2017 NWCDC

Physician Education Mitigates Rx Risks

Workers' comp providers can work with doctors, adjusters and patients to get a handle on pain prescriptions.
By: | December 7, 2017 • 2 min read

As medical costs keep rising and the opioid crisis continues, workers’ compensation providers can influence prescriber behavior to not only control costs but also improve quality of care.

Physician dispensing remains a top challenge. Workers’ comp drugs can be as much as 50 to 1,000 percent more expensive than if dispensed in retail pharmacy. Doctors have financial incentives to dispense from their office, but doing so removes the extra layer of oversight provided by pharmacies, presenting a safety risk to patients.

“We can’t expect adjusters to have the clinical knowledge that doctors and pharmacists spend years developing.” Britten Featherston, PharmD, clinical pharmacist, Healthesystems

According to Jean Feldman, director of managed care for Sentry Insurance and presenter at a Dec. 6 session at the National Workers’ Compensation and Disability Conference & Expo in Las Vegas on pharmacy management strategies, “Doctors often have no idea what the back end cost is when they dispense medications from their office. We need to bring it to their attention.”

Jean Feldman, director of managed care, Sentry Insurance

Similarly, workers’ comp professionals can educate adjusters who are involved in making clinical decisions despite having no or little clinical training.

“We can’t expect adjusters to have the clinical knowledge that doctors and pharmacists spend years developing,” said co-presenter Britten Featherston, PharmD, clinical pharmacist with Healthesystems.

State and federal bodies are making steps in the right direction. CDC opioid guidelines issued in 2016 directly address physicians in an attempt to set best practices.

More states are mandating that doctors check prescription drug monitoring programs before writing a script. California is set to launch a formulary on Jan. 1, 2018, which could provide a model for other states looking to implement their own.

Communication among physicians, adjusters, insurers, pharmacists — and most importantly, patients — is critical to prevent unnecessary pain management prescriptions and to mitigate the risk of side effects and/or interactions between multiple medications.

Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]

More from Risk & Insurance

More from Risk & Insurance

2017 Teddy Awards

The Era of Engagement

The very best workers’ compensation programs are the ones where workers aren’t just the subject of the program, they’re a part of it.
By: | November 1, 2017 • 5 min read

Employee engagement, employee advocacy, employee participation — these are common threads running through the programs we honor this year in the 2017 Theodore Roosevelt Workers’ Compensation and Disability Management Awards, sponsored by PMA Companies.

A panel of judges — including workers’ comp executives who actively engage their own employees — selected this year’s winners on the basis of performance, sustainability, innovation and teamwork. The winners hail from different industries and regions, but all make people part of the solution to unique challenges.


Valley Health System is all-too keenly aware of the risk of violence in health care settings, running the gamut from disruptive patients to grieving, overwrought family members to mentally unstable active shooters.

Valley Health employs a proactive and comprehensive plan to respond to violent scenarios, involving its Code Atlas Team — 50 members of the clinical staff and security departments who undergo specialized training. Valley Health drills regularly, including intense annual active shooter drills that involve participation from local law enforcement.

The drills are unnerving for many, but the program is making a difference — the health system cut its workplace violence injuries in half in the course of just one year.

“We’re looking at patient safety and employee safety like never before,” said Barbara Schultz, director of employee health and wellness.

At Rochester Regional Health’s five hospitals and six long-term care facilities, a key loss driver was slips and falls. The system’s mandatory safety shoe program saw only moderate take-up, but the reason wasn’t clear.

Rather than force managers to write up non-compliant employees, senior manager of workers’ compensation and employee safety Monica Manske got proactive, using a survey as well as one-on-one communication to suss out the obstacles. After making changes based on the feedback, shoe compliance shot up from 35 percent to 85 percent, contributing to a 42 percent reduction in lost-time claims and a 46 percent reduction in injuries.

For the shoe program, as well as every RRH safety initiative, Manske’s team takes the same approach: engaging employees to teach and encourage safe behaviors rather than punishing them for lapses.

For some of this year’s Teddy winners, success was born of the company’s willingness to make dramatic program changes.


Delta Air Lines made two ambitious program changes since 2013. First it adopted an employee advocacy model for its disability and leave of absence programs. After tasting success, the company transitioned all lines including workers’ compensation to an integrated absence management program bundled under a single TPA.

While skeptics assume “employee advocacy” means more claims and higher costs, Delta answers with a reality that’s quite the opposite. A year after the transition, Delta reduced open claims from 3,479 to 1,367, with its total incurred amount decreased by $50.1 million — head and shoulders above its projected goals.

For the Massachusetts Port Authority, change meant ending the era of having a self-administered program and partnering with a TPA. It also meant switching from a guaranteed cost program to a self-insured program for a significant segment of its workforce.

Massport’s results make a great argument for embracing change: The organization saved $21 million over the past six years. Freeing up resources allowed Massport to increase focus on safety as well as medical management and chopped its medical costs per claim in half — even while allowing employees to choose their own health care providers.

Risk & Insurance® congratulates the 2017 Teddy Award winners and holds them in high esteem for their tireless commitment to a safe workforce that’s fully engaged in its own care. &


More coverage of the 2017 Teddy Award Winners and Honorable Mentions:

Advocacy Takes Off: At Delta Air Lines, putting employees first is the right thing to do, for employees and employer alike.


Proactive Approach to Employee SafetyThe Valley Health System shifted its philosophy on workers’ compensation, putting employee and patient safety at the forefront.


Getting It Right: Better coordination of workers’ compensation risk management spelled success for the Massachusetts Port Authority.


Carrots: Not SticksAt Rochester Regional Health, the workers’ comp and safety team champion employee engagement and positive reinforcement.


Fit for Duty: Recognizing parallels between athletes and public safety officials, the city of Denver made tailored fitness training part of its safety plan.


Triage, Transparency and TeamworkWhen the City of Surprise, Ariz. got proactive about reining in its claims, it also took steps to get employees engaged in making things better for everyone.

A Lesson in Leadership: Shared responsibility, data analysis and a commitment to employees are the hallmarks of Benco Dental’s workers’ comp program.


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