Jun
24

The Delta Variant

You are as done with COVID as I am.

COVID is not done with us.

Here in New York’s Finger Lakes everything is open; had a great family night out yesterday, no masks required for those of us fully vaccinated, hiring signs are all over, and the joy that is upstate NY in summer is in full swing.

While we are blissfully enjoying life, the Delta Variant is:

That’s the bad really bad news.

The good news is vaccinations – especially the ones based on mRNA (e.g. Pfizer) are still “spectacularly effective” against the Delta variant. 

As in 96% effective in preventing hospitalizations.

However, that’s after both doses; a single dose is just 33% effective at preventing symptomatic illness.

Here’s the thing. The more of us that get infected, the greater the chance that the damn virus morphs into a deadlier, more transmissible, and thus even bigger problem. So far the vaccines we have are working.

But – and it’s a damn big “but”, far too few of us are vaccinated. That’s particularly true of southern states, where a combination of misinformation,  awful treatment of minorities by some governmental entities and segments of the medical community (the Tuskegee experiment being a prime example) and resulting mistrust, and difficulty with the J&J vaccine have combined to drastically slow vaccination rates.

click here for detailed state-specific data

Here’s a great graphic detailing state progress towards full vaccination…

All this is to say that the fewer vaccinated people there are, the more likely COVID will mutate into something even worse.

What does this mean for you?

Get vaccinated.

Note – if you want to debate or disagree, cite credible sources for your statements. Period.


Jun
17

Thursday catch-up

Doing my best to avoid work on Fridays…so moving this occasional catch-up post to Thursdays…

COVID

Promising news on the effectiveness of a drug to help infected patients fight off the virus was reported by the Economist. The good news – Regen-Cov:

saved the lives of many of those unable to make their own antibodies in response to SARS-CoV-2. Such “seronegative” individuals constituted about a third of the 9,785 hospital patients in the study…compared to a control group given standard treatment … 20% more patients survived

The bad news – it’s stupid expensive, and supply chain issues are hampering production.

A study conducted by the National Institutes of Health indicates COVID may have been in circulation earlier than originally thought. Blood samples from Illinois, MassachusettsMississippi, Pennsylvania and Wisconsin indicate the virus was in those states in December 2019. An earlier CDC study found similar evidence in California, Oregon, and Washington.

These findings indicate a better and more thorough process to identify disease outbreaks may well be warranted.

Comp drugs

WCRI is hosting a timely webinar on Interstate Variations and Trends in WC Drug Payments on June 24. Register here. Gotta say I’m darn impressed by the researchers’ ability to obtain, analyze, and report on payments as recent as Q2 2020. This makes WCRI’s information much more actionable for regulators, clinicians, and payers alike.

Dr. Vennela Thumula and Dongchun Wang of WCRI will be guiding us thru their findings; the webinar is free.

I am finishing up the latest Annual Survey of PBM in WC which will have 2020 and 2019 data; last chance to participate and receive a detailed, respondent-only version of the report. If you want to participate let us know in the comment section below (there’s no cost to participants).

Couple interesting – and very preliminary – takeaways…

  • growing interest in transparency, along with an increased awareness that this isn’t a simple issue.
  • spend continues to decrease, with respondents attributing some of the decrease to COVID.
  • opioid spend continues to drop, but most respondents are still struggling to help chronic pain patients/long-time users of opioids reduce usage.
  • there’s a growing awareness that the PBM pricing model needs to change. With spend declining and a push for transparency, knowledgeable payers understand that paying PBMs less year after year is not sustainable.

Previous public versions of the Survey Report are available here for download at no cost.

 

 

 

 

 

 

 

Hospital pricing

Hospitals are supposed to be publishing their prices – at least Federal regulations require them to. But those smart, sneaky administrators are figuring out all kinds of ways to avoid telling you how much it will cost for that MRI, drug, band-aid, or lung transplant.

From JAMA:

hospitals must publish discounted cash prices (applicable to uninsured patients) and payer-specific negotiated rates. Second, hospitals must display price data, including expected out-of-pocket costs, for “shoppable services” that can be scheduled in advance (eg, office visits) in a consumer-friendly manner that facilitates service-specific comparisons across hospitals (eg, price estimator tools). [emphasis added]

As of early March, only 17 of 100 randomly selected hospitals were complying with the regulations. The penalty for non-compliance is…wait for it…

$300 a day.

Perhaps if the Feds charged hospitals the same way hospitals they charge us, we’d have a bit more compliance. 

How about…the Feds tell the hospitals after the fact what the cost will be, based on a “compliance chargemaster” that takes into account the hospital’s margin, quality scores, number of collection suits it has filed, and medical error rate.

Thanks to the estimable David Deitz MD PhD for the head’s up.

Wellness works

Finally, HealthAffairs reports wellness programs don’t really improve population health, reduce healthcare spending, or improve employment outcomes. 

Almost 40 years ago, I was halfway through a Master’s of Science in Health/Fitness Management when it became obvious this was NOT going to be a lucrative career…quite the opposite. Not saying I was prescient, just that employers sensed this was a nice-to-have and not a got-to-have, and that lack of importance showed in salaries.

Dodged that bullet.

And really finally, congratulations to my favorite baseball team – the White Sox have the best record in baseball after taking 2 of 3 from Tampa Bay. I

know my friends in the Bay area will be heckling me when the Rays surge again…hey, you gotta take advantage of good news when it comes!


Jun
15

A business model in search of a problem

The workers’ comp services business is brutally competitive; a shrinking pie fought over by increasingly aggressive vendors, each striving to differentiate and demonstrate value.

Smaller players and newer entrants are pushing hard, attempting to show how their approach/service model/pricing/technology is better than more-established competitors’. This is keeping the big players on their toes, forcing them to improve, revise, deliver, respond…even innovate.

I can’t – and wouldn’t – fault any vendor for its efforts to differentiate. For buyers, the key is to discern which “differentiators” are actually useful, and which are just marketing-speak intended to make the vendor’s business model viable.

Blah blah blah blah blah…blah

A couple ideas may help separate the real from the flashy.

First – what problem does this solve? and is that your’s, or the vendor’s?

I’d suggest buyers can cut to the core if they ask:

  1. is this is going to decrease my combined ratio?
  2. by how much over what time period?
  3. at what internal cost? and
  4. how – exactly – is it better, and by how much, than my present approach.

Second, what proof statements is the vendor using to get your attention?

Are they comparing their “results” to industry leaders? If so,

  1. Where – exactly – are they getting the data re the leaders’ results?
  2. What is the basis for comparison – are the types of claims, patient demographics, injury types and severity, diagnoses, co-morbidities, employer types, and jurisdictions the same for the new vendor and the industry leaders?
  3. Does the new entrant have enough claims (that are similar to its competitors) for the comparison to be statistically valid?

Finally, dig deep into the methodology and thinking behind the vendor’s approach. Do they really understand at a deep level the problem they are solving, and can they clearly articulate:

  • the causes and origination of the problem (e.g. facility costs are increasing due to revenue maximization efforts by healthcare systems driven by financial pressures)
  • why the current solutions do not meet the buyer’s needs (e.g. broad-based WC PPOs have little negotiating leverage, don’t assess quality, and benefit from high prices and lots of services), and
  • how their solution is better, sustainable, and where and how it integrates into the buyers’ operations, processes, and technology and is consistent with regulatory requirements.

What does this mean for you?

This is not to say there aren’t better answers out there – indeed there are.

The key is to quickly identify solutions with real potential to solve your problem, as opposed to those that solve the vendor’s.

 

 


Jun
11

Low prices every day = higher taxes

Cheap stuff isn’t cheap…you always pay way more than you think…because the hidden costs of that cheap stuff are damn expensive.

Two examples…

Walmart’s slogan is “Save people money so they can live better.”

McDonald’s mission statement includes “make delicious feel-good moments easy for everyone.”

The two giants (and McDonalds franchisees) employ over 4 million workers, paying wages that are significantly higher than the Federal minimum (which is $7.65 an hour) – but certainly not a “living wage.McDonald’s shift workers make less than $10 an hour; Walmart’s was a lot higher, almost $15 an hour.

In just 6 states, 15,000 Walmart and McDonalds workers and many of their families are on Medicaid. Undoubtedly tens of thousands more get their healthcare from free clinics or in hospital ERs. This is especially true in states that did not expand Medicaid – looking at you, Florida, Mississippi, Arkansas, Alabama, and a dozen more.

The median cost of Medicaid – which is NOT per employee, but the employee and dependents enrolled in Medicaid – is about $8000. If we figure just 20% of Walmart and McDonalds’ employees on Medicaid have dependents, taxpayers in those six states are paying $120 million a year for Walmart and McDonalds’ employee healthcare. 

Add to that the cost of uncompensated care for the uninsured – which is subsidized by overcharging privately-insured workers and workers’ comp payers – and its blindingly obvious cheap stuff is far from cheap.

This isn’t just Walmart and McDonalds; workers at Uber, DollarGeneral, Fedex and Amazon and many other companies get their health insurance – and supplemental food aid – from you, the taxpayer. In fact, more than half of Medicaid enrollees are employed by private companies.

Make no mistake – I’m not blaming McDonalds or Walmart or any other company for doing what they are doing – or rather not doing.  Americans are addicted to buying lots of stuff (a lot of which is redundant or really not needed) and demand low prices.

What does this mean for you?

These companies are giving us what we demand, and we are paying a hefty price for cheap stuff. 

 

 


Jun
4

Good luck with the truck.

Let’s get real.

You and your kids are driving 80 mph on a highway, when a truck suddenly veers in front of you.  Since you are a quick-thinking insurance person, you estimate your chance of dying if you hit that truck at about 40 percent – just a bit better than even odds.

Or, you can swerve off the road – where your chance of dying is 1 percent – about 1 in 100.

This…

Or this…

What do you do?

That’s the question facing vaccine skeptics.

Vaccine skepticism is driven by memes, misunderstood data, a lack of understanding of basic math, pure laziness, demagoguing, and social media’s incredible ability to publicize nonsense.

Recently I had an electronic conversation where a COVID vaccine skeptic (my characterization, not their’s) cited “publications and VAERS” as sources for their concerns…I don’t know what publications the commenter was referring to; the only reference provided was a 14-month old TV report.

[reminder – if you discuss or debate, provide credible sources – ideally primary source – for your opinions.  Do your homework and don’t be lazy.  If you spout unsupported opinions – looking at you TJ – be prepared to be skewered.]

Leaving that aside, let’s talk VAERS, the vaccine reporting service run by the CDC and FDA. VAERS accepts reports from providers, vaccine recipients (or those who say they had a vaccine, parents, and “others” of any adverse event regardless of proof that it was caused by the vaccine. And VAERS reports can show deaths due to ANY CAUSE – could be drunk driving, hang gliding, heart attack, cancer, whatever.

Want proof ?A few years back VAERS accepted a report of a doc who felt like he was becoming the Incredible Hulk after a vaccination.  

VAERS is often misrepresented by Vaccine Skeptics lying about “problems” and deaths allegedly caused by the vaccine. [Here’s a great review of VAERS reporting issues]

Ok, the data.

VAERS received 4,178 reports of deaths (0.0017% of all who received the vaccine) between Dec. 14, 2020 and May 3, 2021. Remember about 165 million of us have had at least one shot. [source above]

Even if ALL 4,178 deaths were “caused” by a vaccine – and there is ZERO evidence that’s the case –  reality is your chance of dying from a COVID vaccine is far less than getting struck by lightning.

Compare that to your chance of dying from COVID – I ran the numbers here for a 55 year old white man from zip code 92111 with no pre-ex. The risk is .07 percent.

This person is 40 times MORE LIKELY TO DIE OF COVID than from an “adverse event” after you get a Covid vaccine.

What does this mean for you?

Science always wins…or, put another way,

Good luck with the truck.


Jun
2

It’s not about you.

Highly credible data shows today’s infection rate among the unvaccinated is as high as it was back in January.

Remember January?

Shutdown restaurants. Remote “learning”. No family gatherings. No high school sports. No fans at professional sports. No concerts or weddings or parties or fun.

80,000 of our friends, parents, grandparents, colleagues, and loved ones died of COVID in January.

If you aren’t vaccinated, don’t think you’re safe.  You are not. Your chance of getting COVID is the same as it was back in January.

But that’s not the worst of it.  Research shows the variants are more infectious, and in some states this is driving a hospitalization rate double what it was in January.

What does this mean for you>

Unless you don’t care about leaving family, friends, kids, parents, and loved ones with nothing but memories of you, get vaccinated. 


Jun
1

COVID nonsense

Ok, time for a brief fact-check on some of the nonsense circulating out there.

Some sources are claiming the CDC “changed testing thresholds to “virtually eliminate” COVID-19 cases among vaccinated individuals.”

That’s flat-out wrong. The reality is the CDC changed its guidance to local health departments about testing samples from COVID patients that had been vaccinated before they tested positive for COVID. The CDC will sequence the COVID virus’ genes to gain information on the spread and characteristics of variants.

The change is necessary because using a testing protocol with >28 cycles provides samples that can’t be used to sequence COVID genes. This has NOTHING to do with counting the number of cases or the criteria used to define if a patient has been infected with COVID.

I won’t bore you with the details behind these idiotic claims, except to note the reporters obviously don’t understand science, or math, or English.

Then there’s this.

The meme creator is either a) an idiot or b) a liar, or, c) most generously incredibly lazy.

In fact, the vaccines used here in the US – Moderna, J&J, Pfizer –  have been subjected to rigorous peer-revised studies that have proven safety and efficacy.  A simple Google search yields hundreds of articles about the peer review process, results, methodology in many prestigious journals including the BMJ, New England Journal of Medicine, the Lancet and hundreds of others.

Liability protection is “being offered” as well – and is part and parcel of Federal Law. There’s also a specific mechanism set up to protect those harmed by vaccines.

From FactCheck:

CICP gives benefits to individuals, or to estates of individuals, “who sustain a covered serious physical injury as the direct result of the administration or use of covered countermeasures,” including COVID-19 vaccines, according to the program’s website.

What does this mean for you?

Beware of people peddling nonsense. Check their facts, ask for sources, and trust credible research.


May
24

Bipartisanship at last!

An excellent article by Washington Monthly’s Eric Cortellessa described a Senate antitrust hearing focused on hospital and health care system consolidation.

Believe it or not, the problems created by hospital consolidation have brought bipartisanship to the Senate, with arch-conservative Josh Hawley and liberal icon Richard Blumenthal agreeing that consolidation is bad.

Hawley opined”private equity and their [sic] intervention here is actually helping drive consolidation in a way that is unhealthy in this industry and can be particularly harmful for rural communities…”

Blumenthal: “incentives and self-interest of the private equity funds drive the finances rather than respect and care for the patients who are there or the professional staff who ensure quality care.”

It’s not just private equity – most consolidation is driven by massive health care systems looking to dominate markets and thereby control pricing. And that’s exactly what happens.  According to chair Amy Klobuchar, “hospital prices are 12 percent higher in monopoly markets compared to those with four or more competing hospitals.”

That’s one reason profits are zooming for hospital companies Tenet, UHS, HCA and CHS.

What does this mean for you?

Nothing good.

 


May
5

Comp’s culture of catastrophizing

At the height of the COVID crisis last year, some research organizations, brokers/consultants and “thought leaders” were gravely forecasting how awful this was going to be for workers’ comp.

Sure, we didn’t know what was going to happen, although careful and thorough research would have indicated things weren’t headed towards the “awful”.

Instead, we heard:

  • investment returns were going to suffer;
  • profits were in deep peril; and
  • workers’ comp was going to be the “go to” insurer for COVID due to presumption

These could have happened, but the data clearly indicated these outcomes were pretty unlikely.

Then there’s “social inflation”, a term describing some rather nebulous and ill-defined “drivers” which are allegedly increasing the cost of insurance claims. [There are a host of methodological problems with the research cited in the link and with this study as well]

Social inflation is being blamed for all manner of problems – jury awards (many drastically reduced on appeal), ‘increased litigation”, “broader definitions of liability, more plaintiff-friendly legal decisions.”

This from Fitch’s Robert Mazzouli, [emphasis added]

A high-profile litigation example in the U.S. is the so-called opioid crisis – drug companies have been accused of playing a harmful role in the extensive overuse of opioid medications, with the overuse blamed on both medical prescriptions and illegal sources.

Read that again.

“So-called opioid crisis?” What planet is this guy living on?

Not this one. There is overwhelming evidence against Purdue and other members of the opioid industry.

Not sure where these experts get their information, as research indicates the various “problems” attributed to social inflation are overstated or exaggerated.

What’s abundantly clear about these two issues is workers’ comp insurance people have no idea what’s really driving their business. Instead of doing the hard work to figure out how to address over-spending on claims, too many blame outside forces.

COVID and “social inflation”‘s impact on work comp is insignificant compared to opioids and facility costs.

Opioids drove up workers’ comp rates and claims and claim duration. Yet few work comp insurers have figured out how to help long-term patients reduce or eliminate opioids.

Facility costs are the fastest-growing part of medical spend, driven by:

  • the failure of some states to expand Medicaid;
  • (mostly for-profit) health systems’s amazing ability to over-charge workers’ comp payers and get away with it;
  • changes in reimbursement by Medicare;
  • reliance on PPOs to address facility costs; and
  • grossly inadequate medical bill review

What does this mean for you?

Instead of blaming external issues, work comp execs should focus on understanding medical drivers and how healthcare impacts workers comp.


May
3

Recklessness and Responsibility

The Greatest Country on Earth will not conquer COVID.

Misinformation by “thought leaders” and their followers is the primary reason.

The CDC ‘s experts no longer believe herd immunity is possible. Instead COVID will become woven into the fabric of everyday life, with new variants popping up from time to time, killing the most vulnerable and sickening thousands of us. Lest one think that’s not a big deal, recall the most common version of COVID now circulating in the US came from Britain – and this version is 60% more transmissible than the “original” version. More concerning still, future variants may well be more lethal.

While there are many factors contributing to the herd immunity problem, the biggest driver is vaccine uptake (which contributes to the variant problem).

from US Dept of Health & Human Services via NYTimes

Of course, this doesn’t help.

Sturgis ND during Bike Week

Which leads to the key question – why?

Why don’t people get vaccinated? Why don’t they mask up and physically distance?

Mostly because they listen to “thought leaders”, influencers and friends who spread misinformation.

The key takeaway.

Those of us who have followings, however modest, have a moral and ethical responsibility to use that influence for good. Re-posting and re-tweeting inflammatory, wrong, and just plain stupid “information” is reckless and irresponsible.

It can also be deadly.

Do your research before publishing anything – and don’t just check “sources” that always support your thinking.

When you make a mistake, own it. Correct it publicly and apologize.

I’ve made my share of mistakes, so I’m certainly not immune; a few examples are here, here, here, here, and here.