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

Colin Quinn, President of Included Health Communities, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how Included Health offers tailored care navigation and advocacy solutions to employers and health plans to support their diverse employees and members. Included Health’s aim is to create equity in healthcare, with their first solution creating ways to help support the LGBTQ+ community. As President, Colin strives to raise the standard of healthcare for everyone, no matter what group you belong to or what industry you work in.  Colin Quinn received an MBA from Stanford University’s Graduate School of Business and went on to work in the finance and sales side of the pharmaceutical industry prior to launching Included Health. In 2021, Included Health was acquired by Grand Rounds and Doctor on Demand which has created a robust navigation and advocacy platform to support Employers in raising the bar in their recruitment and retention efforts.  Here’s a glance at what y

Denise Shiffman, Founder and CEO of GroupWell, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how their data-driven, online group therapy platform is providing employers with a ground-breaking way to approach mental health. Group Therapy combines the treatment of both mental health and social health to reduce clinical symptoms. GroupWell leverages technology to provide a platform where clinician-led group therapy can be accessed for specific groups of individuals dealing with similar issues and challenges. In addition, GroupWell provides wellness affinity groups led by certified behavioral coaches that can help people with sub-clinical levels of stress and anxiety as well as nutrition, weight loss, parenting, and other topics to support people’s emotional well-being.  Denise Shiffman held multiple executive roles at tech start-ups and at multi-billion-dollar tech and healthcare companies prior to starting GroupWell. This previous experience has helped her buil

Veeneta Lakhani, the Chief Growth Officer for Vida Health joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how Vida Health is providing care for over 2 Million people through their digital platform that aims to treat both physical and mental illnesses in a combined effort.  Vida Health is a modular platform that aims to prevent, manage and even reverse chronic conditions by bringing together mental and physical healthcare through a ground-breaking digital platform that connects patients to therapists and coaches. Vida Health’s clinical outcomes have led them to receive some of the highest customer satisfaction scores that we’ve seen on this podcast.  Veeneta joined Vida Health to ensure her work in the healthcare industry leads to a future of care where people are looked after day to day through combining physical and mental health work to achieve sustainable outcomes. Veeneta previously held multiple senior executive positions at Anthem Blue Cross and began her care

Wally Gomaa, CEO and Co-Founder of SimplePay Health, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how they’re empowering employees with high-quality care through easy-to-understand benefit design structures. SimplePay Health aims to disrupt the healthcare industry by making the complicated elements of traditional health plans (deductible, coinsurance, confusing bills) a thing of the past while providing their members with the highest level of care. Based out of Dallas, Texas, SimplePay Health is taking on the status quo to reward employees for making choices that actually help lower overall costs. As a former President of a national insurance carrier, CFO of a healthcare provider and a benefits consultant, Wally has gained unique insight into the healthcare industry and leverages the SimplePay Health platform to address some of the problematic issues within our healthcare delivery and payment system.    Here’s a glance at what you’ll learn from Wally in

Harris Rosen and Ashley Bacot of Rosen Hotels & Resorts join Michael in this episode of the Reconstructing Healthcare podcast to discuss how they’ve saved over $450 million in healthcare costs by implementing their own self-insured healthcare model. Rosen Hotels and Resorts has over 4,500 employees and turns over $350 million in revenue per year through their multiple hotels and resorts throughout Orlando, Florida. Harris and Ashley have created a healthcare model that not only saves the company in healthcare costs, but also provides healthier lifestyles for their employees, as they can choose their health over their wallet via the cost savings. Harris Rosen is the President and COO of Rosen Hotels & Resorts and has not only seen the growth of his hotel business, but through the success of his healthcare program, has created ProvInsure to implement their healthcare model into other companies. Ashley Bacot is the President of ProvInsure and Risk Manager for Rosen Hotels & Resorts. Ashley was integr

Marshall Allen is an investigative journalist that has spent more than fifteen years exposing the ways that the health care industry preys on vulnerable Americans. Marshall currently writes for ProPublica and was part of the team to be a Pulitzer finalist for their work in covering COVID-19. In this episode, Marshall discusses how his time investigating the American healthcare system has led to writing his new book, titled “Never Pay the First Bill: and Other Ways to Fight the Health Care System and Win.” Marshall’s career has seen him honoured with multiple journalism awards, such as the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting and coming in as a finalist for the Pulitzer for his work at the Las Vegas Sun, where he worked before writing at ProPublica in 2011. In this episode, you’ll hear about real-life victories as employers and employees fight the healthcare industry. From dealing with price gouging, errors in billing, fraud and unnecessary treatments, Marshall has seen it

Dave Jacobs and David Greenberg join the podcast to discuss how Homethrive is providing their customers access to their own master’s level social worker and a digital platform to help provide care for their aging loved ones at home. Prior to Homethrive, Dave and David both served at Medline. Dave Jacobs as President of the Durable Medical Equipment division and Medline’s Post-Acute business that encompassed nursing homes, home health, assisted living and managed care insurance. David Greenberg served as Executive Vice President of Strategy and Group President, defining and supporting strategic priorities, leading business development initiatives to strengthen the Medline portfolio, and M&A. In this episode, you’ll hear why Dave and David decided to leave their high paying Senior-Executive roles at well-respected companies to create Homethrive. You’ll hear how Homethrive is helping people look after their aging parents while allowing them to stay in their own homes, instead of an aged care facility. 

In this episode, Michael interviews Nate Murray, the Chief Business Development Officer at Crossover Health. Crossover Health is a national primary care medical group that connects employees with remarkable care options while helping employers take control of their healthcare spend.  In this episode, you’ll hear about some of the deficiencies in primary care today and why many large employers have started to engage in direct contracts with providers to offer improved primary care to their employees. Tune in to hear about the evolution of the Crossover Health primary care model and how they are using a team based approach to deliver extraordinary care for their members. Here’s a glance at what you’ll learn from Nate in this episode:  What the Health 2.0 movement is and where it’s going. Why rushed doctor visits equate to poor healthcare and how this impacts costs How deals with Apple, Facebook and Amazon helped Crossover Health design a primary health model. How Crossover Health creates a relationshi

In this episode, Michael moderates a webinar that highlights an employer who took action to help their employees find higher quality, more cost-effective care. The episode highlights two panelists, one with Christin Deacon, the Assistant Director of the New Jersey State Health Plans, and the second with David Vivero, the Co-Founder and CEO of Amino.  Christin is a healthcare leader and public sector entrepreneur. She is a former deputy attorney general and private sector restructuring attorney, and her unique background allows her to have a different perspective on the status quo in the realm of healthcare. She engaged with Amino to get ahold of out-of-network spend and make an impact on the trajectory of cost in New Jersey, which is $2B on pharmacy and $5B on medical and growing.  When David Vivero spoke with Christin and learned the needs of the state and its members, he learned that staying within the network and better hospital selection were primary concerns. Employers and employees were having

In this episode, Michael interviews Omar Dawood, the Chief Medical Officer and Head of Sales at Calm, the #1 app for sleep, meditation and relaxation. The app has over 100 million downloads and over 1.5M 5-star reviews. Omar is a clinician and stage IV cancer survivor with over 25 years of senior management, medical research and clinical experience, innovating medical devices and digital health products as a senior executive. At Calm, he leads B2B employer and health plan sales and is passionate about helping people around the globe lead healthier, happier lives by building resilience through better sleep and improved mindfulness. While 20% of Americans are dealing with a mental health illness of some sort, Omar believes that we shouldn’t forget about the other 80% of people who experience stress and anxiety without a mental health diagnosis. That’s where Calm comes in to act as a preventative measure to improve behavioral and mental health as well as resilience through mindfulness practices, meditation, and

In this episode, Michael introduces Justin Leader, the CMO of Highlight Health and a self-funded benefits and risk advisor. Early in his career, Justin learned about the major shortcomings of the healthcare and health insurance industry and how it is built for profitability, not value. When he met Josh Spivak, the CEO of Highlight Health, they saw an opportunity to build a better solution for an underserved segment of the population.  Highlight Health’s mission is to deliver affordable and accessible healthcare to the nation’s underinsured populations. Their product is not a health insurance product, but rather a healthcare product where in exchange for a fee, an employer’s underinsured employees get access to healthcare, education, and an advocate. The populations they serve typically don’t work enough hours to qualify for full time benefits, can’t afford their traditional benefits, or may be offered limited MEC or Minimum Value plans that really don’t offer access to comprehensive healthcare. &nbs

In this episode, Michael introduces Doug Aldeen, a healthcare and ERISA attorney. He has represented reference-based pricing organizations, PPO networks, medium to small self-funded plans, TPA’s and provider sponsored HMO’s in various capacities.  Doug started his career at an insurance defense firm, then worked at a local HMO for years. It was there that he learned the ins-and-outs of the healthcare industry and realized that “discounts” aren’t real, but the prevalence and unsustainability of cost-shifting very much are. He found that in many cases there’s no correlation between what hospitals charge and their cost, and “turbo-charging”—where hospitals raise billed charges at unreasonable rates—is common in commercial insurance yet illegal in the Medicare world. Doug has seen “turbo-charging” of 12-24x, and 30x pricing on prescriptions and implants.  Surprisingly, employers are often completely unaware of what’s going on under the hood of their healthcare plan. They’re left in the dark because of l

In this episode, Michael introduces Mike Poelman, the founder and president of Apta Health. Although Mike started his career as an accountant and controller, he quickly realized that he was a salesman at heart so he shifted into the TPA world working on self-funded health plans. This is where he realized that things needed to be done differently. Mike saw that lack of transparency and collusion were the biggest problems in the industry, and legacy solutions simply weren’t designed to provide employers what they needed, which is what inspired him to create a number of companies, including Apta Health. Apta Health aggregates middle market employer groups under one umbrella so they can benefit from care coordination and cost containment solutions that are typically only available to Fortune 500 size companies. This member centric approach allows more effective customer service, higher member engagement by a team of experts/advocates to reduce provider gaps, contain costs, and improve the member journey

In this episode, Michael introduces Dr. Simon Mathews, a distinguished researcher, clinician, author, and Chief Medical Officer at Vivante Health. He is also a practicing gastroenterologist at the John Hopkins School of Medicine and the Head of Clinical Innovation at John Hopkin’s Armstrong Institute of Patient Safety and Quality.  Simon’s research centers around understanding and improving the quality of digital health for patients. Unfortunately, he finds that the key issues in healthcare revolve around inefficiency, fragmentation, and a lack of a team-based approach that is centered around the patient’s best interest. This inspired him to work with Vivante Health, so patients with digestive issues could get the personalized, tech-forward support they need to heal. And with digestive disorders—everything from reflux to IBS to autoimmune disorders—making up a burden of $136 billion dollars on an annual basis, it’s clear that there’s a serious need.  Vivante Health serves the large, underapprec

In this episode, Michael introduces Dawn Cornelis, the co-founder and Chief Transparency Officer of ClaimInformatics. ClaimInformatics is a payment integrity solution that helps its clients identify improper healthcare claim payments and recoup the money for the employer.  When Dawn entered the world of claim processing 30 years ago, it didn’t take long for her to see that money was being wasted on a massive scale via unnecessary procedures, upcoding, bad systems, and egregious contracts. Unfortunately, there’s more abuse now than ever. With 3-7% of healthcare claims being inaccurately paid, it’s grown to be a problem that is worth over a trillion dollars. This inspired her to co-found ClaimInformatics to catch errors, fraud and contain costs for members. She emphasizes that these costs aren’t savings, it’s money that shouldn't have been paid in the first place.  ClaimInformatics has a process where they are able to identify six levels of errors that lead to overpayments, including upcoding, mi

In this episode, Michael introduces Jim Wachtel, the Executive Vice President of Sales and Marketing for Renalogic. Renalogic is dedicated to helping employers manage kidney disease in their employee population and reducing dialysis costs with preventive programs and pricing solutions.  Jim was inspired to enter the healthcare industry because he recognized the cultural issues around healthcare. He wanted to support a company that not only helps make treatment accessible to those who need it but also takes measures to prevent chronic illness in the first place.  With this mission in mind, Jim found Renalogic. Renalogic works to reduce the costs associated with dialysis — a treatment for End-Stage Renal Disease (ESRD) — and offers a Kidney Dialysis Avoidance Program for at-risk members. Kidney disease is known as “the silent killer” for a reason: It is estimated that 40% of people with kidney disease don’t know it. And if it progresses from Stage 5 to ESRD and dialysis begins, treatment is expensive

In this episode, Michael introduces Dr. Cristin Dickerson, a founding partner at Green Imaging, a full-service virtual medical imaging network owned and operated by board-certified radiologists. Dr. Dickerson founded Green Imaging to provide affordable, high-quality medical imaging for uninsured and high-deductible patients across the U.S. While she was working for a radiology group in Houston, she realized that she didn’t have control over many aspects of quality or her hours, and everything in Houston was extremely overpriced for patients. Instead of opening a brick-and-mortar center, she instead found imaging centers that were at 50% capacity and bought their unused time at a discount. These were savings that she could then pass on to the patient.  Green Imaging also reverses the traditional billing model so they’re in control of the finances and eliminate the issues that come from split billing. Although pricing can fluctuate in different geographic markets, they’ve still been able to achieve up to 6

In this episode, Michael introduces A.J. Loiacono, the CEO at Capital Rx, a pharmacy benefit manager seeking to create the first efficient and transparent marketplace for prescription prices and ultimately reduce prescription costs for employer groups.  A.J. has over 20 years of experience in pharmacy benefits, finance, and software development. Although he never thought he’d end up in the same industry as his father, he loved the nature of pharmaceuticals and recognized the inefficiencies within the system. He realized that, although every other industry has changed massively over time, pharmacy benefits have gone largely unchanged for over 20 years.  The problem with the pharmaceutical industry is that buyers (employers) and sellers (pharmacy stores) haven’t been able to communicate freely about pricing. Instead, they communicate through a PBM that inflates and distorts the true cost of the drugs. Capital Rx’s mission is to redefine the way prescriptions are priced and administered in the U.S. so

In this episode, Michael introduces Jason Hellickson, the CEO of Regenexx, a global provider specializing in interventional orthopedics. Regenexx partners with self-funded employers to significantly reduce their orthopedic spending while providing employees a choice in care. Regenexx orthopedic procedures leverage the body's natural healing ability to repair damage to bones, muscles, cartilage, tendons, and ligaments non-surgically and with great outcomes. Jason is a long-time athlete who underwent shoulder surgery in 2008. Although the surgery was deemed “successful”, the fact that it took him 12 months to recover, 12 months to swim again, and lasting pain caused him to question whether there were better alternatives. Years later, when he received the same prognosis on his other shoulder, he insisted on an alternative. With Regenexx he was able to swim again just 6-8 weeks after the procedure. He learned that Regenexx could be offered through a self-funded health plan, so he partnered with them as an affilia

Topics Revenue Cycle Management Rising healthcare costs Bundled Pricing Cost Savings Centers of Excellence Improving 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 the employer’s business. Why the bundle