The topic of this week’s episode is employee benefit plans relative to abortion services in light of the US Supreme Court’s recent decision in the Dobbs v. Jackson Women’s Health Organization case.

In this episode, Jessica Waltman, Vice President of Compliance at MZQ Consulting, LLC, a concierge compliance firm, discusses the crucial employer considerations for providing abortion benefits to employees. She also stresses the importance of understanding state laws.

What You’ll Learn From This Episode:

  • 1:21. Jessica’s role and the services offered by MZQ Consulting.
  • 4:06 Access to abortion services in relation to employee benefit plans.
  • 14:57 Important factors to take into account when determining whether to cover abortion benefits.
  • 17:15 The significance of knowing which states protect abortion and which don’t.

Quotes:

16:15 “So I would look at who you have, where you are, what the likelihood you have of employees that need to benefit.”

17:01 “Everybody needs to make their own choice. I would say it’s a lot trickier than you think. I would not just go out whole-hog and issue a personal statement, or promise things to employees until you evaluate the situation thoroughly.”

19:03 “Unfortunately, the provider also has to weigh their risk, and some medical systems are delaying care or choosing different options of care to protect themselves, and it could put the employee benefit plan with exposure issues. This is where I think a lot of litigation is going to come into play because there are laws that conflict with one another.”

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This week’s episode is about the drive to change the way businesses acquire and access healthcare for their employees. Daniel Corliss talks about the difficulties associated with receiving medical care under an insurance policy and how DC Advisory is resolving these issues.

What You’ll Learn From This Episode:

  • 1:33 The difficulties in obtaining healthcare through insurance policies.
  • 3:44 DC Advisory’s client acquisition methods.
  • 8:07 Three ways they get compensated for their services.
  • 11:17 Creating and modifying health-care plans to meet the needs of both employers and employees.
  • 13:30 Starting the discussion with brokers and TPAs about self-funding.
  • 16:30 Using data analytics to make informed long-term planning decisions.
  • 18:36 Boosting health-care consumerism.

Quotes:

12:20 “There is no one size fits all in self-funding, at least I don’t think there is. I think everything should be built from soup to nuts and from scratch for each client.”

13:03 “We have great technology today that allows us to do things more streamlined and efficiently, but guys, we’ve got to get back to doing the work. That’s the only way that we’re going to change this industry, change how we access health care, and change the way that we’re building these health plans for our clients.”

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This week’s episode focuses on transforming pharmacies into investment centers, as Chris Antypas, Director of Pharmacy Solutions at Henderson Brothers Inc., shares his direct patient-care experience and pharmacy expertise, as well as how he is assisting employers in navigating the challenging pharmacy landscape.

What You’ll Learn From This Episode:

  • 1:11 Chris Antypas’ strong commitment to community pharmacy and direct patient care.
  • 3:23 The lack of accountability for the outcome side of the equation in the healthcare ecosystem.
  • 5:32 Misaligned incentives between drugs, patients, employers, and plans.
  • 11:40 How they, at Henderson Brothers, are making the shift and the important role pharmacists play.
  • 15:27 Leveraging data to drive health care innovation.
  • 18:20 Competing with mail-order pharmacies.

Quotes:

4:32 “If we stop our efforts on pharmacy just to make sure we got a good deal, we’re ignoring the most important part of the equation, which comes down to whether or not those medications are actually working.”

5:02 “We’re exposing ourselves to risks in this investment [medications] with an expectation and a hope that a disease is going to improve as a result of it. And I really think, in our entire health care ecosystem, we’re lacking accountability to that outcome side of the equation.”

9:53 “Fundamentally, everybody else just wants utilization, utilization, utilization, but when you pause and look at CMS, they are very aggressively moving towards value-based care. They’re aggressively holding medical providers accountable to A1C and blood pressure. And I think it’s high time for employers to take a similar posture. And as a broker, we have the opportunity to help facilitate that with vendors, essentially, get creative in how we advise, and most importantly, give opportunities to vendors in the marketplace that are actually doing this because, to an extent, it’s happening, it’s just the exception rather than the norm.”

18:59 “Some patients need a pharmacy, and other patients need a pharmacist.”

21:06 “Arguably, there’s been no greater source of pharmacy waste than mail-order pharmacies, yet we continue to incentivize it.”

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The focus of this week’s episode is the pharmaceutical supply chain as TrueScripts founder Nathan Gabhart discusses the role of Pharmacy Benefit Managers in drug spending, in particular how they make money, and how employers can guard against irrational expenditures.

What You’ll Learn From This Episode:

  • 1:48 Nathan’s background, passion for pharmacy, and desire to help others.
  • 2:59 Defining “fiduciary” and the problems associated with it.
  • 4:01 How the pharmaceutical supply chain work.
  • 7:04 What happens if PBMs are taken out of the supply chain.
  • 11:35 The pharmaceutical industry’s complexity and confusion.
  • 17:26 What can you do as an employer to safeguard your plan from fraud and extravagant spending?
  • 19:25 How medical professionals pick the drugs they give their patients.

Quotes:

3:28 “What I think a fiduciary is, is that you cannot make decisions based off your own financial well-being but it’s got to be the financial well-being of the consumer.”

3:39 “The problem is, is in the pharmacy space PBMs, which are pharmacy benefit managers, they sit in the middle of virtually every transaction of every prescription that gets filled, a PBM is involved with 90 plus percent of all those, and PBMs are not considered fiduciary agents. So ultimately, that’s where the problem lies.”

6:50 “From my experience, as a retail pharmacist, if a drug is not covered, the member typically doesn’t just pull out their wallet and pay $500 or $600, they have us call the prescriber and ask what is covered.”

7:27 “I am traditionally an anti-PBM. PBMs have caused a lot of harm to the profession of pharmacy, they really have and they cause a lot of harm to employers. However, if we remove that entire system, from our industry, our industry would collapse in my opinion.”

12:22 “Particularly in the PBM industry, our industry defies the laws of mathematics. And what I mean by that is that a higher discount does not necessarily mean that your net cost is going to be lower.”

17:36 “Follow the money. Anyone you have working around the table on your behalf, ask them how are they generating their revenue, every penny that’s generated off your account, you need to know that.”

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This week’s episode sheds some light on the significance of health insurance literacy as Holly Monger, president of HSM Computing, discusses claim ploys and how she is helping people who need assistance with organizing, tracking, and appealing claims.

What You’ll Learn From This Episode:

  • 1:50 Holly’s transition from nursing to health insurance.
  • 4:55 Typical problems brought on by healthcare illiteracy.
  • 8:08 Why has healthcare education improved so little?
  • 13:30 The assistance she provides to those who require assistance with claims.
  • 17:19 Assistance with long-term care claims.
  • 18:56 Why would she choose to be an employee for life?

Quotes:

7:05 “It’s all about terminology and knowing what questions to ask, and that’s the most frustrating for most everyday people — they’ll call up and say, “I don’t understand why am I doing this.” And that person at the facility isn’t explaining it at a level that they can understand. So that’s where I come in and try and help them out.”

11:37 “First, you have to get the people to want to learn about their health insurance. Most of them don’t.”

12:12 “The danger is that insurance carriers want to do it themselves so they don’t have to pay agents. But when this poor person gets it that way and they try and ask questions, they aren’t talking to anybody that makes any sense. They don’t understand that there is nobody educating them.”

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This week’s episode of the podcast centers around helpful technologies for advisors, as Nick Lozano, co-founder of Janitor Media and director of technology for the CIB talks about how the pandemic has changed the tech world and job market for technology professionals and how even non-tech savvy people can get started with technology.

What You’ll Learn From This Episode:

  • 3:59 Most helpful kinds of technology for agencies and advisors. 
  • 6:28 The labor market changes and how it affects the technology space. 
  • 8:32 How productive remote workers have proven to be.
  • 12:20 Evolving technologies to be on the lookout for.
  • 16:58 Getting started with the technology you have. 
  • 20:40 Where Nick sees the tech world going in the near future.

Quotes:

5:31 “I’ve seen people make huge investments into cloud technologies. Right? They’re leveraging as a service.”

6:59 “Right now, from a labor perspective, as a technology professional, it is really an employee’s market. The employees are setting the terms.”

17:58 “Just start with what you have and graduate as you go. Get the things you need when you need them.” 

20:22 Craft your message first, then worry about the technology to get it out to the world. If your message is good, it doesn’t matter. But, you’ve got to start with that message.”

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Has COVID changed the way we think about live events? How are we supposed to network and market ourselves without face-to-face interaction? This week’s episode dives into successful networking and how it’s the key to your success with the author of Knockout Networking For Financial Advisors And Other Sales Professionals, Michael Goldberg.

What You’ll Learn From This Episode:

  • 3:57 Michael’s definition of networking and why he believes it’s the key to success.
  • 6:10 The networking mindset and how it helps you build and grow.
  • 8:40 Who you should network with for success.
  • 12:51 When to self-promote during a networking conversation.
  • 13:48 Best practices for following up after networking.
  • 17:03 The PEECE concept for networking.
  •  20:43 The importance of listening in networking.

Quotes:

4:28 “I look at it as just learning and helping. It’s a proactive approach, although it can be reactive.”

5:10 “I can connect every single client that I have to date to somebody that I know or knew. I would say just about every one of them has been through referral and a relationship that I have.”

6:16 “For networking to take, you got to give.”

7:21 “Your mindset drives everything. So, if you have a mindset towards a certain disposition, you’re going to have a skill set towards that certain disposition, and then action is going to result.”

11:39 “It’s about the connection. And it’s really about connecting with your ‘one-thirder’ audience.”

 

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This week’s episode focuses on leadership development and continuous improvement as Daniel Matthews, a change leadership expert and author of The Language of Leadership: Nicer Bark, No Bite, elaborates on finding your leadership WHY and building a trusting relationship.

What You’ll Learn From This Episode:

  • 1:35 How a high school dropout got into training and developed his leadership skills.
  • 3:41 How to find your leadership WHY and why it is important.
  • 8:10 Ways leaders create a trusting relationship.
  • 11:07 A childhood experience that taught him how to be considerate of others.
  • 1:42 How to create a culture of accountability.
  • 18:18 The importance of developing an attitude of gratitude.

Quotes:

5:04 “When we take on the role of leadership, we are not just taking on the tasks and responsibilities of the leader. At some point, we’re really impacting the lives of those people we lead and the families they support.”

7:02 “Leadership is all about relationships.”

7:32 “This is what a true leader is; it’s somebody who can get people to do what they want when they want, how they want because they want to. And the only way to do that is if you’ve developed strong working relationships with the people you work with.”

9:41 “The conversation should never constantly revolve around you and what you’re doing and what you think and your family and everything else. It’s about getting to know those people, and once you get to know somebody, you become closer to them. And I’m not saying that you’re going to be like friends where you go out and have a beer every night, but there’s certainly a friendly aspect to that development of trust.”

19:21 “If you want to be able to show gratitude for somebody’s work, you’ve got to be able to do it in ways that are more than just patting them on the back or saying thank you.”

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In this week’s episode, we discuss what other things physicians are doing outside of traditional medicine. Shad Faraz, a Harvard Business School graduate and co-host of the podcast Physicians Off The Beaten Path, discusses how these new perspectives are helping to bridge the gap in the healthcare system in general.

What You’ll Learn From This Episode:

  • 1:50 Shad’s background, as well as his interest in healthcare innovation, policy, and investing.
  • 5:14 What is it like to be a doctor in the 21st century?
  • 9:09 Other things doctors are doing, and how different perspectives can help improve the healthcare system in general.
  • 13:01 The issue with today’s medical curriculum and why Shad believes it should be revamped.
  • 15:13 What is Prescription Digital Therapeutics, why is it important, and what are the barriers?

Quotes:

6:36 “Nowadays, people think about, you know, innovating in the way that they actually deliver care to their patients, or figuring out how big pharma or biotech can be made more sustainable for patients with an eye towards the lower cost of care for patients.”

8:47 “To summarize, almost anything and everything is possible for doctors nowadays, and more and more doctors, I think, are stepping up to the challenge, but there is still an information gap in information asymmetry for some docs, and that’s ultimately why I think your show, my show, and things like that are incredibly beneficial for clinicians.”

11:26 “I think everyone is just blinded by their own incentives and everyone thinks that they’re doing the right thing. They just can’t see the bigger picture, and I think the only way to get beyond that is to just bring all these different people into one room, learn the same language, develop some shared understanding of what’s going on, and move forward.”

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This week’s episode is about a new technology platform that aims to boost the primary care provider and patient relationship, as Ankit Patel, co-founder, and President of Pearl Health, discusses the implications of not having a primary care relationship on both the employee and administrative sides, and most importantly, how they are attempting to solve these issues.

What You’ll Learn From This Episode:

  • 1:40 The impact of not having a primary care relationship on both the employee and claims.
  • 3:29 What distinguishes this new approach from the HMO of the 1990s.
  • 7:09 The Direct Contracting Program versus CMS.
  • 9:52 How they can help to strengthen the primary care provider-patient relationship.

Quotes:

4:01 “I think the thing that is different this time is that we now have the technology infrastructure and the data to ensure that capitation is coming with accountability.”

6:34 “I think when we talk about access to patient care, what I believe has happened over the last 10 years is we have rightly moved the industry towards value, but we have done it in a way that has not really promoted access to patient care.”

10:07 “I think what this really ultimately comes down to is trying to find a way to help solidify the primary care and patient relationship as that patient is navigating and going through the rest of the healthcare system.”

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