Archive for October 17th, 2013

Getting Control Of Healthcare Expenditures – The Reduction Of Healthcare’s Moral Imperative On Employers

Thursday, October 17th, 2013

AMPS

By: Mike Dendy, MHA/MBA        –          CEO/President Advanced Medical Pricing Solutions, Inc (AMPS)

Our current system of corporate healthcare financing is nothing short of absurd.  Health plan members seek care without regard for or knowledge of costs and administrative fiduciaries pay those bills without even the slightest bit of diligence to confirm validity of charges or services rendered.  We buy medical services through expensive purchasing cooperatives (PPOs) that increase rather than decrease costs.  And, we levy the same participation fees on members who work diligently to care for themselves properly as those who manage themselves in near suicidal fashion.

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Why Pay $900,000 To Intermediaries Instead Of Medical Care Givers? Nothing Makes Sense These Days!

Thursday, October 17th, 2013

sense

By Molly Mulebriar

Why pay intermediary fees when both providers of medical care and consumers would be better off dealing direct? Cost Plus Insurance and/or Reference Based Health Plans pay 120% of Medicare to hospitals in most cases. By the time intermediary fees are added, plan sponsors end up paying 135-150% of Medicare equivalent rates. Why not pay these intermediary fees to the provider of medical care instead?

We have seen fees as high as $650,000 (group of 750 employees) and $900,000 (group of 435 employees) – would this money have been better spent paying health care providers instead of auditors, TPA’s and law firms?

Plan sponsors have been willing to expend these enormous fees to protect their employees against balance billing and lawsuits although they do not have any liability themselves (the plan pays what it pays, nothing more, nothing less). However, more plan sponsors are reconsidering this expense and are turning to a reference based pricing model instead.  Onerous fees go away, patients are now, for the first time, participating in a direct dialog with their providers – it’s called “skin-in-the-game.”

At what level of reimbursement are hospitals willing to accept? We see some taking less than Medicare on an exclusive basis in certain areas. In other areas we see 120-150% as the magic number. The vast majority however, want more. After all, they are getting as much as 250-400% of Medicare through managed care contracts  leaving little incentive to settle for less.

See –  Are You Paying Competitive Fees For Your Cost Plus Plan?

Editor’s Note: Molly Mulebriar is a free-lance reporter from Waring, Texas and a frequent contributor to this blog. She can be reached at www.mollymulebriar.org

This Article Destroys Wellness Programs

Thursday, October 17th, 2013

This article destroys wells program

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The Summer of Wellness’s Discontent

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By Al Lewis & Vik Khannahe series of unflattering articles published in Health Affairs early this year – the first unfavorable press wellness had ever received in a top tier policy journal — turned out to be a harbinger of what became the wellness industry’s summer of discontent.  Perhaps in error, the Journal of Occupational and Environmental Medicine (JOEM) also drifted into the sea of credibility on wellness early in 2013 by publishing a meta-analysis of the industry’s claims of economic success.

The analysis, by researchers at Tufts, destroys the industry mythology of respectability by noting that out of over 2,000 papers published in the world’s medical literature, only 10 (0.5%) are worth discussing and that discussion leads essentially nowhere.  Not surprisingly, like our essays here and in Health Affairs, the Tufts work has been universally ignored by the wellness true believers.

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