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Blue Cross has successfully hijacked the term Reference Based Pricing  –  a damn smart marketing move……………………

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“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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Over the past few months I have been telling you about the TRS Care health and drug plan changes coming 1-1-18.

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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.

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A 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.

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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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A dysfunctional Republican party has yet another “Repeal” bill that contains provisions likely to be repealed (again) over time as the unified, “take no prisoners” Democrats gear up to win back the House in next year’s mid-term elections…………………..This newest feeble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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Kaiser Family Foundation Employer Health Benefits Survey on stop loss insurance highlights some interesting statistics…………..

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Do you have fan belt insurance? How about flat tire insurance?

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Texas has a new insurance commissioner………………………..

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Insurance superintendent says premiums are spiking because not enough people are signing up for coverage……………Or are the actuaries incompetent?

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A threat to the pharmaceutical industry………..?

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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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“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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These average utilization changes reflected larger changes in use shortly after the insurance switch that diminished over the subsequent year………………..

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IBM 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.

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Texas grand jury indicts ex-teacher’s aide who faked cancer………….

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If water is a must and healthcare is a right how does one distinguish between the two?

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My 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

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The Bernie Bongo Senate Bill, unlike the ACA, is only 96 pages long……………………

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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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America’s Essential Hospitals announced its opposition to a new ObamaCare repeal and replace bill, warning of cuts and coverage losses…………………

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Medical Bill Review

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By 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?

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As counterintuitive as it seems, preventive measures generally increase rather than decrease costs……

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Two doctors have been suspended and a director ousted after hospital staff piled into an operating room to gawp at an unconscious patient with an object in their genitals…..

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Medicare is getting ready to issue all 60 million of its beneficiaries new cards with new ID numbers as way to combat identity theft and fraud…………..

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The Cartel is at it again…..

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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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TEACHERS, BISD EMPLOYEES AGAINST HEALTH INSURANCE HIKE

(Compare this blog article to the posting immediately blow this post…………

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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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This 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.

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How 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………………

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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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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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JUST RELEASED: A must read book by Dave Chase

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The 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.”

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“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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“I had a client actually offer to pay me even more because of the value I was delivering………….” – David Contorno

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Radical 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………

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Will Haff

Was $83,532.79 worth it?……………………………

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Designed for Public Education Purchasing Professionals with special emphasis on the latest developments that are essential in educational purchasing……….

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Civilian 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.”

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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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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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Our 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.

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This is a bold-faced case of one business basically bribing another business to not use a certain other business!

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Advance 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

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