Monday catch up

What with the HealthWonkReview Tenth Anniversary celebration at HWR HQ last week and finishing up a client project, I neglected my posting duties.

Here’s what I shoulda been writing about.

Work comp

Working with Harbor Health, the State Fund of California has launched an upgraded and updated MPN (that’s medical provider network for those not among the cognoscenti). Contracted thru Anthem, the new MPN is larger and provides more coverage in the rural areas where the State Fund has a lot of business.  While there aren’t any significant changes to how providers will interact with the State Fund, HH’s folks have determined the providers selected are higher performers.  HH will be monitoring performance on an ongoing basis.

Big news in the world of Medicare Set-Asides; NAMSAP has elected a new Board of Directors; the organization’s new leader is Gary Patureau of Louisiana Self Insured Ass’n fame.  Met Gary live for the first time last week, he’s a very experienced work comp exec; he is replacing the irreplaceable Kim Wiswell.  Rita Ayers of Tower MSA Partners is also joining the Board.

Implementing Health Reform

Contrary to the wildly wrong claims by GOP presidential candidates, employment hours have NOT changed due to ACA.  Many economists of that ideological ilk have been moaning for years that employers would cut hours to reduce the number of workers they had to insure.

Well, that hasn’t happened.  Here’s the money quote from a just-published research analysis: 

We did not see increases in 2015 in the probability of working either 25–29 hours or fewer than 25 hours per week. …We also did not observe a large reduction in 2015 (or in 2014, for that matter) in the frequency of working 30–34 hours, as one might expect if employers affected by the mandate reduced hours for workers just above the 30-hour threshold.

Update

A few weeks ago I posted on Millennium Health’s legal problems, $260 million fine and settlement with the Feds.  What I neglected to note was the settlement was with every state AND the Feds; it addressed state and federal legal actions. There have been a few announcements from individual state Attorneys General to the effect that they’ve settled with Millennium; each one was part and parcel of the one announced a few months back.  not – MH is still a consulting client.

News of the Weird 

The Great Buffoon, Donald Trump, actually said something intelligent last week.  I know, who’da thunk it, right?

What the arrogant demagogue said was he’d save Medicare $300 billion a year by “making Medicare” negotiate drug prices. Alas, Trump doesn’t understand that this is against the law – a law passed by his own party and signed by a GOP president.

Good luck with that.

More on this here. And here.

 

 

 

Health Wonk Review – The Tenth Anniversary Edition!

Well, that didn’t take very long…

Hard as it is to believe, Health Wonk Review has been around for a decade.  Yup, since way back in the DSL days, before the birth of the iPhone, before the Great Recession, before health care reform, back when I had brown hair, a group of health care nerds decided to publish a biweekly synopsis of the best of the health care blog-o-sphere.

Note – this post was delayed a couple days; here at HWR Inter-Galactic Headquarters we are still recovering from a mammoth 10th Anniversary Party.

party

The 200+ editions have been hosted by a who’s who of health care; physicians, health policy gurus, health care economists, workers’ comp pros, health insurance brokers, consultants, academics, not-for-profit execs, and even real journalists.  We owe a big thank you to all of you – and to Julie Ferguson, the expert who keeps things on schedule.

Throughout our loooong history, HWR has brought you perspectives from all political stripes – from hard-core free-marketeers to socialist single-payers; ultra-conservatives to hyper-liberals.

Fortunately, we haven’t had much of this..

liberal-vs-conservative-simpsons-300x288

And today is no exception!

With that – here’s what’s been on the blogs of the best-and-brilliantest this last biweek…

Ideas don’t die, they just take a long time to come to fruition.  That’s one view of single payer.  Linda Bergthold’s contribution from healthinsurance.org is a reminder that single-payer advocates haven’t gone away and are delighted indeed that Presidential candidate Bernie Sanders is giving full-throated voice to their cause.  The Bern’s campaign includes a Medicare-for-All proposal that would make consumers’ lives gigantically easier.

bernie-sanders

Dismiss it if you will – but not before you consider that universal health reform, an idea long derided as a non-starting never-happen, has been the law of the land for going on seven years…

A counterpoint to Bernie’s Single Payer comes from Hank Stern’s InsureBlog. Authored by Mike Feehan, the IB post says efforts to advance single payer in several states have been unsuccessful because it costs way too much. 

In fairness, I’d suggest that there cannot be “single payer” in any state, as Medicare alone accounts for more than a quarter of spend in many jurisdictions.  I’d also note that in defense of Sen Sanders, he has been quite up-front on the cost…

And this just in from the galaxy’s leading expert on ACA sign-ups, Charles Gaba. Charles was on the fence about Sanders’ candidacy for president, until Sanders released his single payer plan.

Now, Charles is off that fence and firmly in Clinton’s camp.  If you want to know why this single-payer fan is not favoring the single-payer candidate, click here.  Spoiler alert – Charles really, really understands this – and so will you after you read the entire piece…

My entry this fortnight attempts to cut thru the noise surrounding United Healthcare’s yet-to-be-followed-up-on threat to pull out of the Exchanges and the Rubio-induced death of many Co-Op plans.  It’s important to understand what UNH does – and does not – bring to the table; it’s also important to think of this in the context of what’s really going on.

Fixing an industry that accounts for one-sixth of the nation’s GDP is not going to be smooth, trouble-free, or painless.  Considering how change affected our industrial heartland, what we’ve seen in health care is minor indeed.

Sticking to the impact-of-tectonic-changes-in-healthcare beat, we welcome Roy Poses, MD.  Roy has been with us from the start; he is one of the leading voices identifying, criticizing, and educating us all on conflicts of interest, self-dealing, and, dare I say it, borderline corruption in the US health care delivery, device, pharma, and payer industries. Roy’s post details efforts by physicians at a not-for-profit, religiously-based hospital system in the Pacific Northwest to unionize.

mad-as-hell

Fed up with corporate BS and “managerialism”, the move by these docs may well be the harbinger of events to come.

With it’s foray into blogging, Health Affairs was one of the early adopters among the hard-copy research publishers; they have continuously improved and deepened their commitment.  Their latest is timely indeed, focusing on dramatic improvements in outcomes – and much lower costs – associated with early identification and treatment of mental illness.  

One key finding – 79 percent of high cost mental health patients were under 60 – almost the direct opposite of other high cost patients…

There are big claims for the benefits of wellness by fans – and equally strident derision of those claims by naysayers.  Jaan Sidorov MD sheds some much needed light on the “discussion” – citing studies that indicate a very strong association between wellness programs and total shareholder return. 

Jay Norris, one of the most insightful small-group brokers around, consistently provides insights into the real world of health reform.  His post this week is one of those adding much-needed color to the national discourse on ACA implementation; Jay’s job is to help employers and individuals navigate the system, and his advice and insight provide a real world perspective “policy makers” would do well to carefully consider.

One of the many pros who have been with us from the start is Jason Shafrin aka The Healthcare Economist.  Serendipitously, the good doctor is also celebrating the ten-year anniversary of his most-excellent blog. Jason’s contribution is a compendium of readers’ favorite posts.  Whether it’s comparing the US health care system to Canada’s; opining on other nation’s health care economies, outcomes, and services; defining ACOs or diving deep into the alphabet soup of medicare reimbursement policy, Jason’s the go-to guru.

David Williams of Health Business asks a knotty question – are supplements and food additives that are “Generally Regarded as Safe…safe? Given the dramatic improvements in safety testing, “maybe it’s time to reconsider the cost/benefit of cardiac safety testing at least for certain food additives.”

Pharma costs are high, going higher, and seemingly unstoppable.  Many – including your devoted author – believe direct-to-consumer (DTC) advertising is a major contributor. That’s been allowed under interpretation of freedom-of-speech protections.  Journalist Peggy Salvatore thinks that interpretation is the correct one – and even drug advertising is banned, digital health messaging/marketing will likely make a ban on DTC futile.

From the brains behind HWR – Julie Ferguson – comes the truly frightening news that there are 19 Texas facilities storing more than 10,000 pounds of ammonium nitrate within a half-mile of a school, nursing home, or hospital. Recall that an explosion at a similar facility in West, Texas killed 12, leveled structures all around the facility, caused $230 million in damages – $1 million of which was insured.

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photo credit Mike Stone, Reuters

Julie’s message – training, education, and preparation for local emergency responders would have saved many lives – but Federal funding for the program that ensures local emergency responders know what they are responding to was eliminated in 2012.

HWR has been a labor of love – for all of us. Thanks for reading, and join us again next biweek!

Monday catch up

Too much work and travel last week – actually missed posting three days in a row – my apologies!

Here’s what happened.

In the never-ending saga of California work comp, a recent appeals court ruling found a UR doctor potentially liable for problems associated with terminating a patient’s prescription drugs.  The case, King v CompPartners, appears to revolve around the court’s assertion that the UR physician had a patient-doctor relationship with the patient, and thus had a “duty of care”.

If King v CompPartners stands, there could be major implications for California work comp, including significant changes to the entire UR process and landscape. (CompPartners is a subsidiary of MCMC, an HSA consulting client)

Mitchell Pharmacy Solutions acquired PBM Jordan Reses. Mitchell also announced they will re-brand the company’s PBM services as ScriptAdviser. Jordan Reses’ work comp PBM serves a diverse group of employers including school districts, managed care firms, the State of Kansas; it also provides services for the auto PIP program in NJ for Liberty Mutual and other auto insurers. (Mitchell is a member of CompPharma, a PBM consortium; I am president of CompPharma)

After a multi-year hiatus, friend and colleague Bob Wilson finally posted a top ten predictions for work comp .  Despite his antediluvian political views, Bob is the most entertaining of the work comp bloggers – myself included.

Final enrollment figures for the public Exchanges are outTimothy Jost of Health Affairs reports a total of 11.3 million enrollees, 3 million of which were new for 2016.  While 35% are under the age of 35, we do NOT know what percentage of this group were dependents.  That’s critical, as enrollment among young heads-of-household is key to determine the extent of adverse selectio n.

Tom Barrett of BBG posted on a echocardiogram test a client company paid for; same test, prescribing doc, insurer – two different test providers – 525% difference in cost.

Happy Monday!

Who, precisely, are you talking about?

Sales and account service people talk about what this or that company says, or wants, or complains about, or what it is basing a buying decision on.

But companies can’t talk – so who, precisely, are these sales & service folks talking about?

This isn’t just an academic question, rather it goes to the heart of customer understanding. The reality is each “client” account is a simply an aggregation of different people, each with their own view of what they want, when they want it, how they want it, and how much it should cost.

And that’s just the high-level stuff.

Successful customer relationships involve a deep understanding of and appreciation for how your company’s services affect the individuals touched by those services.  If the senior execs want to see a certain report, then the worker bees have to be able to quickly, easily, consistently, and accurately enter the necessary information.

If your client’s financial folks work best if they get invoices via EDI, then you need to work with their IT folks to set-up a smooth, easy, and fault-free interface and process.  Given your client’s IT department is severely under-resourced, and is also your “customer”, you have to figure out how to make this work for them – which may mean you, the vendor, have to do all the work, or pay another vendor to do it for them.

Your business volume depends on your customer’s customers buying services that incorporate your products/services.  So, the customer’s marketing and sales folks are also your customers.  How can you help them be successful? How does your service/product help them sell more stuff? When problems arise, how will you find out about them and fix them as quickly and completely as possible?

Companies don’t buy and use your services or products, people do.  For any product/service “bought” by a company, there are many individuals within that company who will help determine if that sale is a success, if your services are valued, if you get to continue supplying the service or perhaps get to deliver even more.

What does this mean for you?

Look wide and look deep, ask lots of questions and listen really hard – especially to the stuff you may not want to hear.

Happy and Merry

It’s been a very, very eventful year.  And 2016 may well be even busier. Before I sign off for 2015, a few wishes for the new year.

Donald Trump oozes back under the rock he crawled out from, aka reality TV. Trump’s puerile comments about bodily fluids and his own “greatness” have dominated what passes for serious political debate in this country.  Let’s have a smart, informed, fact-based and objective debate about the role of government, foreign policy, tax policy, the future of health care reform, immigration and voting rights. (yes, I still believe in Santa)

Winter comes to upstate NY.  Tomorrow’s temperatures here will hit 70 degrees.  No snow yet this winter.  The warmest year on record, capped by the warmest December on record.  Seeing a pattern here…

America doubles down on tolerance, understanding, and compassion. And rejects ideas, policies, plans, and laws based on ignorance, racism, and a desperate attempt to marginalize anyone who doesn’t look or worship the way “we” do.

 

Here’s hoping you and yours get to enjoy the last week of the year – and it is happy and merry indeed!

Friday catch-up

Buried in a project and travel this week, so missed a few things worthy of note.

Health care reform

From PwC, a new report on the evolution of primary care.  Key takeaways – The “consumer” of primary care is changing to more elderly and more Hispanic buyers; who delivers primary care is changing as big retail outfits get involved, and reimbursement is getting better too.

A thoughtful piece from Health Affairs unpacking the recent news of health care spending growth.  Important note – remember this is OVERALL growth, not per-insured.  As insurance covers more Americans, it isn’t surprising that health care costs increase as well.

Work Comp

WCRI is out with a revealing studies about California post-reform.  The California study indicates early results show medical costs are down about 5 percent since 2012’s reform implementation.  

There’s a related study just out from CWCI – an exhaustive analysis of the UR/IMR process and results therefrom. Key takeaway – the estimated approval rate for all California workers’ comp medical services ranges between 95.7% and 96.1%.

Had a very interesting evening talking with a couple dozen Wall Street folks about workers’ comp earlier this week.  Interesting because a) it’s still surprising to me that anyone in the investment community really focuses on work comp; b) most were pretty knowledgeable about the space; and c) I learned a lot about the “secondary debt market” for privately held company debt.

Key takeaways:

  • lots of interest in work comp fee schedule dynamics
  • actual dynamics of the specialty services buying process are not well understood
  • so-called white space (un-penetrated accounts, service leakage to non-participating providers) a very hot topic

Other things of interest

Have you heard of the Cochrane Collaboration?  It’s an organization that produces:

systematic reviews and meta-analyses which encompass all of the studies both published and unpublished on a particular [medical] question, studies that have been analyzed and statistically combined to create a summary of what is reliably reliable.

Here’s an excerpt [highlights are mine]

Think of the body of medical procedures, screening programs, and drug treatments as a pie. If you were to divide that pie into thirds, the first third would contain all of those procedures or treatments that we know are underpinned by quality medical research and for which we can truly say with some degree of certainty that they “work.” The second piece of pie would contain those things we routinely do but we don’t have strong evidence that the benefits exceed the harms, because they haven’t been well studied. The last third would contain many things that we do in medicine and health care where there is evidence that they do more harm than good, and we should stop doing those things.

An interesting piece from Harvard Business Review on “why no one is reading your white paper.” I’d suggest it’s also because no one cares – that is, your white paper has to speak to a specific problem that person has.

If it doesn’t, it may be interesting but it won’t be effective.  Effective defined as inspiring that person to do something.

The Anti-Opioid Movement is gaining speed and traction

The pushback on opioids has accelerated dramatically; every day there’s at least one major announcement about states, the Feds, or other entities taking major steps to attack the overuse of opioids.

We are starting to see some progress.  Perhaps most noticeably, a few weeks ago the CDC published draft guidelines re the use of opioids for treating chronic pain.

Unsurprisingly, the pain industry wasn’t happy. They’ve penned letters to CDC officials and Congress, with one complaining: “a lobbying organization that seeks to reduce the prescribing of opioids appears to have played a significant role in developing the guidelines.”

Allow me a moment to pick my jaw off the floor.  This is the height of hypocrisy.

This is coming from an industry that has used the billions it has made from selling opioids to:

  • lobby state and federal elected officials and regulators,
  • pack ostensibly unbiased review panels with drug company shills,
  • fund “research organizations” that published biased research supporting opioids, and
  • brilliantly and effectively promote the use of this incredibly dangerous and damaging drug.

I’m just stunned at the unmitigated gall of these people.

CompPharma (the work comp PBM advocacy organization of which I am president) has joined with the National Safety Council, Physicians for Responsible Opioid Prescribing, American Society of Addiction Medicine, National Coalition Against Prescription Drug Abuse and several other groups to support the DC guidelines.

The human cost of opioids is a constant and terrible reminder of the impact the opioid promotion industry has on each of us.

Yesterday the estimable Steve Feinberg MD sent one of his periodic emails re interesting issues related to work comp and the delivery of care in comp.. This one was a column by Bob Beckel, an editorialist who recounted how he had to check himself into rehab after a mere eight weeks post-op care involving OxyContin and Percocet had addicted him to the stuff.

Truly frightening.  And very common.

A truly awful side effect of the rampant overprescribing of prescription opioids has been the explosive growth in heroin use.  When patients can’t get prescription opioids, those addicted or dependent may well turn to illicit versions of opiates, namely heroin.

myMatrixx’ Phil Walls RPh has written an excellent synopsis of the history and current status of heroin. Detailed, thorough, readable; download and read on your next flight.

Perhaps the most trenchant observation appeared a couple weeks ago in an editorial in the New York Times entitled “How Doctors Helped Drive the Addiction Crisis”.  Here’s Dr Richard Friedman’s concluding paragraphs:

WHAT is really needed is a sea change within the medical profession itself. We should be educating and training our medical students and residents about the risks and limited benefits of opioids in treating pain. All medical professional organizations should back mandated education about safe opioid treatment as a prerequisite for licensure and prescribing. At present, the American Academy of Family Physicians opposes such a measure because it could limit patient access to pain treatment with opioids, which I think is misguided. Don’t we want family doctors, who are significant prescribers of opioids, to learn about their limitations and dangers?

It is physicians who, in large part, unleashed the current opioid epidemic with their promiscuous use of these drugs; we have a large responsibility to end it. [emphasis added]

Kudos to Gov Charlie Baker (R) of Massachusetts.  Gov Baker is calling for a strict limit on initial opioid prescriptions throughout his state.  Of course several docs are protesting this, noting problems of access for patients who need the medications.  It would be even better if these docs noted the problems inherent in opioid prescribing; perhaps they did but the reporter didn’t publish those comments… (thanks to Jake for the tip!)

Finally, there are many, many pieces and parts to ACA, including significant funding for clinical research, patient outcomes research, and research into improving the delivery of care. The Patient-Centered Outcomes Research Institute just closed it’s request for proposals for research into Clinical Strategies for Managing and Reducing Long-Term Opioid Use for Chronic Pain.

There’s nothing more important in the work comp world than this issue.