New medical students have spent so much time on screens that they lack vital practical skills necessary to conduct life-saving operations, a leading surgeon has warned………………

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MEDICAL BILL SOLUTIONS – A Medical Debt Resolution & Advocacy Services Company……

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Voters in two California cities will decide two ballot measures that aim to curb healthcare costs, according to a Kaiser Health News report……………………

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What level of benefits could one expect based on claim reimbursement of 100% of Medicare allowable charges? 

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In this episode, The Phia Group chats once again with one of their Partners in Empowerment, Gregory S. Everett, President and CEO of Payer Compass.

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PBMs use arbitrary and opaque DIR fees to derive record profits at the expense of independent pharmacies, plan sponsors and most importantly consumers……………………..

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The healthcare industry is rife with secrets the healthcare industry doesn’t want you to know. If you have the courage to read this article, you may be wise to order The Schuessler Stick™, overnight delivery.

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Medicare for all is only one election away. Opponents may win 1,000 wars but proponents only need to win one. But this author writes “Medicare for All’ will never work, so let’s stop pushing it.”

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       Victor Lustig

Adam Conover explains hospital gouging practices 20 in this eye-opening 5-minute clip……..

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By Dave Chase

The most persistent myth in healthcare is that high cost equals high quality. It’s a proposition that holds across a great many products that are bought and sold in actual, functioning markets — but that’s not a description that applies to the U.S. healthcare industry.

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A Dallas man has admitted to defrauding a military health insurance program for $50 million.

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Blue Cross of N. Carolina has announced a new, no network health plan (Reference Based Pricing). Coupled with a high deductible, BCBSNC touts a 33% premium savings.

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The county’s complaint alleged broker accepted a $254,000 kickback for referring the county to a major insurer…………………in addition to fees paid directly by the county to the broker…………

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The Beginning Of The End of Group Health Insurance?

The proposal would allow companies to use HRAs to reimburse employees’ premiums on the individual health-insurance market……………………….In lieu of adopting a group medical plan for employees, an employer can give employees money to purchase individual health insurance in the open market....

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An Alabama pharmacy owner has been charged as part of an alleged conspiracy to scam more than $10 million from a federal health insurance program………………

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Earlier this month we learned the state of North Carolina will be terminating their state health plan’s contract with Blue Cross and will instead adopt a Reference Based Pricing plan (Another State Adopts Reference Based Pricing Strategies). Now we learn Blue Cross of N. Carolina will be introducing a new, no network health plan, which is of course, Reference Based Pricing. Is this a case of “If you can’t beat them, join them?”

“It is normal comprehensive insurance, with a high deductible, and the main difference being that reimbursement is based on a ‘reference pricing’ approach similar to what state Treasurer (Dale) Folwell has recently proposed for the state employee plan…………….”

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Have you looked at HealthSmart lately? It’s an exciting time for us. We’ve had a busy year of growth, transition and powerful new solutions. Now more than ever, you should give us a look to see how we can help your clients and prospects. (more…)

“Every day you remain in an RBP plan, your risk of massive liability increases”

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“Why aren’t you gonna pay for my prescription! My doctor ordered it!!!!”

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“Balance billing only occurs when purchasing  goods or services without asking  the price.”

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Employees upset with cost containment move by University officials………….“How long can we continue to offer health care coverage when we’re experiencing 20 percent to 30 percent increases on a regular basis?”

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The KISx Card was created as a solution for self-funded employers to tackle egregious surgical pricing while bringing simplicity to the employee experience……………….

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Working The Spread is nothing new. Seems quite common. The article below is about a lawsuit in which spread pricing is alleged.

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We get unsolicited emails every day like the one below. This one touts a plan we have never heard of before, offering what appears to be “to good to be true” pricing. We thought we would share this for our three readers…………………….

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“What are you talking about! That’s insane” cried the HR lady. …….”I thought you needed to know” I replied.

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The power of large numbers, 1.379 billion Chinese, brings big benefits when negotiating with drug manufacturers…………………………….

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Breaking The Status Quo

Allied National employer groups are proving beyond the shadow of a doubt that the Freedom Plan (our reference based pricing reimbursement) is a better, lower cost, solution than traditional PPO networks.

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Rest Easy In Our Pool

Taming Health Care Alligators Since 1998

The South Texas Health Cooperative (STHC) provides affordable health insurance to member school districts since 1998. Through careful risk management strategies, the STHC risk pool has achieved lower and stable costs while improving benefits at the same time.

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Earlier this year I moved a client from a BUCA PBM to an independent PBM. No benefit or formulary changes were made. Now that I have mature credible claim data on the move from the BUCA PBM to an independent PBM, I find Rx claims have reduced 30.1%.

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This may become the tipping point in health care reform. “The Senate Judiciary Committee chairman questions contract terms between insurers and hospital systems…………..contracts between insurers and hospital systems are limiting competition and pushing up health-care costs……………..”

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In an effort to increase drug price transparency, President Donald Trump signed two bills into law that ban insurers from writing gag clauses into their contracts with pharmacists………………

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Now let me get this straight. Humana tries and fails to negotiate a reasonable rate with enough in-network providers and is punished for it. Well, the solution is to get rid of the network and treat all providers as out-of-network. That’s what Reference Based Pricing plans do.……………..BTW guess where Humana is going to get the $700,000………………………..

– Bill Rusteberg

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Hospitals in central Indiana enjoy a higher profit margin than those elsewhere because they overcharge insurers…………………..

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The following article (Posted on Linkedin by Carl Schuessler) brings to mind deeper issues than the “surface” issues most consumers reading this will take away. The article hints of a gold mine of information leading to more questions than answers.

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“The Stockholm syndrome we have been suffering under is starting to break……………

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First it was Montana, a smallish state somewhere up north of us, who adopted Reference Based Pricing for their state health plan (Montana Adopts Reference Based Pricing Strategies). The little lady up north has big brass cojones! (Tough Negotiator Saves State Millions In Health Care).

Next there is California which is currently considering similar efforts. (California Assembly Bill 3087 Would Control Prices in the Commercial Market).

Now there is yet another state adopting Reference Based Pricing for their state employee plan. They must have heard about the little lady in Montana.

I thought Texas would lead the country on this. After all, several of us have been making noises in Austin over the past two years. Has Texas Lost It’s Cojones?.

– Bill Rusteberg

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“Annual deductibles for Americans with employer-based health coverage are hurtling toward $2,000 on average, according to new studies analyzing employee medical benefits.”

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“Outcomes-based wellness programs don’t work, so why do them?  There is no upside and therefore no argument in favor of poisoning the doctor-patient relationship. “

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Rising prices “chiefly tied to rising prices paid for health services.” Yet health care costs have remained essentially static for the past ten years. It’s the prices that have increased, not the cost of health care. – Bill Rusteberg

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San Antonio’s newest Emergency Room service sparks interest among residents and government officials.  The Emergency Room “is not even open for business but is already causing controversy.”

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 Marilyn Bartlett

Marilyn Bartlett took a deep breath, drew herself up to her full 5 feet and a smidge, and told the assembled handful of Montana officials that she had a radical strategy to bail out the state’s foundering benefit plan for its 30,000 employees and their families………………..

Will Texas be next?

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“No, I am not doing an electrical physical, I’m here for a cold and I don’t need that test!” ……“But sir, your Blue Cross will cover it” came her soothing reply.

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