SAVING THE CITYSix Steps to Superhero Risk Management

Gary Eastes, Risk/Benefits Manager,City of KnoxvilleCheryle Tuttle, Director, CSCTuesday, April 23, 20139:00 – 10:00 am

Gary Eastes, City of Knoxville

PRIMA Public Risk Manager of the Year

Theodore Roosevelt Workers’ Compensation & Disability Management Award

Champion Award for Excellence in Workers’ Compensation Management

Achievement Award for Excellence in Human Resources

HISTORY OF WORK INJURY CLAIMS AND MANAGEMENT

City of Knoxville

Self-insured and self-administered for worker’s compensation and liability

Fire department, police department, public works, et al.

1,700 employees: many are male and over 40, high chronic disease burden

“Employee Safety Is Not

My Responsibility”

“What Works in the Private Sector Will Not

Work Here”

“What We Do Is Dangerous and Employee Injuries Are Unavoidable”

“The Public Does Not

Care”

“Safety Rules Prevent Getting the

Job Done”

“What Matters is Getting the Job Done,

Not How It is Done”

How Things Used to Be

“The Public Does Not Care”

Needs

• Managing the rate of injuries

• Managing claims• Data analysis

Hurdles to Get Over

• Decentralized Management• Lack of a Safety Culture• Lack of Safety Expertise• Poor Data• Limited Data Expertise

Workers’ Compensation Costs

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

$6,000,000

Number of Disability Settlements

Number of Claims over $70,000

Employer

Risk Managemen

tSupervisor

DepartmentCivil

Services

Case Management

Case Manager

PayerInsurer

Employer

Medical

ProvidersPrimary

Care Provider

MROPhysical

Therapist/Rehab

SpecialistSpecialist ProviderInjured

Worker

Key StakeholdersKey Stakeholders

HOW WE TURNED IT AROUND

First Steps

Upgrading Risk Staff

Reopening the Health, Education and Wellness Center

Closing On-Site Medical Clinic

Contracting for Higher Health Care

Education

Improving Use of Data

The Leap• Dramatic expansion of the contract

for on-site medical services (2011)

• Included on-site/dedicated physical therapy, ergonomics expertise, and case management

• Integrating the occupational/health resources in a holistic approach (on-site diabetic educator/nutritionist and fitness specialist)

• Team approach to data analysis

Two Key Organizational Changes

On-site Physical Therapy

Therapy• Full-time therapist puts emphasis on best use of resource rather than managing billing

• Better use of work conditioning

• Resource for safety and work assignments

• Some PT services at employee’s work location

On-site Case Management

• Close coordination with claims adjuster as well as on-site treatment staff

• Direct communication with supervision

• Resource for claims adjuster on medications and other issues

• Familiar to employees

Coordination with The Center

• Coordination of appointments to department needs• Service delivery at work locations (blood draws, drug

tests, physical therapy/work conditioning, classes, disease mgmt coaching)

• Light duty coordination• Case Reviews include treatment staff, case manager

and claims adjuster• Safety Program/Training consultation• Ergonomic consultation• Injury trend reviews

Structure Process Outcomes+ =

Process Changes

Improved Billing

•Total Health and Productivity Program

•Use of a holistic approach to combining resources

18

Improved Data Processing

•Web-based injury report•Control consistency of information

•Segregation of data

IMPROVING THE RISK AND CLAIMS ENVIRONMENT

Success StoriesDrivers & Goals

• Improve claim loss payment and loss adjustment experience

• Gain efficiencies – speed to close claim• Increase stakeholders’ satisfaction

Keys to Success

1. Establish ownership by all key management

2. Engage strong partners committed to our success

3. Design processes for improvement

4. Educate employees

5. Analyze results

6. Optimize Claims Solution

CSC’s RISKMASTER Accelerator

Policy Management Legal ManagementClaims Management

eBillLegal Matter Management

Legal Bill Review

Workers CompPropertyVehicleLiability

Workers Comp PropertyVehicleLiability

Non-Occupational

Automate and StreamlineWorkflow

Event to Claim Model

Easily Integrated Modules

Flexible System

QUESTIONS?