HR Management & Compliance

Experts Say Opioid Crisis Results in More Increases in Insurance Claims

Today, we are joined by Julie Stich, CEBS, associate VP of content, at the International Foundation of Employee Benefit Plans. She will be answering some questions about a recent report that it released called Mental Health and Substance Abuse Benefits: 2018 Survey Results.

Source: Victor Moussa / shutterstock

We at the HR Daily Advisor have published a number of articles in the past year addressing the opioid epidemic and how it plays a role in the workplace. Opioid and substance abuse and addiction are increasing and evolving. So, too, must HR increase its efforts and evolve those efforts to meet the serious challenges that this problem brings to the workplace. Please check out our other articles on this topic, which we have listed below.

HR Daily Advisor: I’ve been following the opioid crisis for a few years now. One thing that all reports have suggested is that it’s been getting worse for a while, and it will get a lot worse before it gets any better. Given what is at stake, it’s stunning to me that 42% of employers were not sure how prevalent substance abuse and addiction were in their organizations. Can you help us understand this statistic?

Julie Stich: Even with increased awareness of substance abuse and addiction, the number one barrier to implementing and advancing ways to combat addiction is workers’ fear that admitting a problem may negatively impact their job security. Workers are also concerned about confidentiality. In many cases, they don’t acknowledge or aren’t ready to address their problems.

If workers aren’t talking about addiction, aren’t seeking treatment, or are hiding addiction problems because of confidentiality concerns, employers are limited in the ways they can identify and measure the prevalence and impact of the problem. It’s challenging to understand the scope of the problem among workers themselves. It’s even more difficult to understand the prevalence among workers’ family members and loved ones. As I’m sure you’re aware, an employee doesn’t have to be personally suffering from substance abuse to have this issue negatively impact his or her work and behavior in the workplace; concern for a loved one can be just as devastating.

It’s important for employers to work toward breaking down the stigma attached to substance abuse (and, indeed, any type of mental health or addiction issue) so employees can come forward in admitting they have a problem and need help.

Employers are also cautious because of the Health Insurance Portability and Accountability Act’s (HIPAA) privacy and confidentiality rules.

HR Daily Advisor: One expert I talked to mentioned that the last thing people with substance abuse and addiction problems lose is their job, often 5 years after they have lost their families and friends. That’s 5 years of warning signs that should have been acted upon but were not. Do you have any insights into why warning signs are so easily overlooked?

Julie Stich: Recognizing signs of mental illness or substance abuse might not be top of mind for people if they haven’t been through a crisis themselves or experienced it through a loved one.

Addicted employees will most likely work hard to hide the problem from their supervisor, so coworkers—those who see a person day to day—may be the ones more likely to notice changes.

The more workplaces talk about warning signs to watch for, the more likely a problem is to be detected earlier. If you know somebody at his or her best, you know when that person is not at his or her best. Maybe a coworker is missing more work than usual. You see the individual isolating himself or herself , even though he or she normally takes breaks or lunch with colleagues. We all have the occasional bad day, but when coworkers start to notice “off” behavior, it’s important that the workplace educate them on how to handle that behavior, by either going to a supervisor privately or directing the coworker to an available employee assistance program (EAP).

And, managers are human; they may feel awkward or unsure about how to approach someone or may not know what is within their rights to do as an employer. EAPs can be invaluable resources here—not only for the employee but also for the employer wondering what to do.

HR Daily Advisor: Given how prevalent opioid and substance abuse issues are, it was only a matter of time before the effects were felt by employers. One thing that your research shows is a clear increase in opioid-related claims. Can you talk about what those claims are, how they work, and how they have changed?

Julie Stich: Claims analysis can show signs of opioid abuse like abnormally high costs, patients visiting several pharmacies, and instances of high-volume dispensing. Other types of claims that can point to a problem include emergency room treatment or urgent-care visits for severe side effects.

When asked how current opioid-related claims compare with 5 years ago, nearly half (46%) of organizations have seen an increase. Interestingly, 27% indicated those claims had increased moderately or significantly (6% or more). Perhaps due to increasing publicity and awareness of opioid addiction, the growth in claims has slowed. Compared to 1 year ago, 38% of employers reported an increasing number of claims. Most in that group saw a slight increase of 1% to 5%; only 11% reported a moderate or significant increase.

HR Daily Advisor: Your research shows that only 30% of organizations have conducted claims analyses. What are some of the reasons why organizations may not want to do such an analysis?

  • Because many employers (42%) are unaware of the prevalence of substance abuse in their organization, it might not be on their radar to perform an analysis.
  • Claims analysis can also be costly, complex, and time-consuming, and not all plans may be structured to do an analysis.

HR Daily Advisor: Your research also showed what methods employers were using to manage the growing number of opioid-related claims. They ranged from prescription drug monitoring programs to increasing drug testing. Are the methods most popularly used also the most effective?

Julie Stich: In this report, we didn’t ask respondents to indicate the most effective methods they’re using.

It’s interesting to note, however, that the most commonly used methods bring together the employer with its vendors or providers, such as its pharmacy benefit managers (PBMs), utilization management companies, insurance networks, and physicians.

HR Daily Advisor: I saw that Narcan (also known as naloxone, a medicine that can immediately reverse an opioid overdose) was only available at 5% of worksites. That number seemed low. Do you have any insights into why that might be?

The low rate of Narcan available at the worksite can also be attributed to low awareness of the prevalence of opioid abuse. If an organization doesn’t have a true sense of the scope of opioid addiction in its workplace, it may think Narcan isn’t needed, or it may think the low risk isn’t worth the complexities of keeping it on hand.

HR Daily Advisor: What is the number one takeaway from your research for HR managers?

Julie Stich: There is no black-and-white answer for tackling addiction in the workplace because this issue is fraught with stigma, uncertainty, and unknowns. Every workplace differs in the size and scope of the problem, as well as in the best ways to tackle it. It’s important for employers to watch for signs of distress and create a culture of acceptance so workers are able to admit if they do have a problem. Early intervention can help prevent (or can mitigate) lost productivity, higher disability claims, absenteeism, and increased prescription drug and medical expenses. Together, these have a significant impact on an employer’s bottom line. But the ultimate consideration is employees’ well-being. Early recognition and proper treatment can save a life.

More Resources on Opioids and Addiction from the HR Daily Advisor