Note – this is a repost; a system problem prevented email notifications for the original post.

Is rather modest – until it isn’t.

Preparing for the next pandemic, monitoring food safety, preventive health services for at-risk people, new drug approvals – all are on hold or severely curtailed as the Federal government shutdown heads towards its fourth week.

Fortunately, funding for most health-related federal programs – the VA, Medicare and Medicaid, other CMS programs – was approved before the current impasse, so most of us will not be affected.

That is, if the shutdown is resolved soon. If not, the downstream effects are going to be felt more deeply – by more of us.

While it may seem like there’s not much impact on most of us, that would be wrong. Specific departments’ policies, funding approval processes, budgetary allocations and the like are often affected by other agencies. For example, there are significant pending changes to healthcare IT standards which must be approved before hospitals, healthcare systems, and other providers and payers can update their systems to comply with Federal laws and regulations.

Programmers are waiting for guidance, and will keep waiting until the deadlock is over. Some of these system updates have deadlines; while the deadlines should be extended if and when the politicos agree to a deal, what should happen in Washington – and did back when adults ran our government – often doesn’t.

This is just one example – and there are hundreds more. Reality is we live in an incredibly complex world, the Federal government is tasked with making sure that world is safe, non-toxic, operates well and does so efficiently. And most government workers are committed to doing that well.

The problem isn’t the workers; it is the press that vilifies them and the politicians that blame government workers for problems the politicians create and exacerbate.

Of course, for those who want to use our national treasure – the National Parks… if the knuckleheads in DC don’t get their stuff together, the Parks may be their own public health crisis.

What does this mean for you?

There are dozens of ways the government affects our lives – almost all of which we don’t know about or appreciate until it’s gone.

Note – due to a snafu in a system upgrade, email notifications for this post never went out last week. So, republishing it for those who missed it.

Continuing my predictions for workers’ comp in 2019, the first five were last week.

But before I do, you may want to read this on the fallacy of so-called “experts” – I occasionally think I am one. (thanks To Tom Lynch of Lynch-Ryan for the link)

6.  The “advocacy” claims model will gain a lot more traction, as more employers, insurers, and TPAs embrace treating “claimants” as actual real people with medical and disability problems.

The problem is – how do we track this? That’s my challenge, but I hope you will let me know of payers embracing the model!

7.  “Opt-Out” will not gain traction.

Allowing employers to “opt out” of workers compensation is a solution in search of a problem – overall work comp is working pretty well, costs are under control, employers don’t see it as an issue, most patients recover and get back to work.

Most importantly, there is no significant political constituency that cares enough about it to make it happen.

Promoted by ARAWC and a few stakeholders invested in managing opt-out business, this isn’t going anywhere. Change does not happen unless there is a problem that needs fixing, and work comp’s problems are tiny in comparison to other issues confronting state legislatures…taxes, school funding, gerrymandering, Medicaid expansion, rural hospital funding, industrial and economic development, natural disaster preparation and recovery…

(Good friend and IAIABC Executive Director Jennifer Wolf Horesjh has a slightly different perspective…you can listen to Jennifer’s podcast here.) . She notes the advocates are working diligently to promote Opt-Out/Non-subscription.

8.   Service companies that deliver best-in-class customer service – and build that into their branding messaging – will win. 

In a commoditized business (which is how most buyers view most work comp services) customer service is critical to success – but most companies in commoditized businesses don’t understand this.

I’d go a step further – because workers comp is a declining, industry, being known for delivering great service is essential to survival.

Yet many businesses just don’t understand this, or if they do,

• they haven’t figured out how to deliver great service,
• or if they do deliver great service they fail to build that into their branding efforts
• if they even have anything that remotely resembles “branding.”

We will be doing some interesting research on this later this year which should help determine a) if my prediction is accurate, and b) what works.

9. More success in reducing long-term opioid usage by more payers.

We’ve learned that diligent, persistent, intelligent and caring approaches to managing chronic pain and long-term opioid usage produce results. The State Funds of California, Ohio, and Washington along with Sedgwick are a few of the payers achieving remarkable success in helping patients handle their chronic pain while reducing their opioid usage.

Vendors including Carisk are also delivering solutions to this knottiest – and most problematic – of work comp problems.

10. Payers will implement business models and processes using Artificial Intelligence  

These will include some or all of these:

• claims intake and triage;
• fraud/waste/abuse triggering and assessment;
• patient and provider communication;
• clinical assessment, including utilization review;
• policyholder communication;
• and more I can’t think of.

That’s it for this year’s predictions. So, what say you?

Almost four weeks into the Trump shutdown, it’s time to examine how this will affect workers’ comp.

Briefly, not much – if it gets resolved soon.

I don’t think it will – more on that below.

First, key Federal agencies are pretty much unaffected.

• The Department of Labor is funded thru September of this year; that includes OSHA and the Mine Health and Safety Administration.
• CMS is still fully operational – so there shouldn’t be any hangups in MSA processing.
• Social Security applications are going to be on hold – but that should have a negligible effect on workers comp/

Second, with a few exceptions, contractors for Departments that are now without funding are furloughed or on leave. 420,000 workers have to keep working – without pay. Several hundred thousand more are not on the job

The Departments of Justice and Homeland Security (I still think that’s a pretty creepy title) and other key agencies and departments are particularly affected as thousands of their workers have to work without pay. Other unfunded departments include Agriculture, Commerce, HUD, Interior, State and Transportation.

The US Trade Representative’s office is closed, we’ll get no economic reporting on jobs or output or prices or GDP. and numerous other independent entities are shuttered.

Here’s the caveat – the longer this stupidity lasts, the more impact it has on the economy, workers, and workers’ comp.

The White House reports that annual GDP drops 0.1% every two seeks the government is shut down. That equates to about $10 billion a week in foregone products and services.

So far, we’re down about $30 billion – a pittance in a $21 trillion economy. What scares the bejesus out of me is this could drag on for months – which will do real and lasting damage to the economy, businesses, and tax receipts.

Identity Loyalty is why it may not end soon. Simply put, compromise isn’t possible because the powers-that-be and their supporters know in their hearts they are in the right – and no amount of data, facts, or logic will change that.

The Wall has a brand that is all its own. It is incredibly powerful to Trump supporters as it is all about protecting them and who they are and what they have from others. This can’t be under-estimated, and is why Trump’s base and the right-wing media were furious with him when he offered to compromise way back in December.

By the same token, the Wall represents all that Trump opponents dislike – if not hate – about the man and what he stands for. Agreeing to pay for the Wall would be amoral at best.

You may have noticed Trump and his allies have been trying to use different language when referring to The Wall…steel slats, border protection, border security. That reflects a desire to change the terms of the current “disagreement” (putting it mildly).

Alas, Trump et al have done such a good job branding the Wall that this belated effort to re-frame things isn’t getting any traction.

What does this mean for you?

For those who elected Mr Trump because they wanted a change, you are certainly getting one.

Is rather modest – until it isn’t.

Preparing for the next pandemic, monitoring food safety, preventive health services for at-risk people, new drug approvals – all are on hold or severely curtailed as the Federal government shutdown heads towards its fourth week.

Fortunately, funding for most health-related federal programs – the VA, Medicare and Medicaid, other CMS programs – was approved before the current impasse, so most of us will not be affected.

That is, if the shutdown is resolved soon. If not, the downstream effects are going to be felt more deeply – by more of us.

While it may seem like there’s not much impact on most of us, that would be wrong. Specific departments’ policies, funding approval processes, budgetary allocations and the like are often affected by other agencies. For example, there are significant pending changes to healthcare IT standards which must be approved before hospitals, healthcare systems, and other providers and payers can update their systems to comply with Federal laws and regulations.

Programmers are waiting for guidance, and will keep waiting until the deadlock is over. Some of these system updates have deadlines; while the deadlines should be extended if and when the politicos agree to a deal, what should happen in Washington – and did back when adults ran our government – often doesn’t.

This is just one example – and there are hundreds more. Reality is we live in an incredibly complex world, the Federal government is tasked with making sure that world is safe, non-toxic, operates well and does so efficiently. And most government workers are committed to doing that well.

The problem isn’t the workers; it is the press that vilifies them and the politicians that blame government workers for problems the politicians create and exacerbate.

Of course, for those who want to use our national treasure – the National Parks… if the knuckleheads in DC don’t get their stuff together, the Parks may be their own public health crisis.

What does this mean for you?

There are dozens of ways the government affects our lives – almost all of which we don’t know about or appreciate until it’s gone.

Yesterday’s top takeaway – the consolidation continues – and the impact can be seen on the exhibit hall floor.

Sure there were some new names on the floor, but there seemed to be fewer companies exhibiting this year than in the past.  Not surprising as work comp claims counts are down, premiums continue to drop, and there’s fewer dollars in the system to support service providers of all stripes.

Yet most companies are still planning to grow, and some of the biggest booths are from newcomers who don’t seem to know a lot about workers’ comp.

Investors talk about structural limits as “headwinds”, conditions that inherently limit growth opportunities.

Trade wars, full employment, declining frequency and employers that – for very good reasons – don’t care much about workers’ comp are combining to reduce growth in comp services.

Two possibilities.

Those headwinds may grow in velocity – or, a recession will increase claims and delay re-employment, which will help service companies while hurting payers’ combined ratios.

The companies planning to grow are hoping to draw to an inside straight.

A few – those with great customer service and a deep understanding of the business – have much better odds of success.

But most seem to be the chump at the table.

Andrew Sprung has posted this month’s Health Wonk Review, highlighting a broad spectrum of perspectives on the Trump Administration’s ongoing efforts to emasculate the ACA, along with research into effectiveness of medical care, drugs, and a deep dive into Republican claims to protect those of us with pre-existing medical conditions.

Reinsurance, catastrophic plans, Texas v United States, are all covered in Andrew’s edition.