Risk Scenarios Live: Lessons in Managing Chronic Pain
When a patient is in pain and in fear of pain, physicians face a dilemma. How to manage that pain in the best way without creating a dependency on pain medications?
When an injured worker is already floundering in a haze of prescription medications and denial, how best to intervene in a way that respects the worker’s rights, preserves the bottom line and most importantly, keeps that person productive?
These and other questions were on the table in the fourth installment of the Risk Scenarios Live presentation at the Ernest N. Morial Convention Center in New Orleans on Wednesday.
“Forget the money. Focus on the outcome.” — Michael Paladino, director, insurance services and claims, VCU Health System
As they watched filmed enactments of fictitious workers’ compensation claim scenarios, a veteran panel of workers’ compensation professionals had plenty to share.
“Forget the money. Focus on the outcome,” said Michael Paladino, director, insurance services and claims, VCU Health System.
The award-winning risk manager went on to say that an organization pays for an injured worker whether it is on the group health side or under workers’ compensation.
So, focusing on where that payment is coming from is less important than bringing the worker back to health, he said.
“We do have to treat the patient as a whole,” said Jill Leonard, assistant vice president of claims operations, Louisiana Workers’ Compensation Corp.
In three vignettes, the panel examined a chronic pain case, a case where a worker was ingesting a wide range of pharmaceuticals, and a scenario where a worker with an injured back failed to understand or comply with his return to work options.
Too often, according Dr. Robert Goldberg, chief medical officer, Healthesystems, there is a rush to surgery or a failure to fully educate an injured worker on their treatment and recovery options.
Rehab Rx: Return to Work
“Injured workers are a rewarding group to take care of, but a challenging group,” said Robert Hall, corporate medical director, Helios.
He and Dr. Marcos Iglesias, vice president and medical director, The Hartford, outlined the barriers to returning injured workers to full functionality and how to overcome them at a Wednesday morning session at the National Workers’ Compensation and Disability Conference, titled “Medical Director’s Perspective: Restoring Function and Returning to Work.”
Comorbid conditions – both physical and psychosocial – present the greatest obstacle.
They not only set people up for injury but also delay recovery. If an injured worker has a physical condition like obesity, diabetes or older age, recovery time usually doubles, Iglesias said.
If that condition is coupled with a psychosocial factor like catastrophic thinking or perceived injustice, the recovery time quadruples. Add in a mental health issue like depression or anxiety, and that time increases by a factor of eight.
Psychosocial risk factors are increasingly gaining awareness from the workers’ comp provider and payer community.
“Self-predictions about return to work are often self-fulfilling prophecies,” Iglesias said. He said that claims managers can identify patients as high or low risk by asking them when they believe they can return to work.
“Any answer beyond 10 to 14 days means they are at high risk for delayed recovery,” he said.
The best way to manage comorbid conditions and speed up return to work is through open and frequent communication between patient, provider, payer and employer, Hall said.
Physicians should use simple language to address patients’ fears and provide reassurance, and payers should follow up with doctors to verify that their treatment plan follows evidence-based guidelines.
Non-pharmacological treatments like exercise and socialization should also pay a big role. As Hall said, “Opioids alone don’t bring about recovery.”
Because time away from work only increases the likelihood of developing depression and exacerbating existing comorbids, returning to work should also be considered part of the rehab process, Iglesias said, and not just the end goal.
Hot Hacks That Leave You Cold
Thousands of dollars lost at the blink of an eye, and systems shut down for weeks. It might sound like something out of a movie, but it’s becoming more and more of a reality thanks to modern hackers. As technology evolves and becomes more sophisticated, so do the occurrence of cyber breaches.
“The more we rely on technology, the more everything becomes interconnected,” said Jackie Lee, associate vice president, Cyber Liability at Nationwide. “We are in an age where our car is a giant computer, and we can turn on our air conditioners with our phones. Everyone holds data. It’s everywhere.”
Phishing Out Fraud
According to Lee, phishing is on the rise as one of the most common forms of cyber attacks. What used to be easy to identify as fraudulent has become harder to distinguish. Gone are the days of the emails from the Nigerian prince, which have been replaced with much more sophisticated—and tricky—techniques that could extort millions.
“A typical phishing email is much more legitimate and plausible,” Lee said. “It could be an email appearing to be from human resources at annual benefits enrollment or it could be a seemingly authentic message from the CFO asking to release an invoice.”
According to Lee, the root of phishing is behavior and analytics. “Hackers can pick out so much from a person’s behavior, whether it’s a key word in an engagement survey or certain times when they are logging onto VPN.”
On the flip side, behavior also helps determine the best course of action to prevent phishing.
“When we send an exercise email to test how associates respond to phishing, we monitor who has clicked the first round, then a second round,” she said. “We look at repeat offenders and also determine if there is one exercise that is more susceptible. Once we understand that, we can take the right steps to make sure employees are trained to be more aware and recognize a potentially fraudulent email.”
Lee stressed that phishing can affect employees at all levels.
“When the exercise is sent out, we find that 20 percent of the opens are from employees at the executive level,” she said. “It’s just as important they are taking the right steps to ensure they are practicing what they are preaching.”
Locking Down Ransomware
Another hot hacking ploy is ransomware, a type of property-related cyber attack that prevents or limits users from accessing their system unless a ransom is paid. The average ransom request for a business is around $10,000. According to the FBI, there were 2,400 ransomware complaints in 2015, resulting in total estimated losses of more than $24 million. These threats are expected to increase by 300% this year alone.
“These events are happening, and businesses aren’t reporting them,” Lee said.
In the last five years, government entities saw the largest amount of ransomware attacks. Lee added that another popular target is hospitals.
After a recent cyber attack, a hospital in Los Angeles was without its crucial computer programs until it paid the hackers $17,000 to restore its systems.
Lee said there is beginning to be more industry-wide awareness around ransomware, and many healthcare organizations are starting to buy cyber insurance and are taking steps to safeguard their electronic files.
“A hospital holds an enormous amount of data, but there is so much more at stake than just the computer systems,” Lee said. “All their medical systems are technology-based. To lose those would be catastrophic.”
And though not all situations are life-or-death, Lee does emphasize that any kind of property loss could be crippling. “On a granular scale, you look at everything from your car to your security system. All data storage points could be controlled and compromised at some point.”
The Future of Cyber Liability
According to Lee, the Cyber product, which is still in its infancy, is poised to affect every line of business. She foresees underwriting offering more expertise in crime and becoming more segmented into areas of engineering, property, and automotive to address ongoing growing concerns.”
“Cyber coverage will become more than a one-dimensional product,” she said. “I see a large gap in coverage. Consistency is evolving, and as technology evolves, we are beginning to touch other lines. It’s no longer about if a breach will happen. It’s when.”
About Nationwide’s Cyber Solutions
Nationwide’s cyber liability coverage includes a service-based solution that helps mitigate losses. Whether it’s loss prevention resources, breach response and remediation expertise, or an experienced claim team, Nationwide’s comprehensive package of services will complement and enhance an organization’s cyber risk profile.
Nationwide currently offers up to $15 million in limits for Network Security, Data Privacy, Technology E&O, and First Party Business Interruption.
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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 Nationwide. The editorial staff of Risk & Insurance had no role in its preparation.