Excellence
in
Risk
Management
Click to edit Master title style
through Enterprise Risk Management
Presented by:
Joey Page
President of Essential Risk Solutions
Learning Objectives Today
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What is ERM?
How does it fit within a Public Entity structure?
Public Sector ERM
Why should we expand our thinking?
TRM & ERM: Key comparisons
ERM – Who’s doing it?
Who’s ready for ERM?
ERM tools & resources
Why ERM? Why Today? Why you?
Why Me? Why your Entity?
• Summed up, Public Entity’s need the concepts of ERM today
more than ever to survive-not simply to exist
• Why TODAY? Simple, economics will drive you to ERM more
than anything else.
• Who has unlimited funds to balance your budget?
• ERM Process helps you go through processes that helps find
funding or unnecessary services.
So What Is Enterprise Risk Management?
Enterprise Risk Management defined:
“Enterprise Risk Management (ERM) is a process, affected by the
organizations leadership, applied in a strategy setting, and across
the organization, designed to identify potential events that may
affect the organization, and manage risk(s) to be within its risk appetite,
to provide reasonable assurance regarding the achievement of
the organization’s objectives.”
Let’s Break It Down
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Process – ongoing and fluid throughout the organization structure
Affected – every person at every level
Applied in Strategy Setting – you have to have a game plan
Applied Across the Organization – no one is left out
Designed to Identify Events – good and bad
Reasonable Assurance – yes management; it works
Geared to Achieve Objectives – touches every department, every school
Sounds good, looks pretty on paper, has all kinds of cool buzz words, and it works.
So why this topic???
Reality checking in government:
• No one is held accountable for much of anything
• More silos in government than grain silos in the Mid-West
• Yes, we have a budget, but theoretically we will not be shut
down if we run out of money( CA has seen some Entities go
belly-up; The whole state is on the brink of financial collapse)
• Most organizations see Risk Managers as claims handlers
• Most Within The Risk Management Community Are Waiting To
Be Told To Look Into ERM
Why Broaden Risk Mgmt?
• Yellow Springs, OH – This village near Dayton will lose
$140,000 in income tax revenue when Antioch College closes
next year due to lack of money, taking with it 160 jobs and
300 students (USA Today – Wednesday, August 8)
What revenues does your entity rely upon? Are there “nonessential” services that might be cut? Any potential risks associated
with that??
Why Broaden Risk Mgmt?
• Pittsburgh, PA – 11 teachers 2 counselors “furloughed” in
addition to 160 teachers who retired last year. District is
dealing with declining enrollment with student population
down by 1,500 from last year (USA Today – Wednesday,
August 8)
• Dallas, Ft Worth, Plano, Austin, San Antonio had to build in
furlough days to help balance budgets this year
What happens when you have fewer employees doing more, fewer resources
available to employees & declining morale??
Why Broaden Risk Mgmt?
• NYC, NY – 3 city traffic enforcement agents were arrested
and charge with writing >46 falsified parking tickets, to make it
appear they had been busy (but no worries, the bad tickets
will be voided) (USA Today – Wednesday, August 8)
How long does it take to recover from a bad reputation??
Why Broaden Risk Mgmt?
• What if your entity has a great crisis response plan in place to
deal with a flu pandemic but you haven’t coordinated it with
surrounding entities, the state, local hospitals or private
businesses?
• How many have had a coordinated discussion of IT risks
across your organization? Consider on-line payments, private
medical information, sensitive financial data, student records...
• Have all of you along the Gulf Coast really sat down and
worked thru the logistics of working together before, during,
and after a hurricane? FEMA?????
(TPCG just entered into inter-local with Monroe)
ERM: A Few Key Issues
• Very broad approach to risk
• Risks identified by risk owners, not “experts” – mitigated by
them, too
• Tied to strategic objectives
• Risk ownership
• ERM “thinks forward”
Real issue for risk managers with ERM today is it is finance and/or internal
audits based.
– If you are not in one of these two areas, you will probably never see
ERM.
– RM’s in Public Sector are not involved in the Finance side of the
equation unlike their private sector counterparts.
– If you have not been provided ERM by your current broker, you will
not see it any time soon.
– If you have not gone out to bid in a long time, and do not plan on going
out to bid soon, you will never see it.
– If your risk manager does not get out of their office to investigate
accidents, conduct facility audits or visit the troops – they are less
inclined to try anything new, including ERM.
• Or maybe you looked into it and just cannot imagine ERM
working in your entity
• QUESTION?
– Has anyone in the audience today ever considered ERM for their organization?
– Is anyone considering or in process of implementing ERM?
– (Will anyone even consider ERM?)
Comparing TRM & ERM
TRM
• Grew out of safety &
insurance purchase
• Risk = bad
• Framed by mgmt process;
focuses on problem solving to
reduce & mitigate risk
• Focuses on insurable risks
ERM
• In US, emerged from
financial & banking indus.
• Risk = bad + good?
• Framed by measurement &
control processes; focuses
on strategic objectives
• Wide focus on ALL risk
TRM & ERM
TRM
ERM
• Starts at the bottom??
• Reports to Legal, HR, Finance
or Manager
• Risk Management Policy across
org?
• Accident review committee,
safety or RM committee
• Starts at the top??
• Reports to CEO, audit
committee or CFO
• ERM mandate established
• Interdisciplinary advisory
council or RM steering comm.
Risk Quadrants - HE
Externally driven
Financial Risks
Interest rates
Loss of funding
Distance
Learning
Changes in
Student Needs
R&D
Asset values
Internally driven
Tuition stability
Cash flow
Strategic Risks
Alliances
Image/Reputation
Intellectual capital
Information
systems
Public Liability
Property Damage
Employee injury
Student activities
Regulatory
environment
Campus Safety
Natural disasters
Hazard Risks
Campus life issues
Operational Risks
Hazard Risk
Risks that are generally covered by insurance, and that result in
non-financial asset impairment.
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Natural hazards
Physical damage to tangible assets
Injury to students, faculty, staff and visitors
Environmental impairment
Injury to citizens on parks, in Civic Centers
Automobile accidents
School bus accidents
Workers’ Compensation
Financial Risk
Risks related to the financial well-being of the institution. This
includes such things as:
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Interest rate volatility
Revenue stability
Cash flow
Asset value
Investments
GASB 45
Auditing Standards by Rating Agency’s
Strategic Risk
• The risk that an institution will be unable to fulfill its mission as a
result of its failure to adapt to the changing needs of its
stakeholders and operating environment, or its failure to implement
all or part of its strategic plan. This includes:
Intellectual property
Distance learning
Changes in demographics
Alliances
Competition by other entities for limited Local, State or Federal
Programs and resources, including Employee’s (yes, you do have
competition)
– Economic Climate
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Operational Risk
Risks related to the operation of the institution and its facilities.
This includes:
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Information technology
Student activities
Succession planning
Board composition
Purchasing procedures
Accounting practices
ERM: Who’s Implemented COSO?
Private Sector
Wal-mart – world’s largest retailer
Unocal Corporation – one of world’s largest oil & gas co’s
General Motors – world’s largest vehicle manufacturer
FirstEnergy Corp – 4th largest investor-owned electric utility
in US
• Toyota-U.S.A.
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ERM – Higher Ed
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University of CA system
University of CO system
Maricopa County Community College District
IL State University
UNC – Chapel Hill
NCSU – ERM Initiative
Abilene Christian University
ERM in Public Entities
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Maricopa County, AZ
State of WA
Bonneville Power (Portland, OR)
Plano,TX??
Emerging…
• NM Association of Counties
• Dallas/Ft Worth International Airport
I am not aware of anyone in Louisiana public sector practicing ERM at this time
Public Entities “Ripe” for ERM
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Looking for “what’s next?”
Want to be visionary, forward thinking about risk
Good upper-level support for RM
Solid, functional RM program with a good leader
Not an organization in turmoil, with strong “silos” and turf
issues
A Few ERM Resources
• Check out the Australian Standard –
http://www.saiglobal.com/shop/script.asp
• URMIA Journal & new ERM initiative – www.urmia.org
• RIMS ERM Center of Excellence is evolving at www.rims.org
• COSO – www.coso.org
• IIA (Internal Auditors) www.theiia.org
• Develop Your Own Standard
So What Does ERM Look Like
Sample Employee Survey
Risk Ranking Tool
Risk Register
Still not able to get arms around ERM?
– Introducing –
• PERS or Public Entity Risk Solutions
• We took the best of the COSO standard that would or could
fit in the Public Entity Framework and created PERS to work
from
WHY? I can’t even understand all the different Standards out there.
Nor is there one applicable to Public Entity’s.
PERS – Old Fashion Risk Management
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About visiting and working across silos
Helping other departments be better at what they do
Do what you can with what you have
Communicate – Risk is not a vacuum
It is about bringing all the stakeholders together to better
manage the entities risk
Why the name change to PERS?
Simple:
• Public Sector Brass dislikes anything new for the most part
and like things they know very little about even less
• Plus, if they looked up ERM, they would see more about it
pertaining to the private sector…
And why should government ever be run like a business????
Remember: With ERM, you must think outside the box
How is Risk Management Evolving?
Transactional
Traditional Risk Management
Hazard-based risk identification & controls
Compliance issues addressed separately
Safety & emergency mgmt handled separately
Purchases insurance to cover risks
A “siloed” approach – risks are not integrated or managed
broadly across the organization
– Risk Manager is the insurance buyer
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Risk is bad – focus is on transferring risk
Integrated
Advanced Risk Management
– More proactive about preventing and reducing risks
– Integrates claims mgmt, contracts review, special event RM,
prevention & training, insurance and risk transfer techniques
– Cost allocation used for education and accountability
– Lowers insurance costs (over time)
– More collaboration – as depts. are willing
– Risk Manager may be the risk owner
Risk is an expense – focus is on managing risk
Strategic
Enterprise-wide Risk Management
– A wide range of risks are discussed & reviewed, including
reputational, human capital, strategic & operational
– Aligns RM process with strategy and mission
– May include “upside risks” (opportunities)
– Helps manage growth, allocate capital & resources
– Risks are owned by all & mitigated at the department level
– Many risk mitigation tools available
– Risk Manager is the risk facilitator & leader
Risk is uncertainty – focus is on optimizing risk
How is Risk Management Evolving
Strategic
Risk is
uncertainty –
focus is on
optimizing risk
Integrated
Advanced Risk Management
• More proactive about preventing and reducing risks
• Integrates claims mgmt, contracts review, special
event RM, prevention & training, insurance and risk
transfer techniques
• Cost allocation used for education and accountability
• Lowers insurance costs (over time)
• More collaboration – as depts. are willing
• Risk Manager may be the risk owner
Transactional
Traditional Risk Management
• Hazard-based risk identification & controls
• Compliance issues addressed separately
• Safety & emergency mgmt handled separately
• Purchases insurance to cover risks
Risk
Management
• A “siloed” approach – risks are not
integrated
or managed
broadly across the organization
Perspective
• Risk Manager is the insurance buyer
Risk is bad – focus is on transferring risk
Risk is an expense – focus is on
managing risk
Who’s Responsible for Risk?
C.M.
Owns Risk
RM Steering Comm.
Oversees Risk
Mgmt. & Employees
Identify & Mitigate Risks
Everyone is Responsible
For Risk
Risk Management Steering Committee
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City Manager ,Parish President, Superintendent
Executive Directors, Asst Superintendents
Entity Attorney
Budget Director
Finance Director
Risk Manager
Risk Management Steering Committee
• Ad hoc committee originally formed to approve large claim
settlements.
• Scope expanded to provide direction and oversight, via RM, to
treatment of risk throughout the Entity.
• Committee meetings have evolved from claims handling to
risk tolerance.
• Approve Insurance Programs, Self Insured Retentions
Managers Need to
Understand under ERM
• They are Risk Managers
• Accepting and managing risk is their responsibility
• The ultimate success of the City, as well as their personal
success, depends on how well they accept and manage risk
• We don’t just tell them what they can’t do
• We help them optimize risk taking
• Risk is a partner with Operations
The New Face of Risk
• A systematic approach to managing the risks
associated with opportunities in a consistent
and coordinated manner, across the entire
organization.
Stakeholders
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Residents
Taxpayers
Citizens
Employees
These are the constituencies that entity leaders and management
strive to satisfy. An amazing balancing act to say the least.
Goals of ERM
• Protect the Entity from risks that prevent it from achieving its
objectives
• Increase the efficiency and effectiveness of operations by
decreasing frictional costs associated with risks and optimizing
the allocation of resources
• Increase opportunities by treating the associated risks within
the entity’s risk appetite
• Increase stakeholder value
Implementation Plan – Steps
Communicate to ALL appropriate stakeholders
– Plan the project
– Conduct risk assessments
– Rank & prioritize risks
– Identify risk owners & mitigation options
– Implement mitigation efforts & track results
– Monitor & revise as necessary
• This needs to be communicated to all appropriate
stakeholders
Entity ERM Process
Entity’s
Vision
Entity’s Goals
Risk Framework
Identify Risk
Universe
Risk Workshop
Control & Action
Workshop
Monitor
Evaluate
Manage
Vibrant, Safe,
Sustainable
City
Premier City
in Which to
Live
Categorize
Risk
Survey
Stakeholders
Cross
Departmental
Discussions
Evaluate Risk
Develop Timeline
Vital Economy
Livable and
Sustainable
Community
Evaluate
Existing
Controls
Take Action
High Degree
of mobility
“Service
Excellence”
Identify
Deficiencies
Monitor Progress
Develop
Action Plan
Address Gaps
Assign
Responsibility
Report Results
Abundance of
Educational,
Recreational
and Cultural
Diverse Business
Center
Standardize
Framework/
Language
Reference
Benchmark
Compile Results
Share Data
Schedule
Workshop
Identify
Additional
Risk
Prioritize Risk
Opportunities
Safe,
Efficient
Travel
ERM Implementation Plan
Project Plan
0-18 mos.
Risk Assessment 12-30
mos.
Develop draft plan
Implement Mgmt Self
Assessment Survey
Risk Ranking
24-42 mos.
Mitigation Options &
Owners
36 – 54 mos.
Implementation &
Tracking
48-60 mos.
Clarify responsibilities &
Use subsequent surveys to
Prioritize risks from Mgmt develop tools & resources
benchmark & track
Survey
as needed (heat maps,
changes
etc.)
Reporting; Monitor &
Modify
60-60+ mos.
Report to management
Develop talking points for
Rank risks from employee
Report to steering
Risk Manager to use with Develop employee survey survey & categorize into committee; identify risk
key decision-makers
risk register
owners & responses
Steering committee or
subcommittees to report
Annual report to all
employees & council
Meet with risk owners to
identify mitigation
strategies & benchmarks
Utilize internal audit to
validate processes?
RM & steering committee
recommends
changes/revisions
Discuss talking points w/
Management
Interview managers & key Incorporate data from
stakeholders (?)
interviews (if appropriate)
Identify risk categories:
strategic, operational,
Discuss talking points with Consider an entity-wide
financial, human capital,
Executive Directors. (3) risk assessment workshop
technology, legal &
regulatory
Review Plan with steering
committee
Consider a dept-specific
ERM project
Identify Risk Champions
Identify & Consult with
Risk Champions
Develop dashboard
reporting tools for
management
Risk Assessment – What if?
• What could happen that would keep you from doing
tomorrow the things you are doing today?
• What keeps you up at night?
• What could go wrong in your area?
• What could go wrong in another area that would impact your
area?
• What little things could go wrong that, taken in the aggregate,
could add up to significant problems?
• What’s going on outside the City that could go wrong and
impact you?
ERM Discovery Questions
Operating procedures
– Is this operating method being performed at optimum levels?
– What steps can be taken to improve operations to better serve its core
customers?
Service Level
– How can services be enhanced or improved considering the importance rankings?
– Are services being provided at the most efficient level?
From a “Citizen Service Prioritization
Assessment”
Staffing
– Is staff being provided where it is needed so that customers can be serviced
efficiently and quickly?
– Are there efficiencies that can be obtained by combining services within or
with other departments to better service its core customers?
Outsourcing
– Are services that are now being outsourced making sense to outsource?
– Are there other services that make sense to outsource?
Revenues
– How can revenues be maximized while maintaining and enhancing service
levels?
– Identify new revenue streams to offset enhanced service levels
Enterprise Risk
• Requires a new approach – not all risk is bad or a problem
• Requires a new approach – not all risks are insurable
• Requires a new approach – Teamwork and eliminate Silo’s
Public Entity Risk Solutions (or ERM)
Vision
– To be the primary source of expertise and guidance for optimizing risk
taking decisions, in support of the Entity’s objectives.
Mission
– To provide the leadership, methodology and tools necessary to
support operating management in its responsibility to optimize risk
taking decisions
Risk Management
Mission Statement
Traditional
– To promote health and safety, and to minimize financial risks to the
Entity by creating a safe environment for its employees, citizens, and
visitors.
Enterprise
– To provide the leadership, methodology and tools necessary to
support operating management in its responsibility to optimize risk
taking decisions
An excerpt from an entity’s long range
planning document
“As new development dwindles, the challenge
becomes sustaining the quality of life through
the protection and enhancement of existing
assets.”
So Why Has ERM Not
Hit The Public Sector?
• Because we do not operate Government like a Business
• The “A” word that is historically absent in the Public SectorACCOUNTABILITY
• We operate in Silo’s in Government
• Brokers either lack knowledge or are fearful they may lose
paycheck if you go to ERM
• RISK Managers have not thought outside the box
Problem from a
Risk Management perspective
• Historically, Risk Managers are not risk takers (old school)
• Been brain washed by the insurance industry as to what their
role is
• Lack the fundamental training required to implement ERM
• Are comfortable where they are in the organization
• Won’t rock the boat
• Are overlooked in the entity’s decision process because old
school known as nay-sayers
• Not much fun at parties
• ERM until just recently has been a threat to
public entity insurance brokers and risk
managers.
– Big Brokerage outfits have put ERM into practice for their
private sector clients, not Public clients
– Smaller Agency’s have not had a need to implement
– Silo mentality
– Risk Managers are not looking out for the future
ERM Bridges Silo’s
Cherish the thought of us working together until we are forced
to-Hurricane Katrina
So where does ERM fit in at the
public sector level?
• Data available tells us it is a fit with everything we do in the
Public sector
• Any and all Departments, Schools, Divisions can improve with
ERM
• Works for the smallest to the largest program
• Fits wherever decisions need to be made
ERM Today
Departments interact consistently in making decisions
Each department provides input that will be impacted
All options are thrown on the table for discussion
Each department has a vote in the decision
Issues like funding, maintenance, insurance, are brought out in
advance.
• Decisions are no longer made in a vacuum
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In other words, those that could be impacted by a purchase, or a
program, or something new are brought together collectively to
decide what is best for the Entity as a whole
Making the switch to ERM
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Homework
Someone needs to facilitate the process
Starts at the top and moves downward in the organization
Is implemented from the bottom up
Everyone comes to realize they are their own risk manager
Risks are identified, and ranked
Risks identified are scored
A plan is put in place to mitigate risks
A Risk Assessment is a lengthy process, but is the most
critical part of the ERM process if it is to be implemented
successfully.
Is it too much of a burden to
implement? Not really
• Start with one or a few departments
• Pick Departments or Directors or Managers that are
motivated
• Start with those that will guarantee you success. Early failures
dooms the best ERM game plan you lay out
(Not a burden, but without a champion, can be tough to implement. And it
requires a risk manager with a passion for what they do)
Example #1
Success in a Solid Waste Department.
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Had highest injury incidents
Their employee’s worked all over the City
Work without direct supervision
Had a mixed bag of educational levels
Had no computer access
The Director had a higher vision and needed to shine
Was over running budget annually
And we were motivated in Risk Management because we had done
our homework, knew what ERM could do for them, had Broker
support, and our own reputation was on the line if it failed
Example #1
In this example:
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Rolling workforce
No access to technology
Picking up waste was priority #1 for our constituents
Majority male workforce, Director was female
Decisions crossed different disciplines
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Equipment Services
Accounting
Payroll
Purchasing
Warehouse
HR
Risk Management
Example #1
Results
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Implemented Self Directed work teams
Representatives from other disciplines added on the team
Implement Gain sharing
Established Benchmarks to prove success
Established on-line training using surplus computers
Goal oriented
Example #1
The results were positive
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Cost to operate decreased
Budgets were maintained
Accidents went down
Complaints declined
Attendance improved
Morale improved
Win, Win, Win
We in Risk had a signed agreement with the Director what was
expected of us as did all other stakeholders
– (Show copy of memo)
Another Example
• Want to save money quick using ERM=HEALTHCARE
• Who can afford healthcare today, much less the years to
come?
• Healthcare costs will bankrupt many an entity in the very near
future
• Retiree healthcare
• GASB 45
• The current presidential agenda???
Learning Objectives Today
If you are like most entities, you probably have a broker or
consultant.
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Higher deductibles
Larger co-pays
Plan Design Changes
Employee’s can no longer afford further cost shifting
NONE OF THESE HAVE WORKED TO CONTROL HEALTHCARE COSTS
On-Site Clinics
• Controls healthcare costs at the point of service
• Is the perfect ERM modeling opportunity in any organization?
Big or Small
• Can address Workers’ Compensation as well as Group
Benefits
Opening an Occupational Clinic success story
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After a 4 year struggle had Top Management support
Started trying for Group Healthcare Clinic
Ended up only with Occupational Clinic
Pulled Committee together
Feasibility studies
Good benchmarking data
Conducted needs assessments with all departments-police,
fire, health, public works, parks
What we were able to accomplish:
• Provided Occupational Care that was uncontrollable at Doc
in the Box Occupational Clinics
• Provided preventive inoculations for departments and did not
take that money, they kept it for other pressing needs
• Saved FD $60,000.00 alone
• Return to work quicker
• Reduced overall WC costs
• Did it less costly in house vs. outside contractor
SAVINGS-The real proof
• Reduced allocated expenses by over 55%
• Lowered WC costs over $350,000.00 after expenses
• Allowed other departments to use it (Health Department
Screenings and programs; FD Health and Wellness programs)
• Could have saved Health Fund $650,000.00 but that was the
only silo we had against us
For other Entity’s
• Odessa has had double digit healthcare cost decreases 4 years
running
• Mesquite and Mesquite ISD partnered on a clinic and are
reporting millions of dollars in healthcare cost and pharmacy
costs savings (they operate a pharmacy in their clinic).
Other success stories
• Travis County (now operates 3 clinics, about to open
pharmacy
• Rockwall ISD just opened a clinic part-time and is seeing
savings
• Amarillo
• Garland
• San Angelo (Clinic and Pharmacy)
• City of Corpus Christi out for feasibility study
• The ERM process and combating rising healthcare costs go
hand in hand
• Also works for the budget process
• Works if done by one section or entire operation
• Once you implement, TRM goes out the window
Be forewarned, in the near future, you will have to have ERM
in place to get the highest bond rating.
Better begin implementation of ERM soon if you are going to be
issuing new debt in the near future.
The Future of ERM in the Public Sector
1. Encourages multi-jurisdictional partnering for a common
cause
2. Sharing of resources – cross jurisdictional agencies will work
together (School District and Parish collaborations; Police
and Fire; City Police and Sheriff’s Dept; etc)
3. Eliminates duplication of services
4. Builds TEAMWORK
5. Saves money for all involved as costs go down when you
work thru decisions together
The biggest challenge for Public Entities
in implementing ERM is bridging silos
Opens door for cross jurisdictional agencies to work together
and save taxpayers money
What’s the point again?
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To prepare for negative events (traditional risk)
To bring new risks into awareness
To understand risk relationships, influence & overlaps
Better decisions, fewer surprises
Achieving entity’s goals & objectives
Conclusion
Is ERM right for you?
– Depends on your willingness to work hard, break down silo’s
– If you need new revenue sources to help balance your Budget
Can it work?
– It is working and will work with any issue or program.
– Can work real quick with Top Management support
– Will work for each of you
• Now is the perfect time to consider ERM to tackle the tough
economic forecast you are facing. It is a work in progress and
requires someone dedicated to the process. It will save you
money that you didn’t know you could save!
• Are you ready for excellence in Risk Management thru
Enterprise Risk Management?
You better be or you may not be able to balance your budgets in the
near future without drastic measures being taken. And it may cost
you more money to borrow if your Bond Rating is lowered
Acknowledgements
Dorothy Gjerdrum, ARM-P
– Executive Director
– Gallagher’s Public Entity & Scholastic Division
John Billingham ARM
– Loss Control Consultant
– Self employed
Questions
Thank You!
For more information:
Joey Page
Essential Risk Solutions
Website: www.essentialrisksolutions.com
Email: jpage@essentialrisksolutions.com
Office: (214) 725-7797
Cell: (972) 742-2334
Fax: (214) 509-9715
Real Examples
Actual Savings
City XYZ
2005-06
2006-07
2007-08
With TPA
With TPA
XYZ Model
Claims & Ancillary Charges
$300,000
$300,000
$220,000
PEER Review
$16,861
$16,450
$0
Bill Review
$55,646
$47,579
$12,399
Utilization Review/Pre-cost
$54,438
$49,280
$9,510
Durable Medical Equipment
$19,767
$19,490
$6,114
Diagnostic (X-rays, MRI)
$33,582
$28,490
$5611
Total
$480,294.00
$461,295.00
$253,634.00
Utilization Control with On-Site Clinic
Model
Claim Utilization
Average visits per injury
Average visits before referral
Average # of x-rays per claim
2007
3.5 per claim
4.5 per claim
16.1 per claim
2008
1 per injury
1 per injury
8 per claim