Archive for April, 2018

Traditional Reference Based Pricing Strategies Don’t Work In Las Vegas

Sunday, April 22nd, 2018

Maybe we should be using Medicare – 20% from now on……………..?

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Brokerage Firm Touts RBP Certification

Sunday, April 22nd, 2018

An east coast insurance brokerage has announced they are now “certified” to market reference based pricing strategies. We find this curious. How does one get “certified?” So we decided to memorialize the process here.

In response to the apparent and curious need to become certified in order to offer clients reference based pricing strategies, RiskManagers.us has developed a simple certification process free to anyone who wants to try it. Simply look in the mirror and chant three times “I desire to become a certified reference based pricing mogul.” Then write this blog certifying your desire to be certified and we will send you your official Reference Based Pricing Certification Certificate at no charge.

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Simple Hospital Agreement

Saturday, April 21st, 2018

RiskManagers.us has facilitated direct provider agreements directly between self-funded employee health & welfare plans for years. It doesn’t take a rocket scientist to do this. It’s all about common sense, traditional American business practices (as opposed to traditional managed care practices), based upon fair value for both parties.

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Again?

Friday, April 20th, 2018

There have been numerous lawsuits filed over the years exposing industry secrets that drive costs up for unwitting consumers. Here is another one that just cropped up……………………

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Rural Broker Contains Costs Through Hospital Partnerships

Friday, April 20th, 2018

Beth Johnson

Some people assume that because Beth Johnson’s brokerage is located in rural Missouri she is at a disadvantage when it comes to designing innovative benefit packages for her clients. They would be mistaken……………………

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Tell Us Your Outrageous Health Care Stories

Friday, April 20th, 2018
 Brian Klepper
Benefit brokers get paid more for doing a bad job. They can get rewards for driving up spending such as trips or other undisclosed compensation………………………

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New Idea For Reducing Health Care Costs Is Actually Really Old

Friday, April 20th, 2018

We have a health care delivery system where the price of health care is unrelated to the cost of providing it, or outcomes, but rather to the relative power of hospitals, third party intermediaries and medical groups to which unwitting consumers gift wealth using other people’s money facilitated through secretive managed care contracts you can see nor audit……………………

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Wednesday, April 18th, 2018

The Cost of Convenience

ppoo

“More employers are seeing the value of adding a little bit of inconvenience to their health plans these days.

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RiskManagers Partners With Prescription Care Management to Reduce Members Prescription Drug Spend

Wednesday, April 18th, 2018

April 17, 2018

YOAKUM, Texas, April 17, 2018 /PRNewswire/ — RiskManagers.us is proud to announce it has entered an agreement with Prescription Care Management (PCM) for members of the RISKMANAGERS HealthCare Purchasing Coalition.

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Texas Insurance Broker Gets Prison Time For Bribery

Wednesday, April 18th, 2018

An insurance broker who admitted paying bribes to land lucrative health insurance contracts at area school districts and the now-defunct water utility was sentenced Wednesday to 37 months in federal prison…………………..

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A David Contorno True Life RBP Experience

Saturday, April 14th, 2018

Moved a large client (1100 employees) to Reference Based Pricing 4/1. As I expected, we had some employees who went to providers with the PPO logo removed and some said they don’t take the plan.

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“Hospitals Are Only Entitled To Collect A Reasonable Fee”

Friday, April 13th, 2018

He contended that authoritative research showed that Medicare plus 25 percent was a reasonable amount for hospitals to charge………………….

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Texas Lawmaker Calls on State to Fix Teacher Retirement System Care

Friday, April 13th, 2018

“Teachers statewide are sharing their stories with us, hellish stories about people having to choose between medication and food, medication and rent, medication and just basic living necessities…….” 

RISKMANAGERS.US: Instead of throwing good money after bad, cost shifting to consumers, all contributing to the erosion of the American middle class, Texas should lead the country in solving health care. Reference Based Pricing, direct contracting, point of sale claim adjudication/payment, cost plus Rx payment methodologies and other risk management strategies have proven successful for Texas employers  like San Patricio County in South Texas. (Beating Medical Trend – Managed Care vs Reference Based Pricing and Health Care Strategies for Political Subdivisions.)

As a Texan I am sad to admit the little tiny state of Montana took the lead two years ago and now we hear the bright red Republic of California may be doing the same with California Assembly Bill 3087. (California Assembly Bill 3087 Would Control Prices in the Commercial Market.) When will Texas legislators wake up? Has Texas Lost It’s Cajones?.

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Historic Healthcare Ruling In Blue Cross Blue Shield Antitrust Litigation

Thursday, April 12th, 2018

“Our case alleges that, for decades, the Blue Cross Blue Shield system has operated as an illegal association of competitors trying to suppress competition in order to inflate their ownprofits at the expense of their customers,” said Hausfeld Chairman and Co-Lead Counsel Michael D. Hausfeld.

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American (Cold) Civil War Expands – Blue States Fight Texas

Thursday, April 12th, 2018

Democratic Attorneys General Fight Texas Over Obamacare Lawsuit

April 9, 2018 at

SACRAMENTO (AP) — Sixteen Democratic attorneys general pushed back Monday against a Texas lawsuit aimed at striking down former President Barack Obama’s health care overhaul.

California Attorney General Xavier Becerra led 14 other states and the District of Columbia in filing a motion to intervene in the Texas case and defend the law, suggesting the Trump administration wouldn’t take such action.

“We’re taking this action to protect the health and financial security of millions of people in our country, as well as billions of dollars of federal funds that go to our states to make sure that we can afford the health care that our families need,” Becerra said at a news conference.

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3 Reasons Why Health Insurers and PBMs Are Merging

Thursday, April 12th, 2018

“Transparency inevitably reduces margins as clients, in turn, demand a better deal as well.”

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California Assembly Bill 3087 Would Control Prices in the Commercial Market

Wednesday, April 11th, 2018

An ambitious California bill would put the state in charge of controlling prices in the commercial healthcare market…………………………

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Oklahoma Squashes Hospital Pricing Transparency

Wednesday, April 11th, 2018

Medical cost transparency bill dies in Oklahoma House with little support……………

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Hilarious Auto Response

Wednesday, April 11th, 2018

This blog sends out posts of interest from time to time to a select group of like minded health care revolutionaries. Today one of our three members responded via Auto Response:

I’m on vacation returning in the second half of April. If it is an urgent matter, please re-send your email with URGENT in the subject line. I’ll be on the lookout for those. Or you can send email to XXXXXX If it’s really urgent, you call also call/text my cell phone.

Or if you prefer, choose from one of my alternative out-of-office messages below

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Primary Care Clinics On Road To Extinction?

Wednesday, April 11th, 2018

Primary care physicians saw office visits fall 18 percent from 2012 to 2016…………….

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Pharmacy Associations Urge Congress For Hearings on PBMs

Tuesday, April 10th, 2018

“Pharmacists have long been concerned with pharmacy benefit managers operating as largely unregulated middlemen in the drug supply chain………………..”

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Blue Cross Antitrust Suit Moves Forward

Tuesday, April 10th, 2018

Blue Cross Blue Shield could be in trouble following a federal court ruling that an antitrust case against the insurer can proceed……………..

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Region One Education Service Center Awards TPA Contract

Tuesday, April 10th, 2018

The Region One ESC Board of Directors has awarded third party administration services to Frates Benefit Administrators…………………………….

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MedZERO Launches Partnership with Asserta Health

Monday, April 9th, 2018

The partnership will enable Asserta Health’s customers–self-insured companies and their employees–to benefit from the significant discounts associated with upfront cash payments………….. 

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Texas School District RFP Seeks Honey Pot Administrative Services

Sunday, April 8th, 2018

 

 

The district’s self-funded health plan is a multi-million dollar honey pot, attracting the worst of the worse in innovative brokerage tactics that make one’s hair stand up……………….

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Lockton Acquires Benefits Administration and Enrollment Firm

Saturday, April 7th, 2018

The acquisition will allow Lockton to expand its benefits administration, enrollment and employee education services and tools for clients of all sizes and demographics………..

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Saturday, April 7th, 2018

Friday, April 6th, 2018

RiskManagers HealthCare Purchasing Coalition 2018

RiskManagers HealthCare Purchasing Coalition ™ is a high performance health care Management Services Organization founded on a simple proposition: Health care cost can be reduced while maintaining or even improving benefits at the same time.

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TPA Did Not Breach Fiduciary Duty Court Rules

Friday, April 6th, 2018

No Breach of Fiduciary Duty for Health Plan TPA That Overpaid Claims for Participant Eligible for ESRD-Based Medicare

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Schuessler Rocks!

Friday, April 6th, 2018

Historically, Employers and their “Brokers” have focused on the wrong 20% of the healthcare dollar (Fixed Costs)……………………

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Will Hospital Continue To Honor RBP Safe Harbor Provider Agreements?

Friday, April 6th, 2018

St. David’s HealthCare acquires The Austin Diagnostic Clinic………….

RISKMANAGERS.US OPINION: Austin, Texas is basically a two hospital town. Both hospital systems have tried their best to discourage local employers from implementing Reference Based Pricing plans in recent years. After all why agree to earn less when secretive managed care contracts continue to pay top dollar? Other area providers such as Austin Diagnostic Clinic are known to have entered into direct agreements with Reference Based Pricing plans in the area at rates slightly above Medicare. Will St. Davids continue to honor these agreements?

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Restaurant Association Launches Association Health Plan

Thursday, April 5th, 2018

The National Restaurant Association’s new Restaurant & Hospitality Association Benefit Trust, designed for restaurants and hospitality businesses with fewer than 100 employees, comes at a time when association health plans are a major topic of debate in Washington.

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Do Corporate Dental Chains Screw Indigent Patients?

Thursday, April 5th, 2018

Corporate dental chains see big profits in adults who can’t afford care…………….

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Teachers Are Pissed

Tuesday, April 3rd, 2018

Kentucky and Oklahoma teachers flood state capitals — and refuse to back down until their demands for pay raises are met. What little do they know is the biggest pay raise they could achieve is smarter management of their health insurance plans…………………………The savings would be immediate, paychecks would increase and benefits would be improved at the same time. It’s found money for the states……………

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Walmart-Humana – Next Disruptor in Health Care?

Monday, April 2nd, 2018

It has been a busy few months tracking all the merger/acquisition/partnership announcements in the health care market…………………………

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Direct Primary Care Legislation Rolls Across the Country

Monday, April 2nd, 2018

Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee……………………

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PPO Escalator Clause Directly Attributable to Medical Trend Factor

Monday, April 2nd, 2018

Employer-sponsored medical plan costs expected to rise 8.4 percent…………..Cost of health care is essentially static but the cost of health insurance is not thanks to escalator clauses (Escalator Clauses, Rising Prices, And Why We Should Care) found in all managed care contracts guaranteeing pay raises  every year for most medical caregivers…………..

Why on earth do plan sponsors continue to rely on managed care contracts they cannot see nor audit yet continue to complain about rising health insurance costs? Their answer –  Blame consumers, cost shift to plan members and continue to use PPO networks………………..

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Well Managed Health Plans Outperform Status Quo Plans

Monday, April 2nd, 2018

Best performers stand out from their high-cost peers in the rate at which they adopt new means of delivering health care………………..

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Blue Cross Files Bankruptcy

Sunday, April 1st, 2018

Shock report from BCBS national headquarters……………………..Mass suicide watch  – 45 BCBS sales representitives feared dead…………….National Guard called to active duty…………..Trump expected to address nation tomorrow………………..

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