Cover Story: Inside the Nature of Inspiration

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It can happen at any point, really, in any organized humaneducational endeavor. You could be sitting in an audience, perhapsit's a university lecture hall, perhaps it's the antiseptic anduninspiring space of the meeting room of a professional trade show.
You're sitting there, doodling in your notebook or on the handoutthat some kindhearted soul with good intentions has given you. Andthen it happens. Someone says something that cuts through thesleep-deprived haze of your business road trip frame of mind anddemands your attention.
In this case, the words that were uttered went like this:
"It is a gift to have a challenge that inspires the imagination."
The words, when they were uttered, came across like the words of aprophet. "I am someone worth paying attention to," the speaker'sinflection seemed to say.
Indeed, the speaker turned out to be someone worth paying attentionto. The words in this case, said at a session on third-partyadministration management during the annual conference of the Riskand Insurance Management Society Inc. in San Diego, were punctuatedby an index finger passionately impaling the air, and were spokenby Gisele Posey, the corporate senior director of workers'compensation and loss prevention for Kindred Healthcare, based inLouisville, Ky.
THAT NEVER HAPPENS
The story of how Posey came to be at Kindred and lecturing in SanDiego this past April might be just as interesting as the resultsshe has been able to produce at Kindred.
After 17 years with the trucking company Yellow Freight, where shehad worked her way through the ranks to the position of corporatedirector of workers' comp, Posey took a buyout in 2004 to be withher newborn daughter Sydney. But six months into the stay-at-homelife, she started to get itchy.
Unable to sleep, she was surfing the Web one night and saw aposting for a corporate senior director of workers' compensationand loss from Kindred Healthcare. "It was one of those rareoccasions when you read a job description and say, 'This is me,' "Posey recalls.
Two weeks later she was in the door at Kindred's headquarters andtalking to Kim Martin, Kindred's senior vice president of riskmanagement and compliance. "She was the first resume that we lookedat, and that never happens," Martin recalls.
Posey was also able to convince Martin that she could translate herexperience in lowering workers' comp costs for her former employerinto the healthcare field. While at Yellow Freight, she shrunkcosts from $75 million to $43 million by implementing several onsite programs, including physical therapy review, medical billreview, orthopedic and psychiatrists review, and telephonic medicalcase management.
Posey also developed and implemented an Injury Counselor Programfor field operations designed to enhance employee communication,strengthen aggressive claims management and reduce employeelitigation.
Posey told Martin she could lower costs at Kindred, but she wasgoing to need some resources.
"She just blew us out of the water with her ability to say, 'Thisis exactly how I would approach it,' " Martin says.
Something else happened when Martin and other Kindred executivesinterviewed Posey that day. She was hired on the spot.
"That is probably the first time in my career that I have offeredanyone the job before they have left the building, seriously," saysMartin.
Right from the start, Kindred's top brass thought they hadsomething special.
"This is the young lady that is going to save the company $10million," Posey remembers Kindred CEO Paul Diaz saying when Diazintroduced her to a group of associates when she joined the companymore than two years ago.
Posey has done much better than that. She was hired in February2005 and, through June 2008, has saved her employer, a company of55,000 employees with hospitals, long-term care facilities andrehabilitation centers operating in 50 states, the equivalent of anestimated $34 million. Last year the company generated more than $4billion in revenue.
So, how has she done it?
For starters, she took a hard look at the TPA that was managingKindred's claims and decided they had to go.
"When I started doing the claims reviews, I noticed that there weresignificant lapses in time between when an examiner indicated thatthey were going to do something and then when they actuallyexecuted the plans, if ever," Posey says. "Also, examiners wereassigning files over to an attorney when there were issues thatthey should have been handling, which were increasing the costs ofthe claims."
"I was able to tell very quickly that the claims were not beinghandled as they should be," Posey recalls. "The previous TPA wasnickel-and-diming us to death."
She conducted an RFP process and settled on Sedgwick CMS. Thatrelationship began in January 2006 and, according to both sides,has flourished.
David North, Sedgwick's president and CEO, says there are threeareas in which Posey stands out. "The first is she is veryknowledgeable," North says.
Secondly, North says Posey is in almost constant motion. "She mustbe viewed at Kindred as one of those people that represents thesaying, 'If you want to get something done, find a busy person.' Ithink Gisele is one of the busiest people I know."
Her third key feature, according to North, is her attention todata. "She uses analytics in our program to monitor where theprogram is at any given time and where she is going to focus hertime to bring some improvements to the program, and that creates avery good partnership," North says.
"I thought one of the first things I needed to do was to partnerwith a TPA that was capable of extracting information that would bebeneficial to our field managers, and that was really one of thethings that stood out in my mind about Sedgwick," says Posey. "Theywere able to cut and dice all kinds of information, and we wereable to pass that on to our operators."
Posey also took over a workers' comp management operation that hadonly one workers' compensation manager. "All she was able to do wasput out fires," Posey recalls.
Right in the door, she got the commitment from Martin to hire twomore managers and has since hired a third.
"I know that some companies think that having an internalmanagement process that manages your TPA is redundant," Martinsays. "But the fact of the matter is it has been a huge return oninvestment (having the in-house managers tracking the TPA) simplybecause TPAs are very busy. They have a lot of clients, and whenyou have got someone who is staying on top of it and making surethat everything is being done and responding to that, that has beenreally remarkable."
Here is how Posey saw it.
"As I indicated, we had had only one person who was responsible forworkers' comp," says Posey. "So, as a result, the loss preventionfolks were handling claims-related issues that normally your lossprevention folks would never get involved in. What I felt wasimportant for the loss prevention folks to do was to reducefrequency and severity, and ironically that had never been thefocus."
Posey also set about strengthening Kindred's transitionalreturn-to-work program.
"We instituted a policy requiring the Sedgwick examiner to contactthe Kindred work comp manager in any instance where our facilityrefused to put an employee in transitional work," Posey says. "Ifmanagement continued to refuse, the issue was brought to myattention to resolve."
"To my staff's credit, only two or three claims have ever hit mydesk in the last three-and-a-half years," says Posey.
Posey has also cut down Kindred's legal costs.
"We do not want a firm to use Kindred files to train a newassociate," says Posey. "Our special account instructions indicatethat we do not want to pay attorneys for doing adjuster work. Also,we monitor hourly rates annually and renegotiate if we feelnecessary. I have also used flat-fee programs in the past. Thisapproach can result in significant savings of up to 35 percent."
Bill Thomas, the president and managing partner of Delaware,Ohio-based Thomas & Co. LPA now does a lot of workers' complegal work in Ohio for Kindred. But when he and Posey met, theywere just young guns, trying to pull some decent recoveries out ofthe Yellow Freight claims files.
"We had a really big case together where we made a really nicerecovery, and then I started to do some more work for YellowFreight," Thomas recalls.
Posey didn't forget about Thomas, and when she needed some helprighting the workers' comp claims ship at Kindred, she broughtThomas' company along to handle Kindred's cases in Ohio.
There are some schools of thought in handling claims that you worklaw firms against one another, giving the work to the firms thatclose the cases the quickest for the least amount of money. Thomas,with his 18 years in the business, thinks that's the wrong way togo about things. "That is just flat wrong," Thomas says of the"sharks in the water" approach.
In contrast, Thomas' company works for Kindred in Ohio for a flatfee. He says Posey's approach to business, maintaining goodrelationships and open lines of communication, is what makes thearrangement work.
SLIPS AND FALLS
It may seem overly simplistic, but in the hospital, long-term careand rehabilitation businesses that Kindred is in, there are onlytwo major categories of employee injuries. One is slips and falls;the other is injuries caused to employees trying to lift patientsby themselves that are too heavy for them.
An additional initiative that Posey has implemented at Kindred isrevamping its safety program. The traditional program involvedrewards for good safety records and safety posters that Poseydescribes as "comic" and "hokey."
"In my experience, it doesn't make a whole lot of sense to paypeople for working safely," says Posey.
Instead, what has worked for her at Kindred is a safety programthat emphasizes family connections over cash incentives.
Using in-house communications staff, Posey and crew created aseries of posters that emphasized the loss to family members ifKindred workers were to slip and fall or injure their back in anill-advised effort to transport a patient on their own.
What Posey instead wanted to focus on were the human relationshipsthat are affected by workplace injury.
"Most of us work hard every day to provide a good life for ourfamilies. We wanted to tap into that mindset as we laid out theframework of why it is important for our employees to work safely,"Posey says.
It's that dual ability, possessing the analytical mind to breakdown programs and crunch numbers, and also having thecommunications skills and the ability to connect with people thatmakes Posey special.
"I think her people skills are so good that she is able to get thebuy-in that she needs because she respects people, and I think theyunderstand that," says Barbara Galluppi, an area senior vicepresident for Arthur J. Gallagher & Co., who has worked withPosey, as she put it, "banging down" reserve levels at Kindred.
Galluppi also says Posey has all the brains that a person couldwant, yet keeps her talent in check.
"She is just smart, but you know how some really smart people thinkthey already know everything? She is very open to new ideas andvery curious," the broker says. But Galluppi says Posey can put herhard shell on if need be. "She is tough when she needs to be tough,she doesn't suffer fools."
It was Virginia Sewing, recently retired from J.C. Penney Inc. andliving in Overland Park, Kan., who was one of the first to spotPosey's talents when she was just a high school girl.
It was Sewing who also saw Posey behind the desk of a DoubletreeHotel working off her undergraduate debts and persuaded her to cometo work for Travelers Inc. to train as a claims representative.
"She was very professional, and I was impressed by herprofessionalism and in her ability to learn quickly and to listento people that had experiences and to learn from other people'sexperience," says Sewing.
Would Sewing call herself Posey's mentor?
"I am extremely proud and honored to be her mentor, and at the sametime, she has very good capabilities on her own," says Sewing."Whenever she was presented with anything that could have been asetback for a lot of people, she moved on beyond that, and I wouldsay that is a trait of a resilient and brilliant person."
DAN REYNOLDS is senior editor of Risk & Insurance