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This profile was last updated on 1/12/15  and contains information from public web pages and contributions from the ZoomInfo community.

Ms. Kimberly George

Wrong Kimberly George?

Senior Vice President, Senior Hea...

Local Address: Chicago, Illinois, United States
Sedgwick Claims Management Services , Inc.
2101 Webster St
Oakland , California 94612
United States

Company Description: Sedgwick Claims Management Services, Inc. is the leading North American provider of innovative claims and productivity management solutions. Sedgwick CMS and its...   more
Background

Employment History

Board Memberships and Affiliations

Education

  • degree , nursing
    Mt. Hood School of Nursing
34 Total References
Web References
"Although workers' comp may not be ...
www.riskandinsurance.com, 25 Nov 2013 [cached]
"Although workers' comp may not be directly documented in the ACA, we will be impacted by accountable care," said Kimberly George, senior vice president and senior health care advisor for Sedgwick Claims Management Services. "I believe if we include ourselves as an industry in the health care reform, we have an opportunity to help shape the quality of care for injured workers."
In her conversations with workers' comp practitioners, George says she has found that some are taking a wait-and-see attitude while others are embracing the potential opportunities. She is urging the industry to understand, discuss, and create solutions in advance of the impact reform will have on workers' comp. "There is one certainty with health reform; nobody knows what will happen," George said.
...
George says the reform is aimed at improving the access to, quality of, and reimbursements for health care. Those are areas where workers' comp practitioners should focus their energies to see how the reform can benefit the system.
Access. "The access to care is not that physicians won't want to treat workers' comp patients. We recognize it is highly reimbursed," George said.
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"As a health care system evolves, it is a natural progression that nurse practitioners and physician assistants will have a greater role in primary care," George said. "When I think of workers' comp specifically, will a payer or jurisdiction allow a nurse practitioner to be the primary provider? We have to be cognizant as a system; if health care is moving in that direction, we have to as well."
Resisting such a change could likely result in poor outcomes for the workers' comp system, both financially and from the injured worker's perspective. George believes jurisdictions and payers need to get on board with expanding the field of primary care providers.
"Otherwise, they will be waiting for medical appointments that may extend out durations and potentially not provide quality care, so patients will have to wait," George said."Every delay in workers' comp or disability impacts costs."
Quality. The quality of medical care in hospitals is likely to improve as the facilities try to avoid lost reimbursements. As George explained, hospitals may be denied reimbursement for patients who are readmitted.
"Quality around nosocomial -- or hospital acquired infection, and [the desire to] send patients home in a safe way, as well as internal quality measures in hospitals will certainly be an improvement," George said."So while the risks to quality and timely care occur from access, it could improve."
...
"They strive to implement quality measures to improve overall health care for the entire population they serve," George said."An ACO seeks to provide patient-centered treatment programs and manage the continuum of care across the health care delivery system, which includes everything from wellness to chronic disease."
George expects reimbursement systems of ACOs to have a big impact on the workers' comp system.
Opportunities. George says the creation of ACOs and consolidation of medical facilities can be an opportunity to improve the quality of care for injured workers.
"Often today payers want to choose the services they have at different entities; pharmacy by one company, physical therapy from another, diagnostics obtained from yet another. They may be selective where physicians can do the surgery," George said.
News and Information from Midland Claims Service, Inc Industrial Injury Claims, Billings, Montana | Midland Claims Service, Inc.
www.midlandclaims.com [cached]
These services generate significant revenue and profit for some TPAs, said Kimberly George, Chicago-based senior vice president of managed care practice and client services for Sedgwick Claims Management Services, a NCSI member.
But improving the value for insurers and self-insurers is questionable when such services focus solely on obtaining discounts and not on improving injured workers' care, Ms. George said.
Kimberly George ...
www.kidschance.org, 22 Sept 2014 [cached]
Kimberly George
by Kimberly ...
www.insurancethoughtleadership.com, 8 Jan 2014 [cached]
by Kimberly George
...
Kimberly George photo
About the Author
Ms. George is a senior vice president, senior healthcare advisor at Sedgwick. In this position, Kimberly will explore and work to improve Sedgwick's understanding of how health care reform affects its business models and product and service offerings. She will also serve as senior healthcare advisor to Stone Point Capital, one of Sedgwick's primary shareholders. Kimberly previously served as Sedgwick's managed care practice lead. She joined Sedgwick in 2001 overseeing integrated disability medical programs and later case management services.
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The expected proliferation of accountable ...
www.riskandinsurance.com, 25 Nov 2013 [cached]
The expected proliferation of accountable care organizations resulting from the implementation of health care reform may improve the quality of care provided to workers' comp patients, says Kimberly George.
As the senior vice president and senior health care advisor for Sedgwick Claims Management Services, George explains that ACOs typically want to move from a fee-for-service payment system to one based on quality of care.
"Today's fee for service is just 'provide more medicine, do more tests, prescribe more of this.' That is how it is reimbursed," George said.
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