What Lies Ahead for Healthcare Solutions
Change is afoot for Healthcare Solutions, the parent company of Cypress Care, Procura Management, ScripNet and Modern Medical. The company’s acquisition by Catamaran closed on April 8. Catamaran, in turn, will be purchased by UnitedHealth, according to a late March announcement. Risk & Insurance® discussed the implications of the Catamaran acquisition with Joe Boures, CEO of Healthcare Solutions.
Healthcare Solutions made a major announcement recently, how do you expect this change to impact your clients?
The acquisition will have a positive long-term impact on our clients but our primary focus right now is making sure that we continue to service our customers with the same discipline and focus as we do today. Our client service model is staying the same so clients should not feel a disruption in service upon close of the acquisition.
Some acquisitions result in the need to re-implement a program as changes occur to the company’s technology platform. In our case, since Healthcare Solutions’ technology platform is already integrated with Catamaran, there is not a need to re-integrate with our customers as a result of the acquisition. This will allow us to stay focused on current initiatives to make our delivery of medical management services as impactful as possible.
How do you see this change playing out for the future of the company?
Without a doubt, the acquisition will have a positive impact on the future of the company. It provides Healthcare Solutions a stable ownership structure in a rapidly consolidating marketplace, along with access to the resources of a $20 billion company.
Catamaran has a long history in the workers’ compensation space and this is an area of investment for the company. Customers will benefit from the combined organization.
Do you expect your role to remain the same?
Yes, I’ll move over as a senior leader of the workers’ compensation business, with similar functions as I have today.
The last few years saw a lot of consolidation in the workers’ comp industry. Do you think we can expect to see more consolidation going forward and why?
Short answer, yes. The primary reason is that there are still a lot of private equity-owned companies with needed exit strategies. There’s also competitive pressures that will ultimately lead to a consolidated marketplace.
You talk to a lot of customers. What are the key challenges your customers tell you they are facing?
Customers continue to be challenged by medical cost inflation coupled with appropriate utilization controls. Healthcare Solutions’ customers are responsible for coordinating appropriate care for injured workers. They are concerned about injured worker safety and outcomes while also being mindful of spend.
If you just look at pharmacy as a microcosm of medical management, customers are concerned about the increase in compound drugs and physician dispensed drugs, as well as the potential over-prescribing of narcotic opioids. These issues alone are concerning to our customers from both a cost and safety point of view.
At the end of the day, customers are looking for how to do more with less. As businesses operate in leaner environments, they are looking for partners and technology solutions they can leverage to have the greatest impact on their programs.
You’ve been in this space for more than 20 years. What is the most significant advancement you’ve seen?
Technology as an enabler to create seamless business processing, which allows many of our products to truly become programs within our customer base. Though we’ve come a long way, there are more efficiencies to be gained. Both claimant-centric and process-centric technology solutions will continue to evolve and add value for customers.
How has your training as an accountant benefited you as a workers’ compensation executive?
The workers’ compensation industry has and will continue to focus on bottom line results. Having an accounting background allows me to deeply understand relationships around how to drive outcomes-based programs in ways others without that experience are at a disadvantage.
But while an accounting background allows one to understand the language of business, there’s so much more to being an effective workers’ compensation executive. Financial spreadsheets don’t allow you to hear the voice of the customer. I believe that you have to spend a lot of time meeting with and listening to customers. Our business is a people business and top leaders need to have both financial discipline and as well as connectivity with their customers.
We know you’re from Philadelphia Joe, so tell us…where do you get the best cheesesteaks?
Without a doubt, Joe’s Steaks + Soda Shop on Torresdale Avenue. Although this isn’t really a fair question, given that my brother-in-law owns the restaurant.
You don’t have to rely on my opinion though, Joe’s Steaks + Soda Shop is consistently acknowledged as one of Philly’s best cheesesteaks by locals.
Early Case Management Speeds RTW, Report Says
Workers’ comp payers need to develop their own tipping points when seemingly routine claims escalate to high-cost levels. That’s among the strategies suggested in a new white paper.
Genex, a managed care firm, analyzed 46,000 claims over 12 months to identify characteristics that may signal a rapid escalation into excessive costs. While admitting there is no magic formula, the company says there are indications that a claim may be one of the estimated 5 percent that will turn into long-term, chronic cases that may cost millions of dollars. Among them are:
- Poor initial physician diagnosis
- Doctor hopping (e.g., three or more specialty physicians)
- Lack of modified work duty options
- Poor employee/employer relationships
- Psycho-social factors, including poor family support
- Preexisting conditions
- Alcohol or drug dependence
“One of the most important steps employers and carriers can take is to analyze claims and to engage telephonic case management for even routine injuries when two or more red flags are identified,” said Pat Chavanu, senior vice president at Genex. “As an industry we have to move away from setting arbitrary dollar figures for when to bring in case management; we need to utilize it earlier when it can make a difference in terms of costs, outcomes and the well-being of the worker.”
According to the analysis, delaying case management for a year can decrease the likelihood of the injured worker returning to work by nearly 20 percent. Claims that use case management in the first nine months are two times more likely to have a successful RTW as those referred three years after the incident.
“This does not mean, however, using case management for all claims,” the paper said. “Benchmarks, data, organizational culture and goals must be defined and incorporated into employer tipping point criteria.”
The company advises payers to hold case management programs accountable. “Look at their costs, how quickly they return employees to work, and whether they help to reduce litigation,” the paper said. “Does the organization also tell you when case management is not necessary? Ask claimants about their experience. Is it positive, negative?”
Payers should develop criteria based on the organization’s RTW goals, the paper advised. Also, they should make sure injured workers have access to a network of savvy workers’ comp providers, and give adjusters tools and resources to identify red flag claim characteristics.
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.