Roberto Ceniceros

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at rceniceros@lrp.com. Read more of his columns and features.

NWCDC Chairman's Message

Deadline Nears for NWCDC Speaker Proposals

Time is almost up for submitting speaker proposals for the 2016 National Workers’ Compensation and Disability Conference & Expo.
By: | February 4, 2016 • 3 min read
NWCDC 2014

Don’t miss the approaching deadline for submitting proposals to speak at the 25th annual National Workers’ Compensation and Disability Conference® & Expo.

NWCDC is attended by workers’ comp and disability management decision makers, including employers and a broad range of service providers.

Last year’s speakers and the ideas they presented at NWCDC in Las Vegas remained hot topics and received mentions in workers’ comp and disability management industry media and social media for many months following the conference.

The only way to qualify is to begin by meeting the deadline for submitting a session proposal idea. The deadline is Friday, February 26, with applications available on the conference website.

After being held in Las Vegas for many years, the conference will shift venues for 2016, taking place Nov. 30 through Dec. 2 at the New Orleans Ernest N. Morial Convention Center.

Potential topic proposals that NWCDC’s speaker selection committee is eager to evaluate include:

  • Injured employee advocacy strategies
  • Urine drug testing and its coordination with pharmacy benefit management strategies
  • The application of value-based care, including accountable care organization use.
  • Medical guidelines, and how best to apply them.
  • Occupational and non-occupational return-to work-strategies meeting ADA compliance.
  • Pharmacy formularies and claims management opportunities.
  • Psych claims and managing psych issues embedded within claims.

Those are just a few of the topic areas we are interested in hearing about from employers, vendors, attorneys, medical providers, regulators and other workers’ comp professionals. We are eager to hear other great topic ideas.

Overall, the conference looks for panels and individual speakers to present strategies that will help worker’s comp and disability claims payers solve claims challenges, teach best practices for selecting and managing service providers, or can enlighten on industry trends.

Presentation proposals can focus on new, innovative strategies that reduce injuries and costs. But risk managers, workers’ comp managers, and disability managers are also welcome, for example, to share their unique experiences with adopting tried-and-true practices at their companies.

Disability management strategies for workers’ comp and non-occupational drivers of employee absence are of interest to us.

If you or your company plans to submit a proposal for a session presentation, please keep in mind that we do prioritize those submissions that include an employer on the panel.

However, we also understand that not all presentations can include an employer speaker and we value the knowledge and information that other workers’ comp professionals serving the payer community bring to the conference.

Here is some advice to increase the potential for having your RFP selected:

  • Consider submitting multiple RFPs because we sometimes receive several proposals from different companies wishing to speak on the same topic. We may only select one presentation per topic in such cases. Submitting multiple RFPs provides an alternative when one of your ideas is a popular one among several submitters.
  • Select topics with relevance for a broad range of workers’ comp professionals. The greater the relevance and the stronger the speaker’s experience and knowledge, the greater the possibility of being selected.
  • Avoid submitting proposals that are mere product or service pitches featuring company personnel responsible for sales or marketing.

For further discussion on potential presentation content, feel free to contact Conference Chairman Roberto Ceniceros at (208) 286-1425 or rceniceros@lrp.com.

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at rceniceros@lrp.com. Read more of his columns and features.
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Opioid Management

Putting UDT to the Test

Data analytics help pinpoint which opioid patients need more or less urine drug screening.
By: | January 20, 2016 • 4 min read
painkiller

Rick Miles M.D. practices medicine in the Appalachian region of Kentucky known for rampant prescription opioid drug abuse, and now the increased use of heroin following measures to shutter area pill mills.

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He knows that many local physicians work diligently to help stem drug abuse by appropriately requiring urine drug testing to monitor patients prescribed addictive opioids.

But he also knows that some doctors over utilize drug testing to increase revenue. And still other physicians are too pressured by business demands to see whether more testing is appropriate for certain patients prescribed the narcotic pain killers.

“It’s hard to get it right,” Miles said of the level of drug screening necessary to assure pain-management patients are neither selling narcotics prescribed to them, nor supplementing consumption of their prescriptions with illegal substances.

Increasingly, though, the workers’ compensation industry is trying to get it right by turning to data analytics to determine the amount of urine drug testing that is optimal for individual patients.

Under a program launched in November, for example, Coventry Workers Compensation Services analyzes its pharmacy benefit management data to identify risk and medical factors that can help pinpoint the level of urine testing beneficial for specific claimants, said Dannielle Foroozandeh, Coventry director of pharmacy product development.

Risk factors that Coventry looks for include: prescribed drug dose amounts, the mix of drugs prescribed, comorbid psychiatric diagnosis such as depression, and any history of abuse or addiction.

“We incorporate all that into our algorithm to identify the overall risk for that patient,” Foroozandeh said. “We can actually become more precise on the patients who should be getting tested more versus those who should be getting tested, but maybe not as frequently.”

Coventry can then relay the information to adjusters and claimants’ doctors in hopes of promoting the efficient administration of urine drug testing (UDT).

The effort follows the rapid rise of various forms of UDT in recent years. Treatment guidelines call for testing when doctors prescribe opioids to any patient, but there is lack of agreement on the appropriate level of testing, leading to criticisms that excessive UDT has become a profit generator for drug-testing companies and physicians billing for urine sample analysis in their offices.

In California alone, claims administrators paid $108 million for UDT performed on injured workers between 2002 and 2014, according to a California Workers’ Compensation Institute report released in October, 2015.
CWCI found that from 2007 to 2014, UDT reimbursements increased from 23.1 percent to 77 percent of all workers’ comp lab payments.

“Absent an accepted empirical, evidence-based protocol on the appropriate level and scope of testing, it is difficult to reconcile the noted increases in the volume and variety of drug testing with clinical appropriateness and favorable outcomes for the injured worker,” the CWCI report said.

In contrast to the excessive application of UDT, the Workers Compensation Research Institute has previously reported that many physicians prescribing narcotics do not use tools, such as UDT and psychological evaluations, recommended for monitoring pain-medication patients to prevent drug abuse.

That is where Coventry’s program can play a role alerting doctors when more testing should occur. Because Coventry recently launched the service, however, its effectiveness in controlling costs remains to be measured. That goal that will soon be realized, though, the company said.

A majority of claim alerts that Coventry sends to adjusters are resulting in approval of UDT for specific patients.
“Which basically shows us we are identifying the right patients,” Foroozandeh said. “We are not going for the lower risk candidates; we are going for the high risk.”

As the program matures, Coventry plans to combine UDT data with other information, such as bill review data, to uncover which doctors may be driving unnecessary costs by over-utilizing the testing.

Combining PBM data and UDT frequency data could also expose cases where test results show a patient should be weaned off opioids, but the doctor continues to prescribing the drugs while simultaneously continuing to bill for UDT services, said
Stacy Jones, senior research associate at CWCI.

“The tests are valuable when they are used right and it would be nice if they were actually used the way they were intended, and that is to monitor whether the patient is or isn’t adhering to their treatment plan, not just getting tested for the sake of getting tested,” Jones said.

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In Kentucky, meanwhile, Miles the M.D. sees business and financial pressure on physicians impacting the frequency with which they test patients.

In the past, doctors might have spent 40 minutes with a patient. That has been reduced to perhaps 15 minutes, an inadequate amount of time to ask questions that can determine whether more testing is appropriate, Miles said.

Conversely, about 25 percent of physicians will rationalize the need for more UDT when they are sold UDT equipment that is used in the doctor’s offices, he said.

“The company comes in and says ‘put this machine in your office, and you do so many a month and you can make this much money.’ So they are doing it for profit,” Miles said. “But people have to understand, and especially workers’ comp has to understand, everybody has reduced what they pay physicians.”

Miles said he foresees increased scrutiny of doctors to evaluate their prescribing of opioids and their frequency of testing. Thanks to data analytics, that scrutiny is already starting to intensify.

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at rceniceros@lrp.com. Read more of his columns and features.
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Market Outlook

Workers’ Comp Renewals Stable for 2016    

While insureds with losses can expect an increase, others can look forward to level pricing or even modest discounts.
By: | December 17, 2015 • 3 min read
Businessman looking through a pair of binoculars

Employers with good loss histories looking to renew their workers’ compensation insurance coverage for 2016 will likely encounter insurers holding their prices relatively level to retain the business.

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“Overall, the market is as flat as it has been for years,” said Pam Ferrandino, executive vice president, national casualty practice leader at Willis.

Insurers are seeking price increases for workers’ comp accounts with losses, and providing single-digit discounts for those with solid loss histories they want to retain.

Debbie Michel, executive vice president and general manager of national insurance casualty, Liberty Mutual

Debbie Michel, executive vice president and general manager of national insurance casualty, Liberty Mutual

“When it all adds up it’s relatively flat,” Debbie Michel, executive vice president and general manager of national insurance casualty at Liberty Mutual, said of current market conditions. “It has been that way for about six months.”

And in a recent sign of market competitiveness, some insurers are now selectively providing large, national accounts with workers’ comp insurance contracts providing coverage for two years, Michel added.

But obtaining a multi-year contract requires “the right risk,” that is “stable, high quality and well priced.”

Specific factors, such as purchasing monoline coverage for California risks or employee concentrations exposed to terrorism risks in large cities, may receive additional underwriter scrutiny, said Christopher Flatt, leader of Marsh’s Workers’ Compensation Center of Excellence.

But in general, buyers are finding a competitive market and even those accounts will find coverage.

The workers’ comp line is performing well for insurers, fueling their ability to provide pricing that preempts policyholders and their brokers from marketing their accounts, Flatt added.

“It was [a good market] last year for employers; it’s probably better this year,” he said.

Most accounts are experiencing rate increases or decreases within 2 percent, meaning the market is flat, agreed John J. Liston, area president in Tampa, Fla. for Arthur J. Gallagher & Co.

“It’s a pretty easy market to place comp in unless you really have a bad issue,” Liston said.

The excess insurance market for workers’ comp coverage renewing on Jan. 1 is also competitive, with more underwriters seeking the business, said Seth Smith, senior vice president of underwriting at Safety National.

Yet, accounts with losses are seeing rate increases.

“However, if it has been a good, clean account and they have their losses under control and are doing a good job, we are seeing flat to decreases,” Smith said.

Data Makes a Difference

Meanwhile, brokers and agents say that more than ever, they are helping workers’ comp insurance buyers wield loss data to improve their purchasing decisions and obtain favorable terms.

In contrast to years past when agents approached underwriters by pleading, “Ah come on man, give me a break on this deal,” brokers are increasingly able to drill deeper into a client’s historical claims data to present intelligent arguments for better pricing and conditions, said Mark Bizer, senior vice president, Assured Neace Lukens in Lexington, Ky.

“We just have a lot more tools than we used to,” Bizer said.

“We are using our tools, really trying to push the market to right-size client retentions.” — Pam Ferrandino, executive vice president, Willis

Analytic tools and market conditions are allowing insurance purchasers to evaluate and adjust their retentions, Ferrandino agreed.

In some cases they are relying on analytic tools to select customized retention levels rather than selecting traditional deductible amounts of $500,000 and $250,000, for example.

“We can now look at clients’ retentions and maybe model them at $350,000 or other thresholds which might have a more efficient breakpoint where there is discernable savings,” Ferrandino said.

“We are using our tools, really trying to push the market to right-size client retentions.”

Insureds may take advantage of market conditions to reduce their deductible, even paying more in premium, to reduce their collateral expense, she added.

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Overall, however, several brokers said they are not seeing significant shifts in deductible levels.

Insurer profitability and premium growth have contributed to underwriters’ ability to exercise flexibility in their pricing, several experts agreed.

NCCI’s “State of the Line” report released in May indicated that workers’ comp insurer combined ratio dropped to 98 during 2014. That represented a 4 percent decrease from the prior year.

It was the first time since 2006 that the ratio fell below 100, pointing to a second year of above average insurer operating gains.

Insurers are evaluating accounts to determine whether they must demand higher pricing for poor loss histories, Bizer said. But they are being “a little more flexible” when policyholders experience a “one-off claim.”

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at rceniceros@lrp.com. Read more of his columns and features.
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