Insight, analysis & opinion from Joe Paduda


Blog news 2

I’ll be traveling extensively throughout April, and will not be able to post as often as I’d like.
However, between speaking at the Pharmacy Benefit Management Conference, moderating a panel at the Global Medical Forum Conference in Zurich on international pharmaceutical pricing, attending RIMS, and visiting with clients, there should be a wealth of material ready for publication towards the end of the month.
What does this mean for you?
not as many emails re new postings for a few weeks…


Medicaid subsidizing employers?

Ten employers in Florida, several of whom are receiving substantial tax breaks from the state, have a total of 49,100 employees enrolled in Medicaid. Florida is one of the few states that does not require employers receiving such tax breaks to provide health insurance as a requirement for the subsidy.
The subsidized companies, WalMart, Publix Super Markets, Winn-Dixie Stores, Burger King Corp. and Walgreen Co have an estimated 29,900 employees and/or family members enrolled in Medicaid.
According to the St. Petersburg Times,
“Combined, these five firms have been approved by the state for up to $10.8-million in tax credits and tax refunds for at least 3,805 jobs


California’s state workers’ comp fund

The State Compensation Insurance Fund of California is the nation’s largest workers’ comp insurer, and by a significant margin. The Fund has experienced tremendous growth in the last few years, driven by the exit or demise of several competing carriers, and the reluctance on the part of many carriers to write business in California around the turn of the millennium.
As the insurer of last resort, SCIF found itself writing thousands of policies when other carriers pulled out or tightened underwriting guidelines.
Peter Rousmaniere, a good friend and incisive expert on the workers’ comp industry, has written a highly readable, and quite damning, report on the Fund that appears in Risk and Insurance. I highly recommend it.


Pharmacy Benefit Management

I’ve been in Arizona at the Pharmacy Benefit Management Institute annual conference for the last couple of days, and will be reporting back in more detail later. Here are a few of the interesting take-aways


Notes on Mr. Greenberg’s departure

Hank Greenberg is gone from AIG; or at least, gone from part of AIG. It is not yet clear what his role will be at CV Starr and other entities that have significant influence over AIG’s operations, executive compensation, and other key matters. My bet is the association will not be long-lived.
His resignation letter is public; it does not say anything surprising (it was, after all, crafted by his attorney). What will be much more interesting is what the Board does after Mr. Greenberg’s departure, and if they adopt the oft-used strategy of blaming everything on the departed.
Not that Mr. Greenberg isn’t primarily responsible for any wrongdoing on his watch; especially in today’s post-Sarbanes-Oxley world he is certainly legally, as well as ethically liable. However, the other Board members also bear responsibility. I would not be in the least surprised if there are additional changes to AIG’s Board in the near future.
Clearly, Greenberg dominated the company through his force of will, intense, brutal management style, brilliance and overwhelming ambition; my few brief meetings with the man did not leave me with any desire to make them a regular event. That said, he built the most successful insurance company on the planet. Those two factors make it both unfair and inappropriate to fault the Board, or anyone else, for their apparent inability or unwillingness to prevent Greenberg from crossing the line into (apparently) unethical or inappropriate stock manipulation.
What does this mean for you?
If you are stockholder, who knows. (I used to be, until last week.) It is all too easy to look back and say should have, would have, but in today’s Spitzer-Sarbanes/Oxley world, all managers may want to re-examine their business practices to ensure they are not even close to, much less over, the ethical/legal line.


HMO enrollment and open access

The backlash against managed care did not reduce HMO enrollment in the late nineties. Although there was a lot of “talk about backlash


AIG’s other challenges

While AIG is publicly wrestling with the big issues of what to do about ex-Chair Hank Greenberg, questionable financial transactions, and its plummeting stock price, it also has a few managed care and claims functions that need to be addressed.
Tops among these is the fallout from consolidation of medical bill processing (for workers comp) from the individual claims offices to two central locations in Georgia and Kansas. While the move has been completed, there appear to be significant issues related to bill processing accuracy and timeliness that have yet to be resolved.
Some of this is to be expected, as moving operations, starting new offices and hiring new staff is bound to create a learning curve. However, it appears that the learning curve is quite a bit longer than providers or regulators are willing to tolerate. A/R issues abound, and sources indicate the centers are inundated with calls from providers seeking information about long-overdue bills. Early reports were that there were problems with the new bill review system’s (implemented last summer) impact on productivity; this is getting better as staff learn the system and fixes are implemented.
AIG has never been known for its claims-paying speed or investments in technology, preferring to focus on underwriting and creativity in identification and exploitation of business niches. It has been the best in the business at the tasks it has chosen to pursue, but will need to direct some of its considerable talent to the basics of bill processing if it is to achieve even average status in that critical area.
What does this mean for you?
Plan transitions carefully, as the old saw goes, “if you don’t have time to do it right in the first place, what makes you think you’ll have time to fix it later”.


Access v. Cost

For consumers, managed care is a choice between limited access to providers and premium costs; the greater the access, the higher the premium; the more limited the choice of providers, the lower the premium. In the late nineties, the so-called “managed care backlash” occurred when cost increases moderated, and consumers demanded access to any provider.
This spawned the “open access” HMO model, tiered benefit plans, and the explosion of PPOs. Now, with costs once more on a double-digit inflation path, there appears to be more willingness on the part of consumers to trade access for lower cost.
The Center for the Study of Health System Change released a national report entitled “More Americans Willing to Limit Physician-Hospital Choice for Lower Medical Costs“.
The Center reported that “Between 2001 and 2003, the proportion of working-age Americans with employer health coverage willing to trade broad choice of providers for lower out-of-pocket costs increased from 55 percent to 59 percent


Medicare drug program to cost states $$

In a posting on, John Rodat has written an excellent summary of the unintended (or perhaps not…) consequences of the Medicare Drug program. Namely, and I quote…
–“Lots of Medicaid clients are also Medicare clients.
–Lots of these “dually eligible” folks are sick and use lots of pharmaceuticals.
This is especially so for those in nursing homes
–So when the Federal government created the new pharmaceutical benefit, it recognized that it would be paying for drugs that were previously being paid for under Medicaid. That would simply have shifted the cost from states to the Federal government
To offset that effect, the new law includes a provision (tenderly called the “clawback”) that establishes a formula by which the states pay the Federal government.”
And, this formula may well cause some states to pay the Feds more than they gain from the Medicare Drug program…
Kudos to Mr. Rodat for his insight.
What does this mean for you?
More supply-fueled demand for drugs means higher total Rx costs.


Blog News

In response to inquiries and questions re “what does this mean to me and my job/company/business?” I’ll be adding a “what does this mean to you” statement at the end of some postings.
I recognize that “you” may not (and will not) apply to all readers, but I simply don’t have the time to respond to all individual inquiries re “so, what are the implications of pharma pricing/California managed care laws/Medicaid/CorVel financials/etc. for my company/business plan/employee benefits plan/future costs?”
Feel free to continue to send questions etc and I’ll get to them as time allows. If I don’t respond with a lengthy message, don’t interpret that as a lack of interest.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



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