View from the top: David Dwortz, Helmsman

David Dwortz is president and CEO of third-party administrator Helmsman Management Services LLC, a Boston-based unit of Liberty Mutual Insurance Co. After joining Liberty Mutual from Ernst & Young in 2000, Mr. Dwortz held various leadership roles in finance, underwriting, distribution and claims before being named to lead Helmsman in 2016. He recently spoke with Business Insurance Editor Gavin Souter about the TPA’s growth strategy, the challenges of managing COVID-19 claims and the progress being made in treating workers compensation claimants on opioids. Edited excerpts follow.

Q: How are you looking to grow Helmsman? 

A: Our strategy has always been on organic growth and that will continue to be the foundation, but we are opening in some new markets and looking at some new products. For example, we were recently approved by Lloyd’s and so we’re opening to the London market, and we’re also exploring expanding into Canada. We’ve also been working with some partners to provide our services to group captives and program business and just generally working more with MGAs. Another area that is relatively new for us is we’re working with some carriers to bolster their claims departments for their insured business. 

We will also look at M&A. We made our first acquisition at Helmsman in 2020 with the addition of Eberle Vivian, which has been a terrific addition to our team, and we definitely will look for more acquisition opportunities where we find the right culture and the right strategic fit. 

Q: Does being owned by an insurer hinder your ability to work with other insurers? 

A: It is a more complicated conversation sometimes because Helmsman is owned by Liberty Mutual. While we act independently, we have to have a little bit more conversation to gain the trust of carriers that we work with. 

Most people don’t realize that the vast majority of our business is with carriers other than Liberty. 

Q: The big story of the past 18 months has been COVID-19; what was your experience and how have you managed COVID-19-related claims, including long COVID? 

A: The keys are getting the right experts on the right claim at the right time. We rely pretty heavily on our medical directors and nurse case managers, and our medical directors are constantly tracking the medical studies and literature, the CDC guidelines and other sources to understand short- and long-term impact and treatments. We always try to follow the evidence-based guidelines wherever possible and fully engage the worker in their recovery. 

There’s a lot of extra thought that goes in, and we have a dedicated team just for COVID and support them with experts to make sure they’ve got all the right resources. 

And then we coordinate with our customers and the jurisdictional requirements that have been coming out to make sure everyone’s making timely and efficient decisions state by state and providing our customers with additional resources. 

Q: Comp has become so much about evidence-based treatment. If there’s little evidence there how do you manage the claims? 

A: COVID claims are unlike anything we’ve ever seen and the scale is also unprecedented, but, if you go back, new and very complex claims have emerged and as a TPA we have a pretty solid history of rolling up our sleeves and trying to understand the complexities. Again, we rely very heavily on our medical directors. 

Q: One of the other big issues with comp over the past few years has been the opioids epidemic. What remains to be done? 

A: I am proud with the progress that’s been made — we’ve got a 44% decrease in the patients receiving an opioid from 2017 to 2020 and opioid prescriptions overall declined 40% from 2017 to 2020 — but there’s a lot that we still have to do. 

We’ve incorporated a new generation of predictive models. We’ve incorporated increased risk of opioid abuse and addiction into our models and data analytics to help identify high-risk claims, highlighting them for our claims teams so we can get the right experts on the right claims even earlier. 

One of the many remaining things we need to do here, though, is address those long-tail claims with opioid dependency. As an industry, we all have gotten better at managing the exposures to opioids going forward, but we still have a pretty big challenge in front of us to help the people who have become dependent on long-term usage. 

Q: Does that involve weaning programs, etc., and are you having successes? 

A: Absolutely, yes. It’s an uphill battle, but we celebrate the wins where we’re able to get someone who was on just massive amounts of prescriptions and we’re able to say they’re effectively off opioids and looking at getting back to work. 

Q: How do you see the TPA sector developing over the next few years? 

A: I see a lot of opportunity and a lot of challenges. We as TPAs are going to be tackling a lot of the same industrywide challenges, like the fight for talent and driving progress on diversity, equity and inclusion. We need to attract and prepare the next generation of insurance and claims experts and the next generation needs to look a lot different than today. 

Q: How do you do that?

A: Just speaking for ourselves, this is maybe one of the top issues that our leaders are tasked with. It starts with current leaders looking inward and educating ourselves and broadening our perspectives and then getting the courage to have uncomfortable conversations and talk about it more broadly and then ultimately building it into the DNA of your organization that you’re looking to have diversity of perspectives. 

Related to talent, we’ve got to adapt to a more remote and flexible workforce. The challenge is how do you maintain your culture and that connection to each other in a different work environment where you’re not coming to the office every day. So, it really drives up those in-person opportunities and interactions have to have a real purpose.