Drug Company Raised Price of Life-Saving Drug 85,000%

January 22nd, 2017

alcor“Questcor took advantage of its monopoly to repeatedly raise the price of Acthar, from $40 per vial in 2001 to more than $34,000 per vial today – an 85,000 percent increase,” said FTC Chairwoman Edith Ramirez.

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Survival Requires Killing Predatory Healthcare Pricing

January 22nd, 2017

toodamnhighPrice is To Damn High!

“All the current reform proposals are a delaying tactic to continue to protect healthcare providers from free market, legitimate pricing”.

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The Coming Demise of PPO Networks

January 22nd, 2017

beggar

Former Managed Care Intermediary

Legitimate prices mean networks would be obsolete………….

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Free At Last, Free At Last, God Almighty Free At Last!

January 22nd, 2017

king

Government meted punishment against citizens may end. Individual freedoms may be restored………..

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Texas Insurance Agent To Be Sentenced Jan. 25? Paid Bribes To Consultant

January 22nd, 2017

mullen1Samuel Mullen , who now lives in the Rio Grande Valley, appeared before U.S. Magistrate Judge John Primomo and pleaded guilty to conspiracy to commit honest services wire fraud. Sentencing was set for Jan. 25 before U.S. District Judge Xavier Rodriguez.

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Medicaid Changes Loom Large For Health Care Industry

January 21st, 2017

medicaid11111

Medicaid is expected to remain a flashpoint as Democrat and Republican governors from around the country press the new Congress and President-elect Donald Trump to keep the ACA’s expansion in place.

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California Halts Health Insurance Plan For Illegal Immigrants

January 21st, 2017

changemind

The plan to sell (give) health insurance to undocumented immigrants is the first California casualty of the Trump presidency…………

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Beginning of Repeal & Replace

January 21st, 2017

freemarket111

ObamaCare is doomed. Everyone acknowledges that, including those who won’t admit it. But the mantra now is Replace. And the question is “With What!” The answer should a “Free Market”………………….It may just happen

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Doctors May Accept Low Fee From Medicare, But Not From All Patients

January 19th, 2017

riplye

“I want to raise awareness of some specialists’ profit-driven behaviors,” said lead author Ge Bai, of the Johns Hopkins Carey Business School in Baltimore. “Then, we can look for solutions.”

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THE HEROISM OF INCREMENTAL CARE

January 18th, 2017

klepper

The following article was send to us from Brian Klepper, PhD, health care industry expert.

“We have a certain heroic expectation of how medicine works. Following the Second World War, penicillin and then a raft of other antibiotics cured the scourge of bacterial diseases that it had been thought only God could touch. New vaccines routed polio, diphtheria, rubella, and measles. Surgeons opened the heart, transplanted organs, and removed once inoperable tumors. Heart attacks could be stopped; cancers could be cured. A single generation experienced a transformation in the treatment of human illness as no generation had before. It was like discovering that water could put out fire. We built our health-care system, accordingly, to deploy firefighters. Doctors became saviors.”

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Cash Pay Health Plans – The Future of Health Care Financing

January 15th, 2017

cashmedical“A provision of Obamacare requires health insurers to spend roughly 80 percent of premiums on medical costs. This was supposed to help control insurance costs.”

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Memo To Congress: Health Insurance is Not Health Care

January 15th, 2017

mulebriar

“Everyone is talking about Congress repealing ObamaCare and replacing it with something else. How about replacing it with a free market?” – Molly Mulebriar

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UnitedHealth Group To Become Largest Operator Of Outpatient Surgery Centers

January 14th, 2017

angryman“Screw You UHC!”

Hospital Administrator Reacts To News

A UnitedHealth Group division is poised to become one of the nation’s largest operators of outpatient surgery centers with a $2.3 billion acquisition announced Monday.

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Massachusetts Out-of-Network ED Physicians Charge 798% of Medicare Rates

January 14th, 2017

outrageous12

Massachusetts out-of-network ED physicians charge 798% of Medicare rates

Written by Brooke Murphy | January 12, 2017

Here are six findings on healthcare cost trends in Massachusetts, according to the Health Policy Commission’s 2016 Cost Trends Report.

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How To Get A New Hip

January 14th, 2017

'I guess I don't need to ask how your new hip is working out.'

www.ted.com/talks/allison_hunt_gets_a_new_hip#t-272889

What Is The Actual Cost Of An Employee’s Doctor Visit?

January 13th, 2017

cost1111There is a lot of discussion about the costs of healthcare, both for users and their employers if the employer is providing insurance.

Side Note: We have seen claim experience that document average cost of a doctor visit is $700. Yes, that’s correct, $700. This includes doctor charges, lab test, radiology, prescription drug/s. Consumers, shielded by low co-pays don’t see this, nor do they care. Four office visits in a year could eat up the premiums paid toward coverage. This is not insurance………….

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January 12th, 2017

riskmanagers.logoRiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

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Tenet To Sell Multiple Hospitals & Exit Health Plan Business

January 11th, 2017

tenet1Dallas-based Tenet Healthcare is seeking to further refine its hospital operations portfolio by selling hospitals in noncore markets………..Tenet expects to fully exit the health plan business this year.

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Are PPO Networks the Worst Negotiators in the World?

January 11th, 2017

unlockppo“An industry insider shared an example that I’ll anonymize. An analysis was done for a school district and one of the things looked at was where lab tests were done. This school district had nearly 1,500 metabolic profiles in the measurement period and paid well over $200,000 when they should have only paid under $10,000. Direct contracting/cash prices averaged 96% less in their market. That’s an average of $150 a test for what should be a $7 test.”

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Whole Foods Adopts Reference Based Pricing Model

January 10th, 2017

wholefoods Whole Foods has implemented Reference Based pricing strategies. AMPS ( advancedpricing.com) has acquired Whole Foods  as a client and is currently  managing a beta-test for them in Austin and in Los Angeles.

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Tucker Carlson Interviews Steven Weissman on Health Care Problems

January 10th, 2017

erick

Great Piece to Include on Your Blog. Tucker Carlson – Fmr Hospital Chief Steven Weissman on Health Care Problems  (4 minutes 27 seconds)

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Employers May Adopt ‘Narrow Networks’ of Health Care Providers

January 10th, 2017

confused“There are signs that employers’ interest in narrow networks may grow in the near future.”  But that is problematic. Why limit choice of providers when you can simply pay all providers the same? That solves access and financial issues for plan sponsors where the difference between profit and loss many times is tied to health care costs. Isn’t it about time consumers realize they are helping to drive costs up by accepting terms and conditions set by insurance companies and complicit plan sponsors too dumb to realize the implication of good intentions (providing employee health insurance) is having a reverse effect on their bottom line? – Signed: Ranting and Raving (Name held upon request).

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100 Year Old Doctor Still Working – Thinking About Going To Law School

January 9th, 2017

oldyoung

After decades of work at Massachusetts General Hospital in Boston, Dr. Walter Guralnick cut back. He’s now in the office just three days a week. It’s an achievement second only perhaps to his age. In November, he turned 100 years old.

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Britain’s Socialized Medicine In “Humanitarian Crisis”

January 7th, 2017

good-news

“This is a national scandal,” Labour leader Jeremy Corbyn said in a statement.

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California Funds 1st Inmate Sex Reassignment

January 6th, 2017

gail

Hi, I’m Gail, Inmate # 206946

A 57-year-old convicted killer serving a life sentence in California became the first U.S. inmate to receive state-funded sex-reassignment surgery…………

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Will Potluck Dinners, Employee Terminations Attract More Paying Patients?

January 5th, 2017

potluck1

Struggling to stem a red tide of falling income is tough when the core cause is not identified and addressed…………………..Could high prices be driving away customers?

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No Decision On Layoffs At MD Anderson

January 5th, 2017

layoffHigher treatment costs left MD Anderson out of the Affordable Care Act marketplace…… the challenge for MD Anderson is funding a high level of research while facing a potential decrease in the number of patients receiving treatment……………………

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Oh Oh…………..Oh My God!

January 5th, 2017

Man shouting, pulling hair

If GOP Doesn’t Replace Obamacare ‘Within Months,’ Insurance Companies Will Go Bankrupt

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This Is What Obamacare Repeal Will Do

January 3rd, 2017

dogchasingcare

I’m a former health insurance CEO and this is what Obamacare repeal will do…….

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Texas Opposes Sex Act

January 2nd, 2017

boobies

Washington bureaucrats  implemented a new rule in July that defined the term “sex” in the Affordable Care Act……………Texas says Sex is in the domain of state control, not federal oversight………

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Year End House Cleaning Discovery Finds Rare Antique Hospital Agreement

December 31st, 2016

molly1Molly Mulebriar, margarita in hand and a bottle of scotch in the other, dropped by our office early this morning to begin New Year’s Celebration festivities. (She is the former Miss Texas 1984 Tequila Chugging Champion and to this day manages to maintain a competitive edge in adult beverage competitions).

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Hospital Contracts Made Simple – 120% Method

December 31st, 2016

monkey Sam Crafting, M.D.

Sam Crafting 120 Hospital Contract For RiskManagers.us

Plan Sponsors, are you trying to direct contract with your local hospital? Dr. Crafting’s boiler plate Hospital Agreement may be just what you need….………..

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Classical Conditioning in Health Care Financing

December 31st, 2016

pavlov Ivan Pavlov

By Molly Mulebriar

If hospital contracts include an annual escalator clause, whey then do these contracts need to be renegotiated every two or three years? An average escalator clause assures an annual increase in reimbursement from 4-6% or more. Isn’t that enough?

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BCBS To Lay Off 70% of IT Staff & Outsource to India

December 30th, 2016

boo11

Blue Cross & Blue Shield is planning to lay off 70 percent of its IT infrastructure staff and offshore the jobs to India…………

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BCBSTX Agrees To Pay Higher Health Care Costs? If So, Will BCBS Insureds Pay Higher Premiums?

December 30th, 2016

envelope And The Answer Is……..

Large hospital system had requested a 5 percent increase worth millions of dollars. Did BCBSTX agree to pay more on behalf of their insureds and will BCBSTX pass the cost increase on to consumers in the form of higher premiums? 

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Wanna Buy A Hospital? Feds Cut Funding For Financially Strapped Hospital

December 30th, 2016

bankruptcy

The penalty comes after news of a deal between Mission Regional and Doctor’s Hospital at Renaissance to save the financially-strapped Mission Regional, a non-profit, and help it expand as a short-term secondary health facility.

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Is Your PHI Safe in Government Hands?

December 29th, 2016

secret1111

Nevada state government’s website was leaking thousands of social security numbers, and highly sensitive personal data. They said it was a hack. Spoiler alert: It wasn’t.”

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Klepper/Sutton Outline High-Performance Healthcare Solutions

December 29th, 2016

box1111Thinking Outside The Box

“Healthcare has become defined by rampant excess, so effective benefit managers will, of necessity, seek unconventional solutions.”

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Cash Cows & Smoke Filled Rooms

December 24th, 2016

smokefilledroom

“A national health care conspiracy between medical care givers and third party intermediaries has created a lucrative cash cow crafted through secretive collaborative contracts of adhesion in smoke filled rooms.” – Molly Mulebriar

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December 23rd, 2016

riskmanagers-logo

RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

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If You Could Go To The Doctor While At Work, Would You?

December 23rd, 2016

onsightcare

Employers are becoming more involved with the well-being of their employees—not just because it can reduce sick days but also because it can improve employee morale and help reduce medical spend.

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School District Restrained From Firing Insurance Agent

December 22nd, 2016

bob

Two South Texas insurance agents have spent 10 years fighting over a lucrative insurance contract allegedly worth millions of dollars in agent commissions……….

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Courageous Julie Broderick

December 21st, 2016

mulebriar

Julie Broderick had 15 years of experience as a securities regulator, and a propensity for speaking her mind before joining Prudential Financial Inc. as an investigative supervisor in 2012.

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Higginbotham Expands with Insurance Associates of the Southwest Merger

December 21st, 2016

mergerThis is the sixth merger Higginbotham has completed in 2016 as part of a growth initiative across Texas whereby the firm partners with brokers with strong local reputations……………….

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Prime Healthcare – Making Money Through Fraud?

December 21st, 2016

primehealthcare1“Feds say Prime Healthcare has figured out how to make money from hospitals — through fraud.”

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HCA Holdings: A Must Read Company Overview

December 20th, 2016

hca

Around 30% of the total admissions are reimbursed by managed care programs. These contracts are negotiated for terms between one and three years, and the rates are increased by around 4% to 6% every year.

Managed care strategy

With managed care forming a substantial portion of total revenues, entering contracts with favorable payment rates becomes an essential HCA business strategy. HCA Holdings negotiated for 80% of its total managed care plans in 2015, 40% in 2016, and 20% in 2017.

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Why We Can’t Control Medical Costs

December 19th, 2016

doctor11111111111111

“There was a universal code of belief everywhere I worked before I came to the USA that we do not torture patients in the off-chance they might live a few extra weeks or months………..but even today, 33 years after I arrived, I am still shocked at the wastefulness of physicians with the Health Care dollar.”

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Catholic Health Initiatives Pulls Out of Insurance Business

December 19th, 2016

shocked

“It’s tough in the health plan business. You lose money. You make mistakes. You plow forward. It takes cash.”

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Blue Light Special – A $49 Colonoscopy

December 19th, 2016

bluelight130x130

$49 Base Price for a colonoscopy is outstanding! Plus the patient gets to choose among several optional services to enhance their colonoscopy experience…………………….

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WebTPA

December 19th, 2016

webtpa

“We save our customers money. Most of our clients costs are below trend or flat ………….our average client covers more than 3,000 members…………”

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Broccoli Mandate To Be Overturned – Guaranteed Access Assured

December 18th, 2016

broccoliAll Americans are currently required to purchase broccoli whether they like it or not. Those who can’t afford it get it free, and those who can only semi-afford it get subsidies (i.e, welfare). Rich bastards have to pay the full cost.

Broccoli prices have skyrocketed as a result of The Affordable Broccoli Act. Quality has eroded with many Americans stuck with purchasing rotten, hardly edible broccoli.

Employers must provide broccoli to all full time employees, or face punishing fines or imprisonment, or both.

With a new administration about to take office, The Affordable Broccoli Act is at risk of being overturned. Broccoli farmers are outraged. Employers are jubilant.

But, never fear, House and Senate Broccoli lovers vow to keep voluntary access to affordable broccoli available to every American.

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MD Anderson Suffers Financial Woes – Are Narrow Networks To Blame?

December 16th, 2016

potluck1

Will turning holiday parties into potluck events save MD Anderson from financial ruin?  I don’t think cost shifting to employees is a viable solution.

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The Federalization of Health Insurance: ACA Repeal & Replace Implications

December 14th, 2016

alanpreston Dr. Alan Preston

“When I evaluate the effectiveness of legislation, I first look to see if it will accomplish its objective. Whether I like the objective or not is a separate issue. The name of the legislation is telling and provides a clue to the objective. The Patient Protection and Affordable Care Act.”

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Managed Care Contracts & Trend Factors

December 13th, 2016

life

By Molly Mulebriar

Are escalator clauses, common to most Managed Care Contracts, the driving force behind trend factors?

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Plan Sponsor Dilemma

December 13th, 2016

confused

How do we know we are doing much better this year than last year?

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Texas Teachers Migrate To High Deductible Plan

December 11th, 2016

angryteacher

Many Texas educators are insured through the Texas TRS ActiveCare health plan. Projecting a $54 million deficit for the upcoming FY 2017, TRS trustees realized plan benefits and premiums changes were necessary. More and more plan participants are selecting  the high-deductible plan option with lowest costs and lowest benefits………………

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A Better Way to Pay for Healthcare

December 10th, 2016

asserta123

Cash pay health plans make sense…………………………..

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Executives, Physicians & Hospital Indicted In Kickback Scheme

December 10th, 2016

omgPhysicians, founders, executives and investors of physician-owned Forest Park Medical Center in Dallas have been charged in a federal indictment for their alleged involvement in a bribe and kickback scheme, according to the Department of Justice.

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Tx. Senator Proposes Bill To Protect Hospitals Against Themselves

December 10th, 2016

jacket

Out of control hospital administrator restrained by staff

“Texas can’t tolerate poor quality care, poor leadership, and individuals who defraud people who are vulnerable and sick.” 

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Texas Free Market Surgery Launches Innovative Bundled Payment System

December 7th, 2016

bundlesInnovative bundled payment system is first of its kind in the state of Texas, currently offers more than 200 surgeries…………….

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Small to Midsized Employers are Now Contracting Directly with Healthcare Providers

December 6th, 2016

sense

Cutting out the “middle man” results in substantial savings and puts employers in control……

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Aetna Fights To Save Humana Merger

December 6th, 2016

perrymason

In his opening statement Monday, DOJ lawyer Craig Conrath, a top lawyer in the department’s Antitrust Division, said Aetna’s retreat from ACA exchanges was an attempt to evade antitrust scrutiny “by the equivalent of closing up shop.”

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Health City Places Ad In Wall Street Journal – Publishes Health Care Fees

December 6th, 2016
advertisingHere’s an ad for Health City Cayman Islands that appears in today’s WSJ. It’s volumes are now up significantly over their levels a year go. With tremendous quality and more American businesses are seeing the sense in sending patients there – Brian Klepper

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Webinar: Strategies To Achieve Better Outcomes Using Bundled Pricing

December 6th, 2016

Complimentary Live Webinar:
Strategies to Achieve Better Outcomes Using Bundled Pricing
Organized by:
World Congress

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2016 Medical Stop-Loss Premium Survey

December 4th, 2016
stop-loss
This year’s survey, its tenth year, reflects the ongoing rise in stop-loss premiums and a continued commitment to employer-sponsored, self-funded health plans.

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Klepper Partners With Prominent Indianapolis Broker Richard Sutton

December 3rd, 2016

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High School Students Recreate $110,000 Drug for $20

December 3rd, 2016

amazingFor $20, a group of high school students has created 3.7 grams of an active ingredient used in the medicine Daraprim, which would sell in the United States for between $35,000 and $110,000.

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Why Competition Drives Drug Prices Up, Not Down

November 30th, 2016

viagraIn June, New York City-based Pfizer raised the price of Viagra by 13 percent. Just days later, Indianapolis-based Eli Lilly followed suit, increasing the price of Cialis by the same amount, reports The Wall Street Journal.

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BCBS To Pay $50,000 Broker Sales Incentive Each Fully Insured Group Sold

November 30th, 2016

holycrap

Holy Crap! BCBS announces $50,000 sales incentive bonus on each new fully insured group sold! Why sell anything else?

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Case of the Singing Canary?

November 30th, 2016

canaryWill Haff, a San Antonio insurance consultant, has had his sentencing postponed a second time (Consultant Sentencing Delayed Again – Now 30 November 2016).Sentencing is now set for February 1, 2017.

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Rising Drug Costs Lead to PBM Scrutiny

November 29th, 2016

kickback222

If prices rise more than an agreed upon rate, excess increases may be offset by additional rebates. For some employers this means the PBM is pocketing some or all of the rebate money, driving record profits. In these cases there is absolutely no incentive on the part of the PBM to lower Rx costs. Rather, they earn more kickbacks as drug costs escalate. This revenue sharing between the PBMs and manufacturers at the expense of consumers continues to fuel spiraling Rx costs.

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Defenseless Utah Hospital System Faces RBP Blitzkreig

November 29th, 2016

blitzkreig

“The purpose of this notice is to formally advise you that University of Utah Health Care does not participate with ELAP or other “cost plus” plans being promoted in Utah or surrounding states.”

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Weslaco Independent School District Continues Aggressive Risk Management Strategies

November 29th, 2016

txfreemkt

Much to their advantage, Weslaco Independent School District in deep South Texas has effectively injected competition in local health care delivery. WISD has learned that health care givers will compete for business if given the opportunity

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Are Health Systems Improving Price Transparency?

November 28th, 2016

pricinggood“Some business is being diverted away from hospitals and toward retail clinics, standalone surgical centers and urgent care facilities that advertise their prices and services……….…’

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After Healthcare’s “Katrina”, Who Wins/Loses?

November 28th, 2016

competitionHealthcare stole the American Dream. But I’m excited to tell you a story about how forward-looking citizens, nurses and doctors are taking it back by fixing healthcare. And it’s working. 

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