Frederick Banting Discovered Insulin in 1923
A new treatment that cures diabetes 1? That’s gonna be one hell of an expensive drug! Unless the spirit of Frederick Banting rises from the laboratory once again.
Frederick Banting was the man who discovered insulin – and gave it away for free (diabetescommunity.com)
This (TASB LEGAL – see link below) seems to be contrary to the general understanding many districts have that a TRS ActiveCare member district which opts to continue participation effective Sept.1 2022 may exit the program any year they choose after that. Instead, according to the document below, it appears they are locked in for five years.
SOURCE: www.medicaleconomics.com
“Nearly two-thirds of our nation’s 5,000 hospitals, or around 3,900, call themselves nonprofit, a designation that allows them to avoid paying taxes.”
With their financial backs to the wall what are plan sponsors to do these days in maintaining an affordable and usable health plan for their employees?
Rebates are commissions.
So Joe Sixpak goes to the pharmacy to fill his diabetes prescription drug. Between Joe and his insurance plan the pharmacy is paid $408. The pharmacy keeps $69. Where does the rest of it go? (more…)
WARNING TO HEART PATIENTS!
A New York Times columnist issues proclamations leading to a significant spike in cardiac related medical encounters among it’s broad base of readers. Reader discretion is advised.
RiskManagers.us, a fee based insurance consultant, is raising fees upon contract renewal due to robust inflationary pressures. Cost increases include E&O policy premium increases, travel expenses and continued taxation amounting to +40% of revenue. Additional expenses include legal, accounting, and outside specialty consulting retainers paid to special practice experts.
A Texas City Gone Politically Tone-Deaf
By Josh Butler
“Your attempts to raise taxes …..have been rejected, twice. Turn your attention to your health plan. It is the single most significant area of opportunity, but you are not taking advantage of it currently. What will it take?”
Source: Linkedin, Author Unknown
Stunning Graph. There’s no question this trend will continue. 20 of 20 years have an increase… We’re up 400% in that time frame.
The American solution to solving the uninsured problem was the Affordable Care Act. The Mexican solution is different.
Seguro Popular is Mexico’s solution to protect their uninsured population. It’s benefit structure is disease based. It’s cost basis is income based. No one is forced to participate and no one is penalized if they don’t.
Maybe we could learn something here as this seems to be a practical, common sense approach to universal healthcare.
Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart.
The battalion began the battle of Hatten with 33 officers and 748 en- listed men. Fifty-two hours later it had an effective strength of 11 officers and 253 enlisted men. All others were either killed, wounded or missing in action.
New broker disclosure rules taking effect 27 December 2021 have most health insurance brokers and consultants running scared. But reptiles earning undisclosed compensation off non-ERISA plans are resting easy. They believe the new disclosure rules don’t apply to them. Or do they?
How can a small school district get better benefits and lower costs than TRS ActiveCare with over 450,000 members?
Texas has a law requiring that health care service providers bill a patient no later than the first day of the 11th month after services were provided.
Free cash flow is created by attracting a disproportionate number of high claimants (the Super Utilisers) to enroll (spin-out) in alternate group coverage by offering them 100% medical coverage with zero out-of-pocket expenses. They voluntarily elect coverage*.
If direct pay models became commonplace, they would empower and liberate both patients and doctors and do more to bring down costs than other healthcare reforms.
Masks don’t work so why wear them? For those of you still wearing your Obedience Mask, how many more years are you going to wear them? Forever?
Imagine being able to provide more employee benefits for free at no cost to either the employer or employee. Sounds too good to be true doesn’t it? Well…………..you might be surprised or…..you might not…………….
“Is This Cuban’s IPO? Buy, Buy, Buy Now!”
Billionaire Mark Cuban’s New Firm Seeks to Reduce Drug Costs
When it comes to lowering America’s notoriously high prescription drug prices, who better to haggle on your behalf than a loud-mouthed NBA team owner best known for bullying referees and hosting a reality TV show?
Now as a matter of public record you can find out more about your PBM’s revenue streams earned from pharmaceutical drug manufacturers under a Texas statute and TDI amendment to the Texas Insurance Code.
Amish Covid — ‘No hospitalization, isolation or vaccines = herd immunity’
Victor Manes, MBA
I AM STUNNED…..I have been in the Hospital Administration/Healthcare Contracting world for 30 years and it amazes me how Health Systems are still trying to hold on to their 1980’s mentality of offering contracts at a % of billed charges.
Self-insured employers will have access to Walmart’s retail and specialty pharmacy services, prescription drugs, telehealth services, optical care, over the counter services, and community health centers.
If a district requests a Blue Cross small group proposal is Blue Cross required to provide one or does the non-compete agreement preclude them from doing so?
Financial Benefit Services and Higginbotham Combine – Employee Benefits Firm in Richardson, Texas, Joins the State’s Largest Independent Insurance Firm
Employer Reacts To Punishing Government Mandates – Vows To Terminate Health Plan
With more punishing government mandates why in hell would an employer continue to put his business at risk by continuing a traditional group health insurance plan when he could simply offer a defined contribution plan allowing employees to pick and choose individual coverage on the open market?
The Affordable Care Act (ACA), enacted into law on March 23, 2010, added Section 501(r) requirements to the Internal Revenue Code that a 501(c)(3) tax-exempt hospital must satisfy to maintain tax-exempt status. The financial assistance policy (FAP) is a requirement mandated by the ACA and implemented as part of the IRS. As per IRS 501(r), an FAP must apply to all medically necessary care provided by the hospital.
Give Me Your Poor, Your Tired, Your Huddled Masses…………..
“You may qualify for hospital financial assistance if your household income is below 350 percent of the federal poverty limit or if your annual out of pocket medical costs exceeded 10 percent of your household income in the past 12 months.”
The cost of money transfer under health insurance plans is +600% more than under a credit card transaction. Cash pay centric health plans cuts out all that wasted money……….
This agreement with Equity Healthcare marks another growth milestone for Centivo, which has now expanded into markets across the United States including Metro New York, Southern California, Central Florida, northern North Carolina, Nebraska, Iowa and Wisconsin.
The old saying “The plan pays what it’s going to pay, nothing more and nothing less” will now have to necessarily say “The plan pays what an outside arbitrator says it will pay, nothing more and nothing less.”
2016 audit of BCBSTX claims shows paid amounts for “emergent” services were in excess of ten times Medicare fees…….
Georgia’s former insurance commissioner was sentenced Tuesday to just over seven years in federal prison and ordered to pay restitution of $2.6 million on 37 counts of mail and wire fraud, money laundering, and aiding the filing of false tax returns.
A Hidden Nugget In The Affordable Care Act
By Bill Rusteberg
A Plan Sponsor may be wise to consider a risk transfer strategy through a program created by the Affordable Care Act but which few plan sponsors are aware of.
“If the proposed mandate cannot guarantee that the individual vaccine recipients are protected against breakthrough infection, nor prevent the spread of the infection to at-risk people (vaccinated or not), then the mandate is based on a false premise.”
In deference to one of our three readers, effective immediately we are prohibiting hospital people and their attorneys from reading this blog.
Mike Dendy wrote about the OPEC of Healthcare, a brilliant analogy that illustrates the intended and unintended consequences of 50+ years of unbridled growth in third party administration. It’s also a great reminder of how everything, even OPEC, can change…
An add-on service providing Reference Based Pricing legal support for possible balance bill escalations or litigation…………………
A supplemental stop-loss product for unexpected and potentially catastrophic specialty drug claims? How’s that possible………………..?
Jerry Hodge had an opportunity and the vision it took to recognize it’s potential but he didn’t have the credit or the money to seize upon it.
By Bill Rusteberg
Yesterday we reviewed a TPA Administrative Services Agreement. It was same old same old until we got to page 13.
By Marty Makary MD
If we wanted to, we could instantly slash daily Covid death rates in HALF (or more) with one pill.
Be Afraid, Very Afraid
By Molly Mulebriar
“You don’t want me to know your business because it won’t be good for you” said the physician group’s business manager some years ago.
By Bill Rusteberg
As RBP grows so will the number of new entrants into the market with improved benefits and competitive pricing. That’s good for business.
A hospital system in Colorado has now announced that they will be refusing organ transplants to all patients who haven’t received a vaccination against Covid-19.
The restaurant business is a tough business. Add to that onerous government mandates and it’s even tougher. But this restaurant owner has had enough……………….
Government dictates employers can punish employees who refuse to take a Chinese Flu vaccination…………….
Removing Financial Barriers To Health Care
This is how to remove all financial barriers to healthcare, improve benefits, and save money at the same time.
Undisclosed broker compensation can be enormous. Take the case of a Texas public school district in the Lower Rio Grande Valley who thought their broker was earning $126,000 in fees.
Stop! Don’t Sign Until You Read It!
Years ago a client signed a contract before we had the chance to review it. When we did we found the vendor was royally screwing the client with new terms and conditions not memorialized in their winning proposal.
I asked the owner who happened to be an attorney too, “Did you read the contract before you signed it?” He bowed up and said “Yes, of course I read the contract!”
“Then why did you sign it?” I countered.
Please, Oh Please, Take This Advice
By Bill Rusteberg
It’s sad how much drugs are costing these days. Most plan sponsors are simply “sucking it up” and paying for these abusively high and egregious prices funded by rate increases passed on, in part, to plan members.
“Don’t bother doing something unless you’re radically different from the competition” – Richard Branson
The Texas Schools Health Benefits Program (TSHBP) is a commercial health insurance program developed for Texas school districts by FBS, a Dallas insurance brokerage.
What happens when Wall Street takes over health care? You may not realize it, but private equity firms — which invest money for wealthy individuals, pension funds and endowments — are buying up medical practices and hospitals all over the U.S., expecting a big return on their money.
Companies and lobbying groups often paint their business foes as the primary problems with the health care system……………..
When Warner saw that his insurance company paid nearly $17,000 toward the $54,000 charge for a covid test, he first thought: “At least I’m not liable for anything”
“Granular Insurance places self-funded employers on a path of certainty with its multi-year rate and benefit guarantee: a meaningful cap on annual premium increases with moderate and predictable changes to an employers’ spec.”
Rental PPO Competitor Reacts To The News
We’ve learned there is a national PPO network active in all 50 states that works as a wrap to RBP plans for an access fee of $1.50 PEPM. This network is Medicare based and has negotiated direct provider agreements at less than 200% of Medicare.
Professional claim negotiators can often resolve balance billing issues in five days or less………..
Tired of waiting for the Texas legislature to act in addressing crippling health care costs affecting hundreds of thousands of Texas educators, in 2019 the Raymondville Independent School District in deep South Texas decided to act.
This Rx program can be offered alongside any PBM administered plan. Rx savings are significant.
A primary care centric model coupled with directed referrals and cash pay strategies is the best way to lower costs, improve benefits (by removing financial barriers to healthcare) and improve member satisfaction. Why not try it?
Centivo’s market momentum is verified by significant savings and improved clinical results………………….
