Luna suggests that the massive cost-savings attributable to ODG guidelines and formulary adoptions may not equate to improvements in health outcomes. The position of ODG and our regulatory partners is the opposite. We believe the only way to achieve real and lasting cost-savings in workers’ comp is through the delivery of quality and timely care resulting in improved patient outcomes, and the best measure of success for workers’ comp reform efforts is time away from work.
When lost-time declines, the lives and livelihoods of workers injured on the job are changed for the better. Thankfully, in large part due to the hard work of the workers’ comp agencies and their stakeholders – TPAs, PBMs, MCOs, and providers charged with ODG implementation and concurrent reform measures – outcomes in ODG states have improved dramatically, including average lost time reductions of 34% (Texas) to 65% (Tennessee), cases receiving opioid doses of 90 MED or more down by 97% with total opioid usage down 58% (Texas), and claim cost declines resulting in annual premium reductions of 64% (Oklahoma), 63% (Texas), and 36% (Tennessee), among others.
Luna tries to elicit fear in the marketplace, painting the ODG Formulary as “draconian” because it’s “binary,” advocating instead for a diagnosis-based formulary, but Luna confuses the role of treatment guidelines and formulary. A formulary adoption is a preauthorization rule, making it more difficult to prescribe the most dangerous drugs, but all medications, including both preferred and non-preferred drugs in the ODG Formulary, open complete evidence-based care guidelines in ODG, where diagnosis, duration, dose, and contraindications are discussed and outlined. It’s through the formulary-guideline linkage that patient selection criteria are applied in the clinician’s office and on the backend through UR.
Luna either does not understand how successful formulary implementations work, or is intentionally misleading the industry. Either scenario is alarming, though given the track records of WCRI, ODG, and our regulatory partners, stakeholders can see through the obfuscation, and his agenda is obvious.
In closing, thanks to WCRI for the excellent research, to stakeholders for your leadership implementing ODG, and to you, reader, for your interest in ODG and the opportunity to respond to criticism.
VP, Workers’ Comp, MCG Health,
and Managing Director, ODG