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.
Where’s Your Bottle of Painkillers?
Medical care providers inconsistently prescribe powerful – and highly addictive – narcotic painkillers across the country, according to a recent study by the federal Centers for Disease Control and Prevention (CDC) and data from Liberty Mutual Insurance.
This variation needlessly endangers patients, drives up workers compensation costs and may not provide a healing benefit to injured workers.
This is largely a problem that shouldn’t exist, since the American College of Occupational and Environmental Medicine (ACOEM) “Guidelines for the Chronic Use of Opioids” provide clear best medical practices for prescribing powerful narcotic painkillers — and advise that they be used only for select patients.
And yet the recent CDC study found tremendous variability in the rates of narcotic prescriptions between states.
For example, in 2012, health care providers in Tennessee wrote 143 pain killer prescriptions per 100 people, while doctors in California issued 57 prescriptions per 100 people.
Shockingly, health care providers across the U.S. wrote 259 million prescriptions for painkillers in 2012, enough for every adult American to have a bottle, according to the study.
A Liberty Mutual study published in 2009 found similar interstate variation in opioid prescriptions for acute work-related lower back pain. In fact, almost eight times as many opioid prescriptions were written in South Carolina for acute lower back pain than in Massachusetts during the study’s time frame.
The problem is clear. So is the solution.
Here are four steps every risk manager should take to help protect injured employees and the bottom line:
• Get informed — Understand if the states where your company operates have high rates of opioid prescribing, and to what extent the workers compensation systems in those states require treating physicians follow the ACOEM guidelines.
Providers treating injured workers in some states are mandated to follow these guidelines, while they are mere suggestions in other states.
• Get involved — Help your regulators and legislators understand the problems associated with narcotic over prescription, for both individuals and employers.
Work with them to appreciate the value of evidence-based medicine, such as the ACOEM guidelines.
• Use the right medical care provider — Having the injured worker treated by a provider experienced in occupational injuries will usually help the worker recover sooner and make the use of narcotics much less likely.
Even in states where employers cannot direct the care of injured workers, they can help employees understand the potential dangers of powerful narcotic pain killers.
• Spot problems early — Closely monitor claims. Use specialized resources to quickly identify the inappropriate use of narcotics and the early warning signs of potential abuse, such as use of multiple pharmacies or physicians, depression and addictive behaviors.
While not everyone has a bottle of painkillers, some have several. And it may be costing those individuals — and their employers — dearly. Get involved to help end this tremendous human and financial waste.
A Modern Claims Philosophy: Proactive and Integrated
According to some experts, “The best claim is the one that never happens.”
But is that even remotely realistic?
Experienced risk professionals know that in the real world, claims and losses are inevitable. After all, it’s called Risk Management, not Risk Avoidance.
And while no one likes losses, there are rich lessons to be gleaned from the claims management process. Through careful tracking and analysis of losses, risk professionals spot gaps in their risk control programs and identify new or emerging risks.
Aspen Insurance embraces this philosophy by viewing the data and expertise of their claims operation as a valuable asset. Unlike more traditional carriers, Aspen Insurance integrates their claims professionals into all of their client work – from the initial risk assessment and underwriting process through ongoing risk management consulting and loss control.
This proactive and integrated approach results in meaningful reductions to the frequency and severity of client losses. But when the inevitable does happen, Aspen Insurance claims professionals utilize their established understanding of client risks and operations to produce some truly amazing solutions.
“I worked at several of the most well known and respected insurance companies in my many years as a claims executive. But few of them utilize an approach that is as innovative as Aspen Insurance,” said Stephen Perrella, senior vice president, casualty claims, at Aspen Insurance.
“We do a lot of trending and data analysis to provide as much information as possible to our clients. Our analytics can help clients improve upon their own risk management procedures.”
– Stephen Perrella, Senior Vice President, Casualty Claims, Aspen Insurance
Utilizing claims expertise to improve underwriting
Acting as adviser and advocate, Aspen integrates the entire process under a coverage coordinator who ensures that the underwriters, claims and insureds agree on consistent, clear definitions and protocols. With claims professionals involved in the initial account review and the development of form language, Aspen’s underwriters have a full sense of risks so they can provide more specific and meaningful coverage, and identify risks and exclusions that the underwriter might not consider during a routine underwriting process.
“Most insurers don’t ever want to talk about claims and underwriting in the same sentence,” said Perrella. “That archaic view can potentially hurt the insurance company as well as their business partners.”
Aspen Insurance considered a company working on a large bridge refurbishment project on the West Coast as a potential insured, posing the array of generally anticipated construction-related risks. During underwriting, its claims managers discovered there was a large oil storage facility underneath the bridge. If a worker didn’t properly tether his or her tools, or a piece of steel fell onto a tank and fractured it, the consequences would be severe. Shutting down a widely used waterway channel for an oil cleanup would be devastating. The business interruption claims alone would be astronomical.
“We narrowed the opportunity for possible claims that the underwriter was unaware existed at the outset,” said Perrella.
Risk management improved
Claims professionals help Aspen Insurance’s clients with their risk management programs. When data analysis reveals high numbers of claims in a particular area, Aspen readily shares that information with the client. The Aspen team then works with the client to determine if there are better ways to handle certain processes.
“We do a lot of trending and data analysis to provide as much information as possible to our clients,” said Perrella. “Our analytics can help clients improve upon their own risk management procedures.”
For a large restaurant-and-entertainment group with locations in New York and Las Vegas, Aspen’s consultative approach has been critical. After meeting with risk managers and using analytics to study trends in the client’s portfolio, Aspen learned that the sheer size and volume of customers at each location led to disparate profiles of patron injuries.
Specifically, the organization had a high number of glass-related incidents across its multiple venues. So Aspen’s claims and underwriting professionals helped the organization implement new reporting protocols and risk-prevention strategies that led to a significant drop in glass-related claims over the following two years. Where one location would experience a disproportionate level of security assault or slip & fall claims, the possible genesis for those claims was discussed with the insured and corrective steps explored in response. Aspen’s proactive management of the account and working relationship with its principals led the organization to make changes that not only lowered the company’s exposures, but also kept patrons safer.
World-class claims management
Despite expert planning and careful prevention, losses and claims are inevitable. With Aspen’s claims department involved from the earliest stages of risk assessment, the department has developed world-class claims-processing capability.
“When a claim does arrive, everyone knows exactly how to operate,” said Perrella. “By understanding the perspectives of both the underwriters and the actuaries, our claims folks have grown to be better business people.
“We have dramatically reduced the potential for any problematic communication breakdown between our claims team, broker and the client,” said Perrella.
A fire ripped through an office building rendering it unusable by its seven tenants. An investigation revealed that an employee of the client intentionally set the fire. The client had not purchased business interruption insurance, and instead only had coverage for the physical damage to the building.
The Aspen claims team researched a way to assist the client in filing a third-party claim through secondary insurance that covered the business interruption portion of the loss. The attention, knowledge and creativity of the claims team saved the client from possible insurmountable losses.
Modernize your carrier relationship
Aspen Insurance’s claims philosophy is a great example of how this carrier’s innovative perspective is redefining the underwriter-client relationship. Learn more about how Aspen Insurance can benefit your risk management program at http://www.aspen.co/insurance/.
Stephen Perrella, Senior Vice President, Casualty, can be reached at Stephen.firstname.lastname@example.org.