Looking to the Future of Workers' Compensation
PCG健康小组的几名成员最近参加了工人补偿研究所的年度问题 & Research Conference in Boston. The conference convenes researchers, regulators, 和来自全国各地的其他工人补偿专业人士讨论他们在行业内看到的趋势.
Below we share a couple of highlights from this year’s conference, 包括对劳动力未来的讨论，以及工人补偿保险向价值关怀的转变. As always, if you have questions about these issues or want more information, we welcome you to be in touch by contacting Coy Jones at firstname.lastname@example.org.
Future Labor Force
在美国，通过基于雇主的保险，劳动力问题与医疗保健密不可分, the impact of unemployment on public health care programs, 以及工人赔偿保险作为医疗保健服务支付人的作用. 今年的会议以与工人补偿相关的问题和研究为主题，以分析我们今天的劳动力市场和展望未来的趋势为开幕.
Dr. Erica Groshen, former Commissioner of the U.S. 会议开幕时，他回答了以下问题:
- Is the economy as tight as a 4% unemployment rate suggests?
- How are artificial intelligence, robots, driverless cars, gig work, and more-fissured workplaces changing work as we know it?
Current labor market conditions: Since the end of the Great Recession, the U.S. has added 9.3 million jobs. As expected, the service industry has seen the most labor growth over the last year, particularly in the areas of professional services, leisure, and health services.
The unemployment rate is now down to 4.1%. Underutilization – discouraged workers, marginally attached workers, and involuntary part time workers – is also in decline. Of the unemployed population, 20.7% are long-term unemployed. 作为劳动力市场紧缩的进一步证明，目前每个职位空缺对应1个.1名失业人员，这与大衰退前的数据相当.
Dr. Groshen also explored the relationship between productivity and wages. She expressed concern that, until 1973, wages and productivity tracked on a one-to-one basis, but, since then, productivity has soared and wages have been stagnant.
Future of work: “零工工作，被定义为替代工作安排和/或临时工作，正在增加. Groshen pointed to concerns related to that sort of work. Gig jobs transfer risks from employers to workers. 雇主保护工人(健康和安全)的责任较弱, wage and hours rules, etc.), less stability for workers and communities (variable jobs or hours, less unemployment insurance, etc.), and less employer-provided training. The Bureau of Labor Statistics (BLS) Current Population Survey, however, 是否发现，每个人都认为零工经济的出现导致了工作和就业的重大转变，但似乎没有产生任何影响. 然而，有一些证据表明，人们并没有把他们收到1099份表格的工作视为“工作”.” Dr. 格罗申建议，需要进行认知研究，以弄清楚人们对零工工作的看法，这样劳工统计局才能调整工具，提出更好的问题.
Artificial Intelligence (AI)当前位置人工智能“复制了日常脑力劳动”，在经济领域也呈上升趋势. When AI is applied to routine work, such as coding, 其结果是，更少的人可以专注于只有人类才能完成的复杂任务，从而完成更高质量的工作. As AI rises in society, many jobs will be lost, 但是其他的就业机会也会被创造出来——类似于经济从农业转向工业时的情况. 创造新的工作岗位需要时间，失业的工人可能会失去一到四年的收入. 这就需要政府改变政策，帮助缩小就业差距.
Dr. 格罗申在会议结束时强调了官方统计数据的重要性. 联邦统计机构最近经历了多次预算冻结和削减, even as the demand for better data has grown. It is a classic public goods problem. Everybody uses it, it would be undersupplied by the private market, but few people are ensuring that it continues to exist.
Workers’ Comp Moves Toward Value-Based Care
As in the rest of health care, 基于价值的护理(VBC)在工人补偿保险提供系统中的使用正在增长. However, also similar to health care delivery more broadly, the acceptance of and readiness for VBC takes time. Also at the Workers Compensation Research Institute Annual Issues & Research Conference, Dr. Randall Lea presented findings from a recent, not yet published study that explored provider, payor, 监管机构准备在工人补偿中使用基于价值的护理服务和支付模式.
According to the study, most providers are informed about, interested in, and open to VBC – but not necessarily excited about the opportunity. 在接受调查的七家供应商中，只有一家通过有限的一人付费试点参与了一些VBC活动. 该服务提供者对这种体验持积极态度，但现在评估结果还为时过早.
The study found that payors are equally neutral about VBC opportunities. 在接受调查的7家支付公司中，只有一家正式参与了VBC(捆绑支付)。. 根据这项研究，支付者更喜欢关注他们认为的价值和护理质量(e.g. 高性能网络)等着看VBC是否会“流行”和可持续发展.
Most regulators surveyed are interested in VBC but cautious. 参与这项研究的15个监管机构之一正在从事与VBC相关的工作，并计划扩大这些努力. While other regulators are preparing for VBC, half of those in the survey are neither using VBC nor preparing for it, citing that they doubt “it will go in that direction.”
Despite the cautious attitude, the survey found that there are a number of providers, payors, and regulators that are currently engaged in conservative VBC. While they may not be ready to take on more comprehensive VBC models, 他们正在实施VBC的基本原则，包括绩效薪酬激励.
Looking toward the future, 该研究为那些希望在工人补偿保险的背景下看到VBC从想法到现实的人概述了关键的考虑因素:
- 提供者需要足够的患者来使VBC发挥作用——如果没有足够的病例来分散风险，提供者将不会对冒险感兴趣. 在没有或有限的雇主对特定提供者的指示的州，可能很难保证案件的最低数量.
- 因为工人的补偿福利和健康保险福利是不同的, VBC in this context needs to implemented with a broader set of measures. Benefits are paid only if the injury was causally related to work, the patient is unable to work, and when residual impairment is ratable. Factors related to causation, Return To Work (RTW), and impairment need to be included in the VBC for workers’ compensation model.
- 表现良好的提供者应通过财政奖励来鼓励参与, outcomes, and treating high acuity patients.
- There must be transparency across all stakeholders
- Payment models should be outcomes-focused, not discount-driven
- Models should be adaptable to current programs and regulatory conditions
- Reimbursement of providers should be fair and quick
- Fee schedules should not be used
- Patients should be steered to providers participating in VBC