Dylan Jordan, CPCU, RPLU

We recently posted our view that medical networks are more of an interference and barrier to needed medical services than a means to reduce costs to employer sponsored group health plans. Evidently, this extends beyond group plans and reaches into the ACA market plans as much, if not more. We recently received an article from an online information source titled, “Size of physician networks varies widely among ACA Marketplace plans, study finds” written by Alan Goforth. The gist of the article reported that these network-based plans only have policyholders access to a modest percentage of doctors in their respective communities. The article reported that “on average, more than one quarter of actively practicing physicians were not included in any marketplace plan network.” The question I raise is WHY NOT? People buy medical insurance to have a pathway to healthcare when needed. How have we allowed ourselves to evolve to a system whereby when we buy insurance, it operates like an exclusive boys and girls club of practicing doctors? How did we evolve to this point whereby we have ceded control of our medical funding resources to third parties who decide not only what we can have with our money, but who we are allowed to get what we need from? It seems to me that the more gimmicks that third parties conceive and market to the public as the latest and greatest cost control devise; the more expensive health care becomes and the narrower the choices as to where we can go to get it are becoming. We continue to advocate that groups have to take back control of the funding that represents claims reserves and be in stronger positions to determine what you can have and where you can go. Whomever controls the money, controls the system. In our view, employers must flip the equation as to who controls the funding for claims. When we give up control of our funds, the system controls us! When we take control of these funds, we control the system! Our groups control their claims reserves in order to minimize the above-mentioned problems. Let us show you how! To learn more, contact us. The Ecchic Group 314-997-8865 www.ecchic.com 11704 Lackland Industrial Drive St. Louis, MO 63146 Article: https://lnkd.in/g-qnSrpA

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Check out my blog post about reviewing your Property & Casualty Insurance today! 🔍 https://wix.to/aV45x9d #newblogpost #riskandcomplianceanalytics #cmandfgroup #pandcinsurance #reviewyourpolicytoday

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Since when did health insurance companies received thier “MD’s”? This is a long article but a fascinating read. We wonder why healthcare costs continue to escalate and premiums are unaffordable? Well, when you have insurance companies being able to add diagnosis’s and conditions to a members healthcare record which allows them to receive more money for treatment - oh and by the way these members don’t have these illnesses…rocket science not needed here! While this seems like its a “Medicare” problem - it’s happening everywhere. In your commercial and group health plan too. Providers trying to charge patients for negotiated discounts, millions of dollars in fake billings, pharmacy rebates being used to increase insurance company profits versus going back to the companies footing these bills or the patients using the drugs. Insurance companies and the organizations that own physician groups and hospitals have figured out how to game the system to increase profits - not deliver better health outcomes. I do believe that there are a lot of great professionals in the medical field that honestly want to improve the lives of people that they treat - they unfortunately now mostly work for companies that don’t really care much about that.

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Check out our latest blog on Talking CAHPS, more specifically on the Health Outcomes Survey which measures patients experience.

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The demand for specialty lines of insurance is on the rise. As the risk landscape continues to pose challenges, expertise, stability, and strong partnerships are key in choosing the right specialty partner. Read Gregory Hohman’s article to learn more: https://ow.ly/LOEt50TWMki #MunichReSpecialty

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The transition from Fee-For-Service to value-based care in healthcare is essential. This article emphasizes the importance of focusing on quality outcomes over process measures to establish meaningful value-based care more effectively and on a larger scale. #Healthcare #ValueBasedCare #QualityOutcomes

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Join us on June 26th and unlock the opportunity to bring substantial value to your business! When was the last time you said your insurance program was "one of the best decisions you've ever made as a company"? Words from our client Frank: "As a family owned and operated company we look to partner with service providers who have a similar mentality like us. Lehigh Captive Advisors & Justin Beidleman display the mentality in understanding hard work, dedication, service, fairness and trust that it takes to operate a business in today's environment. LCA provided us with a unique and alternative way of managing our risk as our company continues to grow. We have never seen stability in the insurance marketplace like we have within a captive. We are approaching 10 years in a captive and our premiums are nearly half of what they would be in the traditional insurance market. Joining a captive has been one of the best business decisions we have ever made as a company. We would highly recommend Lehigh Captive Advisors to any business looking for a true professional, fair, and honest partner to represent their insurance and risk management needs." #CaptivatedbyLCA

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Medicare Advantage in the headlines: 5 recent updates New insights from KFF reveal that Dual-eligible Special Needs Plan enrollees face double the denial rate for prior authorization requests compared to other Medicare Advantage members. Meanwhile, SCAN Health Plan's legal victory against CMS underscores the importance of star ratings in Medicare Advantage. On the flip side, Blue Cross and Blue Shield of Kansas City's exit from the MA market signals challenges amid increasing regulatory demands. Amidst these shifts, some insurers view CMS cuts as an opportunity to enhance member offerings. UnitedHealth Group's defense against an AI algorithm lawsuit highlights the complexity of Medicare coverage determinations. #Medicare #Healthcare #MedicareAdvantage #DSNP #PriorAuthorization #HealthInsurance #CMS #Lawsuit #StarRatings #HealthcarePolicy #UnitedHealthGroup #AI #MedicareCoverage

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"𝒀𝒐𝒖'𝒗𝒆 𝑮𝒐𝒕 𝑨𝒍𝒍 𝑻𝒉𝒆 𝑻𝒐𝒐𝒍𝒔 𝒊𝒏 𝒕𝒉𝒆 𝑻𝒐𝒐𝒍𝒃𝒐𝒙" I attended the Central Penn Business Group on Health annual healthcare forecast yesterday. Innovu presented the keynote address about validating your healthcare data and looking at ways to manage costs. At Eliance Health Solutions - our mission is to help employers manage costs by improving employee health outcomes. So this talk caught my full attention. Fortunately, the three case studies all featured solutions built into our Eliance Advantage plans. 𝐎𝐧𝐬𝐢𝐭𝐞 / 𝐍𝐞𝐚𝐫-𝐒𝐢𝐭𝐞 𝐂𝐥𝐢𝐧𝐢𝐜𝐬 - having a concierge style Primary Care Provider conveniently located to work and available at no or low costs to the member encourage regular checkups and remove barriers that some employees experience when they would really like to go to a doctor, but time and cost are obstacles. At Eliance, access to Penn Medicine's HealthWorks Primary Care Providers in Lancaster County are included in the plan. ✅ 𝐌𝐞𝐝𝐢𝐜𝐚𝐥 𝐌𝐚𝐧𝐚𝐠𝐞𝐝 𝐂𝐚𝐫𝐞 - where a primary care provider analyzes your member's data and ensures your member's providers are keeping high risk members on established care paths. The fact is many providers are extremely busy and its useful to have another set of eyes following a high risk case. At Eliance, we have a physician on staff performing this function - keeping an eye on high risk cases - included in the plan. ✅ 𝐏𝐚𝐭𝐢𝐞𝐧𝐭 𝐀𝐬𝐬𝐢𝐬𝐭𝐚𝐧𝐜𝐞 𝐏𝐫𝐨𝐠𝐫𝐚𝐦 𝐭𝐨 𝐂𝐨𝐧𝐭𝐫𝐨𝐥 𝐑𝐱 𝐒𝐩𝐞𝐧𝐝 - specialty medications drive astronomical costs to employer sponsored health plans. Engaging a service to make sure all manufacturer incentives and grant programs are utilized can save significant dollars. At Eliance, we use Payer Matrix, and have realized 73% savings on specialty medications for our groups - included in the plan. ✅ Hearing the keynote speaker highlight these solutions, essentially as a la carte pieces to be added into your plan at additional, but worthy costs, I was reminded of something a broker recently told me over coffee. We've got "all the tools in the toolbox". If you would like to explore having Eliance as your health plan solution - reach out to me 717-314-3214. If you are a health insurance broker interested in bringing this complete solution to market, especially in the Philadelphia area, reach out.

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