I never cease to be amazed by the amount of really good people doing really great work on behalf of injured workers. Melanie Armstrong, RN, Medical Services Manager with American Mining Insurance is one of those shining stars. After speaking with her on the phone, I was immediately compelled to write about her and her team’s efforts on opioid use and getting workers back to work.
As you can imagine, American Mining Insurance insures difficult risk. We are talking mine operators, explosive contractors, mechanics, manufacturing, and transportation, truly the gamut of heavy duty, physical work. Melanie started her position back in 2006 with a goal to reduce the hundreds of injured workers on opioids down to less than one hundred. She’s done just that and she’s still not finished!
Melanie is an exceptionally knowledgeable and compassionate champion for good care on behalf of injured workers. She has worked closely with her business partners over the years to set up controls on opioid dispensing for new claims. She has built a network of group physicians strategically placed to help with her program. The physicians hold each other accountable, agree to follow evidence based medicine and also agree to the company’s vision and objectives. As Melanie puts it “you meet with the providers, explain that this is the program and do you agree with that? And what we see is each doctor nudging the other to do the right thing. So you meet your goals, you meet the objectives because it’s peer to peer communication and more importantly it positively impacts the injured worker’s treatment plan by being safer and cost effective.” The examiners at American Mining believe this too, they are also questioning use and medical necessity at the front end of new claims.
But more importantly, Melanie continues to work tirelessly on those legacy claims with opioid use. You know the ones. Where some payers may tend to try to settle or just continue paying for maintenance opioid drug use, Melanie works that much harder to get them off the drugs. Data, really digging into its use to have conversations with physicians, comparing opioid use against their peers’ trends and impact on improved outcomes (RTW) makes a difference.
Melanie also recognized the key to winning the opioid war is collaboration. She engages ALL stakeholders in the process beyond just the injured worker and physician, but also the examiner, lawyer, nurse, labor and even judges. And she’s admitted that even if the judge doesn’t agree with the opioid reduction plan, Melanie continues to keep fighting on the claim where many of us would have rolled over and continued to pay for more drugs.
Melanie believes deeply that all workers can return to work without continued use of opioids. Her medical background certainly lends her credibility, but its her tireless belief that no one should be on opioids long term that keeps her up at night finding prescribers that will work with American Mining and be in alignment with their claims management philosophy.
I intend to follow up this blog with more details from Melanie on her program at American Mining Insurance and share those best practices with you. Everyone needs a Melanie, American Mining is sure lucky to have her and so too are their injured workers.