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ESCHEW “C”: Medicare Advantage [Part C] Plans Now?

Posted on May 3, 2024 by Dr. David Edward Marcinko MBA

By Dr. David Edward Marcinko MBA MEd CMP

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Medicare [Dis] Advantage Plans [Medicare Part C] commenced in 2003 or so and I have railed against them since then. First, for their low physician payments. And then as a patient advocate for the last decade. And, today, for both reasons. As a doctor and independent health insurance agent myself, believe me when I speak thusly.

READ: https://medicalexecutivepost.com/2023/11/07/proposed-changes-medicare-advantage/

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Now, while Medicare Advantage plans are undoubtedly not the right choice for everyone, insurance companies still say there are some folks who will get exactly what they need from the plans and at a moderate price.

Nevertheless, Ernesto Jaboneta, the IT Director of California-based Medicare insurance agency Agent Pitstop, acknowledged there are many predatory salespeople who will jump to have you join a plan that doesn’t end up helping you in the long run. Still, there are precautions you can take to make falling into this trap less likely.

“The first thing anyone can do is invite along a family member or trusted friend to any appointments with an insurance agent,” Jaboneta told Newsweek. “Don’t feel pressured to decide right away.”

Before you commit to anything, you should compare plans and find out if your doctors will remain in your network. And if you’re unsure about some of the information you received from an insurance agent, you can also call 1-800-MEDICARE for more assistance.

Jaboneta also said there’s a big difference between captive insurance agents and independent agents, as well, and seniors should take note of this.

“A captive agent is an insurance agent who works directly for an insurance carrier,” Jaboneta said. “They have no incentive to compare options outside their own company, which is different than an independent agent who can compare all the options available. In many cases, when a beneficiary calls into an insurance company to find information, they will be talked into enrolling.”

The open enrollment period lasts from October 15th to December 8th, but there’s another enrollment period from January 1st to March 31st for anyone unhappy with their Medicare Advantage plan who wants to switch or revert to Medicare.

MORE: https://medicalexecutivepost.com/2023/12/24/medicare-part-c-humana-used-a-i-tool-from-unitedhealth-to-deny-medicare-advantage-claims/

INVESTING UPDATE: Managed-care companies are reporting that seniors on Medicare Advantage Part C plans used far more medical services than expected in the final months of 2023. The announcements have sparked two separate selloffs over the past week: The first came January 12th, when UnitedHealth Group announced its fourth-quarter earnings. The second came after Humana just laid out preliminary fourth-quarter results, and said the high utilization trends would have a material impact on its 2024 performance “if current trends continue.”

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

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Filed under: "Ask-an-Advisor", Accounting, CMP Program, Drugs and Pharma, Ethics, Experts Invited, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Touring with Marcinko | Tagged: Agent Pitstop, David Marciniko, Ernesto Jaboneta, Humana, insurance agents, medicare, Medicare Advantage, Medicare Part, Newsweek, Part C, UHC, United Healthcare | Leave a comment »

CMS Emergency Funds for Doctors Affected by Change Healthcare Hack

Posted on April 2, 2024 by Dr. David Edward Marcinko MBA

By Staff Reporters

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Federal health officials said they would offer emergency funding to physicians, physical therapists, and other professionals that provide outpatient healthcare, following a cyberattack that crippled the nation’s largest processor of medical claims and left many organizations in financial distress. The Centers for Medicare and Medicaid Services also announced that it would make advance payments available to suppliers that bill through Medicare Part B, which serves a wide array of healthcare organizations.

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Officials had previously announced a similar program to make emergency payments available for hospitals that had been ensnared by the February 21st hack of Change Healthcare, a unit of UnitedHealth Group, and have struggled to get paid for more than two weeks. The emergency funds represent upfront payments made to healthcare providers and suppliers based on their expected future claims.

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

Source: Dan Diamond, Washington Post [3/9/24]

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Filed under: "Doctors Only", Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology | Tagged: Centers for Medicare & Medicaid Services, Change Healthcare, CMS, medicare, Medicare B, UHC, UnitedHealth Group | Leave a comment »

DAILY UPDATE: UnitedHealth Group and Fidelity Investments Suffer Ransomware Attacks as Stock Markets Crash

Posted on March 6, 2024 by Dr. David Edward Marcinko MBA

By Staff Reporters

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According to Fidelity, in documents filed with the Maine attorney general’s office, miscreants “likely acquired” information about 28,268 people’s life insurance policies after infiltrating Infosys.

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Criminals have probably stolen nearly 30,000 Fidelity Investments Life Insurance customers’ personal and financial information — including bank account and routing numbers, credit card numbers and security or access codes — after breaking into Infosys’ IT systems.

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Healthcare providers across the United States are struggling to get paid following the week-long ransomware outage at a key tech unit of UnitedHealth Group, with some smaller medical providers saying they are already running low on cash.

And, the nation’s health-care system continues to reel from a cyberattack that has crippled payments for tens of thousands of organizations as Daniel Gilbert writes in The Post.

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

Here’s where the major benchmarks ended:

The S&P 500^® index (SPX) dropped 52.30 points (1.0%) to 5,078.65; the Dow Jones Industrial Average decreased 404.64 points (1.0%) to 38,585.19; the NASDAQ Composite fell 267.92 points (1.7%) to 15,939.59.
The 10-year Treasury note yield (TNX) fell about 8 basis points to 4.137%.
The CBOE Volatility Index^® (VIX) rose 0.97 to 14.46.

With chip makers under pressure, the Philadelphia Semiconductor Index (SOX) fell 2.1%, reversing part of a recent surge to a record high. Consumer discretionary and real estate shares also ranked among the weakest performers Tuesday. Banks were one of the few industries to buck the broader weakness, perhaps supported by further declines in Treasury yields. The 10-year Treasury note yield (TNX) almost fell to a four-week low near 4.11%. The KBW Regional Banking Index (KRX) jumped 4.3%.

In other markets, bitcoin plunged almost 10% after climbing earlier Tuesday to a record above $69,000. The cryptocurrency had rallied as much as 36% over the last week of February.

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Filed under: "Ask-an-Advisor", Breaking News, Drugs and Pharma, Ethics, Experts Invited, Financial Planning, Health Economics, Health Insurance, Healthcare Finance, Information Technology, Investing, LifeStyle | Tagged: banks, CBOE, crypto, crypto currency, Daniel Gilbert, DJIA, DOW, Fidelity Investments, Fidelty, Infosys, KRX, NASDAQ, S&P 500, SOX, SPX, TNX, UHC, UHG, United, UnitedHealth Group, VIX | Leave a comment »

DAILY UPDATE: Down Down Third Day

Posted on February 29, 2024 by Dr. David Edward Marcinko MBA

By Staff Reporters

HAPPY LEAP YEAR DAY

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Stocks fell yesterday, while bitcoin almost touched an all-time high after surging 20% in five days as its halving approaches. UnitedHealth dipped on reports that antitrust regulators are investigating the massive insurer.

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Here’s where the major benchmarks ended:

The S&P 500^® index (SPX) fell 8.42 points (0.2%) to 5,069.76; the Dow Jones Industrial Average lost 23.39 points (0.1%) to 38,949.02; the NASDAQ Composite^® (COMP) declined 87.56 points (0.6%) to 15,947.74.
The 10-year Treasury note yield (TNX) fell about 5 basis points to 4.264%.
The CBOE Volatility Index^® (VIX) rose 0.39 to 13.82.

Regional banks and semiconductors were among the weakest performers Wednesday, and communications services and health care shares were also soft. Real estate shares bucked the weakness in many sectors to post firm gains. Food and beverage and consumer discretionary sectors also firmed. In other markets, WTI crude oil (/CL) futures rose to a three-month high at $79.62 per barrel before ending lower after the Energy Information Administration reported a rise in U.S. inventories.

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

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Filed under: "Ask-an-Advisor", Breaking News, Experts Invited, Financial Planning, Health Economics, Health Insurance, Investing, LifeStyle | Tagged: CBOE, crude oil, DJIA, DOW, leap, leap year, NYC, S&P 500, SPX, TNX, UHC, UnitedHealth, VIX, WTI | Leave a comment »

DAILY UPDATE: Low Unemployment Claims, Medicare [Part C] Declines and Stock Market Rebound Gains

Posted on January 19, 2024 by Dr. David Edward Marcinko MBA

By Staff Reporters

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Statistic 187,000: That’s how many first time unemployment claims were filed last week, a surprise decline and the lowest since September 2022. The resilient labor market is continuing to chug along as companies continue to hold on to the workers they have.

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Managed-care companies are reporting that seniors on Medicare Advantage Part C plans used far more medical services than expected in the final months of 2023. The announcements have sparked two separate selloffs over the past week: The first came January 12th, when UnitedHealth Group announced its fourth-quarter earnings. The second came Thursday, after Humana laid out preliminary fourth-quarter results, and said the high utilization trends would have a material impact on its 2024 performance “if current trends continue.”

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

In response, three largest sponsors of Medicare Advantage plans, UnitedHealth Group, CVS Health, and Humana, have seen their shares fall 3.2%, 7.5%, and 14.3% so far this year, respectively, as of midday Thursday. The S&P 500 is down 0.6% over the same period, while Cigna Group—which is reportedly near a deal to sell its relatively small Medicare Advantage business—is up 1%.

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Here’s where the major benchmarks ended:

The S&P 500 index rose 41.73 points (0.9%) to 4,780.94; the Dow Jones Industrial Average^® (DJI) gained 201.94 points (0.5%) to 37,468.61; the NASDAQ Composite increased 200.03 points (1.4%) to 15,055.65.
The 10-year Treasury note yield (TNX) rose nearly 4 basis points to 4.142%.
The CBOE Volatility Index^® (VIX) fell 0.66 to 14.13.

Gains in Taiwan Semiconductor and its industry counterparts sent the Philadelphia Semiconductor Index (SOX) up 3.4% to a three-week high. In a further illustration of tech sector strength, the Nasdaq-100^® (NXD), which includes the NASDAQ’s largest non-financial companies, rose 1.5% to a record closing high. Banking and utility shares were among the market’s weakest performers.

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Filed under: "Ask-an-Advisor", Alerts Sign-Up, Experts Invited, Funding Basics, Health Economics, Health Insurance, Health Law & Policy, iMBA, Inc., Investing | Tagged: CBOE, Cigna, CVs, DJIA, DOW, Humana, medicare, Medicare Advantage, NSDAQ, NXD, Part C, Russell 2000, S&P 500, Schwab, SOX, TNX, UHC, unemployment claiims, United Health Care, VIX | Leave a comment »

PODCAST: The Future of Healthcare Profits

Posted on September 12, 2023 by Dr. David Edward Marcinko MBA

By Eric Bricker MD

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

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Filed under: "Doctors Only", Accounting, Career Development, Drugs and Pharma, Experts Invited, Health Economics, Health Insurance, Healthcare Finance, Information Technology, Videos | Tagged: Drugs, Eric Bricker, healthcare investments, healthcare profits, HIT, IT, pharmacy, UHC, United Health Care | Leave a comment »

DAILY UPDATE: UHC Prior Authorizations Out While the Markets were Up and Down

Posted on August 12, 2023 by Dr. David Edward Marcinko MBA

By Staff Reporters

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Starting next month, UnitedHealthcare will move forward with plans to drop prior authorization requirements for a range of procedures, including dozens of radiology services and genetic tests, among others. Prior authorization has often criticized by patients and doctors as an administrative burden that impedes necessary medical care. Insurers meanwhile say prior authorization provides important guardrails against improper health care utilization, helping to keep down costs.

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

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Here is where the major benchmarks ended:

The S&P 500 Index was down 4.78 points (0.1%) at 4,464.05 and down 0.3% for the week; the Dow Jones Industrial Average (DJIA) was up 105.25 points (0.3%) at 35,281.40, up 0.6% for the week; the NASDAQ Composite was down 93.14 points (0.7%) at 13,644.85, down 1.9% for the week.
The 10-year Treasury note yield (TNX) was up about 8 basis points at 4.162%.
CBOE’s Volatility Index (VIX) was down 0.98 at 14.87.

Within the tech sector, chipmakers were particularly weak. The Philadelphia Semiconductor Index (SOX) sank 2.3% to a seven-week low. Energy shares gained amid strength in crude oil futures, which have rallied 11% over the past month to near nine-month highs.

Small-caps ended modestly higher, with the Russell 2000 (RUT) up about 0.1% but still down nearly 1.6% for the week and down 3.9% for the month.

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

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Filed under: "Doctors Only", Accounting, Alerts Sign-Up, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance | Tagged: CBOE, DJIA, DOW, Health Insurance, NASDAQ, pre-certifications, prior authorizations, S&P 500, UHC, UnitedHealthcare, VIX | Leave a comment »

DAILY UPDATE: Stocks Down Again but Pickleball is Up!

Posted on June 27, 2023 by Dr. David Edward Marcinko MBA

By Staff Reporters

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The NASDAQ and S&P 500 fell to two-week lows, adding to last week’s declines, as investors continued to digest hawkish Fed comments and recession risks.

Here is where the major benchmarks ended today:

The S&P 500 Index was down 19.51 points (0.5%) at 4,328.82; the Dow Jones Industrial Average (DJIA) was down 12.72 points at 33, 714.71; the NASDAQ Composite was down 156.74 points (1.2%) at 13,335.78.
The 10-year Treasury note yield (TNX) was down about 2 basis points at 3.714%.
CBOE’s Volatility Index (VIX) was up 0.77 at 14.21.

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UnitedHealth Group related more people were using the healthcare system (bad news for insurers), and no one exactly knew why. Then yesterday, the sleuths at UBS published a note with a clever hypothesis: Rising healthcare utilization rates could be fueled by…pickleball injuries.

UBS calculated that the game’s surging popularity—among seniors, in particular—will contribute $377 million in medical costs this year for procedures like hip replacements and knee surgeries, Bloomberg reported.

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

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

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Filed under: Breaking News, Financial Planning, Investing, LifeStyle | Tagged: CBOE, DJIA, DOW, NASDAQ, pickleball, S&P 500, Treasury Yield, UBS, UHC, UHG, UnitedHealth Group, volatility | Leave a comment »

DAILY UPDATE: UHC, Merck and the Boring Markets

Posted on June 7, 2023 by Dr. David Edward Marcinko MBA

By Staff Reporters

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UnitedHealthcare’s stunning advance notification change to it’s colonoscopy coverage roils physicians and patients, alike.

LINK: https://www.uhcprovider.com/content/dam/provider/docs/public/prior-auth/Prior-Auth-Gastroenterology-FAQ.pdf?utm_campaign=hcb&utm_medium=newsletter&utm_source=morning_brew

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The Biden administration is confident it will succeed in the courts against Merck & Co’s lawsuit filed on Tuesday, the White House said, defending the Medicare health insurance program’s authority to seek deals on medicine prices. “We are confident we will succeed in the courts: there is nothing in the Constitution that prevents Medicare from negotiating lower drug prices,” White House spokeswoman Karine Jean-Pierre said in a statement.

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

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Behind negative returns for shares of UnitedHealth and Merck, as noted above, UnitedHealth’s shares were off $14.28, or 2.9%, while those of Merck have dropped $3.23, or 2.9%. A $1 move in any one of the 30 components of the Dow results in a 6.59-point swing. In summary:

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Here is where the major benchmarks ended yesterday:

The S&P 500^® Index was up 10.04 points (0.2%) at 4283.84; the Dow Jones industrial average was up 10.48 at 33,573.34; the NASDAQ Composite was up about 47 points (0.36%) at 13,276.42.
The 10-year Treasury yield was little changed at 3.687%.
CBOE’s Volatility Index was down 0.70 at 14.03.

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

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

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DAILY UPDATE: CVS Buys Signify Health, Narcan Goes OTC and the Technology Markets Ascend

Posted on March 30, 2023 by Dr. David Edward Marcinko MBA

By Staff Reporters

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CVS expects to finalize its $8 billion acquisition of Signify Health this week, the retail pharmacy giant said yesterday. CVS beat out both Amazon and UnitedHealth Group to buy Signify, a value-based provider network. The company announced the deal last September, and executives said they expect it to close “on or around March 29th.”

In a phone call following the deal announcement, Shawn Guertin, EVP and CFO at CVS, said the company anticipates that acquiring Signify will “generate attractive returns” for CVS. The acquisition strengthens CVS’s goal of becoming a value-based healthcare company and could give it a leg up over rival Walgreens. Both companies have doubled down on value-based care in the last couple of years, making several multi-billion dollar deals, such as Walgreens’s $5.2 billion VillageMD acquisition in 2021 and CVS’s $10.6 billion takeover of Oak Street Health.

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The U.S. Food and Drug Administration has approved NARCAN, an overdose-reversing nasal spray, for over-the-counter, non-prescription sale, the agency just announced. The FDA green light marks the first naloxone product approved for use without a prescription. Naloxone rapidly reverses the effects of an opioid overdose, including situations where fentanyl is involved. In the 12-month period ending in October 2022, the United States recorded 101,750 overdose deaths, primarily from opioids including fentanyl, according to the FDA.

“Today’s action paves the way for the life-saving medication to reverse an opioid overdose to be sold directly to consumers in places like drug stores, convenience stores, grocery stores and gas stations, as well as online,” the agency said in a news release.

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Here’s how the major indexes performed yesterday:

The S&P 500^® Index rose roughly 57 points (1.42%) to 4027.83; the Dow Jones industrial average was up 323 points (1.0%) at 32717.73; the NASDAQ Composite was up 210 points (1.79%) at 11926.24.
The 10-year Treasury yield was little changed at 3.575%.
CBOEs Volatility Index was down 80 basis points (4.01%) at 19.17.

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

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Filed under: "Ask-an-Advisor", Alerts Sign-Up, Alternative Investments, Career Development, Drugs and Pharma, Ethics, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Investing, Managed Care, Practice Management | Tagged: Amazon, CBOE, CVs, DJIA, DOW, FDA, naloxone, narcan, NASDAQ, S&P 500, Shawn Guertin, Signify Health, Treasury yields, UHC, UnitedHealthcare, Walgreen's | Leave a comment »

PODCAST: Medicare Traditional [A and B] v. Advantage [C] v. Part [D] v. Supplements

Posted on January 23, 2023 by Dr. David Edward Marcinko MBA

By Eric Bricker MD

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

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

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FIVE CONDITIONS: Total 50% of Healthcare Financial Costs

Posted on July 18, 2022 by Dr. David Edward Marcinko MBA

By Staff Reporters

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5 Conditions Total 50% of Healthcare Costs

• Cancer makes up nearly 15% of all healthcare spending with employers in the study paying $533 million for nearly 103,000 cancer claims.
• Musculoskeletal conditions (including joint wear, knee injuries, hip pain, etc.) makes up 13% of healthcare spending with employers spending $477 million for 317,000 musculoskeletal claims.
• Cardiovascular conditions (including heart rhythm issues, stroke, heart attack, and heart failure) makes up 9% of healthcare spending with employers paying $357 million towards 169,000 claims.
• Gastrointestinal conditions (including colitis, irritable bowel system, celiac disease, etc.) makes up 7% of healthcare spending with employers paying $284 million for 136,000 claims.
• Neurological conditions (including Parkinson’s disease, migraines, epilepsy, etc.) makes up 6% of total health care spending with employers paying $225 million for 240,000 claims.

Source: HAC and UHC via ACDIS, April 14, 2022

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

HOSPITALS: 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

MANAGED CARE: 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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Filed under: Accounting, Experts Invited, Funding Basics, Glossary Terms, Health Economics, Health Insurance, Healthcare Finance | Tagged: ACDIS, HAC, healthcare costs, high cost health claims, MCOL, UHC | Leave a comment »

PODCAST: Health Insurance Plans Confusing and Largely Misunderstood

Posted on April 28, 2022 by Dr. David Edward Marcinko MBA

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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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PODCAST: 15 Metrics for Successful Healthcare Companies

Posted on February 16, 2022 by Dr. David Edward Marcinko MBA

Phil Fisher Was One of the Greatest Entrepreneurial Investors of the 20th Century and a Source of Wisdom for Warren Buffett

By Eric Bricker MD

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

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Filed under: Accounting, Book Reviews, Career Development, Ethics, Experts Invited, Glossary Terms, Health Economics, Health Insurance, Healthcare Finance, Information Technology, Investing, Research & Development, Videos | Tagged: CDHP, cost accounting, Eric Bricker MD, managerial accounting, Metrics for Successful Healthcare Companies, Phil Fisher, TeleDoc, UHC, Warren Buffett | Leave a comment »

PODCASTS: How Prescription [Rx] Coverage Works

Posted on December 19, 2021 by Dr. David Edward Marcinko MBA

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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Filed under: Drugs and Pharma, Experts Invited, Funding Basics, Glossary Terms, Health Insurance, Healthcare Finance, Practice Management, Videos | Tagged: Anthem, Caremark, Cigna, CVs, DEA, drug rebates, drug tiers, Drugs, Eric Bricker MD, Express Scripts, Formulary, Health Insurance, medications, Optum, PBM, PBMs, pharmacy, prescription coverage, Rx, spread drug pricing, UHC, United Health Care | Leave a comment »

PODCAST: NaviHealth Digital Health Start-Up

Posted on November 24, 2021 by Dr. David Edward Marcinko MBA

SOLD TO OPTUM

BY ERIC BRICKER MD

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PODCAST: UHC’s David Wichmann Steps Down as CEO

Posted on October 28, 2021 by Dr. David Edward Marcinko MBA

THE WHOLE STORY?

By Eric Bricker MD

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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™

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PODCAST: United Health Group “Harmony” Network?

Posted on August 2, 2021 by Dr. David Edward Marcinko MBA

UHG Uses Those Doctors for their NEW Harmony Network That They Sell as an HMO Insurance Product to Employers.

United Health Group Has Bought Physician Practices in Southern California Totaling 6,500 Doctors, Associated with 133 Hospitals.

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Filed under: Career Development, Experts Invited, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Practice Management, Practice Worth, Professional Liability, Videos | Tagged: Eric Bricker MD, UHC, United Health Group | 1 Comment »

Usual and Customary UnitedHealthcare?

Posted on March 30, 2009 by Dr. David Edward Marcinko MBA

More on “Sleazy” Healthcare Stakeholders

[By Darrell K. Pruitt; DDS]

If the leaders of the American Dental Association have the power and stoic determination to casually sweep aside trouble-making members who might tarnish their image, one would think that they could certainly avoid associating with sleazy healthcare stakeholders; such as UnitedHealthcare.

The Insurance Giants

Have you ever suspected that insurance giants like UnitedHealthcare, WellPoint, Aetna and Cigna (and other members of the National Association of Dental Plans) lie to patients when the say a dentist’s fees are above “usual, customary and reasonable” levels? You could be correct. NY Attorney General Andrew Cuomo says UnitedHealthcare, WellPoint, Aetna and Cigna lie to physicians’ patients – understating New York state physician’s fees up to 28 percent. Why would the crooks treat dentists’ patients any differently?

Employing Tapeworms to Control Fat

Cuomo caught UHC and others cheating their customers with smoke, mirrors and Ingenix – its wholly-owned data mining and consulting subsidiary. Who would have guessed that UHC would tweak Ingenix to manipulate claims data to favor UHC and other insurance companies who subscribe to their services? These are the same parasites who want to run the nation’s Pay-For-Performance (P4P) mandate – a cornerstone of President Bush’s healthcare reform ideas. They want to tweak professional reputations for healthcare reform and the common good.

And of Ingenix

Ingenix is a full-service consulting business for insurers, backed with the credibility of 14 years of accumulated health claims it is privy to. The “friend in the business” not only cooks the data to produce profit-enhancing Usual, Customary and Reasonable (UCR) fee schedules, Ingenix is also active in “pay-for-performance program assessment, strategy, planning, design, implementation, evaluation and improvement.”

http://www.ingenixconsulting.com/about_history.html

So if you like the way UnitedHealthcare dental consultants treat you now, just wait until they are given authority to determine your worth to society using Ingenix leveraging tools.

P-4-P

I first read about pay-for-performance [P4P] in dentistry in February 2006 in an email from Patrick Cannady who is an employee in the ADA Department of Dental Informatics. He told me that nation-wide quality control in dentistry is an important benefit of having a HIPAA-compliant, paperless dental practice – and that the Department of Dental Informatics is very excited about the opportunity to help prepare US dentists for the future. A month or so later, I learned that the NPI number the ADA still pushes on membership is the crucial legal link to government-approved P4P data-mills like Ingenix – a wholly-owned UnitedHealthcare profit center. Do you think it is odd that the NPI is “voluntary,” yet irreversible?

AMA’s Award

In January, the AMA was awarded $350 million in a lawsuit against UnitedHealthcare and Ingenix on behalf of physicians, and they plan to sue other major insurance companies as well. So what has the ADA done to discourage UnitedHealthcare’s and other NADP members’ atrocious behavior that undeniably harms dental patients? You won’t believe it when I tell you. Here’s more: In a recent Associated Press interview, Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee, said UnitedHealthcare is nothing but a company of cheats. He says, “They’re lowballing deliberately. They deliberately cut the numbers so the consumer has to pay more of the cost.”

http://www.google.com/hostednews/ap/article/ALeqM5gL4XFckx9sah3eFEMuHYD3V2WGhQD97763800

So if Cannady’s department is all for P4P and other benefits from interoperable digital records, the question on most ADA members’ minds should be: What does the ADA think of UnitedHealthcare?

ADA News Online

Two weeks ago the ADA News Online posted an advertisement that looks like an article (with no byline) for the spring meeting of the American Association of Dental Consultants (AADC) on May 7-9 in Scottsdale, Arizona.

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3493

Since it is so well known that UnitedHealthcare is the major funding sponsor of the AADC, the word in the neighborhood says AADC, like Ingenix, is another UnitedHealthcare profit center awaiting the wrecking-ball.

Link: http://www.google.com/hostednews/ap/article/ALeqM5gL4XFckx9sah3eFEMuHYD3V2WGhQD97763800

Assessment

Last year’s annual meeting of the dental consultants – who deny dental claims to protect the ethics in dentistry – featured ADA Senior Vice-President Dr. John Luther as a guest speaker. Dr. Luther is Cannady’s boss. He oversees the Department of Dental Informatics. Yep. The ADA is tight with UnitedHealthcare. One can tell a person’s character by the company he or she keeps.

Conclusion

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Filed under: Breaking News, Career Development, Ethics, Health Insurance, Health Law & Policy, Managed Care, Op-Editorials | Tagged: AADC, ADA, Aetna and Cigna, AMA, American Association of Dental Consultants, Department of Dental Informatics, Ingenix, Jay Rockefeller, John Luther, National Association of Dental Plans, NPA, NY Attorney General Andrew Cuomo, P4P, Patrick Cannady, Science and Transportation Committee, Senate Commerce, UCR, UHC, UnitedHealthcare, WellPoint | 3 Comments »

Big Blue and UHG’s New Health Plan Model

Posted on February 23, 2009 by Dr. David Edward Marcinko MBA

Innovative Model -or- Just another Paradigm Shift

By Staff Reporters

According to Reed Abelson, and David Kadlubowski of the electronic New York Times [NYT].com edition, on February 6, 2009, a new medical practice business plan and health care insurance reimbursement model could allow family physicians to practice medicine the way they used to practice. How so?

Exit UHG

The giant insurer UnitedHealth Group is testing a new model of health care that some policy experts say holds great promise, but has yet to prove itself. An earlier trial of the model by UnitedHealth, in Florida, never got off the ground because doctors refused to participate.

Enter IBM

This time however, the insurer is teaming up with seven doctors’ groups to make another attempt, in Arizona, at the prodding of one of the state’s big employers, and IBM. UnitedHealth will try giving doctors more authority and money than usual in return for closely monitoring their patients’ progress, even when patients go to specialists or require hospitalization.

Link: http://www.nytimes.com/2009/02/07/business/07medhome.html?_r=3&ref=health

Moving toward Value-Added Models and Episodes of Care

The insurer will also move away from paying doctors solely on the basis of how many services they provide via CPT® codes and will start rewarding them more for overall quality of patient care [value added and/or episodes of care model].

Link: https://healthcarefinancials.wordpress.com/2009/01/28/a-medical-payment-paradigm-shift

Assessment

One comment heard through the grapevine was “caveat and vendor emptor”; while another sarcastic observer wondered if this was the same “Useless Healthcare Group that we all despise?” And, who is to define the term “medical quality -or- value added care”?

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Early-adopter insight and reports from Arizona participating practitioners is appreciated.

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Filed under: Career Development, Health Insurance, Practice Management, Quality Initiatives | Tagged: Big Blue, CPT codes, episodes of care, IBM, UHC, United Health Care, value added healthcare | Leave a comment »

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