Sixty Best Practices In Sixty Minutes

Transcription

1 Sixty Best Practices In Sixty Minutes Midwest Employers Casualty Company Jacque Jones, Regional Sales Vice President Anjie Severo, Client Services Account Manager

2 Topics for Discussion What are Best Practices and who defines them? Why is it important to try and possibly not get there? What are the key components of a Best Practices program? Is your program at Best Practices level?

3 Best Practices Officially, Best Practices is: A proven method or technique with consistent, superior results Used as a benchmark Something that evolves as improvements are discovered A standard or set of standards as defined by an organization or other source

4 Best Practices Unofficially, Best Practices are: Constantly evolving Finding what s right for the individual organization Loosely defined Something that works Probably impossible to achieve fully Plus more

5 Getting to Best Practice Level Why is it important to strive for Best Practice performance level even if it s not completely attainable? Self insurance - it s your money! Required for certain accreditations Sets the tone as a culture of caring for employees Positive impact on citizenry Improves employee recruitment and retention

6 Best Practices A Best Practice program is defined as one in which the organization understands its total cost of risk and through an integrated management process, systematically reduces the frequency and severity of claims to their lowest levels to achieve superior financial results and the lowest total cost of risk.

7 Key Components of Best Practices Programs Program Coordination Employee Health and Wellness Safety and Loss Prevention Claims Administration (includes medical management) Return to Work Programs Data Management, Benchmarking, Goal Setting

8 Key Components of Best Practices Programs Additional considerations Not one-size fits all Will vary according to your organization s culture Too many components to count or review today Requires visible and real commitment at all levels, from top management down

9 Program Coordination Find the answers in your program! Who has oversight for the Workers Compensation program internally? Is this person: Well respected and VISIBLE? Highly MOTIVATED? KNOWLEDGEABLE about WC issues and laws? A good COMMUNICATOR? EMPOWERED to act?

10 Program Coordination Supporting actors within the organization s workers compensation program Human resources Finance Safety director Safety teams/committees Department managers and supervisors Peer employees Others?

11 Program Coordination Workers compensation partners Insurance agent or broker Third party administrator Insurance carrier or excess carrier Attorneys Managed care professionals Bill review (separate) Pharmacy benefits manager Financial analyst/accountant Others?

12 Program Coordination Utilization of insurance partners in a best practice program: Education Supervisor and employee training Legislative updates Changes in workers compensation laws Industry trends Cost containment results Updates on cases in litigation Others?

13 Program Coordination Management commitment is paramount in a best practice program Be visible and set the tone Reinforce the premise that employee safety is a top priority for the organization Attend safety team/committee meetings Discuss workers compensation results and success stories at departmental or other official meetings Issue an official workers compensation policy statement Lead by example

14 Program Coordination Sample workers compensation policy statement Our District is dedicated to sending everyone home safely every day. In accordance with the state workers compensation statute, organization provides for the payment of medical expenses and wage loss benefits to eligible employees who experience a compensable work-related injury. Employees must report job-related injuries or illnesses as soon as practicable to the applicable supervisor. Supervisors are responsible for submitting the forms and meeting the following reporting deadlines: First report of injury: within 8 hours (1 work-day) Supervisor report: within 24 hours (3 work-days) Departments responsible for the late reporting fines levied by the state will be charged back.

15 Program Coordination Program funding best practice considerations: Total cost of risk (including indirect costs) Proper reserves on claims Actuarial studies Funding strategy Cost allocation Budgetary impact Quantify and publish the cost (operating margins)

16 Employee Health and Wellness Best practice: ensure workers physical abilities match the duties they are expected to perform. Have a job hazard assessment for each position Hire only individuals that are a good match Conduct health risk assessments Include mental and marital services in programs Consider having a physical therapist or industrial clinic physician onsite periodically

17 Employee Health and Wellness Additional best practices Acknowledge aging workforce issues of productivity and workplace injuries and make accommodations Sponsor smoking cessation programs Encourage the use of stairs instead of elevators Institute a stretching program Provide newsletters and booklets involving medical self-care tips

18 Employee Health and More tips: Wellness Incent wellness program participation to cost of benefits Consider sponsoring gym memberships or exercise classes Consider standing workstations, and standing when reading documents or attending meetings Institute a Movement in the Workplace program as employees on average will sit 9.3 hours each day.

19 Safety and Loss Prevention Best practices Top management must be visibly committed for a safety culture to exist Allow employee input Share results Review and modify the safety program Start the safety conversation during the interview process Conduct a separate safety orientation with new employees and continue with regular training Utilize peer review process

20 Safety and Loss Prevention Training vs Education Who? New employees Experienced employees Aging employees Supervisors When? New equipment New policies After an injury Near misses Change in work assignment or environment

21 Safety and Loss Prevention Supervisor s role is crucial! Supervisors help control claims costs Supervisors typically conduct accident investigations and assist with the claims process The supervisor is generally the first person to whom an incident is reported Transitional duty depends on the support of supervisors Supervisors implement changes in policy at the employee level Supervisors are the face of management

22 Safety and Loss Prevention Safety Management Systems Four Cornerstones Management Commitment and Employee Involvement Worksite Analysis Hazard Prevention and Control Training for Employees, Supervisors, and Managers

23 Safety and Loss Prevention Tips: Top management needs to be visible to the employees Top down leadership, bottom up engagement! Enforce your own policies and procedures Ask management to lead by example Make use of vendor partners and their resources Insist on neat and orderly workspaces

24 Safety and Loss Prevention Ideas Use posters and handouts that are eye catching, witty or simple Try Dear John or Stall Street Journal in the bathrooms where you have a captive audience Consider incentives* where it makes sense Develop and use self-inspection checklists Frequently review your more costly injuries Use Twitter for classroom safety awareness tweets

25 Safety and Loss Prevention About accident investigations. Ask questions and do not rely on TPA to conduct investigation Require an investigation on ALL reported incidents Keep disposable or digital cameras on hand Get to the root cause of an incident by using the 5 Whys method Require a corrective action plan to address root cause Track and monitor progress of corrective action plan Do not forget NEAR MISSES!

26 Claims Administration Best practices Report claims within 24 hours to claims handlers Ask claims administrators, nurses and physicians to visit your workplace Request regular claims reviews with your claims professionals Utilize all managed care options available Participate in a pharmacy benefit management (PBM) program Reinforce the need for employees to report ALL incidents

27 Claims Administration Best practices (con t) Certify staff in first aid Use claim information to track and trend losses Have supervisors call claimants weekly while on workers compensation disability Pursue suspected fraudulent claims Attend settlements and hearings if allowed Have supervisor take employee for initial treatment

28 Claims Administration More tips: Establish guidelines for settlement authority when necessary Position complex and high dollar claims for settlement when possible Gain understanding of your state s workers compensation regulations and case law Be aware of the employee referral network Gain an understanding of Medicare Set Asides (MSAs) and how they impact claim settlements

29 Return to Work Programs Did you know? Transitional duty is the most effective counter to moral hazards that keep employees from returning to duty Return to work is the only effective balance to full salary continuation programs and statutes Return to work can strongly influence the cost of medical Return to work provides an employee for 1/3 of the cost you would already be paying 2/3 if he or she was off work Return to work programs require physicians to focus upon work abilities rather than disabilities

30 Return to Work Programs A best practice program: Includes a written plan agreed to by employee with start and end dates Is uniformly applied through all departments Involves meaningful work that is beneficial to the organization May create a bank of meaningful job descriptions that can be provided proactively to treating physicians*

31 Return to Work Programs Additional tips for success Ask treating providers to visit your departments Ask employees to come into facility to pick up temporary total disability (TTD) checks Communication both internally and externally is key Have an outside expert evaluate your RTW program Best practice gap analysis

32 Return to Work Programs Things to keep in mind The cost implications of allowing workers to be off work when light duty work can be found is huge Employees off work 6 months = 50% chance of NEVER returning to work The goal is to get injured workers back to their pre-injury job Employees importance is continuously stressed Effective programs should be communicated and supported by top management as part of a WE CARE culture

33 Data Management How can you monitor movement toward a best practice program? Do you collect data and if so, from what sources? How often do you obtain new data sets? What do you do with this data? What benchmarking methods will you use? What goals will you set? How much data will you share with employees?

34 Data Management Why does all of this matter? The answer is simple: Reducing accidents and their related the expense is critical in the effort to preserve operating margin and meet budget constraints

35 Data Management Why does all of this matter? The answer is simple: Our employees are the ones being injured!

36 Data Management Data sources can include: Claims servicing company (TPA) Internal systems and reporting forms OSHA logs Excess workers compensation carrier Treating providers Managed care providers Insurance agents and brokers

37 Data Management Best practices in tracking and trending data Collect data necessary for analytics Should include data to measure various metrics (examples) Department Cause of loss Part of body Reporting lag time Payroll class code Age of employee Tenure of employee Loss dollars Should be conducted at least quarterly

38 Data Management Best practices in tracking and trending data Use data to set goals for departments and address issues Knowledge gained should be shared Safety committees Human Resources Senior management Interdepartmental committees Individual department managers and supervisors Benchmark data against peers

39 Tips Data Management Ask your insurance partners what types of benchmarking data sets are available Talk to your industry peers, review their websites, attend conferences, participate in roundtables, and read blogs Industry specific benchmarking or even benchmarking by job classification is best if it can be obtained Research best practices standards for your industry and perform related self assessment

40 Assessment Your organization is the best judge of what Best Practices standards to strive to achieve These standards are judged to be Best Practices because they have produced positive results Seek Best Practices standards for your industry and conduct an assessment of your organization Remember: they are your employees, their claims are your claims, and it is your organization s money being spent!

41 Jacque Jones Regional Sales VP (636) Anjie Severo Client Services AM