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U.S. Healthcare: New Frontiers

Faith Logsdon believes that changes in U.S. healthcare provision offer significant opportunities.
By: | December 5, 2017 • 4 min read

The Affordable Care Act (ACA) was enacted in 2010 with many of the measures implemented in 2013 against a background of declining supply of primary care physicians coupled with an increasing demand for services that they provide. The Act proved to be a catalyst in the changing medical landscape and a couple of key trends have emerged regarding healthcare delivery in the United States.

Non Physicians

In 2013, more than 20 states passed regulation to allow non-physicians to open independent offices and disburse medical care and prescriptions. State regulation has enabled professionals, including certified nurse practitioners and physician assistants, to open independent practices to provide health services including monitoring of diabetes, blood pressure, and cholesterol, in addition to administering testing, bloodwork and vaccines. In these cases, the medical professionals are no longer required to collaborate with a licensed medical doctor to administer defined types of medical care.

Nurse Practitioners (NP), specifically, are gaining recognition and the ability to practice independently by setting up their own practices. Currently, 22 states and the District of Columbia have approved full practice status for NPs allowing them to assess, diagnose, interpret diagnostic tests and prescribe medications independently.1 Several states have also empowered NPs to sign death certificates and formal health records and prescribe certain medications.

The dismantling of practice barriers has received encouragement from other Government departments. For example, in 2016, The Department of Veterans Affairs (VA) announced the amendment of provider regulations with a relaxation of full practice authority limitations for VA advanced practice registered nurses.

Outpatients

Another trend has been a rapid increase in outpatient medical services formerly consigned to in-patient/hospital settings including urgent care facilities that offer quick, more cost-effective, local medical services for urgent care needs. This growth has been encouraged by the rollout of ACA and advances in preventative treatment, resulting in shorter recovery times and reduced complications in addition to advanced technology and cost containment. The rising cost of inpatient care has also led to the expansion of outpatient care. Complex procedures and surgeries are now possible in outpatient facilities due to new medical technologies and anesthesia and pain control techniques that reduce complications and allow patients to return home more quickly. For many, outpatient surgery has proven to be safe and effective, achieving similar or better outcomes than inpatient procedures while allowing patients to spend less time in a medical facility and recover more quickly.

It is estimated that about two-thirds of all surgeries are now performed on an outpatient basis.2 Healthcare providers have been setting up free-standing emergency departments as well as partnering with supermarkets and drugstores to offer urgent care.

New Frontiers

Faith-Logsdon, Senior Vice President, Medical Professional Liability, Aspen U.S. Insurance

The new frontiers of outpatient care, created by the growth of non-physicians independent practices, bring new challenges to the insurer. Policies that combine the appropriate mix of professional liability, general liability and privacy and network security (cyber liability) have become increasingly relevant.

A multi-disciplinary approach will ensure the client gets the relevant comprehensive coverage needed for the exposure. It is imperative that the underwriter is aware of existing and changing legislation that varies from state to state as this sets the rules of engagement. The underwriter check-list must include assurance of an on-site Health Insurance Portability and Accountability Act (HIPAA) Compliance Officer as HIPAA requires healthcare organizations to implement secure electronic access to health data and to remain compliant with privacy regulations. Particular consideration needs to be given to evaluating the size of the account in terms of not just number of lives/records but also patient load to ensure that the compliance systems requirements related to exposures can be met.

Compliance considerations should include legal compliance of the practice with a check on reciprocity agreements between states where the practice transacts business as well as practice restrictions applicable to non-physician healthcare professionals. Informed consent is an essential component to any medical practice. Not only is it a recommended best practice, it is actually a requirement in many states.

While outpatient care may have reduced the risk of superbugs and overuse of antibiotics, it has introduced a correspondingly larger exposure to med-tech. (Re)insurers must continue to identify trends and developing regulations in order to evaluate these exposures responsibly and deliver a seamless coverage product to the market.

For more information or to view this article online, visit aspen-insurance.com.

This article is provided for informational purposes only, does not necessarily represent Aspen’s views, and reflects the opinion of the authors in light of market, regulatory and other conditions which may change over time. Aspen does not undertake a duty to update the article.

1 Alaska, Arizona, Colorado, Connecticut, Hawaii, Idaho, Iowa, Maine, Maryland, Minnesota, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Dakota, Oregon, Rhode Island, South Dakota, Vermont, Washington, Wyoming https://www.aanp.org/legislation-regulation/state-legislation/state-practice-environment/66-legislation-regulation/state-practice-environment/1380-state-practice-by-type#north-dakota (Accessed 3 October 2017)
2 The Changing Geography of Outpatient Procedures, Guy David PHD & Mark D. Neuman MD, Issue Brief March 2011v.12/5

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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 Aspen Insurance. The editorial staff of Risk & Insurance had no role in its preparation.




Aspen Insurance is a business segment of Aspen Insurance Holdings Limited.

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]