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2014 Risk All Star: Jeff Driver

A Driven Visionary

Jeff Driver was an 18-year-old orderly in a hospital emergency room when a child died before his eyes. The child had been misdiagnosed and moved to the wrong floor before his respiratory tract closed up.

The experience launched Driver into health care risk management, where he’s been for a quarter-century, always “chasing the effectiveness” of loss control and patient safety. One could say he’s caught it.

Jeff Driver, chief risk officer, Stanford University Medical Center

Jeff Driver, chief risk officer, Stanford University Medical Center

Driver is no stranger to the risk management limelight — he was president of the American Society for Healthcare Risk Management in the past decade — but Risk & Insurance® is placing him back in the light in large part for the creativity of his most recent efforts as chief risk officer at the Stanford University Medical Center.

The highlight is his creation of a new reciprocal risk retention group (RRG) called the Professional Exchange Assurance Co. (PEAC) to help Stanford keep ahead of mandates from the Affordable Care Act.

All health care entities, particularly hospital groups, are feeling the urge to consolidate because of the efficiencies of size and the drive to create Accountable Care Organizations (ACOs). In California, Stanford faces the twist that state law prohibits hospitals from directly employing doctors; they must be employed through “physician foundations.”

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Stanford has two such foundations with plans to include 500 community physicians within three years. Driver had to devise a way to bring these doctors into the Stanford risk management and patient safety program, while mitigating liability and brand risk.

The particular RRG structure, now in place for nearly two years, works for a few reasons. Namely, it gives the affiliated physicians “skin in the game” because they technically own the captive and will enjoy profit-sharing if losses are kept low.

It also works because Stanford Medical’s other captive—the 20-year old, segregated cell, Bermuda-based SUMIT—cannot provide insurance to for-profit physician groups because of tax rules. So SUMIT still provides coverage and services to its in-house faculty physicians while PEAC steps in for affiliated doctors.

With both, Driver can ensure risk management consistency across the enterprise and that effectiveness he has pursued his whole career.

“He has created a vehicle to kind of indoctrinate these newly acquired physicians in much more modern risk management practices,” said Gigi Norris, Aon managing director.

“Jeff is very visionary … and he is very mission driven.”

Driver and his risk management team of 25 are spreading Stanford’s best practices beyond the university as well. One benefit of the RRG structure is that Driver created another entity, The Risk Authority, to serve as its necessary attorney-in-fact, as well as a service provider for external health care entities.

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It delivers Stanford risk management products and services — like tools for early resolution and loss, claims and litigation management, patient safety consulting and value-driven enterprise risk management — around the world.

Driver’s success comes in part because of his leadership. He is able to build a team, empower its members, and motivate them toward success with his vision.

Success builds trust with senior management, which leads to larger teams, bigger projects and more success.

And he’s succeeded because he’s willing to try anything to succeed.

“If people really focus in on how they can do things better rather than doing the same thing, that would serve our patients and our communities very well,” he said.

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350px_allstarRisk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, perseverance and/or passion.

See the complete list of 2014 Risk All Stars.

More from Risk & Insurance

More from Risk & Insurance

Risk Focus: Workers' Comp

Do You Have Employees or Gig Workers?

The number of gig economy workers is growing in the U.S. But their classification as contractors leaves many without workers’ comp, unemployment protection or other benefits.
By: and | July 30, 2018 • 5 min read

A growing number of Americans earn their living in the gig economy without employer-provided benefits and protections such as workers’ compensation.

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With the proliferation of on-demand services powered by digital platforms, questions surrounding who does and does not actually work in the gig economy continue to vex stakeholders. Courts and legislators are being asked to decide what constitutes an employee and what constitutes an independent contractor, or gig worker.

The issues are how the worker is paid and who controls the work process, said Bobby Bollinger, a North Carolina attorney specializing in workers’ compensation law with a client roster in the trucking industry.

The common law test, he said, the same one the IRS uses, considers “whose tools and whose materials are used. Whether the employer is telling the worker how to do the job on a minute-to-minute basis. Whether the worker is paid by the hour or by the job. Whether he’s free to work for someone else.”

Legal challenges have occurred, starting with lawsuits against transportation network companies (TNCs) like Uber and Lyft. Several court cases in recent years have come down on the side of allowing such companies to continue classifying drivers as independent contractors.

Those decisions are significant for TNCs, because the gig model relies on the lower labor cost of independent contractors. Classification as an employee adds at least 30 percent to labor costs.

The issues lie with how a worker is paid and who controls the work process. — Bobby Bollinger, a North Carolina attorney

However, a March 2018 California Supreme Court ruling in a case involving delivery drivers for Dynamex went the other way. The Dynamex decision places heavy emphasis on whether the worker is performing a core function of the business.

Under the Dynamex court’s standard, an electrician called to fix a wiring problem at an Uber office would be considered a general contractor. But a driver providing rides to customers would be part of the company’s central mission and therefore an employee.

Despite the California ruling, a Philadelphia court a month later declined to follow suit, ruling that Uber’s limousine drivers are independent contractors, not employees. So a definitive answer remains elusive.

A Legislative Movement

Misclassification of workers as independent contractors introduces risks to both employers and workers, said Matt Zender, vice president, workers’ compensation product manager, AmTrust.

“My concern is for individuals who believe they’re covered under workers’ compensation, have an injury, try to file a claim and find they’re not covered.”

Misclassifying workers opens a “Pandora’s box” for employers, said Richard R. Meneghello, partner, Fisher Phillips.

Issues include tax liabilities, claims for minimum wage and overtime violations, workers’ comp benefits, civil labor law rights and wrongful termination suits.

The motive for companies seeking the contractor definition is clear: They don’t have to pay for benefits, said Meneghello. “But from a legal perspective, it’s not so easy to turn the workforce into contractors.”

“My concern is for individuals who believe they’re covered under workers’ compensation, have an injury, try to file a claim and find they’re not covered in the eyes of the state.” — Matt Zender, vice president, workers’ compensation product manager, AmTrust

It’s about to get easier, however. In 2016, Handy — which is being sued in five states for misclassification of workers — drafted a N.Y. bill to establish a program where gig-economy companies would pay 2.5 percent of workers’ income into individual health savings accounts, yet would classify them as independent contractors.

Unions and worker advocacy groups argue the program would rob workers of rights and protections. So Handy moved on to eight other states where it would be more likely to win.

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So far, the Handy bills have passed one house of the legislature in Georgia and Colorado; passed both houses in Iowa and Tennessee; and been signed into law in Kentucky, Utah and Indiana. A similar bill was also introduced in Alabama.

The bills’ language says all workers who find jobs through a website or mobile app are independent contractors, as long as the company running the digital platform does not control schedules, prohibit them from working elsewhere and meets other criteria. Two bills exclude transportation network companies such as Uber.

These laws could have far-reaching consequences. Traditional service companies will struggle to compete with start-ups paying minimal labor costs.

Opponents warn that the Handy bills are so broad that a service company need only launch an app for customers to contract services, and they’d be free to re-classify their employees as independent contractors — leaving workers without social security, health insurance or the protections of unemployment insurance or workers’ comp.

That could destabilize social safety nets as well as shrink available workers’ comp premiums.

A New Classification

Independent contractors need to buy their own insurance, including workers’ compensation. But many don’t, said Hart Brown, executive vice president, COO, Firestorm. They may not realize that in the case of an accident, their personal car and health insurance won’t engage, Brown said.

Matt Zender, vice president, workers’ compensation product manager, AmTrust

Workers’ compensation for gig workers can be hard to find. Some state-sponsored funds provide self-employed contractors’ coverage.  Policies can be expensive though in some high-risk occupations, such as roofing, said Bollinger.

The gig system, where a worker does several different jobs for several different companies, breaks down without portable benefits, said Brown. Portable benefits would follow workers from one workplace engagement to another.

What a portable benefits program would look like is unclear, he said, but some combination of employers, independent contractors and intermediaries (such as a digital platform business or staffing agency) would contribute to the program based on a percentage of each transaction.

There is movement toward portable benefits legislation. The Aspen Institute proposed portable benefits where companies contribute to workers’ benefits based on how much an employee works for them. Uber and SEI together proposed a portable benefits bill to the Washington State Legislature.

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Senator Mark Warner (D. VA) introduced the Portable Benefits for Independent Workers Pilot Program Act for the study of portable benefits, and Congresswoman Suzan DelBene (D. WA) introduced a House companion bill.

Meneghello is skeptical of portable benefits as a long-term solution. “They’re a good first step,” he said, “but they paper over the problem. We need a new category of workers.”

A portable benefits model would open opportunities for the growing Insurtech market. Brad Smith, CEO, Intuit, estimates the gig economy to be about 34 percent of the workforce in 2018, growing to 43 percent by 2020.

The insurance industry reinvented itself from a risk transfer mechanism to a risk management mechanism, Brown said, and now it’s reinventing itself again as risk educator to a new hybrid market. &

Susannah Levine writes about health care, education and technology. She can be reached at [email protected] Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]