#the swedlow group | Explore Tumblr Posts and Blogs

streetartsf · 5 years

Text

San Francisco Bay Area Events

Tonight! - Bad Luck of the Draw Club Bring your beer, backwoods and drawing equipment at Burnt oak gallery@badluckofthedrawclub

4/11 Walnut Creek – Bedford Gallery 6-8pm Group Show Tradition Interrupted to 6/23 @bedfordgallery

4/11 SF Art Attack informal artist talk Jennifer Banzaca and Harumo Sato from 4:30-6pm @artaattacksf

4/12 SF SF Ingelside Library – free cartooning for 1 hour by @sirronnorris .he will be doing 6 sessions during month

4/12 Oakland – Autobodyfineart – from 7-9pm Eight paintings by Kara Swedlow @autodobyfineart

4/13-14 SF Fort Mason Festical Pavilion - Art and Craft Fair @Renegadecraft

4/13 SF - Wonderland - @MicahLeBrun solo show @wonderlandsf FINAL SHOW

4/13 Oakland – pt.2 Gallery Solo show Paige Valentine @trophy__wife from 12-10pm @pt.2gallery

4/13 SF - Root Division 7-9pm. Role of food as center of artistic practice @rootdivision

4/13 Oakland – Bad Luck of the Art Show 4 at Burnt Oak Gallery 6-10pm. @badluckofthedrawclub

4/14 SF – The Luggage Store Push It Forward Fundraiser for EduSkate $5 donation. Silent Auction Show @sfskateclub

4/17 Berkeley – Shoh from 4-7pm Open to 5/11 group show of sculptures @shoh_east_bay

4/20 SF – Modern Eden – 78 card tarot deck featuring original aartwork by @LaceyBryantart who is having a kickstater to produce the deck

4/23 SF – Sketch Tuesdays at 111 Minna Gallery 6-10pm @sketchtuesdays

4/26 SF – Art Market

4/26 SF – Back to the Picture Mission Legends, the art of Robles, Rios & Roman from 6-9pm. To May 26th. @back_to_thePicture

5/3 Alameda – The Space by the Bay – featuring @nick.flatt solo show @thespacebythebay

5/3 SF – Mirus Gallery @yohnagao solo show @mirusgallery

28 notes · View notes

leeannclymer · 6 years

Text

Blog Post: Despite the Risks, Most WCMSA Plans Include Funds for Long-Term Opioid Use

Oakland – Nearly 70% of federally mandated and approved Medicare settlements for injured workers require funding for decades of opioid use, often at dangerously high levels and in conjunction with other high-risk drugs. Such a requirement exceeds federal and state clinical guidelines and places patients at high levels of risk.

Workers’ Compensation Medicare Set-Aside (WCMSA) plans are required to set up reserves to cover Medicare beneficiaries’ future medical care for injured workers who are or will soon be Medicare eligible. A new California Workers’ Compensation Institute (CWCI) study examines data from 7,926 California WCMSA plans completed, submitted and approved by the Centers for Medicare and Medicaid Services (CMS) in 2015 and 2016. Authors Alex Swedlow and Dr. David Deitz found that on average, insurers allocated $103,393 at the time of the injured workers’ settlements to cover the future medical expenses associated with their work injuries, with $48,986 (47%) of that amount set aside to pay for prescription drugs. Opioids were the number one type of drug included in WCMSAs, found in 69.4% of the approved plans, and overall, opioids accounted for 27.7% of all WCMSA prescriptions – more than twice the proportion of any other drug category. In terms of costs, the study found that with an average allocation of $33,113, opioids accounted for almost 1/3 of the total dollars reserved for prescription drugs. The opioid combination drug Hydrocodone-Acetaminophen (generally known as Vicodin® or Norco®) was the most common opioid found in the WCMSAs (44% of the opioid prescriptions in the plans, 20.7% of the dollars allocated for opioids), followed by Tramadol HCI and Oxycodone HCI, though even more powerful Fentanyl, linked to more than 20,000 deaths in 2016, accounted for 2.2% of the opioids and 6.6% of the total amount allocated for opioids in the approved plans.

Comparing opioids found in WCMSAs to a case-matched control group of closed workers’ comp permanent disability claims for similar injuries, the authors found that the WCMSAs called for much stronger opioids, as average cumulative morphine milligram equivalents (MMEs) allocated to WCMSAs with opioids were 45 times the level used in the control group during the life of the claim. Likewise, approved WCMSAs with opioids required funding for an average daily dose of 54.7 morphine equivalents (MEDs) for a period of 20.9 years, while 1 in 10 had allocations for a daily dose of 90 MEDs, a marker for elevated risk to the patient. In addition to requiring funds for long-term opioid use, many of the WCMSA plans also included reserves for simultaneous, long-term use of other potentially risky medications. For example, 14.5% of the WCMSAs with opioids also had reserves for sedative-hypnotics, and nearly 5% had allocations for sedative-hypnotics, muscle relaxants, and opioids.

Additional details from the study are available in a CWCI Report to the Industry, “Opioids in Workers’ Compensation Medicare Set-Asides.” CWCI members and subscribers can access the report at www.cwci.org and others can purchase it at the Store.

Blog Post: Despite the Risks, Most WCMSA Plans Include Funds for Long-Term Opioid Use published first on http://www.lexisnexis.com/legalnewsroom/workers-compensation/rss.aspx

0 notes

stogutrosenberry · 7 years

Text

California’s work comp formulary

California’s work comp pharmacy formulary process is moving ahead, but I have grave concerns in two areas – timing and cost. (these are my personal concerns and are not intended to represent the views of CompPharma, LLC.)

First, timing.

The rules writing process is ongoing, while the formulary is slated to be implemented January 1, 2018.

The rules aren’t even finalized yet, and it’s August.

That’s less than five months away. Five months for PBMs, payers, prescribers, patients and pharmacies to make massive changes to processes, internal formularies, IT systems, contracts, call scripts, and a thousand other things.

Next, cost.

I’ve talked with regulators, PBMs, payers, employers, about this issue, and tried to re-engage w regulators, without a whole lot of any success.

Regulators have told me that the drastic cut to the fee schedule won’t be a problem because:

a) Payers can pay for clinical and program management costs separately Well, no. Unbundling pharmacy management services is a non-starter. Most payers don’t have the ability to do pharmacy management inhouse, so they rely on their PBMs. Regardless the payers would have to figure out what should cost how much, and how to charge their employer customers for clinical and program management services. Payers don’t have any way to do this without massive IT changes plus re-doing their internal cost-allocation processes, and/or re-negotiating contracts and policy terms.

b) Payers can just pay above the fee schedule Again, highly unlikely. Most payers can and/or will NOT pay above fee schedule. Many TPAs and insurers are precluded from doing so in their contracts with employers, and most would have to re-program IT, reporting, and bill review systems. Plus, many employers just flat-out refuse to pay above fee schedule.

Now there’s a new formulary in the offing, one that will demand even more from PBMs. There remains much uncertainty around implementation details while the implementation date draws ever closer. Setting aside the very real problems inherent in unbundling clinical and program management services, there’s no way PBMs, payers, and pharmacies could plan for and implement all the things they’d need to do to implement an unbundled or above-fee-schedule pricing methodology by January 1.

The bigger issue is this – California employers’ drug costs have declined for several years, opioid and compound usage is down significantly, and the drastic cuts to the fee schedule plus increased costs to implement and manage the formulary are going to:

make it harder for all parties to implement the formulary; and

make pharmacy management a huge money-loser.

I don’t understand the logic here.

PBMs have been instrumental in cutting opioid usage in California every year for the last five years, investing huge sums in work that dramatically increases patient safety, reduces employers’ costs, but actually reduces PBM revenues and profits.

Now, regulators want to further cut PBM revenues while adding a LOT more work to pharmacy management…

That’s not to say the formulary in and of itself isn’t a potential positive.

From Alex Swedlow…

This formulary is an important step forward. The legislative intent was to increase quality of care and lower the high cost of drugs and the huge frictional costs associated with managing those drugs.

The formulary and regs that link prescriptions to the standard of care (MTUS) will raise quality of care. The exempt, special fill and perioperative drug lists will reduce some of the dispute resolution costs. UR is supposed to be for low frequency, high cost treatment like inpatient services, less so for high frequency low cost care such as pharmacy. That said, those who seek to exploit the new rules and regulations have the incentive and creativity to do so.

Solution:

Delay the implementation of the formulary and related changes for at least six months after the rules and regs are finalized.

Significantly increase the drug fee schedule.

What does this mean for you?

Adding a lot of complexity to the drug approval and delivery process while continuing to slash reimbursement will lead to unintended and potentially adverse consequences.

Note – I’m president of CompPharma, a trade group for work comp PBMs, but fee schedule changes and the like have no financial impact on CompPharma or me personally.

Article source:Managed Care Matters

0 notes