The COVID pandemic created unique challenges for almost every business sector. But with a staff of essential workers, residents among the most vulnerable to the virus, and a work environment that made isolation and social distancing all but impossible, it is arguable that the nursing home industry was impacted more than any other.

This was particularly true in the area of workers’ comp, especially considering executive orders in many states, including Missouri, that COVID infections among first responders and healthcare workers would automatically be considered to be derived from employment.

So how then could Health Care Facilities of Missouri (HCFM), which manages 176 nursing homes, see a 28% decrease in claims, a 59% decrease in lost time, a 35% decrease in medical costs, a 56% decrease in indemnity costs, and a 69% decrease in the total cost of claims from 2020 to 2022? Excellent question.

Right Changes, Right Time

The answer is multi-layered, making the right changes at the right time. For driving needed progress at the right time for the benefit of its members and their workers, Risk & Insurance® recognizes Health Care Facilities of Missouri as a 2023 Teddy Award Program of Distinction.

HCFM shifted gears by first seeking out partnerships better aligned with its goals, resulting in a decision to partner with CorVel. Together, the team has implemented a variety of enhancements to its workers’ comp program, including a new claim reporting system and a crucial 24/7 nurse line.

Scott Gilmore, vice president and co-owner, Carpenter and Company

“They introduced us to an 800-reporting line, which makes life easy,” said Scott Gilmore, vice president and co-owner of Carpenter and Company, the administrator for HCFM.

“We had been doing it the old-fashioned way: Everybody had to fill out a first report of injury form and either mail it or fax it or email it in. Also, with this 800 line, they offer a 24/7 nurse line.”

Providing injured employees with access to round-the-clock support from registered nurses was particularly crucial for Health Care Facilities of Missouri’s nursing homes, which operate 24/7.

“The availability of the advocacy nurse triage was highly appealing to them,” said Lucille DiMaria, account manager at CorVel Corporation.

“It ensured immediate care for employees, with nearly 50% of cases resulting in first aid or self-care, which we followed up on. Speaking with a nurse promptly made employees feel well attended to, regardless of whether they required treatment. For those in need of treatment, we ensured they received appropriate care, ensuring their well-being.”

In addition to more quickly addressing employee concerns, the new system also lightened the burden on supervisors.

“An administrator has a thousand things to worry about,” said Gilmore. “They’re going, ‘Do I really need to report this? Should I send the employee home?’ They don’t have to worry about it. CorVel takes over, they set it up.”

HCFM has achieved significant cost savings by reducing the number of unnecessary doctor visits.

“The first aid-only [claims] have increased, where the nurse is able to assess it and say, ‘I think you can probably just go home and take an aspirin and be fine,’ ” said Gilmore. “ … So, a lot of these fees we’ve been paying to TPAs are down.”

Litigation and other costs have come down as well, he said.

“The report-only has been a nice feature because that gives the facility peace of mind that it’s in the system, but it’s not necessarily something that needs to be formally set up,” said Gilmore.

“We were incurring charges for the adjusters to do that. I don’t have the statistics, but I have to believe it has decreased our litigation rates — I know how many unhappy customers I used to deal with before.

“Time and time again, it would be, ‘Hey, the adjuster’s not calling me back. I left a message, I called the main line, nobody answers.’ I can’t emphasize this enough, but it’s about the improved communication.”

DiMaria agrees.

“Due to the improved speed of contact and increased interaction with injured workers, the occurrence of litigation has decreased,” DiMaria confirmed.

“Often, individuals seek out an attorney because they feel uninformed or haven’t been contacted, and they may be hesitant to reach out to their employer.”

Results Across the Board

With employees spread across 176 facilities, HCFM has also seen significant gains from access to an expanded network of providers.

“In Missouri alone, our network comprises over 70,000 providers. This allows us to direct them to in-network providers, resulting in cost savings for our clients,” said DiMaria.

Lucille DiMaria, account manager, CorVel Corporation

In some rural communities, where numerous providers may opt not to join a network, “we collaborate with these providers using a usual and customary pricing approach. This enables us to monitor rates and prevent overcharging in those areas,” she added.

With improvements in reporting, HCFM is also seeing greater impact on its fraud prevention efforts.

“If somebody’s trying to take advantage of the system, which we’ve seen time and time again, they’re pretty good at digging down,” said Gilmore.

“ ‘Is there anything we can do? Is this legitimate? Do we have witnesses that this happened? Is there recording?’ They do all that investigation, where before, it was fax in the first report, set up the claim, pay the bills. That is not what we’re doing anymore. And it’s been eye-opening.”

Underlying all of these programs is an emphasis on efficiency and transparency.

“Prior to our involvement, the main objective was to streamline reporting and gain visibility into the program’s progress,” said DiMaria.

“We prioritize transparency, ensuring that our clients have access to view all claim activities and reports, keeping them informed of the status of their program in real-time. We have improved communication with the adjusting team, addressing previous concerns and establishing a stronger connection.”

From Pain Point to Selling Point

The benefits to HCFM and its members have been clear and measurable.

“Fast forward to ‘21, ‘22, ‘23, our loss ratios are lower than our average,” said Gilmore. “We have an average loss ratio of about 50%. That’s the lifetime of the program. So, we’ve got a 25% cost of doing business. We’ve got a 50% loss ratio. So the remaining 25% is all surplus that we refund back to the facilities that contribute to it. So that number’s hard to move because it’s so old. But, if you average the last three, four years, our loss ratio is line with 40%.”

The success of HCFM’s new programs isn’t just saving its members money, it is also helping the company attract new members.

“It’s a selling feature for me, because I do the marketing for the program, in addition to all the administration,” said Gilmore. “ … It was tough to sell the old TPA and brag about your claims management service … but now it’s a real selling feature for us, and people respond to that claims reporting process. I just like it so much, I like to talk about it when I’m talking to prospective members.”

Gilmore also attributes the success of their program to CorVel’s personnel.

“The two folks that we have right now, Lucille DiMaria and Jake Anderson, they are difference-makers. They’re utilizing all the tools they have, but it comes down to their picking up the phone and getting right back to the customers, getting back to me. That’s what I appreciate more than anything, just because I’ve seen the other side.”

Without them, HCFM’s experience during the pandemic might have been considerably different.

“It wasn’t really fair for CorVel, coming in at the end of 2019 and then getting hammered with this,” said Gilmore. “But I think we’d have been in a world of trouble if we had not had them on top of this.” &