1. Catastrophic Injury Gap Analysis ACHIEV January 22, 2015

2. 2 Catastrophic Injuries by Type, WA Department of Labor and Industries, 2005-2013 Injury Type200520062007200820092010201120122013Total Burns 16 (5%) 19 (5%) 22 (5%) 23 (6%) 24 (9%) 11 (4%) 10 (5%) 11 (5%) 8 (4%) 144 (5%) Spinal cord injury 18 (5%) 11 (3%) 16 (4%) 18 (5%) 5 (2%) 5 (2%) 6 (3%) 10 (4%) 7 (3%) 96 (4%) Amputation 13 (4%) 9 (2%) 10 (2%) 11 (3%) 8 (3%) 7 (3%) 10 (5%) 10 (4%) 6 (3%) 84 (3%) Brain injury/pathology 31 (9%) 45 (12%) 39 (9%) 41 (12%) 20 (8%) 23 (9%) 21 (10%) 20 (9%) 23 (10%) 263 (10%) Multiple trauma 249 (73%) 285 (73%) 310 (75%) 248 (70%) 184 (72%) 185 (75%) 157 (73%) 158 (70%) 174 (77%) 1950 (73%) Other 14 (4%) 20 (5%) 18 (4%) 13 (4%) 16 (6%) 15 (6%) 10 (5%) 18 (8%) 9 (4%) 133 (5%) Total Number of claims 341 (100%) 389 (100%) 415 (100%) 354 (100%) 257 (100%) 246 (100%) 214 (100%) 227 (100%) 227 (100%) 2670 (100%)

3. 3 0-6 Months6-24 Months24 Months to endAll periods Medical Aid Costs $98,707,782$72,314,318$54,208,458$225,230,558 Accident Fund Costs $15,652,543$51,509,456$121,588,530$188,750,528 Total $114,360,325$123,823,774$175,796,988$413,981,086 Medical Aid, Accident Fund and Total Cost by Time Period WA Department of Labor and Industries, 2005-2011 Medical AidAccident FundAll Claim Costs Median cost for the claims with DOI 2005-2011 $59,715$43,415$113,457 Median cost for the top quartile of claimants $166,347$195,804$384,026 Median Cost for Claims, WA Department of Labor and Industries, 2005-2011

4. 4

5. 5 Frequency of Catastrophic Injury Claim by Hospital, WA Department of Labor and Industries, 2005-2013 HOSPITALFREQUENCY PERCENTAGE HARBORVIEW MEDICAL CENTER107840.37% PROVIDENCE SACRED HEART MEDICAL 1465.5% ST JOSEPH MEDICAL CENTER813.0% PEACEHEALTH SOUTHWEST MEDICAL 793.0% TG ALLENMORE752.8% ST JOSEPH HOSPITAL BELLINGHAM592.2% KADLEC MEDICAL CENTER552.1% ST PETER HOSPITAL552.1% OVERLAKE HOSPITAL MEDICAL CTR532.0% VALLEY MEDICAL CENTER521.9% YAKIMA REGIONAL511.9% PROVIDENCE REGIONAL MEDICAL CTR 481.8% CENTRAL WASHINGTON HOSPITAL471.8% DEACONESS MEDICAL CTR451.7% YAKIMA VALLEY MEMORIAL HOSPITAL 431.6% EVERGREENHEALTH INPATIENT/OUTPATIENT 341.3% SKAGIT VALLEY HOSPITAL281.0% DEACONESS MEDICAL CENTER250.9% GRAYS HARBOR COMMUNITY HOSPITAL 230.9% SWEDISH MEDICAL CENTER230.9% OTHER - WA HOSPITALS38814.5% OTHER - NOT SPECIFIED1826.8% TOTAL 2670 100.0%

6. 6 Year of Injury Median Length of Time in Days From DOI to Receipt of ROA 20057 20067 20077 20085 20095 20104 20113 20123 20133 Median Length of Time from Date of Injury (DOI) to Receipt of Report of Accident (ROA) WA Department of Labor and Industries, 2005-2013

7. 7 Gaps Summary  Improved communication, care coordination, and planning  Need for improved data systems  Improved access to evidence-based medical care

8. 8 Type of Injury Number of Injured who received mental Health Services % of Injured Workers who received Mental Health Services Median Length of Time from Date of Injury to First Date of Service of Mental Health Service Average Length of Time from Date of Injury to First Date of Service of Mental Health Service Burns5544%44 days203 days Spinal Cord5165%60 days252 days Amputations3653%130 days286 days Brain Injury14365%129 days224 days Multiple Trauma45128%361 days483 days Other2019%110 days301 days All Types75634%224 days384 days Percentage of Catastrophic Injury Claims Receiving Mental Health Services WA Department of Labor and Industries, 2005-2011

9. 9 Next Steps  Ad hoc IIMAC advisory group  Through COHE address readily identifiable coordination issues  Address L&I process improvement needs in medical management and communication

10. 10 Ad Hoc IIMAC Group—Prioritizing Gaps  Nurse case management  Skilled nursing facilities  Brain injury rehabilitation  OHMS  Discharge planning  Other administrative barriers  Research and analytical coordination  Mental health care  Durable medical equipment/prosthetics  (life) care planning  Home modifications  Vehicle modifications  Language and cultural barriers  Early identification, tracking, and timely ROA completion  Access to care  Vocational policies and procedures  Statutory pensions

11. 11 Vision and Updates: Innovation in Collaborative, Accountable Care Primary Occupational Health Best Practices Surgical & Specialty Best Practices Chronic Pain Best Practices Behavioral Health Prosthetics HSCs OHMS Burns