March 2024 – Risk Managers

The Uncured Have A Shorter Shelf Life

We don’t cure our patients because it’s not necessary. It’s a choice we made to remain faithful to ourselves and you.

The Erosion of Physician Autonomy

“He Who Controls Referrals Wins” – Molly Mulebriar

“Around 61% of employed physicians said they have moderate or no autonomy to make referrals outside of their practice or ownership system…………..Many physicians say they are losing their ability to influence how patient care is delivered — 60% of physicians said non-physician ownership of practices results in a lower quality of patient care, according to the NORC survey.”

The Reimbursement Conundrum

“The reimbursement battle rages on, a healthcare tug-of-war with patients caught in the middle.”

4,000 Pound Gorilla Sees Value In Direct Primary Care

The trustees of the Hidalgo County self-funded health plan providing healthcare benefits for the county’s +4,000 employees administered by Aetna believes there may be a better solution than traditional fee-for-service primary care.

Marpai Q4 Earning Call Transcript

Get ready for strong earnings……………….

This Week’s Episode of “Can’t Make This Shit Up”

By Preston Alexander

In this week’s episode of can’t make this sh*t up……….

Baltimore Bridge Losses Could Be A Record Shipping Insurance Loss

Insurers could face losses of up to $4 billion after Baltimore bridge tragedy-analyst

By Sinead Cruise, Jonathan Saul and Carolyn Cohn

LONDON (Reuters) -Baltimore’s Francis Scott Key Bridge collapse could cost insurers billions of dollars in claims, analysts say, with one putting it at as much as $4 billion, which would make the tragedy a record shipping insurance loss.

“Three Magic Words”

By Marshall Allen

Laurie Powsner had recently left her full time gig as a social worker, so this year she and her husband got their insurance coverage on the individual market.

Will Grace Ocean/Maersk Rely On Same Law The Titanic Did To Limit Liability?

By Skylar Romines

Could Singapore-based Grace Ocean and shipping giant Maersk look to rely on an obscure law from 1851 to reduce liability for losses caused by container ship Dali crashing into the Francis Scott Key Bridge?

Bernie Demands Danish Company Adopt Canadian Rx Pricing

Bernie Bongo The Economist

Bernie Sanders Calls On Novo Nordisk To Lower Cost Of Ozempic And Wegovy

The White Coat Exodus

By Dutch Rojas

The deal was simple – sacrifice over a decade of your life in school and residency, take on crushing debt, work inhumane hours, and in return, you’d be set for life as a respected physician.

Uh Hmm, You Are Assessed $100,000

Properly managed self-funded risk pools make allowances for unexpected loss either through proper reserving or through contractual obligations of pool members bearing risk.

RBP Shield

Integrated stop-loss coverage and legal defense protection. (Non-believers need not apply).

The Texas School District Courtship Season Begins

TSHBP sent out invites last week to hear their sales pitch. Now TASB has sent out theirs. Who will be next?

TSHB has the more attractive offer – FREE FOOD and GIFT CARDS for attendees.

TRS ActiveCare is at a disadvantage since they are prohibited from competing for business for up to five years under certain circumstances.

ICHRA’s Rock

Attention Employers! Want to get out of the health insurance business? Want to give your employees more choices? Want to freeze your health insurance contribution no matter how much or how little you contribute?

Where Are All The Fat People?

Back in the day fat people were few in number. Now they are the majority of Americans. What happened?

Walmart Learns Human Labor Can Be Cheaper Than Machine Labor

Walmart Self-Checkout Scheme Backfires – INFLATION ALERT: Business overhead expenses for Walmart shopper thieves goes up.

A self-checkout machine doesn’t earn a salary or hourly wage. These silent, non-complaining beasts don’t need expensive company provided health insurance or Workers Compensation. They don’t get paid time off either. The little Beasties, it was thought, were going to reduce payroll costs and increase profits for the retail giant.

Aldeen’s Sunday Morning Bathroom Read

By Doug Aldeen

Oregon recently published the results of a study that confirm that by implementing a cap on facility prices at 200% of Medicare ( IP ) and 185% of Medicare (OP) for its state health plan, costs would eventually decrease. This is a good place to start but there might be another way to look at it as well:

Mark Cuban Fires His Insurance Consultant

“He first turned to the employee benefits consultant who had assured him he was getting a great deal—someone whose advice also cost $30 per employee per month.”

“That’s insane, that was millions of dollars,” Cuban says. “The person who put me into a program where I was paying eight times more than I should have for generic medication, they’re done.”

Around the time he dropped the consultant, Cuban was planning to get a CT colonoscopy, which he says would’ve cost more than $2,000 through insurance. Yet the walk-in cost for the same procedure was less than $500.

Will North Carolina Save $140 Million By Changing Logos?

The North Carolina state employee benefit program will be changing from Blue Cross to Aetna in 2025 for a purported savings. Sounds reasonable but is it true?

Call Armando For Price Check On Specialty Drugs

“Want to save $40,000 on a plan member taking an expensive specialty drug during the course of your plan year? Same manufacturer, same dosage. same packaging. We were able to do exactly that for a Texas county government health plan thanks to Armando. We turn to Armando when we need help sourcing expensive specialty drugs” – Bill Rusteberg

Highmark Small Group Community Rates

If you live in New York state and employ less than 100 employees, go here to see what your group health insurance rates could be under the Benefit Choices health program underwritten by Highmark (Rates shown are for Region 1).

Which Blue Cross Plan Has The Most Members? The Answer Will Surprise You

Largest Health Insurance Companies 2024

Chris Kissell

While some of these large health insurance companies are household names, others might seem obscure to the average consumer. What is the best health insurance company isn’t necessarily the biggest, but here is the list of the 50 largest health insurance companies in the U.S., and a deeper look at each of the top five.

TSHB Offers Free Food and Gift Cards For The Hungry & Gifted

At TSHBP’s 2024 Spring Regional Meetings explore cost-cutting solutions for districts and employees facing budget deficits.

Puppets On A String

United HealthCare says they have hired nearly 20,000 doctors in 2023 alone, according to reports. It also counts an additional 40,000 advanced practice clinicians among its ranks.

Hospital System Adopts Reference Based Pricing For 26,000 Employees?

Ardent Health Services with 26,000 employees, 30 hospitals and over 200 sites of care in six states partners with a legacy Reference Based Pricing TPA to administer their own employee health plan powered by “a powerful alternative to high-cost managed care networks.”

“Cry Me A River” by the Texas Hospital Association

What Texas hospitals got in 2023 as a reward for their service – from a coalition of health insurance interests and like-minded lawmakers – was blame, and even a degree of demonization.

Get Relief from Hospital Bills

Most hospitals offer discounts or bill forgiveness based on income. On average, a family of 4 earning less than $100,000 a year will qualify. We can help you apply — for free.

More Lloyds History By Miller

By Paul Miller

Here is part of an insurance claim made by Mme. Léontine Pauline Aubart, a first-class passenger aboard RMS Titanic.

Throughout her twenties, Mme. Aubart was a nightclub singer, living at 17 Rue Le Sueur, Paris. She boarded the Titanic at Cherbourg with her maid Emma Sägesser, occupying cabin B-35.

Aubart was the mistress of millionaire Benjamin Guggenheim, who was also travelling on the Titanic’s maiden voyage. After the collision, she and her maid entered Lifeboat No. 9. As they clambered aboard, Guggenheim spoke to Mme. Sägesser in German, saying: “We will soon see each other again! It’s just a repair. Tomorrow the Titanic will go on again.”

White Collar Drug Pushers Snub Fat People

The Ozempic Pushers

Some fat patients say doctors are pressuring them to take the miracle drug instead of listening to their immediate health concerns.

Aldeen’s Sunday Morning Bathroom Read (ASO Fiduciary Plan Design 101/Bart Simpson Chalkboard)

A recent review of an Aetna ASO Agreement between a county and Aetna revealed the following provision:

“ASO rates are guaranteed until 10/1/23. If County changes medical and or pharmacy vendors in 2022, all unpaid pharmacy rebates from Aetna will be forfeited.”

IRC 501r Debt Dismissal Technology

HOSPITAL ADMINISTRATOR: “Attention Employers, Give Me Your Poor, Your Tired, Your Huddled Employee Masses………….Why Pay For Health Insurance For Those That Don’t Need It?

This technology aims to streamline access to patient assistance programs, empowering individuals to apply for relief in minutes.

Dear Father, I’m Glad You’re Dead

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

Dear Father, Hope you and Mother are doing well since you left many years ago. Others have joined you since and I will too as soon as God allows. I’m happy you and Mother are dead as times have changed and you would be greatly disappointed if you were to come back for a day and read today’s paper as you used to do during your lunch break, coming home for a sandwich and a cold glass of beer in our sitting room while listening to the farm report on Channel 4. I’m glad you’re dead so you won’t have to live this and wonder what’s to come next. Your daughter and I will never forgo the values you and Mother instilled in us as we grew up. I still say “Sir” and fly the American flag in our front yard every day. Rest in Peace Dad!

America’s Most Flesh Heavy City

As they walked in I thought “OMG, this has got to be one of the unhealthiest bunch of people I’ve ever seen in one room at one time!”

Judy

Judy, a purebred pointer, was the mascot of several ships in the Pacific, and was captured by the Japanese in 1942 and taken to a prison camp.

There she met Aircraftsman Frank Williams, who shared his small portion of rice with her. Judy raised morale in the POW camp, and also barked when poisonous snakes, crocodiles or even tigers approached the prisoners.

Quote of The Day

“Health insurance has long, long ago stopped being insurance; it’s an extremely expensive way of pre-paying for things that you know are going to happen”—Dr. Tony Dale,

The Man In The Iron Lung

SOURCE: Paul Alexander: ‘Man in the iron lung‘

Paul Alexander contracted polio in 1952 when he was six, leaving him paralysed from the neck down.

Here Come The Lawsuits!

Feeling bad? Sue the pharmaceutical company! And while you’re at it………..

Carl Schuessler To Speak At Direct Primary Care Nuts & Bolts to 2.0 Conference

You don’t want to miss this one! Schuessler knows how to rock an audience and get his message across at the same time, all delivered at levels both Joe Sixpack and the POTUS can easily understand. Much to the delight of eager attendees of previous speaking engagements, Schuessler, through his strange and foreign magical powers has proven over and over again the Ebbinghaus effect does not apply when he’s in the room.

TRS ActiveCare Alternative – ICHRA

The majority of Texas school districts are members of the TRS ActiveCare’s (TRSAC) defined contribution government health plan representing more than 400,000 member lives.

Holy Smoke!

If you had bought Marpai stock when it was down near $1 days ago you could have doubled your money.

Mr. Pearlroth

Pearlroth, who was fluent in 14 languages, spent upwards of seven days a week at the library…………..He was so relentless that library officials sometimes had to ask him to leave at closing time.

More Lloyds of London History By Miller

Charlie Chaplin’s original costume was insured at Lloyd’s of London in the mid-1920.

By Paul Miller

The cutaway coat, baggy trousers, over-large boots, felt hat and cane were covered whilst being transported to an exhibition in New York. Whilst they were said to be “worth two shillings to an old-clothes dealer”, they were insured for £10,000. Under the terms of the policy, the clothes had to be guarded at all times and kept in a vault when not being worn.

Attention Insurance Brokers: Here’s Your Texas School District Prospect List

TRS ActiveCare has published a prospect list for insurance brokers interested in Texas public school business.

Reinsurer Pulls Out Leaving Texas School District Risk Manager Speechless

“I don’t find myself speechless very often” ` – Chris Bomberger,

” The Texas School Health Benefits program sent out the distress signal to districts that had pulled out of the state’s benefits system for educators: their reinsurer had pulled out of covering 51 Texas school districts who had negotiated their own benefits to find better cover coverage, better prices or both.”

Aldeen’s Sunday Morning Bathroom Read

FAP Text Book Example: Memorial Herrman Financial Assistance Policy

Sunday Morning Bathroom Read (“If you RBP, the CAA requires you to check the FAP” /ERISA Plan Fiduciary/Part 2 of 2):

Marpai Announces Something But We’re Not Sure What It Is

Marpai Announces “Off-Cycle” New Client Agreement

Source: Marpai (Nasdaq: MRAI), 3/5/2024

Tampa — Marpai, Inc., an independent national Third-Party Administration company transforming the $22 billion TPA market supporting self-funded employer health plans with affordable, intelligent, healthcare, announced that it has signed a three-year agreement to provide healthcare benefit services to a regional organization based in the southeast.

Largest Employer South of San Antonio Hates Belly Buttons

“Please don’t refer to our employees as Belly Buttons. It’s a very serious concern actually!”

SUMMARY: Brownsville ISD goes to bid for PBM services. Proposals received were ranked after an evaluation process lead by the district’s insurance consultant.

Fear-Based Propaganda Profits Big Pharma

“It used to be that pharmaceutical companies were working with the doctors. Now, unfortunately, pharmaceutical companies are captured by the price of their stock. Venture capitalists own the pharmaceutical companies, they own the clinical research organizations, they own the site, and they own the institutional review board. They own the advertising and the marketing. They influence through the media. And so, unfortunately – it’s a loaded question – but it’s a big market. And what we saw during this pandemic was the price of the stock mattered more than the price of a life.”

Don’t Ask, Don’t Tell

How To Find Out How Much Your Broker Is Getting Paid

Under new federal transparency laws health insurance brokers must disclose commissions /compensation to clients and prospects. Most have chosen to ignore the law and continue to do business as usual. Jeffrey Hogan offers tips for employers who are curious how much they are paying their broker but don’t know how to ask.

What Do These San Antonio Medical Providers Have In Common?

The following information is not subject to any gag clauses, NDA’s or Non-compete agreements common to traditional managed care contracts. Students passing this test earn an honorary Doctorate from RiskManagers.us and will forever be addressed in the most appropriate manner, commanding respect and adoration within the close-knit world of fee-for-service health insurance consultants from sea to shining sea.

The Marpai Roller Coaster

Without rhyme or reason Marpai was up 30% yesterday, If you want the thrill of a roller coaster ride buy Marpai and fasten your seatbelt. Join us in gondola #1 for a front row seat.

More Lloyds of London History By Miller

Oliver Reed

One Saturday night, he was at a local pub which was also visited by five sailors who were on shore leave. Upon seeing Reed, they challenged him to a drinking contest. He out-drank them all, downing eight pints of beer, twelve shots of rum, half of a bottle of whiskey, and a couple of large glasses of cognac.

Doctor Hides Bribes As Rent Payments

McAllen doc, Edinburg medical assistant convicted of healthcare fraud

Sugar, Sugar

You can learn amazing things from retired people, i.e., old people who don’t have a dog in the fight anymore (that’s why ink flows better after age 65).

Quote Of The Day

“

“I can make the case that almost no healthcare vendors care about anything other than setting themselves up to be acquired by the PE industry. Once purchased, all the PE firms care about is expanding profits quickly to allow for a quick flip. This includes RBR firms, TPAs, brokers, and PBMs. No one is advocating for the employer and when the efficient market concept kicks in, everyone will be sorry. Employers will eventually get their revenge on all the players who abuse their relationships many of which have fiduciary responsibility.” – Mike Dendy

House Approves Direct Primary Care For Poor People

One third of the government has decided Direct Primary Care is good for poor people too (the other two thirds are the Senate and the Executive Branch). It’s likely the other 2/3 will approve Crenshaw/Schrier Medicaid Primary Care Improvement Act.

An Antidote For Frankenstein Health Plans?

“We have a Frankenstein Health Plan! PLEASE tell us about your Sleeping Beauty Health Plan!” – Struggling in Pretoria

A recent post on Linkedin rings true:

“It’s a bit crazy that many brokers are so terrified of Medical Cost Sharing + DPC that they will put together the ugliest Frankenstein of a health plan with 12 different vendors and like 20 contracts for an employer who has no clue how it all works. The employees are utterly confused and need to be handheld by some random RN who serves as care coordination. Still almost no consumerism injected into the plan. Just a ton of steerage, coordination, and handholding. Is that really “innovative”? Yeah, I guess you saved the employer money for a few more years, but it still seems pretty unsustainable.” – Ben Butler

Medicare For All Is Here!

There’s good news for proponents barking “We need Medicare for all!”. It’s here.

U.S. Senate Bill Sounds Good But How Effective Will It Be?

There’s been a lot of hype over this bill. But is all the enthusiasm warranted?

U.S, Senate Bill To the Public Health Service Act to provide for expanded hospital and insurer price transparency will probably pass but will it have it’s entended effect? We think its not so likely as evidencd by past history in which most hospitals simply choose to ignore the law and pay the fines.

Aldeen’s Sunday Morning Bathroom Read (“If you RBP, you gotta check the FAP” Part I of II Edition)

This is one of Aldeen’s best Sunday Morning Bathroom Reads. We suggest it should be extended as a Monday through Saturday Bathroom Read for his irregular readers.

Managed Care Network Quiz

Healthcare Class 101 is now in session. Read each question carefully and answer to the best of your ability. There are no trick or multiple choice questions. You have three minutes to complete the test.

American Health Insurance Will Bankrupt You

Most Americans have health insurance through their employer. But according to this article 45% of employees have medical debt and its impacted their ability to put food on the table……….

What Do You Call The Guy Who Graduated At The Bottom Of His Class In Medical School?

“Somewhere in the world there is the world’s worst doctor and someone has an appointment with him this afternoon” – George Carlin

How Health Insurance Brokers Can Avoid Extinction & Earn Bigger Bucks

It’s tough being a health insurance broker these days. Fewer carriers to work with and the new pesky transparency law requiring commission disclosure is enough to drive one to drink……………….or voluntary benefits selling.

Blue Cross CEO Suffers $1.2 Million Pay Cut

Blue Cross CEO saw pay cut to $15.7M amid jump in medical, pharmacy claims

JC Reindl – Detroit Free Press

The top executive at Blue Cross Blue Shield of Michigan took home slightly less pay last year as the insurance giant experienced an underwriting loss amid a 12% jump in medical and pharmacy claims, including growing cost pressure from popular weight-loss drugs like Ozempic.

Non-Compete Clauses Are Bullshit

Editor’s Note: Years ago, many years ago, I leased my services and talents to a major BUCA in return for a salary and benefits (I was labeled an “employee”). I was very good at sales and made the company a lot of money. Then six years later my client (The BUCA who paid me for my services and talents and who recognized me as an “employee”) asked me and all the other employees to sign a non-compete agreement. I refused. “Bill, if you don’t sign you will be terminated!” my boss said. “Ok, terminate me” I replied. They didn’t. Anyone who signs a non-compete is an idiot. BTW – NDA Agreements are Bullshit too.