The Emergence of Health Care Risk Management

Article excerpt

THE COMPLEXITY AND INTERRElatedness of many functions in health care have helped redefine the risk manager's role. Consequently, one individual's title and job responsibilities at a large teaching hospital in New York City may have expanded over several years from "risk manager" to "vice president for risk management, regulatory affairs, quality assurance and utilization review." Combining these interrelated functions under centralized leadership is done with increasing frequency to improve coordination and reduce redundancy. Many health care risk managers enter the field from health care backgrounds, particularly nursing, adding knowledge of insurance and law through on-the-job experience, seminars and course work.

Today, health care risk management (HRM) is becoming recognized as an integral part of a total management strategy, essential to meeting the strategic goals of each health care system. Moving beyond the traditional insurance and liability concepts of risk management, HRM provides health care leaders with a new perspective on the health care environment.

HRM strives to optimize clinical and administrative resources through systems that promote synergy and growth, minimize the risk of liability, and maximize the value of insurance dollars spent. Much more than individual products or services, HRM is a process and a function that pervades the organization. Through high-level administrative decisionmaking and integrated hospitalphysician strategies, HRM addresses all aspects of health care risk so that the bottom line and the quality of care are both positively influenced. In today's environment of changing health care delivery patterns, expanding technology and critical service selection decisions, the coming of age of HRM is timely. …