2018 Risk All Star: Rebecca Cady

Caring for Kids Meant Promoting Best Safety Practices for This Risk Manager

Rebecca Cady, 2018 Risk All Star, minimized med-mal litigation risk by focusing on information-sharing and faster response to potential claims.
By: | September 14, 2018 • 2 min read

Children’s National Medical Center (CNMC) was at a critical point in managing its litigation risks, and its medical malpractice captive was at risk of being underfunded.

Rebecca Cady, vice president and chief risk officer, Children’s National Medical Center

For 2018 Risk All Star award winner Rebecca Cady, CNMC’s vice president and chief risk officer, that meant protection for CNMC’s clinicians was at risk — compromising the organization’s mission of caring for children.

“That’s really my motivation,” said Cady. “To do what I can to protect the people who work in this building so that they can focus on taking care of those kids.”

Cady brought litigation and captive management in house. A top issue was that leadership was not getting the critical information it needed to address problems before they could gain real traction.

In addition to a daily check-in call for safety, Cady’s team instituted a weekly C-suite leadership risk huddle for operational and clinical leaders, a bi-weekly huddle to update the CEO and a regular report to brief the board chairman.

This has eliminated unpleasant surprises for senior leadership and the board, said Cady, and raised awareness of how response time impacts risks and outcomes. CNMC now has the lowest rate of serious preventable patient safety events in its history, translating to averted professional liability claims totaling nearly $110 million.

“That’s really my motivation. To do what I can to protect the people who work in this building so that they can focus on taking care of those kids.” — Rebecca Cady, vice president and chief risk officer, Children’s National Medical Center

The key to achieving CNMC’s level of timely and transparent level of communication, said Cady, is to “hard-wire it into the process and make sure that the pathways are clear.”

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Cady also brought clinicians into the loop. Unlike private practice physicians, CNMC’s clinicians didn’t write monthly checks to pay for their professional liability premiums. So costs were out of sight, out of mind. There was a disconnect between the risks they faced and their perceptions of how they personally impacted the organization’s litigation risk.

“No doctor wants to get sued. But the fact that they’re not writing that [premium] check every month means maybe they’re not thinking about it as much as they would,” said Cady.

Cady’s team launched a physician malpractice allocation program, which sets premium for physicians at the division level, and gives CNMC the ability to reward or penalize divisions based on cases filed.

This change helps clinicians “understand that they have some ability to influence the number — that their safety behaviors on the front end ultimately do impact what the organization pays in malpractice.”

The changes implemented by Cady and her team have resulted in a net positive movement on reserves of over $100 million over five years. Program management expenses, including attorneys’ fees, have dropped by 47 percent.

In some organizations, observed Lisa Scafidi, the organization’s director of clinical risk management, “there’s clinical risk management, there’s litigation and the captive, and they live in silos even when they’re in the same department. But there’s more of a fluidity in the way these things interact now [at CNMC] and there’s a lot of benefit to that.” &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Michelle Kerr is associate editor of Risk & Insurance. She 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]