Author: Joe Paduda

Jun
25

Mark Walls returns to Safety National

Posted by Joe Paduda on Wednesday, June 25th, 2014 | Comments

Well, done, Safety National.

As reported by WorkCompCentral, the reinsurer returned Mark Walls to the fold, but in a much more prominent position and one where his value will be maximized.

Kudos to Marsh for figuring out Mark was a valuable commodity and bringing him on board to run their Workers Comp Center of Excellence.  While obvious no-brainer, it was a brilliant move.  It paid off big-time for Marsh as they benefited greatly from the exposure and brand enhancement that came every time one of Mark’s 22,800 (!!) LinkedIn group members logged onto the group site.

Now that he’s back in the friendly halls of SN, he’s got the role, responsibility, and freedom he should have had all along.  When Mark Walls left Safety National to take a position with Marsh, I was rather critical of the reinsurer; now that they’ve brought him back I would be remiss indeed if I did not compliment them on the move.  According to their announcement, Mark will “oversee thought leadership activities and external communications, including developing content for white papers, social media, webinars and speaking engagements…”

In other words, he’ll be Mark – bringing his deep and broad market following, insights and intel, and his own particular brand of humor and rather unique dance moves and alter egos back to whence they came.

Reporting to the top gives Mark the access and SN the direct connection to the market needed to maximize his value.  One suggestion for Mark’s boss – now that he’s back, don’t get all “insurance” on him.  Recognize that his value is immediacy, exposure, his voice.  Don’t wordsmith, monitor, oversee, “manage” the guy – sure he’ll say some things (or wear some costumes) on occasion that will make you wonder, but that’s who he is and why he’s so damn good at getting you the recognition you want.

What does this mean for you?

Good for Mark, and good for Safety National.  And for the rest of you out there in insurance-world, wake up.  SN got a huge bargain, and you missed out.  

 

 

Jun
20

Friday catch-up – non-competes, compounds, and clustermesses

Posted by Joe Paduda on Friday, June 20th, 2014 | Comments

It is a gorgeous day in upstate NY – not that every day in upstate isn’t fabulous.  Hope your weather is equally spectacular.  This week has been nuts…between deals, indictments, PPACA enrollment…gosh how’s a guy supposed to keep up!

First up, my post earlier this week about non-competes generated a lot of attention and more than a few resumes.  I can’t act as a clearinghouse for folks hiring and looking to be hired (much as I’d like to), but a couple companies did reach out to let me know they are looking for workers – non-compete or no.

Broadspire is looking for a bunch of talented, motivated, hardworking people eager to work for a company that cares about them.  Jobs are listed here.

Dane Street is as well – they’ve got eleven jobs open as of now; check them out here.

Evidently OneCall is also hiring, as a friend asked me my thoughts on potentially working for the company.  No comment.

Alas, there are OTHER jobs out there – for people who want to earn “$300 to $1200 per Script and all of its refills” touting compound medications.  The fine folks at TYY Consulting are doing their best to get those meds to people who need them!

Gosh these people are great; “Every patient receives their medication, even if not approved. Should a patient’s script be declined, we send them a 40 gram emergency supply, overnight, and free!!!”

Oh, the wonder of it all!!!

In what can only be described as exquisite timing, WorkCompCentral’s Greg Jones authored a piece in today’s WCC concerning the indictment of a bunch of California docs, “business people”, pharmacists, and assorted hangers-on for a scheme allegedly involving payments of more than $25 million to encourage docs to write scripts for three compound creams that just happened to be formulated based on the profitability of their ingredients.

Hmmmm.  I’m quite sure this is an isolated, one-off case, and wouldn’t want anyone considering a career in the compounding industry to worry at all about any potential legal issues.

The fine folks at Liberty Mutual are encouraging their employees in PA to let their legislators know they support a bill limiting physician dispensing – a practice awfully similar to compounding in that it sucks money out of employers and taxpayers for no good reason.  Kudos to Miss Liberty for pushing this – and hey, other insurers, let’s get cracking, eh?

here’s an excerpt from their piece…

HB 1846 is currently supported by the Pennsylvania Workers’ Compensation Advisory Council (WCAC) so please let your Pennsylvania state Senators know you also support HB 1846, without amendments, by writing an email or making a call today. Take action today and don’t let the orthopods and dispensers dilute this bill.

Click Here to View HB 1846

1) CONTACT one or more members of the Pennsylvania State Senate at the Pennsylvania House and urge them to vote yes on HB 1846 

Despite some wishful thinking to the contrary on the part of at least one CompIQ staffer, that app is going the way of…CompReview, PowerTrak, BR 4.0 and other expired/ing bill review platforms.  Shockingly, StrataWare will be the survivor of the acquisition of StrataCare by Xerox.  I know…who woulda thunk it?

I’d be remiss if I didn’t acknowledge and applaud Bob Wilson’s ongoing efforts to keep us informed about the clustermess that SAIF is making out of the firing of former CEO John Plotkin. Bob is setting a standard here that I won’t even try to meet; kudos to him for keeping a very bright – and extremely well-written – focus on this blatant injustice.

No one can turn a phrase into a knife like Bob can…to wit: ” a huge crapfest ensues, ensnaring all involved into a quagmire-like vortex of controversy.”

Bravo, Bob-o!

I’m also going to nominate SAIF employees for workers of the year; the way these folks have rallied behind John is just, well, unprecedented?  And this for a guy who was just there for a few months.

So here’s to you, SAIFers…a toast with your favorite Gilgamesh 22 – or perhaps a great Oregon Pinot Noir!

Jun
19

Obamacare premium increases for 2015…

Posted by Joe Paduda on Thursday, June 19th, 2014 | Comments

Are averaging 8 percent for individual plans in nine states.  

An analysis by Avalere Health of filed rates indicates rate changes vary from a decrease of 1.4 percent in OR to a 16 percent jump in IN.  Before anyone starts celebrating, let’s remember that these rates barely qualify for educated guesses as many plans are still finalizing and sorting thru enrollment.  With a big chunk of membership not coming in until April, many members haven’t even figured out how to access care, use websites, contact their plans.

Thus the actual underlying cost and utilization trends are essentially unknown.

To say that plans publishing rates are guessing would be accurate indeed.  Therefore it is likely rates  – and the list of plans participating in the Exchanges – will shift more dramatically the next of-round, which is a year from now.

What does this mean for you?

Don’t declare victory or trumpet defeat until we know.  And we won’t – not for a long time.

 

Jun
18

The Good, the Bad, and the Ugly

Posted by Joe Paduda on Wednesday, June 18th, 2014 | Comments

Who else but Clint Eastwood could fairly describe the current state of the workers’ comp services industry’s relationship with its employees.

People like Sandy Blunt, Mark Walls, John Plotkin (and many others) and a few service companies are the Good; doing the right thing, serving their customers, working with their employees to continue to improve, grow, develop.  I single out Mark because he spoke to this yesterday, making a plea for service companies to hire as many recently-terminated workers as possible.

If that were only possible – but we’ll get to that in a minute.

There’s also a Bad side; the folks who suddenly find themselves out on the street after working for years to help build a company.  Sure, some of them deserve to be out of a job – not everyone’s a star, and there are certainly more than a few knuckleheads in our business (just as there are in every industry and profession). But this is an inevitable if really bad effect of our business economy, and one hopes these folks can move on and perhaps even move up.

Except there’s the Ugly.

And oh is it ever.

Scores if not hundreds of work comp professionals have become collateral damage from the recent spate of mergers and acquisitions.  Forced/required/strongly urged to sign non-competes after which some were summarily discharged, now unable to find work in a business they actually know something about, they are forced to seek employment in areas where they have few contacts, little knowledge, and less hope.

Why?

Does a billing clerk, or recruiter, or intake specialist, or sales rep or account manager really represent that much of a threat to mega-huge-giganta-enormous-corp?  Sure, a sales rep or account manager might be reasonable expected to sign a non-compete for a limited time in a narrowly-defined niche, and a senior exec with lots of stock and a generous severance package isn’t going to elicit much sympathy.

But the effort on the part of some companies to prevent regular staff workers from getting a job in this business is way beyond the pale.  Many don’t fully realize what they are signing, and shame on them (and sympathy for them, too).  Others feel like the have to in order to keep the paycheck flowing, not realizing that signing a non-compete doesn’t provide them any guarantee that they will keep getting those checks.

Regardless, this isn’t the right thing to do.

Nor is it the smart thing.

Those clerks, sales reps, account managers, billing folks, intake staff all work with payers’  adjusters, case managers and other folks all day every day.  Once they’ve been laid off and their former contacts find out what happened to them, how are they going to feel?  How are they going to relate to mega-huge-gigantic corp? How motivated will they be to do all the little things necessary to get cases referred, bills processed, invoices paid, authorizations completed?  Especially when their fellow staffers read every day about how much money is being thrown around by the bigwigs?

More broadly, society is going thru wrenching changes as the gap between the very wealthy and the rest continues to grow.  This will be even more ammunition for those that believe the moneyed class doesn’t give a rat’s rear end about the rest.

It’s wrong, it’s dumb, and it’s mean.

What does this mean for you?

How would you want to be treated?

Jun
16

Monday catch-up

Posted by Joe Paduda on Monday, June 16th, 2014 | Comments

After spending the last few days on vacation – the boys’ annual mountain biking trip – plane time is needed to catch up on all that happened while I was getting lost in the high desert west of Fruita, Colorado.

Fruita

CWCI’s June 10 missive listed the top ten work comp writers in California; in addition to indications that premiums will keep increasing, there are a few other takeaways worth contemplating.

  • First, total premiums are above $10 billion, a big jump from 2009’s $6.9 billion – but a LOT less than the $16 billion high hit just a decade earlier.
  • Berkshire Hathaway is writing a boatload of comp, growing their premiums by 49 percent over 2012. State Fund’s premium is also up – but “only” 23.1 percent.
  • Liberty Mutual is out of the top ten, dropping four places to number 12 while reducing premiums by 23 percent. This is the largest decrease among the top 20 carriers.

There’s a bit more to this; Liberty has been de-emphasizing work comp as it continues to focus on personal lines. The news from the Golden State, along with changes in management wherein personal lines and other non-comp folks are ascendant, look like proof positive that the transformation of the company to one shifting its focus away from workers comp is proceeding. (note – I worked for Liberty way back in the day – 22 years ago to be precise)

Those wretches at the FDA have gone and done it again – according to the American Society of Interventional Pain Physicians (the docs that inject stuff into patients) they’ve issued a “warning that all epidural steroid injections pose a serious risk for neurological injury, paralysis and death…” And, ASIPP is urging all their docs to write letters, scream, yell, and lobby to get this horrible injustice corrected.

This, after studies documented  “a 629% increase in Medicare expenditures for epidural steroid injections in use for chronic low back pain, despite the fact that these increases have not been accompanied by population-level improvements in patient outcomes or disability rates.”

As mad as most sentient beings are about the FDA’s unconscionable decision to allow marketing of Zohydro, this is one of those times where the FDA appears to be doing the right thing.

Meanwhile, mergers/acquisitions in the work comp services world – and the fallout therefrom continues. This has been going on for so long that it feels like the normal state of affairs; if one doesn’t hear from at least a couple of analysts, research firms, or investors every week it’s strange indeed.

Finally, I’ve heard from three entities of late who are looking for data analysts.  Many insurers, managed care firms, and TPAs are increasing their investment in analytics.  The emphasis appears to be provider performance, care analytics, and other aspects of medical price, utilization, and cost.

 

Jun
10

Work Comp PBMs – it’s drug trend report time

Posted by Joe Paduda on Tuesday, June 10th, 2014 | Comments

Today’s post is authored by Jack Johnston who is spending his summer interning at Health Strategy Associates; Jack is going to be a senior at Syracuse University (my alma mater); he’s studying Health and Exercise Science.

The three largest PBMs have sent out their annual drug trend reports to tell the Workers’ Comp world what’s been going on this past year.  Instead of you having to read through each entire report and finding out what’s new, I’ve bit the bullet and gone through them for you.  Coventry-First Script, Progressive Medical-PMSI, and Express Scripts have all made much progress and developed new ways to further develop their success.  Let’s give you the skinny…

PBM Goals:

Coventry-First Script has been working with physicians to eliminate the use of narcotics  – due primarily to widely known potential for misuse.  Increasing generic brand utilization to lower costs and helping the older workforce remain healthy enough to work have also been other tasks Coventry’s been working on.

Progressive has managed to accomplish their goal to decrease opioid usage by working with physicians, prescribers, and injured workers.  Progressive Medical is working to ensure injured workers will return to work healthy, as soon as possible, while employers (payers) are getting the lowest possible costs.

Express Scripts is focused on reducing drug costs, utilization, and abuse for workers and prescribers while increasing the use of more affordable generic medication wherever possible.

Summary Findings:

With all three PBMs reporting that OxyContin is once again the most prescribed drug (in terms of dollars) on the market, they’ve been working on ways to decrease the use of opioids.  Progressive reported a 5.0% decrease in opioid usage while Express also showed a decrease of 3.0%.  Progressive also reported that the opioid cost per claim dropped by 6.0% and the workers who were prescribed opioid analgesics this past year used lower dosages compared to 2012; with MEDs diminishing by 9.6% over the year as well.  (First Script did not show any indication of an opioid usage % decrease in their report) correction – First Script indicated utilization per claimant decreased 9.1%, the biggest decline among the three PBMs.

Progressive is using a “Multiple Prescriber Service” to identify injured workers that are getting drugs from more than one prescriber.  With the main focus on multiple opioid prescribers, Progressive notifies all prescribers treating the injured worker and offers guidance to address the issue.

Express Scripts’ MED Management Program allows clients to set max levels for the amount of narcotic medication prescriptions an injured worker can fill.  Once the amount is exceeded, the program employes a review process before additional medication is dispensed. According to Express, the MED Management Program has successfully reduced drug abuse, limited addiction, and controlled costs.

Express has also continued to developed their Physician Outreach Program to encourage the use of generics, which appears to be Express’s main concern.

The First Script network pharmacies are being re-credentialed under stricter requirements including background checks and site audits to ensure legitimate dispensing practices.  The network also blocks narcotics and other controlled substances through mail service to prevent potential drug overdose, diversion, and misuse.  This reduces risk to the patient and the community.

Summary:

  • Opioid use is the main focus of these PBMs.
  • PBMs are having success with decreasing opioid usage through a variety of targeted programs.

What Does This Mean For You?

  • Claimants have a lesser chance to become addicted to their medications (Yay!).
  • Medication costs have lowered over the years.
  • If you’re not using a PBM, sign up and reap the benefits!
Jun
6

Examworks has bought MedAllocators/ASN

Posted by Joe Paduda on Friday, June 6th, 2014 | Comments

It’s official – in a press release that hit the wire just after 5 pm EST, Examworks announced that they have bought MedAllocators for $80 million.  Cash.

That’s a pretty hefty price, as MA’s revenues were less than half that amount.

It’s going to be a great weekend for Ken Loffredo; he almost certainly got a big payday (and well deserved); he will also be running ExamWorks Clinical Solutions, a new division at Exam.  Ken was smart enough to take his payout in cash, rather than stock.  Exam’s management folks recently sold off a big chunk of their holdings, and the stock dropped rather dramatically at right about the same time.

The weekend will be a pretty crappy one for many MedAllocators/ASN workers.  Word has come from several sources that the layoffs have already begun, and they may have started at Solomon Associates, the Pennsylvania IME company also bought by Exam today.

 Yet another big company getting even bigger.  Seems that’s a trend these days…

Jun
6

Friday’s catch up post

Posted by Joe Paduda on Friday, June 6th, 2014 | Comments

Here’s my quick take on other interesting/important news of the week…

There’s been a good bit of chatter about and fallout from Apax’ acquisition of Genex.

Yes, the specialty networks (NSI and MDN) will be part of OneCall, while the case management and bill review will be operated separately. HOWEVER, a single Apax fund purchased all parts of Genex, so the financial ownership is the same. Is it possible that Genex and OCCM will operate independently? Highly doubtful; big investment firms don’t invest hundreds of millions of dollars then ignore opportunities to drive revenue to their other companies.

On a personnel matter, I’ve been inundated with LinkedIn requests and other contacts from current Genex and NSI staff.  According to two individuals, they’ve been asked to sign non-competes by early next week.  If they don’t, they have been told they will be terminated. Ouch.

NCCI published an excellent review of the underwriting cycle, one that is a lot more worthy of a read than that trashy novel tucked into the beach bag.

The on shoring movement, where manufacturers are moving their operations back to North America, appears to be gathering momentum,  Big potential impact on workers’ comp, altho it is important to remember that a) injury rates and severity in manufacturing have declined precipitously and b) a lot of the returning work is going to Mexico.

The rapidly-changing hospital market is dramatically affecting prices, costs, and utilization.  Two excellent pieces in Health Affairs dig into this in detail; the link takes you to one.

Lots more, but time to get to work!

Jun
5

HWR’s not taking any time off!

Posted by Joe Paduda on Thursday, June 5th, 2014 | Comments

Nope, the wonkers are hard at it while the rest are vacationing…we know you’re busy, so we’ll do this one quick – but NOT dirty!
This biweek’s edition of Health Wonk Review starts with the big question – we all know there’s a shipload of waste in the health care delivery and reimbursement system.  So, what do we do about it?
David Cutler and host Harold Pollack discuss what it might take to reduce wasteful spending in the healthcare system and what makes healthcare organizations successful. Is healing the system as simple as treating patients well?
Maggie Mahar brings us an excellent piece on the issues inherent in living longer – dealing with the medical conditions that arise as we age, and paying for them.  A thoughtful and comprehensive discussion.
The most expensive health insurance in the nation is in…a group of mountain towns in Colorado.  Louise explores this as only she can – discussing all sides of the issue, and asking if people who live in less well-to-do areas should be expected to essentially subsidize the cost of living for people who live in resort communities?”
My contribution is a piece on a new tool for folks interested in tracking health care costs, spend, and related matters.  Detailed, specific, and user-friendly, its a welcome addition to the geek’s armamentarium.

The impact of provider market consolidation is being felt all around the country – but the effect may not be as clear as one may think.  From the good folk at Health Affairs we get two Contributing Voices pieces on provider consolidation and market power in health care:

While hospitals are consolidating, there’s also significant stress within management as many hospitals are still struggling to transform their culture from one that worked in the past to one that will thrive in the new world of health care. And some places, like Lehigh Valley Health Network, are further along in the journey. 

Despite Its Best Efforts, ObamaCare Might Improve Some Health Care Delivery is by John R. Graham, NCPA Senior Fellow; Graham finds that certain aspects of ObamaCare might be leading to unintended outcomes that improve medical care.

Kynecting the Dots on Obamacare discusses the puzzling but very real dichotomy between what people don’t like (Obamacare) and what they like (all the parts of Obamacare). Sen. Mitch McConnell’s recent comments about Obamacare and the state health insurance marketplace in Kentucky make it clear that he’s in a quandary as well…

The public debate about the price of Sovaldi (sofosbuvir – Gilead) continues, but is completely focused on whether $1000/ pill for a “miracle” cure can be justified, not on whether in fact the drug is a miracle cure.  But a third skeptical appraisal of the current evidence from clinical research about the drug concluded that the evidence that the drug cures nearly everyone, will prevent most bad results of hepatitis C infection (cirrhosis, liver failure, liver cancer, premature death), and is safer than previous alternatives is weak and questionable.  It seems that the marketing and public relations blitz for Sovaldi and other new, extremely expensive anti hepatitis C drugs has been so effective that it has prevented people from thinking critically about the evidence.  Skeptical, level-headed appraisal of clinical evidence would go a long way to addressing our dysfunctional health care system.  Fortunately, Roy Poses has kept a sharp focus on the important issues…

At Workers Comp Insider, Tom Lynch profiles Dr. Jennifer Christian, a key thought leader in the occupational health arena, focusing on some of her key initiatives aimed at changing the landscape for disability management.

Should you trust your doctor more than Wikipedia?  That’s the question posed by David Williams, who, while finding fault with the study that finds fault with Wikipedia, still believes you should probably rely on your doctor more than you rely on Wikipedia.
Addressing one of the more politically charged issues of the day, InsureBlog’s Kelley Beloff offers her unique perspective on the goings-on at the VA, explaining that it’s *not* a scandal but “business as usual.”

We conclude with a very different type of post, by Amy Berman; Updating her April 2012 Narrative Matters essay, Berman discusses her experiences since being diagnosed with terminal cancer and choosing to utilize palliative care.

Next up to bat:   June 19 when Julie Ferguson at Work Comp Insider takes the reins!