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.
To Better Control Total Workers Comp Costs, Manage Physical Medicine
Soaring drug prices get all the attention in the workers comp space. Meanwhile, another threat has flown under the radar.
More than 50 percent of lost time workers compensation claims involve physical medicine — an umbrella term encompassing physical therapy, occupational therapy, work conditioning, work hardening and functional capacity evaluation.
Spending on physical medicine accounts for 20 to 30 percent of total workers compensation medical costs, a percentage set only to increase in the coming years. Despite the rapid growth of this expense, very few employers are engaged in discussions around how best to manage it.
“Now is the time to take a look at physical medicine and think about how it impacts total cost of risk,” said Frank Radack, Vice President & Manager, Liberty Mutual Insurance, Commercial Insurance – Claims Managed Care. “Employers should investigate comprehensive solutions to keep costs manageable and to deliver quality, evidence-based care to injured employees.”
Liberty Mutual’s Frank Radack defines physical medicine and why it is so important in managing total workers compensation costs.
Upswings in both pure cost and utilization of physical medicine are driving the spending surge. State fee schedule changes are largely responsible for increases in cost. California, for example, has increased the cost of physical medicine services by 38 percent over the past two years, and will increase it a total of 64 percent by the end of 2017. North Carolina changed its approach to its fee schedule effective June 1, 2015, resulting in an almost 45 percent increase in the cost of the average physical therapy visit.
Increased utilization compounds rising prices. Low severity claims like soft tissue injuries typically involve physical therapy, especially when co-morbid conditions threaten to slow down recovery.
“When co-morbids are present, like obesity, more conditioning is necessary for recovery from injury,” Radack said. “With people staying in the workforce longer, we see these claims more often because these types of injuries and co-morbid conditions become more common as people age.”
De-emphasis on surgery also bolsters physical therapy prescribing as patients seek less invasive treatments that might enable a faster return to work, even in a light or transitional duty role. Sometimes, patients with a minor injury might seek out physical therapy on their own as a precaution after an injury or under the mistaken belief it will hasten recovery, even if evidence-based guidelines don’t call for it in every treatment plan.
“Now is the time to take a look at physical medicine and think about how it impacts total cost of risk. Employers should investigate comprehensive solutions to keep costs manageable and to deliver quality, evidence-based care to injured employees.”
–Frank Radack, Vice President & Manager, Liberty Mutual Insurance, Commercial Insurance – Claims Managed Care
“Without proper claims management procedures, some physicians might be inclined to prescribe physical therapy as a palliative measure, even when it doesn’t provide much benefit to the patient,” Radack said.
Brokers and buyers may not be able to do much about fee schedule changes, but they can partner with an insurer that better manages utilization through a multi-faceted claims system, qualified network vendors, data analytics, and peer interventions.
The keys to better managing the soaring cost of physical medicine.
“There is an opportunity to move physical medicine spending into network solutions and partnerships,” Radack said. A strong, collaborative network is key to maintaining direction over treatment decisions.
Liberty Mutual uses a proprietary data analytics program to study its providers’ prescribing and referral patterns and their outcomes. It then builds a network of point-of-entry general practitioners with a proven track record of optimal outcomes.
“The treating physician is a gatekeeper to other services, so it’s important to start there in terms of establishing a plan and making sure evidence based guidelines are followed,” Radack said.
Radack and his team use similar data analysis and partnerships to deploy networks pertaining only to physical medicine, so it can identify physical therapists who understand the occupational space and are focused on effective Return-to-Work (RTW). A provider who doesn’t understand RTW, or even know that the employer of an injured worker has a modified RTW program, may over-utilize PT. Getting employees with soft tissue injuries back into the work place is critical for delivering the best possible medical outcome and a timely recovery.
These therapists know the value of adjusting a treatment plan based on a patient’s progress, which often cuts unnecessary appointments and therapies.
“Our data analytics program is built internally by people who are aligned with the claims organization,” Radack said. “These insights drive our ability to shape networks and direct injured workers to providers with proven outcomes.”
Peer-to-peer interventions also play a big role in adjusting provider behavior and ensuring adherence to evidence-based guidelines. Liberty Mutual’s in house regional medical directors can bring their expertise to bear on challenging claims and discuss how to redirect treatment to meet these guidelines. Liberty Mutual also partners with experts to build networks of physical medicine and physical therapy providers who deliver quality outcomes cost-effectively and to asses a patient’s progress, working with providers to identify and resolve treatment issues.
Sharing information and measuring performance in these settings helps to change the environment around physical medical care. For example, interventions that steer physical therapists back to established, evidence-based medical treatment guidelines often reduce the use of passive therapy treatments, like hot and cold packs, which are not as effective and can slow down recovery.
“Active therapies that get people moving often help them get them back to work faster and at a lower cost,” Radack said. Utilization review also helps to identify unnecessary treatments and signals the insurer to communicate evidenced-based expectations with the therapist or prescribing physician.
Solutions in Action
Physical therapy offers great value in spite of rising prices — but only if it’s managed carefully.
An example of the benefits of managing physical medicine.
Take for example the case of a worker with a shoulder injury. In an unmanaged situation, a physical therapist may prescribe 12 appointments, and the injured worker will go through all 12 sessions with no pre-approval of the treatment plan and no interim checkup.
In a managed situation, the physical therapist may only prescribe eight sessions, because she understands the benefits of a faster return to work and sees that guidelines don’t dictate a full 12 sessions for this injury. Halfway through the eight sessions, she checks in on the patient’s progress and determines that only two more sessions are necessary given the recovery and the medical guidelines; and so adjusts the treatment plan to a total of six sessions.
In this scenario, managed care saves the cost of six sessions over the unmanaged situation, and the employee gets back to work faster with a healthy shoulder.
Ultimately, workers comp buyers can achieve cost savings by making treatment decisions that optimize patient outcomes, rather than cut pure cost. To achieve that, every player — point-of-entry physicians, physical therapists, medical directors, claims managers and patients — need to shoot for the common goal of shortening recovery time by following evidence-based medical guidelines.
“When medical experts and network vendors work in concert with each other, along with data analytics and research to back them up, we can drive down utilization while improving outcomes,” Radack said. “All of these working parts together are the solution to managing physical medicine costs.”
To learn more about Liberty Mutual’s Workers Compensation solutions, visit https://www.libertymutualgroup.com/business-insurance/business-insurance-coverages/workers-compensation
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.