Insight, analysis & opinion from Joe Paduda
Yesterday’s Louisiana appellate court ruling against Coventry’s First Health work comp network is a major blow to comp insurers, employers, and networks in Louisiana, with potential impact in other states as well. The ruling is here. The court’s finding supported … Continue reading Louisiana appellate court rules against Coventry’s work comp network
Read More...Yesterday’s post about Mass General’s mishandling (to be kind) of a woman’s procedure and reimbursement thereof elicited a thoughtful email from the former CEO of a major work comp insurer. Here’s what he said (identifying details removed to protect the … Continue reading Utilization review – A payer’s ethical responsibility
Read More...With the Senate’s passage of a bill preventing cuts to Medicare physician reimbursement for another six months, we’re only waiting on the House’s action to boot the problem further down the road, where it can grow, and fester and frustrate … Continue reading The Medicare physician reimbursement ‘fix’
Read More...Broadspire, one of the largest TPAs in the country, has announced a new network strategy which goes by the acronym BOLD, that is notable as much for what’s missing than what’s present. There’s no mention of Coventry in the list … Continue reading Broadspire’s the first
Read More...I was talking at length with a good friend who works for a large payer last week, discussing the process of getting the organization to make significant, and very much needed, improvements to their managed care program. This got me … Continue reading Why don’t comp payers change?
Read More...This morning’s announcement by CVS Caremark that they are terminating their contracts with Walgreens in 30 days ups the ante in the ongoing battle between the two huge pharmacy firms. The decision came after Walgreen’s earlier announcement that it was … Continue reading CVS Caremark v Walgreens – Who’s going to blink?
Read More...Earlier this week we discussed the impact of pending changes in the world of big pharma will affect workers comp. Changes to Medicare physician reimbursement, also just over the horizon, will have a dramatic impact on workers comp in ways … Continue reading Where the work comp world is headed – part 5, physician reimbursement
Read More...I’ve been somewhat reluctant to write this post, as it takes issue with one of the key presenters at a workers comp conference that I believe is consistently the best I’ve attended. It’s here for one reason: it illustrates how … Continue reading Bias and credibility – a cautionary tale
Read More...Not if your case is highly visible, politically sensitive and focuses on unethical and possibly illegal activity by an Assistant State’s Attorney. I’m referring to Sandy Blunt’s pending appeal before the ND Supreme Court. Blunt has been waiting – and … Continue reading Is there justice in North Dakota?
Read More...Much of my writing over the past few weeks has focused on the future of work comp – the impact of reform, economic influences, the increasing negotiating power of health systems, changes in Medicare’s physician fee schedule (which WILL impact … Continue reading Where the work comp world is headed – part 4, pharma costs
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