Halloween catch up

Off to New Orleans for client meetings; should be interesting spending Halloween evening downtown.

A couple tems of note that deserve mention.

Over the weekend 178 GOP and 1 Dem representative called on CMS to stop with all the value-based stuff. Claiming the agency is overstepping its bounds, a letter signed by these worthies evidently wants Medicare to return to fee for service.

In a word, this is dumb. FFS is a big reason health care costs are out of control while quality is spotty at best. Fiscal prudence would seem to demand rapid adoption of value-based care. I know taxpayers will be far better served when more care is based on what actually works, not on what providers can bill for.

CompPharma’s annual Survey of Prescription Drug Management in Workers Comp will be out tomorrow at CompPharma.com. Big news is respondents’ drug costs dropped 8.7% in 2015. Opioids are still the biggest concern and compounds the top emerging issue.

Finally it looks like occupational injuries declined yet again; the Department of Labor reported the injury rate dropped from 3.2/100 to 3.0.

That is good news indeed – especially for those workers who didn’t get hurt.

Hope your week is most excellent.

Note- sorry about no URL links; posting from my phone which makes that really complicated.


myMatrixx exits the ancillary benefits business

PBM (and CompPharma member) myMatrixx is exiting the ancillary benefits market, turning their DME and home healthcare business over to long-time partner VGM HOMELINK.

According to the press release, myMatrixx will: “move the myMatrixx ancillary business to HOMELINK in an effort to allow both companies to focus on their core business. As a result, HOMELINK will begin servicing all myMatrixx ancillary business…”

This is in process now.  HOMELINK’s Jim Nygren told me his company’s new direct clients:

“will have the option to use our electronic portal or contact us using phone, email and fax.  Our systems has been in place and used by our clients for many years.  As an example of our focus on service, HOMELINK has a live individual answer every call.”

Expect the company to move to firm up its presence in the workers’ comp space.  HOMELINK has had a long standing relationship with Healthesystems that enables a few very large payers to access their services via Healthe’s Ancillary Benefit Management service; it will be selling direct as well in the future. To do that, Nygren said they will be

“doubling sales staff and investing in multiple national marketing campaigns…[this is our] First venture into anything other than organic growth. We will be more aggressive in sales and marketing, building on our relationship with existing clients and growing business through new ones.” 

A myMatrixx transaction had been rumored for some months, but only recently had it become known that the Tampa-based PBM was just looking to spin off the ancillary business. Sources indicate the ancillary business’ annual revenues are somewhat less than $10 million; earnings are said to have been marginal.

A couple general observations.

  1. The ancillary benefits business – durable medical equipment, home health in particular – is fundamentally different from pharmacy.  Pharmacy is the most standardized and automated type of care in the workers’ comp sector.  Compared to pharmacy, DME and HHC are decidedly not standardized or automated.
  2. While some work comp service companies are looking to be one-stop shops, others are focusing on doing one (or perhaps two) thing(s) really well. Both strategies can work – if the overarching guide is customer service. However the one-stop shop strategy is a LOT more difficult to implement and even harder to maintain.  A screw-up in one area almost inevitably taints the entire brand…

What does this mean for you?

Focus is a very, very good thing.


ACA: the real story

OK folks, deep breath here. Let’s take a minute and discuss what’s really going on with the ACA.

ACA – or the more-commonly-used-but-nonetheless-inaccurate-title Obamacare ≠ the Exchanges. I don’t know why pundits, pols, and regular people don’t understand this.

Let’s remember that enrollment in the exchanges and individual plans amounts to about 6% of all insureds in the United States.


Six percent.

Second, remember that the ACA includes a lot more than just the exchanges.

Elimination of pre-existing condition clause, guaranteed issue, coverage of dependents to age 26, Medicaid expansion, changes in Medicare reimbursement all have much more impact on the overall industry and population than the exchanges.

It’s clear that rates in the exchanges are going up a lot. This is because there are not enough young people and healthy people buying coverage on the individual market to offset the expense of us older folks.  And, it’s because the big commercial plans aren’t very good at individual coverage.

As the penalties for failure to obtain coverage increase, we can expect more people to enroll in health insurance. But for now, rates are going up significantly.

That said, I can say from personal experience that our rates are going up less than one dollar for a platinum plan in upstate New York. We are enrolled in a very narrow network with no out of network coverage.

The big commercial plans, United healthcare, Aetna, Wellpoint are all experiencing significant losses in the exchanges. However the plans that are more locally focused and have more expertise in Medicaid and other individual markets are doing well.

Therein lies a lesson. The big commercial plans are very skilled and very experienced in dealing with employer plans. However their expertise is not in the individual market which is why they are getting crushed.

Let’s not forget the ACA is based on private insurers competing. The competitive market is working. As the plans that can’t compete are exiting Exchange markets others are earning more business. This will, over the long term, help control cost and deliver better care to individuals on the exchanges. And, it will make these individual market winners better able to compete for employer business as their cost of care is going to be lower.

Finally, unlike most major federal legislation, there has been no effort on the part of the opposing party to fix the problems with the original legislation.

Hopefully this will be remedied under a new administration.

What does this mean for you?

Progress is painful. But reforming our health care system is absolutely necessary.


OneCall cuts back

Last week One Call Care Management conducted another round of layoffs, with most coming from field sales. I’ve heard a few operations folks were also let go.

Word is the field force reduction is driven by two factors.  First, former CEO Joe Delaney hired approximately 20 reps with NO workers’ comp experience earlier this year in what has been characterized as an “experiment”.  Evidently, the experimental stage is over – these reps are gone.

Second, after keeping the sales staff aligned with products and services (one for DME, another for imaging, a third for PT…), OCCM decided this wasn’t working.  Going forward, reps will be assigned to specific customers/prospects, and will have to be up to speed on all OCCM products.

Sources indicate that out of 118 reps, 38 will be terminated.  It appears some will get with severance and non-competes will be enforced, however I’ve been told OCCM will consider letting terminated reps out of their non-competes on a case-by-case basis.

That would be the right thing to do.

Interestingly, OCCM made the layoff and change in focus while the head of field sales position is open – as it has been for some time.  I’m not sure how this transition from seller-of-one-service to seller-of-all-services is going to progress without someone in charge over the long term. This kind of change isn’t simple, requires ongoing training and evaluation, as well as coordination with the service delivery folks to ensure the inevitable glitches and misunderstandings are handled quickly.

For a company with more than 3000 employees, a reduction of slightly more than one percent isn’t a big deal, and may actually make sense, IF those reps are really capable of “repping” all OCCM products and services.  And if they are treated equitably and given the opportunity to work in the industry.

Going forward, I’d expect we’ll see additional consolidation at OCCM. The company has multiple domestic call centers, and as OCCM off-shores various functions (clinical, scheduling, A/R) the need for US-based staff will likely decrease.

What does this mean for you?

Hopefully new opportunities for the newly-unemployed.



Why are work comp medical costs decreasing?

Medical costs were up a mere 3% in 2014, and actually dropped by a point in 2015 (in NCCI states).

I’ve been in comp a long time, and nothing like this has ever happened. What’s going on?

One likely contributor – 20 million more Americans have health insurance, and work comp doesn’t have to pay for medical care for non-injury-related conditions. (Surprisingly, not many of us know that coverage has increased so much…)

If someone gets hurt at work, has comorbidities, and needs surgery, those comorbidities have to be addressed as part of the treatment plan. If the patient has health insurance, that’s what pays for the non-injury conditions.  If not, work comp’s on the hook.

Clearly, the more workers with insurance, the less added expense for work comp payers.  So, here are my back-of-the-virtual-envelope calculations of the impact of ACA on work comp (a more-qualified researcher needs to do a much more thorough job): 

In 2009 – 2010, 81.8 percent of the employed population aged 18-64 had health insurance. By March of this year, 90.3 percent had coverage, a 10.4 percent/8.5 point increase.

Around 150 million people were employed this March; running the numbers, that means about 13 million more workers had health insurance early this year than did six years ago.

At 3.2 injuries or illnesses per 100 FTEs, that’s 416,000 patients.  About 84,000 of those patients have more severe injuries, the type that may require surgery, physical therapy, and/or more expensive and extensive medication.

We do not know how much of the moderation in medical inflation can be accounted for by expanded health insurance coverage, but we do know there are around 84,000 folks with pretty significant injuries or illnesses that don’t need work comp to pay for non-occupational conditions.

Another factor – employed people with health insurance are healthier than employed people who don’t have insurance.  Sure, there are confounding factors here – how long do they have to be insured to become “as healthy” as folks who’ve had insurance for years, and how much healthier do they get for each year they’ve had coverage.  I get all that. And some really smart researcher at NCCI or WCRI or NASI will figure that out (c’mon, people, the race is on!)

What does this mean for you?

We don’t KNOW ACA how much reducing work comp medical costs, but it is very likely a major contributor.


Thursday catch-up

Sorry folks – it’s been a very busy few days with client meetings and project deliverables. When you’re a one-person operation, it’s just not possible to keep up with posting when client stuff needs doing!

So, here’s a quick review of things you may have missed.

Debates are over…(sounds of cheering, clapping, and general relief)

And thank goodness for that.  By any objective measure, Clinton will be our next president, and the Senate may well flip to Democratic control albeit without the 60 votes necessary to avoid filibusters.

That being the case, it looks like we finally may see some much-needed fixes to ACA.  I’ll dig into these in detail next week, but for now, expect:

  • extension of the federal 100% funding for Medicaid expansion for states who haven’t expanded yet
  • remove the “family glitch”
  • perhaps offer near seniors (that’s me!) the option to buy in to Medicare.

More to come…

Customer service and taking care of employees

My two-part series on customer service got a lot of attention; a very recent story on WalMart’s decision to increase labor costs (!) speaks to much of the same.  The ginormous retailer was having problems with poor store results, unkempt aisles, shoddy appearance of displays and the like.  The solution (or at least a big part of it); pay workers more, and they’ll do a better job. While it is too early to measure results, initial reports are encouraging…

For a company that long relied on low labor costs to deliver low prices, this is a tectonic shift.

The state of the work comp industry

Oregon does a great job reporting on premium rates nationally – thanks to Mike Manley for sharing with me.  Mike  wants to “call attention to…states’ index rates expressed as a percent of median.”, not to changes from previous studies.  Listen to Mike!

Good info from NCCI on macro-factors that will affect the workers comp world: highlights from new Communications Director Dean Dimke are:

  • Employment growth to slow to 2% or less this year and in 2017.
  • Average weekly wages are forecast to increase by 2.2% this year and by 4.2% next year.
  • In 2015, workers compensation medical severity declined for NCCI states, but medical inflation—measuring the price component of that equation—increased by 2.6%.
    Low interest rates continue to constrain investment income in the P/C industry.

For those looking for a lot more detail, WCRI just released its CompScope(TM) reports on work comp medical benchmarks for 17 states.  Great weekend reading!

Break’s over – I got to get back to work!


Pain and pain meds are keeping men out of the workforce

The opioid industry’s insidious tentacles are choking the life out of individuals, families, and communities. Now we learn that nearly 44 percent of men aged 24-54 who aren’t in the workforce are on pain meds.

2/3rds of those men are taking prescription pain killers. Yet many are still in pain – a finding that surprises no one remotely familiar with opioids’ poor record with chronic pain.

Only about 2 percent of these men received work comp benefits in the prior year; it is certainly possible that many more were injured at work, settled their claim, reached maximum medical improvement, or otherwise are no longer receiving WC benefits. Fully a quarter are receiving Social Security disability income.

This is a critically important issue for all of us. Research by Alan Krueger PhD of Princeton University gives us much-needed clarity on why labor force participation is near a 40-year low; it’s about

  • poor health status; 43 percent of  men aged 24-54 not in the workforce report their health as fair or poor
  • 34% of these men report at least one functional disability
  • as a group, these workers report “feeling pain during about half of their time.”
  • average pain rating is 88 percent higher for these men than men who are employed

Of course, Dr Krueger’s research is not just about opioids, but it’s abundantly clear that opioids aren’t helping these men deal with their pain, and pain is keeping many out of the workforce.

This comes on the heels of reports that the death rate for middle-aged whites has been increasing of late – and at least part of the problem is, once again, opioids

What does this mean to you?

STOP approving opioids for chronic pain unless nothing else works. 



Yesterday’s post on the problems inherent in outsourcing/offshoring/automating customer service made the case that customer service functions must be handled internally.

Today, we’ll dig into a case study – the lesson being it’s not about your company’s metrics, cost structure, or “efficiency”, it’s ALL about your customer.

MedRisk is a physical medicine management company serving the workers’ comp industry. (MR has been an HSA consulting client for over 15 years) For years, it had the niche almost to itself, focusing its sales and service attention on corporate buyers. Along came Align Networks, a start-up that concentrated on the desk-level user, delivering stellar service to each and every adjuster and case manager.  Align was quite successful, eventually becoming the largest vendor in the PM management space.

A misstep by MedRisk helped Align.  Some years ago, MedRisk chose to outsource key functions, including some aspects of IT, billing, and outbound call center functions including patient scheduling. This did not go well, and the resulting dissatisfaction among desk-level users led some customers to switch from MedRisk to Align.

Confronted with the loss of business, MedRisk got back to basics.  The lesson was apparent; a dramatic change in customer service was critical. That involved a major shift in understanding about the central importance of the desk-level customer, the provider and the patient, and a recognition that those customers required, above all, personalized service.

Service isn’t about a couple codes on a bill, or the timing of a patient visit, or A/R days outstanding.   I spoke with MedRisk COO Michelle Buckman about this.

When we’re talking to a provider about our contract or a bill or treatment, it isn’t about crunching numbers on the issue, it’s about the overall relationship – we need to be the liaison, to understand it isn’t about that specific issue or problem, but the entire relationship. Anyone who calls in here, we need them to feel and know that the person on the end of the phone understands where they are coming from and is there to solve their problem…they weren’t getting that before.

We recruited US-based college grads who wanted careers in health care, looking to help people; we did NOT look for folks with call center experience.  That training isn’t necessarily helpful as it can be tied to ending calls quickly – that’s not what patients want to hear or how they want to be treated, and adjusters may need to have more time.

In fact, some metrics used by call centers are counter-productive; MedRisk found it’s much more important for staff to spend time on the phone to get a feel for what’s happening with the patient, the provider, the adjuster, to make sure questions are fully answered, issues identified and understood, then to get off that call and on to the next one. Buckman:

Our people are Patient Advocates. That is their title; their job is not just about setting an appointment, but guiding [patients] through the work comp process. Many [patients] don’t know anything about work comp or functional capacity evaluations, so we educate them…every number is a person who couldn’t pick up their child, or go to work; there is a person, a story, a need behind each one of these calls…

[The Patient Advocate] handles each patient end to end, monitors duration and type of care, in contact with the provider regarding progress. If there’s an issue, the Advocate engages one of MedRisk’s US-based PTs to evaluate the issue, [depending on the issue, resolution may include] perhaps peer to peer to discuss utilization and guidelines…if there is an issue, we get all stakeholders together to figure out how to get things back on track.

Getting there took a huge amount of effort and focus and disciplined execution to bring all customer-facing functions back inside the company. In turn, that required major investment in IT, because those customer service folks had to have the information and the tools necessary to quickly diagnose issues, answer questions, and resolve problems.

In-house IT was beyond necessary, it was mission-critical.  Again, Michelle Buckman:

customers want customized workflows, when IT was outsourced, the [outsourcing vendor’s] folks didn’t get our industry or what we wanted to deliver to customers…One size doesn’t fit all, different customers have different protocols – [I] can walk down the hall and talk to developers [so we can] build what that customer needs…doing it internally is phenomenal, developers understand this is not just coding but actually what they are trying to accomplish [with that coding]

MedRisk now numbers 125 Patient Advocates among its 700+ employees. That’s more than common metrics deem necessary, but “over-staffing” means customers aren’t waiting in a queue, stuck on hold, or rushed off the phone. The company pays those Advocates above call center wages, and invests in them. It hires locally, delegates a lot of responsibility to Advocates, looks to Advocates for system, IT, process, and service improvement ideas, and measures “tangible intangibles”, five core values that make up 35% of performance assessment. Treating staff well does produce some striking metrics;

  • the 4 key staff that began the transition from outsource to internalized customer service are still at MedRisk
  • 78% of patients are scheduled within 4 hours of initial notice
  • calls are answered in less than 10 seconds
  • the “regrettable turnover rate” for the Patient Advocate staff, which is simply losing the people MedRisk wanted to keep – is 9 percent (compared to industry averages far more than twice that)
  • average case duration – the length of time a patient is in PT – declined 15 percent after the Customer Advocacy Program went into effect.

More to the point, investor people, is the financial result.  MedRisk’s revenues and profitability have increased dramatically over the last few years, that growth driven in large part by very happy desk-level customers.

To be fair, this growth has been helped of late by their major competitor’s decision to outsource and offshore key customer-facing functions.

What does this mean for you?

For vendors, serving your customers like your cable company does isn’t a recipe for success.

For payers, do you want your front-line staff to deal with a cable company service model? 



Serving workers’ comp patients and payers – what works and why

After several years of intense activity and billions of dollars invested in the work comp service industry by a score of private equity investors, it’s time to take a step back and figure out what’s worked, and why.

And what hasn’t. Namely outsourcing and offshoring customer-facing tasks…


(this is the first in a several-part series)

This isn’t about what’s worked for investors, but rather what works in work comp – better service, fewer screw-ups, improved patient care, lower cost.

For those not steeped in workers’ comp, a bit of background is critical.  Vendors winning a big national contract may just be getting a “license to hunt”; the executive’s signature on the contract is just the start of the real heavy lifting. Success is about the wholesale sale and the retail sale.

To translate a contract into revenue, vendors need to understand how REAL decision makers – the front-line folks – work, what they want and don’t want, like and don’t like, how they are evaluated, assessed, and bonused, what’s important to their bosses, how their IT systems and applications and security works and interfaces/doesn’t interface with the vendor’s systems/apps/security. Sure, every vendor thinks about this and works at it, but not many do it well.

More to the point, every encounter with an adjuster, case manager, or patient is critical to the outcome of the claim. An angry or upset patient will call an attorney, a satisfied patient will not.

With that as a basis, let’s talk about what happens when investors who don’t understand this buy work comp service companies.

With its strong focus on growth and debt service and cost cutting, the new owner employs a strategy that’s worked really well in other industries; reduce costs thru automation, off-shoring, and out-sourcing.

Their thinking is that many of these tasks can be handled faster/cheaper if a computer does them.  If a computer can’t, then someone in Asia, South Asia, or Central America can.  After a consulting company does an analysis of workflows, operations, and systems, the vendor’s US operations are shut down, work is outsourced, and the owners watch the profits leap.

Except, they don’t.  Leap, that is.

That’s because you can’t automate or outsource customer service.

Customer service is delivered in every encounter with every current or potential customer. It requires a boatload of pre-work:

  • developing your products and services to increase the chance for success and reduce the opportunity for screw-ups;
  • building IT systems that deliver the necessary information to those who can act on it when they need it in a form they can understand;
  • hiring, paying, and motivating workers with service at top-of-mind; and
  • training, re-training, and educating workers so they are confident and capable.

Then, it’s about execution.

  • ensuring your customers can understand what your people are saying and vice-versa;
  • empowering your people to address and resolve every issue for anyone who calls, emails, tweets, or instagrams;
  • connecting those customer-facing people with management and staff so the lessons they learn, complaints they here, and opportunities they identify can be used to improve your core products and services;
  • quickly and with minimal red tape.

We’ve all had frustrating customer service encounters with poorly-prepared customer service reps that don’t seem to grasp an issue, can’t address a specific problem but seem to think they can, or are difficult to understand.  This is NOT a slam at those reps, but rather at the companies that employ them.  Putting a person in a position where they don’t have the tools to do the job is a management failure.call_center_cartoon-1

The front-line, desk-level work comp professional has no time to deal with “customer service” that isn’t.  Claims adjusters and case managers need their issue resolved now. Not after lengthy conversations, multiple voice mails and transfers and back-and-forth emails, now.

That’s because their “customers” – workers comp patients and their employers – are anything but standardized.  State regulations, employer requirements, patient needs and wants, physician/provider policies, and the adjuster/case manager’s individual work style make for for complex and constantly-evolving workflows.

Simply put, while much of this can be standardized, documented, and scripted, some cannot – and it’s those encounters that spell success or failure for vendors.

The problem facing investors is this: automating, outsourcing and offshoring customer-facing activities has been wildly financially successful in many other industries.  

Not so much in workers’ comp, where every encounter with an adjuster or patient is critical to the outcome of the claim.

Some have learned that lesson, but many have not, and that’s the subject of tomorrow’s post.