Communications / Technical Issues / Technical Issue

CWCI Updates Interactive Applications With Data Through June AY 2021

Date: 01/10/2022

Late last week CWCI completed and posted updates to our Claims Monitoring, Regional Scorecard, and Prescription Drug interactive applications, which now feature IRIS data on California workers’ compensation claims through June of AY 2021. These apps 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. Links to the on-line tutorials remain posted below the descriptions of each app 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 claims from AY 2009 through June of AY 2021 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. The latest findings include:

Average indemnity paid on lost-time claims at 12 months increased 8.2% from $9,104 on AY 2019 claims to $9,853 on AY 2020 claims; average paid medical rose 4.4% from $8,528 to $8,905.
Data on indemnity and med-only claims reported for AY 2020 as of 6/30/21 show average paid losses on all claims – including COVID claims – at 12 months of development totaled $7,013, which was up 18.2% compared to the average 12-month loss payments of $5,935 on all AY 2019 reported claims. Average paid medical at 12 months on all claims increased 14.8% from $3,308 for AY 2019 to $3,796 for AY 2020, while average paid indemnity at 12 months increased 22.4% from $2,632 to $3,221.
Industry sector data allow analysis of results for any of 9 specific industry sectors. For example, the latest data show total paid losses at 12 months of development on all claims (med-only and indemnity) in the health care and social assistance sector, which has been hard hit by COVID, averaged $5,374 for AY 2020 claims, up 30.5% from $4,096 for AY 2019 claims. The breakdown by benefit type shows average medical payments on all reported health care/social assistance claims at 12 months rose 25.1% from $2,305 for AY 2019 to $2,884 for AY 2020, while average indemnity payments increased 37.6% from $1,791 to $2,464.

The Regional Scorecard App: This application updates CWCI’s Regional Scorecard series with new data on AY 2009-June 2021 claims valued through June 2021. 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. Updated data from the Regional Scorecard app show:

Statewide, total payments per claim for all AY 2020 claims (med-only and indemnity) averaged $7,882, though the amounts ranged from $6,799 in the Central Valley to $8,683 in the Bay Area. The North Counties, which have a relatively high percentage of lost-time claims, ranked just below the Bay Area in terms of average total payments per claim ($8,594), followed by L.A. County ($8,509) and the Inland Empire/Orange County ($8,231).

In the 8-1/2 years since SB 863 took effect, total claim payments for open and closed indemnity claims statewide averaged $40,638 but have been highest in L.A. County ($43,350), the Inland Empire/Orange County ($42,491); and the Northern Counties/Sierras ($41,470) and lowest in the San Diego ($36,551) and the Central Valley ($36,672).
Statewide, expense payments per indemnity claim over the 8-1/2 year post-reform period were $5,482, but there were only two regions where expenses were above the statewide average: A. County ($6,731) and the Inland Empire/Orange County ($6,236). In contrast average expense payments in the rest of the state ranged between $4,042 in the North Counties and $4,842 on the Central Coast.
Since 2013, 52 percent of indemnity claims statewide have involved an attorney, but again, only L.A. County (62.8%) and the Inland Empire (57.4%) had attorney involvement rates above the statewide average. Among the five other regions, the litigation rate on indemnity claims ranged between 39.4% in the North Counties to 49.9% in San Diego.

The Prescription Drug App: This app can be used to identify trends and compare industrywide data on prescription drugs dispensed between January 2007 and June 2021. 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 June 2021. 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. Among the latest findings:

After declining steadily over the past decade, including the period following the adoption of revised pain treatment guidelines in late 2017 and the MTUS formulary in January 2018, opioid utilization may be leveling off, albeit at a much lower level. The percentage of all claims in which opioids were dispensed in the first year fell from a record 24.6% in AY 2013 to just 4% in AY 2019, but for the first time in 8 years, that percentage rose in AY 2020, edging up to 4.2%.
Anti-inflammatories and opioids each accounted for 24.2% of all California workers’ comp prescriptions dispensed in 2015, but in 2016 anti-inflammatories surpassed opioids as the top therapeutic drug group, accounting for 26.7% of the scripts. By 2020, they were up to 34.9% of all prescriptions – while opioids, which had declined steadily, were down to 11.0% of the scripts. Over that same 6-year pan, anticonvulsants increased from 7.1% to 10.4% of the prescriptions, dermatologicals increased from 4.3% to 8.4% of the scripts, and antidepressants increased from 5.7 to 6.8% of the scripts. Meanwhile, musculoskeletal drugs fell from 10.1% to 5.6% of the prescriptions, and ulcer drugs fell from 7% to 5.8%.
Relatively inexpensive ibuprofen and naproxen accounted for 63.3% of the anti-inflammatories dispensed in the first half of 2021, but extremely expensive Fenoprofen Calcium (average payment per script, $1,672) has become a huge cost driver and the #1 workers’ comp drug in terms of total dollars paid. Fenoprofen Calcium, which increased from 0.5% of the anti-inflammatory scripts in 2018 to 2.6% in the first half of 2021 consumed 47.0% of all anti-inflammatory payments in the first 6 months of 2021, and 10.5% of the total drug spend. Other high-cost drugs that have seen dramatic increases in their share of the total drug spend recently include ketoprofen (average price $1,111 per script) which went from 0.4% of the total drug spend in 2019 to 4.1% in the first half of 2021; lidocaine ($209 per script, 3.4% of the total drug spend) and diclofenac sodium topical ($78 per script, 3.2% of prescription dollars in the first half of 2021).

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 latest data.