Insight, analysis & opinion from Joe Paduda


Predictions for 2013 – page two

Following yesterday’s post on predictions for workers’ comp in 2013, here are three more.

4.  Aetna will keep – and grow – their workers’ comp services business

With the acquisition of Coventry, Aetna consolidated its position as one of the largest health plans in the nation.  They also jumped into a leadership slot in the comp services industry, a business that is attractive to mother Aetna for several reasons. Despite opinions to the contrary, it is all but certain that Aetna will keep and seek to grow the Coventry workers comp business.  That will be welcome news for CEO David Young, who’s long been tasked with generating cash while being starved of resources.

5.  Physician dispensing of repackaged drugs – we’ll see higher prices in some states and much more physician dispensing in many. 

With their gravy train in Illinois and Michigan brought to a screeching halt by new regulations, the physician dispensing industry will drive up prices in those states where the practice is still allowed.  North Carolina, Florida and Maryland are among those states where payers should keep a VERY close watch on dispensing and billing patterns. When and where possible, use direction to steer away from those bad actors…

There are also some distressing reports that the big dispensing firms are looking to hire lobbyists in states that currently prohibit or significantly restrict the practice.  Be on the lookout for this in NY and TX.

6.   Several more states will adopt clinical guidelines to help determine appropriate/medically necessary care.

While this may seem like a no-brainer, the reality – as demonstrated by recent events – suggests it is anything but.  The adoption and effective use of evidence-based clinical guidelines is often subject to political grandstanding, parochial attitudes, and ignorant complaints about “cookbook medicine”.  That said, I’m hopeful we’ll see significant progress in New York, Illinois, California and other states.  The more that evidence-based medicine is the basis for assessing workers comp treatment, the better.

We’ll finish up tomorrow.

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Joe Paduda is the principal of Health Strategy Associates




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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