Workers’ Comp – Feeding the Heroin Dragon
CNN recently ran an article on a grandmother addicted to heroin. In what almost seems cliché these days, her heroin use started as a prescription drug addiction. This could have just as easily been the result of treatment for a workers’ comp injury.
Our nation spends billions fighting the “war on drugs,” militarizing the police, incarcerating people, and devastating lives, while the highly-regulated medical and pharmacy industry are free to dispense essentially the same substances. Consider that most inmates are jailed for non-violent crimes, and most of those are drug-related. The cost to society in money and disruption is astounding.
Prescription drugs account for more overdose deaths than all street drugs combined. Moreover, our healthcare system has basically become a primary feeder to the illegal drug market.
This is a health issue and a moral issue – not a criminal issue – and we need to fix our health system.
When you start doing some back-of-the-napkin math, you realize that the workers’ compensation system’s potential contribution to the heroin problem in America is staggering.
As workers’ compensation professionals, it’s critical we understand our impact on society. Every time we help prevent an addiction, we impact not just one person’s life, not just an insurance carrier or an employer and their employees, but the children and families of these potential addicts. We also impact the public’s price tag in emergency room visits, government treatment programs, drug-related accidents, etc.
Consider this. A WCRI study found that about 55–85 percent of injured workers were prescribed opioids. Of the roughly 3.6 million new injuries that occur each year, this equates to 1,980,000 to 3,060,000 potential addicts the workers’ comp industry is creating annually.
Now factor in that 75 percent of heroin users indicate that their “first opiate of abuse” was through prescription drugs, according to a recent JAMA study. Taking it one step past the patients themselves, you uncover that the family medicine cabinet has become a breeding ground for the heroin addictions of our youth.
When you start doing some back-of-the-napkin math, you realize that the workers’ compensation system’s potential contribution to the heroin problem in America is staggering. Bottom line, we need to take ownership – our industry is creating addicts who are creating a massive recurring demand for heroin and other illegal substances.
While I applaud the Drug Enforcement Administration’s recent reclassification of hydrocodone as a Schedule II medication with heightened restrictions, one has to wonder – will this simply drive users to illicit drugs, like heroin, faster? Some addiction experts think so.
Anyone in our industry that’s been involved with addiction weaning programs knows how hard it is to get patients off “the dragon.” The reality is that providers continue to prescribe opioids way too often and for way too long, rather than as a short-term or last resort option. This is a battle that needs to be waged from the front lines.
The key is to make sure we have the systems and processes in place to prevent addiction in the first place. We in the workers’ compensation industry are uniquely positioned to fight this battle and change people’s lives for the better.
Read more of Jason Beans’ Risk Insider articles
Privacy Options Added to Prescription Monitoring Programs
“Prescription Drug Monitoring Programs have great potential to curtail opioid abuse, misuse, and diversion, and granting a variety of interested parties access to PDMP data may further that objective. However, the more entities that can review PDMP information the more important it becomes to develop standards for patient privacy.”
With that statement, members of the National Council of Insurance Legislators added enhancements to its model law to address opioids in the workers’ comp system. The expanded options seek a balanced approach to ensure data privacy.
A majority of states have adopted PDMPs as a way for health care providers to determine what medications their patients are taking. NCOIL last year adopted Best Practices to Address Opioid Abuse, Misuse and Diversion. It addresses how to establish, evaluate, and fund PDMPs that require real-time reporting; create strong evidence-based prescribing standards that recognize one-size-does-not-fit-all and that crack down on so-called “pill mill pain clinics”; promote education among physicians and the public; and encourage treatment and prevention.
NCOIL is comprised of state legislators whose main area of public policy interest is insurance legislation and regulation. At this year’s summer NCOIL meeting in Boston, members of the committees on Health, Long Term Care and Health Retirement Issues, and Workers’ Compensation Insurance unanimously adopted the enhancements to the best practices.
“As states contemplate what privacy options they wish to pursue, legislators should keep in mind that an assurance of confidentiality is crucial to a patient-physician relationship,” the enhancement stated. “Though courts around the country are divided as to whether state efforts to regulate controlled substances outweigh a need for patient privacy, legislators should consider whether it is appropriate to in some way limit what entities other than the physician have a right to know about a person’s medical conditions and treatment.”
The enhancement calls for safeguards to be clearly stated in statutes and regulations “to avoid confusion and to help empower state officials to take action as needed.”
The potential safeguards are:
- Making PDMP data confidential and excluding it from open records or public records laws.
- Explicitly requiring PDMP administering agencies to adopt policies and procedures that reasonably assure that only those who are legally authorized to access the database actually do so.
- Imposing appropriate legal penalties and administrative sanctions such as actions against someone’s license for violations and ensuring that the penalties/sanctions are enforced.
- Specifying who is authorized to access the data and for what purpose.
- Implementing detailed authentication procedures to verify that a user is qualified to access the PDMP pursuant to state law.
A Dreaming Team
Chris Thorn is known as one of the most creative risk managers in the business. After all, his risk management program hit the cover of Risk & Insurance® in March, 2012.
Now the senior manager, payments and risk, for Southwest Airlines is working with Riskonnect, a technology partner that he thinks can take his program to new heights.
“For us, it’s a platform that gives you so many different tools that if you can dream it, you can build it,” said Thorn.
Thorn ditched his legacy risk management information system in 2012 and started working with Riskonnect, initially using the platform solely for liability claims management.
But the system’s “do-it-yourself” accessibility almost immediately caught the eye of Thorn’s colleagues managing safety risk and workers’ compensation.
“They were seeking a software solution at the time and said, ‘Hey, we want to join the party,” Thorn recalls of his friends in safety and workers’ compensation.
“For us, it’s a platform that gives you so many different tools that if you can dream it, you can build it.”
–Chris Thorn, senior manager, payments and risk, Southwest Airlines
What was making Thorn’s colleagues so jealous was the system’s “smart question” process which allows any supervisor in the company to enter a claim, while at the same time freeing those supervisors from being claims adjusters.
The Riskonnect platform asks questions that direct the claim to the appropriate category without the supervisor having to take on the burden of performing that triage.
“They love it because all of the redundant questions are gone,” Thorn said.
The added beauty of the system, Thorn said, is that allows carriers and TPAs to work right alongside the Southwest team in claims files while maintaining rock-solid cyber security.
“This has sped up the process,” Thorn said.
“Any time you can speed up the process, the more success you’re going to have when you make offers to settle claims,” he said.
Since that initial splash in claims management, the Riskonnect platform has gone on to become a rock star at Southwest in a number of other areas. And as Thorn suggests, the possibilities of the system are limited only by the user’s imagination.
With a little creativity and help from Riskonnect as needed, a risk manager can add on system capabilities without having to go on bended knee to his own information technology department.
In the area of insurance policy management, for example, the Riskonnect platform as built by Thorn now holds data on all property values and exposures that can in turn be downloaded for use by underwriters.
Every time Southwest buys a new airplane, the enterprise platform sends out a notice to the airlines insurance broker, who in turn notifies the 16 or 17 carriers that are on the hull program.
Again, in that “anything’s possible” vein, the system has the capability of notifying the carriers, directly, a tool Thorn said he’s flirting with.
“It is capable of doing that,” he said.
“We’re testing out this functionality before we turn on it loose directly to the insurance companies.”
In alignment with the platform’s muscle in documenting, storing and reporting liability and property exposures, the system monitors and reports on insurance carrier financial strength.
If a rating agency downgrades a Southwest program carrier’s financial strength, for example, the system “pings” Thorn and his colleagues.
“Not only will we know about it, but we will also know all programs, present and past that they participated on, what the open reserves are for those policy years and policies,” Thorn said.
“That gives us even more comfort that we have good, solid financial backing of the insurance policies that are protecting us,” Thorn said.
Like many of us, Chris Thorn didn’t set out to work in risk management and insurance. Thorn is a Certified Public Accountant, and it’s that background that allows him to take creative advantage of the Riskonnect platform’s malleability in yet another way.
With the help of the Riskonnect customer service team, Thorn added a function to the platform that allows him to calculate the cost of insurance policies on a monthly basis, enter them into a general ledger and send them over to his colleagues in accounting.
“It’s very robust on handling financial information, date information, or anything with that much granularity,” Thorn said.
The sky is the limit
Thorn and Southwest are only two years into their relationship with Riskonnect and there are a number of places Thorn thinks the platform can take him that have yet to be explored, but certainly will be.
“It’s basically a repository of anything that’s risk-related, it continues to grow,” Thorn said.
“This has sped up the process. Any time you can speed up the process, the more success you’re going to have when you make offers to settle claims.”
–Chris Thorn, senior manager, payments and risk, Southwest Airlines
Not only have Southwest’s safety and workers’ compensation managers joined Thorn in his work with Riskonnect, business continuity has come knocking as well.
Thorn met in July with members of Southwest Airline’s business continuity team, which has a whole host of concerns, ranging from pandemics to cyber-attacks that it needs help in documenting the exposures and resiliency options for.
That Enterprise Risk Management approach will in the future also involve the system’s capability to provide risk alerts, telling Thorn and his team for example, that a hurricane or fast moving wildfire is threatening one of the company’s facilities.
Supply chain resiliency and managing certificates of insurance for foreign vendors are other areas where Thorn and his team plan to put the Riskonnect platform to good use.
“That’s all stuff that’s being worked on by us,” Thorn said.
“They’ve given us the tools, but we’re trying to develop how we’re going to use it,” he said.