Category: Research

Jun
27

Opioid reduction in work comp and the impact on patients and prescribers

Posted by Joe Paduda on Thursday, June 27th, 2024 | Comments

A just-published research study examined the impact of reductions in opioids on workers’ comp patients and prescribers in Ohio and Washington.

(our research which includes payers’ opioid spend is here)

Key takeaways:

  • Providers reported more limited and cautious prescribing than in the past
  • Both patients and providers reported collaborative pain-management relationships and satisfactory pain control for patients.
  • Despite the fears articulated by pharmaceutical companies and patient advocates, opioid review programs have not generally resulted in:
    • unmanaged pain or reduced function in patients,
    • anger or resistance from patients or providers, or
    • damage to patient–provider relationships or clinical autonomy.
  • Other insurance providers with broad physician networks may want to consider similar quality-improvement efforts to support safe opioid prescribing.

From Milbank Quarterly:

The data analyzed in this study were a subset of data collected within a larger parent project—a comparative effectiveness study of the WC agency ORPs [opioid reduction programs] implemented in WA and OH.

I’d note that some Ohio patients and providers surveyed had real and significant challenges with access to care, approvals and care management. The report noted:

The fact that some of the problems described above seem to be particularly acute in OH could be a result of the fact that most WC claims in OH are handled by MCOs, whereas in WA, claims are processed directly by the L&I. The uniquely negative experiences of patients and providers navigating injuries and pain management in OH could be because of MCO dynamics, such as staffing challenges, management issues, or other operational problems. In addition, some MCOs are for-profit companies, which may render them more likely to deny expensive medications, procedures, or consultations.

Note – I was a member of the Advisory Committee for this research project; it was funded by the Patient-Centered Outcomes Research Institute.

What does this mean for you?

Overall, efforts to reduce inappropriate opioid use have been:

  • effective,
  • helpful in getting patients and providers to collaborate, and
  • have not resulted in unmanaged pain. 
Jun
25

Solving pain – opioids, NSAIDs, and better options

Posted by Joe Paduda on Tuesday, June 25th, 2024 | Comments

WCRI’s latest report on drugs in workers’ comp has some excellent news...opioid usage dropped 29% from Q1 2021 to Q1 2023.

WCRI’s data is from 28 study states representing the vast majority of workers’ comp drug spend.

It may well be that NSAIDs are replacing opioids, a welcome event but not without potential downsides, namely side effects of some NSAIDs and far too much physician dispensing of these (mostly) very cheap drugs.

Fortunately other promising therapies – with very low risk – are also now available.

The FDA has authorized AppliedVR’s RelieVRx for treatment of chronic low back pain. RelieVRx’s authorization came after extensive research and massive clinical trials; the latest included over 1,000 participants.

The study was a large randomized controlled trial (RCT), evaluating virtual reality (VR) therapy for treating chronic low back pain (CLBP) at home.  Published in Mayo Clinic Proceedings: Digital Health, the study found AppliedVR’s RelieVRx program produced clinically meaningful improvements in clinically severe and diverse adults with CLBP.

What does this mean for you?

Much safer and quite effective treatment for chronic low back pain = lower risk and excellent outcomes.

AppliedVR is an HSA consulting client. And I’m damn proud to work with them.

Jun
20

Workers’ comp pharmacy – the latest

Posted by Joe Paduda on Thursday, June 20th, 2024 | Comments

We are finishing up our Annual Survey of Pharmacy Benefit Management in Workers’ Comp…here’s three findings from the 15+ we’ve done so far.

1) 60% of respondents are reporting an increase in overall drug spend – with reasons varying from more claims to an uptick in catastrophic cases to jurisdictional impacts.

While we’re a long way from done and more respondent data is coming in, if the trend continues this would be the second year of “non-decrease” in spend, signaling that the years-long drop in spend has stopped – and may have reversed.

This from last year’s Survey…this year’s will include 2022 and 2023 data.

2) Conversely, 80% of respondents are reporting lower opioid spend year over year. If other respondents’ data is consistent, this marks the seventh consecutive year of a decrease – wonderful news indeed as patients and providers choose safer – and often more effective – solutions to pain.
This from last year’s survey

3) Most respondents see a future for AI in the PBM world… but the emphasis is definitely on the future. There seems to be significant hesitation around implementing AI-based tools at this point. Ultimately, respondents see a range of “futures” – ranging from 100% automation of the entire process driven by AI to those who see AI focusing largely on early trend identification and clinical management improvements.

If you woulds like to participate, leave your info in the comment box below.

Public versions of our Annual Survey report are available for download here at no cost and no registration – note respondents get a much more detailed version of the report. 

Thanks to HSA’s Jay Stith and Helen Knight of CompPharma for their work on this year’s Survey.

Jun
19

Facility cost does NOT equal quality – part 4

Posted by Joe Paduda on Wednesday, June 19th, 2024 | Comments

Back to Florida… the home of many workers comp payers’ nightmares.

This time in Miami – where we find Kendall Hospital.  A large teaching hospital, level 1 trauma center, and…the most costly facility within a 10-mile radius.

Combining scores for patient safety, clinical outcomes, patient engagement and cost, Kendall Hospital ranks 6th out of 7 local facilities with a score of NEGATIVE .17 – largely due to its high cost but also because of its unpopularity with patients and below average clinical outcomes.

Kendall earns the worst score possible of -10 for cost – and for years has been one of the most expensive facilities in the area. Of the facilities in the area receiving a grade for patient satisfaction, Kendall ranks last with just a .8 out of 10 and scores a 3 out of 10 in clinical outcomes.

There’s one nearby hospital that scores waaaaay better on Health Strategy Associate’ proprietary Facility Assessment Tool; Larkin Community Hospital.

Larkin Community Hospital, earns a 0 for relative price (the LOWER the score for price the better)– the top score for the metric. It also scores 7 out of 10 for clinical outcomes (more than twice Kendall) and has a high patient safety rating at 8.3 out of 10.

Put it all together, and Larkin comes in as one of the top-rated facilities in all of Florida.

What does this mean for you?

Two things…how many of your patients are going to a very costly hospital with poor scores on patient safety and clinical outcomes?

And what are you going to do about it?

This post penned by Jay Stith, the brains behind HSA”s Facility Assessment Tool (c).

Jun
10

Good news Monday…Government is working.

Posted by Joe Paduda on Monday, June 10th, 2024 | Comments

In Bentonville Arkansas last week for the boys’ annual mountain bike trip…30 years and counting…recovering from a long one Thursday meant no GNFriday.

So here we go…

Driving up I-81 last week I encountered LOTS of construction – bridge replacements, repaving, new guard rails, overpass improvements…got me wondering how much impact the Inflation Reduction Act is having on public roads.

A Shipload. As in almost $200 billion to do desperately needed maintenance in every state.

Plus new factories – and lots of high-paying jobs – in rural North Carolina, along with:

  • 13,000 bridge repair projects – including the notorious Brent Spence Bridge between Ohio and Kentucky
  • 257,000 miles of roads resurfaced and/or improved
  • more than 450 port and waterway projects
  • funding for more than 1,400 drinking water and wastewater treatment projects
  • $3 billion for replacing lead pipes.
  • 500 projects for water recycling, storage, conservation and desalination to improve resilience against drought in the Western U.S.

What’s different about the IRA and other new Federal funding is much has been driven by local governments – towns, cities and counties applying for grants to make big improvements.  This from TIME:

The Biden Administration and the 117th Congress did something radical: Together, they decided to invest in the ideas and aspirations coming from Main Streets across America, rather than from inside the Beltway.

What does this mean for you.

Safer roads and fewer accidents.

More construction jobs.

More demand for materials and equipment.

 

Jun
6

Heat and Virtue Signaling.

Posted by Joe Paduda on Thursday, June 6th, 2024 | Comments

The single biggest risk to workers’ comp is heat.

Heat will have more impact on worker safety, injuries, and illness than any other single factor…a risk that will only increase as our planet heats up.

credit WCRI

Aside from a few very recent studies (kudos to WCRI and NCCI) and rare conference sessions the industry has ignored – and continues to ignore – heat.

Politicians have banned local governments from passing laws to protect workers.

Other pols have failed as well; with a very few exceptions states have neglected to pass and governors to sign legislation to protect workers.

Few “Thought leaders” have spoken out to warn their large audiences to protect workers and encourage politicians and regulators to legislate/promulgate regulations to protect workers, or even just to inform employers that claims will increase along with temperatures…kudos to Jeff Rush of CJPIA and LWCC’s Jill Leonard for their efforts.

Outside of WCRI and NCCI, conference planners (NWC’s Michelle Kerr comes to mind) may be the only stakeholder to make an effort – those efforts mostly rewarded with abysmally low attendance at sessions focused on climate change and heat’s impact on worker safety…

The industry has tried mightily to reform its image; Kids’ Chance, injured worker advocacy, behavioral health and addiction treatment support efforts have gone a long way to strengthen the brand…but all that good will melt away unless the industry’s thought leaders, regulators, employers and insurers do the right thing.

Hypocrisy is “Virtue signaling” while actively and purposely ignoring/discounting what heat will do to workers.

What does this mean for you?

Increasing heat means more kids will need a “chance”.

WCRI’s webinar discussing their research on heat is today

 

May
24

Good news Friday…Nope, no recession here, Obamacare saved my life, and recovery support

Posted by Joe Paduda on Friday, May 24th, 2024 | Comments

Happy Memorial Day Weekend!

Hope yours is filled with family and friends…and time to reflect on those who gave their lives for us.

Thanks to them, we have much to be thankful for.

Starting with…despite what many think we’re NOT in a recession…

From the Guardian’s survey…

The vast majority of respondents, 72%, indicated they think inflation is increasing. In reality, the rate of inflation has fallen sharply from its post-Covid peak of 9.1% and has been fluctuating between 3% and 4% a year.

In April, the inflation rate went down from 3.5% to 3.4% – far from inflation’s 40-year peak of 9.1% in June 2022 – triggering a stock market rally that pushed the Dow Jones index to a record high.

And job creation has been pretty darn great.

Government works!

Remember the botched start-up of the ACA aka “ObamaCare” way back in 2014?

Well, like many new and really big change, its gotten a whole lot better. Almost 2/3rds of Americans view the ACA favorably.

For some, “Obamacare saved my life”…

Support for recovering addicts…

This is really good news…The Feds and California are partnering on a program that pays addicts continuing to remain sober.  The program – “contingency management” –

is the gold standard for stimulant use disorder because you can win things for good behavior. But not a lot of places are providing it yet,” said PK Fonsworth, a psychiatric emergency room doctor and addiction psychiatrist in Los Angeles. (cite WaPo)

Research shows promise for contingency management. For instance, study participants achieve significant periods of sobriety, agree to long-term addiction treatment and even reduce risky sexual behavior.

The Biden administration is pushing more states to consider the approach, calling it a “proven treatment” that “remains underutilized.”

Kudos to CMS (Medicare and Medicaid) and the Golden State for the collaboration.

May
23

Heat = More injuries.

Posted by Joe Paduda on Thursday, May 23rd, 2024 | Comments

With temps here in the northeast nearing 90 degrees F yesterday  – and much hotter in many southern and western states, attention is turning to the implications for workers – and workers’ comp.

Two studies released by NCCI and WCRI show just how damaging excessive heat will be for workers and employers.

WCRI’s study – authored by the estimable Olesya Fomenko, Vennela Thumulaand Sebastian Negrusa, contains a wealth of information which anyone in construction should be aware of…

 

WCRI will be discussing this in a webinar June 6. Register here.

At NCCI’s recent AIS, researchers noted:

  • Days with extreme temperatures, both hot and cold, exhibit 2%-10% more injuries in NCCI states compared to “mild” days.
  • The largest effects of hot days are seen in outdoor sectors, particularly construction.

What does this mean for you?

Underwriters, actuaries, and risk management folks – pay attention. 

May
20

What’s really going on with workers’ comp medical…

Posted by Joe Paduda on Monday, May 20th, 2024 | Comments

Medical inflation in workers’ comp is pretty much flat – as it has been for several years.  Why?

Four reasons.

  1. Claim counts continue to remain pretty flat with lost time claim frequency down yet again.
  2. Drug costs have plummeted over the last decade, and now account for about $2.2 to $2.5 billion or 7% – 8% of total medical spend…down from around $5 billion.
  3. Costs for professional services – docs, PTs/Ots/chiro – remain pretty low. WCRI’s latest publication (available for now cost at the link) shows very little inflation across 36 states. Kudos to WCRI for tracking this up through 2023 – that’s really fresh data.
  4. Facility costs are increasing, but have yet to reach the point where payers actually do anything material about cost control.
    A better way to say this is payers are lazy and complacent, waiting for the crisis to hit before actually doing anything.

What does this mean for you?

Focus on facilities. 

May
17

Good news Friday – 401(k)s are up a ton, consumer protections, and destroying Russian jets

Posted by Joe Paduda on Friday, May 17th, 2024 | Comments

Great news on the economy…

The labor market stays strong, inflation is slowing, and the stock market continues to boom. 

One economist noted “the April report put a soft landing and 2024 rate cut back in investors’ sights…”

That’s about as good as it gets…but just the latest in a long string of economic improvements over the last three years.

About that 401(k)…

Folks with 401(k)s are enjoying a big jump in account value – Bank of America reported the average account increased 17%

Protecting consumers

This week the Supreme Court rejected the payday loan industry’s latest legal attempt to block consumer protections. The Consumer Financial Protection Board was created after the 2008 financial crisis to regulate predatory lending, mortgages, car loans and other consumer finance.

With this ruling, expect the CFPB to push for rapid adoption of consumer protections including:

Ukraine…

Lastly, our allies in Ukraine are FINALLY getting the support they desperately need…and using it to great effect. Earlier this week several jets and buildings  at a key Russian Air Base in Crimea were destroyed.

photo credit CNN

More on what’s happening there next week.

What does this mean for you? 

  • fatter retirement accounts, 
  • lower inflation,
  • and a smackdown of predatory lenders.