By Healthesystems
At the 2025 National Comp conference in Nashville this month, Healthesystems VP of Clinical Services Silvia Sacalis participated in a session focused on the practical management of comorbidities. We sat down with Silvia to learn more about this important and evolving topic in workers’ comp, including how it relates to her area of expertise – prescription drug management.
How are comorbidities a growing area of concern in workers’ compensation?
We know comorbidities are an area of concern because the workers’ comp community is telling us so. In Healthesystems’ 2025 Workers’ Comp Industry Insights Survey, respondents identified comorbidities as the number one barrier to recovery for injured workers and also named comorbidities as the most concerning claim complexity.
Industry data also shows the sheer prevalence of comorbidities in injured worker populations. For instance, a 2025 Workers Compensation Research Institute (WCRI) report shows comorbidities such as hypertension and diabetes are common among injured workers and in workers’ comp claims. And they can negatively impact claim duration, cost, and return-to-work outcomes.
What are the most common comorbidities complicating care for injured workers?
When we talk about comorbidities, we’re referring to the simultaneous presence of two or more diseases or medical conditions in a patient. In workers’ comp, these are usually pre-existing conditions that began before the patient was injured. While many comorbidities are physical, they may also be classified as chronic or acute and behavioral or physiological.
One important point to consider is that if the condition is prevalent in the overall U.S. population, it is likely prevalent in workers’ comp, too. Even if these conditions are not necessarily compensable in workers’ comp, they are still factors in the patient profile that play into the overall complexity of the claim and the management of the injured worker.
Common comorbidities in workers’ comp include:
- Hypertension and Cardiovascular Disease (CVD)
- Mental health conditions such as depression and anxiety
- Substance use (tobacco, alcohol, and prior opioid use)
- Obesity
- Diabetes
- Degenerative conditions such as degenerative disc disease and osteoarthritis
- Chronic respiratory conditions such as asthma and Chronic Obstructive Pulmonary Disease (COPD)
How do comorbidities impact the clinical management of injured workers?
Comorbidities lead to longer recovery times and increase the risk for chronic pain syndromes, which can last for months or years. They may also lead to a higher incidence of complications, for instance from infections or cardiovascular events.
There are also various pharmacological implications:
- Comorbidities like obesity and diabetes can alter pharmacokinetics (how drugs are metabolized by the body). This may mean that dosing modifications need to be considered for these patients, or they may have a higher risk of side effects.
- There may be drug-disease interactions. For example, beta blockers – which treat high blood pressure and cardiovascular disease – can sometimes cause breathing difficulties for people with asthma.
- There may also be drug-drug interactions. An example here is anticoagulants (blood thinners) and NSAIDs (non-steroidal pain-relievers), a combination that can increase the risk of gastrointestinal bleeding.
For all of these reasons, evidence-based prescribing and holistic clinical management are key.
How can we manage the pharmacy side of comorbidities?
This is where a pharmacy benefit manager (PBM) and its embedded clinical pharmacists come in. Managing drug therapy in the presence of comorbidities requires careful medication oversight and strategic coordination. A clinical pharmacist can work closely with claims professionals to identify complex cases where therapeutic regimens are contributing to potential risk or poor outcomes.
These pharmacists can conduct comprehensive medication reconciliation at key timepoints in the claim, applying their clinical expertise and advanced analytics tools to address high-risk drug combinations, adverse events, and other therapy-related risks. In more complex cases, collaboration with prescribers and pharmacists is especially important to align on any concerns in the injured worker’s drug therapy that the prescriber needs to consider, such as contraindications, adherence barriers, or deprescribing opportunities.
Are there any general strategies for optimizing care when it comes to comorbidities?
Yes, whole-person care is one I always recommend. This means looking at the physical, behavioral, and social health factors – anything that can impact a patient’s health. To that end, interdisciplinary team communication is essential – getting the claims professional, clinical experts, pharmacists, and behavioral health professionals to talk to one another about the patient’s needs.
From a technology standpoint, we can use advanced analytics to identify complexities, such as behavioral factors and comorbidities, and make recommendations incorporating these insights to optimize prescription drug therapy. These care plans should always leverage evidence-based medicine to guide treatment and formulary decisions. And finally, taking time to educate patients and caregivers is another powerful way to enhance care. When we talk with patients about medication safety and how to manage their conditions, we set them up for better outcomes.
