Tag: Best Practices

The many layers of risk management in healthcare

Risk management in healthcare consists of many layers

Risk management in healthcare has especially high stakes. In addition to risks related to operations, finances, and reputation, healthcare organizations must consider those that can be a matter of life or death. Hospitals and health systems work tirelessly to ensure the health and safety of their patients. The right healthcare risk management software will help them achieve that goal.

No matter what an organization hopes to improve—from claims management to incident reporting to clinical rounding—an integrated healthcare risk management information system (RMIS) offers the right solutions for improving patient well-being and finding organization-wide success. Read more about the many aspects of risk management in healthcare.

  • Patient Safety & Quality
  • Claims & Insurance
  • Healthcare Enterprise Risk Management (ERM)

Patient Safety & Quality

Medical error is the third-leading cause of death in the United States. This includes process errors, planning errors, and failures to act. With the right reporting and workflow tools, integrated healthcare risk management software eliminates human error and allows clinicians to work in lockstep to provide better patient care.

Incident Reporting

To effectively address adverse events and near misses, hospital risk managers need an informed understanding of what constitutes such incidents. This starts with having the technology to efficiently report them. Integrated data tools—such as data surveillance, patient safety event reporting, and enterprise-wide near miss/unsafe condition reporting—that contain simplified forms with clear instructions make data collection efficient and straightforward.

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TPAs and automation, part 1: Humanizing customer service

Automation is great, except when it isn’t. Examples of the dark side include endless button pressing in automated phone trees that often conclude by yelling the word “operator” into the phone, and receiving form letters or emails containing incorrect, basic information. It’s no wonder the Aspect Customer Experience Index states that “nearly a third of consumers would rather clean a toilet than talk to customer service.”

Yet automation, when done well, remains a central tactic TPAs can deploy to gain competitive advantages in efficiency, accuracy, and resource allocation. When mismanaged, however, it can lead to impersonal service and damaged client relationships. The key to successful automation is to take advantage of technology’s benefits without losing the “human-centric” element. Kristin Smaby explores this concept in Being human is good business.

“In an era when companies see online support as a way to shield themselves from ‘costly’ interactions with their customers, it’s time to consider an entirely different approach: building human-centric customer service through great people and clever technology. So, get to know your customers. Humanize them. Humanize yourself. It’s worth it.”

In this three-part series we’ll examine how strategically balancing the human/automation mix can deliver a competitive advantage through:

  1. Improving customer service
  2. Enhancing employee retention/recruitment
  3. Boosting performance KPIs

Addressing these three initiatives from a human-centric perspective allows your organization to meet the personalized service expectations your clients demand, while gaining the productivity boosts smart automation delivers.

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How NMC aced a smooth, simplified, and organized RMIS switch

Deciding to implement a RMIS system or make a RMIS switch comes with a range of emotions. There’s the excitement of knowing something better is on the horizon. There’s the nervous energy that comes with major change. There may even be dread over the daunting task ahead. After all, you know your current RMIS—warts and all—and a new one takes some time to get used to. But the payoff from getting a new system that’s adaptable to your organization’s specific needs can’t be overstated.

Don’t let the fear of implementation stop you from making a change that will reap benefits for years to come. With a straightforward plan in place that plays to your organization’s strengths, you can slay the implementation dragon—and even enjoy yourself along the way. Such was the case for non-profit professional association New Mexico Counties (NMC), which teamed up with Origami Risk to complete a highly successful implementation.

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Bring personalization to the claims process through automation

A Risk & Insurance article recently stated that the souls of employees everywhere are saying, “Treat me like a human.” This applies to your claimants, as well. You’ve likely already considered many of the ways you can provide them better service, but you may have yet to tap into one of the keys to humanizing the claims process: automation.

The word is everywhere, as pervasive as the technology it’s infiltrating. Automation can bring to mind processes that are cold, robotic, and removed. So, considering software with automation functionalities may raise some hesitations. Will automation put distance between us and our clients? Will processes become mechanical and impersonal? How will this affect our service reputation and brand?

As the article Automation and AI: Miracle Tool or Hostile Takeover points out, automation “is neither the one answer nor a dangerous technology to be shunned. It’s another tool available to your organization, and every tool must be used effectively and for the right problem.”

Automation, when done properly, can bring more heart and soul into the work you do. Many manual processes consist of time-sucking drudgery. They leave you vulnerable to error and service headaches. They can become ingrained within your organization, forcing you to treat every claim or client the exact same way, despite variables, because deviating requires even more work. By using automation strategically, you’ll be able to deliver service to your claimants that’s more personal than ever. With a risk management information system (RMIS) that includes built-in automation, you can make humanizing the claims process a reality.

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The value of branding your claims process

Whether you’re an organization whose business is handling claims for others or one that administers its own claims, claimants are your customers. Viewing claimants through this lens will help focus your efforts on strengthening relationships and delivering better support. You also have the opportunity to go a step further and establish your reputation as truly customer-first. How? Through a straightforward branding exercise.

Before dismissing branding as something far removed from the claims world and better left to marketing and advertising executives, consider that every customer interaction further establishes an organization’s brand. Your reputation for customer service — however good or bad — is out there. You can continue with the status quo, or you can take control and push the narrative.

“Think about it,” says the Insurance Thought Leadership article 3.5 Ways to Deliver Happiness in Claims. “The claimant is going through your process during a time of grief, hardship and huge loss. Your process should not add to the stress. Your process should be easy. It should work to deliver a little happiness for them during this time. You want your beneficiaries to tell stories to their friends, family or other loved ones about how seamless your process was.”

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Using RMIS technology as a service differentiator

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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In a RMIS, the details matter

When choosing a risk management information system (RMIS) or making a RMIS switch, the process of assessing systems sometimes feels like comparing apples to apples. As important as the big functionalities are, organizations would do well to look at the more granular details—details that, however simple they may seem, address their organization’s very specific needs, while also saving time and preventing mental fatigue.

As a Risk Management Monitor article says, “An effective relationship starts with knowing the specific requirements of your enterprise and setting relevant priorities” and then checking how closely your RMIS provider can match them.

Why the little things matter

The workforce today puts in longer hours, more days a week than ever before. But employees aren’t spending all of that time tackling more projects and setting more goals, as one might expect. The 2018 survey Companies Are Overlooking a Primary Area for Growth and Efficiency: Their Managers found that 36% of company managers spend 3 to 4 hours per day on administrative tasks. An employee who spends an hour manually entering data or emailing colleagues about upcoming tasks is using time that could be better spent on more valuable activities like interacting with clients and improving product offerings.

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Make automation matter

It’s not exactly a secret: Regardless of size or industry, every organization stands to benefit from using automation technology to cut down on repetitive, time-consuming administrative tasks. More than simply speeding up a process or getting people to work faster, automating administrative tasks yields value by freeing up employees to focus on the aspects of their job that really matter and provide value.

Automation is wonderful. Except when it isn’t.

As covered in Behind the Hype of Robotic Process Automation (RPA), businesses can run into issues by rushing to reduce costs and improve productivity through automating processes without first evaluating their effectiveness and necessity. The benefits of automating repeatable, administrative tasks can also be lost if automation technology is too difficult to use. The result? Time that could be used performing more high-value activities winds up spent managing software.

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How risk pools can eliminate underwriting inefficiencies and errors

Eliminating underwriting errors for risk pools

As risk pools look to improve or add to the services provided to members, inefficient and ineffective processes always stand in the way. In many cases, inadequate technology (in the form of antiquated databases, disparate systems, and multiple spreadsheets) limits the ability of risk pools to implement change. Take, for example, the challenges associated with processes related to the calculation of members’ premium contributions, such as:

  • Values and exposures collection is time-consuming for staff and members
  • Historical and current loss data is not readily accessible
  • Spreadsheets used to calculate premium contributions increase the risk of error and limit options for easily incorporating changes
  • Visibility into the process is extremely limited for pool staff and members

The right technology can help. It should be capable of tracking and managing the exposures and loss data for all of a risk pool’s members. It should include underwriting tools flexible enough to accommodate changes in rating tables and formulas, while also being easy to use. The right solution should also provide staff and members with role-specific insight into each point in the process.

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Streamlining risk pool operations

As shared-risk pools strive to provide better service and increase the value for their members, the importance of streamlining insurance operations is critical. Not only do pools need to provide the level of services that members demand, but they need to do it in a sustainable way that allows staff resources to maximize the time they spend providing high-value services. As Forrester Research recently published, today’s organizations must apply “digital thinking across everything you do — how you win, serve, and retain customers”.

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