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Vegas – day two

With the national work comp conference well underway, here’s what we saw/heard/learned yesterday.

The session on improving medical networks led by Mark Walls  included a rather blunt and direct Indictment of the work comp network business.  I wasn’t there, but heard from several who were that the panel criticized PPO network developers for failing to consider quality in network recruiting or management – despite their protestations to the contrary.  The reason, as we’ve been discussing here for oh-these-many-years is simple – good providers treating efficiently and effectively make for fewer bills at lower charges.  And that makes for lower revenues for networks charging on a percentage-of-savings basis. And some undoubtedly uncomfortable moments for network folks in the audience…

Kudos to Mark, Pat Venditti of BJC Health, Monica Lichtenstein of Aramark, and Anita Weir or Safeway for speaking the truth.

Deals are getting done.  Vendors are payers are using the conference to finalize agreements and nail down details on negotiations in progress. I”m aware of at least three business relationships that were consummated yesterday, and I’ve no doubt there were dozens more.  This is somewhat unusual, the conference is typically more for starting and continuing relationships than doing deals.

That said, there’s an ongoing demand for really good sales talent and sales leadership.  There just isn’t near enough supply.  The lack of professional, smart, polished sales talent has never been more evident.  Everyone is looking for A players, and finding they’re lucky to find Bs. I’ve been asked by three companies to send talent their way, but there’s not a lot of talent to be found.

Dr Gary Franklin, Medical Director of the Washington state fund, and Dr Sanford Silverman, pain management physician in south Florida, gave a great overview of the problems inherent in using opioids to treat musculoskeletal injuries/chronic pain.  Gary  – who is as passionate and blunt as he is knowledgeable and Sandy – who is terrific at describing the causes of and challenges with addiction treatment – didn’t always agree on specifics, but the 200+ attendees saw two experts talking about solutions.  It was a refreshing, and much-needed change from the usual report on “here’s-how-bad-it-is”.

There seem to be more and bigger booths here than before.  In what’s got to go down as one of the stranger sightings, there are no fewer than three separate booths for EXAMWorks.  There’s the big one at the front, the MES booth, and at least one more for another EXAM subsidiary.  For a “growth” company that has seen revenue from it’s US business increase by a whopping two percent this year one would think they’d be a bit more careful about spending marketing dollars.  Then again, if they are able to convince payers that MES is in fact a different company, EXAM will be able to meet some payers’ requirement/policy to always have at least two different IME vendors.

Which, of course, they’re not.

Finally, I must’ve had a dozen conversations that began with “this isn’t going to be in the blog, is it?”.  No, it isn’t.  If something is told to me in confidence, it doesn’t show up in MCM.  That said, if I subsequently hear the same rumor/report/tidbit from another non-confidential source, I may choose to write about it, but only while ensuing the original source can’t be identified.

So, the sun is coming up, and it’s time to get a workout in before wading once more into the fray.  See you at the Bloggers Speak roundtable this afternoon.

3 thoughts on “Vegas – day two”

  1. Joe, you are spot on – the medical networks here in Florida for the most part add no value to the delivery chain, while extracting huge fees for essentially culling out and eliminating the best, most cost-effective providers.
    The best provider generally defined as the one willing to do the procedure for the lowest fee.
    And as long as clinical outcomes and value (total case cost measured against outcome) are not relevant metrics in workers’ comp nothing will change.
    What surprises me is that the employers are oblivious to the scam which saves them nothing while reducing the quality of the medical care for their workers.
    But what surprises me even more is that providers have been willing to tolerate this abuse- accepting payment 50% below the fee schedule while shouldering non-sensical administrative burden.
    The best providers just opt out.
    Others will tell you that they have no choice, they are powerless to negotiate with these large networks who offer a “take it or leave it” proposition
    It’s a costly, dysfunctional model, for everyone but the network owners.

    1. Rick
      Thanks for the comment. I’d agree that the large generalist networks add little value.

      That’s not the case with specialists, and I’d include PT in tht category. In general they don’t try to exclude the best provider but seek to context with those top providers as a big part of their value proposition is based on sustained RTW.

  2. In my opinion a list of doctors no matter how good wont answer. It is the direction and help you provide the injured person that makes the difference. Making an appointment for the injured person with the best doctor makes a difference. It does help to know who the best Doctors are.

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Joe Paduda is the principal of Health Strategy Associates



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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