Botetourt County, Virginia and San Patricio County, Texas have something in common – the political will to seek innovative strategies to rein in ever increasing, tax payer supported, health care costs for their employees. Challenging the status quo within their respective local health care community takes a rare political courage to prevail – Bill Rusteberg
People travel to visit family and attend business meetings, so why not travel for medical care?
Walmart, Kmart, Safeway, and Kroger all charge $45 for the sildenafil, using the discount card, while Walgreens charges $450 and RiteAid $1,000…………
“We have been sold on the idea that this particular incarnation of the HMO/Managed Care will save the government, save physicians and save patients all at the same time. …….The biggest sin the ACO’s commit is to distract from any real conversation about cost………… “
In the first two days, we had visits from the Florida Legislature, the Florida Department of Insurance, the Florida Department of Health, Humana, UnitedHealthCare, Cigna, Aetna, the Blues, and a range of Florida hospitals.
A researcher paid a middleman procurement company $3,340 for a fetal brain, $595 for a “baby skull matched to upper and lower limbs,” and $890 for “upper and lower limbs with hands and feet.”
The $64,000 Question
Can a plan exclude specialty drugs? The answer is yes. Many PBM’s limit their specialty drug formularies. But, can a plan eliminate all specialty drugs and remain ACA compliant?
How did we get here and why is this so hard to fix?
John Smith Stunned By Cheap Medical Premiums
Nothing like screwing insurance companies….…………
Petr Kellner got his start in the early 90’s selling office supplies……………
This year’s billionaires with connections to the insurance industry include the son of a Chicago meat-packer, a former appliance door-to-door salesman, a World War II flight navigator and a passionate environmentalist.
Arlington Healthcare Group is an established healthcare industry consulting and professional services firm. We help healthcare providers, payers, and industry technology and service enterprises grow and optimize performance and value.
The insurance and financial services company opened its doors 40 years ago on April 1, 1976, by principals Charlie Amato and Gary Dudley with only $1,500 in capital……“When we started this company, we had no idea of the incredible journey it would take us,” said Charlie Amato, chairman and co-founder……..
Enchiladas, tostadas, tacos – getting hungry yet? Grab a cerveza and read on.
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Sam Crafting, Health Care Editor – New York Times
“A business that operates at a loss should raise it’s prices” – Sam Crafting
“Don’t bother doing something unless your radically different from the competition” – Richard Branson
By Bill Rusteberg
Reference Based Pricing, or Cost Plus Insurance has evolved over the past seven years from simply re-pricing claims based on established benchmarks such as Medicare pricing schedules, to a number of evolving hybrids. A Cash Pay Health Plan Option is one, quickly gaining market attention among health care revolutionaries.
“It’s clear hospitals view owning a health plan as a way to build their population health programs by combining medical claims and clinical data.”
Actuary Panics – Pleads for Mercy
“There are enough people enrolled at this point that the market is sustainable. The premiums were just too low.”
The movement to protect consumers from surprise medical bills won a major victory Thursday when Florida Republican Gov. Rick Scott signed a bipartisan bill that will exempt patients from having to pay balance bills from out-of-network providers in certain situations.
By Bill Rusteberg
Reference Based Pricing for health care has become the fastest growing trend in the American health care delivery system. Insurance agents, brokers and consultants upon which health care payers depend for market distribution, are joining the health care Reference Based Pricing revolution in droves. Selling health insurance is becoming fun again. Competing for business has reached new levels of intensity.
Gamblers consistently overestimate the control they have over outcomes, both in gambling and in everyday life. Their belief leads them to engage in seemingly bizarre or ritualistic behaviors such as throwing dice in a certain way or wearing specific colors…….. the illusion of control is widespread, and its effects may be enhanced when people are placed in positions of authority or subjected to time pressure or competition………….
“Only 5% of patients with obesity who lose weight keep it off. Coverage for obesity drugs is improving, but remains uncommon. Only a tiny fraction of the candidates for bariatric surgery have the operation, in part because 70% of physicians won’t give referrals.”
Hello everyone. Once again, it’s time for another case study on how our health care industry is robbing us blind.
Region One Educational Services Center, hereinafter referred to as “ESC”, desires to solicit proposals for various firms to perform as a Third Party Administrator for the ESC’s Cafeteria Benefits Plan (IRC Section 125), Flexible Spending Accounts and Dependent Care Spending Accounts.
“Over the past two years, hospital chains and insurance companies have snapped up urgent-care centers in a spate of mergers and acquisitions.”
“It’s a common practice but it’s wrong.” – Arnulfo Olivarez at his 1/24/2011 sentencing for bribery before Judge Hinojosa.
“As someone that has made a career trying to help healthcare providers and health plans get on the same page as it relates to cost-containment initiatives, I have compiled my personal top ten lessons about RBP from 2015.” – Jason C. Davis
Former Health Insurance Broker
“Some insurers, including Anthem and Humana, say they dropped commissions to keep rates down.”
The proposal attempts to address what DOL and the White House claim are systemic conflicts of interest in broker advisor models………….The proposed rule clearly favors fee-based compensation models for advisors…………….
Although the proposal targets pension and investment advisers per se, the same standards may be applied to fee based insurance consultants – Molly Mulebriar
A large Texas TPA has announced the purchase of the city of Waring, Texas. City officials say the sale was in response to an eroding tax base and high debt. Waring was settled by Bosnian Serbs in the mid 1800’s.
“There have been numerous stories over the years, published widely, regarding “double dipping” by fee based insurance consultants. The scheme is lucrative, with little chance of punishment…..”
William O. Haff leaves the John Wood Federal Courthouse Thursday March 31, 2016. Haff pleaded guilty to conspiracy to commit wire fraud stemming from an F.B.I. public corruption investigation.
William Oliver Haff, 46, of San Antonio admitted that while working for the consulting company hired by the school districts — Wortham Insurance and Risk Management — he was also getting paid on the side by an insurance agent/broker so its clients would land contracts to provide employee insurance there.
After months of public frustration, Anthem sued Express Scripts Monday for more than $15 billion. Anthem argued the St. Louis-based PBM did not share enough drug savings with Anthem, which led to “an obscene profit windfall” for Express Scripts, according to a copy of the lawsuit (PDF).
“You can simply “believe” that Obamacare plans are too costly or experience any of another limitless form of hardship and get yourself out of the law. So in reality, the 4 million Americans that are estimated to pay this fine should receive an “F” in creative writing and imagination. The individual mandate does not exist. It is a mirage.”
“During the past twelve years HSAs have experienced explosive annual growth rates of 25 to 30 percent and are expected to have assets over thirty billion dollars with over 19.7 million Americans currently having accounts.”
“It is impossible to prove something to someone whose salary depends on believing the opposite.” – Upton Sinclair
How refreshing to find a hospital that quotes package prices in advance and is willing to compete for patients based on price and quality. Why are they doing it? For the simplest reason of all: to attract patients.
“Self-funded employers have been forced to rely on PPOs to give a percent off billed charges from these providers. This has done nothing to curb the rising cost of care as most PPOs are taking a portion of ‘savings’ as an additional revenue stream. It benefits them if the billed charge is excessive. In additional to the PPO, many more layers between the patient and the provider further add to the cost. “
“In Dallas, Texas Blue Cross, in its Exchange plan, is paying 10 percent less than what Medicaid pays. So these are low rates. They take all the doctors who accept that fee—and that typically doesn’t include the best doctors, by the way—and that’s how they get their premiums down. They’re convinced that healthy people buy on price.” – John Goodman
Editor’s Note: Nothing in the ACA mandates the reimbursement levels paid to medical care givers. In this case BCBSTX is paying less than Medicaid on their narrow network If BCBSTX can pay an arbitrary number which is less than Medicaid reimbursement rates, what prevents an employer doing the same thing? The employer could build a Base Plan with reimbursement rates half of Medicaid’s and thus limit risk while complying with the ACA. The employer could then offer a Buy Up Plan for those who want “real” insurance
“Narrow networks are simply an aggregation of health caregivers willing to earn less. For example, if Dr. Jones wants $250 for a routine office visit while Dr. Smith wants $55, and if Hospital “A” wants 450% of Medicare while Hospital “B” will take 115% of Medicare, guess which providers are invited to join these narrow networks?“- Homer G. Farnsworth M.D.
Texas providers and hospitals are taking full advantage of the benefits of technology, and it’s yielding results………….
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“Charge-master rates, in reality, serve as nothing more than the starting point for negotiations with the payer”……………….”The ‘full charges’ reflected on hospital Charge Masters are unconscionable”…………………..…
“Hospital discounts mean nothing” – Bill Rusteberg
“The price is too damn high!”
Florida attorney Steven I. Weissman agreed to become interim president of a Miami hospital when its founder, a friend and client of 35 years, died. He quickly got an insider’s view of the healthcare system and found it sickening. Risking long-standing relationships, he has gone public.
The scheme behind turbocharged hospital bills is to provide false value and hidden revenue streams………….a Victor Lustig wet dream
“The insurance company owned by Intermountain Healthcare is promising employers an annual 4% growth in healthcare costs……”
Is a 4% annual increase in health care costs a good deal? No says Homer G. Farnsworth, M.D. – “That’s outrageous! Under Reference Based Pricing, Direct Contracting, and the Asserta Health Cash Plan our clients are reducing health care costs, not increasing them!”
From the founding of the Republic, Americans have joked about the poor handwriting of physicians. Well, all the Americans except the ones who got the wrong medicine because pharmacists misread handwritten prescriptions.
Am I being denied my right to bear arms if I can’t afford the price of a handgun?
The largest health care system in Oklahoma publishes transparent cash pricing……
Government to be quicker to punish free enterprise this year, government officials say……eager bureaucrats gearing up for punishment phase…………..prison farms to be expanded to accept newly minted criminals……..Citizens flee to sanctuary cities…………Canada closes border, says USA must pay for fence………
Edinburg Consolidated Independent School District (ECISD) and Doctors Hospital at Renaissance Health System (DHR) are proud to announce the creation of the Edinburg CISD School Based Health Center, a facility dedicated to the healthcare needs of our students, families, and employees.
Insurance fraud is rampant in health care. For example, we have found numerous instances where nephews, nieces, grandchildren, live-in girl friends and others are added to health insurance policies that are never audited. Dependent eligibility audits should be performed by plan sponsors.
Onsite health clinics are rapidly becoming the hottest trend in population health.
Fairfield County School District in Ohio became the first suburban school system in the country to offer health, dental, vision and mental health services in a single location.
The Weslaco ISD vs Aetna & Robert J Garza lawsuit is a fascinating read. The original pleadings are worth reading for those students interested in peeling back the onion of the opaque world of health care costs.
It appears this six year case is winding down through arbitration ………
Donald Trump released a seven-point health care policy paper this week, boasting that his plank would reduce health care costs and dubbing his plan “healthcare reform to make America great again.”
The Employee Retirement Income Security Act’s reporting requirements trump those of individual states, including a Vermont requirement that self-insured employee health plans must report claims data, the U.S. Supreme Court ruled Tuesday in a victory for Liberty Mutual Insurance Co.
Cash pay health plans are catching of fast. Hospitals are taking note…….