Tag: 2022 News

EK Health Services Inc. is a national workers’ compensation managed care organization, and is a major vendor of utilization and bill review services for California claims administrators.

EK Health just announced the launch of Billtelligent, a proprietary technology that it says is taking medical bill review in workers’ compensation to the next level. Billtelligent eliminates barriers for EK Health, empowering an independence the national managed care company had not previously realized.

Billtelligent leverages a unique cloud-based, modular design focused on efficient bill handling through innovative strategies, supported by nimble technology. The company says it promotes flexibility through intelligent routing, automation, auto-adjudication and the ability to customize workflows with incredible specificity (without cumbersome management requirements).

“We did not want to create another software for software’s sake,” said Eunhee Kim, EK Health’s Owner & CEO. “With Billtelligent, we have control at all levels and we can bring the change our industry deserves. We will be faster, flexible and more accurate. This gives us the ability to better optimize managed care strategies and improve quality of care for injured workers – which is our ultimate focus.”

EK Health says it is keeping with its promise to transform the workers’ compensation industry as an innovator dedicated to integrity, transparency, and customer-focused solutions.

“We have been asked many times to ‘demystify medical bill review’, due to the unnecessary complexities, exorbitant fees and undisclosed revenue sharing that exists today,” shared Zebrah L. Jahnke, VP of Business Development. “We knew offering transparency required full ownership of our processes and technology.”

“It was clear to me that we needed to be free from the constraints of leased software to fully realize our potential. With Billtelligent, we have direct access to PPOs, allowing us to create our own onboarding and custom network design,” Kerri Wilson, EK Health’s President & Chief Operating Officer explained.

The company say the benefits and and advantages include:

– – Stands alone in design, functionality, and customization
– – Was built from the ground up by EK Health, giving complete independence and ownership
– – Is a modern bill review technology designed to evolve
– – Removes barriers through automation & limitless creative workflows
– – Replaces complexity with simplicity
– – Supports EK Health client programs with reduced turnaround times
– – Ensures quality results through efficient execution
– – Intelligent trigger-based routing for near real-time bill processing as the rule, batch processing as the exception
– – Real-time access; real-time status; real-time fixes – all before a bill is finalized
– – Sophisticated pended-bills load balancing to optimize workforce productivity
– – User-friendly, customizable client portal allows external users access to view bills for approval/denials within the bill’s life-cycle
– – Highly configurable and flexible system requiring minimal code changes to introduce new features, adapt to future requirements and onboard new clients-
– – Limitless unique bill routing workflows, automate agreements, and manage client-specific network structures

Through this innovative technology, EK Health says it is not just meeting clients where they are today, EK Health is taking them into the future with nimble solutions realizing immediate gains.

When HLTH launched in 2017, it embarked on an ambitious goal to disrupt the status quo for events within the healthcare industry. It set out to bring a new vision to healthcare events that embodied the industry’s highest aspirations for innovation and transformation, all while evolving the antiquated approaches that have existed for decades.

Healthcare is complex, and the community HLTH serves is multi-layered and consists of diverse individuals and organizations from around the world. Additionally, as the industry experiences a period of rapid change, one important adaptation HLTH is making to address these factors is a focus on audience journeys-tailoring pathways through content, programs and meetings based on a deeper learning about each population and individual that interacts with them.

Over the past five years, HLTH has become the preeminent event in the healthcare industry. This years industry event took place in Las Vegas starting on November 13. Content sessions this year showcase the most exciting, compelling thinkers and industry leaders. The event this year includes the StartUp Health Festival which has gathered thousands of CEOs, investors, world leaders and entrepreneurs to focus on solving the world’s biggest health challenges.

The fifth annual event drew thousands of healthcare leaders and innovators to Las Vegas. It’s only five years old, but the HLTH Conference has emerged as a big deal in healthcare. More than 300 people were expected to speak at the event. Some of the speakers included Greg A. Adams, chair and CEO of Kaiser Permanente, Sam Hazen, CEO of HCA Healthcare, Rosalind “Roz” Brewer, CEO of Walgreens Boots Alliance, U.S. Health and Human Services Secretary Xavier Becerra, and more.

Thomas Kurian, Google Cloud CEO, spoke to healthcare and technology leaders, outlining some of the company’s latest news and talking about how technology is changing the industry. Google Cloud is working with payers, providers, and pharmaceutical companies. “It’s an ecosystem that needs to deliver the care that people need,” Kurian said.

Google Cloud and Epic, the electronic health records firm, have signed an agreement hailed as the first step in enabling customers to run their Epic workloads on Google Cloud. Hackensack Meridian Health said it plans to move its Epic workloads to Google Cloud, touting gains in efficiency, innovation, and security.

Even with the COVID-19 pandemic and its assorted challenges, HCA Healthcare CEO Sam Hazen says the company has emerged with a commitment to embracing healthcare technology. Speaking at the HLTH Conference Sunday, Hazen said technology is the key to advancing everything from patient care to workforce development. “We’ve come out of the pandemic with a very focused effort in digitizing HCA healthcare in ways other industries have done,” Hazen said.

Geisinger CEO Jaewon Ryu made a case for value-based care. Ryu outlined impressive statistics demonstrating the effectiveness of Geisinger’s home-based health program and an initiative to help patients get better food.

To engage in such efforts, Ryu said, “You need a payment model that supports it.” And that’s where he made the case for health systems to move more toward value-based care, and away from the traditional fee-for-service model.

With value-based care, health systems are rewarded for improving patients’ health, and are essentially taking on the risk that they will be successful in keeping patients healthy, or at least from avoiding more costly care.

The Geisinger at Home program, which brings healthcare professionals to patients’ homes to manage complex conditions, has enjoyed considerable success, Ryu said. Patients in those programs have 36% lower hospitalization rates, and they have seen a 20% reduction in emergency department visits.

More summaries of these topics can be read on the Chief Health Care Executive website.

La Vonya Price suffered a stroke in 2003 that initially left her paralyzed. After years of treatment, she eventually regained the use of her body and relearned how to speak, stand, and walk, yet she did not fully recover. Price suffered some permanent paralysis, which limited her ability to walk and the use of her left foot. Throughout 2005 and 2006, Price had to use a walker and a wheelchair because of her limited mobility. By 2007, Price’s condition had improved, but she still struggled with grasping and holding items, although she could hold small items without them falling.

Price first worked part-time for the Victor Valley Unified School District between August 2006 and September 2006 as a substitute para-educator for special needs students. She was not required to take or pass a physical examination for the position, and she did not tell the District she had a disability or any medical restrictions.

After moving to another job elsewhere in 2013, but she returned to the District again in February 2018, when she was hired as a substitute Instructional Assistant for special education students. Price was assigned to work one-on-one with an autistic student, who would sometimes run away from teachers and aides, including Price.

In July or August 2018, Price applied for a full-time position as an Instructional Assistant for special needs students. She received an offer for a full-time position that was contingent on passing a physical exam. When she failed the physical exam for not being “medically suitable for the position,” the District rescinded the offer, terminated her as a substitute, and disqualified her from any future employment with the District.

The part-time and full-time Instructional Assistant positions have the same duties and responsibilities. As a part-time Instructional Assistant, Price was assigned to a one-on-one position with a “runner,” and she successfully performed that position before being offered the full-time position, even though she frequently had to run after students.

Price sued the District for retaliation and various disability-related claims, but the trial court granted summary judgment in favor of the District.  Price contended on appeal that the trial court erroneously granted summary judgment to the District because there are triable issues of fact concerning all of her claims. The Court of Appeal agreed as to her first claim for disability discrimination, but disagree as to the rest of her claims in the published case of Price v. Victor Valley Union High School Dist.- E076784 (November 2022).

The District asserts the fact that Price failed her physical examination means that she was not qualified to perform the job. The Court of Appeal disagreed.

The District reads Quinn v. City of Los Angeles (2000) 84 Cal.App.4th 472 to stand for the broad proposition that an employer may always impose physical requirements as a condition of employment and thus may always refuse to hire someone who does not meet those requirements. In Quinn the plaintiff-police officer was not qualified for the position because he failed a “sound localization test” due to a hearing impairment. “The ability to localize sound is particularly significant to police officers in split second, life-threatening situations when an officer cannot clearly see.” The Quinn court held that the plaintiff’s termination was lawful because he “was never initially qualified for the position” as a matter of law.

The court Quinn court “did not hold that employers have unfettered discretion to deny employment to anyone who fails any physical test, as the District suggests.” Rather, the Quinn court recognized only the “fundamental principle” that employers may deny a position to an applicant who cannot safely perform the essential functions of the job due to a medical condition.

Because the determination of essential job functions is a “highly fact-specific inquiry,” it is usually an issue of fact for the jury to decide. The District argues Price could not perform the essential functions of a special education Instructional Assistant because of her medical restrictions. In particular, the District contends the job had physical demands that Price could not meet, namely, running after students. Even if true, Price has raised a triable issue of fact as to whether this was an essential function of a full-time Instructional Assistant.

Walmart claims in Arkansas state court that 45 of the nations largest insurers wrongly refused to cover losses incurred as a result of defending itself against more than 2,400 opioid lawsuits. Jurisdiction in Arkansas is claimed because Walmart is headquartered in Bentonville, Arkansas, and the parties conduct business in Arkansas, including the Insurers selling insurance to Walmart in Benton County, Arkansas.

This action involves nearly 200 insurance policies spanning two decades, and many of those policies are dozens or hundreds of pages long.

According to the Complaint they failed, they allege that Walmart has paid millions of dollars to 45 Defendant Insurers – many of the nation’s leading insurance companies – for broad general liability policies designed to protect Walmart against potential risks to its business.

They say those risks have now manifested themselves in the form of more than 2,400 Opioid Lawsuits that have been filed against Walmart. Those lawsuits seek damages because of, among other things, bodily injuries allegedly arising out of opioids or opioidcontaining products that Walmart sold, distributed, or dispensed.

Walmart claims it has spent tens of millions of dollars defending itself against the Opioid Lawsuits and expects to spend much more in the future. Walmart timely notified the Insurers of each of the Opioid Lawsuits. But now they say “the Insurers have turned their backs, providing a litany of excuses why the policies supposedly do not cover the Opioid Lawsuits.”

“Those excuses are meritless, as Walmart has repeatedly explained to Insurers, yet they continue to refuse to live up to their obligations under the policies.” And they go on to claim that “the underlying Opioid Lawsuits seek damages sufficient to exhaust all layers of coverage provided by Insurers’ Policies.”.

“Insurers have either reserved their rights to deny coverage, denied their duties to defend or indemnify, and/or otherwise failed to acknowledge their obligations to provide coverage for the Opioid Lawsuits on a series of baseless grounds.”

“For example, certain Insurers have asserted that these lawsuits are not brought “because of bodily injury,” despite complaints and settlements expressly stating otherwise and making clear that the underlying plaintiffs’ alleged damages are because of alleged injury and death to hundreds of thousands of individuals as a result of opioid abuse and addiction.”

“Certain Insurers have also asserted that coverage for the Opioid Lawsuits is excluded because the damages at issue in them were “expected or intended,” even though these lawsuits include numerous allegations of negligent or otherwise unintentional conduct or injuries, many of the settlements are expressly based on negligent conduct, not intentional harm, and Walmart has vehemently denied that it intended or expected to harm anyone.”

Many of the Policies are “primary” or first-level policies, meaning that they obligate the issuing Insurers to defend or to pay for Walmart’s defense and to indemnify Walmart either from the first dollar spent, or once a self-insured retention is satisfied. Those policies were issued by Defendants National Union, American Home, and the Insurance Company of the State of Pennsylvania.

Other Policies are umbrella or excess-layer policies, which, among other things, obligate the issuing Insurers to defend or to pay for Walmart’s defense costs and/or to indemnify Walmart for settlement or judgment costs when those costs exceed specified retention amounts or amounts of coverage available under lower-layer Policies or when coverage is not available or not collectible from such lower-layer Policies. The umbrella and excess-layer Policies were issued by various Insurers.

Andrew Glick claimed injury to his left knee, lumbar spine, neurological system, and “ophthalmology/vision/eye,” while employed as a truck driver by Knight-Swift Transportation Holdings, Inc. when he was injured on November 26, 2018.

Glick was struck by a motor vehicle while crossing the street. The vehicle was traveling at approximately 30 miles per hour at the time of impact, and he was thrown approximately 10 feet, landing on the ground on his left side. Glick was knocked unconscious, and was transported by ambulance to Riverside Community Hospital, where he was diagnosed as having sustained a fractured left tibia, left fibula, left femur, right scapula, right clavicle, right and left temporal bones, L1 vertebrae, L2 vertebrae, L3 vertebrae, L4 vertebrae, and a left “brain bleed.”

On June 9, 2020 the Qualified Medical Evaluator (QME) in Physical Medicine and Rehabilitation noted his “number one problem” was vision difficulty:” The report said that “He was told he has nerve damage behind the right eye, so if he drives or does activities requiring any kind of balance or proprioception, he closes the right eye and only uses the left.” Mr Glick remained temporarily totally disabled.

A QME in ophthalmology reported in August 2020 that he was “not yet permanent and stationary, and required a strabismus (eye muscle) surgery to address superior oblique palsy, because “[t]he function of the 4th nerve cannot be restored.”

After an Expedited Hearing on the issue of whether Mr. Glick was entitled to temporary disability continuing from the last date paid of approximately 11/24/20 and continuing, pursuant to the applicability of Labor Code § 4656 (c)(3)(F), the WCJ issued his F&A, finding that Glick sustained injury to the “ophthalmology/vision/eye,” caused by a “high velocity impact,” resulting in “temporary total disability for which defendant has paid 104 weeks and which said benefit is ongoing.” The WCJ found defendant liable for ongoing temporary total disability pursuant to Labor Code section 4656(c)(3)(F).

Reconsideration of this Award was denied in the panel decision of Glick v Knight-Swift Transportation Holdings, Inc – ADJ11799924 (November 2022).

The WCJ filed his Report, observing that the statutory requirements were met because applicant sustained a high velocity impact to his person, which was the direct cause of both a concussion and a resulting eye injury.

The employer contended that the “plain language or common meaning” of the term “high-velocity eye injuries,” as set forth in Labor Code section 4656(c)(3)(F) refers to “at least some impact of the eye.” And cites as authority Cruz v. Mercedes-Benz of San Francisco (2007) 72 Cal. Comp. Cases 1281 [2007 Cal. Wrk. Comp. LEXIS 247] (Appeals Bd. en banc), were the WCAB applied a “common sense and ordinary meaning” to the term “amputation,” and that a similar analysis of section 4656(c)(2)(F) requires there be “some impact to the eye.”

Andrew Glick cites Glover v. ACCU Construction (June 15, 2009, ADJ665716 (BAK 0154393) [2009 Cal. Wrk. Comp. P.D. LEXIS 301] Glover was operating a mulching mower when he was struck by a metal fragment that entered his nostril, lacerating the nose and fracturing the eye socket before traveling through the brain and lodging in the back of the skull. In Glover the panel concluded “We are not persuaded that “eye” should be defined so narrowly, yet we need not delineate the outer limits of our definition at this time. We have examined applicant’s medical records and find ample evidence of injury to and treatment of the right eye.”

Turning to the issues in the claim of Mr. Glick, the panel followed its reasoning in Glover and concluded “Here, the facts support a similar analysis.”