Archive for July, 2016

New Health Wonk Review, a Yuuuuuuuge Edition and other news of note

Friday, July 22nd, 2016

The Health Wonkers have been on an abbreviated summer schedule, but Steve Anderson at medicareresources.org blog has posted a July edition that is not to be missed: Health Wonk Review for July 21, 2016, the Yuuuuuuuge Edition. It’s got a little bit of everything from Obamacare to opioids — including a look ahead at health expenditure projections and hospitals of the next decade. Catch up on your health policy wonkery!

As long as we’re posting, here are a few other noteworthy news items that caught our eye recently:

Not to be missed: Here’s an essential post to bookmark: Workers’ comp fast facts from Joe Paduda. Great info.

Please respond & share: Yonatan Ben-Shalom is Senior Researcher at Mathematica Policy Research and Project Director of the Stay At Work / Return To Work (SAW/RTW) Collaborative. He puts our a call for ideas: How can states help workers keep their jobs after injury, illness, or disability? This is part of the U.S. Department of Labor’s Office of Disability Employment Policy’s Stay-at-Work/Return-to-Work Policy Collaborative. Offer your thoughts on 1) Which state agencies are in the best position to help workers keep their jobs after an injury, illness, or disability? and 2) What specific types of strategies can these agencies consider?

Pharmaceuticals report: WCRI has new studies on the Impact of Reforms on Physician Dispensing in various states. Get the scoop at WorkCompWire.

Food for thought: Dr. Jennifer Christian has a thoughtful post on Why we need a 1:1 ratio of healers to lawyers when designing reforms for “comp”

State of the industry: The U.S. property/casualty (P/C) industry’s workers’ compensation line generated a significant profit in 2015, according to a new report from Fitch Ratings.

2016 DMEC Annual Conference: Roberto Ceniceros talks about benefits integration and effective wellness strategies in Reaping the Rewards of Benefits Integration.

Prevention Opportunity: 16 percent of nonfatal workplace injuries or illnesses occurred from midnight to 8 a.m. in 2014.

Crisis on the job: Reflections by a Dallas police officer

Quick takes

Dave DePaolo: on the passing of a work comp giant and a fine human being

Tuesday, July 19th, 2016

It is with great shock and deep sadness that we learned of the untimely passing of Dave DePaolo. We send our most sincere condolences to his family and his colleagues.

Dave has been one of the most important voices in our industry and an online workers comp pioneer. He was founder and president of workcompcentral, one of the early online specialty media communities dedicated to news, education and data content to the workers’ compensation industry. He also maintained his own blog, DePaolo’s World, a regular stop for us here at Workers Comp Insider. We’ve relied on and linked to his keen insight here many times.

As an attorney, he had a sharp mind and a deep expertise in the many nuances of the workers compensation system. He was an educator to us all; passionate about the rights and wrongs of the system, and giving voice to the injured worker at the heart of the system. A remarkable man, his influence and voice will be missed. You can learn more about him at his workcompcentral biography. His posted obituary notice is here: DePaolo, WorkCompCentralCentral Founder, Dead at 56. In less than one day, it has amassing 4,500+ views and dozens of comments, well worth reading to get a sense of the impact he had on our community.

Here are two tributes from bloggers that we found moving because both go beyond the basic facts of his life and give a window into the man.

Life is short. Live it like David did. This blog post by Joe Paduda focuses on the way Dave lived his life to the fullest, including some personal details of his life that many of his regular readers may have been unaware.

Godspeed David DePaolo; You Were What Was Right in Workers’ Comp, and Your Voice Will Be Missed
This a warm and heartfelt tribute by Bob Wilson at his blog. Here’s an excerpt:

Exemplifying David’s passion towards our industry, one needs look no further than the CompLaude Awards. CompLaude is an annual effort created by DePaolo to recognize top achievers in our industry. It recognizes people from all sectors of comp, including injured workers; people who have achieved beyond the expected results normally seen in the realm of workplace injuries. David felt strongly that the workers’ compensation industry needs to highlight the good things we accomplish, and fight the persistent negative image cast upon us by external forces and bad players within the industry. He was right to insist on that – and David DePaolo was one of the good things workers’ comp needs to celebrate.

David was unique among industry bloggers because he wrote with a special human interest; he invited us into his home and shared his family with us, all while gearing the overall message to one applicable in workers’ comp. We became acquainted with his parents, following the lives of both his father and mother, through the aging process and related ailments to their ultimate passing. We celebrated their love and suffered his loss, all because David willingly invited us in and made us feel at home.

We’ve just seen the passing of WCRIBMA’s Paul Meagher here in Massachusetts, recently, too. Very sad time for our industry.  Take Joe Paduda’s advice as modeled by Dave: Live your life fully.

2016 White Paper Evaluates Commonwealth Care Alliance

Monday, July 18th, 2016

In April, 2016, I authored a post about Commonwealth Care Alliance (CCA), a Massachusetts HMO dedicated to serving the Dual Eligible population. Duals qualify for both Medicare and Medicaid, and CCA has been the nation’s incubator for how to do that. The Boston-based HMO operates a Senior Care Option plan for Duals over the age of 65 and an Affordable Care Act demonstration project, called One Care, for Duals younger than 65. I’ve been a CCA Director since its inception in late 2003.

Now, with the support of the Robert Wood Johnson Foundation, JSI Research & Training, Inc., has published an extensive evaluation of CCA’s visionary and groundbreaking efforts to treat the nation’s sickest of the sick and poorest of the poor.

In JSI’s words:

The provisions in the ACA were designed to achieve the Institute of Health Improvement’s Triple Aim of improving patient experience of care and the health of populations while reducing the overall cost of health care.

The 22-page White Paper’s thrust centers around CCA’s “Social ACO” model of care. JSI describes the Social ACO approach this way:

These approaches are based on the idea that improving health and cost outcomes of vulnerable populations will necessitate incorporating health, behavioral health, and social services into the ACO model. Social ACOs serve populations with complex and often unmet social and economic needs that impact health outcomes and health system utilization, including needs related to housing, food security and nutrition, legal assistance, employment support, and/or enrollment assistance.

As I noted in April, Duals represent only 4% of the nation’s population, but consume 34% of its health care dollars. They present a societal problem begging for a solution. The Affordable Care Act offers revolutionary innovators like CCA the chance to prove their worth. So far, as the JSI paper suggests, CCA’s approach is spot on. Here’s JSI’s conclusion:

As a pioneer of the social ACO approach, its (CCA’s) story offers insights into the factors and processes that promote successful realization of the Triple Aim for other emerging ACOs focused on complex patient populations.

Payment and delivery reform promises to transform care for the nation’s most vulnerable citizens. This is needed more than ever given rising healthcare costs and continued fragmentation of the care system. CCA’s social ACO model represents one approach to caring for some of the highest risk populations, though even this approach has had to be adapted extensively for the dual-eligible population under 65. Given its longevity of refining a care model, a global capitation payment model and a culture of innovation to care for high-risk, vulnerable populations, CCA’s experience is relevant to any provider organization seeking to transform care for high-risk populations.

Achieving the Triple Aim of improving the health of America’s dual population while lowering the cost of doing so is a rabbit-out-of-the-hat trick of the first order, but, at least to this point, Commonwealth Care Alliance seems to be onto something that will do just that.

One final thought: On the eve of our two presidential conventions, it would be nice if, at some point in all the bloviation, a cogent discussion regarding health care were to be had. And I’m talking about something other than, “On Day 1 we’re going to repeal Obamacare.”

But I wouldn’t bet on that happening. Would you?

On The Passing of Paul Meagher

Tuesday, July 12th, 2016

Last week workers’ compensation lost a true professional and I lost a dear friend.

I first met Paul Meagher 32 years ago when he was Senior Counsel for Associated Industries of Massachusetts (AIM) and I was a young guy who thought he had a big idea. The idea was that if employers were educated about workers’ compensation they would approach it differently and losses and Experience Modifications would fall.

Paul believed in the idea. Workers’ compensation was entering a ten-year crisis, and AIM, at the time the largest such organization in America, needed a solution for its members. So Paul convinced the AIM hierarchy to launch a series of seminars around Massachusetts with my big idea as the centerpiece. And it worked. When employers saw there was a common sense, management 101 solution they took to it like water finding a crack in the floor. It culminated five years later with the creation of the Massachusetts Qualified Loss Management Program, which, along with sensible legislative changes, ended the crisis. A $2 billion dollar problem turned into a $1.3 billion dollar win for the state and its employers.  And it never would have happened without Paul’s steady, shoulder-to-the-wheel work.

Paul went on to become the President of the Massachusetts Workers’ Compensation Rating & Inspection Bureau. He captained the Massachusetts workers’ compensation ship for 16 years until early Saturday morning, July 2nd, when he suddenly, but peacefully, died in his sleep in Maine on the first day of a much deserved vacation. He was only 64 years old.

If you met Paul you would have instantly underestimated him. He had not one gram of outsized ego in his body. His leadership style was calm, even quiet. He was perfectly happy to surround himself with people he judged smarter than himself. He played the steady, unassuming jockey sitting atop the speeding thoroughbred, nudging it along without the horse even knowing he was there. In a world of masses on the make, he just did his job, and the continued exceptional success of Massachusetts workers’ compensation is all the proof you need.

But worker’s compensation, while an important part of his legacy, pales beside the deeper, broader person who adored Addy, his wife of nearly 40 years, and Madeline and Michelle, his two accomplished daughters. When we talked about our families at our regular lunches he would ooze pride in those two young women. About a day and a half before he died we spent an hour on the phone, 40 minutes of which was devoted to his two daughters and my two daughters. He and I were entirely different people, but we were cut from the same cloth when it came to our pride in our children.

Paul made me understand why humility is such an important virtue. He was a successful person who could have flaunted his success, but never did, not for a minute; it just wasn’t in his nature.

The workers’ compensation industry will find a replacement for Paul Meagher. I won’t.