Fresh Health Wonk Review; plus, a RIMS wrap-up

April 19th, 2018 by Julie Ferguson

It’s Health Wonk Review week for April.

Louis Norris has posted the Spring Is Here! Health Wonk Review edition at Colorado Health Insurance Insider. Not sure how the weather is in Colorado, but Spring has decidedly not yet sprung in Massachusetts, where snow is falling outside the window at this very moment. But wherever you are, don’t let the weather interfere with your perusal of this month’s edition, which has some great posts. Please do not overlook Louise’s submission, which she tucks in at the tail end of her post. She’s compiled a post that is well worth a bookmark for future reference: a guide to Medicaid in each state, including a summary of states to watch this year in terms of Medicaid expansion, work requirements, and other changes.

In other news…recapping RIMS

We weren’t at the 2018 RIMS in San Antonio this past week and sorely missed meeting the San Antonio therapy animals, which were apparently a big hit.

We’ve been following along with some great reports. Here are a few things that caught our eye:

Right from the source, you can follow the day-by-day action from the RIMS Daily:
Monday, Tuesday and Wednesday

Safety National’s Conference Chronicles also has many helpful session and event write-ups – there are about 20 entries, so you can get a sampling of some of the latest issues.

RIMS Bestows Top Industry Honors and Awards

Risk Manager of the Year: Q&A with Rebecca Cady

A.M. BestTV at RIMS: Data and Analytics Leaders Reveal Their Biggest Challenge: Show Me the ROI

Technology Is Outpacing Risk Management: Marsh-RIMS Report

5 Trends to Watch in Construction Technology

Crucial Cyber Peril Defense and Coverage Considerations

Saving Lives—Building A Modern Pharmacy Program Amid A Deadly Epidemic

March 22nd, 2018 by Tom Lynch

Dr. Terrence Welsh, Medical Director for the Ohio Bureau of Workers’ Compensation, flew into Boston for WCRI’s 2018 conference to talk about Ohio’s attack on the opioid epidemic. He began with two slides worthy of reproduction here. The first is scary indeed:

 

So, in 2011, the Ohio BWC decided to do something about it. Here are some results through 2017:

So, much has been done, but much remains to be done. One of the many things that might be making a difference is this: Outside the box of the claim, Ohio BWC will pay for 18 months of treatment as long as the injured worker/patient complies with the treatment guidelines. This is innovative, but the Bureau doesn’t have outcome data yet. Dr. Welsh pointed out that, as you can imagine, the program isn’t very popular with opioid-dependent injured workers. The program asks them to give up the opioids they have come to know and love for the rest of their lives. A wickedly difficult thing to do. Regardless, the Ohio BWC should be complimented for the measures it has taken to attack this national horrendoma.

Here is a chart showing the decline in opioid prescriptions for Ohio’s injured workers:

What about the future. There’s a long way to go, but the Bureau  has charted a way forward, although it’s a mighty hard road with a lot of potholes, deep and wide.

The Ohio Bureau is working tremendously hard on this issue. The people in it are dedicated and committed to doing all in their power to rescue the many workers who have fallen into the opioid pungy pit. The emphasis they place on the last bullet of the last slide is critical for winning the battle.

 

WCRI: Keynote: Dr. Erica Groshen On Future Labor Trends

March 22nd, 2018 by Tom Lynch

Dr. Erica Groshen, former Commissioner of the U.S. Bureau of Labor Statistics, began this year’s conference. She is currently Visiting Scholar at Cornell’s Industrial Labor Relations School, and if anyone knows anything about the future of work, it is Dr. Groshen.

Labor market conditions: Since the end of the Great Recession, the U.S. has added 9.3 million jobs. As most of us have observed, the service industry has seen the most labor growth over the last year: professional, leisure and health services. The country’s unemployment rate is 4.1%. Dr. Groshen peeled that onion in discussing labor “underutilization.” She described how in addition to unemployment, underutilization, which addresses discouraged workers, marginally attached workers and part time workers who would prefer full time. That 3rd group stands at 8.2% of the population. Of the unemployed population, 20.7% are long-term unemployed. As further proof of the tightening of the labor market, currently for every job opening, there is 1.1 unemployed person. This seems low, but it’s about where numbers stood before the Great Recession.

Next, Groshen dove into a subject of great concern to me: wage growth. Essentially, there hasn’t been any since 1974. Real wage growth (wages adjusted for inflation) has been 0.0% over the last 12 months. Additionally, Dr. Groshen expressed significant concern about the relationship between productivity and wages. Until 1973, wages and productivity tracked on a one to one basis. Since then, productivity has soared and wages have been essentially stagnant.

The Gig Economy: BLS doesn’t know much about the Gig economy. You read that right. BLS “periodically” surveys 100,000 workers to determine the prevalence of what are called “alternative work arrangements.” Trouble is, the last time that happened was in 2005 (according to Groshen the failure of BLS to perform a really current survey is due to lack of funding). Given what’s happened to our economy since then, 2005’s data is pretty irrelevant. The BLS Current Population Survey, on the other hand is “current,” but what it shows is paradoxical in that there doesn’t seem to be any effect from what everyone perceives is a major shift in work and employment due to the emergence of the Gig economy. Groshen reported that in May 21017 BLS secured funding to conduct a new Contingent Workers Survey. We’ll have results, which will be of tremendous interest, in the near future.

Artificial Intelligence: Dr. Groshen considers AI as something that “replicates routine brainwork.” When AI is applied to routine work, for example, human coding of information, the result is higher quality work done by fewer people who handle the tricky work that humans need to do (at least, until now). As AI  rises in society, many jobs will be lost, but many jobs will be created. The same thing happened when we moved from an agricultural society to an industrial one. Groshen believes this will happen, but that producing the new jobs will take time, which will make things difficult for those who will be swept aside by growth in AI. Displaced workers, according to Groshen, can lose one to four years of income, which will be devastating for many. This will require government policy changes to help bridge the gap in employment. Good luck with that.

Official Statistics: Dr. Groshen emphasized the importance of “official statistics,” pointing out that, “We do not have a single statistical agency in America. We have 17 of them.” The BLS, established in 1884, is the gold standard and biggest of them all. She claims national stats are a public good. Who uses BLS statistics? The federal government, state and local governments, businesses and households (The most popular part of the BLS website is the Occupational Handbook).

There are challenges facing the BLS. Cybersecurity is, of course, a major one. Groshen reported that BLS has never had a data breech (to which I reply, “That we know of). Another challenge is, wait for it – Funding. From 2009 to FY 2019, nominal funding has been flat, standing at $609 million for FY 2019. However, if BLS had been funded at the rate of inflation, FY 2019 would be $715 million.

Dr. Groshen closed with a plea for help. BLS needs help in the form of money. Business has to do a better job of advocating for better and more data, data it relies on to make important decisions. Amen to that.

WCRI’s 2018 Conference: First Impression

March 22nd, 2018 by Tom Lynch

I arrived early for the first day of this year’s conference to find something more than the traditional lobby groups chatting and downing coffee. This year, and for the first time, WCRI has placed a number of charts around the lobby area. And they’re not just fluff. Here’s one:

 

I think this is great for the attendees. Meet friends and colleagues, grab a cup of java and get some sophisticated education at the same time. Kudos to whoever had this idea.

WCRI’s Annual Conference: The Curtain’s About To Rise

March 19th, 2018 by Tom Lynch

This week will see most of the nation’s workers’ compensation cognescenti at the Workers’ Compensation Research Institute’s annual conference in beautiful downtown Brahmin Boston, the home of the bean and the cod, where the Lowells speak only to Cabots, and the Cabots speak only to God.

This is WCRI’s 34th annual conference, and it sports an agenda that should satisfy even the geekiest of data geeks.

To me, two things stand out. First, if you’re coming to my home town expecting not to hear much about drugs, I submit you’ve been living on another planet. Three of the eight total sessions address drugs: two on opioids, one on Medical Marijuana.

Dr. Terrence Welsh, Chief Medical Officer at the Ohio Bureau of Workers’ Compensation, will detail Ohio’s successful program aimed at reducing opioid dependence among injured workers.

In 2011, the Ohio Bureau of Workers’ Compensation (OBWC) found that more than 8,000 injured workers were opioid-dependent for taking the equivalent of at least 60 mg a day of morphine for 60 or more days. By the end of 2017, that number was reduced to 3,315, which meant 4,714 fewer injured workers were at risk for opioid addiction, overdose, and death than in 2011.

After years of thumb-twiddling, other states have made great strides in combating opioid dependence in workers’ compensation, California and Washington State to name just two. But because workers’ compensation is state-based, there’s no national workers’ compensation solution; every state is on its own. Most are actively engaged in building programs to reverse the deadly trend, but workers’ compensation is only the tiny caboose on the back end of the great big American health care train(wreck). Nationally, the health care industry doesn’t seem to be having as much success as workers’ compensation’s committed leaders.

Evidence: U.S. life expectancy at birth dropped in 2015 for the first time since 1993 during the AIDS epidemic. The years 2015 and 2016 saw the first consecutive two-year drop in life expectancy at birth since 1962/63 (generally attributed to an epidemic of flu).  The two-year drop in American’s life expectancy is primarily due to drug deaths. In 2015, the nation suffered 52,400 drug overdose deaths. That’s more people than were killed in car crashes in any year since 1973. In 2016, the total rose to 63,600, more than were killed during the entire Vietnam conflict, which lasted more than a decade. Drug deaths for 2017 appear to be even higher, although, because drug deaths take a long time to certify, the Centers for Disease Control and Prevention will not be able to calculate final numbers for 2017 until December. No other country in the OECD has seen a drop in life expectancy in recent history.

Although it is obviously appropriate that medical issues make up the preponderance of this year’s WCRI sessions, the Keynote Address, to be given by Dr. Erica Groshen, former head of the U.S. Bureau of Labor Statistics, is of great interest to me. In her presentation, “Future Labor Force Trends and the Impact of Technology,” Dr. Groshen will address and analyze current labor market trends and provide official statistics leading to her views on the future of work. Because I have written about America’s pathetic, more-than-four-decade lack of hourly wage growth, I’ll be keenly interested in her remarks. Here are some questions I’d like her to answer:

January, 2018, saw the first substantial monthly hourly wage growth (2.9% from a year earlier) since 1974. This was not repeated in February (0.1% gain in wages, offset by 0.2% growth in the Consumer Price Index)
  • Does Dr. Groshen see any correlation between stagnant hourly wage growth and workers’ compensation’s declining injury frequency and loss costs?
  • If this is a current unknown, should WCRI study it? If not WCRI, then who?
  • Between 1948 and 1973 there was a one to one correlation between productivity and wages. However, since 1973, productivity has risen nearly 75%; wages about 9%. How does Dr. Groshen see this playing out in the next decade?

Two final thoughts about the upcoming conference. I know time is limited, but I wish WCRI had allotted one session to Artificial Intelligence and Machine Learning and their impact now and in the immediate future on workers and workers’ compensation. Artificial Intelligence (AI) continues to gain significant momentum throughout industry.  The workers’ compensation industry is ever so slowly increasing the bandwidth of its AI capability, but it still seems to lag far behind other industries in embracing much that AI has to offer.

Speaking of AI, IBM Q, the creator of Watson, put a 5 cubit quantum computer prototype in the cloud in 2016 and two months ago unveiled a 20 cubit quantum computer available to its clients and a prototype 50 cubit quantum computer. Unlike  current computers, which perform operations sequentially, quantum computers perform many operations simultaneously. An operation which currently can take days, or even weeks, will be done on a quantum computer in minutes, or even seconds.

I would love to see the massive brain power at WCRI turn its attention to this fascinating area and its potential impact on the labor force and workers’ compensation.

See you in Boston.

 

 

 

 

 

 

Ideas of March Health Wonk Review

March 16th, 2018 by Julie Ferguson

The March edition of Health Wonk Review is out, and it’s a good one — David Williams has posted the Ideas of March edition of Health Wonk Review.

Health Wonk Review: Ideas of March Edition

We encourage policy wonk fans to take the time to watch the #CareTalk podcast co-hosted by this week’s David Williams (Health Business Group) and John Driscoll (CareCentrix) – among the topics, what the partnership between Amazon, JPMorgan Chase and Berkshire Hathaway will mean for healthcare.

It’s The Zip Code, Stupid!

February 26th, 2018 by Tom Lynch

“Sixty-percent of life expectancy, which has gone down two years in a row, is determined by where you live, 30% by your genetic code and 10% by the clinical care you get. Zip code matters more than genetic code.”

That was the sobering message delivered by AETNA CEO Mark Bertolini during an interview on CBS this morning. And he’s right. A May 2017 study from JAMA Internal Medicine concluded that geography is the biggest X-Factor in today’s American Hellzapoppin version of health care. The study analyzed every US county using data from deidentified death records from the National Center for Health Statistics (NCHS), and population counts from the US Census Bureau, NCHS, and the Human Mortality Databas and found striking differences in life expectancy. The gap between counties from lowest to highest life expectancy at birth was 20.1 years.

And, surpirse, surprise, it turns out if you live in a wealthy county with excellent access to high level health care, like Summit County, Colorado (life expectancy: 86.83), you’re likely to live about 15 years longer than if you live, say, in Humphries County, Mississippi, where life expectancy at birth is 71.9 years.  So, yes, Zip Code matters. According to the study:

In this population-based analysis, inequalities in life expectancy among counties are large and growing, and much of the variation in life expectancy can be explained by differences in socioeconomic and race/ethnicity factors, behavioral and metabolic risk factors, and health care factors.

On the whole, though, US life expectancy at birth increased by 5.3 years for both men and women — from 73.8 years to 79.1 years — between 1980 and 2014. But the county-by-county magnitude of the increase was determined by where one lives. That is, wealthy counties showed significantly greater increases in life expectancy than poor counties.

What is even more alarming is that some counties have experienced declines in life expectancy since 1980.

The JAMA study is another view from a different angle of inequality in America. According to Bertolini, CVS’s pending acquisition of AETNA, the third largest health insurer in the nation, will be a positive step in leveling the health care field when fully rolled out. He believes CVS’s 10,000 stores will evolve into much more than the Minute Clinics a lot of them are now. Time will tell, but CVS may be on to something here. In an op-ed in today’s New York Times, Ezekiel Emanuel pointed out that since 1981:

The population has increased by 40 percent, but hospitalizations have decreased by more than 10 percent. There is now a lower rate of hospitalizations than in 1946. As a result, the number of hospitals has declined to 5,534 this year from 6,933 in 1981.

People are apparently trying their mightiest to get health care anywhere except a hospital. According to Ezekiel, hospitals now seem less therapeutic; more life-threatening. Also, and this is where CVS is heading, complex care can now be provided somewhere else.

Another red flag from Mark Bertolini’s CBS interview was his reference to life expectancy dropping two years in a row. He’s right about that, too. In 2015 and 2016, life expectancy declined by a statistically significant 0.2 and 0.1 years, respectively.¹ Until now, life expectancy in America hadn’t declined since 1993.

All this is happening while our modern-day Tower of Babel – the US government – remains unwilling, unable, or both, to do anything constructive to improve the situation. Our more than 30-year health care train wreck needs serious attention, not partisan bloviation. To paraphrase Winston Churchill, ” That is a situation up with which we must no longer put.”

The men and women of Humphries County deserve nothing less.

 

¹ 2015’s drop was originally put at 0.1 year by the CDC, but was revised to 0.2 years after Medicare data were re-evaluated.

Going for the gold: An Olympic edition of Health Wonk Review

February 16th, 2018 by Julie Ferguson

Steve Anderson has posted the Health Wonk Review for February 15, 2018: Going for the Gold Edition at HealthInsurance.org blog. It’s an entertaining and wide-ranging smorgasbord of health policy topics of the day.

Here are a few of the topics d’jour:

  • Amazon/Bershire Hathaway/PMorgan’s foray into healthcare
  • Unexpected ER bills
  • CMS attack on freedom of the press
  • Predictions about Alex Azar, newly appointed HHS Secretary
  • The ACA
  • Peruvian healthcare
  • A different kind of hospital coverage
  • A recap of Health Action 2018, Families USA’s annual meet for healthcare activists.

If you aren’t familiar with healthinsurance.org, you should be. Check out the impressive roster of contributing authors and the excellent state health guides.

And just a heads up: In 2018, Health Wonks are on a once-per month schedule so catch this issue – you won’t have a chance for more wonkery until March.

Who’d A Thunk It? Something Good Out Of DC!

February 12th, 2018 by Tom Lynch

Watching our legislators doing their thing in the nation’s capital, one can be forgiven for thinking Vlad the Impaler could learn a thing or two from these folks. But last Friday, in a rare Washington Kumbaya moment, peace broke out and the Bipartisan Budget Act zipped into law with the speed of an Olympic skater, Rand Paul notwithstanding.

The newly minted budget act has pork for everyone, but the pork I like is one little section that won’t get much press coverage, because it benefits poor people who are aging and sick: America’s Dual Eligibles. Duals are those among us who, by virtue of their age, health status and poverty are eligible for both Medicare and Medicaid benefits. The new budget act permanently re-authorizes Special Needs Plans aimed at caring for Duals.

Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) [Pub. L. 108-173), Congress created a new type of Medicare Advantage coordinated care plan focused on individuals with special needs. “Special needs individuals” were identified by Congress as: 1) institutionalized beneficiaries; 2) dually eligible; and/or 3) beneficiaries with severe or disabling chronic conditions. The MMA allowed for the creation of “Special Needs Plans” for these populations. For example, to accommodate the new legislation, my state, Massachusetts, created the Senior Care Option health plan, which “covers all of the services normally paid for through Medicare and MassHealth (Medicaid).”

Medicare, because of the aging of the Baby Boomers, and Medicaid, because of increasing poverty and state expansion through the Affordable Care Act, have grown significantly since 2010, making Special Needs Plans more and more important. Trouble was, Congress had to re-authorize the plans every few years. That concern is now in the past. The Bipartisan Budget Act, with its permanent re-authorization of Special Needs plans makes sure the safety net created by the plans is solid, secure and long-lasting.

The new budget act also re-authorizes the Children’s Health Insurance Plan (CHIP) for another ten years, something that has long had bipartisan support.

Finally, this Congress has done something that will benefit our most vulnerable citizens. Let’s hope it’s not a one-off.

Check out 2018’s first Health Wonk Review at Paduda’s place

January 19th, 2018 by Julie Ferguson

The wonks are back with posts on the ACA, prescription drug costs, workers comp – all the topics and themes you missed over the holiday. Click on over to Joe Paduda’s Managed Care Matters to catch up at his post Ring in the New year with the latest and greatest …

Stop by for the health wonkery and stay for the informed commentary and analysis on Joe’s other blog posts. If you are extraterrestrial and therefore unfamiliar with Joe’s blog, remedy that today!