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Upcoming Webinar

Webinar – Travel Risk Management: Going Beyond Travel Assistance and Insurance

On Dec. 9, learn how to create a travel risk management program that can give employers and employees peace of mind.
By: | November 14, 2014 • 2 min read

Presenters

Webinar_EA

Overview

Webinar Sponsor

Webinar Sponsor

Business travel has never been more global or more compromised by volatility. The search for new markets, suppliers and energy sources is leading employers and their employees into new geographies and political environments, some of them fraught with risk. 

This webinar will look at travel accident insurance and travel assistance programs and how best to marry the two products into a travel risk management program that can give employers and employees better peace of mind. 

Expert panelists will discuss the following: 

  • The concept of “Duty of Care”, its limitations and the exposures it can create.
  • The different insurance coverages that converge in the travel risk space, where they converge and where they might leave gaps.
  • A history of travel accident insurance.
  • Organizational challenges: Melding the roles of human resources and risk management so that they work in concert in managing travel risk.
  • Employer/employee: Who bears which responsibilities in insuring safe outcomes.
  • Loss scenarios and claims examples: Stories from the road of real losses and real claims.

Webinar attendees will be e-mailed a link to the recording of the webinar and its supporting visual materials. 

Space is limited, so register today!

Webinar Date: December 9, 2014 1:00 – 2:00pm EST

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Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at dreynolds@lrp.com.
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On-Demand Webinar

Webinar – True Partners: Accessing Actionable Data in WC Through More Transparent, Collaborative Vendor Relationships

Learn how good, collaborative vendor relationships can help you access meaningful data and improve claims outcomes.
By: | November 13, 2014 • 1 min read

Presenters

Webinar_Acrometis

Overview

Webinar Sponsor

Everyone agrees that gaining access to meaningful, actionable data in a timely manner is one of the keys to balancing return on investment and achieving great workers’ compensation claims outcomes. But getting to that goal is easier said than done. 

Time and again, we hear stories about the frustrations claims executives experience in getting the data that they want, when they want it: Whether that be from carriers, pharmacy benefit managers, or medical service providers. 

In this November, 2014 webinar, Patty Hostine, a 2014 Risk All Star and Responsibility Leader® and the US Director of Disability Management with Flex N Gate, will discuss her approach to creating effective relationships with vendors that stress the importance of timely data transparency. 

Patty will be joined by Jerry Poole, the president and CEO of Acrometis, a claims processing software provider that uses technology to break down the barriers to the safe, effective transmission of actionable claims data. 

Hostine and Poole will discuss: 

  • What types of data are critical to risk managers in reducing their cost of risk and how to overcome the challenges in obtaining the data, especially when it resides with partners.
  • Using data from multiple sources to create a meaningful risk picture.
  • The responsibilities of all involved in the gathering and sharing of critical data, including the employer. This includes effective communication with payers on what data is important to your program and creating expectations on when and how you want that data delivered.
  • Defining and branding your program and its goals so that a productive environment is created for all participants while a high level of partner accountability is achieved.
  • Understanding the benefits to everyone, including vendors, when they cooperate and provide data that risk managers are looking for.
  • How to work with data to make lasting changes to your cost of risk, including what key data risk managers should be using but probably aren’t.

Recording

Download a copy of the slide presentation here.

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

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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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