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

2018 Risk All Stars

Stop Mitigating Risk. Start Conquering It Like These 2018 Risk All Stars

The concept of risk mastery and ownership, as displayed by the 2018 Risk All Stars, includes not simply seeking to control outcomes but taking full responsibility for them.
By: | September 14, 2018 • 3 min read

People talk a lot about how risk managers can get a seat at the table. The discussion implies that the risk manager is an outsider, striving to get the ear or the attention of an insider, the CEO or CFO.

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But there are risk managers who go about things in a different way. And the 2018 Risk All Stars are prime examples of that.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Goodyear’s Craig Melnick had only been with the global tire maker a few months when Hurricane Harvey dumped a record amount of rainfall on Houston.

Brilliant communication between Melnick and his new teammates gave him timely and valuable updates on the condition of manufacturing locations. Melnick remained in Akron, mastering the situation by moving inventory out of the storm’s path and making sure remediation crews were lined up ahead of time to give Goodyear its best leg up once the storm passed and the flood waters receded.

Goodyear’s resiliency in the face of the storm gave it credibility when it went to the insurance markets later that year for renewals. And here is where we hear a key phrase, produced by Kevin Garvey, one of Goodyear’s brokers at Aon.

“The markets always appreciate a risk manager who demonstrates ownership,” Garvey said, in what may be something of an understatement.

These risk managers put in gear their passion, creativity and perseverance to become masters of a situation, pushing aside any notion that they are anything other than key players.

Dianne Howard, a 2018 Risk All Star and the director of benefits and risk management for the Palm Beach County School District, achieved ownership of $50 million in property storm exposures for the district.

With FEMA saying it wouldn’t pay again for district storm losses it had already paid for, Howard went to the London markets and was successful in getting coverage. She also hammered out a deal in London that would partially reimburse the district if it suffered a mass shooting and needed to demolish a building, like what happened at Sandy Hook in Connecticut.

2018 Risk All Star Jim Cunningham was well-versed enough to know what traditional risk management theories would say when hospitality workers were suffering too many kitchen cuts. “Put a cut-prevention plan in place,” is the traditional wisdom.

But Cunningham, the vice president of risk management for the gaming company Pinnacle Entertainment, wasn’t satisfied with what looked to him like a Band-Aid approach.

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Instead, he used predictive analytics, depending on his own team to assemble company-specific data, to determine which safety measures should be used company wide. The result? Claims frequency at the company dropped 60 percent in the first year of his program.

Alumine Bellone, a 2018 Risk All Star and the vice president of risk management for Ardent Health Services, faced an overwhelming task: Create a uniform risk management program when her hospital group grew from 14 hospitals in three states to 31 hospitals in seven.

Bellone owned the situation by visiting each facility right before the acquisition and again right after, to make sure each caregiving population was ready to integrate into a standardized risk management system.

After consolidating insurance policies, Bellone achieved $893,000 in synergies.

In each of these cases, and in more on the following pages, we see examples of risk managers who weren’t just knocking on the door; they were owning the room. &

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Risk All Stars stand out from their peers by overcoming challenges through exceptional problem solving, creativity, clarity of vision and passion.

See the complete list of 2018 Risk All Stars.

Dan Reynolds is editor-in-chief of Risk & Insurance. He can be reached at [email protected]