1st Year RBP Report Card

A mid-size Texas employer went from a BUCA to a Reference Based Pricing plan last year. The benefits remained the same. However, a change was made in the way providers are paid.  In lieu of paying through secretive managed care contracts, the plan paid medical providers based upon a transparent reimbursement schedule tied to a percentage of Medicare allowable charges.

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Texas School District Lowers Healthcare Costs While Improving the Quality of Care

“Managing health care on a local level brings needed accountability to health care financing while providing improved access to care and higher patient satisfaction. The patient-physician relationship becomes more than just a ten-minute office visit; it becomes a true partnership.”  – Bill Rusteberg

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San Antonio Suspends Paid Sick Leave Law

“San Antonio has agreed to delay implementation until December 1, 2019. The stay will allow time for guidance from the Texas Supreme Court on the law’s constitutionality. In the meantime, San Antonio’s Paid Sick Leave Commission has agreed to work with business stakeholders to recommend changes in the ordinance to the San Antonio City Council.”

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Selecting a Third Party Administrator

By William Rusteberg

With the growing suggestion that the BUCAs are inflexible third party administrators unwilling and unable to administer Reference Based Pricing plans and other strategies in the market today, more brokers are seeking new partnerships with independent third party administrators (TPA). An independent TPA can offer much more than a traditional carrier model.

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“Those trying the preserve the wildly under-performing and bankruptcy-inducing status quo healthcare system will do whatever it takes to try to thwart progress” – Dave Chase

Profiting From The Poor

The Nonprofit Hospital That Makes Millions, Owns a Collection Agency and Relentlessly Sues the Poor

Nonprofit hospitals pay virtually no local, state or federal income tax. In return, they provide community benefits, including charity care to low-income patients. In Memphis, Methodist Le Bonheur Healthcare has brought 8,300 lawsuits for unpaid medical bills in just five years.

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New Drug Costs $2.1 Million – A Plan Sponsor’s “Poison Pill”

“Specialty drugs account for about 1% of prescriptions but 95% of prescription costs.” A new drug approved this year will bankrupt health plans……………..Plan sponsors should carefully study their Rx formularies to determine if there are other “Poison Pills” lurking…….then take action.

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