Gallagher Bassett’s Bill Bower shares his perspective on industry trends in telehealth liability claims: risk and insurance

This Senior Vice President and Director of Healthcare at Gallagher Bassett Specialty shares his experience and what the healthcare industry should keep in mind moving forward.

Bill Bower, senior vice-president and director of healthcare at Gallagher Bassett (GB) Specialty, began his career as general counsel in Chicago before moving into claims, first at CNA and then Northwestern Medicine in Chicago, before coming to GB Specialty in 2021.

It is this breadth and depth of experience in law, claims and healthcare that makes Bower unique and compelling in his current role.

Bower sat down with Risk & Insurance at RIMS 2022 to discuss the future of health liability claims. During an engaging hour, Bower openly shared his thoughts on the opportunities, trends and challenges facing our industry.

A solution-oriented leader with a thoughtful demeanor, Bower is transparent and listens intently to conversation. It’s clear why he’s a success as a people’s leader and in the courtroom.

Below is a compilation of his ideas.

Telehealth Trends and Opportunities

One of the greatest opportunities right now is for providers to have the will and the tenacity to jump into delivering care through telehealth.

Bower pointed out that telehealth services are nothing new, but they have gained a new spotlight during the pandemic. Providers have had to find new ways to ensure continuity of care during lockdowns. Bower noted that organizations that don’t let the opportunity for telehealth fade away will succeed because it’s what patients want.

Bower explained how telehealth is the perfect model for many use cases, especially coming out of the pandemic. Once the lockdowns eased, many people were eager to leave the house and go to places like bars, restaurants or the gym.

Bower astutely observed that there wasn’t the same level of excitement about going back to see a doctor in person.

In addition to the need for telehealth services during the pandemic, other use cases include chronic care patients who tend to drop out of treatment because it is long-term and ongoing. For these chronic patients, the convenience and efficiency of telehealth appointments may improve their adherence to treatment.

Behavioral health services are another promising application for telehealth services – when a patient is depressed and having difficulty leaving the house, having a virtual appointment could allow the patient to receive care while he wouldn’t do it otherwise.

A new area of ​​interest is the liability aspect of telehealth claims.

Clinicians using telehealth modalities need to know when patients need to transition to in-person services — and that could be a tough call. Having policies and procedures in place can help providers make the right choice, but this is a growing area of ​​responsibility that could come with the proliferation of telehealth services.

Nuclear Verdicts Pose Difficult Challenges

Nuclear verdicts are currently one of the most difficult challenges facing health care systems.

With more than 100 verdicts exceeding $20 million over the past eight years, nuclear verdicts are becoming more common. And it’s getting harder and harder to predict which cases might go nuclear.

Bower pointed out that often verdicts are not consistent with injuries or damages, so defendants must consider ways to anticipate and confront issues, including using new trial tactics. Presenting the right argument to the jury to compel it to consider the actual damages is a challenge.

Speaking about the effect of nuclear verdicts on telehealth liability claims, Bower said nuclear verdicts are mode-of-care agnostic. Whether a service is provided in person or via a telehealth modality is not a factor.

What does make a difference, however, is that nuclear verdicts tend to result from very serious cases – an operation gone wrong, for example. And these are not the types of health problems usually treated by telehealth.

The most serious medical issues are typically managed during an in-person clinic visit versus a virtual visit, so we may continue to see nuclear verdicts resulting from traditional encounters. That could always change, Bower warned, as the use of telehealth expands.

Healthcare as a target of cybercrime

Healthcare is often seen as an easy target for cybercriminals, so hospitals and other institutions are often affected.

And because hospital infrastructure is critical to providing patient care – often a true life-or-death situation – healthcare institutions often consider paying demand during a ransomware attack to bring their facilities back online so that the patients do not suffer.

It’s about when, not if, a cybersecurity breach will occur.

Bower recommends a combined approach. Healthcare providers should develop strong relationships with their subscribers. The market is tough right now with a lack of capacity and high premiums, but when a breach occurs the hospital needs a strong response with first and third party coverage.

In particular, a first-party cyber policy includes a breach response team comprised of attorneys, forensic experts, and ransomware coverage to help organizations assess and respond effectively to an incident. of ransomware.

Strong infrastructure and procedures within the healthcare facility will help the provider gain assurance in this tougher market. With better controls, breaches are likely to be less frequent and less severe.

As cyber underwriting is now more specialized, companies following the NIST Cybersecurity Framework and who have strong cybersecurity protocols will fare better when it comes to premiums and coverage limits.

Talent risk management

Reaching and keeping good talent is an issue nationwide as we continue to navigate the Great Resignation.

Bower looked internally to describe the work environment at GB Specialty, describing a pre-pandemic virtual work model that led to a smooth transition to remote work.

And remote working conditions are now extremely attractive to people. Employees want to make a change, and they know they have options.

Bower noted that he saw the big resignation having a reverse impact on his team. He’s seen young lawyers who burn out early in their careers and start looking for a change – and they’re looking at risk and claims management. By providing challenging work in a great environment, insurance can fill the talent gap and manage talent risk.

Technology is a game-changer in managing telehealth liability claims

Intelligent automation empowers machines to take over mundane, routine tasks and frees up human brains to perform more critical thinking activities. Machines can mimic our behavior, supporting repeatable rule-based processes like data entry.

And organizations are losing talent because people are overqualified for tasks that can be done by a non-human bot.

At the same time, technology and the use of data can enable us to be smarter, better and faster. The more we can use data and engage in intelligent automation, the more efficient we can become.

Inspiration in intellectual honesty

Ending our conversation on a motivational note, Bower shared with us what inspires him: “Hard work and intellectual honesty inspire me. I learned a long time ago that I’m rarely the smartest guy in the room, but I can work as hard as anyone. I try to show it to others and I am inspired by people who work hard.

“You have to have a balance – and academic honesty inspires me. It’s true that the harder you work, the luckier you get. &

Abi Potter Clough, MBA, CPCU, is a keynote speaker, author, and business consultant focused on leadership and strategy, personal branding, Insurtech, and international risk management. She has over 15 years of experience in a Fortune 500 company with expertise in P&C operational claims leadership, lean management consulting, digital communications and Insurtech. She chairs the CPCU Society’s International Insurance Interest Group and devotes time to numerous international risk management projects. She holds numerous designations in the field of insurance. Abi can be reached at [email protected]