2017 Teddy Awards: Honorable Mention

Triage, Transparency and Teamwork

When the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.
By: | November 1, 2017 • 5 min read

Facing the painful medical cost increases that bedevil so many administrators, the City of Surprise, Arizona, significantly cut its medical expenditures and lost work days by implementing new programs and moving to a self-insured model.

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Historically, Surprise was a member of a municipal risk pool that offered a guaranteed-cost program for workers’ compensation. The program served its purpose for the 15 years Surprise was a member, limiting potential exposure by capping aggregate losses. However, costs and premiums were rising.

When Brian Carmichael assumed the role of risk manager in May 2015, he identified a growing interest in the possibility of self-insurance. In the process, the city conducted a thorough analysis of workers’ compensation and found there was “money being left on the table” in premiums and medical costs. Carmichael’s team began prioritizing changes that needed to be made.

Taking Control With Triage

Carmichael noted that Surprise’s workers’ comp medical expenses, at around $800,000, were far more than they should have been for a city of its size. But the best path for a solution wasn’t immediately clear. The risk management team chose to approach the problem at a grass roots level, enlisting the help of employees to talk about their injury experiences.

Through those conversations, the team noted that the city was relying solely on supervisors to triage or direct care to various medical providers in the event of an injury. With no medical training, supervisors often erred on the side of caution and sent injured workers to the emergency room, sometimes for things as minor as a small cut or sprained ankle.

This resulted in frustratingly long wait times for employees and also high costs for the city.

Brian Carmichael, risk manager, City of Surprise, Ariz.

Carmichael’s team recognized the need for skilled medical triage and decided to search for an appropriate partner. It selected a local company to contract with.

A detailed, in-person training session was given to each department on the new procedure and how it would impact the injury and recovery process. Carmichael said the program evolved over the first few months.

The new procedures allowed the city to gain more control over its claims, including protocols for sending reports and email notifications to all stakeholders during an injury.

The risk management department, including senior adjuster Bretton Jeziorski and adjuster and safety analyst Michelle Boyer, immediately reach out to each injured worker to start investigating and expediting medical care.

“We are all notified within 15 minutes of [an injury], which allows us to reach out directly to them. I think that has been the biggest win for us to have that immediate intervention with our employees,” Carmichael said.

The ability to begin the investigation process sooner is also helping the city to eliminate repeat injuries, driving claims frequency down.

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An increase in transparency about claims costs allows risk management to engage everyone in its push to prevent injuries and improve claims outcomes.

“Being able to show what we are paying and going to departments — from city leadership down to line-level employees — created a culture in which everyone was interested,” he said.

Carmichael said the city saw an “immediate shift” in the entity’s ability to contain costs, dramatically reducing the number of hospital bills that formerly might linger for months before risk management even knew about them.

Between 2015 and 2016, visits to the ER fell by half. Yearly average claim costs fell from $6,584 to $4,220, and workers were receiving better care.

The city also significantly reduced lost workdays by expanding opportunities for return to work. Many employees appreciate having the ability to return to light duty roles at full compensation.

“Oftentimes these employees would go to the ER, never do a follow-up, take a month off from work and just disappear. There were holes in the program,” Carmichael said.

While the City of Surprise lost 572 workdays in 2015, the risk management department was able to reduce that number to only 211 days in 2016.

Inspiring Engagement

Carmichael said that using its new transparency about costs has allowed employees to really see how their participation matters, and to take an active interest in continued improvement. “Their cooperation hasn’t been about compliance but about commitment,” he said.

Numerous suggestions offered by employees in regards to process improvement and tool and equipment modifications have been put into place throughout the City in the past year. To keep that momentum alive, Carmichael said the department speaks to all 1,200 full- and part-time city workers at least every other month.

“Oftentimes employees would go to the ER, never do a follow-up, take a month off from work and just disappear. There were holes in the program.” — Brian Carmichael, risk manager, City of Surprise, Ariz.

The program became so successful the city made the leap to becoming self-insured on July 1, 2017. Whereas most similar programs are administered through a TPA, the City of Surprise has opted to self administer. Carmichael said the team wanted to further contain medical costs by going directly to providers and cutting out any markups in the middle.

Carmichael said this decision has enabled them to negotiate some “unbelievable” rates.

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The city is still protected against catastrophic injuries with a self-insured retention of $500,000 for the general population and $1 million for public safety employees. Surprise also established appropriate reserves that would be three times those limits.

“We’re going to build that and invest the money over the years to reduce the program cost to the employees while still keeping those dollars low,” he said.

Through all these measures, Carmichael said Surprise has been able to reduce workers’ compensation medical expenditures from an average of $800,000 to only $300,000 in two years. And from July to October 2017, there was not a single lost workday.

“We have the buy-in from the employees that it’s in their best interest. They’re being paid. It’s a benefit. If they can be here in some way, they come,” he said. &

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More coverage of the 2017 Teddy Award Winners and Honorable Mentions:

Advocacy Takes Off: At Delta Air Lines, putting employees first is the right thing to do, for employees and employer alike.

 

Proactive Approach to Employee SafetyThe Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.

 

Getting It Right: Better coordination of workers’ compensation risk management spelled success for the Massachusetts Port Authority.

 

Carrots: Not SticksAt Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.

 

Fit for Duty: Recognizing parallels between athletes and public safety officials, the city of Denver made tailored fitness training part of its safety plan.

 

Triage, Transparency and TeamworkWhen the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.

A Lesson in Leadership: Shared responsibility, data analysis and a commitment to employees are the hallmarks of Benco Dental’s workers’ comp program.

 

Craig Guillot is a writer and photographer, based in New Orleans. He 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]