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 !!!