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Paduda: Predictions for Workers' Comp in 2019, Part 2

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I'm continuing my predictions for workers’ comp in 2019. The first five were Tuesday.

Joe Paduda

Joe Paduda

But before I do, you may want to read this on the fallacy of so-called “experts.” I occasionally think I am one.

The “advocacy” claims model will gain a lot more traction, as more employers, insurers, and TPAs embrace treating “claimants” as actual real people with medical and disability problems.

The problem is, how do we track this? That’s my challenge, but I hope you will let me know of payers embracing the model.

“Opt-out” will not gain traction.

Allowing employers to opt out of workers' compensation is a solution in search of a problem. Overall, work comp is working pretty well, costs are under control, employers don’t see it as an issue, and most patients recover and get back to work.

Most importantly, there is no significant political constituency that cares enough about it to make it happen.

Promoted by the Association for Responsible Alternatives to Workers' Compensation and a few stakeholders invested in managing opt-out business, this isn’t going anywhere.

Change does not happen unless there is a problem that needs fixing, and work comp’s problems are tiny in comparison to other issues confronting state legislatures: taxes, school funding, gerrymandering, Medicaid expansion, rural hospital funding, industrial and economic development, and natural disaster preparation and recovery.

Jennifer Wolf Horesjh, good friend and executive director of the International Association of Industrial Accidents Boards and Commissions, has a slightly different perspective; you can listen to Jennifer’s podcast here). She notes the advocates are working diligently to promote opt out/non-subscription.

Service companies that deliver best-in-class customer service — and build that into their branding messaging — will win.

In a commoditized business (which is how most buyers view most work comp services), customer service is critical to success, but most companies in commoditized businesses don’t understand this.

I’d go a step further: Because workers' comp is a declining industry, being known for delivering great service is essential to survival. Yet many businesses just don’t understand this, or if they do, they haven’t figured out how to deliver great service. Or if they do deliver great service, they fail to build that into their branding efforts — if they even have anything that remotely resembles “branding.”

We will be doing some interesting research on this later this year, which should help determine a) if my prediction is accurate, and b) what works.

More success in reducing long-term opioid usage by more payers.

We’ve learned that diligent, persistent, intelligent and caring approaches to managing chronic pain and long-term opioid usage produce results. The state funds of California, Ohio and Washington, along with Sedgwick, are a few of the payers achieving remarkable success in helping patients handle their chronic pain while reducing their opioid usage.

Vendors including Carisk are also delivering solutions to this knottiest and most problematic of work comp problems.

Payers will implement business models and processes using artificial intelligence.

These will include some or all of these:

  • Claims intake and triage.
  • Fraud/waste/abuse triggering and assessment.
  • Patient and provider communication.
  • Clinical assessment, including utilization review.
  • Policyholder communication.
  • And more I can’t think of.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.

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