MHA Workers Compensation Reciprocal

Transcription

1 MHA Workers Compensation Reciprocal Insurance Solutions A better way to acquire Workers Compensation Coverage Casualty Insurance Provider 113

2 About the Reciprocal SHARING A COMMON VISION THAT THERE IS A BETTER WAY TO PROTECT EMPLOYEES AND THE FINANCIAL WELL-BEING OF HEALTH CARE ORGANIZATIONS Montana s hospitals have faced difficult challenges with few options for workers compensation insurance coverage for many years. As the market continues to be unsettled, workers compensation premiums are subject to unpredictable pricing fluctuations. In response to these market irregularities, the MHA Ventures Inc., collaborated with member hospitals to create the Reciprocal. Structure of the Reciprocal Strategic Goals Build strong relationships with Subscribers by understanding their needs and priorities. Provide a mix of services and vendors that continually meet the needs of Subscribers and CASUALTY INSURANCE COMPANY OFFERING EXCESS WORKERS COMPENSATION COVERAGE The Reciprocal is organized and exists under the laws of Montana for the purpose of enabling its Subscribers to inter-insure by exchanging contracts of insurance. The difference in the Reciprocal model over a traditional insurer is a move away from the profit driven commercial model. The focus of the Reciprocal is long term stability and the efficient delivery of workers compensation protection by reducing losses through aggressive risk management. This is achieved through an outstanding loss control and risk brings them value. management program provided by Brentwood Services Administrators, a Reciprocal Ensure that MHA members have a high level partner. of awareness of the Workers Compensation Reciprocal and the services we offer. Earn Subscriber loyalty by measuring SERVICES OF THE MHA WORKERS COMPENSATION RECIPROCAL satisfaction, continuously improving loss One of the Reciprocal s most significant competitive advantages is the depth and breadth control performance, claims management, of specialized knowledge and services it provides through key partners. The experience of and other services we offer. these professionals combined with a solid understanding of the unique needs of Maintain a strong market presence by remaining innovative and flexible in our Montana s hospitals has provided significant improvement in prevention of injuries, decrease in claims, and stabilization in the cost of workers compensation. approach to program and service development. Achieve stabilized pricing for members who purchase our products and services. Maintain a strong financial position that will enable the program to grow and mature. Sharing a common vision 114

3 INTERESTING FACTS Closure rate is 91% on claims for the MHA Workers Compensation Reciprocal for the past 3 years. The Reciprocal reduced frequency of injury by 22% comparing 2011 to 2010 and 41% improvement since year Average cost per MHA claims, life of claim, closed in 2011: $10,950. NCII 2011 on Montana State advisory form states the average medical cost per claim at $42,000. CLAIMS MANAGEMENT PREVENTION FOCUSED Reviewing loss information, studying five year trends, developing a mutual action plan with the facility, completing a hazard assessment of each facility and working with safety committees are all things that we do to prevent future injuries to our employees. Claims Management is designed to support Subscribers when a claim is filed. The experienced staff at Brentwood Services Administrators evaluates the circumstances, establishes communication with the claimant and their provider, and the Subscriber. The claims manager conducts a comprehensive review of the circumstances surrounding the incident; this process is designed to protect the claimant and the Subscribers organization. The claims manager s assessment will evaluate the merit of the claim, establish reserves, and if necessary, enlist legal services. RISK MANAGEMENT AND LOSS CONROL These are key elements in containing the cost of workers compensation insurance. TRAINING WORKSHOPS Brentwood Services Administrators conduct an initial site visit for all prospective Training workshops are conducted by the risk management and claims administrators annually for Subscriber staff working with workers compensation issues. Special training for specific issues may be requested by a facility. Brentwood provides a minimum of quarterly onsite visits to each Subscriber s facility to Subscribers to establish a baseline of the organization s risks and loss issues. Thereafter, evaluate risk management concerns, measure progress on action plans, and make recommendations to enhance risk management programs. The following are a few of the services that Brentwood Services Administrators provides: On-site visits which included complete hazard survey. Spring Conference Education. Quarterly loss prevention activities. Reporting on loss, frequency, trends to see where changes can be made. Special training requested by facilities Safety Materials, PowerPoint s, toolbox safety topics and safety videos specific to hospitals have been developed and made available to Subscribers. Attending Safety meetings at Subscriber facilities upon request. Face to face review of claims. Assistance in training new employer/hr personnel for Workers Compensation purposes Prevention Focused 115

4 SUBSCRIBER SAVINGS ACCOUNTS Reciprocal Subscribers each have an established Subscriber s Savings Account (SSA) that is created from excess funds available at the end of the year. In 2010 and 2011, a portion of these funds were used to offset one quarter s premium for each Subscriber. Based on a formula worked out with the Insurance Commissioner s office, the SSA accounts should continue to grow and provide funds to offset future premiums. CURRENT MEMBERS The MHA Workers Compensation Reciprocal is currently comprised of 6 hospitals throughout Western Montana. Barrett Hospital and HealthCare in Dillon Clark Fork Valley Hospital in Plains Deer Lodge Medical Center in Deer Lodge Mineral Community Hospital in Superior Northern Montana Hospital in Havre Pondera Medical Center in Conrad JOIN US! To request an application form, please contact Kim Wiens at kim@mtha.org or call JOIN WITH US TODAY! MHA WORKERS COMPENSATION RECIPROCAL TH Avenue Helena, Montana Dick@mtha.org or Kim@mtha.org www. Mtha.org 116

5 Yellowstone has the game winning plan for hospital liability insurance and risk management. We understand the X s and O s of insurance and risk management for hospitals! Yellowstone Insurance Exchange, RRG is a member owned professional and general liability insurance company managed by member hospitals to serve their liability insurance and risk management needs. Our primary objective is to ensure the availability of liability insurance and to maintain premium stability over the long-term. Yellowstone offers more than simply insurance. We take a proactive approach to the entire insurance process by reducing the likelihood of a claim before it occurs. Through our superior risk management services and in-house claims handling, we ensure Yellowstone has your hospital s future at the forefront of our intentions. By altering what has been thought of as a commodity based, lowest price wins perception, Yellowstone has developed a way to turn professional and general liability insurance into a profitable investment for rural community hospitals. As a result, any net income for the company is distributed back to the member facilities in the form of Subscriber Savings Allocations. To date, Yellowstone has paid out over $5.0 Million in Subscriber Savings Allocations and over $5.3 Million in returned capital. Our focus is to provide hospitals with ongoing access to fair, affordable coverage while protecting your facility and your reputation kellyc@yierrg.com 10 YEARS

6 Products Hospital Professional Liability (HPL): Provides protection for your facility, employees and volunteers for a claim brought against your hospital for malpractice stemming from services your facility provides. General Liability (GL): Protects hospitals against payments as the result of bodily injury, property damage, medical expenses, libel, slander, the cost of defending lawsuits, and settlement bonds or judgments required during an appeal procedure. Medical Billing Errors & Omissions Liability (Medical Billing E&O): Provides coverage for common regulatory actions such as Recovery Audit Contractors Program Audits (RAC), Medicare audits, Allegations of Non-Compliant Patient Referrals (STARK), Emergency Room Treatment (EMTALA), and alleged violations of Patient Privacy (HIPPA). As part of the coverage and included within the limits of liability are any associated defense costs. You will also have access to leading specialists in the area of RAC as well as shadow audit teams to respond to any allegations under the Federal False Claims Act. You will be assigned defense counsel with special expertise. Privacy Protection & Security Coverage: In today s technology driven world, it is imperative hospitals protect themselves. With data security breaches and employee data being compromised at an alarming rate this coverage provides timely security to our members. Coverage provides for forensic and legal assistance from a panel of experts, notification to those parties who must be notified under law, and credit monitoring. Claims Services At Yellowstone, we understand the importance of protecting your community as well as your reputation. Clearly, some claims have no merit. Should a claim occur, the experienced claim staff carefully evaluates the circumstances, establishes ongoing communication with the member, and begins a comprehensive process designed to prevent the payment of claims without merit and to contain the cost of legitimate claims consistent with fair and ethical industry practices. No one likes surprises. So unlike many insurance carriers, Yellowstone does not act without your knowledge. You will be involved in the claims process from start to finish, every step of the way. Risk Management Services Yellowstone s risk management team is dedicated to improving quality care and decreasing the likelihood of a claim. Risk Management is a key element in reaching these goals. Our risk management specialists conduct periodic onsite visits to evaluate your health care organization and make recommendations to enhance your risk management program. In short, Yellowstone helps translate information into solutions and makes consulting, data management and training resources available at no cost to member hospitals. 118