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COMPETING THROUGH TECHNOLOGY Controlling Health Care Costs by Fighting Painkiller Abuse: Prescribing a Dose of High-Tech Algorithms Although tremendous law may indicate one's likelihood of you becoming addicted. enforcement and regulatory becoming addicted to painkill- it is not like treating high cho resources go into fighting pre- ers. For example, the algorithm l esterol or high blood pressure, scription painkiller abuse, one considers the lag between an where addiction is not a concern. of the most effective tools in injury taking place and when it is some doctors are concerned the fight might turn out to be a reported. Their data indicate that that using analytics and com- computer algorithm. the longer the lag, the greater puter algorithms could lead to With the costs of abuse soar- the risk of painkiller abuse. the wrong treatment for some ing for firms, some are taking a In the case of an employee who have a legitimate need data-driven approach, combining assessed as being high risk, a They note that not all people medical research and guidelines case worker is assigned to the heal the same way. So, some with computer analysis to help omployee right from the start, people who look like addic doctors decide which prescrip who closely monitors the employ. tion risks because they are tion painkillers should be given ee's situation. If, for example, a on a pain medication longer to which patients --IF they should case workersees that a worker than the model says is opti- be given at all. And if they are with a broken ankle continues mal may in fact require longer given, what dosage is best? taking opioids longer than two treatment. In particular, insurers and weeks, an alert may be issued. The growth of analytics to medical-bill review consultants The idea is to intervene so control workers compensation that assist firms in paying their that a broken ankle or a minor costs comes at a time when workers' compensation claims lower back injury does not turn the average medical cost for seek to provide research-driven into a lifetime problem with pre- workers paid to stay at home clinical advice and guidelines to scription painkiller addiction. due to workers compensation doctors on how to better treat Companies can also use claims has reached $28,000, pain. "Better" means not only analytics from Rising and similar nearly doubling in a decade treating pain effectively, but also companies to benchmark their from $15,900. And, although lowering health-care costs by workers compensation cases painkillers can be cheap (about monitoring/ensuring safe use of against those of other com $35 per claim), the medical these drugs, as well as identifying panies in the same industry or treatment that can result, due potential painkiller abusers up geographical location as a way to abuse and/or addiction, can front, before they get addicted to compare the risk they face of be quite expensive, especially Rising Medical Solutions Inc. fraud and abuse to that faced if not closely monitored and is an example of a company that by other companies, which can managed provides algorithms to assess help them decide how much of whether an individual is low, a problem they have. DISCUSSION QUESTIONS medium or high risk for pre- One analytics company 1. Would you recommend that scription painkiller abuse. The executive states that doctors are other companies follow a risk score is computed based not perfect and, without guid- similar approach? on 30 questions that ask an ance, will sometimes not recog- 2. Do you feel that the rights injured employee about things nize cases where patients are in and needs of workers are such as his/her optimism about significant danger of becoming adequately addressed? recovery previous injury his addicted. Another puts it this SOURCE: Timothy W. Martin, When You tory, whether the employee is way. Your doctor's approach to M.D. is an Algorithm Wall Street Journal a smoker, and other areas that pain management could lead to April 11, 2013