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Founder and Chairwoman, The 60 Summits Project Inc.
President, Webility Corp.
Wayland, Mass.

Anchoring a new model in the world disability claimants actually live in.

Getting some good ideas down on paper wasn't enough for Jennifer Christian, the founder and chairwoman of The 60 Summits Project Inc., as well as president of Webility Corp.

After leading a committee that wrote a white paper for the American College of Occupational & Environmental Medicine titled "Preventing Needless Work Disability by Helping People Stay Employed," Christian wanted to create a mechanism to get the guidelines in front of as many people as possible.

And rather than just presenting the ideas, Christian wanted to bring stakeholders together and get them talking to each other. "I wanted to make a difference in the real world, not put a document on a Web site," she said.

That was the inspiration behind the 60 Summits Project, which brings stakeholders together to discuss ways they could improve the stay-at-home and return-to-work process in workers' compensation and disability benefits systems in their jurisdictions.

The 60 Summits Project is introducing a new paradigm in the U.S. and Canada to prevent needless work disability by helping people stay employed. In the traditional benefits processing model, the focus is on processing and adjudicating a person's claim for disability benefits or workers' comp accurately and then paying the benefits promptly, according to the organization's website.

In contrast, the point of the new work disability prevention model is to anticipate and assess the impact of illness or injury on the whole situation and to actively drive the real-world situation toward the best achievable overall outcome.

These summits are planned by the stakeholders themselves and give them an opportunity to meet each other. Although many of the stakeholders, such as employers, physicians, labor, insurers, case managers, occupational and physical therapists, return-to-work specialists, lawyers and managed care are involved in workers' comp and disability cases, many of them have never met each other.

At one of the summits in Montana, for instance, Christian and the head of the state's division of workers' comp were standing at the back of the room talking and Christian asked how many of the people attending the summit knew each other.

The state official responded that Montana was a small state and most people knew each other. Christian later went to the front of the room and asked how many people in the room knew each other and no hands went up.

The problem was that while this official spoke to most of the people in the room on a regular basis, most of those people had not spoken to each other.

By gaining an opportunity to speak with each other across the traditional boundaries, they have been better able to see the system's problems and start to collaborate on possible solutions.

Christian said the way the system responds to people who have been injured on the job is critical because most of these injured people are looking to the stakeholders for guidance and support. The way the stakeholders respond can make all the difference between a good outcome and a bad outcome for the injured individual and the employer.

"What we say is the purpose is to change how people think and see the situation as a precursor to later action," she said.

After the summit is over, participants are asked to come up with a concrete action plan and a personal commitment form. Consortiums and coalitions have begun to spring up after these summits so that the stakeholders in these states can continue to propagate new ways of thinking or make changes to their systems.

The response to the summits has been strong because it is not a mandatory program. People who are interested in what the white paper had to say are interested in the summit as well.

--By Patricia Vowinkel

Jennifer Christian is also cited as a Risk Responsibility Leader because of her efforts to tackle a longstanding thorny problem--the poor functioning of the stay-at-work and the return-to-work process. With her "60 Summits Project" she has crossed traditional boundaries between professions and different sectors of society.

This effort is especially important because it bridges corporate silos that exist among organizations, professions and employees that have made it difficult for all parts of the workplace to reach a common goal--the return of healthy, functioning workers to their jobs.

By holding these 60 Summits throughout North America, Christian, who is also president of Webility Corp., has, almost single-handedly, started the process, person by person, of changing the nature of the workplace to benefit both workers and employers.

Corporate Vice President--Risk Services
SSM Health Care
St. Louis, Mo.

SSM Health Care's approach helped promote patient safety by encouraging communication and allowing for the identification of risks and safety hazards.

As corporate vice president of risk management of SSM Health Care, one of the largest Catholic integrated health care delivery systems in the country, Josephine Goode Evans has been working to improve patient safety and open communication by implementing the Just Culture program.

This program, which was developed by David Marx, has now become mandatory in Pennsylvania, North Carolina, Oregon and Missouri.

SSM Health Care, which includes 20 acute care hospitals and two nursing homes in four states including Illinois, Missouri, Wisconsin and Oklahoma, was the first health care system in Missouri to implement the Just Culture program, said Bonnie Boone, a broker at Alliant Healthcare Solutions who works with Evans and nominated her as a Risk Innovator.

"I look at a lot of accounts and clients and you'd be surprised those who talk about quality and don't have patient safety programs," Boone said.

The Just Culture program helps to promote patient safety by encouraging communication and allowing for the identification of risks and safety hazards. Healthcare is largely dependent on self-identification and reporting of errors and unsafe situations in patient care. Self-reporting depends on the willing participation of the workforce to report.

To get the Just Culture program up and running, Evans developed a three-year plan to educate managers, physicians, and staff at SSM Health Care. Evans's goal is to educate 2000 employees by the end of the year.

This process will assist physicians in peer review. Total implementation time is three years to reach a stage where accountability, quality and mentoring are the norm for a healthcare system.

But implementing the Just Culture program alone wasn't enough. Evans wanted to find a way to have some checks and balances as well. She worked with Marx and developed a customized process of checks and balances after the program was implemented.

In addition to the Just Culture initiative, Evans also has been working to protect her employer from cyber liability.

SSM is also the first healthcare provider with a captive insurance program that includes cyber liability coverage to the full extent possible, Boone said.

Based in St. Louis, Mo, SSM Health Care, has about 24,000 employees and is sponsored by Franciscan Sisters of Mary. In 2002, it became the first healthcare recipient of the Malcolm Baldridge National Quality Award, the nation's highest award for quality.

--By Patricia Vowinkel

Editor's note: In the original article, insurance broker Bonnie Boone was misquoted. We have removed her comment and regret and apologize for the error.

Administrator, Hospitals Self-Insurance Fund of Missouri (HSIFM)
President, Gallagher Healthcare Insurance Services of Kansas City
Kansas City, Mo.

The innovative Caregiver Safety Accreditation cuts the costs incurred by a hospital consortium.

As administrator of the Hospitals Self-Insurance Fund of Missouri, Chris Miller had a problem.

The HSIFM is a consortium of 15 healthcare institutions that self-insure their workers' compensation coverage through a self-insurance trust and the group's loss histories were not good.

Over a period of about four years, Chris and the trust members had watched their benchmarks average 115 percent of benchmark performance and large financial loses were incurred.

The consortium's loss control representatives had been visiting each of the group's 14 hospitals and they had all the right policies and procedures in place. They seemed to be doing everything right. It was just one of those things.

After hearing that explanation about 10 times, Miller began to wonder.

He brought together the hospitals' chief financial officers, human resource directors, risk managers, claims people and safety directors--anyone who had any connection with the loss control problem--and ran a focus group.

In the focus group, they reviewed the claims reports and something wasn't adding up. In the reports, the individuals claimed they had followed all policies and procedures--but even so, the claim still happened. Something somewhere was going wrong.

"What we learned was phenomenal and revealing," Miller says.

The answer? The hospitals' staff was lying to their consortium's loss control representatives. "But we're self-insured, so why lie?" Miller remembers asking.

In some cases it was because the loss control representative was viewed as an "insurance person" or an "outsider" and they didn't want to admit to the individual that they hadn't followed procedures.

In other cases, managers were afraid of disciplining employees, especially their nurses, who are in short supply. They would rather lie than risk upsetting or offending nurses by correcting them even if it was for their own good--to help them avoid an injury.

The solution was a Caregiver Safety Accreditation initiative that Miller developed and began to implement in late 2004, early 2005. The CSA calls for the hospitals to hold one another accountable, for their own collective good. It led to a reduction in the member hospital's benchmark from 115 percent of benchmark performance to 64 percent--a 51-point reduction. Large losses have become large profits and employee injuries have been significantly reduced.

There are now a total of about 25 hospitals from around the country participating in the Caregiver Safety Accreditation initiative, which calls for hospitals to audit each other for workplace safety.

Because there was concern about competing hospitals auditing one another, they made sure to make the process as fair as possible to all the participants. The hospital staff found that they were more honest with one another than they had been with the loss control representative.

The culture also began to change when management began to take more initiative about holding staff accountable.

Miller tells the story of a hospital administrator who was walking past a patient's room where a petite nurse was trying to move an obese patient. He walked in and told the nurse "You're not doing yourself any favors, you're not doing the patient any favors and you're not doing the hospital any favors by doing this alone. Get somebody to help you."

The annual audit, however, is a rigorous process and Miller says he has never seen a hospital get qualified in less than six months and 80 percent of facilities flunk the first time through.

"It's a wake-up call," Miller says.

The audits cover everything from pre-employment and hiring issues to some of the biggest workers comp exposures such as lifting patients and patient transfers as well as slips and falls.

What the audits have found is that most hospitals have the necessary equipment and the staff knows what to do, but they don't do it and the procedures are not enforced.

Most hospitals for instance have gait belts to help nurses while walking with a patient who is at risk of falling. The gait belt goes around the patient and gives the caregiver something to hold onto when walking with a patient. The belt helps the caregiver avoid injury.

Although most hospitals have the equipment, they are usually stuffed in a drawer gathering dust.

After beginning the initiative about three years ago, "we saw claims plummet," Miller says. "Every year we see more and more improvement in claims activity," Miller says.

Successful completion of one of these audits gives a hospital some important bragging rights. "When they pass, we put out a press release and we make a big issue of it internally," Miller says.

In addition to the audits, the initiative also calls for changing the culture in the workplace by emphasizing the importance of safety for the caregivers.

Putting the safety of the caregiver first can be a new and difficult concept for healthcare institutions where they pride themselves on putting the patient first.

But as Miller says, "if you don't protect the caregiver, then there's no one around to care for the patients."

--By Patricia Vowinkel

Former Risk Manager
Indiana Blood Center
Indianapolis

A risk manager's fingerprint identity solution for an Indiana blood bank.

When the Indiana Blood Center decided to convert its donor database software to a new system, Jeff Davies, the Blood Center's former risk manager, recognized that his employer had a potential liability risk on its hands.

On its database, the Blood Center had been storing the Social Security numbers of its donors as well as other personal information. That confidential information represented a risk for the Blood Center. Davies knew that in the event of a data security breach, the Blood Center could be held liable and face significant losses.

In making the conversion to the new system, Davies realized it would be better for the Blood Center to stop collecting donor Social Security numbers.

The FDA, however, requires blood centers to positively identify each of its donors and one of the prime ways of doing this was through the use of the donor's Social Security number. The Social Security number also was used to prevent donors from being in the Blood Center's system under several names such as Bob and Robert.

Davies came up with an elegant and revolutionary solution that eliminated the risk associated with storing donor Social Security numbers on his employer's database.

To positively identify donors, instead of using Social Security numbers, Davies proposed the idea of using fingerprint scans. Donors simply place each of their index fingers on a low-cost sensor that is connected to a Web browser and they are positively identified out of the over 500,000 donors the Blood Center has on record.

Software developed by BIO-key International uses that fingerprint data to develop a unique mathematical template, something like a bar code.

"This lets them stop storing Social Security numbers, which is a liability risk," said Jim Sullivan, director of sales at Wall, N.J.-based BIO-Key. "This is a great solution to a big problem. It was the first time it was done in a blood center," he said.

The fingerprint is a unique identifier and cannot be lost or forgotten like donor ID cards, which have been used by some blood centers. Replacing lost donor ID cards can be costly and donor ID cards are not foolproof.

For donors, meanwhile, the fingerprint scan eliminates the hassle of having to carry around another card in order to be able to donate blood.

Sullivan said that the Red Cross is now interested in using this technology to identify donors and several other blood centers are also considering the idea. The idea of identifying people with fingerprint scans makes a lot of sense for other businesses as well, such as banks and insurance companies.

One reason blood centers and other organizations had not adopted this technology sooner was because of perceptions that the technology was not reliable.

But Sullivan said there have been big improvements in the technology over the last few years and also points out that the software provided by his company is far more advanced than the software that is more widely distributed to general public.

It also helps that the BIO-key software is compatible with a number of different fingerprint scanners or readers, Sullivan said. Those readers are relatively cheap and many computers are now coming with them already installed by the manufacturer as part of the package.

"Some people don't believe in the technology, but they've refined it over the years," Davies said.

The Blood Center's ability to attract donors depended on finding a way to positively identify donors while protecting their confidential information. Donor confidence in the security of their information was crucial.

By investing in the technology of finger scanning, the Indiana Blood Center went above and beyond what any other center has done in this important area.

--By Patricia Vowinkel

Chairman and CEO
VIIAD
Langhorne, Pa.

President
VIIAD
Langhorne, Pa.

Chief Operating Officer
VIIAD
Langhorne, Pa.

Injecting some competition into the health insurance marketplace and simplifying transactions.

If you think it's a hassle trying to figure out what's covered under your health insurance plan, you're not alone.

John Zubak, Harvey Mitgang and April Stiles, the founders of VIIAD, thought there had to be a better way--a way to simplify the health insurance transaction between the consumer, the doctor, the health insurer, and even the consumer's employer.

They came up with two patented products--the Health Ticket and the vNetwork. First the Health Ticket. The ticket is like a health insurance ID card "on steroids," as Stiles, the chief operating officer at VIIAD, put it.

Instead of the traditional plastic ID card that you keep in your wallet, the ticket is more like an airline eticket. You go online to your health insurance provider and print out your ID card online. Or you can call your health insurer's toll free number and it can be sent directly to your health care provider's office.

While accessing your health insurance ID card online or by calling your health insurer is not revolutionary, what is new is that when you print out y our health ticket, it includes detailed information about your health insurance plan in the white space below the image of the ID card.

When you print out the health ticket, the top segment of the paper will be the image of your health insurance ID card. Below that image will be plan information such as copays, and details about your dental benefits, emergency room coverage, physical rehabilitation, gynecological exams, prostate cancer screenings, and well-child immunizations and more. It can even provide up-to-date information about your deductibles and health savings accounts balances, if you have one.

All that information is right there on a sheet of paper, rather than buried in a health plan information book gathering dust in a filing cabinet. When going to the doctor, you present the health ticket and both you and your doctor know upfront what's covered, what the copays are and any other billing instructions.

This reduces calls to the health insurer for that information and eliminates confusion and frustration about what is and is not covered. For the health insurer, it's a huge savings in time spent fielding calls from consumers and doctors. For doctors and consumers, it helps by making it easier to know what's covered.

In addition to the health ticket, VIIAD has come up with a similar idea for workers' compensation coverage. Employees who are injured on the job are not covered by their usual health insurer but by the employer's workers' comp insurer.

Under the current system, workers' comp insurers do not issue special ID cards. But VIIAD is offering a workers' comp ticket health ticket to make it easier for injured workers, their employers, healthcare professionals and the workers' comp insurer to know what's provided under the company's plan.

Now for the vNetwork. Under the vNetwork, VIIAD has quilted together a network of more than 80 regional and local healthcare preferred provider organizations (PPOs) and more than 30 workers' comp PPOs, offering consumers nationwide coverage, which makes them a much more attractive option for employers and their employees.

These regional and local PPOs offer substantial discounts to employers and insurance carriers. Employers that self insure save a significant amount of money through the managed care discounts realized by the vNetwork.

Many of these PPOs are hospital- or physician-owned and provide top-notch healthcare services. But the key disadvantage has been that because they are regional, the employees--the healthcare consumers--can find themselves stuck without a participating provider if they are away from home, outside their PPOs' regional reach.

By bringing the regional PPOs together into the vNetwork, those PPOs gain a nationwide reach and consumers do not have to worry about being unable to find a participating provider if they are traveling or on vacation.

This is good for the regional PPOs and the providers who participate in them because they should see an increase in business as they become more competitive with other nationwide health insurance plans.

Another advantage for providers is that as members of the PPO, they know upfront how much insurers will reimburse them for their services, whereas with other plans, they often have no easy way of knowing what the contracted rate with the insurer will be. For employers, it makes the regional PPOs a more viable alternative for their employees, while increasing the employer's bottomline in the significant savings realized on their medical bills.

VIIAD, in a relatively short time, has had a significant impact on the healthcare industry. School districts, for instance, have been able to maintain benefit levels for teachers that probably would not have been possible without VIIAD.

VIIAD has leveled the playing field and has brought competition to the health insurance marketplace while making the transaction simpler and more affordable for everyone.

--By Patricia Vowinkel