New Idea For Reducing Health Care Costs Is Actually Really Old

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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April 18th, 2018

The Cost of Convenience

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“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

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

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

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”

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

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

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

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

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

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

April 11th, 2018

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

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Hilarious Auto Response

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?

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

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

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

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

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

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

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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April 7th, 2018

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

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!

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?

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

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?

April 5th, 2018

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

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Teachers Are Pissed

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?

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

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

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

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

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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Burger King In Acquisition Talks With Blue Cross

March 30th, 2018

FOR IMMEDIATE RELEASE

Burger King In Acquisition Talks With Blue Cross

Scottsdale, Az – (March 30, 2018) – Burger King, home of the nation’s best, highest in saturated fats mouth watering burgers announced today they are in advanced discussions with Blue Cross on a possible merger.

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What Advisers Should Know About The First Reference-Based Pricing Lawsuit

March 29th, 2018

In Martinsville, Virginia, there is a reference-based pricing lawsuit pending that industry insiders are watching closely, because it could set a precedent for these types of lawsuits moving forward. In this case, a Virginia hospital has been pursuing an $84,000 balance bill from a former patient for nearly four years and through two separate courts……………………

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Health insurers, Big Pharma Play Blame Game Over Drug Prices

March 28th, 2018

Health insurers and pharmaceutical companies are pointing fingers at each other for the rising cost of prescription drugs as scrutiny over drug spending intensifies………………..

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SALGBA Opening Keynote–Shifting Sands in the Health Care Market Place

March 27th, 2018
Inline image

Opening Keynote Presentation focusing on the current political and economic impacts on the health care market place. From DC to Wall Street, what is shifting the sands and how does that effect public sector health care? Speaker: Steven Eastaugh 

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Stop Loss Markets Putting the Brakes On

March 27th, 2018

Recent trends in the medical stop loss market are showing most stop loss risk managers have been suffering significant losses in the past few years.

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Does Self-Insuring Voluntary Employee Benefits Makes Sense?

March 27th, 2018

A plan sponsor can self-fund the coverage a lot less expensively than insuring through a carrier…………..

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Will American Businesses Ever Leave the Health Care World?

March 26th, 2018

 

Some employers that are exasperated by raising health care costs have quietly questioned whether it isn’t time for the government to take over the responsibility of providing health care through a single-payer system.

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MGU CONFLICTS OF INTEREST

March 26th, 2018

MGUs representing multiple carriers face a conflict situation whenever a marginal claim comes in from an important producer………………….

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Gotcha Clause

March 26th, 2018

Recently a Texas school district awarded a contract for TPA administration based, in part, upon representations made to the Board of Trustees by salaried representatives of the TPA. After the contract  was awarded it was discovered material misrepresentations were made prior to contract award and upon which the Board of Trustees placed paramount importance in their decision making process.

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Pharmacy Tourism

March 26th, 2018

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Trump To Target High Drug Prices

March 26th, 2018

“You’ll be seeing drug prices falling very substantially in the not-so-distant future, and it’s going to be beautiful…………………”

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It’s Still About Primary Care

March 25th, 2018

Primary care is an investment and the rest of healthcare is a payment…………….

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Direct Primary Care

March 24th, 2018

This is an excellent 30 minute interview with Dan Meylan of Allied National on Direct Primary Care strategies. This, coupled with Reference Based Pricing, makes sense. Its a win win for the consumer, the plan sponsor, the insurance company and most importantly medical caregivers within respective communities.

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Point of Service Claim Adjudication & Payment

March 23rd, 2018

It exists………………………………A magical health insurance card

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Government Overreach Ends in Whimper

March 23rd, 2018

The government’s attempt to prosecute Shafer as a dangerous FBI-stalking villain ended with a whimper instead of the bang the prosecutor hoped for…………………..Badge heavy FBI agents created private hell for Shafer and his family………………(Badge Heavy – A police officer who believes wearing a uniform with a badge makes him king of the universe. An arrogant police officer).

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Why Apple, Amazon & Google Are Making Big Health Care Moves

March 23rd, 2018

Amazon is setting up a mysterious new partnership with JPMorgan Chase and Warren Buffett…………..

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The Erosion of The American Middle Class

March 22nd, 2018

Five interesting facts from the Kaiser Family Foundation on the decade impact on cost sharing on the enrollee:

  • Deductible responsibility is up 229%
  • Co-Insurance responsibility is up 89%
  • Overall cost share is up 66%
  • Wages are only up 31%

Why should we care?

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The Charge Master Game

March 21st, 2018

 

 

“Percentage of savings fees is the greatest fraud foisted upon consumers since Vicor Lustig sold the Eiffel Tower in 1925.  To earn 24% of an inflated, arbitrary number that no one ever pays is better than robbing a

bank.” – William Rusteberg

 

 

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Rx Copay $20, Pharmacist Paid $1.75, PBM Keeps The Difference

March 21st, 2018

CIGNA Sued for Rx pricing practices…………………..

A federal judge in Connecticut has denied most of Cigna Health and Life Insurance’s claims in its request to dismiss a lawsuit which alleges it artificially inflated prescription drug costs in violation of the health insurance policies of its clients………………

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Need A Medical Procedure? Pick The Right Provider And Get Cash Back

March 20th, 2018

State public employee insurance programs were among the early adopters of this approach………

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Arkansas To Regulate PBMs

March 20th, 2018

Allows the state insurance department to have oversight over PBMs and essentially treat them as insurers………………….

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Resistance To Change Frustrates Health Care Disruptor

March 18th, 2018

Thanks, but no thanks. We don’t believe you and we don’t want to save money and improve benefits at the same time. The fear of pissing off employees far outweighs our bottom line. Plus, we have less employees than we could have by redirecting health care dollars to grow our business. And, we pay our employees less because as the cost of health care increases the less they receive in wage increases. It’s a system we are used to after 40 years of managed care. So, go away please…………

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Clawbacks

March 18th, 2018
 

Patients Overpay For Prescriptions 23% Of The Time — Called ‘Clawbacks’ 

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Screwing Consumers – Are Pharmacists Complicit?

March 18th, 2018

Lawmakers seek to remove ‘gag clauses’ that keep pharmacists from revealing lower prescription drug prices…………………….

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RiskManagers HealthCare Purchasing Coalition 2018

March 16th, 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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Insurance Artificially Inflates Medical Costs

March 16th, 2018

Why on Earth do we insure office visits? And lab tests? We don’t insure fan belts or tires on our vehicle do we?

More employers are realizing they can save a lot of money by not insuring events that are predictable and quantifiable………………We know how to do that, do you? (Hint: Direct Primary Care Strategies).

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March 15th, 2018

Budgetary Constraints & Rising Health Care Costs

Texas political subdivisions are struggling to address rising medical costs which, in most cases, represents their second largest budgetary expense after wages. Seeking economies of scale, some counties, cities and school districts have joined risk pools such as TML, TAC and TRS ActiveCare. However, the concept of the power of large numbers has failed to control costs.

We know why………………………….

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Religious Liberty Gains Win Today

March 13th, 2018

Federal Judge Dismisses Lawsuit against Trump Administration’s End to Obamacare’s Contraception Mandate

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Uber Wants DOL’s Association Health Plan Rule to Consider Gig Workers 

March 13th, 2018

Uber Inc. and its health-care partner, Stride Health, … asked the DOL in separate letters to allow workers with multiple jobs and varied hours to be eligible to participate in association health plans.

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Overpaying for Prescription Drugs: The Copay Clawback Phenomenon 

March 13th, 2018

 

Prescription drug overpayments (also known as “clawbacks”) occur when commercially insured patients’ copayments exceed the total cost of the drug to their insurer or pharmacy benefit manager…..

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Astute Purchasing Agent Nails It

March 12th, 2018

A long time friend who has spent almost all of his working life in the pubic purchasing arena in Texas has a perspective that many of us in the insurance community have failed to acknowledge. 

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Dialysis Treatment Fees

March 12th, 2018

Dialysis treatments for End Stage Renal Disease (ESRD) patients are expensive, really expensive. They can run $600,000, $700,000 or more a year, easy.

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Laredo ISD Seeks Health Insurance The Old Fashion Way

March 11th, 2018

We are continuously amazed political subdivisions like this one continue seek competitive proposals the old fashion way. 

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The RBP Stew

March 11th, 2018

If you are acquainted with reference-based pricing, you either love it or hate it…………….

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DOL Proposal Would Expand Association Health Plan Opportunities

March 11th, 2018

Changes will expand the pool of employers who may be eligible to create, join or establish a self-funded……

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“Right To Shop” Strategies Gaining Traction

March 11th, 2018

State public employee insurance programs are the early adopters of “Right to Shop” health care initiatives………………….Are PPO’s doomed?

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Omnipresent Federal Government Overrules Idaho

March 11th, 2018

 

The Affordable Care Act (ACA) is a federal government mandate all states must follow. As a reminder, the ACA is a “tax” and nothing more according to John Roberts. The federal government has the power to tax and the states are powerless to resist individually.

 

 

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Group To Develop Hispanic-based Health Care Sharing Organization

March 9th, 2018

The Company plans to market to the 58 million Hispanics in the USA a health care sharing model that reduces the costs of coverage while providing quality and timely access to health care services.

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The Rise Of The American Health Care Industrial Complex

March 9th, 2018

The American health care system has become one giant health care industrial complex………….

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March 7th, 2018
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“All advisors must endeavor to systematize their practices as much as possible so that they can remain competitive, highly profitable, and be in a position to grow in a disruptive and fee sensitive environment.”

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Trump Administration Warns Hospital Executive “Change is Coming”

March 7th, 2018

President Trump’s new health secretary issued a warning Monday to a room of hospital executives about soaring health care costs: change is coming, whether you like it or not.

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Is “Free” Cafeteria Plan Administration In Exchange For Products Legal?

March 6th, 2018

 

Many purveyors of voluntary employee benefits offer “free” Cafeteria Plan administration in return for the opportunity to sell voluntary products such as cancer plans. A portion of the commissions earned by writing agents are shared with the Cafeteria Plan administrator thus affording “free” administration services to the plan sponsor.

Is this practice legal?

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