I’m very fortunate to be able to collaborate with a group of true reformers from around the country. We’re committed to transforming our current system of inefficiencies into an efficient system where primary care is empowered, quality and outcomes are measured, and the price tag for services is greatly reduced – Richard Sutton
Insurance companies create vast networks, referred to as PPOs (Preferred Provider Organizations). The only thing that is preferred is the deal the insurance company cuts itself. About a full one third of the total medical spend by an employer can be eliminated by removing in-network pricing variation for commodity care alone.
Employers need to realize that when they pay for PPO access, they are paying to access a network designed to maximize the insurance company’s revenue – not to save the employer money on medical care.
Murry B. Cohen, Appellate Lawyer
Gloria Hicks, v. Group & Pension Administrators, Inc., 13–14–00607–CV, (Tex. App. 2015). Reversing District Court and holding that a citizen’s email to school board trustees urging the board not to contract with plaintiff concerned a matter of public importance, was not commercial speech, and defendant was protected from suit by the Texas Anti-SLAPP statute.
Managed Care Executive
We just can’t think anything other than they are as stupid as stupid gets…….……
The problem facing political subdivisions in seeking competitive bids are many. Politics almost always plays a pivotal role in the process and oftentimes encompasses a mixture of ignorance, money, clan loyalties, and employment.
Unwrap Me Please!
With Phia Unwrapped, The Phia Group replaces wrap network access and modifies non-network payment methodologies, securing payable amounts that are unbeatably low, based upon fair market parameters.
Republicans are going to fund Obamacare subsidies that the Democrats forgot to fund?
It will be voter payback time in 2018 – Lily Livered, Yellow Bellied Cowering Republican elites will be targeted for punishment……….Too many lies for too many years will impact the 2018 mid term elections.
The Democrats are smart. They have learned “Never interfere when your opponent is committing suicide”
Joe’s choice of beer is a good example of his philosophy. He knows that in order for beer vendors to stay in business they must agree to sell based upon the price Joe and others are prepared to pay……………
Mike Dendy, MBA/MHA, vice chairman & CEO, Advanced Medical Pricing Solutions (AMPS) is certainly a market leader and really “gets it”…………..…..Laura Carabello
In 2013 I wrote “Xerox, Eastman Kodak And Cost Plus Insurance” which predicted the inevitable rise of the Mike Dendy’s of the world.(See article at end of this blog entry).
In the article I wrote: “The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide……………..pioneering, successful business endeavors that fail to react quickly and appropriately to market threats end up losing market dominance……………….”
And then, as predicted, (a) Mike Dendy gobsmacked the market with a set of fresh eyes. His company, AMPS, has since become the national leader in Reference Based Pricing strategies, experiencing phenomenal market growth.
“Companies must work constantly to eliminate any cost factor that does not add value to a business process” – Mike Dendy
Texas Supreme Court has ruled state governments do not necessarily have to extend marital benefits to same-sex married couples………………
This case involves the relationship between hospital system and insurance company, and how that relationship affects everyday patients and consumers……..
The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.
Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.
Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.
2017 RiskManagers.us All Rights Reserved
Email: RiskManager@RiskManagers.us
By William Rusteberg
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.
The average premium for a high-deductible health plan for a retired teacher under 65 with no beneficiaries could rise from $1,300 to $9,550 in 2018, under the legislature’s fix…..
Having the right claim payer for your company’s healthcare program(s) will make a positive impact to your bottom line and employee productivity……………..
The hospital industry is participating in a massive flea market, with large chains buying and selling hospitals like Pokémon cards or Monopoly properties.
Prime Healthcare Foundation has a record of purchasing distressed hospitals and making them profitable…………………….
Last August, the center reported a 77 percent drop in its adjusted income over a 10-month span, then recorded an operating loss of more than $111 million for September through November 2016. In response, MD Anderson shared plans to eliminate roughly 1,000 jobs from its 20,000 and it also called of its collaboration with IBM Watson, which was projected to cost more than $62 million.
Nobody is proposing to cut Medicaid. Republicans are merely proposing to limit annual spending increases…………….
Founded in 2009, MDLIVE is a leading telehealth provider of online and on-demand healthcare delivery services and software that benefit patients, hospitals, employers, payers, physician practice groups and accountable care organizations.
Use the Tenth Amendment to deal with this problem, like the Founders intended……
In deference to one of our three readers, effective immediately we are prohibiting hospital people and their attorneys from reading this blog.
Sources: Kaiser Family Foundation analysis of data from Health Coverage Portal TM, a market database maintained by Mark Farrah Associates, which includes information from the National Association of Insurance Commissioners and California’s Department of Managed Health Care. Mini-med companies with a medical focus were included.
Compensation paid to producers under these agreements is usually based on growth and persistency of a producer’s overall book of business. The costs of these programs are not directly included in the premiums or fees for the producer’s customers, but are included in our general distribution costs.
Last year our agents earned over 114 million dollars in commissions and we plan to double that in 2017! Read the rest of this entry »
SA Benefit Services, LLC principals have more than 30 years of combined stop loss experience. We provide stop loss services to third party administrators, consultants, brokers and direct with self-funded groups who have no broker of record. We use only A Rated stop loss carriers.
Medicaid in Texas is a $29,000,000,000 ($29 BILLION) business………………...
Staying on top of new developments occurring at breakneck speed poses a challenge for healthcare professionals……………
Hint: A QSEHRA is something conjured up at the Puzzle Palace in Washington DC…..
The Atlanta Chapter of the Association for Corporate Growth has identified AMPS among the top 40 fastest growing middle market companies in Georgia………….
“Last year AMPS grew by over 70% and we are on a financial track to do the same this year, and we see this strategic investment extending the significant growth we have enjoyed over the past five years.” – Mike Dendy
The hospital claims BCBS of Georgia is refusing to pay contractually agreed-upon rates.
“Acting in secret in the interests of the profiteering insurance companies late Friday afternoon abandons all those people already threatened by Congress and the Trump administration” – Deborah Burger
Get Insured 24/7 has the lowest rates for Errors and Omissions Insurance, providing affordable, easy access to protection for the unexpected. Use our secure portal to enroll and bind in minutes, wherever you are, whenever you want. Pajamas welcome.
“What I’d like to do is legalize inexpensive insurance, and you should be able to get insurance for $1 a day” – Rand Paul
The doctor was dumbfounded: a drug that used to cost $50 was now selling for $28,000 for a 5-milliliter vial…………….
MRI’s can start as low as $250…………Compare that to $2,000, $3,000, $4,000 and more elsewhere………..
Vxtra Partners was founded in 2004 to address the financial inequities, lack of transparency, and technology challenges associated with traditional health care benefits.
Hospital stock prices jumped on Thursday as investors reacted to the Senate’s proposal for repealing and replacing the Affordable Care Act.
Congressional Aide Drafts Healthcare Bill
The bill will “ultimately transition away from Obamacare’s collapsing system entirely so more Americans won’t be hurt,” McConnell said Thursday on the Senate floor.
Accresa is an innovative payment platform that connects physicians, employers and employees…………..
“As any person being bullied knows, and as Freud has written, there are two options: 1. Fight or 2. Flight” – Shawn Gretz
“This could be a career opportunity of a lifetime. We are building something unique……….”
“Your insurance committee is way out in left field! Why would anyone want lower benefits at a higher price!” offered the consultant.
Dr. Chad Williamson last year opened his direct-pay clinic. He has 300 patients who pay $60 per month per individual or $100 per couple. Children are $10 a month. He doesn’t accept insurance, though he said about half his patients do have it…………..
Selerix Systems produces software (BenSelect) to facilitate communication, enrollment, and end-to-end benefits administration for both core and voluntary insurance products. This software is licensed to and used by carriers, brokers, and employers.
In 1967, our population was 204 million and our national health expenditures were 46.5 billion, 5.7% of our GDP or $253 per person. Today, for our population of 330 million, they’re $3.2 trillion, 17.8% of our GDP and $9990 per person…….
“It is a program without any sense of risk management, so this will continue to be the pattern until they kill it. One of the biggest issues is the consulting firm, which has worked with them forever and is not even located in the State.” – Insurance Consultant
Gov. Brian Sandoval vetoed a bill that would have would have made Nevada the first state to attempt a Medicaid-for-all approach to health insurance
The TAGCO Multiple Employer Trust offers employers the benefits and advantages of buying Retiree Medical through the pooling of statewide Retiree Medical risk(s). The program serves residents of Arkansas, California, Louisiana, Montana, Oklahoma, South Carolina, Texas, Virginia, Colorado, Illinois, Iowa, Michigan, Nebraska, North Carolina, New Mexico, Tennessee, Utah, and Wyoming.
Take a total benefits approach. This approach could help minimize liabilities while maximizing total benefits spend. Additionally, savings in one benefits area could allow additional funding for new retiree healthcare solutions……………….Coupling retirement healthcare with Reference Based Pricing strategies may accomplish this goal…………..
The law requires drugmakers to annually disclose the list prices they set, profits they make and discounts they give market middlemen on insulin…………….
This paper will address the cost drivers and why the traditional solutions are becoming more and more ineffective…………….
Is the fox is watching the henhouse? The abuses that can and do exist under this model are egregious…….
Mike Dendy
I recently met with a Fortune 100 company and posed the question, “how much are you paying for hospital services within your PPO network”? They had absolutely no idea. I was not at all surprised, as the actual cost of services is well hidden within a labyrinth constructed by big healthcare companies, their PPO organizations, and their “partner” hospitals.
The number of employers implementing RBR plans is increasing, especially in markets where providers have shown a willingness to accept “reasonable” reimbursement……………..
Nashville, Tennessee, June 7, 2017- Lucent Health (@LucentHealth), the leading Healthcare Risk Management, Administration and Advisory Services company, announced today that it has acquired Appleton, Wisconsin-based Cypress Benefit Administrators.
Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…
Mildred Honeycomb, Famed PBM Professor at MMU
A two sentence tutorial on how to evaluate a PBM proposal…………………..
Switch operators are like the Wizard of Oz: They’re hidden behind a curtain and being paid by manufacturers to end-run your cost-savings efforts. Therefore, you need to pull back the curtain, understand their machinations, and respond.
A large taxpayer supported employer now knows they are overpaying for health care……
In 1993, before the Blues went for-profit, insurers spent 95 cents out of every dollar of premiums on medical care, which is called their “medical loss ratio.”
The average medical loss ratio is now closer to 80 percent. Some of the Blues were spending far less than that a decade into the new century.
The medical loss ratio at the Texas Blues, where the whole concept of health insurance started, was just 64.4 percent in 2010.
Another form of direct contracting is when a plan sponsor outsources the administrative systems and support functions required to operate as a PBM, to a third-party vendor. These vendors can operate “behind the scene” and enable the plan sponsor to “private label” the PBM services.
The benefits to the plan sponsor includes marketplace branding, local control of utilization, formulary design control, acquisition-based drug costs and full share of rebates and manufacturers’ incentives. As a result of these comprehensive support services, plan sponsor’s of almost any size can potentially benefit from these new arrangements and may represent a significant improvement over traditional service contracts.
“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson
“In the past quarter century, the American medical system has stopped focusing on health or even science. Instead it attends more or less single-mindedly to its own profits.”
“So we spit-balled some ideas around and came up with this: The one package people are highly pleased with is Medicaid………………”
Politicians act the way they do because Santa Claus is here and here to stay………..
Emerging Litigation Could be the Savior to Our Dysfunctional Healthcare System. Here’s how………………..
As a drug salesman, Mike Courtney worked hard to make health care expensive. He wined and dined doctors, golfed with them and bought lunch for their entire staffs — all to promote pills often costing thousands of dollars a year. Then he joined the Traitors Club of former pharma reps……….
