It’s time to see how my predictions for 2012 turned out, and a final warning that the annual April 1 post is less than three months away…
So here are they are…and here’s how it went…
1. Health reform will impact workers comp…network discounts will diminish…Network options will change.
DING DING. While the impact of reform is yet to be readily apparent, the data points are trending in that direction. Among the payers I work with and from other data I’ve seen, discounts have eroded and facility costs increased as negotiating leverage has shifted. And, with the notable exception of Aetna, there was almost no movement among major health plans – including Anthem – to start or beef up their work comp offerings.
2. M&A in comp is going to accelerate.
Well, that was easy. With deals ranging from Coventry’s sale to Aetna to ScripNet’s to Healthcare Solutions, plus TMS to MSC, MSC to Odyssey, the Align/Smartcomp merger, sale of Injured Workers Pharmacy, plus several others, 2012 may well have been the busiest year ever in this tiny little niche.
3. Comp rates will go up.
True that. Most states – from California to Florida to Connecticut to Maine – saw rate increases, with rates level in few e.g. NY (hmmm, perhaps due to political reasons?) and lower in the even fewer states with significant reforms (IL).
4. Attacking opioid addiction and dependency will hit the top of many payers’, regulators’, and employers’ agendas.
Halla-freakin’-luya. With PBMs’ opioid programs getting major traction with many clients (at last); IAIABC and AIA developing policies/model language on the topic; an entire, and quite well-attended, track at NWCDC devoted to the issue; major progress in Texas and Washington; a first-ever conference on the subject attracting over 600 attendees (Operation UNITE), and every pundit and opinionator now on the band wagon, you couldn’t swing the proverbial hat without smacking into an opioid program/conversation/report.
We need more.
5. Now that Illinois is starting to approve Preferred Provider Programs, there will be lots of interest followed by disappointment that they really don’t do much to control over-utilization.
Premature at best. The approval process has been somewhat slow, perhaps due to what appears to be a very methodical approach to writing the regs. Jury’s out, till we have some actual PPP performance.
6. As work comp premiums begin to rise, we’re going to see a renewed interest in loss control, risk management, and medical management.
A guarded yes, with particular focus on opioids (see above), utilization management (see California), networks and specialty managed care. To be entirely accurate – which is a noble if unattainable goal – my sense is a lot of the attention focused on specialty managed care is due to the dollars flooding into the space from private equity firms, a flow that has gotten a LOT of attention from payers.
Not much news about more work on loss control or risk management, so it may well be that this prognostication was premature. As this would make the prediction only one-third accurate, I’ll count this a ‘no”.
7. The physician dispensing cost control bill currently pending in Florida will pass.
No DAMN IT. Despite the dedicated, noble and diligent efforts of Senator Alan Hays (the most straight-forward and direct elected official I’ve ever had the pleasure to meet), the bill was never brought to a vote in the Senate, as then-Senate-President Mike Haridopolous refused to allow it to be brought to the floor. If you’re wondering if the $3.4 million spent on lobbying and contributions by the physician dispensing industry had something to do with Haridopolous’ position, I’d say you’re pretty damn naive to “wonder”.
That said, there was GREAT news in Illinois and most recently Michigan, where the profiteering plunderers who suck money out of employers’/taxpayers pockets were dealt severe setbacks when regulations preventing upcharging for repackaged drugs.
8. More payers will diversify their provider network partners.
Done. There are more payers working with more networks than before, and more bill review companies are offering more generalist and specialty networks than ever.
9. York Claims will finish the year well on its way to becoming a top-tier TPA.
It is. With the acquisition of JI Companies and organic growth to boot, they’ve had a pretty good year in terms of revenue growth York’s programs, staff, and capabilities – as well as the approach they take to medical management – are as good as anyone’s.
10. Oklahoma will eliminate the requirement that all employers have workers comp insurance.
Well, blew that one too.
So, here’s the score.
3 – NOs
6 – YESes
1 – NOT YET BUT ON THE WAY.
If this was baseball, I’d be earning gazillions…alas it isn’t so.
6 thoughts on “So, how’d those predictions for 2012 turn out?”
I would like to know how York can be praised like that when they cannot even pay their bills of those helping them service service their clients? To me that indicates they are mis-managing their clients money.
Mike – welcome to MCM and thanks for correcting my mis-read. I can’t speak to York’s payment policies nor to their vendors’ or providers’ billing practices and payment expectations. I was, and am, referring to the medical and claims management, and would note that JI is perhaps the best individual TPA I’ve encountered in both areas.
York Claims as noted in your comments. Not NY.
Last time I checked, TRISTAR had purchased REM.
Joe McL- you are, of course – right. thanks for the catch; I’ve fixed the post.
happy and merry – Joe P
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