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Texas Workers’ Compensation System Trends Presentation for the Texas Self Insurance Association

Texas Workers’ Compensation System Trends Presentation for the Texas Self Insurance Association. Amy Lee Texas Department of Insurance Workers’ Compensation Research and Evaluation Group. What This Presentation Will Cover. Workers’ compensation network participation

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Texas Workers’ Compensation System Trends Presentation for the Texas Self Insurance Association

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  1. Texas Workers’ Compensation System TrendsPresentation for the Texas Self Insurance Association Amy Lee Texas Department of Insurance Workers’ Compensation Research and Evaluation Group

  2. What This Presentation Will Cover • Workers’ compensation network participation • Medical costs and utilization of care • Factors affecting medical costs • Access to care and satisfaction with care • Return-to-work outcomes • Employer participation rates in the Texas workers’ compensation system

  3. Network Participation Has Increased; However, a Relatively Small Percentage of Claims Are In Network

  4. Results from Data Callof Top 13 Insurance Carrier Groups • As of July 1, 2008, 12 out of 13 carrier groups have contracted with or established a certified WC network (an increase from 9 in Sept 2006) • All carrier groups with a network have already begun offering it to policyholders and 10 out 12 carriers are offering a premium credit • Premium credits offered for network participation – up to 15% among carriers • Most participating policyholders were small and mid-sized employers • Carriers estimate that over 104,000 workers will be treated by networks by the end of CY 2009

  5. Total Number of Policyholders That Participated in Networks, Top 13 Insurance Carrier Groups Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group. 2008.

  6. Results from Certified Networks’ Data Call • Currently 33 networks are certified by TDI covering over 234 Texas counties • As of February 1, 2009, roughly 76,000 injured workers were treated by 18 certified networks, compared to 40,000 workers treated by 8 networks a year earlier • Additionally, 12,000 injured workers were treated by political subdivision network programs operated under Chapter 504, Labor Code • Roughly 16% of all new injuries are being treated by networks and this percentage hasn’t changed significantly in over a year • Most of these workers, however, are still being treated by one network; however a handful of other networks have begun increasing their participation rates • There are still several networks certified by TDI that do not have any insurance carrier contracts in place

  7. Medical Costs and Utilization of Care Have Stabilized Over Time, but Effect of Networks is Mixed

  8. Total Medical Payments (Professional and Hospital), One-Year Post Injury, Unadjusted, Injury Years 1998-2006 Note: Injury Year 2004 was excluded from this analysis due to missing data. Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

  9. Average Medical Cost (Professional and Hospital Costs) Per Claim, One-Year Post Injury, Unadjusted, Injury Years 1998-2006 Note: Injury Year 2004 was excluded from this analysis due to missing data. Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

  10. Average Medical Cost (Professional and Hospital Costs) Per Claim, One-Year Post Injury, Adjusted, Injury Years 1998-2006 Note: Injury Year 2004 was excluded from this analysis due to missing data. Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008.

  11. AVERAGE MEDICAL COST PER CLAIM, 6 MONTHS POST INJURY Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Medical cost differences between non-network and Corvel Corcare, Liberty HCN, and other networks are statistically significant. The figures presented above are adjusted for injury type and type of claim differences that may exist between the groups.

  12. Factors Affecting Medical Costs in the Texas Workers’ Compensation System

  13. Number of Workers’ Compensation Claims Reported to the Division of Workers’ Compensation, Injury Years 1998-2007 Note: These numbers include the claims that are required to be reported to DWC, including fatalities, occupational diseases, and injuries with at least one day of lost time. Medical-only claims are not required to be reported to DWC. Source: Texas Department of Insurance, Division of Workers’ Compensation, 2008.

  14. Percentage of Injured Workers Receiving Professional, Hospital and Pharmacy Services, 6 Months Post Injury Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: The figures presented above are adjusted for injury type and type of claim differences that may exist between the groups. Asterisks (*) indicates that the differences between the network and non-network are statistically significant.

  15. Average Number of Evaluation and Management Services Billed Per Claim, Adjusted, Injury Years 1998-2007 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Injury Year 2004 was excluded from the analysis due to missing data. The figures above are adjusted for injury type and claim differences.

  16. Average Number of Other Physical Medicine Services Billed Per Claim, Adjusted, Injury Years 1998-2007 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Injury Year 2004 was excluded from the analysis due to missing data. The figures above are adjusted for injury type and claim differences.

  17. Average Number of Spinal Surgery Services Billed Per Claim, Adjusted, Injury Years 1998-2007 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Injury Year 2004 was excluded from the analysis due to missing data. The figures above are adjusted for injury type and claim differences.

  18. Percentage of Reportable Claims That Are Initially Denied/Disputed for the Top 25 Workers’ Compensation Carriers, Injury Years 1998-2006 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. 1The 2006 figures should be interpreted with caution since the data are incomplete. 2 House Bill (HB) 2600, a workers’ compensation reform bill aimed at reducing medical costs was passed in 2001.

  19. Percentage of MedicalServices Denied for the Top 25 Workers’ Compensation Carriers for Service Years 1998-2007 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note 1: Denial rates for 2007 should be interpreted with caution since these number are tentative. Note 2: House Bill (HB) 2600, a workers’ compensation reform bill aimed at reducing medical costs, was passed in 2001. Note 3: In August 2003, the most recent professional medical fee guideline, which incorporated Medicare’s payment policies, went into effect.

  20. Some Improvements in Workers’ Perceptions Regarding Access to Care Over Time, but Generally Workers in Networks Have Poorer Perceptions

  21. Methods Injured Workers Reported Using to Select Their Treating Doctor Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008. Note: “Selected in other manner” includes recommendations from family or friends or other coworkers, among others.

  22. Type of First Non-Emergency Treating Doctor Selected by Injured Workers Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008.

  23. Percentage of Injured Workers Who Reported Having Problems Getting Medical Care for Their Injury Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008.

  24. GETTING NEEDED CAREpercent of injured workers who reported no problem getting: a personal doctor they like · to see a specialist · necessary tests or treatment · timely approvals for care Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Differences between non-network and Corvel Corcare, Liberty HCN, and other networks are statistically significant. The figures presented above are adjusted for injury type, type of claim, race/ethnicity, gender, age, education, age of injury at the time of the survey, insurance coverage, and self-rated health differences that may exist between the groups

  25. OVERALL SATISFACTION WITH MEDICAL CAREpercent of injured workers who indicated that they were “ extremely satisfied” with the quality of the medical care received for their work-related injury Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Differences between non-network and Texas Star, Corvel Corcare, Liberty HCN, and other networks are statistically significant. The figures presented above are adjusted for injury type, type of claim, race/ethnicity, gender, age, education, age of injury at the time of the survey, insurance coverage, and self-rated health differences that may exist between the groups

  26. Return-to-Work Outcomes Continue To Improve, but Network Results Are Mixed

  27. Initial Return-to-Work Rate Percentage of Injured Workers Back At Work for the First Time 6 Months to 3 Years Post-Injury Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note 1: The study population includes 392,331 workers injured in 2001-2006 who also received Temporary Income Benefits (TIBs). Note 2: Although the increases of initial RTW rates were small, they were statistically significant at the 0.01 significance level.

  28. Mean and Median Days Off Workfor Injured Workers Who RTW At Some Point Post Injury Injury Years 2001-2005 Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2007. Note 1: “Days Off Work” was defined as days from the injury date to the initial RTW date. Please note that these numbers do not take into account any additional time off work that may have occurred after the initial RTW date. Note 2: The analysis was based on the claimants who returned to work, and did not include those who did not return by the end of 2007. Injury year 2006 was excluded because of insufficient data.

  29. Return-to-Work Experiences of Injured Workers, 18-22 Months Post-Injury Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008.

  30. Percentage of Injured Workers Surveyed Who Reported Being Released to Go Back To Work by Their Doctor Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, Survey of Injured Workers, 2005 and 2008.

  31. Percent of Injured Workers Who Indicated That They Had Returned to Work At Some Point After They Were Injured Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Differences between non-network and Texas Star are statistically significant. The figures presented above are adjusted for injury type, type of claim, race/ethnicity, gender, age, education, age of injury at the time of the survey, insurance coverage, and self-rated health differences that may exist between the groups.

  32. Average Number of Weeks Injured Workers Reported Being Off of Work Because of Their Work-Related Injury Source: Texas Department of Insurance, Workers’ Compensation Research and Evaluation Group, 2008. Note: Differences between non-network and Texas Star are statistically significant. The figures presented above are adjusted for injury type, type of claim, race/ethnicity, gender, age, education, age of injury at the time of the survey, insurance coverage, and self-rated health differences that may exist between the groups.

  33. Employer Participation Rates Have Improved, but Employee Coverage Rates Have Declined

  34. Percentage of Texas Employers That Are Non-subscribers, 1993-2008 Source: Survey of Employer Participation in the Texas Workers’ Compensation System, 1993 and 1995 estimates from the Texas Workers’ Compensation Research Center and the Public Policy Research Institute (PPRI) at Texas A&M University; 1996 and 2001 estimates from the Research and Oversight Council on Workers’ Compensation and PPRI; and 2004 - 2008 estimates from the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group and PPRI.

  35. Percentage of Texas Employees That Are Employed by Non-subscribers, 1993-2008 Source: Survey of Employer Participation in the Texas Workers’ Compensation System, 1993 and 1995 estimates from the Texas Workers’ Compensation Research Center and the Public Policy Research Institute (PPRI) at Texas A&M University; 1996 and 2001 estimates from the Research and Oversight Council on Workers’ Compensation and PPRI; and 2004 - 2008 estimates from the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group and PPRI.

  36. Percentage of Texas Employers That Are Non-subscribers by Employment Size, 1993-2008 Note: Non-subscription estimates for 1993 were based on different employer size categories than were used in later years so they are not directly comparable. Source: Survey of Employer Participation in the Texas Workers’ Compensation System, 1993 and 1995 estimates from the Texas Workers’ Compensation Research Center and the Public Policy Research Institute (PPRI) at Texas A&M University; 1996 and 2001 estimates from the Research and Oversight Council on Workers’ Compensation and PPRI; and 2004 -2008 estimates from the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group and PPRI.

  37. Percentage of Texas Employers That Are Non-subscribers by Industry, 2006 - 2008 Estimates Note: Industry classifications were based on the 2002 North American Industry Classification System (NAICS)developed by the governments of the U.S., Canada and Mexico, which replaced the Standard Industrial Classification (SIC) system previously used in the U.S. As a result of this change in industry classifications, industry non-subscription rates for 2004 - 2008 cannot be compared to previous years. Source: Survey of Employer Participation in the Texas Workers’ Compensation System, Public Policy Research Institute at Texas A&M University and the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group, 2008.

  38. Primary Reasons Why Subscribing Employers Said They Purchased Workers’ Compensation (WC) Coverage • Because employer thought having WC coverage was required by law (25% overall; 16% of large employers) • Because WC coverage was available through health care networks • (24% overall; 28% of large employers) • Because of employer concerns over lawsuits • (14% overall; 13% of large employers) • Because employer needed WC coverage to obtain government contracts • (3% overall; no large employers) • Because employer thought WC insurance rates were lower (2% overall; 3% of large employers) • Because employer was able to reduce its WC insurance costs through deductibles, certified self insurance, group self-insurance or other premium discounts (3% of large employers) Source: Survey of Employer Participation in the Texas Workers’ Compensation System, Public Policy Research Institute at Texas A&M University and the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group, 2008.

  39. Primary Reasons Why Non-subscribing Employers Said They Did Not Purchase Workers’ Compensation (WC) Coverage • Because employer thought WC insurance premiums were too high (26% overall; 49% of large employers) • Because employer had too few employees (26% overall) • Because employer was not required by law to have WC insurance (11% overall) • Because employer thought medical costs in the WC system were too high (4% overall; 13% of large employers) • Because employer had few on-the-job injuries (9% overall; 10% large employers) Source: Survey of Employer Participation in the Texas Workers’ Compensation System, Public Policy Research Institute at Texas A&M University and the Texas Department of Insurance Workers’ Compensation Research and Evaluation Group, 2008.

  40. Upcoming Research Projects • Updated Network Report Card (to be published in Sept) • Update return-to-work rates (late summer) • Continue monitoring network participation by employers and workers • Analyze preliminary impact of ODG treatment guideline (early fall) • Survey nonsubscribing employers about availability of data and methods to evaluate the cost and quality of nonsubscriber programs

  41. Workers’ Compensation Research and Evaluation Group (REG) Find Research Reports on TDI Website: • http://www.tdi.state.tx.us/wc/regulation/roc/index.html Contact REG • WcResearch@tdi.state.tx.us • DC Campbell at 322-3566 or Amy Lee at 804-4410

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