Report to the San Francisco Workers Compensation Council Peggy - PowerPoint PPT Presentation

Report to the San Francisco Workers’ Compensation Council Peggy Sugarman Workers’ Compensation Director December 2, 2019

Agenda • Accomplishments, Initiatives & Challenges • Performance Quick Facts • Claim Analytics • Financials Workers' Compensation Council Meeting December 2, 2019 2

Accomplishments & Initiatives Workers' Compensation Council Meeting December 2, 2019 3

Accomplishments Banking Modernization Phase II:  Implemented Phase II of the Banking Modernization Project, activating direct deposit of Workers’ Compensation benefit payments to injured employees (8/6/19) and vendors (7/15/19).  From implementation through 11/22/2019, 13,022 EFT transactions have been processed and 2,215 claims are enrolled in direct deposit for benefit payment  Received Environmental Service Award from the Commission on the Environment on September 24 Finance/Technology:  Successful launch of EK Health managed care services program for the SFMTA, including Utilization Review and Bill Review services Staff Training:  All-staff Mastering Emotional Intelligence training completed in early September Medicare Reporting:  Training scheduled for January, 2020 Alternative Dispute Resolution Program:  324 claims now in the ADR Program, including 147 Fire Department and 177 Police Department claims, as well as  5 claims opted-in to the ADR Program as of 11/22/2019  Experiencing significantly lower rates of legal representation on ADR claims (Fire – 10%, Police – 12%) compared to all claims (Fire – 49%, Police – 50%) Workers' Compensation Council Meeting December 2, 2019 4

Initiatives • RFQ for Special Investigation Services underway with goal of awarding new contracts beginning 7/1/2020 Banking Modernization Phase III for medical provider ACH payment will begin project • development in Q3 • Bank of America bank account closure and reconciliation largely completed; cancelled outstanding checks to be re-issued on December 2 Pre-Planning for largest-ever claim system software update (12-18 months) to 5.X • release of iVOS Claims Enterprise – Visual interface re-design Complete overhaul of user security profiles and access – – Reconfiguration for all existing interfaces (State of California, Medicare, Medical Bill Review, Optum Pharmacy Program, US Bank, Employee Portal/FSP, ISO Claim Research, and all local network interfaces for document imaging, faxes, etc.) and scheduler job activities Development enhancements to improve workflows requiring the 5.0 release to be launched in tandem – UR Cost Containment Program improvements • Workers' Compensation Council Meeting December 2, 2019 5

Challenges Undergoing a State Claims Audit • State Medical Legal Fee Schedule increases will be adopted in 2020 • SB 542, effective 1/1/2020 provides rebuttable presumption for peace officers and • first responders with PTSD, sunsets 2025 – Shortage of psychologists and psychiatrists Workers' Compensation Council Meeting December 2, 2019 6

Performance Quick Facts Workers' Compensation Council Meeting December 2, 2019 7

FY20 Q1 Performance Quick Facts Fiscal Health Claim Volume Ratio of Actuals to Budget Count of New Claims in Period 476 Indemnity Claims FY20 Q1 98.27% 289 Medical Claims Benchmark: 95% Benchmark: 402 Indemnity Claims/Quarter 281 Medical Claims/Quarter Claim Cost Duration Average Claim Cost in Period Average Days Open of Claims Closed in Period Indemnity Benchmark Medical Benchmark 233 Days $580 $685 CCSF $15,699 $15,266 Benchmark: 277 Days SFMTA $4,739 $9,756 $192 $463 Notes: All benchmarks based on rolling four-year averages (FY16-19.) Fiscal health metric includes overhead and claim expenditures and is based on revised budget, excluding any carryforward. Duration excludes disability retirement and future medical claims. Workers' Compensation Council Meeting December 2, 2019 8

Claim Analytics Workers' Compensation Council Meeting December 2, 2019 9

Claim Filing Frequency FY16-19 FY20 Q1 FY20 Q1 Increase / Decrease Average Average Average Total Indemnity + Total Total Indemnity Medical Indemnity + Indemnity + Department Medical Indemnity Medical Indemnity Medical Claims Per Claims Per Medical Medical Claims Per Claims Claims Quarter Quarter Claims Quarter Public Health 82 115 197 73 146 219 -9 or -11% 31 or 27% 22 or 11% Police 83 43 126 100 40 140 17 or 21% -3 or -8% 14 or 11% Fire 62 18 79 74 18 92 12 or 20% 0 or 2% 13 or 16% Sheriff 37 9 46 46 4 50 9 or 24% -5 or -54% 4 or 9% Recreation & 17 20 37 42 4 46 25 or 143% -16 or -80% 9 or 25% Parks Human 23 11 35 33 5 38 10 or 42% -6 or -56% 3 or 10% Services Airport 18 14 32 19 19 38 1 or 3% 5 or 40% 6 or 19% Public Works 15 16 31 12 24 36 -3 or -22% 8 or 51% 5 or 15% Water Pollution 7 4 11 8 4 12 1 or 15% 0 or 5% 1 or 12% Control PUC-Water 8 7 15 7 2 9 -1 or -13% -5 or -71% -6 or -39% Citywide 402 281 683 476 289 765 74 or 18% 8 or 3% 82 or 12% Workers' Compensation Council Meeting December 2, 2019 10

Claims Incurred Per 100 FTE Department 2016 2017 2018 2019 2020 Est. Fire 19 19 23 21 20 Police 23 23 21 20 20 Sheriff 23 20 20 22 20 Public Health 12 11 13 12 12 Citywide 11 11 12 11 11 Recreation & 9 9 9 8 11 Parks Public Works 11 9 10 11 10 Airport 10 10 10 8 9 Human Services 6 6 8 7 7 Water Pollution 2 2 3 2 2 Control PUC-Water 3 3 4 3 2 Notes: 1. 2020 Est. reflects a straight line of Q1 claim volume for the whole fiscal year Workers' Compensation Council Meeting December 2, 2019 11

Claims Incurred Per 100 FTE Top 10 Departments 25 20 Fire Police Sheriff 15 Public Health Citywide Recreation & Parks Public Works 10 Airport Human Services Water Pollution Control PUC-Water 5 0 2016 2017 2018 2019 2020 Est. Notes: 1. 2020 Est. reflects a straight line of Q1 claim volume for the whole fiscal year Workers' Compensation Council Meeting December 2, 2019 12

Claim Cause Distribution Top 10 Claim Cause Groups by Frequency - New Claims in FY2020 Q1 250 200 Recreation & Parks 150 Sheriff Fire Police 100 All Other Departments Public Health 50 0 Bodily Motion Exposure Cumulative Fall, Slip or Physical Caught In, Struck Misc Stress Abrasion Trauma Trip Assault Under, By/Against Between Notes: 1. Claim cause group definitions are listed in Appendix 1 Workers' Compensation Council Meeting December 2, 2019 13

Open Claim Stratification 500 450 400 350 300 250 200 150 100 50 0 100K- 150K- 200K- 250K- 300K- 350K- 400K- 450K- 500K- 550K- 600K- 650K- 700K- 750K- 800K- 850K- 900K- Over 150K 200K 250K 300K 350K 400K 450K 500K 550K 600K 650K 700K 750K 800K 850K 900K 950K 1M Recreation & Parks 11 11 3 5 1 2 1 1 1 1 2 Public Health 67 48 15 11 9 6 4 1 3 1 5 1 1 4 Sheriff 69 48 30 12 4 4 3 2 1 1 2 Fire 87 74 48 19 15 9 5 1 1 1 2 All Other Departments 119 69 34 28 12 3 7 7 4 2 2 1 2 0 1 3 1 4 Police 132 95 70 40 19 17 6 12 1 2 1 1 2 2 1 11 Notes: 1. $100K+ Total Incurred = $324 Million 2. All policy years for which incurred costs >=$100k/claim Workers' Compensation Council Meeting December 2, 2019 14

Open Claim Stratification 1,364 Claims >=$100k $72.9, 23% $324 Million $106.5, 33% Data as of 11/14/2019 $10.4, 3% Police Fire $36.3, 11% Public Health Sheriff $56.5, 17% $41.9, 13% Recreation & Parks All Other Departments Note: Dollar figures in millions Workers' Compensation Council Meeting December 2, 2019 15

Litigation Statistics Open Indemnity Represented Department Claims Added from Represented % Litigated Claims Litigated % Claims FY16-FY20 Q1 Police 420 208 50% 174 41% Fire 284 138 49% 122 43% Public Health 284 95 33% 87 31% Sheriff 208 91 44% 87 42% Human Services 99 50 51% 41 41% Airport 98 29 30% 25 26% Public Works 86 35 41% 32 37% Recreation & Parks 82 29 35% 25 30% Water Pollution 38 16 42% 16 42% Control PUC-Water 37 12 32% 8 22% Citywide 1871 800 43% 703 38% Workers' Compensation Council Meeting December 2, 2019 16

Financials Workers' Compensation Council Meeting December 2, 2019 17