A Thanksgiving Message From Brian Klepper

Here’s wishing all my colleagues on this listserv a very happy Thanksgiving, with deep gratitude for your energetic and thoughtful participation in discussions about how to leverage high performance health care in ways that positively change our health system.
Kaiser Health News ran this lovely article about setting aside some time tomorrow to talk about everyone’s end-of-life wishes. I lost my precious wife Elaine 3 years ago today, but because we were fastidious about specifying how we wanted it to go, it was as smooth and satisfying an experience as possible. We never know what awaits us, and I can’t begin to express how important this is.
One more thing. In honor of Elaine’s memory, here’s a wonderfully sweet piece she wrote on end-of-life for TedMed.
Have a great weekend – Brian

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PPO “Discounts” Off Billed Charges Mean Nothing

 

A fascinating study by Alan T. Sorensen in 2003 on PPO discount patterns is an instructive read. The State of Connecticut’s data of the state’s hospital industry provided Sorensen a rare opportunity to study payer-level differences in negotiated discounts for hospital services and gives the reader insight into certain myths the managed care industry (including carriers, TPAs, agents and brokers) have successfully foisted upon clueless consumers for the past 35 years.

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How One Insurer Makes A Fortune By Reducing Healthcare Costs

“The best way to lower health care costs is to lower health care costs”……………”Healthcare costs are directly related to what we agree to pay for healthcare”…………………..”The secret to lowering health care costs is to find providers willing to take less and discarding providers who want more – it’s called Free Market”…………. “If you want to cut your health care costs by 50% and more, without sacrificing quality or level of benefits, you can…………………”

The following article proves all of the above:

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DOL Gives Kiss of Death in “Healthcare Madoff” Scheme

By Mark Flores

The Complaint also alleges multiple violations of ERISA including, using plan assets to pay excessive fees and expenses, assessing undisclosed fees to the contribution amounts, failing or refusing to pay approximately $16 million for member’s medical claims, then transferring unpaid monies to offshore bank accounts in Bermuda.

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Cost Plus Rx Model For Self-Funded Health Plans

We bring you a network of independent pharmacies with a simple and unique pharmacy payment model. Our cost plus model reimburses drug costs via the nationally published public NADAC list and a fixed drug dispensing fee. No more arcane acronyms like MAC, AWP, and WAC and no more lengthy contracts detailing complex generic and brand definitions.

Editor’s Note: If you are in the pharmacy business I would like to hear from you – any comments or suggestions you may have I will post in a follow-up blog posting………….Rx costs are out of control and the PBM world doesn’t seem to care. Perhaps PBM’s are the bad guys? If not, convince me please………………Write to RiskManager@RiskManagers.us

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The Deception Behind Those In-Network Health ‘Discounts’

UnitedHealthcare  boasts that its PPO—a network of more than 780,000 professionals—cuts the cost of typical doctor visits by 52%, while saving 69% on MRIs. Pull back the curtain, and you’ll see these discounts are an accounting trick. To allow PPOs to advertise big discounts, providers simply inflate their billed charges on a whole range of services and treatments.

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