The company's algorithms comb through millions of digital notes by claims handlers and summaries of the workers' medical records looking for clues such as insomnia, anxiety, a recent divorce or death. And when a claimant's details match the warning signs in at-risk profiles, experienced nurses or other medical staff are assigned to the claim.
In some instances, the company's nurses may reach out to doctors or pharmacists, if there are concerns that painkillers are inappropriately prescribed, perhaps leading to a change in the dosage. Where state law allows, the company can seek to stop opioid prescriptions from being filled.
Data mining of workers' comp cases at Hartford Financial, assisted by advanced analytics and a $100 million investment in a new claims system back in 2012, is one of the lesser-known fronts in the nation's efforts to tackle the epidemic of prescription painkiller abuse. Hartford Financial's workers' comp policies cover more than 7.5 million people across 600,000 employers.
Workers' comp is a mandatory purchase for most businesses, to pay for medical care and lost wages of people hurt while on the job. And abuse of opioid prescriptions in the U.S. workers' compensation system has contributed to higher claims costs borne by employers, trade groups say.
Christopher Swift, since his promotion to CEO in June 2014, has overseen the expansion of a strategy that Hartford Financial credits with a 45% decrease in opioid prescriptions for its workers' comp policyholders from 2014 to 2017, even as the business grew. That was more than double the national decline of 21% over the same period, according to the most recent data from the federal Centers for Disease Control and Prevention.
The Connecticut insurer took in $3.34 billion in workers' comp premiums last year and is currently No. 2 in market share, at 5.8%, according to data from Hartford and the National Association of Insurance Commissioners. Other large workers' comp insurers also use predictive analysis to combat opioid misuse.
The Wall Street Journal interviewed Mr. Swift about Hartford Financial's efforts to address the opioid crisis. Edited excerpts follow.
WSJ: When you became CEO in 2014, how important a subject was opioid abuse to Hartford Financial and to you?
MR. SWIFT: It was a priority for our company, particularly our claims organization. Our comprehensive opioid-management strategy was enabled by a $100 million investment in a new claims system when I was CFO [from 2010 to 2014]. It was designed around what are the data and analytics we want for the future that would help us get people back to work. This opioid crisis has really been developing for the past 20 years. Starting 10 years ago, our medical team and our nurses were seeing prescriptions being extended and extended. It really led to our discovery of just how many pills were being prescribed, and how long people were staying on them.
WSJ: What have been key findings?
MR. SWIFT: Our analysis of claims data revealed that our claimants were being prescribed opioids even for relatively minor injuries. Inappropriately prescribed opioids can triple the amount of time that injured workers are out of work. As a result, we developed a comprehensive opioid-management strategy to limit opioid use.
WSJ: What are elements of this strategy?
MR. SWIFT: Analysis of our data allows us to understand which doctors are responsible prescribers and which are not.
Every opioid prescription is reviewed by a nurse to ensure that it's appropriate in dosage and duration. If a prescription appears to be inappropriate, the nurse will seek information from the prescriber to confirm medical necessity. If the prescriber cannot demonstrate medical necessity, in states where regulations allow, we will stop the prescription from being filled.
We are using our data analytics on a proactive basis to identify those people who might be higher-risk candidates to abuse opioids. We can detect and flag higher-risk factors in three areas: biological, such as heart disease; psychological, such as anxiety; and social, such as a divorce. Some of the flags very correlated to drug misuse include chronic pain, depression, feelings of helplessness or fear of re-injury.
The Hartford's claims system sends flagged claims to higher-level adjusters or clinicians who have experience with complex claims. And we reach out to the injured worker to make sure they are aware that they are taking an opioid, the implications and the side effects.
WSJ: As important as this effort is, isn't Hartford Financial doing exactly what so many insurers are criticized for doing, getting in between a doctor and a patient, and denying treatment?
MR. SWIFT: Our opioid-management strategy is about preventing misuse because we've seen firsthand the devastating impact of opioid addiction on individuals, families and communities.
We believe there are times when opioids are medically necessary. They can be effective for very short-term, acute pain relief. It's important to remember that they were developed for end-of-life pain treatment.
WSJ: What is your response to critics who say that people aren't getting the painkillers they need and that the insurers are mainly worried about cutting costs?
MR. SWIFT: Our priority is delivering positive outcomes for workers and their employers. Approximately 30% of American adults have been prescribed opioids, and one in five who starts a 10-day supply becomes a longer-term user.
We often recommend alternative treatments that are equally effective, and in many cases these treatments cost more than an opioid prescription, such as multiple sessions of physical therapy, acupuncture, or even inpatient rehabilitation.
WSJ: What has been the reaction of employers, injured employees and doctors?
MR. SWIFT: Start with the employers. Without exception, everyone really appreciates the work we are doing here. We know the opioid epidemic is not just a health issue but a real business issue, because active employees might misuse the drugs, interrupting business or leading to higher turnover.
WSJ: What about pushback from doctors?
MR. SWIFT: Most doctors do not mind when we check for appropriateness or question the duration of a prescription. It's like a second check built into the system.
WSJ: What about doctors who are cut out of your network?
MR. SWIFT: Doctors can ask to be added back into the network. If behaviors change and subsequent data supports those changes, we can reconsider it. But our analysis is very data-driven.
WSJ: And the workers. Do some feel the opioids relieve their pain so they don't like your efforts to limit the use of a prescribed drug?
MR. SWIFT: Generally, the end customer appreciates the care and the empathy that we exhibit as we are making sure they get back to work and to good health. [If an injured worker wants to contest his or her treatment, the person can seek a review and hearing with the state workers' compensation board or commission, Hartford Financial says.
WSJ: Do patients know that information about their sleeping, stress level and personal life, including divorce, is being used in claims handling?
MR. SWIFT: Injured workers voluntarily provide information to claims handlers in calls and emails. Also, they authorize us to receive medical records from their doctors.
WSJ: You have met with state and federal lawmakers about these topics. What legislation have you supported, and what do you want passed?
MR. SWIFT: We would really want opioid prescriptions to be limited to short durations, meaning somewhere in the five- to 10-day range. Not trying to be a doctor in prescribing medicine, but you don't need more than five- or 10-day prescriptions. Renewals really need doctor consent. And mandatory physician and provider education. The ground game is really done by our trade group, American Property Casualty Insurance Association, and the industry in total.