By PETER ROUSMANIERE, an expert on the workers' compensation industry
THE BIKE-RACING NURSE
Denise Zoe Gillen Algire, RN, has devoted her career to improving medical care for injured workers. She advises employers and workers' compensation insurers as practice leader for integrated health management at Risk Navigation Group, a consultancy.
She started out in employee wellness and then went to work for Philips Semiconductors. There, she triaged new injuries and illnesses and managed workers' compensation cases and short- and long-term disability claims. A lasting lesson from that job for her was the value of early intervention and communication with injured workers.
Her first manager at Philips taught her the ropes, including the rule of "no backroom case management." Everything that was said should be said in front of the injured worker.
Algire went on to develop a nationwide managed-care program for a third-party administrator. Later she was CEO and chief operating officer for large orthopedic practices. She earned the major occupational nursing professional designations and served twice on the national board of the American Association of Occupational Health Nurses.
Algire has been bike racing for a cure for multiple sclerosis since the late 1990s. In 2009, she ran her first fundraising triathlon.
She advises young workers' comp professionals to expect to be overwhelmed, to be thrown into jobs without specific training. She credits colleagues and professional associations for much of her professional skills.
A successful entrepreneur in managed care, Shelley Boyce founded MedRisk, headquartered in King of Prussia, Pa., in 1994, and she has continued to serve as its CEO. She had worked for a medical provider clinic chain, where she gained experience in sales, operations and acquisitions. When managed care gained traction in workers' compensation in the early 1990s, she conceived a venture that would apply managed-care principles to workers' compensation.
In the face of initial market ambivalence about her concept, Boyce decided to plunge ahead. MedRisk initially provided claims-payers with innovative ways to manage the high cost of physical rehabilitation. The firm today offers a suite of custom claims and medical management solutions.
Over her career, the marketplace has embraced managed-care concepts. She credits the Workers Compensation Research Institute for their studies of the cost-drivers in medical care, which validated her managed-care strategies.
The high complexity of the workers' compensation field appeals to her because it opens up opportunities for product development.
She volunteers on projects to improve education, including at the University of Virginia and Wharton Business School.
THE LEGAL ADVOCATE
Jon Gelman, an articulate advocate for workers, practices workers' compensation law out of his office in Wayne, N.J. The author or co-author of two major treatises on workers' compensation law, he focuses his law practice on catastrophic injuries, such as asbestos and other occupational diseases.
He says that the economy, workforce and medical science have changed, but the litigation-burdened, state-based systems are stuck in the past.
On his workers' comp
blog, Gelman argues for federalization of the workers' compensation system for occupational diseases.
Early in his career, Gelman was greatly influenced by Irving Selikoff, the New York City-based medical researcher who documented the fatal effects of worksite exposure to asbestos. Selikoff's definitive findings on asbestos became the foundation for the use of expert evidence.
Gelman went on to be a key, successful litigator for the banning or severe restrictions in the use of latex in medical gloves and other medical products.
A serious landscape photographer, he believes that learning as much as possible about the past and present workers' compensation system can lead to creative solutions for the future.
THE RESEARCHING DR.
Dr. Glenn Pransky, one of the most prolific researchers on work-related injuries, is director of the Center for Disability Research within the Liberty Mutual Research Institute for Safety in Hopkinton, Mass.
In his invaluable first exposure to occupational medicine in 1975, when he treated shipyard workers in Baltimore, Pransky saw that the needs of injured workers and their employers were not being met by the medical community. In his view, a lot has improved since then, with better trained doctors, more sophisticated employers and better research.
A mentor of his from Calgary, Alberta, taught him the importance of taking time with injured workers, their supervisors and others to fully understand the causes of the injury and ways to achieve the best outcomes.
His research staff has produced more than 100 scientific papers on return-to-work research. These papers are read worldwide and also are translated by Liberty Mutual into improved operations for customers.
The development of detailed medical claims data now allows for research on effectiveness of medical treatment over the entire course of a claim. One area of study for Pransky and his team has been early risk-factor identification.
Pransky advises that, when it comes to informing research, teaching and practice, there is no substitute for spending time in the workplace and with employees who are trying to get back to work.
The career stories of these four individuals share certain themes. One is early career restlessness, marked by curiosity and a high capacity to learn. Another is the importance of identifying early key problems or opportunities. And all four have benefited from large-scale changes in the culture of workers' compensation. One can say that their early personal energy found an outlet in systematic changes underway or about to begin.
Read more at the WorkersComp Forum homepage.
July 23, 2010
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