Increased reliance on tech tools makes disaster planning a must

Key Points

THE PAST DECADE has been an extended on-the-job training seminar on disaster preparedness, from the terrorist attacks of September 11, 2001, to the hurricanes of 2005, to last year's flooding in Nashville. Healthcare industry leaders have had to adopt a new way of thinking to prepare for such business interruption, particularly as their technology systems become more extensive.

The organization executed its plan twice, in 2003 and 2007, because of wildfires in the San Diego area.

How might health plans prepare for a potential catastrophic event? According to Skip Skivington, vice president of operations within procurement for Kaiser Permanente (KP), it's a matter of evaluating risk. In California, the greatest natural risk is an earthquake, and along the Gulf Coast, it's a hurricane.

"The risk should drive your planning process," he says. "You have to prioritize the most likely threat with the largest impact. That's where you want to focus."

The increased focus on disaster planning and business continuity has also reiterated the necessity to have operational backup data centers in case the main facility is put out of commission by a catastrophic event. Health plans have included back-up data centers as a critical element to their preparedness strategies. For example, KP stores its data in multiple data centers, and Skivington says a specialty team within the company's information technology department continually assesses each facility.

Last year, Blue Cross Blue Shield of Louisiana (BCBS of LA) opened a new crisis relocation center in Shreveport, La. Spokeswoman Robin Mayhall says the company had a backup facility in Baton Rouge, but Hurricane Gustav in 2008 left the building unstable.

The Shreveport facility's primary function is to serve as a district office, including 25 employees working in a call center. However, when a potentially catastrophic event is imminent, the company can add 250 workspaces immediately.

"One of the lessons from Hurricanes Katrina and Rita was that having the [primary and] backup data center in the same city was not a good idea," says Cynthia Ponessa, manager of business continuity for BCBS of LA.

Ron Payne, manager of business continuity for Blue Cross Blue Shield of Tennessee (BCBSTN), says the organization also has a contracted backup data center and a disaster recovery system to recover stored data in the event a facility is disabled.

As part of its contingency plans, BCBSTN has alternate voice communications capabilities, Payne says. The strategy includes an automatic transfer to another call center if one facility is damaged so member and provider contact with the plan is not interrupted.

CREATE CONTINGENCY PLANS

Executives say that when anticipating a catastrophic event, certain assumptions have to be made. The most important of which is the likelihood that electrical power will be out for a substantial amount of time.

"As more plans and hospitals become automated, we in turn become more reliant on those tools," Skivington says. "We really feel it when the tools are taken away through power outages."

Never was that more evident than in the days after Katrina hit New Orleans and the Gulf Coast in 2005. Only three of the city's 12 hospitals remained opened, and power was out for days.

The automated system that allowed BCBS of LA to connect to its members and providers in New Orleans, its largest market, was disabled, according to Mayhall. Plan executives made the decision to waive premium payments for members and preauthorizations for procedures in the 14 most affected parishes to ensure access to care.

Members who didn't have their identification cards only had to tell a provider they were insured by BCBS of LA, and physicians were able to bill the plan as they normally would without verification of eligibility. All fees were covered at 100% with no member costs. Undoubtedly, some ineligible claims came through, but BCBS of LA gave members and providers the benefit of the doubt because of the extenuating circumstances and widespread need for medical attention, Mayhall says.

While these decisions were made at the height of the disaster because of the unique situation brought about by Hurricane Katrina, Mayhall says they were based on a comprehensive business continuity plan established by BCBS of LA in 2001 and updated after each succeeding hurricane.

"Things went smoothly, even though we had to make some adjustments, because it was based on a plan that had been refined," she says. "We used our plan during Katrina, and the lessons we learned from that hurricane were implemented during Hurricane Rita about a month later."