Mr. Daniel Buckle

GLG News by Mr. Daniel Buckle, Principal

PBM's Fail Employers with Mail

May 9, 2007

Analysis of:Comparison of Mail Order with community Pharmacy Cost | www.amcp.org

Mail did not produce higher generic utilization rates or lower costs for employers who hired a PBM to accomplish both.

Media Smells Blood at Big Pharma

April 2, 2007

Analysis of:Under The Influence | www.cbsnews.com

60 Minutes aired its story last night on the impact of The Pharmaceutical Lobby in writing and passing  Medicare Prescription Drug Plan.

Over the course of the upcoming Presidential campaign  the high cost of prescription drugs will become an issue and spill over into employer plans as well with implications for PBMS and Pharmaceutical Margins.

Hello Managed Care!

March 28, 2007

Analysis of:Employers Push Health Plans to integrate Onsite Health Centers With Care Management | www.aishealth.com

Edward Deming famous quote comes to mind as I read this mornings Industry Radar about employers pushing health insurers to either run or integrate with the on-site health centers they are either running or planning. hello Health Insurers--the choice is integrate or die. At what point will many of the large managed care carriers realize their large self-funded clients will be walking for vendors capable of fully integrating their services with the strategic direction their efforts to manage health & productivity are taking? Read on

Florida Legislators Research on PBM Business Model

March 28, 2007

Analysis of:Legislature Could consider Options to Address PBM Business Practices | www.oppaga.state.fl.us

The attention of state legislators to PBM business practices has implications for investors in the healthcare sector as well as the business models PBMS will use in the future.

The War on Drug Costs

March 28, 2007

Analysis of:Why Generics Do not Always mean Cheap | online.wsj.com

While the Wall Street Journal has done an admirable job exposing many of the ways PBMS have boosted profits at the expense of their customers they have not yet arrived at the flaws which make the current business models of PBMS susceptible to competition.

Outsourcing In Insurance

September 12, 2006

Analysis of:Insurance Outsourcing Focuses on India | www.insurancejournal.com

Insurance companies have been slow to outsource because management can be quite conservative when it comes to changing the status quo. Actuaries are not risk takers--they want sure things. Billing, Premium collection, IT support, web based enrollment, Policy issue and document management services all lend themselves to outsourcing. Initial forays into outsourcing by insurers seeking IT support were often resisted by inhouse IT departments with turf to defend and actuaries who wanted access to their data in real time. Compliance with 50 different state insurance  departments to satisfy was also a barrier to outsourcing.

Deja Vu All over Again

September 7, 2006

Analysis of:Willis given OK to take some insurer payments | www.businessinsurance.com

The short answer to your question is yes-- brokers are again headed down the slippery slope.

At issue is who is the brokers client and the extent to which full disclosure occurs?

Whom does the broker represent? Does anyone actually believe Willis calls on a company who thinks Willis works for the insurance companies they broker coverage through? I would argue the company who hires Willis ( or Marsh or AON ) believes their broker works for them alone.

The Truth About Universal Healthcare

September 7, 2006

Analysis of:Stethoscope Socialism | www.washtimes.com

 Not a day goes by without a call from a new interest group calling for Universal Healthcare in the U.S. media. At a time when US investors are making  healthcare  their top sector ( Barrons 9/4/2006 http://www.nytimes.com/reuters/business/business-stocks.html?_r=1&oref=slogin  )rarely do the advocates of universal healthcare consider the impact such a change could have on our economy as well as on our nation's families as the population ages. Should healthcare decisions in the US ever move from the realm of doctor-patient to government -citizen perhaps investors should consider the consequences on biotechnology as well as the political fallout of rationing care in a graying America.

Understanding the economic incentives of the US market based healthcare system and the positive contributions to the US economy and its citizens our healthcare system produces should be at the core of any debate on change and this article contains a valuable perspective.

The High Cost of Presenteeism Is Noticeable

September 1, 2006

Analysis of:The Lights are On, But Nobody's Home: Preventing Presenteeism | www.ceridian.com

According to a Cornell University study published in the Journal of Occupational and Environmental Medicine in 2004, presenteeism costs employers $2,000 per employee annually.

Presenteeism is defined as the measure of productivity lost due to an employee who shows up for work but is not fully engaged due to untreated personal health or work life imbalance.

Marsh after Spitzer

September 1, 2006

Analysis of:Investors join calls for Marsh break-up | www.thebusinessonline.com

From an employee benefits perspective, Marsh is today a shadow of its former self in my markets.

Great Info For Healthcare Investors

September 1, 2006

Analysis of:2007 Segal Health Plan Survey | www.segalco.com

This survey presents detailed data on current cost trends for HMO, PPO and Pharmacy benefits for 2007. The data is complete and provides some regional distinctions where statistically significant data allows a conclusion.

This survey confirms several trends effecting healthcare in 2007;

•     PPO trend is 11.6%

•     HMO trend is 11.1%

•     mail order pharmacy trend will decline 3% in 2007

Are You Willing to Pay More For Healthcare To Live Longer?

August 31, 2006

Analysis of:Study Finds Healthcare Good Value Despite Costs | www.washingtonpost.com

Rarely does the phrase good value find its way into the same sentence with healthcare in America today which makes this Harvard based economist a voice of reason in todays media coverage of the Healthcare crisis.

Healthcare investors should read this survey and ask whether higher healthcare costs than Britain or Canada is ultimately a bad thing for the citizens of the US.

BCBS Association:Will No Longer Disclose Financial Results

August 11, 2006

Analysis of:Transparency Has Its Limits | www.modernhealthcare.com

The Blue Cross Blue Shield Association has made a large public splash this week by announcing an initiative which will pool loss data from over 20 not for profit BCBS plans see link http://cms.nationalunderwriter.com/cms/nulh/Breaking%20News/2006/08/04-blues-ab At the same time they will no longer offer financial results in aggregate of their licensed nonprofit blue plans, something they have historically done. It is interesting that BCBS is just now aggregating data across multiple plans and the explanation of what they intend to do with that data can be found by viewing the commentary below.

Healthplans Race Toward, Predictive, Personal and Pre-emptive

August 4, 2006

Analysis of:Employers' Stock in Wellness Rises With No End in Sight | www.managedcaremag.com

This article presents an excellent summary of the current state of wellness in America while providing good insights into the perspective of employers, Health Plans and the U.S. surgeon General.

Competitive advantage for Healthplans will come to the first player to achieve proven competence at making health care "predictive, personal and pre-emptive" for their members. For healthcare companies with a large book of fully insured business this quest has enormous profitability potential that investors should hone in on now.

Linking Lifestyle Choices With Healthcare Costs

August 4, 2006

Analysis of:More Americans See Hiking Health Costs for Unhealthy as Fair | www.plansponsor.com

53% of Americans surveyed now believe charging more for health insurance to individuals with unhealthy lifestyles is fair, up from 37% in 2003. Several, recent polls suggest this majority opinion is widespread.

Investors in the healthcare sector should take note as this opinion is linked to workplace education on wellness as employers prepare for consumer driven health plans.

Healthcare Investors Must Evaluate Underwriting Innovation To Spot Good Bets

June 9, 2006

Analysis of:What We Have Learned In The Last 50 Years and Are Not using | www.milliman.com

Actuarial Science tends to attract orderly and precise minds who have historically been quite content to establish underwriting processes for Group Health Insurance in a manner that projects past experience to arrive at prospective cost. This is true on individual groups as well as blocks of pooled business and is a process which incidently has not changed in 50 years.The US Surgeon General has reported that lifestyle choices are responsible for over 70% of diseases and account for more than 75% of health care costs. Investors need to scrutinize the underwriting methodologies being utilized to see how effectively public healthcare companies are assimilating lifestyle based analytics into the evaluation and pricing of health risks. This competence, along with engagement and successful behavior changes can provide dramatic return on investment. Which Health Care Companies have the courage to change their sacred actuarial methods and act on the data they possess to boost profits? This is a must read article for investors long in the health care sector as well as those considering a position.

Preparing for Consumer Driven Health

June 1, 2006

Analysis of:Time is The Best Medicine in Making The Switch to Consumer Driven Health | www.workforce.com

Early adapters of consumer driven healthcare programs have a lesson to share with employers considering the approach--take the time to educate and to let your workforce adjust to the concept before implementing or face a revolt from your workforce.

Do Not Underestimate the Difficulty of Consumer Driven Full Replacement

May 25, 2006

Analysis of:CALPERS Ponders Benefit Changes | sacramento.bizjournals.com

CALPERS is considering health benefit design changes which could save $64M next year but heavy resistance is expected from unions. The article offers insights into how truly out of touch with actual  medical costs many public sector employees and their union representatives truly are and how difficult this fact will make execution of  a full replacement consumer driven healthcare strategy in the public sector.

Big Margins for Medical Device Makers Face Scrutiny By Consumers

May 25, 2006

Analysis of:Device Maker Pricing Has Big Impact On America's Healthcare Bill | www.healthleadersmedia.com

Medical device makers have been insulated from scrutiny of the public for their excessive margins. The issue has two components;

1. Inappropriate utilization by providers
2. Outrageous product costs

Investors should carefully consider which device makers can even justify their margin in the face of transparent pricing.

The Health and Productivity Connection

May 18, 2006

Analysis of:More insurers Reimburse Doctors for Online Care | www.orlandosentinel.com

Non-emergency office visits account for 20-30% of the average physicians total. Many of these can be handled online via secure communication without costing an employee to miss work. Insurer are beginning to reimburse for online consults.

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