Opioid Rescue Therapy, Not Just A Quick Fix…

Opioid Rescue Therapy, Not Just A Quick Fix…

91 Americans lose their lives every day to opioid overdose, according to the Centers for Disease Control and Prevention (CDC).  That is over 33,000 Americans each year, and the rate is only rising, actually having quadrupled since 1999.  It is now accurately categorized as an Epidemic and, appropriately, stringent private and public institutional changes are being implemented to minimize the likelihood of future abuse.  This includes limited pill counts, prescription drug monitoring platforms, closed formularies, etc.  These improvements reduce the likelihood of future dependency, but what about those already dependent, the most at risk for potential overdoses.  What can we do about them?

The first answer: Keep them alive.  Enter the growing availability of Opioid Rescue Therapies.  Two of the most commonly prescribed are Narcan® and Evzio®.  Both medications utilize naloxone, an opioid antagonist, which can be a life-saving treatment in the case of an opioid overdose.  Rescue Therapies have become standard issue to police, emergency medical personnel, and recently have become available over-the-counter without a prescription at participating CVS Pharmacy® locations in 41 states. The reason: they work.

However, we cannot have Rescue Therapy serve as just a ‘Band-Aid’. Furthermore, the issues of cost need to be addressed. There are currently multiple formulations of naloxone available, the cost of which varies dramatically. Evzio® ($4,500.00) is a brand-name naloxone auto-injector that uses a pre-filled device with a voice-prompt providing direction for use. Conversely, Narcan® ($150.00) is a fast-action nasal spray that also provides two doses, but at a fraction of the cost.

Prescribing naloxone should be viewed as one step in a comprehensive opioid risk assessment strategy. Patients, prescribers, and loved ones should periodically question the opioid doses/regimen employed. Is it effectively reducing pain and improving function with minimal side-effects?  Could a lower dose provide similar efficacy with a reduced overdose risk?  Has weaning been tried recently?  Has an opioid rotation to a lower dose alternative or non-opioid pain reliever been trialed?

When further examining treatment, it is also important to consider additional risk factors, such as other medications employed and co-morbidities. For example, patients with COPD or sleep apnea or who are prescribed opioids in conjunction with central nervous system (CNS) depressants such as diazepam or clonazepam are at a significantly increased risk for overdose.

While the decision to prescribe naloxone can be a necessary emergency step, it is important it be viewed as a window of opportunity for patients and prescribers alike to address the current medication regimen, while ensuring the most cost-effective naloxone formulation is easily accessible for the patients who need it most.

About the Author: Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers and ANS Pharmacotherapy Review Program is the most advanced, results-oriented drug utilization review program in the industry. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

Original content posted on http://ans-solutions.com/opioid-rescue-therapy-not-just-quick-fix/

Advertisements
Medical Marijuana and the Workers Compensation Conundrum – Part 1

Medical Marijuana and the Workers Compensation Conundrum – Part 1

Because the U.S. Federal Government has dug-in its feet, leaving marijuana as an illegal, Schedule I drug under the Controlled Substances Act, state governments have been left to individually pave their own legalization paths, leaving a frustrated public in the wake. Employers, employees, doctors, workers comp case managers, and more feel frustratingly in-the-dark as ever-diversified, continually evolving legislation continues to change the landscape. This is the first post of our two part series of spotlighting medical marijuana in the marketplace.

What We Do Know About Medical Marijuana

Though state laws vary widely on the amount of legal possession and personal cultivation for medical use, to-date 29 states and D.C. have legalized marijuana for medical use, including 8 states who’ve legalized its use recreationally. For medicinal purposes, marijuana has been scientifically confirmed effective for pain relief, appetite stimulation, nausea control, and reducing ocular pressure. It is arguably cheaper and less addictive than opioids, however both research and quality control are lacking. For injured workers and those in the workers’ comp industry, its most-likely application is pain relief, however it’s typically not be the first drug in the treatment lineup for prescribing physicians.

What’s Murky About Medical Marijuana and Workers’ Compensation

Marijuana dispensing differs from run-of-the-mill pharmaceuticals, with product obtained from dispensaries or home growth, not pharmacies, leading to a gap in patient information on potentially dangerous drug interactions. Patient protections also remain muddy. Still illegal under federal law, stateside court rulings are chaotic. Fifteen states offer little to no employee protection, while 11 states explicitly provide protections from retaliatory actions to limits on drug testing from employers. Furthermore, all states with medical marijuana have pending legislation and litigation that could have a broad impact on the workplace, creating a landscape reminiscent of the Wild West.

Who’s Paying For Medical Marijuana Prescriptions?

Who knows? Medical marijuana’s Schedule I status prohibits its inclusion in the National Drug Code, leaving Medicaid and Medicare patients on the sidelines. This lack of regulation also equates to a dearth of coding, complicating processing for pharmacy benefits managers. And state-by-state case law for prescription coverage from employer-sponsored coverage to workers’ comp, like employee protection legislation, also varies widely.

Who’s Got a Headache?

Employers. Though there is federal protection backing drug-free workplace policies, including “zero-tolerance” for specific jobs such as heavy equipment operators, pilots, and surgeons, ever-changing legislation makes it difficult for employers to figure out which end is up. In the meantime, knowledge of state-specific legislation remains key to compliance, with an attitude of managing medical marijuana like any other powerful legal prescription drug that could impair mental capacity a logical choice: Accommodate the needs of injured workers – but uphold a safe work environment, as always. ANS Solutions Medical Cost Containment Programs are the only end to end pharmaceutical cost containment programs in the industry that genuinely put the patient first, while minimizing the cost of settlement in large loss workers’ comp claims.

 

ASansAbout the Author:  Anthony Sambucini is a founding principal and the Chief Executive Officer of ANS Solutions. Anthony specializes in bridging the goals of clinical innovation and business strategy that have helped propel ANS Solutions into a national leader in Pharmacotherapy Review Services for workers’ comp insurers. As a consultant to insurance carriers and attorneys, Anthony customizes services based on the particular needs of the client and oversees all activities related to business development and company operations. For more information about ANS Solutions visit http://ans-solutions.com/.

Original content posted on http://ans-solutions.com/medical-marijuana-and-the-workers-compensation-conundrum-part-1/

Tips to Build an Effective Medical Cost Containment Strategy

Medical Cost Containment

Medical cost containment program is an end to end pharmaceutical cost containment programs which puts the patient first while reducing the cost of settlement in large loss workers comp claims. Today, businesses are challenged to control workers compensation cost and improve the income. Only framing an effective cost containment strategy focuses on different areas and provides possible tricks to avoid any mess.

Using comprehensive and well-coordinated medical cost containment strategies helps you to combat multiple lines of cost escalation. Incorporate the following useful options to your medical cost containment strategies while seeking improvements at your company.

Medical Provider Network

Medical provider network is a combined group of the most experienced workers’ comp physicians, doctors, hospitals and specialized providers who have a prearranged relationship with the company to treat employees who are injured on the job. They deliver consistent quality care and work closely while minimizing paperwork and treatment time and maximizing the results of quick, effective care. The major benefits of instituting a medical provider network are:

* Fewer lost workdays

* Lower medical costs

* Lower litigation rates

Nurse Case Management

Nurse case management requires an active coordination of medical services and communication among the injured employee, employer and physician. The nurse case managers play a major role in improving the patient’s outcome and have deep experience in managing catastrophic and complex injuries. They also keep the employer and the claim representative well-updated on the physical improvement of the injured employee and his ability to return to work.

Rehabilitation Networks

Rehabilitation networks are destined to offer specialized care for helping injured people recover from specific injuries. Like medical provider network, they also play a major role in stabilizing the injured person’s medical condition and maximize the medical outcome.

Utilization Review

Nowadays, utilization review is an integral part of most public and private health plans and is associated with a reduction in bed days and growing hospital costs. Utilization review is considered as the primary cost prevention tool and includes both precertification reviews and concurrent reviews. The process involved in utilization review also includes:

* Guiding patients to cost effective facilities

* Referral co-ordination

* Managing hospital admission and medical appointments

* Pre-certification

* Monitoring patient’s ongoing treatment process

* Planning patient discharge

* Coordinating follow-up appointments and more.

Utilization review managers also act as liaisons between insurance companies, service providers and the injured employee.

Chronic Pain Management

Chronic pain has a huge impact on the life of the injured worker in both monetary and personal fronts. Using data mining and virtual online “check-ins” to monitor and evaluate the physical, psychological and social impacts on the injured employee. This process of evaluation helps in reducing the impact of chronic pain and improves employee health.

Establishing these standards help companies to easily manage their complex claims and ensure the best possible medical outcomes for injured workers.

ANS Solutions, LLC, the fastest growing medical cost containment companies in the USA puts forward a comprehensive suite of programs to minimize the cost of settlement in large loss workers comp claims. Visit http://ans-solutions.com/ for more information.

Medical Cost Containment Strategies that Really Works

 Medical Cost Containment
Medical cost containment is a complex game and has certain strategies that address the financial costs of large loss claims. Employers and insurers should not limit these cost containment strategies to one or few areas, if they want it to be truly effective. The employers and insurers should utilize as many cost containment strategies as they can to save more money. In this article, we can discuss about the different cost containment strategies that are solely dedicated to reducing the overall medical costs.
Effective Cost Containment Strategies
Medical Cost Projection
Medical cost projection strategy is used to evaluate medical bills, medical savings and other comprehensive medical plans. The type of injury, prior medical treatment, co-morbidities, age health status, life expectancy and other pertinent factors are taken into account by medical cost projection professionals for an accurate analysis of the medical needs of the injured worker.
Legal Nurse Expert
A Professional Legal Nurse Consultant is destined to review medical records and gives advice and suggestions on the standard of nursing care. They are allowed to meet the doctor in person and negotiate any evidence supported pharmacy regime in a non-threatening way with the patient. They also assist with depositions and trial preparation and serve as an expert witness support for the compensation claim.
Medical Management
This is the process of having experienced legal nurse consultants to co-ordinate and to manage the medical care received by an employee. A legal nurse consultant would be dedicated to handle the accounts and medical claims for that company. They will review all the medical reports of the injured employees and recommend additional tests to get the employee back to full recovery.
Medical Bill Review
Medical bill reviewing is only done by the companies that are pioneers in performing accurate medical bill diagnosis and charges. Generally, the medical bill charges are compared with the reasonable and customary charges for the medical services provided.
Medical Examinations
These independent medical examinations are done when the patient is sent to another medical practitioner for an alternate opinion. These examinations are conducted in cases where the employee’s medical recovery process is slower than the normal.
Utilization Review
This review includes precertification review done before the medical care, concurrent reviews while the treatment is on progress and retrospective reviews for the medical services that is already provided.
Tactics Involved in Medical Cost Containment
•    Evidence based medical record review for prescription drugs
•    Co-ordination of drug therapies
•    Suggesting alternate medical regimes
•    Deep analysis and monitoring of prolonged duration of therapies
•    Examination and identification of duplicate drugs and therapies
•    Identification of excessive dosages of drugs
Visit http://ans-solutions.com/ to know more about the new medical cost containment approach.

Prescription Drugs and the Workers’ Compensation Arena

The U.S. remains the biggest global consumer of prescription drugs, up from around 76 million in 1991 to nearly 207 million in 2013 however a recent court ruling has called into direct question the prescription practices of physicians nationwide (Volkow).

The occurrence of unnecessary or medically inappropriate prescribing of opioids in pain management is compromising the lives and well-being of injured workers.  There are a number of serious issues concerning the use of opioids in pain management:

  • Not cost effective
    Evidence-based reviews are seldom consulted prior to the prescribing of opioids, and a lack of appropriate physician monitoring and/or patient compliance further contributes to longer recovery periods and increased cost.
  • Increased drug-drug interactions
    Polypharmacy, the use of 4 or more medications simultaneously with opioids, can result in drug-drug interactions with severe consequences for patient health.
  • Risk for Addiction and Abuse
    The highly addictive nature of opioids leads to the necessity of higher doses over time, resulting in cost increase and greater risk of overdose/addiction. .
  • Lack of evidence for proven benefit
    Recovery and return to work rates are not improved by the use of opioids in pain treatment. The American Academy of Neurology and a number of states have released product guidelines advising physicians to proceed with caution when initiating opioid therapy for pain or long-term use.
  • Dose dependent risks for serious harm
    Physicians and patients are not always properly educated on use and good faith prescription practices and guidelines, including risks of remaining on disability, addiction, drug-drug interactions, and dosages at which death and risk of overdose dramatically increase.

Where do we go from here?
It’s never been more obvious than now that effective pain treatment must focus on the legitimacy and efficacy of treatments, keeping in mind the quality of care and quality of life of injured workers.  At ANS Solutions our pharmacotherapy review program is focused on protecting the injured worker by:

  • Better addressing the needs of pain patients with the assessment of treatment programs and help of evidence based reviews.
  • Improving recovery times with the proper monitoring and modifications of treatment.
  • Reducing the risks associated with common opioid treatment regimens by consolidating and coordinating drug therapies between multiple prescribers, identifying duplicate therapies and excessive dosages, and pointing out alternate medication regimens.

Positive change stems from a comprehensive and economically responsible approach in the treatment of pain in workers compensation claims settlements. To learn more about pharmacotherapy review contact ANS today.

References

Volkow, Nora D. Prescription Opioid and Heroin Abuse, House Committee on Energy and Commerce Subcommittee on Oversight and Investigations. https://www.drugabuse.gov/about-nida/legislative-activities/testimony-to-congress/2015/prescription-opioid-heroin-abuse;  April 29, 2014.

Original content posted on: http://ans-solutions.com/prescription-drugs-and-the-workers-compensation-arena/

 

What’s Trending with California Workers’ Compensation

Though workers’ comp claims frequency is declining, a recently released California hospital report indicates claim severity is on the rise. Obtaining data from 35 hospitals and individual facilities, the Milliman and Keenan Healthcare report sourced more than 3,500 claims for review.

Trends identified in the report:

  • A decline in indemnity and medical-only claims, with ALAE costs playing an increasing role in overall claims costs in recent years. More specifically:
    • Higher average costs per indemnity for workers over 30.
    • Lesser average severity of indemnity claims in workers 30 and younger, with payments more likely to be incurred as age increases.
  • Over the 10-year period ending in 2014, overall losses per $100 of payroll have remained flat. This cumulative effect is believed due to reform laws enacted during this time, as identified in the report:
    • 2005-2014: Severity per indemnity claim (indemnity, medical, and allocated loss adjustment) rises almost 5.5%.
    • 2003-2004: Drop in claim severity (reform laws enacted during this time).
    • 2003-2008: Indemnity claim frequency declines dramatically.
  • Costs per indemnity claim for 2014 accidents has decreased approximately 10% from the previous year.
  • Litigated claims showed a significantly higher average claim severity. They contributed to 20% of total claims with indemnity payment, and account for approximately 54% of total incurred losses.
  • Cost projections for 2015: $2.20 loss cost per $100 of payroll.

A Balanced Approach to Medical Cost Containment

In California’s complex and ever-changing workers’ comp environment, informed decision-making is essential to safeguarding results. At ANS, we pride ourselves at staying at the forefront of (legal and technological) industry changes to ensure the best possible outcomes for both our clients and injured workers.ANS’s three-staged Pharmacotherapy Review Program ensures economically balanced and appropriate treatment options for injured workers. Our legal nurse experts excel at presenting actionable treatment modification recommendations in clear, written proposals for treating physicians, including recommendations such as:

  • Consolidation and coordination of drug therapies between multiple prescribers.
  • Consideration of alternate therapies.
  • Specification of weaning programs for over-prescribed narcotics.
  • Use of generics where applicable.

The end result? A cost effective treatment regimen that simultaneously enhances the quality of care for injured workers. Discover more about this advanced and comprehensive treatment strategy. Contact http://www.ans-solutions.com today.

Original content posted on http://ans-solutions.com/whats-trending-with-california-workers-compensation/

The Importance of a Multifaceted Approach to Medical Cost Containment

The biggest hurdle in workers’ compensation medical cost containment is that the injured worker is not getting better. Even though WC claims have steadily declined over the last decade, medical costs keep rising as do the sub-par outcomes for the patient and the payer. What we are seeing is that the inter-connectivity of many factors is hindering the end goal of optimized outcomes. A multidimensional approach is crucial not only for combatting pharma costs, but also for ensuring optimal outcomes for injured workers.

At the end of the day medical care cost containment is more than finding savings, it’s also about examining the big picture to help identify potential areas of exposure while enhancing the quality of care and life for the injured worker.

How is this achieved?  Each case has to be approached individually to develop a custom tailored strategy. It has to start with well-established face-to-face communication with the physician. Once the line of communication is open, actionable treatment recommendations backed by evidence based clinical data can be implemented.

The industry also needs to focus on protocols that will ensure better outcomes and appropriate treatment for injured workers. Compliance protocols will result in improved outcomes for all stakeholders.

While medical expenses are the most obvious cost driver, the full picture involves much more than the number of medical services and associated expenses. Quality medical care directly impacts the speed and likeliness of the injured worker’s return to work. ANS Solutions understands the true cost of these practices and has taken an innovative approach to medical cost containment strategies.

Offering an innovative plan to assist payers, ANS Solutions’ proprietary Pharmacotherapy Review offers the integral assistance needed to optimize claim outcomes:

  • Expert review of cases by legal nurse experts, noting duplicate treatments and unnecessary/ineffective procedures.
  • Actionable, evidence-based treatment recommendations discussed via face-to-face meetings with physicians.
  • Ongoing compliance management with the help of clinical liason officers.

To learn more visit http://www.ans-solutions.com today!

 Original content posted on http://ans-solutions.com/the-importance-of-a-multifaceted-approach-to-medical-cost-containment/