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The MedMetrics blog provides comments and insights regarding the world of Workers’ Compensation, principally, issues that are medically-related. The blog offers viewpoints regarding issues affecting the industry written by persons who have long experience in the industry. Our intent is to offer additional fabric, perspective, and hopefully, inspiration to our readers.

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Wednesday, June 13, 2012

Teach Your Data to Fight Opioid Abuse

By Karen Wolfe

Workers’ Compensation research, networking communities, and press are overflowing with information about Opioid overuse and how it is negatively impacting claim costs and outcomes. Information about the problem abounds. Opioid abuse is clearly recognized as a serious problem in the industry, clearly evidenced by recent research.

Industry research
An example of recent research on the topic is from Alex Swedlow at the California Workers Compensation Institute (CWCI), “An association was found between greater use of Opioids and delayed recovery from workplace injuries.” Swedlow says it’s not so much that the drugs themselves are costly, rather, it is the collateral damage that accompanies their use.

A recent study from NCCI (National Council on Compensation Insurance, Inc.) is entitled, “Early Narcotic Use Is Indicative of Prolonged Use.” Findings showed that high use of narcotics in the first quarter following injury indicates a higher than average probability of narcotic use in subsequent periods.

The list of studies and articles is long. In fact, a Google search for “Opioid abuse in Workers’ Compensation” draws nearly 100,000 results. Now that the problem is well-defined, the focus shifts to correcting it.

Fixing the problem
MedMetrics recently conducted a small study for EK Health and their Next Step program. The Next Step program leverages EK Health’s many professional medical resources to address complex claims where the injured worker is addicted to prescription medications. They effectively apply expert peer to peer consulting to assist treating physicians in weaning claimants from their prescribed drugs. The EK Health Next Step program is uniquely effective in bringing those old and very complicated claims to closure.

While the EK Health Next Step program is a powerful tool, it could have even greater impact on costs and outcomes if implemented earlier in the course of the claim, well before so much damage and costs have played out. Early awareness and intervention by referral to the experts could have exponentially positive effects.

Identifying risky claims early
Busy claims adjustors are not accustomed to identifying early Opioid use in claims. In fact, hey often do not have the means because many claims systems do not capture prescription detail. Moreover, Pharmacy Benefit Management data, another source of critical information, is usually a separate system and is not readily available to claims adjustors. Consequently, they are unaware of narcotic prescriptions. However, they and others who might intervene could be made aware through computer-aided medical management, by teaching the data to find the problem.

Computer-aided management tools
Industry research and data studies serve to define and clarify the problem, but they can also illuminate a very practical means to resolution. The research contains tips and actual predictors of risky claims. A derivative of research is the knowledge of what to look for in the data.

For instance, the NCCI study identifies a predictor that when narcotics are used for pain early in the course of the claim, it can be indicative of impending trouble. Armed with this well-founded intelligence, the problem can be proactively addressed from the beginning of a claim by continually searching for the prescriptive indicators in the data.

Monitor current data
Concurrent data monitoring is a powerful cost control methodology to identify early Opioid use. By monitoring current data for Schedule II drugs prescribed, claims can be automatically flagged and referred for more intense scrutiny. Claims with this critical information will not be overlooked when using computerized data monitoring.

Likewise, providers who prescribe the drugs outside the accepted medical guidelines such as ACOEM (American College of Occupational and Environmental Medicine) can be monitored electronically. The system can identify providers known for higher Opioid prescription rates. When those physicians are involved in a claim, the system sends an alert to the claims adjustor, medical case manager or other key persons. The system can also send a notification to the prescribing physician.

Notifying the prescribing physician in near real time can serve as a potent preventive tool. It puts physicians on notice to let them know they are being observed.

IT resources
Creating vigorous computerized medical management tools such as these is an IT function. Technicians are required to develop the programs under the guidance of the business leaders who understand medical indicators. Unfortunately, many organizations suffer from scarce IT resources and such initiatives are not implemented. Therefore, outsourcing to a company that specializes in developing computerized medical management tools is the right answer.

To learn about MedMetrics medical management data monitoring, contact Karen Wolfe at 541-390-1680 or karenwolfe@medmetrics.org.

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