Tag Archives: Health Insurance

The Validation Institute – How they can Assist Employers

The vast majority of employers are continuing to experience rising health insurance costs. We know there are areas of healthcare from quality differences to the variation in utilization that can negatively impact an employer health plan and its estimated that 30% of healthcare is unnecessary, waste and/or fraud. To solve this there have been many solutions proposed including wellness, imaging management, PBMs, High Deductible Health Plans, Direct Primary Care, Value Based Care, direct contracting and many, many others. In each of these solutions there is typically some sound belief that the concept will work, but there are also a lot of vendors or healthcare providers out there claiming they have the answer and this is often filtered through a broker who may or may not have your best interest at heart (Read about some the egregious behavior here “Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans“).

So how can one identify providers of services who can achieve results? Well that’s where the Validation Institute comes in. To get a sense of the why and what the Validation Institute can do for you, watch this short video:

 
 

For full disclosure I was involved early with this group and since then have assisted in various capacities. I currently serve as a Senior Advisor, Standards and Compliance and also serve as a Judge for the Health Value Awards which are given annually at the World Health Care Congress to companies, employers and brokers who can show that they demonstrably improve the outcomes for their employees and lower costs. The validated Health Value Awards are also reviewed by the Validation Institute.

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PopHealth Week – Annual Medicare Wellness Visit,Value Based Care and Employers

Gregg and I had an interesting discussion on this week’s episode of PopHealth Week. We covered the Annual Medicare Wellness Visit and how it came to be, as well as value based care and some interesting moves by employers (Walmart and the Utah State Employee Health Plan) and providers (Oschner and their ACO).  Listen in:

PopHealthWeek-logo-TWTTR-sq PopHealth Week – The Medicare Annual Wellness Visit, Oschner and Walmart, Utah Employees and high Cost Pharmaceuticals, a new approach.

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Ridiculous Healthcare Pricing

All over the country people are commenting on the ridiculous pricing from healthcare facilities and providers.  Here is a recent example I came across:

Lab Bill

You’ll note that the gross price for these lab tests is $837.74 and the person was told their out-of-pocket responsibility could be $109.85.  What is so amazing about this is I have heard of wellness companies that purchased lab services for their programs being charged $21 for a similar series, without the PSA, if the draw was done at a laboratory service center and $65 if the draws were done onsite at the employer.

So lets take out the PSA at $148.48/$19.47 and there you have it, gross pricing for these services is almost 33 times what they sell this service to wellness vendors on a wholesale basis (which obviously has a profit in it), and the person getting these tests could potentially pay four times that amount out of pocket with their PSA portion excluded.

I assume that the insurer, Continue reading

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Tom Chamberlain, CEO of EdLogics on PopHealth Week

In attempting to control healthcare costs, improve health and seek better utilization of healthcare services by their employees,  one key area of focus by employers needs to be health literacy. It’s clear that poor health literacy is a strong indicator of health care costs. Here are some statistics:

Health Literacy Stats

 

Tom-pic

Tom Chamberlain, PharmD, the Founder and CEO of EdLogics joined Gregg Masters  and me on PopHealth Week  to discuss their platform and how it works to improve Health Literacy and engagement.

 

From their marketing materials:

EdLogics is an education-based consumer engagement company that provides innovative health education and learning management solutions to employers, health plans, healthcare providers, and government entities. Through interactive game-based learning, multimedia educational programs, innovative gamification strategies, and rewards for educational achievement, EdLogics is transforming the way consumers learn about health. The EdLogics Platform makes learning fun and engaging, measures learning comprehension, improves health literacy, and empowers consumers to take greater responsibility for managing their health.

You can learn more about their platform via this video (http://www.edlogics.com/overview/)and listen to the interview on PopHealth Week below:

 

 

PopHealthWeek-logo-TWTTR-sq

For full disclosure, I am an advisor to EdLogics.

PopHealth Week is Produced by Health Innovation Media

 

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A Bill You Can Understand: One Page, One Line, One Price

At the recent Health Datapalooza conferenceSylvia Burwell, the HHS Secretary announced a new initiative, A Bill you Can Understand, :

a challenge to encourage health care organizations, designers, developers, digital tech companies and other innovators to design a medical bill that’s simpler, cleaner, and easier for patients to understand, and to improve patients’ experience of the overall medical billing process.

This is a laudable if perhaps slightly misdirected effort.

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