Outsourcing vs. Insourcing When it makes sense to do both ......The mission of the Broward County...

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Outsourcing vs. Insourcing When it makes sense to do both: Managing Workers‘ Compensation Broward County Public Schools COUNCIL OF THE GREAT CITY SCHOOLS Chief Human Resource Officers & Chief Information Officers Joint Meeting February 6, 2018

Transcript of Outsourcing vs. Insourcing When it makes sense to do both ......The mission of the Broward County...

Page 1: Outsourcing vs. Insourcing When it makes sense to do both ......The mission of the Broward County Public Schools Workers’ Compensation Unit is to effectively, efficiently, and ethically

Outsourcing vs. InsourcingWhen it makes sense to do both:

Managing Workers‘ Compensation Broward County Public Schools

COUNCIL OF THE GREAT CITY SCHOOLSChief Human Resource Officers & Chief Information Officers Joint Meeting

February 6, 2018

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2MISSION AND VISION

BCPS Foundation. BCPS Foundation

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3DISTRICT PROFILE

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4TEACHING & LEARNING

BCPS Foundation. Core Business

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5DISTRICT PROFILE

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Outsourcing and the SMART Program

• The District amended its approach to

implementing its capital program in

anticipation of the SMART Program

A NEW DELIVERY MODEL

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Outsourcing and the SMART Program

Three Primary Reasons to Outsource:1. History of Poor Execution in Construction

2. Not Core Business

3. Scalable to need

A NEW DELIVERY MODEL

Program Manager Cost & Program Controls

Awardees / Partners

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SMART Program Continues to Progress

MOVING FORWARD AND ON TRACK

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Workers’ Compensation (WC) is a statutorily mandated (Chapter 440, Florida Statutes) entitlement program for covered employees, who become injured or ill from a work related accident or exposure. When appropriate, WC provides specific guaranteed benefits such as relevant medical care and partial wage replacement.

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Workers’ Compensation 101

THE BASICS

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10KEY PARTIES INVOLVED

Three Primary Stakeholders

INJUREDWORKER EMPLOYER

MEDICAL

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BCPS Workers’ Comp History

2005 Pre-CBM Structure• Self-Insured

• Fully Outsourced TPA– Subcontracted medical network/services

• Full Compliance with statutory requirements but costs significantly rising

FOUR DISTINCT PERIODS OF HISTORY 10

Pre-CBM Early CBM Pre- Self Administered Current CBM

July 1, 2006 July 1, 2009 July 1, 2013

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$17,043,224.94

$16,066,210.23

$18,160,496.31 $18,257,865.08

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000

FY 1999-2000

FY 2000-2001

FY 2001-2002

FY 2002-2003

FY 2003-2004

FY 2004-2005

Pre CBMPrior to July 1, 2006

Pre CBMPrior to July 1, 2006

PRE-CRITERIA BASED MODEL 11

Experience Development

Total Experience is one year of claims. Experience = paid + outstanding reserve

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June 22, 2005: BCPS Internal WC Audit

Major Findings• Lack of an Integrated

System• Lack of Medical

Consumerism• Lack of Employer

Oversight• Passive Return-to-Work

Program

Program Compliance ≠ Program Performance

12A TURNING POINT

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14FUNDAMENTALS

July 2006 - Program Reform

New Program Structure

• Still Fully Outsourced

• TPA-Single Provider of Services

• SBBC Private Label Network

• Nurses on every claim

• Stay-at-Work Program

• Dedicated BCPS WC Specialist

• Based on the Criteria-Based

Model (CBM)™

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Comparison of Models

Large Contracted Clinician Network with Minimal Inclusions

Enhanced Reimbursement Structure

Based on Clinical Outcomes (Pay for Performance)

Concentrated Network of Trained Clinicians Based on Performance

Traditional Model CBM Model

Financial-Based Model Medical-Based Model

Discount Medicine Focused on Minimizing Unit Costs

Paper Notification of Injury Coordinated by SBBC location staff

Early Intervention Real-Time Telephonic Notification of Injury Coordinated by Dedicated Triage

Nurse

Private Label Network

Priority Driver

Employee/Clinician Driven Medical Utilization

"Cookbook" MedicineEvidenced-Based Medical

Philosophy (C.A.R.P.)

Subcontracted Nurse Case Mangers on Select Claims for Specific Tasks

(Fee for Service)

In-house Nurse Case Manager on Every Claim Throughout Life of Claim

(Service Inclusive)

Medical Consumerism

Employee Primary Conduit of Information with Supervisor

Adjuster/Nurse Primary Conduit for All Communication

Passive Return-to-Work Program

Communication

Return to WorkAggressive Stay-at-Work Program

TRADITIONAL VS. CBM

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$17,043,224.94

$16,066,210.23

$18,257,865.08

$13,083,934.75

$8,966,296.97

$9,926,057.28

$12,620,006.95

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000

FY 1999-2000

FY 2000-2001

FY 2001-2002

FY 2002-2003

FY 2003-2004

FY 2004-2005

FY 2005-2006

FY 2006-2007

FY 2007-2008

FY 2008-2009

Transition Year between Audit & CBM

Early CBM7/1/06 – 6/30/09 Experience Development

16TREMENDOUS FINANCIAL IMPROVEMENT

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Experience at 36 Months

TREMENDOUS FINANCIAL IMPROVEMENT

Fiscal Year Total Incurred at 36 months

FY 1999-2000 $ 18,404,398.51 FY 2000-2001 $ 17,309,558.76 FY 2001-2002 $ 17,534,834.35 FY 2002-2003 $ 17,489,066.06 FY 2003-2004 $ 17,885,819.01 FY 2004-2005 $ 17,184,304.68 FY 2005-2006 $ 11,808,906.00 FY 2006-2007 $ 8,768,790.18 FY 2007-2008 $ 9,343,700.00

FY 2008-2009 $ 10,937,414.49

Average Savings of 45% or $7.9 million per claim year

Early CBM7/1/06 – 6/30/09

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Total Experience at 36 Months

TREMENDOUS FINANCIAL IMPROVEMENT

Average Savings of 38% or $5.9 million per claim year

Early CBM7/1/06 – 6/30/09

$18,404,399 $17,534,834  $17,885,819 

$11,808,906 

$8,768,790 

$10,937,414 

 $‐

 $2,000,000

 $4,000,000

 $6,000,000

 $8,000,000

 $10,000,000

 $12,000,000

 $14,000,000

 $16,000,000

 $18,000,000

 $20,000,000

FY 1999‐2000

FY 2000‐2001

FY 2001‐2002

FY 2002‐2003

FY 2003‐2004

FY 2004‐2005

FY 2005‐2006

FY 2006‐2007

FY 2007‐2008

FY 2008‐2009

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$7,224$6,672

$5,833

$3,616 $3,522 $3,867

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009

Average Experience

per Net Claim ( 12 months)

Average Experience

3 BEST YEARS

Early CBM7/1/06 – 6/30/09

Net Claims represent WC claims filed which have expenses associated with them.. An increase in report only claims will not impact the average incurred figures.

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Lost Work Days

TOTAL LOST DAYS (ILD AND INDEMNITY)

24,535 

8,028 

5,882 5,033 

 ‐

 5,000

 10,000

 15,000

 20,000

 25,000

 30,000

2005‐2006 2006‐2007 2007‐2008 2008‐2009

Over 65% reduction in first year of CBM Program. And 80% reduction by year 3.

Early CBM7/1/06 – 6/30/09

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$90,640,000

$71,346,000

$50,000,000

$55,000,000

$60,000,000

$65,000,000

$70,000,000

$75,000,000

$80,000,000

$85,000,000

$90,000,000

$95,000,000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Reserve has decreasedover $19 million in first 3years of new WC Model at 75% confidence level, 100% funded.

10 Self-Insured WC Reserve Early CBM7/1/06 – 6/30/09

CBM-TPASelf-Insured ReservesEarly CBM

7/1/06 – 6/30/09

21TREMENDOUS FINANCIAL IMPROVEMENT

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22TREND BEGINS TO TURN

Program ComplacencyPre- Self Administered7/1/09 – 6/30/13

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$17,043,224.94

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000

FY 1999-2000

FY 2006-2007

FY 2007-2008

FY 2008-2009

FY 2009-2010

FY 2010-2011

FY 2011-2012

WC Experience Development

23NEGATIVE TREND

Experience DevelopmentPre- Self Administered7/1/09 – 6/30/13

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Total Experience at 36 Months

TREMENDOUS FINANCIAL IMPROVEMENT

$17,309,559 $17,489,066 $17,184,305

$9,343,700

$13,981,535

$10,891,394

$7,274,134

$-

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000

$20,000,000

Pre- Self Administered7/1/09 – 6/30/13

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$7,224$6,672

$5,833

$3,616 $3,522 $3,867$4,431

$5,144 $5,046

$3,756

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013

Average Experience

per Net Claim

( 12 months)

Average Experience per Claim

3 BEST YEARS

Pre-Self Administered7/1/09 – 6/30/13

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Lost Work Days

TOTAL LOST DAYS (ILD AND INDEMNITY)

24,535 

8,028 

5,882 5,033 

6,232  5,635  5,954  6,227 

 ‐

 5,000

 10,000

 15,000

 20,000

 25,000

 30,000

2005‐2006 2006‐2007 2007‐2008 2008‐2009 2009‐2010 2010‐2011 2011‐2012 2012‐2013

Pre- Self Administered7/1/09 – 6/30/13

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MERGERS & ACQUISITIONS

Industry EnvironmentPre- Self Administered7/1/09 – 6/30/13

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In order to insulate SBBC WC program and the CBM model from TPAs and industry as a whole:

– Bring “in-house” core operations and staff to manage the fundamental decision-making including claims and medical consumerism components of the CBM

– Continue to outsource non-core decision-making services, as it specifically relates to the CBM• Claims management software system, bill review, etc.

Industry Environment Current CBM7/1/13 – Present

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1. BCPS program very unique under CBM model.

2. CBM model proven successful when executed faithfully.

3. Inconsistences in TPA administrations / Volatile Insurance Industry

Reasons to Insource WC Program Current CBM7/1/13 – Present

Page 30: Outsourcing vs. Insourcing When it makes sense to do both ......The mission of the Broward County Public Schools Workers’ Compensation Unit is to effectively, efficiently, and ethically

• 28 Positions• Program Mgmt.• Claims Mgmt.• Medical Mgmt. &

Consumerism• SAW/RTW • Strategic Admin Support

Services and Operations

• Intake & Triage (24/7/365)

• Claims System/Software• Medical Bill Review,

Repricing & Payment• Contract Administration &

Vendor Mgmt.

In-HouseSBBC WC Unit

OutsourcedTPA Select Service Contract

Current CBM7/1/13 – OngoingCBM – Self Admin

Current Program Structure

26INSOURCE CORE DECISION MAKING

Current CBM7/1/13 – Present

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31MISSION

BCPS Foundation. WC Unit Mission

The mission of the Broward County Public Schools Workers’ Compensation Unit is to effectively, efficiently, and ethically manage the Workers’ Compensation Program, thereby producing consistently superior outcomes in both human and financial terms.

Current CBM7/1/13 – Present

Page 32: Outsourcing vs. Insourcing When it makes sense to do both ......The mission of the Broward County Public Schools Workers’ Compensation Unit is to effectively, efficiently, and ethically

INDUSTRY PROVES US RIGHT

One year into Self Administration – District’s TPA Acquired

Industry EnvironmentCurrent CBM7/1/13 – Present

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Average Incurred Per Net Claim

AVERAGE INCURRED COST PER NET CLAIM (12 MONTHS)

$5,833

$3,616 $3,522$3,867

$4,431

$5,144 $5,046

$3,756 $3,503 $3,432 $3,571 $3,370

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

Self-Administration

Current CBM7/1/13 – Present

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Total Experience at 36 Months

TREMENDOUS FINANCIAL IMPROVEMENT

$17,885,819

$11,808,906

$9,343,700

$13,981,535

$8,542,738

$9,886,956

$-

$2,000,000

$4,000,000

$6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000

$20,000,000

FY 2002-2003

FY 2003-2004

FY 2004-2005

FY 2005-2006

FY 2006-2007

FY 2007-2008

FY 2008-2009

FY 2009-2010

FY 2010-2011

FY 2011-2012

FY 2012-2013

FY 2013-2014

FY 2014-2015

Current CBM7/1/13 – Present

Page 35: Outsourcing vs. Insourcing When it makes sense to do both ......The mission of the Broward County Public Schools Workers’ Compensation Unit is to effectively, efficiently, and ethically

$16,066,210

$19,123,672

$14,518,611

$9,782,730

$10,029,314

$15,009,179

$10,513,323

$12,818,108

$8,920,163

$6,621,583 $6,000,000

$8,000,000

$10,000,000

$12,000,000

$14,000,000

$16,000,000

$18,000,000

$20,000,000FY 1999-2000

FY 2000-2001

FY 2001-2002

FY 2002-2003

FY 2003-2004

FY 2004-2005

FY 2005-2006

FY 2006-2007

FY 2007-2008

FY 2008-2009

FY 2009-2010

FY 2010-2011

FY 2011-2012

FY 2012-2013

FY 2013-2014

FY 2014-2015

FY 2015-2016

FY 2016-2017

as of 6/30/2017

Experience Development

TOTAL COST PER CLAIM YEAR

Current CBM7/1/13 – Present

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Cash Flow

CLAIMS COSTS - 4 BEST YEARS

21.2

16.518.6 18.6

15.1 14.5 14.5 13.5 13.7

9.611.4

9.912.1

$-

$5

$10

$15

$20

$25

Mill

ions

Average reduction of $3.3M per year

Current CBM7/1/13 – Present

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Lost Days

TOTAL LOST DAYS (ILD AND INDEMNITY)

24,535 

8,028 

5,882 5,033 

6,232  5,635  5,954  6,227  6,427  6,271 

4,187  3,953 

 ‐

 5,000

 10,000

 15,000

 20,000

 25,000

 30,000

Average Reduction of 35% in past two years

“in-house”

Current CBM7/1/13 – Present

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Total Program Costs

ADMINISTRATIVE AND CLAIM COSTS

Current CBM7/1/13 – Present

$3.8 M

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3975% CONFIDENCE LEVEL, 100% FUNDED

Self-Insured Reserve

Actual current reserve is $20,814,000, at the (50%) and confidence (50%) level.

$84,849,000

$90,640,000

$77,647,000

$56,033,000

$48,440,000$45,000,000

$55,000,000

$65,000,000

$75,000,000

$85,000,000

$95,000,000

Reserves have decreased $42M in 11 years of new WC Model at 75%

confidence level, 100% funded

Current CBM7/1/13 – Present

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WC Self-Insured Experience Modification

LOWEST EXPERIENCE MOD SINCE CBM IMPLEMENTATION

Fiscal Year Experience Modification

State Self-Insurer Assessment

2006-2007 2.33 $2,134,260 2007-2008 1.99 $1,561,101 2008-2009 1.76 $1,076,701 2009-2010 1.39 $650,385 2010-2011 1.21 $251,181 2011-2012 1.31 $321,652 2012-2013 1.27 $425,013 2013-2014 1.25 $484,785 2014-2015 1.43 $513,785 2015-2016 1.14 $381,316 2016-2017 1.16 $367,990

2017-2018 1.08 $378,707

The Self-Insurer Experience Modification is used in the calculation of the District’s annual WC state assessment. The rating is promulgated by the state based on a formula using payroll and loss reports submitted by the District.

Current CBM

7/1/13 –Present

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Employee Satisfaction

2016-17 RESULTS

Triage / Initial SurveyMail-in

Post Closure SurveyOnline

95% 77%

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Claim Counts

FOCUS ON LOSS PREVENTION

1,9492,596 2,514 2,310 2,215 2,072 1,970 1,859 1,987 2,085 1,924 1,965

1,4681,087 1,246 1,402 1,393 1,510 1,500 1,497 1,491 1,366 1,364 1,391

3,417 3,683 3,760 3,712 3,608 3,582 3,470 3,356 3,478 3,451 3,288 3,356

0

1,000

2,000

3,000

4,000

5,000

6,000

Net Claims Report Only

Average of 3% reduction

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43IMPROVEMENTS DESPITE INFLATION

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44INDUSTRY INDICATIONS

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It (almost) happened again. Self-Insured TPA services spared

Industry EnvironmentCurrent CBM7/1/13 – Present

MERGERS & ACQUISITIONS

Page 46: Outsourcing vs. Insourcing When it makes sense to do both ......The mission of the Broward County Public Schools Workers’ Compensation Unit is to effectively, efficiently, and ethically

46BROWARD COUNTY PUBLIC SCHOOLS - WORKERS’ COMPENSATION UNIT

THANK YOU