Well it is interesting to me as an expert in the field of company-sponsored benefits, specifically group health insurance, that most carriers are selling against the solution to the quandary in the U.S. - consumer-directed health plans.
As somoeone who understands underwriting as well as anyone, I guess this is simple, health insurance carriers do not possibly want to offer something for 25-50% less premium (consumer-directed plans with HRA or HSA and high-deductibles) as they will STILL get stuck with high claims....remember folks, 5-105 of a company's employees drive 80-90% of claims volume. That means a few employees and/or their dependents can blow up an employer's health plan even if they have say 100 employees.
So simply the insurance carriers, whether charging 400/single employee for a copay plan, or 175/employee with a high-deductible plan, they will still be on the book for a portion of a huge claims (remember these clever guys reinsurance claims over a specific level, say 25k, 50k, or 75k and build that additional stop loss premium in to a group composite rate...)....so maybe Obama and his henchmen need to negotiate better with the Republican Congress and figure out a way to back stop, stoploss for carriers in exchange for them lowering their rate base and passing the real problem in the U.S. (chronically ill patients either not managing illnesses well - think Obesity, Asthma, Heart and Diabetes all in one cluster, or someone who just has huge claims and is catastrophically ill - cancer et al).
The real problem is not healthcare in the U.S., but how to better manage the 5-10% of the population who is consuming enormous amounts of costly healthcare in an inefficient system....if the government truly wants to help, folks who are chronically ill should be mandated to quality based medicine, and the providers in those systems should be compensated MORE, yes MORE, to manage better.
That folks in a nutshell is the solution, but we have these idiots in Washington arguing about things that are not the solution....universal care, single payor, government or no government...none of it matters, evidence-based medicine does....less hospitals, though BETTER hospitals and the same for physicians....more physician assistants, nurse practitioners, and places like Walmart walk in clinics and CVS minute clinics for the routine cold - GTEAT solutions.
We the people demand a solution, not the eggheads in the government.
Monday, April 11, 2011
Tuesday, March 29, 2011
Consumer-directed Plans and Self-funding
Ooh, I like this topic as I believe in them both as long as the liabilities are fenced appropriately with specific stop-loss (think of that as a CAP on a specific employee or family's claims) and aggregate stop-loss (CAP on your entire company's spend)....and doing this with a health reimbursement arrangement owned by the company or employer. This is Shangri La for a guy like me but here is the catch, it requires experts like us guiding, coaching and analyzing for our clients as this is pretty complex stuff that requires expertize. And if done correctly can really be a better way than just giving health insurance carriers the premium dollars to make the margin (PROFIT) they want on your case. I liken this to a fully insured company of say 400 employees that DOES NOT self-fund but wants the power of a health reimbursement arrangement (it is the tool that can pay deductibles for employees and be written off as a business expense as well)...well here is the catch, the greedy underwriters at insurance companies will push for a certain amount of premium regardless of the plan design selected (with pricing matrices they will push the plan they want as they MUST get the premium they want regardless....they know they will have X in claims, then administrative costs, plus profit...so they corner clients).
So it is more of a challenge to fit an HRA in to a fully insured case where carriers have claims data they use "against" you, as well as manual rates (your age, gender, marital status, home zip code) that they blend....so they have 2 "shells" they use on the table and benefit from whichever one they want to use against you to fit you in to their profit box.
This topic I could go on and on, but in general if you shop with a competent broker like Health Insurance Geeks and Nexus, and drive their commissions (when was the last time you reviewed what your broker charge, versus what they delivered in PRICE?...forget all the B.S. services they say they provide, I am talking about premium coming DOWN rather than your broker selling you on the INCREASE!)....
Shady, greedy, self-serving brokers make us crazy here....we work our tails off for our clients on less commissions as we are not reporting to shareholders or dummy boards, hmm-hmm ooops let's call them unnecessary executives in the game of price....
I feel companies who are less than let's say 1,000 employees, should ALWAYS be with a boutique, otherwise they are paying for nonsense.
visit www.healthinsurancegeeks.com or www.nexusbenefits.com for more of our ideas.
So it is more of a challenge to fit an HRA in to a fully insured case where carriers have claims data they use "against" you, as well as manual rates (your age, gender, marital status, home zip code) that they blend....so they have 2 "shells" they use on the table and benefit from whichever one they want to use against you to fit you in to their profit box.
This topic I could go on and on, but in general if you shop with a competent broker like Health Insurance Geeks and Nexus, and drive their commissions (when was the last time you reviewed what your broker charge, versus what they delivered in PRICE?...forget all the B.S. services they say they provide, I am talking about premium coming DOWN rather than your broker selling you on the INCREASE!)....
Shady, greedy, self-serving brokers make us crazy here....we work our tails off for our clients on less commissions as we are not reporting to shareholders or dummy boards, hmm-hmm ooops let's call them unnecessary executives in the game of price....
I feel companies who are less than let's say 1,000 employees, should ALWAYS be with a boutique, otherwise they are paying for nonsense.
visit www.healthinsurancegeeks.com or www.nexusbenefits.com for more of our ideas.
Friday, March 25, 2011
Why the Copay is the Enemy and the Fat Farm of the Health Insurance Carriers
I liken it to drug addiction....in this country the smart folks up in the ivory towers in the world of health insurance knew 2 things...we would LOVE the copay, which we all do now, and that we were going to have a disaster on our hands in 20 yrs...that was back in the early 1990s and voila, here we are....
The copay is both the enemy and the problem, because it hides the cost of everything...if my doctor bills 1200 dollars for a 15 minute visit, but I pay a $25 copay what do I care? However, on the other hand, when my employer moves to a consumer-directed health plan with a high deductible (where I get billed the negotiated physician rates between him/her and my insurance carrier) now I get to see this full $1200 and the allowable amount.
As both an expert in this field, a business owner/entrepreneur and also a consumer, when we move to this model many years ago here at my company, I started BLOWING up my Pediatrician, PCP and also specialists...I remember the first time with my youngest daughter when the Pediatrician wrote 4 prescriptions for her...off to CVS we went and again VOILA, we were told the BRAND NAMES were a total of like 800-900 for the 4 meds, 30 day supplies....I started laughing....immediately called the Pediatrician and said "re-write those bad-boys with all generics"....my bill was like 60-70 for ALL 4 FOR 30 DAYS!!!
That sums it up folks....going to deductibles, negotiated pricing, NO COPAYS for anything, FREE PREVENTIVE MEDICINE, great tools for employers and communcation forums for employees, and we can get out of this mess....also I DO NOT NEED A MEDICAL DOCTOR, to see me to re-order my allergy medicine for another year, which has both been working, and that I have been taking effectively for over 10 yrs...welcome the NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT (btw, tell your kids it is going to be the field to get in to in the next 5-50 yrs...essential to our healthcare success).
This topic, I could ramble for thousands of words right from my hip because I study it, practice it, live in it, believe in it, and have hundreds of clients with whom we have implemented it, and the phone calls on premium increases VANISH!
I hope this helps, and I love writing about this stuff. I would imagine health insurance carriers hate seeing this stuff, however they also know it works...Cigna, Aetna, United Healthcare, they have all had their own employees in these models for 10 or more years....the folks who really hate this are HOSPITALS and DOCTORS because to the scamming ones out there (billing on quantity not quality) they know their offices with Monet artwork are also going to need to become more efficient.
The copay is both the enemy and the problem, because it hides the cost of everything...if my doctor bills 1200 dollars for a 15 minute visit, but I pay a $25 copay what do I care? However, on the other hand, when my employer moves to a consumer-directed health plan with a high deductible (where I get billed the negotiated physician rates between him/her and my insurance carrier) now I get to see this full $1200 and the allowable amount.
As both an expert in this field, a business owner/entrepreneur and also a consumer, when we move to this model many years ago here at my company, I started BLOWING up my Pediatrician, PCP and also specialists...I remember the first time with my youngest daughter when the Pediatrician wrote 4 prescriptions for her...off to CVS we went and again VOILA, we were told the BRAND NAMES were a total of like 800-900 for the 4 meds, 30 day supplies....I started laughing....immediately called the Pediatrician and said "re-write those bad-boys with all generics"....my bill was like 60-70 for ALL 4 FOR 30 DAYS!!!
That sums it up folks....going to deductibles, negotiated pricing, NO COPAYS for anything, FREE PREVENTIVE MEDICINE, great tools for employers and communcation forums for employees, and we can get out of this mess....also I DO NOT NEED A MEDICAL DOCTOR, to see me to re-order my allergy medicine for another year, which has both been working, and that I have been taking effectively for over 10 yrs...welcome the NURSE PRACTITIONER, OR PHYSICIAN ASSISTANT (btw, tell your kids it is going to be the field to get in to in the next 5-50 yrs...essential to our healthcare success).
This topic, I could ramble for thousands of words right from my hip because I study it, practice it, live in it, believe in it, and have hundreds of clients with whom we have implemented it, and the phone calls on premium increases VANISH!
I hope this helps, and I love writing about this stuff. I would imagine health insurance carriers hate seeing this stuff, however they also know it works...Cigna, Aetna, United Healthcare, they have all had their own employees in these models for 10 or more years....the folks who really hate this are HOSPITALS and DOCTORS because to the scamming ones out there (billing on quantity not quality) they know their offices with Monet artwork are also going to need to become more efficient.
Wednesday, March 9, 2011
More on Healthcare Consumerism
Two great things happened today...one was with my co-founder and business partner and the other with one of my clients. First my business partner was explaining how one of his clients that he migrated to a consumer-directed high-deductible health plan strategy had just had an epiphany as they discovered together the cost of a brand name drug (an injectable) versus the generic substitute....it was for a 90 day supply and the brand was 2,000....YES, $2,000 bucks!!!! The generic substitute was $50 for a 90 day supply.
Now had we not moved this client to a non-copay based plan he would have never discovered this little nugget that is a great example of why a single rate for an employer health plan now is soaring closer to $1,000 than ever for what we call a "rich" plan design...funny thing is what we now call a "rich" plan design, back in 1997 we would have scoffed at vehemently...back then what we call rich now was probably 175 bucks a month for a single...now 14 yrs later it is closer to $1,000. Unreal and the reason is the example above...the DEVIL copay system that hides the costs of things.....
Second example was great...talking to a client of mine for 10 years and we have had a HOMERUN moving them from the DEVIL to a new world, through a consumer-directed model. She and I were going through this years' renewal and ideas on how to starve their insurance carrier this year and POOF!! We came up with a great analogy...health insurance needs to become more like auto insurance....deductibles...can you imagine if you had a $10 copay for a wreck in to a pole that could cost $10k...you would almost look for a pole to hit to make the others in the car laugh a little...who would even care, $10 bucks, why not! Now that is not how auto insurance works....$2500 deductible is pretty common to keep the premium down and as a result you would not catch me dead screwing around in a car and playing with POLES! Same deal in health insurance.....if we pay a larger cost of Rx especially, and doctor's visits and charges/lab xray too, we are going to SHOP WAY MORE and watch our dollars....a result as well will be a radical reduction in healthcare consumption etc...
Now finally one thing to highlight is the really sick in this country, the 15% or so....maybe those are the folks Obamanomics should focus on as they are the real problem no one talks about....they drive 80% of the claims and many times have the same 4 ailments that drive most claims anyway. In no way am I suggesting that they should get subpar care, but large consumers of the system and dollars need to pay their fare share, and that is where the government should both back-stop claims from insurance carriers/employers, while also pointing the VERY sick in to very efficient systems...like Mayo, Cleveland Clinic, etc....see this link
http://www.100tophospitals.com/
The true best hospitals in the U.S. should be rewarded for being such, and the poor ones should be shut down. We have too many....funny that NYC does not even have a top 25 system, which is simply appauling as its costs are 2-3 times other places in the U.S....this is the stuff these clowns in Washington need to work on.
Now had we not moved this client to a non-copay based plan he would have never discovered this little nugget that is a great example of why a single rate for an employer health plan now is soaring closer to $1,000 than ever for what we call a "rich" plan design...funny thing is what we now call a "rich" plan design, back in 1997 we would have scoffed at vehemently...back then what we call rich now was probably 175 bucks a month for a single...now 14 yrs later it is closer to $1,000. Unreal and the reason is the example above...the DEVIL copay system that hides the costs of things.....
Second example was great...talking to a client of mine for 10 years and we have had a HOMERUN moving them from the DEVIL to a new world, through a consumer-directed model. She and I were going through this years' renewal and ideas on how to starve their insurance carrier this year and POOF!! We came up with a great analogy...health insurance needs to become more like auto insurance....deductibles...can you imagine if you had a $10 copay for a wreck in to a pole that could cost $10k...you would almost look for a pole to hit to make the others in the car laugh a little...who would even care, $10 bucks, why not! Now that is not how auto insurance works....$2500 deductible is pretty common to keep the premium down and as a result you would not catch me dead screwing around in a car and playing with POLES! Same deal in health insurance.....if we pay a larger cost of Rx especially, and doctor's visits and charges/lab xray too, we are going to SHOP WAY MORE and watch our dollars....a result as well will be a radical reduction in healthcare consumption etc...
Now finally one thing to highlight is the really sick in this country, the 15% or so....maybe those are the folks Obamanomics should focus on as they are the real problem no one talks about....they drive 80% of the claims and many times have the same 4 ailments that drive most claims anyway. In no way am I suggesting that they should get subpar care, but large consumers of the system and dollars need to pay their fare share, and that is where the government should both back-stop claims from insurance carriers/employers, while also pointing the VERY sick in to very efficient systems...like Mayo, Cleveland Clinic, etc....see this link
http://www.100tophospitals.com/
The true best hospitals in the U.S. should be rewarded for being such, and the poor ones should be shut down. We have too many....funny that NYC does not even have a top 25 system, which is simply appauling as its costs are 2-3 times other places in the U.S....this is the stuff these clowns in Washington need to work on.
Monday, February 28, 2011
Health Insurance Consumerism - It is Time
Oil is creaping back in to the middle 3 dollar range at most pumps (and rising other commodity prices), foreclosures are mounting like crazy - in Charlotte NC where we have a home 51% of all 2010 sales were foreclosures....unrest in the middle east, and these insane media/journalists on various shows bring on these also insane "pitch" men for whatever it is they want us to believe talking about how things are in pretty good shape? Are these folks using street drugs?? I mean are they serious? If you took out Obamanomics, i.e. just pour an agregious amount of tax payer dollars in to the broken system to prop it up and make it look like it is not that bad....a mistake, and another lie to us, the US drones. Reality, unemployment is probably 20-25% - what if folks have worked somewhere for 10 yrs at a 1099 and get layed off...oops, we don't count them and they don't count? Ridiculous.... with that as my backdrop, we are in the a great Dip and at the Tipping Point for what we do in my company, which is liberate small companies (5-300 employees primarily) from the bondage of health insurance carriers, their brokers, and the awful advice and push they both give their clients.
High-deductible health plans are the answer to the quandry, and giving employers tools to incorporate consumerism is also the answer. Why do you think Cigna, Aetna, United Healthcare have had THEIR own employees forced in to high-deductible health plans for over 10 years...THEY KNOW THESE THINGS WORK FOLKS!! THEY JUST DON'T WANT YOU TO KNOW THEY DO, BECAUSE THEIR PREMIUM TANKS AND SO DOES THEIR VALUE.
I represent the solution, and Health Insurance Geeks push answers....it does not mean everyone will heed the message but at least we are part of the solution, not part of the broken problem that the majority of brokers and health insurance carriers are still trying to protect.
High-deductible health plans are the answer to the quandry, and giving employers tools to incorporate consumerism is also the answer. Why do you think Cigna, Aetna, United Healthcare have had THEIR own employees forced in to high-deductible health plans for over 10 years...THEY KNOW THESE THINGS WORK FOLKS!! THEY JUST DON'T WANT YOU TO KNOW THEY DO, BECAUSE THEIR PREMIUM TANKS AND SO DOES THEIR VALUE.
I represent the solution, and Health Insurance Geeks push answers....it does not mean everyone will heed the message but at least we are part of the solution, not part of the broken problem that the majority of brokers and health insurance carriers are still trying to protect.
Wednesday, February 9, 2011
My Manifesto - Remove Politicians from Health Insurance
They and them.....are the problems. They meaning all of the politicians jousting to make sure they save their seats, their donors, their pitch, their perks, and THEM, the vested executives of health insurance companies that simply are not following what we are begging for in the US....affordable coverage. Funny thing about this is it is simple to solve really...we just need to lead the TRIBE (and I am a happy Leader of the tribe to which I refer) .... a HUGE TRIBE can get lots done...we need a full court press against large employers, unions, and insurance companies and the politicians intertwined within to FORCE them to deal with disgruntled Americans on this subject. Look what Twitter and Facebook did in Egypt, I mean COME ON PEOPLE!
I SIMPLY DO NOT WANT THE GOVERNMENT TOUCHING ANYTHING HEALTH INSURANCE RELATED...read that again please. Our government is responsible for many of our current bankrupt entitlements and I do not care who points a finger in either direction, Democrat, Republican, Independent, whatever...
In a country (yes us in the US) where we can't even fill top level IT and engineering jobs from within because our talent pool is frankly less than those in other developing countries, we are up against the ropes and ready to go down like Apollo Creed in Rocky III (I think it was that one)...pretty scary stuff for someone like me born on a tiny island off the coast of western Greece to a Greek dad and American mom...they brought my sister and I to the land of opportunity, the great U.S. and raised us here. Now 40 yrs later our society is crippled with debt, inter-political fighting and nothing is getting better, actually worse.
I read about what a Tribe can do (thanks again Seth Godin, you're great) and am throwing a stake in the sand and trying to build my tribe. My company actually sells individual, family and employer-sponsored health insurance, and here I am trying to lead the TRIBE to do things differently. My contemporaries or Peers think I am nuts "our business will get killed"....actually exact opposite. The losers that are trying to oversell, under-educate and profit will lose in the end, and I am not one of them. I just want to help people, employers, their families and employees, and lead my clients to solutions that give them the power to chose, spend wisely and always have predictable financial models in which they can have faith.
In my company we say constantly "the copay is and was the devil"....smart insurance companies knew we would all get addicted to the copays like "crack" and now when we try to lead folks away from that old "COPAY" they shiver...what's the copay? what's the copay? well the answer should be $1,000/mos/employee in premium is the copay. What flavor would you like please? No copay, no health insurance problems...no ridiculous mandated benefits (pay for what we buy like car insurance) no health insurance problems. No middleman in the prescription supply chain (yes you insurance companies) no health insurance problems. No drug advertising like it was long ago, no health insurance problems. But first, nuke the copay, and start asking our doctors what they will charge us. I mean COME ON, can you imagine getting your car overhauled at Honda and not knowing what it would cost? The lazy here in the US would say, man that sounds great!! Okay, lazy, you can't afford the new "copay adjusted" cost of a Honda CIVIC which is now $80,000 and a great lease payment is 2100/mos...okay, who can afford that? Well the 500% increase of it would be just like what has happened in the U.S. with the copay. It melted the system.
I am done for today.
I SIMPLY DO NOT WANT THE GOVERNMENT TOUCHING ANYTHING HEALTH INSURANCE RELATED...read that again please. Our government is responsible for many of our current bankrupt entitlements and I do not care who points a finger in either direction, Democrat, Republican, Independent, whatever...
In a country (yes us in the US) where we can't even fill top level IT and engineering jobs from within because our talent pool is frankly less than those in other developing countries, we are up against the ropes and ready to go down like Apollo Creed in Rocky III (I think it was that one)...pretty scary stuff for someone like me born on a tiny island off the coast of western Greece to a Greek dad and American mom...they brought my sister and I to the land of opportunity, the great U.S. and raised us here. Now 40 yrs later our society is crippled with debt, inter-political fighting and nothing is getting better, actually worse.
I read about what a Tribe can do (thanks again Seth Godin, you're great) and am throwing a stake in the sand and trying to build my tribe. My company actually sells individual, family and employer-sponsored health insurance, and here I am trying to lead the TRIBE to do things differently. My contemporaries or Peers think I am nuts "our business will get killed"....actually exact opposite. The losers that are trying to oversell, under-educate and profit will lose in the end, and I am not one of them. I just want to help people, employers, their families and employees, and lead my clients to solutions that give them the power to chose, spend wisely and always have predictable financial models in which they can have faith.
In my company we say constantly "the copay is and was the devil"....smart insurance companies knew we would all get addicted to the copays like "crack" and now when we try to lead folks away from that old "COPAY" they shiver...what's the copay? what's the copay? well the answer should be $1,000/mos/employee in premium is the copay. What flavor would you like please? No copay, no health insurance problems...no ridiculous mandated benefits (pay for what we buy like car insurance) no health insurance problems. No middleman in the prescription supply chain (yes you insurance companies) no health insurance problems. No drug advertising like it was long ago, no health insurance problems. But first, nuke the copay, and start asking our doctors what they will charge us. I mean COME ON, can you imagine getting your car overhauled at Honda and not knowing what it would cost? The lazy here in the US would say, man that sounds great!! Okay, lazy, you can't afford the new "copay adjusted" cost of a Honda CIVIC which is now $80,000 and a great lease payment is 2100/mos...okay, who can afford that? Well the 500% increase of it would be just like what has happened in the U.S. with the copay. It melted the system.
I am done for today.
Thursday, February 3, 2011
Individual & Family Health Insurance coupled with Group-Sponsored Plans
So get this....now many employers are passing on the full cost of dependent care (think your spouse and children) on to their employers. So when that happens we as employees see quickly how much insurance really costs.
The smart thing to do is to price out if you can do better on your own. Assuming you are relatively healthy, not diabetic and take limited maintenance medications for mild ailments, you certainly can do better on your own. The one thing to look out for are the nuances in product development. Things like maternity that are mandated benefits for employer-sponsored plans, are not in the individual market. But, for those folks who have already built families and are getting crushed with premium pay-throughs, take a look at our rate site and see if you can do better - www.healthinsurancegeeks.com.
The Geeks
The smart thing to do is to price out if you can do better on your own. Assuming you are relatively healthy, not diabetic and take limited maintenance medications for mild ailments, you certainly can do better on your own. The one thing to look out for are the nuances in product development. Things like maternity that are mandated benefits for employer-sponsored plans, are not in the individual market. But, for those folks who have already built families and are getting crushed with premium pay-throughs, take a look at our rate site and see if you can do better - www.healthinsurancegeeks.com.
The Geeks
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