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Shifting Our Focus to Preventing Negative Outcomes from Opioids

Preventing negative outcomes from the treatment associated with a workplace injury is just as critical as preventing the injury from happening.
By: | May 18, 2017 • 6 min read

Providing people who want to work, the opportunity to work is not only important to individual families but also the economy. When workers are injured, they may lose that opportunity. Preventing work injuries from happening in the first place is far and away the best way to keep workers from becoming injured workers. When injuries do happen, it is imperative for all involved, to focus on getting workers healthy and back to their lives.

Once an injury has taken place, a lot can happen during the course of treatment that ultimately will lead to positive or negative outcomes. Preventing negative outcomes from the treatment associated with an injury is just as important as preventing the workplace injury in the first place. To prevent injuries we implement and encourage proper training, awareness and safety protocols. Similar protocols should be used to prevent negative outcomes during the course of treatment so injured workers can return to the most productive life possible.

How can we prevent negative outcomes from happening in the course of treatment of an injured worker? If the course of treatment was process mapped, we might find several gaps in care that could affect outcomes. Importantly, a major gap in care for many would relate to the opioid epidemic. The Centers for Disease Control and Prevention (CDC) report that as many as 1 in 4 patients receiving long-term opioid therapy in a primary care setting, struggle with addiction.1 And, “we now know that overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths.”2 At their best, opioids are valuable tools in mitigating intense acute pain helping injured workers get through the toughest portions of their pain and onto the road to recovery. At their worst, opioids are an intensely addictive therapy that has led to 91 Americans dying every day from overdoses.2

While recent initiatives such as improving access to care for those addicted to opioids, and expanding access to the life-saving drug naloxone used in opioid overdose are important steps towards addressing the epidemic for those that have already developed a negative outcome, we also need to focus on preventing negative outcomes from happening in the first place. To do this, it has become clear that there needs to be a multifaceted approach that identifies a goal and establishes a methodology to achieve that goal for the injured worker. Process models would challenge us to capitalize on available resources and remove wasted steps to be able to identify, maintain and sustain process improvement towards improving opioid epidemic related problems. The process of treatment within Workers’ Compensation is a team effort among many people who influence the care an injured worker receives and as such an approach that utilizes each team member’s expertise as a resource will be useful.

Stephanie Labonville, PharmD, CPE, BCPS, Director of Clinical Operations

The pharmacist role is an evolving and often underutilized available resource that can be instrumental in a multifaceted approach towards preventing negative outcomes. As experts in medication, pharmacists’ skills and knowledge are valuable resources and they have the ability to contribute to integrated care teams by detecting and resolving or preventing drug related problems, helping to ensure the safe and efficacious use of medicines and providing comprehensive drug information to patients and other health care professionals, thereby reinforcing prevention of negative outcomes.

As an industry, we must focus on our role in appropriate and safe pain management. This focus must take into consideration the CDC’s calling on dispensing pharmacists to be on the front lines of addressing prescription opioid abuse and overdose.3 Dispensing pharmacists as part of a Workers’ Compensation PBM must take this front-line role to a value-added level and develop specific program solutions focused on opioid related problems such as Prescription Drug Monitoring Program (PDMP) reviews and education of injured workers and communication with their physicians regarding high-risk drug combinations, high risk opioid doses and safer alternative treatment regimens.

Some drug combinations can be extremely dangerous. For example, there has been much written about the “holy trinity” of drugs: opioids, benzodiazepines and carisoprodol (Soma) and the serious danger inherent in taking 2 or 3 of these together.4,5 Can we really afford to use a pharmacy or PBM that doesn’t have a standardized approach to this combination or one who does not take action before the combinations of medications are dispensed? We need specific programs that reach out to the patient and prescribing physicians on these specific risky drug combinations prior to their dispensing.

Pharmacists who can access state PDMPs can help identify patients at increased risk of overdose, such as those taking high dosages or obtaining opioids from multiple prescribers. They can then help monitor the patient and their prescriptions allowing for proactive consultation with the injured worker and prescriber prior to dispensing high-risk medications.

In addition to consulting with physicians regarding opioid addiction and high-risk drug combinations, it is important for the pharmacist to be able to alert a prescriber to pertinent legislative rule(s) for their state and their patient’s morphine milligram equivalent (MME) before the pills are dispensed. Choosing a PBM with this capability can be critical to preventing negative outcomes.

As injured workers are educated about what medications may work best for them as well as potential risks of various medications or combinations of medications, they are provided the opportunity to become advocates for themselves. We need to ensure that dispensing pharmacists have experienced insight into pain management within Workers’ Compensation, which they can then use to educate patients. Pharmacists as part of the injured worker’s treatment team can use a variety of ways to educate patients including direct phone calls and subsequent informational pieces that address pain management e.g., “If not opioids, then what?”

Many injured workers are scared that their pain will be unmanageable without opioids. Learning that outcomes and pain management are often improved through the use of tapers, other non -addictive medications, non-drug therapies like; cognitive behavior therapy (CBT), massage, movement therapies, socialization, healthier food and lifestyle decisions, will provide the injured workers the resources and support to get on the road to recovery and return them to what they deserve: the opportunity to return to a productive life. The equipped dispensing pharmacist must be an integral member of the medical treatment team to make that a reality.

We can, as an industry, work towards this goal of keeping workers participating in the workforce and in their life by ensuring that we involve knowledgeable, experienced dispensing pharmacists in the treatment plan of our complex cases before a potentially risky pain medication regimen is determined, prescribed and dispensed.

Let’s help protect our most important national resource: our workers before they become statistics, by focusing on prevention as well as management of this problem.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Specialty Solutions Rx. The editorial staff of Risk & Insurance had no role in its preparation.




Specialty Solutions Rx is a full service workers’ compensation PBM that was designed to proactively and effectively address opioids and other high risk medications.

Cyber Liability

Fresh Worries for Boards of Directors

New cyber security regulations increase exposure for directors and officers at financial institutions.
By: | June 1, 2017 • 6 min read

Boards of directors could face a fresh wave of directors and officers (D&O) claims following the introduction of tough new cybersecurity rules for financial institutions by The New York State Department of Financial Services (DFS).

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Prompted by recent high profile cyber attacks on JPMorgan Chase, Sony, Target, and others, the state regulations are the first of their kind and went into effect on March 1.

The new rules require banks, insurers and other financial institutions to establish an enterprise-wide cybersecurity program and adopt a written policy that must be reviewed by the board and approved by a senior officer annually.

The regulation also requires the more than 3,000 financial services firms operating in the state to appoint a chief information security officer to oversee the program, to report possible breaches within 72 hours, and to ensure that third-party vendors meet the new standards.

Companies will have until September 1 to comply with most of the new requirements, and beginning February 15, 2018, they will have to submit an annual certification of compliance.

The responsibility for cybersecurity will now fall squarely on the board and senior management actively overseeing the entity’s overall program. Some experts fear that the D&O insurance market is far from prepared to absorb this risk.

“The new rules could raise compliance risks for financial institutions and, in turn, premiums and loss potential for D&O insurance underwriters,” warned Fitch Ratings in a statement. “If management and directors of financial institutions that experience future cyber incidents are subsequently found to be noncompliant with the New York regulations, then they will be more exposed to litigation that would be covered under professional liability policies.”

D&O Challenge

Judy Selby, managing director in BDO Consulting’s technology advisory services practice, said that while many directors and officers rely on a CISO to deal with cybersecurity, under the new rules the buck stops with the board.

“The common refrain I hear from directors and officers is ‘we have a great IT guy or CIO,’ and while it’s important to have them in place, as the board, they are ultimately responsible for cybersecurity oversight,” she said.

William Kelly, senior vice president, underwriting, Argo Pro

William Kelly, senior vice president, underwriting at Argo Pro, said that unknown cyber threats, untested policy language and developing case laws would all make it more difficult for the D&O market to respond accurately to any such new claims.

“Insurers will need to account for the increased exposures presented by these new regulations and charge appropriately for such added exposure,” he said.

Going forward, said Larry Hamilton, partner at Mayer Brown, D&O underwriters also need to scrutinize a company’s compliance with the regulations.

“To the extent that this risk was not adequately taken into account in the first place in the underwriting of in-force D&O policies, there could be unanticipated additional exposure for the D&O insurers,” he said.

Michelle Lopilato, Hub International’s director of cyber and technology solutions, added that some carriers may offer more coverage, while others may pull back.

“How the markets react will evolve as we see how involved the department becomes in investigating and fining financial institutions for noncompliance and its result on the balance sheet and dividends,” she said.

Christopher Keegan, senior managing director at Beecher Carlson, said that by setting a benchmark, the new rules would make it easier for claimants to make a case that the company had been negligent.

“If stock prices drop, then this makes it easier for class action lawyers to make their cases in D&O situations,” he said. “As a result, D&O carriers may see an uptick in cases against their insureds and an easier path for plaintiffs to show that the company did not meet its duty of care.”

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One area that regulators and plaintiffs might seize upon is the certification compliance requirement, according to Rob Yellen, executive vice president, D&O and fiduciary liability product leader, FINEX at Willis Towers Watson.

“A mere inaccuracy in a certification could result in criminal enforcement, in which case it would then become a boardroom issue,” he said.

A big grey area, however, said Shiraz Saeed, national practice leader for cyber risk at Starr Companies, is determining if a violation is a cyber or management liability issue in the first place.

“The complication arises when a company only has D&O coverage, but it doesn’t have a cyber policy and then they have to try and push all the claims down the D&O route, irrespective of their nature,” he said.

“Insurers, on their part, will need to account for the increased exposures presented by these new regulations and charge appropriately for such added exposure.” — William Kelly, senior vice president, underwriting, Argo Pro

Jim McCue, managing director at Aon’s financial services group, said many small and mid-size businesses may struggle to comply with the new rules in time.

“It’s going to be a steep learning curve and a lot of work in terms of preparedness and the implementation of a highly detailed cyber security program, risk assessment and response plan, all by September 2017,” he said.

The new regulation also has the potential to impact third parties including accounting, law, IT and even maintenance and repair firms who have access to a company’s information systems and personal data, said Keegan.

“That can include everyone from IT vendors to the people who maintain the building’s air conditioning,” he said.

New Models

Others have followed New York’s lead, with similar regulations being considered across federal, state and non-governmental regulators.

The National Association of Insurance Commissioners’ Cyber-security Taskforce has proposed an insurance data security model law that establishes exclusive standards for data security and investigation, and notification of a breach of data security for insurance providers.

Once enacted, each state would be free to adopt the new law, however, “our main concern is if regulators in different states start to adopt different standards from each other,” said Alex Hageli, director, personal lines policy at the Property Casualty Insurers Association of America.

“It would only serve to make compliance harder, increase the cost of burden on companies, and at the end of the day it doesn’t really help anybody.”

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Richard Morris, partner at law firm Herrick, Feinstein LLP, said companies need to review their current cybersecurity program with their chief technology officer or IT provider.

“Companies should assess whether their current technology budget is adequate and consider what investments will be required in 2017 to keep up with regulatory and market expectations,” he said. “They should also review and assess the adequacy of insurance policies with respect to coverages, deductibles and other limitations.”

Adam Hamm, former NAIC chair and MD of Protiviti’s risk and compliance practice, added: “With New York’s new cyber regulation, this is a sea change from where we were a couple of years ago and it’s soon going to become the new norm for regulating cyber security.” &

Alex Wright is a U.K.-based business journalist, who previously was deputy business editor at The Royal Gazette in Bermuda. You can reach him at [email protected]