43. Disclosure  Statement  •  Alex  Swedlow  has  no  ﬁnancial  rela4onships   with  proprietary  en44es  that  produce  health   care  goods  and  services.
44. Pain  Management  in  the  California  Workers’  Comp  System   Agenda   •  Pain Management in the California Workers’ Compensation System •  Controlled Substance Utilization Review and Evaluation System (CURES)
67. Pain  Management  in  the  California  Workers’  Comp  System  Controlled  Substance  U4liza4on  Review  and  Evalua4on  System    (CURES)   CURES Background •  1939 Bureau of Narcotic Enforcement (BNE) creates PMP mandated through the Health and Safety (H&S) Code •  September 2009, CURES program was enhanced with a web-based Prescription Drug Monitoring Program (PDMP) processing 913,874 patient activity reports. •  CURES receives over 5 million records each month from more than 6,700 licensed pharmacies. •  CURES is working with departmental IT to allow for the exchange of PDMP data between state PMPs. •  Now dormant and absent a funding source, the CURES program shuts down on July 1, 2013.
68. Pain  Management  in  the  California  Workers’  Comp  System  Controlled  Substance  U4liza4on  Review  and  Evalua4on  System    (CURES)   Building a Business Case: Estimating CURES ROI: •  Estimate number of claims by opioid use •  Determine potential savings via CURES access •  Adjust for CURES operating budget Claims  w/   CA  Claim  Count   Pcnt  of   Opioid  Scripts (2010) Claims  1  Scripts   34,981    41%  2-­‐3  Scripts 21,206    25%  3-­‐7  Scripts 14,111    16%  >7  Scripts 15,690    18% Total: 85,988 100%
70. Pain  Management  in  the  California  Workers’  Comp  System   Summary •  High rate of inappropriate opioid use; •  Limits in statutes/rules/regs make it difficult to regulate within traditional workers’ comp controls •  Graduated use associated with adverse injured worker outcomes •  Small number of physicians associated with high prescribing patterns •  Rapid increase in drug testing associated to high opioid use with no national guidelines for testing •  CURES has significant potential to increase QOC and lower cost