Archive for September, 2017
Who Starts Tyrone’s Car In The Morning?
Saturday, September 30th, 2017Blue Cross Blue Shield of Texas Validates Reference Based Pricing Strategies
Saturday, September 30th, 2017Blue Cross has successfully hijacked the term Reference Based Pricing – a damn smart marketing move……………………
Balance Billing Is A Plan Sponsor’s Best Friend
Thursday, September 28th, 2017By Bill Rusteberg
“Balance billing only occurs when purchasing goods or services without asking the price.”
Article Reveals More Than Headline
Thursday, September 28th, 2017“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………….
TRS Feeding Frenzy in Full Swing
Wednesday, September 27th, 2017Over the past few months I have been telling you about the TRS Care health and drug plan changes coming 1-1-18.
Hospital Costs Flat – But Plan Sponsors Don’t Benefit
Wednesday, September 27th, 2017
Michael (Mike) DendyCEO/Vice Chairman AMPS Inc.2h
Hospitals are charging 5, 6, 7 times more than they were charging ten years ago. This drastic increase in billed charges must be at least partially due to hospitals’ cost of doing business increasing, right? Wrong.
ObamaCare Endures – Big Government Wins
Wednesday, September 27th, 2017A dysfunctional Republican party breaks promise to repeal ObamaCare.
Tight government control and oversight of 1/5 th of the economy continues. Citizens will continue to be punished if they refuse to purchase health insurance……………….Individual freedom is eroding away bit by bit in this country.
Medical Trend
Tuesday, September 26th, 2017By 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).
Latest So Called “Repeal Bill” Cuts Off All ACA Funding After 2026
Monday, September 25th, 2017A 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…………
Amazing Stop Loss Insurance Statistics
Sunday, September 24th, 2017Kaiser Family Foundation Employer Health Benefits Survey on stop loss insurance highlights some interesting statistics…………..
Got You Covered
Saturday, September 23rd, 2017Sullivan Appointed as Texas Insurance Commissioner
Saturday, September 23rd, 2017Health Insurers in New Mexico To Implement Record-High Premium Increases
Saturday, September 23rd, 2017Insurance superintendent says premiums are spiking because not enough people are signing up for coverage……………Or are the actuaries incompetent?
Amazon In Talks With PBMs
Thursday, September 21st, 2017The Big Heist
Thursday, September 21st, 2017Pfizer Sues Johnson & Johnson Alleging Anticompetitive Practices
Thursday, September 21st, 2017What 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………..
Blue Cross Against ObamaCare Repeal Bill
Thursday, September 21st, 2017“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………………..
Study: Changing Carriers = Higher Utilization?
Thursday, September 21st, 2017These average utilization changes reflected larger changes in use shortly after the insurance switch that diminished over the subsequent year………………..
“Healthcare Tax” To Push Businesses Away From Your Community?
Wednesday, September 20th, 2017IBM recently made a decision as to where to locate 4,000 new hires based on their analysis of where they received the best value from their healthcare expenditure. Consequently, they determined that Dubuque, Iowa was the best location to expand their employment.
Fake-A-Disease Brings In $11,000 For Texas Man
Monday, September 18th, 2017Healthcare Is A Right While Water is a Must
Monday, September 18th, 2017PPO “Discounts” Mean Nothing – Only Dummies Remain Enamored
Monday, September 18th, 2017My Discounts Are Better Than Yours Because My Boss Told Me So
“As we all know discounts are really no longer a relevant method in determining whether a network is “good” or not” – Jeff Bernhard
Unpacking The Bernie Bongo Medicare-For-All Bill
Monday, September 18th, 2017A Billion Here, A Billion There: Selectively Disclosing Actual Generic Drug Prices Would Save Real Money
Monday, September 18th, 2017Because 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………………………
Hospitals Oppose ObamaCare Repeal
Monday, September 18th, 2017America’s Essential Hospitals announced its opposition to a new ObamaCare repeal and replace bill, warning of cuts and coverage losses…………………
Does Your Plan Do This?
Friday, September 15th, 2017Medicare Benefits For All – The Bernie Bongo Plan
Friday, September 15th, 2017By Molly Mulebriar
There is a lot of talk these days about “Medicare For All.” If this is such a good idea, and will “solve” the nation’s broken health care delivery system, why not change your current employee benefit health plan to mirror Medicare benefits and payment schedules?
Another ACA Lie – Preventative Care Actually Does Not Save Money
Friday, September 15th, 2017As counterintuitive as it seems, preventive measures generally increase rather than decrease costs……
Obsession With Genitals Leads To Termination
Friday, September 15th, 2017Get Ready! Medicare Will Mail New Cards to 60 Million People
Friday, September 15th, 2017Investing In The Cartel Can Be Lucrative
Thursday, September 14th, 2017School District Suspends Changes To Healthcare Plan
Wednesday, September 13th, 2017About 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…………………….
Local Brownsville, Texas Blog Provides Better Coverage Than Mainstream Media
Tuesday, September 12th, 2017TEACHERS, BISD EMPLOYEES AGAINST HEALTH INSURANCE HIKE
(Compare this blog article to the posting immediately blow this post…………
Front Page News – 20 Employees Out of +8,000 Complain of Health Care Cost Increase
Tuesday, September 12th, 2017A 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…………………..
Independent Consultants Declare Old Model Fails Customers
Tuesday, September 12th, 2017This summer — and at Independence Hall in Philadelphia, no less — a group of 30 benefits consultants signed their own “declaration” outlining a novel strategy based on collaboration over competition.
How Do We Hold A PBM Accountable?
Tuesday, September 12th, 2017How do we hold a PBM accountable who selects a poorer drug with weaker outcomes and higher risk?
Plan sponsors get screwed even worse than they know………………
Why One California County Went Surgery Shopping
Monday, September 11th, 2017Frustration 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.
Trump To Support Medicare For All?
Monday, September 11th, 2017Demoralized 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………………….
CEO’s Guide To Restoring The American Dream
Sunday, September 10th, 2017TDI Releases Report On PPO Out-of-Network Payments
Thursday, September 7th, 2017The Texas Department of Insurance today released the results of a survey that looked at out-of-network payments by preferred provider organizations (PPOs) for certain services. The survey found that most plans comply with the state requirement to pay such claims “at the usual or customary charge for the service.”
A Texas Public Purchasing Lesson – RGV Vending vs Weslaco ISD
Wednesday, September 6th, 2017
“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…………
Lowering Costs & Getting Paid More Makes Sense
Wednesday, September 6th, 2017“I had a client actually offer to pay me even more because of the value I was delivering………….” – David Contorno
Disrupting Pharmaceuticals
Wednesday, September 6th, 2017Radical Health Care Disruptor vs Status Quo Pharmacy Industrial Complex
Pharmacy benefit managers are, as Bloomberg News explains, “the middlemen with murky incentives behind their decisions about which drugs to cover, where they’re sold, and for how much.”
The system is opaque and perverse — and it’s the only system we know………
Insurance Consultant Sentencing Postponed…..Again
Monday, September 4th, 2017TIMELINE 2018: A Public Education Purchasing Seminar
Monday, September 4th, 2017Designed for Public Education Purchasing Professionals with special emphasis on the latest developments that are essential in educational purchasing……….
Fat Americans
Sunday, September 3rd, 2017Civilian Turns Marine
” 70 percent of today’s youth are not fit to serve in the military due to obesity or being overweight, criminal records, drug misuse or educational deficits.”
Access2MD
Sunday, September 3rd, 2017Access2MD™ 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.
Keypro
Sunday, September 3rd, 2017Since 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.
Not your Typical On-Site Clinic
Sunday, September 3rd, 2017Our health centers are not mere urgent care clinics but comprehensive health management platforms.
Modeled as Patient Centered Medical Homes, our health centers provide collaborative, patient-centric care and optimize resources, support, and value to the needs of each individual patient.
Super TPA Shares Success Strategies
Saturday, September 2nd, 2017I 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.
Third Party Intermediary Screws Consumers
Saturday, September 2nd, 2017This is a bold-faced case of one business basically bribing another business to not use a certain other business!
AMBS Third Annual Consortium Meeting Set For October
Friday, September 1st, 2017Advance Risk Management Solutions, Inc. presents ARMS 2017 Consortium Conference – Tuesday, October 24, 2017 | Thursday, October 26, 2017…………..Moving HealthCare Risk Management in a New Direction