By Mark Pew, Senior VP, Preferred Medical
An article in the June 2020 edition of CLM Magazine entitled “Be Kind and Keep It Simple” piqued my interest in the success of an advocacy program at Fidelity National Financial in Jacksonville, FL. Specifically, the nationwide director of safety and claims management who was responsible for envisioning and implementing the advocacy program, Kimberly Simmons. So I arranged a phone interview with her to dive into even more details behind the impetus and results of her program.
Ultimately, Kimberly defined “advocacy” as a combination of transparency with and reassurance to the injured worker. In other words, the program was about process and interaction; what you do and what you say (including how and when you say it). It looked at the workers’ compensation system from the perspective of the person that was injured, and by switching that perspective it became more human(e) and cost effective. Her goal was to establish trust and faith within the injured worker that they can return-to-work (RTW) by letting them know they were cared for, educated them on what to expect, and established a clear escalation process.
What prompted the change in 2017? What was your inspiration?
Kimberly realized that injured workers were procuring representation (i.e. lawyers) because nobody was listening to them and it took a long time for claims adjusters to approve treatment, respond to phone calls and provide timely payments. In other words, the employer – colleagues of the injured worker – had created over time a perception of not being responsive or caring. Obviously that is a broad stroke statement that generalizes and over-simplifies uniquely individual circumstances (i.e. it did not happen in every claim), but that malaise had become the standard. This is not the first time I’ve heard that attorney involvement is a red flag. Bill Zachry, formerly the group vice president of risk management for the national grocery retailer Safeway, has said on multiple occasions that if an injured worker got a lawyer it represented a failure on his part, as the employer, to effectively serve the injured worker.
Kimberly’s response was to be the first stop for every First Report of Injury (FROI), calling the injured worker to let them know her job was to support them in their journey to recovery. Because of her tenured experience, she could perceive whether they were a malingerer (yes, not all injured workers want to get back to work – yes, it is a small percentage) and if they were she would aggressively address that counterproductive behavior. However, that initial personal contact – not an e-Mail, not a form letter, but an actual phone call – set the stage for the level of concern and engagement for the entirety of the claim process. Her goal was to establish the expectation of both the injured worker and her claims team that listening and responsiveness would be the hallmark of the experience.
Kimberly relayed an example that stuck with her and resonated with me. She got involved in a catastrophic claim that was not receiving appropriate ongoing treatment (the hospital had written him off and so everybody else did too). She had him transferred to a functional restoration program where he made great progress – she prayed for his recovery but was still surprised at his ability to RTW within six months. This unexpected outcome, a result of her personal engagement and over-communication directly with the injured worker’s doctors and family, was a confirmation of her then-evolving advocacy model.
Another example she remembered was a mediation that was likely going to result in a permanent disability decision. Her defense attorney advised her not to speak during the session but she did anyway, expressing regret on behalf of the employer for how the claim had devolved to this standoff. As it turned out, the injured worker wanted to “hurt them” because they had “hurt her,” but once an environment of empathy and respect was established the claim was quickly settled without going to court.
To accomplish that on a repeatable programmatic scale, she needed to change the relationship between her third-party administrator (TPA), their claims adjusters, immediate managers, and human resources team to establish an underlying expectation of empathy and compassion and to focus on providing – quickly – whatever the injured worker needed to proceed in their journey of recovery. This attitude change, which translated into policy change, created a dramatically reduced delay in decisions so appropriate care could be provided in a timely manner.
That is the human side. An advocacy model dramatically changed the financial side too.
Her total work comp costs decreased by 22 percent and future reserves decreased by 44 percent. Injured workers stopped getting attorneys because they now did not feel the need for them. Before her advocacy model started, 175 of the 225 open claims were litigated and each required on average of three days for a claim review. After full implementation of her advocacy model, eight of 225 claims (yes, a reduction of 74 percent) were litigated and claims reviews only required one day. The reduction in the time and costs affiliated with litigated cases (eight instead of 175) and claims reviews (one day instead of eight days) freed up even more time to invest up-front in expressing empathy and compassion to each injured worker. For a process change that required little investment, the return on investment (ROI) was undeniable.
As you can imagine, not every claims adjuster was onboard with this new model and those that did not embrace it were quickly dispatched. However, there was one claims adjuster that was cynical about the change in process for one full year before having an “aha moment” where the value – human and financial – became very clear. The initial cynicism came from the adjuster’s training – the “old way” that Kimberly replaced. What made her salvageable was her high level of competence. What made her different was when she stopped checking boxes and started focusing on the human element.
What does it take to make this kind of change happen?
The leader / visionary must be tenacious (persisting in existence; not easily dispelled). They cannot get frustrated. They must lead by example so those that need to see it first can indeed see it. They have to be consistent and upbeat in their message, fully invested in making the change happen. They must have staying power, even when everybody is saying “no” and there are no positive stories yet. They need to work closely with those above them in the organization to sell them on the idea and identify the upfront cost (from retraining to updating policies and procedures to new measurements). They also need to manage closely those in their own organization (as Jim Collins said in his seminal book “Good to Great,” an effective leader must get the right people on the bus and then make sure they are in the right seats). All of that needs to happen before there are any tangible results. For Kimberly, it literally took one year before her company could see the financial rewards of doing the right thing. The good news is they also saw the human rewards while doing the right thing.
Bottom line is that in order to make change happen, a leader has to be driven by an internal motivation and desire. To borrow a phrase from sports, they must have a “motor” that never stops.
Are you a closet visionary? Read Kimberly’s story. Listen to your own muse. Make something happen. Today.
To read everything on my mind this past week, please visit me on LinkedIn.
Disclaimer: The views and opinions expressed above are those of Mark Pew, and do not necessarily reflect the views of Preferred Medical.
About Mark Pew
Mark Pew, Senior Vice President of Product Development and Marketing for Preferred Medical, is a passionate educator and agitator. Known as the RxProfessor, Mark is focused on the intersection of chronic pain and appropriate treatment, particularly as it relates to the clinical and financial implications of prescription painkillers, non-pharma treatment modalities and the evolution of medical marijuana. He is a strong champion for the workers’ compensation industry to #PreventTheMess and #CleanUpTheMess, movements he created to drive attention to the importance of individualized appropriate treatment for injured workers. Mark is a vocal advocate of the BioPsychoSocialSpiritual treatment model.
Mark serves on the IAIABC’s Medical Issues Committee and SIIA’s Workers’ Compensation Committee. In addition, he serves as technical advisor to regulators and legislators in 20+ jurisdictions on subjects such as drug formularies, treatment guidelines, Opioid Task Force initiatives, encouraging support of non-pharma treatment options and the medicinal use of cannabis. Mark received the WorkCompCentral Magna Comp Laude award in 2016 and the IAIABC’s Samuel Gompers Award in 2017.