Archive for January, 2018
Salt Water Anyone?
Wednesday, January 31st, 2018In Just 2 Hours Amazon Erased $30 Billion in Market Value
Wednesday, January 31st, 2018The 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.
Pre-Order Your Organ Transplant Here – Customized Selection Process Individually Taylored
Wednesday, January 31st, 2018How Two Common Medications Became One $455 Million Specialty Pill
Tuesday, January 30th, 2018The 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.
Amazon, Berkshire Hathaway, JPMorgan Chase To Tackle Health Care
Tuesday, January 30th, 2018
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.”
Tell It Like It Is…………………
Monday, January 29th, 2018When 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”
Monday, January 29th, 2018
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.
The Medicaid Scam: Higher Taxes Are an “Investment” to Generate More Spending
Sunday, January 28th, 2018I 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.
Kicking The Can Down The Road & Believing in Magic
Saturday, January 27th, 2018Large self-funded employer sponsored health plan adopts ill informed strategies to reign in health care costs……………
Call For Cash Pay Providers – Houston Market
Saturday, January 27th, 2018We 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.
Hub International Caught Up in $42M Lawsuit by South Carolina School District
Saturday, January 27th, 2018A South Carolina school district has sued an insurance brokerage and several insurance companies, saying the district was sold excessive policies and charged too much.
5 Days Guaranteed!
Tuesday, January 23rd, 2018Some 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
Tuesday, January 23rd, 2018The 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
Monday, January 22nd, 2018Be Wary of Your Insurance Broker
Sunday, January 21st, 2018The 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
Saturday, January 20th, 2018Some insurance consultants set their fees based upon the value they will deliver to their clients. Others don’t.
Association of Independent Doctors
Friday, January 19th, 2018“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
Sedera Health
Wednesday, January 17th, 2018Recognizing the unmet needs in the traditional health insurance industry, Sedera Health was founded in 2015 as an alternative solution………………..
Oscar Enters Pact With AXA
Tuesday, January 16th, 2018Oscar’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
Tuesday, January 16th, 2018Independent Fiduciary for Self Funded Plans
Tuesday, January 16th, 2018Self-Funded Employers: Quit Losing Money to Hospitals
Monday, January 15th, 2018“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.”
Reference Based Pricing Roadmap
Monday, January 15th, 2018If 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?
Sunday, January 14th, 2018The 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.
CFOs And HR Execs Facing Millions In Personal Liability Due To Unmanaged Health Benefits Plans
Sunday, January 14th, 2018National Alliance of Healthcare Purchaser Coalitions
Sunday, January 14th, 2018The Klement Letter
Sunday, January 14th, 2018“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
H3N2
Saturday, January 13th, 2018Healthcare Debate – “I Must Be A Mean Person”
Saturday, January 13th, 2018Kentucky Imposes Medicaid Work Requirement
Saturday, January 13th, 2018Kentucky 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
Friday, January 12th, 2018“We have encountered resistance with RBP service providers that base their fee on a percentage of billed or savings…………………..”
Healthcare Becomes Largest US Employer
Friday, January 12th, 2018The 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
Friday, January 12th, 2018Today 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
Thursday, January 11th, 2018I gotta work? I never had to before! This is messed up!
States to be allowed to require “able-bodied” Medicaid recipients to work……………
Humana Officially Leaves AHIP
Thursday, January 11th, 2018Humana 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
Wednesday, January 10th, 2018The 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?
Wednesday, January 10th, 2018QUESTION: 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?
Don’t Overlook Fact That Association Health Plans Are MEWAs
Tuesday, January 9th, 2018“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……………….
Fixing Healthcare & Direct Contracting
Tuesday, January 9th, 2018We 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.
Idaho Rebellion
Monday, January 8th, 2018Man Who Posed as a Doctor at 18 Is Going to Prison at 20
Monday, January 8th, 2018He 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……………….
The Man With 11 Hips
Sunday, January 7th, 2018Even 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
Sunday, January 7th, 2018This 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
Sunday, January 7th, 2018A 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.
Buying Business
Saturday, January 6th, 2018“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
Friday, January 5th, 2018It’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.”
Eliminating The Middle Man
Friday, January 5th, 2018
Embodiment of Corruption: Your Health Insurance Network
Friday, January 5th, 2018Secret network pricing helps render patients defenseless against price gouging. It’s as absurd as grocers being permitted to keep the price of milk secret……………..
Congress Outlaws Health Insurance – Workers Rejoice Over New Found Wealth
Thursday, January 4th, 2018If 17.5% of GDP could be transferred to workers tomorrow, and health insurance outlawed, you would see……………………
Made in China: New and Potentially Lifesaving Drugs
Thursday, January 4th, 2018One 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.
Pharma’s Utilizes Blame Game Strategies To Defend High Prices
Thursday, January 4th, 2018Public 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.”
340(b) Hospitals Vow Fight Over Program Cuts
Thursday, January 4th, 2018Hospital 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…………….
Caught
Thursday, January 4th, 20183 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
Wednesday, January 3rd, 2018Woman, 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…………..
Why the U.S. Spends So Much More Than Other Nations on Health Care
Wednesday, January 3rd, 2018Do You Believe In Magic?
Tuesday, January 2nd, 2018
Medicare To Adopt Reference Based Pricing?
Tuesday, January 2nd, 2018Why American Doctors Keep Doing Expensive Procedures That Don’t Work
Tuesday, January 2nd, 2018American doctors routinely prescribe medical treatments that are not based on sound science………………
Monday, January 1st, 2018
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Definition of Fully Insured Health Plan
Monday, January 1st, 2018“A fully-insured health plan is a bundled approach of smoke and mirrors wherein the House sets the rules and always wins.”