Our fourth (!!) Survey of Workers’ Comp Bill Review is nearing completion…one of the good things about doing this every few  years is we can identify trends and the industry’s evolution.

This year we surveyed both executives and front-line staff. Shockingly, they didn’t always agree…

a few initial takeaways…(ratings are 1 – 5, with 5 being the best)

• The Bill Review industry generally held its level of support from 2018. Overall average (all vendors grades from all respondents) was 3.2, just above, equal to 2018.
• Despite respondents’ overall view not changing, there’s less differentiation among the major players; scores have compressed.
• New entrants are making inroads
• Customer service remains absolutely critical to a successful bill review relationship: considered the top reason a company would change bill review vendors and consistently ranked near the top for “most important bill review attribute”.
  • this is consistent across the dozens of surveys of all types HSA has done over the last 2+ decades…
• There is a noticeable difference between executives and front line employees when evaluating customer service – front line average score 3.6 vs. 4.2 for executives.
• Front line employees have different criteria for quality customer service than executives’…: front liners do not seem to care much about soft skill aspects of customer service but rather customization and timely updates while executives have a more traditional sense of customer service.
• Automation is on most people’s minds – but it isn’t all positive. While nearly all talking about it want more automation (for TAT/auto-adjudication/quality reasons) some still need it to handle the basics better than it currently does.
• E-billing, for largely the same reasons as automation, is getting more popular – especially among larger respondents and internally run bill review respondents.
• Bill review vendors are seen as quite transparent – especially compared to 2018. 90% of respondents believed their bill review vendor to be transparent vs. just 52% in 2018. This is despite several complaints about how convoluted % of savings can be.
• Flat rate pricing is rising in popularity while % of savings is not viewed favorably in most cases.

Cautionary note – these highlights are just that – highlights – and there’s often a lot of nuance underlying respondents’ views and perspectives. That will be described in the final report …a public version of the report will be available in a few weeks. (Respondents get a much more detailed version).

What does this mean for you?

Customer service.

RAND’s long-awaited research paper on Alternative Payment Models for California Workers’ Comp is out.

It is…underwhelming, incomplete, doesn’t focus on key metrics, did not include actual examples of APMs in WC (of which there are many), makes inappropriate comparisons, and…I could go on.

Yeah, I know it’s an initial study, but C’mon…

First, a couple intro notes…

• • in laypersons’ terms, Alternative Payment Models (APMs) are different payment schemes/methodologies used in an attempt to improve care/patient experience/save money.
  • APMs include pay for performance, bundled payments (e.g. flat fee for a surgical episode), per member per month flat fees, global payments and other models.
  • APMs are quite commonplace in Medicare/Medicaid, group health, and exchange healthplans and have been for years.
  • Broadly speaking, despite LOTS of different approaches, studies, methods and work, to date APMs’ impact on those metrics has been marginal.

OK…initial takes on RAND’s report. (note I haven’t thoroughly reviewed and analyzed all 95 pages, but wanted to get this out ASAP)

APM in WC

Most importantly, there have been numerous experiments AND long-standing programs with “alternative payment models” in California and other states…somehow RAND missed these. Yes RAND noted Ohio and Washington have done work on APMs, but RAND missed:

• Carisk’s Pathways2Recovery Program (Carisk is an HSA client)
• Paradigm’s HERO programs. – models include full risk transfer and episode of care payment for shoulder, back, knee and other diagnoses.
• Medrisk has had an episode-based managed physical medicine reimbursement model in place for decades. (Medrisk is an HSA client)
  • other specialty network/service companies have had similar programs
• and others I don’t have time to get into.

I note that these are very patient- and condition-specific and narrowly focused – similar to many group health/Medicare/Medicaid APMs…yet should have been included.

Inpatient vs outpatient

Across all payer types, care has been shifting from inpatient to outpatient settings. Unfortunately RAND spends a lot of time on inpatient APMs and nowhere near enough on the outpatient side. 

Outcomes

What is critically important in workers’ comp (and I argue SHOULD be across all payer types) is sustained and rapid return to functionality. There is precious little discussion of the central importance of this primary goal – and how it might/might not be affected by myriad different APM models/studies discussed in RAND’s report.

Comparisons

RAND relies extensively on comparing hospitals in the Hospital Value-Based Purchasing Program (HVBP) to critical access hospitals that are not in that program…without much discussion of the key differences between these facilities, differences that – I would argue – make comparisons sketchy at best.

One issue – poorer patients are more likely to get care at and represent larger percentage of the patient population at critical access facilities…that demographic also consistently rates patient experience lower than wealthier patients. Thus, comparing HVBP program patient experience data to critical access hospital data is difficult – at best.

Access to care

RAND makes a major point about “stakeholders” concerns about access to care. Actual real scientific research paints a different picture.

Let’s get real.

There’s a whole shipload of factors that RAND mentions (very briefly) that deserve a LOT more discussion.

One example – less than a penny of the US healthcare dollar is spent on workers comp medical. That, dear reader, makes it really hard to get the vast majority of health care providers to do ANYTHING.

What does this mean for you?

There are APM in WC…and a lot of history and knowledge and research and expertise around them. Much could have been learned if they were fully considered. 

For a lot less money.

The recession…or lack thereof.

News this morning that our economy grew at 2.4%…further encouraging news as it appears we are heading for a soft landing (ie very limited or no recession).

Also, personal income growth grew nicely at 2.5%…

From NYT:

“If you’re looking for a working definition of ‘resilient,’ look no further than the American economy,” said Joseph Brusuelas, chief economist at RSM. “This is absolutely rock-solid.”

Good info on the impact of the soft landing from HBR here.

What does this mean?

A good economy = more good-paying jobs and better lives for many.

From the desk of GB’s Dr Gary Anderberg comes an excellent summary of global warming’s impact on specific jobs.  Gary is excerpting from a KFF research report published in January…

“highlights” include:

• We estimate there are over 65 million nonelderly adult workers in occupations at increased risk for climate-related health risks, accounting for over four in ten of nonelderly workers.
• Among nonelderly adult workers, many people of color, noncitizen immigrants, and workers with lower educational attainment and income levels are disproportionately likely to be employed in jobs with increased climate-related risks.
• Nonelderly workers in at-risk occupations are about twice as likely as their counterparts in less at-risk occupations to lack health insurance (16% vs. 7%)

And the temps just keep on rising...this summer will break all records for heat, deaths from heat, heat-related injuries…

and it’s only going to get worse.

What does this mean?

This global warming thing has real consequences – as in higher occupational injuries and illnesses.

Last – and most awful, “the greatest country in the world” – at least when comparing American kids dying by gunshot to other industrialized nations…

from KFF

What does this mean for you?

More of us know of more families devastated by gun violence. 

While ignoramuses continue to deny we humans are changing the planet’s climate, folks with P&L responsibilities are calculating the cost of heat and heat-related injuries.

The direct cost of one “heat prostration” claim is about $38,000.

The average company has to generate $1.2 million in revenue to cover each heat prostration claim.

Want specifics?

Excessive heat also creates more injuries of all types…injuries to cherry harvesters in Washington State increase 1.5% for every 1 degree C above 25 C (77 degrees F) – mostly from falling off ladders.

California data shows:

• • compared to days with temps in the 60s,
    • on days when the temperature was between 85 – 90 degrees Fahrenheit…the overall risk of ALL types of workplace injuries was 5 to 7 percent higher.
    • when temps topped 100 degrees, the overall risk of injuries was 10 to 15 percent greater.

OSHA has a very handy calculator employers can use to estimate their costs – especially useful for the half of the country broiling under record temps.

Oh, and the workers most affected by heat? That would be the lowest paid workers, those leases able to afford time away from work…you know, the ones the work comp industry should be “advocating” for.

What does this mean for you?

Ignore science at your financial peril.