2016 Teddy Award Winner

Improve the Well-Being of Every Life

Excela Health changed the way it treated injuries and took a proactive approach to safety, drastically reducing workers’ comp claims and costs.
By: | November 2, 2016 • 6 min read

Excela Health, a health care network operating three hospitals in western Pennsylvania, abides by its mission to improve the health and well-being of every life it touches.

“When we wrote that mission statement about 10 years ago, ‘every life we touched’ was supposed to encompass not only our patients, but our employees and everyone who is here,” said Chief Medical Officer Carol Fox.

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Taking extra care of its employees comes with an added bonus — it helped Excela deeply reduce workers’ compensation claims in the process.

Excela’s across-the-board efforts earn the hospital a 2016 Teddy Award. The numbers speak for themselves: Excela lowered workers’ compensation paid claims costs to $124,076 last year from $859,515 in 2008.

The hospital managed injured employees with a creative and robust return-to-work program and added around-the-clock support from an on-call nursing team. Then it bolstered employee wellness programs and attacked the top causes of workplace injury.

Carol Fox, chief medical officer, Excela Health

Carol Fox, chief medical officer, Excela Health

Excela was formed in 2004 with the merger of three regional Pennsylvania hospitals: Frick Hospital in Mount Pleasant; Latrobe Hospital in Latrobe; and Westmoreland Hospital in Greensburg. The combined health system is the largest employer in the region with more than 4,500 employees.

Excela also runs a home health care and hospice company with 206 workers making more than 275 home visits each day. And there’s a physician practice that employs another 900 people in 98 locations.

That’s a lot of opportunity for accidents and yet just 62 employees filed an OSHA recordable claim in the fiscal year ending June 30, 2016, down from 233 in fiscal year 2008.

Return to Work Program

A big part of  Excela’s efforts is its Temporary Transitional Return to Work Program, launched in 2010 to encourage employees to remain productive after a work-related injury or illness.

“We keep them working and keep them engaged and we care about them,” said Laurie English, Excela’s chief human resource officer.

Excela has been able to put about 95 percent of injured workers in this program. “That’s truly where the cost reduction has happened,” English said.

Take for example cardiac nurse Ruth Ann Martin. She snagged her foot on a computer cord while getting up to answer a patient’s call a few years ago. She tumbled and her kneecap — taking the brunt of the fall — shattered.

After four decades of working at the hospital without so much as a scratch, the injury sidelined her for a month. After she fell, Martin was met in the emergency room by Eileen Kantorik, an occupational health coordinator, who opened a worker’s compensation case for her.

“We keep them working and keep them engaged and we care about them.” — Laurie English, chief human resource officer, Excela Health

Kantorik has stayed by Martin’s side ever since. She found Martin transportation back and forth to the hospital once she was cleared to return to work. She arranged assistance for Martin, who initially needed a walker, to her desk once she arrived. Kantorik checked in on Martin throughout her recovery and was accessible by cell phone after-hours.

“It made me feel better,” Martin said. “They walked me through everything. It helped a lot because you have the fear of the unknown and without that support it would have been a lot harder.”

As she recovered, Martin was approved to perform scaled-back jobs at the same rate of pay. She has since fully recovered and returned to her previous nursing job. Excela recently celebrated her 45th anniversary at the hospital.

“Where there is an unsafe working condition we feel we owe it to our employees to get them back to 100 percent as quickly as possible,” English said.

“We found having the employee in their department, with the people around them that they normally socialize with, helped to keep them engaged and back to full duty quicker.”

Nurse on Call Program

A Nurse on Call program is another new way Excela captured big cost savings by directing employees to its Employee Health department immediately after an injury. Certified occupational health coordinators such as Kantorik advise employees with significant injuries how best to navigate the workers’ compensation process.

This approach gets employees the most appropriate and cost-effective treatment. If an employee’s injury happens after business hours, or on a weekend or holiday, a Nurse on Call (NOC) initiates the process.

In the past, since Excela runs hospitals, its injured employees instinctively walked to the emergency department for treatment, adding unnecessary expense to the claim.

Excela changed that behavior and got staff comfortable with working with an employee health coordinator using best workers’ comp practices.

Employee Health gets employees seen by the appropriate medical specialist and then back on the job, at full pay, as quickly as possible.

This helps the employee avoid using unnecessary vacation or sick time off, said Mary Blackburn, supervisor of employee safety.

“People who have been injured at work have come to really appreciate that program because they have somebody that’s watching after them and ensuring that things are happening the way things are supposed to be happening,” Fox said.

Tackling the Top Hazards

Excela didn’t just improve the way they cared for employees after an injury. They also established a team that would spring to action to study what caused the accident and how to prevent it in the future.

“We are looking at keeping injuries from ever happening,” said David Byers, director of support services and safety.

“If we can keep that from happening in the first place, we don’t have the injury and we don’t have any of the costs to go along with it.”

After Ruth Ann Martin, the nurse, tripped on the extension cord and busted her knee, Excela’s safety team tied up every cord at every work station off the floor throughout the entire health network. They even redesigned all conference rooms to eliminate cord clutter.

Laurie English, chief human resource officer, Excela Health

Laurie English, chief human resource officer, Excela Health

Of all the risks, Excela’s research initially ranked exposure to blood and body fluids (BBFs) as the No. 1 occupational hazard — that’s needle sticks and other sharp-related injuries which can potentially expose workers to blood borne pathogens such as hepatitis or HIV.

In one case, a phlebotomist was in the middle of the blood draw when a nurse quickly entered the room. The phlebotomist flinched, causing the needle to dislodge and stick her.

When the safety team studied the event, they realized there was no mechanism in place to alert staff when a blood draw is under way.

They set to work to create a broad solution with a program called “Get the Point.” It involves staff training and a hospital-wide flag system on all patient rooms with colored signage indicating the safety hazards within.

What’s on Your Feet?

When digging into other top injuries, Excela discovered employees were getting hurt on their way to and from work. Falls and fractures spiked during inclement weather.

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The Safety and Occupational Health Department launched “What’s On Your Feet?” They greeted arriving employees with safety materials and LifeSavers candy at the entrances as a fun way to encourage appropriate footwear. It worked. Entering work became a red carpet moment as employees playfully showed off shoes to safety advocates each morning.

It all falls under their mission to improve the health and well-being of every life Excela touches.

“That’s the Holy Grail,” Fox said. “We want everybody to be at least as good, and hopefully better, when they leave here.” &

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Read more about the 2016 Teddy Award winners:

target-150x150Bringing Focus to Broad Challenges: Target brings home a 2016 Teddy Award for serving as an advocate for its workers, pre- and post-injury, across each of its many operations.

 

hrt-150x150The Road to Success: Accountability and collaboration turned Hampton Roads Transit’s legacy workers’ compensation program into a triumph.

 

excela-150x150Improve the Well-Being of Every Life: Excela Health changed the way it treated injuries and took a proactive approach to safety, drastically reducing workers’ comp claims and costs.

 

harder-150x150The Family That’s Safe Together: An unwavering commitment to zero lost time is just one way that Harder Mechanical Contractors protects the lives and livelihoods of its workers.

 

More coverage of the 2016 Teddy Awards:

Recognizing Excellence: The judges of the 2016 Teddy Awards reflect on what they learned, and on the value of awards programs in the workers’ comp space.

Fit for Duty: 2013 Teddy Winner Miami-Dade County Public Schools is managing comorbid risk factors by getting employees excited about healthy living.

Saving Time and Money: Applying Lean Six Sigma to its workers’ comp processes earned Atlantic Health a Teddy Award Honorable Mention.

Caring for the Caregivers: Adventist Health Central Valley Network is achieving stellar results by targeting its toughest challenges.

Advocating for Injured Workers: By helping employees navigate through the workers’ comp system, Cottage Health decreased lost work days by 80 percent.

A Matter of Trust: St. Luke’s workers’ comp program is built upon relationships and a commitment to care for those who care for patients.

Keeping the Results Flowing: R&I recognizes the Metropolitan Water Reclamation District of Greater Chicago for a commonsense approach that’s netting continuous improvement.

Juliann Walsh is a staff writer at Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Alternative Energy

A Shift in the Wind

As warranties run out on wind turbines, underwriters gain insight into their long-term costs.
By: | September 12, 2017 • 6 min read

Wind energy is all grown up. It is no longer an alternative, but in some wholesale markets has set the incremental cost of generation.

As the industry has grown, turbine towers have as well. And as the older ones roll out of their warranty periods, there are more claims.

This is a bit of a pinch in a soft market, but it gives underwriters new insight into performance over time — insight not available while manufacturers were repairing or replacing components.

Charles Long, area SVP, renewable energy, Arthur J. Gallagher

“There is a lot of capacity in the wind market,” said Charles Long, area senior vice president for renewable energy at broker Arthur J. Gallagher.

“The segment is still very soft. What we are not seeing is any major change in forms from the major underwriters. They still have 280-page forms. The specialty underwriters have a 48-page form. The larger carriers need to get away from a standard form with multiple endorsements and move to a form designed for wind, or solar, or storage. It is starting to become apparent to the clients that the firms have not kept up with construction or operations,” at renewable energy facilities, he said.

Third-party liability also remains competitive, Long noted.

“The traditional markets are doing liability very well. There are opportunities for us to market to multiple carriers. There is a lot of generation out there, but the bulk of the writing is by a handful of insurers.”

Broadly the market is “still softish,” said Jatin Sharma, head of business development for specialty underwriter G-Cube.

“There has been an increase in some distressed areas, but there has also been some regional firming. Our focus is very much on the technical underwriting. We are also emphasizing standardization, clean contracts. That extends to business interruption, marine transit, and other covers.”

The Blade Problem

“Gear-box maintenance has been a significant issue for a long time, and now with bigger and bigger blades, leading-edge erosion has become a big topic,” said Sharma. “Others include cracking and lightning and even catastrophic blade loss.”

Long, at Gallagher, noted that operationally, gear boxes have been getting significantly better. “Now it is blades that have become a concern,” he said. “Problems include cracking, fraying, splitting.

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“In response, operators are using more sophisticated inspection techniques, including flying drones. Those reduce the amount of climbing necessary, reducing risk to personnel as well.”

Underwriters certainly like that, and it is a huge cost saver to the owners, however, “we are not yet seeing that credited in the underwriting,” said Long.

He added that insurance is playing an important role in the development of renewable energy beyond the traditional property, casualty, and liability coverages.

“Most projects operate at lower capacity than anticipated. But they can purchase coverage for when the wind won’t blow or the sun won’t shine. Weather risk coverage can be done in multiple ways, or there can be an actual put, up to a fixed portion of capacity, plus or minus 20 percent, like a collar; a straight over/under.”

As useful as those financial instruments are, the first priority is to get power into the grid. And for that, Long anticipates “aggressive forward moves around storage. Spikes into the system are not good. Grid storage is not just a way of providing power when the wind is not blowing; it also acts as a shock absorber for times when the wind blows too hard. There are ebbs and flows in wind and solar so we really need that surge capacity.”

Long noted that there are some companies that are storage only.

“That is really what the utilities are seeking. The storage company becomes, in effect, just another generator. It has its own [power purchase agreement] and its own interconnect.”

“Most projects operate at lower capacity than anticipated. But they can purchase coverage for when the wind won’t blow or the sun won’t shine.”  —Charles Long, area senior vice president for renewable energy, Arthur J. Gallagher

Another trend is co-location, with wind and solar, as well as grid-storage or auxiliary generation, on the same site.

“Investors like it because it boosts internal rates of return on the equity side,” said Sharma. “But while it increases revenue, it also increases exposure. … You may have a $400 million wind farm, plus a $150 million solar array on the same substation.”

In the beginning, wind turbines did not generate much power, explained Rob Battenfield, senior vice president and head of downstream at JLT Specialty USA.

“As turbines developed, they got higher and higher, with bigger blades. They became more economically viable. There are still subsidies, and at present those subsidies drive the investment decisions.”

For example, some non-tax paying utilities are not eligible for the tax credits, so they don’t invest in new wind power. But once smaller companies or private investors have made use of the credits, the big utilities are likely to provide a ready secondary market for the builders to recoup their capital.

That structure also affects insurance. More PPAs mandate grid storage for intermittent generators such as wind and solar. State of the art for such storage is lithium-ion batteries, which have been prone to fires if damaged or if they malfunction.

“Grid storage is getting larger,” said Battenfield. “If you have variable generation you need to balance that. Most underwriters insure generation and storage together. Project leaders may need to have that because of non-recourse debt financing. On the other side, insurers may be syndicating the battery risk, but to the insured it is all together.”

“Grid storage is getting larger. If you have variable generation you need to balance that.” — Rob Battenfield, senior vice president, head of downstream, JLT Specialty USA

There has also been a mechanical and maintenance evolution along the way. “The early-generation short turbines were throwing gears all the time,” said Battenfield.

But now, he said, with fewer manufacturers in play, “the blades, gears, nacelles, and generators are much more mechanically sound and much more standardized. Carriers are more willing to write that risk.”

There is also more operational and maintenance data now as warranties roll off. Battenfield suggested that the door started to open on that data three or four years ago, but it won’t stay open forever.

“When the equipment was under warranty, it would just be repaired or replaced by the manufacturer,” he said.

“Now there’s more equipment out of warranty, there are more claims. However, if the big utilities start to aggregate wind farms, claims are likely to drop again. That is because the utilities have large retentions, often about $5 million. Claims and premiums are likely to go down for wind equipment.”

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Repair costs are also dropping, said Battenfield.

“An out-of-warranty blade set replacement can cost $300,000. But if it is repairable by a third party, it could cost as little as $30,000 to have a specialist in fiberglass do it in a few days.”

As that approach becomes more prevalent, business interruption (BI) coverage comes to the fore. Battenfield stressed that it is important for owners to understand their PPA obligations, as well as BI triggers and waiting periods.

“The BI challenge can be bigger than the property loss,” said Battenfield. “It is important that coverage dovetails into the operator’s contractual obligations.” &

Gregory DL Morris is an independent business journalist based in New York with 25 years’ experience in industry, energy, finance and transportation. He can be reached at [email protected]