Newsletter Sign-up

By MATTHEW BRODSKY, senior editor of Risk & Insurance®

CHICAGO---Peter Rousmaniere would have surprised you this year in the expo hall at the 18th Annual National Workers' Compensation and Disability Conference® & Expo. He was organized. He was systematic.

With a printout in hand, loaded with dozens of names of vendors and contacts, Rousmaniere started from the booths in the 100s, progressed down that row and turned the corner to the 200s, marched that row, and so on and so on. He stopped at booths where he needed to meet with folks, but also stopped at booths that caught his eye.

Shadowing Rousmaniere on the showroom floor was like following a political candidate, without the baby-kissing and the politics. He knows many people here, and those folks he doesn't, they know him.

But enough about how popular and purposeful the workers' comp columnist is. For more importantly, what Rousmaniere saw on the showroom--beyond the blur of faces and shuffle of business cards--were the two major trends (issues, really) of the workers' comp industry at the moment.

"It's easy to overpredict themes," he said, then tried to do his best.

CHRONIC PAIN

One trend very evident among the workers' comp industry is the drive to get a hold of the chronic pain piece. Rousmaniere pointed out one pharmacy benefit management (PBM) company and another PBM booth and then another.

He stopped at the booth of one of the largest PBMs of the bunch and met the CEO, who already knew who he was. Rousmaniere sprung the question on him: What can you do about drug-related fraud?

That was a question requiring a longer conversation at a future date.

MEDICAL DATA

Another top issue for Rousmaniere was the rush of new products and services on the market that promise a low-cost solution to streamline the delivery and use of medical information and analysis.

At the moment, according to Rousmaniere, there is a "war" being fought between the major managed care firms and outside vendors who specialize in this kind of thing.

The management of medical data is a complicated, mind-bending process. Think of it as a "highway with a lot of different junctions" between the employer/payor on one end and providers on the other. Different vendors can service the different junctions. Managed care firms want to control the traffic. They tell the payors, "We can handle everything," and jealously hope that their clients do not deal directly with any of those other vendors, explained Rousmaniere.

Having and handling medical data is not about protecting turf for the payors, though. It's about having medical intelligence, about the power to control costs. In this regard, you could throw into the mix the loads of vendors whose job it is to negotiate bills with hospitals and other providers, like physical therapists. It is no easy feat.

Dealing in medical data is also about teasing out answers to deeper questions, hidden trends--something that Rousmaniere is particularly adept at.

He has no hesitation in walking up to an innocent booth staffer and dropping this bomb:

"Do you have any interesting insights into the nature of injury, or the complications of injury?"

"Hmmm ... let me give you the card of my colleague and have her get back to you," you could see a vendor sales person saying to Rousmaniere.

He explained that a vendor's answer to that question really all comes down again to their level of medical intelligence. For instance, a physical therapy network should have the data to provide a solid figure on, say, how many delayed recoveries were related to obesity.

Then again, if a vendor doesn't have a grasp of their clients' data--or the data at all--then they might be, well, a little thrown off by Rousmaniere.

"I'm coming in from outer space," he said, his way of saying no one on the showroom floor is asking vendors these kinds of questions.

(Click here to read all of our other coverage from the Annual National Workers' Compensation and Disability Conference® & Expo.)

November 19, 2009

Copyright 2009© LRP Publications