PODCAST: The Blue Cross / Shield Organization[s]

36 Blue Cross Health Insurance Companies Explained

Eric Bricker, MD (@DrEricB) | Twitter

BY ERIC BRICKER MD

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Blue Cross Blue Shield - Health for Life Grand Rapids

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PODCAST: https://www.ahealthcarez.com/blue-cross-explained

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PODCAST: Hospital Price Transparency Regulations

EXPLAINED IN TWO MINUTES

By Eric Bricker MD

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PODCAST: https://www.fshealth.com/hospital-price-transparency-regulations?utm_campaign=Weekly%20Pulse&utm_medium=email&_hsmi=2&_hsenc=p2ANqtz-_ZmuwSwhqaUng6ccvspXNYBrjn8VoHnicgZRLgUpvdYNdXo-YeeDF2nYCu67N5F8dGsrg3Fr5guW-c-rdwZqmR2_XGkg&utm_content=2&utm_source=hs_email&mc_cid=c535b3053b&mc_eid=0192794229

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MORE: https://medicalexecutivepost.com/2021/06/02/hospital-financial-price-transparency/

RELATED: https://medicalexecutivepost.com/2019/09/09/physician-perspectives-on-price-transparency/

MORE: https://medicalexecutivepost.com/2016/08/22/us-state-healthcare-price-transparency-laws/

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PODCAST: How to Sell in Healthcare

How to Read 4 Personality Types

BY ERIC BRICKER MD

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Product Details

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PODCAST: “Signify Health” Start-Up Risk Adjustments [Medicare Advantage Part C]

BY ERIC BRICKER MD

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

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FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: 70% Doctors Owned by Private Equity and Hospitals

THE BUSINESS OF MEDICINE

By Eric Bricker MD

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PODCAST: The ACA “FAMILY GLITCH?

Health Insurance GLITCH-OR-NOT!

BY ERIC BRICKER MD

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MEDICAL RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: APPEALS of Medicare Advantage [Part C] Plans

BY CMS

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PODCAST: Medicare Financial Matters

WHAT COUNTS AS INCOME SOURCES?

BY CMS

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CITE: https://www.r2library.com/Resource/Title/0826102549

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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

FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: What is the COBRA Law?

By Bernie Portal

The Consolidated Omnibus Budget Reconciliation Act of 1985 is a law passed by the U.S. Congress on a reconciliation basis and signed by President Ronald Reagan that, among other things, mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving employment.

CITE: https://www.r2library.com/Resource/Title/0826102549

COBRA compliance can be difficult, especially if you’re handling it yourself. Now, it’s even more complicated thanks to recent stimulus bill changes that implemented a 100% free COBRA subsidy for eligible employees and employers.

In this episode, host Ryan McCostlin talks through the ins and outs of this important component of healthcare law that’s designed to help out employees during the pandemic.

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PODCAST: https://www.youtube.com/watch?v=aHLf2pXoZf0https://www.youtube.com/watch?v=aHLf2pXoZf0

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

Order: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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Benefits of Healthcare Participation in Multiple Medical Payment Models

BY HEALTH CAPITAL CONSULTANTS, LLC

New Research Explores Benefits of Participation in Multiple Payment Models


An August 2021 study published in the Journal of the American Medical Association (JAMA) analyzed medical and surgical episodes of care in U.S. hospitals to determine whether outcomes differed in hospitals that participated in Medicare’s Bundled Payments for Care Improvement (BPCI) Initiative depending on whether the patient being treated was attributed to a Medicare Shared Savings Program (MSSP) accountable care organization (ACO).

This Health Capital Topics article will discuss the study’s findings and potential policy implications. (Read more…)

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

ORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: Medicare Advantage [PART C] Cost Reduction Strategies

BY ERIC BRICKER MD

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ORDER: https://www.routledge.com/Financial-Management-Strategies-for-Hospitals-and-Healthcare-Organizations/Marcinko-Hertico/p/book/9781466558731

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

MORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: MEDICARE: Traveling Abroad Healthcare Care

BY CMS

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International: https://medicalexecutivepost.com/2016/01/30/us-and-international-healthcare-comparison/

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PODCAST: Warren Buffett’s Thoughts on Healthcare

BY ERIC BRICKER MD

CITE: https://www.r2library.com/Resource/Title/0826102549

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In Response to a Question Regarding the Ending of Haven Healthcare–the Joint Venture Among Berkshire Hathaway, JP Morgan Chase and Amazon to Improve Healthcare for their Employee Health Plan Members–Warren Buffett Made the Following Statement:

“Healthcare is the Tapeworm of the US Economy and the TAPEWORM WON.”

Additionally, Warren Buffett Goes on to Say that ‘Prestigious‘ People in the Community Run Hospital Boards and These People Are ‘Fairly Happy‘ with the Healthcare System the Way It Currently Is.

It is Likely that Warren Buffett Formed Some of This Opinion in Speaking About Healthcare with the Vice Chairman of Berkshire Hathaway, Charlie Munger, and Berkshire Board Member and Famous CEO, Tom Murphy.

Charlie Munger Has Served on the Board of a Los Angeles Hospital for 31 Years and Tom Murphy Currently Serves on the NYU Langone Hospital System Board of Directors.

The Support of the Status Quo by ‘Prestigious,’ ‘Fairly Happy’ Hospital Board Members Cannot Be Understated… It Blocks Change and Warren Buffett Appears to Think Similarly.

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PODCAST: Why Kaiser Permanente Health Insurance Has Not Spread?

ACROSS TO MORE OF AMERICA

By Eric Bricker MD

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KAISER VACCINE MANDATE: https://www.msn.com/en-us/news/us/almost-5000-kaiser-permanente-health-care-employees-suspended-for-refusing-vaccine/ar-AAPaVF0?ocid=BingNewsSearch

KP: https://www.msn.com/en-us/news/politics/kaiser-permanente-puts-2000-workers-on-unpaid-leave-over-vaccine-mandate/ar-AAPcwNo?li=BBnb7Kz

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PODCAST: “The Hospital” Book Review

By Brian Alexander

If You Like Michael Lewis Books, You’ll Love This

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ANNUAL FINANCIAL STATEMENT REPORTS: Health Insurance Companies

FOR PHYSICIAN INVESTORS

By David Belk MD

Health Insurance Company Financial Index

Below is a listing of the Nine largest for-profit health insurance Companies. The Annual financial statements are linked to the year for each Company and a four page summary report is linked to the name of the health insurance company at the top of the listing.

CITE: https://www.r2library.com/Resource/Title/0826102549

The relevant pages in each financial statement I used to prepare my summaries are listed next to each year’s statement. Aetna and Coventry’s summaries are combined because they merged in 2012. Health Net also Merged with Centene in 2016 leaving only seven major health insurance companies.

A composite summary for the data for all eight companies is here

Composite Data Table

Click on the name of the health insurance company to open the accordion and view the financial statements.

LINK: https://truecostofhealthcare.org/health-insurance-financial-index/

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PODCAST: Health Insurance Carrier STOCK EARNINGS CALLS

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: The Economics of Healthcare Will Never be the Same After Covid-19

POST PANDEMIC HEALTH ECONOMICS

BY LAURA GLENN

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As a leader in a community health system, Laura talks about how the COVID 19 pandemic has affected the economics of healthcare. Laura Glenn joined Munson Healthcare as the Vice President of the Physician Network in December, 2017.

In July, 2019 her role expanded and she was appointed the President of Ambulatory Services and Value Based Care. In this role, she remains responsible for integration of the employed and aligned physician practices across the system. In addition, she is responsible for advancing population health strategies including the Munson Clinical Integration Network and other value based payment models as well as providing leadership to the home health division, MHC’s clinical service lines and clinical business intelligence.

CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Hospital Owned Health Plans

COST-CONTROL THRU MANAGED CARE

BY ERIC BRICKER MD

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PODCAST: On Medicare PAYMENTS to Doctors

TO SPECIFIC PHYSICIANS

BY ERIC BRICKER MD

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MORE: https://medicalexecutivepost.com/2014/04/13/how-much-your-doctor-received-from-medicare/

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https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Medicare and Nursing Home / Long Term Care

By CMS

CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Healthcare, the Digital Eco-System and the Stock Market?

By Rajeev Ronanki

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Investment guru Jim Cramer says buy stocks along the digitization of everything”.

But – Even Healthcare?

CITE: https://www.r2library.com/Resource/Title/0826102549

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Tele-Health Financial Expansion

BY HEALTH CAPITAL CONSULTANTS, LLC

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Additional $20 Million Directed to Rural Telehealth Expansion

It has been well documented that the COVID-19 pandemic resulted in unprecedented increases in telemedicine utilization across the U.S. However, rural providers and patients, as evidenced by their lower rates of telemedicine usage during this time, have not been able to take advantage of the opportunities provided by telemedicine to the same extent as urban providers.

On August 18, 2021, the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) announced the latest attempt to ameliorate this issue – the distribution of nearly $20 million to 36 recipients for the purpose of strengthening telehealth services in rural and underserved communities and expanding innovation and quality. (Read more…)

CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: On Covid Pandemic Hospital Costs

FOR EMPLOYERSEMPLOYER SPONSORED HEALTH PLANS

BY ERIC BRICKER MD

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PODCAST: How Health Insurance Became America’s Biggest Hustle

BY ENTREPRENUER MD AND ROBERT PEARL MD

In this episode the Entrepreneur MD is joined by Dr Robert Pearl, MD, to talk about his latest book Uncaring and the need to stand up against the current healthcare model.

CITE: https://www.r2library.com/Resource/Title/0826102549

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Robert Pearl, MD: How Health Insurance Became America’s Biggest Hustle

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PODCAST: Why Insurance Carriers Want MEDICARE-FOR-ALL

WHY M-4-A?

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: About Professor Uwe Reinhardt

HEALTHCARE ECONOMIST

By Eric Bricker MD

Uwe Reinhardt PhD was a Princeton Healthcare Economist Who Passed Away in 2017. He Was Possibly the Most Well Known Healthcare Economist in America and Even the World.

CITE: https://www.r2library.com/Resource/Title/0826102549

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RIP: https://medicalexecutivepost.com/2017/11/16/r-i-p-uwe-reinhardt-phd/

Obituary: https://theincidentaleconomist.com/WORDPRESS/UWE-REINHARDT-GIANT-MENSCH-KNIFE-TWISTER/

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PODCAST: Radiology and Healthcare Mis-Communication

BY ERIC BRICKER MD

$128 Billion of Radiology Imaging Studies Are Performed Each Year in America and Unfortunately They Exemplify Healthcare Miscommunication.

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PODCASTS: More Dialysis Center Investigative Reporting

DaVITA and FRESENIUS

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

MORE

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PODCAST: APPEALS Traditional [Original] Medicare

BY CMS

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PODCAST: Understanding Your Medicare Choices

ORIGINAL MEDICARE, PART C, MEDIGAP AND YOU

CITE: https://www.r2library.com/Resource/Title/0826102549

BY MEDICARE – CMS

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PODCAST: The Four [4] Parts of Medicare

UNDERSTAND AND KNOW THE DIFFERENCE: A, B C & D

CITE: https://www.r2library.com/Resource/Title/0826102549

BY MEDICARE – CMS

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PODCAST: “New York Times” Article on Hospital Price Transparency

Learn WHY Hospital Prices Are Kept SECRET

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BY ERIC BRICKER MD

The New York Times Posted an Article Explaining Hospital Prices for Patients on Private Insurance Plans Such as Blue Cross, United Healthcare, Cigna and Aetna.

Your comments are appreciated.

CITE: https://www.r2library.com/Resource/Title/0826102549

MORE: https://medicalexecutivepost.com/2021/06/02/hospital-financial-price-transparency/

PODCAST #2: https://medicalexecutivepost.com/2021/05/19/podcast-price-transparency-in-healthcare/

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PODCAST: United States Health Spending by Race & Ethnicity (2021)

CULTURE IN HEALTHCARE

Culture is a factor to consider with healthcare. Depending on the culture they may seek alternative treatment such as homeopathic and treatment they have been raised with in their country Some cultures will get medications from their country because they believe in their medical system more then what is offered.

BY IHME

Creating a culture of health - Sedgwick

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Dr. Joseph L. Dieleman, Associate Professor in the Department of Health Metric Sciences at the University of Washington, is the lead author of the study “US Health Care Spending by Race and Ethnicity, 2002-2016,” published August 17, 2021 in the Journal of the American Medical Association

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PODCAST: https://www.youtube.com/watch?v=xbkSZmB-3f8&t=171s

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PODCAST: How Medical Prior-Authorization Really Works

Pre-Certification Works OR Doesn’t Work

BY ERIC BRICKER MD

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PODCAST: INELASTIC Healthcare Demand Explained

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

MORE: https://medicalexecutivepost.com/2019/11/10/ricardian-derived-demand-economics-in-medicine/

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PODCAST: On State Health Insurance Commissioners

Not so Hot!

BY ERIC BRICKER MD

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RELATED: https://ocgnews.com/former-georgia-insurance-commissioner-jim-beck-convicted-of-fraud/

MORE: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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What’s the Latest on MEDICARE DRUG PRICE Negotiations?

BY KFF

Prescription drug costs are a major concern for consumers and a fiscal challenge for public and private payers, representing 10% of national health spending and nearly 20% of health benefit costs for large employers and Medicare.

In response, lawmakers are considering a broad range of policy options, including one that would allow the federal government to negotiate prescription drug prices on behalf of Medicare beneficiaries and people enrolled in private plans, a proposal that has strong bipartisan public support.

CITE: https://www.r2library.com/Resource/Title/0826102549

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Could Negotiating Medicare Drug Prices Save $300 Billion Per Year? |  Committee for a Responsible Federal Budget

This brief describes the current status of drug price negotiation proposals, looks back at the history of proposals to give the federal government the authority to negotiate drug prices in Medicare, describes the negotiation provisions in key legislation (H.R. 3), and discusses the potential spending effects for the federal government and individuals.

READ: https://www.kff.org/medicare/issue-brief/whats-the-latest-on-medicare-drug-price-negotiations/

UPDATE: https://www.msn.com/en-us/news/politics/medicare-trustees-sound-alarm-but-progressives-press-ahead-with-irresponsible-medicare-expansion/ar-AAOh6EA?li=BBnb7Kz

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A Novel HYBRID Physician Reimbursement Model 2.0?

MODERN CONSIDERATIONS

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By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

EMERGING HYBRID PAYMENT MODELS

Current reimbursement structures involve the submission and payment of medical CPT® coded claims. But, some doctors feel they need to “up-code” to maximize revenue or “down-code” for fear of having a claim denied. Contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.

CITE: https://www.r2library.com/Resource/Title/0826102549

This hybrid reimbursement system might use a two-payment structure.

For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.

The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.

Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar.

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INVITATIONS: https://wordpress.com/post/medicalexecutivepost.com/246863

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PODCAST: Health Insurance Claims Adjudication Explained

MEDICAL CLAIMS ADJUDICATION

By Eric Bricker MD

Claims Adjudication Occurs between a Healthcare Provider Submitting a Claim to a Health Insurance Company and the Insurance Company Making a Payment Back to the Provider.

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PODCAST: The Health Economics of Renal Dialysis

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KIDNEY DIALYSIS

CITE: https://www.r2library.com/Resource/Title/0826102549

BY DR. ERIC BRICKER MD

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PODCAST: Six [6] Commission Relationships in Healthcare

The Healthcare Industry is Filled with Commission Relationships Where Money Is Paid, But It Is Not Always Obvious.

BY RIC BRICKER MD

Your comments and thoughts are appreciated.

CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: The ‘Weaponization’ Of The CV19 Vaccine?

DR. JOHN TRAVIS MD MPH

John W. “Jack” Travis, MD, MPH, completed his medical degree at Tufts University and a residency in preventive medicine at Johns Hopkins, where he received a Masters in Public Health and created one of the first computerized Health Risk Assessments (HRAs).

Dr. Jack joins colleague Pete R. Peter R. Quinones to describe what he refers to as the “weaponization of vaccines” and specifically concentrates on the CV19 “vaccines”.

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COVID-19 Information | Peachtree Corners, GA

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PODCAST: https://freemanbeyondthewall.libsyn.com/episode-586

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Study Finds COVID-19 Accelerated Physician Practice Acquisitions

Study Finds COVID-19 Accelerated Physician Practice Acquisitions

By Health Capital Consultants, LLC


A recent study from Physicians Advocacy Institute (PAI), prepared by Avalere Health, associated the growing number of both physician practice acquisitions and employed physicians between 2019 and 2021 with the COVID-19 pandemic.

To study COVID-19’s impact on physician employment trends, the June 2021 study evaluated the IQVIA OneKey database that contains physician practice and health system ownership information.

HC Topics Banner Image

To assess these trends at a national and regional level, Avalere researchers studied the two-year period from January 1, 2019 to January 1, 2021. (Read more…)

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The “BUSINESS” of Transformational Medical Practice Skills

[3rd] THIRD EDITION

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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PODCAST: Physician Relative Value Units?

HOW DOCTORS GET PAID!

By Eric Bricker MD

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PODCAST: Stark and AKS Final Rules

ANTI-KICKBACK STATUTE Overview and Impact

Do you want to learn more about the Stark Law and Anti-Kickback Statute Final Rules and how they impact your practice? Join us for a one-hour webinar, presented with Hancock Daniel.

Health Capital Topics Newsletter

By Health Capital Consultants, LLC

PODCAST: https://www.healthcapital.com/resources/stark-and-aks-final-rules-overview-and-impact

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