Category: Research

Oct
19

Research (and other important stuff) Roundup

Posted by Joe Paduda on Friday, October 19th, 2018 | Comments

It’s that time again – WCRI has released it’s latest series of CompScope reports, the most detailed and thorough review of all things work comp medical in 18 key states. If you are an investment analyst, industry tracker, or involved in planning for a TPA, state fund, insurer or large employer, get yourself over to WCRI and get those reports!

If you want to understand what Medicare for All really is, how it might work, and what it means to you, read KFF’s summary review. There are 8 (!) proposals now making the rounds, and I’m betting your healthcare will come from some version of universal coverage within the decade.

Excellent piece by Roberto Ceniceros on premium fraud and its impact on employers and insurers. I’ve got to give credit once more to Matt Capece of the United Brotherhood of Carpenters – he’s been a major force exposing premium and payroll fraud all across the country. For his efforts, IAIABC gave Matt its Samuel Gompers Award. And kudos to Roberto for his in-depth reporting on a critical issue.

NCCI continues to up its game, making research accessible and relevant. Medical marijuana, opioid legislation, air ambulance regs – it’s all here.

Our penultimate piece is a bit more intel on rideshare and rural America – well worth a read if you’re involved in this narrow-but-deep slice of the work comp services world.

Finally, as it’s election season we need to hold those political candidates accountable: Andrew Sprung’s dissection of candidate Bob Hugin’s dissembling on the dismantling of the ACA is just what voters should be asking.

And, from the “coolest/dumbest thing I’ve seen all week” is this. Wondering if this is the answer to speedy ridesharing on the Russian steppes. Who wouldn’t want a jet engine in their Uber?

Hat tip to the Drive!

 

Sep
28

Research Roundup – Friday edition

Posted by Joe Paduda on Friday, September 28th, 2018 | Comments

So, hard as it is to believe, there was some non-Supreme Court hearing stuff going on this week.

I know…I missed most of it too.

So, here’s some of the most important research we all missed while overloading incoming web servers watching yesterday’s hearing.

Drugs, Opioids, and profiteering physicians

The fine folks at WCRI continue to do lots of stuff so we don’t have to. Two things stand out this week; a compendium of every state’s work-comp pharmacy-related regulations, and a webinar on the effectiveness – or lack thereof – of regulations designed to address the should-almost-never-be-allowed practice of physicians dispensing drugs for profit.

Out in the real world, we learn that in many cases it’s harder to get access to drugs to deal with Opioid Use Disorder than to get the opioids that cause OUD. 

14% of plans do not cover buprenorphine/naloxone, a preferred medication for OUD maintenance treatment. Only 11% of plans cover implantable buprenorphine and 26% cover injectable naltrexone, both of which may facilitate adherence for patients with OUD. Seventy-three percent of plans cover at least one abuse-deterrent opioid pain medication, while 100% of plans cover at least one short-acting opioid pain medication.

Hey P&T committees, get with the times!

Making sense of data

myMatrixx’ Cliff Beliveau has an excellent piece on using data visualization to help explain complex issues. Well worth a read.

Dumb things companies do

Roberto Ceniceros’ column on Lockton’s denied-claim research has been on my desktop for weeks. I’ve read it twice, and you should too. Net is this – denying claims is often a really bad idea.

Finally, from the professor who teaches what may be the only most important class in business school comes an eye-opening look into how work is bad for you. The logic and rationale is not what you may think. Here’s just one excerpt, which I would label Companies are not smart:

Companies do not act on the basis of the best evidence. They merge even though much research shows that mergers destroy value. They use forced-curve ranking systems for performance reviews even though extensive evidence documents the harmful effects. There is no reason to believe they would behave any differently with respect to their human capital.

Evidence shows work hours are negatively related to productivity, that giving people more autonomy leads to higher motivation, and that layoffs often harm performance, including profits. So in making employees sick, employers have created a lose-lose situation.

Enjoy the first weekend of fall.

Sep
21

Work comp/Auto medical bill review – initial takes

Posted by Joe Paduda on Friday, September 21st, 2018 | Comments

We are about a third of the way thru interviews for the third Survey of Medical Bill Review in Workers’ Comp and Auto; here are a few initial takes.

  • Bill review has progressed a lot in the last decade, with key advances in:
    • Auto-adjudication of more bills
    • Better coordination/integration with document management
    • Ability to more readily connect with other key systems e.g. treasury/finance, state reporting, claims
  • One area that still needs a lot of work – automated integration with UM/UR applications
  • E-billing is leading to more auto-adjudicated bills, but headaches as well.
  • In general, respondents don’t see a lot of differentiation among bill review vendors.
    • But some respondents point to key differences between vendors and application providers that should be top of mind for payers
  • The most common pricing methodology? so far, it’s a flat fee per bill for bill review and the old percentage of savings for everything else.
  • that said, there are some pretty innovative approaches to pricing out there that bear watching

The last time we did this survey was six years ago.  We will be comparing and contrasting results to document what’s changed and where things are going.

If you’d like to participate, shoot an email to infoAThealthstrategyassocDOTcom.  Substitute symbols for the caps.

Sep
20

Research Roundup

Posted by Joe Paduda on Thursday, September 20th, 2018 | Comments

Trying a new idea out today – a post that is

a) a quick overview of the latest research on stuff that’s important (at least to me) and

b) my thoughts on what it means to you.

Disability

A new report documents the results of a very robust study of work comp patients done in Washington State. It found that “reorganizing the delivery of occupational health care to support effective secondary prevention in the first 3 months following injury” reduced long term disability by 30%.

Briefly, patients treated in the State Centers for Occupational Health and Education were significantly less likely to become permanently disabled than those treated outside the COHE system.

This means – find out what the COHEs are doing, and replicate it.

Hat tip tp Gary Franklin MD MPH, Medical Director of Washington L&I

Employment

We’ll need all those workers back on the job, if the World Economic Forum’s forecast that automation will create millions more jobs than it will destroy. The report claims there will be 58 million more new jobs than lost jobs as companies shift to more automation – and this is within 5 years.

HOWEVER – these jobs will go unfilled if trained and capable workers aren’t around to staff them.

This means – companies best invest in training for tomorrow’s jobs. And integrating this with return-to-work would be pretty damn brilliant.

Monday Claims

More in the string of great stuff from NCCI, this week the Boca brainiacs released a study of “Monday morning claims.” The news is..there’s no news. The implementation of the ACA (THANK YOU for not mis-calling this “Obamacare”) did not change the percentage of claims that were reported on Monday, even in those states that had the largest decrease in the uninsured population post-ACA.

This means – we need to stop talking about Monday morning claims – which aren’t a thing.

More to come next week

Aug
28

Asbestos is back!!?

Posted by Joe Paduda on Tuesday, August 28th, 2018 | Comments

The Trump Administration has loosened rules that will allow broader use of asbestos in manufacturing.  

Here’s how Fast Company put it:

A lengthy report of EPA’s new “framework” for evaluating risk, placed into effect this month, detailed how it would no longer consider the effect or presence of substances in the air, ground, or water in its risk assessments—effectively turning a blind eye to improper disposal, contamination, emissions, and other long-term environmental and health risks associated with chemical products, including those derived from asbestos.

No one knew how dangerous asbestos was until people started dying from exposure to it. How many thousands of dads, brothers, friends, moms and sisters would have been saved if researchers had studied exposure risks and informed the public?  How many tens of billions of dollars would have been saved, not spent on medical care, remediation, lawyers fees?

I don’t think we’ll see any big increase in the use of asbestos – the litigation risk is just astronomical and no insurance company would allow it – so no business will use it (wait, there are unscrupulous business owners that will do anything for profit, so there is some risk…)

But that’s not the point.

The point is that the health risks of any number of substances, compounds, fibers, chemicals will NOT be evaluated before we are exposed to them.

I’m thinking liability insurers are going to be quite concerned by this.

With the EPA abdicating its responsibility to protect the environment and us, the risk of lawsuits and huge awards increases dramatically.

While no insurance company will accept the liability for increased use of asbestos, they may well start re-writing coverage to ensure they aren’t on the hook for tomorrow’s asbestos suits.

What does this mean for you?

Increased health risks over the long term, and increased insurance costs over the near term.

Aug
17

The Opioid Update

Posted by Joe Paduda on Friday, August 17th, 2018 | Comments

72,000 kids, moms, dads, brothers, sisters, best friends died last year from opioid overdoses.

Things are so bad that despite the ever-climbing death toll, news reports announcing the butcher’s bill manage to sound somewhat positive, citing reductions in deaths in a handful of states. Meanwhile, between 2.1 and 4 million Americans suffer from Opioid Abuse Disorder. 

Fentanyl is now the biggest driver, accelerating a years-long upward trend begun by rampant over-prescribing of prescription opioids.

Researchers cite some reasons for optimism; death rates in the west remain pretty flat – likely because the heroin used there is hard to mix with fentanyl…however there’s evidence that the black tar folks are figuring out how to do just that.

Meanwhile, Congress dithers; debating, pontificating, speechifying – and doing precious little.

To date, they’ve allocated a mere billion dollars to the biggest health crisis we’ve seen in decades.

Here in workers’ comp land, CWCI just released an analysis of polypharmacy among work comp patients in California. (Polypharmcy refers to patients getting multiple drugs.)

Two key takeaways:

  • A combination of  opioids, muscle relaxants, and anti-inflammatories was the most common drug cocktail. (opioids combined with muscle relaxants are very, very dangerous)
  • Shockingly, fully one-fifth of patients prescribed 3 or more drugs have back strains without skeletal involvement. Another tenth have various other sprains.  Yup, strains and sprains account for about a third of these patients.

What does this mean for you?

The next time someone protests the UR/IMR process, ask them how many more patients have to die from opioids before they accept that doctors need oversight.

 

Jul
27

Friday catch-up

Posted by Joe Paduda on Friday, July 27th, 2018 | Comments

I thought summer was supposed to be slow…

Sorry for lack of posts last two weeks – just slammed with client work.

here’s what I should have been posting on.

Economy drives employment drives workers comp

The economy boomed in the last quarter, with growth around 4 percent, a number we haven’t seen for four years.

Chart from Statista.

That’s the headline; the real story is less positive. Growth was partially driven by:

Here’s hoping things continue without overheating; forecasts aren’t so positive.

Implications – Lots of jobs open means higher wages and incentives for employers to keep workers on the job and get them back to work ASAP.

For those who just can’t get enough of the tariff issue – here’s the Harvard Business Review’s historical perspective.  Yes, I am a nerd.

Heat = more work-related illnesses/injuries

Deadly fires in Yosemite and California and Greece and Siberia and Sweden. A heat emergency in Japan. Temps in LA at record levels – even overnight. Scorching temperatures here in upstate New York.

Yes, climate change is happening. Yes, humans are the cause. And yes, it’s going to impact workers.

If the wet-bulb temperature (equivalent to that recorded by a thermometer wrapped in a moist towel) exceeds 35°C [95 degrees Fahrenheit], even a fit, healthy youngster lounging naked in the shade next to a fan could die in six hours.

Shifts in weather patterns are far more significant than overall global warming as they lead to very hot and dry conditions some places, hot and wet others, and exacerbate storm intensity among other effects.

Kudos to NCCI – they’ve been producing some highly relevant, much needed, and very useful research of late. Detailed, thorough, and diverse, and well worth your careful review.

One different angle is their ongoing work to highlight the good done by the  workers comp industry every day. Today’s installment is another example of this; there’s a lot more recognition that work comp is about the patients and employers.

Well done.

Opioids in the Federal workforce

Thanks to the great folks who handle my social media, website, and all that technical stuff I don’t understand at all, we’ve got video of testimony before the House Committee on Education and the Workforce.

 

Jul
23

Sloooooow progress in California’s work comp system

Posted by Joe Paduda on Monday, July 23rd, 2018 | Comments

That’s the quick takeaway from a review of CWCI’s just-published report on drug prescription management in the Golden State. (there’s a lot more to this study than this…)

As cognoscenti (a fancy word for nerds) know, the utilization review (UR) and Independent Medical Review (IMR) processes were intended to help ensure patients got the drugs they needed quickly, were protected from dangerous or potentially unsafe drugs, and prescribers would learn what was likely to fly and what wasn’t.

This last was based on decades of experience in healthcare, observing what happens when evidence-based guidelines protected by utilization review processes to encourage/require compliance are put into place. In most every other instance, providers adapted their care models to meet the standards, and after a flurry of appeals at the outset, things settled down a lot.

But, well, hey, this is workers’ comp…

The first two (better care and patient safety) seem to have worked pretty well, but up till now, it appeared that WC prescribers were militant non-learners as the volume and type of UR/IMR requests just didn’t taper off.

My assessment of CWCI’s report is (equivocation alert) prescribers MAY BE changing their behavior – a wee bit. 

Here’s what’s driving my optimistic take (from CWCI):

After the formulary took effect last January, prescription drug requests declined from 44.5 percent to 40.7 percent of all UR decisions in the study sample – a relative decline of 8.5 percent.

I mean, how could one not dance in jubilation, right?

Well, perhaps prescribers have decided to not keep pushing that stone up the hill. Or perhaps it’s just a temporary hiatus.

I’m going to remain optimistic, and you should read the entire report because there’s lots of good info in it.

What does this mean for you?

Less hassle, better care. We hope.

 

Jul
13

Friday catch-up – Hospitals and a BS alert

Posted by Joe Paduda on Friday, July 13th, 2018 | Comments

Glorious week here in New York’s Finger Lakes – high 70s, lots of sun, nice breeze.  I know, Florida friends, you’ll be gloating in February when it’s 10 below and snowing sideways…

Hospitals

NCCI’s just-released research indicates facility costs are rising, driven at least in part by less competition among hospitals. Key takeaway:

Reductions in hospital operating costs do not translate into price decreases. Research to date shows that hospital mergers increase the average price of hospital services by 6%−18%.

Kudos to NCCI for this research and the piece itself. The article is very well-written, concise, and understandable for us laypersons. NCCI has upped its game considerably of late, producing excellent work and explaining what their findings and implications thereof.

I’m going to focus on this in a post next week – there’s a ton of insights here that demand careful consideration from payers and employers.

For those looking to better understand how hospitals set prices, determine what their actual costs are, and how they use data to reduce costs while improving care, read this piece in HealthAffairs.

And there’s this – a hospital in the Cayman Islands is delivering excellent care at a fraction of the cost of US facilities. The facility is fully accredited, provides a simple, bundled price for each procedure (instead of bills for each doctor, facility fee, procedure, implant…) and will be a very attractive option for many Americans with specific health needs.

Medicaid

My bullshit detector went nuts when a press release hit the inbox this week.

In what has to be one of the crappiest, most distorted, unscientific and biased pieces of “research” ever done, a so-called “non-partisan” entity calling itself one of the nation’s “leading public policy organizations” claims:

in some states, up to 70% of able-bodied adults enrolled in Obamacare expansion earned $0 in income

I’m going to dig into this steaming pile of nonsense next week, but for now, know that this is flat out wrong.  There are so many errors, distortions, flat-out wrong statements, conflations, and unsupported conclusions in this “research” it just boggles the mind.

It’s one thing to have principled disagreements on policy. It’s entirely another thing to lie your ass off.

For those interested in real research by unbiased experts, the Kaiser Family Foundation’s recent report on Medicaid Work Requirements is required reading.

OK, rant over – till next week.

 

Jul
11

A billion dollars and better care

Posted by Joe Paduda on Wednesday, July 11th, 2018 | Comments

Work comp drug costs have dropped by over a billion dollars over the last eight years.

What’s even better news is this has been driven largely by sharply lower opioid utilization.

The bad news is there are still far too many patients suffering from Opioid Abuse Disorder brought on by massive overprescription of opioids.

Across all 29 workers’ comp payers surveyed by CompPharma, drug costs dropped almost 10 percent last year compared to 2016. (Total US drug costs decreased last year by 2.1 percent)

The results come from our annual Survey of Prescription Drug Management in Workers’ Comp, a project now in its fifteenth year.

Payers cited clinical programs as the primary driver of lower opioid and total drug spend. A key takeaway come from payers’ views of formularies:

many respondents did NOT want to abandon their internal formularies in favor of a one-size-fits-all blanket formulary. These payers noted patients are all different, their needs evolve throughout the course of treatment and recovery, and therefore their pharmacy needs would change as well. While they were in favor of managed (state-mandated) formularies for initial fills, they want flexibility to adapt to the patient’s condition and needs without putting undue burden on the prescriber and pharmacy to comply with prior authorization requirements.

The public version of the Survey Report is available here for download; respondents received a more detailed version of the Report.

As the author of the Survey, I’d be remiss if I didn’t thank the respondents who have provided data and their views and opinions over the last 15 years. Their willingness to share their insights and perspectives has gone a long way to helping improve patient care.

I’d also note that work comp Pharmacy Benefit Managers have been largely responsible for reducing employer’s drug costs and opioid overuse. Another way to put this – PBMs have dramatically reduced their revenues by improving their customers’ and patients results.