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LeFevre: ODG, NGC and the Formulary Debate

By Phil LeFevre

Tuesday, May 16, 2017 | 982 | 0 | min read

Opioids are synthetic heroin. HEROIN.

Phil LeFevre

Phil LeFevre

Sons, daughters, cousins, brothers, nephews, uncles, mothers and friends, with ruined lives, thanks to opioids. Credit to the Louisiana House of Representatives Committee on Industry and Labor for recognizing the problem, seeing a proven solution in the Official Disability Guidelines and voting in favor of HB 592.

The formulary debate — the competitive guideline debate — is getting heated, and unfortunately, it’s clouding the issue. Good formularies are unquestionably a good idea, because they protect patients. How do I know? We’ve been there, with a successful track record implementing ODG formulary adoptions with our partners in Texas, Oklahoma, Arizona, Tennessee and elsewhere.

Helping some 15,000 people, 97% of high MED patients — sisters, nieces, dads — in Texas get daily morphine equivalent doses down to safer levels, is massive progress. They are unquestionably better off after the formulary.

That former Texas DWC Commissioner Rod Bordelon, who presided over the successful ODG adoption, would be so moved by our joint accomplishments improving outcomes for patients, providers and employers to want to represent ODG as a consultant to other states considering guidelines and formulary, is humbling. Rod is amazing, impeccable in his research, intentions, professionalism and work ethic. Rod puts his name and reputation behind ODG because the model works, and he knows it, firsthand.

With DWC in Texas we achieved better return-to-work outcomes across the board, access to care up 42%, with both denial rates and workers’ comp premiums cut in half. That’s a win-win-win-win for patients, providers, employers and payers. It’s not theory. It is historical record, and it’s happening now in a dozen other ODG states. You can find the positive stories in the ODG in the News section of our site.

That the Louisiana Association of Self-Insured Employers (LASIE), big companies with workforces in both Texas and Louisiana who have seen the results of ODG in Texas, would be so committed to bringing the ODG formulary adoption over to Louisiana, is also very telling.

Outside of family, no one has a greater stake in successful health care outcomes for injured workers than self-insured employers. LASIE Executive Director of Gary Patureau describes their support for HB 592 as follows: 

“We have researched guidelines and formularies for over a decade and we know which ones will work best for our system. Many of our members operate in states that use different guidelines and formularies, and they agree that ODG provides the most comprehensive, most updated and best supporting tools for providing appropriate care and return to work. All one has to do is look to the California formulary experience to see why we are advocating the only multi-state, proven and tested formulary.”

We appreciate the opportunity to respond to Monday's column by Carlos Luna at Reed Group. The column is extremely misleading and inaccurate. Neither Rand Corp. nor the National Guideline Clearinghouse have suggested that any workers’ compensation guidelines are or are not trustworthy.

The interest in ODG across our market has never been greater. The National Council on Compensation Insurance, Workers Compensation Research Institute and the Journal of Occupational and Environment Medicine have all published studies demonstrating the benefits of ODG compliance, which support the real-world outcomes achieved in ODG states, the most recent of which (Tennessee and Arizona) both came onboard in the last 24 months.

I have always encouraged my staff to take the high road and not to engage in negative marketing, but it’s proving difficult. I believe we can, and should, work together to grow the market for evidence-based guidelines and drug formularies. There is too much at stake to be anything other than professional. I see it as a betrayal of trust to the industry to mislead to the degree that is happening in these posts, and I fear their campaign hurts the whole movement to evidence-based medicine.

In our blogs, we point to our successes, because we can. Successes from the ODG solution have been significant, and there are many to choose from.

The National Guideline Clearinghouse

As many know, we no longer submit ODG for consideration in NGC. NGC is not part of our strategic direction for the business. NGC generally includes guidelines from medical specialty societies and academic institutions, not commercial publishers.

We are the leading commercial publisher in the workers’ compensation space and prefer to distinguish ourselves in that way (as a commercial publisher, not a medical specialty society or academic institution). This fits with our new parent company, MCG Health, the worldwide leader in evidence-based medical guidelines for general health care.

None of the leading commercial guideline publishers, including our sister companies at Hearst Health — FDB (First Databank), Zynx Health, MCG, Homecare Homebase, MedHOK and ODG — opt to list in NGC. Medical guidance from our incredible network, the Hearst Health Network, reaches 84% of discharged patients in the U.S. every year — more than 177 million individuals, 60 million home health visits and 3.1 billion prescriptions. None of that care guidance is found in NGC.

NGC is a nice resource primarily for combing the viewpoints of medical specialty societies. It is not intended to be an indicator of trustworthy clinical practice guidelines, nor does it claim such.

The ODG methodology can be found here. It has been ranked among the best and most rigorous in the world for technical quality by Rand Corp. and others.

Conclusion

Patricia Whelan, one of our co-founders, is fond of saying “United We Stand.” As an industry, workers’ comp service providers do a pretty good job of that, but not on the guideline front. This must improve for evidence-based medicine to continue advancing. I hope our silence in the past and future on the Reed blogs is not perceived as ducking and hiding, but as leading with light, setting a better example.  

Phil LeFevre is managing director of the Official Disability Guidelines, published by the Work Loss Data Institute.

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