By Bill Rusteberg
According to the Bureau of Labor Statistics, in 2023 93% of private-industry workers participating in medical care plans had a plan network. That means 7% don’t.
The 93% who do get double digit rate increases every year. The 7% that don’t, don’t.
So why is that? Why does the 7% crowd get so lucky? What’s the difference between the lucky and the unlucky?
Yep, you guessed it. One uses managed care networks you can’t see nor audit, the others don’t.
Managing Reference Based Pricing plans since 2007 with good success we have found rate increases are about as common as a three-legged heifer running in the Kentucky Derby. Maintaining static rates for 5 years and longer is not uncommon in our world. Add a dash of direct contracting and point-of-service real time cash pay claim settlement and you’ve got something to write home about.
Meanwhile back at the Managed Care Ranch the cowboys are restless. “Maybe if we change brands things will get better” said the trail boss. “Let’s try that one more time.”
