There is a limit to what a risk manager can achieve alone. Vicki Haddock, president of the North Carolina Chapter of the American Society for Healthcare Risk Management, tells HRMR why teamwork has reaped dividends for Vidant Health.
With more than 30 years of experience in healthcare risk management, Vicki Haddock, president of the North Carolina Chapter of the American Society for Healthcare Risk Management (NC ASHRM), is well placed to espouse the virtues of ASHRM chapter membership.
“I started in risk management in 1988, and the North Carolina chapter was a great resource because I knew very little about the subject. It was in its early days as a profession in healthcare in North Carolina, but there had recently been a change in the state statute, requiring healthcare risk managers.
“What I found at the chapter was about 25 members who were wiling to share all of their knowledge—policies, procedures, expertise in the area. That peer group of professionals has continued to be important throughout my entire career.”
In addition to its meetings, the North Carolina chapter supports professional development with two-and-a-half days of education for its membership offered twice a year.
“We’re very proud that we have been able to bring high calibre national speakers to a local level so those healthcare risk managers who don’t have educational funds to travel to the national locations can get excellent educational opportunities,” she says.
A current area of focus is the expansion of healthcare delivery, with care increasingly being provided in outpatient settings such as physician office practices. This has led to a need for different skillsets and more information on risk financing alternatives, as health systems grow.
NC ASHRM has also remained in communication with the state legislator and has a very active legislative subcommittee within the chapter, meaning that when changes in healthcare reimbursement are mooted, members’ voices are heard.
When it comes to discussions between members of the chapter, the risk and management of behavioural health patients is currently high on the agenda. Haddock echoes risk managers all over the US when she outlines the problem:
“The behavioral health system in our state is broken and hospitals are having to house many patients with mental health issues in their emergency departments. This is not good for the delivery of care for other emergency department patients, nor is it beneficial to the care and treatment of the behavioural health patient,” she says.
"We are always working to keep up with changes in technology and ensure that our staff are adequately trained, and that we have the right equipment."
“The other big area we’re focusing on this year in our educational program relates to different risk financing strategies—looking at captives, self-insurance and joint programs—because our systems have really expanded their exposures.”
These are topics Haddock is especially familiar with in her own role as vice president, office of general counsel, University Health Systems of Eastern Carolina. The system, which does business as Vidant Health, is a non-profit hospital system made up of eight hospitals, physician practices, home health, hospice, wellness centers and other healthcare services serving 1.4 million people in 29 counties in Eastern North Carolina.
Haddock’s role includes overseeing the system’s in-house legal office, which incorporates eight in-house attorneys dealing with day to day operational and compliance issues. All of the system’s defense work is of outside counsel.
Haddock also oversees the system’s contract management program—there are about 70,000 active contracts within the system. In addition, she is responsible for the system’s insurance departments, its claims department, its risk management department and its commissioned police force, which was introduced roughly 10 years ago in response to increasing violence in the healthcare arena.
Doing the right thing
There have been plenty of accomplishments during the system’s 30-year history, but she is especially proud of its decision relatively early on—in the late 1980s—to move to a self-insurance program.
“It allowed us, in the role of the board, to do the right thing: if we make a mistake with a patient we have always disclosed that, and tried to get that resolved and settled out of the court system, which immediately impacts those patients that we have not offered the best service to.”
The decision to go self-insured was in part driven by the fact that the system had two bankers on its board.
“It was felt that the insurance companies were solely interested in protecting their finances and were not interested in doing the right thing for patients and families or for the healthcare providers.
“The decision to go self-insured was very much driven by a financial model. Having bankers on the board gave us a very sound financial base, so they were able to set up a program to enable us to self-insure.”
The system also brought its claims management in-house—another move that was a little different at the time, but was seen as financially advantageous. By handling its own claims instead of passing them to a third party, the hospital was able to resolve the claims in a shorter timeframe.
“We hired trained and recruited claims adjusters and brought them in-house, managing claims internally since the early 1990s. Before that, we were paying very large fees for claims management and cases were kept open for longer.”
A joined-up approach
Haddock sees Vidant Health’s approach to patient safety and risk management as a wheel with the patient at the centre, and the spokes including aspects such as quality, compliance and security. The joint effort of all these teams is key to the system’s success in handling risk.
“We don’t believe anybody comes to work with the intention of harming the system or harming patients; it’s typically a system issue that contributes to adverse events, so the focus is very much on a team approach,” she says.
“We have experts in a number of arenas who are able to look at the entire picture for the system. The experts involved change depending on whether we’re looking at purchasing different equipment, making changes in our medical records system, or altering our policies and procedures training—so it’s not one small group, or one small area of expertise addressing system issues.”
Some of the major issues currently being addressed by the system relate to electronic health records (EHRs) and ensuring the correct information is available to all the providers so that they can make the right decisions for patients.
Protection of health information is a related issue: the more open the systems are so that practitioners can share the data, the more opportunities there are for breaches to occur.
“It’s a challenge. We are always working to keep up with changes in technology and ensure that our staff are adequately trained, and that we have the right equipment and the right operators.”
A related issue—and another major focus at present—is abuse of prescription drugs through diversion, or doctor-shopping.
The system addresses this with a team of 32 members including providers, information technology and security specialists, risk management teams and operational members, who meet on a monthly basis to look at and address issues that have surfaced in that month or ongoing issues to do with the management of the health records.
“It’s a pretty aggressive approach: they make recommendations for changes both to the content and security of health records and we work in partnership with our state FBI agents on a monitoring program, making sure we are auditing our employees so that we don’t have impaired employees within the work force, but also addressing doctor-shopping from a patient perspective. Dealing with the patients who are seeking narcotics in the emergency department and addressing those is a real challenge.”
One of the main lessons Haddock has learned from her job is that for risk management to work, you cannot function in a silo.
“Communication within your health system and outside the health system is essential to getting all the information you need to make decisions,” she says. “If you are working in isolation in a risk management department, I don’t think you’re going to be very effective.”
In the coming years, she expects risk managers to continue to be challenged by the way healthcare is delivered, with more provided on an outpatient basis and the related challenge of ensuring patients have a safe environment when they go home to their families or care providers.
“We are exploring more telemedicine programs in our system, in response to people wanting things more on demand and more electronically. For example, we have home units that monitor patients with chronic conditions such as diabetes or congestive heart failure and transmit information regarding their blood pressure, their weight and their diet to a nurse on a daily basis so the nurse can evaluate it.”
Now in her fourth decade in the profession, Haddock is pleased that risk management is still moving forward, and remains as enthusiastic about it as ever.
“It was the best job career move I ever made because as risk managers you have the ability to impact the care patients receive and improve that; you have the ability to speak directly to the board, to those people who will be making the key decisions for the system; and you have the ability to change the lives of your employees by making recommendations and changes relating to the work environment. It touches and serves so many different constituents. It’s a great career.”
Vicki Haddock, American Society for Healthcare Risk Management, US