Author Archives

For more than a decade, Carlos Luna has been a trusted adviser to shareholders and stakeholders in claims, utilization review, managed care, insurance, and government agencies. His consultation focuses on effectively incorporating Evidence-Based Medicine (EBM) content and tools into the Workers’ Compensation clinical and claims workflows to achieve improved healthcare, return-to-work, and financial outcomes.

A recognized thought-leader on national workers’ compensation issues, Carlos’ blogs have been published by industry-leading publications such as WorkCompCentral, WorkCompWire, Insurance Business Magazine, Louisiana Comp Blog, and more. He was named a “New Leader in Workers’ Compensation” by WorkCompWire in 2017 and was featured as LegalNetInc.com’s “Thursday Thought Leader” in 2018.

A regular speaker on regional and national workers’ compensation conference circuits, he has become a guiding voice within key regulatory focused associations such as the International Association for Industrial Accident Boards (IAIABC) and the Southern Association of Workers’ Compensation Administrators (SAWCA).

Engaging Regulatory and State Workers’ Compensation representatives has been commonplace throughout Carlos’ career. He has played an integral role in assisting regulatory agencies throughout the country to disseminate training and compliance programs to maximize user adoption of EBM content and tools and reduce overall friction on the system in each jurisdiction.

Carlos is passionate about establishing a balanced workers’ compensation system that benefits all of its stakeholders.

  • The California King Case: Imperceptible Implications for UROs

    Irrespective of overwhelmingly positive data published on appropriate UR decisions, the UR process becomes a target of criticism. Largely driven by a lack of understanding, a push to unravel this layer of protection for injured workers persists. The overutilization of unnecessary medical care is not a benefit, it is a risk. Here are my thoughts on how the King case may motivate this movement come next year’s legislative session.

  • The Narrative of Workers’ Compensation is Changing

    Tragedy has a way of spurring unexpected outcomes bringing people together from all walks of life and disciplines. Here are my observations on the paradigm shifts happening throughout workers’ compensation partly due to the global tragedy that is the opioid epidemic.

  • Complacency or Complexity: California UROs Crawl to Accreditation

    Another important July 1st deadline has come and gone for the California workers’ compensation community. As of mid-June, nearly half of California’s Utilization Review Organizations had yet to complete the accreditation process required by newly modified Labor Code section 4610(g)(4). Is the crawl to compliance due to a complacent system culture or a costly and complex accreditation process?

  • The Crux of the Opioid Epidemic

    The crux of the opioid crisis is in unchecked, inappropriate prescribing habits. Absent of comprehensive medically responsible prescribing standards, today’s opioid issue has the potential to evolve into another prescription drug crisis. Are narrow legislative bills enough to keep injured workers safe and encourage a paradigm shift among prescribers?

  • Collaboration Drives Improved Health Outcomes

    Health care information technology may be making the world smaller in many ways, but wide divides remain in the care and claims continuum. Bridging the gaps in the workers’ compensation space requires a conscientious focus on collaboration, human to human. Collaboration effectively creates an interactive and adaptable system capable of delivering improved patient health outcomes.

  • It’s About Time the Feds Focus on States’ Success in War on Opioids

    The U.S. House of Representatives has held numerous information-gathering meetings. The divide that exists between state and federal government has never been more clear as the feds turn their focus on the success that state workers’ compensation systems are having in the war on opioid abuse. But, are all aspects of the crisis being considered?

  • Beyond Pennsylvania Politics

    Pennsylvania, who is hosting one of the fiercest battles in the war on opioids, will not adopt a nationally recognized evidence-based medicine drug formulary. Is this the outcome of Pennsylvania politics, the right move to preserve the doctor to patient relationship?