ASSOCIATION COUNTY COMMISSIONERS OF GEORGIA - GROUP SELF-INSURANCE WORKERS’ COMPENSATION FUND Columbus Consolidated Gove

1. ASSOCIATION COUNTY COMMISSIONERS OF GEORGIA -GROUP SELF-INSURANCE WORKERS’ COMPENSATION FUNDColumbus Consolidated GovernmentMay 14, 2013 Presenters Ben Pittarelli, ACCG John Smith, ACCG Ashley Abercrombie, Marsh

2. Columbus Consolidated Government (CCG) has been a member of the ACCG – Group Self-Insurance Workers’ Compensation Fund (ACCG-GSIWCF) since July 1, 2002. 176 county governments and authorities participate in this fund CCG participates in the Large Deductible Option with 12 other large Georgia counties and consolidated governments CCG obtains benefits of being self-insured as well as having managed services by ACCG Overview

3. What is a group self-insurance fund? • Risk financing arrangement or mechanism made up of homogeneous members to provide for their insurance and risk management services. • - Very similar to a mutual insurance company (company owned by its policyholders) • - Redirects insurance premiums. Instead of purchasing an insurance product, premiums are used to capitalize a loss funding program and to provide for required services. Any surplus accrues to the benefit of the membership.

4. History & Evolution of Pools • The Texas Municipal League was the first intergovernmental pool (1974). • The ACCG - GSIWCF began in 1982. • Today there are over 500 public entity pools which collect approximately $8 to $10 billion in premium contributions annually.

5. Characteristics of a Group Self-Insurance Pool • Member-owned and controlled • Homogeneous group • Group purchasing power • In Georgia, regulated by the Insurance Commissioner’s Office • Dedicated member services • Operate more cost-effectively than commercial insurance companies

6. Advantages of the ACCG Insurance Programs • Non-profit organization; no income or premium tax • No sales commissions • Extensive knowledge and experience with Georgia public entity workers’ compensation risks • Professional, stable management staff • Well-trained, specialized claims administrative services • Specialized and extensive loss control services • Provide CCG access to state-of-the-art claims information management system • Continued availability of coverage – Over 30 years • Underwriting and investment income belongs to members • Dividends – Over $50 million returned from ACCG-GSIWCF

7. Management oversight by the ACCG professional insurance staff Claims administration services Access to state-of-the-art claims system Excess Workers’ Compensation coverage (Statutory) Subsequent Injury Trust Fund Assessment Workers’ Compensation Board Assessment Banking, actuarial, financial auditing, claims auditing services Unlimited professional loss control / safety consulting services What’s included in the GSIWCF program?

8. Total Cost of Risk – Workers’ Comp Over 2/3 of cost for CCG’s workers’ compensation is in losses within the City’s deductible.

9. Issues at Hand The Estimated Ultimate Losses within the Deductible have increased by 51% and the Pure Loss Rate has increased by 31% since 2007. (BYNAC Actuarial Report - July 6, 2012.)

10. Average number of claims per employees is 1.65 times that of the average ACCG-GSIWCF member (2007-2012 losses) Rising medical costs Cost of treatments Utilization Medicare Set-Asides include Pharmacy as of 2006 Experience modification continues to increase, but NCCI formula change may benefit CCG in 2014 Issues at Hand

11. Managed Care Organizations in Georgia Source: http://sbwc.georgia.gov/sites/sbwc.georgia.gov/files/related_files/site_page/MasterQuarterlyReport.pdf 11

12. √ Make a management commitment to improve CCG’s risk management culture √ Hire a risk manager to be CCG’s advocate √ Review CCG’s posted panel of physicians √ Improve communication with those physicians as well as department heads & Claims Unit; continue… Adjust posted panel if necessary to control costs Explore triage service through the ACCG Claims Unit Review and improve Return-to-Work program Analyze focus areas for loss control efforts, including policies, procedures and training and implement Recommendations on Reducing Costs

13. Claims Manager – 28 years experience Claims Supervisor – 33 years experience Lost Time Examiners – average experience = 18.5 years 3 Certified, Contracted Nurse Case Managers Historical Claims Volume: 14,119 lost time claims 58,372 medical only claims ACCG Claims Administration Team

14. Current Panel System 10 non-associated Physicians Established by the employer Must have 6 physicians to include: 1 Orthopedic 1 Minority No more than 2 industrial clinics CCG Medical Management

15. ACCG Claims Partners Telephonic and field nurse case management, including Utilization Review: GENEX Medical Bill Review / PPO: MCMC 2012 savings for CCG: $1,393,296; 48% below charges submitted Pharmacy: Express Scripts 2012 savings for CCG: $36,249; 22.25% below GA Fee Schedule Physical Therapy: Align Network 2012 savings for CCG: $87,889; 31% below GA Fee Schedule

16. Loss Control Services • Local Government Risk Management Services • - Joint effort of ACCG & the Georgia Municipal Association (GMA) • - Non-profit corporation started in 1988 • - Overseen by joint ACCG & GMA Board • - Purpose is to help fund members prevent and minimize losses • - Funded by and service ACCG and GMA insurance programs

17. Loss Control Recommendations • New LGRMS Director to meet with CCG Risk Manager to review loss analysis specific to CCG, perform risk assessments and formulate a plan for focus areas. • Along with the Risk Manager, meet with the leaders of key departments experiencing high frequency and/or severity in losses. • LGRMS’ Recommended Focus Areas (based on claims from 2008 thru 2012): • Road Department: 17% of Claims & 17% of Claim Dollars • Sheriff’s Department: 22% of Claims, 31% of Claim Dollars Landfill/Sanitation/Sewer – 5% of Claims, 6% of Claims Dollars • Public Officials/Clerical – 5% of Claims, 13% of Claims Dollars

18. Loss Control Recommendations • Develop department-specific Risk Reduction Teams to develop result goals and action plans to focus on areas such as: • - Motor Vehicle Incidents • - Ergonomics • - Walking Working Surface incidents • - Improving Personal Protective Equipment Selection and Usage. • LGRMS will provide: • - Targeted organizational / team technical training • - Consultation with team on a regular basis • - Technical training to department employees based on each team’s action plan

19. Loss Control Services Available • On-Site Training • Regional Training • Computer-Based Training • Web-Based Training • Defensive Driver Training • Public Safety Decision Driver Training

20. CCG is making great strides towards improving its risk management culture CCG currently utilizing most cost-effective and efficient workers’ compensation insurance funding method thru the ACCG-GSIWCF ACCG is committed to collaborating with CCG to improve its’ total cost of risk for workers’ compensation by assessing results and bringing needed resources to CCG Implement new “Team Focused” loss control initiatives Columbus Consolidated Government is a valued member and we will continue to earn your business. Executive Summary