Direct Contracts Are Growing Because “PPOs Don’t Work Anymore”

Direct contracting is quickly growing in the insurance world because “PPOs don’t work anymore,” according to Bud Brooks, President of Brooks Healthcare Solutions. Brooks spoke at a Free Market Medical Association luncheon in Dallas earlier this month and has 25 years in the healthcare and benefits space. PPOs artificially inflate the cost of medical care, Brooks says, because the carriers who build the networks need to take a cut for themselves. Direct contracting offers a level playing field for payors and providers, where neither are dependent upon discounts on inflated prices, or threats to cut people out. If the price… Full Story

Texas Has Third-Highest Insurance Rebates For Individual Market

Private insurers will pay a record of around $1.3 billion in rebates to consumers this year for excessive premiums relative to health care expenses, surpassing the record high of $1.1 billion in 2012, according to a Kaiser Family Foundation report. Rebates may either be paid out in the form of a premium credit or as a lump sum, though lump sum is more common. Rebates are the result of insurance companies not meeting the Affordable Care Act’s medical loss ratio threshold, which requires insurers to spend at least 80 percent of premium revenues (85% for large group plans) on health… Full Story

Blue Cross-Knox City Conflict May Be Going to Federal Court

Blue Cross Blue Shield of Texas is hoping to move the legal battle with Knox County Hospital District to federal court, and the temporary restraining order hearing scheduled for September 10 has been suspended. After 50th District Court Judge Bobby Burnett issued the TRO ordering BCBS to pay Knox County Hospital more than $21 million in what they allege are unpaid insurance claims, BCBS filed a motion in U.S. District Court for Northern Texas in Wichita Falls to move the case to federal court because BCBS of Texas is owned by Health Care Services Corporation in Chicago. “Blue Cross Blue… Full Story

How Award-Winning Dean Foods Flipped Its Healthcare Spend

One might not expect a dairy company to be a top innovator when it comes to providing healthcare to its employees, but Dallas’ Dean Foods has an award winning benefits plan that is keeping quality high while flipping eight percent annual increases to outright annual reductions. Dean Foods began attracting attention when it won the Texas Star Award from the Texas Business Group on Health and Health Value Award from the Validation Institute, both for healthcare innovation. Behind milk and payroll, healthcare is one of the top spends for Dean Foods and its 15,500 employees, and several years ago they… Full Story

Direct Primary Care Now Offered Through Baylor Scott and White ACO

Baylor Scott and White Health is joining the direct primary care movement with a new model in several North Texas clinics this year. The model will allow employers to customize the provider network and make a regular contribution to membership fees, making pricing transparent to control costs and avoid hospitalizations. As in other DPC relationships, members are charged a monthly fee that covers office visits and lab tests. Insurance is still needed for hospitalizations and other services, but because primary care needs are taken care of, patients might be more likely to choose high deductible plans with low premiums. The… Full Story

American Specialty Health Moves to AllianceTexas

AllianceTexas’ newest tenant is benefits management services company American Specialty Health. Hillwood’s 26,000 master planned community planned has leased 164,000 square feet of Class A office space from building owner Griffin Capital Essential Asset REIT. “We are pleased to welcome American Specialty Health to AllianceTexas’ ever-growing office community,” said Steve Aldrich, senior vice president of Hillwood via release. “Our region has an extensive and impressive list of top-tier health companies and with its cutting-edge healthcare services and new employment opportunities, ASH enhances that list in North Texas.” ASH gives guidance in musculoskeletal health solutions, fitness, exercise programs, and more to employer… Full Story

BCBS of Texas Ordered to Pay $21 Million for “Willful Conduct of Fraud”

A Texas judge has ordered Richardson’s Blue Cross Blue Shield of Texas to pay more than $21 million to Knox County Hospital in unpaid insurance claims because of “acts to be willful conduct of fraud,” according to the Times Record News in Wichita Fallas. Bobby Burnett, the presiding judge of the 50th District Court of Texas, also placed a temporary restraining order against BCBS, according to a release from Knox County Hospital District. The restraining order says it was placed because BCBS willfully secured funds that did not belong to them, they engaged in slanderous activities, breached duty of care, and… Full Story

CareFlite Cut Prescription Spending by 40 Percent – Here’s How

CareFlite is used to saving lives in the most dire of situations, but the Grand Prairie nonprofit has also been saving on their healthcare spend. By focusing on prescription drugs, the company has saved hundreds of thousands each year on prescriptions alone. Prescriptions can represent 18 to 23 percent of total healthcare spending for companies, even though only a few years ago the took up only 10 percent of healthcare spending. In 2016, CareFlite spent $863,000 on prescriptions alone for its 660 employees. But three years ago, partially-insured CareFlite moved to an independent pharmacy benefit manager with the help of… Full Story

Holmes Murphy Grants $30,000 to Four North Texas Nonprofits

The Holmes Murphy Foundation Grant Program has selected its inaugural recipients, which selected area nonprofits that align with the foundations pillars of At-Risk Youth Education, Health and Human Services, and Arts and Culture. The foundation has cumulatively awarded $30,000 to the following organizations: Cristo Rey Dallas, Austin Street Center, Children’s Medical Center of Dallas, and Community Partners of Dallas for grants this year. “Holmes Murphy is incredibly honored to have the opportunity to give to four organizations that help uplift the Dallas community,” said Chris Boyd, Senior Vice President of Employee Benefits at Holmes Murphy via release. “This year’s recipients… Full Story

Father and Son Sentenced in Blue Cross Blue Shield and American Airlines Hearing Aid Fraud

A hearing aid scam targeting American Airlines employees has landed a father and son in federal prison for 15 years, AP reports. Prosecutors say the men made false claims on behalf of the airline employees for unneeded hearing aids that were sometimes never delivered, AP reports. Many of the fraudulent hearing tests lasted less than five minutes and were done in a break room at DFW International Airport. Terry Lynn Anderson, 69, was sentenced to eight years in prison and ordered to pay 13.7 million to Richardson-based Blue Cross Blue Shield of Texas. His son Rocky Freeland Anderson, 38, was sentenced to… Full Story