1. Insurance Trends: The Business Implications of an Aging and More Injury-Prone Workforce Adam Seidner MD MPH CIC National Medical Director

2. 2 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

3. 3 Industry/Economic Trends* * NCCI Study

4. 4 Industry/Economic Trends* * NCCI Study

5. 5 Industry/Economic Trends* * NCCI Study 19881998 20082018 - Projected

6. 6 The Aging Workforce

7. 7 Our Aging Population See if can find this type of map for boomers

8. 8  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

9. 9 “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”

10. 10 What Drives Workplace Injury and Healthcare Costs?  Musculoskeletal Problems low 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

11. 11 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

12. 12 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

13. 13 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

14. 14 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

15. 15 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

16. 16 Outcomes  Improve clinical outcomes  Improve Payer/Provider Communication  Fraud Detection  Education – Pharmacy Letters  Quality Assurance and Improvement  Network Development  Disease case management

17. 17 Cost Drivers  Iatrogenic/Nosocomia  Off-label  Compounds  Devices  Addiction

18. 18

19. 19 Medical Care  The U.S. spends well over 2.6 trillion dollars on health care annually

20. 20 Rule Nobody washes a Rental Car

21. 21 You must…  Make a point to know the impact of patient comorbidities on outcomes  Age,  BMI,  Osteoporosis/enia  Deconditioning  ROM - truncal

22. 22 End Points  Measurable- subjective vs objective  Surrogate end point issues

23. 23 Provider Credibility  Public Health and Safety  physicians' attitudes toward the use of deception  most physicians indicated some willingness to engage in forms of deception

24. 24 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

25. 25 Focus  Public Health and Safety  Quality of Life  Cost savings follows

26. 26 What does it all mean? How do we effectively manage technology’s future challenges?

27. 27 Report of Work Ability It is used to:  Identify essential tasks the employee can perform  Determine which tasks can be modified to fit restriction

28. 28 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.

29. 29 What is the Target?

30. 30 Outcomes  RTW  Cost  Minimize Medical Impairment  Satisfied client

31. 31 Work Comp vs. Non-comp

32. 32 Issues of Consideration  Diagnosis  Causation  Resource Utilization

33. 33 Outcome Measures  Reduce cost of claim & lost time days  Assist with identifying modified duty  Ensure appropriate utilization of resources > Ergonomic > Medical > Claim > SIU

34. Thank you!