2015 NWCDC

Focus on Behavioral Issues

Technology is helping to transform medical services, but employers and providers need to focus more on socioeconomic factors.
By: | November 12, 2015 • 2 min read

As a keen observer of the evolution of health and medical care, Dr. Arthur Southam points to socioeconomic factors and fee-for-payment health care as major issues for workers’ compensation professionals.

In his keynote address opening the National Workers’ Compensation & Disability Conference® and Expo in Las Vegas on November 11, Southam, executive vice president, health plan operations, Kaiser Foundation Health Plan Inc., said medical care must focus on quality, not volume.

“The more you do, and the more it costs and the more times you do it, the more you get paid,” he said of the current fee-for-payment system.

The Affordable Care Act, with its emphasis on accountable care organizations, is beginning to change that, by focusing on “paying providers by the package rather than the price.”

“Improving the walkability of our workforce is the highest thing we can do.” — Dr. Arthur Southam, executive vice president, health plan operations, Kaiser Foundation Health Plan Inc.

He noted that a study by the RAND Corp. found that socioeconomic issues are “the most powerful determinant of health,” and that chronic diseases, primarily driven by behavior, are one reason America spends 50 percent more on medical care than any country in the world.

“A large portion of our costs in America could be dramatically reduced if we ate less, moved more, stopped smoking, slept sometimes and we were careful with the substances we ingest,” he said.

The issue of an inactive workforce “should be front and center in your workplace,” Southam said. “Improving the walkability of our workforce is the highest thing we can do.”

Depression also is a leading cause of morbidity, he said.

A striking cause of death, he said, is medical error.

Every year, he said, 98,000 people die from medical errors. That’s equivalent to two 747 jets crashing into each other each week, killing all passengers.

“Our hospitals and medical care system are not as safe as they should be,” he said.

“We have some spectacular outcomes but also some shortcomings.”

The increasing use of electronic health records will help medical providers be more effective and efficient as well as enhance transparency and coordination of care, he said.

But the ubiquitous cell phone, which offers access to tens of thousands of health-related apps and hundreds of biometric measurement tools, may be “the most important advance” in medical treatment.

That digital transformation “takes much of medical care out of the offices and institutions to put it in your home, to put it in your place of work, to put it in your pocket, to put it in your hand.”

The use of voice, video and data in telehealth operations – which is “just starting to scratch the surface” — will also transform health care delivery by improving access to primary and specialty care.

The late Anne Freedman is former managing editor of Risk & Insurance. Comments or questions about this article can be addressed to [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.


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]