This episode of The ShiftShapers Podcast is called “Direct Primary Care In the Employer Market: How To Get There” with John Collier, President and CEO at Proactive MD, a direct primary care (DPC) organization.

John explains the possibilities of DPC that integrates administrative processes, delivers clinically effective healthcare while still remaining financially viable for stakeholders, and promotes patient empowerment through a “patient advocate”.

What You’ll Learn From this Episode:

  • 03:58 How to make DPC widely accepted by employers
  • 07:33 Creating a system that streamlines administrative processes
  • 10:46 Making DPC attractive to physicians & employers alike
  • 16:47 The role of the Patient Advocate to engage & empower

Quotes:

04:59 “Truthfully, while they’re great phenomenal physicians that I’m sure they have incredible clinical outcomes in their DPC practice, they don’t fully understand the business case for what a self-funded employer is facing.”

07:51 “At its core, direct primary care was invented and built to reunite a patient and a physician relationship, in a partnership.”

08:22 “If we’re solely focused on the patient and what is right for that patient, let’s leverage that data to help them take this patient by the hand and walk through the care continuum as primary care was designed to do.”

15:41 “When direct primary care physicians and these groups are working with employers, the care doesn’t stop at that on-site clinic.”

18:15 “The care team would consist, and they would be partners with that physician, is a licensed clinical social worker that’s going to work with the physician to engage a population.”

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This episode of The ShiftShapers Podcast is called “Target and Tame the Drug Spend Monster” with Pramod John, Founder and CEO at VIVIO Health. They discuss the changing nature of specialty drugs as adjuvant therapies and the skyrocketing costs that come with it.

Pramod also discusses the case of Humira biosimilars and AbbVie’s threat to litigate, resulting in it being unavailable in the US. He further explains the broken system that favors big pharma, its detrimental effect on regular citizens, and what we can do about it.

What You’ll Learn From this Episode:

  • 03:31 Growth of specialty drugs & adjuvant therapies
  • 06:16 TNF inhibitors, Humira biosims & AbbVie’s threat to litigate
  • 13:25 Why do Americans pay more for specialty drugs?
  • 19:29 Standing up against unfair pricing

Quotes:

06:08 “If you can put them on adjuvant therapies, whether it extends your life or not and no one’s paying attention, it’s a huge moneymaking machine for pharma.”

07:59 “Humira’s biosim is not available in the US market because AbbVie has threatened to litigate against the 5 manufacturers or 6 manufacturers of biosims.”

16:33 “The government failed because the government has neither price controls to say look, you can’t just charge a bazillion dollars because you want to.”

19:14 “Manufacturers can charge insane prices for a drug that no one else in any part of the world will pay because we’re concentrating more and more dollars from larger and larger number of people into a smaller and smaller number of people.”

21:23 “Until the American people say we’ve had enough to the politicians and everyone else, it’s very difficult to change these things economically because you’re fighting against monopolies.”

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This episode of The ShiftShapers Podcast is called “Creating a Fee-Based Consultancy” with Derek Winn and Jessica Du Bois, Consultant and Employee Benefits Advisor respectively at Business Benefits Group. They talk about the differences of Distilled Concepts from the parent company and how this new division caters to the specific needs of their clients.

Some of their innovations include leading with an RFI before sending a project proposal to fully understand who their client is and what it is they want to achieve, and letting the clients come to them instead of focusing on inbound leads.

What You’ll Learn From this Episode:

  • 05:47 Distinguishing Distilled Concepts from Business Benefits Group
  • 07:28 Letting the clients come to you
  • 13:23 Offering a menu of services & thought leadership
  • 17:31 Providing clients an unforgettable user experience

Quotes:

03:59 “Let’s get to 12, 15, 20% year over year. What are the things that need to happen in order to do that when it comes down to retaining clients, finding new clients, finding new ways to be able to help serve them?”

07:07 “Let’s lead with the distilled, clean, pure ideas, the proven concepts that can help to produce results but also at the same time remain agile in the market.”

12:48 “What else do I need to change in a process of exiting a PEO? If it turns out that leaving the PEO is the best option for that client, then yeah, we’re happy to support them afterwards.”

14:30 “Having an upfront, decided upon fee schedule based on the work you’re providing, that’s one of the big takeaways for other brokers to think about.”

20:40 “As much as we go into those conversations and we’re competing with the large consulting houses, we can also go in and complement them as well.”

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This episode of The ShiftShapers Podcast is called “The $500 Tipping Point” with Amy Chambers, Founder and COO of HealthBridge. Today, David and Amy discuss the complex problem of providing for the healthcare of the functionally uninsured.

Amy explains their program’s benefits to providers such as infusing cash into the system and reducing difficulties in collecting. On the member side, she further shares how this restores their dignity around the issue of money and their faith into value-based care.

What You’ll Learn From this Episode:

  • 01:55 Amy’s background & observations on average American financial capacity
  • 08:52 Designing a program for the functionally uninsured
  • 13:49 Advantages to providers
  • 17:02 Benefits to employee members

Quotes:

04:54 “The average plan out of pocket these days is $8,000 but the average American has about $400 in times of emergency.”

05:42 “64% of people report to have avoided medical care due to these out of pockets. That’s meaningful and it impacts outcomes. It erodes what we’re trying to do in value-based care.”

11:49 “What we’ve created is a first of its kind employee benefit program. It’s going to help the member regardless of their financial status because we talk about a lot of people who are lower income.”

14:23 “We cover all the co-payments, co-insurance, and deductibles for them, all the way up to their out of pocket and beyond if they happen to have any co-pays.”

17:08 “It certainly insulates them against financial crisis. It should arguably improve their access to care. About 25% of those members that you’re sitting knee to knee with in open enrollment actually have no access to credit.”

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This episode of The ShiftShapers Podcast is called “Removing Self-Funding Barriers For Employers and Advisors” with Michael Poelman and Spencer Brydon, President and Regional Vice President of Sales respectively at Novo Benefits.

Today, Michael and Spencer discuss what keeps employers and brokers from going self-funded, as well as what independence and transparency really mean in this space. They also share how brokers can approach stop-loss carriers and reduce complexity moving forward.

What You’ll Learn From this Episode:

  • 01:46 Barriers to becoming self-funded: Perceived risk & complexity
  • 05:49 True independence & transparency
  • 10:26 Pros & cons of different avenues to a self-funded plan
  • 12:27 Talking to a stop-loss carrier & reducing complexity
  • 18:01 The present & future roles of technology

Quotes:

03:14 “Jumping into the TPA realm or vertically and they go to TPA, they tend to see those complexities are worked out because they’ve already prefabbed whatever they’re getting.”

13:48 “A traditional broker might just go out there and market stop-loss but they’re not really again able to get the stop-loss markets to respond with rate discounts that are appropriate for what you’ve put together.”

17:52 “They oftentimes come to us with 1 solution and when they realize that the other solutions might have more to offer, they oftentimes trade up in the sense.”

18:58 “As we start to introduce AI and machine learning into the process, we’re making it much easier to be able to create customized plan stacks that are targeted at a specific population.”

20:19 “If you’re building a plan just based off of a census, you don’t have very much insight, if any at all, into what’s actually going on behind the scenes.”

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This episode of The ShiftShapers Podcast is called “Using Data To Decide When To Go Partially Self Funded” with Hari Sundram, CEO and Founder at Verikai. Today, David and Hari discuss the kinds of data that are used as a surrogate for risk.

Hari explains how brokers can inform their clients on predictive modeling and how having large data sets helps cut through anecdotal biases to provide new premiums and new outcomes.

What You’ll Learn From this Episode:

  • 01:27 The right time to go self-funded
  • 04:32 Data as a surrogate for risk
  • 09:36 Data analysis: How brokers should inform clients
  • 16:14 Predictive modeling: Creating new outcomes with repetitive data

Quotes:

07:45 “Ultimately, the outcome we try to look at is loss ratio applied at an individual level. That’s our goal because ultimately that’s the lynchpin of understanding whether the group has the risk necessary.”

11:19 “When you get back that score, a scenario analysis is laid out for you that says this is a score and this is how it translates into the placement of the business.”

18:24 “The only thing more dangerous than no information is a little bit of information because with a little bit of information, you’re able to apply your bias even more than with no information at all.”

21:30 “The value of predictive modeling is its ability to cut through those things that are anecdotal and find pattern that have occurred historically but have occurred historically repetitively.”

24:41 “If you want to write new premium, you need new information. What you want to do though is make sure that that new information does actually index to the outcome because the outcome is actually consistent.”

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This episode of The ShiftShapers Podcast is called “Help Your Clients Go Back To The Office” with Chris Yarn, CEO of Walk On Clinic. Today, host and Chief Transformation Strategist David Saltzman and Chris discuss how employers can go ahead with testing (or not testing) their employees for COVID.

Chris starts by sharing his experience with helping employers deploy large-scale virus testing and how brokers can recommend these measures. He also explores actual human behavior when it comes to testing positive and its sometimes contradictory nature to EEOC and HIPAA regulations.

What You’ll Learn From this Episode:

  • 05:19 Exploring COVID testing for employers & brokers
  • 10:36 Is there a “definitive” COVID test?
  • 13:35 Human behavior: enforcing EEOC & HIPAA rules
  • 16:30 How to recommend programs to employers
  • 19:11 What is reimbursable to insurance companies?

Quotes:

08:15 “I would advise to consultants and brokers and insurance carrier reps: don’t try and play doctor. Your job is what it always has been and that is help your clients manage risk.”

13:15 “They’re not going to say you’re immune to this thing, but there are hospital systems that are doing blood transfers with people that have had the antibodies and it’s been one of the best clinical treatments for it.”

14:51 “The reality is that patient is on their phone within 10 minutes texting every single one of their coworkers, hey, I tested positive. Make sure you go get a test.”

18:36 “You’re better off contacting biometric screenings companies that have already built processes out and are used to doing large-scale testing.”

21:30 “If you’re an advisor or broker, is your relationship strengthened by providing your clients resources to do return to work testing or COVID or providing them no resource at all?”

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This episode of The ShiftShapers Podcast is called “Disrupting Your Own Disruption” with Eric Silverman, Founder of Voluntary Disruption. Today, host and Chief Transformation Strategist David Saltzman and Eric discuss some major changes to voluntary benefits aka enhanced benefits.

They explore the reasons why enhanced benefits are a practical idea, the improvements in the tech that serves this group, and the strategies to drive engagement among employees and keep benefits attractive.

What You’ll Learn From this Episode:

  • 02:38 Brokers still ignore enhanced benefits
  • 09:52 Introducing technology to streamline access to voluntary benefits
  • 15:09 Secret to engagement: Help people understand their exposures
  • 18:45 The most attractive benefits

Quotes:

07:36 “It’s not exactly the employer that loses as much as it’s the employees. Again, I can’t stress enough, the end-user. Why should an employee be relegated to spend more money for less robust coverage on things that they’re going to buy anyway?”

12:49 “They needed to get into the technological world so we helped streamline and implement our technology completely, again, using that term, the ‘Amazon of Benefits.'”

14:52 “You can still get the participation, engagement, and results even if you don’t have in-person, one-on-one enrollment.”

17:11 “When we implement these things with small to large groups alike, that’s where you truly have the engagement, when they know that you’re only a phone call away, they have a scheduler link.”

19:13 “The most popular plans, still to this day, it happens to be the accident plan, the hospital plan; for any carriers getting really big, medical bridge-type hospital plans, indemnity programs.”

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This episode of The ShiftShapers Podcast is called “The Genomic Revolution – with Darren Rowe”. Today, host and Chief Transformation Strategist David Saltzman and Darren explore the current science of genomics and the potential it holds for precision medicine in the future.

Darren also raises the important social and ethical elements that are inherent with genomics, such as the role of wealth and the possibility of breeding superhumans based solely on their capacity to access this technology. Darren also explains how ROI can be determined in the early stages of genomics today.

What You’ll Learn From this Episode:

  • 04:20 The Genomic Revolution defined
  • 07:55 Applying genomics
  • 11:25 Genetic editing: a social and ethical question
  • 14:29 Precision medicine & insurance companies
  • 19:30 Demonstrating the ROI of genomics

Quotes:

03:26 “What are some things that you might want to think about when you’re purchasing a group plan for your employees? Maybe come up with a top 10 things that people need to recognize.”

08:13 “Anytime you can share a story, you’re touching people. They’re getting to know you better. You’re able to reach out and really say hey, I can identify with you. I get it. I’ve experienced this too. So stories are vital.”

17:47 “You’ll always get business from the audience if you present good content and you do some of the tips I shared earlier. But be negotiable.”

18:02 “Speaking should be used as a paid marketing tool for you to get more clients, for you to get in front of those audiences, to get those private speaking training or speaking gigs as well.”

21:11 “The best way to deal with fear is feel the fear, do it anyway, because you’re up there. You just have to get started.”

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This episode of The ShiftShapers Podcast is called “More Effective and Efficient Prospecting – With Kerry Heaps”. Today, host and Chief Transformation Strategist David Saltzman and Kerry start by discussing public speaking, how it improves prospecting, and how imparting helpful information should be your number 1 priority.

Kerry then explains the importance of body language during public speaking and how strategic use of PowerPoints are not only a requirement by large conferences but also serve as an important teaching tool. Lastly, Kerry also shares her own tips to get over the nerves of speaking in front of a live audience.

What You’ll Learn From this Episode:

  • 01:55 Benefits of public speaking for effective prospecting
  • 05:05 Focus on imparting helpful information
  • 10:51 Making yourself relatable & effective PowerPoint strategies
  • 15:13 How to engage large conferences as a speaker
  • 18:36 Getting over the fear of public speaking

Quotes:

03:26 “What are some things that you might want to think about when you’re purchasing a group plan for your employees? Maybe come up with a top 10 things that people need to recognize.”

08:13 “Anytime you can share a story, you’re touching people. They’re getting to know you better. You’re able to reach out and really say hey, I can identify with you. I get it. I’ve experienced this too. So stories are vital.”

17:47 “You’ll always get business from the audience if you present good content and you do some of the tips I shared earlier. But be negotiable.”

18:02 “Speaking should be used as a paid marketing tool for you to get more clients, for you to get in front of those audiences, to get those private speaking training or speaking gigs as well.”

21:11 “The best way to deal with fear is feel the fear, do it anyway, because you’re up there. You just have to get started.”

 

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