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Predictions for work comp in 2013; how’d I do – part 2

So far, not bad.  Let’s see how my other prognostications worked out…

  1. Several more states will adopt clinical guidelines to help determine appropriate/medically necessary care.
    There’s no doubt clinical guidelines help reduce unnecessary, even dangerous care.  A paper published by Medata and ACOEM explores the issue in detail.  Two states (NM and WY) adopted guidelines early this year, NY has continued, albeit slowly, to roll out more guidelines, and Washington continues to lead the way on opioid-related issues.  That said, there is much left to be done.  I’d have to give this a partial yes, as it hasn’t happened as quickly as I predicted, or anywhere near fast enough.
  2. We will learn that physician dispensing of repackaged drugs has harmed patients.
    Yes, definitely.  Research published by CWCI, and an article authored by Johns Hopkins University and Accident Fund (to be published in 2014) both prove physician dispensing leads to longer disability duration and more medical treatment. Both use case-mix adjusted data, both come from stellar research organizations, and both put the lie to dispensing companies’ claims that outcomes are improved.
  3. The good folks at NCCI will finally schedule a credible liberal speaker for their annual meeting.
    Nope.  While David Gergen was excellent, he is NOT a liberal (or conservative for that matter).  Still waiting for NCCI to get a bit more “fair and balanced”…
  4. The level of interest and activity around opting out of workers’ comp will increase – significantly.
    I’d have to say no.  While Oklahoma is moving forward, and there are rumblings from some other states, there isn’t much of a movement or any discernible trend.
  5. Predictive modeling for claims management will come of age.
    I should have worded this more precisely, as there’s no metric we can use to say yea or nay.  That said, predictive modeling is much more widespread these days than in 2012, with many large and small payers employing some type of modeling on the front end of claims and at various times during the life of the claim.  So this is a yes.

Overall, I got 6 right, 2 partially right, and 2 flat out wrong.  Yikes, that’s barely passing…

Hope to do better in 2014.  Those predictions coming up later this week.

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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