Aetna, Baptist Health System, HealthTexas Medical Group Form ACO

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Former School Board Insurance Consultant Faces Ethics Charge in Louisiana

tikia Rina Tikia
The Louisiana Board of Ethics has charged the Lafayette school board’s former insurance consultant with violating ethics laws by offering a school board member tickets to a New Orleans Saints game while “seeking a contractual and business relationship” with the school board.

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AMPS Seeks Two New Sales Representatives

AMPS is looking to add two top tier sales professionals to help us with the incredible demand for our Reference Based Reimbursement (RBR) solution. Do you want to continue to sell sugar water or come with us and change the self insured world? We love what we do, it’s all we do and no one does it better. If you want to LOVE what you do too, contact John Powers at jpowers@less advancedpricing.com or 630.361.2525

North Carolina Blues Plan Unloads Price Transparency Surprise

Amazing Revelation! Will Coke Cola Recipe Be Next? 

There’s a fascinating story out of North Carolina about that state’s largest insurer unexpectedly publishing information on how much it pays healthcare providers for a wide range of elective, non-emergency services. ……Such payments normally are closely guarded business secrets……………………Providers were not pleased.

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I Don’t Want To Tell You My Current Premiums

“Just give me a quote along with the other five agents I have contacted. Never mind that my current agent has that information!”

“As I’ve aged and acquired more experience and am blessed with the knowledge that dinner is on the table whether or not I make a sale today, I’ve become more stubborn about insisting that if a prospect wants my involvement and engagement in seeking coverage, then they have to co-operate at minimum levels…………”

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PBMs Should be Required to Disclose Fees and Compensation

onionPeeling Back The Onion

Testimony submitted to the Council revealed that drug pricing methodologies and PBM compensation are complex and evolving, including rebates, price spreads, discounts, and other payments from retail pharmacy chains and manufacturers.”

“Substantial evidence was submitted to the Council from ERISA plan sponsors and others that many PBMs do not fully disclose compensation in a manner which is readily understandable to even the most sophisticated plan sponsors and consultants.”

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Long Term Care Insurance – Reducing The Implied Leverage of Insurance

risk

By Michael Kitches

Insurance functions best when it is used to cover high-cost low-probability risks — things that aren’t likely to occur, but would be devastating if they did. Technically, paying insurance premiums on an ongoing basis has a slightly greater expected loss than just retaining the risk, but the trade-off — converting a potential financial disaster into a manageable ongoing premium — is appealing.

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The True Story of Generic Medication Prices

belk
By David Belk, M.D.
A number of generic medications have skyrocketed in price recently and quite a few people have asked me about it. In order to comprehensively address this problem (or at least define it) I did a survey of what pharmacies in the US have paid for 1,240 listings (including different doses and preparations) of over 400 generic prescription medications each quarter from October 4, 2012 through January 7, 2015). I tracked how the price of each listing changed each quarter and in total.

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Brownsville Man Sentenced For Insurance Scheme

BROWNSVILLE – A jury on Wednesday found a Brownsville resident guilty of securities fraud and theft.

Prosecutors said Alberto Alba Villarreal, 45, sold a bogus $1 million investment contract in Nafta Holdings LLC, to help fund a new insurance company. The fraud happened in November, 2008.

Officials said Alba Villarreal instead spent the money in less than three months on personal expenses and lavish purchases.

A jury sentenced Alba Villarreal to 10 years community service and was ordered to pay $10,000 for the securities fraud. He was sentenced 5 years in prison and ordered to pay a $10,000 for the theft count.

Visiting Judge Federico Hinojosa ordered Alba Villarreal to pay $1 million in restitution to the victim.

http://m.krgv.com/news/Brownsville-Man-Sentenced-in-Securities-Fraud-Theft-Case/30759242

See: Funding New Texas Insurance Company Proves Problematic

 

County Commissioners Discover Motherload!

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High Drug Costs – Low Drug Costs – Each Has a Price

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PETER UBEL, MD | MEDS | JANUARY 12, 2015

India is not, yet, a wealthy country. Nevertheless its people experience many of the same expensive-to-treat illnesses as wealthier populations in the U.S. and Europe. Therefore, the country has made a series of policy decisions designed to lower the cost of medical treatments.

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Brit View of American Health Care – Pain In The Arse

pain

Where Americans see “choice” in their private health insurance plans, Brits see wasted time and confusion. Where Americans say “I get to choose my doctor,” Brits ask “why on earth would you want to choose a doctor?” Where Americans talk about “out-of-pocket” and “deductibles” and “co-pays”, Brits say “what?” and get all of the above confused.

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Medicaid Rates Are Going Down & There Is Nothing Doctors Can Do About It

medicaid

By Shirie Leng, M.D.

Medicaid is a federal program for the very poor implemented by grants to states, which do the administration.  Medicaid typically pays doctors about 60 percent of what Medicare pays.  In Florida, a typical primary care visit might pay the doctor $32.  In Alabama, doctors who agree to be the primary care physicians of record for Medicaid patients get a whopping $2.60 per beneficiary per month, a fee with which the doctor has to maintain 24 hour office availability and use EMR.

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Mutual Accident Company

colonial1

Founded in 1937 by a salesman who put up $2,000 and borrowed $3,000 more to start Mutual Accident Company. The company sold only one product; a $1,000 accident policy for $3 per year. Two years later he changed the name of the company and turned it into a stock company. In 1993 the company was sold for $571,000,000. Not too bad for an initial investment of $5,000.

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Consolidation: Less Competition in Health Care

“Continuing consolidation in the health industry has enabled providers to raise their prices without improving the quality of their services…….. The resulting lack of competition among hospitals and other providers allows those providers to monopolize the market and charge higher prices…….health insurance compounds the problem….”

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The Future of Medicine Is In Your Smart Phone

smartphone

Now, at any time of day or night, you can demand and get a secure video consultation with a doctor via smartphone at the same cost (about $30-$40) as the typical copay charge through employer health plans. This may seem exotic now, but several large consulting firms—including Deloitte and PricewaterhouseCoopers—have forecast that virtual physician visits (replacing physical office visits) will soon become the norm.”

Beats calling for an appointment, waiting days to see the doctor, then making your 9:00 a.m. appointment days hence only to see the doctor at 11:00, after sitting in a room full of sick and possibly contagious patients, for a brief 5-10 minutes meeting with your harried and stressed doctor, then driving over to the pharmacy to get your prescription, waiting there for 30-45 minutes with retching, sick and possibly contagious Typhoid Marys and having to deal with Miss Grumpy the pharmacy sales clerk, then driving back to work only to hear your supervisor bitch and moan.

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Self Insurance Administration – A Competitive Market

tpa

Last March, Aetna scored one of the biggest single contracts in its history when the Teacher Retirement System of Texas shifted the administration of its self-insured healthcare benefits program from Blue Cross and Blue Shield of Texas to Aetna.

See: Selecting a Third Party Administrator

“……wellness programs, accountable-care networks, hospital bill audits and direct contracting with providers  appeal to employers……help them (self-funded plans) reduce costs and improve care……..” See: The PPACA – Game Changer for Health Care Financing

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San Antonio Facing $70 Million Cadillac Tax

gruber

Obamacare architect Jonathan Gruber and his Obamacare comic book for stupid Americans

“Gruber said that the trick to selling the “Cadillac tax” was to claim it was a tax on insurance policies and not “people” – Breibart

The City of San Antonio could be liable for huge tax penalties unless it can come to terms with police and fire unions on new collective bargaining agreements that includes less costly health benefits.

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Antibiotics: US Discovery Labelled “Game Changer” For Medicine

tractor2

The decades-long drought in antibiotic discovery could be over after a breakthrough by US scientists. The researchers turned to the source of nearly all antibiotics – soil. This is teeming with microbes, but only 1% can be grown in the laboratory. The team created a “subterranean hotel” for bacteria. One bacterium was placed in each “room” and the whole device was buried in soil.

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Phia Group Announces Implant Cost Pro Service

PHIA

“Implant Cost Pro” Case Study:  A self-funded benefit plan, which had historically secured a 10% discount with an ambulatory surgical center for services involving implants, advanced a $91,000 implant claim to The Phia Group.  Utilizing the Implant Cost Pro service, leveraging cost data and innovative arguments, The Phia Group ultimately secured a negotiated payment of only $22,000; a net 76% or $69,000 in savings.

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For Physicians; The Cheese Has Moved

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At last month’s American Medical Association (AMA) House of Delegates  Interim meeting in Dallas, attendees approved a resolution to study the  impact of physician unionization based on the growing concern about  physician employment arrangements by hospitals and health insurers.

While it’s not likely physician unions will sweep the country, it’s certain physicians aren’t happy. Their reasons are understandable:

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Health Care Fixes Backed by Harvard’s Experts Now Roil Its Faculty

collegeprof-By ROBERT PEAR

WASHINGTON – For years, Harvard’s experts on health economics and policy have advised presidents and Congress on how to provide health benefits to the nation at a reasonable cost. But those remedies will now be applied to the Harvard faculty, and the professors are in an uproar.

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Indictment Alleges Massive Rx Scam – $100 Million in Overbilling

rxscam

“workers’ compensation insurers would be billed in “the $1,500 to $3,000 range” for creams that had a wholesale cost of about $70………

In October and December of 2010, Sorat wore a wire while eating lunch with Ahmed. On the tapes, Ahmed can be heard boasting of his success: “I’m a behemoth, I make 8 to 10 million a month….It’s the fee schedule man! You got to mark it up. It’s like a 200 percent markup”

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Humana / Concentra Seek Primary Care Market Expansion in San Antonio

concentra

Humana seeks primary care sales representative in San Antonio.

The Primary Care Sales Specialist will report to and work in conjunction with the National Field Marketing Leader to help Concentra Primary Care achieve and sustain aggressive new patient and plan membership growth goals for each neighborhood medical center in San Antonio. Responsibilities include:

  • Cultivate strong relationships with insurance agents and community partners to keep Concentra Primary Care top of mind as these professionals interact with our target demographic
  • To help reach our target market Medicare-eligible seniors

(Humana San Antonio job posting 18 days ago).

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How The Kind, Humble Physician Met His Demise

doctors

There once was a kind humble physician who worked for years in an office building across the street from the hospital, toiling day to day to take exceptional care of his patients.  He was open and deliberate, calm and thoughtful.  He himself hired every secretary and medical assistant, every nurse and biller.  His staff formed a protective family who fiercely advocated for both patient and doctor.

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Fixing our broken health care system: Sometimes David wins

david

“You couldn’t invent a worse health care system than the nightmare we have created in the U.S. Our medical costs are almost twice as high per person as they are in most other similar countries but produce only mediocre outcomes………….Almost everyone without a financial stake looking at the U.S. system comes to the same diagnosis that it is crazy, dangerous, and unsustainable………….” Allen Frances, M.D.

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Probability 0.0000000000001%

https://www.youtube.com/watch?v=yuiG78Al3yc

บริษัท กรุงเทพประกันภัย จำกัด (มหาชน) มีนโยบายที่ชัดเจนในการดำเนินธุรกิจ ภายใต้กระบวนการการกำกับดูแลกิจการที่ดี โดยมุ่งเน้นให้มีการเปิดเผยข้อมูลแก่ผู้มีส่วนได้เสียทุกฝ่ายไม่ว่าจะเป็นผู้ถือหุ้น ผู้ลงทุน นักวิเคราะห์ พนักงาน

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