Posts in Category: News and Views

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This room contains pieces drawn from my experiences at Health Decisions. It offers practical advice for anyone involved in managing group health plan expenses.
From the present, this room contains articles and reports by others that I wanted to share. Reasons for sharing will vary, so expect a potpourri.
This room provides reference points and norms I have observed or documented that can be used by persons trying to get their bearings in the often confusing world of group health.
This room contains my views on the future of the US health care system. My intent is not to convince anyone, but to broaden the discussion beyond the political debate that passes for health reform in America.
This room contains recordings and trasncripts of conversations I've had with interesting people I have had the privilege of meeting. Some are friends, some professional acquantances; all have interesting perspectives worth sharing.
From the past, this room contains some of the talks and articles I have done that I thought were worth sharing.

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Reference-based pricing is gaining momentum — here’s why - Employee Benefit Adviser article 

Thursday, July 26, 2018 11:54:00 AM Categories: News and Views
This article makes a good case for billing and payment reform. Reference-based pricing using Medicare is a vast improvement over meaningless PPO “discounts” that currently dominate the self-funded market. Providers have completely co-opted PPO... read more
 

Why Your Health Insurer Doesn’t Care About Your Big Bills - ProPublica Article 

Monday, June 25, 2018 10:08:00 AM Categories: News and Views
Check out Michael Frank’s personal experience with health care billing. The fact that he is very familiar with how the health care system works makes his comments even more powerful. This is not an unusual event. What is unusual is that someone... read more
 

Reducing clients’ health spend by taking an axe to claims - Employee Benefit Adviser article 

Thursday, May 17, 2018 11:37:00 AM Categories: News and Views
We couldn’t have said it better. Audits are how you find and fight the waste, abuse, and fraud in every health plan. When is the last time you audited your plan claim and enrollment spend? It should be every year. If you haven’t audited in over... read more
 

What to know about the first reference-based pricing lawsuit - ebn article 

Monday, April 9, 2018 10:34:00 AM Categories: News and Views
We'll be keeping an eye on this case making its way through the legal system. It may help resolve one of the biggest impediments to payment reform: provider balance billing. read more
 

TPA Has Fiduciary Duty to Establish and Maintain Transparent Fee Arrangements - MyHealthGuide article 

Thursday, October 12, 2017 11:14:00 AM Categories: News and Views
This article in the latest MyHealthGuide Newsletter warns of hidden TPA fees. Hidden fees are more common and costly now than ever before. That growth is tied to PPO agreements that let payers and providers agree on how to spend plan money... read more
 

Self-Insurance Bill Passes House Vote, Heads to Senate - MyHealthGuide Newsletter article 

Monday, April 10, 2017 10:26:00 AM Categories: News and Views
While not garnering the headlines of the “repeal-and-replace” debate, in his "MyHealthGuide” Newsletter Ernie Clevenger shares reporting on a significant development – bi-partisan Congressional action! The House passed a bill, (HR 1304) “The... read more
 

The Latest on Repeal and Replace: What It Means for Employers 

Wednesday, March 8, 2017 4:14:00 PM Categories: News and Views
The Republican controlled Congress announced yesterday that it has taken the first steps toward repealing the Affordable Care Act (ACA) and replacing it with the American Health Care Act (AHCA). There will be a lot of steps and a lot of time... read more
 

How last-minute ACA filers should make out OK - ebn article 

Monday, January 25, 2016 9:43:00 AM Categories: News and Views
The author of this article offers sage advice. Health Decisions' experience is that for most of our clients filing is simple. However, for self-funded plans with complicated work forces, the extension is not only welcomed but needed. To avoid the ... read more
 

Compliance Confusion: How ACA Affects Brides and Benefits Pros - Workforce Article 

Tuesday, January 19, 2016 9:53:00 AM Categories: News and Views
This article humanizes the very real complexity introduced by Affordable Care Act (ACA) employer reporting. The author is correct in noting that, despite their promises, payroll companies cannot handle ACA reporting requirements. You need to... read more
 

ACA Extensions Make for a Happier New Year 

Tuesday, December 29, 2015 11:08:00 AM Categories: News and Views
Less than two weeks ago, we commented on a growing apprehension in the marketplace. Many self-funded companies – especially those relying on payroll vendors – were becoming concerned about the looming deadlines for the Affordable Care Act (ACA)... read more
 
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