The Courage to Create
When I think of the courage to create, and the accompanying traits of passion and perseverance that define Risk All Stars, I can’t help but think of Renee Crow of Kimpton Hotels and Restaurants.
Like a number of our Risk All Stars winners, Crow manages risk at a company that is experiencing rapid growth. Rapid growth brings opportunity. But rapid growth, as we know, carries risk.
When Crow joined Kimpton, the company owned 24 properties. Now, it owns more than 60.
Although customer service underlies so much, there is a laser focus on it in the hospitality business. Much is expected and very little is forgiven.
The organizations these professionals manage risk for are stronger because of their courage.
According to Crow, Kimpton sets high customer service standards, but it was also facing legal snares from guest and employee interactions gone bad. She devised a training program that enabled Kimpton staff across the country to re-enact various customer service scenarios and learn from them.
Crow humbly states that she did what she did because she’d seen enough bad training approaches to know better. But I say what she did was innately brilliant.
She took a risk, or a negative, and created employee engagement across the board in seeking solutions. This is an era when employee disengagement is reported to be at high levels across many industries. The cost of risk at Kimpton has plummeted as a result.
The creative courage of Risk All Stars winner Kris Finell of Rytec Corp. also comes to mind. Finell possessed not merely the courage to create, but also the moxie to confront.
Rytec, another fast growing company, is a manufacturer of high-speed industrial doors. You can easily see the risks and the results when something goes wrong.
Rytec salesmen were in the habit of removing industrial door safety features at the behest of customers. Finell, practically brand new in her role as risk manager, put a stop to it.
Waivers that allow customers to remove safety features on Rytec doors are now a thing of the past.
Finell also had the courage to remove a broker that was friends with one of her supervisors. The relationship wasn’t working for her vision, so she vetted a number of candidates and chose one with the right fit for her.
Talking to these Risk All Stars reminded me that it’s not enough to see something; you have to say and do something. The organizations these professionals manage risk for are stronger because of their courage.
2015 Risk All Stars
Angeli Mancuso: On a Mission to Revitalize (+Responsibility Leader)
Manager, Employee Health & Safety, Cottage Health System
By getting the board of directors behind a goal to decrease patient-handling injuries, Angeli Mancuso has improved employees’ quallity of life.
Timothy Fischer: With Military Precision (+Responsibility Leader)
Tim Fischer was given nine months to address the risk implications of a sizable spin-off.
Tim Kirsch overhauled his company’s safety mission, protecting drivers on the road while slashing workers’ comp claims costs.
The urgent need for a creative solution inspired one Risk All Star to create a unique excess casualty program with benefits on several levels.
Jennifer Cable’s degree is in opera performance. She is also a risk management maestro.
Tracey Gasper: Service Centered (+Responsibility Leader)
This risk manager’s savings for her company can be measured in the millions.
Elizabeth Queen: Building a Unified Travel Program (+Responsibility Leader)
With an existing program now spread enterprise-wide, traveling employees have an improved experience, while the company enjoys lower costs and reduced risk.
One Risk All Star took on the daunting challenge of quickly relocating a sprawling headquarters, and without a single moment of down time.
David Brooks quantifies and manages risks across every industry and product offered by XL Catlin.
Brent Cooley: Shakespeare Minus the Tragedy (+Responsibility Leader)
A series of potentially high-severity events drove the push to launch a safety organization that will help keep theater students safe for years to come.
New to her position in risk management, Rytec’s Kris Finell set about correcting just about everything she could get her hands on.
Albert Fierro: The Fruits of Long, Hard Labor (+Responsibility Leader)
With decades of expertise in captive insurance, Albert Fierro was the ideal person to help AARP rein in its rising workers’ compensation costs.
Adding role playing to training efforts helped Kimpton Hotels’ risk manager teach employees how to avoid mistakes that drive up the cost of claims.
Treasury now drives risk management throughout Meritor’s business units, thanks to the efforts of Todd Chirillo.
Florida’s insurance pool members can rest easy that, thanks to Jeannie Garner’s initiative, they can bounce back in the face of severe storms.
When staff reductions and organizational change made strong leadership imperative, Amanda Lagatta rose to the challenge.
Advocacy: The Impact of Continuous Triage
In the world of workers’ compensation, timing is everything. Many studies have shown that the earlier a workplace incident or injury is acted upon, the more successful the results*. However, there is further evidence indicating there is even more of an impact seen when a claim is not only filed promptly, but also effective triage is conducted and management of the claim takes place consistently through closure.
Typically, every program incorporates a form of early intervention. But then what? While it is common knowledge that early claims reporting and medical treatment are the most critical parts of a claim, if left alone after management, an injured worker could – and often does – fall through the cracks.
All Claims Paths are Not Created Equal
Even with early intervention and the best intentions of the adjuster, things can still go wrong. What if we could follow one injury down two paths, resulting in two entirely different outcomes? This case study illustrates the difference between two claims management processes – one of proactive, continuous claims triage and one of inactivity after initial intervention – and the impact, or lack thereof, it can have on the outcome of a claim. By addressing all indicators, effective triage can drastically change the trajectory of a claim.
While working at a factory, David, a 40-year-old employee, experienced sudden shoulder pain while lifting a heavy box. He reported the incident to his supervisor, who contacted their 24/7 triage call center to report the incident. After speaking with a triage nurse, the nurse recommended he go to an occupational medicine clinic for further evaluation, based on his self-reported symptoms of significant swelling, a lack of range of motion and a pain level described as greater than “8.”
The physician diagnosed David with a shoulder sprain and prescribed two weeks of rest, ice and prescription strength ibuprofen. He restricted David from any lifting over his head.
By all accounts, early intervention was working. Utilizing 24/7 nurse triage, there was no lag time between the incident and care. David received timely medical attention and had a treatment plan in place within one day.
A critical factor in any program is a return to work date, yet David was not given a return to work date from the physician at the occupational medicine clinic; therefore, no date was entered in the system.
One small, crucial detail needs just as much attention as when an incident is initially reported. What happens the third week of a claim is just as important as what happens on the day the injury occurs. Involvement with a claim must take place through claim closure and not just at initial triage.
The Same Old Story
After three weeks of physical therapy, no further medical interventions and a lack of communication from his adjuster, David returned to his physician complaining of continued pain. The physician encouraged him to continue physical therapy to improve his mobility and added an opioid prescription to help with his pain.
At home, with no return to work in sight, David became depressed and continued to experience pain in his shoulder. He scheduled an appointment with the physician months later, stating physical therapy was not helping. Since David’s pain had not subsided, the physician ordered an MRI, which came back negative, and wrote David a prescription for medication to manage his depression. The physician referred him to an orthopedic specialist and wrote him a new prescription for additional opioids to address his pain…
Costly medical interventions continued to accrue for the employer and the surmounting risk of the claim continued to go unmanaged. His claim was much more severe than anyone knew.
What if his injury had been managed?
A Model Example
Using a claims system that incorporated a predictive modeling rules engine, the adjuster was immediately prompted to retrieve a return to work date from the physician. Therefore, David’s file was flagged and submitted for a further level of nurse triage intervention and validation. A nurse contacted the physician and verified that there was no return to work date listed on the medical file because the physician’s initial assessment restricted David to no lifting.
As a result of these triage validations, further interventions were needed and a telephonic case manager was assigned to help coordinate care and pursue a proactive return to work plan. Working with the physical therapist and treating physician resulted in a change in David’s medication and a modified physical therapy regimen.
After a few weeks, David reported an improvement in his mobility and his pain level was a “3,” thus prompting the case manager’s request for a re-evaluation. After his assessment, the physician lifted the restriction, allowing David to lift 10 pounds overhead. With this revision, David was able to return to work at modified duty right away. Within six weeks he returned to full duty.
With access to all of the David’s data and a rules engine to keep adjusters on top of the claim, the medical interventions that were needed for his recovery were validated, therefore effectively managing his recovery by continuing to triage his claim. By coordinating care plans with the physician and the physical therapist, and involving a case manager early on, the active management of David’s claim enabled him to remain engaged in his recovery. There was no lapse in communication, treatment or activity.
After 24/7 nurse triage is conducted and an injured worker receives initial care, CorVel’s claims system, CareMC, conducts continuous triage of all data points collected at claim inception and throughout the life of a claim utilizing its integrated rules engine. Predictive indicators send alerts to prompt the adjuster to take action when needed until the claim is closed – not just at the beginning of the claim.
This predictive modeling tool flags potentially complex claims with the risk for high exposure, marking claims that need intervention so that CorVel can assign appropriate resources to mitigate risk.
Claims triage is constant – that is the necessary model. Even on an adjuster’s best day, humans aren’t perfect. A rules engine helps flag things that people can miss. A combination of predictive systems and human intervention ensures claims management is never stagnant – that there is no lapse in communication, activity or treatment. With an advocacy team in the form of an adjuster empowered by a powerful rules engine and a case manager looking out for the best care, injured employees remain engaged in their recovery. By perpetuating patient advocacy, continuous triage reduces claim severity and improves claim outcomes, returning injured workers to the workforce and reducing payors’ risk.