This week’s episode features a conversation with Matt Newman, best-selling author of “Starting at the Finish Line.” Cancer is not a solitary disease and Matt shares his family’s journey with it and how it eventually afflicted him too. Writing was his catharsis and his ability to strengthen others and teach that their conditions do define them became his inspiration for writing his book. Matt teaches that negativity gains you nothing while positivity leads to success.

What You’ll Learn From This Episode:

• 04:30 A family history of cancer leads to Matt’s diagnosis of brain cancer
• 12:18 Lessons from Larry: Finding strength and the fragility of life
• 14:39 Writing as a catharsis and inspiring people on a global scale
• 18:24 Surround yourself with positivity and success follows

Quotes:

06:32 “The reality is people want what they can’t get. They want life insurance after they can’t get it, long-term care after they can’t get it, a financial plan if they lose 30%, and I would preach every day of the necessity of why we need these plans.”

12:24 “I used to believe in irony. I stopped believing in irony. And I understood that he put in that place to teach me how to act, how to have independence, how to have dignity, how to fight, how to be there for family.”

13:39 “One of the greatest lessons in life in the deepest, darkest of times, we’re given this new set of lenses that we look through them, we see life absolutely differently when we’re understanding how fragile things can really be.”

13:53 “Strength is not how big your arms are. Strength is now how much you bench press. Strength is something that’s located deep down in our bellies at those deepest and darkest of times. We can find it. We can grab it. We can own it.”

18:45 “When you surround yourself with negativity, nothing good comes out of it. And you have to learn to live. It’s sometimes not about tomorrow, it’s not about yesterday, it’s about now. It’s about living in the moment and appreciating the now, right now.”

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This week’s episode features a conversation with Sara Hames, Principal at NBS Advisors. Navigating health plans is a complicated process BUT it shouldn’t be. By simplifying the available options and providing a phone number to call, members and employers can make the most informed decisions for them. Also, providing a better healthcare experience involves educating advisors on attractive packages and networks that they can actually offer their clients.

What You’ll Learn From This Episode:

• 02:54 Improving health plan members’ user experience
• 05:27 Simplifying healthcare shopping for more informed decisions
• 11:16 Conversations personalize the healthcare experience
• 13:20 Educating advisors on available plans and networks
• 17:19 Provide an aggregator number and the clients will come

Quotes:

04:23 “There’s a significant disconnect between what employers think their plans do and what they actually do.”

04:56 “To motivate you to be a good consumer, go out and shop for healthcare. But guess what, you can’t in most cases. In most cases, it is impossible to find out the cost of a service before we incur it. So how is a member supposed to shop?”

05:51 “You’ve already learned I’m not the HSA-qualified plans. And if you stay away from those, you can offer free services to members.”

15:45 “That right provider is generally a direct contracted provider and those types of providers are eager to put together bundled pricing for employers who are willing to steer their employees to them for a set price but at no cost to the member.”

18:35 “The other tool that we’re using quite a bit is the Brainshark, which is just a PowerPoint with a voice-over, but we can put it on the Internet, we can put it on YouTube and people can go back to it as often as they want.”

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This week’s episode features a conversation with Dr. Cristin Dickerson, Founding Partner of Green Imaging. There is a stigma that scanners in hospitals are better than freestanding facilities. However, there is no difference in hardware and professional skill in handling these machines. Knowing this can help patients and employers cut their medical spend for these services by two-thirds and enjoy greater satisfaction with their dedicated concierge.

What You’ll Learn From This Episode:

• 03:22 Why doctor’s do NOT refer to freestanding imaging
• 06:06 How Green Imaging saves money and utilizes existing structures
• 08:18 There is no diagnostic advantage of using hospital scanners
• 13:23 Guaranteeing patient satisfaction with lower costs and better service
• 17:58 Future-proofing imaging centers

Quotes:

05:22 “The hospital price of an exam is somewhere, except for the specialty hospitals, is going to be somewhere around $1,300 to $1,600 and we’re about a third of that. And sometimes we’re lower here.”

06:46 “We’re Green for two reasons. We’re green because we save you money and we’re green because we also are using existing brick and mortar, not just adding more brick and mortar to the system.”

08:32 “Typically, the scanners are the same. Maybe the hospitals change them out a little more regularly because they’re incentivized to do so by the vendors, but there is really no diagnostic difference in scanners really within the last 20 years.”

13:06 “If it’s an employer sending the patient our way, there’s an invoicing process. But it’s really a much-simplified process. There’s not a two-day wait for an auth and all the complicating factors that happen when you’re in a hospital.”

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This week’s episode features a conversation with Niko Caparisos, Principal at Prosperity Benefits. Employers struggle with controlling costs and balancing innovation with tried and tested tactics. For a more strategic and less fragmented approach, having buy-in from the c-suite is critical. On the employee side, empowering them with information and initiative can make them use the plan with as little friction as possible.

What You’ll Learn From This Episode:

• 01:49 3 pressing challenges to employers: Cost, Innovation, and Education
• 04:09 C-suite buy-in drives innovation and strategic multi-year planning
• 10:06 Getting light bulb moments on creating cost savings
• 15:19 Educating employees on how to best use their plans

Quotes:

05:53 “Having the c-suite onboard with the idea of making changes is certainly where you have to begin because typically other departments don’t really want to see change and things are working just fine.”

08:32 “Once you shift the mindset of the owners of the company and the financial partners, they think well, it does make more sense to be strategic. Why don’t we see this over two or three years instead? Or longer.”

16:56 “‘Don’t go to the hospital for an MRI, head to a free-standing imaging facility.’ It depends upon, I think, the employers wanting to share that information, but certainly always framing the plan as being better in several ways is useful to the employee.”

18:00 “I have found that the more health plan sponsor can do, and usually health plan sponsors are where it originates, the better.”

19:48 “Call the number, call the number, call the number. You don’t want, at the same time, you’re being unhelpful or disingenuous in your messaging to say hey, call a 1-800 number, but it’s truly the best structure for an employee to get help immediately.”

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This week’s episode features a conversation with Monica Coleman, Chief Energy Officer at Inside Information Coaching and Consulting. Being adaptable means moving forward and embracing the unknown, the realm where every possibility exists. The P.E.A.K. Process (Perform, Evaluate, Adjust, Key In) gives particular emphasis on its Adjust step where Ego can get in the way of reaching your goals.

What You’ll Learn From This Episode:

• 01:49 Adaptability not accomplishment
• 03:50 Adapting with the P.E.A.K. Process: Perform, Evaluate, Adjust, Key In
• 10:06 Managing your ego and creating positive energy flow
• 18:02 The limiting nature of labels

Quotes:

02:56 “If we don’t adapt and you always do what you’ve always done, you’ll always get what you’ve always gotten. And that’s really the truth.”

05:16 “If you’re not adjusting and taking in the data, you’re not going to be able to be better than you are. You’re just going to ingrain what you’ve already done.”

08:49 “Everything that you ever want in life that you don’t really have is out in the unknown. The unknown is your friend. It’s where everything exists. Every possibility.”

14:19 “If you want to create experiences, you’re going to be severely limited when you’re stuck in your ego all the time.”

References:

“It’s Time to Replace Ambition with Adaptation” Article by Rosie Spinks

“The One Thing” Book by Gary Keller

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This week’s episode features a conversation with Ashok Subramanian, Founder and CEO of Centivo. Plans succeed or fail based on the end-user experience they create. By optimizing the primary care-centered models and offering tailor-fit solutions regardless of the network construction, plans can remove the clunkiness of administrative tasks while ultimately providing the care and satisfaction that users are looking for.

What You’ll Learn From This Episode:

• 02:16 User experience: Why traditional plans fall short of modern expectations
• 06:06 Approaches with network construction
• 10:47 Optimizing the tried-and-tested primary care-centered models
• 16:14 Pharmacy affordability: A question of clinical efficacy vs economics
• 19:14 Communicating with employees to drive engagement

Quotes:

03:57 “Folks are starting to get more sensitive to and starting to understand in much more detail that, as good as a thick network of doctors might feel at the time of enrollment, it’s kind of useless if you can’t actually get into that doctor.”

05:00 “A big part of user experience on the health plan side is increasingly becoming less about the payments of claims and the administrative processing, and far more the integration points around the usage of the healthcare system itself.”

07:13 “The most optimized plans are introducing tailored networks, narrow networks, using reference-based pricing, and other types of approaches to be able to get the efficiency and the value.”

15:04 “When you work more closely with partners by not trying to be all things to all people, you can deliver a better user experience by really optimizing on a simple set of things that matter to members.”

19:56 “For too long now, we’ve simply assumed that the buyer is the employer and employees are simply takers of what those employers decide for them.”

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This week’s episode features a conversation with Justin Breen, Founder and CEO of BrEpic. The highest level entrepreneurs all have a common denominator: they put family first, overcome their greatest obstacles, and adopt a mindset that it’s either winning or learning. Failure is not in their vocabulary. When you think about investments and not costs, you eliminate a scarcity mindset and end up working with people who will propel your business to unimaginable heights.

What You’ll Learn From This Episode:

• 01:44 The road to success starts by putting family first
• 05:12 Misery happens when there is inaction to pursue what you actually love
• 07:51 The most successful entrepreneurs have overcome these 4 things
• 13:50 Think about investment, not cost
• 16:44 Raise your rates

Quotes:

02:07 “You just see a problem, create solution to problem, problem solved, successful global company.”

06:26 “A lot of people are miserable in their own lives because they’re doing things 8 to 10 hours a day that they don’t like to do and/or are not at good at them.”

08:04 “Here are the 4 things: 1) bankruptcy or potential bankcruptcy, 2) overwhelming depression, 3) the highest level anxiety you can ever imagine, 4) likely or possible traumatic experiences as a child or young adult.”

09:36 “As an entrepreneur, there’s no failure. It’s you’re winning or learning. You’re either winning or learning.”

16:44 “My business really took off when I quadrupled my rates, quintupled. That’s when it really took off because it eliminated cost scarcity nonsense.”

References

“Epic Business: 30 Secrets to Build Your Business Exponentially and Give You the Freedom to Live the Life You Want!” Book by Justin Breen

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This week’s episode features a conversation with Kari Niblack, CEO at ACS Benefit Services. TPAs now offer novel and customizable plans while still providing traditional services like manual adjudication and appeals. At the same time, TPAs now assist smaller companies who are on level-funded plans to take the leap into partially-self-funded plans. In 2021 and beyond, data and transparency must be used to help clients make more informed decisions on the plans that are right for them.

What You’ll Learn From This Episode:

• 01:44 Manual adjudication safeguards client money
• 06:04 Handling appeals and offering highly customized solutions
• 09:34 Defining and explaining plan documents
• 13:06 Resurgence of level-funded plans
• 16:49 Using data for transparency and improved member plans

Quotes:

03:48 “We consider ourselves to be stewards of their monies and take that very very seriously. So we’re going to put a lot of extra attention and focus on being that that claim has gone through all the appropriate levels of authority before we release those monies.”

04:46 “If you’re having an inpatient surgery, we want to be sure that what we call the CPT code, which is a technical term, but basically have the hospital’s billing procedures, we want to be sure that there’s not what we call unbundling.”

10:30 “[The plan document] basically is the, we call it the 4 corners of the document that basically sets out all of the benefit structures, what’s covered, what’s not covered, definitions of terms, all of those good things.”

14:08 “With a well-designed, level-funded plan, there is the ability to keep reserves versus if they are fully-insured they do not. So that’s a huge change in the industry.”

21:00 “Call our company and say, ‘I want to see this piece of data as raw as you can make that for me or as thorough as you can make it or as transparent as you can make it for me because then we’re going to make x, y, z decisions.”

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This week’s episode features a conversation with Sheri Tetachuck, Senior Vice President of National Sales at Payer Matrix. The costs of specialty drugs increase every year and employers are footing much of the bill. Unfortunately, aggressive lobbying in Congress allows big pharma to dictate arbitrary prices.

But even this bleak outlook has a silver lining. There are strategies that employers can employ to help drive down costs like alternative funding plans. There is a need to raise awareness of these avenues because specialty drug costs are expected to keep rising.

What You’ll Learn From This Episode:

• 01:44 Specialty drugs drive healthcare costs to unprecedented heights
• 04:36 Explaining the arbitrary reasons behind specialty drugs cost
• 08:47 Strategies for employers to cut down costs
• 14:51 Proactive ways patients can also drive down their spend

Quotes:

02:04 “There’s about 2 to 3% of the members on the plan using about 30 to 70% of the pharmaceutical spend. So it’s quite expensive and it’s not getting any better.”

05:36 “When you look at the cost of sales and marketing to the cost of research and development, it’s about 50% more than that they spend on sales and marketing.”

06:28 “These drugs are life-altering, so they’re very much needed. It’s just the expense of these drugs is ridiculous and it’s basically the drug manufacturers profiteering on these ridiculous specialty drugs.”

09:28 “There’s ways to control the cost on both sides, PBM and the TPA, you can do it by plan design, by excluding the specialty drugs and then working directly with a company that can provide alternative funding.”

17:47 “The qualifications to qualify for a patient assistance program is you can’t have coverage for that drug if you want to get into a patient assistance program. So it really has to be led by the plan and plan design and to carve out the specialty drugs.”

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