A growing economy coupled with an increase in inexperienced workers has the potential to contribute to higher severity in workplace injuries, according to Rich Ives, Travelers vice president of workers’ compensation claims.
He explained that 27 percent of all workplace injuries occur in the first year of a job. In addition, injured workers in more than 30 percent of large losses have less than a year of experience.
With up to 50 percent of large losses leading to chronic pain, Travelers patented its predictive model to aid in identifying those workers most at risk for developing chronic pain. The insurer manages more than 250,000 workers’ comp claims and $3.5 billion in medical treatment annually.
Since the launch of its Early Severity Predictor (ESP) last year, the insurer has noted a 50 percent improvement in claim outcomes (average cost is $40,000 per injury) and a 10 percent reduction in lost work days (return to work benefit).
ESP was developed two years ago by a team that included Dr. Adam Seidner, a known addiction specialist and the global medical director at Travelers.
Travelers runs the predictive model on all its workers’ comp claims, Ives said, noting that 36,000 claims were enrolled in the ESP program within the past 18 months.
“We actually have a lot of analytic models, but the Early Severity Predictor model runs in the background across our entire claim population,” Ives explained.
Besides the reduced claims costs and earlier return to work benefits, Ives said surgeries were reduced by more than 25 percent, which reduced the use of opioids. It’s an important figure, he said, because opioids are prescribed 90 percent of the time for chronic pain, which can develop as a result of surgery.
In addition, use of the model helped the insurer reduce opioid use.
“We have more than 500 nurses that we assign to lost time claims. We have our pharmacy strategies that have specifically been targeting the drug abuse issue,” Ives said. “All of those things combined, we are very pleased to be able to say that across all of our claims, we have actually reduced opioid use by 30 percent over the last two years.”
In doing so, Travelers may spend more earlier in the claim for alternative, evidence- based treatments, Ives said. He offered examples, including aquatic therapy, acupuncture and cognitive behavior therapy.
“We basically take an evidence-based approach and we look at the types of interventions which would include things like physical therapy, which is a big one,” Ives said. “In that way, we actually pay more money earlier on these claims because the cost of that treatment is actually more in the short term, but obviously the long term effects are very good for our customers and for our injured workers.”
Cognitive behavioral therapy or coaching is very important, said Ives.
“We prefer to think of it as more coaching, less therapy given the stigma that can come across from that, but that is also an intervention,” said Ives. “If we can understand in the early days of a claim which individuals might need some of that assistance and coaching, whether it’s from one of our nurses, or whether it’s telephonic therapy to get to some of the coaching of what they’re struggling with, then we believe that’ll really dramatically help across a lot of our claims.”
So far, he said, policyholders are pleased with the results. The insurer keeps employers updated on the status of workers’ injury claims. Ives said it keeps employers engaged with employees throughout the claim and even post-injury. That, he said, tends to result in maximum medical improvement.
“We pass along information, update statuses on our claims electronically to our customers,” said Ives. “One of the things that we try to really coach our accounts, our insureds, is that having them stay engaged with that injured worker, post the injury has a significant impact on that person being able to get back to a state of maximum medical improvement and ultimately getting them back to work.”
As far as chronic pain goes, Ives said there is still more to do. He believes there should be guidelines in place for the treatment of chronic pain.
Federal and state efforts to address opioid issue is still somewhat elementary, he said, noting that the guidelines some states have in place cover acute pain, not chronic pain. He said guidelines need to address the initial prescription, active administration and ween-off period. There also needs to be some way to enforce the guidelines.
“Some states have enacted a database wherein anyone who’s prescribing opioids has to electronically submit that information, and then that information can be enforced. It’s awful hard for states to enforce the guidelines they’re putting into place unless there’s some type of electronic submission of that information,” said Ives.
The insurer hosted a Connecticut state opioid symposium earlier this year to discuss its success with the model and how other organizations can benefit from developing a similar one. One caveat, he said, is the investment needed in utilizing the historical data required for a similar claim model.
“For example, this model [ESP] was really the extent of an effort of over five years’ worth of historical data and the building for us in order to make it real,” Ives said.
Despite the costs associated with developing a similar model, Ives said the benefits are real.
“This is a win-win, we believe, for everyone in that it’s good for American business to reduce their loss costs. It’s good for the injured worker. It’s good for society in general. Obviously, all those things have been good for us as a business as well. We love to think we’re attacking a greater societal issue here,” Ives said.
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