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Collaboration That Leads to Quality Care

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For Dr. Nicholas Massa, vice president of medical affairs at Excellus BlueCross BlueShield, collaboration and quality have been cornerstones of his remarkable 25-year medical career. As a dedicated local physician, he began his journey as a graduate, resident, and practitioner of pediatrics at Upstate University Hospital, where he fostered partnerships, developed innovative programs, and prioritized affordability.

“My priority has always been on the patient’s health and well-being, and this commitment has driven me to foster strong partnerships with our community organizations, health plans, doctors, and hospitals,” says Massa.

Today, he uses this focus on high-quality patient care in his current role at Excellus BCBS. At the nonprofit health plan, he collaborates with 24 other physicians and is a leader among the hundreds of clinical staff, including pharmacy, nursing, and social work team members. Together, they establish a framework for doctors and hospitals to work in unison
with the insurance company, developing best practices that impact access to high quality care.

At Excellus BCBS, positive and collaborative relationships are essential to providing quality, accessible and affordable care to its 1.5 million members across 39 counties of upstate New York. Ninety-eight percent of all local doctors and hospitals are in the insurer’s provider network. These doctors provide high-quality health care, and their work helps the insurer fulfill its mission: To help people in our communities live healthier and more secure lives through access to high-quality, affordable health care.

“When I think of our mission I keep coming back to collaboration because it’s key to how we address the rising costs of healthcare while also maintaining the level of care our members need and deserve,” says Massa.

The team at Excellus BCBS has made collaboration a priority for the betterment of their members by:
• Providing education on the benefits of health screenings and vaccinations

• Supporting community organizations and providers who are breaking down barriers in health care related to race, ethnicity, or social determinates of health

• Connecting its members with a range of support to meet their needs, using internal resources and external partnerships.

“That’s why we’re here. That’s one of the strengths of a local, regional, nonprofit health plan,” Massa adds. “Our focus at Excellus BCBS is on our communities, on quality of care, and on providing it to our members in a way that is as affordable as possible.”

Quality of Care

That focus on quality is what recently earned CNY Family Care in Syracuse an honor from Excellus BCBS known as the “Circle of Excellence Innovation Award.”

Four years ago, CNY Family Care implemented a diagnostic tool for diabetic patients called Retina Vue. “We are very progressive with various types of testing and education,” says Dr. Joseph Augustine, a primary care physician at CNY Family Care.

With diabetes cases on the rise, Retina Vue provides a quick, in-office scan of the retina, allowing physicians to advise patients on next steps within minutes. This proactive approach shows how primary care practices like CNY Family Care prioritize the prevention of complications associated with diabetes.

“Trust is crucial between a provider and patient. The most significant aspect for doctors and patients is building a relationship and diligently following up on conversations, especially regarding diagnoses,” Augustine explains.

“This quality care is measured by health plans like Excellus BCBS, who recognize the importance of that relationship and trust,” says Tony Vitagliano, VP, provider network, Excellus BCBS.

The Circle of Excellence award is not a financial incentive award, but rather a peer-nominated award. The award highlights visionary, quality, and health equity thought leaders in the Excellus BCBS provider network who have made significant impacts on health care delivery and the lives of the health plan’s members.

“We developed the Circle of Excellence awards to recognize those who work in partnership with us and look at different ways to deliver accessible and high-quality care,” Vitagliano said. “Because of doctors like those at CNY Family Care, patients are getting the care they need, when they need it. It’s partnerships like these that make us incredibly proud.”

Access to Care

When providers and insurers work together to improve access to care, they can significantly impact their communities.

“Just as coordination and collaboration have better ensured quality care for patients, they have also helped us to address health disparities,” Massa says. “Part of being a good doctor means getting to know your patients; we recognize that our network of providers has strong relationships with the people they care for, and that trust leads to better outcomes and greater access.”

A prime example in Central New York is Cayuga Health Partners (CHP), a proud partner of Excellus BCBS. This clinically integrated network of primary care and specialty physicians, in conjunction with Cayuga Health System, has established a closed-loop referral process. This process integrates social needs screening, connects patients directly to community resources, and provides direct feedback to providers.

“CHP, an Ithaca-based organization, sets the bar high for the work it has done to help underserved populations through healthcare and social services interventions,” Massa says. CHP CEO Rob Lawlis couldn’t agree more. “We are leading the region with our commitment to health equity and developing health equity capabilities,” Lawlis says. “By addressing unmet social needs, CHP is taking steps to address major barriers to health and wellbeing for vulnerable populations in the community.”

One such step is through a program called “We Ask Because We Care,” in which patients are invited to answer optional questions about race, ethnicity, sex at birth and current gender identity.

Dr. John-Paul Mead, medical director at CHP, adds, “With the data, we can see if there’s a problem with a group that isn’t getting tested in the Ithaca area. We can look at that group and ask, what’s the mammogram rate for that subpopulation?’”

After spending three years mining the data among their patient population— with 80% responding—CHP has identified specific groups it can target for preventive diagnostics. That rate of response means the data is valid, so CHP can get to work.

“We Ask Because We Care represents an innovative way to address health inequities,” Vitagliano says. “By leveraging community partnerships like this, we are able to work together to ensure everyone has a chance to live a healthy life.”

Mead is justifiably proud of the program and its partnership with Excellus BCBS. “Excellus BCBS, like CHP, is truly working to help their members—our patients,” Mead says. “Their support allows us to make an impact on patients’ lives. We both understand that it’s not 

Affordability of Care

just about saving money, but instead about saving lives and preventing disease.”

 

While ensuring that members receive the best possible clinical outcomes and access to care, Excellu
s BCBS is also dedicated to making health care as affordable as possible.

Through programs that work directly with members, their doctors, and the health plan, these collaborations, as Massa explains, allow Excellus BCBS to provide more comprehensive, coordinated, and, at times, even more convenient care for high-risk members while reducing the need for expensive health care services.

REACH Kidney Care
ElenaMarie Burns, an Excellus BCBS employee, faced the challenges of navigating chronic kidney disease (CKD) when her father suffered a stroke in his 50s that led to the discovery that his kidneys were not functioning properly.

She remembers times when her father would stop taking his medication or resist following the doctor’s dietary instructions. “We didn’t have someone to sit and talk to him, like a care management team to have that coordination of care. I think he could have benefited from that,” says Burns. Within a couple of years of diagnosis, her father began dialysis. “The dialysis really did a number on him.”

REACH Kidney Care didn’t exist when Burns was going through this stressful time with her father. Today, this kidney health management program partners with Excellus BCBS and its network nephrologists to provide its members with stage 4-5 chronic kidney disease services that help them to navigate their care and follow their physician’s treatment plan.

Knowing what is available to patients and caregivers now, she says, “I think that education (provided by the Excellus BCBS care management team and REACH Kidney Care) would have given my father a better quality of life.”

Through REACH, members work one-on-one with a multi-disciplinary care team that provides personalized support to help members make the most of their care and manage their CKD. The REACH program is offered virtually, over the phone and in-person at no cost to members that have this benefit included in their plan.

“This program allows us to improve the health of our CKD patients and keep them out of the hospital, decreasing the cost of care,” says Dr. Philip Ondocin of Nephrology Associates of Syracuse. “Excellus BCBS members who are eligible for the program are offered social support and psychological services, which are hard to get for dialysis patients.”

WellBe Senior Medical

WellBe Senior Medical has partnered with Excellus BCBS to bring care directly to the homes of some of the most vulnerable Medicare Advantage members, helping to reduce unnecessary medical costs and improve quality of care.

For 95-year-old member “Ms. D” who was ready for hospice but didn’t qualify based on her diagnoses, WellBe being a part of her care meant she could spend her final days at home with her daughters by her side.

“Ms. D’s WellBe clinical team collaborated closely with her family as an added in-home resource and when her daughters placed an urgent call to WellBe as her mother was having trouble walking and breathing,” says Nurse Practitioner Liz Vasquez, WellBe’s clinical director. “We were able to recognize signs of congestive heart failure and discussed hospital stabilization or hospice enrollment.”

Despite not qualifying for hospice through her existing diagnoses and lack of an echocardiogram, the WellBe team used the Framingham CHF Criteria to diagnose her condition accurately, enabling Ms. D to then qualify for hospice care at home.

“This is just one example of how we focus on patients with serious chronic illnesses, or who are either homebound or home-limited, meaning that it’s difficult for them to get out of the house for appointments,” explains Dr. Raghu Ram, WellBe regional chief medical
officer.

Eligible Excellus BCBS members benefit from personalized in-home care as needed, help managing prescription medications, and in home urgent care services available 24/7.

WellBe collaborates with the patient’s primary care physicians, so they are seen, in the home, between office visits. The goal of this collaboration is to improve outcomes and health care quality, reduce unnecessary medical costs, and provide exceptional member experience.

Additionally, by visiting patients at home, providers can address issues such as personal safety, fall risk, and food insecurity. “We’re often able to see things that may be of concern that wouldn’t otherwise be seen in an office setting,” Ram says.

Excellus BCBS Pharmacy Concierge Program

High drug prices are challenging health plans, employers, patients, and the entire health care system. This upward trend, which is projected to continue in the coming years, has serious consequences for millions of Americans, as one third of the U.S. population reports not taking medication as prescribed because it is just too expensive, according to the American Hospital Association.

The high cost of prescription drugs and the resulting burden on members led Excellus BCBS to develop Pharmacy Concierge, an innovative approach to improving care while reducing costs.

“Pharmacy Concierge makes a powerful difference for our members,” says Massa. “We’re proud that a program now exists that ensures our members are using the most appropriate and cost-effective therapy options.”

The concept of improving care and reducing pharmacy costs by identifying lower-cost generics or modifications to dosages is not unique. “What is unique about Pharmacy Concierge is our focus on health outcomes and safety,” says Excellus BCBS Pharmacist Supervisor Lindsey Shuler.

“It is much more than an algorithm. The program includes a clinical review of every savings intervention and ensures both safety and savings,” she adds.

This past year, the Excellus BCBS clinical team identified a member on an inefficient dosage of a brand name antidepressant. The member was prescribed two tablets daily, despite availability of a higher dose, which would allow for one tablet to be taken daily. The team reached out to the member’s doctor, suggested a change, and today the member is taking the dosage once daily, ensuring a better outcome, as well as saving $3,500 per year.

“We ensure that our recommendation would never result in more out-of-pocket costs for the patient and always ask, ‘What are the most cost effective options that are also the safest for our members?’ We work directly with the prescriber to discuss and suggest alternatives, but the final decision is between the prescriber and patient,” Shuler says.

And with the cost savings often comes medication adherence.

“As a provider, I know that if a patient can afford a medication, they’ll take it more consistently, which provides them a better outcome in the long term,” says Massa.

Collaboration is Key

Excellus BCBS’s strength lies in its commitment to the communities it serves, the doctors and hospitals that it partners with, and the members who rely on them for care.

While costs are increasing in all areas of our lives, from the grocery store to the gas pumps, health care is no exception. But together with its many partners, Excellus BCBS is eager and ready to continue working to prioritize the overall experience and outcomes for their members, providing access to quality care to all people.

“We want our members to have access to the care they need, when they need it, and we do this through strong partnerships, innovative programs to improve affordability, and a relentless focus on our members,” says Massa. “Collaboration is essential in health care because it allows us to leverage strengths and improve where there are weaknesses. By working together, we can create a seamless experience for patients, and ensure they receive the right care at the right time.” 

To learn more about these and the many other programs offered through Excellus BCBS, visit excellusbcbs.com.

Who’s Taking Care Of The Physicians?

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MSSNY’s Peer Coaching Program Combats Stigma, Offers ‘Safe Space’ for Docs Battling Demons

By: Bari Faye Dean

It’s no secret that physicians live in a pressure cooker of stressors. They want to provide the highest quality care to patients, give the most of themselves to their families and personal life and, all the while, find themselves buried in paperwork and the inexplicable frustrations brought on by the technology required to balance healthcare regulations and insurance red tape.

“Doctors aren’t weak. We are strong and resourceful,” said Frank Dowling, MD, a psychiatrist in private practice on Long Island. “But even steel has a breaking point.”

Without intervention, stress and burnout can lead to severe health issues, including depression, PTSD, substance abuse and even suicide. No question about it: something has to give – before a practitioner gives in to stress, burnout or a personal challenge that has been threatening to sideline them. The bottom line, wonders Bonnie Litvack, MD, a Mount Kisco, NY-based radiologist who specializes in breast imaging, is this: “Who’s taking care of the physicians while physicians take care of everyone around them?”

Confidential Assistance from Trained Peer Coaches
The Medical Society of the State of New York’s (MSSNY) Physician Wellness and Resilience Committee launched a Peer 2 Peer (P2P) program. This program offers a vital lifeline to physicians, residents and medical students who are having emotional difficulties but have decided not to seek help because they are afraid of the stigma attached to mental healthcare – especially for physicians who are “supposed to be able to handle everything,” Dr. Litvak said.

When a participant reaches out for help, they are connected with a P2P Program peer supporter, a fellow medical professional, who has been trained to actively listen and offer feedback during one or two phone calls or video chats.

“We are providing psychological first aid,” said Dr. Dowling, who has been a peer supporter since the inception of the MSSNY program. “It’s therapeutic because it provides support and empathy, but it’s not treatment. If the participant needs a clinical referral and agrees to take one, they will be connected with the help they need.”

To date, almost 100 physicians have been successfully trained in crisis management by MSSNY’s P2P Program. During three-hours of training, peer supporters are trained to know what resources are available and how to guide a physician to get the help they need moving forward. If you would like to learn more about becoming a peer supporter, contact Emily Rento, Program Coordinator, at erento@mssny.org.

“Too many doctors are suffering in silence because they fear that if people knew what was going on in their heads, others would look at them differently,” Dr. Dowling said. “The P2P Program allows doctors to help our peers manage their battles confidentially.”

Indeed, the entire program is 100 percent confidential. There is no paper trail. There is no reason to fear retribution at work. If you need help, reach out now. You can get connected with a peer supporter by emailing P2P@mssny.org or by calling 844-P2P-PEER (844-727-7337).

P2P Provides a Safe, Judgment-Free Space
“There is a real need for this program. Many other fields have these types Physicians are human beings and they need a safe space, where they can be validated and talk about their feelings without judgment,” explained P2P Program peer supporter Dr. Litvack.

Dr. Litvack was president of MSSNY in 2020 2021 during the height of the COVID-19 pandemic, when the P2P Program was launched. “COVID exacerbated everything physicians are dealing with at work and in their personal lives. I am proud we were able to start the P2P Program then, Dr. Litvack said. “But it’s a few years later and we see those life stressors haven’t gone away. Physicians faced them long before COVID and we will be facing them long after.”

Take It From Someone Who’s Been There
Janine L. Fogarty, MD, a diagnostic radiologist in Rochester, NY, is not only a trained peer supporter, but she knows first-hand how a career in medicine can cause a level of stress that can engulf a physician. She has been there and retired from that.

“I retired from a long medical career in 2022 because I was burned out beyond repair,” Dr. Fogarty said. “At work, I had all the responsibility and no control. I couldn’t affect change for my patients. I couldn’t do it anymore. I was so emotionally isolated. No one around me knew I was struggling. My work environment wasn’t healthy for me so I couldn’t reach out there. I could talk with friends but they didn’t really understand because they are not physicians.”

Dr. Fogarty remembers the days of the physicians’ lounge, when a step away, a cup of coffee and a quick chat with a colleague could do wonders to calm a stressed doctor down. Those days are long gone, she said. “You put your head down and move forward. You don’t want to disappoint patients or coworkers.”

This combination, she said, is a recipe for disaster in a physician community where shortages are rising at record rates. Bringing back a sense of comradery could be a real solution for physicians who are struggling and need connection, she said.


At the same time, physicians don’t reach out for help because of the stigma they believe is alive and well throughout the medical community.

“Every day, doctors choose to suck it up and don’t get the help they need,” Dr. Dowling said. “If doctors can get help earlier, without anyone knowing, it can make all the difference. The P2P Program has done this for many physicians all around New York.”

If you need someone to talk with or a physician you know is struggling, MSSNY’s P2P Program is here to help. For more information, email P2P@mssny.org or call 844-P2P-PEER (844-727-7337).

Changing Weather Patterns and the Potential Impaction Environments and People

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By Kathryn Ruscitto, Advisor

This week I had the opportunity to talk to two science experts who I have asked to be part of a panel on restoration of parks and landscapes after two recent hurricanes. The Garden Club I belong to in Florida works to raise money to restore pollinator gardens and native plantings, and we will be sponsoring a panel to help people plan for the future.

The scientists listened and observed and said, be sad for what is lost but move on. Our weather patterns are changing, and what worked in the past needs rethinking. What survived, and what didn’t, and how do you use resources and time to plan for the future.

Sobering but great advice.

Health experts are beginning to look at the issue of changing weather patterns and its impact on health as well. Research suggests more respiratory and cardiac- related chronic conditions, spread of parasites and pathogens, as suggested by increases in tick-borne diseases, West Nile and Dengue, and more foodborne illness, as suggested by the recalls we are experiencing due to outbreaks from food across the country.

For those patients who work outside, the exposure is leading to more risks related to heat and cold. Many clinicians were trained in a period where climate impact on patients was not part of anyone’s curriculum. That has changed.

The American Medical Association in November issued stronger statements on this topic:

“Climate change has adversely affected people’s physical and mental health. Climate- related risks are not distributed equally. The AMA recognizes that minoritized and marginalized populations, children, pregnant people, the elderly, rural communities, and those who are economically disadvantaged will suffer disproportionate harm from climate change.”

The American Hospital Association has developed tools for organizations to look at their behaviors and policies to promote sustainable practices and reduce environmental impacts.

It’s a broad topic that leads us to consider both personal and professional implications. How do I adjust my behaviors and even my investments of time and resources in renewable technology and research.

Sobering issues, but we should focus on what we can do individually to improve our education and actions.

Resources:
Climate Doctors: https://www.youtube.com/ watch?v=bgvMYCMy57w

•AHA Survey on Climate Change: https://
www.aha.org/news/headline/2024-01-24 survey- most-clinicians-support-hospital efforts-address- climate-change

AMA Advocacy on Climate Effects: https:// www.ama-assn.org/delivering-care/ public-health/advocacy-action-combatting- health-effects-climate-change

Kathryn Ruscitto, Advisor, can be reached at linkedin.com/in/kathrynruscitto or at krusct@gmail.com

Physician Burnout: Seeing Improvement but Still a FixableCause for Medical Errors

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By: Jenn Negley, Vice President, Risk Strategies Company

Physician burnout is not a new phenomenon, but its prevalence has recently reached alarming levels. According to a 2021 survey by Mayo Clinic and Stanford Medicine, 62.8% of physicians reported experiencing burnout. While the numbers have improved, with a more recent AMA study showing that 50% of physicians are now struggling with burnout, the issue remains far from solved. The lingering effects of the COVID-19 pandemic, growing mistrust in medical science, and misinformation continue to place added stress on healthcare providers, making burnout a critical issue that affects both physicians and patients.

The Lasting Impact of Administrative Challenges

A key factor fueling burnout in physicians is the increasing administrative burden they face. Constantly changing regulations, including the often-onerous prior authorization (PA) processes, have been cited by physicians as major contributors to job dissatisfaction. The American Medical Association (AMA) has voiced concerns about PAs, describing them as a “barrier between patients and necessary care under the guise of controlling costs.” According to the AMA’s latest survey, 95% of physicians reported that the PA process either somewhat or significantly increased their burnout.

While administrative tasks are a challenge in many professions, in healthcare, the stakes are much higher. When physicians are overwhelmed by paperwork, their ability to provide optimal patient care is compromised, which directly impacts patient safety. Medical errors, which are already a significant concern, are further exacerbated by burnout.

Physician Burnout and Its Link to Medical Errors

The relationship between physician burnout and medical errors is well documented. In a study led by Daniel Tawfik and published in Mayo Clinic Proceedings, it was revealed that rates of medical errors tripled in work units where physicians reported high levels of burnout—even in units with top safety ratings. This data makes it clear: burnout doesn’t just affect physician well-being—it directly impacts the quality of care they provide.

Though healthcare systems have made progress in improving patient safety through system-level interventions, we cannot overlook the role of the physician’s mental health. If physicians are experiencing burnout, even the most well-designed systems will fail to prevent medical errors. In fact, burnout could undo many of the safety gains achieved through system-level changes. To reduce errors and improve care, we must address the root cause of burnout.

Addressing the Root Causes of Burnout

There are clear steps that can be taken to reduce burnout and improve both physician well-being and patient care. First and foremost, healthcare organizations must create a culture where mental health is prioritized. This begins by fostering an open dialogue about burnout, encouraging physicians to seek help when needed, and ensuring they have access to mental health resources.

While individual support is crucial, systemic changes are just as important. The administrative burden physicians face must be reduced by streamlining processes such as prior authorizations and cutting down on redundant tasks. Physicians should be allowed to focus on patient care, rather than spending countless hours on paperwork. Furthermore, healthcare leaders must listen to the needs and concerns of their staff, ensuring that burnout is addressed not just as a personal issue but as an organizational one.

• To make a lasting impact, addressing burnout requires collaboration among all stakeholders, including healthcare systems, insurance companies, the government, and technology providers. Solutions should include adjusting workflows, improving reimbursement rates, and eliminating unnecessary administrative barriers. If we tackle these issues, we can create an environment that supports physicians and, in turn, improves the quality-of-care patients receive.

Conclusion: Physician Burnout Is a Fixable Problem

While physician burnout rates have improved, they remain alarmingly high and continue to contribute to medical errors. This is a crisis that cannot be ignored. The good news is that burnout is a fixable problem—one that requires the collective effort of healthcare leaders, administrators, policymakers, and the broader healthcare system. By addressing the root causes of burnout, such as administrative burdens, and fostering a culture of mental health support, we can reduce medical errors and ensure that physicians are able to provide the best possible care to their patients.

For more information, please contact Jenn Negley, Vice President, Risk Strategies Company at 267-251-2233 or JNegley@Risk Strategies.com.

Tackling Drug Costs In New York State

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New York Governor Kathy Hochul signed legislation amending subdivision five of Section 280-a of the New York Public Health Law (“PHL”) and announced new regulations that aim to protect New Yorkers from the rising cost of prescription medications. Both target the operations of Pharmacy Benefit Managers (“PBMs”) by prohibiting business practices that raise the cost of prescription drugs and by increasing opportunities for independent pharmacies to compete with large, PBM-affiliated pharmacies. 

What are Pharmacy Benefit Managers?

PBMs are third-party ‘‘intermediaries’ that help negotiate costs and payment of prescription drugs between the major players in the prescription drug supply chain: health insurance providers, drug manufacturers, wholesalers, and pharmacies. PBMs determine which drugs are accessible to consumers, at what cost, and often by what pharmacies. 

PBMs contract with health insurance providers to manage prescription drug benefits for insured beneficiaries. PBMs do this by creating and maintaining formularies, which are lists of prescription drugs covered by health insurance plans. Each insurance plan has a unique formulary. When creating a formulary, PBMs negotiate discounts and rebates with drug manufacturers. That determines the prices insurance plans pay for prescription drugs and payments pharmacies receive for distributing drugs to consumers insured by the plan. 

When PBMs negotiate rebates with drug manufacturers, they typically retain a percentage of the rebate as profit, rather than passing the full amount to consumers. Because prescription drugs with higher prices often have higher rebates, PBMs are incentivized to include higher priced drugs on their formularies.

PBMs also play an administrative role for insurance providers by directly reimbursing pharmacies for dispensing drugs. PBMs receive administrative fees for these services from insurance providers and profit from ‘spread pricing.’ When a PBM receives a higher payment from an insurance provider than the amount the PBM pays to pharmacies, the PBM retains the difference. Legislators have identified spread pricing as a factor in increasing costs of prescription drugs for consumers.

The Federal Trade Commission reports that only three PBMs manage approximately 80% of all prescriptions filled in the U.S and that pharmacies affiliated with those PBMs account for nearly 70% of all specialty drug revenue. Critics argue that the tightly controlled marketplace has led to increased costs to patients and the closure or sale of independent pharmacies. 

PBM Regulation in New York 

In January 2022, Governor Hochul signed a first-of-its kind law in New York, providing for licensure and registration of PBMs. The law also set new standards that PBMs are required to comply with when operating in the State. In addition to reducing costs for consumers, Governor Hochul cited increased transparency regarding PBMs’ operations as a chief goal of the law.

The State Department of Financial Services is empowered to enforce the law and can receive complaints of violations of the law by PMBs from New Yorkers, pharmacies, and health care providers.

Impact of Amended PHL and New Regulations 

On September 27, 2024, the Governor signed legislation that eliminated the ‘gag clause’ that had prohibited pharmacists from telling consumers about negative reimbursements charged to pharmacies for prescription drugs. Negative reimbursements cause pharmacies not to stock certain drugs, limiting access to essential prescription drugs for consumers. By lifting the gag clause, pharmacists can explain why they cannot stock certain drugs, and consumers can use that information to petition their health insurance provider to increase access. 

The Governor recently announced new regulations governing market conduct for PBMs that:

• allow home delivery of prescription drugs by in network pharmacies;

• mandate PBMs to publish formularies and pharmacy directories;

• require PBMs to establish customer service lines;

• prohibit PBMs from steering patients to affiliated pharmacies;

• prevent PBMs from passing losses onto pharmacies when the PBM mistakenly approves a dispensed drug;

• permit small pharmacies to submit and receive electronic communications from PBMs; and

• require PBMs to apply the same audit standards to all in network pharmacies, helping small pharmacies compete with PBM affiliate pharmacies.

The regulations, supported by the Pharmacist Society of the State of New York, are anticipated to empower consumers, increase access to prescription drugs, level the playing field for small pharmacies and lower costs of prescription drugs across the State. 

For questions, contact Lippes Mathias attorney Sarah E. Steinmann by phone at 315-477-6232 or by email at ssteinmann@lippes.com.

G.M. Crisalli & Associates, Inc.: Celebrating 35 Years of Excellence in Construction Contracting

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By Elizabeth Landry

When Gary Crisalli first began his own general contracting business in Syracuse in 1989, he was working out of a two-bedroom apartment in Solvay. After the first year and for the next seven years, he and his team operated the business out of a residential home they had renovated to meet their business needs before finally settling into their long-term and current location on Hiawatha Boulevard West. From humble beginnings, Crisalli took on projects in almost every industry, growing the business’s portfolio and demonstrating its commitment to excellence while meeting the needs of a diverse array of clients.

Today, G.M. Crisalli & Associates, Inc. (GMCA) is one of the top general contractors in Central NY, having completed approximately 1,700 projects over the course of the business. With a team of about forty people, the organization works on projects across the entire Northeastern United States, from Wisconsin to Maine to Maryland.

As the company celebrates its 35-year anniversary this year, this important milestone serves as a time to reflect on the growth and accomplishments over the years and to look ahead to the many projects still to come. Between Crisalli, President and Owner, and Rocco Paone, Associate, who joined the company in 1991, the team at GMCA has over one hundred combined years of experience in construction contracting and has achieved much success by focusing on meeting the needs of clients for every project, every time. 

Diverse Clients and Industries

Working as a mason when he was just sixteen, and through his college years, Crisalli worked with a large engineering firm, an architectural firm and a construction contracting company before venturing out on his own. Obtaining such valuable field and office experience in his teens and early twenties allowed GMCA to take on any job in many different industries from the first day of business.

“I’ve been telling people since the day we went into business that we build everything except roads and bridges,” said Crisalli. “Due to a past client that Rocco had worked with, GMCA obtained a contract on a very large construction site in our first year. The Solvay cogeneration power plant in Solvay. We were contracted to do a small job at first. The contract exponentially grew as we performed our base contract.  We were asked to work in many areas of the plant. We ended up being there for three years doing anything they wanted us to do, from asbestos abatement to assisting with the walk-down and commissioning of the boilers. That project was a blessing to our company, but it was also a project we knew we could perform well. From day one we did anything that was requested of our company by our client.  The company philosophy is to acquire the knowledge, expertise, and experience to meet any of our client’s construction needs. That 

philosophy got us in the door and has retained our relationships in many different industries.”

The team at GMCA has completed projects for clients in both the public and private sectors, in industries including education, military, commercial, industrial, medical, retail and grocery, as well as building restaurants and places of worship. Having completed numerous original-build and renovation projects for such a diverse range of clients, Crisalli has a long list of favorite jobs the team has worked on over the years, starting with brick removal and replacement for Onondaga County at the Civic Center in 1991. That same year, the team built the first neuro angiogram room at Upstate Medical Center, which led to numerous build and renovation projects for the health center in the following decades. In 1996, GMCA built the flagship Franklin Covey store in New York City across from the Rockefeller Center. In the early-to-mid 2000s, the company assisted with the building and construction management of the Clarence Jordan Vision Center for Mercy Works in Syracuse, the Island Health & Fitness Center in Ithaca, the Abundant Life Discipleship Training Center and the FedEx distribution center, both in East Syracuse, various five-story college housing projects, and Athletic clubs.  One of the most unique projects GMCA has completed is building the penguin exhibit at the Rosamond Gifford Zoo.

Perhaps the most stand-out project in Crisalli’s list of favorites is the Blodgett Dream Center, a sprawling, one-of-a-kind library located within one of the most impoverished schools in the Syracuse City School District. “Many different artisans worked on this project,” Crisalli explained. “It has a spaceship with twenty-nine computers, a Renaissance-themed area with beautiful arches, a prehistoric-themed space with dinosaurs, a Roman Amphitheater where James Earl Jones read to the Blodgett children on the opening day of the library, and a beautiful Egyptian-themed tiled wall entrance and greeting area. 

Adapting to Change

To continue meeting the diverse range of client needs over the years, the GMCA team has been able to adapt to many different settings and requirements. For Paone, working with such a wide range of clients has been one of the most enjoyable aspects of the business.

“Probably what’s been most exciting for me is meeting so many good customers and diverse clients over the years,” said Paone. “We’ve worked with so many different types of clients and we always strive to adapt to their individual wants and needs. We’ve done a tremendous amount of work in medical institutions and hospitals, which have many layers of requirements, as compared to a client who’s planning a building that’s coming out of the ground. Having the ability to adapt to our clients’ needs and re-educating ourselves for every different project has been so important.”

Alongside diverse client needs, GMCA has been successful in adapting to changes within the industries themselves, related to software, technology, communications and more. Crisalli explained how general societal changes have a large impact on contracting, procurement, and managing projects across industries.

“The construction industry has changed a lot over the years,” Crisalli explained. “Everything moves faster now because of the advancements in communications. Society has changed overall as far as how we communicate with each other from purchasing, procurement of subcontractors, materials, regulations, building systems, construction equipment and processes, just about every aspect of building for our clients.   It has been interesting keeping up with all the changes. The different changes over the years have, in turn, altered the way we approach building in many different ways and areas of the industry.  It’s all a little different than when we started out.  The building process must adapt to our client’s needs. It’s more important to plan and schedule all these items immediately following contract procurement.  Our team obtains all the knowledge necessary to plan out the entire building: pre-construction, construction, and turnover phases in the preconstruction phase of the project, prior to putting a shovel in the ground. This practice has led us in making the construction process efficient and successful.”

“The company’s greatest single asset are the people who meet, adapt, and succeed in navigating the changes to our industry. We are very successful because of our staff of smart, knowledgeable, service-oriented people.” Crisalli continued.

Of course, to keep up with all the moving parts within the contracting space as well as the diverse needs of clients, GMCA’s team needs to remain highly knowledgeable and adaptable.  This makes all the difference with clients and ongoing success. Due to a general shortage of skilled trades, this need can sometimes be challenging, but according to Crisalli, GMCA has been successful in this area because of its focus on ongoing training and education, as well as a unique company culture that combats the stress that often comes along with working in construction.

“Over the years, the training processes that we use have changed completely. Now, we train our team on software as well as procedure, making sure everyone has the skills they need to successfully execute jobs. Not only do we train our employees on our own software programs, but we also train them on our clients’ various software programs to help us assimilate into different markets. Although we make sure the team has the knowledge and training to succeed on every site, the construction industry culture can sometimes be stressful. Many of our employees have been with us for over 10 years, and they appreciate that we try to alleviate stress through working as a team and humor. We have a small company atmosphere that works. Someone is always willing to help when another person’s workload suddenly increases.   I really think that helps,” said Crisalli.

Charitable Giving in the Community

Another important aspect of the company culture at GMCA is a great sense of pride in supporting the causes of several organizations and charities throughout many communities. The company facilitated a golf tournament to support Mercy Works’ at The Clarence Jordan Vision Center last year, raising approximately $50,000. Crisalli is a past president of the Baldwin Fund, and GMCA continues to support this charity.  The company has also supported the Fellowship of Christian Athletes (FCA) every year, as well as local organizations such as In My Father’s Kitchen and Francis House.

One charitable organization that’s especially meaningful to Crisalli is Marvelous Ways International in Lakeland, Florida. GMCA supports a golf tournament for this organization each year, which was founded by a couple from Central New York, Mark and Christin Haywood. Marvelous Ways International uses different developmental programs, teams of trained individuals and innovative technology to help monitor and improve outcomes for impoverished youth in Nicaragua, Costa Rica, and Honduras. “This organization helps kids who don’t have many great options in life to succeed. They give these children and teens a hope for the future by monitoring and guiding them through these youthful years and assisting each individual allowing them to choose a path for a successful life. It’s working out well and really making a difference in the life story of many who had few options for success. I am proud we can volunteer our time and resources to help make a positive difference in the lives of others,” said Crisalli.

Looking to the Future

Having worked with an impressive list of diverse clients for 35 years and always leaning into re-evaluation of the business, learning and constructive change along the way, GMCA is moving into the future with a goal of continued progress, growth, and adaptability.

“We always try to take a snapshot of what our economy is doing – what’s hot and what’s not,” said Paone. “We’ll continue to adapt our business corresponding with changes in the economy. Everyone knows the buzzword in Syracuse – Micron – and we’re certainly keeping our eye on that industry so we can adapt our business to service that industry successfully.”

Although change is always certain, especially in the construction contracting marketplace, one thing that will continue to remain constant for GMCA is its centralized mission of focusing on client needs above all else.

 

“Having been in business for 35 years is a real blessing. During that time, we’ve instilled in our team a sense of slow but steady growth, and conveyed the importance of covering our bases so we can ensure the best possible outcomes for our clients,” said Crisalli. “In our industry, it really comes down to this: if you please your clients, you’ll always succeed.”

Manufacturing Trends – Embracing Innovation & Efficiency

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By: James A. D’Agostino, CEO, MEP Center Director

Manufacturing continues to experience a transformative period driven by the rapid adoption of advanced technologies and a focus on sustainability. As we look toward 2025, several key trends are shaping the future of manufacturing. From smart manufacturing and automation to sustainability initiatives, space optimization, and labor efficiency, the industry’s evolution reflects a careful balance between cutting-edge technology and practical, responsible solutions.

Smart Manufacturing, Industry 4.0, and Automation

Smart manufacturing is a central pillar of Industry 4.0, and it continues to gain momentum. This approach leverages interconnected machines, Internet of Things (IoT) devices, artificial intelligence (AI), and data analytics to create highly efficient, autonomous production environments. The integration of digital twins, predictive maintenance, and real-time monitoring allows manufacturers to optimize performance, reduce downtime, and improve product quality. As a result, more manufacturers are moving from reactive to proactive production models, minimizing inefficiencies and maximizing output. Automation isn’t a new concept in manufacturing, but the level of sophistication and accessibility is increasing dramatically. Today’s factories are more reliant on advanced robotics and AI-driven systems to handle tasks that were previously completed by human workers. Collaborative robots, or “cobots,” work alongside humans to enhance productivity, allowing for faster and safer operations. This automation enables companies to scale operations while maintaining flexibility, which is especially important in industries where customization and shorter product lifecycles are becoming the norm.

Sustainability Initiatives

Sustainability has become a strategic priority for manufacturers worldwide, driven by both regulatory pressures and consumer demand. As we head into 2025, manufacturers are even more focused on reducing their environmental footprint through energy-efficient processes, the use of renewable materials, and waste minimization strategies. Closed-loop manufacturing, where waste products are reintroduced into the production cycle, is becoming more prevalent, contributing to a circular economy. Manufacturers are also investing in carbon-neutral operations, including on-site renewable energy sources like solar and wind power.

Space Optimization

As real estate costs rise around the region and the demand for agile production grows, manufacturers are turning to innovative strategies for space optimization. The goal is to maximize productivity within existing or limited physical footprints. One approach involves modular factory designs, where production units can be easily reconfigured or relocated as needs change. These flexible layouts help manufacturers adapt quickly to shifts in production demand or product variety without requiring large-scale infrastructure changes. Additionally, digital technologies such as 3D modeling and simulation tools are being used to optimize the arrangement of machinery, storage, and workflows within a facility. By visualizing and analyzing spatial layouts in virtual environments, manufacturers can ensure efficient material flow, minimize wasted space, and reduce bottlenecks. Smart storage systems, like automated retrieval systems and vertical stacking, allow for higher-density storage without compromising accessibility, further enhancing space utilization. By effectively optimizing space, manufacturers can reduce operating costs, improve energy efficiency, and increase overall production capacity without needing to invest in larger physical plants.

Labor Optimization and Workforce Transformation

The role of human labor in manufacturing is also evolving. While automation reduces the need for manual, repetitive tasks, the workforce is being redefined to focus on high-skill, high-value jobs such as machine programming, maintenance, and data analysis. Manufacturers are prioritizing labor optimization by investing in workforce upskilling programs and creating flexible work environments that allow for a blend of remote and on-site work. The rise of augmented reality (AR) tools is also helping workers perform complex tasks with real-time guidance, improving accuracy and reducing training time.

As we approach 2025, manufacturing trends reflect a confluence of advanced technologies, sustainability concerns, and efficiency improvements. Smart manufacturing, automation, and space optimization are enabling manufacturers to achieve unprecedented levels of productivity, while sustainability and labor optimization ensure the industry adapts to modern economic, environmental, and social challenges. By embracing these trends, manufacturers are not only future-proofing their operations but also contributing to a more resilient and responsible global economy.

TDO is a consulting and training organization based in Liverpool, NY. Our mission is to grow the local economy by helping Central NY manufacturers and technology companies drive operational excellence and cultural transformation to reach their full potential. TDO’s support of the local mission generated $265 million in economic impacts in the last contract period supporting jobs, investments, cost savings, and profitable growth. If you are a small or mid-size manufacturer and would like to talk further, TDO’s team is experienced and fully certified to help. Reach out today to learn more and schedule a free consultation.

The Cost of Hiring

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By Susan Crossett, CEO, CPS Recruitment

Understanding the costs of hiring will help companies determine which recruiting model works best for them.  To make that determination, let’s review the variety of options available and each of their benefits.

Often companies begin with internal recruiting.  Filling open jobs from within, using employee referrals, internal advertising, and posting of jobs has several advantages.  It is cost effective, provides employees with a potential career path, boosts morale and provides a built-in knowledge base.  The downside is the candidate pool is more limited, less diverse and may create gaps in the organization.

External recruiting can mean using a variety of different methods depending on the type of role an employer is seeking to fill.  A company with a strong brand may attract enough candidates without needing to use any third-party intermediary.  They may maintain a database of good quality candidates that have interviewed for a different role, for future opportunities.  Staying connected with alumni who departed in good standing is another way to optimize your candidate database.  A robust candidate database helps to minimize hard costs associated with recruiting talent.

In a highly competitive labor market various other tools are available to assist in the recruiting process.   A company can start with a simple online classified website, such as Craigslist, a low-cost option that allows employers to choose the location and industry sector to post their ad.  Social media jobsites allow for job advertisements and candidate database searching or sourcing, think LinkedIn.

Job Boards are internet-based talent acquisition technologies that aggregate either local, national, or international job offerings.  Typically, employers pay up front to advertise the job offering for a set period of time.  Job aggregators pull jobs from other sites and use a pay per click pricing model when a candidate applies for a job. 

The methods above are relatively low out of pocket costs for talent acquisition.  Depending on the type of role, these tools work very well to find candidates.  If an employer is seeking to fill a senior executive position, a retained search provided by an executive search firm may be the right approach.  A retained search fee is paid up front and usually is paid if a hire was made or not.

Another method for recruitment is using the services of a staffing firm for direct hire, also known as permanent placement.  In this method the fee is only paid once a hire has been made and is typically a percentage of the annual salary for the first year.  It does not include commissions or bonus plans as part of the fee.  According to a recent survey by Staffing Industry Analysts (SIA), the median fee was 25% for a direct hire placement.

Staffing firms also provide temporary or contingent workers to assist employers, for a ramp up, a special project, long-term contracts or to determine if the employee is a good fit for the role.  The fee is determined by the overhead costs associated with the role and the mark-up by the staffing firm.

Depending on the role an employer is seeking to fill may well determine which method is used for sourcing a candidate.  If the role is customer interfacing or revenue generating, then a more targeted approach with the support of a staffing supplier may be appropriate.  If the company does not have a human resources team that includes recruiters establishing a strong relationship with an outside firm that understands the company culture and the types of skills needed for that company, may be the best available option for talent acquisition.

Prioritizing costs vs. efficiency vs. quality will help determine which method best suits your hiring needs.

The Cost of Hiring

Understanding the cost of hiring helps companies decide which recruiting approach works best for them. Let’s explore the key options and their benefits.

Internal Recruiting

Many companies start by filling open roles from within. Internal recruiting uses employee referrals, job postings, and promotions. This method offers several advantages:

  • Cost-effective – No external fees involved.
  • Career growth – Helps employees see a path forward.
  • Boosts morale – Employees feel valued and motivated.
  • Built-in knowledge – Candidates already understand the business.

However, the talent pool is limited, reducing diversity, and potentially creating skill gaps if employees move within the organization.

Some companies, especially those with strong brands, can attract candidates without needing third-party services. They may also keep databases of past candidates or maintain relationships with former employees to rehire them when the opportunity arises. Building a strong candidate database lowers recruiting costs in the long run.

External Recruiting

External recruiting opens new ways to find talent.

Online Recruiting Tools

In competitive markets, companies may rely on online tools to reach candidates:

  • Classified Sites – Platforms like Craigslist offer low-cost, location-specific postings.
  • Social media – Sites like LinkedIn allow companies to post jobs and search candidate databases.
  • Job Boards & Aggregators – These platforms, like Indeed, charge upfront or per-click fees, making them scalable options for local, national, or global recruiting.

Executive Search Firms

For senior roles, companies often use retained search firms, which charge a fee upfront regardless of if a hire is made. This is ideal for businesses seeking top-tier leadership but willing to invest more in the process.

Staffing Firms

Staffing firms offer two main services:

  1. Direct Hire (Permanent Placement) – The fee, typically 25% of the new hire’s first-year salary, is only charged once a successful hire is made.
  2. Temporary/Contingent Workers – Useful for project-based work, seasonal surges, or contract roles. Fees reflect both the staffing firm’s overhead and mark-up.

Matching the Method to the Role

The best recruiting method often depends on the role:

  • Customer-facing or revenue-generating roles may require a targeted approach with the help of staffing partners.
  • Companies without dedicated recruiters may benefit from working with staffing firms that understand their culture and talent needs.

Balancing Cost, Efficiency, and Quality

Ultimately, prioritizing costs, efficiency, and quality will guide businesses toward the recruiting model that best fits their hiring goals.

For more information on the cost of hiring and the best option for your firm/company, you may contact Susan Crossett, CEO, CPS Recruitment at 315-883-5470, SCrossett@CPSRecruiter.com or visit online at www.CPSRecruiter.com. 

Nuclear Energy

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By Earl Hall, Executive Director, Syracuse Builder Exchange

In 2019, the Climate Leadership and Community Protection Act (CLCPA) was passed by the New York State Assembly and the New York State Senate, then signed into law by former Governor Andrew Cuomo.  This legislation requires New York State to reduce greenhouse gas emissions by 40% in 2030, and 85% by 2050 from 1990 levels.  In addition, the CLCPA requires establishing a 100% clean electrical grid by 2040.

Recently there has been a renewed interest in nuclear energy to supplement other clean and renewable technologies such as wind, solar and batteries. Elected officials and others engaged in the New York energy industry have realized it is impractical to reach the above noted requirements within the CLCPA without nuclear energy.  

With increased demand from large manufacturers, industrial owners, future data centers associated with Aritificial Intelligence (AI) and other rate payers, nuclear energy is required to support those important industries and technologies that require clean, reliable, on-demand power 24/7/365.  Micron alone will require 400 megawatts for each of the five potential semiconductor manufacturing facilities in Clay, NY.  To put that into perspective, it would take 12,000 acres of solar panels to produce 100 megawatts of power.

Nuclear energy has proven to be the most effective and efficient energy source to assist in replacing fossil fuels.  The positive characteristics of nuclear energy include:

  • Renewable
  • Low-carbon emissions and footprint (four times less than solar)
  • Safe and reliable
  • Small land footprint
  • Clean and efficient

Oswego, New York is home to the largest producer of nuclear energy in New York State.  The four nuclear reactors along Lake Ontario (one in Wayne County, three in Oswego) produce 20% of the electricity in the state of New York.  The Oswego County community has embraced the nuclear industry over the past 40 years, enjoying the benefits of excellent paying jobs and associated economic development.

The nuclear industry supports nearly half a million jobs in the United States and contributes an estimated $60 billion to the U.S. gross domestic product each year.  Nuclear plants can employ up to 700 workers with salaries that are 30% higher than the local average. They also contribute billions of dollars annually to local economies through federal and state tax revenues.

Nuclear energy technology has transformed industry over the past few decades, with today’s nuclear power plants being smaller, safer, and more efficient than their predecessors from the 1980s.  Nuclear energy will ensure affordable, safe, secure, and

reliable access to electricity services for New York State’s residential and business consumers, at fair and reasonable rates, while protecting the natural environment.

Advanced nuclear development has led to innovative technologies and efficiencies associated with various Small Modular Reactors (SMR).  SMR technologies and capabilities provide different reactors for different solutions.  There are grid scale reactors, industrial scale reactors, high temperature gas reactors and micro-reactors which may be deployed in the future to solve unique challenges in society.  

Nuclear remains the largest source of clean energy in the United States. It generates nearly 800 billion kilowatt hours of electricity each year and produces more than half of the nation’s emissions-free electricity. This avoids more than 470 million electric tons of carbon each year, which is the equivalent of removing 100 million cars off the road.

To achieve New York’s goals as a leader in economic development, including hosting future data centers and supporting the nation’s most robust semi-conductor manufacturing industry, the Public Service Commission and elected officials in the State of New York must include nuclear energy as an additional clean, renewable energy solution.  Now is the time to adopt new, advanced nuclear development technologies to meet immediate and future energy consumption demands of the State of New York, and to comply with the overly aggressive requirements within the 2019 CLCPA.

Sources:             

  • United States Energy Department
  • NYS Public Service Commission
  • NYSERDA Future Energy Economy Summit
  • NYS Blueprint for Consideration of Advanced Nuclear Energy

The Weather Looks Rough Out There: What To Expect From Insurance Markets

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By: Pierre Morrisseau, CEO, OneGroup

It may go without saying, but 2024 continues to be one for the record books when it comes to severe weather events. Even as some of this year’s events have eclipsed past weather events for loss of property and life, it is the cumulative effect of so many events nationwide that is rapidly changing the insurance landscape. The collective cost of losses is resulting in a sea change in both personal and commercial insurance pricing. And as we have seen, these losses are not confined to “traditional” high-risk areas of the country.

As an insurance and risk expert, it seems appropriate and timely to share how we see natural disasters affecting insurance markets going forward. After all, insurance is, for most businesses and individuals, a major cost and an essential component of any business’s operations.

Consider the impact of just two recent storms alone: Moody’s RMS has estimated that the insured losses from Hurricane Helene may exceed $11 billion. Fitch Ratings has estimated that Hurricane Milton will far surpass Helene with insured losses of up to $50 billion. CoreLogic, an insurance industry analytics firm, indicates that there are now around seven million properties at risk of a storm surge from a Category 5 hurricane with a total property value of $11.6 trillion. The NOAA National Centers for Environmental Information (NCEI) recorded 28 separate $1 billion disasters in 2023. Yet despite the increasing occurrences of weather-related losses, Aon research found that only 31% of the roughly $380 billion in economic losses tallied in 2023 were covered by insurance. These numbers are staggering—and worrisome. It is critical that commercial property owners plan for and adapt to survive this “new normal.”

Yet all news is not bad news. For example, reinsurance—the insurance that insurance carriers purchase for themselves to help transfer risk—is likely to see rates lowered in 2025. This will be welcome news as reinsurance rates are a major driver of increased premiums from our carriers. According to analysis by Aon, global reinsurers are seeing strong profits, largely due to carriers shouldering most of the cost of recent insurance claims. While not necessarily good for the carriers themselves, a strong reinsurance market works to stabilize the insurance industry that is providing essential protections to businesses and individuals.

We expect reinsurance pricing to continue to moderate through 2024 and 2025, resulting in greater flexibility with carriers and lower end-costs to insurance buyers. We also anticipate reductions for best-performing risk categories and short-tail risks such as property, health and auto. Still, we believe that reinsurers must do a better job of sharing the cost of risk with their carriers.

To further reduce costs to business insurance buyers, part of the solution involves all entities working closely together to manage risk. First, clients and their insurance agents must collaborate to accurately identify and put in place risk management plans to present to carriers. Agents must work harder to present a positive, well-designed action plan to carrier underwriters. For their part, carriers must step out of their traditional comfort zones to allow for more innovation and modernization. Carriers, in turn, must provide reinsurers better insight into clients’ risk to remove friction costs and provide a clear picture of the original risk.

Finally, as I had mentioned in earlier articles, the entire insurance industry needs to focus heavily on curtailing social inflation. PartnerRe, a leading global reinsurer, defines social inflation as the increase in insurance losses caused by higher jury awards, more liberal treatment of claims and increased use of social media that foments an anti-insurance industry sentiment.

We are encouraged to see progress in each of these areas and are confident, barring any additional major catastrophes, that businesses and individuals will begin seeing much needed relief as we approach a new year.