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Risk Insider: Debbie Michel

Where’s Your Bottle of Painkillers?

By: | August 18, 2014 • 2 min read
Debbie Michel is President of Helmsman Management Services, the wholly owned third party administrator of Liberty Mutual Insurance. She can be reached at [email protected]

Medical care providers inconsistently prescribe powerful – and highly addictive – narcotic painkillers across the country, according to a recent study by the federal Centers for Disease Control and Prevention (CDC) and data from Liberty Mutual Insurance.

This variation needlessly endangers patients, drives up workers compensation costs and may not provide a healing benefit to injured workers.

This is largely a problem that shouldn’t exist, since the American College of Occupational and Environmental Medicine (ACOEM) “Guidelines for the Chronic Use of Opioids” provide clear best medical practices for prescribing powerful narcotic painkillers — and advise that they be used only for select patients.

And yet the recent CDC study found tremendous variability in the rates of narcotic prescriptions between states.

For example, in 2012, health care providers in Tennessee wrote 143 pain killer prescriptions per 100 people, while doctors in California issued 57 prescriptions per 100 people.

Shockingly, health care providers across the U.S. wrote 259 million prescriptions for painkillers in 2012, enough for every adult American to have a bottle, according to the study.

A Liberty Mutual study published in 2009 found similar interstate variation in opioid prescriptions for acute work-related lower back pain.  In fact, almost eight times as many opioid prescriptions were written in South Carolina for acute lower back pain than in Massachusetts during the study’s time frame.

The problem is clear. So is the solution.

Here are four steps every risk manager should take to help protect injured employees and the bottom line:

Get informed — Understand if the states where your company operates have high rates of opioid prescribing, and to what extent the workers compensation systems in those states require treating physicians follow the ACOEM guidelines.

Providers treating injured workers in some states are mandated to follow these guidelines, while they are mere suggestions in other states.

Get involved — Help your regulators and legislators understand the problems associated with narcotic over prescription, for both individuals and employers.

Work with them to appreciate the value of evidence-based medicine, such as the ACOEM guidelines.

•  Use the right medical care provider — Having the injured worker treated by a provider experienced in occupational injuries will usually help the worker recover sooner and make the use of narcotics much less likely.

Even in states where employers cannot direct the care of injured workers, they can help employees understand the potential dangers of powerful narcotic pain killers.

Spot problems early — Closely monitor claims. Use specialized resources to quickly identify the inappropriate use of narcotics and the early warning signs of potential abuse, such as use of multiple pharmacies or physicians, depression and addictive behaviors.

While not everyone has a bottle of painkillers, some have several.   And it may be costing those individuals — and their employers — dearly. Get involved to help end this tremendous human and financial waste.

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]