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IoT-communication-1927706_1920-300x200The Internet of Things (IoT) has made a revolutionary impact on the automotive industry. Just like our smartphones, our cars have become smart cars, more commonly referred to as connected cars. Modern automobiles have the ability to produce, capture, store, process, analyze, and transmit large amounts of data to assist drivers and provide information – telematics. This data can be stored within the vehicle or transmitted to the cloud, the manufacturer or a designated insurance company.

With the increased intelligence of vehicles, forensic investigators are finding new data available to support their investigations and to verify their findings. Research is required to determine what data is available in a specific circumstance. A forensic investigation of an auto-related event generally relies on these three types of data:

  • Driver (driver data and inputs such as steering, braking, acceleration)
  • Vehicle (equipment and safety systems activation, maintenance records)
  • Environment (weather, road conditions, traffic)

We are seeing different devices and industries beginning to utilize connected technology and telematics to capture and make use of these types of data. Here are several examples of trends we are seeing now and what may be coming in the near future that could be very useful for forensic investigations.

Telematics devices

Late model vehicles may be equipped with a manufacturer-exclusive telematics system like GM’s Onstar, Land Rover’s Icontrol, Mercedes Mbrace and Ford’s SYNC. Additionally, there is an abundance of aftermarket telematics solutions that can plug into the on-board diagnostics (OBD) connector under the dash for vehicles with a model year of 1996 or newer. They can sync with a smartphone and provide the same data newer vehicles capture. Inexpensive and easy to install, they are used by insurance companies, fleets and even parents of teen drivers.

Car sharing

Companies like ZIP Car and Car2Go make full use of connected car technology. A customer uses their mobile phone to locate, reserve, and unlock a shared car. When done, they leave the vehicle parked in a designated spot for the next person. This is advantageous for the customer because they will only be charged for the time and miles driven, which are all calculated using the equipment installed in the vehicle.

This data can also be used to help forensic investigators when researching criminal matters, especially when questionable information is presented. In accidents, data can help forensic investigators determine who was driving the car when the accident occurred. In a specific recent case, investigators looking into a hit and run accident with critical injuries involving a shared car used the data to reveal that the listed driver of the shared car was lying when she reported that she was hijacked and the car stolen just minutes prior to the accident. Forensic investigators were able to obtain GPS location information and other data that contradicted those statements. When confronted with the data, the driver admitted that she falsified the story.

Fleet operations

Companies with large fleets of vehicles are finding unique ways to use technology to help improve their business. They can reduce costs and investigate any events that occur – even help reduce or eliminate false claims – by introducing cameras into their telematics programs. Camera footage is streamed to the cloud to provide a historical record, if needed. For example, tow truck companies are adding cameras to their fleets so they can defend claims that the tow truck driver damaged a person’s vehicle when in tow.

Usage-based insurance (UBI)

UBI has grown in popularity. Data is collected from a vehicle monitor, which includes speed, harsh breaking, miles driven, common routes and parking location of the vehicle at night. The insured must agree to have data released to the insurance company and, in return, they receive discounted insurance based on the analysis of the information.

Self-driving technologies

As we look to the future of car manufacturing, is exciting to see the possibilities of cars having 5G WiFi capabilities within the next couple of years. This technology will allow vehicles with equipment such as cameras or lidar (systems that use laser pulses of light to measure and map the surrounding environment) to capture data and send it to the cloud, where it will be analyzed and sent back to the vehicle in almost real time – allowing for even more self-driving capabilities and data to be utilized for investigative potential.

Connected cars and related technology are becoming more commonplace and more affordable. Awareness of the technology and its capabilities is the first step to incorporating recognition and utility of this technology on all forensic vehicle investigations.

This is part two of our series on the emerging technology of IoT and forensic investigations. Click here to read part 1, and if you have any questions or great ideas to share for future posts, please contact us – we want your input!

Michael Hoffman, MSFS, IAAI-CFI, District Manager
Unified Investigations & Sciences, Inc., a Sedgwick company

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WCI-image-2017Because of its relevance at the intersection of workers’ compensation, leave of absence and federal laws like the Americans with Disabilities Act (ADA) and The Family and Medical Leave Act (FMLA), the accommodation process requires a careful and thoughtful approach. Employers often offer light duty or transitional work programs for workers’ compensation claims; however, many times, these options are inconsistently applied to employees on disability or leave of absence. Regardless of the nature of the injury, ADA regulations apply. To maintain compliance, there is a need for consistency among employers in their approach to accommodations and return to work across both occupational and non-occupational injuries and illnesses.

The interactive process

The process for determining if an employee has a disability and whether reasonable accommodations can be implemented is called the interactive process. Typically, this involves a dialogue between an employee and their supervisor, human resource representative or ADA coordinator, and takes into account the advice of healthcare providers. An employee can – but does not need to – request an accommodation to trigger the interactive process; the employer’s obligation begins whenever they become aware that an employee has a disability or suspects that a person may have a disability that is causing problems with work. Also, employees may be on a leave of absence – either occupational or non-occupational – and exhaust their entitlement. In these situations, the employer is obligated to begin the interactive process. Delaying or avoiding the interactive process places an employer at risk.

The steps

The Job Accommodation Network (JAN), is a service of the U.S. Department of Labor’s Office of Disability Employment Policy, available at www.askjan.org. It offers many valuable resources for employers as they navigate accommodations. As recommended in a JAN publication called “The Interactive Process,” follow these steps to support a compliant interactive process:

  1. Recognize an accommodation request or a duty to start the interactive process. Employees may request an accommodation or indicate they are having a problem performing work activities and that the problem is related to a medical condition.
  2. Gather information. Employers need to determine what information is needed to assess the employee’s situation. In some cases, no additional information is needed whereas, in others, it may be necessary for the employee to talk with a healthcare provider to determine the impairment and restrictions. Obtain a job description that outlines the tasks the employee is performing
  3. Explore what accommodations might be available to the employee and identify what environmental modifications could be made. Ask the employee what kind of accommodation would be helpful to complete job-related tasks.
  4. Choose the accommodation. If you have three or four options, JAN recommends asking the employee which option is preferred. There may be times when an accommodation is not reasonable for the employer to accommodate.
  5. Implement the accommodation. Ensure the selected option works as intended and offer assistance throughout implementation as needed.
  6. Monitor the accommodation. Check to ensure the accommodation is working. Also, recognize accommodations are not permanent. Business processes, existing technology and employee conditions change, and those may impact the effectiveness of the accommodation.

Accommodations and return to work will continue to be complex and challenging for even the most experienced risk and benefits professionals. As employers support colleagues with occupational and non-occupational injuries and illnesses, it is important to remain informed on current laws and proposed regulations while maintaining a thorough understanding of organizational policies and procedures. Collaborate with other professionals, break through silos, talk to experts, and use resources like www.askjan.org, www.dol.gov, and www.eeoc.gov. Consistency is key.

Join me, along with my fellow panelists, as we further explore this topic at WCI’s Annual Conference next week in our session “Return to work best practices.” If you have questions or are looking for additional accommodation support, leave us a comment or search our related resources on the blog.

Bryon Bass, SVP, Disability and Absence Practice and Compliance, Sedgwick

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The consequences of initial care direction

bulls-eye-1044725_1920-pbAccurate initial care direction can make all the difference in the outcome of a workers’ compensation claim. When experienced clinicians are engaged and referencing proven triage guidelines, their guidance bolsters treatment safety, accurate diagnosis, and documentation of items that may delay recovery, such as comorbidities, and fosters lasting return to work. The primary purpose of any triage service should be to recommend the correct level of care, and proven triage guidelines are critically important in providing direction. Some triage providers may claim high rates of sending injured employees to self-care; however, if what an employee really needed was to see a healthcare provider, inflated self-care is not a benefit for the employee or the employer. Transparency is key when taking a look at self-care conversion rates, as it gives the employer insight into the validity of triage recommendations.

Protection from long-term cost

The best way to evaluate the accuracy of initial treatment direction is to measure claim development 15-30 days later to ensure effective recovery and continual productivity. Third party administrators have the long view of cases and can see incorrect self-care recommendations causing long-term cost and absence from work. For example, Sedgwick reviewed client programs that moved from a triage company using home-grown guidelines to triage services using proven Schmitt-Thompson guidelines for self-care or treatment recommendations. Our analysis showed that 10-15% of the cases receiving self-care recommendations had 20-50% higher average temporary total disability days. Inaccurate front-end self-care recommendations cost the employee and the employer down the road.

The introduction of telemedicine: Delivering accuracy and saving time

Telemedicine is a quickly expanding service that will continue to grow for occupational injury care. As another tool in the clinical consultation process, telemedicine referral protocols and best practices should also be based on Schmitt-Thompson guidelines. Injured employees may be directed to one of the following treatment options: self-care, telemedicine or in-person care.

Important information about the employee gathered during triage can be passed along to the telemedicine provider to make the online experience faster and more efficient. Potential technology delays can also be mitigated through the clinical consultation triage process, keeping the treatment experience seamless and eliminating pathways that may otherwise cause the injured worker confusion or disengagement.

Injured employee satisfaction

In our own experience launching telemedicine for Sedgwick customers using clinical consultation services, we’ve received positive feedback. Since telemedicine was added as a treatment option, more than 60% of injured employees using the service have responded to post-visit surveys and they have all scored the experience with four or five stars, on a scale of one to five. Consistent and proven triage protocols can make all the difference, and consistent clinician guidance and qualification of the injured worker for telemedicine is a critical first step for a successful experience. The overall process is simple.

graphic for accuracy is a commodity

Provider benchmarking

In-person care referrals should be qualified via proven protocols, but provider choice is also critical. To take one step further in delivering accurate care, clinical consultation nurses  should use benchmarking information whenever possible to match an injured employee with a local provider proven to get the best outcomes in occupational injury care and return to work facilitation. At Sedgwick, we see 73% earlier return to work and 40% faster claims closure when an injured worker is matched with a 4- or 5-star medical provider.

Remember, consistently pairing an injured employee with the correct initial care following an injury is a critical foundation for a safe, effective recovery. It is important to follow stringent and proven guidelines to make sure accuracy prevails. Is your own program evolving to include the latest protocols and care options to best support your employees? Share your experience in the comments and let us know if you have questions

Andrea Buhl, MSN, RN, FNP-BC
SVP, Clinically Integrated Medical Program

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The art of rooting out complicated cost-building tactics and re-pricing complex bills

The healthcare industry has an uneven compensation system. Healthcare providers, by necessity, utilize complex pricing systems and strategies that inflate costs for employers in workers’ compensation. These tactics are deployed to compensate for lost income for services provided in group and private healthcare. Without a systematic and consistent medical bill review program, employers are at high risk to overpay for medical treatments, products and services.

medical-costs-freepik-webEmployers should not be burdened with overcompensating for an imperfect healthcare system when paying for occupational injury care. Risk managers must ensure that exhaustive medical bill re-pricing processes are in place to protect their organizations from overpaying for necessary occupational injury care.

Medical bill review is not as exciting a topic as, say, strategies to counter the opioid epidemic or the impact of behavioral health on workers’ compensation. But effective medical bill review is the cornerstone of an effective overall risk and claims management program. It is important to fully eliminate the risk of even one complex and high-cost bill escaping expert scrutiny and re-pricing. One missed bill could wreak havoc on an employer’s loss budget.

Once the medical bill review process for detection of every complex and high-cost bill is established, the risk manager needs to make sure the right team of multi-disciplinary experts is in place. Medical bill review expertise must include highly skilled and knowledgeable clinicians providing oversight for complex, questionable and costly bills. Clinicians review pricing line-by-line and examine accompanying documentation of care. Nurses also identify non-applicable and inappropriate fees for the treatment documented and re-price complex bills to a reasonable rate. These experts then must document the reasons why services are being re-priced, as well as the regulatory and treatment guidelines they may fall under, to help the billing provider better understand and accept payment rationale.

Consider these three proven bill review strategies:

  1. In one common area of inflation, for example, surgical implant cost is often beyond reasonable and appropriate rates. A reliable and proprietary database exists to help bill reviewers accurately re-price charges associated with surgical hardware. Risk managers must ensure their medical bill review services are utilizing this surgical implant pricing database and implement tactics for maximum re-pricing.
  2. Providers want fast compensation for services provided. That preference for rapid reimbursement allows the effective medical bill review team to create criteria for express reimbursement. If a medical bill meets the scheduled cost criteria, the provider is offered reimbursement within a set amount of days for agreement to compensation discounted to a reasonable rate. Express reimbursement is a fair, reasonable and consistent strategy to secure additional discounts below fee schedule, usual and customary and PPO network reductions.
  3. Finally, the most costly and complex bills should always be pulled for specialty review and negotiation services, in which highly trained, specialized negotiators access targeted bill re-pricing information and agree to discounted compensation with the provider. Documentation of the negotiated agreement is accurately and consistently written to prevent a provider from later disputing the payment.

Employers receiving consistent, justifiable and well-documented complex bill review discounts have behind-the-scenes bill review systems, processes and skilled experts in place who work to re-price every bill at reasonable and appropriate rates. Risk managers: check the pulse of your medical bill review service. Ensure that it provides excellent clinicians, specialty reductions for items like surgical implants and skilled and knowledgeable negotiators to address the most complex bills.

Mary Beth Sanford, Managing Director

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apple-1051018_1920-pixabayCMS now permits some old MSAs to be re-approved

Before this week, the Centers for Medicare & Medicaid Services (CMS) had a simple philosophy: Parties get one bite at the apple when it comes to CMS approval. However, on Monday, CMS released an updated Workers’ Compensation Medicare Set-Aside Portal (WCMSAP) users’ guide that outlined a new process to have older Medicare set-asides (MSAs) reviewed and approved for a second time. This can be industry-changing, as CMS, for the first time, is allowing us a second bite at the apple. CMS calls this new process an “Amended Review.”

There are a few conditions to the Amended Review (from section 12.4.3 of the guide)

  1. The MSA must have been submitted between one and four years from the current date
  2. Cannot have previously requested an Amended Review
  3. The change in the MSA amount must be 10% of the approved MSA amount or $10,000 (whichever is greater)

Despite these limitations, this new process will allow us to submit a previously approved MSA for re-review where before this was not a possibility.

Practical impact

Parties can now go back into their inventory of recently (1 to 4 years) approved MSAs and determine if the approval was too high to facilitate settlement. If it was, current medical and prescription drug records can be reviewed to determine if the MSA can be significantly reduced. If it can, the new Amended Review process may be beneficial.

Pro tip

We only get one chance to reduce the MSA, so make sure all involved parties are relatively close to settlement at the time of the Amended Review. This will allow the parties to act quickly once the Amended MSA is approved.

Michael R. Merlino II, ESQ, SVP, Medicare Compliance & Structured Settlements

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sparklers-1845065_1920pb-webWhen in the Course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the Laws of Nature and of Nature’s God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.” These are the opening words of the Declaration of Independence and with these words our nation was born on July 4, 1776.

This time of year, we mark that declaration with celebrations, picnics, friends and fireworks. And for most, the days around the 4th are spent relaxing and being with family. But for many in the fire and investigation services, the 4th of July also brings extra work from people using fireworks.

Fireworks start an average of 18,500 fires per year, including 1,300 structure fires, 300 vehicle fires, and 16,900 outside and other fires. These fires cause an average of $43 million in direct property damage.   And while many states and localities have outlawed fireworks in some manner or another, the damage done from people misusing fireworks has not decreased in recent years.

To understand the problem, we need to look at the types of fireworks and causes of these fires. There are two grouping of fireworks. The first type includes fountains, sparklers and smoke bombs, which are legal in many municipalities and can be found for sale on many street corners during the holiday. When used as directed, these fireworks can generally be considered safe – the key is using them as directed. The second group of fireworks includes mortars, rockets, firecrackers and roman candles, which will leave the ground and/or explode. While many states have laws in place that allow the sale of these devices, most areas outlaw their use.

Fires caused by fireworks generally happen for one of three reasons:

  • Combustibles were too close to the fireworks
  • Firework remains were improperly disposed
  • Fireworks landed on combustible materials

Sparklers and fountains, while typically safe, can create problems when people either use them in manners not intended or in a location close to combustibles. Many fires have occurred when the person using them decides to light the fireworks next to wood chips or close to a building. One fire recently investigated was caused when the teenage occupants decided to have a “sparkler war” and were lighting sparklers and throwing them at each other. The ensuing trip to the emergency room caused that game to come to a quick end.

Many fires have occurred when the homeowner is done with their festivities and decides to clean up the remains. Most people do not realize the need to soak remaining cardboard tubes in water before placing in a trash can. Due to the types of chemicals and materials used to make the sparks and colors, the tube is treated in a manner so the fire sprays from the end and does not just explode. Once the fireworks have finished, embers can sit inside the tube for a considerable amount of time. If the homeowner places these tubes, boxes and papers inside their trash bin, the glowing embers can now ignite other fuels. Unified Investigations has been called to assess many of these fires where the homeowner placed the full can either next to the building or inside the garage. The ensuing fire then creates another show for the neighborhood that no one wants to see.

The axiom of what goes up must come down also relates to fireworks. When people send bottle rockets, mortars, etc. into the air, they have no idea where they will come down. And, like their legal counterparts, these devices will be hot when they land. One fire investigated by Unified was the result of falling bottle rockets that lit the roof of a barn on fire. Neighbors saw the fire while it was still small, but due to its location, efforts to extinguish it were in vain. The fire destroyed the barn and the house next to it. During the investigation, multiple dozens of rocket remains were noted on the ground and houses surrounding the involved building. All the fireworks were sent skyward by one house in the neighborhood having a party. The homeowner having the party ended up with both criminal and civil charges because of the incident.

When investigating firework-related fires, the investigator needs to account for not just the actions of those involved, but also the actions of people down the block. A neighborhood canvas will assist in determining the location where the fireworks originated and possible responsible parties for subrogation. The scene examination should also reveal the presence of the firework containers and tubes.

We at Unified hope you have a safe and peaceful 4th of July weekend. If you choose to do so, please enjoy fireworks responsibly.

Kevin Reilly, IAAI – CFI, Senior Investigator

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Paid family leave and paid parental leave are currently key topics for employers as they look to expand benefits for their employees. Recently, San Francisco introduced a paid parental leave ordinance and New York announced a new paid family leave benefits law. These new regulations include some elements that take effect July 1, 2017. Below is a brief summary.

bibSan Francisco

The San Francisco paid parental leave ordinance (SF PPLO) impacts all San Francisco-based employers with more than 50 employees nationwide. For example, a company with 1,000 employees across the U.S. and 25 working in San Francisco would be required to provide benefits to their San Francisco team as of January 1, 2017. Employers with 35 or more employees are required to comply beginning July 1, 2017 and employers with 20 or more employees on January 1, 2018.

The law requires employers to provide six weeks of supplemental paid parental leave to employees working in San Francisco for the birth of a child, and the placement of a child for adoption or foster care. Employers must provide up to 45% of supplemental pay so that, when combined with California paid family leave (CA PFL) benefits, employees will receive up to 100% of their normal gross weekly wages (subject to CA PFL maximums). The leave must be completed in the first 12 months after the birth or placement of the child.

Eligibility requirements:

  • Employee commenced employment with the covered employer at least 180 days before the start of the leave
  • The employee performs at least eight hours per week of work in San Francisco for the employer
  • At least 40% of the employee’s total weekly hours for that employer are in San Francisco
  • Employee must be eligible for and receiving CA PFL for baby bonding

One way that employers can comply with (or be exempt from) the SF PPLO is by providing equivalent benefits under their existing paid parental leave policy. Employers should review their policy to be sure it satisfies the following minimum requirements of the SF PPLO:

  • Applies to all employees regardless of (for example):
    • Full-time/part-time status
    • Salaried/hourly
    • Union/non-union
    • Exempt/non-exempt
  • Provides 100% of pay up to six weeks for bonding with a newborn, an adopted child or a foster child
  • Eligibility for leave cannot be greater than 180 days of employment prior to the start of the leave
  • Applies equally to mothers and fathers
  • Applies equally to primary and secondary caregivers

Another way employers can comply with the SF PPLO is by handling it under their California Voluntary Disability/Paid Family leave plan.

The following items would need to be taken into consideration before determining if this is a viable solution:

  • Perform a feasibility study if the voluntary plan is funded with employee contributions
  • Amend the CA voluntary plan to include a separate class for SF employees that would pay 100% benefit
  • Provide written notice to all employees of plan change; including the option to opt out of voluntary plan
  • File revised plan document and employee notice to EDD for approval

If employers are not able to cover the SF PPLO obligation under their existing paid parental leave policy or CA voluntary plan, then they must create a separate policy and process to comply with the ordinance.

For more information on benefits, eligibility, supplemental payments and intermittent leave, along with frequently asked questions, please see the Paid Parental Leave Ordinance on the City and County of San Francisco website.

The benefit details and compliance requirements of new paid leave laws can be complex. If your company has questions or concerns related to the new San Francisco ordinance, please contact your Sedgwick client services director.

New York

On February 22, 2017, regulations for the New York Paid Family Leave Benefits Law (NY PFLBL) were released. After the initial comment period, a revised and updated draft amendment was published on May 24, 2017, which has just closed for further public comment. The proposed regulations can be viewed here; we will continue to update you as the amendment is finalized.

The NY PFLBL will become effective on January 1, 2018 and employees will receive benefits to:

  • Care for the serious health condition of a family member, including a spouse or domestic partner, child (biological, adopted, foster or in loco parentis), parent, grandparent and grandchild
  • Bond with a new child during the first 12 months after birth, adoption or foster care placement
  • Care for a spouse, parent or child as a result of military exigency

The weekly benefit is scheduled to gradually increase in subsequent years and is based on a percentage of New York’s statewide average weekly wage (AWW). Below are the percentages for the weekly benefit:

  • January 1, 2018: 50% of weekly wage for 8 weeks
  • January 1, 2019: 50% of weekly wage for 10 weeks
  • January 1, 2020: 60% of weekly wage for 10 weeks
  • January 1, 2021: 67% of weekly wage for 12 weeks

The benefits are designed to be fully funded by employee contributions, which will be deducted from the employees’ pay. Funding rates have been finalized and are set at 0.126% of the employee’s average weekly wage (capped at the NY state average weekly wage of $1,305.92) or $1.65 per week. Employers can begin payroll deductions as of July 1, 2017.

Full-time employees are eligible after 26 consecutive weeks of covered New York employment and part-time employees are eligible after 175 days of covered New York employment. When an employee returns to work, they must be restored to the same or a comparable position that they had prior to taking PFLBL.

Sedgwick is prepared to support customers for whom we administer statutory disability claims in New York to help them comply with the PFLBL. Pending the release of the final regulations, we recommend that employers:

  • Evaluate their employee demographics to determine whether any employees meet the eligibility criteria
  • Engage with a benefits consultant and/or legal counsel for guidance on policy/plan development including updating employee handbooks or leave material to include the PFLBL
  • Prepare their payroll functions to add another deduction for the PFLBL
  • Prepare to maintain the employees’ existing health coverage for the duration of the PFLBL

For additional information on eligibility and benefits, please see New York’s paid family leave program on the New York State website.

>  This article was originally published in the edge magazine, issue 7. Click through to read additional thought leadership from our experts.

Sharon Andrus, Director, National Technical Compliance, Disability Administration

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HRMR-blog-MaleySedgwick supports Healthcare Risk Management Week June 19-23
Sedgwick’s healthcare risk management team works alongside healthcare risk managers to reduce risks and improve safety by delivering cost-effective claims, productivity, managed care, patient safety, risk consulting and other services. Taking care of people is at the heart of everything we do. Caring counts.

Providers today are transitioning to a value-based world. Financial rewards are no longer reaped based upon the volume of services provided, sometimes regardless of necessity or outcome, but instead upon positive patient outcomes and pleased consumers. Accountability for patients’ total experience is being vigorously enforced and has risen to the forefront of providers’ responsibilities. Healthcare models are changing to focus more on the health and well-being of populations, rather than on the “break-fix” model of treating individuals primarily when they experience acute episodes of illness. Emphasis is on patients’ clinical, financial and emotional status, as well as their expectations, which are assessed on an ongoing basis. The needs of specific populations and cultures must be carefully considered.

The healthcare organization-provider relationship has also changed. Institutions, once focused on pleasing providers as a strategy for maintaining and growing market share, have shifted gears to become patient-centered instead of provider-centered.

For many providers, this transition is challenging. They must actively participate in cross-disciplinary teams, often as leaders, to implement measures designed to continually improve upon the value, cost and quality of patient care.

New attitudes and new models of care

Value-based reimbursement for services has gradually gained ground, but now is moving ahead full steam. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) forged the way for value-based payments, laying out specific payment plans for healthcare providers. Plans emphasize clearly that cost control and quality care are necessary in order for payments to be approved. As a result of the sea change focused on value versus volume, providers must change their methods and, most importantly, adopt a new mindset. They must actively partner with healthcare institutions to establish, promote, and practice within a culture of safety. These transformations in business models and ways of thinking require new skills and education. Many providers, anxious to understand the complexities of the new healthcare environment are going back to school, both literally and figuratively.

New roles, new job skills, new insights

The role of “physician executive” is fast becoming one of the most important roles in the healthcare paradigm. Innovative educational programs are preparing physician leaders and other providers to focus upon the importance of quality over quantity, patient safety and process improvement. These programs are often designed to take the provider out of his or her comfort zone by exposing them to the experiences of other industries, such as manufacturing, engineering, finance and even the airline industry.

A very strong focus has been placed on the impact of systems versus individual actions. Healthcare organizations now realize that poor outcomes can be improved when process improvements are identified and acted upon swiftly instead of blaming an individual for a patient harm event. This is not news to risk management, quality and patient safety professionals. However, concepts that promote the reduction of patient harm are not necessarily well-known to others practicing within the healthcare profession. Many clinicians may have seen risk management, patient safety and process improvement as administrative functions secondary to their provision of clinical treatments.

The role of risk managers, patient safety and quality professionals has changed, too, with increased emphasis on demonstrating value and quality. A major responsibility for these professionals is to teach all levels of healthcare workers how to implement safe, standardized and evidence-based processes that enable health interventions to reach those who need them on a timely basis. Proactive, innovative means to accomplish safety goals are imperative. Data collection is important, but the actions taken following the observance of trends and/or system breakdowns make the difference in ultimate outcomes. Herein lie the greatest challenges. Actions risk management, safety and quality professionals must take to help others embrace the value paradigm include the following:

Educate – Share knowledge regarding the science of patient safety, the principles of risk management and methods of process improvement. Multidisciplinary forums, including those used after serious safety events such as root cause analyses, present an ideal opportunity to share knowledge and problem-solve as a team.

Engage – Let team players know “what’s in it for them.” Value-added services are designed to eliminate waste and streamline activities. A more efficient and joyful workplace can equate to happier employees, better communications and better patient outcomes.

Strategize – Help members of healthcare teams and departments set goals through the establishment of benchmarks that support positive patient outcomes. For example, establishing objectives to reduce infection rates can support both patient safety goals as well as financial targets through reduced readmission rates.

Promote – Secure leadership support and make it well-known that providing value to patients is part of the overall mission and vision of the organization. Use social media, newsletters, broadcast emails, job fairs, posters and other means to keep the focus on providing value to patients.

Evaluate – Implement realistic success monitors and use technology to ease the workload as much as possible. Modify measures as changes occur so they remain meaningful and applicable to patient care and workflow.

Innovate – Support new technologies. Innovation is a clinical and cost imperative. Examples of innovations include artificial intelligence, virtual reality, telehealth and biosensors and trackers, to name a few. Innovations that target, track, prevent, monitor, and treat illnesses demonstrate value. Risk management and patient safety professionals can assist in the determination of return on investment when decisions are made regarding the purchase of new technologies by factoring in the likelihood for reduction in patient harm, improved patient outcomes and patient satisfaction.

Celebrate – Create reward systems to recognize providers, staff, teams and departments that are promoting value and achieving established goals and positive outcomes for patients.

Sustain – Build in systems that check for “slippage” in improvements.

The bonus

Risk management, patient safety and performance improvement efforts are bolstered by new mandates to demonstrate value. Now, goals are better aligned, and with the dedicated efforts of healthcare staff working in teams, costs can be controlled, the patient experience will be ultimately positive and outcomes improved – the overarching aim of value-based healthcare.

> Read more from Robin and other professional liability, healthcare risk management and patient safety experts in our Risk Resource newsletters.

Robin Maley, RN, MPH, MS, CPHRM, CPHQ
SVP, Healthcare Risk Management and Patient Safety

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3D laser scanning: Essential technology in forensic science and claims

When it comes to the claims industry, documentation is essential. In order to come to a conclusion regarding the cause of a fire, traffic accident or product failure, it is crucial for forensic investigators to document in a clear and effective manner. Today, technology plays an important role in improving the quality, speed and quantity of evidence collection; an investigation can be concluded with a higher amount of certainty in a shorter amount of time. The use of 3D scanning technology allows investigators to preserve a permanent, digital copy of a scene that can be viewed virtually via computer. Investigators can conveniently observe evidence, navigate throughout different environments, and take measurements as if still onsite.

What is 3D laser scanning?Focus fire 2

There are several 3D scanning technologies available on the market today, and among the most useful for the forensics industry are 3D laser scanners. 3D laser scanning is the process of capturing millions of points of data and converting them into a virtual environment, or point cloud. These point clouds are used to produce highly accurate and realistic 3D computer models for use in many applications.

Unified employs a laser scanner that works by emitting an infrared laser at a surface which is then reflected back to the scanner. The distance from the object to the scanner is calculated by analyzing the phase shifts in the wavelength between the emitted and returning light. This technology is capable of collecting data at a rate of nearly 1 million points per second at accuracies under 2mm at a distance of 1,000ft. In addition to measuring distance, the scanner takes high-resolution photographs which are used to assign a color value to each individual point allowing for the creation of realistic, full-color point clouds.

Why 3D laser scanning?

damaged vehicleAt typical loss sites, investigators must often choose which parts of the scene are relevant to the investigation and then proceed with documentation accordingly. Often, evidence may not be deemed relevant until late in the analysis, at which point the scene or vehicle may have been changed, making measurements impossible to collect. By creating a digital copy of the scene, sensitive evidence can be preserved that may otherwise be compromised over time. Additionally, there are always “missing photographs” from an inspection that may add value to an investigation. This is no longer an excuse. By taking a comprehensive scan of the scene, typically all potential information of interest is captured and available for future use.

Traditional investigations are generally completed using a combination of tape measures, measuring wheels and photographs. Having so many tools can make documenting large, complex scenes in a timely manner very difficult. In contrast, 3D laser scanning provides more complete and accurate information in a fraction of the time. Each and every collected data point can be referenced and measured much more efficiently using specialized software. The scanner can also easily collect dimensional information that is difficult to gather due to sheer size, accessibility or safety concerns.

3D scanning technology has been around for several decades and has widespread acceptance across a variety of industries. A few examples include forensic and criminal investigations, product design and manufacturing, land surveying, medical science, film and video game production, and the documentation of historical artifacts. Companies use laser scanning to increase efficiency, provide faster turnarounds on projects, reduce labor costs, and add value to customer deliverables. Accuracy and speed lead to predictability, which in turn brings about increased profitability.

How Unified uses 3D laser scanning

  • Creation of 3D walk-throughs allowing juries/audiences to be immersed in an environment; witness points of view can be replicated and incidents can be reenacted in real time
  • Complete documentation of complex dimensional information for vehicle crush, building damage and burn patterns
  • Creation of 2D and 3D building layouts, industrial projects and traffic scenes
  • Scans of evidence, such as vehicles or other objects of interest, which can be placed in separately scanned environments to explore hypothetical scenarios
  • Scans used to increase the accuracy of calculations in engineering simulations for accident reconstruction, structural analysis and fires

Investigations have been changed forever thanks to advanced technologies like 3D laser scanning. Efficiencies and advantages can be realized when information needed by investigators is readily available for future use, no matter what happens to the evidence or the scene. If you would like to learn more about different technologies that Unified Investigations & Sciences is using to enhance our investigations, visit our website at www.uis-usa.com or read more in our previous blog posts.

Please feel free to reach out to us with questions and ideas in the comments section – we love to hear from you.

Seth Behrens, P.E., Forensic Engineer and Nic Cheek, Forensic Consultant
Unified Investigations & Sciences, Inc., a Sedgwick company

 

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Can pizza really change lives? (Those of you who can’t live without pizza probably answered with a resounding yes.) This week, a few colleagues and I had the opportunity to visit a very special place where every slice of pizza served gives back to the commuAlpha_Pizzeria_Pizzanity, sparking a continuous circle of change for those on both sides of the counter.

Last April, Sedgwick partnered with an exceptional organization called the Alpha Project, which provides work, recovery and support services to those motivated to achieve self-sufficiency. The organization was working to open a pizzeria that would be housed in, and eventually supported and staffed by the residents of San Diego’s Alpha Square, home to more than 200 formerly homeless individuals.

One year later, Alpha Pizzeria opened its doors to the San Diego community; this week, we helped the restaurant celebrate its grand opening and raise awareness in the local neighborhood by hosting an evening of free pizza and soft drinks, courtesy of Sedgwick. Our San Diego-area colleagues and other friends joined in the fun. We sampled quite a few menu items and can attest that the food is delicious!  This is, in large part, thanks to local Chef Alex Caraballo, who stepped in to develop recipes and a menu that deliver outstanding flavor and quality to the patrons. Watch the video below to hear from Chef Caraballo about how the partnership developed.

Chef_CaraballoWhat truly sets Alpha Pizzeria apart from the competition is its underlying mission to empower people to regain their footing and to live independently and with dignity. The residents of Alpha Square can now learn basic culinary and restaurant skills in the on-site pizzeria and industrial kitchen. After completing six weeks of training, they can either join the staff at Alpha Pizzeria or pursue gainful employment at other San Diego establishments.

At the event, I met Margaret, an Alpha Square resident who is starting the restaurant training program this month. As she shares in the video below, she never imagined she’d be homeless and in need of a place like Alpha Square. Her desire to find a purpose for getting up each day and doing meaningful work is inspiring. People like Margaret affirm the importance of our financial support and commitment to being present at Alpha Pizzeria. The event was a terrific representation of our caring counts philosophy.

We were honored to have a plaque installed in the restaurant that recognizes Sedgwick’s support. Jay Ayala, managing director of our western region casualty team, was on hand to accept the acknowledgement from Bob McElroy, Alpha Project’s CEO and president. Jay was quick to point out that financial support alone doesn’t solve problems; rather, it takes continual investment in helping people to effect change and make goodness happen in a community.

LeviLevi was the first person to arrive at the event and join us for pizza, and hearing his story was among the most moving aspects of my experience there. He came to apply for a position. Levi told me that the Casa Raphael program, also funded and run by the Alpha Project, helped him put his life back together after a string of addictions. He shared that his life is not perfect, but whose is? Levi is in an infinitely better place than before the Alpha Project came into his life; like many others, he talked about how the organization had saved his life and that he will forever be grateful for their care and support.

Everyone who attended was inspired and encouraged by the stories of people like Margaret and Levi. The Sedgwick delegation felt the warmth and love of all those present for the celebration.

I will leave you with a challenge. Wherever you live, there are worthwhile organizations in need of your time and talents. Sedgwick colleagues demonstrate on a daily basis the power of giving back to our communities because caring counts. Give back just one hour per week or month, and you will surely reap the rewards. We must give while we can because, like Margaret and Levi, we may suddenly find ourselves on the receiving end. Pay it forward today; you will be glad you did.

Jonathan Mast, social media director, Sedgwick