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!

A look back, a look ahead

January 12th, 2018 by Julie Ferguson

2017 work comp recap, 2018 ook ahead

We thought we’d get a drone’s eye view of the work comp landscape and related matters with a retrospective of the 2017 goings on and a look ahead at predictions and trends for 2018.

Work Comp Wire: Leaders Speak: 2017 Year in Review, Part One and Part Two

Business Insurance: Most read workers comp stories in 2017

Business Insurance: Court rulings challenge workers comp sector in 2017

Risk Management: Year in Risk 2017

Insurance Information Institute: Global insured catastrophe losses could reach record in 2017

Insurance Journal: Top Insurance Journal National Stories of 2017

Insurance Insights: 2017 Recap – A Look Back at the Insurance Market

Joe Paduda: How’d I do on my 2017 workers’ comp predictions?

Evil HR Lady: The 2017 Employment Law Year in Review

Fistful of Talent: Events From 2017 That Will Make a Lasting Impact in the Workplace

MedRisk: 2017 Industry Trends Report

Business Insurance: Most read Off Beat stories in 2017

Insurance Thought Leadership: Insurtech: The Year in Review

Insurance Journal: 2017 ‘One of Worst’ for U.S. Weather with 15 Events Costing $1 Billion or More

PropertyCasualty360: 6 ways cybersecurity changed in 2017

Gizmodo: The Great Data Breach Disasters of 2017

Gallup News: The Best Workplace Articles of 2017

Fortune: 34 Business Books You Won’t Be Able to Put Down

USA Today: Year in review: The 50 stories from 50 states that moved us in 2017

The Atlantic: 2017 in Photos: How the First Months Unfolded, Part 2 and Part 3

Google: Year in Search – 2017

A look ahead at what’s in the cards for 2018

Joe Paduda: Predictions for work comp 2018 part 1 and 2018 part 2

Willis Towers Watson: Marketplace Realities 2018: Workers compensation

Marsh: Webcast: Workers’ Compensation: Looking Ahead to 2018

Sedgwick identifies risk and benefits industry trends to watch in 2018 (PDF)

Sedgwick: Navigating 2018 (PDF)

Think Advisor: 5 Big Questions About Health Insurance for 2018

Bloomberg: Health Insurance Marketplaces for 2018

Claims Journal: Tips on Setting Claims Goals for 2018

Gallup News: Are You Ready to Respond to 2018’s Biggest Healthcare Trends?

Littler: Ready or Not, Here It Comes! 2018 Brings New Labor & Employment Laws, Primarily at the State Level

Forbes: 10 Workplace Trends You’ll See In 2018

CNN: Here’s where the minimum wage is going up in 2018

HR Daily Advisor: 2018 Trends to Watch: 6 Trends That Will Impact Employers

Forbes: 3 pitfalls to enterprise risk management in 2018

Insurance Though Leadership: 2018 Predictions on Cybersecurity

Happy holiday Health Wonk Review

December 14th, 2017 by Julie Ferguson

Santa reading Health Wonk Review

First, let us go on record for saying that there is no sly political motive to our use of the term “holiday” in the title of this post. Admittedly, we have a bit of a liberal slant, but we have no aversion to using the phrase “Merry Christmas.” But ho, ho, ho, we do have an inordinate fondness for alliteration. Of course, we might have called it the Happy Hanukkah Health Wonk Review instead, but we wanted to encompass Hanukkah, Christmas, Kwanza, New Year’s, and even the dubious Festivus. Whatever your flavor or inclination, we wish you a merry, happy, joyful one. Pentatonix says it better than we ever could, so a bit of a seasonal interlude before we get to this week’s entries.

The Happy Holiday Health Wonk Review

*** First up, at Managed Care Matters, Joe Paduda is never one to shy away from calling it as he sees it and this week his submission takes on the GOP tax bill, which he describes as “a mess, riddled with math errors, contradictory language, and un-implementable directives.” Congressional leaders say they have reached some agreement and will vote before the end of the year, so Joe’s post will give context.

*** Roy Poses proves once again that the devil is in the details and he consistently makes it his blogging business to dig through the details to hold feet to the fire. At Heath Care Renewal, he tracks down more about a barely-reported Pfizer settlement for “alleged” anti-competitive behavior that nearly slipped through the radar. He says that the lack of negative consequences suggests that the impunity of top health care leaders is is worsening. Check out his post One Barely Noticed Settlement by Pfizer Suggests the Futility of Polite Protests about Health Policy.

*** How will the CVS purchase of Aetna affect the healthcare landscape? Jason Shafrin aka The Healthcare Economist weighs in with his informed observations.  And another of our regular wonks weighs in on the merger. David Williams of Health Business Blog posts CVS + Aetna. Are we sure this adds up? Despite talksthat this combo will lead to a revolution in care delivery, he remains a skeptic and talks about why.

*** Acknowledging that the individual market for health insurance has become unaffordable for many of the unsubsidized — particularly older would-be enrollees — Andrew Sprung outlines various ways to keep Modified Adjusted Gross Income (MAGI) below the subsidy line. Check out his post Steering clear of the subsidy cliff in the ACA marketplace at xpostfactoid.

***  Vincent Grippi of CareCentrix submitted a fun #CareTalk video podcast, featuring HWR regular David Williams teaming with John Driscoll of CareCentrix. In a point-counterpoint format, they spar about the implications of 2017 elections on healthcare (think Maine), move on to value-based healthcare and they close the 10 minute segment with a lightning round.

*** Brad Flansbaum of The Hospital Leader has an interesting post about Locums vs F/T Hospitalists, posing the question, do temps stack up? He reports on a JAMA study, adding his perspective. Now I must confess that the term “locums” was a new to me, but Brad gives it good context. But if you are curious to the origins, as I was, Wikipedia is your friend.

*** In his post The Positive Side of Sharing, InsureBlog’s Henry Stern has the latest on a reader’s experience with a Health Care Sharing Ministry. (He offers this spoiler alert: it’s actually been pretty good).

*** Shopping for individual health insurance or know someone who is? If your state uses HealthCare.gov, you have until December 15 to enroll, but in other states, you may be able to enroll as late as January 31. Victims of Hurricanes Irma and Harvey may also have extensions. Louise Norris has all the details in her  guide to buying individual health insurance at healthinsurance.org. For more, see Timothy Jost’s post on Health Affairs Blog: Open Enrollment Ends Friday—Except For Those Qualifying For Special Enrollment Periods.

*** For our post, we’re delving into our archives for an expose of a mysterious employer. Many have nothing but good to say about him, but others think he is not a good employer. Judge for yourself:

Santa’s workshop: “OSHA problems galore” say whistleblowers
The risks of being Santa
Is Santa Claus a bad employer?


Fresh Health Wonk Review and a big roundup of recent work comp news

November 30th, 2017 by Julie Ferguson

Andrew Sprung has the most recent compendium from the health wonks  at xpostfactoid:

Late Days of Empire Edition: Health Wonk Review. The wonks’ entries are reflecting the healthcare market chaos of the times – check it out! Also note that two weeks from today, we’ll be hosting the next edition here at Workers Comp Insider!


Other workers comp news of note along with general interest items that caught our attention:

Net neutrality & why you should care: If you are a blog afcianado – or if you just like a free an open internet, please make your voice heard about net neutraility. Don’t let the internet service providers do to the internet what cable companies did to TV – make your voice heard in favor of Net Neutrality which is at serious risk or being rescinded. See RIP net neutrality: FCC chair releases plan to deregulate ISPs. This requires immediate action: the vote is December 14. Make your voice heard.

Purdue Pharma: In this weeks’s HWR, Joe Paduda talks about how Purdue Pharma is trying to limit legal liability in the many state suits. Related, there was an excellent recent article in Esquire by Christopher Glazek that is well worth a read: The Secretive Family Making Billions From the Opioid Crisis.

Blankenship for Senate? Convicted coal baron Don Blankenship announced his intention to challenge Joe Manchin for a senate seat in West Virginia. We’re talking about Don Blankenship who was CEO of Massey Energy Co. at the time of a 2010 Upper Big Branch mine disaster that killed 29 miners. We have opinions on Blankenship that we’ve expressed over the years. Hint: thumbs down for the senate.

Grain Bin deaths: Over $1.8 Million in Proposed Fines Following Fatal Grain Dust Explosion – OSHA has proposed $1,837,861 in fines against Didion Milling Inc. following a May 2017 grain dust explosion that killed five workers and injured 12 others, including a 21-year-old employee who suffered a double leg amputation after being crushed by a railcar. We hope the fine will stick – see our prior post Walking down the grain – and the fines.

Gripping read: Atul Gawande’s twitter pointed us to a remarkable story in Emergency Physician’s Monthly: How One Las Vegas ED Saved Hundreds of Lives After the Worst Mass Shooting in U.S. History. Hats off to the incredible medical teams!

Nail salons: US nail salons: the challenge to protect workers from toxic chemicals – Critics mock an EPA scheme to create ‘healthy salons’, but Julia Carrie Wong hears how it is tackling an ‘epidemic’ of health problems from staff, many of whom are Vietnamese immigrants.

Jennifer Christian posts Avoid “one-size-fits-all” thinking in evidence-based medicine, which challenges a blind spot in current thinking – worth a read. From our vantage, Dr. C is always in the forefront of new occ med thinking.

Bionic safety? medGadget has news that Ford is trialing the Exoskeleton to help prevent worker injuries. The device is made by Ekso, a company that devlops full-body exoskeletons for paralyzed people, but the firm thins the technology can prevent injuries in workers who perform physically difficult repeat tasks, such as operating the overhead machinery.

More news – quick links

The American Health Care Paradox: A Lot Of Money For Poor Results

November 29th, 2017 by Tom Lynch

Here’s something all Americans can agree on: Health care costs way too much. But way too much in reference to what? Well, how about the rest of the developed world? How about wealthy countries, our peers, in the OECD, the Organization for Economic Cooperation and Development?

The OECD was formed in 1961. Headquartered in Paris with a membership of 35 nations, the OECD’s mission is to promote policies that will improve the economic and social well-being of people around the world. Annually, it performs comparative analyses of issues affecting its members. One such issue is health care.

Want to know about health care spending around the world, infant mortality, life expectancy, doctors and nurses per capita and a host of other health care topics? The OECD is the place to go.

Which brings us to American health care, which I suggest is a classic paradox. On the one hand, on a per capita basis, we spend 41% more on health care than our wealthy nation peers in the OECD and 81% more than the entire 35-nation OECD average.

OECD Health Care Funding – 2015

(Light blue – Private Funding; Dark blue – Public Funding)

As you can see, while our public funding (Medicare, Medicaid, etc) is comparable to many of the other 34 countries in the OECD, Germany, France and the UK for example, private funding in the US is more than 100% greater than Switzerland, our closest competitor, and 300% greater than the OECD average.

This might be fine if we got what we paid for, but that is not the case. As an example, consider something that should be important to us all: life expectancy. In the US, life expectancy at birth is 78.8 years (76.3 for men; 81.2 for women). In the UK, it’s 81 (79.2 for men; 82.8 for women). In Japan, life expectancy at birth is a whopping 83.9 (80.8 for men; 87.1 for women).

What about infant mortality, the number of deaths of children under one year of age, expressed per 1,000 live births? Our infant mortality rate of 6.1 is 45% higher than the UKs, at 4.2, and 265% higher than Japan’s 2.3 rate.

Curious about obesity? Our obesity and overweight rate is exceeded only by New Zealand’s.

And stop for a moment and consider cancer. Judging by the television ads, one would think the US has more cancer treatment centers than golf courses. Yet our death rate from cancer per 100,000 people is 188. Mexico’s is 115; Japan’s, 177.

In fact, just about the only metric in which we lead the world is smoking cessation. So, yes, it’s paradoxical. Sort of like a big-market baseball team spending gazillions more for players than any other team, only to finish out of the running.

And now, into the fray trots the Republican tax reform plan, which is looking more and more like it will actually become law. This plan would cause 13 million people to  find health insurance unaffordable, which means their new PCP will be their old PCP, the local emergency room where costs are stratospherically higher than anywhere else. In addition, $25 billion will be cut from Medicare, which, although it’s only 4% of the total Medicare budget of $588 billion, can’t be good as more and more baby boomers age into Medicare.

Fixing health care in America is going to take time and a lot more money, but we have to start somewhere, sometime. It’s hard to see where the Republican tax plan even approaches trying to do that.