Lack of Transparency in Rx Pricing

On Tuesday, January 27, 2019, the Senate Finance Committee held an important hearing on the cost of prescription drugs. A key element of the discussion focused on the rebates commonly given by drug manufacturers to pharmacy benefit managers (PBMs). Three PBMs control more than 70% of the pharmacy distribution within the US (link). They are Express Scripts, CVS, and OptumRx. These PBMs develop and manage the drug formularies for carriers and health plans. They are a middleman with considerable control over the pricing of prescription drugs. PBMs receive rebates from drug manufacturers, but under the current system, the discounts do [...]

By |2019-02-01T20:45:02+00:00February 1st, 2019|Pharmacy, Uncategorized|0 Comments

Healthcare Industry Consolidation and Expansion

Over the past few years, the healthcare supply chain in the United States has been undergoing intense consolidation. Hospitals networks are buying physician practices. Large physician practices are acquiring smaller practices. Even insurance companies are buying medical clinics. United Healthcare purchased DaVita Medical Group in December 2017, and, CVS is in the process of purchasing Aetna. Wal-Mart is considering purchasing Humana, and even Amazon has entered the healthcare fray by hiring several new high-powered healthcare executives and physicians to lead their healthcare revolution. All this consolidation begs the question, “What impact will this have on cost and quality in the [...]

By |2018-11-13T19:22:22+00:00November 13th, 2018|Uncategorized|0 Comments

Serving in Our Community

A quote has been in my mind for the past several days. “Ask not what your country can do for you, but what you can do for your country,” by John F. Kennedy. In the lead up to the storm, I worked with eight of my immediate neighbors to prepare ourselves for Irma. As we served each other, our neighborhood became closer. I really like the change. Almost every evening over the past week, I have been on conference calls discussing Hurricane Irma with more than 20 volunteer church leaders across Florida, such as myself. The initial purpose for these [...]

By |2018-04-20T18:40:05+00:00April 20th, 2018|Uncategorized|0 Comments

Disrupting Chaos

The health insurance industry has been in a state of chaos for decades, but the major players in the industry are in no hurry to make any changes. Within the past 10 years: Health insurance carriers’ profits have almost doubled from $8 billion to $15 billion. Hospital revenues have grown from $760 billion to $936 billion. The norm in the current health care delivery system is for hospitals to mark up prices a 1,000%, then give the insurance carriers a 30% discount on those over inflated charges, as part of a Preferred Provider Organization (PPO) or Health Maintenance Organization (HMO) [...]

By |2018-05-09T16:15:57+00:00April 20th, 2018|Uncategorized|0 Comments

Consolidation

The healthcare industry has been undergoing consolidation for many years. The newest trend involves hospitals purchasing physician practices, taking over office administration, adding the doctor and his employees to their payroll. On the surface, this doesn’t seem like it would make much difference, but when we look deeper, the impact on costs is significant. Let’s say that a hospital wants to purchase a physician practice.  The hospital would approach the doctor, and the conversation might sound something like this: Hospital: How would you like to make more money, have more time off, and no longer deal with office administration? Doctor: [...]

By |2018-04-20T18:28:33+00:00April 20th, 2018|Uncategorized|0 Comments

In the Dark

  Monday, my daughter sent me this photo from the path of totality. It caused me to reflect on many things, including my business, employee benefits. Over the past decade, insurance rates have increased by double digits, year after year. Meanwhile insurance carrier’s profits have almost doubled over that same time frame. (Source) In a solar eclipse, the moon passes between the sun and the earth, blocking the sun’s light from the earth’s surface. The healthcare landscape is eclipsed by the insurance industry. Insurance carriers and government legislation pass between healthcare consumers and healthcare providers, leaving the landscape in darkness. [...]

By |2018-05-09T16:14:42+00:00April 6th, 2018|Uncategorized|0 Comments
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