News Reporters Obtain Sensitive, Closely Held Health Care Industry Secrets

UHC Sales Rep. Reacting To News

FOX 8 has obtained a document – among the most sensitive in the healthcare industry……….A local provider sent us a spreadsheet that shows his businesses’ negotiated rates with three insurance companies, Blue Cross Blue Shield, United Healthcare and Humana………………

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Starmark Embarks On Reference Based Pricing Strategies For Small Groups

Designed specifically to address rising healthcare costs for employers with 5 to 99 employees, Healthy Choices plan designs generally calculate reimbursement amounts for healthcare services using reference-based pricing. This approach results in a reasonable fee, which is a multiple of Medicare’s reimbursement rate…………….

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Richard Sutton

I’m very fortunate to be able to collaborate with a group of true reformers from around the country.  We’re committed to transforming our current system of inefficiencies into an efficient system where primary care is empowered, quality and outcomes are measured, and the price tag for services is greatly reduced – Richard Sutton

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America’s Healthcare Secret Pricing Scandal Exposed

Insurance companies create vast networks, referred to as PPOs (Preferred Provider Organizations). The only thing that is preferred is the deal the insurance company cuts itself. About a full one third of the total medical spend by an employer can be eliminated by removing in-network pricing variation for commodity care alone. 

Employers need to realize that when they pay for PPO access, they are paying to access a network designed to maximize the insurance company’s revenue – not to save the employer money on medical care. 

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TPA Loses Lawsuit Against Private Citizen

Murry B. Cohen, Appellate Lawyer 

Gloria Hicks, v. Group & Pension Administrators, Inc., 13–14–00607–CV, (Tex. App. 2015). Reversing District Court and holding that a citizen’s email to school board trustees urging the board not to contract with plaintiff concerned a matter of public importance, was not commercial speech, and defendant was protected from suit by the Texas Anti-SLAPP statute.

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Lily Livered Republicans Cower in Trenches While Democrats Rule Congress

Republicans are going to fund Obamacare subsidies that the Democrats forgot to fund?

It will be voter payback time in 2018 – Lily Livered, Yellow Bellied Cowering Republican elites will be targeted for punishment……….Too many lies for too many years will impact the 2018 mid term elections. 

The Democrats are smart. They have learned “Never interfere when your opponent is committing suicide”

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Mike Dendy – Innovator & Market Leader

Mike Dendy, MBA/MHA, vice chairman & CEO, Advanced Medical Pricing Solutions (AMPS) is certainly a market leader and really “gets it”…………..…..Laura Carabello

In 2013 I wrote “Xerox, Eastman Kodak And Cost Plus Insurance” which predicted the inevitable rise of the Mike Dendy’s of the world.(See article at end of this blog entry).

In the article I wrote: “The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide……………..pioneering, successful business endeavors that fail to react quickly and appropriately to market threats end up losing market dominance……………….”

And then, as predicted, (a) Mike Dendy gobsmacked the market with a set of fresh eyes. His company, AMPS, has since become the national leader in Reference Based Pricing strategies, experiencing phenomenal market growth.

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

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UNITED STATES OF AMERICA and THE STATE OF NORTH CAROLINA, Plaintiffs, v. THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY d/b/a CAROLINAS HEALTHCARE SYSTEM, Defendant.

This case involves the relationship between hospital system and insurance company, and how that relationship affects everyday patients and consumers……..

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MD Anderson Continues To Downsize – Victim of Narrow Networks?

Last August, the center reported a 77 percent drop in its adjusted income over a 10-month span, then recorded an operating loss of more than $111 million for September through November 2016. In response, MD Anderson shared plans to eliminate roughly 1,000 jobs from its 20,000 and it also called of its collaboration with IBM Watson, which was projected to cost more than $62 million.

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MDLIVE

Founded in 2009, MDLIVE is a leading telehealth provider of online and on-demand healthcare delivery services and software that benefit patients, hospitals, employers, payers, physician practice groups and accountable care organizations.

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