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

Topics: Sleep Health Management Outcomes Based Treatment Population Sleep Health Solutions Performance Improvement Neuroscience of Sleep Sleep Medicine Insomnia Sleep Apnea In this episode, Michael introduces you to Dr. Jeffrey Durmer, Co-Founder and Chief Medical Officer for FusionHealth. Join us as we discuss how FusionHealth’s practical sleep applications improve the health and well-being of employees and ultimately help employers manage their healthcare costs. Here’s a glance at what we discuss in this episode: Dr. Drumer’s healthcare experience and what lead him to co-found FusionHealth How Dr. Durmer integrated the clinical and science aspects of sleep The most common sleep conditions and how they impact individuals Sleep as a process and why it is fundamental to our overall health How sleep conditions compare to disease and the differences between sleep disorders and sleep problems For every 1,000 individuals in an employer population about 40% have a sleep disorder or issue but

Topics: Type 2 Diabetes Medication Reduction Diabetes Reversal Nutritional Ketosis Clinical Trials Performance-Based Reimbursement Increased access to care Cost Savings In this episode, Michael introduces you to Bill Snyder, Vice President for Enterprise Partnership Health Plans at Virta Health. Join us as we discuss Virta Health’s mission to reverse type 2 diabetes in 100 Million people by 2025 and how they are accomplishing this. Here’s a glance at what we discuss in this episode: Bill’s healthcare leadership experience and what inspired him to become a part of Virta Health The issues our healthcare delivery system faces as it pertains to misaligned incentives and a lack of price and quality transparency How Virta Health is using food as medicine instead of the traditional approach of additional medications Virta’s definition of diabetes reversal is maintaining a sub-diabetic HbA1c below 6.5%, with the elimination of all diabetic medications, except for metformin What nutrition

Topics: Chronic Conditions Consumerism Clinical and Financial Outcomes Data Science Behavior Enablement Smart Coaching Medication Affordability and Optimization In this episode, Michael introduces you to Glen Tullman, Executive Chairman of Livongo. Join us as we discuss how Livongo empowers people with chronic conditions to live better and healthier lives. Here’s a glance at what we discuss in this episode: Glen’s healthcare entrepreneurial experience and what inspired him to launch Livongo Why our healthcare delivery system is broken and how our system makes it harder for people to live and function with chronic disease and illness How the lack of consumer incentives and price and quality information drives inefficient consumer behavior How Livongo empowers people with chronic conditions to live better and healthier lives How Livongo aggregates data, personalizes it and equips the consumer with the best applicable solutions Livongo focuses on the following chronic conditions – dia

Topics: On-Demand Health Insurance Consumerism Clinical Care Paths Aligned Incentives Cost Savings Dynamic Copays Price Transparency In this episode, Michael introduces you to Tony Miller, Co-founder and CEO of Bind On Demand Health Insurance. Join us as we discuss how Bind provides an innovative platform to address some of the deficiencies in traditional insurance products and makes health insurance easy, affordable and flexible for consumers.   Here’s a glance at what we discuss in this episode: Tony’s serial health care entrepreneurial experience and what inspired him to launch Bind Why our healthcare delivery system is broken and value-based reimbursement may not be the solution How Bind arms consumers with the tools they need to make appropriate cost and quality decisions regarding their healthcare. Bind’s unique Core and Buy-Up plan structure How the “smart” copay structure within Bind compares to traditional insurance copay structures and deductibles/co-insurance How Bind incorporat

Topics: Concierge Support Cost Management Price Transparency Network Optimization Medical Bill Review Reference Based Pricing Level Funding Third Party Administrator (TPA) In this episode, Michael introduces you to Keith Lemer, CEO of WellNet Healthcare. Join us as we discuss how WellNet Healthcare provides employers with an entrepreneurial approach to reducing health care costs and a platform to proactively manage their healthcare expense just like any other expense in their business. Here’s a glance at what we discuss in this episode: Keith’s entrepreneurial/healthcare experience and his career evolution that led to WellNet Keith’s take on what is wrong with our healthcare delivery system and why cost continues to rise How WellNet’s provides employers with a “crawl, walk & run” approach to drive the level of cost savings that an employer wants to achieve WellNet’s ability to educate, incentivize and reward employees for accessing lower-cost health care services that provide network

Topics: Misaligned Incentives Engaged Healthcare Consumer Price Transparency Center of Excellence Local Healthcare Tourism Integrative Medicine Cost Savings In this episode, Michael introduces you to Dr. Josh Luke, a veteran hospital CEO and award-winning healthcare futurist, public speaker, and author. Join us as we discuss Dr. Luke’s newest book, Health – Wealth 9 Steps to Financial Recovery where he outlines specific steps employers can take to proactively control their healthcare costs. Here’s a glance at what we discuss in this episode:   Dr. Luke’s unique professional experience and what lead him to a career in healthcare Why Dr. Luke was motivated to author Health – Wealth 9 Steps to Financial Recovery Why the healthcare delivery system is broken and as a result costs continue to rise A high-level overview of the content in Health – Wealth 9 Steps to Financial Recovery Dr. Luke provides examples of how capitalism plays a key role in the bankrupting of our hea

Topics: Hospital Billing Errors Medical Bill Review Reference-based pricing Price Transparency Network Discount Model Chargemaster Balance Billing Cost Savings In this episode, Michael introduces you to Dr. Merrit Quarum,  Founder and CEO of WellRithms Inc. Join us as we discuss how WellRithms endeavors to transform healthcare through Hospital medical bill review and transparent and economically sustainable reimbursement practices. Here’s a glance at what we discuss in this episode: Dr. Quarum’s diverse health care experience and why he founded WellRithms What is wrong with our healthcare delivery system as it pertains to affordability, reimbursement, and lack of price transparency How WellRithms provides an integrated facility medical bill review and establishes a reasonable reimbursement amount for medical services Why detailed facility medical bill reviews may not be happening with traditional TPA’s and networks and they may not be protecting an employer from unreasonable charges Examp

Topics: Mental Health Behavioral Health Access to Care Quality of Care Evidence Based Care Consumer Experience In this episode, Michael introduces you to Sean McBride, Head of Partnerships at Lyra Health. Join us as we discuss how Lyra Health is transforming mental health care by creating a frictionless experience for patients, providers and employers using technology and data to connect companies and employees to high quality mental health providers, coaching and evidence based therapies.   Here’s a glance at what we discuss in this episode: Sean McBride’s digital health background and why he joined Lyra Health as one of their first employees   What is wrong with our healthcare delivery system as it pertains to mental and behavioral health The misconceptions about effective mental health therapy and what evidence based therapy is How credentialing of providers doesn’t necessarily have a relation to quality of care/therapy delivered How Lyra Health is trying to address mental health access

Topics: Specialty Drugs Data Analytics Net Acquisition Cost vs. Discount Pricing Improving Health Outcomes Specialty Drug Waste Prior Authorization Cost Savings Misaligned Incentives In this episode, Michael introduces you to Pramod John, CEO of VIVIO Health. Join us as we discuss how VIVIO Health, a specialty drug platform, utilizes data analytics and outcomes based models to help employers control their specialty drug spend. Here’s a glance at what we discuss in this episode: Pramod John’s software engineering and supply chain background and why he founded VIVIO Health How drugs may be prescribed off-label and physicians prescribing patterns may be influenced by payments from drug manufacturers How misaligned incentives have propelled our healthcare system into a cycle of complacency and how VIVIO Health seeks to break the cycle Why its critical to focus on specialty drugs to contain costs in Rx spending Why the current discount pricing model doesn’t work and leads to higher medical in

Topics: Pharmacy Benefit Manager Self-Funded Health Plan Misaligned Incentives Rebates Formulary Waste Formulary Design Specialty Drugs Clinical Programs Performance Guarantees In this episode, Michael introduces you to Mindi Fynke, President and CEO of Employee Health Insurance Management (EHiM). Join us as we discuss EHiM’s unique service-oriented PBM model and how they can effectively lower an employer-sponsored health plan’s drug spend. Here’s a glance at what we discuss in this episode: Mindi Fynke’s clinical experience and why she founded EHiM   How rebates from drug manufacturers are intended to move market share and the act of taking rebates from drug manufacturers can be a misaligned incentive and contribute to increased healthcare costs How EHiM seek to address pharmacy waste in an employer’s sponsored health plan’s drug spend with custom formulary design and clinical programs for each client’s unique demographics and claims The conflict of interest that may exist when PBM’s own th

Topics: Fraud, Waste and abuse ERISA Fiduciary Liability Third Party Administrator (TPA) Self-Insured Employers Payment Integrity Misaligned Incentives   In this episode, Michael introduces you to Rick Anthony, Executive Vice President for 4C Health Solutions. Join us as we discuss how 4C Health Solutions, a payment integrity solution, seeks to tackle the epidemic of healthcare fraud and waste for self-insured employers and government programs.   Here’s a glance at what we discuss in this episode: Rick’s extensive experience as a benefit consultant and why he joined 4C Health Solutions The problem with the Network Discount Model The definition of fraud, waste and abuse in healthcare and how it accumulates to $300 Billion annually How fraud can consistently go undetected within a health plan How employer Fiduciary Liability is also applicable to employer health plans and the current risks employers may not be aware of How 4C Health Solutions enables employers to uphold their ERI

Topics: Misaligned Incentives Third Party Administrator (TPA) Savings As A Service (SAAS) Platform Provider Reimbursement Open Network vs. Traditional Network Referenced Based Pricing Direct Contracting Consumer Experience Concierge Service Net Promoter Score   In this episode, Michael introduces you to Cheryl Kellond, Co-Founder, and CEO of Apostrophe Health – a third party administrator who aims to provide savings as a core service and make the healthcare benefit actually feel like a benefit again. Join us as we discuss how they endeavor to build the health plan that can fix America.   Here’s a glance at what we discuss in this episode: Cheryl’s unique experience with product development and sales in the technology industry and why she transitioned into healthcare by starting Apostrophe Health How misaligned incentives and lack of cost and quality transparency impacts our healthcare system Why Apostrophe Health defines themselves as a SAAS model with TPA functionalitie

Topics: Misaligned Incentives Traditional Primary Care Virtual Primary Care Telemedicine Consumer Experience Provider-Patient Relationship Employee engagement Downstream Cost Savings   In this episode, Michael introduces you to Dr. Jay Parkinson, Founder and CEO of Sherpaa. Join us as we discuss how Sherpaa, a virtual primary care practice, provides improved primary care access and high-quality care through an innovative digital platform designed to deliver a better experience for both providers and patients. Here’s a glance at what we discuss in this episode: How misaligned incentives, middlemen in the supply chain of healthcare attempting to maximize profit and complexity impacts cost in our healthcare system Dr. Parkinson’s perspective on problems with the traditional primary care model and the “office visit” model How Sherpaa redesigned processes of getting care and communication practices between primary care providers and patients Why a primary care provider would abandon the t

Topics: Misaligned Incentives Price Variation Price Transparency Commodity Care Outpatient Care Employee Incentives Medical Cost Savings In this episode, Michael introduces you to Dr. Bill Hennessey, Founder, and CEO of Pratter, Inc. Join us as we discuss Pratter’s mission to help millions save billions via their medical cost saving and transparency tool that incentivizes employees to access lower cost, high-quality outpatient healthcare. Here’s a glance at what we discuss in this episode: Dr. Hennessey’s clinical and entrepreneurial experience and why he founded Pratter How price variation, misaligned incentives, egregious hospital pricing and lack of transparency has contributed to increasing healthcare costs The price variation that exists in a routine outpatient care setting and why insurance carriers don’t do a better job guiding people to lower cost, higher quality providers How Pratter’s tool identifies lower cost services and facilities in a searchable format within in a given zip c

Topics: Third Party Administrator (TPA) Medical Bill Review Quality and Cost Transparency Value-Based Reimbursement Bundled Payments Misaligned Incentives Consumer Experience Healthcare Navigator   In this episode, Michael introduces you to Jeff Bernhard, President of Continental Benefits. Join us as we discuss how Continental Benefits is working to disrupt the TPA marketplace with a focus on lowering healthcare costs, improving healthcare outcomes and enhancing the consumer experience for large employers across the country. Here’s a glance at what we discuss in this episode: Jeff’s extensive experience working at one of the largest healthcare insurance companies and why he joined Continental Benefits How misaligned incentives, lack of transparency and the status quo has eroded our healthcare system The three key areas of focus for Continental Benefits How Continental Benefits helps employers reduce costs by reviewing all claims over $5,000 for errors which results in 8-10% savings b

Topics: Concierge Medicine Direct Primary Care (DPC) Healthcare Coach and Advocate Consumer Experience Misaligned Incentives Evidence-Based Outcomes Unnecessary Care   In this episode, Michael introduces you to Dr. Alex Lickerman, Founder, and CEO of ImagineMD. Join us as we discuss the state of primary care in the U.S. and how ImagineMD’s Direct Primary Care model is driving higher quality care, improved patient experience and lower healthcare costs relative to traditional primary care practices. Here’s a glance at what we discuss in this episode: How the lack of price transparency, misaligned incentives, and overutilization leads to waste in the healthcare system The current state of primary care and the negative impact it has on patients and providers How the current primary care system is leading to declining primary care providers as medical students opt for more lucrative practices that offer a better quality of life The unique story of how ImagineMD was founded and the unparallel

Topics: Population Health Misaligned Incentives Expert Medical Opinions Treatment Decision Support Evidence-Based Outcomes Concierge Services Health Advocate Consumer experience   In this episode, Michael introduces you to Dr. Gus Crothers, Medical Director of Clinical Personnel of Grand Rounds. Join us as we discuss how Grand Rounds provides employees and their families with expert second opinions and the technology, information and concierge support they need to find the highest quality physicians and most appropriate care for their specific conditions. Here’s a glance at what we discuss in this episode: Dr. Crothers’ medical background, and why he joined Grand Rounds as the Medical Director of Clinical Personnel How misaligned incentives within our health system lead to the treatment of symptoms rather than the root cause of the illness How waste is actually built into the healthcare system and patients are not armed to be good healthcare consumers The unique story of how Grand Ro

Topics: Population Risk Management Digital Health Program Behavior Change Chronic Disease Performance-Based Pricing Evidence-Based Outcomes Health Coaching Aligned Incentives   In this episode, Michael introduces you to Sean Duffy, Co-founder and CEO of Omada Health. Join us as we discuss how Omada Health uses digital behavior science to help employee populations change their habits, improve their health and reduce their risk of chronic disease. Here’s a glance at what we discuss in this episode: Sean’s diverse background, and how he applied those skills to ultimately launch Omada Health The challenges providers face to align contracts with different reimbursement models and how the fragmented payer market impacts this process Omada Health’s digital health program designed to reduce the risk for chronic diseases such as diabetes and heart disease How Omada Health provides access to innovative tools, health coaching, peer support and an educational curriculum to drive behavior change W

Topics: Data Analytics Data Warehouse & Reporting System Healthcare Waste Identifying Inefficiencies Measuring Program Performance Reporting Flexibility Actionable Insights In this episode, Michael introduces you to Grant Gordon, Co-founder, and CEO of Artemis Health. Join us as we discuss how the Artemis Health Data Analytics Platform provides a set of tools that helps employers leverage their data to identify cost savings opportunities and measure results of existing programs.   Here’s a glance at what we discuss in this episode: Grant’s dynamic entrepreneurial background, and why he was drawn to healthcare data analytics and ultimately launched Artemis Health How the lack of good data and systems for data sharing leads to inefficiencies and impacts the cost and coordination of care The difference between a data platform and a traditional data warehouse and a reporting system The difference between the user experience with Artemis Health’s “apps” structure compared to how a use

Topics: Third Party Administrator (TPA) Health Advocacy Health Navigator Open Source Platform Consumer Engagement Aligned Incentives Net Promoter Score In this episode, Michael introduces you to Dr. Andy Halpert, Senior Director of Clinical and Network Solutions at Collective Health. Join us as we discuss Collective Health’s approach to delivering an extraordinary member experience and their ability to connect and administer an entire health benefits ecosystem for a next-generation health plan.   Here’s a glance at what we discuss in this episode: Dr. Halpert’s diverse experience from patient care to benefits consulting and why he decided to work for Collective Health How misaligned incentives, opacity, and complexity have contributed to the healthcare challenges today How a life-threatening health condition and poor experience with health insurance ultimately led to the launch of Collective Health The difference between Collective Health’s open source platform vs. traditional TPAs an