Month: January 2018
In Just 2 Hours Amazon Erased $30 Billion in Market Value
The market value of 10 large, listed health insurance and pharmacy stocks 1 dropped by a combined $30 billion in the first two hours of trading.
Continue reading In Just 2 Hours Amazon Erased $30 Billion in Market Value
Pre-Order Your Organ Transplant Here – Customized Selection Process Individually Taylored
How Two Common Medications Became One $455 Million Specialty Pill
The drug has been controversial, to say the least. Vimovo was created using two readily and cheaply available generic, or over-the-counter, medicines: naproxen, also known by the brand Aleve, and esomeprazole magnesium, also known as Nexium. The Aleve handles your pain and the Nexium helps with the upset stomach that’s sometimes caused by the pain reliever. The key selling point of this new “convenience drug”? It’s easier to take one pill than two.
Continue reading How Two Common Medications Became One $455 Million Specialty Pill
Amazon, Berkshire Hathaway, JPMorgan Chase To Tackle Health Care
Growing health care costs “act as a hungry tapeworm on the American economy,” said Berkshire Hathaway CEO and chairman Warren Buffett in a statement. “Our group does not come to this problem with answers. But we also do not accept it as inevitable. Rather, we share the belief that putting our collective resources behind the country’s best talent can, in time, check the rise in health costs while concurrently enhancing patient satisfaction and outcomes.”
Continue reading Amazon, Berkshire Hathaway, JPMorgan Chase To Tackle Health Care
Tell It Like It Is…………………
When anyone tells us about manufacturer Rx rebates, our response is “Oh, you mean commissions, right? That’s what this is all about…………commissions. Commissions on a $100,000 per year specialty drug can be $45,000. Opps, I meant the rebate could be as high as $45,000.
Solving Health Care: “It’s The Price Stupid”
This article substantiates what we have been saying – health care costs have remained essentially flat but health insurance costs have not. Providers are simply raising their prices (not their costs) through secretive managed care contracts (PPO) you are not allowed to see nor audit.
Continue reading Solving Health Care: “It’s The Price Stupid”
The Medicaid Scam: Higher Taxes Are an “Investment” to Generate More Spending
I don’t like it when voters support tax increases.
Needless to say, voters rarely if ever vote to raise their own taxes. Instead, they get seduced into robbing their neighbors in exchange for the promise of new goodies from politicians.
Continue reading The Medicaid Scam: Higher Taxes Are an “Investment” to Generate More Spending
Kicking The Can Down The Road & Believing in Magic
Large self-funded employer sponsored health plan adopts ill informed strategies to reign in health care costs……………
Continue reading Kicking The Can Down The Road & Believing in Magic
Call For Cash Pay Providers – Houston Market
We are have a few more openings on our panel for surgeons and proceduralists in the greater Houston area who offer affordable cash pay procedures or have an interest in beginning to offer these. We are providing the infrastructure and the willing consumers, seeking a few more willing providers! Message me, please if interested.
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Hub International Caught Up in $42M Lawsuit by South Carolina School District
A South Carolina school district has sued an insurance brokerage and several insurance companies, saying the district was sold excessive policies and charged too much.
Continue reading Hub International Caught Up in $42M Lawsuit by South Carolina School District
5 Days Guaranteed!
Some medical-claims reduction companies wait until the last minute to resolve your claims – sometimes waiting too long and leaving you and your clients with a bigger bill than necessary.
Working The Spread
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.
Balance Billing Is A Plan Sponsor’s Best Friend
“Balance billing only occurs when purchasing goods or services without asking the price.”
Continue reading Balance Billing Is A Plan Sponsor’s Best Friend
Be Wary of Your Insurance Broker
The insurance industry is an anomaly. How so? It plots to eliminate competition and limit the flow of information in order to maximize income, all at customers’ expense………………
Consulting Fee Sticker Shock
Some insurance consultants set their fees based upon the value they will deliver to their clients. Others don’t.
Association of Independent Doctors
“We as independent docs save patients and employers 200-300% in cost of care compared to hospital employed/subsidized physician care. We are worth supporting and saving!” – Cristin Dickerson
Recognizing the unmet needs in the traditional health insurance industry, Sedera Health was founded in 2015 as an alternative solution………………..
Oscar Enters Pact With AXA
Oscar’s claim to fame is its use of technology and clinical integration to help consumers both use their benefits and navigate the healthcare system………………...
DOL Proposed Regulation Would Allow Association Health Plans
Continue reading DOL Proposed Regulation Would Allow Association Health Plans
Independent Fiduciary for Self Funded Plans
Looking to hiring an independent fiduciary?
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Self-Funded Employers: Quit Losing Money to Hospitals
“What we’re seeing is the gross billed charges are rising anywhere from three to up to seven times the cost,” Glascott said. “It’s stunning.”……………………..The charge increases while the costs are flat.”
Continue reading Self-Funded Employers: Quit Losing Money to Hospitals
Reference Based Pricing Roadmap
If your client is weighing conversion to a Medicare Reference-Based Pricing plan, theres a lot to consider. You need to ensure they avoid common pitfalls, and thats why were here to help.
Does “Free” Administrative Services In Exchange For Insurance Product Constitute Rebating?
The Texas Department of Insurance (Department) has recently received questions and complaints regarding whether insurance companies, agents and/or agencies may provide administrative services to clients without additional charge.
Continue reading Does “Free” Administrative Services In Exchange For Insurance Product Constitute Rebating?
CFOs And HR Execs Facing Millions In Personal Liability Due To Unmanaged Health Benefits Plans
” I don’t see how it’s possible to serve as a fiduciary while not having access to claims data, the ability to hold providers accountable by auditing detailed bills or providing transparency in cost and outcomes to guide participants.” – Chris Shoffner
Continue reading CFOs And HR Execs Facing Millions In Personal Liability Due To Unmanaged Health Benefits Plans
National Alliance of Healthcare Purchaser Coalitions
The Klement Letter
“As an outsider looking in and not having all the political implications and considerations that board members face, I’d like to give you our perspective and advice for consideration on your choices.” – Greg Klement
Flu season is shaping up as one of the worst in years, officials say…………………….
Healthcare Debate – “I Must Be A Mean Person”
Tucker Carlson debates Texas liberal seeking to oust Ted Cruz in November………………
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Kentucky Imposes Medicaid Work Requirement
Kentucky on Friday became the first U.S. state to require that Medicaid recipients work or get jobs training, after gaining federal approval for the fundamental change to the 50-year-old health insurance program for the poor……
Haas Opines On Reference Based Pricing Intermediary Fees
“We have encountered resistance with RBP service providers that base their fee on a percentage of billed or savings…………………..”
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Healthcare Becomes Largest US Employer
The majority of new healthcare jobs are not in clinical roles, but are in administrative and management positions, such as receptionists and office clerks……………
What You Don’t Know About Rx Marketing
Today I received an email asking if I wanted to be the “…only pain management/orthopedic practice that CVS recommends to all their customers for a year…”
Trump Work Requirement Rewrites Health Care Rules
I gotta work? I never had to before! This is messed up!
States to be allowed to require “able-bodied” Medicaid recipients to work……………
Continue reading Trump Work Requirement Rewrites Health Care Rules
Humana Officially Leaves AHIP
Humana officially ended its membership in America’s Health Insurance Plans just before the start of 2018, a spokesperson for the insurer confirmed to Modern Healthcare……………….
Trump To End ObamaCare As We Know It
The other shoe in Donald Trump’s war on ObamaCare is about to drop. It will end ObamaCare as we know it.
Are Political Subdivisions Stupid or Corrupt?
QUESTION: Do political subdivisions have a fiduciary duty towards management of their self-funded employee health & welfare plans? If so, why do some make really stupid decisions?
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Don’t Overlook Fact That Association Health Plans Are MEWAs
“The regulation of AHPs is colored by the fact that they constitute Multiple Employer Welfare Arrangements (MEWAs). Under [ERISA], states have broad authority to apply their insurance laws to self-insured MEWAs. Many states regulate self-insured MEWAs like a commercial insurance company……………….
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Fixing Healthcare & Direct Contracting
We are a direct contracting and bundling entity that works on free market principles and is achieving exceptional results from providers. Pre-negotiated deals have the same level of disruption as retrospectively negotiated deals, but are far less confrontational and afford the ability for providers to step up and do the right thing proactively.
Are you ready for your 2018 health plan rate increase?
Idaho to allow sale of “illegal” health plans……………………..
Man Who Posed as a Doctor at 18 Is Going to Prison at 20
He wore a white lab coat and a stethoscope, but as several would-be patients in South Florida learned in 2015 and 2016, Malachi A. Love-Robinson was no doctor……………….
Continue reading Man Who Posed as a Doctor at 18 Is Going to Prison at 20
The Man With 11 Hips
Even with thirty years of experience as an actuary in the insurance industry, it took me a year to figure this out………
To Win Accounts, Stop Competing
This is another great article from Griswold. Some say competing against the large brokerage houses like Gallaghers, Higginbotham, Willis and others is tough. It’s not………………………….
Supply Chain Management Is Launching A Benefits Revolution
A few months before adviser Mick Rodgers of Boston’s Axial Benefits Group was named EBA’s 2017 Employee Benefit Adviser of the Year, he and 29 other forward-thinking benefits advisers from across the country signed their name to the “Declaration by NextGeneration Benefits Advisers” that declares nothing less than a revolution in employee benefits.
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“How Sweet It Is!
Agreement gave the Blue Cross the health plan business, including administrative services and possibly reinsurance coverage, for six years. In exchange, Blue Cross and Blue Shield gave the plan sponsor more than $20 million………
Pharma, Under Attack For Drug Prices, Started An Industry War
It’s not easy to get Americans mad at a behind-the-scenes industry they’ve barely even heard of, but pharmaceutical companies have spent most of this year trying………………“Who decides what you pay for your medicines? Not who you might think,” a concerned woman’s voice says in a radio spot airing in the District last month. “More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers.”
Continue reading Pharma, Under Attack For Drug Prices, Started An Industry War
Eliminating The Middle Man
Embodiment of Corruption: Your Health Insurance Network
Secret network pricing helps render patients defenseless against price gouging. It’s as absurd as grocers being permitted to keep the price of milk secret……………..
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Congress Outlaws Health Insurance – Workers Rejoice Over New Found Wealth
If 17.5% of GDP could be transferred to workers tomorrow, and health insurance outlawed, you would see……………………
Continue reading Congress Outlaws Health Insurance – Workers Rejoice Over New Found Wealth
Made in China: New and Potentially Lifesaving Drugs
One new drug promises to stop cancer from spreading to other organs. Another would treat blood cancer. A third would use the body’s immune system to kill tumors.
All three show encouraging results, and need just one more step to be approved for use in the United States. The drugs have something else in common: They were created in China.
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Pharma’s Utilizes Blame Game Strategies To Defend High Prices
Public anger over pharma price gouging is running high…………”More than one-third of the list price of a medicine is rebated back to middlemen, like insurers and pharmacy benefit managers.”
Continue reading Pharma’s Utilizes Blame Game Strategies To Defend High Prices
340(b) Hospitals Vow Fight Over Program Cuts
Hospital groups are vowing to push forward with a fight against the Trump administration over changes to a federal drug discount program following a setback last week…………….
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3 weeks ago the facility quoted us billed charges of over $13,000 per dose for the patient’s chemotherapy drugs. We know the Wholesale Aquisition Cost of those drugs is under $700 per dose. (Thank you micromedex!) .
Patient Cures Own Cancer With Kitchen Spice
Woman, 67, who battled blood cancer for five years ‘recovers after treating it with TURMERIC’ in the first recorded case of its kind……………….Doctors say her case is the first recorded instance in which a patient has recovered by using the spice after stopping conventional medical treatments…………..
Continue reading Patient Cures Own Cancer With Kitchen Spice
Why the U.S. Spends So Much More Than Other Nations on Health Care
Continue reading Why the U.S. Spends So Much More Than Other Nations on Health Care
Do You Believe In Magic?
Medicare To Adopt Reference Based Pricing?
“A proposal from the Hamilton Project would give the Centers for Medicare and Medicaid Services (CMS) more resources to scrutinize medical technologies and allow the agency to experiment with “reference pricing”.
Why American Doctors Keep Doing Expensive Procedures That Don’t Work
American doctors routinely prescribe medical treatments that are not based on sound science………………
Continue reading Why American Doctors Keep Doing Expensive Procedures That Don’t Work
Definition of Fully Insured Health Plan
“A fully-insured health plan is a bundled approach of smoke and mirrors wherein the House sets the rules and always wins.”