Insight, analysis & opinion from Joe Paduda

Feb
20

A new opportunity in West Virginia

Jon Coppelman at Workers Comp Insider has written a thoughtful and incisive piece on the new WC market in West Virginia. The state had been (actually, until the middle of this year it still is) a monopolisitic state – employers had to buy their WC insurance from the state.
That’s changing to an open competitive market. The state WC fund, now known as Brickstreet, is going to be the largest carrier in WV for some time, but will inevitably lose market share as competition enters. Jon points out that managing that transition, while adequately serving the needs of existing policyholders, is going to be an incredibly complex and difficult job. Their customer base will shrink, making one of the first tasks of Brickstreet’s execs the management of staff reduction. While building a new agent service infrastructure, upgrading systems, and figuring out how to effectively compete – something they never had to worry about before.
Yikes.


Feb
19

Fixing Bush’s health care plan

Bob Laszewski has found the solution to the Bush health care program’s reliance on the non-functioning individual health insurance market. The plan needs a model that addresses the problems of medical underwriting, denial of coverage, age band underwriting, risk selection, access and availability, and it’s called “Part D”!


Feb
19

Actiq – the off-label poster child

Actiq is a narcotic taken in lollypop form, a technique that gets the drug to the pain centers quickly. Developed for break-through cancer pain, evidence now suggests that only 10% of Actiq users have cancer.The high-powered narcotic has been the subject of several recent reports and a state attorney general investigation concerning off-label use.

Continue reading Actiq – the off-label poster child


Feb
15

Spitzer’s take on work comp reform

If anyone can get workers comp reform addressed in New York, it’s new Goc. Eliot Spitzer (D). In a wide-ranging interview conducted yesterday by the Journal-News, Spitzer noted that work comp reform is at or near the top of his list of priorities.
Likely changes will include a cap on the duration of benefits for injured workers.


Feb
14

Health care dollars – Who spends how much

OK, so I’ve been a little obsessed with the First Health-Concentra deal. Several clients will be directly affected by the merger, and their priorities are mine. But I’ve been ignoring the larger world, including a report published in Health Affairs (subscription required) that has far-reaching implications.
Two researchers at CMS analyzed data on the concentration of health care expenditures, (what percentage of patients spend what portion of total medical expenses) and noted a surprising trend.

Continue reading Health care dollars – Who spends how much


Feb
9

First Health’s 4th quarter results

It looks like the Concentra workers comp deal is coming none too soon. In today’s earnings release, Coventry disclosed that subsidiary First Health’s revenues dropped for the second straight quarter to a two-year low of $49,175k.
This marks the seventh consecutive quarter of flat revenues for the big WC managed care provider.


Feb
8

UPDATE – The monster in the basement – case managers at First Health

As part of the Concentra acquisition, First Health will own a large field case management force. From all indications, Coventry (FH’s parent company) has wanted to get into the case management business for some time – it generates steady fees, as opposed to the ups and downs of Coventry’s core HMO business.
Well, they’re certainly in the case management business now. Concentra has hundreds of nurses and vocational rehab specialists located around the country who spend hours each week driving to attend office visits with work comp claimants, meeting with employers, and discussing cases with adjusters.
At least FH hopes they’re getting lots of windshield time. If they aren’t, they will be sitting around doing nothing while getting paid.

Continue reading UPDATE – The monster in the basement – case managers at First Health


Joe Paduda is the principal of Health Strategy Associates

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