Healthesystems Launches e-Tool to Help Workers’ Compensation Carriers and Payers Manage Opioid Use by Injured Workers.

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OpioidRx RISC Score enables claims professionals and case managers to monitor use of opioid painkillers and prospectively identify situations of potential addiction, abuse, misuse and diversion.

OpioidRx RISC Score represents a leap forward in effective case management of opioid therapy for injured workers.

Healthesystems, a national workers' compensation pharmacy and ancillary benefits management provider, recently released an e-tool that enables workers’ compensation carriers to play a more active role in managing prescription opioid use and identify potential addiction, abuse, misuse and diversion. OpioidRx RISC Score, an acronym for Real-time Indicator & Severity Calculation, is the latest addition to the company’s clinical opioid therapy management program.

Opioids are prescription painkillers that are among the most commonly prescribed drugs for workers’ compensation claimants, according to the National Council on Compensation Insurance (NCCI), an insurance rating and data collection bureau specializing in workers' compensation. NCCI reports that prescription drugs account for 19% of workers’ compensation medical expenses with opioids such as OxyContin® occupying the top spot in terms of dollars spent in 2009.

Although commonly prescribed to injured workers, opioids have a high propensity for addiction and abuse. According to the Centers for Disease Control and Prevention (CDC), prescription painkiller abuse is a growing, deadly epidemic. The numbers are sobering with nearly three out of four prescription drug overdoses caused by opioid pain relievers accounting for 14,800 unintentional overdose deaths in 2008 — more than cocaine and heroin combined.

“OpioidRx RISC Score represents a leap forward in effective case management of opioid therapy for injured workers,” explained Robert Goldberg, M.D., chief medical officer and senior vice president at Healthesystems. “It gives workers’ compensation carriers the information and insights they need to stay ahead of problems.”

The e-tool calculates the level of risk a claimant has with opioid therapy using factors that include the dosage and strength of prescribed drugs. The risk score can be calculated prospectively and in real-time at the prescription pre-authorization stage, and is based on the claimant’s total documented opioid history. It can also be aggregated across multiple claims. “This new tool enables us to put important information at the fingertips of the claims professionals who are best positioned to ensure that injured workers get appropriate therapy while minimizing their risks,” commented Dr. Goldberg. “It supports good clinical decisions.”

OpioidRx RISC Score is already delivering positive results. Claims professionals and case managers have gained visibility to the total opioid use for each claimant with a mouse click. “Since launching the e-tool two months ago, Healthesystems has seen claims professionals taking a more active role in monitoring opioid therapy in the early stages. This is good news for injured workers, employers, and workers’ compensation carriers,” said Dr. Goldberg.

There is clinical evidence that early use of opioids in the course of injury treatment greatly increases the chance of long-term or even lifelong use. Dr. Goldberg explained, “Studies have shown that a patient who is taking opioids 60 days post injury has a higher probability of remaining on them a year later.”

In addition to assessing risk, OpioidRx RISC Score provides claims professionals and case managers with insights and suggestions about initiating conversations with prescribing physicians to improve patient care. “It complements our comprehensive clinical outreach program which leverages our team’s medical expertise and experience to improve care to injured workers and lower the cost of workers’ comp claims to carriers and employers,” added Dr. Goldberg.

OpioidRx RISC Score is integrated into Verticē, Healthesystems’ innovative, web-based claims management portal that delivers real-time pharmacy and ancillary benefits management program information, reports and tools. “OpioidRx RISC Score is another example of how Healthesystems uses data to trigger alerts and claims reviews so workers’ comp professionals can identify clinical issues prospectively and prevent costly mistakes,” said company president Daryl Corr.

About Healthesystems
Healthesystems is a specialty provider of innovative medical cost management solutions for the workers’ compensation industry. The company's comprehensive product portfolio includes a leading pharmacy benefit management (PBM) program, expert clinical review services, and a revolutionary ancillary benefits management (ABM) solution for prospectively managing ancillary medical services such as durable medical equipment (DME), home health, transportation and translation services. By leveraging innovation, powerful technology, clinical expertise and enhanced workflow automation tools, Healthesystems provides clients with flexible programs that reduce the total cost of medical care while improving the quality of care for injured workers. To learn more about Healthesystems or to sign up for the company's newsletters, visit or email info(at)healthesystems(dot)com.

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Christine Duffy
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