Securing the know-how

01-08-2013

Securing the know-how

The increasing complexity of the risks faced by healthcare providers and ACOs means insurers are investing in securing the right products and expertise to provide solutions, as Michelle Hoppes, senior vice president, global risk management & loss control at Allied World explains to HRMR.

In July 2012, Allied World Assurance Company Holdings announced that Allied World had appointed Michelle Hoppes, an experienced healthcare risk manager and the 2011 president of the American Society for Healthcare Risk Management (ASHRM), as senior vice president, global risk management & loss control.

In her new role with AWAC Services Company, a member company of Allied World, Hoppes is responsible for developing loss control products and services for policyholders, helping them assess and manage their organizational risk, while also acting as a healthcare subject matter expert and resource globally. She assumed a position previously held by Susan Chmieleski, who was appointed president of US Professional Lines.

Hoppes’ appointment was notable because she became the latest recruit by an insurance company of someone with this specialist background and knowledge. In response to the Patient Protection and Affordable Care Act (PPACA), the industry has been investing heavily in new products and the right expertise to help its clients cope with the challenges and new risks they now face.

She certainly has the expertise—nearly 30 years of experience in the healthcare industry, focusing on patient safety and risk management. She has held leadership positions in healthcare organizations, medical malpractice insurance companies, and national healthcare risk management consulting companies. She is also a frequent speaker on topics related to enterprise risk management (ERM), quality improvement, data analytics, loss control, leadership and patient safety.

Hoppes acknowledges that specialists in healthcare risk management are increasingly attractive to insurance companies, especially thanks to the rapid changes the profession is facing.

“Healthcare organizations are becoming even more complex and the ability to recognize, predict and support the management of emerging risks will not only require a vast set of risk management skills but also advanced leadership expertise,” she says.

“As such, there is a growing need for insurance companies to have healthcare risk management underwriting experts who are specialists—healthcare is changing rapidly and risk management professionals need to be well-versed in the concepts of ERM,” she says.

Under the umbrella of ERM, she notes, professionals require many skills including an understanding of legal/regulatory matters, clinical/patient safety, environmental and hazard risks, strategic goals, human capital, technology, operations, and financial targets. “This expertise is needed to better understand the emerging risks and exposures as well as to support our clients with the transition to value-based care,” she says.

Hoppes sums up the effect of the PPACA as shifting healthcare away from volume-based care to value-based care—something that requires a big shift in culture and thinking for risk managers and insurers alike.
Allied World is looking to help clients in two ways. “First, we have a growing healthcare vertical that provides coverage alignment for vast areas of risk. This provides a coordinated approach to coverage or the ability for clients to purchase standalone products,” she says.

“Second, we are continually expanding our risk management support to align with the emerging risks and client needs. Healthcare organizations, particularly the newly formed accountable care organizations (ACOs), will face a host of new exposures and how they address these risks will dictate their long-term success. One of the most important aspects will be striving to avoid any gaps in insurance coverage.”

The ACO liability product Allied World is offering is broad in nature and helps avoid gaps by including an array of insurance types including regulatory issues, errors and omissions, medical malpractice and general liability, management and HR concerns, D&O, employment practices, crime coverage, cyber liability and the increasing number of issues related to Health Insurance Portability and Accountability Act (HIPAA) violations and data integrity and privacy coverage.

Allied World’s product offerings have changed both to keep up with the evolving healthcare market and to help guide insureds by offering coverage options to help avoid gaps.

“We used our expertise and background in managed care underwriting to help define and identify some changing and developing risk driven by healthcare reform. With care coordination as vast and diverse as ACO organizations, Allied World’s ACO product offers wide coverage as well and addresses concerns that may arise related to many issues,” Hoppes explains.

It is not just the insurance side that is changing: its risk management program and support are evolving as well. She says the business is no longer focused only on prevention of loss and a rapid response to client needs, but is also branching out into using more advanced data analytics and predictive modelling techniques.

“The use of data and profiling, both to anticipate risk and prevent loss, will be vital,” she says.

Staying ahead of the game will require an expanded approach that not only includes risk management but also patient safety, Hoppes argues. “I believe innovation and prevention of serious safety events will be key to advancing the risk management process.

“We will also be broadening our solution approach by expanding service options to include the development and dissemination of toolkits, release of timely alerts on lessons learned and emerging risks, increasing our professional development options, incorporating benchmarking and the use of data analytics in the high risk clinical areas, and broadening our clinical expert network.”

healthcare risk manager, global risk management, loss control, patient safety