Archive for December, 2014

Your ObamaCare Advisors – Simplifying Complex Concepts

Wednesday, December 31st, 2014

bromely

Kaya Bromley

“Ms. Bromely’s gift of simplifying complex concepts has assisted hundreds of organizations in designing and implementing individualized strategic plans necessary to comply with the Obamacare mandates.”

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What Can Employers Do To Reduce The Cost Of Obamacare? The 9.5% Rule Rocks!

Tuesday, December 30th, 2014

acarule9

Getting employees to reject group health insurance gets the employer off the hook, that’s the key. The 9.5% Rule makes that easy to accomplish” – Sam Crafting, M.D.

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Medical Care Consultants Inc.

Tuesday, December 30th, 2014

clinic

“We will finance the start up cost to establish your employee health care clinic”

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In-Store Clinic Growth Continues

Tuesday, December 30th, 2014

He might have his own solo practice -- or he might be managing a clinic unit for a big retailer near you.

The Convenient Care Association (CCA) estimates the number of health clinics located inside retail stores has increased 12 percent in the past year, to 1,800.

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More Providers Are Leaving PPO Networks……And Suing

Monday, December 29th, 2014

angrydocOver the past decade, there has been a significant increase in the number of physicians who have dropped out of Preferred Provider Organization (‘‘PPO’’) and Health Maintenance Organizations and have attempted to negotiate their own reimbursement schedules. With this growing trend we are beginning to see a wave of provider lawsuits begging for larger reimbursements.

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Selecting a Third Party Administrator

Sunday, December 28th, 2014

tpa

By William Rusteberg

Selection of a third party administrator (TPA) is crucial to the success of a self-funded plan. Criteria usually revolve around several factors including compatibility. Corporate philosophies of the employer and TPA should harmonize.

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Free Health Insurance But No Doctors?

Sunday, December 28th, 2014

medicaidBy ROBERT PEAR DEC. 27, 2014

WASHINGTON — Just as millions of people are gaining insurance through Medicaid, the program is poised to make deep cuts in payments to many doctors, prompting some physicians and consumer advocates to warn that the reductions could make it more difficult for Medicaid patients to obtain care.

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The PPACA – Game Changer for Health Care Financing

Monday, December 22nd, 2014

The Affordable Care Act (ACA) has had a fundamental impact on health care financing in this country. It has effectively provided added incentives for plan sponsors to consider modified self-funding arrangements for their employee health and welfare plans in lieu of fully-insured plans. The advantages of doing so are clear.

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Hospital Contracts Made Simple – 120% Method

Monday, December 22nd, 2014

monkey Sam Crafting, M.D.

Sam Crafting 120 Hospital Contract For RiskManagers.us

By Bill Rusteberg

Hospital contracts, if you can get your hands on one, may prove too complicated for most. Page after page of legalese followed by five or six pages of reimbursement schedules makes for dull reading. On occasion one will be delighted to discover that some payers utilize a simplified, shortened version that even monkeys can understand.

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Blue Cross Subsidiary Touts Cost Plus Insurance

Saturday, December 20th, 2014

acs-cost-plus-sheet

Click for an Informational Video ←

ACS Benefit Services Inc. , a wholly owned subsidiary of BCBS of North Carolina, is a third party administrator active in marketing and administration of Referenced Based Pricing, Cost Plus Insurance plans.

“How does ACS Benefit Services Cost Plus pricing compare to BCBS North Carolina’s PPO pricing?” – Molly Mulebriar

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Keeping Up With New Payment Models: “Cost Plus” or “Medicare Plus”

Saturday, December 20th, 2014

katz

“Providers across the country are experiencing a new “reality” in payment models where patients are presenting “Medicare PLUS” or “Cost PLUS” insurance cards, the latest tactic of self-funded, commercial employee benefit plans…….We’ve seen reimbursement levels range from 110% to 140% of Medicare….”

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Leana Wen – What Does It Take To Bring Transparency To Medicine?

Thursday, December 18th, 2014

Leana

Doctors in the U.S. don’t have to tell patients about conflicts of interest. When physician Leana Wen asked her fellow doctors to open up, the reaction she got was frightening.

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Eliminating Third Party Profit Stacking In Health Care

Wednesday, December 17th, 2014

hpc

“HPC has developed a “dream team” of highly experienced medical claim negotiators and nurses………Future products include buying or building a PBM for our clients and operating it at cost. The goal is to shift the profits from PBM’s to Payers and their clients in the same way that we are doing with Large Dollar Claims.”

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Gilead Faces Suit Over Hepatitis Drug’s Price

Wednesday, December 17th, 2014

solvaldi

Solvaldi costs $84,000 per course of treatment in the United States, but only $900 in Brazil. Why?

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Darwin Award Study Exposes Sex Differences In Risk Taking

Tuesday, December 16th, 2014

streesed

Sex differences in risk seeking behaviour, emergency hospital admissions, and mortality are well documented. However, little is known about sex differences in idiotic risk taking behaviour………..Idiotic risks are defined as senseless risks, where the apparent payoff is negligible or non-existent, and the outcome is often extremely negative and often final.

” It is conceivable that the sex difference is attributable to sociobehavioural differences in alcohol use. Anecdotal data support the hypothesis that alcohol makes men feel “bulletproof” after a few drinks….”

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Costs Are A Function Of What We Agree To Pay

Sunday, December 14th, 2014

J. Patrick Rooney is the Godfather of Cost Plus Insurance. Rooney acknowledged that hospitals may need to charge more than Medicare will pay, but contended that authoritative research showed that Medicare plus 25 percent is the reasonable amount for hospitals to charge.  J Patrick Rooney (1927 – 2008)

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H.H.C. Group Launches Cost Charge Ratio Reference Based Pricing Service

Sunday, December 14th, 2014

hhc

Like our Medicare Based Pricing Product, Cost Charge Ratio Based Pricing offers a number of advantages over pricing based on a percentage off billed charges alone. Both eliminate excess charges due to providers artificially inflating their prices for services delivered.”

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AMPS Acquires Claims Delegate Services

Sunday, December 14th, 2014

aaaaa

“Our clients are often speechless when we document what they are paying for hospital services after what they believe are the PPOs discounts…………………..On average we find payment levels of over 260% of Medicare and many times we find post PPO payments greater than 400% of Medicare………….”

AMPS is the leading and fastest growing  Cost Plus / Reference Based Pricing company in the United States. Quick to react to market demands  ( Xerox, Eastman Kodak And Cost Plus Insurance )  AMPS provides competitive pricing coupled with superior service.

“Companies must work constantly to eliminate any cost factor that does not add value to a business process” – Mike Dendy

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Local Government Strategies to Address Rising Health Care Costs

Thursday, December 11th, 2014
Summary:
Rising costs over the last decade have prompted many local governments to make changes to their health plans and strategies. Cost sharing, wellness program, and disease management initiatives are widely reported. Other changes cited include increased reliance on high-deductible plans, dependent eligibility audits, and altering retiree benefits.

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Another Point of View (To Preceding Post)

Wednesday, December 10th, 2014

I understand that you have very prestigious degrees and that this is a 5 year old post. However, this is why I felt compelled to comment. You should have known to prepare better, and this shouldn’t have been up for this long.

While you may have the “General Concept”, you clearly lack the requisite knowledge to understand the details behind MAC pricing, or any drug pricing logic for that matter.

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Don’t Get Caught By PBMs’ MAC Mousetraps

Wednesday, December 10th, 2014

big macFor most of the world, the letters MAC conjure up a Big Mac — the inviting super-sized hamburger that people love but enjoy at their peril.

But for health plans providing prescription drug coverage, the acronym represents an incomprehensible concept inserted into prescription coverage contracts by pharmaceutical benefit management companies (PBMs).

Unfortunately, unbeknownst to most health plans, this MAC is far more pernicious than any oversized hamburger. In fact, PBMs insert the MAC concept into contracts in three ways to relieve health plans of millions in savings that they would otherwise obtain from using generic drugs over branded drugs.

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Walgreens Tests Virtual Doctor Visits Through App

Tuesday, December 9th, 2014
virtual
Walgreen is testing a new telemedicine service that lets patients see a doctor without leaving home or visiting any of the drugstore chain’s clinics.

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Texas TPA’s Must File Annual FIN 486 Report

Monday, December 8th, 2014

tdi

Texas TPA’s are required to file an annual report to the Texas Department of Insurance to include current financial statement, total number of plans and employee lives along with biographical affidavits of officers and controlling shareholders. The FIN 486 Report includes Exhibits A-E.

DOL Audits To Ramp Up in 2015

Monday, December 8th, 2014

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3 Carriers Control Health Insurance Market

Saturday, December 6th, 2014

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Medical Malpractice Costs Declining

Friday, December 5th, 2014
belk  By David Belk, M.D.
The cost of medical malpractice has dropped dramatically in the US over the last decade and I now have all the numbers needed to prove it!

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Self-Funding Strategies, Tactics and Opportunities

Friday, December 5th, 2014
crap1
Seasoned self-funders and advisors new to the world of self-funding will learn how to engage employers in compelling conversations that are quite different from the typical renewal discussion. Learn why premiums are just “CRAP.”

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Sales – The Engine That Drives Economics

Friday, December 5th, 2014

mulebriarBy Molly Mulebriar

Sales is a profession. It entails a multitude of disciplines. Coping with continuous rejection and fear ensures the profession a steady procession of former salesmen. Those who overcome these weaknesses thrive. They are among the top earners in the country.

A successful salesman knows how to handle rejection. He has no fear of cold-calling. He is an expert observer and critical thinker. His powers of deduction are keen. He understands the importance of body language. He is patient and self-motivated. He listens. He has empathy. He is a problem solver.

When I asked a seasoned salesman in San Antonio to what he could contribute as to the basis of his success, he said “Molly, there are four principles, that if applied consistently, will lead anyone towards a successful sales career.”

1. Establish your right to be there

2. Establish the need common to most

3. Establish specific needs

4. Offer a solution

Pace Of Health Care Cost Increases Falls To A 54 Year Low

Thursday, December 4th, 2014

really

Pace of Health Care Cost Increases Falls to a 54-Year Low

“The share of the economy devoted to health care, which appeared to be growing inexorably for decades, has been the same since 2009…. Spending for health care in 2013 averaged $9,255 a person … Health spending grew at about the same pace as the economy and accounted for 17.4 percent of the gross domestic product, which reflects the total output of goods and services.” (The New York Times; subscription may be required)

 

Want A Free Trip To Sunny Costa Rica? Do Business With Borris!

Thursday, December 4th, 2014
By Mark Lisheron and Lynn Walsh
costarica
“I’ve Offered Free Costa Rica Trips To School Trustees Across Texas & There’s Nothing Wrong With It”

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Surgery Restriction Plan For Smokers & Obese Revealed

Thursday, December 4th, 2014

bureaucrat

A single payer “free” system of medical care often places a government bureaucrat in the doctor’s examining room with veto power over physician decisions.

“Smokers and the morbidly obese will be denied routine surgery unless they quit smoking or lose weight..…” – BBC News, 3 December 2014

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Texas Lawmakers To Tackle Healthcare Challenges

Wednesday, December 3rd, 2014

texas

Mike W. Thomas – San Antonio Business Journal

Texas lawmakers have been presented with a list of healthcare challenges that need to be addressed during the next legislative session that begins in January.

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Hell-Care

Tuesday, December 2nd, 2014

hellcare

“Hell-care, or healthcare, in the U.S. entails a grim future.”

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L&H Salesmen Are A Dying Breed

Tuesday, December 2nd, 2014

salesman2

It’s common knowledge in the insurance world that there is a serous demographic issue among producers. The average age of an agent or broker, according to industry statistics, is pushing 60 years old.

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