How the Long-Term Staying Power of COVID-19 Is Impacting Workers’ Compensation

The coronavirus pandemic may have a vaccine, but that does not mean it’s been eradicated. Now is the time for workers’ comp professionals to recognize what the impacts of the virus could be moving forward.
By: | February 11, 2021

The COVID-19 pandemic has certainly changed every industry. There is no sector that hasn’t had to adjust to the “new normal” ushered in by the virus and its lasting impact.

For the workers’ compensation industry, the time to adjust had to happen quickly and effectively. The first COVID-19 cases were confirmed in the United States early in 2020, and professionals in workers’ comp did not hesitate to act.

In June 2020, myMatrixx first addressed this topic, diving into how best to address clients’ needs in very challenging times. As the virus continues to be a long-term concern, Hollie Lamboy, senior vice president, product development at myMatrixx, reflects on what that has meant for an industry dedicated to helping injured workers through some of the toughest times.

Here’s what she had to say.

Risk & Insurance®: How has the long-term presence of the virus impacted workers’ compensation? How are things within the industry growing and adapting now that the virus has lasted long past the short term?

Hollie Lamboy: We can say without a doubt that there has been a significant impact on the industry, clearly. Any event that affects people’s ability to work on a large scale is also going to affect workplace injury rates.

Hollie Lamboy, senior vice president, product development, myMatrixx

There is also ongoing uncertainty. From the beginning there were unknowns around how a global pandemic that put millions of people out of work was going to impact us. There has been some compelling evidence to support this, particularly the drop in scripts across the industry. For example, California has seen a reduction in prescriptions for workers’ comp cases.

Overall, I think payers and the industry as a whole are examining whether there are certain populations who may require measures, such as preventive or behavioral care, which traditionally haven’t been largely considered part of workers’ compensation.

In some ways these conversations are just beginning, but given the long-term presence of the virus, the industry now looks to be engaging in broader and deeper discussion around these topics. This includes coverage of preventive measures and how behavioral care should be implemented, especially given new indicators around the increased behavioral health needs of the workforce during the pandemic.

R&I: What lessons do you think were learned early in the pandemic to prepare for the long-term “new normal” in WC? Or, in other words, how are the lessons learned early on being applied now?

HL: From my viewpoint, this pandemic has really put a different focus on behavioral health, especially in terms of how people are reacting to the huge shift from working in the office to working from home. There has been an increase in anxiety and other mental health factors that go with living through the last year.

No one could have predicted this shift, but so much of the early focus was on finding effective treatment or speculating when there was going to be a vaccine.

Of course, these questions are important, but they also fed into greater unknowns that increased uncertainty among both the industry and injured workers. I think what we realized from looking at these unknowns, was how much of a behavioral focus they required compared to a traditional treatment focus. Hindsight is always 20/20, but from a product perspective, it is now very clear how important the role of behavioral care has become in workers’ comp, and myMatrixx is well into the development phase of behavioral health solutions.

R&I: What would you say comp programs were looking for in terms of solutions toward the beginning? What are they looking for now?

HL: Apart from the increased focus on behavioral care, there are many fundamentals that have been fairly consistent during the course of the pandemic.

Given the unknowns, our primary focus throughout has been on following the evidence as it comes out regarding the virus itself, what effective treatments look like and the timeline for vaccine development. To develop effective solutions and products in workers’ compensation, we need to be able to answer those questions.

If you think about the first responders and essential workers exposed to the virus, we need to know the long-term costs of treatment and with drugs associated with treatment post-diagnosis. We’re also still analyzing the potential need for preventive coverage for those occupations as well.

But again, as the pandemic is still far from being behind us even with the vaccine, the industry is determining whether that would be a benefit of workers’ comp.

R&I: New claims were on a decline at one point during the pandemic. Is that still the case? Why or why not?

HL: Yes. I think it’s important to point out that there was already a natural decline prior to the pandemic that has only accelerated. We were already seeing a situation where payers were becoming more aggressive due to factors such as the opioid crisis.

Given COVID-19, there obviously was going to be a natural decline due to folks being out of work and/or not at the job site. Factors like the high rate of unemployment and the decline in business for many sectors have all contributed to this, particularly as growing infection rates have continued to climb in this country, and many communities are recommitting to quarantine and lockdowns.

We’re continuing to watch the rate of new claims now that the vaccine is available to see if there is any slowdown in the decline.

However, until we have more robust preventive care and effective treatment solutions, I think we will still continue to see lower rates of claims. But again, as the industry is still coming to a larger understanding of what workers’ comp payers will be covering in regard to comprehensive treatment and preventive measures.

R&I: When the rate of claims coming in saw a decline, what impact did that have on the pharma side of workers’ comp? (There was some data showing prescription fill declining. Is that still the case? Are there other patterns or trends emerging as well?)

HL: Speaking on the topic of behavioral health, one area in pharmaceuticals where we have actually seen a small-scale increase since the pandemic is in prescriptions for behavioral health, or psychotropic drugs.

However, with a decrease in workplace injuries, there will of course be a decline in acute pain across the population that then causes a decline in prescriptions. We have seen an uptick in anxiety, depression, insomnia and other mental health concerns. So, it really is a case of the drugs following the conditions that people are experiencing.

We have also seen some increased utilization of drugs with potential relationships to COVID-19, although it is still too soon to draw firm conclusions. For example, respiratory medications, such as inhalers or cough suppressants that you would see for asthma or COPD, have seen an uptick. Although what we have seen is not on the level of pain medication in terms of utilization. But it’s those slight, yet noticeable, increases that we’re continuing to watch and respond to.

Taken as a whole, it has obviously forced the industry to look at this differently. So, in the cases where perhaps those drugs may not have been covered on formulary, payers may be electing to cover those given the possibility of the diagnosis and that treatment begins at the outset.

R&I: Do you think that the comp industry has its footing on how to continue through COVID? Why or why not? What can the industry look to/find a solution in, in order to keep persevering through?

HL: It’s a question of how well we can continue to manage uncertainty for at least the next year.

As just one example, even the vaccine rollout has brought new questions. We are able to leverage insights with our parent company Express Scripts, such as reports of side effects or issues in the distribution process. The industry is in a learning curve right now, and our team takes pride in staying on top of that information so we can keep our clients informed.

Going back to prevention because of COVID-19, the workers’ compensation industry is asking big questions for COVID about taking a preventive approach or the standard treatment after diagnosis.

Obviously, there are some big implications there that need to be sorted out. myMatrixx is taking the most effective approach that we possibly can and staying connected with health care professionals.

As always, product development has to follow the clinical evidence and the data, and that is what we’re continuing to look at. I think we can see the light at the end of the tunnel at this point, and there’s a sense that we have a plan to persevere.

R&I: We’ve covered a good amount. Is there anything else you would like to add on the topic?

HL: In spite of the uncertainty, we have been committed to using the information and resources we have, combined with what we’re continually learning to both define and get to a new equilibrium.

We operate in a data-driven environment. One of the greatest strengths of myMatrixx for our clients is our ability to be flexible and adjust our solutions in a customized way that enables us to help our partners manage this pandemic effectively. &

Autumn Demberger is a freelance writer and can be reached at [email protected].

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