Beau Fowler

Nashville Based RE Investor

[Encyclopaedia Britannica @Britannica]

The first 3 letters of 'Sweden' and 'Denmark' spell out 'Sweden.'

The remaining letters spell out 'Denmark.'

[Beau Fowler @Geau4Beau]

@TerribleMaps Brilliant reporting!

[Beau Fowler @Geau4Beau]

@mcuban @grok Mark Cuban for president!! 🇺🇸

[Mark Cuban @mcuban]

My testimony today at the Texas State capital
I’m the co-founder of https://t.co/xY30tR9MWn.
We started Cost Plus Drugs because the prescription drug market is too complicated, too opaque and too expensive.
Our model is simple: we show what we pay for a drug, add a transparent markup and pharmacy fee, and show the customer the price.
No games. No hidden spread.
And a large percentage of our customers already have insurance.
They come to us because our cash price is often lower than what their insurance plan asks them to pay.
That tells you something is wrong.
Here are five things Texas can do about it.
1. Let patients shop for cheaper drugs
If someone's insurance says a prescription costs $500, but they can buy the exact same drug for $100 cash, let them buy it for $100.
Then credit that $100 toward their deductible and out-of-pocket maximum wherever Texas has authority to do so.
Patients should be rewarded for saving themselves and their health plan money.
They shouldn't be punished for it.
That's how you create something healthcare desperately needs:
Price competition.
2. Standardize PBM and TPA contracts
Texas should require the state, cities, counties and school districts to use standardized model contracts and mandatory terms for PBMs and TPAs.
I've reviewed these contracts.
They routinely run hundreds of pages.
I've seen contracting packages longer than a thousand pages.
There is no human being—or group of human beings—on this planet who can stay awake and understand every provision in contracts that complicated.
I don't care how much coffee they drink.
I call it contractual terrorism.
The vendor only has to sneak a couple of tricks through hundreds of pages.
The employer has to find every one.
It can't.
I've developed a model PBM contract designed to eliminate the major tricks and hidden economics we've identified.
Texas can have it for free.
Use mine. Improve it. Open source it.
I don't care.
Just stop making every government entity negotiate these contracts from scratch.
3. Make the economics public
If taxpayers are paying the bill, taxpayers should know the price.
Pricing. Fees. Rebates. Guarantees. Pharmacy reimbursement. Affiliate compensation. Audit rights.
Make them public.
I'm not talking about patient information or legitimate security information.
I'm talking about the money.
You cannot have an efficient market without price discovery.
Without price discovery, you get information asymmetry.
And when one side knows dramatically more than the other, guess who wins?
Not taxpayers.
Not employers.
Not patients.
Open the contracts up and let competitors see what they have to beat.
That giant sucking sound you hear will be money moving away from healthcare conglomerates that are too big to care and back toward taxpayers, employers and patients.
In the immortal words of Charles Barkley:
I guarantee it.
4. Kill the gag clauses
PBM contracts are like Fight Club.
The number one rule of Fight Club is that you can't talk about Fight Club.
The number one rule of many PBM contracts seems to be that you can't talk about your PBM contract.
That's insane.
Let employers compare pricing, rebates, fees, guarantees and reimbursement terms.
Markets work better when buyers know what other buyers are paying.
5. Make enforcement hurt
If a healthcare company commits a serious violation, give them one mulligan.
But after a second material federal or Texas enforcement action within a defined period, make them ineligible for new Texas government contracts for a period of time.
Two strikes.
You're out.
Today, some of these companies can make billions, get caught, pay a fine and write it off more easily than I wrote off an NBA fine.
That's not deterrence.
That's a cost of doing business.
And Texas should spend more on enforcement.
If Texas spends $10 million auditing contracts and analyzing claims and prevents $100 million in unnecessary spending, that's not overhead.
That's a 10x return on investmen

[Beau Fowler @Geau4Beau]

@StateDept At some point in the not so distant future this account will apologize for this post.

[Beau Fowler @Geau4Beau]

@HedgieMarkets Just check it on hopper first

[Beau Fowler @Geau4Beau]

@SenTomCotton The American consumer needs to be the priority. Propping up a small industry at the expense of everyone else is un American. If you can’t support yourself in a free market and need the government to survive you should move to Europe.

[Beau Fowler @Geau4Beau]

@j_sexton333 @jamminpete @mcuban Mine is definitely not the best.

[Beau Fowler @Geau4Beau]

@jamminpete @mcuban So pretty quick! Sounds like we have room for improvement down here. In a lot of ways… 🇨🇦🇺🇸

[Beau Fowler @Geau4Beau]

@SisyphusUnleas @mcuban Thanks for sharing

[Beau Fowler @Geau4Beau]

@SisyphusUnleas @mcuban How long did you have to wait to get the hip replacement? Any Americans response to your statement is that it takes longer over there so our prices are justified

[Beau Fowler @Geau4Beau]

@jamminpete @mcuban How long did you have to wait to get the hip replacement? Any Americans response to your statement is that it takes longer up there so our prices are justified.

[Mark Cuban @mcuban]

My thoughts on how to get towards Universal Healthcare

[Beau Fowler @Geau4Beau]

@RT_com This is not news

[Beau Fowler @Geau4Beau]

@nari4thewin @FreddyLA7 False

[Beau Fowler @Geau4Beau]

@ginny_crisp Thx! I’ll report back

[Beau Fowler @Geau4Beau]

@NESpower I just heard a loud boom in the alley between Belmont and oakwood & beechwood and linden. Several houses lost power

[Mark Cuban @mcuban]

Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies.

They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight.

Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies

We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient.

This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country

[Mark Cuban @mcuban]

First step is to require any hospitals that enjoy Non Profit Tax Benefits, to publish monthly all of their actual General Ledger transactions and invoices.

You are non profit. You are being subsidized and often funded by taxpayers. We are your stakeholders, along with patients. There ain't a damn economic thing that you can't show.

And no, Medicare Cost Reports are not comprehensive accounting reports.. They are pretty much useless for this.

Second step is to make all NDAs and Confidentiality Agreements for any financial healthcare agreement, illegal

It's beyond insane that US Senators, and POTUS, can't see what the federal government is paying for medications being provided through TriCare.

With these sources of data, then, and pretty much only then, could proponents of M4A begin to figure out a plan