PODCAST: Health Plan Innovation

PLAN EQUALS ALIGNMENT INNOVATION

By Eric Bricker MD

Your thoughts are appreciated.

THANK YOU

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PODCAST: Traditional Medicare Part A for Hospital Coverage and Part B for Physician and Outpatient Services

UNDERSTAND AND KNOW THE DIFFERENCE

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Your thoughts are appreciated.

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PODCAST: Laboratory Test Costs in EHRs and Physician Behavior


Johns Hopkins Hospital Listed the Cost of 61 Lab Tests on Doctors’ Computer Screens … While They Were Ordering Labs.



By Dr. Eric Bricker MD

Results:

–Just Seeing the Cost of the Lab Test DECREASED the Number of Labs Ordered Per Patient by 9%.

–Doctors Also SUBSTITUTED a Lower Cost Lab Test for a Higher Cost Lab Test 10,000 Times.

The Doctors Were NOT Clinically Directed to Change Their Behavior.

The Doctors’ Pay Was NOT Affected by Their Lab Ordering Either Way.

This Study Illustrates How Giving Doctors Cost Information in a Setting of Clinical and Financial Independence AUTOMATICALLY Decreases Healthcare Waste.

Doctors Can Be Much Better Stewards of Healthcare Dollars … and the Technological Innovation Needed is Minimal.

Disclosure: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.

YOUR COMMENTS ARE APPRECIATED.

Thank You

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PODCAST: Decline of Employer Family Healthcare Coverage

Households 1% Poorer in Last 10 Years Because Family Premiums Up 71%

YOUR THOUGHTS ARE APPRECIATED.

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

Thank You

***

PODCAST: Direct Primary Medical Care

NOT FEE-FOR-SERVICE MEDICINE

Direct Primary Care (DPC) Involves an Employer or a Patient Paying for a Doctor via a Monthly Membership Fee.  DPC Doctors Do NOT Bill Insurance.  There is NO Fee-for-Service.

Texas CEO Magazine Eric Bricker 1 - SO 14 - Texas CEO Magazine


There is Copay for Each Office Visit and Visits are Unlimited.

Direct Primary Care Doctors Are Most Frequently Family Practice Physicians, but Internal Medicine and Pediatricians Can Also Have Direct Primary Care Practices.

The Average Direct Primary Care Practice Has a Panel of 345 Patients, with a Goal of About 600 Patients at Full Capacity.

For Comparison, the Typical Fee-for-Service Primary Care Doctor Has a Patient Panel of 2,500.

57% of Direct Primary Care Practices Contract with Employers That Pay the Monthly Membership on the Employee’s Behalf.

Direct Primary Care is a Strategy to Increase the Quality of Care and Decrease Healthcare Costs for an Employee Health Plan.

Disclaimer Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.

THANK YOU
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PODCAST: Employee Health Plan MISALIGNMENT with Fee-for-Service Medicine

Current Partners Not Aligned With PLAN Goals

Dr. Boram (Kim) Park, MD - Dallas, TX | Internal Medicine

BY DR. ERIC BRICKER MD

Employee Health Plans Have Have a MISALIGNMENT Problem with the Current Fee-for-Service Healthcare System…i.e. Their Current Partners Are Not Aligned With Their Goals

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Health Insurance Carriers Are Misaligned by Owning PBMs That Make More Money in Rebate Kick-Backs When the Employee Health Plan Spends More Money on Expensive Prescription Drugs.

Doctors Are Misaligned When They *Are Employed by Hospitals That Tie Test and Procedure Ordering Volume to Doctor Compensation.

Hospitals are Misaligned When They Buy Physician Practices and Raise the Prices for In-Office Testing and Procedures by 300%… Even Though NOTHING Has Changed Other Than the Sign on the Door.

Accordingly, True Employee Health Plan Innovation is ALIGNMENT Innovation That Provides Care Outside the of the Status Quo Fee-for-Service System.

Onsite Clinics, Near Site Clinics, Direct Primary Care and Capitated Virtual Care All Provide Real Alignment Innovation for Employee Health Plans.

ASSESSMENT: Your comments are appreciated.

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

THANK YOU

***

PODCAST: Domestic CEOs and Healthcare in America

WHY THEY DO NOT CARE?

By Eric Bricker MD

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Your comments are appreciated.

THANK YOU!

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PODCAST: Novartis Drug Company Settlement with the USA

Why SOME Doctors Take Money from Pharmaceutical Companies

Q&A: Eric Bricker, chief medical officer of Compass patient advocacy service - Dallas Business ...

BY ERIC BRICKER MD

MAssive Global Drug Company Novartis Paid $678M to Settle Charges from the US Federal Government.

The Charges Were Regarding Illegal Payments and Kickbacks to Doctors that Were Thinly-Veiled as ‘Speaker Fees’ and Fancy Dinners.

Why Where the Doctors Not Held Accountable and What Does This Say About a Doctor’s Mentality on Money?

Learn the Psychology of Doctors and Money.

Understand How It Leads to Counterproductive Relationships Between Physicians and Drug Companies, Which Can Compromise the #1 Rule in Medicine: The Patient Comes First, Always.

Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health

YOUR THOUGHTS ARE APPRECIATED

Thank You

***

PODCAST: Health Insurance Customer Service Rankings

INDUSTRY RANKINGS

According to Forrester Research, Health Insurance Customer Service is Ranked 15th Out of 19 Industries.

Image result for eric bricker

BY DR. ERIC BRICKER MD

Specifically, Forrester Research Says That Customer Service is ‘Poor’ at Blue Cross of Texas and Illinois, Blue Shield of California, CareFirst Blue Cross, Anthem, United Healthcare, Cigna and Aetna.

Hospital Billing Customer Services Is Bad Too.

Hospital Billing Complexity is So Troublesome to Patients, that 40% Say They Avoid Preventive Care and Screening Tests Just to Avoid the Billing Headache.

Healthcare Customer Service is Terrible Because Health Insurance Companies and Hospitals Do Not Need Good Billing Customer Service to Be Successful, As Demonstrated by High and Rising Health Insurance Stock Prices and Large and Growing Hospital System Revenue.

For Health Insurance Companies and Hospitals, Not Fixing Their Poor Customer Service May Be a Calculated Business Decision.

Implications: To Help Make Their Employees’ Lives Better, Employers May Need to 1) Hire a Healthcare Navigation Company or 2) Deliver More Care to Their Plan Members Outside of the Traditional Health Insurance and Hospital Systems… and Avoid the Terrible Customer Service All Together.

Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health and is the Former Co-Founder of Compass Professional Health Services.

Your thoughts and comments are appreciated.

THANK YOU

***

PODCAST: Private Equity Firms Are Making Partial Purchases of Physician Practices.

Older Doctors Sell Out to Private Equity

Private Equity Firms Are Making Partial Purchases of Physician Practices

BY ERIC BRICKER MD

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The Deals Are Frequently Structured as Follows:

–The Private Equity Firm Offers an Up Front Lump Sum of Money and Administrative Services Such as Billing and Collections for the Practice.

–In Return, the Doctors in the Practice Agree to Have 30-40% of All Future Revenue Go to the Private Equity Firm.

The Up Front Lump Sum Can Be Equal to as Much as 10 – 20 Years of Income for a Physician.

The Older Doctors in the Practice Who Are Usually the Partners Frequently Take This Deal, Resulting in the Younger Partners Making Less Take-Home Pay.

Implication for Employers:

Private Equity Firms Create Larger Group Practices to Have Better Negotiating Leverage with Commercial Insurance Carriers and Obtain Higher Fee-for-Service Reimbursement.

Overall Healthcare Costs for Physician Services Go Up, While the Take-Home Pay for Doctors Goes Down… and the Private Equity Firm Keeps the Difference.

NOTE: The Older Doctors Who Are Paid the Lump Sum Are Still Required to Stay at the Practice for a Certain Number of Years After the Transaction.

YOUR THOUGHTS AND COMMENTS ARE APPRECIATED

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DIY Textbooks: https://medicalexecutivepost.com/2021/04/29/why-are-certified-medical-planner-textbooks-so-darn-popular/

THANK YOU

***

PODCAST: Mental Health Conditions are Common

Mental Health Conditions Are Common and Complicate Co-Morbid Medical Diseases As Well.

Image result for eric bricker

By Eric Bricker MD

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7% of the US Adult Population Has Depression.

Depression is Highest Among 18-25 Year Olds at 11%.

19% of US Adults Have Anxiety and 56% of Those with Anxiety Are Impaired By Their Condition.

12% of People with Diabetes Have Associated Depression… Resulting in Missed Appointments, Poorer Diet, Decreased Medication Adherence and Increased Complications.

To Address This Problem, The Intermountain Health System Incorporated a Mental Health Provider in Their Primary Care Clinics.

Results: Improved in Diabetes Care, Decreased Hospitalizations and Decreased ER Utilization.

Treating Mental Health Not Only Improves Mental Wellbeing, But Also Lowers Overall Healthcare Costs as Well.

Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.

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MARCINKO ON MENTAL HEALTH START-UPS: https://medicalexecutivepost.com/2020/09/30/mental-health-entrepreneurial-start-up/

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

Your thoughts are appreciated.

NOTE: If you or someone you know is considering suicide, please contact the National Suicide Prevention Lifeline at 1800-273-TALK (8255), text “help” to the Crisis Text Line at 741-741 or go to suicidepreventionlifeline.org.

THANK YOU

***

PODCAST: A Three Decade Long History of Employer-Sponsored Healthcare Costs

The History of Employer-Sponsored Healthcare Costs in the Last 30 Years Can Be Broken Down Into 3 Segments:

THREE VITAL SEGMENTS

Image result for eric bricker

BY ERIC BRICKER MD

1) The 90s HMOs: Lower Premiums, Lower Out-of-Pocket Costs, Many Many Rules Restricting Care.

2) The 2000s PPOs: High and Even Higher Premiums, Lower Out-of-Pocket Costs, Fewer Rules Restricting Care.

3) The 2010s CDHPs: Lower Premiums, HIGH Out-of-Pocket Costs, Fewer Rules Restricting Care.

The Last 30 Years Have Taught Us that Employer-Sponsored Health Plans CANNOT Have All 3–Low Premiums, Low Out-of-Pocket Costs and Few Care Restrictions.

In the 2020s, Employers Are Moving More of Their Employee Healthcare OUTSIDE of the Traditional Healthcare and Health Insurance System with On-Site Clinics, Near-Site Clinics, Virtual Urgent Care, Virtual Primary Care and Bundled-Payment Centers-of-Excellence.

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

MANAGED CARE HISTORY: https://medicalexecutivepost.com/2014/11/19/a-brief-history-of-managed-care/

YOUR THOUGHTS ARE APPRECIATED

THANK YOU

***

PODCAST: The “4 Ps” of [Medical] Marketing

THEIR Specific Meaning in Healthcare

Dallas 100: No. 6 Compass Professional Health Services ...

BY. DR. ERIC BRICKER MD

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The 4 Ps of Marketing Have Specific Meaning in Healthcare:

Product: Must Have a 10X Better Value Proposition to Break Into a Market of Incumbents.

If the Product is for Providers, It Needs to Improve Top-Line Revenue–E.g. Robotic Surgery.

If the Product is for Payors, It Needs to Decrease Healthcare Costs–E.g. CDHPs

Price: Must Motivate the Channel to Sell the Product.

Placement: Where Customers Go to Buy Products–E.g. GPO or Broker/Benefit Consultant

Promotion: Outbound Marketing via Interruption with VALUABLE CONTENT and Inbound Marketing with VALUABLE Video, Audio, Written Content.

All 4 of These Ps Then Need to Be Applied to a Specific Market Segment… Not the Entire Market.

If Your Market is Everyone, It Is Essentially No One.

***

ASSESSMENT: Your thoughts and comments are appreciated.

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

MARCINKO ON MEDICAL MARKETING: https://medicalexecutivepost.com/2019/03/28/crafting-a-medical-practice-marketing-plan/

THANK YOU

***

PODCAST: ‘Hacking of the American Mind’

BOOK REVIEW

See the source image

BY ERIC BRICKER MD

Our Brains Have a Reward Chemical Called Dopamine That Causes a Brief Pleasurable Feeling Followed by a Worsening of our Mood.

However, Our Brains Also Have a Contentment Chemical Called Serotonin That Causes Peace and a Calming of our Mood.

Substances and Behaviors That Stimulate Dopamine Include: Sugar, Caffeine, Alcohol, Nicotine, Illicit Drugs, Prescription Narcotics, Social Media Apps, Gambling and Sex.

Substances and Behaviors That Stimulate Serotonin Include: The Amino Acid Tryptophane, Positive Relationships with Others, Service to Others, Prayer and Meditation.

Corporations Tailor Their Products with Dopamine Stimulating Strategies to Increase Sales.

Facebook’s Chamath Palihapitiya Even Admitted on CNBC that Facebook Intentionally Designed its Social Media Platform to Stimulate Dopamine in the User’s Brain To Make Them Use the App More.

Unfortunately, the Constant Stimulation of Dopamine in Our Brains Has Increased Obesity, Metabolic Syndrome, Cancer, Cardiovascular Disease, Diabetes and Depression.

Lustig Estimates That 75% of the $4 Trillion Spent on US Healthcare is for These Diseases That Can Be Traced to Our ‘Hacked Minds.’

Dr. Robert Lustig is a Pediatric Neuroendocrinologist at the University of California at San Francisco. His Book ‘Hacking of the American Mind’ Posits that Corporate Predators Exploit Our Brain Chemistry to Increase Their Profits at the Expense of our Health.

ASSESSMENT: Your thoughts and comments are appreciated.

THANK YOU

***

PODCAST: Established Sales Strategies That Are Effective When Applied to Healthcare

HEALTHCARE SALES TECHNIQUES

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Learn Established Sales Strategies That Are Effective When Applied to Healthcare:

1) Prospecting: The Strategy of Aaron Ross in Dividing Prospecting into Seeds, Nets and Spears Was Effective in Generating Leads at Compass Professional Health Services.

2) Pitching: The Miller-Heiman Strategy of Identifying Economic, Outcome and Technical Buyers Allows for Effective Pitching to a Buying Team.

3) Closing: The Model of ‘Fit-Risk-Price’ is Essential To Understanding How and When to Close a Sale.

Image result for eric bricker

BY ERIC BRICKER MD

THANK YOU

***

PODCAST: Drs. Vivian Lee, Marty Makary, Atul Gawande and Robert Pearl Blame Physician Culture for the Poor State of US Healthcare

At Least in Part ACCORDING TO THESE BOOKS

Texas CEO Magazine Eric Bricker 1 - SO 14 - Texas CEO Magazine

BY ERIC BRICKER MD

Understandably, Many Doctors Take Issue with This Accusation and Say They Treat Their Patients with Integrity and Accountability. Both Statements May Be TRUE … How is That Possible?

Because of Bad Apples.’

While the Majority of Physicians May Put Their Patients First, There Are a Minority of Physicians that Put Money, Power, Prestige and Promotions Ahead of Patients. It’s These Bad Apples That Ruin Physician Culture.

Problem: Fee-for-Service Rewards Bad Apple Physicians, While Paying the High-Integrity Doctors as Well.

Assessment: If Doctors Want to Keep Fee-for-Service, Then the Bad Apples Must Be Reduced Through 1) Increased Transparency, 2) Greater Doctor Self-Regulation, 3) More Federal Oversight and 4) Increased Employer Investigation.

Many of the Books by Drs. Vivian Lee, Marty Makary, Atul Gawande and Robert Pearl Blame Physician Culture in Part for the Poor State of US Healthcare

Your thoughts are appreciated.

THANK YOU

***

PODCAST: How Much Does Medicare Actually Pay Each Doctor?

Medicare Released Data on What It Paid To Each Doctor in America from 2012 to 2015 and the Wall Street Journal Compiled That Information Into an Amazing Searchable Database.

Texas CEO Magazine Eric Bricker 1 - SO 14 - Texas CEO Magazine

BY DR. ERIC BRICKER MD

The Findings:

1) Some Individual Doctors Were Paid Upwards of $5.8 Million Dollars by Medicare in Just a Single Year!

2) The Specialists That Charged Medicare the Most Tended to Be Vascular Surgeons, Ophthalmologists, Oncologists and Cardiologists.

Implications for Employer-Sponsored Health Plans:

1) Medicare Data Can Be Used to Identify High Volume Physicians and Surgeons.

2) The Highest-Costing Doctors Are Concentrated in a Relatively Small Number of Specialties That Can Be Targeted for Detailed Review, Feedback and Possible Exclusion/Steerage Away.

ASSESSMENT: Your thoughts and comments are appreciated.

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

THANK YOU

***

PODCAST: The RAND Corporation Found that Commercial Health Insurance Plans Pay Hospitals 241% What Medicare Pays

The RAND Corporation Found that Commercial Health Insurance Plans Pay Hospitals 241% What Medicare Pays.

But Also That It Varies from 150% to 400%.

Dr. Boram (Kim) Park, MD - Dallas, TX | Internal Medicine

BY ERIC BRICKER MD

Health Insurance Companies Paid for Hospital Outpatient Services at an Even Higher Average Rate of 293% of Medicare.

A Detailed Look at the RAND Analysis Reveals that the ‘Basket’ of Services at Each Hospital Had Very Little Data.

For Example, the RAND Study’s Data for the Baylor Scott & White Hospital System in Dallas – Fort Worth Represented Only 0.4% of the Hospital’s Total Revenue.

For the Texas Health Hospital System Also in Dallas – Fort Worth, the RAND Study’s Data Only Represented 0.96% of the Hospital’s Total Revenue.

That Sample Size Is Likely Too Small to Make Accurate Comparisons from One Hospital System to Another Regarding their Commercial Insurance Prices Relative to Medicare.

ASSESSMENT: Your thoughts and comments are appreciated.

THANK YOU

***

PODCAST: Direct Employer Contracting for Medical Services

Employers Can Enter Into Direct Contracts with Doctors, Hospitals and Other Healthcare Facilities for Medical Services for Members of Their Employee Health Plan.

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Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY ERIC BRICKER MD

Reimbursement Typically Takes the Form of a Bundled Payment or a Lower Rate of Fee-for-Service.

Employers with Greater Than 500 Employees Tend To Engage in Direct Contracting.

Mid-Market Employers with a High Concentration of Employees in One Geographic Area Tend to Engage in Direct Contracting as Well.

The Employer Frequently Uses an Independent TPA to Process the Claims for the Direct Contract.

Also, the Employee Health Plan Changes the ‘Benefit Level’ Such that Care at the Direct Contract Facility is Often at $0 Out-of-Pocket Cost for the Member.

Engaging the Plan Members with Navigation Services is Helpful to Make the Experience Integrated with the Overall Health Plan Offerings.

YOUR THOUGHTS ARE APPRECIATED.

CITE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

THANK YOU

***

PODCAST: First Rules of Population Health

One of the 1st Rules of Population Health is That 5% of the Population Generates 50% of Total Healthcare Costs

Image result for eric brikker

BY ERIC BRICKER MD

However, That 5% of High-Cost Claimants is a Heterogenous Population

2.5 Percentage Points of the 5% Are Claimants That Were Either High-Cost Claimants the Previous Year with On-Going Complex Medical Situations or Generated Claims Related to Chronic Diseases Such as Diabetes or Multiple Sclerosis.

HOWEVER, the Other 2.5 Percentage Points of the 5% Are Claimants That Generated Zero or Almost-Zero Claims in the Previous 12-Months.

They Essentially ‘Blow Up’ Out of Nowhere.

This Video Describes the 4 Categories of These High-Cost Claimants:

1) Previously Known and Prolonged High Costs

2) Previously Known and Episodic High Costs (that no longer continue)

3) Previously Unknown and Prolonged High Costs

4) Previously Unknown and Episodic High Costs (that no longer continue)

Learn the Clinical Diagnoses That Make Up Each Category and the Secret of Which Groups to Target and Why.

Your thoughts are appreciated.

THANK YOU

***

PODCAST: Hospital Employee Roles [Nurses, Med Techs, Clerks and More]

So You, Your Family and Friends Can Have a Practical Understanding Should You or They Ever Be Hospitalized

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BY ERIC BRICKER MD

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Learn the Roles of 1) Nurses, 2) Charge Nurses, 3) Shift Coordinators, 4) Techs and 5) Clerks in a Hospital So You, Your Family and Friends Can Have a Practical Understanding Should You or They Ever Be Hospitalized

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Nurses on General Medical and Surgical Floors Typically Have a 4:1 Patient to Nurse Ratio During the Day and an 8:1 Patient to Nurse Ratio Overnight.

Nurses in the ICU Typically Have a 2:1 or 1:1 Patient to Nurse Ratio.

Nurses on a Floor or Unit Have a ‘Charge Nurse‘ Who is the Head Nurse for the Floor for That Specific Shift.

Those Charge Nurses Then Collaborate with the Shift Coordinator Who is a Very Senior and Experience Nurse Who Coordinates All the Patient Beds for a Particular Division at a Large Hospital (e.g. All Medicine Patients vs. All Surgical Patients) or for the Entire Hospital If It Is a Smaller Hospital.

Medical Techs Provide Support Roles in Patient Rooms Such as Checking Vitals, Blood Glucose Finger-Sticks, Etc.

The Clerk Sits at the Nurses Station for the Floor and Typically Answers the Call-Button for Each of the Patient Rooms During the Day in Addition To Their Administrative Responsibilities.

Your thoughts are appreciated.

THANK YOU

***

PODCAST: “Inelastic” Demand in Healthcare

Economic Implications of Pain Suffering and Imminent Death?

Inelastic Demand in Healthcare: Economic Implications of Pain, Suffering and Imminent Death.

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By Eric Bricker, MD

Inelastic Demand Occurs When the Quantity Demanded for a Good or Service Does NOT Change When the Price Changes.

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

Consequently, When the Supply of a Healthcare Service is Limited, then the Price Goes Up … Way Up, Since the Quantity Demanded Does Not Change.

Examples of Inelastic Demand with Limited Supply in Healthcare Are:

1) Emergencies

2) Patented Medications for Diseases That Have No Other Alternatives

3) Doctor Specialties Where the Patient Has No Choice in the Services Such As Radiologists, Anesthesiologists and Pathologists

The High-Cost Claimants with Inelastic Demand Drive the Majority of Healthcare Costs for a Group.  They Generally Fall into 3 Diagnosis Categories: 1) Orthopedics, 2) Cardiovascular and 3) Cancer.

Orthopedics Should Be the 1st Priority for Lowering Healthcare Costs for a Population … While Demand May be Inelastic, Usually There is Choice and Not a Limited Supply of Orthopedic Services.

Efforts in Orthopedics Should Focus on Increasing Choice, Such as Free Travel to Centers-of-Excellence with Bundled Pricing.

Cardiovascular Care and Cancer Care Tend to Have Inelastic Demand AND Limited Supply. Therefore, the Best Way to Lower Healthcare Costs in These Areas is Through Prevention.

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

PODCAST: Fundamentals of Healthcare Finance

Today’s Video is a Fundamental of Healthcare Finance That Every Professional Must Understand… and that Most Consumers DO NOT.

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2021 Medical Captive Forum | Roundstone Insurance

BY ERIC BRICKER MD

The Formulary is the List of Medications That Are Covered by Health Insurance.  Not All Medications Are Covered. The Doctor Does Not Know What Medications Are or Are Not on Their Patients’ Formularies. However, the Pharmacy Does Via Computer Software That They Use.

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

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Formularies Have Many Rules Associated With Them:

1) Prior Authorization – Approval Must Be Given by the Health Insurance Company/PBM Before They Agree to Pay for a Medication.

2) Step Therapy – Certain Less Expensive Generic Medications Have to Be ‘Tried’ First and Fail Before a Doctor Can Prescribe a More Expensive Brand-Name Medication.

3) Mandatory Generics – If a Brand Name Medication Has A Direct Generic Equivalent, Then the Insurance May Only Agree to Pay for the Generic and Not the Brand.

4) Mandatory Mail Order – Certain Chronic Medications That Are Filled for 90 Day Supplies Must Be Filled via Mail Order and Not at the Retail Pharmacy.

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

PODCAST: The Income and Substitution Effects in Healthcare Finance

Important Economic Concepts to UNDERSTAND

Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY ERIC BRICKER MD

One of Their Applications Pertains to the Impact on Time Spent Working Vs. Time Spend on Leisure if a Healthcare Worker’s Pay is Changed.

DEFINITION: The INCOME EFFECT States That If a Worker’s Pay is Decreased, They Will Work More Hours to Maintain the Same Income. Conversely, If a Worker’s Pay is Increased, They Will Work Fewer Hours and Still Maintain the Same Income.

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

A Real-World Example of the Income Effect is When Medicare Decreased Reimbursement for Echocardiograms and as a Result, Decreased Cardiologists’ Pay. Accordingly, Cardiology Practices Increased the Number of Patients They Saw Per Day to Make Up for the Lost Pay and Maintain Their Income.

The SUBSTITUTION EFFECT States That Work and Leisure Time Have OPPORTUNITY COSTS for Each Other.

If a Worker’s Pay Goes Up, then the Opportunity Cost for Leisure (i.e. Not Working) Also Goes Up and the Worker Will Work MORE, Not LESS. Conversely, If a Worker’s Pay Goes Down, then the Opportunity Cost for Leisure Goes Down and the Worker Will Work LESS, Not MORE.

Whether the Income or Substitution Effect Dominates Depends on the Person and the Situation.

THE POINT: In the World of Fee-for-Service Reimbursement, a Decrease in Doctor Pay Per Service May Result in Doctors Providing More Services In Order to Maintain Their Income… Nullifying Any Cost-Savings.

PODCAST: The Income and Substitution Effects Are Important Economic Concepts to Understand in Healthcare Finance.

Your thoughts appreciated.

THANK YOU

***

PODCAST: How New Technologies Are Predictably Spread and How it Applies to Healthcare

BY ERIC BRICKER MD

[Book Review]

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The Technology Adoption Lifecycle Was Explained in Geoffrey Moore’s Famous Book ‘Crossing the Chasm.

If You Are a Healthcare Entrepreneur or Innovator Your MUST Understand and Apply the Technology Adoption Lifecycle.

It States that Disruptive Innovation (i.e. Innovations that Require Behavior Change) Is Not Evenly Adopted Across a Population.

Rather, People Segment Themselves into Sub-Groups That Adopt the New Innovation Differently. To Whit:

**************

Early Adopters Love Tinker and Like New Innovations Just Because They Are New. Early Adopters Tend to Not Be Price-Sensitive.

Pragmatists Have a Specific Problem that the New Innovation Will Solve and If They See Other People Using It, They Will Use It Too. Pragmatists Are Somewhat Price-Sensitive.

Conservatives Would Rather Not Adopt the New Innovation, but if it is Already Built-in to Something They Already Buy, Then They Will Be More Likely to Use It. Conservatives are Very Price Sensitive.

Skeptics Will Never Adopt the New Innovation.

**************

To Spread a New Innovation, One Must Cross the Chasm Between the Early Adopters and Pragmatists With a ‘Niche‘ and ‘Bowling Pin‘ Strategy.

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

***

PODCAST: The Future of Healthcare Looks to Medicare’s Past?

See the Future of Healthcare By Looking to Medicare’s Past

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Texas CEO Magazine 2016 Economic Forecast: Dallas - Texas ...

BY DR. ERIC BRICKER MD

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Desire for a Healthcare ‘Safety Net’ Goes Back Almost 100 years to President F.D.R. and His “New Deal

FDR Was Able to Pass Social Security, but He Also Wanted a Healthcare Safety Net Too.

Presidents Truman and Kennedy Also Wanted a Federally-Funded Healthcare Safety Net.

LBJ Carried the Torch of the Healthcare Safety Net. He Was Able to Have Medicare Legislation Passed in 1965 by Combining 3 Separate Proposals and Acts:

1) Hospital Insurance

2) Doctor Insurance That Was Voluntary

3) the State-Administered Kerr-Mills Act 

Hospital Insurance Became Medicare Part A. Doctor Insurance Became Medicare Part B. The Kerr-Mills Act Became Medicaid.

Presidents Carter and Clinton Also Wanted to Expand the Healthcare Safety Net. President Obama Expanded the Healthcare Safety Net with Passage of Obamacare. President Biden is Seeking to Expand the Healthcare Safety Net Too.

The Arc of Government-Funded Healthcare Stretches Back Almost 100 Years and Will Inevitably Result in the Full Government Payment for Healthcare in America.

It’s Not a Question of If, But When.

Implication: United Health Group is Making Many Acquisitions to Become a Vertically Integrated Healthcare Company to Position Itself as a Major Government Contractor for the Eventual Federal Takeover.

PODCAST: https://www.youtube.com/watch?v=OAh7Rl7w1wM

Your thoughts are appreciated.

THANK YOU

***

PODCAST: The Hidden War for Patients and Money

The Role of Referrals and Patient Volume in Healthcare Finance

Patient Referrals are BIG Business for Hospital Systems

Hear the Story of How UMass Memorial Health Care Specifically Targeted Referring Physicians

BY ERIC BRICKER MD

Your thoughts are appreciated

THANK YOU

More on Referral Leakage: https://medicalexecutivepost.com/2015/04/24/medical-provider-network-referral-leakage/

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Product Details

TEXTBOOK ORDER: 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

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PODCAST: Corporate Practice of Medicine Laws

Dictate Doctors Cannot Work for Corporations?

Texas CEO Magazine Eric Bricker 1 - SO 14 - Texas CEO Magazine

ERIC BRICKER MD

These Laws Were Put Into Place So Doctors Would Not Put Shareholders Before Patients and So Corporations Would Not Interfere with Doctor Judgement.

Corporate Practice of Medicine Laws are at the State-Level, NOT the Federal Level.

Each State Has Their Own Exceptions Such as 1) Doctors Can Work for Companies That Are Owned by Other Doctors and 2) Doctors Can Work for Hospitals.

However, Private Equity Firms Have Been on a Physician Practice Buying Binge.

Private Equity Firms Bought 355 Physician Practices from 2013 – 2016.

Two of the Largest Purchases Were KKR‘s Purchase of Envision’s 25,000 Doctors for Almost $10 Billion and Blackstone‘s Purchase of Team Health’s 20,000 Doctors for $6 Billion.

QUERY: If Corporate Practice of Medicine Laws Say that Doctors Cannot Work for a Corporation, How are Private Equity Purchases of Physician Practices Legal?

This Video by Colleague Eric Bricker MD Explains
https://www.youtube.com/watch?v=2epmk4_-kUI

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Your comments are appreciated.
THANK YOU

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PODCAST: Is Doctor Culture Uncaring?

Dr. Robert Pearl’s Book from Moral Injury to Fee-for-Service … and More

Bricker - This Week Health

By Eric Bricker MD

Dr. Robert Pearl Was the CEO of the Permanente Medical Group from 1999 to 2017. Permanente is the Physician Group for all of Kaiser Permanente. It is the Largest Physician Group in America with 10,000 Doctors, 38,000 Staff and 5 Million Members.

EDITOR’S NOTE: Normally, book reviews are boring but this presentation from colleague Eric Bricker MD is well worth a watch.

PODCAST LINK: https://www.youtube.com/watch?v=omPqBq6_f-E

ASSESSMENT: Your thoughts are appreciated.

THANK YOU

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PODCAST: Medicare Advantage Plans [Insurance Company Goldmine]

Medicare Advantage PART C

Insurance Carriers Want Medicare-For-All to Happen?

https://roundstoneinsurance.com/wp-content/uploads/2020/01/Eric-Bricker-Headshot_500x500-480x480.png

By Eric Bricker MD

A Commonwealth Fund Study Found Insurance Carrier Revenue from Medicare Advantage Plans Increase 5X More Than Revenue from Employer Sponsored Health Plans.

In Fact, Government Sources (Medicare Advantage, Medicaid Managed Care, ACA/Obamacare Plans) Make Up More Revenue ($213B) for the 5 Largest Insurance Carriers Than Revenue from Employers ($148B).

Government Payers Are the New Cash Cow for Health Insurance Companies.  
And so, Medicare-Advantage-for-All May Happen … Because Insurance Carriers WANT It to Happen.

PODCAST: A Commonwealth Fund Study Found Insurance Carrier Revenue from Medicare Advantage Plans Increased 5X More Than Revenue from Employer Sponsored Health Plans.

Your thoughts are appreciated.

THANK YOU
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PODCAST: Healthcare Artificial Intelligence, Machine Learning and Natural Language Processing

PODCAST ON UnitedHeathcare Group Annual Report

Dr. Eric R. Bricker, Internist in Dallas, TX | US News Doctors

By Eric Bricker MD

An Annual Report from UnitedHealth Group Says United is Going Drive Growth by Using AI and Machine Learning to 1) Help High Risk Patients, 2) Assist Patients with Multiple Chronic Diseases, 3) Partner with Providers and 4) Be More Patient-Centric.

Some More Concrete Examples of How AI and Machine Learning Can Be Used in Healthcare and Health Insurance Are:

1) Better Underwriting of Risk

2) More Highly Focused Prior Authorization

3) Cherry-Pick the Individual Health Insurance Market

However, the Execution of AI’s and Machine Learning’s Finding Requires Human Behavior Modification–an Almost Impossible Task for Any Insurance Carrier to Accomplish Because of Their Low Credibility with Patients, Doctors and Nurses. Without Credibility and Trust, All the AI and Machine Learning in the World Will NOT Change People’s Behavior.

PODCAST LINK: https://www.youtube.com/watch?v=c9knoA30sD4

Disclaimer: Dr. Bricker is the founder of Texas Family Insurance – an independent insurance agent that sells Oscar Health.

ASSESSMENT: Your comments are appreciated.

THANK YOU
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PODCAST: Stock Market Impact on Health Care

The Dramatic Rise in the Stock Market Over the Last 10 Years Has Caused Institutional Investors Like Pension Funds to Re-balance to Private Equity

EP269: COVID-19—Prepping for the Next Wave: What Payers ...

By Eric Bricker MD

A Typical Pension Fund Portfolio Will Be 51% Bonds, 28% Equities, 6% Real Estate, 5% Private Equity, 4% Other and 6% Cash. As a Result of Rebalancing Money Out of Skyrocketing Equities, Private Equity Funding Has Doubled to Over $1.2 Trillion in the Last 10 Years.

Specifically in Healthcare, Private Equity Investment in Providers (i.e. Physician Groups, Surgery Centers, Imaging Centers, etc.) Doubled to $30 Billion in Just ONE YEAR. The Private Equity Investment on the Payor Side of Healthcare PALES in Comparison at Only $1 Billion. The Majority of These Private Equity Investments Plan on Making Money By INCREASING Healthcare Costs in a Fee-for-Service Payment Environment.

Healthcare Costs Don’t Rise By Accident. They Rise Because Specific People Make Specific Plans to Increase Costs to Earn a Return on Their Investment.

Sources: https://www.ssga.com/investment-topic…​, https://www.barrons.com/articles/reba…​, https://www.privateequityinternationa…

Private equity sees a lot to like in healthcare

PODCAST LINK: https://www.youtube.com/watch?v=X3hpyeQaKDk

ASSESSMENT: Your thoughts are appreciated.

Diversification: https://medicalexecutivepost.com/2014/11/12/the-negative-short-term-implications-of-diversification/

Hospital Endowment Fund: https://medicalexecutivepost.com/2015/01/08/on-hospital-endowment-fund-management/

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

Product Details

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

THANK YOU

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CEO ADMITS: Payments in Value-Based Contracts Were Actually Fee-For-Service Based

Fee-For-Service Physician Reimbursement Not to be Replaced Anytime Soon!

AN EXPOSE’

Image result for eric brixcker

By Eric Bricker MD

VALUE BASED CARE PROPONENTS?

Definition: Value-Based Care (VBC) is a health care delivery model under which providers — hospitals, labs, doctors, nurses and others — are paid based on the health outcomes of their patients and the quality of services rendered. Under some value-based contracts, providers share in financial risk with health insurance companies. In addition to negotiated payments, they can earn incentives for providing high-quality, efficient care.

VBC differs from the traditional fee-for-service model where providers are paid separately for each medical service. While quality care can be provided under both models, it’s the difference in how providers are paid, paired with the way patient care is managed, that provides the opportunity for health improvements and savings in a VBC environment.

DICTIONARY CITATION: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

MEDICAL EXECUTIVE-POST REVIEW:

Advocacy: https://medicalexecutivepost.com/2015/10/19/the-case-for-value-based-medical-care/

Status: https://medicalexecutivepost.com/2018/12/07/the-state-of-value-based-care-vbc/

Transition: https://medicalexecutivepost.com/2017/08/06/transitioning-to-value-based-medical-care-payments/

Physicians: https://medicalexecutivepost.com/2016/02/03/value-based-care-vbc-and-physician-performance/

THE SHOCKING EXPOSE’

But – During a Panel Discussion Captured on YouTube at the 2019 HLTH Conference in Las Vegas, Blue Cross Blue Shield of Arizona CEO Pam Kehaly Admitted that Only 10% of the Payments in Value-Based Contracts Were Value-Based.

So, what gives?

VIDEO: https://www.youtube.com/watch?v=PfAxOpyP-sA

Your thoughts are appreciated.

Product Details

ORDER: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

THANK YOU

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