What’s Changing? Medicine, Workforce, Says Paradigm Expert in NCCI Webinar

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With advancements in medical treatments and changes in how workers' compensation is handled across the country, it's tempting to say that the future is now, but the reality remains that the future is still ahead of us -- and not always certain.

As Paradigm's Michael Choo shared with NCCI's Damian England and Jon Sinclair in a recent webinar, the more things change, the more changes are still to come, particularly with medical advancements and an aging workforce.

GLP-1 and More

Choo highlighted the rapid advancement in technology and research that's taken place in the past decade, emphasizing that new innovations and treatment options have led to better recovery for workers and better outcomes for payers.

One medical development that has grown from research efforts has been the use of GLP-1.

"People think it's the cure for obesity," Choo said, noting that 65% of the U.S. adult population is obese, contributing to "200 or so" medical conditions.

But the weight-loss drug is also gaining attention for potential use in workers' compensation.

"Is it right for workers' compensation?" Choo said. "It can be helpful for individual workers, but is it right for all?"

Another development that Choo highlighted was the use of robotic surgery.

"It will be a huge benefit to workers, as we're moving to the orthopedic world," Choo explained.

But although robotic surgery can reduce complications, nothing's perfect.

"With every innovation, there's downsides," Choo said. "We must be aware of them and do the risk versus benefits assessment."

When it comes to surgery options, restorative techniques also hold promise for workers' compensation, Choo noted.

"Nerve transplants and tissue transfer can restore people back to original functioning," Choo said. "We just did a facial transplant on an injured worker, and he's able to eat and engage with the community in a way that wouldn't have been possible 10, 20 years ago."

Another technology, virtual reality, has become a pain-management tool, particularly as a way to immerse patients in a setting that takes their mind off of pain.

"It's distracting from the pain," Choo said. "It's pain management to a point where if it's more tolerable, we might not need medication."

Similarly, virtual reality can be used to incorporate established therapies and assist patients in recovery with things like an exercise routine.

Costs are Changing

Sinclair noted that there has been a shift away from opioids in workers' compensation that mirrors the more cautious approach to prescribing opioids across the general population.

That's resulting in lower costs for opioids as well as lower costs for medications that are prescribed for treating the side effects of opioids.

However, one class of pain medication, topicals, has seen "exploding" costs recently, according to Sinclair.

"They have common ingredients that you can get over the counter," Sinclair said.

But will topicals continue to trend in an expensive direction? Sinclair noted that over time, their use declines.

"What we see with topicals is they are being used early on, but we're not seeing them being used two, three years on, like opioids," Sinclair said.

Another factor affecting costs, according to Choo, is the use of at-home monitoring, which emerged from the COVID-19 pandemic as a treatment alternative to hospital stays for recovering workers, particularly as providers seek less inpatient time for patients.

"CMS allowed hospitals to get reimbursed, and monitoring systems evolved to allow patients to be taken care of at home," Choo said. "It could mean less cost, but sending people home might not be cheaper."

Fewer Providers, Older Workers

Some other realities that could affect costs down the road are the current shortage of healthcare professionals and the aging workforce.

"It's supply and demand," Choo said. "Healthcare professionals could demand higher pay and it could lead to a shortage of care."

Additionally, Bureau of Labor Statistics data show that over the next 10 years, workers 55 and older will account for 25% of the workforce.

And with older workers come challenges for recovery, according to Choo. In particular, older workers have less capacity for recovery and a greater incidence of comorbidities.

"These things are going to become more and more of an issue for workers' comp," Choo said. "We'll see how that goes."

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