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Blue Cross economist Michael Bertaut recently tweeted a series of posts explaining what has gone off the rails, and why.

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By Jeff Bernhard, President of Continental Benefits

When I see the below chart, it reminds me how much Employers need real solutions to get the wasted spend out of the system. 

When I see the info in the chart on the right it reminds me of an Employer with an eroding margin.  It also reminds me of the union member that doesn’t get a pay increase because unpredictable healthcare costs have eaten up the budget. 

Lastly, it reminds me of the school that needs to lay off 100 teachers because of the wasted, unnecessary spend in the system. 

It has been this way for the past 20 years and has gotten worse each year. 

I am so glad to bring a real solution, with reputable partners (TBA), in 2018 to the self-funded Employer market that helps self-funded Plan Sponsors get rid of this waste with no gimmicks, cost shifting or tricks.  This solution will work on a “A” carrier PPO network. 

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“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that has no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices. I am positive we will one day see plan participants sue their plan for breach of fiduciary duties. We are seeing this trend among retirement plans, health plans will be next” – Bill Rusteberg

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A parents worst nightmare………………

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If you’ve got health insurance, now’s a good time to be paying attention. Each year, prescription coverage changes, and yours will likely be changing in 2018…………………..

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“As long as third party intermediaries continue to pay for these high cost drugs, the manufacturers will remain at the trough…………Many of our clients remove these drugs from their formularies” – Bill Rusteberg

It takes balls to say ENOUGH IS ENOUGH I’M NOT PAYING THIS ANYMORE!

Self-Funded Plan Sponsor Discovers He Has Balls……….

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A Texas jury has ruled it OK for school board members to accept bribes if the transaction is between friends. Therefore, bribes exchanged between enemies must be illegal…………………………..

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“If you told me six years ago that we’d be able to find that when a hospital had a payment increase, a member of Congress representing that hospital got a funding increase, I would have laughed you out of the room……………..”

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SOURCE: Brian Klepper

New oncology therapies carry astronomical price tags—most people know this. Receiving far less attention is the question of actual therapeutic value……………..

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Humana representative Andrew Grove, whom prosecutors named as an unindicted co-conspirator, recorded a May 2013 conversation between himself, Mullen and Hernandez……………..After being confronted by the FBI, Haff agreed to cooperate and began secretly recording conversations ……………….Joshua Cerna was cooperating with the FBI by then, and in a recording of their conversation………………………..

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“The Mullen Group had 20 accounts, but SAISD represented 80 percent of their commission revenue, so it was important to keep its relationship with Mrs. Hernandez,” Holmes testified…………….

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Groups representing health insurers and consumers are urging state regulators to prevent the damage that could result from one of President Donald Trump’s executive orders……………..

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The timing is right for the Universal Health Coin; it’s revolutionary, disruptive and anonymous utilizing blockchain for the future of healthcare……………………

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Proposed tax bill, if passed, will eliminate the government’s broccoli mandate. Americans will no longer be forced to purchase broccoli. Currently, citizens who don’t buy broccoli are subject to a  broccoli tax as much as 2.5% of income.

A spokesman for the American Broccoli Association stated “Broccoli is a right, not a food. If broccoli consumption declines, we will see people die in the streets. We are gonna do everything we can to turn this around in 2018!

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Rx costs are bankrupting health plans across the United States. Rx costs amount to 25-35% of total health care spend and rising. Many plan sponsors are besides themselves, failing to reign in costs. Instead, they suppress wages and hire less employees………………..

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Conspirators forged a conspiracy that lasted from 2007 through 2015, federal authorities contend.

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Ordinance requires employers with at least one employee who works within the city limits to either pay at least a specific amount per hour worked within the city and county limits (or for paid time off) towards the cost of health coverage for any such employee, or pay a surcharge over to the city…………

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The Texas Medical Board’s (the “Board”) adoption of new telehealth licensing regulations may finally put to bed long-running challenges to the state’s historically rigid position with respect to healthcare services delivered remotely via telemedicine…………..

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The status quo insurance broker focuses the renewal conversation around carriers, networks and plan design changes. Focusing on these areas and not the health-care supply chain does absolutely nothing to reduce true costs.

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The problem is there is no such thing as being half pregnant. A half pregnant approach only extends and aggravates any pain associated with change and simply takes longer than necessary to achieve the end goals  which are  lower costs, better benefits and higher wages.

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The price you pay is all a black box………………………..

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Working families across the country are spending more of their income on insurance that doesn’t protect them as much as it used to………………….

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“If one has a brain and a backbone, they can achieve amazing things in health benefits. “ – Dave Chase

Peddlers offer everything from antibiotics to contraceptives laid out among the traditional fruits and vegetables…………

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America is set to endure one of the most perilous flu seasons in years – with doctors warning it could be similar to the deadly 2014 outbreak. 

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Plan sponsors and their administrators are increasingly at risk of legal exposure for breach of fiduciary duties. This lawsuit is an early example. Experts in our industry suggest more to come, rivaling the potential to earn more in legal fees that will make the famous Tobacco Settlement look like peanuts.

The weapon of choice of plaintiff’s attorneys is:

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The tragic truth of where our country is heading can be found in the article that follows. A growing welfare state is effectively eroding the American work ethic. In this article, a working American earning a good income decided to work less in order to receive welfare funded health insurance……………

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Dave Chase

Any company over 100 employees or so is an insurance company in all but name. The wise ones are already self-insured……

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Established in 1959, this TPA is one of the largest, privately-held insurance services organizations in the country…..

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Ever hear of a longer waiting period than 90 days? Paying for coverage for 51 years before coverage took effect brings cause for reflection…………….

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Justin Shafer & Family

“A friend of mine was released from unlawful confinement today. I’m a happy man” – Darrell Pruitt

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