Dave Dickey

How Much Variation Should There Be in the Pricing of a CT Scan, from the *Same​* Provider in Michigan? Here's a real life example of from one of finHealth's clients. The names have been changed to protect the innocent (until proven guilty).   This is the actual distribution of CT scan of the abdomen and pelvis with contrast in the Michigan region – all from the same provider. Typical cost at this facility is $400, but here we also see this same provider exceeding $2,700 on multiple occasions. Why does the contract allow much significant pricing variation for the same service from the same provider? Is your BUCA contract allowing for this? Do you know? 𝑯𝒐𝒘 𝒘𝒐𝒖𝒍𝒅 𝒚𝒐𝒖 𝒌𝒏𝒐𝒘? #healthcare #cost #fiduciary #howwouldyouknow

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As Becker's Healthcare highlighted yesterday (link below) more and more health systems are divesting their health plans. Why is this? #BusinessModel theory might suggest it's because of the inherent conflict between incumbent #healthcare business models and #healthinsurance business models. Different resources, processes, and profit formulas (RPPs) are required to support very different value propositions. Established businesses often struggle to pivot their business models as leaders don't fully grasp the complexity of launching a new business model that requires very different capabilities for success. But some leaders do this quite well, and they set up innovative businesses as autonomous business units, providing the required space, support, capital, and different metrics of success required to succeed. What's an example of a health system or health care entity you've seen do this well? It can be a build, buy, or partner example. I'll start. Providence and Ayin Health Solutions. Ruth Krystopolski Todd Dunn Zeev Neuwirth, MD Brittany Ryan Chris Calder Will Behrmann Kris Shepard https://lnkd.in/ecr4NrPR

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I really enjoyed participating in this podcast with Capital Rx ‘s Justin Venneri . We talk about how important it is for employer’s to use their voice NOW to get what they need to manage their plans appropriately. So many employers complain about the fact that they can’t get data from their health plan partners and that their brokers refuse to disclose compensation. Both of these issues are solvable NOW whilst in the middle of renewal negotiations. We also talk about how important it is for employers to get credible data about their groups and to have access to data platforms like Judi that give plan fiduciaries direction and accountability around their drug spend. Now is the time to spend quality time doing fiduciary PBM procurement to discover whether or not your employer PBM partner is extruding value from your plan members. Most are. In addition, now is the time to take action on other big cost drivers especially including hospital costs. Employers who embrace this task yield huge value for their plan members and act in their interests. Hope you listen to our discussion! #pharmacy #PBM #compliance #healthplans #healthcare #transparency #procurement #healthdata #healthanalytics #healthinnovation #healthleadership #hospitals #healthcarecosts #fiduciary #fiduciaryduty Christine Arnold Steve Schutzer, MD Lisa Trumble Peter Hayes Chris Deacon Darren Fogarty Patrick Long Al Lewis 🇺🇦 Moving to Value Alliance Kerry Wood Wyatt Bosworth Dean Jargo Tim Denman Raju Kattumenu Josh Spivak John Bass Christopher Gormley Les Wilkinson Michael Brouthers 🎙Spencer Smith, CSFS® Doug Aldeen Jamie Greenleaf AIF, CBFA, C(k)P Julie Selesnick Dave Chase, Health Rosetta-discovering archaeologist Derek Moore Kevin Joyce Jay Silverstein Justin Leader

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Proud to partner with Brown & Brown Insurance & Eric Kasen on this piece for BenefitsPRO about the future of #ICHRA for large groups. At SureCo we're building the first private enterprise health marketplace, and ICHRA is the first step. As more people and companies adopt this model, it will create more demand for carriers to create products specifically for this cohort and price them competitively. For the first time, the health coverage system will work as it should—in service of the employee.   https://lnkd.in/gtmr5_fn

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Health insurance isn’t really insurance - at least not in the way we think of typically think of insurance. In its most basic form, insurance is the pooling of premium dollars to create a fund which can be accessed by those who file claims with the assumption that not all will file claims. Those who don’t file claims subsidize those who do. For instance, only about 40% of homeowners ever file a homeowner’s claim in their lifetime, so the 60% who never file a claim help pay the claims of those who do. Same percentages with auto insurance. Fewer than 10% of workers ever file a disability claim, so the 90% who never file a claim underwrite those who are disabled. You get the idea. Health insurance is very different. No matter how many jumping jacks you do or how many carrots you eat or how robust your genes may be, eventually we will all have medical claims. Health insurance should actually be called 'pre-paid medical'. Most people incur 80% of their lifetime medical spend after age 40. 50% of lifetime spend after age 65. And 30% of lifetime spend in the final year of life. Unlike other forms of insurance, with medical claims, it’s when, not if. Since use of healthcare services is inevitable for everyone, our best aim must be using those services in the most efficient way to achieve the healthiest and longest lives possible. Understandably, most people have no idea how to do that. Garner does. www.getgarner.com

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A provider compensation approach requires balancing numerous objectives that seem to compete with each other, such as provider and market requirements vs. the financial viability of a health system. HSG Advisors offers proven best practices to align multiple goals into one integrated and effective strategy. Read more in this article: "Provider Compensation: Five Key Challenges Health Systems Face, and Strategies to Overcome Them." #providercompensation #healthcareconsulting #physician #hospital #healthsystem #compensationstrategy

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Brad Paulis, ASA, MAAA, and Partner at Continuing Care Actuaries will be participating in the LeadingAge / Ziegler CCRC CFO Conference Brad’s session will be on Thursday, April 25 at 11:00 AM CT HCBS Pivot – A Closer Look into Continuing Care at Home This year’s HCBS discussion will pivot to the topic of Continuing Care at Home (CCaH). As organizations look to diversify revenues and service lines, expanding the continuum into people’s homes will take a fresh look in this year’s session. Objectives: 1. Overview of services that are provided for Continuing Care at Home and payor arrangements for CCaH 2. Overview of trends related to this emerging area of care 3. Deep dive into case studies exploring the “Look of CCaH”

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Check out our latest blog on Talking CAHPS, more specifically on the Health Outcomes Survey which measures patients experience.

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Doug’s story showcases the impact of Sympl Benefits' referral and second opinion programs. By offering employees more options and access to specialized care, we empower individuals like Doug to explore alternative treatments that can lead to better health outcomes and significant cost savings. Discover how Freightliner of Grand Rapids is leveraging Sympl Benefits' solutions to prioritize employee well-being and drive healthcare savings. Watch the full video to learn more about Doug's journey and see how your organization can benefit from implementing similar programs. https://lnkd.in/gVJbyRY9 #EmployeeWellness #HealthcareOptions #CostSavings #SymplBenefits

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Excellent article by Nona Tepper at Modern Healthcare explaining how Medicare Advantage #starratings are calculated and how they impact member recruitment. While they're not perfect, Stars ratings provide a good quality indicator for those choosing a plan. Check out the article here. Nona Tepper Modern Healthcare

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There is a clinical relationship between Income and Outcome. Thoughtful insurers & employers are improving population health, creating health plan savings, and empowering people to live healthier, happier, longer lives... This is an actual member review submitted voluntarily, without compensation, to Trustpilot

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For all the plan sponsors/administrators out there -- we found this article in Benefits Pro helpful/timely regarding this year's #RxDC reporting for 2023. The earlier you can confirm how you're going to handle the submission, the better! As the author notes, "...no good faith relief is available for this third reporting submission. In addition, no deadline extension is available, even though June 1, 2024, falls on a Saturday." Click below to read the entire article. #knowledgeshare #news #PharmacyBenefitAdministration https://okt.to/VjYh5i

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As the only agency in WI focused exclusively on healthcare businesses, we know more then others that not all employees want a copay driven health plan. Which is why it makes sense to offer "Multiple Plan Choices" to provide best insurance options for healthcare workers based on their family's needs. Recently I had a physicians retire with over $200,000 in his H.S.A. account. Want to learn more about this and other strategies - email me! Considering Health Savings Accounts (HSAs) for your healthcare needs? Check out this insightful article from HealthSherpa detailing everything you need to know about HSAs, their benefits, and how they can empower you to manage healthcare costs effectively. #HealthcareSavings #HSA #HealthcareCosts #HealthcareFinance #healthcare #medicine #doctors #physicians #dentists #mediaspas Read more here:

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DIRECT PRIMARY CARE - SAVE $$$ & IMPROVE CARE Here's a great article from Preston Alexander on how Direct Primary Care can positively impact employer health plans. https://lnkd.in/gqXEZ9MZ

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With budget busting healthcare expenses, take a look at a TPA built for partnership.   💡Flexible. 🚀 Forward-looking. 📉 Lower cost self-funded health plans. Get the blueprint for transparent, flexible health plans on a turnkey integrated platform. Inside: 🔸98% Member Satisfaction Survey Rating 🔸95% of Member Calls Answered in Less Than 30 Seconds 🔸4% Medical Trend - national trend is 8-10%. 🔸1.8% Pharmacy Trend - national trend is 8.4%. 🌠 With a high-touch service model, companies improve the employee experience, significantly lower healthcare costs & regain control of their claims. ➡️ Download here: https://lnkd.in/enTH3Fyj?

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For our 30th episode of #AstonishingHealthcare, Jeffrey Hogan (President, Upside Health Advisors) returned to explain why there is a "tremendous opportunity" for #plansponsors to use their power - right now - to get their data from their existing carrier or vendors to meet their obligations under the Consolidated Appropriations Act (#CAA). 🎧 Listen to the full episode here, and you'll also hear Jeff explain what areas plan sponsors are targeting for savings beyond #PBM, the importance of a #trustedpartner/source of data (e.g., JUDI®), and more: https://okt.to/ewijCm

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🛑 "My broker said we can't carve out our #PBM." 🛑 If your broker is telling you this, #selffundedemployer - maybe it's time to find a new broker. Good brokers CAN make this happen. They can help getting a carve out to a transparent PBM. The medical carrier probably will charge (ridiculous) admin fees to integrate with the transparent PBM, but it can be worth the hassle. The rebate fee credits can be tempting to keep your plan fully integrated too. Vertically integrated medical/pharmacy carriers make it very hard to carve out intentionally, because they want all the profit. Just keep in mind, however, lawsuits from breaches of fiduciary duty by plan members can offset those rebate fee credits pretty quickly.... #pharmacy

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Medicare Advantage unrest, Change Healthcare fallout and more big takeaways from insurers’ Q1 https://lnkd.in/eyg48k7e via Healthcare Dive #MedicareAdvantage #ChangeHealthcare #Cybersecurity #CMS #Medicaid

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