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Forum: Health - Disability 09-21-2018, 10:55 AM
Replies: 17
Views: 898
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, 04:34 PM
Replies: 17
Views: 898
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, 09:59 AM
Replies: 8
Views: 258
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, 04:17 PM
Replies: 8
Views: 258
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, 10:15 AM
Replies: 17
Views: 898
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, 11:13 AM
Replies: 17
Views: 898
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, 10:06 AM
Replies: 17
Views: 898
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, 09:12 AM
Replies: 64
Views: 6,445
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, 09:54 AM
Replies: 12
Views: 1,653
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, 09:05 AM
Replies: 12
Views: 1,653
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, 09:04 AM
Replies: 9
Views: 661
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, 08:55 AM
Replies: 12
Views: 1,653
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, 09:32 AM
Replies: 11
Views: 1,353
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, 08:45 AM
Replies: 3
Views: 841
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, 08:11 AM
Replies: 163
Views: 21,481
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, 08:03 AM
Replies: 11
Views: 1,353
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, 08:30 AM
Replies: 163
Views: 21,481
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, 09:15 AM
Replies: 11
Views: 1,353
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, 08:52 AM
Replies: 163
Views: 21,481
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?
Forum: Health - Disability 06-27-2018, 08:57 AM
Replies: 95
Views: 5,879
Posted By WhosOnFirst
I'm not certain that the law didn't intend for...

I'm not certain that the law didn't intend for exactly what yoyo is planning on doing. My interpretation of the structure of the ACA is that it is intended to encourage early retirement. By linking...
Forum: Health - Disability 05-25-2018, 09:04 AM
Replies: 279
Views: 49,285
Posted By WhosOnFirst
The biggest problem with drug pricing is the...

The biggest problem with drug pricing is the monopoly power of the drug manufacturers. If you want to solve high drug costs, look to limit monopoly power. Requiring pricing approval is one method. ...
Forum: Health - Disability 04-03-2018, 09:56 AM
Replies: 0
Views: 731
Posted By WhosOnFirst
Blockchain in Healthcare

https://www.forbes.com/sites/brucejapsen/2018/04/02/unitedhealths-optum-and-humana-in-blockchain-deal-to-improve-doctor-directories/#15f7f58c3998

This is the first legitimate (in my opinion)...
Forum: Health - Disability 12-19-2017, 09:56 AM
Replies: 32
Views: 5,089
Posted By WhosOnFirst
My state has a vaccination registry that is...

My state has a vaccination registry that is updated when I get a flu shot through work. I'm not certain if that information is publicly available.

This is off topic but I've often pondered the...
Forum: Health - Disability 12-07-2017, 10:23 AM
Replies: 23
Views: 2,561
Posted By WhosOnFirst
I agree that it was only a matter of time. It...

I agree that it was only a matter of time. It feels to me like we will see a return to the HMOs of the 80s. Narrow networks with no out of network coverage sold along with "wellness" benefits looks...
Forum: Health - Disability 11-22-2017, 10:27 AM
Replies: 18
Views: 2,350
Posted By WhosOnFirst
When you are adjusting data to account for...

When you are adjusting data to account for differences in the population mix, you need to determine your adjusted number by changing the distribution of the population and not the metric your are...
Showing results 1 to 25 of 72

 

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