Happy spring…or what passes for it here in upstate New York, which is one day of temps in the high fifties followed by…snow.
Caught a few folks with my annual April Fools post; here’s a list of 10 that are waaaay better than anything I’ve ever done (Arnold’s dip is great) (altho I gotta say the post about Coventry acquiring United Healthcare was a beauty)
(I’m starting a new thing with today’s catch up; there will be a very brief “this may mean” after each snippet to give my take on potential implications)
Back to the real world…where I’m going to get all macro on you for a few minutes.
First up, an excellent piece on how the “news” distorts our world view. For example, when Anna Nicole Smith died a few years ago, that story alone eclipsed coverage of every other country in the world – except Iraq, which happened to be at war. In fact, Ms Smith’s untimely demise received10 times the coverage of the Intergovernmental Panel on Climate Change’s seminal report.
No wonder Americans don’t understand anything about anything not on the cover of People or watched on TMZ…
This may mean – it’s helpful to read non-US news sources; BBC and the Economist are two places to start.
Gary Schwitzer has an excellent primer on statistical significance for journalists, an area of study that seems to have escaped many of our leading writers. A key quote:
hard-and-fast rules on statistical significance are somewhat problematic. [emphasis added]
The somewhat arbitrary choice to set the p-value for statistical significance at less than 5% was made nearly 100 years ago. There’s nothing magical about it. It’s just become a time-honored norm…
In focusing on statistical significance, let’s not forget to question whether even results with a p-value < 0.05 are clinically significant. In other words, did they make a meaningful difference in people’s lives?
What’s happening in health care?
Hospitals in states that haven’t expanded Medicaid are struggling – big time. Kansas is particularly hard hit. What’s behind this is the PPACA reduced Medicare and other funding for hospitals, anticipating it would be replaced by increased Medicaid and private health insurance coverage, and a concomitant reduction in indigent care. When Kansas – and many other states – rejected Medicaid, the hospitals were left hanging. In Kansas alone, the drop in hospital revenue is almost a half-billion dollars.
The latest data suggests 283 mostly-rural hospitals are in financial trouble; since 2010, 48 have closed. This cannot be attributed solely to a failure to expand Medicaid, but it certainly plays a major role.
This may mean – potential cost shifting to private insureds and workers comp in non-Medicaid expansions states.
Wages are starting to creep up as labor markets begin to tighten and employers find they can’t find the skills they need unless they pay more. There’s also more job movement, as folks leave their current employer for higher pay down the street. This from The Economist:
In labour-intensive industries the American way of low pay, low staff retention and low motivation may be a false economy. Perhaps a third of Walmart’s staff are reckoned to quit in any given year, which could be one reason why it often scores poorly for customer service. In 2014 it said inept shelf-stocking cost it $3 billion a year—more than its planned pay rise. As the economy improves, many retailers are busy hiring new staff only to see others walk out of the door…
This may mean – higher indemnity payments, but potentially shorter disability duration as jobs are more plentiful.
Deals
Finally, in what has to be one of the bigger deals of this young year, United Healthcare is acquiring PBM Catamaran, which is just about to close their acquisition of work comp PBM/network/medical management firm Healthcare Solutions (an HSA consulting client). This will create a third major PBM to compete with Express Scripts and CVS/Caremark; the new OptumRx (UHC’s PBM)/Catamaran combo will rival CVS/Caremark in size with about a billion scripts annually; ESI remains the market leader.
This may mean – added strength for the work comp PBM business due to more buying power and clinical resources.
