Public Risk January/February 2021 by Moire Marketing Partners

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION JANUARY/FEBRUARY 2021

Navigating Port Risk PAGE 6

ALSO IN THIS ISSUE

MEET EDDIE C. BEECHER

Winner of the 2021 PRIMA Pioneer Excellence Award! PAGE 11

THE FUTURE OF INSURANCE INÂ THE AUTONOMOUS VEHICLE INDUSTRY PAGE 12

SPECIALIZED EXPERTISE PLAYS A KEY ROLE IN COMBATING OPIOID USE DISORDER FOR INJURED WORKERS PAGE 16

YOU COULD BE HERE

Public Risk Management Association

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JANUARY/FEBRUARY 2021 | Volume 37, No. 1 | www.primacentral.org

CONTENTS

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.

PRESIDENT Sheri D. Swain Director, Enterprise Risk Management Maricopa County Community College Tempe, AZ PAST PRESIDENT Scott J. Kramer, MBA, ARM County Administrator Autauga County Commission Prattville, AL PRESIDENT-ELECT Melissa R. Steger, MBA, CRM Asst. Dir., WCI & Unemployment Ins. University of Texas System Austin, TX

Any Port in a Storm:

NAVIGATING PORT RISK

DIRECTORS Forestine W. Carroll Manager of Risk Management Memphis Housing Authority Memphis, TN Lori J. Gray Asst. Director of Finance for Risk and Wellness Services County of Prince William Woodbridge, VA JamiAnn N. Hannah, RMPE Risk Manager City of Gallatin Gallatin, TN Laurie T. Kemper Sr. Risk Management Consultant City/County Insurance Services Salem, OR Adam Maxwell Director of Admin Services City of Westerville Westerville, OH

By Joe Jarret

Michael S. Payne, ARM, HEM Risk Manager City of Reno Reno, NV

11 Meet Eddie C. Beecher

WINNER OF THE 2021 PRIMA PIONEER EXCELLENCE AWARD!

NON-VOTING DIRECTOR Jennifer Ackerman, CAE Chief Executive Officer Public Risk Management Association Alexandria, VA EDITOR Jennifer Ackerman, CAE Chief Executive Officer 703.253.1267 • jackerman@primacentral.org

The Future of Insurance in the Autonomous Vehicle Industry By Steve Miller, CIC, CRM

IN EVERY ISSUE

Specialized Expertise Plays a Key Role in Combating Opioid Use Disorder for Injured Workers By Kate Farley-Agee

| 4 NEWS BRIEFS | 20 ADVERTISER INDEX

ADVERTISING Jennifer Ackerman, CAE Chief Executive Officer 703.253.1267 • jackerman@primacentral.org

Public Risk is published 6 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: info@primacentral.org • Web site: www.primacentral.org Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year. Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine. POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314. Copyright 2021 Public Risk Management Association

JANUARY/FEBRUARY 2021 | PUBLIC RISK

IS YOUR ENTITY READY FOR COVID?

As we enter a new year, count on PRIMA to continue to provide COVID-19 education, including return-to-work planning, for the public risk management community. COVID-19 education includes webinars, podcasts, blogs, and more!

Check out the latest at primacentral.org/education/center/

MESSAGE FROM PRIMA PRESIDENT SHERI D. SWAIN

Reflections

s we turn the corner into a new year, my thoughts immediately go from the unprecedented year (at least in my lifetime) we are leaving behind straight to the promise of hope that 2021 brings with it. During all the chaos of 2020, I almost managed to make it through unscathed, but suffered a nasty fall in mid-December. It is bad news to fall anytime, but as you get older, yikes! The good news is I am going to be fine. Last year proved to be a difficult and challenging year for us all, and at the same time brought great awareness. As a country, we were starkly reminded of the importance of tolerance, inclusion, integrity and kindness that we have allowed to erode. We made great strides in making that realization and can hopefully move forward once again. This last year has taken a toll on many of us. I consider myself blessed and grateful for what I have but know so many that have suffered unimaginable loss. In my last article, I talked about finding those nuggets along the way. I can say, while it was a hard year, I definitely found some nuggets. There have been several reports globally of varying animal species that were thought extinct reappearing in the absence of humans in their habitats. Firefighters came from around the globe to help fight the devastating fires in Australia and the western states in America, particularly California. A wonderful show of solidarity against a common threat even while the world battles a pandemic. As I set my sights on bigger and better for 2021, I want to leave you with this last nugget of hope (taken from a friend’s Facebook post):

The fire poppy is

a rare and vibrant wildflower that

appears only after a wildfire. Their

seeds lie dormant for many decades

and only take a cue to germinate from

wildfire smoke. With rain and sun caused

by less shade from bushes and shrubs, fire poppies come alive in glorious beauty. “The fire poppy is a rare and vibrant wildflower that appears only after a wildfire. Their seeds lie dormant for many decades and only take a cue to germinate from wildfire smoke. With rain and sun caused by less shade from bushes and shrubs, fire poppies come alive in glorious beauty.” May you all be blessed with fire poppies through the coming year.

Sincerely,

Sheri D. Swain PRIMA President 2020–2021 Director, Enterprise Risk Management Maricopa County Community College Tempe, AZ

JANUARY/FEBRUARY 2021 | PUBLIC RISK

NEWS BRIEFS

NEWS Briefs

SPOKANE WANTS TO SWITCH TO ELECTRIC POLICE VEHICLES Spokane, Wash., City Council President Breean Beggs is pushing the city to begin converting the Spokane Police Department fleet from gasoline to electric vehicles, but other city officials are warning he's moving too fast, too soon. Beggs has been voicing frustration in recent weeks and wondering aloud why the city won't agree to pilot the use of four electric vehicles for the police department while it builds a long-term electrification plan. "What I've really been wanting to hear is how we can do it, not all the reasons why we can't," Beggs said, after more than a year of pushing the city to embrace electric vehicles. City officials agree that an all-electric fleet of vehicles is the inevitable path forward, but differ on how quickly to implement it and the feasibility of such a transition in the short term. "I don't know that the (police department) is the place to pilot an electric car," David Payne, the city's fleet services director, told the council. Replacing a handful of vehicles in the police department's fleet would typically be uncontroversial, but Beggs and the City Council have held up the purchase of four police patrol

PUBLIC RISK | JANUARY/FEBRUARY 2021

vehicles—two Ford K8 hybrids and 2 Chevy Tahoes—as they inquire about the possibility of buying Teslas instead. The expected cost over their life cycle is less than gasoline vehicles, but the upfront cost of electric vehicles tends to be higher, according to an analysis presented Monday by Nathan Groh, the city's sustainable transportation analyst. Beggs pointed out that the city's cost analysis assumed that the two vehicles

would have an equal lifespan— bout five years and 125,000 miles—contrary to the information its own analysts had found. He argued that over time, the electric vehicles would be "substantially cheaper, because they last longer." Despite the advantages offered by electric vehicles, officials warn the electric cars bring challenges when it comes to patrol—chief among them, keeping the cars charged through the rigorous demands of officer use.

What I've really been wanting to hear is how we can do it, not all the reasons why we can't. Spokane, Wash., City Council President Breean Beggs

7 WAYS TO KEEP REMOTE WORK SUCCESSFUL POST-PANDEMIC By Daniel Castro, Government Technology Last spring, as businesses began closing their doors and state and local governments issued stay-at-home orders in response to the start of the coronavirus pandemic, many organizations began allowing their staff to work remotely. While these changes were born out of necessity, teleworking has long had appeal for its many benefits, such as lower turnover, reduced relocation costs and positive environmental impact. Months into the pandemic, it is clear that the massive teleworking experiment has largely been a success, with a number of organizations announcing plans to extend this option permanently to their staff, but making this change sustainable over the long term will require additional adjustments. For many people, teleworking during the pandemic was a significant change. In May, approximately 35 percent of employed Americans worked from home, according to the Bureau of Labor Statistics (BLS). Women were more likely to telework, with approximately 41 percent of female workers teleworking compared to 31 percent of males. And those holding college degrees teleworked the most—nearly 54 percent of workers with a bachelor’s degree teleworked, and 69 percent of those holding advanced degrees did so. The number of teleworkers has since dropped. In September, BLS reported 33.5 million Americans teleworking because of the pandemic, approximately 23 percent of the U.S. workforce. But this still reflects a significant increase, since only a few years ago between 4 million and 5 million Americans worked remote. As both employers and workers have gained experience with teleworking, and as the technology has proven its reliability and convenience, many workers will likely continue to telecommute, at least part time, even after the pandemic. To ensure this transition to telework is effective over the long term, both public- and private-sector organizations should focus on the “seven C’s”:

Cloud: Organizations that have adopted cloud-first strategies are well-positioned for telework because their services are accessible remotely. Organizations should use the shift to telework to expedite their migration of services to the cloud. Collaboration: Working from home is not productive without the right tools for collaboration. While video conferencing tools are a must, so are other collaboration tools, such as project management and whiteboarding tools. Organizations will need to make sure their employees have the software they need to work effectively from home. Cybersecurity: Teleworkers face unique cybersecurity risks, especially if they are using their own devices, which may not have proper security controls to prevent intrusions. Organizations need to continue providing security awareness training and move quickly to adopt multifactor authentication across all services. Culture: One of the biggest barriers to telework adoption is organizational culture. Employees are often concerned that if they are not in the office they will lose out on important opportunities for face-to-face interactions with their managers or that their peers may consider those working remotely to be making less valuable contributions to the team, potentially hurting their opportunities for professional

advancement. Organizations that want to make telework a success will need to embrace it from the top down. Camaraderie: Most people have experienced how email and text communications can quickly devolve into a series of hostile, or even toxic, interactions that might not otherwise occur face-to-face. However, a variety of new AI-based tools can monitor these electronic exchanges to perform sentiment analysis and help managers respond to employee concerns. Community: With employees working remotely, many lose out on opportunities for the type of water cooler conversations that help build community within an organization. Organizations will need to dedicate time and resources to building their own virtual community and encouraging social interaction that fosters strong working relationships. Commute: One of the benefits of teleworking is no commute, which can save hours of travel each week, not to mention the associated costs. But commuting offers some upsides, such as an opportunity to disconnect from work, listen to a podcast, or go for a walk or bike ride that may fall by the wayside. Indeed, Microsoft has proposed a “virtual commute” tool to help workers plan time for reflection and establish a boundary between work and home.

JANUARY/FEBRUARY 2021 | PUBLIC RISK

TITLE

NAVIGATING PORT RISK BY JOE JARRET

PUBLIC RISK | JANUARY/FEBRUARY 2021

“To reach a port we must sail, sometimes with the wind, and sometimes against it. But we must not drift or lie at anchor.” Oliver Wendell Holmes, Sr.

CCORDING TO THE DEPARTMENT OF HOMELAND SECURITY,

the operation of our nation’s ports depends on carefully balancing

competing needs: maintaining the security of these bustling economic

and transportation hubs, ensuring the continued flow of goods, and ensuring that the multitude of agencies and components (e.g., police, harbor patrol, owners, businesses) involved in port security and operations can perform their daily activities. Needless to say, this sounds like a job for a public risk manager.

Despite the fact that I took maritime law in law school, I didn’t feel I had a solid grasp on port operations when I became the risk manager for a public entity that had a bustling port facility. Like others who were not a member of the maritime industry, I was unaware that there are various descriptions for places where maritime vessels can dock. I quickly learned that a port is not the same thing as a harbor, or a terminal. Generally speaking, a port is most commonly defined as an area on both land and water, whether on the sea or a river that provides facilities for shipping vessels to load and unload their cargo. A harbor is a physical area where water meets land and results in a sheltered bay, while terminals are the set of facilities at a port where loading and unloading of cargo/containers takes place. Terminals are named on the basis of the

type of cargo that can be handled by them. Cargo can range from petroleum products, to grain, coal, ore, bulk goods, dry goods, and cargo that is carried in drums, bags, pallets, or boxes. In the end, ports are gateways for cargo and/or people which are made up of terminals that specialize in one or the other.

PORT RISK

Although ports present many risk management challenges common to other public facilities, it is important to note that ports are becoming increasingly sophisticated intermodal hubs for distributing goods, on both national and internationals scales. As such, the risks facing risk managers on a day-to-day basis are larger and more complicated than ever. Modern ports require substantial investments in marine

structures, specialized high-value equipment, warehousing, and logistics. Add to this the global nature of port operations, and you have an operational environment that is susceptible to natural catastrophes, terrorism, operational stress, joint venture failure, and political risks. Such scenarios create breeding grounds for claims, whether from shipowners, cargo interests, or other users of the port or terminal. Over the last several years, liability has increased significantly, due in no small measure to an increasingly litigious world. Some of more common factors unique to ports, and as such, of concern to risk managers include: • • • • • • • • • • •

Proximity to major shipping lanes Spill response equipment available Ship repair facilities available Tug assistance available Fire-fighting services and equipment available Cargo unloading equipment available Depth of water in the harbor and its physical characteristics Proximity to major population centers Ecological sensitivity of the coastal environment Economic activity along the coast Safety and security considerations

JANUARY/FEBRUARY 2021 | PUBLIC RISK

ANY PORT IN A STORM: NAVIGATING PORT RISK

• Agreements with neighboring states; and • Marine Protected Areas (MPAs) Note: The U.S. has established nearly 1,000 MPAs to protect endangered places in our oceans, estuaries, coastal waters, and Great Lakes. Despite the fact that ports can present risk management challenges not often faced by other facets of government, both enterprise risk management and stalwart risk management techniques such as risk avoidance and transfer, all play a part in protecting a port.

ENVIRONMENTAL RISKS

Maritime commerce relies not on one single port or terminal, but on a system of harbors, ports and waterways that help move goods from suppliers to manufacturers and consumers. Communities rely on small businesses, and they rely on seaports that connect American farmers, manufacturers and service providers to the global marketplace. Consequently, today’s citizens expect their ports to demonstrate a sincere commitment to sustainable development, as well as the preservation of the environment. While efficient ports are vital to the economic development of their surrounding areas, the related ship traffic, the handling of the goods in the ports and their distribution can cause a number of negative environmental impacts. The environmental aspects of each port vary according to the activities conducted

PUBLIC RISK | JANUARY/FEBRUARY 2021

within the port. However, the most common environmental risks/complaints faced by risk managers include: • Air quality • Port waste • Water quality • Relationship with local community • Noise • Hazardous waste • Energy consumption In many ports across the U.S. and Canada, risk managers are working with environmentalists in an effort to reduce diesel emissions and carbon emissions, both of which are believed to negatively impact air and water quality, and therefore on the health of the surrounding community.

SAFE HARBORS SHIPS IN DISTRESS

One aspect of harbor risk that also involves law, politics, and public policy concerns the decision to grant or refuse refuge to a ship in need of assistance. With the increase of global shipping comes an increase of ships in distress. The most important consideration in the decision to grant or refuse refuge to a ship in need of assistance is the issue of risk. Prior to exploring this concept further, it is important to distinguish between life-saving measures of a distressed ship’s crew-an act that isn’t debatable amongst harbor management- versus attempts to salvage the

ship and its cargo. When it comes to providing assistance to a distressed ship, the assessment of risk is not limited merely to the success or failure of measures implemented to support the ship and her cargo. Rather, when there is a request for refuge, the consideration receiving the highest priority should be what happens if the endangered ship is beyond assistance and develops into a total loss while at the place of refuge. When attempting to determine whether a port should grant refuge to a distressed ship, the United States Coast Guard, in accordance with International Maritime Guidelines on Places of Refuge for Ships in Need of Assistance, suggests the following risks be assessed when determining whether a port can adequately assist a ship in distress: • Human Health and Safety, including the safety of the crew, professional responders, and the public at large • Natural Resources, including threatened and endangered species, subsistence species, commercial species, habitat, and cultural resources • Economic Impacts, including commercial shipping and fishing, marine tourism and recreational fishing, and non-marine related economic activities When it comes to the refuge decision-making process, the issue of prime concern in the assessment of risk is balancing the perceived and objective risks to the environment and to

the local and surrounding communities. Once a harbor determines it is desirous of assisting a distressed ship, the risk manager must consider the consequences should the endangered ship appear to be beyond assistance and thus precipitating into a total loss while at the place of refuge and in the vicinity of the coastline. Port projects and operations are exposed to a complex and changing range of risks. As ports continue to be increasingly vital towards the sustainability of freight and passenger transport, there is an emerging need for the development and application of sound risk management methodologies and tools which will deliver a systematic assessment and management of the myriad of risks challenging today’s port risk manager. By proactively responding to safety, financial, construction, and operational risks, the risk manager can be instrumental in providing optimal protection against the many risks facing their port facility. Joe Jarret is an attorney, federal & state mediator, and a former public risk manager. He is a pastpresident of the SW Florida chapter of PRIMA, and PRIMA’s 2016 Author of the Year.

When attempting to determine whether a port should grant refuge to a distressed ship, the United States Coast Guard, in accordance with International Maritime Guidelines on Places of Refuge for Ships in Need of Assistance, suggests the following risks be assessed when determining whether a port can adequately assist a ship in distress:

• Human Health and Safety, including the safety of the crew, professional responders, and the public at large • Natural Resources, including threatened and endangered species, subsistence species, commercial species, habitat, and cultural resources • Economic Impacts, including commercial shipping and fishing, marine tourism and recreational fishing, and non-marine related economic activities When it comes to the refuge decision-making process, the issue of prime concern in the assessment of risk is balancing the perceived and objective risks to the environment and to the local and surrounding communities. Once a harbor determines it is desirous of assisting a distressed ship, the risk manager must consider the consequences should the endangered ship appear to be beyond assistance and thus precipitating into a total loss while at the place of refuge and in the vicinity of the coastline.

JANUARY/FEBRUARY 2021 | PUBLIC RISK

NOW OPEN! SUBMIT BY MARCH 2, 2021 A P P LY AT

primacentral.org/awards

PRIMA’S 2021 ACHIEVEMENT AWARDS A PPLY OR NOMIN AT E A PR IM A MEMBER FOR A N OUTS TA NDING ACHIE V EMENT AWA RD ! Each year, PRIMA honors individuals and entities that have excelled in the field of public sector risk management. Winners will be honored at PRIMA’s 2021 Annual Conference. P R I M A M E M B E R S A R E E L I G I B L E T O A P P LY F O R T H E F O L L O W I N G AWA R D S : • Public Risk Manager of the Year • Outstanding Achievement for a Public Sector Risk Management Program • Outstanding Achievement for a Public Sector Risk Management Product • Outstanding Achievement for a Risk Pool Program or Product • Enterprise Risk Management (ERM) Outstanding Achievement Award • Chapter Recognition Award • Chapter Service Award (Chapter Use Only)

PIONEER EXCELLENCE AWARD WINNER

Meet Eddie C. Beecher

WINNER OF THE 2021 PRIMA PIONEER EXCELLENCE AWARD! PRIMA’s Pioneer Excellence Award honors a long-term PRIMA member who has truly benefitted from all the benefits PRIMA has to offer.

1. HOW DID YOU END UP IN PUBLIC RISK MANAGEMENT?

I began my professional career as an intern with the City of North Miami as they were developing a self-insurance program. My project was to assist the deputy city manager in developing policies and procedures for the City’s newly created risk management program. A few years later, I was recruited to become the city’s risk management administrator.

2. WHAT ARE THE THREE MOST SIGNIFICANT WAYS RISK MANAGEMENT HAS CHANGED SINCE YOU STARTED?

Well, considering I started in risk management before the common office fax machine and post-it notes became widely popular… we have faced a world-wide pandemic on a scale that none of us have experienced. We have a greater focus on cyber terrorism and cyber security. Technology has advanced to allow us greater access for investigations and enhanced data analytics. Lastly, there is better training to ensure safety and security of personnel.

3. WHAT ARE THE TOP THREE BENEFITS PRIMA PROVIDES TO YOU?

networking and educational opportunities here in Florida. We have an excellent active South Florida Chapter and our other chapters around the state. I’m proud to call our executive board my friends.

EDDIE C. BEECHER Director of Human Resources City of Pompano Beach, Florida

4. WHAT PRIMA BENEFITS DO YOU THINK BEST SERVE NEW RISK MANAGERS IN THE FIELD?

I still remember my first PRIMA Annual Conference! The conference and PRIMA Institute are great ways for new risk managers to learn about a variety of risk management topics and issues. I like to use the PRIMA Cybrary for research and to check out programs that my peers have developed. RiskWatch, PRIMA’s e-newsletter and Public Risk magazine are an awesome resources to keep current on emerging issues. Thanks for being a long-term member of PRIMA, Ed! You are truly a PIONEER!

PRIMA continues to be the premier resource for public risk management information. The educational and networking opportunities that PRIMA has provided to me professionally, both nationally and locally are truly invaluable. I credit PRIMA and my peers, both locally and on a national level, with helping me with my professional success. We have enjoyed amazing

JANUARY/FEBRUARY 2021 | PUBLIC RISK

THE FUTURE OF INSURANCE IN THE

Autonomous Vehicle Industry BY STEVE MILLER, CIC, CRM

PUBLIC RISK | JANUARY/FEBRUARY 2021

UTONOMOUS VEHICLES (AVs) ARE POISED TO TRANSFORM THE FUTURE OF MOBILITY, and as the technology evolves, so will the associated risk exposures. To effectively manage these risks, insurance underwriters will need to adapt along with the industry to provide adequate coverage when true commercialization occurs. No longer in the realm of science fiction, autonomous vehicles are poised to become a common presence on roads and highways in the not-so-distant future. The market volume of fully automated cars is expected to grow to $13.7 billion by 2030, and that same year, one in 10 vehicles globally is projected to be selfdriving, according to Statista.

The use of autonomous vehicles continues to gain momentum with companies like Waymo testing autonomous taxis in Phoenix, Walmart using autonomous cargo vans to deliver groceries in Arizona, and Pizza Hut working together with Toyota on autonomous delivery solutions. As adoption of the technology increases, so does the overall risk exposure for businesses operating in this dynamic and rapidly changing niche. Insurers will need to develop products that keep pace with the evolution of driverless technology to best protect businesses from potential losses. Existing commercial product lines ranging from auto insurance to cyber liability will also need to be adapted to cover new risk exposures.

Most policies were designed for minimal vehicle upgrades (e.g., running lights and audio systems) and are not wholly applicable to the values of AV equipment stacks and the cost to repair sophisticated electronics. Companies that own upfitted vehicles will need inland marine policies that protect them from risks associated with damage to the equipment stack, separate from damage to the vehicle.

PRODUCT (GENERAL) LIABILITY

AUTO INSURANCE

The advent of autonomous vehicles could see the risks associated with driving, including injury to people or property, shift from individual driver liability to the manufacturers. Insurers will need to develop policies that address areas such as algorithm defects, malfunctioning computer vision technology, and failure of internet communications.

INLAND MARINE

Technology Errors & Omissions (E&O) Due to the increased technologies on board, an accident involving an autonomous vehicle can trigger coverage under two separate lines of insurance—product liability and technology errors and omissions. It will be important for AV companies to ensure they secure these coverages from the same carrier whenever possible. It also will be important for the industry to develop hybrid policies that address the whole risk.

Carriers should start developing auto policy language with autonomous vehicles in mind, factoring in vehicle differences like equipment stack (e.g., sensors and cameras) and electrification that currently are not accounted for in traditional vehicles. Increased telematics and video capabilities in these AVs will also improve the claims process, speeding up processing and time to resolution.

Carriers will need to look at insuring damage to the AV’s equipment stack such as LIDAR, RADAR and cameras. Auto policy forms alone don’t adequately cover this type of exposure.

CYBER LIABILITY

Cyber liability is another area where insurers will need to evolve to protect AV companies

from changing cyber risks. This includes designing products to protect companies in situations where a hacker takes control of the vehicle remotely or gains access to a vehicle’s system and its owner’s personal information, compromising data privacy and security. As insurers work to adapt policies that keep pace with the evolving risk of driverless technology, they also will need to factor in changing legal and regulatory requirements for autonomous vehicles. This means navigating a patchwork of state regulations and any future federal regulatory frameworks. Currently, there are 29 states that have enacted legislation related to autonomous vehicles in the U.S. The seismic shift in the way vehicles will be driven presents risks the insurance marketplace has never seen. While the traditional insurance marketplace has kept up with the growth in first-party testing and limited public pilots to date, insurers will need to quickly adapt and evolve to underwrite and cover AV risks when true commercialization gets underway. Steve Miller, CIC, CRM, leads Insurance Office of America’s (IOA) mobility and innovation group. Miller leverages his coverage knowledge and carrier relationships to develop new and innovative solutions in the emerging and disruptive future mobility field.

JANUARY/FEBRUARY 2021 | PUBLIC RISK

FREE TO MEMBERS

Cost Allocation and Public Entity Budgeting JANUARY 19 | 12:00 – 1:00 PM EST SPEAKER: David Parker, ARM-P, CPM, IPMA-SCP, Director, Enterprise Risk Management, Pima Community College Nothing in government has the reach of the budgetary process. A solid understanding of governmental funding principles and risk management cost allocation methods can be a powerful tool. Spotlight the importance of your program and focus decision makers upon the generators of loss. You may also be a hero who effectively defends the general fund: your elected official’s most flexible dollars. This session begins with budgeting principles, evaluates loss funding methods and options and examines several models for allocating risk management costs. ATTENDEE TAKEAWAYS: 1. Understand governmental funding basics under GASB 2. Evaluate GASB loss reserving and funding requirements and options 3. Learn several effective strategies for cost allocation

PRIMA PODCASTS PRIMA Podcasts are a convenient and quick way to learn about hot topics in the public risk management sector.

Listen at primacentral.org Also available on

Specialized Expertise Plays a Key Role in Combating

OPIOID USE DISORDER for Injured Workers BY KATE FARLEY-AGEE

PUBLIC RISK | JANUARY/FEBRUARY 2021

HAT’S BECOME CLEAR FROM YEARS OF COMBATING OPIOID USE DISORDERS IS THAT, FOR MOST PATIENTS, RECOVERY IS DIFFICULT AND OFTEN PROTRACTED. Just as important, we’ve learned that the greatest chance for success arises when the

most accomplished health care professionals are empowered to deliver care that is well-

coordinated, that incorporates multiple treatment methods, and that adopts a biopsychosocial perspective. By working together, health care professionals and their network partners are

best suited to help injured workers recover from opioid use disorder and get back on the job.

ATTACKING THE PROBLEM FROM MULTIPLE SIDES

The notion of attacking the problem from multiple sides isn’t unique to combatting opioid use disorders. Public health officials are turning to this playbook to fight COVID-19. Health experts are imploring people around the world to wear face coverings, wash hands, maintain distance from others, avoid large gatherings, and to quarantine when ill or exposed. Alone, none of these efforts is as effective as the combination. Likewise, when treating an opioid use disorder, relying on a menu of options is far more likely to achieve success than is any single measure. The urgency of this problem has become clear to employers. In 2017, 95 percent of opioid overdoses occurred among those aged 15 to 64, the prime working years. It’s little surprise then that three in four employers report having had an issue with opioids in the workplace. Knowing these statistics and risks, there are several

approaches that have aided in preventing opioid use disorder. These range from early intervention screening tools, risk-factor monitoring, best-practice prescribing guideline adherence, and careful patient selection and follow-up.

WHAT WE’RE TRYING TO ACHIEVE WITH TREATMENT

The goal of therapeutic treatment for an opioid use disorder is to lower the risk of harm to the patient and to others. This means reducing the chance of illicit or unwanted drug use and the associated health risks. Opioid use disorder, like addiction in general, is a chronic disease that can subjugate both the brain and a person’s behavior to deleterious ends. So, while an alcoholic will always be an alcoholic, the goal is to help a person become a recovering alcoholic. The same holds for opioid use disorder. The goal is to eliminate opioid misuse knowing that while the risk of relapse might diminish, it never disappears.

Beyond the obvious physiological gains of curbing misuse of opioids, there are broader treatment benefits in discontinuing the drug of abuse, remaining free of the drug, and being productive at work, at home, and with family and friends. To reach these important ends, it’s crucial that treatments consider the whole person. The various players orbiting an injured worker in treatment must act in concert to establish the most solid foothold that could lead to a successful outcome. Clinicians and prescribers, case managers, employers, and family and friends all have a role to play.

AS ALWAYS, THERE ARE MANY CONSIDERATIONS TO WEIGH There are numerous steps to consider when establishing a recovery regimen for opioid use disorder. They are:

• Personalized diagnosis and treatment planning • Coordinated care

JANUARY/FEBRUARY 2021 | PUBLIC RISK

COMBATING OPIOID USE DISORDER FOR INJURED WORKERS

• Behavioral therapies • Access to FDA-approved medications • Evaluation and treatment of comorbid mental health issues • Best practices for ongoing pain management • Long-term follow-up to prevent relapse • Recovery-support services Perhaps most important of these measures is the idea that the diagnosis and treatment planning should be tailored for an individual and his or her support systems such as family and friends. From there, clinicians overseeing recovery treatment should be sure care remains coordinated. This means aligning efforts to address possible behavioral health conditions such as anxiety and depression. These efforts aren’t easy nor are they always successful on the first try. By one estimate, nearly nine in 10 patients in treatment for opioid use disorder suffer relapse. Given this, it’s wise to provide additional support alternatives for those attempting recovery. These include mutual aid groups, peer-support specialists, and other relevant community services. Taken together, the breadth of these measures offers the fullest chance of helping an injured worker recover from opioid use disorder. Given the inherent murkiness surrounding a patient’s response to treatment for opioid use disorder it’s critical to remain vigilant for the possibility of relapse. That’s why detoxification alone remains an insufficient and easy-to-topple treatment. A relapse-prevention program is essential. This can include a variety of measures including hypnosis, relaxation techniques, or acupuncture. Psychosocial treatments can help patients hone their coping skills, change their environment, engage in further counseling, and perhaps group therapy, 12-step, or other self-help programs. For these types of recovery support services to work, it’s important to put in place a plan for long-term follow-up. That’s the surest way to help reduce the likelihood of relapse. It’s wise to measure and evaluate outcomes of treatments to help improve interventions and therefore increase patient safety. Variations among treatment types include inpatient recovery, residential hospitals, and outpatient recovery. Some considerations for quantifying outcomes

PUBLIC RISK | JANUARY/FEBRUARY 2021

include how long a patient remains in a treatment program, the percentage of negative urine tests, and the degree to which the patient rates his or her condition. The latter refers to issues such as the presence and intensity of cravings. Whatever method a clinician leans on to help an injured worker, it’s important to engage in regular and frequent follow-up, careful monitoring, and support.

IDENTIFYING A GOOD RECOVERY PROGRAM IS CRITICAL

Given the enormous challenges of corralling opioid use disorder, it’s wise to look for any potential advantages in this fight. Perhaps the most significant is to field a diverse team that works in service of the injured worker struggling with opioid use disorder. Ideally, this partnership would include: • • • • • •

Clinicians and prescribers Nurse case managers The pharmacy benefit manager The employer Family and friends And, of course, the injured worker

When concerns arise that an injured worker could be misusing opioids, it’s important to have a protocol in place and a treatment network to turn to. This process should include identifying those injured workers who might benefit from an intervention, having a process for enrolling the injured worker into a treatment regimen, tapping into a strong network of recovery specialists, and using pharmacy and clinical data to help support these measures through rigorous data analysis.

A STRONG SPECIALTY NETWORK CAN BETTER HELP INJURED WORKERS RECOVER

Provider networks can be broad-based or narrow. What’s most important when considering treatment of opioid use disorder is that its providers have relevant expertise, repeatable protocols, and a multidisciplinary team in place including an experienced intake coordinator and someone with expertise in behavioral health. Having this kind of bench strength makes it possible to assemble a complete and experienced

recovery team. There is also value in seeking network partners armed with knowledge about both injured workers and addiction recovery such as with a specialized network within a broader network. A well-established network can feature complementary conduits specializing in opioid use disorder, behavioral health, diagnostics, and other relevant services. A network that is well-suited to helping an injured worker suffering from an opioid use disorder is also likely to offer various treatment options for the injured worker including inpatient, outpatient and residential. This enables clinicians and others who are a part of the injured worker’s recovery team to customize the treatment plan.

ULTIMATELY, IT COMES DOWN TO EXPERTISE Having a record of success in treating patients with opioid use disorder is essential. The same is true for the network itself. In order to identify those providers with the most to offer patients, it’s imperative that a network screen for clinicians with the proper training who have demonstrated skill at helping patients recover. A broad-based network can mine for these types of metrics around performance and efficacy in treatment of patients experiencing opioid use disorder. And, naturally, a broad network can select providers using a larger and more diverse base of data.

A network with sufficient depth can not only boost the number of providers who meet quality standards, it also can rely on more rigorous standards for inclusion within this opioid-recovery pool of clinicians. By having more providers to choose from, a network can be more selective about whom it includes within a specialty network, including those built around addiction and misuse or related areas of behavioral health. These providers can be further stratified to select those who have experience in treating injured workers and in treating patients with opioid use disorder.

SPECIALTY NETWORKS CAN PUNCH ABOVE THEIR WEIGHT Provider networks offer several advantages. These partnerships involving clinicians, facilities, and payers provide access to high-quality

care for patients at a reasonable cost. Network parameters help ensure quality care by vetting providers and by stipulating standards of care. Specialty networks operate in the same way— grouping together exceptional providers in order to achieve improved outcomes. There are other potential benefits to relying on a specialty network that’s part of a larger entity. For example, the same parameters, data feeds, and workflow procedures in place for a broader network would apply to the specialty network. The specialty network draws strength from and is more robust by being part of a larger network. This type of multilayered expertise also can help ensure proper billing and coding procedures are used and that errant patterns are flagged. Capable network oversight involves knowing how injured workers with an opioid use disorder are treated and should be cared for based on best practices. An understanding of the inherent complex nature of these cases can help minimize disruption to treatments as well as wasteful or ineffective spending. There are other reasons to pay particular attention to the strength and reliability of a network within workers’ comp. Injured workers may see treating providers based on a recommendation from a case manager. Under the grand bargain of workers’ comp, injured workers are putting trust in their employer to provide access to well-qualified and accomplished clinicians. Much of the work of promoting this trust falls to experienced case managers, who often have good working relationships with top providers. That strength in the clinical realm can be matched with strength in a network itself to offer the best-possible assistance to injured workers with an opioid use disorder. The network and clinical experience, together, can direct more power toward enabling recovery and promoting better case outcomes. Expertise wins out in other realms as well. The rise of technologies including artificial intelligence is making it more likely that case managers will receive alerts much sooner when injured workers begin to show warning signs

When concerns arise that an injured worker could be misusing opioids, it’s important to have a protocol in

place and a treatment network to turn to. This process should include identifying those injured workers who

might benefit from an intervention, having a process for enrolling the injured worker into a treatment regimen, tapping into a strong network of recovery specialists, and using pharmacy and clinical data to help support these measures through rigorous data analysis.

of an opioid use disorder. As these data tools become more precise, they’ll further empower case managers to intervene early by suggesting, for example, that an injured worker be referred to a psychiatrist or an addiction specialist. Scouring the data for anomalies also can help promote safety and efficiency in other ways. This includes flagging unusual prescribing patterns or billing practices. Data insights also offer an avenue for education of patients and providers alike around emerging research concerning opioid use disorder.

WHILE MUCH WORK REMAINS, THE TEAM APPROACH OFFERS THE BEST BET

down to expertise. That’s expertise in the network itself, in case management, and, of course, in providers with specific skills and experience in approaches to opioid usage. Aligning these efforts offers injured workers the best possible team for achieving recovery and returning to work. Kate Farley-Agee is the vice president of network operations for Coventry, overseeing the company’s national broad-based provider network and 18 certified managed care organizations across the country.

Treating injured workers who are also suffering from opioid use disorder comes

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