November 2022 – Risk Managers

136% Of Respondents Report Either a Negative or Positive Patient Experience

“Surprisingly, when asked about healthcare experiences, 76% said they have had a positive patient experience in the past three months and 60% said they have had a negative experience.”

The Broker’s Antidote to Lost Revenue

New Employee Benefit

No administration
No payroll deductions
No reconciliation

Get an Underwritten quote without PHQ’s in 48 hours!!!

This is where the small group health insurance market is going – rapid simplified underwriting. In the not too distant future we believe brokers will have the ability to field rate firm quotes in minutes.

Lionel To Partner With Lisa?

The Lisa Plan, an employer funded cash driven health plan strategy, is considering a partnership with Lionel to provide timid brokers and plan sponsors with sleep insurance designed to allay fears of the unknown. No longer will Lisa Plan members wonder and worry if their plan will be accepted by medical caregivers.

“The Dallas ISD Insurance Scandal” Starring The Cookie Jar Bandit

This is old news but relevant in today’s age of cell phones and instant messaging………

“Carver Dan Peavy (Peavy) was elected a trustee for the Dallas Independent School District (DISD) in 1986, so serving until 1995. By the early 1990s, he controlled purchases of insurance for DISD employees. He was a friend and business associate of Eugene Oliver, an insurance agent who had been convicted as an accomplice to murder” (PEAVY v. WFAA TV INC ).

When You Have A Good Product, People Will Buy It When It’s Free

“The Biden administration announced Tuesday that it’s seeing a big uptick in the number of new customers buying private health insurance for 2023 from the Affordable Care Act’s marketplace. The boost in enrollment is largely driven by generous subsidies—extended through 2025 in the Democrats’ $1.9 trillion coronavirus relief law—that keep monthly premiums payments at $0 or just a few dollars monthly for most people who sign up.“

Are You Licensed? ISI Has A Job Opening For You

Operating worldwide, Insurance Supermarket International Inc. operates through a network of offices including Toronto, Canada; Miami, U.S.A.; and Brasov, Romania, with a team of over 700 globally….

The Biggest Company In The World

by Daisy Wolf and Vijay Pande

We think the biggest company in the world will be a consumer health tech company.

Aldeen’s Sunday Morning Bathroom Read (post turkey stupor/WTF edition)

Doug Aldeen• ERISA Healthcare Attorney and General Counsel

“WTF” can best be summarized as follows:

A) William “The Fridge” Perry lining up as a fullback (all 338 lbs) for the 1985 Chicago Bears;

B) A number of not for profit hospitals charging 13% interest on a “credit card” for outstanding medical bills for individuals that are already functionally uninsured and now deeper in debt;

C) Marilyn Monroe/JFK/Lee Harvey Oswald/ all killed within 13 months of each other;

D) A NYC investment bank charging recently released felons $30 transaction fee’s on a $500 debit card (true story);

E) All of the above.

Why Can’t Group Health Insurance Be This Easy?

Easy Access Health Insurance In Minutes………………..

Our new and improved online quoting system is now live! You can now get instant quotes and rates, without ever leaving your desk. So, if you’re looking to find a new health insurance company, or just want to find out what you qualify for, you can do it right now! Get started by clicking below – Isaac Higgins

Time Value of Money In Healthcare

Why would any plan sponsor that’s able to pay cash at the point of service reimburse a hospital more than their discounted cash price?

The time value of money in a typical claim cycle averages 90 days X cost of money. What is 90 days worth in the value of services received in today’s dollars? Suppose a claim under a PPO contract is paid at 225% of Medicare and the cash price is 100% of Medicare, the time value of money under a PPO contract in this instance is 2.25. That beats money market and CD rates these days.

Transferring Risk To Medicare

Plan sponsors have all sorts of risk transfer strategies from which to choose from. Stop loss insurance is an obvious risk transfer strategy. Then there is ACA mandated HFAP risk transfer and specialty drug risk transfer. How about transferring risk to Medicare? It’s the older folks who have more medical expense needs often driving up costs for a group plan.

Rx With A Little Help From Our Friends

TotalRx.net is a valuable way to get access to network contracted rates, without worrying about deductibles or maximum benefit limits. With an unlimited formulary, and zero program rules, members are given a freedom seldom available to them in the benefit marketplace today.

67% Of Americans Believe Health Insurance Is Cheap As Hell

“There are plenty of Americans who are fine with what they are paying for insurance, including 67% who think their insurance premiums are fairly priced or inexpensive……..69% spend less than $500 per month on insurance…………….53% spend less than $250 per month“

And best of all, 60.6% of Americans pay no income taxes…………….life is good in America!

Boon-Chapman University

Leadership Can Be Learned At Boon-Chapman. Boon-Chapman’s Program was designed for Two Types of Leaders: “People Leaders” and “Thought Leaders.”

Hero Health

2 Minute Introduction for Employers

2 Minute Introduction for Advisors

Walgreen Blitzkreig

Walgreens plots ‘aggressive’ strategy to build out healthcare services, CEO Roz Brewer says

On the heels of several high-profile acquisitions, Walgreens aims to be a point of entry for consumers for healthcare services ranging from urgent care to specialty care and even in-home health.

Cash Pay Health Plan

“Pam said she was told that if everyone paid the lower cash rates then there would not be any reason for people to use their health insurance.” SOURCE: Yes, You Can Pay Cash for Health Care.

How Drug Makers Pushed Diabetes Patients Into The Danger Zone

Drugmakers pushed aggressive diabetes therapy. Patients paid the price.

Pharmaceutical giants launched years-long marketing campaigns for a treatment target they helped create, and as their sales of diabetes drugs soared, so did incidents of low blood sugar, a potentially deadly medication risk.

Aldeen’s Sunday Morning Bathroom Read

Are hospitals gaming the system at the expense of low income patients?

Who’s Gonna Decide What’s Usual & Customary?

“The insurer may not base the reimbursement to the physician or provider on the insurer’s usual and customary rate; and shall reimburse the phnysician or provider at the physician’s or provider’s specialty rate in accordance with the physician’s or provider’s expertise, experience and rate history.”

Texas To Cede Millions More to TRS ActiveCare?

“It is the intent of the legislation that the premiums for TRS-Care and TRS ActiveCare be calculated and adjusted taking into consideration the money appropriated ($286,337,761) under this section.”

Hospitals Often Don’t Help Needy Patients, Even Those Who Qualify

Some make getting aid hard, delay checking eligibility and press for payments that aren’t refunded…….

Freeing Doctors to Care for Patients

“This is going to be the solution that frees you from the dysfunctional medical system…….People have been led to believe that healthcare is so expensive that they can’t afford it without insurance… we teach you how to go without insurance and yet not be financially at risk. We call it assurance, vs. insurance.”

Vince Speranza

I was a 19-year-old machine gunner at the Battle of the Bulge in World War II. And I didn’t talk about my Army service for more than 65 years after that.

Snowden Releases Explosive Email – Jeopardizes American Business Practices

Ed Snowden releases a new cache of emails purloined while working for the CIA. One explosive email exposes a sinister conspiracy to upend American commerce.

Telemedicine Back In The Day

https://youtu.be/79aBG1wk-oo?t=70

Texas Legislature – The Jockeying Begins

“And They’re Off!”

The next biennial Texas legislative session begins January 10, 2023 and it’s going to be a doozy, action packed with a significant number of bills to be introduced related to insurance matters.

Legacy Health Insurance Broker Explains Why You’re Getting A Rate Increase

https://youtu.be/o-cJsE-kdaM?t=58

Doing Nothing VS Doing Something

The Immutable Johnny Dollar

Johnny Dollar was every insurance executive’s dream, an investigator who found the bad guy, or girl, and kept the insurance company from paying out a bunch of money on a bogus claim. People offered him a cut of the money and women offered him even more but Johnny couldn’t be persuaded to throw away his integrity for a bribe.

Hospitals Face Financial Disaster

It takes hospitals months and months to get paid for services. It involves pre-certification, claims filing, handling claim disputes, chasing patient share and a whole lot of other nonsense. After reading the article below timing couldn’t be better to suggest to hospitals there is a better way.

Pharmacy Benefit Managers (PBMs) Explained – Learn How the Money Flows

PBMs are one of the seven parts of the prescription medication ecosystem………………

Self-Insured Plan Powered By Direct Primary Care

Hannah

By David Contorno on Linkedin (Posted Saturday, 13 November 2022

Our 13 year old daughter, Hannah Contorno, who many of you met at our inaugural You Powered Synpoisum, was diagnosed with a rare blood disorder this week called Acute Immune thrombocytopenia (ITP).

Vitori Health Named A Market Shaping Entity

“Employer-purchasers need to let go of their “devil you know” mindset and stop buying into the narrative that employees can’t handle change. Although there may be risks in taking action, they are far less than the risks of comfortable inaction that have enabled a vast transfer of wealth from working Americans to the medical industrial complex.” – Neil Quinn

Public Entity RFP Scoring Revealed

By Bill Rusteberg

If you’re active in vying for public sector business we extend our deepest sympathies. It’s a tough world out there dealing with politicians and bureaucrats.

What’s The Best Way To Chop Prescription Drug Costs? Axe Your PBM

Plan Sponsor Confronts Predatory Business Model (PBM) & Wins

Hospital spend equals 40% of a plan’s spend. Professional spend equals about 20%. That leaves 40% left over. Guess which beast feasts on the remaining 40%?

RBP =40%, Specialty Rx = 15%

Interesting numbers happen when a plan excludes specialty drugs……………Then factor RFP & CPO…

Veterans Day 2022

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.

The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.

County Adopts Uninsured Business Model

“We then compared that uninsured person to us – what we’re paying – and in many cases what we found is we’re paying more than an uninsured person.”

ERISA-Covered Companies Must Disclose Health Plan Costs

“Full disclosure of direct and indirect compensation triggers the business equivalent of finding out one’s spouse cheated on them.”

The Truth About Feigning Benevolence

Employers Don’t Pay – You Do

Employers don’t pay a dime towards employee health insurance. Employees pay the full boat but don’t realize it. Try explaining that to the police and fireman union during the next negotiation cycle.

HSA’s Rock

A HSA is by far the best tax advantaged investment ever devised by mankind. Contributions are tax exempt. Withdrawals before age 65 for qualified medical expenses are tax exempt. Withdrawals at age 65 and used for any reason are tax exempt.

The Payer You Never Heard Of

You won’t see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?”

(This article first appeared on this blog March 7th, 2021. It was written at the suggestion of the President of a local County Medical Society representing over 4,000 physicians in Texas. His intention was to recommend it be published in their monthly newsletter. It never was.)

Primary Care Gold Rush Continues

Walgreens-backed VillageMD announces $8.9 billion deal

by Bloomberg 08 Nov 2022

by Michelle F. Davis

VillageMD, the primary-care provider controlled by Walgreens Boots Alliance Inc., has agreed to acquire Summit Health-CityMD in an $8.9 billion deal that shows the drugstore operator expand deeper into health-care services to reduce its reliance on retail.

File This Under “Ain’t Gonna Happen” & “Herding Cats”

New proposals for universal health care in Oregon and Washington

ROGER COLLIER

NOVEMBER 6, 2022

Once again, it’s time to consider universal health care. What are the implications? Could it happen?

Antidote For BUCA & RBP Plans

Status quo health care pricing through managed care contracts hasn’t worked out very well. Reference Based Pricing is an alternative, transitory strategy that has worked. But there is something better……….

Stand Alone Rx Aggregate Stop Loss

If Rx standalone Stop Loss premium = 2-3% of overall Rx spend and the savings on medical stop loss premium is 5%-10% when carving out the Rx program, what is the net difference?

PCI Direct Care Partners With ReviveHealth

ReviveHealth and PCI Direct Care have partnered in a collaborative effort to bring a differentiated and competitive solution providing affordable and easy access to primary health care and prescription drugs for members located in the Lower Rio Grande Valley in deep South Texas.

Sneaky Underwriting – Who Let The Dogs Out?

Insurance companies have traditionally required a minimum percentage of employees to enroll in coverage. Participation requirements helps insurance companies avoid adverse selection. Minimum participation requirements have traditionally been 75%.

Government Bureaucrats Say Doctors Worth Less

Doctor Responds To News – Opens DPC Practice

“The Medicare payment schedule released today puts Congress on notice that a nearly 4.5% across-the-board reduction in payment rates is an ominous reality unless lawmakers act before Jan. 1”

$1,842 Average Savings Without Cost Shifting

The independent thought leaders at Catalyst for Payment Reform (CPR) have recognized Vitori Health as a Market-Shaping Enterprise (MSE) that’s helping to reshape the dysfunctional incentives that influence today’s healthcare market.

Plan Sponsor Reviews 5 Year Plan Performance

By Bill Rusteberg

Five years ago a San Antonio plan sponsor had enough. Self-insured with a BUCA wasn’t working out too well. Three years in a row annual rate increase of 20% and more each year was unsustainable. Drug costs were going through the roof. Something had to be done.