Is Sweden Ready for Digital and Virtual Care?

healthcare worker manipulating a virtual screenSweden’s healthcare system is regar- ded as one of the best in the world, with it ranking highly in relation to health outcomes and quality of care1. We are however living in a changing society with new needs and rising healthcare costs driven by an ageing population and increasing incidence of chronic disease.

In order to effectively meet these emerging challenges, healthcare must become more efficient and patient-centered. The shift beyond digital to virtual care has the potential not just to modernise the healthcare system and “do better with less” in terms of public resources and tax money, but to also improve quality and access to health services for a population with increa- sing expectations for seamless care.

Digitalisation of care is the new black

While the last few decades have seen other industries such as banking and retail becoming more efficient and consumer-centric through the use of technology, the healthcare sector is just beginning to realise the benefits of the digitalisation.

Through a survey we conducted in spring 2015, 1,034 Swedes provided us with their perspectives on digital and innovative care solutions. Their answers reveal that there is an open- ness of Swedes to use new digital and virtual care, as well as a willingness to receive care with the help of modern technologies:

1. OECD Reviews of Health Care Quality Sweden 2013

4 PwC • 2015

  • Over 40% of respondents are open to virtual care and DIY (do-it-yourself) solutions over traditional care options.
  • 33% are open to having a live visit with a physician via a smart-phone application.
  • 20% would be willing to receive care via videocalls.
  • 74% said yes to being monitored virtually via a wireless heart moni- tor if the situation called for it.
  • 43% believe that virtual care can lead to faster access to care.
  • Only 6 % were most concerned about privacy in relation to virtual care; in contrast, 41% voiced the qu- ality of care as their biggest concern.

    © 2015 PricewaterhouseCoopers


What Will Workers’ Compensation Look Like in 20 Years?

Dept. of Workers' Comp crystal ballBy Safety National

At the 67th Annual SAWCA Convention, Frank Neuhauser, Executive Director of the Center for the Study of Social Insurance (CSSI) at University of California at Berkeley, opened this keynote session by discussing the future of workers’ compensation.

Workers’ Compensation’s Inefficient Delivery

He noted that the current system does not efficiently address the issues that employers and employees face today. In 1915, the system was primarily created to support a heavily industrialized workforce, which is no longer the case.

The organizational costs associated with administering $1.00 of medical treatment under workers’ compensation is estimated to be $1.25 versus .14 cents to administer at this same level of service under a group health plan.

In addition, the use of workers’ compensation Medicare set asides (MSA) create a loss between 25-40% to Medicare and the MSA process has exposures related to it that are inefficient and have the potential to become costly.

Neuhauser recommends that a more-streamlined approach needs to be designed by the states to limit the duration of employers’ liability of two years and then assess insurers and self-insurers “fair” payment to a Medicare Trust Fund.

Improvement Needed on Controlling Non-Traumatic Claims Costs

Non-traumatic injuries make up 67% of claims and 75% of claim dollars. So where do these injuries frequently occur? An employee is four times more likely to suffer a fatal injury away from the workplace and 75% of workers are in occupations that are low hazard.


California Workers’ Compensation – North vs South


At the 2015 California Coalition on Workers’ Compensation Annual Conference, a panel discussed the huge disparity in claims costs between northern and southern California.  The panel consisted of:

    • Alfonso Moresi – Commissioner, Workers’ Compensation Appeals Board and partner in law firm Laughlin, Falbo, Levy and Moresi
    • Richard Newman – Chief Judge for the California Department of Industrial Relations
    • Mark Priven – Principal with Bickmore Risk Services

map of California showing higher Workers' Comp rates in LA areaThe litigation rates in Southern California are much higher than the rest of the state, accounting for approximately 75% of the total court opening filings statewide. Along the same lines, the number of workers’ comp judges in Southern California is also significantly higher than the rest of the state so that they can process this high volume.

For those that practice in both areas of the state, there is a significant difference in the level of professionalism and conduct in the courts and there are also procedural differences seen in the different areas. By statute, the procedures in the two areas should be the same but, in practice, that is not the case. One of the major differences is that lawyers in Southern California usually will not settle claims without an appearance before the Board. Most plaintiff attorneys in the South do not even meet with their clients until the Board hearing and they use that first Board appearance as their initial meeting spot. In Northern California, judges will sanction attorneys who show up for a hearing unprepared.

Insurance carrier rates are 11-32% higher in the Los Angeles area versus the rest of the state. This trend is only in the LA area, not the San Diego area, therefore it is not a Southern California trend.

For public entity self-insured employers, claims costs in the LA area are 15-20% higher than the rest of the state. One-third of this is due to increased frequency, and two-thirds is due to higher individual claim costs.


Mobile Apps Reduce Readmissions

July 15, 2015 | Sherree Geyer – Contributing writerRevolving door of hospital readmissions cartoon

POSTED IN: Mobile, Quality and Safety, Financial/Revenue Cycle Management, Patient Engagement, Population Health

Cynthia Deyling, MD, chief quality officer at Cleveland Clinic, sees burgeoning use of mobile technology at the health system.

While emphasizing that, of course, “some readmissions are clinically appropriate and necessary,” Deyling says Cleveland Clinic, like so many other hospitals and health systems these days, is putting a focus on “reducing preventable readmissions through improved patient education, follow up, communication and care coordination.”

Smartphones are playing a big part in helping them get there.

“We have apps in development that will support access by allowing patients to quickly identify local Cleveland Clinic resources, including on-demand scheduling,” she says. “Other tools, including apps that promote patient wellness and chronic disease management, are also in use.”

A 2014 study from the Mayo Clinic showed that patients who used smartphone apps to record weight and blood pressure – and participated in cardiac rehab – lowered cardiovascular risk factors and 90-day readmissions. According to the study, 20 percent of the app-user patients experienced readmission compared to 60 percent of patients who completed rehab only.

Another mobile technology survey from HIMSS this year suggests “healthcare organizations are widely beginning to deploy mobile technologies with the aim of engaging patients.” Use of mobile technology continues to interest providers as a way to meet requirements for meaningful use and Medicare reimbursement requirements, the study shows.

Andrey Ostrovsky, MD, CEO of Boston-based Care at Hand, developer of an app-based care coordination system, says the move toward value-based payments drives efficient use of affordable, accessible technologies, such as mobile apps.

“Our company wouldn’t exist if not for Affordable Care Act,” he says.

Indeed, the rise in mHealth technologies correlates with ACA’s plan to to reduce preventable, excessive readmissions with cuts to the Inpatient Prospective Payment System in 2012. Medicare spends more than $17 billion annually on avoidable readmissions with penalties that total up to 3 percent of inpatient claims for 30-day readmissions.


Is Horseplay in the Workplace Compensable?

By ReduceYourWorkersComp 07/08/2015

Homer Simpson workplace safety poster. No HorseplayHorseplay and lack of safety and loss control mechanisms is a significant driver in any workers’ compensation program.  By instituting effective written policies, stakeholders can take a proactive step to controlling costs by preventing unnecessary workplace injuries.


An All Too Common Hypothetical

Frank and Ralph work for Sparky Electric Company.  One day Frank is working on a power line about 15 feet above the ground in a cherry picker.  Ralph triple-dog-dares Frank to jump to a trampoline located on an adjoin property.  Frank accepts the dare, but misses the mark.  He breaks both legs and suffers a low back injury.  Are these injuries compensable?


Compensability of Horseplay

It is a common misconception that “horseplay” is not compensable.  To the contrary, horseplay is often compensable under most state workers’ compensation laws.  In evaluating these cases, courts will typically follow the rules outlined in Larson’s Workers’ Compensation Law. These factors include:

  • The extent and seriousness of the deviation;
  • The completeness of the deviation, i.e., whether it was commingled with the performance of a duty or involved an abandonment of duty;
  • The extent to which the practice of horseplay had become an accepted part of the employment; and
  • The extent to which the nature of the employment may be expected to include some horseplay.

Important to this discussion in the “prohibited acts doctrine,” and whether the employer’s policies and procedures specifically prohibit the act that results in the workplace injury.  No policy can be ironclad and anticipate every aspect of an employee’s conduct while on the job.  Certain modifications can be made to promote a safer work environment and reduce workers’ compensation exposure.


Effective Safety and Loss Controls

  • Safety Training.  The development of an effective safety-training program for all employees is the first step to reducing unnecessary claims in any workers’ compensation program.  This training must incorporate all new employees and follow-up programs tailored to the needs of existing persons.  Information and assistance on these program is typically available free of charge through a state department of labor or other entities concerned about worker safety.
  • Incentive Programs.  Employers and other stakeholders concerned about worker safety have seen immediate success in the reduction of work injuries through incentive programs.  These incentives include financial bonuses for the reduction of work injuries, as well as other fringe benefits.
  • Accident Investigation.  Workplace accidents do happen.  This is why it is important for an employer to respond to them in an effective manner.  Part of this includes empowering employee’s to have confidence that when an incident is reported, it will be properly investigated and resolved with understanding and compassion.
  • Other Safety Programs.  Any safety program requires buy-in from supervisors and management.  If this takes place, the culture of safety will dominate a workplace and the results will trickle-down to other employees.

Communicating Effectively to Different Generations

By Safety National 06/09/2015 09:12:00

Learnincartoon about multi-generational workforceg the differences in communication preferences that vary between Baby Boomers, Generation X and Millennials can help you manage these generations more effectively. This session at PRIMA’s 2015 Annual Conference explored generational differences and how to best communicate to each of them.

Moderator:  Sean Schaefer, Assistant Vice President at GenesisSpeaker:  Candy Whirley, Owner of SBG Services, LLC

The current generations in the professional workforce are broken down into Baby Boomers (born 1946 – 1964), Generation X (born 1965 – 1980) and Millennials (born 1981 – 2000). Effective communication occurs through the following five stages:

1. Awareness

  • Boomers – Discuss business need allowing opportunity for questions.
  • Gen X – Discuss business need providing background and facts.
  • Millennials – Convey personal and business benefits.

2. Understanding

  • Boomers – Create shared meaning and convey common goals.
  • Gen X – Paint a picture of the future and describe goals.
  • Millennials – Collaborate through discussion forums and open dialogue.

3. Acceptance

  • Boomers – Encourage questions and reply objectively to challenges.
  • Gen X – Involve people in exploring the impact and benefits.
  • Millennials – Coach, mentor and provide immediate and ongoing feedback.

4. Alignment

  • Boomers – Build support for behavior, organizational goals, business results and rewards.
  • Gen X – Clarify expected behavior, organizational goals, business results and rewards.
  • Millennials – Illustrate expected behavior, organizational goals, business results and rewards.


Impact of Autonomous Vehicles

Safe Texting While Diving at Last?

illustration of futuristic self-driving carsBy Safety National 06/10/2015

At the 2015 PRIMA Annual Conference, Jeff Myers and John Willemsen from Munich Re America presented a session titled “Autonomous Vehicles: The Largest Impact to Transportation and Infrastructure”.

The NHTSA classifies five levels of vehicle automation from Level 0 – no automation to Level 4 – no human intervention needed.  Most vehicles are Level 1 with some automation (anti-lock brakes). Many vehicles are Level 2 (lane centering, auto braking, blind spot warnings). The Google Car is Level 3. Most manufactures are developing a level of automation for their vehicles. Tesla indicates they will have an autonomous vehicle on the road by the end of 2015.  By 2035 the expectation is that 25% of vehicles on the road will be autonomous.

There are moral and ethical implications associated with these vehicles. In a potental collision situation, the vehicle could have to decide whether the priority was to protect the vehicle occupants or a pedestrian in the path of the vehicle. For example, if the vehicle swerves to avoid a pedestrian, it could strike something and kill the vehicle occupants instead of the pedestrian. This is something that will have to be considered when programming these vehicles.

94% of vehicle accident are caused by driver error.  In the US alone there were 5.6 million accidents in 2013 and almost 33,000 fatalities. There is a significant portion of the US economy devoted to recovery from auto accidents including towing companies, body shops, attorneys, parts suppliers, and medical providers. 16% of all organ donations come from death associated with auto accidents.

Autonomous vehicles are already being utilized in hazardous industries such as mining. Mercedes has a self-driving truck that they are currently testing. If this technology becomes widespread, it would completely revolutionize the trucking industry.

Insurance companies are concerned about the impact this will have on their bottom line. Appoxmately 40% of Property & Casualty  premiums are derived from auto insurance. With most accidents caused by driver error the technology should cause a significant decrease in accidents. On the liability side, with autonomous vehicles, the liability shifts from the driver of the vehicle to the manufacturer who supplies the technology.


California Officials Continue Major Emphasis on Workplace Safety


Cal/OSHA logoThe nation’s most populous state continues to emphasize that employers must make for safe working conditions for those under their employ.

In late April, Workers’ Memorial Day 2015 honored the men and women who were injured or died on the job in California and throughout the world. This international day of remembrance and action is held annually on April 28, the date when Congress passed the Occupational Safety and Health Act of 1970 which promises every worker the right to a safe job.

“On this day we renew the nation’s 45-year commitment to workplace safety and remember the California workers who lost their lives while on the job,” said DIR director Christine Baker. “Employers who maintain safe working conditions are building a more prosperous California by protecting workers and preventing costly injuries.”

Cal/OSHA, which is a division of DIR, was established in 1973 as a state-run program to enforce effective standards, assist employers to establish and maintain safe working conditions, and to provide information, research, education and training in occupational safety and health.

It was the first in the nation to adopt an Injury and Illness Prevention Program (IIPP) standard in 1991 and the first to adopt a heat illness prevention regulation in 2005, followed by high-heat regulations for some industries, including agriculture, construction, landscaping, and oil and gas extraction, in 2010. This innovation is part of Cal/OSHA’s ongoing effort to identify workplace hazards before they result in trauma and loss.

“Cal/OSHA is dedicated to preventing workplace injuries and illnesses through a multifaceted approach that includes education, outreach, permitting, licensing, consultation services, and development of new occupational health and safety standards, as well as strong, clear, and consistent enforcement,” added Cal/OSHA Chief Juliann Sum. Cal/OSHA has initiated other significant safety programs. Continue reading California Officials Continue Major Emphasis on Workplace Safety

Is Your Mobile Workforce Driving Up Your Exposure?

One text or call could wreck it allThis session at PRIMA 2015 addressed the various risks related to having a mobile workforce and explored strategies for accident prevention. Speakers included Michael Fann, ARM-P, TML Risk Management Pool; Matt McDonough, CSP, Safety National.

Due to technological advancements, the workforce is now more mobile than ever, but these devices can be distractions and can drive up your exposure. The leading cause of workplace fatalities is roadway incidents, followed by violence, slips, trips and falls, and contact with objects. In 2013, 1,099 people lost their lives to fleet incidents. Distracted Driving has caused 421,000 injuries and 3,328 deaths in 2012, and 424,000 injured and 3,154 deaths for 2013.

Distracted driving is a major risk that employers with a mobile workforce face today.  Distractions can range from cell phones to street signs.

Here are four solutions to keep your mobile workforce safe and to eliminate distracted driving:

Driver Education/Training

There are several programs available designed to help minimize these risks through an online simulation. Courses like these address distracted driving awareness and safe driving techniques.


Telematics is a crash resistant black box installed in the vehicle that records information during driving. Some have a camera that is turned on when triggered by a hard break. This information can be very useful for employers who cannot ride with the drivers all the time.

1-800 Driver Programs

Everyone has seen these “How’s my Driving” signs are the back or side of vehicles.