Insurance Trends:  The Business Implications

of an Aging and More Injury-Prone WorkforceAdam Seidner MD MPH CIC

National Medical Director

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Overview Managing Rising Medical Costs

Medical Inflation types - physician, hospital , DME, pharmacy, surgical centers, etc

Alliances > Employee health and wellness> EE education> Provider Networks and Education

Interventions > Preplacement and fitness for duty> Proven strategies for DME, pharmacy management

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Industry/Economic Trends*

0

5

10

15

1980

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2007p

Inci

den

ce R

ates

per

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FT

E W

ork

ers

(BL

S)

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1250

2500

3750

Claim

s per 100,000 W

orkers

(NC

CI)

Recessions

Manufacturing Industry Injuries and Illnesses per 100 Full-Time Workers

Private Industry Injuries and Illnesses per 100 Full-Time WorkersNCCI Lost-Time Claims per 100,000 Workers

* NCCI Study

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Industry/Economic Trends*

* NCCI Study

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Industry/Economic Trends*

* NCCI Study

1988 1998

2008 2018 - Projected

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The Aging Workforce

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Our Aging Population

See if can find this type of map for boomers

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The number of jobs held by older workers will more than double between 1995 and 2020

Older workers injured on the job have higher costs per claim than younger workers.

Impact on Worker’s Comp

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Impact on Worker’s Comp

“Older workers are a resource we can no longer afford to waste! Projected tight labor markets requires us to better use our experienced mature workers. This does not mean business as usual, however. We must change our strategies and practices in the 3R’s,

Recruitment, Retention, and Retraining.”

-- Barbara McIntosh, Ph.D. In “An Employer’s Guide to Older

Workers”

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What Drives Workplace Injury and

Healthcare Costs?

Musculoskeletal Problemslow back disease, carpal tunnel syndrome, knee and shoulder disorders

Compromised Musculoskeletal Health stiffness and immobility, reduced strength and endurance, chronic soft tissue pain, obesity and deconditioning

Job safety and design initiatives(ergonomics, work organization) are not well coordinated with worker health issues, such as aging and individual capacity, chronic disease, and disease susceptibility

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Revise age groups on this slide?

TRAVELERS BOOK OF BUSINESS

REPORT ON SELECTED DIAGNOSIS GROUP CATEGORIES FOR ACCIDENTS BETWEEN 01/01/2001 AND 12/31/2006

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Additional known drivers of musculoskeletal injury and healthcare cost

Physical Activity Sedentary Life Style Level of physical activity at work does

not seem to protect from MSD

Ergonomics Trunk loading Uninterrupted repetitive work Biomechanically unsound work

postures

Medical Issues Poor compliance with medical

management Inappropriate or misdirected medical

care

Aging issues Loss of mobility due to aging Osteoarthritis of the spine, knee and

shoulder Decline in cardio-vascular health Doubling of chronic disease per

decade >40 years old

Stress issues Perceived Job Stress Elder and dependent care

responsibilities (in women) Past or current major depression

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Identifiable Factors Promoting

Musculoskeletal Wellness

Positive attitude towards aging and fitness

Leisure Exercise

Noise reduction

Good overall health

Utilization of ergonomic interventions: tool selection and job design

Teamwork and co-worker support in the workplace

Low management strain Low work-family strain Agreement between workers

and managers on level of workplace risks

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Goals of all Healthy Workplace Projects

Combine Occupational Safety and Health with individual Health Promotion

Evaluate (and overcome) obstacles to combined program

Evaluate health benefits and cost-effectiveness of these initiatives

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Content common to all

Healthy Workplace projects

Health promotion

Integration of health promotion with traditional OSH

Qualitative research

Scientific approach to processes, focus groups, interviews

Economics Evaluate intervention costs

Survey measures & biometrics

Common pool of measures for comparability

Expertise in advanced statistical techniques

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Outcomes

Improve clinical outcomes Improve Payer/Provider Communication

Fraud Detection

Education – Pharmacy Letters

Quality Assurance and Improvement

Network Development

Disease case management

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Cost Drivers

Iatrogenic/Nosocomia

Off-label

Compounds

Devices

Addiction

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Medical Care

The U.S. spends well over 2.6 trillion dollars on health care annually

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Rule

Nobody washes a Rental Car

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You must…

Make a point to know the impact of patient comorbidities on outcomes

Age, BMI, Osteoporosis/enia Deconditioning ROM - truncal

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End Points

Measurable- subjective vs objective

Surrogate end point issues

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Provider Credibility

Public Health and Safety

physicians' attitudes toward the use of deception

most physicians indicated some willingness to engage in forms of deception

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Guidance

Ensure correct diagnosis

Review the Quality of Evidence supporting off-label use

Informed Consent Issues

Standard of Care vs. State of the Art

Investigational and Experimental treatment

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Focus

Public Health and Safety

Quality of Life

Cost savings follows

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What does it all mean?

How do we effectively manage technology’s future challenges?

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Report of Work Ability

It is used to:

Identify essential tasks the employee can perform

Determine which tasks can be modified to fit restriction

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Why have an early return to work

program? An employee’s chance for successfully resuming his or her regular job is maximized if the employee returns to work soon after the injury.

Implementing a modified return-to-work program is critical in promoting successful RTW.

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What is the Target?

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Outcomes

RTW

Cost

Minimize Medical Impairment

Satisfied client

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Work Comp vs. Non-comp

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Issues of

Consideration Diagnosis

Causation

Resource Utilization

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Outcome

Measures Reduce cost of claim & lost time days

Assist with identifying modified duty

Ensure appropriate utilization of resources > Ergonomic> Medical> Claim> SIU

Thank you!