Opioid Awareness and Workers Comp Risks with Raji Chadarevian of the NCCI

Aug 20, 2024

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Welcome to RIMScast. Your host is Justin Smulison, Business Content Manager at RIMS, the Risk and Insurance Management Society.

Justin Smulison interviews Raji H. Chadarevian, Executive Director, Actuarial Research , the National Council of Compensation Insurance, or NCCI, about opioid use and related risks for injured workers. Raji and Justin talk about the statistics. The good news is that through the joint efforts of insurers, the NCCI, prescribing physicians, pharmacies, and employers, the utilization of opioids for pain management in injured workers, while appropriate in some cases, has decreased sharply in the last eight years, and continuing efforts to find alternative pain management systems should keep that trend going.

Listen in for more information about recovery awareness, and what your company can do to help injured workers avoid opioid addiction.

Key Takeaways:

[:01] About RIMS.

[:14] RISKWORLD 2025 will take place in Chicago, Illinois from May 4th through May 7th. The call for submissions is now open through August 27th. A link to the submission form is in this episode's show notes.

[:30] Virtual Workshops! Applying and Integrating ERM is back and it will be hosted by Elise Farnham on September 25th and 25th and also on December 4th and 5th.

[:56] On August 29th, Pat Saporito returns to discuss Optimizing Risk Management with Artificial Intelligence.

[1:05] On October 9th and 10th, Chris Hansen returns to deliver Fundamentals of Insurance. Other dates for the Fall and the Winter are available on the virtual workshops calendar at RIMS.org/virtualworkshops.

[1:24] RIMS-CRMP Prep Courses! On September 10th and 11th, the RIMS-CRMP Exam Prep will be held with NAIT. There is another RIMS-CRMP Exam Prep on September 12th and 13th.

[1:38] The next RIMS-CRMP-FED Exam Prep course will be hosted along with George Mason University on December 3rd through 5th, 2024. Links to these courses can be found on the Certification Page of RIMS.org and in this episode's show notes.

[1:53] Events! We've got the DFW RIMS 2024 Fall Conference and Spa Event happening on September 19th in Irving, Texas. Learn more about that event in Episode 299, which features an interview with the Texas State Office of Risk Management.

[2:11] Also on September 19th is the RIMS Chicago Chapter's Chicagoland Risk Forum 2024. Register at ChicagolandRiskForum.org.

[2:21] Registration opened for the RIMS Canada Conference 2024 which will be held from October 6th through the 9th in Vancouver. Visit RIMSCanadaConference.ca to register.

[2:33] Registration is also open for the RIMS Western Regional, which will be held from September 29th through October 1st at the Sun River Resort in Oregon. Register at RIMSWesternRegional.com.

[2:48] We want you to join us in Boston on November 18th and 19th for the RIMS ERM Conference 2024. The agenda is live. The keynote will be announced soon. We want to see you there! A link is in this episode's show notes.

[3:04] The nominations are now open for the RIMS ERM Award of Distinction 2024. Nominations are due August 30th. A link to the nomination form is in this episode's show notes.

[3:16] If you or someone you know manages an ERM program that delivers the goods, we want to hear about it. A link is in this episode's show notes. All RIMS regional conference information can be found on the Events page at RIMS.org.

[3:32] The Interview! With National Recovery Month in September, and National Opioid Awareness Day, September 21st, I wanted to shine a light on opioid addiction and Workers' Compensation claims with new data about opioid abuse and how it impacts the workplace.

[4:05] This is a critical risk and I wanted to speak with someone who can tell the story about the data, so I reached out to Raji Chadarevian, the Executive Director for Actuarial Research at the National Council of Compensation Insurance, or NCCI.

[4:24] He has the insight and perspective on the new data that's being released, so let's hear all about it! Raji Chadarevian, welcome to RIMScast!

[5:03] Raji states that the NCCI celebrated its 100th anniversary in 2023. The mission of NCCI is to help foster a healthy workers' compensation system. It's an advisory agency for 38 states and the District of Columbia, serving as a comprehensive source for all things workers' comp.

[5:47] Raji explains that as an advisory organization, the NCCI provides ratings and statistical advisory insights to the industry, as a whole. It also collects a variety of data.

[6:05] Raji is the Executive Director of Research at NCCI. He tells the story behind the numbers. The brainiacs do the research and help him tell the story.

[6:47] NCCI collects data representing $30 million in workers' comp premium for just under four million policies a year, six million employer risk reports with detailed information about premiums, claims, and 10 million transactions with detailed information on lost-time claims.

[7:17] NCCI collects data on 52 million payments to medical providers for claims every year. The Medical Data Call, where NCCI collects this information, started in 2010. It contains meaningful information to understand the experience of the injured worker throughout the recovery process.

[8:01] Mapping the medical data, NCCI gets to understand the medical services provided, where they are provided, by what provider, and for what purpose. The data provides details of drugs prescribed and where they are dispensed, to understand the use of opioids in workers' comp.

[8:41] Managing pain is a big part of the recovery for workers' comp injuries. Over the years, NCCI has published opioid use for some 40 states where it collects medical data. This data details precise utilization trends, the types of narcotics used, and the frequency of use.

[9:18] The data shows carriers that cover workers' comp for employers are able to compare their experience in any one jurisdiction to statewide trends and act on that intelligence to manage their pharmacy experience.

[9:45] In the last eight years, there has been a huge change in opioid prescribing in workers' comp. We've seen a significant decrease. The NCCI data shows that in the last eight years, opioid use in the year after an injury has decreased from 42% of lost time claims to 16%.

[11:14] Raji notes this is a very important trend. Being addicted to pain medications makes it hard to manage your daily work when that addiction is taking hold. Opioid use is not opioid addiction. Opioid utilization can lead to opioid addiction.

[11:50] There are alternatives to treating pain that have come through with the greater awareness of opioid addiction.

[12:04] It's RIMS plug time! Webinars! On August 27th, Riskonnect returns to discuss How To Successfully Deploy AI in Risk Management. On September 5th, Merrill Herzog debuts on RIMS Webinars with the Role of Insurance in Building Resilience Against an Active Assailant Attack.

[12:26] On September 12th, HUB International returns to deliver the third part of their Ready for Tomorrow series, Pivot and Swerve: Staying Agile During Shifting Market Dynamics.

[12:41] On September 19th, Origami Risk returns to deliver Leveraging Integrated Risk Management For Strategic Advantage. More RIMS Webinars will be announced soon and added to RIMS.org/Webinars. Register there. Registration is always complimentary for RIMS members.

[13:00] The RIMS ERM Conference 2024 will be held November 18th and 19th in Boston, Massachusetts. The agenda is live.

[13:12] The submission process is open for the RIMS ERM Global Award of Distinction. A link to the application is in this episode's show notes. The deadline for submissions is August 30th.

[13:22] So review your organization's ERM program. If you feel it was successful and you have the numbers and the data to back it up, compile that information and get ready to submit your ERM program for the ERM Award of Distinction.

[13:37] Back to the Interview! The use of alternative pain medications has driven opioid utilization coming down from 42% of indemnity claims to about 16% of indemnity claims. If you look at all claims, opioid utilization is about one in 16, as opposed to one in four, 10 years ago.

[14:12] The huge decrease shows a dramatic change in the way the systems are treating the injured workers, in terms of medications provided. When NCCI first tried to address the opioid epidemic in workers' comp, it held interviews with physicians, carriers, and regulators.

[14:50] Workers' comp is a highly regulated system. The regulators had some say in how to manage opioids and other pain prescriptions. There was a meeting of the minds of all stakeholders: those defending the workers, prescribing physicians, carriers, and employers.

[15:30] Opioid addiction was an epidemic that impacted the workers' comp system heavily. The conversations with stakeholders led to important insights on what the system can do to manage this experience.

[15:57] Each carrier told NCCI they were already developing a specific program to manage the prescribing patterns for injured workers. Regulators were very interested in which opioids were being prescribed. Fentanyl used to be in the top 10 but not anymore.

[17:35] The decrease in use was a result of increased awareness across the board, from patients, physicians, claims managers, and employers. Everyone was on board about the seriousness of the opioid situation.

[18:11] We have time for one more break! The Spencer Educational Foundation's goal is to help build a talent pipeline of risk management and insurance professionals. That is achieved, in part, by a collaboration with risk management and insurance educators across the U.S. and Canada.

[18:28] Whether you want to apply for a grant, participate in the Risk Manager on Campus program, or just learn more about Spencer, visit SpencerEd.org.

[18:39] On September 12th, 2024, we look forward to seeing you at the Spencer Funding Their Future Gala at The Cipriani 42nd Street in New York City. Our recent guest from Episode 293, Lilian Vanvieldt-Gray, will be our honoree.

[18:55] Lilian is the Executive Vice President and Chief Diversity, Equity, and Inclusion Officer at Alliant Insurance Services and she will be honored for her valuable contributions to supporting the future of risk management and insurance.

[19:12] That was a great episode, so after you finish this one, please go back and listen to Episode 293.

[19:18] Let's conclude our interview with Raji Chadarevian of the NCCI. Justin notes that the decline in opioid utilization has been observed across all study states and the 10 most common medical conditions.

[19:53] The share of claims with high opioid usage in the first year following an injury has decreased by approximately 85%, reaching an all-time low of two percent, for injuries occurring in 2022. Opioid utilization has started to level off.

[20:17] Utilization at the early stages of the injured worker's recovery increases the likelihood of continued use. Managing the early stage of opioid utilization is important.

[20:57] Physicians have told NCCI that one of the strategies they use is to draw up a contract between the prescribing physician and the injured worker that describes when the opioid utilization is going to decrease and then stop. That is effective in managing expectations.

[21:28] The more opioids you have, the more you want. Having that contract allows the prescribing physician to manage the opioid use over time. That is critical because once a person gets to a certain stage of using opioids, it's very hard to get the person off opioids.

[21:57] Some injured workers return to work while using prescribed opioids and some do not. One side effect of opioid addiction is polypharmacy, an increase of medications being taken, and it becomes very difficult to manage from a medical perspective.

[22:49] The data has shown that if you're able to manage opioid utilization from the beginning, the injured worker's recovery can be managed in a predicted way.

[23:31] Risk managers need to pay great attention to the injured worker where there is opioid use, making sure that injured workers who do get on an opioid have the necessary support from a nurse case manager, along with the physician, looking out for the patient's care.

[24:19] Opioid utilization results in an improved condition over time, so it's tricky to manage. Measuring pain is also very difficult. Raji advises risk managers to make sure they have the right physicians and people assisting with those cases where there is an opioid prescribed.

[24:52] Pay more attention to those folks. If opioid utilization is not well-managed, the consequences can be dramatic. Besides polypharmacy, often the patient is not able to sleep, able to function or go back to work, which becomes a bigger issue.

[25:48] Raji suggests there are multiple ways to make sure your employees are well-educated from a health perspective. Part of wellness is to be educated and understand the impact of opioids, and such. There are programs to supply your employees with that information.

[26:26] HR organizations, workers' comp management, loss control management, and insurers have the tools to help your workers and aid in awareness.

[27:00] It's also important to know that health organizations have training for physicians about opioid addiction and alternative prescriptions for pain management. This coming year, NCCI is looking at alternative pain management techniques like behavioral therapy, and physical therapy.

[27:58] There is also virtual reality treatment that has an impact. The NCCI study will look at what is currently being used to manage pain and what alternative treatments are effective, including cannabis, depending on the state and jurisdiction.

[29:07] The use of virtual reality for treating pain is in training the brain to understand the pain messages coming through that may be associated with trauma. The pain from an injury may be associated with the psychological impact of the trauma. Virtual reality may treat that impact.

[30:19] Raji says that there are some interesting studies taking place now on treating pain with virtual reality, including one at the University of Central Florida.

[30:47] Raji contributed to a series for NCCI on the future of workplace safety technology. Raji found that technology to help with posture and carrying things is important in a warehouse. In workers' comp, there are a lot of lower back injuries that could be avoided with proper posture.

[33:33] Justin hopes to see some unveiling of ergonomic wearable tech at RISKWORLD 2025 in Chicago.

[33:46] The NCCI has an upcoming podcast later in 2024, the NCCI State of the Line Podcast. Raji looks forward to being a regular guest on the show, "if the podcasters are like you, Justin, making the conversation as good as this."

[35:00] Justin thanks Raji for coming on RIMScast to help raise awareness of National Recovery Month and National Opioid Awareness Day and for helping injured workers get the pain management they need and return to work safely.

[35:24] Special thanks again to Raji Chadarevian of the National Council on Compensation Insurance. Lots of NCCI links are in this episode's show notes. Later this year, listen for Raji on the upcoming NCCI State of the Line Podcast.

[35:44] It's RIMS plug time! The RIMS App is available to RIMS members exclusively. Go to the App Store and download the RIMS App with all sorts of RIMS resources and coverage. It's different from the RIMS Events App. Everyone loves the RIMS App!

[36:17] You can sponsor a RIMScast episode for this, our weekly show, or a dedicated episode. Links to sponsored episodes are in our show notes. RIMScast has a global audience of risk and insurance professionals, legal professionals, students, business leaders, C-Suite executives, and more. Let's collaborate and help you reach them! Contact pd@rims.org for more information.

[37:01] Become a RIMS member and get access to the tools, thought leadership, and network you need to succeed. Visit RIMS.org/membership or email membershipdept@RIMS.org for more information.

[37:19] Risk Knowledge is the RIMS searchable content library that provides relevant information for today's risk professionals. Materials include RIMS executive reports, survey findings, contributed articles, industry research, benchmarking data, and more.

[37:35] For the best reporting on the profession of risk management, read Risk Management Magazine at RMMagazine.com. It is written and published by the best minds in risk management. Justin Smulison is the Business Content Manager at RIMS. You can email Justin at Content@RIMS.org.

[37:56] Thank you for your continued support and engagement on social media channels! We appreciate all your kind words. Listen every week! Stay safe!

Mentioned in this Episode:

DFW RIMS 2024 Fall Conference and Spa Event | Sept 19‒20

Chicagoland Risk Forum 2024 — Presented by RIMS Chicago Chapter — Sept. 19, 2024

RIMS Western Regional — Sept 29‒Oct 1, Oregon | Registration is open!

RIMS Canada Conference 2024 — Oct. 6‒9 | Registration is open!

Spencer Educational Foundation — Funding Their Future Gala 2024 | Sept. 12, 2024

RIMS ERM Conference 2024 will be in Boston, MA Nov. 18‒19 | Register Now

RIMS ERM Award of Distinction — Nominations Open Through Aug. 30, 2024!

RISKWORLD 2025 will be in Chicago! May 4‒7

RIMS DEI Council

RIMS-Certified Risk Management Professional (RIMS-CRMP)

RIMS Strategic & Enterprise Risk Center