In November 2018, Baylor St. Luke’s Medical Center in Houston made two medical errors, the second of which lead to the death of a 75-year-old patient. After an investigation by the Houston Chronicle and ProPublica, the Centers for Medicare and Medicaid Services issued a report in early 2019 that outlined a pattern of blood labeling errors at the hospital. A ProPublica article on the report states:
Dr. Ashish Jha, an expert in hospital quality, reviewed the government’s findings and said it appeared St. Luke’s was struggling to meet basic care standards. The labeling mistakes, he said, seemed indicative of ‘a broader systemic problem.’… St. Luke’s appeared to miss warning signs in the months prior to the deadly mistake, according to the government report.
The “broader systemic problem” Dr. Jha mentions is, unfortunately, not unique to St. Luke’s. Many hospitals and healthcare systems face organization-wide, process-related issues, especially in a modern healthcare landscape that’s rife with change. Mergers, multiple technology platforms, and changing healthcare policies, to name just a few, contribute to widespread miscommunication and a lack of transparency. This, in turn, jeopardizes the overall quality of care within these organizations.
Hospitals can stem the scope of these issues by implementing a healthcare enterprise risk management (ERM) program. Healthcare ERM establishes a standardized framework for identifying risk across an organization, encourages cross-departmental collaboration, and shifts hospitals from a reactive clinical risk program to a proactive holistic risk management program. A straightforward process, along with the right technology the leverages healthcare analytics, can help to make this shift effective.
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Organizations often miss a crucial step in their drive to acquire and implement technology as a means to remain competitive. The ability of commercial insurance brokers to leverage data and analytics to bring in new business, write policies, and provide added value to their clients is about more than selecting the best risk management information system (RMIS). To get the most out of the investment in technology and become a digital leader, a brokerage should first assess if essential foundational elements are present.
The next-level broker
A next-level brokerage is a firm that has undergone the process of digital transformation, a term that CIO contributor Mark Edmead defines in Digital Transformation: Why its important to your organization as “the acceleration of business activities, processes, competencies and models to fully leverage the changes and opportunities of digital technologies and their impact in a strategic and prioritized way.”
An anonymously attributed response to the Commercial Property/Casualty Market Index (Q4/2018) survey question, “What opportunities for commercial insurance brokers do you see?” can be also be read as a more specific description of the next-level broker. He or she is able to “maximize use of technologies and analytics to grow business and do so with reduced expenses.” Furthermore, the next-level broker has the “[i]ncreased ability to target growth in select industries via use of data and analytics.” Finally, he or she is able to “[i]dentify new ways via technology and through the use of data and analytics, to solicit, write, and service business.”
Analytics functionality is an essential component in the digital transformation into a next-level brokerage. However, the act of putting a RMIS in place (or modernizing an existing system) doesn’t mean that all expectations around analytics will automatically be met. The right mix of people and data must also be present.
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The healthcare industry has especially high stakes when it comes to risk management. The risks aren’t simply business- or reputation-related, though those are important. The most significant ones can be a matter of life or death. Patient safety is at the heart of every hospital’s risk management program and, because of this, a generic risk management information system (RMIS) may not be up to the challenge.
Hospitals and healthcare organizations may consider using a generic RMIS for a variety of reasons. Perhaps another part of the organization is already using one, so it seems simpler and cheaper to stick with the same system. Although using a single platform across an organization is typically a logical approach, given the healthcare industry’s uniquely critical needs, this approach may not cover the healthcare setting’s unique needs and thus can fail, adding more hassle, expense, time, and risk not only to your organization, but also to your patients.
In terms of both the software and the service team supporting that software, a dedicated healthcare risk management solution offers clear advantages over a generic RMIS. This gives healthcare organizations greater insight for staying on track and, ultimately, improving patient safety.
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In what is already a competitive landscape, 2018 saw a record number (626) of mergers and acquisitions among insurance brokers. According to Business Insurance reporting, more than half of these deals involved P&C brokers and agents.
At the same time, Earnst & Young’s US and Americas non-life insurance outlook 2019 points out that a “gradual shift toward direct sales can be seen in personal and small commercial lines.” While the report holds that the proliferation of D2C channels that reduce dependency on brokers is unlikely to have a significant impact on large commercial lines in the near future, the trend can and should be taken as a sign of things to come.
“One of the biggest keys to success in this environment is differentiating your agency from others that offer similar services,” writes Mike Lover in the PropertyCasualty 360° article Want to make your customer service truly stand out? Answer these questions.
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A 2016 analysis published in BMJ revealed that medical error is the third-leading cause of death in the United States. This includes process errors, planning errors, and failures to act. Martin Makary, a health policy expert at Johns Hopkins and an author of the analysis, explains that the “complex medical system” in the U.S. “sometimes lacks transparency that results in the wide variation in quality of medical care that is the endemic problem in safety.” Makary also notes that “safety nets are missing and standardization is lacking.”
At the heart of this standardization problem lies outdated technology and confusing systems. Many healthcare providers continue to use lagging systems that don’t efficiently collect or analyze data. Furthermore, a mix of legacy and new systems makes for potential conflicts that add to the confusion and fortify workplace silos. Without the sharing of information, organizations fail to see big-picture strategies and solutions that could help prevent medical errors and increase patient safety.
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Another Groundhog Day has come and gone. Or has it?
In the movie Groundhog Day, weatherman Phil Connors (played by Bill Murray) is forced to relive the same day, over and over again, no matter how he tries to change the outcome. The Environmental, Health and Safety Newsletter recently compared the latest release of the Census of Fatal Occupational Injuries with previous years and observed a similar phenomenon.
The article notes, “The latest census is remarkably consistent with the previous reports. People continue to die in numbers, proportions and circumstances much as they did the year before, and the year before that and the year before that. There are a lot of Groundhog Days in how we’re getting killed on the job.” Even worse is the fact that these factors are no secret. “The same hazards keep killing workers,” the article continues. “What’s most likely to kill someone is not a trick question. It’s an open-book exam.”
If something as critical as lowering workplace deaths can get trapped in an endless cycle of no progress, it shows just how immovable some of these challenges can be. Lack of desire or effort isn’t always to blame.
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One of the Claims Journal’s most popular articles of 2018 covered the Altus report that investigated the possibility of Amazon entering the claims management sector. The fact that Amazon tried to poach employees from Lemonade and recruit for a new product manager position certainly provided enough circumstantial evidence to fire up the rumor mill.
The report highlights some of the advantages Amazon brings to the table. The customer-facing infrastructure — from Alexa and Echo devices to an online juggernaut offering an expansive consumer marketplace and digital media center — is unlike anything currently in the insurance space. In addition, Amazon Home Services, which offers on-demand repairs and potential assistance with installing large replacement goods; its array of supported smart home devices; and its direct access to customer purchase history make the company poised to completely transform the claims management process.
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When it comes to the ability to manage risk and losses, risk managers often face the challenges that come with claims data that is spread across multiple systems and spreadsheets. At the same time, they’re being asked to do more with less. In a previous post, we looked at ways an integrated claims management solution—one that includes multiple integration and workflow automation options—can transform claims administration processes. But you don’t have to be a self-administered organization to benefit from claims management functionality in a RMIS. The following features are just a few examples how such a solution can help you consolidate all of your organization’s claims data in a single system, streamline workflow processes, and perform analysis that contributes to more informed decision making and improved claim outcomes. … read more
A recent article, “Transforming into an analytics-driven carrier“, examines best practices in what is a multi-stage journey that requires equal parts business and analytics leadership. The end goal is an organization where:
- Data-driven decision making is the standard
- Analytics is central to claims adjustment, underwriting, and pricing processes
- Analytics drive the entire business, functions are better integrated, and organizational silos no longer exist
The transformation is also dependent on having the right technology in place in order to begin to get buy-in and build momentum as a strategic vision for the organization is implemented. As a McKinsey Quarterly article puts it, companies must begin to build a foundation which enables change. “People have been talking about data-driven cultures for a long time, but what it takes to create one is changing as a result of the new tools available. Companies have a wider set of options to spur analytics engagement among critical employees.” For carriers still looking to move off of core legacy systems that struggle with modern requirements, even starting down the path to becoming an analytics-based insurer may seem out of reach. … read more
Ironically, cargo theft is often “driven” by where trucks are parked. Recent reports from CargoNet, a division of Verisk Analytics, and the Transported Asset Protection Association Europe, found a positive correlation between cargo theft from trucks and roadside parking.
In the third quarter of 2015, cargo thefts from vehicles parked along the side of a road in the United States and Canada increased 144 percent when compared to the same period a year prior. That increase is in spite of an overall decrease in cargo thefts between the third quarters of 2014 and 2015. … read more