I received this nice message yesterday. Its all about sharing ideas / information that makes us all better at delivering health care solutions for our mutual clients.

“Bill, I read your blog. In fact, you don’t know this but your blog provided me much of my initial understanding of network discounts, reference based pricing and so on back in 2015.” 

 

 

Senate Bill Would End PPO’s

A new bill introduced in the US Senate, if passed, will lead to extinction of PPO’s in this country. If consumers and plan sponsors are able to access the Medicare network at Medicare pricing, (Renting Medicare’s Provider Networkwhy would anyone stay with a PPO with pricing averaging two, three, or more times than Medicare pricing? Would you?

Purveyors of Reference Based Pricing strategies will rejoice because instead of paying 120% to 150% of Medicare now, they will swiftly reduce the benchmark to, at a minimum, 100% of Medicare allowable. And, I expect, some plan sponsors will tag their reimbursement to 80% of Medicare allowable as a cost sharing measure with plan members……………Bill Rusteberg

Continue reading Senate Bill Would End PPO’s

Brokerage Firm Touts RBP Certification

An east coast insurance brokerage has announced they are now “certified” to market reference based pricing strategies. We find this curious. How does one get “certified?” So we decided to memorialize the process here.

In response to the apparent and curious need to become certified in order to offer clients reference based pricing strategies, RiskManagers.us has developed a simple certification process free to anyone who wants to try it. Simply look in the mirror and chant three times “I desire to become a certified reference based pricing mogul.” Then write this blog certifying your desire to be certified and we will send you your official Reference Based Pricing Certification Certificate at no charge.

Continue reading Brokerage Firm Touts RBP Certification

New Idea For Reducing Health Care Costs Is Actually Really Old

We have a health care delivery system where the price of health care is unrelated to the cost of providing it, or outcomes, but rather to the relative power of hospitals, third party intermediaries and medical groups to which unwitting consumers gift wealth using other people’s money facilitated through secretive managed care contracts you can see nor audit……………………

Continue reading New Idea For Reducing Health Care Costs Is Actually Really Old

Texas Lawmaker Calls on State to Fix Teacher Retirement System Care

“Teachers statewide are sharing their stories with us, hellish stories about people having to choose between medication and food, medication and rent, medication and just basic living necessities…….” 

RISKMANAGERS.US: Instead of throwing good money after bad, cost shifting to consumers, all contributing to the erosion of the American middle class, Texas should lead the country in solving health care. Reference Based Pricing, direct contracting, point of sale claim adjudication/payment, cost plus Rx payment methodologies and other risk management strategies have proven successful for Texas employers  like San Patricio County in South Texas. (Beating Medical Trend – Managed Care vs Reference Based Pricing and Health Care Strategies for Political Subdivisions.)

As a Texan I am sad to admit the little tiny state of Montana took the lead two years ago and now we hear the bright red Republic of California may be doing the same with California Assembly Bill 3087. (California Assembly Bill 3087 Would Control Prices in the Commercial Market.) When will Texas legislators wake up? Has Texas Lost It’s Cajones?.

Continue reading Texas Lawmaker Calls on State to Fix Teacher Retirement System Care

Historic Healthcare Ruling In Blue Cross Blue Shield Antitrust Litigation

“Our case alleges that, for decades, the Blue Cross Blue Shield system has operated as an illegal association of competitors trying to suppress competition in order to inflate their ownprofits at the expense of their customers,” said Hausfeld Chairman and Co-Lead Counsel Michael D. Hausfeld.

Continue reading Historic Healthcare Ruling In Blue Cross Blue Shield Antitrust Litigation

American (Cold) Civil War Expands – Blue States Fight Texas

Democratic Attorneys General Fight Texas Over Obamacare Lawsuit

April 9, 2018 at

SACRAMENTO (AP) — Sixteen Democratic attorneys general pushed back Monday against a Texas lawsuit aimed at striking down former President Barack Obama’s health care overhaul.

California Attorney General Xavier Becerra led 14 other states and the District of Columbia in filing a motion to intervene in the Texas case and defend the law, suggesting the Trump administration wouldn’t take such action.

“We’re taking this action to protect the health and financial security of millions of people in our country, as well as billions of dollars of federal funds that go to our states to make sure that we can afford the health care that our families need,” Becerra said at a news conference.

Continue reading American (Cold) Civil War Expands – Blue States Fight Texas

Hilarious Auto Response

This blog sends out posts of interest from time to time to a select group of like minded health care revolutionaries. Today one of our three members responded via Auto Response:

I’m on vacation returning in the second half of April. If it is an urgent matter, please re-send your email with URGENT in the subject line. I’ll be on the lookout for those. Or you can send email to XXXXXX If it’s really urgent, you call also call/text my cell phone.

Or if you prefer, choose from one of my alternative out-of-office messages below

Continue reading Hilarious Auto Response

RiskManagers HealthCare Purchasing Coalition 2018

RiskManagers HealthCare Purchasing Coalition ™ is a high performance health care Management Services Organization founded on a simple proposition: Health care cost can be reduced while maintaining or even improving benefits at the same time.

Continue reading

Will Hospital Continue To Honor RBP Safe Harbor Provider Agreements?

St. David’s HealthCare acquires The Austin Diagnostic Clinic………….

RISKMANAGERS.US OPINION: Austin, Texas is basically a two hospital town. Both hospital systems have tried their best to discourage local employers from implementing Reference Based Pricing plans in recent years. After all why agree to earn less when secretive managed care contracts continue to pay top dollar? Other area providers such as Austin Diagnostic Clinic are known to have entered into direct agreements with Reference Based Pricing plans in the area at rates slightly above Medicare. Will St. Davids continue to honor these agreements?

Continue reading Will Hospital Continue To Honor RBP Safe Harbor Provider Agreements?

Teachers Are Pissed

Kentucky and Oklahoma teachers flood state capitals — and refuse to back down until their demands for pay raises are met. What little do they know is the biggest pay raise they could achieve is smarter management of their health insurance plans…………………………The savings would be immediate, paychecks would increase and benefits would be improved at the same time. It’s found money for the states……………

Continue reading Teachers Are Pissed

PPO Escalator Clause Directly Attributable to Medical Trend Factor

Employer-sponsored medical plan costs expected to rise 8.4 percent…………..Cost of health care is essentially static but the cost of health insurance is not thanks to escalator clauses (Escalator Clauses, Rising Prices, And Why We Should Care) found in all managed care contracts guaranteeing pay raises  every year for most medical caregivers…………..

Why on earth do plan sponsors continue to rely on managed care contracts they cannot see nor audit yet continue to complain about rising health insurance costs? Their answer –  Blame consumers, cost shift to plan members and continue to use PPO networks………………..

Continue reading PPO Escalator Clause Directly Attributable to Medical Trend Factor