Healthcare organizations face considerable volatility from inflation and cost concerns, coupled with commodities and supply chain constraints. Furthermore, higher market interest rates are impacting asset valuations and cost of capital. Claims, from professional liability and workers’ compensation programs can further erode capital and place resource constraints on risk managers working to mitigate losses and prevent future harm events. Nuclear verdicts are ever-present in the media and employees are facing unprecedented levels of burnout, fatigue and staffing shortages.
Under these business conditions, understanding employee injury trends and their potential linkages to professional liability trends is essential to successful horizon planning. Effective risk management horizon plans allow the organization to define a strategy to capitalize on current risk control strengths or to open new avenues to reduce exposures that are creating systemic vulnerabilities.
With the influx of big data and artificial intelligence, healthcare systems are inundated with loss runs, stewardship reports, internal data reports and other sources of analytics that typically take a siloed view of insurance program (casualty, liability, health and benefits). Risk managers can take a key role in breaking down silos by creating a common vision and widespread understanding of the data.
Siloed WC program
Siloed PL program
Siloed H&B program
The lack of cross pollination between programs can place constraints on risk managers working to develop leading strategies to predict and control future losses. Providing risk management information to support claims performance is essential to an organization achieving the best results. Employee-related issues (staffing shortages, injuries, clinician burnout) to operational challenges (cyber threats, workplace violence, solvency), hospitals and health systems will continue to face a multitude of risks. How healthcare entities understand and mitigate these risks will be critical to their ability to survive (and thrive) in this volatile environment.
Healthcare professional liability claims data is studied at great length to gage trends, claims disposition, settlement costs, average claim costs, percentages that go to trial, verdict trends at trials and other indicators. Systems often lack a vantage point into the transversal layers of their data to get to the single version of the truth. In addition, healthcare professional liability data often lacks common coding nomenclature to be able to dissect trends easily and more importantly correlate those trends to the events occurring on the casualty and benefits data. Human resources are, after all, at the root of organizations and understanding trends affecting the vital workforce is essential to mitigating future losses in the professional liability space. The level of mental health claims on both the workers’ compensation and benefits programs could leave the organization vulnerable to liability claims and vice versa.
A quantifiable tool combines healthcare professional liability claims and workers’ compensation claims to provide a unique view into the loss experience that is driving frequency and severity. By looking at the loss trends in a simultaneous analytical disposition, we can visualize patient described casualty events that can lead to professional liability claim risks. An analytics tool extracts patient described trends from both hospital professional liability loss runs and workers’ compensation loss runs to provide data singularity. By bringing forward both professional liability and workers’ compensation analytics, we can begin to refine strategies to reduce harm and protect employees. A good analytics tool should seek to answer some of the following questions:
Quantifiable data provides a clear vision of high-risk care activities that impact patient care without relying on manual claims coding at intake. When healthcare systems begin analyzing these trends through an integrated lens, new strategies and risk planning can take shape. With the right analytics, organizations will begin developing strategies using transverse data visualization and connect loss trends throughout the ecosystem.
For more information on how our WTW Adverse Event Consulting team can help you, please contact us.
