August 2022 – Risk Managers

Texas County Eliminates Brand Name & Specialty Drugs – Covers Only Generics

A rural Texas county eliminated all brand name and specialty drugs from their employee group medical plan several years ago. The high cost of drugs was bankrupting their plan.

Teachers Are Pissed Over Health Insurance

“The premium for one month of health care for teachers is 1/3 of their take-home pay. That’s sad and why CCSD cannot keep teachers. They get paid more and better benefits by leaving the district.”

Amazon Vs. Apple: Only One Will Rewrite The Rules Of Healthcare

At 50 million members, Amazon could become the nation’s No. 1 insurer and healthcare system, capable of demanding lower costs from every player, including doctors, hospitals and drug makers.

CA Services, LLC – Stop Loss Experts

Bob is highly regarded in the stop-loss community for presenting easy-to-underwrite submissions, and educating underwriting on the vendor and health system values that benefit the employer group and the carrier.

Public Service Announcement

You can never be more careful these days. Announcing the New Outdoor Seatbelt now available at participating retail outlets.

The El Paso ISD Health Care Model

The more you pay, the more you save and the more you save, the less you pay…………..

The Ultimate 100% Health Benefit Plan

Health Care Bonus Award: Tahiti and The Bass Boat You’ve Wanted

“When a patient offers their right to obtain benefits from their insurance, that assignment of benefits is in and of itself consideration in full, exchanged for services and treatment. An assignment of benefits is thus not a form of access to consideration, and rather, is the consideration itself. One might ask why a medical service provider would ever choose to accept an assignment of benefits in lieu of the right to bill a patient for 100%. ” – Adam Russo, Attorney

MarpaiRx

Psst Godfather! Marpai is causing trouble! We gotta keep drug prices up there! Is Marpai crazy or what!

MarpaiRx Pharmacy Benefit Management Solution to Decrease Prescription Costs

MyHealthGuide Source: Marpai (Nasdaq: MRAI), 8/258/2022

NEW YORK — Marpai, an AI technology company transforming TPA in the self-funded employer health plan market, announces a new PBM solution available to current and potential clients nationwide called MarpaiRx. MarpaiRx is powered by a collaboration with MedOne Pharmacy Benefit Solutions (MedOne). MedOne is a trusted leader in the pharmacy benefit management market, delivering enhanced member experiences, improved clinical outcomes and net cost reduction through its aligned and performance-based model.

Medical Stop Loss Insurance Up 10%

Medical Stop-Loss Premiums Up Nearly 10% for 2022

MyHealthGuide Source: Stephen Miller, CEBS, 8/26/2022, SHRM

This year, the average stop-loss coverage premium for self-insured group health plans in the U.S. increased 9.8 percent for the nearly 250 health plans in HR consultancy Segal’s national medical stop-loss database’s 2022 dataset. That’s up from 8 percent in the 2021 dataset.

Building A Better Health Plan

*“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson*

A health care strategy that makes sense. It can be placed alongside any health plan of the employer’s choosing without asking anyone’s permission.

Analyzing Risk Begins Here

RiskManagers.us offers independent actuary services for self-funded health & welfare plans. This critical element forms the foundation upon which comprehensive risk management services are based. Without an actuarial analysis of plan performance a plan sponsor cannot be certain recommended risk management strategies will produce anticipated results.

Selling Health Insurance 1973-2022

1973 – No such thing as Major Medical or “networks.” Indemnity plans only. No medical underwriting. Two year rate guarantee. $15 daily room allowance. Employee rate <$20. Family rate < $40. Growing government intervention with the passage of Medicare a few years prior. HMO’s begin.

Amazon Throws In The Towel (again)

Amazon is shutting down its fledgling health care service, Amazon Care, at the end of this year.

You Are Killing My Health System

“Our country’s health system is not a “charity!” ………………An influx of foreign nationals are choking the health system……………………

Florence Hodges

Hospital volunteer exposes inner workings at hospital…….says she sees doctors every day but can’t afford them………..

Are Primary Care Physicians Underpaid?

Are primary care physicians underpaid? New study suggests the answer is yes……

Building A Better Health Plan

MedSave Management LLC builds direct primary care programs for employers interested in providing employees and their family members with:

Third Party Environment Under Attack

Removing primary care and specialty care out of a third party environment makes sense. That’s where the majority of claim volume comes from.

Network Carrier Pushes Level Funding

*Every Tom, Dick and Harry Is Getting Into Level Funding These Days*

Level funding is becoming popular with small fully-insured groups……….

Aldeen’s Sunday Morning Bathroom Read

Doug Aldeen – Healthcare Attorney

Sunday morning bathroom read (plus bonus Big Ten joke): Is the acronym “CON” (“Certificate of Need”) more accurately described as “Cannot Operate Nearby” ? Dale Folwell, the NC Treasurer, might be onto something………………….

Mulebriar Publishes Redacted DPC Agreement

The Mulebriar organization has released a redacted copy of a Direct Primary Care contract (DPC) of an organization that recently touted on social media they were the largest DPC provider in the United States.

Brave New World

Insurance brokers, especially health insurance brokers, are finding themselves in a fast moving and dynamic world of change. Business as usual is not business as usual anymore. It’s something different. It’s not so much about selling skills these days, it’s more about information flow.

Sole Source Vendor Contract Award

By Molly Mulebriar

It’s rare we see a public political subdivision in Texas award a contract without going through a competitive bidding process. That’s accomplished by designating a vendor as a sole source vendor. In other words no one else can do what the sole source vendor does.

Meet Your New Company Doctor

Modern medicine meets modern convenience…………………..

Expand your healthcare benefits package to include Akos as virtual primary care. As a member of the Akos health plan, your employees have unlimited access to many of the services Akos has to offer. The benefits are available with no copay and $0 deductible.

So? Whatcha Gonna Do About It?

Aon: U.S. Employer Health Care Costs Projected To Increase 6.5 Percent Next Year

IRS Announces Bad News For Plan Sponsors

Faceless, unelected government bureaucrats, having more power than God, have decided employers will have to pay more for ACA compliant coverage in 2023.

UHC Gifts Millions To Address Food Insecurity

With obesity running rampant it would seem food insecurity affects very few these days. A quick visual confirms a majority of Americans have successfully solved food insecurity in this country. Those unfortunate few that haven’t are rejoicing with the news UHC is coming to the rescue……………

NAIC Passes Dog & Cat Insurance Model Act

Dogs and cats are happy today after the NAIC passed the Pet Insurance Model Act. Dogs are barking and cats are purring all across the Fruited Plains after hearing the news.

“Finally, we’re not subject to stringent pre-existing conditions” said Boudreaux Wilson the 3rd, a Blue Healer mix from Yoakum, Texas. “Are we gonna get government subsidies next?”

Government Gifts $64 Billion To Health Insurance Companies

While you were sleeping the government passed a new law which includes $64 billion to extend a policy under Obamacare to reduce health insurance costs. TRANSLATION: Government just gifted $64,000,000,000 to American health insurance companies to be disguised as “subsidies”, a politically correct term for “welfare payment.”

Walks Like A Duck, Acts Like A Duck, Looks Like A Duck

Level funding is a form of self-funding that looks, acts, and feels like a fully-insured plan. It’s ideal for groups who have low risk tolerance and who want all the guarantees and safeguards of a fully-insured plan.

Plan Document Language That Makes Sense

Plan sponsors provide employees “health care expense accounts.” This is called health insurance. Like most company expense accounts there are stipulations employees must abide by.

The Patient Will See You Now!

At Revive, we have a saying: “The patient will see you now.” That’s because we’ve created a solution that puts patients in charge of their care and addresses the current challenges of the health care system.

5 Reasons Virtual Primary Care Is Going Viral

As a physician, I agree with the majority of my peers who expect virtual primary care to surpass in-person care within five years…………………….

Another BCBS Plan Buys A TPA

Blue Cross of Alabama has been buying up small regional TPA’s and rebranding under the name 90 Degrees Benefits. Blue Cross of North Carolina owns a TPA too. Now we see more BCBS plans entering the TPA market. Here’s the latest……

Another Entrant Into The Level Funded Market

There’s More Than One Way To Skin A Cat!

Level Funded Stop Loss insurance provides all the benefits of self-funding by retaining all unused funds, lower maximum costs, no lasers, and flexibility in plan design.

DPC + 501r = Almost Free Health Care

By Doug Aldeen – ERISA Healthcare Attorney and General Counsel

95 million American earn less than $35,612 or 275 percent of the FPL. Why pay for anything other than DPC with a 501 r wrap?

South Texas Insurance Broker Is Abnormal

Alex Zuniga is an independent insurance broker / consultant in deep South Texas who doesn’t fit the mold. He’s different.

Come & Get Your Copiers

“Come and get your copiers” says the City Manager. “But we have a five year contract!” says the vendor. “Doesn’t matter” says City Manager ……………………

Cano Health Direct Primary Care

Our friendly drivers will pick you up, take you to your appointment, and then bring you back home – all in the comfort of our specialized vehicles. And we will deliver your prescriptions to your home at no cost to you.

Radion Health

Level funded health plans are becoming a viable option to fully-insured plans. Radion Health has all the right selling buttons………………………..

Holy Smoke – Group Health Plan To Add 87,000 Employees

The economy must be thriving these days. Business must be booming. The nation’s largest employer whose revenue this coming year will break all previous records will be adding 87,000 new employees to their health plan.

DPC Outlaw Comes To Town

**Patients Spending Quality Time At The Doctor’s Office**

Remember Xerox? How about Eastman Kodak? Both were pioneers in their industries. They were visionaries providing solutions by fulfilling previously unmet needs, creating new markets that did not exist before. Now we are seeing something similar in health care……………….

868 Wasteful Drugs

You Are Required To Know – It’s The Law

By Patrick Moore on linkedin

If you’re a CFO or HR expert then you really need to hear me on this: You are now required to know how much money people are making off of your healthcare budget.

Are You A Genius? Try This To Find Out

WOW!

Comprehensive
healthcare benefits with
nationwide access

We bring you transparent access with direct-pay medical providers who get paid at the time of service so the patient is not billed afterwards! Our comprehensive network of doctors, dentists, pharmacies, labs, and everything in between for a truly complete healthcare package.

Size Doesn’t Matter

Everyone thinks size matters when purchasing employer sponsored medical insurance. It doesn’t

Ruben Edelstein

By Bill Rusteberg

Ruben Edelstein practiced managed care in his own way. The son of immigrants, he ran a successful furniture business in South Texas. An astute businessman, he grew the business with locations throughout the Lower Rio Grande Valley in deep South Texas.

Marpai To Acquire Maestro Health

First there was Continental Benefits. Then there was Marpai. Now there is……………………..

Marpai To Acquire Maestro Health

MyHealthGuide Source: PRNewswire, 8/4/2022

NEW YORK — Marpai, Inc., an AI-technology company transforming the $22 billion TPA market supporting self-funded employer health plans, announced it has signed a definitive agreement to acquire Maestro Health (“Maestro”), a leading TPA servicing over 80 self-insured employers, based in Chicago, Illinois.

Fully-Insured Rx Plans

A carved out custom fully insured prescription drug benefit plans for the large group health benefits marketplace? This is interesting. Will this lower the cost of drugs?

Death Claims Rise 40%

N. Korean Hospital Pre-Certification Program

In the N. Korean model, patients play an important role in the “pre-certification process” which is tied to a per admission “deductible” intended to speed up access to needed healthcare……………………

Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

Sunday morning bathroom read (Deep Thoughts by Jack Handy “SNL” edition):

We Have A Problem With Fat People

“We’ve gone from fat acceptance to fat celebration. To view letting yourself go as a point of pride? The term body positivity is used to mean ‘I’m perfect the way I am because I’m me.’ It’s Orwellian.” – Bill Maher

Legacy Health Insurance Brokers Are Bad For Your Health

Legacy health insurance brokers are worthless. They’re bad for your financial health. They’re lazy, dumb and often great golfers.

City of Raymondville Seeks Competitive Health Insurance

Here’s an opportunity for health insurance brokers to earn big bucks by simply forwarding this RFP to the four or five remaining fully insured carriers active in the market. Effortlessly, lift your index finger, gently tap the send button, and email the link below to your favorite BUCA rep. They’ll do the work while you play.

The Full-Risk Capitation Model: Why Make the Change?

By Christopher Chen, MD

Consider a typical primary care doctor who sees 30 patients a day, generating some $600,000 in a year ………………………..

It’s time to expose the secret drug scam at the heart of American health care

BYHOWARD DEAN

July 26, 2022 at 4:47 AM CDT

In 2021 alone, pharmaceutical firms provided a staggering $204 billion in price concessions for brand-name medicines–but the funds have mostly benefited insurers and their pharmacy benefits managers.

A federal court recently exposed the rot at the heart of America’s health care system.

The Primary Care Gold Rush

Retailers, payers and startups could capture 30% of primary care market by 2030: report

By Heather LandiAug 2, 2022 12:30pm

Bringing new care and reimbursement models to the market along with a bigger focus on virtual care, these nontraditional players are gaining traction and have the potential to grab as much as a third of the U.S. primary care market by 2030, according to a new report from Bain and Company.

Revive Health Expands Growth Trajectory

Emerging Leader Accelerates Growth Trajectory and Market Penetration

PONTE VEDRA BEACH, FL / ACCESSWIRE / August 3, 2022 / ReviveHealth™, Inc. has announced they have acquired ManifestRx™, an innovative national digital pharmacy services platform, as they continue their quest to become a preeminent leader in digital health whole-person care.

How Would You Deal With An Unexpected $1,908 Hospital Bill?

The parents of Maddux Brown saved big when they learned that nonprofit hospitals are required to provide financial assistance. You and your loved ones could, too!

By Marshall Allen

When 6-year-old Maddux Brown underwent a 15-minute surgical procedure his dad Jason didn’t expect the bill to empty his bank account.

Go deeper (2 min. read)

800 Life Case Seeks Health Insurance Proposals

This 800 pound gorilla is located in deep South Texas, in the Lower Rio Grande Valley.