Communications / Technical Issues / Technical Issue

Claims Monitoring, Regional Scorecard, and Pharmaceutical Applications Updated Through June 2020

Date: 01/19/2021

CWCI has completed updates to three of our interactive data applications (the Claims Monitoring, Regional Scorecard, and Prescription Drug tools). Institute members who log onto our website (www.cwci.org) with their username and password can access each of these updated apps, as well as our recently revised inpatient hospitalization tool and the COVID-19/Non-COVID-19 Claim tool, from the drop-down menu under the Research tab on our home page. The applications provide you and your staff online access to detailed data to examine and compare industry data on key metrics as noted below. Each of the three updated apps also has an on-line tutorial to help guide users.

The Claims Monitoring App: This tool allows users to view industrywide trends in average paid medical (with MCC), average paid indemnity, and combined medical and indemnity payments for AY 2008-2019 claims at development periods from 3 to 72 months either for all claims or just indemnity claims. Users also can choose to view the percent change in each of these average payments compared to the prior accident year; obtain data by region or industry; and access results on heat maps highlighting regional differences. The medical payment data can be broken into categories to show average payments for Treatment, DME/Pharmacy, Medical Cost Containment (MCC), and Med-Legal expense. This version of the app is based on data valued through June 2020 (IRIS 22A). Among the findings:

First-year paid medical losses (including MCC) averaged $8,616 for AY 2019 indemnity claims, up 1.5% from $8,493 in AY 2018. The distribution of the medical loss components shows medical treatment accounted for 80.6% of the payments, pharmacy/DME accounted for 2.2%, med-legal expense comprised 3.5%, and MCC represented 13.6%.
More developed data on AY 2014 indemnity claims shows that at 72 months post-injury, paid medical losses with MCC averaged $22,664, with treatment accounting for 75.4% of that amount; pharmacy/DME representing 4.1%; med-legal expense comprising 8.6%; and MCC accounting for 11.9%.
First-year paid indemnity on AY 2019 lost-time claims averaged $10,343, up 10.5% from AY 2018, while more developed data on AY 2014 indemnity claims at 72 months post-injury show average indemnity payments of $23,299.
Since AY 2013 (post-SB 863), average total paid loss trends for indemnity claims have varied significantly by development period, ranging from a 3.1% decrease in paid losses at 48 months to a 28.6% increase at 3 months.

The Regional Scorecard App: This app, an extension of CWCI’s Regional Scorecard series, has been updated to include AY 2008-2020 data valued through June 2020. Users can view regional or statewide data on 19 key metrics, compare results from 7 different 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 also may use filters to view results for all claims or just indemnity claims, by injury year, and by industry. Examples of findings from the Regional Scorecard app:

For the 12.5-year period spanning AY 2008 through June 2020, average claim payments across all claims, including med-onlys, were $20,627 in L.A. County, the highest in the state, but average payments on indemnity claims were higher in the Orange County/Inland Empire region ($51,923 vs. $51,560). A. County claimants also were slightly older and had more job tenure at the time of injury than claimants from any other region.
Women comprised 41% of California’s injured worker population during the 12.5-year period. San Diego had the highest proportion of female claimants (44.2%), followed by Los Angeles County (42.5%) and the Bay Area (42.4%), while the Central Valley had the lowest percentage of female claimants (36.1%). Women accounted for 78% of the state’s health care claims from AY 2008 through June 2020, as well as 44% of the food service claims, 41% of the retail claims; and 38% of the clerical claims.
A. County and Orange County/Inland Empire had the highest percentage of indemnity claims involving attorneys, 63.6% and 60.0% respectively for AY 2008-2020 claims). That result was consistent across all industry sectors and across each of the individual accident years.
Over the 12.5-year span, the average time elapsed between injury date and employer notice was 59 days for L.A. County indemnity claims, and 44 days for Inland Empire/Orange County claims. In no other region of the state did the average exceed 25 days. The time elapsed between the injury date and the claims administrator notification was 78 days in Los Angeles; and 61 days in the Inland Empire/Orange County, while in all other areas of the state the claims administrator notification took place in an average of 39 days or less.
From AY 2008 – June 2020, claims from Orange County/Inland Empire and L.A. County had the state’s highest average medical payments/indemnity claim ($25,296 and $24,073 respectively), but since AY 2016, average medical payments on indemnity claims from the North Counties/Sierras have been the highest in the state ($15,567 vs. the statewide average of $13,729.)
The average number of TD days on AY 2019 indemnity claims statewide was 56, with results ranging from 52 TD days in L.A. County and San Diego to 63 days on the Central Coast.
For AY 2015–AY 2019, allocated loss expense payments for all claims (M-O and indemnity) statewide averaged $1,257. Once again, there was significant regional variation, with average expenses per claim ranging from a low of $769 in the North Counties/Sierras to $1,839 in L.A. County.

The Prescription Drug App: This app can be used to examine and compare industrywide data on prescription drugs dispensed between January 2007 and June 2020. The app includes claim-level results so users can measure and compare prescription drug utilization by accident year at various levels of development and service-level data based on prescriptions filled within a given calendar year. The app also features a series of dashboards that can generate statewide or regional prescription drug data either for all claims or for just indemnity claims. Global selection settings and drop down menus allow users to view results for different levels of development; for open and/or closed claims; for specific drug groups; by opioid drug name; for generic and/or brand drugs; for specific industries; and for specific accident years or service years. As with our other online applications, once the user selects the specific metrics they are interested in, results automatically display in the tables and graphics, with regional data displayed in color-coded heat maps. The Interactive Research Report provides a guide to help users through the app, reviewing the data in each dashboard, and demonstrating options for generating customized views and screenshots of the data and exhibits available. Examples of recent findings:

Anti-inflammatories are the #1 drug category in California workers’ comp, accounting for 34.8% of the prescriptions dispensed to injured workers in the first half of 2020, nearly three times the proportion noted for opioids, which still rank second, but have declined from a record 31.6% of the workers’ comp prescriptions in 2009 to 11.7% in the first 6 months of last year.
Though relatively expensive (averaging $108/prescription), anticonvulsants, often prescribed for off-label use as painkillers instead of opioids, have become the 3rd most common drug category in California workers’ comp, accounting for 10.7% of the prescriptions in the first half of 2020.
Since 2015, dermatological payments have averaged $258/prescription — higher than any other class of drugs. During this period, diclofenac sodium topicals’ share of the dermatologicals dispensed to injured workers has tripled from 19.3% in 2015 to 57.6% in the first half of 2020.

How to Access the Applications

To access the updated interactive data apps, log on to our website (www.cwci.org) with your username and password. (If you haven’t set up a member 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 information to log in). Once you are logged on, use the drop-down menu under the Research tab and click Interactive Research Tools, then scroll down and click on the app you want to open. Each app also has an on-line tutorial to help guide users. As new data becomes available, CWCI automatically updates the apps to provide the most current data available.