Insight, analysis & opinion from Joe Paduda

Oct
12

Work comp services – the commodity trap and avoidance thereof

Few would argue that work comp services is largely a commodity industry…“price” is the ultimate decision criterion in many most buying decisions. There are exceptions, but many are really service guarantees backed by financial penalties…another way for purchasers to demonstrate fiscal prudence.

aka, “strategy” often devolves to attempts to escape the commodity trap.

The first step is to understand what’s lost in the typical sales process is the “value” inherent in the service. 

Way back in 2009 I wrote this:

For several years bill review has been [and still is] a commodity.

Despite vendors’ best efforts to differentiate, most buyers place great emphasis on price. As a result, bill review vendors have worked hard to squeeze out cost…bill review vendors have lost sight of their reason for existence – to ensure their customers pay only what they legally are required to. Instead they compete on the basis of how cheaply they can write checks out of their customers’ checkbooks.

This is not entirely the bill review vendors’ fault. Their customers bear much of the responsibility for the situation, playing vendors off against each other in an effort to reduce the payer’s admin expense. And the payers have succeeded. That success has come at a cost which some payers are only recently beginning to grasp [and now, 14 years later, many payers still don’t].

This is NOT unique to bill review...lazy buyers and brokers/consultants usually commoditize claims, networks, clinical services, occupational medicine, Medicare Set Asides and other services.

Why?  Because it is easy, requires little effort, and, frankly, vendors fail to focus on value.  Rare indeed is the service company that really, really trains its sales folks, or invests in market research, or has any concept of branding. So, yeah, it’s on the vendors too.

Value starts with understanding how your customers define success…and by “customers” I mean the individuals who will make and influence the buying decision.

What does this mean for you?

Organizations don’t buy – people do. But if you do not KNOW what the buyer values, you can’t get out of the commodity trap.

More…

this from an excellent Harvard Business Review piece...

price does equal value in the eyes of a customer when all other strategic factors in the purchase decision are equal, which often occurs with commodities.

Many other products and services are customized rather than commoditized, and, in these cases, price doesn’t equal value. Steve, for example, is CEO of a kitchen design and installation company specializing in large and expensive homes. When his inquiries dropped, he leapt to the assumption that he was “too expensive.” So, he embarked on a round of price cutting. But was cost really the issue? To find out, we assisted by interviewing some of his clients who chose a competitor. A typical example was Jenna.

She’d sought three quotes for the kitchen of her large home. “They came in at different prices, naturally,” she said. “I could have bought a new car at the prices supplied.” She explained that the kitchen contractor she chose wasn’t the cheapest. More important to Jenna were four other factors: innovative design (she spent a lot of time with each contractor trying to find the best design solution), work quality (recommendations from previous customers about kitchen finishes), customer service (easy to deal with and good listening skills), and quality of inclusions (the brands of dishwasher, sink and taps recommended).

The final factor, she said, was “trust.” It was “very important because she wasn’t going to be there every day checking on the installation of plumbing and electrical fittings.”

Your position on the scale of commoditized vs. customized depends on how much unique value you contribute to your products

If you – the service provider – don’t fully understand what your customers value AND are able to clearly and crisply articulate how your company can deliver that value, you’re forever going to compete on price.

And in the highly mature, scale-centric, declining industry that is work comp services guarantees ever-lower prices and ever-lower profits.


Oct
11

Yay North Carolina!

The Tar Heel State is the latest to expand access to Medicaid, a move that will drastically improve the health of 600,000 (!!!) North Carolinians and financial stability of dozens of hospitals and hundreds of other care providers.

40 states have now expanded Medicaid under the Affordable Care Act (aka Obamacare)…holdouts include Florida, Texas, Mississippi, Alabama, Missouri…

Think this doesn’t impact workers comp?

Think again.

States where work comp facility costs have risen the most – courtesy WCRI.

This from Captain Obvious – Hospitals in states that failed to expand Medicaid are using workers’ comp as a financial lifeline.

What does this mean for you??

Failing to expand Medicaid is unconscionable.  It greatly improves the health of babies, moms, kids, and older folks – at very, very little cost to taxpayers. 

The blatant hypocrisy of politicians claiming to respect life while blocking Medicaid expansion is disgusting.


Oct
6

Good news Friday….

Ok, time to set aside the current clustermess in the House of Representatives… because…

there is REALLY good news about the economy!

Inflation is waaaay down…and has been trending that way for months.

Core inflation in August was darn close to the Fed’s 2 percent target, signaling things have vastly improved.

Wages are growing faster than inflation

which is one reason personal consumption (what people spend, not what businesses and governments spend) remains quite strong… (personal consumption is a major economic driver)

13 million new jobs have been created since mid-January 2021, meaning there are more people working now than…ever.

What does this mean for you?

Don’t let negativity drag you down…Reality is, we are in far better economic shape than we were a few years ago.

Even pre-COVID.

 

 


Oct
4

Walls or windows?

This email arrived earlier this week;

I really enjoyed your newsletters until you started showing your political side; It’s unfortunate that you had to make that known to your audience.

I’ll leave aside the fact that I’ve been “showing my political side” for the more than two decades I’ve been writing MCM, moreover I’ve been transparent on my views on everything from:

  • opioids to
  • politics to
  • physician dispensing to
  • Congressional Republicans’ attacks on the ACA to
  • Russia’s war on Ukraine to
  • vaccination skeptics to
  • the work comp industry’s failure to understand health care to
  • TPA profiteering on managed care fees to
  • some state legislators’ unconscionable failure to expand Medicaid to
  • Texas’ legislators ridiculous grandstanding
  • and about a gazillion other topics.

What is distressing about the former subscriber’s note is the underlying unwillingness to consider alternative viewpoints, to open one’s mind to different ways of thinking through issues, of critically evaluating one’s own beliefs.

That is especially true today, when we seem more willing to build walls than open windows.

I’d bet exactly none of my 2,510 subscribers agree with every one of my opinions and posts – nor should they. As I’ve publicly admitted, on occasion I’ve been wrong on facts, gone a bit too far or changed my opinion (right Rob Gelb?), mostly because a reader challenged me to think differently or I’d been lazy or lax in my research.

What’s distressing about the former subscriber’s note and subscription cancellation is it is symptomatic of a much broader “closing of the American mind.”

We lament society’s polarization while refusing to engage with others who may have different views.

We ostracize others for their views on a single subject, when we may well agree on most things.

We decry government’s ability to get anything done while supporting candidates who refuse to compromise.

I’m quite sure the unsubscriber and I agree on many things…perhaps the evil of Purdue Pharmaceuticals, the unconscionable profiteering of physicians dispensing drugs, the questionable ethics of non-transparent claims “fees”, the critical importance of getting patients to the right provider quickly, the problems with brokers and consultants who follow the latest fad instead of doing the hard work to actually help their employer clients (nurse triage, anyone??).

Alas we’ve become latter day Inquisitors, willing to demonize anyone that doesn’t agree entirely with us. The Pope’s inquisitors tortured, burned, and crippled Cathars for the sin of their different interpretation of Catholicism.

Today, nine centuries on, we are at risk of returning (hopefully only metaphorically) to the horrific days of the 1300s.

What does this mean for you?

We are far more alike than we are different, share far more similarities than differences. 

Let’s try.

 


Oct
3

Long Covid’s impact on workers’ comp

Is the subject of a WCRI webinar at 2 pm eastern TODAY. No charge, but there’s a limit of 500 registrants.  Register here.

The webinar follows publication of WCRI’s Dr. Bogdan Savych’s study of Long COVID’s impact on workers’ comp (Study is free to WCRI members; non-members incur a fee).

A very brief summary from WCRI CEO Ramona Tanabe:

“Among all workers with COVID-19 claims, 6 percent received treatment for long COVID conditions, some more than a year after the initial infection. At an average of 18 months of post-infection experience, these workers received more than 20 weeks of temporary disability benefits and received about $29,000 in medical care.”

Note the relatively low medical cost…$29,000.

Other studies have examined Covid costs for patients covered by commercial health and Medicare Advantage. (note some are NOT Long Covid)

Long Covid – a study published in May of 2022 (note that was a while ago…) indicated the average annual medical costs of LC was $9,000.

CDC – costs average around $9,000 for care in the first 6 months after confirmed infection.

  • Using a large electronic administrative discharge database, Shrestha et al estimated a per-patient cost of $24,826 for inpatient care for adult patients with COVID-19.
  • Tsai et al examined claims data and found that the mean cost per outpatient visit of a Medicare beneficiary with a COVID-19–related diagnosis was $164.
  • Bartsch et al used simulation modeling and estimated median direct medical costs of a COVID-19 diagnosis ranging from $57 to $15,943, depending on the patient’s age and the severity of the case.
  • Another study found that COVID-19–related hospital costs per adult hospitalization varied from $8,400 in a general ward to more than $50,000 in an intensive care unit with a ventilator (7).

A useful synopsis of Long Covid issues, treatment, and symptoms is here.

What does this mean for you?

To date, Long Covid is not expensive. Regular readers would have anticipated this.


Oct
2

Not invented here

If we didn’t invent it, it didn’t need to be invented. 

That’s an expansion of the well-known “not invented here” meme, one far too common among workers’ comp insurers, TPAs, health plans and other large organizations.

We have all encountered this countless times…you can see it in the “Not Invented Here” bias visible in expressions of execs dismissing a new approach, front-line workers rolling their eyes during training, mid-level managers listing in great detail all the reasons this will never work.

I recall a session with the “business analytics” team from a very large workers’ comp insurer, set up by an exec that wanted to “get my ideas” on health care data analytics and the uses thereof…This quickly devolved into a litany of “yeah we already do that…yup tried that and it didn’t work…nope that will never work here…

Digging into a couple of these objections quickly revealed the dismissing party didn’t even try to understand the idea, how it would help them, why it was actually NOT something they’d done before.

Sure, this infects EVERY organization, but the infection is far less dangerous in those that value open discussion, seek contrary opinions, keep asking questions, and are open to learning from failure.

There’s a big push to get more young people involved in the industry.

Like many industries insurance is graying-out; unlike many, insurance is finding it hard indeed to attract the best and brightest. The “Not Invented Here” cancer is a major reason creative, innovative, bold thinkers quickly dismiss the idea of working in insurance, workers’ comp, and claims.

Not so for potential workers satisfied with doing the minimum, happy to parrot their bosses’ trite and obsolete views as they laze their way through the workweek.

The futility of this post is the organizations where NIH is most pervasive are those most blind to that infection.

What does this mean for you.

Asking painful questions is hard. It’s also key to survival.

 

 


Sep
29

Good news Friday…

Well, in an effort to counter the stupidity that has infected some in Washington, I’ll do my best to find glimmers of good news to start your weekend.

Ukraine

Ukraine is making solid if not spectacular progress in its offensive…and the news that we are sending very capable missiles may help our allies speed things up. The missiles – known as ATACMS – are very elusive and pack a big punch. These are NOT the long range ATACMS…at least not yet.

Grain, shipping, and avoiding world hunger

Resilient Africa headed south to deliver grain

Most notably, Ukraine has figured out how to win the war at sea – without having any ships. This has enabled Ukraine to ship grain to Africa and other places , a huge help for people at high risk of starvation. Seven ships have passed through Ukraine’s “grain corridor” despite Russian threats to sink any and all ships.

Aging…or not.

Big medicine is spending gazillions on research to help us live longer. While that’s kind of a good thing, reality is most of what kills (excluding firearms, traffic accidents, and drugs) us is due to:

  • not enough exercise
  • not enough sleep
  • too much food
  • too much alcohol

So, the “good news” is if you commit to exercising (cardio and strength), sleep, a healthy diet and one drink per day, you won’t need to buy whatever Big Medicine is selling.

And you can use those dollars to buy books, go to concerts, visit your grandkids, and donate to worthy charities!

Lastly, Crime.

News from the FBI that its efforts to combat violent crime is yielding dividends.  From the FBI…The FBI, alongside its state and local law enforcement partners, executed over 4,000 arrests, over 2,500 drug seizures, over 1,600 weapons seized, and the dismantlement of over 50 violent organizations.

remember that when some knucklehead politician says he’s going to eliminate the FBI..

(note three family members worked for the FBI (two were special agents), one died in the line of service, so, yeah, I’m “biased”)

 

 


Sep
27

Medical debt is crushing Americans

One out of three adults has medical debt. 

For many, this has a major impact on daily life…

Medical debt can be a huge obstacle, preventing families from buying a home, purchasing or leasing a vehicle, even paying for college for their kids.

That’s because credit bureaus include medical debt in their scoring algorithms. 

Looks like that will be changing…

From the Vice President:

The Consumer Financial Protection Bureau will propose a new rule to make clear that medical debt cannot impact the credit scores of the American people.  Once this rule is final, it will mean, one, that

consumer credit reports will not include medical debt and, two, that

creditors will not be able to use medical debt to determine a person’s eligibility for credit. 

Almost 2/3rds of those with medical debt had insurance when they began treatment...a quarter of those had their claims denied.

What does this mean for you?

Help is on the way.


Sep
25

A gubmint shutdown and you

Joni Mitchell’s Big Yellow Taxi provides today’s lede…and for good reason. The handful of elected House members on the verge of shutting down the entire government claim no one will notice when the Feds are furloughed.

Ha.

Here’s a very brief list…

  • Most inspections of hazardous waste sites and drinking water and chemical facilities would stop.

  • CMS will furlough non-essential workers, potentially delaying MSA processing

  • OSHA will shut down all but critical operations
  • FEMA has begun rationing its money, pausing about $1.5 billion in longer-term recovery projects to ensure it has enough cash on hand in the event of a major, deadly crisis

  • Workplace safety inspections would be reduced or, if the shutdown persists, potentially stop

  • New applications for Social Security will be delayed, affecting some claim settlement negotiations
  • In past shutdowns the E-Verify system (for employers to verify work status/eligibility) wasn’t operating, likely limiting new hiring
  • Major infrastructure projects would stop
  • The Community Health Center Fund (CHFC), which sends federal funding to health centers – could be halted, among others…patients would have to seek care elsewhere, further increasing the burden on hospitals.
  • Enrollment in clinical trials would be delayed or postponed
  • Grants for new clinical research would halt
  • Funding for Federal courts runs out October 13 (although some may be able to continue operating)
  • 10,000 kids would lose access to HeadStart  – and thousands of others would also lose daycare, impacting parents’ ability to work.

sources here, here, and here.

What does this mean for you?

After you’ve burned the place down, where will you live?


Sep
22

Leaving Las Vegas

Quick takeaways from National Work Comp…

Don’t know what total attendance was, but seemed somewhat less than in pre-COVID years. Exhibit hall corridors were pretty empty despite sessions located around the exhibits.

Newest thing du jour – AI...sessions on AI, vendors promoting various applications, attendees mentioning AI in conversations about claims, data interpretation, claim intake, you name it.

Nurse triage – just…stop. Far too many are touting nurse triage – almost all without a clue as to what exactly this is, why they want to do it, what a “nurse” is, and how this will improve things. More on this in a future post, but for now:

  • define nurse – do you need an RN? APRN? LPN? nursing assistant?
  • what expertise/training/experience does this “nurse” need? orthopedics? emergency medicine? trauma? behavioral health?
  • okay, so a new RN is on the phone with a person…exactly what value does this add? Be specific.
  • more to come.

Events – by all reports myMatrixx’ get together was really well attended...I didn’t get to any others as they were past my east-coast bedtime. I do miss the myMatrixx transportation services from years past :( (mM is a consulting client)

There was a beach party outside my window that prevented a lot of us form getting to sleep before 11. Mandalay Bay staff was far less than helpful, told me this was on me as I should have checked the event calendar before booking my room (WTF!) and offered to send housekeeping up with a couple earplugs…I will NEVER stay there again.

Optum’s dog party was a big hit – great idea, really smart marketing, and good buzz generator.

Provocative session addressed anxiety, suicide and depression – more on that later. Sobering and much needed. Really respect the speakers for sharing their views and personal experiences. Yvonne Guibert – you are an inspiration.  

Booth staff – STOP pitching your stuff. JUST STOP. Until you have a decent sense for what the person in front of you needs, wants, is challenged by, don’t say anything other than a one-sentence line about the service/product your company delivers. 

have an excellent weekend.


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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