Mary Chmielowiec
Executive vice president, PointRight Inc. Brad Granger
Business development, PointRight Inc.
With families, patients and lawyers paying increasingly close attention to quality of care, PointRight
outlines the significance of effective risk analytics to the assessments of US healthcare providers.
A $114 million verdict in Florida for inadequate protection of a resident at risk of falling; a class-action lawsuit settled for $50 million in California for inadequate staffing; $100,000 dollars spent in legal fees overturning a survey citation. These are just a few examples of the unforeseen expenses that can devastate the game plan of predictable results and financial stability for any captive. While unexpected events seem to happen all of the time, the impact on the organisation’s cost of risk and the ability to attract patients that provide the most attractive revenue opportunity is significant. Realistically, many seemingly unexpected events can be anticipated and avoided using data analytics.
Attract revenue, manage risk Today, the cost of risk is highly focused on the sum total of an
organisation’s operations that relate to risk, including self-insured losses and related loss adjustment and administrative expenses. This perspective, however, is too narrow. Building a captive with members that enhance their revenue opportunity and minimise their risk is an achievable goal, and accordingly, captives that take a proactive stance and make use of available tools will reap financial rewards and attain expected results. Data analytics can help captives be proactive and nimble by identifying trends early, while recognising, measuring and monitoring areas of greatest exposure. For example, data analytics can do the following:
• Validate that publicly reported information is accurate • Ensure patient care and conditions are coded correctly and completely • Identify patients with conditions that lead to costly litigation • Anticipate a facility’s next survey citation
• Answer the question: does this facility meet the risk profile for my captive?
US Captive . April 2011 27
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