By David Young, CEO, Coventry Workers’ Comp Services
In 1911 this country’s first state-based Workers’ Compensation laws were enacted. Catastrophic worker injuries and deaths followed by the financial ruin of families made it necessary for society to radically change the way workplace injuries were compensated and how employers would be protected in return. The American Workers’ Compensation system is just beginning its second century since the ‘compensation bargain’ was struck.
As we look to the next 100 years, many are speculating about how this system – that has become as complex as the problems it attempts to solve – will continue to balance the needs of workers and employers. While the possibilities are wide-ranging, including the prospect for additional ‘opt out’ states, the most critical need to be solved is one shared equally by workers and employers. This is the prescription opioid utilization and abuse epidemic. Injured workers are suffering addiction, even dying, devastating their families personally and financially. Employers are struggling to manage excessive pharmacy expense as well as to mitigate the risk of employees at work despite chemically impaired function. As in 1911, all of our society bears this risk.
Einstein told us that the definition of ‘insanity’ is doing the same thing over and over again and expecting different results. Our healthcare system must radically change its approach to pharmaceutical pain management if we want to stop this insanity.
As this problem reaches beyond the workers’ compensation system, so shouldn’t the solutions?
Consider the option of implementing a fully integrated pharmacy system, one providing a holistic view of the patient’s prescription drug therapy regardless of the payer (group health, work comp, personal injury, and government). This concept is similar in intent to the Prescription Drug Monitoring Programs (PDMP) currently being instituted allowing physicians and pharmacists to validate non-drug seeking behaviors prior to prescriptions being filled. Many states are beginning to collaborate in this endeavor which could lead to a national database making it easier to identify and prevent overutilization of narcotic medications whether a patient pays cash or uses any type of prescription fulfillment program. While some PBMs are able to offer cross-coverage profile sharing, few employers today utilize the same PBM across benefit lines, thereby limiting the opportunity for safer and holistic patient care – for now. Similarly large pharmacy chains share platforms which have the extensive capability to identify therapeutic duplication and prevent narcotic shopping, but again – are we capitalizing on these opportunities?
The iGeneration concept represents the mobile technologies that are “individualized” in the way they are used. This iGeneration, rich in apps and functionality, expands our reach to more individuals than ever before, including injured workers and their health care professionals. The iGeneration suite of apps enables a two-way information sharing highway. Prescribers will have real time access to the most current evidenced based medical guidelines for narcotic care. This real-time communication highway allows for coaching, education, and early intervention opportunities to the end consumer which may mitigate potentially aberrant behaviors and serve to increase individual accountability. There are health care reminder apps, weight loss apps, exercise monitoring apps and smoking cessation apps, we need to extend these concepts to narcotic management holding individuals accountable for their personal use of narcotics through decision-support content and interactive dialog with their healthcare providers.
We should not overlook the opportunities we may gain through health care reform. Electronic health records offer innumerable benefits when one considers the visibility health professionals could gain into the health status of patients, including current and past narcotic use, co-morbidities, contraindications and therapeutic duplications that go unseen and unmanaged today. In essence, electronic health care records could remove patient driven barriers (intentional ‘filters’ compounded by the limits of individual memory) and allow for transparency into the patient’s complete medical and pharmaceutical history. Similarly e-Prescribing offers the opportunity to minimize prescribing errors and potential diversion by creating point-to-point fulfillment.
As we envision a better future, we must also consider advancements in science. Science is primed to deliver solutions matching medications with the physical chemistry of the patient by aligning drugs to an individual’s genetic makeup. This personalized prescribing approach and the opportunity to recognize bio markers to predict narcotic reactions will arm providers with concrete evidence as to when specific meds are favorable vs. not, allowing them to monitor and mitigate potential issues. Though such genetic testing will require vigilance to protect the privacy rights of the patient, the injured worker, there is benefit in knowing who may be prone to substance abuse prior to planning a medication course of treatment.
The opportunity for integrated pharmacy care, enabled by technology and science, offers great promise. I hold hope for the next 100 years as we embrace the power in the opportunities that are clearly before us.
About David Young
David Young is the Chief Executive Officer of Coventry Workers’ Comp Services. Since joining Coventry in 2007 he has served as Senior Vice President of Networks, responsible for the network expansion and integration of the First Health and FOCUS networks as well as Chief Operating Officer responsible for the oversight of the daily operations within the network, care management, and pharmacy products.
Prior to joining Coventry, Mr. Young was President of Concentra Network Services. Additionally, he held the position of Chief Financial Officer at Community Education Partners, a private education company that built and ran alternative schools and also served as Director of Mergers and Acquisitions for Radiologix, Inc.
David is a graduate of Texas A&M University with degrees in Accounting and Finance and served in the United States Marine Corps reserves from 1983 through 1989.
About Coventry Workers’ Comp Services
Coventry Workers’ Comp Services, a division of Coventry Health Care, Inc. (NYSE: CVH), is the leading provider of cost and care management solutions for property and casualty insurance carriers, (workers’ compensation and auto insurers), third-party administrators and self-insured employers. We design best-in-class products and services to help our partners restore the health and productivity of injured workers and insureds as quickly and as cost effectively as possible. We accomplish this by developing and maintaining consultative, trusting partnerships with our clients and stakeholders, built on a foundation of innovative and customized solutions that support the claims management process.