Broward County Board of County Commissioners Formerly Ascension - - PowerPoint PPT Presentation

Formerly Ascension Insurance

Broward County Board of County Commissioners

October 2018

Headquartered in Walnut Creek, CA, Relation has 35 offices and nearly 500 employees

• Local expertise with global resources

Objective of delivering exceptional customer value rather than shareholder return

• Privately held : Parthenon Capital and Century Capital

Comprised of nationwide innovators, leaders and advisors that have experience developing and executing new solutions and identify emerging trends Broad, diverse client base with vast public entity experience Manages more than $1B in premium and backed by leading private equity investment firm, Parthenon Capital, with over $3.5B in capital commitment Awards and Distinctions

• Named one of the fastest growing brokerage firms by Business Insurance, July 17, 2015
• Recognized as an Elite Agency by Insurance Business in 2015, 2016 and 2017
• Elite Women award by Insurance Business

About Relation In Insurance Services

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RELATION IN INS - FLORIDA

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Risk Management and Loss Control Consultants Leading Employee Benefits Broker & Consultant Licensed Third Party Administrator – Adjudicate Claims

• 75,000 per month
• $600,000,000 per year
• 9.5 million members

Licensed FL Insurance Agency – Brokerage

LOCAL

FLORIDA FOCUSED 100% of our workers compensation book is Florida

• rganizations with Florida claims.

LIKE MINDED

GOVERNMENT CENTRIC Specialist in governmental insurance and program administration since 1982.

SATISFACTION

98.6% CUSTOMER RETENTION Industry leading customer retention rates are 98.6% in

• ur Florida operation.

.

SEASONED

LONG EMPLOYEE TENURE Incredibly low employee turn-over. Offering great people, with extensive Florida experience.

DEFINING FACTS

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98.6%

Injury Triage

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What Who

When

TIME OF INJURY Designed to be a service for the time of incident, Available 24/7. REGISTERED NURSES Registered Nurses, triage trained, handling all calls. APPROPRIATE CARE RESOURCE Facilitating the right level of care from the first day.

INJURY TRIAGE SERVICE PROFILE

Why

FROI MEDICAL CALL CENTER Workplace injury triage unit. Care Advice Text Message Incident Info

E-Mail Notification

• Incident Details
• First Report
• Provider

Notification

• OSHA 300
• Other Forms

S1 Triage Incident Call

Demographic Info Injury Info Care Advice

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FROI SYSTEM

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CARE TEXT

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TIMELY REINFORCEMENT

Text message hits employees phone immediately following the phone call.

PROVIDER PIN

Google maps pin location provided, if a treatment location was recommended to caller.

FIRST FILL

Promotion of Client’s PBM program first fill info provided as part of care text.

CARE SUMMARY

Details of the care advice provided are included within the text for easy reference and reinforcement.

Dear Cerri, regarding the recent workplace injury you reported, the triage hotline is recommending you follow this care advice for your smashed finger on your right hand for the next 24 to 72 hours. Activity/lifting as tolerated. If it hurts (more than mild discomfort) cease activity. May continue/return to work duties. Immediate prescription needs can be filled with at pharmacy using following info: Rx Group: XXXFF123456789 RX BIN: 321654 RXPCN: S1PBM

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WHAT IS IS HR API I LI LINKAGE?

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HR API LINKAGE

Our API HR system connection will request from the HR software the information of the specific employee on the

• phone. It then extracts the data needed electronically in

the background of the call. Our system is a real time request scenario. This connection allows for our Triage service to deliver:

• Immediate employment verification
• The most accurate reporting data
• A 50% faster call duration
• The best injured worker experience

99.9%

Demographic Data Accuracy

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Easily Customized Easy to Use

Connect to a Triage nurse with a simple touch of the button.

Photo Sharing

Real time photo sharing, allowing the nurse to see the injury for better evaluation.

✓ Works with iPhone or Android ✓ Connect to RN w/ Touch of a Button ✓ Real Time Photo Sharing ✓ Unlimited Downloads

INTERACTIVE PHONE APP

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Reflect company specific information such as post injury protocols or First Fill

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CUSTOM SURVEYS

Text Survey Platfrom First hand knowledge on injured worker’s experience with s1. Quantifiable Reports

“She was professional, helpful, polite, and knowledgeable! Well done!” — Injured Worker

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IN INJURY TRIAGE CASE STUDY

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Disposition Facility Type

• Avg. Cost Per Facility Type

Call 911 Emergency Room $2,092 Immediate Care Self Care $0 Occ Health/UC/ER within 24 hours Urgent Care $176 Occ Health/UC/ER within 4 hours Self Care Possible Outcome Combos # of Combo Occurrence Initial Treatment Savings Call 911 Emergency Room 1 $0.00 Call 911 Self Care 1 $0.00 Call 911 Urgent Care $0.00 Immediate Care Emergency Room 4

• $3,832.00

Immediate Care Self Care 2 $0.00 Immediate Care Urgent Care 61 $116,876.00 Occ Health/UC/ER within 24 hours Emergency Room 1

• $1,916.00

Occ Health/UC/ER within 24 hours Self Care 8 $1,408.00 Occ Health/UC/ER within 24 hours Urgent Care 49 $46,942.00 Occ Health/UC/ER within 4 hours Emergency Room 7

• $6,706.00

Occ Health/UC/ER within 4 hours Self Care 11 $23,012.00 Occ Health/UC/ER within 4 hours Urgent Care 37 $10,633.80 Self Care Emergency Room $0.00 Self Care Self Care 124 $55,279.20 Self Care Urgent Care 3 $0.00 FROI Only FROI Only 200 $0.00 Totals 509 $241,697 Total dollars saved in avoided medical expenses for every dollar spent in injury triage fees.

$8:$1

RETURN ON INVESTMENT

$241,697

INITIAL TREATMENT SAVINGS

$29,720

TRIAGE & FROI FEES

MEDICAL MANAGEMENT

MEDICAL MANAGEMENT PROGRAM

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Relation Insurance partners with Quinlan Medical Management (QMM) for medical case management, vocational rehabilitation services, in-patient and out-patient pre-certifications. QMM is a regional provider of quality, experienced medical case management throughout Florida and the Southeast.

Rapid Telephonic Case Management Field Case Management Vocational Rehabilitation Services Catastrophic Case Management Inpatient Pre-Certification Outpatient Pre-Certification Return-to-Work Coordination After Hours Call Center

+ + =

PROMPT COMMUNICATION

01

IMMEDIATE CARE COORDINATION

02

GOAL DIRECTED PLANNING

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OPTIMAL CASE RESOLUTION

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MEDICAL MANAGEMENT PRINCIPLES

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CERTIFICATIONS & CONTINUING EDUCATION

CCM

Certified Case Manager

CRRN

Certified Registered Rehab Nurse

CDMS

Certified Disability Management Specialist

CRC

Certified Rehab Counselor

COHN

Certified Occupational Health Nurse

• Case Managers continually update their skills by attending industry conferences, medical and claims-

related seminars, hold group “best practice” discussions and share knowledge throughout the company.

• Provide bilingual Case Managers who speak Spanish, Creole, and French.
• All case managers are licensed and hold at least one certification in the following areas:

MEDICAL MANAGEMENT STAFF

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Case managers have extensive experience with Workers’ Compensation, governmental entities, and know the local medical provider community. The seasoned staff can identify any pre-existing pathology which may impact recovery from the current work injury.

RAPID TELEPHONIC CASE MANAGEMENT

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86% of QMM telephonic case management patients return to work within 60 days Rapid telephonic case management is designed to promote optimal medical treatment coordination while decreasing medical, indemnity, disability, and litigation costs. Telephonic nurse case managers will begin immediate medical management of a claim, drawing on their clinical expertise. The TCM will accurately identify the appropriate medical intervention, manage cost- effective treatment, and return the injured employee to work at the earliest opportunity.

FIE IELD CASE MANAGEMENT

*Paradigm Outcomes study

Independent studies show a 4-to-1 ROI in cases receiving field intervention*

Relation Insurance/QMM offers

Consistent case management strategy specific to your needs Rapid communication and response to status changes Goal-directed planning Optimal case resolution Total transparency with all charges, expenses

FIE IELD CM COST SAVINGS

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Broward County currently spends $1500-$2000/month.

• 24 billable hours of case management/month

Incumbent company has proposed a rate increase to $90/hr.

• $2160/month. A $160 increase cost/month; $1920

increase cost/year Other Vendor has proposed fee of $92/hr.

• $2208/month. A $208 increase/month; $2496

increase/year Relation proposed fee is $80/hr.

• New lower cost of $1920/month. $80 savings/month,

$960 savings/year

2000 2160 2208 1920 $1,750.00 $1,800.00 $1,850.00 $1,900.00 $1,950.00 $2,000.00 $2,050.00 $2,100.00 $2,150.00 $2,200.00 $2,250.00 Monthly Cost

Monthly Case Management Cost Savings

Current Price Proposed incumbent price Other Vendor price Relation

IN INPATIENT AND OUTPATIENT PRE-CERTIFICATION

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Highly trained Nurse Case Managers review, investigate and validate the medical necessity and appropriateness of the treatment plan. NCMs make recommendations on certification or non-certification of the proposed treatment, hospitalization and surgeries, as well as the frequency, duration and type of

• utpatient therapies.

Preadmission certification Outpatient procedures and treatment Emergency admission review Physical Therapy concurrent review Continued stay/concurrent review Behavioral Health and chemical dependency Second surgical opinion Home health care Diagnostic testing review Durable Medical Equipment

IN IN-PATIENT PRE-CERT SAVINGS

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Price per in-patient Annual Charge Current fee: $100 $10,000 Incumbent proposed fee: $125 $12,500 Other Vendor proposed fee: $125 $12,500 Relation/QMM proposed fee: $ 95 $ 9,500

*price per inpatient pre-certification and the annual cost for 100 referrals per year Relation shows savings of $30 per pre-certification and annual savings of $3,000.

10,000 12,500 12,500 9,500 $0 $2,000 $4,000 $6,000 $8,000 $10,000 $12,000 $14,000 Annual Cost

Annual In-patient Pre-Cert Cost

Current Price Proposed incumbent price Other Vendor price Relation

OUT-PATIENT PRE-CERT COST SAVINGS

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Price per out-patient Annual Charge Current fee: $72 $7,200 Incumbent proposed fee: $85 $8,500 Other Vendor fee: $95 $9,500 Relation/QMM fee: $85 $8,500

*price per out-patient pre-cert and the annual cost for 100 referrals per year

7,200 8,500 9,500 8,500 $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000 Annual Cost

Annual Out-patient Pre-Cert Cost

Current Price Proposed incumbent price Other Vendor price Relation

VOCATIONAL CASE MANAGEMENT PROGRAM

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Certified Rehabilitation Counselors(CRC) will be assigned, and begins review of the file/medical records. The CRC and employer discuss the physical demands and essential functions of the job. Specifics including body positioning, load, duration, are assessed and documented. A job site analysis is available, at the employer request. CRC schedules physician consult(s) to review physical demands, essential job functions, restrictions and accommodations if needed. If MMI is not imminent, CRC will design a vocational rehab plan. At the employer’s request, the CRC can also provide a transferable skills analysis, labor market survey and assist with a job search

VOCATIONAL CM SAVINGS

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Price per VOC case Annual Charge Current fee: $85 $42,500 Incumbent fee: $85 $42,500 Other Vendor fee: $92 $46,000 Relation/QMM fee: $80 $40,000

*Price per request for annual cost based on 500 hours annually

Relation proposed fee shows $2,500 annual savings over current spend

42,500 42,500 46,000 40,000 $37,000.00 $38,000.00 $39,000.00 $40,000.00 $41,000.00 $42,000.00 $43,000.00 $44,000.00 $45,000.00 $46,000.00 $47,000.00 Annual Cost

Annual VOC Cost

Current Price Proposed incumbent price Other Vendor price Relation/QMM price

Medical Bill Review

MEDICAL BILL REVIEW RESULTS

Relation Rresults 1.18 thru 6.18 (Rx Bills Excluded)

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Total reductions off billed charges submitted by medical providers.

63%

TOTAL SAVINGS Total number of business days between time of carrier received date & bill completion.

4 DAYS

TURN AROUND Average PPO discount applied to post bill review allowance on bills from network providers.

12.5%

PPO DISCOUNT Total number of medical bills from providers within the PPO network.

77%

NETWORK PARTICIPATION

ADDITIONAL MBR METRICS

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MEDICAL BILL REVIEW RESULTS

Projected Broward County RMD Results (Rx Bills Excluded)

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Total dollars saved for every dollar spend in bill review fees.

$57 : $1

RETURN ON INVESTMENT

SCRIPT MANAGEMENT

BC BOC EXISTING RX SNAPSHOT

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REDUCING BROWARD RMD SCRIPT SPEND

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Dollars saved in prescription expenses that are avoided entirely, versus discounted.

MORE COST AVOIDANCE

There are 7 trigger buckets used to flag the right

• claims. Each trigger with its own weighted points.

RISK SCORE SYSTEM

Clinical medical reviews, specific to pharmacy treatment, are completed. Same-specialty peer to peer communication with treating MD, following review.

PEER TO PEER INTERACTION

EFFECT ON BC BOC’S Rx SPEND

• $35,338 Spend Reduction from 2019
• Year 2 is the second year of savings tracking,

and where the program’s effect fully presents itself.

Year 2, 63% Savings

The claims effected in this program can make up as much as 80% of the total spend.

Effects 30% to 80% of Rx

• $23,248 Spend Reduction from 2018
• First year begins to show the effect of
• program. Patient weaning, physician

cooperation, etc. take time to fully initiate.

Year 1, 25% Savings

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CONCLUSION

STATE OF THE ART TRIAGE PROGRAM

Projected savings of $241,000 annually in avoided unnecessary medical treatment.

LOCAL & EXPERIENCED CASE MANAGEMENT

$6,460 annual reduction in case management fees compared to existing case management fee structure .

MAXIMIZED BILL REVIEW SAVINGS

Projected savings of 63% off total charges, equating to over $8,000,000 in annual medical savings.

MORE THAN ADMINISTRATIVE

.

WHY MOVE FORWARD WIT ITH RELATION

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FLORIDA PUBLIC ENTITY EXPERTISE FOCUS ON Rx AVOIDANCE

Projected Savings of $68,000 over a 2 year period from intervention measures. Relation’s workers compensation book of business is almost 100% Florida public entities. We are specialists in managing claims costs and integrating Loss Control Programs.

THANK YOU