Ping Ping King

Cutting out the managed care middleman and contracting directly with medical providers may seem like a drastic solution for reducing health plan costs. Yet for employers who’ve been whipsawed by relentless cost increases, it may be the only solution that actually works. The profit-bloated managed care industry, with much to lose, has propagated many myths about why this sensible approach won’t work. But their solutions haven’t worked. Costs continue to surge and employers are desperately seeking relief. It’s time to debunk the myths about direct provider contracting and shed some light on this ingenious, innovative cost-containment strategy.

Myth 1: Employers cannot negotiate as good a deal with medical providers as can managed care companies. The truth is employers can often negotiate just as good a deal, or better. Providers welcome direct agreements for the very reason that they are not like conventional managed care contracts. Physicians have complained for years about adversarial agreements and poor reimbursements forced upon them by HMOs and PPOs. This negative perception has created a strong willingness among medical providers to do business directly with employers. These “win-win” agreements ultimately save employers money without shortchanging the providers. Unlike managed care companies, direct agreements disclose all contractual details so both employer and provider know the deal they’re getting and nothing can be hidden by a middleman’s “cut.”

Myth 2: You need large numbers of employees to negotiate direct provider contracts. The truth is physicians and hospitals will often contract with employers for limited numbers of employees. When a direct agreement is fair and reimbursement terms are reasonable, providers quickly realize it’s a smart business decision to work with employers in their own community. A local employer, regardless of size, represents an established group of existing lives as prospective patients, ready to use the direct network providers. Direct networks have been successfully developed in areas where the employer had as few as 30 employees.

Myth 3: Direct contracting won’t work in areas where other PPO networks are available. The truth is doctors are sick of disadvantageous agreements and miserable reimbursements forced upon them by managed care companies. They actually welcome the opportunity to contract directly with employers. For many doctors, the very fact it’s an agreement with the employer, and not a managed care company, is reason enough to participate in a direct network. A direct agreement establishes a true business relationship between provider and employer, one that promises the provider quicker reimbursements, better benefit payment levels, and easier access to the ultimate payer (the employer). It’s also a gesture of good community relations for any physician, medical group, or hospital to demonstrate.

Myth 4: Direct networks create more administrative burdens and higher costs. The truth is once direct networks are developed, the advantages of “owning” a network quickly outweigh “leasing” one from a managed care company. There are no recurring network access fees; less physician attrition; fewer employee complaints; simpler self-renewing contracts; better provider relationships; straightforward plan design features; and the ability to choose the best contractors for utilization review, case management, claims processing, and other administrative tasks. Managed care companies have failed to contain employer medical cost increases, despite all their so-called network management efforts. Ironically, and coincidentally, managed care industry profits are at an all-time high while employers continue to suffer.

Myth 5: Direct contracting exposes employers to greater liability. The truth is direct contracting poses no greater risk of litigation than any other benefit program component and may actually offer greater protection against it. Direct contracting is intended only for self-insured employers whose plans are governed by ERISA, which offers built-in protection against liability. ERISA preempts state tort laws and limits the employee’s ability to hold an ERISA plan liable for malpractice under state laws, which govern malpractice, not ERISA. Because direct provider agreements state the employer is not providing/directing medical care and has no role whatsoever in any medical decision, the protection offered by ERISA’s preemption is safely maintained.

Myth 6: Managed care companies can’t (or won’t) process claims for direct networks.
The truth is that processing claims and administering benefits for employer-owned provider networks are well within the technical capabilities of managed care companies. Their feigned inability to process direct network claims is one of many ways that managed care companies hold their employer-clients hostage in networks that are owned, leased, or arranged by the managed care companies themselves. If an existing managed care company cannot or will not administer direct network claims, there are plenty of third party administrators (TPAs) than can handle it, usually at a lower cost per employee. For employers that want direct networks in select locations (but want to keep commercial networks elsewhere), using a TPA is a convenient and cost-effective way to get the job done.

Myth 7: Managed care companies do a better job containing costs and saving employers money. If that was true, employer medical plan costs would be falling instead of rising. The truth is employers who have implemented direct provider contracting are experiencing lower costs and higher savings. One national employer with 20,000 employees has used direct networks to keep their health plan cost trend flat for the past five years. Another major employer reduced its health plan costs by more than 20% without reducing benefits or shifting costs to employees.

Bottom Line: Cutting out the managed care middleman and contracting directly with medical providers can help savvy employers reduce benefit costs and regain control over their corporate health care plans.

Howard “A.J.” Lester is president of A.J. Lester & Associates, Inc., a leading employee benefits consulting firm based in Houston, TX that helps major employers reduce health plan costs by developing directly contracted medical provider networks as an alternative to commercial PPOs. Since 1994, A.J. Lester has developed direct provider networks for well-known national employers across 35 states, negotiating agreements with nearly 80,000 physicians and over 800 hospitals on behalf of clients. A.J. Lester & Associates has helped its clients save tens of millions of dollars on their health benefit programs.

Read the Case Studies of employers who have reduced costs through direct provider contracting.

Okay, you know the drill: purchase a house below the current market rate, make some repairs and improvements to it, and then turn around and sell [flip] the house to generate big profits.

While the concept of flipping houses is nice, the reality is that so much more is involved in flipping real estate. Without the proper knowledge on how the process works, you could end up being saddled with a house you really do not want to own or end up taking a big loss on the sale of your property.

The real estate market has the potential to create huge profit windfalls for the savvy buyer. Here are a couple of tips to help increase your profit margin when flipping houses:

Buy low and sell high. How do you find homes to buy below the market?

1. Create a free brochure titled “3 ways to avoid foreclosure and get cash NOW for your equity”. Then, distribute your brochure to people who are currently in the foreclosure process and homeowners who are currently 90 to 120 days behind on their mortgage payments.

By the way, one of the helpful tips in your brochure should be to call you for a quick sale.

You can obtain foreclosure information from your local court house. For a list of homeowners who are currently behind on their mortgage payments you will need to contact a credit agency - Experian.com, Equifax.com, or TransUnion.com.

2. Contact divorce attorneys in your area. Offer your home buying service as a resource to help clients liquidate their homes quickly at a fair price.

Now, before you get into house flipping there are five main points you must take into consideration prior to closing on your deal:

Acquisition Costs - Every home will cost you money before the deal is even finalized. Plan on writing out checks to your attorney, to the title company, government agencies - such as recording fees, and an application fee for a mortgage [unless you are paying cash], and other closing costs.

Look into getting an option arm mortgage loan with a 1% minimum payment. This type of loan program can increase your cash flow by cutting your monthly payment in half!

These loans will also allow you to take a small piece of your equity and turn it into a tax deduction by creating deferred mortgage interest.

Management Costs - During the period you own the home you can expect to shell out cash for property taxes, utilities, lawn maintenance, homeowners insurance, mortgage payments, and more. The longer you keep the home, the more expenses you will incur.

Home Improvement Costs - Are you ripping out the kitchen? Laying new flooring? Putting in a new garden? Whatever repairs and improvements you make, are you certain that you can recoup these costs when you flip the house? Will the value of the house increase enough to cover your expenses?

Selling Costs - Once you are ready to sell the home, will you be selling it privately or through a realtor? Real estate commissions running as high as 6% can eat up your profits very quickly. In addition, you will need to pay an attorney to represent your interests and pay any other related expenses.

Capital Gains - A “good problem” to have is to make so much money off of flipping houses that you have to worry about paying capital gains taxes. You may avoid federal taxes, but your state or local government may assess a tax on you. Count on it especially if you live in a high tax area!

The “deal” you thought you made with the purchase of a house can quickly evaporate if the market turns cold or your expenses run too high. Carefully consider all five points before taking action and know your local real estate market inside and out.

Yes, people do make tidy profits by flipping houses, while others lose out. Do your homework before jumping in to make certain that you understand everything before buying a house that you plan on flipping later.

Hartley Pinn has recently created the Mortgage Leads Generator Training Course to teach people how to make over $50,000 a month working part-time (10 to 15 hrs per week) as a mortgage loan officer.

Please feel free to reprint this article as long as the resource box is left intact and all links are hyperlinked.

I was watching one of my favorite television mini-series, HBO’s Band of Brothers, and I came across a forgotten viewpoint from the production.

Although the program centered around the time immediately following the Battle of the Bulge and the besieged 101st Airborn during World War II, part of the drama focused on the leadership of a lieutenant and his platoon. This lieutenant would simply leave his men and wander off for a walk . . . to talk to regiment . . . to get help . . . or god knows what. He was never there to set direction, to discuss operations, to counsel, or even to listen. One scene has him asking questions of a soldier in a foxhole. The soldier answers and then asks the officer a question, but the soldier is talking to thin air. The officer had already turned his back and faded away . . . as if he had never been there at all.

The officer should never have commanded a combat team. He was possibly put there to gain experience, while seeking further advancement. He was shown with an academy ring. The implication being that he was part of a “good old boy” network. This is not unusual in business or the military. The minor sin was that he received command from favoritism or preferential treatment. The major sin was that he assumed command without proper training.

The First Sergeant described the situation exactly: he wasn’t a bad leader because he made bad decisions, he was a bad leader because he made no decisions. A bad leader is worse than no leader. A leader has responsibilities and the people under that leader should have expectations of ability. When an attack was imminent by the platoon, the sergeant complained to an officer up the chain of command. There was no one else to send, but the captain took aside the lieutenant and explained exactly what was to be done: keep advancing and take the village. The attack came and as soon as the platoon came under fire, the lieutenant froze and gave confusing orders to his men. The advance was stopped.

The captain took another lieutenant from another platoon and sent him as a replacement in the thick of the battle to bring order to the attack and finish the advance. Within minutes they took the village.

Now, of course, sometimes it is better to make no decision, while you survey the job, the market, the industry, or your employees, but when decisions are needed, the leader must step up and make decisions. In the case of the lieutenant, his indecision cost lives, including his own.

“Leadership is action. In its most basic form, leadership involves moving people from one place to another, either physically or figuratively. And if you’re going to get people moving, you’d better be sure you know where you’re headed. You have to make decisions about your desired destination and how you’re going to get there. You need to make the right decisions, you need to make them stick, and you need to accept the consequences.”
— John Baldoni from his book 180 Ways to Walk the Leadership Talk

You could say the lieutenant accepted the consequences and died, but he didn’t even do that. He merely shut down. He died as a consequence, but didn’t really accept the consequences.

A leader needs to make decisions, and he should be trained to make them. There is nothing wrong with a bad decision based on sound judgment (unless it becomes a pattern), but no decisions based on no judgment, is unforgivable. No decisions can cost time; cost money; and can even cost lives.

Author Don Doman: Don is a published author of books for small business, corporate video producer, and owner of Ideas and Training (http://www.ideasandtraining.com), which provides business training products. Don also owns and Human Resources Radio (http://www.humanresourcesradio.com), which provides business training programs and previews 24-hours a day.

The New York Public Library caters to more than 16 million users each year through a combination of four research libraries and 87 branches that are situated in Manhattan, Staten Island, and the Bronx. The Library also serves 25 million other people every year through its website, www.nypl.org, which has a massive collection of historic photographs and documents.

Currently, because of the demands of a rapidly growing public, the Library is undergoing a five-year plan to expand. The major components of this are detailed below:

• Reconfigure and renovate the Fifth Avenue edifice to add a massive lending library that will complement its existing research divisions. This will, in effect, give rise to the world’s most complete library.
• Construct two new “Hub” libraries that will be situated in Staten Island and Northern Manhattan. These new structures will have expanded services and longer hours of operation. They will also be designed after the Bronx Library Center and will collaborate with libraries in their vicinities to offer much needed services for their local communities.
• Bolster the library’s online presence to make its programs and assets accessible to more people worldwide.
• Bolster the Library’s financial status by refining operational efficiencies and increasing fundraising efforts.

The expansion of the New York Public Library is aided by a $100 million gift From Stephen A. Schwarzman. The gift from Stephen Schwarzman, founder of Blackstone Group, is the largest outright, unrestricted donation to a New York City cultural institution.

Blackstone co-founder Stephen Schwarzman is an active philanthropist who has raised money for the American Jewish Committee and the Kennedy Center for Performing Arts.

Stephen Schwarzman is profiled on Builders & Titans for Time Magazine 100.

Stephen Schwarzman is a Chairman of the Board of Trustees for the Kennedy Center.

In the early 1990’s it was noticed that the English capital had no exact approach of suggesting & rating restaurants. An idea was anticipated to do a restaurant publication which would be filled with delicious London eateries including Swiss restaurants plus a range of costs. The food guide would be in the shape of a minute pocket food book and it would make it easy to carry all over the place with you.

What makes the food guides so unique and dissimilar from any other food guide is the fact that the restaurants are recommended by normal individuals, not accomplished restaurant judges. Following the victory of the restaurant guide, later followed the victory of the website. The review website itself will probably tell you just about anything you need to consider about pretty much any Australian restaurants in London, it’s uncomplicated to navigate around & has a fine search area where you just have to put in the name of the Malaysian restaurants & what town it is in and rating based website will find it for you.

The website itself has three separate sections in all, the capital Restaurants, UK restaurants and Venues and Parties. the English capital & UK eateries are pretty self explanatory, locations & parties is a section which offers venue and service hire.

Parties & Events is all based on endeavouring to make organising a party or an event as simple as possible. the eatiries have options to help you with everything along with suggestions on what they know will work well and added extras. The 1st sub section is the venue finder, with this all you have to do is enter your location & the number of people coming that would suit you and it will often bring up all the venues and colleges. There is also a services finder so if one would are looking for Bristol Caterers to cater your Xmas party then maybe Hardens is presently able to make ideas for you. Other options consist of corporate event entertainment, food & drink, event security and other essentials. If you are having a corporate do or wedding visit http://www.hardens.com/event-services/caterers/.

There is an old adage that knowledge is power and for many who pursue an education, the saying is quite true. Without an education to gain knowledge about a subject or field, there is no power to get the job or lofty position one desires. There is no power to obtain a good salary and there is rarely enough power to move life in the direction it needs to go. Luckily, one does have the power to make the decision to gain the necessary knowledge that will move things right along. Along with higher earning power, knowledge can also bring greater self-confidence.

Knowledge can be offered in many different mediums. These days the largest provider of knowledge and information is the Internet. Many turn to Internet learning as a convenient way to get an education that leads to a degree. When the degree program in completed, the knowledge is passed and the power turns on. Graduates are likely to see the jobs they want are now attainable, as are the highly sought after salaries and benefits that come with them. Upon attaining their positions, many find that their sense of self is much stronger. This gives them the power to pursue a whole new set of goals.

You may remember TV’s Lieutenant Columbo, the dumb like a fox detective who solved one crime after another.

Do you remember his signature line, when he had one foot out the door, and the smooth and savvy suspect was gloating in his imminent victory over this bumbler?

That’s right. Columbo would look back, gesture with his index finger and say, “Just one more thing…”

You knew he had something on his mind that was going to trip up the bad guy.

Well, I suggest you have one more thing up your sleeve for each working day, before you call it quits. Try to get just one more thing done.

This article, what you’re reading right now, is my one more thing!

I’ve already written my quota for the day, but it’s after dinner, and I want to accomplish something else. (It’s up to you, to determine whether this offering is truly an accomplishment!)

I could have done a number of other things, like clean more receipts and errant scraps of paper off my two desks. Or, I could have penciled out my plan for tomorrow, or have read someone else’s article.

But I chose to do this, and I must say, it’s flowing fairly easily.

No matter what you choose to do, when you commit to achieving just one more task, you get in return a great feeling of accomplishment.

You feel you’re ahead of the game, on top of the world.

And just imagine doing 365 more things this year, and another 10 or 20,000 things over the course of a lifetime.

Not bad, for pushing yourself, just a little.

Believe me, this article didn’t hurt at all!

Dr. Gary S. Goodman, President of Customersatisfaction.com, is a popular keynote speaker, management consultant, and seminar leader and the best-selling author of 12 books, including Reach Out & Sell Someone® and Monitoring, Measuring & Managing Customer Service. He is a frequent guest on radio and television, worldwide. A Ph.D. from USC’s Annenberg School, Gary offers programs through UCLA Extension and numerous universities, trade associations, and other organizations in the United States and abroad. He is headquartered in Glendale, California, and he can be reached at (818) 243-7338 or at: gary@customersatisfaction.com.

A skydive is an activity requiring a person to break his/her
free fall from a certain height using a parachute.

This is how skydiving is done:

A group of people called skydivers (these people are
professionally trained and should not be imitated under any
circumstances, unless a person has undergone the same kind of
training) meet to perform a skydiving act.

The skydivers pay a base operator to take them up in the sky on
a light cargo plane. To be able to skydive, they would have to
jump out of their aircraft into the sky.

A skydiver usually travels at the speed of 12,000 feet or 4000
meters altitude and free falling from the sky. To help them slow
down their speed in a safer altitude, they would have to
activate their parachute at a certain height.

Once the parachute is open, the thrill of the skydive is almost
finish. But then again, at a high altitude, the skydiver still
needs to get back safely to the ground without hitting any
obstacles like trees, electric post and other tall
infrastructures.

The skydiver now is able to control his/her parachutes to
his/her preferred direction.

Speculations to the reason why skydivers skydive is because this
is the sport or activity closest to us humans, being able to fly
at all.

Most skydivers when asked says that in skydiving, they can do
pretty much whatever a bird can do on air, except that they
cant fly up. Also, most skydivers feel that to skydive is a
kind of addiction from the adrenaline rush that they get from
it.

But to skydive is only an aerial activity wherein the skydivers
use their body as a flying machine instead of an actual machine
itself.

For inexperienced skydivers, the first jump is usually a tandem
jump. A tandem jump is to skydive together with an experienced
skydiver.

The beginner is usually in front of the professional, while the
professional secures the jump exit, maintain freefall position
and make sure it is stable and control the parachute in the
skydive.

A skydive may seem to be a complex skill but it is actually a
basic activity that can be understood even on the first jump.
The first skydive is very crucial to all skydiving enthusiasts,
here they learn the basics of the skill and learns to overcome
their fear of not being able to control the chutes properly.

The four basic skills of a skydive is basic safety, free fall,
operating the parachute and safe landing.

Basic safety is really just being able to know how to properly
execute a skydive.

This would include checking of your gears, normal exit from the
plane, how to react when facing an emergency, how to correctly
deploy your parachute, knowing how to handle common malfunction,
picking the right landing area and setting up and properly
executing a landing

For the free fall maneuvers, skydivers basically need to learn
how to maintain a stable skydive experience while they are free
falling, belly first from the sky. They must also learn to move
or turn while they are free falling all the while maintaining
the belly down position.

Parachute deployment may very well be the key to a perfect
skydive. Learning to know when and how to deploy your parachute
also ensures the safety of the jumper. The practical minimum is
about 2,000 feet for advanced skydivers to deploy their
parachutes.

A good landing also ensures a safe skydive experience and of
course a chance to impress everyone who is watching.

Q1.Why would I need a web site?
A1.

- Improve my service by providing the existing clients with useful resources

That will help me to build up the loyalty of the clientele and get returning clients.

Examples: my contact details, this month special, technical info on the products.

- Obtain new clients via Internet
That is how I am going to make new sales.

Example: local resident searching for “car dealers Geelong” on Google,
will find my web site with latest stock details and pricing.

- My strongest competitors already have web sites!
That is how I am going to match and beat them in the competition.

Q2.How am I going to achieve my online business goals?

A2.Initially I will have a nice but not an expensive web site.

It will be positioned on major search engines and drive
potential clients to my business. It will be supported by
a smart Internet marketing strategy tailored for specifically for my business.

That may include pay-per-click, email marketing or other methods.
I will be spending more money on my web site only AFTER it starts generating
income.

Q3.What is my web site checklist?

A3.Domain name registration, web hosting, web design, SEO - optimisation for search engines,
Internet marketing, web site updates and web site maintenance.

These services are provided by different types of businesses.
Some companies can deliver a complete web site service.
I am going to ask my providers BEFORE I sign up how they are going to contribute
to achieving of my online business goals.
I will not sign up if they talk megabytes and technologies.
I am interested in visitors and dollars!

Q4.What if I already have a web site?

A4.No matter how good is my web site - it will age.

I need to update it every 6 - 12 months.
If your web site does not have a consistent targeted web traffic
I may never get a Return On Investment.

If it is a case - my web site may need an immediate makeover.

Q5.What are the typical web site expenses, including hidden?

A5

- Web site design and development: $500+ (one off)
- Web site hosting: $240+ (annually)
- Web site marketing: $50+ (monthly)
- Web site update and maintenance: $30+ (monthly)

Q6.What type of web site is for me?

A6.Typically there are 3 types of web sites on the Internet.

Depending on my type of business, its size and
targeted audience I should choose from:

1.Basic presence on the Internet

Internet version of my business card and online brochure.
Benefits:

- extended branding of my business

- all hours availability of information for EXISTING clients

- improved image of my business

- professional email address instead of my local ISP

Examples: legal and accounting firms, printing.
Costs:$500+, annual maintenance $250+

2.Powerful marketing tool
Interactive web site.

Benefits:

- make existing clients return again and again

- establishing special relationship with clients

- get NEW clients

Example: hardware shop, travel agency.
Costs: $1500+, annual maintenance $500+

3.Additional sales channel
e-commerce web site suits retailers and wholesalers of goods.
Works really well if brands and characteristics
of products are well known or easy to explain.
Great business value if the price is right.

Examples: stationary suppliers, books CDs,DVDs
Costs:$2500+, annual maintenance $1000+

RKD Unger is the founder of Infopulse Pty Ltd (Australia) and Internet Marketing Australia. Infopulse is a developer of SEO Explorer - a free SEO tool for webmasters.

1. Participate in chat rooms related to the product
you’re reselling. Start a conversation with a person
without trying to sell to them. Later on, while you
are chatting, mention the product you’re reselling.

2. Create a free ebook with the advertisement and
link of your affiliate web site. The subject of the free
ebook should draw your target audience to down-
load it. Also submit it to some ebook directories.

3. Start your own affiliate program directory. Join
a large number of affiliate programs and list them all
in a directory format on your web site. Then just
advertise your free affiliate program directory.

4. Write your own affiliate program ads. If all the
other affiliates use the same ads you do, that does
not give you an edge over your competition. Use
a different ad to give yourself an advantage over
all the other affiliates.

5. Use a personal endorsement ad. Only use one if
you’ve actually bought the product or service for the
affiliate program. Tell people what kind of benefits
and results you’ve received using the product.

6. Advertise the product you’re reselling in your
signature file. Use an attention getting headline and
a good reason for them to visit your affiliate site.
Make sure your sig file doesn’t go over 5 lines.

7. Join a web ring. It should attract the same type
of people that would be interested in buying the
product you’re reselling. You could also trade links
on your own with other related web sites.

8. Participate on web discussion boards. Post your
comments, answer other people’s questions, and
ask your own questions. Include your affiliate text
link under each message you post.

9. Create a free ezine. Use your ezine to advertise
the affiliate programs you’ve joined. Submit your
ezine to online ezine directories and promote it on
your web site.

10. Start a private web site. Use it as a free bonus
if people buy the product you resell. You could
also allow people to join for free and you could
advertise the affiliate program you’ve joined.

About the author:

Rojo Sunsen is a specialized bounty hunter who prefers to work quietly/confidentially for the benefit of her clients.