Rather than basing Rx pricing by applying a discount off arbitrary sticker prices the strategy is to base pricing off what retail pharmacies pay for drugs. For example, if a pharmacy pays $10 for Drug A, the plan sponsor pays $10 plus a margin. This is Reference Based Pricing for Rx claims. But according to the following article this strategy does not save money. The American Rx pricing mystery continues…………….

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Lone Ranger Refuses To Wear Mask in Solidarity 

“I think it’s an insult to Texans to be required to do something they should have discretion for,” said Hugh Reed

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Texas expands elective surgery ban to more than 100 counties

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Big Medicine would love to trap your doctor in their job, even if it’s abusive.

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Look Kemosabe, Greg’s Pulling His Hair Out!

“The order is not a law, there is no requirement that any police officer enforce it, and it’s unenforceable. We can’t spend our time running from place to place for calls about mask we can really do nothing about.”

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SOURCE: Mike Reagan on Linkedin

“This West Texas doctor says he has a low cost cure for Covid-19 (Budesonide), we don’t need a vaccine and the “stay at home, shut down businesses mentality” is politically motivated. He further states that the way we are treating Covid is wrong.”

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Plan sponsors should determine whether they are a “covered entity” as newly defined under the final rule for nondiscrimination purposes. If not Katy-Bar-The-Door for out-of-the-box risk management strategies……..

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RiskManagers Interlocal Purchasing Cooperative is designed for Texas political subdivisions seeking alternatives to traditional managed care health insurance plans.

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“This first article in a three part series will focus on Pharmacy Benefit Managers – one of the three most influential opponents of price transparency.”

Twenty years ago Express Scripts was a $1 Billion revenue company, but now they have over $100 Billion in revenue per year.  No inventory to trouble with, no warehouses needed, no fleet of trucks to maintain………………the only thing needed are contracts of adhesion cleverly designed to screw third party beneficiaries……………………………..

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All the proper reserving in the world may not cure a severe case of lasers. The Great Laser Pandemic is running rampant, striking angst and fear among plan sponsors everywhere.

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Great news: We and our partners at CBS News won the 2019 Society of Professional Journalists – Sigma Delta Chi Public Service gold medal for network news for our health costs partnership, “Medical Price Roulette.”

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These are the tools of the trade a 72 year old industry dinosaur uses to underwrite group medical plans, projecting future costs, rate setting, reserve requirements, quantifying IBNR, etc.

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Xerox, Eastman Kodak And Cost Plus Insurance

“The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide.” – Bill Rusteberg

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Works on Brass But Not on Walnuts

When asked recently during a question and answer period at a symposium I attended, a member of the audience asked “What do you tell employers who voice concern about some of your strategies to reign in health care costs?”

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Pssst, God Father, Justin’s At It Again!

Cartels: “an association of manufacturers or suppliers with the purpose of maintaining prices at a high level and restricting competition………………

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Let the Sun Shine In…………………………………………………………

This will be the end of PPO networks and will turbocharge the explosive growth of Reference Based Pricing strategies…………………..

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Dr. Belk gives a talk to One Payer States, a group advocating for a single payer system…………

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Authorities said Hickman and the others recruited public-sector employees who were paid to get prescriptions they didn’t need and hadn’t been prescribed. Among the more than two dozen people who have pleaded guilty was John Gaffney, a Margate-based doctor who admitted signing prescriptions for patients he never saw………………..

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Tom, Dick and Harry on the way to a conference decided to stop along the way and get a hotel room. It was late at night, but they saw in the distance ahead a hotel with a neon sign that said “Vacancy.”

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In the eighth annual Disruptor 50 list, CNBC identifies private companies whose breakthroughs are influencing business and market competition at an accelerated pace. They are poised to emerge from the coronavirus pandemic with tech platforms that have the power to dominate.

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The El Paso Independent School District was the second public school district to challenge TRS ActiveCare in 2019 by offering employees a commercial health plan option in direct violation of TRS ActiveCare mandate prohibiting Texas school districts from doing so. So how has the commercial plan option fared financially so far?

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Man Racked By Guilt Complex – Scientists determine post recovery symptoms may require lifetime counseling………………..

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99% of traditional health plans offer no incentives to shop for best prices and outcomes. Doesn’t matter where an insured goes, the same patient responsibilities apply. The same deductible, same co-pays, same maximum out-of-pocket costs.

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Giving employees daddy’s unlimited credit card and telling them they can go anywhere they want for treatment and their out-of-pocket expense will be the same no matter where they go or who they see, is the dumbest thing employers can do to their employees.

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Pay particular attention to #2,. ICHRAs make sense for employers who are tired of fighting health care costs every year, dealing pesky insurance salesman all while at risk of government punishment should they misstep along the way…………..ICHRA’s Shake Up Market

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The suits allege that Willis and its directors breached their fiduciary duties under U.S. securities laws by filing incomplete and misleading information with the Securities and Exchange Commission on the transaction.

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“Telemedicine has advanced ten years in only two months.” – Gilberto ‘Beto’ Garcia, Jr

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Telehealth claim lines increased more than 4,000% in the past year………………

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Remove third party barriers to care and guess what? Presto, you’ve just solved health care………..

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We believe it is important that our customers understand how these independent producers are compensated, so we offer this overview of our producer compensation programs.

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Earn a total bonus of up to $24,000 with the BCBSTX Grand Slam Bonus Program!

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We all knew how UHC vs Houston Methodist  cat fight would eventually turn out. This type of thing happens all the time, going all the way back to the previous century. No one knows what these cats have agreed to as far as what we all will end up paying for health care. Neither side wants you to know and therein lies the basis of their shared interests……………..

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Payer Compass’s reference based pricing plus direct primary care can reduce plan costs by up to 40%.

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“A broker can “power up” the bonus to $150,000 per employer group……Commissions of 3 to 6 percent of the total premium……could be about $50,000 a year on the premiums of a company with 100 people, payable for as long as the plan is in place. ……Commissions can be even higher, up to 40 or 50 percent of the premium, on supplemental plans that employers can buy to cover employees’ dental costs, cancer care or long-term hospitalization…………..Bonuses…..as much as $100,000 per group, and “there’s no limit to the number of bonuses you can earn.”

Health Care Service Corporation, which oversees Blue Cross Blue Shield plans serving 15 million members in five states, disclosed in its corporate filings that it spent $816 million on broker bonuses and commissions, about 3 percent of its revenue that year.

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Driving across town to earn $87,000 is one hell of a way to make living…………..

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Willacy County is seeking competitive proposals for: Employee Medical, RX, Dental & Vision plan

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According to this illustration, the following statistics can be derived:

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We are a grassroots movement of doctors, nurses, students, business leaders, and everyday citizens from across the United States that are demanding a more honest and fair health care system.

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Government mandate forces health plans to cover Truvada, the only FDA approved drug used to prevent HIV. Annual cost of this drug is $25,000…………………

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School districts will be forced to reexamine finances including health care spend……………….

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2019 Annual TRS-ActiveCare Financial Report

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If you have a spare 2.5 hours, this is worth watching…………………………

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Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. 

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Do the PPO Kickback Scheme described in this July 2011 blog posting still exist…………..?

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I don’t speak German, but I think she said: “What The F**k?!”

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If collectors are calling you insisting that you pay for an unfair bill, insist they provide you with the contract obligating you to pay. Without a written agreement that you owe money, you have no legal obligation to pay………………

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Reference Based Pricing Lawsuit Grabs National Attention

“Few of us, when confronted with the threat, ‘Your money or your life! ’ would, like Jack Benny, pause and respond, ‘I’m thinking, I’m thinking.’ Most of us would empty our wallets. Does that act of acquiescence demonstrate acceptance of an offer and create a contract?”

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Ready to be your own boss? You have what it takes to become a GEICO Local Agent! As a GEICO Local Agent, you’ll write business for GEICO and our affiliates as an independent, small business owner, right in your own back yard.

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Albert Einstein knew that the quality of a solution was directly related to a person’s ability to identify the problem they were trying to solve. He famously said, “If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and five minutes thinking about solutions.”

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Our Clearinghouse Model^SM simplifies drug pricing and frees up resources to improve patient care. Sometimes a simple change delivers revolutionary results…………..

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“We are very disappointed that CMS continues down the unlawful path of requiring hospitals to disclose privately negotiated contract terms,” the group said in a statement………….

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Your broker advisor will probably never recommend ICHRA’s because to do so will destroy their business model. That’s probably why you’ve never heard about ICHRA’s until now……..

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Q4intelligence is a business, sales, and marketing consulting firm working with insurance and benefits agencies.

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We are Maestronites, and our people are at the core of what we do.  We value an innovative approach, a drive to disrupt, an enthusiasm towards making a difference, and most importantly, a passion to make employee health & benefits “people-friendly” again.

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Evil LASER MONSTER waits for you from the darkness of stop loss hell………………

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Approximately 4 minutes long, this man delivers a powerful message with meaning for everyone

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“Hi, I’m from Amerman Insurance Services, may I come over to talk to you about insurance this afternoon?”

Amerman? Never heard of you. Goodbye……………..

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A Llama Named Winter May Hold the Key to a Coronavirus Treatment

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The Weslaco Independent School District believes insurance agents are so invaluable they hired three of them……….”At no cost to the district”……and they are getting the TPA for free too………. 

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Former Amarillo Mayor, Fairly Group CEO file lawsuit against Amarillo ISD

“This suit does not seek to recover monetary damages from AISD. I am simply ‘raising my hand’ to shed light on a process I believe is flawed and unfair to Amarillo’s teachers and taxpayers.” – Alex Fairly

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Linda poised to be the next president of TMA representing more than 53,000 doctors in Texas………………….

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“The CIGNA plans continue to offer better benefits with greater freedom of choice and fewer restrictions than TRS at competitive deductions along with its annual contribution to the Health Savings Account.”

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Guarantee “No-Laser” Contract – We guarantee not to raise the specific deductible relative to an individual at renewal who may be experiencing on-going claims.  Additionally, the terms for the renewal will not represent a premium increase which includes the entire expected cost of a known future excess claim.

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