C6-COUNTY OF LA FIRE DEPARTMENT CARVE OUT PROGRAM CASE STUDY

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Bryce Todd
10 years ago
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1 C6-COUNTY OF LA FIRE DEPARTMENT CARVE OUT PROGRAM CASE STUDY Feb 10, :45pm - 05:00pm Session Type: Breakout

2 PRESENTERS BATTALION CHIEF GEORGE CRUZ Los Angeles County Fire Department ALEX ROSSI Workers Compensation Contract Administrator Risk Management Branch, County of Los Angeles CEO Office JOE CARILLO Risk Management Branch, County of Los Angeles CEO Office BRUCE MILLER Vice President, Intercare Holdings Insurance Services Moderator - Agnes Hoeberling Chief Operating Officer, Intercare Holdings Inc. Page 2

3 LOS ANGELES COUNTY FIRE DEPARTMENT PROFILE Fire Protection and life safety services to 3,976,398 residents Serving 58 district cities and all Unincorporated Areas Square Miles 2,305 Total incidents 314,508 Total Personnel 4,667 2,930 are Local 1014 represented employees (CO population) Page 3

4 COLA FD EMERGENCY OPERATIONS OVERSIGHT Fire Stations Health Haz Mat Air Operations 171 Stations Life Guard Division Wild Land Division Forestry Division Page 4

5 SESSION OVERVIEW The COLA Carve Out Program for the Fire Department examines the innovative, forward thinking and collaborative methods that the County and the Labor Unions implemented to achieve their mutual desire to reduce cost and meet injured workers need for quicker and higher quality of treatment. Union and management were engaged in negotiation in the most important elements facing both the County and the workers. The study shows how a collaborative strategy between union, management, TPA and the medical service providers can work hand- in- hand to create substantial savings by allowing parties to negotiate control over medical treatment while protecting injured workers by selecting only the best qualified medical providers to treat the employees. By the end of this session participants will be able to: 1 2 Assess whether a Carve Out Program from the WC System will solve some of their risk management challenges of a Fire Department or municipality; Assist Risk Managers creating a collaborative partnership with Union Leaders to establish an effective Carve Out Program; 3 Help Risk Managers design a strategy to implement a carve out program specific to their needs. Page 5

AGENDA Carve-Outs ADR for WC in Collective Bargaining Agreements Authority Process/Methods COLA FD County RM Branch - CEO Intercare Holdings Insurance Services Goals Why What gave rise to the idea

6 AGENDA Carve-Outs ADR for WC in Collective Bargaining Agreements Authority Process/Methods COLA FD County RM Branch - CEO Intercare Holdings Insurance Services Goals Why What gave rise to the idea Challenges Resources Stakeholders Buy-in WC System Program Design Support System Program Components Advantages/Disadvantages Outcomes/Results Employee Satisfaction Direct Financial Impact Indirect Savings Page 6

GOALS Goals Critical Tasks To provide participating employees with compensable WC claims with an expedited process to resolve medical disputes and faciliatate prompt return to work: Build employee

7 GOALS Goals Critical Tasks To provide participating employees with compensable WC claims with an expedited process to resolve medical disputes and faciliatate prompt return to work: Build employee trust Expedite resolution of disputes/issues Expedite benefit delivery Enhance Labor-Management relations Improve organizational effectiveness Improve program cost effectiveness Establish Labor/Management Committee Empower Committee to monitor, evaluate and address implementation issues Define participants Establish critical components: IME Process/Physician Selection IME Panel/Scope of Work UR Component Communication/Education Plan Data Collection/Measuring Results Dispute Resolution Develop notices addressing IME process Establish coding requirements Revision of appointment letters - neutrality Page 7

8 PROGRAM DESIGN Components Restructuring RTW Program Features Light Duty Assignment Desk Alternate Positions Specific Bureau Assignment Resources RTW Department: Battalion Chief Fire Captains Civilian Staff RTW Staff Expedited Medical Care Initial Treatment Centers Ortho Facilities Cardiac Evaluation Program Appointment protocols Reporting timelines Pe-qualified and selected Treatment Centers IME Panel Intercare UR Protocols Dispute resolution through IME IME s cannot be designated as IW PTP Intercare IME Panel URO Page 8

9 CHALLENGES Employer: Resources Buy-in from all stakeholders Competing priorities Applicant s attorney Ensuring injured worker attend IME appointments TPA: Dual process: IME vs QME/AME Cancellations of scheduled examinations; Multiple IME exams IME availability in specific specialties Conflicting opinions between AME, QME or IME Impact on workflow Medical Provider: IME s ability to schedule appointments within timeframes allowed by Agreement IW Cancellations of scheduled exams Volume of records to review Page 9

10 Benefits ADVANTAGES - Employee satisfaction - Improving benefit delivery - Expedited claim process - Early RTW - Reduced litigation - Reduction of lien filings - Foster a more cooperative work environment - Improved partnership through ongoing communication - Potential cost avoidance Page 10

11 STRATEGY FOR A SUCCESSFUL PROGRAM 1 Proper planning. Patience is a virtue. 2 Collaboration and teamwork from all stake holders. Compassion and empathy for the injured colleague. 3 Perform GAP analysis to ensure ongoing and continual improvement. Seek team and stakeholder feedback. 4 Execute upon and refine communication. Clearly define status reporting and communication requirements. Page 11

12 FIRST YEAR RESULTS - SUCCESS STORIES Shorter Timelines: Receipt of IME Reports within 30 days Expedited treatment plans Claims Decisions Symbiotic relationship Injured worker satisfaction Collaborative and cooperative environment Program Impact: Higher participation in modified duty program Increased productivity Fewer liens Page 12

13 FIRST YEAR STATISTICS 1196 CO Claims Filed 390 Disputes arose requiring IME appointments Claim Decisions Based on IME Reports: % Accepted % Denied 4.5 Days Average Days to Schedule IME Appointment 32 Days Average Days from IME Appointment to IME Report - 25% failed to attend IME - 8.7% ruled as related to another injury - 1% good faith personnel issue - 1% failed to sign MA form Page 13

14 Q & A Page 14

NEGOTIATED WORKERS COMPENSATION PROGRAMS (NWCP) A win-win for Employers, Insurers, Union Employees, and their Joint Health Funds.

NEGOTIATED WORKERS COMPENSATION PROGRAMS (NWCP) A win-win for Employers, Insurers, Union Employees, and their Joint Health Funds. Specific Statutory Authority Required The following states allow for this