A 2019 MID-YEAR REVIEW OF THE PREVAILING INDUSTRY INFLUENCES IMPACTING CLAIM OUTCOMES
January - June 2018 vs. January - June 2019
Through analysis of our pharmacy data January to June 2018 vs. 2019, at a high level, we are seeing fewer claims, fewer opioids, a slight increase in prescription cost per claim and a slight increase in claim age. A snapshot of our mid-year trends in 2019 is in the following video and listed below.
OPTUM 2019 MID-YEAR
Our full mid-year report describes the importance of our Total Care Management Solution and how we anticipate a shift toward alternative pain control treatments and the effect on our lines of business.
2019 MID-YEAR TRENDS SNAPSHOT
PHARMACY CLAIM DATA
In year to date 2019, pharmacy spend and number of prescription both continue to decline at 8.7%, there was slight increase in the average claim age that influenced the modest 2.0% increase in utilization. However, our programs have helped to nearly maintain the average prescription cost per claim with only a slight increase of 0.5%.
And while we saw fewer new claims/injuries and overall faster resolution of those claims, our analysis shows that older claims are more influential to overall costs than in the past. Older claims generally have higher utilization of medications and use higher-cost medications including opioid analgesics. Our clinical programs, trends analysis and claim management tools have helped to keep utilization of these older claims in check and to decrease the total cost per claim by 6.4%.
While opioid analgesics remain the most frequently prescribed therapeutic class in the management of workers’ copmensation claims, both in terms of the percentage of total spend and the total number of prescriptions dispensed, the total percentage of opioid prescriptions dropped to 25.2%.
2018 TRENDS REPORT
INDUSTRY TRENDS REPORT
2018 proved to be another successful year and led to positive outcomes for our payers and for the industry. Our Optum programs and services helped control overall pharmacy utilization and costs as we achieved an 8.3% reduction in average cost per claim
We also reached a 7.1% reduction in opioid spend in relation to opioid claims. As we review our 2018 pharmacy results, we will also expand on how this may impact ancillary, PPO and settlement solutions.
To view our 2018 Trends report, click on the pdf link or for a brief overview, watch the video showing the industry trend highlights