By Bill Rusteberg
As members of the +400,000 member TRS ActiveCare risk pool “The Power of Large Numbers” and “Economies of Scale” bring comfort to small Texas school districts . “We could not get comparable coverage on our own, much less at affordable rates” is the mind thought of school district officials throughout the state.
“San Antonio has agreed to delay implementation until December 1, 2019. The stay will allow time for guidance from the Texas Supreme Court on the law’s constitutionality. In the meantime, San Antonio’s Paid Sick Leave Commission has agreed to work with business stakeholders to recommend changes in the ordinance to the San Antonio City Council.”
Hospital billed charges total 1661% of Medicare. A typical PPO “discount” would be between the range of 50-70%. If the later, the hospital would be paid about 498% of Medicare. Plan paid 180% of Medicare. Hospital still wants more money. Plan sponsor says “Not in my lifetime!”
“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.”
By William Rusteberg
With the growing suggestion that the BUCAs are inflexible third party administrators unwilling and unable to administer Reference Based Pricing plans and other strategies in the market today, more brokers are seeking new partnerships with independent third party administrators (TPA). An independent TPA can offer much more than a traditional carrier model.
“Those trying the preserve the wildly under-performing and bankruptcy-inducing status quo healthcare system will do whatever it takes to try to thwart progress” – Dave Chase
In his time at the hospital, from 1999 to 2007, his salary rose from$185,000 to $300,000, and he qualified for bonuses up to $220,000 if he met certain billing targets.
By Bill Rusteberg
While visiting Washington DC last year on business, I ended each day with a short visit to Off The Record, a bar located at the Hay Adams Hotel across the street from the White House. This place is always packed with interesting people and I had occasion to meet a few of them.
Texas and Colorado issue cease and desist orders to health care sharing ministry………
See hospital administrator morph into an insurance broker before your very own eyes…………….From Hospital administrator to power broker in under five minutes…..
New immigration regulations leave coverage purchased with ACA subsidies off the list of positives.
If you are a new era health insurance consultant this video will drive you nuts.
A knee replacement surgery costs an average of about $30,000 at U.S. hospitals, but only $11,000 at Galenia Hospital in Cancun, Mexico.
With the lid ajar on Pandora’s box, we are likely to see employer demands pegged to price transparency and more strategies built on provider prices.
Health plans, TPAs, and brokers can now contain costs while knowing that patients have a legal advocate standing by.
“Anthem is determining whether an outpatient MRI, CT scan, or PET scan is “medically necessary” based on where the service is performed.”
Risk payment models present a daunting challenge to the very cultural of medicine—for most physician practices. Physicians identify their practices as clinical enterprises more than businesses………………..
SOURCE: Axios
“In 1999, the average health insurance coverage for a family consumed 14% of the average household income … By 2017, family coverage absorbed more than double that amount, to about 31% of take-home pay.
The Brownsville Independent School District, like many public schools across Texas, is facing mounting, crippling health care costs through their self-funded health insurance program.
“What do you do for a living?” asks the neighbor. “I destroy relationships” replies the salesman.
Approved in May, the treatment’s price — set at $2.1 million — stoked concerns about the astronomical costs of potential cures for rare diseases and upset parents who initially could not get insurance coverage for the breakthrough treatment.
Once labor unions learn the truth about what’s driving health care costs and become aware of proven methods to reduce costs while improving benefits at the same time, they will become a powerful force for change.
He makes millions, threatens to deprive teachers, state employees, retirees and their families of affordable health care coverage.
The Nonprofit Hospital That Makes Millions, Owns a Collection Agency and Relentlessly Sues the Poor
Nonprofit hospitals pay virtually no local, state or federal income tax. In return, they provide community benefits, including charity care to low-income patients. In Memphis, Methodist Le Bonheur Healthcare has brought 8,300 lawsuits for unpaid medical bills in just five years.
Innovative Defined Contribution plan now available for groups of up to 99 employee lives. This could be a value add to small group health plans such as those available through Allied National (www.Alliednational.com) and others.
There is only one known cure for the disease……… however the drug, priced at $2.1 million, is too expensive and not covered by health fund……toddler has only one more month to receive a new drug that could cure him………………
“Specialty drugs account for about 1% of prescriptions but 95% of prescription costs.” A new drug approved this year will bankrupt health plans……………..Plan sponsors should carefully study their Rx formularies to determine if there are other “Poison Pills” lurking…….then take action.
Seven year old boy files Tooth Fairy claim…………….No-limit tooth provision to set record reimbursement rate……….Tooth Fairy spokesman hints at bankruptcy…..
“These manufacturers would be able to use a new National Drug Code (NDC) in doing so, possibly enabling them to offer lower prices than are available under their existing distribution contracts…………………….”
A large Texas school district recently approved an across the board 4- 4.78% pay raise. Or is that number really 1% before taxes? The difference goes to area medical providers in the form of higher health care costs memorialized within secretive managed care contracts crafted by third party intermediaries. If the district had taken better advice, they could have lowered their health care costs 15-25% without a reduction in benefits, thus giving their employees a significant raise this year. Other Texas school districts are doing just that………………..
“Hospital systems are seen as the evil empire, and facility costs are seen as driving healthcare expenses,” Dickerson says. “So we tried to keep people from going to hospital system.”
The Brownsville Independent School District recently went out for Request for Proposals for TPA services for the district’s self-funded employee health plan. The four finalists include Aetna, Blue Cross, United HealthCare and one independent TPA.
Mission Impossible Assignment for Plan Sponsors
Nothing is secret about health care costs although many third party intermediaries wish it so. Piecing all the data towards responsible stewardship of an employer sponsored health plan is not impossible. Reviewing managed care contracts is not impossible either. Once I was told I would never get my hands on a Blue Cross hospital contract. I did. – Bill Rusteberg
“If Congress cannot address even obvious market failures in private health care, a federal takeover of our entire health-care sector will become that much more attractive.”
Each investment would be $15 million, with an estimated 30 percent return on investment each year for a decade……………..
“It doesn’t look like a hospital, and it doesn’t feel like a hospital,” Kristy Nations said on a recent visit to pick up medications at the pharmacy. “It actually feels good to be here.”
American Health Care: If you’re poor it’s free, if you’re rich it’s affordable, but if you’re a middle class American you’re screwed.
A quick read of the minimum requirements knocks out all TPA’s except the BUCAs. This will be a bidding war between Aetna (incumbent), Blue Cross and United HealthCare. Smart money is on Blue Cross. Sadly though, changing the logo on the I.D. card won’t solve the problem of runaway health care costs………….
The TRS ActiveCare program is a ticking time bomb for Texas conservatives and a point of light for Texas liberals. Unless it’s fixed quickly Texas will become a Blue State faster than a melting raspa in deep South Texas on an August afternoon.
With the stroke of his pen, Gov. Greg Abbott signed into law some of the strongest patient protection laws in the nation to shield Texans from the financial pain and misleading practices of free standing emergency rooms, where patients face a more than 80% risk of being balanced billed.
A retiree health plan is when ex-employees are provided for or allowed to purchase health care through their former employer.
“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.
“Nola’s commitment to excellence and her dogged approach to problem solving fits in perfectly with our culture here”
When Mike Dendy is involved, it’s golden. Introducing CarynHealth……………
Mention Reference Based Pricing to a hospital official anywhere and you may experience first hand a human meltdown unfold before your very own eyes……………….
“Burn in hell, you sorry SOBs. Your plan to cut payments to hospitals could possibly be the most moronic idea I have ever seen come out of state government, and since you retardicians have taken power, and that’s saying a lot………….poor people generally don’t vote for your party, so you want them to die.”
The ACA is a naked command to buy an insurance product the government deems suitable,” Texas Solicitor General Kyle Hawkins argued in court papers.
“Bereft of penalties, the mandate now raises no revenue and therefore cannot by any conceivable definition be considered a tax,” he added. “Stripped of its tax status, the individual mandate is nothing more than an unconstitutional congressional mandate to purchase health insurance.”
North Korea’s “first” insurance, reinsurance broker launches new website
A federal judge has rejected the Trump administration’s rules for association plans………….
Since the passage of the ACA un-elected bureaucrats in Washington have been issuing regulations faster than a melting raspa on a deep South Texas afternoon in August. Now the focus is on whorehouse high prescription drug costs…………
Ruling will fundamentally change the way employers provide employee health care benefits……..
Managed Care Castle Under Siege
If current proposals come to fruition, the issue of narrow networks or surprise billing will no longer be the consumers’ problem………providers could be left holding the bag if their ability to negotiate is undermined by disclosing rates to managed care entities …….the need to contract could conceivably be impacted and the foundational concept of managed care could break down.
Is there a single soul who is surprised that an engineer came up with this? The 10,535 pages of the Obama Care legislation reduced to 4 short sentences.
bill that some insurers lobbied quietly to quash made its way through the Legislature and was signed by Gov. Phil Murphy on Sunday.
“The French are on vacation more than they’re at work.” “They can’t wait to get laid off so they can live off generous unemployment.” “They have no ambition.” – (secretsofparis.com) Read the rest of this entry »
“340B is a well-intentioned drug discount program gone awry………..” Has the program departed from its statutory foundation?
“Members of the Health, Education, Labor and Pensions (HELP) Committee approved a sweeping measure Wednesday that tackles a range of big-ticket health care concerns.
A benefits veteran has read the new final regulations. He’s not impressed.
HOSPITAL PRICES ARE TOO DAMN HIGH!
Several states have implemented forms of reference pricing for public plans…………..
“The recommendation of this agenda is to recommend to the Board of Trustees the firm that will provide the best value as the Consultant to help guide the district in reviewing options related to our employee benefits program.”
Politicians want to rein in aggressive tactics used by nonprofit hospitals to collect unpaid bills, including suits and garnishing of wages………….
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.
