California Workers Compensation

The California workers compensation insurance system has been a system in crisis for years. With a struggling economy and skyrocketing medical costs, benefits to injured workers have steadily been trimmed over the past two or three decades as businesses and governments struggle to keep costs under control. In recent years, many states have passed legislation to reform their workers compensation systems in an effort to keep the grand bargain from imploding.

But it’s not all bad news. In fact, certain trends and innovations are promising to breathe new life into the system:

Nurse triage services are catching on in a big way with companies of all sizes as a way to control costs. And they’re a win-win – they help employers avoid paying for costly emergency room treatment or unnecessary clinic visits, and they help injured workers get appropriate treatment faster than they would if they were waiting in the ER.

Nurse triage services use experienced nurses, follow strict clinical guidelines, and use special software to assess an injured worker’s symptoms and determine the appropriate level of care. It’s no secret that injured workers generally have better outcomes when they seek care sooner rather than later, so a nurse triage service is an invaluable first line of defense against runaway medical costs. Using these services can:

Increase self-care and cut down on claim volume
Reduce OSHA reportable injuries by avoiding unnecessary medical claims
Make sure more claims are handled through your medical provider network
Cut down on the amount of time an injured employee is off work
Provide vital documentation of incidents, helping to ensure compliance with laws and reduce instances of fraud
Provide 24/7 control of medical treatment for employers with multiple work shifts
Identify potentially serious and life threatening injuries not recognized by the injured employee

Telemedicine. Advances in technology have changed consumers’ expectations, including from their healthcare treatment. Telemedicine solutions are responding to those expectations by:

Providing early intervention and triage of less complex claims
Improving access to care
Providing faster non-emergency care
Improving cost efficiency by cutting down on non-emergency care delivered by hospitals

When you consider the physician shortage many are predicting in the coming years, telemedicine could soon be playing an even bigger role in managing your workers compensation claims.

Leading the fight on opioid drug abuse. There were 28,647 opioid-related deaths in the U.S. in 2014, a 9 percent increase over 2013. President Obama has called for $1.1 billion in funds to address the crisis. And presidential candidates are talking about it on the campaign trail. It’s nothing short of a public health emergency.

The workers compensation industry has been on the forefront of battling this crisis by advocating for treatment guidelines, restriction of physician dispensing of opioids, formularies tied to utilization reviews, and other measures. Working with payers, Pharmacy Benefit Managers have been able to cut opioid prescriptions for new claims by 5 to 7 percent per year for the last two years, which has no doubt led to a significant reduction in adverse consequences such as addiction, misuse, and death. Nurse Case Managers have developed specific opioid protocols, educating injured workers and physicians on non-opioid alternatives, using evidence-based practices, and ensuring that PBM information is reviewed and addressed by prescribing physicians.

These are all promising trends, and through leadership and innovation, there may be hope for the California workers compensation insurance system.

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