Game Changing Strategies to Transform Workers’ Compensation Results

www.onecallcm.com© Copyright 2013 One Call Care Management. All rights reserved.

Game Changing Strategies to Transform Workers’

Compensation Results

RIMS Chicago

www.onecallcm.com© Copyright 2013 One Call Care Management. All rights reserved.

Kevin Glennon, RN, BSN, CDMS, CWCP, QRPVice President-Home Health & Complex Care Services

Email: [email protected]: 407-448-5879

www.onecallcm.com© Copyright 2013 One Call Care Management. All rights reserved. 3

Disclosure Statement

Kevin T. Glennon, RN, BSN, CDMS, CWCP, QRP works for One Call Care Management as their Vice President of Home Health and

Complex Care Services. A provider of Home Health, Infusion Therapy, Complex Care Coordination, Medical Equipment, Devices and Supplies

and Assistive Technology Products and Services in the Workers’ Compensation Industry.

Off label use of certain medications may be discussed during this presentation along with Nursing considerations.

Discussions related to urine drug testing companies may be discussed during this presentation .

Additionally no financial relationships exist with any commercial party.


Topics for discussion Discuss current claims industry trends and the current

financial impacts

Review challenges such as co-morbidities, obesity, and the aging workforce

Review strategies to foresee and proactively manage potential costly adverse events

Discuss strategies they may assist in mitigating the rising medical costs of workers’ compensation claims


The Current Trend According to preliminary estimates, lost-time claim frequency declined

by 5% in Accident Year 2012

Claim frequency for workers compensation injuries increased 3.8% in Accident Year 2010 marking the first increase since 1997 Prior to the 2010 uptick, claim frequency had been declining at an

average rate of more than 4% per year since 1990 Following the 2010 uptick, claim frequency declined in 2011, albeit by a

modest 0.9%

In 2012, while frequency decreased by 5%, the average cost per lost-time claim increased 1% for indemnity and 3% for medical

Prescription drug (Rx) use, a medical expense that makes up 19% of all workers compensation (WC) medical costs


Factors that increase the aging worker’s potential for risk

Muscle Weakness

Balance Problems

Vision Problems

Side Effects from Medications

Mental status changes

Manic behavior

Any change in affect

Confusion

Not eating/sleeping properly

Somnolence/Agitation


Challenges

Equipment needs change

Potential for additional surgery

Medications may be contraindicated or no longer effective

Liver and Kidney issues

Loss of family caregiver/support

Are all these changes related

Is anyone monitoring who is prescribing what medications


A Classic ExampleThe literature on the management of ankle fractures in patients with diabetes has shown outcomes to be generally poor

42.3 % incidence of complications in patients with diabetes compared to people without (McCormick and Leith)

Conservative management may be preferable to surgical treatment

32 % higher infection rate found in people with diabetes ( Flynn, et. al.)

Those patients with diabetes who were treated conservatively had a greater tendency to become infected over those who treat with open reduction internal fixation (ORIF)

People with diabetes who are poorly controlled and had evidence of neuropathy were shown to be very difficult to manage


Prolonged Recovery04-29-1997 06-30-1997


Mitigating Risk

With varying perspectives on what constitutes an older worker, there is no set definition.

The Age Discrimination in Employment Act of 1967 (ADEA) applies to individuals aged 40 and over

The majority of workers in their 50s work full-time regardless of health status.3

These workers are often affected by health conditions that can limit their ability to work.

More than one-third (35%) of workers in their 50s who report being in fair to poor health indicated that a health condition limits the type or amount of work they can do


OBESITY – ICD 9 278 Obese claims are 2.8

times more expensive than non-obese claims at the 12-month maturity

This cost difference climbs to a factor of 4.5 at the three year maturity and to 5.3 at the five year maturity

The cost difference (at the five year maturity) is less for females than for males


Obesity Related Co-Morbidities

Hypertension Dyslipidemia Diabetes Coronary Heart

Disease Stroke Gallbladder Disease Some Cancers

Osteoarthritis Orthopedic Problems Impaired Mobility Peripheral Vascular

Disease Liver &Kidney Failure Sleep Apnea


Overly involved family members

Over time, patients adapt to their conditions and some stop working out

Stop using prescribed equipment or agreeing to therapy

Family prevents nursing from completing necessary interventions

Physicians and nurses will not pursue aggressive treatment when a patient refuses


A Costly Scenario 35 year old Quad

Recurrent Hospitalizations for Respiratory Failure

Average cost per hospitalization~ $76,500.00

Average time between hospitalizations~ 3 weeks

8 Hospitalizations over 6 months

$1,224,000.00 annual expense/hospitalizations

24 Hour/day RN @ $96.50/hour~ $2,316.00/day

CNA 17 Hours/day @ $32.50/hour ~ $552.50/day


Proactive Interventions Back to inpatient rehab for a “tune up”

Re-education for Family (the medically necessary reason to use the respiratory aids in the home)

Re-education regarding the need to allow the nurses to complete physician orders

Installed ceiling lift system $22,395.73

Purchased Cough Assist and Suction Pump $10,211.28

Changed Nursing Agencies (lowered hourly rates)

Lowered level of care from RN to LPN/LVN

Total Spend $58,767.01

Total Estimated Annual Savings $1,446,467.50


How do you implement needed change

This is when the case needs the home health care professional to transform into a super educator

It’s essential to demonstrate how the equipment, treatment or other therapeutic change will speed recovery, enhance quality of life, and extend a person’s independence

That – along with controlling the costs of claims – is the whole purpose of pro-actively managing any claim


NCCI Reports

Pharmacy costs are 19% of total medical spending

in Worker’s Compensation


Physician Dispensing Varies by State


Narcotics Share of Paid Rx


Drug Deaths Now Outnumber Traffic Fatalities in US

Approximately 38,000 deaths annually

1 death every 14 minutes Death toll has doubled over

the last decade Prescription Drugs now

cause more deaths than Heroin & Cocaine Combined

OxyContin Habit can run twice as much as a Heroin Addiction

Most commonly abused Drugs

OxyContin Fentanyl Actique Vicodin Xanax Soma


TOP 50 DRUGSOXYCONTIN®LIDODERM®HYDROCODONE-ACETAMINOPHEN LYRICA®CELEBREX®GABAPENTINSKELAXIN®CYMBALTA®MELOXICAMCYCLOBENZAPRINE HCLTRAMADOL HCLOMEPRAZOLEFENTANYLFLECTOR®OXYCODONE HCLULTRAM® EROXYCODONE HCL-ACETAMINOPHENCARISOPRODOLNAPROXENKADIAN®ZOLPIDEM TARTRATEOPANA® ERAMRIX®TIZANIDINE HCLAMBIEN CR®

PERCOCET®IBUPROFENNAPROXEN SODIUMOXYCODONE-ACETAMINOPHENACTIQ®ENDOCET®AVINZA®LUNESTA®DURAGESIC®NEXIUM®LOVENOX®FENTANYL CITRATEMORPHINE SULFATEEFFEXOR XR®DENDRACIN, NEURODENDRAXIN®TOPIRAMATETOPAMAX®DICLOFENAC SODIUMPROPOXYPHENE NAP-ACETAMINOPHENETODOLACNABUMETONEPROVIGIL®LEXAPRO®ZANAFLEX®SEROQUEL®


Adherence/Efficacy

All individuals are different

Slow Metabolizers

Fast Metabolizers

Non Metabolizers


Based on adherence studies…

Less than 30% of claimants take their medications as prescribed

More than 30% fill their medications but do not take them

More than 30% take additional medications and/or substances that can reduce or eliminate the efficacy of the prescribed medications


Thank You

Kevin Glennon, RN, BSN, CDMS, CWCP, QRPVP Home Health & Complex Care Services

One Call Care ManagementPhone: 800-700-9393 ext. 2048

Fax: 407-710-1683Cell: 407-448-5879

[email protected]


• NCCI Publishes New Research on Prescription Drug Expenditures• Posted Date: September 26, 2013• Source: NCCI Medical Data Call, for Service Year 2011. • The 35 jurisdictions for which NCCI provides ratemaking services are AK, AL, AR, AZ,

CO, CT, DC, FL, GA, HI, IA, ID, IL, KS, KY, LA, MD, ME, MO, MS, MT, NE, NH, NM, NV, OK, OR, RI, SC, SD, TN, UT, VA, VT, and WV. The seven independent bureau states for which NCCI collects the Medical Data Call are IN, MA, MN, NC, NJ, NY, and WI.

• Data used with permission. • Source: NCCI Medical Data Call, for all states except CA, DE, MI, PA, and TX, which

were derived from sample data provided by carriers • Relative Service Years 1 through 10 • Data used with permission • Source: NCCI Medical Data Call, for all states except CA, DE, MI, PA, and TX, which

were derived from sample data provided by carriers • Relative Service Years 1 through 10 • Data used with permission

References

Documents

Game Changing Strategies to Transform Workers’ Compensation Results