Before we go further, I’d like to clear something up: Wellness is not the same as medicine…….
Archive for December, 2018
Worshiping the False Idols of Wellness
Sunday, December 30th, 2018Texas School District Set To Close 12 Schools
Sunday, December 30th, 2018Austin 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…………..
Underwriter Opines on Reference Based Pricing
Sunday, December 30th, 2018By 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.
Reference-Based Pricing: a Welcome Disruption
Sunday, December 30th, 2018Disruptors Change History in Boston – “Tea Anyone?”
These plans are a game-changer in our industry, and a much-needed disruption to the status quo……………
WELLNESS PROGRAMS – The Good, The Bad, and The Just Plain Silly
Saturday, December 29th, 2018
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………………..
Employer Based Food Insurance
Saturday, December 29th, 2018The government bestowed a big tax break on employer-purchased food plans a few generations ago……..
High RBP Fees Offsets Plan Savings
Friday, December 28th, 2018“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.”
Protection Money In Healthcare
Tuesday, December 25th, 2018“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.“
Merry Xmas Mulebriar!
Monday, December 24th, 2018Mulbriar receives unsolicited Christmas gift revealing best kept secrets of out-of-network reimbursement strategies among the BUCA’s…………………..
Doctors Strike
Thursday, December 20th, 2018
TPA / RBP Vendor Compares Fees To Competition
Thursday, December 20th, 2018Commission driven broker / consultants push certain products over others. Here’s an example…….
Managing Risk vs Servicing Risk – The End of Status Quo Brokers?
Wednesday, December 19th, 2018With little formal training, a majority of health insurance brokers back in the day were simply spreadsheet artists………………………….
Insulin’s Inventor Sold the Patent for $1
Tuesday, December 18th, 2018Insulin’s Inventor Sold the Patent for $1. Then Drug Companies Got Hold of It.
Never underestimate the greed of a pharmaceutical company.
A $5,571 Bill For Sitting In A Waiting Room
Tuesday, December 18th, 2018More evidence the American healthcare delivery system is in melt down………………Continued destruction of the American middle class…………….
Is 150% of Medicare The RBR Sweet Spot?
Monday, December 17th, 2018
On average, commercial rates were 89 percent higher than Medicare rates……………….That means 5-% of commercial rates are less than 89% of Medicare………………..
Uh Huh, Right………………………
Monday, December 17th, 2018John Roberts – ObamaCare Savior
The Individual Mandate no longer ‘triggers a tax’ beginning in 2019……………………..
Tyrone Is At It Again Godfather!
Monday, December 17th, 2018I came across the single best explanation of AWP or Average Wholesale Price and I want to share it with you.
Telemedicine Back In The Day
Monday, December 17th, 2018Blue Cross Faces Antitrust Claims
Saturday, December 15th, 2018John Sherman
Blue Cross Blue Shield faces allegations of anti-competitive behavior that violates the Sherman Antitrust Act of 1890………………………………….
McAllen Independent School District Seeks Insurance Consultant
Friday, December 14th, 2018McAllen Independent School District (the “District”) invites your submittal on:
Insurance &Employee Benefits Consulting Services
Free Market Fails, Government Steps In…………….
Friday, December 14th, 2018Why Does 100 Year Old Life Saving Drug Cost So Much?
Friday, December 14th, 2018For 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…………
ERISA Class-Action Litigation over Fees in Health and Welfare Plans
Thursday, December 13th, 2018A 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…………..
Sales Bonus or Bribe?
Thursday, December 13th, 2018“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.
I Own You – Do What I Say or I’ll Break Your Legs!
Wednesday, December 12th, 2018Pssst, Godfather, Bill Is Attempting To Move Our Business!
“Tell Bill I’ll make him an offer he can’t refuse………………………………………”
Rebates!
Tuesday, December 11th, 2018Handling Health Claims: Traditional Carriers vs TPAs
Tuesday, December 11th, 2018“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….”
Sierra-Berkshire Associates
Tuesday, December 11th, 2018What Is AWP?
Tuesday, December 11th, 2018Rare View Behind The Curtain
Tuesday, December 11th, 2018Drug 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…………………………..
That’s Not What We Were Told!
Monday, December 10th, 2018Hermann Ebinghaus
How effective are employee health insurance benefit meetings? Or are they a waste of time?
Texas: Short Term Medical Plans Under Attack
Sunday, December 9th, 2018In 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………….
Deep South Texas Faces Unique Health Care Challenges
Sunday, December 9th, 201825% 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…………………
Tyler Man Connected To PBM Kickback Scheme
Saturday, December 8th, 2018Texas Insurance Consultant Forfeits License
Saturday, December 8th, 2018Convicted Texas insurance consultant William Haff forfeits insurance licenses……………accepted bribes to steer public school business to insurance broker………………
Health Care Sharing Memberships Top 1 Million
Saturday, December 8th, 2018A 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…………………………….
Decades Old BCBS Love Hate Relationship Continues……….
Saturday, December 8th, 2018Hospital administrators throughout Texas say the insurance company is using “strong-arm” tactics to push unfavorable contracts……………
Guaranteed Cost Stop Loss Insurance
Saturday, December 8th, 2018Plan Sponsors At Risk For High Fees – Breach of Fiduciary Oversight
Saturday, December 8th, 2018
“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.”
Communist China Adopts Free Market Medical Costs Strategy
Friday, December 7th, 2018China 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……………..
Wallet Biopsy Determines Prognosis
Friday, December 7th, 2018Here’s To The Crazy Ones……………….
Thursday, December 6th, 2018“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…………………….”
Turd Polish Season
Thursday, December 6th, 2018Most 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.
Get Your Healthcare Before It’s Too Late
Thursday, December 6th, 2018If 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.
Pigs To The Rescue…………………
Thursday, December 6th, 2018Find Out If You Have Cancer in 10 Minutes
Wednesday, December 5th, 2018Charge Master Rates & Magical Discounts
Wednesday, December 5th, 2018How to Bring the Big Health Insurers to Their Knees
Tuesday, December 4th, 2018Missouri Chamber Health Plan Misses It’s Mark
Tuesday, December 4th, 2018“When the data is hidden, you have no choice but to hope that the insurance company is managing your money appropriately.” – Adam Berkowitz
Indemnity Insurance Plans Provide Best Coverage
Tuesday, December 4th, 20184 Reasons Reference Based Pricing Could Become The Norm
Monday, December 3rd, 2018Reference 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……………….
The Wall Street Journal: Employers Change Tactics To Curb Health-Insurance Costs
Monday, December 3rd, 2018
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.
Health Care Lobby VS Dale Folwell
Sunday, December 2nd, 2018“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………………
Montana Association of Counties Moves To Reference Based Pricing
Saturday, December 1st, 2018Why 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.
BCBS To Administer State’s Reference Based Pricing Plan
Saturday, December 1st, 2018If 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……………..