Insurance carriers have put a lot of effort into identifying best practices associated with these high risk areas for underwriting purposes. In fact, a small group of well-known insurance carriers have even created specific underwriting criteria to recognize the best performers, while working with others to help them improve their clinical outcomes.

 

A good broker will do the same for their clients, helping them get ahead of issues by marrying together various industry resources. A solid three-pronged approach to this would involve:

 

1. Partnering with a team of well-known clinicians with proven expertise in practicing medicine to collaborate with the client and provide Peer-to-Peer review, recommendations, and an audit to assure compliance in key clinical areas.

2. Participation by one of a select few, but well known, insurance carriers to help subsidize the cost of the program in full or in part, depending on cost and level of engagement.

3. Use of knowledge gained from these clinical engagements to help design and craft risk transfer programs, with built-in mechanism that specifically recognizes the client’s improvement over time, in the form of premium rebates or upfront credits.

 

The services in this approach would be offered on a risk-specific basis or as part of an enterprise risk platform. The latter is becoming more and more palatable to larger providers, as they enter into risk based contracts, for example. The downside risk associated with risk based contracts can be incorporated into the integrated risk platform, which helps to absorb the excess cost, while protecting our client’s balance sheet from the financial loss.

 

Best practices associated with high risk procedures

Here are some of the best practices that we have identified as the common denominators for successful health systems across the country:

 

– Create an oversight Committee to review progress on quality measures

– Implement electronic monitoring of the Intensive care unit

– Provide a vibrant Simulation lab training program, for proactive training on key clinical staff deficiencies

– Use computerized physician order entry (CPOE), which can significantly reduce medication errors

– Adopt proven strategies in combating hospital acquired conditions such as ventilator associated pneumonia, urinary tract infection, central line associated blood stream infection and pressure ulcers.

 

There is also a growing commitment to upgraded analytical capabilities for mining key data to identify high cost procedures and at risk patient populations. This capability helps ensure resources are effectively applied to reduce errors and improve clinical outcomes while reducing the cost of care.

 

A former client for example, did a phenomenal job in this area.  By using data intelligently, they have recalibrated their entire care package for hip replacements and knee surgeries,. Their approach was very straightforward; identify all stakeholders and, all touch points associated with each procedure; review the cost associated with all aspect of the care, including medical equipment, vendors etc., identify and eliminate inefficiencies, leverage specific contracts to reduce cost further on vendors. At each trial, costs came down and outcomes were equal or better. The program has been so successful that they have since adopted it for other specialties.

 

High risk procedures don’t have to mean high insurance costs.  With the right approach, you can lower risks and premium costs, while actually improving care.