Nissan North America
• Operations include Automotive styling, Engineering,
Manufacturing and distribution, consumer & corporate financing,
sales and marketing.
• Primary risk: Manufacturing- High speed repetitive processes
– Launched Safety One Program in 2002
– Investment in Ergonomics: We understand the ROI
• Focus on Data Driven Analytics
Safety One
•Aligned Safety performance as a Key Performance Indicator (KPI) . KPI performance
drives Action & Accountability. DART is the primary KPI for Safety.
•Shared responsibility in all layers of line organization
•Safety and Ergonomics focus on action driven by analytics
35.00
NNAS - Safety Performance
FY2001 - FY2011 (as of 02/29/12)
30.00
25.00
Rec: -82%
FY01-FY11
LT: -91%
Since FY2001
Rec: 31%
20.00
Rec: 12%
15.00
Rec: 30%
10.00
Rec: 28%
Rec: 10%
Rec:
+11%
Rec: 15%
Rec: 26%
Rec:
25%
Rec:
-26%
DART:
-22%
LT: 12%
FY10
FY11 as of
Feb 29
5.00
0.00
FY01
FY02
FY03
FY04
FY05
FY06
FY07
FY08
FY09
REC GOAL
28.10
24.00
17.29
12.40
11.30
7.57
7.24
6.23
6.98
Rec Rate
29.10
20.19
17.67
12.32
8.90
8.01
8.87
7.58
5.60
7.02
5.21
DART GOAL
4.32
1.70
DART Rate
2.27
1.77
LT GOAL
0.00
4.70
2.81
1.90
1.80
1.58
1.31
1.12
1.45
1.25
0.49
LT Rate
6.47
4.01
3.82
2.71
1.60
1.44
2.13
1.54
1.25
0.65
0.57
Monthly Tracking/Reporting
Critical Success Factors
• Attitude that WC costs are controllable
• Thorough assessment of current conditions (SWOT)
– Quantitative
• Multivariable analysis of any adverse trends (severity, lost work days)
•
•
•
•
•
– Qualitative
Selected quantifiable targets/goal setting
Explored, selected and prioritized fast, free and quantifiable high
payoff solutions
Collaborative execution
Post implementation progress reporting
Continuous improvement mentality beyond incremental gains
Where Does the Money Go?
Scripts
(how soon are we seeing narcotics prescribed, who is prescribing them, duration?)
Lost work days
(How many workers out w/o surgery)
20% Conversions
(Why/prevent?)
Operations
Surgery
(Accountability practices)
(impact)
Spend on Dr. Hayes?
(Is there a more effective MD in the area?)
Adjuster
severity
(reserve
accuracy)
Litigation expenses
Cormobidities
(impact/manage)
Shoulders
(Who is suing us, at
what point, and why?)
(Body movement? Can we profile the
costly claims and get in front of them?)
Current Severity Trends
Average Cost Per Claim Comparison
40%
PY 2007
PY 2009
PY 2008
PY 2011
PY 2010
24%
20%
3%
6%
3%
0%
59 Month Comparison
-20%
-12%
47 Month Comparison
35 Month Comparison
23 Month Comparison
11 Month Comparison
-18%
-32%
-40%
-35%
-37%
-44%
-60%
Incurred
59
Average Incurred
% Change
Average Paid
% Change
2006
$13,344
47
2007
$11,678
2007
$10,889
-12%
$12,384
3%
$10,202
-18%
2008
$11,181
$9,769
$10,050
3%
Paid
35
2008
2009
$10,797
$7,338
-32%
2009
$7,130
$9,392
$4,709
$6,095
-35%
23
11
2010
$4,466
2010
$3,255
-37%
24%
$2,655
-44%
2011
$4,033
$1,413
$1,504
6%
Partnership to Drive Results
(strategy maps)
Project Charter
Affiliate: NNA
Date Prepared: 6/4/2010
Project #
Last Revision Date:
Project Title
Project Type
Claims Management Strategy
FY'10 Medical Management Initiative
NISSAN PROGRAM TASK LIST
Upper-Level Goals:
1. Establish measurable criteria for claim audits.
2. Review criteria with stakeholders prior to the audit to ensure expectations are communicated and understood.
3. Complete semiannual file audits and quarterly claim reviews to assess file quality, adherence to claims best practices, progression of claims toward
resolution and ultimately performance of Work Comp Third Party Administrator (ESIS).
3. Assess areas of high, standard and low performance in handling of Work Comp claims.
4. Provide feedback to stakeholders for continuous process improvement.
5. Obtain feedback and action plans from stakeholders to improve deficient areas of performance.
6. Assess audit tool annually to focus on areas that need improvement to encourage.
Updated March 15, 2008
Task #
Nissan North American, Inc.
2009 Open Items List
Claims - Loss Control
Tuesday, January 05, 2010
Target (First Metrics)
Definition
Current Value (baseline)
Cumulative audit score calculated after
Will have after July audit
auditing appx 50 WC files
Target Value
Gap
85%+
TBD
Milestones
Due Date for Intensive Discussion
(VF3) or End of Team Activity Date
(DECIDE I3)
Implementation Start Date
(Estimated for DECIDE / Actual for V-FAST)
6/10/2010
10-Jun-10
Due Date for Target Achievement
(End of DECIDE Phase E or VF5)
Subject
Item
Responsible
Party
Start
Date
Target
Actual
Completion Completion
Date
Date
1-Apr-11
CLAIMS-LOSS
CONTROL
2009-2010
Task
Task
initiated
Task
completed
Change to
task list
Missed
deadline
Responsible Start Date
Target
Actual
Team
Complete Complete
Member
1
Data Management Tasks
Analysis and Evaluation of Systems including KCRS and
RiskAdvantage,
2
Provide Wish List of system capabilities
Carol
3
Identify available medical cost containment reports from current
systems
Develop benchmarks and Dashboard Scorecard
Justin
Janet
12/1/2008
5
6
Review with Nissan
Develop schedule for metrics reports with ESIS
Janet
Janet
3/9/2009 3/23/2009
3/23/2009 4/1/2009
1
Communication and Teamwork Tasks
Process map both internal communication and external
communications with CHS, ESIS, Nissan and external providers
4
Justin
1/16/2009
4/1/2009
Comments
Justin is also in the process of doing a broader
analysis of systems. Although this task may assist
him in that larger project, the goal of this analysis is
to define current usage, needs, abilities and
integration of the systems to ensure that the team
is able to effectively utilize these tools now
Carol will provide an outline of essential system
capabilities based on needs and experience with
other systems
3/2/2009
Status / Comments
3/9/2009 To provide a benchmark to measure improvement
and compliance with best practices as well as
overall program management
Get input from Nissan team for final metrics list
Preconditions (incl. Physical Scope , budget, 2nd metric etc.)
Second measurement will be obtaining a timely response and action plan from TPA 30 days
post presentation of audit findings.
Implementation of action plan and effectiveness will be gauged at the next 6 month review.
ESIS Dedicated Unit
Staffing Update
Basis for Project Benefit Calculation
Estimated Project Benefit
Benefit Categories:
1) Claim Costs
2) TPA Service Fee
Warren, Dove,
Bartlett
Ongoing
Grady
Ongoing Ongoing Reports
due on 10th
of each
month
Period considered for the amount below:
Monthly Scorecard
Benefit Calculation Formula:
1) Claim costs measured by performance year in comparison to previous policy year at same
point in time valuation. Values derived from monthly Beecher scorecard.
2) Service Fee will be impacted in Yr 2 of contract contingent upon Yr 1 performance and
audit scores.
Project Approval
Date
MMSEA -Signature
MEDICARE
Role
Company
Department
Name
Leader
Nissan
Treasury/Risk Mgmt
Jason Bartlett
Team Members
Company
Ongoing
Department
Name
ESIS
Kim Metzler
ESIS
Miles Tate
Brad Koehl
CHS
NNA
Medical Mgmt
Justin Rhodes
NNA
Medical Mgmt
Cheryl Shull
Beecher Carlson
Claims
Janet Warrant
(Includes Financial Validator)
Role
Acct Mgr
Manager
Company
Department
Cheryl S.
1/20/2009
Miles &
Cheryl F.
Janet
1/26/2009
Janet
3/1/2009
Cheryl F.
with team
1/26/2009
1/26/2009 3/23/2009
3/28/2009
6
1
Medical Case Management & Cost Containment Tasks
Review and revise the Care Management Status Report form
2
Obtain access to appropriate protocols and guidelines
Carol
2/2/2009
3
Reconvene Provider Panel Committee to review and credential
Kerry
1/29/2009
Cheryl S.
1/26/2009
Janet
1/26/2009
2/2/2009
Janet
2/15/2009
3/2/2009
Janet
Janet
Carol
Janet
2/1/2009 2/15/2009 2/16/2009
2/15/2009 3/2/2009 2/20/2009
Kerry
David
Janet
Janet
1/28/2009 1/30/2009 2/6/2009
2/2/2009 2/6/2009 2/11/2009
2/2/2008 2/15/2009 2/17/2009
2/2/2009 4/1/2009
March and June set up - need to set up September
and December
2/2/2009 4/1/2009
JB
2009-2010
Name
Role
MMSEA for Products
Liability
Myers
8/3/2009
TMCS has agreed in writing that they Providers
will perform
4
Define Second Opinion, Second Surgical Opinion and IME and
work for current program using NGRe
as reinsurer.
develop process and protocols for all three
Provide
a list of triggers (red flags) for catastrophic injury
TMCS is working on price for pre52006
programs
management and process for escalation of case for appropriate
with NMIC (Hawaii captive) as insurer.
Asmanagement
of 10-6medical
6
Facilitate
debrief on Ojomoji claim
09 Nissan was waiting for new number. Sompo
agreed to report on Products Liability
andaudit
will
7
Develop
tool for CHS Medical Management
Complete Audit of CHS Medical Management
have a price within first 2 weeks89of January.
Present Medical Update to team
10
Establish
triggers and process for escalation of claims to and
Waiting to see regarding the Hawaiian
captive.
Manager
Med Mgmt
(Mfg)
Med Mgmt
(Non-Mfg)
Director
Claims
© 2007 NISSAN MOTOR CO.,LTD. All rights reserved.
ESIS will provide information on a monthly
including, basis
roles andand
responsibilities including on-site and field
case management,
a formal staffing analysis will be completed
on a mail process and documentation
2
ESIS and CHS to host a "Meet & Greet"
quarterly basis going forward. ESIS is preparing
3
Develop report card and peer review process
update with target completion 10/15/09.
4
Complete
Closed item for Finalizing Scorecard.
Willreport card and peer review
5
continue to provide monthly scorecard.
within Nissan and process for handling issues
ESIS CONTRACT
Form 0701
RENEWAL
2009-2010
1
2
ESIS Renewal
Contract wording
Barlett, Dove,
Warren
ESIS Renewal
Agree on renewal terms and
Performance Guarantee to
provide to Rhonda for Final Bartlett, Dove,
Negotiation with ESIS
Warren
1/5/2010 1/31/2010
Claims Management & Administration Tasks
Provide list of Nissan, CHS and ESIS users
Provide access to Beecher Carlson Extranet
3
Review Transitional Duty Program with Recommendations
Review of contract wording. Jason
and
Janet will
4
Set up Quarterly Claim Review Calendar
discuss prior to negotiations with ESIS.
5
Set up Date for follow-up audit
Project Management Tasks
7/1/2009
2/15/2010
CLAIMS CLOSURE
2009-2010
ESIS Open Claims
Warren
TBD
3/1/2010
First phase of closure project completed during ESIS
staffing Analysis. Kim Metzler updated open claims
and will be updating on a quarterly basis. 12/01/09
update showed total decrease at $2.1 million
Janet
2/2/2009
3/2/2009
4/1/2009
3/17/2009
This is rolled into VTP process map. Provided
copies of escalation procedures developed for
other clients 03/15/09
Progress Reporting
Nissan North America
Knowing precisely where and
how
to f ocus to lower y our cost of risk
23 Month Goals Scorecard Focus On Outcomes for PY10
Program Period PY10
(4/1/10 to 3/31/11)
valued as of
Base Period PY09
(4/1/09 to 3/31/10)
valued as of
Base Period PY08
(4/1/08 to 3/31/09)
valued as of
2/29/12
(23 Months)
2/28/11
(23 Months)
2/28/10
(23 Months)
885
3.2
959
3.4
3.48
48%
Total incurred (all claims)
Total paid
Goal %
1
Total claims frequency > $0
Frequency rate per 100k man hours
2
Avg employee lag
%of claims w/ employee lag < 1 day
Goal $
4
Payroll per $1000 (payroll/$1000)
Units produced - weighted NNA
Man hours
-8%
-8%
-10%
-9%
3.81
32%
4.53
38%
-9%
-23%
$3,952,431
$6,837,944
$10,109,507
-42%
-61%
$2,349,856
$4,515,804
$7,334,089
-48%
-68%
$774,518
$823,998
$893,775
-6%
-13%
1,403,123
27,805,746
1,160,655
27,864,989
1,027,534
28,209,390
21%
0%
37%
-1%
-10%
$7.47
$5.10
$8.30
$11.31
-32%
-39%
-55%
-10%
-10%
$5.30
$0.22
$2.82
$0.14
$5.89
$0.25
$9.84
$0.36
-47%
-36%
-52%
-42%
-71%
-60%
0%
$7,130
$4,466
$7,130
$10,243
-37%
-37%
-56%
$2,655
$4,709
$7,431
-44%
-64%
Closed claims
834
891
894
-6%
-7%
$1,337,964
$2,661,070
$4,140,804
-50%
-68%
$1,604
$2,987
$4,632
-46%
-65%
94%
93%
91%
7.63
107
13.53
157
20.53
211
-44%
-32%
-63%
-49%
Total incurred indemnity
$3,579,628
$6,447,904
$9,640,103
-44%
-63%
Total paid indemnity
$1,996,984
$4,150,919
$6,931,321
-52%
-71%
12%
16%
21%
$33,454
$18,663
$41,069
$26,439
$45,688
$32,850
-19%
-29%
-27%
-43%
-35%
-53%
-27%
-43%
Incurred closed claims
Avg severity/closed claims
All claims closing ratio
Claims coded as indemnity
Lost Time Rate per Unit Produced
Claims w/ indemnity incurred
Indemnity as a % of all claims
159
18%
Average incurred indemnity
Average paid indemnity
8
987
3.5
Incurred /units produced - weighted NNA
Incurred / man hours
Average paid
7
2010 variance
to 2008
Incurred % $1000/payroll
5. Average incurred - all claims
6
2010 variance
to 2009
100%
Avg employer lag
%of claims w/ employer lag < 1 day
3
Variance to
goals
Indemnity closed claims
Indemnity closing ratio
Indemnity as a % of total incurred
Open indemnity claims
62%
61
94
131
57%
60%
62%
91%
94%
95%
46
63
80
Medical Management Process
Investigation
Case Closure
Superior
Compensability
Outcomes
Resolution Plan
RTW & Medical
Management
Establish Standardized Case Management Process
• Injury Reporting
– Early employee reporting- day of injury event or within 2 weeks of
symptoms for cumulative trauma injuries
– Rapid reporting to ESIS – within 24 hours of Nissan knowledge
• Standardized Investigation and Information
– Employee Medical Manager Statement (EMMS)- completed by
Nissan and provided to ESIS and the treating physician prior to
first medical examination
– Daily meeting to investigate &plan cases strategically and
collaboratively
– Incident investigation information package to ESIS & physician
– Attending Physician Report – work collaboratively with medical
community to establish required feedback from physician. The
goal is to secure standard/consistent medical information for
determining work relatedness and to manage the injury and case
effectively.
Tools of the Trade
•
•
•
•
•
•
•
Process Map
Supervisor Incident Report
Employee/Manager Medical Statement
Daily Incident Reporting
Medical Management Care Map
Compensability Dashboard
Case Management Tracking
Injury Process Map
Non-Urgent Work Related Injuries – Reporting Responsibilities
Company
Designated
Medical Clinic
Employee
Employee’s Supervisor
No
Refer to their personal
physician. Fees are the
responsibility of the
employee
Nissan Dallas
Provide the
employee with a
copy of Work
Related Injury
Instructions to
Employee
End
Does the employee
specifically report the
problem to be work related?
Ask!
Yes
Go to WIN Nissan
World/Safety and
Medical/ Dallas or
WINHR and print Work
Related Injury
Investigation form &
instructions to
employee and manager
Reviews
Employee Section
of Injury
Investigation form
& job description
Assesses and
provides initial
treatment if
employee agrees
**
Complete Investigation
and email both pages of
Injury Investigation Form
Safety Mgr. & Medical
Management Mgr. &
ESIS Adjustor
Employee completes the
front page (Employee
Section) of the Work
Related Injury
Investigation form.
Supervisor reviews to
ensure form is fully
completed by employee
Supervisor must sign for
indicating they reviewed.
Employee reports a complaint
of pain or incident/injury to
direct supervisor or other work
group manager if direct
supervisor is not available *
Start
Send employee to
company
designated Clinic
with a copy of
completed
Employee Section
of Injury
Investigation Form
& Job Description
Completes Work
Status Report
(DWC 73)
Should include
specific restrictions
***
Attend
assessment
appointment at
company
designated clinic
Return DWC 73 to
supervisor (in
person if able)
Information
**
Work Related Injury Investigation Form
Unless emergency care is required, no medical
evaluation or care is authorized under workers
comp until the Employee Section is completed by
employee and signed by Nissan management.
Provide
Employee’s Job
Description to
ESIS
Go to page 2
Return to
Work
Provides
completed DWC
73 copy to
employee
ESIS Adjustor
* Employees are
expected to report
an injury or
complaint of pain
the same shift it
occurs
Call report into
ESIS within 1
business day 1888-361-5807
24/7 service
*** The physician must
identify tasks the
employee can safely
perform, specific
restrictions and estimated
duration of same (DWC73
Work Status Form)
972.465.7552 / 800.937.7460
Fax #: 800-373-5156
Email: Becky.Clifton@esis.com
ESIS may call the
supervisor for incident
related and job related
information
Treatment or
payment for care
may be negatively
impacted if there is
a delay in
reporting by
employee or
Nissan
Supervisor Incident Report
1st Step: On-line system designed to
document facts
• Supervisor completes by the end of the
shift the incident or injury is reported
• Capture worker’s account of the event
•Description of incident by Supervisor
•Initiate investigation & determine root
cause of incident: 5 whys
•Initiates interim safety countermeasures
Provides:
•Notification to management, Safety and
Medical Management
• Establishes accountability
•Feeds reporting database
Employee/Manager Medical Statement
2nd Step: Designed to document & tie
the incident & injury symptoms to
medical management
• Capture worker’s account of the
event in writing and signed by EE
• Identify manager’s concerns
• Verify EMMS with recorded
statement (gap analysis)
• Meet face to face with employee if
there are discrepancies
Daily Incident Reporting
On-site team of experts collaborate to review incidents in daily 11:00 meeting:
• Safety – Safety & Ergonomics Job Review to determine root cause and help
with corrective measures on the floor with manufacturing
• Medical Management : CHS– Medical Job Review, determine causation
• ESIS – Compensability and defense issues addressed, plan strategically
Medical Management Care Map
•Establish evidence based medicine expectations at the outset with all
stakeholders. Based on ODG guidelines. Establishes accountability !
•Focuses on worker’s functional capabilities and successful progression through
treatment gateways.
•Weekly case management meetings to identify variances to care plan and develop
action plans to mitigate the same, using the Case Management Dashboard.
Compensability Dashboard
•Facilitate timely exchange of information between Safety, Medical and TPA.
•Vet compensability concerns from each perspective.
•Make the correct decision at the outset.
Case Management Dashboard
•Used by Medical Management to track and report progress of cases
•Presented in Case Management weekly meeting for discussion
•Quick visual management, we only discuss yellow and red cases
•Focuses on barriers to progression and solutions/actions to be taken
Physician Performance
Average LOA by Physican - Canton Plant
2008
2009
Average LOA by Physican - Smyrna Plant
2010
2008
200
180
160
140
121
120
151
137
134
130
122
120
102
101
95
92
91
83
60
64
40
40
35
27
22
11
0
Sundaram, Mani
0
Geissler, William
HAND ELBOW SURGERY ORTHOPEDIC SURGERY
Geissler, William
ORTHOPEDICS
61
60
52
51
16
78
76
80
68
27
17
0
Katz, Howard
PHYSIATRY
20
Vohra, Rahul
PHYSIATRY
14
11
0
0
Sundaram, Mani
PLASTIC SURGERY
0
0
Coogan, Philip
Joyner, Kyle S
Weikert, Doug
Berkman, Richard
Garside, Blake
Kioschos, Michael
Steinagle, Timothy J
HAND ELBOW
SURGERY
HAND ELBOW
SURGERY
HAND ELBOW
SURGERY
NEURO SURGERY
ORTHOPEDICS
ORTHOPEDICS
ORTHOPEDICS
Fiscal Year Comparison - Smyrna Referrals
Fiscal Year Comparison - Canton Referrals
120
120
100
100
80
80
60
60
40
40
20
20
0
105
103
102
100
80
0
145
144
140
20
2010
180
160
100
2009
200
0
FY 2010
FY 2009
FY 2008
FY 2010
FY 2009
FY 2008
Restricted Duty Impact
TTD COST AVOIDANCE
Workers’ Compensation
$1,800,000
$1,618,808
$1,600,000
$4.8m Cost Avoidance
2006 - 2009
$1,423,854
$1,400,000
•
Realized $4.8m cost avoidance in
Workers’ Compensation Program
costs
•
Favorably impacts loss pick forecasts
used for Global Captive Funding
•
Favorably impacts ACE stop loss
premiums
$1,200,000
$1,078,680
$1,000,000
$800,000
$695,433
$600,000
$400,000
$200,000
$2006
2007
2008
2009
ALTIMA
BODY ASSY
PAINT
PQ
SCM
STAMPING
TRIM
2.89
1.25
0.68
0.50
0.70
1.31
2.55
Reported
LT Rate as
of 1/31
2.43
1.33
0.98
0.71
0.00
0.48
1.66
Smyrna
1.45
1.14
2.35
Decherd
1.84
1.60
1.92
Plant
Goal
Safety Performance
•
Favorably impacts Safety KPIs and
OSHA reporting requirements
•
Improves Safety LT rate by 51%
•
Improves Decherd LT rate by 17%
Adj LT
Rate
5.41
2.12
1.72
1.07
0.61
0.95
3.56
Reduce Lost Work Days
• Baseline:
– 2007 to 2009: average 129 days for all lost time claims
– Varying placement mobility from plant to plant
– Majority of 90 day restriction being used prior to surgery
• Goal: Reduce average lost work days
– Lost time rate
– Duration of disability
• Solution:
–
–
–
–
–
–
Performance analytics
Performance incentives for operations
Treating MD’s no longer determines return to work status
Non surgical stay at work
Transitional job banks
Disability management plans/care mapping
Claim Management
Surgeon Utilization
Total NNA - Physician for FY09 & FY10 (as of 12/31)
35
29
30
25
20
15
15
10
10
5
1
10
3
2
3
0
GENERAL SURGERY
HAND ELBOW SURGERY
FY2009 (as of 12/31/2009)
NEURO SURGERY
FY2010 (as of 12/31/2010)
ORTHOPEDIC SURGERY
Surgeries by Site
Surgical Cases by Site for FY09 & FY10 (as of 12/31)
Surgery - FY2009
Surgery - FY2010
20
19
18
16
14
12
12
10
8
8
7
6
4
3
2
2
0
Nissan Canton
Nissan Decherd
Nissan Smyrna
Continuous Improvement
$25,000
$22.5M/39% Reduction
to Loss Rates
$20,000
$15,000
$10,000
In $000s
$5,000
Increase in severity
$0
2004
2005
2006
Initial Loss Projection
2007
2008
Year
2009
2010
Current Loss Projection
2011