Nov
13

Developments in the WC PBM world

Cypress Care, one of the leading Workers Comp Pharmacy Benefit Management firms, has just announced the company has received a “strategic investment” from Dallas-based Brazos Private Equity Partners. The company has also added David George (former President of AdvancePCS) to the management staff; George will be taking over the CEO spot from co-founder Hank Datelle and has also made an investment in Cypress Care.
The press release contains the typical comments about all parties’ delight at the deal and enthusiasm for the future. As one who has been directly involved, I can attest that in this case, the PR has it right. David George is a highly experienced and very well respected managed care pro with stints at United Healthcare and on the Board of Concentra, Inc. Bart Hester, a former colleague of George’s at AdvancePCS will be joining Cypress as EVP Account Management and Strategy; the rest of the Cypress senior management team including co-founder Lisa Datelle and President Marc Datelle are all staying with the company.
Note – Cypress Care is a Health Strategy Associates consulting client an dsponsors our annual Survey of Prescription Drug Management in Workers Compensation.


Nov
9

Results of California’s WC reforms

OK, I know a lot of readers are not exactly holding their collective breath waiting for more updates from the WCRI conference…but a few are. (hard to believe, I know…)
So, for those eagerly waiting, here’s the latest.
A panel discussed the results of the reforms to the California WC system. Overall, the results have been quite favorable wiith rates declining, and better control over medical care and costs.

Continue reading Results of California’s WC reforms


Nov
9

Texas’ WC reforms – predictions for the future

A panel at the WCRI conference discussed the TX workers comp reform initiatives aka House Bill 7; here are my impressions in chronological order.
The (relatively) new WC fee schedule, (new as of 8/2003), set reimbursement at Medicare +25%, and allowed for employers to direct injured workers to specific health care providers. The change was a significant decrease for surgery, and an increase for Evaluation & Management services. Surgical prices dropped 31%, while E&M prices jumped by over 23%.

Continue reading Texas’ WC reforms – predictions for the future


Nov
8

WCRI’s new workers comp medical price research

I’m attending the annual Workers Compensation Research Institute today and tomorrow and will be posting from the meeting.
The first presentation was an analysis of WC provider fee schedules, comparing the actual fee schedules to providers’ operating expenses. It will come as no surprise that some states’ fee schedules are pretty low, while others pay up to 2.5 times more than Medicare (alaska, for one).
No extra credit for guessing which type of service is paid at a higher rate; most fee schedules pay relatively more for surgery than for evaluation and management services.

Continue reading WCRI’s new workers comp medical price research


Nov
8

What now?

The Democrats’ capture of the House will bring new focus to health care, the uninsured, prescription drug pricing, and Medicare Advantage programs. Here’s the prognostications.

Continue reading What now?


Nov
7

the flattening world of health care

Medical tourism looks to be exploding, growing much faster than many (your author included) had expected. The latest figures indicate a half-million Americans sought care overseas last year.
Much of the care is delivered in Canada and Mexico, but lots of folks are traveling to India and Thailand for complex medical procedures. And the quality appears to be quite high in many of the facilities.

Continue reading the flattening world of health care


Nov
6

Coventry’s WC acquisition strategy

Coventry’s public statements and documents point to a possibility that the big managed care company will be looking to expand it’s workers comp offerings through acquiistion. The business, known to the cognoscenti as First Health Workers Comp, has made little progress since it was acquired by Coventry almost two years ago. FH is suffering from a lack of attention by Coventry senior management, flat revenues, and serious competition from Aetna and others.
While acquiring more WC entities may help FH, basic logic would indicate that before you add to a company, you ought to make sure the company you have is running smoothly.
Otherwise all you’re doing is putting lipstick on a pig.


Nov
6

Drugs, profits and politics

By any accounting, Part D has been a boon to the pharmaceutical industry (free registration required). Revenues and profits at Pfizer, Lilly, and other manufacturers have jumped. This will undoubtedly lead to more research dollars available to search for cures for awful diseases, an effort exclusively funded by the US taxpayer that will benefit the entire world.
Aren’t we generous?

Continue reading Drugs, profits and politics