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Publix Super Markets, Inc.

Publix Super Markets, Inc. . The Road to Self-Administration Marc Salm - Vice President Risk Management National Council of Self-Insurers June 2, 2014. Publix Super Markets . 1077 Stores 6 States; 157,000 Employees $28.9B in Sales

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Publix Super Markets, Inc.

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  1. Publix Super Markets, Inc.

    The Road to Self-Administration Marc Salm - Vice President Risk Management National Council of Self-Insurers June 2, 2014
  2. Publix Super Markets 1077 Stores 6 States; 157,000 Employees $28.9B in Sales 108th on the Fortune 500 list in 2013 Publix is the 7th largest Retail Grocer in the United States
  3. Risk Management
  4. A Good Environment for Self-Administration? Geographic Footprint Experience administering Florida WC Relationship with our Primary Insurance Carrier – the Hartford Deductibles/Retentions The Burdens of Self-Administration Support from the Company The very best I/S Support for any Risk Management Department, anywhere
  5. The State of the Department In 2008 – Workers Comp Full Self–Administration: 64 Associates CARE 6.1 Claims System Proprietary RMIS Intranet –based Intake (P013) Internal Bill Review (Fair Isaacs ) Internal Nurse Case Management Occupational Health Rehab Coordinator Florida EDI Claims Manager, Team Leaders, LT Adjusters, MO Adjuster, Support SRS 2 Dedicated Associates @venture RMIS Teleclaim Intake SRS Bill Review, Nurse Case Management, EDI Publix approved vendors including PT, Legal, Surveillance, PBM, Outside Nurse Case Managers Florida Non Florida
  6. The State of the Department In 2008 – What Changed? CARE 6.1 was outdated with limited functionality: Manual processes Outside interfaces Could not handle non-Florida WC or any liability claims Provider had limited knowledge Updated only as required by State law Heavy reliance on Cambridge to maintain Publix’s data
  7. Step 1- Claims and RMIS System Recommendation 2008-2010 looked for a new Claims and RMIS System(s) Retained Consultant Dave Tweedy Requested detailed RFP and demonstrations from 4 systems Narrowed choice to two systems Performed in-depth analysis of functionality of systems Went to contract with both finalists Selected CSC RiskMaster X in July 2010
  8. Step 2 - General Liability Implementation 2010-2011 Publix self-administered Customer Incident intake and Non-Attorney Represented GL, Auto and Druggist Claims. Replaced a fax customer claim intake process with a web based Customer Incident Intake Replaced an ACT! contact system with RiskMaster X Implemented RiskMaster Business Analytics
  9. Step 3 – Florida Workers Comp Implementation 2011-2013 Replaced CARE with RiskMaster Data transfer Replaced Intranet FNOI with Web–based Associate FNOI Reporter Replacement of proprietary RMIS with RiskMaster Business Analytics Revised Payment Processes Implemented in November 2013
  10. The Final Step – Full Self-Administration - Current Scope Workers Compensation Claims in Georgia, Alabama, South Carolina, North Carolina, Tennessee. Medical Bill Review Nurse Case Management EDI ( including Medicare) Represented Claims and Lawsuits (All States): GL Auto Druggist Other Medicare Reporting
  11. The Final Step – Full Self-Administration - Current Cost Savings over TPA service fees Greater Control and Alignment with Business Goals Improve Associate Performance Use RiskMaster to it’s fullest capabilities Improve efficiencies and outcomes Eliminate the Risk of TPA mergers and acquisitions
  12. The Final Step – Full Self-Administration - Current Before we did more work, we confirmed: Agreement (in principal) of our Insurance Carriers Publix would add the associates necessary to transition to Self-Administration Management of 500 or so lawsuits per year The support of the Publix I/S Department At least some ROI The number of claims and lawsuits A Tier 1 Strategic Project
  13. The Final Step – Full Self-Administration – I/S Support 12 I/S Associates are devoted to Self Administration: 5 System Analysts A Systems Analyst/Programmer A Sr. Systems Analyst A Programmer Analyst A SQA Analyst A Sr. SQA Analyst A Lead Sr. SQA Analyst and An I/T Delivery Manager
  14. The Final Step – Full Self-Administration - Current Implementation Consultants v. Change Management Associate
  15. The Final Step – Full Self-Administration – Consulting Selected Marsh as our Consultant in June, 2013. The Marsh team is lead by Senior VP, Annette Sanchez The Publix team is lead by Strategy Team Leader, Lori Chaney
  16. The Final Step – Full Self-Administration Publix and Marsh agreed on “Work Steams” There are 11 Work Streams Together, the 11 Work Streams are further broken down into 71 Milestones Each Work Stream is co-led by a Marsh Consultant and a Publix Associate or Associates
  17. Work Streams
  18. Work Streams
  19. Workers’ Compensation 2008 Vice President Director of Workers’ Compensation/ Casualty Insurance Assistant to Director/Claims Manager Medical Admin Manager Claims Manager/FL Team Leader Non-FL Occupational Health Specialist Rehab Coordinator Medical Administrators (8) Occupational Health Analyst (1) Bill Review Supervisor W/C Analyst Non-FL (1) Team Leader Miami Team Leader (Jax) Team Leader (Lklnd) Lost Time Adjusters Manf/Dist (2) Supp III (1) Support II (1) W/C Analyst (1) Med Bill Analyst (5) Data Entry Analyst (2) Analyst Asst. (1) Lost Time Adjusters (2) Medical Only Adjusters (1) Supp Asst. (2) Lost Time Adjusters (2) Medical Only Adjusters (3) Supp Asst. (3) Lost Time Adjusters (4) Medical Only Adjusters (4) Supp Asst. (2)
  20. Workers’ Compensation Self -Administration Vice President Director of Workers’ Compensation/ Casualty Insurance Assistant to Director/Claims Manager Medical Admin Manager Claims Manager/FL Team Leader Non-FL Occupational Health Specialist Rehab Coordinator Medical Administrators (8) Medical Administrators (1) Occupational Health Analyst (1) Bill Review Supervisor W/C Analyst Non-FL (1) Lost Adjusters Time (3) Medical Only Adjusters (2) Supp. Asst. (1) Team Leader Miami Team Leader (Jax) Team Leader (Lklnd) Lost Time Adjusters Manf/Dist (2) Supp III (1) Supp. III (1) Support II (1) W/C Analyst (1) Med Bill Analyst (5) Med Bill Analyst (1) Data Entry Analyst (2) Data Entry Analyst (2) Analyst Asst. (1) Lost Time Adjusters (2) Medical Only Adjusters (1) Supp Asst. (2) Lost Time Adjusters (2) Medical Only Adjusters (3) Supp Asst. (3) Lost Time Adjusters (4) Medical Only Adjusters (4) Supp Asst. (2)
  21. Workers’ Compensation Self-Administration _ _ BAR (3) Vice President Asst. to Director/Claims Manager Director of Workers’ Compensation/ Casualty Insurance Project/Process Manager Off. Supv. Admin Asst. Director of Liability Claims W/C Analyst (4) W/C Analyst (1) Sick Pay Analyst (1) Data Entry (1) Mail Rm. Adm. Supp. II (3) Mail Rm. Adm. Supp. II (2) File Rm. Admin. Supp. I (4) File Rm Adm. Supp. I (2) Manager Atty Rep/Litigated Claims Manager GL Claims Services Attorney Legal Asst. (2) Rehab Coordinator Occupational Health Specialist Claims Manager/FL Team Lead Non-FL Medical Admin Manager ______________ W/C Analyst Non-FL (1) Lost Adj. Time (3) Medical Only Adj. (2) Supp. Asst. (1) Occ Health Analyst (1) Claims Supv. Sr. Claims Consultant (3) Claims Consultant (3) Claims Spec. (1) Admin (3) Admin (1) Claims Supv Sr. Claims Consultant (4) Claims Consultants (2) Claims Spec. (2) GL Supv Liability Adj (3) Liability Analyst (6) Liability Spec. (Admin) (1) GL Supv Liability Adj (3) Liability Analyst (5) Liability Spec. (Admin.) (1) GL Supv Liability Adj (2) Liability Analyst (5) Video Examiners (2) Medical Adm.(8) Medical Adm.(1) Bill Review Supervisor Lost Time AdjManf/Dist (2) Supp III (1) Supp. III (1) Support II (1) W/C Analyst (1) Team Lead (Lklnd) Team Lead Miami Team Lead (Jax) Lost Time Adj. (2) Medical Only Adj. (1) Supp Asst. (2) Lost Time Adj (4) (4) Medical Only Adj (4) Supp Asst. (2) Lost Time Adj. (2) Medical Only Adj. (3) Supp Asst. (3) Med Bill Analyst (5) Med Bill Analyst (1) Data Entry Analyst (2) Data Entry Analyst (2) Analyst Asst. (1) ___________

  22. Thank You

    Marc Salm
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