Leaders Speak

By Nikki Wilson, Pharm.D./MBA, Director, Clinical Products, Mitchell Pharmacy Solutions Each day, we hear more heartbreaking accounts of individuals and families impacted by the opioid epidemic. To address this crisis, more aggressive clinical intervention and opioid management programs are being adopted, and opioid use has steadily decreased for workers’ compensation patients. However, according to an… [Read more]

By Joe Paduda, Principal, Health Strategy Associates After last week’s column on electronic payments, I heard from several colleagues in the work comp claims business, all chiding me for my lack of enthusiasm about implementing e-payments for everyone. Their argument came down to “if we’re going to do this, we should go all in…because…efficiency!” Two… [Read more]

By Joe Paduda, Principal, Health Strategy Associates The workers’ comp industry is highly mature with way more capacity than needed. Premiums are declining, shrinking administrative budgets. Front-line staff are getting older, more expensive, and much more mobile. Every insurer and TPA has lots of open adjusting slots – and little chance of filling them. Meanwhile… [Read more]

By Daniel Anders, Esq., MSCC, CMSP, Chief Compliance Officer, Tower MSA Partners Whether they realize it or not, workers’ compensation, no fault, and liability payers can now access data about a Medicare beneficiary claimants’ enrollment in Part C Medicare Advantage and Part D Prescription Drug Plans. The Provide Accurate Information Directly (PAID) Act, effective December 11, 2021,… [Read more]

By Daniel Anders, Esq., MSCC, CMSP, Chief Compliance Officer, Tower MSA Partners The past several years have seen much debate in the workers’ compensation community around whether settling parties should or should not seek approval of a Medicare Set-Aside from the Centers for Medicare and Medicaid Services. One question was would CMS recognize a non-submit or evidence-based… [Read more]

By Kathy Tazic, Managing Director, Client Services, Sedgwick The COVID era of the past two years has shined a bright light on our collective dependence on technology. No matter where we are, all of us want to be able to do many activities of our daily lives from any connected device. The same holds true… [Read more]

By Kathy Tazic, Managing Director, Client Services, Sedgwick  Every day, workers’ compensation professionals interact with people who have had something unexpected happen to them at work — a slip and fall, a violent trauma, musculoskeletal damage, exposure to a harmful disease or toxin. That illness or injury becomes a claim that must be handled in accordance… [Read more]

Brian Peers, DPT, MBA, Vice President, Clinical Services and Provider Management, MedRisk When you think about major health conditions affecting society, what comes to mind first? Cancer, diabetes, and heart disease all dominate the collective conversation, and rightfully so. They impact millions of people across the globe and have their own societies, awareness months, cereal… [Read more]

Brian Peers, DPT, MBA, Vice President, Clinical Services and Provider Management, MedRisk Acute pain has a purpose, chronic pain, not so much. People feel pain when the brain receives a signal that a disease or injury threatens their well-being. The brain signals a worker that they’ve hurt their back, so they quit doing what caused… [Read more]

Aimee Peters, LCSW, Chief Clinical Innovation Officer at Ascellus Historically, claims adjusters have been hesitant to address behavioral health components related to physical injury claims for workers’ compensation. The reasoning being that physical-only claims generally have more predictable timelines and adding a psychological (psych) component to a physical injury claim complicates anticipated outcomes such as… [Read more]