“It looks like we are entering the “shipping & handling” awareness phase of healthcare costs.”
Purveyors of Reference Based Pricing strategies can’t seem to agree on what the reference benchmark should be. Thirteen years ago J. Patrick Rooney (1927-2008) said it was 125% of Medicare. Was he right?
The state of North Carolina has received considerable push back from the medical community in their efforts to reign in rising health care costs for public employees. Scheduled to implement Reference Based Pricing strategies beginning January 1, 2020, the state’s medical industry (primarily hospitals) have pushed back so hard there is now doubt the plan will ever take effect.
Sharing plans are not new. They have been around for years. While not insurance, these programs can offer affordable access to health care.
HealthComp Hosts “Lunch & Learn” with H-E-B and Baptist Integrated Health Partners in San Antonio
“Businesses are really angry about the system, and there is a lot of frustration with its rising costs and dysfunction………”
“How Much Did You Say That Xray’s Gonna Cost?
A little ole housewife with cash in her purse has more bargaining power than Blue Cross, United HealthCare and Aetna combined………………………
SOURCE: Frenkel Benefits
“The largest single Sun Life claim was $7.5 million and the largest injectable drug claim was $1.8 million. Injectable drugs account for 9.2% of the total cost of large cost claims.
“It’s evident that many brokers believe the (PPO) networks are not the long-term answer, but brokers and consultants continue to push business to the traditional model or utilize TPAs with carrier or independent networks because it’s the status quo, what we have always done.”
Successful pandering to gain voters is best achieved by promising free stuff. Each national election we end up getting more free stuff. And we haven’t yet run out of other people’s money…..Hallelujah!There has not been a competitive health care market for years. Managed care contracts have contributed to that. Some employers have fixed health care buy most haven’t. This blog has written about the former in the past so if you are a regular reader you know exactly what we are talking about.
Massachusetts hospitals stash $1,600,000,000 in offshore accounts…………….
Ralph Weber
Ralph says bundled health care pre-negotiated cash pricing comes in at an average of 108% of the Medicare rate. That’s a very good number in case you’re wondering……………….
Transparency in health care pricing doesn’t make a whole lot of sense when it’s other people’s money paying for all of this. Who cares what the cost is when all you have to pay is a small co-pay, or some sort of deductible. Then, when you enter that Magical Kingdom called Maximum-Out-Of-Pocket Limit you tend to go crazy in getting more health care to (1) milk it for all it’s worth and (2) revenge against the evil insurance carrier that makes you pay so much in co-pays and deductibles while charging you an arm and a leg in insurance premiums.
Health care pricing transparency does makes sense when Reference Based Pricing strategies are employed. “My plan will pay you $500 for that procedure, so how much will you charge me? Oh, never mind, I think I can find someone else that will do it for $500………………………
If you live anywhere on this planet and need free health insurance that covers pre-existing conditions without any waiting period what so ever, come quickly to California now! No passport needed nor pesky immigration hurdles to jump through. Just cross the border at any point of your choosing, turn yourself in and get a free airplane or bus ticket to the Golden State.
“If you are isolated and lonely, but you have someone that you remember, like nurse April, nurse Tina, or nurse John, and they’re like, ‘Hey, how are you doing?’ And you’re greeted with warmth and love, well yeah, I’m gonna come back”………………Three (lonely) patients visited the hospital 500 times in one year………………..
“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.”
Victor Lustig
“Percentage of savings fees is the greatest fraud foisted upon consumers since Victor Lustig sold the Eiffel Tower in 1925. To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a bank.”
Insurance Brokers Fight For Markets
We received notice / invitation to bid from the McAllen Independent School District along with 211 other vendors shown as email recipients. The brokers among them will be stumbling all over themselves to get quotes from the same four or five markets……………………This is exactly why smart brokers stay away from public RFP’s…………….
“In 2018, Blue Cross members seen at South Florida Sanitas clinics—which opened in late 2015—had 32 percent fewer inpatient admissions, 34 percent fewer outpatient visits and 20 percent fewer emergency room visits compared with members who went to nonaffiliated clinics.”
At $2.1 million, newly approved Novartis gene therapy will be world’s most expensive drug
Status Quo Health Insurance brokers are in for a lot of explaining to do. “Mr. Employer, I’m receiving $340,000 more than the $124,000 I’ve disclosed to you in the past. Plus, if I convince you to renew with your current carrier, I get an additional $25,000 renewal bonus! You OK with that? “
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.
The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.
I love this stuff! Targeting signed Broker of Record Letters makes so much more sense than blindly quoting policy renewals, throwing mud against the wall to see what sticks, and “hoping for the best.”
By Bill Rusteberg
Health share plans are growing in popularity these days. Cost is significantly lower than insurance plans as you will see by clicking the link below. However beware these plans are not insurance and there is no guarantee claims will be paid/covered.
By Bill Rusteberg
Hidden fees in health care delivery earned by third party intermediaries can be significant.
Healthcare providers set astronomical, arbitrary prices, and employers and insurers have few options. But a solution is emerging.
Tired of waiting for the Texas legislature to act in addressing crippling health care costs affecting hundreds of thousands of Texas educators, the Raymondville Independent School District in deep South Texas has decided to act.
Local school districts voice concern over rising costs for health coverage
“To attract providers, Washington lawmakers chose a relatively high figure to start: The plan caps payouts at 160 per cent of federal Medicare rates……..”
Plan is expected to be competitive “in part to savings from a cap on rates paid to providers……………..”
The following article reports that “TRS trustees noted the only tools available to them to address rising costs each year are to”:
Really?
Meanwhile, smart plan sponsors have solved the rising cost of health care in Texas and it ain’t by increasing premiums and lowering benefits. Rather, it’s by lowering costs and improving benefits at the same time……sounds crazy doesn’t it?
(The Texas legislature’s answer to addressing rising health care costs is House Bill 3987, that if passed, will authorize a committee to study the issue and report back in two years. But some Texas school districts are not waiting……..)
Health Plans Should Prepare For Plan Fallout Of HHS Rule Requiring Manufacturers Disclose Drug Prices
The El Paso Independent School District is set to adopt an exemption to Texas Education Code 22.004(i), which prohibits a District that has implemented employee group health coverage pursuant to Chapter 1579 of the Insurance Code (TRS ActiveCare) from providing any kind of alternative group health coverage at their May 14 board meeting.
The Real David in David & Goliath
Employers…..contrary to what you think, health insurance carriers make MORE revenue and profit as your health care costs go up. It’s federal law.
Pssst…Godfather, Mulebriar Is At It Again!
“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that have no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see nor audit, violates fiduciary duties and is contrary to basic, common American business practices. “
Each time I see a Request for Proposals put out by insurance consultants requiring a PPO Re-Pricing Exercise in an effort to determine which network has the best discounts the temptation to reach out to Jose Cuervo is tough to ignore.
If you’re an insurance company, the simplest way to make more money, is to PAY MORE for medical services. In fact, provider negotiations should go like this:
Doctor: I want $100 for this procedure.
Insurance Company: No, we won’t pay you a penny less than $250.
This is what a +400,000 life group plan offering status quo healthcare strategies gets you these days…………
“For-profit hospitals charge 700% more than Medicare prices, while non-profit hospitals charge 550% more. Traditional PPO plans offering a 50% discount may end up paying 300% more than the Medicare price”. In Texas where Reference Based Pricing strategies have been around since 2007, plan sponsors are paying between 120% to 150% of Medicare…………………….The Reference Based Pricing Blitzkreig is gaining market share quickly……………
A long time friend who has spent almost all of his working life in the pubic purchasing arena in Texas has a perspective that many of us in the insurance community have failed to acknowledge.
“Please don’t leave us Grandpaw!!!”
Hey Grandpaw, I’m thinking of giving my children (your grandchildren) a few free gifts this year but I may decide later to take them back. But………. I’m worried the government will require you to disown us under penalty of sanctions!
Diagnosed with the “Big C?” At least 10% beat it because they didn’t have cancer in the first place……...
UHC Company Executives?
A Florida federal judge stepped down Monday from a proposed class action claiming UnitedHealthcare improperly classified a certain cancer treatment as experimental to avoid providing coverage, saying his personal opinion prevented him from ruling fairly on what he called “immoral and barbaric” actions.
“An employer maintaining a workplace clinic (or considering one) needs to understand the group health plan compliance risks and the general risks associated with doing so and take reasonable steps to mitigate those risks.
Meanwhile, back at the ranch, the Texas legislature kicks the can down the road……………..again.
One simple test, we can improve quality of life and save healthcare resources……………..
Blue Cross Blue Shield of Texas removes 14 DFW hospital emergency rooms with out-of-network docs from network………………….
Will food program drive down health care costs in Chicago and Dallas? A portion of your BCBS premium dollars will be allocated to find out……………
Imagine if you need some sort of surgical procedure like a knee replacement. Simply go on-line and book it. Your employer has arranged to pay the providers you select prior to services rendered, including all or a part of your share of the cost. It’s that easy.
RFQ 2019-0006 Package for a Consultant for Health Insurance for Webb County can be obtained from our EBid site located at: https://webbcountyebid.ionwave.net/CurrentSourcingEvents.aspx
Trustees project Medicare trust fund will be depleted in seven years………..So let’s do Medicare For All and see if we can go broke faster……………………………Never mind. Sam, fire up the ole printing press will ya………..we’ed be needing some money to pay for all this.
“The main impact of digital business models is on company evaluation, which reflects the hype that some companies have created in the investor community. Companies like Oscar, Clover Health, and Bright Health are valued at over $1 billion USD each after only a few years of operation.”
At first glance Texas Senate Bill 1530 looks appealing. Balance billing protection for self-funded health & welfare plans would be a welcomed gift from government, especially among purveyors of Reference Based Pricing plans.
Morning Shift Arriving At Work
One in three workers reported using prescription pain relievers — the majority under treatment of a physician………………………
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Behind the Scenes, Health Insurers Use Cash and Gifts to Sway Which Benefits Employers Choose
The insurance industry gives lucrative commissions and bonuses — from six-figure payouts to a chance to bat against Mariano Rivera — to the independent brokers who advise employers. Critics call the payments a “classic conflict of interest” that drive up costs.
PPO’s are a fraud and more are beginning to understand that. The only thing PPO’s can guarantee is the promise of no balance billing. That’s a powerful and effective coercive method used to foster obedience to status quo strategies of the past 35 years. However, the truth is we are all running out of money to fuel the American Healthcare Monster. Breaking away from status quo solutions will soon become a national epidemic towards fundamental change bringing sanity to health care costs in this country – Bill Rusteberg.
We’re excited to have a contract for services with the Texas Free Market Surgery Center. Our Texas clients who join the Oklahoma State Medical Association (OSMA) health plan will now have access to bundled pricing in Austin, Texas.
McAllen Independent School District (the “District”) invites your submittal on: RFP No. 2018-200 – Fully Insured Dental Plan…………………….
The TRS ActiveCare plan for Texas school districts is imploding. Many want out of the program…….
