Risk Managers – Page 38 – Thought Leadership on Health Insurance

Life After Death

“All my medical training told me you were either alive or dead. There was no in-between. But suddenly, I was reading from a cardiologist describing patients who had died, then come back to life, reporting very distinct, almost unbelievable experiences.”

America’s Big Three Entitlement Bankruptcies Are Inevitable

BY Stephen Anderson

America’s federally sanctioned entitlement programs, Medicare, Medicaid, and Social Security, each face bankruptcy in the next few years. Medicare and Medicaid were created in 1965 as part of President Lyndon Johnson’s Great Society legislation. Social Security was created in 1935 to provide retirement income for Americans who reached the age of sixty-five. These three entitlement programs consume about fifty cents of every federal budget dollar, or $2.7 trillion in fiscal year 2023.

How Do PBMs Get Away With It?

What an easy question! First they arbitrarily inflate the price…………

Texas County Enjoys Flat Medical Spend

Referred by Ron Barshop

Montgomery County has saved $10-$12 million on urgent care visits and $100,000 in labs which has kept medical spend flat for two years.

Brownsville ISD To Enter The World of Aquarius

Next Friday the largest employer south of San Antonio will be conducting a public interview of 14 vendors who responded to their Request For Proposals for administration of their self-funded health plan. This poses an excellent opportunity to ask questions, an opportunity not to be wasted.

Aldeen’s Sunday Morning Bathroom Read

Another Sunday Bathroom Read By Doug Aldeen – A Weekly Series

“The New York Times reported in June that Minneapolis-based Allina Health had an explicit policy to cancel outpatient appointments for patients with at least $4,500 in unpaid medical debt.”

Chip Pushes DPC For Veterans

The bill allows veterans the option to enroll in direct primary care……

Hiring Anyone By Default Is Never A Good Idea

You don’t know who you hired but you sure as hell know who you fired……………

U.S. Drug Prices Are Outrageous

List prices in other nations are significantly 10 times less: In France, Australia, the U.K., Sweden the Netherlands and Germany, Ozempic is between $80 and $100, according to the analysis.

Meet The World’s Youngest Healthcare Billionaire

SOURCE: Meet the world’s youngest healthcare billionaire

Claire Wallace – Wednesday, August 23rd, 2023

Ludwig Theodor Braun, 33, is the world’s youngest billionaire who earned his fortune in healthcare, according to Forbes’ live net worth tracker.

Pool Filter Insurance Anyone?

You Want How Much!

If people would shop around for health care like they do for everything else they would be amazed at the savings they can achieve.

Set Rules Before Engaging A John To Avoid An Uncompensated Screwing

By Charles Specht, CIC, CDA – Charles Specht, CIC, CDA – Helping P&C & EB Brokers win new clients as I negotiate lower insurance premiums for Business Owners by as much as 55% annually

Do you ever set the “Rules of the Game” with your prospects BEFORE you go through the quoting process? You should! If you don’t, this will happen…

Lawyers See Gold In Them Darn Hills Yonder

Schlichter Widens Net for Fiduciary Claims

That next wave of fiduciary litigation seems to be expanding, based on social media outreach by the law firm of Schlichter Bogard.

If You Want To Know Why………..

By Dutch Rojas – Educating Patients, Doctors, Self-Insured Employers, Nurses, Benefits Leaders about healthcare

If you want to know why employers must provide benefits…….

Ozempic – Parlez-vous Français ?

Cela va vous énerver énormément …………………….

A one-month supply of Ozempic has a list price of $936 in the U.S., according to the report, while it cost just $83 in France and $87 in Australia.

“The Only Thing A Son-Of-A-Bitch Understands Is Another Son-Of-A-Bitch”

By Bill Hennessey, M.D.

Give the Hospitals a Taste of Their Own Medicine – Hire CareGuides Advocates CGA helps save money before and after care occurs.

Cliff Dwellers or Half Pregnant Tulip Lovers?

The problem is there is no such thing as being half pregnant. A half pregnant approach only extends and aggravates any pain associated with change and simply takes longer than necessary to achieve the end goals which are lower costs, better benefits and higher wages.

We’re On To Your Specialty Drug Strategies!

“We don’t cover specialty drugs”

Plans requiring members to seek manufacturer patient assistance for expensive specialty drugs as a prerequisite for coverage through a side agreement have caught the attention of pharmaceutical manufacturers.

Field Rate A RBP Group Plan

Use the chart below to develop composite rates for a typical RBP plan. Then compare to your tradition managed care plan. This will give you an idea of the savings to be achieved.

Ending Discrimination In Healthcare

“Where you go for health care is your business, how it’s paid is ours” – Bill Rusteberg

Drug Dealer Enjoys Higher Profits

CARDINAL HEALTH: Profits Up – Posted on August 19, 2023 by Dr. David Edward Marcinko MBA – By Staff Reporters

Pharmaceutical distributor Cardinal Health raised its 2024 profit expectations following strong demand for generic and specialty drugs such as GLP-1 medications, the company announced in its Q4 2023 earnings call.

Medical Debt In Texas

By JEANNE PINDER, the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded… More by Jeanne Pinder

What’s The Message Behind Doors #1 & 2?

Beware! Monsters and Demons lurk behind Door #3

DOOR # 1

The Oxbridge platform has been designed to move up to 50% of an employer’s annual health benefit spending into episode of care programs. This enables a radical level of transparency into the underlying costs of care and gives covered beneficiaries a way to avoid the crushing out of pocket costs that have become standard in traditional HMOs and PPO plans. Episode Benefit Plans represent the first truly unique new health benefit offering since the introduction of PPOs and Point of Service Plans in the late 1980s.

Maintaining Grandfather Status

By Patrick Henry

Plan sponsors must weigh the difference between government diktats and pragmatism tied to personal beliefs and monetary constraints.

Why Blue Shield of California Ditching CVS Could Upend Drug Plans

“The decision was partly driven by CVS’ hesitancy earlier this year to cover a cheaper generic version of Johnson & Johnson’s prostate cancer drug Zytiga……”

Risk Transfer Strategy Overlooked By Most Plan Sponsors

Why Pay For Health Insurance For Those That Don’t Need It?

Multiplan Cartel – “Mafia Enforcers For Insurers”

Article Referred by Bob Calvisi

“MultiPlan knows it can get away with acting, in the words of an analyst, ‘like a mafia enforcer for insurers,’ because virtually every commercial healthcare payor has agreed to use its repricing methodology, leaving healthcare providers with no practical option but to accept the ‘repriced’ reimbursement amount that MultiPlan imposes……….”

There Are Over 32,000 Generic Drugs & +90% Cost Less Than $20

More plan sponsors are wondering why they are covering brand name and specialty drugs when there are over 32,000 generic drugs to choose from.

Not For Profit Hospital To Build $2.5 Billion Facility In Austin, Texas

Not for profit hospitals like this one don’t pay taxes. In return Uncle Sam mandates they must have a financial assistance policy in place to help those in the community who can’t afford health care. A $2.5 billion hospital is probably gonna be some kind of expensive for most people, even those with health insurance.

How To Stretch A 10 Second Decision To Infinity

A True Story

Take a ten second decision where everyone wins and nobody loses to a political subdivision then start your stop watch. You will be amazed how long a 10 second decision actually takes.

Billy Eats Your Medical Bills

Billy is a new website that allows you to compare hospital prices for healthcare services. The prices are based off of hospitals’ own pricing data that the Federal Government requires them to release to the public.

Milton Thinks You Should Know How The System Works

“You really don’t understand, do you? If we approve expensive drugs, then the system goes broke. Then no one gets healthcare……Plus, if I approve too many expensive drugs, I won’t get my bonus at the end of the month. So giving out too many approvals wouldn’t be a smart thing for me to do. Would it?”

The Hidden Fee Costing Doctors Millions Every Year

by Cezary Podkul

A powerful lobbyist convinced a federal agency that doctors can be forced to pay fees on money that health insurers owe them. Big companies rake in profits while doctors are saddled with yet another cost in a burdensome health care system.

The Most Important Story of This Year

By Chris Deacon on Linkedin

This may be one of the most important stories of this year, if not the most important. Not because it highlights one more way insurers and middlemen extract vast profits from the healthcare industry. Rather, it perfectly illustrates why trust in the system and its regulators is beyond broken.

West Texans

There’s something about West Texans. They’re different.

Kraft Heinz vs Aetna…..Why Now?

Kraft Heinz Sues Aetna Health Insurance Company… Why Now? Kraft Heinz claims that Aetna inappropriately administered their employee health plan since 2012.

98% Of Americans Are Clueless About The American Health Care System

By Dutch Rojas – Educating Patients, Doctors, Self-Insured Employers, Nurses, Benefits Leaders about healthcare

The Biggest Con In History

Victor Lustig

Victor Lustig would be proud…………..A 4,500 life Texas school district has been conned into believing they are getting free ASO claim administration

Excessive Fee Litigation Spreads to Self-funded Health Plans

“Plan sponsors may be exposed to fiduciary liability of their own if they do not pursue claims against their TPAs for excessive fees and fraudulent practices”

23% Premium Increase = 15% Commission

By Spencer Smith

It’s time to put your thinking cap on…Should you build commission into your employer’s stop loss premium or work off a direct consulting fee? That’s for you to answer, not me, but here is the math…

End Restrictions On Physician Owned Hospitals To Expand Quality Care

“Charges at existing physician-owned hospitals for eight common procedures were one-third lower than what a traditional hospital charged in the same markets…..”

Only Sex Pistols Can Solve Healthcare

“Raw, rude, and a rejection of everything……………completely different operating philosophy……………………an innovation shock…………… nothing was sacred”

Senators Push IRS To Launch Nonprofit Hospital Probe

By Sarah Owermohle Aug. 8, 2023

WASHINGTON — A bipartisan group of senators wants federal tax regulators to probe nonprofit hospitals’ compliance with community benefit requirements, ratcheting up a longtime campaign to hold the tax-exempt providers accountable.

Over 100,000 Doctors Quit Health Care In 2021

Over 100,000 physicians quit healthcare in one year alone — 2021 — and this exodus is continuing………………….

Agriculture Risk Management

The Vital Role of Crop Insurance: Protecting Farmers, Ensuring Food Security, and Strengthening Rural Economies

A World Without Prices

Somehow, hospitals and insurers continue to get away with only providing estimates and not actual prices for their services and procedures. This allows our healthcare system to remain rigged for their profit and to the detriment and demise of patients, families, communities, tax payers, unions, employers, and municipalities across the country.

Mexican Counterfeit Medication May “Contain Deadly Doses of Fentanyl”

Fentanyl is a synthetic opioid far more powerful than morphine, and it has been blamed for about 70,000 overdose deaths per year in the United States. Mexican cartels produce it from precursor chemical smuggled in from China, and then often press it into pills designed to look like other medications.

This Is What Happens When Gov’t Interferes With Health Care Delivery

Ron Barshop on Linkedin

State of Texas HHS has a wall with a chart 3-4x more complex than this. It was impossible plumbing to comprehend. I asked 20 years ago of a state health care leader there “does anyone here understand all this ?” He smiled in that big Texas way and just looked down chuckling. ACA btw has likely added way more boxes, triangles, ovals and pipes.

What’s Driving Auto Insurance Premium Hikes?

“It’s probably the worst period for auto insurers in 30 years at least”

Holy Grail Cancer Drug?

Scientists have developed a holy grail cancer drug that kills all solid cancer tumors while leaving other cells unharmed…………..

The Tail Is Wagging The Dog

By Bill Hennessey, M.D.

“Earth to employers/employees – BUCA networks permit 1,000% pricing variation for the same care in the same city in the same network. PHCS permits over 2,000% pricing variation. 80% of you don’t meet your deductible so you are paying out-of-pocket cash for all care.”

Aldeen’s Sunday Morning Bathroom Read – Nope Edition, Part 1

Sunday Morning Bathroom Read (“Nope” Edition Part I/And yes, it is a two part series):

Quit Hiding Your Fees In The Fixed Costs!

Hiding fees in claims is a long practiced tradition in American health care finance. Just about everyone seems to be in on the take.

Famous So. Texas Rodeo Goat Brings Community Together

Willy the Texas rodeo goat, on the lam for weeks, has been found safe

HOUSTON (AP) — Willy the rodeo goat, who has lassoed the hearts of residents in a rural South Texas county ever since she escaped from an arena enclosure July 15, has been found.

Healthcareistan

The Legal Cavalry Has Arrived

The “worst” result Health Rosetta team has driven is a 20% absolute reduction in per capita spending while health plans/outcomes dramatically improved. The secret behind that has been Health Rosetta’s largest investment — assembling the Dream Team of attorneys who have leveled the contractual playing field.

Cash Pay Provider Network

Connecting Health Plans with the Largest Cash Pay Marketplace

University of Texas Dropping Weight Loss Drug Coverage

The UT System’s decision comes after Ascension, a St. Louis-based health system with 139,000 employees, made the same decision to no longer cover weight loss drugs under its employee health plan.

Biden Administration Wants More Adderall For Attention Deficit Americans

Adderall Shortage Has US Agencies Urging Drugmakers to Boost Output

Story by Ike Swetlitz • Yesterday 4:56 PM

(Bloomberg) — US drug regulators and law enforcement officials asked pharmaceutical companies to manufacture more Adderall, an ADHD medication that has been in short supply for nearly a year.

Employers Cut Off Access to Weight-Loss Drugs for Workers

By Bryce Heinbaugh on LinkedIn

All we needed to see was proof other large employers are courageously putting a stop to covering these drugs for weight loss as it is unsustainable.

Actuaries advising us to prepare our clients for as high as 15% increases in claims costs next year because of these weight loss drugs, especially to our struggling public entity clients like schools and municipalities who are facing layoffs and further cuts.

Employers Are Fighting For Their Healthcare Data

Hello hard working brokers!

In my continued effort to educate and inform, here is more information about what employers are doing (fighting) for data that shows how their health plans overpay for care. Please click on this Bloomberg news report released today to learn more.

The Immortal Henrietta Lacks

SOURCE: HeLa – Wikipedia

In 1951 a 31 year old women was admitted to the John Hopkins Hospital with symptoms of irregular vaginal bleeding, and was subsequently treated for cervical cancer.