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The nation's opioid epidemic began with about 20 states relaxing laws that had discouraged doctors from treating “chronic, noncancer pain” with these prescription pain medications, an expert told Business Insurance's 2011 Virtual Workers Comp Cost Control Strategies online conference Thursday.
The trend that began in the late 1990s allowed “extreme permissiveness” in increasing opioid doses prescribed to injured workers, said Dr. Gary M. Franklin, medical director for the Washington State Department of Labor and Industries and a research professor in the departments of Environmental and Occupational Health Sciences and Medicine at the University of Washington in Seattle.
“Within a year or two of the laws…becoming more permissive, we began to notice deaths in the Washington workers compensation system,” Mr. Franklin said. “These deaths (from prescribed opioids) were unintentional poisoning deaths. They were not suicides.”
While Washington state eventually introduced measures to curb doctors' prescribing of the pain medications in noncancer cases, some workers compensation payers also have taken measures to discourage the overprescribing of opioids.
Oklahoma City-based Hobby Lobby Stores Inc., for example, adopted prescription protocols for flagging and scrutinizing claims where opioids have been prescribed, said Becky Robinson, the company's assistant vp-risk management.
Hobby Lobby's aggressive efforts have included bringing in pharmacy benefit manager experts to help educate the employer's in-house claims management staff, Ms. Robinson said.
The employer also coordinates with its third-party administrator to prevent drug abuse, identify claim problems before they escalate, and hold injured workers and doctors accountable.
Among other measures, her plan of action includes contacting doctors to learn why they may be prescribing certain drugs, Ms. Robinson said. That can lead to finding alternatives, such as transferring an injured worker's care to a medical specialist.
Julie A. Fortune, senior vp and chief claims officer for Arrowpoint Capital in Charlotte, N.C., said directing her pharmacy benefit manager to help identify “high-risk claimants” based on their prescribed medications in combination with peer-to-peer outreach to treating doctors, when appropriate, has helped her reduce inappropriate prescription practices and reduce costs by 37% year-over-year.
“Our success ratio of influencing the peer is at 82%, and 35% of the meds were discontinued after further evaluation by the prescriber,” Ms. Fortune said.
The treating physician, the injured worker and attorneys have to understand that claims managers are there to genuinely help them, added Michael J. Shor, managing director of Best Doctors Occupational Health Institute in Boston. Additionally, claims managers “must be very well-schooled in chronic pain and chronic pain treatment and pharmacology.”
They don't have to be high-level experts, but they must understand when a claim is headed in the wrong direction, Mr. Shor said.
Most importantly, effective treatment “is really based on the injured worker's belief that the clinician, the claim executive, the employer are really there to help them through (the) process,” Mr. Shor concluded.
The virtual conference, including webcasts and downloads, will be available on demand starting Friday. Register here to view the event.
Emerging risks associated with mobile workforces, lagging claim closure rates and the potential impact of congressional deficit negotiations are some of the critical issues shaping the workers compensation landscape, a panel of experts said.