FIVE CONDITIONS: Total 50% of Healthcare Financial Costs

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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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

THANK YOU

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PODCAST: 15 Metrics for Successful Healthcare Companies

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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Related: https://thehealthcareblog.com/blog/2022/02/03/after-the-crash/?utm_campaign=THCB%20Reader&utm_medium=email&utm_source=Revue%20newsletter

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Product Details

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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YOUR COMMENTS ARE APPRECIATED.

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PODCAST: NaviHealth Digital Health Start-Up

SOLD TO OPTUM

BY ERIC BRICKER MD

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YOUR COMMENTS ARE APPRECIATED.

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PODCAST: UHC’s David Wichmann Steps Down as CEO

THE WHOLE STORY?

By Eric Bricker MD

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YOUR COMMENTS ARE APPRECIATED.

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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™

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

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PODCAST: United Health Group “Harmony” Network?

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.

YOUR THOUGHTS ARE APPRECIATED.

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Usual and Customary UnitedHealthcare?

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More on “Sleazy” Healthcare Stakeholders

1-darrellpruitt

[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

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

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

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Big Blue and UHG’s New Health Plan Model

Innovative Model -or- Just another Paradigm Shift

By Staff Reporters56372274

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.

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  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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