Month: September 2017

Article Reveals More Than Headline

“The provider network is probably the biggest thing we think about,” said Kristine Grow, a spokeswoman for the industry group America’s Health Insurance Plans…………

Editor’s Note: This article is entitled one thing, but moves down multiple rabbit trails. The quote above for example illustrates the status quo mindset of many Americans mired in the quicksand of PPO networks. Then the article goes into “subsidies” which of course is just a politically correct word for welfare, or Americans on the dole. It seems to this reader the intended thrust of the article is focused on welfare payments to offset the cost of health insurance…………..Another massive transfer of wealth and America’s continuing  move towards socialism………….

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Medical Trend

By Bill Rusteberg

Medical trend (inflation) is largely due to inflated medical costs guaranteed to increase year after year in managed care contracts through annual escalator clauses (Escalator Clauses, Rising Prices, And Why We Should Care). In addition, renegotiated contracts effectively cause a double whammy (renegotiated provider contracts always end up costing more, not less).

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Latest So Called “Repeal Bill” Cuts Off All ACA Funding After 2026

A dysfunctional Republican party has yet another “Repeal” bill that contains provisions likely to be repealed (again) over time as the unified, “take no prisoners” Democrats gear up to win back the House in next year’s mid-term elections…………………..This newest feeble version maintains the government’s control of 1/5 th of the American economy and gives more power to bureaucrats…………

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Pfizer Sues Johnson & Johnson Alleging Anticompetitive Practices

What Consumers Can’t See Will Hurt Them

If Pfizer is successful, it could discourage brand name companies from using deals with insurers to limit competition

Editor’s Note: Plan sponsors have no idea how the economics of our health care delivery system are birthed behind closed doors between third party intermediaries (carriers, PBM’s, etc) collaborating with one another………………….It’s all about the money and nothing about consumers………..

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Blue Cross Against ObamaCare Repeal Bill

“The bill contains provisions that would allow states to waive key consumer protections……”

Editor’s Note: Why is BCBS against the latest attempt to repeal ObamaCare? Could it be that onerous mandates that drive costs up leads to higher premium costs resulting in higher carrier profits through application of the Minimum Loss Ratio government requirement? If a carrier is required to return 80 cents on the dollar in benefits, the higher the cost the more income the remaining 20% produces to the benefit of the carrier’s bottom line. Carriers these days are breaking financial performance records in valuation growth………………..

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A Billion Here, A Billion There: Selectively Disclosing Actual Generic Drug Prices Would Save Real Money

Because pharmacies, not generic manufacturers, are “where the money is,” the opportunity for savings comes from reducing reimbursement to pharmacies for generic drugs. In the case of generic drugs, potential savings could exceed 10 percent………………………

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School District Suspends Changes To Healthcare Plan

About 20 employees (less than 1% of the district’s work force) has succeeded in getting the largest employer south of San Antonio to suspend a scheduled increase in members costs towards the district’s self-funded employee health plan.

Perhaps the next step is to get these 20 or so employees to picket and protest outside the community’s two hospital systems against egregious costs. That $1,000 toothbrush charged by some hospitals could be their first bargaining chip…………………….

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Front Page News – 20 Employees Out of +8,000 Complain of Health Care Cost Increase

A small group of 20 employees of the largest employer south of San Antonio, Texas, or about .0025% of the entire labor force, receives front page news over health insurance cost increase protest. The other +8,000 employees remain silent………………….. 

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Why One California County Went Surgery Shopping

Frustration with sky-high hospital bills and a lack of local competition is common to many employers and consumers across the country……….Fed up with wildly different price tags for routine operations, some private employers are steering patients to top-performing providers who offer bargain prices.

Santa Barbara County, with about 4,000 employees, is among a handful of public entities to join them.

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Trump To Support Medicare For All?

Demoralized Republican Majority Leaders Sulk

Will Trump support the Democrat’s Medicare For All proposal next week? The do-nothing Republicans have been a huge disappointment to Trump supporters. Last week, signalling his frustration with lying Republican politicians, Trump joined with the Democrats in getting the debt limit extended.

Will Trump join Democrats in calling for a single payer system? Perhaps so. There are just too many political positives in doing so. Trump can point to the disfunctional health care system and basically say “Enough is enough! We need to get this past us. No one in the health care delivery system wants to fix it, so government will have to fix it! It’s time we put this to bed and start concentrating on creating new jobs, lower taxes, and make America Great Again…………………..

With 48 Democrats in the Senate, Trump needs only two Republicans to support a single payer system. That should be no problem at all………………….

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A Texas Public Purchasing Lesson – RGV Vending vs Weslaco ISD

“RGV brought this action, claiming that the Board’s action violated section 44.031(b) of the Texas Education Code. Particularly, RGV complains that the Board failed to consider the criteria listed in section 44.031(b);  it believes that consideration of those criteria conclusively establishes that its bid was superior to the accepted bid…………..WISD’s failure to comply with section 44.031(b) provides a basis for RGV to raise its complaints in a court without first exhausting its administrative remedies.   Therefore, the trial court erred in granting WISD’s plea to the jurisdiction. ” Appellate Court Opinion

A Request for Proposal evaluation process includes criteria upon which points are assessed in the evaluation process. Failure to comply with the formal evaluation process can lead to vendor protests…………

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Access2MD

Access2MD™ was founded in early 2012 by practicing physicians who wanted to change the clinical landscape. Innovative, “out of the box thinking” and progressive ideas have brought Access2MD™ to where it is today and this same approach will drive the company direction into the future.

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Keypro

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization.

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Super TPA Shares Success Strategies

By Jeff Bernhard, President of Continental Benefits

I had a conference call this week with the CEO of a company with 1,500 employees lives covered with one of the BUCA PPO plans. His employees deductibles were $1,500 and an OPM of $5,000. I told him the we, Continental Benefits, could give you the same “A” PPO network, but also add bundled guaranteed pricing for 100 + different medical speciality surgeries with vetted and high quality surgeons.

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