Archive for September, 2017

Amazon In Talks With PBMs

Thursday, September 21st, 2017

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

(more…)

The Big Heist

Thursday, September 21st, 2017

(more…)

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………..

(more…)

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………………..

(more…)

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………………..

(more…)

“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.

(more…)

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………….

(more…)

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?

(more…)

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

(more…)

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……………………

(more…)

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………………………

(more…)

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…………………

(more…)

Does Your Plan Do This?

Friday, September 15th, 2017

Medical Bill Review

(more…)

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?

(more…)

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……

(more…)

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…..

(more…)

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…………..

(more…)

Investing In The Cartel Can Be Lucrative

Thursday, September 14th, 2017

The Cartel is at it again…..

(more…)

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…………………….

(more…)

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…………

(more…)

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………………….. 

(more…)

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.

(more…)

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………………

(more…)

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.

(more…)

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………………….

(more…)

CEO’s Guide To Restoring The American Dream

Sunday, September 10th, 2017

JUST RELEASED: A must read book by Dave Chase

(more…)

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.”

(more…)

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…………

(more…)

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

(more…)

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………

(more…)

Insurance Consultant Sentencing Postponed…..Again

Monday, September 4th, 2017

Will Haff

Was $83,532.79 worth it?……………………………

(more…)

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……….

(more…)

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.”

(more…)

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.

(more…)

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.

(more…)

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.

(more…)

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.

(more…)

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!

(more…)

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

(more…)