Insight, analysis & opinion from Joe Paduda
There hasn’t been much in the popular press about consumer-directed health care of late. What a relief. That doesn’t mean we can bury the idea, as economists and policy makers of a libertarian bent are going to keep returning to the “market as solution to all” mantra until we successfully implant a wooden cross in their cold small hearts.
And to some degree consumerism in health care is appropriate and warranted, and therefore part of the answer to the health care reform question.
Jon Coppelman at Workers Comp Insider has written a thoughtful and incisive piece on the new WC market in West Virginia. The state had been (actually, until the middle of this year it still is) a monopolisitic state – employers had to buy their WC insurance from the state.
That’s changing to an open competitive market. The state WC fund, now known as Brickstreet, is going to be the largest carrier in WV for some time, but will inevitably lose market share as competition enters. Jon points out that managing that transition, while adequately serving the needs of existing policyholders, is going to be an incredibly complex and difficult job. Their customer base will shrink, making one of the first tasks of Brickstreet’s execs the management of staff reduction. While building a new agent service infrastructure, upgrading systems, and figuring out how to effectively compete – something they never had to worry about before.
Yikes.
Bob Laszewski has found the solution to the Bush health care program’s reliance on the non-functioning individual health insurance market. The plan needs a model that addresses the problems of medical underwriting, denial of coverage, age band underwriting, risk selection, access and availability, and it’s called “Part D”!
Actiq is a narcotic taken in lollypop form, a technique that gets the drug to the pain centers quickly. Developed for break-through cancer pain, evidence now suggests that only 10% of Actiq users have cancer.The high-powered narcotic has been the subject of several recent reports and a state attorney general investigation concerning off-label use.
If anyone can get workers comp reform addressed in New York, it’s new Goc. Eliot Spitzer (D). In a wide-ranging interview conducted yesterday by the Journal-News, Spitzer noted that work comp reform is at or near the top of his list of priorities.
Likely changes will include a cap on the duration of benefits for injured workers.
OK, so I’ve been a little obsessed with the First Health-Concentra deal. Several clients will be directly affected by the merger, and their priorities are mine. But I’ve been ignoring the larger world, including a report published in Health Affairs (subscription required) that has far-reaching implications.
Two researchers at CMS analyzed data on the concentration of health care expenditures, (what percentage of patients spend what portion of total medical expenses) and noted a surprising trend.
One of the potential side effects of the Concentra-First Health deal relates to Aetna’s workers comp network. Concentra is one of, if not the, largest customers for AWCA (Aetna acronym for their network). Concentra re-sells the Aetna network to its bill review customers; these deals may now be at risk.
Continue reading FirstHealth and Concentra – the impact on Aetna
Timing is everything; Coventry’s fourth quarter financials release came on the heels of the Concentra acquisition announcement, allowing the observer to compare results to prognostications.
Continue reading The Concentra – First Health deal: Coventry’s views
It looks like the Concentra workers comp deal is coming none too soon. In today’s earnings release, Coventry disclosed that subsidiary First Health’s revenues dropped for the second straight quarter to a two-year low of $49,175k.
This marks the seventh consecutive quarter of flat revenues for the big WC managed care provider.
In yet another sign of the impending attainment of critical mass on health care reform, the SEIU and WalMart have found common ground.
Who woulda thunk it?
