“Drug prices are out of control, and Big Pharma continues to raise the prices for all Americans……….Not only does that mean higher prices at the pharmacy counter, it also means higher premiums and other healthcare costs for everyone.”

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After satisfying their initial waiting period averaging 47 years, approximately 30% of the American workforce is eligible for special health care pricing while the remaining 70% aren’t. Paying for it during their entire waiting period, they deserve better pricing………………..

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The RFP is essentially requesting the services of an assortment of experts…………….

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“It’s time we cut out the middleman and get our citizens the savings they desperately need.”

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Progressive plan sponsors are either half pregnant flower lovers with a passion for tulips or cliff dwellers not afraid of sharks.

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The purpose of this event is to inform employers, brokers, legislators and regulators about emerging initiatives to expand access, improve quality and reduce the cost of health care. – Dan Meylan

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The fatality rate may prove to be comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally……………

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Texas Detainee demands immediate release, $5,000,000 and medical care…………

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The private market will offer new funding strategies for employer-sponsored health plans……

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Emergency room physicians (and their anesthesiologist cousins) are a different breed. They don’t often join managed care networks. They serve a captive audience. The only emergency room door exit is to the billing department. They  charge an arm and a leg. They are the Balance Bill Kings of Health Care because they almost always do and never, almost never, ever, negotiate. But that’s about to change in Texas………………unless your’e insured through an Arm & A Leg Plan (self-insured plan). 

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Under prevalent status quo heath plans, cost containment means higher deductibles, higher out-of-pocket expenses, less choice. All are impediments to health care.

On the other hand, under Reference Based Pricing plans, cost containment means lower deductibles, lower out-of-pocket expenses, more choice. There are less impediments to health care. 

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The Shield is an ERISA-compliant product that deals with high-dollar medical claims and COMPLETELY PROTECTS the member from balance billing abuses with guaranteed savings.

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In summary, the lawsuit alleges that CIGNA accepts the out-of-network provider’s claims at the full billed charges and requests the same amount from the self-insured health plan.

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Psst……Have You Heard About Distilled Concepts?

These guys are marketing geniuses – well done website effectively sends the message that health plans can be made better……………..It starts with a Spark………..

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The creator of The Schuessler Stick™, Carl Schuessler explains his success in building a rural community health care plan while freezing his ass off in a Georgia deer blind. Listen to Carl starting at 8:00 – 20:30.

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Texas school districts enrolled in TRS ActiveCare have not had competitive options available to them until now. No matter how large a risk pool is, economies of scale doesn’t matter when risk management systemically fails to adopt proven strategies in a dynamic and changing market.

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“We have budgeted $2 million for our employee health insurance plan. Build me a plan  for my 350 employees that doesn’t cost a penny more than that!” was the directive from the CEO, a Type A personality who doesn’t take “no” for an answer and expects results even if impossible. So we did……………..

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“It is a common misconception that clients are entitled to receive any data, at any time, simply by virtue of being self-insured and having elected to receive Protected Health Information (PHI). This is not the case…….”

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High deductibles are road blocks to needed health care and do nothing to impact health care costs. Smart employers are discovering they can improve benefits and lower costs at the same time. The following article referred by Dan Meylan describes the problem we all face to these man made barriers to health care……………..

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Dr. Rebecca is passionate about providing holistic primary care to families. She understands that healthcare is expensive, which is why she is starting her practice with an innovative new model called “Direct Primary Care.”

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Inspectors found that Medicare Advantage insurers had added diagnoses for diabetes, heart disease and other conditions in 99.3% of chart reviews of patient information…………….

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Click on the link below and learn how Bartlett successfully moved the State of Montana state health plan over to Reference Based Pricing……………..It’s all about Rational Analytics and ARM TWISTING…..

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From: Bill Smith, President, Cigna Group Insurance [mailto:businesscommunications@cigna.com]
Sent: Wednesday, December 18, 2019 12:03 PM
To:
Subject: Important news from Bill Smith, President, Cigna Group Insurance

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David John Rendall
March 19, 1937 – January 1, 2020

David used his marketing skills and passion for deal making to start several healthcare related businesses that have evolved into a large enterprise, which currently has operations in 4 continents and clients in over 80 countries.

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Congress showers health care industry with multibillion-dollar victory after wagging finger at it for much of 2019

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“The emergence of biologics and gene specific medications will serve to drive these increases further as we move forward, as evidenced by Zolgensma (treats Spinal Muscular Atrophy) at an estimated $2.1 million and Luxturna (gene therapy for a retinal disease) at an estimated $850,000.”

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Posted by: MBJ Newswires in Insurance, Newsmakers 01/06/2020

Stephen Cali is joining HUB International’s Employee Benefits division, accepting the role of Sr. Vice President / Sr. Benefits Consultant.

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“The problem is moral hazard in an administrative state………..people alter behavior when they don’t have to pay for something………”

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Market Evolution of Reference Based Pricing Plans

Timing is everything when it comes to new and innovative ideas in health care delivery as the market must be ready and receptive. In 2005 it wasn’t……………..But two years later it slowly took hold in Texas…………And we were ready.

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Cigna Sued for RICO Violations, “Brazen Embezzlement and Conversion Scheme” -Health Plan Litigation Tsunami: Part 2

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Primary care has revived as it is viewed as a less expensive way to lower downstream health care spending. 

“Although maybe only 5% of health care cost is incurred in the primary [care] environment, a good or bad decision determines what the next 95% looks like”

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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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The problem I see with most health insurance consultants is almost all pre-determine a client’s tolerance for risk before determining where the risk tolerance actually lies.

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For over 30 years I have helped individuals and corporations obtain the best  ways of paying for medical care. 

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Doctors would be paid at the Medicare level while hospitals would be reimbursed at 110% of Medicare’s rate………..

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Whenever I give a talk about healthcare, I ask the audience, “What is the worst addiction problem we have in the United States?”

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Health care is a business like any other, and it can follow good business principles. Like other industries it can benefit from bottom-up innovation by entrepreneurs and intrapreneurs, rather than rely solely on top-down reforms coming out of Washington, DC. That’s what this book is about.  

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If this passes it will have a profound effect on the future of employer sponsored health plans………no longer held hostage to jobs they hate but need for health care benefits, plan members will be able to control their own health care benefit decisions………..

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