The-Shift-Shapers-Podcast-(Rough-Comp-2)

Sally-Ann Polson, President of MedWatch, started her career with a focus on “case management and utilization management”. Over the years, that field 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 what 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 suggest.
  • What can be done with understanding underlying disease states
  • The role of predictive modeling
  • Why biometrics matter

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Can any business – ours included – continue without attracting younger practitioners? The good news is that there is a small wave of Generations X, Y and Z taking an interest in the insurance industry. But they are attracted and retained for very different reasons than their parents. 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 – to our business
  • Why you have to know your mission

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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 has been reverse engineered to include as many different lines of service as possible under a simple, affordable monthly pricing structure. As ever-growing personal responsibility amounts have caused some Americans to become “functionally uninsured”, interest in DPC is growing. Learn what’s new today and what is coming soon!

What You’ll Learn From this Episode:

  • What are the different traditional DPC models?
  • What are the strengths/weaknesses of those models?
  • How are new approaches being developed?
  • How is technology helping
  • What needs to happen to make this practice model more attractive to employers?

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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 conversation around a concept known as Direct Contracting. We will also find out why Mike thinks that healthcare is like the OPEC oil cartel.

What You’ll Learn From this Episode:

  • What is the myth of the network discount?
  • Why does that matter to patients and payers alike?
  • Will networks be eliminated or replaced with personal networks?
  • How accurate are most claims?
  • What is Dzdirect contractingdz and what problems can it solve?

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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 physicians is combining to drive technology to fill the gaps. Learn about the latest and greatest on this episode.

What You’ll Learn From this Episode:

  •  What is the need?
  • Which populations are the target?
  • Is compliance better?
  • What information is captured?
  • How, and to whom, is the information sent or shared?

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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 driving significant cost savings without sacrificing quality of care or outcomes.

What You’ll Learn From this Episode:

  • How did the current state of pricing become so chaotic?
  • What is “Episode of care” pricing
  • Is it important for patients to know the costs up front (spoiler alert: the answer is not) what you may think).
  • How do you drive understanding, employee engagement and employer take up?
  • Can offshore medical facilities also play a role?

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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 next-generation agency that keeps it simple.

They believe that as the industry has become more complex, clients really want simple explanations and clear pathways to their goals. They 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.

What You’ll Learn From this Episode:

  • How do you handle the complexities of today’s market?
  • What is health care chain management?
  • How can advisors reframe correctly who is driving costs?
  • What are the four strategic areas they focus on?

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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 year’s resolutions, too. It isn’t too late for you to make your firm’s resolutions for the New Year. Listen in and learn from Amy.

What You’ll Learn From this Episode:

  • What’s the difference between a goal and a resolution?
  • How many resolutions make sense and when are you going overboard?
  • How you can keep the resolutions list high-level, but practical
  • How to assess your business’ success during and at the end of the year

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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 of other industries, largely due to a lack of transparency or tangible competition.

Opportunity will grow from greater industry transparency and responsibility, as consumers will save money and maintain better health. We need to look beyond physical health and appreciate mental, spiritual, and financial health as well.

What You’ll Learn From this Episode:

  • The three essential principles of healthcare’s oncoming trend: Transparency, Responsibility, and Opportunity.
  • Why healthcare is the only industry where consumers don’t shop around.
  • What opportunities flow from responsibility and transparency.
  • The difference between wellbeing and wellness.
  • Why there has been an uptick in interest around self-insured plans. 
  • How companies of all shapes and sizes can approach a self-funded health plan, and how an advisor can approach that conversation.

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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 answer to an industry that remains unnecessarily confusing, even for many folks within the industry. The average layman stands no chance in a system created by the rule makers, for the rule makers.

Our guests lay out how the government, Big Pharma, hospital systems, and health insurance companies are incentivized to stop price deflation and maintain complexity.

The second edition is peppered with actual examples of how they have used the principles in the book with their clients – and the success those clients have enjoyed in gaining control over their plans while delivering a climate of health and well-being for their employees.

Mark and Jennifer also outline what has changed since the first time they wrote about consumer-driven healthcare in 2009. The lack of transparency in the market is still an issue, but organizations are starting to deliver tools that aid consumers in making choices.

What You’ll Learn From this Episode:

  • What prompted the first edition back in 2009
  • What has changed since then and why update now amid the unsettled environment
  • Have we made progress in consumerism since 2009
  • What will it take to de-isolate consumers from the cost of care
  • Cost is the third rail. Why won’t politicians deal with it
  • The three principles: Transparency, Responsibility and Opportunity
  • What is the difference between wellness and well-being
  • Do we need to create a higher level member experience
  • Why the uptick in interest about self-insured plans
  • How can small and mid-size firms self fund and how does an advisor begin that conversation

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