Insurance Trends: The Business Implications
of an Aging and More Injury-Prone WorkforceAdam Seidner MD MPH CIC
National Medical Director
2
Overview Managing Rising Medical Costs
Medical Inflation types - physician, hospital , DME, pharmacy, surgical centers, etc
Alliances > Employee health and wellness> EE education> Provider Networks and Education
Interventions > Preplacement and fitness for duty> Proven strategies for DME, pharmacy management
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Industry/Economic Trends*
0
5
10
15
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007p
Inci
den
ce R
ates
per
100
FT
E W
ork
ers
(BL
S)
0
1250
2500
3750
Claim
s per 100,000 W
orkers
(NC
CI)
Recessions
Manufacturing Industry Injuries and Illnesses per 100 Full-Time Workers
Private Industry Injuries and Illnesses per 100 Full-Time WorkersNCCI Lost-Time Claims per 100,000 Workers
* NCCI Study
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Industry/Economic Trends*
* NCCI Study
5
Industry/Economic Trends*
* NCCI Study
1988 1998
2008 2018 - Projected
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The Aging Workforce
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Our Aging Population
See if can find this type of map for boomers
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The number of jobs held by older workers will more than double between 1995 and 2020
Older workers injured on the job have higher costs per claim than younger workers.
Impact on Worker’s Comp
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Impact on Worker’s Comp
“Older workers are a resource we can no longer afford to waste! Projected tight labor markets requires us to better use our experienced mature workers. This does not mean business as usual, however. We must change our strategies and practices in the 3R’s,
Recruitment, Retention, and Retraining.”
-- Barbara McIntosh, Ph.D. In “An Employer’s Guide to Older
Workers”
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What Drives Workplace Injury and
Healthcare Costs?
Musculoskeletal Problemslow back disease, carpal tunnel syndrome, knee and shoulder disorders
Compromised Musculoskeletal Health stiffness and immobility, reduced strength and endurance, chronic soft tissue pain, obesity and deconditioning
Job safety and design initiatives(ergonomics, work organization) are not well coordinated with worker health issues, such as aging and individual capacity, chronic disease, and disease susceptibility
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Revise age groups on this slide?
TRAVELERS BOOK OF BUSINESS
REPORT ON SELECTED DIAGNOSIS GROUP CATEGORIES FOR ACCIDENTS BETWEEN 01/01/2001 AND 12/31/2006
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Additional known drivers of musculoskeletal injury and healthcare cost
Physical Activity Sedentary Life Style Level of physical activity at work does
not seem to protect from MSD
Ergonomics Trunk loading Uninterrupted repetitive work Biomechanically unsound work
postures
Medical Issues Poor compliance with medical
management Inappropriate or misdirected medical
care
Aging issues Loss of mobility due to aging Osteoarthritis of the spine, knee and
shoulder Decline in cardio-vascular health Doubling of chronic disease per
decade >40 years old
Stress issues Perceived Job Stress Elder and dependent care
responsibilities (in women) Past or current major depression
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Identifiable Factors Promoting
Musculoskeletal Wellness
Positive attitude towards aging and fitness
Leisure Exercise
Noise reduction
Good overall health
Utilization of ergonomic interventions: tool selection and job design
Teamwork and co-worker support in the workplace
Low management strain Low work-family strain Agreement between workers
and managers on level of workplace risks
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Goals of all Healthy Workplace Projects
Combine Occupational Safety and Health with individual Health Promotion
Evaluate (and overcome) obstacles to combined program
Evaluate health benefits and cost-effectiveness of these initiatives
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Content common to all
Healthy Workplace projects
Health promotion
Integration of health promotion with traditional OSH
Qualitative research
Scientific approach to processes, focus groups, interviews
Economics Evaluate intervention costs
Survey measures & biometrics
Common pool of measures for comparability
Expertise in advanced statistical techniques
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Outcomes
Improve clinical outcomes Improve Payer/Provider Communication
Fraud Detection
Education – Pharmacy Letters
Quality Assurance and Improvement
Network Development
Disease case management
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Cost Drivers
Iatrogenic/Nosocomia
Off-label
Compounds
Devices
Addiction
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Medical Care
The U.S. spends well over 2.6 trillion dollars on health care annually
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Rule
Nobody washes a Rental Car
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You must…
Make a point to know the impact of patient comorbidities on outcomes
Age, BMI, Osteoporosis/enia Deconditioning ROM - truncal
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End Points
Measurable- subjective vs objective
Surrogate end point issues
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Provider Credibility
Public Health and Safety
physicians' attitudes toward the use of deception
most physicians indicated some willingness to engage in forms of deception
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Guidance
Ensure correct diagnosis
Review the Quality of Evidence supporting off-label use
Informed Consent Issues
Standard of Care vs. State of the Art
Investigational and Experimental treatment
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Focus
Public Health and Safety
Quality of Life
Cost savings follows
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What does it all mean?
How do we effectively manage technology’s future challenges?
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Report of Work Ability
It is used to:
Identify essential tasks the employee can perform
Determine which tasks can be modified to fit restriction
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Why have an early return to work
program? An employee’s chance for successfully resuming his or her regular job is maximized if the employee returns to work soon after the injury.
Implementing a modified return-to-work program is critical in promoting successful RTW.
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What is the Target?
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Outcomes
RTW
Cost
Minimize Medical Impairment
Satisfied client
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Work Comp vs. Non-comp
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Issues of
Consideration Diagnosis
Causation
Resource Utilization
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Outcome
Measures Reduce cost of claim & lost time days
Assist with identifying modified duty
Ensure appropriate utilization of resources > Ergonomic> Medical> Claim> SIU
Thank you!
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