“In response to the continued relentless rise in health care costs, Insurers are taking a long, hard look at the value PPOs deliver versus their ability to contain medical costs.“
Month: May 2016
The Cost of Convenience
“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.”
Memorial Day 2016
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.
Billed Charges vs PPO Allowed Charges vs Cost Plus Insurance
By Bill Rusteberg
A random sampling of hospital / facility claims incurred in the Lower Rio Grande Valley, Texas (The Valley) illustrates the crazy world of health care pricing strategies.
Continue reading Billed Charges vs PPO Allowed Charges vs Cost Plus Insurance
Dereliction of Fiduciary Duties Triggering DOL Investigations
“The penalties for this type of fraud should be severe. All benefits leaders and their consultants should be overhauling how they manage care and cost, or risk the consequences. It’s particularly notable that the Department of Labor is now arguing that fiduciary dereliction in health benefits is rampant.” – Brian Klepper
Continue reading Dereliction of Fiduciary Duties Triggering DOL Investigations
Annual Healthcare Costs For Families Hit $25,000
As health care costs escalate, Cost Plus / Reference Based Pricing plans gain traction within the employer community…………….
Continue reading Annual Healthcare Costs For Families Hit $25,000
Moving Patient Payment Upfront
Hospital systems are beginning to screen patients in high-deductible plans for their propensity to pay. And for those who can, they are developing systems to collect in advance of care.
New Approved FDA Drug Costing $1 Million A Year?
More and more employers are eliminating specialty drug coverage entirely. They really have no choice.
Imagine a small employer group of 250 employees assuming outright the risk of $1 million for Smoker Smith who now has lung cancer and is taking one of the new specialty drugs costing $85,000 per month. There is no way for the employer to continue his group medical plan.
Continue reading New Approved FDA Drug Costing $1 Million A Year?
The OPEC OF Healthcare
Mike Dendy, MBA, MHA
“OPEC laughed at the US and the rest of the world when we complained that $120 per barrel oil was choking the life out of business and the public in general around the world. Rather, they built ski mountains in their deserts out of the rest of the world’s money and threatened to drive oil prices even higher. ”
HealthSmart Announces New CEO of BridgeHealth
(May 17, 2016)—HealthSmart announced today that Mark Stadler has been named CEO of BridgeHealth, effective June 1, 2016. Mark joined HealthSmart in September 2011 and has been the leader in our commitment to price transparency and empowering our members to become savvy healthcare shoppers.
Continue reading HealthSmart Announces New CEO of BridgeHealth
David Belk
David Belk, M.D.
Hello. It’s time for another chapter on the many ways in which our health care system is a total mess.
Surge In Drug Prices Zinging Some Health Insurers
In an Oct. 5 report, The Wall Street Journal noted that prices for the 30 best-selling drugs last year had gone up an average of 76 percent since 2010 – eight times faster than general inflation.
Continue reading Surge In Drug Prices Zinging Some Health Insurers
Plan Sponsor Guilty of Breach of Fiduciary Duties?
Continue reading Plan Sponsor Guilty of Breach of Fiduciary Duties?
Highmark Sues U.S. Over Affordable Care Act
“All we’re asking is for the federal government to do what they promised” – David Holmberg.
Continue reading Highmark Sues U.S. Over Affordable Care Act
Low Cost Software Tool for Medicare Reimbursement Strategies
Need a low cost Windows solution for creating and managing Medicare and other RBRVS based fee schedules? Try RBRVS EZ-Fees…….
Continue reading Low Cost Software Tool for Medicare Reimbursement Strategies
Blue Cross Blue Shield Enrollment Office
Blue Cross mobile enrollment office – when gas was 17 cents, and health insurance was affordable
Playing Doctor
In a deep dark recess of today’s Federal Register, large corporations just quietly received permission to “play doctor” with their employees.
Cash Pay Plans Make Sense
“Those who say Cash Pay Plans are pie-in-the-sky dreams are mistaken. If man can fly then so can Cash Pay Plans.”
Nothing Makes Sense In Health Care Financing
Continue reading Nothing Makes Sense In Health Care Financing
BREAKING: High Court Punts On ACA Birth Control Battle
Will Religious Institutions Be Required To Fund Against Their Will?
By Jeff Overley
Law360, New York (May 16, 2016, 10:35 AM ET) — The U.S. Supreme Court on Monday sent a long-running battle over the Affordable Care Act’s contraception mandate back to lower courts, directing the Obama administration and religious nonprofits to work out a compromise.
Continue reading BREAKING: High Court Punts On ACA Birth Control Battle
Is HealthSmart For Sale?
Is HealthSmart TPA for sale? Word on the street says it is so.
Texas Gets 1115 Waiver Extension
Hidalgo County health officials breathed a sigh of relief after the federal government last week extended the state’s 1115 Waiver program that provides hundreds of millions of dollars for health care services throughout the county.
Multi-Tier Provider Networks
“Multi-Tiered provider networks will work best if an employer creates their own proprietary network on a direct basis rather than rely on third party intermediaries. Here is how it would work: Area providers are invited to enter into direct agreements with ABC Fence Company. They are given three choices: Tier 1 – 100% of Medicare, Tier 2. 125& of Medicare and Tier 3. 150% of Medicare. Plan participants who use Tier 1 providers pay less out-of-pocket than if they had used Tier 2 providers. Using Tier 3 providers would take economic courage.” – Homer G. Farnsworth, M.D.
Rx Clawback Scheme Fleeces Customers
Companies are charging copays that exceed the customers’ costs for their drug. Pharmacists call it a clawback – the company is essentially clawing back money from you and, our source tells us, you probably don’t even realize it’s happening. “They have no idea,” the pharmacist says.
Austin Texas Pharmacy – “We Don’t Deal With Insurance Companies”
Medsavers Pharmacy is a family owned and operated pharmacy in Austin, Texas founded in 2005 on the principle: “we don’t deal with insurance companies.”
Continue reading Austin Texas Pharmacy – “We Don’t Deal With Insurance Companies”
Wellcentive – Transitioning to Value Based Care
Quality improvement, revenue growth, and business transformation for providers, health systems, employers, and payers transitioning to value-based care.
Continue reading Wellcentive – Transitioning to Value Based Care
Shifting Risk To Hospitals & Physicians -Episodic Bundled / Fixed Pricing
As Medicare and private insurers continue to struggle with implementing accountable care organization- and population-linked payments, an increasing amount of attention is being paid to a less expansive but almost as complex method of shifting risk to hospitals and physicians: paying a fixed price for an episode of care, or bundling.
Continue reading Shifting Risk To Hospitals & Physicians -Episodic Bundled / Fixed Pricing
Continental Benefits – The Purple Cow
Continental Benefits is one of the fastest growing TPA’s in the United States. Founded in 2013 this national TPA is committed to reducing health care costs 25% and more. And they are doing just that.
Changes At Maxor
New CEO takes charge………….Maxor to exit correctional pharmacy services?
Ruben Edelstein
By Bill Rusteberg
Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in deep South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley.
Anthem CFO To Resign
“The timing of DeVeydt’s resignation may “generate uncertainty among investors until fully understood”
Crazy World of Health Care Pricing
Why should you pay more to go to The Valley than the knuckle head sitting next to you?
Aetna Selfies
Enter Aetna, which is making its foray into this space with “Aetna Funding Advantage,” available to groups with as few as 10 employees.
Businesses Opting For Freelancers To Dodge Government Punishment
Continue reading Businesses Opting For Freelancers To Dodge Government Punishment
County Demonstrates Political Courage To Challenge Local Provider Community
“The leadership of Botetourt County has, like many municipalities, been searching for innovative ways to reduce their health costs without increasing deductibles and co-pays to the members….”
Botetourt County, Virginia and San Patricio County, Texas have something in common – the political will to seek innovative strategies to rein in ever increasing, tax payer supported, health care costs for their employees. Challenging the status quo within their respective local health care community takes a rare political courage to prevail – Bill Rusteberg
Continue reading County Demonstrates Political Courage To Challenge Local Provider Community