Ted Holden, MHP

Surety Bonds are an incredibly valuable tool for organizations utilizing their banks debt facilities to secure repayment mechanisms tied to contracts. If your organization is collaterlizing large sums to participate in Value Based Care payer contracts in Medicare Advantage or Medicaid contracts, surety bonds can help free up these obligations on your balance sheet.

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Executive summary notes below ⬇ : ⚖ Health Benefits and Risks: GLP-1 drugs can significantly reduce obesity-related health risks such as diabetes, heart disease, and stroke. However, there is potential misinformation regarding their use, and off-label usage can lead to known and unknown health risks. ❔ FDA Guidelines and Eligibility: Ensuring GLP-1 usage adheres to FDA guidelines is crucial. These drugs should be prescribed based on specific criteria, such as a BMI of 30 or greater (side note that this is an inaccurate measure of obesity but somehow still the standard of care), or 27 with certain co-morbidities. Prior authorization programs can help ensure that only eligible employees receive these medications. 💲 💰 Cost and Financial Considerations: GLP-1 medications are expensive, costing around $1,000 per month without insurance. Despite the initial cost, effective use of these drugs can lead to long-term savings by reducing overall healthcare expenses related to obesity, if used in combination with lifestyle changes. 😎 Employee Satisfaction and Retention: Including GLP-1 coverage in health plans can enhance employee satisfaction and retention. Studies show that companies providing these benefits have higher employee satisfaction, with nearly all employers continuing coverage to show commitment to employee wellbeing. 🧐 🔎 Comprehensive Support Approach: A holistic approach involving due diligence, continuous monitoring, and educational support is essential. Employers can leverage third-party vendors or pharmacy benefit managers to ensure proper use and support for employees, including lifestyle and wellness programs to maintain weight loss after discontinuing GLP-1 drugs. ⚠ Warning from my own research if you are seriously considering adding this benefit: - Patients who fail to adopt and implement complimentary lifestyle changes (eating enough protein and exercising to maintain muscle mass) are likely to regain all of the weight they lost and likely more because they are likely to lose muscle mass, a key factor in burning calories, as a result of GLP-1s utilization. - Offering this benefit could increase your desirability as a destination employer, but it also could attract employees who specifically intend to leverage this benefit, negatively impacting your healthcare costs through adverse selection. #EmployeeBenefits #Wellness #EmployeeSatisfaction #EmployeeRetention

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The Optavise Healthcare Glossary is updated for 2025! Featuring easy-to-digest information about important benefits concepts and terminology, this guide is perfect for sharing with employees before open enrollment, during onboarding, or any time you want to raise awareness. Check it out and contact me to learn how Optavise can help educate your clients’ employees. http://spr.ly/6043cF0tB

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The Optavise Healthcare Glossary is updated for 2025! Featuring easy-to-digest information about important benefits concepts and terminology, this guide is perfect for sharing with employees before open enrollment, during onboarding, or any time you want to raise awareness. Check it out and contact me to learn how Optavise can help educate your clients’ employees. http://spr.ly/6045qNk35

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When is the best time to fix a problem, before or after it blows up? Kicking the can down the road can increase the cost of the "fix" by double, triple, or more. The same logic applies to employer health plans. Why kick the can down the road on one of the largest expenses employers face? The "fix" will boost revenue, increase financial responsibility, and enhance employee retention. All are long-term positive results for an employer. The alternative, stay the course with the current status quo health plan with the same results we've seen for the last 20-plus years. That's right, more rate increases, higher out-of-pocket expenses for employees, and an increased amount of revenue required to be committed toward the 2nd or 3rd largest empoyer expense.

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Houston H&B leaders (employers), message me if you’d like to join us. Two spots left. Hear from 👇🏻 •Michael Williams, CEBS on the state of the market • Maggie Stroud of Kelsey-Seybold Clinic on what strategies your peers are exploring and implementing around quality-centric medical networks. The good, the bad, the ugly. •I’ll share how member engagement, education, incentives and embedded plan design lower member and plan cost while improving health outcomes…and when it doesn’t. Ask questions, challenge us, & network.

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Since when did health insurance companies received thier “MD’s”? This is a long article but a fascinating read. We wonder why healthcare costs continue to escalate and premiums are unaffordable? Well, when you have insurance companies being able to add diagnosis’s and conditions to a members healthcare record which allows them to receive more money for treatment - oh and by the way these members don’t have these illnesses…rocket science not needed here! While this seems like its a “Medicare” problem - it’s happening everywhere. In your commercial and group health plan too. Providers trying to charge patients for negotiated discounts, millions of dollars in fake billings, pharmacy rebates being used to increase insurance company profits versus going back to the companies footing these bills or the patients using the drugs. Insurance companies and the organizations that own physician groups and hospitals have figured out how to game the system to increase profits - not deliver better health outcomes. I do believe that there are a lot of great professionals in the medical field that honestly want to improve the lives of people that they treat - they unfortunately now mostly work for companies that don’t really care much about that.

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Austin Littrell of Medical Economics offers some insight into Zocdoc's 2024 "What Patients Want" report on health care trends in the attached article. Good overview of the report as well as a link to the full report which offers 29 pages of statistics on a variety of relevant topics. Both are definitely worth a read. You may need to create a username and password to access the article, but there is no paywall.

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For all the plan sponsors/administrators out there -- we found this article in Benefits Pro helpful/timely regarding this year's #RxDC reporting for 2023. The earlier you can confirm how you're going to handle the submission, the better! As the author notes, "...no good faith relief is available for this third reporting submission. In addition, no deadline extension is available, even though June 1, 2024, falls on a Saturday." Click below to read the entire article. #knowledgeshare #news #PharmacyBenefitAdministration https://okt.to/rVNQem

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Chronic care and primary care provider shortages are affecting private and public entities nationwide. Learn how Ochsner's nationwide digital medicine program is bridging these gaps in care for the Amerihealth Caritas Medicaid population. #healthcare #digitalmedicine #caregap #healthcareindustry

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Despite brokers reporting stable premiums, employees face rising healthcare costs through increased deductibles and out-of-pocket expenses. Texas employers pay hospitals up to 315% of Medicare's pay for the same procedures. This significant price disparity directly contributes to higher out-of-pocket expenses and in most cases higher health insurance premiums for "quality health insurance." Most brokers also have the same old tactics where they create urgency for employers to renew their plan 2-3 months early for reasons you can only assume based on what I just shared. Brokers also often deliver low premiums each year, creating the illusion of stable costs. However, the reality is that the quality of healthcare is decreasing as employees shoulder more of the financial burden. It's crucial to address these hidden costs and work towards better healthcare solutions. #employeebenefits #grouphealhinsurance #healthcare

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PA Week - Optimal Team Practice The need for access to quality care in the U.S. continues to outpace the graduation rates amongst a number of healthcare provider types, not just Physicians. There are some great leaders moving on this aspect of healthcare: getting more providers in the game. But, this isn't a one-dimensional game. As a Nation, we have one resource that needs more support: PAs working at their fullest extent of training, education and experience. What the American Academy of Physician Associates calls Optimal Team Practice. Anyone aiming to improve access and quality care in healthcare should be well-read on this front and it's ability to be a game-changer (and a good example for other professions): https://lnkd.in/g74MhxNF. #PAweek #PAsgobeyond

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A great article by the FACHC that highlights the importance of local community health centers and the impact they have. Read more about it below!

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While occurrence coverage is more, it often is of benefit to insureds when tail coverage is contemplated. Please take a moment to review some scenarios in which occurrence is a superior product.

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