Paduda: AI, Automation, Junk Health Plans and Other Misadventures

Thursday, July 13, 2023 | 0

MyMatrixx’ Chief Innovation Officer Cliff Belliveau, one of the smartest and most articulate tech people I have ever met, penned an excellent summary of artificial intelligence's potential uses in and impact on workers’ comp.

Joe Paduda

Cliff highlights key opportunities and challenges in claims, medical management, fraud detection and claims oversight.

Will automation disrupt construction? A better question might be, “When will automation disrupt construction?”

Even better: “When will what parts of the construction industry be disrupted by automation?”

All are addressed here.

The net is this: The author isn’t convinced we’ll see massive automation within the next decade but points to a key use of technology that is already speeding up construction and making it more efficient, to boot.

Junk health plans — defined as plans with significant limits that often aren’t clearly identified upfront — and surprise medical bills are facing increasing scrutiny. The White House is proposing strict disclosure standards and time limits on junk plans:

The new proposed rules would close loopholes … that allow companies to offer misleading insurance products that can discriminate based on preexisting conditions and trick consumers into buying products that provide little or no coverage when they need it most.

The two sort of complement each other. The junk plans don’t protect families from health care providers’ aggressive billing practices.

The proposed rule would highly limit the duration of the plans, require clear disclosure of policy terms (written in English) and would close coverage loopholes.

And one more note of interest for smaller employers looking at self-funded plans, and especially level-funded plans: AM Best’s April 28 Market Segment Report indicates:

• Two out of 5 small employers (with three to 199 employees) are in level-funded plans.
• Just a year ago it was 1 out of 8 employers.
• Stop-loss insurance loss ratios jumped to 85% in 2021, driven by new and very expensive specialty drugs and a lot more million-dollar claims.

Just in the last year, five specialty drugs, each costing more than $1 million annually per patient, have come to market.

What does this mean for you?

Smaller employers, be very, very careful of self-insuring. 

Joseph Paduda is co-owner of CompPharma, a consulting firm focused on improving pharmacy programs in workers’ compensation. This column is republished with his permission from his Managed Care Matters blog.