Insight, analysis & opinion from Joe Paduda

Aug
14

UPS deal with Gallagher Bassett

Several industry sources indicate UPS has decided to move about a quarter of its workers compensation business from Liberty Mutual to TPA Gallagher Bassett. The transition date is 1/1/2007.
UPS has been with Liberty from the beginning, and this represents a significant loss, as both claims administration and managed care will be moved to GB.
This is a major win for GB, and may mean that the big TPA has revised its business practices and cleaned up its act. GB has had a few embarassments in the marketplace of late, notably the Broward County School Board fiasco. UPS’ adviser is Aon, a consulting/brokerage house I have been less than impressed with in the past; perhaps Aon, which developed a managed care contracting and evaluation strategy as a direct result of its consulting work at a very large payer, has also upgraded its talent and output.
It appears the rationale was UPS’ desire to reduce the number of eggs per basket. It remains to be seen if the folks in brown have used the right approach and picked a decent basket.


Aug
11

UHC facing tough scrutiny on options

United Healthcare’s stock plunged yesterday after it reported it could not file its second quarter financials on time due to difficulties dealing with stock options for Chairman Bill McGuire and others.
UHC’s stock has dropped 22% this year, largely due to regulatory scrutiny of UHC’s practice of backdating stock options for McGuire, who now holds options valued at about $1.6 billion. At least that was the options’ value before the stock’s slide.
This is not the only issue UHC is facing. It’s management of HMO Medica has come under scrutiny of late as well. There are allegations that the management contract was much too lucrative and UHC’s performance was substandard.
UHC grew in large part due to McGuire’s visionary leadership, business acumen, and focus on building value. The dark side of the McGuire era, one that may now be ending, is now showing itself, and it isn’t pretty. It looks like outright greed from here.


Aug
11

First Health’s work comp financials

Coventry’s First Health unit enjoyed an uptick in workers comp revenues in 2006 from Q1 to Q2, but revenues have been essentially flat over the last five quarters.
Here are the work comp division’s revenue numbers (in millions of dollars)
2005 Q2 $54
2005 Q3 $51
2005 Q4 $53
2006 Q1 $51
2006 Q2 $55
Overall, the entire FH division (work comp, commercial, and other lines) has seen declining revenues, from $224 million in Q2 2005 to $215 million in the most recent quarter. Note that the most recent 10-Q filing indicates revenues have gone up appreciably from the first half of 2005 to this year; this is partly because the acquisition did not close until January 28 2005, making revenue numbers from that quarter artificially low.
More on First Health is here.


Aug
10

Work comp Rx news

News reports indicate Amerisource Bergen (ABC), the hospital supply firm, is unloading its Pharmerica subsidiary. Actually, it is forming a joint venture with Kindred Healthcare to combine both companies’ long term care businesses in a new entity.
These companies provide drugs and supplies to nursing homes around the country, have annual combined sales of $1.9 billion and rather thin profits of $75 million.
Pharmerica also was the parent company of workers comp PBM Tmesys/PMSI, which evidently is staying within the ABC company fold.
Last week PMSI/Tmesys also made several changes in management, including promoting Mark Hollifield to president to replace Dave Weidner, who moved on to another senior position within the parent company. Hollifield, who was promoted to COO at the end of March 2006, is a well-regarded manager. Tamara Wagner, the long-time head of sales departed as well, and an interim sales leader was appointed from within.
Other sources indicate Coventry’s First Health unit is looking into entering the WC PBM business, likely by going the acquisition route.


Aug
10

Illegal money laundering? Just say “Noe”

In the “we could not make this stuff up” category, former Ohio coin dealer/money manager Tom Noe (!) is set to be sentenced on September 12 for funneling illegal campaign contributions to the Bush re-election campaign . Noe is likely to spend upwards of two years in prison, and perhaps a lot “upwards”. The funds totaled $42,000, and helped Noe attain the coveted “Pioneer” status in the Bush campaign.
The bad news won’t end there for Noe; several weeks after his sentencing he will begin defending himself against separate charges filed by the state of Ohio relating to his alleged theft from the reserves of Ohio’s Bureau of Workers Compensation. For those who have not been following Noe’s transgressions, be advised, the man was pretty busy.


Aug
9

Medicare cuts physician reimbursement – Not!

CMS is going to change the way it pays physicians. Really. Well, CMS Director McClellan says they will, and soon. Policy types will recall that every year, physician reimbursement for procedures under Medicare is slated to drop by between 3% – 5%, depending on total expenditures the prior year and a really complicated formula (that is never followed). So each year, physicians scream, and every year, politicians say “no, just kidding”, and tweak the reimbursement to send a few more dollars to the docs. And I do mean “few”.
This year expect the same to happen; it is an election year, there are lots of powerful (read “lots of money”) forces in play here, and few elected officials want to take the political hit for cutting Medicare. So far, 80 senators have signed a letter asking that reimbursement levels be increased, not reduced.
Despite the political realities, McClellan is of the opinion that our elected officials will come up with a pay-for-performance scheme for CMS. Whether it ever gets through Congress is another story altogether.
For further edification, I’ll pass on the perspective of Bob Laszewski, long-time national health care policy expert and good friend. Bob’s view is that the increase in utilization driven by physician practice patterns is leading to the huge cost increases we are seeing in Medicare, and the stats back him up. Medicare’s per-service reimbursement in 2006 is essentially unchanged from five years ago, while utilization has gone up dramatically. So, price controls have not worked to hold down medical inflation.
Thus the interest in pay for performance for physicians. While it sounds interesting, it’s really hard to do.
As tough as it’s going to be, I see no better alternative.


Aug
9

Bilateral Oligopolies

The increasing consolidation in the health insurance market is beginning to run up against the same situation among health care providers, creating the market condition known as a bilateral oligopoly (few sellers and few buyers). This appears to be happening in Denver, where UHC is battling HealthOne over contract terms, reimbursement and likely other sticky issues.
There are two points here.
First, according to several sources, HealthONE is an excellent system with enviable outcomes; therefore is entitled to ask for better reimbursement than lower-performing systems. One of those sources is UHC itself. Here’s a quote from the press release
“”Interestingly, HealthONE hospitals earned the highest quality rankings among Denver metropolitan hospitals for a majority of procedures evaluated in UnitedHealthcare’s first ever-report card, released in June of this year,” said Patrick Powers, HealthLeaders-InterStudy senior analyst. “These report cards are part of UnitedHealthcare’s new pay-for-performance initiatives, which should translate into improved rates for high quality hospitals.” That’s only half of the story, as we aren’t privy to the rates UHC is offering and HealthONE is demanding. That said, HealthONE seems to have a strong case for strong rates.
Second, while a “bilateral oligopoly” may send you (and certainly sent me) scrambling for the e-dictionary, the net is the big players do battle while the consumers try not to get trampled underfoot. Here we have a very large insurer and a very large provider fighting over rates and access, while the consumer waits anxiously for these behemoths to resolve (or not) their squabbles.
Reminds me of the old joke about what you find between elephants’ toes.
Slow running natives.


Aug
8

CDHP Summit

I’ve received an invite from the folks conducting the Consumer Driven Healthcare Summit to attend the September 13-15 conference as a representative of the blog world, sort of a “press invite”. I applaud their openness in two respects – first, I’ve not exactly kept my skeptical views of consumerism in health care to myself; and second, bloggers are a wierd, strange, new form of media that many don’t yet recognize as important or even worth noting.
So, I’m looking forward to it.
The agenda includes talks by Paul Ginsburg of the Center for the Study of Health System Change (one of the few truly excellent policy/analysis concerns); Jon Gabel on how much consumers are actually contributing to their HSA accounts; Karen Davis of the Commonwealth Fund, Ron Pollack of Families USA and John Iglehart of Health Affairs on the Downside of Consumer Driven Healthcare; and several sessions on results of studies and research into various aspects of CDHP and its cousins.
This should be fun. And I’ll be doing my best to report live from the scene, in the best tradition of Matthew Holt.


Joe Paduda is the principal of Health Strategy Associates

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