Archive for June, 2015

4 Reasons Why Self-Funded Employers Should Choose A TPA Over An ASO

Tuesday, June 30th, 2015


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.


Beating Medical Trend – Managed Care vs Reference Based Pricing

Monday, June 29th, 2015


“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 That Could Undo The Healthcare System

Sunday, June 28th, 2015

[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.


Brownsville ISD vs HealthSmart Settlement Terms Revealed

Saturday, June 27th, 2015


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



Thursday, June 25th, 2015


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.”


More Proof Managed Care Doesn’t Work – The Continued Failure of PPO’s

Wednesday, June 24th, 2015


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


The Answers is No – Your Management Sucks

Tuesday, June 23rd, 2015


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.


Summer Session 2015

Monday, June 22nd, 2015

Designed for Public Purchasing Professionals with special emphasis on the latestdevelopments that are essential in general purchasing.

List of Speakers    

Medicare Part G

Monday, June 22nd, 2015


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. 


Drug Compounding Scam – Express Scripts Reacts

Monday, June 22nd, 2015

express  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.


WellDyneRx Helps Polk County Save $1.9 Million On Rx Spend

Sunday, June 21st, 2015

weldyneThe key to managing pharmacy benefits is having a good pharmacy benefit manager to ensure savings while maintaining the quality of the program.


Democrats: “Underinsurance” To Be Campaign Issue for 2016

Friday, June 19th, 2015


“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.”


San Benito ISD To Close On-Site Clinic – “Clinic Drives Higher Costs”

Thursday, June 18th, 2015


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.


Justice Department Strikes

Thursday, June 18th, 2015
“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice”


The Truth About Voluntary Benefits

Thursday, June 18th, 2015


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.”


United Health Care To Purchase Aetna?

Thursday, June 18th, 2015
“UnitedHealth Group Inc. has approached Aetna Inc. about a takeover deal that would likely be valued at more than $40 billion, … the latest move in a frenzy of merger talks in the health-insurance industry


The Clock

Monday, June 15th, 2015

clockClick here

South Texas Health System Defends 920% Price Markup

Monday, June 15th, 2015

Rick Scott

What business do you know that marks up their prices by 920% and still stays in business?


Selling ObamaCare – Gruberize The Process

Sunday, June 14th, 2015


“Michelle and I don’t want anyone telling us who our family’s doctor should be – and no one should decide that for you either. Under our proposals, if you like your doctor, you keep your doctor. If you like your current insurance, you keep that insurance. Period, end of story”. – Barack Obama


Corpus Christi ISD Hires New Health Insurance Consultant

Friday, June 12th, 2015


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.


TRS ActiveCare 2015-2016 Benefits & Rates Published

Friday, June 12th, 2015

These 10 Hospitals Could Pick Your Pocket Clean

Friday, June 12th, 2015
What other business can inflate their costs by 100% and still stay in business?


Food And The Cost of Health Care

Friday, June 12th, 2015


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?


Tenet To Buy Brownsville Doctors Hospital?

Wednesday, June 10th, 2015


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 To Buy HCC

Wednesday, June 10th, 2015


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?

Wednesday, June 10th, 2015

Animal testing: In 1970 Dr Robert White transplanted the head of one monkey onto the body of another, as shown in this diagram. If Spiridonov's head were to be successfully transplanted his jugular vein and spinal cords would have to be similarly fused with those of his new donor body

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 1000% Of Medicare Rates? That’s Outrageous!

Tuesday, June 9th, 2015


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.


Small Company May Revolutionize U.S. Health Care Industry

Monday, June 8th, 2015


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?

Dave Belk, M.D.

Monday, June 8th, 2015
Here's my latest blog for HuffPost:

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

Dave Belk MD

Preventing Low Volume Hospitals From Performing Certain Surgeries

Monday, June 8th, 2015

practice“If you’re only performing a hip replacement surgery three times a year, chances are you won’t do it as well as a surgeon who performs 200 a year. Practice makes perfect.”


Sunday, June 7th, 2015


The shared vision of and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

 2014 All Rights Reserved


DOL Audit Letter – Are You Prepared?

Sunday, June 7th, 2015


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.


Direct Provider Contracting Pays Off

Thursday, June 4th, 2015


“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.


Blue Shield Loses Tax Exempt Status – Others To Follow?

Thursday, June 4th, 2015

bcbs“They act like a regular insurance company: big profits, generous salaries, and high rates.” That’s the conclusion Johnson came to as the state was auditing Blue Shield’s 76-year-old tax exemption.”

‘We’ve served our purpose and it’s time to disband and the assets can go back to the public.’”


Dr. Bilhartz Rebuts Dr. Gawande

Thursday, June 4th, 2015


“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.”


ETMC Files $1 Million Suit – Wants To Be Included In PPO

Wednesday, June 3rd, 2015



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.


Data Shows Large Increases In Hospital Charge Master Rates

Tuesday, June 2nd, 2015

lustig Victor Lustig


Physician’s Group To Decide Telemedicine Policy As Insurers Expand Telehealth Coverage.

Monday, June 1st, 2015



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.”