Aug
10

We are all Hawaiians

The disaster in Maui is one of the most awful things I’ve ever seen. An entire town of 12,000 is gone, burned to the ground by a horrific firestorm.

At last 36 are dead, while countless others survived only because they jumped into the ocean to avoid being burned to death.

Here’s how we should think about this.

Of all the places in the US, no one ever thought Maui, a tourist paradise, would ever be in the news for a devastating wildfire. If it can happen in Maui, it can happen in Ohio, or New Jersey, or your home town.

Think it can’t?

So did residents of Lahaina.

What does this mean for you?

Prepare. Now. Not tomorrow, not next week, not as a 2024 goal.  Now.

Here’s a detailed discussion along with a list of what to do.

note – I am on Threads – joe_paduda


Jul
31

Just the facts, ma’am…

Another day, another record-breaking heat wave. And this one is really really bad.

Amazon workers are going on strike…construction crews on the Canadian border are knocking off early to avoid heat…Florida utility workers are postponing checks for gas leaks due to excessive heat risks

Yet some folks still don’t think we humans are the problem…they call up all kinds of specious arguments supported by “I read an article…” “They said…” “This one scientist”

I’ve put together a handy point:counterpoint addressing deniers’ arguments…feel free to plagiarize!

About global warming!

Denier: Scientists don’t agree that humans are driving global warming or, another equally wrong argument that “non-human events” (volcanoes??) are the driver.

Well…Net is even four years ago, almost every climate scientist agreed global warming is caused by humans.

Every credible scientific organization agrees.

More than 400 billion metric tons of carbon have been released into the atmosphere from the consumption of fossil fuels and cement production since 1751- half of which was emitted since the 1980s. 

There are no credible sources asserting non-human greenhouse gas production is a significant contributor to the 45% increase in carbon over the last 150 years. (If you have any, please post in comments below)

Denier: The climate changes all the time…those scientists don’t know why.
Well…research shows climate changes NOT associated with greenhouse gases were most likely generated by earth’s wobbling on its axis – and the sun was cooler long ago.
Denier: You can’t prove human-generated greenhouse gas increases are causing these big weather events.
Well…yes we can.  Attribution science is becoming ever better at predicting future events based on human-caused global warming’s effects.
Denier: Weather was worse (pick a time) and here’s a chart/graph/meme that proves it.
These are misleading misuses of data from credible sources...one fave is this – which is actually from the EPA…which deniers use to say “see…it was worse back in the thirties!!”
A graph showing the temperature of the year Description automatically generated
Well…a “heat wave index” is really misleading as it refers to a specific event – a “heat wave” and doesn’t address global warming.  Fortunately, the EPA has this. As you can see, things varied in the past – up until about 1980…then, the trend is only up.
Screen Shot 2023-07-29 at 2.55.32 PM.png
What does this mean for you?
Feel free to forward this to your denier/skeptic friends and family. 
note: ALWAYS happy to entertain differing viewpoints…please remember to include credible sources for your arguments!

Jul
24

Research on wearable tech – it’s the data too!

Two recently-published peer-reviewed studies give more insight into the utility and effectiveness of wearables/digital health.

Key takeaway – digital health will affect care management and patient recovery in ways we are just beginning to grasp. 

One study examined 864 patients’ use of Plethy’s Recupe program.

Top takeaway – The better a patient’s mood, the lower their pain level and the more they comply with their exercise programs. While correlation is not causation, the connection between mood and recovery is clear.

While this may be obvious, the real takeaway is wearable technology can be an early-warning system, giving care givers and other stakeholders (i.e. claims adjusters, care managers) real-time insight into their patients’ mood and pain level.

Instead of waiting for the practitioner’s notes, reading and interpreting those notes, and (hopefully) determining the patient’s mood and pain level, wearable tech can alert care givers and case managers to potential recovery-delaying issues and intervene before problems become entrenched.

Digital health – specifically a wearable sensor plus Recupe app – is also associated with strong adherence to a home exercise program, significant decreases in pain and improvements in range of motion. This descriptive study looked at total knee arthroplasty patients, finding “Recupe patients recovered to lower pain levels with fewer patient visits and health care utilization [than reported by other published information].”

What does this mean for you?

Taken together, these studies show digital health’s effects are broad indeed…the instant access to key data points can help stakeholders quickly respond to patients’ needs and issues.

note – Plethy is an HSA consulting client.

 

 


Jul
12

A week away from the blog is now past…here’s what I missed.

myMatrixx’ Chief Innovation Officer Cliff Beliveau – one of the smartest and most articulate tech people I have ever met – penned an excellent summary of AI’s potential uses in and impact on workers’ comp in yesterday’s WorkCompWire.

Cliff highlights key opportunities and challenges in claims, medical management, fraud detection and claims oversight…download his piece and save it.

Will automation disrupt construction? A better question might be “when will automation disrupt construction?”

Even better “when will what parts of the construction industry be disrupted by automation?”

All are addressed here.

Net is this – the author isn’t convinced we’ll see massive automation within the next decade...but points to a key use of technology that is already speeding up construction  – and making it more efficient to boot.

Surprise! medical bills and Junk healthplans – defined as plans with significant limits which often aren’t clearly identified up front – are facing increasing scrutiny. The White House is proposing strict disclosure standards and time limits on junk plans…

“The new proposed rules would close loopholes…that allow companies to offer misleading insurance products that can discriminate based on pre-existing conditions and trick consumers into buying products that provide little or no coverage when they need it most,”

The two – surprise! bills and junk plans, sort of complement each other…the junk plans don’t protect families from healthcare providers’ aggressive billing practices.

The proposed rule would highly limit duration of the plans, requiring clear disclosure of policy terms (as in written in English), and close coverage loopholes.

And one more note of interest for smaller employers looking at self-funded plans, and especially level-funded plans...AM Best’s April 28 2023 Market Segment Report indicates:

  • 2 out of 5 small employers (3 – 199 employees) are in level-funded plans
  • Just a year ago it was 1 out of 8 employers…
  • stop loss insurance loss ratios jumped to 85% in 2021 driven by new and very expensive specialty drugs and a lot more million dollar claims.

Just in the last year, 5 specialty drugs, each costing more than a million dollars annually per patient – have come to market.

What does this mean for you?

Smaller employers be very, very careful of self-insuring… 


Jun
22

How much is too much?

The average family of four’s healthcare insurance and related costs are more than $31,000.

Which begs the question – how much is too much?

At what point do workers, employers, taxpayers make that call?

Because it is going to happen.

Look at your budget, your income, your future expenses…when does healthcare become unaffordable? a quarter of your income? a third?

Sure, you aren’t paying the entire $31k…

  • your employer pays a big chunk,
  • taxpayers subsidize employee benefits so
  • taxes are higher due to that subsidy,
  • but your deductible/coinsurance costs are likely several thousand dollars.

What does this mean for you?

I’d ask you to think hard about this – because we will all have to make this choice.

Sooner than we’d like.


Jun
21

Quick hits….

Healthcare costs for the average family of four topped $31,000 in 2023.

That’s the latest from Milliman.

Think about that – what percentage of your annual income is $31,000?

a third?

a quarter?

a fifth?

to calculate your total costs, click here.

Climate change’s impact on worker health and workers’ comp is getting more attention every day.

It is now hitting the C-Suite…

This morning, Harvard Business Review called out increasing focus by business execs around wildfires:

we are seeing a rapid rise in employer inquiries related to employee health and the best practices around air quality concerns.

The piece has excellent recommendations.

Word to the wise – whether you are an insurer, TPA, risk manager or captive manager, regardless of your view on human-caused global warming, when the C-Suite comes calling you’d best have a plan. 

Even better, you’d best have implemented it.

good news…

339,000  – that’s May’s increase in employment. That is spot on the average monthly increase for the last 12 months…

over the last year over 4 million jobs have been created. 

That, dear reader, is just terrific.

More than 1.35 million Americans have been kicked off Medicaid to date…and that’s without totals from Texas and several other states yet to report.

This will:

Argh.

 


Jun
8

Can Texas Mutual help Texas’ health insurance/healthcare needs?

Texas has some rather troubling healthcare problems…and Texas’ legislators are asking the state’s largest workers’ comp insurer to help solve those problems.

First, a few Texas healthcare data points…

Of course, one of the big issues is Texas refuses to expand Medicaid for reasons I must admit are confusing at best.

And the Feds are looking to cut almost $9 billion in funding; Texas has a convoluted tax-and-transfer thing in place which CMS believes is illegal…

I’ve been digging into this of late…collecting background information, interviewing the leader of TM’s new venture and reaching out to legislators behind a bill that asked required Texas Mutual to help (details below); TM is in the process of standing up a health insurance entity that will begin operations early next year.

From the State’s website:

HB 3752 allows a subsidiary of the Texas Mutual Insurance Company to provide a health insurance product to Texans. The goal is to increase access to affordable health insurance for individuals, especially those in rural communities, and employees of small businesses.

Effective Date: September 1, 2021.

The bill would also require the company to fully explore methods to increase health insurance competition, use innovation to increase quality of care for lower costs, avoid discriminating against patients with pre-existing conditions and provide transparency when developing health benefit plans.

(3)  ensuring adequacy of benefits and access to care for individuals in this state with preexisting conditions;

(4)  issuing coverage in a manner that does not discriminate against individuals with preexisting conditions;

Not later than September 1, 2022, the company shall submit to the legislature a report explaining how any anticipated health benefit coverage offerings would comply with all considerations and guiding principles for developing health benefit coverage offerings under Subsection (a).  This subsection expires January 1, 2023.

Gotta admit, this is a head-scratcher.

 


May
31

More hospitals are going to close

More than a quarter of rural hospitals in Texas, Kansas, Mississippi, Alabama, Georgia, South Carolina and Tennessee are at immediate risk of closing. 

Notably these are all states that have refused to expand Medicaid and therefore have a lot of people without health insurance.

The problem is exacerbated by the end of the Public Health Emergency which means more people without health insurance will be seeking care at hospitals at imminent risk of closing. 

Check out your state’s situation here

What does this mean for you?

If you live in the rural south, stay healthy, don’t have an accident, and don’t get pregnant.


May
26

US healthcare quality is poor because…

Consumers don’t care.

Yesterday we dove into the disconnect between patient satisfaction (my nurse was sooo nice and my room…wow!) and quality of care (how likely was I to die).

Today, we focus on how this affects our healthcare. Or, as the researchers put it;

In an era of management by satisfaction survey, how does hospital competition shape the kind of medical services offered to patients? 

Leaving out the coefficients, standardized deviations, null estimates and other researchers’ esoterica, we find:

Local competition among hospitals leads to higher patient satisfaction, but lower medical quality. 

Yep, because we consumers value quiet rooms and nice nurses more than surviving an operation, health care facilities seem to focus more on quietness and niceness than on, you know, patients actually surviving.

And that’s because hospitals are competing desperately for private-pay patients, the ones insured by employers that pay three times more than Medicare. As the authors put it;

as a business strategy, investing in hospitality and hotel amenities offers a much higher return than medical quality. 

this research speaks to broad concerns about the unintended consequences of marketization…Hospitals have traditionally been conceived as an essential service to a community, but are becoming more like products in a consumer marketplace.

Those working in hospitals are increasingly expected to focus on the pursuit of customer satisfaction.

The day-to-day institutional question is shifting from “will this improve patient health?” to “will this raise satisfaction scores?” 

What does this mean for you?

Depends… life > comfort?


May
25

Patient satisfaction ≠ Quality of care

Health care quality is a huge issue in the US; despite claims that we have the best healthcare in the world, reality is far different.

Why?  I’d argue its because healthcare consumer behavior drives our for-profit system.

What makes patients happy is completely unrelated to the actual quality of medical care they receive – or how likely they are to die.

Research article is here.

the horizontal axis indicates hospital performance by deciles for each category…note patient satisfaction doesn’t vary by hospital mortality and varies just a little by medical quality, but varies a LOT by nurse communication.

The effect of nurse communication on patient satisfaction is four times larger than the effect of the hospital’s mortality rate. Yup, as long as the nurse smiles, is responsive and nice, we’re satisfied. Never mind if we’re a lot more likely to die.

Another oft-measured factor, the quietness of the rooms, has a 40% larger effect on patient satisfaction than medical quality.

This is because hospitals provide two separate and distinct kinds of services  – the technical delivery of medical care and “room and board-related” services. Patients are much better at observing and rating the “hospitality” part of their hospital stay than the medical care they get.

To quote the authors;

Hospitality is the fast track to customer satisfaction in medicine. 

What does this mean for you?

Customer satisfaction is the fast track to profits… not to good medical care.