Friday, November 7, 2014

RiskPro® Products and Data

Our Suite of Technology Products and Data Provide a Strategic Platform for Your Most Challenging Risk Issues.

All enterprise risk management industry participants rely heavily upon information to perform their roles and to serve their constituents. The delivery of risk management, insurance, and claim solutions require consistent, accurate information be shared confidentially across a large and fragmented industry.

We provide a broad range of general and custom underwriting, claims, and loss control applications and information that support key risk management, casualty, health, and disability insurance transactions. The components of these application suites can be combined and modified, or supplemented with new application components, to provide custom solutions for large, complex, multi-entity business enterprises. Our products and services are deliverd through the RiskPro® Core, RiskPro® Health and MSA RiskPro® brands.

These applications and services are tailored to a clients specific needs, so you may be assured that you will only pay for what you need. We provide twenty-four hour, seven-day-a-week support services for all of our products and services.

Interested in learning more about our products?  Call us at 585-586-4530. 

Thursday, November 6, 2014

How to Improve Your Captive Insurance Company Performance

John J. Kelly, the founder and managing partner of Hanover Stone Partners LLC, has recently written an article published in Property Casualty 360 entitled “5 Steps to Improving Your Captive's Performance”. 
The article offers important information about Clams Management, Reinsurance Strategies, Consolidation or Re-domestication Opportunities, Independent Viewpoints, and Governance. 

Wednesday, November 5, 2014

The Context of Risk Profile Development

All of us practice some form of “risk management” by approaching life’s opportunities and challenges each day in an organized way.  In the context of an enterprise, Risk Profiling is a way to help organize each opportunity and challenge to be measured and managed over time.

To build risk profiles for a company or organization, the best place to start is to understand the mission and values of the organization through it mission statement. For example, the mission statement of Apple Computer after Steve Jobs died has been reported as,

“Apple designs Macs, the best personal computers in the world, along with OS X, iLife, iWork and professional software. Apple leads the digital music revolution with its iPods and iTunes online store. Apple has reinvented the mobile phone with its revolutionary iPhone and App Store, and is defining the future of mobile media and computing devices with iPad.”

During the 1980’s, Steve Jobs reportedly stated Apple’s mission was,

“To make a contribution to the world by making tools for the mind that advance humankind.”

Which statement provides the best context for building Risk Profiles at Apple Computer? They both do, because each mission statement helps to define the context to meet the future opportunities and challenges of the organization.

Therefore, Enterprise Risk Profiling is an organized way to identify, analyze, treat, and monitor challenges to support the organization’s opportunities and values. The primary questions to ask before any effort to create Enterprise Risk Profiles is “Do we have an approach and framework to understand our mission’s opportunities and challenges?” In other words, “How do we maximize our opportunities to create value which include identification, analyses, treatment, and management of risks”?

Each organization is different, but generally it starts with the senior executives and directors clearly articulating the goals and objectives of the organization to maximize value. Thereafter, the organization needs leadership and resources to execute the strategies to achieve the objectives. Within the execution of the strategies, Risk Profiling gains its necessary context.

Tuesday, November 4, 2014

CMS Announces Payment Rules

Last week the Centers for Medicare and Medicaid Services (CMS) announced several payment rules to reward higher quality and lower cost programs, including Medicare Set Asides.

The final rules include Medicare payments to physicians and non-physician practitioners, hospital outpatient departments, ambulatory surgical centers, home health agencies and dialysis facilities that treat patients with end-stage renal disease.
The new CMS rules are an attempt to gain greater value for the healthcare expenses of the system, and are welcomed by the provider and payer communities. Some of the highlights include:

•  Better coordination of care for beneficiaries with multiple chronic conditions. Beginning in 2015, the Medicare Physician Fee Schedule will include a new chronic care management fee. This separate payment for chronic care management will support physician practices in their efforts to coordinate care for Medicare beneficiaries with multiple chronic conditions. Presumably, this should help improve the coordination of care for patients outside of regular office visits.

•  Rewarding value rather than volume. In 2015 Medicare is continuing to phase in the Value-based Payment Modifier, which adjusts traditional Medicare payments to physicians and other eligible professionals based on the quality and cost of care they furnish to beneficiaries. The adjustments translate into payment increases for providers who deliver higher quality care at a better value, while providers who underperform may be subject to a payment reduction.

•  Providing incentives to hospital outpatient departments and facilities to deliver efficient, high-quality care. The Hospital Outpatient Prospective Payment System/Ambulatory Surgical Center (OPPS) rule includes opportunities to promote greater packaging of payments for items and services rather than making separate payments for each individual service.

•  Better information for providers and beneficiaries to understand the total scope, cost, and quality of care. To assist physicians in improving quality of care for their Medicare beneficiaries, CMS recently made Quality and Resource Use Reports available. The reports include information about the scope, cost and quality of care that is delivered to the Medicare beneficiaries they serve, both inside and outside of their practices. These reports should improve care coordination and reduce unnecessary services. Also, the Physician Compare website allows consumers to search for information about physicians and other health care professionals who provide Medicare services so they can make informed decisions about who delivers their care.

•  New quality and performance measures for dialysis facilities. The End-Stage Renal Disease (ESRD) Prospective Payment System rule introduces new quality and performance measures for outpatient dialysis facilities. In 2017, a Standardized Readmission Ratio, which assesses the rate at which ESRD dialysis patients return to an acute care hospital within 30 days of discharge from an acute care hospital, will attempt to reduce unnecessary hospital readmissions.

Blackburn Robert 
By Robert J. Blackburn, Managing Principal, Blackburn Group, Inc.
Contact Bob at .