In a 2007 meeting with a large Texas employer I recommended they walk away from PPO networks and pay claims based on certain pre-defined metrics. Immediately the TPA account manager chimed in “It won’t work! Hospital and doctors will not take the insurance, members will be denied care. Don’t do it!” she said.
We did it anyway. And it worked. And it started a revolution…………
Remember when you were a little kid and you were told you couldn’t have something? Your brain silently responds “Uh Huh, watch me!”
1982 – Brokers can’t shop stop loss. WE DID
1984 – Brokers can’t unbundle TPA services. WE DID
1986 – Brokers can’t import prescription drugs from Canada – WE DID
1990 – Brokers can’t negotiate direct provider contracts – WE DID
1997 – Brokers can’t work on a fee only basis – WE DID
1998 – Brokers can’t create & manage risk pools – WE DID
2005 – Brokers can’t see, review or audit managed care contracts – WE DID
2007 – Brokers can’t eliminate managed care contracts – WE DID
2012 – Brokers can’t limit Rx formularies – WE DID
2016 – Brokers can’t negotiate direct cash pay provider contracts – WE DID
