Before we go further, I’d like to clear something up: Wellness is not the same as medicine…….

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Austin school district officials are proposing closing 12 schools, among other cost savings that total $55.1 million, as the district faces a deficit for the third year in a row…………….but will they address their second largest expense – health insurance? They can cut millions while improving benefits at the same time but no one seems to have told them that…………………….Meanwhile a large municipality near Houston continues to sell city land to pay for health care for city employees…………..

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By David Stanard   VP, Underwriting Manager at Excess Risk Reinsurance Posted on Linkedin

As an underwriter, I’m always surprised by the examples given when discussing RBP. They always seem to omit the fact that RBP has almost NO impact on an employers drug spend. In today’s market, that’s 30-40% of your cost.

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Disruptors Change History in Boston – “Tea Anyone?”

These plans are a game-changer in our industry, and a much-needed disruption to the status quo……………

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The good news is that the wellness industry is finally coming around (kicking and screaming at times) to the realization that their programs are not a health care cost savings strategy………………..

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The government bestowed a big tax break on employer-purchased food plans a few generations ago……..

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“By the time you add third party intermediary fees of $1 million and consider the additional balance billing liability to plan participants, Cost Plus Insurance may not make much sense to those in the domino parlor.”

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“Paying protection money (PPO access fees) for the promise of no balance billing against egregious, arbitrary sticker pricing that have 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 traditional American business practices.“

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Mulbriar receives unsolicited Christmas gift revealing best kept secrets of out-of-network reimbursement strategies among the BUCA’s…………………..

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Commission driven broker / consultants push certain products over others. Here’s an example…….

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With little formal training, a majority of health insurance brokers back in the day were simply spreadsheet artists………………………….

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Insulin’s Inventor Sold the Patent for $1. Then Drug Companies Got Hold of It. 

Never underestimate the greed of a pharmaceutical company.

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More evidence the American healthcare delivery system is in melt down………………Continued destruction of the American middle class…………….

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On average, commercial rates were 89 percent higher than Medicare rates……………….That means 5-% of commercial rates are less than 89% of Medicare………………..

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John Roberts – ObamaCare Savior

The Individual Mandate no longer ‘triggers a tax’ beginning in 2019……………………..

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I came across the single best explanation of AWP or Average Wholesale Price and I want to share it with you.

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 John Sherman

Blue Cross Blue Shield faces allegations of anti-competitive behavior that violates the Sherman Antitrust Act of 1890………………………………….

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McAllen Independent School District (the “District”) invites your submittal on:

                     Insurance &Employee Benefits Consulting Services 

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Is government mandated price controls the answer to rising health care costs……………?

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For a product that’s nearly 100 years old prices are too high, forcing diabetes patients to ration their drugs and sacrifice their health for financial reasons………only hree drugmakers control all of the U.S. insulin supply……………..list prices for one type of insulin grew 600% over 14 years…………

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A potential mine field for health-plan fiduciaries involves failure to ensure that plan participants pay only ‘reasonable’ fees for services, including co-insurance and deductibles…………..

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“The employer has no one — not the carrier, the broker, the third party administrator, the pharmacy benefit manager, the hospital or the doctor — sitting on their side of the table, with a shared incentive to lower healthcare cost.”

– Nelson Griswold, president of Bottom Line Solutions in Nashville, Tenn.

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Pssst, Godfather, Bill Is Attempting To Move Our Business!

“Tell Bill I’ll make him an offer he can’t refuse………………………………………”

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Rebate programs do not save employers money…………………………..

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“For the lion’s share of claims, the TPA is still leasing a large carrier network in order to secure the negotiated discounts with doctors and hospitals. But … there are some services for which the carrier’s network rates are egregiously high — and for those services the TPA will simply apply Medicare reimbursement levels instead….”

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Affordable Care Act Increases Need for Actuarial Services……………

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It is an elevated drug price that is rarely what is actually paid……………So why use it?

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Drug prices are difficult to determine for patients. Drug wholesalers, distributors, healthcare providers, pharmacy benefit managers and pharmacists keep prices hidden from the public. Until now…………………………..

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Hermann Ebinghaus

How effective are employee health insurance benefit meetings? Or are they a waste of time?

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In January, the 86th Texas Legislature will convene in Austin. Hopefully, they will address expanding health coverage in Texas, prohibit short-term coverage from discriminating based on health status, and limit the maximum time an individual may be enrolled to less than 364 days………….

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25% of the population in deep South Texas receive free health care. Known as The Valley, the region has unique health care and economic challenges including a high diabetes rate, high poverty rate, and heavy dependence upon government and health care jobs…………………

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Tom Slack, of Tyler, received more than $1.5 million in illegal kickbacks………………

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Convicted Texas insurance consultant William Haff forfeits insurance licenses……………accepted bribes to steer public school business to insurance broker………………

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A million Americans — a number that is growing — have rejected medical insurance for membership in one of the 104 known and active Health Care Sharing Ministries in North America…………………………….

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Hospital administrators throughout Texas say the insurance company is using “strong-arm” tactics to push unfavorable contracts……………

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Guaranteed cost stop loss insurance for today’s environment……….

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Bringing financial stability. Ensuring peace of mind.

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“Health-plan participants could conceivably choose to challenge health-plan fees with general fiduciary-breach claims. In fact, it is reasonable to expect that such claims will be made against other health-plan sponsors, given that plaintiffs’ firms have begun to solicit potential class representatives and request health-plan fee information from employers.”

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China embraces competitive bidding instead of price fixing?………….A free market approach in a communist country?…………………….Mao Zendong must be rolling over in his grave these days……………..Meanwhile back in the United States Cloned Zendong’s move forward pushing their Cultural Revolution with fervor……………..

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Patients must be first class fund raisers – their lives depend on it…………………………

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“Here’s to the crazy ones. Misfits, rebels, troublemakers. They are not fond of rules. They have no respect for the status quo. They change things…………………….”

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Most traditional benefits brokers are wrapping up Turd Polish season (aka Open Enrollment). You know, that process of trying to make the “pay more, get less” benefits discussion that happens every year.

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If you’re currently without healthcare for next year or are in search of a new program heading into 2019, you need to know that the deadline to purchase health insurance through the government Exchange is December 15.

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Pig hearts could soon be tested in humans after scientists pass important milestone…………..

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Blood test to detect cancer within just 10 minutes developed by scientists

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The American health care revolution is in full swing and growing………………….

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“When the data is hidden, you have no choice but to hope that the insurance company is managing your money appropriately.” – Adam Berkowitz

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Plan liability is well defined and budgetable, patient liability is too…………….

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Reference based pricing isn’t new, nor is it unproven. The need to control still-growing health insurance costs will make more large employers sit up and take notice of the practice……………….

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Company leaders are grappling with how to deal with the rising cost of health insurance in ways that get beyond the longtime strategy of simply passing on more of the burden to workers.

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“Lobbying? We’ve got 9 million taxpayers and 720,000 participants in this plan who understand that they aren’t consuming health care, it’s consuming them.” – Dale Folwell

Folwell’s plan is attracting national attention because of its far-reaching implications………………

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Why The Move to a Medicare Reference Based Pricing program?

The cost of medical services continue to rise at a rate far faster than inflation of other goods/services and faster than employees’ pay. Reference based pricing is the most effective tool we have to bend that cost curve. This change will mean less money going to health care expenses and more going into employees’ pockets. It also creates a system that is more fair, transparent, comparable and predictable than how hospitals charge us now.

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If You Can’t Beat Them, Join Them…………………………BCBSNC embraces Reference Based Pricing in order to retain +700,000 employee lives in the great state of North Carolina……………..

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