August 14, 2014


Are you feeling a little out of touch on your health policy wonkery over the summer? Wondering how things are progressing with ACA and other health policy issues? Catch up on your reading at Health Wonk Review: August Recess Edition. Brad Wright posts a substantive issue at Wright on Health - check it out!

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August 13, 2014


Summer reading! Here's a roundup of links to a variety of recent studies and reports that we find noteworthy - some that haven't received wide circulation.

Mathematica: Risk Factors Associated with Disability Following Work-Related Injuries (PDF)
Nan L. Maxwell and Nathan Wozny of Mathematica Policy Research have issued a study on work-related disability using a previously untapped database -- administrative data on claims filed under the Federal Employees' Compensation Act (FECA) -- to show how risk factors underlying disability following a work-related injury differ across groups defined by demographics, employment characteristics, and injury type (that is, injury or illness). Differences exist in three areas: the probability of incurring an injury, the probability of incurring a disability once an injury has occurred, and the size of the association between a risk factor and the probability of incurring a disability. This heterogeneity was previously undetected in narrower data sources and highlights the importance of tailoring efforts to identify and support individuals at - risk of disability to the population of interest.

NASI: State Policies on Provider Market Power (PDF)
The National Academy of Social Insurance (NASI) and Catalyst for Payment Reform (CPR) issued a comprehensive evaluation of state laws addressing the power of health care providers to negotiate higher prices, cataloging the laws and regulations state governments are using to maintain or increase competition in health care markets, which the recent wave of mergers among hospitals and other consolidation among providers has significantly reduced. See the press release for a summary.

Health Affairs: Price Transparency For MRIs Increased Use Of Less Costly Providers And Triggered Provider Competition
Covered by Sarah Kliff in Vox, When health care prices stop being hidden, and start getting real
"That lack of transparency in health prices partially explains why there is huge variation in what doctors charge for the exact same service. An appendectomy can cost anywhere between $15,000 and $186,000. Doctors don't usually feel the need to make their prices competitive when shoppers can't see them.
Over the past two years the Blue Cross and Blue Shield health plans have been running a quiet experiment, to see what would happen if prices became available in some cities but not others. And they found that just the act of making prices available can have a really dramatic impact on what they had to spend to get patients a very basic procedure."

AECOM: Alcohol Use Disorders Linked to Decreased 'Work Trajectory'
Workers with alcohol use disorders (AUDs) are more likely to have a flat or declining "work trajectory," reports a study in the July Journal of Occupational and Environmental Medicine, official publication of the American College of Occupational and Environmental Medicine (ACOEM).

The Influences of Obesity and Age on Functional Performance During Intermittent Upper Extremity Tasks
Journal of Occupational and Environmental Hygiene, Lora A. Cavuotoa* & Maury A. Nussbaumb. In this study, the main and interactive effects of obesity and age on functional performance were assessed during intermittent exertions involving the upper extremity.

Multiple jobholding in states in 2013
Monthly Labor Review presents data on the multiple-jobholding rate, or the percentage of individuals who hold more than one job, by state and region.

And two not-to-be missed reports we've previously noted:

NCCI: Workers Compensation Claim Frequency--2014 Update
According to preliminary estimates, workers compensation lost-time claim frequency declined by a relatively modest 2% in Accident Year 2013. The Great Recession of 2007-2009, which was the most serious and long lasting economic contraction since the Great Depression, had a considerable effect on claim frequency changes. Frequency increased in Accident Year 2010 and has declined in each subsequent accident year.

WCRI: 8 revealing state studies on workers compensation
WCRI has issued eight new state-specific studies identified new predictors of worker outcomes that can help public officials, payors, and health care providers improve the treatment and communication and injured worker receives after and injury - leading to better outcomes.
Bill Coffin looks at data and results of Phase 1, covering Indiana, Massachusetts, MIchigan, Minnesota, North Carolina, Pennsylvania, Virginia and Wisconsin.

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August 7, 2014


Catching up on our summer reading post vacation, we have a number of pointers to noteworthy news. First we note that according to a recent RIMS survey, the total cost of risk for businesses rose 2% in 2013. To segue on that, we turn to Cavalcade of Risk - a few of our friends have hosted recent issues: See The Italics and Dot-Dot-Dot Edition of the Cavalcade of Risk at Jaan Sidorov's The Population Health Blog, plus the prior edition Cavalcade of Risk #213 hosted by Jason Shafrin at Healthcare Economist, which kicks off with a great TED video clip on our relationship with fear from Sebastien Foucan.

,,, and here's more recent news in the world of workers comp

NCCI's Workers Compensation Claim Frequency--2014 Update - "According to preliminary estimates, workers compensation lost-time claim frequency declined by a relatively modest 2% in Accident Year 2013. The Great Recession of 2007-2009, which was the most serious and long lasting economic contraction since the Great Depression, had a considerable effect on claim frequency changes. Frequency increased in Accident Year 2010 and has declined in each subsequent accident year."

Frequency, high finance, and the future of work comp managed care - Joe Paduda talks about the impact of the drop in claim frequency on the work comp managed care industry: "Fewer claims = fewer services needed = fewer bills; less need for UR, case management, and related services." He discusses the likey impact, noting that, "Meanwhile the supplier market is consolidating, and managed care vendors are scrambling to capture enough of the shrinking market to survive the coming shakeout."

The Outsourcing Universe - For more on managed care, check out Peter Rousmanier's thoughtful column on specialized work comp services in Work Comp Central: "The workers' compensation insurer is for many the centerpiece of a mature industry. ...Within this industry, however, specialized services as an extension of claims management grew since 1990 from about $4 billion in total costs to about $18 billion today. This service universe expanded dramatically and changed repeatedly in products, organization, and leadership. Let's review this evolution and ask if two decades-plus of growth is coming toward an end."

8 revealing WCRI state studies on workers compensation - Bill Coffin of PropertyCasualty360 notes: "The studies measure five specific worker outcomes: recovery of physical health and functioning, return to work, earnings recovery, access to medical care, and satisfaction with medical care.
These metrics are measured to help public officials, payors and health care providers, among others, to identify how state-level systems are performing, and identifying where and what kinds improvements or reforms they might need."

Paying for Detox - At Risk & Insurance, Roberto Ceniceros notes that in response to the opioid crisis, workers comp payers are increasingly turning to detoxification programs and other multidisciplinary treatment modalities to address the problem. He discusses the opportunities and challenges in substance abuse treatment.

Zero PPE: The Future of Safety in Construction? - Scott Schneider of the The Laborers' Health and Safety Fund of North America issues a safety challenge. He notes that, "too often the first solution proposed to achieve this goal of zero injuries is to put all workers in personal protective equipment (PPE)" but wonders if the emphasis is misplaced: "Personal protective equipment is at the bottom of the hierarchy of controls for a reason."

Obamacare Update: On this topic, we follow Jonathon Cohn's writings, among others - here are two of this noteworthy recent articles: How Much Is Obamacare Raising Your Insurance Rate? Depends on Which State You Live In and Obamacare's Impact on the Uninsured, State by State.

News Briefs:

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July 17, 2014


Catch up on your Health Policy Wonkery for the summer - Jennifer Salopek has posted Health Wonk Review: Polar Vortex Edition at Wing Of Zock. It's a great edition and one of only two to be published during the abbreviated summer schedule, so get your wonk fix now!

Up? Down? Sideways? What's up with health care costs? - Joe Paduda: "First, let's not confuse "costs" with "insurance premiums". Unfortunately, many mass media outlets don't understand that insurance premiums are not costs...which certainly contributes to the confusion ... Second, let's not confuse "price" with "cost", as this report does."

NCCI data reveal need for new model for workers' comp claims management - "What's easy to notice and applaud is the industry's improvement. Not only is the 2013 workers' comp combined ratio of 101 far from the 2001 peak of 122, it is also a seven-point improvement over the previous year. However, the improvement represented in this data must be considered carefully, as the second, more telling story highlights a systemic problem the industry has yet to reconcile."

It's Just Work Comp - DePaolo: "...why is there so much controversy in workers' compensation?"

Can You Link Insurance Premiums To Smoking? - "Another recent study found that smokers missed an average of 6.16 days of work per year as opposed to the 3.86 days missed by non-smokers, and that a smoker taking four 10-minute smoke breaks actually worked one month less over the course of a year than a non-smoking employee. The Centers for Disease Control (CDC) estimate that each smoking employee costs a company an additional $3,391 per year - including $1,760 in lost productivity and $1,623 in excess medical expenses. So, smoking employees seem to be an excellent target to help an employer manage its costs, and not just the cost of providing healthcare."

CDC: Opioid Painkiller Prescribing Varies Widely Among States - "Health care providers wrote 259 million prescriptions for opioid painkillers in 2012 - many more in some states than in others - according to a Vital Signs report recently released by the Centers for Disease Control and Prevention that highlights the danger of overdose. The report also has an example of a state that reversed its overdose trend."

News Briefs

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LexisNexis Workers' Comp Law Center  LexisNexis Top 25 Blogs for Workers' Compensation and Workplace Issues – 2011 Honorees.  LexisNexis Top 25 Blogs for Workers' Compensation and Workplace Issues – 2012 Honorees. LexisNexis Top Blogs for Workers' Compensation and Workplace Issues – 2013 Honorees.
LexisNexis Workers' Comp Law Center Top Blog of the Year


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