Insight, analysis & opinion from Joe Paduda

Oct
18

Halloween HealthWonkReview!

Okay, I’m a bit early on the pumpkin-and-costume thing, but time is going by so damn fast I want to be early for once.

It’s also open enrollment time! that joyful event where we all get completely confused, baffled beyond belief, our minds all-a-boggled by all the tiny print on the screen describing in excruciatingly minute detail really important nuances in health benefit design that, if we ignore, will cause us to go bankrupt and die. Fear Not – Louise is here in her SuperWoman costume, typing madly away to bring you all you need to know about individual market enrollment – and in English too!

There’s been a lot of chatter about simplifying all this stuff, with much of it about Medicare for All. My contribution this week unpacks the argument that MFA would somehow harm Medicare. Hint – MFA is not the boogyman it’s made out to be.

Andrew Sprung’s found out that Bob Hugin, Republican candidate for the Senate seat held by Bob Menendez in NJ may well be hiding his real views on healthcare – but no one is asking. Andrew’s not afraid to ask…What’s behind the curtain, Mr Hugin?

Hank Stern over at Insureblog.net doesn’t like the HMO-only plans offered to his clients in the Buckeye State; Hank sees the evil hand of Obamacare at work, limiting his clients’ choices.

Our favorite healthcare economist, Jason Shafrin, has been looking into the costs of mental health that go beyond medical care. He’s also done a lot of research into medication adherence. And I can’t find any meme that works for this entry…darn it.

 

If you don a nursing costume, you may need to add a back brace. Nursing assistants get more back injuries than any other occupation. That’s the scary news from Tom Lynch at Workers’ Comp Insider.

The estimable David Williams is on a search to uncover a deep mystery – what happened to “Consumer Directed Health Plans”??? Join David as  he finds this to be a conundrum wrapped in an enigma; were they ever REALLY “consumer” directed?

Leaving my poor attempts at humor behind, Ranit Mishori MD MHS asks some very pointed questions about political determinants of health, determinants such as the for-profit motive and prioritizing religious beliefs over science.

Out long-term colleague Roy Poses MD FACP has been focusing on this as long as HWR has been around (15 years and counting). Roy’s learned big health care corporations, particularly pharma, biotech, device, and health insurance companies, provide significant sources of funding to dark money organizations.  It appears nearly all such money from health care organizations supports right- wing/ Republican/ pro-President Trump activities.

What happened to putting patients above all?

Thanks for reading, and thanks for writing contributors!


Oct
17

Who’s investing in work comp services now?

Several years ago it was smaller private equity firms who bought companies for $75 – $200 million, built them up, and sold them off. Then it was the bigger PE firms who put together a couple of these and hoped to sell them for more than they paid – and were mostly successful.

One of the first deals was way back ten years ago – and what’s transpired with that deal is emblematic of the evolution of the industry.

PMSI was sold by owner Amerisource Bergen after the PBM industry’s founding company just kind of melted away. HIG Capital picked it up for  about $50 million, and quickly brought in one of the most talented managers I’ve ever had the honor of knowing – Eileen Auen. Greatly aided by a major cash infusion, Eileen and her team turned the all-but-buried company around. HIG profited  handsomely when it was sold to Stone River and merged with Progressive Medical, a deal that was backed by Kelso.

The new company, renamed Helios, grew and was eventually sold to OptumRx, a division of giant health insurer UnitedHealthcare.

Optum is what is known as a “strategic” buyer. Strategics are investors that buy assets to add to its existing operation, ideally leveraging existing infrastructure, customers, systems, and suppliers. The result is infrastructure costs (and ideally supply costs) are reduced and revenues increased.

So, we have strategics such as Optum, Mitchell (see acquisitions of Pharmacy Benefit Managers), and Paradigm buying companies that somehow make the whole greater than the sum of the parts.

I’d note that some of these transactions seem a bit of a stretch, but, hey, I’m not the one who went to Harvard Business School, so what do I know.

The financial investors are the other entities still in the game.  Of late, it’s been the giants – Carlyle, Stone Point, KKR – investment firms with billions in ready cash, deep knowledge of the business, and the savvy needed to pick out management teams and business models that will flourish in what is a declining industry – workers’ comp.

We haven’t seen much activity on the small end of the deal world – except for Adva-net and a couple smaller transactions things have been pretty dull of late.  While there are a bunch of smaller companies in various geographic and/or service niches, there’s been precious little trading activity over the last couple of years (with a couple exceptions)

There’s one more investor type that’s getting more active these days – distressed asset investors. Their strategy is to find companies that aren’t doing well financially and buy them – sometimes out of bankruptcy or just before they tank.

I’d expect we’ll see more of the distressed asset folks making the rounds in Las Vegas in six weeks, finding out what’s up and who’s making it and who isn’t.

What does this mean for you?

The work comp service industry is getting awfully mature.

 


Oct
15

It’s complicated.

Let’s have a reasoned and fact-based discussion of why I believe the trade war is bad for your business and your job.

At its most basic level, the issue is this – there are few simple answers to big problems. Sure, there are soundbites and memes that may make you feel good… but like that second helping of dessert, it tastes great but leaves you feeling bloated and unhappy.

For example – “Trade wars are good and easy to win.”

If you want to get a country to change it’s industrial policy or actions, a trade war is certainly one option.

Some think the tariffs on China were an appropriate way to get its attention. And no doubt, the import duties on steel and aluminum and manufactured goods got noticed.

But tariffs are a two way street; the Administration’s actions resulted in China imposing retaliatory taxes on US exports of coal, farm goods, motorcycles, asphalt, Vaseline, cars, meat, airplanes and a bunch of other stuff.

It’s not just China – The tariffs on Canadian newsprint were crushing US newspapers, many of which have been barely staying afloat. The tariffs were finally overturned after hundreds of jobs were lost.

Farmers aren’t as fortunate; there are hundreds of millions of bushels of soybeans piling up – with no buyers in sight. Farmers looking to store this grain can’t afford new silos, as the price of steel has gone up 25%.

And jobs are at stake.  From Forbes:

“The tariffs, quotas and retaliation would increase the annual level of U.S. steel employment and non-ferrous metals (primarily aluminum) employment by 26,280 jobs over the first one-three years, but reduce net employment by 432,747 jobs throughout the rest of the economy, for a total net loss of 400,445 jobs.” [emphasis added] The analysis found, “16 jobs would be lost for every steel/aluminum job gained.”

It’s not just employment; tariffs don’t operate in a vacuum, but are one tool governments have to influence other countries. In fact, there are real national security issues in play here.

One is North Korea; China has more influence on North Korea than every other country combined, so when we anger the Chinese, they get a lot less interested in enforcing arms and energy embargoes on the rogue state of North Korea.

Then there’s China’s illegal building of naval bases in the South China Sea, which is a shipping bottleneck; over a quarter of the world’s shipping transits the Sea. It is also home to huge reserves of carbon-based energy deposits. The pace of construction has greatly accelerated of late and the number of troubling incidents in the area has increased – a Chinese naval vessel almost collided with a US destroyer a few weeks ago.

Okay, you say, we’ll get this resolved and all will go back to the way it was, farmers and pork producers and Boeing and coal miners will be fine.

Not so fast.

In reality, China – and other countries affected by our tariffs – have already shifted their purchasing to other countries. Brazil and Argentina are huge grain and meat producing countries, and they are benefiting greatly from the trade war.

US farmers are getting hammeredUS wheat exports globally have plummeted by 21 per cent in just the first half of 2018. This means fewer dollars for farm equipment, fencing, fuel, fertilizer.

And farmers are the canary in the coal mine; this trade war is going to have lasting and serious repercussions for our economy and each one of us; the longer it goes on, the worse it will get.

What does this mean for you?

When you’re stuck in a hole, the first thing to do is stop digging. 

Why this affects you – a recession hurts all of us – lowering employment, increasing healthcare costs, increasing work comp claims.

But long-term losses of markets causes long-term damage to entire economic sectors. That’s the real issue here.

 


Oct
12

Friday catch-up

Another crazy busy week is coming to a close, and its time to catch up on what I missed, didn’t get to, or just figured out.

I know what you’re doing this weekend…you’re going to be poring over NASI’s annual report on workers’ compensation which just hit the virtual newsstand – and you need to get a (free) copy. For those unfamiliar with the report, it is the only comprehensive, national report that provides detailed, state-by-state financials on medical and indemnity spend by type of payer. Along with a treasure trove of other great info.

The big news – total work comp medical paid in 2016 dropped (!) 0.3% from the previous year. Work comp spent just over $31 billion on medical in 2016.

What’s driving the decrease? I say a big contributor is reduced spending on pharmacy, which I’ve been tracking for 15 years.

Notable – WorkCompCentral’s William Rabb teased out one major issue – the worker-unfriendly government in Michigan’s efforts to cut benefits for workers resulted in a 15% drop in benefit payments. Ouch.

Kudos to Accident Fund’s United Heartland for talking about the good work they do helping patients recover. I’ve had the honor of working with folks at AF and United Heartland in the past – they are good people focused on doing the right thing.

Work comp bill review and case management company Genex’ acquisition of Priority Care Services will cause a bit of disruption in the specialty services sector. Sources indicate PCS will be the “home” of specialty services in the Genex/Mitchell operation, with everything but IME and Pharmacy consolidated under PCS.  More on this later, as there are repercussions…

Healthcare costs are almost $20,000 per family. While premiums in the ACA marketplaces have stabilized, the reality is premiums would be significantly lower if the Administration hadn’t stopped making cost sharing payments and Sen. Marco Rubio R FL hadn’t cut off the funds needed to help start-up insurers compete with the big boys. Rubio’s action singlehandedly killed off several new insurers founded to offer competitive insurance…so much for the “free market”!

Last, this drives me NUTS – managers, execs, supervisors who use the “I” word all the time. There is no “I” dammit. There is only “we”.  This is not about you, your feelings, your work, your anything.  It is about everyone working towards the same goal, and when you say “I did this” or “My results were X” you denigrate the contributions of others, make them less likely to work to achieve future goals, and send a signal that you have a fragile ego that needs stoking.


Oct
9

My post last week about the (minor) impact of rideshare services on work comp elicited responses from a couple of transportation companies, as well as one anonymous reader who wanted to talk about OneCall’s program (more on that below).

Full disclosure – a few years ago I was among those asserting rideshare companies would disrupt work comp transportation. I’m a lot smarter now (well, perhaps not smarter, just able to see why I was wrong)

Jim Nygren of HOMELINK sent in a detailed comment, which led to a rather extensive back-and-forth email conversation (I disagreed with some of his assertions, and wanted to have a conversation instead of putting up the comment and responding). As readers know, I’m happy to get comments and corrections, but not enthusiastic about marketing masquerading as comments or contributions.

The Jim and Joe conversation was professional, courteous, and perhaps a bit frustrating for both parties. After wrestling with the specifics of our conversation, I decided to post it here.  I don’t have any business dealings with HOMELINK; I’ve heard mostly good things about the company, I do like that it is employee owned. I also appreciate the work that HOMELINK has done in an effort to use rideshare services; they’ve clearly spent a lot of time and resource on this.

Here’s the conversation (“Jim” denotes his statements, rest should be self-explanatory)

Jim – Appreciate your post and perspective as always.  There are some materially inaccurate comments/assumptions made that need to be addressed, my comments below.  The most important thing to know is Rideshare is NOT an exclusive option, if properly implemented it is a tool within a complete transportation solution.

Joe response to Jim comment – I never said or implied rideshare would be an “exclusive option”.

From the original post –

Here’s why I don’t think they’ll replace work comp-specific transportation companies.

This is not to say L/U (Lyft/Uber) won’t be part of the answer – I’m just suggesting that “part” may be pretty defined and not nearly as big as we may have thought a while back.

Jim – My comments come from the perspective of the company I work for, HOMELINK, which began offering Rideshare as a solution in 2015.  I look forward to your feedback.

(Jim then quoted text from my original post, with his comment below each quote; here I’ve denoted that text from my original post as “Joe’s original post”) –

Joe’s original post – The big one – being late for or missing an IME is really, really expensive – the payer has to pay the IME doc the $1000 – $2000 anyway, rescheduling an IME incurs more indemnity, attorney, and other expense, and it makes adjusters nuts. The same is true for PT or other medical treatment – although not quite as bad.
Jim’s comment –           Rideshare programs are a great solution for just this point.  The transparencies provided from real time monitoring of rides allows immediate rescheduling if an adverse issue arises.

Joe response to Jim comment – This may still lead to delays in getting the patient to the IME – unless L/U informs you with sufficient time to reschedule – which is likely much more than 5 minutes – I still don’t see how this solves the issue.

Joe’s original post –
WC patients don’t all have smartphones, so figuring out which patients can access L/U is a necessary first step
Jim’s comment –  The benefit of this program is the patient does not utilize commercial applications.  The coordination and monitoring of rides are done through the vendor, such as HOMELINK.

Joe’s original post –  L/U drivers wait a maximum of 5 minutes – this doesn’t work for patients
Jim’s comment –         Through HOMELINK’s processes, every patient is qualified before the coordination of the ride.  Patients with specific needs or limiting diagnoses are coordinated with transports meeting their exact needs.

Joe response to Jim comment – And L/U aren’t able to accommodate most of these patients, supporting my assertion.

Joe’s original post –
L/U drivers aren’t going to go up to the patient’s door and help them get into the vehicle
Jim’s comment –  As mentioned before, these patients would undergo our initial Rideshare assessment and coordinated with transports meeting their exact needs.

Joe response to Jim comment  – And L/U aren’t able to accommodate most of these patients, supporting my assertion.

Joe’s original post –
L/U drivers’ vehicles typically aren’t accessible for patients with limited physical ability
Jim’s comment –  This would be vetted in the assessment process as outlined above.

Joe response to Jim comment – And L/U aren’t able to accommodate most of these patients, supporting my assertion.

Joe’s original post –
Some WC patients aren’t native English speakers, and may require drivers to speak their language
Jim’s comment –  This would be vetted in the assessment process as outlined above.

Joe response to Jim comment – And L/U aren’t able to accommodate most of these patients, supporting my assertion.

Joe’s original post –
If you try to schedule a pickup for a time in the future, L/U typically don’t reach out to drivers until a few minutes before that pickup time – which may well not work for patients in remote areas
Jim’s comment –  Since HOMELINK coordinates the referral, these necessary communications all occur within our patient care teams.

Joe response to Jim comment – This doesn’t refute my core assertion – there’s still a 5 minute rule.

Joe’s original post –
which brings us to location – L/U work really well in metro areas, and not so much in more rural/suburban settings. So, schedulers may find L/U doesn’t have available drivers
•im’s comment –  Rideshare and traditional transportation are not mutually exclusive, Rideshare is a cost savings tool to be used by payers when the situation allows.  In this example, if Rideshare did not have adequate coverage a traditional transport would be coordinated.

Joe response to Jim comment – never said rideshare and traditional WC transport were “mutually exclusive” – far from it.

Joe’s original post –
you can’t talk to a person at L/U – ever. Many WC transportation services involve a three-way call between the scheduler, driver, and patient; this is just not going to happen with the ride-sharing services.
Jim’s comment –  Our relationship and developed workflows allow our patient care coordinates to have open communications with the driver.

Joe response to Jim comment  – This doesn’t refute my assumption – are these calls three way ?

Joe’s original post –
Finally, while the dollars are significant in WC, they really don’t amount to that much compared to other opportunities in Medicaid and Medicare. If you’re L/U, you’re going to focus on those payers and ignore WC.
Jim comment –  If you’re looking at Rideshare organizations making a direct play with WC you are correct.  However, relationships established in this space with companies such as HOMELINK have allowed for payers to capitalize on substantial savings.  We have shown comparative savings (Rideshare vs. traditional transportation) approaching up to 40%.  This is not an exclusive tool in a transportation portfolio, it is another innovative approach to improve patient experience and optimize savings.  Since our rollout in 2015, we have seen Rideshare utilization becoming a larger percentage of our partner’s transportation mix.

Joe response to Jim comment – I asked what percentage of rides are rideshare, Jim responded it is “in the double digits” but would not go beyond that.  Thus, it’s not possible to determine if this “savings” is meaningful or not.  “approaching up to” is marketing-speak – what is the actual percentage saved for what percentage of rides?

The net – HOMELINK is clearly trying to make the best possible use of rideshare, and kudos to the company for it’s efforts. Much of what they’ve done operationally is to deal with the very real challenges inherent in the L/U business model – a model that is NOT going to change to serve a very tiny market. I’m still waiting to see much of an impact – for reasons I note a couple of paragraphs below.

Re my correspondence with the anonymous commenter re OneCall; s/he made several assertions about OCCM’s use of rideshare. However, I emailed s/he back to ask how s/he knew this, and whether s/he is a OCCM person or customer, and never heard back. (note – the commenter is from Jacksonville, FL, which, perhaps coincidentally, is OCCM’s home town). I’m happy to hear from OCCM, as I noted in the post, or from OCCM’s transportation customers, but readers do need to know who you are to properly understand your statements.

Takeaway – Absent any credible data, it is not possible to quantify the impact of rideshare on work comp transportation. Therefore, we’re stuck with assumptions, albeit ones based on experience.

More important takeaway – There have been any number of “innovations” coming into work comp from outside the industry; models based on what works in group health or Medicare, or efforts to adapt technology and business processes to “fix” problems inherent in workers’ comp.

Most have not worked, or if they have, the impact has been minimal. There are a bunch of reasons for this:

  • Every state is different, thus vendors must adapt their tools/approaches/business models to fit 51 different sets of requirements.
  • Work comp is tiny and getting tinier – It accounts for 1.25% of total US medical spend, and claim counts continue to decline. Thus the payoff for the investment needed to adapt technology/programs/approaches can be vanishingly small  – or even negative – in states that have relatively low work comp spend.
  • But (most) vendors must be able to serve customers everywhere – so you are going to lose money in many states and hope you make your profits in the handful of big ones with a lot of comp exposure – California, New York, New Jersey, Texas, Pennsylvania, Illinois, etc.

What does this mean for you?

Innovation in comp will mostly come from inside comp.


Oct
8

Are claims that “Medicare for All” will hurt Medicare accurate?

CMS Administrator Seema Verna said last week that “Medicare for All would become Medicare for None.”

Verna said – and I quote:

A) “By choosing a socialized system, you are giving the government complete control over the decisions pertaining to your care, or whether you receive care at all.”

Uh, Medicare’s recipients are pretty damn happy with Medicare’s “government run healthcare” today – much happier than those of us insured thru employers

Verna fails to explain how MFA is fundamentally different from Medicare as it exists today – and therefore would somehow become this “government-controlled healthcare” monster.

Her claim appears to be based on unfounded assumptions, namely MFA would be fundamentally and in some ways diametrically different from Medicare. Yet she provides no credible rationale for this assertion, instead using code words such as “socialized medicine” to grossly mis-characterize the proposals for MFA (note I’m not advocating for MFA, as I’ve said before, however I do believe something like it is in our future because the current system is unsustainable)

In fact, the MFA proposals consistently support keeping the core of Medicare the same, just expanding it to include the rest of us.

B) “Rather than straining Medicare, we are working to strengthen Medicare.”

I call Bullshit.

Recall that her boss, President Trump, and the Republicans in Congress proposed a budget that would cut $537 BILLION from Medicare over the next decade. I’m hard-pressed to figure out how cutting over a half-trillion dollars from Medicare will “strengthen” it.

Finally, she says C) “Let’s learn from the mistakes made in Medicaid when the Affordable Act pushed millions of able-bodied Americans into a program designed for pregnant women, children, aged and those with disabilities, only to then incentivize states to serve the able-bodied before protecting Americas most in need.

The ACA did not “push” millions of able-bodied Americans” anywhere. The reality is those “able-bodied Americans” could not afford or get health insurance – it was too expensive, wouldn’t cover their pre-existing conditions, or just wasn’t offered, period. The “free market” failed them – and Verna et al have yet to offer any plans that would help millions of working-classAmericans get affordable health insurance

It also didn’t favor those new Medicaid members over current ones – that’s just not true and is a blatant mis-characterization of the law.

What does this mean for you?

I’ve been waiting for the current Administration’s national strategy/plan to fix healthcare. If this is symbolic of their thinking, we’re going to get MFA sooner than I thought.


Oct
5

For work comp, Lyft and Uber aren’t the answer

Transporting work comp patients to and from medical visits, PT, IMEs, hearings and the like is a big business – big for worker’s comp that is.

At first blush, it looks like a perfect opportunity for Lyft and Uber (L/U)- they’ve got a gazillion drivers everywhere, a great service model, and they are much less expensive than the traditional work comp transportation services.

In fact, OneCall and Lyft announced a partnership over two years ago (interested to hear how that’s working out; if you know please comment below).

Here’s why I don’t think they’ll replace work comp-specific transportation companies.

  • the big one – being late for or missing an IME is really, really expensive – the payer has to pay the IME doc the $1000 – $2000 anyway, rescheduling an IME incurs more indemnity, attorney, and other expense, and it makes adjusters nuts. The same is true for PT or other medical treatment – although not quite as bad.
  • WC patients don’t all have smartphones, so figuring out which patients can access L/U is a necessary first step
  • L/U drivers wait a maximum of 5 minutes – this doesn’t work for patients:
    • with limited movement ability trying to get ready
    • who aren’t really interested in making that IME appointment
    • whose doctor appointments may run late
  • L/U drivers aren’t going to go up to the patient’s door and help them get into the vehicle
  • L/U drivers’ vehicles typically aren’t accessible for patients with limited physical ability
  • Some WC patients aren’t native English speakers, and may require drivers to speak their language
  • If you try to schedule a pickup for a time in the future, L/U typically don’t reach out to drivers until a few minutes before that pickup time – which may well not work for patients in remote areas
  • which brings us to location – L/U work really well in metro areas, and not so much in more rural/suburban settings. So, schedulers may find L/U doesn’t have available drivers
  • you can’t talk to a person at L/U – ever. Many WC transportation services involve a three-way call between the scheduler, driver, and patient; this is just not going to happen with the ride-sharing services.
  • Some states regulate transportation fees, which may not work in the L/U pricing model.
  • Finally, while the dollars are significant in WC, they really don’t amount to that much compared to other opportunities in Medicaid and Medicare. If you’re L/U, you’re going to focus on those payers and ignore WC.

This is not to say L/U won’t be part of the answer – I’m just suggesting that “part” may be pretty defined and not nearly as big as we may have thought a while back.

I’m sure there are other reasons – as well as arguments for L/U as successful disruptors. I look forward to hearing them.

What does this mean for you?

Once again, what looks simple isn’t because of the inherent complexities of work comp.


Oct
3

Chronic opioids can be solved

That’s the key lesson from today’s session on Dealing with legacy opioid claims at IAIABC’s 104th Convention.

BWC Ohio’s Nick Trego PharmD, State Fund of California’s Chief Medical Officer Dinesh Govindarao MD, Washington L&I Medical Director Gary Franklin MD MPH, and Sedgwick Pharmacy Director Paul Peak all documented significant reductions in long-term opioid usage in their patient populations.

That means many fewer moms without kids, husbands without wives, and kids without grandparents.

Among the takeaways…

Prevention is critical – we’re doing a very good job of preventing more Opioid Abuse Disorder (OAD) patients.

Flexible treatment options are critical – every patient is different, with some responding to Medication-Assisted Therapy and others not.  The same is true for exercise, yoga, cognitive behavioral therapy, acupuncture, and PT.

Closed physician networks, formularies and UR with teeth are critical – it’s tough to get bad docs to become good ones, so kicking them out of your panel is necessary.

Analytics are critical – to identify patients at risk of OAD, to monitor progress, to evaluate success, to learn what works and what doesn’t and why.

Full payer access to Prescription Drug Monitoring Programs is critical – but only available in a handful of states. Access to PDMPs that require physician usage would go a long way to reducing inappropriate prescribing and polypharmacy.

Results – Across the board we heard of dramatic reductions in the volume and potency of scripts prescribed and the number of patients taking opioids over the long term.

What does this mean for you?

It can be done, it is being done, and it must be done.


Oct
2

What are work comp bill review “savings”

In the last few days of our Survey of Bill Review in Workers’ Comp and Auto, and once again the question that won’t go away is…

What exactly are bill review “savings”?

Are they:

  • below fee schedule/UCR?
  • below billed charges?
  • inclusive of negotiations or is that separate?
  • inclusive of clinical edits or are they separate?
  • derived from rules as well as dollar reductions
  • inclusive of duplicates – either full or partial, and what defines each?
  • net of fees or gross?
  • inclusive of network discounts?
  • inclusive of of adjuster denials of specific service lines?

 

And how do you pay for them?

Are the charges for bill review fair, transparent, logical, consistent with contractual terms, and consistent across bills?

Are they based on a percentage of savings, and if so, savings compared to what benchmark?

Why are some vendors’ fee schedule savings so much lower than others? Could it be because FS savings don’t incur additional charges, but all other savings types do?

We’ll have some answers in a few weeks.

 


Sep
28

Research Roundup – Friday edition

So, hard as it is to believe, there was some non-Supreme Court hearing stuff going on this week.

I know…I missed most of it too.

So, here’s some of the most important research we all missed while overloading incoming web servers watching yesterday’s hearing.

Drugs, Opioids, and profiteering physicians

The fine folks at WCRI continue to do lots of stuff so we don’t have to. Two things stand out this week; a compendium of every state’s work-comp pharmacy-related regulations, and a webinar on the effectiveness – or lack thereof – of regulations designed to address the should-almost-never-be-allowed practice of physicians dispensing drugs for profit.

Out in the real world, we learn that in many cases it’s harder to get access to drugs to deal with Opioid Use Disorder than to get the opioids that cause OUD. 

14% of plans do not cover buprenorphine/naloxone, a preferred medication for OUD maintenance treatment. Only 11% of plans cover implantable buprenorphine and 26% cover injectable naltrexone, both of which may facilitate adherence for patients with OUD. Seventy-three percent of plans cover at least one abuse-deterrent opioid pain medication, while 100% of plans cover at least one short-acting opioid pain medication.

Hey P&T committees, get with the times!

Making sense of data

myMatrixx’ Cliff Beliveau has an excellent piece on using data visualization to help explain complex issues. Well worth a read.

Dumb things companies do

Roberto Ceniceros’ column on Lockton’s denied-claim research has been on my desktop for weeks. I’ve read it twice, and you should too. Net is this – denying claims is often a really bad idea.

Finally, from the professor who teaches what may be the only most important class in business school comes an eye-opening look into how work is bad for you. The logic and rationale is not what you may think. Here’s just one excerpt, which I would label Companies are not smart:

Companies do not act on the basis of the best evidence. They merge even though much research shows that mergers destroy value. They use forced-curve ranking systems for performance reviews even though extensive evidence documents the harmful effects. There is no reason to believe they would behave any differently with respect to their human capital.

Evidence shows work hours are negatively related to productivity, that giving people more autonomy leads to higher motivation, and that layoffs often harm performance, including profits. So in making employees sick, employers have created a lose-lose situation.

Enjoy the first weekend of fall.


Joe Paduda is the principal of Health Strategy Associates

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