Program administrator Irwin Siegel Agency (ISA), headquartered in Rock Hill, New York, has been providing innovative and competitive insurance solutions for over 35 years to niche markets that include social service, developmental disability, addiction treatment, behavioral/mental healthcare, and youth development service providers.
We spoke with Sheila Shaw, Senior VP, and Brad Storey, MSW, Director of Risk Management, about two of their programs: addiction treatment and behavioral/mental health care to look at how some fundamental changes taking place in these fields are affecting the services they’re offering and the insurance programs they will need.
Sheila has been in the insurance industry for nearly 30 years and joined ISA 19 years ago as an underwriter, working her way up to her current position of Senior Vice President. Brad, who has a Master of Social Work degree from Rutgers in Administration, Policy, & Planning, joined ISA in 2007 after working with several community mental health programs in Northern New Jersey.
Annie George (AG): Provide us with a brief overview of the programs that cover these industries.
Sheila Shaw (SS): “Our behavioral and mental health program is for organizations that provide mental health counseling through residential and outpatient treatment programs. These are typically your community mental health centers. Programs are for individuals with schizophrenia, bipolar disorder, major depression, etc., and are designed to assist people in need of behavioral health services while focusing on recovery as the ultimate objective.
“Our addiction treatment program is designed for organizations and facilities that support individuals striving to overcome many forms of addiction, including alcohol, substance abuse, eating disorders, gambling. These facilities may offer a variety of services, such as counseling, workshops, and vocational programs.
“We insure both profit and nonprofit organizations in these segments.”
AG: What trends are you seeing taking place in these industries?
Brad Storey (BS): “One of the most significant directions taking place is the integration of primary and behavioral health care services being delivered under one roof. Rather than having an individual who has been diagnosed with schizophrenia, for example, go to one facility for counseling and psychiatric medication, and then visit another facility for physical health care, all these services will be available at one location.
“The integration of services is occurring for a few reasons: to improve quality of care, establish continuity of care, and leverage cost-reductions in the process. Typically, the administrative overhead costs associated with sharing information between primary care and mental health care providers is significant. In bringing these services together, community centers will be able to experience cost savings. This used to be a very segmented industry, but the reduction of funding has really forced a lot of diversification among organizations.
“Integration will also put the focus on the individual to receive the services he or she needs, as opposed to having to chase after these services. You’ll now have one case manager coordinating the various services needed among multiple providers, instead of the many case managers that were typically assigned to one person. This will streamline the overall process and provide better care.
“What’s more, in keeping the person in the community and providing more services within that community, hopefully we will see fewer individuals going to the hospital. Hospital care is a much more expensive treatment than the community setting, which tends to control costs more.
“Additionally, by 2014 all healthcare providers are strongly encouraged to implement electronic health records with incentives for early implementation and penalties for not. The objective is to store all protected health information electronically, facilitating the sharing of this information. Integration will facilitate this process.”
AG: What other major trend are you seeing?
BS: “As folks return from Iraq and Afghanistan, there’s been a significant push to provide services for veterans and their families within the community. Traditionally and even today, the Veteran’s Administration and Veteran’s Affairs typically provide many of these services. But the influx of troops returning home has overwhelmed the system, and we’re beginning to see a great deal of grant opportunities and funding available for services to be provided at the community level. This tends to create an additional challenge for the community provider because the funding streams for veteran services are very different from the typical mental health services, which receive funding from Medicaid/Medicare, private pay, or other third-party payors. Knowing how to locate the dollars and attaching your organization to those dollars can be complicated because most of the funding is coming from the VA.
“In June, for example, I was working with one of our current clients that is getting involved in providing services to vets. They’re acquiring an organization that specifically provides veteran services to the homeless. I worked with the client to help get the funding. Because of my prior work experience with a provider of veteran services, I was familiar with how to access those dollars and where to apply for those grants, enabling the client to get the additional financial stream needed into their organization.”
Brad explained that veterans are the most rapidly growing population entering addiction and behavioral health care facilities, with the geriatric population right behind. In addition, he explained that the veteran population presents a challenging situation for an organization due to the wide range of issues they have. “You have individuals with traumatic brain injury, addiction, homelessness, and post traumatic stress disorder,” said Brad. “You see an increased rate of suicide among this population, particularly as it pertains to PTSD. It takes a unique clinician to be able to work with the vet population. Ultimately, it can be somewhat challenging when it comes to retaining qualified staff.
“These trends pose some unique challenges for your community health care centers as the scope of the services with which they traditionally are accustomed to dealing have now been broadened.”
AG: How will these changes affect the type of insurance needed?
SS: “Since the community mental health care centers will also have primary care doctors on staff, they will need Medical Malpractice, something they most likely haven’t had to cover in the past. Another key area is that centers have been set up to provide mental health services, which don’t necessarily require all the medical equipment that a primary care physician would need in a general practice. Physical plant renovations will be undertaken to account for the space required to have this equipment to deliver the primary care services. There will be an increase in the Property coverage needed for this equipment, and coverage will have to be placed to protect against exposures during renovation. And you’ll have data breach exposures associated with electronic health records.”
BS: “Also, some of these mental health care centers, for example, have been converted from old grocery stores, remodeled to meet community needs. As they upgrade these facilities, they’ll look into using efficient building materials. From an energy-efficiency standpoint as well as cost savings down the line, it makes sense to really look at what’s available when remodeling.”
AG: How is your insurance program addressing these trends?
SS: “We are well positioned with ACE, our partner in these programs. We’re working with ACE to address these trends, and have the ability to put together coverage for whatever is needed, including, for example, coverage for primary care doctors. We already have an insurance program that encompasses veteran services, and through our risk management department we assist clients that offer these types of services with any questions and issues regarding loss control and mitigation unique to this segment.
“Our program with ACE is accessible to brokers and agents exclusively through us on a national basis, and is open access with no premium volume commitment. We provide comprehensive coverage throughout all lines, including: General Liability, Professional Liability, Sexual Abuse, Umbrella, Commercial Auto, Workers Comp, Inland Marine, Crime, among others. Builder’s Risk coverage can be incorporated into the package program.
“On the Professional Liability side, we cover clinics offering different types of therapies and psych services, with psychiatrists automatically covered on a primary basis on our policy. Sexual Abuse coverage applies under various scenarios: an employee-client situation, client-to-client, client to a third party, and third party to client. There is very broad coverage in the program.”
“Additionally, since ACE has so many coverages available outside the program, we can reach out to them to fulfill all of our client’s needs through one carrier.”
“We’re offering Cyber Liability through a separate carrier, a key coverage with the implementation and sharing of electronic health records.”
AG: Do you see this as an industry that’s growing even during these tough economic times?
BS: “The economy has definitely impacted the industry with cut-backs and the services provided. But the industry as a whole is looking for ways to make the services more affordable. What’s more, the veteran population and the issues they’re now facing at home has seen a spike in the need for services. Lastly, societal attitudes as they pertain to counseling and therapy have shifted the landscape significantly. There’s been a generational shift, reducing the stigma of mental health and addiction, which has allowed people to come forward and seek out these services.”