By Helen Froehlich, CRC, Senior Vice President, Utilization Management, Genex Services
As 2020 began, a persistent opioid overdose epidemic was near the forefront of a list of national concerns in the United States. Some 20 million Americans (PDF) are reported to have a substance use disorder and two million of those misuse opioids.
There was some room for optimism at the start of 2020, however, due to the fact that opioid-related deaths had begun to trend down in 2019 for the first time in decade. That optimism was quickly overshadowed when the pandemic arrived early in the year, reshaping so much of everyday life as well as public health interventions. In fact, experts are now predicting that 2020 is likely to be the deadliest year on record for opioid overdoses. For those struggling with an opioid use disorder, the pandemic no doubt contributed to the daily challenge of managing that condition.
The perfect storm
Quarantine, social isolation, limited access to care, shuttered businesses, widespread layoffs, social unrest, home schooling … the list goes on and on. These factors have caused a perfect storm of stress and anxiety leading to new and exacerbated pre-existing mental health challenges. Employers are noticing this trend. According to the National Safety Council, more than 90% of employers are concerned about mental health and chronic stress impacting their employers’ fitness for duty.
As Americans struggle to meet these pandemic-related challenges, many are turning to drugs and alcohol as a coping mechanism. Early indicators of all substance overuse in the pandemic are concerning. One national laboratory company, Millennium Health, reported increases of 32 percent for the presence of non-prescribed fentanyl, 20 percent for methamphetamine, 10 percent for cocaine and 13 percent for heroin in a survey of 500,000 urine drug screens performed between mid-March and May 2020. A Nielsen report indicated that alcohol sales were up by nearly 27 percent in the same period and early data from a national tracking system at the University of Baltimore pointed to an 18 percent increase (PDF) in suspected drug overdoses in this same period.
Case manager’s role in combating opioid misuse and abuse
Where do employers go from here? Public health spending is falling short, medication-assisted treatment is rare, and the worst drug overdose epidemic in U.S. history is culling our labor force. While there are many beneficial tools being implemented to address these issues there is a vital tool that you may be overlooking — case management.
A case management program that uses a wide lens to manage all aspects of a claim with a focus on patient engagement, education, provider outreach and medication review, can make a positive impact on opioid misuse and abuse.
Proactive patient engagement
Engaging a case manager as soon as potential risks are identified is the most proactive approach to patient education and safety. Case managers can work quickly to complete a holistic assessment of the injured employee, which includes identifying a complete medication list and concerning medications or contraindications, and consult with the prescriber to discuss concerns as well as opportunities for alternative treatment plans. From first opioid utilization through discontinuation, a case manager can support patients at each step of therapy, advocating for the safe and effective discontinuation of opioids for injured employees. The case manager can provide continued follow-up with the injured employee and provider if weaning is necessary.
It is imperative that the case manager considers “the whole person” and routinely looks to uncover behaviors that could signal an injured employee is having trouble managing stress that comes with an injury. This could also be a sign of increased risk for substance abuse issues. Asking questions related to mental wellness and mental health challenges is key, for example:
- Does the employee appear less confident about making a speedy recovery and getting back to work?
- Does the employee appear to be turning to self-destructive behaviors in an attempt to cope?
- Is the employee receptive to recommendations for self-care and other means of promoting wellness?
Injured employee education
Educating the injured employee is a key role of the case manager and includes ongoing patient engagement to provide educational materials, answer questions, and ensure compliance with an appropriate medication regimen. Case managers provide patient education on safe and appropriate use of medications including co-morbid prescriptions, contraindications, and benefits and risks. They also work with injured employees on medication reconciliation, to introduce complementary alternative therapies, and identify non-medical risk factors.
Case managers may also review all medications being used along with available medication history to initiate a conversation with the provider and modify prescribing behavior where needed. A medication review may uncover opportunities for therapeutic intervention. In addition, therapeutic duplication, drug interactions, and polypharmacy can be addressed.
Case managers can contact the prescriber to conduct discussions on the medication(s) in question, education regarding medication cost and potential dangers, and to request prescriber agreements with recommended changes. Case managers can also play a decisive role in identifying a comprehensive pain management solution that looks beyond medications and explores other options including cognitive behavioral therapy, mindfulness and general health and wellness.
Prevent, manage, and mitigate opioid risks
The opioid crisis has taken a grievous toll on the health of many Americans, in particular, those dealing with work-related injuries. And although 2020 may be behind us, pandemic-related stress, anxiety, social isolation and uncertainty continue to linger.
Opioid management presents intense challenges, and early intervention is imperative to limit opioid risk and avoid dependence and addiction. The end goal is to prevent, manage, and ultimately mitigate the risk of death and adverse claim outcomes related to opioid use. The case manager plays a central role in this process. Engaging the injured employee, identifying risks, and providing necessary communication and education to all parties, are critical steps in effectively addressing the opioid problem in workers’ comp.
About Helen Froehlich
Helen Froehlich, CRC, is the senior vice president of Genex’s Utilization Management services, where she provides oversight of telephonic case management, utilization review, and physician advisor services for Genex’s URAC-accredited utilization and case management programs.
About Genex Services
Genex Services provides best-in-class clinical solutions that enable customers to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex, a clinical management leader throughout North America, serves the top underwriters of workers’ compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis. Its clinical expertise consistently drives superior results related to medical, wage loss, and productivity costs associated with claims in the workers’ compensation, disability, automobile, and health care systems. Genex, Mitchell, and Coventry have recently combined their joint industry expertise and advanced technology solutions into one organization to simplify and optimize property, casualty and disability claims processes and services.
Genex Services is a WorkCompWire ad partner.
This is NOT a paid placement.