Teddy Award Winner

Making the Grade

The Miami-Dade County Public Schools successfully contain threats that drive up workers' compensation costs.
By: | November 1, 2013 • 5 min read

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.

R11-13p38-40_05MiamTEDDY.inddScott B. Clark, risk and benefits officer for the district, is credited with having put controls on the pervasive practice of treating physicians dispensing drugs in their clinics.

 

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.

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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.”

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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. R11-13p38-40_05MiamTEDDY.inddClark 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.

Peter Rousmaniere is a journalist and consultant in the field of work injury risk. He lives in Woodstock, Vermont. Peter can be reached at [email protected]

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.

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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.

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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]