By Sheena Harrison
Dec. 6, 2011
Insurers, brokers and third-party administrators say they’re working with primary physicians to help wean claimants off Schedule II narcotics, such as oxycodone and methadone, if they start to develop a dangerous dependence on such drugs.
Some companies also are creating strategies to assist workers who already have become hooked in hopes of preventing opioid overdoses and deaths, as well as containing medical claim costs.
“A number of employers are looking at different ways to intervene earlier in the process,” said Nancy Decato, Los Angeles-based managing director and West zone practice leader for claims consulting with Marsh Risk Consulting.
Brokers such as Marsh and Lockton Cos. and insurer Liberty Mutual Group Inc. say “peer-to-peer” physician reviews are a standard in workers comp to help doctors head off addiction problems before they become too serious.
In such cases, a company’s medical director or another medical professional will review workers comp claims that appear to have excessive opioid dosages or prescription refill rates. From there, the medical director would talk with the claimant’s treating physician to create a plan for using a lower amount of such medications or transitioning an injured worker to less addictive prescriptions.
Physician peer review is one of the first steps for Liberty Mutual in helping workers comp patients who are in danger of dependence, said Dr. Constantine Gean, regional medical director for Liberty Mutual in Glendale, California.
“We try to work with primary care specialists when we can and give them options,” he said.
Such reviews are advantageous because they provide professional guidance for doctors who may not have much experience in safely prescribing opioids, said Keith Rosenblum, senior risk consultant with Lockton in Kansas City, Missouri.
“When clinicians contact them and discuss it, (doctors are) quite open,” Rosenblum said.
Outside of early intervention, some workers comp experts are looking for ways to assist workers comp claimants who have developed opioid dependence.
For the last six months, TPA Broadspire Services Inc. has worked to create a chronic pain management program that targets opioid concerns in workers comp. The program, which has not yet been named, is being created in part to address the growing opioid epidemic, said Dr. Jacob Lazarovic, Broadspire’s chief medical officer in Sunrise, Florida.
“We wanted to make sure that we were getting the right treatment for the right person,” he said.
Atlanta-based Broadspire has a team of medical professionals who review difficult workers comp claims twice a week and craft specialized treatment plans. The company also performs regular physician peer reviews and analyzes other patient data for signs of opioid trouble.
If a patient has risk factors for dependence, such as depression, Broadspire’s team may recommend cognitive behavioral therapy or other treatments to help a claimant reduce his or her need for opioids, Lazarovic said.
“You can’t always eliminate pain,” he said. “You have to minimize it and help people cope with it. CBT is one way to do that.”
Broadspire’s medical team also connects some claimants with addiction treatment specialists who use medications to wean injured workers off dangerous drugs, Lazarovic said.
Dr. Thomas Jan of Massapequa, New York, is on the front lines of such assistance. He specializes in physical therapy, as well as pain management and prescription addiction treatment. About 30 percent of Jan’s addiction patients are workers comp claimants, he said.
Much of Jan’s work focuses on using the medication buprenorphine to help patients become less dependent on opioids. The drug works by blocking the ability of powerful narcotics to produce a “high” feeling in patients.
Workers comp carriers have been willing to cover patients’ addiction treatment, including outpatient rehabilitation programs, Jan said. He believes insurers are amenable, in part, because their employees—namely claims adjusters—are saddened and frustrated by cases where claimants become hooked on opioids.
“Instead of hearing horror stories, they’re starting to hear solutions,” Jan said of how insurers view addiction treatment.
Gean of Liberty Mutual said the insurer has been willing to cover addiction treatment similar to what Jan provides if early intervention methods aren’t immediately effective for workers comp claimants.
“If a specialist is needed, it really behooves the insurance company and the patient to have that done as quickly as possible,” he said.
The main challenge to treating addiction or dependence is that the patient has to be willing to receive the help, Decato of Marsh said.
“You can’t really force someone,” she said. “They have to be ready and they have to be committed to it. You need the right patient from an insurer or a TPA perspective.”
Gean said screening tools, such as predictive models and patient questionnaires, can help identify claimants who are willing to receive help for dependence problems.
As workers comp experts look to stem opioid abuse, Lockton’s Rosenblum said he believes many in the industry will focus on preventing addiction rather than waiting to provide treatment after patients have become dependent on narcotics. “We can’t wait for that,” he said.
Still, Gean believes the workers comp industry can play a key role in helping to fight the prescription abuse epidemic nationwide.
“Anything that benefits the patients benefits us as well,” Gean said. “It’s really a win-win.”
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