Insight, analysis & opinion from Joe Paduda

Feb
8

UPDATE – The monster in the basement – case managers at First Health

As part of the Concentra acquisition, First Health will own a large field case management force. From all indications, Coventry (FH’s parent company) has wanted to get into the case management business for some time – it generates steady fees, as opposed to the ups and downs of Coventry’s core HMO business.
Well, they’re certainly in the case management business now. Concentra has hundreds of nurses and vocational rehab specialists located around the country who spend hours each week driving to attend office visits with work comp claimants, meeting with employers, and discussing cases with adjusters.
At least FH hopes they’re getting lots of windshield time. If they aren’t, they will be sitting around doing nothing while getting paid.

Continue reading UPDATE – The monster in the basement – case managers at First Health


Feb
7

The Edwards Plan

I’ve been trying to find a summary of the Edwards plan unblemished by opinion/criticism/odds-making, and so far all I’ve found is the same article written several different ways, and no synopsis.
No wonder we’re having a tough time engaging in a substantitive debate.

Continue reading The Edwards Plan


Feb
5

my aching back

Controversy over treatment types, overly generous payments to physicians to endorse a product, lawsuits alleging faulty research, the FDA under fire for inadequate evaluation, fights over reimbursement for a new procedure, and confusion over the usefulness of a common and very expensive procedure.
If you want to know why the US health care system is so dysfunctional, I give you low back pain.

Continue reading my aching back


Jan
31

Cavalcade of Risk – the Paduda edition

After a year of badgering other bloggers to host an edition of Health Wonk Review, I’ve been guilted into hosting the Cavalcade of Risk, a related-but-different grand rounds of things insurance- and risk-management related.
I’m doing this from a beach-side hammock in Puerto Morelos, MX, so if there are garbled sections, blame it on the cervezas.

Continue reading Cavalcade of Risk – the Paduda edition


Jan
31

The Bush health care plan’s problem and the real world

If you want to know why the Bush health care plan will not work, you need look no further than the individual insurance cancellation brouhaha in California.
Blue Cross of California and other carriers stand accused of combing through high cost members’ application forms to find any mistake, inadvertent or not, and then using that to cancel their coverage.
While Blue Cross’ practice (which they have admitted) is reprehensible, it’s also understandable in today’s dysfunctional insurance market.

Continue reading The Bush health care plan’s problem and the real world


Joe Paduda is the principal of Health Strategy Associates

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A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.

 

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