Brokers and Agents
PointRight welcomes Brokers and Agents to this page as we have designed this specifically for you. On this page you will find tools to help you understand our business as well as tools to support you in yours.
What is MDS?
What is DIA?
Insurance Services – Frequently Asked Questions
Why did PointRight get started in analyzing liability?
We have been providing data analysis to nursing homes for 15 years. In 2004, we began to focus on helping nursing homes reduce their professional liability exposure by improving their quality and identifying high-risk situations. We assembled a database of nursing homes’ professional liability loss histories so we could do predictive modeling on who gets sued and why. So far, we have collected loss data on more than half of the nursing homes in the US.
What sort of information and tools are available to measure and manage risk?
We have methods to measure and stratify risk. The quantitative analysis allows us to identify which risk management programs will have the most impact on risk reduction. For example, our underwriting analytics make use of a comprehensive database of public and private information such as occupancy, payer mix, staffing analysis, survey results, survey deficiencies, and measures of structure, care processes and clinical outcomes. These are combined with data elements of known predictive value that are systematically extracted from the application and the loss history. Through our diagnostic process, a facility’s performance is benchmarked against that of other facilities within its state, survey district and rating territory. Potentially modifiable risk factors that deviate adversely from the benchmarks and have significant impact on risk are identified, and a risk management prescription is developed that focuses on those factors.
For risk management, a facility may make use of its Minimum Data Set (MDS). The MDS is part of the federally mandated process for clinical assessment of all residents in Medicare or Medicaid-certified nursing homes. This process provides a comprehensive assessment of each resident’s functional capabilities and helps nursing home staff identify health problems. Our tool analyzes MDS records and identifies risk in the residents. The tool is focused on high-risk monitors and identifies residents who are likely to have a fall, who suffer with pressure ulcers or who are near end of life.
Another risk management tool combines incident tracking with analytics to provide powerful risk management insight for facilities. By quickly capturing adverse events, monitoring and managing them, the potential for litigation and loss is greatly reduced. Our Incident tracking system combines real-time data with investigative incident management tools for use by facility administration and their claims counsel. These tools provide objective incident reporting, proactive steps for intervention and the ability to immediately communicate with risk management, legal and corporate administration at the time a negative event occurs.
How can claims analytics impact program profitability?
Each carrier or captive is different when it comes to managing claims. Some do it themselves and others use a third-party administrator (TPA). Some will fight everything, some ignore issues, and some pick the lawyer with the lowest hourly rate. Using analytics, you can efficiently triage the claims and decide whether each claim needs to be settled promptly or be defended.
When a claim occurs, how can a facility determine its defensibility?
If there is a claim, in several hours, tools—via the use of models—can analyze how bad the claim is for the facility. We can determine whether the facility will have trouble defending itself (because of its track record), or whether this claim is unusual and there is a good case for defending it.
How can you help a facility when proving the cause of the claim?
Getting to the heart of the claim and figuring how much it may be, or whether it should be settled, is a key point. By using data analysis to remove emotion from the case and by presenting the raw facts, the case may be able to be settled. While the family may be very upset, the situation may have been inevitable based on the health condition of the resident. We perform an analysis that looks at a resident and compares them to the rest of our database to see what the likely outcomes are for similar situations.
How can loss analytics lower settlements?
By analyzing the loss itself, we can lower the cost of the claim. The combination of quick action and good analytics has taken a case that could have resulted in a $75,000 lawsuit and settled it for $10,000. In this case, a facility was being sued for allegedly providing inadequate care planning and having no fall prevention program. Analysis of the MDS record for the resident uncovered that the resident’s overall health and low propensity to fall compared to a national benchmark supported the facility’s decision not to restrain this resident because the likelihood of a fall was low. Showing analysis like this to an attorney can save significant money in the long run.
How can carriers detect a ‘lucky’ versus ‘unlucky’ risk?
Lucky is someone who is not a very good performer but hasn’t gotten sued yet. Unlucky is someone who is performing well but something unexpected goes wrong. If facility risk can be measured, you can determine whether a claim was just bad luck or if it could have been prevented. If there is an area where the facility is lacking, pressure can be put on the facility to make changes. The data makes the situation clear. With this in mind, you can run a portfolio with a much greater degree of predictability of when you should expect claims and when you will need funds for the claims. Luck is eventually going to run out which could result in a disaster.
How can you help facilities to invest in the right places?
Our models allow a much more in-depth and quantitative view. The models mathematically identify the areas of risk, and where facilities will get the greatest monetary impact from risk management dollars. PointRight’s tools and the risk models allow facilities to monitor and measure the impact of their programs.
How can following the claim through every stage, from underwriting to claims handling and back, make a difference?
Measurements and rewards are very important. If you understand where a facility is exposed in the underwriting process, you can give it leverage points in the risk management process and protect it when losses come back around.. Seeing the whole picture can provide a valuable insight to where the captive should target its funds. If a facility has a problem with complaints, work on communication strategy. What directs the attention of the facility is when the claim becomes a teachable moment.
