Archive for December, 2015

Tough Talk With Hospitals Ends In Missing Person Report

Thursday, December 31st, 2015

mulebriar

By Molly Mulebriar

Recently I was asked to assist a speaker in preparing for a talk to be given to an audience of hospital administrators at their annual convention. The topic was “Why You Should Be Prepared For Direct Contracting with Local Employers.” So I wrote the following advice:

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What Will Be The Uber of Insurance?

Thursday, December 31st, 2015

friendsuranceInsurance is ripe for disruption, and here are seven candidates that could revolutionize the industry much as Uber is upending travel.

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Large Political Subdivision Fails To Determine Best PPO Discounts

Wednesday, December 30th, 2015

mulebriar

Could this be a gifting of public funds with no basis upon which to determine best value?

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Continental Benefits – Stepping Outside The Box

Tuesday, December 29th, 2015

boxContinental Benefits has brought some of the brightest and most entrepreneurial minds in healthcare together with a focus on not just stepping outside of the box, but tearing it down and building something entirely different.

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Plan Trustees Sue TPA for Breach of Fiduciary Duties

Tuesday, December 29th, 2015

shocked

The plan conducted a claims audit in 2004 and found that Great-West had paid almost $1 million in out-of-network claims in full as billed, rather than as a percentage of the usual, customary and reasonable charge.

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Telemedicine Gaining Acceptance Among Patients, Insurers

Monday, December 28th, 2015

penskyPenske Truck Leasing is working with Aetna and Teladoc to offer virtual services to its 18,000 employees, 20 percent of whom have taken advantage, according to the company’s vice president of benefits and compensation, Joe O’Neill.

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Some U.S. Hospitals Mark Up Costs By 1,000%

Monday, December 28th, 2015

life

“There is no justification for these outrageous rates,” says Prof. Anderson, “but no one tells hospitals they can’t charge them. For the most part, there is no regulation of hospital rates and there are no market forces that force hospitals to lower their rates.”

Editor’s Note: “Market forces” and “Regulation of Hospital Rates” are not synonymous.

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Single-Payer Health Care On Colorado Ballot In 2016

Monday, December 28th, 2015

free1

Free Health Care For All 

To finance the project, Colorado employers would pay nearly 7 percent in a payroll tax. Employees would pay 3 percent or more of their gross pay toward the health plan. The self-employed would need to pony up 10 percent of their annual net income…..

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Allied National’s Provider Freedom Plan

Sunday, December 27th, 2015

alliednationbalAllied’s unique Provider Freedom plan option  allows you to choose any health care provider without restrictions or penalties. There are no preferred providers or networks required.

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A Conflict of Interest For Doctors

Sunday, December 27th, 2015

belk David Belk

Greetings, I hope everyone is enjoying this holiday season.

About three weeks ago I was interviewed for a show called Mind the Business where I discussed three stories that had been in the news recently about fraud and conflicts of interest in healthcare.

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Democrats Bash Health Insurance Companies

Tuesday, December 22nd, 2015

confused“The insurance companies, the drug companies, are bribing the United States Congress”

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Audit Claims? What A Novel Idea!

Tuesday, December 22nd, 2015

snooZe

If hospitals defraud Medicare, could they also defraud private pay health plans too? Most plan sponsors don’t audit their health care claims either because they never have “so why start now?”, or they are prohibited from doing so through contracts of adhesion i.e, managed care contracts. 

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Arlington Healthcare Group

Tuesday, December 22nd, 2015

arlingtonAs former healthcare executives ourselves, we understand the challenges leadership faces to be successful in this fast-paced industry.

We use our industry expertise to help you develop and execute strategic plans that evolve your business.

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Most Shared Blog Entry for 2015

Monday, December 21st, 2015

linkedinThe most shared article on this blog for 2015 – Lawsuit Exposes Insurance Industry’s Best Kept Secret

Saturday, December 19th, 2015

logo

RiskManagers.us is a specialty company in the benefits market that, while not an insurance company, works directly with health entities, medical providers, and businesses to identify and develop cost effective benefits packages, emphasizing transparency and fairness in direct reimbursement compensation methods.

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A Picture Is Worth 1,000 Words

Saturday, December 19th, 2015

DMN-hospital-graph-w-mpirica-quality-scores

(Click on Picture To Enlarge)

You may know a hospital by its general reputation, but is it really the best place to go for the specific type of surgery you need? And is it true you “get what you pay for” in health care? Do higher prices mean higher quality? 

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Mulebriar Announces 2015 Award for Comment Excellence

Thursday, December 17th, 2015

fox

Risk Manager:  “Excuse me Mr. Fox, there are some hens missing”.  “Can you  check the security cameras to see what happened?”

BCBS:  “Sorry, the images on those cameras are proprietary”.  “But here is a letter stating we didn’t steal any hens.”

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CEO Reviled for Drug Price Gouging Arrested

Thursday, December 17th, 2015

martin

Martin Shkreli, the boyish drug company entrepreneur, who rocketed to infamy by jacking up the price of a life-saving pill from $13.50 to $750, was arrested by federal agents at his Manhattan home early Thursday morning on securities fraud related to a firm he founded.

Shkreli’s extraordinary history—and current hold on the public imagination—makes the case more noteworthy than most involving securities fraud. The son of immigrants from Albania and Croatia who worked as janitors and raised him deep in working-class Brooklyn, Shkreli both epitomizes the American dream and sullies it.

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Cadillac Tax Delayed 2 Years

Wednesday, December 16th, 2015

cad

In the early hours of December 16, 2015, Congressional negotiators reached………….

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America’s Painkiller Epidemic Grips The Workplace

Wednesday, December 16th, 2015

zombie

New study claims that as much as 80 percent of employers face prescription drug abuse by workers.

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An Unprecedented Look At Medical Costs Nationwide

Tuesday, December 15th, 2015

​Researchers have compiled data on $682 billion worth of claims to look at the truth behind medical costs.

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Thief Steals Hospital Laptop, Government Punishes Hospital

Tuesday, December 15th, 2015

thief

The laptop computer was taken from an unlocked treatment room “off of the inner corridor” in the hospital’s radiology department………….

Government punishes hospital with $850,000 fine……….

Hospital passes on the cost to consumers….……..

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Have You Done Your Risk Assessment, Doc?

Tuesday, December 15th, 2015

darrell

The fines for not having prepared a risk assessment will always be more expensive than quietly surrendering to extortion.

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Contraceptive Mandate – Second Guessing Religious Beliefs

Tuesday, December 15th, 2015

pope1

Symposium: Contraceptive mandate cases – why the Supreme Court will instruct lower federal courts to stop second-guessing religious beliefs : SCOTUSblog

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Employer Health Plans Pay Disproportionate Share of Prescription Drug Costs

Tuesday, December 15th, 2015

drugwsj

By Drew Altman

Kaiser Family Foundation analysis of data from the Centers for Medicare and Medicaid Services and Truven Health Analytics showing that drugs account for 10% of U.S. health spending but 19% of employer insurance benefits.

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Why Health Insurance Is Now A Far Bigger Nightmare Than It Ever Was

Tuesday, December 15th, 2015

goodolddays

In the good old days health insurance was an irritant but not a nightmare. If you had high premiums, you had low deductibles.  And if you had high deductibles, you had low premiums.   Now we have high premiums and high deductibles.

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Ten Benefit Strategies

Tuesday, December 15th, 2015

This abbreviated video summarizes ten benefits strategy in three minutes:

https://www.youtube.com/watch?v=rMXukAf_4ok&feature=youtu.be

Insurers Forces To Compete Harder For Self-Insured Business

Monday, December 14th, 2015

selfunding More than 3 in 5 U.S. companies are self-insured, and self-insurance is almost universal among large employers……Roughly 60% of members at Aetna, Anthem and Cigna are in ASO plans

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McAllen ISD Enters Into Direct Contracts in Addition To BCBS Network

Sunday, December 13th, 2015

wow

By Bill Rusteberg

The McAllen Independent School District’s (MISD) self-funded health plan is administered by Blue Cross & Blue Shield (BCBS). BCBS traditionally utilizes their own proprietary managed care network and typically requires their network access exclusively as part of their bundled ASO services.

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The Future of PPOs and Provider Contracting

Sunday, December 13th, 2015
cant`
Every day we receive email blasts and newsletters with headlines discussing revenue based contracting, High Value and Narrow Networks and the future of PPOs. There are those that suggest that the PPO is a dying entity, to be replaced with a referenced based solution for paying Providers, while others see the value in a PPO network offering, but struggle with how to improve the impact on the Health Plan’s medical spend.

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Would You Like Fries With That?

Saturday, December 12th, 2015

 

What happens when you take a complex product, say like health insurance, that is tendered via a legal and binding contract drafted by lawyers and allow the public to decide what is good coverage?

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Islamic Insurance for Infidels

Saturday, December 12th, 2015

islma

Enthusiastic Islamic Insurance Brokers Tout Infidel Insurance Coverage

Takaful, or Islamic insurance, is a cooperative scheme, where in which the participants pay a premium in the form of donation or tabarru in a common pool in return for the ability to draw upon that pool upon a valid claim.

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McAllen ISD Seeks Insurance Consultant

Friday, December 11th, 2015

ATTENTION BIDDER

McAllen Independent School District is accepting submittals on the following item: (more…)

City Draws Fire Over Health Plan

Friday, December 11th, 2015

lincoln

“The hospital was forced to file suit against 10 individual patients. In the end, the insurance companies payed the requested amount, the individuals paid their out-of-pocket expenses and eventually the repricing company stopped the practice.”

Editor’s Note: This article does not tell the whole story and may be misleading. We called the city for more information and found this to be an interesting case study; City of Richmond eschews managed care contracts and instead implements a reference based pricing model for their self-funded health plan in a local one hospital town. Hospital pushes back hard, city stands firm and to this day continues to pay medical caregivers through their reference based pricing model. This is more evidence that Cost Plus / Reference Based Pricing will work only as long as the Plan Sponsor is “all in” and willing to take a stand.

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Cities Unite To Negotiate Lower Health Care Costs

Tuesday, December 8th, 2015

different

“Fed up with soaring costs, Dallas and 30 other North Texas municipalities are asking hospitals to submit bids indexed to federally controlled Medicare prices to cover the cost of care for city employees”

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Reference Based Pricing In Action

Tuesday, December 8th, 2015

mulebriar

“This illustrates how PPOs have failed to control Hospital Claims Costs for plan sponsors, and how this model is your best resource in preserving your client base and employer sponsored health plans.”

– Magellan Risk Management

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Health Insurance Broker’s Commissions Continue Decline

Sunday, December 6th, 2015

 oacar“Oscar isn’t the only insurer to slash brokers’ commissions. UnitedHealthcare cut them to $10 per contract per month from $15…”

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Will ObamaCare Save PPO Networks From Doom?

Friday, December 4th, 2015

lifeguard

Will the government step in, reverse market trends, and save PPO networks from extinction? 

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Hillarycare Tried to Put Everyone in an HMO, Obamacare Is Succeeding

Friday, December 4th, 2015

hillarykissing

Those of us who fought co-Presidents Bill and Hillary Clinton’s 1993-4 attempt to put every American in an HMO thought we had won that battle. We were wrong. President Obama is achieving their goal with Obamacare.

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Investigation Reveals Solvadi Drug Pricing Strategy

Thursday, December 3rd, 2015

solviadi18-Month Investigation Reveals a Pricing and Marketing Strategy Designed to Maximize Revenue with Little Concern for Access or Affordability

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Unaffordabe Affordable Care Saves Employers Big Bucks

Thursday, December 3rd, 2015

Andy Puzder, CEO of Carl’s Jr. and Hardee’s parent CKE Restaurants, says that just 420 of 5,453 full-time workers offered a $5,500-deductible plan were willing to pay the $1,116 premium. The New York Times reports that insurance take-up by fewer than 10% of low-wage workers is commonplace.

Wendy’s (NASDAQ:WEN) initially expected its health insurance tab to jump by $25,000 per restaurant, but cut that to $5,000 after finding few interested employees.

Government Rules Against Helping Sick Pets

Tuesday, December 1st, 2015

sickpuppySupreme Court lets stand Texas law limiting online advice from veterinarians about sick pets

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UHC Regrets Entering ObamaCare Market Place

Tuesday, December 1st, 2015

Private Health Insurance 1973 vs 2014

Tuesday, December 1st, 2015

ribpley

In 1973,  75% of all Americans were covered by private health insurance (https://www.ssa.gov/policy/docs/ssb/v38n2/v38n2p21.pdf)

In 2014, 41 years later,  private insurance covered 70.4% of all Americans. (https://www.ssa.gov/policy/docs/ssb/v38n2/v38n2p21.pdf)

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Male Lives Matter

Tuesday, December 1st, 2015
male
A year-and-a-half ago, we noted the shameful discrepancy in the kinds of “first dollar” care offered women and children……………

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Sudden Collapse of Health Co-Op in N.Y. Leaves Doctors Owed Millions

Tuesday, December 1st, 2015

healthrepublic

Health Republic Insurance of New York was one of 23 nonprofit health cooperatives created nationwide by the Affordable Care Act and was, by far, the largest of those to fail.

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