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Coventry's $278 million miscue
Coventry Health will be taking a $278 million charge against earnings to cover the company's fine plus interest and legal costs resulting from last week's Louisiana appellate courte ruling in a workers comp PPO network case. On a per-share basis,...
Louisiana appellate court rules against Coventry's work comp network
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...
Broadspire's the first
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...
CMS, MSAs, and credit where credit is due
My post on Monday about the internal memo released by CMS regarding MSA allocations triggered a round of name-calling, motive-assumption, and general nastiness by people in the MSA business furious that I awarded PMSI much of the credit for the...
Coventry - a good Q1 2010, but what about the future...
Coventry released its Q1 2010 financials today, and looking at the numbers one would have to be a naysayer to find fault. The company is successfully exiting the Medicare Private Fee for Service business, growing its Medicare, Medicaid, and Part...
Workers comp's missing link - tying bill review to utilization review
The comp industry spends millions on utilization review - certifying a procedure, hospital stay, therapy, or treatment as 'necessary' - or not. What most payers don't realize, or, more correctly, probably realize and don't discuss, is the reality that their...
The terrible burden of SOHDS
The tradition here at MCM is to honor all the important holidays, with none so important as April 1. In the five and a half years I've been publishing this blog, the April 1 post has become a challenge -...
Health reform's implications for work comp, part 3
Yesterday and Monday we reviewed the macro and micro impacts of health reform on work comp. Today we're going to focus on how reform will impact the comp network business. There are two types of comp networks, those based on...
The Anthem Wellpoint mess: the other part of the story
There's something missing from the debate/argument/shouting surrounding Wellpont's rate increase announcement; nowhere, in any statement I could find, did the company or it's critics address the core issue, Wellpoint's inability to control costs. Isn't that what healthplans are supposed to...
How's Coventry doing?
Pretty well. With the demise of health reform and the company's continued focus on core businesses at the expense of ancillary or unrelated operations, things are looking up for the mid-tier managed care company. Last week's Q4 2009 earnings call...
UPDATE - Changes at Coventry work comp
Coventry's work comp division has recently gone thru some changes at the upper management levels. The overhaul has affected clinical ops, senior management, and sales, and according to insiders may not yet be complete. Chris Watson is now COO, moving...
Work comp medical costs - heading up...
To no one's surprise. work comp medical costs appear to be on their way up, and at a rate significantly higher than the medical CPI. First the what, then the why. The latest data from NCCI indicate comp medical inflation...
Workers comp managed care - predictions for 2010
You'd think I'd learn not to make public predictions that may come back to haunt me, providing ammunition for folks who think I don't know diddly. But I subscribe to Teddy Roosevelt's philosophy" "The only man who never makes mistakes...
Last year's work comp managed care predictions
One year ago - against my better judgment - I made eight predictions about what would happen in the work comp managed care world. Here's how I did. 1. Coventry will be acquired. Well, that's a helluva way to start...
If private health insurance worked, we wouldn't need health reform
Lost in the fight over health reform is a single, huge truth - if the private insurance market worked, there would be no need for reform. We wouldn't be in this mess if private insurers were able to control cost...
The National Work Comp Conference - first impressions
It's good to be back in Chicago. The 'comp conference', the shortened title given to LRP Productions' annual National Workers Comp and Disability Conference, has recently been exiled to, of all places, Las Vegas. (Does anyone else see the slightest...
What you missed on MCM
For at least a couple weeks, many of the 1642 people who subscribe to MCM didn't receive notices when new posts went up. It looks like we've figured out the problem (electronic fingers crossed), so here's what's been on the...
UPDATE - the Texas report on work comp networks
New news on yesterday's post - turns out that 'costs' are not based on billed charges, but on payments. Unfortunately, the report doesn't make that clear - nowhere in the report does it define 'costs' as payments, it does state...
Texas' report on workers comp networks - fatally flawed?
Texas' Department of Insurance has been analyzing the performance of workers comp networks for the last couple of years, and the latest report has some pretty interesting results. Unfortunately, those results look to be based on a faulty analysis, making...
Health reform and workers comp - the view from IAIABC
Reform - whether it happens this year, in ten years, in one big change or a series of smaller steps - is going to have a big impact on workers comp. That's the takeaway from one of the sessions yesterday...
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