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

Topics: Consumerism Pharmacy Benefit Manager Transparent Model Misaligned Incentives Reference Based Pricing Rebates Formulary Alignment In this episode, Michael introduces you to Paul Ford, the Founder, and CEO of OrchestraRx. Join us as we discuss OrchestraRx’s consumer-driven pharmacy benefit model and the impact it can have on an employer-sponsored health plan’s drug spend. Here’s a glance at what we discuss in this episode: Paul’s unique experience in healthcare and why he founded OrchestraRx The anti-competitive landscape and lack of transparency that enables healthcare costs to rise How OrchestraRx’s model is different from the traditional pharmacy benefit manager The difference between a Traditional PBM Model and a Transparent PBM Model How OrchestraRx’s consumer-driven pharmacy benefit manager model is trying to address the employer’s total net cost Why incentives in a traditional pharmacy benefit manager contract are misaligned   How a smaller PBM can provide more savings to an

Topics: Healthcare driven Wage Stagnation Overtreatment & Unnecessary Care Healthcare Fraud and Abuse Aligned Incentives ERISA Fiduciary Liability Benefit Consultants Lower Healthcare Costs Opioid Crisis In this episode, Michael introduces you to Dave Chase, the Author, and Co-Founder of the Health Rosetta. Join us as we discuss Dave’s new book and his blueprint for structuring a high-performance employer-sponsored health plan. Here’s a glance at what we discuss in this episode: Dave’s unique experience as an investor, entrepreneur, and author focused on healthcare and why he founded the Health Rosetta ecosystem Why Dave felt compelled to write the book The CEO’s Guide to Restoring the American Dream: How to Deliver World Class Healthcare to Your Employees at Half the Cost and the factors that contribute to higher healthcare cost How much of the care we receive is unnecessary and how misdiagnosis of medical conditions and overtreatment leads to higher costs Health fraud and abuse is

Topics: Meditation Mindfulness Alternative Wellness Program Employee Productivity & Performance   In this episode, Michael introduces you to Stephen Sokoler, the Founder and CEO of Journey Meditation. Join us as we discuss how Journey Meditation offers a powerful wellness tool through simple approachable meditation practices that are taught to employees in a live or virtual setting.   Here’s a glance at what we discuss in this episode: Stephen’s unique business background, and why he launched Journey Meditation Defining mindfulness and meditation and how they are different Understanding how the exercise of meditation can cultivate a state of mindfulness What scientific research says about how meditation positively impacts the mind and body How Journey Meditation seeks to make a positive impact on an employer’s workforce Types of companies that work with Journey Meditation The class structure for Journey Meditation, what resources are included and how employee impact is mea

Topics: Bundled Payments Value-Based Pricing Ambulatory Surgical Centers Price Transparency Employee Steerage Aligned Incentives Concierge Services   In this episode, Michael introduces you to Suzanne Webb, the CEO of Exclusive Surgeries Solutions, LLC. Join us as we discuss how Exclusive Surgeries Solutions offers consumers improved access to quality surgeons and significant cost savings through bundled payments at select ambulatory surgical centers.   Here’s a glance at what we discuss in this episode: Suzanne’s unique experience working for providers and health systems and why she decided to launch Exclusive Surgeries Solutions, LLC How  higher administrative costs are contributing to the increasing unit cost of healthcare How Exclusive Surgeries Solutions increases consumer access to quality surgeons   How Exclusive Surgeries Solutions saves  employers 30-40% compared to network discounts offered by traditional carriers Why decreasing ambiguity in provider compensation and qu

Topics: On-Demand Health Care Concierge Improving the Consumer Experience Healthcare Advocacy Healthcare Navigation Open Source Platform Consumer Engagement & Utilization Aligned Incentives Net Promoter Score In this episode, Michael introduces you to Rajeev Singh, the CEO of Accolade. Join us as we discuss how Accolade’s unique healthcare concierge model and open source platform leads to better employee health care decisions, improved consumer experience and engagement and lower downstream healthcare costs. Here’s a glance at what we discuss in this episode: Rajeev’s unique business experience and why he decided to enter the healthcare industry How aligning consumer incentives can help decrease healthcare cost trend and waste The Accolade intake model and how it is designed to help assist employees in their healthcare journey The difference between the traditional insurance carrier model compared to Accolade’s healthcare concierge model How Accolade’s focus on consumer experience ha

Topics: Video Telemedicine Onsite Health Clinic Population Health Risk Management Consumer engagement Convenience Care Cost Savings Improved Patient Experience Aligned Incentives   In this episode, Michael introduces you to Dr. Glenn Hammack, the founding President of NuPhysicia and its subsidiary Medicine At Work. NuPhysicia is a spinout company from the University of Texas, where Dr. Hammack served as Assistant Vice President for the University of Texas Medical Branch and founding Executive Director of their Electronic Health Network, developing and managing their telemedicine programs. Join us as we discuss how Medicine At Work brings a turnkey onsite health clinic solution to middle market employer groups.   Here’s a glance at what we discuss in this episode: Dr. Hammack’s versatile experience in healthcare and how he launched Medicine At Work How Dr. Hammack leveraged electronic health records and telemedicine in a capitated care environment to improve quality and lower costs

Topics:   Cost and Quality Transparency tool Healthcare Consumer Engagement Network Steerage Consumer Cash Rewards Shared Savings Aligned Incentives Concierge Service In this episode, Michael introduces you to Rob Graybill,  the Vice President of Product and Sales Strategy for Vitals SmartShopper. Join us as we discuss the Vitals SmartShopper product,  an incentive and engagement program designed to empower employees to make more informed and cost effective healthcare decisions.   Here’s a glance at what we discuss in this episode: Rob Graybill’s 15 years of experience in healthcare and his role as one of the creators of the Vitals SmartShopper program How Vitals SmartShopper’s incentive driven healthcare redirection program rewards employees with cash when they shop for and select lower-cost, high-quality facilities for treatments and procedures What services can be “shopped” for in the SmartShopper program How Vitals Smartshopper determines the $$ incentive reward to pay employees wh

Topics:   Pharmacy Care Manager vs. Pharmacy Benefit Manager Misaligned Incentives Formulary and Clinical Program Alignment Rebate Chasing Medication Adherence Cost Savings Concierge Service In this episode, Michael introduces you to Bill Resnick who is the Chairman and CEO of EmpiRx Health, a revolutionary Pharmacy Benefit Management company. Join us as we discuss EmpiRx Health’s unique model of pharmacy care management and its impact on decreased pharmacy utilization, increased cost transparency and ultimately, lower healthcare costs. Here’s a glance at what we discuss in this episode: Bill Resnick’s background and how he went from working for large insurance carriers and PBM’s to launching his own consulting agency and ultimately EmpiRx Health How perverse incentives in the PBM and drug industry drive higher costs Defining transparency in prescription drug pricing and the healthcare industry Understanding the intricate roles of Pharmacy Benefit Managers, Drug Manufacturers, Pharmacies and

Topics:   The Consumer Healthcare Journey Navigating the Complexities of the Healthcare System Care Coordination Consumer Engagement Steerage The Net Promoter Score  Improving the Consumer Experience Healthcare Advocacy Unbundled Approach to Healthcare   In this episode, Michael introduces you to Worth Houghton who is a 25-year veteran of the employee benefits industry and Vice President of Sales for Quantum Health. Join us as we discuss Quantum Health’s unique model of care coordination and it’s impact on higher benefits engagement, better clinical outcomes, and ultimately, lower healthcare costs.   Here’s a glance at what we discuss in this episode: Worth Houghton’s background and how he got into the Healthcare Industry Five components of healthcare that drive complexity Understanding why consumers are not engaging in traditional insurance carrier resources when they should be How Quantum Health is trying to address the problems of low benefits engagement, low clinical engageme

Topics:   Pass Through vs. Traditional PBM Models Price Transparency Consumer Engagement and Steerage Rebate Chasing Formulary Management Misaligned incentives In this episode, Michael introduces you to Gary Hattendorf, Western Regional Sales Vice President, and Byron Mickle, Senior Vice President at Navitus Health Solutions.  Join us as we discuss the differences in PBM models, formulary management and how Navitus helps employers manage pharmacy costs with a low net cost approach. Here’s a glance at what we discuss in this episode: Gary Hattendorf’s background and how he got into the Pharmacy Industry Understanding the different PBM Models Understanding how PBM contract language and definitions can be used to artificially manipulate performance statistics The history of rebates and how “Rebate Chasing” may have an adverse impact on the employer net cost How drug manufacturers may increase their medication price in order to recoup rebates paid to the PBMs How Navitus Health Solutions

Topics:  Evidence-Based Pharmacy Risk Management Misaligned Incentives Specialty Drug Management Rebate Chasing Prior-Authorization Formulary Management Reference based pricing In this episode, Michael introduces you to Tery Baskin, PharmD, Founder & CEO of RxResults.  Join us as we discuss the misaligned incentives that may exist in typical Insurance Carrier and PBM formularies and how proper formulary management can drive significant savings for an employer. Here’s a glance at what we discuss in this episode: Tery Baskin’s background and how he launched RxResults Understanding the left and right side of the Healthcare equation The Rebate “sleight of hand” and Rebate Chasing Pharmacy Benefit Manager Contracts and what to be aware of How Pharmacy Benefit Managers controlling the prior-authorization process for drugs distributed through their own specialty pharmacies may constitute a conflict of interest How drug manufacturers and PBM’s may use the FDA “safe and effective” label to promo

Topics Referenced Based Pricing (RBP) Value based payment Healthcare Claims Costs Cost Savings Network Discounts Risk Management Balanced Billing Plan Document In this episode, Michael introduces you to Ryan Day, President of HST. Join us as we look into HST’s reference-based pricing services and how a bottom-up approach  to provider reimbursement can offer employers more control over their healthcare costs than a traditional insurance network model. Here’s a glance at what you’ll learn in this episode: An introduction to Ryan Day and his unconventional path into Healthcare What a Buyer’s Beware Market is and the results it has traditionally produced Definition of Reference Based Pricing (RBP) How RBP can eliminate the need for a network of providers Who sets the provider reimbursement levels in an RBP plan and common benchmarks How emergency room visits are a handled vs. pre-certified visits to a facility The risk for balance billing and how HST’s Patient Advocacy Center addresses these

Topics Telemedicine Employee Engagement Cost Savings Aligned Incentives Return on Investment Consumer Experience In this episode, Michael introduces you to Dave Guttman, President of First Stop Health (FSH). Join us as we dive into the telemedicine services offered by First Stop Health and how their company is able to generate high rates of utilization and guarantee a positive ROI for an employer. Here’s a glance at what you’ll learn in this episode: An introduction to Dave Guttman and his unconventional path into healthcare Why divorcing any buying decision from the payment accountability is problematic What telemedicine can treat effectively What makes FSH fundamentally different from other Telemedicine vendors What a Telemedicine visit actually saves employer How FSH performs better than an embedded Telemedicine solution How FSH drives extraordinary engagement rates through custom communication strategies How the PEPM cost structure encourages employees to use the Telemedicine service

Topics Healthcare Cost Increases Price transparency tools Healthcare Advocacy and Improved decision making High Deductible Health Plans Healthcare Consumerism Network Steerage Net promoter scores In this episode, Michael introduces you to Dr. Eric Bricker, Chief Medical Officer and Co-Founder of Compass Professional Health Service. Join us as we explore the services offered by Compass and how they strive to make benefits feel beneficial. Here’s a glance at what you’ll learn in this episode: An introduction to Dr. Eric Bricker, and how he launched his ‘atypical’ career Fee for service and third party payments – why the incentives aren’t aligned How Compass acts as a support tool, and offers a high-end benefit experience to employees How Compass can help employers promote all the various ancillary benefits they provide to employees Financial benefits of joining Compass How Compass utilizes consumerism risk assessments to better identify ways to help employees Net promoter scores 

Topics Prescription Drugs Price transparency Price Variation at Pharmacies Consumer Driven Mobile Tools Consumerism Driving Higher Employee Engagement rates Cost Savings   In this episode, Michael introduces you to Bryce Canfield, Vice President of Business Development and Andrew Slutzky, General Manager of GoodRx. Join us as we delve into the services offered by GoodRx and how they can help you save money on your next prescription. Here’s a glance at what you’ll learn in this episode: An introduction to Bryce Canfield, Andrew Slutsky, and how GoodRx got it’s launch Utilizing the Individual Consumer Tool and the savings it offers to consumers How the Employer Tool provides real-time drug pricing and notifies employees of cost saving opportunities they are not taking advantage of How GoodRx leverages relationships with PBMs to offer consumers better prices Challenging  drug price differentials at different pharmacies by enabling price conscious consumers How to build trust  and drive

Topics Revenue Cycle Management Healthcare Payment Models Network Alternatives Cash Pricing Personal Concierge Service Shared Savings Incentives Consumerism In this episode, Michael introduces you to Korb Matosich, Co-Founder and President of Asserta Health. Join us as we examine the services offered by Asserta Health and how they can offer less hassle for providers, lower costs for employers, and give consumers more control. Here’s a glance at what you’ll learn in this episode: An introduction to Korb Matosich and how he found importance in launching Asserta Health Why how we pay for healthcare is the biggest fundamental issue of healthcare Why Networks are one of the leading contributors to exorbitant healthcare costs How the Asserta Health platform enables “cash” payments by health plans and consumers that deliver significant cost savings  How the Asserta Health Personal Concierge makes the process easy for the employee Typical savings on elective procedures through Asserta Health an

Topics Lack of competition in healthcare Prescription Drug Pricing Voluntary Mail Order Solutions Transparent Drug Pricing Aligning Employer & Consumer Incentives In this episode, Michael introduces you to Mike Voegele. Join us as we dive into the services offered by CRX International, an international prescription provider, and how the company is able save employers and their employees money on Brand and Specialty medications. Here’s a glance at what you’ll learn in this episode: Introduction to Mike Voegele Cost drivers behind the US system of pharmaceutical drugs Prescription drug crisis and how CRX International fits in Incentives for employers to participate in the CRX International program Typical  savings on Brand and Specialty medications for the employer How CRX International is able to get better pricing than large PBM’s through international pharmacies in Tier 1 Countries How CRX integrates with PBM Prior Authorization or Step Therapy process Methods for driving employee awar

Topics Diabetes Chronic Disease and Illness Incentives and Engagement Reducing Hospital Admissions and ALOS Cost Savings In this episode, Michael introduces you to Tom Milam, founder and True Life Care (TLC).  Join us as we discuss the impact of diabetes on individuals and healthcare costs and how the TLC program helps employees save money, improve their health and can lower costs to their health plan by thousands of dollars per person per year. Here’s a glance at what you’ll learn in this episode: An introduction to Tom Milam Type 1 and Type 2 Diabetes - causes, impacts and monitoring Healthcare cost for a person with Diabetes vs. person without Diabetes Rate of ER and Hospital admissions within diabetic population Average out-of-pocket spend for individuals with Diabetes Barriers to treatment adherence, behavior change and testing compliance by Diabetic population How the True Life Care provides an incentive for Diabetic population to engage with Health Coaches Expected cost savings w

Topics Lower Healthcare Costs Self-funded Medical Healthcare vs. Health Insurance Improving the Consumer Experience Complexity and Transparency in Healthcare Network Steerage In this episode, Michael introduces you to Dave Berg, co-founder and Chairman of the Board of Redirect Health. Join us as we explore the services offered by Redirect Health and how they’ve turned the traditional health insurance model on its head to successfully lower healthcare costs for their clients. Here’s a glance at what you’ll learn in this episode: An introduction to Dr. Dave Berg How Dave was able to lower his company’s healthcare costs by over 30% over 8 years Why Dave made routine care free for his employees How Redirect Health puts healthcare before insurance with a subscription model The non-transparency and complexity of the healthcare marketplace How Redirect Health implements six steps before insurance is utilized Helping those members with Chronic Disease and Illness How Redirect Health collaborates w

Topics Revenue Cycle Management Rising healthcare costs Bundled Pricing Cost Savings Centers of Excellence Improving the Employee Experience In this episode, Michael introduces you to Sachin ‘Sach’ Jain, CEO of Carrum Health. Join us as we discuss how Carrum Health has created an alternative marketplace for lower cost surgical procedures with a focus on creating an exceptional employee experience. Here’s a glance at what you’ll learn in this episode: Who Sachin Jain is, and how he found his way into the healthcare field. The Healthcare Marketplace – Why supply and demand play such a vital role in costs, and why the healthcare marketplace doesn’t interact or operate like any other marketplace for service and goods in the country. How Carrum Health is working to solve two systemic issues in Healthcare payments today How Carrum Health created a marketplace for select surgical procedures that sits outside of traditional HMO/PPO network to allow providers to compete directly for employer’s busine