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.
Achievement Marches Forward
The guiding philosophy of the Red River Army Depot team is that soldiers’ lives depend on the quality of their work, and workers’ lives depend on how safely they achieve that quality.
Red River Army Depot, recipient of the Teddy Award in 2007 and again in 2012 in the federal category, continues its outstanding efforts in minimizing workplace injuries and emphasizing safety – both on and off the job.
Red River, which employs more than 5,400 workers, including more than 2,500 civilians, is a military installation in Texarkana, Texas that repairs and rebuilds tactical combat vehicles and equipment. Due to the success of its workers’ compensation and safety programs, the depot since 2007 has consecutively achieved the lowest lost-time rate within the Army’s major industrial installations.
In 2007, the depot established “Role Model” standard operating procedures that streamline the entire workers’ compensation process, resulting in a significantly faster return to work. To date, RRAD continues to achieve decreases in costs and lost-time days, as well as number of claims filed.
Since the implementation of the procedures in 2007, the depot has returned 68 injured employees to work, with a cost avoidance of more than $55 million, decreased lost-time cases by 68 percent, decreased lost-time case rate by 47 percent, decreased the number of lost-time days by 90 percent, decreased the number of claims filed by 55 percent and decreased claims costs by $1 million.
A Model for Others
Moreover, Red River is recognized throughout the Army for having established the “prototype” processes and procedures that have facilitated the success of its return-to-work program. The depot has shared best practices throughout the Army, and continues to mentor several other installations including Anniston Army Depot; Pine Bluff Arsenal; McAlester Army Depot, Memphis, Ft. Polk, Ft. Hood and others.
“The key to success is great communication. We care about the workforce and are diligent in those activities — not only when an employee gets hurt, but we’re also trying to prevent accidents in the first place.” — Brent Jones, safety officer, Red River Army Depot
Ann Harmon, injury compensation program administrator, said she particularly loves the fact that the depot has implemented an accident review board, in which injured workers and their supervisors can communicate their opinions on how the team can better the process.
“To me, it really gets the buy-in of employees and makes them feel like they are an integral part of the depot,” Harmon said. “Our number one priority is making each one of our injured workers feel special, getting them recovered and back to employment.”
The accident review board, chaired by the depot’s commander, reviews accidents to learn what employees think needs to be done to prevent such accidents from occurring in the future, and enhances management’s ability to make sure corrective actions have taken place or are in the process of taking place, said Brent Jones, safety officer.
In the discussions, employees, management and union representatives are all “sitting across the table, eye to eye, no one looking down their nose at anyone else,” Jones said. “It’s truly an open forum for sharing information.”
“The key to success is great communication,” he said. “We care about the workforce and are diligent in those activities — not only when an employee gets hurt, but we’re also trying to prevent accidents in the first place.”
Red River has also received numerous awards from the Army, including an “all GREEN” audit rating in 2012 by an Army Materiel Command (AMC) inspectors’ general team, and recognition for having the best workers’ comp program within the AMC, based on program effectiveness, proactive case management, and creation of new and improved processes using the principles of Lean Six Sigma. In March, Red River invited OSHA to audit its safety program, which resulted in OSHA recommending the installation for the agency’s Voluntary Protection Program Star status, recognizing the depot for maintaining injury and illness rates below the national average for similar installations.
A great deal of the success of Red River’s workers’ comp and safety programs can be attributed to Harmon, said chief of staff Theresa Weaver. Harmon works “so diligently” to coordinate with the depot’s safety officer, director of emergency services, the hygiene offices and legal offices, to quickly identify and resolve any workers’ comp claim disputes.
The team also keeps communication with the local medical community “fresh,” by making sure that new physicians and staff who come to the area know of the depot’s workers’ comp and safety programs, and that the team is willing to accommodate any type of injury and work situation, Weaver said.
“Lastly, we care about our employees’ safety after they leave work,” she said. “One of our employees recently had a terrible car accident, and we just want our employees to take safety very seriously, so they don’t have to pay the ultimate price.”
Managing Construction’s True Risk Exposure
When it comes to the construction industry, the path to success is never easy.
After a long, deep recession of historic proportions, the sector is finally on the mend. But as opportunities to win new projects grow, experience shows that more contractors go out of business during a recovery than during a recession.
Skilled labor shortages, legal rulings in various states that push construction defects onto general liability policies, and New York state’s labor laws that assign full liability to project owners and contractors for falls from elevations that injure workers are just some of the established issues that are making it ever harder for firms to succeed.
And now, there are new emerging risks, such as the potential for more expensive capital, should the Federal Reserve increase its rates. This would tighten already stressed margins, perhaps making it harder for contractors and project owners to invest in safety and quality assurance, and raising the cost of treating injured workers.
Liberty Mutual’s Doug Cauti reviews the top three risks facing contractors and project owners.
“Our customers are very clear about the challenges they are facing in the market,” said Doug Cauti, the Boston-based chief underwriting officer for Liberty Mutual’s construction practice.
“Now more than ever, construction risk buyers – and the brokers who serve them – are leveraging our team’s deep expertise to find solutions for complicated risks. This goes way beyond what many consider the traditional role of an insurance carrier.”
Other leading risks facing contractors and project owners.
Given the current risk environment, firms that simply seek out the cheapest coverage could leave themselves exposed to these emerging risks. And that could result in them becoming just another failed statistic.
So what is the best way to approach your risk management program?
Understanding the Emerging Picture
Construction firms have been dealing with multiple challenges over the last several years. Now, several new emerging risks could further complicate the business.
After an extended period of historically low interest rates, the Federal Reserve is indicating that rates could rise in late 2015 or sometime in 2016. That would surely impact construction firms’ cost of capital.
“At the end of the day, an increased cost of capital is going to impact many construction firm’s margins, which are already thin,” Cauti said.
“The trickle-down effect is that less money may be available for other operational activities, including safety and quality programs. Firms may need to underbid and/or place low bids just to get jobs and keep the cash flow going,” Cauti said.
“Now more than ever, construction risk buyers – and the brokers who serve them – are leveraging our team’s deep expertise to find solutions for complicated risks.”
— Doug Cauti, Chief Underwriting Officer, Liberty Mutual National Insurance Specialty Construction
“Experience shows us that shortcuts in safety and quality often lead to more construction defect claims, general liability claims and workers’ compensation claims,” Cauti said.
Currently, the frequency of worker injuries is down on a national basis but the severity of injuries is on the rise. If those frequencies start creeping up due to less robust safety programs, the costs could grow fast.
And if this possible trend is not cause enough for concern, the growing costs associated with medical care should have the attention of all risk managers.
“Five years ago medical costs represented 56 percent of a claim,” said Jack Probolus, a Boston-based manager of construction risk financing programs for Liberty Mutual.
“By 2020, that medical cost will likely grow to 76 percent of an injured worker’s claim, according to industry experts,” Probolus said.
Rising interest rates and rising medical costs could form a perfect storm.
Focusing on the Total Cost of Risk
For risk managers, the approach they utilize to mitigate the myriad of existing and emerging risks is more important than ever. The ideal insurance partner will be one that can integrate claims management, quality assurance and loss control solutions to better manage the total cost of construction risk, and do it for the long term.
Liberty Mutual’s Doug Cauti reviews the partnership between buyers, brokers and insureds that helps better manage the total cost of insurance.
In the case of rising medical costs, that means using claims management tools and workflows that help eliminate the runaway expense of things such as duplicate billings, inappropriate prescriptions for powerful painkillers, and over-utilization of costly medical procedures.
“We’re committed to making sure that the client isn’t burdened in unnecessary costs, while working to ensure that injured employees return to productive lives in the best possible health,” Probolus said.
The right partner will also have the construction industry expertise and the willingness to work with a project owner or contractor from the very beginning of a project. That enables them to analyze risk on the front end and devise the best risk management program for the project or contractor, thereby protecting the policyholder’s vulnerable margins.
“We want to be there from the very beginning,” Liberty Mutual’s Cauti said.
“This isn’t merely a transaction with us,” he added. “It’s a partnership that extends for years, from binding coverage, through the life of the project and deeper as claims come in and are resolved over time,” he said.
In other words, it’s a relationship focused on value.
Today’s construction insurance market – with an abundance of capacity – can lead to new carriers entering the market and/or insurers seeking to gain market share by underpricing policies.
“We see it all the time,” Liberty Mutual’s Cauti said.
Where does this leave insureds? Frustrated at pricing instability, or by the need to find a new carrier. And wiser, having learned the wisdom of focusing on value, that is the ability to better control the total cost of risk.
“Premium is always important,” notes Liberty Mutual’s Cauti. “But smart buyers also understand the importance of value, the ability of an insurer to partner with a buyer and their broker to develop a custom blend of coverages and services that better protect a project’s or contractor’s bottom line and reputation. This is the approach our dedicated construction practice takes.
Why Liberty Mutual?
For more information on how Liberty Mutual Insurance can help assess your construction risk exposure, contact your broker or Doug Cauti at [email protected].
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Liberty Mutual Insurance. The editorial staff of Risk & Insurance had no role in its preparation.