Friday catch-up, innovation, and what kills it.

A few items of interest from around the work comp world…then a brief discussion of what works, and what doesn’t, in driving innovation.

Brian Allen’s now with Mitchell International’s ScriptAdvisor PBM operation.  A highly experienced government affairs professional, Brian’s been in the business for longer than he might admit.  Good pickup by Mitchell, which has rapidly grown its work comp pharmacy business and is likely the third largest PBM.

The fine folks at BWC Ohio have done exemplary work reducing overuse of opioids. Under the leadership of John Hanna MBA, RPh, over the last five years, BWC saw:

  • 44% fewer patients were taking opioids,
  • 48% lower opioid consumptiomn overall,
  • a prior authorization turnaround time of 4 hours (!) down from 2.5 days,
  • overall drug costs were down 7.7% year over year,

John and his folks have saved countless lives, prevented untold misery, significantly reduced employers’ and taxpayers costs, and done it all at a governmental organization. Yes, they have some significant advantages, but so do you.

John’s retiring this fall, but I fully expect BWC to continue to make progress as Nick Trego PharmD takes the reins…

And yes, I do have a man-crush on John.  I have huge respect for him. Thanks WorkCompCentral for the tip.

Innovation CAN happen in insurance – here’s a quick case study of one company’s pursuit of improvement via incremental, evolutionary, and disruptive innovation. 

Here’s the summary – but you really should read this.

Creating a culture of innovation is about much more than hiring a Chief Innovation Officer or creating a new department.  Culture change takes time and significant effort, and shifting culture toward innovation is no different. The process may start at the top, but it’s fundamentally about getting all employees involved.

But bureaucracy can frustrate innovation…

Also from Harvard Business Review, a piece on how bureaucracy screws up business and results and frustrates people.

(respondents) reported spending an average of 28% of their time—more than one day a week—on bureaucratic chores such as preparing reports, attending meetings, complying with internal requests, securing sign-offs and interacting with staff functions.  Moreover, a significant portion of that work seems to be creating little or no value.

But here’s the key takeaway – “Only 20% of respondents said that unconventional ideas were greeted with interest or enthusiasm in their organization. Eighty percent said new ideas were likely to encounter indifference, skepticism, or outright resistance.”

Article source:Managed Care Matters

Best Dallas Weight Loss Specialist

The blog post Best Dallas Weight Loss Specialist is courtesy of:

Best Dallas Weight Loss Specialist – Dr. Michael Cherkassky – 469-434-3380

If you’re in the process of choosing which weight loss program you’re going to embark upon, you’d certainly be remiss to not consider some of the many benefits of working closely with a the best Dallas weight loss specialist. While many weight reduction products and services come with their fair share of side effects and often result in only temporary results, working with a medical weight loss specialist can be far more successful for many individuals.

Michael Cherkassky, M.D. 12850 Spurling Road, Suite #110 Dallas TX, 75230 469-434-3380

For one thing, the weight loss methods utilized by Dr. Cherkassky involve natural methods like wholesome nutrition and frequent exercise, both of which have virtually no side effects when used correctly. The supplements he utilizes when necessary are also associated with minimal side effects, making his weight loss programs ideal for those who are looking to lose weight without worrying about negative ramifications.

One of the other amazing benefits of choosing a doctor who specializes in medical weight loss is that you’ll receive frequent care from qualified specialists who are able to oversee your overall health in a detailed, helpful manner. Instead of just being familiar with weight reduction, physicians like Dr. Michael Cherkassky are able to ensure that your health is improved and not negatively impacted by your weight reduction service.

Best Dallas Weight Loss Specialist – Dr. Michael Cherkassky – 469-434-3380

The Best Dallas weight loss specialist - Dr. Michael Cherkassky

Best Dallas Weight Loss Clinic – Dr. Michael Cherkassky – Call 469-434-3380

All things considered, you should definitely learn more about what the services at weight loss clinics can offer you. You might not know it, but your next and final successful diet program might be closer than you think. If you’re considering visiting a specialist and you’re trying to choose which of the local doctors is best for you, we would love to hear from you at 469-434-3380. Our friendly staff would love to answer your questions regarding the benefits of working with a weight loss specialist Dallas TX; call today to schedule a consultation!

Best Dallas Weight Loss Specialist syndicated from

Don’t miss this HWR

This month’s Health Wonk Review provides great insight into where healthcare is headed – and what we need to watch for.  Thanks to Health System Ed’s Peggy Salvatore for mining the best of the blogosphere.

A couple of don’t miss posts:

Who Really Needs the Public Option? Trump Country, Trump Country is most in need of a way to bypass the ACA marketplaces entirely. Democrats’ favorite policy option – the public option – would be most valuable in precisely the deep-red areas that went most fervently for Republicans and the President.  Get it all here.

And friend and colleague Tom Lynch focuses on workers’ compensation cost control has focused mainly on lowering medical costs, which is almost always an outsourced function. Consequently, many employers have relinquished control over their workers’ comp program, migrating away from best practices that are at the heart of true workers comp cost control. Read the full blog here.

Article source:Managed Care Matters

Healthcare reform – Implications for work comp, Part 2

We’re all suffering from repeal-and-replace exhaustion, so I’ll keep this light and entertaining.  Or at least try to.

Quick – Is work comp the lion or the gazelle?

With ACA very likely to remain the law of the land, here are the over-arching implications for workers’ comp:

  • Growing cost pressure on providers from group health and governmental payers will make those providers increasingly look to work comp to replace “lost income”
  • Healthier workers will heal faster and need fewer healthcare services

Revenue maximization is the industry term for getting as much revenue from each patient as possible.  This entails:

Rest assured work comp is one of the payers in the cross-hairs of “revenue maximizers”.

Next, as those with coverage likely won’t lose it, and we may see even more folks covered if other states adopt Medicaid as we discussed yesterday, the good news is

Can we quantify this?  Not yet, but the research clearly indicates health reform has been good for comp.

As providers adopt new revenue maximization approaches, will work comp be able to keep them at bay?

What does this mean for you?

Which gazelle will you be – the one resting in the lion’s jaws, or his slightly faster brother?

Article source:Managed Care Matters

Worth reading: Methadone, police violence, and taking children from their parents

A few of the recent pieces I recommend reading:

Larissa MacFarquhar in the New Yorker: When Should a Child Be Taken from His Parents?

Brian Rinker at STAT: 32 churches and no methadone clinic: struggling with addiction in an opioid ‘treatment desert’

Renee Bracey Sherman in the New York Times: The Right to (Black) Life

Brianna Ehley at Politico: ‘I just started flowing. It was the only thing that helped.’In tough neighborhoods, can high-school mental health counselors cut the school-to-prison pipeline?

Yamiche Alcindor in the New York Times: In Sweltering South, Climate Change Is Now a Workplace Hazard

Article source:Science Blogs

Healthcare reform implications for workers’ comp, Part 1

With Congressional efforts to repeal/replace/revise ACA behind us for now, it’s time to consider what all this means for workers’ comp.

First up – Medicaid expansion

Currently 32 states have expanded Medicaid; 19 have not. Expect more states to consider expanding Medicaid as the combination of Federal dollars and struggling hospitals makes a compelling case for state adoption.

In addition, the Trump Administration may well allow states more flexibility in expanding Medicaid, and this will likely lead to more states opting in. For example, Arkansas has applied for permission to add coverage to a more limited population…other states will almost certainly follow suit.

Other states, including Texas, are facing the dual realities that their poorer citizens’ health status is declining, and hospital financials are deteriorating as well.

A couple data points illustrate the linkage between Work Comp and Medicaid

63% of Medicaid recipients have at least one family member working full time. This varies among states, from 77% in Colorado to 51% in Rhode Island. 15% have a part time worker. Only 19% of recipients’ familes have no one working.

Many employers (e.g. those with <50 FTEs) that

  • don’t provide health insurance &/or
  • aren’t required to provide health insurance under ACA
  • &/or have a lot of part time workers who don’t qualify for employer-sponsored health insurance

recommend workers who qualify sign up for Medicaid.

The potential implications for claiming behavior are apparent.

We all know workers comp premiums are driven by employment. Most credible studies indicate Medicaid expansion increased employment in states that expanded Medicaid.

More employment = more payroll = more workers’ comp premium and more claims (NOT higher frequency, which is a percentage and not a raw number)

There’s also implications for disability filings…A just-published study found “a 3-4 percent reduction in the number of people receiving supplemental security income… in states that expanded Medicaid.”

What does this mean for you?

The work comp industry dodged a bullet when Congress didn’t repeal ACA. However, watch carefully as other efforts to de-fund and otherwise cut back on Medicaid are ongoing.


Article source:Managed Care Matters

Rosario’s Dallas Medical Weight Loss Review

The following interesting post Rosario’s Dallas Medical Weight Loss Review was first published to: Michael Cherkassky MD

Dr. Michael Cherkassky is a Dallas weight loss doctor that specializes in medical weight loss. Dr. Cherkassky has helped many patients in Dallas lose weight without surgical procedures. In this interview a patient discusses her experience and success with the medical weight loss program.

My first name is Rosario, and I live in Fort Worth.

How long have you been coming to the weight loss clinic?

I started the medical weight loss program three months ago. I’m so, so happy. I was 189 and now I’m 162. I feel so healthy, so happy and my stress is gone [laughs]. Yes, it’s a really, really good experience to be here with the doctor.

What other types of weight loss did you try before you started the weight loss plan?

I tried everything, all kind of pills, I’ve got a big box with pills because I tried so many different labels. Some did not do anything. Here at the weight loss clinic I got my diet plan. I follow the diet and everything is perfect.

Was there one specific thing that made you decide that you have to do something different about losing weight?

When we want to lose weight, we will try everything. Then one day somebody told me about this weight loss place and I said, “Okay, I’ll try it.” I’m here and I’m so happy. I did not do anything for a long time. Finally I decided to come in.

Tell me what it was like when you first came here to the office?

Later on, they were so polite when I came in. They made me feel comfortable. They gave me a little cookie, or they asked me for potato chips or something so they could help me with my snacking. When I get out, I tried my chips in the car, and I say, “No, it doesn’t taste good. Why do they burn on my tongue?” Then I said, “Oh, this is the right place. It works.” [laughs] Yes, it works.

dallas medical weight loss phentermine supplement

SenPaste and Sensotherapy – Medical Weight Loss Supplements

That was the SenPaste?


Did the SenPaste work right away?

Yes, right away. I tried eating the chips after the appointment and I can’t because it doesn’t taste good. That is exactly what we need to get something because when we’re so hungry or we’ve got a problem a nd we can’t stop eating. But with this SenPaste you stop to eating because it doesn’t taste like anything anymore. You say, “Why am I eating if I do not get any flavor?” Then I love it. I love this place.

Great. Tell me about the office staff and how they help you.

The office staff here is so polite. They ask me if you need something give us a call. Did you want to try the paste, come here we do I think once a week. I don’t know, I’ve forgotten but they’re so, so polite. They’re so friendly, the doctor, you’re okay. They check your body, your health, your lungs.

Other weight loss clinics that I went to said, “Oh, come back after a month.” Here, they told me, “You don’t feel good, give us a call.” The first week they called me, “Hey, everything is okay? Do you feel good, is there any problem?” I say, “No.” They’re fantastic people.

What it’s like now after you have lost weight versus when you started?

I feel so different. I’m happy. Now that it’s true I feel so different. Before when I would try to go up and down the stairs it was hard. I would try to do it once or twice a day. Now I can go up and down many times. I feel healthy. The doctors have said everything is okay. My heart and blood pressure are good. Everything is good according to my primary doctor.

I get to be my better self. I have my your clothes and I feel great, “Now I can wear it.” It’s a lot different. It makes you feel better, happy. I am now working with the people at church. I help everybody because I feel like I can do it because I have lost weight. When I was so big, I’ll say, “No. I want to sit down and do nothing.” It was hard when I want to do something because I felt, [panting]. With two or three steps, [panting]. Now I feel really, really good and still I want to lose more weight.

Tell me about the program and eating regular food.

They give you the diet plan. It has to be 1200 calories at a day. You can follow the diet but sometimes I didn’t. Only I eat if I had to go the the restaurant, I’d go. But I’d check, “I will get 600 cal. Okay. Not that. I can get it.” I had to get to 1200 calories a day. That is great because you don’t need to follow a special program that is hard to follow. Only you take care of what you eat. You can drink soda if you want it. But you see the calories. They’re okay. I would drink my soda but I can’t eat too much.

Dallas Medical Weight Loss Patient Review - Rosario 03

Dallas Medical Weight Loss Review from Rosario – Michael Cherkassky, M.D.

Overall, do you find it easy to follow?

On Sunday, I get a free meal on the diet plan. I eat whatever I want. I can go to the restaurant, and the doctor says, “Sunday is yours.” Okay, but I take care. When I follow the program, I lose weight. When I don’t follow it, I don’t lose weight. Slowly, slowly. Before, you know the problems and the weight are gone. Before, I do this one diet, and I follow it for one week, and then I try another diet again next week. I want something, and I say, “No, I have to follow.” This one, no.

How has your eating changed now that you are not hungry all the time?

The doctor gives you the medicine. The first time is hard because you are always eating and wanting junk food. The first week is a little hard, but you do it. The next week is easy one like 100%. The next one is 90%, the next one is 80%, then your desire goes down, down, down, down until you didn’t want it. That is the big point.

When your body get it, it’s like a transformation for your body. When you get it, it’s easy. It’s easy only you need to follow, follow. You don’t go back because you’ll say, “Okay, if I’ll go back, I will get a little weight.” Your stomach doesn’t like you to go back. That is the best I think.

Is it easier to exercise now than before?

I do samba, before I walk but now I do samba and I feel so happy. I drink a lot of water and do exercise. Because you lose weight then your body is becoming soft. Then if you do exercise it keeps you in a good shape, then your body goes back easily. Exercise is better because you feel good and your body is start to coming back without any problem. Then the patients come to the doctor, do exercise, and drink a lot of water, that’s it and be happy.

Schedule a Medical Weight Loss Consultation Today

Dallas weight loss specialists

New Patient Discount for Dallas Medical Weight Loss | Call 469-434-3380

Call the office of Dr. Michael Cherkassky today to schedule an appointment. Your first medical weight loss appointment includes a complete physical and medical history review. In the event that you have conditions that prevent you from receiving a prescription, Dr. Cherkassky will provide you with a customized weight loss plan to help you reach your weight loss goal quickly and without being hungry. Call his office today to arrange your first weight loss appointment. Call 469-434-3380.

Rosario’s Dallas Medical Weight Loss Review syndicated from

New NACCHO president on Zika, equity & the ACA: ‘We can’t do this alone. We have to do it together’

Umair Shah’s story isn’t an uncommon one in public health. Starting out in medicine, with a career as an emergency department doctor, he said it quickly became clear that most of what impacts our health happens outside the hospital and in the community.

Today, that philosophy drives his work as executive director of Harris County Public Health (HCPH) in Houston, Texas — an agency that serves the third-largest county in the nation, home to about 4.5 million residents. In fact, Shah, who first joined the agency in 2004 and become director in 2013, said the agency’s mantra is this: “Health happens where you live, learn, work, worship and play.” Last year, HCPH became the first public health department in Texas to be selected as Local Public Health Department of the Year by the National Association of County and City Health Officials (NACCHO), which recognized HCPH for its commitment to engagement, equity and innovation.

Take for example, its work with Microsoft on mosquito “smart traps.” The traps, now being piloted in Harris County, can identify a mosquito by the oscillation of its wings and capture data on the environmental conditions at the time it was caught. The hope is that public health practitioners like Shah can eventually use all that data to predict where disease-carrying mosquitos will show up and where the agency should deploy the preventive measures that head off potential disease outbreaks.

“We’re not looking at the public health of yesterday or today, but toward the public health of tomorrow,” Shah told me. “That’s how we’re positioning ourselves.”

In July, Shah became the new president of NACCHO. He spoke with the Pump Handle last week about achieving healthy equity, the impact of the Affordable Care Act and elevating the public health narrative. (The following has been edited for clarity and length.)

Pump Handle (PH): In becoming NACCHO’s new president, you talked about changing the “invisible narrative” around public health. Why do you believe this is important and how do you recommend local public health workers go about that?

Shah: The challenge we have in the public health field is that we’re all very good at what we do and yet our work is largely invisible — like the disease outbreak that doesn’t happen — and so it’s hard to show the value of that work. So raising the visibility, drawing attention to actual work being done…that helps people value that work and then they become interested in investing in that work.

Here in Texas — because we’re such a football-loving state — I like to describe public health as the offensive line of the team. There’s lots of other players on the team that often get the recognition… but it’s public health doing all the blocking and pushing that allows the rest of the team to be successful.

We have an investment issue in our country. The vast majority of health-related expenditures go to health care delivery systems and not to public health and prevention. So we need to be thinking about how we can reframe that and I believe the public health workforce has role in that. We are the ambassadors of our field and when we’re willing to raise the visibility of the work we do, it translates into reframing the value proposition, if you will, of public health.

PH: Your agency has a strong focus on embedding health equity principles in everyday public health work. Why do you believe equity-focused work is so important at this particular time?

Shah: Equality really is the lens by which we approach so many of the activities we’re engaged in. At HCPH, we have a strong stance toward incorporating the social determinants of health into everything we do, from theoretical modeling to our response to Zika — we even have a health equity coordinator embedded in our multidisciplinary (Zika) response team.

We’re finding that communities are feeling that they’re being left out. …They feel like they don’t have a voice or don’t see a role for themselves in the decision-making process. Health equity really allows us to (elevate) community voices and perspectives as well as the social factors that determine health. Often, we find that it’s the areas not traditionally in the purview of public health that we need to be focused on. That’s why we’ve taken such an assertive role in incorporating health equity into our work.

PH: You work in a state at high risk of Zika virus. Can put in context just how much work and coordination it takes to prepare for Zika and the possibility of a local outbreak?

Shah: HCPH confirmed the first Zika positive case back in January 2016, and it was before a lot of the interest happening around Zika domestically. That meant we had to build the plane while we were flying it.

We worked very diligently with our federal, state and local partners, and with a number of health care organizations, hospitals systems, providers, medical societies — all sorts of different stakeholders. At the end of day, it was an incredibly instructive process in the real need for government to work together with the public in ensuring the health of our community and in preventing what could have been a remarkably worse situation.

Our department spent $1.5 million of its resources on Zika last year. We waited quite a bit of time for things to come through from the federal level and for Congress to approve a package, but we couldn’t rest on our laurels. We had to be very aggressive.

We’ve been investing an incredible amount of resources, staffing and capacity building not just in mosquito control, but in epidemiology, communications, policy work, environmental and veterinary work. This multidisciplinary approach gives us the best opportunity to respond to Zika in our community. That said, it only takes one mosquito to get Zika from a traveler from a Zika-affected area and — boom — now we have Zika in the community. We have to stay vigilant and that’s the real challenge.

PH: According to recent data from your agency, Harris County’s infant mortality rate is higher than both the state and national averages, with black families experiencing a disproportionate amount of that burden. What is your agency doing to address this?

Shah: This goes back to the health equity issue.

There’s a number of things we’ve been doing. We’re participants in Global Latch through our WIC program, which is an opportunity to remind new mothers about the importance of breastfeeding. We’re members of the Harris County Child Fatality Review Team, where we review cases of children who have died through a prevention and policy lens. We operate 16 different WIC sites or prevention clinics throughout the community, where we use an equity lens approach to address the mitigating factors that impact health with a particular family.

We see this as a global issue that requires a multifaceted approach from the health department. So it’s not just an approach of our clinics and WIC sites or just the human health side; but really believing it requires a look at the (social) conditions too.

PH: How important has the Affordable Care Act been for the community you serve?

Shah: The ACA has had a great impact both in widening access and in creating opportunities for us to partner with the health care sector.

Sometimes there’s this perspective that because Texas didn’t expand Medicaid, that we haven’t made any efforts, or few efforts, to improve coverage. But even without Medicaid expansion, the uninsured rate has dropped both statewide and locally. Enrollment increased in the marketplace from 135,000 in 2014 to almost a quarter-million in 2017. But we still have a good portion of our community, especially in certain communities, who aren’t aware of how to access health care coverage. We have to make sure people are aware they may be eligible for subsides.

But we also have to recognize that while health care coverage is important and necessary, it’s not sufficient. We need to recognize that health goes beyond health care…and when health care and public health work together, we can leverage the entirety of our systems to improve the health of our community.

What’s been missing in all the discussions around the ACA repeal is that a significant portion of CDC funds is in the ACA’s Prevention and Public Health Fund (PPHF) — if that fund went away, you’d have a 12 or 13 percent cut to CDC’s budget. We receive about $1.5 million through the PPHF…and so if you have a reduction in dollars at the federal level, you start to have an impact on what’s happening in Texas to the tune of about $28 million. That’s just through the health departments — the PPHF monies also go to community groups. We have to remember public health in all of this.

PH: The PPHF has become a critical source of funding for a variety of public health activities at the local level. Can you provide a couple examples of what we stand to lose if that fund disappears?

Shah: We’d lose dollars for surveillance, epidemiology, infectious disease response, health promotion. Many of those dollars aren’t just about disease, but about infrastructure and capacity. For example, when we have something like Zika or Ebola, we can chase the dollar by being reactive or we can have a system where local and state public health are well-resourced. That means we’re not being reactive to the next disease of the day, but proactively building capacity so we’re ready to respond to myriad issues.

PH: As a physician, you came to public health via the world of medicine. As such, what’s one thing you wish public health workers better understood about their colleagues in medical care? What’s one thing you wish those in medicine better understood about public health?

Shah: I don’t want to forget the importance of the public health-health care interface. What I would say is we can’t do our jobs effectively unless we work hand in hand with each other.

When you look back at Ebola, it is an incredible testament that only Mr. (Eric) Duncan (the first Ebola patient diagnosed in the U.S.) and two additional nurses were exposed. That is an incredible success story, and yet that is also the challenge for public heath. When I treat cancer in a child, I can show you a poster child for cancer treatment. But it’s much harder to show the image of the kids who were prevented from getting cancer in the first place.

At the end of the day, we can’t do this alone. We have to do it together.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

Article source:Science Blogs