- What baseline assessment of trends regarding different measures of access can be constructed from medical claims data?
An estimated 16 million workers use workers' compensation (WC) insurance annually in California. Many recent policy changes might have affected access to care for injured workers. For this report, the authors assess the various dimensions of access to care in the evolving policy environment to ensure that injured workers have adequate access to needed medical care and the opportunity to achieve better health outcomes. Access to care is an important domain to monitor, especially among vulnerable populations, as patients with better access to care systems are more likely to receive comprehensive, higher-quality care and are therefore more likely to experience better outcomes.
The key objective of this report is to describe access to medical care among injured workers in the state of California, as mandated by Labor Code Section 5307.2. The authors analyze administrative and medical service bill data to examine changes over time for measures related to access to care for injured workers. The authors aim to highlight potential access-to-care barriers in the WC system and to understand whether changes in the WC system may be increasing access for injured workers.
Overall, there were increases in claims, bill lines, and spending per provider. Although these increases were moderate to large in number, many of the differences were not statistically significant. These results suggest a concentration of treatment for injured workers, in which a relatively smaller number of providers furnished care to injured workers. Increasing concentration could offer opportunities for specialization in the treatment of work-related injuries. On the other hand, increasing concentration could lead to future access barriers related to scheduling.
- Fewer providers provided care to California WC patients in 2014 than in 2010.
- The specialties with the largest declines from 2010 to 2014 in WC-participating providers were family medicine/general practice, chiropractic medicine, and pharmacy providers. Most other specialties were relatively stable.
- Over the same period, there was an increase in the number of WC injuries.
Utilization and payments per provider
- The average number of claims per provider increased from 2010 to 2014.
- Payments per provider increased by $8,813, on average, from 2010 to 2014.
- The observed increases in average claims per provider, bill lines per provider, and payments per provider were likely driven by changes in very large practices or health systems treating many injured workers.
Utilization and payments per injury
- For most service categories, utilization within 12 months of injury declined from 2010 to 2014.
- Payments for many service categories changed from 2010 to 2014. Payments for drugs, medicine services, and outpatient-facility services decreased, while payments for evaluation and management services increased.
Timeliness of care
- There was a small increase in the median wait time between injury and any evaluation and management visit.
- The pattern is similar between Northern and Southern California, but there were differences in timeliness of care between types of injury.
Monitoring provider churn
- Provider churn — switching from one primary care provider to another — decreased from 2010 to 2014.
Pathways of care
- Having the first visit in an emergency room occurred in only about 10 percent of injuries, with most of those injuries not resulting in an inpatient admission.
- Injured workers starting with an evaluation and management visit were typically able to be seen within one day of injury, with the second visit typically occurring four to five days later (when it was to see a nonspecialist) and about ten to 13 days later (when it was to see a specialist); that number increased somewhat over time.
- The average number of bill lines in a 12-month period following injury varied considerably across these different pathways, as well as over time.
Table of Contents
Defining and Measuring Access
Data and Methodology
Trends in Provider Participation, Utilization, and Payments
Timeliness of Care and Provider Churn
Pathways of Care
Discussion and Recommendations
Statistical Code Used to Determine Provider and Service Types