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Risk Managers Blog 02/18/2020 09:12
Turning Bronze Plans into Gold Plans at Bronze Plan costs is a common but unspoken strategy……………but who is benefiting from “beating the system?” By Bill Rusteberg Hospitals have been turning Bronze into Gold to the benefit of plan members unfortunate enough to be victims of cost shifting by plan sponsors. Facing double digit rate increases […]
Risk Managers Blog 02/15/2020 10:40
“China’s stated aim is to become the pharmacy to the world with its own companies. And what we’re seeing with Western generic drug companies, they’re collapsing because they can’t compete.” Expert: China Has ‘Global Chokehold’ on Medicine, Can Shut Down Our Pharmacies, Hospitals in Months ROBERT KRAYCHIK 14 Feb 20201709 China could effectively shut down […]
Risk Managers Blog 02/14/2020 12:40
How do we know we are doing much better this year than last year? What was this year is the last year plus or minus this year’s change. If change is the only constant why do we need to measure it? You don’t know if something is better if you didn’t know how to measure […]
Risk Managers Blog 02/13/2020 09:16
You won’t see recognizable logos or insurance company names on their health insurance I.D. cards. You may wonder “what kind of insurance is this?” The Rise of Reference Based Pricing By Bill Rusteberg For 35 years we have lived in the world of managed care. Consumers have been conditioned to believe networks of “preferred” providers […]
Risk Managers Blog 02/10/2020 07:37
“If a hospital (y) later turns down “two times Medicare (2x) and it goes to court, their lawyer is going to say, ‘We could lose this thing……………………..” 200% of Medicare represents a “savings” over a typical 60% PPO discount? Quizzify’s Surprise Medical Bills Solution Featured in New York Times Those of you who automatically delete […]
Risk Managers Blog 02/08/2020 11:36
Rather than kicking the can down the road to the next legislative session, TRS ActiveCare trustees should take note and consider adoption of newer, proven risk management strategies as other risk pools have done………………………. 8 February 2020 By Bill Rusteberg Tired of waiting for the Texas legislature to act in addressing crippling health care costs […]
Risk Managers Blog 01/30/2020 16:31
After satisfying their initial waiting period averaging 47 years, approximately 30% of the American workforce is eligible for special health care pricing while the remaining 70% aren’t. Paying for it during their entire waiting period, they deserve better pricing……………….. “The share of people age 65 to 74 in the workforce is projected to reach 30.2% […]
Risk Managers Blog 01/29/2020 17:43
The RFP is essentially requesting the services of an assortment of experts……………. The successful candidate will necessarily need to bring a team of experts to the table to include the following disciplines: actuary, legal, provider relations, forensic accounting and claim auditor. The winner may be either a large nationally known firm with all the internal […]
Risk Managers Blog 01/26/2020 16:31
“It’s time we cut out the middleman and get our citizens the savings they desperately need.” Bill to eliminate third-party pharmacy benefit managers could save state millions by Destiny Washington Friday, January 24th 2020 OKLAHOMA CITY (KOKH) — Oklahoma could soon join the growing number of states backing away from using Pharmacy Benefit Managers (PBM’s) to administer […]
Risk Managers Blog 01/25/2020 12:45
Progressive plan sponsors are either half pregnant flower lovers with a passion for tulips or cliff dwellers not afraid of sharks. By Bill Rusteberg There is a growing trend among progressive brokers, consultants and third party administrators pushing alternate payment methods for medical care givers. All share two things in common – (1) They understand […]
Risk Managers Blog 01/24/2020 17:23
The purpose of this event is to inform employers, brokers, legislators and regulators about emerging initiatives to expand access, improve quality and reduce the cost of health care. – Dan Meylan Jan 24 at 3:27 PM Allied National is a pioneer in the small group level funded market and one of the first third party administrators to embrace reference based pricing and create a direct primary care wrap plan. […]
Risk Managers Blog 01/24/2020 16:22
The fatality rate may be comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally…………… Most seasonal flu viruses have a case fatality rate of less than 1 in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case […]
Risk Managers Blog 01/22/2020 19:30
Texas Detainee demands immediate release, $5,000,000 and medical care………… Detainee files complaint alleging lack of adequate medical care Posted: Tuesday, January 21, 2020 9:00 pm BY ERIN SHERIDAN Staff Writer An undocumented man with Parkinson’s disease has filed suit against a Willacy County ICE detention center and the private, for-profit prison contractor that manages the […]
Risk Managers Blog 01/22/2020 16:33
The private market will offer new funding strategies for employer-sponsored health plans…… Health Policy Predictions for 2020 SOURCE: MZQ Consulting (www.mzqconsulting.com) Our last post listed health policy developments that happened at the end of 2019. This time, we are looking into our crystal balls and making some friendly health policy predictions for 2020. States Will Take the […]
Risk Managers Blog 01/22/2020 16:04
Emergency room physicians are a different breed. They don’t often join managed care networks. They serve a captive audience. The only emergency room exit door is to the billing department. They charge an arm and a leg. They are the Balance Bill Kings of Health Care because they almost always do and never, almost never, […]
Risk Managers Blog 01/20/2020 09:33
Under prevalent status quo heath plans, cost containment means higher deductibles, higher out-of-pocket expenses, less choice. All are impediments to health care. On the other hand, under Reference Based Pricing plans, cost containment means lower deductibles, lower out-of-pocket expenses, more choice. There are less impediments to health care. WORKSPAN DAILY | JANUARY 14, 2020 Self-Funded Employers Driving […]

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