Column: Workers' Comp

Telemedicine’s Urgent Questions

By: | April 7, 2017 • 2 min read
Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

The often-quoted, “If you build it, they will come,” from the movie “Field of Dreams” isn’t always a guiding principle in workers’ comp product offerings. Emerging products more often follow the marketing principle, “Get buyers to come and pay for it and then we’ll build it.”

It’s not always true. Some vendors carefully develop products before taking them to market. But frequently enough, they’re offered before sellers are ready to meet their big-picture promises.
We’ve seen these scenarios unfold with workers’ comp offerings like predictive modeling and high-performance doctor networks.

On the positive side, the practice spurs innovation. Larger, well-funded employers become early adopters, pushing vendors to improve their offerings. Vendors, meanwhile, gain vital customer feedback on performance.

Are products really capable of something new, or just streamlining existing capabilities, perhaps with a new label?

But the practice puts pressure on purchasers to study what they’re paying for. Is a product really built on a state-of-the-art platform or is it a reworked older system? Are products really capable of something new, or just streamlining existing capabilities, perhaps with a new label?

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The growing application of technology means purchasers will need to ask those questions more frequently and spend more time learning. Telemedicine offers an example.

The big-picture promises of telemedicine in workers’ comp — that it will save money, reduce injured worker time away from the job, and improve access to medical care — are still largely somewhere out in the future, although occurring in small doses.

Lessons health care insurers learn about telemedicine will eventually migrate to workers’ comp. But right now, workers’ comp hasn’t even settled on what telemedicine is. Are existing nurse-triage systems using video technology really “telemedicine?”

Nurse-triage services have great value. But shouldn’t telemedicine be something more than a post-injury assessment of whether a worker needs first aid or an emergency room visit?

A more robust definition would encompass using video technology for post-surgical doctor visits, obtaining second opinions on surgery procedures and providing ongoing treatment.

In workers’ comp, those services are still challenging to provide on a broad, multi-state basis. Jurisdictional regulatory hurdles remain. It is also difficult for payers to offer telemedicine options when doctor networks are not prepared to deliver. Conversely, it’s challenging for doctor networks to promise care delivery when they don’t know how much telemedicine demand they might experience.

Despite the challenges, there are reasons for optimism that telemedicine will become available to more injured workers.

But with much of that promise still more buzz than proven capability, product buyers have a lot of questions they will need to ask and have answered. &

More from Risk & Insurance

More from Risk & Insurance

2017 RIMS

Cyber Threat Will Get More Difficult

Companies should focus on response, resiliency and recovery when it comes to cyber risks.
By: | April 19, 2017 • 2 min read
Topics: Cyber Risks | RIMS

“The sky is not falling” when it comes to cyber security, but the threat is a growing challenge for companies.

“I am not a cyber apocalyptic kind of guy,” said Gen. Michael Hayden, former head of the Central Intelligence Agency and National Security Agency, who currently is a principal at the Chertoff Group, a security consultancy.

Gen. Michael Hayden, former head of the CIA and NSA, and principal, The Chertoff Group

“There are lots of things to worry about in the cyber domain and you don’t have to be apocalyptic to be concerned,” said Hayden prior to his presentation at a Global Risk Forum sponsored by Lockton on Sunday afternoon on the geopolitical threats facing the United States.

“We have only begun to consider the threat as it currently exists in the cyber domain.”

Hayden said cyber risk is equal to the threat times your vulnerability to the threat, times the consequences of a successful attack.

At present, companies are focusing on the vulnerability aspect, and responding by building “high walls and deep moats” to keep attackers out, he said. If you do that successfully, it will prevent 80 percent of the attackers.

“It’s all about making yourself a tougher target than the next like target,” he said.

But that still leaves 20 percent vulnerability, so companies need to focus on the consequences: It’s about response, resiliency and recovery, he said.

The range of attackers is vast, including nations that have used cyber attacks to disrupt Sony (the North Koreans angry about a movie), the Sands Casino (Iranians angry about the owner’s comments about their country), and U.S. banks (Iranians seeking to disrupt iconic U.S. institutions after the Stuxnet attack on their nuclear program), he said.

“You don’t have to offend anybody to be a target,” he said. “It may be enough to be iconic.”

The world order that has existed for the past 75 years “is melting away” and the world is less stable.

And no matter how much private companies do, it may not be enough.

“The big questions in cyber now are law and policy,” Hayden said. “We have not yet decided as a people what we want or will allow our government to do to keep us safe in the cyber domain.”

The U.S. government defends the country’s land, sea and air, but when it comes to cyber, defenses have been mostly left to private enterprises, he said.

“I don’t know that we have quite decided the balance between the government’s role and the private sector’s role,” he said.

As for the government’s role in the geopolitical challenges facing it, Hayden said he has seen times that were more dangerous, but never more complicated.

The world order that has existed for the past 75 years “is melting away” and the world is less stable, he said.

Nations such as North Korea, Iran, Russia and Pakistan are “ambitious, brittle and nuclear.” The Islamic world is in a clash between secular and religious governance, and China, which he said is “competitive and occasionally confrontational” is facing its own demographic and economic challenges.

“It’s going to be a tough century,” Hayden said.

Anne Freedman is managing editor of Risk & Insurance. She can be reached at [email protected]