Archive for October, 2007

Lack of Information by Liberals on SCHIP

Sunday, October 28th, 2007

I always have fun reading the liberal blogs and just how far off these people are. The comments below are from

“In the days following the President’s last veto, Dems and Republicans began to see the light, as they felt pressure from their constituents to support such a good bill. We’ll see that pressure continue. We may never change the President’s attitude toward providing healthcare for children, but we may shift the power dynamic soon regarding who gets to make that decision.”

First, The USA should not pay for healthcare for individuals over the age of 21. This bill that Bush Vetoed would have paid for the healthcare of “children” to 25 years of age. Also, the wages were way off regarding who qualified. No one that I know of has a problem with poor or working poor having tax paid subsidized healthcare, but it should not be for everyone. President Bush has not said he wants children to die in the streets from lack of healthcare. The liberals just can’t get this right about Bush.

The SCHIP bill is simply an attempt by the liberals to extend government controlled healthcare to the majority of citizens. If this bill had been signed by President Bush, most “kids” up to age 25 would have healthcare via the government and seniors 65 and over would be mostly in government ran programs. Hmm, that would have only left age 26 to seniors totally in the private sector. Again, it just seems to me that the SCHIP bill was an effort to piece mill nationalized healthcare.

After Hillary’s failed healthcare attempt in the early 1990s, the Clinton administration and its T.V talking helpers said it would just have to be done one piece at at time. I guess we see that happening with SCHIP.

Available National Work Comp PPO Networks

Sunday, October 21st, 2007

I continue to be amazed that many in the work comp industry do not understand the PPO industry, although it is a mature business model. Many payors and consultants believe payors are limited to only Aetna or Coventry work comp PPO networks. See the below statement from

“Unstated but obvious is the most important rationale - as the Coventry combo is the last big WC network standing, national WC payers have no other options. Yes, CorVel does have a national network, but none of the payers surveyed consider it a serious option.”

The above is simply not true. There are several quality national workers’ compensation PPO networks in the marketplace. Prime Health Services, Beechstreet, IHP, and others. The market simply does not have to be stuck with Coventry and Aetna. Payors and consultants need to pay attention to the market options. Otherwise, they are going to be paying more than necessary for their PPO.

Why All The Workers’ Compensation PPO Consolidation in 2007?

Saturday, October 13th, 2007

Why is the medical cost containment industry experiencing all the PPO consolidation in 2007? The answer is fairly simple. The payor community won’t make fast decisions. It is not unusual to see payors take two (2) to three (3) years to make a decision to choose a new workers’ compensation PPO. With such a slow response, it doesn’t allow PPOs to easily gain new business, even if they are much better than the current PPO vendor of the Payor.

It takes approximately 10 years to create a really quality PPO that is able to compete on the national stage. However, if a workers’ compensation PPO doesn’t obtain new business early in its genesis, then it may never have the 10 years needed in development. It takes a lot of capital and patience to last the years of needed.

The market in late 2007 had a major shift. Two larger named PPOs, including the market “800 pound Gorilla”, for all practical purposes merged in the market place. In my opinion, this occurred because the payors were not making choices at a fast enough pace to satisfy the business model needs of those two PPOs.

Most PPOs are paid on a percentage of savings that they achieve for their clients. However, these rates have been pushed down greatly over the past seven (7) years. This decline in % of savings rates has reduced revenues to PPOs along with ever increasing and deepening fee schedules in the various U.S states.The payor community consisting of TPAs, Insurance Carriers, and Self Insured employers are unfortunately hurting themselves by not choosing new PPO options more quickly. The consolidation of the market continues to take away PPO choices. However, all is not lost. There are quality PPO choices in the mature space of workers’ compensation PPOs. Hopefully, the payor community, which is now faced with a consolidation process that is ongoing, will understand and react by choosing competitive quality PPOs. If they don’t act soon, they will be paying much more for PPO savings all across the country. As in economics in general, monopolies only drive up costs. The new “800 pound Gorilla” is going to be pushing pricing up much sooner than later.