During our time at RIMS 2014, we had Workers’ Comp industry stakeholders participate in WorkCompWire’s “4 For 14” series, focused on what to look for this year and in the future! Here’s what Brian Allen, VP of Government Affairs and Tron Emptage, Chief Clinical Officer at Progressive Medical/PMSI had to say:
1. What do you believe will be the most significant development in the Worker’s Comp industry in 2014?
BA: We have already seen Oklahoma follow Texas’s lead and adopt a closed formulary. California and Louisiana have both talked about. I think, given the early success in Texas, that a growing number of states will begin the process of drafting legislation or regulation to adopt a closed formulary.
TE: I agree with Brian. I think that many states and organizations will look more closely at formulary and guideline developments especially in light of some of changes that have been made recently and the outcomes that are being reported.
2. What is the top issue/problem you and your organization are currently grappling with?
BA: I think that compounds are starting to trend along a path similar to the path opioids have traveled. It looks like some of the past work we have done is bending the opioid curve. Compounds are emerging as a profit center for a lot of practitioners and there isn’t a lot of science around their use and the cost per compound is accelerating at a rapid rate.
TE: Compounds is an important issue as there are many facets to contemplate when being used for treatment of a work related issue. While there are many good and appropriate reasons to utilize a compounded medication, there are many reasons why they are being overused and potentially abused as a part of treatment. Being able to pull all the relevant information into a claim regarding a compound is important and due to the invoicing and out of network dispensing issues that surround compounded medications, it continues to be an issue to work on for Payers and PBMs.
3. Looking out 5 years, beyond obvious trends, what do you think one big change in the Workers’ Comp industry will be?
BA: With the advancement of electronic medical records and better information sharing between health care professionals, I think we are going to see a lot more coordination of and efficiency in care between the workers’ comp treating physician and the general health treating physician when an injured worker is dealing with co-morbidities. PBMs have played a key role in reaching across disciplines and systems to coordinate pharmacy care and this model could be expanded to all health care professionals. This coordination and efficiency could also help provide access to a greater array of specialists using telemedicine to aid in the treatment of an injured worker residing in a rural or remote area.
TE: Well it may be an obvious trend, since so many folks in our industry track it, but I do believe we’ll see less opioid utilization over the next five years with a trend toward using more adjunctive medications in our chronic pain claimants.
4. What is one thing you’d like to promote?
BA: For health care in general, and for workers’ compensation care specifically, I would like to see reimbursement move to an outcome based model and the shifting of services to the most cost efficient and convenient delivery system. For example, pharmacy care is more convenient and less costly when rendered by a pharmacist rather than a physician. Another area I have always wondered about are routine blood tests to monitor progress for individuals on long term medications. Do those necessarily need to be done in a doctor’s office or could they be done at the pharmacy with the pharmacist and physician communicating about results and therapy adjustments. What about preventative care? Many workers are overweight which adds costs to recovery from workplace injury. What if health insurers, employers, workers’ comp payers, and the workers were to coordinate on a plan to help the worker lose weight and used a local fitness center, pharmacy, or convenient clinic to do weekly weight checks and provide encouragement and motivation to the worker? We have got to shift our thinking on how we measure success and how we reward success in the health care system. We have to get away from pay-for-procedure models.
TE: Collaboration between prescribers, providers and payers for better overall care. I think the more we share information, in secure and appropriate means, the better the outcomes for the claimants we serve. With the aid of technology, I’d like to continue to see advancements in this area. With secure portals and exchange of information, case managers, adjustors, and providers are better able to communicate treatments and treatment options that can lead to better outcomes.
About Brian Allen
As Vice President of Government Affairs at Progressive Medical & PMSI, Brian Allen serves as an advocate for both payors and injured parties alike. He helps clients build effective strategies to navigate or otherwise comply with legislative and regulatory issues that impact workers’ compensation payors.
A former Utah legislator and lobbyist, Brian is highly regarded by policymakers nationwide for his extensive governmental knowledge and ability to drive collaboration. He has an extensive history in a wide spectrum of legislative and executive branch assignments, including insurance, workers’ compensation, technology, and municipal and local government. Throughout his career, Brian has provided strategic advice, educated policymakers, authored rules and legislation, and given expert testimony.
Brian represents the company on CompPharma, a consortium of PBMs that develops solutions to some of the industry’s most pressing pharmacy issues.
About Tron Emptage
Chief Clinical Officer Tron Emptage oversees Progressive Medical & PMSI’s comprehensive suite of clinical programs that help payors gain more control over costs and achieve better outcomes for injured workers. Tron leverages two decades of pharmacy and managed care experience in the development and management of medication plans, utilization reviews, physician outreach, clinical intervention and pharmacist and nursing support to ensure injured workers receive the right therapy at the right time.
Tron has been instrumental in developing a number of innovative clinical initiatives, including a patent-pending data analytics model and a urine drug monitoring program – further helping the company transform the way workers’ compensation payors manage claims and contain costs.
He is a frequent speaker at leading industry conferences and the author of several white papers and journal articles on topics ranging from prescription drug misuse to pharmacy management strategies. He also is the lead clinician on the company’s annual Workers’ Compensation Drug Trends Report.
Tron earned his bachelor of science in pharmacy from The Ohio State University and a master of arts from Ashland University. He is an experienced lecturer and teacher and is affiliated with several professional and community organizations.