Making the Grade
The inventor of the instant camera in the mid-20th century, Edwin Land, once said, “Don’t undertake a project unless it is manifestly important and nearly impossible.”
Scott B. Clark and Rosa Royo have, perhaps without knowing it, taken that advice to heart. And in doing so, they have earned the Miami-Dade County Public Schools a 2013 Teddy Award, the Theodore Roosevelt Workers’ Compensation and Disability Management Award.
Clark is the risk and benefits officer of the school district. Royo supervises its workers’ compensation program. It is the fifth largest public school district in the country: 350,000 students and rising, and 50,000 employees.
Royo and Clark are constantly hit by forces that threaten to drive up workers’ compensation costs. Florida workers’ compensation veteran Jerry Fogel said that many of state’s public school systems struggle to keep work injury costs down while enrollments increase. Miami-Dade County’s enrollment and school facilities are steadily growing.
Daily, Royo’s unit deals with very active unions with a myriad of contractual agreements and employment constraints, Florida’s well known high rate of physician drug dispensing, the presence of many long-tenured workers with histories of multiple work injuries and personal health issues, and the high cost of health care in South Florida.
It’s not possible to compare Miami-Dade County’s performance with national benchmarks. Miami-Dade County, like other Florida public entities, provides injured workers with state-prescribed “illness in line of duty” benefits, or salary continuation, which in Miami-Dade County runs for upwards of 13 weeks of benefits from the date of injury.
Employees receive 100 percent of pre-injury wages under this program. After 13 weeks, the conventional workers’ compensation benefits take over. Miami-Dade County, again like other public entities in Florida, does not aggregate these two benefit databases.
Teachers, teacher aides and others directly working with students total about 25,000 employees. The non-teaching staff includes 1,228 drivers, 500 full-time and 2,300 part-time food service personnel, 2,482 custodians, 1,353 security guards and 160 armed police.
Royo manages claims with the assistance of third-party administrator Gallagher Bassett.
On July 1, Clark signed on to an excess policy with Safety National with a specific limit of $1.5 million. In the last 20 years, he has had few claims that pierced the limit.
Clark, who served as president of the Risk and Insurance Management Society in 2011, is credited with having put controls on the pervasive practice of treating physicians dispensing drugs in their clinics.
Nationwide, studies report that physician dispensing greatly increases drug costs with no apparent improvement in claims outcome. This practice costs employers across the country around $1 billion a year.
Florida has been one of the hotbeds of physician dispensing, and Clark was one of the first employer executives to do something about it. He found little value in physician dispensing except for a minority of injured employees who did not have access to transportation for easy access to pharmacies.
Third-party billers, retained by physicians, were plaguing Miami-Dade by demanding payment for what Clark considered excessive drug charges. He couldn’t prohibit dispensing among network providers (Florida is an employer choice state) because many of the providers in question were valued members of Miami-Dade’s health insurance provider network. In any event, his preferred provider networks did not want to jump into this briar patch.
So he created a Pharmacy Validation Program in which bills for repackaged prescriptions are adjusted to the proper state fee schedule. This meant working out agreements with the third-party billers. The district saved more than $3 million. In 2010, it received a Risk Innovator™ award from Risk & Insurance® for the program.
Collaboration vs. Conflict
Collaborating rather than fighting with unions has been Clark’s mantra for decades, having joined Miami-Dade County 28 years ago in risk management.
On modified duty for recovering employees, he said that “we have probably now as good an understanding with unions as any employer has.”
He crafted the 13-week salary continuation program in part to lower the almost universal habit of freshly injured workers retaining attorneys. Given that the mandated illness on duty benefit is for only 10 days, this extension was highly valued by employees. And, “the unions get unions dues during salary continuation,” which was a key motivator for union buy-in, he said.
Part of that bargain is an extraordinary written agreement with the unions that expects injured workers to adhere to medical advice. Clark said that “the unions understand that when the worker does not do the right thing,” he and Royo have to right to invoke the agreement, which they have done,
Royo and Clark have been long aware that co-morbidities may not be causing work injuries but they greatly complicate and stretch out recovery. These co-morbidities include hypertension, obesity, smoking and substance abuse.
In particular, Miami-Dade County tries to influence the health status of its bus drivers. The most troublesome risk for them is getting in and out of their buses. As there are several kinds of buses, drivers have to learn to get in and out several times over.
But a more important long-term concern for Royo is her drivers’ extensive co-morbidities, or pre-existing conditions.
“They are a middle-aged group, about 47 in age and 70 percent overweight. Age is against me and weight against me.” She discovered in Miami-Dade’s health insurance data base that transportation employees are more prone to hypertension.
Because many of them wait around between their early shift bringing kids to school and their afternoon shift, she has taken advantage of that time to bring in individuals who can speak to them about health issues and potential medications.
Miami-Dade County has gradually built up a wellness program of prevention by bringing in educational programs on a variety of nutritional and health-related issues.
In addition, though Gallagher Bassett and the TPA’s managed care partner, Coventry, there are three full-time medical professionals on the Miami-Dade County account for oversight of medical management. Clark said there is also a nurse on site to coordinate wellness activities.
Royo and Clark expect to expand wellness programs in the future — exactly the direction in which other employers sooner or later will head.