Julian Rives

Employers and business owners who are tired of the traditional PBM experience need to read this article.

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I am getting more and more calls about my opinion on the #CMSfinalrule and my #hottake is: GOOD! We need MORE regulation, MORE barriers to entry, and MUCH MORE oversight of what some of these "Agents" are doing. Curious why? Here is an example: Member became medicare eligible April 1. Member's POA calls me this morning. Member is Dx stage 4 lung cancer, currently hospitalized, DNR, refusing cancer treatment, and has requested hospice and palliative care. Member's POA attended a Medicare seminar sponsored by a prominent supplement provider. At the follow-up appointment, the agent attempted to "hard sell" a Medigap Policy WITH GYM MEMBERSHIP, DVH Plan, Overpriced PDP, AND as if all that wasn't bad enough, a LIFE INSURANCE POLICY. A direct quote from the member today: "He said, well if he [member] gets better, he'll really need the gym membership to get back in shape....and more life insurance is never a bad thing." The member also noted, he has called 3-4 times per day to follow-up AFTER she told him he is not interested. I cannot even begin to describe the egregious lack of empathy, respect, compassion, and human decency this agent represents. The worst part is, this is not the first, nor will it be the last one of these stories I hear. I hear them almost weekly. As a community, this is your #calltoaction. We must BE BETTER. Your commission check should NEVER come before human decency and care for the member.

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Update to MA 2025 Final release ( more details are still required). The final (4/23/24) introduces changes to the regulations concerning agents, brokers, and Third-Party Marketing Organizations (TPMOs) in several areas: Unified Compensation Framework: The new regulations implement a unified compensation structure for agents and brokers across all plans. A single compensation rate is set for all plans, updated annually, which also includes a revision of the scope of items and services within agent and broker compensation. Separate payments for administrative services by agents and brokers are eliminated (administrative is defined but more details coming). Oversight and Compliance: Enhanced oversight measures are introduced to ensure that agents, brokers, and TPMOs (includes FMO’s) comply with the updated compensation structures and marketing rules. TPMO Marketing and Data Privacy: TPMOs are now subject to stricter marketing and communication rules. The final rule prohibits TPMOs from selling or sharing personal beneficiary data collected during marketing activities without explicit beneficiary consent. A new one-to-one consent structure is required, where TPMOs must obtain explicit consent from the beneficiary for each TPMO that will receive their data, ensuring more transparent and controlled use of beneficiary information. Prohibitions on Overrides: The regulations explicitly prohibit compensation structures that include additional payments known as "overrides" for TPMOs, which could influence the marketing and enrollment practices in favor of higher-paying plans. As we all know this will need further evaluation but recordings; trainings; portals etc will all be included in the total capped enrollment comp. #MAfinal2025 #medicareadvantage

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Approximately 24,200 openings for physicians and surgeons are projected, on average, to open every year for the next decade. Check out this Becker’s article to see which specialties have the most (and least) projected change in the next 10 years. #CHG #Healthcare #Healthcarestaffing #locums #physician #providerrecruting

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For our Ambulatory Surgery Center News launch, we are creating series of sector outlooks on trends our editorial team is seeing. These include: Surging Patient Volumes: Uncover the factors driving increased demand. Higher-Acuity Cases: Learn how ASCs are strategically approaching more complex procedures. M&A Activities: Discover the dynamics behind mergers and acquisitions in the ASC market. Multi-Specialty Strategies: Explore how diversification can fuel growth. And much more! Whether you're an ASC administrator, physician, investor, or simply curious about this growing healthcare segment, this is a quick read to bring you up to speed quickly on what we're seeing. Aging Media Network WTWH Media LLC https://lnkd.in/g_39ySme

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Analytics and data exposes the myth about service solutions and service delivery. It is much beyond break/fix or cost of parts/labor, it goes into incurred cost due to down time & decreasing patient/staff satisfaction. Did you know that our remote service could provide less downtime* for you and your imaging systems? This would mean more uptime, which translates to much-needed time for your patients and higher staff satisfaction. If downtime is not an option for you, we would love to be your partner. Just contact your local partner and we can look into remote support suitable for your systems. #Philips #RemoteService #PartnerWithPurpose #ImprovingLives #Innovation

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The US allows direct to consumer advertising by pharmaceutical industry. I propose no change to this law. However, I propose that our public healthcare system spend the same marketing budget as the pharmaceutical industry on patient education. And, your marketing budget and marketing channels must be made public. Why? Because your R&D and your sales are subsidized by my tax dollars. And if you advertise to doctors who prescribe more because of your ads then you are responsible for tracking patient data (all of which is already done) and report patient outcomes based on your profits. Now, everyone's incentives are aligned - patient, doctor, government, and pharma. Other than that, have at it.

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MedImpact Healthcare Systems, Inc. is putting control back in the hands of #healthcare payers. That's why we offer plans the freedom to choose from turnkey solutions, custom bundles, or a la carte services based on their needs. DM me to learn more. 🙂 #wearemedimpact #atruepartner #healthplans #healthcaretechnology

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MedImpact Healthcare Systems, Inc. is putting control back in the hands of #healthcare payers. That's why we offer plans the freedom to choose from turnkey solutions, custom bundles, or a la carte services based on their needs. DM me to learn more. #wearemedimpact #atruepartner #healthplans #healthcaretechnology

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Heading to #Asembia next week? Make sure to connect with our team from #AccessMarketIntelligence. Schedule some time to discover how we can help keep you informed about the specialty marketplace with the industry’s most comprehensive #SpecialtyPharmacyDatabase! #specialtypharmacy #axs24 Let's Connect!

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Is your PBM truly working for your benefit? Too often, PBMs manage numbers to their advantage, leaving clients with suboptimal savings. It's time to demand more from your pharmacy benefits partner. At DisclosedRx, we believe that loyalty should lie with the client, not just the contract. We go above and beyond to ensure that you receive the best possible outcomes, not just the bare minimum. Don't settle for a PBM that prioritizes its own interests. Choose a partner that puts your needs first and consistently delivers the results you deserve. Ready to experience the DisclosedRx difference? Connect with us on LinkedIn today to learn how we can help you unlock the full potential of your pharmacy benefits strategy. #FullyDisclosedPBM #DisclosedRx #FiduciaryPBM

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Medicare-Negotiated #Drugs May Not Get Favorable Coverage In Part D: Will CMS Intervene? Some highlights on #PBM formulary strategies from my recent #IRA webinar https://drugch.nl/3TWOcj4

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It strikes me as very important that the court did not rule on geographic restrictions for #340B covered entities. Contract Pharmacy geographic restrictions will: 1. Reduce access for patients 2. Restrict innovation related to patient engagement and access, 3. Likely increase costs to patients, and 4. Create a non-competitive business environment that will likely result in higher dispensing fees. There is no evidence that “remote” pharmacies harm program integrity. More detail on follow on posts on each of these points. Health Resources and Services Administration (HRSAgov), HHS Centers for Medicare & Medicaid Services National Association of Community Health Centers (NACHC) PhRMA #340B #CoveredEntities Advocates for Community Health

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🩺 Attention medical writers! 📝 Are you ready to specialize in CME/CE content? Discover your strengths and unlock your potential in this satisfying field! In just 4 minutes, you'll receive a personalized report with insights and actionable steps to help you confidently create CME/CE content, find clients, and build a sustainable niche. 🌟 Are you ready to assess your CME/CE competencies? Click the link to take the quiz now! #MedicalWriting #CME #CareerGrowth

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By restricting 340B, we can do real harm to patients, especially low-income and uninsured patients. 340B allows stronger communication between pharmacist and patient, and therefore enhanced patient education. When we take away 340B, we even potentially take away patients' ability to access medication at pharmacies most convenient to them, which can create even further access barriers. #340B #Pharma #PatientAccess

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The FTC Finally Rules on Noncompetes!!! Hospitals slam FTC's noncompete ban The Federal Trade Commission on April 23 voted 3-2 to ban noncompete agreements in a move it estimates will save up to $194 billion in healthcare costs over the next decade. Though the FTC recognized that it does not have jurisdiction over nonprofit entities, it reserved the right to evaluate an entity's nonprofit status, which would include a significant portion of the 6,120 hospitals in the U.S. Specifically, the agency said that "some portion of the 58% of hospitals that claim tax-exempt status as nonprofits and the 19% of hospitals that are identified as state or local government hospitals in the data cited by [American Hospital Association] likely fall under the commission's jurisdiction and the final rule's purview." The final rule would have significant implications for the healthcare industry and has been described by Federation of American Hospitals President and CEO Chip Kahn as a "double whammy" against hospitals. "The ban makes it more difficult to recruit and retain caregivers to care for patients, while at the same time creating an anticompetitive, unlevel playing field between taxpaying and tax-exempt hospitals — a result the FTC rule precisely intended to prevent," Mr. Kahn said in a statement shared with Becker's. "In a time of constant healthcare workforce shortages, the FTC's vote today threatens access to high-quality care for millions of patients." About 18% of the U.S. workforce, or 30 million people, is covered by noncompete agreements, from senior executives to fast-food workers, according to the FTC. The American Medical Association estimates that between 35% and 45% of physicians are bound by noncompete clauses. Existing noncompetes for most workers will no longer be enforceable once the rule takes effect, but there are exemptions. Existing noncompetes for senior executives (less than 0.75% of workers) can remain in force. However, employers cannot enter into or attempt to enforce any new noncompetes, even if they involve senior executives, which the FTC defines as workers earning more than $151,164 a year and who are in policymaking positions. #ftc #noncompetes #hospitals #physicians

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Last year, Tennessee rescinded its law requiring all radiology technologists to be state licensed, with the exception of limited x-ray. In 2022 someone falsely claimed to be an ARRT registered technologist to gain employment. As a result, the ARRT filed a trademark infringement lawsuit against this individual, who now owes nearly $55K in attorney fees. It is crucial to ensure proper licensing and credentials to maintain the integrity of the healthcare industry. Let's work towards creating a safer and more trustworthy environment for patients and healthcare professionals alike. #radiology #certification #licensure #education #patientsafety #accuratediagnosis #radiationsafety

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