Insight, analysis & opinion from Joe Paduda
Jason Shafrin, our favorite health care economist, has this fortnight’s edition of HealthWonkReview ready for your reading pleasure.
Lots of scary stories sure to get you ready for the spooky season!
I was thinking it’s about time for another post on the good folks in workers’ comp. A follow up to the few I’ve published in the past. In thinking about the subject, I realized I’ll never know many of the really good ones; I’m just one person.
So, allow me to render compliments to a broader group…
The claims handlers, executives, program managers and medical management folks I know – and I know a lot of them – are, with rare exceptions, good people trying to make sure injured workers get the best possible treatment as quickly as possible so they can get back to work. There’s way more concern about quality care than there is about the cost of that care, a strong focus on figuring out the “right” treatment and the right provider, a real desire to make sure the right thing gets done.
Yes, there are some adjusters who are burnt out, overwhelmed, poorly trained, managed or evaluated based on flawed or downright stupid metrics. There are misguided “managed care” programs that force adjusters to use crappy vendors so those vendors keep paying fees to the adjuster’s company. There are mistakes made, documents misplaced, miscommunications and missteps aplenty.
But focusing on the relatively small number of problems gives a grossly distorted picture of the claims adjusting process and profession.
These are people, just like us, who are trying to do a very tough job that involves individuals who are hurt, in pain, scared, and sometimes belligerent. Claimants’ families are worried about their loved one, their financial future, their security. Claimants’ managers often don’t understand much about work comp, need to get tasks done, and aren’t exactly sure how this whole work comp thing works. Attorneys may – or may not – be interested in what’s best for the claimant, but won’t allow the adjuster to talk directly with the claimant. And the C-Suite decision makers may not – for myriad reasons – give claims, medical management, ops, or other departments enough resources, IT expertise, staff, or assistance to do what they need to do.
Despite what some in the press say, most of you are doing a good job under trying and difficult circumstances.
Thanks.
It’s just around the corner; time to get those appointments nailed down and social calendar set. There’s always a lot to do and much to learn. I’ve been going to NWCDC since it was held in the basement of a hotel in Chicago; based on that long experience here are a few things I’ve learned.
Finally, among the events you should strongly consider, register here for the 2nd Annual Women in Work Comp Leadership Forum; it starts at 2 pm on November 10, the day before the official NWCDC kickoff.
Sure, the news is replete with stories about work comp claimants busted for posting pictures of their car repairs or elk hunts or CrossFit workouts.
But social media is also a force for good – it enables communities to learn quickly about news that wouldn’t be worth any mass media’s time. Communities can share their views, provide guidance and support, engage intelligently.
Bob Wilson, the legendary WorkCompKing, John Plotkin and I will take the stage at 5:30 pm Nov. 11 at the Mandalay Bay in Vegas to discuss how social media can be used for good. (Registration is here; cocktails and hors d’oeuvres will be served) Our Bob’s public discussion of SAIF’s appalling treatment of Plotkin is well known and but one example of the power of social media. (Bob’s post on the session is here.)
More to the point, the SAIF community’s support for John would have been much more difficult to marshall, document, and report without social media.
That and Bob’s biting wit and relentless pursuit of the issue may well make other organizations a bit more cautious before crossing the stupid line.
Hope to see you there
Two entries were inadvertently left out of last week’s Health Wonk Review – my apologies!
From Bill Danylik comes this report on a survey indicating perhaps half of large employers are going to be affected by the “Cadillac Tax by 2018. Fine by me; the tax was part of the great compromise reached to fund ACA way back when. It is intended to reduce the favorable tax treatment of benefits, one that subsidizes rich benefit plans.
Posting at the HealthInsurance.org blog, Wendell Potter provides insight into why some states have experienced big increases in individual health insurance premiums. Mr Potter thinks this is due to the similarity between the US health insurance business and the casino industry.
Hmmm, will Native Americans will come to rule health insurance soon?
OK, if you’re off today, enjoy. If not, back to work!
Harvest time is here, and we have a cornucopia of cogitation from contributors for your consideration. (sorry, it’s late…)
The lede
This may be mis-named, as Roy Poses MD’s take on the latest in the ongoing revolving door debacle presents a decidedly unappetizing look at regulatory processes. The candidate nominated to head the FDA has strong ties to the industry he will be regulating. While a superficial review of Robert Califf’s CV doesn’t indicate much of concern, a deeper dive uncovers a board position at a drug company and various and sundry other financial ties.
Dr Poses’ unstinting efforts to teach the rest of us about the far-too-chummy relationships between regulators and regulatees makes him one of our industry’s best.
Implementing Reform
In what may be the umpteen gazillionth effort by the GOPers in the US House of Representatives to do something, anything to kill PPACA, we now have a lawsuit filed by that august body accusing CMS of overstepping its authority re cost-sharing subsidies for exchange enrollees. Attorney Max Horowitz, an expert in the law brings us this tight description of the issue; if you just want to know the basics, click thru.
A huge effort has been underway to automate and integrate health care delivery. Peggy Salvatore shares the latest from the Office of the National Coordinator of Health IT. The ONCHIT announced that it has rolled back Meaningful Use requirements and put in place a 10-year plan for complete nationwide health IT interoperability. These two documents come on the heels of the release of the Federal Health IT Strategic Plan two weeks ago. This is a big deal folks…
Meanwhile, the Colorado version of ACA seems to be moving along albeit with bumps along the way, some of them – shockingly – created by the same folks who continue to try to kill PPACA. Colorado Health Insurance Insider shares what’s happening as health plans set premiums for future years and wonder what happened to the Risk Corridor payments they were promised. Thanks Louise!
The fine folk at HealthAffairs are careful students of all that is payment reform; they direct our attention to limitations in the current shared-savings models employed by Medicare, limitations that means those models don’t work that well for low cost ACOs. Two execs have come up with a creative alternative, one with global risk-adjustment that may address some of the issues with the current model. This is exactly what health reform is supposed to do – get smart people to figure out better ways to do things.
Yay!
Reports of the death of physician private practice may be exaggerated – or at least very, very premature. Jaan Sidorov at Population Health Management provides a very interesting post detailing why and how small physician groups are competing quite well in these days of mega-huge health systems.
My contribution is a piece offering a quick review of a bunch of issues in the healthcare world including the Cadillac tax, premium increases, employee cost sharing, and payer consolidation. All in one easy-to-digest bite!
This next post may cause major indigestion in corporate board suites.
While company executives seem to always escape without any penalty when their companies do bad things, one exec may well get hammered. The top exec at Massey Mining, the company tied to the Upper Big Branch mine disaster is facing trial for his role in the tragedy that killed 29 miners. The question to be addressed involves the level of responsibility a CEO has when things go horribly wrong. WorkCompInsider’s Julie Ferguson includes links to some pretty telling video detailing what CEO Don Blankenship is is accused of.
For post-prandial lethargy sufferers
You know those health plan emails encouraging you to exercise? They may get more serious soon…Hank Stern and friends at InsureBlog are telling us that FitBit may be one way healthplans will find out exactly how many steps you’ve taken. Not to worry; it will be HIPAA compliant.
We’d be remiss if we didn’t give Hank a shout-out; his blog recently was named the #2 Men’s Health Blog. I gotta believe something from Maxim hit the top spot – no other way to keep IB off the top of the podium…and you know how shallow men are!
That’s enough for now. enjoy your Friday, have a ball this weekend, and get out to those Farmer’s Markets!
In 2012, the entire US opioid market was $8.34 billion.
Workers’ comp paid about 17% of that bill.
One of every six opioid dollars was spent by the work comp industry.
That’s a stunning statistic.
Recall that workers’ comp medical expenses account for about 1.5% of total US medical spend. Sure, there’s a lot of pain in comp – but there’s a lot of pain in non-comp diagnoses as well. Chronic non-cancer pain, end-of-life pain treatment, cancer-related pain, acute injuries, surgical recovery, dental procedures can all result in opioid prescriptions.
But few group health patients get opioids for non-skeletal back pain.
What does this mean for you?
We’ve accomplished a good deal in reducing inappropriate prescribing of opioids to comp patients.
But we have very, very far to go. This is NOT the time to rest on our rather meager laurels.
CompPharma, a consortium of workers’ comp pharmacy benefit managers, released the 12th Annual Survey of Prescription Drug Management in Workers’ Comp yesterday. The Survey is an in-depth look at the issue based on telephonic interviews with 21 TPAs, insurers, state funds, and self-insured employers.
This year, we (I’m the author of the study) found that drug costs increased across all respondents. Comparing total 2013 and 2014 drug spend across all respondents, costs climbed 6.4%.
However, that increase was driven by a minority of respondents as only 7 of the 21 saw costs go up.
Looking at inflation another way, we also calculated the average increase for each respondent; trend was essentially flat.
We offer these different metrics to provide readers with as much data as possible so they can draw their own conclusions. One could argue that you have to look at cost changes across an entire industry to really understand what’s happening. Another perspective focuses on individual payers. As the payer’s policyholder base doesn’t change that much from year to year, a payer-specific view is more accurate.
The big question is what is driving drug spend increases. In that, respondents’ views were pretty consistent – physician dispensing, opioids, and compounds. I’d note that the industry has had some pretty good success addressing opioids; PBMs that report on this have all been able to decrease opioid spend over the past couple of years.
Another cost driver, mentioned by a couple respondents, was likely a major contributor: price inflation for generic medications. Fortunately, that has leveled off somewhat of late, although entrepreneurs will continue to look for opportunities to make their fortunes by buying up manufacturers (of little-used drugs) and dramatically increasing prices.
A couple points that bear making.
First, work comp pharmacy is about as different from group health/medicaid/medicare as chalk and cheese. There are:
Second, the PBM industry has done a remarkable job of bringing down the rate of inflation over the last dozen years. Yes, there have been a couple spikes over that time, but ten out of twelve years we have seen a ‘decrease in the rate of increase.”
While premium increases remain at pretty low levels, employees’ share of costs is increasing. In fact, that’s one reason premium increases are as low as they are. Without the higher employee premium contributions, deductibles and copays, premiums would have gone up a couple more points. According to Bloomberg, several factors are contributing:
Consolidation among health plans continues, although there’s little evidence that it will lead to lower costs or better quality.
CEOs from Aetna and Anthem testified before Congress last week, with both touting the benefits of their pending acquisitions of smaller health plans. While it sure looks like the consolidation binge is concentrating power in the hands of a very few health plans, Anthem CEO Joseph Swedish claimed otherwise, stating: “health insurance is flush with competition…The number of health insurers increased by 26% in 2015 with 70 new entrants offering coverage.”
Not sure Mr Swedish’s claim accurately portrays the state of competition in health insurance, and the American Hospital Association and AMA certainly think it’s a bad thing. An analysis by the AMA indicates
The combined impact of proposed mergers among four of the nation’s largest health insurance companies would exceed federal antitrust guidelines designed to preserve competition in as many as 97 metropolitan areas within 17 states
While I am VERY skeptical about any analysis by the AMA, I believe that in this case they have a point. As one expert notes:
I’m aware of no peer-reviewed, published analyses that show that insurance mergers, on average, benefit consumers.
What does this mean for you?
Huge changes in the health care system will have far-reaching implications; watch for more battles between big provider groups and big payers, with smaller payers suffering fall out. This “fall out” will take the form of higher medical costs due to lack of bargaining power,
