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What works in wellness
Getting employees to change unhealthy habits, exercise, eat right, and do all the other little things that make for better health and lower health care costs is fiendishly difficult. As a nation, we've proven that if anything, trying to change...
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...
Can the surgical implant problem be fixed?
According to Bill Kidd's piece [sub req] in WorkCompCentral this morning, several states are attempting to address the rapidly growing problem of surgical implant device fees via regulation or legislation - by basing reimbursement on the manufacturer's invoice. While it...
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...
A look back at RIMS - DME formularies, claim triage, and drug costs
Following RIMs, it was off to NCCI for their conference, then a furious few days to catch up and follow up and get a couple deliverables out. Now that there's a few minutes to go back thru my notes from...
How many dollars are wasted on physical therapy?
Probably a lot. Perhaps most. And certainly a big chunk of the bucks your insurer/TPA is paying. Unlike surgery, imaging, drugs, and other types of medical treatment, PT has long been a bit of a black art. The clinical guidelines...
Sixth Annual Survey of Prescription Drug Management in Workers Compensation
The decrease in the workers comp drug cost inflation rate that persisted for five years appears to be over. According to HSA's Sixth Annual Survey of Prescription Drug Management in Workers Compensation, the five-year 'decrease in the rate of drug...
Trends in Work Comp drug management
The five year downward trend in drug cost inflation appears to be over, driven by excessive utilization, pain management, and price increases on a couple key drugs. But not all payers are experiencing increased costs; some actually saw costs decline...
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...
UPDATE - Ethics in workers comp managed care
For the update, see UPDATE below. Also, if you would like a copy of Todd's marketing presentation, email me at infoAThealthstrategyassocDOTcom. The presentation is not copyrighted, marked confidential or proprietary, or otherwise protected from distribution. Original post The world of...
Another question for your work comp managed care vendors
Following on yesterday's post, I received several emails from payers and vendors alike suggesting other pertinent questions payers may want to pose to their vendors. The most common pertained to fee-sharing between TPAs and vendors. This practice has long existed...
If health reform fails, part 2 - the providers
Yesterday we examined the potential impact on insurers and insureds of a failure to pass meaningful comprehensive health reform . Today we'll look at the effect on providers. Again, we'll leave aside the possibility of individual bills addressing physician compensation...
What happens without health reform?
We know that much of the town hall opposition has been funded by right-wing advocacy groups. What we don't know is what will happen if they are successful in stopping Congress' efforts to pass and the President's to sign a...
Comp cost escalation in California; no answer in sight
There are two key takeaways from the WCIRB report on California's work comp costs (as reported by workcompcentral.com). Medical costs are rising fast, and managed care costs are rising much faster. Medical expenses climbed 7.9% last year, led by a...
Diagnostic lab networks come to work comp
There are specialty managed care offerings for PT, imaging, pharmacy, home health, DME, facilities; even dental. Till now, the only type of medical spend that didn't have a custom answer had bern diagnostic lab. That gap has now been filled....
Why doesn't Paradigm have more business?
'Managing the Impossible', an analysis of catastrophic case management firm Paradigm's results and comparison of those results to those achieved by work comp insurers, has been sitting on the upper right corner of my desk for a couple of months...
Two key takeaways from HSA's bill review survey
The two overarching issues in work comp bill review are state reporting and the non-connect between utilization review/medical management and bill review. Bill Review Workers comp payers spend hundreds of millions of dollars each year on medical management - pre-cert,...
Tinker's HWR = good summer reading
Health Wonk Review welcomes a new host - the Boston - based Tinker Ready hsa this week's edition up and running with a Jersey theme. Welcome, Tinker!...
Major findings from HSA's First Annual Workers Compensation Bill Review Survey
We've completed the First Annual Workers Comp Bill Review Survey and there are several highlights worthy of mention. (If you've requested a copy of the results you will receive it by the end of next week) Bill review is considered...
How's work comp doing - the details
Dennis Mealy, Chief Actuary at NCCI, got into the details with his State of the Line address at NCCI's annual conference. We'll focus on workers comp, but it's important to remember comp is a part of the overall property and...
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