Company Wellness Coordinators

Wellness plans don’t work. In theory they may, but in reality they don’t. Changing behavior is very hard to do, especially if it is societal and ancestral. 

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The American Welfare State continues to grow. Proponents don’t call it welfare though. They call it “subsidies” instead. That’s a nicer, cleaner, less controversial term intended to calm frayed political nerves among those who work for a living and pay their own way. So when you read the following article, mentally substitute the term “subsidy” to “welfare.” 

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PCM saves 10-15% of total drug spend by utilizing therapeutic alternatives………….

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“You are hearing the warning for the end of the road for the classic standalone” pharmacy benefit business…………………………”

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“Hospitals are losing money on Medicare and Medicaid patients! They must charge commercial payers more to make up the difference!” is a much used argument to gouge consumers up to 1000 times more than what Medicare pays. Perhaps there are other contributing factors to hospital angst these days? 

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The Law of Unintended Consequences……………Revenue enhancement through deception?

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The settlement resolves a lawsuit in which the DOL alleged that the TPA breached its fiduciary duties and committed prohibited transactions when it retained and did not disclose “network management fees” consisting of the difference between amounts charged to plans and amounts paid to health care providers……………..

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Throughout the past year, and without much fanfare, Amazon.com Inc. has gained approval to become a wholesale distributor from a number of state pharmaceutical boards, according to a review of public records.

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In an unprecedented move, the Blue Cross & Blue Shield Association announced this morning Disneyland has concluded talks with all BCBS plans in the United States and has reached a definitive agreement to purchase the Blues for $4.3 trillion. A spokesman for the BCBS Association has scheduled a press conference this afternoon to provide details.

In tandem with this blockbuster announcement was breaking news out of Chicago………

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PPOs are Dying – Why Pay for One?…………….Do you pay for a grocery store network…………?

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The Weslaco ISD lawsuit against Aetna is a fascinating read. The pleadings provide clues for those who are curious about various revenue streams found (or not found) within some administrative contracts for third party administration of group medical plans.

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When it comes to hospital bills, you don’t get the itemized version of the bill, so you often have no idea what you are actually paying for………. (more…)

Edmundo was a fighter. He fought hard for his clients and protected those he loved. He lived life on his own terms, and he died on his own terms. This rock solid, self-made man will be missed by many. 

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TPA Loses Lawsuit Against Private Citizen

“The Texas Legislature unanimously adopted one of the strongest Anti-SLAPP statutes in the nation and showed their continued support of the First Amendment.  On June 17, 2011, the Texas Citizens Participation Act (the “Texas Anti-SLAPP statute”) was signed into law by Gov. Rick Perry.”

“The statue allows a judge to dismiss frivolous lawsuits filed against one who speaks out about a “matter of public concern” within the first 60 days.  “Matter of public concern” is defined expansively in the statute.” (slappedintexas.com/primer/)

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“I’ll Make You An Offer You Can’t Refuse”

Can anybody use 5% of their healthcare spend back?? Give me a call so I can show you why there is 5% there and how we will find and recover it for you.

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For 20+ years, Open Enrollment has meant explaining to employees how they’re going to pay more and get less when it comes to health benefits……………………..

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A TPA specializing in self-funding for small group plans of 100 employee lives or less offers a unique Reference Based Pricing model that includes the promise of no balance billing.

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Whistleblower Joe Rannazzisi says drug distributors pumped opioids into U.S. communities — knowing that people were dying — and says industry lobbyists and Congress derailed the DEA’s efforts to stop it

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Brownsville Independent School District, the largest employer south of San Antonio, Texas is seeking an insurance consultant for the district’s self-funded employee health & welfare plan.

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Pharmacy benefit manger Express Scripts will acquire medical benefits management company eviCore Healthcare for $3.6 billion, which will give the company an entry point into a growing market, the company announced Tuesday in a securities filing.

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David Conterno

“When the industry goes to higher deductibles, we remove them. When the industry goes to narrow networks, we remove networks. When the industry goes to narrow formularies, we expand them. When the industry invests in specialty care and surgical centers, we invest in primary care. When the industry looks to bring in more insurance products, we bring in less. Instead of increasing obstacles to getting any and all care, we need to be removing all obstacles to getting the right care.”

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By Bill Rusteberg

Plan sponsors must recognize change brings risk and reward and understand doing nothing brings risk too. So what’s the difference?

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Of 48 cancer drugs approved between 2009-2013, 57% of uses showed no benefits and some benefits were ‘clinically meaningless’, says BMJ study…………………

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Physician Joins Witness Protection Program?

“We knew for years that if a patient is a smoker the risk of lung cancer is high.   So why did we not have annual chest x-ray as a screening tool? ” (Name Withheld) M.D.

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“Why Didn’t I Think of This!

Bernie Madoff

“If not for this kickback arrangement, the four hospitals would have been financially responsible for the patient transports at significantly higher rates………………..”

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Insurance industry continues to be rocked by innovative upstarts. This time disruption is not confined to health care, it is encroaching upon the property & casualty industry too…………..

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Under association health plans, small businesses can join associations — based on certain types of professional, trade or interest groups — that offer insurance to members.

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Recent Foreign Medical Graduates Seek Internship in USA

By any objective standard, the United States trains far too few physicians to care for all the patients who need them. We rank toward the bottom of developed nations with respect to medical graduates per population………………….

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The Trump administration is poised to roll back the federal requirement for employers to include birth control coverage in their health insurance plans, vastly expanding exemptions for those that cite moral or religious objections……………….

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“If it gets signed by this governor, it’s going to send shock waves throughout the country…..”

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A new analysis on how much Idaho would save by switching public employees to a self-insurance model puts the amount at $13 million for the first year of operation……….

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“Don’t Miss 70% – 85% of Billed Charge Reimbursement Rates!” touts Health Care Networks of America (HNA).

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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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What if a plan existed where employees could get what they wanted regardless of their health status and regardless of group participation requirements?

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The Employer Healthcare & Benefits Congress (EHBC) brings together attendees from across the world to discuss the latest developments in employee benefits industry, from corporate health & well-being programs and the latest in healthcare reform, to trends in voluntary benefits and self funded insurance, the EHBC has the information you need.

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States can apply for a federal waiver “to implement innovative ways to provide access to quality healthcare……” Does that include Reference Based Pricing strategies?

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The Monty Hall Problem is an interesting study of Probility & Combinatorics. Actuaries among us will enjoy this short video………………………

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