Industry Watch

No Reprieve from Medical Costs Amid Rising Price of Care

Payers must remain focused on preventing claims and mitigating severity.
By: | January 17, 2018 • 4 min read

Medical expenses rattled workers’ compensation payers when they reached 60 percent of claim costs, exceeding indemnity as the most expensive portion of addressing worker injuries.

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Now, rising medical costs are pushing that 60 percent squarely into the rearview mirror. They have reached 69.3 percent of a claim’s expense in Florida and are running 64 percent – 65 percent in other states.

Claim-severity drivers such as obesity and an aging-worker population will extend the trend.

“That is going to continue to gradually inch even higher in terms of the percent of payment going to medical expenses versus indemnity,” said David Dwortz, president of Helmsman Management Services. “With the increase in severity, medical is definitely going to continue to be a major concern, a huge focus for keeping control of payers’ overall costs.”

Meanwhile, nationwide medical inflation is expected to grow at 2.3 percent for 2018, faster than at any time since 2010. That rate of medical inflation, however, is not significant enough to sound alarm bells.

It is also not surprising because medical inflation had been at historically low levels going back to 2010, Dwortz said.

“I don’t think anyone expected that to continue into perpetuity,” Dwortz commented.

Although a percentage point higher than the average over the last few years, the 2.3 percent growth in expected 2018 medical pricing is not historically unusual, said Patrick Cote, an economist at NCCI Holdings Inc., the workers’ comp research and rating organization.

While the current rate of medical inflation is worth keeping an eye on, it is a “middle of the road” level of increase, he added.

David Dwortz, president, Helmsman Management Services

But the continued overall creeping up of medical expenses, including medical price increases, is a potent reminder that employers and other claims payers must remain constantly engaged in the battle to prevent claims and mitigate their severity when they do occur.

It also calls for understanding price increases — in contrast to addressing the utilization of different components of medical care — to judge whether various drivers of medical price movement realistically can be mitigated, said George Furlong, senior VP, managed care program outcomes and analytics at Sedgwick Claims Management Services Inc.

For example, many state fee schedules do not control hospital pricing. If that pricing spikes, there are limited measures for addressing it when employers already have proven cost-containment practices in place, such as medical provider networks.

Similarly, Average Wholesale Price, influenced by pharmaceutical manufacturers, drives drug pricing and can’t be controlled like the utilization of prescriptions.

“With the increase in severity, medical is definitely going to continue to be a major concern, a huge focus for keeping control of payers’ overall costs.” — David Dwortz, president, Helmsman Management Services

Understanding the influence of price changes will help payers better determine whether focusing on controlling utilization will or won’t be productive, Furlong explained.

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“I’ll give you a quick example,” Furlong said. “In California they had a significant increase in physical therapy services (pricing) over the last couple of years. It had a lot of people looking for utilization issues when they didn’t exist.”

NCCI’s expectation of medical inflation growth for 2018 is based on its monitoring of the Personal Health Care deflator from the Centers for Medicare & Medicaid Services.

Medical inflation expected to increase during 2018 will follow from the nation’s expanding economy and the accompanying overall inflation driving up wages in the labor-intensive healthcare industry, states a Medical Cost Trend report from PwC.

Advances in technology and pharmaceuticals will also contribute to nudging up the price of medical care.

Jeff Kuss, chief claims officer, AF Group

Increasing prices, however, are not all bad news, explained Jeff Kuss, chief claims officer at insurer AF Group.

“They come up with new processes or procedures that may be more expensive on the front end, but ultimately they are going to get the better outcome at the back end for the injured worker,” Kuss said. “Some of that is progress and how we improve the care and delivery system.”

The ultimate impact of 2018 medical inflation on employers’ total worker’s comp expenses will depend on factors driving utilization, such as their worker-population demographics and safety efforts.

Most claims cost increases, for instance, are falling on those involving older workers with little cost changes attributed to claims involving younger employees, Furlong said.

Insurance rates are down in most states due to continually declining frequency, added Frank Pennachio, a partner at Oceanus Partners. Despite medical inflation, some employers who have managed to reduce their claims frequency may actually pay less in total worker’s comp expense, Pennachio elaborated. &

Roberto Ceniceros is senior editor at Risk & Insurance® and chair of the National Workers' Compensation and Disability Conference® & Expo. He can be reached at [email protected] Read more of his columns and features.

More from Risk & Insurance

More from Risk & Insurance

In the Fast-Paced World of Retail, This Risk Manager Strives to Mitigate Risks Proactively and Keep Senior Leaders Informed

Janine Kral works to identify and mitigate risks, building strong partnerships with leaders and ensuring they see her as support rather than a blocker. 
By: | October 29, 2018 • 4 min read

R&I: What was your first job?

My very first paid job was working on my uncle’s ranch in British Columbia in the summers. He had cattle, horses and grapes — an unusual combo. But my first real job out of college was as a multi-line claims adjuster at Liberty Mutual.

R&I: How did you come to work in risk management?

Right out of college I applied for a job that turned out to be a claims adjuster at Liberty Mutual. I accepted because they were offering six weeks of training in Southern California, and at the time that sounded really fun. I spent about three years at Liberty Mutual and then I spent a short period of time at a smaller regional insurance company that hired me to start a workers’ compensation claims administration program.

I was hired at Nordstrom as the Washington Region Risk Manager, which was my first job in risk management. When I started at Nordstrom, the risk management department had about five people, and over the years it has grown to about 75. I’ve been vice president for 11 years.

R&I: What’s been the biggest change in the risk management and insurance industry since you’ve been in it?

I would say that technology has probably been the biggest change. When I started many years ago, it was all paper and no RMIS.

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R&I: What risks does the retail industry face that are unique?

We deal with a lot of people — employees and customers. With physical brick and mortar settings, there are the unique exposures with people moving in and out in a public environment. And of course, with ecommerce, we have a lot of customer and employee data, which creates cyber risk — which is not necessarily a unique risk in today’s environment.

R&I: Can you describe your approach to working with senior leaders and front-line staff alike to further risk management initiatives?

It starts with keeping the pulse of what’s happening with the business. Retail moves really fast. In order to identify and mitigate risks proactively, we identify top risk areas and topics, and then we ensure that we have strong partnerships with the leaders responsible for those areas. Trust is critical, ensuring that leaders see us as a support rather than a blocker.

R&I: What role does technology play in your company’s approach to risk management?

Janine Kral, claims adjuster, Nordstrom

We have an internal risk management information system that all of our locations report events into — every type of incident is reported, whether insured or uninsured. Most of these events are managed internally by risk management, and our guidelines require that prevention be analyzed on each one. Having all event data in one system allows us to use the data for trending and also helps us better predict what may happen in the future, and who we need to work with to mitigate risks.

R&I: What advice might you give to students or other aspiring risk managers?

My son is a sophomore in college, and I tell him and his friends all the time not to rule out insurance as a career opportunity. My advice is to cast a wide net and do your homework. Research all the different types of opportunities. Read a lot — articles, industry magazines, LinkedIn. Be proactive and reach out to people you find interesting and ask them about their careers. Don’t be shy and wait for people and opportunities to come to you. Ask questions. Build networks. Be curious and keep an open mind.

R&I: What are your goals for the next five to 10 years of your career?

I have always been passionate about continuous improvement. I want to continue to find ways to add value to my company and to this industry.

R&I: What is your favorite book or movie?

My favorite book is Shantaram by Gregory David Roberts. It’s a true story about a man who was in prison in Australia after being convicted of armed robbery, and he escaped to India. While in India, he passed himself off as a doctor in a slum. It’s a really interesting story, because this is a convicted criminal who ends up helping others. I am not always successful in getting others to read the book because it’s 1,000 pages and definitely a commitment.

R&I: What’s the best restaurant you’ve ever eaten at?

Fiorella’s in Newton, Massachusetts. Great Italian food and a great overall experience.

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R&I: What is your favorite drink?

“Sister Carol.” I have no idea what is in it, and I can only get it at a local bar in Seattle. It’s green but it’s delicious.

R&I: What is the riskiest activity you ever engaged in?

Skydiving. Not tandem and without any sort of communication from the ground. Scary standing on a wing of a plane, but very peaceful once the chute opened, slowly floating down by myself.

R&I: If the world has a modern hero, who is it and why?

I can’t think of one individual person. For me, the real heroes are people who have a positive attitude in the face of adversity. People who are resilient no matter what life brings them.

R&I: What about this work do you find the most fulfilling or rewarding?

It’s rewarding to help solve problems and help people. I am proud of the support that my team provides others. &




Katie Dwyer is an associate editor at Risk & Insurance®. She can be reached at [email protected]