Column: Workers' Comp

What’s Old May Be New Again

By: | November 2, 2015 • 2 min read
Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

Perhaps it’s time to eliminate workers’ compensation medical care and treat injured workers in the more-efficient and lower-expense group-health system.


That’s a potential strategy I’m hearing discussed more often, reminding me of the attempts 20 years ago to do just that.

The “24-hour care” system, which melded workers’ comp medical care into group health, emerged from the idea that group-health plans would treat employees 24/7, no matter where or when an injury or illness occurred.

But why would the strategy succeed this time?

Proponents respond that the Affordable Care Act’s push to hold medical providers accountable by basing their compensation on the treatment outcomes they produce, rather than on a fee-for-service model, will make health care offered under workers’ comp appear even less efficient.

A workers’ comp health care fee-for-service model that encourages more treatments won’t be sustainable, they add.

Employers would be better off treating all injuries in the group health system without regard for causation. — Dr. Bernyce Peplowski, consultant former health care executive

It won’t make sense for employers to pay their group-health doctors under a system holding them accountable while simultaneously compensating doctors to treat injured workers under a system clinging to fee-for-service, said Dr. Bernyce Peplowski.

Peplowski worked for Kaiser Permanente when it operated a 24- hour-care pilot program in Southern California from 1994 to 1997. She has since served in several roles, including as senior VP, national medical strategy and innovation for U.S. HealthWorks Medical Group and as the medical director for California’s State Compensation Insurance Fund.

Under the current workers’ comp system, employers regularly pay for injuries with questionable causation factors. When it’s unclear whether an aging worker’s knee problems resulted from a strenuous job or from their genetic makeup, employers often pay for treatment through the less efficient workers’ comp system, Peplowski said.

So employers would be better off treating all injuries in the group health system without regard for causation, added Peplowski, who is now a consultant and proponent of combining workers’ comp medical care and group health care.

Under Kaiser’s 1990’s pilot, the health plan charged the County of San Diego $330 per employee per month for group health care plus $16 per employee per month for the expense of treating any workers’ comp injuries.

Successful results allowed Kaiser to return $200,000 to the county.

But other 1990s-era 24-hour-care pilots managed differently failed to produce positive results. At the same time, the rapidly increasing workers’ comp insurance pricing that fueled the interest in 24-hour care reversed.

That killed interest in continuing the innovation. Employers were content with cheaper insurance.


But things are different today, proponents of merging workers’ comp care with group health argue.

Today, drivers of ever increasing health expenses are not going away and will continue to place greater strain on employers, the proponents maintain.

There is also evidence that employers are growing increasingly restless with paying more to treat the same type of injury under workers’ comp than they do under their group health plan.

While many entrenched parties would resist a shift to a new workers’ comp treatment model, perhaps it is time for new pilot programs.

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]