Dr. J.'s Jottings: Upgrading Workers' Comp & Disability Benefits Systems

60 Summits Project Diffuses Down Under

I'll be in Australia and New Zealand later this month, promoting the new work disability prevention model and teaching doctors clinical decision making in SAW/RTW. 

An article about the new model and The 60 Summits Project was published today in RTW Matters, an Australian based website.  There's a catchy little quote about the Emperor's New Clothes. 

RTW Matters kindly provided me with a link so you can read the article -- even if you don't subscribe.  Incidentally, the site is well worth exploring more fully.

http://www.rtwmatters.org/article/articleG.php?id=920&t=60-summits-project-hits-oz

Smiling,
Dr. J

The Value of Information in "The Information Age"

I'm sure as heck not an economist.  But because I run a business that offers internet-based training and continuing medical education, I've been thinking about the costs of developing educational materials, versus the social / economic impact of education, versus the prices being charged for it.   The plight of newspapers and magazines is also on the forefront.  Ruminating and thinking a bit more broadly, I suddenly saw that: 

1.  "They" are calling this post-industrial period in America the Information Age.  "They" say that the way that America will be able to compete is because of our superior information.  The new American worker is supposed to be the knowledge worker.

2.  At the same time, Americans are also demanding / asserting that knowledge and information should be free.

3.  The internet gives providers of free information -- who may have subsidized or unsustainable money-losing business models -- unlimited free access to a marketplace in which they compete with purveyors of paid information, thereby rendering them unsustainable too.  

Why doesn't this trio of facts mean that we have created a mechanism to eviscerate the US economy? 

Smiling wanly,
Dr. J
President
Webility Corporation
www.webility.md

Begging for Improvement: IMEs & Impairment Ratings

A recent expose by the New York Times about workers' compensation Independent Medical Examinations in the state of New York, coupled with public debate about the inaccuracy and inadequacy of methods for evaluating (rating the extent of) Permanent Impairment in both California and New York have raised the visibility of these issues.  On one of the professional list-servs I follow, someone asked today whether anyone has had experience with quality improvement initiatives in these areas.  You might be interested in my response (see below): 

 

The State of Washington 's Department of Labor & Industries (L&I) has done two projects on IMEs, both of which I was involved with, the first in 2001 and another in 2004-5 .  Our company, Webility, was a sub-contractor in both of those projects.

 

L&I was exploring ways of improving the quality of independent medical examinations (IMEs) procured by the agency.   Dissatisfaction by both labor and employers in Washington led to the commissioning of these projects.  By the time the second project was complete, that furor had died down.  (I suspect both sides were appeased by the fact that L&I was studying the matter, and their fickle attention turned to other issues.)  To my knowledge, neither report has never been made public, but they should be available upon request.  From the two projects, L&I received much input and many recommendations, some of which they have implemented. 

 

In the 2001 project, the IME Improvement Project, MedFX was the prime contractor, Dr. Jeffrey Harris of MedFx was Project Director and I was Clinical Director. (Dr. Harris led the development of ACOEM’s 1st   Edition of its evidence-based practice guidelines.) This project researched existing literature on IMEs, explored best practices around the country in IMEs, analyzed L&I’s IME procurement processes, interviewed workers, treating physicians and IME physicians, and audited a sample of IME reports. The final work product laid out findings and made recommendations for improvement.   

 

Among other things we discovered during the first project was the remarkable dearth of literature on this topic.  About the only literature that exists would be classified as "exhortative" in which one practitioner advises others how to write a good report.   One tidbit we uncovered was that in the late 1990's, only 9 (or 19, don't recall now) doctors in the entire state of New Jersey were doing impairment ratings.  We were able to find only one little comparative study (long forgotten now).  The Lax article didn't appear until 2004.   David Sikberg and I wrote an article about the IME procurement process for the Journal of Workers' Compensation entitled "Time to Release the Untapped Power of IMEs" which appeared in the Summer 2002 issue. 

 

In the 2004-05 project, entitled the Independent Medical Examination (IME) Quality Assurance Pilot Project, Expert Clinical Benchmarks (ECB), a subsidiary of MedRisk, was the prime contractor, with Webility and IMX Medical Management Corporation as sub-contractors. ECB provided Ruth Estrich as liaison with L&I, while Webility’s principals led the project. I was Project Director and David Siktberg stepped up as Technology Lead when the technological demands of the project exceeded ECB’s capability. Dr. Elizabeth Genovese from IMX served as Associate Project Director for Peer Review and Operations.

I drove the second project from the beginning, envisioning it as an opportunity to make a significant contribution both to Washington and to a whole industry.  It was essentially a feasibility project to answer the question whether auditing IMEs is feasible and whether providing feedback of IME authors improves the subsequent quality of their reports. The work involved (a) developing a tool and method for auditing and then scoring IME reports, (b) assembling and training a team of 19 peer reviewers to do the audits, (c) reviewing and scoring several hundred IME reports, (d) providing feedback to half of the IME report authors, and (e) monitoring for changes in audit scores over time. As part of that effort, I wrote two web-based training courses hosted on Webility’s training system. The first one trained the 19 peer reviewers/auditors on how to evaluate IMEs and use of the auditing instrument. The second one was entitled “Writing Even Better IMEs” and was offered to half of the 42 orthopedists whose IME reports were being steadily audited over a six month period. Only 2 of them started the course but both found it excellent.  (Interestingly, they had both produced high-scoring IME reports.) 

 

The project  demanded very intensive technology support. In addition to implementing the two web-based courses, software had to be custom-developed to capture audit data, deploy an complex automated scoring algorithm involving variable weighting of IME report components, and produce feedback reports to the IME authors. The final deliverable was a report of findings and recommendations, in which we pronounced that IME auditing was feasible and produced valid enough results to justify business decisions (procurement preferences) -- and that changes to the procurement and payment process could be used to drive up the typical quality of IME reports obtained. 

 

Warning:  Do not read beyond this point if strongly-worded opinions offend you.

 

In doing these and other related projects, I have come to see that claims adjusters have only a few arrows in their quiver for use when the claim situation seems to be veering off in an unexpected or obviously wrong direction.  They use all four arrows very freely, especially the middle two.  The more inexperienced or overwhelmed the examiner is, the more seductive these options look.   Those arrows are:

 

1.  Nurse case management (positive approach)

2.  IME (usually seen as hostile by claimant)

3.  Surveillance (usually not seen by claimant but when detected, is seen as very hostile)

4.  Litigation

 

One of the most stunning features of both of the Washington projects was L&I's lack of curiosity about (or lack of willingness to explore)  the impact of the IME on the overall claim situation as well as a rather profound failure to grasp the  potential impact of low quality IMEs  and the other arrows in the claims quiver  on claim outcomes.   This view is NOT unique to L&I -- it pervades the claims industry.  No claims payer that I have personally encountered has been willing to explore the question of return on investment in IMEs.    I heard ONE presentation at a conference in which the claims payer tried to document the AGGREGATE quantatitve / objective impact of case management on claim outcomes.   I've never personally heard any discussion about the QUANTITATIVE AGGREGATE benefit of surveillance.   On the other hand,  I am aware that a few claim operations have quietly examined the impact of litigation on claim outcomes.  One friend's internal company survey showed that litigating a claim added a median of $30,000 to its ultimate cost.

 

Why should L&I  buy $30 million worth of independent opinions each year --  if they have no impact on the outcomes?    If they have no impact, why buy any at all?  Would it make sense to pay $40 million instead IF those IMEs would help resolve stuck claims by clarifying issues and getting services to workers who need them so they can get better and close their claim more quickly thus shortening claim duration?   Or, IMEs that would stand up in court and help reduce costs by stopping inappropriate care or continuing work disabiltiy -- to the tune of, say, $200 million in reserve reductions?  In my opinion, claims operations are afraid that an inquiry into these matters might embarrass them (the claims operation) and they prefer to keep the "embarrassment" gun aimed at the independent examiners. 

 

And yet, current IME procurement practices are designed to deliver EXACTLY the low quality crap they do today.   In the absence of  clear indications for use, documented outcome expectations and verification,  quality standards and report specifications that provide a basis for refusal to accept work that does not measure up, and either positive or negative consequences for comparative quality,  physician examiners are rewarded for the lowest quality stuff they can get away with.

 

Q:  When  are claims shops going to start tackling these questions?  

A.  When claims operations become less primitive, and more willing to take a hard look at the effectiveness of their processes and start taking a more systematic approach rather than seat-of-the-pants approach, that's when.    Today, they are like giant factories with many assembly lines and complex machines, each operated by an "artiste".  None of the machines have dials or indicators of how well the process of managing the injury episode is working (its ACCURACY or  EFFECTIVENESS ).  The only thing they have been monitoring  and trying to improve is SPEED, EFFICIENCY, and COMPLIANCE with the law.  For one specfic example with respect to IMEs, most claim operations don't collect and track information about which doctor provides the IMEs they need, nor volume/quality/nature of the work they do.  All that data is locked inside individual claim files.   So, until they start to pay attention,  many insurers  (like L&I) may think  they have 550 doctors on  their  "approved examiner list" and not even realize that 70% of their IMEs are being done by a relative handful of doctors, half of whom are spending 15 minutes with the patient and churning out reports that would be consistently scored as "serviceable", "fair" or "poor" by our grading criteria.

 

Q.  And when will that be? 

A.  When the people who run claims operations are people with curiosity and training in the use of quantitative / objective evidence to support making changes in the management of the claims process.    I bet the people who procure copy machines and  paper and pencils at major insurance companies use a more rigorous and quality oriented process than the people handling their IME proccurement process do.  The procurement people know the difference between buying only on price vs. optimizing both quality and price.  I'm quite sure the procurement people at Airbus and Boeing do.

 

Q.  Aren't claim operations moving in that direction? 

A:  Not really.  They  have had efficiency (administrative cost reduction) as the goal, not improved decision-making or claims outcomes.  In my opinion, the net result  of the HUGE changes the claims management industry has been through in the last decade basically amount to heroic efforts to be able to make stupid decisions more quickly.    Many people with years of experience in claims have said that today's much-more-efficient claims adjusters now have no time to get familiar with their claims and simply cannot make good decisions because they don't know what the heck is going on.   That blinking "EASY" button labeled IME is very appealing.  

 

End of outburst.  Back to work.

How Competition Impedes Innovation & An Idea for Forwarding the Action on Healthcare Reform

Wouldn't it be fantastic if workers' comp payers moved to "Multi-Payor Portals to Maximize Provider Satisfaction & Streamline Payments"?  See flyer below about the Healthcare Payments Solutions Expo of 2009.    I know nothing about it, but VERY big players will be presenting.  
 
Unfortunately, since commercial payers (insurers,  TPAs, health plans,  HMO's) are mostly financial transaction companies, they tend to think of their payment processes as a key part of their competitive advantage  --- as in,  " we're easier to work with than they are " , " our processes catch more problems than theirs do,"  etc.  So they are unlikely to actually join together to do this unless forced to by external forces.  ....such as maybe huge infusions of government cash.   What do you bet?
 
My original vision for Webility (our for profit training and consulting company) was that we would build a multi-payer "communications utility" and handle the 100-200 million communications about SAW/RTW that occur yearly between multiple parties:  employers, insurers, providers.  Similar to  the challenge of getting payers together for  consolidated  PAYMENT utilities, the claims handlers, managed care/disability companies, etc.  were actively uninterested in funding development of (or even using) a COMMUNICATIONS utility, precisely because they viewed their ability  to communicate more effectively than "the other guy" as another competitive advantage. 
 
So, in other words,  although  competition SUPPOSEDLY serves the marketplace well because it allows payers with better payment processes and more effective communications methods to stand out and win market share, that is (pardon my French ) b.s.   The actual result is fragmentation, cacaphony, and astounding inefficiency -- and patients falling between the cracks, productivity and jobs  being lost,  and dollars being wasted.  
 
When I read the Institute of Medicine's book on the state of healthcare in the US, I became so depressed I stopped reading after two chapters.  What they failed to say -- but what shone out of every single page -- was the FAILURE OF  ENTREPRENEURIAL CAPITALISM to meet the  AGGREGATE needs of the society  --- and the  ABDICATION OF GOVERNMENT from its rightful responsibility for assuring the public's health.  Personally, I am NOT in favor of the government taking over the actual  doing of the  healthcare work, and delivering of services individuals.  I DO SEE its rightful role in setting priorities, establishing expectations and ground rules, and  designing specifications for a system that then the private sector competes within and delivers services.    In my view, the government should take charge of designing and assuring the adequate performance of the DELIVERY system, not just the payment system. 
 
So, I guess in some ways, I'd like to see us (the  whole  US) engage in a nationwide initiative similar to The 60 Summits Project (the non-profit organization we run), but for healthcare in general.  First, assemble a group of wise experts  of good will from many sectors / stakeholder groups and invite them to dialogue and develop a vision --  a set of  principles  and features  and general design specifications that a good healthcare system must meet -- and have that serve as the blueprint for  system improvement.  Sort of like a Healthcare Declaration of Independence and Constitution.    Take it around the country, and build buy-in and refine it through many public meetings.  And in those meetings, push people (including legislators, regulators, politicians, healthcare industry businesses, NON-healthcare businesses, etc. etc. ) to start  thinking about how to embody those values/principles/specifications in actual laws / regulations / insurance policies, business policies and contracts, etc. etc. 
 
Without that guiding document to serve as the intellectual framework, and without  an orderly process of building agreement around a solid foundation of core commitments,  we're left with political sausage making, and the tussle of powerful vested interests and balancing of power, which is frighteningly likely to result in random surgery and mutations of the astounding hodgepodge  of a healthcare non-system that  we have today.

 

Jennifer Christian, MD, MPH

President, Webility Corporation www.webility.md

Founder & Chair, The 60 Summits Project www.60summits.org

 

Selected news releases for today's health care executives

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Healthcare Payments Solutions Expo 2009Not displaying correctly? Please click: http://www.worldrg.com/emailbroadcast/HW09077/HW09077_2.html

Register by May 8th and Save $300, Mention Promo Code HFD938 July 28-30, 2009 Hilton Suites Chicago Magnificent Mile • Chicago, IL www.worldrg.com/healthcarepayments The only event that brings together payers and providers to capture the $64 billion opportunity of automating healthcare payments, addressing CDH billing issues and eliminating bad debt. The ONLY conference of it’s kind with 10 Payer Case Studies and 9 Provider Case Studies! Top Reasons to Attend: Payers Providers Implement Pre-Care Cost Transparency Tools to Maximize Patient & Provider Satisfaction Understand the Newest Developments in Real-Time Adjudication: Case Studies from United, Humana & BCBS of TN Leverage Tech Tools to Support CDH Products: From Innovative Card Designs to Patient Portals Embracing Multi-Payor Portals to Maximize Provider Satisfaction & Streamline Payments Take a Strategic Look at the Future of Healthcare Payments Maximize Up-Front Payments with New Self-Pay Tools: From Kiosks to Online Pay Portals Capture Cost-Savings with Standardized Transactions: Duke Case Study Utilize Patient-Friendly Billing Technology to Improve Practice Management Integration and Minimize Bad Debt Create Up-Front Collections and Revenue Cycle Management Training on Limited Resources Ensure Customer-Friendly Billing Practices with Tracking Tools & Metrics Hear what Top-Performing Plans and Hospitals are doing in a 100% Case-Study Based Setting: Register by May 8th and Save $300, Mention Promo Code HFD938 Register | Request Brochure | View Website | Add to Calendar

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"Out of the Box" Foundation for Healthcare Reform by ACOEM

I just sent this message (below) to MoveOn -- and wanted to share it with as many people as possible.  Since they must get thousands of messages per day, I have little confidence they will pay attention, read the recommended documents, and reflect on their big ideas  -- but maybe you will.

 

I wrote:

 

   MoveOn's healthcare reform stuff strikes me as INCREDIBLY naive and superficially thought through -- even irresponsible.  It is patently absurd to state confidently that going to a national healthcare system will reduce costs by 30%.  When the country took on Medicare, the politicians (including LBJ) who wanted to pass it argued that it would be cost neutral -- but actually KNEW it would increase costs.  They were so ideologically committed, they hid the financial realities from themselves and others.

 

    For an infusion of fresh thinking and an "out of the box" view by public health-trained experts with a foot in healthcare AS WELL AS other sectors of society, I recommend that you familiarize yourselves with these two documents:

 

http://www.acoem.org/guidelines.aspx?id=5396

 

and

 

http://www.acoem.org/guidelines.aspx?id=566

 

    It seems as though MoveOn's input on healthcare reform is mostly coming from well-intentioned people with soundbite level knowledge and knee-jerk thinking about "everybody should get everything they want/need" rather than stewarding the welfare of the whole society -- e.g. sort of the "bread and circuses" group.  I've read in the past that democracy will fail when the masses get the picture that they can vote themselves benefits.  Feels very much like we are on the verge of that now.    

 

With concern for the present, and respect for what you have done in the past,
Jennifer Christian, MD, MPH
The 60 Summits Project www.60summits.org
Webility Corporation www.webility.md
Active in the American College of Occupational & Environmental Medicine www.acoem.org

"Conflict of Interest" in The 60 Summits Project?

I got a (reasonable) inquiry from someone, so thought I would make it clear to everyone:  

 

Neither I nor the central 60 Summits Project nor Webility Corporation has any economic relationship with the people and organizations I mentioned in my post about the orthopedist who likes the results being produced by the work disability paradigm.... but we ARE philosophically well aligned, which is why Jerry Fogel and OptaComp supported the Florida Summit so enthusiastically!  And although, yes, the success Dr. Northrup describes is a success for OptaComp and Jerry (who is a consultant to OptaComp), it is more importantly a demonstration of the power of the work disability prevention model.   So I wanted to share it with you -- and was happy to tell you who did it!

 

The purpose statement in our revised Partner Attraction Plan for The 60 Summits Project says that we are "creating a community of like-minded people" across North America.  And, that within our community, we intend to "enable buyers and sellers of products and services that effectively prevent needless work disability to find each other so that they thrive and prosper". 

 

We all gotta stop acting "too pure to be paid".  If the people who adopt this new model can't do well by doing the right thing, how the heck will this paradigm ever get propagated and take hold?

 

The reality is that we all choose things to do because they benefit us in some way --  either they are fun or they make us feel like we are good people, or they help us advance our knowledge, mastery, reputations or careers, or they further our sales goals or they reduce our overhead.    My personal intention is that all the people associated with The 60 Summits Project  -- including me -- profit in some way from our participation in or support for it -- personally, professionally, financially -- and ideally in all three ways!  

 

I've pasted our revised purpose statement below.  You can find the entire Partner Attraction Plan on the 60 Summits Project's website.   

 

Cordially,
Jennifer Christian, MD, MPH

Chair
The 60 Summits Project, Inc.
www.60summits.org
95 Woodridge Road
Wayland, MA 01778
877-607-8664
jennifer.christian@60summits.org

 

What is the purpose of The 60 Summits Project?

The 60 Summits Project is a grassroots initiative that is creating a multi-stakeholder community of like-minded people who intend to:

·         Prevent needless work disability by helping people stay employed; 

·         Upgrade the performance of workers' compensation and disability benefits systems by employing a multi-stakeholder collaborative approach to:

§          mitigate the impact of illness, injury or impairment on each individual’s ability to function at work, and

§          promote the economic vitality and productivity of workers, employers, and local economies;

·         Use as our framework the new work disability prevention paradigm and 16 recommendations for improving the stay at work and return to work process laid out in a report entitled “Preventing Needless Work Disability by Helping People Stay Employed” from the American College of Occupational & Environmental Medicine (ACOEM);

·         Inspire and convince people to take action to make those improvements and cooperate under the new paradigm;

·         Lead by example and support each other in actually doing these things ourselves;

·         Within our community, enable buyers and sellers of products and services that effectively prevent needless work disability to find each other so that they thrive and prosper;

·         Grow our community until people across

North America

are employing this new multi-stakeholder, collaborative, and problem-solving approach, and it eventually becomes the norm everywhere.

 

 

 

Orthopedist says he likes the work disability prevention paradigm

Here are some notes from a voicemail and a subsequent conversation I had earlier this week with an orthopedist from Florida.  He had emailed me to ask permission to use some slides from my presentation entitled A New Paradigm for Worker's Compensation & Disability Benefits System: The Work Disability Prevention Model.  I gave it at the Florida Summit on Preventing Needless Work Disability last summer.

I asked him to tell me what, if any, changes he had seen since the work disability prevention (WDP) approach had been put in place.  I read him these notes afterwards, and he said I got it right.  
 
He said:  "I didn't enjoy workers comp before because we could never achieve the results with work comp that we do  with our other patents.  This approach that you and Jerry Fogel are advocating is right down my alley. The main thing that makes it more satisfying is that patients come in with a different attitude and approoach than the normal work comp patients -- from the way they treat the staff at the front desk through seeing the doctor and going to therapy. Now they know what the rules are, what their roles are, they have been educated before they come in.  OptaComp has told them  "We're going to take care of you, and send you to a great doctor who will make sure you get the care you need and can get back to work soon."  (Work comp patients in other programs already know the "tricks of the trade" when they come in, but I don't see this with the OptaComp ones.)  In one year, we have only had one work comp patient in this program who has had an attorney -- in comparison to prior years when we would see 25% - very impressive." 
 
"Thank you very much for your contribution / this presentation.   Your slides comparing the assumptions under the old claims management model vs. the new work disability prevention model hit it on the nailhead!  I am very happy with the approach, very happy with outcomes.  Have been practicing sports medicine approach for over 13 years, so this has been an easy transition for me.  But now I enjoy taking care of work comp  patients, because we have better results, the patients are happier, and everything seems to flow much easier."

[Dr. Tod Northrup, DO, practices orthopedics at the  Florida Sports Medicine Institute with offices in St. Augustine and Jacksonville.  He is describing the results that Blue Cross Blue Shield's OptaComp program has produced. Jerry Fogel from Imagine Clinical is a consultant to OptaComp.] 

So, as I hear it, the thing that has made Dr. Northrup start enjoying work comp patients is that they are now coming in the door with their "fur lying down" because of the more positive way they have been treated by OptaComp (and probably their employer since the OptaComp program has involved a lot of employer training, too.)  He likes this new model -- which is balm for my little soul. 
 

Excited about Michigan Summit April 30-May 1

I just finished and sent off the Powerpoint for my keynote presentation for the MIchigan Summit on Workability being held in Lansing on April 30 and May 1.   This is the first of our events to occur since the economy melted down last fall.  The Michigan Summit planning group REFUSED to give up, even when things didn't look good, and now it looks like their event is going to be WONDERFUL.  As I worked on the Powerpoint, I put my mind into the future, and could feel how positive, inspiring and energy-filled that Summit is going to be. 

Jim Epolito, the former CEO of the Michigan Economic Development Corporation, is going to do the "kick-off" before my keynote address.   Last Friday, I oriented him by phone to the design of the day and the purpose / goals of the Michigan Summit .  It was wonderful to hear the anticipation and excitement in his voice after I described The 60 Summits Project and how pertinent our message is during this time of economic downturn -- especially for Michigan. 

British Columbia - 1st to commit to a Canadian SAW/RTW

A group in British Columbia has just decided to hold a Summit in November, 2008! People from several BC organizations held their own feasibility meeting this week to decide whether it makes sense to bring the 60 Summits Project idea there. The meeting was apparently a great success. There was strong multistakeholder support for the content of the ACOEM work disability prevention guideline and a wish to be associated with the 60 Summits Project. They agreed to aim at an initial summit in November of this year.

The first planning meeting is tentatively set for Feb 13th at which time the organizational structure will be established. Dr. Larry Myette, Director of Strategic Workplace Health for the Healthcare Benefit Trust that manages benefits for many of the healthcare employers in BC, convened the feasibility meeting and has agreed to serve as interim chair of the group. Among other attendees at the
feasibility session were WorkSafeBC and the Canadian Institute for the Relief of Pain & Disability.

If you wish to help plan the BC Summit or simply be invited to the actual event, contact Dr. Myette, who can be reached at: (250) 479-4089.

60 Summits Project Update

Yay! I just learned yesterday that Montana will hold three Summits in April 2008 in conjunction with The 60 Summits Project. The Governor's Labor Management Advisory Council on workers' compensation will be the lead sponsor, along with the State of Montana, the Montana State Fund, the Montana Building Contractors Association and the Sisters of Charity Leavenworth Health System and others. Three members of the Labor-Management Advisory Council are on the Summit Planning Committee! Montana has been looking for a new model to adopt in the return to work arena, and will be engaging the whole state in a conversation about implementing the new work disability prevention paradigm.

In 2007, we:
  -- held 5 Summits in 2 states, one in Northern California, and four in North Dakota, for a total to date of 7 Summits in 4 states.
  -- got 6 new Summit Planning groups formed and off the ground in Arizona, Ohio, Florida, Massachusetts, Michigan and Montana.
  -- benefited from association with our Charter North American sponsors, Prudential Financial and Webility Corporation, whose generous contributions made many of our 2007 activities and 2008 plans possible.
  -- developed materials, methods and other key infrastructure including our new-and-improved website: www.60summits.org

As of yesterday, we already have 7 Summits on the calendar for the first half of the year (MN-1, MT-3, OH-1, AZ-1, and FL-1). We're entering several new states in the next few months.

Now that we've built a solid foundation, I'd like to open the throttle in 2008. My goal is to be halfway to 60 -- to have activity underway in 30 states and provinces -- by the end of 2008.

In 2007, I travelled all over the continent and met a lot of very good people with a lot of talent and pent-up energy they want to put into improving these "systems". I represented the 60 Summits Project at meetings in Arizona, British Columbia, California, District of Columbia, Florida, Illinois, Idaho, Illinois, Maine, Massachusetts, Michigan, Minnesota, Montana, North Dakota, Ohio, Oregon, Rhode Island, Quebec, Texas, and Washington. Meanwhile, the 60 Summits Project staff built the "guts" of The 60 Summits Project as an on-going endeavor: developing materials and methods that would set appropriate expectations and create strong planning groups and successful Summit events and follow-on action groups.

We are building an organization that has to be comfortable with local variation and individual eccentricities due to the volunteer nature of most of our groups -- but we are centering ourselves around some unifying themes and values. Key among them are a Partner Attraction Plan (see www.60summits.org) and the Commitment to Partnership. Together they lay out our mutual commitments to how we are BEING with each other in addition to what what we are DOING together.

It's been a challenging roller-coast type ride, and this project has consumed the vast bulk of my professional time and most of my creative energies. And wow, do I ever find it exciting and fulfilling! When I enter a room for a feasibility session (the next one is Feb 7 in Madison, Wisconsin), I am CONFIDENT that I am with a remarkable group of people -- because who else would accept our invitation?

In our push to put "meat in the hamburger", we haven't paid as much attention to developing our sponsor relationships. Now that we've built a strong engine that's really ready to take us places, I'd like to put a lot more fuel into it. The 60 Summits Project derives its revenue from a combination of sponsor contributions and fees charged for services to local Summit planning groups. It's time to build up our sponsorship contributions by attracting organizations that are a good fit with us and forming on-going mutually fulfilling relationships with them, too.

Sponsor contributions to The 60 Summits Project make it possible for us to:
  -- build and maintain our infrastructure including our new website (www.60Summits.org)
  -- bring the possibility of The 60 Summits Project to new states
  -- form new groups and support them until they get organized and off the ground
  -- provide partial matching grants for local Summits
  -- support the action coalitions that are springing up after Summits occur
  -- and, in 2008, to hold our first national conference.

Summit Planning groups, once established, decide whether they want to be an official part of The 60 Summits Project and to have our support, in which case we then charge fees for our services. The local Summit planning groups in turn meet their expenses by charging registration fees to Summit attendees and garnering support from local sponsors.

I'd like to speed this whole thing up and be able to enter new states more often. I'd also like us to provide even BETTER support to the local groups -- especially the action coalitions that are springing up after the Summits -- so they can really become an ON-GOING and EFFECTIVE force for positive change in their states. As I said, our 2008 goal is to be halfway to 60 by year's end -- to have activity underway in 30 states.

You may wonder how you can help. Here are two ways:

  1. By passing along names and contact information for people who will want to participate in this project in specific states, either as a Summit planner, attendee, or as a local sponsor.

  2. By becoming a sponsor of our North American effort at some level. Join Prudential Financial and Webility Corporation as North American sponsors, or find another level at which to to contribute that suits your situation.

Ask yourself if your company:

  ---Likes to underwrite worthwhile activities, and would see supporting this inspiring grassroots effort as the right thing to do.

  ---Sees itself as a potential beneficiary of our initiative, and wants to assure the success of The 60 Summits Project by providing visible endorsement as well as financial support.

  ---Will benefit from being visibly associated in the marketplace with The 60 Summits Project's cutting edge thinking and an initiative that is being hailed as "brilliant and fresh . . . a new paradigm . . . a clear blueprint for positive change."

Sondra Seay from Florida has joined The 60 Summits Project as manager of sponsor relations. You can reach her at sondra.seay@60Summits.org.

North Dakota, here we come!

We're putting the final touches on preparations before North Dakota's four Stakeholder Summits on Preventing Needless Work Disability the week of September 10-14.  These Summits will have a different "feel" than the prior ones in larger states have had, largely because of the small size of the cities we will be in.   

(If you're curious about North Dakota, go to wikipedia like I did or to the official North Dakota website. The largest city we will visit is Fargo with a metro area of about 175,000 people.  The state capital is Bismarck whose metro area has about 100,000 people.  The Grand Forks area is about the same size.  The smallest we will visit is Dickinson, with about 20,000 people.)

Workforce Safety & Insurance, the state's workers' compensation insurance fund, is the sole sponsor of this series of Summits  -- and boy have they been a great partner to work with!   Their planning team has been preparing for this for months, intent on building better relationships, improving communications, and increasing collaboration among employers, physicians, and WSI in order to improve overall outcomes in workers' compensation cases.  In these final days, WSI has put their employer account reps and nurse case managers on the phone, inviting employers and doctors to the meetings.  Happily, attendance looks like it will be good. 

I suspect that the attendees at this Summit will be quite different than the attendees at the most recent Summit held in California in June.   In California, there were a lot of specialists in disability management or occupational medicine, or corporate staff or labor representatives or non-profit organizations with a special interest in disability and return to work.  Many had never met each other before.

In North Dakota, we will be close to the ground in a predominantly rural state.  Not many companies there with corporate disability management staffs.  The room is likely to be filled with small business owners/managers and local practitioners -- and they may already know each other.  There's a severe shortage of doctors in some specialties and some towns.  This will be a conversation with "the front line."   In fact, there will be a panel of local doctors and employers as part of each of the Summits, reacting to the recommendations made in the new ACOEM work disability prevention guideline, and talking about which ones they believe can be implemented successfully in their community. 

One of the things I love about this 60 Summits Project is the unique flavor and features -- and people -- in the workers' compensation and disability benefits system of each new state I visit.  Given the comparatively harsh , remote, and rural quality of life in North Dakota, I bet I'll be learning some new perspectives.   I'm also willing to bet I'll hear the same major themes in North Dakota that are everywhere. 

1.The lack of a team approach to preventing needless work disability during the stay-at-work and return-to-work process is harming the well-being of individuals, companies, and communities.   

2.People of good will in these two most critical stakeholder groups are inspired by the new model of working together portrayed in the Guideline as a good way to achieve better outcomes of the worrkers' compensation system for both injured workers and their employers.

Bringing the 60 Summits idea to Montreal, Quebec

The 60 Summits Project is entering Canada for the first time.  [The "60" in our name comes from the number of US states (50) plus Canadian provinces (10).] 

I'll be in Montreal the week of August 20, and among other planned activities have invited a small number of people to join me in exploring the feasibility of creating a stakeholder summit to propagate the new work disabiltiy prevention paradigm there -- in other words, to bring The 60 Summits Project to Quebec.   

The purpose of the meeting is to answer these questions:

1.  Is the time ripe in the province of Quebec to build a widely-shared positive vision of how the stay-at-work and return-to-process should function -- and then make that a reality? 

2.  Should we capitalize on the new paradigm embodied in The American College of Occupational & Environmental Medicine's work disability prevention guideline and use it as the framework for discussion at a Stakeholder Summit on Preventing Needless Work Disability by Helping People Stay Employed?

3.  Are there desirable future outcomes that such a Summit might make possible?

4.  Are there enough people of good will with gumption and commitment to "improving the system" available and willing to do the work to plan and produce a Summit for Quebec?

Stay tuned -- We'll wait to see who shows up, and how they react to the idea.  For me, this meeting is going to be especially fun because I enjoy listening to and speaking French -- even though my ability is at about the level of a nursery school age child.  It will be fascinating to appreciate how these issues look to Canadians and particularly the Quebecois.

I'm also going to be in Montreal to give a lecture on disability prevention and the use of disability duration guidelines that will be filmed as part of an on-line curriculum for physicians who are working in the area of insurance and legal medicine.  Three Canadian physicians will be part of the session.  Again, it will be fun to engage in dialogue with physicians in a different country (and thus a different environmental context) about a topic of shared interest.