Revitalizing the Program
Anne-Marie Amiel assumed her post at Columbus Consolidated Government in Georgia three years ago, becoming the first risk manager for the consolidated City of Columbus and the County of Muscogee government in over a decade.
Since then, she and a colleague have been successfully reconfiguring the government’s workers’ compensation, liability claims and safety programs.
Given the short amount of time she’s been working there and her limited resources, it’s uncanny how many accomplishments the first consolidated city-county in Georgia has produced.
Amiel has not only substantially reduced the time spent by employees on leave by revamping the return-to-work program, but she has reduced costs per claim, enhanced the workers’ comp process and begun overhauling safety and training procedures.
The reduced volume of lost-time days experienced by the public entity and its 3,000 employees has been a great benefit to Columbus — in more than just fewer days off the job.
In 2011, the average number of days out of work for government employees was about 109, Amiel said, noting that she took oversight of the program for the entire year in 2013, when the number dropped to 53.
In 2014, the number was 28, nearly half of the 59-day figure projected by the Department of Labor’s National Disability Guidelines for that year, Amiel said.
So how did she do it?
An enhanced return-to-work program for employees with limited capacity played a big role.
“Often the doctor says that an employee can come back to work but cannot do all
the essential functions of their job,” said Amiel. ”If someone has a knee injury, for instance, they often can’t be driving heavy equipment but could be driving something smaller.”
Amiel understood that offering light duty to more employees was not only good for the company and its self-insured workers’ comp program, but was also psychologically beneficial to workers.
“If someone is injured and out of work for more than 12 weeks, psychologically they tend to start thinking of themselves as disabled, and it gets to be harder and harder to bring them back to work,” Amiel said.
To make the process more effective, she centralized the return-to-work program instead of leaving it to various government divisions to handle their own employees.
In the past, Amiel said, many of Columbus’ departments would provide only as much light or transitional duty as could be absorbed within their own divisions, meaning that large numbers of employees unable to take on full duties had no choice but to stay at home and collect workers’ compensation checks.
Under Amiel’s supervision, that has changed.
“I have worked with all of our departments to allow their employees to be provided light duty in another department when there is none available in their own.”
One striking example of the new policy resulted in additional monetary benefits to the government.
A police officer who was not able to perform her normal duties was placed in the public works department, where she helped create a database of addresses for Columbus, and identified a cross-referencing system failure with a local utility’s database.
“I have worked with all of our departments to allow their employees to be provided light duty in another department when there is none available in their own.” — Anne-Marie Amiel, risk manager, Columbus Consolidated Government, Georgia
As it turned out, a local water utility was using an outdated address list, meaning that Columbus’ water bill mistakenly included trash collection charges for several new addresses, while Columbus was collecting trash at those locations without pay.
Now able to collect accurate fees for services provided, “the increase in Columbus’ revenue due to that one light-duty assignment between 2013 and 2014 has been approximately $100,000,” Amiel said.
“I am still assigning people from other departments to public works duty to help them with the water department database,” said Amiel.
“Like most employers these days, we have a lot of tasks that need to be completed but insufficient personnel to perform them,” she said. “Utilizing light-duty employees to accomplish these tasks is beneficial to both employer and employee.”
Lower Costs Per Claim
That was only the beginning. Through Amiel’s efforts, the government’s total incurred cost per claim (the sum of medical and indemnity benefits and other incurred costs for all claims, divided by the total number of all claims) has dropped dramatically.
Costs per claim dropped by more than 60 percent over three years, from $9,971 in 2011 to $3,641 in 2014.
After Amiel began exercising oversight of the program, the organization’s total medical costs per indemnity claim dropped from $6,307 in 2011 to $2,014 in 2014. An indemnity claim is paid when the employee is out of work and is receiving the wage benefit from workers’ compensation.
One key step leading to these improvements was a change in Columbus’ third-party administrator and a move to managed care in early 2014. Today, Columbus is using USIS/AmeriSys as its TPA and managed care organization (MCO).
The shift was transformational, said Amiel.
“Under the old system, the people managing our claims were not medical professionals,” she said. “I really wanted a medical professional who could triage with our employees when they were hurt and help guide them to the correct treatment.”
At AmeriSys, a nurse case manager handles the medical side of all claims — and only Columbus’ claims. That makes a difference, Amiel said.
“With a workforce of over 3,000 employees, we need people who understand our culture and who get to know our employees,” she said.
Also instrumental to Columbus’ improvements was moving away from the state’s so-called “panel system.”
“In Georgia, the law says that if you use that system you need a list of six unique medical providers your employees can tap when they are injured,” Amiel said.
“The panel needs to include one minority member, for instance, one orthopedic specialist, and one walk-in provider, among others.
“The problem has increasingly become we have larger practices buying out smaller ones so it can be difficult to find six quality providers.”
Managed care acts as an alternative to the panel system for Columbus, she said.
“Under managed care, what happens is the MCO gets approval from the state workers’ comp board for a whole network of providers and we now have access to over 200 providers,” Amiel said.
“Our MCO system provides both 24/7 coverage and medical management of claims, plus a larger network of available medical providers than does the panel system.
“I have visited all of our regular medical providers so that I could make sure they know the city has a ‘face’ and someone on whom they could call if they need more information on an employee or if they want to discuss potential light duty work.”
The new system’s utilization review is also “one of the keys to cost control of injury claims.”
She noted that under the panel system “any dispute brought before the State Board of Workers’ Compensation would essentially have a doctor’s opinion on one side and a professional adjuster’s on the other. If you were a judge, would you not take the opinion of the doctor over the adjuster? I know I would,” she said.
With the MCO system, there is a peer review system at an earlier stage than a court hearing. That peer review can result in medical professionals talking to other medical professionals and coming to a consensus on the appropriate course of treatment.
That works to the benefit of the employee and gives the employer a greater confidence on the treatment plan being implemented, she said.
“When one utilizes an MCO system there is a much more robust peer review system,” Amiel said.
Loss Control Strategies
Since bringing on the new TPA, Amiel said, she has been tracking accident trends and using that information to discuss potential safety improvements to work environments with Columbus’ department heads.
“For instance, we have stepped up employee training and workplace inspections provided to our employees, including different forms of driver training to include not only standard vehicles, but also vans and larger trucks,” she said.
“I have also rewritten our accident review policy to bring it more in line with national standards,” she said. “We have adopted a system that is widely in place nationally, whereby employees are assigned points for various types of at-fault accidents according to the degree of severity.
For example, a trash truck that hit a mailbox would be assigned fewer points than the driver of a city vehicle that hit a stopped car at an intersection.
“Disciplinary actions are given in a progressive manner,” she said.
Among those who are impressed by Amiel’s efforts is Columbus, Ga. Mayor Teresa Tomlinson.
“We have seen a transformation in our workers’ comp claims system through a more engaged management effort and best practices techniques,” Tomlinson told Risk and Insurance®.
“In three years, we are down from [roughly] $10,000 per claim to $4,000 per claim. That comes from having diligent in-house workers’ comp personnel and a systematic approach to deal with the injuries and claims of our employees expeditiously.
“We are better able to assess their needs and get them healthy and confident to return in just 28 days on average.”
“Of course,” she said, “the best investment we can make for taxpayers is education and training through our safety plan. If the injury never happens, we are all better off and that’s our goal.
“In the event of an injury, our efforts turn to investing in a system that gets our valued employees healthy and safely back to work.”
Read more about all of the 2015 Teddy Award winners:
Revamped Program Takes Flight: The American Airlines and U.S. Airways merger meant integrating workers’ compensation programs for a massive workforce. The results are stellar.
Checking Out Solutions: From celebrating safety success to aggressively rooting out fraud and abuse, Stater Bros. Markets is making workers’ comp risk management gains on multiple fronts.
Revitalizing the Program: In three years, the Columbus Consolidated Government was able to substantially reduce workers’ compensation claims costs, revamp return-to-work and enhance safety training.
Spreading Success: Barnabas Health wins a Teddy Award for pushing one hospital’s success in workers’ comp systemwide.