A Paramount Parable
Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.
Home for the Holidays
Neal Chambers surveyed the holiday turkeys on display at his local grocer on Nov. 23 and mused. Fresh or frozen? Tom or hen? Free range or kosher? Locally produced or from the foothills of the Smoky or the Sierra Mountains?
Chambers threw thrift to the wind and plunked down $52 for a 16-pound organic bird from Upstate New York.
What the heck? After four brutally slow years, the construction company he managed risk for was showing signs of reemergence.
True, the company’s estimators were not happy. Where once they needed to bid 10 jobs to land one, each job now took 30 or 40 bids to land.
Neal’s company, Paramount Construction Co., based in Des Moines, Iowa, worked with larger companies historically.
But in order to land projects, it was now moving down to the middle market and competing against smaller regional operators with local expertise. This was not an easy road to hoe.
But Paramount was doing what it felt it needed to do to compete successfully.
At the office holiday party on Dec. 19, held at the River Bluff Country Club, Neal could see signs that the C-suites were feeling a little better about things. Nice carving station, good wine in the glasses and some generous door prizes. He took in a deep breath and let it out.
Things had been tough for a while. He’d been working hard. He’d been worried.
“Go ahead, have a drink,” he told himself. “It’s free and now is as good a time as any.”
Neal had one glass of wine in him and was waiting his turn to fill his plate at the sushi appetizer table when he saw one of the vice presidents, Tom Murphy, lift his phone to his ear.
As he listened to the caller, Murphy turned and looked at Neal. With his other hand, he gestured to Neal to join him. Murphy’s hand was free because he did not drink at company functions … ever.
“It’s Constantine,” Murphy said in a whisper when Neal got closer. “Something’s up. He tried to reach you but…”
Murphy shrugged non-judgmentally.
Constantine, head of operations. Good guy. No nonsense.
“This is Neal Chambers,” Neal said into Murphy’s phone.
“Neal, it’s Jonny Constantine. We’ve got a bit of a situation.”
“Shoot,” Neal said.
Constantine exhaled audibly into the phone. Neal could tell that Constantine was a little upset.
Neal shot a look of worry at Murphy.
“Look, we just had an accident with an excavator operator on the site here in Mille Lacs. We’ve got one seriously injured employee and some structural damage to a neighboring building.”
“How bad is the injury?” Neal said.
“It’s not pretty. I think this poor kid is going to lose his left leg below the knee,” Constantine said.
“And the building?”
“Well. The wall on the demo wasn’t supported right and the operator knocked it into this neighboring wall. It was a pretty big bump.”
Neal hung up with Constantine and gave Murphy his phone back.
As he turned his own phone on to check messages, Neal Chambers felt any holiday warmth drain out of him. The wine that had been so enjoyable 20 minutes ago now struck him like a cheap depressant.
2014 was supposed to be Paramount’s breakout year. But now Chambers had a significant workers’ compensation and general liability claim to worry about.
Looking around the brightly lit room at his fellow employees, Neal Chambers had an uneasy feeling that 2014 wasn’t going to be that great after all.
No Bench Strength
What worried Neal Chambers were the personnel cuts Paramount undertook to survive during the brutal commercial construction downturn that seized the country during the Great Recession.
The most worrisome cuts came in the area of safety, where some highly paid talent had been laid off. But there were also cuts in estimating, where other senior personnel with beefier paychecks left the company.
You couldn’t put the cart before the horse. Although things were turning around, Paramount was not yet at a place where it could hire big ticket talent to fill the gaps. Not yet.
Yet the company was trying to grow again and take on more projects. The combination worried Neal Chambers.
The accident with the excavator in Mille Lacs wasn’t catastrophic. But it was the beginning of a series of workplace accidents that plagued the company through the first six months of 2014.
Neal’s conversations with finance added to his anxiety.
“We’re just not making the money on these projects I thought we were going to be,” said Tom Murphy’s elder brother Pat Murphy, the company CFO.
Bidding for projects in unfamiliar territories and on unfamiliar scales, Paramount’s overworked estimators were missing the mark time and again.
The combination of an increased injury frequency rate and thinner margins was not making a good impression on Paramount’s surety and insurance underwriters.
Both Pat and Neal feared that year-end premium increases could be in the works.
Paramount’s revenue shortfalls created friction with subcontractors.
Jonny Constantine got into several heated arguments with subcontractors, alleging that they were botching projects by not moving more efficiently.
There were now a handful of legal proceedings underway. In those cases, Paramount was alleging that subcontractors violated the terms of their contracts by not completing the work in time, or completing it in substandard fashion.
Win or lose, those lawsuits meant one thing to Neal Chambers and Pat Murphy. They meant more costs, more margin erosion.
“We’re in a tight spot,” Neal Chambers said.
“I know we are,” Pat said, somewhat impatiently.
“The thing is, I don’t know what we can do between now and 2015 renewals to make a better impression,” Neal said.
“It’s almost like a roll of the dice,” he added. “I don’t know what else we can get out of the safety department in terms of management.”
“We need better talent and more of it,” Pat said.
The question was where.
A Horse With No Name
The answer to Neal’s question, as it turned out, was “nowhere.”
The talent crunch that Paramount was experiencing, and which was causing it so much pain, was not isolated to Paramount. But some of its competitors moved more quickly than Paramount in acquiring and retaining the talent to help them take full advantage of the upturn.
Others moved even less effectively than Paramount. But in a competitive economy, being in the middle was no place to be.
As 2014 moved from the second quarter to the third and fourth, adding to Paramount’s workers’ compensation woes and its sinking profit margins came yet another issue.
That issue was increasing commodities prices. Paramount’s overworked estimators, working in the unfamiliar middle market, failed to take into account a gradual increase in the cost of steel, copper wiring and other key construction materials.
There simply was no place to turn to hire the sort of experience in safety or in estimating that could put Paramount back on track.
As Paramount’s executives looked forward to their year-end renewals for their insurance programs, the company was looking at unpalatable premium increases.
“You’re looking at a 30 percent mark-up with your workers’ compensation premiums and at least a 25 percent increase in the amount of collateral you’re going to have to put up in workers’ compensation and in surety,” said the company’s broker, Ed Scarborough. “You’re also looking at an increase in your general liability.”
The construction market continued to recover. But Paramount now needed to play defense.
Faced with insurance and surety increases and declining margins, Paramount had no choice but to do what it didn’t want to do. Already bereft and hamstrung due to a lack of talent, Paramount undertook more layoffs.
One of the first to go was Neal Chambers.
In November of 2014, Neal Chambers and his daughter Annabelle went shopping for a turkey. Annabelle was fourteen and well versed in sustainable agriculture practices at school.
“We’re getting an organic turkey, right?” she asked her father.
“No, Annabelle, I’m afraid not,” Neal said.
Neal reached into the meat freezer and pulled out a frozen Honeybreast turkey and threw it into his shopping cart with a disheartening “clang.”
Risk & Insurance partnered with Liberty Mutual Insurance to produce this scenario. Below are Liberty Mutual Insurance’s recommendations on how to prevent the losses presented in the scenario. These lessons learned are not the editorial opinion of Risk & Insurance.
1. Value is replacing price: It’s no longer enough to be the lowest bidder. Contractors must now prove to clients that they have the capacity to deliver a project that is the most cost-effective in the long term. That means not only delivering a quality product, but having the risk management program and coverage in place to mitigate potential finger pointing and costly litigation down the road.
2. Keep an eye on commodities: Nowhere are the realities of the global economy more evident than in the area of commodities. Demand cycles for copper, steel, coal and other materials in developing or maturing economies are going to have an impact on prices here at home. Models that take into account commodities fluctuations will be increasingly important. In addition, any new rating programs based on Construction Value should be carefully evaluated compared to a payroll based program.
3. Talent rules: Qualified estimators and safety officers left the construction industry in droves during the downturn. Making sure the talent is in place to take advantage of the upturn in the rebounding commercial construction business is an important consideration. Don’t overlook the added value of a well-documented quality assurance program.
4. Understand new geographies: Competing in this new market may mean having to enter new geographic areas to find business. Trying to compete in New York state without understanding its Byzantine labor laws would be a mistake. So would entering into any new geography without an understanding of local regulations and how they could impact costs. Conversely, demonstrating local experience to a client would be a key selling point here.
5. Delivery methods matter: New markets mean new delivery methods. Whether it is design-build, identifying a construction manager at risk, or the complexities of public-private or international partnerships, insurance and risk mitigation are going to have to be adequate to cover these trending delivery methods. Effective communication amongst all parties including contractual relationships continues to be a vital aspect of any project.
A Dim View
Disclaimer: The events depicted in this scenario are fictitious. Any similarity to any corporation or person, living or dead, is merely coincidental.
All’s Well That Begins Well?
Darryl Korn shook off his loafers and propped his bare feet next to an errant branch of rosemary on the stone wall that separated his patio from the long slope down to the Missouri River. As the light faded, he sipped the Provencal rosé in his glass and let the fruity dryness of the wine pucker his mouth into a happy grimace.
Korn, the CEO of Heaven’s Gardens, a Midwestern retailer based in Jefferson City, Mo., specializing in high-end patio and lawn furniture and accessories, was literally in his element.
A wood fire burned not far away in one of his company’s stone pizza ovens. Just a few minutes now and the flatbread he’d made with his own hands would be in there bubbling.
With his wife and children in town seeing a movie, this was one of those moments he wished he could capture; peace of mind, how rare it was.
It was the sight of the dying light on the river that got him thinking about work again. River: flood risk.
Korn’s workday included a review of his company’s risk management program with his risk committee. Most CEOs wouldn’t sit in on such meetings, but Korn did.
Korn felt great about the meeting. He reflected on how the company documented and ranked all property risks, flood, named storm, earthquake and tornado on a matrix broken down by zip code.
The company also worked with its carrier on an engineering risk assessment that provided the carrier with crucial information such as the age of the buildings and the construction materials they were composed of.
With operations bordered by Idaho, Utah and Arizona to the West and Tennessee, Kentucky and Ohio to the East, the company was particularly keen on showing underwriters its crisis management and business continuity muscle in the wake of a tornado, flood or earthquake.
Transparency and good data, that was the way to good coverage at the best price, Korn told himself, secure that he had mastered risk management wisdom that people at the C-suite level, even in mid-2015, didn’t usually concern themselves with.
Equally satisfying to Korn was the risk committee’s report on the company’s financial and operational resilience risk management strategy. From interest rate swaps to alternate energy suppliers in the face of catastrophe, it was all there.
The underwriter for Heaven’s Gardens, Hammond Kresley of regional insurer Butte Mutual, was enjoying a similarly peaceful sunset from his deck across the river. Although, being an underwriter, Kresley had a single malt in his hand.
Butte Mutual’s property portfolio, which roughly mirrored Heaven’s Garden’s geographic focus, was also broken down and ranked by zip code and degree of risk. Just as it did with Heaven’s Garden, Butte Mutual worked with many of its property insureds to provide risk engineering services that provided a deeper dive in the underwriter’s quest for transparency and good data.
Butte Mutual’s confidence in the diversity of its book of business and its approach to risk engineering was such that it had aggressively sought out new property business in this rate-challenged environment.
The company considered its approach to data, engineering and underwriting a differentiator, something that allowed it to take on business that its competitors wouldn’t dare to.
Darryl Korn was setting down his glass of rosé to slide the pizza in the oven when it hit. As his wine glass fell and shattered and the plate glass windows on the back of his house cracked, Korn initially thought the region was being bombed. It took seconds until he realized that for the first time in his life, he was experiencing an earthquake.
The earthquake was a 6.9 on the Richter scale on the New Madrid Fault, severely damaging numerous regional companies.
Scrambling for Information
Thankfully, Korn and his family escaped injury in the rare Missouri quake, but his company didn’t.
Yes, everyone knew about the New Madrid Fault. But no one thought it would rupture, or at least not at this intensity.
One of the cruelest twists for Heaven’s Gardens was that the facility which housed its servers– which the company boasted to underwriters was well out of reach of a flooding Missouri River or any of its tributaries– was badly damaged in the quake.
Store managers and operations staff accustomed to digital communication with headquarters were knocked off line and were slow to get important information to headquarters.
Thus, exquisitely bad data clouded company leadership’s perspective for the first few days after the quake.
“I don’t think we lost a single major supplier, “the company’s logistics chief, Raif Heck, told Korn and other leadership the day after the quake.
But due to poor communications, the company learned two days later that Heck was wrong.
Two of the metal fabricating companies that supplied Heaven’s Gardens with its grills and additional oven hardware were severely damaged. Ten Heaven’s Gardens stores in Missouri and Illinois were also hit hard.
Two of the damaged stores were in St. Louis, which meant the loss of key sales producers.
After suffering a delay due to bad information, the company scrambled to identify alternate hardware suppliers, but the process dragged on and on. Even undamaged stores suffered delays in reopening due to overwhelmed municipal inspectors being unable to visit properties quickly enough to issue certificates of occupancy.
The inspection delays got so bad that Korn himself got on the phone with the deputy mayor of St. Louis.
“There’s not a single crack in those structures,” Korn said, in one of several instances where he completely lost patience with the chaos all around him.
“No way can we issue certificates of occupancy until we get those properties inspected and we are still days away from that,” the deputy mayor replied.
“Days?” Korn exclaimed.
“Days.” said Hammond Kresley, in a meeting with the Butte Mutual reserving oversight committee (ROC), as it tried to get a handle on what sort of reserves it was going to need to set aside to cover insured quake losses and business interruption losses.
That screeching sound they all heard was Butte Mutual’s aggressive underwriting program — that it built up and justified over years — grinding to a halt.
Until it could get a handle on its quake losses, the carrier wasn’t going to take on any new business that looked even remotely risky.
A month after the quake, Heaven’s Gardens was seeing double-digit sales drop-offs in its undamaged stores due to its supply problems. The company prided itself on locally sourced materials and simply didn’t have the backup suppliers to keep it going in a meaningful way.
Quake damage to retail sites and first- and second-tier suppliers was something the company had known was possible. What was so maddening was the fact the company had paid a good deal of money for a risk engineering assessment and now all of that looked like it was going to waste.
The risk engineering assessment was great from a premiums paid and eventual claims perspective, but not much use with business recovery. Not from this rare earthquake event anyway.
It was like the company was blind where it most needed vision. What exactly was down and how bad was the damage? That was the problem.
By the summer of 2016, a mere year after the ῀M 6.9 quake that rattled Missouri and Illinois, Heaven’s Gardens, from a revenue perspective, had lost 15 percent its pre-quake size.
When it came to design and product execution, the company was spot-on with its approach to functional, rustic outdoor furnishings. Its “locally-sourced” mantra was also golden.
But that ended up mattering little to frustrated customers who couldn’t pick up the equipment they’d ordered due to supply delays. Brand loyalty still meant something in this country, but not so much that somebody who ordered a pizza oven in April was happy to get it in October.
A year after the quake, the company still hadn’t found the second of two grill and fittings suppliers that met its local sourcing and design criteria.
Competitors to the East and West, some of them whose design couldn’t hold a candle to what Heaven’s Gardens produced, moved in to pick up pieces of the company’s business.
It took Butte Mutual six months to determine something that should have been good news but wasn’t. It turned out that the carrier had more than enough reserves to comfortably withstand insured losses from what became known as the “Hannibal Cannibal,” the quake named for its epicenter in Hannibal, Mo.
But a lack of visibility into its property portfolio meant the carrier failed to take the aggressive action it needed to take in these market conditions.
Deprived of the fullness of its topline growth potential, Butte Mutual survived, but its tepid growth for the next three years was off-putting to shareholders.
The company should have been a regional carrier star and instead became a mediocrity.
Risk & Insurance® partnered with Esri to produce this scenario. Below are Esri’s recommendations on how to prevent the losses presented in the scenario. This perspective is not an editorial opinion of Risk & Insurance®.
1. Engineer success: Using GIS to determine property vulnerability on the front end of a catastrophe is a well-accepted practice. But what about the back end? Consider leveraging access to high resolution geographic information from ArcGIS that can provide disaster damage assessment on the back end, mitigating the chance of overwhelming field staff and supporting faster and more efficient response to your property customers.
2. Protect against data and communication losses: Depending on access to your own company’s physical data storage and communications infrastructure following a disaster could be severely shortsighted. Consider ArcGIS cloud and mobile solutions that house data and provide communications capabilities outside of your natural threat footprint.
3. Ask more of business partners: Using location information Heaven’s Garden constructed reasonably sound business continuity and disaster recovery plans for each of its facilities. But its network of suppliers lacked this same insight. As a consequence, the company suffered supply chain failures that greatly inhibited its ability to recover from the New Madrid earthquake.
4. Demand and ensure better transparency: Using ArcGIS post event data and imagery gives you visibility in real time to property damage and other crucial information in the aftermath of a disaster. Settling for a listing of possibly affected properties categorized by ZIP code is an outmoded method of assessment that will not be looked at favorably by underwriters and will be a boon to your unimpacted competitors.
5. Speed of recovery: Risk managers and their organizations cannot place enough emphasis on speed of recovery. Stories are emerging post-Superstorm Sandy and other recent disasters about risk managers who through preparation and boldness got on the loss scene and had their businesses back up in a fraction of the time that it took competitors. Nothing is holding you back but conformity.
The Next Wave of Workers’ Comp Medical Cost Savings
Managing medical costs for workers’ compensation claims is like pushing on a balloon. As you effectively manage expenses in one area, there are bound to be bulges in another.
Over the last decade, great strides have been made in managing many aspects of workers’ compensation medical costs. Case management, bill review and pharmacy benefits management are just a few categories that produce significant returns.
And yet, according to the National Council on Compensation Insurance (NCCI), medical costs remain the largest percentage of workers’ comp expenses. Worse still, medical costs continue to be the fastest growing expense category.
Many medical services are closely managed through provider negotiations, bill review, utilization review, pharmacy benefits management, to name a few. But a large opportunity for medical cost containment remains largely untouched and therefore represents a significant opportunity for cost savings.
Ancillary medical services is a term used to describe specialty or supplemental health care services such as medical supplies, home health care, durable medical equipment, transportation and physical therapy, etc.
According to Clifford James, Vice President of Strategic Development at Healthesystems in Tampa, Fla., modernizing the process for managing ancillary medical services presents compelling opportunities for cost savings and improved patient care.
Source: 2014 Healthesystems Ancillary Medical Services Survey
“The challenge of managing these types of medical products and services is a cumbersome and extremely disconnected process,” James said. “As a result, it represents a missing link in an overall medical cost management strategy, which means it is costing payers money and patients the most optimal care.”
James singled out three key hurdles:
Lack of transparency
As the adage goes, you can only manage what you can measure.
Yet when it comes to the broad range of products and services that comprise ancillary benefits, comprehensive data and benchmarking metrics by which to gauge success are hard to come by.
The problem begins with an antiquated approach to coding medical services that was developed in the 1970s. The coding system falls short in today’s modern health care environment due to its lack of product and service level detail such as consistent units of measure, quantity and descriptors.
As a result, a meaningful percentage of ancillary benefits spending is coded as “miscellaneous,” which means a payer has little to no visibility into what product or service is being delivered — and no way to determine if the correct price is being applied or if the item is even necessary or appropriate.
Source: 2014 Healthesystems Ancillary Medical Services Survey
“It’s a big challenge. Especially when you consider that for many payers, it’s difficult to determine exactly what they are spending, or identify what the major cost drivers are when it comes to ancillary services,” James said. And when frequently over 20 percent of these types of services are billed as miscellaneous, payers have zero visibility to effectively manage these costs.
Measurement and monitoring
Often, performance that is monitored is given the most attention. Therefore, ancillary programs that are closely monitored and measured against objective benchmarks should be the most successful.
However, benchmarks are hard to determine because multiple vendors are frequently involved using disparate data and processes. There isn’t a consistent focus on continuous quality improvement, because each vendor operates off of their own success criteria.
“Leveraging objective competitive comparisons breeds success in any industry. Yet for ancillary services there is very limited data to clearly measure performance across all vendors,” James said. “And for payers, this is a major area of opportunity to promote service and cost containment excellence.”
Source: 2014 Healthesystems Ancillary Medical Services Survey
If you ask claims executives about their strategies for improving the claims management process, a likely response may be “workload optimization.” The goal for some is to enable claims professionals to handle a maximum case load by minimizing administrative duties so they can leverage their expertise to better manage the outcome of each case.
But the path towards “workload optimization” has many hurdles, especially when you consider what needs to be coordinated and the manual way it frequently is done.
Ancillary benefits are a prime example. For a single case, a claims professional might need to coordinate durable medical equipment, secure translation services, arrange for transportation and confirm the best physical therapy plan. Unfortunately they often don’t have the needed time, or the pertinent information, in order to make quick, yet informed, decisions about the ancillary needs of their claimants.
In addition there is the complexity of managing multiple vendor relationships, juggling various contacts, and accessing multiple platforms and/or making endless phone calls.
“We’ve been called the ‘industry integrator’ by some people, and that’s accurate. We are delivering a proven platform connecting payers with providers and vendors on the ancillary medical benefit front. It’s never been done before.”
– Clifford James, Vice President of Strategic Development, Healthesystems
Modernizing the process
To the benefit of both payers and vendors, Healthesystems offers Ancillary Benefits Management (ABM).
The breakthrough ABM solution consists of three foundational components — a technological platform, proprietary medical coding system and a comprehensive benefits management methodology.
The technological platform integrates payers and vendors with a standardized architecture and processes. Business rules and edits can be easily managed and applied across all contracted vendors. All processes – from referral to billing and payment – are managed on a single platform, empowering the payer with a centralized tool for managing the quality of all ancillary providers.
But when it comes to ancillary products, the critical and unique challenge Healthesystems had to solve is the antiquated coding system. This was completed by developing a highly granular, product-specific coding system including detailed descriptions and units of measure for all products and services. This coding provides payers with the clearest understanding of all products and services delivered including pricing and all the necessary utilization metrics.
“We bring the highest level of transparency and visibility into all ancillary products and services,” James said, adding that the ABM platform uses an extensive preferred product coding system 15 times more detailed than any other existing system or program.
This combination of sophisticated technology, proprietary coding system and benefit management methodology revolutionizes the ancillary category. Some of the benefits include:
- Crystal-clear transparency
- A more detailed and comprehensive view into ancillary products and services
- An automated process that eliminates billing discrepancies or resubmittals
- Integrated and consistent processes
- Strategic program management
Taken together, the system leapfrogs over the existing hurdles while creating entirely new opportunities. It’s a win for vendors and payers, and ultimately for patients, who receive the optimal product or service.
“We’ve been called the ‘industry integrator’ by some people, and that’s accurate,” James said. “We are delivering a proven platform connecting payers with providers and vendors on the ancillary medical benefit front. It’s never been done before.”
To learn more about the Healthesystems Ancillary Benefits Management solution visit: http://www.healthesystems.com/solutions-services/ancillary-benefits