Paduda: Sloooooow Progress in California's Work Comp System

Wednesday, August 15, 2018 | 0

That’s the quick takeaway from a review of California Workers' Compensation Institute's recent report on drug prescription management in the Golden State. (There’s a lot more to this study than this.)

Joe Paduda

As cognoscenti (a fancy word for nerds) know, the utilization review (UR) and independent medical review (IMR) processes were intended to help ensure that patients got the drugs they needed quickly, were protected from dangerous or potentially unsafe drugs, and prescribers would learn what was likely to fly and what wasn’t.

The last was based on decades of experience in health care, observing what happens when evidence-based guidelines protected by UR processes to encourage/require compliance are put into place. In most every other instance, providers adapted their care models to meet the standards, and after a flurry of appeals at the outset, things settled down a lot.

But, well, hey — this is workers’ comp.

The first two (better care and patient safety) seem to have worked pretty well, but up till now, it appeared that WC prescribers were militant non-learners, as the volume and type of UR/IMR requests just didn’t taper off.

My assessment of CWCI’s report is (equivocation alert) prescribers MAY BE changing their behavior, a wee bit. 

Here’s what’s driving my optimistic take (from CWCI): After the formulary took effect in January, prescription drug requests declined, from 44.5%, to 40.7% of all UR decisions in the study sample, a relative decline of 8.5%.

I mean, how could one not dance in jubilation, right?

Well, perhaps prescribers have decided to not keep pushing that stone up the hill. Or perhaps it’s just a temporary hiatus.

I’m going to remain optimistic, and you should read the entire report, because there’s lots of good info in it.

What does this mean for you?

Less hassle, better care. We hope.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.