During our time at RIMS 2017, we had Workers’ Comp industry stakeholders participate in WorkCompWire’s “RIMS Review” series, focused on what to look for this year, and key takeaways from the conference! Here’s what Daryl Corr, Chief Executive Officer at Healthesystems had to say:
What do you believe will be the most significant development in the workers’ comp industry for this year?
I’m going to address this from the area of the market we know best, which is pharmacy and ancillary services management, although it also has a significant impact on the industry overall – and that’s the magnitude of states moving forward with very significant, work-comp specific initiatives intended to correct systemic problems, primarily one of the largest cost drivers, which is pharmacy. We’ve seen an outpouring of regulatory activity throughout 2016 and into this year to address overall drug management, much of which has been focused on opioids. On a high level, there has been a volume of state-specific formulary activity, notably the California DWC, which is geared up to implement a formulary this summer that will impact the care of hundreds of thousands of injured workers. Then there are other complementary initiatives we’ll continue to see a lot of – initial opioid prescribing limits, legislation mandating PDMP checks by prescribers, and new rules in states including Ohio and Vermont that only allow opioids to be reimbursed in the workers’ comp setting if they follow treatment guidelines. Many of these initiatives should help facilitate positive change.
What is the top challenge you and your organization are currently working on?
It’s not a new challenge, but it’s certainly always an evolving one where we continually look to maximize opportunity – and that’s a lack of adherence within the workers’ comp system. I’m not just speaking about patient nonadherence to treatment, although that’s certainly one example of it. I’m addressing a challenge that occurs at every level of the managed care model. On one hand, you need strategies to mitigate the factors that work against the ideal care model – physician dispensing, drug diversion, compounds, and private-label topicals, to name a few. On the other hand, at the prescriber level there exists a level of nonadherence to evidence-based medicine. And further down that care model there are additional challenges at the claims management and pharmacy levels. Ultimately, the larger solution is to foster a more adherent model by providing a better and easier overall healthcare experience. Part of that includes communicating with prescribers to support evidence-based care, and intervening with pharmacies to help them navigate the workers’ comp system. We can also empower claims professionals with the tools and education they need to make the decisions most likely to drive their claims in a positive direction. And we can help patients become active and educated participants in their treatment.
What was one major takeaway for you from this particular RIMS conference?
Data was clearly a focal topic across all areas of the insurance industry at RIMS. When used strategically and appropriately, data is incredibly valuable, especially when it can have a meaningful impact on outcomes. But it’s also interesting to consider the tremendous responsibility it brings. Healthcare is a top target for cyber attacks – I believe IBM reported that more than 100 million patient records were breached globally in 2016. So as the industry gathers and shares more information electronically though the expanded use of PDMPs, EHRs, mobile applications and other e-health tools, protecting the patient’s security must remain foremost. A key focus has to be on infrastructure and data security, especially as you consider extending your technological reach to include mobile and other technology applications.
What is one thing you’d like to promote?
We still see an enormous amount of opportunity from a cost containment perspective, especially when you look at driving transparency into the system. In other words, creating the ability to shed light on the factors that are truly driving cost and utilization, as well as having the flexibility to quickly incorporate measures that will mitigate these factors. And usually these are fast-moving and constantly evolving. For example, in our Ancillary Benefits Management program, we’ve built a model that provides an unmatched level of transparency into activity around services that have traditionally been limited in the way they can be managed. These would include services such as physical medicine, durable medical equipment, home health, transportation and language. This has allowed us to see what is truly driving costs – and it goes well beyond the pure price of goods and services. Service mix, treatment duration, product selection – all of these factors must be considered and managed accordingly. And they’re always changing, which is why ongoing monitoring is also a critical component of our program.
Daryl Corr is Chief Executive Officer at Healthesystems. Mr. Corr has long been a technology innovator developing new ways in which to improve the delivery and quality of medical services. His focus on innovation has helped improve performance across the industry by automating various manual functions and improving transaction efficiency. His efforts to make disparate processes and systems work together helped transform the organizations he managed. Under Mr. Corr’s leadership, Healthesystems has grown into one of the largest workers’ compensation pharmacy and ancillary medical benefits management providers in the market.