The Only Way to Pay Less for Health Care Is to Pay Less for Health Care

January 18th, 2019

This 35 minute podcast is well worth the time………….Listen to the Master, David Contorno…..

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Wellness Programs Expected To Hit New Highs

January 18th, 2019

Wellness Consultants Cheech & Chong

Attention HR Directors! Take your Wellness Program to a high & reap the rewards of a happy and mellow workforce! 

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Health Insurance Brokers Identify Key Cost Drivers?

January 17th, 2019

“Brokers are also seeing high demand for benefits communication, employee engagement and transparency as a way to address the rising cost of healthcare…..” REALLY? How in the world will this reduce health care costs?

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Are Rising Drug Cost Destroying Group Health Plans?

January 17th, 2019

“The primary villain in the multi-year erosion of the value of the employer-provided health benefit, and private insurance generally, has been drug costs.”

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Court Case Addresses Cross-Plan Offsetting

January 17th, 2019

“The court strongly hinted that the practice violated ERISA’s fiduciary duty rules, including the requirement that plan assets of one plan be used for the ‘exclusive purpose’ of benefiting individuals covered by that plan.”

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Texas Teachers Giveth Raises – Health Insurance Taketh Away…………

January 17th, 2019

A RETIRED TEXAS SUPERINTENDENT ON WHY TEACHERS ARE QUITTING IN DROVES: “UPS starts people with no experience (HS diploma or GED) at $13 per hour plus full benefits. Within a couple of years you can graduate to a route where drivers make six figures after five years. In 7 years you can make over $100k delivering packages. In contrast, my wife is in her 25th year as a teacher with a Masters degree. She makes $57k and has some of the worst insurance in the country”

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What Can We Do About The Cost Of Health Care?

January 16th, 2019

Answer: Pay Less For Health Care………………………………..

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RBP Vendor Fees In An Evolving Competitive Market

January 16th, 2019

As Reference Based Pricing (RBP) strategies take hold in the market, with more vendors entering the fray for market share, the inevitability of increasing competition becomes evident. That is good news for plan sponsors……………………

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PBM Consultants Know More Than General Benefits Consultants

January 16th, 2019

 

 

“Find help from experts—do not use a general benefits consultant—this is tricky stuff!” That is a true statement. Most general benefits consultants don’t know squat about the PBM world and simply make recommendations off spreadsheets. “This one is the best because they are offering AWP-28%!”

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Health Care’s Most Needed Next Step

January 15th, 2019

January 14, 2019

By Brian Klepper

It seems inevitable that, in the near future, an innovative health care organization is going to seize the market opportunity, gradually cobble all the pieces together, and demonstrate to organizational purchasers that it consistently delivers better health outcomes at significantly lower cost than has previously been available.

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Oversight Committee Launches Sweeping Drug Price Investigation

January 15th, 2019

“The goals of this investigation are to determine why drug companies are increasing prices so dramatically, how drug companies are using the proceeds, and what steps can be taken to reduce prescription drug prices.”

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Public Entities Address Rising Retiree Health Insurance Costs

January 14th, 2019

The following article can be summed up as follows: Changing from a Defined Benefit Plan to a Defined Contribution Plan saves money…………………….

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Robbing Peter To Pay Paul

January 14th, 2019

The majority of recoupments are taken at the expense of self-insured plans to the benefit of fully-insured plans………………..

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Hospital Transparency? Good Luck

January 14th, 2019

“There is “sobering evidence” that the level of price transparency is actually getting worse…….

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No Benefit Waiting Periods for All Americans!

January 13th, 2019

Most group health insurance plans have a 30, 60, or 90 waiting period before coverage starts. We know of one that has an even longer waiting period…………..

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Is Health Care A Right or A Commodity?

January 12th, 2019

The master of reason and logic explains……………………..

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This Week’s Savings Shenanigan Story……

January 11th, 2019

It pays to shop for health care. A $40,000 drug for 1/10th of that……………..This broker is worth her weight in gold. Is yours?

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Want To Know The Price? Go Fuck Yourself!

January 11th, 2019

WELCOME TO OUR MODERN HOSPITAL WHERE IF YOU WANT TO KNOW A PRICE YOU CAN GO FUCK YOURSELF……………………………….

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Proposed Expansion of HRA’s A Game Changer

January 10th, 2019

Employers of any size may offer HRAs to reimburse employees for the cost of their premiums for individual health insurance coverage…………….

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North Carolina’s Brewing Battle Over Health Care Value

January 10th, 2019

“We’ve got 9 million taxpayers and 720,000 participants in this plan who understand that they aren’t consuming health care, it’s consuming them.” — Dale Folwell, N.C. Treasurer

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Payer Compass Success Was Inevitable……………

January 8th, 2019

Karmac The Magnificent predicted the eventual emergence of a more competitive market with multiple vendors competing for business. Now we see a growing and dynamic market with more competition, lower costs and many vendors. And the market leader appears to be Payer Compass……………..

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School District Fails To Address Rising Health Care Costs?

January 8th, 2019

Houston Independent School District is in financial hot water. There are many reasons for this. One is the Robin Hood effect wherein HISD must transfer local taxpayer money to the state for re-distribution to poorer school districts. Another is the rising cost of health care, Houston ISD’s second largest budget item. 

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You Want How Much!

January 7th, 2019

Medical providers can charge whatever they want. Heretofore no one cared. Until now…..

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Rural Texas Hospital Defies The Odds

January 7th, 2019

This story also reflects some of the challenges faced by rural hospitals everywhere……………

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Is Payer Compass The # 1 Reference Based Pricing Vendor?

January 6th, 2019

“We are extremely proud of the success Payer Compass has achieved to date as we have grown the company to serve over 125 payer customers, representing nearly 1,000 employer groups and over two million covered lives.”  –  Greg Everett

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How Do You Measure Savings?

January 3rd, 2019

Question: How do we know we are doing better (saving money) this year than last year?

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Why Are Employers Embracing Reference Based Pricing Plans?

January 3rd, 2019

They are running out of money…………………………………

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Primary Care Is An Investment – The Rest of Health Care Is A Payment

January 3rd, 2019

The end objective is a better health care delivery model with an alignment of “enlightened self-interests” and a balance between rewards and value for the employer, employee, and provider……..

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January 1st, 2019

Confessions of a Reformed Health Insurance Broker – From Innocence To Darkness

Slowly we saw the rise of third party administrators, the evil purveyors of self-funded employee health & welfare plans…..

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Christus Health Publishes Something

January 1st, 2019

Oh, this makes sense! Everyone knows what 1100000003 is. Last time I had a 1100000003 was last year and my insurance paid only $1,654 for almost a 50% discount. Oh-My-Gosh, 1100000027 looks really competitive………! I’m going to Christus Health next time!

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Worshiping the False Idols of Wellness

December 30th, 2018

Before we go further, I’d like to clear something up: Wellness is not the same as medicine…….

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Texas School District Set To Close 12 Schools

December 30th, 2018

Austin school district officials are proposing closing 12 schools, among other cost savings that total $55.1 million, as the district faces a deficit for the third year in a row…………….but will they address their second largest expense – health insurance? They can cut millions while improving benefits at the same time but no one seems to have told them that…………………….Meanwhile a large municipality near Houston continues to sell city land to pay for health care for city employees…………..

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Underwriter Opines on Reference Based Pricing

December 30th, 2018

By David Stanard   VP, Underwriting Manager at Excess Risk Reinsurance Posted on Linkedin

As an underwriter, I’m always surprised by the examples given when discussing RBP. They always seem to omit the fact that RBP has almost NO impact on an employers drug spend. In today’s market, that’s 30-40% of your cost.

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Reference-Based Pricing: a Welcome Disruption

December 30th, 2018

Disruptors Change History in Boston – “Tea Anyone?”

These plans are a game-changer in our industry, and a much-needed disruption to the status quo……………

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WELLNESS PROGRAMS – The Good, The Bad, and The Just Plain Silly

December 29th, 2018

 

 

 

The good news is that the wellness industry is finally coming around (kicking and screaming at times) to the realization that their programs are not a health care cost savings strategy………………..

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Employer Based Food Insurance

December 29th, 2018

The government bestowed a big tax break on employer-purchased food plans a few generations ago……..

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High RBP Fees Offsets Plan Savings

December 28th, 2018

“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Cost Plus Insurance may not make much sense to those in the domino parlor.”

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Protection Money In Healthcare

December 25th, 2018

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 or audit, violates fiduciary duties and is contrary to traditional American business practices.“

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Merry Xmas Mulebriar!

December 24th, 2018

Mulbriar receives unsolicited Christmas gift revealing best kept secrets of out-of-network reimbursement strategies among the BUCA’s…………………..

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Doctors Strike

December 20th, 2018

 

 

TPA / RBP Vendor Compares Fees To Competition

December 20th, 2018

Commission driven broker / consultants push certain products over others. Here’s an example…….

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Managing Risk vs Servicing Risk – The End of Status Quo Brokers?

December 19th, 2018

With little formal training, a majority of health insurance brokers back in the day were simply spreadsheet artists………………………….

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Insulin’s Inventor Sold the Patent for $1

December 18th, 2018

Insulin’s Inventor Sold the Patent for $1. Then Drug Companies Got Hold of It

Never underestimate the greed of a pharmaceutical company.

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A $5,571 Bill For Sitting In A Waiting Room

December 18th, 2018

More evidence the American healthcare delivery system is in melt down………………Continued destruction of the American middle class…………….

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Is 150% of Medicare The RBR Sweet Spot?

December 17th, 2018

 

On average, commercial rates were 89 percent higher than Medicare rates……………….That means 5-% of commercial rates are less than 89% of Medicare………………..

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Uh Huh, Right………………………

December 17th, 2018

John Roberts – ObamaCare Savior

The Individual Mandate no longer ‘triggers a tax’ beginning in 2019……………………..

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Tyrone Is At It Again Godfather!

December 17th, 2018

I came across the single best explanation of AWP or Average Wholesale Price and I want to share it with you.

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Telemedicine Back In The Day

December 17th, 2018

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Blue Cross Faces Antitrust Claims

December 15th, 2018

 John Sherman

Blue Cross Blue Shield faces allegations of anti-competitive behavior that violates the Sherman Antitrust Act of 1890………………………………….

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McAllen Independent School District Seeks Insurance Consultant

December 14th, 2018

McAllen Logo 2C BlackFFCC00

McAllen Independent School District (the “District”) invites your submittal on:

                     Insurance &Employee Benefits Consulting Services 

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Free Market Fails, Government Steps In…………….

December 14th, 2018

Is government mandated price controls the answer to rising health care costs……………?

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Why Does 100 Year Old Life Saving Drug Cost So Much?

December 14th, 2018

For a product that’s nearly 100 years old prices are too high, forcing diabetes patients to ration their drugs and sacrifice their health for financial reasons………only hree drugmakers control all of the U.S. insulin supply……………..list prices for one type of insulin grew 600% over 14 years…………

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ERISA Class-Action Litigation over Fees in Health and Welfare Plans

December 13th, 2018

A potential mine field for health-plan fiduciaries involves failure to ensure that plan participants pay only ‘reasonable’ fees for services, including co-insurance and deductibles…………..

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Sales Bonus or Bribe?

December 13th, 2018

“The employer has no one — not the carrier, the broker, the third party administrator, the pharmacy benefit manager, the hospital or the doctor — sitting on their side of the table, with a shared incentive to lower healthcare cost.”

– Nelson Griswold, president of Bottom Line Solutions in Nashville, Tenn.

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I Own You – Do What I Say or I’ll Break Your Legs!

December 12th, 2018

Pssst, Godfather, Bill Is Attempting To Move Our Business!

“Tell Bill I’ll make him an offer he can’t refuse………………………………………”

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Rebates!

December 11th, 2018

Rebate programs do not save employers money…………………………..

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Handling Health Claims: Traditional Carriers vs TPAs

December 11th, 2018

“For the lion’s share of claims, the TPA is still leasing a large carrier network in order to secure the negotiated discounts with doctors and hospitals. But … there are some services for which the carrier’s network rates are egregiously high — and for those services the TPA will simply apply Medicare reimbursement levels instead….”

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Sierra-Berkshire Associates

December 11th, 2018

Affordable Care Act Increases Need for Actuarial Services……………

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What Is AWP?

December 11th, 2018

It is an elevated drug price that is rarely what is actually paid……………So why use it?

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Rare View Behind The Curtain

December 11th, 2018

Drug prices are difficult to determine for patients. Drug wholesalers, distributors, healthcare providers, pharmacy benefit managers and pharmacists keep prices hidden from the public. Until now…………………………..

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That’s Not What We Were Told!

December 10th, 2018

Hermann Ebinghaus

How effective are employee health insurance benefit meetings? Or are they a waste of time?

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Texas: Short Term Medical Plans Under Attack

December 9th, 2018

In January, the 86th Texas Legislature will convene in Austin. Hopefully, they will address expanding health coverage in Texas, prohibit short-term coverage from discriminating based on health status, and limit the maximum time an individual may be enrolled to less than 364 days………….

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Deep South Texas Faces Unique Health Care Challenges

December 9th, 2018

25% of the population in deep South Texas receive free health care. Known as The Valley, the region has unique health care and economic challenges including a high diabetes rate, high poverty rate, and heavy dependence upon government and health care jobs…………………

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Tyler Man Connected To PBM Kickback Scheme

December 8th, 2018

Tom Slack, of Tyler, received more than $1.5 million in illegal kickbacks………………

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Texas Insurance Consultant Forfeits License

December 8th, 2018

Convicted Texas insurance consultant William Haff forfeits insurance licenses……………accepted bribes to steer public school business to insurance broker………………

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Health Care Sharing Memberships Top 1 Million

December 8th, 2018

A million Americans — a number that is growing — have rejected medical insurance for membership in one of the 104 known and active Health Care Sharing Ministries in North America…………………………….

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Decades Old BCBS Love Hate Relationship Continues……….

December 8th, 2018

Hospital administrators throughout Texas say the insurance company is using “strong-arm” tactics to push unfavorable contracts……………

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Guaranteed Cost Stop Loss Insurance

December 8th, 2018

Guaranteed cost stop loss insurance for today’s environment……….

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RxReins

December 8th, 2018

Bringing financial stability. Ensuring peace of mind.

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Plan Sponsors At Risk For High Fees – Breach of Fiduciary Oversight

December 8th, 2018

 

“Health-plan participants could conceivably choose to challenge health-plan fees with general fiduciary-breach claims. In fact, it is reasonable to expect that such claims will be made against other health-plan sponsors, given that plaintiffs’ firms have begun to solicit potential class representatives and request health-plan fee information from employers.”

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Communist China Adopts Free Market Medical Costs Strategy

December 7th, 2018

China embraces competitive bidding instead of price fixing?………….A free market approach in a communist country?…………………….Mao Zendong must be rolling over in his grave these days……………..Meanwhile back in the United States Cloned Zendong’s move forward pushing their Cultural Revolution with fervor……………..

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Wallet Biopsy Determines Prognosis

December 7th, 2018

Patients must be first class fund raisers – their lives depend on it…………………………

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Here’s To The Crazy Ones……………….

December 6th, 2018

“Here’s to the crazy ones. Misfits, rebels, troublemakers. They are not fond of rules. They have no respect for the status quo. They change things…………………….”

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Turd Polish Season

December 6th, 2018

Most traditional benefits brokers are wrapping up Turd Polish season (aka Open Enrollment). You know, that process of trying to make the “pay more, get less” benefits discussion that happens every year.

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Get Your Healthcare Before It’s Too Late

December 6th, 2018

If you’re currently without healthcare for next year or are in search of a new program heading into 2019, you need to know that the deadline to purchase health insurance through the government Exchange is December 15.

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