Erosion of the California Work Comp Reforms & MPN

Recently, we were researching the likely impact of an MPN (Medical Provider Network) implementation for a client in California.  The data can vary dramatically depending upon the client and region of the state.

The California Workers' Compensation Institute (CWCI) issued a Research Report in early June regarding the impact of physician networks in California Workers' Comp. In the report, one thing jumped out even more than the MPN data.  The recent reforms California has made are not working.  The workers’ compensation system is eroding badly.


ER Visits Rise Under the ACA

One of the main selling points of the Affordable Care Act (ACA) was the contention that it would reduce the number of people going to the emergency room (ER) for non-emergency services.  When a patient does not have health insurance, these costs are often subsidized by taxpayers.  And even when there is insurance coverage, an ER visit is much more expensive (by 5-10 times) than a doctor’s office or walk-in clinic visit.

After the ACA’s first two years, it appears that the law has had the opposite impact on patient behavior—and ER visits are increasing. A lot.


The Joy of Hitting the Numbers

I just started ANOTHER weight loss regimen.

It is tough for me. My lifestyle is inconsistent. I eat out and entertain A LOT. Last week, I had dinners planned for six nights in a row, not to mention business lunches. It takes a toll on the body. Still, I go up and down, and I need to figure out a way to maintain the same weight. I have young kids. I want to be around to know my grandchildren.


If You Can't Beat Them, Buy Them: Why Some Drug Costs Are Going Up

I have done some analysis on pharmacy costs for clients recently. During that time, I noticed an increase in the cost per prescription for some drugs. Our pharmacy partners have shown the same trend in their data. This upsurge made no sense to me.


When Yelp Reviews are Better than Hospital Rating Systems

Here is my latest Risk & Insurance article that blog readers may find interesting. In it, I share some thoughts on the problems with Hospital Rating Systems and how employers and payers can get to meaningful provider quality measures: When Yelp Reviews are Better than Hospital Rating Systems

Read more at Risk & Insurance »


A Few More Observations on the ProPublica/NPR Debate

Last week, I shared my thoughts on the hot debate ignited by the recent ProPublica/NPR series, “The Demolition of Workers’ Compensation.” While I focused on “big-picture” questions that we must ask ourselves as we examine the points raised, I did want to follow up with some additional commentary. The authors took on some important issues in their articles, but I must take issue with a number of the assumptions and conclusions they made in the process.


Workers' Comp: Like a Nasty Divorce

Here is my latest Risk & Insurance article that blog readers may find interesting. In it, I share some views on the ProPublica/NPR series on "The Demolition of Workers' Comp" and the ensuing industry debate: Workers’ Comp: Like a Nasty Divorce

Read more at Risk & Insurance »


Whether You Believe You Can or You Can't — You Are Right

The other day on the drive home, Mike Ditka was being interviewed on the radio. He had some good quotes. Commenting on teams or players, he quoted Henry Ford and said, “If you believe you can do something or you can’t do something, you are right.”


Leadership Navigation: Resourcefulness vs. Process

I recently went on a long boat ride to the middle of nowhere. The ship was very well run. Because of the tight space, everything had a clear place. Everyone knew their jobs well. Whether pulling into port or fishing, the crew all knew what had to be done to run the process. They fixed broken items. They cleaned, maintained, and kept the ship organized. They prevented and prepared for any future potential issues.


Attitude—It Affects Surgery Outcomes

A recent Mayo study reinforces what we have always believed.  A person's attitude and happiness really affect how quickly they recover.