Breakthrough Testing Still in Need of Traction
If a workers’ compensation payer agreed to fund genetics testing to ensure an injured worker would actually benefit from prescribed medications, the simple cheek swab and lab test would cost about $700.
But according to three speakers who promoted genetics testing during the Risk and Insurance Management Society Inc.’s recent 2015 conference, these still-misunderstood tests could save countless more dollars and improve employee health.
They said the tests would map an individual’s genetic uniqueness to help doctors understand how well a patient would metabolize specific medications. That would further help doctors prescribe drugs most probable to be safe and effective for each patient.
Pharmacogentic testing (PGX) would eliminate the trial-and-error process doctors and patients currently practice when trying to find the right medication for patients who frequently react differently to specific drugs, the speakers said.
The current process delays effective therapeutic treatment and drives up costs when a prescribed drug doesn’t have the intended impact. Trial and error also endangers lives when costly and escalating drug regimens that don’t work eventually include prescriptions like opioids, which may harm certain patients or trigger addiction, according to these genetics testing proponents.
They see PGX becoming a “standard of care” and part of an overall march toward “personalized medicine.”
Only 50 percnt of patients currently respond positively to the medications they are prescribed.
Yet with few people who have actually participated in PGX and insurers still not paying for it, skepticism remains.
Fewer than a dozen people attended the RIMS conference session on PGX, including myself and another writer.
Was lack of interest due to 9 a.m. start time in New Orleans, a late-night party town? Or was it the employee and risk manager skepticism the speakers know must be overcome before the PGX takes off, as they expressed confidence it will?
“Even the physicians aren’t comfortable with it yet,” said Geralyn Datz, one of the speakers and director of Southern Behavioral Medicine Associates. A recent poll of thousands of doctors revealed that only 28 percent of them had “some comfort level” with the testing, Datz said.
Yet the speakers made some convincing arguments for PGX’s future.
The U.S. Food and Drug Administration currently recommends genetic testing for patients prescribed 160 different medications and 15 of those drugs are used in workers’ comp in “a major way,” said Kimberly George, a senior VP at Sedgwick Claims Management Services Inc.
Only 50 percent of patients currently respond positively to the medications they are prescribed, Datz said. She thinks consumers wanting more effective health care will eventually demand the testing.
Sonny Roshan, chairman and CEO of Aeon Clinical Laboratories, said the federal Centers for Medicare & Medicaid Services is a proponent of the testing, another reason the speakers expect its eventual adoption.
Roshan is also working with a large health insurer wanting to learn more about PGX.
The signs point to a potential that doctors will eventually consult PGX results before writing prescriptions for more workers’ comp patients. But it will also take more than just doctor and patient willingness to use the tests.
Claims adjusters, for example, will have learn of their benefits and claims payers will eventually demand to see return on investment documentation.
An Overlooked Risk?
The 2012 National Survey on Drug Use and Health, conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), found the rate of binge drinking among people ages 65 and older was 8.2 percent, the rate of heavy drinking was 2 percent, and the rate of current illicit drug use among adults ages 50 to 64 has increased during the past decade.
“According to SAMHSA experts the baby boomer generation contains a higher percentage of illicit drugs users than any other age group because boomers were the first generation to participate in widespread use of a variety of recreational drugs, the first generation to have prescription medications readily available to them, and the last generation to grow up with a strong stigma against seeking substance abuse treatment,” said Kevin Glennon, vice president, clinical education and quality assurance, One Call Care Management.
Baby boomers’ formative years played out during a period of broad experimentation with and acceptance of illicit drugs.
Now they’re entering a phase of life where any children they have are likely grown and independent and retirement is on the horizon, which could translate to fewer responsibilities both at home and at work.
That freedom may make it easier for boomers to pick up old habits, only this time with prescription medications.
The national drug use survey estimates that the number of adults age 50 and older who will need alcohol or drug treatment will increase from 2.8 million in 2002-2006, to 5.7 million by 2020.
Currently, 4 million older adults need substance use treatment, including 0.4 million for illicit drugs, 3.2 million for alcohol, and 0.4 million needing treatment for both.
“Today, many boomers are turning to prescription opioids as their drug of choice. Baby boomers do not view this as an issue requiring intervention, and as such are extremely guarded when treatment options are discussed,” Glennon said.
Employers and workers’ comp payers should not overlook these factors if they have an older worker on prescribed painkillers for a work-related injury or illness.
“After a certain period of time the patient will begin to develop a resistance to [the opioid] and it stops controlling the pain effectively,” said Bill Spiers, vice president of risk control services, Lockton.
“Because the healing time is slower, just by nature of the effects of aging on the body — they regenerate tissues slower — it extends that period of time. So what ends up happening is the person — and this happens typically with soft tissue injuries — will experience slower pain improvement, and so the medical professional will look for solutions.”
Pharmacy benefit management is one go-to way to keep an eye out for red flags and monitor physician prescribing patterns, but employers can take a more proactive approach by setting up a workplace support system.
One factor that can contribute to an older worker’s propensity to abuse a substance is the psychological component. Some boomers certainly look forward to retirement with excitement, but others fear losing a sense of purpose or relevance. That disconnectedness lends itself to loneliness and depression, both of which can contribute to the development of an addiction.
“Today, many boomers are turning to prescription opioids as their drug of choice. Baby boomers do not view this as an issue requiring intervention, and as such are extremely guarded when treatment options are discussed,” — Kevin Glennon, vice president, clinical education and quality assurance, One Call Care Management
“There are two reasons why injured workers have problems with their claim; when they get injured, they’re either angry or afraid. And those cause workers to shut down and not want to get treatment or cooperate,” Spiers said. Lockton trains ‘injury counselors’ to work one-on-one with patients, providing the type of support that the workers might be lacking from their own social network.
“The injury counselor tries to develop a friendship so they stay in touch. Not everyone has strong family or social ties around them, so they need someone that follows up with them and stays on top of them,” Spiers said.
“Things like depression can exacerbate that claim, one technique that employers use to keep that person motivated to work though their pain is to keep them engaged in the workplace, which they do through close communication.”
Employers can also make extra efforts to keep injured workers — especially those nearing retirement age — engaged in activities both in and outside of the workplace through wellness initiatives. Encouraging exercise can help an injured worker grown stronger both physically and mentally, Spiers said.
Providing a support network and establishing a channel of communication may in fact be the best that employers can do, since a red flag isn’t raised on every case where a medication is abused.
“Addiction or abuse, regardless of the drug of choice is often very hard to detect,” Glennon said. “There are functional alcoholics that work and function with no signs of intoxication, the same holds true with prescription drug use or abuse.”
RIMS Recap: Tech Trends that Could Change Everything
Last month, Gordon Clemons, CEO and Chairman of CorVel Corporation, presented at the RIMS Conference in New Orleans, La. about emerging technology and how it is impacting risk management and workers’ compensation. The discussion served as a springboard for new insights on how technology will change the industry, and reaffirmed the need for integrated systems and human interaction for the best results.
The presentation noted the future is here – and technology is constantly evolving in hopes of outpacing tomorrow’s needs. As these technology platforms become more inherent in daily life, the gap in translating their utilization to workers’ compensation will begin to close.
Technology in Healthcare
While many consumer-based technology advancements exist in other industries, perhaps most notably in the retail space helping vendors to reduce various delays in the sales experience, people may forget that healthcare, too, is a consumer industry. And as such, healthcare also experiences workflow lags, which can be collapsed.
While patients and claims may not lend themselves as freely to mobile applications and technology that subscribes to the “Internet of Things” philosophy, the rapid rate of development foretells the not-too-far-off arrival of the “a-ha,” “wow factor”-type application that consumers are seeking in the healthcare industry.
Once we get there, we can only expect that the Pangea of resources will yield better outcomes. The potential impact to medical management includes more affordable/accessible healthcare, patient convenience, personal assistance, automatic inputs to claims systems and less administration from both patients and injured workers.
“Healthcare is stubborn about change. There are more data points in healthcare and there is a greater need for high quality and accuracy,” Clemons said.
Tech Trends for the Next Digital Decade
As an industry advocate in all things innovation, CorVel has been keeping tabs on emerging tech trends. As they begin to influence in other industries, it sparks the question – will they eventually change workers’ compensation?
Here are some of the trends on CorVel’s radar:
Smart phones and tablets were the first mobile devices to really start to gain traction across people’s personal lives. Since then, wearables (like Fitbits and smart watches) have been part of the next digital generation to be taken up by consumers.
As these personal devices quickly advance, wearables could offer payors and employers added insight into the wellness of claimants through the extent of their retrievable data.
Beacons are devices that use low-energy Bluetooth connections to communicate messages or triggers directly to a smart device (such as a phone or tablet). Retailers have started using this technology, sending offers to near-by consumers’ phones. Now the concepts of smart mirrors and smart walls offer a one-stop-shop with recommendations related to the preferences of the shopper – making a hyper-efficient business model. It is possible that we could see these devices adapted to being a catalyst for healthcare’s business model by reducing the delays of administrative work.
Formally known as unmanned aerial vehicles (UAV), drones can be remote-controlled or flown autonomously through pre-defined flight plans within their internal systems. Some carriers are testing the use of drones to potentially be used to evaluate property damage and responding to natural disasters.
As most injuries reported in workers’ compensation are musculoskeletal injuries, the industry lends itself well to the benefits of telecommunications and telemedicine. With the rise of electronic capabilities, telemedicine becomes another option to help guide an injured worker through their entire episode of care, reducing time delays.
In order to get to that point in time, implementing these trends (and those that are yet to be launched) will only be as successful as the population willing to accept them. Buy-in will require a commitment to the long-standing pillars of the industry. According to Clemons, “While technology can truly move the needle in workers’ compensation, it will take more than bells and whistles to maximize its impact.”
“People’s feelings are valid. The skepticism surrounding new technology is not misplaced, but neither is the enthusiasm,” Clemons said.
New Trends, Same Priorities
Beyond the buzzwords and hype surrounding the latest apps and devices, for new technology to succeed within the workers’ compensation realm, it boils down to the two primary concepts that drive the industry to begin with – effective infrastructure and a people-first philosophy.
The power of applicable resources and the actionable data that results from them is in the foundation of the systems themselves; that primarily being through the influence of integration. It is not a new concept; however, as technology advances and the reach of analytic capabilities broadens, it is important to find a provider that can harness this data and channel it into effective workflows to increase efficiencies and promote better outcomes.
CorVel’s proprietary claims management system has been developed and supported by an in-house, full-time information systems division to be intuitive and user-friendly. Complex, proprietary algorithms link codified data across the system, facilitating collaboration between services, workflows, customers, and technology and eliminating the risk that a crucial piece of information will be missed. The result is an active “ecosystem” providing customers with actionable data to provide the most accurate, comprehensive picture at any time, while also collapsing inherent delays.
For the injured worker, the critical human touch connection in the workers’ compensation process can never be minimized. By cutting lag time throughout the various inefficiencies underlying the industry’s workflows, CorVel can connect injured workers with quality care sooner. As systems advance, claims and managed care associates do not have to spend as much time on administrative work and will instead be able to devote more time to the injured workers, reviving the human touch aspect that is just as impactful within the industry.
Regardless of the technology that lies ahead, CorVel looks to the future with investments in innovation, while not losing sight of their role and responsibility to clients and patients. Dedicated to constant improvement for the services they provide injured workers and industry payors, CorVel is committed to improving industry services one app, click, drone (or whatever is yet to come) at a time – perhaps something to discuss in San Diego at next year’s RIMS conference.
For more information, visit corvel.com.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with CorVel Corporation. The editorial staff of Risk & Insurance had no role in its preparation.