By: Dennis M. Sponer, CEO, ScripNet, Inc. For Workers’ Compensation (WC) payers, whether private or public, carrier or self insured, make-buy decisions about Managed Care Organizations (MCOs), Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) are based on many factors. Professional reputation, timely and responsive customer service, and ultimately – how it improves patient… [Read more]
Leaders Speak
Jeffrey Miller: Compound Drugs in California: Panacea or Problem?
By: Jeffrey D. Miller Chief Operating Officer, Paladin Managed Care Services According to the California Workers’ Compensation Institute, California employers and insurers have seen a nearly 10% increase in payments for physician-prescribed compound drugs over the past three years, which has substantially increased the overall cost of medications provided as workers’ compensation benefits. This problem… [Read more]
Archie Anderson: Is the Insurance Sector Ready for Big Data?
By: Archie Anderson, President, Options & Choices, Inc. (OCI) We are beginning to hear more about “big data” and opportunities on the horizon with the use of big data. The possibilities make me wonder if the insurance sector – healthcare, property/casualty and other forms of benefits – are ready for the potential economic and competitive… [Read more]
Archie Anderson: The Problem with Absence
By: Archie Anderson, President, Options & Choices, Inc. (OCI) The problem with employee absence for employers is not that it occurs. Absences from the workplace will happen. Employees take well deserved, earned vacation and paid time off. Employees will get sick and miss time from work. Some employees will become injured on the job; some… [Read more]
Derrick Amato: Early Intervention: Not a Magic Bullet, But a Powerful Weapon Nonetheless
By: Derrick Amato, Vice President, Workers’ Compensation Sales & Strategy, MultiPlan Early intervention (EI) by definition has an expressed expectation that workers’ compensation cases be triaged as soon as possible for determination of the need for first aid, self treatment modalities, direction of care, case management and/or other special needs based on the complexity of… [Read more]
Derrick Amato: Investing in the Art of Claims Management
By: Derrick Amato, Vice President, Workers’ Compensation Sales & Strategy, MultiPlan Previous Leaders Speak segments have dealt with; RFPs, medical fee schedules, opiate influence on case costs and outcomes and varied definitions of evidence based medicine. Each of these topics is timely and from my point of view creates residual influential need for re-defining best… [Read more]
Emil J. Bravo: Unbundled Services – The Pros and Cons Part II
By: Emil J. Bravo Executive Vice President, Gallagher Bassett Services, Inc. This week we will explore those claims-related services that are most commonly considered for “bundled” and “unbundled” options. Claims Administration System The claims administration system is the most significant component that you should consider to purchase on a bundled basis from the Third-Party Administrator… [Read more]
Emil J. Bravo: Unbundled Services – The Pros and Cons
By: Emil J. Bravo, Executive Vice President, Gallagher Bassett Services, Inc. There are a number of things to consider when contemplating the structure of your workers’ compensation program, beginning with whether to transfer the risk (insurance) or retain the risk (self-insurance). Today’s marketplace offers a variety of competitive options, from a Guaranteed Cost (GC) program,… [Read more]
Dave North: Change is Coming – Change is Here
By: David A. North, President & CEO, Sedgwick Claims Management Services, Inc. Embrace change. It’s profound as both a personal and business philosophy. The reality is over half the states are currently debating workers’ compensation legislative reform and change is inevitable. Those organizations that recognize and prepare for change will thrive, and those who don’t… [Read more]
Dave North: Quality Healthcare Assumes Center Stage
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]