Public Risk January/February 2022 by Moire Marketing Partners

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION JANUARY/FEBRUARY 2022

WORKPLACE HEALTH AND SAFETY TRENDS OF 2022 PAGE 7

ALSO IN THIS ISSUE

ADVOCATE OR ADVERSARY? THE ROLE THE EMPLOYER MUST PLAY PAGE 12

THE EVOLUTION OF WORKERS' COMPENSATION NETWORKS PAGE 16

FREE TO MEMBERS

The Price of Leadership FEBRUARY 16 | 12:00 PM – 1:00 PM EST SPEAKER: Randy Anderson, CSP, Co-Founder and Independent Training Consultant, E3 Professional Trainers, LLC Leading is something that usually happens long before a person is granted a “position of authority.” Prior to becoming a manager or supervisor, leaders establish themselves as a person of influence, regardless of title. Being an effective leader, however, isn’t easy, and it comes at a cost. Anyone can make suggestions or complain about those that are above them but having the courage to make decisions that affect others and persevering through the frustrations and challenges to make a real difference is something not everyone is willing to do. In this session, attendees will learn the difference between influence and authority and how to maximize their impact through correctly utilizing both. ATTENDEE TAKEAWAYS: 1. Confront tendencies to manage when you should be leading, and be equipped to refocus on people and culture rather than tasks as often as possible 2. Learn an equation for building a legacy of leadership and the three keys to developing broader influence and impact with subordinates, peers, and even team members at a higher level within their organization 3. Incorporate a double-barreled approach of initiative and commitment to generate a higher level of employee engagement and empowerment

JANUARY/FEBRUARY 2022 | Volume 38, No. 1 | www.primacentral.org

CONTENTS

The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.

PRESIDENT Melissa R. Steger, MPA, CRM Asst. Dir., WCI & Unemployment Ins. University of Texas System Austin, TX PAST PRESIDENT Sheri D. Swain Director, Enterprise Risk Management Maricopa Community Colleges Tempe, AZ PRESIDENT-ELECT JamiAnn N. Hannah, RMPE Risk Manager City of Gallatin Gallatin, TN DIRECTORS Dana S. Henderson, CWCP Risk Manager Town of Mount Pleasant Mount of Pleasant, SC Steve M. LePock, II Risk Manager Virginia Beach City Public Schools Virginia Beach, VA

Workplace Health and Safety Trends of 2022 By Paul Binsfeld

Ann-Marie A. Sharpe, ARM, RMPE Director, Risk Management City of Miami Miami, FL Laurie T. Olson Sr. Risk Management Consultant City/County Insurance Services Salem, OR Adam F. Maxwell, CLRP Director, Administrative Services City of Westerville Westerville, OH Michael S. Payne, ARM, HEM Risk Manager City of Reno Reno, NV NON-VOTING DIRECTOR Jennifer Ackerman, CAE Chief Executive Officer Public Risk Management Association Alexandria, VA EDITOR Claire Howard Manager of Marketing & Communications 703. 253.1262 | choward@primacentral.org ADVERTISING Claire Howard Manager of Marketing & Communications 703. 253.1262 | choward@primacentral.org

12 Advocate or Adversary? The Role the Employer MUST Play By Cheryl Tinsley, ARM, ABC

IN EVERY ISSUE

16 The Evolution of Workers' Compensation Networks By Jill Harris

| 4 NEWS BRIEFS | 20 CALENDAR OF EVENTS

Public Risk is published 6 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: info@primacentral.org • Web site: www.primacentral.org Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year. Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine. POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314. Copyright 2022 Public Risk Management Association

JANUARY/FEBRUARY 2022 | PUBLIC RISK

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MESSAGE FROM PRIMA PRESIDENT MELISSA STEGER

Sustaining a Culture Takes Nourishment

ublic sector entities focus on the needs of the community they serve. For the service to be successful, public-sector employees need to understand their purpose. Who are their customers? What do their customers need? How should service to the customers be delivered? Organizational vision, mission, policies, and procedures communicate purpose and roles to their employees. Vision is a future statement that establishes the direction an organization is headed. The statement is the pinnacle definition of organizational success proudly shared with others. The statement also helps attract and maintain employees who are like-minded and committed to the organization’s purpose. The mission is a current statement focusing employees on who and how they serve with an emphasis on and direction toward the vision. The mission statement drives the organization outlining the business objectives and framework to prevail. Policies explain why certain actions are required by employees. Policies ensure compliance with regulatory requirements, but they also provide guidance to employees promoting success in their work product and behavior. Procedures are coupled with policies, providing step-by-step instructions to employees on how to meet requirements. Organizations should have transparent and meaningful policies defining expectations and uniformity to processes. Public entities should periodically review policies and procedures to ensure they remain current and relevant to regulatory requirements and the pace of change within the organization. Employees should periodically be reminded of the policies and procedures and updated on any changes to promote organizational effectiveness with a focus on the vision and mission.

Organizational vision, mission, policies, and procedures help define the customers and community served and the service delivered by the team. Let’s demonstrate the importance of each through a scenario. Imagine yourself at a local pub. You are standing in front of a dart board, but you have never played the game. You know enough to understand that the bullseye (the VISION in our example) is extremely important to the game, but you don’t understand its role. You need someone to explain that the MISSION is to put the dart in the center of the bullseye. At this point in our example, do you have enough information to win the game? Probably not because you don’t yet know the rules of the game, specifically how you get that dart to the bullseye. Merely walking to the board and sticking the dart in the bullseye might get you into a fight. That behavior is not conducive to our MISSION. You need to familiarize yourself with the rules, or POLICIES and PROCEDURES, of the game. You now understand to win you must throw the dart from behind the line drawn on the floor. Even with this information, most of us would not be able to hit the bullseye. Like learning our risk management roles, hitting the bullseye takes plenty of practice and sometimes a little luck. The scenario reveals that simply having a vision, mission, policies, and procedures is not enough. Leaders must continuously educate and communicate the purpose and process to the team. Employees need to understand the expected behavior toward the vision and mission as well as follow the policies and procedures to ensure successful delivery and consistency of service. One additional piece important to organizational success is culture. Culture is the culmination of traits, values, expectations, and practices established through team behavior. Culture is inherent. A culture within your

organization will exist whether it’s purposefully built, or not. Policies and procedures help establish a stronger organizational culture. Trust and unity develop when employees understand the routine, purpose of their work, and the core ethical values and priorities essential to the organization they serve. For employees to succeed, organizations should design their culture with intent and commit the necessary time to establish expected behavior. Coupled with our vision, mission, policies, and procedures, I have many common statements I use as gentle reminders to my team of our program culture. “Leadership isn’t tied to a title. We’re all leaders.” “It’s always right to do the right thing.” “Treat our customers with dignity and respect.” “We aren’t living to work; we’re working to live.” The culture you build needs continuous nurturing to sustain consistency and growth toward your organizational vision. In closing, I congratulate each of you on another successful year. Now that 2022 is here, I encourage you to evaluate your organizational vision, mission, policies, and procedures to determine if their intent mirrors the direction of your public entity. You should make any necessary edits and take the time to reinvigorate your team and familiarize them with their roles toward the organizational vision. Don’t forget to evaluate your culture. Sustaining a culture takes nourishment. Remember to continuously teach, guide, and model expectations of your team. Sincerely,

Melissa R. Steger, MPA, CRM PRIMA President 2021–2022 University of Texas System Austin, TX JANUARY/FEBRUARY 2022 | PUBLIC RISK

NEWS BRIEFS

NEWS Briefs

DO EMPLOYERS HAVE TO COMPLY WITH FEDERAL OSHA’S VACCINE-OR-TEST MANDATE RIGHT NOW? January 13, 2022 | JDSupra

Unless the Supreme Court intervenes, employers in roughly half of the United States must vaccinate or test employees by February 9, 2021. In those states, federal OSHA regulates workplace safety directly, and so the federal large employer vaccine-or-test mandate will go into effect without state input. What if my state has its own OSHA-approved workplace safety agency? In general, state workplace safety agencies—not federal OSHA—directly regulate employers operating in these states. These are often called “state plan states” in workplace safety circles. Federal OSHA standards generally won’t apply immediately to employers in states with state plans. The large employer vaccine mandate pending at the U.S. Supreme Court is an example. State Plan States and Federal OSHA States Instead, these states must adopt any regulation or standard passed by federal OSHA—or an effective alternative. Technically, these states were required to tell federal OSHA by January 7, 2021, whether they’ll adopt the mandate and are required by January 24 to act on that decision. But with the Supreme Court challenge pending, many state agencies aren’t exactly jumping to decide. There is quite a bit of uncertainty as a result. In the meantime, some state safety regulators, Virginia’s included, indicated that covered employers will have several weeks from state adoption to state enforcement. In other words, they do not intend to apply the ETS retroactively. Assuming the mandate survives the Supreme Court, when, if, and how it becomes law in state plan states is likely to vary. Compliance deadlines will probably vary also, but generally speaking, employers subject to state plans will have more leeway than their federal plan counterparts. Read More: https://www.jdsupra.com/legalnews/do-employers-have-to-complywith-7996911/

PUBLIC RISK | JANUARY/FEBRUARY 2022

WORKERS COMP MARKET STABLE ENTERING 2022

January 12, 2022 | Danielle Ling | Business Insurance The workers compensation insurance market entered the new year in a favorable environment as signs of economic recovery continue to stabilize renewals, market experts say. “Our outlook for the foreseeable future continues to be stable for most buyers,” said Debbie Goldstine, Chicago-based executive vice president of U.S. casualty, technical intelligence & emerging risk at Lockton Cos. “Signs of economic recovery did present in our renewals, and our payroll forecasts for work comp renewals for the second half of the year were up about 5%.” In November, the National Council on Compensation Insurance published its 2021 Workers Compensation Financial Results Update, which assessed the calendar year combined ratio at 87%. The reserve position for private insurers remained strong, growing to a redundancy of $14 billion as of year-end 2020 — results a spokeswoman said showed the market to be “resilient.” A.M. Best & Co. revised its previous outlook for the U.S. workers compensation insurance market for 2022 from negative to stable, noting an unexpected “muting” effect the COVID-19 pandemic had on insurers’ balance sheets and operating performance. The comp market continues to report favorable combined ratios driven by consistent loss ratios, according to A.M. Best’s most recent report, issued in November. Underwriting results deteriorated only slightly, benefiting from “lesser fraud, fewer workplace accidents, and lower defense costs.” Read More: https://www.businessinsurance.com/article/20220112/ NEWS08/912347140/Workers-compmarket-stable-entering-2022

WITHHEALTH PUBLISHES WHITEPAPER ON STRENGTHENING WORKPLACE SAFETY January 11, 2022 | Cindy Judd | Yahoo! Finance

WithHealth, Inc. (the "Company"), a digital precision care telehealth company for employers and their employees, is pleased to publish its whitepaper on strengthening workplace safety, highlighting what employers must do, can do, and should do to protect their workforce and their customers from COVID-19. Employers must understand all of the requirements of the OSHA Emergency Temporary Standard (ETS). Employers can adopt a culture of safety, including daily assessments, face coverings, routine environmental cleaning services, routine testing and positive test notification processes. WithHealth Founder and Chief Executive Officer, Cindy Salas Murphy, stated: "The COVID-19 pandemic has given us an opportunity to reexamine how we enable workplace safety for our employees and our customers. These opportunities have come at great cost. We have experienced illness, lost loved ones, suffered economic hardship, highlighted inequities in healthcare, and are living through a tremendous workforce shortage. However, it is my calling to ensure the losses we have experienced are not in vain. We must learn from this experience and create a workplace for tomorrow that is safer than ever. Together, we can commit to creating a workplace that is prepared to prevent illness, address inequities, and ensure that employees feel supported and respected through challenging times. Public health officials are encouraging us as business leaders to help increase the number of vaccinated Americans, as seen from the newly issued OSHA-ETS. Additionally, new research suggests that Americans trust their employers more than they trust government leaders, community leaders, and even religious leaders. This is why it is important for business leaders to share trusted information from the CDC, FDA and other public health experts in an effort to support our employees to make the best decisions for themselves and their families. Read More: https://finance.yahoo.com/news/withhealth-publishes-whitepaperstrengthening-workplace-133000192.html?guccounter=1&guce_refe rrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8& guce_referrer_sig=AQAAAAg6TqTN3ip_nE9XTZUFt2U1CCIk8_ kdMOVPYOwk-87Z59gpI2NG7lpTqlUhj-Gpt4v5oatiF2xOg3bnqNXWyGjHBXVZzmmwAlnhXqkwAJS_SCwMJHpPZbG02GLrbTLvV589t5TPra8lmtDwA8OXu21rpwhQr7MDWJ4dUp66VWUe

GROW EMPLOYEE ENGAGEMENT WITH A STRONG INVESTIGATION PROCESS

December 29, 2021 | Noah Webster | Risk Management Monitor In a tight labor market, employers are seeking to gain or retain a workforce with more pay, work for home and other perks. They can also improve retention through a culture of trust and consideration. Improve how you listen and investigate when someone on your team speaks up about compliance. If you investigate with urgency and respond, then you’ll gain trust and build employee engagement. Here is an anecdotal case, from the perspective of the business: An anonymous report comes in from a small foreign office, that says “It seems like there is something going on between the marketing lead and a partner. I suspect they are wasting marketing funds.” The seriousness of the issue is not entirely clear—maybe the person reporting the issue is questioning the quality of the marketing campaigns. It is a challenge to reach people overseas. Some initial questions are asked, but the case sits for months before anyone starts reviewing the matter closely. After almost a dozen interviews, no one reveals anything useful. The answer has to be found by sifting through years of email. The investigation ultimately uncovers how the company is being taken advantage of. It is shocking how so many people in the office know the marketing lead is stealing company funds, but said nothing. After the late start, combined with actual wrong-doing that is festering, the person who reported the wrongdoing and the rest of the office have stopped caring. The business is left with a problem infecting the whole office, instead of having to deal with only one or two bad actors. Compliance is a Retention Issue A compliance report may raise questions about potentially uncomfortable topics: harassment, fraud, conflicts of interest or any number of issues highlighted in a typical code of conduct. When a report is substantiated, someone might be disciplined or fired—thus, colleagues may view the person who reported the issue as disloyal to the team. Those who come forward may also fear that their company may not care about the reported issue or try to cover it up, and maybe even retaliate against them. Read More: http://www.riskmanagementmonitor.com/grow-employee-engagement-witha-strong-investigation-process/

JANUARY/FEBRUARY 2022 | PUBLIC RISK

PIONEER EXCELLENCE AWARD WINNER

Kurt V. Treiber, Jr., MBA, CPSI, CCMO

WINNER OF THE 2022 PRIMA PIONEER EXCELLENCE AWARD! PRIMA’s Pioneer Excellence Award honors a long-term PRIMA member who has truly benefitted from all the benefits PRIMA has to offer. 1. HOW DID YOU END UP IN PUBLIC RISK MANAGEMENT?

I started my career in Public Risk Management when I took the position of Risk Manager/Purchasing Assistant for the Town of North Branford, CT, where I worked for 5 1/2 years. I then moved to my current position as a full-time Risk Manager for the Town of Wallingford, where I have been for the past 21 years.

2. WHAT ARE THE THREE MOST SIGNIFICANT WAYS RISK MANAGEMENT HAS CHANGED SINCE YOU STARTED?

I started in Risk Management over 26 years ago; there have been several significant changes, most notably technology. With the advent of tablets and smartphones, we are connected in ways never thought possible before. With this technology has come Cyber risk and Cyber security issues which are a significant focus of Risk Management today. Also, having to navigate thru a pandemic has created new threats and challenges. Finally, with many employees shifting to working remotely, trying to quantify

PUBLIC RISK | JANUARY/FEBRUARY 2022

and qualify the risks associated with this change in the workforce has been a challenge.

3. WHAT ARE THE TOP THREE BENEFITS PRIMA PROVIDES TO YOU?

Networking is a significant benefit of PRIMA, both on the national and chapter levels; this has been a tremendous help to me over the years. The educational opportunities have also been a great resource; from seminars to classes, there are always ways to stay current on the latest risk management topics. Lastly, the National Conference has been a great benefit over the years.

4. WHAT PRIMA BENEFITS DO YOU THINK BEST SERVE NEW RISK MANAGERS IN THE FIELD?

PRIMA website is a treasure trove of resources that any new Risk Manager would benefit from. The Public Risk Management magazine and the e-newsletter are two other excellent resources that allow those new to Risk Management to get information on the latest topics and trends occurring in Risk Management.

KURT V. TREIBER, JR., MBA, CPSI, CCMO

5. WHAT ARE TWO THINGS PRIMA COULD GET BETTER AT (WHETHER IT'S EDUCATION, REACH-OUT, ETC.)

PRIMA could assist the chapters better with more support and outreach. I know PRIMA has a mentoring program, but I believe it could be more publicized. We need to get young people interested in Risk Management to see it as a viable and exciting career.

WORKPLACE HEALTH AND SAFETY TRENDS OF 2022 BY PAUL BINSFELD

WORKPL ACE HEALTH AND SAFET Y TRENDS OF 2022

rom the pandemic to the “Great Resignation,” the events of the past two years have transformed organizations everywhere, driving innovation for workplace health and safety. And as organizations prepare for the new year, they can expect the landscape of workplaces to continue to evolve. Here are my predictions for 2022’s workplace health and safety trends.

THE GREAT RESIGNATION AND THE INCREASE OF WORKPLACE INJURIES

REMOTE WORKPLACE INJURIES

This influx in U.S. workers leaving their jobs has been coined the “Great Resignation” by Anthony Klotz, an associate professor of management at Texas A&M University. Of course, reasons for resigning vary between individuals, but Klotz explained to the Washington Post that these reasons can be attributed to four main causes: a backlog of resignations delayed from the pandemic; higher levels of burnout; shifts in identity during the pandemic and, as such, shifts in jobs; and the return to in-person work, after enjoying the convenience of working from home.

With remote work here to stay, what does this mean for the future of workplace injuries, now that the home has become the workplace?

With so many workers switching jobs and organizations hiring new workers, while still being understaffed, there is less time for training. And without a proper training process, organizations put themselves and their employees at greater risk for workplace injuries.

To effectively address these injuries and avoid unnecessary visits to the ER, I again foresee employers providing their workers with access to nurse triage or, if they already provide nurse triage, perhaps looking to enhance their current program. Employers must ensure their triage process is easy-to-use so that employees understand the process for contacting a triage nurse, which can be especially confusing for remote workers without the support of their supervisor in the workplace.

Between April and August 2021, 20 million American workers resigned from their jobs, reports Fast Company from recent U.S. Bureau of Labor statistics.

As such, I foresee an increase in workplace injuries in 2022 which will lead to a demand for nurse triage and solutions for reporting of and training on workplace safety issues.

PUBLIC RISK | JANUARY/FEBRUARY 2022

Even though organizations have plans in place to return to the workplace, many will remain or transition back to being remote. According to an Upwork survey, 22% of the American workforce will be remote by 2025.

A Chubb study reports that 63% of remote workers are more cautious around their home to avoid the hospital and, as such, risk of exposure to COVID-19. But they are still encountering work-related injuries. In fact, the same study found that 41% of remote workers reported pain developing in their backs, shoulders, and wrists, possibly due to the need for more ergonomically sound home workplaces.

To further eliminate barriers to utilizing nurse triage, employers should consider easy and efficient injury reporting tools that allow employees to access a triage nurse through the channel they are most comfortable with: chat, call, or video.

THE FUTURE OF TELEHEALTH

At the beginning of the pandemic, telehealth usage reached all-time highs. According to McKinsey, overall telehealth utilization for office visits and outpatient care was 78 times higher in April 2020 than in February 2020. As of the summer of 2021, telehealth usage has stabilized, while still 38X higher than before the pandemic, McKinsey reports. Even though these rates are impressive when compared to pre-pandemic usage, one must ask why they have plateaued. Of course, the necessity of virtual care was a driving factor of the telehealth surge in April 2020, but why has usage dropped by 50% since then? One reason could be that the overwhelming demand did not allow for enough time and resources for vendors to perfect their telehealth processes. With issues in both staffing and scaling technology, telehealth may have only been chosen out of necessity. However, we can expect this experience to improve. McKinsey reports that investment in virtual care and digital health more broadly has skyrocketed, fueling further innovation, with 3X the level of venture capitalist digital health investment in 2020 than it had in 2017. If your organization offers telehealth as an employee benefit, it is important to ensure you are investing in a vendor who is a part of the future of telehealth. Ask your vendor what services and improvements to customer experience they will provide as telehealth models everywhere evolve to include a range of services enabling longitudinal virtual care, integration of telehealth with other virtual health solutions, and hybrid virtual/in-person care models, with the potential to improve consumer experience/convenience, access, outcomes, and affordability, according to the same McKinsey report.

MANDATES FOR COVID VACCINES AND TESTING

Organizations across the country are searching for an efficient COVID-19 testing and reporting process to prepare for evolving regulations, like the OSHA emergency temporary standard and federal vaccine mandate. If passed, they would require all businesses with 100 or more employees to ensure their workers are either vaccinated or tested once a week, which could include substantial fines up to $14,000 per violation. Employers face a sudden need for an efficient testing and vaccination reporting process to follow these regulations, if they pass. Your organization should look for a solution that includes secure reporting and information management to comply with following these rules, if necessary. Another important factor in vaccination reporting is booster shot reporting. As the omicron variant spreads, studies point to booster shots a way to help control the virus, as reported by The Washington Post. In the future, booster shots may become a requirement for workplaces, so it is important to have a process in place to report and record them.

THE NEED FOR EMPLOYERS TO ENGAGE IN BENEFITS UTILIZATION

With the increase in remote working, it has become more difficult for employees to access and navigate their healthcare, benefits, and communications with their employers. At the same time, employers are expected to be more engaged in the health, safety, and wellness of their employees to increase employee satisfaction, productivity, and retention. Organizations understand that employees need easier access to their health and wellness benefits via digital tools. In fact, a Mercer survey reports that 68% of employers globally plan to increase their spend on digital health and wellness. The pandemic has increased the urgency for easy access to these services, but it can be difficult for employees to navigate through many benefits vendors. And with Mercer

JANUARY/FEBRUARY 2022 | PUBLIC RISK

WORKPL ACE HEALTH AND SAFET Y TRENDS OF 2022

reporting that 44% of employees are less likely to leave employers who provide support for their well-being during the pandemic, employers must ensure they are not only providing care but supporting employees to access this care. Consider all the benefits you likely already invest in, including medical, dental, and vision care; access to employee assistance programs and other wellness-related benefits; an intake, triage, and reporting system for workers’ compensation claims; and more. Without proper access, these health and wellness benefits that organizations invest heavily in are underutilized. Employees aren’t getting the care they need, and employers aren’t getting a return from the programs they invest time and money to provide. A digital solution provides direct access to these benefits, which, in turn, increases employee satisfaction, productivity, and retention.

MENTAL HEALTH IN THE WORKPLACE

With over 40% of Americans reporting increases in mental distress, according to the CDC, employee mental health has become a focus for organizations across the country. Mental Health America reports that 85% of employees believe their workplace affects their mental health and wellbeing. Not only can investing in mental health resources greatly impact employees, but it can also improve an organization’s bottom line. In fact, employers see a return of $4 for every dollar invested in support of employee mental health, according to the National Safety Council. This increase of focus on employee mental health and wellbeing will continue to destigmatize mental health and drive innovation of mental health resources. We will see both the demand and opportunities for digital mental health resources, provided by employers. As your organization looks to invest in a digital workplace health and safety tool, it is important that mental health support is a factor in your search. Ensure that this tool allows for easy access to employee assistance

PUBLIC RISK | JANUARY/FEBRUARY 2022

programs, where employees can receive the mental health care that they need.

EMPLOYEE PRIVACY AND APP FATIGUE

Every benefit provider has their own website and app, each requiring a download and different password to remember. But that doesn’t mean they get used. In fact, a recent Statista report shows that 25% of apps downloaded are only used once. While organizations are looking to invest in digital health and wellness, as stated above, they should consider where these digital solutions should be accessed. By housing your benefits under one solution, preferably with single sign-on for easy access, your employees will have a seamless process, avoiding app fatigue and increasing their utilization of benefits. Make sure that your digital workplace health and safety tools can address the safety and privacy concerns of your employees. To avoid the security issues that may arise from downloading an app, look for a tool that works and feels like an app but that can be accessed via link. Your organization should also ensure

that your solution supports HIPAA technical safeguards for encryption, multi-factor authentication, and audit logging.

ARTIFICIAL INTELLIGENCE AND THE CUSTOMER EXPERIENCE

The drive of innovation we continue to experience of course includes the artificial intelligence industry, which Arizton reports will grow at a compound annual growth rate (CAGR) of over 46.21%, due to the evolution in health technologies. I expect the adoption of artificial intelligence to both increase data quality and the customer experience. For example, at Company Nurse, we see a demand in multiple channels for nurse triage. One of these being the option to use an AI chat so that employees can easily and efficiently report their injuries. And when employees can utilize a channel they are most comfortable with, they will have more confidence in the injury reporting, which, in turn, leads to an increase in data quality. Paul Binsfeld is the president and founder of Company Nurse and CEO of Lintelio

DAYS

55+

EDUCATION SESSIONS

80+

SPEAKERS

70+

EXHIBITORS

EXHIBIT AT THE PRIMA 2022 ANNUAL CONFERENCE JUNE 5-8 EXHIBITOR FACTS 50% of the attendees will attend ONLY the PRIMA Annual Conference 82% of PRIMA attendees have the purchasing power or a major influence in decision-making for their entities 70% of attendees have more than 20 years of experience in risk management

Conference.PRIMACentral.org

NETWORKING EVENTS

ADVOCATE OR ADVERSARY? The Role the Employer MUST Play BY CHERYL TINSLEY, ARM, ABC

RECENTLY SPOKE AT A QUARTERLY MEETING OF THE MISSOURI CHAPTER OF PRIMA ON THE ROLE EMPLOYERS MUST PLAY to create an advocacy-based claims approach to their worker’s compensation program. During my 30 years of work in the public sector, focusing on loss control and worker’s compensation, my approach leaned toward advocacy.

But I didn’t know that. “Advocacy” feels like the latest buzzword in claims management, doesn’t it? The approach I took to managing worker’s compensation was to focus on the person, not on the claim. I used to tell my co-workers that paperwork and processes are NEVER more important than people. What we were doing would today be an example of an advocacy approach to claims. Public sector employees don’t get many opportunities to brag about being ahead of the curve, but I guess our people-first approach was in fact advocacy.

According to the Workers Compensation Benchmarking Study, published in 2019 by Rising Medical Solutions, an advocacy-based claims model is “an employee-centric customer service claims model that focuses on employee engagement during the injury recovery process, removes adversarial obstacles, makes access to benefits simple, builds trust, and holds organizations accountable to metrics that go beyond cost containment.” (Workers Compensation Benchmarking Study, page 24, Rising Medical Solutions, December 2019).

In the last several years, many articles have been published in trade magazines about the shift of insurance carriers and third-party administrators from a traditional claims management system to an injured worker advocacy approach. Many articles start with a definition of advocacy. The need to begin with a definition that indicates the approach is still unknown to many in the business of managing a worker’s compensation program.

The insurance industry is still amid the great shift from adversary to advocate. Rising Medical’s 2019 study, along with a 2016 study, indicated a gap in knowledge of advocacy between the C-suite and the adjusters. The 2016 study showed 50 percent of respondents, all “claims leaders”, knew what an advocacy approach to claims was. The 2019 study focused on front-line adjusters. The same question revealed 72 percent did not

know what advocacy was. (page 24, Rising, December 2019). It is difficult to implement an advocacy system if 72 percent of those primarily responsible for making it happen do not know what it is. To be fair, adjusters take on the role of adversary, at least from the injured worker’s point of view, during times when claims must unfortunately be denied. Many adjusters carry a heavy caseload, which complicates the “focus on employee engagement” part of the advocacy model as defined earlier. It’s very difficult to engage employees when the adjuster has difficulty promptly returning phone calls or emails due to heavy caseload. The 2021 Workers’ Comp Industry Insights Survey Report, published by Healthesystems and Risk & Insurance Magazine, asked respondents to identify top barriers to injured worker recovery. A similar question was asked in both the 2016 and 2019 Rising Medical surveys.

JANUARY/FEBRUARY 2022 | PUBLIC RISK

ADVOCATE OR ADVERSARY? THE ROLE THE EMPLOYER MUST PL AY

The table below shows common responses from both surveys.

BARRIERS TO RECOVERY* Lack of Return to Work/Accommodation Option Litigation Psycho-social issues/other co-morbidities Lack of good employee/employer relationship Lack of time to proactively communicate with stakeholders Employee doesn’t understand the work comp system *Taken from Rising Medical Table 12, p. 16 and Healthesystems/Risk & Insurance, p. 8. Items listed do not represent complete listing. Italics added for emphasis.

The italicized items on the table are those employers can, and should, impact. Employers must be the bus driver of claims management. One of my pet peeves is to hear an employer say “we don’t do work comp.” Whenever I hear this, I think to myself, “my, you are a very large company or public entity to have no employees!” If you have employees, you “do” work comp. It’s the law my friends. The people I’ve overheard probably meant they have chosen to transfer the duties of managing claims to an outside vendor, either a carrier or third-party administrator. But in the end, you as the employer are the responsible party. No matter if you are fully insured, self-insured, or part of a pool, your money is being used to cover your legal and other obligations to protect your entity and your employees who may sustain an injury while working for you. Let’s look in some detail at ways employers can drive the advocacy bus: 1. Offer modified/light/transitional duty. Although described in a variety of ways, offering work to an injured worker who has some restrictions following an injury is a win for all concerned. If your employer does not currently offer modified duty work, begin as soon as possible! There are always some departments in any public entity that are short on staff and funds to hire more, and full of work. Ask all your departments to identify work that can be done by someone who must stay seated, only use one arm, must work indoors, etc. Sometimes departments have seasonal needs for extra hands. If an injured employee’s home department is not able to accommodate

PUBLIC RISK | JANUARY/FEBRUARY 2022

work restrictions, temporarily transfer the worker to another department who needs some help and has work that will accommodate the restrictions. Departments get extra help, and the injured employee gets regular pay while recovering from the work injury. Here’s another important part: charge the employee’s wages, which will be his/her regular wages, back to the home department. Their salary and benefits are budgeted in the originating department. Require the employee’s regular supervisor to maintain regular contact with their injured employee, even just to collect a timesheet or check in weekly. Regular contact will help the injured employee continue to feel connected to their work area. 2. Develop good employee/employer relationships. Many articles, books, classes, etc. have been and will continue to be offered on this topic. Here’s the quick version: people don’t always agree, but people can be respectful in their differences. If an employee is successful in becoming a tenured employee, they are apparently successfully performing the work duties they were hired to do and have assimilated into the corporate culture. In other words, you like them. So, if you like them before they are injured, treat them like you still like them after they sustain a work-related injury. Here are just a few tips: a. Train supervisors to maintain communication even if the injured employee is not at work. Supervisors are busy, and often get caught up in daily tasks. Encourage a weekly phone call or even a text to check on an injured worker. The injured worker is doing

the important work of getting better so they can return to helping with the workload at the office. Treat the person rehabbing at home as just as valuable as they were when they were at the office working. Make sure supervisors know it’s okay to talk to an injured worker. I am familiar with people who hired an attorney because their supervisor refused to discuss their modified duty work status when they called. b. Risk managers lead by example. Contact injured workers who will be missing work time or changing regular job duties. Prepare a one-page sheet outlining how workers compensation benefits are handled and offer specific contact information for someone in your office in case the injured worker has questions. Seriously injured workers are overwhelmed. Offering something in writing is helpful. Consider putting it in a folder that is easily identifiable. Even if you are fully insured. Remember, you are driving this advocacy bus. c. Use language that avoids jargon. Every industry creates its own jargon. We speak of claimants, TTD, PPD, compensability, etc. in the language of work comp. Realize everyone does not speak our language. As you prepare your one-page sheet, avoid using words that are common to us, but unknown to injured employees. 3. Litigation. Obviously, you are not allowed to advise an employee whether to obtain legal counsel. This is wholly the employee’s decision. However, the reasons injured workers hire an attorney are often unrelated to the seriousness of the injury. Providing quick and transparent communication about the process, providing contact information, and maintaining contact will often encourage an injured employee to at least try the process without an attorney. A couple of items to consider: a. Watch your language. Several years ago, I was invited by the Human Resources Director of my public entity to join her at a meeting of HR professionals. Since I was a guest, my table companions asked what I did, etc. When I told them I coordinated workers compensation, and one of our goals was to try to lower our litigation rates, one of the people at the table said, “why even bother?! They all end up getting attorneys anyway!” I quickly took a sip

of coffee to hide my expression. (I do not have a poker face friends.) And yes, this person did work at a public entity. Her language indicated to me that her culture was Us verses Them, and They always got an attorney. Do not assume an adversarial stance with your co-workers. You are all on the same team. b. Provide the entire picture up front. If an injured employee is facing surgery or has a serious injury that you know will result in a permanent partial disability settlement, explain that part of the process up front. In Missouri where I live, the Missouri Department of Labor/ Division of Workers Compensation publishes Chart Number 1, Permanent Partial Disability (WC-110-AI). I regularly included this chart in my discussion with injured employees either while they were in the hospital recovering from a serious injury, or before they had needed surgery due to an injury. I would go through a quick example showing how ratings are computed into settlements in Missouri. I included my memorized statement about not being able to advise them whether or not to hire an attorney as that was their choice entirely. Provide a complete picture of the process. If you are transparent, the employee may be less likely to call an attorney to explain the same process. c. This shift may take some time. In some corporate cultures, the jump to hire an attorney is “what everyone does”. Changing the mindset will take a few employees who have successfully navigated the workers compensation system to begin to see a reduction in your litigation rates. 4. Lack of time to proactively communicate with stakeholders. If your adjuster does not have time to proactively communicate with stakeholders, you may need a new carrier or TPA. Take the lead role in communicating. Pull all your key players together and explain that communication is paramount to you. Practice it yourself, and expect it from all your team members, whether they are direct co-workers, or vendor partners. In the world of government purchasing, some things cannot change immediately. But as you send out RFP’s, include asking about adjuster caseload. You need all your key players to have time to respond and reach out proactively.

One of my pet peeves is to hear an employer say “we don’t do work comp.” Whenever I hear this, I think to myself, “my, you are a very large company or public entity to have no employees!” If you have employees, you “do” work comp. It’s the law my friends.

5. Employee does not understand the work comp system. Of course, they don’t. Work comp is not their job – it’s yours (remember, you “do” work comp). The injured worker is likely an expert at their job, and you would NOT understand their work if you suddenly were dropped into their sandbox. Do your part to educate your injured employees on benefits and process as we have already discussed. This will reassure your employee that they are a valued part of the process of getting them back to work, and make interactions easier with the adjuster, medical providers, and nurse case managers. In the end, building an atmosphere of trust is key to advocacy. An employee is more likely

to trust their employer first before trusting an insurance carrier or TPA that is unknown to them. Taking the lead in building trust, in driving the advocacy bus, is a must for employers, and will improve relationships with the other key players in the work comp sandbox, including adjusters, etc. During this time of worker shortages, employers will be more likely to retain valued employees if they consistently treat employees with value and respect. Focus on people before processes and paperwork – a concept that worked long before the word Advocacy was used to describe it. Cheryl Tinsley, ARM, ABC has over 30 years of experience in public entity risk management.

JANUARY/FEBRUARY 2022 | PUBLIC RISK

THE EVOLUTION OF WORKERS' COMPENSATION NETWORKS

BY JILL HARRIS

mid all the changes in health care — and all the challenges that remain — experienced workers’ comp networks are evolving to meet the needs of providers, injured workers, and employers. Today, we see constructive partnerships between providers and payers that include a wide variety of provider types and a range of specialty services to serve injured workers. Next-generation networks are often tighter, specialty-focused, smaller — right-sized — networks that benefit all involved by grouping together the best of the best. Many such networks pull together smaller groups of providers with specific expertise who can best help injured workers. And, of course, specialty networks focus on narrow areas to let clinicians do more of what drives them and what they’re best at doing. These newer networks present providers with opportunities to keep up with their peers who are utilizing new treatment regimens with emerging technologies such as telemedicine and remote patient monitoring.

EVEN EVOLVING NETWORKS MUST COME WITH A SOLID FOUNDATION

A successful network is built on a foundation set in provider access, specialization, compliance capabilities, and quality controls. Comprehensive networks leverage industry experience, knowledge, and data analytics to provide greater discounts, specialties, and a geographic footprint that ensures clients have access to providers who support the needs of the injured workers they serve. Access: Today, thanks to deeper insights into patient trajectories, continual network review allows the best clinicians to rise to the top of the stack. Powerful analytics and algorithms pull data to evaluate outcomes and push data to aid clinicians in taking care of patients to promote network optimization. Processes powered by analysis, savings, geographic coverage, and strategic partnerships within the provider community also assure the best provider relationships remain intact, and network access remains comprehensive. Compliance: Network compliance requires strong relationships with state agencies and close monitoring of state medical boards, physician practice acts, pharmacy boards, and state regulatory agencies and rules. Networks must be knowledgeable and dedicate significant resources to ensure compliance of filings and reports, and coordinate program requirements with their providers and clients. Experienced resources monitor new legislation and regulation, address compliance of all applicable laws, have audit processes to verify guidelines and measure compliance processes on an ongoing basis. Quality: Optimal quality assurance programs are comprehensive, systematic, ongoing, and compliant with regulations pertaining to provider network quality improvement processes. Quality networks collect actionable intelligence through strong provider relationships, and monitor policies and procedures to maintain current provider database information across all applications for adjusters, case managers, clients, and injured workers. Networks also need multi-faceted quality management programs that review

provider credentials, verify compliance, and regularly confirm provider participation in the work comp network and the ability to accept new patients.

STRONGER PROVIDER ENGAGEMENT IS MOVING THE NEEDLE FORWARD

Most doctors don’t learn about workers’ compensation in medical school or residency, and implementing return to work practices can be difficult because physicians are not trained in them.1,2 While networks continue to be the best at what they’ve always done: managing the relationship with the provider, its particularly beneficial for them to take this engagement to the next level in workers’ compensation. Strong networks need highly skilled, cost effective providers who offer clinically appropriate, quality treatment to injured workers, and when backed with additional clinical resources and support systems can achieve the best possible outcome. Next level engagement is key to ensuring these types of providers are part of the network so injured workers can be channeled to them whenever possible to address every injury type and promote the best treatment. Next level provider engagement expands provider interactions to include personalized training, comprehensive tools, best practice provider programs, and recognition models for very important providers (VIP). Provider Education: It’s important to educate providers on the benefits of handling workers’ compensation claims as an extension of their current referral patterns, and how workers’ compensation eliminates patient collection activities and builds continuity of care. In addition, personalized training, workers’ compensation specific provider tools, as well as access to state and network specific reference manuals helps build collaborative and trusted partnerships with providers. Online Tools: Providers often spend more time on administrative tasks than on patient care. Online access to information helps improve front and back-office efficiency by allowing those team members to view bill status, repricing information, and Explanation of Reviews (EORs). By providing on-demand access to this information office staff can easily

get the answers they need without wasting time making phone calls. Continued investment in online tools improves the way practices complete tasks and benefits both payers and providers.

EVOLUTION IS KEY TO SUCCESSFUL OUTCOMESBASED NETWORKS

Outcomes-based networks (OBN) provide a channeling mechanism to health care providers who demonstrate a depth of experience in treating workers’ compensation injuries. One of the most important yardsticks for their success is the ability to help injured workers return to work, and to achieve this highly successful OBNs are always evolving and evaluating new information to arrive at the best-possible mix of effective care. One-way OBNs get consistently better at quantifying outcomes is through powerful data analytics and improved technology. Even a few years ago, the rigor of analysis we see today simply wasn’t possible. There are many important metrics to consider when determining if providers demonstrate a clear depth of experience in treating workers’ compensation injuries including treatment lag, lost-time rate, indemnity and medical paid per claim, as well as other expenses. Providers must show consistently better measures of clinical outcomes, medical utilization, pharmacy utilization, return to work, and financial outcomes when compared to their peers. Reviewing all claim types and comparing providers to their peers identifies those providers with the best overall claim outcomes. It’s also critical to look beyond the injury itself and consider factors such as mental welfare, comorbid conditions, and socioeconomic factors.

CUSTOMIZATION IS REINVENTING THE WAY NETWORKS ARE BUILT

Many states allow customization of provider networks to support compliance through built in measures that allow the right custom provider selection for each employer’s specific program. Customized networks can also be integrated with nurse triage, clinical programs, telemedicine, pharmacy, and other specialty networks to deliver even greater overall outcomes.

JANUARY/FEBRUARY 2022 | PUBLIC RISK

THE EVOLUTION OF WORKERS' COMPENSATION NETWORKS

States that permit direction of care are ideal for network customization and allow injured workers to be directed to preferred providers who are familiar with the workers’ compensation system, meet necessary contracting and credentialing requirements, and align treatment plans with nationally recognized guidelines. These networks also offer clients that analyze their own claims data the ability to include providers based on their analytic results.

TRADITIONAL NETWORKS ARE EXPANDING TO INCORPORATE SPECIALTY SERVICES

When the network lens is expanded to include specialty services clients gain the benefit of an array of supports at reduced rates through their existing network relationship. In conjunction with provider network rates, contractual relationships with providers of durable medical equipment (DME), diagnostics, physical therapy, home health, and other services within an extended network can further streamline patient care. These models often offer a single point of contact for all specialty equipment and services, scheduling, clinical oversight, and greater injured worker satisfaction. In the past, many of these same providers may have been referred to physicians or adjusters without the benefit of rates below fee schedule or hands-on coordination. Specialty network services are often foundational to workers’ recoveries and combined with physician networks can add up to a more inclusive recovery experience for injured workers. This already sizable outlay comes as we could be poised for an increase in the types of injuries that specialty services are perhaps best equipped to treat.

NETWORKS CONTINUE TO MAKE INROADS INTO MENTAL HEALTH CONCERNS

About one-quarter of the U.S. workforce suffers from depression. These employees are out from work twice as often with five times the “lost productive time” of others.3 To achieve the best possible outcomes for injured workers with mental health concerns we’ve come to understand that it’s wise to focus on

PUBLIC RISK | JANUARY/FEBRUARY 2022

the whole person, including mental health issues. Today, successful workers’ compensation models of care consider these aspects from the start and incorporate strong mental health provider networks. This is important because finding the right provider and gaining timely access to that provider is key to helping injured employees deal with mental health hurdles. In workers’ comp, behavioral health provider networks often include psychiatrists, psychologists, and professional counselors. Unfortunately, challenges around access to these types of mental health providers are growing, particularly in rural communities.4 There are only about 2,000 occupational medicine specialists in the U.S. for a population of 129 million full-time employees, and an average of 250 occupational physicians retire every year.5 More than half of counties in the U.S. don’t have a psychiatrist and nearly two-thirds have a shortage of mental health providers.6 While the outlook for treatment access remains worrisome, incorporating mental health providers into a larger workers’ compensation network can help address these access issues. Some mental health professionals hope the societal inequities and short¬comings highlighted by the COVID crisis will also lead to further innovations in delivering care such as using telemedicine to reach patients in the comfort of their own location.

RETHINKING NETWORKS FROM A MORE HOLISTIC PERSPECTIVE CREATES VALUE

More than half of workers’ compensation cases run from $10,000 to $500,000, and a decent percentage will experience a hospital admission.7 Expanding workers’ compensation networks to actively recruit highly experienced providers, offer customization, and incorporate additional services creates value and increases the network’s ability to comprehensively manage overall network needs including: • Credentialing providers • Supporting payers and workers in the community • Helping providers to grow and diversify their patient base • Allowing payers and providers to anticipate expected payments and reserve • Positively effect overall medical costs

• Channeling to providers with workers’ compensation expertise (where allowed) Today, work comp networks are also doing more to partner with providers than ever before. Supporting providers with administrative tasks and other assistance allows them to focus on providing quality medical care rather than unnecessary paperwork. In essence, a strong network means providers have someone blocking and tackling on a range of issues so clinicians can focus on injured workers. These include offering providers streamlined utilization review programs, scheduling services, and electronic billing. The benefits that workers’ compensation networks bring to employees, employers, and providers are clear. What will be most interesting to see is how these networks will continue to evolve to meet the industries ever-changing needs. Jill Harris is the senior vice president of network operations, Coventry. References: 1. https://www.businessinsurance.com/ article/00010101/NEWS08/311089996/Trainingdoctors-about-workers-comp-can-cut-costs. Accessed July 16. 2021. 2. https://www.dol.gov/sites/dolgov/files/ODEP/ research/saw-rtw/RoleofPhysicianinRTW_ FINAL_2015.pdf. Accessed July 16, 2021. 3. https://www.mckinsey.com/industries/ healthcare-systems-and-services/our-insights/aholistic-approach-to-addressing-the-us-behavioral-health-crisis-in-the-face-of-the-globalcovid19-pandemic. Accessed July 16, 2021 4. Access https://news.un.org/en/story/2020/10/ 1075122. Accessed November 21, 2021. 5. https://riskandinsurance.com/next-level-occhealth-training-will-help-improve-care-for-injuredemployees/. Accessed July 16, 2021 6. shortages https://www.mckinsey.com/industries/ healthcare-systems-and-services/our-insights/aholistic-approach-to-addressing-the-us-behavioralhealth-crisis-in-the-face-of-the-global-covid-19pandemic. Accessed November 21, 2021. 7. National Council on Compensation Insurance. Research Brief. “Medical Services by Size of Claim”; NCCI. Research Brief. “Medical Services by Size of Claim—2011 Update” 6. https://www.shrm.org/resourcesandtools/ tools-and-samples/how-to-guides/pages/ howtocreateareturn-to-worklight-dutyprogram. aspx. Accessed July 19, 2021

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