Harbor Health Systems NWCDC Presentation Shows Impact of Comorbidities on Workers' Compensation Outcomes and Physician Scoring Models


New Orleans, LA (WorkersCompensation.com) - A Harbor Health Systems study analyzing more than 7,000 workers’ compensation claims involving claimants possessing one or more comorbid conditions found increased claims duration, higher medical costs, higher temporary total disability (TTD) days and higher rates of litigation. Harbor Health Systems, a One Call Care Management company, presented these findings at the National Workers’ Compensation & Disability Conference (NWCDC), in New Orleans, Louisiana earlier today. 

“Because of the higher costs and increased duration associated with claims involving comorbidities, it is essential to proactively manage claims and guide these more complex cases to the physicians with the best track record and highest performance scores,” noted Linda Lane, President of Harbor Health Systems. “By accurately scoring physicians who frequently see claims with comorbidities, we’re able to ensure the injured worker gets the best quality care throughout the recovery process, helping him or her return to work faster, reducing overall claims costs.” 

The Harbor Health Systems research evaluated seven comorbidities – addiction, diabetes, hypertension, mental health, obesity, tobacco use, and multiple comorbidities – and how these factors impacted the following metrics:

  • Total claims costs incurred
  • Total medical costs incurred
  • Claim duration
  • TTD days
  • Litigation rate
  • Recidivism
  • Surgery rate

The analysis found that the presence of comorbid conditions impacted claims in the following ways:

  • Claim duration is significantly longer for the claims involving comorbidities with the exception of tobacco claims. Claim duration increased by 76 percent for claims involving multiple comorbidities; 67 percent for claims involving addiction and 55 percent for obesity-related claims.
  • With multiple comorbidities, incurred total costs increased 341 percent.
  • Claims in all the comorbidity groups had significantly higher TTD days compared to the control group. TTD days increased by 285 percent for multiple comorbidities claims; TTD days in addiction-related claims increased by 274 percent. 
  • Litigation rates increased exponentially when claims involved multiple comorbidities, mental health or addiction. Litigation rates for claims with multiple comorbidities increased approximately 147 percent; for addiction-related claims they increased 224 percent and for mental health related claims they increased by 258 percent.
  • Surgery rates increased dramatically as well when comorbidities were involved. Surgery rates increased 123 percent for claims involving multiple comorbidities, 140 percent for claims involving obesity.

Lane concluded with the recommendations to record more complete patient data at the beginning of a claim and incorporate comorbidities into utilization review, as well as factor them into treatment procedures so that claims managers can dramatically improve care and recovery of injured workers at a lower overall cost. 

Learn more about the Harbor NWCDC session here:  Comorbidity Impact on Claims and Doctor Performance: What the Research Shows

To learn more about how an outcomes-based approach can reduce risk and produce cost savings for your organization, visit http://harborhealthsystems.com/

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