Leana Wen – What Does It Take To Bring Transparency To Medicine?

December 18th, 2014


Doctors in the U.S. don’t have to tell patients about conflicts of interest. When physician Leana Wen asked her fellow doctors to open up, the reaction she got was frightening.

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Eliminating Third Party Profit Stacking In Health Care

December 17th, 2014


“HPC has developed a “dream team” of highly experienced medical claim negotiators and nurses………Future products include buying or building a PBM for our clients and operating it at cost. The goal is to shift the profits from PBM’s to Payers and their clients in the same way that we are doing with Large Dollar Claims.”

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Gilead Faces Suit Over Hepatitis Drug’s Price

December 17th, 2014


Solvaldi costs $84,000 per course of treatment in the United States, but only $900 in Brazil. Why?

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Darwin Award Study Exposes Sex Differences In Risk Taking

December 16th, 2014


Sex differences in risk seeking behaviour, emergency hospital admissions, and mortality are well documented. However, little is known about sex differences in idiotic risk taking behaviour………..Idiotic risks are defined as senseless risks, where the apparent payoff is negligible or non-existent, and the outcome is often extremely negative and often final.

” It is conceivable that the sex difference is attributable to sociobehavioural differences in alcohol use. Anecdotal data support the hypothesis that alcohol makes men feel “bulletproof” after a few drinks….”

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Costs Are A Function Of What We Agree To Pay

December 14th, 2014

J. Patrick Rooney is the Godfather of Cost Plus Insurance. Rooney acknowledged that hospitals may need to charge more than Medicare will pay, but contended that authoritative research showed that Medicare plus 25 percent is the reasonable amount for hospitals to charge.  J Patrick Rooney (1927 – 2008)

We now know many PPO contracts, even after significant “discounts”, reimburse 260%, 400% or more of Medicare allowable. Our medical costs continue to escalate  because we continue to agree to pay our health claims through secretive managed care contracts we cannot see.

Cost Plus / Reference Based Pricing provides a common sense approach. The golden age of managed care (PPO’s) has passed.

Below are 26 articles which will give the reader a good understanding of the issues surrounding health care costs and possible common sense solutions:

Reference Based Pricing Gains 10% Market Share……. Balance Billing & Provider Pushback……. Cost Plus Insurance To Make Offer To Hospitals?……. Selling Fear & Cost Plus Insurance……. Cost Plus / Medicare Benchmarking Continues To Gain Market Acceptance – Are PPO’s Facing Extinction?……. How Do You Evaluate Cost Plus Insurance Through Competing TPA’s?……. Milliman Analysis Of Cost Plus vs PPO Plan……. A TPA Divorce Can Be Revealing – How Many Mistresses Were There?……. Are You Paying Competitive Fees For Your Cost Plus Plan?……. Selecting a Third Party Administrator……. Guess Who’s Coming For Dinner?……. Hospitals Dismiss Significance Of Chargemaster Prices?……. You Can’t Fix What You Don’t See……. A Wave Change In Insurance Payment Models: Cost Plus, Not Bills ……. Reference Based Pricing, Individual Responsibility & Willing Providers……. Xerox, Eastman Kodak and Cost Plus Insurance……. How Some Cost Plus Health Plans Are Structured……. Cost Plus Audit – Legal Indemnification Fees Getting You Down?……. Supreme Court Ratifies Cost Plus Health Insurance……. Bill O’Reilley Opines on Cost Plus……. AMPS Achieves 100% Growth in 2012 – Touts Cost Plus Model……. Insurance Plan Pits Hospitals vs. Employers……. Medicare Based Pricing for Smart Payors……. Federal Judge Rules In Favor of Cost Plus Insurance……. Managed Care Under Siege…… Health Care Strategies for Texas Political Subdivisions…….

Once we rid ourselves of traditional thinking we can get on with creating the future” – James Bertrand

“Costs are a function of what we agree to pay” – Bill Rusteberg


H.H.C. Group Launches Cost Charge Ratio Reference Based Pricing Service

December 14th, 2014


Like our Medicare Based Pricing Product, Cost Charge Ratio Based Pricing offers a number of advantages over pricing based on a percentage off billed charges alone. Both eliminate excess charges due to providers artificially inflating their prices for services delivered.”

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AMPS Acquires Claims Delegate Services

December 14th, 2014


“Our clients are often speechless when we document what they are paying for hospital services after what they believe are the PPOs discounts…………………..On average we find payment levels of over 260% of Medicare and many times we find post PPO payments greater than 400% of Medicare………….”

AMPS is the leading and fastest growing  Cost Plus / Reference Based Pricing company in the United States. Quick to react to market demands  ( Xerox, Eastman Kodak And Cost Plus Insurance )  AMPS provides competitive pricing coupled with superior service.

“Companies must work constantly to eliminate any cost factor that does not add value to a business process” – Mike Dendy

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Local Government Strategies to Address Rising Health Care Costs

December 11th, 2014
Rising costs over the last decade have prompted many local governments to make changes to their health plans and strategies. Cost sharing, wellness program, and disease management initiatives are widely reported. Other changes cited include increased reliance on high-deductible plans, dependent eligibility audits, and altering retiree benefits.

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Another Point of View (To Preceding Post)

December 10th, 2014

I understand that you have very prestigious degrees and that this is a 5 year old post. However, this is why I felt compelled to comment. You should have known to prepare better, and this shouldn’t have been up for this long.

While you may have the “General Concept”, you clearly lack the requisite knowledge to understand the details behind MAC pricing, or any drug pricing logic for that matter.

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Don’t Get Caught By PBMs’ MAC Mousetraps

December 10th, 2014

big macFor most of the world, the letters MAC conjure up a Big Mac — the inviting super-sized hamburger that people love but enjoy at their peril.

But for health plans providing prescription drug coverage, the acronym represents an incomprehensible concept inserted into prescription coverage contracts by pharmaceutical benefit management companies (PBMs).

Unfortunately, unbeknownst to most health plans, this MAC is far more pernicious than any oversized hamburger. In fact, PBMs insert the MAC concept into contracts in three ways to relieve health plans of millions in savings that they would otherwise obtain from using generic drugs over branded drugs.

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