Another week in physical isolation – no business trips, lots of zooming, plenty of dog walks.

Suzie’s not stressing…

She’s doing the Vulcan mind-meld with brother Louie…

And the pups let Deb borrow the dog grooming tools to clean me up a bit (yes I still have two ears)

Some folks are seeing the bright side…

And others are making the best of it.

Have a sports-free weekend!

This drug may work, then it won’t…testing is ramping up, then it isn’t…we’re going to open up!…then we’re not.

I’m as frustrated and tired of this mess as you are. So, time to bring some joy into the world…

You think you have it rough?

This is Suzie, one of our two Newfoundlands, exhausted after a tough morning cleaning dishes.

And here she is trying to wake my wonderful bride…Deb’s not having it.

Finally, for my friends and colleagues in Florida, California, and other points south – rejoice – you aren’t  here in New York’s Finger Lakes…this was yesterday.

But don’t lose hope…there’s this…

Happy Friday to all – here’s the non-COVID news of note from the week.

The brilliant minds at WCRI aren’t slacking while WFH (working from home).  Their latest is the 20th edition of the CompScope state-specific reports detailing the performance of 18 state workers’ compensation systems. Free to members…

Also, download a free copy of WCRI’s report on medical prices for services paid in 36 states.

NCCI’s annual meeting is still on for May 12; it kicks off virtually at 1 pm eastern. This is a must-attend for all looking for the latest intel on all things workers’ comp.

Good news and helpful stuff

Gotta love the State Fund of California – the Fund is contributing $25 million to each of two programs ($50 million in total):

• one for essential workers who contract COVID-19 or are ordered to self-isolate due to a potential exposure. The fund will provide assistance with wage replacement up to 6 weeks and assist any worker without health coverage with uncovered medical costs.
• the other is for qualified policyholders, it will help defray the costs of safety-related expenses, planned or already incurred, related to protecting their workforces from COVID-19. Get info here – it is first come, first served.

If you are stressed a bit more than usual these days, spend a few minutes with Carisk’s David Vittoria – a wonderfully compassionate speaker – today or early next week by signing up here. (I work with Carisk).

If you’re not entirely comfortable working remote and want to be more effective in those Zoom meetings, here’s some very useful advice. Spoiler alert – we’re all on TV now, and the camera is the key.

For those new to WFH, some useful tips from the Harvard Business Review will help you manage the back-and-forth between work and non-work time; HBR says:

• plan your day
• prioritize what’s most important and stick to the list
• have transition time in the morning to get going, and in the pm to wind down.

If you miss people – I certainly do! – here’s a wonderful piece on how neighbors can connect and stay connected, regardless of how long we’re “apart”.

Finally, JAMA’s allowing free access to a summary of all the drugs currently being evaluated as potential treatment for COVID19. Hat tip to WaPo for the head’s up. [The link is a more readable summary of the JAMA piece.]

With payrolls plummeting and premium dollars poised to follow suit, workers’ comp payers are looking for the proverbial nickels in the couch cushions.

While pharmacy costs have been declining for years, there are several ways payers are losing money by overpaying for drugs.

Here’s one.

Almost all work comp payers pay for drugs based on a discount below AWP. Generics get a much deeper discount than brands, perhaps 45%+ compared to 13% or so. That being the case, you’re getting a much better price on all your generic meds.

Well, perhaps.

First, what is a generic? Again, seems straightforward, but thru the miracle of legalese, it can be anything but. I’ve seen many a PBM-Payer contract where the definition of generic was, well, opaque.

there’s a definition in there somewhere…

A “generic” is a generic… right…?

Well, no. Among the generic definitions I’ve seen are:

• a generic drug is a medication the contains the same chemical substance as a drug that was originally protected by, and is no longer protected by, chemical patents.
• a generic drug is a medication listed as a generic by a compendia (such as Medispan’s GPI, or generic product identifier)
• a generic drug is a medication with an “O” or “Y” identifier
• a generic drug is a medication available from multiple manufacturers

And, that definition was buried in the dense print on page XXX, while the pricing referring to generics was somewhere else, and the process and timing of linking the two, and the data source for the actual prices were either nowhere in the contract or buried somewhere else.

Unless you a) know exactly and precisely what the definition should be; b) read and understand the entire contract so you can connect a definition to a pricing level to a pricing basis/compendia/source; c) have the expertise, staff, resources, and time to monitor the actual pricing you are getting, you don’t KNOW if you are overpaying for “generics”.

What does this mean for you?

Do you know what you don’t know?

Things that are keeping me awake at night (besides the normal problems associated with being a 61 year old guy)

The number of people without health insurance will increase – a lot, driven by:

• 10 million have lost their jobs – as of last week – and those lucky enough to have good health insurance will be hard-pressed to pay health insurance premiums much less deductibles and copays.  This from the Economic Policy Institute, “EPHI” is Employer provided health insurance”; link to interactive site is here
  
• Many service workers don’t have employer-sponsored health insurance; some might qualify for Medicaid after a layoff unless they stay working part time or have other income. For those who live in the 17 states that haven’t expanded Medicaid, it’s even harder to qualify.
• The Trump Administration is refusing to open the Federal Insurance Exchange to allow people without health insurance to sign up – but pretty much every state-run exchange has already done this.
• The Trump Administration is still trying to overturn the ACA, which would kill Medicaid expansion, eliminate the requirement that insurers cover young adults (between 18 and 26) on their parents’ insurance plans, and allow insurers to discriminate and upcharge people with pre-existing medical conditions.
• more on this issue here.

Note – in yesterday’s press conference, President Trump did make some vague comments about possibly using Medicare and/or Medicaid to pay for COVID treatment. Here’s the quote:

“I’m not committing,” said Trump. “I have to get approval. I’ve got a thing called Congress. It’s something to look at and we have been looking. “

This would require a massive change to Medicare and/or Medicaid laws, followed by an equally massive change in lots of regulations, followed by…who knows what.  Reality is, there are way better ways to address this.

Back to the growth in the uninsured and implications for COVID:

• some/many will not get tested for COVID as they can’t afford treatment and are terrified of debt.  Some of these folks will continue to work because they have to, which increases the likelihood they’ll spread the disease.
• hospitals and other healthcare providers – which are already struggling financially because they aren’t doing profitable surgeries for privately insured patients – are going to be delivering a lot of care to people who can’t pay for it.

Net – fewer people with decent health insurance will mean more people will get infected, and the healthcare delivery system is going to have serious financial problems.

A modest proposal.

Here’s a fix.  The federal government makes COVID testing and treatment a federal benefit for all residents (yes undocumented people too) and reimburses providers at Medicare rates.

This would:

a) alleviate the huge financial pressure on hospitals, EMS, and all healthcare providers;

b) increase the number of people tested; and

c) get us back on track sooner than if we do nothing.

Well, the WORST thing about this damn pandemic is I can’t do my annual April Fool’s post.  So, instead of actually working, I’ve been trolling twitter for the best COVID tweets and the inter-webs for great stories.

This story wins the prize…

 

Ok, now the twitter-verse’s take on Covid!

 

 

Dad joke alert…

Sports fans…

A new sport!

 

 

Zoom meetings ain’t new after all…

Snark alert

The COVID shutdown’s impact on nature

Hoarding alert!

 

 

Sorry!

 

regular COVID jokes…

– People with a cold – “I just want to stay in bed and do nothing, I feel terrible”  People with Corona Virus – “I feel terrible, I think I will go skiing in Austria, visit the Eiffel Tower and maybe do some white water rafting in Camino de Santiago”

– To the people who bought 20 bottles of soap leaving none of the shelves for others, you do realise that to stop getting Coronavirus, you need other people washing their hands too.

– During self isolation.. Dogs: “Oh My god, you’re here all day and this is the best as I can love you, see you, be with you and follow you! I am so excited because you are the greatest and I love you being here so much!

Cats: “What the hell are you still doing here?”

– Mexico is asking Trump to hurry up and build the wall NOW!

 

Tomorrow back to our regular broadcast…

 

 

 

That’s “During Covid-19”; hopefully we’ll be “AC” soon (After Covid-19)

I’ve been spreading so much doom and sadness it’s time to make amends.

OK, here’s some tips and advice from a person that’s been working from home for 20 years.

1.  You will get a LOT more done at home than you do at work – if you are disciplined.  Fewer people to chat with, run into in the hall, and engage in non-work conversations means more time – and more ability to focus.
2. Keep your cell phone on the charger, and use a wireless headset.  That way you won’t run out of battery, and you can pace around while you are on the phone. You’ll find that is way better then sitting at a desk or table – and way healthier too. Put that headset on the charger whenever you aren’t using it.
3. Turn the email off for several periods during the day so you can focus on the task at hand. Unless you’re waiting on a time-critical email, being off the grid for an hour or so at a time isn’t a problem.
4. Prioritize your tasks – now that you have more control over your daily work, make very sure that you do the stuff that’s important first. As a former professor told me many times, “Do the important stuff, THEN the urgent.”  Best way I’ve found is to write a list, then number them in order of importance – and stick to it.
5. Don’t worry about background noise from dogs, kids, partner or spouse. We are all in the same situation.
6. Respect those directly affected by COVID-19 and preparations for same. They may not have time for idle chitchat, when they ask for something it’s probably important, and they are really stressed.

Finally, it’s entirely okay to call people and talk business, ask for things to get done, check on progress, and otherwise carry on. This will pass, and in the meantime life has to go on.

What does this mean for you?

There’s a lot to be said for getting back to “normal” even when that “normal” is different than it was last week. 

 

A dozen years ago, there were lots of relatively small companies delivering specific services to work comp payers.

There were 10 PBMs.  5 bill review application and more diagnostic imaging vendors. Dozens of case management companies. Scores of IME firms.  The same for DME, home health, transportation/translation, and UR.  Lots more TPAs too.

Today’s landscape is dramatically different.

3 PBMs have significant market share.

Conduent is the largest BR app provider, with Mitchell second and Medata gaining share; their competitors were acquired.

There’s one major dx imaging firm.

A dominant IME company.

There’s been vertical consolidation (think Examworks rolling up the IME business) and horizontal mergers (One Call buying PT, DME, home health, dental and T&T companies; Paradigm buying case management, network, and niche service firms, Mitchell/Genex doing the same).

Sure, there are smaller companies, many of which are flourishing – think HomeCare Connect, MTI America and Carisk (the latter two are HSA consulting clients).  There are much larger ones – think MedRisk (HSA consulting client) – that focus on a single service. These companies identified a niche, and/or developed a unique capability and/or deliver exemplary service – simple in concept, brutally hard in execution.

What’s happening in the workers’ comp service industry shouldn’t be a surprise to anyone with a lick of business sense; comp is a shrinking business, with flat medical costs and fewer claims every year.

For an excellent summary, read this Harvard Business Review article.

Point being there are two distinct ways to survive and even thrive in a rapidly consolidating industry – get big, get efficient, lower costs – or focus narrowly and/or deliver exemplary service.

In either case, a relentless focus on identifying and solving customers’ problems will determine if you live or die.

Both models have big issues and challenges;

• cybersecurity is a huge challenge for small companies with limited resources;
• efficiency does not and cannot mean lowering customer service standards; and
• buyers (managed care and claims execs) value different things than front line workers – but you have to please both.

What does this mean for you?

If you’re wondering where you will be in a few years, wonder no more. There will be fewer service companies delivering fewer services to a smaller group of ever more demanding payers.