Page 21 - April 2017 Newspaper

Insurance... Insurance... Insurance... Insurance... Insurance...

A New Risk Transfer Model Designed for High Risk Procedures

As a former health care ing medicine to collaborate cost, while protecting our client’s balance A former client for example, did a phe-
underwriter, I’ve spent a with the client and provide sheet from the financial loss. nomenal job in this area. By using data
lot of time assessing vari- Peer-to-Peer review, recom- Best practices associated with high risk intelligently, they have recalibrated their
ous root causes of poor mendations, and an audit procedures entire care package for hip replacements
clinical outcomes in many to assure compliance in key Here are some of the best practices that and knee surgeries,. Their approach was
high risk procedures, such clinical areas. we have identified as the common denom- very straightforward: identify all stake-
as OB, ED and Surgery. It 2. Participation by one of inators for successful health systems holders and, all touch points associated
is still one of the most a select few, but well across the country: with each procedure; review the cost asso-
critical aspects of under- known, insurance carriers • Create an oversight Committee to ciated with all aspect of the care, including
writing, as these proce- to help subsidize the cost of review progress on quality measures medical equipment, vendors etc., identify
dures drive the majority the program in full or in • Implement electronic monitoring of and eliminate inefficiencies, leverage spe-
of large verdicts and settle- part, depending on cost the Intensive care unit cific contracts to reduce cost further on
ments in the industry. and level of engagement. • Provide a vibrant Simulation lab train- vendors. At each trial, costs came down
Insurance carriers have BY WESLY GUITEAU, 3. Use of knowledge ing program, for proactive training on key and outcomes were equal or better. The
put a lot of effort into iden- EXECUTIVE ASSOCIATE, gained from these clinical clinical staff deficiencies program has been so successful that they
tifying best practices asso- engagements to help design • Use computerized physician order have since adopted it for other specialties.
ciated with these high risk RISK STRATEGIES and craft risk transfer pro- entry (CPOE), which can significantly High risk procedures don’t have to mean
areas for underwriting pur- COMPANY grams, with built-in mech- reduce medication errors high insurance costs. With the right
poses. In fact, a small group anism that specifically rec- • Adopt proven strategies in combating approach, you can lower risks and premi-
of well-known insurance carriers have ognizes the client’s improvement over hospital acquired conditions such as venti- um costs, while actually improving care.
even created specific underwriting criteria time, in the form of premium rebates or lator associated pneumonia, urinary tract
to recognize the best performers, while upfront credits. infection, central line associated blood Please contact your
working with others to help them improve The services in this approach would be stream infection and pressure ulcers. local expert: Christina
their clinical outcomes. offered on a risk-specific basis or as part of There is also a growing commitment to Stabile, Healthcare Sales
A good broker will do the same for their an enterprise risk platform. The latter is upgraded analytical capabilities for mining Executive, Kahn-Carlin, A
clients, helping them get ahead of issues becoming more and more palatable to larg- key data to identify high cost procedures Risk Strategies Company,
by marrying together various industry er providers, as they enter into risk based and at risk patient populations. This capa- at cstabile@
resources. A solid three-pronged approach contracts, for example. The downside risk bility helps ensure resources are effectively kahn-carlin.com or
to this would involve: associated with risk based contracts can be applied to reduce errors and improve clin- (305) 648-7500
1. Partnering with a team of well-known incorporated into the integrated risk plat- ical outcomes while reducing the cost of or visit www.
clinicians with proven expertise in practic- form, which helps to absorb the excess care. risk-strategies.com.

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South Florida Hospital News southfloridahospitalnews.com April 2017 21