The Wrath of Comorbidity

The importance of maintaining health or managing diseases is obvious when controlling healthcare costs, population health, and personal health. It also crosses the human capital spectrum with its effects on other lines of data like workers’ compensation. In case you are new to my blogs, comorbidity is two or more medical conditions existing simultaneously regardless of their causal relationship.

Before I get into the human capital element of comorbidity, I am going to discuss the medical nature of why these comorbidities cause havoc. This will make you say, “This all makes sense” after reading about the collateral damage that comorbidities have on workers’ compensation claims.

Health Comorbidities Contribute to Workers’ Comp Costs

Obesity

  • Increases the amount of stress across weight bearing joints
  • Increases chance of osteoarthritis in weight bearing joints
  • Effects post-operative healing:
    • Increases tension on the wound edges and contributes to possible wound rupture
    • Slows healing by increasing tissue pressure and reducing the availability of oxygen to the wound

Read colleague Sashi Segu’s blog, Obesity: A Weighty Issue for Employers to learn more.

Hypertension

  • Decreases oxygen and nutrient delivery to the wound site
  • Pumps blood less efficiently through the body
  • Prolongs edema at injury site

Diabetes

  • Contributes to tissue destruction and inhibits the normal wound repair process
  • Hyperglycemia can add oxidative stress, interfering with the healing of tissue
  • Increases the chance of nerve damage

Tobacco Use

  • Nicotine acts as a vasoconstrictor, interfering with oxygen supply
  • Carbon monoxide in cigarette smoke causes lack of oxygen to tissue
  • Post-op patients who smoke show a delay in wound healing and increased complications

Read colleague Sashi Segu’s previous blog, Poor Health Increases Disability and Workers’ Compensation Costs, to learn more.

Comorbid Conditions Often Lead to Lost-Time Claims

Now, on to the human resource damage. Researchers from Harbor Health Systems analyzed more than 7,000 workers’ compensation claims, finding that claims associated with comorbid conditions experienced increases in:

 

 

Workers’ compensation claims are generally categorized by Medical Only or Lost-Time. Lost-Time includes a medical claim, but it is defined by the fact that time must be taken off work to recover. Workers’ compensation claims with a comorbidity diagnosis are more likely than the average claim to involve Lost-Time. The All Claim” columns in the National Council on Compensation Insurance (NCCI) chart show that 81% of claims are of the Medical Only variety. In contrast, when an obesity comorbidity is present, the stats flip; 81% result in Lost-Time along with a medical payment.

Workers’ compensation claims with a comorbidity diagnosis are more likely than the average claim to involve Lost-Time.

 

 

When we compare type of visits with comorbidities and all claims, we see that if a comorbidity is involved, hospital visits make up a high proportion of visits. The following exhibit shows the distribution of visits resulting in a comorbidity diagnosis by provider type for select comorbidities.

 

 

Costs associated with comorbidities are also higher than without. The following chart shows that claims with a comorbidity diagnosis are about double the medical costs of otherwise comparable claims. The y-axis shows the relative value of the comorbidities to the All Claims category.

 

 

Multiple studies have shown that obesity has a profound effect on cost. Duke University performed a study on the effect obesity has on Workers’ Compensation claims. The study, which had 11,728 claimants, showed the following:

 

 

Multiple studies have shown that obesity has a profound effect on cost.

Research conducted by NCCI provided additional insight into the significance of obesity for claims costs.

 

 

Additional sight lines into your human capital data is imperative if you want to be a data-driven company, using solid potential savings as part of your decision-making process.

 

Brandon Conroy

Brandon Conroy

Brandon Conroy, ASA, FCA, MAAA, is a leader in developing and implementing new tools and strategies that reduce client risk. He’s developed and implemented an interactive healthcare cost projection model, underwriting templates, renewal presentations, IBNR tools, a health plan chooser tool, and financial wellness education models. Brandon left Innovu in February 2019 to pursue other interests.

Related Blogs

Using Data Analytics to Manage Your Rx Costs: Part 2

Last week my blog focused on two danger zones that can increase your year-end prescription drug expenditures and derail your fiscal budget. This week I...


Using Data Analytics to Manage Your Rx Costs: Part 1

Ah, Spring! At home the birds are chirping, tulips are blooming, and your annoying neighbor is running the lawnmower at 7:00 am on a Saturday!...


Do Healthcare Giant Mergers Benefit Consumers?

Mergers of healthcare giants have made big news. If you’re like most of us, you’re asking: Why would a Prescription Benefit Manager (PBM) buy an...