Month: April 2023

What a turnaround story…This is the poorest and one of the smallest school districts of over 1200 in Texas…………….

Fee based independent insurance consultants are comfortable within their own skin, confident their relationship with their client is founded on shared philosophies and goals. They know if they don’t produce acceptable results, they are replaceable. They’re good with that. They sit on the same side of the table as their client on equal terms.

“Benefits RFPs are universally awful and HR should abandon them…… RFPs are suited for buying a commodity, but not selecting a consultant……”

A warehouse filled with Magic Dust has been discovered in a remote area of DeWitt County. Governor calls upon school districts to remain calm………………

Weight Loss Program Costing Only +$12,000 Per Year! Who’s going to pay for this because most working Americans can’t?

“About eighty percent of the food on shelves of supermarkets today didn’t exist 100 years ago.”
― Larry McCleary MD

“I don’t think people realize that 54% of the nation’s children are covered by Medicaid,” Brooks said.

“We finally have a plan sponsor with the guts to do this,” Tony Sorrentino, a lawyer who is president of Health Plan Fiduciary Compliance LLC, a health-care compliance consulting firm based in Parker, Colo., said in an interview.

Why was her employer’s small group plan paying for it? And now it’s “free”?

This afternoon Katrina Daniel will be presenting an update on administration and performance of TRS-ActiveCare, a government health plan for Texas school districts. The Board Packet will be posted here later today.

A first hand, eyewitness account of the movement of Jews to Palestine after WW2 as told by a 99 year old WW2 American soldier, Herbert Margol, February 18, 2023.

Have you ever received an email so compelling you want to know more? You like the message, but wonder “What the Hell is this all about?” So you click on the link provided hoping to learn something new and exciting that will help your clients save money on health care. But doing so may have provided a complete stranger a door without a lock to your basement vault.

Artificial Intelligence (AI) is amazing. The following was generated in under 30 seconds by AI software when prompted with “Create Direct Primary Care Proposal”:

As a benefits consultant actuary services are core to your business proposition value……..

Because healthcare is local, we create programs built around your community, not national boxed programs that may or may not fit your unique needs. Gain more control with lower costs, reduced uncertainty, and increased transparency.

What kind of strategy saves money over Reference Based Pricing schemes? That’s probably what you’ll be wondering after reading this latest blog posting and a visit to Highlight Health’s website. That’s on purpose. But we know the secret – can you guess what it is? Hint: Doug Aldeen, famed Austin, Texas ERISA attorney is considered by many to be the Godfather who started this national movement………………..

Plum Health provides excellent health care services. We focus on prevention and wellness. We want to partner with you to create better health outcomes by providing compassionate service in a timely manner.

Ozempic is a popular diabetes medication that also helps with weight-loss. The other name for Ozempic is #Semaglutide. At higher doses of 1 mg per week it suppresses appetite and can lower weight by 10-13lbs. Ozempic is only approved for Type 2 Diabetes, NOT weight-loss. Ozempic costs about $995 per 8 mg pen… which could potentially last you almost 2 months. It suppresses appetite even more and can lead to 35lbs of weight-loss. Wegovy is approved for weight-loss. Wegovy costs about $1,432 per month.

School districts can reduce health care costs and improve benefits at the same time if they want to. It’s all about leadership.

Former Ashtabula Area City Schools Superintendent Mark Potts writes that the district’s experience shows the cost-reduction benefits of being able to shop for public employee health plan coverage as a price-informed consumer.

Same Day Prescription Drug Delivery

Add virtual care and you will almost never need to take time off from work to see a doctor at 2:00 for your 11:00 appointment

SOURCE: The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

“Uber Health is foraying deeper into healthcare with a new feature that allows providers to order prescriptions to be dropped off at patients homes same-day. The same-day prescription delivery is meant to help patients adhere to a medication schedule.”

Plan Sponsors Enjoy Pain & Suffering – Embrace Self-Flagellation

The article below (click on link for full article) doesn’t shed light on anything new. These practices have been going on for years. There have been hundreds of lawsuits exposing these egregious practices including Weslaco ISD vs Aetna, Anheiser Busch vs Cigna, Hi-Lex vs Blue Cross, Oakland County vs Blue Cross. Chippewa – Luce- Mackinac Community Action vs BCBS and many more.

Plan sponsors can’t afford to offer plans where plan members can go to any pharmacy, pay the same copay regardless of the retail price, and have the cost funded at the point of service using other people’s money.

Faster than a speeding bullet, more powerful than a locomotive, able to leap tall buildings at a single bound—look, up there in the sky, it’s a bird, it’s a plane, it’s First Connect!

“Trulicity was heavily marketed to doctors despite a high NNT, number needed to treat. NNT tells you how many patients need to be treated and for how long for one patient to benefit from the drug. It turns out that we have to treat 327 people for three years to prevent one non-fatal heart event, and that treatment costs $2.7 million.”

Plan member screwed by his own health plan

What do you mean I owe $5,000! The cash price for the whole thing was $87! You have a fiduciary duty to make sure things like this don’t happen! You should have had a cash pay health plan option like MedSave! You knew that option was available but you didn’t do it! I’ll see you in court!

Writing group medical insurance is a pain in the ass. You need detailed claim information for the past two years, census data, large case management notes and a whole lot of patience working with picky underwriters who always want more. Getting a firm quote takes days and weeks.

The Most Innovative Healthtech companies To Watch 2023

The federal government’s endorsement of RBP solidifies its position as a legally viable and effective health care pricing model. Fiduciaries must consider federal regulations, guidance, and legal precedents that support the use of RBP when evaluating its potential benefits. The endorsement by the federal government serves as a strong signal to fiduciaries that RBP is a legitimate and beneficial option for health insurance plans.

A BUCA renewal on a +200 life, fully-insured case warns the information contained in the re-rate calculation is CONFIDENTIAL and proprietary. Therefore we cannot confirm or deny its Blue Cross.

Dave and Erin, from Buffalo, New York, met foraging in dumpsters 14 years ago. They are still finding treasures together today.

SOURCE: The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

Thousands of doctors are expected to reach retirement age in the next three years, and their replacements won’t be physicians.

So much for your promises. You’ve given me nothing but shattered dreams……………….

MEDSAVE MANAGEMENT LLC is pleased to announce a new health plan option members may choose when seeking medical care. This program is designed for self-funded health plans interested in achieving additional plan savings while improving benefits at the same time without disrupting existing relationships.

It’s a new type of health plan you never heard of………………….

Blue Cross pays participating doctors lucrative commissions through what we call their Wuhan Virus Preventative Care Program (WVPCP).

Superintendent Stetson Roane (on left), Ben Clinton Assistant Superintendent (on right)

A case study of how to build a pay-for-itself community health clinic with other people’s money while making a profit at the same time…………………

WHO SHOULD TAKE THIS SEMINAR AND WHY……….

This seminar will have class topics that emphasize cost savings to government entities. It is designed for persons having administrative responsibilities in the area of purchasing, especially applicable to all areas of the public sector including counties, municipalities, council of governments, state agencies, governmental funded non-profit organizations, and other special governmental districts.

Just In Case……………………………..

Primo’s Transmission is a third generation business located in Brownsville, Texas. I had occasion to use their services several weeks ago. I wrote a letter to the owner today, a young man with a rare business sense, a drive for excellence with a “Can Do” spirit, instilled by previous generations before him.

Blue Cross Blue Shield has more contracted providers in-network than the beach has sand. So what’s the problem?

Little Johnny asks his savvy health insurance broker father “Daddy, what to PBMs do?

“We guarantee we will match or beat your renewal rates for better benefits!” says the health insurance broker. “All we need is a copy of your renewal and Summary of Benefits and we’ll have you a quote by end of day tomorrow!”

A pharmacy in Nuevo Progreso. (Veronica G. Cardenas / For The Times)

“Her son had stopped at two drugstores in Nuevo Progreso, picking up Xanax at one and Percocet at the other. While the Xanax may have been legitimate, the Percocet was not.”

By the end of 2023 all Plan Sponsors MUST submit a fiduciary attestation to the DOL saying, “I’ve had no Gag Clauses since 12/27/2020.” Trouble is there is not a plan sponsored managed care plan on the entire planet that can honestly attest to that.

Easy Money is a health insurance broker in the Lower Rio Grande Valley, Texas who makes his living bidding on public entities from the comfort of his living room couch. He’s a lone operator with no staff of his own and no office overhead to speak of.

Doctors recommend plenty of fresh air and bed rest when one is down and out. A $100 tow truck provides a healthy environment and more bang for your medical buck than a stuffy, germ filled $2,000 ambulance box on wheels……………………..

What’s better, going online and learning you tested positive for a deadly, low survival cancer or having your doctor explain, in a soothing reassuring manner, you have a deadly, low survival cancer? The message is the same so what’s the problem?

“Who’s at fault here? It’s not the broker. It’s not the insurance company either. It’s the plan sponsor who makes the system possible for what it is. They are in a position of power which most don’t understand they have. They should dominate the equation. A dominant fee based and experienced insurance advisor helps them do just that. “Me Too” fee based insurance advisors don’t. The later works for fees, the former works on principle.” – Bill Rusteberg

If 400 low cost generic drugs can satisfy +90% of one’s pharmaceutical needs, how important is it to cover the remaining <10% of pharmacy needs which drive up overall Rx spend by +80% or more?

Blue Cross identifies three factors driving rising heath insurance costs:

• Chronic disease
• Prescription drugs
• Unhealthy lifestyles

Chasing nickels and dimes instead of dollars is never a good idea……………..

“Medical trend” means medical inflation. It’s not driven by free market economics. Rather it’s journey to your health insurance renewal is spawned through managed care contracts you can’t see nor audit.

“Molly, Wait Until You Hear About This………………….!”

I bet you’re facing a health insurance rate increase again. Just a feeling I have founded on experience. My gut is never wrong. And, it’s a double digit increase for heavens sake.

Article Referred By Rusty Rusteberg

The Blue Cross representative for the second largest employer south of San Antonio has another gem to add to his renewal presentation. The Brownsville Independent School District (BISD) health insurance premiums are some of the highest among school districts across the state. Now he has another explanation why health care costs are going up again. “It’s all your fault your rates are rising again! You’re the unhealthiest population in the USA, the planet even!”

THE PODCAST BY KEVINMD 

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The U.S. health care system ranks poorly among high-income countries, but the direct primary care (DPC) model offers a potential solution. In this model, primary care providers are paid a consistent fee through a retainer or membership program, rather than relying on insurance billing. This frees up providers to spend more time with patients and offer comprehensive care. Both patients and providers in the DPC model report high levels of satisfaction and there is evidence of decreased utilization of expensive services and lower overall health care costs. Join us as we speak with Dr. Sara Pastoor about the potential for the DPC model to improve primary care and the health care system in the U.S.

Texas regulators seize and liquidate Friday Health 

“It will be one of the largest health insurance failures ever. After almost $300 million in losses in just three years and ending with a quarter-billion-dollar liability, the Texas Department of Insurance moved to liquidate Friday Health Plans’ Texas subsidiary.”

“I Can Eat Whatever I Want Because I’m On Mounjaro!”

People who are overweight are flocking to the drug Ozempic to slim down. Looming is an even more powerful weight-loss treatment.

Rural Americans face a wide array of healthcare issues. Not only are they more likely than their urban counterparts to die of chronic conditions like heart disease, cancer, and stroke, but they also have higher rates of obesity and diabetes, according to the National Institutes of Health.

A group of six US representatives and senators introduced bipartisan legislation to extend access to telehealth by eliminating the deductible requirement for those with Health Savings Accounts.

PBM drug pricing transparency reform bill headed to the full Senate

The bipartisan pharmacy benefit manager bill, which was approved by a Senate committee, would make it illegal to charge health plans and payers more for a prescription drug than what PBMs reimburse to the pharmacy.

Indiana hospital care: Employers and workers paid $2 billion above the national average

New analysis shows that $1.6 billion would have come from 30 non-profit hospitals – and employer groups are now urging state lawmakers to take legislative action.

No matter how you slice it, today’s version of Direct Primary Care (PCP) is Virtual Primary Care with a little bit of Brick & Mortar added in.

“PBMs are modern gangsters,” Yost said in a statement. “They were designed to protect and negotiate on behalf of employers and consumers after Big Pharma was criticized for overpricing medications, but instead they have absolutely destroyed transparency, scheming in the shadows to control drug prices on all sides of the market………………….

 “It used to be that the best and the brightest went into primary care because it was the most challenging……………..I don’t mean because you have to see a patient every five minutes. I mean that every time a patient walks through the door, you don’t know what’s going to come at you, and you have to be prepared for anything.”

Covenant HealthCare, two physicians to pay $69M in false claims settlement

Hayley DeSilva – Wednesday, March 29th, 2023 

Saginaw, Mich.-based Covenant HealthCare and two physicians have paid $69 million in three civil settlements for allegedly violating the False Claims Act, the Justice Department reported March 29. 

by Patrick Rucker, Maya Miller and David ArmstrongMarch 25, 5 a.m. EDT

Internal documents and former company executives reveal how Cigna doctors reject patients’ claims without opening their files. “We literally click and submit,” one former company doctor said.

“What would your plan have paid for these claims?” asked the plan sponsor shopping for competitive alternatives.