Without action, TRS-Care will eventually fail altogether……..Is Reference Based Pricing the Solution or will Texas continue to drink managed care cool aid?……………..or  follow Montana’s example? Montana Adopts Reference Based Pricing Strategies

(more…)

Ask most Americans about obtaining their health care outside of the United States, and they respond with disdain and negativity……. Of course, that’s exactly what Yellow Cab thought about Uber, Kodak thought about digital photography, General Motors thought about Toyota and Borders thought about Amazon. 

(more…)

 Jane Nelson

On January 23, 2017 Texas Finance Committee Chairwoman Jane Nelson created the health care cost work group…………………

(more…)

By Bill Rusteberg

Reference Based Pricing plans have been around for many years now. Fear of lawsuits by medical caregivers is a concern for middle and late adapters of the model, causing many to pay a premium for protection against them. And, the cost to do so can be significant. 

(more…)

Going Bare VS Looking For Cover

Does your insurance consultant have proper E&O cover? You may be surprised that is answer may be “no” in some cases. 

(more…)

 Dr. Alan Preston

Revamped health savings accounts, portable employee plans would ease financial burden on consumers

By Alan Preston, For the Express-News January 21, 2017

One of the campaign promises of the Trump administration is to repeal and replace the Affordable Care Act, and Congress is working on precisely that. As with most legislation, the ACA has parts that are helpful and parts that are hurtful. Some of the good or bad of the law depends on whether or not you benefit from it.

(more…)

“I come from an environment where if you see a snake, you kill it. At GM, if you see a snake, the first thing you do is hire a snake consultant. Then you get a committee on snakes and discuss it for a couple of years.” – Ross Perot

(more…)

Why advisers must move faster to untether commissions from group health rates

(more…)

Sam Mullen has plead guilty to bribing an insurance consultant and faces up to 5 years in prison. Sentencing was set for Jan. 25, 2017 but now has been delayed until March 15.

(more…)

If the ACA individual mandate goes away, the biggest loser for insurance brokers will be MEC plans while the biggest winner will be Short Term Medical plans. MEC plans offer limited coverage and often cost up to $100 per month while Short Term Medical plans offer comprehensive coverage at similar or lower costs. Smart brokers with MEC plans on the books should be prepared to adapt to what we believe will be a transformational market in 2017.

One broker is ready to accommodate the market – www.agilehealthinsurance.com

BREAKING: DOJ Wins Bid To Block $37B Aetna-Humana Merger

A District of Columbia federal judge on Monday sided with the U.S. Department of Justice in the government’s suit to block the proposed $37 billion merger between health insurance giants Aetna Inc. and Humana Inc.

“Questcor took advantage of its monopoly to repeatedly raise the price of Acthar, from $40 per vial in 2001 to more than $34,000 per vial today – an 85,000 percent increase,” said FTC Chairwoman Edith Ramirez.

(more…)

Price is To Damn High!

“All the current reform proposals are a delaying tactic to continue to protect healthcare providers from free market, legitimate pricing”.

(more…)

Former Managed Care Intermediary

Legitimate prices mean networks would be obsolete………….

(more…)

Government meted punishment against citizens may end. Individual freedoms may be restored………..

(more…)

Samuel Mullen , who now lives in the Rio Grande Valley, appeared before U.S. Magistrate Judge John Primomo and pleaded guilty to conspiracy to commit honest services wire fraud. Sentencing was set for Jan. 25 before U.S. District Judge Xavier Rodriguez.

(more…)

Medicaid is expected to remain a flashpoint as Democrat and Republican governors from around the country press the new Congress and President-elect Donald Trump to keep the ACA’s expansion in place.

(more…)

The plan to sell (give) health insurance to undocumented immigrants is the first California casualty of the Trump presidency…………

(more…)

ObamaCare is doomed. Everyone acknowledges that, including those who won’t admit it. But the mantra now is Replace. And the question is “With What!” The answer should a “Free Market”………………….It may just happen

(more…)

“I want to raise awareness of some specialists’ profit-driven behaviors,” said lead author Ge Bai, of the Johns Hopkins Carey Business School in Baltimore. “Then, we can look for solutions.”

(more…)

The following article was send to us from Brian Klepper, PhD, health care industry expert.

(more…)

“A provision of Obamacare requires health insurers to spend roughly 80 percent of premiums on medical costs. This was supposed to help control insurance costs.”

(more…)

“Everyone is talking about Congress repealing ObamaCare and replacing it with something else. How about replacing it with a free market?” – Molly Mulebriar

(more…)

“Screw You UHC!”

Hospital Administrator Reacts To News

A UnitedHealth Group division is poised to become one of the nation’s largest operators of outpatient surgery centers with a $2.3 billion acquisition announced Monday.

(more…)

Massachusetts out-of-network ED physicians charge 798% of Medicare rates

Written by Brooke Murphy | January 12, 2017

Here are six findings on healthcare cost trends in Massachusetts, according to the Health Policy Commission’s 2016 Cost Trends Report.

(more…)

www.ted.com/talks/allison_hunt_gets_a_new_hip#t-272889

There is a lot of discussion about the costs of healthcare, both for users and their employers if the employer is providing insurance.

Side Note: We have seen claim experience that document average cost of a doctor visit is $700. Yes, that’s correct, $700. This includes doctor charges, lab test, radiology, prescription drug/s. Consumers, shielded by low co-pays don’t see this, nor do they care. Four office visits in a year could eat up the premiums paid toward coverage. This is not insurance………….

(more…)

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.

(more…)

Dallas-based Tenet Healthcare is seeking to further refine its hospital operations portfolio by selling hospitals in noncore markets………..Tenet expects to fully exit the health plan business this year.

(more…)

“An industry insider shared an example that I’ll anonymize. An analysis was done for a school district and one of the things looked at was where lab tests were done. This school district had nearly 1,500 metabolic profiles in the measurement period and paid well over $200,000 when they should have only paid under $10,000. Direct contracting/cash prices averaged 96% less in their market. That’s an average of $150 a test for what should be a $7 test.”

(more…)

 Whole Foods has implemented Reference Based pricing strategies. AMPS ( advancedpricing.com) has acquired Whole Foods  as a client and is currently  managing a beta-test for them in Austin and in Los Angeles.

(more…)

(more…)

“There are signs that employers’ interest in narrow networks may grow in the near future.”  But that is problematic. Why limit choice of providers when you can simply pay all providers the same? That solves access and financial issues for plan sponsors where the difference between profit and loss many times is tied to health care costs. Isn’t it about time consumers realize they are helping to drive costs up by accepting terms and conditions set by insurance companies and complicit plan sponsors too dumb to realize the implication of good intentions (providing employee health insurance) is having a reverse effect on their bottom line? – Signed: Ranting and Raving (Name held upon request).

(more…)

After decades of work at Massachusetts General Hospital in Boston, Dr. Walter Guralnick cut back. He’s now in the office just three days a week. It’s an achievement second only perhaps to his age. In November, he turned 100 years old.

(more…)

“This is a national scandal,” Labour leader Jeremy Corbyn said in a statement.

(more…)

Hi, I’m Gail, Inmate # 206946

A 57-year-old convicted killer serving a life sentence in California became the first U.S. inmate to receive state-funded sex-reassignment surgery…………

(more…)

Struggling to stem a red tide of falling income is tough when the core cause is not identified and addressed…………………..Could high prices be driving away customers?

(more…)

Higher treatment costs left MD Anderson out of the Affordable Care Act marketplace…… the challenge for MD Anderson is funding a high level of research while facing a potential decrease in the number of patients receiving treatment……………………

(more…)

If GOP Doesn’t Replace Obamacare ‘Within Months,’ Insurance Companies Will Go Bankrupt

(more…)

I’m a former health insurance CEO and this is what Obamacare repeal will do…….

(more…)

Washington bureaucrats  implemented a new rule in July that defined the term “sex” in the Affordable Care Act……………Texas says Sex is in the domain of state control, not federal oversight………

(more…)