Hartford Business Journal

www.HartfordBusiness.com • September 11, 2017 • Hartford Business Journal 19 Data analytics, medical devices offer opioid alternatives By Gregory Seay gseay@HartfordBusiness.com L ike baseball, basketball and other arenas where data is invaluable, analytics has come to pain man- agement. Travelers Cos., a leading U.S. workers compensation carrier in Hartford, is using a proprietary predictive model — the first of its kind — to identify individuals most susceptible to chronic pain. In this way, clini- cians and patients can take steps to prevent injuries, or prepare for surgery, and curb the need for opioids or other painkillers. Travelers' patented "Early Severity Pre- dictor," or ESP, was designed specifically for that purpose. "The body can do amazing things to heal itself, but you have to have the right choices,'' said Dr. Adam Seidner, a physi- cian and pain-management expert who is national medical director at Travelers. Travelers says it manages more than 250,000 workplace injury claims and 3.5 billion medical treatments annually. Since 2015, the insurer has applied ESP in more than 20,000 cases, identifying more than 9,000 injured workers who it says were at risk of developing chronic pain. But rather than administer narcotics, these workers "received a customized, sports medicine-like regimen of treatment precisely sequenced to aid and accelerate their recovery,'' the company said. The result, it said, was that injured workers who participated in the pro- gram in the past year have, on average, recovered and returned to work faster. Moreover, the few who were prescribed pain-relieving opioids got them at much lower dosages than is typical and for a shorter duration, Travelers said. Finally, the average cost of employees' down time — nearly $40,000 per injury — was cut by as much as half, the insurer said. "Helping employees avoid chronic pain and the slippery slope to possible opioid de- pendency is critical to reversing this disturb- ing and costly health crisis," Seidner said. Other non-opioid options to managing chronic pain are already in use or on the horizon, experts say. These include body massages, acupuncture, aromatherapy and hypnosis. Nonsteroid pain-relievers and anti-inflammatories such as acetomi- nophen, the active pain-reducing ingredi- ent in brands like Tylenol, ibuprofen found in Aleve and Midol, and naproxen found in Advil, also are options. Electro-mechanical and electronic neurostimulators, too, are being enlisted among the non-addictive options available to pain victims, who covet prompt relief without side effects. In Norwalk, Biowave Corp. markets a patented technology that delivers tempo- rary relief by disrupting nerve signals to the body's pain receptors in deep tissue, said founder Bradford Siff. The National Football League's New York Giants was Biowave's first customer; 30 of the league's 32 teams now deploy its devices to help players deal with pain from game injuries, Siff said. "It's pain relief at the press of a button,'' he said. Thirty-minutes of Biowave treatment just below the surface of the skin provides up to 72 hours of pain relief — triple the duration of comfort from more traditional transcutaneous electrical nerve stimula- tion (TENS) machines, technology that dates to the 1970s, he said. The Biowave- Pro is priced at $3,500; a smaller, home prescription version costs $895. Biowave and older TENS technologies, Siff said, are among alternatives to easing pain symptoms. Implantable, battery-powered pain-management devices, too, are available, if not costly, at $50,000 to $80,000. Giants head athletic trainer Ronnie Barnes confirms the team uses Biowave, along with other "passive'' pain-relief technologies, "to help provide short-term relief during chronic pain flare-ups and in controlling symptoms such as pain, in- flammation and swelling. Biowave, TENS and similar modalities provide us with necessary options in pain management." However, Travelers' Seidner says research has yet to prove the efficacy of neurostimulators, and cautions they may not deliver the full relief users' expect. Siff, too, admits that Biowave and TENS machines are not "going to replace pills.'' Jacobs, who oversees the virtual call center. "We do a good job assessing them, figur- ing out how they get to the right person,'' Jacobs said. Anthem behavioral-health manager Ana Secondo supervises 17 Anthem EAP case managers who each juggle some 60 cases monthly. Anthem has seen a rising number of EAP calls involv- ing opioid misuse, signaling, Secondo said, a growing public awareness — and less shame and stigma — as to their hazards. "It's a good thing that we're seeing more opioid cases, due to the heavy media attention,'' Secondo said. Anthem refers EAP callers to medical pro- viders and will also follow up with members within 24 to 48 hours, officials say. Through its EAP call center, Anthem plays an indirect role in curbing opioid misuse, Jacobs and Secondo say. One way is via its "Pharmacy Home" program offered to its commercial and Medicaid customers. Under the program, individuals are as- signed to one pharmacy and/or one care pro- vider who handles patient-members' opioid prescriptions. This way, Anthem EAP experts say, physicians can monitor their patients' access to opioids while also ensuring they are receiving appropriate drug counseling and other mental-health support. Since the April 2016 launch of Pharmacy Home, Anthem says it has enrolled nearly 450 members and sent warning letters to over 3,100 members who met the defined criteria. Overcoming the stigma EAPs have come a long way, Fallon said, since their formal start in the 1950s with former Eastman Kodak Co. and other big employers, evolving as an outgrowth of the movement to identify and rehabilitate work- ers with alcoholism. Early EAPs, he said, were seen as tools to ID individuals with alcohol addiction and quickly intervene using worker peers and addiction counselors to help them. Later, as care professionals identified other workplace "stressors'' that can nega- tively impact workers' performance, experts say EAPs evolved to assist those, too. By the 1980s, when the nation's cocaine addiction kicked in, EAPs were in full swing. Almost every large U.S. employer, and many smaller ones, offered EAPs as a workplace benefit. Today, painkillers made from opioids have largely sup- planted alcohol and cocaine as users' drug of choice. But one fact about EAPs remains: The stigma on tapping EAPs for help, especially when "alcoholic'' and "ad- dict'' labels are applied, experts say. "People feel embarrassed about using EAP services,'' Fallon said. To erase EAPs' stigma, experts say em- ployers can foster more tolerance and understand- ing in their offices and shop floors, by educating workers about the stress- ors and other fac- tors that promote addiction. Not all individuals with an addiction got their by choice; genetics, mental- health issues and other risk factors render some people more susceptible, experts say. Bennett, the Fort Worth, Texas, EAP con- sultant, contends that EAPs' effectiveness could be strengthened if more employer- members held them accountable for yield- ing positive, evidence-based outcomes for their users. There is room, too, he said, for employers and their staffs to deepen their understanding of the multiple layers of treatments that exist, particularly for heroin and other opioids. Travelers' National Medical Director Dr. Adam Seidner speaks at a recent opioids forum. Biowave's neurostimulator is a pain relief device, and opioid alternative, used by the New York Giants football team. PHOTO | CONTRIBUTED PHOTO | CONTRIBUTED Why should employers care? Prescription painkiller misuse costs employers billions of dollars each year, causing employees to be less productive at work or not at work at all. Employees who misuse prescription drugs are more likely to: Take unexcused absences Be late for work Quit or be fired within one year of employment Be involved in workplace incidents File workers' compensation claims What can employers do to curb opioid misuse? Educate employees about the health and productivity issues related to prescription drug abuse. Incorporate information about substance abuse in workplace wellness programs or strategies. Offer health benefits that provide coverage for substance abuse disorders. Expand drug testing to include prescription drugs. Publicize drug-free workplace policies and incorporate guidelines regarding prescription drugs. Provide employee assistance programs, wellness and work-life programs that include information and services related to substance abuse prevention, treatment and return-to-work issues. Train managers to recognize and respond to substance abuse issues so problems can be ad- dressed in uniform, cost-effective and business-sensitive ways. Source: National Safety Council HBJ PHOTO | STEVE LASCHEVER Jodi Jacobs, oversees the virtual call center at Anthem Blue Cross and Blue Shield Dorinda Daniels is an EAP case manager at health insurer Anthem.

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