Paduda: Will We Learn the Right Lessons from the COVID Crisis?


The COVID pandemic is forcing our very conservative industry to do the unthinkable. Insurers who abhorred work from home (WFH) have shifted 90% + of their workforce out of central offices.  Payers that paid lip service to telemedicine are scrambling to get their vendors, patients, and employers on board.

In retrospect, executives should have done both a long time ago. Many other industries adopted WFH and flexible officing years back.  Pretty much every group health insurer, managed Medicaid and Medicare Advantage plan fully implemented telemedicine more than a year ago.

To be sure, some payers – Cincinnati Insurance and Strategic Comp among them – have long had professionals managing claims from home offices, but most insurers have resisted the move. To be fair, I’ve been in many claims operations where there was great collaboration, strong teamwork, and everyone liked to be there.

The resistance to WFH seems to stem at least in part from some executives’ concern that employees will goof off and not work if management isn’t a cube or two over. It’s a control thing, a throwback to the long-ago day when supervisors walked the factory floor with their eagle eyes watching every move, using time-and-motion studies to get the last second of productivity out of every worker.

Bosses treated workers like automatons, as if they were programmable robots instead of thinking, creative, responsible, caring humans.

If you’ve ever driven a late-sixties American made car you know how that turned out; crappy fit-and-finish, most cars had mistakes that had to be fixed before they even left the assembly line, and lots of warranty repairs. When you stand over workers, they a) don’t feel responsible for their work and b) don’t use their brains to help make the process and the output better.

There’s another issue here – the press is rife with reports of an aging insurance workforce, concerns about expertise leaving the industry and few young workers choosing insurance as a profession.

Would you? If you were a younger person in a relationship, perhaps planning on kids, would a long commute to a desk job with modest pay where a boss constantly monitors you be your idea of paradise?

How about a job where you could flex your work hours within limits, could collaborate remotely and occasionally in a central office, and didn’t have to sit in traffic, soaking up fumes, wasting time, and paying for gas?

Payers are also regretting they didn’t do more than pay lip service to telemedicine (I’m using the term to cover everything from triage to rehab to psych to follow-up visits). Reality is, existing patients aren’t getting the treatment they need, and thus their return to work clearance is on hold, because they can’t get into their treaters. While telemedicine isn’t a cure-all, if it had been implemented broadly it would have been a huge help.

Patients could have continued their PT under the watchful eye of a clinician. Treating physicians could have discussed medications and the result of therapy with patients, helping move them thru the recovery process. Patients concerned about returning to work could have engaged with psych professionals to address their fears and concerns. The most innovative would have shipped wearable technology to patients so they could actively monitor patients’ rehab process, evaluate strength gains and compare range of motion.


Our resistance to innovation, abhorrence of anything remotely risky, new, or different, and deep complacency will be costly indeed.

Rahm Emanual, the former White House Chief of Staff and Mayor of Chicago once said “never let a good crisis go to waste.” Here’s hoping industry leaders learn not just the small lessons of COVID19, but the larger, strategic ones as well. If they don’t, our industry will be even less prepared for the next crisis.

By Joe Paduda

Joseph Paduda, the principal of Health Strategy Associates, is a nationally recognized expert in medical management in group health and workers' compensation, with deep experience in pharmacy services. In addition to consulting with managed care organizations, employers, health care providers, insurers and private equity firms, Health Strategy Associates conducts regular surveys on managing work comp pharmacy costs, utilization review, bill review systems and claims systems.

Paduda is also the prolific author of the controversial Managed Care Matters blog and a founder of Health Wonk Review, a collaborative blog on health care policy.


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