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Monday catch-up – management moves in work comp services

Just when you think things are calming down in the work comp world, you get a week like last week.

Leading off, management changes.

First, sources indicated occupational clinic company US Healthworks laid off a sixth of its management staff, most in headquarters state California. This comes just six months after the company announced a major expansion in the Southeast with the acquisition of Lakeside Occupational Medicine Clinics.

The Lakeside deal followed a series of clinic acquisitions in other states over the last few years.

Acquired by healthcare giant Dignity Health for $455 million in 2012,word from these sources is USHW has not produced the desired financial results of late.

Couple major management changes in the work comp Pharmacy Benefit Management business.

OptumRx CEO Emry Sisson will be departing effective March 1, 2017.  Emry took the role after the Helios/Catamaran/Optum entities were combined; prior to that he shared the CEO slot at Progressive Medical and third-party biller Third Party Solutions with Tommy Young (Tommy left after the Optum acquisition).

Optum parent United Healthcare will be looking inside and out for a replacement. Knowledgeable sources within Optum indicate this was solely Emry’s decision and in no way driven by United or Optum.

Mitchell Pharmacy Solutions’ Brian Anderson will also be moving on; I’ve known Brian for over a decade and he is one of the most forward-thinking, innovative people in the industry.  He helped start the third-party billing business, so I do hold that against him :). Haven’t heard of a replacement yet and will let you know when I do.

Coventry Work Comp Services business is said to be coming back on the market.  Word is the “book” will be not be released until parent Aetna’s acquisition of Humana is resolved.

That may well take a while…

Evidently this was the subject of much speculation at the JPMorgan Healthcare conference last week.  Key to any transaction will be the status of Coventry’s provider network contract.  Industry followers will recall Aetna’s first attempt to sell the business ended rather abruptly when potential buyers’ bids were much lower than expected due to concern about Coventry provider network contracts.

Word is the vast majority of those contracts – and especially those with providers who have a lot of Coventry business – have been transferred to “Coventry paper”. This should make the company much more attractive.

Conflicting reports on whether Aetna will bundle all component parts or pursue a different path.

Finally, registration for NCCI’s Annual Issues Symposium is open, and AMCOMP’s annual meeting is set for mid-March in Las Vegas.  Agenda is here.

One thought on “Monday catch-up – management moves in work comp services”

  1. Good news. Hope there is a sale soon!

    In the past few years, all the Aetna Agreements include a “Workers’ Comp” Addendum that stipulates reimbursement at 80% of the state fee schedule (which, of course, is TERRIBLE). They do allow providers to ‘opt out’ of that network, but still. I also suspect that many practices that don’t accept work comp wind up on the network anyways.

    Hopefully, they will be sold soon so it will be easier for Providers to negotiate reasonable reimbursement for workers’ comp.

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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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