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MONTANA SELF INSURERS' ASSOCIATION

July 2022 Update

  • MSIA Dues – Due by July 31
  • MSIA Business & Annual Meeting & Governor’s Conference – Missoula 9/28
  • National Council of Self Insurers Conference Report
  • Welcome New Members – MES, Prodigy Rx & Clarus IME!
  • AMA Guides Proposed 2023 Updates Open for Public Comment by 7/15

MSIA Dues – Due by July 31

We have sent out the first notice regarding MSIA dues for 2022 – 23. We spent most of our time this year working on improving our Association and broadening our impact, both in Montana and nationally. We created the WCCM – a business/labor group dedicated to discuss workers’ compensation issues. While we will not agree on everything, we have already had a positive impact on holding back changes that would not be positive for our system. We joined WCRI – the national workers’ compensation think tank, MSIA has become a member of the NCSI Executive Committee and will be spearheading an effort at greater communication between state self-insurer associations. We took care of the business of your Association, created the MSIA CE Webinar Series and increased both Employer and Associate member numbers. MSIA is poised to help put in more changes during the next legislative session to improve the system for all – not just one side. By supporting balanced changes, we help ensure long-term positive impacts, not just immediate impacts.

You can your dues pay via electronic funds transfer, check made out to MSIA and mailed to our office address below, or by credit card through our website, Montana Self Insurers' Association (mtselfinsurers.org). You will need your Members Only password to access the credit card payment system. Members will continue to have access to the latest information within Montana, research from across the country and system results. If you need more information or have questions, don’t hesitate to contact me.

MSIA Business & Annual Meeting & Governor’s Conference – Missoula 9/28

The MSIA Business Meeting will be held at the Missoula Hilton Garden Inn on Wednesday, September 28, starting at 8:30a for members and invited guests only. We will discuss MSIA issues – last year’s meeting minutes Montana Self Insurers' Association (mtselfinsurers.org) (Members Only section under Governance Documents). You will need your Members Only password to access the Governance Documents – please contact me if you need it refreshed. We will also discuss proposed Bylaw changes, our budget and business operations results. We will also vote on two Board seats – both Mike Marsh of Midland Claims, MSIA Board Treasurer/Secretary and Dee Walcheck of Logan Health have agreed to run again for their seats. Members will have the opportunity for other nominations from the floor as well. 

The MSIA Annual Meeting will start at 9a and will again be open to all. Our guest speaker will be Dr. Greg Vanichkachorn, of the Mayo Clinic.

Dr. Greg Vanichkachorn - MD, MPH, FACOEM Occupational & Aerospace Medicine Physician, Mayo Clinic. Dr. Van is an occupational and aerospace medicine physician at the Mayo Clinic. He is the medical director for Mayo’s first program for COVID long haulers, the Covid Activity Rehabilitation Program. Prior to his work at Mayo, he practiced in northwest Montana for nearly a decade, helping injured workers recover their function and lives. Outside of medicine, he is an avid fly fisherman, an Ironman triathlete, and a private pilot.

Dr. Van will speak about the Mayo’s Long-COVID work and their latest results. We are working with Dr. Van to get CE credits for his presentation as well.

The Governor’s Conference will also be at the Missoula Hilton Garden Inn and will start the afternoon of September 28. Register here: 2022 Governor's Conference (regfox.com). The Conference will run from September 28 – 30 and the agenda is:

  • OPENING KEYNOTE: The National Commission's Report 50 Years Later: What is Needed to Achieve the Vision of the "Grand Bargain" - Elaine Weiss
  • Plumbing & Wiring: Thoracic Outlet Syndrome - Dr. John Schumpert
  • When Words Don't Help - Bob Wilson
  • ODG by MCG - Improving Workers' Compensation Outcomes with Evidence-Based Medicine - Patrick Robinson
  • Lighting the Torch - Mark Pew
  • Physician Roundtable: Hot Topics in Workers' Compensation - Dr. Maggie Cook-Shimanek, Dr. Devin Owens, Dr. John Petrisko, Dr. John Schumpert & Dr. Hans Schwertz
  • Workers' Compensation Trends, Topics and What Will Happen (Maybe) - Peter Strauss
  • Examiner Panel Discussion: The Evolution of Working Claims - Kevin Bartsch, Jaimie Kern & Chris Simonson
  • Workers' Compensation Court Case Review - Judge David Sandler
  • The 4 Things You Need to Do - Mark Pew & Bob Wilson
  • Medicare Secondary Payer Landscape: The 3 Pillars - Amber Worman & Ciara Koba
  • CLOSING KEYNOTE: If We Share The Vision, Why Do We Argue - Tamara Hall

Register for the Governor’s Conference here: 2022 Governor's Conference (regfox.com)

National Council of Self Insurers Conference Report

Thanks to your support of our efforts, we have become active with the National Council of Self-Insurers. They have elected me to their Executive Committee, which serves as their Board of Directors. I made some good contacts while at the NCSI Annual Conference held in Scottsdale from June 12 – 15, including some of my Executive Director peers from other state self-insurer organizations. I anticipate putting together an improved communications vehicle through the NCSI for state associations to trade information on what is working and the issues we are dealing with. I have already shared information on MSIA activities as well.

The NCSI Conference provided very high quality presentations from national leaders, including Mark Pew the RX Professor, Max Koonce of Sedgwick (an MSIA member), Ann Klein of Majoris Health Systems (an MSIA member), Phil Walls of myMatrixx (an MSIA member) and others. Speakers’ presentation packages are available through the NCSI Conference website at https://www.natcouncil.com/2022-annual-meeting

Sedgwick’s Max Koonce was the keynote speaker and reviewed our world, social issues, COVID and politics, which all shape our attitudes and ultimately, our work. In looking at the WC systems through the lens of Dr. Richard Victor’s book, Threats and Opportunities for Workers’ Compensation Systems, Scenarios for the 2030’s, Koonce identified some issues facing our systems:

Demographic Changes – the great resignation, really, the realization of the retirement bubble we all knew was coming, combined with societal changes as a result of the pandemic’s impact on how we live. The result is record numbers of job openings along with low unemployment. Add that some employers are flip-flopping on whether people will be in the office, or not. The ultimate reality is likely a hybrid of at home and in office work environments. As well, we have grown in our appreciation of the need and necessity of paying attention to mental health issues.

Health Care Reform – in addition to governmental reforms of health care, our societal perspective of health care has changed. Koonce reported that some 90% of 18 – 24 year olds trust the medical information they get from social media. Koonce also reported that a recent Robert Wood Johnson study found that only 30% of Americans have trust in health systems and institutions. While they trust their physicians, they do not trust the systems those physicians work for.

Legislative and Regulatory Reforms – over the past two years we have seen more presumptions put into law, whether via Executive Order or statutory changes. Of all those, Koonce highlighted the Illinois legislative changes which provide the only definition of the rebuttable presumptions for COVID. Illinois statutory language permits a rebuttal to a COVID claim, if the employer could prove they followed the CDC guidelines. Unfortunately, it seems so far, the Courts in Illinois have found that if the worker contracted COVID through work, it remains as compensable, regardless of the standards the employer put in place. As well, Illinois then enacted language that makes staph infections suffered by first responders presumed to have occurred at work, and therefore compensable. On the flip side, Washington enacted legislative language that provides a presumption of workers’ compensation coverage for a disease that is the subject of an Executive Order – obviously, this is not limited to COVID – but would apply to the next pandemic as well.

The growing attitude within the systems and society is our responsibility to take care of the employee, and less concern over which silo those benefits may come from. While there is nothing particularly wrong with the sentiment, nor the goal, how we manage it and what it means for the workers’ compensation systems has yet to be fully recognized.

Klein, President of Majoris Health Systems talked about their experience with change as a result of crisis. It is trite at this point to say the pandemic threw us all for a loop. However, how we responded and how we can use those lessons going forward should inform us on those lessons going forward.

There is no magic here – just hard work and a need to understand yourself and your organization. There have to be honest discussions, both internally and with your customers regarding

Identifying the Problem – not really knowing what the issues are, means you will never address them

Reinforce the Relationships & Open New Lines of Communication – resolving problems and working together requires trust. A lack of clear, open, honest and broadening lines of communication means this business relationship will never be a business partnership.

Gather & Use New and Better Information – while some information may not to be on point – ask how the information could be used versus dismissing it as irrelevant to the issue

Klein quoted Rahm Emanuel when he said, “Never let a good crisis go to waste when it is an opportunity to do things you had never considered or that you did not think were possible.” Everyone, from the lowest position in an organization to the highest is affected by crisis. Do not overlook those on the front lines, the front desk and particularly those with direct customer contact in reviewing the strategic and tactical approaches to doing things differently – and in so doing – differentiating yourself and organization as a contributor and partner.

That goes as well for your staff – if they really are your most valuable resource, dedicate attention to what they know, what they are saying and what they are feeling. Ask, What’s working?, What’s not working?, What are your key concerns? and, How can I help?

Walls, of myMatrixx spoke of a new term, to me, “pharmacovigilance” - monitoring drugs and drug interactions at the pharmacy level.

For example, Walls cited that all NSAIDs – non-steroidal anti-inflammatory drugs - have cardio-vascular side effects. The most famous examples are Celebrex and Vioxx cases. While some impacts are not significant, consider who is most susceptible to cardio-vascular issues – our aging population. Then consider what else is happening - a clear and steady aging of our workforce. While we do not have an specific correlation to increased medical issues on this issue at this time – it opens interesting questions.

Walls’ perspective is that our opioid crisis was like teaching physicians how to fly a plane - - but not teaching them how to land it. As a result, while we have made great strides, we are a long way from resolving the crisis. He touted Prescription Monitoring Drug Programs (PDMPs), which are now enacted in all 51 jurisdictions, as effective in providing pharmacovigilance in that all filled prescriptions are recorded. The issue with PDMPs in many states, is physicians are not required to review the data for their patients prior to writing a prescription. However, PDMPs, even with those flaws have been effective in limiting drug interactions and illegal drug trade. While we’re a long way from greater effectiveness there is progress. A growing issue is with Cannabis – as an illegal drug, it is not recorded in the PDMP programs. 

Rachel Fikes, Chief Experience Officer for Rising Medical Solutions (an expected MSIA member) lead a panel discussion on the Rising Workers’ Compensation Benchmarking study and results with Dr. Tyrone Spears, City of Los Angeles Workers’ Compensation Chief and Vicki Kennedy, formerly the Assistant Director for Insurance Services with the Washington Dpartment of Labor & Industries. The study reviewed the resiliency of workers’ compensation organizations and provided comparisons, based on survey responses of how different types of organizations work to remain resilient.

Spears lead off with one of the impacts we all feel from the pandemic – the great resignation – which he termed the great realization. This, because he recognizes that people realize they don’t want to work. With that, Spears pointed out that people want to have work with a purpose. Decision makers – those who are real leaders – understand that they are there to help their staff work for a just cause, not just to have a job. The move towards an advocacy-based claims management fits this approach particularly well. In recognizing the social determinants of health, providing more understanding what people need to recover and thrive after a workplace injury rather than managing claims by rote attention to benefits based on law.

Both Spears and Kennedy talked about the American Hospital Association’s quantification of the social determinants of health –

  • Socio Economic Factors             40%
  • Physical Environment                 10%
  • Health Behaviors                         30%
  • Medical Care                                 20%

In addressing these issues, in addition to providing the legally required benefits, claim management results will improve. While spending some time and resources (money) in addressing things like, how someone may be able to get to and from medical appointments or child-care for the time a parent may be recovering from surgery are not legally required, but can make a significant difference in the overall cost of the claim and the time away from work. In addressing those issues, the relationship between the injured worker and claims examiner is also positively different. The focus shifts from what is legally required to what is needed to bring the injured worker to recovery. That is the ultimate goal of a modern workers’ compensation claims operation.

Mark Pew and Ashley Wynn-Grimes provided a new perspective on cannabis as a medicine. Our conversations have shifted from whether cannabis is legal or not, as the majority of states have already answered that question for medical purposes and many have decided it is legal for recreational purposes as well.

The new conversation is how to best use cannabis as medicine. Their presentation provided the scientific support and demonstrated the value of having a trained medical professional involved in medical cannabis usage. For all other drugs, we have strict dosing and use requirements. For cannabis we often rely on a high-school educated bud-tender for advice and direction. Wynn-Grimes offered that a trained medical professional regarding the impacts and dosing of different strains, different methods of ingestion and a more scientific approach can make a significant difference in results and the resulting quality of life for the injured worker. Absent that approach, at best the patient is involved in a guessing game and may or may not return to a productive life.

More and more we are recognizing the need to regulate the use and dosing. Currently, there may be 100- 150 medical professionals who are familiar with the impacts of cannabis as a medicine. Until that number increases, we will remain in the wild west of medical usage. As an example, CBD is legal in all 51 jurisdictions, thanks to the federal farm bill, which created cannabis for these purposes as a crop, not a drug.

The NCSI website has the Conference information and individual presentation packages at the 2022 Annual Meeting page here: https://www.natcouncil.com/2022-annual-meeting

Welcome New Member – MES Solutions !

Medical Evaluation Specialists (MES Solutions or MES) is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims.

MES understands the necessity for standards and evidence-based IME and peer review services. MES IME Services, Peer Review Services, and Disability Review Services are tailored to meet unique client, statutory, and regulatory requirements. We build custom workflows, portals, and processes that are aligned with the business requirements of our clients. We honor the fixed cost mind set that makes business predictable. So whatever customization needs to take place is on us. For more information contact Tyler Catalano at 206-291-6656 or tyler.catalano@messolutions.com. Visit their website at Home (messolutions.com)

Welcome New Member - Prodigy Rx !

Prodigy started with a simple objective: to deliver pharmacy benefits with full transparency. Prodigy’s founders have decades of experience in clinical pharmacy, workers’ compensation, group health, PBM and other ancillary clinical services.

We have seen incredible advancements in therapies, clinical specialists and clinical services that continue to make a difference in the lives of patients. On the other hand, with all of these improvements, the industry has become segmented, disjointed and siloed. A disconnect exists between pharmaceutical costs and clinical outcomes. Information does not efficiently flow between patients, payers and providers. As a result, we have a sick-care system rather than a health care system, and the cost of pharmacy and other medical services continues to rise. It is time for a better way to do pharmacy. We have applied decades of deep understanding and expertise to redesign how we deliver pharmacy to do it better, faster, smarter - for patients, providers and payers. For more information contact Bryan Condie at 801-664-5820 or BCondie@ProdigyRx.com. Visit their website at Prodigy Rx.

Welcome New Member – Clarus IME !

Clarus IME represents a wide range of medical professionals in specialties ranging from Orthopedic Surgery, Physical Medicine and Rehabilitation (Physiatry), Neuropsychology, Psychology, Forensic Psychiatry, Internal Medicine, Cardiology, and others. We are comfortable dealing with reported injuries to all body parts including the spine as well as TBI cases, psychological examinations, and even the assessment of COVID long-haul issues. In complicated cases, the group of doctors we represent can often work as a panel, allowing us to bring together the necessary specialists to assist claimants dealing with multiple medical issues. We pride ourselves on the teamwork of our doctors in addition to their exceptional education and experience.

If you need an IME, expert witness, chart review, impairment rating, or even something as simple as a job analysis, we are happy to arrange it with the appropriate doctor(s). Clarus IME has developed sophisticated methods of obtaining, sorting, and managing records – and more than willing to help you with those tasks, too. We work out of locations around the state of Montana that range from our primary offices in Missoula to Glasgow. For more information contact Jere Kolstad at 406-546-0474 or JereKolstad@ClarusIME.com. Visit their website at clarusime.com.

AMA Guides Update Public Comment

Proposals to update the AMA Guides® to the Evaluation of Permanent Impairment are being considered by the AMA Guides Editorial Panel for adoption, with an effective date of January 1, 2023. Specific topics addressed include spine impairment, upper extremity range of motion, and editorial changes to ear, nose, and throat evaluations. Proposals build upon the update to the sixth edition issued in 2022. 

Interested parties and organizations who utilize the AMA Guides are invited to participate in the process to comment on the proposed changes to the medicine and impairment ratings. The AMA Guides Editorial Panel will consider all available information and comments prior to adopting these changes as part of AMA Guides Sixth 2023. 

The public comment period is scheduled for June 1- July 15, 2022. Based in part on your direction and MSIA input, Montana has not adopted the new updates to the Guidelines, and our analysis has not been completed on the proposed changes. This topic will be a discussion point at the Governor’s Conference with a medical panel lead by the ERD Medical Director, Dr. Maggie Cook-Shimanek.


For more information on how to participate and to begin the request process, please visit https://ama-guides.ama-assn.org/books/pages/public_comment  

I look forward to seeing everyone at the MSIA Business & Annual Meeting – your attendance or proxy is VITAL to our conducting our business – including Associate members!

Enjoy the summer while we can!