Time to take off the CrankyPants and list all the reasons I really love workers’ comp – and yes, there are more than three!

• Work Comp is great because it has a REAL outcome – care is judged based on getting the patient back to functionality.  And that’s how ALL medical care should be measured!
• Work Comp is great because it works pretty well, most of the time.  Not the highest standard, but given all the efforts by all the bad actors to screw things up, it’s a minor miracle it hasn’t come to a grinding halt everywhere.
• Work comp is great because most docs, PTs, pharmacists, and rehab professionals, and yes even attorneys are diligent, responsible, committed, and concerned.
• Work comp is great because the vast majority of claimants really truly want to get better fast and get back to work.
• Work comp is great because it is a pretty small world, reputations spread quickly, and the community supports those who do good work.
• Work comp is great because it is a LOT better than the alternative…
• Work comp is great because almost all of the regulators I know really want to make the system work better/faster/cheaper/more responsibly.
• Work comp is great because there are many smart, loud, and committed folks talking and writing about what needs to happen and why.  Sure they/we get frustrated a lot, but they keep it up.  I’m talking about you, WorkersCompInsider; Roberto Ceniceros, Rebecca Shafer, David DePaolo, Denise Algire, Bob Wilson, Peter Rousmaniere, Richard Krasner, Mark Walls, Jen Jordan.
• Work comp is great because CWCI president Alex Swedlow really knows his stuff, calls it like he sees it, and can make even the most arcane, technical, dry stuff interesting and important.
• Work comp is great because WCRI has upped its game considerably.  Research now uses much more current data and their work in social media is getting stronger by the day.
• Finally, work comp is great because we hold each other accountable.

 

The week flew by, so I’m running to catch up on things I should’ve posted on earlier.

Looks like mother Aetna is getting her arms around Coventry work comp; reports indicate about three dozen Coventry work comp IT folks were laid off earlier this week, including most of the staff supporting BR 4.0, their bill review application.  This will come as no surprise to current clients and loyal readers; under the former ownership, there was little investment in the application over the past several years.

The question is – what happens to those current clients?  

First, indications are Coventry will not be doing bill review either on an application or service basis. If this the case, ALL Coventry BR clients will have to transition to a new provider.

Some payers have been planning for years to move to a competitor; expect Medata and Stratacare to pick up a couple of very big payers.  Mitchell will likely be very active, and MCMC is well-positioned to take on business too.  I would not expect ACS-CompIQ to be much of a factor as contacts indicate their service and performance levels of late have been less than acceptable.

Coventry WC may do a “renewal rights” deal with one of the other BR companies to transition clients, private-label one of the four competitors’ application, or – least likely – tell current BR 4.0 clients they are on their own.  As all Coventry BR clients will have to implement a new application, expect a lot of focus on this in the coming year.

Which may delay other critical IT upgrades/implementations/projects for some time…

Health reform

On the subject of health reform, looks like the trickle of uninsureds signing up for coverage thru the exchanges is going to increase.  A just-released Gallup poll indicates 56 percent of uninsureds who are going to get coverage will do so via the exchanges. Of all uninsureds, 53 percent are planning to buy insurance and 38 percent say they will pay the fine…

One of the less-well-known components of PPACA, outcomes research, has continued to make major progress.  The latest from the Patient Centered Outcomes Research Institute lists key initiatives and reviews the current process.  Of interest to work comp folks;

1. Strategies for preventing the progression of episodic acute back pain into chronic back pain
2. Compare the effectiveness of innovative strategies for enhancing patients’ adherence to medication regimens. Studies should take into account the needs of patients with chronic conditions who are prescribed medications for short- and/or long-term indications.
3. Compare the effectiveness of specific features of health insurance on access to care, use of care, and other outcomes that are especially important to patients.
4. Treatment options for people with opioid substance abuse

This is truly important work.

A good piece on working with work comp PBMs appeared in Claims Management. Authored by Jeffrey Austin White and Cathy Whitford of the Accident Fund, it includes some very helpful suggestions on how to get the most out of your PBM.

Brad wright has had a busy few days; his eponymous blog just went thru a major upgrade, he’s added two excellent authors, and- on top of all that – he’s hosting this week’s HWR

Health Wonk Review: The New Wright on Health Edition

Here in no particular order are items of interest that have come up this week.

• Heath care spending growth in 2012 was a low 3.7 percent – the fourth consecutive year it has been under 4 percent.  Moreover, health spending grew less than GDP growth, so health care’s percentage of the economy actually decreased.

• Rumors persist that bill review and auto insurance tech company Mitchell International is buying bill review tech company Stratacare.  Word from multiple sources is the deal is close to done – that said, this one is especially tough to pin down… That said, there’s a lot of buzz out there.  IF this pans out we’ll dive into the implications – but as of now that’s a definite “IF”.

• There’s a new book out on insurance regulation; it isn’t specific to WC however it is a good quick reference on PPACA, Dodd-Frank, and other timely topics.  It’s the Insurance Regulation Answer Book 2014.

• On a much narrower but critically important issue, I direct you to the current issue of The Back Letter.  A colleague described the key takeaways thusly: “the ongoing Medtronic food fight around BMP (bone morphogenic protein)…The Back Letter has done a nice job identifying that the core issues here go way, way beyond a single product, and focuses appropriately on the pervasive evils (OK, those are my words) that conflicts of interest bring.”
  There’s also an excellent piece on doctor shopping for opioids in this issue; Thanks for the tip Doc.
• A terrific paper by Milliman addresses the “adverse selection” and “Obamacare death spiral” nonsense.  Briefly, newborns, adult females, and older folks look to be the most profitable members – turning the industry on its head.  Back in the good old days – two weeks ago – insurers wanted healthy folks only.  Now, thanks to risk adjustment baked in to PPACA, things are a LOT different.

Enjoy the weekend!

So far, not bad.  Let’s see how my other prognostications worked out…

1. Several more states will adopt clinical guidelines to help determine appropriate/medically necessary care.
   There’s no doubt clinical guidelines help reduce unnecessary, even dangerous care.  A paper published by Medata and ACOEM explores the issue in detail.  Two states (NM and WY) adopted guidelines early this year, NY has continued, albeit slowly, to roll out more guidelines, and Washington continues to lead the way on opioid-related issues.  That said, there is much left to be done.  I’d have to give this a partial yes, as it hasn’t happened as quickly as I predicted, or anywhere near fast enough.
2. We will learn that physician dispensing of repackaged drugs has harmed patients.
   Yes, definitely.  Research published by CWCI, and an article authored by Johns Hopkins University and Accident Fund (to be published in 2014) both prove physician dispensing leads to longer disability duration and more medical treatment. Both use case-mix adjusted data, both come from stellar research organizations, and both put the lie to dispensing companies’ claims that outcomes are improved.
3. The good folks at NCCI will finally schedule a credible liberal speaker for their annual meeting.
   Nope.  While David Gergen was excellent, he is NOT a liberal (or conservative for that matter).  Still waiting for NCCI to get a bit more “fair and balanced”…
4. The level of interest and activity around opting out of workers’ comp will increase – significantly.
   I’d have to say no.  While Oklahoma is moving forward, and there are rumblings from some other states, there isn’t much of a movement or any discernible trend.
5. Predictive modeling for claims management will come of age.
   I should have worded this more precisely, as there’s no metric we can use to say yea or nay.  That said, predictive modeling is much more widespread these days than in 2012, with many large and small payers employing some type of modeling on the front end of claims and at various times during the life of the claim.  So this is a yes.

Overall, I got 6 right, 2 partially right, and 2 flat out wrong.  Yikes, that’s barely passing…

Hope to do better in 2014.  Those predictions coming up later this week.

Congratulations to Broadspire CEO Danielle Lisenbey for her designation as one of Business Insurance’ Women to Watch, a well-deserved award to be sure. Last year saw PMSI CEO Eileen Auen receive the same award. Those worthies are in rare company as they, along with MedRisk’s Shelley Boyce are female CEOs, a rare commodity in work comp.

Why aren’t there more women running workers comp insurers, big service firms and TPAs?

Sure there are lots in senior roles at brokerage houses, vendors and insurers/TPAs, but very few in the top slot. It isn’t due to lack of experience or expertise or a track record of success. And there may well be more women than men in many companies in every position.

Except the top one.

As the father of two intelligent and very capable young women, I’m very much hoping this pattern/misogyny/lack of opportunity changes and fast.

But they have some time, unlike the female mid- and upper- managers who have spent years accumulating expertise and savvy that has still not given them the opportunity they deserve.

Lets get going here boys. It’s 2014.

 

 

Is up at Healthcare Economist, where industry veteran Jason Shafrin provides insights into ACA and all things health policy.

Happy December.  While we were doing all things Thanksgivukkah, the world continued.  Here are the “high”-lights. Such as they are.

The deadline to “fix” the federal health care exchange passed; with White House officials declaring:

1. it never really was a guaranteed drop-dead date; 
2. it’s fixed for most some about 50,000-at-a-time users; and
3. the small employer enrollment deadline has been extended for a year.

What is NOT fixed is the back end; insurers are not getting accurate information about who enrolled; the plans they enrolled in; or the amount, if any, of their subsidy.  It appears the Administration has decided that somehow the insurers will figure it out and if they don’t that’s the insurer’s issue.

That’s unfair, wrong-headed, and blithely ignorant, not to mention irresponsible.  Health insurers have spent hundreds of millions of dollars preparing for January 1, and now they’re being told “we screwed up and it’s your problem if you don’t know who your members are, don’t get paid for those members, and can’t tell doctors if someone is covered.”

On the state exchanges, there’s a mixed bag with states enrolling lots of folks, while others (MD, OR) having their own issues. Those states signing up folks may find the problems with the interface with the feds spill over. Here’s a sampling of the latest figures:

• New York – 76,177
• California – 385,556
• Kentucky – 60,000+
• Colorado – 6001

The Feds get much more oversight authority over compounding pharmacies; a bill addressing the issue was just signed into law that gives the FDA a significant role in monitoring compounders.  Recall one Massachusetts compounder was implicated in illnesses and least five deaths associated with contaminated drugs used for back injections.

In the much smaller work comp world, there’s been a shake-up at Coventry Workers Comp, with Art Lynch taking over the top spot from suddenly-departed David Young. Some may see this as a sign that owner Aetna isn’t interested in comp; I don’t.

On the even-smaller work comp doc dispensing issue, Pennsylvania is the latest battleground, with legislation just introduced to cap reimbursement for physician dispensed repackaged drugs at 110%, with a five day limit on scripts.   Legislation is here; Please please please forward the link and get your government affairs folks involved, and thanks to WorkCompCentral’s Mike Whitely for the heads’ up.

Finally, as far as I know, there weren’t any more acquisitions in the work comp world over the weekend…