A fresh Health Wonk Review for your perusal

May 18th, 2017 by Julie Ferguson

Jason Shafrin, our favorite Healthcare Economist, has posted a fresh collection of health policy punditry, the “I will build a great Health Wonk Review . . . and nobody builds Health Wonk Reviews better than me, believe me”  edition. Want the scoop on AHCA, national drug policy, pharma, bundled payments or other current topics in the policy arena? Check out this post. If you don’t follow the health arena on a daily basis, Heath Wonk Review is a great way to keep up with the important news.

If you are feeling particularly wonky or would like to follow back issues, got to Health Wonk Review’s home page.

 

Workers’ Compensation Performance Measurement: Keep The Bull’s Eye Simple

May 17th, 2017 by Tom Lynch

For the last decade, injury frequency has been trending steadily lower. There are a number of reasons for this: automation, loss of manufacturing jobs, better safety engineering, etc. Injury severity, however, has not followed suit despite technological gains in claim administration and medical management and an ever so slow move to the use of predictive analytics.

This creates challenges for employers, especially of the small and middle market variety, and, to a certain degree, even for a few national, enterprise accounts who find themselves pretty much where they were ten years ago in terms of style and policy with respect to workers’ compensation. One reason for this is the deep rooted legacy mentality and resistance to change of many insurers and Third Party Administrators. In many ways, these organizations remind me of flies circling around a light in a lampshade, mistaking movement for progress.

However, employers still foot the bill and are still in command. Keeping in mind that the workplace is the best place to control workers’ compensation costs, employers still need to build and maintain solid programs to prevent and contain loss. Case in point is Bob Oberosler, Vice President of Loss Prevention for Rite Aid, a national pharmacy chain. At the New Jersey Self Insurers Association’s Annual Meeting a couple of weeks ago, he described his company’s work to craft a forward thinking loss prevention and workers’ compensation management program and communicate it to employees who are far and wide, indeed. But before that could happen, Mr. Oberosler said, he faced an even more daunting task – getting management’s commitment and buy-in to the effort. The good news is this happened and Rite Aid has been enjoying some spectacular results because of it.

This got me thinking. In order to sustain C-Suite commitment, a risk manager, or Loss Prevention VP, such as Bob Oberosler, needs to provide the Leadership team a steady, easily understandable Performance Measurement Results Dashboard. So, what should be the characteristics of such a Dashboard?

Performance measurement should have four characteristics: It should be simple, it should be meaningful, it should be consistent and it should be continuous.

By simple, I mean easily and quickly understood by senior management. Meaningful means that it should sit in senior management’s sweet spot; it should be something that is anticipated and valued by leaders. It should be consistent, because those leaders, once trained to view performance in one way, do not appreciate abrupt course changes. And to be effective over the long term, it has to be a continuous and routine process. The mantra should be: What is consistently well-measured is highly valued.

With this framework in mind, I usually recommend that monthly or quarterly reports to senior management measure two things religiously: Incurred losses per full time equivalent employee (and this should be done by department, division and company) and incurred losses per every hundred dollars of payroll (again, split out by department, division and company). Before any measurement occurs, however, management should settle on targets, which should be a bit of a stretch, but attainable. And target selections should be set against actual performance in the prior three or four years. For instance, if costs per FTE have been in the $200 to $300 range in the last few years, a good target would be a reduction of 30% to 40% in the current year.

Senior managers have finite attention spans. Therefore, workers’ compensation performance measurement should fit on one page, a Scorecard that senior management can assimilate in no more than a few minutes. If the information is pithy enough, that’s as long as it should take, but it should also lead to fruitful discussion about management actions to enhance performance, discussion that comes out of knowledge.

There are many other solid and valuable workers’ compensation metrics, but, in Lynch Ryan’s experience, these two are the ones that senior managers appreciate the most.

All of this assumes, of course, that, as at Rite Aid,  a serious and ongoing safety, workers’ compensation and injury management program is humming along and that all parts of the organization have been trained in how to keep it that way.

Reactions To “Pharma’s Nine Words”

May 15th, 2017 by Tom Lynch

We received a lot of thoughtful feedback to last week’s post on drug company Direct To Consumer (DTC) television advertising. I thought I’d share a couple that are representative of the whole.

This from a doctor in Florida:

You have acutely illustrated the challenge that allopathic physicians now battle with every day. In short, big Pharma has found a way to circumnavigate the drug salesperson and physician and go directly to the end consumer
Every physician feels significant pressure to satisfy their patients even when the request for certain pharmaceuticals is unreasonable; if the patient walks out of your office empty-handed chances are they won’t come back, so at the very least most patients have some prescription in hand upon their exit.

And this from a C-Suite Chief of Marketing:

I must confess upfront that I was one of those “DTC advertisers” in the early 2000s, having worked with Eli Lilly, Boehringer Ingelheim and Pfizer to name a few former clients.

Over the years I’ve read conflicting studies on DTC’s effectiveness and impact.  This said, there is typically a relationship between the largest category spender and market share.

You may also be interested in a dated survey from the FDA on the subject.  While there are definitely some “pro’s” associated with these efforts, including but not limited to patient empowerment (more prepared for doctor’s appointment, asking thoughtful questions, generally being more involved in one’s health, and better conversations about one’s condition and possible treatments). But there are also some “con’s,” including but not limited to:  overpromises/over statements of a drug’s potential benefits (and a corresponding downplay of possible side effects); pressure on physician’s part to prescribe a patient-requested drug, among others.  (But let’s not forget that there were physicians who were also in pharma’s pockets long before DTC, prescribing certain drugs based on lucrative relationships with companies.  Certainly not all of them… but unfortunately there were – and likely still are – some “bad apples.”)

It will be interesting to see how this debate evolves as baby boomers age.  Let’s hope that the patient is the ultimate winner here!

We can all agree with that last bit about hoping the “patient is the ultimate winner.”

We welcome responsible, thoughtful comments from our readers.

 

 

Pharma’s Nine Words

May 11th, 2017 by Tom Lynch

Any idea what the nine most frequently spoken words on US television are? How about:

My doctor said…

Tell your doctor…

Ask your doctor…

These words come at the beginning, “My doctor said,” the middle, “Tell your doctor,” and the end, “Ask your doctor,” of Direct To Consumer (DTC) television advertising with which Big Pharma bombards Americans every day. This is especially true during the morning network shows between 7:00 and 9:00 AM, the evening news hours and the occasionally funny prime time sitcoms that follow. The ads also feature a swell story with great looking actors and sweet music that plays as someone doing a voiceover tells us all about the 25, or so, ways the drug being pushed can kill us.

DTC ads come in many forms, but in 2015  69% of them were television ads with about a third of those coming from Pfizer. These ads have been allowed since the mid-1980s, but gained momentum in 1997 when the FDA relaxed the rules regarding television. Since then, it’s been Katy bar the door.

According to Pharmacy and Therapeutics (P&T), a peer reviewed journal for managed care and hospital formulary management:

The average American television viewer watches as many as nine drug ads a day, totaling 16 hours per year, which far exceeds the amount of time the average individual spends with a primary care physician.5,23,27

Since beginning the recovery from the Great Recession, television DTC has seen staggering growth:

 

 

According to Kantar Media, 72% of the commercial breaks in the CBS Evening News now have at least one pharmaceutical ad in them. These ads have a specific demographic target: Baby Boomers. Until 2012, they were mainly aimed at conditions such as dry eyes, erectile dysfunction, smoking cessation, chronic pain, constipation, heartburn, allergies and cholesterol. But in the last five years, they’ve made a deep dive into cancer, rheumatoid arthritis, and other illnesses to seniors. And, a reflection of our time, Opioid Induced Constipation hit the field during the 2015 Super Bowl. I can still hear the collective national gasp from that one.

Kantar Media reports Pharma spent $6.4 billion on DTC in 2016, with television garnering more than two-thirds of the spend. Since 2012, television spending is up 62%. During that time, the number of drug companies annually spending more than $50 million and the number spending more than $100 million has doubled. For example, last year, makers of Viagra and Cialis spent a combined $306 million convincing older (and increasingly younger) men that without those magic little pills their once prodigious sexual prowess, rapidly approaching Wooly Mammoth-like extinction, will never rise again, literally (but watch out for that 4-hour thing).

And when a new drug hits the market, first year spending can be breathtaking. Consider Opdivo, which debuted in 2015. The drug treats a certain kind of end-stage lung cancer (non-small cell lung cancer), which has a US patient population of less than 200,000. Yet Bristol-Myers Squibb, Opdivo’s maker, spent $93 million marketing it in its first year.

All this money begs an obvious question: Does it work? Well, even Pharma’s not sure, saying ROI is only one measure of a brand’s marketing success. Who is sure? The American Medical Association, which, in 2015, saying it was a colossal waste of money, called for an “outright ban” on Direct To Consumer advertising. The AMA also said doctors felt pressured by vulnerable patients who were looking for relief from one thing or another and that older drugs often work just as well, or even better, than the newer high-priced brands. Of course, it is preposterous to think we’ll ever return to to good old days of the 1980s before DTC advertising became more than a gleam in a marketer’s eye. The drug lobby is nearly omnipotent and there is the  little matter of commercial free speech. Moreover, drug makers claim they are providing valuable information with which consumers can make informed choices. Yet, according to the World Health Organization, “DTC is used to drive choice, not to inform it.”

America is one of only two countries in the world that allow Direct To Consumer drug advertising, the other being New Zealand, a country with a population of less than 4 million. The medical community doesn’t like it there, either.

Pharma has long had a wish to bring DTC to the European Union. That’s not going to be happening, however, as last year 22 of the 27 members rejected the idea.

The P&T white paper, mentioned above is presents an excellent analysis of DTC advertising, and ProCon.org has a nifty for-and-against page regarding DTC advertising. They’re both worth a look.

Health Wonk Review: the Groundhog Zombie Goes Back to the Future Edition

May 4th, 2017 by Julie Ferguson

 

It’s quite the day to be going to press with a new Health Wonk Review. We were trying to think of  a movie themed metaphor for today’s edition but can’t decide between Back to the Future, Groundhog Day or a zombie flick, so we’re going for a mashup.   Suspense is in the air as we await a vote later today on the revised AHCA. Or at least that’s what the media has been predicting as the bill suddenly sprang back to life late  yesterday after some arm twisting and deal sweetening in the corridors of power. One wonders what the hurry is since the Congressional Budget Office has not had sufficient time to weigh in and a quick vote would seem to violate the pledge of a minimum three-day public review. But maybe avoiding those pesky details are are seen as features not bugs. Our wonks submitted posts from the past week, so most were submitted before yesterday’s frantic hubbub of activity, yet still make trenchant observations about the revised bill. And of course, even though this topic is currently dominating the news, many of our wonks have healthcare observations on topics other than repeal-and-replace so if you are tired of the ongoing legislative goings on, read on.

Joe Paduda has kept an eye on the repeal & replace movement with his series of posts on the ACA deathwatch at Managed Care Matters. In his most recent post, he talks about flaws that plague the current bill and why it is destined to fail: ACA Deathwatch: No, AHCA is not going to pass Congress

At healthinsurance.org blog, Harold Pollack warns us to get ready for the uncomfortable questions with AHCA. Currently, an estimated 27 percent of American adults have been diagnosed with declineable preexisting conditions. Rollback of protections for those with pre-existing conditions means health insurers will again be rummaging through your health history.

Think the $8 billion that the revised AHCA bill earmarks for preexisting conditions solves that problem? Timothy Jost explains why that is unlikely at Health Affairs Blog.

One drum that Roy Poses of Health Care Renewal continues to beat (thankfully) is pointing out how health care organizations are increasingly run by a network of insiders who often put self-interest ahead of patients’ and the public’s health. As we head into today’s vote, he points out another vivid example: How Legislators rigged the repeal of the ACA to keep their own health insurance affordable.

Vincent Grippi points us to a post by Care Centrix CEO John Driscoll at The Homefront blog examining the recent struggle of the American Healthcare Act and highlighting why value-based care is an important part of the solution in his post Coal Mining Isn’t Coming Back and Neither is Fee-for-Service Medicine. It makes great points in light of recent congressional goings on.

Louise Norris of Colorado Health Insurance Insider looks at what’s next in Colorado for health care reform noting that, lately, it’s been a whirlwind. A bill to help out people over 400% of FPL just failed, disappointing many; there is uncertainty about Anthem BCBS staying in the exchange; insurers don’t have an exit clause if Cost Sharing Reduction funding is eliminated; rates will be filed late this year due to market uncertainty, and there is a bill to eliminate the exchange still in progress.

InsureBlog‘s Bob vineyard highlights the financial challenges of actually *paying* for even minor health care in his post Buddy, Can You Spare a Dime?

It’s tough being a cancer patient. New urgent care clinics designed specifically for cancer patients help ease the burden and could be a model for the rest of healthcare. David Williams of Health Business Blog talks about what distinguishes these clinics and wonders why such services aren’t available to all healthcare consumers.

Brad Flansbaum of The Hospital Leader has a challenge to physicians: How often do you ask this (ineffective) question? A recent study calls into question the effectiveness of a widely accepted practice.

Healthcare Economist Jason Shafrin looks at the hedonistic treadmill and asks if it works in reverse when it comes to acclimating to deteriorating health conditions. (Don’t know what the hedonistic treadmill is? We sure didn’t but it is our nomination for concept of the day). He cites an recent study on the topic.

Here at Workers Comp Insider, we recently commemorated Workers Memorial Day, a time remember those who were hurt or killed on the job. In conjunctions with that event, the National Council for Occupational Safety and Health issued The Dirty Dozen, highlighting employers who put workers and communities at risk due to unsafe working conditions.

Next up to bat: May 18, 2017 – Jason Shafrin – Healthcare Economist.

April 28: Workers Memorial Day

April 28th, 2017 by Julie Ferguson

Every April 28 is dedicated to Workers Memorial Day, when working people throughout the world remember those who were hurt or killed on the job. It’s also a time to recommit to and renew the quest for safe workplaces. The following are some resources that list events and offer information that you can use to raise awareness.

Workers’ Memorial Day 2017 Events Also, see OSHA’s event calendar.

More news and events at 28april.org

Facebook

Twitter at #wmd17

The Weekly Toll: Death in the Workplace

Death on the Job: The Toll of Neglect, 2017
This is the 26th year the AFL-CIO has produced an annual report on the state of safety and health protections for America’s workers.

The Dirty Dozen: National COSH Releases Report on Companies That Put Workers at Risk
In his post at Confined Space, Jordan Barab links to the report and says:

“Just in time for Workers Memorial Day, the National Council for Occupational Safety and Health (National COSH) has announced “The Dirty Dozen” employers of 2017, highlighting companies that put workers and communities at risk due to unsafe working conditions. National COSH chooses the “Dirty Dozen” by soliciting nominations from health and safety activists around the country.”

More on the history at Wikipedia: Workers Memorial Day

Fresh Health Wonk Review and other noteworthy news

April 20th, 2017 by Julie Ferguson

It’s Health Wonk Review week and Brad Wright has a fresh, newsy, engaging issue posted over at Wright on Health, the Health Wonk Review: Who’s On First? Edition.

He grapples with health reform, alternative facts, and many other topics. To stay in the know in this dynamic climate, HWR is a great way to stay current on the changing landscape.

 

Here are a few other news items we’ve noted this week: 

In the “in case you missed it” department:

Quick takes

Worker Memorial Day and a voice for the workers

April 19th, 2017 by Julie Ferguson

April 28 is Workers’ Memorial Day, a time when workers and their families, labor unions and safety advocates commemorate workers who were killed on the job: 4,800 fatalities per year, or an average of 13 workers who lose their lives every day. The AFL-CIO dedicated the first Worker Memorial Day in 1970 as a day of remembrance for those who have been killed or suffered injuries/illnesses on the job. It also sheds light on the preventable nature of most workplace incidents with its theme of Remember the dead – Fight for the living.

When it comes to work fatalities, numbers don’t tell the whole story. Jordan Barab of the newly resurfaced Confined Space blog profiles some of these deaths in his Weekly Toll. It’s tough but important reading. Those of us who work in insurance can be focused on dollar and cents and lose touch with the real reason many of us entered the workers’ comp arena. And even the most dedicated number-crunchers among us see the wisdom that the least expensive claims are the ones that never happen.

Jordan’s blog focuses mainly on policy and political issues around worker safety, but he explains why he decided to pick up the grim task of compiling this list:

But ultimately, we’re only fighting the policy and political issues because working people are getting hurt and killed every day in the workplace, and more has to be done to stop the carnage. Today I resume a necessary — if depressing — task that I conducted every couple of weeks in the last version of Confined Space: The Weekly Toll, a list of every worker I could find that was killed in the workplace over the previous week or two. The main reason I started the original version of Confined Space in 2003 was that I realized that while a few workers killed in workplace incidents sometimes receive enormous media attention, most workers die alone and unnoticed by anyone except their immediate families and friends. Something had to be done to ensure that these thousands aren’t dying in vain.

Jordan has been a tireless voice for worker safety throughout his career. He was Deputy Assistant Secretary of Labor at OSHA from 2009 to 2017. Prior to that, he worked for the House Education and Labor Committee, the Chemical Safety Board, the AFL-CIO, OSHA and AFSCME. His Confined Space blog was one of the early blogs that inspired us as we launched Workers Comp Insider. He put his blog on ice while working for OSHA, but he has recently relaunched it and is an important voice in looking to the health and safety of workers – particularly in an administration that has pledged to cut regulations and funding for many programs.

We have talked about and are concerned about the defunding and elimination of the Chemical Safety Board. The administration has also rolled back some important albeit controversial OSHA regulations and it is expected that OSHA will suffer further curtailment. Scott Schneider looks at some of the programs that are at risk and why they are important in OSHA Regulations: The Next Target

The President asked businesses and industries for advice on which regulations should be cut and he received 168 submissions from corporations and industry special interest groups.  Unfortunately, eliminating many of these are likely to have a corrosive effect on worker health and safety. Meanwhile, for the voice and interests of the worker and worker safety, Confined Space is an important read.

Freshly posted Health Wonk Review at InsureBlog

April 7th, 2017 by Julie Ferguson

Start your Friday with your morning beverage of choice and a fresh edition of Heath Wonk Review. Over at InsureBlog, Hank Stern has posted the Health Wonk Review: Pre-Passover edition. In his Twitter promo for this edition, he promises “Everything from horseradish to opioids” – you are probably not going to find too many insurance-related posts quite that eclectic!

In addition to wonks weighing in on RyanCare and the future of the ACA, other topics include opioids, physician burnout, the physician mission, price transparency, “the coding swindle” and more. Check it out!

We bring one post in particular to your attention – a post by HWR regular Brad Wright at his Wright on Health blog. He relates an up-close-and-personal encounter with the health care system, and reflects on his experience in the larger context of healthcare availability and accessibility.  Wonkery is all well and fine, but there is nothing quite like a personal testimonial to make a powerful impact. (Wishing you the best as you recover, Brad!)

 

 

The Psychosocial Buzz Is Getting Louder

March 24th, 2017 by Tom Lynch

“We know the single greatest roadblock to timely work injury recovery and controlling claim costs. And it’s not overpriced care, or doubtful medical provider quality, or even litigation. It is the negative impact of personal expectations, behaviors, and predicaments that can come with the injured worker or can grow out of work injury.

This suite of roadblocks is classified as “psychosocial” issues – issues which claims leaders now rank as the number one barrier to successful claim outcomes according to the Workers’ Compensation Benchmarking Study’s 2016 survey – and they drive up claim costs far more than catastrophic injuries, mostly due to delayed recovery.”

That’s the beginning of a new White Paper authored by friend and colleague Peter Rousmaniere and Rising Medical Solution’s Rachel Fikes. The Paper, How to Overcome Psychosocial Roadblocks: Claims Advocacy’s Biggest Opportunity, reports on Rising’s 2016 Benchmarking Survey and describes how the workers’ compensation claims management community is ever so slowly coming to realize the leading cause of delayed recovery for America’s injured workers is psychosocial in nature and that efforts to deal with this have, up to now, been woefully inadequate.

Rousmaniere and Fikes point to enlightened employers and insurers who are leading their companies to a greater acceptance of the need for competent, professional intervention to help injured workers overcome mental and emotional barriers delaying their return to employment.

They cite the work of Denise Algire, Director of Risk Initiatives and National Medical Director for Albertson Companies, a grocery chain with more than 285,000 employees. They also report on efforts by The Hartford, Nationwide Insurance and CNA.

All of the progressive actions undertaken by these organizations have one thing in common: the development of an empathic interview methodology devoted to understanding the “whole person” to discover which claims will need more intensive and specialized intervention.

At the Albertson Companies, Ms. Algire espouses the Advocacy-based model of claim management. This model emphasizes building a conversational and trust-based relationship with an injured worker through organic dialogue. She has introduced a modified Linton tool for screening injured workers for psychosocial comorbidities and has contracted with an external telephonic triage firm to conduct initial screenings.

At The Hartford, Medical Director Marco Iglesias reports 10% of claims fall into the psychosocial bucket with at least one psychosocial comorbidity, but they consume 60% of total incurred costs. He says adjusters now ask each injured worker an important question: “When do you expect to return to work?” The Hartford’s analytics indicate any answer longer than ten days is a red flag for the future.

Nationwide Insurance, under the direction of Trecia Sigle, VP of Workers’ Compensation Claims, is building a specialized team to address psychosocial roadblocks. Nationwide’s intake process will consist of a combination of manual scoring and predictive modeling, and then adjusters will refer red-flagged workers to specialists with the “right skill set.”

Pamela Highsmith-Johnson, national director of case management at CNA, says the insurer introduced a “Trusted Advisor” training program for all employees who come into contact with injured workers. CNA’s Knowledge and Learning Group helped develop the training with internal claims and nursing staff.

This White Paper adds to the now undeniable research indicating the psychosocial problem is the biggest one facing the workers’ compensation claims community today. The leading experts agree that empathy, soft talk and the advocacy-based claims model is the method of choice for helping injured workers whose claims carry a psychosocial dimension. The experts cited in the White Paper all agree that adjusters will require extensive and repetitive training to learn the new techniques.

However, all of this is a heavy lift for an adjuster community overburdened and overwhelmed with work, a group for which the average lost time claim load is often north of 150. Even with better training, they can’t do it alone. To really turn the psychosocial tide will require a well-rounded team of claims adjusters, nurses, case managers and external, well-trained clinicians working together with transparent, technologically advanced communication.

The missing links thus far are those well-trained clinicians and the advanced communication. Without these two components, the adjuster community will be sore-pressed to achieve meaningful results.