Publix Super Markets - National Council of Self Insurers

Report
The Road to
Self-Administration
Marc Salm - Vice President Risk Management
National Council of Self-Insurers
June 2, 2014
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1077 Stores
6 States; 157,000
Employees
$28.9B in Sales
108th on the
Fortune 500 list in
2013
Publix is the 7th
largest Retail
Grocer in the United
States
Workers
Compensation
Consumer
Litigation
Customer
Claims
Insurance

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
Florida

Full Self–Administration:
◦
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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
Non Florida

SRS
2 Dedicated Associates
@venture RMIS
Teleclaim Intake
SRS Bill Review, Nurse
Case Management, EDI
◦ Publix approved vendors
including PT, Legal,
Surveillance, PBM,
Outside Nurse Case
Managers
◦
◦
◦
◦

CARE 6.1 was outdated with limited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

2008-2010 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
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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

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
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

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):
◦
◦
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◦
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GL
Auto
Druggist
Other
Medicare Reporting

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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

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

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
Implementation Consultants
v.
Change Management Associate
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Selected Marsh as our Consultant in June,
2013.
The Marsh team is lead by Senior VP, Annette
Sanchez
The Publix team is lead by Strategy Team
Leader, Lori Chaney
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
Work Stream
Publix Associate (s)
Co-Leading Work Stream
Staffing
Director of Workers Compensation
& Director of Liability Claims
Communications
Director of Workers Compensation
& Director of Liability Claims
Operations
Director of Workers Compensation
& Director of Liability Claims
Facilities & Equipment
Risk Management Projects and
Process Manager
Systems
I/T Delivery Manager
Analytics, Audit & Benchmarking
Manager, Business Analysis and
Reporting
Work Stream
Publix Associate (s)
Co-Leading Work Stream
Associate Engagement and
Training
HR Systems Developer
Expense & Litigation Management
Director of Liability Claims
Transition and Data Migration
I/T Delivery Manager
Regulatory and Insurance
Director of Workers Compensation
Finance
Manager, Business Analysis and
Reporting
Workers’ Compensation
2008
Vice President
Assistant to
Director/Claims
Manager
Claims
Manager/FL
Team Leader
(Jax)
Lost Time
Adjusters
(2)
Medical Only
Adjusters
(1)
Supp Asst.
(2)
Team Leader
(Lklnd)
Lost Time
Adjusters
(2)
Medical Only
Adjusters
(3)
Supp Asst.
(3)
Director of Workers’
Compensation/
Casualty Insurance
Team Leader
Non-FL
Team Leader
Miami
Lost Time
Adjusters
(4)
Medical Only
Adjusters
(4)
Supp Asst.
(2)
W/C Analyst Non-FL
(1)
Lost Time
Adjusters
Manf/Dist
(2)
Supp III
(1)
Support II
(1)
W/C Analyst
(1)
Occupational
Health Specialist
Occupational Health
Analyst
(1)
Rehab
Coordinator
Medical Admin
Manager
Bill Review
Supervisor
Med Bill Analyst
(5)
Data Entry
Analyst
(2)
Analyst Asst.
(1)
Medical
Administrators
(8)
Workers’ Compensation
Self -Administration
Vice President
Assistant to
Director/Claims
Manager
Claims
Manager/FL
Team Leader
(Jax)
Lost Time
Adjusters
(2)
Medical Only
Adjusters
(1)
Supp Asst.
(2)
Team Leader
(Lklnd)
Lost Time
Adjusters
(2)
Medical Only
Adjusters
(3)
Supp Asst.
(3)
Director of Workers’
Compensation/
Casualty Insurance
Team Leader
Non-FL
Team Leader
Miami
Lost Time
Adjusters
(4)
Medical Only
Adjusters
(4)
Supp Asst.
(2)
W/C Analyst Non-FL
(1)
Lost Time
Adjusters
Manf/Dist
(2)
Supp III
(1)
Support II
(1)
W/C Analyst
(1)
Lost Adjusters
Time (3)
Medical Only
Adjusters
(2)
Supp. Asst.
(1)
Occupational
Health Specialist
Occupational Health
Analyst
(1)
Medical Admin
Manager
Rehab
Coordinator
Bill Review
Supervisor
Med Bill
Analyst
(5)
Med Bill
Analyst
(1)
Data Entry
Analyst
(2)
Data
Entry
Analyst
(2)
Analyst Asst.
(1)
Medical
Administrators
(8)
Medical
Administrators
(1)
Workers’ Compensation
Self-Administration
__
BAR
(3)
Asst. to
Director/Claims
Manager
Director of
Workers’
Compensation/
Casualty Insurance
Vice President
Project/Process
Manager
W/C Analyst
(4)
Data Entry (1)
Mail Rm. Adm. Supp. II (3)
Sick Pay Analyst
(1)
File Rm. Admin. Supp. I (4)
W/C Analyst (1)
Claims
Manager/F
L
Rehab
Coordinato
r
Lost Time
Team Lead Team Lead Team Lead Adj
(Lklnd)
Miami
(Jax)
Manf/Dist
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)
(2)
Supp III
(1)
Support II
(1)
W/C
Analyst
(1)
Off. Supv.
Admin Asst.
Team Lead
Non-FL
W/C Analyst
Non-FL
(1)
Lost Adj.
Time (3)
Medical
Only Adj.
(2)
Supp. Asst.
(1)
Occupational
Health
Specialist
Occ Health
Analyst (1)
Director of
Liability Claims
Mail Rm. Adm. Supp. II (2)
File Rm Adm. Supp. I (2)
Manager
GL Claims
Services
Medical Admin
Manager
______________
Bill
Review
Superviso
r
Medical
Adm.(8)
Medical
Adm.(1)
Med Bill
Analyst (5)
Med Bill
Analyst
(1)
Data Entry
Analyst
(2)
Data Entry
Analyst
(2)
Analyst Asst.
(1)
___________
GL
Supv
Liability
Adj (3)
Liability
Analyst
(5)
Liability
Spec.
(Admin.)
(1)
GL
Supv
Liability
Adj (3)
Liability
Analyst
(6)
Liability
Spec.
(Admin)
(1)
Manager Atty
Rep/Litigate
d Claims
Attorney
Legal
Asst.
(2)
GL Supv
Liability
Adj (2)
Liability
Analyst
(5)
Video
Examiner
s (2)
Admin
(3)
Admin
(1)
Claims
Supv
Sr. Claims
Consultan
t (4)
Claims
Consultan
ts (2)
Claims
Spec. (2)
Claims
Supv.
Sr.
Claims
Consulta
nt (3)
Claims
Consulta
nt (3)
Claims
Spec. (1)
Marc Salm

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