Insight, analysis & opinion from Joe Paduda
California workers comp rates are likely to drop again. Clearly, the WC reform initiatives are starting to pay off.
That’s good. Sort of.
When rates drop, employers’ costs go down, leaving more money for investment, profits, higher wages, and perhaps even health insurance.
That’s the good news.
Continue reading California’s rate reduction – not all good news
Coventry has hired a new medical director for their workers comp managed care business. Dwight Robertson has long experience in the business (starting in the late eighties); knowledge of the provider, payer, and managed care industries (USHealth Works, Zenith, Crawford, AIG, UnitedHealthcare, Conservco); and a frank, open, and direct style.
He also has recent experience as a First Health customer, a perspective that may help focus his new company on the customer.
You’re swamped. I’m swamped. Work, kids, parents, sports, Iraq, vacation plans, tax season, Anna Nicole – there are hundreds of urgently important things filling your time, demanding your attention.
Health care reform is too complicated, too big, too partisan, too much to think about.
It’s also going to affect you, your family, your income, our economy and quality of life more than any other issue on the table today.
Health care reform is the biggest, most influential issue facing America today.
Sources indicate Fiserv has terminated its efforts to sell third party biller Third Party Solutions thru Bank of America. This despite Fiserv’s interest in shedding non-core assets, begun under CEO Jeff Yabuki. While Fiserv may still entertain offers, it is unlikely any will approach the rumored goal of $275 million Fiserv was asking for TPS.
While more than a few private equity/venture firms assessed TPS, evidently no term sheets approached the desired valuation. Issues may have included concern about TPS’ “complicated” A/R situation.
Meanwhile, competitor WorkingRx is still for sale…
What does this mean for you?
A temporary continuation of the current awkward third party biller-pharmacy-PBM-payer struggle/business relationship.
The short answer – elimination of a major network and bill review competitor, acquisition of a PBM and case management operator, and an annual revenue increase for Coventry’s specialty division of about $320 million.
Continue reading What Coventry is getting from Concentra – the details
The state of Washington is a monopolistic workers comp state; unless an employer is large enough to be self-insured, it has to buy workers comp insurance from the state itself.
As a monopolistic state, the regulators have even more power than in the highly regulated but non-monopolistic states. One area of particular interest is how the state deals with the WC drug formulary, which specifically excludes Actiq and Lyrica.
Washington’s Health Dept. just released new guidelines on the use of narcotic opioids; the guidelines, their development process, and the impact of same should be watched carefully by regulators, insurers, managed care firms and most of all prescribing physicians.
Two timely topics are in the news; the likelihood of cuts in the additional payments for Medicare Advantage programs and reductions in Medicare reimbursement rates for physicians.
The juxtaposition is just too…obvious to pass without comment.
Matthew Holt isi hosting this week’s edition – click thru for the latest and greatest.
A study just released by the Commonwealth Fund supports my contention that in comparison to the other health care reform measures now in Congress, Pres. Bush’s health care reform plan would have minimal impact on health care costs and the number of uninsured..
On the positive side, Sen Ron Wyden’s Healthy Americans Act and the Stark/Kennedy/Dingell expansion of Medicare look pretty good.
The Bush health care reform (his words, not mine) package was supposed to be revenue neutral. Then, it was going to result in an increase in Federal tax revenue of half a trillion dollars over ten years. Now, it looks like the increase will be a third of a billion.
What gives and who cares and why should they?
