Nurse Case Manager Chronicles

Getting Injured Workers Off Opioids: What Role Does Your Nurse Case Manager Play?

It’s not news that the opioid epidemic continues to spread. But nurses know how to intervene and stop addiction.
By: | July 31, 2018 • 4 min read

Paradigm’s Linda Kenavey played a key role in helping Tim Stout get his life back, opioid-free.

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Tim Stout, a worker for a glass factory, was laying lines one day when he was struck on his left side by a large mold and crushed between the machine and a wall.

He had multiple rib fractures. His left lung was crushed. He suffered third-degree burns to his left arm and a pulmonary collapse.

But Stout was determined to heal and began the long process of recovery with a positive attitude. Unfortunately, his pain was intense, and opiates were introduced into the mix.

Opioids in Workers’ Comp

Prescription opioid misuse costs the United States $78.5 billion each year for health care costs, lost productivity, addiction treatment and criminal justice involvement. Around 21 to 29 percent of patients prescribed opioids end up misusing them, and of these, 4 to 6 percent transition to heroin abuse.

In workers’ compensation, opioids make up a third of all prescribed pain relief drugs.

“When people are injured, they want pain relief. Everyone wants to be pain free. We’ve programmed an entire generation to believe they shouldn’t have pain,” said Linda Kenavey, network manager, Paradigm Outcomes.

When asked how often she encounters opioids in comp claims, Kenavey said, “Probably every day in every case.”

VIDEO: As awareness of opioid dangers has increased, patients like Tim Stout (right) are open to learning how to manage their pain without addictive drugs.

Thankfully, however, “now that the opioid epidemic came center stage, there is more of an awareness. Workers’ compensation carriers are recognizing the costs that come with treating workers for opiate addiction.”

On top of that, injured workers are conscious of the negative effects opioids can have on their healing process and their transition back to work.

Until recently, Kenavey said, it was rare to hear a patient say, “I don’t want to take that.” Now the story is different, because there is so much information out there on the dangers of opioids.

This was much like Stout’s case. He knew opioids were dangerous, and he wanted to get off them before a toxic and addictive pattern was born.

Workers Advocating for Their Well-Being

“As far as I know, since I wasn’t on his case until two years in, he had always been on opiates. The physicians did decrease frequency and dose, but he was always on them,” said Kenavey, who became this worker’s nurse case manager in 2016.

“He was nonfunctional. When I first met him; functionality was very limited. He couldn’t participate in his daily life. He described his lifestyle as having been completely changed since his injury, making even the simplest activity of daily living a challenge.”

“When people are injured, they want pain relief. Everyone wants to be pain free. We’ve programmed an entire generation to believe they shouldn’t have pain.” — Linda Kenavey, network manager, Paradigm Outcomes

Most important to Stout was walking his dog. But while the dog was a great motivator to get this injured worker moving, Kenavey noted, Stout was having trouble keeping up with the dog’s pace.

Kenavey managed the case onsite for Paradigm, which, she said, had a team of specialists who coordinated with Stout’s treating physician on a program focused primarily on function and restoration.

Linda Kenavey (left), network manager, Paradigm Outcomes, with injured worker Tim Stout

Extensive physical therapy proved a moot point; it helped, but not nearly enough to get Stout back to his routine. Kenavey even had him in aqua therapy and a cognitive behavioral program for three months.

“We saw improvement, but he wanted more.”

Finally, Stout was sent to The Rosomoff Comprehensive Rehabilitation Center in Miami, Florida. Kenavey spoke of this center’s excellence, stating that Stout had “terrific gains” after his one-month stay.

It was a big turning point for him.

“He was invigorated when he was discharged from the program and able to walk his dog twice daily, sometimes two miles at a time without distress,” said Kenavey.

“Upon returning to his home, he was completely off of all opiate medications and committed not to return to dependency on such medications.”

Battling the Use of Opiate Pain Killers

For this worker, it was a happy ending. But for others, opioids pose a huge obstacle to recovery.

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“The workers’ compensation population has to be treating early on, to the extent that they are funding programs to get workers off opiates,” said Kenavey.

Those addicted, she explained, can get through the physical withdrawal, but when chronic pain remains past withdrawal symptoms, many want to return to the drug.

Dependency on opioids can be replaced by recognizing and treating biopsychosocial factors with cognitive behavior therapy and understanding, she said. Depending on the injured worker’s individual needs, a carefully managed rehab program can be the appropriate choice, she added.

One example: Kenavey had another case in which a woman was on fentanyl patches and oxycontin pills for years. With just five weeks in a rehab center, she was off all opioids.

In addition, this same woman’s compensation costs went down significantly. Before, when she was on opioid-based medications, Medicare was paying up to $400,000. After her cognitive behavioral therapy, medical costs had decreased to $80,000.

“They’re not bad people; they were injured, and recovery is painful. I think the insurance industry knows it has to go farther,” Kenavey said.

For her, the nurse case manager plays an integral role in opioid intervention.

“The nurse case manager has to go to the doctor’s appointments and ask ‘Do you have any intention of decreasing these doses?’ ” she said.

“This is very important. When the patient is home, the nurse must attend doctor visits to explain how grueling the experience was [to get the worker off opioids]. Nurse case managers can explain the whole pain process.” &

Autumn Heisler is the digital producer and a staff writer at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

4 Companies That Rocked It by Treating Injured Workers as Equals; Not Adversaries

The 2018 Teddy Award winners built their programs around people, not claims, and offer proof that a worker-centric approach is a smarter way to operate.
By: | October 30, 2018 • 3 min read

Across the workers’ compensation industry, the concept of a worker advocacy model has been around for a while, but has only seen notable adoption in recent years.

Even among those not adopting a formal advocacy approach, mindsets are shifting. Formerly claims-centric programs are becoming worker-centric and it’s a win all around: better outcomes; greater productivity; safer, healthier employees and a stronger bottom line.

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That’s what you’ll see in this month’s issue of Risk & Insurance® when you read the profiles of the four recipients of the 2018 Theodore Roosevelt Workers’ Compensation and Disability Management Award, sponsored by PMA Companies. These four programs put workers front and center in everything they do.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top,” said Steve Legg, director of risk management for Starbucks.

Starbucks put claims reporting in the hands of its partners, an exemplary act of trust. The coffee company also put itself in workers’ shoes to identify and remove points of friction.

That led to a call center run by Starbucks’ TPA and a dedicated telephonic case management team so that partners can speak to a live person without the frustration of ‘phone tag’ and unanswered questions.

“We were focused on building up a program with an eye on our partner experience. Cost was at the bottom of the list. Doing a better job by our partners was at the top.” — Steve Legg, director of risk management, Starbucks

Starbucks also implemented direct deposit for lost-time pay, eliminating stressful wait times for injured partners, and allowing them to focus on healing.

For Starbucks, as for all of the 2018 Teddy Award winners, the approach is netting measurable results. With higher partner satisfaction, it has seen a 50 percent decrease in litigation.

Teddy winner Main Line Health (MLH) adopted worker advocacy in a way that goes far beyond claims.

Employees who identify and report safety hazards can take credit for their actions by sending out a formal “Employee Safety Message” to nearly 11,000 mailboxes across the organization.

“The recognition is pretty cool,” said Steve Besack, system director, claims management and workers’ compensation for the health system.

MLH also takes a non-adversarial approach to workers with repeat injuries, seeing them as a resource for identifying areas of improvement.

“When you look at ‘repeat offenders’ in an unconventional way, they’re a great asset to the program, not a liability,” said Mike Miller, manager, workers’ compensation and employee safety for MLH.

Teddy winner Monmouth County, N.J. utilizes high-tech motion capture technology to reduce the chance of placing new hires in jobs that are likely to hurt them.

Monmouth County also adopted numerous wellness initiatives that help workers manage their weight and improve their wellbeing overall.

“You should see the looks on their faces when their cholesterol is down, they’ve lost weight and their blood sugar is better. We’ve had people lose 30 and 40 pounds,” said William McGuane, the county’s manager of benefits and workers’ compensation.

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Do these sound like minor program elements? The math says otherwise: Claims severity has plunged from $5.5 million in 2009 to $1.3 million in 2017.

At the University of Pennsylvania, putting workers first means getting out from behind the desk and finding out what each one of them is tasked with, day in, day out — and looking for ways to make each of those tasks safer.

Regular observations across the sprawling campus have resulted in a phenomenal number of process and equipment changes that seem simple on their own, but in combination have created a substantially safer, healthier campus and improved employee morale.

UPenn’s workers’ comp costs, in the seven-digit figures in 2009, have been virtually cut in half.

Risk & Insurance® is proud to honor the work of these four organizations. We hope their stories inspire other organizations to be true partners with the employees they depend on. &

Michelle Kerr is associate editor of Risk & Insurance. She can be reached at [email protected]