Seven out of ten work comp adjusters say…

Senior Associate Jack Johnston joins us again, getting us up to speed on his research into work comp adjusters -

Over the past month or so I’ve been doing research on the claims adjuster profession to get a better understanding of what adjusters like, don’t like, and what their managers can do better – both in improving the adjuster’s lot and the companies they work for. From what I’ve gathered from various online sources, for the most part, adjusters aren’t the happiest, most fulfilled workers.

Gathering information from general websites such as www.glassdoor.com and adjuster-specific websites – www.claimspages.com, www.adjusterspace.org, and fromoneadjustertoanother.ning.com has produced a few positives and a lot of negatives.  Here’s what adjusters have to say about their job and the company they work for:

The Good:

Among those with good things to say, when it came to the pros a lot of them talked about the good benefits they received.  Getting paid during time off and having a 401k; can’t complain about that!  Another somewhat common pro was the flexibility of the work schedule.  Some adjusters stated that if they were doing well enough with work, they could get permission to work from home.  Other adjuster work-life positives included satisfaction with their compensation and the enjoyable camaraderie with co-workers.

The Bad & the Ugly:

While there were a lot of different complaints listed in the many sites I was researching, there were a handful that popped up repeatedly.

Let’s start with caseloads.  There seems to be a ridiculous number of cases handled by some adjusters, forcing them to work overtime (which they don’t get paid for).  Overall, most adjusters appear to be overworked; common complaints included: we are “always behind on work” and “There was an enormous amount of work that is expected of everyone, and it can be very defeating to have most of your days end without a feeling of accomplishment. (sic)” 

Even if an adjuster is doing a good job in the office (or at home), s/he probably shouldn’t expect much of a reward.  Promotions are scarce and raises tend to be paltry, with most getting a 1-2% increase (and that’s only if you are lucky enough to be given a raise).  The lack of ability to move up in the organization has upset many of the adjusters as they feel they aren’t rewarded for the work they put in with the heavy caseloads they deal with every day.

A fair amount of reviewers I read complained that instead of promoting within their company, the firm would hire someone from an outside company and place them in the higher position.  That’s a low blow to the employees who have been working there for years, expecting their effort and loyalty to lead to more responsibility and more income only to see the new person get the job.

Another common complaint is that managers are not qualified and don’t do a good job providing feedback to adjusters.  The adjusters never receive compliments or congratulations and are always told what they are doing wrong and how much more work they have to do.  They complain that they are not trained enough to handle some of their cases efficiently and they also feel that their offices are understaffed.  The adjusters want upper management to be realistic.

Conclusion:

I understand that this is certainly not the voice of all of the claims adjusters in the workers’ comp world but this is what I’ve found.  Websites like www.glassdoor.com can be easily accessed and false information, positive or negative, can be posted by bad actors. 

With that said, 69.2% of adjusters on the glassdoor website would not recommend their job to a friend.

Summary:

  • Adjusters like their benefits, salary, and co-workers… for the most part.
  • Schedules can be flexible (can work from home with permission).
  • No raises, room for growth, and no pay for working OT.
  • Overworked, large caseloads.
  • Always behind on work.
  • Lack of feedback from upper management.
  • And perhaps the most telling quote – “Run, do not work here”

Hartford changes Medical Directors

As of next Monday, Marcos Iglesias MD will be moving from Midwest Employers to the Hartford, where he will be taking over as Medical Director from Rob Bonner, MD.

I know both well, and the move is a good one.  Rob has done yeoman work at the Hartford, particularly in the areas of pharmacy, disability rating, and analytics.  He’s also been a leading voice in the effort to add more science to the practice of workers’ comp medicine, speaking out against physician dispensing, directing research on compound medications, and leading a key committee at the American Insurance Ass’n focused on workers’ comp. I’ve worked with Rob on a number of issues, and hope to work with him in the future on projects as he transitions to a less-full-time schedule.

Marcos is equally passionate about the right care for the right patient.  With extensive experience in occupational medicine practice as well as leadership roles at several insurers, he will bring an equally strong voice to the Hartford.

I’d be remiss if I did not acknowledge the insight shown by Midwest Employers in actually staffing a corporate medical director position.  I can’t think of any other reinsurers with MDs, and far too few primary insurers have full-time medical directors. Among those that do, many don’t have anywhere near the influence, responsibility, or authority they need and deserve. The Hartford is one insurer where the Medical Director does more than most; alas most workers’ comp payers don’t understand that medical is now approaching 2/3 of claims costs.

If they did, there’d be a lot more medical directors with a lot more authority and responsibility.

What does this mean for you?

Does your work comp insurer get it?

 

Friday catch-up

A rather busy week to be sure.   Not exactly beach reading, but plenty of food for thought while you’re manning the grill, watching the game, or lolling about.

Reform rollout

The biggest news was the decline in health care costs, an occurrence that surprised everyone.  If you missed it, healthcare spending declined by 1.4% in the first quarter of 2014 – earlier predictions had it increasing by almost 10 percent.  

Pundits who had cited the earlier incorrect figures as evidence of the horribleness of Obamacare are looking pretty, well, stupid.  If they blame increases on O-care, shouldn’t they attribute declines to it as well?  Not if you’re the Wall Street Journal...who gets this week’s prize for convoluting facts to fit their worldview…

Before we get too giddy, I’d expect costs to bump up this quarter and next as the newly insured start using their benefits.  Hopefully PPACA advocates won’t make the mistake opponents have and read too much into the numbers.  We’re a long way from understanding the impact of PPACA on cost trends…

A helpful analysis by the Kaiser Family Foundation on the impact of Medicaid non-expansion in the South reveals:

  • nearly 80% of the 4.8 million uninsured US adults who fall into the coverage gap (no Medicaid and can’t afford insurance) live in the South;
  • the coverage gap in the South disproportionately affects people of color.

Another KFF report indicates:

  • 57% of Exchange enrollees were previously uninsured
  • many are enrolled in narrow-network plans
  • most think their health plans are a good value, but some still struggle with the premiums

The work comp world

With the reports that Aetna is looking to sell Coventry’s work comp business, there has been lots of talk about who’s going to do the deal. CWC’s revenues have been declining for the last three years, so there isn’t a huge amount of interest among financial buyers.  Apax/OneCall is the early frontrunner; the investment firm seems to have an insatiable appetite, bottomless cash (and credit) resources, and a remarkable ability to see high values where other potential investors do not.

A key point worth pondering – Aetna has NOT re-contracted their provider network; any buyer will have to convince providers to sign a work comp-only contract.  Considering comp is just over 1 percent of US medical spend, and many providers never see a work comp patient, and  very, very few providers have more than one work comp patient a month, and (sources tell me) at least half of the Coventry work comp network’s providers likely don’t even know they are IN the Coventry work comp network, that’s going to be a heavy lift.

A timely report from WCRI analyzes Ambulatory Surgical Center costs, prices, and expansion; the brainiacs in Boston have come looked at 23 states and find there’s not a lot of consistency across the group with ASCs less costly than hospitals in some states and pricier in others.  Another report looks just at prices paid to ASCs - which are also wildly variable…

The agenda for this fall’s Las Vegas National Workers Comp meeting is out; one timely session will feature principals from three investment firms very active in the work comp space; they will be discussing the role of private equity in workers’ comp.

Make those plans now!

Aetna is selling Coventry Workers’ Comp

It was perhaps the worst-kept secret in the industry; Aetna’s effort to sell the Coventry work comp business.

Now the secret is out, and yes it is true – they are looking to sell the entire thing – network, bill review, PBM, case management, and the rest.  

While a couple of friends have chided me – and undoubtedly more will – for my statements that this wouldn’t happen, I’d suggest that it may not.

The reasons are two-fold.  First, the PBM, FirstScript, uses Express Script’s retail pharmacy network and processing engine.  It represents about a third of the total revenues of Coventry Work Comp (CWC).  If Express decides it wants to own that business, or terminates the network and processing engine deals, FirstScript is in trouble.  Anyone looking at CWC is going to look at that as a risk.

Second, Aetna still has not figured out how to deal with the network contract issue. As I noted in a previous post:

The network generates the lion’s share of the margin; if Aetna wanted to sell the WC business it is hard to see how it could transfer the network’s provider contracts to the new owner as most are a combined WC/group/governmental contract. Sure, Aetna could guarantee access to their contracts going forward for some period certain, but given Aetna’s history with workers comp, any buyer would be very reluctant to bet the future of their investment on that guarantee.

Word is Aetna is NOT going to support the work comp contracts, which means whoever buys CWC – if anyone does – is going to have to convince providers to sign a contract based solely on work comp claims.  Considering workers’ comp accounts for just over 1 percent of total US medical spend, that’s a tough sell.  

So, who’s likely to bid on the asset that some lunatic said could go for as much as $1.5 billion?  (must’ve been on their way out of Colorado at the time..).

We’ll dig in to that later…

Mark Walls returns to Safety National

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.  

 

 

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

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!

Obamacare premium increases for 2015…

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.

 

The Good, the Bad, and the Ugly

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?

Monday catch-up

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.