Super Spending
Oct 26, 2017

A new report issued by Express Scrips and profiled in shows that Wilfredo Pareto was onto something. The report looks at what the writers call the "super spenders" in prescription drug costs, folks who spend $50K or more annually on maintenance pharmaceuticals, generally for chronic conditions. In 2016, about 3 out of every 1,000 people in the analysis accounted for more than 20 percent of total pharmacy spending.

Glen Stettin, M.D., Senior Vice President, Clinical, Research and New Solutions at Express Scripts observed, "At a fraction of a percent of all Americans, this population may seem small. However, every person in America is on a first-name basis with at least one other person - a relative, friend, or colleague - who has annual drug costs that are nearly the same amount as the median U.S. household income." (According to the US Census Bureau, that's $57,617 as of earlier this year.)

As a risk manager, you probably know a few of these folks also. Some of them are your fellow employees, while others visit your company premises for various reasons or drive in the same traffic as your company vehicles. And that's the rub. When a person taking one or more complex drugs, or a whole cocktail of sophisticated medicines, is involved in a workers' compensation incident or a premises or auto liability claim, the clinical component and management of that claim goes to a whole new level.

Consider - potential drug interactions can go off the charts. Common co-morbid issues ratchet up. The involvement of medicines commonly used in the treatment of musculoskeletal injuries - like opioids and relaxants - can become highly problematic. Reviewing potential drug interactions takes on new urgency. As the number of ordinary, working citizens on complex drug regimens continues to go up, the importance of getting a full drug and co-morbid history and having a first class drug interaction review process built into your claims handling also goes up. This applies to far more than just your comp claims. Think about a slip and fall in a company restroom or a fender bender on the interstate. All types of physical injury become potential bottomless pits when the injured party was already on a $50K annual drug regimen.

The mantra of the 21st Century seems to be "nothing ever gets simpler." Pre-existing conditions used to be an issue for the benefits manager across the hall. Now it's in your in-box as well.

Ignorance is Not Bliss

Quick now, what's the current dollar value of your embedded MOOP? You probably have one. If the term "embedded MOOP" went right past you, you have a view into one of the population wide problems that impacts workers' compensation as well as group health and disability - our relative lack of health literacy in the US. While this issue has been gaining attention lately in terms of its impact on company health plans and how employees use or fail to use them correctly, it has powerful implications for workers' comp, or any exposure based on health and disability, as well.

In a recent report, Five Ways to Engage Employees in Health Education and Build Health Literacy, Jennifer Benz points out, "According to The National Assessment of Adult Literacy, only 12% of adults have proficient health literacy. This means that almost 9 out of 10 adults lack the skills needed to manage their health and prevent disease." (Quoted here) Think about what that means in the context of an aging workforce where a growing number of your comp claims have one or more co-morbid conditions complicating recovery and RTW. According to a George Washington University study, "adults with low health literacy are less likely to comply with prescribed treatment and self-care regimens, make more medication or treatment errors, and lack the skills needed to navigate the healthcare system." In other words, you have in your population a not inconsiderable number of injured workers with confounding non-occupational conditions which are not being treated effectively because their health plan has them baffled. Other research has shown that people with low health literacy are more likely to overuse emergency rooms and make other basic errors in accessing medical care.

What can you do? Are you making the best use of nurse assisted intake for possible comp claims? Are you directing care to the extent permitted in each jurisdiction? Are you and your claim handler or TPA getting critical information to the injured worker quickly? Are you partnering with your claims adjusters to use case management effectively - and to use it as an employee service, not just a way to hammer down medical costs?

Medical care gets more complicated every year. Just take a long look at your new open enrollment materials for your health plans. (Yes, it's that time of year again.) This complexity doesn't stop with your group health benefit's annual enrollment. What can you do to help your injured workers navigate the health care world as well as make them intelligent consumers of medical services when comp is footing the bill?

Oh yes, the embedded MOOP. That's your Maximum Out of Pocket exposure as embedded in your in-network group health plan. Here's a handy little three page explanation from SHRM in case you missed it last enrollment season. Spoiler alert: a thorough grounding in New Math will help.

A Steam Boiler Hack Attack? 

In a manner of speaking, yes. A new Zogby Analytics survey commissioned by the Hartford Steam Boiler Inspection and Insurance Company (HSB) (Business Wire summary here) gives fresh insight into the frequency and nature of hack attacks on American corporations in 2016. The BW lead should give everyone pause: "More than half of U.S. businesses (53 percent) have experienced a cyber attack in the past year..." More than half. Wow.

The resulting havoc was spread over several categories. Malware and viruses constituted the primary agents of harm. Most worrisome are the serious attacks, including "distributed denial of service (DDoS) attacks (35 percent); ransomware (29 percent); cyber extortion (25 percent) and social engineering (13 percent)." Let's pause to review that list briefly. The first type, DDoS, can do serious harm to your business and quite possibly to your clients who depend on services you provide electronically. DDoS has the potential to be far more than a nuisance, while the last three can easily be major crimes.

Most ransom and extortion attacks (that we know about) have been fairly small potatoes, but so are most robberies and other old fashioned physical, "stick 'em up" crimes. The real question is - how many of these nickel and dime extortions have been rehearsals or probes in hopes of bigger scores?

The biggest weak link that allows your business to be hacked? Disgruntled or careless employees were cited as the root of 45% of the incidents reported. Hacking in its many splendored forms has been the subject of many Journal items and, unfortunately, it looks to continue as a major topic of discussion. Most of us still think of hack attacks as a nuisance, a minor ledger entry, but recent headlines should give everyone with a risk management responsibility serious pause. Are we paying enough attention? The recent events at Equifax, to cite just one example, should make you shiver and wonder - could that happen in my company? Gee, maybe I should pursue a less risky line of work. Stunt pilot perhaps? Trapeze artist? Shark hunting?


Share This
* Required Fields