“You probably won’t be keeping it. That’s a prediction from Joel Ario, who oversees these health exchanges for the Department of Health and Human Services.
Dr. Garrison Bliss has found a way to decrease the role of insurance companies in day-to-day medical care that leaves both doctors and patients with more money.
The U.S. Supreme Court on April 15 will convene a private conference to consider an appeal by Virginia Attorney General Ken Cuccinelli (R) for an expedited review of a federal judge’s ruling in the state’s lawsuit against the federal health reform law, CQ HealthBeat reports (Norman, CQ HealthBeat, 3/23).
Balance Billing… it happens. With health care reform in effect and costs of providing benefits soaring, our industry has become increasingly careful with their claims dollars. Plan Administrators, seeking to cut costs and enforce their plan documents, are combating provider overcharges with a new vigor.
Some risk managers want more transparency from their third-party administrators on the financial arrangements they have in place with vendors………………………………..
Rather than moving toward a competitive world, we seem to be moving toward the opposite extreme: monopoly. Major consolidation is underway both on the provider and insurer sides of the market. And while this trend was already underway before Barack Obama became president, without doubt it is accelerating because of ObamaCare.
The graph below shows what things look like in the market for commercial insurance in major Texas cities:
Blue Cross already has 70% of the market in three of the nine largest metropolitan areas. In all of them, and for the state as a whole, more than 60% of all customers buy from only two insurers.
The health care reform law could threaten the ability of employers that self-fund their health care plans to design those plans, benefit experts say. The level of some of those threats could be known in just a few weeks.
Insurance Brokerage Exchange (IBX) is a software package designed to assist employers in seeking competitive proposals on group life and disability plans. Rights to the system are delegated to select brokers/distributors.
Financing and administering health care through a self-funded employee welfare plan takes many forms. Financing is accomplished through mix of employee and employer contributions – determining the money value of the plan, current and projected is easy. Determining the actual value is not as easy. Determining who shares in the money sometimes takes a path of convoluted twists and turns.
TRS ActiveCare covers the majority of Texas school districts. Effective 2011 the plan rates will increase approximately +9%, and benefits will reduce. A quick review of the benefit reductions brings the credit to approximately 4%, for a total actuarial increase of +13% – 14%. http://www.trs.state.tx.us/TRS_activecare/documents/ppo_rates_benefits_fy12.pdf
Cost Plus groups pay less for the same coverage. It is that simple. What better way is there to save on medical costs than by paying providers less?
Providers have the right to appeal claims which will end up with either one of two outcomes; they either win or they lose. If they lose, providers can sue. If they sue, the Cost Plus group is indemnified by an outside insurance policy.
Attempts by providers to balance bill the patient becomes a non-issue, fast.
Cost Plus clients do not rely on contracts with medical care facilities much like consumers don’t have contracts with their local grocery store.
The first Cost Plus group who led the Cost Plus revolution in Texas was Bill Miller Bar B Q in San Antonio – Bill Miller Forbes. Their story has been repeated by over 50 other Texas employers since.
There are a lot of rumors and misconceptions in the marketplace these days regarding the Cost Plus revolution. If you have any specific questions that need truthful answers, write RiskManager@sbcglobal.net
A service that sends caregivers to an employee’s home or office delivers health-care savings to its corporate clients.
David McCann – CFO.com | US
March 15, 2011
Among the many innovations designed to reduce the cost of health care, one is decidedly counterintuitive: house calls.
WhiteGlove House Call Health, a company that has built a strong corporate following in Texas over the last four years, says its house-call medical care will improve the health-care experience while lowering costs.
National Journal (3/15, Fox) reports, “Prescription drug prices have risen more quickly over the past four years than costs for other medical goods and services,” the Government Accountability Office reported Monday.
Farmers have until March 15 to purchase or modify crop insurance policies for 2011. The deadline applies to most spring-planted field crops, including corn and soybeans.
CIVIL WAR! We are in the early stages of an uprising of the states seeking to throw off the heavy demands of the federal government in the health payment arena.
A pharmaceutical company has won exclusive rights to sell a synthetic form of a hormone to prevent premature births.
A drug for high-risk pregnant women has cost about $10 to $20 per injection but this week the price shoots up to $1,500 a dose, meaning the total cost during a pregnancy could be as much as $30,000.
Four Texas legislators have pocketed tens of thousands of dollars from the Texas Wind Insurance Association (TWIA) they were supposed to oversee.
San Benito Independent School District in deep South Texas is seeking competitive health insurance proposals a full six months out from the proposed effective date of October 1.
The Obama administration has granted waivers or adjustments to five states and more than 1,000 unions, companies, and other organizations representing nearly 3 million people who no longer have to comply with healthcare-reform requirements — for now.
That news comes despite two looming congressional investigations into whether politics influences who received a waiver — what one GOP congressman is calling “crony care.”
Austin, Texas-based Capson Physicians Insurance Co. announced it is licensed to underwrite in six additional states: Alaska, Arizona, Louisiana, Indiana, Missouri and Nevada.
Capson’s medical malpractice protection is now available to healthcare providers in a total of 18 states.
Capson, which launched late last year with investors including BlueCross BlueShield Venture Partners L.P. and Beazley Investments Ltd., allows users to acquire medical malpractice coverage through an online model.
In any other field, Jeffrey Brenner would be a millionaire. But because he’s in health care, he doesn’t know how he’s going to make ends meet. Like entrepreneurs in every market, Brenner thought outside the box. He discovered an ingenious way of lowering health care costs: focus on the “hot spots” of medicine — the high-utilizing, high spending patients — and solve their problems with unconventional care.
CHICAGO – Walgreen Co plans to sell its pharmacy benefit management business to Catalyst Health Solutions Inc in a $525 million cash deal that would allow Walgreen to focus on its drugstore and healthcare businesses.
Judge Roger Vinson took the president to the woodshed last week for a lesson on which branch of government has the final word on the Constitution.
I’m sending you a special alert to let you know that tomorrow, March 9 at 10:30 AM Eastern, I will testify before the House Energy and Commerce Committee Health Subcommittee. More information about the hearing is available at http://energycommerce.house.gov/news/PRArticle.aspx?NewsID=8312
The hearing will examine five specific provisions in the Patient Protection and Affordable Care Act (ACA) and five related bills to eliminate advanced appropriations made in the law. I will be speaking about the issues associated with health care policy mandates and the ten fatal flaws in the ACA.
Live streaming of the testimony will be available at http://energycommerce.house.gov/
There is a bubbling trend from both states, and now “encouragement” from President Obama to let states create their own versions PPACA. He told states: “If you can create a plan that covers as many people as affordably and comprehensively as the Accordable Care Act does…without increasing the deficit…you can implement that plan.”
The U.S. Supreme Court recently declined to hear a workers’ compensation insurance case that concerned an illegal immigrant in Louisiana who had sought coverage after a workplace accident. The Court’s refusal to consider the case means states are left to decide the issue of whether workers who entered the United States illegally may benefit from workers’ compensation coverage.
Over the next decade I believe we are going to see a major transformation of American medicine.
The workers’ compensation industry in the years ahead will exist much as it has for decades in many respects. Policyholders will purchase coverage from either an agent or a company, with a portion of the market deciding to join the self-insured crowd. Some will be interested in few company attributes other than price, while some will look to their insurance provider for true value-added services. The most commonly seen services would be in the area of loss prevention, policyholder access to claims data, and a relationship with their insurance provider that leads to lower experience mods, and ultimately, lower costs.
The passage of PPACA has caused many insurance brokers to consider alternative health care products for self-insured clients. Among those products is an international provider network.
Stop loss insurance is available to cover foreign risk.
Funding employee benefit risks through a captive insurance company is not for every employer, but those that do so can reduce their costs, reap significant tax breaks and provide enhanced benefits to employees, according to a new Business Insurance whitepaper.
A new proposed regulation announced by the Department of Health and Human Services (HHS) would ensure students enrolled in health insurance coverage through their college or university benefit from critical consumer protections created by the Affordable Care Act.
A U.S. judge Thursday put on hold his ruling that President Barack Obama’s healthcare overhaul was unconstitutional, allowing the White House to continue implementing the landmark legislation for now.
Giant Berkshire Hathaway, which makes much of its money on insurance and investing insurance premiums, does not provide liability insurance for its own directors. Continue reading No D&O Insurance Is Good For Investors – If Directors Mess Up With Your Money, They Will Lose Their Money Too
State and municipal governments are facing tight budgets and many are having difficulty paying for their police, fire, schools and services. Where the municipalities can’t cut back, however, is on insurance. Continue reading Public Entities & Their Insurance Providers Adjust Sails In Fiscal Storm
With college spring break fast approaching many college students will be traveling with their friends to various locations to celebrate the week off of school. One of the most popular locations to visit has become one of the most dangerous locations to visit for US citizens. It may surprise you to learn that the most dangerous location to travel to is Mexico. Everyone knows not to drink the water in Mexico, but that is not the biggest threat in Mexico these days. Continue reading Spring Break in Mexico – New Business Opportunity for Kidnap & Ransom Insurance Brokers