Executive Summary« Read Less
Conducted in-person at NWCDC 2019 and via online through Risk & Insurance, the 2020 Workers’ Comp Industry Insights Survey drew responses from 669 industry stakeholders, all of whom first identified their organization type and individual role. This allowed us to analyze results collectively, while also examining the ways in which views sometimes varied between industry segments and professions.
70% report changing population is top industry challenge
Three issues stood out as being top-of-mind for the vast majority of participants: the changing workforce population; comorbidities/poor worker health; and the increasing complexity of claims. With some minor exceptions, these were considered the top three challenges for our industry, an assessment that appears all the more accurate as the COVID-19 virus strikes. And we see clear connections between these challenges. For example, older workers, the most impactful population trend by a wide margin, are more likely to suffer comorbidities, which are a leading contributor to medical complications and complex medical claims.
Growing concern about the ability to manage claims was revealed in multiple incidences throughout the survey. For example, claims process/workflow automation was consistently selected as the #2 most important technical advancement over the next 3 – 5 years (telemedicine was #1). And over 80% of participants agreed that the greater complexity of claims is requiring more clinical decisions to be made during the claims management process. Those decisions put additional pressure on claims professionals and case managers already under heavy workloads, increasing the risk that something will be missed.
83% report complex claims mean more clinical decisions for claims management
Arguably the biggest (pre-COVID-19) risk for workers’ comp programs over the past decade has been opioid abuse, but concern about opioids appears to be on the decline. Opioid abuse did not make it into the list of top 5 industry challenges in this year’s survey (as compared to #3 last year), nor did participants see it as a top health or claims risk. As an industry, we have made progress in curbing opioid abuse, but we still have work to do and it would be premature to claim victory. A view apparently shared by insurance carriers who bucked the trend by ranking opioids/substance abuse their #1 claims risk.
PTSD and other mental health conditions have surpassed opioids as a perceived challenge and risk. This is probably due to a combination of two factors: an increasing number of states expanding coverage for first responders and an overall increase in reported incidences of mental health conditions, driven in part by the large number of millennials now in the workforce who are more likely to experience and seek treatment for conditions such as anxiety and depression.
PTSD/mental health conditions surpassed opioids as perceived risk
Escalating medical costs was the #1 challenge for survey respondents in last year’s survey, so we dug a little deeper this year and learned that containing hospital costs is the top priority overall, followed by Rx drugs and physician/professional fees. Responses to the cost question tended to vary, however, depending on the type of organization or individual role. For example, insurance carriers were more focused on Rx drug costs than hospital costs and participants in clinical roles put physical medicine ahead of physician/professional fees.
While the overall trends revealed in the survey were consistent, results varied on some questions, depending on who was responding. For example, executive leaders were more concerned about legislative and regulatory changes than other participants, ranking it as their second most important challenge. Executive leaders also have more confidence in artificial intelligence as an important technology, ranking as the second most important technology over the next 3-5 years, as opposed to other participants for whom artificial intelligence was not seen as important. Information technology and/or data analytics professionals were not among the survey participants and it is possible that executive leaders know more about how artificial intelligence is being applied in workers’ comp.
Medical program managers ranked opioids and substance abuse as their number one program challenge, in contrast to number four ranking opioids and substance abused received overall. This is likely because medical directors and managers are keenly aware that opioid use is still prevalent and risky. Medical program managers were also more concerned than any other group about new and expensive medical treatments, possibly because they have greater insight into the efficacy and cost-benefit ratios of new drugs, devices, and therapies.
Medical program managers still see opioids as top challenge
The type of organization participants worked for also seems to have influenced their perspectives with insurance carrier participants expressing greater concern about opioids and substance abuse, as well as prescription drug prices, as compared to those from employers and government agencies. And claims professionals and case managers stood out in their selection of comorbidities as the number one claims risk, which came in at number three in the overall results. These variations may reflect their closer familiarity with claims and the factors that can drive them off course.
The aging workforce and increased prevalence of comorbidities, among both older and younger workers, are contributing to more complex claims, and now more serious complications for COVID-19 patients (almost 90% of COVID-19 patients admitted to the hospital suffer from comorbidities). And the aging workforce presents other challenges for workers’ comp. For example, the average worker age in the insurance and healthcare industries is also rising, and a wave of retirements will likely lead to a shortage of experienced people to process claims and care for injured and ill workers, just as demand is increasing.
Technology will help to bridge the gaps. Increased use of telemedicine in workers’ comp will help alleviate long wait times to see physicians and should also make those visits less expensive. Telemedicine has also proved to be an invaluable tool for providing access to care without risk of infection during the current pandemic.
Improved claims automation will allow claims professionals to focus their time and attention where it is most needed, help guide clinical decisions, and improve communications between the claims and care management teams. Enhanced data visualization and predictive analytics will be crucial in detecting and mitigating risks early in the claims process. And we should expect new risks, not only from dramatic events like the COVID-19 pandemic, but also from more commonplace occurrences.
We know from past experience that changes are often accompanied by unexpected consequences. New drugs to treat chronic pain brought the opioid crisis, and the current movement away from opioids could lead to other forms of inappropriate prescribing. Treating comorbidities may result in polypharmacy and the risk of adverse drug reactions. Medical innovations, such as biologics and new medical devices, present new opportunities for promising treatment alternatives, but also for fraud, waste, and abuse. And legislative changes, such as expanding coverage for PTSD and other mental health conditions will help many patients receive much-needed treatment but might also increase caseloads and costs.
The 2020 Workers’ Comp Industry Insights Survey shows us that workers’ comp professionals are keenly aware of the wide-scale changes taking place. Our job as industry leaders is, whenever possible, to anticipate the implications of those changes and prepare for them.
report changing population is a top industry challenge
report complex claims mean more clinical decisions for claims management
report better claims efficiency will lower medical costs
report top claims risk is the failure to detect early warning signs before they escalate
Overview of Participants
669 industry stakeholders responded to the survey:
- Employer 214
- Brokerage 92
- Insurance Carrier 88
- Healthcare Provider 69
- State/Government Agency 54
- Consultancy 50
- Third Party Administrator 30
- Law Firm 26
- Managed Care Organization 23
- Other 23
to Reveal Organizations
PARTICIPANT INDIVIDUAL ROLES
- 154 Claims Management
- 141 Executive Leadership
- 120 Risk Management
- 89 Broker/Agent
- 37 Legal/Regulatory
- 33 Clinical/Case Management
- 28 Healthcare Provider
- 16 Medical Program Management
- 8 Procurement
- 43 Other Roles
Top Industry Challenges
The top 5 biggest challenges facing the workers’ compensation industry in 2020
The changing workforce/population demographics
Increasing complexity of claims
Comorbidities and poor worker health
New and expensive medical treatments
Regulatory and legislative changes
Executive leaders ranked regulatory and legislative changes more highly than any other group, ranking it as their second most important challenge.
People ages 50-59 are 3X more likely to die from the COVID-19 virus and those aged 60-69 are 10X more likely to die than younger counterparts.1
The top 5 challenges for participants’ workers’ comp programs in 2020
Comorbidities and poor worker health
Increasing complexity of claims
Changing workforce population
Opioids and substance abuse
Mental health exposures
All roles were in agreement on the top 3 program challenges EXCEPT medical program managers whose top 3 challenges were:
- 1. Opioid and substance abuse
- 2. New and expensive medical treatments
- 3. Mental health exposure/PTSD coverage
Comorbidities and poor health are a serious concern for COVID-19 patients with 19% of patients with at least one comorbidity and 29% of patients with two or more comorbidities being admitted to intensive care, as compared with 8% of patients overall. 2
Population trends that will have the biggest impact on workers’ comp programs in 2020
Millennial/younger worker influence
Temporary/gig worker trend
First responder coverage
Racial, ethnic and gender diversity
The aging workforce was the #1 population challenge across all organizations and roles.
Nearly ¾ of workers aged 65 or older - 5 million people - cannot work remotely due to the nature of their jobs and extra precautions may be needed to protect the health of these workers during the pandemic.3
Most important technologies over the next 3-5 years
Claims processing/workflow automation
These were the top 3 technologies selected by most roles with the exception of executive leaders who ranked Artificial Intelligence as the 2nd most important technology.
Since the virus began spreading in the US, at least 18 states have adjusted their worker’s comp rules to allow for increased access to telehealth for injured workers.4
Most concerning health risks within claims populations
Respondents across the board ranked chronic pain their top concern and almost put mental health/PTSD ahead of opioids and substance abuse, which could indicate a shift in workers’ comp medical management priorities.
Some chronic conditions appear to pose more risk than others for COVID-19 patients, with one large study reporting that of patients hospitalized 57% had hypertension, 41% were obese, and one third had diabetes.5
Medical cost containment priorities in 2020
Rx Drug Costs
DME, diagnostics, and other ancillary benefits
Insurance carriers differed slightly with overall results, ranking Rx drugs costs as their #1 area of focus and hospital costs #2.
Hospital costs for COVID-19 patients are estimated to be in the $10,000 - $20,000 range if no ventilator treatment is required. With ventilator treatment, costs can average nearly $90,000.6
Most concerning claims risks
Not detecting claim warning signs early enough
Charges for medical services unrelated to workplace injury
Injured worker opioid/substance abuse
Lack of transparency into medical prices
New medical treatments and drugs
Insurance carriers ranked injured worker opioid substance abuse as their #1 risk. Claims managers and clinical/case managers selected comorbidities as the #1 risk.
Some states have explicitly given WC coverage to certain workers,4 and many, along with the federal government, have mandated group health coverage for the virus.7 For “essential” workers who are not in public safety and healthcare jobs, compensability remains a big question.
Most to least agreed statements on current topics
The increasing complexity of care is requiring more clinical decisions to be made during the claims management process
Improved claims efficiency can help lower medical costs
The aging healthcare workforce and anticipated physician shortage will drive up medical costs in workers’ comp
Prescription drug activity is an early and reliable indicator of potential risks
Medical marijuana will be covered by workers’ comp insurance in more state over next 2-5 years
Medical advance and new treatment present new opportunities for FWA
The cost saving potential from ancillary benefits (i.e. DME, Transportation) is underestimated by many workers’ comp payers (only statement that had more neutral and disagree than agree)
Claims managers most agreed that improved claims efficiency can help lower medical costs, while risk managers most agreed that the anticipated physician shortage will drive up medical costs in workers’ comp.
Although workers’ comp claims may decrease temporarily due to business closures and telecommuting, the frequency and severity of workers’ comp claims is expected to increase in the wake of the COVID-19 pandemic,8 demanding even more decisions regarding an entirely new disease.
1. Kofman, A. and Hernandez-Romieu, A. “Protect older and vulnerable healthcare workers from COVID-19.” STAT. March 25, 2020. https://www.statnews.com/2020/03/25/protect-older-and-vulnerable-health-care-workers-from-covid-19/
2. Glick, T. et. al. “Association of Comorbidities with COVID-19 Outcomes.” New England Journal of Medicine, Journal Watch. April 1, 2020. https://www.jwatch.org/na51250/2020/04/01/association-comorbidities-with-covid-19-outcomes
3. U.S. Bureau of Labor Statistics. Job Flexibilities and Work Schedules. September 24, 2019. https://www.bls.gov/news.release/pdf/flex2.pdf
4. Healthesystems. “States Move to Make COVID-19 Compensable.” April 20, 2020. https://medmonitor.healthesystems.com/regulatory-developments/states-move-to-make-covid-19-compensable/
5. Richardson, S. et.al. “Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized with COVID-19 in the New York City Area.” Journal of the American Medical Association. April 22, 2020. https://jamanetwork.com/journals/jama/fullarticle/2765184?guestAccessKey=906e474e-0b94-4e0e-8eaa-606ddf0224f5&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=042220
6. Rae M. et. al. “Potential Costs for COVID-19 Patients with Insurance Coverage.” Peterson-KFF Healthsystem Tracker. March 13, 2020. https://www.healthsystemtracker.org/brief/potential-costs-of-coronavirus-treatment-for-people-with-employer-coverage/
7. Pollitz, K. “Private Health Coverage of COVID-19: Facts and Issues.” Kaiser Family Foundation. March 18, 2020. https://www.kff.org/private-insurance/issue-brief/private-health-coverage-of-covid-19-key-facts-and-issues/
8. Hussein, F. “Workers’ Comp Premiums Could Skyrocket with COVID-19 Claims.” Bloomberg Law. March 30, 2020. https://news.bloomberglaw.com/daily-labor-report/workers-comp-premiums-could-skyrocket-with-covid-19-claims