Eagle Care Health Solutions

Direct Primary Care Threat to Hospital Systems... Lowers Hospital Revenue by $300K per Year per Primary Care Clinician. More specifically, Non-Fee-for-Service Primary Care in the form on Onsite Clinics, Near-Site Clinics and Direct Primary Care for People on Employer-Sponsored Health Plans. Employer-sponsored health insurance pays hospitals?254%?of what Medicare pays, i.e. employer-sponsored health insurance is a 'cash cow' for hospitals. Non-Fee-for-Service Primary Care decreases hospitalizations by?22%?and ER visits by?11%?(as demonstrated by Dr. Brent James from Intermountain Health). Accordingly, lowering hospitalizations and ER visits for patients with employer-sponsored health insurance represents a serious?financial loss to hospitals. How much?of a financial loss? The answer can be calculated using the following statistics: --800?patient panel size per primary care provider --5%?annual hospitalization rate for people on employer-sponsored health insurance --22%?annual ER visit rate for people on employer-sponsored health insurance --$27,932?average allowed amount per hospitalization for patients on employer-sponsored health insurance --$2,453?average allowed amount per ER visit for patients on employer-sponsored health insurance Result: Each primary care provider reduces hospital revenue by approximately?$298,000?per year through decreased hospitalizations and decreased ER visits. Sources at AHealthcareZ YouTube Channel. #PrimaryCare #DPC #Hospitals #Healthcare #HealthcareCosts

If you like claims denials, you will love healthcare.gov... Insurance claim denials aren’t just frustrating paperwork; they have real, painful consequences for employees and their families. A recent study found that insurance plans purchased through Healthcare.gov had a shocking 20% denial rate, leaving countless individuals without the care they need. The human toll is incalculable. In 2023, denial rates among insurers on healthcare.gov ranged from as low as 1% to as high as a staggering 54%. A record 23.6 million consumers selected a plan via healthcare.gov in 2025. While it is challenging to determine precisely how many of those work for small businesses, it could be as many as 18 million. This does not include participation or denial rates for state exchanges because comprehensive data for state-run exchanges is not readily accessible. Given the lack of standardized reporting across all states, it's difficult to determine whether denial rates on state exchanges mirror those on the federal platform. For employees of small businesses, these denials can mean skipped medications, delayed treatments, and worsening health conditions, all while trying to stay productive at work. Many face impossible choices: fight a complex appeals process, pay out of pocket, or go without care entirely. No one should have to choose between their health and their financial stability. Small business owners and leaders, this issue directly affects your workforce and your company’s success. When employees can’t get the care they need, absenteeism rises, morale drops, and productivity suffers. To help employees access quality, affordable healthcare, small businesses can explore non-traditional healthcare strategies that bypass the inefficiencies of traditional insurance. Direct Primary Care (DPC) offers employees unlimited access to primary care for a flat monthly fee, improving preventive care and reducing costly ER visits. Medical Cost Sharing provides an alternative to insurance, pooling resources among members to cover major medical expenses. Care Navigation Services help employees find high-quality, cost-effective providers and effectively appeal denied claims. Other solutions, such as self-funded health plans, health reimbursement arrangements (HRAs), and hybrid insurance models, offer businesses greater flexibility and cost control while ensuring employees receive the care they need. By thinking outside the box, employers can protect their teams’ health and financial well-being while keeping healthcare costs sustainable. #healthcare #claimsdenials #employeebenefits #eaglecarehealthsolutions https://lnkd.in/gQGPkqck

Texas takes on PBMs & ERISA Health Plans?? In case you missed it, Texas Attorney General, Ken Paxton, issued an opinion last week concluding that TX-HB 1763 & TX-HB 1919 are enforceable against PBMs & health benefit plan issuers, even if they are part of an ERISA-covered plan. These laws, passed in 2021 and now part of the Texas Insurance Code, were intended to curb PBM practices that impact independent pharmacies and patient choice. They impose new contracting, reimbursement, and referral restrictions on PBMs operating in Texas. What do the bills do? ? PBMs can’t reduce payments to pharmacies via post-claim adjudication or pay affiliated pharmacies more than independent ones. ? PBMs must disclose detailed reimbursement schedules to pharmacies. ? PBMs and issuers cannot force patients to use affiliated pharmacies to maximize benefits. ? PBMs cannot leverage prescriber or patient prescription data for marketing their own pharmacy networks. ? These laws apply to all PBMs and issuers covering Texas residents, even if they are based outside Texas. However, like virtually all state insurance laws and mandates this would not apply to the plans most employers utilize because ERISA typically preempts state laws. Or would they? The big questions are: 1. Why does the Texas AG believe this does not apply in this case? ? The laws regulate PBM business practices, not the structure or benefits of ERISA-covered plans. ? The bills do not dictate how ERISA plans design their benefits or determine eligibility, only how PBMs interact with pharmacies and patients. ? Similar to laws already upheld by the U.S. Supreme Court – The Texas AG relies on Rutledge v. Pharmaceutical Care Management Association (2020), where the Supreme Court ruled that a state law regulating PBM reimbursement rates was not preempted by ERISA. ? The laws do not prevent ERISA plans from offering standardized benefits nationwide, meaning they do not fundamentally disrupt ERISA's goal of uniform plan administration. ? Maybe most importantly, because ERISA does not govern PBM-pharmacy contracts, states retain the authority to regulate these agreements. 2. How will this potentially impact self-funded health plans in Texas? ??PBMs may pass additional compliance costs onto health plans, leading to higher fees, cost-sharing, or formulary changes for ERISA plans. ??Employers offering nationwide ERISA plans may need to adapt their PBM contracts specifically for Texas to ensure compliance. ??Some ERISA plans might modify their pharmacy benefit structures by adjusting pharmacy networks to align with new Texas rules. While the AG argues these laws survive ERISA preemption, legal challenges will ultimately determine if there is there is a change coming to how self-funded health plans operate in Texas. In the meantime, y'all may want to review those PBM contracts. ??

#HappyNewYear from Eagle Care Health Solutions! ?? As we step into the New Year, we're filled with hope and excitement for what the future holds. At Eagle Care, our journey is all about enhancing #health and wellbeing, and this year, we are more committed than ever to making a positive impact in your lives. Here's to a year of good health, happiness, and breakthroughs. Wishing you and your loved ones a joyful and prosperous 2025!

As the holiday season is upon us, we want to extend our warmest wishes to you and your loved ones. This year, more than ever, we are reminded of the importance of health, care, and community. At Eagle Care, we're not just about providing health solutions; we're about nurturing a healthier, happier world. Your trust and support have been the greatest gifts to us. May this festive season bring you joy, peace, and good health! ????

Happy #Halloween from the Eagle Care team!

?? Got a Healthcare Horror Story? ?? It’s that time again! Join us for an unforgettable episode of Why Does Healthcare Suck? as we jump into the scary side of healthcare – and no, we’re not talking about Halloween! This time, we’re inviting YOU up on stage to share your story. ???? Whether it’s a spooky bill, a jaw-dropping insurance surprise, or an epic doctor showdown, we want to hear it all! Let’s pull back the curtain on what healthcare is really like. Who’s in? ?? ?? Mark your calendar: Oct. 31st @ 11am CST

With AI, what a time to be alive! You should’ve heard our president, Harlon Pickett discuss what AI, automation, and technology can do to help businesses.

Join us for 'Why Does Healthcare Suck? - Quality Care: Leveraging Navigation for Better Employee Health.' ??? October 1 at 2 PM CST ?? We are breaking down the misconceptions of what navigation is. Uncover how navigation within health plans can transform employee health and align with your business goals. Perfect for HR professionals and business owners. Save your spot today! Remember that our format encourages your questions and interaction.