Micro-Dot Image of Heretofore Secret Health Care Strategium
Mulebriar’s elite undercover investigators have successfully infiltrated (Name Redacted) hard copy files located on a desolate ranch in deep South Texas to which no roads lead.
“We knew they were up to something new and exciting but rather than relying on rumors we decided to act” said Molly Mulebriar while relaxing at her favorite watering hole in Waring, Texas on a hot Texas afternoon in August. “The challenge was finding the truth with hard evidence to back it up, so we did.”
Material gained from the investigation (including the Micro-Dot image shown above) outlines an unusual risk management strategy for self-funded group medical plans.
Instead of a traditional TPA centered plan, the strategy employs a direct-to-provider cash reimbursement strategy generating plan savings far in excess of either traditional managed care plans or Reference Based Pricing plans.
An internal memo states “Our strategy removes the middle men and reestablishes direct patient-to -provider relationships. Everyone wins, the member, the provider, and the plan.”
Claims are paid in real time, including office visits. Plan members have no financial responsibilities unless they prefer to seek medical care the old fashion way.
All primary care referrals are handled by the plan, not the primary care physician. “We have found primary care physicians happily give up the referral process responsibility” states an internal memo.
Selected pharmacies are paid in cash every two weeks, removing the PBM middleman for even more savings. “We pay local pharmacists their cost plus a margin” one memo stated.
The TPA remains the backroom record keeper for stop loss insurance purposes.
When asked which organization her crack team infiltrated, Mulebriar shrugged, ordered another Lone Star beer and replied………………“Ask me when Happy Hour ends…….”
For those who know Mulebriar, Happy Hour never ends…………………………..
