Archive for the ‘Uncategorized’ Category

Sullivan Appointed as Texas Insurance Commissioner

Saturday, September 23rd, 2017

Texas has a new insurance commissioner………………………..

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Health Insurers in New Mexico To Implement Record-High Premium Increases

Saturday, September 23rd, 2017

Insurance superintendent says premiums are spiking because not enough people are signing up for coverage……………Or are the actuaries incompetent?

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Amazon In Talks With PBMs

Thursday, September 21st, 2017

A threat to the pharmaceutical industry………..?

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The Big Heist

Thursday, September 21st, 2017

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Pfizer Sues Johnson & Johnson Alleging Anticompetitive Practices

Thursday, September 21st, 2017

What Consumers Can’t See Will Hurt Them

If Pfizer is successful, it could discourage brand name companies from using deals with insurers to limit competition

Editor’s Note: Plan sponsors have no idea how the economics of our health care delivery system are birthed behind closed doors between third party intermediaries (carriers, PBM’s, etc) collaborating with one another………………….It’s all about the money and nothing about consumers………..

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Blue Cross Against ObamaCare Repeal Bill

Thursday, September 21st, 2017

“The bill contains provisions that would allow states to waive key consumer protections……”

Editor’s Note: Why is BCBS against the latest attempt to repeal ObamaCare? Could it be that onerous mandates that drive costs up leads to higher premium costs resulting in higher carrier profits through application of the Minimum Loss Ratio government requirement? If a carrier is required to return 80 cents on the dollar in benefits, the higher the cost the more income the remaining 20% produces to the benefit of the carrier’s bottom line. Carriers these days are breaking financial performance records in valuation growth………………..

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Study: Changing Carriers = Higher Utilization?

Thursday, September 21st, 2017

These average utilization changes reflected larger changes in use shortly after the insurance switch that diminished over the subsequent year………………..

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“Healthcare Tax” To Push Businesses Away From Your Community?

Wednesday, September 20th, 2017

IBM recently made a decision as to where to locate 4,000 new hires based on their analysis of where they received the best value from their healthcare expenditure. Consequently, they determined that Dubuque, Iowa was the best location to expand their employment.

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Fake-A-Disease Brings In $11,000 For Texas Man

Monday, September 18th, 2017

Texas grand jury indicts ex-teacher’s aide who faked cancer………….

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Healthcare Is A Right While Water is a Must

Monday, September 18th, 2017

If water is a must and healthcare is a right how does one distinguish between the two?

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PPO “Discounts” Mean Nothing – Only Dummies Remain Enamored

Monday, September 18th, 2017

My Discounts Are Better Than Yours Because My Boss Told Me So

“As we all know discounts are really no longer a relevant method in determining whether a network is “good” or not” – Jeff Bernhard

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Unpacking The Bernie Bongo Medicare-For-All Bill

Monday, September 18th, 2017

The Bernie Bongo Senate Bill, unlike the ACA, is only 96 pages long……………………

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A Billion Here, A Billion There: Selectively Disclosing Actual Generic Drug Prices Would Save Real Money

Monday, September 18th, 2017

Because pharmacies, not generic manufacturers, are “where the money is,” the opportunity for savings comes from reducing reimbursement to pharmacies for generic drugs. In the case of generic drugs, potential savings could exceed 10 percent………………………

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Hospitals Oppose ObamaCare Repeal

Monday, September 18th, 2017

America’s Essential Hospitals announced its opposition to a new ObamaCare repeal and replace bill, warning of cuts and coverage losses…………………

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Does Your Plan Do This?

Friday, September 15th, 2017

Medical Bill Review

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Medicare Benefits For All – The Bernie Bongo Plan

Friday, September 15th, 2017

By Molly Mulebriar

There is a lot of talk these days about “Medicare For All.” If this is such a good idea, and will “solve” the nation’s broken health care delivery system, why not change your current employee benefit health plan to mirror Medicare benefits and payment schedules?

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Another ACA Lie – Preventative Care Actually Does Not Save Money

Friday, September 15th, 2017

As counterintuitive as it seems, preventive measures generally increase rather than decrease costs……

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Obsession With Genitals Leads To Termination

Friday, September 15th, 2017

Two doctors have been suspended and a director ousted after hospital staff piled into an operating room to gawp at an unconscious patient with an object in their genitals…..

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Get Ready! Medicare Will Mail New Cards to 60 Million People

Friday, September 15th, 2017

Medicare is getting ready to issue all 60 million of its beneficiaries new cards with new ID numbers as way to combat identity theft and fraud…………..

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Investing In The Cartel Can Be Lucrative

Thursday, September 14th, 2017

The Cartel is at it again…..

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School District Suspends Changes To Healthcare Plan

Wednesday, September 13th, 2017

About 20 employees (less than 1% of the district’s work force) has succeeded in getting the largest employer south of San Antonio to suspend a scheduled increase in members costs towards the district’s self-funded employee health plan.

Perhaps the next step is to get these 20 or so employees to picket and protest outside the community’s two hospital systems against egregious costs. That $1,000 toothbrush charged by some hospitals could be their first bargaining chip…………………….

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Local Brownsville, Texas Blog Provides Better Coverage Than Mainstream Media

Tuesday, September 12th, 2017

TEACHERS, BISD EMPLOYEES AGAINST HEALTH INSURANCE HIKE

(Compare this blog article to the posting immediately blow this post…………

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Front Page News – 20 Employees Out of +8,000 Complain of Health Care Cost Increase

Tuesday, September 12th, 2017

A small group of 20 employees of the largest employer south of San Antonio, Texas, or about .0025% of the entire labor force, receives front page news over health insurance cost increase protest. The other +8,000 employees remain silent………………….. 

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Independent Consultants Declare Old Model Fails Customers

Tuesday, September 12th, 2017

This summer — and at Independence Hall in Philadelphia, no less — a group of 30 benefits consultants signed their own “declaration” outlining a novel strategy based on collaboration over competition.

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How Do We Hold A PBM Accountable?

Tuesday, September 12th, 2017

How do we hold a PBM accountable who selects a poorer drug with weaker outcomes and higher risk?

Plan sponsors get screwed even worse than they know………………

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Why One California County Went Surgery Shopping

Monday, September 11th, 2017

Frustration with sky-high hospital bills and a lack of local competition is common to many employers and consumers across the country……….Fed up with wildly different price tags for routine operations, some private employers are steering patients to top-performing providers who offer bargain prices.

Santa Barbara County, with about 4,000 employees, is among a handful of public entities to join them.

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Trump To Support Medicare For All?

Monday, September 11th, 2017

Demoralized Republican Majority Leaders Sulk

Will Trump support the Democrat’s Medicare For All proposal next week? The do-nothing Republicans have been a huge disappointment to Trump supporters. Last week, signalling his frustration with lying Republican politicians, Trump joined with the Democrats in getting the debt limit extended.

Will Trump join Democrats in calling for a single payer system? Perhaps so. There are just too many political positives in doing so. Trump can point to the disfunctional health care system and basically say “Enough is enough! We need to get this past us. No one in the health care delivery system wants to fix it, so government will have to fix it! It’s time we put this to bed and start concentrating on creating new jobs, lower taxes, and make America Great Again…………………..

With 48 Democrats in the Senate, Trump needs only two Republicans to support a single payer system. That should be no problem at all………………….

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CEO’s Guide To Restoring The American Dream

Sunday, September 10th, 2017

JUST RELEASED: A must read book by Dave Chase

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TDI Releases Report On PPO Out-of-Network Payments

Thursday, September 7th, 2017

The Texas Department of Insurance today released the results of a survey that looked at out-of-network payments by preferred provider organizations (PPOs) for certain services. The survey found that most plans comply with the state requirement to pay such claims “at the usual or customary charge for the service.”

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A Texas Public Purchasing Lesson – RGV Vending vs Weslaco ISD

Wednesday, September 6th, 2017

“RGV brought this action, claiming that the Board’s action violated section 44.031(b) of the Texas Education Code. Particularly, RGV complains that the Board failed to consider the criteria listed in section 44.031(b);  it believes that consideration of those criteria conclusively establishes that its bid was superior to the accepted bid…………..WISD’s failure to comply with section 44.031(b) provides a basis for RGV to raise its complaints in a court without first exhausting its administrative remedies.   Therefore, the trial court erred in granting WISD’s plea to the jurisdiction. ” Appellate Court Opinion

A Request for Proposal evaluation process includes criteria upon which points are assessed in the evaluation process. Failure to comply with the formal evaluation process can lead to vendor protests…………

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Lowering Costs & Getting Paid More Makes Sense

Wednesday, September 6th, 2017

“I had a client actually offer to pay me even more because of the value I was delivering………….” – David Contorno

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Disrupting Pharmaceuticals

Wednesday, September 6th, 2017

Radical Health Care Disruptor vs Status Quo Pharmacy Industrial Complex

Pharmacy benefit managers are, as Bloomberg News explains, “the middlemen with murky incentives behind their decisions about which drugs to cover, where they’re sold, and for how much.” 

The system is opaque and perverse — and it’s the only system we know………

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Insurance Consultant Sentencing Postponed…..Again

Monday, September 4th, 2017

Will Haff

Was $83,532.79 worth it?……………………………

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TIMELINE 2018: A Public Education Purchasing Seminar

Monday, September 4th, 2017

Designed for Public Education Purchasing Professionals with special emphasis on the latest developments that are essential in educational purchasing……….

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Fat Americans

Sunday, September 3rd, 2017

Civilian Turns Marine

” 70 percent of today’s youth are not fit to serve in the military due to obesity or being overweight, criminal records, drug misuse or educational deficits.”

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Access2MD

Sunday, September 3rd, 2017

Access2MD™ was founded in early 2012 by practicing physicians who wanted to change the clinical landscape. Innovative, “out of the box thinking” and progressive ideas have brought Access2MD™ to where it is today and this same approach will drive the company direction into the future.

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Keypro

Sunday, September 3rd, 2017

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization.

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Not your Typical On-Site Clinic

Sunday, September 3rd, 2017

Our health centers are not mere urgent care clinics but comprehensive health management platforms.
Modeled as Patient Centered Medical Homes, our health centers provide collaborative, patient-centric care and optimize resources, support, and value to the needs of each individual patient.

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Super TPA Shares Success Strategies

Saturday, September 2nd, 2017

I had a conference call this week with the CEO of a company with 1,500 employees lives covered with one of the BUCA PPO plans. His employees deductibles were $1,500 and an OPM of $5,000. I told him the we, Continental Benefits, could give you the same “A” PPO network, but also add bundled guaranteed pricing for 100 + different medical speciality surgeries with vetted and high quality surgeons.

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Third Party Intermediary Screws Consumers

Saturday, September 2nd, 2017

This is a bold-faced case of one business basically bribing another business to not use a certain other business!

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AMBS Third Annual Consortium Meeting Set For October

Friday, September 1st, 2017

Advance Risk Management Solutions, Inc. presents ARMS 2017 Consortium Conference – Tuesday, October 24, 2017 | Thursday, October 26, 2017…………..Moving HealthCare Risk Management in a New Direction

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David Contorno

Thursday, August 31st, 2017

Attention all TPA’s and PBM’s that may want to work with me and my clients……you will give me any and all data I ask for, in an expeditious and COMPLETE manner, without talk of extra costs or complexity. Your entire purpose is to analyze data and make decisions on that data, on behalf of our clients, with their money.

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National Direct – Satisfying the Greed Factor

Thursday, August 31st, 2017

WHY WORK FOR ANYTHING LESS THAN THE MOST YOU CAN GET?”
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Why The Healthcare Industry Will Eliminate PPO Networks

Thursday, August 31st, 2017

Mike Dendy

Eliminating the PPO domination of healthcare financing will represent a paradigm shift but one that is long overdue.

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Anthem Steers Members Away From Hospital Based Imaging Services

Wednesday, August 30th, 2017

In a move that it says will save members money, Anthem is rolling out a program that steers individuals away from hospital-based imaging services and toward less costly, freestanding imaging centers.

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BCBS of Georgia’s Solution to Non-Emergency ER Visits?

Wednesday, August 30th, 2017

BCBS of Georgia held a webinar last week. From what we have been told, BCBS and Anthem are cancelling Emergency Room benefit payments that are not “emergencies.” We have done the same with some of our self-funded clients. Significant savings have been achieved. No longer will Mommy take little Johnny to the ER for a fever and pay a low co-pay. Now when Little Johnny’s mommy gets the bill, her co-pay for non-emergency ER visits will be 100%……………….

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To Promote Health Care Excellence, Let’s Recognize Approaches That Assure Value

Tuesday, August 29th, 2017

Aug 28, 2017

BY BRIAN KLEPPER

A challenge for health care purchasers is choosing vendors whose performance matches their cost and outcomes claims. A 2015 Mercer surveyfound that only 41 percent of worksite clinic sponsors think that they’re saving money. As Al Lewis and Tom Emerick have detailed, many wellness and disease management companies simply overstate their results. In many cases employers may not realize that they, not the vendor, take the risk for results.

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Report Touts PBM “Savings” off Egregious Sticker Prices?

Tuesday, August 29th, 2017

Part-time PBM Salesman

“Costs would run an estimated 58 percent higher without PBM management tools and the pharmacy pricing and manufacturer discounts negotiated by the PBM”.

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Aetna Violates HIV Patient’s PHI? 12,000 HIV Patients Affected?

Tuesday, August 29th, 2017

Legal groups on Monday filed a class-action lawsuit against the health insurer Aetna, alleging the company violated the privacy of its customers by sending many of them letters through which the phrase “filling prescriptions for HIV” was visible through envelope windows.

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WellNet’s Fall Broker Tour Offers Self-Funded Insights with Focus on Reference Based Pricing

Sunday, August 27th, 2017

WellNet’s Fall Broker Revolution Tour is coming to a city near you. This tour is for brokers and consultants whose clients are tired of the carrier lip service.

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General Patton Addresses His Troops

Friday, August 25th, 2017

Damn it! We can’t continue to go around selling PPO plans instead of reference based pricing plans…..

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Converting PPO “Discounts” To Medicare Allowable

Tuesday, August 22nd, 2017

They were floored and shocked to find out that the 60% discount of billed charges in their area actually converted to 270% of Medicare charges!……………

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Money Affects Behavior

Tuesday, August 22nd, 2017

Amazing what people will do when they get told what their real costs are…………….

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PBM’s Bypass Middlemen – Cutting Out Insurance Companies From Gravy Train

Friday, August 18th, 2017

By cutting certain players, often insurers, out of the drug supply chain, disruptors are challenging the drug-pricing paradigm, as well as the value of prescription coverage…………

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Express Scripts Lawsuit Should Raise Everyone’s Eyebrows 

Friday, August 18th, 2017

The information that’s revealed is shocking………………….

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Texas Balance Billing Law To Take Effect September 1

Thursday, August 17th, 2017

The bill expands a patient’s ability to mediate their claims with the insurance companies and sets new guidelines for mediation………………….

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Bernhard Opines on Fake News – PPO Discount Game

Thursday, August 17th, 2017

Jeff Bernhard – President of Continental Benefits

Does everyone realize that a discount guarantee is really useless/ineffective for a self-funded offer/RFP? When does a discount ever lead to lower spend? How silly!

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Medicaid Overpaid Texas $18.9 Million For School Based Health Services

Thursday, August 17th, 2017

Texas received $18.9 million from Medicaid for school-based health services that were billed improperly, and the federal government is seeking to get the money back.

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Blue Cross Michigan Hit With Flurry of ERISA Lawsuits

Thursday, August 17th, 2017

A Shell Game Common To Health Care Financial Transactions

As a plan sponsor are you paying undisclosed fees that don’t show up on the fixed cost side of the ledger but rather on the claim cost side? There are numerous lawsuits that have exposed this industry practice and is not limited to BCBS………………….

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Texas Permanently Bans Taxpayer Funding of Abortion

Wednesday, August 16th, 2017

Bill prohibits insurance providers from forcing Texas policy holders to subsidize elective abortions

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Freedom Plan

Tuesday, August 15th, 2017

A Man Before His Times – Martin Luther announcing “Free at Last” Reference Based Pricing Plan

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Nixon Went to China. Can Trump Go to Single Payer?

Tuesday, August 8th, 2017

Only Trump can make single-payer health care happen in this country…………..

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Why A Pennsylvania Insurer’s Collapse Could Whack Californians In the Wallet

Monday, August 7th, 2017

Penn Treaty’s liquidation poses a “potential shock to the health marketplace” as the losses pile up, according to the A.M. Best credit rating firm. Industry analysts estimate the parent company has long-term claims liabilities approaching $4 billion, but only about $700 million in assets.

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Your Network Discount Analyses Are Useless

Saturday, August 5th, 2017

Throw it in the trash. Seriously…………………. 

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Smoke & Mirrors – Comparing PPO “Discounts”

Saturday, August 5th, 2017

Many independent fee based insurance consultants are sucked into the PPO “discount” vortex……………..

The carriers are very good at playing this game and my belief is that most consultants don’t get it or pretend not to get it, thus doing a great dis-service to their client.”   – PHO Sales Representative

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Cigna, Other Health Insurers’ Profits Surge, Ignoring ACA Chaos

Friday, August 4th, 2017

U.S. health plans stocks up 26%, outperforming S&P 500…………….

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Institute For Supply Management Announces September Seminar

Wednesday, August 2nd, 2017

 

This program is applicable to all areas of the public education sector, including school districts, junior colleges, and colleges.

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What Employers Need To Know To Manage Health Costs

Tuesday, August 1st, 2017

Employers can immediately reduce the cost of health insurance by 20% by simply shifting their focus to proven strategies…..

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Why Most Health Plans Strive To Make Healthcare Cost More

Tuesday, August 1st, 2017

 Brian Klepper

“The truth is that group health plans typically earn a percentage of total expenditures, and it is in their interest for healthcare to cost as much as possible.”

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Crowne Consulting Group

Monday, July 31st, 2017

As the future of healthcare lingers in a national debate, Crowne Consulting Group, Inc.delivers achievable ways for employers to decrease medical expenses while enhancing care for employees.

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Amazon Launches Secret Healthcare Team?

Saturday, July 29th, 2017

Is this the beginning of Amazon’s move into the healthcare industry?

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How to Determine if Your Company [or Client] is Overpaying for Rx

Friday, July 28th, 2017

The costs shared here are what the pharmacy actually pays; not AWP, MAC or WAC…………

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McCain Kills Repeal

Friday, July 28th, 2017

The Republican party is split. The Democrats are unified. This is a perfect case where “You don’t interfere when your opponent is committing suicide.”

Surgeons Excited About Slug Slime

Friday, July 28th, 2017

The European slug is average in every way: slimy, brownish, shorter than a credit card. But Arion subfuscus has a minor superpower………………

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Adam Ruins Everything

Friday, July 28th, 2017

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