Report to the San Francisco Workers Compensation Council Peggy - PowerPoint PPT Presentation

Report to the San Francisco Workers’ Compensation Council Peggy Sugarman Workers’ Compensation Director June 3, 2019

Agenda • Accomplishments & Initiatives – Alternative Dispute Resolution (ADR) Program – Banking Modernization • Performance Quick Facts • Claim Analytics • Financials Workers' Compensation Council Meeting June 3, 2019 2

Accomplishments & Initiatives Workers' Compensation Council Meeting June 3, 2019 3

Carveout / “Alternative Dispute Resolution” • Joint Labor Management Committee has met monthly • List of Independent Physician Evaluators growing • Training of staff is ongoing • Presentations made to SFPD and SFFD Management in preparation for launch • Benefit notice letters revised • Communications with Member Advocate/Ombudsperson solidified • Received Request to Negotiate by Deputy Sheriff’s Association, approved by the State • TO DO: Notify local attorneys of program Workers' Compensation Council Meeting June 3, 2019 4

Accomplishments • EK Health Amendment II drafted, approved by City Attorney’s Office and distributed to contractor. The agreement extends duration/value, modifies some key terms, and extends service to SFMTA • Medicare Section 111 Policy & Procedure Training conducted for CCSF on April 4 and Intercare on April 24 • Completed FY20 & FY21 Annual Budget Development & Negotiations with MBO, securing additional resources for Police/Fire while reducing departmental budgets for reallocation of savings • Ergonomics Awareness ELM Program completed Workers' Compensation Council Meeting June 3, 2019 5

Initiatives • EK Health Managed Care Services for SFMTA – Tentative Implementation Date of 9/1 • Bank of America Bank Account closure and reconciliation (Fall 2019) • Assessment of Pharmacy Benefit Program Cost/Benefit Analysis to shape program future • Nurse Triage/Reporting Hotline update • Banking Project update . . . See following slides Workers' Compensation Council Meeting June 3, 2019 6

Banking Modernization Road Map • Phase One: Account Migration to US Bank completed on July 1, 2018. – Automated Positive Pay; FSP integration for automated bank reconciliation; eliminated a complex manual process for daily funding of benefit payments; automated accounting entries for disbursed benefit payments – Positive Pay service was enhanced to include payee name, enhancing fraud controls – Transformed account structure to a Master Zero Balance Account and subsidiary disbursement accounts, reducing administrative risk of accounting errors that cause WC administrative penalties and bank fees; and maximizing City funds in higher yielding accounts for as long as possible prior to disbursement • Phase Two will activate electronic payments for claimants and vendors. – Lower processing costs for the 295,000 payments and 80,000 checks issued annually by the Workers’ Compensation Division. – Reduce the environmental impact of mailing checks and remittances. – Offer greater flexibility and convenience to all participants in the WC system. – Enhance the use of technology and automation in financial processing. • Phase Three will activate electronic payments for medical providers (Early 2020 Launch – Estimated). – Consolidate all changes under one payment processing model. – Expand the impact of the Phase Two benefits by increasing the volume of electronic payments. Workers' Compensation Council Meeting June 3, 2019 7

Banking Systems Overview ACH Network Payment clearing house DATA DATA US Bank iVOS Claim System Controller’s PPSD Payment instruction assembly, Accounts payable data Active employee direct deposit positive pay, reconciliation, generation bank data resolution of errors • Source of data for • Payment preference employee bank accounts management • Bi-weekly data export of • Record clear/settlement Check Printer deletions, additions, dates Integration with printer (APEX) changes, etc. • Processing ACH for claimants and vendors returns/refunds TTD SUBROSA LIFE PENSION Workers' Compensation Council Meeting June 3, 2019 8

Phase Two Accomplishments • AP Export Specification • Training – Completed/Adopted 1/25 – All Staff Training 5/22, refresher ~1 week before go-live • AP Reconciliation Import Specification – Finance Team Training on ACH – Completed/Adopted 4/12 Processing Tools at US Bank 4/29 • PPSD Employee Bank Account Data File • Production Environment Upgrade – Specification development completed, Migrate all new code, business – Second Test File Transmitted 5/29 process updates, scheduler jobs and • Data Transmission configuration changes; assign – Integration Testing Completed 3/14 payment preferences • Check & Remittance Statement Layout – July 6-7 (estimated) – Completed/Adopted 5/2 • Implementation • End-to-End Testing – July 8, 2019 – 6/3 to 6/14 • Claimant & Vendor Outreach Campaigns – Targeted Vendor Enrollment 5/28, Claimant Opt-out 6/7 (Estimated); estimated initial enrollment of 100 Vendors and 1,100 eligible claimants Workers' Compensation Council Meeting June 3, 2019 9

Performance Quick Facts Workers' Compensation Council Meeting June 3, 2019 10

FY19 Q2 Performance Quick Facts Fiscal Health Claim Volume Ratio of Actuals to Budget Count of New Claims in Period 385 Indemnity Claims FY19 Q3: 104.3% 310 Medical Claims Benchmark: 95% Benchmark: 396 Indemnity Claims/Quarter 275 Medical Claims/Quarter Claim Cost Duration Average Cost of Claims Closed in Period Average Days Open of Claims Closed in Period Indemnity: $11,062 217 Days Medical: $755 Benchmark: 324 Days Benchmark: Indemnity: $15,627 Medical: $613 Notes: All benchmarks based on rolling four-year averages (FY15-18.) Fiscal health metric includes overhead and claim expenditures and is based on revised budget, excluding any carryforward. Duration excludes disability retirement and future medical claims. Workers' Compensation Council Meeting June 3, 2019 11

Claim Analytics Workers' Compensation Council Meeting June 3, 2019 12

Claim Filing Frequency FY15-18 FY19 Q3 FY19 Q3 Increase / Decrease Average Average Average Total Indemnity + Total Total Indemnity Medical Indemnity + Indemnity + Department Medical Indemnity Medical Indemnity Medical Claims Per Claims Per Medical Medical Claims Per Claims Claims Quarter Quarter Claims Quarter Public Health 88 106 194 69 135 204 -19 or -21% 29 or 27% 10 or 5% Police 77 44 121 88 47 135 11 or 14% 3 or 8% 14 or 12% Fire 59 17 76 58 22 80 -1 or -2% 5 or 31% 4 or 5% Sheriff 35 8 44 43 8 51 8 or 22% 0 or -4% 7 or 17% Human 21 13 35 26 7 33 5 or 22% -6 or -47% -2 or -5% Services Public Works 15 15 30 10 22 32 -5 or -33% 7 or 47% 2 or 7% Recreation & -6 or -36% -4 or -20% -11 or -27% 17 21 39 11 17 28 Parks Airport 19 14 33 12 15 27 -7 or -36% 1 or 8% -6 or -17% PUC-Water 8 7 15 8 6 14 0 or -1% -1 or -16% -1 or -8% Library 6 4 10 6 4 10 0 or 3% 0 or 5% 0 or 4% Citywide 395 275 670 386 308 694 -9 or -2% 34 or 12% 24 or 4% Workers' Compensation Council Meeting June 3, 2019 13

Claims Incurred Per 100 FTE Department 2015 2016 2017 2018 2019 Est. Fire 21 19 19 23 21 Sheriff 21 23 20 20 21 Police 20 23 23 21 20 Public Health 12 12 11 13 12 Citywide 11 11 11 12 11 Public Works 10 11 9 10 10 Library 7 5 6 10 8 Airport 10 10 10 10 7 Recreation & 9 9 9 9 7 Parks Human Services 7 6 6 8 7 PUC-Water 3 3 3 4 3 Notes: 1. 2019 Est. reflects a straight line of Q1 – Q3 claim volume for the whole fiscal year Workers' Compensation Council Meeting June 3, 2019 14

Claims Incurred Per 100 FTE Top 10 Departments 25 20 Fire Sheriff Police 15 Public Health Citywide Public Works Library 10 Airport Recreation & Parks Human Services 5 PUC-Water 0 2015 2016 2017 2018 2019 Est. Notes: 1. 2019 Est. reflects a straight line of Q1 - Q3 claim volume for the whole fiscal year Workers' Compensation Council Meeting June 3, 2019 15

Claim Cause Distribution Top 10 Claim Cause Groups by Frequency - New Claims in FY2019 Q3 200 150 Human Services Sheriff 100 Fire Police All Other Departments Public Health 50 0 Exposure Bodily Cumulative Fall, Slip or Physcial Misc Struck Abrasion Caught In, Stress Motion Trauma Trip Assault By/Against Under, Between Notes: 1. Claim cause group definitions are listed in Appendix 1 Workers' Compensation Council Meeting June 3, 2019 16

Open Claim Stratification 500 450 400 350 300 250 200 150 100 50 0 100K- 150K- 200K- 250K- 300K- 350K- 400K- 450K- 500K- 550K- 600K- 650K- 700K- 750K- 800K- 850K- 900K- 950K- Over 150K 200K 250K 300K 350K 400K 450K 500K 550K 600K 650K 700K 750K 800K 850K 900K 950K 1M 1M Recreation & Parks 10 13 2 6 2 3 1 1 2 Sheriff 61 50 24 11 6 3 3 1 1 1 2 Public Health 69 40 16 11 8 7 4 3 2 4 1 1 1 1 2 Fire 89 75 52 13 14 8 4 1 1 1 1 1 2 All Other Departments 126 67 41 22 14 5 6 7 3 2 2 1 2 0 1 4 0 0 4 Police 127 98 68 37 22 16 9 8 1 2 1 1 1 2 3 1 1 9 Notes: 1. $100K+ Total Incurred = $318 Million 2. All policy years for which incurred costs >=$100k/claim Workers' Compensation Council Meeting June 3, 2019 17