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Some potentially great strategies are emerging to eliminate narcotic opioid misuse in the workers comp system.
Third party administrator and risk management services provider ESIS Inc., for example, is testing a program that sets off a string of intervention events beginning when an injured worker fills their first prescription for narcotics.
ESIS' pilot program seems somewhat similar to strategies other insurers and their vendors have recently announced. The strategies generally call for early investigations to determine whether opioid prescriptions are a good idea for a claimant's chronic pain condition.
These strategies rely on reaching treating doctors and workers as early in the prescription fill process as possible, meaning long before several prescriptions for the drugs have been filled. Because at that point a claimant may well be on the road to addiction or an overdose death.
These strategies are necessary because of the alarming rate at which addiction and deaths are occurring across the nation due to the misuse of opiods.
Fortunately, in the comp industry insurers competing to save employers money and help workers return to their jobs may spur the right solution.
ESIS' approach is interesting because the TPA is first conducting a pilot program to see how well its strategy will work. Other insurers and vendors are launching similar processes immediately.
But data on the effectiveness of such a program would be great so I hope ESIS, a unit of ACE, later shares their outcomes with us.
For now, ESIS' program relies on pharmacy benefit manager automation to
trigger a “drug utilization advisory” when the first fill occurs, explained Deb Gleason a clinical resource manager for ESIS in Philadelphia.
A comprehensive review can then occur, looking at the various medications the employee is currently taking, drug-to-drug interactions and other case factors.
A report is then prepared so case managers can discuss the specific claimant's narcotic prescription with the treating physician.
Other aspects of ESIS' program include training case managers so they understand pain management and behaviors a claimant might exhibit if their goal is mainly to obtain drugs.
There is also a process to help identify patients who may have a tendency to overuse opioids before that can happen.
In some cases there are very legitimate needs for opioid prescriptions, Ms. Gleason said.
But it's great to see the workers comp industry taking action that could help claimants that may suffer more serious harm than good because of narcotics,
Now allow me to do a little marketing. I recently wrote a story on what some other insurers and work comp vendors are doing to help stem unnecessary opioid use. It is available here, but may require registration if you are not a BI subscriber.
An entire series of stories on opoid abuse are available under one of our “solution arcs,” which are available midway our workers comp page here.