2222222222

2017 Teddy Award Winner

Workers’ Compensation Improvements in Health Care

The Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.
By: | November 1, 2017 • 6 min read

The Valley Health System embarked on a journey to completely transform its workers’ compensation program. Now, five years later, Valley can boast it did just that.

Valley Health  is a regional healthcare system that serves residents in northern New Jersey and southern New York. From 2012 to today, Valley reduced its annual workers’ compensation budget by 69 percent while the number of employees increased 14 percent. Lost-time claims per year went from 171 to 79 and workplace violence injuries decreased by 50 percent in just one year.

Advertisement




“This culture of safety has really made everybody, from the top down, more aware of their areas to see what’s in place for the safety of our employees,” said Linda Carey, a registered nurse at Valley who witnessed the changes firsthand.

In 2011, Valley’s workers’ comp budget reached a staggering $2.1 million and its incident rate was 5.72, leading to a two-and-a-half month-long site evaluation by OSHA. At the end, OSHA presented the health system with a list of safety recommendations.

It was just the catalyst Valley needed.

“Back in 2011, the workers’ comp program — while our nurses give excellent care — was not being run as it should be and a lot of our claims were going to the excess carrier,” explained Barbara Schultz, director of employee health and wellness, Valley Health.

When OSHA gave its recommendations, Valley began its own assessment to move in a more proactive and strategic direction.

Enhancing Safety

Health care workers are highly susceptible to workplace violence, whether it be a combative patient, a confused patient or even an outside force like an active shooter.

“Hospitals are soft targets. We embrace the role of the family,” explained Schultz.

Barbara Schultz, director, employee health and wellness, Valley Health

“Visiting hours are almost around the clock. We are a welcoming institution, which makes us very porous in terms of access.”

On top of that, regulations and rules have changed for hospitals over the past few decades. Where once a nurse or physician could use restraints to hold back a combative patient, laws prevent the use of such force unless in extreme circumstances.

“More staff is vulnerable. We’re caregivers, we’re meant to be there, and sometimes these patients lash out and swing.”

Once OSHA gave its recommendations, Valley tracked incidences of patient-on-caregiver violence, benchmarking the unit, the shifts incidences occurred and the type of patient involved. They used this data to further educate and train employees on safe work practices, creating the Safety and Security Director role in the process. This role reviews best safety practices across the system’s facilities.

Dan Coss, Valley’s Director of Security, Public Safety and Environmental Services, is an important asset to the safety protocols at Valley, Schultz said. With a PhD in the science of safety and security, Coss made employee safety paramount.

“He strengthened relationships with local authorities,” said Schultz, “he helped with workplace violence as a whole and brought in the Code Atlas team.”

Code Atlas is a 50-member team of trained staff members ready to address combative patients 24/7. This team is prepared to handle disruptive patients from the moment they arrive to the point where they are stabilized and cooperative. Overall, this team reduced workplace violence claims by half.

Also included in Coss’s job was incorporating active shooter training.

Valley hosts three to four small drills per month and one large drill per year involving local law enforcement.

Advertisement




During the smaller drills, “Dan will come in as a relative with a bill complaint or someone who’s lost a loved one. He comes in yelling at the top of his lungs. The whole point is to get out of the situation safely,” Schultz explained.

“The staff is expected to respond by fleeing — run and get out of the way. If they don’t have the ability to run, they’re told to hide. If Dan sees you, he will pretend to shoot you.”

“I’ve been briefed on the drill [afterwards],” said Carey.  “It’s frightening even when you know it’s a drill. It gives people an idea of what they’ll feel and how they might react.”

Lissette Carcano, workers’ compensation care coordinator, Valley Health, once volunteered to be a patient during a drill.

“Visiting hours are almost around the clock. We are a welcoming institution, which makes us very porous in terms of access.” — Barbara Schultz, director, employee health and wellness, Valley Health

“I was an ER patient locked in a room with a nurse. You shake in your boots. It becomes real, but I felt very comfortable with the nurse,” she said.

The larger drill takes a year to plan. Valley must get EMS, fire rescue and local law enforcement on board before enacting an active shooter drill. Instead of Coss acting as the perpetrator, the police volunteer an officer to enter the selected facility holding a red gun to indicate that it is fake.

Sometimes, Schultz added, they will use simulation rounds, or training ammunition. In these instances, the fake gun makes a loud sound — similar to the sound of a real gun being fired — but the ammunition is fake and non-lethal.

“It’s scary for the employees, but they have an opportunity to handle the situation in a relatively safe way,” said Schultz.

“We’re looking at patient safety and employee safety like never before.”

Aligning Comp Philosophies

The biggest challenge Valley faced was aligning each individual nurse case manager with the new philosophy for safety and security. Before, Schultz said, each nurse had their own way of providing care to injured workers. To get workers back safely and efficiently, Valley knew it had to set one standard of care.

Lissette Carcano, workers’ compensation care coordinator, Valley Health

The Workers’ Compensation Care Coordinator role was created to oversee the entire workers’ comp process, guaranteeing that the quality and type of care was uniform across the Valley network. This role, according to Schultz, was pivotal for the success of the workers’ comp program.

“I needed someone who was kind, compassionate but firm. Someone who could manage with consistency,” said Schultz. Carcano fit the bill.

“She’s one of the best I’ve ever seen,” said Cari Burhenne, regional claims service manager, PMA Companies.

Carcano entered Valley and provided the adjusters with what they needed while continuing to care for each worker, Burhenne explained.

Valley’s philosophy used to be “full-duty or no duty.” Carcano worked to get injured workers into temporary duty roles suitable for them while they recovered, and thanks to her return-to-work advocacy, Valley’s lost-time claims decreased from 171 per year to 79.

“The focus on return to work, I think, is number one in what reduced Valley’s overall claims costs,” said Burhenne.

“Valley is very invested in doing what’s right for their employees. There’s the business sense but also that sense of caring for their employees. It’s a great combination.”

When a worker is injured on the job, Schultz and Carcano have worked hard to get their employees seen by physicians and other health care providers as quickly as possible.

Advertisement




“The way Barbara and Lissette established great relationships with physicians has made the [workers’ comp] process streamlined and effective; it’s very expeditious,” said Carey. “They are looking for the best care for employees and patients.”

The health care system also implemented a full-scale safe patient handling program, overhauled its dining and environmental services safety committees and implemented health awareness among its employees.

Carey added, “When our employees are healthy and safe at work, our patients benefit.” &

_______________________________________________________

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.

 

Autumn Heisler is the digital producer and a staff writer at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

High Net Worth

Your High Net Worth Client Wants to Live in the Danger Zone? Here’s What Your Resiliency Plan Should Look Like.

Having a resiliency plan and practicing it can make all the difference in a disaster.
By: | September 14, 2018 • 7 min read

Packed with state-of-the-art electronics, priceless collections and high-end furnishings, and situated in scenic, often remote locations, the dwellings of high net worth individuals and families pose particular challenges when it comes to disaster resiliency. But help is on the way.

Advertisement




Armed with loss data, innovative new programs, technological advances, and a growing army of niche service-providers aimed at addressing an astonishingly diverse set of risks, insurers are increasingly determined to not just insure against their high net worth clients’ losses, but to prevent them.

Insurers have long been proactive in risk mitigation, but increasingly, after the recent surge in wildfire and storm losses, insureds are now, too.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy,” said Laura Sherman, founding partner at Baldwin Krystyn Sherman Partners.

And especially in the high net worth space, preventing that loss is vastly preferable to a payout, for insurers and insureds alike.

“If insurers can preserve even one house that’s 10 or 20 or 40 million dollars … whatever they have spent in a year is money well spent. Plus they’ve saved this important asset for the client,” said Bruce Gendelman, chairman and founder Bruce Gendelman Insurance Services.

High Net Worth Vulnerabilities

Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

As the number and size of luxury homes built in vulnerable areas has increased, so has the frequency and magnitude of extreme weather events, including hurricanes, harsh cold and winter storms, and wildfires.

“There is a growing desire to inhabit this riskier terrain,” said Jason Metzger, SVP Risk Management, PURE group of insurance companies. “In the western states alone, a little over a million homes are highly vulnerable to wildfires because of their proximity to forests that are fuller of fuel than they have been in years past.”

Such homes are often filled with expensive artwork and collections, from fine wine to rare books to couture to automobiles, each presenting unique challenges. The homes themselves present other vulnerabilities.

“Larger, more sophisticated homes are bristling with more technology than ever,” said Stephen Poux, SVP and head of Risk Management Services and Loss Prevention for AIG’s Private Client Group.

“A lightning strike can trash every electronic in the home.”

Niche Service Providers

A variety of niche service providers are stepping forward to help.

Secure facilities provide hurricane-proof, wildfire-proof off-site storage for artwork, antiques, and all manner of collectibles for seasonal or rotating storage, as well as ahead of impending disasters.

Other companies help manage such collections — a substantial challenge anytime, but especially during a crisis.

“Knowing where it is, is a huge part of mitigating the risk,” said Eric Kahan, founder of Collector Systems, a cloud-based collection management company that allows collectors to monitor their collections during loans to museums, transit between homes, or evacuation to secure storage.

“Before, insurance was considered the only step in risk management. Now, our client families realize it is one of the many imperative steps in an effective risk management strategy.” — Laura Sherman, founding partner, Baldwin Krystyn Sherman Partners

Insurers also employ specialists in-house. AIG employs four art curators who advise clients on how to protect and preserve their art collections.

Perhaps the best known and most striking example of this kind of direct insurer involvement are the fire teams insurers retain or employ to monitor fires and even spray retardant or water on threatened properties.

High-Level Service for High Net Worth

All high net worth carriers have programs that leverage expertise, loss data, and relationships with vendors to help clients avoid and recover from losses, employing the highest levels of customer service to accomplish this as unobtrusively as possible.

“What allows you to do your job best is when you develop that relationship with a client, where it’s the same people that are interacting with them on every front for their risk management,” said Steve Bitterman, chief risk services officer for Vault Insurance.

Site visits are an essential first step, allowing insurers to assess risks, make recommendations to reduce them, and establish plans in the event of a disaster.

“When you’re in a catastrophic situation, it’s high stress, time is of the essence, and people forget things,” said Sherman. “Having a written plan in place is paramount to success.”

Advertisement




Another important component is knowing who will execute that plan in homes that are often unoccupied.

Domestic staff may lack the knowledge or authority to protect the homeowner’s assets, and during a disaster may be distracted dealing with threats to their own homes and families. Adequate planning includes ensuring that whoever is responsible has the training and authority to execute the plan.

Evaluating New Technology

Insurers use technologies like GPS and satellite imagery to determine which homes are directly threatened by storms or wildfires. They also assess and vet technologies that can be implemented by homeowners, from impact glass to alarm and monitoring systems, to more obscure but potentially more important options.

AIG’s Poux recommends two types of vents that mitigate important, and unexpected risks.

“There’s a fantastic technology called Smart Vent, which allows water to flow in and out of the foundation,” Poux said. “… The weight of water outside a foundation can push a foundation wall in. If you equalize that water inside and out at the same level, you negate that.”

Another wildfire risk — embers getting sucked into the attic — is, according to Poux, “typically the greatest cause of the destruction of homes.” But, he said, “Special ember-resisting venting, like Brandguard Vents, can remove that exposure altogether.”

Building Smart

Many disaster resiliency technologies can be applied at any time, but often the cost is fractional if implemented during initial construction. AIG’s Smart Build is a free program for new or remodeled homes that evolved out of AIG’s construction insurance programs.

Previously available only to homes valued at $5 million and up, Smart Build recently expanded to include homes of $1 million and up. Roughly 100 homes are enrolled, with an average value of $13 million.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work.” — Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“We know what goes wrong in high net worth homes,” said Poux, citing AIG’s decades of loss data.

“We’re incenting our client and by proxy their builder, their architects and their broker, to give us a seat at the design table. … That enables us to help tweak the architectural plans in ways that are very easy to do with a pencil, as opposed to after a home is built.”

Poux cites a remote ranch property in Texas.

Curt Goetsch, head of underwriting, Private Client Group, Ironshore

“The client was rebuilding a home but also installing new roads and grading and driveways. … The property was very far from the fire department and there wasn’t any available water on the property.”

Poux’s team was able to recommend underground water storage tanks, something that would have been prohibitively expensive after construction.

“But if the ground is open and you’ve got heavy equipment, it’s a relatively minor additional expense.”

Homes that graduate from the Smart Build program may be eligible for preferred pricing due to their added resilience, Poux said.

Recovery from Loss

A major component of disaster resiliency is still recovery from loss, and preparation is key to the prompt service expected by homeowners paying six- or seven-figure premiums.

Before Irma, PURE sent contact information for pre-assigned claim adjusters to insureds in the storm’s direct path.

“In the high net worth space, sometimes it takes longer potentially to recover, simply because there are limited contractors available to do specialty work,” said Curt Goetsch, head of underwriting for Ironshore’s Private Client Group.

Advertisement




“If you’ve got custom construction or imported materials in your house, you’re not going to go down the street and just find somebody that can do that kind of work, or has those materials in stock.”

In the wake of disaster, even basic services can be scarce.

“Our claims and risk management departments have to work together in advance of the storm,” said Bitterman, “to have contractors and restoration companies and tarp and board services that are going to respond to our company’s clients, that will commit resources to us.”

And while local agents’ connections can be invaluable, Goetsch sees insurers taking more of that responsibility from the agent, to at least get the claim started.

“When there is a disaster, the agency’s staff may have to deal with personal losses,” Goetsch said. &

Jon McGoran is a novelist and magazine editor based outside of Philadelphia. He can be reached at [email protected]