Column: Workers' Comp

Let’s Keep Adding Value

By: | March 1, 2016 • 3 min read

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

Since the inception of Obamacare, opponents worked to scuttle the ACA and in fact are still trying to.


Whether a future president, Democratic or Republican, seeks to reshape the ACA — and funding for value-based care — remains to be seen. But it will be another two years before they can make a realistic attempt.

By then, we should have more performance data on the value-based initiatives that came to life under the ACA. If the arrangements continue to show value, future political leaders are unlikely to dismantle the incentives driving their growth. Similarly, value-based arrangements launched by the private sector should also expand.

Value-based health care initiatives include accountable-care organizations (ACOs) and bundled payment models. Both are alternatives to our current fee-for-service system that rewards medical providers for delivering volume over quality outcomes.

Whether a future president, Democratic or Republican, seeks to reshape the ACA remains to be seen. But it will be another two years before they can make a realistic attempt.

The ACA and Medicare funding pushed the spread of ACOs and bundled payments. There are now more than 700 ACOs nationwide.
Medical providers participating in ACOs bear financial risk. They accept a set payment for managing the health of a defined population, such as all the employees covered under a group health plan.

The idea aligns incentives so providers improve the population’s health. That should mean fewer care services will be necessary.

Results so far show only modest health care expense reductions. But they have improved outcome quality, said David Muhlestein, senior director of research and development at Leavitt Partners, a health care intelligence firm.

A bundled payment model of value-based health care, however, provides greater opportunity for improving workers’ comp medical outcomes than does an ACO, Muhlestein and other experts believe.

Unlike an ACO, a bundled arrangement doesn’t require providers to care for an entire population. Instead, medical providers provide all care necessary to remedy a specific medical episode, such as a workplace shoulder injury.


In return, providers accept one bundled payment for all services the patient receives from the beginning of their care for that specific injury to its conclusion.

Bundled payment arrangements are also spreading. Medicare counts 1,500 participants in these arrangements, including hospitals and doctor groups.

While Muhlestein and others believe bundled payment options provide more opportunities to improve outcomes for workers’ comp cases than do ACOs, other experts tell me they expect there will be room for ACOs to treat injured workers.

That is important for workers’ comp, because clearly, we need a better health care system. One built on measures that show positive outcomes, not one built on political whim.

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.


That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.


Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

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