Okay, here’s the last of my predictions for the work comp business 2012…
7. The physician dispensing cost control bill currently pending in Florida will pass.
After several years of political intrigue, huge campaign contributions from companies making enormous profits from physician dispensing, and continual efforts by good actors in the system, outraged taxpayers and employers will finally succeed in limiting reimbursement for drugs dispensed by docs to the original underlying price of the non-repackaged drug.
I hope. And so should you.
That won’t’ be the end of the issue; Maryland, South Carolina, and other states are also battling to limit this latest and greatest abuse of the comp system. Even if we win in Florida, there will be many more battles ahead.
8. More payers will diversify their provider network partners.
As Aetna winds up its work comp network operation, payers’ interest in exploring other network options will increase. Following the lead of Broadspire and ESIS and enabled by technology that makes it easier than ever to mix and match provider networks, we’ll see several other large payers award more network business to more network companies. Expect firms such as Anthem, HFN, Horizon, Cofinity, Rockport and Prime to gain share.
That doesn’t mean anyone should count Coventry out. They are the oldest, largest, and most entrenched, and are working hard to address network gaps that will arise when their relationship with Aetna finally ends (which is still a long way away).
9. York Claims will finish the year well on its way to becoming a top-tier TPA.
Through savvy deal-making, a pretty intelligent sales approach, and what is by several accounts a strong focus on doing the right thing for the employer (and not just generating fees for York), York has transformed itself from what was a not-very-good TPA a decade ago to a well-regarded and very well run organization. York’s robust technology and strong market share in key sectors (especially governmental entities in several states), coupled with the expertise they’ve added as a result of acquisition (I’m especially impressed with the JI Companies deal) bodes well for their future.
Perhaps I should modify the headline – York already is a top tier TPA in terms of capabilities; these capabilities will drive them towards the top tier in terms of revenue and market share.
10. Oklahoma will eliminate the requirement that all employers have workers comp insurance.
There are moves afoot in several states to reconsider the work comp mandate, but none have more traction than the one in OK. Whether it’s because they share a long border with the only state that doesn’t require comp (Texas), many of their larger employers also have big operations in Texas and like the opt-out there, or there’s something more ephemeral, a sense that work comp as currently constructed doesn’t work the way it should anymore, Oklahoma may well be the next state to allow employers to opt out.
There’s already a study group authorized by the State Senate that’s looking into the feasibility of the change; their findings should be released in the next few weeks. that will be just in time for the next legislative session which starts in February.
This may not become law in 2012, but I’d expect some movement that allows some employers to opt out, perhaps in a pilot program as early as next year.
Well, there we have it. Oh, there’s one more..
11. My annual April Fool’s post will generate some controversy, tick off a few people, and generally cause consternation among those who either don’t have a sense of humor or can’t read a calendar. It will also not get me in as much hot water as some others because I have to vet it through my PR department…
Jan
12
