Leaders Speak

As a physician and claims professional, I have had the privilege of helping individuals and populations lead fulfilling lives at their job, society and home. Work is valuable, whether it occurs in an occupational, civic or domestic domain. On the other hand, worklessness can be deleterious to an individual’s health and wellbeing, as well as contributing to…[Continue Reading]

The anywhere, anytime promise of telemedicine is helping propel its growth in group health. Now, that same shiny prospect of unprecedented flexibility is drawing attention in workers’ compensation as a means of meeting the unique challenges facing injured workers. In our last installment, we defined telemedicine and telehealth as connecting a patient with a health…[Continue Reading]

For many consumers, living the good life increasingly means living the on-demand life. We can do our banking or order up a car service in seconds with only our phones. Two-day delivery for goods, once the exception, is now commonplace. Music, books, and movies appear for our entertainment in an instant — no wait required. Simply put, speed equals success…[Continue Reading]

The movement towards value-based care has been front-and-center in healthcare for the last several years. But while we can all agree that focusing care on patient outcomes is mutually beneficial to a number of healthcare stakeholders, moving from a fee-for-service to a fee-for-value system has been a challenging road. In workers’ compensation, we’ve barely begun…[Continue Reading]

I recently shared an article discussing the fact that the workers’ compensation system is not functioning as designed, with some key data points that show just how badly the industry is missing the mark with it comes to litigation. In a nutshell, workers’ comp was created to reduce the need for litigation, and yet it has become a highly litigious market. This translates to enormous…[Continue Reading]

Workers’ compensation was designed to reduce litigation by trading out the employee’s right to sue his or her employer for negligence in exchange for limited guarantee of care and compensation. This exclusive remedy “bargain” was the justification for why the system was first created a little more than 100 years ago. If we look at intent and where we are today…[Continue Reading]

The workers’ compensation system has, for the most part, functioned successfully for more than 100 years. There are certainly controversies but the vast majority of injured workers get the medical treatment and the dollars they need to heal and return to productivity. But there is another segment of injured workers with quite different stories to tell. These are the injured workers who…[Continue Reading]

Legacy cases may be the bane of your existence. You might have a case in particular where you know the injured worker is frustrated with the workers’ compensation system — the scrutiny, the providers, the delays, the denials — and yet he shows no interest in settling. You know because the adjuster asks him every few months. And yet, his claim continues for years…[Continue Reading]

Is it possible to forecast Medicare Set Asides using data analytics? How does an analytics approach compare to conventional methods? And what is the value proposition for making the switch? These are great questions that we will attempt to address in this article, as well as our case for the use of data analytics to forecast Medicare Set Asides. The foundation for this report begins…[Continue Reading]

Last year we addressed the results of our non-group health payer survey findings regarding Medicare Secondary Payer (MSP) compliance programs. MSP compliance is excessively costly not only due to the added costs of compliance to a claim settlement, but additional costs are incurred due to delays in claim settlements and litigation. We proposed that…[Continue Reading]