So let’s get down to what’s really happening here. Once upon a time the PBM models were a different type of creature but as time moved on they became less about a better and affordable price for prescriptions and more about and algorithmic machine to create …
Continue Reading
Insurance
Optum certainly kept this very quiet when they sold their hospice facilities to Compassus and I don’t think they even told their own investors. I could not locate any SEC 10k filings or even a Form D from a search I did and this sale took place a year ago. …
Continue Reading
This is a video of a recent presentation I did at the 74th Annual AAPS (American Association of Physicians and Surgeons) meeting. I don’t do too much blogging anymore as I don’t want to be confused with all the “junk” news out there but thought this is worth…
Continue ReadingThis should not really come as a big surprise as what hasn’t the pharmacy benefit managment business touched? So what is Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “outliers, Pharmacists Required to Fix outliers as They Show Up As Non …
Continue Reading
Here we go again, back to those Ingenix algorithms and business models, getting a rerun of sorts of what occurred in 2011. In 2011 there was one main lawsuit from the AMA along with many others that were filed (some being still settled) over using formulas t…
Continue Reading
Here we go again. If you haven’t figured this out yet, when you buy a Cigna Health insurance policy you get a two for one with 2 insurers. Cigna provides the insurance benefits and then it’s pharmacy benefit manager, PBM OptumRX (biggest revenue sector subs…
Continue Reading
If you don’t know what a Quant is, take time out and watch video #2 in the footer of this blog as they are not just limited to working at financial firms. As a matter of fact, hedge funds and banks can’t hire enough of the and the same holds true for insurer…
Continue Reading
I had to include the bit about the comparison here about doctors and pilots as this correlation over the years has been used so many times and some very strange writings as doctor are not pilots, but some folks seem to think the two are more similar than they…
Continue Reading
Everyone now has made the big change to convert from ICD9 to ICD10 Coding for medical billing. When all of this was taking place, many said it would really not improve care and so far, that’s what we have seen. The big coding change has not any impact in th…
Continue ReadingI’m starting to see more doctors in Orange County selling out their practices to United Healthcare’s Optum subsidiary. Sometimes when patients go for their next appointment, in addition to see their doctor’s name on the door, it also now says OptumCare. So …
Continue Reading