Why Competition Drives Drug Prices Up, Not Down

November 30th, 2016

viagraIn June, New York City-based Pfizer raised the price of Viagra by 13 percent. Just days later, Indianapolis-based Eli Lilly followed suit, increasing the price of Cialis by the same amount, reports The Wall Street Journal.

Read the rest of this entry »

BCBS To Pay $50,000 Broker Sales Incentive Each Fully Insured Group Sold

November 30th, 2016

holycrap

Holy Crap! BCBS announces $50,000 sales incentive bonus on each new fully insured group sold! Why sell anything else?

Read the rest of this entry »

Case of the Singing Canary?

November 30th, 2016

canaryWill Haff, a San Antonio insurance consultant, has had his sentencing postponed a second time (Consultant Sentencing Delayed Again – Now 30 November 2016).Sentencing is now set for February 1, 2017.

Read the rest of this entry »

Rising Drug Costs Lead to PBM Scrutiny

November 29th, 2016

kickback222

If prices rise more than an agreed upon rate, excess increases may be offset by additional rebates. For some employers this means the PBM is pocketing some or all of the rebate money, driving record profits. In these cases there is absolutely no incentive on the part of the PBM to lower Rx costs. Rather, they earn more kickbacks as drug costs escalate. This revenue sharing between the PBMs and manufacturers at the expense of consumers continues to fuel spiraling Rx costs.

Read the rest of this entry »

Defenseless Utah Hospital System Faces RBP Blitzkreig

November 29th, 2016

blitzkreig

“The purpose of this notice is to formally advise you that University of Utah Health Care does not participate with ELAP or other “cost plus” plans being promoted in Utah or surrounding states.”

Read the rest of this entry »

Weslaco Independent School District Continues Aggressive Risk Management Strategies

November 29th, 2016

txfreemkt

Much to their advantage, Weslaco Independent School District in deep South Texas has effectively injected competition in local health care delivery. WISD has learned that health care givers will compete for business if given the opportunity

Read the rest of this entry »

Are Health Systems Improving Price Transparency?

November 28th, 2016

pricinggood“Some business is being diverted away from hospitals and toward retail clinics, standalone surgical centers and urgent care facilities that advertise their prices and services……….…’

Read the rest of this entry »

After Healthcare’s “Katrina”, Who Wins/Loses?

November 28th, 2016

competitionHealthcare stole the American Dream. But I’m excited to tell you a story about how forward-looking citizens, nurses and doctors are taking it back by fixing healthcare. And it’s working. 

Read the rest of this entry »

MEC Plans – A Tax Dodge Whose Time Has Come & Gone?

November 26th, 2016

mulebriar

By Molly Mulebriar

Minimal Essential Coverage (MEC) plans are simply a tax dodge utilized by employers seeking to minimize the Affordable Care Act’s punishing mandates. By offering a MEC plan with essentially no benefits other than coverage for preventative care an employer can avoid the $2000 per year fine for every full time employee (minus the first 30).

Read the rest of this entry »

Cleveland Clinic CEO Dr. Toby Cosgrove’s warning to all US hospitals

November 23rd, 2016

hospitalbeds

“Hospital occupancy across the United States is about 65 percent,” said Dr. Cosgrove.

Possible reader concluesion/s:

  1. Too many hospitals
  2. Not enough sick people

Read the rest of this entry »

Selecting a Third Party Administrator

November 23rd, 2016

tpa

Selection of a third party administrator (TPA) is crucial to the success of a self-funded plan. Criteria usually revolve around several factors including compatibility. Corporate philosophies of the employer and TPA should harmonize.

Read the rest of this entry »

Interesting News From Medical Mutual of Ohio

November 22nd, 2016

Rx Ch-ch-changes

Interesting news from Medical Mutual of Ohio (via email):

Read the rest of this entry »

Belk: Generic Drug Pricing Going Down

November 22nd, 2016

belk

Hello again and Happy thanksgiving…………
Good news is a pretty rare thing when discussing health care costs in the US. In fact, good news has been a rare thing overall this year. This is why I was rather shocked to discover very good news in the last place I would ever expect to find it: prescription medication prices.

Read the rest of this entry »

Has Health Care Hacking Become An Epidemic?

November 21st, 2016

batman1

One in three Americans, more than 113 million medical records were compromised in 2015. 2016 statistics show the trend will be worse, with one in four Americans affected.

Read the rest of this entry »

Moving Away From PPO’s Can Be Legally Challenging – Contracts Really Do Mean Something

November 18th, 2016

confusedWhat Should I Do?

By Molly Mulebriar

Tired to seeing your claim costs escalating, year after year despite representations from managed care intermediaries that cost saving “discounts” are ever increasing and have never been higher? And, you should thank PPO’s for saving you 50% or more off health care costs.

But, RiskManagers.us has now proven to your satisfaction the real truth behind ever increasing health care costs. You are finally ready to jump off the cliff into what you perceive as shark infested waters with the assurance you will (1) survive, (2) the sharks are more afraid of you than you are of them and (3) the cleansing currents will take you to an island paradise where health care costs are fair, reasonable, predictable and essentially static. Umbrella drinks abound.

Read the rest of this entry »

Edison Machine Focus of $140 Million Lawsuit

November 18th, 2016

bloodfinger

Claims she would revolutionize the blood-testing industry with her patented Edison machine, a device that she said could conduct diagnostic tests with a single pinprick……………….

Read the rest of this entry »

Health Care Watch Dog Continues Search For Truth

November 17th, 2016

belk David Belk

Hello Again Everyone! You might remember that, last Summer, I wrote a blog that questioned United Health’s claim that they lost hundreds of millions of dollars on the ACA exchanges last year. In short, I used their own financial statements to show that their profits, revenues and madical loss ratios didn’t square with their claims very well.

Read the rest of this entry »

Cancer Treatment In Cuba

November 17th, 2016

cuba

“She exhausted all possible treatments in the U.S. and decided to go to Cuba to try a cancer vaccine available there called Cimavax. After starting the medication, her breathing improved and energy was restored.”

Read the rest of this entry »

Mexican Dogs Get Better Deals

November 15th, 2016

mexicandogA friend  runs a hunting lease in deep South Texas. I asked if rattlesnakes pose a danger to hunters. “Yes, could be, but not that prevalent. What you may find interesting is antivenom for my hunting dog who had an unfortunate up close experience with one was $700 but the same antivenom needed by one of my hunters was $20,000. Same drug. You ought to put that on your blog.”

That’s interesting, I thought, but Mexican dogs get it much cheaper, around $200. Savvy ones, who have been around the block a few times and know how to negotiate, get it slightly north of $14…………..It’s those Mexican dogs that can teach Trump a thing or too about the “Art of the Deal.” 

Read the rest of this entry »

Veterans Day Weekend in Houston Heights

November 13th, 2016

houston

While in the Houston Heights over Veterans Day weekend, I took my daily walk through the Heights. As I turned to go down Courtlandt Street, I noticed a “garage sale” ahead with a small crowd around a table. As I got closer, I saw this was something extraordinary. It was not a garage sale, but something very different. And, it turned out, something very special.

Curious, I joined the small crowd of on-lookers as a young man explained the history of various WWII artifacts on display. “This is A WWI helmet, still has the insides all intact, worn by British soldiers in the trenches of France. This is a WWII helmet, used by Americans although this on has a German flag symbol on the side of it. ….”

Standing next to me was a 94 year old veteran and his daughter. He was clutching a photograph. I asked him if he was a veteran. “Indeed, here is a picture of me with my crew. I was the pilot, the one standing on the far left here.” How old were you back then I asked. “I was 21.”

I could tell this was a special gathering of spectators. The atmosphere was thick as the young man gave his most interesting “tour” of his mini-museum. He overheard my conversation with the old man, and asked if he could see the picture too. After a brief discussion, he asked “Sir, my I have your signature please. “Yes” he chuckled, “As long as it’s not on a check!”

The old man continued, “I have quite a few things I have kept since the war that I want you to have. I think this will be a good home for them…………………….

Read the rest of this entry »

Hospital Strong-Arms Self-Funded Employers

November 13th, 2016
godfather
Dozens of companies have received a letter, via their insurance administrators, asking them to waive their rights to sue……. . If they don’t, a fact sheet included in the letter says, the companies’ employees  will no longer have access to discounted in-network prices………..……..

Read the rest of this entry »

On Draining Swamps

November 12th, 2016

Read the rest of this entry »

Veterans Day 2016

November 11th, 2016

 rusreberg

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.

Read the rest of this entry »

HealthSmart Announces New CEO

November 11th, 2016

healthsmartDALLAS, TEXAS, November 11, 2016 – HealthSmart, a leading independent provider of managed care solutions for self–funded employers across the country, today announced that Phil Christianson has been named the Company’s new President and Chief Executive Officer, succeeding Tom Kelly, who has resigned from the Company to pursue other interests.

Read the rest of this entry »

Who’s Your Daddy?

November 9th, 2016

daddy“Mr. Rosenthal’s company, Health Street, has over the last six years grown into one of the city’s leading providers of drug tests and, more recently, DNA tests. He has contracts with some 10,000 companies……….……………..”

Read the rest of this entry »

State of Texas Employees Lose 3.8 Lbs Each In Bold Weight Reduction Program

November 9th, 2016

fatwomen1

We Collectively lost 15.2 Lbs!

“Since April, 15,000 current and former state employees—90 percent of whom are at risk for diabetes, cardiovascular disease or other related conditions—have lost more than 57,000 pounds through Real Appeal.” 

57,000 lbs / 15,000 employees = 3.8 lbs each

Read the rest of this entry »

Hidalgo County Voters To Decide Financial Health Care Scam Today

November 8th, 2016

scam“Hospitals agreed to assess a fee on themselves for every outpatient served and put that money into a fund that is then sent to the federal government to be multiplied.” TRANSLATION: Hospitals inflate medical charges to consumers, put these additional inflated dollars into a fund that Uncle Sam will match with money taken from working men and women through forced taxation.  Consumers are charged twice, once in the form of onerous taxation and second when they seek medical care.

“Many opponents believe the district would mostly benefit the shareholders at Doctors Hospital at Renaissance. The physician-owned hospital is one of the biggest supporters of Proposition 1.” TRANSLATION: Hospital can’t lose. They fund through overcharging patients which Uncle Sam matches, then these funds which are now double return back to the hospitals in the form of patient revenue.

Read the rest of this entry »

CVS Warns of Coming Retail-Prescription Tumult

November 8th, 2016

cvs“Very-recent pharmacy-network changes in the marketplace are expected to cause some retail prescriptions to begin migrating out of our pharmacies this quarter.”

Editor’s Note: We have found PBM pricing at CVS to be some of the highest, along with Wallgreen’s pricing. Some of our clients have excluded both pharmacy chains from their network and have achieved plan cost reductions.

Read the rest of this entry »

Boots Predicts Hillary Win

November 7th, 2016

goat

A “psychic” billy goat from Scotland named Boots chose a piece of paper that had Clinton’s name on it, thus predicting her victory.

Read the rest of this entry »

Chinese Monkey Predicts Trump Win

November 7th, 2016

chinesemonkey

A “mystical” Chinese monkey named Geda, who often predicts the winners of European soccer games, chose Trump as the winner of the U.S. election by choosing a banana near a cardboard cutout of the GOP candidate.

Read the rest of this entry »

The Truth About Managed Care Contracts

November 5th, 2016

hmo1

“Paying protection money for the promise of no balance billing against egregious, arbitrary sticker pricing that has no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices”  – Molly Mulebriar

Read the rest of this entry »

Wikileaks: Mulebriar Exposes PPO Kickback Scheme

November 4th, 2016

shocked

Health care consumer reacts to shocking revelation

Wikileaks has released a purloined email today in response to Mulebriar’s interview with Julian Assange earlier this week (Wikileaks Releases Mulebriar Transcripts – Part One). In an email dated 2011 to RiskManagers.us, Mulebriar expresses shock and amazement that PPO contracts may not always pass on the full “discount” to consumers. She asks, “Are 100% of PPO discounts passed on to the consumer? In this case, the answer is no.”

Read the rest of this entry »

Insurance Broker Pleads Guilty To Bribery

November 3rd, 2016

Samuel Mullen, (left) who is alleged to have bribed an insurance consultant for area school districts, walking out of federal court today in San Antonio with his lawyer, David R. Gorena (right). Mullen entered a not guilty plea to a charge of conspiracy to commit wire fraud. Photo: /Guillermo Contreas /Staff / San Antonio Express-News

Samuel Mullen, (left), walking out of federal court today in San Antonio with his lawyer, David R. Gorena (right) admitted Tuesday that he bribed a consultant for area school districts for inside information to help win insurance contracts.

Read the rest of this entry »

Wikileaks Releases Mulebriar Transcripts – Part One

November 3rd, 2016

mulebriar123

Wikileaks today has released Part One of Mulebriar’s exclusive interview with Julian Assange. The interview was held at the Ecuador embassy in London on Monday.

Read the rest of this entry »

The Ethical Stain on U.S. Medical Care

November 2nd, 2016

klepper

Treatments Dr. Bestermann advocates for are based on solidly established science. They have been disregarded, not because most physicians don’t believe in science, but because healthcare’s scientific foundation has been trumped by financial incentives.” 

Read the rest of this entry »

Wikileaks To Release Interview Transcript With Molly Mulebriar

November 2nd, 2016

mulebriar123Wikileaks will release the first installment of Assange’s interview with Molly Mulebriar sometime later this afternoon or tomorrow morning. Julian Assange, founder of Wikileaks, says the release will rock the managed care industry.

The Extinction of Health Insurance Agents

October 31st, 2016

salesman2

“What is an health insurance salesman daddy?”

Read the rest of this entry »

Reference Based Pricing – The Hospital’s Perspective

October 30th, 2016

othereside

A 2017 webinar will cover hospital’s view of Reference Based Pricing. An attorney who has advised multiple hospitals on how to respond and interact with self-insured payers taking RBP approaches shares her unique insights on how hospital administrators view common points of contention, as well as opportunities for more collaborative payment arrangements.

Read the rest of this entry »

HCA Profit Rises 38% in Q3

October 29th, 2016

everybodywins

Revenue has  increased 4.2 percent year over year, to $10.3 billion in the third quarter of 2016. Could the ever present annual escalator clause found in managed care contracts be driving revenue increases?
Read the rest of this entry »

Bob, Let Us Know When You Run Out of Money

October 28th, 2016

thatcherq

Your decision to continue your current PPO program is understandable. You are not out of money yet.

Read the rest of this entry »

British Physicians List 40 Procedures Of Little Or No Benefit

October 27th, 2016

hangoverq

Providing an intoxicated patient with intravenous fluids will not help them feel better or speed discharge from the hospital.

Read the rest of this entry »

Poor Lisita!

October 27th, 2016
lisitaa
One of this blog’s three readers sent the following sad story in response to one of our recent posts (Yikes)

Read the rest of this entry »

Yikes

October 26th, 2016

mad

Martita, a sixty year old Texan, just received her individual health insurance renewal notice from Blue Cross, the only health insurance company that sells individual health insurance in her area in Texas.

Read the rest of this entry »

Aetna Exec: People Will Pick Beer Over ObamaCare

October 25th, 2016

germanbeer34

People can do the math. Gas for the car, beer on Fridays and Saturdays, or health insurance.

Read the rest of this entry »

What If An Employer Cannot Pay Government Fees (Taxes)?

October 25th, 2016

confused

Many employers incorrectly believe there is a chance they can play the “audit lottery” and avoid all ACA related penalties………….

Read the rest of this entry »

Healthcare Fraud Investigations Target C-suit

October 25th, 2016

bernieWhy Didn’t I Think of This!

The Department of Justice has taken a strong stance on pursuing healthcare executives involved in fraud cases to hold them personally responsible.

Read the rest of this entry »

The Out-of-Network Battle Heats Up

October 23rd, 2016

blitzkreig

Payors have begun to take internal steps to avoid the “phantom charges” they claim are being billed by out-of-network providers……………...

Read the rest of this entry »

Tribal Health Plans Utilize Medicare Rates For Savings

October 23rd, 2016

tonto

“Tonto, is that your health plan!” ….”Yes, Great White Father finally came through – It’s called Reference Based Pricing!”

Read the rest of this entry »

Edgewood ISD To Drop Reference Based Pricing Plan

October 23rd, 2016

mulebriar

The Edgewood Independent School District in San Antonio, Texas, has decided Cost Plus / Reference Based Pricing is not for them.

Read the rest of this entry »

City of Lewisville Publishes Health Insurance Analysis – Compares Cost Plus To PPO

October 22nd, 2016

llewisville

The report is a compelling comparative analysis between a PPO proposal and a Cost Plus Insurance proposal, an evaluation of a non-traditional approach to health care financing and a traditional managed care proposal worth reading.

Read the rest of this entry »

340b Rx Program – Discounted Rx For “Poor People” or Profit Center For Hospitals?

October 22nd, 2016

rxprogramThe drug industry argues the 340b program has surpassed its original purpose of providing care to poor patients and now acts as a profit generator for hospitals.

Read the rest of this entry »

Risk of ‘Mass Exodus’ of Doctors from Medicare

October 22nd, 2016

doctorfingerOne recent survey of physicians found nearly 40 percent expect a “mass exodus” from Medicare……………………..

Read the rest of this entry »

Medicare for All – Being Cost Efficient Gets Incredible Results

October 16th, 2016

socializedmed

Universal health care, Medicare for All, will establish cost efficiency that eliminates major medical bills and medical related bankruptcies

Read the rest of this entry »

President Clinton Blasts Obamacare and Pushes for Medicare / Medicaid for All

October 16th, 2016
It begins at the 26 minute mark and is done by 28:24.
SOURCE:  Benefit Revolution

October 16th, 2016

americanworker

Benefits Brokers Going the Way of the Dodo Bird – A New Species Emerges

October 16th, 2016

beggar

Former Health Insurance Broker

Employees should be outraged and plan sponsors should feel like Madoff has been managing their money — it is time for change and the incumbents are just not getting the job done.

Read the rest of this entry »

Texas Insurance Officials Fine Zenefits $550K for Noncompliance

October 16th, 2016

zen

The Texas insurance regulators have fined human resources software startup, Zenefits, $550,000 for its past use of unlicensed health insurance brokers.

Read the rest of this entry »

Lucent Health Signs Strategic Alliance with The Phia Group

October 16th, 2016

lucentLucent is ensuring that the Plan Sponsors they serve will be provided the best fiduciary protection and objective, final appeals handling in the industry.

Read the rest of this entry »

HST Reference Based Pricing Presentation

October 14th, 2016

hst

Ed Day, President, HST and Cindy Hom, VP of Business Development, MedWatch  pride themselves in being ahead of the curve in Reference Based Pricing strategies. The HST approach makes sense. This is a must see 29 minute video:

Read the rest of this entry »

Introducing Meritain Connect

October 13th, 2016

meritain_newsletter_announcement

Introducing Meritain Connect: 

Now it’s even easier to stay on top of your health plan management

Meritain Health is proud to announce our new, enhanced website for members, employers, organizations and producers—Meritain Connect. It’s an all-in-one online tool for managing your employee benefits account. And this newly upgraded website will be yours to access beginning Monday, October 17, 2016.

Read the rest of this entry »

How To Deal With A Bully In Business

October 13th, 2016

Have you ever met a bully in your business dealings? If you say “No” you are probably lying, or too stupid to spot one. A recent experience leads us to post this excellent video on how to deal with a bully

Read the rest of this entry »

Phia Group’s Quarterly News Letter

October 11th, 2016

adam

Adam Russo, Phia Group

This past quarter has been one of the most exciting in our history, and we have all of you to thank for helping make that happen…………

Read the rest of this entry »

Dear John, I have Good News & Bad News………….

October 11th, 2016

dearjohn

In order to rebalance our existing and future book of business, we are increasing our  HMO new and renewal commission rates, and reducing the commission rates for all new and renewing  PPO health plans………..

Read the rest of this entry »

To Drive Real Health Care Reform, Look At What Employers Are Doing

October 10th, 2016

fix10 percent annual gain in employer health care costs has held wage gains to 2 percent or so in most recent years…….Taking money out of the pockets of consumers is deadly for growth in a consumer-driven economy……

Read the rest of this entry »

UnitedHealth Accused Of Price Gouging

October 10th, 2016

whao

UHC customers paying $50 co-pay for a drug that cost less than $15? 

Read the rest of this entry »

The Truth About The Blues

October 9th, 2016

tell111

“When receiving a group medical insurance proposal from the Blues, they can claim to have better discounts than the rest of the competing offers (be it a self-funded or fully insured plan) and their pricing to get the business will surely reflect substantial discounts. But now what? Will you as the client ever actually receive the full value of their hospital contracts or physician discounts? Most likely not.”

Read the rest of this entry »

Will Public Corruption Probe Expand To “The Valley?”

October 7th, 2016

valley1Court paperwork, however, said the corruption spread further, enabling the Mullen group to land contracts for their clients at South San ISD and Bexar Met. The FBI is also investigating the trio’s activity at school districts in the Rio Grande Valley, the documents show.

Read the rest of this entry »

Hospital Must Release Information on Pricing Methodology

October 7th, 2016

secret1

This is an interesting case with huge ramifications for Reference Based Plan Sponsors in Indiana and beyond.

Hospital billed patient $625,000. A billing expert has determined the reasonable value of the services Parkview provided was $246,640, about 39 percent of what was charged in the case. Hospital must now disclose pricing methodologies in court…………………..

Read the rest of this entry »

Percentage of Doctors Employed By Hospitals Is Up

October 6th, 2016

Read the rest of this entry »

PHIA To Support “The Big Heist” Project

October 4th, 2016

heistThe Phia Group is pleased to support Dave Chase’s “The Big Heist” project. Dave Chase is a long-time healthcare industry consultant, entrepreneur, author, and provocateur. Mr. Chase is also the executive producer of the upcoming film, “The Big Heist.” 

Read the rest of this entry »

Is It Legal?…………….YES, IT’S LEGAL…NO IT’S NOT!

October 4th, 2016

gaming

For years Plan Sponsors have dreamed how to transfer health care risk to the federal government. If Medicare eligible plan participants could be removed from a group’s health care plan legally, these higher risk members would no longer be a risk factor to contend with. How can one game the system? Read the rest of this entry »

Tenet Hospitals To Pay $513M, Admit Kickbacks

October 3rd, 2016

cookie

Tenet Healthcare Corp. and two of its hospitals will pay $513 million and enter guilty pleas to resolve investigations into payments of kickbacks for referrals of pregnant immigrants, the U.S. Department of Justice said Monday.

Read the rest of this entry »

Consultant Sentencing Delayed Again – Now 30 November 2016

September 30th, 2016

haff

William O. Haff

San Antonio insurance consultant’s sentencing delayed again to 30 November, 2016. Smart money bets more indictments to come, following this week’s indictment of Samuel Mullen……

Read the rest of this entry »

A Golden Ticket That Fast-Tracks A Drug Through The FDA

September 30th, 2016

wonkaDrugmaker Sarepta Therapeutics won a big victory when its $300,000 muscular dystrophy drug was recently approved, but the company had other reasons to celebrate, too. They were also awarded the drug world’s equivalent of a Willy Wonka golden ticket.

Read the rest of this entry »

Is Expanding Medicaid a Good Idea for Texas?

September 30th, 2016

money11111“I offer three perspectives as to why Texas should not expand Medicaid” – Alan M. Preston, MHA, Sc.D.

Read the rest of this entry »