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Zurich wins Business Insurance award

April 2, 2019

Zurich North America’s managed care team was named “Managed Care Provider Team of the Year” for its multifaceted approach to managing and mitigating opioid- and benzodiazepine-related risks.

Zurich North America took home the “Managed Care Provider Team of the Year” award at the 2019 Business Insurance U.S. Insurance Awards.

Dr. Nina McIlree, vice president, Medical Management, for Zurich North America, accepted the award at a March 21 ceremony in New York.

The award “recognizes a team of professionals at a workers compensation managed care provider … that provides services to commercial clients.”

Zurich opened its award submission with a quote:

“The epidemic of opioid addiction and overdose has appropriately garnered national attention.... By contrast, there has been little effort to address inappropriate prescribing of benzodiazepines….” – “Our Other Prescription Drug Problem,” featured in the New England Journal of Medicine (February 2018)

That quote may have caught the judges’ attention, but it is likely that Zurich’s—and its customers’—positive results in the fight against drug addiction is what earned Zurich the award.

Like opioids, benzodiazepines have a high potential for abuse and have seen rapid spikes in prescribing patterns. When combined with opioids, the results can be fatal—nearly one of three opioid deaths involved a benzodiazepine.

Zurich’s managed care team continues to take a multifaceted approach to managing and mitigating opioid- and benzodiazepine-related risks. The goal is a high-quality and safe outcome for injured workers and a reduction in claim costs for customers.

Here are some of the key activities that have helped Zurich reach these goals:

  • Advanced data applications: Vital Signs is a predictive model designed to evaluate a series of workers’ compensation claim variables including prescription drug use. Insights and alerts are delivered to claims professionals in real time and help support decision-making based on the unique circumstances of each claim. Recent enhancements included an expanded injury scope and optimized scoring methodology.

    Vital Signs now identifies opportunities for nurse case management (NCM) referral 2.5 times faster than before. In such cases, early NCM assignment can produce significant benefits, including $6,000 to $26,000 in terms of cost mitigation, according to our claims monitoring, and the possibility of a faster, fuller recovery for the worker.

  • Controlled substance reviews: Leveraging pharmacy data, our automated algorithm evaluates a series of factors related to controlled substances, including: Opioid use: Chronic, high-dose and/or multiple opioids; use of Demerol® or a benzodiazepine; multiple pharmacies and/or prescribers.

    Zurich’s medical team reviews flagged claims files and works with the prescribing physician to identify alternatives in the best interest of the injured worker. Through targeted outreach, referrals and escalation, Zurich has reduced opioid use on average by over 50 percent as of year-end 2017.

  • Regulatory response: In response to California’s drug formulary implemented in January 2018, opioids and benzodiazepines are a key focus for Zurich with prescriptions sent for utilization review. Zurich’s opioid and benzodiazepines results have been stunning: 49% lower spend, 62% fewer claimants and 63% less prescriptions.

  • Customer education: In addition to developing solutions that promote better claim outcomes, Zurich is also committed to educating customers and brokers through a multichannel approach including in-person and webinar presentations, videos, blogs, infographics and more.

Such efforts have enabled Zurich and its managed care team to deliver impactful results for its customers and demonstrate how they can help manage and mitigate risk—not just insure against it.

Zurich was named a finalist in three other award categories:

  • Diversity & Inclusion Initiative of the Year;
  • Insurance Underwriting Team of the Year (management liability/professional liability/cyber liability); and
  • Insurance Consulting Team of the Year.

If you’d like to learn more, contact David Hilgen.