Work comp claim reporting – why no data?

There’s very little publicly-accessible data about who reports work comp claims, via what channel.  We just finished up a brief project for a client interested in comparing their data to national benchmarks, and we found precious little data on the topic. It may be out there, but it sure is hard to find…

We know the sooner claims are reported the better; there’s some good research out there altho arguably the best – the Hartford study – is dated.  There is more info about the impact of delays in reporting on ultimate claim costs, which is certainly critical, but that’s “outcome” information.  What we don’t know is the “process” information – which helps payers understand where they stand and what they can and need to do to improve.

Payers need to know when and who and via what channel claims are reported, by type of payers, states, industries, employer sizes, class codes – if they want to set goals, figure out where to put their efforts, who to target.

In general, we learned that the vast majority of claims are reported by employers via phone.  Whilst many payers have web- or email-based reporting capabilities, these are rarely used.  Some have developed smartphone-based reporting, but with a couple exceptions (very large self-insured employers) very few claims come in via this channel.

What does this mean for you?

Should we do a Survey of Work Comp Claim Reporting?  I’m thinking this may be worthy of study; perhaps HSA should develop and conduct a quick study to gather some baseline intel on the current state of the industry.

If this makes sense to you, please say so in the comment section.

Thanks!

 

 

 

 

Workers’ comp – the near-term outlook

NCCI’s just-published assessment of work comp trends has a wealth of information, much of it well worth contemplation by anyone in the industry.

Here are a few takeaways that jumped out at me.

  • Overall the current state of the market is steady – the market and rates are firm, premiums are trending up modestly, frequency is continuing its structural slow decrease, and claims cost inflation appears to be well within acceptable ranges.
  • Employment has returned to its pre-recession level, yet the percentage unemployed remains above 6 percent.  Employment drives premium so that’s good news, however there’s plenty of room for that percentage figure to drop even more.
  • More specifically, employment in manufacturing and construction, traditionally high-premium industries, remains lower than it was before the recession.  If this picks up significantly, so will work comp premiums and rates.
  • If investment yields remain low, we may well see premiums increase as insurers seek to offset the decline in ultimate cash flow.
  • Medical trend is pretty low as well as the work comp world’s experience parallels group and governmental program results.

Which leads to the key questions – what could change the outlook from “steady”?

  • A surge in employment especially in construction will increase injury risk and premium volume.
  • Continued low investment returns may force insurers to raise rates.
  • An uptick in medical inflation – perhaps due at least in part to cost-shifting – could lead underwriters to push rates up quickly.

What does this mean for you?

Lots of ifs and maybes; fortune favors the alert.

 

 

Survey of Drug management in work comp – quick take

This is the eleventh (!) year I’ve been involved in surveying workers’ comp payers to get their take on pharmacy management.  Now that Yvonne Guibert (thank you Yvonne) has finished collecting the data, I’m working on the report.  It’s going to take a week or so, but I’ve pulled a couple highlights to whet your appetite.

  • Overall, drug spend declined for most of the 25 respondents, with some seeing percentage decreases in the double-digits.
  • In addition, total spending (across all respondents) declined as well – by about the same margin.
  • Top problem? close between opioids and physician dispensing, same as last year.
  • Biggest emerging problem? Compounds, without a doubt.
  • 21 of 25 respondents said prescription drug costs were more or much more important than other medical cost issues at their organization.
  • 88% of the 25 respondents (large, mid-sized, and small WC TPAs, state funds, and carriers) have a urine drug monitoring program in place today or will by the end of the year.

Much more to come – the data geek in me is getting all fired up about what we’re going to learn.

Thanks to the 25 organizations who spent time collecting their data, then sharing it with Yvonne.  This is not an easy task, but one that really helps all of us understand what is going on with pharmacy programs, utilization, solutions and cost drivers and how payers are addressing the issue.

Stay tuned…

Friday catch-up

Here’s the quick summary on a couple happenings in work comp this week.

The big news comes from Liberty Mutual, where long time Medical Director David Deitz will be retiring, and Frank Radack has been named VP of managed care.

David is one of the true stars in this business, and this will be a big change for Liberty.  Word is one of his regional medical directors will assume the leadership role on an acting basis; more to come on that to be sure.  Dr Deitz has a wealth of experience; he has developed and implemented evidence-based guidelines, is an extremely knowledgeable analyst, a very effective communicator to clients, prospects, and regulators alike, understands the US health care delivery system like few others, and knows work comp.  I am fortunate indeed to count him as a friend, and hope we get to work together again.

Frank is a very experienced business guy with a strong history at Liberty; he ran Liberty’s bill review operation years ago before taking over their reporting/RMIS function some years back.  His depth of knowledge about what customers want to know and what is important to them will undoubtedly help Liberty focus their managed care efforts.

Friend and colleague Todd Brown informed me (and others) that Maryland is looking for input from self-insured employers and groups on prescription drug costs.  Their survey is here.  Given the physician dispensers’s BS claims about lower costs and better outcomes associated with their nefarious practices, it would behoove any and all self-insured employers to respond to the Survey.  Like, NOW.

Adjusters are happier than we thought…

Jack’s been getting ever deeper into the world of the adjuster of late – here’s his latest post.

Over the past couple weeks Joe and I developed and sent out an Adjuster Survey to get more insight into adjusters’ (and other front-line staff’s) work life. We are looking for first hand information as website reviews and other second-hand sources can be easily misinterpreted.

Surprisingly, the response rate to date is an astronomical 24.4%.  We are delighted with our results, but we’re looking for more.

Perhaps even more surprising adjusters’ views of their work life are very positive; contradicting what I had read online prior to developing the survey.

Just over 90% of our participants claimed that their daily workload was either “manageable” or “a bit too much, but still manageable.”  We were very pleased to see that these participants were not getting overworked and that they were at least tolerating their work environment.  About 66% of the survey participants said that their work environment was “great” or even “unbelievably fun and enjoyable,” while another 30% said that the work environment was “tolerable.”

A tiny percentage – 3% of participants – claimed that their work environment was “not fun at all.”

We are data hounds here at Health Strategy Associates, and need you to help develop an even better understanding of adjuster likes, dislikes, and attitudes.

Please take roughly 2 minutes out of your day (that’s all it takes!) and fill out our survey.  In appreciation of your participation, you will receive a $5 Starbucks eGift card via email if you fill out our survey by Friday.

We’ve been getting great feedback thus far and would like to continue this run.  Once again, here is the survey link if you missed it.  Enjoy the (generally pretty good) work week!

Seven out of ten work comp adjusters say…

Senior Associate Jack Johnston joins us again, getting us up to speed on his research into work comp adjusters -

Over the past month or so I’ve been doing research on the claims adjuster profession to get a better understanding of what adjusters like, don’t like, and what their managers can do better – both in improving the adjuster’s lot and the companies they work for. From what I’ve gathered from various online sources, for the most part, adjusters aren’t the happiest, most fulfilled workers.

Gathering information from general websites such as www.glassdoor.com and adjuster-specific websites – www.claimspages.com, www.adjusterspace.org, and fromoneadjustertoanother.ning.com has produced a few positives and a lot of negatives.  Here’s what adjusters have to say about their job and the company they work for:

The Good:

Among those with good things to say, when it came to the pros a lot of them talked about the good benefits they received.  Getting paid during time off and having a 401k; can’t complain about that!  Another somewhat common pro was the flexibility of the work schedule.  Some adjusters stated that if they were doing well enough with work, they could get permission to work from home.  Other adjuster work-life positives included satisfaction with their compensation and the enjoyable camaraderie with co-workers.

The Bad & the Ugly:

While there were a lot of different complaints listed in the many sites I was researching, there were a handful that popped up repeatedly.

Let’s start with caseloads.  There seems to be a ridiculous number of cases handled by some adjusters, forcing them to work overtime (which they don’t get paid for).  Overall, most adjusters appear to be overworked; common complaints included: we are “always behind on work” and “There was an enormous amount of work that is expected of everyone, and it can be very defeating to have most of your days end without a feeling of accomplishment. (sic)” 

Even if an adjuster is doing a good job in the office (or at home), s/he probably shouldn’t expect much of a reward.  Promotions are scarce and raises tend to be paltry, with most getting a 1-2% increase (and that’s only if you are lucky enough to be given a raise).  The lack of ability to move up in the organization has upset many of the adjusters as they feel they aren’t rewarded for the work they put in with the heavy caseloads they deal with every day.

A fair amount of reviewers I read complained that instead of promoting within their company, the firm would hire someone from an outside company and place them in the higher position.  That’s a low blow to the employees who have been working there for years, expecting their effort and loyalty to lead to more responsibility and more income only to see the new person get the job.

Another common complaint is that managers are not qualified and don’t do a good job providing feedback to adjusters.  The adjusters never receive compliments or congratulations and are always told what they are doing wrong and how much more work they have to do.  They complain that they are not trained enough to handle some of their cases efficiently and they also feel that their offices are understaffed.  The adjusters want upper management to be realistic.

Conclusion:

I understand that this is certainly not the voice of all of the claims adjusters in the workers’ comp world but this is what I’ve found.  Websites like www.glassdoor.com can be easily accessed and false information, positive or negative, can be posted by bad actors. 

With that said, 69.2% of adjusters on the glassdoor website would not recommend their job to a friend.

Summary:

  • Adjusters like their benefits, salary, and co-workers… for the most part.
  • Schedules can be flexible (can work from home with permission).
  • No raises, room for growth, and no pay for working OT.
  • Overworked, large caseloads.
  • Always behind on work.
  • Lack of feedback from upper management.
  • And perhaps the most telling quote – “Run, do not work here”

Health care cost trends – a new tool

With 18% of the economy driven by health care, cost inflation rates are vitally important. A just-released white paper reviews a new approach to measuring health cost inflation rates that will help employers, health plans, and workers comp payers assess overall trends, compare their experience to a benchmark, and forecast where things are headed.

The research, conducted by S&P/Dow Jones uses a series of indices to break out various cost areas.  The white paper is available for free here; while the statisticians amongst us (that does not include your faithful author) will find much to geek out over, this amateur’s take is:

  • the methodology is sound and carefully constructed;
  • it uses payment data from commercial health plans representing about 40% of all enrollees;
  • the data is from fee-for-service plans;
  • it is state- and in many cases area-specific; and
  • it provides details on medical, inpatient, outpatient, pharmacy (brand and generic).

Any input from real analysts on the indices would be more than welcome.

Here are a few of the key highlights from the initial edition, which includes data from Feb 2010 to April 2013.

  • Overall trend has been at or below 5 percent since August of 2010
  • Trend as of April 2013 was about 4.3 percent
  • Drug trend has been bouncing between 0 percent (!) and 2 percent since October 2010, with brand cost showing much less fluctuation while generic inflation was at 15 percent when last measured.
  • Hospital trend is consistently 3 to 4 points higher than professional services trend
  • There’s a LOT of interstate variation; for example as of February 2013, IL trend was around 1 percent while Texas’ was about 4.75 percent.

What does this mean for you?

All in all, a very valuable addition to the toolset available for regulators, businesses, and health plans.

Medical marijuana in work comp – take a deep breath, folks…

Sorry, no pun intended.  Not suggesting you inhale, but rather take a step back before you get all excited about a single court case.

Finally, there’s an actual real live bona fide true factual documented report of medical marijuana (MM) paid for by work comp.  To date, there’s been much speculation, a lot of pixels published, and way too much hot air – but now we have our first – and as far as I can tell only – time a work comp payer has been told to pay for MM.

Let the floodgates open.

Or perhaps not.

Our industry loves to hyperventilate endlessly on newly-emerging-highly-unlikely-but-really-scary cost drivers.  Medical marijuana, obesity, an aging population have had their day in the virtual sun, and although the latter two are worth discussing, the reality is the research indicates they just aren’t that much of a factor.

But now, a court in New Mexico has said an insurer has to pay for marijuana.  Thanks to the pros at WorkCompCentral, the case, Vialpando v. Ben’s Automotive Service and Redwood Fire & Casualty, is now on the tip of everyone’s tongue.  The claimant’s attorney is telling insurers to contract with marijuana dispensaries (!), others are opining the “floodgates” will open, and friend Mark Pew is advising employers to implement drug-free workplaces.

Before we spend a lot of time and energy on this, let’s consider the real world.

There is little credible research indicating medical marijuana is an effective treatment for pain.  Yes, there is some evidence that in relatively small populations MM has been beneficial, however they aren’t large enough, nor objective enough, to provide convincing proof.  Notably, it is difficult for researchers to study a Schedule I drug, and that has undoubtedly hampered the process.  Despite that limitation, over 40 studies have been conducted, and according to Medscape; “The majority of the studies showed an improvement in pain relief in comparison to a placebo or to other traditional pain medications. About a quarter of the studies showed no improvement.”

When one digs into the research, there’s quite a bit of variation in the study design, the pain type, duration, measurement methodology and assessment process making it difficult if not impossible to come up with an overall sense of efficacy or effectiveness. Some research even indicates THC can increase sensitivity to some types of pain.

THC – the most studied active ingredient in marijuana – has been studied extensively, with mixed results.  In a relativecly-small study of advanced-stage cancer patients, some subjects become highly agitated and anxious after ingesting THC orally.  Others reacted differently, and to varying degrees.

All that said, I could not locate any large-scale, double-blind randomized control studies addressing the effect of MM on pain.  The studies tend to be small, deal with discrete groups of volunteers (hey, want to get paid to get high?), and focus on one specific type of pain (neuropathic the most common, where the effect of MM seems to be pretty significant).

Does MM offer a possibly-better-alternative to opioids?  Absolutely.  Does it come with its own set of problems?  Absolutely: about 10 percent of users may become “addicted”; others experience very high anxiety levels; it certainly can be diverted.

What does this mean for you?

Until and unless there is credible research and a clear understanding of the risks and potential benefits of medical marijuana, we won’t see widespread – or even very little – use in workers’ comp.  Schedule I status, problematic side effects, social stigma, and legal issues are all major barriers – and will remain so.

Okay, let’s get back to real issues.

BTW, kudos to WCC; the article is comprehensive, well-researched, and provides a solid background on the overall issue as well as an explanation of the legal situation in New Mexico and other states.

Big data in work comp – no panacea

There’s so much excitement about big data and the potential for it in work comp that it would be all to easy to forget some basics.

The law of small numbers chief among them.

Work comp accounts for a tad more than one percent of US medical spend – $30 billion in comp medical vs $2.8 trillion in total medical spend in 2012.

Many docs treat just a couple of work comp claims a year, and those who do handle a lot of WC claims see a wide range of injuries: knees, ankles, backs, shoulders, hands damaged by cuts, sprains strains and severe trauma.  When looking to compare providers – or procedures for that matter – researchers need enough data points to develop a statistically-valid sample set.  In most cases, no single provider has enough claims to enable clear-cut evaluation.  And, if they do, there aren’t any other providers in their service area with the necessary volume, making comparisons nigh-on-impossible.

The issue is statistical validity and statistical accuracy. Simply put, is the measurement procedure capable of measuring what it is supposed to measure. Without enough data, there just isn’t enough information to accurately assess performance.

That’s not to say researchers can’t do very meaningful and helpful analyses; the one just published on opioid prescribing by physicians dispensing docs to work comp claimants is a perfect example; the ongoing research by CWCI, WCRI, and NCCI provide plenty of additional examples.

The problem occurs when consultants, payers or managed care firms try to make definitive statements about individual providers based on inadequate data.  In my experience, provider rankings are often – but not always – based on little more than reimbursement or “savings” figures, and in no way account for “quality” measured by return to work, disability duration, cost-per-claim.  There isn’t enough data to case-mix adjust, not enough data to make comparisons, or really “rate” docs.

I would note that some payers, most often state funds, and some managed care firms, notably MedRisk (HSA consulting client) have a wealth of data and can (and do) make valid comparisons.

What does this mean for you?

Beware of rankings, ratings, and comparisons of individual providers.  Unless the underlying data is robust.

Yet more evidence doc dispensing is a disaster

There is NO reason, no rationale, no logic behind docs dispensing drugs to workers comp claimants.  

Proponents claim it is better care, leading to speedier recovery and lower costs.

We long suspected the opposite is true; that is, claimants getting drugs from docs get more treatment, incur higher medical costs, are out of work longer and run up bigger claim costs than claimants with the exact same injury who don’t get pills from their physicians.

Thanks to CWCI, we know that’s the real impact of doc dispensing.

Now, we know even more – we know that dispensing docs prescribe more opioids for longer times, thereby increasing the risk of addiction and drug diversion and overdoses and death.  Thanks to a research paper authored by Johns Hopkins University Medical School and Accident Fund, there’s clear and convincing proof that doc dispensing is a highly risky, very dangerous, and very expensive proposition.

Here is the money quote:

“we found 39% higher medical costs, 27% higher indemnity costs, and 34% higher frequency of lost-time days associated with physician-dispensed versus pharmacy-dispensed medication. We found even more striking differences related to physician-dispensed opioids versus pharmacy dispensed opioids. The effect was nearly doubled and revealed 78% higher medical costs, 57% higher indemnity costs, and 85% higher frequency of lost-time days associated with physician-dispensed versus pharmacy-dispensed medication. [emphasis added]

And yes, the analysis was case-mix adjusted.

It’s not about convenience; Claimants get drugs for free and quickly thanks to PBMs and pharmacies who are only too happy to fill their scripts.

It’s not as if the drugs they dispense – NSAIDs, antibiotics, pain meds, stomach acid treatments – MUST be consumed within nanoseconds or the claimant dies.  None of the top 50 doc-dispensed drugs are deemed time-critical.

It’s about docs sucking more money out of employers’ and taxpayers’ wallets.  While dispensing more opioids, and keeping patients out of work longer.

Which brings up a question:

Why in hell are regulators and legislators not banning physician dispensing?