2013 Third-Party Payer Track

Download a 29-page Preview Guide (pdf) to the 2013 National Rx Drug Abuse Summit.

Right Drug, Right Test, Right Time
Tuesday, April 2, 2013, 12:30 pm – 1:45 pm
 Moderator Michelle Landers
Executive Vice President and General Counsel, Kentucky Employers’ Mutual Insurance
 Presenters Dr. Lenox Abbott
Director, Laboratory Operations and National Standards, Quest Diagnostics
Tron Emptage
Chief Clinical Officer, Progressive Medical
Dr. Richard Victor
Executive Director, Workers’ Compensation Research Institute
 Session Description Over 70 percent of workers’ compensation claimants on chronic opioid therapy greater than three months are not taking their pain medication as prescribed due to misuse or abuse, according to a recent report published in Business Insurance. The Workers’ Compensation Research Institute (WCRI) shows that fewer than 7 percent of treating doctors conduct baseline and periodic urine drug screens.

The use of innovative clinical programs guided by data analytics, along with the use of diagnostic testing and other tools to identify potential excessive use or misuse by claimants earlier in treatment helps ensure that patients are receiving the right therapy at the right time. Earlier clinical intervention combined with regular, random drug testing has been shown to improve adherence with physician expectations and can also help identify potentially dangerous drug combinations that might delay recovery.

This session provides a focused conversation on practices that help control pharmacy-related claims expense, while improving outcomes for claimants and payers.

 Learning Objectives 1. Outline how clinical programs can identify excessive use or misuse of opioid.
2. Describe the impact of behavioral interventions in chronic opioid cases.
3. Explain the value of urine and drug screening.
Cost-Savings Strategies
Tuesday, April 2, 2013, 2:00 pm – 3:15 pm
 Moderator Mary C. Colvin, CPA
Chief Operating Officer, Kentucky Employers’ Mutual Insurance, and Board Member, Operation UNITE
 Presenters Jeremy Corbett
Chief Medical Officer, Kentucky Spirit Health Plan/Centene Corporation
Dr. Steven Moskowitz, MD
Senior Medical Director, Paradigm Outcomes
 Session Description According to the Coalition Against Insurance Fraud, the cost of prescription painkiller abuse for insurers is $72.5 billion. Doctor shoppers cost insurers $10,000 to $15,000 per patient; the toll in lost productivity is $42 billion, and the criminal justice bill is $8.2 billion. Chronic pain claims account for up to 50 percent of a worker’s compensation insurers large loss claims. Driving these costs are prescription medications, opioids high among them. Over the long term, an individual case can have reserves as high as $1 million or higher. Solutions involve getting the injured worker to treatment that is more effective and often non-opioid.

In this session, you will hear multiple cost-savings strategies that work to drive down the cost of prescription drug abuse for insurance and workers’ compensation companies. These strategies include national and state initiatives in the areas of policy and procedure creation, prescription drug monitoring programs, case management, government partnerships, and mobile technology.

 Learning Objectives 1. Learn the latest data about the cost of prescription drug abuse to insurance companies.
2. Outline the statutory basis for lock-in programs.
3. Prepare strategies that you can implement in your state.
Using Analytics to Track, Monitor, and Reduce Costs
Tuesday, April 2, 2013, 3:30 pm – 4:45 pm
 Moderator Michelle Landers
Executive Vice President and General Counsel, Kentucky Employers’ Mutual Insurance
 Presenters Joe Anderson
Director of Analytic Services, Progressive Medical
Dr. Robert Hall
Medical Director, Progressive Medical
Anne Kirby
Chief Compliance Officer and Vice President, Medical Review Services, Rising Medical Solutions
James Masingill
Vice President, Claims Operations, Markel First Comp Insurance Company
 Session Description A study in the Journal of Occupational & Environmental Medicine found that workers’ compensation claims are nearly four times more likely to turn into catastrophic claims, with costs tallying more than $100,000, when long-acting opioids are prescribed. According to the National Council on Compensation Insurance (NCCI), physician dispensed drugs costs anywhere from 10 to 300 percent more when prescriptions are not managed through the Pharmacy Benefit Manager.

The importance of catching “at-risk” cases early is vital to turn around this trend. However, it’s shortsighted to simply track and address opioids in a vacuum because other drugs alter their use and patient impact. In this session, attendees will hear firsthand accounts of how companies deployed analytics to reduce employee addiction potential, improve employee health outcomes, increase return-to-work probabilities, cut prescription costs, and lower indemnity costs.

 Learning Objectives 1. Identify warning signs of misuse and abuse and how claim managers can take action.
2. Tell how payers can use effective analytics to identify relevant trends.
3. Explain how Pharmacy Benefit Managers can use analytics with strong clinical programs.
4. Describe the role and benefits of predictive analytics in the workers’ compensation industry.
A Tale of Two Companies
Wednesday, April 3, 2013, 1:30 pm – 2:45 pm
 Moderator Alix Michel, JD
Shareholder and Attorney, Litigation Section, Chambliss, Bahner & Stophel
 Presenters Jim Andrews
Senior Vice President, Pharmacy Services, Healthcare Solutions
Michael Gavin
Chief Strategy Officer, PRIUM
Ronald A. Mazariegos
Claim Executive, Arrowpoint Capital
Dave Smith
Divisional Vice President, Risk Management, Family Dollar Stores
 Session Description Industry research shows that employers and insurers spent over $1.4 billion on narcotics for workers’ compensation in 2012. However, a 2009 study (Franklin et al, Clinical Journal of Pain, Dec. 2009) found that less than one-third of patients taking opioids for low back pain improved by at least 30 percent in pain function; even fewer (16 percent) saw improvement in functionality.

In this session, attendees will hear from two companies that used early intervention and utilization management programs to better manage claimant utilization while reducing drug expenditures. You will learn when to deploy clinical tools (cognitive behavioral therapy, functional restoration, opioid weaning, and/or detox or addiction treatment) and medical/legal strategies like utilization review, independent medical exams, direction of care, and physician depositions to make sure injured employees do not continue to receive drugs they don’t need.

 Learning Objectives 1. Evaluate opioid management methods available to employers.
2. Analyze how and when to leverage clinical tools and medical and legal strategies to curtail abuse of prescription drugs.
3. Describe the importance of collaboration between workers’ compensation payers and pharmacy benefit managers.
A Tale of Two States
Wednesday, April 3, 2013, 3:00 pm – 4:15 pm
 Moderator Joseph Paduda
Principal, Health Strategy Associates
 Presenters Dr. Gary Franklin
Medical Director, Washington State Department of Labor and Industries
Amy Lee
Special Deputy Commissioner, Policy and Research, Texas Department of Insurance, Division of Workers’ Compensation
 Session Description According to the Hopkins-Accident Research Fund Study, “workers prescribed even one opioid had average total claims costs four to eight times greater than claimants with similar claims who didn’t get opioids.” The country is suffering from over 475,000 Emergency Room visits per year attributed to the misuse of prescription drugs alone, according to the Centers for Disease Control and Prevention (CDC).

What do Texas and Washington State have in common? Both states have yielded positive results from regulatory and legislative efforts to control opioid use and abuse in the workplace. During this session, you will hear how Texas and Washington have employed unique, yet highly effective approaches. Texas has utilized the Texas Closed Formulary, which requires physicians to obtain pre-authorization before prescribing opioids. Washington State passed guideline-driven legislation requiring doctors with patients receiving more than 120 morphine equivalent doses for six months, to refer patients to pain specialists and order drug testing as well as psychological screening for dependency and addiction. Attendees will also learn about the International Association of Industrial Accident Boards and Commissions’ (IAIABC) forthcoming model regulations for opioid use.

 Learning Objectives 1. State what is needed to pass regulations and legislations to control opioid use.
2. Analyze different approaches to determine what would work in their jurisdiction.
3. Formulate ideas you can implement in your home states.