The learning curve

For Ann Lambrecht, clinical risk management consultant for Coverys, risk management is about learning, evolving and providing creative solutions. She spoke to HRMR about the hot issues facing her clients today.

The major issues facing risk managers in 2015 are manifold, but two stand head and shoulders above the rest. Ann Lambrecht, clinical risk management consultant for Coverys, has seen her clients repeatedly seek help for issues surrounding the Health Insurance Portability and Accountability Act (HIPAA) and the Emergency Medical Treatment and Active Labor Act (EMTALA) as healthcare providers across the US seek to comply with these pieces of legislation.

Where HIPAA is concerned, the main questions relate to achieving confidentiality and security, while EMTALA’s implications for screening examinations when patients arrive in the emergency room raise liability issues and the possibility of sanctions and penalties.

Other hot topics include caring for behavioral health patients—which is overwhelmingly a clinical issue—and the national opioid prescription overdose crisis.

After more than 20 years in risk management, Lambrecht has become used to change. A qualified attorney and nurse, her risk management career has included stints at a large Michigan health system, a regional medical center, and several insurance companies—most recently at Coverys, where she serves hospitals, health systems and large physician practices to assist them in developing and implementing clinical risk reduction strategies..

During the course of her career she has seen healthcare risk management become more heavily regulated than ever. There has been an increase in patient safety initiatives—aimed, for example, at reducing hospital-acquired infections or tackling Ebola. She has helped Coverys respond to these by answering questions received through the Coverys Helpline and developing publications and webinars on patient safety topics.

“We were fortunate to have an infection prevention specialist on staff who has developed publications to assist our clients in managing the recent Ebola issue,” Lambrecht states.

She has also worked to address issues such as the consolidation of systems and the development and expansion of physician multi-specialty groups. Coverys has responded to the rise in consolidation with the development of Coverys Custom Accounts, an account underwriting division which aims to offer solutions to large providers to address the unique risks associated with the new and often complex structures that are being formed.

“Coverys Custom Accounts is an important program that we are very proud of. We have received a lot of traction with larger hospitals and provider groups that need customized insurance solutions including specialized clinical risk management programs,” says Lambrecht.

“Our risk products are unparalleled in the industry. They are uniquely developed and delivered to serve clients that are staying independent, being acquired or are acquiring hospitals or physician practices. An example is our risk assessments that help with the due diligence process of a merger or acquisition, or provide a healthcare entity with an accurate picture of how they are doing.”

New models

Another significant change is the dramatic shift in the models used to deliver care. This, too, has had an impact on the risks faced by healthcare organizations.

“One model that appears to be expanding is the role of the nurse practitioner,” says Lambrecht. “I recently updated Coverys’ educational offering on this topic to help our clients understand the benefits of utilizing nurse practitioners and manage the associated risks.”

For all the changes that are taking place there is certainly a lot of opportunity as well.

“In light of these changes it’s no surprise that the role of the healthcare risk manager has greatly expanded to include compliance, quality, safety and security, medical staff office and other roles.

“It has changed largely because so many other office practice or facility functions are connected to risk management that there has to be some operational link. The risk manager is the obvious person to be the operational link,” says Lambrecht.

In this new landscape, she sees a lot of risk managers being required to conduct due diligence for acquisitions or for their own organization, if that is being acquired.

More broadly, she says, risk managers must also face the challenge of having the time to identify and address the risks within their organizations and staying current on the regulations, standards and publicly reported quality data.

“This is why their involvement in local and national risk societies is so important for a risk manager. They can get a wealth of information and education on cutting-edge risk management matters,” she says.

Lambrecht herself is the immediate past president of the North Carolina ASHRM chapter and has held a number of positions within the organization, including PR & Marketing chair, vice president and president. She is also on the national ASHRM Chapter Leadership Committee.

“My experiences with my local ASHRM chapters shaped my understanding and appreciation of the challenges healthcare providers face every day at the various points of care,” she says.

Other formative experiences have included her nursing career, when she worked in a hospital that was very proactive in clinical areas and in achieving high patient satisfaction at a time when there was little talk about this particular healthcare measure.

“That experience as a nurse, particularly in that hospital, enabled me to see a profound and positive impact on patients’ lives and outcomes,” she says.

Later, during her legal career, Lambrecht defended many different hospitals and saw the potential for a more proactive approach to risk management throughout US healthcare.

“I saw the same clinical issues arise over and over again. I wondered if we could adopt the proactive model from my hospital to prevent or mitigate harm, and produce optimal patient outcomes and give patients and caregivers a great experience.”

The risk management mission

Later still she headed a risk management team set up to help the regional health authorities in Trinidad & Tobago develop a risk management program. This, too, shaped her understanding of what good healthcare risk management should achieve.

“It was a profound experience for me. I saw that risk managers everywhere are united by the goal of trying to prevent harm and give patients a good experience, so I said to myself: it doesn’t matter if you’re in a sophisticated system or in a system that may not have all those resources, as long as that goal is the same, and everybody’s working hard to try and accomplish it.”

Lambrecht says that she is always learning in her role, and that one of her greatest lessons has been to listen so that someone feels heard, respected and understood.

“Being non-judgmental is important because we never know what we would do faced with the set of circumstances that a care provider is in. I’ve also learnt to be creative in my approach to problems; this can really make a difference in how things are championed and accomplished.”

Other key lessons include always seeking input from those who would be affected by recommendations and from other experts.

“However broad your experience, it is valuable to get a different perspective by asking somebody else, and it enables you to bring in evidence and information to influence decisions. I’ve also learnt to give a variety of options whenever possible.”

Lambrecht is in favor of the way healthcare risk management is being integrated into all risk domains of an organization or practice, in line with the philosophy of enterprise risk management.

“It gives a more accurate snapshot of the potential risks, and because we have a more accurate snapshot we can really anticipate and start addressing those risks instead of waiting for something to happen.”

In the future she hopes risk managers will continue to have more interaction with key stakeholders and leaders so they can help guide and educate them about the true impact of a given risk.

“I would also like to see local risk management societies reach out to risk managers, obtain input on what they are facing every day and what their hot topics are and provide just-in-time learning to help them meet those challenges.”

At the same time, she plans to use her role at Coverys to continue to learn and innovate as she strives to keep pace with clients’ needs.

“Healthcare reform has increased my clients’ and my own responsibilities. However, I am truly excited to help my clients navigate these uncharted waters and grateful to have the Coverys resources to do this,” she says.

“It helps me achieve my number one objective of being a trusted and sought out resource for my clients.”