During our time at RIMS 2015, we had Workers’ Comp industry stakeholders participate in WorkCompWire’s “RIMS Review” series, focused on what to look for this year and in the future! Here’s what Kevin Glennon RN, BSN, CWCP, VP Clinical Education & Quality Assurance Programs at One Call had to say:
What do you believe will be the most significant development in the Workers’ Comp industry in 2015?
Within our Home Health and Complex Care division, a significant challenge we see and assist with is the occurrence of complex, high-severity, and catastrophic cases. These types of injuries are multi-faceted, often requiring home care, equipment such as a wheelchair, home modifications and other services as injured workers transition from a hospital or rehab facility back to their home. We get involved as early as possible to ensure a smooth continuum of care and to control costs at every step. In this way, we optimize care and quality of life for the injured worker, save costs for customers, and ease the burden of managing these files for claims staff. Part of the challenge with these complex cases is also managing pharmacy costs and utilization, as well as monitoring the use of non-prescription drugs.
What is the top challenge you and your organization are currently working on this year?
In the past five years, the number of workers in the United States between the ages of 55 and 64 increased by over 50 percent – and this trend will only increase as baby boomers hit 65 at the tune of 10,000 a day until 2030. The aging workforce poses a specific set of challenges to workers’ compensation. Although older individuals do not generally experience a higher rate of injury than their younger counterparts, they often experience more severe injuries, and in general, require more time to recover. At One Call, we are looking at how we can incorporate quality guidelines into our Home Health procedures to ensure optimal outcomes. For example, we immediately determine if there are any pre-existing medical conditions, such as diabetes or high blood pressure. We monitor nutritional intake; have measures to avoid bedsores or pressure ulcers from developing; and take inventory of any prescribed medications or whether the claimant is taking over-the-counter drugs—all of these factors could affect recovery.
Looking out 5 years, beyond obvious trends, what do you think one big change in the Workers’ Comp industry will be?
The growing trend of states working to legalize medical marijuana has created challenges in the workplace as well as in workers’ compensation programs. At the federal level, marijuana is categorized as an illegal substance, but in the states where medical marijuana is now legal, it is used for various medical purposes. As a result, key issues include the conflict that exists between state and federal laws, lack of evidence for the efficacy of medical marijuana, and risks posed to employee safety. Currently, medical marijuana is predominantly requested to manage pain in WC cases. However, payers rely on evidence-based guidelines when making coverage decisions. Without FDA approval or a large-scale randomized, controlled human trial to demonstrate medical value, many payers are choosing to categorically deny coverage of medical marijuana. It’s a catch-22: lack of evidence continues to hamper adoption, and yet clinical trials are not permitted under current federal law.
What is one thing you’d like to promote?
For those still at the RIMS conference on Wed, April 29 at 2:00 pm, I will be participating on the panel, “Legalized Marijuana: Its Impact on the Workplace,” and delivering an overview of state legalization and the issues related to the use of medical marijuana in the treatment of injured workers. My co-presenter is the Colorado state risk manager Markie Davis who will be sharing Colorado’s experience with legalized marijuana for both medical and recreational use.
Courts could rule that payers should cover medical marijuana for treatment. However, there are potential risks in doing so, such as mental health issues, delays in return to work, diminished levels of productivity, and safety hazards, especially if users operate heavy machinery or drive vehicles.
In the meantime, organizations should stay abreast of new cases, judgments, and verdicts that could forecast further impact on policies. If you cannot attend my session at RIMS on Legalized Marijuana, I will also be presenting on similar topics at the national PRIMA Conference, the National Workers’ Compensation & Disability Conference, and California JPA (CAJPA) Conference.
About Kevin Glennon
Kevin Glennon, RN, BSN, CWCP, is Vice President, Clinical Education & Quality Assurance Programs at One Call Care Management. He has over 30 years of experience in healthcare, encompassing clinical and claims management for workers’ compensation, auto, and general liability. His background includes medical case management of complex and catastrophic injuries and long-term disabilities. He applies his combined knowledge and experience to assist organizations in better managing and controlling costs associated with complex injury claims for the best-possible outcomes. For the last 17 years, Kevin has spearheaded the development of One Call’s Home Health + Complex Care division. He manages an extensive clinical education and quality assurance program.