Healthcare Solutions Podcast | Season 3
Providing Solutions One Episode at a Time
“There’s not one definition of a specialty drug…specialty drugs have a vague group of criteria that many times isn’t clear. You have to find out how your plan defines specialty drugs. If you find generic drugs on a specialty list, you need the right people by your side to fix that.” — Vinay Patel, founder of Mako-Rx
Patients who receive medical balance bills are ill-prepared to decipher what they’re being billed for and why. If there’s any chronic disease more prevalent than healthcare “pricing toxicity”, we don’t know what that might be. Plenty of us calling for transparency in healthcare throw the term “payment integrity” on the table as often as possible. If we stop talking about it, then the predatory billers win…and we just can’t have that.
Physicians who want their autonomy back and the other stakeholders who also see the value there can all come together on January 20th, 2024 in Columbia, SC at the Riverbanks Zoo for a networking event. Don’t wait to get registered at www.indedocs.com. We’ll hear from doctors, health plans, legislators and employers who have a role to play in solving tough problems in our healthcare system. While others may be convinced that bigger is better in healthcare; there are still those of us who believe that local communities have a better handle on how to fix the problems that affect them most.
When it comes to health plan compliance the Consolidated Appropriations Act of 2021 is the most recent law we have to spend time learning about. In this podcast, Tony Sorrentino, President of Health Plan Fiduciary Guides (HPfid), gives us some compelling food for thought and action items.
I’m not a huge fan of SciFi as a genre. Mainly because I don’t identify with the future state that’s controlled by robots and I don’t want to admit that our futures are a grim reality of the outcomes of our current day choices. When I read, “2060” by Dr. Richard Young, it made me realize that I need to grow up, grow a spine, grow a pair…whatever your cliche for “pull up your big girl pants and fix this thing” is. Our healthcare system is going to eat up every possible dollar there is to spend on infrastructure, education, quality of life and more if we don’t do something. Listen to Cristy Gupton and Dr. Young talk about his latest book and pick up a copy right away. You won’t regret this eye-opening glimpse into our futures if we stay still.
Hospitals in America have become major corporate entities with the power to bankrupt you and your employees. But yet, they claim to be “not-for-profit”. What gives? Well, the devil is in the details and many hospitals have become masters at hiding the details. There’s an ace in your hand though. It’s section 501R of the Internal Revenue Code. Never heard of that? Well, you’re in luck if you’re a subscriber to Healthcare Solutions Podcast. Listen here and learn.
Healthcare is consistently the #2 or #3 highest expense on an employer’s balance sheet. There’s no denying that you’re in the healthcare business even if you don’t think you are. That’s why it’s important to view your organization’s healthcare spend as every other high-cost expenditure you have and manage it accordingly. After all, the Employee Retirement Income Security Act (ERISA) and the Consolidated Appropriations Act of 2021 (CAA) require you to pay close attention to it. Step one? Listen to this podcast with Cristy Gupton and Kari Niblack as they give you food for thought regarding your employee health plan.
Recently, the NC General Assembly voted to approve a bill that would allow the state’s largest healthcare services organization (notice I didn’t say “health insurance company”) to continue its vertical integration scheme while using policyholder contributions and taxpayer dollars to fund their expansion. What employers should be upset about with that is the favoritism those lawmakers are showing to BCBSNC. Did those same legislators pass a bill in your favor that would help your company grow? Nope. The message here is that there’s more than one health insurance option in this country and it doesn’t have to bear the logos of Blue Cross, UnitedHealthcare, Cigna or Aetna. Give another option a close look. You’ll probably find a partner more aligned with your interests than you realize.