Transcript Game Changing Strategies to Transform

Game Changing Strategies to
Transform Workers’
Compensation Results
RIMS Chicago
© Copyright 2013 One Call Care Management. All rights reserved.
www.onecallcm.com
Kevin Glennon, RN, BSN, CDMS, CWCP, QRP
Vice President-Home Health & Complex Care Services
Email: [email protected]
Phone: 407-448-5879
© Copyright 2013 One Call Care Management. All rights reserved.
www.onecallcm.com
Disclosure Statement
Kevin T. Glennon, RN, BSN, CDMS, CWCP, QRP works for One Call
Care Management as their Vice President of Home Health and
Complex Care Services. A provider of Home Health, Infusion Therapy,
Complex Care Coordination, Medical Equipment, Devices and Supplies
and Assistive Technology Products and Services in the Workers’
Compensation Industry.
Off label use of certain medications may be discussed during this
presentation along with Nursing considerations.
Discussions related to urine drug testing companies may be discussed
during this presentation .
Additionally no financial relationships exist with any commercial party.
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Topics for discussion
 Discuss current claims industry trends and the current
financial impacts
 Review challenges such as co-morbidities, obesity, and
the aging workforce
 Review strategies to foresee and proactively manage
potential costly adverse events
 Discuss strategies they may assist in mitigating the rising
medical costs of workers’ compensation claims
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The Current Trend
 According to preliminary estimates, lost-time claim frequency declined
by 5% in Accident Year 2012
 Claim frequency for workers compensation injuries increased 3.8% in
Accident Year 2010

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marking the first increase since 1997
Prior to the 2010 uptick, claim frequency had been declining at an
average rate of more than 4% per year since 1990
Following the 2010 uptick, claim frequency declined in 2011, albeit by a
modest 0.9%
 In 2012, while frequency decreased by 5%, the average cost per losttime claim increased 1% for indemnity and 3% for medical
 Prescription drug (Rx) use, a medical expense that makes up 19% of
all workers compensation (WC) medical costs
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Factors that increase the aging
worker’s potential for risk
 Muscle Weakness
 Manic behavior
 Balance Problems
 Any change in affect
 Vision Problems
 Confusion
 Side Effects from
Medications
 Not eating/sleeping
properly
 Mental status changes
 Somnolence/Agitation
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Challenges

Equipment needs change

Potential for additional surgery

Medications may be contraindicated or no longer effective

Liver and Kidney issues

Loss of family caregiver/support

Are all these changes related

Is anyone monitoring who is prescribing what medications
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A Classic Example
The literature on the management of ankle fractures in patients with diabetes has
shown outcomes to be generally poor
42.3 % incidence of complications in patients with diabetes compared to people
without (McCormick and Leith)
Conservative management may be preferable to surgical treatment
32 % higher infection rate found in people with diabetes ( Flynn, et. al.)
Those patients with diabetes who were treated conservatively had a greater
tendency to become infected over those who treat with open reduction internal
fixation (ORIF)
People with diabetes who are poorly controlled and had evidence of neuropathy
were shown to be very difficult to manage
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Prolonged Recovery
04-29-1997
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06-30-1997
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Mitigating Risk
 With varying perspectives on what constitutes an older
worker, there is no set definition.
 The Age Discrimination in Employment Act of 1967
(ADEA) applies to individuals aged 40 and over
 The majority of workers in their 50s work full-time
regardless of health status.3
 These workers are often affected by health conditions
that can limit their ability to work.
 More than one-third (35%) of workers in their 50s who
report being in fair to poor health indicated that a health
condition limits the type or amount of work they can do
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OBESITY – ICD 9 278
 Obese claims are 2.8
times more expensive
than non-obese claims
at the 12-month maturity
 This cost difference
climbs to a factor of 4.5
at the three year maturity
and to 5.3 at the five
year maturity
 The cost difference (at
the five year maturity) is
less for females than for
males
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Obesity Related Co-Morbidities




Hypertension
Dyslipidemia
Diabetes
Coronary Heart
Disease
 Stroke
 Gallbladder Disease
 Some Cancers
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


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Osteoarthritis
Orthopedic Problems
Impaired Mobility
Peripheral Vascular
Disease
 Liver &Kidney Failure
 Sleep Apnea
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Overly involved family members
 Over time, patients adapt to their conditions and
some stop working out
 Stop using prescribed equipment or agreeing to
therapy

Family prevents nursing from completing
necessary interventions
 Physicians and nurses will not pursue aggressive
treatment when a patient refuses
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A Costly Scenario

35 year old Quad

Recurrent Hospitalizations for Respiratory Failure

Average cost per hospitalization~ $76,500.00

Average time between hospitalizations~ 3 weeks

8 Hospitalizations over 6 months

$1,224,000.00 annual expense/hospitalizations

24 Hour/day RN @ $96.50/hour~ $2,316.00/day

CNA 17 Hours/day @ $32.50/hour ~ $552.50/day
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Proactive Interventions

Back to inpatient rehab for a “tune up”

Re-education for Family (the medically necessary reason to use the respiratory aids in the home)

Re-education regarding the need to allow the nurses to complete physician orders

Installed ceiling lift system $22,395.73

Purchased Cough Assist and Suction Pump $10,211.28

Changed Nursing Agencies (lowered hourly rates)

Lowered level of care from RN to LPN/LVN

Total Spend $58,767.01

Total Estimated Annual Savings $1,446,467.50
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How do you implement needed change
 This is when the case needs the home health care
professional to transform into a super educator
 It’s essential to demonstrate how the equipment,
treatment or other therapeutic change will speed
recovery, enhance quality of life, and extend a person’s
independence
 That – along with controlling the costs of claims – is the
whole purpose of pro-actively managing any claim
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NCCI Reports
Pharmacy costs are
19% of total medical
spending
in Worker’s Compensation
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Physician Dispensing Varies by State
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Narcotics Share of Paid Rx
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Drug Deaths Now Outnumber
Traffic Fatalities in US
 Approximately 38,000
deaths annually
 1 death every 14 minutes
 Death toll has doubled over
the last decade
 Prescription Drugs now
cause more deaths than
Heroin & Cocaine
Combined
 OxyContin Habit can run
twice as much as a Heroin
Addiction
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 Most commonly
abused Drugs
 OxyContin
 Fentanyl
 Actique
 Vicodin
 Xanax
 Soma
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TOP 50 DRUGS
OXYCONTIN®
LIDODERM®
HYDROCODONE-ACETAMINOPHEN LYRICA®
CELEBREX®
GABAPENTIN
SKELAXIN®
CYMBALTA®
MELOXICAM
CYCLOBENZAPRINE HCL
TRAMADOL HCL
OMEPRAZOLE
FENTANYL
FLECTOR®
OXYCODONE HCL
ULTRAM® ER
OXYCODONE HCL-ACETAMINOPHEN
CARISOPRODOL
NAPROXEN
KADIAN®
ZOLPIDEM TARTRATE
OPANA® ER
AMRIX®
TIZANIDINE HCL
AMBIEN CR®
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PERCOCET®
IBUPROFEN
NAPROXEN SODIUM
OXYCODONE-ACETAMINOPHEN
ACTIQ®
ENDOCET®
AVINZA®
LUNESTA®
DURAGESIC®
NEXIUM®
LOVENOX®
FENTANYL CITRATE
MORPHINE SULFATE
EFFEXOR XR®
DENDRACIN, NEURODENDRAXIN®
TOPIRAMATE
TOPAMAX®
DICLOFENAC SODIUM
PROPOXYPHENE NAP-ACETAMINOPHEN
ETODOLAC
NABUMETONE
PROVIGIL®
LEXAPRO®
ZANAFLEX®
SEROQUEL®
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Adherence/Efficacy
All individuals are different
Slow
Metabolizers
Fast
Metabolizers
Non
Metabolizers
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Based on adherence studies…
 Less than 30% of claimants take their
medications as prescribed
 More than 30% fill their medications but do not
take them
 More than 30% take additional medications
and/or substances that can reduce or eliminate
the efficacy of the prescribed medications
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Thank You
Kevin Glennon, RN, BSN, CDMS, CWCP, QRP
VP Home Health & Complex Care Services
One Call Care Management
Phone: 800-700-9393 ext. 2048
Fax: 407-710-1683
Cell: 407-448-5879
[email protected]
© Copyright 2013 One Call Care Management. All rights reserved.
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References
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NCCI Publishes New Research on Prescription Drug Expenditures
Posted Date: September 26, 2013
Source: NCCI Medical Data Call, for Service Year 2011.
The 35 jurisdictions for which NCCI provides ratemaking services are AK, AL, AR, AZ,
CO, CT, DC, FL, GA, HI, IA, ID, IL, KS, KY, LA, MD, ME, MO, MS, MT, NE, NH, NM,
NV, OK, OR, RI, SC, SD, TN, UT, VA, VT, and WV. The seven independent bureau
states for which NCCI collects the Medical Data Call are IN, MA, MN, NC, NJ, NY, and
WI.
Data used with permission.
Source: NCCI Medical Data Call, for all states except CA, DE, MI, PA, and TX, which
were derived from sample data provided by carriers
Relative Service Years 1 through 10
Data used with permission
Source: NCCI Medical Data Call, for all states except CA, DE, MI, PA, and TX, which
were derived from sample data provided by carriers
Relative Service Years 1 through 10
Data used with permission
© Copyright 2013 One Call Care Management. All rights reserved.
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