States Look To Medicare-Based Reference Pricing Strategies

April 25th, 2019

Meanwhile, back at the ranch, the Texas legislature kicks the can down the road……………..again.

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The Future of Personalized Medicine is Here

April 25th, 2019

One simple test, we can improve quality of life and save healthcare resources……………..

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Power Struggle in Dallas

April 25th, 2019

Blue Cross Blue Shield of Texas removes 14 DFW hospital emergency rooms with out-of-network docs from network………………….

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A New Kind of Pharmacy

April 25th, 2019

Blue Cross To Offer $10 Co-pay Food Plan

April 25th, 2019

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……………

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Need Surgery? Go On-Line and Book It

April 24th, 2019

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.

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Texas House Bill 3933 – A Panacea for Reference Based Pricing Plans?

April 23rd, 2019
The Texas legislature is considering numerous bills of interest to those of us engaged with health care delivery in this state. HB 3933 is one, that if passed, will have a considerable impact upon the health care community.

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Webb County Seeks P&C Insurance Consultant

April 23rd, 2019

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

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PBM’s

April 23rd, 2019

Going Broke? Never Mind, Just Print More Money

April 22nd, 2019

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.

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Disruptive Digital Business Models For Health Insurers

April 22nd, 2019

“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.”

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Texas Considers Balance Billing Legislation For Self-Funded Plans

April 21st, 2019

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. 

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33% of U.S. Workforce Using Prescription Pain Medications

April 18th, 2019

      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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The Antithesis of Managed Care

April 18th, 2019

Insurer Paid +300% of Medicare But The Discount Was Really Good

April 18th, 2019

In the article by Marshall Allen that follows patient questions why Aetna paid  a grossly inflated rate of more than 300% of Medicare for his in-network claim. Well, that’s not the way Aetna or any other managed care company wants you to look at it. Instead they want you to focus on “discounts.” Managed care companies like Aetna reinforce that focus by sending patients EOB’s highlighting those amazing and magnificent discounts applied against billed charges. Could it be you may be looking at a 50% discount off double the price?

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Health Insurance Hustle

April 18th, 2019

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.

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The Death of PPO’s

April 17th, 2019

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.

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Reason & Logic Won’t Move TRS ActiveCare Trustees

April 16th, 2019
TRS ActiveCare Plan Manager Struggles To Save Program
“It’s impossible to prove something to someone whose salary depends on believing the opposite” – Upton Sinclair

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Another Win For The Oklahoma Medical Association

April 16th, 2019

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.

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Fully Insured Dental Plan Request for Proposals

April 15th, 2019

McAllen Independent School District (the “District”) invites your submittal on: RFP No. 2018-200 – Fully Insured Dental Plan…………………….

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Adverse Selection Dooms TRS ActiveCare

April 15th, 2019

The TRS ActiveCare plan for Texas school districts is imploding. Many want out of the program…….

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Scientist Proves Employee Benefit Meetings Are A Waste of Time

April 13th, 2019

The Ebbinghaus Study is widely accepted as a definitive study in human intelligence. The study concluded that within 24 hours we will forget 75% and within 30 days we will forget 90%. The remaining 10% will remember only 5%.

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Why Do Some Fiduciary Violations Go Unpunished While Others Result in Jail

April 12th, 2019

“People are going to jail over ERISA fiduciary violations and the dollar amounts pale in comparison to what is being wasted on the employee health plan side of ERISA.”

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Is Medicare Supplemental Insurance Worth It?

April 12th, 2019

Dr. Dave opines again on Medicare supplemental insurance policies…………….

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RBP Market Growth Continues – Blue Cross Adopts No Network Model

April 11th, 2019

 

The North Carolina Blue Cross Blue Shield “My Choice” policies aim to change the way doctors and hospitals are paid by limiting reimbursement for services to 40% above what Medicare would pay. The plan has no network of doctors and hospitals…………………

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Hospital Insults Plan Sponsor – Wants 1,947% of Medicare

April 9th, 2019

Hospital demands almost 2,000% of Medicare to settle claim………………….

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Health Insurance Bankrupting Americans – Personal Debt Reaches New Highs

April 8th, 2019

A new survey from Gallup shows that Americans borrowed a staggering $88 billion in 2018 to pay for health-care costs that were not covered by their insurance plans………..….

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Cancer Cure?

April 8th, 2019

Activated immune cells travel throughout the body, killing tumors wherever they find them…………….

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Surprise Medical Bills – Two Texas Physicians Respond

April 8th, 2019

“Conditions and diseases of healthcare systems which are relevant to this discussion include: incentive malalignment syndrome, hypermetricosis, benefit managementosis, maladaptive dysdocumentosis and more.” – Texas Physician

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3 Ways Employees Can Reduce Prescription Costs

April 8th, 2019

Senator Cruz Proposes 4th Method To Reduce Drug Costs?

In an unprecedented move, Tx. Senator Ted Cruz introduces Senate Bill to free the worlds most successful drug importer. “Chapo has proven cheap and effective drug importation is possible! With his direct-to-source plus vast American distribution system, El Chapo, his organization has the where with all to help solve our broken health care delivery system. FREE CHAPO!

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InstaMed

April 7th, 2019
Creating electronic movement of healthcare data and money faster than a melting Raspa …………..

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Doctors Practices Leaving Charlotte Hospitals Catch The Eye Of Their Industry

April 7th, 2019

By Alex Olgin  Mar 25, 2019

For the more than 40 doctors at Lakeside Family Physicians and Huntersville OB/GYN, the move away from Novant Health is a return to how they used to practice medicine. Both groups were independent before joining with Novant about 15 years ago.

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Employers Get Choosier About Workers’ Doctors

April 6th, 2019

Many big companies are mining data from their own health plans and public records and working with consultants to compare physicians, searching for those with the best results and competitive costs.

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A Million Views in 44 Days! ClearHealthCosts Price Transparency TED Talk Goes Viral

April 6th, 2019

Jeanne Pinder scores big with TED talk…………………….

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Status Quo Consultants vs New Age Consultants

April 4th, 2019

By Bill Rusteberg

Last year I had the privilege to make a presentation to the Board of Trustees of a Texas independent school district. The district’s self-funded health & welfare plan was in trouble and they wanted to hear how we have been able to keep costs static over time for other school districts we have been fortunate enough to manage over the past twenty years. Those districts have beaten medical trend while improving benefits at the same time and at half the cost.

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Outrage Over Rising Costs of 100 Year Old Drug

April 3rd, 2019

Insulin manufacturers and PBMs have faced mounting pressure amid outrage over the rising cost of insulin, a nearly century old lifesaving drug.

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Clarity Benefit Solutions – TPA for Tax Advantaged Plans

April 3rd, 2019

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Clarity Benefit Solutions is a broker-friendly benefits technology company and TPA for Tax-Advantaged Plans with 25+ years of industry experience.  Our easy-to-use programs and tools are designed to innovate, integrate, and automate – taking the frustration out of benefits with solutions that actually work.

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How Two Common Medications Became One $455 Million Specialty Pill

April 3rd, 2019

You can walk into your local drugstore and buy a month’s supply of Aleve and Nexium for about $40. For Vimovo, the pharmacy billed my insurance company $3,252.

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DOL “End Run” Ends In Defeat

April 3rd, 2019

Stringent government control of health care continues to defeat efforts of free market proponents……………….

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Texans Support Consumer Protection Laws Against Medical Price Gouging

April 2nd, 2019

Texas Free Standing Emergency Rooms (FSER) resemble urgent care centers, but on average, an FSER costs 10 times as much as an urgent care visit for the same condition……………..

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New PHI Procedure

April 2nd, 2019

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The Balance Billing Myth

March 31st, 2019

A seemingly valid concern about Reference Based Pricing strategies on the part of consumers is the possibility of balance billing leading to personal debt, lawsuits and ruined credit.

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The Evolution of Reference Based Pricing

March 31st, 2019

Change over time is a constant……………………………………

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Thurman James Chapman

March 31st, 2019

OCTOBER 13, 1925 – MARCH 27, 2019

Thurman James (T.J.) Chapman, age 93, of Austin, Texas passed away peacefully at his home on March 27, 2019 after a long illness.

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Donna Independent School District Seeks Insurance Consultant

March 30th, 2019

Donna Independent School District is accepting Insurance Consulting Services RFP #032219-487 at the office of the purchasing agent located at:

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Judge Strikes Down Trump Administration’s Health Care Plan

March 29th, 2019

The most powerful branch of government strikes down proposed rules for association health plans………….The Trump administration had rolled out the plans after President Trump signed an executive order directing Labor Secretary Alexander Acosta to consider allowing more small employers to form association health plans.

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WellCare bought by Centene

March 29th, 2019

WellCare Health Plans Inc. will be acquired by Centene Corp. in a $17.3 billion cash and stock deal.

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Slapped in North Carolina

March 29th, 2019

“Delay and Confuse” is one of the oldest tactics used by incumbents under attack. The North Carolina flirtation with Reference Based Pricing for their state employees is a classic example.

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$15,000,000,000.00

March 28th, 2019

$15 billion deal creates insurance powerhouse………………..

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Reference Based Pricing Model For Prescription Drugs

March 28th, 2019

Reference pricing divides drugs into therapeutic classes, which allow a payer to identify an average price to use as a reference point……………………

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ObamaCare On The Ropes Again – Investors Skittish

March 27th, 2019

Here we go again. Another challenge to the ACA. But this time investors are weighing the odds and taking their money elsewhere…………………..

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Litigation vs. Negotiation: How to successfully structure RBP

March 26th, 2019

As consultants we have options when it comes to vendors, and if you’re in this healthcare revolution, I urge you to choose your partners thoughtfully and more importantly, in alignment with the values you communicate as an adviser…………….

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Medical Providers Declare War In North Carolina

March 23rd, 2019

North Carolina may not embrace Reference Based Pricing strategies for the state employee plan after all. The North Carolina medical community has declared war. “Delay and Confuse”, a time tested tactic, is the weapon of choice……….

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Health Care Prices vs Health Care Costs

March 23rd, 2019

  Dave Chase

Hospitals have overplayed their hand just like Pharma. At a certain point, gluttony has blowback.

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Health Plans For State Employees Use Medicare’s Hammer On Hospital Bills

March 23rd, 2019

Some states are moving to control costs of state employee health plans by implementing defined contribution plans, a move away from traditional defined benefit plans. Montana, North Carolina, Oregon and Delaware are states that have implemented defined contribution health plans for their state employees or are about to do so. Meanwhile Texas is considering a House Bill to “study alternatives” to health care financing for their state employee benefit programs.

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Finnish Government Collapses Due to Rising Cost of Universal Health Care

March 23rd, 2019

Finland’s welfare system is generous in its provisions. Now it’s running out of money………….

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A Reason to Be Skeptical of the Workplace Wellness Industry

March 22nd, 2019

Study of a comprehensive workplace wellness program concludes that it didn’t change employees’ behavior or health care costs. Employees who took part didn’t become healthier or more productive, and were not more likely to go to the gym or run in a local race. Total health care costs didn’t drop, either.

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Amazing Statistic!

March 21st, 2019

The latest survey shows that

three out of four people make

up 75% of the population

 

 

The 20 Most Expensive Drugs in the U.S.A.

March 21st, 2019

All 20 of these drugs are priced well over $25,000 for a monthly supply, or + $300,000 per year

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Will Texas Consider Feasibility of Reference Based Pricing Strategies for Public Educators?

March 20th, 2019

               $64,000 Question

House Bill 3987, if passed, will direct a commission to study alternative mechanisms for offering health benefit plan coverage to the affected employees  of the TRS ActiveCare program and their dependents. Will “alternative mechanisms” include a study of Reference Based Pricing strategies? Will Texas follow the lead of Montana, North Carolina and the South Texas Health Cooperative? 

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Insurance Agent Who Stole 80+ Identities Gets Probation

March 18th, 2019

A Colorado insurance agent who created more than 80 phony life insurance policies has been sentenced to probation.

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What Health Care Consumers Never See

March 15th, 2019

I get emails like the one below almost every day on claims incurred under various Reference Based Pricing plans. The redacted email below shows how egregious health care billing practices are and what consumers are expected to pay in relationship to what Medicare pays.

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3 Drug Manufacturers Hold 7,000,000 Americans Hostage – Life or Death?

March 15th, 2019

The Canadian inventor of insulin sold his patent for $1 to the University of Toranto back in the 1920’s to benefit mankind with a life saving, inexpensive drug. Now three drug manufacturers hold the power of life and death over 7,000,000 diabetic Americans. Why?

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A Cost Effective Approach to Reference Based Pricing

March 14th, 2019

 

 

Going with a PEPM subscription model yields greater plan savings than charging a percentage of savings. Our RBP solution, powered by Payer Compass, uses that model and helping is helping clients save up to 72% over traditional PPO networks.

Texas School District Continues Deficit Spending On Health Plan

March 14th, 2019

The Donna Independent School District (DISD) in deep South Texas continues to under fund their self-funded health plan. In a competitive RFP process last year the district moved their self-funded health plan administration from Blue Cross to United HealthCare. However, the change in plan administrators have not shown any savings to date, although there is a “shared savings” fee paid to the administrator. Try explaining that to the boys in the domino parlor.

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New Health Plans Expose Insureds To Less Risk

March 14th, 2019

New health plans expose insureds to less risk:

The risk of systematic rising health insurance costs, erosion of  benefits and less choice. Provider payments are fully transparent unlike traditional health plans that cloak provider pricing in secrecy.

Members may select any provider of choice unlike PPO and HMO plans. There are no high deductibles and in some cases no deductibles at all. So what’s the catch?

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Some TPA’s Are Planning For Survival, Others Are Not

March 13th, 2019

With a single payer system only one election away, some TPA’s are looking towards the future. Others have their heads in the sand.

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Blue Cross Enters Food Business

March 13th, 2019

For a low co-pay of $10 every time you order a meal and a reasonable $6 delivery charge (tips encouraged) you can get free meals from Blue Cross if you live in designated areas. You don’t even have to be a Blue Cross member, although we suspect those are the ones paying for all of this……………

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Mother Knows Best

March 12th, 2019

A major carrier (Mother) will require all new self-funded employer customers (Children) to incorporate this feature into their plan designs……………….As children don’t you hate to be told what to do?

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Lockton Enters Reinsurance Business

March 11th, 2019

Reinsurance is a key pillar of Lockton’s aggressive growth plan……………………..

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Monkey Business?

March 11th, 2019

1980’s BCBS Representative At Work

I remember years ago when I was a naive young salesman for BCBS working in a rural area office. I was eventually promoted to a big city office. It was a new experience for me. I noticed real fast that all the other sales reps. were involved in some sort of  “monkey business.”

They were typing up group health insurance proposals in the confines of their company paid offices (door closed of course) on behalf of competitors, pocketing commissions earned in addition to their BCBS salary. One rep. showed me his check stubs from more than one competitor and said “Bill, why don’t you do the same? It’s easy money! And, if I get fired or quit, I have a nice steady income coming in!”

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Population Health on Steroids

March 11th, 2019
Does your self-funded health plan have the latest technology required for advanced risk management purposes?

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Solving Health Care At An Affordable Price

March 7th, 2019

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Opening The Black Box

March 6th, 2019

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Retail Rx Prices Vary a Lot!

March 6th, 2019

I take a prescription drug that costs $18 at a mom & pop pharmacy in Cuero, Texas that costs $95 at a chain pharmacy 34 miles down the road in Victoria, Texas. A pharmacist friend told me his cost is $6…………..But of course not too many people know this or care. All they see is a Rx co-pay which effectively hides the scheme from public outcry…………..Many of our clients exclude two of the largest drug store chains in the country because they know prices there are 500-600% higher at the retail level than most independent pharmacies. That alone will save on average 5-10% off a group’s total drug spend.

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