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big-dataThis week, I spoke at The Center for Excellence track as part of the 2015 Workers’ Compensation and Education Conference in Orlando, FL. The responses from attendees reconfirmed how much people are seeking to understand how big data and predictive analytics can play a role in their organizations.

One overwhelming theme emerged from those in my session. Big data must be used to build and sustain personalized healthcare and productivity models.

As you might imagine, there was a lot of information covered and for those unable to attend I want to share some of my thoughts on this topic. So here are some key things you need to know.

Big data, actionable data, predictive data…the industry is abuzz with discussions about the importance of data.  However, data, even organized data, provides no value in business until it is paired with purposeful action. Industry systems and practices have evolved to give business leaders unprecedented access to information. One of our biggest opportunities to revolutionize our injury management solutions is to use big data to develop and sustain models that personalize the injured worker’s healthcare experience and provide guidance to all stakeholders on how to use this information to affect change. The overall concept is to turn big data into results!

I want to share some important areas in which data can be used to build models that will individualize healthcare management strategies.

You have identified the factors that lead to large loss development.  Now what?

Match treatment intervention solutions and injury management team skill sets to injuries and circumstances that will benefit from those solutions and provide training and guidance to this team on how best to improve the outcome for each injured worker. A multi-disciplinary team consisting of claims adjusters, nurse case managers, behavioral health specialists, vocational rehabilitation specialists, pharmacists and physicians should be interconnected through systems and practices.

Triggers derived through predictive modeling must get specific injury situations into the hands of the team members whose skills will provide the best and speediest remedy. Seamless transitions across the injury management team and exchanges of information must be automated. For example, psychosocial and co-morbidity information systematically captured and stored is included in a trigger that can engage a behavioral health specialist or provide the examiner or nurse with the information needed to tap into the most effective strategies to improve outcomes. Strategic prescription drug safety solutions are deployed by systematically connecting prescriber, dosage and drug duration information across dispensers, networks and claims administrators. A vocational rehabilitation specialist may be deployed for a claim without continuing medical issues in which return to work has not yet been achieved.

You have scored providers through analysis of medical cost or wholesale claims outcomes. What do you do with the information?

Measure the injured employee population receiving treatment with the providers whose scores reflect their affiliation with the best recovery and return to work outcomes. Look at the outcomes at a state level, customer and office level so that claims adjusters, case managers and other stakeholders in care direction can be notified of improvement needs.

Be sure that provider performance measures include important claims management components such as lower rates of litigation, faster return to work and lower expense area claims cost. Our experience shows that factors such as faster return to work, less opioid prescriptions and fewer litigated claims are some of the best value areas affiliated with providers with proven good outcomes.

Make sure the provider information is valid. Be sure system flags or symbols identify providers with recently validated information. Sending an injured worker to the incorrect address of a good provider is a terrible outcome wrought from good intentions. Make sure that the claims adjusters and nurse case managers using your provider search tools are accessing valid and verified provider information.

Please watch for future posts as we share more information on big data and predictive analytics. If these points raise more questions than answers, please leave a comment here or visit www.sedgwick.com to learn more about what Sedgwick is doing in this space.

George Furlong, SVP Managed Care Program Outcomes Analysis
Managed Care Management | Sedgwick

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CMandel2-180pxOn Tuesday, August 25, 2015, from 9:50 – 11:00 am Sedgwick will present one important aspect of next level claim strategies in “New Thinking in Risk Management: Leveraging Program Integration and Cross-functional Collaboration for Better Results.” This session will draw on some of the strategies outlined in an IRMI article by the same name and published last month at www.irmi.com, in the “claim management” online column. I hope you’ll read the entire column, but in the meantime, if you’ll be at the Workers’ Compensation Institute annual conference in Orlando (8/22/15-8/26/15) I hope you’ll find time to come by and join the conversation I’ll be leading along with Mark Denesevich, Verizon, Director, Risk Management and Cathy Gannon, Sr. Manager WC at Eaton Corporation, both of whom are leading voices in the movement to align and integrate occupational and non-occupational exposure management. Here’s a peek at the content we’ll be presenting and discussing.

One important next level opportunity is from a long-minimized and largely untapped synergy between casualty claims (risk management) and the benefits world. Some argue that these worlds are just too different and distinct to bring together, whether through simple alignment or partial to full integration. Managers are often more comfortable in their own functional areas and sometimes crossing over can stretch expertise and focus. Fundamentally, however, claims are claims though subject to the unique rules of processing and resolution, many of which are dictated by third parties as well as statutes and regulations. This may be one reason that workers’ compensation “option” programs exist today in only two states – Texas (for more than 100 years) and Oklahoma (since February 2014). For the record, Tennessee and South Carolina have also introduced their version of “option” legislation, which could become law as early as 2016.

Risk and benefit managers debate the use and value of integrated vs. “siloed” services and strategies. Integrating claims administration, medical bill review, preferred provider networks and case management can benefit claims management via maximum customization and savings. However, there’s been a shift in thinking and growing interest in a more collaborative, aligned and even fully integrated services approach, one which takes many forms, but at its core incorporates a more integrated and collaborative strategy from date of incident through claim closure. The targeted goals for this approach are:

  1. Ensuring an appropriate employee experience throughout the life of the claim
  2. Targeting and delivering outcome optimization
  3. Minimizing the Cost of Risk associated with the reasons employees are under medical care
    and/or unable to contribute productively to their employer’s mission

This session will spell out readily obtainable, practical and real-world benefits of an integrated “one system” services program which, if properly executed and leveraged, can achieve the goals noted above. An integrated services program strategy and approach can lead to sharper outcome focus and faster resolutions, while better meeting employee- and employer-specific needs. To help you see the possibilities in your own organization, you’ll hear from risk, claim and benefit leaders from two prominent national employers whose programs are already delivering the goods. They demonstrate how collaborating more closely confers greater benefits both tangible and intangible, along with the tools, processes, methods and tactics that have led to demonstrable results. Here’s more on our session content.

Shared goals

On its face, the value of collaboration seems obvious. From both an employee benefits and risk management perspective, providing care for the individual is of the utmost importance. One of the main objectives is ensuring the right outcome. Essentially, this opportunity can be defined as leveraging the basic skill sets of investigation, verification, documentation and equitable resolution that are common between these two realms. The nuances and distinctions that exist between them are not insignificant, but the key goals are the same: caring for people under medically-related distress (regardless of source), minimizing disruptions to workforce productivity and closing claims efficiently and effectively with fairness to all parties and their respective goals and objectives. The key components of process effectiveness in both worlds include rapid, accurate reporting; timely, complete investigations; compassionate and equitable treatment of employees; verification of facts; compliance with laws and statutes; efficient and effective resolutions and robust cost control tactics.

Although these components have varying levels of impact in each field, they are fundamental to process effectiveness in both. This is not to say that there aren’t peculiar and unique aspects of each that require certain expertise and skills to achieve more specific end goals. However, while blending skill requirements among a common group of claims professionals can be challenging, it is not rocket science. Defining and filling positions to enable successful claims handling in both worlds is imminently doable. The biggest hurdle may in fact be the necessary extent of collaboration among and between these typically distinct functional areas and their leaders in order to secure the best outcomes for injured employees.

Motivations and hurdles

So what should motivate the pursuit of such an opportunity? Well, make no mistake that the cost of claims, especially when you combine casualty and benefit claim expenses, can be the biggest portion of the budget in both risk management and benefit departments. Clearly, companies can’t afford to ignore the size of these direct expenses, which often represent more than 2% of gross revenues.1 Arguably, depending on your industry and the size of your company, employee injury and medical costs are the largest component of employee-related expenses, with the obvious exception of compensation. Since most corporate leaders consider claims expenses material and controllable, it seems logical to look more closely at how they can be specifically controlled. An initial question would be: How do we get key functional leaders to care more about the truly significant leverage possible in managing employee injury and health exposures more collaboratively? A core answer is: By working toward enterprise priorities, not just personal or departmental priorities.

In addition to the medical expenses related to claims, there is the cost of lost productivity from employees not available to perform their jobs, in whole or in part. It’s been noted that this “indirect” cost component of injuries and disease represents, by some estimates, 4 times2 the “direct” costs that often get the most attention. Translating that into more meaningful dollars, you get 8 cents per revenue dollar on each claim dollar expensed. When you look closely at the possible costs involved, a total absence management (TAM) view seems as though it should be a natural priority.

Many employers are already effectively managing employee injury and disease exposures. There are discernable trends emerging toward fewer silos, and more performance-oriented measurement focused on short- and long-term strategies. Those companies taking a more collaborative approach can benefit from key elements such as:

  • Integrated reporting across departments
  • Integrated measurement across departments
  • Robust analytics that result in prescriptive actions with impact
  • Innovative tools targeted to specific process opportunity areas
  • A more holistic focus on the care of affected employees
  • The over-arching goal of a healthy, productive workforce

More opportunities

Looking more broadly at the evolving strategies around new and best practices in claims handling, other opportunities are emerging that are worthy of further investigation and understanding including:

  • Compassionate care – While the traditional casualty claims handling process has been focused on timely reporting, cost control and closure time, an important part of the next-level paradigm emphasizes compassionate care at the forefront for people who are injured and ill, without losing sight of other goals. This new focus makes sense when you consider the potential benefits of improved communication and understanding of the individual’s needs, which can reduce the possibility of litigation.
  • Enhanced communications – This includes changing the way that claimant communication is delivered and ensuring this happens in a consistent, meaningful way. This begins with the insurer/employer and the claims service provider/mechanism used at the center of the resolution process. Critical to this paradigm shift is the adoption of a clear and unambiguous understanding of and communication around the strategies and priorities that would underpin a claimant-focused approach. Once the strategies and priorities are set, however, success is entirely in the execution; in other words, the players doing what they say they will with a dedicated focus on established goals.
  • Proactive approach – With the emergence of enterprise and strategic risk management strategies, we are seeing significant benefits from an integrated claims management approach. As documented in the 2014 RIMS Executive Report: Claims Reporting and Management Practices, “well-run claims programs contribute to decisions which influence whether: 1) the entity is in compliance with regulatory and insurance program coverage mandates; 2) injured parties are treated respectfully and responded to in a timely fashion; 3) property will be restored as quickly as possible and 4) the entity’s reputation can be damaged or improved through its loss responses.”3 I think this list captures the key outcomes to which many aspire.

So join Mark, Cathy and I as we dive deep on this new thinking and opportunity for getting to the next level in claim management. See you in Orlando!

Chris Mandel, SVP, Strategic Solutions
Sedgwick

1 Advisen/RIMS Benchmark Surveys (conducted annually)
2 Unrecognized Costs of Risk, RiskInfo.com
3 RIMS Executive Report: Claims Reporting and Management Practices, 2014

 

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3D-drugsLast week, the Food and Drug Administration (FDA) made an extremely unique drug approval that was the first of its kind. In fact, it was one of the most revolutionary drug-related approvals seen in years. The FDA approved the first 3D printed drug, Spritam (levetiracetam), which is used to treat certain types of seizures. Just imagine: pills manufactured directly from a 3D printer. Based on a technology first developed by Massachusetts Institute of Technology (MIT) in 1997, Aprecia Pharmaceuticals’ 3D drug printing technology allows the company to manufacture tablets that can be easily absorbed orally and therefore would be indicated in patients who have issues swallowing.

I first heard of the potential with this technological innovation from a TED talk given by Lee Cronin, a chemist from the University of Glasgow.  Cronin, along with other chemists and pharmaceutical companies across the globe, envision 3D printing as the future for drug manufacturing and I think there is reason to support such a claim. While the innovation is still in the infant stage of development, it does not take long to imagine the possibilities that Cronin outlined in his talk will likely be within our reach in the near future.

While the FDA will have much to say about any new potential for manufacturing, 3D drug printers could be the way forward in allowing for patient-specific care. Currently, if I need a prescription for antibiotics, my physician would select the right drug for the infection and prescribe one of a few strengths manufactured today. However, 3D drug printing technology could allow for specific drugs and strengths based on my weight, genetics, age, etc. That is, if 3D drug printers find their way from pharmaceutical companies to physicians’ offices or pharmacies, the ways to customize medications based on patient-specific needs would be endless.

And of course, the more concerning option comes to mind pretty quickly when thinking through all the potential scenarios. Imagine if individuals could somehow obtain their own 3D drug printers. Resourced with a 3D drug printer, the right software and “chemical inks,” they could potentially find ways to manufacturer their own controlled substances like opioids or benzodiazepines. Or maybe even worse, it leaves the potential for individuals to have the ability to develop brand new, never-studied drug molecules that could lead to unknown adverse events and consequences.

As technology advances and provides greater opportunities for patient-specific care, industry leaders need to be watchful for advancements that could lead to potential problems. While cutting-edge solutions like 3D printing could provide amazing care and savings, they also have the potential to create new health safety risks if technology advances faster than regulation.

Dr. Paul Peak
Director Clinical Pharmacy, Complex Pharmacy Management
Sedgwick

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WCI-The-Center-for-Excellence-graphicI am very excited about our Center for Excellence session, “Evolving Healthcare Models and Workers’ Compensation Opportunities” on August 26th at the Workers’ Compensation and Education Conference. We have a great panel that will share how digital health and evolving healthcare delivery models have the potential to significantly enhance workers’ compensation access to care, address quality care opportunities and reduce health and productivity costs.

I encourage you to read the guest blog below by Dr. Sri Mummaneni, M.D., M.P.H., FACOEM, Chief Health Officer for OPUS Telehealth, and watch my interview with Dr. Mummaneni on this topic.

Most importantly I encourage you to attend WCEC 2015 and the entire Center for Excellence sessions. If you have questions you can reach me on Twitter @kimberlyanngeo. See you next week.

Kimberly George, SVP, Corporate Development, M&A, and Healthcare
Sedgwick

One of the reasons I became a physician is because I was able to understand complex scientific issues and teach them to others. As a doctor, I relay complex medical issues to patients so they may have the tools to take better care of themselves. Unfortunately, in our current system, there is a disconnect between the healthcare delivered and the health care received. Patients are disconnected from doctors, and the medical community is disenfranchised from patients due to faults in the system. This fragmented environment altered the course of my career from a physician connecting with individual patients to a physician who finds ways to help doctors and patients reconnect. Digital technology allows me to make that farther reaching connection.

On behalf of OPUS Telehealth, I am looking forward to participating in “The Center for Excellence – The Study of Medical Cost Drivers in Workers’ Compensation.” Sponsored by Sedgwick at the 2015 Workers’ Compensation and Education Conference next week in Orlando, Florida.

Today, patients are looking to become more in charge of their own healthcare.
It should come as no surprise that a high degree of patient engagement improves patient outcomes while simultaneously enhancing patient satisfaction and reducing the overall cost of care to payors.
Today, technology drives this patient engagement.
Traditionally, doctors only have patients’ attention for a few minutes during office visits, and usually while the patient is sick or injured. With the growth of digital health, doctors and patients interact more frequently and efficiently, with technology acting as the vital conduit between patients and their support systems.

A new era has arrived

Telemedicine provides a conduit for all healthcare providers and patients to engage via remote face-to-face visits. In a workers’ compensation case, a patient may have as many as 2 to 4 times the number of doctor visits as a patient being treated for the same condition in group health.

Reasons for these increased visits notwithstanding, the multiple follow-up visits can now be done remotely through a patient’s mobile phone or tablet. This dramatically cuts down on patients’ travel time, and decreases the workload for the physician’s office staff. In addition, having better access to a physician may reduce the number of excess follow-up visits and provide those visits at a lower cost. Remote visits also have the added benefit of lower missed appointments rates because the device is always with the patient.

Remote patient monitoring (RPM) allows physicians to monitor patients’ vitals including blood pressure, blood sugar, pain levels, weight and more. Doctors and nurses monitor these metrics along with patients’ answers to health surveys, using both automated and manual processes, and the way patients respond to their technology determines what education patients receive.

For example in a workers’ compensation case, a nurse may see a negative trend in the patient’s pain, activities of daily living or work performance, and suggest exercises or other therapy to bring the injured worker back on the path to recovery.

How valuable is this regular monitoring? A study in JMCM demonstrated that RPM decreased a diabetic’s HgA1C, a measure of blood sugar over time, by 1.8%. In comparison, a good medication for diabetes will reduce HgA1C by 1%. When healthcare provides better results than medication at a fraction of the cost, providing that care is a no-brainer.

Four areas of caution:

1. The technology needs to fit into clinical models and workflow, or it risks pushback from treating physicians.

2. Telemedicine and RPM also have to fit into the daily routines of patients and their families.

3. The technology provides a tsunami of raw data that must be properly interpreted. Physicians and technology platform providers need to collaborate and ensure the best hardware is deployed (because hardware is designed to collect specific types of data), while simultaneously being mindful of the software used to filter that data, converting it into actionable information that can drive on-the-fly decisions.

4. Arguably, the most important area is that this vast repository of personalized data needs to be secured. Not just password protected (which generally constitutes HIPAA compliance), but truly secure. Imagine locking a precious item inside a safe and sending the safe, with the key attached to it, via messenger to your doctor. Anyone that sees the safe while it’s in transit can use the key to open the safe. That’s basically what we do every time we send an “encrypted” message over the internet.

At OPUS Telehealth, we take the security of patient data very seriously. HIPAA compliance isn’t enough when we’re talking about handling the most precious information anyone has. That’s why OPUS Telehealth set up its own proprietary wireless network to secure the entire pipeline of data from a patient to a physician. This is the only way to truly ensure patient information isn’t compromised.

I look forward to discussing this exciting topic next week. Please be sure and attend the Center for Excellence sessions.

Dr. Sri Mummaneni, M.D., M.P.H., FACOEM
Chief Health Officer for OPUS Telehealth

sri photo

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DI-blog-graphic-equalsizeAt Sedgwick, we see the value of diversity and inclusion every day in many of our common business practices. Putting these concepts into action enhances our customer service capabilities, expands our business strategies, attracts a wider pool of qualified job candidates, and positions us to identify the next generation of leadership.

Today’s workforce is becoming increasingly diverse and includes individuals from four separate generations and various racial and ethnic backgrounds, as well as those with other defining characteristics and experiences. By acknowledging and understanding these differences, we can better recognize the unique, defining traits that make our customers who they are and facilitate the best possible outcomes for their injured workers. This is program customization at its most meaningful.

To accomplish these objectives, we must be willing to explore new sources of industry talent and develop policies and practices that consider how different backgrounds and experiences bring value to our core business. A good starting point is engaging and listening to the diverse talent within our own organization already.

Responding to our clients

The Spanish-speaking population recently became the majority in the state of California. It stands to reason that our client populations mirror this trend. Significantly, Hispanics suffer a proportionately higher incidence of severe industrial injuries. The combination of accident severity and ineffective communication creates the perfect storm that leads to a long and costly claim experience. Integrating cultural competency into claims management best practices is not only the right thing to do; it’s an industry necessity.

Increasingly, customers require bilingual claims examiners, and we at Sedgwick have redoubled our efforts to incorporate bilingual talent into our claim units. Currently more than 20 percent of our examiners in California are bilingual. Our ability to communicate in a native language is a critical tool for gaining the trust of injured employees for whom English is a second language. Additionally, it is just as important that we understand how differences in culture and values affect perceptions and play a vital role in claim resolution. Removing language-related and cultural barriers reduces friction in the system.

Drawing on their skills, our bilingual colleagues have helped us improve our client service. Working with our internal development team at Sedgwick University, we produced “cheat sheets” to help colleagues who are not bilingual translate technical terms into Spanish. We are also working to introduce our bilingual capability to our clients’ employee populations early in the process–before claims are filed–so those for whom English is a second language are reassured that, should they experience an injury, they have advocates on their side and alternatives to litigation.

Growing a diverse team

The availability and retention of talent is a continuing challenge for the claims industry. To meet this challenge, support growth, and provide our customers with continuity of service, Sedgwick offers training and development through our Industry Advancement Program (IAP). The program provides accelerated training for college graduates and qualified internal colleagues to prepare them for careers as claim representatives at Sedgwick. The IAP, just one of the many educational programs developed by Sedgwick University, is conducted in three phases over a four-month period. It starts with orientation, job shadowing opportunities, webinars and self-paced learning, followed by two or three weeks of “Claims College” at one of Sedgwick’s educational centers in California. During the final phase, trainees continue learning through a combination of assignments and handling caseloads under the guidance of experienced mentors and supervisors. This course of study aims to introduce graduates to the breadth of opportunities available to them. The intensive training allows new professionals to begin their careers with a firm foundation, which, in turn, helps them build long-term careers in the industry.

As one might expect, these programs serve to introduce the industry to a new generation of claims professionals, many of whom are millennials. Understanding the needs of this population has led us to modify our programs to reflect career development opportunities more in line with their expectations. From our experience, these individuals are looking for employment that is not only opportunity-rich, but also meaningful in purpose. The early integration of cultural competency and diversity and inclusion strategies into our curriculum is particularly appealing to millennials and an important building block in their development.

Most importantly, the IAP encourages us to explore new and different sources of talent that reflect the rich diversity in our communities. These talent pools may include ethnic diversity, along with various other attributes and life experiences. Military veterans, for example, offer excellent employment skills and characteristics that match up well within our job requirements.

Developing leaders

In addition to developing sources for emerging talent, the need to identify future leaders is critical to the success of our company and our industry. Effective succession planning shares many common objectives with the core values of diversity and inclusion. By definition, the process is inclusive: inviting colleagues with new ideas, innovative perspectives and diverse experiences to drive the growth and vitality of our company. It also helps our leaders empower others through delegation. Entrusting responsibility to others is critical to our colleagues’ growth as individuals and to our collective organizational growth now and in the future.

Business reputations flourish when companies demonstrate their commitment to diversity through inclusive internal practices reflecting a “care of people” philosophy and aggressively recruiting a wide range of talent externally. Additionally, customer satisfaction improves because barriers to effective communication are removed. The real payoff is an increased level of loyalty and commitment from colleagues who develop a sense of pride in being a part of the organization that values their individuality.

Jay Ayala
Managing Director
Sedgwick

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opioid-managementIt is possible that 2015 will be the year remembered as the turning point in addressing the opioid and narcotic epidemic in the United Sates. This year, almost every conference, publication and industry expert has addressed the topic. Just last month, Jim Harvey of Sedgwick blogged about this pressing societal issue: Opioid medications: Gateways to heroin use? Yet even with all the information available, it is still difficult to know where to start being proactive and creating appropriate intervention approaches.

At Sedgwick, our commitment to good healthcare stewardship goes beyond the day-to-day responsibilities involved in ensuring injured employees recover and return to work. Our partnership and ongoing collaboration with providers is invaluable in aiding our goal to provide personalized, quality healthcare for every injured employee. Sedgwick was the first third party administrator (TPA) to host forums for medical providers focused on technical efficiencies, treatment, productivity and patient satisfaction trends, and future enhancements. We ask leaders in the medical treatment community how we can work better together to improve treatments and outcomes for patients.

We have hosted meetings for medical directors in California for the past four years and we are looking forward to hosting our first event in Orlando on August 23. This meeting is the first of its kind in Florida and it will take place during the 2015 Workers’ Compensation Educational Conference.

The rich depth of our client base puts us in the unique position of having a vast amount of accurate, actionable and outcomes-based data, organized in a manner to help providers identify trends more efficiently. Recently, a University of Kentucky study on opioid addiction and narcotics revealed that only 26% of healthcare providers felt they had adequate training or knowledge to recognize, manage and prevent prescription drug misuse. To respond to these concerns and to address current trends, we plan to share what Sedgwick is doing to help manage misuse and discuss the signs our pharmacists see. Most importantly, this meeting is geared to collaboratively identify data and resources that medical directors and healthcare providers need the most.

These meetings allow us to work together to change the future of workers’ compensation by discussing solutions that can improve the overall quality of care for injured and ill employees, while supporting the efforts of the medical community.

We encourage medical directors to attend this event and look forward to exchanging ideas. Click to register by August 19; space is limited to only 40 qualified participants. Please send us your questions or thoughts in the comments section.

Tracey Radford, RN, MBA, ARM, CPDM, VP Managed Care Client Services

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The 2015 Workers’ Compensation Educational Conference (WCEC) is just three weeks away. This year thousands of people will come together in Orlando from August 23 – 26 to learn and exchange ideas about challenges facing our industry and opportunities to serve clients and injured workers.

WCI-The-Center-for-Excellence-graphicI am pleased that this year Sedgwick is sponsoring a new segment within the conference entitled The Center for Excellence – The Study of Medical Cost Drivers in Workers’ Compensation.

There will be six great sessions featuring many well-known industry experts. Steve Rissman and the rest of his team at WCI have done a great job again this year providing an outstanding conference line up.

At Sedgwick, we believe it is vital to look for new topics and unique perspectives that push the envelope and provide an even more meaningful learning experience. With the newly formed Center for Excellence, we are excited to provide a series of sessions that take a deep-dive into areas of greatest concern for attendees.  Our goal is to impart a level of thought-leadership that will provide attendees with unique perspectives, exceptional ideas and collaborative tools to handle the complex challenges they are facing in their daily work. Listed below are the six sessions that will be covered.

  1. Big data: Analytics and trends
  2. Advancements in management of catastrophic Injuries
  3. Managing prescription drugs and powerful narcotics
  4. Affordable Care Act: A workers’ compensation status update
  5. Quality care movement
  6. Evolving health care models and workers’ and compensation opportunities

I encourage you to attend the WCEC conference and The Center for Excellence sessions in particular. Watch the video below to hear more about my session on the Affordable Care Act. Richard Victor, Executive Director of the WCRI will join me in this session.

I look forward to seeing you in Orlando and especially in The Center for Excellence sessions sponsored by Sedgwick on Tuesday, August 25 and Wednesday, August 26.

 

Dave North, President & CEO of Sedgwick

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WCI-The-Center-for-Excellence-graphicI am looking forward to the 2015 Workers’ Compensation Educational Conference in Orlando. I will be moderating The Center for Excellence – The Study of Medical Cost Drivers in Workers’ Compensation panel titled, “Managing prescription drugs and powerful narcotics.” We have some amazing panelists who are going to share their forward thinking approaches to early intervention and  effectively addressing claims with long-term exposure to narcotics. I want to encourage you to attend the Workers’ Compensation and Education Conference and especially The Center for Excellence track.

Let’s take a look at why this will be such an important session for you to attend. We have found in the course of managing the opioid problem with our workers’ compensation claimants, that many physicians are not open to changing or reducing the medications.  In considering the WHY, I have the following thoughts:

  • More than half of injured workers take opioids which have severe side effects. It has become the standard of care rather being reserved for the worst cases. Furthermore, rather than discontinuing the medications when there is a side effect, we see physicians give additional medications to treat the side effect. Dr. Melissa Broadman, SVP, Pharmacy and Utilization Review for Sedgwick talked to WorkCompWire recently about long-term opioid use. “ Melissa Broadman: Monitoring Prescriptions Can Reduce Costs, Boost Productivity – and Improve Lives
  • When it comes to managing pain, the subjective nature of the level of pain is what is used to determine the amount and frequency of the medication prescribed, instead of the mountain of well documented medical evidence.
  • Few physicians calculate or set thresholds as to the highest dose they will prescribe. Instead they let the patient dictate by their pain level.
  • The improvement of function while taking these medications needs to be well documented in order to assess whether they should continue. Many doctors are not even inquiring about the injured workers functionality.
  • These medications are very addictive. To manage a patient that has escalated beyond reasonable doses requires a great deal of skill and patience.  Frequently, physicians do not have the staff to answer the phone calls and reactions to any lowering of doses or weaning programs.
  • This issue becomes compounded when physicians realize they have caused the problem in the first place and just how complicated it is to fix
  • We are still operating in a fee for service environment in the workers’ compensation system and the bottom line is physicians want to keep their patients happy. Especially in employee choice state jurisdictions, the injured worker will find another physician to meet their needs.
  • Change and real patient management requires a willingness to be open and honest about practice patterns and to take a good long look at what is in the actual best interest of the patient to allow them to return to LIFE.
  • We need to find a way to stop the madness and treat injured workers with the highest quality care because they deserve it!

What are your thoughts on managing prescription drugs and powerful narcotics in the workers’ compensation system? Share your thoughts or questions here or reach me on Twitter @HealthyBart and I will be sure and ask our expert panel to address your questions. I look forward to seeing you in Orlando.

Dr. Teresa Bartlett, SVP Medical Quality

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WCI-The-Center-for-Excellence-graphicI think by now most would agree that “big data” is more of a catch phrase that encapsulates all things data, including interconnectivity of data repositories, trend analysis, benchmarking, predictive analytics and claim level interventions. Big data is a critical component of risk management and cost mitigation and many believe it is still in its infancy. This is why, as part of The Center for Excellence – The Study of Medical Cost Drivers in Workers’ Compensation track at the 2015 Workers’ Compensation Educational Conference in Orlando, I am moderating an all-star panel on big data.

“Thinking big data” is about ensuring your organization utilizes all information available to make meaningful business-related decisions and implement appropriate corrective interventions. While it doesn’t matter if the data is used for dashboarding, trending, benchmarking or predictive modeling, it does matter that the claim professional and nurse case managers understand the data and analysis behind the solutions being implemented and the intended consequence of their actions. Simply put, big data’s purpose is to link data – a lot of data – with action.

Health costs continue to rise and the proportion of claim costs associated with medical benefits continues to grow and outpace indemnity costs. The question that you must ask, and  what our panelists will share insight into, is how you can go from strategic to tactical, high to low, with data to translate corporate-level initiatives to drive desk-level solutions. Aligning trends with meaningful claims interventions can be one of the most vexing challenges faced by an organization.

I encourage you to watch the video below as I talk more in-depth about big data and analytics. Then leave your questions and comments or send them to me via Twitter @SPRogers68; I can share them with our panelists and provide the most insightful dialogue possible.

Most importantly, Sedgwick is pleased to sponsor The Center for Excellence – The Study of Medical Cost Drivers in Workers’ Compensation track and I encourage you to join us in person. If you have not registered please do so at wci360.com.

Scott Rogers, EVP of Casualty Operations

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According to the Centers for Disease Control and Prevention (CDC), 46 people in the U.S. die from an overdose of prescription painkillers every day.[1] Deaths from prescription painkiller overdoses have increased more than 400% among women and 265% among men since 1999.[2] These kinds of statistics have been published across media channels over the past year and have prompted legislative action or dialogue across the U.S.

Now the CDC has published a new study indicating kinship between overuse of drugs such as opioids and marijuana to an alarming increase in heroin use, particularly among demographic groups not linked to heroin use in the past. According to the study, posted in a CDC Vital Signs release on July 10, 2015, heroin use in the U.S. increased 63% from 2002 through 2013. One remarkable finding of the study is that heroin use, historically considered a fringe society drug, has increased among a broad range of demographics, including men and women, most age groups and all income levels – as is the case with opioid drug abuse.

CDC-graph-heroin-use-and-opioids

The report indicates that abusers of opioid pain killers are 40 times more likely to be heroin abusers, compared to cocaine abusers who were 15 times more likely to be heroin abusers. Also, 59% of the heroin-related overdose deaths in the U.S. involved at least one other drug. One of the primary conclusions of the study is that there is a very strong correlation between use and abuse of heroin and opioid pain relievers.

Dr. Teresa Bartlett, Senior Vice President, Medical Quality at Sedgwick, said that clinical programs must consistently identify cases in which drugs are not being taken as prescribed. Injured employees receiving opioid medications must be consistently monitored for compliance. Diversion of medications creates dangerous situations in which opioid pain relievers are provided to family members or individuals in the community for non-medical use.

Risk managers and safety managers should consider these trends and make sure their claims administrators are implementing the safeguards necessary to close this potential gateway by preventing prescription drug abuse. Prevention measures include:

  • Prescription drug point-of-sale intervention by a trained clinician, pharmacist or peer physician when a prescription drug does not correlate with the injury diagnosis or if it is a chronic pain stage drug being prescribed for an acute injury. Referrals and diagnosis-based formularies with the pharmacy benefit management network are necessary for consistent intervention.
  • Peer intervention for prescriber education and alternative treatment negotiation for claims in which drugs have been provided for long-term chronic pain.
  • Identification of cases where potential diversions are occurring through systematic and strategic deployment of drug compliance testing to ensure that injured employees are taking medications as prescribed. We strongly recommend you have a written best practices policy for urine drug screening.
  • Assistance for long-term chronic users of opioid pain relievers through transfer of care or referral to abuse treatment when necessary.
  • Involvement of a behavioral health specialist, who can engage with injured workers being weaned from long-term opioid use for chronic pain. The specialist can identify risk factors for turning to illicit drugs in addition to providing behavioral management tactics.
  • Use of a Prescription Drug Monitoring Program by healthcare providers to evaluate their patients’ prescription drug use.
  • Use of an Opioid Agreement with injured employees and their prescribers as a standard part of claims management and case management.

According to Eddy Canavan, VP, Workers’ Compensation Practice and Compliance for Sedgwick, it is unlikely that a heroin addiction could become a compensable extension of a workers’ compensation injury. However, this is an untested area and employers should review their claims administrator’s and pharmacy benefit management networks’ clinical drug intervention programs to mitigate risk and to protect the health and safety of their injured employees.

Some opioids and heroin share another common risk: exposure to HIV infection.  An HIV outbreak was recently documented in rural Indiana and linked to injectable Opana, an opioid made more potent when crushed, dissolved in water and injected. According to a New York Times update, nearly 150 cases of HIV were documented in rural Indiana as a result of users sharing needles to inject Opana.[3] Insurers and employers must be vigilant to know where the drugs they are buying for injured workers are going.

Safety and risk leaders should act now to make sure drug prevention and health safety practices in claims and case management are aligned to safeguard their injured employees from this alarming trend.

James Harvey, SVP, Managed Care Products & Product Development