The folks at WorkCompCentral find the most interesting stuff. Today’s edition featured an item about the new head of North Dakota’s work comp agency – here’s how they put it:
“Highway Patrol Director Bryan Klipfel [was named] as director of Workforce Safety and Insurance (WSI) and U.S. Department of Agriculture executive Clare Carlson as deputy director and public affairs officer for the agency.”
The announcement, which came from the Governor’s office, quoted the governor: “in his 30 years with the Highway Patrol, Klipfel had a strong record of accomplishments and was highly regarded for his knowledge and integrity in both the Highway Patrol agency and law enforcement statewide.”
WorkCompCentral noted “Klipfel currently is the human resources manager for Job Service North Dakota. He has a degree in public administration from the University of North Dakota.”
Is it just me, or does this look like political patronage?
What does a former patrolman know about workers comp? Turns out he admittedly doesn’t know anything.
According to a local paper in ND, “Bryan Klipfel says he knows little about workers compensation, but the former state Highway Patrol commander believes his management and listening skills will help him do well as director of North Dakota’s Workforce Safety and Insurance agency…”I’m going to work with Bruce (Furness) for a couple of weeks, and I’ll just have to learn some of that information as time goes on,” Klipfel said. “My strong points are that I have leadership ability, and I understand human resources, how to deal with people. And I think that’s the big part (of the job) right now.”
Huh?
He’s going to learn on the job? While getting mentoring for a ‘couple of weeks”? In a business that is incredibly complex? At a time when investments and reserving practices are critically important?
And his qualifications are his understanding of human resources and leadership ability?
Yikes. This bears further investigation.

Jim McGarry has moved on, and David Young has moved in. That’s the quick report on changes at the top of Coventry’s work comp unit – but more is coming.
McGarry, who reportedly has a solid relationship with Allen Wise, will be working on other tasks within the company. And no, this isn’t one of those executive sinecures hiding an internal exile. By all accounts McGarry is well respected and liked by his colleagues on the senior management team, and bigger things are in the offing.
Young came into the organization in the Concentra deal. Generally well regarded by customers, his promotion has been characterized by several as a good thing; he is viewed as more customer-oriented than execs from First Health.
The change was relayed to several Coventry work comp customers Friday and today, along with news about a restructuring of the IT support and maintenance functions. These were consolidated along with other product line support in the Coventry IT department; going forward work comp will have dedicated resources. No surprise here; there have been indications for several weeks that new CEO Allen Wise has been seeking to better allocate costs by product. More specifically there has been ongoing concern about SG&A expense for work comp.
The restructuring of provider contracting and relations is not yet final. That said, there are signs that work comp contracting will be handled by separate staff. While this will likely help reduce facility costs for other lines (that deliver over 80% of Coventry’s total revenues) without the market share of group and Medicare, comp contracting staff will find it very hard indeed to negotiate with facilities. Remember, comp only amounts to 2% of the typical hospital’s revenues.
With the hiring several weeks ago of Pat Scullion as work comp CFO at Coventry, the new management team is almost complete. And the timing of the Scullion hire was nothing if not fortuitous, as several sources indicate Aetna is seeking to renegotiate its PPO contract with Coventry. As Aetna is the de facto network for Coventry in multiple jurisdictions (Coventry has exclusive marketing rights for four more years), it is negotiating from a rather strong position – Coventry would be in a very tough spot without Aetna.
What makes this particularly interesting is the Aetna exec seeking to renegotiate the deal is Dan Fishbein, the same Dan Fishbein who ousted Scullion from his prior role as president of Aetna’s work comp unit. And yes, that was the same Pat Scullion who negotiated the original deal on behalf of Aetna.
Now that must make for a very fun negotiation session; Aetna is negotiating for a higher price (that’s just a guess) or better terms while sitting across the table is the guy who knows more about their financial position than anyone left at Aetna.

In no particular order, here’s what I’m hearing about goings-on at Coventry’s workers comp division.
Coventry has told several clients it is hiring dozens of staff to improve the quality of provider data; interestingly this message has gotten to some customers but not to all. This message was out there for a few months, and has been repeated recently – but again, not all have heard the same message. If this is indeed happening, kudos, albeit belated, to the company for recognizing that bad data not only frustrates customers but reduces Coventry’s own revenues and profits.
Much more recently there seems to be movement within the provider relations/contracting units to split work comp provider contracting out separately from the other lines of coverage – group, PPO, and Medicare. There had been some indication Cvty was considering just adding WC specific contracting staff, but this seems inconsistent with senior management’s push to restrain SG&A expenses. This is a little puzzling, as the other lines added much needed bargaining power to Coventry’s efforts to get attractive work comp rates from hospitals and other providers. If it is indeed splitting the negotiations, Coventry seems to be following through on CEO Allen Wise’s stated desire to emphasize its core business – small group HMO.
There are also indications that the company is getting ready for a re-organization of its work comp business, a re-org that will likely affect operations in the [correction] Burlington MA, Sacramento, and Dallas offices. No specific word on timing, but my guess is sooner rather than later.
There’s more swirling around, but these data points are the only ones that have been confirmed by multiple sources.

My post yesterday regarding Coventry’s workers comp business generated a few emails – some asking what exactly was my point? For those unwilling to click back, my closing sentence was “The work comp business accounts for 6.2% of [Coventry’s} total revenues.”
My point was workers comp amounts to less than one-sixteenth of Coventry’s total revenue ergo it is not nearly as important/significant/vital as those in the work comp field might think. Yes, it may be inordinately profitable (helped by price increases over the last couple years, but hurt by bargain pricing on the pharmacy business), but it is still only 6.2% of total revenue.
Now lets think about that.
The new CEO, Allen Wise, has publicly stated his desire to focus more closely on the core business (small group HMO). To that end, Wise has slashed spending intended to expand Medicare networks, begun a close examination of SG&A spending in the work comp business, and asked a lot of tough questions about provider contracting, and more specifically, hospital contracting. As reported here earlier, He was quite vocal about his concern over rising hospital costs, and their impact on the HMO medical loss ratio (MLR).
In the work comp business, Coventry has committed to hire (or is already hiring) dozens more staff to help clean up their provider database – a task that is, according to some clients, long overdue. It is also working on several significant upgrades to its bill review application. They are also continuing to try to build a carve-out network comprised of expert physicians, and are reportedly marketing that to several large payers.
These efforts, while laudable and necessary, are also expensive, and will further increase SG&A expenditures.
So, the question you have to ask yourself is, if you were Allen Wise, and you were running a company that was really good at small group HMO, and had kinda lost its way, and you looked at this other business which was generating six percent of your revenue and eating up resources, and distracting your provider relations people and perhaps increasing your HMO hospital costs, what would you do?
What does this mean for you?
If you haven’t figured it out by now…

A detailed review of Coventry’s latest 10k provides a little perspective on the size of the work comp business. here are a few numbers to consider (all figures for 2008).
– Total WC revenues – $737 million
– PPO revenues – $86 million
– PBM revenues – $230 million (estimated)
– Bill Review, case management, UR, IME, MSA etc revenues – $421 million
By way of comparison, total revenues amounted to $11.9 billion. The work comp business accounts for 6.2% of total revenues.
Any questions?

NCCI’s newly released report on fee schedules provides interesting reading. If you don’t have the time right now, here’s the key quote:
“For comparable injuries, when WC pays higher prices than GH for specific services, those services tend to be used more often in WC than in GH. [emphasis added]”
No kidding.
Before you dismiss this as common knowledge, remember that (in most states) work comp hospital reimbursement is much higher than for group health. That’s why hospital costs are the fastest growing sector of comp medical expense.
Here’s another quote: “Reimbursement for care that physicians provide at hospitals and other facilities is more likely to exceed the fee schedule than care provided in their offices.”
So, physician reimbursement is usually higher in facilities, and the facility’s costs are typically higher as well.
Yet regulators in Florida are adopting fee schedules that continue, if not worsen, this situation by dramatically increasing reimbursement for outpatient services. The reimbursement scheme will pay hospitals 74% more than Medicare for surgeries and four times Medicare for other outpatient services. And the comp system in South Carolina is deteriorating daily, due in large part to overpayment of hospitals. The state adopted a Medicare+40% hospital fee schedule on 10/01/06. Now, per NCCI, there is a 23.7% WC rate increase filed and pending.
Minnesota is considering similarly suicidal behavior, specifically a hospital inpatient payment standard that would pay smaller Minnesota hospitals about 90% of their billed charges; larger hospitals would get about 85% of their billed charges on higher-dollar inpatient bills.
What does this mean for you?
Clients are reporting hospital expenses are rising faster that at any time in recent memory. Don’t look for any help from the regulators.
Tip of the hat to workcompcentral.com for the NCCI report info.

With the passage of the stimulus bill, it’s timeti consider the implications fir workers comp. I’ll get to the details next week, but there are a few broad statements we can make today.
First, the unemployment rate will not drop much more. Comp insurers, Occ Med clinics, managed care firms and TPAs started feeling the effect of a rapid drop in frequency last summer, a drop that would have accelerated throughout this year. For carriers, the decline was good news/bad news, as fewer claims meant lower claims expense, while fewer employees produced lower premiums.
The funding for COBRA and Medicaid will help keep folks insured, thereby decreasing cost shifting (below what it would have been without the bill). This is very good news indeed; although it is impossible to calculate what cost shifting would have done to comp, it would undoubtedly have driven medical costs up significantly.
Over the long term the effectiveness research funding will be a big help to payers and providers. Solid guidelines for back injuries will be most welcome.
There’s much more to come.

Both. At least that’s how company execs want to ‘brand’ Corvel – but it isn’t what their TPA customers want to hear.
Me? I’m not so sure.
Here’s how Corvel described itself in a recent SEC filing:
“CorVel Corporation is an independent nationwide provider of medical cost containment and managed care services designed to address the escalating medical costs of workers’ compensation and auto policies.”
Interestingly, the company’s website does not describe itself as a TPA, and combines its TPA business with case management in case management. While this hasn’t changed since this time last year, it does muddy the waters – is Corvel a TPA with managed care services, or a managed care company that does a bit of claims adjusting?
In last week’s earnings call, CEO Dan Starck said “We also continued with our Enterprise Comp expansion; our strategic initiative of bringing a new approach to claims management and our overall transition to becoming a full service provider to the workers’ compensation market…The addition of our claims administration product expands our service offering in this area and continues to open new opportunities.”
Starck went on to say a lot about Enterprise Comp:
“Moving forward in 2009, we will continue to focus on our four key initiatives and their role in transitioning the organization to a full service provider. The first initiative is the continued expansion of Enterprise Comp. Despite the continued decline in the overall volume of claims; we believe that this initiative is on point. In fact in this market environment, we believe that this initiative continues to grow their importance.
Traditionally, through our managed care services, CorVel has only had access to a small number of employer customer opportunities. The employers that purchased their TPA services and managed care services separately. This group of employers is the minority in the workers comp market.
Enterprise Comp provides the ability for CorVel to meet the needs of the larger segment of the employer market, the employers that buy their services in a bundled format. By owning all of the major components of the workers’ compensation continue, claims administration, managed care and the software applications needed to integrate and execute the different business lines. We feel we are in a strong position to bring the truly differentiated product to the market.
Over the course of the past few quarters, our field operations have been busy with the all of the integration activities that must take place after acquisitions have been completed. At the same time, our IT team has been busy developing our claims management software application into one that begins to realize the vision of Enterprise Comp in the future.
Much of the December quarter involved laying the foundation of the software into our production systems and the beginnings of field implementation. Although I discussed the Enterprise Comp imitative [sic] at times it’s just getting started, our claims administrations today as a company are strong.
We currently administer workers’ compensation claims in 45 states, and have the ability to deliver service in all 50 today. We expect to see improving growth in this product line as our software and system’s integration process continues and our sales force gain the momentum.”
Whew. That’s a lot to digest – but the net is the two guys who run the place obviously believe Enterprise Comp is a big part of their future.
After reading all that, I contacted Corvel. Here’s what they had to say about the TPA business, their strategy related to that business, and where they’re headed.
“…selling services to employers is where we’ve moved some emphasis. We didn’t really choose this path so much as the managed care market matured. Beginning in the mid-’90’s the TPA’s began to see that they could control the managed care business if they first won the claims administration business. So, they priced the claims work down to control accounts and then began to participate economically in the managed care subcontracting that had previously just been purchased from independents such as CorVel or Intracorp or the many others…CorVel continues to expand in our Enterprise Comp initiative and to gradually reduce our older more commoditized services. I believe we have a unique new technology for claims management and that we’ll see a breakthrough in that area over the next two years similar to the big changes we enjoyed in what we call Network Solutions.”
From a financial perspective, Corvel looks like a managed care company with a small presence in the work comp/P&C TPA business. Corvel paid about $15 million apiece for two TPAs (Schaffer, Baltimore MD and Hazelrigg, SoCal). Corvel’s TPAs account for 8.6% of annual revenues. The company reported both TPAs produced $24 million in revenues; annualizing that number to account for the partial year for Schaffer gives an annual TPA revenue of just under $26 million. It is highly doubtful their revenues have been increasing; TPAs have been under tremendous price pressure over the last two years. It could be the TPAs are driving more network, bill review, and case management revenues to the parent company, but the revenue picture doesn’t support that view. Corvel paid about 1.2x revenues for the two TPAs, a reasonable number – although the deals were done during a soft market when valuations are typically lower than normal.
As a side note, the TPA acquisitions aren’t mentioned in the company’s history.
Financially, Corvel has been hampered by the decline in claims frequency; revenues were essentially flat last quarter from the previous year’s quarter at around $77 million. This was noticeably better than the profit picture as EPS dropped from $0.43 to $0.34. The news was better for the last three quarters, with revenues increasing a few points from the same period in 2007 ($225 million to $233 million). However, gross margins declined over that time from 25.5% to 24.2% primarily due to a 9.5% increase in G&A costs.
The company’s stock is also pretty low these days – not that stock value is related to actual value today, as pretty much anything that doesn’t have ‘beer’ in its name has been hammered recently.
Which leads back to the original question – what is Corvel? From here it looks like the TPA strategy hasn’t generated growth or profits to date – overall revenues are flat over the last few years and profits down, while the patient management segment (where TPA revenues are reported) declined from 44.4% of revenues in 2005 to 42.4% in 2008. The company is investing heavily in Enterprise Comp, and perhaps this investment will pay off in a couple years. With that noted, as I’ve said before, Corvel’s entry into the TPA business infuriated some customers – including a couple very big ones. It remains to be seen if their managed care business will stabilize, or at least shrink slowly enough to allow Corvel enough time to build their TPA capability and business.
What does this mean for you?
Be very careful not to antagonize current customers when you change strategies.
But be equally careful your customers don’t move your services inhouse.
thanks to SeekingAlpha for the transcript.