PODCASTS: The “Long Fix” for America’s Healthcare Crisis

By Vivian Lee MD PhD MBA

Politics and Prose

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ERIC BRICKER MD PODCAST: https://www.youtube.com/watch?v=fbXM44YSBfs

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Product Details

ORDER: https://www.springerpub.com/the-business-of-medical-practice-9780826105752.html

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DICTIONARY: Health Insurance and Managed Care

Designated a Doody’s CORE TITLE

To keep up with the ever-changing field of health care, we must learn new and re-learn old terminology in order to correctly apply it to practice. By bringing together the most up-to-date abbreviations, acronyms, definitions, and terms in the health care industry, the Dictionary offers a wealth of essential information that will help you understand the ever-changing policies and practices in health insurance and managed care today. For Further Information.

Review

The Dictionary of Health Insurance and Managed Care lifts the fog of confusion surrounding the most contentious topic in the health care industrial complex today. My suggestion therefore is to ‘read it, refer to it, recommend it, and reap’.”
Michael J. Stahl,PhD, Physician Executive MBA Program, William B. Stokely Distinguished Professor of Business, The University of Tennessee, College of Business Administration

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

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

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PODCAST: Hospital CFOs Found Doctors Drive $1.56 Million / Doctor / Year by Ordering Tests and Performing Procedures!

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By Eric Bricker MD

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AMA ECONOMICS: https://medicalexecutivepost.com/2022/08/01/ama-to-teach-medical-students-about-health-economics/

Health Economics: https://medicalexecutivepost.com/2022/07/31/podcast-history-applied-to-health-economics/

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

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STOP-LOSS Health Insurance?

What is stop-loss insurance AND how does it work?

By Staff Reporters

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A stop-loss health insurance policy covers claims above a health insurance plan’s retained claims. The claims fund of a self-funded employer will pay claims up to the predetermined deductible for each of the company’s covered employees. The role of the stop-loss is to cover all claims above these deductible levels.

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

According to RoundStone Insurance, aggregate stop-loss insurance is designed to protect an employer who self-funds their employee health plan from higher-than-anticipated payouts for claims. Stop-loss insurance is similar to high-deductible insurance, and the employer remains responsible for claims below the deductible amount.

An individual stop-loss insurance carrier determines the average expected monthly claims per employee / per month PEPM based on the employer’s history. Then, this figure is multiplied by a percentage ranging from 110%-150%. That determined amount is then multiplied by the enrollment on a monthly basis to establish the aggregate deductible.

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

BUSINESS: 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

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How Much Health Insurers Pay for Almost Everything Is About to Go Public

By Julie Appleby KHN

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READ HERE: https://khn.org/news/article/health-insurers-price-transparency-public-rates-costs/?utm_source=pocket-newtab

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PODCAST: Value Hole in Health Insurance Plan Design

By Eric Bricker MD

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

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A Doctor – Economist’s Solution for Health Reform

My Laundry Wish List for all US Healthcare Stakeholders

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Fox News

As President Obama spoke, prodded and cajoled for Congress to pass HR 3200-3400 in 2008, I believe that for any healthcare reform effort to work successfully for the American people – for the long term – we need to consider the following in no particular prioritized order:

  • Insurance portability uncoupled from patient employment
  • Health insurance regional exchanges with inter-state purchase competition
  • Doctor, drug, DME and hospital pricing and payment transparency for HSAs, and all of us
  • Modifying or eliminating AMA owned CPT Codes®; a huge money maker for them
  • Abandoning ala’ carte medicine for values-based outcomes
  • Reduce JCAHO influence; encourage competition from Norwegian Det Norske Veritas [DNV]
  • Reduce big-pharma influence thru-out the entire medical education, career and care pipeline
  • End DTC advertising from big-pharma
  • Promote wholesale drug purchase competition, MC bidding and generic drugs
  • Encourage evidence-based medicine, not expert-based medicine
  • Less pay for medical specialists with a  re-evaluation of the hospitalist concept
  • Advance the dying art of physical diagnosis, teach and embrace Paretto’s 80/20 rule for clinic issues
  • Reduce lab test, diagnostic imaging and testing
  • Encourage private 24/7/365 medical offices and clinics; and on-site and retail clinics
  • Abandon P4P, medical homes and disease management ideas
  • Give more economic skin-in-game to patients relative to health benchmarks
  • Concretize the “never-event” prohibitions and include a list of patient health responsibilities
  • More pay for primary care docs and internists
  • Adopt digital records and cloud computing for patients
  • Phase in true eHRs incrementally; and abandon CCHIT for open source SaaS
  • Promote Health 2.0 social media.
  • Augmented scope of practice, numbers and pay for NPs and DNPs, etc
  • Reduce pay for CRNAs and increase it for staff RNs
  • Develop step down triage and treatment units to reduce the number of full service ERs
  • Increase medical, osteopathic, dental, optometric and podiatric medical school classes
  • Increased practice scope for dentists, podiatrists and optometrists
  • Make some sort of catastrophic HI mandatory, much like auto insurance for all
  • End pre-existing conditon health insurance contract clauses
  • More choice  and end of life control for the terminally ill patient
  • Increase marketplace competition with fewer political and financial “externalities”.
  • Teach basic healthcare topics in school and encourage physical exercise
  • Health and insurance education should be, but is not, the “answer” for Americans
  • Protect borders and discourage undocumented illegals
  • Adopt medical malpractice tort reform
  • Make all stakeholders fiduciaries
  • No public “option” unless you like food stamps, Section 8 housing, public transportation and schools
  • Budget deficit neutrality
  • Slow down!

Assessment

Recently, while in the Baltimore/Washing area, I was asked by several reporters to opine on the healthcare debate; which I did so freely having never been known as the shy type. And, regular readers will note that many of these items have been used as posts or comments on this ME-P. Unfortunately, my “laundry list” interview was pre-empted by two local but boisterous town-hall meetings with respective passionate politicians. It was redacted no doubt, but never broadcast. Thus, I missed the potential for my “five minutes” of fame. C’est la vive!

Conclusion

There you have it; direct and straight forward. And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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INTERVIEW: A Healthcare Financing Solution for Entrepreneurs?

Former: CEO and Founder
Superior Consultant Company, Inc.
[SUPC-NASD]

EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.

-Dr. David E. Marcinko MBA CMP®

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Staff & Contributors - CHAMPIONS OF WAYNE

By Richard Helppie

Today for your consideration – How to fix the healthcare financing methods in the United States?

I use the term “methods” because calling what we do now a “system” is inaccurate. I also focus on healthcare financing, because in terms of healthcare delivery, there is no better place in the world than the USA in terms of supply and innovation for medical diagnosis and treatment. Similarly, I use the term healthcare financing to differentiate from healthcare insurance – because insurance without supply is an empty promise.

This is a straightforward, 4-part plan. It is uniquely American and will at last extend coverage to every US citizen while not hampering the innovation and robust supply that we have today. As this is about a Common Bridge and not about ideology or dogma, there will no doubt be aspects of this proposal that every individual will have difficulty with. However, on balance, I believe it is the most fair and equitable way to resolve the impasse on healthcare funding . . . .

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

Let me start in an area sure to raise the ire of a few. And that is, we have to start with eliminating the methods that are in place today. The first is the outdated notion that healthcare insurance is tied to one’s work, and the second is that there are overlapping and competing tax-supported bureaucracies to administer that area of healthcare finance.

Step 1 is to break the link between employment and health insurance. Fastest way to do that is simply tax the cost of benefits for the compensation that it is. This is how company cars, big life insurance policies and other fringe benefits were trimmed. Eliminating the tax-favored treatment of employer-provided healthcare is the single most important change that should be made.

Yes, you will hear arguments that this is an efficient market with satisfied customers. However, upon examination, it is highly risky, unfair, and frankly out of step with today’s job market.

Employer provided health insurance is an artifact from the 1940’s as an answer to wage freezes – an employer could not give a wage increase, but could offer benefits that weren’t taxed. It makes no sense today for a variety of reasons. Here are a few:

1. Its patently unfair. Two people living in the same apartment building, each making the same income and each have employer provided health insurance. Chris in unit 21 has a generous health plan that would be worth $25,000 each year. Pays zero tax on that compensation. Pat, in unit 42 has a skimpy plan with a narrow network, big deductibles and hefty co-pays. The play is worth $9,000 each year. Pat pays zero tax.

3. The insurance pools kick out the aged. Once one becomes too old to work, they are out of the employer plan and on to the retirement plan or over to the taxpayers (Medicare).

4. The structure is a bad fit. Health insurance and healthy living are longitudinal needs over a long period of time. In a time when people change careers and jobs frequently, or are in the gig economy, they are not any one place long enough for the insurance to work like insurance.

5. Creates perverse incentives. The incentives are weighted to have employers not have their work force meet the standards of employees so they don’t have to pay for the health insurance. Witness latest news in California with Uber and Lyft.

6. Incentives to deny claims abound. There is little incentive to serve the subscriber/patient since the likelihood the employer will shop the plan or the employee will change jobs means that stringing out a claim approval is a profitable exercise.

7. Employers have difficulty as purchasers. An employer large enough to supply health insurance has a diverse set of health insurance needs in their work force. They pay a lot of money and their work force is still not 100% happy.

Net of it, health insurance tied to work has outlived its usefulness. Time to end the tax-favored treatment of employer-based insurance. If an employer wants to provide health insurance, they can do it, but the value of that insurance is reflected in the taxable W-2 wages – now Pat and Chris will be treated equally.

Step 2 is to consolidate the multiple tax-supported bureaus that supply healthcare. Relieve the citizens from having to prove they are old enough, disabled enough, impoverished enough, young enough. Combine Medicare, Medicaid, CHIP, Tricare and even possibly the VA into a single bureaucracy. Every American Citizen gets this broad coverage at some level. Everyone pays something into the system – start at $20 a year, and then perhaps an income-adjusted escalator that would charge the most wealthy up to $75,000. Collect the money with a line on Form 1040.

I have not done the exact math. However, removing the process to prove eligibility and having one versus many bureaucracies has to generate savings. Are you a US Citizen? Yes, then here is your base insurance. Like every other nationalized system, one can expect longer waits, fewer referrals to a specialist, and less innovation. These centralized systems all squeeze supply of healthcare services to keep their spend down. The reports extolling their efficiencies come from the people whose livelihoods depend on the centralized system. However, at least everyone gets something. And, for life threatening health conditions, by and large the centralized systems do a decent job. With everyone covered, the fear of medical bankruptcy evaporates. The fear of being out of work and losing healthcare when one needs it most is gone.

So if you are a free market absolutist, then the reduction of vast bureaucracies should be attractive – no need for eligibility requirements (old enough, etc.) and a single administration which is both more efficient, more equitable (everyone gets the same thing). And there remains a private market (more on this in step 3) For those who detest private insurance companies a portion of that market just went away. There is less incentive to purchase a private plan. And for everyone’s sense of fairness, the national plan is funded on ability to pay. Bearing in mind that everyone has to pay something. Less bureaucracies. Everyone in it together. Funded on ability to pay.

Step 3 is to allow and even encourage a robust market for health insurance above and beyond the national plan – If people want to purchase more health insurance, then they have the ability to do so. Which increases supply, relieves burden on the tax-supported system, aligns the US with other countries, provides an alternative to medical tourism (and the associated health spend in our country) and offers a bit of competition to the otherwise monopolistic government plan.

Its not a new concept, in many respects it is like the widely popular Medigap plans that supplement what Medicare does not cover.

No one is forced to make that purchase. Other counties’ experience shows that those who choose to purchase private coverage over and above a national plan often cite faster access, more choice, innovation, or services outside the universal system, e.g., a woman who chooses to have mammography at an early age or with more frequency than the national plan might allow.  If the insurance provider can offer a good value to the price, then they will sell insurance. If they can deliver that value for more than their costs, then they create a profit. Owners of the company, who risk their capital in creating the business may earn a return.

For those of you who favor a free market, the choices are available. There will be necessary regulation to prevent discrimination on genetics, pre-existing conditions, and the like. Buy the type of plan that makes you feel secure – just as one purchases automobile and life insurance.For those who are supremely confident in the absolute performance of a centralized system to support 300+ million Americans in the way each would want, they should like this plan as well – because if the national plan is meeting all needs and no one wants perhaps faster services, then few will purchase the private insurance and the issuers will not have a business. Free choice. More health insurance for those who want it. Competition keeps both national and private plans seeking to better themselves.

Step 4 would be to Permit Access to Medicare Part D to every US Citizen, Immediately

One of the bright spots in the US Healthcare Financing Method is Medicare Part D, which provides prescription drug coverage to seniors. It is running at 95% subscriber satisfaction and about 40% below cost projections.

Subscribers choose from a wide variety of plans offered by private insurance companies. There are differences in formularies, co-pays, deductibles and premiums.

So there you have it, a four part plan that would maintain or increase the supply of healthcare services, universal insurance coverage, market competition, and lower costs. Its not perfect but I believe a vast improvement over what exists today. To recap:

1. Break the link between employment and healthcare insurance coverage, by taxing the benefits as the compensation they are.

2. Establish a single, universal plan that covers all US citizens paid for via personal income taxes on an ability-to-pay basis.  Eliminate all the other tax-funded plans in favor of this new one.

3. For those who want it, private, supplemental insurance to the national system, ala major industrialized nations.

4. Open Medicare Part D (prescription drugs) to every US citizen. Today.

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PODCAST: IC-HRA [Individual Coverage – Health Reimbursement Arrangement] Explained

Health Insurance Job Options

By Eric Bricker MD

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DEFINITION: ICHRA (we pronounce it “ick-rah”) stands for “Individual Coverage Health Reimbursement Arrangement” (not the common misnomer of individual coverage health reimbursement accounts)  and is available for employers to start using as of January 2020. ICHRA is an evolution of another type of HRA, called a QSEHRA, that was created in 2017. Both allow employers to reimburse employees tax-free for individual health insurance, but ICHRA represents a “super-charged” version of QSEHRA with higher limits and greater design flexibility that will appeal.

More: https://www.takecommandhealth.com/ichra-guide

CITE: https://www.r2library.com/Resource/Title/082610254

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SURVEY: Resources Offered by Health Insurance Plan Transparency Tool

By MCOL

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Percentage of Resources

 •  Finding in-network providers: 72%
 •  Telehealth: 55%
 •  Ability to select PCP online: 53%
 •  Help navigating benefits and healthcare options: 50%
 •  Cost estimates for healthcare services: 50%
 •  Status of deductible: 49%
 •  Reviews of doctors and facilities: 46%
 •  Online appointment scheduling: 41%
 •  Financial incentives/rewards for choosing cost-effective care: 25%

Source: Health Sparq, “2022 Annual Consumer Sentiment Benchmark Report,” January 2022

CITE: https://www.r2library.com/Resource/Title/082610254

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PODCASTS: Health Economics and the AMA

By Professor Jon

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PODCAST: https://www.youtube.com/watch?v=fwYYae_U1OI

PODCAST: https://medicalexecutivepost.com/2022/05/30/ama-to-teach-medical-students-about-health-economics/

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Healthcare A.I. and Financial Outcomes Survey

By Staff Reporters

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17% of Healthcare Execs Said AI Would Affect Financial Outcomes

 •  60% of respondents expect AI to impact clinical outcomes.
 •  17% said AI would affect financial outcomes.
 •  13% said AI would impact their operation outcomes.
 •  9% said AI would impact administrative outcomes.
 •  61% of executives hope to bring about a complete digital transformation in their organizations within three to five years.

Source: Morning Consult via HealthIT Analytics, April 14, 2022

CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Health Insurance Plans Confusing and Largely Misunderstood

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By Eric Bricker MD

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According to One Survey, only 4% of People Understand the Basic Insurance Terms of Deductible, Co-Insurance, Copay and Out-of-Pocket Maximum.

In Another Survey by United Healthcare Itself, Only 9% Understood the Terms Premium, Deductible, Co-Insurance and Out-of-Pocket Max.

This Lack of Understanding is Not the Fault of the Employee Benefits Professionals or the Employees… Rather, the Health Insurance Plan Designs Are Just Too Complicated.

CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: https://www.youtube.com/watch?v=Yp6TI7iu-m0

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Comments Appreciated

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PODCAST: The Decline of Employer Sponsored Family Healthcare Insurance Coverage

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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The Health Insurance Stock Index

Versus Industry Benchmarks

[By staff reporters]

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Assessment

Your thoughts are appreciated.

RESOURCES:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

THANK YOU

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

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

Update on COVID-19 Booster Shots

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Update on COVID-19 booster shots
In case you missed it: If you or a loved one are 50 or older, or are moderately or severely immunocompromised, you can get an additional Pfizer or Moderna COVID-19 booster shot at no cost to you.

The CDC recommends an additional booster shot for certain individuals to increase protection from severe disease from COVID-19. People over the age of 50, or who are moderately or severely immunocompromised, can get an additional booster of Pfizer or Moderna 4 months after their last dose.

This is especially important for those 65 and older who are at higher risk from severe disease and most likely to benefit from getting an additional booster.

Learn More: Remember: Medicare covers the COVID-19 vaccine, including booster shots, at no cost to you. Find a COVID-19 vaccine location near you.

Sincerely
The Medicare Team

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MORE: https://www.medicare.gov/medicare-coronavirus?utm_campaign=20220406_cvd_prv_gal&utm_content=english&utm_medium=email&utm_source=govdelivery

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30% of Adults Surveyed Would Give Up Their Current PCP

By Staff Reporters

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Primary Care Providers

A survey was recently conducted by Centivo of 805 US adults ages 18-64 with employer-sponsored private health insurance. The survey found that respondents were willing to accept the following conditions in exchange for significant cost savings:

 •  50% would accept referrals for specialists as a requirement.
 •  47% would select a primary care physician (PCP) from a defined list.
 •  30% would give up their current PCP.
 •  28% would stop seeing a current specialist.

Source: Centivo Via PR Newswire, March 16, 2022

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PODCASTS: All You Need to Know About Government Healthcare

By Eric Bricker MD

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1) Traditional Medicare: Health Insurance for Seniors 65 and older. Medicare Part A is coverage for hospital services. Medicare Part B is coverage for doctor, physical therapist and other provider services and for outpatient services such as labs and imaging.

2) Medicare Advantage: Health Insurance for Seniors 65 and older administered through a private health insurance company. It is sometimes referred to as Medicare Part C. It can be chosen instead of Traditional Medicare and often includes Dental Insurance, Vision Insurance, Hearing Aid Insurance and Prescription Drug Coverage.

3) Medicare Part D Prescription Coverage: Additional insurance for people on Traditional Medicare to cover their prescription medications as well. Medicare Part D is administered by private insurance companies.

4) Medicare Supplement Plans: Insurance that can be purchased in addition to Traditional Medicare to cover the expenses that Traditional Medicare does not cover, such as hospitalization deductibles and Medicare Part B co-insurance.

5) Medicaid: The health insurance program administered by each state for it’s economically disadvantaged residents. It is funded in part by the Federal Government and in part by each state. It is administered by private health insurance companies.

6) Affordable Care Act (ACA) Exchange Plans: Health insurance for people under 65 who make too much money to qualify for Medicaid, but do not received health insurance through their employer. ACA Exchange Plans are subsidized by the Federal Government and administered by private insurance companies.

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PODCAST: How Prescription Drug Coverage Really Works

By Eric Bricker MD

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


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PODCAST: Dysfunctional Employee Healthcare Benefits

By Eric Bricker MD

Article in the Journal of the American Medical Association

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PODCAST: More on Health Insurance from a Medical Technology CEO

A Professional and Personal look at Health Insurance, with Karl Albrecht
Rich talks with the president of Action Benefits, Karl Albrecht about the state of Health Insurance. 

Albrecht also gives a candid insight to his personal fight with pancreatic cancer and how being a Health Insurance executive as well as a patient, has given him a unique perspective on how things work, and how they could improve.
Image

BY RICHARD HELPPIE

PODCAST: https://richardhelppie.com/karl_albrecht/

YOUR COMMENTS ARE APPRECIATED.

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AMA: Prior Authorization and Patient Harm?

By Staff Reporters

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Prior Authorization and Patient Harm

 •  34% of physicians report that PA has led to a serious adverse event for a patient in their care.
 •  24% of physicians report that PA has led to a patient’s hospitalization.
 •  18% of physicians report that PA has led to a life-threatening event or required intervention to prevent  permanent impairment or damage.
 •  8% of physicians report that PA has led to a patient’s disability/permanent bodily damage, congenital anomaly/birth defect or death.

Source: AMA, “2021 AMA prior authorization (PA) physician survey,” February 2022

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Understanding the “Language” of Healthcare Finance, IT, Economics and Insurance

Join Our Mailing List

By Ann Miller RN MHA

The ME-P is Doing Its’ Part with Comprehensive Dictionaries and Glossaries

Product DetailsProduct DetailsProduct Details

[Click on each icon for a larger view]

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55% of Consumers Find it Stressful Paying a Healthcare Bill

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By Staff Reporters

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An annual study of over 1,500 U.S. consumers, shows:

 •  55% of consumers find it stressful paying a healthcare bill.
 •  53% of consumers find it stressful understanding their plan’s coverage and benefits.
 •  53% of consumers find it stressful comprehending what they owe.
 •  59% of consumers find it stressful reconciling a bill issue with their payer.

Source: Cedar via GlobeNewswire, December 7, 2021

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

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Average Annual Healthcare Growth Rates of Spending, Utilization and Price

By Staff Reporters

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Average Annual Growth Rates of Spending, Utilization, and Prices

 •  Spending per person: commercial insurers (3.2% per year); Medicare fee for service (1.8% per year)
 •  Utilization per person: commercial insurers (0.4% per year); Medicare fee for service (0.5% per year)
 •  Prices paid to providers: commercial insurers (2.7% per year); Medicare fee for service (1.3% per year).

Notes: For hospitals and physicians’ services, 2013-2018
Source: Congressional Budget Office – January 2022

“The Prices That Commercial Health Insurers and Medicare Pay for Hospitals’ and Physicians’ Services”
 

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PODCAST: Health Insurance Costs Have Risen 55% in the Last Decade

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By Eric Bricker MD

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Health Insurance Cost Has Risen 55% in the last 10 Years. The Annual Health Insurance Cost for Family Coverage is Now $21,000 Per Year

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Dysfunctional Employee Benefits Article in Journal of the American Medical Association

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: How to Read Healthcare Insurance Reports

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Prescription Patient Assistance Programs

BY ERIC BRICKER MD

With 43 Million Americans Having Lost Their Job at Some Point During the Pandemic and About 1/2 Those Jobs Providing Health Insurance… the 1st Group–People Who Do Not Have Health Insurance–Needs to Be Aware of How These Programs Work.

In this Video You Will Learn the Patient Assistance Program Process for:

1) 2 of the Most Common Types of Insulin

2) The Highest-Revenue Medication in America: Humira

**Note: At the Time of the Video’s Recording, the Unemployment Rate in the US was 15%. As of November 2021, the Unemployment Rate is 4.2%.

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CITE: https://www.r2library.com/Resource/Title/082610254

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31% of Americans Don’t Know How They’d Pay for Severe Illness

By Staff Reporters

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31% of Americans Don’t Know How They’d Pay for Severe Illness

A recent survey by HealthcareInsider that polled 1,062 adults aged 18 and up asked, “If you were to experience a severe illness how would you pay for treatment?”

 •  Don’t know: 31%
 •  Credit card: 26%
 •  Non-retirement savings: 17%
 •  Borrow money from family: 16%
 •  Retirement savings: 11%
 •  Health Savings Account: 9%
 •  Borrow from a finance institution: 8%
 •  Crowdfund online: 6%

Source: HealthCareInsider, December 2nd, 2021COMMENTS APPRECIATED.

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PODCAST: Ray Dalio on How the Healthcare Economy Works

Economy Works’ Applied to Healthcare … Credit Cycles and Healthcare Policy

By Eric Bricker MD

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

RICARDIAN DEMAND HEALTH ECONOMICS: https://medicalexecutivepost.com/2021/12/14/ricardian-derived-demand-economics-in-medicine/

RISING HEALTH CARE COSTS: https://medicalexecutivepost.com/2018/03/11/medical-treatment-costs-becoming-expensive-25-factors/

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PODCAST: Direct Healthcare Contracting

How it Works for Employers and Hospitals?

BY DR. ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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

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PODCAST: CIGNA Executive Public Relations “Whistle Blower”

Wendell Potter is a Famous Ex-Executive from Cigna Who Left His High Paying PR Job in 2007 to Reveal the True Story Behind Health Insurance Carrier Public Relations.

BY ERIC BRICKER MD

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PODCAST: How to Sell in Healthcare During the Pandemic

BY ERIC BRICKER MD

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Marketing V. Advertising V. Sales: https://medicalexecutivepost.com/2020/03/09/on-marketing-adverting-and-sales/

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PODCASTS: Employer Sponsored Health Plans Explained [Part I and II]

Self and Fully Insured Fundamentals and Basics

[A Two Part Presentation]

DR. ERIC BRICKER MD

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

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PODCASTS: How Prescription [Rx] Coverage Works

Formulary Tiers, PBM, Rebates, Spread-Pricing Explained

By Dr. Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Milliman Medical Care Guidelines

Pervasive MCG Health Insurance Denials

BY ERIC BRICKER MD

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PODCAST: What a Hospital CEO Should Do?

Operational and Financial Changes

BY ERIC BRICKER MD

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OVERVIEW: Healthcare Finance and Insurance Terms & Definitions

Produced FROM Merck Manual

By Roger I. Schreck

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Health care in the US is technologically advanced but expensive, costing about $3.6 trillion in 2018, which was 16.9% of gross domestic product (GDP) (1). This percentage is significantly higher than in any other nation.

According to the Organization for Economic Cooperation and Development (OECD), in 2018 the next highest spending countries were Switzerland (12.2% of GDP) and France, Germany, Sweden, and Japan (each about 11%), while the average of the 35 OECD countries (OECD35) was 8.8% (2).

ASSESSMENT: Of course, the absolute amount and the rate of increase of health care spending in the US are widely regarded as unsustainable. Consequences of increased US spending on health care include the following:

LINK: https://www.merckmanuals.com/professional/special-subjects/health-care-financing/overview-of-health-care-financing

CMS GLOSSARY: https://www.cms.gov/CCIIO/Resources/Files/Downloads/dwnlds/uniform-glossary-final.pdf

GOVERNMENT: https://www.bls.gov/ncs/ebs/sp/healthterms.pdf

Product Details

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: 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: 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: 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: Health Insurance Plan Trends and Clauses

Medical Trend for 2020 is Estimated to be 6%.

Where Does That Number Come From?

Insurance Companies and Hospitals Negotiate Their Contracts Every 3-5 Years.

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MORE: 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: Hospitals Charge More When Patients are Un-Insured?

BY ERIC BRICKER MD

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

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PODCAST: Health Insurance Business Harms?

Health Insurance Business Harms Doctors, Patients and Hospitals
Inside Healthcare with Nate Kaufman
Rich Helppie brings back healthcare expert and consultant, Nathan Kaufman, Managing Director of Kaufman Strategic Advisors. 

Rich and Nate talk about the current policy issues surrounding healthcare, and why the United States’ approach to health insurance, care and finance are woefully inadequate in today’s landscape.

PODCAST: https://richardhelppie.com/nathan-kaufman/

YOUR THOUGHTS AND COMMENTS ARE APPRECIATED.

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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

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DICTIONARY: Health Insurance and Managed Care

BOOK REVIEW

“The Dictionary of Health Insurance and Managed Care lifts the fog of confusion surrounding the most contentious topic in the health care industrial complex today. My suggestion therefore is to ‘read it, refer to it, recommend it, and reap’.”


Michael J. Stahl, PhD, Physician Executive MBA Program [William B. Stokely Distinguished Professor of Business]

The University of Tennessee, College of Business Administration

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