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 are being incorporated into health plans. More importantly, many employers and employees are beginning to realize that they are the ones who are really in charge. What You’ll Learn From this Episode...
Jul 09, 2018•23 min
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, she has started one of the few intern and mentorship programs in the business. Now, she wants to scale it. Coupled with her involvemen...
Jul 02, 2018•18 min
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 decision points is the way through. What You’ll Learn From this Episode: How we got into such a confusing m...
Jun 25, 2018•21 min
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 a consumer environment in health care that approximates our consumer engagements in every other industry. What You’ll Learn From this Episode: Why we must stop focusing on network discoun...
Jun 18, 2018•23 min
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 look for in a TPA relationship and how your TPA is now an integral part of the client experience. What You’ll Learn From this Episode: Ho...
Jun 11, 2018•22 min
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, CEO and Chairman of North American Specialty Hospital, helps us to understand the changes and how to help clients embrace a benefit that is advantag...
Jun 04, 2018•20 min
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 behind the questions that will ensure we end up with the right tools. What You’ll Learn From this Episode: Why tech we purchase often creates more confusion than it resolves. Are ...
May 28, 2018•22 min
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 how plans can provide better quality care while lowering costs in this space. What You’ll Learn From this Episode: How big is this spend? What Chad’s background is and how...
May 21, 2018•22 min
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 of initiatives, advices and changes. Jessica joins us to sort it all out and to let us know what we should expect in the coming months. W...
May 14, 2018•22 min
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, addressing this problem has been more art than science. David believes that created a challenge to delivering measurable outcomes – which is precisely the metric plans need. ...
May 07, 2018•21 min
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 increased interest in self funding, the cost and quality curtain is being pulled back. Many U.S. companies are offering huge employee incentives in e...
Apr 30, 2018•20 min
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 are getting. Phil discusses the emerging patterns that we can be alert for, as well as the challenges within different industries and different types of accounts – f...
Apr 23, 2018•21 min
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 that data provides multiple levels of analysis, from focusing on the patient through the other elements and constituencies in the system. David explains why there is a steep lear...
Apr 16, 2018•22 min
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 wellness, as well as productivity, absenteeism and presenteeism. The good news is that as this problem grows, there are employer-based solutions that help both employer and employees and t...
Apr 09, 2018•20 min
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 news is that Brian sees a new model emerging that focuses on delivering value across the entire health care delivery chain. What You’ll Learn From this Episode: What the curren...
Apr 02, 2018•21 min
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 pat...
Mar 26, 2018•23 min
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 app...
Mar 19, 2018•23 min
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 solut...
Mar 12, 2018•21 min
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”...
Mar 05, 2018•21 min
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....
Feb 26, 2018•20 min
Over the years, "case management and utilization management" 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 that 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 s...
Feb 19, 2018•25 min
The good news is that there is a small wave of Generations X, Y and Z taking an interest in the insurance industry. 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 – ...
Feb 12, 2018•19 min
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 ha...
Feb 05, 2018•23 min
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...
Jan 29, 2018•22 min
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 phy...
Jan 22, 2018•21 min
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 dr...
Jan 15, 2018•22 min
Bob Gearhart Sr. and Bob Gearhart Jr. 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. 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 nex...
Jan 08, 2018•23 min
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 ...
Jan 01, 2018•24 min
Mark Gaunya and Jennifer Borislow continue their discussion from last episode about why healthcare is so expensive and share their ideas to slow rising prices. With the release of the second edition of their book Bend the Healthcare Trend , Mark and Jennifer are advocating for consumer-driven healthcare as the solution to rising expenses. In analyzing the healthcare system, inflation greatly outpaces the general economy. Our guests explain why the industry’s prices rise so much faster than those...
Dec 25, 2017•26 min
Nine years ago, Mark Gaunya and Jennifer Borislow wrote “Bend The Healthcare Trend” to explore how healthcare consumers could counteract the damaging effect of a system with misaligned incentives, opaque pricing schemes, and unnecessary complexity. They are about to release the 2nd edition of their definitive book and ShiftShapers talks to them about how much has changed; and how little has changed! The authors believe that what has not changed is that consumerism and transparency are still the ...
Dec 18, 2017•19 min
