Theo Awards 2026: In Conversation with State of Nevada Risk Management Division

How the State of Nevada and Optum cut workers’ comp claims involving opioids from 17.8% to 9.9% without taking an anti-opioid stance.
By: | October 29, 2026

What happens when a minor injury spirals into opioid dependency? The State of Nevada watched it happen to an injured employee, and it changed how the state manages medical care in workers’ compensation. Mandy Hagler, Deputy Director of the State of Nevada Risk Management Division, and Kelly Kalaguire, SVP of Account Management at Optum, explain how Nevada cut the share of claims involving any opioid from 17.8% to 9.9%, while the average morphine equivalent dose fell from 43.7 to 35.0. 

Nevada built structure around its philosophy. The first-fill list allows up to a seven-day supply of a short-acting opioid so injured workers get relief right away, long-acting opioids require prior authorization, and the rules tighten after the first week. A treatment contract with step-down expectations was in place before state law required one. A flagged prescription triggers a same-day notice to the adjuster and nurse case manager, and every partner knows their role before a claim arrives, supported by monthly claims reviews and quarterly clinical roundtables. The approach is deliberately nuanced rather than anti-opioid, since opioids can be the right call after major surgery or a catastrophic injury. 

Watch the full interview to discover why Hagler says a philosophy without structure is a pipe dream, how the team changed physician behavior without telling providers they were wrong, and how Nevada measures the harm that never happens. &

The R&I Editorial Team can be reached at [email protected].

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