Service Spotlight

Workers’ Comp Patient Transportation

In this Q&A, the VP of one workers’ comp service provider shares how to soothe a common pain point for injured workers: Getting to appointments on time.
By: | February 5, 2018 • 6 min read

Traditional transportation services meant to deliver injured workers to and from medical appointments may be at best inefficient, and at worst, antiquated. Both injured workers and payers want more control and transparency while also saving time and money.

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Historically, third party providers are limited in flexibility. In this Q&A, Linda Colsen, vice president and national product leader at One Call, shares how the industry can soothe transportation pain points.

R&I: What’s wrong with traditional transportation in workers’ comp?

First and foremost is time, particularly when there has been an issue with a missed appointment. Odds are, you don’t learn about a missed appointment until well after it has been missed. The process to reschedule an appointment in itself can be a headache. When adding in the time factor, an injured worker could be looking at days or in some cases, weeks later than the original appointment.

The second factor is the cost. In the perfect scenario, you need two drivers: one to take the injured worker to their appointment and the second to take them home. Until recently, however, there

Linda Colsen, vice president and national product leader, One Call

hasn’t been an effective solution to send a second driver to retrieve the injured worker from their appointment and transport them back to work or home. With traditional third-party transportation providers, payers end up spending a lot of dollars on wait time, which means paying a driver to sit in the parking lot while the injured worker is at their appointment.

Lastly is visibility, and specifically, a lack of visibility —knowing if the injured worker got picked up on time, if they overslept, if they’re on their way to the appointment and if they arrived on time.

R&I: How do these transportation challenges impact outcomes?

Without real-time visibility, delayed transportation may mean missed appointments, which means the injured worker doesn’t get the care they need. Rescheduling the appointment and another ride creates more logistical challenges for claims staff, case managers, injured workers and healthcare providers. Ultimately, missed appointments mean slower recovery and more stress for injured workers and higher costs for workers’ compensation payers. Transportation troubles leads to costly and subpar outcomes for everyone involved.

R&I: What can the industry do about it?

Technology has given us real-time, on-demand ride hailing services. For the average consumer, they offer more convenience and comfort for significantly less than a traditional cab. A real-time ride request reduces downtime because it can use drivers who are nearby. It also allows users to track their driver and cancel or reschedule a ride easily as well as log their ride history. We asked ourselves, ‘Why can’t we use this in workers’ comp?’

One Call decided to leverage this technology with the creation of RelayRIDE, which may be used for any injured worker needing transportation to medical appointments. Real-time visibility enabled by the RelayRIDE technology means the One Call team can monitor ‘live’ trips in progress and take steps to mitigate issues, such as driver cancellations, by quickly scheduling the trip with another driver. This active trip monitoring means injured workers receive the treatment they need quickly, which may result in a shorter claim life.

R&I: How does it work?

We partnered with Lyft in August 2016, originally utilizing their services to handle the more difficult, rush cases.

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Over the course of the partnership, we have developed our proprietary web-based application, which connects directly to Lyft through an open application programming interface (API). This allows One Call to seamlessly utilize RelayRIDE to fulfill ambulatory transportation referrals if the request is in a Lyft coverage area.

Once a ride has been scheduled, One Call initiates a series of text messages to inform the injured worker of their transportation arrangements. They provide details about their upcoming ride such as driver identification, vehicle information and ride tracking. These text messages also enable injured workers to request a return ride with the press of a button on their phone. Wait time charges are eliminated for rides fulfilled through RelayRIDE as each leg of the trip is handled independently. At the end of their ride, they are able to provide instant feedback by rating their ride experience and driver.

One Call has a team dedicated to monitor rides in real-time through RelayRIDE. Through this active monitoring, our team is alerted to potential issues and can be proactive in addressing transportation issues that historically resulted in missed appointments. We will immediately notify the medical provider if an injured worker is a “no show” or if a late arrival is anticipated, which ultimately reduces the administrative burden on our customers’ to make multiple follow-up calls.

One Call decided to leverage this technology with the creation of RelayRIDE, which may be used for any injured worker needing transportation to medical appointments. Real-time visibility enabled by the RelayRIDE technology means the One Call team can monitor ‘live’ trips in progress and take steps to mitigate issues, such as driver cancellations, by quickly scheduling the trip with another driver. This active trip monitoring means injured workers receive the treatment they need quickly, which may result in a shorter claim life.

R&I: Have you seen any benefits from this program yet?

Lyft drivers have provided more than 100,000 “rush” rides this year. These are rides for non-emergent ambulatory appointments.

For us, visibility and transparency are the biggest benefits. Claims managers and nurses can see active rides and ride history through the web portal. They know right away if a driver didn’t show or is delayed. They can act immediately to either arrange a new ride or to reschedule the appointment. They’ll know if a patient missed an appointment and can reach out to them sooner rather than later. It removes some decision-making steps for the patient and cuts out some of the cost and liability of using a traditional transportation service.

R&I: What are other key benefits of using a modern ride-sharing service?

By helping patients keep their scheduled appointments, it can prevent expensive emergency room visits. The system can also track appointment history and mileage for reimbursement purposes. The transparency and accountability components may also reduce likelihood of fraud.

R&I: What about from the patient’s perspective?

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Approximately 98 percent of American adults have internet access. This program is reaching patients where they are at that moment and creating a seamless experience for them; they can request, track, or cancel a ride and see their history through the online dashboard. If they don’t want to log on and schedule a ride themselves, they can text “N” to our dispatchers who will send a driver for them.

The program will also send text reminders to patients 20 minutes before their driver is set to arrive, so they can be ready to go.

R&I: Are there other ways that technology can address challenges in worker’ comp?

Live video conferencing is increasingly playing a role in workers’ comp. Most of the conversation is centered on telemedicine —connecting doctors and patients when in-office visits aren’t feasible. But we’re applying video consultation to a different challenge: language barriers. Patients with Limited English Proficiency (LEP) may struggle to communicate with their medical provider, and if they can’t understand their treatment plan they are far less likely to stay engaged in their recovery.

RelayTRANSLATE is our technology-enabled video interpretation solution that is part of a broader program we’re developing called RelaySOLUTIONS, which also includes RelayRIDE. Through RelayTRANSLATE, the injured worker can request on-demand interpretation in their chosen native language, and the platform will connect them with a live person who can interpret for them via video. This is absolutely critical to achieve better outcomes for patients. &

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

Exclusive | Hank Greenberg on China Trade, Starr’s Rapid Growth and 100th, Spitzer, Schneiderman and More

In a robust and frank conversation, the insurance legend provides unique insights into global trade, his past battles and what the future holds for the industry and his company.
By: | October 12, 2018 • 12 min read

In 1960, Maurice “Hank” Greenberg was hired as a vice president of C.V. Starr & Co. At age 35, he had already accomplished a great deal.

He served his country as part of the Allied Forces that stormed the beaches at Normandy and liberated the Nazi death camps. He fought again during the Korean War, earning a Bronze Star. He held a law degree from New York Law School.

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Now he was ready to make his mark on the business world.

Even C.V. Starr himself — who hired Mr. Greenberg and later hand-picked him as the successor to the company he founded in Shanghai in 1919 — could not have imagined what a mark it would be.

Mr. Greenberg began to build AIG as a Starr subsidiary, then in 1969, he took it public. The company would, at its peak, achieve a market cap of some $180 billion and cement its place as the largest insurance and financial services company in history.

This month, Mr. Greenberg travels to China to celebrate the 100th anniversary of C.V. Starr & Co. That visit occurs at a prickly time in U.S.-Sino relations, as the Trump administration levies tariffs on hundreds of billions of dollars in Chinese goods and China retaliates.

In September, Risk & Insurance® sat down with Mr. Greenberg in his Park Avenue office to hear his thoughts on the centennial of C.V. Starr, the dynamics of U.S. trade relationships with China and the future of the U.S. insurance industry as it faces the challenges of technology development and talent recruitment and retention, among many others. What follows is an edited transcript of that discussion.


R&I: One hundred years is quite an impressive milestone for any company. Celebrating the anniversary in China signifies the importance and longevity of that relationship. Can you tell us more about C.V. Starr’s history with China?

Hank Greenberg: We have a long history in China. I first went there in 1975. There was little there, but I had business throughout Asia, and I stopped there all the time. I’d stop there a couple of times a year and build relationships.

When I first started visiting China, there was only one state-owned insurance company there, PICC (the People’s Insurance Company of China); it was tiny at the time. We helped them to grow.

I also received the first foreign life insurance license in China, for AIA (The American International Assurance Co.). To date, there has been no other foreign life insurance company in China. It took me 20 years of hard work to get that license.

We also introduced an agency system in China. They had none. Their life company employees would get a salary whether they sold something or not. With the agency system of course you get paid a commission if you sell something. Once that agency system was installed, it went on to create more than a million jobs.

R&I: So Starr’s success has meant success for the Chinese insurance industry as well.

Hank Greenberg: That’s partly why we’re going to be celebrating that anniversary there next month. That celebration will occur alongside that of IBLAC (International Business Leaders’ Advisory Council), an international business advisory group that was put together when Zhu Rongji was the mayor of Shanghai [Zhu is since retired from public life]. He asked me to start that to attract foreign companies to invest in Shanghai.

“It turns out that it is harder [for China] to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

Shanghai and China in general were just coming out of the doldrums then; there was a lack of foreign investment. Zhu asked me to chair IBLAC and to help get it started, which I did. I served as chairman of that group for a couple of terms. I am still a part of that board, and it will be celebrating its 30th anniversary along with our 100th anniversary.

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We have a good relationship with China, and we’re candid as you can tell from the op-ed I published in the Wall Street Journal. I’m told that my op-ed was received quite well in China, by both Chinese companies and foreign companies doing business there.

On August 29, Mr. Greenberg published an opinion piece in the WSJ reminding Chinese leaders of the productive history of U.S.-Sino relations and suggesting that Chinese leaders take pragmatic steps to ease trade tensions with the U.S.

R&I: What’s your outlook on current trade relations between the U.S. and China?

Hank Greenberg: As to the current environment, when you are in negotiations, every leader negotiates differently.

President Trump is negotiating based on his well-known approach. What’s different now is that President Xi (Jinping, General Secretary of the Communist Party of China) made himself the emperor. All the past presidents in China before the revolution had two terms. He’s there for life, which makes things much more difficult.

R&I: Sure does. You’ve got a one- or two-term president talking to somebody who can wait it out. It’s definitely unique.

Hank Greenberg: So, clearly a lot of change is going on in China. Some of it is good. But as I said in the op-ed, China needs to be treated like the second largest economy in the world, which it is. And it will be the number one economy in the world in not too many years. That means that you can’t use the same terms of trade that you did 25 or 30 years ago.

They want to have access to our market and other markets. Fine, but you have to have reciprocity, and they have not been very good at that.

R&I: What stands in the way of that happening?

Hank Greenberg: I think there are several substantial challenges. One, their structure makes it very difficult. They have a senior official, a regulator, who runs a division within the government for insurance. He keeps that job as long as he does what leadership wants him to do. He may not be sure what they want him to do.

For example, the president made a speech many months ago saying they are going to open up banking, insurance and a couple of additional sectors to foreign investment; nothing happened.

The reason was that the head of that division got changed. A new administrator came in who was not sure what the president wanted so he did nothing. Time went on and the international community said, “Wait a minute, you promised that you were going to do that and you didn’t do that.”

So the structure is such that it is very difficult. China can’t react as fast as it should. That will change, but it is going to take time.

R&I: That’s interesting, because during the financial crisis in 2008 there was talk that China, given their more centralized authority, could react more quickly, not less quickly.

Hank Greenberg: It turns out that it is harder to change, because they have one leader. My guess is that we’ll work it out sooner or later. Trump and Xi have to meet. That will result in some agreement that will get to them and they will have to finish the rest of the negotiations. I believe that will happen.

R&I: Obviously, you have a very unique perspective and experience in China. For American companies coming to China, what are some of the current challenges?

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Hank Greenberg: Well, they very much want to do business in China. That’s due to the sheer size of the country, at 1.4 billion people. It’s a very big market and not just for insurance companies. It’s a whole range of companies that would like to have access to China as easily as Chinese companies have access to the United States. As I said previously, that has to be resolved.

It’s not going to be easy, because China has a history of not being treated well by other countries. The U.S. has been pretty good in that way. We haven’t taken advantage of China.

R&I: Your op-ed was very enlightening on that topic.

Hank Greenberg: President Xi wants to rebuild the “middle kingdom,” to what China was, a great country. Part of that was his takeover of the South China Sea rock islands during the Obama Administration; we did nothing. It’s a little late now to try and do something. They promised they would never militarize those islands. Then they did. That’s a real problem in Southern Asia. The other countries in that region are not happy about that.

R&I: One thing that has differentiated your company is that it is not a public company, and it is not a mutual company. We think you’re the only large insurance company with that structure at that scale. What advantages does that give you?

Hank Greenberg: Two things. First of all, we’re more than an insurance company. We have the traditional investment unit with the insurance company. Then we have a separate investment unit that we started, which is very successful. So we have a source of income that is diverse. We don’t have to underwrite business that is going to lose a lot of money. Not knowingly anyway.

R&I: And that’s because you are a private company?

Hank Greenberg: Yes. We attract a different type of person in a private company.

R&I: Do you think that enables you to react more quickly?

Hank Greenberg: Absolutely. When we left AIG there were three of us. Myself, Howie Smith and Ed Matthews. Howie used to run the internal financials and Ed Matthews was the investment guy coming out of Morgan Stanley when I was putting AIG together. We started with three people and now we have 3,500 and growing.

“I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.” — Maurice “Hank” Greenberg, chairman and CEO, C.V. Starr & Co. Inc.

R&I:  You being forced to leave AIG in 2005 really was an injustice, by the way. AIG wouldn’t have been in the position it was in 2008 if you had still been there.

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Hank Greenberg: Absolutely not. We had all the right things in place. We met with the financial services division once a day every day to make sure they stuck to what they were supposed to do. Even Hank Paulson, the Secretary of Treasury, sat on the stand during my trial and said that if I’d been at the company, it would not have imploded the way it did.

R&I: And that fateful decision the AIG board made really affected the course of the country.

Hank Greenberg: So many people lost all of their net worth. The new management was taking on billions of dollars’ worth of risk with no collateral. They had decimated the internal risk management controls. And the government takeover of the company when the financial crisis blew up was grossly unfair.

From the time it went public, AIG’s value had increased from $300 million to $180 billion. Thanks to Eliot Spitzer, it’s now worth a fraction of that. His was a gross misuse of the Martin Act. It gives the Attorney General the power to investigate without probable cause and bring fraud charges without having to prove intent. Only in New York does the law grant the AG that much power.

R&I: It’s especially frustrating when you consider the quality of his own character, and the scandal he was involved in.

In early 2008, Spitzer was caught on a federal wiretap arranging a meeting with a prostitute at a Washington Hotel and resigned shortly thereafter.

Hank Greenberg: Yes. And it’s been successive. Look at Eric Schneiderman. He resigned earlier this year when it came out that he had abused several women. And this was after he came out so strongly against other men accused of the same thing. To me it demonstrates hypocrisy and abuse of power.

Schneiderman followed in Spitzer’s footsteps in leveraging the Martin Act against numerous corporations to generate multi-billion dollar settlements.

R&I: Starr, however, continues to thrive. You said you’re at 3,500 people and still growing. As you continue to expand, how do you deal with the challenge of attracting talent?

Hank Greenberg: We did something last week.

On September 16th, St. John’s University announced the largest gift in its 148-year history. The Starr Foundation donated $15 million to the school, establishing the Maurice R. Greenberg Leadership Initiative at St. John’s School of Risk Management, Insurance and Actuarial Science.

Hank Greenberg: We have recruited from St. John’s for many, many years. These are young people who want to be in the insurance industry. They don’t get into it by accident. They study to become proficient in this and we have recruited some very qualified individuals from that school. But we also recruit from many other universities. On the investment side, outside of the insurance industry, we also recruit from Wall Street.

R&I: We’re very interested in how you and other leaders in this industry view technology and how they’re going to use it.

Hank Greenberg: I think technology can play a role in reducing operating expenses. In the last 70 years, you have seen the expense ratio of the industry rise, and I’m not sure the industry can afford a 35 percent expense ratio. But while technology can help, some additional fundamental changes will also be required.

R&I: So as the pre-eminent leader of the insurance industry, what do you see in terms of where insurance is now an where it’s going?

Hank Greenberg: The country and the world will always need insurance. That doesn’t mean that what we have today is what we’re going to have 25 years from now.

How quickly the change comes and how far it will go will depend on individual companies and individual countries. Some will be more brave than others. But change will take place, there is no doubt about it.

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More will go on in space, there is no question about that. We’re involved in it right now as an insurance company, and it will get broader.

One of the things you have to worry about is it’s now a nuclear world. It’s a more dangerous world. And again, we have to find some way to deal with that.

So, change is inevitable. You need people who can deal with change.

R&I:  Is there anything else, Mr. Greenberg, you want to comment on?

Hank Greenberg: I think I’ve covered it. &

The R&I Editorial Team can be reached at [email protected]