CWCI's Claims Monitoring, Pharmaceutical, and Regional Scorecard Interactive Tools Updated Through AY 2019

The Institute has completed updates to our Claims Monitoring, Regional Scorecard, and Prescription Drug interactive applications, using IRIS data on claims through AY 2019.  CWCI members who log on to our website (www.cwci.org) with their user name and password can access each of these updated applications from the drop down menu under the Research tab on our home page.  The applications provide detailed data that can be used to examine and compare industry data on key metrics as noted below.  In addition, the on-line tutorials posted along with each of the applications and our earlier Interactive Research Reports (Claim Monitoring, 9/29/17; Regional Scorecard, 10/11/17, and Prescription Drug, 4/25/18) remain available in the Research section of our website to help guide users.

The Prescription Drug Application: This tool can be used to identify trends and compare industrywide data on pharmaceuticals dispensed to California injured workers between January 2007 and December 2019.  The app includes claim level data so users can examine prescription drug utilization by accident year at different levels of development, and service-level data based on prescription drugs dispensed within each calendar year.  A series of dashboards allow users to build custom views of statewide or regional prescription drug data for all claims or just indemnity claims, while 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; by opioid drug name; for generic and/or brand drugs; for specific industries; and for specific accident years or service years.  As users choose specific metrics to view, the accompanying tables and graphics automatically change to display the results, with regional data provided in color-coded heat maps.  The Interactive Research Reports can be used to review the types of data in each dashboard and to demonstrate options for generating customized views and screenshots of the data and exhibits available.  Some examples of recent findings:  

• Opioids were dispensed w/in the first 3 months of development in 20.2% of all 2014 claims (M-O + Indemnity) but following the adoption of the MTUS prescription drug formulary and pain treatment guidelines that proportion has dropped steadily, falling to just 2.5% of all 2019 claims.
• Anti-inflammatories surpassed opioids as the #1 drug category in California workers’ comp in 2015, and the latest data show they accounted for more than 1/3 of all prescriptions dispensed to injured workers in 2019 – nearly 3 times the proportion noted for opioids, which accounted for 11.9% of prescriptions last year, making them the 2^nd most common WC drug category, just ahead of anticonvulsants in terms of volume.  
• Anticonvulsants are dominated by 2 drugs: gabapentin and pregabalin, which accounted for nearly 90% of all anticonvulsants dispensed in 2019. Generic gabapentin has been widely available for some time, but until last July, pregabalin was only available as a brand drug (Lyrica).  Nevertheless, the new data show the introduction of 9 generic versions of pregabalin in the 2nd half of last year did impact the market and yield savings, as 35% of the pregabalin dispensed last year was generic, at an average cost of $372 vs. $587 for the brand drug.   
• Payments for dermatologicals have averaged $295 per prescription since 2014 – far higher than any other class of drugs. Much of this cost has been driven by topical dermatologicals which are marketed by private labelers.  These contain high concentrations of ingredients that are available OTC and are marketed with catchy names at inflated costs.  Diclofenac sodium topicals are prime examples.  The Prescription Drug App shows that since 2014, diclofenac sodium topicals’ share of all dermatologicals dispensed in Calif WC has quadrupled from 13.1% to 51.4%, and its share of dermatological dollars has increased fivefold, climbing from 4.2% in 2014 to 20% in 2019. 

The Claims Monitoring Tool: This application can be used to determine industrywide trends for average paid indemnity, average paid medical (with MCC), and combined medical and indemnity payments for AY  2008-2019 claims at development periods from 3 to 72 months for either 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, DME/Pharmacy, Medical Cost Containment and Med-Legal expense.  Among the recent findings:   

• Average medical payments (including MCC) on all claims (including M-Os) at 3 months have increased steadily since bottoming out in AY 2012, climbing from $1,328 to $1,555 in AY 2019 (+17.1% over 7 years). At the same time, average medical losses on all claims at 12 months fluctuated, though 1st-year payments on AY 2018 claims (the latest year for which 12-month data is available) averaged $3,533, still 3% below the $3,644 level noted for AY 2012 claims.
• Comparing average indemnity payments within the first year on lost-time claims from AY 2018 and AY 2019 shows average indemnity increased 8.2% at the 3-month benchmark, 6.0% at the 6-month benchmark, and 5.1% at the 9-month benchmark. The most recent data on 1^st year indemnity payments shows the average indemnity paid on lost-time claims at 12 months post injury increased from $8,225 on AY 2017 claims to $8,443 on AY 2018 claims (+2.7%).
• Paid losses on all (med-only + indemnity) claims in the construction sector at 6 months post injury averaged $6,581 in AY 2019, with indemnity payments accounting for just under $2,600 (or about 40%) of that total, and medical with medical cost containment accounting for $3,981. The medical cost breakdown shows med-legal payments accounted for 1.3% of the medical payments at 6 months, pharmacy/DME accounted for 1.7%; medical treatment represented 86.6% and medical cost containment comprised 10.4%. In contrast, paid losses at 6 months on AY 2019 claims from all industries averaged $3,736, with indemnity payments averaging $1,392 (37.3% of the total) and medical with medical cost containments averaging $2,343.

The Regional Scorecard Application: This application updates data originally published in CWCI’s Regional Scorecard series with new data on AY 2008-2019 claims valued through December 2019.  Users can view regional and statewide data on 19 key metrics, compare results from 8 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:   

• Despite differences in industry mix, demographics, attorney involvement, and claim closure rates, average paid benefits for open and closed indemnity claims in the Bay Area, L.A. County, the Inland Empire/Orange County; and the No. Counties/Sierras for the most recent 5-year period (AY 2015-2019) measured through December 2019 were nearly identical ($31,177 in the Inland Empire/Orange County; $31,176 in the No. Counties/Sierras; $31,050 for the Bay Area, $31,017 for L.A. County). A. County, however had the state’s highest average expense costs per indemnity claim ($4,063) vs. $3,524 in the Inland Empire/Orange County; $2,219 in the Bay Area; and $1,759 in the No. Counties/Sierras.    
• The average number of paid TD days on AY 2015-2019 indemnity claims statewide was 63, but results ranged from 57 days in Los Angeles County to 82 days in the No. Counties/Sierras.
• Among AY 2019 indemnity claimants statewide, average job tenure at the time of injury was 5.0 years, but in L.A. County it was 6.2 years and in the Bay Area it was 6.0 years. A. County had the highest level of attorney involvement (42.1% of AY 2019 indemnity claimants from L.A. were represented vs. 23.1% of Bay Area claimants and 31.0% of indemnity claimants statewide). 

How to Access the Applications

To access the updated interactive data apps, log on to our website (www.cwci.org) with your user name 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 dropdown menu under the Research tab and click Interactive Research Tools, then scroll down and click on the app you want to open.  When new data becomes available, CWCI automatically updates the apps to provide the most current data available.