1. Healthcare 101 by Steven Lash
Thanks for your time today Mr. Practice Director. I have been in this industry for over 20 years and I have not seen Medicare introduce an opportunity like this to help patients get healthier and generate income. For every 1,000 patients you enroll you will generate $500K in annual revenue.
May 15, 2016

2. A few basic things you wanted to know about Healthcare or didn’t want to know but were afraid to ask or stuff you really didn’t care about?

3. History of payment systems in US
In the 1900s payment rates were set by Blue Cross –Usual & Customary
Rise of employer insurance for medical expenses
1966 Medicare & Medicaid
Huge expansion
Spending soared
Payment based on cost
In the 1970s and 80s medical expense inflation was double digit
Mid 1980s President Reagan revamped healthcare – PPS & DRGs
1990s – 2000s HMOs and Capitation was the rage and in vogue
Rise of PPOs and fixed price contracts
2010 – Affordable Care Act (ACA)

4. Employer-sponsored Medical Plan aka Health Insurance
Insurance that provides for the payment of benefits as a result of sickness or injury to a covered member (employee or dependent)
Financially providing funds against the risk of incurring medical expenses among covered individuals
An estimate of future medical expense is based on actuarial studies of historical healthcare expenses projected forward for the population of employees and their dependents
A monthly premium is established to ensure that money is available to pay for the health care benefits of covered members
Increases in premiums are due medical inflation, increased utilization, and additional medical procedures being covered by a plan
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5. Types of Financing Techniques
Fully Insured
An employer determines that “buying” insurance from a carrier (Aetna, Cigna, etc.) is better for their business – does not want to assume “risk”
Typically best suited for smaller employers (< 300 employees)
Only determination is negotiating the premium since the “risk” is shifted from the company to the insurance carrier
Governed by state regulators- Department of Insurance
Self Insured or Self Funded
An employer determines that it has sufficient size (number of employees) to manage the overall financial “risk”
Employer is responsible for all medical expenses –pay as you go
All private employers health plans are governed by federal law – ERISA (Employee Retirement Income Security Act)