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The Road to Self-Administration Marc Salm - Vice President Risk Management National Council of Self-Insurers June 2, 2014.

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Presentation on theme: "The Road to Self-Administration Marc Salm - Vice President Risk Management National Council of Self-Insurers June 2, 2014."— Presentation transcript:

1 The Road to Self-Administration Marc Salm - Vice President Risk Management National Council of Self-Insurers June 2, 2014

2  1077 Stores  6 States; 157,000 Employees  $28.9B in Sales  108th on the Fortune 500 list in 2013  Publix is the 7 th largest Retail Grocer in the United States

3 Workers Compensation Customer Claims Consumer Litigation Insurance

4  Geographic Footprint  Experience administering Florida WC  Relationship with our Primary Insurance Carrier – the Hartford  Deductibles/Retentions  The Burdens of Self-Administration  Support from the Company  The very best I/S Support for any Risk Management Department, anywhere

5 FloridaNon Florida  Full Self–Administration: ◦ 64 Associates ◦ CARE 6.1 Claims System ◦ Proprietary RMIS ◦ Intranet –based Intake (P013) ◦ Internal Bill Review (Fair Isaacs ) ◦ Internal Nurse Case Management ◦ Occupational Health ◦ Rehab Coordinator ◦ Florida EDI ◦ Claims Manager, Team Leaders, LT Adjusters, MO Adjuster, Support  SRS ◦ 2 Dedicated Associates RMIS ◦ Teleclaim Intake ◦ SRS Bill Review, Nurse Case Management, EDI ◦ Publix approved vendors including PT, Legal, Surveillance, PBM, Outside Nurse Case Managers

6  CARE 6.1 was outdated with limited functionality: ◦ Manual processes ◦ Outside interfaces ◦ Could not handle non-Florida WC or any liability claims ◦ Provider had limited knowledge ◦ Updated only as required by State law ◦ Heavy reliance on Cambridge to maintain Publix’s data

7  looked for a new Claims and RMIS System(s) ◦ Retained Consultant Dave Tweedy ◦ Requested detailed RFP and demonstrations from 4 systems ◦ Narrowed choice to two systems ◦ Performed in-depth analysis of functionality of systems ◦ Went to contract with both finalists ◦ Selected CSC RiskMaster X in July 2010

8  Publix self-administered Customer Incident intake and Non-Attorney Represented GL, Auto and Druggist Claims.  Replaced a fax customer claim intake process with a web based Customer Incident Intake  Replaced an ACT! contact system with RiskMaster X  Implemented RiskMaster Business Analytics

9  Replaced CARE with RiskMaster  Data transfer  Replaced Intranet FNOI with Web–based Associate FNOI Reporter  Replacement of proprietary RMIS with RiskMaster Business Analytics  Revised Payment Processes  Implemented in November 2013

10 Scope  Workers Compensation Claims in ◦ Georgia, Alabama, South Carolina, North Carolina, Tennessee. ◦ Medical Bill Review ◦ Nurse Case Management ◦ EDI ( including Medicare)  Represented Claims and Lawsuits (All States): ◦ GL ◦ Auto ◦ Druggist ◦ Other ◦ Medicare Reporting

11  Cost Savings over TPA service fees  Greater Control and Alignment with Business Goals  Improve Associate Performance  Use RiskMaster to it’s fullest capabilities  Improve efficiencies and outcomes  Eliminate the Risk of TPA mergers and acquisitions

12  Before we did more work, we confirmed: ◦ Agreement (in principal) of our Insurance Carriers ◦ Publix would add the associates necessary to transition to Self-Administration ◦ Management of 500 or so lawsuits per year ◦ The support of the Publix I/S Department ◦ At least some ROI ◦ The number of claims and lawsuits A Tier 1 Strategic Project

13  12 I/S Associates are devoted to Self Administration: ◦ 5 System Analysts ◦ A Systems Analyst/Programmer ◦ A Sr. Systems Analyst ◦ A Programmer Analyst ◦ A SQA Analyst ◦ A Sr. SQA Analyst ◦ A Lead Sr. SQA Analyst and ◦ An I/T Delivery Manager

14 Implementation Consultants v. Change Management Associate

15  Selected Marsh as our Consultant in June,  The Marsh team is lead by Senior VP, Annette Sanchez  The Publix team is lead by Strategy Team Leader, Lori Chaney

16 Publix and Marsh agreed on “Work Steams” There are 11 Work Streams Together, the 11 Work Streams are further broken down into 71 Milestones Each Work Stream is co-led by a Marsh Consultant and a Publix Associate or Associates

17 Work Stream Publix Associate (s) Co-Leading Work Stream StaffingDirector of Workers Compensation & Director of Liability Claims CommunicationsDirector of Workers Compensation & Director of Liability Claims OperationsDirector of Workers Compensation & Director of Liability Claims Facilities & EquipmentRisk Management Projects and Process Manager SystemsI/T Delivery Manager Analytics, Audit & BenchmarkingManager, Business Analysis and Reporting

18 Work Stream Publix Associate (s) Co-Leading Work Stream Associate Engagement and Training HR Systems Developer Expense & Litigation ManagementDirector of Liability Claims Transition and Data MigrationI/T Delivery Manager Regulatory and InsuranceDirector of Workers Compensation FinanceManager, Business Analysis and Reporting

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21 Lost Time Adjusters (2) Medical Only Adjusters (1) Supp Asst. (2) Lost Time Adjusters (2) Medical Only Adjusters (3) Supp Asst. (3) Lost Time Adjusters (4) Medical Only Adjusters (4) Supp Asst. (2) Lost Time Adjusters Manf/Dist (2) Supp III (1) Support II (1) W/C Analyst (1) Occupational Health Analyst (1) W/C Analyst Non-FL (1) Medical Administrators (8) Med Bill Analyst (5) Data Entry Analyst (2) Analyst Asst. (1) Vice President Director of Workers’ Compensation/ Casualty Insurance Assistant to Director/Claims Manager Claims Manager/FL Team Leader (Jax) Team Leader (Lklnd) Team Leader Miami Team Leader Non-FL Occupational Health Specialist Rehab Coordinator Bill Review Supervisor Medical Admin Manager Workers’ Compensation 2008

22 Lost Time Adjusters (2) Medical Only Adjusters (1) Supp Asst. (2) Lost Time Adjusters (2) Medical Only Adjusters (3) Supp Asst. (3) Lost Time Adjusters (4) Medical Only Adjusters (4) Supp Asst. (2) Occupational Health Analyst (1) Vice President Director of Workers’ Compensation/ Casualty Insurance Assistant to Director/Claims Manager Claims Manager/FL Team Leader (Jax) Team Leader (Lklnd) Team Leader Miami Team Leader Non-FL Occupational Health Specialist Rehab Coordinator Bill Review Supervisor Medical Admin Manager Workers’ Compensation Self -Administration

23 Lost Time Adj. (2) Medical Only Adj. (1) Supp Asst. (2) Lost Time Adj. (2) Medical Only Adj. (3) Supp Asst. (3) Lost Time Adj (4) (4) Medical Only Adj (4) Supp Asst. (2) Occ Health Analyst (1) Vice President Director of Workers’ Compensation/ Casualty Insurance Claims Manager/F L Team Lead (Jax) Team Lead (Lklnd) Team Lead Miami Occupational Health Specialist Bill Review Superviso r Medical Admin Manager ______________ Workers’ Compensation Self-Administration BAR (3) Rehab Coordinato r Team Lead Non-FL Asst. to Director/Claims Manager Project/Process Manager Off. Supv. Admin Asst. Director of Liability Claims Manager GL Claims Services GL Supv Liability Adj (3) Liability Analyst (5) Liability Spec. (Admin.) (1) GL Supv Liability Adj (3) Liability Analyst (6) Liability Spec. (Admin) (1) GL Supv Liability Adj (2) Liability Analyst (5) Video Examiner s (2) Attorney Legal Asst. (2) _

24 Marc Salm


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