Healthesystems participated in the Texas Division of Workers’ Compensation’s (DWC) second quarterly insurance carrier meeting, where the DWC shared updates on key initiatives and trends.

These meetings are vital for keeping up to date with key developments within the Texas workers’ comp system, offering early insight into regulatory updates, emerging trends, and potential challenges, enabling proactive planning for evolving system priorities.

The 2024 Health Care Cost and Utilization Report was shared, and the DWC reported on key benchmarks from 2018-2023.

Total healthcare costs have decreased 14%, dropping from $997 million to $857 million. Claim frequency is down 11% as well, dropping from 296,000 to 264,000. The average cost per claim is down 4%, from $3,367 to $3,24.

In the same time period, pharmacy costs fell 40%, from $69 million to $41 million, with pharmacy utilization is down 35% from 108,000 claims to 70,000. The average drug spend per claim dropped 7% from $638 to $595.

Although not provided in the report, DWC noticed a rise in compound and topical medications; DWC plans to investigate this further, and carriers are advised to monitor closely.

Costs for professional services are down 5%, from $556 million to $529 million, and utilization for these services dropped 11%, from 281,000 claims to 251,000 claims. The average cost for professional services per claim, however, did increase 7%, from $1,976 to $2,105.

The DWC also reported on a telemedicine rule update; as of June 1, 2025, treating doctors may conduct Maximum Medical Improvement (MMI) exams via telemedicine under certain conditions.

As for legislative updates, the DWC reported that House Bill 331 went into effect May 24, 2025, creating a presumption for first responders with heart attacks/strokes. Additionally, effective September 1, 2025, Senate Bill 815 will set limits for AI use in utilization review decisions for workers’ compensation claims. The DWC noted that there will be ongoing legislative focus expected on first responder benefits, coverage/liability, and scope of practice.

And finally, the DWC discussed compliance and other initiatives:

• Death Benefit Audits: 6.7% of enforcement actions but 50% of penalties, carriers are urged to audit internally.
• Performance-Based Oversight (PBO): 2025 Health Care Provider Assessment Plan focused on return-to-work outcomes; finalization expected by August.
• Plan-Based Audit: New audit underway on designated doctor referrals/testing; draft to be shared for feedback once complete.
• AMA Guides Study: DWC evaluating adoption of a more current version.