Molly Mulebriar, margarita in hand and a bottle of scotch in the other, dropped by our office early this morning to begin New Year’s Celebration festivities. (She is the former Miss Texas 1984 Tequila Chugging Champion and to this day manages to maintain a competitive edge in adult beverage competitions).

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 Sam Crafting, M.D.

Sam Crafting 120 Hospital Contract For RiskManagers.us

Plan Sponsors, are you trying to direct contract with your local hospital? Dr. Crafting’s boiler plate Hospital Agreement may be just what you need….………..

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 Ivan Pavlov

By Molly Mulebriar

If hospital contracts include an annual escalator clause, whey then do these contracts need to be renegotiated every two or three years? An average escalator clause assures an annual increase in reimbursement from 4-6% or more. Isn’t that enough?

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Blue Cross & Blue Shield is planning to lay off 70 percent of its IT infrastructure staff and offshore the jobs to India…………

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 And The Answer Is……..

Large hospital system had requested a 5 percent increase worth millions of dollars. Did BCBSTX agree to pay more on behalf of their insureds and will BCBSTX pass the cost increase on to consumers in the form of higher premiums? 

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The penalty comes after news of a deal between Mission Regional and Doctor’s Hospital at Renaissance to save the financially-strapped Mission Regional, a non-profit, and help it expand as a short-term secondary health facility.

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Nevada state government’s website was leaking thousands of social security numbers, and highly sensitive personal data. They said it was a hack. Spoiler alert: It wasn’t.”

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Thinking Outside The Box

“Healthcare has become defined by rampant excess, so effective benefit managers will, of necessity, seek unconventional solutions.”

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“A national health care conspiracy between medical care givers and third party intermediaries has created a lucrative cash cow crafted through secretive collaborative contracts of adhesion in smoke filled rooms.” – Molly Mulebriar

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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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Employers are becoming more involved with the well-being of their employees—not just because it can reduce sick days but also because it can improve employee morale and help reduce medical spend.

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Two South Texas insurance agents have spent 10 years fighting over a lucrative insurance contract allegedly worth millions of dollars in agent commissions……….

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Julie Broderick had 15 years of experience as a securities regulator, and a propensity for speaking her mind before joining Prudential Financial Inc. as an investigative supervisor in 2012.

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This is the sixth merger Higginbotham has completed in 2016 as part of a growth initiative across Texas whereby the firm partners with brokers with strong local reputations……………….

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“Feds say Prime Healthcare has figured out how to make money from hospitals — through fraud.”

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Around 30% of the total admissions are reimbursed by managed care programs. These contracts are negotiated for terms between one and three years, and the rates are increased by around 4% to 6% every year.

Managed care strategy

With managed care forming a substantial portion of total revenues, entering contracts with favorable payment rates becomes an essential HCA business strategy. HCA Holdings negotiated for 80% of its total managed care plans in 2015, 40% in 2016, and 20% in 2017.

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“There was a universal code of belief everywhere I worked before I came to the USA that we do not torture patients in the off-chance they might live a few extra weeks or months………..but even today, 33 years after I arrived, I am still shocked at the wastefulness of physicians with the Health Care dollar.”

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“It’s tough in the health plan business. You lose money. You make mistakes. You plow forward. It takes cash.”

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$49 Base Price for a colonoscopy is outstanding! Plus the patient gets to choose among several optional services to enhance their colonoscopy experience…………………….

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“We save our customers money. Most of our clients costs are below trend or flat ………….our average client covers more than 3,000 members…………”

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All Americans are currently required to purchase broccoli whether they like it or not. Those who can’t afford it get it free, and those who can only semi-afford it get subsidies (i.e, welfare). Rich bastards have to pay the full cost.

Broccoli prices have skyrocketed as a result of The Affordable Broccoli Act. Quality has eroded with many Americans stuck with purchasing rotten, hardly edible broccoli.

Employers must provide broccoli to all full time employees, or face punishing fines or imprisonment, or both.

With a new administration about to take office, The Affordable Broccoli Act is at risk of being overturned. Broccoli farmers are outraged. Employers are jubilant.

But, never fear, House and Senate Broccoli lovers vow to keep voluntary access to affordable broccoli available to every American.

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Will turning holiday parties into potluck events save MD Anderson from financial ruin?  I don’t think cost shifting to employees is a viable solution.

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 Dr. Alan Preston

“When I evaluate the effectiveness of legislation, I first look to see if it will accomplish its objective. Whether I like the objective or not is a separate issue. The name of the legislation is telling and provides a clue to the objective. The Patient Protection and Affordable Care Act.”

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By Molly Mulebriar

Are escalator clauses, common to most Managed Care Contracts, the driving force behind trend factors?

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How do we know we are doing much better this year than last year?

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Many Texas educators are insured through the Texas TRS ActiveCare health plan. Projecting a $54 million deficit for the upcoming FY 2017, TRS trustees realized plan benefits and premiums changes were necessary. More and more plan participants are selecting  the high-deductible plan option with lowest costs and lowest benefits………………

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Cash pay health plans make sense…………………………..

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Physicians, founders, executives and investors of physician-owned Forest Park Medical Center in Dallas have been charged in a federal indictment for their alleged involvement in a bribe and kickback scheme, according to the Department of Justice.

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Out of control hospital administrator restrained by staff

“Texas can’t tolerate poor quality care, poor leadership, and individuals who defraud people who are vulnerable and sick.” 

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Innovative bundled payment system is first of its kind in the state of Texas, currently offers more than 200 surgeries…………….

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Cutting out the “middle man” results in substantial savings and puts employers in control……

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In his opening statement Monday, DOJ lawyer Craig Conrath, a top lawyer in the department’s Antitrust Division, said Aetna’s retreat from ACA exchanges was an attempt to evade antitrust scrutiny “by the equivalent of closing up shop.”

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Here’s an ad for Health City Cayman Islands that appears in today’s WSJ. It’s volumes are now up significantly over their levels a year go. With tremendous quality and more American businesses are seeing the sense in sending patients there – Brian Klepper

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Complimentary Live Webinar:
Strategies to Achieve Better Outcomes Using Bundled Pricing
Organized by:

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As an extension of my work on high performing clinical and financial risk management offerings, I have joined with prominent Indianapolis broker Richard Sutton to establish Worksite Health Advisors (WHA).

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For $20, a group of high school students has created 3.7 grams of an active ingredient used in the medicine Daraprim, which would sell in the United States for between $35,000 and $110,000.

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