Insight, analysis & opinion from Joe Paduda

Nov
15

The soon-to-be not-so-Big Three

The big three will soon be the not-so-big three, expecially if their legacy health care cost problem is not resolved soon. I’m referring to the domestic US auto industry, where legacy health care costs have been crippling GM Ford and Chrysler for years. And the worst is yet to come.
Chairmen of all three stopped into the White House to plead their case yesterday, and were met with the usual “we’ll get right on studying that problem.”
One of the more interesting proposals advanced by the auto chairs is a reinsurance pool to cover catastrophic claims.
And even more interestig was the hopeful tone struck by GM’s Rick Wagoner when he noted that the new Democratic majority appears interested in helping employers struggling with health care costs.
What does this mean for you?
When big manufacturers get behind major changes to the US health care system, we’re closer to finally attacking the problem.


Nov
15

Why Mike Leavitt needs Dale Carnegie

Yawn.
It didn’t take the HHS Secretary Mike Leavitt long to start in with the tired rhetoric about the evils of government-run health care(free reg req). Leavitt does not want the Feds to negotiate drug prices. Heck, he doesn’t even want Congress to give the Feds the power to do so.
Why not? What’s the Secretary scared of?
According to him, it’s the old archenemy of all things good – government-run health care. While I too am a firm believer in the power of the free market, Leavitt’s logic falls apart upon even the most rudimentary exam.

Continue reading Why Mike Leavitt needs Dale Carnegie


Nov
14

In-housing v off-shoring

I’ve been spending a good deal of time examining the growing trend in medical tourism – Americans seeking medical care in far-off lands. The motivation is primarily cost; procedures can be less than half the cost overseas compared to US prices.
Other employers are contracting directly with providers, eliminating the health plan “middle men”.
Another option for employers seeking to gain more control over health care is via in-house clinics.

Continue reading In-housing v off-shoring


Nov
14

Better and better – Health Affairs’ blogging

The blog run under the auspices and banner of the highly esteemed journal “Health Affairs” is starting to get some traction.
Recent posts examining the implications of the elections on health care, GOP and Democratic views of the elections on health policy, and a well-done piece on the reality of the nursing shortage all bode well for the journal’s blogging future.
Now if they could just figure out how to post every day…


Nov
13

Developments in the WC PBM world

Cypress Care, one of the leading Workers Comp Pharmacy Benefit Management firms, has just announced the company has received a “strategic investment” from Dallas-based Brazos Private Equity Partners. The company has also added David George (former President of AdvancePCS) to the management staff; George will be taking over the CEO spot from co-founder Hank Datelle and has also made an investment in Cypress Care.
The press release contains the typical comments about all parties’ delight at the deal and enthusiasm for the future. As one who has been directly involved, I can attest that in this case, the PR has it right. David George is a highly experienced and very well respected managed care pro with stints at United Healthcare and on the Board of Concentra, Inc. Bart Hester, a former colleague of George’s at AdvancePCS will be joining Cypress as EVP Account Management and Strategy; the rest of the Cypress senior management team including co-founder Lisa Datelle and President Marc Datelle are all staying with the company.
Note – Cypress Care is a Health Strategy Associates consulting client an dsponsors our annual Survey of Prescription Drug Management in Workers Compensation.


Nov
9

Results of California’s WC reforms

OK, I know a lot of readers are not exactly holding their collective breath waiting for more updates from the WCRI conference…but a few are. (hard to believe, I know…)
So, for those eagerly waiting, here’s the latest.
A panel discussed the results of the reforms to the California WC system. Overall, the results have been quite favorable wiith rates declining, and better control over medical care and costs.

Continue reading Results of California’s WC reforms


Nov
9

Texas’ WC reforms – predictions for the future

A panel at the WCRI conference discussed the TX workers comp reform initiatives aka House Bill 7; here are my impressions in chronological order.
The (relatively) new WC fee schedule, (new as of 8/2003), set reimbursement at Medicare +25%, and allowed for employers to direct injured workers to specific health care providers. The change was a significant decrease for surgery, and an increase for Evaluation & Management services. Surgical prices dropped 31%, while E&M prices jumped by over 23%.

Continue reading Texas’ WC reforms – predictions for the future


Nov
8

WCRI’s new workers comp medical price research

I’m attending the annual Workers Compensation Research Institute today and tomorrow and will be posting from the meeting.
The first presentation was an analysis of WC provider fee schedules, comparing the actual fee schedules to providers’ operating expenses. It will come as no surprise that some states’ fee schedules are pretty low, while others pay up to 2.5 times more than Medicare (alaska, for one).
No extra credit for guessing which type of service is paid at a higher rate; most fee schedules pay relatively more for surgery than for evaluation and management services.

Continue reading WCRI’s new workers comp medical price research


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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