2017 Teddy Awards: Honorable Mention

Triage, Transparency and Teamwork

When the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.
By: | November 1, 2017 • 5 min read

Facing the painful medical cost increases that bedevil so many administrators, the City of Surprise, Arizona, significantly cut its medical expenditures and lost work days by implementing new programs and moving to a self-insured model.

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Historically, Surprise was a member of a municipal risk pool that offered a guaranteed-cost program for workers’ compensation. The program served its purpose for the 15 years Surprise was a member, limiting potential exposure by capping aggregate losses. However, costs and premiums were rising.

When Brian Carmichael assumed the role of risk manager in May 2015, he identified a growing interest in the possibility of self-insurance. In the process, the city conducted a thorough analysis of workers’ compensation and found there was “money being left on the table” in premiums and medical costs. Carmichael’s team began prioritizing changes that needed to be made.

Taking Control With Triage

Carmichael noted that Surprise’s workers’ comp medical expenses, at around $800,000, were far more than they should have been for a city of its size. But the best path for a solution wasn’t immediately clear. The risk management team chose to approach the problem at a grass roots level, enlisting the help of employees to talk about their injury experiences.

Through those conversations, the team noted that the city was relying solely on supervisors to triage or direct care to various medical providers in the event of an injury. With no medical training, supervisors often erred on the side of caution and sent injured workers to the emergency room, sometimes for things as minor as a small cut or sprained ankle.

This resulted in frustratingly long wait times for employees and also high costs for the city.

Brian Carmichael, risk manager, City of Surprise, Ariz.

Carmichael’s team recognized the need for skilled medical triage and decided to search for an appropriate partner. It selected a local company to contract with.

A detailed, in-person training session was given to each department on the new procedure and how it would impact the injury and recovery process. Carmichael said the program evolved over the first few months.

The new procedures allowed the city to gain more control over its claims, including protocols for sending reports and email notifications to all stakeholders during an injury.

The risk management department, including senior adjuster Bretton Jeziorski and adjuster and safety analyst Michelle Boyer, immediately reach out to each injured worker to start investigating and expediting medical care.

“We are all notified within 15 minutes of [an injury], which allows us to reach out directly to them. I think that has been the biggest win for us to have that immediate intervention with our employees,” Carmichael said.

The ability to begin the investigation process sooner is also helping the city to eliminate repeat injuries, driving claims frequency down.

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An increase in transparency about claims costs allows risk management to engage everyone in its push to prevent injuries and improve claims outcomes.

“Being able to show what we are paying and going to departments — from city leadership down to line-level employees — created a culture in which everyone was interested,” he said.

Carmichael said the city saw an “immediate shift” in the entity’s ability to contain costs, dramatically reducing the number of hospital bills that formerly might linger for months before risk management even knew about them.

Between 2015 and 2016, visits to the ER fell by half. Yearly average claim costs fell from $6,584 to $4,220, and workers were receiving better care.

The city also significantly reduced lost workdays by expanding opportunities for return to work. Many employees appreciate having the ability to return to light duty roles at full compensation.

“Oftentimes these employees would go to the ER, never do a follow-up, take a month off from work and just disappear. There were holes in the program,” Carmichael said.

While the City of Surprise lost 572 workdays in 2015, the risk management department was able to reduce that number to only 211 days in 2016.

Inspiring Engagement

Carmichael said that using its new transparency about costs has allowed employees to really see how their participation matters, and to take an active interest in continued improvement. “Their cooperation hasn’t been about compliance but about commitment,” he said.

Numerous suggestions offered by employees in regards to process improvement and tool and equipment modifications have been put into place throughout the City in the past year. To keep that momentum alive, Carmichael said the department speaks to all 1,200 full- and part-time city workers at least every other month.

“Oftentimes employees would go to the ER, never do a follow-up, take a month off from work and just disappear. There were holes in the program.” — Brian Carmichael, risk manager, City of Surprise, Ariz.

The program became so successful the city made the leap to becoming self-insured on July 1, 2017. Whereas most similar programs are administered through a TPA, the City of Surprise has opted to self administer. Carmichael said the team wanted to further contain medical costs by going directly to providers and cutting out any markups in the middle.

Carmichael said this decision has enabled them to negotiate some “unbelievable” rates.

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The city is still protected against catastrophic injuries with a self-insured retention of $500,000 for the general population and $1 million for public safety employees. Surprise also established appropriate reserves that would be three times those limits.

“We’re going to build that and invest the money over the years to reduce the program cost to the employees while still keeping those dollars low,” he said.

Through all these measures, Carmichael said Surprise has been able to reduce workers’ compensation medical expenditures from an average of $800,000 to only $300,000 in two years. And from July to October 2017, there was not a single lost workday.

“We have the buy-in from the employees that it’s in their best interest. They’re being paid. It’s a benefit. If they can be here in some way, they come,” he said. &

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More coverage of the 2017 Teddy Award Winners and Honorable Mentions:

Advocacy Takes Off: At Delta Air Lines, putting employees first is the right thing to do, for employees and employer alike.

 

Proactive Approach to Employee SafetyThe Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.

 

Getting It Right: Better coordination of workers’ compensation risk management spelled success for the Massachusetts Port Authority.

 

Carrots: Not SticksAt Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.

 

Fit for Duty: Recognizing parallels between athletes and public safety officials, the city of Denver made tailored fitness training part of its safety plan.

 

Triage, Transparency and TeamworkWhen the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.

A Lesson in Leadership: Shared responsibility, data analysis and a commitment to employees are the hallmarks of Benco Dental’s workers’ comp program.

 

Craig Guillot is a writer and photographer, based in New Orleans. He can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Management

The Profession

Pinnacle Entertainment’s VP of enterprise risk management says he’s inspired by Disney’s approach to risk management.
By: | November 1, 2017 • 4 min read

R&I: What was your first job?

Bus boy at a fine dining restaurant.

R&I: How did you come to work in this industry?

I sent a résumé to Harrah’s Entertainment on a whim. It took over 30 hours of interviewing to get that job, but it was well worth it.

R&I: If the world has a modern hero, who is it and why?

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The Chinese citizen (never positively identified) who stood in front of a column of tanks in Tiananmen Square on June 5, 1989. That kind of courage is undeniable, and that image is unforgettable. I hope we can all be that passionate about something at least once in our lives.

R&I: What emerging commercial risk most concerns you?

Cyber risk, but more narrowly, cyber-extortion. I think state sponsored bad actors are getting more and more sophisticated, and the risk is that they find a way to control entire systems.

R&I: What is the riskiest activity you ever engaged in?

Training and breaking horses. When I was in high school, I worked on a lot of farms. I did everything from building fences to putting up hay. It was during this time that I found I had a knack for horses. They would tolerate me getting real close, so it was natural I started working more and more with them.

Eventually, I was putting a saddle on a few and before I knew it I was in that saddle riding a horse that had never been ridden before.

I admit I had some nervous moments, but I was never thrown off. It taught me that developing genuine trust early is very important and is needed by all involved. Nothing of any real value happens without it.

R&I: What about this work do you find the most fulfilling or rewarding?

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Setting very aggressive goals and then meeting and exceeding those goals with a team. Sharing team victories is the ultimate reward.

R&I: What is the most unusual/interesting place you have ever visited?

Disney World. The sheer size of the place is awe inspiring. And everything works like a finely tuned clock.

There is a reason that hospitality companies send their people there to be trained on guest service. Disney World does it better than anyone else.

As a hospitality executive, I always learn something new whenever I am there.

James Cunningham, vice president, enterprise risk management, Pinnacle Entertainment, Inc.

The risks that Disney World faces are very similar to mine — on a much larger scale. They are complex and across the board. From liability for the millions of people they host as their guests each year, to the physical location of the park, to their vendor partnerships; their approach to risk management has been and continues to be innovative and a model that I learn from and I think there are lessons there for everybody.

R&I: What is the risk management community doing right?

We are doing a much better job of getting involved in a meaningful way in our daily operations and demonstrating genuine value to our organizations.

R&I: What could the risk management community be doing a better job of?

Educating and promoting the career with young people.

R&I: What have you accomplished that you are proudest of?

Being able to tell the Pinnacle story. It’s a great one and it wasn’t being told. I believe that the insurance markets now understand who we are and what we stand for.

R&I: Who is your mentor and why?

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John Matthews, who is now retired, formerly with Aon and Caesar’s Palace. John is an exceptional leader who demonstrated the value of putting a top-shelf team together and then letting them do their best work. I model my management style after him.

R&I: What is your favorite book or movie?

I read mostly biographies and autobiographies. I like to read how successful people became successful by overcoming their own obstacles. Jay Leno, Jack Welch, Bill Harrah, etc. I also enjoyed the book and movie “Money Ball.”

R&I: What is your favorite drink?

Ice water when it’s hot, coffee when it’s cold, and an adult beverage when it’s called for.

R&I: What does your family think you do?

In my family, I’m the “Safety Geek.”

R&I:  What’s your favorite restaurant?

Vegas is a world-class restaurant town. No matter what you are hungry for, you can find it here. I have a few favorites that are my “go-to’s,” depending on the mood and who I am with.

If you’re in town, you should try to have at least one meal off the strip. For that, I would suggest you get reservations (you’ll need them) at Herbs and Rye. It’s a great little restaurant that is always lively. The food is tremendous, and the service is always on point. They make hand-crafted cocktails that are amazing.

My favorite Mexican restaurant is Lindo Michoacan. There are three in town, and I prefer the one in Henderson as it has the best view of the valley. For seafood, you can never go wrong with Joe’s in Caesar’s Palace.




Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]