Jeff Evans, CRM, ACSF Passionate Risk/Insurance Educator-Coach-Author on LinkedIn: TO COVER OR NOT TO COVER - THAT IS THE QUESTION Here's a great post from… (2024)

BULLSEYE!!!Dean Jargo hit it right on in this post. Most employees do not realize what "good" benefits are, much less "great" benefits.But the reality is that employers can provide great benefits without increasing cost by just using a more strategic approach. One developed with an advisor who's interests are aligned with their, and transparent. Yes, it is possible to reduce costs for both the employer and their employees and increase the quality of care while reducing the overall cost for the employer's health plan. Other employers are already doing it. And those os us that are committed to changing the status quo can help employers who are ready for a change.

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Great post from Kimberly Carleson! She points out something most employers do not realize, the Big Health Insurance companies are paying their claims haphazardly, with minimal if any review. It's not their money so why should they worry about it. The reality is that they're more interested in keeping their provider network partners happy, at the expense of employers and members. They've successfully sold the "Big Lie" to most employers, that there is nothing that can be done about the rising cost of healthcare. The BUCAs use "Big Lie" as cover for their egregious claims paying tactics. Including collecting a 30% fee on claims they recoup that should have never been paid in the first place. Basically, they gat a bonus for making mistakes, whether unintentional or not.There are other options available to employers, they just have to look at them.

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Great post from Dave Chase! How long do we continue to allow our healthcare system to grow at the expense of our communities. They no longer serve the communities, but rather extort them and syphon off resources from the community to add to their revenues. Greed and growth over patients, care and community.

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TIME TO BAN PHARMACEUTICAL ADVERTISING?This is most likely wishful thinking since BIG PHARMA and PBMs spend so mocu mony lobbying, but It would sure help control the cost of prescription drugs, even if it's just be eliminating the billions spent on commercials, ads, etc.The really messed up part of all this advertising is that “fewer than one-third of the most common drugs featured in direct-to-consumer television advertising were rated as having high therapeutic value.”I'll say that again FEWER than 1/3 of the most common drugs advertised were rated as having high therapeutic value. Of course , the adds make them sound like the greatset thing since sliced bread, unless you listen the the disclaimers, "could cause . . . , don't take if allergic to . . ." https://lnkd.in/gvSrg6hM

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Great review of how the Big Pharmacy Benefit Managers manipulate employers and employees for profit over health. Employers have been hood-winked by obfuscation and deception.One of the biggest con jobs is "rebates". Really? How is overpaying for something just to get a portion of the overpayment back a good thing?Think about it like this: - Brand name drug "A" treats XYZ ailment, costs $10,000/month and pays a rebate of $3,000/per fill (30 day qty.). - Alternative therapeutic equivalent drug "B" with equal or higher efficacy costs $4,000/month but pays no rebate. - Employer lets PBM keep drug "A" on formulary over drug "B" for rebates. - Net Annual Cost of Drug "A" is $84,000 ($120,000 - $36,000 in rebates) - Net Annual Cost of drug "B" is $48,000 (no rebates) - Opportunity Cost: -$36,000 or +$36,000? - "But we got a $36,000 rebate . . ." - No, you overpaid by $72,000 to get a $36,000 rebate (your money back) and gave your PBM a $36,000 contribution to their profits instead of yours. The other games played on employers are just as bad.

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Here's a great post from Dean Jargo. He is absolutely right. The Big Health Insurance companies allow an astonishing amount of claims to be paid fraudulently, adding to their profits at the expense of employees and their health plan members. It is critical that employers put a stop to this abuse for both them and their employees. For employers, this is not only an issue of managing cost, but their fiduciary obligation to manage plan assets. Yes, employers are fiduciarily liable for this fraudulent abuse of plan assets and overcharging to employees/plan members.

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Here's an article addressing a currently under-utilized tool in managing both cost and quality in employer health plans. I am a firm believer in the value Virtual Care provides to health plans and their members. However, Virtual Specialty Care has even more potential to help those members with more significant health issues get the care they need by being more cost effective for members and the health plan, more accessible for members, and delivering both with the use of high-quality providers.From my perspective the accessibility is huge. Most employees/health plan members don't know where to start in finding a high-quality specialist. Also, the ability to access these specialists virtually allows for much more flexibility in scheduling an appointment by eliminating the need to physically drive to an appointment. And both the flexibility in seeing the specialist and the reduced cost contribute to the adherence of the necessary treatment plan.This is a great tool for ensuring health plan members can access the high-quality care they may need, with the added benefit of better managing the cost and quality of their care.

This is an interesting article discussing inefficiency in our current healthcare system. This is also a contributor to the high cost of healthcare.The fact that there are more administrative personnel than healthcare professionals in our current system should be concerning to all. "Research has shown that there aretwice as manyadministrative staff as there are clinicians working in U.S. healthcare. There areover 22 millionhealthcare providers in the United States."Also, consider that many of those additional positions are senior executives with littel or no medical training or experience, but paid substantial salaries, many higher than the highest paid healthcare providers delivering care.A great example of the inefficiencies is still completing paper forms and submitting them via fax versus completing electronically and uploading or emailing them. Two administrators for every one healthcare provider? Really? That's a lot of overhead.

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Mark Cunn=ban's response to getting into the pharmacy space is great! "It's the easiest industry I've been in to disrupt," Mr. Cuban said.Why is it so easy to disrupt? Because it's so complicated, unnecessarily, and som any intermediaries have their fingers in the pie that when you introduce a simple, affordable, easy-to-use competitor it takes off. People know what the prices are and it's very transparent.Go figure, who'd have thunk someting so simple would take off compared to the vague, opaque, confusing version?

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