blackburn group inc.

Healthcare For Workers Compensation and Liability Insurance

In 2018, the healthcare industry will evolve to reduce costs throughout the system.  Workers Compensation and Liability Insurance professionals need to know the key healthcare trends to take advantage of cost savings in the systems.

Some of the major areas are:

Outcome based payment structures. Even though the Centers for Medicare & Medicaid Services (CMS) bundled payment initiative has been delayed, the industry is beginning to adopt these models.  As an example, a JAMA Internal Medicine study of Joint Replacement using bundled payment models, for “3,942 patients who received joint replacement surgery, there was a decrease of $5,577 (20.8%) in total spending per episode.   Most of the hospital savings came from implants and supplies, and most of the rehabilitation savings came from decreased use of institutional care.  Additionally, the study found, “A large portion of savings came from declines in implant prices and usage of high cost post-acute services—both changes that may be implemented rapidly without intensive investment in care coordination.” 

Market Consolidation. Health insurers want long term relationships with clients, and gaining market share is of primary importance to them.  An example of this trend is CVS’s recent announcement to buy Aetna to create a more integrated healthcare network of medical treatment and pharmaceutical products and services.

Amazon. Along with everything else available to consumers from Amazon, people will likely be able to purchase drugs from them in the near future.  With 30-40 people (up from just a handful a year ago) at Amazon working on setting up a pharmacy service,   it is expected that Amazon will disrupt the prescription drug market by purchasing a pharmacy benefit management company in the near future.  Stay tuned for more savings from these products and services.

Generic Drugs. In 2017, the Food and Drug Administration (FDA) approved 1,027 generic drugs detailed in a new report from the Health and Human Services Administration (HHS).  While there may be certain areas of treatment where prices will remain high due to research and development expenses, the regulatory approval of cost effective generic drugs is an important trend to keep in mind as you manage claims.

Telehealth. While the integration of remote technology into medicine is not new, there will be significant advances in 2018.  In a new report from CMS, telehealth providers will be supported with streamlined billing codes to encourage cost saving advances.  In the final rule, Medicare will finalize a “separate payment for CPT code 99091 (Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.”  New CMS funding for these procedures will likely expand into all areas of medicine in the future. 

To learn more about how our risk, claim and healthcare practices are achieving significant savings for our clients, contact Robert J. Blackburn at This email address is being protected from spambots. You need JavaScript enabled to view it. or 585-586-4530.


Blackburn Robert

By Robert J. Blackburn, Managing Principal, Blackburn Group, Inc., contact him at This email address is being protected from spambots. You need JavaScript enabled to view it..

Blackburn Group, Inc.   RiskPro® is a registered trademark of Blackburn Group, Inc.