Insurance Denials Mirror Government Budget Cuts in Care
Unfortunately one of the great lies of US HC. Ask anyone with a serious illness that has been denied care by an insurance company that subcontracted out the denial process to a company owned by overseas private equity firms. Or how about this one. The heart transplant got approved. But the rejection meds were not. You can’t get care if you cant afford it or if your insurance company denies it. Which is just as bad as your government limiting it for budget reasons. Same issue. Different budget Anyone else got stories like these ?
CEOs Overlook Benefit Contracts, Missing Easy Cash Flow
Don't you wish CEOs knew what was in their HC benefits, brokers and consultants contracts? I bet they can add more cash flow by paying attention to this than 90 pct of the things they want to do for...
Insurers Hide Denials, Charge Appeals—Demand Transparency Now
Want to know how ridiculous and awful Ins company and their PBM denials are? The insurance company that denies the claim, that is if it’s them and not a subcontractor like medica , also picked the network and doctors. So they...
AI‑Powered Incorporation Service Could Boost State Revenues
If I was the governor of a state looking to grow their revenues, I would add the ability for anyone to incorporate using an AI agent and stablecoins. And charge a premium for the service Post the agent in the...
Support Break Up Big Medicine Bill for Affordable Healthcare
So why haven't you come out in support of the Break Up Big Medicine Bill ? Or did I miss it ? Until that passes, there is absolutely zero chance of affordable healthcare or universal healthcare Full Stop
PBMs' Formulary Tactics Drive Billion‑Dollar Patient Costs
The same companies you say are denying claims, are the ones you prop up buying access to formularies. Tell your members to stop being afraid of the PBMs and the insurance companies that own them, or they own. Your...
Healthcare Costs: Measure as Percentage of Revenue
For all the consultants and experts out there. As a percentage of sales, how much do you think healthcare benefits are, annually So a company with 1m in sales and 50k in HC benefits is 5 pct. Etc
Can Independent TPAs Replace PBMs and ASOs?
Is there anything an independent TPA can do to replace PBMs and ASOs ? Ideas ?
Embracing Confirmation: The Power of Saying Yes
Yes
Explore Healthcare Benefits Insights in Podcast Transcript
If you care about HC benefits, read the transcript. Listen to the Pod It’s good https://lnkd.in/gfE2wJwz
Charge Masters Are Fake Prices Exploiting Patients for Profit
Gotta make charge masters real prices or get rid of them. The CM is like WAC in pharma. It's a made up number that abuses the uninsured , those in their deductible phase, and those who need...
Hospitals Gain Profit by Accepting All Patients
Appreciate it. A couple reasons why we disagree. Most don’t know if their commercial insured business is profitable by carrier. But that’s a topic for another day. Most hospital assets/caregivers (surgeons and some others that get...
Insurers Outsource Care and Denials to Profit‑driven Firms
They don’t depend on Medicare/caid , they depend on being able to arbitrage the taxpayer funds they recieve. They take their capitation amount , then outsource the actual performance of care to either the providers they own or VBC...
Hospitals Overpay Insurers While Employers Foot the Bill
The greatest problem in healthcare ? Hospitals, even market dominant hospitals, won’t walk away from the big ins companies that underpay, late pay, clawback, deny claims, waste their time in denial appeals, and require them to pay up to 8...
Hospitals Should Bypass Insurers, Negotiate Directly with Employers
I’ve heard that hospitals pay between 2 and 8 percent of their revenues to RCM consultants Why can they not do it internally ? I don’t get how you can outsource this. But the bigger question is why do you...
Local Hospital Pharmacy Beats Big PBM for Formulary Trust
Question. who would you trust more to determine your corporate formulary, a big PBM, or your local hospital system and their pharmacy team ?
HSAs Without Insurance Could End Perpetual Premium Debt
The one debt you can’t ever pay off ? Your insurance premiums. You literally will pay an insurance premium monthly, till you die. But we don’t look at it like it’s a debt paid to an insurance company that...
NBA League Pass Needs All-Streaming Service Bundle
NBA league pass should offer a bundle that includes all the streaming services. I think they will get to this when they can.
Social Media Pressures Insurers to Prioritize Patient Lives
When your insurance company needs their social media team to convince them to do the right thing and save a patient’s life Break up the big insurance companies
Jefferson Health Sues Aetna over Downcoding, Avoids Class Action
Jefferson Health sues Aetna over ‘downcoding’ policy I’m surprised they couldn’t make this a class action lawsuit https://t.co/tZgfdFxRJE
CEOs' Blindness to Healthcare Costs Fuels Overcharges
Almost right. It’s more expensive because CEOs of self insured companies, hire the biggest insurance companies to manage their spend on care. Resulting in them having no idea how they spend their money. Look up those same prices...
Increasing Volume Drives Lower Biosimilar Medication Prices
We are just getting started. As our volumes go up, our prices go down. And we are adding more branded meds and soon more specialty meds. If you use humira, stelara or other meds that have biosimilars, we...
Cut Benefits Costs, Add $0.25 EPS per Share
Great question. Answer: smart one. Every dollar saved on benefits goes right to the bottom line. A public company with 100m shares can add 25c per share, annually, if they had a clue about...
AI May Outperform PBMs in Transparent Healthcare Pricing
Serious ? Who would you trust more for personal healthcare information, @chatgpt, @claudeai , @GeminiApp , @grok Or the PBMs and Insurance companies you have integrated into your EHR ? Yes you do a better job of protecting PHII, but that’s not...
CEOs Ignore LLMs for Costly Health Insurance Contracts
You know who isn’t using LLMs for their Health insurance ? CEOs Employee benefits are the 2nd largest expense line item for pretty much every company. Yet they do t take the 30 secs to run their contracts through an ask...
Empty Hospital Beds Still Incur Full Fixed Costs
Great point. They say they lose money on Medicare and Medicaid. But they know the fixed costs are still going to cost them money when those beds are empty. And they will still be paying doctors , nurses...
Hospitals Blind to Costs, Overreliant on Consultants
Most hospitals don't know their costs. Things I've asked for that made them roll their eyes : A BOM for surgeries P&L for each insurance carrier P&L for Medicaid or Medicare business Why do they need consultants for everything. ...
Hospitals Overspend on Consultants and Supplies, Resist Savings
Why aren’t any of these at risk hospitals publishing their full accounting so everyone can see where they spend their money ? All but one group of hospitals that I have looked at potentially investing in, spend so much on consultants...
Bernie Urged to Expose HealthFirst's Owners, Push Breakup
Hey @BernieSanders, look up who owns HealthFirst, the insurer that cut off her insurance for a nickel and explain to us all why you are not actively supporting the Break Up Big Medicine Bill ? Why am I calling you out...
Taxpayer-Backed Loans Inflate Healthcare Costs, Bankrupt Patients
The point is that we spend taxpayer money to guarantee or fund loans that don’t matter a fraction as much as paying for your health. Most people can’t afford their deductible. We should guarantee the amounts patients can’t afford...
Taxpayers Fund Everything Except Our Health Debt
Let me help rephrase for you Bernie. Need a loan for college so you can party for a semester and drop out? Taxpayers will loan you money for it. Need an SBA loan for your business ? Taxpayers will...
AI Automation Risks: IP, Taxes, and Market Uncertainty
I can’t wait to read the Risks section of your IPO Prospectus and future SEC filings Risks: within the next 4 years we expect to completely recreate all processes and procedures in each organization to optimize the replacement of humans with...
UNH Split Into 2,700 Firms: Potential Value Boost?
Michael Ha , if UNH broke themselves up into literally 2700 companies , the biggest 10 going public as standalone, how much more shareholder value would they create ?
Insurance Deductibles Turn Hospitals Into Subprime Lenders
The are a function of health insurance plans. The insurance companies create plans with deductibles that most people can’t afford. So to get to the insurance money from their plan, they will loan the patient money to cover...
Sharing Your Image Boosts Visibility for All Users
Innovate. When SORA came out , to learn how it worked I put my image out for all to use. Why ? Because it let me attach that @costplusdrugs showed up at the end of any video that used...
AI Agents Give Workers Extra Hour without Pay Cut
Smart, bigger companies will enable their employees to create and use agents (within security guardrails ), improve their productively but MOST IMPORTANTLY, they will reduce their work day by an hour to start. Same pay. Reward...
AI Success Requires Business Reinvention, Not Simple Tech Add‑On
If my “repaving” you mean “reinventing “, yes. One of the challenges is that most corporate knowledge is still in someone’s head. Knowledge is far different than information. LLMs and agents can capture all the information ...
When AI Agents Flood Markets, Trust Becomes Currency
In the near future. the marginal cost to create and run an agent will be minimal, so unlimited numbers of agents will compete in what appears to be an absolutely efficient market. However, there will be too...
Insurance Fees Undermine Care: Doctors, Nurses Underpaid
Des and Nurses are underpaid. Independent doctors are getting ripped off to the point of barely getting paid after fees The biggest insurance companies are awful for beneficiaries and for employers. One example ? What good is insurance if patients...
Big PBM Contracts Are Costing You—Let AI Expose the Rip‑off
If you have a deal with the biggest PBMs you are getting ripped off A simple way to realize this is to take both your insurance and PBM contracts and out them in @claudeai and just ask the following "How...
Master New Tech, Boost Earnings Amid Economic Chaos
An article from the 90s explaining how in the 1980s, personal computers changed the dynamic of college vs high school workers. College grads learned how to use PCs and grew wages faster Mind you, this was when interest...
Future Homes: Smaller Footprints, Lower Costs, Easier Living
No. I’m saying in 10 years , this is how new houses will be built. Less acreage. Less internal square footage. More actual human living space. Far easier to maintain and lower maintenance costs. Less cost to...
Bandwidth May Bottleneck Outdoor AI Beyond 5G
Will outdoor AI use cases, particularly when we get to “world view” based AI, overwhelm 5G ? Satellite uplinks ? And make many of those use cases, unusable ? Is the bottleneck going to be bandwidth ?
Congress Urges Curb on Costly Medicare Advantage Subsidies
Congressional advisers call to rein in Medicare Advantage spending amid industry pressure I’ll summarize for you. EVERY SINGLE FAMILY IN THE USA IS PAYING $800 A YEAR to the big insurance companies because taxpayers pay them more than it...
Net Pricing Could Cut Patients' Drug Costs by 40%
If big pharma sold to big 3 distributors at net prices rather than list prices, patients would save on average 40pct on their specialty and brand medications. This isn't hard. @BernieSanders @HawleyMO @SenTedCruz @SenateGOP @SenWarren @AOC https://t.co/COdRaMJPgq
Avoid PBM Per‑employee Fees; Choose Per‑claim Pricing
Don't let your company get ripped off by PBM fees. Paying per employee for services is insane. There are plenty that will charge you per claim and let you manage your own formulary and pay lower costs. ....
Transparent Pricing Would Stop Companies Adopting Exploitative Health Plans
No. Companies would understand pricing better and wouldn’t sign up for rapacious health plans that they force their employees into https://t.co/oSzKYa5915
LLMs Poised to Become Tomorrow’s Hidden Infrastructure Layer
Will today's leading foundational LLMs be the DEC,Cray, Wang, Radio Shack, Sun, Data General, Compaq, etc of tomorrow ? GenAI LLMs want to be the operating systems of today and tomorrow. It's possible they will be the CP/M, DOS,...
Rapid Productivity Boom Threatens Wealth Concentration, Requires Early Action
How concentrated do you think the wealth generation will be ? What do you see as second order social implications of productivity hyper-acceleration? If we don’t address the issues you anticipate now, before it happens, I don’t know that it’s...
From Mocked Streaming to AI: Skeptics Missed Evolution
It used to be people laughed at streaming. First it was only low quality audio. The. When video came along it was the size of a postage stamp. Then there wasn’t enough bandwidth to scale. To everyone...