Category: Workers Comp

Jul
6

We don’t need no stinkin’ science!

Posted by Joe Paduda on Wednesday, July 6th, 2016 | Comments

I think we’ve figured out why, in the face of compelling evidence to the contrary, plaintiff attorneys in California continue to argue the work comp system mis-serves a large number of workers’ comp patients.  

Before we delve into this, allow me to stipulate that many applicant attorneys are likely well-intentioned, seeking to do good, and may well believe that a lot of work comp patients are ill-served by the work comp system.  Since they only talk with work comp patients that have complaints, that would not be surprising.  And, a relatively few work comp patients are, indeed, ill-served by the system for a variety of reasons – a bad employer and/or boss, crappy doctor, under-trained and/or over-worked claims adjuster – even a lousy attorney.

That said, it appears their representative organization, the California Applicant Attorneys’ Association, is not conversant with research methodology, processes, or statistics – and that’s why they don’t understand that the work comp system is working pretty well.

I draw this conclusion after reading an article entitled “Calling all Applicants: The Injured Worker Survey” from a July 2016 CAAA publication. In the piece, author Richard Meechan argues:

“Nothing makes sense – up is down and they (the Committee on Health and Safety and Workers’ Compensation, or CHSWC) have graphs and charts to prove it.”  

The “Injured Worker Survey” Mr Meechan refers to will apparently enable the CAAA to:

“see how the system is working for the most seriously injured workers.  That would be workers that were out of work for more than a year, our clients, to be more exact.”

This is because the CAAA apparently doesn’t (want to) believe the myriad research studies published by research organizations about injured worker outcomes and related matters.

If you, dear reader, are puzzled by this, allow me to explain. Careful and valid data analysis by experts examining credible data sets can be, and often is, translated into “graphs and charts” to help the non-statistically-endowed understand what is really going on.

In the article, Meechan states he is skeptical of research finding “95 percent of medical requests were approved and that injured workers were satisfied with their medical treatment.”  That skepticism resulted in the CAAA’s enlistment of three attorneys to help the CAAA committee on Health and Safety figure out how to “respond” to these “tales” (referring to the research presented at CHSWC meetings).

While I could find no evidence that any of the enlistees have an educational or experiential background in statistics, statistical analysis, business analysis, the physical sciences, or operations management (heavy in analytics), one of the three did study economics back in the nineteen-sixties. This isn’t to denigrate the trio, rather to contrast their relatively modest scientific research and statistical analysis credentials with those of folks who actually do research.  Like CWCI. And WCRI. And RAND.

Using SurveyMonkey, the CAAA is conducting their “survey” and will likely publish “results” in an attempt to show the information presented at CHSWC meetings, based on reams of research published after hundreds of hours invested in very sophisticated analytical processes employing highly-refined datasets and tested methodologies vetted by actual, real, live, statisticians with decades of experience and darned impressive credentials in data analysis and everything that goes into it is, well, wrong.  

And CAAA will do this based on responses from an on-line, open access survey with no data validation or proof that you are actually an “Injured Worker” needed.

Hey, you can try it yourself, here.

So here’s where the problem lies.

In the article, Mr Meechan notes that fewer than one percent (33) of the 3700+ survey responses asserted they had been out of work for a year or more. Apparently that is concerning. Mr Meechan asks others to help get the word out, as “one hundred responses is the gold standard for surveys and we are short.”

That single statement demonstrates a complete lack of of even a basic understanding of statistics.  Mr Meechan is apparently confusing statistical validity with an arbitrary “gold standard”.  Further, there’s an assumption that all that is needed is 100 SurveyMonkey responses from respondents who claim to have been injured and out of work for more than a year, and he and his associates will have what they need to refute all that science stuff CHSWC throws up there on the screen.

As anyone who has one day of stats knows, without valid underlying data to start with, the whole exercise is pointless.

More directly, garbage in, garbage out.

And in this case, the underlying data is, indeed, meaningless. A gazillion monkeys could be typing away and deliver lots of “results”. Some whizkid could figure out how to program a bot to fill them out with no human intervention at all.  More prosaically, a bunch of law clerks could earn some extra hours banging away on laptops or iPads completing SurveyMonkey surveys.

In this instance it is indeed possible that some or most of the respondents at some point had an encounter with the work comp system. Or not.

I belabor this point not to embarrass the attorneys, for that is NOT my intent. Rather it is to point out an obvious conclusion:

As reform opponents think that a SurveyMonkey random survey will be more valid than real research studies conducted by experts, we now know why “nothing makes sense” to them.

They don’t have a clue.

They are totally, fundamentally, and blindingly ignorant of even the most rudimentary statistical terms and concepts.

 

Note – I don’t have a link to the original article.  sorry – ask CAAA for your copy.

Jul
5

Where work comp’s fraud problem REALLY lies

Posted by Joe Paduda on Tuesday, July 5th, 2016 | Comments

It’s not about the individual claimant who’s working while getting benefits, or the Sunday afternoon injury reported as on-the-job come Monday morning, or the migrating pain.

The construction premium fraud racket may well be a far bigger issue for workers’ comp than the sum of individual claimant problems.  That’s my conclusion after listening to several experts who deal with this issue every day, in every state.

I don’t pretend to understand this at anything other than a very high level, but suffice it to say it is massive.  Moreover, by far the biggest problem is on really big projects – we aren’t talking about the local sub who builds decks and redoes bathrooms.  Bridges, airports, office parks, malls, government buildings – all targets for fraudsters who under-report wages, fail to obtain valid workers’ comp insurance, and rely on horrendously short-staffed enforcement of laws that are often far too permissive.

Here’s how this works.  A contractor or subcontractors contracts with “facilitators” that obtain work comp insurance from agents and provide insurance certificates to labor brokers tasked with finding and paying workers.

The work comp insurance coverage is usually minimal, and is based on false payroll data.

Far too often these labor brokers cash their payments from the facilitator, payments that can run into the tens of thousands of dollars per week (and the facilitator may well get a % of the check as a kickback from the check cashing facility).  The broker may pay the actual workers in cash.

So, the general contractor has the paper that shows they have insurance and their labor costs are low (this is a highly competitive business, and construction contractors usually win or lose business based on their cost of labor).  The facilitator makes money on the front end and back end, the labor broker usually doesn’t pay the workers what they tell the facilitator the costs are, and the check cashing store makes anywhere from a couple percent to near ten percent in fees.

The folks who get screwed by construction work comp premium fraud are diverse – most importantly, it’s the worker.  They get caught up in the scheme when they get hurt, and either there is no workers’ comp insurance at all or the paper trail is, at best, inconclusive as to the worker’s coverage.  Often dumped at the door of the nearest ER, the worker is stuck for the cost of their care, or, more likely, the taxpayer is.

The original work comp insurer gets screwed too, with perhaps thousands of dollars of premiums foregone due to fraudulent reporting while the “insured” is deemed covered by state law.

And ethical contractors find themselves facing a very difficult situation; either lose bids to lower-cost competitors or play the work comp fraud game.

What does this mean for you?

We’re going to dig deeper into this in future posts, because we really need to.

 

Jun
29

It’s the workers’ comp industry’s fault.

Posted by Joe Paduda on Wednesday, June 29th, 2016 | Comments

Yep, it’s your fault that the popular press smacks you around, citing a few examples of alleged insurer screwups as proof that you’re all a bunch of cold-hearted, nasty, lazy incompetents motivated only by profit.

Gun-Point-Suicide-Attempt

When was the last time your company actually talked publicly about the good stuff you do?  The patients you help?  The above-and-beyond service you provided to the paraplegic who needed something expensive and special that you approved so they could get on with their life? The spouse you spent hours on the phone with, explaining how work comp works, when the checks would be there, how you’d make sure her husband would get the care he needed?

The hugely expensive inpatient drug detox to help a long-term opioid user get clean, get her life back, and perhaps return to work?

(update-  the good folks at Midwest Employers are sharing their work on YouTube.) Kudos to MWECC – and here’s hoping a) they do more of this and do more to publicize it and b) others follow suit)

The lengths you went to to prevent a young woman from being subjected to cervical implant surgery, knowing that the outcomes for patients with her condition were universally poor?

The dangerous drug interaction you prevented, despite the screams of protest from the claimant’s physician and/or attorney?

Wait…you never publicly talked about this?  Never once mentioned it, much less actually – God forbid – used this an example of the good work your people do?

Never published a case of the month, or sent out a release honoring one of your employees for going above-and-beyond in helping a work comp patient?

Then stop your bitching about ProPublica, NPR, the plaintiff’s bar, and muckraking journalists and bloggers.  Because it’s your fault.

There are a bunch of reasons why insurers, TPAs, and funds don’t do this – all of them short-sighted, ignorant, and indefensible.  Fact is, if you don’t tell your story, others will. And in the work comp industry’s case, those “others” have bludgeoned you near to death with some true, real life examples of major screwups, along with many mis-interpreted, mis-understood, or just plain BS examples of alleged incompetence and/or misconduct.  I’ve spoken with several industry executives, and all decry the silence – their employers’ silence.

We are in an election year, folks.  We are hearing about opt-out, about alternatives to workers’ comp, about a “broken system”, about how poorly you serve “claimants’ (I hate that word).

What does this mean for you?

Worker’s comp isn’t broken.  

But if you don’t get off your butt and show why, it damn sure will be.

 

 

Jun
15

Disability – it’s not a “medical” condition

Posted by Joe Paduda on Wednesday, June 15th, 2016 | Comments

A while back I had the pleasure of interviewing Glenn Pransky MD, M.Occ.H., the director of Liberty Mutual’s Center for Disability Research.  As I noted in a post a few months ago;

Glenn is the Director of Liberty Mutual’s Center for Disability Research; he is an occ med physician and has his Master’s in Occupational Health as well and has authored over a hundred articles, research papers, and book chapters.  That’s all quite impressive; what really struck me is how approachable, genuine, and open Glenn is. [my use of his first name is intentional, Glenn is completely without pretension or ego.]

Here’s the first installment of the interview (note I captured this as accurately as possible however any errors are mine) :

MCM: How has the “condition of disability” evolved over the last 20 years?

GP:  [There’s been an] Increase in the amount of health care treatment where it isn’t so clear that it makes people a lot better, along with growth in Social Security disability. More and more people seem to see themselves as permanently disabled.

Workers are staying in jobs longer because they have no resources to retire.

There are more employees with chronic conditions or who are in poor health; [there’s a] wave of baby boomers who are really unhealthy…less routine exercise in our working population. The Return to Work context of 20 years ago has changed, major shift in chronic musculoskeletal conditions is more prevalent today than it was 20 years ago – we are shifting from acute to more chronic disease state.

[Most recently there has been a] Shift from traditional jobs to non-standard work arrangements, contractors, out of house, gig economy etc. Non-traditional work situations are limited in terms of resources for RTW.  The Upside is there is more focused problem-solving on RTW these days than before

MCM: What “causes” disability?
GP: A lot of factors. It starts with a health condition that limits [the person’s] ability to work. Whether it becomes a work loss is due to other factors; whether there are accommodations available, the treating physician’s focus on disability prevention, and whether there is reassurance that the injured worker’s RTW will be safe and supported.

For everyone who’s disabled according to Social Security there’s someone working full time that means there is more [to the disability] than the health condition. Work is better for people, as prolonged disability is bad for your health. Research indicates that even when controlling for the patient’s medical condition, when working age people are out of work, they become sedentary, depressed, detached, and mortality increases.

There are significant opportunities [to mitigate disability]; early positive contact w the injured worker makes a difference; work accommodations offered for temporary alternate duty reduces TTD days by 30%, supervisor response “how can I help”, how can we accommodate” can make a difference of 20% reduction in TTD…Also having a formal policy and consistent approach to it makes a difference.

For insurers- early contact and problem solving research in Australia shows this reduces TTD days.

MCM: What is the role of medical treatment and treaters in disability; causation, prevention, and mitigation?
GP: Providers that are focused on RTW are better for patients and deliver the best outcomes when they practice EBM and communicate w patients on this; there is good evidence that this improves RTW. There are a series of studies from Bernacki in JOEM – more recent ones from WA COHE program…when patients get medical care that does not have a strong evidence base, disability is prolonged. Opioids are a great example.

More to come from Dr Pransky – my quick takeaway is this:

Disability is NOT a medical condition.  

Jun
10

Work comp pharmacy – early results of 2016 Survey

Posted by Joe Paduda on Friday, June 10th, 2016 | Comments

I’m up to my eyeballs in the 13th (!!) Annual Survey of Prescription Drug Management in Workers’ Compensation; the response from payers willing to devote time to the project has been gratifying indeed.

Previous Survey reports are available here; note these are the Public versions; respondents get a much more detailed and comprehensive version.

A bit of background first.  I conduct these surveys telephonically, speaking to the individual at the insurer/self-insured employer/state fund/TPA/trust who is directly responsible for the pharmacy program. In addition to asking their opinions and views, we get data on a variety of key metrics including:

  • drug spend for 2015 and 2014
  • opioid spend for 2015
  • compound drug volume
  • generic fill and efficiency rates
  • mail order usage

A few early findings.

  1. Pharmacy continues to be seen as more important than other medical ost areas, primarily due to the “downstream” effects of opioids on claim duration, return to work, and related pharmacy spend.
  2. Most respondents are seeing a decline in drug spend.  This is a bit of a surprise, as national research suggests drug costs are going up.  A possible explanation is that (most of) these payers are pretty sophisticated, have been working diligently on pharmacy issues for years, and most (but certainly not all) have employed a variety of programs to reduce unnecessary use of potentially dangerous drugs.
  3. The percentage of spend that goes to opioids varies greatly, from around 21% to over 50%.  Some of this is due to regional or state differences, but much is not. Much more to dig into here.
  4. Mail order continues to be woefully under-used, with most respondents reporting penetration rates in the low single digits.  Argh.
  5. Compound drugs are seen as highly problematic and payers have a wide variety of programs/efforts/mechanisms in place to address compounds.

Much more to come; when the Survey Report is done I’ll post a link.

Enjoy the weekend!

 

Jun
6

Monday catch-up

Posted by Joe Paduda on Monday, June 6th, 2016 | Comments

Summer’s arrived in upstate New York – and boy do we appreciate it. While I was watching all the trees turn green, I missed reporting on a bunch of stuff last week.

So better late than never, here it is.

P&C industry outlook

Let’s start with the macro stuff.  A couple weeks back, Fitch published a piece wherein they opined the P&C industry is in for a tough time this year. After several years of stellar performance, Fitch expects prices to decrease as competitors battle for market share. Here’s how they put it:

Renewal rates are flat or declining for most commercial market segments following a hardened market from 2011-2014. The price competition comes from underwriting success and market capacity expansion from earnings accumulation. As price competition intensifies however, this will likely be a drag on premium growth, according to Fitch. Commercial lines written premium volume grew by only 1.8 percent in 2015.

For work comp, Fitch identified prescription drug costs and continued low interest rates as problematic; the first increases costs while the second reduces investment income.

Opioids

The number of opioid scripts in the US actually declined last year. And that was the third year in a row. That’s the best news we’ve heard in quite a while. Since 2012 – the peak year for opioid script volume – the number of scripts has dropped by 12% – 18% (depending on the data source).  

In case you’re interested, prescription opioids accounted for about $10 billion in total spend in 2015. Workers comp accounted for around 14% of that, a rather striking figure when you consider total work comp medical spend accounts for 1.4% of overall US medical spend.

Yup, work comp uses about ten times more opioids than other payers.

And how the bad news; the drop in scripts hasn’t been accompanied by a decrease in the death count, which stands at 28,000 for 2014.

California Workers’ Comp

Well, at least it hasn’t gotten any worse.  That’s my take on the just-released CWCI study on the UR/IMR process for Q1 2016.

  • IMR volume is about the same as last year at 160,000 determination letters per year;
  • the overall IMR uphold rate is the same as last year at 89%;
  • Rx drug requests still account for nearly half of all disputed medical service requests submitted for IMR (and 40% of the Rx drug IMRs are requests for opioids or compound meds);
  • and a small number of docs still account for the majority of the disputed  service request that undergo IMR (the top 10% of medical providers accounted for more than ¾ of the IMR service requests).  

My take – the IMR process is preventing people who don’t need opioids from getting scripts for opioids.  That’s a very, very good thing.  Yet the same docs keep prescribing this crap to patients knowing full well these requests will be rejected.

I’m very much looking forward to hearing all those “injured worker advocates” heaping praise upon the system for protecting their clients’ health and wellbeing, and that of their kids as well.

I’ll personally nominate each of them for a Comp Laude Award.

Jun
2

Opioids and Workers’ Comp – a quick update

Posted by Joe Paduda on Thursday, June 2nd, 2016 | Comments

The rest of the world is beginning to catch up to the progress workers’ comp has made fighting the opioid scourge.  Kudos to PBMs, payers, regulators, researchers and some physicians for recognizing the incredibly negative effects of opioids years ago, and taking action to mitigate some of these effects.

That is NOT to say we’re anywhere close to getting this solved – far from it.

But we have seen some evidence of decreases in the number of new claims getting opioids in some areas and an overall decline in opioid scripts and morphine equivalents (MEDs).  We’ll have more information in a couple of months when CompPharma (a consortium of work comp pharmacy benefit managers) releases its 13th Annual Survey of Prescription Drug Management in Workers’ Compensation. (note I’m president of the organization and am conducting the research, past reports are available free for download here.)

A few factoids to give some perspective:

From CWCI’s most recent research:

  • Opioids declined to 27.2% of all scripts dispensed to California work comp patients in 2014, down from a peak of 31.8% in 2008.
  • Average number of morphine equivalents per script declined from 550 in accident year (AY) 2007 to 422 in 2012.
  • The % of work comp patients receiving opioids within 24 months of injury increased from 22.4% in 2005 to 27.9% in AY 2012
  • Express Scripts reported overall spend for opioids declined 4.9% in 2015, the fifth consecutive decrease.
  • Helios reported:
    • the percentage of work comp patients getting opioids declined by 1.6% from 2013 to 2014.
    • opioid utilization dropped 2.9% over the same period

What we have NOT seen is any significant progress dealing with the knottiest and most important problem – long term opioid users.

I can’t count the number of erstwhile start-ups, business ventures, and eager entrepreneurs I’ve spoken with who contend they’ve figured it out.

By definition, anyone who claims to have a universal solution most certainly doesn’t understand the problem.  Unlike reducing initial and secondary scripts, addressing patients who’ve been taking opioids for months is very much an

  • individual,
  • patient-by-patient approach
  • requiring flexibility,
  • a deep understanding of the disease state and chronic pain and addiction,
  • a willingness to experiment and fail, and
  • a very long term commitment to a business model that almost certainly will not be hugely profitable.

That’s not to say there isn’t opportunity – there most certainly is.

What does this mean for you?

We’re at the end of the beginning of the work to address opioids.  This will take focus, years, diligence, and unrelenting focus.

May
24

Workers’ comp – for hospitals, it’s where the money is

Posted by Joe Paduda on Tuesday, May 24th, 2016 | Comments

Two recent articles in Health Affairs highlight a growing issue for employers and taxpayers; some hospitals are increasingly looking to work comp as a profit maker.

Depending on the state, facility costs can account for anywhere from around 32 – 40% of total work comp medical expenses (different states classify locations-of-service differently).

Ge Bai and Gerard Anderson examined the fifty US hospitals with the highest charge-to-cost ratios and found their markups over Medicare-allowable costs were three times higher than the average hospital.

This is critical in work comp because state work comp regulations often base facility reimbursement on charges – despite NO evidence or requirement that those charges have any basis in reality.

Fully 20 of the fifty hospitals are in one state – Florida – that uses a percent-of-charges reimbursement methodology for hospital outpatient services (manual is here).

Bai and Anderson’s latest work provides a deeper dive into hospital profitability.  A few key quotes:

  • Hospitals with for-profit status, higher markups, system affiliation, or regional power, as well as those located in states with price regulation, tended to be more profitable than other hospitals.
  • Hospitals that treated a higher proportion of Medicare patients, had higher expenditures per adjusted discharge, were located in counties with a high proportion of uninsured patients, or were located in states with a dominant insurer or greater health maintenance organization (HMO) penetration had lower profitability than hospitals that did not have these characteristics.

The methodology used by Bai and Anderson is somewhat different from that used by other researchers in that it excluded income from non-patient care services. I infer that they did this to focus specifically on the actual care delivery cost and not factor in other revenues from services such as parking, gift shops, investment income, etc.

So, what are the implications?

  • Work comp is a soft target for facilities in many states
  • The percentage-of-charges methodology is a license to…profit
  • More profitable facilities have likely already figured out how to make the most revenue possible from every source – including workers comp
  • Less profitable hospitals are going to learn from their more profitable competitors
May
20

Who’s running your company.

Posted by Joe Paduda on Friday, May 20th, 2016 | Comments

Is it the execs or the IT department?

The workers’ comp, and, for that matter, the entire property and casualty insurance industry, is chronically systems-poor.  While other industries view IT as a strategic asset, continually investing billions in IT, WC/P&C considers IT an expense category to be mined for pennies to add to earnings per share.

We all know how much execs HATE unallocated loss adjustment expenses…

Execs at payers are hamstrung by IT departments that can’t/won’t/aren’t able to implement systems changes. In fairness, IT departments are hamstrung by a lack of strategic vision in many C-suites, which in turn is motivated by financial markets or executive comp plans at mutuals.  Suffice it to say there is plenty of blame to go around – but the result is insurers’ strategy is often greatly limited by IT.

For example, underwriting and distribution. Yes, Google’s initial foray into insurance was short-lived, but that wasn’t because they weren’t selling insurance. In fact profits were good – but “good” by insurance standards, not by tech standards.  Google just couldn’t make the profit levels they are used to.

At some point another tech innovator will figure this out and/or decide a lower profit level is just fine, and then woe betide insurers.

Another example – the medical management world is changing dramatically, and work comp insurers are very hard pressed to adapt. Bundled payments, narrow networks, electronic medical records and vertically integrated delivery systems are here today, and will grow dramatically in importance tomorrow. Flexibility, adaptability, and the ability to move quickly are essential – and equally impossible.  Changing vendors requires IT to design, implement, test and monitor new data feeds to multiple systems and stakeholders.

Conversely, some payers have tied themselves to external vendors who act as consolidators or pipes, thereby greatly reducing the carrier’s IT burden.  In exchange, a LOT of power is transferred to the pipe vendor.  That’s fine if:

  1. incentives are aligned over the long term, and
  2. the vendor is able and willing to make changes to providers, processes, and feeds as necessary, and
  3. there’s transparency.

However, expediency and underinvestment comes at a cost.

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CEO T Rex: “Hey, when is that B2B platform scheduled for testing?”

CIO Triceratops: “18 months after I get the money to hire the staff you cut to reduce ULAE…”

The B2B and healthcare delivery market is evolving at a pace akin to that the dinosaurs saw after the meteor hit.  So, here’s a couple of questions you may want to ask yourself.

  1. Does your strategy drive your IT, or does your IT drive your strategy?
  2. What’s your plan to adapt to the revolutionary changes hitting distribution and medical management?
  3. Does your IT department, management, vendors, and infrastructure support that plan?
  4. What happens when – not if, but when – a carrier or new entrant builds the infrastructure and capability you can’t or won’t?
May
13

Friday catch-up

Posted by Joe Paduda on Friday, May 13th, 2016 | Comments

Got to love May!  Everything is greening up, baseball season is in full swing, college graduations, flowers are blooming.

While I was out smelling the new blossoms, a bunch of stuff happened.

Implementing health reform

There’s been a lot of press about UnitedHealthcare’s decision to leave the Exchanges, with opponents citing the move as more proof of the impending demise of wrongly-named “Obamacare” and others noting it’s much ado about not much.

A brief and compelling post by David Williams is in the latter camp; David notes:

[United] specializes in selling high-priced plans to corporate accounts. In the price-sensitive world of the exchanges that’s a losing proposition. No surprise — United wasn’t getting traction.

As a former UHC employee (albeit from two decades ago), I have to agree.  UHC never focused on the individuals or employers or demographic groups that seem to be signing up for insurance via the Exchanges.  There are several distinct attributes of health plans winning in the Exchanges; Health plans that have expertise in Medicaid, understand local markets and have very strong local brands, and/or are vertically integrated delivery systems are succeeding.

Bernie Sanders’ campaign appears to have “inspired” Hillary Clinton to talk more about offering a public option in the Exchanges, namely allowing a to-be-defined group to buy-in to Medicare. Notably, Sec. Clinton first broached the public option back in February, so this isn’t really new news. However, it does mark the first time she’s mentioned the Medicare buy-in. (a more detailed review of Clinton’s health policy platform is coming up next week)

From JAMA, the news that employer coverage of health insurance has not changed over the last few years.  This is a key reason the Exchanges have not enrolled more higher-income folks; they are getting their insurance thru their workplace.

Finally, before you get too wrapped up in the media nonsense about prices, enrollment, and the failure/success of ACA, read Larry Levitt’s piece in Vox on Obamacare 2017.

Workers’ comp

WCRI in partnership with the good folks at IAIABC published a must-have guide to State Workers’ Compensation Laws.  Order your copy at the link; investors, analysts, compliance departments and regulators all need this on the virtual bookshelf.

Friend and colleague Peter Rousmaniere’s Working Immigrants blog has been especially active of late; Peter’s been documenting the reality behind immigration trends, and his charts and graphs will speed your understanding of what’s ACTUALLY happening.

(spoiler alert – there is no big influx of Mexicans these days…)

Finally, a terrific post by a woman – a neuroscientist – who finally decided to treat her anxiety with medication.  It is an excellent piece addressing the balance between over-medication and the positive impact drugs can have – when they are the right choice.