Executive Summary« Read Less
Conducted in-person at NWCDC 2019 and via online through Risk & Insurance, the 2020 Workers’ Comp Industry Insights Survey drew responses from 669 industry stakeholders, all of whom first identified their organization type and individual role. This allowed us to analyze results collectively, while also examining the ways in which views sometimes varied between industry segments and professions.
Three issues stood out as being top-of-mind for the vast majority of participants: the changing workforce population; comorbidities/poor worker health; and the increasing complexity of claims. With some minor exceptions, these were considered the top three challenges for our industry. And we see clear connections between these challenges. For example, older workers, the most impactful population trend by a wide margin, are more likely to suffer comorbidities, which are a leading contributor to complex medical claims.
Growing concern about the ability to manage claims was revealed in multiple incidences throughout the survey. For example, claims process/workflow automation was consistently selected as the #2 most important technical advancement over the next 3 – 5 years (telemedicine was #1). And over 80% of participants agreed that the greater complexity of claims is requiring more clinical decisions to be made during the claims management process. Those decisions put additional pressure on claims professionals and case managers already under heavy workloads, increasing the risk that something will be missed.
Arguably the biggest risk for workers’ comp programs over the past decade has been opioid abuse, but concern about opioids appears to be on the decline. Opioid abuse did not make it into the list of top 5 industry challenges in this year’s survey (as compared to #3 last year), nor did participants see it as a top health or claims risk. As an industry, we have made progress in curbing opioid abuse, but we still have work to do and it would be premature to claim victory. A view apparently shared by insurance carriers who bucked the trend by ranking opioids/substance abuse their #1 claims risk.
PTSD and other mental health conditions have surpassed opioids as a perceived challenge and risk. This is probably due to a combination to two factors: an increasing number of states expanding coverage for first responders and an overall increase in reported incidences of mental health conditions, driven in part by the large number of millennials now in the workforce who are more likely to experience and seek treatment for conditions such as anxiety and depression.
Escalating medical costs was the #1 challenge for survey respondents in last year’s survey, so we dug a little deeper this year and learned that containing hospital costs is the top priority overall, followed by Rx drugs and physician/professional fees. Responses to the cost question tended to vary, however, depending on the type of organization or individual role. For example, insurance carriers were more focused on Rx drug costs than hospital costs and participants in clinical roles put physical medicine ahead of physician/professional fees.
The aging workforce and increased prevalence of comorbidities (among both older and younger workers) are contributing to more complex claims, as well as other challenges for workers’ comp. The average worker age in the insurance and healthcare industries is also rising, and a wave of retirements will likely lead to a shortage of experienced people to process claims and care for injured workers, just as demand is increasing
Technology will help to bridge the gaps. Increased use of telemedicine in workers’ comp will help alleviate long wait times to see physicians and should also make those visits less expensive. Improved claims automation will allow claims professionals to focus their time and attention where it is most needed, , help guide clinical decisions, and improve communications between the claims and care management teams. Enhanced data visualization and predictive analytics will be crucial in detecting and mitigating risks early in the claims process. And we should expect new risks.
We know from past experience that changes are often accompanied by unexpected consequences. New drugs to treat chronic pain brought the opioid crisis, and the current movement away from opioids could lead to other forms of inappropriate prescribing. Treating comorbidities may result in polypharmacy and the risk of adverse drug reactions. Medical innovations, such as biologics and new medical devices, present new opportunities for promising treatment alternatives, but also for fraud, waste, and abuse. And legislative changes, such as expanding coverage for PTSD and other mental health conditions will help many patients receive much-needed treatment but might also increase caseloads and costs.
The 2020 Workers’ Comp Industry Insights Survey shows us that workers’ comp professionals are keenly aware of the wide-scale changes taking place. Our job as industry leaders is to anticipate the implications of those changes and prepare for them.
report changing population is a top industry challenge
report complex claims mean more clinical decisions for claims management
report better claims efficiency will lower medical costs
report top claims risk is the failure to detect early warning signs before they escalate
Overview of Participants
669 industry stakeholders responded to the survey:
- Employer 214
- Brokerage 92
- Insurance Carrier 88
- Healthcare Provider 69
- State/Government Agency 54
- Consultancy 50
- Third Party Administrator 30
- Law Firm 26
- Managed Care Organization 23
- Other 23
to Reveal Organizations
PARTICIPANT INDIVIDUAL ROLES
- 154 Claims Management
- 141 Executive Leadership
- 120 Risk Management
- 89 Broker/Agent
- 37 Legal/Regulatory
- 33 Clinical/Case Management
- 28 Healthcare Provider
- 16 Medical Program Management
- 8 Procurement
- 43 Other Roles
Top Industry Challenges
The top 5 biggest challenges facing the workers’ compensation industry in 2020
The changing workforce/population demographics
Increasing complexity of claims
Comorbidities and poor worker health
New and expensive medical treatments
Regulatory and legislative changes
Executive leaders ranked regulatory and legislative changes more highly than any other group, ranking it as their second most important challenge.
The top 5 challenges for participants’ workers’ comp programs in 2020
Comorbidities and poor worker health
Increasing complexity of claims
Changing workforce population
Opioids and substance abuse
Mental health exposures
All roles were in agreement on the top 3 program challenges EXCEPT medical program managers whose top 3 challenges were:
- 1. Opioid and substance abuse
- 2. New and expensive medical treatments
- 3. Mental health exposure/PTSD coverage
Population trends that will have the biggest impact on workers’ comp programs in 2020
Millennial/younger worker influence
Temporary/gig worker trend
First responder coverage
Racial, ethnic and gender diversity
The aging workforce was the #1 population challenge across all organizations and roles.
Most important technologies over the next 3-5 years
Claims processing/workflow automation
These were the top 3 technologies selected by most roles with the exception of executive leaders who ranked Artificial Intelligence as the 2nd most important technology.
Most concerning health risks within claims populations
Respondents across the board ranked chronic pain their top concern and almost put mental health/PTSD ahead of opioids and substance abuse, which could indicate a shift in workers’ comp medical management priorities.
Medical cost containment priorities in 2020
Rx Drug Costs
DME, diagnostics, and other ancillary benefits
Insurance carriers differed slightly with overall results, ranking Rx drugs costs as their #1 area of focus and hospital costs #2.
Most concerning claims risks
Not detecting claim warning signs early enough
Charges for medical services unrelated to workplace injury
Injured worker opioid/substance abuse
Lack of transparency into medical prices
New medical treatments and drugs
Insurance carriers ranked injured worker opioid substance abuse as their #1 risk. Claims managers and clinical/case managers selected comorbidities as the #1 risk.
Most to least agreed statements on current topics
The increasing complexity of care is requiring more clinical decisions to be made during the claims management process
Improved claims efficiency can help lower medical costs
The aging healthcare workforce and anticipated physician shortage will drive up medical costs in workers’ comp
Prescription drug activity is an early and reliable indicator of potential risks
Medical marijuana will be covered by workers’ comp insurance in more state over next 2-5 years
Medical advance and new treatment present new opportunities for FWA
The cost saving potential from ancillary benefits (i.e. DME, Transportation) is underestimated by many workers’ comp payers (only statement that had more neutral and disagree than agree)
Claims managers most agreed that improved claims efficiency can help lower medical costs, while risk managers most agreed that the anticipated physician shortage will drive up medical costs in workers’ comp.