June 12, 2018

Factors Influencing Claim Outcomes

Managing claims requires navigation and coordination of a variety of influences, each with an affect on a claim as unique as the claim itself. In particular, comorbidities and chronic pain and its treatment can profoundly impact claim outcomes.

Comorbidities are health conditions that co-exist with the workers’ compensation injury or illness and as such, can impact the claim and an injured workers’ recovery. Common comorbidities include aging, obesity, depression, insomnia, hypertension, cardiovascular disease, arthritis, diabetes, and substance use. When comorbid conditions complicate the treatment of a compensable injury the overall cost of the claim may escalate and the duration of the claim may extend. Proactive management of these conditions at every stage is therefore important.

Chronic Pain and its Treatment
Chronic pain is often treated with opioid analgesics. Many are aware of the risks of misuse and abuse associated with using opioid analgesics, but often overlooked is the impact this potent medication can have on the body. Opioid analgesics have the potential to affect every major body system, which can be compounded with the existence of comorbid conditions or the use of multiple opioids. One way to determine if a claim with multiple opioid analgesics requires additional caution or monitoring is to understand the morphine equivalent dose (MED), which can be used as part of a medication management program.

Other factors influencing claim outcomes include the body part affected and the nature of the injury, as well as:

  • The number of prescribers treating the injured worker
  • The number of pharmacies utilized to fill prescriptions
  • Prescribing behaviors and medication patterns
  • Both patient and prescriber demographics
  • Employing medication monitoring or a medication agreement
  • Application of a multidisciplinary approach
  • Use of ancillary services

Understanding the various factors that can affect claim outcomes allows for more proactive medication management, providing a path to brighter outcomes – both clinically and financially.

Helios Partner Post OutcomesClick here to learn more about each of these factors, including what to look for when handling a claim.


About Helios
HeliosHelios brings the focus of workers’ compensation and auto no-fault Pharmacy Benefit Management, Ancillary, and Settlement Solutions back to where it belongs – the injured person. This comes with a passion and intensity on delivering value beyond just the transactional savings for which we excel. To learn how our creative and innovative tools, expertise, and industry leadership can help your business shine, visit www.HeliosComp.com.

Partner Post:
This is a sponsored post from WorkCompWire marketing partner Helios.

  • RSS
  • Twitter
  • LinkedIn