Game Changing Strategies to Transform Workers’ Compensation Results

1. Game Changing Strategies to Transform Workers’ Compensation Results RIMS Chicago

2. Kevin Glennon, RN, BSN, CDMS, CWCP, QRPVice President-Home Health & Complex Care ServicesEmail: kevin_glennon@onecallcm.comPhone: 407-448-5879

3. 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.

4. 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

5. 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 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 lost-time 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

6. Factors that increase the aging worker’s potential for risk • Manic behavior • Any change in affect • Confusion • Not eating/sleeping properly • Somnolence/Agitation • Muscle Weakness • Balance Problems • Vision Problems • Side Effects from Medications • Mental status changes

7. 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

8. 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

9. Prolonged Recovery 04-29-1997 06-30-1997

10. 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

11. 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

12. Obesity Related Co-Morbidities • Hypertension • Dyslipidemia • Diabetes • Coronary Heart Disease • Stroke • Gallbladder Disease • Some Cancers • Osteoarthritis • Orthopedic Problems • Impaired Mobility • Peripheral Vascular Disease • Liver &Kidney Failure • Sleep Apnea

13. 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

14. 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

15. 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

16. 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

17. NCCI Reports Pharmacy costs are 19% of total medical spending in Worker’s Compensation

18. Physician Dispensing Varies by State

19. Narcotics Share of Paid Rx

20. Drug Deaths Now Outnumber Traffic Fatalities in US • Most commonly abused Drugs • OxyContin • Fentanyl • Actique • Vicodin • Xanax • Soma • 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

21. 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® 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®

22. Adherence/Efficacy All individuals are different Slow Metabolizers Fast Metabolizers Non Metabolizers

23. Based on adherence studies… Less than 30%of claimants take their medicationsas prescribed More than 30%fill their medications but do nottake them More than 30%take additional medications and/or substances that can reduce or eliminatethe efficacy of the prescribed medications

24. 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 kevin_glennon@onecallcm.com

25. References • 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