Monthly Archives: September 2015

Blue Cross finds angioplasty payments vary widely by market

Did you know that the median amount that a Blue Cross insurer paid for an angioplasty in Los Angeles was between $10,749 and $67,937, a 532% difference and the most extreme variation in the report? In Chicago, Blue Cross reimbursed providers between $15,951 and $49,604 for the same types of angioplasties, a 211% difference. There Read More

What Is A Medical Loss Ratio? The Check Will Be In The Mail

Did you know that Medical Loss Ratio is arguably the single most important financial measure in the healthcare world? For an insurance company, it represents how much of the annual premiums goes toward medical expenses versus marketing, administration and insurance company profit. It is now legislatively limited to 20% on small company plans and 15% Read More

How Fitbit and IBM Watson are transferring the power of healthcare data from one hand to another

Did you know that a recent announcement by wearable device pioneer Fitbit and IBM Watson’s healthcare unit will rapidly democratize access to personal health data, as well as access to complex computational capability and placing it, literally, in people’s hands? Separately, IBM Watson Healthcare announced a major push into the healthcare analytics space through strategic Read More

9 New York Doctors Are Accused of Defrauding Medicaid Using Homeless People

Did you know that 9 New York doctors are indicted in March 2015 on Medicaid fraud using homeless people as patients? The doctors offered free shoes as an inducement to be subjected to a raft of unnecessary medical tests and equipment prescriptions. These tests led to $7 million in false Medicare and Medicaid billings between Read More

Why Do Other Rich Nations Spend So Much Less on Healthcare?

Did you know that the United States spends 18% of its GNP on healthcare, more than 50% higher than the Netherlands, who is the second highest spender? Why does the United States spend so much more? The biggest reason is that U.S. healthcare delivers a more expensive mix of services. For example, a much larger Read More

Cut Health Coverage Or Send Obamacare Cadillac Tax To Junkyard?

Did you know that a survey by the International Foundation of Employee Benefit Plans reveals that 62% of companies facing a 40% Cadillac tax hit in 2018 are already changing their coverage to avoid it? Conversely, only 2.5 percent of companies say they will pay it. How do you avoid it? Change to higher deductible Read More

2015 Milliman Medical Index

Did you know that in 2015, the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $24,671 according to the Milliman Medical Index (MMI)? The cost for this family has nearly tripled since Milliman began tracking this information in 2001. This creates a Read More

Employers Plan Strategic Changes to Health Benefits

Did you know that the majority of midsize and large U.S. employers (84%) expect to make changes to their employee health benefits program over the next 3 years, according to nw research from consultancy Towers Watson? Two-thirds are planning to use claims and other data to evaluate plan performance and employee behavior changes in lifestyle Read More

Why Is There So Much Unnecessary Care?

Did you know that Walmart is receiving unexpected benefits from its leading edge program for medical “centers of excellence”? Walmart is sending employees to chosen “centers of excellence”, and is finding that 30% of the transplants initially recommended are not necessary.Read More

Can The Apple Watch Really Keep The Doctor Away?

Did you know that the Apple Watch, while still early in its development, has the capacity to become the first commercial data-gathering and synthesis system for personal health metrics? With the availability of specialized biosensors and real-time access to medical records, it could deliver event or monitor-driven, ultra-personalized medical info to you, and evaluate and Read More