Looking Back and Projecting Forward: The Evolution of DMEC

By Marcia Carruthers, MBA, ARM, CPDM

Co-Founder and Board Chairperson
DMEC

Looking back, now almost 30 years, the national growth and recognition of the Disability Management Employer Coalition (DMEC) has been achieved through a number of underlying structural principles that have served as building blocks for a strong foundation. Much of what worked back in 1992, continues to keep us focused on our core values and employer member base. Lessons learned, ongoing creativity, and opportunities seized spurred us to fine-tune our model, and in the process, assured our future expansion and viability. From the perspective of a co-founder and Board Chair, and as I turn over the leadership to another generation, I thought it instructive at this juncture to review DMEC’s past history and place in the ever-evolving industry of disability, absence, and productivity management.

Early Ideas, Passion, and Corporate Environment

The concept of DMEC began at the desk of Sharon Kaleta, co-founder, in 1991, as we worked together at Rohr Industries (an aerospace subcontractor, now part of United Technologies). As a large employer with self-insured benefits, we were keenly aware of the need to manage all aspects of disability in what then was termed simply “disability management,” but was to be the precursor of integrated disability and absence management (IDAM). Through our previous positions in risk management, we were schooled in worker’s compensation (WC) philosophies and early intervention. We both knew that close monitoring of cases, emphasis on return to work (RTW), flexibility of all self-insured benefits (WC, healthcare, long-term disability (LTD), and voluntary state disability insurance (SDI)), and coordination between departments was key to cost-effectively managing our claims. Our platform of self-insurance allowed flexibility, inventiveness, financial viability, and a path to integration.

We also knew the challenges of proving cost savings and overcoming the “silo mentality” were critical to “selling” the program to upper management. Fortunately, the vision at the time has held us in good stead — identifying a need, seeing the big picture, and translating that into to practical applications and solutions to ensure cost-effective programs for employers.

This “can do” attitude and the willingness to “take a risk” were fundamental elements for this entrepreneurial effort. Underlying our corporate mantra of cost savings and productivity, we knew in our hearts that “work was curative,” and it was simply “the right thing to do.” We were passionate that employees should not be “put out to pasture.” We set our sights on avoiding LTD, retirement disability, and social security disability (SSD) if at all possible.

The economic environment in 1992 was recessionary, so employers were primarily focused on managing costs. It was also the beginning of the push in compliance program expansion. Things were much simpler back then — as we were only focused on four main compliance programs:

• Rehabilitation Act of 1973;
• workers’ compensation;
• California state disability; and
• Americans with Disabilities Act (ADA).

With ADA in its infancy, not much was known about the implications, as case law was just forming. Little did we know that the door was just opening to more and more compliance issues that would continue to support the need for employer education and DMEC’s program offerings.

While we felt we had a good program, we wanted to learn more from other employers who were doing similar things. Enter Cathy Cather (then with Alexander & Alexander and now with her own firm, Cather Healthcare Consulting) who we met at an industry meeting. She offered to set up some lunches with other clients who were expressing interest in sharing ideas too. Thus was the birth of what has become a core component of DMEC — employers sharing ideas, programs, and methodology with other employers over a meal. One of the first attendees at these lunches was Diana Henderson, who was then National Workers’ Compensation Manager at Hunt-Wesson (now leading her own consulting firm, The Henderson Group). She would become our first Treasurer when we incorporated in 1995.

Even back then, the concept that was spawned included expansion of DMEC into all 50 states and even internationally. We felt that the concepts we were proposing would work regardless of the statutory environment, type of insurance, and even size of the company. In short, it was a universal concept of getting employees back to work as soon as possible, along with keeping the workforce productive as a healthy and right thing to do.

We were convinced that we could accomplish this more easily in a self-insured environment where we had the most control. We were fortunate to be very nimble in this respect and could easily coordinate claims and settlements, even without technology. In fact, we coined the term “sneaker net” to describe how we coordinated claims management simply by walking down the hall. We captured all of our data on spreadsheets and relied on telephone and mail for communication — technology was yet to provide the tools that would assist in overseeing our programs. Armed with the newly published Medical Disability Advisor (1991), we applied data and objective evidence to claims decisions. Luckily for us, at this time we were not constrained by the HIPAA privacy laws soon to come down the road in 1996, which made sharing medical and claims information more difficult.

DMEC Takes Form

Armed with a strong and visionary leadership team of women, early lunches quickly turned into more formalized events. The first two meetings in early 1992 were set to capture a more regional reach — the first as a side meeting to the California Self Insured Association (CSIA) in San Diego in March and another at the Risk & Insurance Management Society (RIMS) Conference in Anaheim in April. At the CSIA, a revolutionary document was passed out, authored by John Garamendi (then the Insurance Commissioner); it was an early model of the Universal Health Care concept that would be funded by employers through an 8% payroll fee (Proposition 166). Although three municipal pilots were authorized by Governor Pete Wilson, Proposition 166 was ultimately defeated.

While it may seem so, healthcare reform is not a new idea! Employers had strong feelings (pro and con) about this approach. Many wanted to influence a system where all benefits were coordinated or integrated, including a revised “clean slate” system of WC in California.

Given these looming big ideas on the horizon, and the fact that at each meeting the number of DMEC attendees doubled, we felt a larger, more formal meeting was in order. We invited the Director of Worker’s Compensation, Casey Young, to come and educate us on the implications of 24-Hour Coverage in Los Angeles. What happened in June 1992 would be one of our first lessons learned. Casey gave us some basic information on the concept he had proposed. Getting legislative backing was the next step. Would DMEC be willing to assist in developing model 24-hour programs to do this? Our answer was yes to this first challenge!

Teams were formed and three models were developed over the next few months: fully-insured, self-insured with a third-party administrator (TPA), and self-insured/self-administered. Many of the participants became active members of DMEC, including Joe Wozniak (then with AAA) who was to become Board Treasurer in 1996 (and served in that role until his retirement in 2016). While our model programs were never adopted into legislation at the time, a few years later State Congressman Steve Peace included a portion of them into WC reform. While we were disappointed, we learned that the legislative route was not where we would be most effective.

In the process, we added considerably to the composition of the DMEC membership including brokers, TPAs, and other industry suppliers who would become key members and sponsors. We also knew that we had to meet where we could easily garner the most attendees, so LA (and eventually Orange County) were chosen as the future meeting location, and thus we began regular meetings.

As part of our vision, the full integration model was the ultimate application. This model would include WC, STD, LTD, disability retirement, internal medical clinics, and RTW — all nicely tied up with a bow. It assumed top-down approval, integrated corporate structures, and financial models. Only a few organizations tried this Cadillac model, and Southern California Edison (SCE) was one of them in September of 1992. The consulting team was headed up by Phil Polikoff and was fueled by a million-dollar contract. We had great hopes for its success as it had everything going for it. Unfortunately, it did not survive. Deborah Jacobs (currently Manager of Disability at Amazon and a member of the DMEC Governance Committee), was an LTD technician at the time and saw the process unfold. Her observation was that the failure was primarily a result of not meeting the expected ROI. In particular, the technical systems and processes were not integrated to enable the expected success. It was too much, too soon. The company disbanded the model and went back to their “silos”.

Gearing Up

Financing DMEC was initially accomplished “on a wing and a prayer,” starting with nothing but our own sweat equity and some willing partners to get us off the ground. Family members stuffed envelopes, employers provided postage and copying services, and we were barely in the black. A&A provided support to pay for early lunches, meeting fees were established to cover basic costs, membership fees were introduced, and sponsorships were solicited. The first DMEC chapter was established in 1993 in Costa Mesa (Orange County).

The first sponsorships were secured from Voluntary Plan Administrators (Jack Bredehorn), Keenan & Associates (John Keenan), Marsh & McClennan (Vicki Schweitzer), and Unum (Phil Bruen). Carriers and TPAs were active in the integration piece too. Keenan’s Innovative Care Services spearheaded by Debby Kweller (current DMEC Board member), integrated TPA services with insurance carrier programs. Voluntary Plan Administrators and Unum partnered to create an integrated benefit mix of WC, voluntary state disability (VSD), STD, and LTD.

Even at that juncture, we knew we were onto something. Meeting attendance expanded, people joined, speakers were secured, and “word of mouth” marketing spread the message to like-minded employers and suppliers. Early attendees, Bill Molmen and Tom Parry (IBI), then with California Workers Compensation Institute, flew from San Francisco to Orange County to attend our meetings and hear what was being proposed. It was clear that what DMEC had to offer was of interest to others outside of Southern California, and our next chapter in Northern California was launched. San Francisco become a chapter in 1995, followed by Washington (Seattle), and then Portland (Oregon). Eventually DMEC would establish chapters in 20 different locations across the U.S. in order to meet the demand of a growing and hungry environment needing education, training, and practical information. We were off and running with passion, vision, partners, and a small financial base to keep us at least one meeting ahead!

Building a Virtual Foundation: Incorporation Without “Brick & Mortar”

Knowing early on that we needed to establish a permanent and formal organizational structure, DMEC incorporated in 1995 as a 501(c)6 trade association and trademarked our name and first logo.  Administration was handled out of our homes while working at Rohr full time, assisted only by a part-time administrative assistant. Given our limited capital, we decided early on not to establish a “brick and mortar” location, eventually adding Sharon Kaleta and myself as contracted and virtual employees in 1998. This was to become a visionary move; a necessity given our financial situation. Operating without the necessity for a physical office has become a tool to attract and retain employees, operate with great flexibility, and expand nationally. Fortunately, the boom in personal computers and the introduction of the internet allowed us to successfully operate in a “virtual” environment, both cost-effectively and fluidly. We were just ahead of our time or as the saying goes…necessity is the mother of invention!

Partnership and volunteerism also become the hallmark of DMEC’s growth. Insurance Educational Association (IEA) partnered in launching our first designation, Certified Professional in Disability Management (CPDM), in the classroom in 1996. San Diego State, along with IEA, assisted in developing the first distance learning CPDM offering in 1997, which is now the standard for adult learning. Unum was the first to partner in offering webinars, donating their platform at a time when we couldn’t afford to lease one ourselves. Risk & Insurance contracted for a partnership agreement in 1999. Spring Consulting Group provided pro bono assistance to produce our well-respected and anticipated, national Leave Management Survey and Behavioral Risk Survey. In the mid-2000sm we also participated in academic projects with Michigan State and Cornell University. Partners were our path to expanded recognition and respected information.

Enduring Cornerstone: The National Conference

The first DMEC conference was held in San Diego, CA in 1996. Partnering again with IEA, we put on a one-day program complete with a handful of exhibit tables and a little over 100 attendees. Ready to go it on our own in 1997, we launched what was to become an industry recognized event — the National Conference held each summer. From our humble beginnings, we have grown that meeting into a 700+ attendee event, with over 60 exhibit booths and locations across the country. It has become a place to learn the latest in absence and disability best practices, mingle with the experts in the field, network with peers, and shop for state-of-the art products and services.

Key to conference success in the early years, and continuing to the present, is the behind-the-scenes strong support of volunteers. This important “person power” makes possible well-trained, welcoming, and knowledgeable conference assistance. There is no way we could have thrived without this strong base of support, which continue to be the face of DMEC at conferences and meetings. Many of these volunteers have been involved for decades. One DMEC member in particular, Christi Doe, has volunteered for over 20 years; she is a “tried and true” example of the dedication our members feel and for which we are much indebted.

Next Steps: Solidification Years

So many programs developed at DMEC have become recognized resources in the industry, fueled in part by “thinking outside of the box.” Most were instrumental in the spread of IDAM in the formative years. Once thought to be “a flash in the pan”, the fundamentals of this industry have matured and become part of an established discipline. A few of the more influential products and concepts that have led to the established base of knowledge are:

• Total Integration and Absence Management: DMEC led the move from a simple disability management concept to total integration models, expanded absence management, and now compliance.
• Respected and Unique Conferences: The DMEC Annual Conference has become an industry standard; the DMEC Compliance Conference is the only one offering practical tools and training; and, the Behavioral Risk Conference, offered a first of its kind education and has now shifted into preconference workshop/sessions at the DMEC Annual Conference).
• Webinars: The Virtual Education Forum and Tools & Tactics series provide convenient, focused, and timely topics using a technology platform that is accessible to both members and nonmembers.
• Behavioral Risk & Disability Management: Introduction and recognition of the “whole person,” including identification of psychosocial factors, supported a new concept call behavioral risk; this concept launched several national conferences beginning in 1997, and now, ongoing conference sessions, articles, surveys, and tools to assist with the integration of behavioral aspects of claims and productivity management.
• Surveys: DMEC’s annual and biannual assessment of trends and challenges in leave management, behavioral risk, RTW, and compliance offer industry benchmarks.
• Publications: Industry standards were captured in the three volumes of disability management basics, Tools of the Trade, The Return to Work Manual, and Terms of Trade; the DMEC Bulletin, @Work Magazine, and timely white papers and think tanks offer best practices.
• Certified Professional in Disability Management (CPDM): CPDM was the first industry-recognized course of study leading to proven expertise in disability program management, case management, and RTW. Over 2,000 individuals have completed this course of study.
• Employer Advisory Committee (EAC): This well-respected and progressive group of employers serves to advise DMEC of employer needs and challenges.
• Executive Advisory Board (EAB): Made up of representatives of DMEC’s National sponsors, these thought leaders provide insight and strategic advice for programming and projects.
• Toolkits: Practical worksheets, check lists, and information provided as a member benefit give employers a starting point for their programs.
• Think Tanks: Workplace Warrior, Extreme Productivity, and Virtual Workplace were strategic and forward-thinking concepts explored with industry experts over two days and documented in white papers.
• Technology Applications: DMEC and its partners were the first to offer a disability certification (CPDM) through a virtual classroom format and offer an online webinar series (Virtual Education Forums) to the industry and members. DMEC was also one of the first to place an emphasis on data analysis and ROI in conference sessions.
• Responsive Certification Offerings: Keeping pace with member needs, DMEC launched the Certified Leave Management Specialist (CLMS) and the FMLA/ADA Training for Supervisors and Managers to its members and the industry.

Lessons Learned: The First 30 Years

It seems instructive to review how our early assumptions evolved or were discarded — what worked and what we outgrew. A number of these elements played out over many years, although some were apparent early on. Little things like name badges and the beautiful wood boxes that held them were visual aspects of our select group of professionals, but we grew in sophistication, and utilized technology that offered better solutions. We had to be adept at changing with the times and always look for a “better solutions”. The following stand out as the most significant and best sum up some lessons learned:

• Not a Flash in the Pan – Disability, absence, and productivity management were not concepts with a short shelf life as many had thought, but an enduring, expanding, and ever-changing discipline. In the 1990s no one had any idea that compliance would dominate the industry and help determine the next version of integration
• Brick and Mortar Is Old School – As mentioned earlier, we didn’t have the luxury of establishing a permanent physical office location. Luckily, based on technology changes, we could operate virtually with a little creativity. Except for a few challenges like forwarding mail and physically storing records, we quickly learned that offering a job as a virtual worker afforded our employees the flexibility to live where they wanted, avoid commuting, save time, and if needed, be available for personal or family needs. It assisted in developing a loyal, hard-working, and productive workforce located throughout the U.S.
• Consistent Economic Advantage – Initially we thought that our concepts would only be viable in a recessionary environment where cost-saving was the driver. We learned in the next prosperous economic cycle that good times provided a need for our training and information. Keeping employees productive and happy at work, as well as getting people back to work early, meant that employers could engage and keep talent in a tight market.
• Full Integration Model Proves Impractical – While we had thought that full integration (as above in the case of Southern California Edison) would be ideal, it quickly became evident that a more incremental and gradual approach worked best. The implementation process often takes years, and requires the efforts of multiple thought leaders in a company, before it is successful. We had to be patient — slow and steady leads to success.
• Legislative Influence Is Not Our Bailiwick – Disappointed with the imperfect legislative process during our early years, we learned that we could be more effective by developing a bottom-up, corporate approach. Providing the tools, education, and resources for employers, we would be much more effective at inducing change. While current CEO Terri Rhodes has testified in the last few years at U.S. Senate hearings on topics related to disability, we devote the majority of our time to the practical and pressing issues of employers.
• Mental Health Stigma Remains – Psychosocial issues impacting absence and productivity were seen as targets for a truly unified program — integrating the physical and behavioral. While DMEC offered tactics and solutions in the mid-1990s, the acceptance of this discipline is limited, and the stigma remains entrenched. The World Health Organization (WHO) has projected that 12 billion workdays will be lost to depression and anxiety disorders by 2030.2 Clearly, this is a call to action to make strides to eliminate this problem!
• Chapters Are So 1990s – Early on we made a strong push for chapters in every metropolitan area of the U.S. Those were the days of frequent luncheon meetings, employer-supported participation in associations, and fewer traffic issues. Fast forward to the 21^st century, and our members no longer have the luxury of getting their education at the lunch hour. In 2018 we closed our last chapter, and the final curtain on the chapter network concept. It has been replaced with more technology-based applications for quicker, and timely delivery. Multiple-day conferences still serve the important purpose of face-to-face networking and information sharing.
• Elusive RTW – For those of us in the industry for 30 years, it serves as a point of frustration that RTW has not become universal, in spite of the ADA and the ADAAA and the plethora of research that underscores the fact that work is restorative and essential to well-being and self-worth. Considered a fundamental cornerstone of what we do, RTW will continue to be an integral part of our curricula and focus.
• Making It Personal – From the very beginning, offering a welcoming approach to any meeting was part of the DMEC brand. Recognizing members as colleagues and friends instilled an ongoing environment of friendly inclusiveness, or as some have said, “like a class reunion” that keeps members returning year after year. This has separated us from other competing associations and conferences.

A Word About the DMEC Hug

A word about a signature aspect of DMEC — the DMEC hug. As mentioned above, DMEC has prided itself from the very beginning as being an organization that is warm and welcoming. Hugging (after an initial handshake introduction) has been a normal part of the sincere greeting that we considered part of our brand. Big smiles and cheerful hellos were a normal gesture when you registered for a meeting or conference. Solidarity in thought and an underlying “caring” feeling are common traits of many DMEC members. Fast forward to this era of the #MeToo movement where society has rightfully questioned some inappropriate human interactions. How does the DMEC hug fit into that environment? In thinking about this going forward, we certainly have to be considerate and thoughtful, but I suspect most members would agree, the DMEC hug is a symbol of who we are as a community of caring and giving individuals. Respect has always been key. I hope in the future that offering a sign of sincere human warmth — a hug — does not need to fade away. 

Projecting DMEC Forward: The Next Phase in Our Evolution

As I see it, the next era of DMEC expansion will be affected by four aspects of the environment in which we operate: place, people, practice, and purpose. Based on our past accomplishments, confidence in exponential projected growth, and continued demand for what we do, here’s what I see developing down the road.

Place

First, we are now at a unique point in the industry where we are an internationally-recognized trade association with a proven record of almost 30 years. Members and the industry have come to respect and depend on the educational programs and strategic thinking that we have developed.

Secondly, our place in history makes this a pivotal time with the continuing need and focus on compliance (practical application) and disability education. In an article in the May 2017 issue of Business Insurance, it was noted that integrated disability has made a comeback — “a new wave of momentum around the concept of integrated disability management.”3 Given the “500 different federal, state, and municipal rules governing job absence in the United States,” coupled with “more than 70 bills introduced in January 2019,” Bryon Bass, Sr. VP of Sedgwick clearly pointed out that this creates some significant “compliance challenges for employers.”4 DMEC is the organization that responds to these needs and provides the practical tools and resources required to stay in compliance.

Finally, in terms of growth pattern, DMEC is just gaining momentum, and that will hopefully continue exponentially in the next few years. In the last five years alone, the number of new DMEC members per year has increased by nearly 200%, and total membership is up by 90%. Internal projections put corporate membership at 4,000 and combined conference attendance at 2,000 by 2029.

People

The leadership team at DMEC is moving from a founder basis to a more normalized association environment. We are fortunate to have a strong leadership team that will propel us to the next phase, led by CEO Terri Rhodes. Terri understands DMEC inside and out, having served as Chapter President (Portland 1997), Executive Director (2003-2006), and National Board member (2013-present). As I step out of the Board Chairperson role I’ve held since 2013, Kevin Curry, Senior Revenue Officer at ReedGroup, will be taking over. With his strong knowledge and respect in the industry, Kevin is a seasoned professional who will help strategically guide the organization in the next few years. Strongly supporting him is the thought leadership of the other board members: Debby Kweller, Michael Crowe, Kimberly Mashburn, Robin Nichols, and Terri Rhodes. And finally, the influential backbone of the Executive Advisory Board (EAB) and Employer Advisory Council (EAC), Board Governance Committee, and highly qualified staff. This team will lead the charge with all the attributes for success — proven experience, passionate dedication, and sophisticated, strategic, and innovative thinking — all pivotal attributes for future growth

The next generation also plays a significant role in the future trajectory of our industry. As needs and expectations change, the viability of the organization will depend on fresh ideas, inputs of energy, and a focus on the succession planning of DMEC membership and the industry.

Serving the needs of our members and being responsive to their role in developing and implementing disability and absence programs for corporations is central to our “people power.” These professionals are charged with keeping employees productive and at work. Development of ongoing programs to meet those needs, as well as offering strategic advice on their “next steps” in developing a more fully integrated program and “whole person” approaches, will be required. People have always been, and will always be, our “core focus.”

Practice and Products

Fulfilling the needs of the industry and employers with practical solutions, products, and benefits has always been the goal. Underlying this has been primarily the model of integration of all programs that touch disability. This continues to be a challenge as full integration has been elusive. But underlying this broad interpretation is the concept of cooperation, collaboration, and a broad view of the absence event. Being responsive and keeping our members aware of new ideas and a vision for what is ideal will continue. This includes behavioral/mental health concepts; interpreting legal and legislative changes for integration which is ever changing; networking (in person and virtual); timely education (in person, online, and credentialed); and programs not yet conceived to ensure continued growth and prominence.

Purpose

Finally, a word about what propels most professionals in this field. Aside from obvious compliance, profitability, and bottom-line requirements, there has always been an unspoken caring attitude, a sense of “helping”, and a shared passion that unites most in this industry. It is probably this that I am most proud of — being associated with a large body of professionals who put purpose above self-interest.

A Final Message to Practitioners

What does this all mean for you as a practitioner as you grow your career? Those learnings that helped develop DMEC can also help you personally as a successful professional and leader.

• Passion: Build on your passion and follow your dream. You will not only attain your goals but will have the self-satisfaction of knowing you helped others too.
• Collaborate: Share knowledge, help others, and surround yourself with like-minded colleagues. We can all accomplish so much more if we do it together. This is a path to breaking down corporate silos and expanding influence.
• Differentiate: Take risks, think outside of the box, and be creative. It challenges your mind and can often result in innovative solutions.
• Scope: Take a “whole person” view by considering both the physical and underlying behavioral/mental health. While this applies to all generations, a new wake-up call is on the horizon. Consider the “The Aging Millennial” article in the July/August 2019 Workforce Management issue which shared findings that indicate life stresses are not being helped by wellness programs. Instead, “a growing number…(have) more health problems than previous generations.”5 More alarming is the fact that “more than half of top 10 medical conditions are psychological.” DMEC’s ongoing educational programs provide models that incorporate behavioral risk and management concepts into every IDAM program.
• Analyze: Build on what you’ve learned, analyze mistakes, and incorporate best practices. Collect data, add predictive modeling, and build on your success. Get consultative help if you need it.
• Celebrate: Don’t forget to celebrate what you’ve accomplished and cheer on your employees who have returned to work. We are all winners in this process!
• Volunteer: Reach out and participate in DMEC and other community programs; encourage others to join or attend DMEC programs. You will gain friends and access to valuable information.
• Be thoughtful: Make eye contact, smile, be open to change, and assist others who may be struggling with their programs. And if appropriate, hug your neighbor!

It has been a wild ride! Thanks to everyone who has helped DMEC on this amazing journey. As I look to the future, I do so with great anticipation and trust that it will continue to expand on an even greater trajectory. The solid foundation that Sharon Kaleta and I built, with the help of Joe Wozniak and others too many to mention, is just the start. The enduring DMEC core values, expanding and diverse membership, and loyal and generous sponsors will secure the future. Lead by strong leaders like our CEO Terri Rhodes and incoming Board Chairman Kevin Curry, along with our Board of Directors, EAB, EAC, and staff will ensure an expansion into the 22^nd century. I pass the baton on to you and your successors. The future belongs to you and new generations. Make the best of it — make it yours!