We’ll use the format of several intense but brief presentations with plenty of interaction for our October Lunch & Learn. This format will help us develop topics for additional exploration at future meetings and our May 2020 Annual Conference.

Please check our registration site at Eventbrite for the agenda and registration.

(Note: our November meeting is Thursday November 21st. An earlier mailing had the wrong date.)

Interesting "away" meetings for WellOK Members

Community Oncology Alliance is an organization of providers of oncology care across the United States. They hold a major meeting in Washington DC each fall and are looking for employers to attend to help them understand the employer's perspective on cancer care. A WellOK member who attended last year said it was a good experience. You may be able to score a free meeting this year.

National Alliance of Healthcare Purchaser Coalitions holds its Annual Meeting on November 11-13 in Washington DC. One employer member of WellOK is invited to attend at no cost. The usual registration fee is about $400. Transportation and lodging is not included.

Contact us at info@wellok.org if you are interested in either meeting.

Hospital Guide by WellOK

For the past two years, WellOK has partnered with Quantros, Inc. to make sense of publicly available quality and safety data. Quantros puts a front end on the rich trove of data that hospitals must report to Centers for Medicare Medicaid Services.

Our subscription to Quantros allows our Director of Quality Initiatives, Susan Driesel RN CPC, to extract quality results for 28 major surgical and medical conditions. Examples include: gallbladder removal; spinal fusion; joint replacement; cardiac care; heart bypass and valve replacement.

Two questions we get frequently: why not just rely on your physician to help refer you to the best place? Why not just go by best reputation or the real-life experience of friends and family?

First, your physician may not know the quality score for particular services at all our regional and state hospitals. Most don't. Physicians who are employed often refer to specialists and hospitals in their own health systems — and in many instances are expected to do so. Those referral patterns don't take quality into account.

Second, no hospital does everything well. One anecdote: Stan Schwartz recently reviewed claims on a spinal fusion operation done at a renowned Eastern hospital with a great reputation and on certain “top ten” hospital lists again this year. It is a great hospital, but if you need spinal fusion, you might elect to go elsewhere: For spinal fusion, their score was at the very low end of the rating scale.

Our Hospital Guide clearly illustrates that certain hospitals in our region are great at certain things but not necessarily all things.

The guide is updated about every quarter as new data become available. As of this date, data are current through 2018Q3.

Several caveats: these ratings are based on care reported to CMS. For that reason, patients on commercial coverage, who are generally younger, may be underrepresented. Also, be careful about extrapolating from one procedure to another. Because s surgeon and hopsital are skilled at joint replacement, they are not necessarily as good at, say, joint arthroscopy surgery.

The Hospital Guide is in our Members Only section and requires a registration and password for access. If you are employed by one of our WellOK member organizations (here), email us at info@wellok.org and request a registration.

September Member Innovation Showcase: More Details

Set aside lunchtime on Thursday September 26 for our new September Showcase. Five WellOK members will present the innovations, challenges and obstacles they've learned in the last year. Here are the topics:

  • How we installed direct primary care and the benefits we experienced

  • How direct contracting for specialty, imaging and lab services can save money and help covered members afford care

  • A wellness program that actually worked

  • Lessons learned on the path to becoming partially self-insured

  • How "reference-based pricing" actually worked for us

  • How we used pharmacogenetics to improve care

Place: Hilton Garden Inn Midtown Tulsa (the usual)

Lunch: provided

Time: 11:30AM to 1:30PM. September 26th Thursday

Cost: Free to WellOK members; $15 for non-members and guests

Registration is required. Click here to register.

Save the date for WellOK's 4th Annual Conference

Friday May3rd starting at 8:15 am at Doubletree Hotel Warren Place.

We have an all-star lineup of speakers from around the country focusing on three topics this year:

  • Healthcare quality and why you need to incorporate quality in how you purchase healthcare

  • Patient engagement: the key to getting people to do what they should do

  • Steps to handle the coming expenses of budget0busting specialty drugs

Registration and the agenda will be available soon.

January 2019 Lunch and Learn: Approaches to enhancing employee health engagement

Jan Berger, MD, MJ, is a national thought leader in healthcare. Dr. Berger has authored four books and served on the editorial boards of several healthcare journals. Her medical and jurisprudence degrees are from Loyola University. She is assistant professor for the schools of medicine and communication at Northwestern University in Chicago.

She is the CEO of Health Intelligence Partners in Chicago, an International health care consulting company focused on healthcare strategy and business development.

Dr. Berger will offer expert advice to help you engage your employees in their own healthcare. She will share that knowledge with us at our first Lunch & Learn of 2019.

Registration opens on January 3 here.

October Lunch & Learn

Primary care is so fundamental to getting good outcomes and controlling costs.  Primary care physicians and other advanced practitioners have been erroneously referred to as "gatekeepers." In fact, they are navigators, advisors, sages, counselors and more.

So many questions involve primary care:

  • Are my covered members with diabetes under best possible control and on a path to avoid costly and disabling complications? And what about those with high blood pressure, high cholesterol and other chronic conditions?

  • Are my members being appropriately advised about alcohol, tobacco, drug use, nutrition and other modifiable risk factors?

  • Can my members reach their primary care physicians and providers to get timely intervention that can prevent costly emergency room treatments?

  • Do my members get good care during transistions of care such as hospital discharges, emergency room follow-ups and more?

  • Do my members have to jump hurdles to be seen when unexpected illness occurs?

  • Are my providers aware of social determinants of health that come to bear on the outcome of any medical treatment (income, adequate housing, access to healthy food, access to transportation, health literacy, a safe home environment, for example)?

Plan on joining us on Thursday October 25 at 11:30for an engaging Lunch & Learn so you can better understand the value of the primary care you are buying for your members. Formal announcement to follow....

Special April Lunch & Learn

Please mark Thursday April 26th from 11:30 to 1:15 for a special lunch meeting. We will meet at QuikTrip's Corporate headquarters. Melisa Weaver, APRN-CNP, will be up from Oklahoma City to lead a discussion of bariatric surgery for obesity.

Many of us help make policies about bariatrics or know employees who have undergone procedures. But are you really versed in the personal side of weight loss surgery and exactly what happens?

Melisa will take us through the whole process of bariatric surgery, starting from the extensive pre-operative evaluation patients go through. She'll step us through the surgery, recovery and the permanent life changes persons experience after these surgeries.

If you are on our mailing list, you should receive an invitation to register in the next several days. If you are not on our mailing list, go to our contact page and let us know.

A reading trifecta for employers who purchase healthcare

Here are three must-reads for you and your company:

  1.  The CEO's Guide to Restoring the American Dream by Dave Chase. WellOK members can download a free copy of the e-version here.
  2.   An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal. 
  3. Mistreated by Robert Pearl, MD

These three books are great reads and will change your thinking about American healthcare.


Alcohol use in US is increasing and high-risk drinking and alcohol use disorders area driving those increases

A publication in JAMA Psychiatry indicates that 1 in 8 Americans may be at risk related to alcohol consumption. This may be a public health problem much like the current opioid epidemic but with a much longer fuse.


The concept of the out-of-work, down-on-luck alcoholic is not operative today. The vast majority of people with alcohol use disorders or risky drinking have jobs and/or are raising families. They are college students and parents and grandparents and in every walk of life. The one thing they all have in common is either a lack of understanding--or a denial--of the risk.


One big question should be:  how do I measure how much a "drink" is? 





Choosing Wisely now for your iPhone

Consumer Reports and ABIM Foundation have extended their collaboration on the Choosing Wisely Initiative by creating a free app for your smartphone. The app provides both the patient's perspective and the physician's perspective on a wide range of medical tests, procedures and treatments.

You may have Amazon, Yelp, Wikibuy and other apps to help you shop for merchandise. Here's one that can help you make better decisions when buying healthcare.

Look in the Apple App Store for the free app.

How much money are we wasting on blood sugar measurements?


There is no single culprit in the battle against rising healthcare costs; rather, there are many drivers contributing to the increase. Soaring prices for medical services, new costly prescription drugs and medical technologies, paying for volume over value, unhealthy lifestyles, and a lack of transparency concerning prices and quality are all factors contributing to the spike in premiums.

Patients with diabetes require lifetime care to prevent or minimize potential complications- especially affecting the eyes, kidneys, nerves, and blood vessels. Most Type 1 persons with diabetes require insulin, and it’s essential they monitor blood glucose with frequent “finger stick” testing (self-monitored blood glucose or SMBG) or with a continuous glucose monitor.

For decades however, daily SMBG testing has also been ordered for patients with the more common Type 2 diabetes who do not require insulin. Does SMBG benefit exceed cost for this group? Does SMBG improve glucose control? Does it improve lives? Prior clinical research studies suggested perhaps mild benefit, but questions remained.

In 2013 the Choosing Wisely program recommended against “routine” SMBG for those not requiring insulin. An exciting confirmation of this approach was presented at the American Diabetes Association 77th Annual Meeting (and published in the June 10, 2017 issue of the Journal of the American Medical Association).

     - Kenneth Piper, MD, Consulting Physican Advisor, WellOK

"An Americal Sickness" by Elisabeth Rosenthal is a must-read for businesses

Elisabeth Rosenthal is a healthcare writer (and physician) who has published extensively in the New York Times and Kaiser Health News. She recently published "An American Sickness: How Healthcare Became Big Business." It's available on Amazon and other sites.

It's a great read that anyone using, buying or arranging healthcare should get. 

(And remember, if you do make purchases on Amazon, help support WellOK by going to smile.amazon.com and select "WellOK" as the non-profit you support. It won't cost you a penny extra!)

The Curious Case of Duexis

Duexis represents the genius of the pharmaceutical industry in turning lead into gold. A recent article in January 2017 issue of the JAMA Internal Medicine, a respected publication,  pointed out how you may be spending an unnecessary $2000 each month for every member taking this medication.

It’s a combination pill that combines the ingredients in 3 prescription-strength ibuprofen pills (generic Advil) and about 4 over-the-counter famotidine pills (general Pepcid). Purchased individually, the cost for both would be about $16 per month. An enterprising person can actually purchase the same ingredients in different strengths per pill without a prescription for about the same amount.  (For the technically-minded, Duexis is 800mg ibuprofen and 26.6 mg famotidine. A generic ibuprofen is 200 mg and costs about 2¢; a generic famotidine is 20 mg and costs about 8¢.)

The cash price for Duexis at large Tulsa pharmacies is about $2330.00. No, that is not a misprint. The cash price for the prescription is over 144 times the cost of the ingredients separately. When Duexis was first marketed a few years ago, the average wholesale price was about $160. Now the average wholesale price is over $2000. 

The manufacturer encourages usage of the drug by allowing patients to avoid copayments through coupons and other methods. An employer may be paying thousands of dollars each year because an employee can get a drug for free instead of $16 per month.

Why would a pharmacy benefit manager even permit this drug on a formulary? That’s because the PBM may get a rebate from the manufacturer each time the drug is prescribed. Think about this: if your PBM is covering Duexis, you may be paying over $2000 a month you don’t need to and your PBM may be sharing part of that excessive payment while they are “managing” your pharmacy benefits.

There are other ways pharmaceutical manufacturers may circumvent controls that some PBMs put on this medication. The bottom line is the same: the patient may save a few dollars and you waste thousands.

To be fair, Duexis is a combination drug that is intended to assure that people taking a high dose of ibuprofen gets a medicine at the same time that helps protect the stomach and intestinal lining. The vast majority of people can do quite well taking the medications separately.

So does your PBM have Duexis on the formulary? 

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