Universal Risk Management
Risk management theory and practice fascinates — and can also appear so complex — because it resides in so many different professional realms and takes such different shapes.
Some of this year’s Risk All Stars work for widely known companies with billions in assets. Others work for a nonprofit that cobbled its solutions together with government grants.
In some examples, winners of the award were armies of one, who either through specialization or a unique perspective effected sweeping change. But creativity, passion and perseverance, the traits that we base this award on, are found in every winner.
In the person of Dr. Mike Tomecek, of the Oklahoma Spine & Brain Institute, Risk & Insurance® gives an award for the first time to a neurosurgeon; perhaps it won’t be the last.
Dr. Tomecek uses electrodiagnostic functional assessments to determine whether medical hardware removal surgery is really necessary. His specific knowledge of nerve function, coupled with technology, allows him to determine whether the movements that are actually causing pain or immobility are connected to medical hardware or are coming from some other place.
With his assessments, Dr. Tomecek acts as a patient advocate who is reducing surgeries and recommending site-specific physical therapy, a far less costly and intrusive treatment.
Risk All Stars winners Chris Chathams and Latitia Estrada are working-class heroes. These safety and human resources specialists work for the Timber Products Manufacturers Association.
The association is a trade group for smaller operators in the extremely hazardous timber industry in the Pacific Northwest. Using massive, unforgiving chain saws to bring down big trees, workers in the timber industry get hurt badly when something goes wrong.
The forestry companies that depend on the association as a safety education resource don’t have the resources to offer safety training on their own, even though such training is drastically needed.
Using grants from OSHA, Chathams and Estrada created a safety training program that in a three-year span reduced injuries for some member companies by 75 percent. That’s a lot of workers and their families suffering less trauma.
Richard Pcihoda, the director of risk management for the Pennsylvania Real Estate Investment Trust, moved with speed and effectiveness when Superstorm Sandy struck. One of PREIT’s shopping malls suffered millions in damage when the storm hit.
But Pcihoda had planned ahead, lining up a reconstruction contractor so he didn’t have to wait in line for help after the fact. Pcihoda’s planning, and his great relationships with his adjusters, resulted in the Hudson Mall reopening a mere 17 days after the storm.
Business interruption was lessened and many jobs saved as a result.
Risk management can be a thankless job. It demands hard work and attention to detail that some people would rather not think about.
But we think about it. The 2014 Risk All Stars awards are our way of saying thanks.
Complete coverage of the 2014 Risk All Stars winners begins here.
Leading From the Front
Making your fellow employees safer and creating more risk resiliency in your organization requires much more than simply doing your job.
It means doing the hard work to find a unique and practical solution, and then having the backbone and drive to implement that solution despite whatever obstacles you might face. In effect, doing the right thing over the easy thing.
These eight Responsibility Leaders do that and more. Through their drive and passion, they are the ones creating solutions that benefit not only their organizations but their employees and their communities.
Leslie Lamb works for Cisco Systems, with 75,000 employees and more than $100 billion in assets. You could count the members of her risk management team on one hand.
But Lamb’s Global Risk & Resilience Management team is bold and acts strategically. They dig deeper into the business, to take the time to meet with department heads in the effort to better understand their risks.
Lamb and her team created that most precious of dynamics. They created a dialogue among company leaders that is risk-focused. The award-winning Lamb reports that after a five-year effort, that dialogue is not only ongoing, it is expanding.
Sprague Operating Resource’s David Hershey displayed courage and dedication in standing up for his fellow risk managers. When insurance carriers decided in one fell swoop to stop notifying designated third parties that policies naming them as insureds were cancelled, he stood up to take a leading role.
In demanding that such notification be restored contractually, Hershey was insisting that insurance be what it says it is: a backstop that enables the smooth and productive flow of commerce.
“Commerce is not in business to justify the insurance industry, insurers, agents and brokers,” Hershey said, in one of the most relevant statements that may have ever appeared in this publication.
His status as a Responsibility Leader® stems from the essence of the definition of the award. He made a difference for an entire industry by leading when no one else stepped forward.
Hershey also furthers the profession of risk management by being a frequent speaker and author on risk management topics. He talks to college students about careers in risk management and teaches insurance at the Insurance Library of Boston.
Hershey and the rest of the 2014 Risk All Stars Responsibility Leaders® are not only doing what needs to be done, they are helping others to do it as well.
Here are the 2014 Risk All Stars Responsibility Leaders.
Champion for Change
Workers’ Compensation Manager Patty Hostine created dramatic gains for Cooper Standard Automotive by championing a fundamental change in the way both management and employees perceived the company’s approach to injury treatment and recovery.
That kind of transformation is never an easy sell. But Hostine’s ability to clearly communicate the benefits of the change to people at every level of the organization is the hallmark of a Responsibility Leader®.
“When she came on board we had all kinds of new management — nobody was on board with our thought process,” said Gerry King, who hired Hostine to manage workers’ compensation at Cooper Standard.
“So it was taking them and making them see the business side of workers’ compensation that a lot of people don’t look at,” King said.
Hostine is also committed the members of her team, and to making sure that everyone involved has the tools and knowledge they need to excel.
“Her ethics are above reproach,” said Mick Altherr, coordinator of health, safety and environment, and workers’ compensation at Cooper Standard Automotive, “and that drives her theme of being fair, firm and friendly. … She’s an amazing talent with her drive for knowledge. She shares her thought process to educate the people who work with her.”
Filling a Need for Safety
Saws and heavy lumber make the timber and wood products industry inherently dangerous. But many small companies lack resources to provide adequate safety training to employees.
Enter Latitia Estrada and Chris Chathams of Timber Products Manufacturers Association (TPM). The duo leveraged their nonprofit status to win government grants to create and provide training to member organizations at no cost.
The training programs, consisting of webinars, worksheets, and videos, bring awareness to the highest-risk areas of the industry, all the way from logging in the forest to working a sawmill on the factory floor.
Over the past two years, more than 80 employers and 2,200 employees in seven different states have received training.
The pair estimates they’ve saved participating companies more than $134,000 in training costs alone, not including costs saved by lowering injury rates.
One company was able to slash their injury rates by 50 percent.
Chathams and Estrada have also widened TPM’s involvement within the safety industry.
They’ve worked with different chapters of the American Society of Safety Engineers, the Northern Idaho Safety Fest and the Montana Safety Fest.
Looking to the future, they’ve also helped TPM create a safety scholarship and internship program.
Making a Difference
David Hershey is a prolific speaker and writer on risk management topics. The list of industry awards he has won and industry leadership positions he occupies runs longer than most restaurant menus.
He serves as a board member, president, vice president, and committee member — both now and in the past — for the New Hampshire chapter of the CPCU, the Massachusetts and Delaware Valley chapters of RIMS, the Philadelphia Area Risk Managers Association, the Governor’s Council on Insurance Fraud, and the Association of Certified Fraud Examiners.
He has also volunteered his creativity and passion about risk management by serving on the External Affairs Committee and Standards & Practices Committee of the national RIMS organization.
Sharing his knowledge with others, Hershey taught classes for the Insurance Society of Philadelphia and the Independent Insurance Agents & Brokers of New Hampshire.
In challenging insurance carriers to restore their obligation to inform named insureds when a policy is cancelled — and establishing a process to make sure his company was protected — Hershey made a difference to countless others in the risk management community, not just himself or his company.
“Notification is one of the core concepts of risk management,” he rightly noted.
Taking on a Mighty Challenge
You sign on to share the burden of managing risk for a high-profile $15 billion company. Months down the road, you’re bidding “Happy Retirement” to half of your team and wondering how you’re going to manage it all alone. That scenario could send a chill down the spine of any seasoned risk professional.
But Dan Holden took on the challenge, and he thrived —identifying multiple savings opportunities in the insurance and risk management programs of Daimler Trucks North America.
Holden made a critical assessment of his responsibilities. He carved out the pieces that needed his attention most, and sought alternative means to get the rest accomplished, like relying more heavily on the company’s TPA and on the company’s existing online portal.
He also skillfully leveraged his resources, tapping into the expertise of his brokers, other vendors, and former colleagues to gather the tools he needed to succeed.
Taking on the work of two men, Holden persevered by looking at the big picture and restructuring his priorities.
That freed him up get creative in making adjustments to DTNA’s insurance program, negotiating better policy terms by highlighting the impact of the economic downturn. The determination to rise above every challenge is what makes Holden a Responsibility Leader®.
Worth Her Weight in Gold
The company Leslie Lamb works for has more than 75,000 employees and $100 billion in assets.
Imagine the amount of work involved to break down department silos and gain a better understanding of risk on a department by department basis.
It can’t have been easy to go to company leadership and say that you want to conduct risk meetings with each department, to get a better understanding of not only each department’s risk but how risk straddles the entire company.
But that’s what Leslie Lamb and her risk management team of three did.
Senior leaders who didn’t before are now talking to one another about risk as a result of Lamb’s drive to unify all stakeholders.
The result is a sharing of information about exposures, risk scenarios and how best to mitigate them.
Because of Lamb’s leadership, Cisco can take to its underwriters a story that is far more educated and nuanced. Underwriters like that; they like it very much.
As a Responsibility Leader® and winner of a Risk All Stars Award, Leslie gets a plaque and mention in this magazine. But to the company that employs her, she is worth her weight in gold.
Running to the Fight
Maybe it’s his history in emergency management and current service as a volunteer firefighter that gives Richard Pcihoda the reflexes to run to the fight, because that is what he did as Superstorm Sandy threatened in October of 2012.
Pcihoda, the director of risk management for the Pennsylvania Real Estate Investment Trust, based in Philadelphia, wasn’t the only risk manager whose job got a lot tougher when Sandy hit, but it looks like he outperformed many of his contemporaries.
Not only did Pcihoda conduct the necessary planning and preparation to reduce his own company’s business interruption, he went out of his way to counsel his company’s Jersey City (N.J.) Hudson Mall tenants on coverage and recovery methods after the mall suffered millions in damage.
Pcihoda looked at the whole picture and acted on it. The day after the storm struck, Pcihoda jumped in his truck and drove to Jersey City, getting there before formal travel bans were in place to jump start the recovery process.
He had his contractors in place ahead of the storm to get a jump on reconstruction. He had the adjuster relationships to pull it together seamlessly.
Pcihoda is a Risk All Star because he possesses passion, creativity and perseverance. He’s a Responsibility Leader® because through his actions, he shows others how it’s done.
Creating His Own Solution
When the 16 institutions comprising Wisconsin Technical Colleges faced persistent problems obtaining insurance coverage suited to their unique needs, Steven Stoeger-Moore didn’t just find the solution — he created it.
Stoeger-Moore helped to establish Districts Mutual Insurance (DMI) in 2004 to represent the colleges and provide better insurance and risk management services.
Under his self-implemented “Rule of 16,” he ensures that if any school has a problem, all 16 colleges benefit from DMI’s solution. That dedication led to the development of comprehensive risk management programs — provided to each school at no cost — for electrical and fire safety inspections, emergency response planning, legal consultations, and employee health and safety consultations, among many others.
And when those programs were tested, Stoeger-Moore sprang into action. In the past 10 years, the Wisconsin Technical College System has weathered both a tornado and a major fire. Both times, he was at the scene within 24 hours of the event, providing claims and insurance guidance as well as comfort for shaken colleagues.
Stoeger-Moore has also worked to bolster the industry’s future by encouraging young people to consider a career in risk management. Through DMI, he creates opportunities for young people to learn about the colleges’ unique challenges and the programs created to meet them.
Changing the WC Medical Care Mindset
Controlling overall workers’ compensation medical costs has been an elusive target.
Yet, according to medical experts from Healthesystems, the Tampa, Fla.-based specialty provider of innovative medical cost management solutions for the workers’ compensation industry, payers today have more powerful options for both offering the highest quality medical care and controlling costs, but they must be more thoroughly and strategically executed.
Specifically as it relates to optimizing patient outcomes and controlling pharmacy costs, the key, say those experts, is to look beyond the typical clinical pharmacy history review and to incorporate a more holistic picture of the entire medical treatment plan. This means when performing clinical reviews, taking into account more comprehensive information such as lab results, physician notes and other critical medical history data which often identifies significant treatment plan concerns but frequently aren’t effectively monitored in total.
Healthesystems’ Dr. Robert Goldberg, chief medical officer, and Dr. Silvia Sacalis, vice president of clinical services, recently weighed in on how using a more holistic, comprehensive strategy can make the critical difference in the ongoing medical care cost control battle.
Fragmentation, Complexity Obscure the Patient Picture
According to Dr. Goldberg, fragmentation remains one of the biggest obstacles to controlling overall healthcare costs and ensuring the most successful treatment in workers’ compensation.
Robert Goldberg, MD, discusses obstacles to controlling overall medical costs and ensuring the best treatment in workers’ compensation.
“There are several hurdles, but they all relate to the fact that healthcare in workers’ comp is just not very well coordinated,” he said. “For the most part, there is poor communication between all parties involved, but especially between the payer and the provider. Unfortunately, it’s rare that all the stakeholders have a clear, complete picture of what’s happening with the patient.”
Dr. Goldberg explains that health care generally has become a more complex landscape, and workers’ comp adds another level of complexity. Physicians have less time to spend with patients due to work loads and other economic factors, and frequently there isn’t adequate time to develop a patient specific treatment strategy.
“Often we don’t have physicians properly incentivized to do a complete job with patients” he said, adding that extra paperwork and similar hurdles limit communication among payers, nurse case managers and other players.
In fact, Dr. Sacalis emphasized that it’s not only the payer, but often the healthcare provider who is not getting a complete picture. For example, a treating doctor may not be the primary care physician and therefore they may not have access to the total healthcare picture for the injured worker.
“Most of all, payers need to adopt a more collaborative approach in their relationships with physicians, employers and patients, as well as networks involved. It will result in getting people back to work through appropriate medical care and moving the case along to a prompt closure.”
– Robert Goldberg, MD, FACOEM, Chief Medical Officer, Healthesystems
“It’s often difficult for multiple physicians to communicate and collaborate about what’s happening because they may not be aware of each-others involvement in that patient’s care,” she said. “Data sharing is lacking, even in integrated healthcare systems where doctors are in the same group.”
Done Right, Technology Can Bridge the Treatment Strategy Gap
Dr. Sacalis explained the role technology advancements can play in creating a more holistic picture of not only an injured workers’ post-accident state or pace of recovery, but also their overall health history. However, the workers’ comp industry by and large is not there yet.
“Today’s technology can be very useful in providing transparency, but to date the data is still very fragmented,” she said. “With technology advancements, we can get a more holistic patient view. However, it is important that the data is both meaningful and actionable to promote effective clinical decision support.”
Silvia Sacalis, PharmD, explains the role that technology advancements can play in creating a more holistic picture of an injured worker’s overall health.
Healthesystems, for example, offers an advanced clinical solution that incorporates a comprehensive analysis of all relevant data sources including pharmacy, medical and lab data as part of a drug therapy analysis. So, for example, the process could uncover co-morbidities – such as diabetes – that may be unrelated to a workplace injury but should be considered in the overall treatment strategy.
“Healthcare professionals must ensure there are no interactions with any
co-morbidities that may limit or affect the treatment plan,” Dr. Sacalis said.
In the majority of cases where Healthesystems has performed advanced clinical analysis, information gathered from the various sources has uncovered critical information that significantly impacted the overall treatment recommendations. Technology and analytics enable the implementation of best practices.
She cites another example of how a physician may order a urine drug screen (UDS), yet the results indicating the presence of a non prescribed drug were not reflected in the treatment regimen as evidenced by the lack of modification in therapy.
“Visibility and transparency will help with facilitating a truly effective treatment plan,” she said, “Predictive analytics are necessary tools for proactive monitoring and detection of trends as well as early identification of cases for intervention.”
Speaking of Best Practices …
Dr. Goldberg highlighted that the most important overall best practice needed to secure the optimal outcome is centered around getting the right care to the right patient at the right time. To him, that means identifying patients who need adjustments in care and then determining medical necessity during the entire case trajectory.
“It means using evidence-based medical treatment guidelines that are coordinated,” he said.
“You must look at the whole patient, which means avoiding the typical barriers in the workers’ comp treatment system, issues such as delays in authorizations, lengthy UR processes or similar scenarios that are well intentioned but if not performed effectively they can get in the way of expedited care.”
Dr. Goldberg and Silvia Sacalis provide recommendations for critical steps payers should take to achieve the best outcomes for everyone.
Dr. Goldberg noted that seeking out the most effective doctors available in geographic locations is another critical best practice. That requires collecting data on physician performance, patient satisfaction and medical outcomes, so payers and networks can identify and incentivize them accordingly.
“This way, you are getting an alignment of incentives with all parties,” Dr. Goldberg said, adding that it also means removing outlier physicians, those whose tendencies are to over-treat, dispense drugs from their office or order unnecessary durable medical equipment, for example.
“Visibility and transparency will help with facilitating a truly effective treatment plan. Predictive analytics are necessary tools for proactive monitoring and detection of trends as well as early identification of cases for intervention.”
– Silvia Sacalis, PharmD, Vice President of Clinical Services, Healthesystems
“Most of all, payers need to adopt a more collaborative approach in their relationships with physicians, employers and patients, as well as networks involved,” he said. “It will result in getting people back to work through appropriate medical care and moving the case along to a prompt closure.”
Dr. Sacalis added that from a pharmacy perspective, another best practice is becoming more patient-centric, using a customized and flexible approach to help payers optimize outcomes for each patient.
“Focus on patient safety first, and that will naturally drive cost containment,” she said. “Focusing on cost alone can actually drive results in the wrong direction.”
Dr. Goldberg explains how consolidation in the health care and WC markets can impact the landscape and quality of care.
Dr. Goldberg and Silvia Sacalis discuss if injured workers today are getting better treatment than they were twenty years ago.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Healthesystems. The editorial staff of Risk & Insurance had no role in its preparation.