Scientist Proves Employee Benefit Meetings Are A Waste of Time

April 13th, 2019

The Ebbinghaus Study is widely accepted as a definitive study in human intelligence. The study concluded that within 24 hours we will forget 75% and within 30 days we will forget 90%. The remaining 10% will remember only 5%.

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Why Do Some Fiduciary Violations Go Unpunished While Others Result in Jail

April 12th, 2019

“People are going to jail over ERISA fiduciary violations and the dollar amounts pale in comparison to what is being wasted on the employee health plan side of ERISA.”

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Is Medicare Supplemental Insurance Worth It?

April 12th, 2019

Dr. Dave opines again on Medicare supplemental insurance policies…………….

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RBP Market Growth Continues – Blue Cross Adopts No Network Model

April 11th, 2019

 

The North Carolina Blue Cross Blue Shield “My Choice” policies aim to change the way doctors and hospitals are paid by limiting reimbursement for services to 40% above what Medicare would pay. The plan has no network of doctors and hospitals…………………

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Hospital Insults Plan Sponsor – Wants 1,947% of Medicare

April 9th, 2019

Hospital demands almost 2,000% of Medicare to settle claim………………….

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Health Insurance Bankrupting Americans – Personal Debt Reaches New Highs

April 8th, 2019

A new survey from Gallup shows that Americans borrowed a staggering $88 billion in 2018 to pay for health-care costs that were not covered by their insurance plans………..….

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Cancer Cure?

April 8th, 2019

Activated immune cells travel throughout the body, killing tumors wherever they find them…………….

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Surprise Medical Bills – Two Texas Physicians Respond

April 8th, 2019

“Conditions and diseases of healthcare systems which are relevant to this discussion include: incentive malalignment syndrome, hypermetricosis, benefit managementosis, maladaptive dysdocumentosis and more.” – Texas Physician

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3 Ways Employees Can Reduce Prescription Costs

April 8th, 2019

Senator Cruz Proposes 4th Method To Reduce Drug Costs?

In an unprecedented move, Tx. Senator Ted Cruz introduces Senate Bill to free the worlds most successful drug importer. “Chapo has proven cheap and effective drug importation is possible! With his direct-to-source plus vast American distribution system, El Chapo, his organization has the where with all to help solve our broken health care delivery system. FREE CHAPO!

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InstaMed

April 7th, 2019
Creating electronic movement of healthcare data and money faster than a melting Raspa …………..

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Doctors Practices Leaving Charlotte Hospitals Catch The Eye Of Their Industry

April 7th, 2019

By Alex Olgin  Mar 25, 2019

For the more than 40 doctors at Lakeside Family Physicians and Huntersville OB/GYN, the move away from Novant Health is a return to how they used to practice medicine. Both groups were independent before joining with Novant about 15 years ago.

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Employers Get Choosier About Workers’ Doctors

April 6th, 2019

Many big companies are mining data from their own health plans and public records and working with consultants to compare physicians, searching for those with the best results and competitive costs.

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A Million Views in 44 Days! ClearHealthCosts Price Transparency TED Talk Goes Viral

April 6th, 2019

Jeanne Pinder scores big with TED talk…………………….

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Status Quo Consultants vs New Age Consultants

April 4th, 2019

By Bill Rusteberg

Last year I had the privilege to make a presentation to the Board of Trustees of a Texas independent school district. The district’s self-funded health & welfare plan was in trouble and they wanted to hear how we have been able to keep costs static over time for other school districts we have been fortunate enough to manage over the past twenty years. Those districts have beaten medical trend while improving benefits at the same time and at half the cost.

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Outrage Over Rising Costs of 100 Year Old Drug

April 3rd, 2019

Insulin manufacturers and PBMs have faced mounting pressure amid outrage over the rising cost of insulin, a nearly century old lifesaving drug.

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Clarity Benefit Solutions – TPA for Tax Advantaged Plans

April 3rd, 2019

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Clarity Benefit Solutions is a broker-friendly benefits technology company and TPA for Tax-Advantaged Plans with 25+ years of industry experience.  Our easy-to-use programs and tools are designed to innovate, integrate, and automate – taking the frustration out of benefits with solutions that actually work.

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How Two Common Medications Became One $455 Million Specialty Pill

April 3rd, 2019

You can walk into your local drugstore and buy a month’s supply of Aleve and Nexium for about $40. For Vimovo, the pharmacy billed my insurance company $3,252.

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DOL “End Run” Ends In Defeat

April 3rd, 2019

Stringent government control of health care continues to defeat efforts of free market proponents……………….

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Texans Support Consumer Protection Laws Against Medical Price Gouging

April 2nd, 2019

Texas Free Standing Emergency Rooms (FSER) resemble urgent care centers, but on average, an FSER costs 10 times as much as an urgent care visit for the same condition……………..

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New PHI Procedure

April 2nd, 2019

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The Balance Billing Myth

March 31st, 2019

A seemingly valid concern about Reference Based Pricing strategies on the part of consumers is the possibility of balance billing leading to personal debt, lawsuits and ruined credit.

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The Evolution of Reference Based Pricing

March 31st, 2019

Change over time is a constant……………………………………

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Thurman James Chapman

March 31st, 2019

OCTOBER 13, 1925 – MARCH 27, 2019

Thurman James (T.J.) Chapman, age 93, of Austin, Texas passed away peacefully at his home on March 27, 2019 after a long illness.

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Donna Independent School District Seeks Insurance Consultant

March 30th, 2019

Donna Independent School District is accepting Insurance Consulting Services RFP #032219-487 at the office of the purchasing agent located at:

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Judge Strikes Down Trump Administration’s Health Care Plan

March 29th, 2019

The most powerful branch of government strikes down proposed rules for association health plans………….The Trump administration had rolled out the plans after President Trump signed an executive order directing Labor Secretary Alexander Acosta to consider allowing more small employers to form association health plans.

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WellCare bought by Centene

March 29th, 2019

WellCare Health Plans Inc. will be acquired by Centene Corp. in a $17.3 billion cash and stock deal.

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Slapped in North Carolina

March 29th, 2019

“Delay and Confuse” is one of the oldest tactics used by incumbents under attack. The North Carolina flirtation with Reference Based Pricing for their state employees is a classic example.

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$15,000,000,000.00

March 28th, 2019

$15 billion deal creates insurance powerhouse………………..

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Reference Based Pricing Model For Prescription Drugs

March 28th, 2019

Reference pricing divides drugs into therapeutic classes, which allow a payer to identify an average price to use as a reference point……………………

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ObamaCare On The Ropes Again – Investors Skittish

March 27th, 2019

Here we go again. Another challenge to the ACA. But this time investors are weighing the odds and taking their money elsewhere…………………..

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Litigation vs. Negotiation: How to successfully structure RBP

March 26th, 2019

As consultants we have options when it comes to vendors, and if you’re in this healthcare revolution, I urge you to choose your partners thoughtfully and more importantly, in alignment with the values you communicate as an adviser…………….

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Medical Providers Declare War In North Carolina

March 23rd, 2019

North Carolina may not embrace Reference Based Pricing strategies for the state employee plan after all. The North Carolina medical community has declared war. “Delay and Confuse”, a time tested tactic, is the weapon of choice……….

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Health Care Prices vs Health Care Costs

March 23rd, 2019

  Dave Chase

Hospitals have overplayed their hand just like Pharma. At a certain point, gluttony has blowback.

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Health Plans For State Employees Use Medicare’s Hammer On Hospital Bills

March 23rd, 2019

Some states are moving to control costs of state employee health plans by implementing defined contribution plans, a move away from traditional defined benefit plans. Montana, North Carolina, Oregon and Delaware are states that have implemented defined contribution health plans for their state employees or are about to do so. Meanwhile Texas is considering a House Bill to “study alternatives” to health care financing for their state employee benefit programs.

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Finnish Government Collapses Due to Rising Cost of Universal Health Care

March 23rd, 2019

Finland’s welfare system is generous in its provisions. Now it’s running out of money………….

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A Reason to Be Skeptical of the Workplace Wellness Industry

March 22nd, 2019

Study of a comprehensive workplace wellness program concludes that it didn’t change employees’ behavior or health care costs. Employees who took part didn’t become healthier or more productive, and were not more likely to go to the gym or run in a local race. Total health care costs didn’t drop, either.

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Amazing Statistic!

March 21st, 2019

The latest survey shows that

three out of four people make

up 75% of the population

 

 

The 20 Most Expensive Drugs in the U.S.A.

March 21st, 2019

All 20 of these drugs are priced well over $25,000 for a monthly supply, or + $300,000 per year

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Will Texas Consider Feasibility of Reference Based Pricing Strategies for Public Educators?

March 20th, 2019

               $64,000 Question

House Bill 3987, if passed, will direct a commission to study alternative mechanisms for offering health benefit plan coverage to the affected employees  of the TRS ActiveCare program and their dependents. Will “alternative mechanisms” include a study of Reference Based Pricing strategies? Will Texas follow the lead of Montana, North Carolina and the South Texas Health Cooperative? 

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Insurance Agent Who Stole 80+ Identities Gets Probation

March 18th, 2019

A Colorado insurance agent who created more than 80 phony life insurance policies has been sentenced to probation.

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What Health Care Consumers Never See

March 15th, 2019

I get emails like the one below almost every day on claims incurred under various Reference Based Pricing plans. The redacted email below shows how egregious health care billing practices are and what consumers are expected to pay in relationship to what Medicare pays.

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3 Drug Manufacturers Hold 7,000,000 Americans Hostage – Life or Death?

March 15th, 2019

The Canadian inventor of insulin sold his patent for $1 to the University of Toranto back in the 1920’s to benefit mankind with a life saving, inexpensive drug. Now three drug manufacturers hold the power of life and death over 7,000,000 diabetic Americans. Why?

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A Cost Effective Approach to Reference Based Pricing

March 14th, 2019

 

 

Going with a PEPM subscription model yields greater plan savings than charging a percentage of savings. Our RBP solution, powered by Payer Compass, uses that model and helping is helping clients save up to 72% over traditional PPO networks.

Texas School District Continues Deficit Spending On Health Plan

March 14th, 2019

The Donna Independent School District (DISD) in deep South Texas continues to under fund their self-funded health plan. In a competitive RFP process last year the district moved their self-funded health plan administration from Blue Cross to United HealthCare. However, the change in plan administrators have not shown any savings to date, although there is a “shared savings” fee paid to the administrator. Try explaining that to the boys in the domino parlor.

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New Health Plans Expose Insureds To Less Risk

March 14th, 2019

New health plans expose insureds to less risk:

The risk of systematic rising health insurance costs, erosion of  benefits and less choice. Provider payments are fully transparent unlike traditional health plans that cloak provider pricing in secrecy.

Members may select any provider of choice unlike PPO and HMO plans. There are no high deductibles and in some cases no deductibles at all. So what’s the catch?

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Some TPA’s Are Planning For Survival, Others Are Not

March 13th, 2019

With a single payer system only one election away, some TPA’s are looking towards the future. Others have their heads in the sand.

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Blue Cross Enters Food Business

March 13th, 2019

For a low co-pay of $10 every time you order a meal and a reasonable $6 delivery charge (tips encouraged) you can get free meals from Blue Cross if you live in designated areas. You don’t even have to be a Blue Cross member, although we suspect those are the ones paying for all of this……………

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Mother Knows Best

March 12th, 2019

A major carrier (Mother) will require all new self-funded employer customers (Children) to incorporate this feature into their plan designs……………….As children don’t you hate to be told what to do?

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Lockton Enters Reinsurance Business

March 11th, 2019

Reinsurance is a key pillar of Lockton’s aggressive growth plan……………………..

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Monkey Business?

March 11th, 2019

1980’s BCBS Representative At Work

I remember years ago when I was a naive young salesman for BCBS working in a rural area office. I was eventually promoted to a big city office. It was a new experience for me. I noticed real fast that all the other sales reps. were involved in some sort of  “monkey business.”

They were typing up group health insurance proposals in the confines of their company paid offices (door closed of course) on behalf of competitors, pocketing commissions earned in addition to their BCBS salary. One rep. showed me his check stubs from more than one competitor and said “Bill, why don’t you do the same? It’s easy money! And, if I get fired or quit, I have a nice steady income coming in!”

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Population Health on Steroids

March 11th, 2019
Does your self-funded health plan have the latest technology required for advanced risk management purposes?

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Solving Health Care At An Affordable Price

March 7th, 2019

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Opening The Black Box

March 6th, 2019

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Retail Rx Prices Vary a Lot!

March 6th, 2019

I take a prescription drug that costs $18 at a mom & pop pharmacy in Cuero, Texas that costs $95 at a chain pharmacy 34 miles down the road in Victoria, Texas. A pharmacist friend told me his cost is $6…………..But of course not too many people know this or care. All they see is a Rx co-pay which effectively hides the scheme from public outcry…………..Many of our clients exclude two of the largest drug store chains in the country because they know prices there are 500-600% higher at the retail level than most independent pharmacies. That alone will save on average 5-10% off a group’s total drug spend.

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Seize The Day & Reference Based Pricing

March 5th, 2019
One of many emails I get every week about Reference Based Pricing strategies. Seems there are more and more TPA’s entering that space in partnership with either ELAP, AMPS, Six Degrees or Payer Compass, the Big Four. Then there are all the others like HST and UCC making inroads too. Now we are seeing some of the BUCA’s entering into the Reference Based Pricing space via their wholly own TPA subsidiaries with the apparent mantra “If you can’t beat them, join them.”

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Specialty Drugs Are Killing Your Renewals!

March 5th, 2019

War On Drugs Continues……….

We specialize in helping self-funded employers dramatically reduce Rx spend while providing members a $0 Rx copay for many name brand and specialty meds.

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Insurer of Last Resort

March 5th, 2019

“No problem Joe, I’ll make a call for you”

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Glenn McLellan – Sales & Account Management at Centivo

March 4th, 2019

For 35 years I have worked closely with all constituents in the self-insurance industry to help our industry be the best that it can be. From my perspective, the development of Centivo is the culmination of every effort I have made for a TPA to be “world class” and represent the future.

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TPA Offers New Health Plan Model

March 3rd, 2019

Centivo offers an alternative to traditional insurance carriers or third-party administrators……..

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War On Drugs – The Indians Are Restless

March 3rd, 2019

Boston Tea Party

What’s the price of tea in China? How about insulin………….Insulin which was discovered in the 1920’s and whose patent sold for $1, has doubled in price between 2012 and 2016 while the price of insulin drug lantus increased 49% in 2014 alone. Why? In this war on drugs we should “Just Say No.”

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It’s Scary – House of Representatives or House of Horrors?

March 2nd, 2019

Rather than finding a way to provide for the small minority who still need health insurance, they want to overhaul the whole health system for everyone……………….

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Texas Addresses Balance Billing Issue

March 1st, 2019

A Texas Senate Bill was introduced a few days ago that addresses balance billing issues including credit reporting agencies……………….

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SOAP

February 28th, 2019

 

Our STRATEGIC OPEN ACCESS PLAN (SOAP) is designed to clean up your group medical program using common sense and traditional American business practices. Clients who adopt our strategies will realize plan savings of 20-40% while maintaining or even improving benefits at the same time.

 

 

“Cleaning up Your Employee Health Plan”

Field Rated Dental/Vision Plan

February 28th, 2019

Still quoting the same 100/80/50 Dental Plans that were popular 20 years ago? Let’s surprise your client with a new and innovative dental offering.

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Naysayers Bring Message of Impending Doom

February 28th, 2019

Maybe the problem with solving health care in this country centers around the apparent abundance of naysayers………………

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Jilted Lover Wants Back Billion Dollar Engagement Ring

February 28th, 2019

Judge, he’s a bully, manipulative, passive-aggressive and self-centered. I don’t love him anymore!

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SmartDecision Offered By HealthSmart

February 27th, 2019

A Reference Based Pricing solution called SmartDecision. It offers RBP, bundled pricing, cost and quality information, and a concierge service to help members navigate the entire healthcare episode. Please review our flyer to learn more about this truly unique program. Click here to download.

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Attention Health Insurance Brokers: You’re One Election Away From Extinction

February 27th, 2019

Medicare-for-all would move every American onto one government insurer in two years, while providing everyone with medical, vision, dental and long-term care at no cost………….

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February 27th, 2019

Anthem Antitrust Atty ‘Stunned’ At Cigna Balk On $54B Deal

A 25-year veteran antitrust lawyer for Anthem Inc. testified Tuesday he was stunned by Cigna Corp.’s sudden and allegedly fatal resistance to their now-abandoned, $54 billion tie-up, in the second day of a multibillion-dollar Delaware Chancery Court trial over the collapsed deal.

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February 26th, 2019

In Florida, Drug Re-Importation from Canada Finds New Champions, Old Snags

“Florida is joining the growing ranks of states that, squeezed by climbing drug prices, are eyeing the Canadian fix…. Legislation has been advanced this year in about a dozen states that would advance wholesale drug importation programs … While statehouses may be abuzz, in Washington, national politics impedes feasibility. And skeptics question how much relief these initiatives could actually provide.”
Kaiser Health News

Departments Ask for Advice from Health Plan Sponsors: Preserving ‘Grandfathered Status’ Under the ACA

“The specific questions include: [1] Do any of the requirements for maintaining grandfathered status create particular challenges, and how could these requirements be modified to reduce these challenges? [2] Why do plan sponsors choose to retain grandfathered status? [3] What are the costs and benefits that plan sponsors consider in deciding whether to retain grandfathered status? [4] Is preserving grandfathered status important to plan participants? [5] What changes in benefits typically trigger a loss of grandfathered status?” 
Segal Consulting

To RBP, or Not to RBP: That Is The Question

February 26th, 2019

Once upon a time, health benefits were just that – “benefits.”  Now, it’s assumed health insurance is included in an employment package, and what was once a benefit is now an entitlement…..

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Single Mom Jailed Over Unpaid Medical Bill

February 25th, 2019

Mugshot photo of Melissa Welch-Latronica, 30, of LaPorte. (Porter County Sheriff’s Dept.)

Single mother goes from traffic stop to bench warrant to jail over unpaid medical bill: ‘It just isn’t right’

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Insulin Makers Face Drug Pricing Suit

February 22nd, 2019

Price of Drugs Is Too Damn High!

“This ruling blows the insulin racket wide open,’’ said Steve Berman, a plaintiffs’ lawyer who is one of the leaders of the potential class-action case. The ruling “clears the way for us to begin obtaining discovery from the manufacturers and PBMs so we can shine the light on exactly what has driven insulin prices sky-high,’’ he said.

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Primary Care – The Future of Employee Care?

February 22nd, 2019

“Direct primary care (DCP) — a fee-based model that gives individuals unlimited access to a primary care doctor for anywhere between $60 to $150 a month, without insurance being billed — is the “future of healthcare….”

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New MEWA in Texas Announced

February 21st, 2019

Last month, we received our license to sell Association Health Plans (AHPs) to medical groups in Texas through the Oklahoma State Medical Association (OSMA). They have a proven track record of providing significant savings to their members and offer a broad range of health plans.

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