CWCI Updates 4 Interactive Applications with Data Through 12/31/22

Earlier this month CWCI posted updates to our Claims Monitoring, Medical Services, Regional Scorecard, and Prescription Drug applications, which now feature IRIS data on claims valued as of 12/31/22.  The apps are available to CWCI members who log on to 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 App allows users to examine industrywide trends for average paid indemnity, average paid medical, and combined medical and indemnity payments for claims from AY 2009 through AY 2022, at development periods from 3 to 72 months, for all claims or just indemnity claims.  The application 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.  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: 

• Average medical payments at 24 months on indemnity claims (including COVID claims) increased in recent years, with the new 24-month data on 2020 claims showing average medical rose 6.2% to $14,405, the highest level in at least a dozen years. However, early data on 2021 indemnity claims at 12 months shows average medical fell 2.9% from $8,908 to $8,646, the first decrease in 6 years.
• Average paid indemnity on indemnity claims (including COVID claims) which climbed steadily at the 3-, 6-, 9-, and 12-months of development, increased 4.1% at the 24-month benchmark between AY 2019 and 2020, increasing to $15,827. This followed a 10.9% increase between AY 2018 and 2019. 
• Excluding COVID claims, at 24 months average paid medical on indemnity claims rose 6.8% from $13,560 in 2019 to $14,482 in 2020.

The Medical Services App contains medical service data for claims with 2012-2022 initial treatment dates, valued as of 12/31/22.  It allows users to monitor utilization and payment trends for medical service categories at various levels of development and across key claim characteristics.  Examples of the latest findings: 

• The average number of E&M and Physical Medicine visits per indemnity claim in the 1st year of treatment remains below 2012 levels (when SB 863 was enacted) but with the adoption of the RBRVS fee schedule and other reforms, the average paid per indemnity claim for 1st-year E&M visits has increased from $1,124 in 2012 to $1,475 in 2022 (+31.2%) and the average paid for 1st-year Physical Medicine has grown from $1,267 to $1,722 (+35.9%). 
• The N. Counties/Sierras had the highest proportion of indemnity claims with Major Surgery in the first year of service, (24.5% in 2021) but the lowest proportion of indemnity claims with Physical Medicine (59.3%). A. County had the greatest percentage of indemnity claims with 1st-year Physical Medicine (72.3%), followed by San Diego (72.0%) and the Inland Empire/Orange Co. (70.0%). 
• The Bay Area, L.A. County, and the Central Coast had the lowest proportion of indemnity claims with Major Surgery within 12 months: 1%, 17.3%, and 18.4% respectively.  Average payments (professional fees + facility payments) for 1st-year Major Surgery on indemnity claims in 2021 were highest for claims from the N. Counties/Sierras ($7,706) and out-of-state (7,232), and lowest for claims from San Diego ($5,466), Inland Empire/Orange Co. ($5,619) and L.A. County ($5,704). 

The Regional Scorecard App offers new data on AY 2008-2022 claims valued through 12/31/22.  Users can view regional and statewide data on 19 metrics, compare results from 7 regions, and identify regional and statewide trends.  The app shows average medical, indemnity and other payments (with breakdowns of average TD and PD, allocated loss adjustment expense, and demographics, claim status, and claim volume.  Users may also drill down to view results by injury year and industry.  Examples of the latest Regional Scorecard data: 

• Initial data on AY 2022 indemnity claims show that statewide benefit payments averaged $12,420, (43% medical, 57% indemnity). Results ranged from $10,686 on the Central Coast, which had the 2^nd lowest medical payments behind the Central Valley and the 2nd lowest indemnity payments behind San Diego, to $17,008 in the N. Counties/Sierra, where paid medical averaged $9,289, 74% above the state average.  In L.A., paid losses on 2022 indemnity claims averaged $13,248, 6.7% above the state average, as both paid medical and indemnity exceeded the state average, while the Bay Area’s average paid loss was only 3.8% above the state average as lower medical payments largely offset higher indemnity.  
• Since 2018, L.A. County has accounted for 24% of all claims in the state, 26% of indemnity claims, and 27.6% of total claim payments. The Central Valley has ranked second with 20.9% of all claims, 19.5% of indemnity claims, but it has had only 17.6% of claim payments; the Inland Empire/Orange Co. has had 19.2% of all claims, 19.5% of indemnity claims and 19.8% of claim payments; and the Bay Area has had 18.0% of all claims and indemnity claims, and 18.6% of claim payments. 
• For the 5-year period ending in December 2022, 43% of indemnity claims statewide involved an attorney. Attorney involvement was highest in L.A. County (53.8%) and the Inland Empire/Orange Co. (48.2%), but was below the statewide rate in San Diego (40.5%) and the Central Coast (40.2%). The attorney involvement rate during this 5-year span was lowest in the No. Counties/Sierras (30.2%), the Bay Area (35.1%), and the Central Valley (36.2%).    

The Prescription Drug App can help identify trends and compare industrywide data on prescriptions filled between January 2010 and December 2022.  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 drugs dispensed during the 13-year period ending in December 2022.  Dashboards allow users to build custom views of statewide or regional pharmaceutical data for all claims or indemnity claims, and global selection settings and drop down menus allow them 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 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 with first-year opioid prescriptions fell from 24.3% in 2013 to 2.7% in 2021, but since Opioid/Pain Management Guidelines were adopted and the Formulary took effect in 2018, other first-year opioid utilization metrics (prescription/user, morphine equivalents/prescription, and morphine equivalents/user) stabilized. Buprenorphine, used to treat opioid use disorder, has been the fastest growing opioid, increasing from 0.5% of opioid prescriptions in 2010 to 5.1% in 2022.   

• Results vary by drug group, but from 2010 to 2017, average prescription payments across all drug groups were highest in L.A. County ($120). Since 2018, however, L.A. County’s average has dropped to $84, and is now 3rd lowest in the state behind the Inland Empire ($80) and San Diego ($75). 
• Dermatologicals surpassed anticonvulsants to become the second most heavily used drug group last year (behind anti-inflammatories) with 10.2% of the prescriptions. Dermatological prescription payments averaged $140 in 2022, with lidocaine (average $184) representing 27.6% of the dermatological dollars, followed by diclofenac sodium topicals (average $52) which consumed 21.4% of the payments, and diclofenac epolamine (average $549) accounting for 7.7% of the payments.  Low-volume/high-priced dermatologicals that consumed a disproportionate share of the dermatological payments included lidocaine-menthol ($880); methyl salicylate-lidocaine-menthol ($1,935); and, once again, non-FDA approved Xyrlix kits containing a diclofenac sodium solution & adhesive sheet ($4,124).     

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.