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Work Comp Opioid Strategies Draw National Attention

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As the opioid-abuse epidemic continues to draw national attention, the workers’ compensation industry was spotlighted on Monday for perhaps having part of the solution.

A Travelers Insurance program called Travelers Early Severity Predictor was featured in a CBS News article on Monday, titled “A Way to Predict Who Will Become a Drug Addict.”

The severity-predictor program assesses the likelihood that an injured worker will develop chronic pain, a condition for which opioids and other painkillers are frequently prescribed. The insurer then works with injured workers and their doctors in some of those cases to try to eliminate or reduce the need for painkillers that can slow recovery or lead to addiction.

Travelers rolled out the program with a media announcement in April 2016, although it was in operation before that.

The CBS News article detailed how Travelers developed its program using predictive analytics, with the help of a database of 1.5 million injuries and disabilities.

The Early Severity Predictor looks at factors in a claim including the injured worker’s general musculoskeletal health, mental health, drug regimen and any comorbidities. Claimant demographics and the nature of the injury are also considered.

“Probably 80% of the time it’s a bad idea to prescribe opioids,” Dr. Adam Seidner, Travelers’ national medical director, told CBS News.

Last year, Travelers said it had applied the Early Severity Predictor in more than 20,000 cases from early 2015 to April 2016. Of those, 9,000 injured workers were identified as being at risk of developing chronic pain. Injured employees who participated in the program recovered and returned to work more quickly on average, the carrier said, and were less likely to receive a prescription for opioids.

A Travelers spokeswoman said on Monday that updated figures for the program were not available.

Travelers is not alone in the workers’ comp industry in looking for ways to head off problems associated with opioid use.

Lockton, an insurance brokerage and provider of risk management services, has collaborated with other companies to develop a program called Biopsychosocial Injury Recovery Model, or BIRM. Injured workers participating in the program are evaluated for signs that their recovery will be delayed. One of the predictors for delayed recovery is more than three weeks of opioid use, said Keith Rosenblum, Lockton’s senior strategist for workers’ compensation risk control.

Workers in the program may be evaluated to determine how much of their pain is caused by physical factors and how much is due to psychosocial variables. Appropriate therapy is then prescribed.

Rosenblum said BIRM has been tested for the past few years in individual claims. Starting this month, Lockton will deploy the program on a more systematic basis, working with 15 to 25 employer clients by the end of the year. Data will be collected to determine what impact BIRM has on claim outcomes.

“Have we moved the needle with no other interventions?” Rosenblum said.

Third-party administrator Broadspire uses a different approach to opioids, through its First Opioid Fill Program. The TPA takes a number of steps as soon as an injured worker fills an opioid prescription, including sending an educational packet to the physician, and an opioid information letter to the claimant. The claim is monitored for additional opioid fills, and a case manager is assigned at four weeks as needed.

Subsequent steps might include physician peer review at 10 weeks, and consideration of non-drug treatment such as cognitive behavioral therapy.

In results presented last year, Broadspire said pharmacy spending in a First Fill group of claims was 22% lower than in a control group in which the program wasn’t implemented. The First Fill group had 14% fewer opioid prescriptions.

Since then, Broadspire has continued the program, albeit with minor modifications, said Dr. Jacob Lazarovic, senior vice president and chief medical officer with Broadspire’s medical department.

“In terms of measurable results, the combination of the (First Opioid Fill) program and our other opioid and pain-management mitigation programs continues to produce favorable outcomes,” Lazarovic said in an email.

For example, the percentage of opioid-using claimants taking a morphine equivalent dose of 120 milligrams per day declined steadily from 13.7% to 9.2% over the course of 2016, he said.

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