It's that time of year again -- this year the RIMS conference heads to Philadelphia, PA and Emerson Software Solutions will be exhibiting again!
Schedule a time to stop by booth 1865 to see some of the new innovative features within eRIMS2, including:
- Enhanced Workflow Management
- eRIMS2 Mobile for Smart Phones and Tablets
- Smart Policy Management
- Healthcare Incident Management
- Microsoft Outlook Integration
- Claims, COI, Property management and more!
We often get calls or requests for product demonstrations from Risk Managers who aren't sure if they are going to go "all in" and purchase a RMIS. After all, there are definite thresholds that neccessitate investing in a system to manage claims, properties, polices and more.
With decades of experience, some of the folks here at Emerson put their heads together on some high-level guidelines when starting the process of looking at a new Risk Management Information System.
The Official RMIS Buyer's Guide steps through some of the common questions and aspects that go into the decision to purchase a new RMIS. Some things that are covered include:
- How to start the process of looking at vendors
- What is "the Cloud"?
- Varieties of user licensing
- Reporting and Analytics
Best of all, it's free. Just click the button below and we'll email you a copy today.
Being in business for over 22 years, one of the most unique (and frankly, interesting) industries for Risk Management is Healthcare. With such a spotlight of attention being placed on healthcare organizations to lower costs and increase quality and safety, it's a very dynamic and fast-paced environment to be involved in Risk Management. Drilling down to the root causes of events and near-misses is a big part of staying ahead of the Healthcare risk, quality and safety curve.
These are a few ways to be sure a healthcare organization is utilizing their risk management technology to fully optimize it's effectiveness.
- Simplicity. Is the task of entering a patient event or near miss simple for nurses and other employees? Does the risk management solution provide for the ability to record accident information into a mobile device, that allows for ease of photo, video or audio documentation?
- Automation. Each event should be automatically routed for investigation, review, follow-up and approval as necessary. Work-flow automation within the risk management technology should provide a means for this to occur.
- Really Powerful Analytics. By turning event data into valuable information, smarter decisions can be made, and safer care provided.
Risk Management Information Systems (RMIS), depending upon how the company utilizes the system, can become either a tremendous benefit, or overwhelming burden. As business complexities continue to increase, organizations are faced with the challenge of managing their chainging risks; regulatory compliance, incident and claims management and property exposures.
Is your Risk Management Software Holding your Organization Back?
Despite the innate purpose of a RMIS, (which is to improve operational functionality of an organization, while decreasing costs and overall risk), improperly designed, chosen or integrated systems can actually hold an organization back.
Consider the following questions:
- Does your organization allow an outdated system to dictate inefficient processes?
- Does your organization currently settle for bad data or reports, forcing you to seek needed information elsewhere?
- Has your organization been scarred by bad implementation, resulting in settlling with a bad RMIS system?
If you have answered “Yes” to any of these questions, you are likely being held back by your current risk management software platform. And, it is possible that you have become disenchanted with the idea that risk management solutions can provide true value for your business.
How Risk Management Software can Benefit your Organization
After considering what your RMIS platform shouldn’t do, it is time to switch gears to focus on what it can do for your organization. Properly implemented and managed risk management software solutions can enable your organization to:
- Proactively identify and address risks discovered throughout the enterprise
- Prevent operational issues commonly resulting in financial losses
- Provide real-time information, providing increased visibility into the area of risk exposure
- Enhance individual accountability across all departments
- Enforce organizational standards as defined as well as implementation consistency
- Rapidly assess and address risk reduction and/or process improvement opportunities as they are presented
Your RMIS software doesn’t have to be, and shouldn’t be a burden to your organization. Proactive behaviors coupled with the investment of time and resources, are the keys to risk management software resulting in success for your business.
Profitability and Risk Management: How RMIS systems CAN Drive Profit
In a challenging economic environment, company leaders must continue to focus on driving revenue growth, while searching for new, proven risk management methods. To accomplish this, organizational leaders in partnership with their finance departments are looking for ways to marry their need for accurate reporting data with the need to mitigate risks. By fostering risk and finance alignment, organizations can boost profitability.
Successful alignment occurs when risk and finance see eye-to-eye. The primary barrier to reaching alignment is poorly integrated systems. A proven solution to help facilitate commonalities across processes is risk management information system (RMIS). In addition to fostering communication clarity and integrated systems, an RMIS platform CAN also drive profit.
RMIS Systems Drive 4 Primary Profit Opportunities
While there is certainly a cost involved in any software platform implementation, it is important to consider the net cost of the program, taking in any opportunities for boosting profit, into the equation. Successful RMIS implementation offers four primary opportunities for boosting profit, including:
1. Process Improvement- Enhanced efficiency across risk management processes presents the opportunity for a more profitable workforce, ultimately affecting your bottom line in a positive fashion.
2. Freed up Capital- Attention to risk management detail often presents opportunities for organizations to re-negotiate their letters of credit, freeing up capital for other areas of the company.
3. Enhanced Decision Making Capabilities- Decision making is often only as good as the outputs utilized to finalize corporate strategies. Through enhanced data accuracy and clarity, organizations are better poised to make strong business decisions.
4. Increased Work Safety- Cause analysis and thorough review of incident trends can lead to enhanced safety programs within the workplace. Fewer accidents equates to fewer dollars spent.
Leading industry executives will continue to search for methods to integrate their finance and risk management areas in an effort to not only monitor expenditures and financial opportunities, but to drive their bottom line profit margins. Implementation of an RMIS platform is a proven strategy that CAN boost your organization's bottom line profits.
Claims Management Systems - Do they Aid the Claims Process or Dictate it?
Executives of any business are focused on two priorities- profitability and growth. Top tier executives focus on the same priorities; however, the concept of risk management is top of mind as each and every decision is made. While some initially view the area of risk management as a cost center, top executives understand that without efficient processes developed to manage risk, their business’s bottom line is at risk.
Claims Management- The Hidden Opportunity
While risk management encompasses virtually all parts of a business enterprise; compliance, safety, claims, policies and audits, one of the most overlooked opportunities for a business to not only reduce costs but to gather vital information needed to make business decisions is the claims process.
The data collected through the claims process over time can provide insights into product trends, liability risks, health and safety risks and even organizational behavior. However, the information is either not collected during the process or it isn’t properly utilized.
Claims Management System Implementation
Implementing a system that isn’t tailored to a company’s processes can be a hindrance. Successful claims management systems don’t dictate how you will resolve claims; they simply work in partnership with existing processes to produce more efficient resolution outcomes.
To integrate a claims management system that provides value and improves performance, begin by examining the state of your current data’s integrity. Next, define what organizational structure within the area of claims will best match your organizational goals while producing cost effective performances. Evaluate your current claims management processes, noting those that are effective and those with opportunity for improvement. Implement a system in alignment with your processes, scheduling focused data review points to extract valuable trends resulting from your changed processes.
Claims management should be addressed with the same focus and attention to detail as any other corporate function. The results from successful implementation will be a balance between operational efficiency and cost reduction, without the unnecessary sacrifice of important data collection and analytics, needed to make organizational decisions.
You’re taking the big step, researched and purchased a new RMIS system. The old system was slow, couldn't keep up with your claims management needs and the service you got varied...depending on who was answering the phone on the particular day you called. Your CFO is excited about the new risk management system and wants it up and running yesterday. You’ve spoken with the RMIS provider's implementation team on a conference call and kickoff is next week. Now what?
Here are three thinks that should be avoided unless you want to assure RMIS implementation failure:
- Don't involve your users
Without user involvement there is no commitment to a project. Without user commitment it is nearly impossible to define project scope and requirements therefore dooming the project before it ever gets started. Put together a team of stakeholders that want the system to succeed and are committed to making this happen.
- Loosley define Requirements
Vague or inadequate requirements will result in a Risk management system that does not meet user needs. This is often the reason companies state their new system does not work. A thorough analysis of user requirements and development of associated test cases to confirm the requirements are met is essential to success.
Software cannot meet needs that are not identified up front. So it is important to invest sufficient time to determine customer needs and how the system will fulfill those needs. Take time to determine what the system is supposed to do before you begin to configure it. Unfortunately, projects often get started before this task is complete in order to meet hard deadlines.
- Tolerate Scope Creep
A sure way to derail a RMIS project is to tolerate scope creep without taking change control into account. Obviously, priorities often change in a Risk Management department, and often times, it happens mid-stream during an implementation. Without instituting a clearly defined change control process, deadlines are likely to be missed while waiting for software to be reconfigured based on additional needs.
Part of every implementation of eRIMS2, Emerson Sofware Solutions' RMIS web-based software, includes a full project team that manages the implementation from start to finish. Our implementations are much faster than that of our competition, partially due to the ability to asist clients in avoiding these and other pitfalls.
Have other ideas? Let us know! Any good "cat herding" stories?
You have a risk management system and need data in your system to make it work for your company. Your TPA and/or Insurance Company have your claim data. How can you get the TPA/Insurance Company data into your system so you can do your risk management analyses? Let’s take a broad brush look at the 8 steps you will need to take to accomplish populating your system with data.
- Communicate with your TPA/Insurance Company about your desire to receive data from their system in a format that you can import into your system.
- The TPA/Insurance Company will typically work with you to meet your request, however; there have been instances where they at first seem cooperative, only three months go by and you haven’t gotten past this step – so be diligent when necessary.
- Upon reaching an agreement with the TPA/Insurance Company, you will receive their data transfer specifications which includes a specific file format and a copy of their code tables (translation tables for the data that is stored in coded form, such as storing ‘01’ in a state field instead of ‘Alabama’). Note that each TPA/Insurance Company have their own format; there is no current agreed upon standard, electronic data interchange (EDI), file transfer format for risk management data. To reduce headaches and project timelines, ensure that you get the latest version of the file transfer specifications documentation from your TPA/Insurance Company and are aware of upcoming changes.
- Mapping of the TPA/Insurance Company file formats and translation of the code tables into your risk management system’s data format will need to be performed. Make sure representatives from the TPA/Insurance Company and your IT shop are communicating to answer questions about code translations from one system to the other and to define fields that may appear to be ambiguous. Ensure the data you need to run your system properly are available in the data feed from the TPA/Insurance Company. In some instances, the TPA/Insurance Company can provide additional data on an as needed basis.
- Software will need to be developed from the mapping in the previous step to read the file and translate the data and codes into your risk management system.
- Protocols, timing and procedures need to be established for the data file transfer. In most instances the data files are PGP encrypted and are transferred via FTP push (data sent to your server) or pull (data retrieved from their server) protocol model, based on what the individual TPA/Insurance Company makes available.
- A test phase will ensure that the data are being read properly into your risk management system by verifying, on a macro scale, the number of claims imported, totals on transaction values for specific dates and a count of notes per claim. On a micro scale, verify individual data fields between your risk management system and the TPA/Insurance Company system.
- Setup the procedures to run automatically and let the process begin. Periodically verify the import, at least on a macro scale, to ensure that you are receiving all of the data that you think you should be receiving.
There is a discussion group on LinkedIn entitled “Risk & Claims Data Conversions And Interfaces” that shares best practices and ideas for risk, claims and insurance data conversions as well as interfaces.
How often have any of us in Risk Management heard about or been in conversations surrounding senior leadership making Risk Management a priority (or not so much of one)?
"If I could only get our CEO to understand how important it is that we hire a Claims Manager..." It's almost as if there's a bit of "Red Headed Step-Child" mentality throughout the industry.
Why? I see three main reasons:
- Personalities. The typical CEO is your "Type A" who doesn't want to focus too long on anything that distracts from the most important priorities: profitability and growth. In the short run, Risk Management is typically seen as a cost center, so Mr. Big sees it as somewhat of a necessary evil. With this being the case, how likely is it that a company with such a mentality going to invest in a strong, independent and driven Risk Manager?
- Most Risk Managers are spread thin. Let's face it, Risk Management encompasses virtually every single department and aspect of a business. While having the intention of setting aside five to ten hours a week for a month to focus on a RMIS implementation or Safety Training Program, it's far from reality. When you're responsible for audits, schedules, policies, captives, claims, (including the lost time claim where Ned Jones wasn't wearing eye protection while using the grinder in one of your fifteen plants), board presentations, safety, driver training, compliance, and as we've seen lately, tornadoes and earthquakes, life often gets boiled down to managing the biggest fire raging at that second. Oh yeah...you also need to convince senior leadership that we can help drive profitability.
- Lack of Sales experience in the Risk Management department. People running businesses have a limited view of the businesses that they run. It's a fact. Often times (if not most), the opportunities and threats that they are presented with by their direct reports will fall in line with what they WANT to hear. Ever wonder why you can't get your proposed budget approved to tackle the 18 day accident reporting lag time problem? There's a good chance that its because no one above you cares as much or understands the problem as you do.
While the C-suite has made tremendous strides in recent years in supporting, adopting and promoting risk management efforts, there is often still that misconceptions that risk management is "a foot on the brake" when a company is trying to go faster.
Over the next few weeks, we'll discuss some of the points above in more detail, and some ideas of how to overcome them.
Disagree with some (or all) of my assertions? Great! Let us know your thoughts.
So, I'm sitting at my desk slowly absorbing warm life from my first cup of Keurig of the day when the phone rings. "Are we getting good claims data from Holder TPA for the University of West State system? You need to get on top of that."
Sweet. My first failure of the day and I can't even feel my toes yet. What is it about getting computers to talk to each other that's so complicated?
It turns out, that idiot-savant on your desk may be able to calculate pi to the nine thousandth decimal in a second, but ask it to swap baseball cards with its equally digital brethren and you might as well be trying to convince your teenager that Facebook is actually a "public" forum. Great!
The labyrinthine vagaries of chip to chip data transport can be pretty esoteric in the details. I "overheard" the following exchange on an import blog ... "The first error is due to the fact that you are trying to import an Oblivion mesh without first removing the Bethesda-Havok blocks ...". Come again Commander Data? Did the Borg get my records?
A big part of getting a good data exchange going between a TPA or Carrier and a RMIS is nailing down the basics up front. As usual the "four W's" loom large as a handy dandy checklist for getting started.
- Who do we need to talk with?
- What data do we need from each other?
- Where should I put it when do I get it?
- Why is this data important to our client's operation?
Getting these questions answered up front can prevent your rasterizer from clashing with your connectagazoink down the road. I'll be expounding and pontificating (as I am wont to do) on the "four W's" when I get Holder TPA vs. UWS out of divorce court and back into counseling, and finish my coffee.
I'm interested to hear about your experiences with and perceptions of claims and risk management data exchanges. Is it a squeaky wheel that's burning all your grease or do things just hum along for you? Hopefully, it's a little better than this:
Inquiring minds want to know.