Wednesday, September 12, 2012

Worker's Comp Claims: A Hard Pill to Swallow - TRILLIUM ...

Mike ChochrekMichael Chochrek, Insurance Solutions Principal Consultant,?Harte-Hanks Trillium Software

Worker?s compensation insurers are facing an uphill battle due to increased costs, longer average periods of disability, and the refusal of state insurance commissioners to increase premiums out of fear of hurting the economy and receiving negative political backlash. However, these issues pale in comparison to another major problem: the sharp increase in the use of narcotic painkillers as the first line of treatment after an injury.

These powerful and highly addictive prescription drugs were once utilized only for a short period of time when dealing with the most serious and painful of injuries. When prescribed and used properly, opioids are a very effective pain management tool. However, in recent years, the regular use of these drugs has become commonplace for seemingly minor injuries. In short, some doctors and patients view these drugs as a ?magic pill.? This trend is leading to an adverse impact on the overall recovery phase of injured workers and is costing the insurance industry millions of dollars in additional medical and wage indemnification payments.

The following statistics underscore why the insurance industry must deal with this issue for both social and financial reasons:

Compounding the issue of rising costs, insurers are also dealing with workers who are improperly obtaining prescriptions from doctors, giving birth to a new fraud term: Drug Diversion. This refers to the practice of injured parties obtaining prescriptions from doctors for painkillers that are in high demand and then reselling them for a profit on the black market. This not only adds to the costs of claims, but also can lead to increased crime and drug abuse.

It is often said that the hardest part of solving a problem is admitting you have one. Given the number of studies and research completed in this area over the past few years, the insurance industry has to admit that it is facing an issue of epidemic proportions. So what can insurers do? With effective claims data management, resulting in high claims data quality, insurers can develop and implement an action plan to combat opioid drug overuse and abuse. ?

With high-quality claims data, an insurer can identify claims that contain a narcotic painkiller prescription for an injury that normally does not require that level of pain management. An insurer can also determine which regions have the highest instance of painkiller prescriptions, right down to the individual doctor and type of medication. The earlier an insurer can uncover these claims, the better chance for securing successful outcomes.

Trillium?s Claims Data Quality solution, as further explained in the Trillium white paper, Improving Claims Outcomes with High Quality Data, can help solve this issue for you. By leveraging customized logic and a unique ability to search and parse through the numerous free form text areas of a claim, indicators can be pinpointed and analyzed as never before. A real-time, continuous, and thorough analysis of pending claims can identify high-risk claims the instant a certain profile is met. Once they are flagged, actions can be put it place to minimize the potential abuse of painkillers and the negative impact it can have on your bottom line.

For more information on the situation the United States is facing with the over-prescription and misuse of opioid painkillers, please see the Centers for Disease Control and Prevention?s report, Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- United States, 1999?2008.

Source: http://blogs.trilliumsoftware.com/trilliuminsights/2012/09/workers-comp-claims-a-hard-pill-to-swallow.html

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