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Craig D. Thorne, M.D.
VP/Medical Director, Employee Health and Wellness
Onsite Clinics for ALL Care:
The Erickson Living Experience
Joselle Bamford, R.N., C.O.H.N.
Sr. Occupational Health Nurse
1. Overview of Erickson Living’s integrated health, safety
and well-being program
2. Onsite Employee Health and Wellness Centers:
Personal and work-related services
Improved reporting and compliance
Return-to-work process
Provider performance management
3. Impact on reducing Workers’ Compensation costs
4. Q&A
Today’s Objectives
Erickson Living at a Glance
• Third-largest
independent living
provider in U.S.
• 23,000+ residents
served
• 14,000+ staff; 8,500
full-time
• 96% occupancy;
industry standard is
90%
Erickson Living Locations
ColoradoWind Crest
FloridaDevonshire at PGA National
Chatsworth at PGA National
KansasTallgrass Creek
MarylandCharlestown
Oak Crest
Riderwood
MassachusettsBrooksby Village
Linden Ponds
MichiganFox Run
New JerseyCedar Crest
Lantern Hill
Seabrook
North CarolinaWindsor Run
PennsylvaniaAnn’s Choice
Maris Grove
TexasEagle’s Trace
Highland Springs
VirginiaAshby Ponds
Greenspring
19 communities, 11states
Greenspring Village, Springfield, Virginia
Vision, Mission and Values
Erickson Living® helps
people live better lives.
We strive to be the most
valued and trusted
leader in senior housing
and services through
operational excellence,
integrated senior health
and wellness and a
commitment to the
Erickson Way culture
and values.
Respect & Caring
Diversity
Friendliness & Enthusiasm
Integrity
Responsibility
Excellence
Teamwork
“We share our gifts to create communities that celebrate life”
Person-Centered Approach
“Caring enough to understand the individual and
customizing our approach to recognize the
person’s gifts, their needs, their preferences, and
their goals”
Integrated Employee Health, Safety, and Well-
Being at Erickson Living
Health advocacy
Personal health & wellness
Work-related services &
safety promotion
Workers’ compensation
care and management
Employee Health and Wellness Center Brochure
Our EHWC Provider Team
Our Journey: 2010-2017
• U.S.: 1985-1992: National health care costs increased 10% annually; workers’ comp costs increased nearly 15%.
• JHMI: 1992-2002 (Bernacki et al, JOEM, Vol. 45, No. 5, May 2002)– Patient advocacy & customer service, preferred provider network using
‘sports medicine’ model, close follow-up, continuous dialogue between parties & injured employee, & in-house legal services to settle certain cases.
– 73% decrease in lost time & medical claims; 54% decrease in all costs (incl. admin costs).
– 77% decrease in temporary/total days paid.
• Hospital of the University of PA: 1997-2002 (Green-McKenzie at al, JOEM, Vol. 44, No. 12, Dec. 2002)– 46% decrease in lost time mainly due to modified duty.
– 10% decrease in total claims.
Evidence-based workers’ compensation
management
Lean Six Sigma Methodology to Improve
Workers’ Compensation Management
• Structured brainstorming meeting which concluded these 7 priorities: 1. Describe critical pathways; draft SOP for
refinement
2. Eliminate waste: e.g., unnecessary & multiple data entry
3. Correct inconsistencies
4. Minimize handoffs; build in accountability
5. Determine process & outcome measures
6. Reengineer IT support systems
7. Determine training, coaching & consultative needs
Improving our Workers’ Compensation
Management: 2010
Structured brainstorming…
Goals*: 1. Map & standardize WC processes2. Reduce waste: info overload, time delays between steps, defects, re-work & variation3. Monitor processes & finances to advise communities on ongoing basis4. Prioritize to determine greatest point of need for improvement5. Produce balanced scorecard & report success compared to internal & external benchmarks
Assumptions:1. Accidents don’t just happen: they can be prevented & lessons can be learned2. Consistent processes are important to outcomes: but flexibility needs to be built in3. Too much info can be overwhelming: technology & info must support our customers (employee, manager, HR, nurse, provider & TPA)
*Deming: consistency of purpose, break down barriers
All ideas placed into 3 buckets: Waste, No brainers & Future!
Tools used: post-its, brown paper& enthusiasm…
Please refer to handout
Workers’ Compensation
Management: 2017
Employees are encouraged to seek medical treatment for their work injury/illness through the
onsite Employee Health and Wellness Center.
1. Onsite Nurse Practitioner (NP) performs physical assessment of injury/illness and
determines treatment plan and work abilities.
2. Employee can receive physical therapy through onsite Outpatient Rehab Department.
3. NP can review and address any barrier with Transitional Duty assignment.
4. NP can determine need for referral to specialist, if appropriate.
5. NP can closely monitor injury recover and facilitate optimal communication.
Barriers with Transitional Duty or Return-To-Work Process:
• Offsite provider/specialist maintaining off work status with minimal supporting medical
evidence.
• Supervisor cannot accommodate work restrictions NP.
• Employee “refuses” the Transitional Duty assignment or makes minimal attempt to perform
the assignment.
• Work restrictions change and updates are not communicated to supervisor.
• Work restrictions placed by offsite provider are not advancing.
Onsite Medical Treatment by EHWC
Early adjudication of claims that present as “Questionable” require timely recognition and
communication of the “Red Flags”. NP can provide assistance with early identification of a
questionable claim:
– Obtain injury details from different sources – Security, Manager/Supervisor, and the employee.
– Reach out to Human Resources for possible information that may be triggering/impacting claim.
– Discuss red flags identified with claim adjuster, Human Resources and Sr. Occupational Health Nurse
within 48 hours, to determine a plan of action.
– NP can provide key stakeholders with additional “Red Flag” information.
2016 - 67 claims denied by CorVel
2017 - 46 claims denied by CorVel through 9/30/17
Questionable Claim Intake Process
New injuries within last 7 days:
(employee name) Dining Associate (CC Dining) 8/31/17 Finger Laceration Employee states he was putting bus bins
away, and while reaching for a bin, he cut his right index finger on a small piece of glass. Employee washed finger
immediately. OCV Security completed assessment and report. No further medical treatment was warranted and
employee resumed unrestricted work duties. Not seen in the EHWC. No LT. No TD. (Claim #: 0877-WC-17-0001343).
(Start Date 6/25/2017)
Updates on Injuries within last 30 days:
(employee name) Housekeeper (CC Housekeeping) 8/19/17 Low Back Injury Employee states she injured her back
about 2 weeks ago and then again this past Saturday 8/19/17. She cannot recall the specific day she initially injured her
back, however she states it resolved in a few hours and that is why she did not report it. This past Saturday she states she
injured her right lower back again doing the same work duty which was mopping. She states the mop head became
detached from the handle which thrust her forward causing pain to her right lower back. She has continued to work without
seeking medical treatment until 8/19. OCV Security was contacted and a report was taken while the employee was in the
EHWC on 8/21. Employee was treated in the EHWC and released to RESTRICTED DUTIES that include: No lifting, pushing,
pulling > 5 lbs. Accommodated in Gen.Services department. Employee also seen at Patient First on 8/19. Plan of care and
work restrictions remain the same. On 8/22 Patient First placed employee off work with resuming restricted work duties on
8/23 and a full duty release on 8/28. PT started on 8/23. Employee seen in the EHWC on 8/23. LT: 1 day. TD: 6
days. (Claim #: 0877-WC-17-0001279). UPDATE: Employee continues with PT treatment. Resumed unrestricted work
duties effective 8/28.
Sample Weekly Communication Email – to leaders,
adjusters and corporate support partners
S = specific
M = measureable
A = attainable
R = relevant
T = time-bound
Also refer to position description for full listing of essential
duties and responsibilities.
S-M-A-R-T Goal Process
EHWC Center Provider Goals 2017: Financial
• Achieve Increase in Elective Use by 5% Compared to Same Time from Previous Year. (Visits include Sick Visits and Follow Up, Health IQs and Follow Up, Well Visits, Flu Vaccines, and Smoking Cessation).
• Verify Insurance Information at Time of Appointment and Collect Missing Insurance Information Within 2 Working Days.
• Achieve Employee Health and Wellness Center Revenue Projections and Budget Control.
• Achieve Average Incurred Cost per Workers’ Compensation Incident At/Below Internal Benchmark.
• Achieve 50% Increase in Well Visits from Previous Year.
Mid-year and Year-end Performance Scorecard
Definition of Value on Investment (VOI)
• ROI (Return on Investment) is the measure of the tangible benefits of a program or service (e.g. revenue).
• VOI includes:– Cost avoidance (e.g. clinical services that are offered at the
workplace instead of ER/Urgent Care/Private physician office)
– Intangible benefits (e.g. stay- at-work programs to reduce lost work time and staff replacement costs, increased employee satisfaction and engagement, higher productivity and decreased absenteeism, increased retention, improved population health metrics, etc.).
• VOI includes ROI.
EHWC VOI Calculation
EHWC VOI Calculation – cont’d
Workers Compensation –
Savings Compared to Market Trends
• $9,026,974 in hypothetical savings over market rate '11-'17• Savings represent the additional expense Erickson would have incurred had
their rates grown with the market.
2.25%
1.94%
2.06%
2.29%
2.46%2.37%
2.27%
2.38%2.47%
2.62%2.71% 2.71% 2.69% 2.69%
1.60%
1.80%
2.00%
2.20%
2.40%
2.60%
2.80%
3.00%
Actual Actual Actual Actual Actual Actual Forecast
FY11 FY12 FY13 FY14 FY15 FY16 FY17
WorkersComp - % ofWages
WorkersComp -MarketRates
Key Insights
Apply evidence-based practices to improve Worker’s Compensation
management.
Practice quality improvement to get a little bit better every day.
Partner well with CorVel to understand and use all available
resources:
Close contact with Adjusters and monthly case reviews
Weekly calls with CorVel Account Manager to address concerns
and opportunities.
Set clear S-M-A-R-T goals and track progress on a scorecard.
Celebrate successes and reward strong performance
2016 ACOEM Corporate Health Achievement
Award
Thank you.
Questions?See you at the
pool !!!