“Winners Keep Score”

By Brian Allen

When I first entered insurance sales about 30 years ago, my mentor and sales manager shared this quote with me: “Winners keep score.” Throughout my career, this quote has stuck with me.  He emphasized that if I wanted to see continuous improvement in my sales results, I needed to measure and track what led to a sale.  It was great advice; by measuring results and looking at trends, I was able to identify the activities that led to better results, which ultimately led me to a successful career. Keeping score has helped me in all facets of my professional and personal life, and it can help in workers’ comp, too.

Let’s look at how Texas has measured its progress in workers’ compensation. As the Texas Legislature was heading into the 2005 Regular Session, the senators and representatives were fielding numerous complaints about the workers’ compensation system and the Texas Workers’ Compensation Commission (TWCC). Costs were high, satisfaction levels were low and the TWCC was facing a lack of confidence from both stakeholders and legislators. Nothing motivates legislators to make changes like angry voters. This is especially true when constituents on all sides of an issue are equally unhappy.  That perfect storm in Texas in 2005 led to the introduction of HB7, a major overhaul of the Texas workers’ compensation system. 

HB7 was over 360 pages long, repealed much of the workers’ compensation law at the time and replaced it with new language and ideas. Additionally, the structure was changed. The TWCC was dismantled and replaced with the current Division of Workers’ Compensation (DWC) within the Texas Department of Insurance. Finally, HB7 issued a statutory declaration of four specific system goals:

1. Each employee shall be treated with dignity and respect when injured on the job
2. Each injured employee shall have access to a fair and accessible dispute resolution process
3. Each injured employee shall have access to prompt, high-quality medical care within the framework established by this [legislation]
4. Each injured employee shall receive services to facilitate the employee’s return to employment as soon as it is considered safe and appropriate by the employee’s health care provider

The legislation also mandated that the DWC evaluate the effectiveness of any changes and use tools and technology to simplify and streamline the administration of the system. Other changes included a requirement for e-billing, development of a “closed” drug formulary, creation of health care networks, better oversight of medical review organizations, allowance for fee negotiations outside of the fee schedule, creation of the Office of Injured Employee Counsel and significant changes to strengthen the Ombudsman office. 

Of particular note is the requirement to evaluate the effectiveness of any changes.  The DWC has an entire unit entitled the ‘Research and Evaluation Group’ that is focused on reviewing data, evaluating the impact of any changes in the system and identifying trends that would require intervention.    

Ultimately, the Texas Division of Workers’ Compensation understands the importance of keeping score. Prior to launching their drug formulary in 2011, the DWC collected comprehensive data on drug utilization and costs. That data became the baseline for comparative purposes following the launch of the drug formulary. The DWC also, wisely, made no other changes in their prescription drug policy following the implementation of the drug formulary so any measurable impacts would be directly attributable to just the drug formulary changes. This move led to the compilation of compelling data showing a significant decrease in the use of opioids and the overall cost of medications. This data has spawned interest in drug formularies in workers’ compensation systems across the country and improved outcomes for injured workers.  

Another critical data point measured by the DWC is injured employee satisfaction with various facets of the Texas workers’ compensation system. This speaks directly to the four goals identified by the legislature and measures the human impact of changes made to the system. Chart one, below, identifies overall satisfaction with medical care received out of network and within several networks chosen for this comparison.  Over the seven-year period compared, satisfaction levels remained fairly constant with an overall all slight decrease in the combined level of satisfaction.

Source: Texas DWC Research and Evaluation Group Network Reports Cards, years 2011 to 2017

Chart two looks at the injured employee’s perceived access to needed medical care.  Over time, the perception on access to care has remained level.   

Source: Texas DWC Research and Evaluation Group Network Reports Cards, years 2011 to 2017

Another important data point watched carefully by employers and policymakers is the cost of workers’ compensation insurance. In December 2017, the Texas DWC reported that premium costs have decreased 63% since the 2005 reforms in HB7. For states looking to attract businesses, this is a winning number.  Texas is consistently ranked as one of the best states to do business, but the Lone Star state advanced to the number two spot on Forbes Best States list in the fall of 2017. 

Keeping score has helped Texas win on the business side of the workers’ compensation equation. It is admirable that the Texas legislature enumerated four goals all focused on the injured employee and that the Research and Evaluation Group measures those goals. However, it is important not to lose sight of the injured employee in the midst of the business success. Overall satisfaction and access to care have remained constant in the 60% range. Back in my days as an insurance agent, my goal was to retain 90% of my customers at renewal time and I generally got pretty close. If my retention rates had landed in the 60% range, I would have had to work hard selling new business to make up for the lost revenue.  

Injured employee satisfaction levels of 60% are pretty good, especially given all of the changes seen in the Texas system. However, since we are keeping score: can we do better? We should consider this not just in Texas, but also across the country. Is there an opportunity to win on the frontier of injured worker satisfaction without sacrificing success in reducing costs?  If we aren’t keeping this score, we should be. To improve satisfaction we need to first measure it.  As my old mentor frequently reminded me, “Winners keep score.”  

=================================================================

Brian Allen is the vice president of government affairs for Mitchell.  He is a former state legislator with over 25 years of political experience. Brian is actively promoting positive policy solutions for workers’ compensation around the country.