• Follow Essays, Opinions and Curated News for the Health Economics, Finance & Business Management Space on WordPress.com
  • Member Statistics

    • 703,340 Colleagues-to-Date [Sponsored by a generous R&D grant from iMBA, Inc.]
  • Our ME-P Channels

  • ME-P Archives Silo [2006 – 2018]


    New "Self-Directed" Study Option SinceJanuary 1st, 2017
  • Dr. David Marcinko [Publisher Emeritus]


    As a Distinguished University Professor and Endowed Department Chairman, Dr. David Edward Marcinko MBBS DPM MBA MEd BSc CMP® was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; Oglethorpe University and Atlanta Hospital & Medical Center in GA; and Aachen City University Hospital, Koln-Germany. He is one of the most innovative global thought leaders in health care entrepreneurship today.

    Professor Marcinko was a board certified physician, surgical fellow, hospital medical staff Vice President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010, by PM magazine. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics and trade publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    As a licensed insurance agent, RIA – SEC registered representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® online chartered designation education program; as well as Chief Editor of the HEALTH DICTIONARY SERIES® Wiki Project.

    Dr. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”. Presently, Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc.



  • PodiatryPrep.org

    Lower Extremity Trauma
    [Click on Image to Enlarge]

  • Most Recent ME-Ps

  • ME-P Free Adverting Sales Consultation

    The “Medical Executive-Post” is about connecting doctors, health care executives and modern consulting advisors. It’s about free-enterprise, business, practice, policy, personal financial planning and wealth building capitalism. We have an attitude that’s independent, outspoken, intelligent and so Next-Gen; often edgy, usually controversial. And, our consultants “got fly”, just like U. Read it! Write it! Post it! “Medical Executive-Post”. Call or email us for your FREE advertising and sales consultation TODAY [770.448.0769]

    Product Details

    Product Details

  • Medical & Surgical e-Consent Forms

  • Hope Hetico RN MS [Managing Editor]

    Prof. Hetico





    USNews.com, Reuters.com,
    News Alloy.com,
    and Congress.org

    Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

    Product Details

    Product Details

    Product Details

  • iMBA White Papers

    Customized Industry Topics [$1,500 unlimited corporate license]October 1st, 2017
    Medical Clinic Valuations * Endowment Fund Management * Health Capital Formation * Investment Policy Statement Analysis * Provider Contracting & Negotiations * Marketplace Competition * Revenue Cycle Enhancements; and more! HEALTHCARE FINANCIAL INDUSTRIAL COMPLEX
  • Ann Miller RN MHA [Executive-Director]

    iMBA VIRTUAL OFFICES [1.770.448.0769] Atlanta, GA.
    Location doesn't matter. We welcome new long-distance clients and colleagues.

  • ME-P Publishing


    If you want the opportunity to work with leading health care industry insiders, innovators and watchers, the “ME-P” may be right for you? We are unbiased and operate at the nexus of theoretical and applied R&D. Collaborate with us and you’ll put your brand in front of a smart & tightly focused demographic; one at the forefront of our emerging healthcare free marketplace of informed and professional “movers and shakers.” Our Ad Rate Card is available upon request [770-448-0769].

  • Reader Comments, Quips, Opinions, News & Updates

  • Start-Up Advice for Businesses, DRs and Entrepreneurs

    ImageProxy “Providing Management, Financial and Business Solutions for Modernity”
  • Up-Trending ME-Ps

  • Capitalism and Free Enterprise Advocacy

    Whether you’re a mature CXO, physician or start-up entrepreneur in need of management, financial, HR or business planning information on free markets and competition, the "Medical Executive-Post” is the online place to meet for Capitalism 2.0 collaboration. Support our online development, and advance our onground research initiatives in free market economics, as we seek to showcase the brightest Next-Gen minds. ******************************************************************** THE ME-P DISCLAIMER: Posts, comments and all opinions do not necessarily represent iMBA, Inc.
  • OIG Fraud Warnings

    Beware of health insurance marketplace scams OIG's Most Wanted Fugitives at oig.hhs.gov

Values-Based Health Insurance

Join Our Mailing List

Another New Idea?

[By Staff Writers]

According to Mark Fendrick MD and Michael E. Chernew PhD, instead of the one size fits all approach of traditional health insurance, a “clinically-sensitive” cost-sharing system that supports co-payments related to evidence-based value for targeted patients seems plausible.  

The Model

In this model, out-of-pocket costs are based on price and a cost/quality tradeoff in clinical circumstances: low co-payments for interventions of highest value, and higher co-payments for interventions with little proven health benefit.  

Benefit Product Packages

Smarter benefit products and packages are then designed to combine disease management with cost sharing to address spending growth. 

product sales


What do you think of this new health insurance business model; is it revolutionary or evolutionary?


Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com


Product DetailsProduct Details

Product Details



3 Responses

  1. Porter and Omstead-Teisberg

    Michael Porter and Elizabeth Omstead Teisberg recently stated in their book, Redefining Health Care, that limiting competition is not the solution, but rather, “The only way to truly reform health care is to reform the nature of competition itself.” The offer that this reform should be focused around “value based competition over the care cycle at the medical condition level.”

    Porter explained that, “Because of the lack of effective competition at the condition level, the actual organization and structure of care delivery by most providers is not aligned with patient value. Lack of value-based competition on results has allowed care of a patient to be fractured across numerous specialties, hospital departments, and physician practices, each of which focuses on its discrete intervention.

    Nobody integrates care for the medical conditions as a whole and across the full care cycle, including early detection, treatment, rehabilitation, and long-term management.”

    Submitted by,
    Robert James Cimasi; MHA, ASA, CMP
    Health Capital Consultants, LLC
    St. Louis, MO.


  2. Values Based Health Insurance

    Reference pricing, tiered provider networks and narrow networks—three benefit design strategies that are gaining favor among employers and health plans trying to find ways to slow premium growth.

    While these designs aim to encourage value-informed consumer choices, some perceive them as overly restrictive.

    What do you think?

    Dr. David Edward Marcinko MBA


  3. On VBP

    The basic misconceptions about managed care in many hospital systems and physician groups is often caused by misunderstanding and distrust of value based purchasing (VBP) initiatives and how they work. With the Medicare rules constantly changing physician and hospital reimbursement this adds frustration and more confusion to the mix.

    A recent analysis of past hospital bonuses being wiped out by new hospital penalties makes VBP suspect to many. Physicians are seeing the SGR changes being delayed along with new fines and scrutiny all of which makes the new government sponsored reimbursement programs suspect as well, especially for those on a fast track requiring 85% of reimbursement to be under VBP by 2018. Many providers see this as an unfunded mandate, especially those who face the imperative of building an “insurance company like” infrastructure platform to integrate data and finance.

    For many health plans and employers or their TPAs this VBP is still new. I am hearing employers are delighted to have Medicare leading the charge as they did with DRGs and RBRVS, but they are still a bit mystified as to how the purchasers will build a “provider like” monitoring and management system to track Total Cost of Care (TCOC). While all purchasers are familiar with Per Member Per Month (PMPM) as a key measure of success in managing cost, there will need to be adjustments tied to patient risk and quality to make the capitation or bundles fair and attractive for employees.

    This Insurance-like and provider-like platform merging clinical decision support with financial prospective payment tools is similar to the managed care of the early 1980s and based upon the vison of many good HMOs of the 1970s. Kaiser Permanente as the original community based health plan in the 1950s has expanded to other parts of the country as a pioneer in integrating not only physician and hospitals services but also integrating the financing of these services as a membership organization. In every discussion of integrated delivery networks (IDN) Kaiser is shown as the sustainable example. The reason for Kaiser’s success is that they not only changed how care is delivered but also changed how it is paid for by participating employers and their employees. Therefore, it is not surprising we are now hearing a new term being used by both purchasers and physicians in their discussions with each other and that is “Kaiserfication”.

    We are seeing a rebirth of physician sponsored health plans morphing from Accountable Care Organizations (ACOs) to risk management entities using the tools they have built and skill sets learned over the past decade of clinical integration. This has taught us another new word – “recapacitation”, or the ability to downsize unused, overly expensive services with high use and high need services that are competitively priced and delivered in a consumer concentric manner.

    This recapacitation has triggered many consolidations and has, in a reverse manner, forced employers and payers to build narrow networks of top quality, low cost providers to offer yet another alternative product to their employer clients to select. In other words while providers merge into bigger and bigger health systems, purchasers are carving out subsets of these systems. These purchasers use these narrow networks and direct patient flow by offering forgiveness on copays and deductibles to incent patients in the direction of these narrow networks instead of the broader networks of the past. By using these high performance panels for outpatient business, purchasers can demand that physicians uses select hospitals on a product line by product line basis. This means all ob-gyn may go to one hospital and all cancer care to another. This breaks down the attempts by health systems to control all services in a given geographic area but also puts in place quality parameters for all services, thus making employers confident that the health plan is using their best quality measures to secure better care and better prices.

    All in all managed care of the 1970s has returned with a good twist – quality data, new reimbursement options and new tools for reducing exposure to Preventable and Avoidable Costs (PACs).This is very consistent with Medicare’s vision of Accountable Care and with the recent announcement of moving all reimbursement away from fee for service by January 1, 2018.

    William J. DeMarco MA CMC
    Pendulum HealthCare Development Corporation


Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: