Project Results

To see results of the Demonstration project done by the New York Department of Civil Service, click here

Public Policy Goal:

To evaluate an innovative system for integrating the prescription drug benefits provided through traditional health insurance and workers' compensation. It was hoped this system would improve the quality of care by: enhancing access to prescription benefits; eliminating the need for initial out-of-pocket payments and lengthy reimbursement; identifying undesired drug interactions; and improving outcomes of care.

Project Objective:

To compare the costs and satisfaction associated with the use of the "ONECARD Rx" with the costs and satisfaction associated with injured workers using the traditional method of obtaining prescription drugs. Specifically to:

1. Assess the experience of ONECARD Rx during the first 18 months of operation;
2. Determine the impact of the program on health outcomes and expenditures;
3. Provide information that might be useful to others considering similar innovations.

Project Description:

To evaluate the ONECARD Rx demonstration project. This was done by:

• Analyzing electronic administrative data from the State Insurance Fund, the Department of Civil Service, and the New York employee health plans;
• Abstracting data from a sample of paper claims submitted to the State Insurance Fund;
• Surveying workers' compensation claimants with new claims during the ONECARD Rx period; and
• Interviews with key stakeholders

Key Findings and Accomplishments:

1. Injured workers who used the "ONECARD Rx" liked their prescription drug benefit better than injured workers who did not use it. It prevented them from having to pay any out of pocket expenses or file additional reimbursement claims. However, about one quarter experienced longer waiting times at the pharmacy than workers not using the "ONECARD Rx";
2. Based on the paper claims sample, if all drugs paid for by the State Insurance Fund were purchased via ONECARD Rx, expenditures for those drugs would be expected to decline by 30%-36% and there would be additional savings of administrative expenses;
3. There was low enrollment (2.1% of those eligible), primarily due to high number of injured workers for whom no prescriptions were ordered and lack of knowledge of the benefit. The incentive for employee's to use ONECARD Rx is not as large as anticipated. The value of the ONECARD Rx increases for injured workers with the need for drugs and the likelihood of use increased with State Insurance Fund expenditures for other medical and indemnity benefits;
4. Unfamiliarity of the benefit was a problem for pharmacists and they have an incentive to bill directly to the State Insurance Fund (higher reimbursement rates) directly rather than to use ONECARD Rx for reimbursement.
5. Confirmation of a work related injury in the first 24 hours was often a problem;
6. Although sample sizes were low, it appears there were no clear differences in quality of care measures.
7. ONECARD Rx would likely work well in settings where:
   1. Workers' compensation injuries are common, often severe and lasting in nature
   2. Workers' compensation care can be provided in managed care settings;
   3. Discounts for volume can be utilized;
   4. The number of employee health plans with which coordination is needed is small;
   5. Workers' compensation accident reporting and claim submission procedures are electronic, not paper-driven.

Reports and Publications:

   "Findings from the ONECARD Rx Satisfaction Survey"  The Lewin Group, Inc., August 23, 2000.

   Evaluation of the New York State ONECARD Rx Workers' Compensation Benefit, Final Report,  The Lewin Group, Inc., September 20, 2001

Presentations:

David Stapleton, PhD, "Medical Care and Health Services Research Priorities," Robert Wood Johnson Workers' Compensation Health Initiative Annual Meeting, September 6-7, 2001, Newport, RI.

David Stapleton and Gina Livermore, "Findings of the ONECARD Rx Impact Evaluation," New York State Department of Civil Service Employee Benefits Division, October 3, 2001, Albany, NY.

David Stapleton, PhD, "Early Lessons from ONECARD Rx," National Academy of Social Insurance, January 24-25, 2001, Washington, DC.