your team’s reputation? Are you seen as problem solvers who efficiently deliver value?  Or is your program overcomplicated and time consuming? I recommend that not only in the planning process, but that you regularly conduct a SWOT Analysis. Get the team together and some post-it-notes …

We will assess our organization, team and program — SWOT:

  • Strengths: characteristics of the business or project that give it an advantage over others.
  • Weaknesses: characteristics that place the business or project at a disadvantage relative to others
  • Opportunities: elements that the project could exploit to its advantage
  • Threats: elements in the environment that could cause trouble for the business or project
Grace in the Workplace VI SWOT chart 2nd FINAL

Out of this exercise you might come up with the following solutions:  Expand our ERM panel to include a representative that is leading Strategic Planning, or produce a one page executive report that highlights how ERM would have prevented or mitigated unwanted events, or integrate ERM into one or more of the more high-profile initiatives.

But, no matter what good work you do, if others don’t know about the value you are delivering, you will never win the war!

Our Good News Plan:

While you’re building your program, begin to publish even the smallest of “victories”.  It may be a positive result that your team has had outside of the ERM program – “we reduced the injuries in the foodservice group by 10 percent in the last year by conducting weekly meetings with line workers who led discussions on safety…”  Get one of the workers to give a testimonial.

The idea is to publish often, tell real stories about how lives are impacted, and build your teams’ reputation as problem solvers. Then as you progress with delivering your “good news” messages about your ERM Program you will already have people’s attention and respect.

Publish often and in many forms: website, small posters, handouts, internal publications, and external publications.

Key Takeaway: Develop tactics that consider the advantages and disadvantages of your organization, your team, and your ERM program.  Claim even the smallest victories and communicate them out often and through as many channels as possible.  Focus your team on positively impacting people and solving problems.

Remember — it’s not Risk Management, it’s Change Management!

* Sun Tzu was a Chinese military general, strategist and philosopher who lived in the Spring and Autumn Period of ancient China.
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Grace in the Workplace: How to gracefully bring together traditional risk management and change management techniques, and enterprise risk management conceptsRead more of Grace’s Sun Tzu series. 
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Risk Insider: Chris Mandel

Risk Management Effectiveness: What Matters Most

By: | November 5, 2014 • 3 min read
Chris Mandel is SVP, strategic solutions for Sedgwick. He is a long-term risk management leader and a former president of RIMS. He can be reached at chris.mandel@sedgwickcms.com.
Topics: ERM | Risk Insider

People are always trying to glean the keys to success in risk management. Well, here’s what I know: No two successful practitioners are doing exactly the same thing. Nor are they following a template based strategy. What you can take away from that is that a) there’s no one right way to practice risk management, and b) the best risk strategies are those that are aligned with, if not custom designed to fit, the needs and priorities of the organizations for which they are intended.

What matters most in achieving risk management success? For starters, a thoughtfully cultivated risk culture is prerequisite to long term success. Keep in mind that your employees’ risk taking and risk-managing behaviors — without a specific design and strategy for your intended risk culture — will not likely be the behaviors or culture you most need and ideally desire. Therefore, communicating your expected culture is a pursuit of great value to your long term risk management effectiveness.

Here are 10 other items that, in my opinion, matter most in effectively managing risk. If you operate with these elements in place, you will be more likely to have an effective strategy that other leaders will both contribute to and enable through resources.

Downside Protection Job 1: The first priority is to make sure reasonably preventable loss is addressed through both mitigation and financing tactics. Management and governance rightly assume this is under foot.

Influence and Gumption: Every senior risk leader must have the respect to be heard and the gumption to push back on risk owners and stakeholders with whom they may disagree.

Consistency: With risk process and sub-processes being the way in which the work gets executed, it is essential that their use be consistently applied by all users.

Process Rigor: Processes that produce results and have impact require a rigorous approach to how they are designed, measured for effectiveness and continuously improved.

Data Interpretability: Reporting actionable information is a must for showing results and impact.

Communication Clarity: Beginning with a clear definition of risk itself, an entire sub-strategy for communicating your messaging will ensure you reach the right recipients at the right time with the right message.

Reliable Measurability: Not every risk can or should be quantitatively measured but when you do, make sure it is as believable as possible.

Value Creation: Recognizing and leveraging risk for gain is the necessary evolution of the discipline’s practitioners if they ever hope to move beyond the tactical.

Managing to Appetite and Capacity: Risk cannot be effectively managed without a clear view into how much risk you are taking, want to take and have the capacity to take or assume.

Aligning Risk and Performance: The penultimate outcome for risk professionals is they manage risk relative to performance. Alignment, if not integration, between these disciplines is essential to achieving short and long term goals.

Sure, there are other tactical elements of a good risk strategy and framework, but I believe they will naturally flow out of these elements when put into practice with the proper senior level mandate and regular reinforcement of strategy.

Read all of Chris Mandel’s Risk Insider contributions.

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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

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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 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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