Insight, analysis & opinion from Joe Paduda
The press is reminding us on a daily basis of the problems inherent in a health insurance system based on private insurers. And it’s not like the media has to go searching very far for examples of egregious misconduct.
And I’m an advocate of private health insurance.
I met with quite a few managed care execs at RIMS, as well as several network vendors. There’s a disconnect between the two groups.
Hank Stern, veteran HWR host and erudite observer of all things health insurance and policy related hosts this biweekly edition of Health Wonk Review.
Here’s to Hank!
Actiq has hit the big-time.
Newsweek’s latest edition will feature an article on the off-label prescribing of the highly potent narcotic lollypop, an article noting that as much as 80% of scripts for Actiq are for off-label use.
Sources indicate this was brought to the reporter’s attention by an unusual source – the risk management department of The Washington Post, Newsweek’s sister publication, noticed a high incidence of Actiq scripts among its workers comp patients, and started digging into the issue.
May well be more lightly attended than this year, if a very spotty survey of exhibitors is any indication. Vendors, who accounted for at least half of all attendees, were uniformly unhappy about exhibit floor traffic in New Orleans this year.
Pharmacy chains demand higher payment for workers comp scripts. WC takes more work, as the pharm tech has to determine eligibility and do more work to get a script processed. Therefore, it’s logical that the chains charge more for WC.
Except that isn’t what’s happening.
There was not one, but two (2) fire alarms in my hotel last night. So what, you say?
Here’s what. The hotel is chock-full of risk managers, safety professionals, underwriters, and property/casualty claims execs. And not a one of them followed the mechanical lady’s pleas to “exit the hotel quickly and calmly by using the stairs”.
“Risk manager” is a professional designation, not a personal attribute.
Dozens of brand spanking new workers comp pharmacy benefit managers (PBMs). Last year at RIMS every aisle was packed with shiny new booths staffed by folks who, as swiftly became painfully obvious, were rather new to WC.
Either they didn’t want to come to New Orleans (they are definitely missing out) or they are out of business, or out of the comp business. Most likely they found their group health contracts, systems and processes, and cost management techniques just didn’t work in the highly-regulated, state-specific, first-dollar-every-dollar world of WC.
We’ll miss their enthusaism and humor-generating ability (“and how many members do you have? what kind of tiered copays are you using? let me tell you about our unique formulary that controls costs!”) and trinkets.
Sort of.
Coventry released their earnings report last Friday and hosted a “get to know the new workers comp team” event at RIMS last night. Here are the take-aways.
I’ve been following Bob Laszewski’s views on Medicare Advantage with some interest. My take is the program is about to embark on a financial bread-and-water diet, a regimen prescribed by the Democratic Congress seeking funds to offset physician reimbursement increases (or more accurately to prevent decreases) and fund the S-CHIP program.
Bob’s view is that the rural programs will not suffer too much, while MA plans located in urban areas may well have their subsidies reduced. The MA program sponsors are now pulling out the lobbying stops, employing a variety of questionable and downright distasteful marketing.
The latest descent-to-previously-unplumbed-depths is their manipulation of minority groups as “victims” of the heartless Dems.
