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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, October 19, 2011

How to Stop Opioid Use in Workers’ Compensation, a White Paper

Rather than trying to rescue drowning victims, we should find out who is pushing them in the water upstream—and stop them!

It’s no secret opioid use in Workers’ Compensation has reached the critical level, having escalated over the past ten years. The issue is serious, not only because of the cost in dollars, but it also has a human toll. Productivity in the workplace is jeopardized, the risk for new injuries is exacerbated, and claimants’ lives are devastated by addiction. Much has been written and important studies have been conducted on the topic.

Recent studies illuminate the problem
A central location that links to recent studies and articles on the topic along with serious discussion is found on Linkedin, the Work Comp Analysis Group. The studies by NCCI and CWCI are convincing. The only reasonable conclusion is that the problem is real, it is serious and it is growing. Specifically, the increase in drugs as a percentage of claim costs is disturbing. Moreover, the studies also show overutilization is the cost driver, not increases in drug costs. This article is offered by way of contributing a tool to the solution side of the problem.

The solution side of the issue
To address the solution side of the issue, it seems only logical that efforts are directed to the upstream source, those who prescribe the drugs. That narrows the scope considerably since only specially-licensed MD’s can prescribe DEA (Drug Enforcement Administration) controlled drugs. Moreover, only those drugs that have been prescribed and billed through the Workers’ Comp system are causing huge increases in claim costs. Consequently, the spotlight of prevention should focus on the prescribing doctors.

Of course, illicit drugs and drug trafficking exist everywhere. While these drugs may contribute to reduction in employee productivity and risk of new injuries, illicit drugs will not impact pharmacy costs in Workers’ Compensation claims. Only prescribed drugs can do that.

Using analytics to nab the perpetrators
As a Workers’ Compensation analytics company, MedMetrics analyzes and quantifies physician performance based on the data. Networks, insurers, TPA’s, and self-insured employers are increasingly using this information to create outcome-based, quality medical provider networks. MedMetrics includes prescribing behavior along with multiple other performance indicators analyzed for individual providers.

Not as easy as it would seem
Identifying physicians who overprescribe Schedule II drugs should be easy. According to the studies they comprise only a very small percentage of treating physicians. However, analyzing physician performance in Workers’ Comp requires collecting data from multiple sources. Billing data is needed for diagnostic and treatment information, though billing for drugs is typically not found there. Yet, some is, particularly when physician dispense the drugs themselves.

Additionally, claims data is needed to evaluate outcomes of the treatment such as lost time, actual paid amounts, and disability ratings. Yet another data set is needed, that of prescribed drugs found in Pharmacy Benefit Management (PBM) data.

Adding to the complexity of what would otherwise seem simple is the proliferation of drugs in this category. Many of the drugs are opioids, meaning they are artificial versions of the real thing—morphine. As new iterations of these drugs emerge, so do new drug names and NDC’s (National Drug Code) that is supposed to identify them. The DEA (Drug Enforcement Agency) classifies the drugs with still another set of codes.

Overall provider performance analysis
Once collected from the various sources, the data must be integrated, validated and analyzed. Comprehensive data analysis that is very simply described here provides a complete picture of provider performance in context with conditions in the entire claim. When provider performance is evaluated using all the key factors, a fair determination can be made about providers’ practices.

Link analytics to action
Those charged with carving out quality networks can make use of this information about individual physician performance, including prescribing behavior on an ongoing and current basis. Moreover, they also have in hand the objective and tangible rationale for removing poorly performing physicians from their networks.

MedMetrics takes this process a step further. User organizations can elect to be notified when a low-ranking physician, including those who have been identified as over-prescribers of Schedule II drugs submit a bill. This “head-up“ approach allows organizations to proactively intervene, thereby linking analytics to action.

Thursday, October 6, 2011

Steve Jobs—Remembering and Connecting the Dots

“You can only connect the dots in your life by looking back—not forward.” Steve Jobs

This quote is from Steve’s famous Stanford commencement address in 2005. Of course, his message to new college graduates was if you look back you can see how far you have come and also gain some insight into how you arrived here.

It’s worth reflecting on his idea, especially as we mourn Steve’s loss. Look back and connect the dots, those events and decisions made along the way in life and also in organizations. Consider also paths not taken. Then consider how each has affected, inspired, and lead to the present.

Steve Jobs was an extraordinary innovator, and he was also pragmatic. He designed and developed useful, easy to use products while incorporating artistry. His work exemplified powerful, yet elegant simplicity. Remarkably, Steve Jobs’ values can be translated into many lives and processes, even Workers’ Compensation analytics.

Looking back to connect the dots is a very powerful way to understand the present. Descriptive analytics are quantitative analyses of historic data. Descriptive analytics inform and suggest conclusions by connecting the dots in the data to evaluate processes and participants' actions. For instance, evaluate provider performance, frequency and duration of medical services, direct medical and indemnity costs, and disability status (among other factors) to describe the treatment pathways that led to the current status of a claim. Data elements (the dots) are analyzed to re-portray and inform users regarding outcome. Analytics also offer decision support regarding the effectiveness of past decisions and the results of the participants’ actions throughout the process.

Steve Jobs advised against looking forward in this particular speech. Yet predictive analytics can employ the same values and use the same techniques he proposed, thereby offering predictive knowledge about what is likely to happen next. Based on historic “dots”, future results can be predicted with defined levels of mathematic probability. Therefore, when the same combination of “dots” occurs again, predictive analytics can suggest the likely result.

Connecting the dots using analytics should always produce easy to use tools so that the user will gain understanding of what has occurred, what it produced, and where it is likely to lead. Moreover, analytics and predictive analytics should be elegantly simple to use.

Steve Jobs set a very high bar in the digital and communications world. We can best memorialize him by designing and developing powerful analytic tools that are elegantly simple and always with the user in mind.

Learn more about MedMetrics analytics tools.