Insight, analysis & opinion from Joe Paduda
“Utilization changes are the driving force in drug cost changes for WC.”
That’s the key takeaway from the expanded version of NCCI’s annual WC Prescription Drug Study; this 2007 edition goes well beyond prior editions to include more detailed information on cost drivers, stat-by-state variations, generics, and the growth in drug spend during the life of the claim.
But the key is utilization.
The key takeaway? Utilization, not price, is driving drug spend.
Nothing. At least it shouldn’t. But two states (California and New York), base their workers comp fee schedule for drugs on Medicaid’s rates – despite the complete lack of similarities between the two.
Why is this a problem? Lots of reasons.
Most significantly, it takes two seconds for a pharmacy to verify a Medicaid claimant’s eligibility and obtain approval for a script. Two seconds. That’s because Medicaid in most states is ‘single payer’ — there’s one place the pharmacy has to check, and only one. And, the claimant usually has a card, and if not, the pharmacy knows exactly what codes to enter to process the script.
Not so in workers comp.
Continue reading What does Medicaid have to do with workers comp?
I have long assumed individuals working at employers that do not offer health insurance are more likely to file workers comp claims. With the number of employers offering health insurance declining, a logical corollary is more claims will be filed.
Logical, but wrong.
Continue reading The correlation between health insurance and work comp claims
You can’t cover the national comp conference without addressing the gorilla in the room – Coventry Workers’ Comp.
With capabilities in networks, bill review, pharmacy, case management, MSAs, Coventry touches/impacts most of the major payers, and a lot of the mid-tier and smaller ones as well. Here’s what I heard.
I’ve been remiss. After spending all day yesterday at meetings, giving a speech, and running into old friends and colleagues at the National Work Comp Conference there was just no time left for blogging.
Here’s the quick take from yesterday, with more detail to follow.
Continue reading The National Work Comp Conference – quick take
And the winner of the “most bizarre workers comp accident of the day award” goes to; insurance company employee John Doe, who shot himself in the legs while sitting at his desk.
I’ve always been a ‘non-advocate’ of tight fee schedules and broad based discounted networks. Actually it’s a little more than that – I believe mandated across-the-board low fees are counterproductive, ill-conceived, harmful, and may actually increase costs while decreasing access to good providers.
Other than that. they’re fine.
The final presentation at WCRI’s 2007 conference was an analysis of the pre- and post-reform changes after Florida changed its fee schedule on 1/1/2004 (raising it significantly for physicians and decreasing it for facilities).
Back pain is a huge issue in workers comp – not only due to cost, but also because the range of treatment options is seemingly as broad as the number of claimants.
I’m attending the annual WCRI meeting in Boston today and tomorrow, and will be blogging from the meeting. For those not up on all things workers comp, the workers comp research institute is, along with NCCI and the CWCI, among the leading research and education organizations dealing with workers comp.
Perhaps the most important topic at WCRI this year is the evaluation of recent reform initiatives in California and Texas.
Here are the highlights from Texas – numbers are not included as the results are preliminary.
Continue reading WCRI conference report – how’s Texas doing?
OK, we’re now going to abruptly transition from the broad interest (Canadian health care policy) to the hairs-breadth narrow – this is for the folks who deal with workers comp pharmacy issues.
One of the biggest challenges facing WC payers is getting claimants into their PBM program. My firm has surveyed payers about WC pharmacy management each spring for four years, and this is the one issue where there has been no change over that time.
Retail pharmacies’ difficulties in determining eligibility is the key reason per-script costs are so much higher in WC than in group health, Part D, or individual heath insurance.
Here’s why.