You're so good at explaining complicated topics and have great energy. Thank you so much for these videos, I work in healthcare tech and this is eye opening.
Love your teaching style. Very detailed and on point. Was able to follow the words spoken vs words written on board perfectly. Thank you. Very informative. Love when all of a sudden your video pops up on my RUclips.
Don't forget Humana is rapidly expanding CenterWell Primary Care. Here in Arizona the largest healthcare system, Banner Health recently expanded from MA DSNP only to MA HMO & PPO plans as well. Keep up the great work, Dr. Bricker. Thank you!
Dr Bricker is such a beast. Last 90 seconds of this video I’m thinking, “Okay, so hospitals are shifting the profit to themselves? What’s the problem?” @8:04 “So here’s why it’s a problem…” Well played, sir. Well played…
Love your videos. I’m a healthcare lawyer working with small/medium size clinics and provider groups and find them very helpful. There was an article in the wsj titled “you arent as sick as government claims” with a proposal on direct deposit to medicare beneficiary hsa plans to avoid upcoming and insurer tactics. Might be a good video topic.
Couple questions - don't commercial plans have MLRs as well, so why do inter company eliminations only affect MA? And in your example, the $6120 you call profit - is that actually profit, or is it just what the payvider gets to keep (and might have to spend on physician care for the bene and thus actually keep less of the $6120 after costs)
Hospitals may have a leg up in being payviders due to being 340B covered entities. UPMC is and some others too. Locally Mass General Brigham has several 340B hospitals.
If Insurance companies can expand their provider arms, they can leverage economy of scale to perform well in their Star rating, and smaller health groups tied to those get pressured to take risk and still have steep requirements to earn the incentives they bring, or a much smaller fraction. More win-win for payers. Know the importance of your local lives, managing their health, and bringing quality care. Your leverage is keeping lives loyal to your brand.
Are there additional administrative costs that the provider has and now are the responsibility of the payvidor which decreases the profit so that it’s less than the 50% that you calculate?
Dr. Bricker I so enjoy these videos, thank you! Vertical integration in healthcare is such a hot topic, I'd be curious to learn more about why entities like United/Optum seem to be getting a lot of the VI criticism, but entities like Kaiser Permanente do not receive this level of criticism. Is it because one is an open network, and the other is closed? Other reasons you might think? Thank you!
Hi Dr. Bricker, Thank you for another great video! At the end you mention hospitals will go to carriers to get more money from commercially insured on self-funded plans. Are you talking about provider contracts and wouldn't fully insured plans also be affected?
Yes, but insurance carriers want fully insured groups to have steady trending higher claims so the insurers can raise premiums and keep the 15% MLR of a larger number.
As a general rule, risk-based compensation arrangements, where providers are more profitable the better the job they do keeping people healthy, catching disease processes early, advising on behavioral health issues, etc. represent significantly better alignment of incentives among payers, providers and patients than fee-for-service compensation arrangements. I would be curious to hear if anyone has a different view on this topic. Thanks!
Do you believe a free market healthcare system would decrease costs, increase innovation, and improve service quality among hospitals and pharmaceutical companies especially if you got rid of things such as certificate of need to allow more local hospitals to compete with one another?
![I.N "HALLUCINATION" | [Stray Kids : SKZ-PLAYER]](http://i.ytimg.com/vi/n5B5q1Hwt_U/mqdefault.jpg)
You're so good at explaining complicated topics and have great energy. Thank you so much for these videos, I work in healthcare tech and this is eye opening.
Thank you for watching and for your feedback.
Love your teaching style. Very detailed and on point. Was able to follow the words spoken vs words written on board perfectly. Thank you. Very informative. Love when all of a sudden your video pops up on my RUclips.
Thank you for watching and for your feedback.
Don't forget Humana is rapidly expanding CenterWell Primary Care. Here in Arizona the largest healthcare system, Banner Health recently expanded from MA DSNP only to MA HMO & PPO plans as well. Keep up the great work, Dr. Bricker. Thank you!
Thank you for those additions.
Excellent intro to Payvider trend - thank you Dr Bricker.
Thank you for watching and for your feedback.
Dr Bricker is such a beast. Last 90 seconds of this video I’m thinking, “Okay, so hospitals are shifting the profit to themselves? What’s the problem?”
@8:04 “So here’s why it’s a problem…”
Well played, sir. Well played…
Thank you for watching and for your feedback.
Would love more insight on payviders, especially from a contracting perspective!
Thank you for your feedback.
Love your videos. I’m a healthcare lawyer working with small/medium size clinics and provider groups and find them very helpful. There was an article in the wsj titled “you arent as sick as government claims” with a proposal on direct deposit to medicare beneficiary hsa plans to avoid upcoming and insurer tactics. Might be a good video topic.
Thank you for your suggestion.
Couple questions - don't commercial plans have MLRs as well, so why do inter company eliminations only affect MA? And in your example, the $6120 you call profit - is that actually profit, or is it just what the payvider gets to keep (and might have to spend on physician care for the bene and thus actually keep less of the $6120 after costs)
Hospitals may have a leg up in being payviders due to being 340B covered entities. UPMC is and some others too. Locally Mass General Brigham has several 340B hospitals.
Thank you for the info.
This is a really good summary
Thank you for watching.
If Insurance companies can expand their provider arms, they can leverage economy of scale to perform well in their Star rating, and smaller health groups tied to those get pressured to take risk and still have steep requirements to earn the incentives they bring, or a much smaller fraction. More win-win for payers.
Know the importance of your local lives, managing their health, and bringing quality care. Your leverage is keeping lives loyal to your brand.
You can Health First (Brevard Co. FL) to that list. They started with this model back in the late 90's.
Thank you for the addition.
Are there additional administrative costs that the provider has and now are the responsibility of the payvidor which decreases the profit so that it’s less than the 50% that you calculate?
Dr. Bricker I so enjoy these videos, thank you! Vertical integration in healthcare is such a hot topic, I'd be curious to learn more about why entities like United/Optum seem to be getting a lot of the VI criticism, but entities like Kaiser Permanente do not receive this level of criticism. Is it because one is an open network, and the other is closed? Other reasons you might think? Thank you!
Hi Dr. Bricker, Thank you for another great video! At the end you mention hospitals will go to carriers to get more money from commercially insured on self-funded plans. Are you talking about provider contracts and wouldn't fully insured plans also be affected?
Yes, but insurance carriers want fully insured groups to have steady trending higher claims so the insurers can raise premiums and keep the 15% MLR of a larger number.
I appreciate your detailed breakdowns, although this is such a sham it feels like justifying a protection racket.
Thank you for your comment.
As a general rule, risk-based compensation arrangements, where providers are more profitable the better the job they do keeping people healthy, catching disease processes early, advising on behavioral health issues, etc. represent significantly better alignment of incentives among payers, providers and patients than fee-for-service compensation arrangements. I would be curious to hear if anyone has a different view on this topic. Thanks!
Thank you for sharing your thoughts.
Do you believe a free market healthcare system would decrease costs, increase innovation, and improve service quality among hospitals and pharmaceutical companies especially if you got rid of things such as certificate of need to allow more local hospitals to compete with one another?
Yes. Thank you for your comment.
this seems like it should be illegal, it seems anti competitive towards small health care providers
Yes. It is legal. Thank you for watching.
@@ahealthcarezmaybe legal bc they paid off corrupt govt to get their way
The audio in a video is more important than the image quality...
Thank you for your feedback.
Kaiser is terrible. Don’t use them if you can help it.
Thank you for sharing your experience.