Vendors – read this.

B2B sales is NOT about “value”, RoI, relationships, or anything else you think it is.

It is about meeting the emotional/psychological needs of the key buyers.

You may have sensed this, or interpreted it as “relationships” that make deals happen  – but that is a misread. The reason relationships work is they reflect the sales person’s deep investment in getting to know the buyer(s), understanding what drives them (outside of obvious business goals), and mitigating their fears.

A terrific piece in Harvard Business Review speaks directly to this…(quotes from the article)

  • findings indicate that B2B customers prefer interactions that fuel their psychological needs — even if they require more time or cost more money.
  • Among vendors who provide “poor” service, only 33% of respondents reported that the vendor knows them personally. In contrast, among vendors who provide “good” service, respondents indicated the vendor knows them personally more than twice as often (70%).
  • Even when you have an effective solution in mind, provide your clients with options so they’re reminded that they’re in control.

  • (this is directly supported by our most recent survey of prescription drug management in workers’ comp…respondents overwhelmingly want PBMs to provide them insight so they can fix problems collaboratively)
  • Our study also included some interesting findings around empathy. Expressing empathy, a common way of increasing connection with our friends and family, can backfire if customers perceive it to be disingenuous. Too often, service providers script empathy into customer interaction, assuming it’s what customers want to hear. That’s a mistake. Our research indicates that customers far prefer a service provider who responds knowledgeably over one who “feels their pain.”

What does this mean for you?

be genuine.

ask questions, don’t present.

don’t schmooze.


Regulations – the good and the bad

Work comp and healthcare are probably the two most highly regulated sectors of the economy – and yes I’m including the financial sector.

Over the last 25 years I’ve spent a ton of time with regulators, legislators, lobbyists and the government folks tasked with implementing those laws and regulations.

Here are my learnings…

  • < 5 state legislators know anything about workers’ comp, and only a smidge more about healthcare.
  • what legislators DO know is from mass media (healthcare) or lobbyists (work comp, because there’s never any mass media coverage of work comp)
  • the laws that pass (with some exceptions) leave much to the regulators
  • Regulators are mostly thoughtful, diligent, attempt to do the right thing and generally open to input.
    • There are some glaring exceptions – Florida being the most problematic.
  • That said they rarely – and understandably – fully understand the potential impacts of their rulings, with big consequence for injured workers, employers, and taxpayers.

According to sources that know a lot about financial regulation, the collapse of Silicon Valley Bank was due in large part to laws passed by Congress (with mostly R and some D support) that loosened capital and other requirements for a lot of banks.

Incompetence added fuel to the dumpster fire. Now staunchly-Libertarian Silicon Valley investors and business owners have suddenly become huge fans of central government intrusion into private business (what a bunch of %$#(*&># hypocrites).

credit New Statesman

From the LATimes:

venture investment firms…actually launched the run on SVB on Thursday, when they suddenly urged their companies to pull their deposits from the bank, triggering the $42-billion outflow. “And they now want the Taxpayer to bailout their investments…?! Capitalism, Silicon Valley-style.”

Tellingly, SVB dropped a half-million dollars lobbying to get those laws passed…and their CEO – a huge champion of de-regulation was the biggest champion.

Now we have what just might become a global financial problem that – with better US banking legislation and regulations – would never have happened.

What does this mean for you?

If you are a state legislator, find and talk with objective and informed people in each area you’ll be voting on.

If you are a regulator, do what you can with what the legislature gives you, but be realistic…work comp is <1% of US medical spend, so do NOT expect healthcare providers to do anything different for their work comp patients – even if your regulations require them to.

If you are a Federal legislator, think a lot more about some massive effort to shrink the government.

Those Silicon Valley Libertarians sure wish they did.



Lessons from Ukraine

A recent report from Phillips O’Brien and podcast from War on the Rocks got me thinking about parallels between Ukraine’s military and the workers’ compensation industry.

The net is the military units that allow front-line forces to be creative, adapt, and make key decisions about tactics, weapons used and allocation of resources are much more effective than those units which must follow strict plans from distant leaders.


  • In less successful organizations senior leadership tends to be hidebound, sets plans in concrete, allows subordinate units and leaders little freedom or flexibility in carrying out those plans, and measures “success” with metrics that are usually more process (we fired XX artillery rounds and killed YY enemy) than outcome (we took X hectares of land at the cost of YY munitions and casualties)
    Or in work comp terms, process (we answered Y calls in Z seconds, filled out XXX forms, cut medical bills by XXX dollars…) instead of outcome (our medical cost per claim was YYY, claim duration on closed claims was AAA and our closure rate was ZZZ).
  • In more successful organizations (those with better outcomes) senior leadership listens hard to front-line staff, develops back-channel as well as formal reporting processes, sets clear objectives and asks local leaders what resources they need to accomplish those objectives, and uses that information – and local leaders’ insights – to help determine which objectives will be pursued.
    In workers’ comp terms, a really effective organization would provide front-line staff with intel on which providers are most effective, which are profiteering dirtbags, what hospitals have the highest clinical outcome and patient safety ratings and are most cost-efficient…educate front line staff on the importance of these metrics, and enable adjusters and case managers to figure out how to best use that information when talking with patients, providers, employers and families.

Until relatively recently Ukraine’s military was pretty much a carbon copy of Russia’s. Recall Ukraine was a Soviet client state and its military’s structure, leadership model, training, and equipment was identical to the USSR’s. The result was very much a top-down military with even platoon-level 40 soldiers) and squad-level (12 soldiers) leaders required to follow strict plans on:

  • where to go,
  • what path to take to the objective or when retreating,
  • what weapons to use,
  • when to attack and withdraw,
  • how to assault or defend an objective, and myriad other details.

That’s how Russia is fighting in Vuheldar – where it is failing miserably in large part due to stupid tactics.

Some Ukrainian units have evolved to a less-dictatorial leadership model; Ukraine is by no means immune from Russian-style leadership, but it appears to suffer somewhat less from it. Bakhmut is an example; (my layperson’s guess is) leadership sees the battle as a key to the upcoming Ukrainian offensive; Russia is suffering huge and unsustainable losses in personnel and equipment due to human wave attacks and massive shelling. Ukraine is losing hundreds of soldiers as well, but it appears to be delegating authority on local tactics to local unit leaders, likely reducing casualties.

That means fewer Russian soldiers, shells, cannons and vehicles to resist Ukraine’s spring offensive, and more Ukrainian assets to attack.

Alas leaders at many workers’ comp payers – and most insurers – focus way too much on “the plan” and way too little on the planning process and figuring out how to enable local leaders to achieve objectives,

For an excellent discussions of where Russia is doing smart and dumb things due mostly to leadership click here.

What does this mean for you?

Planning and setting objectives is critical, as is delegation and enabling local leaders to figure out how best to accomplish those objectives.


Two COVID things

It’s been a blissful few months as COVIDF has retreated into the background, likely to remain with us forever but hopefully as a nuisance not the million+ killer it was for the last couple of years.

So, two new items.

First, in what can only be described as a huge waste of taxpayer money, a very large and very scientific study found ivermectin does not reduce COVID symptoms. 

Shocking, right?


  • double-blind, randomized, placebo-controlled platform trial
  • 1206 US adults with COVID-19
  • median time to sustained recovery was 11 days in the ivermectin group and 11 days in the placebo group.

Hucksters, charlatans, former US presidents and other of the willfully-ignorant will undoubtedly parse, lie, misstate, ignore, or otherwise continue to claim that a veterinary medicine for treating bacterial infections is actually a cure for a viral infection.

to quote a T-shirt recently spotted…

Lab leak, nefarious plot, or animal-to-human transmission?

Last week the new broke that the US Department of Energy thinks  – albeit with “low confidence” – that COVID leaked out of a Chinese lab.

This is sort of like saying “Tom Brady is going to sign with the Yankees as a pitcher…heard this from a guy I know who was on a plane sitting next to a woman who looked like a reporter and saw her writing that Brady’s heading to spring training in Tampa…”

This is NOT to disparage the scientists at DoE, rather to remedy what seems to be a serious lack of reading ability on the part of too many who can’t seem to grasp – or rather refuse to accept – that things are rarely black-and-white, or as friend and colleague Pier Rousmaniere notes in his signature line;

Doubt is not a pleasant condition, but certainty is absurd. – Voltaire

[Unless, of course, one has completed a rigorous 1200 person RDB – CT study]

Nine Federal intelligence agencies have completed their research on the “where did COVID come from?” question…Two of those concluded a likely lab leak, five said natural causes and two said they don’t know.

Given the really lousy record these state-of-the-art labs have when it come to keeping deadly viruses contained, it is certainly possible it leaked.

Reality is  – it is unlikely we will ever know – for certain.

What does this mean for you?

Read carefully before posting.


Wildly off-topic # 14 – the Russian “offense”

Last time we talked tanks

This time we’ll focus on Russia’s winter offensive. If you don’t have time, just skip to the takeaways at the bottom of this post.

credit Institute for the Study of War; I highly recommend ISW’s briefings

Quick take – the offensive isn’t going well. While Russia is making advances, they are measured in meters not miles, and are coming at horrendous cost in dead, injured, and captured Russian troops. The Russians did capture Soledar and have make barely measurable progress around Bakhmut and a couple other places but none of those are – in any way – changing the reality on the ground.

Which is Russia is screwed.

As we discussed in WOT #10, you need troops and equipment to fight a war.

The Russians lost a huge amount of equipment last year – hundreds of tanks, armored fighting vehicles, cannons, trucks, trains – equipment it cannot readily replace, if at all. If you want to attack, as Russia is trying to do in its winter offensive, you really need armored vehicles to penetrate opponents’ lines and break out into less well-defended territory. Dug-in defenses  – usually several lines deep – are very, very hard to defeat unless you can blow a really big hole in them and exploit the opening with fast-moving vehicles.

So, in what is eerily reminiscent of World War One, Putin the Butcher is throwing thousands of untrained men at Ukraine’s front lines. (If you want a taste of that, I highly recommend the book and film “All Quiet on the Western Front“.) Trigger alert – it is really awful and disturbing, and the German general is a bald version of Putin the Butcher.

PtB’s tactics are pretty awful…

  • untrained ex-prisoners and recruits from Russia’s far east are forced to attack Ukrainians positions.
  • they are slaughtered – because they have no idea what they are doing, have minimal weapons and ammunition, and are going up against entrenched, battle-hardened and well-supplied Ukrainians, but
  • in so doing, the Ukrainians reveal their positions, which are then bombarded with rockets and artillery and attacked by much more capable Russian troops.

That is NOT to say Russia’s “real” soldiers are invulnerable. Reports from the front indicate Putin’s “elite” units lost dozens of armored vehicles and hundreds of soldiers over the last few days…equipment and men which Russia cannot afford to lose.

Putin the Butcher has a seemingly inexhaustible supply of poor young men but they are a very poor substitute for modern military vehicles and artillery.


While others much more knowledgeable than I see this war grinding on for years, I’m hard pressed to agree.


  • cannot replace most lost equipment,
  • is losing more and more of its irreplaceable, experienced and well-trained troops,
  • has not demonstrated its generals have any idea what to do,
  • is facing an increasingly better-equipped and far more motivated enemy, and
  • is losing the information and intel dimensions.

Like we saw late last spring, all is well until it is not, and then it goes really, really badly for Putin the Butcher.

all previous posts on this topic are here.



Far too many work comp industry CEOs are dinosaurs.

Their refusal to adapt to today’s labor market will ensure they fail their investors/policyholders.

Two things triggered this post.

  1. an extensive conversation – or rather series of conversations – with the CEO of a very large payer whose workers are no longer required to work in office. When I asked about work from home, this eminently reasonable individual was mildly surprised, saying something like “of course we support WFH…there’s no reason for most of our folks to go to an office…they did just fine during COVID and like WFH so why change?” This person noted real estate and related costs would be reduced as would other expenses associated with an office-based work environment.
  2. A conversation with the estimable Bill Zachry, a person I am fortunate indeed to consider a good friend and mentor. Bill noted the challenges payers are experiencing finding and keeping adjusters.

It seems wildly obvious that WFH will help payers keep and find staff while lowering overall costs, significantly reducing ULAE (unallocated loss adjustment expense). Every payer C-suite has been on a cost-cutting rampage for several years in an effort to improve margins and adapt to declining frequency and shrinking rates.

In what can only be described as a logical fallacy, many payers are now “requiring” staff return to the office for more than an occasional day.

Good luck with that.

Most people do NOT have to work in an office, yet many CEOs refuse to accept that they – the Tyrannosaur Rexes of our time – cannot bend lesser beings to their will.

Sure, many workers are already back in the office, and some few prefer it. But most would much prefer not:

  • having to deal with child care emergencies by taking PTO;
  • commuting;
  • dealing with office politics;
  • wasting time at birthday parties, Monday morning “how was your weekend” chats, water cooler analyses of whatever sporting event, updates on officemates’ kids amazing (insert school/sports/music/theater/other), or the millions of other time wasters engrained in office-based work.

Shockingly, workers would much prefer to spend the 2 hours or so a day commuting with their family, or doing work, or exercising, or gardening or whatever.

And they’d rather save big bucks by ditching a car and its attendant insurance, license, tax, toll and maintenance costs; giving up the monthly commuting pass; not paying to park; having lunch at home and on and on.

To be sure there are arguments, some of them even reasonable, in favor of in-office work…yet the fact that most every organization survived COVID WFH is a rather compelling proof statement that WFH works.

What does this mean for you?

Mesozoic-era management will fail as will its proponents and the organizations they lead.


Wildly off-topic #13 – Tanks.

Last time we talked about weapons…how many each side had, what’s been lost, and the challenges in replacing those weapons.

Today’s newsfeed arrived with the VERY welcome news that Germany has OK’ed supplying Leopard 2 tanks, and we will be sending Abrams tanks to Ukraine. The UK had committed to send 14 of its Challenger II tanks to Ukraine… Note that countries that use Leopard 2s have to get permission from Germany before sending them to Ukraine; with this latest announcement sources indicate Ukraine will get at least 100 Leopard 2s.

This will supply roughly one brigade – and is about 1/3 of what Ukraines’ leaders say they need.

These are “main battle tanks” [MBTs], a term describing very heavy, very well armored vehicles with very powerful cannons. Unlike the other armored vehicles already sent to or on the way to Ukraine, MBTs are much more likely to survive an IED, land mine, rocket or artillery attack.


  • Leopard 2 tanks are very capable; well armored and with a very powerful cannon, highly mobile, durable and simpler to maintain than the US Abrams tank
  • there are thousands of them in more than 19 armies

  • The US Abrams is equally if not more capable, BUT…
    • guzzles fuel (although it can use jet fuel, gasoline, or diesel)
    • requires a lot more maintenance
    • is really heavy and thus harder to transport


These will not be there tomorrow…however I’d bet NATO countries will be sending tanks from their current units rather than pulling mothballed older versions and going through what could be a long and difficult process of upgrading them and preparing them for battle.

Then there’s spare parts, fuel, ammunition, training, repair and maintenance  personnel and facilities and transport. These are massive, very complex vehicles that require a lot of care and feeding.

Experts contend that Ukraine’s Army has shown itself quite able to learn complicated weapons systems quickly; it’s use of the HIMARS rocket system, artillery, and anti-ship missiles has been pretty impressive.

What does this mean?

This is a major move, one that will definitely improve Ukraine’s chances of retaking territory. 

That said, like any tool, it comes down to how well it is used. 


Workers’ comp 2023 – what does the year hold – part 2

Yesterday the annual crawling-out-on-a-limb began, today it concludes with 5 more predictions for workers’ comp in 2023.

6. The growing impact of global warming will force changes in risk assessment, management and mitigation; technology adoption; and claims.
The predicted (heat injuries, wildfires, hurricane intensity, sea level rise) and unforeseen (atmospheric river-driven flooding, landslides, and destruction and others) changes in climate and weather will lead to more and different injuries and illnesses, higher risks for fire fighters and public safety workers, and unpredictable problems related to polluted storm water runoff, water-borne disease and perhaps invasive species.
Expect revisions to both federal and state OSHA regulations especially around heat and outside workers along with calls for better planning to prepare for severe weather events.

7. Payers and perhaps regulators will make significant efforts to address rising facility costs.
As for-profit healthcare systems look to pad record profits and not-for-profits seek to survive, payers will be looking for better cost control answers than simply doing more of the same stuff they’ve been doing for the last two decades. Network discounts (NOT THE SAME AS SAVINGS) are declining as facilities wise up to most payers’ lackadaisical/ineffective attempts at employee direction and unsophisticated contracting strategies.
Smarter payers will deploy multiple payment integrity layers  – both pre- and post-payment. All should demand more – much more – from their bill review vendors/technology suppliers, all of whom have long refused to entertain the thought that they could do better – much better.

8. Premiums will increase – mostly late in the year.
As infrastructure, green energy, re-shoring of chip manufacturing and EV incentives ramp up in the fall so will employment. While there’s disagreement among economists (yeah, who woulda thought??) expect big hiring in categories from archeologists and bridge builders to wireless broadband construction workers.  Manufacturing, heavy construction, trades, logistics will all be hiring…as these tend to be higher frequency (more claims than average) and higher severity (claims are more severe and costly) this means higher premiums and more claims.

Good news indeed for my friends in Cincinnati!

Oh, and mark me down for one who does not see a significant recession in our near future.  I know, I’m no economist (who disagree a lot about this) but hiring is too strong, these major investments are on the horizon, and inflation is coming under control  – all indications that a “soft landing” is more likely than not.

9. SB1127 – aka the CAFE Act (California Attorney Full Employment Act) will cause heartburn and consternation among Golden State employers and tax payers.
SB1127 shortens the time period for employers to determine the compensability of claims, a change which will lead to – among other problems – more initial denials and less time for injured workers to receive medical care while their employer researches the claim. Further, AB1127 appears to allow for penalties of up to $50,000 for claims that are “unreasonably rejected” by the employer – but the bill a) doesn’t define what constitutes an “unreasonable rejection” and b) doesn’t exclude claims that are already closed.

Expect attorneys to look for the Golden Ticket case – one that they think will establish precedence – and pursue it like a starving person at a Vegas buffet (or Cafe’).

There’s good news too…I don’t see much else on the regulatory horizon that is cause for concern.

10. More consolidation among payers and service providers.

Despite a major drop-off in financial investors’ interest in work comp, we’ll see  more consolidation as “strategics” aka TPAs and service providers acquire smaller TPAs and service providers. This is classic mature industry…scale is key, significant growth will mostly be driven by acquiring competitors or companies in complementary or related service and margins are in peril.

The bad news is 2023 prices will likely be a good deal less than in the recent past. Fewer potential buyers, less interest from PE firms, and a growing recognition that workers comp is a declining business (what took these people so long to see this?!) are all contributors.

What does this mean for you?

Prepare for climate change and more employment in higher frequency and severity sectors, and make your bill review company get its act together.


Workers’ comp 2023 – what does the year hold?

Its that time again, when I throw caution (and good sense) to the wind, polish up the crystal ball and guess reveal what big things will happen in worker’s comp this year.

Off the diving board, and hope there’s water in the pool…

  1.  The soft market continues…
    And it won’t harden in 2023. Medical costs remain very much under control (with  an exception), rates continue to drop, employment remains very strong (essential for return-to-work) and there’s lots of payers fighting for market share.
  2. Medical spend is NOT a problem – and will NOT be in 2023.
    With a couple notable exceptions – to be covered in a future post – medical inflation will remain under control. In part this is driven by much lower drug spend and more specifically the continued decline in opioid spend. The latter has a big impact on claim closure and total medical spend.
  3. Behavioral health and its various iterations will gain a lot of traction.
    More State Funds, carriers and TPAs will adopt BH programs, more patients will benefit, and more dollars will be spent. There’s a growing recognition that medical issues aren’t hindering “recovery” near as much as psycho-social ones. This is great/wonderful/long-needed and will really benefit patients and payers alike. Kudos to early adopters, and LETS GO to you laggards!
  4. One Call will be sold. 
    I keep forecasting this…and one day I’ll be right.  It has to be this year. CEO Jay Krueger and colleagues have OCCM on a better track, but structural problems (i.e. declining claim volume) and internalization of One Call-type services by Sedgwick and others make the future…less than promising. Couple that with recent ratings actions by Moody’s and S&P and it’s time to do the deal.
  5. New technology will make its impact felt.
    Wearables, chatbots (I HATE THEM), and Virtual Reality-driven care are three ways tech platforms/systems/things will significantly ramp up in ’23. Expect several large/mid-tier payers to adopt new tech in a major way – aka not just a small pilot.
    Structural issues with health care (try to find a LCSW or Psych-trained counselor), lack of trained adjusters, and frustration with rising rehab expenses are all contributors.  

Later this week – the other 5 predictions.


Today’s the latest in a three-part update on Russia’s war on Ukraine – we covered military manpower and the motivation to fight before the holidays, today we finish with (a very brief) discussion of losses and supplies of materiel and ammunition, and the overall supply (logistics) situation.


According to Ukraine’s Ministry of Defense, Russia has lost over 2000 artillery systems, 4700 trucks and fuel tanks, 550 planes and helicopters, 3000 tanks and over 6000 armored trucks to date. I’m skeptical; opponents’ claims re the casualties and destroyed materiel and machines suffered by the other side are usually pretty – if not downright wildly – optimistic.

I’d suggest the UK’s figures are more accurate:

4,500 armored vehicles, 63 fixed-wing aircraft, 70 helicopters, 150 unmanned aerial vehicles (UAVs), 12 naval vessels, and over 600 artillery systems.

And yet another source which seems to have pretty specific data…and is summed up neatly in this piece.

The latest analysis shows that in the ongoing war in Ukraine, total Russian equipment losses reach 8,515 as of 21 December. In contrast, Ukraine’s military has lost 2,613 pieces of equipment in combat.

Russia had far more materiel at the outset, but is having a very difficult time replacing losses of their more modern equipment and vehicles.

From Army Technology – Ukraine has received:

the Patriot air defence missile system is on the way – this will help combat Russia’s assault on civilian infrastructure

US has provided or promised to provide more than 11,000 military platforms for the land, sea, and air domains (crewed and uncrewed) and more than 105 million small arms, mortar, and artillery munitions, among an undisclosed number of other high-end missiles.

Platforms provided include Mi-17 helicopters and T-72 tanks, and western equipment such as the High Mobility Artillery Rocket System, 155mm, 122mm, and 105mm artillery, and armoured mobility vehicles such as the M113, M1117, and Mine Resistant Protected Vehicles, also known as MRAPs.

While Russia is getting drones, some armored vehicles and tanks and ammunition from a few allies/suppliers, it doesn’t have near the supply chain enjoyed by Ukraine. The NATO equipment is more modern, more lethal, and harder to locate and destroy than much of the equipment Russia is now using as replacements for lost equipment.

US Javelin rocket – used against armored vehicles

HOWEVER, a rule of thumb is about a third of equipment is out of action at any one time due to maintenance, repair, upgrade, or training.

AND, there are reports that NATO and US supplies of some munitions and equipment are running low, and replacement/restocking will take time. A very detailed study is here.


I wrote a pretty detailed post 10 months ago about logistics, which is simply getting enough supplies to the units that need them – when they need them. Simple enough in concept  – incredibly hard in practice, and while one could certainly think planning is everything, history suggests that pre-war plans are usually based on the wrong assumptions.

Here are key takeaways…

  • Russia’s incredibly corrupt government has enriched a handful of oligarchs. These gazillionaires got huge contracts to supply tires, medical kits, rations, clothing, winter gear and spare parts; build military bases; fabricate tanks, airplanes, helicopters, rockets, ammunition, armored vehicles, airplanes, trucks and artillery; and spent most of those rubles on huge yachts, estates in Switzerland, supercars, Caribbean resorts, designer baubles and personal security staff. As a result, the military is short of pretty much everything, which is why…
  • Russia is running out of ammunition.  Reports indicate it may need to use artillery shells that are years past their use-by dates. turning to Iran and North Korea for ammunition, drones, and other materiel.
    This from

    • Degraded ammunition can injure or kill troops who fire it. “You load the ammunition and you cross your fingers and hope it’s going to fire, or when it lands that it’s going to explode,” the official said.

(a very good discussion of this is Martin van Creveld’s SUPPLYING WAR)

What does this mean?

Ukraine is winning. That does NOT mean it has – or will – win.

That depends on continued support from NATO and all of us.