February 28-March 1, 2019, marked the 35th annual Workers Compensation Research Institute (WCRI) Issues and Research Conference. The theme of this year’s event, “Breaking Down Barriers to Improve Injured Workers’ Outcomes,” signified two core ideas that were evident in each session. The first was that workers compensation can no longer operate in a silo. As the phrase “continuum of care” continues to permeate the healthcare industry, workers compensation systems are broadening the scope of their work to include effective prevention, treatment, rehabilitation, and return to work strategies. Second was the importance of treating injured workers not just as patients and claimants, but as participants in the workforce as a whole—and thus, an important indicator of the nation’s economic health.
Opioids in Workers Compensation
The Opioids in Workers Compensation session shared both critical data points and updates from key states. For instance, according to research conducted by the WCRI, older workers (55 years of age and over) receive more opioids prescriptions than younger workers. Additionally, among 11 industries analyzed, the mining, construction, and fishing industries comprise the highest percentage of opioid prescriptions. While it is possible that these are higher-hazard industries—thus leading to more severe worker injuries—this does not explain the rising opioid overdose rate in the U.S., which has been steadily increasing since the late 1990s and has increased over 250% since.
Speakers noted that Massachusetts and Arizona both saw record-breaking opioid-related deaths statistics since 2011, with Arizona having the highest-ever recorded number of overdose deaths in 2017. States have responded to this issue in numerous ways, from declaring a state of emergency (as in Arizona), to revamping workplace prevention efforts and return to work programs. Following the declaration of a state of emergency, the Arizona Department of Health Services completed a series of emergency response deliverables in support of the Opioid Action Plan and the Arizona Opioid Epidemic Act. These efforts have resulted in an increased in availability and access to Naloxone, a life-saving medication that can reverse opioid overdoses. Furthermore, Arizona now requires that prescribers and pharmacists check the Controlled Substances Prescription Monitoring Program prior to dispensing prescriptions, and has implemented dosage restrictions on opioid prescriptions (such as a 5-day limit for initial fills).
Return to Work Programs and On-Going Initiatives
The Institute for Work and Health’s session on Return to Work Programs and On-Going Initiatives highlighted the paradigm shift taking place in some of these programs. Instead of focusing solely on getting workers back onto the payroll, they aim to truly targeting rehabilitation and other re-integration efforts through coordinated, evidence-based, and outcomes-driven services. The presentation focused on an evaluation conducted at a large, 4,300-member health care system in Ontario, which demonstrated the feasibility of implementing a complex, multi-component disability management policy with positive outcomes. The collaborative model adopted by the organization included inputs from union representatives, and strongly emphasized timeliness and transition-planning among union representatives and supervisors. This model and its results will likely provide inspiration for other workers compensation program administrators going forward.
Telemedicine has become a buzzword in the medical community over the past few years—with the concept having made its way into the realm of workers compensation, the conference’s Challenges in Telemedicine session was of interest to many attendees. Overall, uncoordinated systems and a lack of clear regulatory parameters continue to pose challenges to the success of telemedicine within workers compensation; no quantitative data on the use of telemedicine in workers compensation currently exists, and regulatory parameters remain highly fragmented from one state to another.
The intersection of Group Health Deductible and Workers Compensation was also explored at this year’s event. According to the Kaiser Family Foundation, the average group health plan deductible has steadily increased since 2008, along with an increase in enrollments in high deductible plans—both of which impact workers compensation claims. The WCRI found that the impact of these high deductible plans is more evident in specific types of claims (such as those related to soft tissue), demonstrating how certain injuries are more sensitive to cost-sharing mechanisms than others.
The Nationwide Workers Compensation Trends session highlighted a notable shift in payments from hospital outpatient facilities to ambulatory surgical centers (ASCs) that occurred between 2011 and 2016. This finding supports the larger healthcare industry trend of increased utilization of ASCs for outpatient surgeries as a cost-cutting mechanism for avoiding facility fee payments. Speakers noted, though, that many of the observed nationwide trends are undermined by the extreme variation in states’ reimbursement rules.
Another session focused on the question, Are Workers Compensation Benefits Declining? According to the National Academy of Social Insurance, the ratio of workers compensation benefits paid as a proportion of total wages has been decreasing since the 1990s and is currently at its lowest level since the 1980s. Certain groups have interpreted this trend as a reflection of an overall erosion in benefits offerings. However, when analyzing these trends, it is necessary to consider factors such as increased workplace safety (rather than decreased reporting) and declining workplace accident rates worldwide. These declining accident rates are apparent in all industries and developed nations.
Finally, several key workforce trends were shared during the Policies Impacting Workforce Now and the Future session. These ranged from the impact of the opioid epidemic on the labor force to the overall outlook of the U.S. and global economy. While the dire predictions associated with automation have not fully come to fruition, it is expected that automation will disproportionately displace jobs for low skilled workers and provide little to no replacement alternatives.
Overall, the workers compensation realm faces challenges and barriers that reflect those commonly found in the broader healthcare space. Lack of coordination, interoperability, and visibility into outcomes (both in terms of wellness and cost) continue to hinder organizations’ ability to curate timely programs that target the critical moments following the point of injury. The Issues and Research Conference provided a valuable venue for the convergence of industry experts currently working to identify these optimal windows and the strategies to be used within each of them. The emphasis on collaboration and coordination demonstrated throughout the event closely mirrors the ongoing efforts in the healthcare field overall to leverage a holistic approach to cost-containment through data-driven care-planning strategies.