Posts by Jim Edholm

Exploring Partially Self-Funded Health Care and Its Risks

If you’re a CFO or CEO you think about EBITDA.  A lot.  Heck, that’s really your job, isn’t it? And the fact is that one of the biggest “EBITDA Vampires” is your company’s health plan.  I’ll even tell you how much it’s probably stealing from you – $1,500 – $3,500 per covered employee per year.…

Two Relevant and Related Articles

I saw these two articles on LinkedIn.  The first one really raised my blood pressure – once again the drug makers are ripping off Americans, particularly those in private plans. https://www.businessinsider.com/cost-first-fda-approved-marijuana-medication-epidiolex-2018-8 There is an epilepsy drug now approved by FDA.  The first one based on marijuana, and the drug maker is suggesting that it be…

Whose Money Will Fix the Community Hospital?

I’m encouraged by the efforts on the part of Massachusetts legislators to address the problems of community hospitals.  Many of our local hospitals put out an excellent product at a VERY reasonable cost.  We should protect them.  Sorry, Partners, but MGH isn’t the answer to EVERY medical problem, your protestations to the contrary. In fact,…

Getting Rx’d Again by Your PBM??

This story is told on the accompanying video, or you can read it below. OK, there’s no such verb as “Rx,” but it kinds looks like an insult or not-so-good thing, so I couldn’t resist. If you have a health plan, and if you are with the typical Pharmacy Benefit Manager (PBM), then you’re probably…

Health Insurance Self-Funding Is a Tactic, Not a Strategy

Most employers and far too many brokers think that once they begin to self-fund their health plan they have achieved Nirvana, the Promised Land or the End Zone. Nope.  No way, no how.  You’ve just started on your journey. Look at the chart below, which illustrates how self-funding works.  Throughout the year your employees and…

When Your Hospital Tries to Bully You

I recently saw an item in a health-related publication I follow.  Parts of it were a surprise to me.  And from him I’ve learned a lesson that can help YOU, dear Reader Dr. Bill Hennessey is the founder of Pratter, Inc.  They are a Pittsburgh area consultant that help health plans and employers and individuals…

Why You Need a Medical “Boy Scout” or “Girl Scout”

Scouts are Pathfinders, Good-Deed Doers and helpful folks to have around.  Anytime you’re in unfamiliar terrain, they can come in handy. Nowhere is that more true than medicine.  Most of us are baffled by medical jargon, often uncertain exactly what it is our doctor has told us, particularly if the news is bad.  And doctors…

Is Your Broker REALLY on Your Side??

We all know that the real driver of your health plan costs is medical claims, right? Claims are the Culprit Granted, if you’re a small firm, say fewer than 15 people on the plan, you’re generally not big enough to fix it so that your claims and your premium are proportional.  You’re going to be…

Trump Healthcare Executive Orders – Good News or Bad?

On Friday the 13th (heh-heh) President Trump signed the Executive Order that he says is designed to promote “Healthcare Choice and Competition Across the United States.” So is that what it is, as the President’s supporters contend, or is it, as Senators Chuck and Nancy and their admirers argue, a deadly blow to healthcare in…

The Modern Health Cost Scourge– Diabetes… & What to Do About it

Diabetes is, indeed, a scourge. Almost 1 in 10 American adults has diabetes, and faces – in the absence of proper disease management – a dark future. In fact, although only 8% of Americans have diabetes, it accounts for 25-30% of all health care dollars! The way diabetes works is that higher glucose levels thickens blood…
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