Communications / Technical Issues / Technical Issue

CWCI Interactive Applications Updated With Data Through June AY 2023

Date: 12/28/2023

This month CWCI completed and posted updates to four of our online, interactive applications: the Claims Monitoring, Regional Scorecard, Medical Services, and Prescription Drug applications, which now include IRIS data on California workers’ compensation claims valued through June 30, 2023. All four applications are available 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 applications offer detailed data that can be used to examine and compare industry data on key metrics as noted below.

The Claims Monitoring Application: This application allows users to examine industrywide trends for average paid indemnity, average paid medical, and combined medical and indemnity payments for claims from AY 2011 through March of AY 2023 at development periods from 3 to 72 months for all claims or any combination or medical only and/or indemnity claims. The tool can be used to calculate the percent changes in average payments for each metric across accident years; isolate data for a particular region or an industry; and visualize regional differences displayed on heat maps. Paid medical loss data can be broken out to show average payments for Treatment, Pharmacy, Medical Case Management, Med-Legal expense, and other medical payments. Some examples of the latest findings:

Including COVID claims, average first-year paid indemnity per insured indemnity claim continues to trend up, with the average paid on Q1 2023 claims rising to $3,813 (+0.3% from the AY 2022 average); the average paid on AY 2022 claims at 6 months climbing 7.5% to $6,339; the average paid on AY 2022 claims at 9 months rising 8.5% to $8,457; and the average paid on AY 2022 claims at 12 months jumping 9.1% to $10,430.
Including COVID claims, average paid medical per Q1 2023 insured indemnity claim fell to $3,117, down 1.27% from the AY 2022 level, but average paid medical at other first-year benchmarks rose, as the average paid medical for AY 2022 indemnity claims at 6 months hit $5,382, up 1.0% from the AY 2021 level; average medical payments on the AY 2022 indemnity claims at 9 months increased 7.2% to $7,209; and medical payments on AY 2022 indemnity claims at 12 months averaged $8,777, up 1.6% from the AY 2021 average.
Including COVID claims, total medical plus indemnity payments averaged $19,196 for AY 2022 insured indemnity claims at 12 months, and $29,606 for AY 2021 claims at 24 months. Results, however, varied significantly by industry, with food service workers having the lowest average payments at 12 months ($13,292 for AY 2022 claims) and 24 months $19,876 for AY 2021 claims) while construction workers had the highest average payments; $30,182 at 12 months on AY 2022 claims and $42,942 at 24 months on AY 2021 claims.

The Regional Scorecard: This application updates CWCI’s Regional Scorecard series with data on AY 2010-June 2023 insured and self-insured claims valued through June 2023. Users can engage regional and statewide data on 19 key metrics, compare results from 7 regions, and identify regional and statewide trends. 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. Examples of updated data from the Regional Scorecard:

Statewide, total payments per claim for all AY 2022 insured and self-insured claims, including med-only claims, averaged $8,188, but the amounts ranged from $7,106 for the Central Coast to $9,808 in the N. Counties/Sierra, which had the highest average medical payments in the state ($5,182 vs. $4,096 for L.A. County, which ranked second, and the statewide average of $3,748).

Since the pandemic began in 2020, 36.2% of all insured and self-insured indemnity claims in the state have involved an attorney, but only L.A. County (44.8%) and the Inland Empire/Orange County (41.0%) have exceeded the statewide rate. In contrast, the level of attorney involvement in indemnity claims since 2020 has been lowest in the N. Counties/Sierra (24.5%), the Bay Area (29.9%) and the Central Valley (30.5%).

Statewide, allocated loss adjustment expenses (ALAE) on insured and self-insured indemnity claims since 2020 have averaged $3,095, but once again, only L.A. County ($3,752) and the Inland Empire/Orange County ($3,550) exceeded the state average. Meanwhile, average ALAE on indemnity claims was well below the state average in the N. Counties/Sierra ($2,336); the Central Valley ($2611); and the Bay Area ($2,672).

Medical Services Application: This application contains detailed medical service data on insured and self-insured claims from service years 2016 through June 2023 that allows users to monitor utilization and payment trends for different categories of medical services at different levels of claim development and across key claim characteristics. Examples of findings from the latest update:

Among AY 2022 insured and self-insured indemnity claims, 68.1% involved physical medicine (PM) services within one year of first treatment. These claims averaged 12.9 first-year PM visits and average first-year PM payments of $1,738. At the other end of the treatment spectrum, 15.5% of the AY 2022 indemnity claims had a major surgery within the first year of treatment, resulting in an average of 1.2 paid surgery days and average first-year major surgery payments of $6,428.

Diagnostic data show that 81.0% of indemnity claims for hernias had a major surgery in the first year, followed by claims for joint traumas, diseases, and disorders (48.9%), and arm/shoulder fractures (42.9%).

Average professional medical service and facility fee payments for AY 2022 claims with first-year major surgeries were highest for claims involving diseases and injuries of the eye ($10,008), followed by claims involving shoulder and arm fractures ($9,799), and lower extremity fractures ($7,681). Claims for diseases and injuries of the eye also had the highest average number of days with major surgery services (2.1 days).

The Prescription Drug Application: This application can help identify trends and compare industrywide data on prescriptions dispensed on insured claims between January 2010 and June 2023. 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 the 13-1/2 years ending in June 2023. 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 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 from a menu of specific metrics, the tables and charts automatically display the results, with regional data provided in color-coded heat maps. Examples of recent findings:

The percentage of claims in which opioids are dispensed continues to trend down, with only 2.9% of AY 2022 indemnity claims involving opioids in the first 3 months, 7% of AY 2021 indemnity claims involving opioids in the first 12 months, and 10.4% of AY 2021 claims involving opioids in the first 24 months – all record lows since CWCI began tracking opioid use in AY 2010.

Anti-inflammatories remain the #1 drug category in California workers’ compensation, but since service year 2018 their share of the prescriptions has been flat, ranging between 30.5% and 32.2%. Meanwhile dermatologicals’ share of the prescriptions has grown from 6.8% in 2018 to 12.1% in 2023, surpassing both anticonvulsants and opioids to become the second most prevalent drug category in the system.

In the first half of 2023, dermatologicals surpassed anti-inflammatories to become the #1 drug category in terms of total drug spend, consuming 19.0% of total workers’ comp prescription payments, reflecting the relatively low average cost of the most common anti-inflammatories and the high cost of many of the dermatologicals – especially private label topical medications prescribed for off-label use. The application also reveals that a relatively new dermatological drug, the injectable Dupilumab (Dupixent) used to treat eczema and atopic dermatitis, represented just 0.2% of the dermatological prescriptions in the first half of 2023, but with an average payment of $3,720 per prescription, it consumed 5.9% of the dermatological drug spend for that period.

How to Access the Applications: 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.