Insight, analysis & opinion from Joe Paduda
The recent imposition of a work comp pharmacy fee schedule in New York has shaken the industry – and that’s not hyperbole. The latest news out of Albany is likely to intensify the aftershocks.
The preliminary guidance from the State is PBMs cannot charge more than the fee schedule, and cannot pay pharmacies more than the fee schedule.
Continue reading NY’s workers comp fee schedule – further developments
Several sources indicate health care cost inflation is now running about 7%, with the latest coming from Towers Perrin. This jibes with other reports, and is consistent with last year’s final figures.
As always, the data underlying the overall result paint a more complete picture.
Continue reading Medical cost trends and consumer-directed health plans
The brains behind Health Wonk Review reside in Julie Ferguson’s noggin; and this fortnight’s edition resides at Workers Comp Insider.
While lots of folks have been taking vacation, not so with the various and sundry contributors to HWR!
CMS’ hospital reimbursement change is going to create winners and losers; among the biggest winners will be UnitedHealthcare.
Among the losers, their competitors.
The adage goes something like – when the US sneezes, the world catches a cold, signifying just how much influence this country has on the rest of the world.
That’s analogous to Medicare’s impact on the health care sector. And Medicare is about to change the way it pays hospitals, a change that will have a dramatic effect on every private payer from HMO to individual carrier to workers comp insurer to self-insured employer.
The latest shot in the battle against drug costs comes from the Centers for Medicaid and Medicare Services, which is reported to be denying coverage for off-label use of drugs such as Actiq and Fentora.
Whenever CMS moves, the healthcare world shakes, and this is no exception. There are a host of possible ‘downstream implications’ in areas as diverse as workers comp, formulary management, and hospice.
Coventry closed the Concentra acquisition four months ago, and has been working diligently to merge this new acquisition and First Health. While it is still early, here’s what things look like after four months.
(sources are today’s earnings call and discussions with industry insiders)
Coventry’s latest quarter was a good one. The key to financial success in the health plan business is the MLR, or medical loss ratio; Coventry delivered a Q2 MLR of 77.5% resulting from a combination of higher premiums and lower than expected medical claims. Premiums were up 5.1% YTD, while the medical expense increase was slightly lower at 4.9%.
To listen to some, you would think single payer health care will cause the sky will fall, and it will be full of really large rocks when it hits our heads.
At least that’s what the editors at the Wall Street Journal (subscription required) would have you believe will happen if Wisconsin adopts a single payer system.
While I’m no fan of single payer, I’m even less enamored of junk economics masquerading as policy analysis. And junk is what the editors’ arguments are.
Continue reading Murdoch is out! WSJ taken over by Chicken Little!
Marsh has released a ‘report’ on managing workers comp claims. While it is undoubtedly a marketing piece, it doesn’t do the firm much good as it reflects a broad lack of understanding of the primacy of medical expenses as a cost driver in workers comp.
Continue reading Why are workers comp medical expenses going up so fast?
