The ShiftShapers Podcast: Recent Episodes
David Saltzman
Change either paralyzes or energizes - the choice is yours. David Saltzman is one of the foremost experts in Transformation Strategies. In Shift Shapers, we will introduce you to businesses and entrepreneurs who have become energized and who have profited by shaping the shifts in their markets and practices.
Cybercriminals don’t need to “hack” our systems when they can trick someone into handing over access, and AI is making those tricks more realistic and scalable. We talk with Daniel Metcalfe of Cyberfin about where benefits advisors are most exposed and the layered, practical steps that reduce breach risk while still letting teams use AI responsibly.
• why employee and employer data is “gold” to attackers
• how advisors get used as a pathway to bigger targets
• why MFA and antivirus alone don’t stop social engineering
• where agencies are most vulnerable today: email credentials and tool connections
• what “layered” user-based protection looks like in real life
• why password managers change the social engineering game
• how ongoing security awareness training finds gaps faster than annual check-the-box training
• why cloud storage is not the same as encrypted backups
• how AI is already being used inside agencies without formal approval
• practical AI wins that avoid sensitive data and improve efficiency
• what client expectations are becoming in an AI world and why relationships still matter
The fastest way to waste a benefits budget is to ignore the beliefs running the workplace. If employees aren’t engaging with expensive benefits plans, the problem may not be the coverage or the vendor list. It may be the everyday mindset that shapes trust, motivation, and how safe people feel speaking up.
We sit down with Lizzie Benton, founder of Libertymind, to unpack what “mindset” really means inside an organization and how it quietly becomes culture through habits, language, and leadership norms. We explore why values on a wall don’t matter if the lived experience signals control or suspicion, and how a transactional employer-employee relationship can drain performance even when the perks look generous. Along the way, Lizzie shares practical ways to build trust through authenticity and vulnerability, including the simple power of saying “I don’t know, but I’ll find out.”
For employee benefits advisors and small business owners, we get concrete about what to watch for: the phrases leaders use about their teams, the emotional “temperature” when you walk into an office, and the subtle signs that disengagement is baked into the system. We also challenge the “more benefits equals better results” assumption by focusing on intrinsic motivation: autonomy, agency, growth, and meaningful impact. Finally, we look ahead at the AI workplace and why culture, communication, and human connection become even more important as mundane work gets automated.
If you want better employee engagement and better benefits ROI, press play, then subscribe, share this with a colleague, and leave a review with the culture signal you think advisors should never ignore.
We talk with Jared Pierce about why many provider networks run on outdated contracts and why that breaks trust for providers, members, and plan sponsors. We dig into how Unity builds a primary, provider-aligned network for self-funded plans that protects access while still driving real savings.
• Jared’s early start building PPO networks at 17 and how it shaped his view of the system
• Why legacy PPO networks “live off old paper” and what that means for pricing and trust
• How reference-based pricing can create confusion, appeals, and members turned away
• What “RBP-level reimbursement with real contracts” looks like in practice
• Using historical claims data and member nominations to build a customized network
• Why clear, simpler contracts improve provider participation and reduce noise
• Bootstrapping growth without private equity and staying independent longer
• Where Unity is seeing adoption and what advisors should watch next
• The future network model tied to member incentives and smarter plan design
We bring compliance specialist Carol Taylor back to unpack why employers keep getting blindsided by benefit plan obligations like RXDC reporting, PBM disclosures, and fiduciary duties under ERISA. We map the real-world risks, the paperwork traps that cause rejected filings, and the simple audit habits that keep penalties from stacking up.
• RXDC reporting basics and why it exists
• why employers still miss RXDC years later
• where legal responsibility lands even when vendors file
• practical steps for HIOS access and employer uploads
• CAA 2026 expansion of PBM disclosure and rebate rules
• what PBM transparency can reveal about pricing and compensation
• ERISA fiduciary exposure for employers and individual decision-makers
• how advisors draw boundaries to avoid functional fiduciary status
• renewed ACA employer mandate enforcement around 1094 and 1095 filings
• why a mental health parity enforcement pause does not remove MAPEA duties
• ongoing No Surprises Act IDR problems and cost impacts
• using a compliance audit checklist and reviewing E&O coverage limits
We talk with Mark Gaunya about why employer health insurance often feels like a casino where the house wins and how employers can flip the odds with transparency, ownership, and smarter plan design.
We break down how captive risk sharing works, what it takes to implement, and the real financial and employee-experience wins that come from getting off the less bad renewal hamster wheel.
• Why the US healthcare system “works” as designed for rulemakers, not end users
• How the less bad renewal cycle traps employers without claims data and transparency
• Why Mark wrote Captivated Health and how case studies teach faster than jargon
• Captive insurance versus traditional self-funding, including stop loss and risk layers
• The four pillars of Captivated Health: members first, consumerism, wellbeing culture, self-governance
• How employers can control the SPD, stop loss contract, and TPA agreement
• outcomes from captive ownership: lower trend, pharmacy control, surplus, and rebate distributions
• Practical stories: bundled maternity pricing plus shared savings, adding LASIK through plan design
• The leadership mindset shift from system decision to self-decision
• What implementation really looks like for HR and finance without adding headcount
If you're an employer and you're struggling with these kinds of issues, and most of you are, or if you're a broker and you have clients who are struggling with these issues, please get the book, "Captivated Health. Take Control. Gain Transparency. Leverage Confidence." CLICK HERE
We challenge the old wellness playbook and show how coaching, claims integration, and clinical guardrails turn behavior change into measurable cost control. GLP-1s, chronic condition priorities, and realistic timelines come together in a system that bends trajectories instead of chasing fads.
• why awareness and incentives fail without habit formation
• building coaching into chronic care to shift daily decisions
• measuring ROI with leading indicators and claims trends
• onboarding with claims to target high-impact conditions
• integrating point solutions into a coordinated system
• using GLP-1s with coaching, guardrails, and taper plans
• setting realistic timelines for years two and three
• how AI and claims integration guide next-best actions
For more information or to schedule a demo of the Benepower Advantage, go to Benepower.com
They absolutely can either call me or they can email me at arutkowski at navigatewell.com
Medicare is full of fine print, fast-changing rules, and enough junk mail to fill a suitcase. So what actually separates the agents who barely survive from the ones who become the trusted name in their community? We sit down with Paige Phillips, founder of the Paige Phillips Insurance Agency and author of Medicare Playbook for Agents, to get practical about what works when the stakes are someone’s healthcare and finances.
We talk about the unglamorous details that build a thriving Medicare book of business: relationship-building, client education, and the discipline of doing a true needs analysis. Paige shares why “getting the plan right” means checking doctors and prescriptions down to the dosage, and why the best agents think long-term through retention, renewals, and referrals instead of chasing AEP like a short-term payout. We also dig into year-round touchpoints that keep clients connected, from birthday outreach to thoughtful follow-up after major health events, and how a simple “call me first” mindset protects seniors from confusing ads and sales calls.
On the regulatory side, we cover Medicare compliance, CMS oversight, and why cutting corners is the fastest way to lose trust. Paige breaks down IRMAA (the income-related monthly adjustment amount), the two-year lookback, and how to set expectations so clients aren’t blindsided by a premium surcharge. We close by looking forward at technology and AI, and what the next generation of retirees may demand from the Medicare enrollment process.
Subscribe for more conversations on the shifts shaping benefits and insurance, then share this with an agent who cares about doing it right and leave us a review with your biggest Medicare question.
Healthcare stays expensive because the system hides prices and quality from the people paying for care, especially employers. We talk with Katie Talento about how CAA 2026 transparency and Department of Labor fiduciary rules could expose PBM practices, reshape contracting, and give plan sponsors real leverage if enforcement follows.
• Why invisible prices and invisible quality break the healthcare market
• How incentives and lobbying protect opacity across hospitals, PBMs, insurers and drugmakers
• Why Washington lacks ERISA and employer-plan expertise
• What CAA 2026 changes for PBM disclosures and fiduciary responsibility
• How “check the box” compliance can fail without enforcement
• How employers can use machine readable files plus claims data for network analysis
• Why cash-pay and direct contracting get blocked by network contract provisions
• What near-term reforms could bend the cost curve, including stronger HSA and ICHRA models
You can find me at katytolento.com
Surprise billing for patients is largely gone, so why are so many self-funded employer health plans still getting hammered by out-of-network costs? We sit down with Scott Bennett, Chief Provider Relations Officer at the PHIA Group, to unpack what the No Surprises Act is doing in the real world and why federal arbitration is starting to look less like a safety valve and more like a payment engine.
Scott walks us through the mechanics that matter: QPA as the median contracted rate, the short open negotiation window, and the IDR process where an arbitrator picks one of two numbers. Then we dig into the headline signals from PHIA’s national NSA report analyzing more than 1.25 million federal IDR disputes across 23,000-plus providers. When offers land five to six times above QPA and initiating parties win around 80% of the time, it creates a powerful incentive to file early and file often. For employer-sponsored health plans, especially self-funded groups like school districts and public safety employers, that can translate into budget shocks, higher renewals, and rising stop-loss pressure even when members never see a bill.
We also explore why a small cluster of providers can drive a disproportionate share of disputes, what hotspots in certain states may be telling us about market power and network penetration, and how brokers and benefits advisors can protect clients with better data, tighter timelines, and a real IDR strategy instead of a reactive scramble. If you advise plan sponsors, this is a must-listen on NSA compliance, healthcare cost containment, fiduciary responsibility, and the evolving economics of out-of-network reimbursement.
If this helped you, subscribe, share it with a colleague, and leave a review so more plan sponsors and advisors can find the conversation. What IDR pattern are you seeing in your own claims data?
Employers keep paying for the symptoms of obesity, diabetes, and metabolic syndrome while the root causes go untouched. We unpack why many wellness models fail, how insulin resistance hides for years, and what chronic disease reversal can look like when a physician-led metabolic health team measures the right signals and tapers meds safely.
• metabolic syndrome as a dominant driver of employer healthcare costs
• why low-fat guidance and ultra-processed food worsen hunger and outcomes
• fasting insulin and CGMs as earlier and more actionable markers than glucose alone
• nutritional ketosis versus diabetic ketoacidosis and why the terms get conflated
• GLP-1 medication costs plus the idea of a structured GLP-1 off-ramp
• reported outcomes including weight loss and guaranteed improvements in A1C and blood pressure
• deprescribing as a safety requirement when health improves quickly
• ROI logic for self-funded plans including claims reduction and lower pharmacy spend
Call my cell phone, 262-255-9545. brett@toward.health
We explore how employers can manage healthcare like any other cost by shifting from insurer-built, passive plans to employer-built, actively managed designs. Carl Schuessler, Jr. shares candid tactics on data, precision testing, and honest change management that help advisors become true risk partners.
• defining a health plan mission that aligns to EBITDA and predictability
• focusing on data hot spots such as MSK, imaging, pharmacy, and facilities
• using billing audits and cost containment partners to reduce leakage
• when and how to apply precision tests as costs drop
• overcoming fear of self-funding with worst-case clarity and reserves
• building crawl-walk-run-fly ramps with navigation, pharmacy, and bundles
• unbundling components to align incentives and improve outcomes
• elevating advisors to CFO-level strategic partners
As a benefits advisor, you need more than a platform. You need a partner that makes you indispensable and impossible to replace. That’s BenePower. For more information or to schedule a demo of Benepower, go to BenePower.com
We dig into who truly makes claim decisions in self-funded plans and why that matters when ethics and compliance collide. Adam Russo shares how fiduciary prudence, transparent compensation, and NSA arbitration are reshaping risk, trust, and costs.
• plan sponsors as final decision makers on claims
• plan documents lagging laws and mandates
• compliance versus ethics as distinct obligations
• transparent compensation, performance fees, and caps
• fiduciary prudence in subrogation and settlements
• NSA and IDR process failures driving higher spend
• negotiation strategy, data, and calibrated offers
• governance, documentation, and audit-ready processes
For more information or to schedule a demo of Benepower, go to BenePower.com
We dig into why growth stalls when roles blur and the founder stays the bottleneck. Forrest Durer shows how clear seats, weekly scorecards, and steady leadership cadence create accountability and make scaling calm and repeatable.
• common founder-led bottlenecks and warning signs
• seats defined by 5–7 responsibilities not titles
• building a simple pyramid with an integrator or COO
• activity-based KPIs and weekly scorecards
• busy work versus productive work
• weekly one-to-ones and leadership cadence
• documenting processes for onboarding and quality
• writing and using vision and core values daily
• letting go at the 80% standard to free the founder
• when and how to use fractional leaders
We revisit how employers can control healthcare spend while expanding employee choice through ICRAs, with Chad Schneider of Thatch sharing what works, what breaks, and what’s next. We dig into change management, decision tools, dynamic contributions, and the broker’s evolving role.
• Why ICRAs surged after 2020 and boomed in 2024
• Carrier expansion and a stronger individual market
• The real barrier being change management and fintech
• Decision support that mirrors travel-style shopping
• Dynamic contributions that create equity across markets
• Carve-out classes to manage renewals and strategy
• Common misconceptions among brokers and employers
• Data, APIs, and real-time enrollment tracking
• Emerging perks, localized networks, and future trends
Please feel free to go to our website, which is thatch.com, reach out to me on LinkedIn. I’d love to chat with you, and we can happily go through our process, quoting, show you all the cool bells and whistles, and we’d love to be able to engage further.
We revisit how PPOs got built on discounts and show why total value beats sticker price. Scott Smith joins us to explain nationally curated high-performance networks that rank providers on effectiveness, appropriateness, and cost, and how that changes renewals, member experience, and fiduciary risk.
• why traditional PPO discounts miss total cost of care
• how consolidation and narrow networks increase abrasion
• claims-based scoring at the provider NPI level
• quality metrics that matter: effectiveness, appropriateness, cost
• member tools: stars, plain-language summaries, mobile access
• plan design that waives cost sharing for high-quality choices
• PEPM pricing without shared savings games
• national footprint for TPAs and large employers
• faster ROI and improved MLR through reduced waste
• roadmap to a true BUCA alternative
We explore how reducing variation in cost, outcomes, and experience creates real value, and why deep provider metrics and real-time member support outperform box-checking credentialing. Kate Grohal shares a playbook for aligning incentives without repeating the mistakes that soured HMOs.
• defining quality as reducing variation across cost, outcomes, experience
• Kate’s path from patient escort to quality leader
• why NCQA alone falls short for measuring provider performance
• additional metrics: infection rates, readmissions, team engagement, co-management
• building value-based networks that screen out low-performing providers
• real-time care navigation via nurses, MAs, and app-based prompts
• behavior change through waived cost-sharing and premium reductions
• the downside of PEPM fees and paying for non-performance
• differentiating value-based care from old-school HMO denial tactics
• employers moving from back seat to driver’s seat
• tech adoption gaps and the next five-year horizon
Visit BenaPower.ai or email info@BenaPower.com to schedule a demo
For more information, visit HatcherMedia.net — that’s H A T C H E R Media.net
We revisit the rising problem of the “functionally uninsured” and ask how to restore real access for employees who delay care because of confusion and cost. Paymedix CEO Tom Policelli shares how a super EOB, upfront provider payment, and 0% financing change behavior and bend trend.
• confusion outranking cost as the top barrier to care
• hospitals pushing prepayment and the access wall it creates
• income-tier patterns driving ER and inpatient overuse
• super EOB mechanics and single monthly reconciliation
• provider payment upfront and revenue-cycle relief
• employer savings of two to three trend points annually
• advisor positioning and retention benefits
• partnerships with EXO Health to improve network economics
• TempoPay for pharmacy access and first-dollar fills
• risk management via broad pooling and automatic eligibility
• national expansion through aligned partners and TPAs
• a third path beyond prepay or bill-and-pray collections
“Go to PayMedix.com.”
Pharmacy benefits shouldn’t feel like a black box. We sit down with Susan Thomas, Chief Commercial Officer at Lucy Rx, to unpack why drug costs keep rising and what it takes to build a benefit that serves patients and plans—not middlemen. Susan started as an oncology nurse and moved into PBM leadership, and that dual lens shows up in everything we cover: from the real-world stress of waiting days for an oral chemo to the hidden economics of rebate chains and vertically integrated networks.
We dig into the two biggest levers for change. First, formulary autonomy: instead of being locked to a single, opaque GPO, a marketplace approach lets employers compare multiple rebate contracts, see drug-level net cost, and choose the best path for categories like Humira biosimilars or GLP-1s. That shift enables utilization management that protects value without opening the floodgates. Second, network independence: when PBMs own specialty and mail, steering is inevitable. By contracting with integrated health systems for specialty and modern mail partners for home delivery, plans can speed therapy, reduce waste from 30-day auto-ships, and improve member experience at a lower overall cost.
We also talk fiduciary duty, policy momentum, and technology. Employers need verifiable net-cost math—not averages—to defend decisions in a post–J&J lawsuit world. Washington’s scrutiny is rising, and incumbents are signaling changes, but structural misalignments remain. On the tech front, AI-driven reporting and specialty navigation are already here, while precision medicine and pharmacogenomics promise to target high-cost drugs to the patients who will benefit most. The question is whether the industry will embrace smaller, smarter populations when volume shrinks and outcomes improve.
If you care about cutting pharmacy spend without compromising care, this conversation is a practical roadmap: ask for drug-level net cost, insist on formulary choice across GPOs, require independent specialty and mail, and set utilization criteria that put patients first. Subscribe, share this episode with a colleague who manages pharmacy benefits, and leave a review with the one PBM metric you wish you’d had sooner.
What if benefits work leaped from horse‑and‑buggy speed to highway pace? We sit down with Julian Lago, co‑founder and CEO of BenePower, to explore how AI is already compressing days of quoting, enrollment, and service into minutes—and what that means for brokers, HR leaders, and members who need clear answers right now.
We dig into the practical side of agentic AI and retrieval‑augmented generation: how specialized models fetch plan rules, accumulators, and pending claims to answer real‑world questions like “what’s left on my deductible?” with accuracy. Julian explains why virtual care is no longer just telemedicine, how ambient documentation can free clinicians to focus on patients, and why unified front‑door experiences beat a jumble of point solutions. Along the way, we talk about emotion AI that detects stress, switches languages seamlessly, and brings empathy to urgent moments—like getting an ID card to a parent driving to urgent care—without losing speed or precision.
For employers, the conversation moves from tools to outcomes: steering to high‑value care, reducing surprise bills, and designing plans people actually use. For advisors, it’s a playbook for differentiation—showing clients how to use data, automation, and hyper‑personalization to improve health and lower costs while keeping a human in the loop for sensitive decisions. We also address the hard edges: privacy, HIPAA alignment, model hallucinations, and emerging state regulations that set boundaries around clinical advice.
If you’re ready to trade legacy friction for clear, measurable gains, this episode lays out where to start, what to watch, and how to scale. Subscribe, share with a colleague, and leave a review telling us which workflow you want AI to fix first.
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Change can energize or paralyze—so we chose energize. We sat down with Eric Silverman, founder of Voluntary Disruption and a four-time guest, to unpack what’s actually moving the needle in enhanced benefits today. The surprise? Products haven’t radically shifted, but execution has. Simple, high-interest options like pet insurance, ID protection, legal plans, and life paired with long-term care continue to win attention. The real breakthroughs are how teams communicate, guide choices, and run enrollment with less friction and more trust.
We dig into decision support tools and their mid-market roadblocks, then map how AI can personalize choices with Amazon-like clarity. Think smart nudges that connect plan design to real life: a high-deductible plan paired with accident coverage, or young families steered toward urgent care-friendly options. We also trace a major distribution shift—from carrier direct to advisor-led strategies—where brokers step up to own the full package: medical, pharmacy, disability, life, and voluntary. That move isn’t just good practice; it’s how you reduce risk across absenteeism, presenteeism, and unexpected costs.
Communication is where results jump. Text-first outreach beats inbox fatigue. Short, captioned videos from HR leaders outperform generic vendor clips. Family-focused messaging, including the emergency contact, turns open enrollment into a shared decision. We share a practical playbook: launch midweek, keep enrollment windows short, host content on a 24/7 microsite with searchable chapters, and go off the January 1 cycle to escape fourth-quarter chaos. Virtual, self-service enrollment replaces one-on-one sales pressure and leaves a clean digital trail that cuts buyer’s remorse and HR headaches.
If you advise employers—or lead HR—and want better participation without arm twisting, this conversation gives you the modern blueprint. Subscribe, share with a colleague who needs a smarter enrollment strategy, and leave a review with your top takeaway so we can dive deeper next time.
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
What if the clinic your team actually uses is the one parked outside the office? We sit down with Chris Yarn, CEO of Walk On Clinic, to unpack why on-site and mobile primary care crush near-site options on utilization, trust, and measurable savings—often with fewer clinic days. The story begins with a simple truth: convenience wins. When clinicians are visible and familiar, employees engage more, follow through on care, and keep the relationship going virtually with the same people they see in person.
We break down a standout case: a near-site clinic three days a week just over a mile away versus a mobile clinic two days a week on-site. After ten months and 800 employees, 515 chose on-site, only 15 went near-site. That utilization shift powers tangible outcomes: lower urgent care and ER visits, time savings measured against payroll, and pharmacy strategies that can offset clinic costs. Chris explains how zero-dollar ghost claims at Medicare rates create conservative ROI models, and how plan-aligned referrals remove the “we don’t take your insurance” friction that derails self-funded plans.
You’ll hear a practical framework for choosing the right model: headcount thresholds, geographic routing for distributed workforces, and which plan designs benefit most. We also explore how a broker’s mindset shaped Walk On Clinic’s approach—quarterbacking imaging, specialty, and pharmacy decisions so plan assets get used. Along the way, Chris shares lessons on branding and visibility, from creative content to educating the market on why hybrid care—on-site plus virtual continuity—outperforms stand-alone telemedicine.
If you’re a benefits leader, broker, or operator hunting for real-world ROI and a better member experience, this conversation is a playbook for turning primary care into the true front door of the plan. Subscribe, share with a colleague, and leave a review with your biggest question about building on-site access at scale.
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
We explore what executive coaching really is, how it helps leaders make better decisions and show up with presence, and why advisors can use it to grow their practice and help clients cut costs and claims. We share signals that coaching is needed, how to introduce it without awkwardness, and how to build strong referral partnerships.
• Clear definition of executive coaching and who benefits
• Common leadership traps and the “business affair” pattern
• Executive presence as a practical skill set
• Turning vague goals into measurable outcomes
• How advisors spot coaching cues in client orgs
• Scripts for raising coaching without judgment
• Building trusted referral partnerships with coaches
• Why AI and hybrid work raise the stakes
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Healthcare costs keep climbing while employees want plans that actually fit their doctors, budgets, and lives. We tackle that tension head-on with Chad Schneider, head of broker channel at Thatch, and unpack how ICHRAs—individual coverage HRAs—let employers lock in predictable budgets while giving every employee real choice on the individual market.
We start by demystifying ICHRAs and why 2024 became the breakout year: broader carrier participation, stronger individual risk pools, and better technology. Chad breaks down the biggest barriers leaders worry about—change management, compliance, billing across multiple carriers and states—and shares how infrastructure-first platforms handle the messy “money movement” behind the scenes. From clean decision support that feels like booking travel to licensed, state-specific experts for complex cases, we show how employees can navigate dozens of plans with clarity and confidence.
Then we get tactical. You’ll hear how to design contribution strategies that create equity across age and geography, using dynamic benchmarks instead of blunt flat-dollar allowances. We explore the 11 ICHRA classes for smart carve-outs, the role of voluntary and high-impact perks, and how newer carriers are pushing legacy players to improve networks and benefits. On data, we explain what you can measure without claims visibility—engagement, satisfaction, enrollment completion—and how emerging APIs make application tracking and digital ID cards standard rather than speculative.
Looking ahead three to five years, Chad forecasts tighter integrations, more transparent pricing, and perks once reserved for large groups becoming available to small employers. The result is a practical blueprint: cap volatility, expand choice, and elevate the broker’s role from renewal jockey to program architect. If you’re ready to rethink the benefits playbook and give your team plans that fit their lives, this conversation lays out the steps and the pitfalls to avoid.
Enjoyed the conversation? Follow the show, share it with a colleague, and leave a quick review to help more leaders discover smarter benefits strategies.
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Costs are spiking, access is shrinking, and members are stuck on hold while scans get delayed—yet the fix might be hiding in plain sight. We sit down with Dr. Cristin Dickerson, CEO of Green Imaging, to unpack how independent imaging, transparent bundles, and human-led AI can lower trend, reduce friction, and actually make benefits plans feel usable. From private equity acquisitions that quietly triple rates to the national radiologist shortage sparked by years of “AI will replace you” hype, we trace the real-world forces shaping price, quality, and time-to-care.
Cristin shares a playbook advisors and employers can put to work now: build redundancy so a single tech outage doesn’t stall care, keep the front end human while automating the back office, and route members to independent centers with clear, all-in pricing. You’ll hear how a large Texas municipality sought savings but discovered a bigger win—restored access that gave employees back hours and eliminated surprise bills. We delve into what price transparency rules overlook, why hospital quotes are often incomplete, and how direct-pay bundles circumvent games that leave members vulnerable.
We also get practical on tech. Forget AI that “reads the study” in isolation; the real gains come from tools that structure reports so radiologists never take their eyes off images, and from analytics that turn one CT into population health insights like bone density, coronary calcium, and cardiac chamber sizing. Add a clinician portal that lets DPCs and primary care search by code and price, submit narrative orders, and reach a radiologist by phone, and virtual care starts to work the way it should—fast, connected, and accountable.
If you advise employers or run a health plan, this is a roadmap to cut waste without compromising care: utilize data maps and claims rebundling to model savings, favor DPC-centric designs for a simpler member experience, and help independent centers remain independent with fair, direct contracts. Subscribe, share with a colleague who battles imaging chaos, and tell us: where are your members getting stuck, and what would a clear path to a scan change look like for your team?
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Leadership bottlenecks can silently strangle even the most promising companies. When decisions, initiatives, and progress all funnel through one person—typically the founder or CEO—growth becomes impossible. Charlie Rhea knows this pattern all too well.
As an implementer of the Entrepreneurial Operating System (EOS), Charlie has witnessed the remarkable transformation that occurs when leadership teams embrace a different way of operating. The framework he teaches provides three critical benefits that most organizations desperately need: crystal-clear vision, disciplined execution (what EOS calls "traction"), and team health built on vulnerability-based trust.
What makes EOS particularly effective is its practical simplicity. Rather than offering vague leadership principles, it delivers concrete tools like the Accountability Chart—an organizational structure that flips conventional thinking by designing around functions first, then placing people second. This approach systematically eliminates bottlenecks by distributing accountability throughout the leadership team.
The most surprising element Charlie emphasizes is the often-overlooked importance of team health. Drawing from Patrick Lencioni's work, EOS focuses on creating vulnerability-based trust—the willingness to have difficult conversations for the greater good of the company. As Charlie notes, "Culture eats strategy for breakfast," and no amount of brilliant planning can overcome a dysfunctional leadership team.
"The Five Dysfunctions of a Team" - Patrick Lencioni
"Traction" - Gino Wickman
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
High-deductible health plans have created "functionally uninsured" people who have insurance cards but can't access care due to high out-of-pocket costs, creating barriers to necessary healthcare and driving up long-term expenses. We discuss a solution with Tom Policelli of Paymedix.
• Consumer confusion about benefits is the #1 issue, with affordability a close second
• 45% of insured people avoided necessary care last year due to cost concerns
• Nearly 30% of hospitals now require payment before scheduling services
• 25% of commercially insured people have no available credit
• Healthcare utilization by lower-income tiers mimics Medicaid patterns - delaying care until emergencies
• PayMedix's "Super EOB" consolidates billing and offers 0% interest financing
• Employers using PayMedix save 2-3% annually on healthcare trend
• Unlike consumer credit companies, PayMedix uses an insurance mindset to spread risk
• PayMedix maintains 95% employer retention versus the 30% industry average
• TempoPay acquisition provides a card-based solution for pharmacy costs
• Partnerships with companies like XO Health are expanding PayMedix's reach nationwide
Visit paymedix.com to learn more about implementing these solutions.
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
A 75-year legacy built on survival, relationships and faith continues to drive innovation at Conner Insurance, where CEO Ben Conner and his team focus on providing sound counsel during life's most significant moments.
• Founded in 1949 by WWII veteran Henry Clay Conner Jr., whose 30 months surviving in Philippine jungles shaped core values of seriousness, relationships, and entrepreneurial spirit
• Second-generation leadership of four Conner brothers emphasized shepherding the next generation into leadership roles while maintaining family values
• Mission evolved from "selling policies" to walking alongside clients during critical life moments including medical diagnoses, accidents, and positive transitions
• Over 80% of clients experience flat or reduced healthcare expenses through innovative supply chain management, especially in pharmacy benefits
• Team members know individual patients by name, working to source medications affordably for both employers and employees
• Documentary "It's Not Personal, It's Just Healthcare" educates about systemic problems in healthcare delivery
• Challenges traditional strategies like high-deductible health plans that create false "consumerism" while making healthcare inaccessible
• Remains independent despite private equity consolidation in insurance industry, focusing on talent development and embracing technologies like AI
Visit connerins.com to watch the full documentary "It's Not Personal, It's Just Healthcare" and learn more about their approach.
"It's Not Personal, It's Just Healthcare"
"The Ideal Team Player" - Patrick Lencioni
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Jessica DeAngelo, Chief Hiking Officer at Hike to Become, shares how unplugging in nature revolutionizes business thinking and helps executives rediscover clarity and creativity away from digital distractions.
• Former global sales director who transformed her life by committing to daily hiking after feeling overwhelmed by corporate demands and new motherhood
• Created the Hike 31 Challenge based on four principles: Hike or walk, In nature, Keep tech off, Every day
• Takes executive teams on guided hiking experiences that create space for connection and independent thought
• Incorporates forest bathing exercises that allow business leaders time alone with their thoughts
• Clients report experiencing clarity on complex problems, rediscovering joy, and generating breakthrough business ideas
• Companies see ROI through faster decision-making, innovative approaches, and reduced executive burnout
• New book "The Wild Advantage" explores how reconnecting with nature helps executives think more creatively in the age of AI
Text HIKE to 33777 to join the Hike 31 Challenge or visit Jessica DeAngelo.com to learn more about bringing this transformative experience to your team.
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Paid leave has transformed from a nice-to-have into a powerful retention and engagement tool for employers seeking to attract and keep top talent. Seth Turner of AbsintheSoft shares insights on how properly structured leave programs can create positive employee experiences that drive loyalty and productivity.
• 86% of employees look for paid leave when job hunting, and 42% won't apply without it
• Well-designed leave programs should address diverse workforce needs across life stages
• Employees who feel supported during leave are more likely to return engaged and become brand ambassadors
• The regulatory landscape is growing increasingly complex with 13 states now mandating paid family leave
• Technology helps streamline administration, maintain compliance, and improve employee experience
• Utilization rates vary by industry, ranging from 10-40% of employees taking leave annually
• Effective programs consider both compliance requirements and strategic business objectives
• Modern systems use AI and mobile communications to simplify processes for all stakeholders
To learn more about managing paid leave effectively, visit absensesoft.com or contact Seth directly at seth@absencesoft.com
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
We explore the concept of time as our most precious resource with Andrew Hartman, founder of TimeBoss, who shares a framework for achieving results without overwhelm and burnout.
• Andrew's journey began when work stress caused him to lose his sense of smell for six months
• 77% of knowledge workers experienced burnout in the past year, up from 75% pre-COVID
• The "always on" work culture has eliminated boundaries between professional and personal life
• Most people treat time like credit instead of cash, creating debt for their future selves
• Setting a work hour constraint (Andrew uses 50 hours) forces better prioritization
• Weekly planning meetings help identify the 20% of tasks that yield 80% of results
• Implementing strategic time management can reclaim 4-10 hours per week
• "Comeback time" after interruptions can take up to 23 minutes of productivity
• Creating "commitment plans" and finding "vacation shields" allows for true rest
• Working at your "highest sustainable pace" enables sustained peak performance
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Recorded live at the Ascend Conference in Salt Lake City, David A. Saltzman sits down with Hans Kullberg, CEO and Founder of Avocado Health. Together, they explore how Avocado Health is solving one of the biggest challenges facing employers and employees alike: helping working parents get the right answers, right when they need them.
Hans shares how his own journey as a father of five inspired him to build a text-first platform that provides parents with evidence-based guidance on everything from toddler sleep issues to adolescent anxiety—without the endless rabbit holes of Dr. Google.
The discussion covers the massive productivity costs of presenteeism, why text messaging is the most effective format for support, and how AI plus human advocates deliver empathetic, on-demand solutions that reduce stress for families and cut costs for employers.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Working Parents = Productivity Costs
60% of employees are parents, and presenteeism costs employers $8,000 per worker annually.
📌 Texting Beats Dr. Google
Avocado Health uses SMS to deliver expert pediatric, developmental, and behavioral guidance instantly.
📌 AI + Human = Empathy at Scale
97% of questions can be answered by AI, with human advocates stepping in for complex cases.
📌 Reducing Claims and ER Visits
Quick triage and trusted guidance prevent unnecessary urgent care and hospital costs.
📌 Boosting Benefits Utilization
The platform helps employees discover and use existing employer-sponsored resources.
⏱️ In This Episode
00:00 Live from Ascend: Introducing Hans Kullberg
02:00 From fatherhood to founding Avocado Health
04:00 The scope of challenges working parents face
07:00 Presenteeism, absenteeism, and attrition explained
10:00 Why text messaging is the most accessible solution
14:00 AI + human empathy in care delivery
18:00 Real-life RSV case study: avoiding hospitalization
22:00 Connecting employees to existing plan benefits
26:00 Employee onboarding and education via SMS
30:00 Serving rural and underserved populations
34:00 The future: languages, Medicaid, municipalities
38:00 Building scalable, accessible support for all parents
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Recorded at the Ascend Conference in Salt Lake City, David A. Saltzman talks with Lorenzo Amaya, Vice President of Business Development at Integrated Source One. They explore the nationwide physician shortage, the challenges of quality care and timely access, and how innovative solutions like on-site, near-site, and mobile clinics are changing healthcare delivery for employers and employees alike.
Lorenzo shares his journey from banking to telemedicine, and how Integrated Source One works to remove friction from care — making it more affordable, proactive, and accessible no matter where employees are. The conversation dives into proactive healthcare strategies, the role of virtual primary care, and meeting patients where they are with flexible delivery models.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 The Physician Shortage Is Real
Patients are waiting months for appointments, creating a bottleneck in care.
📌 Quality and Access Go Hand in Hand
Lorenzo explains why true care solutions must address both simultaneously.
📌 Virtual Care Is Here to Stay
From chronic condition management to urgent needs, telehealth is becoming the norm.
📌 On-Site, Near-Site, and Mobile Clinics Reduce Friction
Flexible care delivery can keep employees healthier and out of the ER.
📌 Proactive Care Saves Costs
Continuous access and preventive screenings stop expensive, episodic events before they happen.
⏱️ In This Episode
00:00 Live from Ascend: Introducing Lorenzo Amaya
02:00 From banking to telemedicine and healthcare innovation
04:30 The scope and causes of the physician shortage
07:30 Quality of care and reimbursement challenges
10:00 The telehealth boom post-COVID
13:00 Generational comfort with virtual healthcare
16:00 Streamlining access for better patient experiences
19:00 On-site, near-site, and mobile clinics explained
23:00 Cost and feasibility considerations for employers
26:00 Serving underserved and rural areas
29:00 Proactive care vs. urgent care
33:00 Employer adoption and employee education
37:00 Reducing ER visits and plan costs
40:00 Frictionless care for better outcomes
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Recorded live at the Ascend Conference in Salt Lake City, this episode of ShiftShapers features John Troutman, Vice President of Business Development at Mind Club America. Host David A. Saltzman and John discuss the “mutual mystification” surrounding mental health solutions—and how employers and advisors can start cutting through the noise with real access, real engagement, and real outcomes.
From personal burnout to a professional mission, John shares how his experience as a former pastor helped shape his drive to help a million people get the mental health support they need. The conversation unpacks access issues, poor utilization reporting, stigma, and the vital importance of employer-led engagement.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Access Delays Are Still the Norm
Even with growing awareness, many plans make employees wait 3–5 months for help. Mind Club offers care within 2 business days.
📌 Engagement Starts at the Top
Mental health solutions are most effective when leadership participates first and normalizes use among employees.
📌 Mental Health Month ≠ Mental Health Action
Awareness isn’t enough. Employers must embrace solutions that proactively support emotional well-being year-round.
📌 Most Utilization Reports Are Useless
John explains why vague or absent reporting leaves employers in the dark about what they’re actually paying for.
📌 Proactive Care Beats Reactive Cleanup
Mind Club encourages regular mental fitness with assessments, gamification, and behavioral nudges before crisis hits.
⏱️ In This Episode
00:00 Live from Ascend: Introducing John Troutman
02:00 Burnout, personal healing, and a mission to help a million people
05:30 What is “mutual mystification” in mental health?
08:00 The real-world problems with EAPs and plan access
10:30 Access in two days—not months
12:00 Predictive vs. reactive mental health models
15:00 How Mind Club’s app keeps users engaged
17:30 Messaging employees: Start with leadership
20:00 Why reporting and data transparency matter
23:00 How to start the mental health conversation with skeptical employers
27:00 What employers want: happier, healthier teams
30:00 Looking ahead: personalization, AI, and robust networks
34:00 Mind Club’s flexibility across funding models
36:00 Final thoughts on solving the mental health crisis
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
In this episode of ShiftShapers, host David A. Saltzman sits down with Reuven Shelef, CEO of Out of the Box Consulting and creator of the Untangling Complex Challenges methodology. Reuven shares why our brains default to negativity when faced with uncertainty—and how to move from emotional reactivity to clarity and action.
With a blend of logic and emotional insight, Reuven helps leaders and teams understand how to recognize internal blockers, reframe stress, and break through stuck patterns—professionally and personally.
More from Reuven Shelef: https://ReuvenShelef.com/
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at http://BenePower.com
🔑 Key Takeaways from This Episode
📌 Negativity Comes First—By Design
Our brains are wired for survival, not solutions. Recognizing this helps us shift toward creative thinking.
📌 You’re Not Powerless
Reuven explains how we can reclaim control—even when external systems and policies feel overwhelming.
📌 The Story Is the Stress
Often, it’s not the facts that hurt us—it’s the story we tell ourselves about those facts.
📌 Getting Unstuck Starts With Awareness
A simple process of brain dumping and categorization reveals surprising root causes—and new options.
📌 Leaders Must Create Space
Inviting authentic conversation and emotional safety at work can unlock powerful transformation.
⏱️ In This Episode
00:00 Why people get stuck under pressure
02:00 Childhood conditioning and survival wiring
04:30 Different brains, different blockers
07:00 Logical vs. emotional approaches to problem solving
10:30 What we can control (and what we can't)
13:00 The danger of unchecked internal stories
15:30 Reuven’s tools: fact vs. meaning, brain dumps, and mapping
18:00 Spotting hidden challenges
20:30 Leading with empathy and creating psychological safety
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
In this episode of ShiftShapers, host David A. Saltzman talks with Ramesh Kumar, CEO and co-founder of zakipoint health. Ramesh shares how a personal mission to help his father navigate healthcare led to a professional pursuit: transforming overwhelming claims data into actionable insights for employers, advisors, and members.
The conversation explores the evolution of predictive modeling, the growing importance of fiduciary responsibility in plan design, and how AI-powered platforms are helping advisors simplify benefit decisions and improve outcomes. Ramesh offers real-world examples of how data can shape plan strategy, change behavior, and improve care—before costs spiral out of control.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Claims Data Is the Starting Line—Not the Finish
TPAs can’t block it. Advisors must request it. With the right tools, data can reveal inefficiencies and drive smarter decisions.
📌 Predictive Modeling Meets Personalization
Ramesh explains how modern AI doesn’t just stratify risk—it tailors messages and care nudges to drive better action at the member level.
📌 Fiduciary Awareness Is on the Rise
High-profile lawsuits and rebate opacity are forcing plan sponsors to demand better data—and use it.
📌 AI Is Rewriting the Navigation Experience
Agentic AI will soon act as your members’ personal guide—making healthcare access faster, smarter, and more human (even if it’s not human).
📌 Member Engagement Must Be Proactive
You can’t educate after the ER visit. The future belongs to platforms that reach members before the bill comes.
⏱️ In This Episode
00:00 Introduction to Ramesh and zakipoint health
02:00 From personal mission to industry disruption
04:00 The problem with too much (bad) data
06:00 Turning claims into strategy: risks, costs, gaps
08:30 How fiduciary pressure is reshaping advisor roles
10:00 Making healthcare navigation member-centric
14:00 Predictive modeling and behavioral segmentation
16:30 Agentic AI and rethinking healthcare workflows
19:00 AI in mental health, coaching, and chronic care
20:45 What's next for advisors and tools
22:00 Ramesh’s 5-year vision: frictionless healthcare access
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
In this episode of ShiftShapers, host David A. Saltzman welcomes Sally Pace, CEO of Connect Healthcare Collaboration and co-founder of The Granite List—a platform built to help benefits advisors compare point solutions with clarity and confidence.
Sally shares how her background in storytelling and communication led to the creation of employee engagement strategies that bridge the gap between tech and human connection. From clinical and benefits advocacy to empowering advisors with transparency tools, Sally emphasizes how trust, education, and personalization are reshaping the future of benefits.
👉 Learn more or create a free profile at: www.thegranitelist.com
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Don’t Wait for Enrollment to Start Educating
Sally explains why the most effective strategies involve consistent, year-round communication—not just an annual packet.
📌 Real Advocacy Requires Real People
Benefits are confusing. Using high-touch, concierge-style advocates helps employees actually use what’s offered.
📌 Data Is Powerful, But Not Enough
AI can identify needs—but human guidance drives understanding and usage. Together, they make an unstoppable team.
📌 Fiduciary Pressure Is Rising
With plan sponsors increasingly held accountable for engagement, education is no longer optional—it’s essential.
📌 The Granite List Gives Advisors a Clearer View
Point solutions are overwhelming. The Granite List brings organization, community insight, and streamlined comparison to the marketplace.
⏱️ In This Episode
00:00 Introduction to Sally and her background
02:11 Lessons from HGTV and marketing communication
04:00 Building human-centered engagement tools
06:00 The staggering underutilization of benefits
08:40 Why AI needs a human touch to work
10:50 Making enrollment an opportunity, not a hurdle
12:30 Advisors and the fiduciary conversation
16:00 Birth of The Granite List platform
18:00 Helping advisors and consultants vet point solutions
20:00 Transparency and personalization in benefit design
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
In this episode of ShiftShapers, host David A. Saltzman welcomes Dave Chase, co-founder of Health Rosetta, a movement that has become a national force in transforming employer-sponsored healthcare.
Dave shares the deeply personal story that drove him to create Health Rosetta and the powerful framework that emerged—one focused on transparency, outcomes, and economic sustainability.
The conversation explores how Health Rosetta empowers benefit advisors and employers to break free from the traditional health plan model, the crucial role of data access, and the open-source tools now available through Nautilus Health Institute. Dave also unveils the evolution of RosettaFest from an internal network event into the premier gathering for high-performance health plan innovators across the country.
👉 Join RosettaFest 2025 in Denver: https://rosettafest.org/
👉 Explore open-source tools from Nautilus Health: https://www.nautilushealth.org/
🤖 Sponsored by BenePower BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 A Personal Tragedy Sparked a Movement
A system failure that devastated a friend’s life inspired Dave Chase to create a new framework for health plans.
📌 It All Starts with the Health Plan Contract
Perverse incentives and system dysfunction stem from opaque, outdated plan contracts—Health Rosetta sets a new standard.
📌 Training a New Class of Benefit Professionals
Health Rosetta focuses on empowering benefit advisors with the tools and standards to drive measurable change.
📌 The TPA, PBM, and Hospital Contracts Matter Most
Dave breaks down the three most critical contracts and how employers can renegotiate smarter, data-driven deals.
📌 Nautilus Health Is Open-Sourcing the Playbook
With $4M+ of legal, contracting, and tech investment, Health Rosetta is giving away the tools others would keep locked up.
📌 Unfettered Data Access Is a Game Changer
Claims transparency isn’t optional anymore—especially under the Consolidated Appropriations Act.
📌 RosettaFest Is the Epicenter for Innovation
Once closed-door, RosettaFest now brings together employers, advisors, clinicians, and tech innovators for radical collaboration.
⏱️ In This Episode
- 00:00 Introduction to Health Rosetta
- 01:02 Founding Story and Inspiration
- 02:11 Building the Framework and Ecosystem
- 08:28 Challenges and Pushbacks
- 16:08 New Developments and Future Plans
26:20 Conclusion and Final Thoughts
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
In this episode of ShiftShapers, host David A. Saltzman speaks with Joanna Conti, founder and chairman of the nonprofit Conquer Addiction. Joanna’s journey began when her own daughter faced life-threatening alcoholism, prompting a years-long search for effective treatment—and an urgent realization: no one was measuring long-term success.
Joanna shares the results of her groundbreaking research following over 100,000 addiction patients, and exposes the massive gaps in transparency, accountability, and outcomes in today’s treatment centers. She also unveils how employers and families can now access verified recovery data to choose truly effective care—and how a new bundled care model is reshaping the rehab industry.
Conquer Addiction Website: https://conquer-addiction.org
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Most Treatment Centers Don’t Track Outcomes
Joanna explains why fewer than 1% of rehabs conduct post-treatment follow-ups—and how Conquer Addiction is changing that.
📌 Verified Success Rates Vary Widely
While the average recovery rate is 36%, Joanna’s research shows some centers achieve 50%+ and others less than 15%.
📌 Aligning Incentives with Accountability
New bundled-rate models require rehabs to offer relapse support—creating better outcomes and real transparency.
📌 Employers Bear the Cost
Substance use disorders can cost employers $25,000 per year per employee—before treatment even begins.
📌 A National Claims-Based Registry Is Coming
Joanna’s team is building a predictive model using de-identified claims data to rank treatment center effectiveness nationwide.
📌 Hope and Progress
Joanna’s personal story ends with hope: her daughter is thriving after 13 years in recovery—and now four kids of her own.
⏱️ In This Episode
00:00 Introduction to Treatment Duration and Outcomes
13:59 Accessing Treatment Center Data
14:31 Challenges in the Treatment Industry
14:51 Aligning Incentives for Better Outcomes
16:32 Financial Struggles of Treatment Centers
16:58 Using Data to Identify Effective Treatment Centers
17:56 The Role of Compliance and Legislation
18:35 Developing a National Claims Registry
19:28 Predictive Modeling for Treatment Effectiveness
20:40 Sharing Data with Rehabs and Payers
21:42 Future Goals and Conclusion
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Why Reducing Variation = Better Outcomes
In this episode of ShiftShapers, host David A. Saltzman welcomes Kate Grohall, co-founder and Vice President of Value-Based Solutions at Holista. Kate shares her powerful journey from working with patients in a teaching hospital to building a transformative platform focused on reducing variation in care, cost, and outcomes.
She unpacks how Holista restores trust in the provider-patient relationship, leverages real-time communication tools to improve outcomes, and helps employers drive change by demanding value—not volume.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Quality = Reducing Variation
Kate defines healthcare quality as reducing unpredictability across cost, outcomes, and patient experience.
📌 C Still Equals MD
Most consumers can't distinguish between top- and bottom-tier physicians. Holista’s proprietary vetting process closes that gap.
📌 Restoring the Provider-Patient Relationship
Holista rebuilds what’s been lost by re-emphasizing relationships and collaboration across care teams.
📌 Real-Time Care Prevents Crisis
Through a patient app and nurse engagement, Holista helps patients avoid unnecessary ER visits and complications.
📌 Incentives That Actually Change Behavior
Forgiving copays and reducing premiums for high-value care choices gives patients immediate financial benefits.
📌 Employers Take the Wheel
Employers are stepping out of the back seat and demanding better results—and Holista helps them drive smart, sustainable change.
⏱️ In This Episode
00:00 Introduction to Better Health Outcomes
00:47 Kate Grohall’s Journey into Healthcare
03:12 Understanding Quality in Healthcare
05:19 Challenges in Reducing Variation
06:50 Provider and Patient Experience
08:57 Quality Metrics Beyond Standards
13:13 Real-Time Communication in Healthcare
14:41 Changing Behavior and Incentives
21:31 Future of Healthcare and Technology
22:56 Employers Taking the Driver's Seat
24:53 Conclusion and Final Thoughts
This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com
Why Are We Paying More for Worse Health? | ShiftShapers
In this episode of ShiftShapers, host David A. Saltzman welcomes Helene M. Epstein—writer, speaker, and patient advocate behind the Substack series Patient No More. Helene dives deep into America’s epidemic of medical errors, misdiagnoses, and system failures. She breaks down why even the most advanced technology and training haven’t improved patient safety, how profit-driven healthcare puts patients at risk, and—most importantly—what individuals can do to protect themselves and their families.
From shocking statistics about misdiagnosis to the hidden realities of rural hospital closures, Helene provides practical advice and hope for patients who are ready to become their own advocates.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Medical Harm Is Underreported and Overlooked
One in four hospital patients is harmed—and most of those incidents aren’t even recorded. Medical error remains a massive, hidden problem.
📌 Diagnostic Error Is Common—and Dangerous
5–25% of U.S. adults are misdiagnosed each year. The most common errors? Testing failures, insurance barriers, and lack of communication between patients and providers.
📌 The System Is Built for Billing, Not Healing
EMRs, insurance company rules, and corporate healthcare ownership have prioritized profits and paperwork over patients—leaving safety and transparency behind.
📌 Rural and Marginalized Patients Are at Greater Risk
Access to care is shrinking as hospitals close pediatric and maternal units, especially in rural and underserved communities.
📌 Patient Advocacy Is Rising
Helene shares why empowered patients—armed with information, organized records, and second opinions—are the best defense against medical error.
📌 Practical Steps: Protect Yourself
Keep copies of your records, use health portals, seek second opinions, and research providers before major procedures. Being “patient no more” means taking an active role in your own care.
More from Helene M. Epstein
Patient No More is a free Substack by patient advocate Helene M. Epstein, offering practical advice to help you avoid misdiagnosis and medical error. Read her ongoing guide to surviving American healthcare at https://helenemepstein.substack.com/
⏱️ In This Episode
- 00:00 – Why Does U.S. Healthcare Cost So Much and Deliver So Little?\
- 01:00 – What Counts as Medical Error and Harm?
- 03:00 – The Impact on America’s Workforce
- 04:30 – Corporatization and the Decline of Access
- 07:45 – The Prevalence of Diagnostic Errors
- 10:00 – The Role of Insurance in Delaying Proper Treatment
- 12:00 – Medication Errors, Pharmacy Mistakes, and Communication Gaps
- 15:00 – Why Electronic Medical Records Don’t Fix the Problem
- 18:30 – Patient Advocacy, “Patient No More,” and Surviving American Healthcare
- 21:00 – Misdiagnosis in Women, Children, and Marginalized Groups
- 24:30 – The Future of Patient Safety and System Reform
Rethinking PPOs: How High-Performance Networks Deliver Value | ShiftShapers
In this episode of ShiftShapers, host David A. Saltzman sits down with Scott Smith, founder and CEO of Logro Network, to discuss a revolution in health plan design: the nationally curated high-performance network. Scott unpacks the origins of PPOs, why the old “discount everything” approach is broken, and how a focus on total value—cost, quality, and outcomes—can transform employer health plans.
You’ll learn how Logro Network uses massive data sets and provider scoring to give members more choice and better information, all while helping plans rein in costs and fulfill their fiduciary duty.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Why PPOs Are Stuck in the Past
Traditional networks focused only on unit cost, not total value—leaving members and plans exposed to higher downstream costs and mediocre quality.
📌 Volume and Discounts Aren’t Enough
Providers are leaving old PPOs as deep discounts become unsustainable. The cheapest care isn’t always the best, and a “race to the bottom” can cost more in the long run.
📌 High-Performance Networks = Data-Driven Choice
Logro Network’s national footprint scores providers on cost, quality, and appropriateness using over 50 billion claims—empowering members to pick the best care for their needs.
📌 Quality ≠ High Cost
Surprisingly, the best providers are often not the most expensive. High-quality care can lower total cost of care through fewer complications and better outcomes.
📌 Member Experience Is Central
With transparent, easy-to-read provider profiles (using AI to simplify 300+ metrics!) and broad network access, members get more control, less disruption, and the right information to make informed decisions.
📌 A Win for Employers and Brokers
Plans using high-performance networks can see immediate cost reductions, better renewal rates, and lower medical loss ratios—while meeting growing fiduciary expectations.
⏱️ In This Episode
- 00:00 Introduction to High Performance Networks
- 00:47 Guest Introduction: Scott Smith
- 01:30 The Evolution of Networks
- 04:22 Challenges of Traditional Networks
- 07:09 Introduction to High Performance Networks
- 09:55 Building a High Performance Network
- 14:04 Member and Plan Benefits
- 21:02 National Coverage and Future Plans
In Part 2 of our powerful conversation with David Contorno, president and founder of ePowered Benefits, we go beyond the strategies and structures of health plan design—diving into the real-life struggles that are shaping smarter, more compassionate solutions.
Host David A. Saltzman and David Contorno discuss the realities of scaling direct primary care, creative ways to bridge care gaps, and the challenges of educating employers and advisors about fiduciary responsibility. But the heart of this episode is personal: David shares how his own battles with chronic pain and mental health have transformed his perspective—and the way he builds health plans.
The conversation uncovers the hidden crisis of mental health in the workforce, the need for more accessible and innovative care models, and the legacy that disruption can leave when leaders dare to do things differently.
If you missed Part 1, catch it now for the story of smart plan solutions and shifting structures.
🎧 Listen to Part 1 now: https://www.buzzsprout.com/2045524/episodes/17232879
📺 Watch Part 1 on YouTube: https://youtu.be/rYP7-z8WD0A
🔑 Key Takeaways from This Episode
- Direct Primary Care & Beyond: How scaling DPC and innovative provider relationships are breaking down care deserts.
- Cash Pay Pathways: Why starting with cash pay—and embedding it into employer plans—can dramatically change access and cost.
- Fiduciary Responsibility: Why ignoring smarter plan options is a risk for employers, and what needs to change for true accountability.
- Educating for Change: How complexity and legacy promises are barriers, and what it really takes to shift mindsets.
- The Mental Health Undercurrent: David’s raw account of dealing with chronic pain, mental health stigma, and his personal journey toward healing—including non-traditional therapies like virtual support and psychedelic treatment.
- A Legacy of Empathy: Why the next wave of health plan design must address the whole person—physically and mentally—and how employer-sponsored plans can help lead the way.
⏱️ In This Episode
00:00 Introduction and Guest Welcome
00:54 Scaling Direct Primary Care (DPC)
01:33 Challenges and Solutions in DPC
03:19 Employer and Provider Perspectives
07:50 Cash Pay and Reference-Based Pricing
17:47 Mental Health and Innovative Solutions
25:56 Closing Thoughts and Personal Reflections
What does “smart” health plan design look like in an industry packed with legacy thinking and rising costs? In Part 1 of a special two-part ShiftShapers interview, host David A. Saltzman welcomes back David Contorno, president and founder of ePower Benefits—and one of the industry’s most well-known disruptors.
David pulls back the curtain on his journey from traditional insurance to innovative plan design, explaining why “business as usual” can’t fix the healthcare system. He discusses creative strategies like reference-based pricing, direct provider contracting, and the evolution of self-funded health plans. Through stories, data, and first-hand insights, David lays out the “shifting structures” that are changing how employers, brokers, and providers think about benefits.
🔜 Don’t miss Part 2 next week! We’ll dive even deeper as David shares the personal struggles that reshaped his perspective on plan design, including lessons from his own healthcare journey.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders. 🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
- The Origin Story of a Disruptor: David shares how starting in insurance as a teen led to a lifetime of challenging the status quo.
- Why Health Insurance Is Failing: Hear David’s epiphany about how current health plans fall short of protecting people from catastrophic loss.
- Reference-Based Pricing & Beyond: Understand the pros, cons, and evolution of “blunt instrument” cost-saving strategies.
- Direct Provider Contracting: Learn how building new provider relationships can drive savings and better outcomes.
- Fiduciary Responsibility for Employers: Discover why doing what’s always been done is now a liability, not a strategy.
⏱️ In This Episode
00:00 Introduction and Guest Welcome
00:59 David Conno's Background and Early Career
03:03 The Epiphany: Realizing the Flaws in Health Insurance
09:35 The Power and Challenges of Reference-Based Pricing
18:23 The Cash Pay Experience and Personal Health Journey
28:03 Innovative Solutions: Direct Primary Care
31:24 Conclusion and Final Thoughts
Understanding Trump's Executive Order on Drug Pricing | ShiftShapers
In this episode of ShiftShapers, host David A. Saltzman welcomes Tiffany Ryder, emergency medicine PA, host of Healthcare Liberty Lab, and writer at Red Flag Hero on Substack. Tiffany breaks down President Trump’s executive order on drug pricing and what it could mean for patients, providers, and pharmaceutical companies.
She explores key issues like most favored nation pricing, transparency in drug costs, and the role of PBMs and middlemen. Drawing from her frontline experience and policy knowledge, Tiffany explains how these changes may impact everything from consumer behavior to research and development in the pharmaceutical world.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders. 🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Trump’s Executive Order Is Not What It Seems
Initial reactions framed it as a price control, but deeper analysis reveals an effort to create competitive pricing similar to standard market structures—challenging the global imbalance of U.S. drug costs.
📌 The U.S. Pays More—And It’s Unsustainable
Americans make up only 4% of the world’s population but generate 75% of pharma’s profits. Tiffany explores how this executive order could shift the burden globally rather than stifling innovation.
📌 Transparency Could Empower Consumers
One of the most promising aspects of the order is a potential direct-to-consumer model and increased pricing transparency. It may spark a shift in consumer behavior, giving patients tools to understand what drugs should actually cost.
📌 PBMs and Middlemen Drive Up Costs
Tiffany highlights how pharmacy benefit managers (PBMs) and other intermediaries inflate costs, create confusion, and block consumers from accessing the best value for their medication.
📌 Generational Shift in Patient Trust Is Happening
Today’s younger patients are skeptical of the healthcare system but often feel powerless. Tiffany argues that consumer apathy is a major barrier—but rising costs could force change from the ground up.
📌 Clinicians and Patients Both Hold the Key
Tiffany believes change can start with both groups opting out of the broken system. Asking more questions, rejecting rushed visits, and demanding accountability are small acts that can fuel major reform.
⏱️ In This Episode
00:00 – Introduction to Trump's Executive Order on Drug Pricing
01:08 – Meet Tiffany Ryder: From Rural Louisiana to Healthcare Advocate
03:55 – Key Takeaways from the Executive Order
06:40 – Impact of Most Favored Nation Pricing
09:56 – Challenges and Potential Outcomes
15:23 – The Role of Transparency in Healthcare
24:36 – Generational Shifts in Patient Attitudes
27:06 – Future of Healthcare: Incremental Changes or a Major Overhaul?
29:45 – Conclusion and Farewell
🎧 Replay Episode: Rethinking Healthcare Costs with Direct Pay Models
As healthcare expenses continue to rise and insurance premiums stretch beyond affordability, more Americans are exploring alternatives. In this replay episode, we're revisiting a powerful conversation with Dr. Jawad Arshad, CEO of WoW Health Solutions, on how direct pay models could reshape ambulatory care.
Dr. Arshad breaks down the benefits, challenges, and potential of a direct pay approach — offering insights into a future where patients and providers interact more freely, transparently, and affordably.
Whether you're a healthcare professional, policymaker, or patient, this episode offers a thought-provoking look at how the healthcare system could work better.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
In this REPLAY episode of ShiftShapers, host David interviews Paula Muto, a practicing surgeon and founder of Uber Docs. Paula shares her perspective on the inefficiencies in the current healthcare system, comparing buying health insurance to renting an apartment, and advocates for a direct pay model to improve the situation. She explains how Uber Docs facilitates transparent, direct transactions between patients and physicians, ultimately aiming to lower overall healthcare costs by empowering consumers. Key topics include the significant portion of healthcare costs dedicated to management rather than medical care, and how technology and consumer behaviors can drive positive changes in the healthcare landscape.
00:00 Introduction to Today's Guest and Topic
01:03 Paula Muto's Background and Inspiration
02:19 The Flaws in the Current Healthcare System
13:47 The Direct Pay Model Explained
15:55 How Uber Docs is Revolutionizing Healthcare
20:33 Conclusion and Final Thoughts
In this episode of ShiftShapers, host David A. Saltzman sits down with David Blair, founder and CEO of LucyRx, to explore a growing crisis in American healthcare: pharmacy deserts. As rural and underserved communities lose access to local pharmacies, millions are left without a vital link in the healthcare chain. David unpacks the economic and systemic challenges driving pharmacy closures and shares how LucyRx is stepping in to reshape the future of pharmacy care.
From the SPARC (Sustaining Pharmacy Access & Rural Care) program to the push for federal regulation, David outlines what it takes to restore pharmacy access, reduce costs, and deliver more integrated care. This conversation also highlights the importance of aligning pharmacy locations with care providers—a proven strategy for improving outcomes and affordability.
📌 Related Resources:
- AMA: Physician Shortage is a National Emergency https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage?utm_source=chatgpt.com
- HCSC: Linking Medical and Pharmacy Benefits Improves Care https://www.hcsc.com/newsroom/category/affordability/connecting-medical-pharmacy-benefits-improve-care-lower-costs?utm_source=chatgpt.com
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Pharmacy Deserts Are a Healthcare Emergency
Millions live without convenient access to a pharmacy, leading to delays in care and worsening health outcomes. David Blair explains how this silent crisis is affecting rural and underserved populations.
📌 SPARC: A Scalable Solution for Pharmacy Access
LucyRx’s SPARC program brings pharmacy services back into communities through a hybrid of innovation, advocacy, and strategic partnerships.
📌 Federal Regulations Could Reverse the Trend
David advocates for smarter, centralized policy to address industry-wide economic challenges and ensure that pharmacies remain viable in low-density areas.
📌 Integrated Care Saves Money—and Lives
Blair highlights how co-locating care and pharmacy services leads to better health outcomes and significantly reduced costs.
📌 The Future of Pharmacy Is Local + Digital
The industry is evolving toward community-based pharmacy care that is supported by modern tech infrastructure and national reform.
⏱️ In This Episode
00:00 – Introduction to Rural Pharmacy Challenges
00:09 – Meet David Blair of LucyRx
01:07 – The Role of Pharmacists in Healthcare
01:48 – Understanding Pharmacy Deserts
02:41 – The Impact of Pharmacy Closures
05:31 – LucyRx's SPARC Program
07:18 – Advocating for Federal Regulations
09:58 – Economic Challenges for Pharmacies
17:05 – Integrated Specialty Care Network
20:58 – Future of the Pharmacy Industry
22:47 – Conclusion and Final Thoughts
In this episode of ShiftShapers, host David A. Saltzman welcomes compliance expert Carol Taylor, JM, of BenefitMall, for a deep dive into the rapidly evolving world of employer compliance. From court rulings and legislative penalties to HIPAA security updates and AI-driven benefit denials, Carol offers critical insights for anyone navigating today’s tangled regulatory landscape.
She unpacks the latest on ERISA preemption battles, mental health parity lawsuits, and the real-world impact of complex compliance rules on small agencies and employers. With rising penalties and tech-driven claim denials making headlines, Carol arms listeners with strategies to stay compliant—and stay out of court.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 Penalties Are Rising—And Enforcement Is Too
Missing a CHIP notice or 5500 filing? That could cost thousands per day. Carol outlines the latest penalty increases and why the IRS is stepping up enforcement.
📌 HIPAA Security Changes Are Coming
From encryption rules to breach simulations, the proposed HIPAA security updates raise the bar—especially for small agencies who now face enterprise-level expectations.
📌 Compliance Risks from AI-Powered Claim Denials
Carol explains how AI is being used inappropriately by some carriers—and why plan sponsors need to examine how these tools align with ERISA.
📌 ERISA, MIA, and Legal Landmines
With court cases mounting over PBM regulation and mental health parity, Carol breaks down what’s at stake and how employers can avoid becoming the next headline.
📌 Future-Proofing Your Compliance Strategy
From updated plan docs to tighter internal protocols, Carol shares best practices that can help advisors and agencies stay ahead of evolving rules.
⏱️ In This Episode
00:00 – Introduction to Compliance Challenges
02:01 – Legislative Updates and Penalties
09:25 – HIPAA Security Rule Changes
18:11 – Court Cases and Legal Battles
23:20 – Mental Health Parity and Addiction Equity Act
27:00 – Future of Compliance and Final Thoughts
In this episode of ShiftShapers, host David A. Saltzman sits down with Neal Shah, co-founder of Counterforce Health, to explore how artificial intelligence is transforming the fight against denied health insurance claims.
Shah shares his personal journey from finance into healthcare advocacy, shaped by firsthand experiences navigating the broken healthcare system for his family. That path ultimately led to the creation of Counterforce Health—a free AI-powered platform that’s helping patients and small clinics appeal insurance claim denials with unprecedented efficiency.
With millions of claims denied each year—and most never appealed—Shah explains why automation is the key to leveling the playing field and giving patients back their voice. He also introduces Maxwell, Counterforce’s next-gen AI assistant, and previews the platform’s expanding capabilities for tackling insurers head-on.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
Why 450 Million Claims Get Denied—and Go Unchallenged
Despite the high success rate of appeals, fewer than 2% of denied claims are contested. Shah explains how complexity, red tape, and lack of awareness keep patients and providers from fighting back.
From Wall Street to Healthcare Warrior
Shah’s journey from finance to elder care—and ultimately to launching a mission-driven tech company—reveals how personal pain points can inspire powerful innovation.
How Counterforce Health Uses AI to Automate Appeals
The platform generates detailed appeal letters using legal precedents, medical journals, and historical data—empowering users to overturn denials without legal or medical expertise.
A 70% Win Rate That’s Beating the Odds
While national appeal success rates hover around 40–50%, Counterforce Health is seeing over 70% success—thanks to smart automation and a deep understanding of insurer tactics.
Introducing “Maxwell”: AI That Talks Back to Insurers
Neal reveals a sneak peek at Maxwell, an AI-powered voice assistant designed to handle phone calls with insurance companies—reducing workload and stress for patients, caregivers, and providers.
🎥 Watch the Maxwell demo: https://drive.google.com/file/d/1qckxAYx10cMvA_rL_vfSHxCktF19a9Qa/view
⏱️ In This Episode
00:00 Introduction: The Problem with Denied Claims
00:59 Meet Neal Shah: A Journey from Finance to Healthcare
03:22 The Birth of Counterforce Health
06:44 Understanding the Health Insurance Crisis
11:58 Counterforce Health: How It Works
14:42 The Role of AI in Fighting Denied Claims
22:42 Future Prospects and Final Thoughts
In this episode of ShiftShapers, host David A. Saltzman sits down with Vinay Patel, PharmD, founder of MakoRX, to expose why prescription pricing remains so confusing—and what can be done to fix it.
Patel breaks down how pharmacy benefit managers (PBMs), vertical integration, and opaque pricing structures are driving up costs for patients—while limiting access and undermining local pharmacies. From subscription pharmacy programs to cash-pay and compounding models, Patel shares bold, practical solutions for bringing real transparency back into the healthcare system.
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
- The Truth About Prescription Pricing
Patel explains how PBMs and vertically integrated systems distort drug pricing—making it difficult for patients to know what they’re really paying and why. - The Power of Local Pharmacies
Community pharmacies often serve as the most frequent healthcare touchpoint for patients. Their role in building trust, offering consultations, and providing accessible services is critical to public health. - How MakoRX’s Subscription Pharmacy Program Brings Real Cost Transparency
Patel details a model offering 300 commonly prescribed medications for a flat monthly fee—providing predictable costs and supporting a national network of independent pharmacies. - Breaking Up Healthcare Oligopolies
To fix what’s broken, Patel supports breaking up vertically integrated giants, allowing regional players to compete on quality, service, and fair pricing. - The Role of Compounding and Cash-Pay Pharmacies
With growing demand for affordability, Patel highlights how compounding and cash-pay pharmacies are offering lower-cost alternatives and bypassing insurance constraints. - A Vision for Integrated, Transparent Care
Patel explores a future where technology enables collaboration between pharmacists and medical providers—creating a more coordinated, transparent, and patient-focused care model.
⏱️ In This Episode
00:00 Introduction and Guest Welcome
00:54 Vinay Patel's Career Journey
04:28 Challenges in the Healthcare System
05:49 Political Perspectives on Healthcare Reform
14:17 The Role and Importance of Community Pharmacies
20:02 Subscription Pharmacy Programs
25:30 Future Trends in Pharmacy and Healthcare
27:20 Conclusion and Farewell
Part 2 of our deep dive into Disability Insurance (DI) on the ShiftShapers Podcast goes beyond the basics—diving into strategic implementation, evolving underwriting standards, and revenue-generating opportunities for advisors.
In this episode, host David Saltzman continues the conversation with Don Schamay, Regional Director of Executive Benefits at The Principal, to explore how disability insurance can be a transformative tool for both clients and advisors.
Don shares his insights on how DI is becoming more accessible and relevant across demographics—from young professionals starting their financial journey to high-income executives looking to protect complex compensation packages. He explains how advisors can offer real value by aligning DI solutions with life stages, business needs, and long-term financial goals.
Whether you’re an advisor looking to enhance your client relationships or a business owner considering executive benefits, this episode is packed with actionable insights and forward-thinking strategies.
✅ Key Takeaways from the Episode:
- Young Professionals and DI
DI isn’t just for high earners—young professionals stand to gain the most by locking in coverage early, when they’re healthy and premiums are lowest. Don shares how DI can be a cornerstone of early-stage financial planning. - Business & Executive Solutions
Business owners and C-suite professionals have unique income protection needs. Learn how DI solutions can be customized to protect not only personal income but also business continuity and executive benefits. - Underwriting Improvements
Traditional DI policies were often viewed as complex and hard to secure, but times have changed. With faster, more flexible underwriting options, advisors can now help clients get covered more efficiently than ever before. - Revenue Potential for Advisors
DI is more than a risk management tool—it’s a practice-building opportunity. By positioning themselves as income protection strategists, advisors can deepen trust, retain clients, and grow revenue. - Advisor Education and Client Communication
Don emphasizes the advisor’s role as an educator—helping clients truly understand the risks of income loss and the powerful ways DI can protect what they’ve worked so hard to build.
⏳ Episode Timestamps:
📌 00:00 – Introduction to Disability Insurance
👩⚕️ 01:03 – Understanding the Needs of Young Professionals
🏢 04:52 – Business Solutions for Disability Insurance
💼 09:07 – Executive Benefit Solutions Explained
📝 13:14 – The Underwriting Process and Its Evolution
💰 15:17 – Revenue Opportunities for Advisors
🎓 18:27 – Learning Resources and Final Thoughts
📢 This Episode is Sponsored by BenePower
BenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders.
🔗 Learn more at Benepower.com
Welcome to Part One of our deep dive into Disability Insurance (DI) on the ShiftShapers Podcast! In this two-part series. In this episode, host David Saltzman converses with Don Schamay, Regional Director of Executive Benefits at The Principal, about the often-overlooked importance of disability insurance in a comprehensive health insurance strategy. Don shares his journey from military service to a seasoned expert in disability insurance, emphasizing the critical need for both individual and group disability insurance to protect one's income. The discussion covers the prevalence of disability, how group and individual disability insurances differ, and the significance of educating clients about income protection and insurance options.
Key Takeaways from the Episode:
✅ Importance of DI – Disability insurance (DI) is an often-overlooked but crucial component of a comprehensive health insurance strategy. It provides financial protection if one is unable to work due to illness or injury.
✅ Group vs. Individual DI – Group disability insurance often covers basic salary and is a cost-effective, foundational benefit for businesses. Individual DI can supplement group coverage by filling in gaps and covering additional forms of income.
✅ Coverage and Income Protection – Properly structured DI ensures that individuals have a safety net that covers up to 80% of their income, considering both salary and other compensations like bonuses and K1 distributions.
✅ Market Trends – The DI market has become more competitive and robust, improving the quality and affordability of coverage. Newer carriers have entered the marketplace, stabilizing and enhancing the options available.
✅ Advisor’s Role – Advisors must educate clients on the significance of DI, ensuring that they understand the risks and the options for mitigating them. This includes both group and individual solutions tailored to the client's specific needs.
Episode Timestamps:
⏳ 00:00 Introduction to Disability Insurance
🛡️ 00:48 Don Schamay's Journey into Disability Insurance
💡 02:47 The Importance of Disability Insurance Today
📊 05:57 Understanding Disability Income Protection
🔍 06:57 Group vs. Individual Disability Insurance
📈 11:41 Coordinating Group and Individual Coverage
🎯 17:44 Advisors' Role in Disability Insurance
📉 20:44 Market Stability and Competition
📢 This Episode is Sponsored by BenePower
BenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders.
🔗 Learn more at Benepower.com.
Resources & Links:
🌐 Council for Disability Income Awareness: https://thecdia.org/
In this episode of ShiftShapers, Host David Saltzman interviews Dave Toeben, president of Insight Insurance Services, about how insurance professionals can enhance their business through business continuation planning. Dave shares his journey from focusing on group health insurance to specializing in buy-sell agreements, key person, and deferred compensation plans. They discuss the importance of reviewing buy-sell agreements, including recent legal changes such as the Conley case, and explore collaborative opportunities for health insurance advisors to expand their services and solidify client relationships.
This Episode is Sponsored by Benepower
BenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders. Learn more at Benepower.com.
Reach out to Dave Toeben at dave@look2insight.com or 615-636-1105
Scaling Your Insurance Practice: Insights from Business Continuation Planning
- Shift Beyond Group Health Insurance: Business continuation planning, buy-sell agreements, and key person insurance are essential for scaling a business beyond group health insurance.
- Importance of Buy-Sell Agreement Review: Regularly reviewing and updating buy-sell agreements is crucial to avoid unintended liabilities and ensure smooth business transitions in case of catastrophe.
- Disability Insurance Parallel: Often overlooked, disability insurance can be as crucial, if not more so, than life insurance in buy-sell agreements, providing necessary funds if a business owner becomes disabled.
- Partner Collaboration Opportunities: Health insurance advisors can partner with specialists in business continuation planning to offer comprehensive services without needing to master every aspect themselves.
- Educational and Revenue Potential: By engaging in business continuation planning, health insurance advisors can not only solidify client relationships but also significantly boost their revenue streams.
In This Episode
00:00 Introduction and Guest Welcome
00:45 Dave Toeben's Career Journey
01:13 Transition to Business Continuation Planning
02:30 Understanding Business Continuation Planning
03:55 Importance of Disability Insurance
06:18 Opportunities for Health Insurance Advisors
08:27 The Connolly Case and Its Implications
10:25 Partnering and Mentorship in Business Continuation
18:05 Choosing the Right Carriers
20:50 Conclusion and Contact Information
In this episode of Shift Shapers, Susan Thomas, Chief Commercial Officer at LucyRx, discusses how LucyRx is addressing the issues and conflicts within the traditional Pharmacy Benefit Manager (PBM) landscape. The conversation delves into the structural problems of traditional PBMs, the role of misaligned incentives, and how LucyRx aims to eliminate these conflicts to benefit plan sponsors and patients. Key topics include formulary management, specialty pharmacy networks, and the importance of transparency and true net cost evaluations.
This Episode is Sponsored by Benepower
BenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders. Learn more atBenepower.com.
Key Takeaways
Misaligned Incentives in PBMs: Traditional PBMs have misaligned incentives due to their vertical integration with large insurance companies and ownership of mail and specialty pharmacies. This drives up costs for plan sponsors.
Transparent Formulary Management: LucyRx offers a formulary marketplace that eliminates exclusive arrangements with Group Purchasing Organizations (GPOs), allowing plan sponsors broader access to formularies and more flexible utilization management.
Independent Pharmacy Network: LucyRx contracts with independent pharmacy networks, such as Amazon, to provide a more efficient and cost-effective mail delivery service, ensuring quicker access to medications.
Educational Initiatives: LucyRx is actively educating advisors and plan sponsors on the benefits of their new pharmacy care model through a robust roadshow and sharing real-world case studies.
Future of Pharma: With advancements in AI and machine learning, precision medicine can help in developing more effective targeted treatments. However, skepticism remains about whether large PBMs and pharma companies want a smaller, more precise target population.
In This Episode
00:00 Introduction to PBM Issues
00:39 Meet Susan Thomas from LucyRx
00:50 Susan's Journey into Healthcare
02:06 Problems with Traditional PBMs
02:28 LucyRx's Approach to PBM Conflicts
06:23 Formulary Management Innovations
13:55 Network and Specialty Pharmacy Solutions
16:17 Educating Advisors and Plans
20:23 Future of Pharmacy Benefits and AI
22:07 The Story Behind LucyRx
23:25 Conclusion and Farewell
In this episode of Shift Shapers, David interviews Ross Bjella, founder and CEO of Alithias, Inc., to discuss the challenges of changing health care behavior and the inaccuracies in measuring those changes. They explore the complexities of helping patients understand their health care options and costs, and advocate for transparent, actionable data to aid in more informed decisions.
This Episode is Sponsored by Benepower
BenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders. Learn more at Benepower.com.
Transforming Health Care Behavior: Insights from Ross Bjella, CEO of Alithias, Inc.
Ross shares his journey into the health care sector, the importance of data-driven strategies, and how incentives can help patients choose high-value care providers. He also delves into the impact of consumer-directed health plans and how different company cultures affect health care engagement.
Key Takeaways
Carrots Over Sticks: Positive incentives (carrots) work better than punitive measures (sticks) in driving desired behavioral changes in healthcare.
Challenge of Accurate Data: Current tools and survey methods for measuring behavior changes in healthcare are not as accurate as desired. Ensuring accurate data collection and utilization is critical.
Impact of Cost on Patients: High deductibles and out-of-pocket responsibilities can lead to patients being functionally uninsured, causing them to delay care and potentially leading to more severe health outcomes and increased costs.
Importance of Actionable Data: Access to clean, normalized data that is understandable and actionable for patients and their families is crucial for making informed healthcare decisions.
Effective Communication and Incentives: Effective communication strategies and financial incentives (like waiving deductibles or providing cash rewards) can significantly improve patient engagement and lead to cost savings for both providers and patients. Tailoring communication and benefits to the culture of the organization is essential for success.
In This Episode
00:00 Introduction to Healthcare Behavior Challenges
00:47 Meet Ross Bjella: Journey to Healthcare Solutions
01:03 Understanding the Problem: High Costs and Insurance Issues
04:43 The Role of Data in Healthcare Decisions
08:33 Actionable Data for Patients and Plans
16:02 Engaging Employees and Employers
21:20 Measuring Success and Future Outlook
27:15 Conclusion and Final Thoughts
In this episode of Shift Shapers, we explore strategies to enhance the growth and adoption of Direct Primary Care (DPC) with Dr. Bernard Bubanic, CEO and President at Integrated Source One. Dr. Bubanic shares his journey and insights into creating a multidisciplinary approach to healthcare, ensuring access to comprehensive care without the financial hurdles. We discuss the integration of various services such as telehealth, behavioral health, and musculoskeletal services, as well as the importance of building relationships with patients for better health outcomes. The episode also covers how this model can provide measurable savings for employers and improve plan designs.
Key Takeaways
- Multidisciplinary Approach: Dr. Bernard Bubanic's practice, Integrated Source One, focuses on direct patient care rather than just direct primary care. This includes primary care, health coaching, musculoskeletal options, and behavioral and mental health services, all offered under one umbrella.
- Employee and Family Coverage: Integrated Source One covers not only the employees but also their dependents at no additional cost. This approach is helping with better engagement and substantial cost savings for employers over time.
- Brick-and-Mortar and Virtual Care Integration: The practice combines onsite, near-site, and mobile clinics with telehealth services. This ensures continuity of care and immediate attention, making sure patients get timely and efficient care without the traditional wait times.
- Savings and ROI for Employers: By integrating direct patient care services into employee benefit plans, employers witness reduced healthcare costs and premiums over time, with a higher engagement rate by the third year, leading to significant long-term savings.
- Future Expansion and Technology: Moving forward, the practice is looking to incorporate new technologies, including AI, to enhance patient care quality and efficiency. This will continue to lower costs while improving health outcomes for patients.
In This Episode
00:00 Introduction to Direct Primary Care
00:37 Guest Introduction: Dr. Bernard Bubanic
01:15 The Journey to Integrated Source One
02:59 Challenges in Traditional Healthcare
04:11 Direct Patient Care: A Multidisciplinary Approach
05:35 Innovations in Healthcare Delivery
06:11 Seamless Integration of Onsite and Virtual Care
09:11 Measuring Success and ROI
12:30 Plan Design and Employee Benefits
19:54 Future of Direct Primary Care
21:14 Conclusion and Final Thoughts
Join us on this episode of ShiftShapers as host David Saltzman sits down with former New Jersey Congressman Rob Andrews, one of the key authors of the Affordable Care Act (ACA). Fifteen years after the ACA's passage and ten years since its implementation, Rob shares his journey from aspiring sports writer to influential lawmaker, his role in drafting the ACA, and thoughtful reflections on its successes, shortcomings, and future prospects. We delve into topics such as healthcare coverage expansion, consumer protections, cost control, value-based healthcare, mental health parity, and the ongoing provider shortage. Currently serving as the CEO of the Health Transformation Alliance, Rob continues to advocate for value-based health arrangements. Don't miss this insightful conversation for a deep dive into the evolution and future of U.S. healthcare.
Key Takeaways:
- Journey to Congress and ACA Involvement: Rob Andrews initially aspired to be a sports writer but ended up in politics, driven by a mix of early professional exposure and personal family experiences. He was significantly involved in drafting portions of the Affordable Care Act (ACA).
- ACA Achievements: The ACA successfully expanded coverage to millions, with Medicaid expansion and subsidies being critical components. It improved patient rights, eliminating pre-existing condition exclusions, extending coverage for young adults, and removing lifetime and annual policy limits.
- Shortcomings and Future Goals: ACA did not sufficiently address healthcare costs. The prevailing issue is that the system rewards the number of procedures over the quality of outcomes. There's a need for more focus on preventive health measures, behavioral health services, and better alignment of payment to performance.
- Healthcare Provider Shortage: There is a significant shortage of primary care providers and behavioral health professionals. Proposed solutions include increased compensation and incentives such as debt relief programs for medical students who work in underserved areas.
- Value-Based Healthcare: Value-based healthcare is crucial for better outcomes, involving rewarding providers based on risk-adjusted, clinically sound outcomes Both quantitative metrics (e.g., reduced A1C levels in diabetics) and qualitative measures (e.g., patient self-evaluation) should be considered to assess quality effectively.
- Current Role: Rob Andrews is the CEO of the Health Transformation Alliance, focusing on pooling resources to buy healthcare more efficiently and promoting value-based arrangements among member companies.
In This Episode
00:00 Introduction and Guest Welcome
00:41 Rob Andrews' Journey to Congress
03:14 Involvement in ACA Drafting
04:53 ACA Successes and Shortcomings
07:03 Future Improvements and Value-Based Healthcare
10:07 Addressing Primary Care and Behavioral Health Shortages
16:13 Measuring Quality in Healthcare
17:47 Rob Andrews' Current Role and Conclusion
Are you struggling to navigate the complex world of gag clause attestation requirements? In this must-watch episode of Shift Shapers, Jennifer Berman, JD, CEO of MZQ Consulting, provides a comprehensive breakdown of everything plan sponsors and advisors need to know about these critical compliance requirements.
From the Consolidated Appropriations Act of 2021 to today's implementation challenges, discover how these regulations are reshaping healthcare plan transparency. Jennifer explains why many contracts still contain illegal gag clauses in 2024 and what this means for your organization. Learn about the crucial differences between fully-insured and self-funded plans, and how these differences impact your compliance obligations.
Key topics covered:
- Detailed explanation of gag clauses and their impact on healthcare plans
- Step-by-step guide to annual CMS attestation requirements
- Understanding potential penalties and enforcement mechanisms
- Navigation of the HIOS system reporting process
- Critical differences between fully-insured vs. self-funded plan requirements
- Practical strategies for verifying gag clause compliance
- Tips for accessing and utilizing plan data effectively
- Real-world challenges in contract review and compliance
This episode delivers essential insights for anyone involved in healthcare plan administration and compliance. Whether you're managing benefits for your organization, advising clients on their healthcare plans, or ensuring regulatory compliance, you'll gain valuable knowledge about navigating these complex requirements. Jennifer's expertise provides actionable guidance for insurance professionals, consultants, and organizational leaders who need to understand and implement these critical transparency regulations.
In This Episode
00:00 Introduction to Gag Clause Attestation
00:45 Understanding Gag Clauses
01:39 Legal Requirements and Compliance
03:00 Challenges and Real-World Implications
04:58 Access to Plan Data and Its Importance
07:11 Reporting and Documentation
07:33 Understanding Certification and Penalties
10:02 Annual Reporting Requirements
10:18 Advisor's Role in Compliance
10:40 Self-Funded vs Fully Insured Plans
13:03 Ensuring No Gag Clauses
13:20 Final Thoughts and Key Takeaways
14:39 Conclusion and Farewell
Unlocking Post Claim Adjudication: Insights with Jordan Hersh
In this episode of ShiftShapers, host David explores the complex world of post claim adjudication with Jordan Hersh, Vice President of Enterprise Solutions at Vālenz. They discuss the intricacies of self-funded plans, reference-based pricing, and the potential savings associated with renegotiating out-of-network claims. The conversation delves into high performance networks, the inverse relationship between cost and quality in healthcare, and methods for improving transparency and cost containment. Learn about the strategies that can lead to significant cost savings while maintaining high-quality care.
In This Episode:
00:00 Introduction to Post Claim Adjudication
00:34 Meet Jordan Hirsch from Vālenz
01:29 Understanding Post Claim Work
02:13 Reference Based Pricing: Pros and Cons
03:55 Narrow Networks vs High Performance Networks
08:14 Out of Network Claims and Cost Containment
15:23 Transparency in Medical Care Costs and Quality
17:18 Incentives for Care Coordination
18:28 Wrapping Up: Savings and Final Thoughts
Quotes:
“Readmission rates, complication rates, mortality rates, we’re taking that into account and making sure that when people do people stay in-network or go to the panel of those high-performance network partners, they’re getting top tier coverage.”
“Depending on the primary PPO network regardless of broad network or network of concise nature, there’s going to be out-of-network medical claims. And that can cost self-funded plans a lot of money if it’s not managed correctly.”
“Some plans we’ve seen pay out-of-network claims at full bill charges, some take a usual customary approach. Having a much more direct and aggressive approach can really be a game-changer for self-funded plans and materially impact the bottom line.”
“So being able to achieve a discount, that can also assure them that they’re going to be paid and have a little bit more clarity on how the member responsibly can be split up. Oftentimes we see self-funded plans offering some type of incentive.”
“So a plan with a medical spend with a million dollars, implementing these types of tools into the right education training to the members, could reduce their overall medical spend by about 25%.”
What if technology could bridge the gap in healthcare access for underserved communities? Join us on this episode of ShiftShapers as we explore the intersection of healthcare technology and underserved communities with Kornelius Bankston, Managing Partner at TechPlug. Discover how innovative solutions are being tailored to meet the unique challenges faced by marginalized populations. Learn about the role of economic factors, geographical disparities, and the historical context affecting these communities, and see how grassroots efforts and collaborations with local health departments are paving the way for better healthcare access. Dive into the specifics of projects like SensorMed, which offer remote patient monitoring and other tech-based health solutions, and understand the foundational work that TechPlug is doing to bridge gaps in healthcare through specialized tech incubation.
We'll explore the real-world challenges faced by marginalized populations, such as transportation hurdles, prescription adherence, and food security, and how innovative solutions like remote patient monitoring are making a difference. Using New Orleans as a case study,Kornelius reveals how TechPlug collaborates with local health departments to assess and meet community needs effectively.
As we journey through TechPlug's early initiatives, Kornelius shares insights from his diverse career path, from aspiring physician to biotech recruiter and beyond. Learn about the grassroots efforts crucial for educating communities on healthcare technology and the challenges of building trust around data security. Cornelius's unique perspective underscores the importance of continuous innovation tailored to diverse populations' needs. Don't miss this thought-provoking conversation on making healthcare accessible for everyone.
Key Moments In this Episode:
“We identify an ambassador in a city, and typically it’s the department of health, to partner with to bring these innovative solutions to the community.”
“As opposed to developing solutions in a vacuum, we’re able to bring real data, real time, quantitative and qualitative information back to the companies within our portfolio so they can provide the best possible solution to these populations.”
“I really don’t think a lot of companies that have innovative health solutions are really conscientiously having their innovation addressing the population.”
“There’s a lot of distrust within the healthcare system.”
“In tech, there’s this whole idea around privacy and data security and a lot of populations of underserved and marginalized communities really don’t understand where the data is going and who’s keeping data and how they get empowered by the data.”
00:00 Introduction to Healthcare Technology for Underserved Populations
01:52 Understanding Underserved and Marginalized Communities
03:02 Challenges Faced by Underserved Populations
04:55 Innovative Solutions and Technology in Healthcare
05:48 Community Assessment and Partnerships
09:57 The Role of TechPlug in Healthcare Innovation
14:37 Building Trust and Overcoming Skepticism
16:11 Future Prospects and Challenges in Healthcare Technology
18:43 Addressing Privacy and Data Security Concerns
20:07 Conclusion and Acknowledgments
In this episode of the ShiftShapers Podcast, host David Saltzman chats with Marissa Rufo, JD, MBA, a subject matter expert from MZQ Consulting, to demystify the complexities surrounding Medicare Creditable Coverage. They discuss why it's significant for employers and employees alike, particularly in light of recent legislative changes and the growing number of older employees in the workforce. The conversation addresses compliance requirements, methods for determining creditable coverage, and practical steps employers need to take to avoid penalties and lawsuits.
Medicare creditable coverage is a requirement for group health plans to be comparable to an average Medicare Part D plan. The consternation and confusion around creditable coverage has increased due to recent changes in legislation and the growing number of Medicare-eligible individuals still working full-time. Employers have a fiduciary duty to ensure compliance with creditable coverage requirements, as failure to do so can result in lawsuits and penalties. While employers are not required to have actual creditable coverage, they must determine the creditability of their prescription drug plans, provide notices to Medicare-eligible employees, and report their credibility status to CMS annually. Failure to provide accurate notices can result in financial costs and penalties for employees. There are two methods for calculating creditable coverage: the simplified determination method and the actuarial analysis method. Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals. MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.
Takeaways
- Medicare creditable coverage is a requirement for group health plans, comparable to an average Medicare Part D plan.
- Employers have a fiduciary duty to ensure compliance with creditable coverage requirements.
- Failure to provide accurate notices can result in financial costs and penalties for employees.
- Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals.
- MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.
In this episode of Shift Shapers, host David Saltzman sits down with Alycia Riedl, the new National President of NABIP, to discuss the future of the healthcare advisory industry. Alycia shares her personal journey from reluctance to passion in the industry, following the legacy of her innovative father. They explore key issues on NABIP's radar, such as transparency, technology, and advocacy against single-payer systems. Alycia emphasizes the importance of evolving the role of advisors and her vision for a consumer-centered healthcare system. Additionally, they address leadership values and the strategic goals of NABIP for the coming years. Tune in to learn about the upcoming developments and strategic initiatives aimed at supporting healthcare advisors and improving the overall healthcare landscape.
Key Takeaways From This interview:
Career Journey: Alycia Riedl’s unexpected path to the insurance industry fueled by a passion for helping others.
Innovation and Adaptability: The importance of continuous improvement and innovation in the insurance industry.
Consumer-Centered Healthcare: NABIP’s commitment to a transparent, consumer-focused healthcare system.
Advisor Challenges: Addressing the difficulties advisors face with restrictive laws and compensation issues.
Leadership and Empathy: Reidl's emphasis on empathetic, data-driven leadership that supports team well-being.
The focus of this week's episode is on how modern healthcare system innovations utilize throwback TPA. Bob McCollins, vice president of sales at Edison Health Solutions, explains what’s happening in the TPA industry today and how a throwback TPA can help combine all the fantastic solutions out there to provide top-notch services.
What You’ll Learn From This Episode:
2:34 What throwback TPA means and how it works with current healthcare systems.
4:35 Keeping all of the various solutions together for the benefit of clients and potential clients.
7:57 TPAs need to be adaptable or focused on a single path in order to provide best-in-class services.
11:10 Changes to offerings and support in reference-based pricing.
14:48 Tasks they outsource to third parties.
16:39 Factors affecting claims' automatic adjudication.
20:35 TPA in the coming years.
This episode originally aired September 26, 2022
This week's episode delves into the world of pharmacogenomics (PGx) and how it is changing the way we approach medication management. We sit down with a leading expert in the field to discuss the current state of PGx adoption, the challenges it faces in gaining wider acceptance in the medical community, and the potential impact it could have on our healthcare system in the future. From the role of direct-to-consumer testing to the importance of involving clinicians in the decision-making process, we explore the complexities of this emerging field and what it could mean for patient care. Join us for this informative and thought-provoking conversation on the cutting edge of personalized medicine.
What You’ll Learn From This Episode:
1:54 Overmedication: A systemic problem in healthcare.
4:16 The evolution and future of pharmacogenetics (PGx) as a standard of care.
12:44 Implementing pharmacogenomics testing in employer healthcare plans: Overcoming adoption challenges and practical applications.
14:51 The adoption curve of pharmacogenomics testing in healthcare: A bottom-up mission.
17:34 The future of PGx: Adoption by early adopters and the role of payers.
This Episode Originally Aired March 13, 2023
In this episode of ShiftShapers, host David Saltzman discusses the recent Supreme Court decision to overturn the 40-year Chevron Deferment precedent and its implications for advisors and their clients. Joined by Jennifer Berman, ERISA attorney Jennifer Berman, the NABIP (National Association of Benefit Insurance Professionals) Legislative Vice Chair and CEO of MZQ Consulting, the discussion explores the decision's potential long-term effects on federal regulations and compliance in the healthcare sector. They delve into how this ruling shifts the responsibility from federal agencies to the judiciary in interpreting ambiguous statutes and assess the impact on specific regulations like compensation disclosures under the Consolidated Appropriations Act. Berman emphasizes to advisors and employers the importance of maintaining fiduciary duties and regulatory compliance while staying informed about future changes.
More from MZQ Consulting
Key Takeaways:
SCOTUS Decision Impact: The Supreme Court recently overturned the Chevron Deferment, shifting the power of interpreting ambiguous federal statutes from federal agencies to the judiciary. This major change may lead to increased challenges to existing regulations.
Immediate Effects on Law: Currently, the ruling doesn't change existing laws or regulations. However, advisors should anticipate more court challenges to federal regulations based on ambiguities in the underlying statutes.
Advisors' Immediate Actions: Advisors should communicate to their clients that no immediate changes are necessary. They should continue to follow current laws and regulations and focus on fulfilling their fiduciary duties.
Potential Healthcare Changes: Specific areas in healthcare, such as compensation disclosures and mental health parity, may become more contentious and face judicial challenges. However, statutory requirements like HIPAA, COBRA, and ACA reporting remain intact.
Need for Robust Fiduciary Processes: Advisors should emphasize the importance of maintaining documented fiduciary processes, including setting up committees, meeting regularly, and properly documenting actions to demonstrate compliance and best efforts.
In this episode of the ShiftShapers Podcast, host David Saltzman chats with Ashley Reid, founder and CEO of Wellist, to explore how companies can better connect employees to vital health and well-being resources. Reid discusses her transition from a marketing career to corporate strategy and the inception of Wellist. Driven by personal experiences with cancer care, she sheds light on the current challenges employers face in meeting wellness needs and how Wellist's Precision Resource Matching Platform uses AI to address these issues. They delve into practical examples, the financial impact of optimized benefits, and the importance of whole-person support. Reid shares how actionable data can help employers make informed decisions, and also the future aspirations for Wellist to become a standard support system across diverse industries.
Key Takeaways
- Organizations are increasingly focusing on connecting employees to the right wellness resources and benefits at the right time to boost overall well-being and engagement.
- The use of AI and data-driven platforms is transforming the employee benefits industry by providing personalized and efficient access to support resources.
- Employers can optimize their health benefits investments by leveraging data analytics to identify redundancies and gaps in their current offerings.
- Comprehensive employee support addressing a wide range of needs, including mental health and daily living aids, is becoming essential for maintaining workplace productivity and employee satisfaction.
- There is a growing trend toward standardizing integrated support systems to ensure employees can easily access the health and wellness assistance they need, particularly during critical life events.
In this episode of the ShiftShapers Podcast, host David Saltzman engages in a deep conversation with Matt Loper, CEO and co-founder of Wellth. They explore how healthcare plans can leverage behavioral economics to achieve better outcomes. Loper recounts his journey from aspiring biotechnologist to a leader in healthcare technology, emphasizing his efforts to increase patient engagement and improve health outcomes by using behavioral science and technology. The insightful discussion for business leaders also focuses on the core issues Wellth aims to solve, the importance of daily member engagement, and the need for consistent, trust-based relationships to drive better health behaviors and quality metrics. Loper shares insights on the methodologies employed, including targeted outreach and personalized communication strategies. He also touches on the future goals and expansions of Wellth.
Key Takeaways:
- Innovative Problem-Solving: Embracing behavioral economics offers innovative solutions to longstanding healthcare engagement challenges.
- Engagement is Key: Recognizing the engagement gap in healthcare underscores the importance of leveraging behavioral science and technology for patient involvement.
- Personalized Approaches Matter: Tailored communication and daily engagement strategies prove essential for nurturing healthier behaviors and improving overall healthcare outcomes.
- Financial Benefits of Engagement: Quantifying the financial impact of behavioral interventions highlights significant cost-saving opportunities for healthcare providers.
- Trust and Expansion Drive Success: Building trust-based relationships and expanding services are crucial components of achieving long-term success in healthcare innovation.
From from Wellth: https://www.wellthapp.com/
In this episode of the ShiftShapers podcast, host David Saltzman welcomes Stephen Sokoler, founder and CEO of Journey, to discuss the importance of mental health care in the workplace. Stephen shares his personal journey, from entrepreneurial beginnings to discovering meditation and ultimately founding Journey in 2015. They delve into pressing mental health challenges including stigma, therapist shortages, and the inefficiency of traditional EAPs. Stephen outlines Journey's proactive and inclusive approach to mental health care, emphasizing the importance of early intervention, awareness, and cultural competency. Tune in to learn how Journey is making mental health care more accessible and effective, and boosting EAP utilization through innovative strategies.
Key Takeaways:
- Daily Integration: Embedding mental health resources in workplace tools like Slack improves accessibility.
- Cultural Competency: Providing multilingual and culturally relevant content ensures effective support.
- Confidentiality: Strong privacy measures are crucial for employee trust and usage of mental health services.
- Thorough Evaluation: Comprehensive assessments help tailor support to individual needs.
- Awareness: Increasing awareness and reducing stigma around mental health resources is vital.
More From Journey
In this episode of the ShiftShapers podcast, we're joined by Daniel Cobb, Vice President of Sales and Strategy at Strategic Benefit Resources, to discuss the evolving landscape of Stop Loss Self Funding and the tech and data solutions supporting it. Cobb shares his journey from the mortgage business to insurance, emphasizing the significant changes and opportunities in self-funded health benefits plans. We discuss how the expansion of self-funded plans is now reaching groups as small as 25 employees. Cobb also explains the role of artificial intelligence in pricing stop loss, as well as the increasing demand for transparency and flexibility in health benefits management. Cobb also offers insights into how advisors can help clients transition to self-funding, the importance of understanding client needs, and other future trends in the industry. Business owners and executives - from large and small firms alike - stand to benefit from the important insights in this business podcast.
Key Takeaways:
- The expansion of self-funded health plans now includes smaller groups, with as few as 25 employees participating.
- Artificial intelligence and advanced data tools are crucial in pricing stop loss and expanding self-funded health plans to smaller groups.
- Advisors need to understand whether their clients are savings buyers or quality buyers to effectively present self-funding options.
- Transparency and access to first-dollar claims data are key benefits of self-funding, allowing for better management of healthcare costs.
- The future of self-funding involves greater access to data, regional variations in plan management, and continued evolution of high-performance health plans.
Strategic Benefit Resources: https://www.strategicbenefitresources.com/
Thank you for tuning into this insightful episode of Shift Shapers. If you enjoyed our conversation with Daniel Cobb, please rate, follow, share and review our podcast. Stay tuned for more episodes where we explore the latest trends and innovations in the health benefits industry.
In this episode of the ShiftShapers podcast, host David Saltzman welcomes Steven Amiel, CMO at NextGen Benefits, to explore why marketing has become more challenging, costly and less effective in terms of ROI than ever before. They delve into the new regulations on tracking and targeting prospects, discussing how the move toward double opt-ins has changed the landscape of data collection. The importance of authentic communication is highlighted through real-world examples, emphasizing why marketing messages need to be genuine and aligned with personal branding. They also discuss the pitfalls of overextending marketing efforts, particularly on platforms like LinkedIn, and the need to focus on conversions rather than likes or opens. Steven provides insights on the shift from mass advertising to an account-based marketing approach and the crucial role of first-party data in effective marketing. He addresses how different strategies apply to small versus large companies and emphasizes the importance of building executive credibility and personalized engagement in sales. Steven also talks about future marketing trends, including interactive webinars and storytelling, as key strategies for 2024 and beyond.
Key Takeaways:
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Government regulations have changed how health benefits marketers can track and target prospects, emphasizing the need for authentic communication.=
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Authenticity is crucial in marketing communication to establish a personal connection and engage prospects effectively.
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Emphasize conversions over likes or opens to drive meaningful results in marketing efforts.
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Shift toward building first-party data through engaging strategies and personalized interactions to improve deliverability and lead quality.
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Focus on differentiating yourself by understanding prospects, establishing executive credibility, and aligning messages with the target audience for successful marketing campaigns.
More from NextGen Benefits: https://www.nextgenbenefits.com/
This episode of the ShiftShapers Podcast features a discussion with David Mordo, Senior Compliance Officer at MZQ Consulting, focusing on essential legislative and regulatory knowledge advisors need to possess, especially pertaining to offering health benefit packages. The conversation highlights the recent FTC ruling on non-compete clauses, emphasizing its potential impact on employers and the broader implications for your workplace. Mordo and our host David Saltzman also delve into a pressing lawsuit against Johnson & Johnson related to fiduciary duties and prescription drug pricing, forecasting a rise in similar legal challenges. Furthermore, the interview underscores the importance of advisors understanding their role in ensuring employer clients comply with fiduciary responsibilities, especially in relation to employee health plans and benefits to meet complex compliance regulations.
Key Takeaways from the episode of the ShiftShapers Podcast:
- The Federal Trade Commission banned non-compete clauses, aiming to boost employee wages and opportunities.
- Lawsuits over fiduciary responsibilities in benefit plans are increasing, underscoring the importance of acting in employees' best interests.
- Advisors are pivotal in educating employers on fiduciary duties and compliance to navigate benefit complexities.
- Compliance professionals help translate regulations for brokers and employers to ensure adherence to regulations and to avoid risks.
- Fiduciary care under ERISA is crucial for all employers to comply with regulations and protect employees.
https://www.mzqconsulting.com/
In this episode of ShiftShapers, host David Saltzman invites David Mordo, Senior Compliance Officer at MZQ Consulting, to discuss the intricacies of prescription drug reporting (RxDC) as mandated by the Consolidated Appropriations Act of 2021. The conversation delves into the transparency requirements for employers regarding their prescription drug plans, encompassing the scope of reporting, deadlines, submission processes, and implications of non-compliance. With a focus on the pivotal role of employers, insurance carriers, third-party administrators (TPAs), and Pharmacy Benefit Managers (PBMs) in this process, the talk highlights the collaborative effort needed to ensure compliance. Mordo offers valuable insights are offered on how brokers and advisors can assist their clients in navigating the complexities of RxDC reporting, the selection of vendors for report preparation, and the importance of timely action to meet regulatory deadlines.
Key Takeaways From This Episode:
- RxDC is part of the Consolidated Appropriations Act of 2021, requiring employers to provide prescription drug plan information.
- Employers have to comply with multiple reporting requirements related to prescription drug plans annually.
- Reports for 2024 regarding prescription drug plans are due on June 3rd.
- Employers are responsible for ensuring compliance with prescription reporting, even if they use TPAs or PBMs for assistance.
- Brokers need to ensure vendors for reporting have experience, are reasonably priced, and can deliver timely and accurate data.
Welcome to this episode of the ShiftShapers podcast, where we explore the journey of Donovan Ryckis, CEO of Ethos Benefits. Here, we discuss fiduciary responsibility in healthcare as Ryckis tell us the story of his personal evolution. From managing a Gold's Gym to working in securities advising, he ultimately established a flourishing healthcare agency. His narrative unveils the hurdles and triumphs encountered when transitioning from a commission-driven approach to fee-based consulting. Throughout our conversation, Ryckis underscores the pivotal role of fiduciary duty and transparency in cultivating client trust in the healthcare industry.
Ryckis sheds light on the intricacies of reference-based pricing, highlighting its potential in managing healthcare expenses while acknowledging the accompanying need for heightened administration and employee communication. Moreover, he articulates how Ethos Benefits' commitment to ethical standards and delivering genuine value has been instrumental in its ascent. Business executives and other organizational leaders, we invite you to tune in to this episode of ShiftShapers and learn the importance of selecting a benefits vendor who acts with the healthcare recipients’ best interests at heart. After all, you deserve a healthy workforce that appreciates the best possible benefits..
Takeaways:
- Adopting a fee-based consultancy model and embracing fiduciary responsibilities are key for tailoring optimal healthcare solutions for clients.
- Embracing radical transparency, including commission disclosures, fosters candid dialogues and fortifies client relationships.
- Reference-based pricing emerges as a potent strategy for cost control in providing healthcare benefits, albeit requiring meticulous administration and communication efforts.
- Storytelling not only shapes agency culture, but also nurtures robust client connections.
- While the momentum behind fee-based models is palpable, the industry still grapples with the gradual acceptance of compensation disclosure.
In this episode of the ShiftShapers podcast, Jon Shooshani, co-founder of JOON, discusses the concept of lifestyle spending accounts (LSAs) and their impact on health and well-being. Shooshani shares his journey from being deeply interested in health and wellness to the founding of his company, JOON, which offers personalized wellness and lifestyle benefits for employees. LSAs are employer-funded accounts with flexible spending on well-being-related items and experiences. They may vary in name and structure across different companies. Shooshani explains the value of LSAs in promoting employee health, satisfaction and retention, while also covering practical aspects like budgeting, implementation and the unique features of JOON’s platform. The story concludes with a touching background on the company's name and vision to provide meaningful employee benefits. Throughout this podcast, business executives and owners, big and small, will receive expert insights on how to provide competitive benefits packages that serve their employees well.
ShiftShaper Episode Takeaways- A lifestyle spending account (LSA) is an employer-funded fund that allows employees to spend on items and experiences that contribute to their well-being.
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LSAs can be customized and flexible, offering a range of categories such as health and wellness, professional development, work-from-home purchases, and family care.
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LSAs can have a positive impact on employee well-being and satisfaction, and can be used as a tool to attract and retain employees.
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Employers can determine the amount and reset frequency of LSAs based on their budget and goals. LSAs can be administered and streamlined through platforms like JOON.
This episode of the ShiftShapers Podcast features host David Saltzman interviewing John Clay, president of Better Source Benefits, about unique health plan solutions for small and mid-sized groups. John shares his background in the insurance industry, highlighting the journey from working in materials control to discovering innovative health plan solutions. Despite challenges, such as a lack of options beyond traditional insurance providers, John discusses how attending conferences and learning from others in the industry transformed his approach to offering health plans. He emphasizes the importance of understanding the needs of smaller businesses and how custom, level-funded health plans can offer significant benefits. The conversation also delves into the future of health plans for small and mid-sized businesses and how creative solutions can positively impact employee health outcomes and financial security.
This episode of the ShiftShapers podcast features an interview with Yoona Kim, the CEO and co-founder of Arine, a company focusing on medication intelligence via AI to improve clinical and financial outcomes in healthcare. In this episode, Kim shares insights from a healthcare background into the challenges surrounding drug prescriptions including accessibility, cost, and the impact of incorrect or suboptimal medication on patient outcomes. Arine leverages large-scale data analysis to provide actionable recommendations, aiming to correct discrepancies in medication use, particularly in polypharmacy (multiple medication) cases. The technology not only promises to significantly reduce hospitalizations and overall healthcare costs within a short period, but also enhances patient adherence to prescribed medication regimes. Kim elaborates on the collaborative process with healthcare providers and insurers to implement these changes effectively, highlighting the potential for widespread improvement in healthcare management and outcomes.
In this episode of the ShiftShapers podcast, we explore the complex world of Pharmacy Benefit Managers (PBMs) and their impact on healthcare costs, sparked by the Johnson & Johnson lawsuit. Our guest, USRxCare President Renzo Luzzatti, with a 30-year healthcare background, discusses the Consolidated Appropriations Act of 2021, which is aimed at shifting power back to payers from vendors by enhancing transparency and fiduciary responsibilities. The episode sheds light on the lawsuit against J&J for excessive pharmaceutical payments through their PBM, Express Scripts, highlighting the issue of overpayment in the industry. Luzzatti emphasizes the necessity of fiduciary PBMs, devoid of conflicts of interest, and the importance of transparency and beneficiary interests. We also discuss how employers can strategically manage their pharmacy benefits to avoid overpayment and ensure compliance with fiduciary duties, emphasizing the role of advisers in navigating this complex territory. The conversation also touches on current trends and future outlooks for managing pharmacy benefits more effectively and ethically. Each of these insights are critical to business owners and other organizational leaders who must manage healthcare benefits to be cost-effective while providing for employee health needs.
USRxCare: https://usrxcare.com/
In this episode of the ShiftShapers podcast, David Sloves, CEO of Nonstop Health, discusses the evolution and impact of Medical Expense Reimbursement Plans (MERPs) in the healthcare industry. He explains how MERPs differ from traditional health reimbursement arrangements (HRAs), HSAs, and FSAs by offering first-dollar coverage and customizable financial outcomes for both employers and employees. Sloves outlines the historical context of MERPs, their tax benefits, and how they aim to address the skyrocketing costs of healthcare and improve access to medical services. The conversation also covers the challenges of implementing MERPs, their role in enhancing employee satisfaction, recruitment, and retention, and the broader implications for the healthcare system in the United States. Through anecdotes and data, Sloves makes a case for MERPs as an ethical and effective solution to the current healthcare crisis.
We wrap up by celebrating the successes of mission-driven companies in the healthcare industry, specifically how they've introduced advanced healthcare programs to employers. David Slove recounts overcoming initial skepticism and the strategies that led to significant financial benefits for clients, thanks to the MERP model. As we close, we reflect on the cascading impact of such inclusive healthcare initiatives. These efforts aren't just reshaping employee benefits—they're empowering businesses, stimulating the consulting community, and fostering a culture of retention and recruitment excellence from the heart of conservative states to the broader national arena.
Bill Snyder, CEO of Vivante Health, discusses the importance of digestive health and its impact on healthcare spend. Digestive health issues like irritable bowel syndrome and GERD affect a significant portion of the population, leading to high claim spend and unnecessary utilization. The medical establishment is becoming more aware of these conditions, but diagnosis and treatment can still be challenging. Vivante Health aims to supplement traditional care with digital interventions to improve patient outcomes. By leveraging data and predictive modeling, Vivante Health can provide personalized care and identify trigger foods that cause inflammation.
Snyder, with a background in healthcare and a personal connection to digestive disorders, highlights the widespread impact of conditions such as irritable bowel syndrome, ulcerative colitis, and GERD on individuals and healthcare spending. The discussion covers the lack of awareness, diagnosis challenges, and the potential of digital interventions to improve care. The importance of the gut-brain connection and its relation to stress, anxiety, and possibly Alzheimer's disease is also explored. Snyder shares insights into how Vivante Health is addressing these issues through pattern recognition, personalized care pathways, and dietary adjustments to manage symptoms, significantly improving patients' lives. The conversation also touches on the future of digestive health care, the role of data in advancing treatment, and Vivante Health's approach to integrating with the healthcare ecosystem.
Welcome to another insightful episode of ShiftShapers! Join host David Saltzman as he delves into a conversation with Maya Perl, the visionary co-founder of Zorro. Together, they unravel the intricacies of the Individual Contribution Health Reimbursement Arrangement (ICHRA) and its profound impact on both employers and employees.
Discover how ICHRA empowers employers to revolutionize healthcare benefits by offering a defined contribution model, granting employees the autonomy to select tailored health plans that cater to their unique needs. Maya shares her inspiring journey in the healthcare realm, unveiling the genesis of Zorro and how their innovative platform, infused with AI prowess, simplifies plan selection, making healthcare more accessible and cost-effective than ever before.
In this discussion, explore the unparalleled advantages of ICHRA, including substantial cost savings, enhanced flexibility, and a plethora of personalized healthcare options. Learn how Zorro's cutting-edge technology educates employees, streamlines allowance calculations, and facilitates seamless enrollment into ICHRA plans, irrespective of employer size or geographical boundaries.
Join us as we uncover the transformative potential of ICHRA in reshaping the healthcare landscape, fostering higher retention rates, and paving the way for a healthier, more empowered workforce. Don't miss out on this enlightening exploration into the future of healthcare—tune in now and embark on a journey towards a healthier tomorrow!
On this episode of ShiftShapers, a podcast focused on the employee benefits industry, host David Saltzman discusses the secrets of business growth with Kevin Trokey and Wendy Keneipp from Q4 Intelligence.
The ShiftShapers Podcast is brought to you by MZQ Consulting, offering concierge-level service for all your benefits compliance needs, and the agility to keep up with the changing landscape.
In this enlightening discussion, Kevin and Wendy share their experiences and lessons learned which are also included in their book, “The Salesperson's Guide to Growing a Business.” The conversation touches on the importance of shifting from accidental to intentional business strategies, the role of marketing, effective prospecting in sales, the impact of technology, and the crucial role of leadership in an organization. They emphasize the need for viewing sales as a relationship and advice-based endeavor, while providing great insights regarding industry practices and strategies.
In this episode of the ShiftShapers Podcast, host David Saltzman interviews Ryan James Miller, a performance coach, consultant, keynote speaker and author of the book “Wounds.” Miller shares his professional journey and the adversities he had to overcome, including his father's abandonment, his fight for acceptance during his adolescence, the layoffs during the 2011 recession, and surviving the Route 91 Harvest Festival shooting in Las Vegas in 2017.
The ShiftShapers Podcast is brought to you by MZQ Consulting, offering concierge-level service for all your benefits compliance needs, and the agility to keep up with the changing landscape.
Ryan talks about how these experiences led to his realization of the link between personal wounds and unlocking one's unique greatness. He stresses on the importance of acknowledging wounds, understanding the rippling impact, finding the good and unlocking the greatness within oneself. Ryan presents “Wound Analysis Framework” that helps in personal transformation based on these principles.
What are the compliance issues that you should be aware of and what's coming down the pike legislatively for your business?
In this episode of the ShiftShapers podcast hosted by David Saltzman, ERISA attorney Jennifer Berman, the NABIP (National Association of Benefit Insurance Professionals) Legislative Vice Chair and CEO of MZQ Consulting, discusses various compliance issues that employers and their advisors must know.
00:00 Introduction to Compliance Issues and Legislative Updates
00:49 Understanding Mental Health Parity
02:51 Changes in Mental Health Parity Law
03:47 Annual Reporting Requirements
08:04 Understanding Prescription Drug Data Collection (RxDC)
12:42 The Complexity of ACA Reporting
16:57 Understanding Gag Clause Attestation
25:28 The Importance of Fiduciary Responsibility
33:39 Legislative Updates: Employer Reporting Bill and More
39:21 The Future of Telehealth and Virtual Care
41:09 Conclusion and Final Thoughts
Ever wanted to know what consumers really desire from their brands? Then you won't want to miss this episode with our phenomenal guest, Kurt Bartolich, the founder of Brand Certain. Kurt's bi-annual survey of 1,600 consumers provides precious insights into shifting consumer preferences, shattering the old paradigm of 'uniqueness' in favor of genuine qualities like honesty and authenticity. We unearth the importance of convenience and originality to consumers and scrutinize case studies: Bed Bath and Beyond's failure to meet consumer desires and Verbo's triumphant brand positioning.
Can CEOs master the art of public speaking? Kurt's years of experience lend us invaluable advice on this topic. With a focus on honesty, transparency, and authenticity, he discloses practical tips to enhance unscripted, natural conversation, ensuring your brand message resonates with consumers. We also delve into a crisis management case, examining how Toyota navigated troubled waters. This episode is a treasure trove of practical takeaways on building consumer trust and shaping successful brands - a must-listen for anyone invested in understanding and meeting consumer needs.
Want to revolutionize your company's healthcare experience? Tune in as we welcome Ryan Robbins, the dynamic co-founder of Ello Benefits, who is here to discuss the transformative power of direct primary care (DPC) and its potential to significantly impact medical costs, improve employee experiences, and manage chronic conditions. Ryan offers an insider's perspective on how his team is shaking things up in the healthcare industry, providing tailored solutions to enhance efficiency and effectiveness in underserviced markets.
Shifting gears, we delve into the role our physicians play in the healthcare equation, highlighting the importance of understanding patients' insurance status. Ryan shares how they are educating employees on optimal use of medical insurance through open enrollment meetings, with physicians playing a vital role. We also touch on the benefits of DPC from the perspective of both physicians and employees, and the advantages of level funded plans for employers with fewer than 300 employees. Don't miss out on this eye-opening conversation as we unpack these innovative ideas and strategies leading to a better healthcare experience for all.
Want to crack the secret to building enduring business relationships? What if we told you that the key is not hidden within complex strategies but lies in simplicity, authenticity, and selflessness? This awe-inspiring conversation with Andre Davis, a respected communication specialist and public speaker, brings that theory to life.
You'll be fascinated as Andre unravels his approach to forming meaningful connections, emphasizing genuine interest in understanding someone's story, needs, and goals over pushing an agenda. Andre also breathes life into the concept of servant leadership, challenging traditional thoughts and showing how helping others when they can offer you nothing in return is a powerful tool for long-term success. Prepare to be deeply moved and influenced by Andre's perspective.
Furthermore, Andre sheds light on the compelling influence of 'Go-Giver' on his business philosophy and how it shapes his strategy in forming authentic connections on platforms like LinkedIn. He also emphasizes the immense power of effective communication in building trust, standing out, and establishing a strong business presence. Filled with Andre's enlightening anecdotes and practical tips, this episode is an invaluable guide to anyone willing to step up their relationship-building game in business. Be ready for an incredible journey that combines the power of communication, authentic leadership, and the magic of giving in the world of business. Enjoy the ride!
Are you tired of feeling lost in the complex world of healthcare? Ever wish you had a guide to navigate you through it all? Well, meet Keith Somers, co-founder and CRO of HealthCorum, a company that's revolutionizing the healthcare sector, giving you the power to make informed decisions. Keith shares his personal journey of how his encounters with wasteful and low-value care inspired him to tackle these issues head-on, advocating for high-value, high-quality care.
HealthCorum's approach is simple yet innovative - transparency and data-driven insights. This episode reveals how risk adjustment using data analytics can provide a fair comparison of healthcare providers, leading to potential massive cost savings. Keith also explains how HealthCorum is fighting to improve patient outcomes at a grassroots level, marrying price transparency and data-driven scores to empower you, the consumer. No more feeling left in the dark when making healthcare decisions, tune in to understand how HealthCorum is lighting the way!
Do you often find yourself wrestling with the myriad of challenges in benefits administration? Tune into our fascinating conversation with Shannon Goggin, co-founder and CEO of Noyo, as we traverse the landscape of benefits experience enhancement for customers. Shannon shares the inception story of Noyo, a visionary company that simplifies data exchange across divergent systems and how their mission is to enable secure data sharing with the goal of delivering the right information to the right people, at the opportune time.
Ever felt exasperated by the industry's stumbling blocks such as the absence of universally accepted standards or the herculean task of processing an ocean of information? We've got you covered! We dive into the heart of these issues and discuss how Noyo provides comprehensive solutions for companies longing to integrate a seamless benefits experience into their software. We also unravel the knotty issue of premium leakage and delve into the transformative potential of technology, particularly AI, in boosting operational efficiency and reducing the burden on employers. Catch the wave and join us in exploring the monumental influence of AI in managing data and the urgent requirement for speedy carrier set-up and how Noyo's pioneering technology simplifies this process.
Imagine a future where health plans come with no deductibles and no copays, doesn't it seem like a fantasy? But what if it's not? In our enlightening conversation with James Millaway, the CEO of Zero Health, we unpack the concept of health plans without the burden of deductibles and copays. We trace the history of these cost-sharing measures and their effect on overall healthcare costs. We also highlight the idea of insurance and how it should be a guard against catastrophic risks, not everyday events.
Moving onto the second half of our discussion, we delve into the realm of efficient healthcare purchasing and its potential for significant cost savings. We ponder on how employers and brokers can enable their employees to make informed decisions about their care. The talk also covers the integration of care management and the potential savings in medical expenditure. Our discussion reaches its peak as we talk about the future of healthcare and the vital role of trust. We explore Zero Health's impact on this future, and the importance of creating a trustworthy product. Don't miss out on this insightful conversation where we reimagine the future of healthcare.
Have you ever wondered about the hidden layers of healthcare costs? Today, we bring you insights from an eye-opening conversation with Dr. Keith Smith, co-founder of the Surgery Center of Oklahoma. Dr. Smith shares his personal journey of navigating the healthcare industry, and the shocking discovery that hospitals were not always the best advocates for patients or surgeons. He and his colleague dared to change this by establishing their own facility, a radical move that influenced the Trump Executive Order Mandating Price Transparency.
We're also discussing the rising trend of self-funded healthcare plans and why employers are looking for alternatives to traditional ones. Imagine a zero-deductible and zero-copay approach to healthcare; it's happening, and it's giving companies a competitive advantage in the labor market. But it's not all smooth sailing; there are important regulations to consider like CAA notifications and ERISA. Plus, we highlight why quality assurance remains crucial when choosing healthcare facilities.
Rounding off, we question traditional quality metrics and argue for the value of price transparency in measuring the quality of care. We draw on insights from Marty McCary's book Unaccountable to challenge the reliability of existing quality metrics. Finally, Dr. Smith shares his thoughts on the future of healthcare and the ongoing need for more transparency and patient advocacy. So, sit back and join us for a compelling discussion filled with revelations about the evolving healthcare industry.
Ever wondered how the Pharmacy Benefit Management (PBM) industry really works? Join us for an enlightening chat with our guest, Dave Parker, the Vice President of Sales and Marketing at TrueScript, as we unravel the intricacies of the traditional PBM relationship. Gain insight as Dave dissects key terms like average wholesale price and net cost, and unveils the ways PBMs make their money. We also delve into the trend of manufacturers moving closer to employers to shake off spread pricing models. More importantly, discover why it’s crucial to ask the right questions in a PBM relationship.
We also step into the fascinating world of pharmacogenomics testing for prescription drugs, a game-changing approach that could redefine the healthcare industry. Picture this - a one-time test that prevents the misprescribing of medications, saving patients and doctors from hefty medical bills and hospital stays. Indeed, such a test already exists, and some PBMs are benefiting from the potential savings it brings. We’ll also investigate the prospect of making this a routine test for newborns and what it could mean for stop loss carriers. Last but not least, Dave returns to introduce us to the emergence of transparent PBMs - a revolutionary shift that is transforming the industry and proving particularly appealing to younger consumers. Tune in for an episode packed with industry insights and thought-provoking discussions.
Prepare yourself to be fascinated by Dr. Kyle Rickner, co-founder and chairman at Primary Health Partners, as he takes us on an inspiring journey of how direct primary care became his answer to physician burnout and subpar patient experiences. Step into the world of evolving healthcare models as we dissect the barriers that prevent more physicians from transitioning to this progressive model. Together, we untangle the web of the traditional fee-for-service system and how it has stagnated the growth of direct primary care. We also unpack the implications of misused health insurance and sky-rocketing premiums leading to a precarious cycle of healthcare costs.
In the latter half of our enlightening conversation, we journey across state lines to understand how direct primary care physicians unite in their mission to deliver patient care. Listen to Dr. Rickner narrate the challenges and triumphs of coordinating care for a substantial client base, all while pushing the scalability model forward. We also shine a spotlight on the significance of data collection in establishing the value of direct primary care and highlight the urgent need for educating people about its benefits. Join us and share our curiosity, as we discover how direct primary care is revolutionizing the healthcare industry.
Ever wondered if your business is really understanding the true cost of healthcare? Join us as we pick the brain of Kelly McDevitt, the President of the Nonprofit Integrated Benefits Institute (IBI). With a whopping 40 years of industry experience, Kelly unpacks how IBI assists businesses in deciphering the often-complex healthcare costs beyond just medical and pharmacy expenses. We dive into the increasing curiosity around self-insured plans and the pivotal role of data in employer decision-making. Plus, you'll discover how IBI’s benchmarking data provides a panoramic view, setting the stage for strategic planning.
Then, as the conversation deepens, we navigate the murky waters of delayed healthcare and the difficulties it presents in sourcing relevant claims data. Our journey takes us into the heart of the pandemic's impacts on health and disability claims - including prolonged health issues related to COVID-19. Kelly sheds light on how businesses can utilize this data to craft well-informed decisions, the significance of benchmarking, and the unique challenges HR teams are currently facing. Tune in for an insightful conversation packed with valuable insights for employers seeking to understand the labyrinth of healthcare costs.
Have you ever wondered about the balance between empowering employees and maintaining control as a leader? Get your answers as we have an enlightening conversation with Kristen Hadeed, author of Permission to Screw Up and Leadership Thought Leader. Kristen takes us on her leadership journey, a journey that began when she was 21 and saw 45 of her employees walk out on her, a pivotal event that reshaped her leadership approach. She shares how this experience transformed her into an advocate for fostering an environment of trust, empowerment, and psychological safety.
What if your team could solve problems without micromanagement? Would it be more effective? Kristen takes a deep dive into these questions and unravels the delicate balance between supporting employees and giving them ownership of their work. She also shares her insights on how to avoid micromanagement and the impact it can have on your team’s morale and your own wellbeing. At the heart of her message is the importance of cultivating a culture of trust that encourages constructive feedback.
Can vulnerability be a game-changer in the workplace? Let's find out from Kristen's personal experience. She unveils how her honesty and vulnerability with her team not only led them to trust her but also gave her a second chance. Listen in as she passionately talks about the value of fostering an environment of vulnerability in the workplace. You'll learn the importance of striking a balance between guiding and supporting employees and giving them ownership of their work. It's time to explore the creation of human workplaces where vulnerability is embraced. This episode is loaded with wisdom, practical advice and a fresh perspective on leadership. Don't miss out!
GET KRISTEN'S BOOK: Permission To Screw Up
You ever wonder why the current healthcare system is so expensive and seemingly broken? Get ready to explore the potential of innovative healthcare plan designs that seek to reduce out-of-pocket costs and increase access to care with our special guest, Kevin Kickhaefar, President and Chief Growth Officer at Gravy. We'll learn about Kevin's fascinating journey from the Midwest to leading a healthcare startup and his vision of a redesigned healthcare system that works for everyone. We'll investigate the integration of direct primary care with plan design, and the challenges that brokers and advisors face in the current climate.
Thinking about level-funded and self-funded plans? Our insightful discussion with Kevin also covers their impact on employers and traditional health insurance carriers. We'll explore how these plans provide employers with more control over their healthcare costs, leading to a more sustainable model for the future. Learn about how direct primary care can bridge the healthcare gap in underserved communities, and how innovative partnerships like the Gravy Pay card and Teladot are simplifying the payment process and virtual visits for patients and providers alike. If you're curious about the future of health insurance, this is one episode you won't want to miss.
Join us for a riveting conversation with our guest, Daniel Grun, Chief Marketing Officer at Leading Edge Administrators. From nonprofit to insurance, he brings a unique perspective to our discussion about the key factors keeping the market static - cost, access, and education of care. Daniel drops knowledge on the benefits of strong partnerships and the increasing influence of self-funded plans in the industry. We also dig into the vital role of training and establishing a bond of trust in selling and keeping insurance businesses afloat.
Stay tuned as we navigate the terrains of data lakes, benchmarking, and reference-based pricing, technologies that are radically altering outcomes. Get an inside look at how Artificial Intelligence, guided by correctly labeled data, is bridging the underwriting gap. Join us as we tackle the responsibilities attached to selling insurance plans, the necessity for proper education, and the thrill (and risk) of being on the cutting edge. Buckle up for an enlightening discussion on the ever-changing insurance panorama and how to master the art of navigating it.
Are you ready to tackle the trust problem impacting organizations across all industries? Join us as we unravel the secrets to building trust with our exceptional guest, Corey Sheer, founder and CEO of TrustCentric Consulting. Corey shares his journey and research on the structure of trust, and reveals the three vital building blocks that can make or break trust within an organization: organizational competencies, problem-solving skills, and demonstrating care for others.
Dive into the world of trust with us as we examine the importance of making trust a key performance indicator (KPI) to become more strategic. Corey highlights five critical priorities for organizations seeking to build trust: regular employee feedback, honest conversations, a clear strategy, transparency, and clear ownership of tasks and projects. We explore how prioritizing these elements can help create a culture of trust and the impact of a lack of trust on key performance indicators like employee productivity, retention, loyalty, and advocacy. Corey even shares some practical advice for leaders eager to start rebuilding trust in their organizations. Don't miss this insightful conversation that will help you transform your organization's trust landscape!
Are you a Type A personality? Discover how our guest, a fellow Type A individual, managed to transform their career journey to find meaning and fulfillment in their work. We dig deep into the need for variety and engagement for easily bored Type A personalities, the impact of early childhood experiences on our tendencies, and the role societal influences play in shaping our career choices. Plus, we reveal how understanding our coping mechanisms is essential to finding a career that truly works for us.
Feeling trapped in a role that doesn't suit your personality? Find out how to self-assess what you're tolerating and not accepting in your life, and how making small decisions can help shift your experience for the better. We also discuss the significance of being aware of your emotions throughout the day, so you can reach that tipping point where it becomes less painful to make a change than to stay stuck in a lane that doesn't work for you.
What if there was a way to revolutionize musculoskeletal care while reducing unnecessary procedures? Discover how Dr. Michael Greiwe, founder of OrthoLive, is using telemedicine to ensure patients receive the right treatment. In our engaging conversation, Dr. Greiwe shares his journey from medical school to creating OrthoLive and the importance of listening to patients' stories in making informed diagnoses.
We also explore the power of shared decision-making in healthcare, empowering patients to become informed and communicate with their physicians for better compliance and outcomes. Learn how coming together and creating a plan benefits both patients and physicians while potentially transforming the way we approach musculoskeletal care. Join us as we discuss the future of OrthoLive as a network of surgeons providing efficient and cost-effective healthcare solutions.
What if healthcare as we know it is stealing the American Dream? Join us on this eye-opening episode as we welcome Dave Chase, creator and co-founder of Health Rosetta, to discuss the vital role of benefits advisors in preventing medical mistakes and saving the US economy. Learn how Dave's personal journey to understand a tragic misdiagnosis led him to create a movement aimed at transforming healthcare and restoring the American Dream.
Together, we explore the origin story of Health Rosetta, how the ACA sparked the journey to change, and how the 2016 election illuminated the need for a drastic overhaul of our healthcare system. Discover how wage stagnation and rising premiums have contributed to economic depression for the working and middle classes over the past 30 years, and why it's time to take action. Uncover the potential of using LEED standards to accredit and certify health plans, and how focusing on quality and affordability could be the key to reducing healthcare spending. Don't miss this powerful conversation with Dave Chase as we work towards restoring the American Dream through healthcare transformation!
SPECIAL NOTE: Join Dave and the Health Rosetta team at ROSETTA FEST August 7-9, 2023 in Chicago. Click HERE for more information.
Imagine uncovering the secrets to managing the ever-changing world of healthcare and pharmacy expenses, gaining insights on how to reduce total healthcare spend, and staying ahead of the industry's money-making machine. We had the pleasure of speaking with Joey Dizenhouse, senior VP and head of IHP at Health Trust Performance Group, who shared his journey from being an actuary in Canada to navigating the complexities of the U.S. healthcare market. Joey dives into the challenges plan sponsors face in managing the cost of prescription drugs and the three main areas of focus to address this issue: individual drug prices, usage, and mix.
In our conversation, we also explore the idea that creating scale isn't always the solution for reducing healthcare spend. Joey emphasizes the importance of leverage, spend, and deep subject matter expertise in this process. He also sheds light on the intricacies of formulary control and the tenacity needed to fight against the industry's powerful forces.
Lastly, we delve into the fascinating world of pharmacogenetic testing and its potential impact on the healthcare industry. Joey shares his thoughts on the possible benefits and drawbacks of utilizing this technology, and the role of benefit advisors in this process. Don't miss this engaging and informative conversation with Joey Dizenhouse, as we uncover the keys to better understanding and managing pharmacy costs and volatility in healthcare.
THE SALTZMAN GROUPFor more information go to our WEBSITE
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Why is self-funding becoming a popular choice for small businesses, and how can you implement it effectively? Join us in an engaging conversation with Chris Corkran, President and CEO of Creative Benefits Consultants, as he shares his journey and expertise on this innovative benefits solution.
We dive deep into the level-funded healthcare plans approach , discussing strategies for helping employers save money while providing improved benefits for their employees. Learn about the crawl, walk, run continuum and taking a holistic approach to benefits consulting. Chris also shares valuable insights on the importance of working with an independent benefits consultant to navigate these decisions. Don't miss this opportunity to gain practical knowledge on creative benefits solutions for small groups.
THE SALTZMAN GROUPFor more information go to our WEBSITE
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This week's episode explores the fascinating intersection between the traditional agency model and the gig economy. In a rapidly changing world where frictionless relationships and instant, on-demand services are sought after, how can the insurance industry adapt to attract younger generations and diverse talent?
Join us as we delve into the potential of platform-as-a-service solutions and their role in revolutionizing the employee benefits landscape, offering opportunities for both advisors and employees alike.
What You’ll Learn From This Episode:0:45 From unexpected beginnings to the insurance industry.
1:32 Addressing the failure of employee benefits: Enroll-a-five’s mission.
5:13 The first gig economy play in insurance: Monetizing expertise and expanding reach.
7:16 Meeting the needs of a changing workforce: Fragmentation, friction, and the call for streamlined solutions.
9:07 A pathway for engaging the youth and diverse populations.
11:57 The role of benefit advisors in driving engagement and care.
14:19 Presenting a customized solution for employers.
15:50 Balancing relationships and technology in the industry.
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THE SALTZMAN GROUPFor more information go to our WEBSITE
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This week's episode delves into the revolutionary advancements in genetic testing and its transformative impact on healthcare. With the advent of precision medicine, the ability to analyze an individual's genetic makeup has become a total game changer. By understanding how genes influence drug response and metabolism, healthcare providers can tailor treatment plans for optimal effectiveness while minimizing risks and costs. Join us as we explore the potential of genetic testing to revolutionize patient care and address concerns surrounding privacy and discrimination fears.
What You’ll Learn From This Episode:
1:04 Journey to expanding offerings: Antimicrobial stewardship and medication adherence programming.
2:42 Addressing inefficacy and personalized medicine: Leveraging genetic information.
5:13 Educating payers for improved outcomes and cost reduction.
6:22 The process of genetic testing and how the various pieces come together.
8:12 How the integration of genetic test results works in the doctor-patient interaction and its broader implications.
11:31 Improving patient outcomes and cost-efficiency.
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THE SALTZMAN GROUPFor more information go to our WEBSITE
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This is where we should put the guests name, title and web address. Also if we link to a book or a paper or other.
This week's episode explored the intriguing realm of modernizing ancillary benefits, shedding light on the shifting landscape of employee benefits and the profound impact it has on employers and their workforce. The discussion emphasized the increasing significance of ancillary benefits, such as dental, vision, and life insurance, in today's competitive market, where employers strive to attract and retain top talent.
The conversation delved into the evolving expectations of employees, the role of technology in streamlining benefits administration, and the growing recognition of the interconnectedness between benefits, company culture, and overall employee experience. Join us as we uncover the transformative power of modernizing ancillary benefits and its profound implications for businesses of all sizes.
What You’ll Learn From This Episode:0:49 Unexpected path: From engineering to employee benefits.
1:41 Unveiling a forgotten corner: Addressing dental insurance gaps.
3:14 From connected toothbrushes to building an insurance company.
7:27 Beam’s mission to empower brokers and enhance customer experience.
12:12 The strategic connection between benefits, culture, and measurable outcomes.
15:38 Enrollment, participation, and employee happiness outcomes.
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THE SALTZMAN GROUPFor more information go to our WEBSITE
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In this week's episode of the ShiftShapers Podcast, the spotlight shines on the evolving landscape of self-funded plans and the critical role of third-party administrators (TPAs). Jay Kempton, President and CEO of the Kempton Group, discusses the increasing demand for TPAs and the education gaps among advisors. From discussing the industry's growth and the need for knowledgeable TPAs to navigating regulatory boundaries and understanding ERISA, this episode provides valuable insights for advisors and industry professionals alike.
What You’ll Learn From This Episode:0:56 Increased business opportunities and growth for TPAs in a challenging industry.
2:56 Deficits among advisors in understanding ERISA and self-funded plans.
3:57 Expanded scope of fiduciary responsibility for plan administrators and sponsors.
6:15 Liability and accountability: The role of advisors in addressing unethical vendor practices.
8:27 Lack of patient engagement: Disempowerment and limited decision-making rights.
11:17 Empowering patients as healthcare buyers: Changing perceptions and social challenges.
13:56 Shifting healthcare behavior: Unfulfilled expectations of patient engagement.
15:55 The power of bundled healthcare for informed decision-making.
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As healthcare costs continue to rise and insurance premiums become increasingly unaffordable for many Americans, the concept of direct pay models has gained traction.
In this episode, we sit down with Dr. Jawad Arshad, CEO at WoW Health Solutions, to explore the idea of a direct pay model for ambulatory care. We dive into the benefits and challenges of such a model for ambulatory care and explore how it could potentially transform the healthcare industry.
Join us for a thought-provoking conversation on the future of healthcare in the United States.
What You’ll Learn From This Episode:0:47 ER physician turned CEO: An insight into the challenges faced by providers and payers in healthcare delivery.
2:09 Understanding direct pay model for ambulatory care: A transparent and consumer-centric approach to healthcare payment.
5:17 Addressing misconceptions about insurance policies and direct pay models.
7:25 Benefits of Direct Primary Care and Challenges in the Current Healthcare System
11:55 The role of benefits advisors in changing employee behavior and reducing healthcare costs.
11:47 Exploring the direct pay model and insurance deductibles: Can you still file for reimbursement?
16:07 Alternative arrangements and market stressors driving direct pay models.
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The Saltzman Group
David Saltzman, RHU, DIA, Certified StoryBrand Guide
865-219-3667
david@thesaltzmangroup.com
www.thesaltzmangroup.com
This week's episode is all about ancillary benefits and why they should be an important consideration for employers.
Together with Kevin Curran, founding partner at Salt Margin, We'll dive into the world of employee benefits and explore the ways in which ancillary benefits can add value to your company's offerings. While health insurance and retirement plans are often top of mind for employers, ancillary benefits can make a big difference in attracting and retaining top talent.
It's time to shine a light on these often-overlooked benefits and discover how they can give your company a competitive edge in today's tight job market. So, sit back, grab a cup of coffee, and join us as we explore the world of ancillary benefits.
What You’ll Learn From This Episode:0:48 How Kevin got started in the insurance business.
3:30 The flawed approach to marketing traditional ancillary benefits.
5:09 The shift towards ancillary benefit consulting: Opportunities and challenges for advisors.
8:17 Coordinating with leave programs: How it can save you money on short-term disability insurance.
12:27 Reverse discrimination and overcoming it: Strategies for successful advisors and agencies.
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The Saltzman Group
David Saltzman, RHU, DIA, Certified StoryBrand Guide
865-219-3667
david@thesaltzmangroup.com
www.thesaltzmangroup.com
In this week's episode, we delve into the increasing popularity of pet insurance in the workplace. As a larger number of Americans own pets, employers are acknowledging the significance of incorporating pet-related benefits into their employee wellness programs.
Join David Saltsman and Aaron Oaks, CEO of United Pet Car, as we explore the benefits of pet insurance for both employees and employers and discuss how this trend is shaping the future of employee benefits.
What You’ll Learn From This Episode:0:30 Aaron shares his journey: From Non-Pet Healthcare to Pet Insurance.
2:20 Exploring the gaps and challenges in pet care.
3:36 Pre-existing conditions and exclusions in traditional pet insurance.
5:31 The growing market of pet ownership and the lack of proportional increase in pet insurance coverage.
6:25 A new approach to financial protection for pets.
8:13 A discussion on the HMO model and referral system in pet healthcare.
9:47 A step-by-step guide to enrolling in united pet care’s plan.
11:49 Understanding the fee structure for vet services on the plan.
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This week's episode features a fascinating conversation about the future of healthcare and the challenges facing the industry in providing a frictionless experience for members. Rob Gelb, CEO of Valence Health shares insights on how their company is working towards creating a single point of coordination and alignment for all parties involved in healthcare, from the patient to the payer, to reduce complexity and improve the overall experience.
Join us as we explore the exciting possibilities and potential obstacles that lie ahead in the ever-evolving world of healthcare.
What You’ll Learn From This Episode:2:03 Two major problems facing the healthcare industry
4:05 Educating and Aligning with Self-Funded Employers and Their Networks
6:16 The four pillars that need to be aligned in your business.
8:41 Helping clients Move from reactive to proactive: A real-life example from the healthcare industry.
10:09 An example of how the integrated optimization platform has changed the member experience of an association.
12:05 Consultative approach to introducing integrated optimization platform to struggling employers: An example conversation with benefit advisors.
13:25 How Valence Health communicates and delivers integrated care to members.
14:47 Finding the balance between simplifying user experience and maintaining partnership with other providers.
15:50 Designing a frictionless healthcare system: Balancing expanded services and a seamless member experience.
18:24 Building a frictionless future: Creating alignment and coordination for patients, plans, payers, and providers.
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In this week's episode, we explore leadership development with a renowned expert in the field, Katie Ervin. She provides insights into how organizations can identify and cultivate leadership potential in their employees. Additionally, she emphasizes the importance of self-awareness and emotional intelligence for effective leadership. We also discuss strategies for overcoming imposter syndrome and empowering introverted individuals to step up as leaders.
Join us for a thought-provoking discussion on the keys to successful leadership development.
What You’ll Learn From This Episode:0:59 Katie's journey to becoming a CEO.
2:47 The importance of building relationships and trust in leadership and the workplace.
5:20 The significance of self-awareness and a growth mindset for leaders and organizations.
7:16 The importance of effective leadership development for business growth.
10:35 How to become your inner cheerleader and find your inner coach.
12:04 Helping other leaders realize their potential.
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In this week's episode, Lee Smith, the CEO of SalesFuel and author of "SalesCred: How Buyers Qualify Sellers," shares insights on the significance of credibility in sales. He emphasizes how credibility is often overlooked in today's fast-paced and technology-driven sales environment, and how sales is more of an intelligence game than a numbers game.
In, Lee shares his journey in sales and how he started SalesFuel to help salespeople become more credible with their buyers. He also covers the three pillars of credibility and the five levels of credibility in sales, as well as the importance of avoiding arrogance in sales.
What You’ll Learn From This Episode:0:27 Lee shares his journey in sales and how he started his company, SalesFuel, to help salespeople become more credible with their buyers.
2:38 Buyer perception and the importance of credibility in sales.
4:59 The three pillars of credibility.
9:51 The five levels of credibility in sales.
14:08 The importance of credibility and avoiding arrogance in sales.
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In this week's episode, we dive into the important topic of mental health in the workplace. Haley Prophet, a consultant, and expert in this field, shares valuable insights on how to create a supportive workplace culture that promotes connectedness, safety, trust, care, and compassion.
Haley emphasizes the need for leaders to shift their mindset from being bosses to being coaches, and to view the current situation as an opportunity for growth and evolution. With the pandemic drastically changing the way we work, it's more important than ever to prioritize mental health in the workplace.
Join us as we explore these important issues and learn from Haley's insights.
What You’ll Learn From This Episode:1:50 Expert insights on workplace well-being.
4:43 The shared responsibility between employers and employees in prioritizing workplace well-being.
7:30 The importance of organizational culture and recognizing symptoms of a bad culture: Emphasizing the connection between well-being and organizational performance.
12:01 The importance of value on investment (Voi) In businesses: Moving beyond ROI to embrace holistic measures of performance and well-being.
14:06 Creating a multi-pronged approach to address mental health in the workplace: Shifting mindsets and embracing opportunities for growth and evolution.
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We were voted BEST INDUSTRY PODCAST at the 2023 YouPowered Benefits Conference!
In this week's episode, Daniel Meylan, Senior VP of broker relations at Payer Compass, shares his insights on the importance of transparency in the insurance industry and why it's often lacking. In spite of the importance of transparency for establishing trust and building strong client relationships, many brokers have difficulties disclosing their revenue sources.
In this interview, Meylan shares his perspectives on how brokers can navigate this challenge, emphasizing the need for completeness, transparency, and ethics. He also touches on the role of data and technology in the future of the industry, and why he's optimistic about the next generation of brokers.
What You’ll Learn From This Episode:
1:47 Daniel Meylan’s background in the broker-dealer world.
4:00 The three classes of the American healthcare system and how transparency will change the system over the next decade.
6:31 How direct primary care and reference-based pricing are promoting transparency in healthcare.
11:10 The challenges of modernizing technology infrastructures in the insurance industry and how aggregating data can eventually lead to transparency in healthcare costs for consumers.
13:36 The consolidated appropriations act and its implications on fiduciary responsibility, class action lawsuits, and broker disclosure.
17:50 Meylan shares his views on the future of the insurance industry.
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We were voted BEST INDUSTRY PODCAST at the 2023 YouPowered Benefits Conference!
This week's episode features a fascinating discussion with Dr. Paula Muto, a practicing surgeon and founder of Uberdoc, a healthcare platform designed to provide patients with greater access and control over their medical care. In this insightful conversation, Dr. Muto shares her unique perspective on the current state of healthcare in the US and highlights the need for a more patient-centered approach. She emphasizes the importance of separating the practice of medicine from the business of healthcare and explains how Uberdoc is revolutionizing the traditional healthcare model by empowering patients to take charge of their care journey.
What You’ll Learn From This Episode:
2:10 A surgeon’s perspective on direct pay model and why health insurance is like renting an apartment.
3:39 Building health equity: Moving from rental to a mortgage model in healthcare.
6:35 The healthcare spending crisis: Why two-thirds of healthcare spending is wasted on managing data and care, and how we can redirect the funds to improve patient outcomes.
9:19 The future of healthcare consumerism: Empowering patients to take control of their care.
11:35 The direct pay model: A practical solution for consumer-driven healthcare.
14:05 Uberdoc’s role in direct pay model: Making medical appointments and payments simple and transparent.
17:46 Separating medicine from healthcare.
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We were voted BEST INDUSTRY PODCAST at the 2023 YouPowered Benefits Conference!
This week's episode of our podcast features a fascinating conversation with Eric Silverman, a renowned speaker, author, and voluntary benefits expert. Eric discusses the evolving world of voluntary benefits and enhanced benefits, highlighting the important role technology has played in transforming it. He also delves into the increasing trend of outsourcing non-expertise areas in the industry, which he predicts will become more prevalent in the next few years. With his charismatic storytelling skills, Eric offers valuable insights into the benefits industry's future.
What You’ll Learn From This Episode:
2:12 Enhanced benefits: The key to attracting and retaining talent in today’s economy.
5:02 Exploring the changing landscape of employee benefits: The rise of non-traditional insurance and the importance of effective communication.
7:12 The benefits of effective communication strategies.
9:32 The importance of employer engagement and the journey vs. destination mindset in employee benefits.
13:25 Understanding responsibility creep in the broker and advisor industry: The challenges and solutions
17:26 The future of voluntary benefits: trends and outsourcing possibilities.
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We were voted BEST INDUSTRY PODCAST at the 2023 YouPowered Benefits Conference!
This week's episode delves into the world of pharmacogenomics (PGx) and how it is changing the way we approach medication management. We sit down with a leading expert in the field to discuss the current state of PGx adoption, the challenges it faces in gaining wider acceptance in the medical community, and the potential impact it could have on our healthcare system in the future. From the role of direct-to-consumer testing to the importance of involving clinicians in the decision-making process, we explore the complexities of this emerging field and what it could mean for patient care. Join us for this informative and thought-provoking conversation on the cutting edge of personalized medicine.
What You’ll Learn From This Episode:
1:54 Overmedication: A systemic problem in healthcare.
4:16 The evolution and future of pharmacogenetics (PGx) as a standard of care.
12:44 Implementing pharmacogenomics testing in employer healthcare plans: Overcoming adoption challenges and practical applications.
14:51 The adoption curve of pharmacogenomics testing in healthcare: A bottom-up mission.
17:34 The future of PGx: Adoption by early adopters and the role of payers.
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We were voted BEST INDUSTRY PODCAST at the 2023 YouPowered Benefits Conference!
This week's episode features a fascinating conversation with Mitch Case, the founder of More Than a Meal, a company that provides personalized and impactful meal gifting experiences to employees. Mitch shares his insights on why traditional gifts like gift cards are no longer effective in engaging employees, and how a customized meal experience can create a more intimate and visceral connection. He also discusses how the pandemic has changed the way employers engage with their employees and how More Than a Meal has adapted to meet those changing needs. Stay tuned for an insightful conversation on employee engagement and creative gifting ideas.
What You’ll Learn From This Episode:2:00 More Than a Meal and its mission.
3:53 Benefits of personalized meal delivery services for employees.
6:38 Employee feedback.
12:20 An overview of the process of personalized meal delivery for corporate clients in Kansas City and beyond.
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We were voted BEST INDUSTRY PODCAST at the 2023 YouPowered Benefits Conference!
In this episode, we sit down with Chris Labrecque to discuss the future of the benefits consulting industry. Chris shares his insights on the changing landscape of the industry and how it is moving from a cost-focused approach to one that places a strong emphasis on value. He shares his experiences having conversations with clients and how they are eager for a new approach that can provide different results. Chris is passionate about the industry's future and provides a unique perspective on how the industry can respond to the challenges it faces in 2023 and beyond. Join us for this exciting conversation with Chris Labrecque as we delve into the future of benefits consulting.
What You’ll Learn From This Episode:
1:32 Understanding and addressing social determinants of health.
3:44 Dealing with the restrictions of separated insurance companies and not sharing information.
5:44 Leveraging human capital management and financial services to improve employee engagement and reduce turnover in population health management.
7:27 The importance of connecting employees to the cause of the organization for increased productivity and mental health
10:10 HR conundrum: Balancing multiple vendors and maintaining population health
18:02 The future of the benefits and insurance industry
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In this week's episode, we welcome Jason Cutter, an expert in sales and author of the book "Selling with Authentic Persuasion." He shares his insights on the intangibles that make a difference in sales, including the importance of follow-ups, pausing, and understanding the fear that customers may have. Jason also provides valuable tips on how to build value and overcome objections in the sales process. Don't miss out on this opportunity to learn from an experienced professional in the field and gain a new perspective on sales success.
What You’ll Learn From This Episode:
1:36 Jason’s journey from marine biology to sales and training: Navigating a non-linear career path.
4:00 Distinguishing between order takers and sales professionals in the employee benefits industry
6:15 The importance of authenticity in sales: Moving from being an order taker to being real
8:32 The Five Sales Success Traits
11:55 The importance of authenticity and curiosity in sales.
14:47 Understanding and managing fears in sales.
17:05 The importance of understanding the difference between manipulation and positive persuasion in sales, and the need to strive for positive outcomes in order to achieve success in sales.
19:25 The little things that make a difference.
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In this week's episode, we dive into the world of HSAs and telemedicine extensions. With the rise of the COVID-19 pandemic, telemedicine has become a vital tool in healthcare. However, there have been some questions about how it relates to HSAs and the laws surrounding them. We'll be discussing the gray area surrounding this topic and the recent changes made by the Cares Act to clarify the situation.
Together with Jessica Waltman, vice president of compliance at MZQ Consulting, we explore the ins and outs of HSAs and telemedicine and how they may affect you.
What You’ll Learn From This Episode:1:26 Understanding the impact of the pandemic on telemedicine and HSAs.
3:55 Extension of HSA provision for telemedicine: What you need to know.
6:05 Risks of not paying for telemedicine treatment in HSA plans
10:22 The importance of group plans to have mental health parity.
14:31 The importance of a functional house of representatives in addressing current issues
17:08 Congress addresses issues with telemedicine and HSAs during the pandemic.
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In this week's episode, we dive into the ACA reporting changes that have recently been implemented by the federal government. With the end of good faith compliance, it's more important than ever to ensure your reporting is accurate.
Jessica Waltman, vice president of compliance at MZQ Consulting, will discuss the impact of the family glitch and changes to the affordability percentage on employer coverage. Employers will want to pay close attention as we explore the potential consequences of noncompliance and the steps you can take to ensure your coverage meets the new standards.
What You’ll Learn From This Episode:
2:19 What is RX DC reporting and why is it important as a new federal reporting requirement for group benefit plans
4:42 Causes of delays in data collection and reporting.
6:34 Compliance and reporting requirements for group health plans and good Faith compliance standard
9:07 New online plan transparency tools for health plans.
12:40 The impact of machine-readable data on network development and cost control.
14:56 ACA reporting changes: No more good faith compliance and increased penalties for mistakes.
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This week's episode delves into ALVA10's goal of fostering a constructive relationship between healthcare purchasers and the diagnostic industry in order to improve healthcare efficiency and effectiveness by identifying and translating healthcare purchaser problems into diagnostic solutions sourced from the pre-commercial diagnostic industry.
Lena Chaihorsky, VP of Innovation at ALVA10, also emphasizes the importance of optimizing medication regimens to improve health outcomes and reduce waste in healthcare.
What You’ll Learn From This Episode:1:32 How Lena Chairhorsky is applying a numerical approach to healthcare finance and strategy
3:06 ALVA10’s goal to facilitate a constructive relationship between healthcare purchasers and the diagnostic industry in order to improve the efficiency and effectiveness of healthcare.
6:02 Collaborating with payers to address specialty spending on autoimmune diseases.
12:34 Pharmacogenomics: maximizing the effectiveness of drug therapy through genetic profiling.
15:44 Pharmacogenomics’ impact on improving patient outcomes and lowering costs.
19:05 The top chronic diseases causing high healthcare costs in the United States, and how diagnostic testing can help manage these diseases more effectively.
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In this episode, we discuss the issue of people avoiding necessary medical care due to financial constraints, which can lead to worsening health and hospitalization. Paytient, a company founded and led by Brian Whorley, aims to address this issue by offering interest-free credit cards provided by employers or health insurance partners. These cards can be used to pay for healthcare services at various providers and allow individuals to pay for their care over time without incurring interest or fees. The aim of this solution is to reduce the number of people who delay or postpone medical treatment due to financial concerns and make healthcare more affordable for individuals. CEO Brian Whorley believes that this solution can be implemented with various types of health plans.
What You’ll Learn From This Episode:1:29 The problem of unfunded healthcare affects everyone.
3:16 What events or factors contributed to the issue of high healthcare costs and limited access to care?
11:31 Paytient credit card: A better way to pay for out-of-pocket healthcare costs. The resurgence of self-insured plans and how they’re becoming a viable option.
13:39 What is the broker/advisor conversation with an employer look like?
15:51 Brian’s view on the future of the industry.
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In this week's episode, Simple Pay Health co-founder Wally Gomaa discusses the main difficulties facing the health insurance industry. He sees a lack of transparency and complexity, but he also sees stakeholders working to develop a better healthcare model.
Contrary to popular belief, he does not think that the healthcare system is broken; rather, he believes that it was not created with the needs of consumers in mind. With a focus on simplicity and transparency for all stakeholders, including patients, providers, and plan sponsors, Simple Pay Health seeks to make healthcare and health insurance operate more like other industries.
What You’ll Learn From This Episode:
1:38 Cost and complexity being the two primary challenges in the health insurance space.
3:39 Who benefits from the current system, exactly?
8:15 Empowering patients by giving them the freedom to select where they receive care.
10:08 Implementation of the Simple Pay Health Model in stages.
13:41 How does the new model affect overall claim spending?
15:50 Building a Network for Simple Pay Health: Partnerships and Optimization
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This week’s episode is about optimal medical therapy, a term used to describe the best possible medical treatment for patients with the goal of improving their health and reducing the risk of complications. William Bestermann discusses the fact that optimal medical therapy is not currently provided in the US, despite there being a large amount of evidence supporting its effectiveness.
Bill is a board-certified internist with a focus on optimal medical therapy for chronic diseases. He is known for being a fresh thinker in the industry, has been actively involved in bringing about new ideas in the industry, and has written thought-provoking columns on the subject.
What You’ll Learn From This Episode:
1:45 Bill's motivation for getting involved in cardiovascular and related conditions.
4:20 What is optimal medical therapy, and why isn’t it currently provided in the US?
6:47 Efforts to develop the push to overcome the financial pushback.
13:23 Why the cheapest care is the best care?
15:34 What is the cost of not having optimal medical therapy in place?
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This week's episode delves into dealing with workplace complaints—reasons why employees are hesitant to report cases, as well as challenges on the employer side, particularly on the HR side. Jared Pope, a self-described “recovering lawyer” and the founder of Work Shield, aims to bridge this gap. In this episode, he discusses how they are helping businesses effectively manage the reporting, investigation, and resolution of workplace grievances.
What You’ll Learn From This Episode:
1:29 The recovering lawyer: the history of his business and the solution it offers.
3:12 Main reasons why 75% of employees fail to report incidents of harassment or discrimination.
6:54 How overworked and stressed-out HR staff is affecting conflicts resolution in the workplace.
8:57 The top 3 issues that Work Shield is handling for employers.
12:23 Harassment, bullying, and discrimination in the workplace.
14:20 Are some of the grievances motivated by diversity, equality, and inclusion?
17:08 Do these issues also arise in the public sector?
19:21 Golden nuggets of advice for employers.
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In this week's episode, EmsanaRx, PBC CEO Greg Baker gives us a bird's-eye view of the healthcare system. Find out what issues jumbo organizations are having and how the PBM is contributing to them. He also discusses EmsanaRx's efforts to break the cycle by developing PBMs that are committed to serving the general welfare while establishing incentives that make sense for PBMs, clients, and members.
What You’ll Learn From This Episode:
1:22 Greg’s realization of the bigger issues that needed to be addressed after analyzing the PBM contracts and data from large organizations.
3:15 The issue with most healthcare systems operated by for-profit businesses.
5:33 The role PBMs play in drug approval: part of the reason switching to generic medications hasn't been able to solve the issue.
9:45 How they are developing a PBM that is not motivated by profit but by the public good in order to drive clinical experience and outcome.
14:14 Partnership with Cleveland: Creating formularies that truly benefit patients.
17:54 Creating incentives that make sense to PBMs, clients, and members by separating fulfillment.
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The topic of this week's episode is how Plansight is innovating the RFP process in exciting ways.
Everyone despises RFPs, and anyone who doesn't has probably never had to complete one. Together with Spencer Smith, Plansight's SVP of Sales, and the host of the Self-Funded With Spencer podcast, we discuss the main pain points that every agency faces during this process and introduce Plansight's cutting-edge solution to these issues.
What You’ll Learn From This Episode:
1:55 Spencer talks about the topics they cover on his podcast.
4:15 The main issues that every agency has with the RFP procedure and the solutions Plansight provides to address them.
6:59 Spencer explains Plansight's approach to addressing the issue of bias in the auction process.
12:23 How they're dealing with regional differences.
13:30 How the system benefits brokers and how they are equipped to use it.
16:25 The top-notch deliverables and the various methods of presenting them to the clients.
20:15 Plansight has a promising future now that insurance companies are embracing technology.
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This week’s episode explores the critical need for greater incentive alignment throughout the healthcare system.
We had the pleasure of speaking with David Zimmerman, Vice President of Customer Relationships and Growth at Mount Sinai Health Partners. David discusses how Mount Sinai is reimagining how healthcare is delivered and paid for. Additionally, he talks about the discussions being held by some of the major players in the healthcare system regarding the alignment and realignment of incentives and so much more.
What You’ll Learn From This Episode:
1:23 David's professional path: a young college graduate with revolutionary aspirations who desired to be at the forefront of change in the healthcare industry.
3:29 The dramatic need for greater alignment of key stakeholders across the healthcare system.
5:44 Arguments against the healthcare system being flawed.
7:20 How Mt. Sinai is bringing quality and value to community hospitals by utilizing its experience and historical data from decades of service.
10:51 The ACOs' potential future success in the healthcare system.
14:45 Which is best suited to manage the network—doctors and the organizations that provide the care, or some other third party?
15:56 The evolution of healthcare into a consumer good.
16:59 How they are attempting to move the needle from a regional to a national scale.
19:50 The healthcare system's short- and long-term goals.
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This week's episode features Cleveland Clinic’s senior sales and product development manager, Meghan Cassidy. Megan describes how the clinic motivates doctors and all support staff to focus on delivering high-quality care while driving better cost outcomes. She also discusses the growing trend of getting a second opinion and how important it is to do so before making a decision about your healthcare.
What You’ll Learn From This Episode:2:30 The issues with the healthcare system that the Cleveland Clinic is attempting to fix.
5:13 A lack of communication and an emphasis on competition are two major causes of issues in the healthcare system.
6:48 The Cleveland Clinic's stance on value-based care: sharing risk together.
12:38 The Cleveland Clinic: a one-stop healthcare.
14:33 The upsurge of interest in getting a second opinion, and two options for getting one at the Cleveland Clinic.
16:49 How frequently does the second opinion differ from the first?
17:46 The trajectory of the work that they are doing.
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This week's episode focuses on the resurgence of interest in self-funded health plans. Adam Russo, managing partner of The Law Offices of Russo & Minchoff and co-founder and president of The Phia Group, explains what is new about these plans and what brokers need to know to remain competitive in the market.
What You’ll Learn From This Episode:1:43 What's new in the ever-changing healthcare industry and what do you need to know?
4:17 Closing the knowledge gap among advisors.
12:12 How they keep track of all the various state laws and state variations.
15:21 The growing concern regarding adherence to mental health parity
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This week's episode is about the transition from the direct contracting model to the Accountable Care Organization (ACO). Quantum Health's vice president of health systems, Eric Parmenter, summarizes what has happened in direct contracting and ACO in the previous six years. He also talks about current and potential roadblocks to broader implementation of these techniques.
What You’ll Learn From This Episode:1:35 Major issues that employers are currently experiencing and may continue to experience in the coming years.
5:04 Employers’ engagement in direct contracting or ACO in 2022.
8:31 The Association of Physicians' definition of quality healthcare: The inverse correlation between quality and cost.
12:30: Three obstacles to the implementation of direct contracting and ACOs.
14:54 The function of carriers in the ACO model.
17:19 Analytics and reporting: Measuring the goals and objectives that the buyer and seller have agreed upon.
20:04 The trajectory of the ACO model.
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This week's episode is about the fascinating medical innovations that the Profero team is brewing. Marc Sweeney, its CEO, elaborates how genetic testing can help provide quality healthcare while reducing the cost and even avoiding the disease in the first place.
What You’ll Learn From This Episode:1:18 Three decades in the pharmaceutical business: How Marc's small deeds of kindness developed into a passion that's fundamentally altering the industry.
2:18 The problems they are attempting to resolve: Getting the best medication at the best cost.
4:33 How genetic tests can be used to reduce cost.
10:40 An intriguing project is in the works: tailoring a drug's formulation for the patient based on the results of a genetic test.
11:25 How the general public view genetic testing or genomics.
12:50 Using nutrigenomics to prevent disease before it even occurs.
19:08 Marc’s hope to optimize technology without sacrificing genuine human connection.
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The focus of this week's episode is on brokers' contributions to the transformation of the entire healthcare system. Elaine Horton, a partner at EBC Austin, Texas, discusses the system's flaws and how they are being addressed, beginning with eliminating expenses and defining the function of brokers in the system.
What You’ll Learn From This Episode:
- 1:27 Elaine's journey: The healthcare obstacles that brought her to her current position.
- 3:20 Significant issues with the healthcare system and actions being taken to address them.
- 6:33 Eliminating costs from the system, starting with the little bits of the pie.
- 8:19 Rebate Check: Using a flexible and transparent PBM as a starting point to reduce the cost of incredibly expensive medications.
- 15:09 Why benefit plan architects should not be paid on a commission basis.
- 15:48 Which is a better way to pay advisors—fixed fees or a percentage of savings?
- 18:06 The direction the industry is headed in given the changes over the last two years.
- 20:06 Ways to improve the appalling level of healthcare literacy among employees.
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This week's episode focuses on NavMD's initiatives to transform the healthcare system, one health benefit plan at a time. Glenn Fisher, the CEO, discusses the importance and challenges of obtaining quality data, as well as some tools and strategies they use to empower advisors and producers, allowing them to focus on the business.
What You’ll Learn From This Episode:
- 1:10 Glenn Fisher's transition to the healthcare industry after 30+ years as a serial entrepreneur.
- 2:51 Empowering advisors: Giving back 40% more time in the day to work on the business rather than in the business.
- 4:46 Overcoming Data Acquisition Challenges: Establishing and Maintaining Strong Carrier Relationships
- 5:45 The 3 pillars of a strong foundation.
- 8:02 How the accuracy of predictive analytics is assessed.
- 14:07 Pharmacogenetics: Effects on health and how businesses are embracing it..
- 18:11 A blueprint to empower producers.
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The focus of this week's episode is on how modern healthcare system innovations utilize throwback TPA. Bob McCollins, vice president of sales at Edison Health Solutions, explains what’s happening in the TPA industry today and how a throwback TPA can help combine all the fantastic solutions out there to provide top-notch services.
What You’ll Learn From This Episode:
- 2:34 What throwback TPA means and how it works with current healthcare systems.
- 4:35 Keeping all of the various solutions together for the benefit of clients and potential clients.
- 7:57 TPAs need to be adaptable or focused on a single path in order to provide best-in-class services.
- 11:10 Changes to offerings and support in reference-based pricing.
- 14:48 Tasks they outsource to third parties.
- 16:39 Factors affecting claims' automatic adjudication.
- 20:35 TPA in the coming years.
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In this week’s episode, Ted Mills, CEO of Perigon Health 360, discusses his best practices for boosting compliance among patients. He explains the consequences of reduced compliance from both a health and financial perspective. He also breaks down Perigon’s “unit dose verification” process and how monitoring compliance elevates the role of the pharmacist and the care plan. Finally, Ted talks about the importance of maximizing patient engagement.
What You’ll Learn From This Episode:
- 1:30 Defining “compliance”.
- 3:06 The problem in not taking one’s medication in terms of health as well as the dollar value of plans.
- 9:00 Why complications that come with adding a second medication contribute to decreased compliance.
- 12:19 Defining “unit dose verification”.
- 13:06 Useful technologies on the market to consider, and what’s upcoming.
- 16:01 Reducing friction to improve compliance.
- 18:46 Developing a strong relationship with patients in a post-COVID world.
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In this week's episode, Keri Cooper, licensed clinical social worker and author of the book Mental Health Uncensored, discusses the teen mental health crisis that has been making headlines. She emphasizes the importance of parental involvement and shares some tried and true methods that she's used in her own practice for the past 20 years.
What You'll Learn From This Episode:
- 1:46 How Keri became involved in the mental health field.
- 3:30 Five simple things that can have a huge impact on your mental health.
- 4:51 How gadgets and social media contribute to mental health problems.
- 7:05 Educating children about the dangers of excessive use of mobile devices and social media.
- 12:38 How parents handle peer pressure and keep their children's best interests in mind.
- 14:20 Learning to say no and dealing with your children’s disappointment.
- 16:10 Using mental health as a crutch.
- 17:15 What parents can do to help their children avoid suicide.
Quotes:
3:11 “If we, as our own being, are not taking care of our physical body, we can't have optimal mental health.”
4:08 "Sleep, I think is crucial. That's how your body really restores itself, and if we're not on top of that and setting up good sleep habits for these kids from an early age, I think we're missing a big piece of this.”
5:12 “You have to get the devices out of the bedroom. There is nothing good happening on your child's device at three in the morning.”
9:42 “As teenagers, you want to fit into a social circle—this is very normal. So, of course, you're going to compare, it's really the hardest part of life for that, but to give them the perspective that you're not in competition with anybody.”
12:51 “Parents really need to start thinking, is this what I want? Is this what's best for my family? Or am I just going along with what everyone else does?”
17:00 “Yes, you have anxiety. And yes, that's real. But we need to be able to learn the skills to work through it, and to be able to enjoy our life and not just throw our hands up and say I can't.”
3:11 “If we, as our own being, are not taking care of our physical body, we can't have optimal mental health.”
4:08 "Sleep, I think, is crucial. That's how your body really restores itself, and if we're not on top of that and setting up good sleep habits for these kids from an early age, I think we're missing a big piece of this.”
5:12 “You have to get the devices out of the bedroom. There is nothing good happening on your child's device at three in the morning.”
9:42 “As teenagers, you want to fit into a social circle—this is very normal. So, of course, you're going to compare, it's really the hardest part of life for that, but to give them the perspective that you're not in competition with anybody.”
12:51 “Parents really need to start thinking, is this what I want? Is this what's best for my family? Or am I just going along with what everyone else does?”
17:00 “Yes, you have anxiety. And yes, that's real. But we need to be able to learn the skills to work through it, and to be able to enjoy our life and not just throw our hands up and say I can't.”
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This week's episode focuses on CPESN USA's clinically integrated network of community pharmacies. Troy Trygstad, Executive Director of CPESN USA, explains how we can leverage these existing relationships to deliver lower-cost but higher-quality and higher patient satisfaction.
What You’ll Learn From This Episode:
- 1:32 A chain without actually being a chain.
- 2:30 Problems that CPESN is attempting to mediate
- 6:31 The value proposition that locally owned pharmacies must have in 2022.
- 13:11 Using existing strong and trusted local relationships to develop a common way of expressing value.
- 18:28 The trajectory of pharmacy practice—going beyond dispensing.
Quotes:
2:21 “At the end of the day, our job is to bring together the value propositions of mom-and-pop pharmacies out there and really act like a chain without being a chain.”
5:03 “CPESN is all about how you can be a one-location pharmacy in rural Kansas but contract with 3500 other pharmacies to have a common product and a common set of performance metrics.”
8:23 “What is a value proposition [in 2022] is to use that dispensing event and the trust and the access and the frequency of our interaction as a very qualified health care unit with very qualified underutilized healthcare providers as a way of engaging a patient differently.”
This week's episode focuses on using your story to reach your target audience as Anthony Pacheco, president at P1311, discusses how to transform it into an exceptional but relatable message.
What You’ll Learn From This Episode:
- 1:17 Anthony’s pursuit of more affordable, higher-quality healthcare.
- 4:03 How to make your brand stand out while also being very relatable.
- 15:36 How they are bringing in a diverse clientele.
- 17:42 How COVID has altered everything.
- 20:09 Challenges and opportunities in the healthcare industry.
Quotes:
2:23 “Just understanding that healthcare is very negotiable. A lot of times, what we don’t realize is that you can get a better quality of care for a lower cost. So, that’s kind of what brought me into this industry.”
2:41 “Most people think, you know, the rest of our lives, if you pay more money for something, you kind of have this reasonable expectation that it’s better quality. That’s not the case in medicine.”
14:35 “Every client is different, but if you show a strategy of five-year projections versus what can I do for you today, you have a better chance of winning that broker of record, right on the spot and developing with that client an understanding of their culture.”
This week's episode features Kelly Fristoe, the newly elected president of the National Association of Health Underwriters, who discusses recent developments and important changes they're implementing to better serve their members in this rapidly evolving industry.
What You’ll Learn From This Episode:
- 1:28 Kelly’s journey to becoming NIHU’s president.
- 4:52 The primary reasons for changing the name of NIHU.
- 7:59 Crafting NIHU’s objectives to evolving customer needs.
- 9:14 Educating and preparing members about mergers and acquisitions.
- 11:50 Changing member compensation from commission-based to fee-based agent.
- 15:31 How they are assisting members with employer market issues.
- 17:27 Bringing technology to NIHU’s members to enhance their business.
- 18:11 Major health policy goal.
- 18:45 The significance of organizational changes within NIHU.
Quotes:
8:36 “Our customers’ expectations are changing. They want us now to help them solve the high cost of health care.”
10:26 “If we can help our members be better equipped and know what to expect, and have a toolkit, so to speak, on how to go about doing this and doing it right, that, I think, will create a better situation for our members and we’ll become more valuable to them.”
12:42 “If I change from a commission-based agent to a fee-based, then when I’m sitting at their negotiating table, along with them, there’s no question in their mind who I’m representing. The recommendation that I’m going to make is in their best interest.”
The topic of this week's episode is employee benefit plans relative to abortion services in light of the US Supreme Court's recent decision in the Dobbs v. Jackson Women's Health Organization case.
In this episode, Jessica Waltman, Vice President of Compliance at MZQ Consulting, LLC, a concierge compliance firm, discusses the crucial employer considerations for providing abortion benefits to employees. She also stresses the importance of understanding state laws.
What You’ll Learn From This Episode:
- 1:21. Jessica’s role and the services offered by MZQ Consulting.
- 4:06 Access to abortion services in relation to employee benefit plans.
- 14:57 Important factors to take into account when determining whether to cover abortion benefits.
- 17:15 The significance of knowing which states protect abortion and which don’t.
Quotes:
16:15 “So I would look at who you have, where you are, what the likelihood you have of employees that need to benefit.”
17:01 “Everybody needs to make their own choice. I would say it’s a lot trickier than you think. I would not just go out whole-hog and issue a personal statement, or promise things to employees until you evaluate the situation thoroughly.”
19:03 “Unfortunately, the provider also has to weigh their risk, and some medical systems are delaying care or choosing different options of care to protect themselves, and it could put the employee benefit plan with exposure issues. This is where I think a lot of litigation is going to come into play because there are laws that conflict with one another.”
This week's episode is about the drive to change the way businesses acquire and access healthcare for their employees. Daniel Corliss talks about the difficulties associated with receiving medical care under an insurance policy and how DC Advisory is resolving these issues.
What You’ll Learn From This Episode:
- 1:33 The difficulties in obtaining healthcare through insurance policies.
- 3:44 DC Advisory’s client acquisition methods.
- 8:07 Three ways they get compensated for their services.
- 11:17 Creating and modifying health-care plans to meet the needs of both employers and employees.
- 13:30 Starting the discussion with brokers and TPAs about self-funding.
- 16:30 Using data analytics to make informed long-term planning decisions.
- 18:36 Boosting health-care consumerism.
Quotes:
12:20 “There is no one size fits all in self-funding, at least I don’t think there is. I think everything should be built from soup to nuts and from scratch for each client.”
13:03 “We have great technology today that allows us to do things more streamlined and efficiently, but guys, we’ve got to get back to doing the work. That’s the only way that we’re going to change this industry, change how we access health care, and change the way that we’re building these health plans for our clients.”
This week's episode focuses on transforming pharmacies into investment centers, as Chris Antypas, Director of Pharmacy Solutions at Henderson Brothers Inc., shares his direct patient-care experience and pharmacy expertise, as well as how he is assisting employers in navigating the challenging pharmacy landscape.
What You’ll Learn From This Episode:
- 1:11 Chris Antypas’ strong commitment to community pharmacy and direct patient care.
- 3:23 The lack of accountability for the outcome side of the equation in the healthcare ecosystem.
- 5:32 Misaligned incentives between drugs, patients, employers, and plans.
- 11:40 How they, at Henderson Brothers, are making the shift and the important role pharmacists play.
- 15:27 Leveraging data to drive health care innovation.
- 18:20 Competing with mail-order pharmacies.
Quotes:
4:32 “If we stop our efforts on pharmacy just to make sure we got a good deal, we’re ignoring the most important part of the equation, which comes down to whether or not those medications are actually working.”
5:02 “We’re exposing ourselves to risks in this investment [medications] with an expectation and a hope that a disease is going to improve as a result of it. And I really think, in our entire health care ecosystem, we’re lacking accountability to that outcome side of the equation.”
9:53 “Fundamentally, everybody else just wants utilization, utilization, utilization, but when you pause and look at CMS, they are very aggressively moving towards value-based care. They’re aggressively holding medical providers accountable to A1C and blood pressure. And I think it’s high time for employers to take a similar posture. And as a broker, we have the opportunity to help facilitate that with vendors, essentially, get creative in how we advise, and most importantly, give opportunities to vendors in the marketplace that are actually doing this because, to an extent, it’s happening, it’s just the exception rather than the norm.”
18:59 “Some patients need a pharmacy, and other patients need a pharmacist.”
21:06 “Arguably, there’s been no greater source of pharmacy waste than mail-order pharmacies, yet we continue to incentivize it.”
The focus of this week's episode is the pharmaceutical supply chain as TrueScripts founder Nathan Gabhardt discusses the role of Pharmacy Benefit Managers in drug spending, in particular how they make money, and how employers can guard against irrational expenditures.
What You’ll Learn From This Episode:
- 1:48 Nathan’s background, passion for pharmacy, and desire to help others.
- 2:59 Defining “fiduciary” and the problems associated with it.
- 4:01 How the pharmaceutical supply chain work.
- 7:04 What happens if PBMs are taken out of the supply chain.
- 11:35 The pharmaceutical industry’s complexity and confusion.
- 17:26 What can you do as an employer to safeguard your plan from fraud and extravagant spending?
- 19:25 How medical professionals pick the drugs they give their patients.
Quotes:
3:28 “What I think a fiduciary is, is that you cannot make decisions based off your own financial well-being but it’s got to be the financial well-being of the consumer.”
3:39 “The problem is, is in the pharmacy space PBMs, which are pharmacy benefit managers, they sit in the middle of virtually every transaction of every prescription that gets filled, a PBM is involved with 90 plus percent of all those, and PBMs are not considered fiduciary agents. So ultimately, that’s where the problem lies.”
6:50 “From my experience, as a retail pharmacist, if a drug is not covered, the member typically doesn’t just pull out their wallet and pay $500 or $600, they have us call the prescriber and ask what is covered.”
7:27 “I am traditionally an anti-PBM. PBMs have caused a lot of harm to the profession of pharmacy, they really have and they cause a lot of harm to employers. However, if we remove that entire system, from our industry, our industry would collapse in my opinion.”
12:22 “Particularly in the PBM industry, our industry defies the laws of mathematics. And what I mean by that is that a higher discount does not necessarily mean that your net cost is going to be lower.”
17:36 “Follow the money. Anyone you have working around the table on your behalf, ask them how are they generating their revenue, every penny that’s generated off your account, you need to know that.”
This week's episode sheds some light on the significance of health insurance literacy as Holly Monger, president of HSM Computing, discusses claim ploys and how she is helping people who need assistance with organizing, tracking, and appealing claims.
What You’ll Learn From This Episode:
- 1:50 Holly’s transition from nursing to health insurance.
- 4:55 Typical problems brought on by healthcare illiteracy.
- 8:08 Why has healthcare education improved so little?
- 13:30 The assistance she provides to those who require assistance with claims.
- 17:19 Assistance with long-term care claims.
- 18:56 Why would she choose to be an employee for life?
Quotes:
7:05 “It’s all about terminology and knowing what questions to ask, and that’s the most frustrating for most everyday people — they’ll call up and say, “I don’t understand why am I doing this.” And that person at the facility isn’t explaining it at a level that they can understand. So that’s where I come in and try and help them out.”
11:37 “First, you have to get the people to want to learn about their health insurance. Most of them don’t.”
12:12 “The danger is that insurance carriers want to do it themselves so they don’t have to pay agents. But when this poor person gets it that way and they try and ask questions, they aren’t talking to anybody that makes any sense. They don’t understand that there is nobody educating them.”
This week’s episode of the podcast centers around helpful technologies for advisors, as Nick Lozano, co-founder of Janitor Media and director of technology for the CIB talks about how the pandemic has changed the tech world and job market for technology professionals and how even non-tech savvy people can get started with technology.
You can find show notes and more information by clicking here: https://bit.ly/3tEwR1Q
Has COVID changed the way we think about live events? How are we supposed to network and market ourselves without face-to-face interaction? This week's episode dives into successful networking and how it’s the key to your success with the author of Knockout Networking For Financial Advisors And Other Sales Professionals, Michael Goldberg.
You can find show notes and more information by clicking here: https://bit.ly/3zDDqWs
This week's episode focuses on leadership development and continuous improvement as Daniel Matthews, a change leadership expert and author of The Language of Leadership: Nicer Bark, No Bite, elaborates on finding your leadership WHY and building a trusting relationship.
You can find show notes and more information by clicking here: https://bit.ly/3Gnt91V
In this week’s episode, we discuss what other things physicians are doing outside of traditional medicine. Shad Faraz, a Harvard Business School graduate and co-host of the podcast Physicians Off The Beaten Path, discusses how these new perspectives are helping to bridge the gap in the healthcare system in general.
You can find show notes and more information by clicking here: https://bit.ly/3sRPXS4
This week's episode is about a new technology platform that aims to boost the primary care provider and patient relationship, as Ankit Patel, co-founder, and President of Pearl Health, discusses the implications of not having a primary care relationship on both the employee and administrative sides, and most importantly, how they are attempting to solve these issues.
You can find show notes and more information by clicking here: https://bit.ly/3yRkS4H
This week's episode delves into a new development in the dental insurance industry. Josh Jackson, founder of Promptous, discusses the company's efforts to provide better, simpler, and more affordable dental services that are designed to be used, rather than a plan that is not intended to be used.
You can find show notes and more information by clicking here:
https://bit.ly/3sJxpTO
This week's episode gives insight into the necessity of having the right support to help you navigate the complexity of things that occur before and after a loss. Esther Pipoly is the founder and owner of Loss of Life Advocates, a bereavement consulting firm that assists families in preparing for life's unexpected transitions, such as loss. She is also the author of Lying on the Floor Holding My Breath...: The Grief Experience and the Lessons I Learned After I Got Up.
You can find show notes and more information by clicking here: https://bit.ly/3xronOD
This week's episode digs into how drug price is determined, with John Zevzavadjian, president at RxSense, explaining how pricing changes from the moment the producer sends the items to the distribution channels to the end consumers.
You can find show notes and more information by clicking here: https://bit.ly/3OaviSi
In this week's episode, Frank Sutter, a chiropractor and Associate Director of the Harvard Business School's Health Care Initiative, explains why he left medicine and how the medical system in the Netherlands inspired him to go back and change the healthcare in the United States.
You can find show notes and more information by clicking here: https://bit.ly/3KDW4QL
This week's episode is all about determining which EAP is best for your organization. Because there is no such thing as a one-size-fits-all solution, John Troutman, National Director of Mazzitti & Sullivan EAP, discusses the vast range of possibilities and what to look for in an EAP.
You can find show notes and more information by clicking here: https://bit.ly/3xjbaax
This week’s episode explores the new tools available for doctors shifting to direct primary care. Mark Nolan, chief operating officer of Hint Health talks about some of the reasons why a lot of doctors would like to escape into the old-fashioned doctor-patient practice and what’s stopping them from doing so.
You can find show notes and more information by clicking here: https://bit.ly/3JkGXef
This week's episode is all about recognizing our inner leadership gold. Roxanne Kaufman, CEO of ProLaureate, discusses how to find and cultivate these skills, as well as how they might affect the company's future.
You can find show notes and more information by clicking here: https://bit.ly/3IO45k6
This week's episode is about effective communication. Deirdre Van Ness, a keynote, speech, and story artist talks about the importance of connecting at the emotional level, especially in a sales setting, as well as some proven techniques to establish that connection.
You can find show notes and more information by clicking here: https://bit.ly/3tYO6dU
This week’s episode gives insight into benefits and healthcare solutions from employment to retirement. Carrie Espinosa, principal advisor at Horizon Benefit Services talks about the comprehensive solutions that they offer to employers, as well as employee education to help them make informed decisions and how to do that effectively.
You can find show notes and more information by clicking here: https://bit.ly/3w5oGxP
This week’s episode is about the importance of creating a good culture within the company. Peter Drucker once said that “culture eats strategy for breakfast.” And in this episode, Nikki Fielding, chief culture fairy at Conscious Culture Fairy discusses how to spot a bad culture, as well as tools, and ways to bridge the gap.
You can find show notes and more information by clicking here:
https://bit.ly/3HWzi5e
This week’s episode is intended to help brokers and advisors understand how automation tools work and why it’s worth the expense of their time as Tonya Sowles, founder and CEO at Sowles Consulting talks about the pain points of managing a small business and how these tools can help make a business workflow more effective and efficient.
You can find show notes and more information by clicking here:
https://bit.ly/350ZrRV
This week's episode gives insight into what it takes to live a legendary life. Tommy Breedlove, a mindset coach, Wall Street Journal & USA Today bestselling author, and featured keynote speaker talks about how you can find your purpose in life and shares some valuable techniques to conquer your time and start living a meaningful life.
You can find show notes and more information by clicking here:
https://bit.ly/3oX4auL
This week's episode of the ShiftShapers Podcast talks about how companies are shifting the way they do business. According to Gleb Tsipursky, an internationally-recognized thought leader and the CEO of Disaster Avoidance Experts, this shift has begun even before COVID-19 and will continue even after the pandemic ends. In this episode, we talk about the challenges of managing the workplace, more specifically, what leaders need to know in terms of adapting their corporate culture?
You can find show notes and more information by clicking here:
https://bit.ly/36kO9sf
This week’s episode is about supplemental health benefits. Mike Zarrillo, Chief Revenue Officer at Brella Insurance discusses the market's current state, what's new, and what's on the horizon. We'll dive into understanding what makes a good supplemental benefit and what opportunities exist in this market for advisors.
You can find show notes and more information by clicking here:
https://bit.ly/3gVqnVC
This week's episode delves into alternatives to musculoskeletal surgeries. In an effort to reduce costs while improving patient outcomes and satisfaction, Mark Testa, Executive Vice President of Regenexx talks about some cool stuff their company is doing to help employers save money on their orthopedic spending and patients avoid elective surgery.
You can find show notes and more information by clicking here:
https://bit.ly/3r18f2u
This week's episode is about small group businesses. Our guest, Nancy Giacalone, is the president of Olympic Crest Insurance, a locally owned and operated insurance brokerage firm. In this episode, she discusses the difficulties that small business owners face, as well as some strategies and opportunities for advisors.
You can find show notes and more information by clicking here:
https://bit.ly/33gL1MJ
This week's episode focuses on the healthcare supply chain. We've been hearing a lot about it, but what exactly is it? Phil Hamburger, risk advisor at Ellerbrock-Norris provides insights about this system and highlights how they can improve benefits while simultaneously lowering costs. He also offers advice on how to start the conversation with the clients and how to educate employees.
You can find show notes and more information by clicking here:
https://bit.ly/3ApjSDr
This week’s episode is about bringing your A-game every day. Machen MacDonald, founder and lead strategic business coach at ProBrilliance talks about what it truly means to bring our A-game and what holds us back when we have those days where we don’t. We’ll dive into understanding self-awareness and how that affects our ability to perform at our best.
You can find show notes and more information by clicking here: https://bit.ly/3IvodYM
This week’s episode goes over how Chronic Kidney Disease (CKD) is a major driver of high claims costs, but we don't often see it at the top of claims reports. Kimberly Langford, a registered nurse and the director of Business Development - Specialty Care Management, discusses the major causes of kidney disease and how businesses can mitigate the risks associated with it, particularly in terms of reducing high-cost dialysis claims.
You can find show notes and more information by clicking here: https://bit.ly/3qMQsuP
This week’s episode explores the tools and techniques used to level up employee communications especially around benefit plans. Joel Daniels, Chief Advocate of Revolution Benefits Group, explains how they utilize CRM and create workflows for employee engagement. He also shares his take on choosing the right software for your business and overcoming perceived barriers in the insurance industry.
You can find show notes and more information by clicking here:
https://bit.ly/3pXXXyp
This week’s episode describes what separates successful, high-performing individuals from everyone else. Michael Zipursky, CEO of Consulting Success and author of Elite Consulting Mind, discusses the importance of taking action and having a deeper understanding of our limiting beliefs and intentions. He also touches on the common behaviors that prevent people from making progress in their business.
You can find show notes and more information by clicking here:
https://bit.ly/3s0So57
This week’s episode offers interesting insights on how we can leverage Telehealth to close healthcare gaps. Justin Davis, CEO at Congruity Health, describes how transforming the Telehealth industry can lead to proactive care and decreased healthcare costs. He also identifies the central friction points throughout the shift and ways to handle them.
You can find show notes and more information by clicking here:
https://bit.ly/3rvcAvz
This week’s episode features a group fostering a unique collaborative environment to help benefit consulting firms excel. Scott Smith, president and CEO of True Network Advisors, shares how his group builds a collaborative process across different agencies and the challenges that lie beneath it.
You can find show notes and more information by clicking here:
https://bit.ly/3EoVaEk
This week’s episode explains why it takes both art and science to make a health benefit plan work for all stakeholders. Allison DePaoli, founder of Altiqe Consulting, shares their process in creating a health plan that affects all constituents positively while helping people work through the setbacks in these plans.
You can find show notes and more information by clicking here:
https://bit.ly/30SG9vY
This week’s episode focuses on the use of improvisation as a valuable training tool for business professionals. Peter Margaritis, author of Improv is No Joke, describes what improv can do for your career and organization. He also introduces the effectiveness of the "Yes, and..." principle in sharpening your leadership and communication skills.
You can find show notes and more information by clicking here:
https://bit.ly/2Z9aHcg
This week’s episode looks at how having a marketer’s mindset can make a difference to your business. Kate Colbert, author of Think Like a Marketer, explains the importance of stories in today’s competitive world. She also shares the common pitfalls of DIY marketing and why companies should avoid them.
You can find show notes and more information by clicking here:
https://bit.ly/30DAkCu
This week’s episode presents key insights into where the rising musculoskeletal claims are coming from and how we can prevent them. Melissa Gill, owner and CEO of On-Site Solutions, highlights the significant intervention of physical therapy in minimizing the risks of work-related injuries and in creating a proactive, positive, and engaging workplace culture.
You can find show notes and more information by clicking here:
https://bit.ly/3HflOle
This week’s episode highlights the tools and techniques to be effective and confident in building a referral base. Bill Cates, president of Referral Coach International, provides an in-depth discussion on the "Perpetual Revenue System" and what should be covered in order to successfully turn referrals into introductions.
You can find show notes and more information by clicking here:
https://bit.ly/3nHs8sF
This week’s episode looks into the prevalent chronic conditions that women suffer from and the main reasons why they're unable to have access to proper care. Joe Connolly, founder and CEO at Visana Health, explains how a tech-enabled, high-touch care model can provide solutions and make a difference to women's healthcare.
You can find show notes and more information by clicking here:
https://bit.ly/2XTKnST
This week’s episode covers the significant decision factors that every patient must have in this current state of healthcare. Dr. Sanjay Prasad, surgeon and author of Resetting Healthcare, explains the need to reform the industry and how transparency can also help raise the quality of care.
You can find show notes and more information by clicking here:
https://bit.ly/3G6Vyc6
This week’s episode introduces a self-care tech platform for Diabetics. Integrated with AI and Machine Learning, this new approach to healthcare is believed to enhance consumer experience. Lonny Stormo, CEO of Pops Diabetes Care, describes what these tech advances would offer as we lean toward consumer-driven healthcare.
You can find show notes and more information by clicking here:
https://bit.ly/3Eq1Um8
This week’s episode suggests how employers can optimize their recruitment process to hire top talent and set them up for success. Robert Nickell, founder and CEO of Rocket Station, delves into the 3 foundational steps critical for the hiring and success of every individual or outsourced talent.
You can find show notes and more information by clicking here:
https://bit.ly/2Xpzojc
This week’s episode looks into the problem areas of every regulation that puts industries through expensive endeavors and tons of paperwork. Sarah Borders, co-founder and principal consultant at Benefits Compliance Solutions, gives interesting tidbits that clients can do right away to mitigate some of the risks.
You can find show notes and more information by clicking here:
https://bit.ly/2VGeCvr
This week’s episode introduces a next-level type of healthcare that people can already receive in the comfort of their own homes. John Young, SVP Growth at Nice Healthcare, explains why it's going to be a growing demand for employers and members.
You can find show notes and more information by clicking here:
https://bit.ly/3zM9TqP
This week's episode gives profound insights into how insurance advisors can drive sales and win relationships using the psychology of persuasion. Brian Ahearn, author of Persuasive Selling for Relationship Driven Insurance Agents, talks through the different methods that need to be applied at every step of the sales cycle in order to create long-lasting client relationships and close sales without coming off as a "salesy" person.
You can find show notes and more information by clicking here:
https://bit.ly/3zLRevi
This week’s episode discusses the best strategies that business owners must do to preserve their most important asset: focus. A Managing Director of Trinity Blue & Taylor Insurance, Trey Taylor defines the practice of growing your organization’s culture, the revolutionary steps in recruiting people, and the important components to include when tracking your KPIs. All of these are based on his book, A CEO Only Does Three Things.
You can find show notes and more information by clicking here:
https://bit.ly/3kEIVLe
This week’s episode suggests how business leaders can move their companies forward through a better partnership with the HR department. Karen Young, founder and president of HR Resolutions, cites the fundamental topics in her book, Stop Knocking on My Door, which aims to promote employee satisfaction and productivity in the workplace.
You can find show notes and more information by clicking here:
https://bit.ly/3zvqf6X
This week’s episode explores the major areas of concern with healthcare illiteracy and the huge need for innovative tools in bridging the gap between industries and providers. Ben Hale, co-founder and CEO of Bright HR, presents the do’s and don'ts in providing healthcare education so that industries will be better informed, satisfied consumers.
You can find show notes and more information by clicking here:
https://bit.ly/3fW3LnN
This week’s episode helps advisors learn more about advising clients about Federal benefits, from Social Security to Medicare and beyond. Frank Cardenas, Co-founder at FEDlogic, discusses how employees and employers can both benefit from more guidance around these often-confusing benefits.
You can find show notes and more information by clicking here:
https://bit.ly/3ivEXVp
This week’s episode features a conversation with Scott Beck, CEO at BeckTek. Businesses worldwide now rely heavily on email to communicate. While convenient and relatively safe, it does have a fatal flaw that hackers exploit for maximum effect. Phishing is a billion-dollar scam that attacks big and small companies alike. With the SLAM Method, a simple yet effective guide, you too can spot phishing emails and prevent the bad guys from gaining access to your personal information.
You can find show notes and more information by clicking here:
https://bit.ly/3li27k4
This week’s episode features a conversation with Brian Butler, Vice President of Client Development at Flipt. PBMs use several tactics which drive up the overall costs of medical benefits. This expense is shouldered by members and employers, increasing pharmacy spend and pushing up plan costs. Innovating this model requires consumer empowerment to make intelligent health care decisions and advisors armed with specialty knowledge and data to impart to their clients.
You can find show notes and more information by clicking here:
https://bit.ly/3kRUGjn
This week's episode features a conversation with Steve Overton, Co-founder, and CEO at Plansight. RFPs are difficult on advisors and extra hard of carriers who may or may not know how they are being represented to clients. Additionally, RFPs are time-consuming, difficult to decipher, and sometimes written with a particular carrier or plan in mind. Technology is being used to smooth out that process and make the RFP experience simpler and more equitable for all constituencies.
You can find show notes and more information by clicking here:
https://bit.ly/2VXBBlp
This week’s episode features a conversation with Mary Talley Bowden, M.D., an ENT from Houston, Texas and mother of 4 boys. After experiencing first-hand how traditional, insurance-driven practice models work against patients, Mary decided that she would innovate the patient experience in her own practice. By blending wellness and ENT, she has created a service that has vastly improved her patient satisfaction and catapulted her business to greater heights.
You can find show notes and more information by clicking here:
https://bit.ly/3xrj0vO
This week’s episode features a conversation with Carl Schuessler, Jr., Managing Principal at Mitigate Partners. Acting as a fiduciary means acting as stewards that improve financial outcomes. There is an emphasis on trust that has become even more apparent with the creation of the Affordable Care Act. Fiduciaries also deliver active management as opposed to passive management, a beneficial role that provides massive savings.
You can find show notes and more information by clicking here:
https://bit.ly/2Uj8RCO
This week’s episode features a conversation with T.J. Morrison, President at Benefit Design Specialists. Direct contracting offers competitively priced bundles to patients and quick payments to providers. They carve out a niche away from networks while, at the same time, avoiding direct competition with them. Direct contracting uses data-based baseline pricing to set the most competitive rates for otherwise cost-inflated procedures.
You can find show notes and more information by clicking here:
https://bit.ly/3wLLSOX
This week’s episode features a conversation with Mike Vasquez, CEO and Founder at Opioid Clinical Management. The opioid crisis has been largely ignored for the past 15 months but this doesn't mean it has gone away. Novel withdrawal symptom indicators help advisors and employers identify the differences in addiction and withdrawal patterns. This allows employers to intervene with the providers to reduce their spend while safeguarding the health of members.
You can find show notes and more information by clicking here:
https://bit.ly/3pXR93t
This week’s episode features a conversation with Silvia Garcia, Founder and CEO of Feel Logic and Happiest Places to Work and Former Global Director of the Happiness Institute of Coca-Cola. The topic of happiness, what it is and how do we achieve it, has been magnified by the pandemic. In the workplace, there are 8 ways that employers can facilitate happiness including increasing employee recognition, building a social support system, and focusing on personal growth.
You can find show notes and more information by clicking here:
https://bit.ly/3ppJP0n
This week’s episode features a conversation with Surya Singh, CEO and Co-founder at gWell. Muskoskeletal claims are growing monster that gobbles up claims spends. Cutting-edge tech in genomics, AI, and machine learning help create diagnostics for the best treatments since many chronic conditions have genetic markers associated with them. At the same time, this technology cuts costs by as much as a third of current spends, a significant percentage that's of interest to employers and patients alike.
You can find show notes and more information by clicking here:
https://bit.ly/34ysY1K
This week’s episode features a conversation with Suzanne Delbanco, Executive Director at Catalyst for Payment Reform. Consolidation in the provider marketplace has detrimental effects on patients, such as provider unwillingness to change in favor of improved patient experience. In policy reform, the central issue is price transparency remains a battleground where Suzanne is very active. She also comments on the recent uptick in direct contracting solutions and the incoming changes ushered by the pandemic.
You can find show notes and more information by clicking here:
https://bit.ly/3f9v3r4
This week’s episode features a conversation with Robert Pfeiffer, Principal at Disruptive Strategies. Disruption has become inevitable in avoiding increasing annual premiums. From going self-funded to fully utilizing technologies like on-site clinics and telehealth, employers can now confidently choose lower-cost healthcare without any loss in quality. New agile healthcare community facilities also drive down costs while also helping increase compliance, resulting in more accessible healthcare to even more patients.
You can find show notes and more information by clicking here:
https://bit.ly/3bbQqpa
This week’s episode features a conversation with Mike Case Haub, CEO at CHC Health. Optimized medication can reveal drug therapy problems that patients were not even aware of, as well as determine if lower-tier medications can work just as well or better than current prescriptions. This translates to cost savings to employees and employers. These conversations also reveal to patients what drugs they have to take and why, therefore increasing adherence and patient buy-in.
You can find show notes and more information by clicking here: https://bit.ly/3eJU3DM
This week’s episode features a conversation with Doug Geinzer, Founder and President at High Performance Providers. Bundled plans provide cost benefits to providers while also connecting patients to quality healthcare. Direct contracting gives patients lower costs which are transparent upfront and provides options for destination medicine too. For an even more attractive offer, patients also get safety guarantees in high performance networks with proven reliability.
You can find show notes and more information by clicking here: https://bit.ly/3sS5sq3
This week’s episode features a conversation with Matt Scovil, CEO at Medefy. Apps and AI are essential pieces in modern healthcare but having real people communicate with members, using technology to assist, has produced significantly higher engagement. Also, a multi-channel approach that involves the entire household empowers individual members to make much more informed healthcare decisions.
You can find show notes and more information by clicking here: https://bit.ly/3n6AJEv
This week’s episode features a conversation with Dave Romeo, author of "How to Wow! — The Art of Consistently Delivering Legendary Customer Service." Giving customers a user experience they'll remember is not complicated. It does however require a genuine demonstration of your desire to help. Not only does this spark lasting connections, but it also returns your investment several times over.
You can find show notes and more information by clicking here: https://bit.ly/3sQ6pjH
This week’s episode features a conversation with Matt Newman, best-selling author of "Starting at the Finish Line." Cancer is not a solitary disease and Matt shares his family's journey with it and how it eventually afflicted him too. Writing was his catharsis and his ability to strengthen others and teach that their conditions do define them became his inspiration for writing his book. Matt teaches that negativity gains you nothing while positivity leads to success.
You can find show notes and more information by clicking here: https://bit.ly/3fAQ7HJ
This week’s episode features a conversation with Sara Hames, Principal at NBS Advisors. Navigating health plans is a complicated process BUT it shouldn't be. By simplifying the available options and providing a phone number to call, members and employers can make the most informed decisions for them. Also, providing a better healthcare experience involves educating advisors on attractive packages and networks that they can actually offer their clients.
You can find show notes and more information by clicking here: https://bit.ly/2OOQhAe
This week’s episode features a conversation with Dr. Cristin Dickerson, Founding Partner of Green Imaging. There is a stigma that scanners in hospitals are better than freestanding facilities. However, there is no difference in hardware and professional skill in handling these machines. Knowing this can help patients and employers cut their medical spend for these services by two-thirds and enjoy greater satisfaction with their dedicated concierge.
You can find show notes and more information by clicking here: https://bit.ly/2Q6MmyT
This week’s episode features a conversation with Niko Caparisos, Principal at Prosperity Benefits. Employers struggle with controlling costs and balancing innovation with tried and tested tactics. For a more strategic and less fragmented approach, having buy-in from the c-suite is critical. On the employee side, empowering them with information and initiative can make them use the plan with as little friction as possible.
You can find show notes and more information by clicking here: https://bit.ly/3sYDYQ1
This week’s episode features a conversation with Monica Coleman, Chief Energy Officer at Inside Information Coaching and Consulting. Being adaptable means moving forward and embracing the unknown, the realm where every possibility exists. The P.E.A.K. Process (Perform, Evaluate, Adjust, Key In) gives particular emphasis on its Adjust step where Ego can get in the way of reaching your goals.
You can find show notes and more information by clicking here: https://bit.ly/2Mz6RTl
This week’s episode features a conversation with Ashok Subramanian, Founder and CEO of Centivo. Plans succeed or fail based on the end-user experience they create. By optimizing the primary care-centered models and offering tailor-fit solutions regardless of the network construction, plans can remove the clunkiness of administrative tasks while ultimately providing the care and satisfaction that users are looking for.
You can find show notes and more information by clicking here: https://bit.ly/3u1QQGo
This week’s episode features a conversation with Justin Breen, Founder and CEO of BrEpic. The highest level entrepreneurs all have common denominators: they put family first, overcome their greatest obstacles, and adopt a mindset that it's either winning or learning. Failure is not in their vocabulary. When you think about investments and not costs, you eliminate a scarcity mindset and end up working with people who will propel your business to unimaginable heights.
You can find show notes and more information by clicking here: https://bit.ly/3nTE3BA
This week’s episode features a conversation with Kari Niblack, CEO at ACS Benefit Services. TPAs now offer novel and customizable plans while still providing traditional services like manual adjudication and appeals. At the same time, TPAs now assist smaller companies who are on level-funded plans to take the leap into partially-self-funded plans. In 2021 and beyond, data and transparency must be used to help clients make more informed decisions on the plans that are right for them.
You can find show notes and more information by clicking here: https://bit.ly/38L0uEI
This week’s episode features a conversation with Sheri Tetachuck, Senior Vice President of National Sales at Payer Matrix. The costs of specialty drugs increase every year and employers are footing much of the bill. Unfortunately, aggressive lobbying in Congress allows big pharma to dictate arbitrary prices.
But even this bleak outlook has a silver lining. There are strategies that employers can employ to help drive down costs like alternative funding plans. There is a need to raise awareness of these avenues because specialty drug costs are expected to keep rising.
You can find show notes and more information by clicking here: https://bit.ly/2XtkuoZ
This week’s episode features a conversation with Ronny Leber, International Keynote Speaker and Tony Robbins Trainer. Virtual events used to be the medium of last resort but the pandemic provides opportunities that highlight its strengths rather than its weaknesses.
From expanding your reach to a vastly wider audience to using video messaging as a means of communication, video puts you right in front of the people you want to be speaking to. Ronny also explains that your body, focus, and words should all be geared towards your client to achieve peak performance exactly when it counts.
You can find show notes and more information by clicking here: https://bit.ly/2LkWdyV
This week’s episode features a conversation with Rob Tull, Success Coach at Path2 Coaching. Achieving traditional success is often assumed to produce happiness. However, when emotional needs take a backseat in pursuit of this goal, it produces a toxic environment that can leave you feeling stuck.
"Structured stuckness" is designed to leave you feeling this way because of society's absolute focus on outcomes. The key to getting unstuck is prioritizing your emotional benefits to avoid the long-term regret that comes with traditional models of success.
You can find show notes and more information by clicking here: https://bit.ly/3b5CUV1
This week’s episode features a conversation with Linda Czuper, Children's Life Coach at Adventures in Wisdom. WFH is causing stress and fear in kids. Linda gives tips for parents to be present in their children's lives because the face that parents show kids sets the tone for a good day.
Parents can empower their children to create their own stories in today's environment and should watch out for negative self-talk, a red flag that highlights the fears that their children may have. Linda also provides actionable tips on how parents can become better teachers, a role they may not have been prepared for pre-pandemic.
You can find show notes and more information by clicking here: https://bit.ly/3rBvKNM
This week’s episode features a conversation with Bill Stratton, Founder of the Entrepreneurial Leadership Associates, LLC. There are six key components that result in entrepreneurial success: Vision, People, Data, Issues, Process, Traction. Bill also introduces the concept of LMA (Leadership + Management = Accountability) and how this even guides better hiring practices to reach company goals.
You can find show notes and more information by clicking here: https://bit.ly/3mD0pqv
This week’s episode features a conversation with Patrick Schwerdtfeger, Business Futurist, Keynote Speaker, and Author of "Pandemic, Inc.: 8 Trends Driving Business Growth and Success in the New Economy." The key message to business can be summed in the acronym SALVAGED. Smart businesses can keep pace with the rapid changes of today by adapting to these observations and employing systems to future-proof their operations.
You can find show notes and more information by clicking here: https://bit.ly/381GpbJ
This week’s episode features a conversation with Jordan Hersh, Vice President, Enterprise Solutions at Vālenz. Renegotiating out-of-network claims can provide cost savings to members. On the plans side, Jordan also explains how offering discounts can help ensure timely payments. If insurers communicate the benefits of staying in-network and offering incentives, this can avoid confusion with the EOB and arm members with the knowledge of how post-claims adjudication works.
You can find show notes and more information by clicking here: https://bit.ly/3orHwIr
This week’s episode features a conversation with Tom Loarie, CEO at BryoLogyx, Inc. and Host at The Mentors Radio Show. Mentoring benefits people of all backgrounds and professions and Tom shares his process of coaching that lets people flourish into their highest levels. Trust is the basis of a mentoring relationship and Tom always begins by asking what is it that you really want to do? Whose story are you really living? And if you pursue what you really like and be the best at it, you will always be successful.
You can find show notes and more information by clicking here: https://bit.ly/39pvgDR
This week’s episode features a conversation with Deb Rubin, Certified Life and Success Coach at Deb Rubin Coaching. Oftentimes successful people base their success on the standards of others while disregarding their own personal happiness and values. Deb teaches her clients how to recognize their limiting beliefs and introduces S.M.A.R.T. goals which stand for Specific, Measurable, Achievable, Relevant, and Time and how this can bring real joy into lives that have become lost in life's treadmill.
You can find show notes and more information by clicking here: https://bit.ly/3pVLzOu
This week’s episode features a conversation with Craig Clemente, President & Chief Operating Officer at Specialty Care Management. Specialty care is both a claims exposure and a clinical component and Craig details how plans need to focus on both. He also explains the nuances of the plan document language and the need to have member champions to spread awareness. Finally, Craig discusses the steps plans can take to bring down the extreme costs of specialty drugs and air ambulances.
You can find show notes and more information by clicking here: https://bit.ly/3fahSEz
This week’s episode features a conversation with Robert LeCureaux, Vice President of Client Development at ScoutRx Pharmacy Benefits Consultants. PBMs have been focused on profitability rather than providing a beneficial service. Though alternative funding options are available, PBMs are less likely to cooperate since there is no financial incentive to do so. Robert's group helps members minimize their spend by offering Specialty Pharmacy, Copay, and International Pharmacy Programs.
You can find show notes and more information by clicking here: https://bit.ly/359dOBd
This week’s episode features a conversation with Dr. Diane Hamilton, Founder and CEO of Tonerra , and author of "Cracking the Curiosity Code". Curiosity in the workplace enables out of the box thinking and strengthens emotional intelligence through empathy, a key competency to talk to clients on an emotional level. Creating a culture of curiosity starts with the leaders who need to recognize the potential savings and revenues that curiosity can create when it translates to innovative business ideas.
You can find show notes and more information by clicking here: https://bit.ly/2THUhBg
This week’s episode features a conversation with Scott Campbell, Senior Vice President of Stealth Partner Group. Advisors need to be aware of new trends that are beginning to help shape an updated stop loss segment. The shift to direct contracting and broader data sets help employers make smarter choices in their self-funded plans so they gain control, provide a better employee experience and enjoy continued and growing cost savings.
You can find show notes and more information by clicking here: https://bit.ly/2HzuNTX
This week’s episode features a conversation with Charles Henson, Managing Partner of Nashville Computer. Working from home can be a perilous electronic journey, especially for those of us without technical teams available. Charles and David discuss the prevalence of cybercrime and what you and your family can do to create a more secure computing environment and how to keep your information off the dark web.
You can find show notes and more information by clicking here: https://bit.ly/3dC9vAZ
This week’s episode is a conversation with Steve Peterson, Partner at Tress Solutions. Today, Steve shares his professional journey which is defined by recognizing good opportunities and taking the plunge.
He tells the story of how he adapted to his client's needs and provided solutions to their biggest pain point: cannabis trash collecting. Steve explains that investing in the right people came first in entering an emerging cannabis niche worth $5 billion.
You can find show notes and more information by clicking here: https://bit.ly/3dhBANT
This week’s episode is part 2 of our conversation with Sean Schantzen, Co-Founder and President at Health Rosetta Group. Today, Sean predicts what the future may hold for the insurance industry and the tools and techniques needed to meet those changes.
Sean discusses the trend of mid-market companies banding together to rebuild infrastructures and the increasingly commonplace occurrence of building their own hospitals. He also discusses the main factors that drive pharma costs and the changes that are reshaping views on risk management.
You can find show notes and more information by clicking here: https://bit.ly/34jABZk
This week’s episode is a conversation with Sean Schantzen, Co-Founder and President at Health Rosetta Group. Today, Sean shares his insights on what top advisors are doing to bring innovation, control, cost savings, and better user experiences to their clients.
Sean explains that transparency is central to reestablishing a relationship of trust between advisors and employers. He also discusses the Mr. Potato Head problem and how architecting new plans from the ground up is the only solution to give stakeholders what they really want.
You can find show notes and more information by clicking here: https://bit.ly/3j3ubng
This week’s episode is a conversation with Tom Malesic, Founder and CEO at EZSolution. Today, Tom introduces basic digital marketing concepts on major social media platforms like Facebook and LinkedIn.
Tom goes into detail on finding your audience on Facebook and using industry tricks to reach them more effectively. He also shares unusual metrics that you can use to track your marketing progress and ways you can improve your lead generation website.
You can find show notes and more information by clicking here: https://bit.ly/35SVRrl
This week’s episode is a conversation with Ron Laikind, an adventurer with a penchant for adaptability and owner at Extreme Mist PCS, LLC. Today, Ron explains how he meets the needs of current times through on-the-spot creativity.
He shares that the idea for a misting system began on camelback while traversing the African desert. Ron also shares how he has since adapted his product to fight COVID-19 and adjusted it for use in the sanitation industry.
You can find show notes and more information by clicking here: https://bit.ly/2RnaYAN
This week’s episode is a conversation with Jason Treu, Chief People Officer at Unstoppable Workplaces. Today, Jason discusses how companies can experiment with communication strategies to maintain connections with their team members.
Jason also talks about the changes that companies need to adapt to in an increasingly digital environment. To survive, companies need to implement empathetic strategies for teamwork and get regular feedback from employees.
You can find show notes and more information by clicking here: https://bit.ly/322acPL
This episode of The ShiftShapers Podcast is called "The Importance of Emotional Intelligence" with Alan Cohen, President at ASC Coaching & Speaking, TEDx speaker, and author of "The Connection Challenge" and "Those Difficult Talks."
Today, Alan defines emotional intelligence and a key aspect of it known as empathy. He also discusses the role of self-assessment in leadership to overcome blind spots and how a shared purpose can make people transcend pettiness and achieve greatness.
You can find show notes and more information by clicking here: https://bit.ly/3joyysI
This episode of The ShiftShapers Podcast is called "Dealing with VUCA - Your Key To Surviving Future Shock" with Ira Wolfe, President and Chief Googlization Officer at Success Performance Solutions.
Today, Ira defines VUCA (volatility, uncertainty, complexity, ambiguity) and contextualizes it to the global pandemic. He comments on the stress of the accelerated use of technology and how responding to it causes disruption but also leads to adaptation.
You can find show notes and more information by clicking here: https://bit.ly/31s3iDn
This episode of The ShiftShapers Podcast is called "What Does Your Brand Say About You?" with Gary Hernbroth, Founder and Chief Motivating Officer at Training for Winners. Today, Gary shares how to cultivate your own personal brand and the importance of authenticity.
He also discusses the top characteristics of a salesperson, such as listening and follow-through, and provides a real-life example of an insurance agent leveraging authenticity to create a lasting business partnership.
You can find show notes and more information by clicking here: https://bit.ly/31XEIsP
This episode of The ShiftShapers Podcast is called "The One Thing Holding Your Business Back" with Ed Krow, Founder & HR Strategist of Ed Krow, LLC. Today, Ed explains that businesses need to adapt to the Experience Age to manage their employees better.
He also shares that businesses can achieve their next big milestone by letting others make the difficult decisions for them. Not only does this boost creativity to run a business, but it also fosters trust in the company culture moving forward.
You can find show notes and more information by clicking here: https://bit.ly/2FbCLl3
This episode of The ShiftShapers Podcast is called "You Can't Be A Thought Leader In One Day" with Andrea Pass, founder and CEO of Andrea Pass Public Relations. Today, Andrea shares what it means to be a publicist and how thought leaders are created using the free tools available to public relations.
Andrea also discusses the relevance of PR with social media and how she applies the traditional PR methods to keep her clients up to date in the digital world. She also provides actionable tips for businesses in employee benefits to get started on their own PR.
You can find show notes and more information by clicking here: https://bit.ly/2ZFj64u
This episode of The ShiftShapers Podcast is called "New Developments In Pharmacy Cost" with Garrett D'Antoni of NavRx, a prescription benefit manager (PBM) with a commitment to transparency.
Garrett begins by defining companion diagnostics then breaks down the confusing nature of NDC codes and why some PBM's can charge astonishing amounts for prescribed medications. He also goes into detail about the increasing popularity of pharmacy tourism and the significant cost savings it offers.
You can find show notes and more information by clicking here: https://bit.ly/2ZFj64u
This episode of The ShiftShapers Podcast is called "Thinking About Starting A Podcast" with Elzie Flenard, Founder of audio marketing agency Enterprise NOW! and The MAYOR of Podcast Town, a community for podcasters by podcasters.
Elzie shares what makes a successful podcast, from having the right motivations and mindset, to the more technical aspects behind producing a show flow, post-production, and the CRAB process which stands for Compose, Record, Arrange, and Broadcast.
You can find show notes and more information by clicking here: https://bit.ly/38MRyxd
This episode of The ShiftShapers Podcast is called "Direct Primary Care In the Employer Market: How To Get There" with John Collier, President and CEO at Proactive MD, a direct primary care (DPC) organization.
John explains the possibilities of DPC that integrates administrative processes, delivers clinically effective healthcare while still remaining financially viable for stakeholders, and promotes patient empowerment through a "patient advocate".
You can find show notes and more information by clicking here: https://bit.ly/3iaAmGa
This episode of The ShiftShapers Podcast is called "Target and Tame the Drug Spend Monster" with Pramod John, Founder and CEO at VIVIO Health. They discuss the changing nature of specialty drugs as adjuvant therapies and the skyrocketing costs that come with it.
Pramod also discusses the case of Humira biosimilars and AbbVie's threat to litigate, resulting in it being unavailable in the US. He further explains the broken system that favors big pharma, its detrimental effect on regular citizens, and what we can do about it.
You can find show notes and more information by clicking here: https://bit.ly/2ALItrX
This episode of The ShiftShapers Podcast is called "Creating a Fee-Based Consultancy" with Derek Winn and Jessica Du Bois, Consultant and Employee Benefits Advisor respectively at Business Benefits Group. They talk about the differences of Distilled Concepts from the parent company and how this new division caters to the specific needs of their clients.
Some of their innovations include leading with an RFI before sending a project proposal to fully understand who their client is and what it is they want to achieve, and letting the clients come to them instead of focusing on inbound leads.
You can find show notes and more information by clicking here: https://bit.ly/2BYKNvR
This episode of The ShiftShapers Podcast is called "The $500 Tipping Point" with Amy Chambers, Founder and COO of HealthBridge. Today, David and Amy discuss the complex problem of providing for the healthcare of the functionally uninsured.
Amy explains their program's benefits to providers such as infusing cash into the system and reducing difficulties in collecting. On the member side, she further shares how this restores their dignity around the issue of money and their faith into value-based care.
You can find show notes and more information by clicking here: https://bit.ly/3eZ7mic
This episode of The ShiftShapers Podcast is called "Removing Self-Funding Barriers For Employers and Advisors" with Michael Poelman and Spencer Brydon, President and Regional Vice President of Sales respectively at Novo Benefits.
Today, Michael and Spencer discuss what keeps employers and brokers from going self-funded, as well as what independence and transparency really mean in this space. They also share how brokers can approach stop-loss carriers and reduce complexity moving forward.
You can find show notes and more information by clicking here: https://bit.ly/2TVKmsu
This episode of The ShiftShapers Podcast is called “Using Data To Decide When To Go Partially Self Funded” with Hari Sundram, CEO and Founder at Verikai. Today, David and Hari discuss the kinds of data that are used as a surrogate for risk. Hari explains how brokers can inform their clients on predictive modeling and
The post Ep #313: Using Data To Decide When To Go Partially Self Funded – with Hari Sundram appeared first on ShiftShapers Online.
This episode of The ShiftShapers Podcast is called "Using Data To Decide When To Go Partially Self Funded" with Hari Sundram, CEO and Founder at Verikai. Today, David and Hari discuss the kinds of data that are used as a surrogate for risk.
Hari explains how brokers can inform their clients on predictive modeling and how having large data sets helps cut through anecdotal biases to provide new premiums and new outcomes.
You can find show notes and more information by clicking here: https://bit.ly/2Lz31pn
This episode of The ShiftShapers Podcast is called "Help Your Clients Go Back To The Office" with Chris Yarn, CEO of Walk On Clinic. Today, host and Chief Transformation Strategist David Saltzman and Chris discuss how employers can go ahead with testing (or not testing) their employees for COVID.
Chris starts by sharing his experience with helping employers deploy large-scale virus testing and how brokers can recommend these measures. He also explores actual human behavior when it comes to testing positive and its sometimes contradictory nature to EEOC and HIPAA regulations.
You can find show notes and more information by clicking here: https://bit.ly/3dy0BDj
This episode of The ShiftShapers Podcast is called "Disrupting Your Own Disruption" with Eric Silverman, Founder of Voluntary Disruption. Today, host and Chief Transformation Strategist David Saltzman and Eric discuss some major changes to voluntary benefits aka enhanced benefits.
They explore the reasons why enhanced benefits are a practical idea, the improvements in the tech that serves this group, and the strategies to drive engagement among employees and keep benefits attractive.
You can find show notes and more information by clicking here: https://bit.ly/2xuEPkp
This episode of The ShiftShapers Podcast is called "The Genomic Revolution - with Darren Rowe". Today, host and Chief Transformation Strategist David Saltzman and Darren explore the current science of genomics and the potential it holds for precision medicine in the future.
Darren also raises the important social and ethical elements that are inherent with genomics, such as the role of wealth and the possibility of breeding superhumans based solely on their capacity to access this technology. Darren also explains how ROI can be determined in the early stages of genomics today.
You can find show notes and more information by clicking here: https://bit.ly/2Y7LZ9m
This episode of The ShiftShapers Podcast is called "More Effective and Efficient Prospecting - With Kerry Heaps". Today, host and Chief Transformation Strategist David Saltzman and Kerry start by discussing public speaking, how it improves prospecting, and how imparting helpful information should be your number 1 priority.
Kerry then explains the importance of body language during public speaking and how strategic use of PowerPoints are not only a requirement by large conferences but also serve as an important teaching tool. Lastly, Kerry also shares her own tips to get over the nerves of speaking in front of a live audience.
You can find show notes and more information by clicking here: https://bit.ly/3boXI73
This episode of The ShiftShapers Podcast is called "Dealing With People You Can't Stand - with Dr. Rick Brinkman". Today, host and Chief Transformation Strategist David Saltzman and Rick talk about bringing out the best in people by first understanding intent and criteria.
With these, and the knowledge of 13 archetypes of people you can't stand, it becomes much easier to understand where they are coming from and to communicate what you want to tell them effectively.
You can find show notes and more information by clicking here: https://bit.ly/34syFNU
This episode of The ShiftShapers Podcast is called "Employee-customized Wellness Programs - with Daniel Freedman". Today, host and Chief Transformation Strategist David Saltzman and Daniel discuss wellness challenges in the workplace, expanding wellness to include emotional support, and migrating these classes to the online space.
The key difference is the social aspect and Daniel provides examples of how companies that cater to the social needs of their employees see a boost in happiness and productivity, even as people from across the world work from home amidst the coronavirus pandemic.
You can find show notes and more information by clicking here: https://bit.ly/2ULsP76
This episode of The ShiftShapers Podcast is called "What is Stress - and How Can We Cope? - With Lynn Jonen, PhD" and today, host and Chief Transformation Strategist David Saltzman and Lynn discuss the problems caused by stress, understand the underlying causes, and explore various solutions.
This discussion is especially relevant nowadays with the drastic changes brought about by COVID-19 and the corresponding stress that it causes on people. David and Lynn also talk about spiritual health and its role in keeping stress at bay.
You can find show notes and more information by clicking here: https://bit.ly/2Jn6rdx
This is part 2 of The ShiftShapers Podcast episode called "Reading the Regulatory Tea Leaves - with Jessica Waltman" and today, host and Chief Transformation Strategist David Saltzman and Jessica discuss transparency changes on the regulatory front and how these changes can affect you and your clients.
In particular, Jessica breaks down into plain language the transparency rules that affect hospitals and the differences with the rules for insurers and employer-sponsors in disclosing information. Jessica also explains how the new rules affect regular consumers and how requests for information can be made.
You can find show notes and more information by clicking here: https://bit.ly/3bhTduz
This is part 1 of The ShiftShapers Podcast episode called "Reading the Political Tea Leaves - with Jessica Waltman" and today, host and Chief Transformation Strategist David Saltzman and Jessica discuss health insurance and health-related matters in today's political climate.
Jessica, who is Principal at Forward Health Consulting, provides easy to understand insights about what is happening with the Affordable Care Act or ACA and how scrapping it affects much more than just Obamacare. She also provides a fearless forecast on the future of the ACA under a Sanders, Biden, and second Trump administration.
You can find show notes and more information by clicking here: http://bit.ly/39UV0Fx
This episode of The ShiftShapers Podcast is called "Innovation and Problem Solving, with Jayne Morgan, M.D." and today, host and Chief Transformation Strategist David Saltzman, together with Jayne, Director Of Innovation at Piedmont Healthcare, discuss innovation and how it is applied at Piedmont.
Also discussed is diversity in clinical trials; why it is lacking and the progress of making it more inclusive to more minorities. The role of the FDA is also clarified when it comes to making changes in addressing health gaps and producing solutions that affect all demographics of people.
You can find show notes and more information by clicking here: http://bit.ly/39BqJeO
This episode of The ShiftShapers Podcast is called "Finding The Right Stop-Loss Partner" and today, host and Chief Transformation Strategist David Saltzman is joined by Mehb Khoja, President of Medical Risk Managers, Inc. to discuss the topic from the perspectives of both employers and MGU's.
Mehb explains the lag times experienced between incurring and paying claims, shares his insights on why it is not advisable to swing back and forth from fully-insured to self-insured, and defines what lasering is and its significance in this industry.
You can find show notes and more information by clicking here: http://bit.ly/38jRGT6
This episode of The ShiftShapers Podcast is called "Finding Happiness When Success Isn't Enough" and today, host and Chief Transformation Strategist David Saltzman is joined by Freda Doxey, Founder of the A Wise Coaching and Counseling Company. Freda begins by sharing some of her tools and techniques to deal with the stresses of 2020.
She goes on to explain the differences between internal and external stress and breaks down the 3 parts of internal stress: What am I thinking? What are the emotions attached to it? And what do I believe?
And to round up the episode, Freda explains the need for a coach and its particular differences with a mentor and a sponsor. She also answers the crucial question of how to find life's happiness when success is not enough and the roles of helpfulness, satisfaction, and mindfulness in this equation.
You can find show notes and more information by clicking here: http://bit.ly/2vTTPqW
In this episode of the ShiftShapers Podcast, host and Chief Transformation Strategist David Saltzman is joined by Jim Hoitt, Senior Vice President at Captive Division at Berkeley Accident & Health.
Jim shares his in-depth knowledge and insights into the world of Captives and discusses its 2 models and the nature of each. He also takes a deep dive into the kinds of companies that benefit the most from a Captive, from their shared goals to the ideal company size to their financial commitments.
But Jim also discusses the major plus sides to the arrangement which include providing the best healthcare for companies at a lower cost, absorbing losses and mitigating risk factors to help ensure success across models. He also explains the key role an adviser plays in all of this and how the ultimate goal is to provide guidance and filter the best-fit companies.
You can find show notes and more information by clicking here: https://bit.ly/37EgmFb
In this episode of the ShiftShapers Podcast, host and Chief Transformation Strategist David Saltzman sits down with Jeremiah Solven, Founder of the Conquer Academy.
Today he shares his unique mindset which he honed when he was in his Ranger unit, the Badmuthers, and explains how a triangle of leadership, personal performance, and character are at the core of this mindset.
With this mindset, Jeremiah pursues his best version of himself and this is what he teaches to his students as well.
You can find show notes and more information by clicking here: https://bit.ly/37bcLOJ
In this episode of the ShiftShapers Podcast, host and Chief Transformation Strategist David Saltzman chats with Brian Clarke to discuss the life insurance company's perspective on life settlement.
Brian is the Director of Business Development at Reliant Life Shares and he shares details on how life insurance companies handle life settlement, from paying out death benefits to undertaking risk to dealing with government regulation.
Brian also shares how individual investors can participate in this market and changing the mindset around life settlement to see the real value it has to those who need it.
You can find show notes and more information by clicking here: https://bit.ly/3b7ofpF
In this episode of the ShiftShapers Podcast, host and Chief Transformation Strategist David Saltzman chats with David Vivero, Co-Founder and CEO of Amino.
David shares his knowledge of consumerism in healthcare and discusses how consumers want transparency of information and choice, but not too much that it ends up frustrating them. He also talks about how Amino connects consumers to services they want and the engagement and ROI that employers can expect from offering this service.
You can find show notes and more information by clicking here: https://bit.ly/2U1Jljg
In this episode of the ShiftShapers Podcast, host and Chief Transformation Strategist David Saltzman sits down with cognitive neuroscientist Gleb Tsipursky to talk about why "trusting your gut" could be the worst business advice you could follow.
Gleb starts with breaking down the SWOT analysis and how this popular business tool actually feeds into cognitive biases and might not be producing the results you thought it would. He also gives tips on how to avoid personal cognitive biases and introduces 5 questions to ask yourself before a sale or another big decision.
You can find show notes and more information by clicking here: https://bit.ly/367eqED
In this episode of the ShiftShapers Podcast, host and Chief Transformation Strategist David Saltzman chats with Lisa Rehburg, President of Rehburg Life Insurance Settlements. Lisa explains what a life insurance settlement is and how policy owners can actually sell their life insurance policies for cash.
Lisa goes on an in-depth discussion where she discusses the benefits to agents who will offer this, the legalities of life insurance settlements, and the growing appeal of this type of settlement to boomers who are now approaching senior age.
You can find show notes and more information by clicking here: https://bit.ly/2QG0tca
In this episode of the ShiftShapers Podcast, host and Chief Transformation Strategist David Saltzman chats with Ryan Sachtjen, Co-Founder at WatchTower to discuss some 21st-century technological innovations that help advisors use more of their time facing clients and selling.
Ryan goes into intricate detail on common RFP issues today and how automating workflows of companies can positively affect the bottom line. He also discusses what the future holds for brokerage firms that could lead to significant shifts in industry.
You can find show notes and more information by clicking here: https://bit.ly/2FlgXQL
In this episode of the ShiftShapers Podcast, host and Chief Transformation Strategist David Saltzman sits down with Richard Turrin, independent fintech, AI consultant, and author of “Innovation Lab Excellence: Digital Transformation from Within” to discuss what an “Innovation Lab” is and how it creates significant impact to companies which embrace it. He goes into further detail
The post Ep #294: Creating Digital – Ready Or Not! – with Richard Turrin appeared first on ShiftShapers Online.
In this episode of the ShiftShapers Podcast, Host and Chief Transformation Strategist David Saltzman features Peter Nieves, Chief Commercial Officer at WINFertility, as he explains what Family Building is and how it is different from in vitro fertilization. Peter explains the driving factors behind Family Building and how there is a surge in demand in
The post Ep #293: Fertile Ground For Fertility Benefits – with Peter Nieves appeared first on ShiftShapers Online.
In this episode of the ShiftShapers Podcast, Host and Chief Transformation Strategist David Saltzman features Craig Gussin, President at Retire with Renewals (among many other positions), and is widely considered an insurance expert with decades of experience. Today he talks about safeguarding your family in the sudden and unexpected event that something happens to you
The post Ep #292: Retire WITH Your Renewals – with Craig Gussin appeared first on ShiftShapers Online.
In this episode of the ShiftShapers Podcast, David welcomes Kornelius Bankston. Kornelius is managing partner at techPLUG, an innovation firm that integrates tech and healthcare for diverse populations. David and Kornelius discuss the determinants of healthcare such as location transportation, prescription availability and food security. Kornelius explains what marginalized communities are and what they need.
The post Ep #291: Technology Brings HealthCare and Innovation to Underserved Communities – with Kornelius Bankston appeared first on ShiftShapers Online.
In this episode of the ShiftShapers Podcast, David talks to Hugh O’Toole. Hugh is CEO of Innovu, a company that offers analysis services and well-designed products to help companies seamlessly integrate data across all programs. David and Hugh discuss the use of data to help advise companies. Hugh explains the process of cleaning data sets
The post Ep #290: Become a Data Driven Organization – with Hugh O’Toole appeared first on ShiftShapers Online.
In this episode of the ShiftShapers Podcast, David talks to Vicky Westra. Vicky is the Founder and Chief Executive of Artistas Café and Javamo Art for Autism, both social enterprises supporting individuals diagnosed with Autism. She’s a board member of Autism Shifts, a program and community of parents, educators and employers dedicated to understanding autism on
The post Ep #289: Finding Outstanding Employees From New Communities – with Vicky Westra appeared first on ShiftShapers Online.
In this episode of the ShapeShifters Podcast, Host and Chief Transformation Strategist David Saltzman features Kev Coleman, President and Founder of AssociationHealthPlans.Com to explain what AHP’s are all about and how small businesses can benefit from them. Kev is a consumer advocate, researcher, and published writer whose works have appeared on The Wall Street Journal,
The post Ep #288: Are Association Health Plans the Future? – with Kev Coleman appeared first on ShiftShapers Online.
In this episode of the ShapeShifters Podcast, David welcomes Jeanne Moore. Jeanne is a registered nurse who is now working in the health insurance industry, and providing consulting services. She is the author of Nurses Take Back Health Care One Employer At A Time. Jeanne talks about the shift in the role of nurses in
The post Ep #287: Nurses Take Back Healthcare – with Jeanne Moore appeared first on ShiftShapers Online.
Host and Chief Transformation Strategist David Saltzman welcomes Emma Passe, COO of E-Powered Benefits and self-described relentless change seeker, to share her thoughts on change and empowered leadership by females and other minorities. Emma describes how things have changed and continue to change in the landscape of leadership, as well the different elements that make
The post Ep #286: A Relentless Change Seeker Seeks Change – with Emma Passe appeared first on ShiftShapers Online.
Today’s episode of The ShiftShapers Podcast welcomes The Telephone Doctor Nancy Friedman on the show to share her thoughts on customer service, how it goes wrong, and the best ways to fix it. Nancy discusses common phrases customers hear which simply do not encourage good business, and moves on to the more modern modes of
The post Ep #285: Communicate Better! The Doctor is IN! – with Nancy Friedman appeared first on ShiftShapers Online.
Today’s episode of The ShiftShapers Podcast explores innovative ways of sourcing the best talents for agencies. Host David Saltzman features Susan Rider, Vice President of Employee Benefits and Human Capital Strategies at Gregory & Appel Insurance, and they discuss disabilities, diversity, and inclusion in the workplace. Susan begins by sharing her own learning difficulties and
The post Ep #284: Finding New Talent In New Places – with Susan Rider appeared first on ShiftShapers Online.
Today’s episode of The ShiftShapers Podcast by David Saltzman is called “Healthcare’s New Front Door” and focuses on the expanding space of telemedicine. David features Kelly Bliss, Chief Client Officer at Teladoc Health, and explores what telemedicine is all about and how it breaks barriers to serve millions upon millions of people in need. Kelly
The post Ep #283: Healthcare’s New Front Door – with Kelly Bliss appeared first on ShiftShapers Online.
Starting a podcast to help deliver clients sounds easy enough, right? Ben Krueger of Cashflow Podcasting says there is more to it than meets the eye – including a healthy dose of commitment. But if you do it right it can be rewarding on a number of fronts. Ben helped us launch ShiftShapers, so we
The post Ep #282: Creating A Podcast That Delivers Clients – with Ben Krueger appeared first on ShiftShapers Online.
Josh Luke is a man with many vantage points on our health care system: author, public speaker, healthcare futurist, and hospital administrator. He believes that the current healthcare system is irreparable. So, what are his thoughts about how we move forward and craft something that actually works? What You’ll Learn From this Episode: Why affordability
The post Ep #281: The System is Broken Beyond Repair: Now What? – with Josh Luke appeared first on ShiftShapers Online.
How can plan participants use transparency tools to stay in network, but still find less expensive, higher quality care? Bill Hennessey is CEO at Pratter, Inc. and says the data proves – without argument – that providing transparency tools that are easy to use will help employers and their employees bust through the price/quality walls.
The post Ep #280: And Transparency Shall Set You Free – with Bill Hennessey appeared first on ShiftShapers Online.
How does a nationally-recognized agency owner keep the joy in what she does – and what are her secrets for accomplishing that goal? Tanya Boyd, of the eponymous Tanya Boyd Agency, suggests we “quit it with the noise” and how to handle it when obstacles, limitations and beliefs collide. What You’ll Learn From this Episode:
The post Ep #279: Keeping the Joy In What You Do – with Tanya Boyd appeared first on ShiftShapers Online.
With all the noise and change in our industry, some find chaos and others find opportunity. Some of us need a Sherpa to help climb that opportunity market. But how do you get started, what do you look for in a guide or coach and how can you get to the summit? Ryan Miller is
The post Ep #278: Climbing the Mountain? Get a Sherpa to Guide You! – with Ryan Miller (Part 2) appeared first on ShiftShapers Online.
With all the noise and change in our industry, some find chaos and others find opportunity. Some of us need a Sherpa to help climb that opportunity market. But how do you get started, what do you look for in a guide or coach and how can you get to the summit? Ryan Miller is
The post Ep #277: Climbing the Mountain? Get a Sherpa to Guide You! – with Ryan Miller (Part 1) appeared first on ShiftShapers Online.
Shannon Skaggs, President at Quantum Health, knows that the average significant health event lasts 11 months, involves 5-7 providers and requires the patient to make 41 decisions. On this episode, Shannon explores how a patient can deal with all of that and discusses the tools and techniques that are available to help them. What You’ll
The post Ep #276: Employees Need Deeper Guidance For Their Health Care Journey – with Shannon Skaggs appeared first on ShiftShapers Online.
Steve Watson is a CFO/CHRO of a 500-life group who has learned that there is a critical lack of understanding about benefits among his peers. In this interview, Steve offers his candid impressions about his efforts to educate other C-suite leaders and how benefits advisors can be more effective when talking with them. What You’ll
The post Ep #275: Benefits from a CFO’s Perspective – with Steve Watson appeared first on ShiftShapers Online.
We have had guests talk about benefits and P&C mergers, but how do you create a successful joint venture between benefits and accounting firms while managing the complexities of a highly regulated market? On this episode, we chat with Adam Rosenfeld, President of BT Benefits about the challenges and successes of just such a joint
The post Ep #274: Creating a JV with an Accounting Firm – with Adam Rosenfeld appeared first on ShiftShapers Online.
How do you deal with a bifurcated market, and what can we learn from our Taft/Hartley cousins? Jim Garrison, President at Pacific Federal, a private TPA in Southern California, discusses that and more in this episode. What You’ll Learn From this Episode: How to deal with different market segments in the same state. How the
The post Ep #273: The North and The South – Managing a Complex Market – with Jim Garrison appeared first on ShiftShapers Online.
A personal encounter with the medical system led to a decision that making a difference required a different approach. So Adam Berkowitz launched an agency that takes a new-day perspective in its operations and interactions with clients. What You’ll Learn From this Episode: The personal experience that began the process. Leveraging technology to control expense
The post Ep #272: Starting An Agency In Today’s Climate – with Adam Berkowitz appeared first on ShiftShapers Online.
Creating a pharmacy model that provides help for underserved populations using reclaimed prescriptions required a pharmacist with a mission, a change in legislation and a vision. Phil Baker is a pharmacist on a mission who has created a whole that is more than just the sum of its parts. What You’ll Learn From this Episode:
The post Ep #271: A Good Shepherd Making a Huge Difference – with Phil Baker appeared first on ShiftShapers Online.
With the massive amount of creative disruption happening in our industry, the need for advisor education is greater than ever. The University of Lynchburg’s Tom Scott has relied on industry experts and others to create a new Masters degree which focuses on the practical aspects of the new world of health benefits. What You’ll Learn
The post Ep #270: The New “Masters In Health Plan Design” Degree – with Tom Scott (Part 2) appeared first on ShiftShapers Online.
With the massive amount of creative disruption happening in our industry, the need for advisor education is greater than ever. The University of Lynchburg’s Tom Scott has relied on industry experts and others to create a new Masters degree which focuses on the practical aspects of the new world of health benefits. What You’ll Learn
The post Ep #269: The New “Masters In Health Plan Design” Degree – with Tom Scott (Part 1) appeared first on ShiftShapers Online.
With all of the focus on deconstructing health plans, the technical aspects of self-funding, advising clients on compliance, and more – it is often hard to remember the amount of good we do as an industry. Advisor Tom DiLiegro’s experience as a young man drove that point home in a very personal and long-lasting way.
The post Ep #268: Don’t Forget The Most Important Part – with Tom DiLiegro appeared first on ShiftShapers Online.
It doesn’t do a lot of good if a firm has the best benefit plans in the world, but the employees don’t really know about them or understand how they work. What are some of the key tools and techniques you should use to make sure your client’s message is getting through? Ellen Anreder, Owner
The post Ep #267: Better Communication and Plan Branding Yields Happy Clients – with Ellen Anreder appeared first on ShiftShapers Online.
Many firms are diversifying their client offerings and beefing up their value propositions to achieve success in the current environment. Some firms are finding that path by offering HR services. Barry Cohn and his wife’s firm have been moving in that direction and are about to make a big-time change to their practice. What You’ll
The post Ep #266: Opportunities Offering HR Services To Employers – with Barry Cohn appeared first on ShiftShapers Online.
Deconstructing health plans is a challenge – especially so in small markets. What are those conversations like, and is it possible to achieve success with new health plan strategies outside of large markets? Josh Baker, President of Butler Benefits in Amarillo, Texas, shares his experience and success secrets with us. What You’ll Learn From this
The post Ep #265: Overcoming Small Market Challenges With Today’s Plans – with Josh Butler appeared first on ShiftShapers Online.
There is a great deal of discussion in our industry about “deconstructing” health plans and the benefits available when an employer embraces a deconstructed plan while working with the correct advisor. Robson Baker, advisor at Clarus Benefits, has studied this strategy and has great advice for those already working on deconstructed plans, and for those who
The post Ep #264: Deconstructing a Plan is Better Than Constructing A Plan – with Robson Baker appeared first on ShiftShapers Online.
Western medicine is not the only way to achieve health and wellbeing. How can Yoga and meditation affect your clients’ health care spend and create a better environment for their employees? Naama Pozniak, CEO of A+ Insurance Services, has dedicated herself to bringing those disciplines to advisors and their clients. What You’ll Learn From this
The post Ep #263: Using Yoga and Meditation to Reduce Health Care Costs – with Naama Pozniak appeared first on ShiftShapers Online.
Within our own firm – and for clients – technology has become an often-confusing maze of choices. How do you know what to look for and how to make the right long-term choice? Jeff Severson, President of Trinity Advisors, has made a career of learning how to keep advisors and their clients from falling into
The post Ep #262: Don’t Make The Wrong Tech Decisions – Get Help First! – with Jeff Severson appeared first on ShiftShapers Online.
From application to claims, DI is a bit of a different animal. Underwriting is both medical and financial, and policy provisions are (understandably) more complex than a life sale. Death is not subjective, but disabilities are, and oftentimes this leads to claim challenges. Eric Buchanan, JD, and his firm help claimants when the rubber meets
The post Ep #261: Avoiding Landmines and Litigation in DI Claims – with Eric Buchanan appeared first on ShiftShapers Online.
Product, marketing and technical knowledge alone are not enough to be effective with today’s prospects and clients. Dana Dombrowski, a coach with Hit The Ground Running, shares some of her tips and techniques for advisors who need to listen more carefully, speak more clearly, and act more deliberately. What You’ll Learn From this Episode: Why
The post Ep #260: Beyond Product and Marketing: Hearing and Being Heard – with Dana Dombrowski appeared first on ShiftShapers Online.
A client called to tell Jennifer Borislow that two employees who were away on vacation had an accident and informed her that one died, one has serious injuries. The client asked for help and Jennifer soon learned that because the employees were young and had not done much – if any – advance planning, sorting
The post Ep #259: Helping Clients Avoid “If I Had Only Known” Syndrome – with Jennifer Borislow appeared first on ShiftShapers Online.
Taylor Lindsey is a partner at Employee Benefit Consultants, but he is also the fourth-generation member of the firm and he is working to morph this highly-respected old-line agency into a totally modern value-based, data-driven firm. Listen in and learn some of the tools and techniques he has employed to overcome that challenge. What You’ll
The post Ep #258: Can a 4th Generation Agency Go Value Based? – with Taylor Lindsey appeared first on ShiftShapers Online.
Increased interest in self-funded plans means more clients are gaining access to data, but data without interpretation that creates actionable changes is pretty much useless. Ross Bjella, CEO of Alithias knows how to make that happen – and shares his insight on this episode. What You’ll Learn From this Episode: Exposing the problem of data
The post Ep #257: Turn Data Into Action to Help Plans Deliver Results – with Ross Bjella appeared first on ShiftShapers Online.
Wellness is evolving, but it is also an often-challenging subject for advisors. What is working and what isn’t? What will provide a demonstrable ROI and how do you set expectations and position these programs with prospects and clients? Ed Buckley, Chairman and CEO of Peerfit, has studied this area for years and has the answers
The post Ep #256: Talking About Wellness Making You Sick? What’s New and What’s Working – with Ed Buckley appeared first on ShiftShapers Online.
Our guest on this episode, Jacques Loveall, is Chairman of the United Food and Commercial Workers Trust, which, after being buffeted by the system as end users and an (almost) afterthought, has made some long-overdue changes in ownership and control of healthcare delivery. It is has been a fascinating journey, and they are just getting
The post Ep #255: Taft/Hartley Plans May Be The Leading Edge of Change – with Jacques Loveall appeared first on ShiftShapers Online.
Contributor Jessica Waltman joins us for her quarterly visit to discuss the legislative and regulatory changes going on in Washington. Beyond the jockeying for the 2020 Presidential race, there is a great deal going on that you may not have been able to hear about over that din. Listen in to learn what you should
The post Ep #254: Legislation and Regulation Update – What to Watch – with Jessica Waltman appeared first on ShiftShapers Online.
In Mel Schlesinger’s new book, The Better Medicare Solution: What No One Is Telling You, he does the math and lays out his belief that Medicare Supplements are a much better option for almost all consumers. He won’t even sell Medicare Advantage Plans! In this fast-paced interview, Mel makes the case and explains why. What
The post Ep #253: Medicare Advantage Plans Aren’t the Best Option for Most – with Mel Schlesinger appeared first on ShiftShapers Online.
Can you create an agency that is focused more on relationships and results than on the traditional sales-driven mentality? That’s what Braden Monaco, Co-founder and Managing Partner at Blue Horizon Benefits, set out to learn. Along the way, he and his team created a concept they call the “Total Concierge Approach,” which creates true results-driven
The post Ep #252: This Agency Is Designed To Flip The Industry On Its Head – with Braden Monaco appeared first on ShiftShapers Online.
Mark Blum has taken a very different path to get to the healthcare universe – starting as a labor organizer and negotiator who quickly found healthcare to be the most frequent stumbling stone in negotiations. The determination to find a way to resolve that issue has brought him to some interesting destinations and some surprising
The post Ep #251: What If Employees Owned Their Employer-based Plans? – with Mark Blum appeared first on ShiftShapers Online.
We have had a few guests discussing RBP, but the inevitable comments come down to how to implement it successfully more than how the components work (or occasionally – don’t work). Lester Morales is CEO of Next Impact, and he shares his extensive experience about how to go from “here to there” without the usual
The post Ep #250: How To Enable Reference Based Pricing Without Freaking Out Clients and Employees – with Lester Morales appeared first on ShiftShapers Online.
Have you finally “had it” with commission compression, but don’t have a clue about how to escape the commission boa constrictor and move toward a fee-based or hybrid practice model? Cheryl Perez, President of BIG-HR, shares her agency’s journey and offers specific advice about what KPIs to watch, how to value what you provide to
The post Ep #249: Navigate From Commissions To Fees and Gain Control – with Cheryl Perez appeared first on ShiftShapers Online.
With the stratospheric rise in advisor interest in self-funding as a base financing design for bringing other state-of-the-art tools to employers, it is critical for advisors to understand the components and players. Jonathan Socko is Senior Vice President for Sales & Business Development for East Coast Underwriters and offers his advice for newbies and seasoned
The post Ep #248: Stop Loss – Who’s Who, What’s What and Why’s Why – with Jonathan Socko appeared first on ShiftShapers Online.
In this episode, we explore some of the most common questions advisors ask about self-funding and discuss concerns ranging from minimum group size to tools and techniques. Our guest on this episode of ShiftShapers is Adam Russo, Esq., co-founder and CEO of The Phia Group, as well as the founding and managing partner at a
The post Ep #247: How to Have a Self-Funding Conversation with Employers – with Adam Russo appeared first on ShiftShapers Online.
On this episode of ShiftShapers, Tobe Gerard shares valuable insight into how she built a successful agency specializing in long-term care insurance. She had 20 years of experience in the insurance industry before starting her firm, and for the past 15 years, she’s built a highly efficient, effective and successful agency using a unique strategy.
The post Ep #246: Building A Successful Referral-Based LTC Practice – with Tobe Gerard appeared first on ShiftShapers Online.
On this episode of ShiftShapers, our guest and I discuss the new and diverse tools that advisors within the insurance industry are using to market their businesses. The fastest growing method happens to be video, and Bart Camarata is an expert on the topic. Bart is the creator and host of BenefitAdvisor TV, where he leverages his Middle Tennessee State education
The post Ep #245: The Magic of Marketing Your Practice with Video – With Bart Camarata appeared first on ShiftShapers Online.
Drug costs are soaring and driving more of medical spend than ever before. The good news is that there are tools coming to market to help consumers and plans alike. That is what our guest, Gary Becker, CEO of ScriptSourcing, and I discuss on this episode. We begin with an exploration of why prescription drugs
The post Ep #244: Countering Rising Medical Spend from Pharma – With Gary Becker appeared first on ShiftShapers Online.
Clients want more than a broker slinging the same old solutions – they want an advisor who can help them understand where the money is going, and how to control their spend over the entire claims spend continuum. Our guest on this episode, former professional poker player turned benefits advisor John Sbrocco, has spent time,
The post Ep #243: No Bluffing: How You Can Transform from Broker to Benefits Advisor – with John Sbrocco (Part 2) appeared first on ShiftShapers Online.
Clients want more than a broker slinging the same old solutions – they want an advisor who can help them understand where the money is going, and how to control their spend over the entire claims spend continuum. Our guest on this episode, former professional poker player turned benefits advisor John Sbrocco, has spent time,
The post Ep #242: No Bluffing: How You Can Transform from Broker to Benefits Advisor – with John Sbrocco (Part 1) appeared first on ShiftShapers Online.
Specialty drugs represent an ever-growing driver of our overall enormous drug spend. Pramod John, our guest on this episode, is CEO of Vivio Health, which is singularly focused on using outcomes revealed by data and analytics to bend the hockey-stick curve of this spending trend. What You’ll Learn From this Episode: Why do Americans have
The post Ep #241: Data and Analytics Bend Specialty Drug Cost Curve – with Pramod John appeared first on ShiftShapers Online.
There is a fast-growing movement toward bundled, all-in one-price medical services that save money, provides less complexity for members, and may make networks (as we know them today) obsolete. Our guest on this episode is Stan Schwartz, M.D., the Chief Medical Officer of The Zero Card, a company which is in the forefront of making this
The post Ep #240: Schedule It. Bundle It. Save On It! – with Stan Schwartz, M.D. appeared first on ShiftShapers Online.
Pharmacy costs are increasing exponentially – some estimate that they will soon represent more than a quarter of all plan spend. Yet this portion of the industry is so opaque that it is nearly impossible to accurately understand what, exactly, is being paid – and where those payments actually go. Our guest on this episode
The post Ep #239: Making PBMs Fully Transparent with Kent Thomas appeared first on ShiftShapers Online.
Direct Primary Care (DPC) has been available for some time, but it has been marketed mainly to individuals. Today, a small number of DPC doctors and executives are making substantial strides toward breaking into the employer market. Our guest, Alex Lickerman, MD, Founder and CEO at ImagineMD, thinks the time is right and explains how
The post Ep #238: Bringing DPC to The Employer Level – with Alex Lickerman, MD appeared first on ShiftShapers Online.
On this episode, Megan Chiarello (Grassetto Creative) and your host – two admitted marketing geeks – discuss how to create impactful marketing campaigns and events. Megan offers her advice on the three questions you must answer to create success with your marketing efforts. We explore the differences between selling and marketing, and much more. What
The post Ep #237: Three Questions To Successful Marketing Campaigns – with Megan Chiarello appeared first on ShiftShapers Online.
The midterms will undoubtedly create conversations and different directions for what we can expect around healthcare legislation and regulation. In part two of our two-part episode, Jessica outlines some of the thinking on both sides of the aisle, the key players to watch, and much more. What You’ll Learn From this Episode: What can we
The post Ep #236: Healthcare And The Midterm Elections . . . And Beyond – With Jessica Waltman (Part 2) appeared first on ShiftShapers Online.
Legislative and regulatory changes that affect your practice and your clients continue to happen despite the other noise from the Hill. In part one of this two-part interview with regular contributor Jessica Waltman, we will explore those initiatives and what you need to know to advise your clients appropriately. In part two we discuss . . .
The post Ep #235: Legislative and Regulatory Changes You Need To Know About –With Jessica Waltman (Part 1) appeared first on ShiftShapers Online.
In our visit with, Eric Parmenter (National Leader of Value-based Care at Collective Health) we discuss a little-known metric that research proves correlates positively with growth. The Net Promoter Score has been used in other industries for more than 10 years, but despite its simplicity and effectiveness, it has not been widely applied in our
The post Ep #234: What Is Your Net Promoter Score? – With Eric Parmenter appeared first on ShiftShapers Online.
Brian Klepper, Principal at HC Performance Inc. and Worksite Health Advisors, believes that the value being delivered in today’s health care system is a “train wreck” and that many are complicit – and know that they are complicit. He explains why he believes that Fee For Service is the crack cocaine of healthcare. The good
The post Ep #233: Fee For Service Is The Crack Cocaine Of Healthcare – with Brian Klepper appeared first on ShiftShapers Online.
Forbes Magazine called our guest, David Contorno, “One of America’s most innovative benefits leaders.” So, what’s he up to and what tools, techniques and strategies is he bringing his clients? We discuss why the “old way” just isn’t working and how this leads employers to a dilemma. We also explore whether the advisor community is
The post Ep #232: Providing 21st Century Advice to Clients – With David Contorno appeared first on ShiftShapers Online.
Gene Thompson is both a Project Director and Director of Health City Cayman Islands (HCCI), an amazing facility that is delivering higher quality, lower cost care with greater patient satisfaction scores. Pioneered by Dr. Devi Shetti, a physician and health care visionary based in India, HCCI has become a leading model for medical tourism. With
The post Ep #231: Medical Tourism: Changing Attitudes Provide Huge Opportunities For Plans And Advisors Alike – with Gene Thompson appeared first on ShiftShapers Online.
Mike Dendy is CEO and Founder at Advanced Medical Pricing Solutions (AMPS) and a student of the irrational pricing and misaligned incentives that drive today’s US healthcare system. We begin our conversation by discussing the widely-held myth of the PPO discount. From there we explore the general pricing methodologies and incentives in healthcare. Once you
The post Ep #230: Why US Healthcare Is Like OPEC And Why Networks May Disappear – with Mike Dendy appeared first on ShiftShapers Online.
David Snow is Chairman and CEO of Cedar Gate Technologies and a self-described “health care junkie” whose career has touched nearly all facets of the health care system. As such, David has a very unique view that informs how he works with and helps companies use data to drive better decision-making. We discuss the notion
The post Ep #229: How 360-degree Data and Analytics Is Changing The Industry – with David Snow appeared first on ShiftShapers Online.
Ten years ago, a number of physician “academies” came together to pioneer the concept of Medical Home. Today, that concept is more widely known as Direct Primary Care (DPC). Today, interest in DPC and the practice model itself is rapidly evolving. Our guest, Jon Hernandez is the CEO at PeakMed Direct Primary Care in Colorado,
The post Ep #228: The Evolution of Direct Primary Care – with Jon Hernandez appeared first on ShiftShapers Online.
As our population ages and medicine gets better, we are dealing with more chronic disease than ever before – and it is a huge cost driver in overall medical spend. Most of it falls into five categories and it represents a significant portion of overall spend. Sterling Smith, Director of Ventures at ACAP Health, offers perspective, as
The post Ep #227: Helping Employers Manage The Cost of Chronic Disease – with Sterling Smith appeared first on ShiftShapers Online.
In the 40’s we hired hands. In the 80’s we hired hearts and minds. Today we hire every bit of every employee – and that includes issues they deal with in their private lives. Savvy employers understand the drag on productivity that causes, and are providing information to help employees make smarter and more informed
The post Ep #226: Life Follows Employees To Work Every Day – with Anna Mittag appeared first on ShiftShapers Online.
T.J. Morrison is a second-generation agency owner with an interesting insight into what is happening in the self-funded universe. He believes that the huge interest in these plans requires that they be designed and operated differently than in years past. Listen to learn why T.J. thinks RBP is like a divorce attorney and Bundled Pricing
The post Ep #225: Reference Based Pricing is Like a Divorce Attorney with T.J. Morrison appeared first on ShiftShapers Online.
With 23% of the US population using 3 or more prescription drugs, it is amazing that many physicians are still (essentially) guessing which drugs to prescribe. Adverse drug events cause 1 million ED visits, 280,000 hospitalizations and are the fourth leading cause of preventable death. But pharmacogenomics can alleviate all of those AND lower costs
The post Ep #224: Science vs. Drugs: Lower Cost and Better User Experience – with Joe Spinelli appeared first on ShiftShapers Online.
One of the benefits of moving from old-fashioned “wellness” programs to today’s wellbeing initiatives is the opportunity to include and address more of the issues employees are dealing with. One such issue has been under the radar, but is now beginning to be addressed: life challenges. In this episode we explore what that means, and
The post Ep #223: A Cult of Caring: Wellbeing Beyond Healthcare – with Mark Donohue appeared first on ShiftShapers Online.
Employers are beginning to move the needle on healthcare, and advisors have their ear. There is a lot of debris from old models that needs to be cleared, and on this episode we explore how that is happening and what is coming in its place. New and innovative models of care delivery and payment models
The post Ep #222: The Status Quo Just Won’t Cut It – with Julien Emery appeared first on ShiftShapers Online.
Relatively new to the benefits arena, Dawn McFarland, President of M&M Benefit Solutions began to look around and realized that there weren’t many OTHER new folks coming into the business. Worse, many older practitioners are aging out of the business with no succession plans. Coupled with her involvement with the California Association of Health Underwriters,
The post Ep #221: Where the Heck IS Everybody? – With Dawn McFarland appeared first on ShiftShapers Online.
The current health care environment is complicated, convoluted and fraught with misaligned incentives, care decisions that focus on a single price point and doesn’t help consumers plan based on a desired final outcome. Scott Schoenvogel, CEO at Compass Professional Health Services, believes that healthcare navigation programs that account for benefits, consumer decision making and clinical
The post Ep #220: Changing The Care Path – with Scott Schoenvogel appeared first on ShiftShapers Online.
We have been talking about consumers in healthcare since the turn of the century, but real health care consumers – in the true sense of the word – are still apparently hanging out at the unicorn farm somewhere far away. Eric Haberichter, Co-founder at Access Healthnet knows why – and is working hard at creating
The post Ep #219: How To “Retail-ize” Health Care And Free The Unicorns – with Eric Haberichter appeared first on ShiftShapers Online.
Not too many years ago, the role of a TPA was fairly straightforward: Pay claims, handle eligibility and make a network connection. In today’s fast-paced and rapidly growing self-funding world, a TPA has to be flexible, nimble and multi-faceted. Jeff Bernhard, President of Continental Benefits, represents a TPA built for today’s commerce. We talk about what to
The post Ep #218: Today’s TPAs Must Deliver Much More – with Jeff Bernhard appeared first on ShiftShapers Online.
Travel for treatment used to be an esoteric benefit reserved for only the largest of employers. Today, the benefits are as much quality as cost driven and most often involve fully-accredited facilities. Some even use U.S. physicians and are attached to teaching hospitals. Yet for many employers and employees it still remains mysterious. Jim Polsfut,
The post Ep #217: Overcoming Travel For Treatment Objections – with Jim Polsfut appeared first on ShiftShapers Online.
According to our guest, Erica Kiefer, VP of Sales and Marketing for AgencyBloc and a tech veteran in a number of sectors, we often neglect to investigate some critical questions when choosing software. In addition to looking at the user interface or the sheer functionality of any tool, Erica cues us in on the questions
The post Ep #216: Don’t Forget These Questions When Buying Tech Tools – with Erica Kiefer appeared first on ShiftShapers Online.
Musculoskeletal claims represent 16-22% of medical spend in most plans. Yet with a misdiagnosis rate of nearly 40% and with new evaluative and treatment regimens, plans can save as much as 25-35% of that spend. Chad Gray, CEO at Integrated Musculoskeletal Care) has been tracking this trend and is one of the foremost experts on
The post Ep #215: How To Save 25-35% On Musculoskeletal Claims – with Chad Gray appeared first on ShiftShapers Online.
Jessica Waltman is principal at Forward Health Consulting and one of the most in-demand healthcare political and regulatory analysts in the country. She is also a ShiftShapers regular contributor. As we approach the mid-term elections, you may not be hearing much healthcare discussion on the legislative front, but the regulatory environment has been chock full
The post Ep #214: The Red Hot Regulatory Environment – What You Need to Know! – with Jessica Waltman appeared first on ShiftShapers Online.
David Weingard is an entrepreneur who used his personal experience with diabetes to create Fit4D, a company that helps with both the personal and financial costs of this widespread and growing disease. David believes that even with all of the work that has been done, there is a huge opportunity for improvement. In the past,
The post Ep #213: Personal Experience Creates New Help For The Human And Financial Costs of Diabetes – with David Weingard appeared first on ShiftShapers Online.
Gene Thompson is both a Project Director and Director of Health City Cayman Islands (HCCI), an amazing facility that is delivering higher quality, lower cost care with greater patient satisfaction scores. Pioneered by Dr. Devi Shetti, a physician and health care visionary based in India, HCCI has become a leading model for medical tourism. With
The post Ep #212: Medical Tourism: Changing Attitudes Provide Huge Opportunities For Plans And Advisors Alike – with Gene Thompson appeared first on ShiftShapers Online.
Data and reporting is playing an ever-more important role in helping advisors and employers manage their health care chain and spend. But our guest on this episode, Phil Litvin, Business Development Manager at First Capitol Consulting, warns that there are some red flags you may not even be aware of when evaluating the reporting you
The post Ep #211: Watch Out For These Reporting Red Flags – with Phil Litvin appeared first on ShiftShapers Online.
David Snow is Chairman and CEO of Cedargate Technologies and a self-described “health care junkie” whose career has touched nearly all facets of the health care system. As such, David has a very unique view that informs how he works with and helps companies use data to drive better decision making. We discuss the notion
The post Ep #210: How 360-degree Data and Analytics Is Changing The Industry – With David Snow appeared first on ShiftShapers Online.
Michael Walsh, founder and CEO of Cariloop, is an expert on a growing problem that most employers may not even realize they have – and that is taking its toll on their employees’ productivity. According to Michael, there may be more than 25 million workers caring for someone and that has an impact on financial
The post Ep #209: Helping Employers Deal With The Growing Problem Of Employee Caregivers – With Michael Walsh appeared first on ShiftShapers Online.
Brian Klepper, Principal at HC Performance Inc. and Worksite Health Advisors believes that the value being delivered in today’s health care system is a “train wreck” and that many are complicit – and know that they are complicit. He explains why he believes that Fee For Service is the crack cocaine of healthcare. The good
The post Ep #208: Fee For Service Is The Crack Cocaine Of Healthcare – with Brian Klepper appeared first on ShiftShapers Online.
Laura Carabello, Founder and Principal at CPR Strategic Marketing and Communication has spent the last 10 years focusing on domestic and international medical tourism. In this fast-paced episode, we discuss the inroads that both types of medical travel have made, beginning with jumbo employers and working their way to more recent acceptance and adoption by the mid-market.
We also explore some of the pricing mechanisms behind the trend and why these facilities deliver high-quality care, great patient satisfaction, and impressive savings to plans and employers. Laura explains how plans can communicate these benefits and what advisors need to know to connect their employers with appropriate facilities.
What You’ll Learn From this Episode: * Why the take-up has seemed slow, despite the savings and quality. * Which facilities are in the forefront of delivering these services. * That Adoption by business coalitions has been strong. * How pharmacy is being brought into the arrangements. * How to find “Centers of Excellence” and why they are important.
Featured on the Show: * CPR
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The post Ep #207: Better, Less Expensive Medical Care – Beach Included! With Laura Carabello appeared first on ShiftShapers Online.
Bret Brummitt, Managing Partner at AG Insurance Agencies and a thought leader in our business, believes that the two greatest things that have happened to our business are “Obamacare and Zenefits.” If that seems counterintuitive, listen in to hear Bret explain how those two things have shaped some of the transformative steps now taking place in the industry.
We explore the role technology is and will play as the future unfolds. But Bret believes that we also need to rethink the offering, the approach, the compensation structures and more.
What You’ll Learn From this Episode: * Why products are never as good as the demo and how to work around that. * How the entire transaction is being reshaped. * The key competencies future agencies will need to exhibit. * Whether the KPIs have changed and what really matters. * The importance of alternate revenue streams and alternate compensation models.
Featured on the Show: * AG Insurance
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The post Ep #206: The Two Greatest Things That Happened To Our Business – with Bret Brummitt appeared first on ShiftShapers Online.
Jack Hooper, Founder at Take Command Health, believes that data is the key to helping consumers connect with the plan that is right for them. Employees make plan decisions for a variety of reasons, but often do not find the plan that is right for them and do not understand the long-term impact of selecting the wrong plan.
We discuss why it has been impossible for consumers to shop for healthcare in much the same way they shop for most everything else in their lives and Jack highlights some solutions that are coming to market.
What You’ll Learn From this Episode:
- What the right decision is and how consumers can find it
- What pre-group options are and why they matter
- The big opportunity for benefit advisors
- How to have the benefits conversation with employers
- What decision support tools are needed
Featured on the Show: * Take Command Health
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The post Ep #205: Using Data To Create Better Health Care Consumers – with Jack Hooper appeared first on ShiftShapers Online.
In part 2 of our visit with, Eric Parmenter (National Leader of Value-based Care at Collective Health) we discuss a little-known metric that research proves correlates positively with growth. The Net Promoter Score has been used in other industries for more than 10 years, but despite its simplicity and effectiveness, it has not been widely applied in our industry.
The best part of this predictive metric is that it only requires that you ask one simple question. While the question may be “simple”, the psychology behind it is anything but. Listen and learn more about this powerful index. We also discuss some thoughts from Eric’s book about reducing stress and enhancing joy!
What You’ll Learn From this Episode:
- What is a Net Promoter Score
- What is the research behind the Score
- How clients divide into three significant cohorts
- Why the Score positively correlates with growth
- Why a one-question survey beats anything else – if you use the right question
- Some thoughts on reducing stress and finding joy in your work and personal life
Featured on the Show: * Collective Health * Net Promoter Score * Stop!: 21 Stops to Reduce Stress and Enhance Joy by Eric Parmenter * Net Promoter System
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The post Ep #204: What Is Your Net Promoter Score? – With Eric Parmenter (Part 2) appeared first on ShiftShapers Online.
In the first of this 2-part episode, Eric Parmenter, National Leader of Value-based Care at Collective Health will explore why a market where buyers and sellers don’t know each other has led to misaligned market incentives. We also discuss a new variation of ACOs, the “E-ACO” that may answer some of the realignment that needs to occur to fix the broken triangle. What You’ll Learn From this Episode: * What the “Broken Triangle” refers to and why it matters. * What ACOs were originally intended to be. * How the ACO model can be applied in an employer setting. * The four ereas of health benefit plans. * The role of value-based care.
Featured on the Show: * Collective Health * Fixing The Broken Triangle
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The post Ep #203: Fixing The Broken Triangle – With Eric Parmenter (Part 1) appeared first on ShiftShapers Online.
Sally-Ann Polson, President of MedWatch, started her career with a focus on “case management and utilization management”. Over the years, that field has evolved and expanded to include a wide variety of disciplines that help members and plans alike. Sally-Ann sorts it all out and discusses her view of what the future looks like.
What You’ll Learn From this Episode: * How the “rear view mirror” vantage point is moving toward looking out the windshield. * What “population health” is all about and why it matters * Why the evolution of this field seems to have taken longer than logic might suggest. * What can be done with understanding underlying disease states * The role of predictive modeling * Why biometrics matter
Featured on the Show: * MedWatch
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The post Ep #202: The Evolution of Case Management – With Sally-Ann Polson appeared first on ShiftShapers Online.
Can any business – ours included – continue without attracting younger practitioners? The good news is that there is a small wave of Generations X, Y and Z taking an interest in the insurance industry. But they are attracted and retained for very different reasons than their parents. Steven Griswold has first-hand knowledge as the head of a multi-generational firm dating back to 1948.
What You’ll Learn From this Episode: * The very unusual path Steve’s father took to starting their agency * How Steve joined the agency and what he learned from that journey * How a crisis helped to reshape the agency * What it is that attracts younger advisors – especially Millennials – to our business * Why you have to know your mission
Featured on the Show: * Griswold Insurance
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The post Ep #201: How To Attract and Retain Young Advisors – With Steven Griswold appeared first on ShiftShapers Online.
Ten years ago, a number of physician “academies” came together to pioneer the concept of Medical Home. Today, that concept is more widely known as Direct Primary Care (DPC). Today, interest in DPC and the practice model itself is rapidly evolving. Our guest, Jon Hernandez is the CEO at PeakMed Direct Primary Care in Colorado, and he is one of the drivers who are pushing DPC into its next evolution.
In this fast-paced interview we discuss different models of DPC and how the next version of DPC has been reverse engineered to include as many different lines of service as possible under a simple, affordable monthly pricing structure. As ever-growing personal responsibility amounts have caused some Americans to become “functionally uninsured”, interest in DPC is growing. Learn what’s new today and what is coming soon!
What You’ll Learn From this Episode: * What are the different traditional DPC models? * What are the strengths/weaknesses of those models? * How are new approaches being developed? * How is technology helping * What needs to happen to make this practice model more attractive to employers?
Featured on the Show: * PeakMed.com
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The post Ep #200: The Evolution of Direct Primary Care – With Jon Hernandez appeared first on ShiftShapers Online.
Mike Dendy is CEO and Founder at Advanced Medical Pricing Solutions (AMPS) and a student of the irrational pricing and misaligned incentives that drive today’s US healthcare system. We begin our conversation by discussing the widely-held myth of the PPO discount. From there we explore the general pricing methodologies and incentives in healthcare.
Once you wrap your head around all of that, the discussion of how often claims are incorrectly priced and what can be done about it will bring us to a conversation around a concept known as Direct Contracting. We will also find out why Mike thinks that healthcare is like the OPEC oil cartel.
What You’ll Learn From this Episode: * What is the myth of the network discount? * Why does that matter to patients and payers alike? * Will networks be eliminated or replaced with personal networks? * How accurate are most claims? * What is Dzdirect contractingdz and what problems can it solve?
Featured on the Show: * Advanced Pricing
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The post Ep #199: Why US Healthcare Is Like OPEC And Why Networks May Disappear – with Mike Dendy appeared first on ShiftShapers Online.
Our guest on this episode, Mark Seghers, Chief Sales Officer at Healthio, helps individuals, their families and their providers to fill in the blanks during the 5000 hours they spend away from their doctors. For the last several years we have been talking about how The Internet of Things (IOT) will change medical care – and today that conversation is becoming real.
Aging Baby Boomers who insist on remaining at home even while they manage chronic conditions, combined with a shortage of 90,000 physicians is combining to drive technology to fill the gaps. Learn about the latest and greatest on this episode.
What You’ll Learn From this Episode: * What is the need? * Which populations are the target? * Is compliance better? * What information is captured? * How, and to whom, is the information sent or shared?
Featured on the Show: * Healthio
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The post Ep #198: Technology Puts Healthcare In Patient’s Hands And Creates Community – with Mark Seghers appeared first on ShiftShapers Online.
Dr. Marc Grossman, Founder and CEO at PriceMDs, has a unique 30-year perspective on the industry, having spent time as a surgeon, an administrator and a hospital owner. Over that time he has developed a keen sense of the chaotic and often adversarial pricing system that is prevalent in today’s medical and insurance industries.
He believes that “Episode Of Care” pricing for non-emergency procedures can help all constituencies operate in a more intelligent, effective and efficient manner, while driving significant cost savings without sacrificing quality of care or outcomes.
What You’ll Learn From this Episode: * How did the current state of pricing become so chaotic? * What is “Episode of care” pricing * Is it important for patients to know the costs up front (spoiler alert: the answer is not) what you may think). * How do you drive understanding, employee engagement and employer take up? * Can offshore medical facilities also play a role?
Featured on the Show: * Price MDS
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The post Ep #197: Episode Of Care Pricing Eliminates Surprises And Saves Money – With Dr. Marc Grossman appeared first on ShiftShapers Online.
Bob Gearhart Sr. and Bob Gearhart Jr. – known simply as “Senior” and “Junior” (or “The Bobs”) to their clients and friends – have found the formula for a highly successful multi-generational agency. Combining a depth of knowledge and an application of technology, they have built a next-generation agency that keeps it simple.
They believe that as the industry has become more complex, clients really want simple explanations and clear pathways to their goals. They have taken another leap and put their fees at risk, which they feel puts them on the same side of the table as the client. Learn how they do it on this episode of ShiftShapers.
What You’ll Learn From this Episode: * How do you handle the complexities of today’s market? * What is health care chain management? * How can advisors reframe correctly who is driving costs? * What are the four strategic areas they focus on?
Featured on the Show: * DCW Insurance
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The post Ep #196: Old School + New School = Unbeatable Combination – With the Gearharts appeared first on ShiftShapers Online.
Many of us make personal resolutions at the new year, but corporate resolutions can be an even more powerful way of keeping your eye on the big picture during the coming business year. Amy Evans, President of Colibri Insurance writes annual resolutions for her firm, but she goes a step further – she publishes them!
We caught up with Amy to discuss her feeling that this is a key part of her agency’s success. We explore last year’s list and the impact it had on her practice and we chat about this year’s resolutions, too. It isn’t too late for you to make your firm’s resolutions for the New Year. Listen in and learn from Amy.
What You’ll Learn From this Episode: * What’s the difference between a goal and a resolution? * How many resolutions make sense and when are you going overboard? * How you can keep the resolutions list high-level, but practical * How to assess your business’ success during and at the end of the year
Featured on the Show: * Colibri Insurance Services
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The post Ep #195: Corporate New Year’s Resolutions Focus On The Big Picture – with Amy Evans appeared first on ShiftShapers Online.