A seemingly valid concern about Reference Based Pricing strategies on the part of consumers is the possibility of balance billing leading to personal debt, lawsuits and ruined credit.

(more…)

Change over time is a constant……………………………………

(more…)

OCTOBER 13, 1925 – MARCH 27, 2019

Thurman James (T.J.) Chapman, age 93, of Austin, Texas passed away peacefully at his home on March 27, 2019 after a long illness.

(more…)

Donna Independent School District is accepting Insurance Consulting Services RFP #032219-487 at the office of the purchasing agent located at:

(more…)

The most powerful branch of government strikes down proposed rules for association health plans………….The Trump administration had rolled out the plans after President Trump signed an executive order directing Labor Secretary Alexander Acosta to consider allowing more small employers to form association health plans.

(more…)

WellCare Health Plans Inc. will be acquired by Centene Corp. in a $17.3 billion cash and stock deal.

(more…)

“Delay and Confuse” is one of the oldest tactics used by incumbents under attack. The North Carolina flirtation with Reference Based Pricing for their state employees is a classic example.

(more…)

$15 billion deal creates insurance powerhouse………………..

(more…)

Reference pricing divides drugs into therapeutic classes, which allow a payer to identify an average price to use as a reference point……………………

(more…)

Here we go again. Another challenge to the ACA. But this time investors are weighing the odds and taking their money elsewhere…………………..

(more…)

As consultants we have options when it comes to vendors, and if you’re in this healthcare revolution, I urge you to choose your partners thoughtfully and more importantly, in alignment with the values you communicate as an adviser…………….

(more…)

North Carolina may not embrace Reference Based Pricing strategies for the state employee plan after all. The North Carolina medical community has declared war. “Delay and Confuse”, a time tested tactic, is the weapon of choice……….

(more…)

  Dave Chase

Hospitals have overplayed their hand just like Pharma. At a certain point, gluttony has blowback.

(more…)

Some states are moving to control costs of state employee health plans by implementing defined contribution plans, a move away from traditional defined benefit plans. Montana, North Carolina, Oregon and Delaware are states that have implemented defined contribution health plans for their state employees or are about to do so. Meanwhile Texas is considering a House Bill to “study alternatives” to health care financing for their state employee benefit programs.

(more…)

Finland’s welfare system is generous in its provisions. Now it’s running out of money………….

(more…)

Study of a comprehensive workplace wellness program concludes that it didn’t change employees’ behavior or health care costs. Employees who took part didn’t become healthier or more productive, and were not more likely to go to the gym or run in a local race. Total health care costs didn’t drop, either.

(more…)

All 20 of these drugs are priced well over $25,000 for a monthly supply, or + $300,000 per year

(more…)

               $64,000 Question

House Bill 3987, if passed, will direct a commission to study alternative mechanisms for offering health benefit plan coverage to the affected employees  of the TRS ActiveCare program and their dependents. Will “alternative mechanisms” include a study of Reference Based Pricing strategies? Will Texas follow the lead of Montana, North Carolina and the South Texas Health Cooperative? 

(more…)

A Colorado insurance agent who created more than 80 phony life insurance policies has been sentenced to probation.

(more…)

I get emails like the one below almost every day on claims incurred under various Reference Based Pricing plans. The redacted email below shows how egregious health care billing practices are and what consumers are expected to pay in relationship to what Medicare pays.

(more…)

The Canadian inventor of insulin sold his patent for $1 to the University of Toranto back in the 1920’s to benefit mankind with a life saving, inexpensive drug. Now three drug manufacturers hold the power of life and death over 7,000,000 diabetic Americans. Why?

(more…)

Going with a PEPM subscription model yields greater plan savings than charging a percentage of savings. Our RBP solution, powered by Payer Compass, uses that model and helping is helping clients save up to 72% over traditional PPO networks.

The Donna Independent School District (DISD) in deep South Texas continues to under fund their self-funded health plan. In a competitive RFP process last year the district moved their self-funded health plan administration from Blue Cross to United HealthCare. However, the change in plan administrators have not shown any savings to date, although there is a “shared savings” fee paid to the administrator. Try explaining that to the boys in the domino parlor.

(more…)

New health plans expose insureds to less risk:

The risk of systematic rising health insurance costs, erosion of  benefits and less choice. Provider payments are fully transparent unlike traditional health plans that cloak provider pricing in secrecy.

Members may select any provider of choice unlike PPO and HMO plans. There are no high deductibles and in some cases no deductibles at all. So what’s the catch?

(more…)

With a single payer system only one election away, some TPA’s are looking towards the future. Others have their heads in the sand.

(more…)

For a low co-pay of $10 every time you order a meal and a reasonable $6 delivery charge (tips encouraged) you can get free meals from Blue Cross if you live in designated areas. You don’t even have to be a Blue Cross member, although we suspect those are the ones paying for all of this……………

(more…)

A major carrier (Mother) will require all new self-funded employer customers (Children) to incorporate this feature into their plan designs……………….As children don’t you hate to be told what to do?

(more…)

Reinsurance is a key pillar of Lockton’s aggressive growth plan……………………..

(more…)

1980’s BCBS Representative At Work

I remember years ago when I was a naive young salesman for BCBS working in a rural area office. I was eventually promoted to a big city office. It was a new experience for me. I noticed real fast that all the other sales reps. were involved in some sort of  “monkey business.”

They were typing up group health insurance proposals in the confines of their company paid offices (door closed of course) on behalf of competitors, pocketing commissions earned in addition to their BCBS salary. One rep. showed me his check stubs from more than one competitor and said “Bill, why don’t you do the same? It’s easy money! And, if I get fired or quit, I have a nice steady income coming in!”

(more…)

(more…)

(more…)

(more…)

I take a prescription drug that costs $18 at a mom & pop pharmacy in Cuero, Texas that costs $95 at a chain pharmacy 34 miles down the road in Victoria, Texas. A pharmacist friend told me his cost is $6…………..But of course not too many people know this or care. All they see is a Rx co-pay which effectively hides the scheme from public outcry…………..Many of our clients exclude two of the largest drug store chains in the country because they know prices there are 500-600% higher at the retail level than most independent pharmacies. That alone will save on average 5-10% off a group’s total drug spend.

(more…)

One of many emails I get every week about Reference Based Pricing strategies. Seems there are more and more TPA’s entering that space in partnership with either ELAP, AMPS, Six Degrees or Payer Compass, the Big Four. Then there are all the others like HST and UCC making inroads too. Now we are seeing some of the BUCA’s entering into the Reference Based Pricing space via their wholly own TPA subsidiaries with the apparent mantra “If you can’t beat them, join them.”

(more…)

(more…)

“No problem Joe, I’ll make a call for you”

(more…)

For 35 years I have worked closely with all constituents in the self-insurance industry to help our industry be the best that it can be. From my perspective, the development of Centivo is the culmination of every effort I have made for a TPA to be “world class” and represent the future.

(more…)

Centivo offers an alternative to traditional insurance carriers or third-party administrators……..

(more…)

Boston Tea Party

What’s the price of tea in China? How about insulin………….Insulin which was discovered in the 1920’s and whose patent sold for $1, has doubled in price between 2012 and 2016 while the price of insulin drug lantus increased 49% in 2014 alone. Why? In this war on drugs we should “Just Say No.”

(more…)

Rather than finding a way to provide for the small minority who still need health insurance, they want to overhaul the whole health system for everyone……………….

(more…)

A Texas Senate Bill was introduced a few days ago that addresses balance billing issues including credit reporting agencies……………….

(more…)