Healthesystems paired up with Risk & Insurance magazine to survey more than 500 workers’ comp professionals to weigh in on the top concerns, challenges, and successes for their programs in 2019 and beyond.
Approximately 512 industry stakeholders responded to the survey and results are delineated by role for additional perspective.
Claims Management
28%
Risk Management
24%
Program Management
11%
Cost Containment/
Procurement
Legal/ Regulatory
5%
Medical Services
3%
Other
20%Do you agree that communication between stakeholders is a major challenge in managing benefits for injured workers?
What do you see as the biggest challenge for your workers’ comp program in 2019 and beyond?
Escalating Medical Costs
45%Comorbidities and
Worker Health
Opioids/Substance Abuse
38%Growth of Complex Claims
34%Mental Health Exposures
30%Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
#1 challenge among Claims Management segment
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
Opioids remain a top challenge for 2 of 5 overall respondents
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
31% of Risk Management view this as a top challenge
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
1 of 3 Cost Containment/Procurement professionals consider a top challenge
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
With medical costs approaching 70% of claim costs in workers’ comp, it’s unsurprising that professionals across industry disciplines view this as a top concern.
Note the related aspect of the top 5 answers. Factors such as patient comorbidity, inappropriate prescribing or use of opioids, claim complexity, and psychosocial factors all are drivers of medical costs if left unmanaged. Notably, Mental Health Exposures are becoming a more significant consideration as legislation covering mental-only injury in vulnerable populations (e.g., PTSD among first responders) is gaining momentum across a number of states.
Of the four most-represented roles in the survey, those in a Claims Management role were the only segment not to prioritize escalating medical costs as their #1 concern. Comorbidities/Poor Worker Health and Growth of Complex Claims were higher priorities for this segment.
What industry trend do you think will have the biggest impact on your workers’ comp program in the next year?
Drug Trends
44%Technology
28%Medical Innovation
11%Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
Professionals in Cost Containment/Procurement Identified Technology as the #1 Trend
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
1 in 10 Risk Managers thinks disruptors like pharmacogenomics and medical devices will have the biggest impact
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
Of the choices provided, Drug Trends was the trend that respondents viewed as having the biggest impact on their program over the next year. Examples included specialty pharmacy, opioids, and medical marijuana.
Despite decreases in opioid prescribing rates, they still represent an overly large portion of pharmacy and overall medical spend due to their negative downstream impacts. Add-on therapies for opioid side effect management cost about 4x more annually than the cost of opioid therapy alone 1 – and this is just the tip of the iceberg when considering more severe impacts including ER visits and hospitalization, delays in functional improvement, and extended claim durations.
Those in Cost Containment/Procurement were the only segment that did not rank Drug Trends #1 – Technology trends such as telehealth and wearables earned the top spot among this group. There were also a number of write-in answers for trends around Analytics and employee Health & Safety.
Rank the below items in order of priority for your organization’s workers’ comp program.
Cost Containment
47%Program Efficiencies
23%Clinical Management
22%Market Differentiation
8%Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
1 in 3 Risk Managers and Program Managers ranked as #1 priority
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
58% of Nurse Case Managers ranked as #1 priority
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
21% of Executive Leaders view this as the #1 priority. Another 29% view it as the #2 priority after Cost Containment
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
Respondents overwhelmingly selected Cost Containment as the #1 priority for their workers’ comp programs. But Program Efficiencies and Clinical Management, which follow closely, are key components of cost containment, with 30% of every healthcare dollar wasted in the U.S. due to factors such as system inefficiencies and unnecessary or wasteful services.2
Programs that promote efficiency through intelligent claim workflows and easy-to-use interfaces directly contribute to overall cost reductions, while integrating a clinical focus has immediate and long-term impacts on utilization of pharmacy, as well as other ancillary medical services such as durable medical equipment or physical therapy – where clinical data have traditionally not existed in a consumable or actionable way within the claims management process.
There were some differences in the prioritization mix outside of the four most-represented segments. Nurse Case Managers and Medical Providers selected Clinical Management as their #1 priority. And those identifying as Executive Leadership place a heavy focus on Market Differentiation; they were the only segment to prioritize this answer right behind Cost Containment.
What workers’ comp program has your organization implemented that you’re finding the most success with?
Opioid Management
22%Medication Therapy
Management
Population Management
16%Technology
16%Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
Program Managers cite this as their most successful area of program results
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
27% of Risk Manager are seeing success from implementing some form of a population management model
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
1 of 4 Cost Containment professionals feel implementation of tech-focused programs such as mobile strategy or telehealth has been successful.
Claim Management
Risk Management
Program Management
Cost Containment/ Procurement
Respondents aren’t just worrying about challenges. They are tackling them head-on through program implementation. And this question represented the highest diversity in answers among the respondent segments.
1 in 3 Claims Management professionals feel good about the progress they are making in Opioid Management, while Risk Managers are focused on Population Management – an evolving conversation as workforce composition shifts to accommodate an increase in workers aged 55+, an influx of millennial workers, and a growing portion of self-contractors in today’s “gig” economy.
The most successful program implemented by Program Managers is some form of Medication Therapy Management, through which a clinician directly engages with a patient to address concerns in his or her medication regimen. While we know that an engaged injured worker is vital to recovery, it’s important to also consider the way in which we are engaging them – and direct clinician-to-patient outreach has proven effective. A survey published in the New England Journal of Medicine reported the top tactics for improving patient engagement to be 1) clinicians spending more time with patients and 2) shared decision-making. 3
A significant number of write-in answers also referenced Employee/Return to Work programs.
Informing you on current and emerging issues impacting workers’ comp since 2011.
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