BJC HealthCare Brings Workers’ Comp In-House, Cuts Claims Costs
- Gain control over claim data to improve decision making
- Self-administer workers' compensation with CSC's RISKMASTER Accelerator software
- Moved claims processing from TPA to in-house team
- Cut claims volume in half
- Reduced lost-time cases by 73 percent
BJC HealthCare, based in St. Louis, Missouri, is one of the largest nonprofit healthcare organizations in the United States. With net revenue of $3.2 billion, BJC serves urban, suburban and rural communities and includes 13 hospitals and multiple community health locations. Services include inpatient and outpatient care, primary care, community health and wellness, workplace health, home health, community mental health, rehabilitation, long-term care and hospice.
BJC, with 27,000 employees in hazardous healthcare environments, self-insures and self-administers its workers’ compensation program. High volumes of claims and time lost from work would normally be expected from an operation of this size. Not so for BJC. The regional health system averages 500 to 600 claims a year. In any given week, there are only 6 to 8 people out of work on workers’ compensation.
These enviable statistics are the result of more than a decade of focusing on risk data to improve safety and return-to-work programs.
At the turn of the century, BJC was using a regional third-party administrator (TPA) for workers’ compensation. “The TPA had an in-house legacy system that didn’t give me access to any data,” said Patrick Venditti, director of BJC Corporate Health Services. “That was very frustrating because data is what I use to drive decisions.”
The TPA enlisted BJC in its efforts to improve the legacy system, and eventually decided to implement a risk management information system from a software vendor. Venditti participated in the interview process and helped the TPA select CSC’s RISKMASTER. However, even after formal training and extensive collaboration with the TPA, Venditti still didn’t have control of the data that he needed. That’s when he started looking at in-house workers’ compensation systems.
Taking it all In-House
After several years, BJC decided to self-administer its workers’ compensation program. BJC was already using RISKMASTER for general liability, auto liability and hospital incident reporting. Having that existing master license was only one reason that BJC selected RISKMASTER. The other reason was easier access to the former TPA’s data files — transferring them from one RISKMASTER system to another would be the easiest way to preserve BJC’s vital data.
Since moving RISKMASTER in-house, the company has continued to stay current with the latest features. “We’re able to make modifications much more easily and adapt the system to our needs, which is one of the real strong points with the RISKMASTER application,” Venditti said.
Data-Driven Safety Programs
BJC proactively addresses workplace safety with its Council of Occupational Health Professionals consisting of representatives at each hospital who specialize in occupational health, ergonomics, safety and infectious disease. An employee who experiences workstation discomfort or notices an unsafe condition can contact an ergonomic specialist to resolve the situation before it results in an injury.
“We focus not only on preventing the injuries but, when the injuries occur, we case manage them so that employees get back to work quickly with minimal disruption in their lives,” Venditti said.
BJC uses a two-part process to expedite workers’ compensation claims. It starts with a custom field created with RISKMASTER for capturing a risk-triage code. Each case is identified as green, yellow or red, indicating low, medium or high risk. Around 80 percent of the cases are green. The rest fall into the medium- or high-risk categories. “About 15 to 17 percent of our cases are either yellow or red,” Venditti said. “For some reason, other factors interfere with the way those cases proceed. They need a little bit more handling and a little bit more specific skills on the part of the case coordinator as well as the physicians.”
The second step is using the color code in conjunction with physician information in BJC’s RISKMASTER system to determine which doctors are best suited for each particular claim. The time- and money-saving triage approach, driven by data, wasn’t possible until the organization took its workers’ compensation program in-house.
Worth the Work
Before self-administration, BJC had between 150 and 250 lost-time cases a year, which is not bad for an organization of this size with a longstanding emphasis on prevention. However, since moving to a self-administered program, lost-time cases have dropped to an average of 75 per year. What’s more, benefit payments for lost-time care have dropped by 73 percent.
To keep lost time down, case managers work with the doctors to help injured employees comply with any medical restrictions. Then they work with managers to get employees back to functional capacity, and into some kind of a productive role in the hospital.
The healthcare system has also seen a 50 percent reduction in its workers’ compensation claims. In 1998, there were approximately 1,150 claims each year. Today, thanks to the entire workers’ compensation program from prevention to first report of injury and back to productive employment, BJC now manages between 500 and 600 claims annually.
“Data’s a good thing, and RISKMASTER gives us plenty of good data,” Venditti said. “You’ve got to be able to capture the meaningful information and then look at it and see what it’s telling you — and act upon it.”
The ability to add and modify fields using RISKMASTER has been the biggest benefit, allowing the team to gather data on key areas such as patient handling. “That was a major benefit from the beginning with RISKMASTER.”
Venditti sees CSC’s strategic alliances with software leaders such as SAP® BusinessObjects™ and StrataCare as a true commitment to customers. “Those are things that are positive because they’re giving the customer a step to the edge. This business is so dynamic, it gets changed on a weekly basis and suddenly you’ve got to look at things a little differently and change your business processes. And you’d better have the systems to allow you to be flexible and adaptable.”