New government accounting rules enable local officials to get unfunded obligations to retirees under control.
“Homo sapiens have always sought redemption. Today it is through data. Numbers have replaced Yahweh and Indra. But, just like the old gods were, numbers can be moody, arbitrary and, occasionally, downright unfair. Numbers are a human construct, after all.”
K&K Insurance Group, Inc., a subsidiary of Aon plc, has launched a new website at www.PrivateSchoolK12-kk.com offering K-12 student accident coverage. The website is designed for private, non-boarding K-12 schools and offers the ability to quote and purchase insurance online and receive coverage documents immediately via email.
Stressed Heath Insurance Broker Contemplates Future
“Brokers that are comfortable working on a fee-basis will be fine, but the majority of small and mid-size brokers still work on a commission basis, so this could be a real risk for them if they do not have the skill set or culture in their organization to engage clients on a fee-basis,” O’Connor says.
“The only hope is more hospitals/health systems take-risk based contracts as accountable care organizations and fill the national void with myriad local fee standing health plans who can give the remaining national carriers a run for their money and keep competition alive.”
Only massive bureaucracies with huge compliance and legal departments are equipped to deal with the approximately 40,000 pages of the Patient Protection and Affordable Care Act’s laws and regulations. It is crushing competition.
Every stakeholder was benefiting from the system, except one: the patient. In addition to the official costs of care and drugs, there was another price people had to pay: a fee known as “the envelope.”
EDINBURG – The Commission on Cancer of the American College of Surgeons granted three-year accreditation to the Doctors Hospital at Renaissance cancer program.
“The VA is funded with millions of dollars and billions of dollars but you will not pay providers? How is it the veteran’s fault that you are such an incompetent part of the United States government?” – Fred Rendon
Summary: The only way insurance companies can compete for business on the PPACA exchange is through lower rates. That is accomplished by paying providers less. Benefit design is mandated and therefore not a differentiator in plan selection.
DHR hopes to double size, but faces opposition from other local hospitals
Remember Xerox? How about Eastman Kodak? Both companies were pioneers in their industries. They were visionaries providing solutions by fulfilling previously unmet needs, creating new markets that did not exist before.
“Traditional models rely on a non-transparent contracting process in which insurance companies negotiate discounts off of over-inflated charges.”
Brownsville Independent School District (BISD) is seeking proposals for administration of the district’s self-funded employee health plan. BISD is currently with Blue Cross.
Chicago, IL, July 16, 2015 — Health Care Service Corporation (HCSC), the nation’s largest non-investor-owned health insurer, today announced several enhancements to its Blue Directions private exchange solution for large employers, available now for the upcoming 2016 benefit plan year.
Premiums are spiking around the country. Obama is in denial.
“Charging a fee for access to a group of health care providers has been a fantastic business. Low investment in capital assets, minimal labor costs and bountiful cash flows attract our country’s smartest investors. With margins above 60 percent, it is no surprise the Goldman Sachs of the world own networks.”
In health care provider-insurer contracts, three types of clauses inhibit price transparency: (1) non-disclosure agreements, or “gag clauses;” (2) anti-tiering/anti-steering clauses; and (3) most favored nation clauses.
New York Times reports that out-of-pocket spending on “most major birth control methods fell sharply in the months after the Affordable Care Act began requiring insurance plans to cover contraception at no cost…………….
“The provider, as is the case with many, initially told us that it was not interested in negotiating at all….”
Intel was rigorously managing its equipment suppliers but not its health care suppliers…….Intel decided it could use its purchasing power in markets where it had operations to influence health care players—care providers, health plan administrators or insurers, and other employers—to rise above their competing self-interests and work together to redesign the local health care system….
“Emergency departments are often more profitable than hospitals admit, as they are the source for roughly half of inpatient admissions. Patients admitted in emergency situations are rarely price-conscious, and revenue from ED admissions is often counted as part of subsequent inpatient stays. Furthermore, as non-urgent cases presenting in the ED are often relatively cheap to treat and well-covered by ED reimbursement rates, hospitals lack the incentive to redirect them to cheaper sites of service.”
“The U.S. Department of Health and Human Services has interpreted reference pricing as consistent with the principles of the Affordable Care Act when implemented by large, self-insured employers, and has adopted a salutary wait-and-see stance.”
Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected.
Upon hearing the news, hordes of actuarys flock to liquor stores throughout the fruited plane seeking solace……………..“An actuary is a person who passes as an expert on the basis of a prolific ability to produce an infinite variety of incomprehensible figures calculated with micro-metric precision from the vaguest of assumptions based on debatable evidence drawn from inclusive data derived by persons of questionable reliability for the sole purpose of confusing an already hopelessly befuddled group of persons who never read the statistics anyway.”
The perception that BISD was screwed by HealthSmart over so called provider “pricing discounts” demonstrates common ignorance. This is understandable since the general public has no understanding whatsoever how our health care delivery system is structured.
Aetna buys Humana for $37B amid record number of health care deals
High deductible plans are creating new headaches for hospitals, including more unpaid bills and seasonal demand for some healthcare services as patients wait to hit their deductibles before seeking non-urgent care.
The bulk of the savings through high deductible plans, up to 75%, come from lower utilization. It’s not the value of the increased deductible per se, it’s the change in behavior. When it’s other people’s money it doesn’t matter, but when it’s your money it’s a completely different dynamic.
Instead of jacking up prices, hospitals should work with local health plans to achieve equitable solutions – lower reimbursement rates for lower deductibles and co-insurance. Is 250% of Medicare and chasing dollars better than 100% of Medicare and not chasing dollars?
Mike Dendy, President of AMPS (Advanced Medical Pricing Solutions)
By Mike Dendy
I have been in the healthcare business as a benefits consultant for 25 years. 10 of those years were spent as a TPA owner/manager with the last 10 as CEO of a cost management company reviewing the work of ASOs, TPAs, and PPOs. I can say without reservation that employers with self funded (ERISA) healthcare plans should choose a quality TPA over an ASO carrier for the following four reasons.
“Reference Based Pricing represents the last frontier in innovation to control health care costs in a tightly regulated and controlled market” – Bill Rusteberg
[The chart] outlines the growth of administrators in healthcare compared to physicians over the last forty years. A picture is worth a thousand words, isn’t it?
You see, when you have that much administration, what you really have is a bunch of meetings. Lots of folks carrying their coffee from place to place. They are meeting about more policies, more protocols to satisfy government-created nonsense. But, this type of thing in healthcare isn’t fixing things. It’s not moving the needle.
HealthSmart to pay BISD $2 million in three payments………….
Local Brownsville blog reports on terms of Brownsville ISD vs HealthSmart settlement. The controversy concerned the promise of deep PPO discounts and the perceived notion on the behalf of BISD they were screwed. This is a classic example of suing a Ham Sandwich and winning through extortion. (type in Brownsville ISD in the search box on this blog for previous postings) – Molly Muebriar
Scalia wrote that the justices who authored the majority displayed “no semblance of shame” in their opinion. His dissent is littered with jabs at his fellow justices. “Today’s interpretation is not merely unnatural; it is unheard of,” Scalia writes. He describes another aspect of the majority’s analysis to be “pure applesauce.”
Milliman’s report is the latest indication that health-care costs, which saw a historic slowdown in their rate of inflation in the years after the Great Recession of 2008, are headed back up toward the trends seen before the financial meltdown
Why Cigna Rejected $47 Billion Bid by Anthem
June 22, 2015
Cigna Corp. rejected Anthem Inc.’s $47 billion takeover bid, saying it was inadequate, not in the best interests of shareholders and that Anthem’s management wasn’t fit to lead a merged insurance giant.
Say you are an older senior citizen and can no longer take care of yourself and the government says there is no Nursing Home care available for you. So, what do you do? You opt for Medicare Part G.
In one example recently highlighted by CBS Evening News, a compound pharmacy was able to successfully bill one of our competitors $44,707 for a one-month supply of compounded resveratrol, an antioxidant found in red grapes that can be purchased over the counter for $157.
“We’ve got some 17 million more people covered … but they can’t access the care they seem to be entitled to,” McDermott said. “It costs too much to use the care. That’s the deceptive part about it.”
The San Benito Independent School District board of trustees has decided to close their on-site medical clinic this year.
“The clinic is driving costs because of the way the referral system has worked” said the SBISD superintendent.
Marsh Consulting Group
“Here’s a little-known secret: Voluntary benefits often provide the broker with a first-year commission exceeding 60%, compared to a 3-7% commission for health plans………….These products, which typically pay out less than 50% of the premiums toward actual claims, may in the end hurt employers’ creditability once their employees realize that voluntary benefits aren’t much of a benefit after all.”
What business do you know that marks up their prices by 920% and still stays in business?
Corpus Christi Independent School District has awarded Gallagher a multi-year $200,000 per year contract for health insurance consulting services. The previous consulting firm, Wortham, charged $85,000.
By Molly Mulebriar
We are all aware that health care costs continue to rise. We have fooled ourselves about why that is so. But what does this article have to do about food?
Brownsville Doctor’s Hospital filed for bankruptcy on Dec. 11, 2013, and according to that filing, it had $8,093,632.54 in liabilities and $5,059,441.93 in assets.
Tokio Marine Holdings of Japan said Wednesday that it has agreed to buy U.S. specialty insurer HCC Insurance Holdings Inc (HHC) for $7.5 billion, making the acquisition the largest by a Japanese company so far this year and the largest ever by a Japanese insurer.
Will ObamaCare cover head transplants? If not, will Obama change his mind? Republicans hope so and have volunteered Ted Cruz as donor.
Some hospitals charge more than 10 times the Medicare rate, according to a new study published in Health Affairs on Monday.
“…..the mystery of the chargemaster continues. “What other industry can you think of that marks up the price of their product by 1,000% and remains in business?” said co-author Gerard Anderson.”
Company with 12 employees and $3.5 million in revenue has bid on contract that would earn more than $1 billion – Poised to become the financial backbone of the U.S. health care system?
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Here's my latest blog for HuffPost: http://www.huffingtonpost.com/david-belk/the-skyrocketing-cost-of-_b_7492476.html It addresses the skyrocketing prices of brand name prescription drugs. Nearly every brand name medication has gone up in price over the last couple of years; most have gone up more than 10 times the rate of inflation. Dave Belk MD
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Are you ready for your DOL audit? Maybe you should be since plan audits are on the rise – there are 17,000 new IRS agents out of training now, hungry to prove their worth. With quotas to reach and maintain, to advance up the lucrative federal government job corp ladder demands tangible results.
“The opportunity is that an employer group who is self-insured has the ability to create a flexible plan best suited for its employees,” Bud Brooks, President at Brooks Healthcare Solutions, says.
Brooks says that it all boils down to avoiding the use of big, broad-based PPOs.
‘We’ve served our purpose and it’s time to disband and the assets can go back to the public.’”
“Alternative payment models are just another illusion for affordable care that has a different name. ACOs are merely one more bureaucratic experiment that shuffles chairs around on the deck of the Titanic, while the boat remains in fast pursuit of the iceberg.”
The hospital says exclusion from the preferred provider networks (PPO) of these companies has created “serious and negative consumer impact.”
Note: Another good reason to leave the managed care world and pay medical caregivers a transparent, fair and reasonable reimbursement based off pre-determined benchmarkes.
Forbes (5/31) contributor Bruce Japsen wrote that the American Medical Association is set to debate and vote on telemedicine recommendations by the AMA’s Council on Ethical and Judicial Affairs “as the nation’s largest health insurers widen coverage of telehealth to unprecedented numbers of their health plan subscribers.”
“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.”