Comorbidities Compound Workers Comp Costs & Recovery

Underlying Conditions Complicate Workers’ Comp Injury Rehabilitation

New research from a Harbor Health Systems study demonstrates the significant impact of underlying conditions on workers’ comp claims. Commonly associated with higher costs and increased duration, this latest research illustrates an undeniable link between patients with comorbidities and undesirable claims outcomes.

A Problematic Pile-Up

Analyzing data from more than 7,000 workers’ comp claims, encompassing seven common comorbidities: Obesity, hypertension, diabetes, mental health, addiction, tobacco use, and combination comorbidities, claims associated with comorbid conditions were found to have incurred an array of undesirable side effects…

• Higher medical costs
  • Multiple comorbidities increased total costs a whopping 341%
• Longer claims duration
  • 76% increase with multiple comorbidities
  • 67% increase with addiction
  • 55% increase with obesity
• More temporary total disability days (TTD)
  • Significantly higher overall in all groups
  • 285% higher with multiple comorbidities
  • 274% higher with addiction
• Increased surgery rates
  • Up 123% with multiple comorbidities
  • Up 140% with obesity
• Increased litigation
  • 147% higher with multiple comorbidities
  • 224% higher with addiction
  • 248% with mental health-related claims

Overall Outlook

While tobacco use had little effect on claims, multiple comorbidities and obesity had the greatest impact on overall, followed by addiction, mental health, and hypertension. Relationships between comorbidities were also found further complicate health and financial risks, with worker age throwing yet another wrench in the works.

Changing Direction

Given these research findings, it is obvious a more comprehensive, systemic approach to workers’ comp claim management is essential to improving treatment results, from a more thorough intake data analysis and the management of multiple health issues addressed by numerous providers and prescriptions, to identifying and finding alternative treatments to those that could result in narcotics abuse.

Quality Matters

Minimizing these risks and providing optimal outcomes for injured workers while controlling workers’ comp costs is no easy feat, and requires a tried and true strategy. ANS Cost Containment Programs work uniquely to address these issues with the only true face-to-face, end-to-end pharmaceutical cost containment program in the industry that genuinely puts patients first while minimizing claims costs through personalized relationships and in-depth case knowledge and review.

Rapid treatment progress and reduced claims costs are possible. Achieve maximum all-around results. Discover how with http://www.ans-solutions.com today.

 

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Is Regulation the Answer to Rising Pharma Costs?

National pressure has been building for government regulation on pharmaceutical costs.  A recent poll from the Kaiser Family Foundation found that 72% of Americans think drug costs are unreasonable and demand more transparency from drug companies, especially when it comes to how they set prices.(1) In the face of this discourse, the accountability of pharmaceutical companies has grown as a key focus of recent state and federal regulations.

In the state of Vermont, expensive prescriptions drugs distributed by manufacturers must now justify their exorbitant costs, according to a newly introduced state bill. This new approach, dubbed ‘transparency bills’ stipulates that the information provided by drug makers will be made public, and if they fail to submit, fining will result. It further requires that health insurers provide information to enrollees, potential enrollees, and providers regarding the exchange plans’ drug formularies, including covered drugs, cost-sharing prices, drug tiers, prior authorization, step therapy and utilization management requirements, whose facets are rarely known and understood. Similar measures have also been introduced in other states including California, New York, North Carolina, Oregon, Pennsylvania, Texas, and Virginia.

A debate has been brewing around whether regulation is truly the best solution for pharmaceutical cost containment. Opposing views are camped around the significance of immediate verse long-term effects. Those in opposition raise concerns that such regulation will only produce modest consumer savings while the reduction in pharmaceutical revenues will slow the pace of innovation thus reducing life expectancy and the release of new drugs for future generations. Proponents believe that the benefit of lower prices experienced by consumers now far outweighs these concerns. Influenced by this growing debate, researchers at RAND Corporation examined the impact of drug price regulation in the US. Key findings include(2):

• The regulation of pharmaceutical prices has increased in recent years on a global scale
• Regulation has been seen to reduce pharmaceutical revenues.
• Alternative approaches that reduce consumer costs without affecting pharmaceutical revenues are more likely to benefit current and future generations of consumers.

Ans Solutions specializes in pharmaceutical cost containment that optimizes outcomes for the injured worker while also minimizing financial impact for payers.

Sources

• http://kff.org/health-costs/poll-finding/kaiser-health-tracking-poll-august-2015/
• http://www.rand.org/pubs/research_briefs/RB9412.html

Original content posted on http://ans-solutions.com/is-regulation-the-answer-to-rising-pharma-costs/

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/

What Role does the Doctor-Patient Relationship Play in the Opioid Epidemic?

According to the DEA, sales of prescription painkillers in the United States have quadrupled since 1999. If that isn’t enough to raise eyebrows, consider the following: almost twice as many people abuse prescription drugs as the number of people abusing cocaine, heroin, hallucinogens and inhalants combined. And if that’s that enough, the U.S. Center for Disease Control and Prevention has stated that prescription drug overdose death rates in the United States have more than tripled since 1990 and have never been higher. These statistics have raised serious concerns, triggering efforts to build competency around opioid prescription practices in the treatment of chronic pain.

The Doctor-Patient Relationship

The doctor-patient relationship must extend beyond merely establishing a treatment program. It should be treated as an intersection between education, treatment, intervention, and compliance that is formative in controlling the opioid epidemic. The dialogue between doctor and patient can help to uncover additional risk factors, warning signs, and complications that could hinder an injured worker’s recovery or put them at risk for addiction or death. Engaging in open conversation with patients regarding their medical history and other current treating physicians (if more than one) opens the door to more informed treatment practices. For instance, this practice would be instrumental in identifying a patient whose clinical picture is more consistent with addiction. In which case, the treating physician would be prompted to utilize a non-opioid treatment plan that may also be far more cost effective. Further, it is through this relationship that patients can receive the necessary education on the risks and dangers of their prescribed opioid pain treatment plan thus promoting adherence to prescription guidelines.

ANS Pharmacotherapy Review

In our pharmacotherapy review program we take a highly comprehensive and multidisciplinary approach to the evaluation and treatment of injured workers. Through our advanced techniques our experts are able to uncover opportunities for modifications that can improve patient efficacy. Our proven results not only improve the quality of care and life for the patient but also reduce associated medical costs.

For more information on ANS drug utilization review through pharmacotherapy contact us today or visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/what-role-does-the-doctor-patient-relationship-play-in-the-opioid-epidemic/

High Risk Patient Profiles & Opioid Abuse

Predictive models in our industry show that specific risk factors correlate to the potential for long term opioid use -most notably, patients that smoke and/or have a history of substance abuse.   With increased opioid prescribing linked to trends of misuse and abuse and opioid related overdoses contributing to more deaths annually than vehicular crashes, it begs the question, are risk factors truly being taken into account with the treatment of chronic pain?

Improving Opioid Painkiller Practices

Physicians considering opioid therapy for an injured worker with chronic pain should use a structured approach. There should be a comprehensive evaluation for the cause of pain, assessment for risk of opioid abuse or addiction, detailed treatment history including a review of medical records and routine assessment for safety and effectiveness of the opioid therapy program once in place. A dedicated focus on the patient will allow treating physicians to:

• Get ahead of the warning signs of drug abuse and addiction.
• Modify a treatment program based on patient’s recovery.
• Modify treatment based on the availability of alternative treatments and therapies that may be more effective, and have fewer side effects.
• Avoid unnecessary or inappropriate pharmaceutical and medical treatments in the event there are multiple treating physicians in the picture.

Risks should be acknowledged openly and managed, whenever possible, before prescribing opioids. When continuous opioid therapy for as little as two weeks can produce drug tolerance in some patients, the bottom line is, we need to start thinking more about the injured worker.

ANS Drug Utilization Review

Interventions with prescribers can be instrumental in not only preventing long term opioid use but also improving the quality of life and treatment for patients while also driving down medical costs. At ANS, our approach to drug utilization review includes an extensive review of a patient’s medical history allowing our experts to pinpoint risk factors and other considerations that are all too often overlooked by other medical cost management programs in the industry.

For more information about our medical cost containment strategies contact us today or visit www.ans-solutions.com.

This content was originally posted at http://ans-solutions.com/high-risk-patient-profiles-opioid-abuse/

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.

 

The Financial Repercussions of MSAs on Large Loss Claims

Medicare recommends an allocation of funds in a Workers’ Compensation settlement that is set aside to ensure that the injured party’s qualified medical expenses are funded, also known as Medicare Set Aside. These funds must be used to pay for treatment related to the Workers’ Compensation injury, that would otherwise be paid for by Medicare. The financial repercussions of MSAs on settlements can be significant.

Part D Exposure

As part of the Medicare Modernization act of 2003, Medicare indoctrinated what is known as Part D prescription drug coverage beginning in 2006. In other words, an allocation must be made for future prescription drug treatment in a Medicare Set-Aside. Rising pharmacy costs, including medications an injured worker may have been prescribed once in the previous 2 years, along with treatment, has created an environment in which Payers are subject to unreasonably high claim settlements.  The “Prescription Affliction” suffered by Payers is lovingly referred to as Part D exposure and it leads to claims staying open longer or not settling at all. As a result, these claims rack up millions of dollars in cost for Workers’ Compensation Payers.

Reducing Medicare Set Aside and Part D Exposure

A proactive approach is necessary before settlement and preferably early in the process for optimal results. At ANS, we mitigate Medicare Part D exposure with a three pronged approach:

• PharmReview – during this stage, the injured worker’s existing pharmaceutical regimen is assessed and modification recommendations are determined.
• PharmIntervention – a face-to-face discussion with the treating physician to achieve consensus on a modified medication regimen and commitment on a future course of treatment.
• PharmCompliance- an ANS Clinical Liaison Officer ensures compliance with the new prescription treatment plan. This provides a proactive management of the case to optimize hard cost savings.

Only highly credentialed legal nurse experts who are experienced in the treatment of catastrophic injuries, such as those employed by ANS, can provide actionable recommendations based on the individual patient and engage effectively with treating physicians. This technique yields a clear medical action plan that drives down costs while simultaneously improving the quality of care for the injured worker, allowing for reasonable settlement of the claim.

ANS’s pharmaceutical cost containment technique has reduced pharma costs by up to 25%. To find out more about reducing MSA and Part D exposure, contact us today.

This post was originally published at http://ans-solutions.com/.