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Opioid prescriptions skyrocketed in the 1990s, when the drug was first marketed as the “problem solver” to chronic and acute pain. Doctors bought into what manufacturers were selling. Overprescribing went off the rails. Patients suffered.

The rise in prescription opioid-related overdose deaths really began in 1999, according to CDC data. A second wave of rapid increases in overdose deaths plagued the U.S. in 2010, this time with a rise in heroin abuse. Synthetic opioids, like fentanyl, took off in 2013.

The need for better pain management — without opioids whenever possible — remains a core issue for the National Comp conference, and a topic you’ll find on this year’s program agenda.

Dr. Michael Lacroix, licensed psychologist, medical director, The Hartford, will share his insights at National Comp 2022 alongside Dr. Nikki Wilson, director, clinical product & pharmacy solutions, Mitchell; Dr. Dorothy Riviere, chief clinical officer, Bardavon Health; and Dr. Mark Williams, medical director at The Hartford, during the session “Pain Management that’s Easier to Swallow: Non-Pharmacological Alternatives.”

Lacroix and Williams shared some of their thoughts with Risk & Insurance in advance of the presentation.

The harrowing history of the opioid epidemic cannot be understated; an average 100,000 people die every year, the National Center for Health Statistics reported. Thirty-five billion dollars in health care costs have been spent trying to fight the epidemic, and an additional $14.8 billion in criminal justice costs have been spent on drug-related crime and theft.

The workers’ compensation industry is doing its part, trying to limit the number of opioid scripts written for injured workers.

“The number of the proportion of scripts issued per claim in workers’ comp is down about 10%,” said Dr. Michael Lacroix, licensed psychologist, medical director, The Hartford. He noted the pandemic has certainly impacted that number in recent years, but overall, regulators, doctors and prescribers are paying attention to the number of scripts written.

Workers’ comp is also tuning in to other pain treatment modalities as a means to curb the rate at which opioids are introduced into a claim. The biggest contender: movement.

When looking at an injury, Dr. Mark Williams, medical director, The Hartford, said there are a number of benefits movement can have on recovery.

Dr. Mark Williams, medical director, The Hartford

“When you have a musculoskeletal injury, a lot can be at stake,” he said. Musculoskeletal injuries impact three primary areas — the joints, the muscles that move them and then connective tissues like ligaments and tendons. And all three impact each other’s recovery.

“For example, if there is a muscle spasm, that will immobilize the joint and that tends to persist joint pain. The joint is restricted. When you apply motion, you start to restore normal motion to the joint,” Williams said.

Physical therapy, chiropractic manipulations, massage and acupuncture are just some of the therapies being utilized today. Each has properties to hone in on the injury and give the injured worker the tools needed to bring modality back while also strengthening the muscle and surrounding tissue.

“These physical/manual medicine modalities are very effective. Physical therapy, we know, restores function to injured tissues and muscles. Massage therapy can address inflammation that develops by actually, physically dispersing those accumulating fluids,” Williams explained. “Chiropractic’s role is about joint mobilization and joint manipulation. You restore normal biomechanics to the injured joint.”

The positive impact of movement doesn’t stop there; benefits of non-pharmaceutical interventions abound beyond the physical healing of the injury.

1) Incorporating a comprehensive plan of action using movement therapies instead of opioids can reduce mental health barriers for injured workers.

Mental health still faces stigmatization today, despite recent stressors, like the pandemic increasing anxiety and depression by as much as 25%, the WHO reported. More adults are feeling the pressures and health strains caused by mental illness, and injured workers are no different.

Take the pandemic out of the picture entirely, and an injured worker can still feel boughts of anxiety, depression and stress. They’re facing upheaval to their work life and home life due to injury. They’re likely facing financial strains if they are out of work. Plus, they’re entering the comp space usually for the first time, which can be confusing or overwhelming without having background knowledge of the industry.

At the core of it, they’re in pain.

It’s a lot of uncertainty to face, and mental illness can contribute to increased absenteeism and lost productivity, not to mention prolonging the claim. “Combined with substance abuse, mental health disorders cost employers between $80 billion and $100 billion in these indirect costs,” IRMI reported. Prescribing an opioid to manage pain may seem like a simple fix, but studies show undiagnosed mental illness can increase the risk of an opioid use disorder.

The good news: Employers are acknowledging the need to address mental health.

“More employers are open to acknowledging mental health in the workplace,” Lacroix said. “That’s a big thing, because when you are open to recognizing it, people are more open to admitting it.”

Movement is a big proponent of mental health. Movement itself has been linked to improved circulation, mental clarity and mood — all important pieces to injury recovery. By adding in movement to address pain, it takes opioids out of the equation and has the injured worker focusing on rehabilitation versus solely pain management.

“Claims last longer when mental health issues are comorbidities, and in workers’ comp, treatment costs also go up significantly,” said LaCroix.

2) Movement therapies may be a bigger cost upfront, but they help eliminate long-tail opioid-related costs that can mount.

Dr. Michael Lacroix, medical director, The Hartford

When it comes to movement therapies, the upfront cost may look unappealing. A single physical therapy session could equal anywhere from $30 to $400, as an example, whereas an opioid prescription costs as little as one trip to the doctor’s office for the script.

“Oftentimes, there’s an assumption that because drugs are cheaper, you can save money by just prescribing medication. But if you look at the long-term, these movement strategies actually bring in a very nice return on investment,” Lacroix said.

The cost to get a single person the help they need to combat an opioid addition can be upwards of thousands of dollars and can take years of treatment. For perspective, The National Institute on Drug Abuse broke down the costs per type of opioid treatment:

Williams pointed to a study conducted by WCRI in 2020, “The Timing of Physical Therapy for Low Back Pain: Does It Matter in Workers’ Compensation?” in which it  found that patients who received physical therapy later in injury recovery had 24% higher medical costs and 58% longer temporary disability duration.

A WCRI webinar released this year, “Patterns and Outcomes of Chiropractic Care,” found that indemnity payments were 35% lower for claims that received chiropractic care and temporary disability duration was 26% shorter.

“Both studies demonstrate that there are fewer medical interventions, including use of opioids, when physical medicine and movement are used in these claims,” Williams said.

3) Movement addresses the root cause of the pain instead of masking symptoms like most medications.

The reason opioids grew in popularity in the 1990s is because they worked as advertised: They eliminated pain for those who took them … so much so, that many began to rely solely on them to take away their pain. But studies have shown that continued use of opioids can actually increase pain.

“It is possible for opioids to lead to chronic pain because of chemical and structural changes in the nervous system, known as central sensitization, as a response to prolonged durations of use,” said Williams.

Movement works differently. It’s not there to mask the pain but instead give injured workers the tools and exercises needed to address their pain head on.

That’s because the right movements encourage an injured worker to gain strength right at the spot of injury.

Movement therapies like physical therapy, chiropractic manipulation or massage are just one alternative to opioids. But the list goes on when it comes to combating the epidemic. As Williams said, the workers’ comp industry is just getting started.

“We’re early in the game, and it’s one of the reasons why we’re constantly trying to raise awareness of these non-pharmaceutical interventions and these non-opioid interventions,” he said.

While you’re eagerly awaiting your trip to Vegas for National Comp, here’s a resource to learn more about new and innovative types of physical therapies workers’ compensation is starting to tune in to. Also, hear from session panelist Dr. Riviere prior to the conference about some of the latest workers’ comp trends of note.

If this topic is of interest to you, don’t miss out on Curt DeWeese, director and physical therapist for Atlas Injury Prevention Solutions, and John Rhyne, corporate EHS director for Rehrig Pacific Company, as they discuss how one company utilized physical therapy to reduce MSDs by 86%.

“These are not new concepts,” Williams added, “but the appreciation for them is gaining through the validation of scientific research. We want to get providers aware of the services that are out there, have regulators and payers make these services available to the injured worker, and from there, I think we’ll start to see a great change.” &

Hear more from these physicians and other workers’ comp industry leaders at National Comp 2022 at Mandalay Bay in Las Vegas, Oct. 19-21.

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A myriad of state and local laws and abrupt shifts from one administration to the next are creating challenges for employers trying to stay on top of it all.

Ancillary benefit programs may be just one piece of the workers’ compensation puzzle, but they can have significant cost and duration implications if not managed well.

Lara Heal, senior director of managed care for MEMIC, a private mutual workers’ compensation insurance company, knows the value of having a solid dashboard tool.

“Having transparency into our total program so that we can understand where our physical therapy and radiology spend is going is one piece of it,” Heal said. “But the quality of care and the outcome that injured worker receives is equally, if not more, important. At MEMIC, our ultimate goal is for our injured worker to get back to work and back to a productive lifestyle. That’s all part of our mission to make workers’ comp better – for everyone.”

As MEMIC’s medical cost containment partner, CorVel prioritizes helping Heal’s team pinpoint meaningful data that can be used by everyone from the claims handler to the executive. With modular analysis capability, CorVel’s dashboard is designed to help senior leaders like Heal save valuable time and customize views so that each level of her organization can understand what story the claims data is telling.

CorVel’s ancillary benefits dashboard provides a clear picture of total program spend, utilization patterns, and jurisdictional considerations that affect the delivery of care for injured workers.

“When we review program results using the dashboard, it’s not confusing, and we can trust what the data is telling us. It’s critical that there is an efficient way to use this information that makes sense for the business need,” Heal said.

Lara Heal, Senior Director of Managed Care, MEMIC

A large part of managing ancillary benefit spend comes down to how clearly claims handlers can spot opportunities to re-channel claims in-network.

“The job of a claim handler is so complex,” Heal said. And having clear data that illustrates differences in patient outcomes helps claim handlers have confidence in the significance of guiding patients toward network providers who can deliver care swiftly and effectively.

“Giving managers the tool to really focus in on utilizing our networks benefits the injured worker, as well as our bottom line,” Heal said.

“The spend is one piece of it, but it’s the quality of care and the outcome that the injured worker is receiving that’s most important,” Heal said. “If they’re waiting too long to get a diagnostic test done and their treatment’s being delayed, recovery will also be delayed. This is why utilizing a network of high-quality physical therapy or radiology providers who can get our injured worker an appointment quickly is important.”

Sarah Scott, Vice President of Network Services, CorVel

The ancillary benefits dashboard allows MEMIC to illustrate the impact of both prospective and retrospective approaches to network utilization throughout their service territory. Sarah Scott, CorVel’s vice president of network services explained: “Prospective management is when the claims adjuster refers into their ancillary program at the time treatment is ordered. It allows for impact to both treatment utilization and spend per visit resulting in overall reduction in costs and improved outcomes.

“Retrospective management impacts medical cost after the treatment has been rendered, resulting in overall reduction in cost,” Scott added. “So, if the claims handler misses a referral or they receive the claim after treatment was initiated, we can capture a network discount for the client.”

Heal’s team has been able to use the dashboard to establish benchmarks that reflect the nuances of MEMIC’s multi-state ancillary benefit program. “We know there are jurisdictional differences, and we know what those are,” she said.

“Having the ability to drill down by state of jurisdiction, from Maine to Florida and beyond, enables us to identify opportunities, target our strategies and better manage our ancillary program.”

CorVel’s dashboard provides a mechanism to identify alternative network providers. “Some states allow for greater control of medical care,” Scott said. “Having the ability to identify claims treating out of network allows the carrier to take action. Additionally, providing an alternative in-network provider within 5 miles makes the dashboard a really powerful tool.”

Along the path to finding the most expedient means of recovery for injured workers, it’s easy to lose sight of how well programs like ancillary benefits are being utilized.

“It was important when we were selecting our ancillary benefit partners that we had transparency and visibility into those programs,” Heal said. “Without the ability to easily obtain and review our data, it is difficult to develop strategies to improve outcomes. We see it as a significant aspect of what makes MEMIC different.”

At CorVel, the goal has been to make the ancillary benefits dashboard into a tool that supports carrier clients like MEMIC in identifying opportunities and crafting strategies toward improvement. “The challenge,” Scott said, “is to make these dashboards actionable for our clients.

“Program utilization is the number one KPI we measure on the MEMIC program, drilling into the percentage of their medical spend channeled through their prospective and retrospective ancillary programs,” Scott said. “We establish targets for their team to work toward and utilize the dashboard to report their progress and program impact back to them.”

“Prior to the dashboard, we had this information, but it was difficult to interpret multiple reports from multiple sources and pull it together in order to take appropriate action,” Heal said.

Ultimately, to support injured workers on their path to recovery, using data is a powerful way to improve care and outcomes.

“When you don’t have good, actionable data and you’re relying on anecdotal information, it just doesn’t work,” Heal said.

For more information, visit www.corvel.com.

This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with CorVel. The editorial staff of Risk & Insurance had no role in its preparation.

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