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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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Dependent Audits DONE RIGHT: How? 

Tuesday, November 27, 2018 11:16:00 AM Categories: Tools of the Trade
A dependent eligibility audit, when DONE RIGHT, is not a burden on your workforce, and still generates a positive return on investment. In order to do a DEA the RIGHT way, the focus needs to be on the response rate. Earlier this year, a... read more
 

Dependent Audits DONE RIGHT: When? 

Wednesday, November 14, 2018 11:08:00 AM Categories: Tools of the Trade
For many of you, it's Open Enrollment season. Whether it is or isn't, it's definitely a good time to consider a Dependent Eligibility Audit (DEA). Many groups use Open Enrollment ... read more
 

Dependent Audits DONE RIGHT: Why? 

Wednesday, November 7, 2018 10:55:00 AM Categories: Tools of the Trade
A Dependent Eligibility Audit (DEA), when DONE RIGHT, is an extremely effective tool for managing a plan's rising health care costs. At this point, every organization is in one of three... read more
 

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
 

Prudence says: Don’t forget your ongoing fiduciary tasks! 

Tuesday, May 22, 2018 10:22:00 AM Categories: Tools of the Trade
In this video, Prudence discusses the ongoing fiduciary responsibilities that need to be accounted for. The resources Prudence refers to are: https://www.irs.gov/pub/irs-pdf/p969.pdf;... 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
 

Prudence says: Get a plan of action that’s on FIRE! 

Tuesday, April 3, 2018 4:11:00 PM Categories: Tools of the Trade
In explaining the responsibilities of a fiduciary, Prudence separated the plan year into three phases: Ready, Aim, and Fire! In this video, Prudence focuses on the final four months of the year - the "FIRE" phase. In this phase, it's time for... read more
 

Prudence Says: Use Facts to AIM Your Plans and Decisions 

Tuesday, February 27, 2018 4:03:00 PM Categories: Tools of the Trade
Lately, Prudence has been explaining the basics of the fiduciary plan year, breaking it down into three phases: Ready, Aim, and Fire! This week, she's back to discuss months 5-8 of the year, or the "AIM" phase. This phase is all about leveraging... read more
 
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