Communications / Technical Issues / Technical Issue

CWCI Interactive Applications Updated Through AY 2020

Date: 08/04/2021

Last week CWCI completed and posted updates to our Claims Monitoring, Regional Scorecard, and Prescription Drug interactive applications, featuring IRIS data on California workers’ compensation claims through AY 2020. The applications are available exclusively to CWCI members who log on to our website (www.cwci.org) with their username and password. Once logged in, users can access the apps from the drop-down menu under the Research tab on our home page. The on-line tutorials posted along with each app also remain available in the Research section of our website to guide users. The applications offer detailed data that can be used to examine and compare industry data on key metrics as noted below.

The Claims Monitoring App: This application can be used to examine industrywide trends for average paid indemnity, average paid medical, and combined medical and indemnity payments for AY 2009-2020 claims at development periods from 3 to 72 months for all claims or just indemnity claims. The tool can be used to calculate the percent changes in average payments for each metric across accident years; obtain data for a region or an industry; and view regional differences displayed on heat maps. Medical payment results can be broken out to show average amounts paid for Treatment, Pharmacy, Medical Case Management, Med-Legal expense, and other medical payments. Among the latest findings:

Average indemnity paid on lost-time claims at 12 months rose 11.7% from $8,224 on AY 2018 claims to $9,186 on AY 2019 claims; average paid medical rose 2.4% from $8,352 to $8,553.
Average indemnity payments on lost-time claims within the first year increased in 2020, with average paid indemnity at 3 months climbing 6.7% from $3,235 in AY 2019 to $3,451 in AY 2020, while average paid indemnity at 6 months jumped 7.4%, and average paid indemnity at 9 months rose 6.0%. Those increases were only partially offset by decreased medical payments within the first year, as average paid medical on lost time claims at 3 months only declined 2.6% from $3,422 in AY 2019 to $3,333 in AY 2020, while average paid medical was down 3.1% at 6 months and 2.8% at 9 months.
Average paid losses at 6 months post injury on indemnity claims in the health care and social assistance sector, which was heavily impacted by COVID claims last year, totaled $8,994 in AY 2020, up 8.0% from 2019. Average indemnity payments on these claims were up 12.0% and accounted for $5,142 (or 57%) of that total, while medical accounted for $3,851 (43%). In comparison, paid losses at 6 months on AY 2020 indemnity claims from all industries averaged $11,284, with indemnity payments averaging $5,900 (52.3% of the total) and medical averaging $5,385 (47.7%).

The Regional Scorecard App: This application updates CWCI’s Regional Scorecard series with new data on AY 2008-2020 claims valued through December 2020. Users can view regional and statewide data on 19 key metrics, compare results from 7 regions, and identify regional and statewide trends that have developed. The app includes data on average medical, indemnity and other payments (including breakdowns showing average paid TD and PD, allocated loss adjustment expense, and data on demographics, claim status, and claim volume. Users may also drill down to view results by injury year and industry. Sample findings from the Regional Scorecard app:

Statewide, total payments per claim for all AY 2020 claims (med-only and indemnity) through the end of last year averaged $4,940, but the amounts varied significantly by region, ranging from $4,271 in the Central Valley to $5,565 in the North Counties and Sierras. In general, total payments per claim were above the statewide average in urban regions [Bay Area ($5,543), Inland Empire/Orange ($5,245) and Los Angeles ($5,145)], with the exception being San Diego, where payments on AY 2020 claims averaged $4,616, 6.6% below the statewide average.
Over the 8-year period following the 2012 reforms (SB 863), total claim payments for open and closed indemnity claims statewide averaged $39,753, but they have been highest in L.A. County ($42,116), the Inland Empire/Orange County ($42,084); and the Northern Counties/Sierras ($40,677) and lowest in the Central Valley ($35,697) and San Diego (35,839).
Statewide, expense payments per indemnity claim over the 8-year post-reform period were $5,345, but there were sharp regional variations, as these expenses ranged from $3,994 in the North Counties/Sierras to $6,455 in Los Angeles County.
Post-SB 863 TD claims statewide have averaged 120 days of paid TD, with results ranging from 107 days in San Diego to 132 days in Los Angeles County and the Inland Empire/Orange County.
A. County continues to have the highest level of attorney involvement (62.3% of AY 2015 – 2020 indemnity claimants from L.A. were represented vs. 41.0% of Bay Area claimants and 51.0% of indemnity claimants statewide).

The Prescription Drug App: This app can be used to identify trends and compare industrywide data on prescription drugs dispensed between January 2007 and December 2020. Claim level data allows users to examine prescription drug utilization by accident year at 6 levels of development, and service-level data allows users to look at prescription drugs dispensed during calendar years 2007 to 2020. The app’s dashboards allow users to build custom views of statewide or regional pharmaceutical data for all claims or indemnity claims, and the global selection settings and drop down menus allow users to see results at different levels of development; for open and/or closed claims; for specific drug groups; for generic and/or brand drugs; by opioid drug name; by industry; and for specific accident years or service years. As users choose specific metrics to view, the accompanying tables and charts automatically display the results, with regional data provided in color-coded heat maps. Some examples of recent findings:

Opioid utilization has dropped sharply over the past decade, and since the adoption of revised pain treatment guidelines in late 2017 and the MTUS prescription drug formulary on 1/1/18, the percent of all claims in which opioids have been dispensed w/in the first 3 months has fallen from 8.2% of all 2017 claims to 2.5% of 2019 and 2020 claims. Likewise, the percent of claims with opioids dispensed in the first year has fallen from 9.8% in AY 2017 to 4.0% in AY 2019.
Anti-inflammatories accounted for 24.4% of all prescriptions dispensed to California injured workers in 2015, surpassing opioids as the top therapeutic drug group in California workers’ comp. By 2020, they had increased to 35.1% of all prescriptions – more than 3 times the proportion noted for opioids, which declined to 11.3% of the prescriptions last year, followed by anticonvulsants (10.3%), dermatologicals (8.4%), and antidepressants (6.7%).
Together, ibuprofen and naproxen accounted for 2/3 of the anti-inflammatories dispensed to injured workers last year, but with an average cost of $11 and $45 respectively, they only accounted for 26.9% of anti-inflammatory payments. In contrast, fenoprofen calcium represented just 1.1% of the anti-inflammatory prescriptions, but it had an average cost of $1,497 per prescription, so it ranked first among anti-inflammatories in terms of total payments, consuming 29.2% of the anti-inflammatory dollars last year. Notably, fenoprofen calcium accounted for only 0.1% of the anti-inflammatory payments in 2016.
Gabapentin and pregabalin accounted for nearly 90% of all anticonvulsants dispensed in 2020. Generic gabapentin has been available for some time, but generic pregabalin was not available until July 2018. The average payment for a generic pregabalin prescription last year was $244 vs. $657 for brand-name pregabalin (Lyrica). The increased use of generic pregabalin, which went from 9.0% of the generic anticonvulsants dispensed in 2019 to 18.6% in 2020, helped reduce anticonvulsants’ share of the total drug spend from 14.6% in 2019 to 10.6% in 2020.

How to Access the Apps: log on to www.cwci.org with your user name and password (if you don’t have an account, select “Your Account” at the top of the home page, click “Add Me as a Member User” from the pull-down menu, complete the form, then use that info to log in). Once you are logged on, use the dropdown menu under the Research tab and click Interactive Research Tools, then click the app you want to open. As new data becomes available, CWCI will update the apps to provide the most current data.