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.


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.


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.


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. &


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

Janet Sheiner, VP of risk management and real estate at AMN Healthcare Services Inc., sees innovation as an answer to fast-evolving and emerging risks.
By: | March 5, 2018 • 4 min read

R&I: What was your first job?

As a kid, bagging groceries. My first job out of school, part-time temp secretary.

R&I: How did you come to work in risk management?

Risk management picks you; you don’t necessarily pick it. I came into it from a regulatory compliance angle. There’s a natural evolution because a lot of your compliance activities also have the effect of managing your risk.

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


There’s much benefit to grounding strategic planning in an ERM framework. That’s a great innovation in the industry, to have more emphasis on ERM. I also think that risk management thought leaders are casting themselves more as enablers of business, not deterrents, a move in the right direction.

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

Justified or not, risk management functions are often viewed as the “Department of No.” We’ve worked hard to cultivate a reputation as the “Department of Maybe,” so partners across the organization see us as business enablers. That reputation has meant entertaining some pretty crazy ideas, but our willingness to try and find a way to “yes” tempered with good risk management has made all the difference.

Janet Sheiner, VP, Risk Management & Real Estate, AMN Healthcare Services Inc.

R&I: What was the best location and year for the RIMS conference and why?

San Diego, of course!  America’s Finest City has the infrastructure, Convention Center, hotels, airport and public transportation — plus you can’t beat our great weather! The restaurant scene is great, not to mention those beautiful coastal views.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

The emergence of risk management as a distinct profession, with four-year degree programs and specific academic curriculum. Now I have people on my team who say their goal is to be a risk manager. I said before that risk management picks you, but we’re getting to a point where people pick it.

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


The commercial insurance market’s ability to innovate to meet customer demand. Businesses need to innovate to stay relevant, and the commercial market needs to innovate with us.  Carriers have to be willing to take on more risk and potentially take a loss to meet the unique and evolving risks companies are facing.

R&I: Of which insurance carrier do you have the highest opinion?

Beazley. They have been an outstanding partner to AMN. They are responsive, flexible and reasonable.  They have evolved with us. They have an appreciation for risk management practices we’ve organically woven into our business, and by extension, this makes them more comfortable with taking on new risks with us.

R&I: Are you optimistic or pessimistic about the U.S. health care industry and why?

I am very optimistic about the health care industry. We have an aging population with burgeoning health care needs, coupled with a decreasing supply of health care providers — that means we have to get smarter about how we manage health care. There’s a lot of opportunity for thought leaders to fill that gap.

R&I: Who is your mentor and why?

Professionally, AMN Healthcare General Counsel, Denise Jackson, has enabled me to do the best work I’ve ever done, and better than I thought I could do.  Personally, my husband Andrew, a second-grade teacher, who has a way of putting things into a human perspective.

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

In my early 20s, I set a goal for the “corner office.” I achieved that when I became vice president.  I received a ‘Values in Practice’ award for trust at AMN. The nomination came from team members I work with every day, and I was incredibly humbled and honored.

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

The noir genre, so anything by Raymond Chandler in books. For movies,  “Double Indemnity,” the 1944 Billy Wilder classic, with insurance at the heart of it!

R&I: What is your favorite drink?


Clean water. Check out Water.org for how to help people enjoy clean, safe water.

R&I: What’s the best restaurant at which you’ve eaten?

Liqun Roast Duck Restaurant in Beijing.

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

China. See favorite restaurant above. This restaurant had been open for 100 years in that location. It didn’t exactly have an “A” rating, and it was probably not a place most risk managers would go to.

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

Eating that duck at Liqun!

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

Dr. Seuss who, in response to a 1954 report in Life magazine, worked to reduce illiteracy among school children by making children’s books more interesting. His work continues to educate and entertain children worldwide.

R&I: What do your friends and family think you do?

They’re not really sure!

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