Care Bridge Analyzes More than 8M Claims, Discovers $2B in Overspending that Could Be Due to Inflated Medicare Set Aside Costs

WorkersCompensation.com Senior Editor of Premium Media Dara Barney took some time with Care Bridge CEO Deborah Watkins to talk evidence-based medicine and data analytics, specifically surrounding a report that the medical data utilization/analysis company recently released

1) Tell readers a little bit about this report, and why it is important to work comp industry members and stakeholders.

We conducted a survey in 2016, looking at what payers’ perceptions were of MSA’s. What was interesting about that study? 100 percent of respondents agreed that Medicare Set Asides (MSAs) delayed or precluded claims settlements. We interviewed 36 companies (carriers, TPA’s, self-insureds, and state funds). What was the most common reason for high costs? Prescription drugs. In studies before, we could see the inflation, but not quantify it.

We then spent months wrangling more than eight million claims over ten years to analyze the true costs of care. It was quite compelling. While the drug weaning process could take anywhere from one to seven years (Per data analysis: only 50% of workers comp claimants were using opioids in the 7th year and 25% were using opioids in the 10th year), the Centers for Medicare and Medicaid Services (CMS) requires primary payers to forecast an injured worker’s prescription drug profile that is active at the time of settlement into the future, an average of 24 years.

We had a third-party post settlement account administration firm help us corroborate these findings, and the results were consistent. The two big lessons here are: We are paying too much for Set-Asides. The use of data science is the new standard to drive better outcomes for claims.  

2) We have the data. How do we utilize it and make changes for improvement?

Let’s get organizations like the American Insurance Association (AIA) and California Workers Compensation Institute (CWCI) involved. They can use this information for policymaking to drive some changes in the Medicare Secondary Payer review process, in establishing best practices. This data needs to be looked at as a new standard for forecasting MSA’s, using data science as the standard for MSP compliance.

What we have used in the past 15 years needs to be “sunsetted.” By using a data-driven approach, companies can contain costs by nearly half, or $2 Billion dollars, AND obtain an MSA in minutes instead of weeks and settle claims six to eight months faster.

3) What is the key takeaway for parties interested in this report?

Historically the cottage industry has used a lot of scare tactics and threats to instill fear and drive profits. This data-driven approach takes that negative element out and provides an unbiased view of the true costs. The current conventional model is a very entrenched process, that is extremely slow. The industry is changing; it will continue to adapt and adopt technology solutions. The use of data science proves, in a valid, reliable and quantifiable way, that prescription drug use continues to change over time and that a new standard can be set to offer payers more accurate projections.   

(The Care Bridge report is sponsored content; The in-depth interview is designed with intent to provide a news summary.)

Share This Article: