Opioid infographic illustrates BWC’s success, pharmacy leadership

Document’s release coincides with director’s retirement

By Nick Trego, Clinical Operations Manager, Pharmacy Department

Click on infographic  for larger image.

BWC’s communications department recently completed an infographic summarizing our work over the last six years to rein in excessive opioid prescriptions and the dangers they pose to injured workers, namely abuse, addiction and death.

Using a mix of colors, illustrations and statistics, the infographic is a roadmap of the steps we’ve taken to reduce the number of injured workers dependent on opioids from 8,029 in 2011 to 4,101 in 2016, a near 50 percent drop.

It’s called “Saving Lives — BWC battles the opioid crisis.” A better title might be, “Saving Lives — a tribute to John Hanna.”

Hanna, our pharmacy director, retires Sept. 29 after eight years in the job. More than anyone, it is John who is responsible for the achievements highlighted in the infographic, as well as for other pharmacy program reforms we’ve implemented to protect injured workers.  Along the way, with the backing of BWC leadership, he also built a pharmacy department that is a model in the work comp industry today.

When John arrived at BWC in 2009, we had no real pharmacy department to speak of. It was essentially a mix of disparate services shared by various personnel in service offices throughout the state. We had no formulary, no clinical review committees. Controls and best practices were low. Costs and drug utilization were high. For a system that experienced more than 100,000 new injured workers a year, we had to do better.

What followed over the next several years were a series of improvements to reduce inappropriate prescribing of opioids and other dangerous drugs. We created a Pharmacy & Therapeutics Committee of six physicians and six pharmacists to provide recommendations on all medication-related policy. We created the first work-comp-specific closed formulary in the nation. We stopped coverage of any new opioid formulation until it was reviewed by our P&T Committee. And in 2016, we implemented a rule that requires providers to use a set of best practice guidelines when prescribing opioids. If they don’t follow those guidelines, they risk losing their BWC certification.

To further demonstrate our commitment, we offer injured workers who meet specific criteria up to 18 months of paid recovery services if the treatment for their workplace injury leads to an opioid addiction.

In other enhancements, we developed an automated program that flags claimants with high-risk medication regimens. We implemented “electronic edits” that require all drugs in medical-only claims to have a prior authorization to continue to be covered past 60 days. The same goes for workers who’ve had no claim activity for 270 days. We became the first state agency to cover naloxone products, as well as the first state agency to add Abuse Deterrent Formulations of opioids as a choice for prescribers. And earlier this year, our board of directors approved a rule restricting first prescriptions for opioids to seven days or 30 doses.

Our work has garnered local and national media attention, and work comp programs across the country are calling us, wanting to mirror our success. Topping it off, we wound up saving our agency money. That’s right, I said “saving.” For every dollar we spent on reforms, 50 came back to us in savings. All told, our department spends nearly $49.6 million less on medications today than we did in 2011.

Not that any of this was cost-driven. John always told us, “If we implement best clinical practices, the savings will follow.”

Earlier this year, Gov. Kasich recognized John for his efforts, awarding him the Governor’s Award for Employee Excellence. The industry has recognized his efforts, too. Just last month, the International Association of Industrial Accident Boards and Commissions named John and our team winners of its 2017 Innovation Award.

None of this was easy, but John kept us focused on one guiding principal: “Do what’s best for the injured worker. That’s why we’re here.”

Thanks, John.

Click here for more on BWC’s efforts on the opioid front.

 

Motivation equals success

By Jim Landon, RN, and Mukesh Kumar Singh, CFE, LLM, MBA, BWC Compliance & Performance Management

In any workers’ compensation claim, motivation is always a key factor in not only the rehabilitation of the injured worker but for a successful return to work.

While this holds true in any industrial injury claim, it’s particularly true for catastrophic injuries that result in an amputation. When an injured worker suffers an amputation injury, not only are they faced with physical hurdles to overcome but also the challenge of regaining their self-esteem.

Obtainable goals, collaboration
Injured workers who suffer an amputation must learn to adapt both physically and mentally to return to a state of normalcy post-injury. Without motivation and obtainable goals, the injured worker will quite often ultimately fail. However, for an injured worker to be motivated it is crucial they have a strong support system. This system should consist of a positive collaboration between family members, the employer, providers, as well as BWC and the managed care organization (MCO) for ultimate success.

A key to this success is fitting the injured worker with the correct prosthesis as soon as he or she is medically stable to do so. The philosophy of this is well proven. There is only a limited window of opportunity in sustaining the motivation factor for the injured worker before frustration and poor self-esteem set in. If this does not occur, a successful return-to-work and the return to a normal life are unlikely.

The process of fitting the injured worker with the correct prosthesis follows a very simple logic. In choosing the proper device it need not be high tech or low tech, but the right tech.  The choice should be fitting a device that provides optimal function and gives the injured worker the best chance of not only returning to gainful employment but to a pre-injury quality of life.

Support + motivation = success
We must remember that behind every claim number is a person that is more than likely going through the worst period of their life, and they need collaborative support. Support provides motivation.  Motivation equals success.

We saw this recently when we participated with Ryan Nagy, an injured Middleburg Heights police officer, in the Wounded Heroes’ Trek of Hope. Together, we trekked the Annapurna circuit in Nepal.

Ryan’s successful return to work and a normal life following his above-the-knee amputation is a testament to teamwork along with BWC and finding ability in disability with a courageous attitude. His motivation, goal setting, collaboration and a strong support system at home and at work made the difference. Learn more about Ryan’s story by viewing this video.

Continuing the workers’ comp conversation

By Kendra DePaul, BWC Other States Coverage Manager

Oklahoma: home to Will Rogers, Route 66 and CompSource Mutual Insurance Company – host of the 2017 Annual Conference of the American Association of State Compensation Insurance Funds (AASCIF). AASCIF is an association of workers’ compensation state funds from 26 different states, plus 8 workers’ compensation boards in Canada.

The conference was held in Oklahoma City in late June and hundreds of attendees gathered from around the country to discuss hot topics in the workers’ comp industry.

As was mentioned in a previous post, three BWC employees are members of AASCIF’s committees tasked with planning session topic and finding speakers for the annual conference. Michael Rienerth, Ergonomics Technical Advisor is on the Safety and Health Committee. Bill Teets, Communications Director is on the Communications Committee and I am on the Enterprise Risk Management and Underwriting Committee.

Along with planning sessions, committee members were also asked to share their knowledge and experience at track sessions at this year’s conference. Mike presented on violence in the workplace. Bill presented on crisis communication and the strategy of thought leadership. And I presented on state to state coverage conundrums.

Shadya Yazback, our Chief of Enterprise Services, also presented a session on preparing the business for large scale IT changes.

Additional sessions were held on the use of predictive analytics, the state of the economic, emerging technologies, telemedicine, and other topics affecting the industry as a whole.

Two of the main session speakers, Richard A. Clarke, Former National Security Advisor and Frank Abagnale, American Security Advisor (you may know him from the movie Catch Me If You Can), discussed the importance of safeguarding our personal information and the constant threat of cyber security.

We also heard the inspiring story of an Oklahoma City Bombing survivor and the friendship that developed with her rescuer. The story reinforced the amazing capacity of people to heal from wounds (both physical and metal) and the important role of the people who support them through their recovery.

In addition to the speakers, AASCIF holds an annual Communication Awards competition. I am happy to report that BWC won two awards this year. We received 2nd place in the Excellence in the Writing category for the “Trek through Nepal” article. And we won 1st place in the Print Marketing Piece category for a marketing piece we created for Other States Coverage. Working with the communications department, we targeted our marketing to a specific group of employers based on their size and the type of work they do. The marketing piece generated several inquires and we ended up issuing three policies, meaning we received a return on our investment.

As always, the conference was a whirlwind of activities. In addition to educational sessions, we spent time getting to know members of the other states workers’ comp funds, discussing ways to improve our operations and even having a little fun. Since we were in Oklahoma, we couldn’t close the trip without experiencing a rodeo and visiting the National Cowboy and Western Heritage Museum. Yee Haw!

BWC nurses help provide quality, holistic care for Ohio’s injured workers

By Mary Charney, BWC Director of Nursing

Nursing: The Balance of Mind, Body and Spirit. That’s the theme for National Nurses Week that runs this week until Friday, May 12. This year’s holistic theme also reflects BWC’s approach to caring for Ohio’s injured workers.

BWC’s 58 nurses work in a variety of areas, from medical policy and employee health to rehabilitation, claims management and clinical advisement.

They help Ohio’s injured workers and each of us remember to balance our lives — our mind, body and spirit — for total wellness.

National Nurses Week is a good time for all of us to appreciate nurses and thank them for what they do. Take time to remember the last time you talked with a nurse and how that nurse helped you. Nurses make a difference in our health care journey throughout life.

Nursing is the largest of all health care professions, according to the American Nurses Association (ANA), which declared 2017 to be the Year of the Healthy Nurse. Accordingly, the association is encouraging nurses to be healthy role models for the rest of us.

In its Healthy Nurse, Healthy Nation™ Grand Challenge, the ANA states thatNurses, at 3.6 million strong and the most trusted profession, have the power to make a difference! By choosing nutritious foods and an active lifestyle, managing stress, living tobacco-free, getting preventive immunizations and screenings, and choosing protective measures such as wearing sunscreen and bicycle helmets, nurses can set an example on how to BE healthy.”

For more information on National Nurses Week, visit the American Nursing Association’s National Nurses’ Week website. Again, thank you to our nurses!

Provider perspective: Ohio Workers’ Compensation Medical & Health Symposium in photos

We did not think it was possible – the second year was better than the first for the Ohio Workers’ Compensation Medical & Health Symposium. We increased participation with a capacity crowd of more than 400+ health-care providers.

Thank you!

We appreciate everyone who joined us for our two-day event held last week in conjunction with the Ohio Safety Congress & Expo at the Hyatt Columbus. You share our joint passion for the comprehensive care of Ohio’s injured workers.

A special thanks to the symposium’s exceptional speakers, exhibitors and participants as well as our Medical & Health Division for leading this unique, multi-disciplinary event at no cost to participants.

For ongoing learning, Ohio’s providers took advantage of continuing education opportunities designed for chiropractors, nurses, occupational and physical therapists, pharmacists, physicians, psychologists, rehabilitation counselors and case managers.

What was new this year?

In 2017 our annual symposium featured an exhibit area with 13 exhibitors who help care for Ohio’s injured workers. The exhibitors ranged from prosthetic suppliers and health-care associations to inpatient and outpatient rehabilitation facilities. In addition, we added continuing education for occupational and physical therapists, pharmacists and psychologists.

We continue to include state, national and international experts for our symposium sessions detailing best practices in caring for Ohio’s injured workers. And, we are overwhelmed by the positive comments we are receiving from symposium participants.

Now as we look forward to 2018, experience the symposium by reviewing highlights from 2017.

#BWCmhs exhibitors ready to see providers at med & health symposium!

Between sessions exhibitors visited with #BWCmhs providers.

An association exhibitor was available to answer questions about a safe medicine and responsible treatment program for providers’ patients.

Dr. Matthew Levy (center), orthopedic surgeon at Cleveland’s St. Vincent Charity Hospital answers questions after presenting Periarticular Injuries of the Lower Extremity.

Providers waiting in line to ask Dr. Atchison questions after the first session. He is a medical director for the Rehabilitation Institute of Chicago who presented on managing pain and return to work early.

mhs providers in line

Dr. Ali Rezai, Director of the Neurological Institute at OSU Wexner Medical Center (center) talking with attendees after his session on Neuromodulation Advances for the Management of Chronic Disease.

Dr. William Marras, Director of OSU Spine Research Institute (left) pictured below with BWC’s Dr. Stephen Woods. Dr. Marras presented study results on the clinical lumbar motion monitor.

Dr. Nicholas U. Ahn, orthopaedic surgeon, University Hospitals of Cleveland, reviewed a recent discography study in the last session. He presented another study that examines workers’ comp patients with nonorganic pain.

Attendees on break between sessions.

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Kevin T. Glennon, vice president of clinical services for One Call Care Management in Jacksonville, Florida. Glennon spoke about the work comp challenges of the aging workforce. Read a detailed blog about his presentation here.

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Dr. Susan K. Blank, co-founder and chief medical officer for The Atlanta Healing Center, an outpatient treatment recovery program. Dr. Blank spoke about addiction and misuse of controlled substances. Read more in our blog Wired for addiction.

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Dr. Richard W. Rosenquist, M.D., chair of the pain management department at the Cleveland Clinic, addressing the transition from acute to chronic pain.

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BWC’s Dr. Brian Wilson, DC, introduces Dr. Robin A. Hunter, DC., who presented on approaches to non-opioid treatment options.

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Phil LeFevre, senior vice president of business development for the Work Loss Data Institute LLC in Austin, Texas greets a seminar participant. He presented on using the Official Disability Guidelines for evidence-based care management.

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Gerald Steiman, M.D., a practicing physician at Steiman Neurology Group in Columbus.He delivered a presentation on concussions.

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Attendees also heard from Dr. Michael Coupland, a registered psychologist who spoke about pain in his presentation, The Psycho Neurobiology of Pain: Up Pain, Down Pain, Good Brain, Bad Brain. Check out the BWC Blog here for a review of his presentation.

See you next year!

Coping with pain

‘Visualize your way out of it,’ psychologist tells work comp audience

By Tony Gottschlich, BWC Public Information Officer

There’s another way to deal with chronic pain that doesn’t involve medications or surgery, a psychologist told an audience Friday at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

It’s called Cognitive Behavioral Therapy, and it’s not as complicated as it sounds. In fact, the techniques are rather simple, said Michael Coupland, medical director for Integrated Medical Case Solutions in West Palm Beach, Florida.

Cognitive Behavioral Therapy (CBT) is a widely accepted form of psychotherapy that is based on the cognitive model: the way that individuals perceive a situation is more closely connected to their reaction than the situation itself.

Coupland explained that we can condition our brains to control pain or banish it from our consciousness. But it takes practice, a daily repetition of mantras, deep breathing techniques, meditation and other mindfulness methods for it to take root and stick.

Thanks to neuroplasticity, the brain can reorganize or rewire itself, both physically and functionally, throughout your life in response to your environment, behavior, thinking and emotions.

“Exercise your neurons, visualize your way out of this,” he said. “I tell my patients, ‘Whether you believe in this or not, just humor me and do this every day for eight weeks.’ These techniques help stand down the body’s stress-arousal system.”

Coupland admitted it’s tough for most patients to accept this approach. Mindfulness, a state of active, open awareness of the present moment, and meditation are about “letting go,” but the American educational system teaches us to “hold on” to everything we learn.

Coupland shared with the audience a book he authored in the style of Dr. Seuss that illustrates the simplicity and effectiveness of CBT. It’s titled, “Up Pain, Down Pain, Good Brain, Bad Brain,” and can be found for free here.

For more on Coupland and his work, visit www.icms.us or www.cope-with-pain.com.

‘Wired for addiction’

Addiction specialist addresses work comp health symposium

By Tony Gottschlich, BWC Public Information Officer

Many believe drug addicts are weak-willed people of diminished moral character who choose drugs, getting high and even criminal behavior over a proper, law-abiding life.

And they would be wrong, a longtime psychiatrist and addiction specialist said Friday morning at the 2017 Ohio Workers’ Compensation Medical & Health Symposium.

“Addiction is not about the drugs or the behavior, it’s all about the brain,” said Dr. Susan K. Blank, co-founder and chief medical officer for The Atlanta Healing Center, an outpatient treatment recovery program. “This is a genetically inherited brain disease.”

Blank, speaking to a capacity audience at the Greater Columbus Convention Center, spoke for an hour on the topic, “The Perfect Storm: Pathophysiology of Controlled Substance Misuse and Addiction.” Her presentation was the first continuing education session on the final day of the two-day symposium for health care professionals.

Blank explained there are three key forces behind addiction, and choice has little, if anything, to do with it. They include:

  • Genetics. Our brains are hardwired for addiction because of our genes. Some of us inherit malfunctioning “dopamine feedback loops.” When we experience pleasure, whether from food, drugs or sex, it’s because our brains are releasing the feel-good neurotransmitter dopamine. In addicts, that feedback mechanism doesn’t shut down and they just want more and more, regardless of the consequences. “It’s never enough,” Blank said. This is particularly hard to overcome if the addiction started in one’s youth. That’s because drug and alcohol abuse can damage the prefrontal cortex, our brain’s impulse-control center, which is still developing into our mid 20s.

Worried your children might be future addicts? Look for the thrill-seeking child who thrives on adrenaline, the child who’s the first to take a dare. These are behaviors that demonstrate he or she is seeking a dopamine release, Blank said.

  • Exposure. Growing up around addicts increases the likelihood of addiction.
  • Environment. There must be an environmental trigger or stressor – loss of a job or loved one, for instance – that keeps the addiction cycle going.

“You have to have all three legs of that stool for addiction to manifest itself in your life,” said Blank, who is also president of the Georgia Society of Addiction Medicine. Genes alone won’t doom you.

Addictions often start through prescription drugs, she said, and can’t stop without outside help. They lead to brain changes that can’t be undone. “Our rational brain is gone.”

Drug overdose is the leading cause of accidental death in the United States in recent years, fueled by powerful opioids, heroin especially. Ohio is the nation’s overdose death capital, with 3,050 OD deaths in 2015, or more than eight per day, according to state-by-state statistics compiled by the Henry J. Kaiser Family Foundation.

Blank noted that addictions aren’t limited to painkillers and street drugs, of course. People can be addicted to sugar, sex, tobacco and other dopamine triggers, too. It’s all about the dopamine. (Surprising fact to nonsmokers: “Nicotine is better than food, sex and morphine,” Blank said.)

Blank provided a number of sobering facts and statistics, including this one: “This is a chronic disease and there is no cure.”

But there is hope, she said. Addictions can be managed, and many addicts go on to live long, productive and healthy lives. Nationwide, opioid prescriptions are falling and there’s a growing awareness and understanding that addiction is a disease.

She concluded her remarks with a warning: “If you can’t escape addiction, choose yours carefully.”

The health symposium concluded Friday. It was held in conjunction with the 2017 Ohio Safety Congress & Expo, the Ohio Bureau of Workers’ Compensation’s annual safety, health and workers’ compensation conference.