Creating An Advocacy-Based Claims Model
Business leaders in the healthcare industry invest significant time and resources to create positive corporate cultures, engage employees, and earn their trust and commitment to success. Yet in the workers’ compensation segment of our industry, all too often the focus seems to be on conflict instead of caring. We are in the business of delivering benefits…so, how do we get back to the basics of what workers’ compensation was founded on and change the conversation from adversary to advocate? How do we ensure that the treatment of injured workers aligns with our corporate values and culture? And how could changing the mindset from a cost protection model to a patient protection model improve outcomes–not only for injured workers but for employers as well?
A Brief History of Heroin Use in the United States: Evolving Impact on Rx Drug Abuse
The possibility of injured workers becoming addicted to heroin is quite high. In fact, individuals who were addicted to prescription opioids are 40 times more likely to become addicted to heroin. This paper will first place heroin use in a historical context, examine causes for the current epidemic, and then arm the claims professional involved in the management of workers’ compensation claims with the tools necessary to help prevent the crisis from continuing.
A Guide for Claims Handlers: Specialty Drugs in Workers’ Compensation
Twenty years ago there were only 10 specialty drugs on the market and they were rarely seen in workers’ compensation. Today there are over 300, and drugs such as anticoagulants and antivirals are making their way into claims. There is a great deal of confusion surrounding specialty drugs. What are they? How are they utilized in workers’ comp? Read our Guide for Claims Handlers for an informative overview of specialty drugs.
White Paper: Specialty Drugs in Workers’ Compensation: A Population Based Assessment
Specialty drugs represent the fastest growing category of drugs in the United States and projections indicate that they will account for half of all drug costs in less than five years. In general terms specialty drugs are defined as very expensive drugs that are designed to treat relatively rare conditions. Although prevailing opinion has indicated that many of these conditions, such as multiple sclerosis and hemophilia, will have little impact on drug spending, in workers’ compensation, myMatrixx identifies seven significant patient populations in this white paper in which specialty drugs are the treatment of choice and will most likely be deemed compensable. Read more in our in-depth report.
White Paper: Compounding is Confounding Workers’ Compensation
myMatrixx’s Phil Walls, RPh, Chief Clinical and Compliance Officer, and Michael Nguyen, PharmD are contributing authors to CompPharma’s white paper on the use of compounds in injured workers. The use of compounded drugs has increased five-fold in the last five years, raising questions about their use and their costs. Are they safe? Are they more effective than manufactured drugs? When should they be used? This and much more is covered in this information packed paper.
Case Study: A Look Inside An Opioid Drug Treatment Case
In workers’ compensation, it is commonplace for Pharmacy Benefit Management companies (PBM’s) to inherit catastrophic cases. This study tells of one such claim that myMatrixx faced. Drug therapy costs had reached alarming heights and the claim was in urgent need of intervention. myMatrixx’s Clinical Team approached it with the goal of mitigating risks for both the patient and the insurer. The study reviews a clinical intervention with a case including multiple opioids totaling over $27,000 a month. The case was brought to myMatrixx by Safety National who was concerned about the cost of this regimen as well as health risks for the injured worker. The outcome delivered a savings of over $250,000 per year for the claim.
Navigating Medical Marijuana in Workers’ Compensation
Nationwide employers and insurers are struggling to grapple with the potential effects of medical marijuana in workers’ compensation. Not the least of these is the issue of legality. While on a federal level it is illegal to be in possession of marijuana under any circumstances, 17 states and the District of Columbia have made it legal to use marijuana for medical purposes and similar legislation is currently pending in another six states. Throughout the country, even in states that have legalized its use, federal law prevents doctors from prescribing marijuana. This conflict between state and federal laws raises any number of issues that directly affect the workers’ compensation industry and the workplace as a whole. Despite legalization, it remains to be seen what accommodations employers must make in those states in which medical use of marijuana is allowed. myMatrixx takes an in depth look at this topic in a white paper and the impact it is having on workers’ compensation.
Opioids in the Treatment of Injured Workers: When and How to Maximize Effectiveness
Use of prescription painkillers has increased in staggering proportions compared with other medication classes, in terms of the number of prescriptions written, costs and incidence of overuse and abuse. It has been noted that adherence to guidelines for instituting and monitoring opioid therapy can have a significant impact on cost control in managing the care of an injured worker. The earlier in the claim that insurers are alerted to problems, even to the point of predicting cases in which potential exists, the easier it is to ensure improved outcomes. This white paper will review red flags to look out for and how to identify risk earlier when opioids are used in a patient’s therapy.
Managing the Unintended Pain of Opioids in the Workers’ Compensation Industry
Dramatic increases in opioid use causes concern not only from a drug cost standpoint, but also because evidence suggests a link to longer duration of disability. Misuse, overuse and addiction are real risks that extend well beyond the worker’s compensation industry. Well-established communication with the physician, backed by evidence based pain management guidelines and best practices, can improve the end results for every stakeholder: decreasing liability for the physician, improving outcomes and decreasing side effects for the patient.