Category: Workers Comp

Apr
10

those damn vendors

Posted by Joe Paduda on Tuesday, April 10th, 2007 | Comments

Insurance companies, employers, and TPAs rely on vendors to process bills, build and operate networks, manage prescriptions and PT, support litigation, and provide expert advice on problematic medical issues. In many instances the vendors are selected thru a competitive bidding process, wherein the lowest bidder gets the deal, or at the least has a much better chance of landing the business than their more costly competitors.
But in others, the selection process goes on seemingly without end.

Continue reading those damn vendors

Apr
5

Work comp reform – the Dark Side

Posted by Joe Paduda on Thursday, April 5th, 2007 | Comments

California, New York, and Texas are all in various stages of reforming their workers comp systems. Florida’s reforms have been in place for several years, and rates have dropped thru the floor. WC premiums have decreased even more, with some employers seeing cuts of 50%. South Carolina may also see changes, and there are initiatives on the table in several other states as well.
Lower costs are great, for the buyer. Employers can move on to other important issues, shoving risk management initiatives to the bottom of the pile. They can move their business easily, as there are more work comp insurers clamoring for their business, eager to lower premiums even further in an effort to capture market share.
But there can be a significant downside to successful reform efforts.

Continue reading Work comp reform – the Dark Side

Apr
2

AIG – profits and reserves

Posted by Joe Paduda on Monday, April 2nd, 2007 | Comments

The financial reporting season for publicly traded companies using the calendar year is just about over. AIG’s numbers look rather good, with a 34.1% improvement in net profits on revenue growth of 3.9%. Sure, the company has had its struggles with regulators, but the overall results are quite impressive.
The increase in profits came on the heels of a $1.8 billion increase in reserves for workers comp claims over 2005. The reserves were bumped up despite an improvement in the loss ratio for the DBG operation (domestic business group, the home of most of AIG’s work comp business) from 82.5% in 2005 to 69.1% in 2006.

Continue reading AIG – profits and reserves

Mar
29

Coventry-Concentra update

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

Coventry has hired a new medical director for their workers comp managed care business. Dwight Robertson has long experience in the business (starting in the late eighties); knowledge of the provider, payer, and managed care industries (USHealth Works, Zenith, Crawford, AIG, UnitedHealthcare, Conservco); and a frank, open, and direct style.
He also has recent experience as a First Health customer, a perspective that may help focus his new company on the customer.

Continue reading Coventry-Concentra update

Mar
27

the end of the third party biller auction?

Posted by Joe Paduda on Tuesday, March 27th, 2007 | Comments

Sources indicate Fiserv has terminated its efforts to sell third party biller Third Party Solutions thru Bank of America. This despite Fiserv’s interest in shedding non-core assets, begun under CEO Jeff Yabuki. While Fiserv may still entertain offers, it is unlikely any will approach the rumored goal of $275 million Fiserv was asking for TPS.
While more than a few private equity/venture firms assessed TPS, evidently no term sheets approached the desired valuation. Issues may have included concern about TPS’ “complicated” A/R situation.
Meanwhile, competitor WorkingRx is still for sale…
What does this mean for you?
A temporary continuation of the current awkward third party biller-pharmacy-PBM-payer struggle/business relationship.

Mar
23

Washington’s smart policy on opioids

Posted by Joe Paduda on Friday, March 23rd, 2007 | Comments

The state of Washington is a monopolistic workers comp state; unless an employer is large enough to be self-insured, it has to buy workers comp insurance from the state itself.
As a monopolistic state, the regulators have even more power than in the highly regulated but non-monopolistic states. One area of particular interest is how the state deals with the WC drug formulary, which specifically excludes Actiq and Lyrica.
Washington’s Health Dept. just released new guidelines on the use of narcotic opioids; the guidelines, their development process, and the impact of same should be watched carefully by regulators, insurers, managed care firms and most of all prescribing physicians.

Continue reading Washington’s smart policy on opioids