Archive for August, 2018

How RBP Plans Can Easily Contract With All Providers

Monday, August 20th, 2018
By Bill Rusteberg
Through an innovative plan design, Reference Based Pricing (RBP) plans seeking to contract with local providers can do so quite easily.  It’s turning lemons into lemonade and it’s called an APO (All Provider Organization).

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Is Low Bid Always The Best Bid?

Sunday, August 19th, 2018

The science of how to compete against “low bid” is a discipline learned by losing. Over time a seasoned salesman will learn how to beat the “low bid” and win more than he loses.(How To Win Against A Competitor’s Low-Ball Price Bid – Forbes)…………….In the article that follows the “high bidder” who lost to the “low bidder” is protesting. Is the $700,000,000 savings really true……………….? Common sense dictates otherwise.

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Dirtiest Industry Secrets Exposed By Retired Insurance Agent

Sunday, August 19th, 2018

This anonymous agent reveals the dirtiest secrets of his profession, and the rules for building your personal safety net

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Telemedicine + Teachers = A+ Combo?

Sunday, August 19th, 2018
Niche marketing is a smarter way to quicker sales………………….

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How Much Did You Pay For Your Banana?

Saturday, August 18th, 2018

Imagine a banana in a supermarket.  It costs $1 for those paying with Visa, $3 for those paying with MasterCard, and $32 for those paying with cash.  You can’t sign up for Visa until you’re 65, and you can only get a MasterCard if you have a nice employer or a decent income.  Worse, customers have no idea that such price discrepancy exists.  They don’t even know how much they’ll pay for the banana until long after they’ve eaten it…………………

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Friends With Benefits Episode #9

Friday, August 17th, 2018

Jeff Bernhard and David Contorno interview  William Rusteberg on Reference Based Pricing

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Connecting Consumers With High Performance Medical Care

Friday, August 17th, 2018

It’s a fact that a huge variation exists in surgical quality by hospital. A hospital that has great outcomes in one type of surgery (such as orthopedics) may have poor outcomes for other surgery types (such as cardiac surgery or women’s health). Based on this, BridgeHealth created a program that connects members with high performance surgical facilities for their specific surgery type.

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Competitive Health Named to the 2018 Inc. 5000 List

Friday, August 17th, 2018

August 15, 2018 by Alex Mulvenna

IRVINE, Calif–August 15, 2018–Competitive Health, Inc., a leader and innovator in network and ancillary product solutions (CHI), today announced that it has been named to the Inc. 5000 list.

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Quality Is Not A Constant In PPO Networks

Thursday, August 16th, 2018

There are quality providers and poor quality providers. Why would you choose the later?

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Beware of Health Care Consultants’ Partnerships

Wednesday, August 15th, 2018

This article exposes a common practice in our industry and should be read by every CEO. Brokers and consultants earning undisclosed commissions through recommendations they make happens all the time. I see it and expose it but CEO’s don’t. Try showing some of them the evidence and see the reaction. 

Recently I was tasked in reviewing a 2,500 employee school district in Texas. Disclosed compensation to the Agent of Record was $128,000. Actual compensation was $614,000 shared by two brokers one of which the district never met or knew. What did the district do? They fired the brokers and hired a local broker to earn the $614,000.  –  Bill Rusteberg

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Blue Cross Hit With Flurry of ERISA Lawsuits – Again

Monday, August 13th, 2018

When are plan sponsors going to wake up? Hidden fees driving up health care costs are more common than you would think. But its true. We could name dozens of lawsuits filed over recent years exposing practices that would make your toenails curl up. Here is one example:Weslaco ISD vs Aetna Yet many plan sponsors look the other way and continue to fund the conspiracy…………………….

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Cutting Out The Middle Man

Sunday, August 12th, 2018

Have you ever wondered why healthcare spending is so high? We did. So we decided to peel back all the layers in the system and really look at where all the money was going. We were surprised by what we found……………………..

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The Attack of The Rebates (COMMISSIONS)

Saturday, August 11th, 2018

Health and Human Services Secretary Alex Azar has said Americans “do not have a real market for prescription drugs” because drug middlemen and insurers get a wide range of hidden rebates (COMMISSIONS) from drugmakers, but those savings may not be passed on to consumers or Medicare.

Editor’s Note: Lets not pretend any more. “Rebates” are simply “Commissions” paid to third party intermediaries to push drugs. Dressing up the English language like calling welfare “subsidies” and crippled “handicapped”, and queer “gay” may give a softer touch, but is it really necessary? The meaning is the same isn’t it?

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Defending The ACA Versus Enforcing The ACA In Texas v. United States

Thursday, August 9th, 2018

A potential upcoming preliminary injunction could block enforcement of the entire ACA or, alternatively, of the individual mandate, guaranteed issue, community rating, and preexisting condition exclusion ban provisions of the ACA………………….

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Are Employers Ready to Shake Up Health Care?

Thursday, August 9th, 2018

Frustration with the US health care system is mounting. There’s a disconnect between what we spend and what we get in terms of high-quality outcomes and a good patient experience. Employers have the power to change that………………………….

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Schuessler Highlighted in Employee Benefit Adviser

Wednesday, August 8th, 2018

Employee Benefit Adviser has just published an article this week listing the top social media users among insurance advisers across the United States. The usual suspects were listed, like Carl Schuessler the famed inventor of the ever so popular Schuessler Stick……………………………….

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Whistleblower Will Receive $17.2 Million From Overbilling Case

Monday, August 6th, 2018

A San Diego whistleblower will receive $17.2 million with the settlement of a 7-year-old false claims lawsuit against Prime Health Care regarding overbilling for Medicare services at 14 California hospitals.

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Guess Who Will Pay For Prime Healthcare Settlement?

Monday, August 6th, 2018

Passing along losses to consumers is one pen stroke away……………Will Prime Healthcare renegotiate their managed care contracts?

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David “Nostradamus” Contorno Reveals Amazing Prediction

Sunday, August 5th, 2018

David “Nosradamos” Contorno

I’ve hesitated to predict this publicly…but I am ready to now…………………….(Drum roll please)

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Specializing in Specialty Drugs: A New Middleman Steps In

Sunday, August 5th, 2018

Companies that negotiate for better prices on specialty drugs without the incentive of discounts and rebates…………………………..

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Trump Administration Exploring Idea of Importation of Drugs

Saturday, August 4th, 2018

It came as something of a surprise when Health and Human Services Secretary Alex Azar announced that the administration was exploring the importation of prescription drugs to fight high domestic prices……………………

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CEO Finally Realizes Health Care Was His Problem

Friday, August 3rd, 2018

“If you employ a workforce and offer benefits, your business IS a healthcare business” – Jim Immelt

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San Antonio Firm Saves on Specialty Drugs

Friday, August 3rd, 2018

San Antonio firm provides alternative source for specialty drugs with significant savings………

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Rx – Where Does All The Money Go?

Thursday, August 2nd, 2018

“[In] 2016, total US expenditures on pharmaceutical drugs, including the gross profits of all the intermediaries, were $480 billion … Two-thirds of this total ($323 billion) was captured by drug manufacturers in the form of net revenues. The remaining third ($157 billion) was retained as gross profits in the supply chain.

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TRS ActiveCare Announces Benefit Changes, Rate Increase 2018-2019

Thursday, August 2nd, 2018

The TRS Board of Trustees has adopted medical and pharmacy benefit changes to reduce a projected premium increase to 5.7 percent, instead of 7.2 percent. The main benefit changes were to add new freestanding emergency room (ER) copays and adjust specialist copays, deductibles and maximum out-of-pocket amounts.

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Two-Sided Transactions – How Will Supreme Court Decision Affect PPO’s?

Wednesday, August 1st, 2018

On June 25, the US Supreme Court issued a 5–4 opinion in a case that may have significant implications for health care……………….The case of the two-sided transaction………………

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Association Health Plan Regulation Face Challenges

Wednesday, August 1st, 2018

“The DOL acknowledged that AHPs will be MEWAs and that states will retain their existing authority related to MEWA regulation and enforcement….

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Trump Delivers On Promise of More Affordable Health Insurance Options

Wednesday, August 1st, 2018

Article Referred By Dan Meyland – Allied National

HHS announcement below – 12 month STM Contracts renewable for 36 months (details below)

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