Category: Workers Comp

Dec
10

The return of 24 hour coverage?

Posted by Joe Paduda on Monday, December 10th, 2007 | Comments

A decade ago a lot of folks were working on ’24 hour’ coverage – the combination/integration of workers comp and group health and disability management. AIG, United Healthcare, Reliance National, Broadspire (nee Kemper) and Unisource Administrators were among the players; the Integrated Benefits Institute was founded, and consultants formed practices and marketed their expertise to interested parties. (disclosure – I was heavily involved in the AIG-UHC, Reliance-UHC, and Unisource-UHC-AIG programs)
Then it all sort of faded away, and not much was heard until today’s announcement that Sedgwick CMS and UHC have re-entered the market.

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Dec
4

WC Bill Review – status update

Posted by Joe Paduda on Tuesday, December 4th, 2007 | Comments

Networks aren’t the only work comp managed care service experiencing change these days. The bill review business is also looking a bit tumultuous, with the landscape shifting in response to, as well as independent of, Coventry’s moves.
I’ll be examining the industry this week, looking at a few of the major entities at a time.

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Nov
29

It’s Utilization, &^%())!!

Posted by Joe Paduda on Thursday, November 29th, 2007 | Comments

“Utilization changes are the driving force in drug cost changes for WC.”
That’s the key takeaway from the expanded version of NCCI’s annual WC Prescription Drug Study; this 2007 edition goes well beyond prior editions to include more detailed information on cost drivers, stat-by-state variations, generics, and the growth in drug spend during the life of the claim.
But the key is utilization.
The key takeaway? Utilization, not price, is driving drug spend.

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Nov
20

What does Medicaid have to do with workers comp?

Posted by Joe Paduda on Tuesday, November 20th, 2007 | Comments

Nothing. At least it shouldn’t. But two states (California and New York), base their workers comp fee schedule for drugs on Medicaid’s rates – despite the complete lack of similarities between the two.
Why is this a problem? Lots of reasons.
Most significantly, it takes two seconds for a pharmacy to verify a Medicaid claimant’s eligibility and obtain approval for a script. Two seconds. That’s because Medicaid in most states is ‘single payer’ — there’s one place the pharmacy has to check, and only one. And, the claimant usually has a card, and if not, the pharmacy knows exactly what codes to enter to process the script.
Not so in workers comp.

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Nov
8

The buzz from the comp conference

Posted by Joe Paduda on Thursday, November 8th, 2007 | Comments

You can’t cover the national comp conference without addressing the gorilla in the room – Coventry Workers’ Comp.
With capabilities in networks, bill review, pharmacy, case management, MSAs, Coventry touches/impacts most of the major payers, and a lot of the mid-tier and smaller ones as well. Here’s what I heard.

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