Jeff Evans, CRM, ACSF Passionate Risk/Insurance Educator-Coach-Author on LinkedIn: Great post from Dave Chase! How long do we continue to allow our… (2024)

Here's another great post from Chris deacon illustrating someting I've said for years, "Medicine is no longer about our health and a relationship with our doctor. It's Big Business, and the capital 'B' stands for 'Billions' in revenue."Chris hits the nail right on the head, "It is profoundly unsettling that our hospital systems, once a trusted institution responsible for the well-being and care of human lives, have shifted towards solely a profit driven enterprise; where people are assessed not for their healthcare needs but for their revenue potential. This deeply dehumanizing approach, as exemplified by the language used by companies like Personify Health isn't just disappointing; it's abhorrent."As an employer sponsoring a health plan, a plan member, patient, consumer and human being, it is critical you understand your role in or healthcare system and how to protect yourself and those around you. You are your best advocate. If you're not sure how to tackle this issue reach out to myself or one of the other forward thinking advisors that are moving against the status quo to help employers and their employees "win" in a healthcare system that has been rigged against them by the BUCAs, healthcare systems, Pharmacy Benefit Managers and Big Pharma. We are transparent in how we work and align our interests with those that we work with.

Another great post from Kimberley Carleson shining a light on the claims paying practices of the Big Health Insurance companies! If your health plan administrator is one of the BUCAs, you have to ask yourself "Why wouldn't they want to save $500K-$600K? Especially if it's my money!" How far could that $500K-$600K go if reinvested in your business?Also, if your current broker isn't bringing this to your attention, you shouold probably be asking "Why?". Why are they okay recommending a company that's stealing from you?Is it because the higher the claims, the higher the increase at renewal, and the higher the increase in their commissions? Are they being paid an additional bonus for keeping you with that carrier? Are their interests really aligned with yours?

I ran across this article on ICHRAs and wnat to share a few thoughts.While I do beleive they have a particluar niche in the market place, I do not beleive they are the end all, be all solution some believe they are.There are a lot of great aspects to them, however, they are based on the individual medical insurance market which is currently very limited. Individual medical plans are primarily HMO-based with limited networks, and premims that don't seem overly competitive. And, I'm not sure how this is going to enhance the doctor-patient relationship as the article mentions.Additionally, these products do nothing to change the trend of increasing premiums out-of-pocket costs, and perpetuate the flaws in our current fee-for-service healthcare market. Also, having done numerous employee enrollments, I do not beleive all employees want to take on the responsibility of making their own choices in coverage.These are just a few of my concerns. If the individual market were different, more viable, sustainable and affordable products were available, then I could see ICHRAs as a stronger option. Just my 2¢.

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Here's a great post form Taylor Davis addressing the need for employer health plans to be audited, especially when the BUCAs manage, or as the article points out, mismanage their plans. Overpayments, fraud, and abuse in claims paying can happen to any employer. The questions is "what do you do about it?" Contribute to someone else's profits or save those funds for the benefit of your own company?

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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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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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