Cover Story

The New Frontier of Care

Our Teddy Award winners in 2013 raised the bar yet again.
By: | November 1, 2013 • 10 min read

After nearly two decades of presenting the Theodore Roosevelt Workers’ Compensation and Disability Management Award, you might think the process of judging the awards would be more or less rote. In fact, the opposite is true. It has never been a more exciting time to witness the transformation of the industry, and to bear witness to how far employers have come, not just in their programs, but also in the way they think about injury prevention and management, and the value of a safe and healthy workforce.

A difficult economic climate has driven employers to double-down on their efforts to prevent incidents and injuries, and to be ever more creative in their efforts to rein in workers’ compensation and disability costs. If necessity is the mother of all invention, then workers’ compensation risk management is as inventive a field as you’ll ever encounter.

“Managing a successful workers’ comp program requires constant creativity to keep the bar moving in the right direction,” said Yolanda Romero, director of workers’ compensation for the Southeastern Pennsylvania Transportation Authority (SEPTA). “We often come up with what we believe is a great solution, however, eventually the program plateaus and new tweaks are needed to keep the momentum going.” Romero, who served as a Teddy Award judge for a decade after SEPTA won a Teddy Award in 2003, appreciates the accomplishments of this year’s finalists and winners, and knows what they’re up against. “The key is to keep the creative juices flowing constantly,” she said.

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There isn’t enough time — or pages — to give you every detail of this year’s exceptional Teddy Award applicants, finalists and winners. So in the spirit of Fantasy Football, Risk & Insurance® has drawn together a “dream team” of injury prevention, workers’ compensation and disability management programs, to highlight the areas where these programs shine brightest.

A Golden Ounce of Prevention

The only good injury is the one that never happens — no one would argue the point. Zero workplace incidents or injuries remains the holy grail for many employers. But for most, that is a perpetually elusive goal. Over time, safety professionals and risk managers began to see that it wasn’t enough to give employees safety gear and train them to work safely. It wasn’t enough to conduct accident investigations or job hazard assessments. They needed to reach further.

That need has led employers into territories that were once considered fringe, including ergonomics, which was widely perceived as “new age voodoo” only two or three decades ago. Thankfully, that has changed. Boston-based Teddy Award winner Partners HealthCare is one of many organizations that now has a comprehensive ergonomics program with dedicated staff to conduct evaluations and address issues. Partners’ ergonomics staff responded to more than 900 service requests in 2012.

R11-13p24-27_01teddy2.indd“Managing a successful workers’ comp program requires constant creativity to keep the bar moving in the right direction.”
— Yolanda Romero, director of workers’ compensation for the Southeastern Pennsylvania Transportation Authority

PHC also obtained a National Institute for Occupational Safety and Health grant to fund its “Be Well, Work Well” project in collaboration with the Harvard School of Public Health: Center for Work, Health and Well-Being. The project’s aim is to assess and address the work environment as well as personal factors associated with increased risk for musculoskeletal disorders, and to promote ergonomic principles through small group and one-on-one training.

Stretching and core strengthening programs are now earning respect, when they were once thought of as a little over-the-top. But over time, participating companies began to see results in reduced injury frequency. Then others started taking a more serious look.

Arizona Public Service, the largest affiliate of Teddy Award finalist Pinnacle West Capital Corp., launched a pilot stretching and core conditioning program in 2011. The program gives employees the skills they need to improve balance and coordination in order to reduce injuries. The program also puts a focus on mental awareness and attention control — key factors in incident prevention. The program has resulted in a noticeable drop in strain and sprain injuries for the Phoenix-based energy holding company.

Worcester, Pa. civil construction company American Infrastructure has a stretching program that’s companywide. AI’s philosophy is that all employees are industrial athletes. That’s why everyone — from workers on job sites to office staff — participates in a morning stretching program. According to AI, the program serves a dual purpose. The stretching helps prime employees to be physically ready for the tasks ahead. It also helps prime them mentally, getting them thinking about working and moving safely right off the bat.

Another type of initiative that’s gaining traction in recent years is wellness programs. Once thought of as a “nice to have” that was more the purview of HR, wellness programs were perceived strictly as a means to reduce health care costs. Today, executives are catching on to the fact that healthier employees are not only less likely to get hurt, they also bounce back faster if an injury does occur, and have fewer complications related to comorbidities such as diabetes, obesity or heart disease.

That said, companies actively connecting the dots between wellness and injury outcomes are still somewhat few and far between. That’s another reason Pinnacle West earned the attention of the Teddy Award judges.

Pinnacle West has taken an active approach to employee health and wellness, launching its internally branded “Health Matters” program. The Health Matters program includes free screenings and assessments for employees, helps them assess their risk for disease and helps them develop personal wellness goals and plans. Employees are invited to utilize online weight loss coaching, smoking cessation programs, discounts on gym memberships, a vast library of healthy recipes and more.

Pinnacle West also recognizes that it’s not enough to tack a flyer about available wellness programs on the company bulletin board. That’s why the company is actively tracking employee participation in its programs, setting annual target goals for participation in each stage of the program and devoting resources to getting the Health Matters message out.

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American Infrastructure’s wellness efforts are every bit as laudable. “Our focus,” the company wrote in its application, “has become not only to be America’s safest construction company, but America’s healthiest construction company as well.” Their commitment is clear. The company offers biometric testing for blood pressure, heart rate, cholesterol levels, blood sugar and more, and urges all employees to “know your numbers.” Employees can take their numbers and sit down with health coaches to develop action plans for improving their health. Among other initiatives, AI’s programs include a stepping program that helps employees track their steps throughout the day. Stepping challenges with prizes attached help keep people motivated. The company has also had great success with weight loss challenges.

“We’ve always been a company that goes beyond compliance. We wanted to take our safety culture to the next level,” said Bryan Schwartz, AI’s risk manager.

Working Toward Recovery

Incredible strides have been made in the area of return-to-work. Armed with a better grasp of the effect of lost time on both injury durations and the company’s bottom line, employers are more committed to keeping injured workers on the job and productive.

“Our focus has become not only to be America’s safest construction company, but America’s healthiest construction company as well.”
— American Infrastructure

Progressive companies are breaking free of the old mind-set of creating rigid transitional duty positions to accommodate work restrictions, and trying to fit all injured employees into those frameworks. Instead, they’ve shifted focus to the employee rather than the position, and on building customized transitional work around the injured employee’s capabilities.

Teddy Award winner PetSmart’s approach to return-to-work sets the right tone. All transitional duty jobs at PetSmart can be combined or modified to meet the needs of the associate’s restrictions. That focus helps guide managers to keep an open mind about transitional duties, and to look closely at what the injured employee is capable of doing. Injured employees at PetSmart are able to perform any number of essential store functions, from taking grooming appointments to helping with animal adoptions through in-store affiliate PetSmart Charities.

Teddy Award finalist Eisenhower Medical Center in Rancho Mirage, Calif., has taken a comprehensive approach. Three years ago, the organization took on the arduous task of assessing and cataloguing every job description, every essential and nonessential function of each position, and the skills or capabilities needed to perform each one of those functions. Initially, this database has been used to help identify the tasks most likely to cause injury. It is also used to guide treatment to help an employee resume the essential functions of his or her job faster. But during the recovery process, the database provides an invaluable, detailed body of information that helps the risk management and medical staff efficiently customize transitional positions based upon an injured employee’s specific abilities, and make adjustments smoothly as recovery progresses.

Solutions Large and Small

At Partners HealthCare, the best care for an injured employee is easy to find. The health system maintains eight Occupational Health Service clinics, staffed by occupational health nurse practitioners (OHNPs) experienced in evaluating and treating injured employees. OHNPs are the key point of contact for each case, coordinating treatment protocols, incident investigations and return-to-work plans. Dedicated claims specialists support the OHNPs. In turn, administrative assistants support the claims specialists — ensuring that they don’t become mired in paperwork and can focus on the needs of each injured employee. The OHS clinics are overseen by four medical directors — each one a board-certified and experienced specialist in occupational and environmental medicine.

Such a solution is unquestionably state-of-the-art. But the fact is that most employers outside the health care field don’t have the resources to follow that model. Nevertheless, plenty of employers are pulling out all the stops to get their people the care they need. Teddy Award-winning Miami-Dade County Public Schools, for example, uses a 24/7 call center for receiving notice of injuries. Injured workers are immediately directed to the best nearby specialty physician using a geo-access tool that identifies the providers nearest the injured worker’s location.

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Other employers are finding ways to maximize the resources they do have. And sometimes, the simplest and smallest of changes are the ones that will make the biggest impact. Phoenix-based PetSmart’s tetanus program is a perfect example. Because of the nature of its operations, PetSmart employees face significant risk exposure from animal bites. That means that an injured employee might need a tetanus shot in addition to treatment of the wound. As such, every bite, no matter how minor, required an office visit to ensure that the employee’s tetanus status was up-to-date.

But all of that changed when PetSmart began tracking the status of employees’ tetanus shots. With stores armed with that small, but vital piece of information, employees with minor injuries could be treated with standard first aid and sent back to work, with no need for a provider visit. This one small inexpensive change has made a tremendous impact on the company’s bottom line.

At American Infrastructure, one small change that has had a huge impact was a simple color change. As with other companies across a variety of industries, AI’s new employees faced a higher risk of injury than their more experienced counterparts. AI reasoned that ideally, everyone should be looking out for the well-being of new hires, not just their immediate supervisors. But it’s easy to lose track of who’s who on a busy job site. That’s why the company opted to purchase bright green hard hats for new recruits. That way everyone remains constantly aware of the location of employees who might need help, some extra guidance or a safety reminder.

Promising Teddy Award applicant Kimco Staffing of Irvine, Calif., faced a massive obstacle with workers seeking treatment outside of the company’s medical provider networks (MPNs) and receiving excessive and unnecessary treatments. Workers’ comp judges widely disregarded the company’s attempts to enforce its MPN rules if an injured worker claimed to be unaware of the requirement. Kimco took the solid first steps of providing the MPN requirements to each employee, at the time of hire and at the onset of each claim — and requiring employees to acknowledge it in writing. But then the company went one step further, heading off any doubts by taking a picture of each employee holding the signed document. Courts are now more inclined to honor Kimco’s MPN policy, and to release Kimco from the burden of paying for unauthorized treatment.

In addition, companies such as American Infrastructure and PetSmart are also leveraging the power of newer technologies, using iPads for everything from safety module training to capturing pictures of hazards instantly to distributing critical incident metrics to regional and district managers in the field.

Risk & Insurance® congratulates this year’s Teddy Award winners and finalists on their exceptional efforts to create safer workplaces and provide the best possible care for their injured team members.

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Risk Manager Focus

Better Together

Risk managers reveal what they value in their brokers.
By: | June 1, 2017 • 11 min read

Michael K. Sheehan, (left) Managing Director, Marsh and Grant Barkey, Director of Risk Management, Motivate International Inc.

Ask a broker what they can do for you and they will tell you. But let’s ask the risk manager.

What do risk managers really need in a broker? And what do the best brokers do to help risk managers succeed in their jobs?

Chet Porembski, system vice president and deputy general counsel, OhioHealth Corp.

Risk managers say it’s a broker who helps them look knowledgeable and prepared to their bosses. It’s someone who sweeps in like a superhero with an ingenious solution to a difficult problem.

Risk managers want to see brokers bring forth better products year after year. They want a broker who shows up at renewal time with new ideas, not just a rubber stamp.

Great brokers embed with the risk management team and learn everything they can about the company and its leaders. They help risk managers prepare and keep tabs throughout the year on changes at the organization with an eye towards planning the future.

“There’s the broker that sees themselves as just a hired ‘vendor,’ or I should say, somebody that basically just does the job at hand,” said Chet Porembski, system vice president and deputy general counsel at OhioHealth Corp.

“And then there’s the broker that views themselves very much as a business partner.  They truly bring added value to the relationship.”

These brokers look at the tough issues the risk manager is facing and bring in the resources to try to help their client in ways even the client might not have thought about yet. They also do advanced planning that makes the risk manager’s job easier when a problem arises.

“That’s the kind of broker I want.” Porembski said.

And that’s the kind of broker many risk managers need more than ever.

“The only way that the relationship is going to be successful is if you build a tremendous amount of trust.” — Frances Clark, director of risk management and insurance, Sentara Healthcare

That’s because risk managers are under increasing pressure these days. They carry more weight as corporations shrink their departments to cut costs.

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Climate change, cyber threats and geopolitical shifts are turning what were once unthinkable losses into risks that are almost commonplace. And this is all happening in an under-insured risk environment, according a study by PwC entitled Broking 2020: Leading from the Front in a New Era of Risk.

Thankfully there are good brokers out there, risk managers say, who can bring more value to a client today than ever before and help ease that fear.

Brokers — the traditional intermediary in the risk transfer chain — do in fact have a tangible and growing role in developing viable and innovative solutions for the risk manager, according to PwC’s study.

They are the “global risk facilitation leaders.”

“[Whatever] organizations are doing in the short term — be this dealing with market instability or just going about day to-day business — they need to be looking at how to keep pace with the sweeping social, technological, economic, environmental and political (STEEP) developments that are transforming the world,” PwC said in the report.

Advisors That Are Getting It Done

Cyber risks are just one growing challenge that all organizations grapple with.

Frances Clark, director of risk management and insurance at Sentara Healthcare, remembers when her broker first suggested that she hold a leadership tabletop cyber drill.

Clark said her broker kept saying, “I know this is going to be a painful experience, but you are going to come out so much better in the long run.”

Frances Clark, director of risk management and insurance, Sentara Healthcare

Her broker was right, and went so far as to help arrange a system-wide drill that included representatives from the legal, finance, security, communications, marketing and medical teams.

They reviewed the many ways a cyber attack can happen and then practiced a response.

“We benefitted greatly from that exercise,” Clark said.

When Doctors on Demand developed a telemedicine app to offer mental health services through mobile devices, the company ran up against insurance limitations across state lines. All states require that the physician giving the advice be licensed in the same state where the patient is located.

The concern was for patient encounters where the patient actually crossed state boundaries during the encounter, due to the utilization of a mobile phone. The patient may have started with a properly licensed physician in the original state, but then crossed into a neighboring state where the physician was not licensed.

Larry Hansard, a regional managing director at Arthur J. Gallagher & Co., and a 2017 Power Broker®, worked to secure medical professional liability coverage without the traditional licensure exclusions placed on medical professionals by insurance carriers.

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The initiative he helped develop actually changes how health care can be delivered to patients. It allows the emerging telemedicine sector to now offer services around the world.

Two-thirds of the risk managers in the PwC Broker 2020 survey labeled their brokers as “trusted advisors.” But the same survey found that some participants see their broker as more of a straightforward service provider rather than as a source for solutions.

The survey results indicate there is plenty of room for brokers to bring more value to clients.

OhioHealth’s brokers meet each year with OhioHealth’s risk management team to review insurance coverages.  And when the health system holds quarterly risk management retreats, the brokers attend. They bring with them education and insights on a broad range of topics, from property insurance markets to cyber solutions.

Porembski’s brokers also collaborate with the risk managers when there’s an upcoming presentation on risk issues to senior management. Sometimes the brokers help prepare the presentation, he said.

“We end up looking exceptionally good to our senior leaders and our board,” he said.

Involving the broker in interactions with leaders outside the traditional risk management team has benefits beyond selling products, he said. It extends the relationship circle.

Clark tries not to think of her brokers as outside vendors just providing a service. She wants them to be as committed and knowledgeable about the organization as she is.

“The only way that the relationship is going to be successful is if you build a tremendous amount of trust,” Clark said.

“You have to be completely open and honest about everything, no matter how bad it is, or how bad it may look to the market or underwriters.”

“Once you establish that trusting relationship, I think everything else falls into place,” she adds.

Sentara underwent significant growth recently, acquiring five hospitals in about six years. The expansion required a vast amount of integration on insurance programs and a merger of risk management departments and claims.

Clark said her brokers rolled up their sleeves and expertly navigated her through the consolidation.

“I can’t reiterate enough how most risk managers don’t know how to deal with an M&A unless you’ve gone through it.”

She said she wouldn’t have been able to manage the risk of the mergers without her broker’s counsel.

Grading the Broker

Mike Lubben, director of global risk management at Henry Crown & Co. in Chicago, sets standard expectations of his insurance brokers: know the exposures, understand how a risk manager has to sell ideas internally and understand the urgency of requests.

He lets his brokers know his expectations with regular report cards, complete with letter grades. And he isn’t shy about giving out Fs.

  • How did the broker service the EPLI coverage?
  • Did the broker provide expertise and coverage analysis?
  • Was there anything creative?
  • Did the broker recommend new endorsements based on the previous exposure?
  • Did the broker recommend any risk mitigation programs?
  • How well did he communicate and help with presentations?

“A good broker will think this is fantastic,” Lubben said.

This method starts the conversation. It helps Lubben establish long relationships with some stellar brokers.  But if the broker misses the mark, Lubben can have a talk with them about ways to do better in the future. Some brokers he has sent away.

Recently a broker failed on what Lubben calls “blocking and tackling,” the basics like returning phone calls within one day and responding promptly to emails.

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Lubben gave him an “F” on those subjects and told him why. The broker still didn’t improve his game and was eventually replaced.

For many people, insurance can seem very routine from renewal to renewal. But a really good broker will break from routine and come back with some kind of enhancement or improvement.

If the renewal is flat with no change in premium, then Clark says she’ll ask, “What are you going to do for me this year?”

The best brokers are always striving for better, she said.

“Without the brokering community, you would be hard pressed to do your job. I really appreciate what the brokers do, they bring a level of expertise that we can’t possibly have on all lines of coverage.” — Mike Lubben, director of global risk management at Henry Crown & Co.

Motivate International Inc., which operates more than half of the bike share fleets in North America, went through a recent renewal.

Their broker, Marsh, explored more than 10 options with different strategies and programs. In the end, after all of that, they decided the expiring coverage was the best fit.

“Those exercises are very valuable for risk managers,” said Grant Barkey, Motivate’s director of risk management.

“As an innovative company committed to delivering best-in-class services, we believe thorough exploration leads to informed decision-making.”

A good broker understands that a company’s day-to-day operations and a highly effective risk management program have implications for what type of policy should be procured, he said.

Brokers need to partner with risk managers to figure out what those options are, and what the markets are saying and then succinctly relay the information to management.
They also need to have the tact and curiosity to inquire about future plans and figure out what resources might be needed to better serve their client.

When PwC surveyed risk managers, most put their insurance carriers and industry groups ahead of their brokers as the primary source of cyber and supply chain risk solutions; yet these areas are still cited as risk managers’ top concerns.

“Becoming the go-to partners for developing and coordinating innovative and effective solutions in these priority risk areas is at the heart of the commercial opportunity for brokers.” PwC said in its report.

“Yet, our survey suggests that these are important areas where brokers are falling short of the market’s demands and therefore need to adapt.

For example, less than a third of respondents are very satisfied with brokers’ analytical and modelling services across a range of areas.”

When participants were asked how their brokers could be more efficient, respondents put risk analysis at the top of PwC’s survey list. Significantly, more than a third also cited ‘big data’ analysis.

Finding the Right Fit

Paul Kim, Co-CBO of U.S. Retail at Aon Risk Solutions, helps match brokers to risk managers. He keeps in mind that insurance companies tend to sell product, while the clients are looking to manage risks. The right broker assists in mapping risks to existing products and also customizing broad solutions, he said.

“The risk manager’s job has become more complex in the current environment, but there are so many tools available for those individuals to make better informed decisions that truly help protect the overall risk profile of their companies,” Kim said.

Paul Kim, Co-CBO of U.S. Retail, Aon Risk Solutions

That’s why finding the right broker should be first and foremost, he said. Look for an individual with strong industry knowledge, product expertise and market relationships. A strong broker is able to effectively communicate what the risk manager’s goals are to the marketplace to be able to execute and achieve those goals.

“Not every broker can do that,” Kim said.

“Not every broker is the right broker.”

PwC said those brokers who quickly master the art and science of identifying ambiguous threats and then mobilize a broad private/public stakeholder pool to economically manage those risks over time will pull ahead of their competition.

“We’re really generalist,” Lubben said.

“Without the brokering community, you would be hard pressed to do your job. I really appreciate what the brokers do, they bring a level of expertise that we can’t possibly have on all lines of coverage.”

When selecting a broker, the risk manager should also take into account the entire organization behind the broker. Ask about the additional support systems that are available to the broker’s clients.

The company should have a deep bench so when the primary broker is out of the office there’s someone else to rely on who is almost as knowledgeable. The broker organization should also be able to assist you with your budgeting and forecasting from a financial risk perspective.

In PwC’s survey of risk managers, nearly three-quarters want analytics from their broker to help inform their decisionmaking, with concerns over new and emerging risks being a strong driver for this demand.

Clark also thinks it is vitally important for a broker to offer a claims advocate, somebody on the outside, when you are dealing with a carrier on a complicated claim.

“Otherwise you are vulnerable to what the carrier says,” Clark said.

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To lead in this new era of risk, it’s also important that brokers forge close relationships with a broader set of stakeholders that includes governments, academia, specialist risk consultancies and even their industry peers, PwC said in the report.

It’s also going to be important to develop shared databases and research capabilities.

In turn, brokers need to assure this diverse stakeholder group that they are the right party to lead.

Clark, at Sentara Healthcare, said she knows what her risk exposures are today, but she’d like her brokers to anticipate her needs before she does.

“It’s kind of crazy, but amazingly some of them do it,” Clark said.

The broker will also use past experience and industry knowledge to anticipate where policy terms and conditions can be tweaked and improved upon.

“They will, say, advise us that we need to change this policy language, and then a year later you have a claim on that and you thank your lucky stars that they changed it,” Clark said.

“It is amazing to me every time it happens.”  &

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