Public Risk February 2018

PUBLISHED BY THE PUBLIC RISK MANAGEMENT ASSOCIATION FEBRUARY 2018

FLEET SAFETY POLICIES ENSURING YOUR SAFE RESPONSE TO EMERGENCIES PAGE 6

ALSO IN THIS ISSUE

SIX REASONS WHY IT’S VITAL TO HAVE A NURSE AT THE FRONT-END OF THE WORKERS’ COMP CLAIMS PROCESS PAGE 10

BRIDGING THE TRANSPORTATION GAP WITH RIDESHARING PAGE 15

FEBRUARY 2018 | Volume 34, No. 2 | 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 Amy J. Larson, Esq. Risk and Litigation Manager City of Bloomington Bloomington, MN PAST PRESIDENT Terri L. Evans Risk Manager City of Kingsport Kingsport, TN PRESIDENT-ELECT Jani J. Jennings, ARM Insurance & Safety Coordinator City of Bellevue Bellevue, NE DIRECTORS Brenda Cogdell, AIS, AIC, SPHR Risk Manager, Human Resources City of Manassas Manassas, VA Scott J. Kramer, MBA, ARM City/County Director of Risk Mgmt Montgomery County Commission Montgomery, AL

Fleet Safety Policies

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ENSURING YOUR SAFE RESPONSE TO EMERGENCIES

By Joe Garcia

Forestine Carroll Risk Manager Memphis Housing Authority Memphis, TN Sheri Swain Director of Enterprise Risk Management Maricopa County Community College District Tempe, AZ Lori J. Gray Risk Manager County of Prince William Woodbridge, VA Donna Capria, CRM, CIC, AINS Risk & Insurance Coordinator WaterOne of Johnson County Lenexa, KS NON-VOTING DIRECTOR Marshall Davies, PhD Executive Director Public Risk Management Association Alexandria, VA EDITOR Jennifer Ackerman, CAE Deputy Executive Director 703.253.1267 • jackerman@primacentral.org ADVERTISING Jennifer Ackerman, CAE 703.253.1267 • jackerman@primacentral.org

10 Six Reasons Why it’s Vital to Have a Nurse at the Front-End of the Workers’ Comp Claims Process

By Paul Binsfeld

IN EVERY ISSUE

15 Bridging the Transportation Gap with Ridesharing

By Joseph McCullough

Public Risk is published 10 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 2018 Public Risk Management Association

| 4 NEWS BRIEFS | 19 ADVERTISER INDEX

FEBRUARY 2018 | PUBLIC RISK

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JUNE 3–6, 2018 Managing risk in our cities, counties, schools, states and tribal nations presents unique challenges and PRIMA’s Annual Conference is the only conference dedicated to YOU: public sector risk management professionals.

Join more than 1,000 of your public risk management colleagues, leaders and experts for an exceptional learning and networking opportunity in Indianapolis.

REGISTRATION NOW OPEN! conference.primacentral.org

MESSAGE FROM PRIMA PRESIDENT AMY J. L ARSON, ESQ.

ne of my favorite places to visit is Washington, D.C. Whenever I’m there, I try to go and see at least one historical location and if I’m lucky and have the time, I visit the Lincoln Memorial. I find solace and the ability to re-center when I think about the great things that Abraham Lincoln accomplished throughout his life and how they have impacted our lives and our country.

Besides the famous Gettysburg Address, Lincoln is also the source of many idioms we still use today. One that I have on a Post-it in my office: “When you reach the end of your rope, tie a knot and hang on.”

When I think about this quote, many times I think about PRIMA and what it means to me. The PRIMA Community, whether it be PRIMAtalk or the Cybrary, is where I go when I’m faced with a situation where I need help, because why reinvent the wheel when someone smarter than me has probably already come up with a resource available for issues I am facing.

Another resource PRIMA offers is the Speaker’s Bureau. The PRIMA Speaker’s Bureau gives chapters the opportunity to request a speaker from an extensive list of experts talking about a variety of topics relevant to risk management today, including: contractual risk transfer; onsite wellness clinics; cybersecurity; civility; risk management leadership; selling risk management; enterprise risk management, and many more at no cost. You can learn more about the Speaker’s Bureau by visiting PRIMA’s website or by contacting Shaunda Ragland, PRIMA’s education director.

Before I wrap up this month’s article, I wanted to remind you that registration has opened

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So, when you reach the end of your

rope, remember that you have access to a multitude of resources at PRIMA. And, as always, if you cannot find what you are looking for, you can always call the PRIMA

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O

The Wisdom of Lincoln

offices or any of the members of the board to help you find answers.

for the Annual Conference in Indianapolis, June 3–6, 2018. This year’s conference provides registrants with three days of learning opportunities with daily general sessions and more than 55 classroom sessions, in addition to multiple opportunities to meet with vendors who are ready with products and services geared to make the work of public sector risk managers more efficient and cost-effective.

So, when you reach the end of your rope, remember that you have access to a multitude of resources at PRIMA. And, as always, if you cannot find what you are looking for, you can call the PRIMA offices or any of the members of the board to help you find answers.

“The better part of one’s life consists of his friendships.”

And “To ease another’s heartache is to forget one’s own.”

Until next month,

Amy J. Larson, Esq. Risk and Litigation Manager City of Bloomington Bloomington, MN

I’ll close with two more of my favorite Lincoln quotes:

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NEWS BRIEFS

NEWS Briefs

TESTING FOR TAINTED MARIJUANA CHALLENGES STATES

In states that have legalized pot, regulators have struggled to make sure the bewildering array of products on dispensary shelves are safe to consume, reports Stateline. States where the drug has been legally sold for several years such as Colorado, Oregon and Washington are still trying to figure out standards and laboratory testing rules for potential toxins such as pesticides, solvents and mold.

“The big challenge with this industry is the speed at which it innovates and evolves,” said Danica Lee, director of public health inspections for the city of Denver. “It continues to be a bit of an adventure.”

The link between illness and tainted marijuana isn’t well established. But anecdotes have emerged of vulnerable consumers, such as cancer patients, contracting dangerous infections after smoking bad weed.

States and cities are trying to head off a health crisis before it can happen. They’re balancing public safety concerns against some marijuana growers’ and manufacturers’ reluctance to pay for testing that’s expensive and not proven to improve safety, and some laboratories’ eagerness to run additional tests.

Lori Ajax, California’s chief of cannabis regulation, said in 2017 that writing regulations for lab testing was probably the biggest challenge her team faced in writing medical marijuana regulations. The medical marijuana rules have since been folded into rules for the adult use market, which opened Jan. 1.

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State regulators have had no guidance from the federal agencies that usually set health and safety standards for agriculture, food and medicine because the federal government considers marijuana to be illegal. They have been hampered by the fact that there’s little research on how marijuana tainted with potential toxins affects humans, partly because the federal government funds limited marijuana research.

And they’ve also had to adjust testing regulations to reflect the costs and amount of tests fledgling legal marijuana markets can handle.

In Oregon, for instance, initial rules rolled out in October 2016 for marijuana

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testing and laboratory accreditation contributed to backlogs at laboratories and shortages of product on dispensary shelves.

Regulators, seeking to ease the pressure on the market, issued new rules in December that reduced the number of times a harvest, or a batch of chocolates or candies, would have to be tested.

Donald Morse, a dispensary owner and chairman of the Oregon Cannabis Business Council, a trade group, said too much testing would have raised the price of marijuana too far. “It would have been out of reach to most people, and they would end up going back to the black market.”

The big challenge with this industry is the speed at which it innovates and evolves… It continues to be a bit of an adventure.

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People don’t just smoke marijuana. They vaporize it, bake it into brownies, use it in eye drops, and rub extracts of it onto their skin. Some people use the drug as medicine, others for the fun of getting high.

Danica Lee, director of public health inspections for the city of Denver

As of December 28, 128 officers had died in the line of duty in 2017, with 44 shot and killed. That’s down 10 percent from 2016, when 143 officers died, with 66 gunned down, according to data released by the National Law Enforcement Officers Memorial Fund, a nonprofit aimed at honoring officers and improving safety.

The only other year with fewer deaths in the past five decades was 2013, when 116 officers were killed.

“This is one of those good-news, bad-news situations,” said Craig Floyd, president and chief executive of the fund. “On one hand, you had 128 officers who made the ultimate sacrifice, showing the cost of public safety, but for the first time since 2013, the number of deaths has actually declined.”

Reasons for the drop could range from advanced safety gear such as bulletproof vests, better training, better relationships and reduced violence in communities—or just 2017 being an outlier, experts say.

NEW YORK CITY TO INSTALL PERMANENT BARRIERS TO PROTECT PEDESTRIANS Mayor Bill de Blasio is beginning the new year looking to protect pedestrians from potential vehicle attacks in New York City, reports CBSNewYork.

The mayor said the city will invest $50 million to install 1,500 permanent protective metal barriers, known as bollards, to create safer sidewalks and pedestrian plazas at key locations.

The NYPD and Department of Transportation are surveying sites to determine where the bollards work best.

The rollout will begin in March. All of the barriers are expected to be installed over the next five years.

“In 2017, New Yorkers witnessed the horrible capacity of people willing to do us harm, whether it was in our subways, on our bike

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paths or in Times Square,” de Blasio said.

“But we will not be cowed, and our expanded investment today in barriers and bollards in our public spaces underscores our resolve in keeping New York City safe from future attacks. In this new year, we can and will protect our iconic public spaces while New Yorkers go on living our lives, including by hosting a record number of tourists.”

“These additional safety bollards will allow us to better protect many of our landmark locations and many of the areas most frequently used for recreation,” said Police Commissioner James O’Neill.

The announcement was made in Times Square where a U.S. Army veteran mowed down a crowd last May, killing 18-year-old Alyssa Elsman, a tourist from Michigan, and injuring 22 other people.

In this new year, we can and will protect our iconic public spaces while New Yorkers go on living our lives, including by hosting a record number of tourists.

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ON-DUTY POLICE DEATHS NEAR RECORD LOW

New York City Mayor Bill de Blasio

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PUBLIC RISK | FEBRUARY 2018

FLEET SAFETY POLICIES ENSURING YOUR SAFE RESPONSE TO EMERGENCIES

BY JOE GARCIA

F

IREFIGHTERS AND FIRST RESPONDERS RISK THEIR LIVES EVERY DAY. And while there is no

arguing with the hazards of battling fires, it’s more than just flames at the scene that pose a threat to these brave men and women. Often, it’s the drive from the fire station to the emergency scene

that can be the real, unexpected danger. In 2016, the National Fire Protection Association (NFPA) reported an estimated 15,425 crashes involving fire department emergency vehicles. In fact,

firefighters are statistically more likely to be injured or die in a motor vehicle-related incident than during the course of a firefighting operation. Therefore, it is vital that every community fire and

emergency department places significant emphasis on their fleet safety policy. Doing so will not only save money (from claims or unexpected costs) but, more importantly, save lives in the community.

Don’t have a fleet safety policy in place?

Consider creating a comprehensive one as soon as possible. It is a key element for a fire department to reduce and control emergency vehicle accidents. Effective policies include information and actionable items on key topics such as safety inspections and documentation, agency vehicle response policies and training.

SAFETY INSPECTIONS AND DOCUMENTATION

Emergency vehicle inspections help ensure all vehicles are safe and operable for use in the field. A department’s fleet safety policy should require all vehicles receive routine inspections throughout the year, as well as basic vehicle

operational inspections prior to each “tour of duty.” An itemized list of the specific parts to be checked during inspections should be included.

Vehicle operators, command operators and maintenance personnel should contribute to the policy and provide feedback on what the routine inspection frequency should be, based on department use of the vehicles.

One of the primary vehicle parts to be included on any itemized list is the vehicles tires.

Ensuring the tires are in good condition and properly inflated is essential for the vehicle to manage the maneuvers and weather conditions it must operate in daily. According to the Technical Committee on Fire Department

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FLEET SAFET Y POLICIES: ENSURING YOUR SAFE RESPONSE TO EMERGENCIES

Apparatus, tires should be replaced at least every seven years, if not sooner. Factors contributing to tire aging include heat, usage, oxygen concentration and the inner liner. If during any inspection an issue is identified, repairs should be scheduled immediately. Or, when the time comes, tires should be scheduled for replacement due to age.

Some conditions may warrant a vehicle being removed from service until repairs can be made. Such conditions may include excessive leakage of fluids, poor tire condition, brake or steering defects, missing or broken seatbelts or inoperable wiper blades. Repairs should be made by trained and certified mechanics and, when complete, thoroughly tested before the vehicle is reinstated into the fleet.

All department members who perform inspections and maintenance must also know how to properly document and file paperwork. These documents may be required for insurance or investigation purposes if the emergency vehicle is involved in an accident.

AGENCY VEHICLE RESPONSE POLICIES Within the fleet safety policy should be a policy regarding vehicle response, or how an

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emergency team arrives at a scene. Safe arrival is critical and drivers should follow the response guidelines to reduce the risks and exposures they face en route to an emergency scene including, the use of emergency sirens, speed reduction in high traffic areas and proper intersection and right-away practices. Additionally, the policy should clearly indicate the types of calls that require lights and sirens and those that do not.

TRAINING

Firefighters complete extremely rigorous training to earn their position; however fighting the fire isn’t the only danger for which they must train. There are many basic operational and emergency-specific risks and hazards that firefighters operating an emergency vehicle should be aware of and a fleet safety policy is only as good as the training that is provided to uphold and understand it.

For example, in order to drive an emergency vehicle, firefighters are required to complete formal training on the exact apparatus they will be operating and, in some states, may require a commercial driver’s license. To assist, departments should provide new drivers practical drive-time to practice. Cone courses are a good tool for learning to maneuver large vehicles through obstacles without hitting hazards.

Furthermore, other elements of driver training should include (but not be limited to) a review of all applicable, important department policies and procedures—including fleet safety, disciplinary and emergency procedures—as well as basic familiarization with equipment and important driving techniques—such as defensive driving and distracted driving avoidance, passing and signaling, backing up, stopping, parking and intersection practices.

Additionally, beyond the basics of operation, there are some important, specific, emergencyrelated risks that all drivers should be aware of and that a policy should address, including siren syndrome, fatigue, seatbelt usage and light usage.

• Siren Syndrome describes the tendency drivers have to operate an emergency vehicle faster or more aggressively because the sirens are sounding. This may be a result of adrenaline rush and can cause the driver to lose control of the vehicle. Motorists on the road do not always hear sirens immediately and if an emergency vehicle is being operated under siren syndrome, it can increase the risk of an accident due to overdriving the emergency vehicle. Training is the best way to prevent siren syndrome

A thorough fleet safety policy should also include procedures for what to do in case an emergency vehicle is involved in an accident. Having a plan in place can reduce the consequences following the accident.

The policy should include steps such as, reporting the crash to dispatch; notifying the department so the appropriate personnel can respond to the scene and to the original emergency; documentation of the event; filing a claim and vehicle inspection.

and, if possible, basic driver training (and practice time) should include vehicle operation while the siren is sounded.

• Fatigue: Operating an emergency vehicle while fatigued is a major hazard because it lowers visual efficiency and increases reaction time. Often, emergency personnel face fatigue issues due to their unique and ever-changing schedules. While firefighters are known to engage in physical activity to wake themselves up during times of fatigue, the only real answer is proper rest and sleep.

With so many other distractions and hazards relating to operating an emergency vehicle, drivers who feel fatigued should refrain from operating the apparatus.

• Seatbelt Usage: It is a well-established statistic that 3 out of 4 people who are ejected from a vehicle will die. While it may seem obvious, a seatbelt requirement in the fleet safety policy is non-negotiable and should be strictly enforced.

• Vehicle Lighting Usage: Emergency vehicles often use lights and sirens to notify other motorists to the urgency of their response and provide warning of a hazard.

However, when responding to a scene

with emergency lights, emergency vehicles will often exceed the speed limit or pass through traffic intersections (e.g. run a red light). These actions increase the risk for an emergency vehicle getting into an accident (see sire syndrome above). Therefore, it is helpful to outline within the fleet safety policy directions for determining which emergencies require lights and siren response and therefore avoid unnecessary excessive speed and aggressive driving. Your policy should match the language for emergency vehicles found in your state’s governmental immunity statute.

Remember, driver training is not a one-time event. It should be continual throughout a driver’s career as a refresh on policies, techniques and new procedures.

AN ACCIDENT OCCURRED, NOW WHAT?

A thorough fleet safety policy should also include procedures for what to do in case an emergency vehicle is involved in an accident. Having a plan in place can reduce the consequences following the accident. The policy should include steps such as, reporting the crash to dispatch; notifying the department so the appropriate personnel can respond

to the scene and to the original emergency; documentation of the event; filing a claim and vehicle inspection.

Attending to the safety of the crew and all involved parties is the number one priority when an accident does happen, and this includes providing medical assistance and securing the accident scene to prevent further damage or injury.

Responding quickly and efficiently to an emergency is always the goal of first responders such as firefighters. However, without a sound fleet safety policy, emergency vehicles may never make it to the scene. If a department can put a plan in place with a comprehensive policy and train its vehicle operators and personnel, then they will be well positioned to handle any emergency that may come their way.

Joe Garcia is a risk management specialist for OneBeacon Government Risks.

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6 A NURSE

REASONS WHY IT’S VITAL TO HAVE

AT THE FRONT-END OF THE WORKERS’ COMP CLAIMS PROCESS

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W

BY PAUL BINSFELD

E ALL KNOW THAT ACCIDENTS IN THE WORKPLACE HAPPEN. Although proper training and

precautionary measures can help to reduce the number of such injuries, they can’t be fully avoided.

And when they do occur, they’re a pain. A pain for the worker who’s suffering from an injury and

may not know what to do next. A pain for organizations facing piles of bills from their employees’ emergency room visits. And to top that off, employers must deal with the inevitable paperwork, management of medical providers, claims investigations, and more. Employers are left spending a lot of time and money.

Through utilizing nurse triage for workplace injuries, this pain can be minimized. Placing a nurse at the front-end of the workers’ comp claims process has several benefits:



EMPLOYEES KNOW WHAT TO DO FIRST

When an employee is injured in the workplace, there can be a lot of confusion. From a stubbed toe to a serious wound, employees might not have any idea what to do next. Do they tell their supervisor first? Do they treat the wound themselves? Do they need to go to the emergency room? Where do they start?

Many times, supervisors who are notified of these incidents err on the safe side and send injured employees to the emergency room—no matter how big or small the injury.

Even though this may seem like the right thing to do for employees, it can mean for them hours and hours of waiting to be seen by a medical professional for injuries that only need a few minutes to be treated.

When a company implements a nurse triage service for their employees, that confusion is relieved. Employees and their supervisors know

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SIX REASONS WHY IT’S VITAL TO HAVE A NURSE AT THE FRONT-END OF THE WORKERS’ COMP CL AIMS PROCESS



EMPLOYEES FEEL CARED FOR

This is a plus for both the employee and the employer.

Accidents happen.

With nurse triage, handling workplace injuries isn’t so painful anymore.

When employees are given a clear process on how to handle their injuries, they know their employer cares about them and wants them to receive proper treatment.

Triage nurses are experienced, patient, quick-thinking, and most important of all—compassionate.

Having a compassionate nurse as their first point-of-contact, means that employees are comforted and receive immediate medical attention.

Being referred to pre-approved medical facilities also gives employees the confidence that they are going to get care covered by their employer. And helping to avoid a trip to the emergency room lets them know their employer cares about their time.

Employers understand that happy employees mean less turnover and a positive culture. With nurse triage, this can also mean fewer claims, less litigation, and reduced costs.

exactly whom to contact when an accident takes place and the employer is notified immediately of their injury.

This process also helps employees to get immediate care. Nurse triage contact centers allow for 24/7/365 access. Right away, employees are put in touch with a compassionate nurse. In many cases, with the nurse’s guidance, the employee can resolve the pain with 100 percent self-care.



EXPERT ADVICE

Having a trained RN available at a moment’s notice means that the injured worker does not need to rely on the advice or decision of their supervisor. A medical expert is there to instill confidence, so the employee can stay calm during the confusion or anxiety their injury may bring.

If the further medical attention is needed, the nurse guides the employee to the appropriate facility—one that has the proper equipment and medical practitioners to help with their specific injury.

Employers can also rest assured that their employees are getting the right advice from the right people. No longer do they have to worry about supervisors making dramatic decisions (sending all injured employees to the emergency room) or making no decisions at all (ignoring their workers’ injuries).

The employee’s information is sent to the proper facilities so that they are seen as quickly as possible and the incident can be resolved smoothly.

Although triage nurses are trained experts, they also have sophisticated clinical algorithms for more reliable and systematic triage of workplace injuries. These decision trees allow for nurses

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to more-deeply assess and understand each worker’s unique situation.

Injured workers receive the best advice for taking care of themselves and are each guided to the appropriate level of treatment.



EMPLOYERS SAVE TIME

With a nurse at the front-end of the claims process, employers save time. Because employees are encouraged and incentivized to report their injuries immediately, there is no gap in communication. Their incident is reported, all the necessary information is recorded, and each stakeholder (including the worksite supervisor, claims adjuster, HR liaison, and RTW coordinator) is immediately notified.

This instantaneous reporting is also important because it allows for organizations to have the most influence over medical care and RTW outcomes. When employees wait to report an injury, they might have already visited an ER and taken what they thought was necessary time off of work.

Not only does this allow for employers to save time from the reduction of late-reported injuries, but it helps them to escape the mountains of tedious paperwork that workplace injuries inevitably bring. The nurses take care of the reporting in real time, immediately delivering the information to all the stakeholders.



EMPLOYERS SAVE MONEY

Nurse triage may at first seem like an extra expense, but it actually helps organizations to reduce their costs.

Employers may fear that communicating workers’ compensation information would lead to an increase in their employees filing claims.

Instead, sharing this information reduces medical, disability, and litigation costs.

Supervisors tend to send injured workers to the emergency room. However, this level of care is usually not necessary. Many times, the nurse can guide the injured worker through self-care and recommend over-the-counter medications.

The employee may not even need to seek any

further medical help, leading to a 10 to 30 percent claims reduction.

If the circumstances do call for more medical care, the nurse will direct the injured worker to a pre-designated facility. This ensures employees are getting treatment at medical centers that the organization approves, avoiding being overcharged.

If incidents are reported at the time of injury, medical costs can be dramatically reduced.

Implementing nurse triage to take place directly after an incident can many times prevent injuries from becoming workers’ comp claims.

A slight cut can quickly become a dangerous infection. Having a nurse assess the incident right away ensures that these minor injuries don’t become anything more.

Statistics show that reporting an incident on the day it occurs reduces medical spending by 18 percent compared to waiting two weeks to report it, 29 percent compared to waiting three weeks, and 45 percent compared to waiting five weeks. The faster claims are addressed and handled, the less they cost.

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NURSE TRIAGE REDUCES LITIGATION

documentation is available to help avoid fraud and reduce litigation.

As previously discussed, nurse triage ensures employees that their organization cares for them and will help them get the medical care that they need. And when employees feel cared for by their organization, the rate of litigation and false claims declines.

Nurse triage can lead to a decrease in claims by up to 20 percent and reduce claims costs by 30 percent.

Accidents happen. With nurse triage, handling workplace injuries isn’t so painful anymore.

Because employees receive nurse triage through a contact center, these interactions are recorded. Not only does this ensure that the quality of these triage services is managed, but it also allows for documentation of the incident. If the incident results in a claim, this

Paul Binsfeld is the president and founder of Enspiri Solutions and Company Nurse, LLC.

LEARN IN YOUR OWN TIME WITH

PRIMA PODCASTS! PRIMA’s Podcasts are a quick and convenient way to learn on-demand and on your own time!

Meant to provide you with information on specific topics important to the public risk management sector and hot topics, PRIMA Podcasts are the perfect way to fit in education and training into your busy schedule.

Check www.primacentral.org for new Podcasts!

CURRENT PODCAST TOPICS INCLUDE: School Risk Management Workers' Comp Best Practices

AND MORE! FEBRUARY 2018 | PUBLIC RISK

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Further your public sector risk management education without leaving the office!

This Webinar series features top presenters delivering risk knowledge to your desktop!

PRIMA’S 2018 RISK MANAGEMENT

WEBINAR SERIES PRIMA WEBINARS ARE FREE FOR MEMBERS! Visit www.primacentral.org today to register for individual Webinars or for the entire program!

F E B R UA RY 2 1 | 1 2 : 0 0 P M – 1 : 3 0 P M E ST OPIOID ADDICTION SPEAKER: Fernando Branco, MD, Medical Director, Midwest Employers Casualty Company DESCRIPTION: During this webinar, we will discuss the origins of our current opioid epidemic. What changed in medicine around 20 years ago to cause the opioid explosion? What is addiction? When is addiction diagnosed? What are the current trends on the opioid addiction? What should we expect in the next few months and years? What can insurance companies do to improve the handling of claims involving opioid addiction?

AT T E N D E E TA K E AWAYS :  Understanding of the opioid addiction epidemic  Determine what steps to take to control claims with opioid addiction  How to avoid opioids and medications that control opioid’s side effects to be included in the claim  The future of the opioid epidemic

For more information, or to register, visit primacentral.org/webinars.

Bridging the Transportation Gap with

RIDESHARING

BY JOSEPH MCCULLOUGH

E

very year, as many as 3.6 million people miss medical appointments due to an inability to arrange reliable transportation. This happens in spite of the fact that $6 billion is spent on healthcare-related transportation each year. Reliable transportation is a key element within the continuum of care and barriers in transportation can lead to missed and rescheduled appointments—which derails an individual’s progress and complicates their recovery with costly consequences.

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BRIDGING THE TRANSPORTATION GAP WITH RIDESHARING

Missed appointments associated with workers’ compensation injuries cause employers to accommodate more time off for the injured worker, which can cause productivity to lag and drive up indemnity costs. Keeping an injured worker’s treatment plan on track is essential to achieving healthier outcomes and cost-effective claims resolution.

This transportation gap is a serious healthcare issue.

At the onset of a workplace injury, people often assume that a family member or friend can drive the injured worker to medical appointments.

Unfortunately, these ‘volunteer’ drivers are often not available. Alternative options, such as public transportation and healthcare transport services, can also pose problems for injured workers. Navigating public transportation with an injury can be dangerous. Service interruptions are common with traditional healthcare transport services providers. Issues with either solution may lead to late or missed doctor and/ or therapy appointments.

Ridesharing services can avoid the disruptions associated with the transportation gap altogether.

Within the last decade, ridesharing services such as Lyft and Uber have become a widely accepted means for transportation. Tens of millions of people use these services around the globe to commute—eliminating costly fees typically associated with other forms of transportation.

The exponential growth of ridesharing may end many Americans’ long-standing need for automobile ownership. The Bureau of Labor Statistics predicts that by 2025, households will spend more on ridesharing than on owning and operating individual vehicles.

THEN AND NOW

Despite the exponential growth in the use of ridesharing services for personal use, the vast majority of healthcare transportation coordinators within workers’ compensation still rely on an antiquated approach to sourcing ambulatory/sedan transportation services.

These coordinators rely upon a network of

independent drivers or the use of commercial services—like taxis. This method requires an inordinate amount of oversight in order to locate, vet and manage the transportation and injured worker/driver interaction. Not surprisingly, this approach often leads to missed connections, delays and re-booking of both the transportation and the medical appointment.

The traditional transportation solution offers little to no ability for the adjuster or case manager to monitor and confirm transportation in real time. Rush appointments are particularly problematic and expensive using this outdated method.

From a consumer perspective, the experience is seldom convenient or effective. Injured workers often find themselves waiting for extended periods of time before and after their appointments and have difficulty identifying their driver or car in crowded areas.

Forward-thinking players within workers’ compensation are integrating technology

Within the last decade, ridesharing services such as Lyft and Uber have become a widely accepted means for transportation. Tens of millions of people use these services, around the globe, to commute—eliminating costly fees typically associated with other forms of transportation. The exponential growth of ridesharing may end many Americans’ longstanding need for automobile ownership. The Bureau of Labor Statistics predicts that by 2025, households will spend more on ridesharing than on owning and operating individual vehicles.

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platforms with commercial ridesharing services, like Lyft and Uber, allowing the adjuster, coordinator and injured worker to monitor rides—in real time—with the assurance that the driver is available, vetted, on-time and reliable. Injured workers know their driver’s name, make of car and if desired, license plate number. The technology-enabled ridesharing solution is easy, safe, prompt and accommodates restrictions injured workers may have due to their injury.

That may sound simple, but it’s a radical change. Going from passive to active ride management is a transformative experience for everyone involved.

Before the injured worker is picked up, the technologyenabled ride management functions are faster, simpler and less timeconsuming. Users avoid the potential for a failed or late pick-up, as well as the need for time to make a new appointment and re-book transportation arrangements. All transactions are transparent; all parties know what is happening at all times. Injured workers can rate their satisfaction with their driver and ride for additional insight into the customer experience.

THE PROOF IS IN THE NUMBERS

Although data regarding the use of ridesharing services in the healthcare industry is still scarce due to the fact its use is relatively new within the space, what numbers exist are remarkable.

CareMore, a Medicare health plan in California, partnered with Lyft for a pilot to coordinate nearly 500 rides for Medicare beneficiaries. The beneficiaries’ age and relative health affected their ability to drive and therefore they relied on a third party to get to appointments.

Because many of the beneficiaries do not own or could not use a smartphone, CareMore and Lyft established a process where they could use a landline phone or basic cellphone to call for a ride. Nearly one-third of the beneficiaries said that receiving a ride to and from appointments was as important to their

health as monitoring their blood pressure. The Lyft drivers who participated in the program also received training to appropriately handle Medicare patients.

The results were impressive: • Average wait times for Lyft rides were less than nine minutes, compared to more than 12.5 minutes for traditional medical transportation service contractors.

• More than 80 percent of beneficiaries said they were satisfied with the service they received.

In a pilot between Lyft and a leading provider of reliable and consistent connections to care in the workers’ compensation industry, the average injured worker was picked up in under nine minutes from the time a vehicle was dispatched. The collaboration also improved the fulfillment of ‘rush’ ride requests by more than 64 percent. Rush requests represent

one of the biggest challenges in healthcare transportation today. The constant feedback loop from multiple parties saves time, keeps everyone informed, and provides transparency into the transportation transaction.

Driver qualifications and the safety of the patient continue to be the highest priorities when collaborating with ridesharing services. Providers should be aware of credentialing of drivers, including licensing, verification of driving record and background for seven years, drug tests, vehicle registration, licensing to operate as a passenger transport vehicle, and additional local requirements. Workers’ compensation providers should verify that Lyft’s standards meet or exceed all of these requirements. In addition, Lyft performs a proprietary vehicle inspection and re-credentials its drivers every six months.

The workers’ compensation industry can now utilize technology-enabled active ride

FEBRUARY 2018 | PUBLIC RISK

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BRIDGING THE TRANSPORTATION GAP WITH RIDESHARING

Driver qualifications and the safety of the patient continue to be the highest priorities when collaborating with ridesharing services.

Providers should be aware of credentialing of drivers, including licensing, verification of driving record and background for seven years, drug tests, vehicle registration, licensing to operate as a passenger transport vehicle, and additional local requirements.

management applications, allowing for the proactive resolution of care interruptions and ensuring continuity of care for injured workers.

For example, if an injured worker is running late due to traffic, the facility can be notified, in real time, enabling the immediate adjustment of the appointment to keep the care plan on track.

This is a dramatic change and is available today.

A technology enabled rideshare solution saves time for the claims adjuster and case manager.

Instead of calls or e-mails back and forth to schedule and confirm transportation details, the process is digital, fast and smooth. Time

once spent following up and re-scheduling rides is now available for other essential tasks.

The data generated by the digital process enables monitoring in real time, and provides information for monitoring and measuring the entire service.

WHAT’S THE PROGNOSIS?

Ridesharing services will soon be recognized as a “best practice” in bridging the transportation gap and keeping injured workers on the road to recovery throughout the workers’ compensation industry. Fasten your seat belt. Things are going to get interesting.

Joseph McCullough is the senior vice president of transportation and language at One Call Care Management.

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PRIMA Community lets you: • Connect with your peers and share information on risk management • Participate in discussion groups/communities • Post questions or respond to others’ questions • Obtain access to an exclusive member directory • Access documents from digital libraries • Create private and public groups to network online with your peers • View member blogs or create your own JOIN YOUR PEERS TODAY! community.primacentral.org

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PUBLIC RISK | FEBRUARY 2018

ADVERTISER INDEX

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PRIMA ANNUAL CONFERENCES June 3–6, 2018 PRIMA 2018 Annual Conference Indianapolis, IN Indiana Convention Center June 9–12, 2019 PRIMA 2019 Annual Conference Orlando, FL Gaylord Palms June 14–17, 2020 PRIMA 2020 Annual Conference Nashville, TN Gaylord Opryland June 13–16, 2021 PRIMA 2021 Annual Conference Milwaukee, WI Wisconsin Center

PRIMA INSTITUTE November 5–9, 2018 West Palm Beach. FL

ISO 31000 TRAINING March 13–14, 2018 St. Louis, MO Hyatt Regency St. Louis at the Arch November 14–15, 2018 Alexandria, VA The Alexandrian Hotel

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