Executives from Enlyte provided their perspective on the impact of pharmacy, (including medical marijuana), return to work and mental health treatment trends in the field of workers’ compensation.By: Susannah Levine | January 14, 2022Topics: Workers’ Comp | Workers’ Comp Forum

Enlyte experts from disparate disciplines reflected recently on three emerging and future trends in workers’ compensation.

Enlyte is the parent company of Mitchell, Genex and Coventry, which provides technology, clinical services and network solutions for the property and casualty insurance industry.

1) Technology

COVID-19 accelerated the adoption of technology by five to 10 years in 2020 and 2021, and that trend will continue beyond 2022, predicts Rebecca Morgan, vice president, product management, Mitchell.

While automation, data analysis and digitization are familiar territory to many in the risk management industry, stay-at-home orders motivated late adopters to replace manual processes involving paper, such as billing, with electronic processing.

Not only do they not require a physical presence, Morgan said, but digitization reduces “friction”: getting lost in the mail, scanning the paper, inputting data, even the time spent opening envelopes.

Payments made by paper check are also expensive, she said, four to 30 dollars per check, according to Mitchell estimates, whereas electronic payments reduces the cost by 60% to 90%.

After the heroic level of effort spent equipping an entire workforce to work from home, the industry got a taste of the possibilities greater automation can offer, Morgan said.

While it’s hard to predict the risk issues around the corner, by implementing the latest technology, claims organizations “are better prepared to navigate whatever comes next.”

Rebecca Morgan, vice president of product management, Mitchell

That includes new employee training, with its sacrificed first weeks of employment and cumbersome three-ring binders.

“Technologies such as predictive analytics, automation and digitization will help employees get up to speed quickly” by directing their attention to “information they need when they need it.”

This is also true for claims adjusters and bill reviewers, who switch jobs frequently.

According to a 2020 study by the Bureau of Labor and Statistics, employees change jobs every 4.1 years. This requires claims organizations to have a solid plan around training and retraining new employees.

“Thousands of conditions and permutations could pop up on a single claim,” Morgan said, more than a human can keep track of, especially an inexperienced human. But not technology.

When those thousands of conditions and permutations are programmed into the technology, machine learning and predictive analysis put next steps front and center. Those include conditions that trigger intervention even seasoned adjustors might not have caught.

With a constantly retrained workforce, “newcomers can perform better, faster,” Morgan said.

2) Mental Health and Return to Work

Mental health was at the forefront of employers’ minds even before the pandemic, and it’s even more so now, said Tammy Bradly, Enlyte’s senior director, clinical product marketing.

Employers and insurers should work with their workers’ comp PPOs to ensure their networks include credentialed mental health providers when needed, she advises.

There are practical as well as moral reasons to do so, Bradly said.

About 25% of America’s workforce lives with depression, which sets off a chain reaction: productivity falls from absenteeism, which leads to lost revenue for the employer and strained relationships with its customers. Employees with depression often fall out of work twice as often and have five times the “lost productive time” as their cohorts.

“When we think about poor mental health, few of us would likely put it at the top of the list for most costly illnesses,” Bradly said. “But when you account for direct (health care/treatment) and indirect costs, mental disorders top the list of the most burdensome and costly illnesses in the United States at over $200 billion a year.”

Pre-pandemic, 10% of the workforce reported depressive conditions; now four in 10 do, according to Mental Health America. Bradly cited a McKinsey study finding that 23% of employees with mental health or substance abuse conditions drive 60% of overall workers’ comp medical spending.

Mental health and physical health conditions are inextricably entwined. Those who live with one are more likely to live with the other.

Getting hurt on the job brings a heightened risk of mental hardship. An HHS study revealed the likelihood of injured employees being treated for depression was 45% greater compared with employees who were not injured.

Tammy Bradly, vice president of clinical product development, Coventry

The pandemic era has brought a fresh wave of mental health challenges to the workforce. While many American employees who experience COVID-related isolation, loss and anxiety often have limited access to mental health treatment, Employer Assistance Programs (EAP) remain a promising alternative.

Thanks to social changes, including testimony from prominent athletes about their own mental health struggles, mental health issues are shedding some of the stigma that inhibited many workers from seeking help through their EAPs in the past. Company leadership also has a role in educating employees about the value of seeking help when they need it.

Employers and insurers should look at strategies to intervene on workers’ comp claims before they become problematic, Bradly said, using technology such as predictive analytics.

“We can look at claims data and identify from Day 1 which claims should be clinically managed,” she said. “Then companies can put their clinical assets on the right claims.”

Case managers can serve as resources for identifying underlying psychosocial barriers that may impact an injured employee’s recovery and return to work.

“Who on the care team knows the employee and, likely, the family better than the case manager?” Bradly said.

The case manager may be the first to spot when an injured employee experiences poor mental health. That doesn’t always mean sending the worker out for psychiatric evaluation.

“It may simply just mean providing support, coaching, education and self-help methods. The case manager can help the injured employee build resilience by providing self-help educational material around relaxation, mindfulness and even meditation activities to improve their mental wellbeing.”

If a higher level of intervention is required, the case manager can discuss with the claims handler and provider and assist in coordination of the referral.

3) Pharmacy and Marijuana Trends

The good news: opioid use continued to fall between 2019 and 2020, according to Mitchell Pharmacy Solutions data, and the trend will continue, said Mitch Freeman, senior vice president and chief clinical officer, Mitchell.

He attributes the trend to a combination of factors. First, the insurance industry has leveraged the Center for Disease Control’s guidelines for appropriate prescription of opioids as clinical data in acceptable care.

“Pharmacy benefits managers are good at stopping early opioid use,” he said. When use is nipped in the bud, the risk of long-term use and addiction falls precipitously.

The industry has also developed risk-scoring algorithms that identify which claims are at risk of escalating. That early-warning signal “triggers us to reach out to the prescribing physician to get the claim back on track,” Freeman said.

The system is solid but not perfect. In some cases, the patient is already addicted, and then no intervention will help. Then the patient is referred to opioid use and misuse treatment.

Treating physicians are often unaware of how the prescription they write is actually dispensed, Freeman said. He cites a “classic” example: a physician prescribes Lortab (generic hydrocodone) to a post-surgical patient for pain. The doctor prescribes 84 tablets – one to two tablets every four to six hours as needed for pain for a week – often the standing orders built into the hospital’s protocol.

As a precaution against misuse, there are no renewals. Patients must make another appointment to get more.

The pharmacist dispenses the 84 tablets. The patient takes them around the clock – not as needed for pain.

“The patient is on the way to addiction,” Freeman said.

The outlook for marijuana, a less insidious but still problematic drug, is “hazy,” he said. As states legalize medical marijuana, legal recreational use follows, a trend the risk community is watching carefully.

The concern, Freeman said, is whether the workers’ compensation carrier is obliged to cover the script for medical use. In some jurisdictions, such as New York, “the questions physicians and carriers ask are, How do I monitor usage? How do I control and track usage and effectiveness?”

The answers are elusive because of the lack of quantification; because there are no standardized codes for marijuana, it’s hard to see when, where, and by whom the drug is used.

The fact that it is still illegal federally complicates the matter. When prescribed, it is not reimbursed to pharmacies but to patients. Many patients who qualify for medical marijuana cards don’t bother “jumping through the hoops” to obtain them, Freeman said, opting instead to buy their marijuana through legal recreational stores or underground markets. &Susannah Levine writes about health care, education and technology. She can be reached at riskletters@theinstitutes.org.