Episode #21 - Paul Carroll - Workers' Compensation Staffing & Innovation

What does the staffing shortage and work-from-home mean for workers' compensation?

  • 00:10:11 - 05:10:11

    Jerrod Bailey 00:03

    Welcome to Reimagining Healthcare: a New Dialogue with Risk and Patient Safety Leaders presented by Medplace. We're excited to bring you conversations with top risk and patient safety thought leaders from organizations across the country. Please subscribe to get the latest news and content. And if you find this valuable, please share it with your colleagues. We want to create meaningful dialogues in your own community. And if you're interested in participating as a guest, please send us an email at speakers@Medplace.com. So my name is Jerrod Bailey. I'm the CEO of Medplace and we've been playing hosts today.


    And today I'm joined by Paul Carroll, the editor in chief of insurance thought leadership. Hey, Paul. Hi, how are you? I'm well, good to meet you.


    So let me I got a little bit of background on you and tell me if you want to add anything to this. But Paul is editor in chief of insurance thought leadership, a digital publishing platform that is a catalyst for change in insurance and risk management. Paul is also the co founder of and partner with the devil's advocate group love the name, a strategy consulting boutique. So he spent 17 years as a reporter and editor at The Wall Street Journal. He was nominated twice for the Pulitzer Prize, and was a finalist in 1996. That's some pretty, pretty good bonafides


    Paul Carroll 01:21

    Oh, it was great. I really enjoyed my time at the Wall Street Journal. People asked me where I was based. And I tell them Well, New York, Chicago, Brussels, New York, San Francisco, Mexico City and San Francisco. So I got around a little bit at a great time.


    Jerrod Bailey 01:37

    I love it, what a what a place in the time that you were there, what a place to learn. And I'm sure the energy there was was pretty palpable. It seems like you you really latch onto ideas. You're a thought leader, you really I'm an idea person to think it has changed the world and come up with one spark thing to hear it can be pretty great. I've read some of your work here. Obviously, you're doing a lot in the insurance space. What's your role right now the just the insurance thought leader perspective.


    Paul Carroll 02:14

    So the goal is really just to try to drive innovation. I mean, my trajectory is that I did all this stuff at the Wall Street Journal, I migrated toward technology. And got to know all the Bill Gates's and Steve Jobs and Michael Dell's and Larry Ellison to the world during that sort of phase. And then was recruited out of the journal by a consulting firm that pioneered the idea of Digital Strategy. That was kind of hard to think back before that concept existed.


    But in those days, the guys in the pinstripe suits would set the strategy and then they go off and buy a bunch of computers. And the idea of this consulting firm was to flip that. So I went from focusing on the technology and the companies to focusing on what it could do in terms of innovation. And then that journey really is continued from there.


    Probably the big book that I've done, I've done, I don't know, eight or nine by now, which something called Billion Dollar Lessons. So Jim Collins was all the rage in the early 2000s, doing books that did deep research into success stories. And it occurred to me having covered a disaster or two in my time at the Wall Street Journal, that there were failures to enable you to learn from them. So a buddy of mine, Chunka Mui, and I got our old consulting firm to lend us 20 researchers for two years. And we looked at 2500 failures, and said, Here are the patterns of failure that you might want to focus on avoiding while you're also trying to emulate the patterns of success. And that led to this consulting firm, you talked about the devil's advocate group, where we stress tests, big corporate strategies, and then led me to think about insurance. Because about 10 years ago, I realized that there were four areas that have yet to be turned upside down by digital technology, government higher education and health care. So insurance so your a double bagger, you're hitting two of them.


    Jerrod Bailey 04:19

    Yeah. Well, you asked me how I know it's, it's funny. There's groups, there's groups that I've met that were really proud of going digital during COVID Finally, right and they said what does that mean? It says, well, we got away from faxes only got two PDFs. I said there's a long road ahead, opportunity ahead of


    Paul Carroll 04:35

    you. Very true. And that's what I'm trying to do. I have this deep background in technology and watching the digital revolution unfold. And yeah, I I come in and deal with people who think that getting away from fax machines is progress. And I'm I've been ranting about burning all the fax machines and so forth. So that's what we tried to do. It's set up as a platform that in some ways, it's sort of like what you're doing, you don't have to have everybody working for you directly, you can just get the best thinking and the best ideas. So we publish articles and, and try to do whatever we can to drive innovation in insurance.


    Jerrod Bailey 05:21

    That's great when I look at the opportunity, because I've done things across every industry you've ever heard of, including consumer industries. And I actually built a company that launched companies as a business, we launched about 100 tech products into the market, and over a five year period, so you get enough of that.


    And you've seen this working with clients, you get enough that pattern recognition in things start to become apparent, when I look at healthcare and the opportunity that's been done in other industries around the marketplaces and around more liquid type of resourcing, and things like that. I mean, it's you hit on some of this resourcing issues in this article that we'll talk about, but it hasn't been created and healthcare, it hasn't been created an insurer tech and I don't I don't even know that, necessarily. Some of the leadership has the vision yet for how it could happen.


    But it seems really obvious to me that like the next sort of gig economy push is going to be into these spaces because something's got to change fundamentally, we're not going to get enough nurses and doctors back into the, into the coffers here anytime soon to backfill where we're missing people. Right?


    Paul Carroll 06:28

    Yeah. Couldn't possibly agree more.


    Jerrod Bailey 06:30

    Yeah, that's great. Well, so you deal with a few things around insurance. But work worker's comp is an area that you know, a thing or two about, what just your assessment Where's, what's the current state of of workers comp, generally, maybe as it applies to technology? Or we're where the major stressors are right now.


    Paul Carroll 06:52

    So, yeah, workers comp is an area we get into a lot. And it's one that I think, has a lot of promise. If you actually look, in a lot of cases, workers comp rates are going down, which isn't typically happening in other parts of insurance. And the reason is that people are doing the sort of thing that I've been preaching that a lot of us have been preaching for a while, which is prevention, right?


    So I tell people that nobody wakes up in the morning and says, I'm going to go buy an insurance policy, that's going to be really exciting thing I'm going to do today. Nobody wants to buy insurance, they want protection, they want safety, they want peace of mind. And there are lots of ways that people are making workplaces safer. And because of that, you're seeing the rates gradually decline.


    And in most states, the US is weird, because all the regulation is state by state. And so the pricing is on state by state. But there is I think real progress going on.


    There also is progress going on, in terms of how you handle the claims. So I think in general, people think about AI, and it's a sort of fairy dust that you sprinkle on a problem and the problem goes away. That doesn't happen. But there are some very targeted uses of AI in workers comp. So that when a claim starts, you can look at it. And you can say, Hmm, this is likely to become a complicated one. Maybe I ought to focus on that now and get one of my best people focusing on that now. And you can look at others and say, this is pretty simple. We're just going to make a payment, we're going to do whatever we have to do, we're going to help the person get the person back to work, whatever.


    Jerrod Bailey 08:52

    And yet today, they're all sort of treated with the same amount of weight coming through, right and you and we find all these bottlenecks of unnecessary bottlenecks, right?


    Paul Carroll 09:03

    That's, that's the thing. And that's where the technology is starting to be applied by some of these TPAs third party administrators, and others and is making progress. People are also realizing that there are the psychosocial as they call them aspects to workers comp.


    So it's not just oh, Paul has a cut finger, we're going to treat all the cut fingers the same and obviously, the issues are more serious than that. But you don't just look at them. You also look at who Paul is and where he is in his career and what sort of financial stresses he has and all these other things and you look at the environment and decide okay, this makes Paul more or less likely to go out and hire a lawyer and, and maybe make something more complicated.


    There also are and this is where you guys are playing a role. Are you analyses of doctors, so you decide that these are the really good doctors in this area. So we're going to try to steer somebody to that doctor, those doctors, rather than just telling the person Good luck, go find somebody and talk to us after you've had your appointment. So there are a lot of things sort of happening around the edges that are encouraging about workers comp,


    Jerrod Bailey 10:27

    you know, it's interesting, because we sit in just a very narrow part of that process, right, which is getting that like an independent review done by me, finding the doctor lining up schedules, getting the injured worker out there to be able to be evaluated and getting the report back, all that kind of mechanics of it. And it's interesting, it's been done the same way for 40 years, it seems like, and when you look underneath the first couple of layers, and you see, and like one of the problems, that process can take months, right. And there's aggregators, and there's a lot of finger pointing at doctors and others saying, well, it just takes a long time to get these things done.


    But when you look under the hood, there's 1000 Little steps there that are somebody's manually kind of doing right, and somebody has to think about it today. Remember that that wasn't done. And they have to. So when you add all those things up, it's kind of like when I talked about the speed of light and latency with internet packets.


    Remember, when you used to have to like communicate with a website and in Japan, but you had to wait for the speed of light to get those packets there and back again, and you're sending millions of packets. And, and that doesn't seem like a lot. I mean, you're talking you might you know, milliseconds to send that packet around the world. But when you're doing millions of them back and forth, it adds up and it creates what's called latency, right? It creates a lot of protracted amount of time. So people got smart and started taking that server in Japan and replicating it over in the US. So we didn't have the speed light issue anymore. The same thing happens when you unpack like these complicated workflows. And they happen in workers comp all the time, not just with IMEs, but with other things. And it's how many clicks does it take to do something? How much time does it take who's is there reminders that automatically gets sent out or you're waiting for the failure of people to remember these things, you add those things up in. And when you figure out that you can eliminate 90% of that.


    I think that's also where opportunities are simple workflow automation that just hasn't been implemented yet in the industry at these core levels. But you know, imagine the day where an IME gets done in a week, instead of potentially months. And in those things, also, we think are opportunities. Now AI plays a big role in that and how records get access, like just medical records, pulling those out of hospitals, organizing them in a way that becomes really seamless for the reviewing physician to be able to review those. There's a lot of opportunity for AI just to do some of that cleanup work that humans are doing right now. But anyway, I guess we could riff on this all day long. But


    Paul Carroll 12:58

    I just to amplify a couple of points you made there one. I'm actually seeing that show up a lot more in underwriting. Now. I know that's not the topic, but it is an area that's a great analog. Yeah, but yeah, there. The idea initially was that AI was going to figure out, okay, what kind of a risk is Paul, and be much more precise, and that's happening. But what's really happening is that the AI is managing the whole process, right?


    So you get something submitted. And it's not here's a whole dump for the underwriter. It's we've gone through these documents, even though a lot of them are PDFs or paper. So you have to scan you have to kind of understand what's going on. And we're extracting all that information. We're checking the submission against what we can find on the internet, third party data sources and so forth. And instead of just sort of saying here, Mr. Ms. underwriter, here's a packet figured out, a lot of that is organized. And that speeds the process greatly in workers comp, the speed is not only for the sake of efficiency, but it also can fundamentally change the relationship between the medical provider safe that can the employer and the employee, because if you get hurt, you want somebody to acknowledge that you got hurt, you want something to happen quickly. And if it doesn't happen quickly, then you're thinking that dumb employer doesn't care about me at all. But if it does happen quickly, then that changes the whole nature of the conversation.


    Jerrod Bailey 14:27

    Right? It feels responsive, it feels like they're taking care of me. And you see the same thing in other industries like med mal is a good industry, an analogue as well, right something happens that was unintended in the clinical setting, right there was a procedure and someone was badly injured or there was a death that occurred that's a scary moment, right? And if you as the as the as the patient or is their surviving family, get nothing but crickets for months, the likelihood of you eventually having to find outside counsel and having to go make this a much, much bigger deal. I mean, it's very high likely that that's why you're seeing the adoption of things like communication resolution programs and other things in that space.


    But I think you're right. I think the opportunity is it's a brand opportunity, right? For these employers who they have to keep hiring in their in their local communities. And you see these Glassdoor reviews and things like that, like one of the ways that we can be responsive is by figuring out how to how to make these responses to bad situations a little bit more. Quick, right? Right.


    You know, there's a company I'll tell you about, they're actually based here in Phoenix, which is where many places based it's called Yellow Bird, they were heard of this? No. We mentioned the point earlier, you said one of the trends that's happening is employers are being more diligent about making their environment safer. Yep. And that's why we're seeing this reduction, Yellow Bird and I'm always beating the drum as far as like, how do you make talent and access to talent, more accessible workforces more fluid? Will Yellowbird, which I think is Go yellowbird.com is their website. They have a national network of like OSHA certified consultants or independent contractors that can come in, and they can help evaluate a location advice, things like that. It's really fascinating. But it's, it's a total marketplace for, for work on to be able to get this talent when you need it where you need it. And at a good rate. I'll look it up. I've not heard of them. But they sound interesting. Yeah, they're one of the top startups here in town.


    Okay, so I want to jump into this article that you wrote, it's on work comp, Central. It's the biggest issue facing workers comp. Essentially, if I was going to sum it up, it's about the the work from home trend. I saw some stuff from Mark walls, safety nationals interview, but what what? How did you land on that, on that article? What's going on that peak? That is a topic for you?


    Paul Carroll 17:00

    Oh, it was sort of a subset of the general staffing crisis. In insurance. People have been talking to them about that for a while, because insurance is an older industry, in terms of the employees who are there who are there, it still surprises me that the industry hasn't been able to figure out a way to get people excited, because it's a massively important industry. And it's one going through a lot of change. Steve Jobs used to talk about wanting people who wanted to put a dent in the universe. And if you want to put a dent in the universe, you could do a lot worse than to, to work in insurance. But it seems like eight or nine out of 10 of the people I talked to just fell into the insurance industry. Yeah, well, I was gonna do this and that, and then this came along. And then okay, I am and 15


    Jerrod Bailey 17:52

    years, 20 years later, I met Yeah, job.


    Paul Carroll 17:54

    Yeah. And they're, they're enjoying it. And there were a lot of good paying jobs and insurance. But anyway, that was sort of the, the Genesis and then Mark, who is a smart guy I've known for a long time. and I were talking, and it turns out that it's really sort of a double whammy for workers comp. Because they are dealing with their own staffing issues that a lot of these people who say were part of the great resignation, or who just are less inclined to, to enter the industry are moving out of the industry. And at the same time, they're having to deal with all the changes at their science, right. So the, the clients are having fewer people who were there. So they're working those people harder, there may be training them less, the dangers are going up. There's a shift from all being in the office or the warehouse or whatever, to having a lot of things on from home. That creates all kinds of uncertainty. So it's workers comp, probably more than any other part, at least of the insurance industry that I'm aware of, is going through a significant transition at the moment. Well,


    Jerrod Bailey 19:14

    I mean, as as someone who employs people, and most of them work from home it's not the first time I've heard this, right, like, so we now have people working from home, what what does that create them? For us as employers from a liability perspective? How much responsibility should we be taking over what their environment is? They're like, that's a that's a really big question, right? I don't know. Are you seeing any answers to those questions yet? Or where are you getting better questions?


    Paul Carroll 19:46

    Well, Mark had one thought and I find this sort of interesting because I've been fortunate enough to be in that sort of environment for 26 years now. Since I left the Wall Street Journal and when to this consulting firm, I was either on a plane or I was at home. And when I was at home my kids were little, and they come in after preschool or whatever, and run in and give me a hug. And I could do whatever I wanted with them at that point of the day, which is great.


    And in fact, the staff I had on this magazine that I did for the consulting firm was based all around the country, because if you're the pioneer in digital strategy, then you're also going to be a pioneer and things like remote work. So I, this is not new to me personally, the thing that, that Mark said, that I thought was potentially very useful, is you want to encourage the people who work for you at home, to sort of declare a space as their workspace. Because what you want to be able to do is say, Well, okay, this was an injury that happened at work, this was not an injury that happened at work, this was an injury that happened because of work, this was not. And if you have people say, Well, I'm not going to just take my laptop and go sit on the couch, or go out on the patio, by the pool, or, or whatever, then you can sort of say, alright, you have an office, and when you are in that office, and you have that computer open, you are working. And then you can get people to take a picture of the work space. So you can have people take a look at that and say, oh that thing hanging over your head is probably not a great idea. That ball on the floor that you use to play with your cat or dog is probably not a good idea. And you can give people some advice on how to make the environment safer. Beyond that, I think people are still feeling their way through it. But I thought that was pretty good advice for Mark.


    Jerrod Bailey 21:49

    Well, that's interesting. So I just had the idea if Yellowbird builds that into their their tech product, you could have a virtual person virtually analyze a virtual space, and write a report on it. Any mitigation steps, and probably being that out across the fleet of work from home workers pretty quickly.


    Paul Carroll 22:09

    Right? I like it, there also are things you can do that get maybe a little sketchy because people worried that their privacy is being invaded. But you could have the camera basically on people to make sure that they're doing what they say they're doing their work. And when they say they're working, and all that kind of stuff. I'm not a big fan of that, just because you know, I've always worked based on output. If I get the work done, great. If I don't then beat me up about it. But I don't want you to look into my face all day long.


    Jerrod Bailey 22:42

    Yeah, yeah, that seems a little a little intrusive. Interesting. Well, I mean, I love that we can talk about technology. It's really rare. I mean, I'm sure you find bright spots in the industries that you're working in. But it's it's nice to talk to somebody who's seen enough technology deployed to to be able to imagine how it might get used. Let's see. So it any other ways that because we're you know, we're always like, how does tech? How does tech play into these industries? Right, everybody's thinking about people in process. Right. But technology seems to be that third pillar that is specifically in healthcare and insurance. You don't hear it being supported enough? Is there any other areas where you think technology is, is really kind of the big opportunity? The big missed opportunity currently?


    Paul Carroll 23:34

    Um, I mean, there are, I actually, excuse me wrote a book with two colleagues, including this fellow chunka. Moy, who I wrote a billion other lessons with, called a brief history of a perfect future. That came out a year ago. And that tries to project out into 2015, and talk about all the things that are possibilities. And healthcare is a big one.


    But it's sort of a funny one, because there's an issue that people tend not to think about enough when it comes to technology. And that's quite profound and tends to mess up a lot of projections. And that's false positives. So people talk about how you can run around with your Apple Watch or the Fitbit I'm wearing or whatever. And you can conceivably get notified that you have an issue that could be restaging, a heart attack or something like that. And that's great. That's profound, but you're going to get an awful lot of false positives.


    There's a smart fellow published and gotten to know about named Al Lewis with an outfit called crucify. Excuse me, again, that helps educate people. As employees, he's hired by employers to help educate them on what is useful and what's not useful when it comes to health care. And he figures that it costs about a million dollars to prevent a heart attack. Right? If you're going to have all these false positives, and then run people through tests, and this, that and the other thing, it costs about a million dollars to prevent a heart attack, and you're going to do an awful lot of damage to some of those other people in the process. Because as you know, put in stand, sir, as you do whatever, you are potentially creating problems.


    There was a recent report about colonoscopies, which people have talked about as sort of the gold standard of medical care for a while. And it turns out that there are an awful lot of false positives. Basically, every 450 colonoscopies will find one potential will prevent one cancer. And there are potential side effects to colonoscopies. And then there's some other things that can come up against the treatment. So nobody's saying don't do colonoscopies, but if you take a look at it, it's not this clear, positive in the way that it's been presented for a long time. And of course, in healthcare, you get money talking, because there are an awful lot of people who make an awful lot of money, doing an awful article and Oscar peas, and they're going to push back on the on the results. So I know that a general point and you were looking for something more specific, but I would just say that, that whenever you think about the potential for technology, think not just about the good stuff that's going to happen. But the potential downsides as well, because there always are downsides.


    Jerrod Bailey 26:51

    Well, in the healthcare industry, we talk a lot about AI helping with the, the exactly that with the identifying illnesses, where humans couldn't and that sort of thing. And what is the liability to the AI that messes that up? Right, or the AI that wasn't updated with the latest medical knowledge and in all the sudden it's making recommendations, not just to one patient, but at scale? Right to lots and lots of people? And who's you know, who's on the hook for that? And how do you how do you sign your service agreements with companies like that? And there's all kinds of service agreements out there that have nothing? You know, they they're very explicitly say there is no liability for the AI company for suggesting whatever they say just in the process. So yeah, I mean, it's a brave new world. But you know, when Skynet decides to be evil, or just, we've got we've got a problem on our hands, right?


    Paul Carroll 27:47

    Yeah, the best solution that I've come up with so far is what we call a centaur, sort of half human, half horse, in this case, half human half machine. Some people don't like that term and refer to that sort of idea sideboards rather than centaurs. You know. Yeah, exactly.


    But there actually is a lot of work that McKinsey, which I've done some work with, has done on this topic. And they say that, even though there's a lot of talk about eliminating jobs, the only job that's ever been fully eliminated is that an elevator operator with everything else, it's sort of a combination work gets offloaded, but the person is still in charge.


    And the best uses I've seen in medicine, RSA, the the radiology, a eyes that will take a look at something and will intentionally spot a lot of things with false positives, and then you put those in front of the human expert, who no longer has to go through the you know, 5000 and then we're going to be nothing and in the process is getting bored and so forth. And conceivably a little sloppy, you just say okay, these are the interesting cases, take a look at those and then that person is the one who makes the decision and you know, carries all the liability and all the other stuff that the doctors are used to dealing with already.


    Jerrod Bailey 29:13

    Love it. Well, all this was this was great. Now tell me at least for our audience, if they want to reach out to you what, what do you what do you help with? What is your, your consultancy? What do you what do you guys typically helping with?


    Paul Carroll 29:30

    So it's typically stress testing distress testing, a strategy that the idea of the devil's advocate is that you look at the Catholic Church and if someone was being considered for sainthood, deep in the process, they would appoint a devil's advocate. The person's the exact title was actually defender of the faith. So the person was not there to say I'm the devil and I'm gonna go get Somebody or whatever, but it would just erase all the potential objections. And what we found with this book billion dollar lessons is that of the 2500 disasters we looked at 47% should have been identified ahead of time. They were just stupid as a Avon deciding that it wasn't really about its cosmetics and its sales force, it was a culture of caring. So then they went off and bought a medical equipment, business and retirement homes, and no idea how to run them and sold them off a couple years later at a massive loss. So it was that kind of stuff.


    And we also learned that almost always that knowledge was present. So there were people who knew that the idea was a disaster, they just didn't have a way of bringing that to the surface. So we go in, and we interview people and help them bring those objections to the surface. So surface. So you know, there's a big car company that was all set to go on autonomous cars. And it turned out there were a lot of reasons not to, they delayed by probably four years now in rolling out this robo taxi service and probably saved billions of dollars. That's our big success story.


    Jerrod Bailey 31:20

    Amazing. I love it. Well, I would love to find out more of those stories. I've done a lot of innovation in my career. And it's the thinking exercise of strategy, and you know, what people are doing and what's the best way to optimize it? Or whether or not to do it is it's always interesting to me. Well, Paul, anything else that you want to? You want to


    Paul Carroll 31:40

    know, I just would encourage people to go check out insurance thought leadership.com, I do a weekly newsletter, which actually is where this article you're talking about originated. So if you're interested in insurance, come check us out.


    Jerrod Bailey 31:54

    That's great. And we'll link to your LinkedIn and smoothie in your websites and things like that in the show notes, but I appreciate you joining me it was really great conversation. Perfect Android. Great. Well for everyone else. Thanks for listening to reimagining healthcare and new dialogue in risk and patient safety with leaders from around the US. Subscribe and Share if you found it valuable and if you'd like to participate again as a guest just email us at speakers at Medplace.com Make sure to follow Paul and connect with him on LinkedIn and all thanks so much for the for the conversations was great. Thanks for the chance

Insurance Thought Leadership Editor-in-Chief Paul Carroll brings light to a staffing shortage in workers' compensation, and ways technology can both help and harm the industry. He explains the dilemma of reducing at-home injuries, and the fine line between at-home risk management and surveillance. Paul also dispels misconceptions about healthcare AI, and explores some of the ethical applications of machine learning.


Paul is the Editor-in-Chief of Insurance Thought Leadership, a digital publishing platform that is a catalyst for change in insurance and risk management. Paul is also the co-founder of and partner with the Devil's Advocate Group, a strategy consulting boutique. He spent 17 years as a reporter and editor at the Wall Street Journal. He was nominated twice for a Pulitzer Prize and was a finalist in 1996.


Guest - Paul Carroll


Paul is the Editor-in-Chief of Insurance Thought Leadership, a digital publishing platform that is a catalyst for change in insurance and risk management. Paul is also the co-founder of and partner with the Devil's Advocate Group, a strategy consulting boutique. He spent 17 years as a reporter and editor at the Wall Street Journal. He was nominated twice for a Pulitzer Prize and was a finalist in 1996.

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