Watch New AHealthcareZ Videos
VIDEO: American Rescue Plan and Healthcare... President Biden Stimulus Explained (11:29)

The American Rescue Plan was Signed into Law by President Biden on March 11, 2021.

The Law Has Specific Sections on Healthcare and Health Insurance:

ACA / Obamacare Health Insurance for 2021-2022:
1) Premium Tax Credits Will Be Increased so that the Maximum Premium Will Be Reduced from 9.83% to 8.5% of a Household's Income.

2) The 'Subsidy Cliff' Will Be Eliminated So That Households Making More Than 400% of the Federal Poverty Level Will Now Qualify for Subsidies.

3) To Obtain the New Subsidies, People Must Enroll or Re-Enroll Between April 1 and May 15, 2021

Unemployment 'Special Rule':
1) People Who Have Received Unemployment Benefits in 2021 Will Qualify to Have their Obamacare Health Insurance Premiums Paid For at 100%.

2) However, the Existing ACA 'Family Glitch' Still Applies. I.e. If another Member of the Household is Eligible for Employer-Sponsored Health Insurance (e.g. a spouse who is still employed), then the Household is NOT Eligible for Any Premium Tax Credit Subsidy.

COBRA:
1) 100% of the COBRA Premiums Will Be Paid for by the Federal Government for April 1st - Sept. 30, 2021.

2) COBRA Plan Members Have Historically Had Higher Medical Risk Because of the Adverse Selection in Signing Up for COBRA. The American Rescue Plan May Have a Mixed Impact on This Risk.
 
VIDEO: The Business Case AGAINST Value-Based Healthcare (11:13)

There is a Business Case Against Value-Based Healthcare.

Journalist Marshall Allen from ProPublica Highlighted How 2 Value-Based Care Solutions Were Rejected by Healthcare Companies: More Efficient Eye Droppers and Multi-Use Chemotherapy Vials.

Businesses Constantly Strike a Balance Between Value Creation and Value Extraction.

The Fiduciary Responsibility of Healthcare Companies to their Investors and Shareholders Requires Them to Extract as Much Value as Possible vis a vis Their Value Creation.

While the Above 2 Examples May Have Been Good for Patients, They Did Not Result in Increased Value Extraction for the Companies... Hence, They Did Not Happen.

Accordingly, Value-Based Care May Be Good for Patients, But It is Not Good for Healthcare Businesses.

Any Healthcare Company That Claims to Promote Value-Based Care Needs to be Viewed with Skepticism.
VIDEO: Hospital Charges Higher Prices if You Are Uninsured... Learn Why (5:49)

This Video is the True Story of My Wife's MRI. Our Family Pays for Healthcare Cash Pay... Not with Health Insurance.

The Hospital Wanted to Charge Her $4,034... Which is a 45% Discount Off of Billed Charges of $7,335. Because I Work in Health Care and Health Insurance, I Knew That This Hospital Did Not Bill $7,335 for an MRI.

Turns Out the $7,335 is a 'National Average' of Billed Charges for This Type of MRI According to a Hospital Revenue Cycle Consulting Firm Called nthrive That the Hospital Uses. I Don't Know How nthrive Came to That Amount.

The Hospital Agreed that They Should Instead Bill Their Own Billed Charges and Not the Supposed 'National Average.' The Hospital's MRI Billed Charges Were $3,849.

After Applying a 45% Discount, the Final Cash Pay Price Was $2,117... about Half the Originally Quoted Price.

Whether or Not This Hospital Made an Honest Mistake, I Do Not Know, but Charging Different Amounts to Different Customers is Called 'Price Discrimination.' In Many Situations it is Illegal.
VIDEO: How to Use GoodRx to Check Prescription Prices (6:42)

GoodRx Shows Prescription Drug Prices After the PBM Discount Has Been Applied.

If You Have Health Insurance and Are on an HSA Plan, the GoodRX Price May Not Be Your Exact Price (since the discount may be run through a different PBM than yours), But It Will Be in the Ballpark.

For a Brand Name Medication, the Ballpark Price Will Likely Be $200, $300 or $400+ Per Month.

When a Doctor Prescribes You a Medication, Look It Up on the GoodRx App While Still in the Examining Room.

Show the Price to the Doctor and If It is Too Expensive For You, Ask "Can We Look at Some Other Options.  This One Costs Too Much."

On the GoodRx App You Can Search by Medical Condition (e.g. Diabetes) or Symptom (e.g. Pain) and the App Will List the Most Common Categories of Medications in Descending Order.

Pick the Top Category and the App Will Show Medications in that Category Along with Their Prices. Find a Medication that You Can Afford and Ask the Doctor if That One Will a Suitable Replacement.
VIDEO: Health Insurance Carriers Now Subject to Antitrust Regulation (6:05)

Congress Passed and the President Signed the Competitive Health Insurance Reform Act of 2020 (CHIRA).

CHIRA Calls for Health Insurance Companies to NO LONGER Be Exempt from Antitrust Regulation.Since 1945, Insurance Companies Where Not Subject to Federal Antitrust Regulation because of the McCarran-Ferguson Act Signed by FDR.

CHIRA Passed by a Unanimous Vote in the Senate. Why Did Every Senator Agree to Subject Health Insurance Companies to Antitrust Regulation.

A Possible Reason is that Health Insurance Companies Have Made Record Profits During the COVID-19 Pandemic... While the Rest of America Suffers and Our Country Endures a National Tragedy.

No Politician Could Be Seen Protecting the Health Insurance Industry in this Environment.

The Department of Justice Said in a Press Release that they Were Eager to Take Advantage of their New Antitrust Powers with Health Insurance Companies.

The National Law Review Even Wrote that Private Antitrust Litigation Against Health Insurance Carriers Is Now Possible..
VIDEO: Hospital 340B Drug Program Explained (5:05)

Under the 340B Drug Program, the Department of Health and Human Services Requires Pharmaceutical Manufacturers to Give Discounts on Medications to Hospitals That Provide Care to Low Income Patients.

The 340B Program Mandates a 13% Discount on Generics and a 23% Discount on Brand-Name Medications Sold to Hospitals.

The 340B Program Was Put Into Place in 1992 as Part of the Veterans Health Care Act. 1,300 Hospitals Participate.

Approximately $30B Worth of Medications Were Sold at a Discount to Hospitals as Part of the 340B Program in 2019.

According to a PhRMA Industry Study, Hospitals Are Paid 2X Their Cost for the Drugs... for a Total of $60B in Payments to Hospitals for 340B Medications.
VIDEO: CMS Healthcare Price-Transparency Regulation Explained (7:50)

The CMS Healthcare Price-Transparency Regulation Went into Effect on Jan. 1, 2021.

The Price-Transparency Regulation Requires Hospitals to Post 1) Billed Charges, 2) Maximum and Minimum Negotiated Rates (Prices) with Insurance Carriers, 3) the Cash Price for a Patient that Does Not Have Insurance and 4) the Payor-Specific Negotiated Rates (e.g. for Blue Cross, United Healthcare, Cigna, Aetna, etc.)

Hospitals Will Be Fined $300 Per Day if they Do Not Comply and They Will Be Listed on a CMS Website of Non-Compliant Hospitals.

Hospitals Must Post Prices for 300 Services, 70 of Which Are Dictated by CMS.

An Example Hospital's Price-Transparency Data File is Reviewed... the Findings are Quite Surprising!

Related Video: Hospital Cost Accounting Explained--Why Hospitals Don't Know Their Own Costs
VIDEO: Haven Healthcare Didn't Fail... It Quit (6:42)

Haven Healthcare Was the Non-for-Profit Joint Venture by Amazon, Berkshire Hathaway and Chase That Was Founded 3 Years Ago to Address the High Cost, Low Quality and Poor Patient Experience in Healthcare.

Haven Announced on Jan. 4, 2021 That It is Disbanding.

Haven Healthcare Had a Serious Problem with Conflicts-of-Interest with Berkshire Hathaway's Majority Ownership of the Dialysis Company DaVita.

DaVita Charges Employee Health Plans $4,000 Per Dialysis Session--$12,000 Per Week--Whereas Medicare Only Pays $250 Per Session.

Dialysis Costs are a Huge Problem for Employee Health Plans and Any Strategy by Haven to Reduce Dialysis Costs Would be to the Detriment of DaVita and Berkshire Hathaway.

The Last Thing Healthcare Needs Is Another Corporate Entity Trying to 'Fix Healthcare' with an Underlying Conflict-of-Interest.
VIDEO: Pharmacy to PBM 'Switch Operators' Front Run Employer Health Insurance Plans (5:48)

A 'Switch Operator' is a Software Clearinghouse Between a Pharmacy and a PBM that Allows the Pharmacy to Check the Patient's Drug Formulary, Copay and other Insurance Information.

McKesson's RelayHealth and Change Healthcare Are the Two Companies That Dominate the Switch Operator Market.

Switch Operators 'Sell' the Right to Automatically Insert Prescription Coupons at the Point-of-Sale at the Pharmacy to Pharmaceutical Manufacturers.

These Automatic Coupons Allow Drug Companies to Get Around the Employer Health Insurance Plan Design Copay, Co-Insurance and Deductible and Lower the Out-of-Pocket Cost for the Patient.

As a Result, Patients are More Likely to Stay on Expensive Brand Name Medications Than Change to Less Expensive Generic Medications Because of the 'Artificially' Low Out-of-Pocket Cost Manipulated by the Drug Company.
VIDEO: Map of HIGH Hospital ICU Occupancy During COVID 2020 (4:16)

The New York Times Published a US Map of High ICU Occupancy due to COVID-19 on Dec. 16, 2020.  The Data from the US Department of Health and Human Services and is for the Week Ending Dec. 10th.  Analysis of the Map Reveals:
1) Texas Has ICU Availability Challenges: Major Texas Cities of DFW, Houston, Austin, San Antonio and El Paso Appear to Have the Majority of Their ICUs with Greater than 90% Occupancy. 2) Las Vegas with its Open Casinos Has Almost ALL of Its ICU Beds Occupied and Los Angeles Also Appears to Have Greater than 1/2 of Their ICUs with Greater than 90% Occupancy. +MORE
VIDEO:  Surgery Volume is Back and So is COVID... Are There Enough Hospital Beds?? (7:18)

The Volume of Surgical Procedures Plummeted with COVID in the Spring. By Summer, Surgeries Were Back to 89% of Pre-COVID Levels... Using Hospital Beds and Staff.

Now That the 3rd Wave of COVID is Surging This Late Fall/Early Winter, ICU Occupancy is at 77% Nationally and Anecdotally, COVID Patients are Waiting in the ER 24-48 Hours to Be Admitted. Are Surgery Volumes Still High? 
VIDEO: Consultants Advise on How to Increase Healthcare Costs (3:20)

Consultants Assist Pharmaceutical Companies and Hospital Systems in Raising the Cost of Healthcare.

The New York Times Reported on Nov. 27, 2020 that Consulting Firm McKinsey Advised Pharmaceutical Company Purdue to Pay Over $14,000 to Pharmacy, PBM and Insurance Carriers for Every Member That Overdosed or Became Addicted to Oxycodone or Oxycontin.

In a Separate Example, a Management Consulting Firm Told a Hospital--that was considering ACOs and Value-Based Payment Models--to 'Milk' Fee-for-Service Payment as Much as They Could for as Long as they Could.
The Centers for Medicare and Medicaid Services (CMS) Announced on Dec. 1st Changes to Doctor and Healthcare Provider Payment for 2021:
--Radiologists, Chiropractors and Nurse Anesthetists Will Have Their Reimbursement Lowered by 10%
--Pathologists, Physical Therapists and Occupational Therapists Will Have Their Reimbursement Lowered by 9%
--Anesthesiologists, Cardiothoracic Surgeons, Interventional Radiologists and Nuclear Medicine Physicians Will Have Their Reimbursement Lowered by 8%
--ER Doctors Will Have Their Reimbursement Lowered by 6%
Amazon Has Recently Launched an Online Pharmacy. The Question on People's Minds Is, "Will Amazon Pharmacy Be Revolutionary in Healthcare?"

Arguably, the One of the Most Important Areas in Healthcare is Cost... Medications are Often Very Expensive and Any Innovation to Lower the Cost of Drugs Would Be Amazing.

This Video Compares the Cash Price of Generic and Brand Name Medications on Amazon Pharmacy to GoodRx--the Discount Medication App that Can Be Used at Many Pharmacies.
How to Sell in Healthcare PODCAST

CLICK THE IMAGE TO LISTEN TO THE PODCAST ON YOUTUBE (29 Min)

In Episode 13 of the How to Sell in Healthcare PODCAST You Will Learn How to Read 4 Personality Types in Order to Sell Better. 4 Personality Types / Communication Styles:

1) "Drivers" - Active, Task-Oriented - Motivated by Power and Control, Strength: Progress, Weakness: Low Empathy

2) "Extroverts" - Active, Relationship-Oriented - Motivated by Attention/Praise, Strength: Building Relationships, Weakness: Low Attention to Detail

3) "Structured" - Passive, Task-Oriented - Motivated by Being Correct, Strength: Frequently Right, Weakness: Slow Decision-Makers/Prone to Analysis Paralysis

4) "Peacemakers" - Passive, Relationship-Oriented - Motivated by Being Liked, Strength: Helping Everyone Get Along, Weakness: Don't Speak-up Enough Learn How to Adjust Your Sales Approach with Each of These Personality Types so as to Better Fit Your Solution to Their Need.
BOOK: Healthcare Money Campfire Stories - 16 Lessons in the Business of Healing.

Learn 16 Ways Money Influences Healthcare and the Practice of Medicine That You Have Never Seen Before. 'Healthcare Money Campfire Stories' is based on the true experiences of Dr. Eric Bricker.

Lessons Include:
1)  Hidden Financial Conflict-of-Interests by Some Doctors and Hospitals

2)  Physician Skill - Patient Complexity Mismatch That Leads to Misdiagnosis and Improper Treatment

3)  Insurance Carrier Strategy to Copy Healthcare Innovation and Mold it to Their Benefit

CLICK HERE to Shop on Amazon.com

To Listen to Audiobook of 'Healthcare Money Campfire Stories' on YouTube, CLICK HERE

About

Dr. Eric Bricker is an internal medicine physician who graduated with Honors from the University of Illinois College of Medicine and completed his residency at Johns Hopkins Hospital in Baltimore. 

Dr. Bricker is the former Co-Founder and Chief Medical Officer of Compass Professional Health Services. Compass is a Healthcare Navigation service that grew to 1.8 million members across 2,000+ clients including T-Mobile, Southwest Airlines and Chili's/Maggiano's Restaurants. Compass was acquired by Alight Solutions in July 2018. Alight is a 10,000 person employee benefits and HR outsourcing company that separated from Aon in 2017.

Dr. Bricker is also the founder of Texas Family Insurance - an independent insurance agent sells Oscar Health | Disclaimer: AHealthcareZ.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com Thank you for your support!

Subscribe to Healthcare Finance Video Newsletter

The Current 3,000+ Subscribers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health.  YOUR INFORMATION WILL NOT BE SHARED OR SOLD.

Copyright AHealthcareZ, LLC 2018