The Texas Workers' Compensation Research and Evaluation Group released a report analyzing health care cost and utilization, based on administrative data reported by insurance carriers to the DWC as of June 2024 for claims with injury dates or service dates from January 2018 through December 2023.

This report’s findings can offer key insights to guide clinical strategy and identify targeted intervention opportunities. The study covers both network and non-network claims across professional, hospital, dental, and pharmacy services.

There is a wide range of insights available in this report, and what follows are key highlights:

• Total health care costs declined by 14%, driven by an 11% decrease in total claims and a 4% reduction in the average cost per claim
• While 11% fewer claims received professional services, the average cost per claim rose 7%, from $1,976 to $2,105
• Pharmacy service costs fell 40% from $69 million to $41 million. This reflects a 35% drop in the number of claims with pharmacy services and a 7% decrease in the average cost per claim (from $638 to $595)
• From 2018 to 2022, the total cost of non-network claims decreased by 19%. The average cost per claim fell 3%, largely due to a 12% decrease in pharmacy service costs, from $915 to $803. Data for network claims was unavailable
• Cost for chiropractic service costs fell by 21%, followed by an 11% decline in both medical services and durable medical equipment costs
• Pharmacy claims decreased significantly, with lost-time claims falling by 32% and the average cost per claim decreasing from $1,069 to $938. Medical-only pharmacy costs decreased by 36%, while the average cost per claim increased by 5%, from $410 to $431.
• The average cost of non-network claims rose 4%, from $3,304 in 2018 to $3,445 in 2022. Lost-time claims’ average cost decreased 7%, while medical-only claims increased 6%

The report also includes a breakdown by claim type, provider, and pharmacy cost by drug category.