Claims & RM Roundtable:Business Value from the Risk Management Module

Kathy FerrisMary GrowneyErika Haskell

Agenda

• Why PI chose to use OASIS RM• What PI does with the RM module to provide true

business value to our customers• How PI uses the RM module• Who uses it at PI

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Why PI chose to use OASIS RM

• Single place to manage program details– Site, room, catering, AV, staff and speaker attendance,

registrations, waiting list, participation

• Flexible location to record, manage, and track nonrisk products and services

• Everyone in our company is able to access the information– Risk Management– Business Development Department– Underwriting– Claims

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What PI Does with RM: Overview

• Schedule courses, track participation – View schedule, details– View participation in

OASIS – Report with InfoView

• CME Transcript• RM consults via File

Notes• Business value:

– Manage offerings– Track RM issues– Identify opportunities for members: risk mitigation and

patient-safety improvement– Tracking of PI-provided CME:

• physicians and staff

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How PI uses the RM module

1Schedule classes and print/share class schedules1

3 Track class participation and reporting

4 Track consultations using File Notes

5 Evaluate cause of claims and identify potential Risk Management materials and courses to offer

2 Generate correspondence based on registrationand class participation

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How PI uses the RM module

1Schedule classes and print/share class schedules1

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How PI uses the RM module

1Schedule classes and print/share class schedules1

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How PI uses the RM module

2 Track class participation and reporting

Kirk, JamesMcCoy, LeonardPavel, ChekovSpok, CaptainUhura, NyotaScott, MontgomerySulu, HikaruChapel, Christine

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How PI uses the RM module

• Confirmation Letters• Pre-course assessments• Tip Cards• Course Surveys

2 Generate correspondence based on registrationand class participation

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How PI uses the RM module

3 Track class participation and reporting

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How PI uses the RM module

4 Track consultations using File Notes

We identify the type of contact (incoming call, email, other) with the opening characters of the Short Description.

We end the File Note with specific categories/topics we track that can be extracted in reports.

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How PI uses the RM module

4 Track call consultations using File Notes

Then we can see how many times a clinic or physician called about specific categories/topics from the File Notes.

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How PI uses OASIS for RM

• Clinical RM fields are used to identify issues that contribute to claims

• Data fields allow deep-dive reporting used to develop:

5 Identify Risk Management issues for content creation and timely consultation on mitigation

individual case studies articles long-format CME tailored interventions

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Who accesses the RM module

• PI takes a team approach to account service• Business Development Department Uses– Uses information to keep current on member

needs and activities– Demonstrates value of RM services utilized or

available included with the cost of policy

• “Thirty-five Fantastic Family Practice providers and employees participated in 15 CME courses—some more than once! That same education would have cost $4,500 out in the marketplace.”

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Who accesses RM information

• Underwriting– Renewal Risk Assessment– Monitor account commitment to risk mitigation and

quality improvement

RM Mandate – CIS or RM Participant Summary

RM Mandate – CIS or RM Participant Summary

Client Interactions – File NotesClient Interactions – File Notes

Claims information / Loss experience – Clinical RM screen

Claims information / Loss experience – Clinical RM screen

CIS & PolicyCIS & Policy

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Business value to our customers• What PI has done to use the RM module to go beyond supporting

RM but to providing information directly to members about the education services that risks and employees utilize

CME Transcript & WA State RM Mandate Satisfaction1

2 File Notes, Claims Data Analysis and Reportingto Identify New RM Materials & CME

3 Renewals, Risk Assessment, & Service Plans

4 Experix – Provide RM to Non-Insureds

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Business value to our customers

• Washington State physicians are required to complete a risk management training program once every three years.

• We track RM Mandate requirements in OASIS:

CME Transcript & WA State RM Mandate Satisfaction1

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Business value to our customers

• We provide a CME Transcript to our physicians indicating if they have met the RM Mandate

CME Transcript & WA State RM Mandate Satisfaction1

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Business value to our customers

2 File Notes, Claims Data Analysis and Reportingto Identify New RM Materials & CME

Clinical RMClinical RM

PIAA CodingPIAA Coding

Claims issuesClaims issues

File Notes Subject TypesFile Notes Subject Types

CIS Demographics for Participants

- Region- Professional

Designations

CIS Demographics for Participants

- Region- Professional

Designations

Identify Topics based on:1.Losses2.Client contact (consultations)3.Location (based on demographics)4.Audience tailoring (based on CIS demographics)

Identify types of content:1.Blog2.Articles3.Tip Cards4.CME

- In person for individual groups- Online

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Business value to our customers

3 Renewals, Risk Assessment, & Service Plans

• Risk Assessment • Service Plans

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Business value to our customers

• Track courses non-insureds take in OASIS so we can also report on this

4 Experix – Provide RM to Non-Insureds

Separate RM Customer classification for non-insureds

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RM Module Use Takeaways

• OASIS captures a wide variety of information.

• Put together, this information supports:

− Risk Management services

− Underwriting integrity

− Claims Management

− Accredited CME program

• With all the information in one place, we’re able to demonstrate the added value that Physicians Insurance members and customers have come to expect.

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Suite 702Boston, MA 02110

617-259-1200

New Jersey Office2 Tower Center Boulevard

10th FloorEast Brunswick, NJ 08816

732-353-3500

www.Delphi-Tech.comwww.OASISCustomerGroup.com (OCG Forum)