Dealing with changing demographics

As workers get older and larger, the workers comp formularies may have to change

By Dennis H. Pillsbury

Two important demographic shifts are having a profound impact on workers compensation—the aging of the workforce and the increased weight of the workforce. The former presents a mixed picture:

On the upside, older workers tend to suffer fewer injuries on the job. That's because our experience (Yes, I am an older worker—or at least I'm older.) helps us avoid injury-causing activities, according to some experts. Or, as Richard Pimentel quipped at an NCCI meeting, "It's because we can't friggin' move."

On the downside, when older workers do get hurt, we often take longer to heal. In the most serious cases, complications—exacerbated by diseases that affect older individuals (diabetes, hypertension, and high cholesterol)—can result in a long healing process or even permanent disability with no possibility of a return to work.

And the workforce is getting older. In fact, Jim Andrews, R.Ph., senior vice president of pharmacy services for Cypress Care, points out that "24% of the workforce will be 55 or older by 2013, according to the Bureau of Labor Statistics."

So what's an employer to do? Get rid of us old guys and just hire young, less experienced workers? That could mean more injuries, since younger workers tend to work faster and less carefully. That speed also can result in the work being done in a less-than-satisfactory manner, especially if there are no experienced workers there to "learn them the ropes."

So it looks like you're better off with us old guys.

The second demographic change has no up side. Jim Andrews points out that obese workers have 45% more claims and eight times more loss work days, according to a study by Duke University. Unfortunately, that's not the end of the bad news. The number of obese Americans has steadily increased to reach 33.8% of U.S. adults in 2010, according to data compiled by the Centers for Disease Control and Prevention. And the problem has been growing at a rapid rate. At the turn of the century, no state had an obesity prevalence of 30% or more. Today, there are 10 states where the obesity rate is higher than 30%.

And just as was the case with older workers, obese workers who are injured on the job take longer to heal, often for many of the same reasons cited above—diabetes, hypertension, and high cholesterol.

Then how do you and your workers comp insurer respond in the best way to deal with these risks? Your insurer certainly can't use the unpopular method of simply raising rates in today's soft and competitive market. And that's certainly not a long-term solution to a problem that will be with us for a long time to come.

Think outside the box

Cypress Care recently completed its first pharmacy drug trends study, and the results provide some interesting insights into how the changing demographics have impacted which drugs are being prescribed and what that means for workers comp insurers. (To request a copy of the 2011 Drug Trends Report, visit www.cypresscare.com/contact.htm.)

One of the more interesting findings is that a number of drugs being prescribed are not used to treat the actual injury but to counteract conditions—such as diabetes, high blood pressure and/or high cholesterol—that could slow recovery. "This is probably one of the most important findings," says Nancy Hamlet, senior vice president of marketing for Healthcare Solutions, parent company of Cypress Care. "A lot of these drugs are not included in the workers comp formulary, but companies are starting to realize that they may need to provide them for successful return to work. This certainly represents a paradigm shift in the way workers comp insurers handle claims involving older workers."

The study found a 26.3% increase in utilization and a 1.6% increase in spending for drugs used to treat high cholesterol, blood pressure, and blood sugar. "Medications within the therapeutic classes of lipotropics, hypotensives, cardiovascular preps, and diabetic therapy are used to address these conditions," the study pointed out. The study found that these therapies combined to contribute 3.5% of the overall spending of workers compensation insurers included in the study for drugs in 2010. There also was an increase in the percentage of workers utilizing these classes of drugs from 3.2% to 4.3%. "The average age of injured workers utilizing these medications in 2010 was 58.5 years, 10 years greater than the average injured worker's age across all classes of medication," the study noted.

Wellness is key

Jim Andrews goes on to point out that drug therapy is just part of the solution. "While these medications help to mitigate the effects of these chronic conditions, modifying drug treatment plans to accommodate the potential approval of these drugs is only the first step. There also needs to be a shift in the way that workers comp insurers handle workers from simply paying claims to emphasizing wellness in a way that takes into account the changing demographics."

He continues by noting that "the types of exercise change as aging comes around, as well as recognition that obese individuals put greater strain on joints, making some exercise programs problematic. How does that translate when setting up a wellness program? Employers will need to look at the demographics of their workforce and institute appropriate exercise opportunities."

Medications also need to be looked at more carefully. "Dosing may need to change if an individual is obese," Jim says.

Another change that has emerged in recent years is "people just want a pill to take care of their problems," he points out. And this can lead to dependency in some cases. In fact, the study found that narcotic analgesics continue to be the most utilized class of medications in Cypress Care's population. The study points out that "the use of narcotics to treat chronic non-cancer pain is controversial; however, when used with appropriate supervision and monitoring, it has proven to be an effective standard of care." Overall, workers comp insurers spent 38.5% of total medication spending on this class and it represented 34.7% of utilization.

Not surprisingly, the problem of dependence increases as the claim ages. The study found that "the potency of narcotic analgesics, measured in morphine equivalents, trends steadily as the claim ages up to services year 12 where it plateaus just short of 120 morphine equivalents per day. It is commonly accepted that the 120 morphine equivalents per day threshold signifies when therapy may become ineffective and unsafe."

The data would certainly indicate that at least some of the patients may have become dependent and in need of drug therapy. However, Jim points out, "There is a dearth of programs for drug dependency recovery. We are currently working to get in front of this." He adds that, unlike previous decades where illegal drugs fueled dependencies, "most addiction problems come out of the medicine cabinet today."

And Jim points out that a recent court decision makes it clear that ignoring the trend is not really an option for employers. In Renner v. AT&T, the Superior Court of New Jersey upheld an appeal from a workers comp judge's ruling that found a worker's death was compensable because her job was sedentary and her inactivity at work was an appreciable factor in causing her death.

So sitting back and doing nothing is a poor option for a variety of reasons. Agents have an opportunity to help their clients work toward changing the paradigm and lowering their workers comp and group health costs in the process.

Healthcare Solutions is the parent company of Cypress Care. Please visit www.healthcaresolutions.com or www.cypresscare.com for more information.