Leaders Speak

By: David A. North, President & CEO, Sedgwick Claims Management Services, Inc. A shift in current thinking is beginning to emerge when it comes to the treatment of injured workers. We have become an industry focused on delivering managed care rather than health care, and change is inevitable. Less emphasis should be placed on negotiating… [Read more]

By Dr. Steven Feinberg, CMO, American Pain Solutions (APS) and Dr. Melvin Belsky, CCO, APS & Medical Director, Corporate WC, Safeway, Inc. Remarkably, there is an evidenced-based alternative to out of control and unnecessary medical and indemnity costs where the injured worker’s functional recovery is delayed. Its implementation on a larger scale requires a paradigm… [Read more]

By Dr. Steven Feinberg, CMO, American Pain Solutions Many physicians do not fully understand the proper role of opioids in the treatment of injured workers and they do not understand the importance of a biopsychosocial, whole-person approach as promoted in the evidence-based and presumptively correct California DWC Medical Treatment Utilization Schedule (MTUS) Chronic Pain Medical… [Read more]

By Jeffrey D. Miller, Chief Operating Officer, Paladin Managed Care Services Healthcare reform as passed in President Obama’s “Patient Protection and Affordable Care Act” is a reality and will be with us in some form into the future. Opinions vary widely on the merits, drawbacks, and implications of this new law, and your particular assessment… [Read more]

By: Kent Spafford, Chairman of the Board, One Call Medical Since my first column, “Embracing Quality,” I have received a significant number of responses from readers who agree that price can no longer be the sole criterion by which they make their service-buying decisions, and quality has become increasingly more important to an overall cost-effective… [Read more]

By: Kent Spafford, Chairman of the Board, One Call Medical Having been engaged in workers’ compensation for many years, it’s been interesting to monitor industry trends over time. Since September 2009 and over the last 18 months, there has been considerable movement to embrace “quality” and the impact it has on overall claims costs and… [Read more]

By: Shelley Boyce, CEO, MedRisk Workers’ Compensation managed care has come a long way since its emergence in the mid-1990’s. When it first arrived on the scene, managed workers’ comp looked a lot like group health – big generalist discounted networks – with discounts below state fee schedules instead of discounts below billed charges. As… [Read more]

By: Shelley Boyce, CEO, MedRisk Evidence-based medicine is now widely accepted in workers’ compensation and guidelines are proliferating. New York State recently implemented guidelines addressing lower back, neck, shoulder, and knee conditions and is working on a fifth guideline on carpal tunnel. I applaud this and other states’ efforts to go far beyond simply authorizing… [Read more]

By Joe Paduda, Author, Managed Care Matters Last week’s piece detailed the problems inherent in the RFP process; lots of vendors doing lots of work answering lots of questions in an attempt to win business where only one will succeed. Decisions delayed, decisions deferred, decisions never made. Potential vendors answering formulaic questions with pat answers,… [Read more]

By Joe Paduda, Author, Managed Care Matters Workers comp payers – TPAs, employers and insurance companies – buy lots of services from many different vendors. Some are ‘purchased’ by adjusters and case managers on a claim-by-claim basis, but most payers use the formal ‘request for proposal’ process when big dollars are at stake. Vendors of… [Read more]