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Search: Posts Made By: WhosOnFirst
Forum: Health - Disability Today, 11:23 AM
Replies: 15
Views: 299
Posted By WhosOnFirst
That makes sense. Good luck trying to justify...

That makes sense. Good luck trying to justify that to the regulators if they notice the slopes are different. Your best bet is to file under two different licenses in my opinion so that it doesn't...
Forum: Health - Disability Yesterday, 11:16 AM
Replies: 15
Views: 299
Posted By WhosOnFirst
A strict reading of the ACA prevents using...

A strict reading of the ACA prevents using different slopes by area. It has been a couple of years since I was deep into ACA products but in practice I saw carriers using both 1 and 2 to varying...
Forum: Health - Disability 01-16-2019, 10:59 AM
Replies: 315
Views: 57,288
Posted By WhosOnFirst
Two questions on the chart. For J&J is that just...

Two questions on the chart. For J&J is that just their drug business or is it encompassing on all their product lines? What costs are all included in the marketing bucket and the R&D bucket? In...
Forum: Health - Disability 12-12-2018, 12:07 PM
Replies: 35
Views: 3,888
Posted By WhosOnFirst
Another new study from an ACO association. ...

Another new study from an ACO association.

Article: https://www.forbes.com/sites/brucejapsen/2018/12/12/as-acos-face-change-group-touts-2-7-billion-medicare-savings/#1a29440b2453
...
Forum: Health - Disability 10-09-2018, 02:32 PM
Replies: 35
Views: 3,888
Posted By WhosOnFirst
It may have been me, the price increase due to...

It may have been me, the price increase due to elimination of the lifetime max was between 1% and 5% depending upon the product. Most of our plans at the time were closer to the 1% range. The...
Forum: Health - Disability 10-08-2018, 10:57 AM
Replies: 35
Views: 3,888
Posted By WhosOnFirst
We used to do that pre-ACA. It was lifetime...

We used to do that pre-ACA. It was lifetime limits but people hated them. Personally, I have a hard time justifying $1 million plus expenses for myself. Frankly, I'm not certain my NPV is worth it.
Forum: Health - Disability 09-21-2018, 11:55 AM
Replies: 35
Views: 3,888
Posted By WhosOnFirst
https://www.forbes.com/sites/brucejapsen/2018/09/2...

https://www.forbes.com/sites/brucejapsen/2018/09/21/move-to-population-health-hits-hospital-finances/#59bd241d78fb

This article shows that there is about a 1% decrease in hospitals margins that...
Forum: Health - Disability 09-14-2018, 05:34 PM
Replies: 35
Views: 3,888
Posted By WhosOnFirst
Regarding a conflict between primary care and...

Regarding a conflict between primary care and hospital utilization. I've performed several studies on wellness initiatives and PCP utilization. Every study I've done has shown an increase in the...
Forum: Health - Disability 09-14-2018, 10:59 AM
Replies: 8
Views: 735
Posted By WhosOnFirst
This all makes sense. It seems similar to how an...

This all makes sense. It seems similar to how an auto mechanic will charge for parts. What they bill for the parts is not necessarily what they paid for the parts.

Seeing the margins laid out in...
Forum: Health - Disability 09-13-2018, 05:17 PM
Replies: 8
Views: 735
Posted By WhosOnFirst
PBM/Pharmacy Pricing Spread

https://www.bloomberg.com/graphics/2018-drug-spread-pricing/

I found this article interesting. I was vaguely aware of how PBMs make their money but I hadn't known about it in this detail. Does...
Forum: Health - Disability 09-13-2018, 11:15 AM
Replies: 35
Views: 3,888
Posted By WhosOnFirst
You nailed it exactly, what I was seeing was...

You nailed it exactly, what I was seeing was regression to the mean. The problem with the specific programs I was looking at is that there were only 20-40 enrolled and they were selected primarily...
Forum: Health - Disability 09-12-2018, 12:13 PM
Replies: 35
Views: 3,888
Posted By WhosOnFirst
I haven't worked a lot with ACOs. The few...

I haven't worked a lot with ACOs. The few situations I did work with were fairly narrow and the contracts with the provider paid the provider a portion of the PMPM difference from year 1 to year 2. ...
Forum: Health - Disability 09-11-2018, 11:06 AM
Replies: 35
Views: 3,888
Posted By WhosOnFirst
ACO Savings

I read an article about ACO savings. There is a link to the actual study in the story.
...
Forum: Health - Disability 08-31-2018, 10:12 AM
Replies: 67
Views: 9,900
Posted By WhosOnFirst
I agree. I'd submit the documentation that you...

I agree. I'd submit the documentation that you have to your state DOI and ask that they investigate this "doctor". I'm surprised your carrier didn't investigate for fraud. Although, they may have...
Forum: Health - Disability 08-13-2018, 10:54 AM
Replies: 12
Views: 3,146
Posted By WhosOnFirst
It is very hard to tell from the ACA if narrow...

It is very hard to tell from the ACA if narrow networks had a downward effect on costs. There was so much changing all at once. The companies that have been most successful were historically...
Forum: Health - Disability 08-10-2018, 10:05 AM
Replies: 12
Views: 3,146
Posted By WhosOnFirst
Thanks for this! So this isn't some new...

Thanks for this! So this isn't some new disruptive trend but rather a contracting by GM with a different TPA.
Forum: Health - Disability 08-09-2018, 10:04 AM
Replies: 9
Views: 1,148
Posted By WhosOnFirst
:iatp: I always think of a claim as a single...

:iatp:
I always think of a claim as a single bill submission. A single medical event can have multiple claims. A single claim can have multiple procedures or charges.

It sounds like you have an...
Forum: Health - Disability 08-09-2018, 09:55 AM
Replies: 12
Views: 3,146
Posted By WhosOnFirst
The market is moving away from broad networks and...

The market is moving away from broad networks and towards narrower networks. GM is self-funded so having this option for their employees is not necessarily something that out of the ordinary. I...
Forum: Health - Disability 07-12-2018, 10:32 AM
Replies: 12
Views: 2,503
Posted By WhosOnFirst
I'm not certain what CMS changes you are...

I'm not certain what CMS changes you are referring to but I'm guessing this falls into the Medicare realm which is outside my area of expertise. In the Medicaid market, there has been a significant...
Forum: Health - Disability 07-11-2018, 09:45 AM
Replies: 3
Views: 1,027
Posted By WhosOnFirst
I'm not familiar with trauma fees in specific but...

I'm not familiar with trauma fees in specific but from the article it sounds like this is a service provided that goes above and beyond a normal ER visit type situation. Since invoking these trauma...
Forum: Health - Disability 07-09-2018, 09:11 AM
Replies: 163
Views: 22,815
Posted By WhosOnFirst
How can the RA program be anything other than...

How can the RA program be anything other than budget neutral? I mean unless all the carriers are incorporated in Lake Woebegon where they can all be above average risk.
Forum: Health - Disability 07-09-2018, 09:03 AM
Replies: 12
Views: 2,503
Posted By WhosOnFirst
I'm not jaded enough to go quite that far. ...

I'm not jaded enough to go quite that far. Insurers have been looking for ways to get out of paying for every itemized thing for quite some time. It makes predicting costs a lot easier if you pay a...
Forum: Health - Disability 07-06-2018, 09:30 AM
Replies: 163
Views: 22,815
Posted By WhosOnFirst
This seems really weird to me. I mean, the...

This seems really weird to me. I mean, the calculations to generate RA aren't hard and they must have all of the code written to do it. The only thing I can think of is if some large carrier didn't...
Forum: Health - Disability 07-05-2018, 10:15 AM
Replies: 12
Views: 2,503
Posted By WhosOnFirst
My opinion, take that for what it is worth, is...

My opinion, take that for what it is worth, is that very little of the push toward value instead of volume is evidence based. There is some evidence that in my company that value based contracting...
Forum: Health - Disability 07-03-2018, 09:52 AM
Replies: 163
Views: 22,815
Posted By WhosOnFirst
Ooooh. I remember those. Are they as much fun...

Ooooh. I remember those. Are they as much fun now as they were two years ago?
Showing results 1 to 25 of 78

 

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