Medical Marijuana and the Workers Compensation Conundrum – Part 1

Because the U.S. Federal Government has dug-in its feet, leaving marijuana as an illegal, Schedule I drug under the Controlled Substances Act, state governments have been left to individually pave their own legalization paths, leaving a frustrated public in the wake. Employers, employees, doctors, workers comp case managers, and more feel frustratingly in-the-dark as ever-diversified, continually evolving legislation continues to change the landscape. This is the first post of our two part series of spotlighting medical marijuana in the marketplace.

What We Do Know About Medical Marijuana

Though state laws vary widely on the amount of legal possession and personal cultivation for medical use, to-date 29 states and D.C. have legalized marijuana for medical use, including 8 states who’ve legalized its use recreationally. For medicinal purposes, marijuana has been scientifically confirmed effective for pain relief, appetite stimulation, nausea control, and reducing ocular pressure. It is arguably cheaper and less addictive than opioids, however both research and quality control are lacking. For injured workers and those in the workers’ comp industry, its most-likely application is pain relief, however it’s typically not be the first drug in the treatment lineup for prescribing physicians.

What’s Murky About Medical Marijuana and Workers' Compensation

Marijuana dispensing differs from run-of-the-mill pharmaceuticals, with product obtained from dispensaries or home growth, not pharmacies, leading to a gap in patient information on potentially dangerous drug interactions. Patient protections also remain muddy. Still illegal under federal law, stateside court rulings are chaotic. Fifteen states offer little to no employee protection, while 11 states explicitly provide protections from retaliatory actions to limits on drug testing from employers. Furthermore, all states with medical marijuana have pending legislation and litigation that could have a broad impact on the workplace, creating a landscape reminiscent of the Wild West.

Who’s Paying For Medical Marijuana Prescriptions?

Who knows? Medical marijuana’s Schedule I status prohibits its inclusion in the National Drug Code, leaving Medicaid and Medicare patients on the sidelines. This lack of regulation also equates to a dearth of coding, complicating processing for pharmacy benefits managers. And state-by-state case law for prescription coverage from employer-sponsored coverage to workers’ comp, like employee protection legislation, also varies widely.

Who’s Got a Headache?

Employers. Though there is federal protection backing drug-free workplace policies, including “zero-tolerance” for specific jobs such as heavy equipment operators, pilots, and surgeons, ever-changing legislation makes it difficult for employers to figure out which end is up. In the meantime, knowledge of state-specific legislation remains key to compliance, with an attitude of managing medical marijuana like any other powerful legal prescription drug that could impair mental capacity a logical choice: Accommodate the needs of injured workers – but uphold a safe work environment, as always. ANS Solutions Medical Cost Containment Programs are the only end to end pharmaceutical cost containment programs in the industry that genuinely put the patient first, while minimizing the cost of settlement in large loss workers’ comp claims. 

About the Author:  Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

Original content posted on http://ans-solutions.com/medical-marijuana-and-the-workers-compensation-conundrum-part-1/

Are Primary Care Physicians Leaving Opioid Deaths to Chance?

A recently released study from the Journal of Addiction Medicine has uncovered an alarming trend. Patients with opioid addiction, also referred to as opioid use disorder (OUD), experience an alarmingly high death rate – one 10 times higher than those not suffering opioid addiction. Not surprisingly, the study has raised some tough questions about the existing treatment infrastructure, and the system’s failure to identify and aid such at-risk individuals.
The Sobering StatsUsing electronic health records from a major university healthcare system from more than 2,500 patients ranging in age from 18 to 64, all identified as having an OUD, 465 deaths were observed during the eight-year period studied, 2006-2014. Drug overdose and disorder was the leading cause of death (19.8%), with deceased patients commonly experiencing other substance abuse disorders (tobacco, alcohol, cannabis, cocaine). Other causes included cardiovascular disease (17.4%), cancer (16.8%) and infectious disease (13.5%, of which 12% had hepatitis C). Alcohol abuse and hepatitis C were identified as primary markers. Compared to the general population, the deceased were more likely to be male (41.7% vs 31.6%), uninsured (87.1% vs 51.3%), and older at the time of initial OUD diagnosis (48.4 vs 39.8 years).
Unintended EffectsThough health care reforms (Federal Mental Health Parity, Addiction Equity Act, and the Affordable Care Act) were intended to lead to an expansion of services for substance abuse disorders in primary care, shifting them from previously isolated treatment centers, there appears to be a significant portion of the population slipping through the cracks. This suggests multiple issues within the current healthcare delivery system in identifying and addressing patients battling addiction:

• Ignorance of the true risks of opioid abuse and corresponding treatments.
• A lack of timely and sufficient screening for identifying patients with addiction.
• Identification of addiction issues too late to provide appropriate/effective interventions.
• A lack of addiction specialists on-site, as well a as a lack of outside resources for treatment.

The healthcare industry must find a better way to identify and treat patients suffering substance abuse disorders – before they pay the ultimate price. Clinicians in the primary healthcare setting could be a driving force – provided they receive proper training and assistance. For the worker, an effective pharmacotherapy review program ensures that recommended prescription treatment plans are necessary and appropriate and can help eliminate the potential for addiction.
This was originally posted on http://ans-solutions.com/are-primary-care-physicians-leaving-opioid-deaths-to-chance/

The Position of Workers Compensation in 2017

With the election of a new president who is ushering in a new era for the government, the trickle-down effect to the workers’ compensation industry just might sweep you off your feet. Prepare yourself with the industry knowledge you need, and avoid being overtaken by the tsunami…

The 2017 Workers’ Compensation Industry Issues to Watch:

• The Affordable Care Act (ACA)
  Like a rogue wave, changes to the ACA may pop-up with little notice. These changes will influence the industry, including claims frequency, claims shifting, and cost shifting if/when private insurance is lost by injured workers, potentially shifting the industry back into the role of “medical insurance for the uninsured.” Preparing for engagement and rapid response to proposed legislation will remain integral as ACA changes are ironed-out in the coming year.
• Nationwide Physician Shortages
  America is projected to be short an estimated 12,000 to 31,000 primary care physicians by 2025, according to the Association of American Medical Colleges. Surgeons are also expected to be in short supply. Though effects will vary based on geographic location, coupled with population growth, the aging Baby Boom population, Affordable Care Act instability, and the nationwide opioid crisis, this single phenomena could converge in a myriad of issues within the workers comp industry.
• Changes to the Workforce
  As the economic current in the U.S. changes, the manufacturing industry may re-emerge, detracting from what is currently a service-based economy. The mobile workforce will also continue to evolve, such as remote and telecommuting positions. Workforce changes aren’t simply labor-related, however, the aging American workforce across the country will also play a large role.
• Prescription Drug Abuse
  The overuse and abuse of prescriptions drugs, particularly opioids, continues to be a turbulent issue in the industry, driving workers’ comp costs and leaving opposing forces facing-off at a line in the sand. As federal and state lawmakers continue to bandage this issue across the medical industry, claims management teams and attorneys will need to move forward in addressing this issue in claims, monitoring prescriptions, recommending “drug contracts,” and better engaging with physicians regarding the risks of abuse, where permitted. On the flipside of the drug abuse coin, the consequences of injured workers medical marijuana scripts influencing on-the-job risks will continue to be a sticky wicket.
• Profit & Loss Scenarios
  Though the workers’ comp industry saw their first underwriting profits in 2013, the trend is not expected to continue. Falling rates and increasing exposures, particularly over the long term, point to a negative outlook overall, with combined ratios of 100% projected for the coming year. Medical providers still continue to increase reimbursement rates to offset costs from lackluster Medicare and Medicaid payments, and medical and pharmaceutical advancements increase the risk of loss. Maintaining proper reserves, conducting timely settlement reviews, and utilizing appropriate resources over the course of the year will be key.

Make Progress in Managing Risks & Costs

No matter how fast the tide rushes in, ground yourself in facing this year’s obstacles with positive change, putting yourself in the best position to avoid being washed out in the chaos. With the transparent, mutually beneficial workers compensation cost containment services of ANS Solutions and our medical cost containment strategies, you can support both financial savings and positive outcomes, with a program that actively engages workers compensation patients with a positive experience, gaining unmatched results via true, face-to-face interactions between all involved parties for a complete team approach to care. Ride the wave of the future, contact http://www.ans-solutions.com today.

Sources:

http://www.wci360.com/news/article/how-to-fix-the-primary-care-physician-shortage

http://www.beckershospitalreview.com/hospital-physician-relationships/15-things-to-know-about-the-physician-shortage.html

Original content posted on http://ans-solutions.com/the-position-of-workers-compensation-in-2017/

Naloxone (Narcan): What Workers Comp Payers Need to Know

Though it has been on the market since 1971, this year is expected to be a landmark year in Naloxone (Narcan) sales nationwide, and this trend is expected to continue due not only to the opioid epidemic sweeping the nation, but the fact that opioids still remain the most frequently prescribed category of medication used in workers’ comp pain management.

Preventing Death from Opioid Overdose

In its hallmark form, Naloxone was approved for injection by the FDA in 1971. An opioid agonist, it was used in hospital and emergency settings to temporarily reverse the dangerous effects of overdose, including sedation, low blood pressure, and potentially fatal respiratory depression. However new outpatient options have recently entered the market, putting this potentially life-saving drug in the hands of the general public.

• Evzio (2014)
  The first FDA-approved naloxone auto-injector available in the U.S., this small, portable device, similar in nature to an Epi-pen, can be used by patients or family members in the event of overdose. (Holds a significantly higher average wholesale price than Narcan and traditional injectables.)
• Narcan (2016)
  A single-dose, ready-to-use nasal spray that requires the patient to be lying on their back for proper administration.

Not a Magic Bullet
Reversing the effects of opioids at the receptor site and blocking further binding, naloxone takes effect in 3 minutes, wearing off in about 30-to-90 minutes depending on the opioid taken. Though it reverses the clinical and toxic effects of overdose, it only displaces opioids for a short time.

Access Expanding
Despite its short-term effects, legislative and regulatory reforms are making naloxone increasingly available nationwide as states struggle to combat the opioid epidemic. Anesthesiologists, PMR physicians, physician assistants, nurse practitioners and pain management specialists are writing the majority of prescriptions for patients undergoing opioid treatment therapies. Civil liability protection has been expanded for First Responders employing its use. Some states have even made naloxone available for sale as an over-the-counter medication.

Turn the Tide
Due to opioid over-prescription and abuse in our country, Naloxone is unfortunately a necessary medication. However, at ANS Solutions, we believe the best way to prevent opioid overdose is by circumnavigating its use with the patient-doctor education and equally effective, scientifically-proven alternative medical treatments that protect the outcome of injured workers, and reduce unnecessary opioid treatments and associated costs. With our medical cost containment strategies, safe, efficacious cost-effective care is possible. Discover more at http://www.ans-solutions.com today.

Sources: http://helioscomp.com/docs/default-source/continuing-education-2016/072816-optum-naloxone-use-in-wc-ce_final.pdf 

Original content posted on http://ans-solutions.com/naloxone-narcan-what-workers-comp-payers-need-to-know/

Effective Pharma Management Can Help Offset Increases in Prescription Costs

2015 saw rising drug prices contributing to the growth in pharmacy spending for American workers’ compensation payers. Meanwhile, opioid and compound drug cost management continues to be an Achilles heel. An effective pharma cost management program can offset these costs by aiming to improve pain treatment regimens for injured workers.

Pharmacotherapy Review Can Reduce Opioid Spend

Opioids continue to be the costliest class of medications for occupational injuries. To combat the rise in opioid utilization in chronic pain treatment of injured workers, ANS introduced a face-to-face and highly proactive approach to addressing pain physician prescribing practices.  Known as Pharmacotherapy review, it starts with an extensive review of the injured workers’ medical history along with their existing pain treatment regimen and historical physician treatment practices. An ANS Legal Nurse expert with intimate case familiarity visits the doctor in person at their office and negotiates an evidence supported pharmacy regime in a face-to-face and collaborative interaction. The treatment recommendations agreed to during this process not only contribute to reduced opioid prescriptions but often enhance the quality of care and life for injured workers with more risk averse and often more appropriate treatment alternatives.

Combating Rising Compounded Medication Costs

In 2015, the average cost for payers of compounded medications per prescription hovered around $2,000. The cost is high and so are the risks to patients:

• Compounded drugs are not federally regulated and product quality assessments are lacking unlike their FDA-approved counterparts.
• Compounded drugs are not clinically evaluated for safety or efficacy.
• Compounded preparations do not have standard product labeling or prescribing information with instructions for safe use.
• Compounding pharmacies are not required to report adverse events to the FDA
• Potential errors in the preparation of compounded drugs can and have caused adverse effects on patients.

Due to the unnecessary risks compounded drugs pose to patients these products are not considered first-line therapies in the treatment of injured workers. ANS Solutions leads the way in providing medical cost containment strategies that help our clients ensure that pain treatment therapies are appropriate, safe and economically responsibly. By managing compounded medications, clients can reduce unnecessary costs and mitigate the potential harmful effects to patient safety caused by pain physician prescribing habits.

Optimized Financial and Patient Outcomes

ANS medical cost containment programs work uniquely to address these and other legal issues that ensure the most rapid and cost reduced settlement of claims in the industry. Our proven strategies are so effective we offer a 1 million dollar pilot program performance guarantee, completely risk free.  To learn more contact us today or visit www.ans-solutions.com.

 

This content was originally published at http://ans-solutions.com/effective-pharma-management-can-help-offset-increases-in-prescription-costs/

Medical Cost Containment Does Not Mean Compromised Care

The existing way that the workers’ compensation industry handles large loss claims has been contributing to diminished quality in care for injured workers, increased costs associated with treatments, and poorly coordinated care. Care delivery within workers’ compensation programs is arguably even more inefficient than in general healthcare but it does NOT have to be this way. Payers can have the best of both worlds with medical cost containment strategies that provide quantifiable outcomes that positively impact the patient’s health while also driving down associated treatment costs.

How does Medical Cost Containment Improve the Quality of Care for Injured Workers?

Interventions with prescribers can be instrumental in improving the quality of life and treatment for patients. ANS PharmaIntervention is designed to help treating physicians detect and correct underlying problems, promote functional improvement and reduce narcotic usage. Our legal nurse experts conduct comprehensive reviews of a patient’s medical history often uncovering risk factors and other considerations that can be overlooked by treating physicians. They are then able to collaborate with treating physicians to improve the current treatment plan based on actionable, evidence based recommendations. The benefits to the injured worker include but are not limited to:

• Reduced risk for prescription opioid painkiller addiction.
• A modified treatment program based on recovery.
• A modified treatment program based on the availability of alternative treatments and therapies that may be more effective, and have fewer side effects.

All of which contributes to measurable improvements in quality of care and life for the injured worker- even increasing the likelihood of returning to work sooner.

How Does Medical Cost Containment Positively Impact Your Bottom Line?

Ensuring injured workers receive the right care at the right time from treating physicians, minimizes the financial impact of catastrophic injuries. The goal of ANS PharmIntervention is to improve quality of care by applying expert clinical knowledge and experience to recommend, where appropriate, alternative treatments and therapies. The financial benefits of the ANS PharmIntervention strategy stem from its ability to aid treating physicians in:

• Improving opioid painkiller practices.
• Avoiding unnecessary or inappropriate pharmaceutical and medical treatments.
• Avoiding duplicate therapies in the event of multiple treating physicians.

When done correctly, medical cost containment ensures that patients receive the highest quality of care balanced with the necessary cost controls.

Care without Compromise

ANS Legal Nurse Consultants provide comprehensive reviews of large loss claims while delivering optimized financial results and quality of care for injured workers. To learn more about our medical cost containment strategies visit our website at www.ans-solutions.com.
This content was originally published at: http://ans-solutions.com/medical-cost-containment-does-not-mean-compromised-care/#sthash.iSdyqFjt.dpuf

The Human Side of Medical Cost Management

When we talk about the costly nature of large loss Workers’ Comp claims, it is sometimes hard to think beyond the financial impact.  Further to this point, when medical cost containment strategies are discussed they are often geared toward addressing the clinical and pharmaceutical treatment programs for injured workers from a financial perspective. What about the less tangible side of medical cost containment-the human costs which are equally as significant and damaging?

Addressing Human Costs in Medical Cost Containment

When we talk about the human cost of large loss claims, we are really talking about the effect a case has on the quality of life for an injured worker and their family. While all medical cost containment strategies focus on financial cost drivers, not all strategies address human costs. There are many drivers that can contribute to compromising an injured worker’s quality of life. These human cost drivers include, but are not limited to:

·         Pain treatment through highly addictive opioids, coupled with a lack of patient education on the risks and dangers of these drugs, subjects injured workers to a path of drug addiction which may hinder or prevent their recovery.

·         Lack of appropriate physician monitoring and/or patient compliance to a prescribed medical treatment regimen can contribute to a longer recovery period.

·         Lack of monitoring patient’s treatment program and progress results in missing the warning signs of drug abuse and addiction, missed opportunities to modify a treatment program based on patient’s recovery, lost opportunities to modify treatment based on the availability of alternative treatments and therapies that may be more effective, and have fewer side effects.

·         Lack of coordination between multiple treating physicians can attribute to greater increase for drug abuse or unnecessary or inappropriate pharmaceutical and medical treatments.

ANS Cost Containment Strategies

The ANS PharmacotherpyReview Program is the most advanced and results-oriented cost containment strategy in the industry. At the first of three stages, we assess the existing treatment program using evidence based reviews to assess medical necessity. We also identify duplicate therapies, excessive dosages and alternate medication regimens. Our experts then make actionable treatment modification recommendations that ensure optimal outcomes for the patient. This includes consolidating and coordinating drug therapies between multiple prescribers.  In the second stage, our nurse experts work with treating physicians to obtain commitment on a modified future course of treatment. For a positive therapeutic outcome, we move to stage three where an ANS Clinical Liaison Officer proactively manages each case to ensure physician and patient compliance with the revised course of treatment.

ANS Solutions

Our approach to cost containment was uniquely developed to simultaneously ensure a medically appropriate and cost effective treatment program and enhanced quality of life and care for the injured worker. For more information on our industry leading cost containment strategies visit us at www.ans-solutions.com. 

This content was originally published at www.ans-solutions.com.

 

About ANS Solutions

The ANSwer to Medical Cost Containment

ANS Solutions is one of the fastest growing health care cost management companies in the USA. Over the course of a decade, we have designed and honed a series of medical cost containment strategies that are truly unique in the industry.Our expertise includes the entire suite of Workers’ Compensation Medical Cost Containment Services designed to help our customers lower claim costs, improve loss rations, reduce risk and exposure, and dramatically improve the quality of care for injured employees. Our clients include some of the nation’s leading insurance carriers, Fortune 1000 self-insured companies, and the largest third party administrators in the United States. ANS is also one of the few Medical Cost Containment providers able to successfully perform pharma reviews and interventions with clients operating in ex-parte states.

A Better Drug Utilization Review 

ANS is an innovator in the field of Drug Utilization Review and implements a 360 degree approach to pharma review and intervention that we call our Pharmacotherapy Review. Because we have highly credentialed and experienced professionals on the ground in all 50 states, the analysis and intervention we do with doctors, lawyers and other claim stakeholders is highly effective.  Our face to face approach has set a new standard in our industry, a standard so high that we are able to offer our 1 Million Dollar Pilot Program Guarantee on case savings.  

The Road To Settlement  

ANS Pharma Cost Containment, Medical Cost Projection, and Legal Nursing Services programs enable ANS to achieve optimal outcomes for both workers and insurer’s alike.  To learn more about how ANS can help you navigate complex Workers Compensation Medical Cost Containment visit our website today.