National Workers’ Comp Event Kicks Off
The 23rd annual National Workers’ Compensation and Disability Conference® & Expo takes place Nov. 19-21 at the Mandalay Bay Resort and Casino in Las Vegas. The conference is produced by LRP Publications, which also publishes Risk & Insurance®.
As the 2014 conference begins, here’s a look at several highly anticipated breakout sessions.
Managing the Costs of Medical Containment and Cost Control Services
Wednesday, Nov. 19 from 2:30-3:45 p.m.
The workers’ comp system has become ever more complex and with it are additional costs, especially when it comes to the medical component. But while there are some big expenses, there are ways to hold costs down and measure the return-on-investment.
“We all know about medical costs, but many of us don’t peel back the onion,” said Joe Picone, claim consulting practice leader of the risk control and claim advocacy practice at Willis. “[The session] will also allow industry professionals to see how other companies are looking at it and measuring their ROI.”
Picone, who will be joined in the session by David Abbene, a managing director for Marsh, says it boils down to the medical costs, of which managed care is a driving force. Many industry practitioners see managed care as something of a mystery and are not sure where their dollars are exactly going.
Do things such as physician performance or outcomes-based networks work? What about your pharmacy benefit manager? How do you measure it? What should you be measuring? Or nurse case management, Picone said. “Every one is a piece of the onion that people don’t understand.”
While workers’ comp practitioners understand the importance of ROI and measuring effectiveness, they don’t seem to be doing it. A recent study by Healthesystems on managing ancillary medical services to control costs bears that out.
“Eighty-five percent [of respondents] said it’s important to measure ancillary services,” Picone said, “but only 5 percent do.”
Often, workers’ comp payers use a variety of managed care resources and hope for the best. But Picone said using everything from specialty networks, nurse case management, and other tools is like throwing everything against the wall, which is inefficient.
The situation is especially complicated by the plethora of available vendors, all claiming to be superior to the rest. Stakeholders need ways to determine which best fit their needs. Picone will offer a variety of strategies to help.
“Liberty Mutual did a study and peeled back the onion, matching claims and patient characteristics. They tried to find claims that were the same then said, ‘which have nurse case managers and which ones did not? They said there was an 18 percent net savings [in medical costs] with nurse case managers,” Picone said. “Liberty did a great job with that study. That’s what analytics are finally showing us — you actually can compare two claims and see what you are saving.”
Additional strategies involve ways to measure the effectiveness of tools such as pharmacy benefit managers, physician performance, physical therapy, medical bill review, nurse case triage, and Medicare set-aside agreements. Doing so will allow for better decision-making and better outcomes.
“The next generation of managed care is peeling back the onion, determine if it’s working,” Picone said. “Do you switch providers? Why? When? How do I measure it and determine if the next guy is going to be better than last vendor?”
The industry is not properly measuring what matters, Picone said. In the session, the speakers will identify where unwarranted costs can creep into a workers’ comp program, discuss how to apply strategies for eliminating unnecessary expenses, and describe how to evaluate medical management spend for optimal outcomes.
Ethics for HR Specialists, Risk Managers and Claims Adjusters
Thursday, Nov. 20 from 1:30-2:45 p.m.
If a plaintiff’s attorney tells you which defense lawyer, expert, or vendor to hire, what would you do? What if a lawyer starts acting unlike a lawyer? In fact, how do you ensure someone contacting you about a claim is actually an attorney?
These are just a few of the many scenarios that could lead to unethical decisions and severe penalties.
“I’ve seen everything from potentially unethical decisions to criminal [activity] in a 35-year career,” said Eugene F. Keefe, a partner with Keefe, Campbell, Biery & Associates in Chicago. “I’ve probably seen a dozen people get criminal convictions.”
During his session on ethics, Keefe will provide details about two particular claims handlers who made somewhat “comical” mistakes and ended up in prison. While incarceration is not a typical outcome, there are many questionable situations facing those involved in claims management.
“I’ve also seen adjusters make what I would consider to be challenging decisions where they really don’t have the evidence to support what they are doing and do it on a personal basis,” Keefe said. “The anonymous phone call, and somebody shuts down all benefits. You have to find a more ethical basis for the decision to support denial of benefits.”
The good news is that many scenarios that raise ethical questions tend to resolve themselves. “With most ongoing claim decisions, the day-to-day business of adjusting doesn’t involve even close to criminal behavior,” Keefe said. “The system itself brings lawyers on both sides to the table. There are a lot of different resources for claims managers to look to. That’s something that’s good about our industry. There are checks and balances throughout our system that should lead to ethical behavior.”
Nevertheless, suspicious incidents do happen in claims handling. Keefe says he often is asked by clients how to address certain situations.
“I get asked all the time by adjusters and in-house risk people, ‘I saw this happen. What is the best approach?’” he said. “There are some basic standards everybody should follow. If you see something anomalous, ask somebody. If you are satisfied, put that in place.”
Documentation is one of the key strategies to keep everything on the right path. Without that, a claims handler could, for example, bear responsibility for a vendor who acts in bad faith.
“You may be asked to do invasive, questionable or shocking things,” Keefe said. “Always discuss and analyze such requests with management and your defense attorneys.”
It’s also important to be cognizant of privacy and other laws. The provisions of HIPAA and GINA, for example, must be followed.
“Managers and adjusters get sued, fired, or criticized all the time for any small breach of confidentiality,” Keefe noted. “Don’t be the first in your office to blab.”
Claims managers and risk managers who have been in the industry for a while will get the most benefit from the session. Keefe will discuss the risks and solutions to a variety of ethically challenging scenarios and offer best practices.
“If something doesn’t appear accurate or you note there may be any type of problem, solid ethics requires you report it and correct it,” he said. “By being ever-vigilant, you protect your job, yourself, and your employer.”
Top 10 Ways to Reduce Your Legal Expenses NOW
Wednesday, Nov. 19 from 2:30-3:45 p.m.
It may seem odd that an attorney would co-present a session on ways to pay less in legal fees. “I’m probably not the most popular member of the defense bar by telling clients how to pay less,” said Richard Lenkov, a partner with Bryce Downey & Lenkov LLC. “My goal is to be a business partner first. It’s important for me to deliver a product in the most cost-effective way possible.”
Lenkov, along with veteran workers’ comp practitioner Jill Dulich, senior director for Marriott Claims Services, maintains there is way too much unnecessary legal expense in the workers’ comp system.
Anyone who reviews and pays litigation bills may be surprised by the data the two will show detailing the wasted legal expenses.
“Suffice to say there is an incredible amount of excess inherent in the system,” Lenkov said. “It’s not getting better it’s getting worse as different layers get added to the system. So there’s always going to be some excess. It’s our mission to have takeaways to get rid of some of that.”
From an attorney’s standpoint, Lenkov says one strategy is to make sure vendors stick to a budget. He shares a way to avoid paying unnecessary costs to them.
“One way is to not pay them more than they have quoted or you have budgeted,” Lenkov said. “It’s very important for clients that those folks stay within the parameters of reserves and budget, or what is already incredibly expensive is more so. So it is important for my clients for them to stick to budgets.”
The session will also address the issue from a claims viewpoint. “It presents a unique opportunity to hear from Jill, one of the foremost members of the workers’ comp community,” Lenkov said.
The two will offer practical tips to reduce and even eliminate legal expenses sooner rather than later. Examples of some of the strategies to be explained are:
- Manage your vendors.
- Manage your TPA.
- Hire the right attorney.
- Conduct negotiations skillfully.
Lenkov said the session won’t be all work.
“While we are going to deal with important topics, [it will be] in a very interesting and fun way as well,” he said. “We’re going to have some real-world examples, hypotheticals and some trivia too – maybe even a giveaway or two!”
Loss Mitigation of High Value Workers’ Compensation Claims
Friday, Nov. 21 from 10-11:15 a.m.
High-value workers’ comp claims can be a nightmare for companies. But they need not be.
“We were able to take down some significant reserves; very significant reserves in some of these older cases,” explained Christianne Quinn, the national workers’ compensation manager for The Pep Boys. Quinn will outline the steps her company took and, along with co-presenter David R. Kunz, managing partner at Kunz & Germick, will discuss risk analyses to identify and close claims thought to be lost causes.
“Comp has a long tail; cases can be open and sometimes stay open for many years when they really should be closed. So you end up with a long tail that affects the actuarial calculations that go into reserving,” Quinn said. “You also have old claims, or new claims involving preexisting injuries. Many of these claims involve excessive medications where you’re paying thousands a month for medications.”
With medical taking over indemnity as the driving costs in a claim, that needs to be the focus of high-value claims — how to reduce those expenses. They require special attention to get them off the books.
“You can’t apply the same analyses and strategies to high-value claims as you can for run-of-the-mill claims. The size of the high-value claim dictates a greater degree of aggressiveness on your loss mitigation strategies. You must be a lot more active,” Kunz said. “What we see a lot is all cases [being] handled the same, rather than vetting them to identify high-value claims that need more attention.”
The first step is to identify those high-value claims that are appropriate for closing sooner rather than later. “Many times they’re just on a payment schedule,” Quinn said. “On a lifetime claim, often ongoing medication is simply paid out and years go by without any activity by the employer.”
The interactive session will seek audience input to help determine claims that have a good probability of being closed successfully. Quinn said often a fresh set of eyes looking at a high-dollar claim can help determine if it ultimately can be closed. “We’ll present new ideas people can take away and review their claims.”
For more information, visit www.wcconference.com. To post your thoughts on the conference, join the conversation on LinkedIn’s National Workers Compensation and Disability Conference & Expo, a subgroup of the Work Comp Analysis group.