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On-Demand Webinar

Webinar: Succeeding with an Unbundled Claims Management Approach

Learn how to succeed with an unbundled claims management approach.
By: | June 19, 2014 • 1 min read

Presenters

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Overview

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Webinar Sponsor

Unbundling workers’ compensation managed care services can make a lot of sense for some employers. But meeting the demands of a changing environment is a constant challenge whether you are — considering unbundling — have recently unbundled — or want to gauge the effectiveness of your unbundled program. Limited risk management resources, the complexities of data management and transparency, and increased medical costs are combining to push claims executives to improve their approach. Not doing so is to risk bad outcomes, not only for injured workers but for corporate bottom lines.

A diverse panel will offer employer, managed care, and claims executive perspectives on unbundled approaches, including:

  • Considerations when unbundling managed care services
  • An effective team approach, including the coordination of internal resources and the various vendors involved in unbundled claims management
  • Best practices in data management, including addressing the state reporting burden
  • Using performance measures to validate the effectiveness of an unbundled approach

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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On-Demand Webinar

Webinar: Foreign Acquisition Risks – Be Prepared

Learn about the best way to mitigate the risks of foreign acquisitions.
By: | May 7, 2014 • 1 min read

Presenters

Webinar_TNA

Overview

Our increasingly global economy has forced the majority of organizations to look beyond their domestic borders for growth opportunities. But building a presence in a foreign market from scratch can take years. International acquisitions are the most effective way to ramp up a presence quickly, tapping into an existing network of clients and suppliers in a new market.

Webinar Sponsor

Webinar Sponsor

Managing the risks of foreign acquisitions can be tricky business. Language barriers, cultural differences, local politics, technological incompatibilities and regulatory compliance issues can turn a lucrative deal into a disaster. The grim reality is that many mergers fail to deliver upon the goals they were intended to achieve.

Meticulous planning and preparation are the best way to mitigate the risks of foreign mergers and acquisitions. This webinar will focus on the challenges of entering new business climates and the communication strategies needed to help local stakeholders and newly acquired employees understand your corporate risk management philosophy.

In this webinar, sponsored by The National Alliance for Insurance Education & Research, expert panelists will discuss these topics and issues related to foreign acquisitions:

  • Assessing cross-border uncertainties. A discussion of techniques or protocols for evaluating cross-border risk, pricing it and possibly transferring it.
  • The use of captives. The use of captives in managing foreign acquisition risk is attracting growing attention from the risk management community. This discussion will address which cross-border risks are best housed in captives and how those captives should be managed.
  • Problem venues. This aspect of the webinar will look at which venues, though attractive from a business opportunity standpoint, require extra vigilance on the part of risk managers.
  • Local paper. Local paper is a requirement in some geographies but not in others. The panelists will discuss the use of local paper and other insurance issues that business executives operating in foreign countries need to be aware of.

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: Healthcare Solutions

Achieving More Fluid Case Management

Four tenured claims management professionals convene in a roundtable discussion.
By: | June 2, 2014 • 6 min read
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Risk management practitioners point to a number of factors that influence the outcome of workers’ compensation claims. But readily identifiable factors shouldn’t necessarily be managed in a box.

To identify and discuss the changing issues influencing workers’ compensation claim outcomes, Risk & Insurance®, in partnership with Duluth, Ga.-based Healthcare Solutions, convened an April roundtable discussion in Philadelphia.

The discussion, moderated by Dan Reynolds, editor-in-chief of Risk & Insurance®, featured participation from four tenured claims management professionals.

This roundtable was ruled by a pragmatic tone, characterized by declarations on solutions that are finding traction on many current workers’ compensation challenges.

The advantages of face-to-face case management visits with injured workers got some of the strongest support at the roundtable.

“What you can assess from somebody’s home environment, their motivation, their attitude, their desire to get well or not get well is easy to do when you are looking at somebody and sitting in their home,” participant Barb Ritz said, a workers’ compensation manager in the office of risk services at the Temple University Health System in Philadelphia.

Telephonic case management gradually replaced face-to-face visits in many organizations, but participants said the pendulum has swung back and face-to-face visits are again more widely valued.

In person visits are beneficial not only in assessing the claimant’s condition and attitude, but also in providing an objective ear to annotate the dialogue between doctors and patients.

RiskAllStars
“Oftentimes, injured workers who go to physician appointments only retain about 20 percent of what the doctor is telling them,” said Jean Chambers, a Lakeland, Fla.-based vice president of clinical services for Bunch CareSolutions. “When you have a nurse accompanying the claimant, the nurse can help educate the injured worker following the appointment and also provide an objective update to the employer on the injured worker’s condition related to the claim.”

“The relationship that the nurse develops with the claimant is very important,” added Christine Curtis, a manager of medical services in the workers’ compensation division of New Cumberland, Pa.-based School Claims Services.

“It’s also great for fraud detection. During a visit the nurse can see symptoms that don’t necessarily match actions, and oftentimes claimants will tell nurses things they shouldn’t if they want their claim to be accepted,” Curtis said.

For these reasons and others, Curtis said that she uses onsite nursing.

Roundtable participant Susan LaBar, a Yardley, Pa.-based risk manager for transportation company Coach USA, said when she first started her job there, she insisted that nurses be placed on all lost-time cases. But that didn’t happen until she convinced management that it would work.

“We did it and the indemnity dollars went down and it more than paid for the nurses,” she said. “That became our model. You have to prove that it works and that takes time, but it does come out at the end of the day,” she said.

RiskAllStars

The ultimate outcome

Reducing costs is reason enough for implementing nurse case management, but many say safe return-to-work is the ultimate measure of a good outcome. An aging, heavier worker population plagued by diabetes, hypertension, and orthopedic problems and, in many cases, painkiller abuse is changing the very definition of safe return-to-work.

Roundtable members were unanimous in their belief that offering even the most undemanding forms of modified duty is preferable to having workers at home for extended periods of time.

“Return-to-work is the only way to control the workers’ comp cost. It’s the only way,” said Coach USA’s Susan LaBar.

Unhealthy households, family cultures in which workers’ compensation fraud can be a way of life and physical and mental atrophy are just some of the pitfalls that modified duty and return-to-work in general can help stave off.

“I take employees back in any capacity. So long as they can stand or sit or do something,” Ritz said. “The longer you’re sitting at home, the longer you’re disconnected. The next thing you know you’re isolated and angry with your employer.”

RiskAllStars
“Return-to-work is the only way to control the workers’ comp cost. It’s the only way,” said Coach USA’s Susan LaBar.

Whose story is it?

Managing return-to-work and nurse supervision of workers’ compensation cases also play important roles in controlling communication around the case. Return-to-work and modified duty can more quickly break that negative communication chain, roundtable participants said.

There was some disagreement among participants in the area of fraud. Some felt that workers’ compensation fraud is not as prevalent as commonly believed.

On the other hand, Coach USA’s Susan LaBar said that many cases start out with a legitimate injury but become fraudulent through extension.

“I’m talking about a process where claimants drag out the claim, treatment continues and they never come back to work,” she said.

 

Social media, as in all aspects of insurance fraud, is also playing an important role. Roundtable participants said Facebook is the first place they visit when they get a claim. Unbridled posts of personal information have become a rich library for case managers looking for indications of fraud.

“What you can assess from somebody’s home environment, their motivation, their attitude, their desire to get well or not get well is easy to do when you are looking at somebody and sitting in their home,” said participant Barb Ritz.

As daunting as co-morbidities have become, roundtable participants said that data has become a useful tool. Information about tobacco use, weight, diabetes and other complicating factors is now being used by physicians and managed care vendors to educate patients and better manage treatment.

“Education is important after an injury occurs,” said Rich Leonardo, chief sales officer for Healthcare Solutions, who also sat in on the roundtable. “The nurse is not always delivering news the patient wants to hear, so providing education on how the process is going to work is helpful.”

“We’re trying to get people to ‘Know your number’, such as to know what your blood pressure and glucose levels are,” said SCS’s Christine Curtis. “If you have somebody who’s diabetic, hypertensive and overweight, that nurse can talk directly to the injured worker and say, ‘Look, I know this is a sensitive issue, but we want you to get better and we’ll work with you because improving your overall health is important to helping you recover.”

The costs of co-morbidities are pushing case managers to be more frank in patient dialogue. Information about smoking cessation programs and weight loss approaches is now more freely offered.

Managing constant change

Anyone responsible for workers’ compensation knows that medical costs have been rising for years. But medical cost is not the only factor in the case management equation that is in motion.

The pendulum swing between technology and the human touch in treating injured workers is ever in flux. Even within a single program, the decision on when it is best to apply nurse case management varies.

RiskAllStars
“It used to be that every claim went to a nurse and now the industry is more selective,” said Bunch CareSolutions’ Jean Chambers. “However, you have to be careful because sometimes it’s the ones that seem to be a simple injury that can end up being a million dollar claim.”

“Predictive analytics can be used to help organizations flag claims for case management, but the human element will never be replaced,” Leonardo concluded.

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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