Agenda. Which Stakeholders Can Add Value? Start With Building a Team That Can Identify, Then Address the Trends

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1 INNOVATIVE SOLUTIONS FOR REDUCING WORKPLACE INJURIES Chris Strachan, Principal Agenda The Importance of an Internal Baseline Data Set, in Addition to Peer Data Harnessing Internal Data to Create Meaningful, Customized Dashboard Reports Some Best Practices on Using Customized Reports to Drive Positive Change & Shape Safety Culture Specific Opportunities, Resources & Strategies Unique to Hospitals 2 Which Stakeholders Can Add Value? Start With Building a Team That Can Identify, Then Address the Trends Hospital staff responsible for managing workers compensation program (HR, leave of absence, employee safety, finance, medical director) Broker team TPA/Insurer claims team Workers compensation defense attorneys Outside consultants safety training subject matter experts, etc. Peer hospitals 3 1

2 January February March Average July August September Average April May June Average October November December Average Harnessing Internal Data For Baseline What Data? How Frequently? Measure Against Ourselves or Others? If Others, Who? Objective Need for a high-level baseline figure of annual workers compensation costs and claims data Strategy Create Baseline comparison tools to track high-level current results by policy year in snapshots against Baseline 4 Baseline Comparison 4/1/16 to 12/31/16 POLICY YEAR # OF CLOSED PAID RESERVES TOTAL INCURRED TOTAL TOTAL RESERVES CLAIMS CHANGE IN INCURRED NET CHANGE CLOSED NET CHANGE CLAIMS 1/1/ ,231 $ 872,1 $ 436,923 $ 1,7,677 $ 638,74 $ 614,14 $ 1,948,178 $ 1,334,24 $ $ /1/14-1 1,39,798 $ 2,11,97 $ 9,332 $ 698,926 $ (6,46) $ 1,94,13 $ 2,814,23 $ 869,393 $ /1/ ,84 $ 1,381,984 $ 674,28 $ 821,687 $ 147,69 $ 1,619,868 $ 2,3,671 $ 83,83 $ 1/1/ ,86,74 $ 1,991,91 $ 1,8,7 $ 8,44 $ (224,31) $ 2,936,649 $ 2,847,13 $ (89,14) $ /1/ ,89,724 $ 2,14,37 $ 86,37 $ 93,86 $ 43,499 $ 2,71,81 $ 3,49,231 $ 298,1 $ /1/1-11 2,39,739 $ 2,876,81 $ 1,33,43 $ 682,644 $ (6,786) $ 3,663,169 $ 3,9,49 $ (13,674) $ /1/8-1,399,361 $,78,348 $ 1,2,3 $ 1,33,71 $ (216,61) $ 6,91,681 $ 6,914,8 $ (37,623) $ /1/6-8 7,34,92 $ 7,476,724 $ 698,77 $ 43,14 $ (29,63) $ 7,732,799 $ 7,879,828 $ 147,29 $ /1/ ,263,92 $ 61,442,82 $ 2,793,87 $ 2,24,864 $ (3,6) $ 64,7,462 $ 63,683,689 $ (373,773) TOTAL 81,789,7 $ 8,9,29 $ 9,868,119 $ 7,942,33 $ (1,92,784) $ 91,67,839 $ 92,91,63 $ 1,293,791 $ TOTAL 81,966,91 $ 8,881,796 $ 1,3,42 $ 9,18,12 $ (1,287,3) $ 92,271,993 $ 94,899,88 $ 2,627,81 $ 11,86 11, Baseline Comparison, Total Claims: 4/1/16 to 12/31/17 ### ### ### ## January Q1 Total Claims Apri 24 February May 24 March 3 23 June Average Aver Q2 Total Claims ### ### ### ## July Q3 Total Claims Octo 29 August Nove 19 September 14 Dec 24 Average Aver Q4 Total Claims 6 2

3 Internal Data First Then Future Benchmarking Objective Need for more granular tools for measuring and tracking specific claims management and prevention trends year-over-year. Need to identify valuable, actionable trends. Strategy Create Stats Report document to measure more detailed claims management data, and Dashboard Report documents to focus on top claim trend drivers; measure quarterly. 7 Stats Report Claims Management Quarterly and YTD Summary Report Period 17 YTD 17YTD vs 16YTD 16 YTD 16YTD vs 1YTD 1 YTD New Activity Indemnity: New Claims Sum of months 91-13% 14-6% 111 Medical Only: New Claims Sum of months % 162 % 162 Total: New Claims Sum of months % 266-3% 273 Total: New Closed Sum of months 33 4% % 278 Closing Ratio Avg of months 13% -1% 114% 9% 1% Claim Management Indemnity: All Open Avg of months 217-8% 236-3% 243 Avg Cost Per Open IN - overall Avg of months $7,873 % $7,77 -% $74,62 Avg Cost Per Open IN - Last 12m Avg of months $9,71 27% $7,641 37% $,93 Medical Only: All Open Avg of months 33 68% -4% 33 Total Open Claims Avg of months 21-2% 26-7% 276 Open Litigated Count Avg of months 94-1% 14-9% 11 Open Litigated Percent Avg of months 37% -8% 41% -2% 42% over $k Count Avg of months 2-43% 4-28% Total Future Reserve Avg of months $9,,712-2% $9,6,73-19% $11,876,74 Net Paid Sum of months $4,996,931-29% $7,48,42 23% $,734,247 Injury Details FTEs (estimate in gray) Avg of months 324 7% % 2742 Injury Rate (per 1 FTEs) Avg of months % % Dashboard Report (cont.) 9 3

4 # of Open Effective Date Total Paid In Reserves Total # of Claims Claims 1/1/17-12/31/17 $637,229 $843,269 $1,48, Claim # Department Claim Description Date of Loss Status Total Paid In Reserve Total SURGICAL SVCS PPRO - Repetitive motion - Unrelated to computer Use 1/26/17 Open $ 41,69 $ 49,876 $ 91, SURGICAL SVCS PHPPGB: Pushing/Pulling Gurney or Bed 2/16/17 Open $ 33, SURGICAL UNIT 6E FSW - Slip/Fall on Wet Floor 8/27/17 Open $ 33, PEDIATRIC ICU -PICU PPR - Reaching 7//17 Open $ 31, SURGICAL SVCS PPO - Pushing or Pulling - NOC 7/8/17 Open $ 29, INTENSIVE CARE -ICU PH: Patient Handling (PH) - no other details available 2/6/17 Open $ 24,966 Total FREQUENCY BY DEPARTMENT FREQUENCY BY CAUSE Cause # of Claims % of Claims PPL - Lifting 16.2% $ 6, % EXBCN - Body fluid exposure with potential for inf 1 4.9% $ 13,9.9% $ 6.1% $ 13.2% $ 1.% $.3% $ 14.1% MSO - Stress - NOC % $ 77,834.3% SCP - Struck or physical injury by combative patient % $ 8,298.6% SEVERITY BY DEPARTMENT ENVIRONMENTAL SVCS 6.% $ 6,4 4.4% PLANT MAINTENANCE 9 2.9% $ 1.% $ 1.2% 3.6% $ 13, % $ 4.6% $.3% PLANT MAINTENANCE 9 2.9% $ 196,1 13.2% $.9% $ 2.7% SURGICAL UNIT 6E 8 2.6% $ 19,43 7.4% $.9% $ 4.6% $ 4.4% PEDIATRIC ICU -PICU 1.3% $ 61, % $ 2.9% $ 2.7% SEVERITY BY CAUSE $ 4,9 $ 78, PLANT MAINTENANCE FT - Trip/Fall - NOC 8/2/17 Open $ 23,13 $ 2,864 $ 76,377 $ 39,884 $ 73, PHLEBOTOMY FT - Trip/Fall - NOC 9//17 Open $ 21,339 $ 1,831 $ 73,17 $ 3,926 $ 61, PLANT MAINTENANCE PPRO - Repetitive motion - Unrelated to computer Use 2/7/17 Open $ 39,62 $ 22,26 $ 61,881 $ 29,836 $ 8, SURGICAL UNIT E SOPP - Struck or physical injury by person other t /27/17 Open $ 22,92 $ 3,249 $ 8,17 Department # of Claims % of Claims Total Department # of Claims SURGICAL SVCS % $ 322, % SURGICAL SVCS 3 Total 14 4.% $ 92, % Total 117 Total Total % $ 712, % Total # of Open Effective Date Total Paid In Reserves Total # of Claims Claims 1/1/16-12/31/16 $1,2,8 $1,122,89 $2,648, Cause $ 3,86 $,822 $ 31,176 $ 388,637 $ 689,813 % of Claims Total 11.4% $ 322, % 196,1 # of Claims % of Claims Total 13.2% % $ 9,4 14.1% PPRO - Repetitive motion - Unrelated to computer % $ 196,6 13.2% PHPPGB: Pushing/Pulling Gurney or Bed 3 1.% $ 134,28 9.1% $ 7.3% $ 6.1% $.6% $.3% $ 4.2% PPC - Pushing or Pulling Cart (EVS bin, food cart, 4 1.3% $ 61, % PPL - Lifting 16.2% $ 6, % % $ 1,82, % $ 38.% $ 1,129, % Claim # Department Claim Description Date of Loss Status Total Paid In Reserve Total TRANSPORTATION PHRB: Repositioning patient in bed (sliding, scooting) 1/11/16 Open $ 99,92 $ 1,791 $ 2, ADMITTING CIBO - Caught in, under or between - NOC /27/16 Open $ 68, ENVIRONMENTAL SVCS SO - Struck or injured by - NOC /8/16 Open $ 34, ENVIRONMENTAL SVCS MSO - Stress - NOC 1/2/16 Open $ 7, ENVIRONMENTAL SVCS PPL - Lifting 6/27/16 Open $ 4, Customer Relations FT - Trip/Fall - NOC 7/11/16 Open $ 3,139 Total FREQUENCY BY DEPARTMENT DIETARY % $,828.8% CENTRAL SVCS & SUPP 1 FREQUENCY BY CAUSE Cause # of Claims % of Claims $ 48,48 1.8% $.9% $ 1.7% SEVERITY BY DEPARTMENT SEVERITY BY CAUSE Needle Stick % $ 8,8.3% PHRB: Repositioning patient in bed (sliding, scooting) PPL - Lifting 13.% $ 1,37.7% SE - Struck or physical injury from equipment malf % $ 3,83.1% SCP - Struck or physical injury by combative patient % $ 13,13.% SO - Struck or injured by - NOC 9 3.% $ 34,77 11.% 14.% SURGICAL SVCS 3 11.% $ 241,32 9.1% ADMITTING $ 98,17 $ 166, CARDIOTHORARIC UNIT 32 FSW - Slip/Fall on Wet Floor 8/21/16 Open $ 83,837 $,476 $ 139,312 $ 12,67 $ 137, LABOR & DELIVERY PHRT: Repositioning patient in bed (turning) 1/1/16 Open $ 79,911 $ 1,78 $ 131,691 $ 38,79 $ 114, VOLUNTEER SERVICE FO - Fall off an object (chair, stool, ladder, fur 9/27/16 Open $ 77,42 $,482 $ 98,24 $ 2,787 $ 98, SURGICAL SVCS PPC - Pushing or Pulling Cart (EVS bin, food cart, 8/9/16 Open $ 4,24 $ 49,813 $ 9,4 Department # of Claims % of Claims Total Department # of Claims SURGICAL SVCS 3 11.% $ 241,32 9.1% ENVIRONMENTAL SVCS 22 Total % $ 1,276, % Total 3.8% Total 1.9% $ 17, % LABOR & DELIVERY 8 3.1% $ 169,83 6.4% Total % $ 1,81,91 9.7% Total 94 Cause $ 37,11 $ 9,29 $ 662,866 $ 627,919 $ 1,29,78 % of Claims Total 8.% $ 46, % $.3% $ 3.4% FSW - Slip/Fall on Wet Floor % $ 219, % FT - Trip/Fall - NOC 8 3.1% $ 2,8 7.7% PPC - Pushing or Pulling Cart (EVS bin, food cart, 14.4% $ 11,744.7% FO - Fall off an object (chair, stool, ladder, fur 7 2.7% $ 139,88.3% $ 37, % $ 2,44, 77.2% # of Claims % of Claims Total 4 1.% $ 3,36 11.% % $ 1,994,23 7.3% 16 Dashboard Report (cont.) 1 17 Dashboard Report Top Claim Trend Drivers SUMMARY DATA AS OF 12/31/17 TOP TEN CLAIMS DIETARY 1 4.9% 14,33 MEDICINE TELEMETRY 4W % 17,86 PHLEBOTOMY 11 INTENSIVE CARE -ICU 1 3.2% 68,198 TRANSPORTATION 1 3.2% 4,742 SURGICAL UNIT E 9 2.9% 87,6 MEDICINE TELEMETRY W 9 2.9% 4,182 PHLEBOTOMY % $ 13, % SURGICAL UNIT E 9 2.9% 87,6 INTENSIVE CARE -ICU 1 3.2% 68,198 ENVIRONMENTAL SVCS 6.% 6,4 SURGICAL UNIT 4E 1.6% 43,19 MEDICINE TELEMETRY W 9 2.9% 4,182 CIBO - Caught in, under or between - NOC % $ 38,49 2.6% FT - Trip/Fall - NOC FSW - Slip/Fall on Wet Floor 14 4.% 9,17 PPRO - Repetitive motion - Unrelated to computer Use % 196,6 CPO - Cut, Punctured, Scrape - NOC % 14,132 EXS - Body fluid exposure with potential for infection? % 4,441 FT - Trip/Fall - NOC % 9,4 PH: Patient Handling (PH) - no other details available 4 1.3% 17,732 FSW - Slip/Fall on Wet Floor 14 4.% 9,17 PPO - Pushing or Pulling - NOC 7 2.3% 82,762 MSO - Stress - NOC % 77,834 PPR - Reaching 1.6% 62, Dashboard Report Top Claim Trend Drivers SUMMARY DATA AS OF 12/31/17 TOP TEN CLAIMS ENVIRONMENTAL SVCS 22 8.% $ 46, % TRANSPORTATION 8 3.1% INTENSIVE CARE -ICU % $,19.2% TRANSPORTATION 8 3.1% $ 37,81 14.% LABOR & DELIVERY 8 3.1% $ 169,83 6.4% OB MATERNITY 6 2.3% 1,1 DOU 6 2.3% $ 9, % SECURITY 6 2.3% 4,78 OB MATERNITY 6 2.3% $ 1,1.9% VOLUNTEER SERVICE 4 1.% $ 146,92.% CARDIOTHORARIC UNIT % 139,966 Customer Relations 1.4% $ 9,29 3.4% SURGICAL UNIT E 1.9% 88,826 PPC - Pushing or Pulling Cart (EVS bin, food cart, 14.4% $ 11,744.7% MSO - Stress - NOC % $ 218, % FSW - Slip/Fall on Wet Floor % $ 219, % EXS - Body fluid exposure with potential for infection? splash 1 3.8% $ 2,2.1% FT - Trip/Fall - NOC 8 3.1% $ 2,8 7.7% SO - Struck or injured by - NOC 9 3.% $ 34,77 11.% MSO - Stress - NOC % $ 218, % CIBO - Caught in, under or between - NOC 3 1.2% $ 168, % PPL - Lifting 13.% $ 1,37.7% PHRT: Repositioning patient in bed (turning) 3 1.2% $ 132,86.% 12 4

5 Case Study: What Trends Do the Dashboards Show? FREQUENCY BY DEPARTMENT Surgical Services continues to have the highest frequency of incidents for the past 2 years. Environmental Services has made some improvement in 17 in terms of frequency; they previously had been at the top of the chart in 16, but have dropped to #3 in frequency and off the top 1 in terms of severity on the 17 report. Dietary Services and Environmental Services are #2 and #3 respectively on the current 17 report. In 16, Environmental was #3 and Dietary was #2 they have swapped rankings, but both remain in top three year-over-year. FREQUENCY BY CAUSE Needle sticks were at the top of the list in both 1 and 16 in terms of frequency, but have dropped off the list on the 17 report great news here! Slip/Trip/Fall injuries have increased from ranking #7 in 16 to #4 in 17. Lifting injuries have dropped year-over-year from #3 to #9 in terms of frequency by cause. Caught In, Under, Between and Repetitive Motion have both jumped to the top of frequency by cause in 17, ranking #1 and #2 respectively; neither was a leading cause of injury in 16, so this should be investigated further and followed by safety training. 13 Case Study: What Trends Do The Dashboards Show? (cont.) SEVERITY BY DEPARTMENT Environmental and Transportation departments both dropped off the top ten list by severity in 17, whereas they were the top two in 16. Surgical Services went from #3 in 16 to #1 in 17 as the poorest performing department in terms of severity. This accompanies its ranking as #1 poorest performing in terms of frequency in 17. SEVERITY BY CAUSE When added together, trip/fall and slip/fall on wet floor number of claims account for the #1 cause by severity in both 16 and 17. Ergonomics/Repetitive motion and lifting of all sorts, along with pushing or pulling of all sorts, continue to drive frequency and severity for the past three years. 14 Baseline Approach Allows Continual Tracking of Key Trends & Results As a team, together we have been able to drive some significant results for the workers compensation program this year, including : 4/1/16 12/31/16 $1,92,784 in total net reserve reductions 28 claim closures % reduction in total reserves $373,773 reduction in total incurred in policy years 197- Continued substantial progress on Legacy Claims (see next slide) 1

6 Benefit of Using Targeted Baseline Benchmarking: Legacy Claims (1) As of 4/1/16 As of 12/31/16 Difference No. of Open Claims (2) Total $82,4,111 $82,37,69 ($368,42) Total Paid $76,6,78 $77,374,748 $1,317,963 Total Reserve $6,348,326 $4,662,322 ($1,686,4) (1) Legacy Claims = 1/1/1 policy term and prior 27% reduction in Open Legacy Claims 27% reduction in Legacy Claim Total Reserves. 16 Benefit of Using Targeted Baseline Benchmarking: Year-Over-Year Effect As of 4/1/16 As of 12/31/17 Difference No. of Open Claims 76 1 (2) Total $79,124,11 $79,148,779 $24,628 Total Paid $74,8,87 $7,49,282 $1,4,42 Total Reserve $,11,29 $3,689,497 ($1,42,798) 33% reduction in Open Legacy Claims 28% reduction in Legacy Claim Total Reserves Total increased year-over-year to a positive figure (1) Legacy Claims = 1 policy term and prior 17 Specific Opportunities, Resources & Strategies For Hospitals Employee safety must be seen as a true, shared responsibility and a top priority for supervisors and department heads BEFORE this cultural shift can spread to employees. Incorporate as a key metric within performance reviews, profit and loss impact Safety performance metrics and training initiatives are a priority across leadership of all departments Accident trend investigation and action plans responsibility placed on supervisors/department heads Through use of custom Dashboard and Stats Reports, track and monitor opportunities for strategic risk management and loss prevention initiatives to address new trends immediately 18 6

7 Specific Opportunities, Resources & Strategies For Hospitals (cont.) Near Miss or Find It, Fix It programs with employee recognition and/or reward incentives company-wide Sponsor free lunch for winning employee s entire department to get started. Hospital-wide recognition can be just as impactful as a reward system. Use of weekly/monthly newsletters or e-blasts to feature employees engaged in positive participation. Rewards can be tricky with nonprofit hospitals, but free food is generally not a problem. 19 Specific Opportunities, Resources & Strategies To Hospitals (cont.) Aggressive and targeted claims advocacy strategy (broker, defense attorney, adjuster) Find the right flow for managing open claims. Use a targeted strategic approach: group claims with certain plaintiff attorneys, approaching Medicare eligibility, legacy claims, difficult to get a response from plaintiff attorney claims, etc. Keep running tabs on what claims have been touched and when. Maintain post-claim review summary for next steps and strategy log to oversee adjuster teams/defense attorneys. Specific Opportunities, Resources & Strategies To Hospitals (cont.) Phone/In-Person interviewing of all potential workers compensation defense lawyers (individual attorneys, not firms) Different attorneys have different skill sets: organized and efficient, the bulldog, kill them with kindness, Sherlock Holmes each skill set has its best use and applies best to certain cases. Don t be afraid to reassign cases when you need to send a message. Ask about current caseload to confirm they are not overloaded. 21 7

8 Specific Opportunities, Resources & Strategies To Hospitals (cont.) Service Team Roundtable Strategy Meetings (Pre- or Post-Claim Review) Comprised of worker s compensation defense attorneys, adjuster team, broker team and medical director to collaborate and make tweaks to the ever-evolving special handling instructions o Example: structured settlement strategy consideration on all claims with Medicare Set Aside exposures valued at specific $ values or higher Peer Hospital Roundtable Strategy Meetings Each side participants: employee health, medical director, broker team, HR, finance Discuss which strategies are working, which are not Trends, best practices, lessons learned, solutions to common issues Exchange intel on key vendors surrounding workers compensation program 22 In Closing... In order to perpetuate continued success, we recommend continuing commitment to employee safety with top priority in these areas: 1. Aggressive claims management/advocacy/strategy 2. Through customized Dashboard and Stats Reports, continue to track and monitor opportunities for strategic risk management and loss prevention initiatives to address trends as they develop 3. Help improve safety culture through coordination of internal/external resources and strategies to help promote increased awareness, accountability, recognition and overall positive culture of employee safety 23 Chris Strachan Principal, Marsh & McLennan Agency, LLC chris.strachan@marshmma.com This document is not intended to be taken as advice regarding any individual situation and should not be relied upon as such. Marsh & McLennan Insurance Agency LLC shall have no obligation to update this publication and shall have no liability to you or any other party arising out of this publication or any matter contained herein. Any statements concerning actuarial, tax, accounting or legal matters are based solely on our experience as consultants and are not to be relied upon as actuarial, accounting, tax or legal advice, for which you should consult your own professional advisors. Any modeling analytics or projections are subject to inherent uncertainty and the analysis could be materially affective if any underlying assumptions, conditions, information or factors are inaccurate or incomplete or should change. CA Insurance Lic: H