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Jan
31

Friday’s catch up and quick takes

The week flew by, so I’m running to catch up on things I should’ve posted on earlier.

Looks like mother Aetna is getting her arms around Coventry work comp; reports indicate about three dozen Coventry work comp IT folks were laid off earlier this week, including most of the staff supporting BR 4.0, their bill review application.  This will come as no surprise to current clients and loyal readers; under the former ownership, there was little investment in the application over the past several years.

The question is – what happens to those current clients?  

First, indications are Coventry will not be doing bill review either on an application or service basis. If this the case, ALL Coventry BR clients will have to transition to a new provider.

Some payers have been planning for years to move to a competitor; expect Medata and Stratacare to pick up a couple of very big payers.  Mitchell will likely be very active, and MCMC is well-positioned to take on business too.  I would not expect ACS-CompIQ to be much of a factor as contacts indicate their service and performance levels of late have been less than acceptable.

Coventry WC may do a “renewal rights” deal with one of the other BR companies to transition clients, private-label one of the four competitors’ application, or – least likely – tell current BR 4.0 clients they are on their own.  As all Coventry BR clients will have to implement a new application, expect a lot of focus on this in the coming year.

Which may delay other critical IT upgrades/implementations/projects for some time…

Health reform

On the subject of health reform, looks like the trickle of uninsureds signing up for coverage thru the exchanges is going to increase.  A just-released Gallup poll indicates 56 percent of uninsureds who are going to get coverage will do so via the exchanges. Of all uninsureds, 53 percent are planning to buy insurance and 38 percent say they will pay the fine…

One of the less-well-known components of PPACA, outcomes research, has continued to make major progress.  The latest from the Patient Centered Outcomes Research Institute lists key initiatives and reviews the current process.  Of interest to work comp folks;

  1. Strategies for preventing the progression of episodic acute back pain into chronic back pain
  2. Compare the effectiveness of innovative strategies for enhancing patients’ adherence to medication regimens. Studies should take into account the needs of patients with chronic conditions who are prescribed medications for short- and/or long-term indications.
  3. Compare the effectiveness of specific features of health insurance on access to care, use of care, and other outcomes that are especially important to patients.
  4. Treatment options for people with opioid substance abuse

This is truly important work.

A good piece on working with work comp PBMs appeared in Claims Management. Authored by Jeffrey Austin White and Cathy Whitford of the Accident Fund, it includes some very helpful suggestions on how to get the most out of your PBM.


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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