The Work Comp world according to California

I was in California last week as I am often.  After meetings in Calabasas, Burbank, San Mateo and Napa in addition to attending the PARMA (Public Agency Risk Managers Association) conference in Monterey, I found several interesting things:

• Good work with reduced resources: Cuts last year in California reduced a $25.4B state budget deficit to $9.6B with an ongoing $10B operational shortfall.  Budget cuts, now and in the future, mean less resources for all aspects of state, county and local government, including Work Comp.  The effect of resource reduction was apparent in discussions at PARMA, but it was also obvious that everyone is trying their best to be productive (and creative) with what they have.  Every single dollar counts, in expense and savings, and every decision is strategic.
• Prescription drug over-utilization dominates conversation: While Work Comp costs are complex and have many contributors, the high use of prescription drugs remains a key component.  But I also have seen this becoming less of an academic exercise (at this point, everybody acknowledges it is a problem) and more of a conscious action plan.  From requiring pre-authorization by contract … to deposition of treating physicians … to the use of a Pharmacy Benefit Network (PBN) … to physician engagement via programs like our QMI Program … status quo is no longer the standard.
• Physicians are trying: There are physicians with bad outcomes and seemingly bad intentions (in March 2011 the California Workers’ Compensation Institute (CWCI) reported that 10% of physicians that prescribe Schedule II drugs account for nearly 80% of all prescriptions).  However, the majority of physicians are trying hard to do the right thing and in some cases not fully educated on the negative long-term repercussions to these drugs.  For those that are inattentive or oblivious, an epiphany by engagement is critical.  For the “bad actors”, forcing the issue through UR is an imperative.
• There is success in removing patients from drugs: While the general assumption is that removing patients from drugs is almost an unattainable goal, there are clinics with unique approaches and solid outcomes that are having a positive impact.  I met with two such facilities and will discuss them further this week.

I look forward to diving into more detail this week.

In this together – Mark

On Twitter @PRIUM1