Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

In this episode, Michael introduces Marek Ciolko, the CEO of Gravie, a unique health plan that offers employers a shared savings model and employees the opportunity to personalize their insurance to meet their needs. Gravie does this by helping employers control costs while still providing employee-selected coverage and a better experience throughout the process. Marek has a long history of operations management for Deloitte and companies within the healthcare industry. It was on this journey that he realized that there are only so many ways to bend the curve and reduce healthcare costs for everyone with incentives alone. He realized that the core of health insurance needed to be tackled, which is why now, through Gravie, he strives to level the playing field between the group and individual marketplace of health insurance within their platform.  The current state of the world with the COVID-19 outbreak makes it painfully obvious that the consumer is underserved in our current system. Gravie’s mission is

In this episode, Michael introduces Steve Watson, a CFO/CHRO and founder of Trendbreakers, a community of finance, human resources, and benefit advisor professionals that are on a mission to break the trend of rising employee healthcare costs. Trendbreakers helps CFOs, CHRO’s and business owners make the best employee benefit decisions by offering support, education, and consulting.  Steve is a unique guest because he’s on the payor side of business...i.e., he is working for an employer who ultimately pays for healthcare via their insurance. He recognizes that the current healthcare system is lucrative for organizations and certain people, but also sees the problem with employers and families paying heavily for benefits they may not even use. A few years ago, his employer had a million-dollar claim that was going to increase premiums by 30% - and his broker’s commission by 30%, too. Through deeper investigation and learning, he recognized the incentive imbalance and that the system was rigged against emp

In this episode, Michael introduces two partners of ScoutRx, Robert LeCureaux, the VP of Client Development and Amy Bandy, the VP of Operations. ScoutRx helps employer groups and members maintain affordable prescription drug costs through the use of their three core cost containment strategies.  When previously working in the pharmacy and PBM industry in very different roles, Rob and Amy both recognized that it was very profit-driven and not much thought was given to the consumer and the burden of cost. They didn’t like this status quo - and how members had no voice and too many roadblocks - which is what inspired them to team up with other partners to create Scout Rx.   With a lack of marketplace options to address the rising price and utilization of specialty medications, ScoutRx has made it their mission to bring overall costs down and create a better member experience. To date, they have been able to drive an average savings of about 43% for their clients, a sign that they are succeeding in

In this episode, Michael introduces Matt McCambridge, the co-founder, and CEO of Eden Health, a virtual primary care and navigation platform centered around care teams. Eden Health helps employees navigate today’s complicated healthcare landscape across insurance, primary care, and mental healthcare so they can make smart, well-informed and cost-conscious decisions.  Matt had a personal situation that influenced his decision to move out of the venture capital space to launching a start-up in healthcare. When Matt’s sister was sick as a kid, Matt and his family personally witnessed the broken components of the healthcare system. Now, Matt is seeing how the “coordinated care” offered by Eden Health has made a difference in the lives of patients like his sister.    Eden Health is a certified Primary Care Medical Home - the top-of-the-line quality certification in the country for primary care; this model emphasizes team-based care, communication, and coordination, which has been shown to lead

In this episode, Michael introduces Gabriel Mecklenburg, the co-founder and COO of Hinge Health, a musculoskeletal solution for employers and health plans. Hinge Health is pioneering the world's most patient-centered digital hospital, starting with musculoskeletal health. Gabriel brings a unique perspective to the company because of his background in clinical research and because he, too, has been a patient needing this type of care.  When Gabriel sustained a ligament tear practicing Judo while in college, he became exposed to many musculoskeletal treatments. He realized that the whole field was very much “behind the times” - and decided to switch his area of study to pursue a better solution in the industry. Because he felt distant from the patient when doing clinical research, he and his partner decided to do something that could positively impact patients at scale. When they realized there was nothing out there for musculoskeletal health from a digital health perspective, they created Hinge Health.&nb

In this episode, Michael introduces John Powers, the Executive Vice President of Sales and Marketing for Advanced Medical Pricing Solutions (AMPS). AMPS provides market-leading healthcare cost containment services for self-funded employers, public entities, municipalities, labor unions, brokers, consultants, TPAs, payers, reinsurers, and HMOs. John is widely known as one of the most successful fraud investigators in the industry having conducted investigations in all 50 states and over 120 countries internationally.  John dove into the healthcare industry about 12 years ago when he saw problems arising within the system. He found that many people held a misconception about their healthcare plans by thinking their plan covers everything when, in fact, it likely doesn’t. John believes consumerism is the missing link in our healthcare model, and he predicts a future where more employers move to a model of defined benefits. This, he believes, will make the system more equitable and transparent.  Among o

In this episode, Michael introduces Shane Foss, the founder and CEO of Hooray Health. Hooray Health leverages an Urgent Care and Retail Clinic National Provider Network built for Individual and Group limited medical insurance plans. Shane has over twenty years of tenure as an executive in the medical industry and it was through this work that he became frustrated with the healthcare options in America.  When Shane injured his back and needed medical care, he experienced the shortcomings of the healthcare delivery system first-hand when he received a balance bill from an urgent care center. He was able to negotiate down his bill, but the experience left him wondering what other Americans do in similar scenarios. This led to his discovery that many Americans are “functionally uninsured” and there’s no standardization of cost or transparency in the healthcare system.  Shane was thus inspired to create a new platform that filled a gap in the market: affordable basic healthcare. Through this inspiration,

In this episode, Michael introduces Dr. Neil Leibowitz, a psychiatrist, attorney, and the chief medical officer at Talkspace Online Therapy. Talkspace is a technology company whose aim is to expand access to mental healthcare. Dr. Leibowitz has an impressive educational and professional background and spent a good deal of time working with larger healthcare organizations. Through his experience, Dr. Leibowitz ultimately concluded that the smaller companies doing interesting things were the ones that would truly change the game, which is why he was drawn to Talkspace. When it comes to access to care, Dr. Leibowitz made the surprising discovery that even those with insurance struggle to get care when they need it. With high co-pays, deductibles, and luck-of-the-draw when it comes to doctors, inaccessibility does extend even to those with good coverage. What’s more, when it comes to effective therapy, it’s critical to find a therapist who “fits,” as opposed to one randomly selected in the provider network. &nbs

Topics: Specialty Drugs Specialty Pharmacy vs. Retail Pharmacy Pharmacy Benefits Misaligned Incentives Price Transparency  Medication adherence versus compliance Quality of care  Cost Savings In this episode, Michael introduces you to Andy Reeves, the Co-owner and CEO of OptiMed Specialty Pharmacy. Join us as we discuss how OptiMed Specialty Pharmacy is bringing transparency to the market and helping employers circumvent traditional specialty pharmacy distribution channels to lower costs. Here’s a glance at what we discuss in this episode: Andy’s experience as a clinical pharmacist and what motivated him to become an entrepreneur  Key issues that are impacting our health care delivery system and how misaligned incentives are increasing costs   How siloed health care impacts employer and employee costs OptiMed seeks to harmonize health care for the consumer through integrated services to reduce overall costs  How a specialty pharmacy differs from a retail pharmacy  The difference between med

Topics: Misaligned incentives Fraud, Waste, and Abuse Health Insurance Consumer spend Medicare National Provider Identifier In this episode, Michael introduces you to Marshall Allen, an Investigative Journalist at ProPublica. Join us as we discuss how Marshall pierces the healthcare facade by investigating and reporting on stories that highlight the dysfunctional elements of the healthcare system that negatively impact consumers and patients, including his most recent article, “Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You”.  Here’s a glance at what we discuss in this episode: ProPublica focuses on investigative journalism that is in the public’s interest related to the abuse of power across industries  What inspired Marshall to become an investigative healthcare journalist and the types of stories he focuses on How fraud, waste, and abuse impacts all consumers of healthcare  How a personal trainer without a medical license was able to obtain multiple National Provi

Topics: Pharmacy Benefit Manager (PBM) Misaligned Incentives Price Transparency  Efficacy versus Effectiveness Consumerism Specialty Drugs Drug Waste Drug Manufacturer Rebate Steerage   In this episode, Michael introduces you to Mort Jorgensen, the Co-founder, and CEO of Rx’n Go, Paul Ford, the Founder of OrchestraRx and Pramod John, the CEO of VIVIO Health. Join our round table as we dive into the current state of the Pharmacy Marketplace and ideas to challenge the inefficiencies and problems in traditional Rx purchasing.  Here’s a glance at what we discuss in this episode: The table’s opinion about the current mergers of the largest PBMs with insurance companies and how this could impact the marketplace The complexities and challenges with the current pharmacy purchasing structure  How payors have zero visibility into the pricing for Generics, Brand and Specialty Drugs How current benefit design is a part of the transparency problem  The Pareto Principle, how it relates to drug spend

Topics: Healthcare Financial Wellness Navigation Quality Transparency Steerage  Narrow Network Smart Match Health Savings Account   In this episode, Michael introduces you to David Vivero, the Co-founder and CEO of Amino Health. Join us as we learn about Amino Health, a health care financial wellness platform that integrates with an employer’s existing health care benefits to enable employees to find, book and pay for high-quality care.  Here’s a glance at what we discuss in this episode: How David Vivero’s diverse experience in real estate, venture capitalism and working with disruptive startups led him to launch Amino Health How David’s own health care experience inspired him to change the status quo by providing transparency, empathy, and convenience in health care Why price transparency alone isn’t enough to fix our broken health care system  The definition of health care financial wellness and why it is important  One of the biggest financial strains on individuals is their health

Topics: Healthcare Literacy  Wellness Gamification Content Tool Employee Engagement Behavior Change   In this episode, Michael introduces you to Al Lewis, the CEO of Quizzify. Join us as we learn about Quizzify, a health literacy content tool that leverages gamification and comedy to educate individuals and drive savings and well being through increased awareness. Here’s a glance at what we discuss in this episode: How Al Lewis’s diverse experience in consulting, leadership and authorship lead him to launch Quizzify  The employer’s key role in the quality of care and cost containment of healthcare expenses  How Quizzify works and is different from every other wellness program out there The definition of health literacy and the economic impact of low health literacy  The differences between health literacy and traditional wellness How Quizzify aligns incentives with clients by offering an engagement guarantee  Quizzify is the only vendor that partners with Harvard Health and Medical S

Topics: Healthcare Finance Healthcare Literacy Misaligned Incentives Corruption Supplier Induced Demand Forced Competition Consumer Education Change Management Steerage   In this episode, Michael introduces you to Dr. Eric Bricker, an internal medicine physician, and former Co-Founder and Chief Medical Officer of Compass Professional Health Services. Join us as we learn more about Dr. Bricker’s new venture, AHealthcareZ, a healthcare finance video blog designed to educate on all things healthcare and create a more educated payor community.   Here’s a glance at what we discuss in this episode: Dr. Bricker’s clinical, business and leadership experience and why he founded AHealthcareZ How Dr. Bricker identified an opportunity to educate healthcare stakeholders and consumers about healthcare fundamentals   Why Dr. Bricker chose video as the medium to provide education on an array of topics to create a healthcare knowledge foundation for his audience The types of topics that Dr.

Topics: Opioid Crisis Pain Killers Mental Health Addiction Chronic Pain Treatment Facilities In this episode, Michael introduces you to Tim Ryan, the Founder of a Man in Recovery Foundation. Join us as we learn more about how opioid addiction impacted Tim’s personal life and how he is striving to help others’ suffering from addiction and bring awareness of the opioid epidemic. Here’s a glance at what we discuss in this episode: Tim’s story as a successful consultant, entrepreneur and his journey from heroin addict to convict to becoming the founder of A Man in Recovery Foundation The types of drugs that fall under the umbrella of opioids Why 90% of individuals who are addicted to opioids will either succumb to an overdose or will be incarcerated   How 75% of addiction begins with prescriptions and overprescribing from providers How insurance coverage plays in role in inadequate options for treatment of addiction How a lack of treatment facilities and short duration of treatment via insur

Topics: Medical Captives Stop loss Risk Taking, Risk Sharing, Risk Shifting Data Analytics Transparency Cost Control Direct Provider Network Funding Strategies Cost Containment Strategies   In this episode, Michael introduces you to Michael Schroeder, the President of Roundstone Insurance. Join us as we discuss how Roundstone Insurance provides employers with expertise in the captive marketplace coupled with turnkey insurance management services. Here’s a glance at what we discuss in this episode: Michael’s experience as a practicing attorney, a property and casualty insurance expert and his path to joining Roundstone Insurance and applying the property and casualty captive insurance model to employer health insurance How small employers are impacted the most from healthcare cost inflation How the lack of price and quality transparency in healthcare is one of the key issues in the payment system Why some states such as Montana, North Carolina, and Oregon have stepped away from the tr

Topics: Opioid Crisis Advocacy Pain Management Mental Health Addiction Chronic Pain Stress Management In this episode, Michael introduces you to Harry Nelson, a leading health law expert, and the author of The United States of Opioids: A Prescription for Liberating A Nation in Pain. Join us as we discuss the history of the opioid crisis, the implications of the current epidemic and what role employers can play in being part of the solution. Here’s a glance at what we discuss in this episode: Why Harry was inspired to write The United States of Opioids: A Prescription for Liberating A Nation in Pain The evolution of America’s first opioid crisis in the late 1800s and early 1900s and how the reverberations from the first crisis are evident in the current crisis How the second leg of the Opioid crisis began in the late 70’s and early 80’s How it was only in the early 2000s is when we first began identifying data on overdose, death rates and addiction related to opioids In 2017, there were o

Topics: Telemedicine Virtual Clinic Primary Care Direct Primary Care On-Demand Primary Care Pediatric Care Subscription Impact Entrepreneur Pharmacy Utilization   In this episode, Michael introduces you to Robbie Cape, CEO, and Co-Founder of 98point6. Join us as we discuss how 98point6 is seeking to tackle the primary care crisis by removing barriers and offering a people friendly and cost-effective platform to increase access to primary care. Here’s a glance at what we discuss in this episode: Robbie’s extensive experience in consumer technology businesses and products and what led him to co-found 98point6 The current state of primary care and the challenges providers experience within the traditional environment By 2020 there will be a shortage of 20,000 primary care physicians in the United States How a genuine relationship with a primary care provider can lower the incidence of premature death and provide a lifetime savings of 33% per individual healthcare cost Why some healthca

Topics: Onboarding Platform Comprehensive Digital Platform Benefits Administration Care Navigation Innovative Marketing Self-funded Plans Medical Loss Ratio Third Party Administrator   Reference Based Pricing   In this episode, Michael introduces you to Nancy Reardon, Chief Product and Strategy Officer of Maestro Health. Join us as we discuss Maestro Health’s comprehensive platform to make employee health and benefits people friendly and cost effective. Here’s a glance at what we discuss in this episode: Nancy’s extensive leadership experience in health insurance and what led her to join Maestro Health How a lack of transparency and misaligned incentives in healthcare has led to skyrocketing employer costs and HR administrative burdens, year after year Why the medical loss ratio (MLR) has created misaligned incentives and why insurance companies are not motivated to reduce costs How Maestro Health provides a single comprehensive platform designed to simplify health benefits and inclu

Topics: Women’s Health Pediatric Health Digital Clinic Platform Family Planning Fertility Maternity Return To Work Telehealth Consumer Experience Point Solutions   In this episode, Michael introduces you to Katherine Ryder, Founder and CEO of Maven Clinic. Join us as we discuss how Maven Clinic simplifies and modernizes the maternity and family planning healthcare experience for women and families. Here’s a glance at what we discuss in this episode: Kate’s unique background in business and financial journalism and what lead her to found Maven Clinic Why there is need to empower women’s health and recognize their consumer spend Reasons why 43% of new mothers are dropping out of the workforce even though 75% did not intend to leave How Maven simplifies and modernizes the maternity and family planning healthcare experience for women and families Maven is a digital clinic that provides a holistic experience with high touch and on demand information via mobile app with access to physi