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Art Lynch became CEO of Downers Grove, Illinois-based Coventry Workers’ Comp Services, a unit of Aetna Inc., in November 2013 and is responsible for Coventry’s overall revenue, operations, networks, pharmacy and care management products. He spoke to Business Insurance Deputy Editor Gloria Gonzalez about the opioid epidemic, return-to-work programs and how technology can help improve treatment outcomes for injured workers. Edited excerpts follow.
Q: What do you see as the key issues in the workers compensation space these days, and how that has evolved over the past three to five years?
A: There have been a number of changes that are looking to set limits on the initial supply of opioids that injured workers can receive and regulations that are causing prescribers to access (prescription drug monitoring programs) to help control the number of injured workers initially exposed to opioids. And different states are looking at those types of issues as well as the adoption of formularies for certain high-cost opioids and compounds.
Separately, for quite a while we were all wondering what was going to be happening with the Affordable Care Act and what that might do to the supply of physicians in the workers compensation space.
Q: Let me follow up on that point. I’m curious how you deal with the uncertainty, how that affects how you think about this issue and how you can prepare for any impacts with regard to injured workers given that uncertainty.
A: We’re a division of Aetna, and Aetna is staying very closely involved in what’s happening on the federal level. We have open lines of communications with the regulatory folks within Aetna so that we are staying as up-to-date as we possibly can with what’s going on. That being said, until there’s more concrete not only legislation but also rule adoption, it’s going to be very difficult to predict what we’re going to have to do in reaction to the changes.
Q: Can you give me a sense of the impact of the opioid epidemic from a workers comp perspective and how you’ve been trying to address this from your company’s perspective?
A: It goes without saying that the opioid epidemic is obviously a top public health concern in the United States, and so it’s impacting the workers compensation community as well. And this is seen in that roughly one out of every four prescriptions dispensed is an opioid. Beyond the extreme consequences of death and addiction that may occur, this epidemic is prolonging time away from work and driving up costs in the workers compensation system. Some of the strategies that are being utilized within the workers compensation space are early intervention and educational outreach to prescribers, patients and adjusters. We utilize drug utilization assessments and peer-to-peer outreach with providers and some specialty pharmacy nurse case management to help manage individuals at risk for opioid use and abuse.
Q: What are you seeing from a regulatory or legislative perspective to help combat the opioid problem?
A: From a regulatory perspective, I’d probably put it in three different buckets. One would be looking at ways to limit the initial supply of opioids — and honestly, this can impact workers comp, but this is something that more broadly could be impacting all of health care. Second would be revised, renewed treatment guidelines specific to opioid use. Last would be looking at closed or mandatory formularies, a lot of which probably could be prompted by the success of the Texas closed formulary. But several states have or will adopt some of these closed formularies or state-mandated formularies by the end of this year.
Q: What are you seeing in terms of return-to-work trends among employers?
A: I think that employers and managed care companies are looking to promote greater advocacy and trust between the employer and the employee to help drive improved return to work. If I was going to sit here and say what drives the most effective return-to-work programs, it would incorporate preventive interventions such as ergonomic evaluation, which we do here. You have formal job analysis and transitional duty alternatives that are communicated, or at least written, in advance so that when an injury or illness occurs, the injured worker can very quickly know what to expect. And then lastly, health and wellness support and care coordination built into their return-to-work program. It’s looking more holistically. Yes, you’ve got an injury, but there may be other comorbidities that you have to take into consideration to treat that specific injury.
Q: Are there any technologies that you’re seeing being used to help deal with the issues in the workers compensation system, whether it’s cost-related or perhaps improving the treatment outcomes for injured workers?
A: I can tell you that we have worked on and deployed mobile apps and web portals to try to improve the communications. I’ll say it’s particularly between ourselves, nurse case managers and adjusters at this point in time. Integrated into the mobile apps and web portals are also increasingly advanced decision support tools to help make informed decisions and take actions on a case and even using push notifications to enable faster response. But beyond that, I think that the next step would probably be to look at the lack of adoption of telemedicine in our space. I think that as telemedicine gets more broadly adopted in the general health care space, it will see increasing adoption in the workers compensation space.