(( Now he’s directing the same transparency logic toward how hospitals and health systems get paid through “Cost Plus Wellness,” a direct contracting platform that connects self-insured employers with providers through publicly posted contracts.
“This is meant to offer a template to employers to take advantage of the savings from direct contracts,” he said.
The platform, which is described as an “open-source project” rather than a business, has no intermediaries, no spread pricing, no balance billing, no prior authorization requirements and no hidden administrative fees. Under the platform’s contract terms, employers and third-party administrators are required to pay within 30 days of receipt of a claim. }}
You’re never going to see than from United Healthcare.
Good idea in theory, and it probably works for some medium sized companies that have a single location but I don’t see how this scales to Fortune 500 companies - where you would have to sign contracts with hundreds of healthcare providers - and each healthcare provider would also have hundreds of contracts.
Additionally, employers generally LIKE prior authorization - it keeps their expenses lower - especially for self-insured employers.
More from the link:
His pitch to hospitals? Once administrative issues, late payments, clawbacks, denials and legal costs are fully accounted for, the largest commercial payer relationships may be the least profitable.
I think he is a bit naive if he thinks, say Exxon, is going to be any less likely to have a late payment than Anthem. There will still be administrative issues (all those contracts that likely require some sort of renewal), there will still be denials (claims on a terminated employee) that need to be sorted. There will still be billing codes that someone within Exxon would have to agree to pay.
I think what Cuban is doing in this industry is outstanding and I wish more billionaires used their money and expertise for good as he does, but I think this solution is unlikely to be as impactful as Cost Plus Drugs.
Fortune 500 companies are already signing hundreds and thousands of contracts with all kinds of vendors. Why would employee health care be any different?
But I agree with you, in an outpost where the company only had a few employees, they’d need to do something else.
We’ll see how it goes. Most of the time GoodRX is cheaper than Mark Cuban’s Drug Company, but he’s still cheaper than 99% of the health insurers.
My point is, that once you do that, you might as well employ a third-party administrator who has expertise in such contracts so that your employees/resources can focus on your core business - as the existing model currently operates.