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

The current health care environment is complicated, convoluted and fraught with misaligned incentives, care decisions that focus on a single price point and doesn’t help consumers plan based on a desired final outcome. Scott Schoenvogel, CEO at Compass Professional Health Services, believes that healthcare navigation programs that account for benefits, consumer decision making and clinical decision points is the way through.

What You’ll Learn From this Episode:

  • How we got into such a confusing mess of a system.
  • What kind of help consumers really need.
  • How to help employees understand the often-inverse relationship between cost and quality in healthcare.
  • Why bundled pricing coupled with appropriate advisement helps employees and plans.
  • How and why patients need to take control of their care.

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

We have been talking about consumers in healthcare since the turn of the century, but real health care consumers – in the true sense of the word – are still apparently hanging out at the unicorn farm somewhere far away. Eric Haberichter, Co-founder at Access Healthnet knows why – and is working hard at creating a consumer environment in health care that approximates our consumer engagements in every other industry.

What You’ll Learn From this Episode:

  • Why we must stop focusing on network discounts.
  • Why is the typical shopping experience still opaque in healthcare?
  • How we create a more normal market.
  • The three immutable characteristics that must be present.
  • How to move beyond surgical and include diagnostic and therapeutic.

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

Not too many years ago, the role of a TPA was fairly straightforward: Pay claims, handle eligibility and make a network connection. In today’s fast-paced and rapidly growing self-funding world, a TPA has to be flexible, nimble and multi-faceted. Jeff Bernhard, President of Continental Benefits, represents a TPA built for today’s commerce. We talk about what to look for in a TPA relationship and how your TPA is now an integral part of the client experience.

What You’ll Learn From this Episode:

  • How Jeff’s carrier background informed his choices when building his TPA.
  • New ways TPAs can help clients reduce medical and pharma spend.
  • Population health matters more now than ever.
  • Why your TPA’s strategic partnerships may matter more than the network.
  • Changes in PBMs and DPC are integral to a successful TPA relationship.

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

Travel for treatment used to be an esoteric benefit reserved for only the largest of employers. Today, the benefits are as much quality as cost driven and most often involve fully-accredited facilities. Some even use U.S. physicians and are attached to teaching hospitals. Yet for many employers and employees it still remains mysterious.

Jim Polsfut, CEO and Chairman of North American Specialty Hospital, helps us to understand the changes and how to help clients embrace a benefit that is advantageous to both employer and employee.

What You’ll Learn From this Episode:

  • What problems can travel for treatment overcome?
  • Why it has taken so long to catch on with average employers.
  • How quality now drives the decision.
  • New patient-centric features.
  • Should plans rewrite SPDs to require travel for treatment?

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

According to our guest, Erica Kiefer, VP of Sales and Marketing for AgencyBloc and a tech veteran in a number of sectors, we often neglect to investigate some critical questions when choosing software. In addition to looking at the user interface or the sheer functionality of any tool, Erica cues us in on the questions behind the questions that will ensure we end up with the right tools.

What You’ll Learn From this Episode:

  • Why tech we purchase often creates more confusion than it resolves.
  • Are demographic shifts changing advisors’ expectations and vendors’ offerings?
  • How can buyers get beyond the product when evaluating choices?
  • The critical importance of owner engagement.
  • How does your choice of tech inform your brand integrity?

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

Musculoskeletal  claims  represent  16-22%  of  medical  spend  in  most  plans.  Yet  with  a  misdiagnosis  rate  of  nearly  40%  and  with  new  evaluative  and  treatment  regimens,  plans  can  save  as  much  as  25-35%  of  that  spend.

Chad  Gray,  CEO  at  Integrated  Musculoskeletal  Care)  has  been  tracking  this  trend  and  is  one  of  the  foremost  experts  on  how  plans  can  provide  better  quality  care  while  lowering  costs  in  this  space.

What You’ll Learn From this Episode:

  • How big is this spend?
  • What Chad’s background is and how it informs decision making.
  • Where the breakdown begins.
  • How analysis deals with the variability of these claims.
  • What the “grand rounds” methodology is.

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

Jessica Waltman is principal at Forward Health Consulting and one of the most in-demand healthcare political and regulatory analysts in the country. She is also a ShiftShapers regular contributor. As we approach the mid-term elections, you may not be hearing much healthcare discussion on the legislative front, but the regulatory environment has been chock full of initiatives, advices and changes.

Jessica joins us to sort it all out and to let us know what we should expect in the coming months.

What You’ll Learn From this Episode:

  • New CMS Guidance on Medicare Advantage Plans.
  • Short-term and AHP rules.
  • What’s happening in Idaho and Iowa and what does it mean for the nation?
  • Will Congress do anything before the end of the year?
  • Should advisors “shelter in place” until next year?

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

David Weingard is an entrepreneur who used his personal experience with diabetes to create Fit4D, a company that helps with both the personal and financial costs of this widespread and growing disease. David believes that even with all of the work that has been done, there is a huge opportunity for improvement.

In the past, addressing this problem has been more art than science. David believes that created a challenge to delivering measurable outcomes – which is precisely the metric plans need. But he is committed to changing that.

What You’ll Learn From this Episode:

  • How large is this population?
  • What are the four biggest diabetes management challenges facing plans?
  • What are some of the new programs, and what differentiates them?
  • What challenges exist for payers to deliver high value, high touch clinical support?
  • Where do we go from here and what does the future look like?

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

Gene Thompson is both a Project Director and Director of Health City Cayman Islands (HCCI), an amazing facility that is delivering higher quality, lower cost care with greater patient satisfaction scores. Pioneered by Dr. Devi Shetti, a physician and health care visionary based in India, HCCI has become a leading model for medical tourism.

With the increased interest in self funding, the cost and quality curtain is being pulled back. Many U.S. companies are offering huge employee incentives in exchange for the quality and lower cost they provide. Gene offers a fascinating insight into this growing trend.

What You’ll Learn From this Episode:

  • How does the vision of how health care is delivered in the west drive HCCI?
  • Who is Dr. Shetti and why is his model driving change in hospital-based care?
  • What pricing methodologies are at work and what savings are there?
  • How is quality measured in these facilities?
  • What is the experience like for an employee who takes advantage of HCCI opportunities in their plan?

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small

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

Data and reporting is playing an ever-more important role in helping advisors and employers manage their health care chain and spend. But our guest on this episode, Phil Litvin, Business Development Manager at First Capitol Consulting, warns that there are some red flags you may not even be aware of when evaluating the reporting you are getting.

Phil discusses the emerging patterns that we can be alert for, as well as the challenges within different industries and different types of accounts – from commercial to Taft-Hartley and more.

What You’ll Learn From this Episode:

  • What is “one-dimensional” reporting?
  • Why is it important to use reporting all year rather than as a one-time, end-of-year solution?
  • How are employers overspending without realizing it?
  • Why are advisors often between a rock and a hard place?
  • Will ACA reporting be commoditized in the future like payroll and tax accounting software?

Featured on the Show:

Listen to the Full Interview:

This Episode is Sponsored by:

Enjoy The Show?

Subscribe-with-iTunes-smallSubscribe-with-Stitcher-smalliHeartRadio-small