Higher Education Risk Management Workers' Compensation Benchmarking Survey Results, Facts and Solutions

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1 September 2014 A PMA Companies Thought Leadership Publication Higher Education Risk Management Workers' Compensation Benchmarking Survey Results, Facts and Solutions

2 Higher Education Risk Management Workers Compensation Benchmarking Survey Results, Facts, and Solutions Results of the 2014 Higher Education Workers Compensation Survey conducted in June 2014 by PMA Companies and the University Risk Management and Insurance Association (URMIA), as well as solutions to the workers compensation challenges faced by colleges and universities. Frank X. Altiere, III, RIMS Fellow, CPCU, ARM, AU, IIA, AIS President, PMA Management Corp. During the past 15 years, the workers compensation environment has changed dramatically and become increasingly complex. The chart below illustrates some of those changes. Colleges and universities face these new realities and more. Higher education facilities operate 24/7 and may include employees working in various situations, from food service areas to chemical labs scattered across multiple locations and far-reaching campuses. University workforces are aging, and returning employees to work after an injury can be more difficult than ever. To assist higher education risk professionals with these challenges, PMA Companies partnered with URMIA to co-sponsor the 2014 Higher Education Workers Compensation Survey. The survey is intended to uncover the critical opinions of higher education risk management professionals regarding workers compensation challenges and provide URMIA members with bestpractice solutions. To achieve optimum workers compensation results in today s environment, colleges and universities need to explore different approaches and implement new solutions. Workers Compensation Environment Then Now Indemnity/medical split, 60%/40% Pharmacy Small part of medical costs Complexity of fee schedules/billing was limited Obesity not a major issue Aging workforce was not an issue Traditional insurance used more frequently to finance workers compensation losses Siloed approach to controlling costs with more focus on claim management vs. prevention Medical is nearly 60% of claims costs Pharmacy 19% of medical spending Narcotics about 30% of Rx spend Physician dispensing Claims Age, obesity, co-morbidities driving higher costs Economic pressure on return-to-work Aged claims are very expensive More alternatives including self-insurance, captives, etc. Holistic approach needed to reduce total cost of risk About the Survey In June 2014, URMIA and PMA Companies co-sponsored a survey of higher education risk management professionals. The questionnaire was fielded and tabulated by J.P. Murphy, Ph.D. and Company, an independent survey research firm established in 1980 that has completed surveys among corporate decision-makers for BlueCross-BlueShield licensees, Prudential Insurance Company, Principal Financial Group, Cigna/Intracorp, and Kimberly-Clark Professional/Jackson Safety, among numerous others. Qualified individuals who oversee workers compensation programs for URMIA member colleges/universities were invited to take part. The survey generated a 35% response rate, above industry standards for surveys of this type. Survey respondents represent 2

3 institutions in 40 states and are approximately evenly distributed across URMIA s three student enrollment size categories (Under 4,000 students; 4,000-13,999 students; more than 14,000 students). Responses were primarily from risk management professionals who have significant responsibility for workers compensation in their organizations. Eighty-six percent of the respondents held vice president, director, manager, or supervisor positions in their institutions Higher Education Workers Compensation Survey Results Biggest Workers Compensation Concerns: Please Indicate Your Three Biggest Workers Compensation Concerns The biggest workers compensation concerns cited by survey respondents were an aging workforce, selected by 57% of respondents, and returning employees to work (56%). Controlling claims frequency (39%) and medical and/or pharmacy costs (32%) were cited as the next most significant concerns. Costs Trends, Factors, and Outlook Have Your Workers Compensation Claims Costs (Medical and Indemnity) Changed Over the Past Three Years? 3% Increased About the same Decreased Unsure 22% 29% 46% Nearly one-half of respondents (46%) reported an increase in workers compensation claims costs over the past three years; only 22% have seen a reduction. 3

4 Check the Biggest Reasons for Claims Cost Increases Select Two Respondents with increased claims costs primarily attributed the increases to higher frequency and/or severity of injuries (48%) and/or increased medical and/or pharmacy costs (44%). These two cost drivers had more than twice the number of mentions compared with the other factors presented. Over the Next Three Years, What Do You Expect Will Be the Two Most Significant Developments Impacting Your Workers Compensation Costs? Aging workforce (53%) and medical and/or pharmacy costs (50%) are the developments most expected to affect costs over the next three years. Co-morbidity conditions (24%) placed third. 4

5 Principal Ways of Managing Workers Compensation Programs What are the Most Important Ways You are Currently Managing Your Workers Compensation Program? Select Four Claims management (78%), return-to-work programs (60%) and loss prevention (54%) are the top strategies survey respondents are using for managing their workers compensation programs. The Aging Workforce How Is Your Institution Addressing the Needs of Aging Workers? Select All That Apply *67% selected 1 or more of the following: accommodations in job duties, changes in job/task design, job rotation Offering wellness programs (78%) is the way most survey respondents said they are addressing the needs of aging workers. The proportion of respondents doing any work-related adjustments for aging workers (accommodations in job duties, changes in job/ task design, and job rotation) is 67%. 5

6 Does Your Institution Offer Employee Wellness Programs? In Which Areas Does Your Institution Offer Wellness Programs? Select All That Apply No 20% Yes 80% Four out of five (80%) respondents said that their institution has an employee wellness program, either as an employee benefit or to reduce workers compensation costs. Four elements are present in three-quarters or more of all wellness programs information on health topics (86%), fitness centers (81%), weight loss (81%), and smoking cessation (76%). Stress management (67%) and biometric screening (50%) also have significant, if somewhat lower, rates of use. Return-to-Work What Are Your Biggest Obstacles to Returning Injured Employees to Work? Select One or Two Only Respondents said their two biggest obstacles to returning injured employees to work were the lack of modified duty positions (49%) and the resistance of managers/supervisors (36%). Lack of a formal return-to-work program (23%) and employee resistance/abuse (23%) were also cited as obstacles. 6

7 Risk Management Information and Benchmarking What Are the Two Most Effective Ways You Use Risk Management Information to Manage Your Workers Compensation Program? Risk managers said that the most effective ways they use risk management information is to monitor and manage claims (65%) and identify emerging claims trends (42%). Taking corrective action was the next largest response (36%). Why Do You Feel Your Benchmarking Reports Are Not Effective for Peer Comparison? Of those respondents who said their benchmarking reports are not effective for peer-group comparison, 66% said the primary reason was not enough peer information available. Lack of a credible database (43%) and too few categories with comparisons (39%) were the next most significant reasons. 7

8 Selected Risk Management Solutions Seven Target Areas for Optimizing Your Higher Education Workers Compensation Program 1. Reducing Workers Compensation Costs Through a Holistic Approach Addressing workers compensation risk in higher education requires a comprehensive approach that works continuously throughout the year to minimize exposures, control costs, and address the needs of injured workers. This holistic approach to workers compensation risk management provides pre-loss, loss-reduction, and post-loss strategies to effectively address all three needs. 2. Controlling Frequency and Severity Loss Prevention for Higher Education One of the most important areas in a workers compensation program is a strategic approach to loss prevention. It is imperative to understand where your losses are coming from and what s driving your costs. Each year, evaluate your workers compensation claims history dig deep, examine your loss data by location and occupation. Examine specific loss trends and your organization s loss drivers, as well as profiles of injured workers. For example, many colleges and universities experience the majority of workers compensation claims from their physical plant employees. The aging workforce can play a key role in these claims, as workers tend to age in jobs, and may not be able to handle the physical demands of their jobs as they become older. In addition, the following strategies will help positively impact your workers compensation program. Execute good employee recruiting, hiring practices, and onboarding strategies Enhance employee engagement through education and job recognition programs to promote job satisfaction Show leadership commitment observe, recognize, and demonstrate safe work practices Establish a culture of safety by factoring safety into all business decisions Offer wellness programs to help your aging workforce stay healthy and improve the well-being and productivity of all workers 3. Aging Workforce Zero In on Claims Severity Higher education risk managers named the aging workforce as their top workers compensation concern and the most significant development expected to affect their workers compensation costs during the next three years. It s no wonder. Medical and indemnity severity rates have been found to be 51% and 56% higher, respectively, for workers age compared to younger workers, according to the National Council on Compensation Insurance, Inc. (NCCI). Claims frequency is less of an issue, as rates were within approximately 5% of each other in all age groups. 8

9 Address the aging needs of workers through a multi-disciplinary approach. Help older workers stay healthy through wellness programs that include exercise and hearing programs and eye examinations. Offer physical accommodations and safety features to address older worker needs, such as introducing/enforcing weight limits for tasks and redesigning jobs for older workers to eliminate climbing. Aging workers, as well as workers of all ages, can benefit from your institution implementing a slip, trip, and fall program. Aging workers are a valuable part of your workforce. Capitalize on the collective strengths of your most experienced workers. 4. Co-morbidities/Worker Health Clearly, employee health conditions can directly impact workers compensation costs. For example, according to a Duke University Medical Center Analysis, the most obese workers file twice as many workers compensation claims as healthy-weight workers, and workers compensation medical and indemnity costs are 5-10 times higher for the most obese workers. WC Medical Claims and Indemnity Costs are 5-10 Times Higher for the Most Obese Workers Courtesy of the Insurance Information Institute. To address worker health issues, consider the following two key areas: Focus on pre-hire efforts. Improve your screening and interviewing processes to ensure that job candidates have the physical capability to handle the job tasks they are being hired for, in accordance with state and federal laws. Update your job descriptions to ensure they include the physical demands of essential job functions. Allocate additional resources for employee health. In the survey, 80% of respondents offered wellness programs, with these four elements in three-quarters or more of all wellness programs: information on health topics (86%), fitness centers (81%), weight loss (81%), and smoking cessation (76%). An integrated risk management and wellness program can not only reduce medical plan costs and increase productivity, but can also improve employee morale and health and reduce the frequency and severity of workers compensation claims. PMA Companies white paper, Integrating Risk Management and Wellness Programs, which can be found on our website, provides additional guidance on wellness programs from a workers compensation perspective. 9

10 5. Addressing Medical & Pharmacy Costs Medical costs Indemnity costs 41% 59% Workers Compensation Claims Costs In the workers compensation industry, medical costs account for approximately 59% of claims costs, with pharmacy costs comprising approximately 19% of medical costs according to the National Council on Compensation Insurance, Inc. Effectively reducing workers compensation costs requires a multi-faceted managed care strategy. Your managed care program should be fully integrated with your workers compensation claims program and provide the following components: Medical case management and clinical services Robust bill review services Preferred Provider Networks and specialty networks for physical therapy, diagnostic services, and durable medical equipment Nurse triage/early intervention services, to evaluate and direct care at time of loss Pharmacy benefit management, including programs to monitor narcotic utilization Out-of-network services Quality and regulatory assurance programs Pharmacy nurses for claims where narcotics have been dispensed 6. Return-to-Work The importance of returning employees to work as soon as is medically safe can t be understated. Survey respondents reported that a return-to-work program is the most effective strategy for reducing claims severity. Lack of modified duty positions and resistance of managers/supervisors were identified as the biggest obstacles to returning employees to work. The following provides guidelines for establishing a modified duty program: Develop a formal written policy with time limits and obtain management and union buy-in Train and educate supervisors on why return-to-work is important, expectations concerning use, and how it saves money Inventory potential modified duty jobs Consider developing job banks Each supervisor/manager recommends three jobs in their department Educate medical providers on: Availability of modified jobs Need for physical capacity information Return-to-work philosophy Track and manage employees on modified duty Consider central budgeting of modified duty expense 10

11 Gaining supervisor/manager buy-in for your return-to-work program is critical for its success. To ensure management support, consider the following steps: Introduce return-to-work as a policy Hold supervisors/managers accountable for losses and compliance (i.e., chargebacks) Communicate compliance and savings achieved Include return-to-work objectives in performance evaluations Develop specific roles, particularly who will manage the return-to-work policy Avoid having no one in charge of an employee who returned to work; engage human resources Establish policies that encourage return-to-work Conduct a semi-annual meeting with return-to-work stakeholders 7. Benchmarking Scorecards are used all the time to determine level of performance. Benchmarking offers a scorecard for setting goals, measuring performance, and achieving results for your workers compensation program. There are many benchmarks that can be used to measure your workers compensation program see accompanying table. Sample of Benchmarks to Measure Your Workers Compensation Program Calendar-year payments Claims closure rates Average cost for closed claims Medical savings Calendar-year costs of workers compensation claims per employee Ratio of lost-time vs. medical-only claims Five-year overview of workers compensation claims by type and cost Percentage of claims closed within 90 days Number of employees injured within first 90 days Top ten most expensive workers compensation claims Frequency/severity by locations Age of injured worker at time of accident Incurred cost per $100 of payroll Injured workers with multiple claims Claim reporting lag time In deciding which metrics to use, consider your audience, which could include any or all of the following: Risk Management CFO Safety Director Excess Carrier Claims Manager Board of Directors CEO Start with 5 to 10 key metrics most important for your audience, and, at least annually, measure your performance against your own results from prior years as well as your industry peers. Be sure that your benchmarks link directly to bottom-line results. As you review your results, look for actionable areas for improvement. 11

12 Conclusion Workers compensation continues to be a major challenge for colleges and universities with significant budgetary and employee welfare implications. The 2014 Higher Education Workers Compensation Survey provides an overview of best practices for colleges and universities. To continue improving your program, we urge you to review the survey results with your senior management team. Education is a powerful tool in effecting change. Study your institution s specific trends. Are they similar to the survey results? Consider issues such as the aging workforce, claims frequency, medical costs, costs by locations, etc. Ensure that you complete a risk management assessment each year. Finally, don t forget the importance of setting goals. Measure, benchmark, and evaluate your results. Be sure to share your results with your constituencies and develop and implement action steps to improve your workers compensation performance. About the Author Frank X. Altiere, III is President of PMA Management Corp. He has 35 years of risk management and insurance experience with a focus on helping organizations develop and implement high-performing risk management programs. He has spoken at many conferences and seminars and has authored articles on the total cost of risk, claims management, workers compensation, and achieving return-on-investment for self-insured clients. Mr. Altiere, a Risk and Insurance Management Society (RIMS) Fellow, holds CPCU, ARM, AU, IIA, and AIS designations and is a member of the Self-Insurance Institute of America. About PMA Companies PMA Companies ( provides risk management solutions and services in the U.S., specializing in workers compensation for larger accounts. Headquartered in Blue Bell, PA, PMA Companies is part of the Old Republic General Insurance Group ( the largest business segment within Old Republic International (NYSE: ORI), one of the nation's 50 largest publicly held insurance organizations. PMA Companies includes: PMA Insurance Group, specializing in workers compensation, and providing other commercial property & casualty insurance products PMA Management Corp. and PMA Management Corp. of New England, providing results-driven TPA and Risk Services specializing in workers compensation and liability About URMIA The University Risk Management and Insurance Association (URMIA) is an international non-profit educational association serving colleges and universities. Its core purpose is to promote the advancement and application of effective risk management principles and practices in institutions of higher education. URMIA represents more than 2,100 individuals at 570 institutions of higher education and over 100 companies. URMIA s members range from small schools and community colleges to the largest educational institutions. The URMIA National Office is in Bloomington, Indiana, at Indiana University. For more information, visit or call

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