Archive for March, 2018

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

Thursday, March 22nd, 2018

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

Thursday, March 22nd, 2018

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

Thursday, March 22nd, 2018

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

Monday, March 19th, 2018

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

Friday, March 16th, 2018

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.