Transcript Document

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ASSOCIATION COUNTY COMMISSIONERS OF GEORGIA GROUP SELF-INSURANCE WORKERS’ COMPENSATION FUND
Columbus Consolidated Government
May 14, 2013
Presenters
Ben Pittarelli, ACCG
John Smith, ACCG
Ashley Abercrombie, Marsh
Overview
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• Columbus Consolidated Government (CCG) has been
a member of the ACCG – Group Self-Insurance
Workers’ Compensation Fund (ACCG-GSIWCF) since
July 1, 2002.
– 176 county governments and authorities participate in this
fund
– CCG participates in the Large Deductible Option with 12
other large Georgia counties and consolidated
governments
– CCG obtains benefits of being self-insured as well as having
managed services by ACCG
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What is a group self-insurance fund?
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• Risk financing arrangement or mechanism made
up of homogeneous members to provide for their
insurance and risk management services.
- Very similar to a mutual insurance company
(company owned by its policyholders)
- Redirects insurance premiums. Instead of purchasing an
insurance product, premiums are used to capitalize a loss
funding program and to provide for required services. Any
surplus accrues to the benefit of the membership.
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History & Evolution of Pools
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• The Texas Municipal League was the first
intergovernmental pool (1974).
• The ACCG - GSIWCF began in 1982.
• Today there are over 500 public entity pools which
collect approximately $8 to $10 billion in premium
contributions annually.
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Characteristics of a Group Self-Insurance Pool
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• Member-owned and controlled
• Homogeneous group
• Group purchasing power
• In Georgia, regulated by the Insurance
Commissioner’s Office
• Dedicated member services
• Operate more cost-effectively than commercial
insurance companies
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Advantages of the ACCG Insurance Programs
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• Non-profit organization; no income or premium tax
• No sales commissions
• Extensive knowledge and experience with Georgia public
entity workers’ compensation risks
• Professional, stable management staff
• Well-trained, specialized claims administrative services
• Specialized and extensive loss control services
• Provide CCG access to state-of-the-art claims information
management system
• Continued availability of coverage – Over 30 years
• Underwriting and investment income belongs to members
• Dividends – Over $50 million returned from ACCG-GSIWCF
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What’s included in the GSIWCF program?
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• Management oversight by the ACCG professional
insurance staff
• Claims administration services
• Access to state-of-the-art claims system
• Excess Workers’ Compensation coverage (Statutory)
• Subsequent Injury Trust Fund Assessment
• Workers’ Compensation Board Assessment
• Banking, actuarial, financial auditing, claims auditing
services
• Unlimited professional loss control / safety
consulting services
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Total Cost of Risk – Workers’ Comp
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Over 2/3 of cost for CCG’s workers’ compensation is in losses
within the City’s deductible.
29%
71%
Incurred Losses within the Deductible
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Premium
Issues at Hand
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The Estimated Ultimate Losses within the Deductible have
increased by 51% and the Pure Loss Rate has increased by
31% since 2007. (BYNAC Actuarial Report - July 6, 2012.)
5,000
5
4,000
4
3,000
3
2,000
2
1,000
1
0
0
2007
2008
2009
2010
Policy Year
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2011
2012
Pure Loss Rate
per $100 P/R
Losses in
Thousands
Estimated Ultimate Losses within the
Deductible
Issues at Hand
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• Average number of claims per employees is 1.65
times that of the average ACCG-GSIWCF member
(2007-2012 losses)
• Rising medical costs
– Cost of treatments
– Utilization
– Medicare Set-Asides include Pharmacy as of 2006
• Experience modification continues to increase, but
NCCI formula change may benefit CCG in 2014
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Managed Care Organizations in Georgia
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Source: http://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/related_files/site_page/MasterQuarterlyReport.pdf
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Recommendations on Reducing Costs
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√ Make a management commitment to improve CCG’s
risk management culture
√ Hire a risk manager to be CCG’s advocate
√ Review CCG’s posted panel of physicians
√ Improve communication with those physicians as well
as department heads & Claims Unit; continue…
• Adjust posted panel if necessary to control costs
• Explore triage service through the ACCG Claims Unit
• Review and improve Return-to-Work program
• Analyze focus areas for loss control efforts, including
policies, procedures and training and implement
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ACCG
Claims
Administration
Team
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• Claims Manager – 28 years experience
• Claims Supervisor – 33 years experience
• Lost Time Examiners – average experience = 18.5
years
• 3 Certified, Contracted Nurse Case Managers
Historical Claims Volume:
14,119 lost time claims
58,372 medical only claims
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CCG Medical Management
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Current Panel System
• 10 non-associated Physicians
Established by the employer
• Must have 6 physicians to include:
– 1 Orthopedic
– 1 Minority
– No more than 2 industrial clinics
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ACCG
Claims
Partners
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• Telephonic and field nurse case management, including
Utilization Review: GENEX
• Medical Bill Review / PPO: MCMC
– 2012 savings for CCG: $1,393,296; 48% below charges submitted
• Pharmacy: Express Scripts
– 2012 savings for CCG: $36,249; 22.25% below GA Fee Schedule
• Physical Therapy: Align Network
– 2012 savings for CCG: $87,889; 31% below GA Fee Schedule
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Loss Control Services
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• Local Government Risk Management Services
- Joint effort of ACCG & the Georgia Municipal
Association (GMA)
- Non-profit corporation started in 1988
- Overseen by joint ACCG & GMA Board
- Purpose is to help fund members prevent and
minimize losses
- Funded by and service ACCG and GMA
insurance programs
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Loss Control Recommendations
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• New LGRMS Director to meet with CCG Risk Manager to
review loss analysis specific to CCG, perform risk
assessments and formulate a plan for focus areas.
• Along with the Risk Manager, meet with the leaders of key
departments experiencing high frequency and/or severity in
losses.
• LGRMS’ Recommended Focus Areas (based on claims
from 2008 thru 2012):
Road Department: 17% of Claims & 17% of Claim Dollars
Sheriff’s Department: 22% of Claims, 31% of Claim Dollars
Landfill/Sanitation/Sewer – 5% of Claims, 6% of Claims Dollars
Public Officials/Clerical – 5% of Claims, 13% of Claims Dollars
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Loss Control Recommendations
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• Develop department-specific Risk Reduction Teams to
develop result goals and action plans to focus on areas
such as:
- Motor Vehicle Incidents
- Ergonomics
- Walking Working Surface incidents
- Improving Personal Protective Equipment Selection
and Usage.
• LGRMS will provide:
- Targeted organizational / team technical training
- Consultation with team on a regular basis
- Technical training to department employees based on
each team’s action plan
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Loss Control Services Available
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• On-Site Training
• Regional Training
• Computer-Based Training
• Web-Based Training
• Defensive Driver Training
• Public Safety Decision
Driver Training
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Executive
Summary
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• CCG is making great strides towards improving its risk
management culture
• CCG currently utilizing most cost-effective and efficient
workers’ compensation insurance funding method thru the
ACCG-GSIWCF
• ACCG is committed to collaborating with CCG to improve its’
total cost of risk for workers’ compensation by assessing results
and bringing needed resources to CCG
• Implement new “Team Focused” loss control initiatives
• Columbus Consolidated Government is a valued member and
we will continue to earn your business.
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