Some U.S. Hospitals Mark Up Costs By 1,000%

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“There is no justification for these outrageous rates,” says Prof. Anderson, “but no one tells hospitals they can’t charge them. For the most part, there is no regulation of hospital rates and there are no market forces that force hospitals to lower their rates.”

Editor’s Note: “Market forces” and “Regulation of Hospital Rates” are not synonymous.

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RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

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CEO Reviled for Drug Price Gouging Arrested

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Martin Shkreli, the boyish drug company entrepreneur, who rocketed to infamy by jacking up the price of a life-saving pill from $13.50 to $750, was arrested by federal agents at his Manhattan home early Thursday morning on securities fraud related to a firm he founded.

Shkreli’s extraordinary history—and current hold on the public imagination—makes the case more noteworthy than most involving securities fraud. The son of immigrants from Albania and Croatia who worked as janitors and raised him deep in working-class Brooklyn, Shkreli both epitomizes the American dream and sullies it.

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McAllen ISD Enters Into Direct Contracts in Addition To BCBS Network

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By Bill Rusteberg

The McAllen Independent School District’s (MISD) self-funded health plan is administered by Blue Cross & Blue Shield (BCBS). BCBS traditionally utilizes their own proprietary managed care network and typically requires their network access exclusively as part of their bundled ASO services.

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The Future of PPOs and Provider Contracting

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Every day we receive email blasts and newsletters with headlines discussing revenue based contracting, High Value and Narrow Networks and the future of PPOs. There are those that suggest that the PPO is a dying entity, to be replaced with a referenced based solution for paying Providers, while others see the value in a PPO network offering, but struggle with how to improve the impact on the Health Plan’s medical spend.

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City Draws Fire Over Health Plan

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“The hospital was forced to file suit against 10 individual patients. In the end, the insurance companies payed the requested amount, the individuals paid their out-of-pocket expenses and eventually the repricing company stopped the practice.”

Editor’s Note: This article does not tell the whole story and may be misleading. We called the city for more information and found this to be an interesting case study; City of Richmond eschews managed care contracts and instead implements a reference based pricing model for their self-funded health plan in a local one hospital town. Hospital pushes back hard, city stands firm and to this day continues to pay medical caregivers through their reference based pricing model. This is more evidence that Cost Plus / Reference Based Pricing will work only as long as the Plan Sponsor is “all in” and willing to take a stand.

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Unaffordabe Affordable Care Saves Employers Big Bucks

Andy Puzder, CEO of Carl’s Jr. and Hardee’s parent CKE Restaurants, says that just 420 of 5,453 full-time workers offered a $5,500-deductible plan were willing to pay the $1,116 premium. The New York Times reports that insurance take-up by fewer than 10% of low-wage workers is commonplace.

Wendy’s (NASDAQ:WEN) initially expected its health insurance tab to jump by $25,000 per restaurant, but cut that to $5,000 after finding few interested employees.