Leaders Speak

By Dan Anders, Chief Compliance Officer, Tower MSA Partners If you ask the workers’ compensation payer community about the value of a Medicare-Set Aside or MSA, some might say, “An MSA is not valuable to us; it’s just something we have to do when we close a claim with a Medicare beneficiary.” Others see MSAs… [Read more]

By Dan Anders, Chief Compliance Officer, Tower MSA Partners Section 111 Mandatory Insurer Reporting is a Medicare compliance requirement that most employers and other workers’ compensation payers think someone is handling correctly for them. While there’s been talk about stiff penalties for quite some time, none have been assessed, so why worry? With a name… [Read more]

By Nikki Wilson, Pharm.D./MBA, Mitchell Are you aware of the top medications driving cost in your pharmacy program? Although every program is inherently different, a few key categories should be afforded extra scrutiny. These relatively low volume, high impact drug categories not only have an effect on spend, but also on claims outcomes, making them… [Read more]

By Brian Allen, VP of Government Affairs Three states recently joined the cohort that has pushed to legalize marijuana over the past decade: New York, New Mexico and Virginia. A third of the U.S. has now completely decriminalized marijuana and a majority of states have partially decriminalized the drug for medicinal use. What’s next for… [Read more]

By Melissa McGarry, Director, Product Implementation, Coventry The coronavirus pandemic has taught us much about disparities in health care. We know, more than ever, that access to robust care carries profound and, indeed, life-altering consequences. For years now, we’ve understood the same holds true for helping injured workers get back on the job: quality of… [Read more]

By Lori Daugherty, Chief Executive Officer at Integrated Medical Case Solutions (IMCS) Group We are learning that COVID-19 has the potential to invoke devastating and long-lasting symptoms on all its victims, regardless of age, underlying disease or symptom severity. Some COVID-19 patients, known as “long haulers,” suffer prolonged effects of the virus, despite having only… [Read more]

By Lori Daugherty, Chief Executive Officer at Integrated Medical Case Solutions (IMCS) Group As the COVID-19 pandemic enters its second year, experts warn that even when this disease crisis has passed, the behavioral health ripple will linger far longer– maybe a decade. Why? Rapid lifestyle change, residual after-effects of the disease itself, stress from a… [Read more]

Dr. Michael Lacroix, Medical Director, The Hartford In our previous article, we reviewed The Hartford’s Mental / Behavioral Health (BH) Group Benefits (GB) Short-Term Disability (STD) claims from 2015-2018 and compared them with BH claims from The Hartford’s California WC business for the same time period. To recap: (1) in both cases, primary BH claims… [Read more]

Dr. Michael Lacroix, Medical Director, The Hartford The twin scourges of the opioid crisis and the COVID-19 pandemic have caused many in Workers’ Compensation (WC) and Disability management communities to think more broadly about the various factors that impact both impairment and return to work (RTW). Mental health and illness are getting significant attention, with… [Read more]

By Donna Bradshaw, Vice President, IME Services, Genex Services Though the COVID-19 pandemic has presented many challenges, workers’ compensation (WC) programs have continued to push claims forward – often with the assistance of independent medical examinations (IMEs) to help make determinations on claims, medical, and return-to-work (RTW) concerns. The objectives of an IME have remained… [Read more]