Voices of Self Funding: Recent Episodes
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Join in on the conversation with host Ramesh Kumar, CEO and Co-Founder of zakipoint Health, as he interviews key self-funding experts and dives deep into impactful topics and perspectives surrounding the self-funding industry.
Make sure you continue to tune in to hear unparalleled perspectives in each upcoming episode! We will cover a diverse mix of topics ranging from the challenges that TPAs face, price transparency, competitive implications, and more.
What separates a great stop-loss partner from an average one? According to Joe Dore, President and CEO of USBenefits, it's not just pricing; it's proactive collaboration. In this episode of Voices of Self-Funding, Joe joins host Tom Testa to share how early intervention, strategic partnerships, and a consultative approach can help employers avoid costly surprises, reduce high-dollar claims, and make smarter decisions in an increasingly challenging healthcare environment.
For more information on stop-loss coverage and other self-funding topics, visit www.hcaa.org.
This episode is sponsored by zakipoint Health.
Tom sits down with Matthew to tease his upcoming TPA Summit session: Building Health Plans that Consumers Understand and Love. The complexities of Consumer Simplification for TPAs and Administrators.
Tom sits down with Nick to tease his upcoming TPA Summit session: Ending Rx Guesswork -- And Yes This Impacts GLP-1s
Tom sits down with David to tease his upcoming panel participation in a TPA Summit session: Rewiring PBM Contracts for True Alignment
In this episode of Voices of Self-Funding, host Tom Testa sits down with Angel Onuoha, co-founder and CEO of Avelis Health, for a deep dive into how AI agents are reshaping payment integrity, claims auditing, and healthcare cost management.
Inspired by his own experience navigating inflated medical bills after multiple knee surgeries, Angel set out to tackle one of healthcare’s biggest hidden problems: payment errors and billing complexity. The conversation explores how Avelis is using AI agents to transform summary plan documents into auditable claim rules, identify overpayments in real time, and even deploy voice AI to communicate directly with providers about denied or recouped claims.
Angel also unpacks why generic large language models can be dangerous in healthcare workflows, the importance of explainability and auditability in AI systems, and how organizations must rethink PHI security, access controls, and trust when deploying AI at scale. Angel shares his perspective on why today’s payment integrity ecosystem suffers from misaligned incentives — and why AI may finally give TPAs and self-funded employers the tools to proactively reduce waste without adding administrative burden.
If you want to understand where AI in healthcare is moving beyond hype and into real operational impact, this is a conversation you won’t want to miss.
This episode is sponsored by zakipoint Health.
Are you tired of the "lazy way" to cut healthcare costs—just increasing deductibles and co-pays?
In this episode, we’re talking to someone who calls that approach what it is: the definition of insanity.
Host Ramesh Kumar welcomes Adam V. Russo, Esq.—co-founder and visionary of The Phia Group, LLC, an innovative cost containment leader and attorney who represents employers and plan fiduciaries across the U.S.
Adam is here to break down the secrets of delivering a great healthcare experience on a self-funded plan. You'll learn:
- Why Direct Primary Care (DPC) is being called the "best" plan design choice for both employee retention and health, with studies showing a 13% reduction in overall claim spend in the first year.
- How Adam's company, a successful self-funded employer, leveraged DPC to personally circumvent a $6,000 to $10,000 ER bill for just $80 a month.
- The critical need for a complete employee mindset shift and a five-year education plan to truly win at cost management.
Don’t miss this powerful conversation on why increasing cost-sharing measures has failed, and how DPC offers a path to long-term success. Tune in now!
This episode is sponsored by zakipoint Health.
In this episode of "Voices of Self-Funding," host Ramesh Kumar sits down with Trey Hinson, Founder of Goliath Sales Strategies and a seasoned marketing and sales leader with over 24 years in the healthcare benefits space.
Trey unpacks what authentic, research-driven sales and marketing look like in today’s self-funded ecosystem. You’ll learn:
- Why modern brokers are demanding measurable outcomes, value-aligned proof, and a disciplined ICP strategy—and how carriers and TPAs can better meet those expectations.
- The shift from feature-centric pitching to case-study-backed storytelling.
- The importance of rep enablement for building a sales system that scales sustainably.
This is a must-listen conversation for anyone looking to strengthen broker relationships, improve retention, and build sales systems that last. Tune in now!
This episode is sponsored by zakipoint Health.
In this episode of "Voices of Self-Funding," host Ramesh Kumar welcomes Jonathan Socko, President of East Coast Underwriters, LLC, a Managing General Underwriter (MGU) specializing in Stop Loss insurance.
Jonathan shares his perspective on stop-loss underwriting for small groups and unveils the blueprint for a remarkable success story: a 30-life employer group that has been successfully self-funded for 10 years with their PMPM costs increasing only 10% over that decade.
You'll learn:
- The crucial role of partner cohesion between the broker, TPA, and stop-loss carrier to manage claims proactively.
- Why data transparency and a specific data flow are non-negotiable for effective claim prediction and management.
- The essential mindset shift—and commitment to aggressively attacking costs—that ensures a small group’s self-funded plan remains successful and sustainable.
Don't miss this conversation for an insider's view on stop-loss and the strategy that delivers long-term savings.
This podcast is sponosred by zakipoint Health.
In this episode of Voices of Self Funding, host Tom Testa sits down with Matt Ohrt, National Executive Director of the Free Market Medical Association (FMMA), to explore how employers can take back control of healthcare costs and quality through free market principles. Matt shares his personal journey – from a 25-year HR career and near-fatal accident to leading national reform movements like Self Fund Health, Rise Up Health, and Healthcare Best Practice Group. Together, they explore how self-funded employers can drive meaningful change by demanding transparency and value, the rise of direct primary and specialty care as cost-saving, patient-centered alternatives, and why breaking healthcare’s “monopoly mindset” is key to restoring competition, affordability, and trust – all while looking ahead to what’s next for self-funding and free market reform in 2026 and beyond.
This episode is sponsored by zakipoint Health.
In this preview episode of Voices of Self‑Funding, host Tom Testa sits down with Mike Strong, Director of Policy & Operations Strategy, Health Plan Cost Containment at Reliant Health Partners, to discuss his upcoming Executive Forum 2026 session: “Who Really Wins? Transforming the TPA Playbook for IDR.” Mike offers a candid look at how the Independent Dispute Resolution (IDR) process is evolving, why traditional arbitration strategies may no longer be enough, and what TPAs can do now to protect margins while strengthening payer‑provider relationships.
Hear the full session live at Executive Forum 2026 — register now and be part of the industry’s most important conversations.
In this preview episode of Voices of Self-Funding, host Tom Testa sits down with ClarityCare AI co-founders Hermine Tranie and Alex Andrei to discuss their groundbreaking Executive Forum 2026 session: “How to Actually Use AI: A Hands-On Mini-Hackathon for Self-Insured Leaders.”
Unlike typical conference talks, this immersive 90-minute workshop invites attendees to roll up their sleeves and build with AI in real time. Hermine and Alex preview what to expect from the hackathon format, share how AI is already reshaping prior auth and utilization management, and explain why TPAs and self-funded employers need to stop talking about AI – and start using it.
Don’t miss this unique opportunity to get practical with AI at Executive Forum 2026. Register now and secure your seat in the Ballroom.
In this special episode of Voices of Self-Funding, host Tom Testa sits down with Executive Forum 2026 keynote speaker Mike Abrashoff, former Commander of the USS Benfold and best-selling author of It’s Your Ship. Hear how Abrashoff turned the Navy’s lowest-performing ship into the top-ranked vessel in just one year – without changing a single crew member.
In this quick preview, Mike shares lessons on leadership, culture, and accountability that apply far beyond the military and offers a taste of the powerful message he’ll bring to San Antonio this February.
Catch the keynote session live at Executive Forum 2026 — register today to reserve your seat and join the industry’s most important conversations.
In this special preview episode of Voices of Self Funding, co-host Tom Testa sits down with Ron Peck, Chief Legal Officer at The Phia Group, to discuss his highly anticipated session at Executive Forum 2026: “Fiduciary Gotchas and the Company You Keep.” From revenue-sharing arrangements to PBM contracts and vendor disclosures, Ron shares what TPAs need to know now as courts and regulators sharpen their focus on fiduciary responsibilities. With plaintiff attorneys getting more creative and DOL audits on the rise, this conversation is a must-listen for anyone looking to protect their business and stay compliant.
Catch the full session live at Executive Forum 2026 — register today to reserve your seat and join the industry’s most important conversations.
In this episode of Voices of Self-Funding, host Tom Testa speaks with MIT-trained AI researcher and ClarityCare AI co-founder Hermine Tranie about how artificial intelligence is delivering measurable wins in utilization management (UM) and prior authorization (PA). Hermine explains how AI agents convert unstructured records into structured insights, drive real-time approvals at the point of care, and free up nurses for higher-value tasks – boosting accuracy, efficiency, and compliance.
As a preview to her interactive “AI Mini-Hackathon” session at HCAA’s 2026 Executive Forum, Hermine shares a practical roadmap for adoption and what TPAs and self-funded employers can do today to start seeing ROI. Click here to register.
In this episode of Voices of Self-Funding, host Ramesh Kumar welcomes Lee Lewis, Chief Strategy Officer at the Health Transformation Alliance and host of the Broken Benefits podcast. Together, they explore how some of the nation’s largest employers are reshaping healthcare and what smaller self-funded employers and TPAs can learn from their playbook. Lee introduces his “ABC” framework: Advanced Primary Care, Behavioral Health, and Centers of Excellence. They dive into why direct primary care is gaining traction, how advanced behavioral therapies like TMS and ketamine can unlock cost-effective mental health care, and why Centers of Excellence and tiered networks are becoming essential levers for better outcomes at lower cost.
From strategies to supplement traditional networks to practical steps TPAs can take to differentiate and deliver value, this is a powerful conversation packed with actionable insights for anyone rethinking healthcare benefits in a self-funded world.
Registration is now open for HCAA’s Executive Forum 2026, where conversations like this continue live. Learn more at HCAA.org.
In this episode of Voices of Self-Funding, host Ramesh Kumar welcomes Arun Santhebennur, Co-founder and CEO of Voicegain, to explore how voice AI is reshaping healthcare operations for TPAs, payers, and health plans.
They tackle the tough truth that 95% of AI pilots fail, unpacking why — from hype and skill gaps to the “build vs. buy” dilemma and change management challenges. More importantly, they share where AI is already succeeding: automating claims status calls, streamlining utilization management, and making complex health plan information accessible to members.
Listeners will hear a roadmap for launching successful AI pilots — starting with proven use cases, aligning incentives, and using AI to augment (not replace) people. It’s a forward-looking conversation on turning AI from a risky experiment into a real value driver.
This episode was sponsored by WLT Software. For more information, visit HCAA.org.
In this episode of Voices of Self Funding, Jeff Walter and Jim Farley discuss their strategic merger, titled "Merging for Independence". They reveal how independent TPAs like JP Farley and PBA are uniting to drive innovation and enhance customer experience, avoiding absorption by larger firms.
Discover how this merger focuses on enhanced service with PBA's EOS system and in-house IT, improving operational efficiency, data management, and enabling quick, independent service delivery for customers. The discussion also highlights their future focus on Direct Primary Care (DPC) and the use of nurse navigators to optimize member experience and efficiency. It’s a compelling conversation for understanding how TPAs are evolving to offer superior, independent solutions and seamless third-party integration.
This episode was sponsored by WLT Software. For more information, visit HCAA.org.
In this episode of Voices of Self-Funding, host Ramesh sits down with Jeffrey Bloom, a 25+ year veteran in healthcare and employee benefits, to unpack the power of Direct Primary Care (DPC) for self-funded employers.
Jeff brings deep expertise spanning underwriting, care delivery, and affinity markets — and a passion for reshaping member experiences. Together, they explore how DPC:
- Delivers hard savings: 12–18% reduction in year one healthcare spend (net of fees), plus an additional 8% stop-loss discount by deflecting high-cost claims.
- Transforms access: Members get appointments in 24–48 hours—far faster than traditional systems.
- Drives satisfaction & productivity: A scalable, capitated model that eliminates balance billing, improves engagement, and enhances workforce health.
This conversation reframes primary care not just as a benefit, but as a strategic cost-containment lever for employers committed to optimizing spend and boosting employee well-being.
This episode was sponsored by WLT Software. For more information, visit HCAA.org.
In this episode of Voices of Self Funding, host Ramesh welcomes Dr. Michael Fenster — better known as “Chef Dr. Mike” — interventional cardiologist, classically trained chef, and leading voice in the field of culinary medicine. Chef Dr. Mike will be familiar to many of our listeners as the keynote speaker at HCAA’s 2025 Executive Forum.
Together, they dive into what it means to move beyond basic nutrition advice toward a truly holistic food-health experience — where timing, setting, social connection, and emotional well-being are all part of the recipe. They explore how employers can build healthier ecosystems for their workforce, and why investing in food as medicine could offer meaningful returns when it comes to preventing chronic disease.
It’s a rich and energizing conversation that rethinks the role of food in well-being, as well as the role self-funded employers can play in making it work. This episode was sponsored by WLT Software. For more information, visit HCAA.org.
In this episode of Voices of Self Funding, host Ramesh sits down with Marjorie Morrison — renowned entrepreneur, licensed psychotherapist, and mental health innovator. With decades of clinical and business experience, Marjorie brings deep insight into how self-funded employers can better support mental health while navigating the complexity of today’s benefit landscape. She draws on her work as founder of PsychArmor and Psych Hub, as well as her policy and employer-facing advocacy efforts, to share what’s working — and what’s next. They discuss:
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The myth of one-size-fits-all mental health.
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Understanding the range of needs and solutions.
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How evidence-based practices are driving the next wave of tech-enabled mental health care.
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Why self-funded employers must take the lead in creating meaningful, flexible mental health benefit structures.
Tune in for an honest, energized conversation that reframes mental health as a strategic business priority — and learn how to turn complexity into action.
This episode was sponsored by WLT Software. For more information, please visit HCAA.org.
In this episode of Voices of Self-Funding, Ramesh Kumar sits down with Kari Niblack, CEO of Boon-Chapman, and Amy Gasbarro, President of ELMCRx Solutions, to explore what transformational leadership looks like in the self-funded space.
They discuss:
- Aligning vision and execution – How successful leaders bring teams together with clear goals and strategy.
- Authenticity in leadership – The power of leading with transparency, purpose, and a parallel personal brand.
- Differentiation in self-funding – How to stand out and drive innovation in a competitive market.
- Long-term strategies for empowering teams – The mindset and tools needed to create high-performing, future-ready organizations.
Tune in for valuable insights on what it takes to lead, innovate, and inspire in the ever-evolving world of self-funded healthcare.
This episode was sponsored by WLT Software. For more information on managing risks and controlling costs, please visit HCAA.org.
Employers need proven strategies to manage risks and control costs, but with hundreds of point solutions on the market, how do brokers know where to focus? In this episode, a leading benefits consultant shares the innovative solutions they're implementing, why these choices matter, and the pivotal role a trusted TPA plays in this process. Tune in to gain insights that can guide your own risk and cost management decisions.
This episode was sponsored by Valenz Health. For more information on managing risks and controlling costs, please visit HCAA.org.
Join me for an insightful conversation with Kirti Mutatkar, CEO of UnitedAg and President of HCAA. Discover how Kirti tripled UnitedAg’s business by leveraging the powerful resources of HCAA, and how she's bringing that same energy and passion to benefit other HCAA members. We’ll dive into the value HCAA provides to TPAs, brokers, and employers, and explore how its digital programs and live events have empowered organizations like UnitedAg to grow. Kirti will also share her vision as HCAA President and what members can expect in the next two years. Don't miss this deep dive into how HCAA helps employers offer more affordable healthcare to their employees.
This episode was sponsored by Valenz Health. For more information on HCAA, please visit HCAA.org.
Join us as we sit down with Paul Ashley, CEBS, a Vice President and Consultant at NFP. Paul has 22 years of experience managing health plans for upper- to middle-market employers. During the podcast, we talked about the various ways that organizations can improve transparency and reduce their pharmacy costs, as well as examining the latest trends in PBM contracting.
This episode was sponsored by Valenz Health. For more information on PBM contracting or other topics related to the self-funding industry, please visit HCAA.org.
Join us as we welcome Oliver Ayres, President Key Family, Key Benefit Administrators, to discuss the Direct-to-Employer (DTE) approach to improve health care cost containment. Oliver simplifies the complexities of DTE, empowering both employers and employees to navigate the health care benefits maze more effectively. In this episode, Oliver breaks down the intricacies of DTE and shares how it can both cut costs and boost access for self-funded employers and their teams. He will also share real-world examples of how it outperforms the Reference-Based Pricing model for employers and employees. Finally, he'll share valuable advice for brokers, employers, and TPAs considering DTE adoption.
This episode was sponsored by Valenz Health. For more information on DTE or other topics related to the self-funding industry, please visit HCAA.org.
In this episode, Ramesh continued his discussion with Fred Goldstein, co-founder and lead host of PopHealth Week, a weekly radio show that engages thought leaders, disruptive companies, and health systems in the field of Population Health Management. This is the second of a two-part podcast that was recorded in front of a live audience at HCAA's Executive Forum and examined GLP-1, weight loss, gene therapies, reinsurance, and outcomes based contracts. The discussion also focused on population health and the use of data, access to primary care, maternity and musculoskeletal care, and more.
This episode was sponsored by Valenz Health. For more information on captives or other topics related to the self-funding industry, please visit HCAA.org.
In today's episode, Ramesh interviews Fred Goldstein, co-founder and lead host of PopHealth Week, a weekly radio show that engages thought leaders, disruptive companies, and health systems in the field of Population Health Management. This is the first of a two-part podcast that was recorded in front of a live audience at HCAA's Executive Forum and examined GLP-1, weight loss, gene therapies, reinsurance, and outcomes based contracts. The discussion also focused on population health and the use of data, access to primary care, maternity and musculoskeletal care, and more.
This episode was sponsored by Valenz Health. For more information on captives or other topics related to the self-funding industry, please visit HCAA.org.
On this episode of Voices of Self Funding, Ramesh hosted Michael Schroeder, the legal luminary-turned-maverick CEO of Roundstone. A lawyer by training, Mike has been on the frontlines, advocating for captives and unveiling the nuances within this captivating world of captives.
Ramesh sat down with Mike to gain an understanding of the current state of the captive market, the market’s path to maturity, the components of a captive, and how to evaluate the different types. We also gained a sneak peek into some of the challenges on the horizon for captives within the realm of self-insurance.
This episode was sponsored by Valenz Health. For more information on captives or other topics related to the self-funding industry, please visit HCAA.org.
In our latest episode, we're thrilled to host Dr. Jerry Beinhauer, a clinician turned innovator and the brains behind Apaly Health. Join us as we unravel the mysteries of Direct Primary Care (DPC) arrangements including how to improve access, mitigate employee population risks, uncover the metrics that matter, and slash costs for ER and specialist visits.
This episode was sponsored by Valenz Health. For more information on Direct Primary Care or other topics related to the self-funding industry, please visit HCAA.org.
Prepare yourself for a transformative exploration as we delve into the critical realm of Musculoskeletal (MSK) programs. In this eye-opening discussion, long-time orthopedic surgeon, Dr. Steven Schutzer examines the exorbitant costs associated with unnecessary surgeries and how self-funded employers could scale models to tackle the MSK issue head on. We talked about how Virtual Diagnosis could be the game-changer we've been waiting for, and how advanced data analytics platforms are helping to identify members for targeted interventions. Tune in now to hear about the intricacies of MSK programs and learn strategies to improve your benefits program.
This episode was sponsored by Ikigai Growth Partners. For more information on MSK programs or other topics related to the self-funding industry, please visit HCAA.org.
Employers want a new solution every quarter and expect the TPA to integrate, share data, enroll and support the member. This makes it difficult to not only evaluate the impact of point solutions, but also to access data across solutions and drive substantial value. How should you address this? And how should you approach the explosion of point solutions?
This episode was sponsored by Ikigai Growth Partners. For more information on point solutions or other topics related to the self-funding industry, please visit HCAA.org.
In this podcast, we talked with two experienced private equity investors in the self-funded space and learned about their 25-year history. The discussion delves into how each PE firm's investments help to differentiate and grow businesses. We explore failures and changes in the self-insured market, including cost containment, alternative contracting, and member experience. The podcast also covered unlocking value, the impact on existing models, member navigation, price transparency, and incentives. We evaluated trends in the large market that impact the mid-market and where TPAs and solution providers should focus to drive enterprise value. Only ignore this podcast if you don't want to know where the self-funded puck will be in five years time.
Surgeries are hard on everyone involved. Patients, family, providers, and employers as they have to foot the bill. There are many things that go wrong in our fee-for-service healthcare system. Gatorade can help fix this for everyone involved. Yes, listen to how a specialized surgery management program uses Gatorade drink and their secret sauce to make this a great experience for everyone involved and reduce costs.
With increasing complexity self-insured employers select TPAs or carriers based on a number of criteria. And decide to work with the partner if they deliver value, and can showcase it. How do you deliver and communicate value to self-insured employer? And how can a TPA capture the value?
In this podcast we sit down with Spencer, the host of "Self-funded with Spencer," the other podcaster serving the self-insured employer industry. We both reflect on what we learned from talking to experts in 2022, and what we are seeing in 2023 for RBP, captives, stop loss, care navigation, price transparency, and cost containment. This is a highly impactful podcast that synthesizes the 2021 and gives you a roadmap of what to expect in 2023.
Member engagement is increasingly challenging with the fragmentation of solutions being offered. While more solutions should be an opportunity, Joe Hodges from CareValet goes deeper into the topic of member engagement and healthcare benefits. Join in on the conversation as Ramesh and Joe uncover specific ideas on how to increase engagement, the value of it, and the steps TPAs should take to start this journey.
This episode is sponsored by Nokomis.
Nurse navigation and advocacy have become very popular topics, but we don't know what aspects of nurse navigation are key in reducing costs and delivering a good member or patient experience. In many cases, the connection between nurse navigation and reduction in healthcare cost reduction has not been investigated properly. In this episode, Casey and John break down the key steps of nurse navigation, the corresponding discount on stop-loss premiums, and the upcoming challenges in doing this properly for self-insured employers.
This episode is sponsored by: Nokomis.
In this episode, Ramesh sits down with Rob Gelb from Valenz and Jeff Bak from Imagine360 to discuss the key trends in the cost containment space. Some of the questions that will be answered include; What are the different ways employers can contain costs? What is going to be effective in the post-price transparency future? Where does RBP sit in the spectrum of solutions?
This episode is sponsored by: MeMD.
Do you want to know how to drive value from DPC? In this episode, Ramesh sits down with Dr. Jeremy Smith and Katelynn Smith from MyMDConnect, as well as David Jacobson VP of Sales at Entrust to discuss DPC and care navigation. How do you ensure members are using it, and using it appropriately? What has been the ROI of DPC and concierge programs?
Everyone has talked about price transparency, and how much it is going to change. In this episode, Ramesh sits down with the Founder of Launchpad, Mike Orth, to discuss brass tacks and price transparency. What does the plan sponsor need to provide? What are the fines? Why is it difficult? How can you simplify it? What is a three-step approach to delivering value to plan sponsors and capturing value from it?
This episode is sponsored by TALON.
Every innovation that aims to improve healthcare costs, access, or outcome for self-insured employers can be pressure tested by the broker community and possibly vetted. Tune into this episode featuring Chris Fisher of BenefitsAlly, about the secrets to engaging brokers with your solution. Chris has done more than 125 messaging videos for different solutions to garner interest from brokers and has spent over 15 years working as a broker, TPA, and vendor selling in the self-insured employer space.
This episode is sponsored by: Magellan Rx.
Dr. Makary, surgeon, public policy expert, and author of the book "Price we pay" talks passionately on this episode about how to bring disruption to the healthcare system. And how to go underneath the areas of focus to address the inappropriateness of care and the higher prices we pay for healthcare. What is ahead in 2022? How can you help shape the plans and programs to deliver value to your members?
This episode is sponsored by: MedWatch.
Post pandemic, mental health issues and substance abuse have reached a critical stage in our communities. Employers are asking, employee's families are experiencing a lot of challenges. Learn from Julie Meuller, an innovator in the self-funded space, who has put these mental health and substance abuse programs at her company and is helping 10s of other self-funded employers.
This episode is sponsored by: Magellan Rx.
In this episode, Ramesh goes to a higher level with the author of Never Pay the First Bill, Marshall Allen, to talk about how employers can educate their members about healthcare prices and the upcoming price transparency. This conversation provides a unique perspective on actions employers can take to leverage price transparency.
This episode is sponsored by: The Phia Group.
Care navigation programs are incredibly valuable in delivering a great experience for patients and significantly lower costs for employers. But why aren’t they the norm? Tune into this episode as our guest, Michelle Bounce, COO at J.P. Farley, a leading TPA, describes a life-changing personal encounter with our healthcare system, where she lost her child and faced the cold and impersonal healthcare system. And through this chilling experience, it has forever shaped and guided her desire to improve healthcare for all through an empathic care navigation model that treats the “human side of healthcare.” Michelle guides us through how TPAs can effectively turn care management on its head by simply “doing the right thing” and the cost savings follow suit.
This episode is sponsored by: MedWatch.
If you are trying to leverage innovation to deliver high impact to self-insured employers, this podcast is a must-listen for you! Ashok Subramaniam, CEO and co-founder of Centivo, a forward-thinking TPA, answers some of the important questions of major disruptions in the industry around price transparency, unbundling of provider networks, stronger relationships between brokers and TPAs, and the areas of focus to clarify your true value to employers. He frankly outlines where the puck is going to be in 3 years time – you don't want to be there.
This episode is sponsored by: WLT Software.
Healthcare consumers don't trust our healthcare system. COVID-19 has brought this into sharp contrast. However, building trust is vital for effective care, reducing population risk, and driving down costs. Why should you care about building trust with employees and members on your self-insured employer plan? Listen to Kirti Mutakar, CEO of UnitedAg, a healthplan and TPA, on their approach to building trust with a difficult-to-reach employee population in the agri business, and the results this has delivered.
This episode is sponsored by: AMPS.
TPAs are increasingly facing a challenge around customer service, stuck doing tactical interactions with members, and seeing churn from their customer support team. Employers want more from their benefits and the support to their employees. Technology can help - but how? What is available? How are big health plans leveraging data and technology? Come and find out from Vijay Bhatt, Deputy CTO at Harvard Pilgrim, a health plan that has grown rapidly.
This episode is sponsored by: Zipari
In this episode, Ramesh interviews Matthew Albright, Chief Legal Officer at Zelis, who has been involved in various healthcare regulatory issues, having worked at CMS. In this podcast episode, we will answer key questions such as what is the intent of price transparency regulation? What are the key requirements that TPAs and Employers need to worry about? What is the simplified version to worry about? And finally, what are the recommended steps to take?
This episode is sponsored by: WEX
In this episode, Ramesh interviews Dallas Scrip, CEO of Benefit Management LLC from Wichita, KS, and Ashok Subramanian, CEO of Centivo, from Buffalo, NY. This episode dives into questions about the challenges TPAs face in competing against BUCA carriers, what investments TPAs need to make, and what the advantages TPAs have in their business model.
(Please Note: The episode was recorded before the Buffalo Bills game against Kansas Chiefs in the Superbowl.)
This episode is sponsored by: Optum Rx
In this episode, Ramesh interviews Dr. Keith Smith, founder of the Surgery Center of OK, one of the pioneering firms that have published their fixed prices down to the dollar for surgeries for more than 10 years. This podcast episode will touch on what a specialized surgery network means, what type of surgeries can be directly steered to specialized centers, what kind of savings to expect, and whether or not quality and cost are better at these specialized surgery centers.
This episode is sponsored by: ECHO Health.
In this episode, Ramesh talks with Brian Klepper, an expert, and consultant on contracting to create high-performance provider contracts. The podcast will answer questions like: What are the issues with the way providers deliver care or programs, which category of services can employers put in outcome-based/high-performance contracts, what data is needed to contract and manage these outcome-based initiatives, how to go about seeking these contracts. This episode is sponsored by: ELAP.
In this episode, Ramesh talks with Ernie Clevenger, someone who has dedicated his entire entrepreneurial career to bringing better care, managing risks and leveraging healthcare technology. He is founder of CareHere, a successful worksite clinic, now part of Premise Health. Ernie also runs and distributes MyHealthGuide, a newsletter bringing latest developments in the self-insured employer space. Today's podcast will answer questions pertaining to different models of operations like worksite clinics to direct on-site primary care models, what are the pricing models, what are the emerging trends, how is virtual primary care competing with direct primary care model, and what is the role of data to support these disparate models.
This episode is sponsored by: Deerwalk.
Honest discussion on Reference Based Price with Steve Rasnick: Steve is a veteran of the TPA space, having built and sold multiple TPA businesses, and more importantly a strong believer in the value of bringing innovation and better solutions to the self-insured employer industry. Today's podcast will answer questions about where RBP works, who is the right employer, what happens to the employee and provider relations, is it worth it, what are the steps to take to make RBP effective? We’ll also examine what can you do to improve patient education/advocacy, and what are still some of the challenges involved in selling and supporting RBP?
This episode is sponsored by: MedWatch.
Virtual Primary Care of the future: We interviewed Paul Kowalski, one of the early enthusiasts of telemedicine, and currently VP & GM at Teledoc Health. Today's podcast will answer key questions about telemedicine, whether it is a affordable alternative to various healthcare needs, the value offer for the consumer and employer, and the transition from episodic care to continum care. And, we'll discuss the vision for virtual primary care, and perhaps some of the challenges along the way.
This episode is sponsored by: DataPath.