Wednesday, May 16, 2012

A Tale of Two Claim Types: Healthcare Solutions Drug Trends Report

The first thing you notice about the 2012 Workers' Compensation Drug Trends Report from Healthcare Solutions is that the authors have decided to tell two different stories with the data - one focused on "developing claims" (0-3 years from date of injury) and another focused on "mature claims" (3+ years from the date of injury). 

Kudos to Jim Andrews and his team for giving us some insight into what all of us intuitively suspected as we examined other drug trend reports: that the behavior of claims changes markedly over time... and that looking at all claims together in one big lump wasn't allowing us to glean intelligent conclusions. 

If I had one request, though, it would be to create an even more granular look at the data.  The report notes that "significant increases in both the number of prescriptions and the prices of prescriptions occur in the first three years of a claim.  The most significant increase occurs between the first and second service year when a 65% increase in the number of prescriptions and a 76% increase in the average price per prescriptions is observed."  Instead of grouping these claims into the "developing" category, I think it would be fascinating to pull the data set into a sub-set of first year, second year, and third year claims to see how drug mix, drug class, and spend change even within that time period.  But then the report would run 100 pages instead of 25...

The most interesting story that I see in the data is around the long term impact of opioid use.  Among developing claims, opioids are used by 65.7% of injured workers while other drug classes are relatively uncommon in this stage of the claim life cycle (anticonvulsants are used by 9.9% of injured workers, antidepressants by 4.8%, and ulcer drugs by 2.4%).

And what happens as claims age into the "mature" category?  Opioids are used by 71.2% of these injured workers.  But more importantly, we begin to see the complexities of long term use of analgesics.  The side effects are clear: depression (antidepressant use goes up almost 5X to 23.5% of injured workers), neuropathic - or idiopathic - pain (anticonvulsant usages goes up almost 3X to 28.2%), and GI issues (usage of ulcer drugs goes up more than 5X to 12.4% of injured workers).

Coincidence?  No.
A direct consequence of the original work injury?  Probably not.
Additional costs being driven by underlying overutilization of narcotics?  Most likely. 

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