What’s Trending with California Workers’ Compensation

Though workers’ comp claims frequency is declining, a recently released California hospital report indicates claim severity is on the rise. Obtaining data from 35 hospitals and individual facilities, the Milliman and Keenan Healthcare report sourced more than 3,500 claims for review.

Trends identified in the report:

• A decline in indemnity and medical-only claims, with ALAE costs playing an increasing role in overall claims costs in recent years. More specifically:
  • Higher average costs per indemnity for workers over 30.
  • Lesser average severity of indemnity claims in workers 30 and younger, with payments more likely to be incurred as age increases.
• Over the 10-year period ending in 2014, overall losses per $100 of payroll have remained flat. This cumulative effect is believed due to reform laws enacted during this time, as identified in the report:
  • 2005-2014: Severity per indemnity claim (indemnity, medical, and allocated loss adjustment) rises almost 5.5%.
  • 2003-2004: Drop in claim severity (reform laws enacted during this time).
  • 2003-2008: Indemnity claim frequency declines dramatically.
• Costs per indemnity claim for 2014 accidents has decreased approximately 10% from the previous year.
• Litigated claims showed a significantly higher average claim severity. They contributed to 20% of total claims with indemnity payment, and account for approximately 54% of total incurred losses.
• Cost projections for 2015: $2.20 loss cost per $100 of payroll.

A Balanced Approach to Medical Cost Containment

In California’s complex and ever-changing workers’ comp environment, informed decision-making is essential to safeguarding results. At ANS, we pride ourselves at staying at the forefront of (legal and technological) industry changes to ensure the best possible outcomes for both our clients and injured workers.ANS’s three-staged Pharmacotherapy Review Program ensures economically balanced and appropriate treatment options for injured workers. Our legal nurse experts excel at presenting actionable treatment modification recommendations in clear, written proposals for treating physicians, including recommendations such as:

• Consolidation and coordination of drug therapies between multiple prescribers.
• Consideration of alternate therapies.
• Specification of weaning programs for over-prescribed narcotics.
• Use of generics where applicable.

The end result? A cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. Discover more about this advanced and comprehensive treatment strategy. Contact http://www.ans-solutions.com today.

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Why ANS Pharmacotherapy Review is so Effective

The prescription pain medication crisis is taking its toll across the U.S. Costs are extreme, with a broad array of collateral damage fanning out from those effected to families and industries, among the hardest hit, workman’s comp. So extreme are the effects of addictive and deadly prescription opioids, even the Federal Government has taken notice, with the CDC stepping in to release new opioid prescribing best practices earlier this year in hopes of ushering in a new era for an ailing nation. The issue is out in the open. Are you missing out on the opportunity to protect patients and break the pharmaceutical cost cycle with a lackluster pharmaceutical intervention program?

Not all drug utilization review programs are created equal

Traditional pharmaceutical intervention programs often yield poor results. Why? Insufficient “drug evaluations” yield sub-optimal analyses, neglecting to account for patient and prescriber history, co-morbidities, and other important factors. Peer-to-peer, phone-based approaches questioning treatment efficacies have the tendency to put doctors on the defensive or induce feelings of frustration over micro-management. Non-binding, verbal commitments lead to repeated calls regarding the implementation of reduced treatment protocols, and ultimately future “call-dodging.” Settlement dates are then repeatedly pushed out, with poor clinical outcomes resulting.

ANS’s proprietary Pharmacotherapy Review

Pharmacotherapy review processes built on the foundation of the intelligent and intimate collaboration of all vested parties produces superior results. How does ANS’s Pharmacotherapy Review fix what’s broken in the typical pharma intervention system?

• In-depth, in-person collaborations. 
  In-office visits with legal nurse experts featuring evidence-based, patient-centered treatment plans presented in a non-threatening manner increase openness to alternative therapies.
• Clear guidelines.
  Written, signed, collaborative agreements are established within 4-5 weeks, complete with detailed drug utilization changes curtailing costly pharma regimes, keeping all parties accountable and on the same page.
• Patient-centered care.
  Physician-directed care with the interest of the injured patient in-mind, including expert consultation, thorough review of medical history and prescription data, and clinically-proven drug alternatives reduce Payer costs and improve patient quality of life, decreasing the potential for drug related issues such as drug interactions and overdose.
• Friendly follow-ups.
  Doctors work with a dedicated CLO (Clinical Liason Officer) until settlement. Repetition of visits with an established legal nurse builds better relationships, allowing for amiable quarterly follow-ups regarding compliance and treatment evaluations, ensuring proper dosing modifications or weaning of medications.
• Quantifiable impact (& performance guarantee).
  The hard work accomplished by ANS representatives and collaborating parties is seen in post-meeting reporting, showing enhanced clinical and patient outcomes as well as reduced pharmaceutical treatment costs. In fact, ANS proprietary Pharmacotherapy Review program boasts:
  • A success ratio of 94% of all case referrals.
  • Enhanced clinical/patient outcomes.
  • Acceleration of MSA settlements.
  • Average cost reductions of over 25%.
  • Loss ratio reductions from 1-2%.
  • Average first year savings of over $7,000.
  • Average life expectancy savings of greater than $250,000.
  • An average return on investment of 20 to 1.

Tired of using the same procedures and expecting a different outcome?
You won’t get extraordinary results with the average pharmaceutical intervention programs. Redefine success with the help of ANS Solutions Pharmacotherapy Review.

Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/why-ans-pharmacotherapy-review-is-so-effective/

Bipartisan Opioid Abuse Bill

In an effort to reverse the rapidly rising death toll from heroin, prescription drugs, and opioids across the U.S. which has recently risen to surpass automobile accidents as the leading cause of injury-related deaths according to the CDC, legislation has been drafted in a rare bipartisan effort.

The Comprehensive Addiction and Recovery Act (CARA)
Designed to strengthen prescription drug monitoring programs, better trace the diversion of opioid drugs, and increase promotion and access to addiction recovery services, CARA will also open up a variety of prevention and treatment avenues:

• Prevention and education efforts designed to prevent methamphetamine, opioid, and heroin abuse.
• Increased availability of Naloxone, an opioid overdose reversal agent, to first responders and law enforcement personnel.
• Disposal sites for unwanted prescriptions.
• Resources to identify and treat incarcerated individuals suffering opioid-related addiction disorders.

Well On Its Way
The bill has been approved by the House and the Senate, with both parties offering broad support. It is the first time in decades Congress has passed comprehensive addiction legislation, and the first time in history they’ve supported long-term addiction recovery. CARA is now on its way to the President’s desk, where it is expected to be signed into law. Mr. Obama has already requested $1.1 billion in funds toward the fight against opioid addiction.

Taking Action
Do you wish there was something you could do now to help in the fight against the nation’s continually rising opioid epidemic? You don’t have to wait on CARA to start making a difference. ANS Solutions proprietary Pharmacotherapy Review helps curtail costly and potentially dangerous pharmaceutical treatment regimens, ensuring optimal patient outcomes through expert knowledge and evidence-based, alternative treatment methods devised face-to-face with the help of treating doctors. Discover the difference an actionable drug utilization review can make. Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/bipartisan-opioid-abuse-bill/

Patient Engagement Encouraged through Prescription Drug Label Enhancements

Upcoming improvements to prescription drug labeling are hoped to positively affect patient care across the board. Intentionally kept in the dark on the ingredients and indications of prescription drugs for well-over 100 years, the healthcare industry is shifting from the past’s blind trust to finally realizing today’s modern paradigm: Engaging patients as active participants in their own healthcare endeavors.
Small Label, Big Impact
Improving the synchronization between in-office care and home care, the FDA’s latest labeling procedures will not only help patients under a physician’s care better understand why each medication is being prescribed, clearly listing indications on each prescription drug product’s label, but offer a vast array of opportunities for the betterment of treatment regimes, helping…
In the understanding of prescription regimens and scheduling.

• Verify each prescription is effective/providing benefits for its intended purpose.
• Reduce confusion following brief or rushed clinic encounters.
• Make the identification of drugs easier to allow for proper use/best practices.
• Reduce the incidence of over-prescription, duplicate or unnecessary medications.
• Keep not only patients, but caregivers, pharmacists, and other treating physicians in-the-know on conditions being treated and desired outcomes.
• Improve safety by reducing prescription or dispensing errors.

The Missing Link
This added information, “knowledge” (dubbed the “sixth” patient right in a recent publication of The New England Journal of Medicine), is bringing to light details which have previously fallen through the cracks in today’s modern world of typically rushed, commonly overcomplicated healthcare regimens. Information critical to the patient’s understanding of why a medication has been prescribed and for what conditions or purposes, allowing for a clearer assessment of efficacy for all involved parties.
Are You Living In The Dark?
At ANS Solutions, we also understand the benefits of synchronicity in patient care. The role this plays in in treatment progression, effectiveness, and quality of life from the treatment of routine health issues to return-to-work programs for injured workers is second-to-none. That’s why our industry standard pharmacotherapy review program focuses on face-to-face collaborative care, built upon the integrative collaboration of all effected parties, from the injured worker to our skilled nurse experts and treating physicians, allowing us to produce the very best outcomes in the business with the latest in clinically-proven treatment regimens.
Healthcare costs and injured workers ailing? Uncover a new era in workers’ comp treatment. Contact http://www.ans-solutions.com today.
Sources:

• http://www.painmedicinenews.com/Web-Only/Article/08-16/Adding-Medication-Purpose-to-Prescription-Drug-Labels-Improves-Patient-Safety/37249/ses=ogst

 Original content posted on http://ans-solutions.com/patient-engagement-encouraged-through-prescription-drug-label-enhancements/

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/

The Importance of a Multifaceted Approach to Medical Cost Containment

The biggest hurdle in workers’ compensation medical cost containment is that the injured worker is not getting better. Even though WC claims have steadily declined over the last decade, medical costs keep rising as do the sub-par outcomes for the patient and the payer. What we are seeing is that the inter-connectivity of many factors is hindering the end goal of optimized outcomes. A multidimensional approach is crucial not only for combatting pharma costs, but also for ensuring optimal outcomes for injured workers.
At the end of the day medical care cost containment is more than finding savings, it’s also about examining the big picture to help identify potential areas of exposure while enhancing the quality of care and life for the injured worker.
How is this achieved?  Each case has to be approached individually to develop a custom tailored strategy. It has to start with well-established face-to-face communication with the physician. Once the line of communication is open, actionable treatment recommendations backed by evidence based clinical data can be implemented.
The industry also needs to focus on protocols that will ensure better outcomes and appropriate treatment for injured workers. Compliance protocols will result in improved outcomes for all stakeholders.
While medical expenses are the most obvious cost driver, the full picture involves much more than the number of medical services and associated expenses. Quality medical care directly impacts the speed and likeliness of the injured worker’s return to work. ANS Solutions understands the true cost of these practices and has taken an innovative approach to medical cost containment strategies.
Offering an innovative plan to assist payers, ANS Solutions’ proprietary Pharmacotherapy Review offers the integral assistance needed to optimize claim outcomes:

• Expert review of cases by legal nurse experts, noting duplicate treatments and unnecessary/ineffective procedures.
• Actionable, evidence-based treatment recommendations discussed via face-to-face meetings with physicians.
• Ongoing compliance management with the help of clinical liason officers.

To learn more visit http://www.ans-solutions.com today!

 Original content posted on http://ans-solutions.com/the-importance-of-a-multifaceted-approach-to-medical-cost-containment/

Examining the Effects of Price-Focused Reform

Workers Compensation Research Institute (WCRI) recently conducted a series of studies aimed at examining the effects that federal and state regulations are having on the reduction of pharma spend. What the industry is seeing is an emerging trend in physician prescription reimbursement that begs the question, is price-focused reform effective?

One particular regulation, enacted to cap prices paid by tying the maximum reimbursement to average whole price (AWP) has left physicians in certain states dispensing new drug strengths and formulations at higher prices in efforts to compensate for lost revenue. AWP is set by the original drug manufacturer, however new strengths/formulations are seen as generic, not repackaged. This technical distinction allows the new “manufacturer” to set a new, much higher, AWP, sidestepping reforms. Highlighted in the report, Physician Dispensing of Higher-Priced New Drug Strengths and Formulation, the muscle relaxant cyclobenzaprine, one of several drugs prescribed in this manner, illustrates the effects of such dispensing practices (sales from the first quarter of 2014, post-reform):

• California
  • Typical 5-10mg dose: $0.38-0.39 per pill
  • New 7.5mg product: $3.01 per pill
  • Prescription increase (in same quarter): 55%
• Florida
  • Typical 5-10mg dose: $1.29-1.75 per pill
  • New 7.5mg product: $4.11 per pill
  • Prescription increase: 49%
• Illinois
  • Typical 5-10mg dose: $1.25-1.55 per pill
  • New 7.5mg product: $3.86 per pill
  • Prescription increase: 22%
• Tennessee
  • Typical 5-10mg dose: $1.08 per pill
  • New 7.5mg product: $3.97 per pill
  • Prescription increase: 19%

How can you reduce large loss claim outcomes in the face of these cost drivers?
This trend is driving up medical costs not just in the workers compensation industry, but in the healthcare industry as a whole. With our proprietary pharmacotherapy review, ANS is able to cut through the red tape and provide our clients with quantifiable results. The results achieved not only lower financial costs, but dramatically improve the quality of life and care for the injured worker.

Get on the road to settlement to day with ANS Solutions.

Original Content posted on http://ans-solutions.com/examining-the-effects-of-price-focused-reform.