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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This week’s episode features a conversation with Ronny Leber, International Keynote Speaker and Tony Robbins Trainer. Virtual events used to be the medium of last resort but the pandemic provides opportunities that highlight its strengths rather than its weaknesses.

From expanding your reach to a vastly wider audience to using video messaging as a means of communication, video puts you right in front of the people you want to be speaking to. Ronny also explains that your body, focus, and words should all be geared towards your client to achieve peak performance exactly when it counts.

What You’ll Learn From This Episode:

  • 02:08 Tapping into the power of virtual events
  • 04:51 Virtual events have unprecedented reach vs in-person events
  • 09:22 Using video to set yourself apart in sales
  • 14:41 Achieving peak performance when it counts

Quotes:

03:35 “You can basically reach the whole world at much cheaper costs and also, you can create new client groups that were not available before. There are some magical things happening out there.”

13:21 “It’s also about, for example, creating experiences like sending video messages. There’s so few people right now out there doing that but this is a great way also that you can separate yourself from the rest.”

17:13 “You really need to have an external focus. You need to be fully there at your client because let’s be honest, how many of us in everyday life, you are with somebody and suddenly you’re drifting off in your mind?”

18:20 “The words that you’re using. The content. What comes out of your mouth, but not just what comes out of your mouth, also what are you saying to yourself? Because words have the ability to create biochemical reactions in our body.”

20:06 “Really make a plan. What are the outcomes that you want to achieve this week? How is it going to relate with what you ultimately want to achieve? And give it some time and schedule time for your private life.”

References

Ronny Leber’s website

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This week’s episode features a conversation with Rob Tull, Success Coach at Path2 Coaching. Achieving traditional success is often assumed to produce happiness. However, when emotional needs take a backseat in pursuit of this goal, it produces a toxic environment that can leave you feeling stuck.

“Structured stuckness” is designed to leave you feeling this way because of society’s absolute focus on outcomes. The key to getting unstuck is prioritizing your emotional benefits to avoid the long-term regret that comes with traditional models of success.

What You’ll Learn From This Episode:

  • 01:56 The road to Path2: Getting unstuck and finding happiness
  • 06:49 Work-life balance vs prioritizing emotional needs
  • 09:41 The myth of success = happiness causes long-term regret
  • 12:40 Work from home is a fully-integrated environment
  • 16:15 Recognizing and overcoming “structured stuckness”

Quotes:

05:28 “Is the problem me or is the problem my path? And that’s what I realized is it wasn’t me, it wasn’t the choices I made. It was the path I was on and that causal and sequential structure I was looking at.”

08:26 “I can’t control the objective goals in front of me. I can put my best effort forward but I can’t control the outcome of it, so why hang emotional needs on the outcome?”

14:15 “The thing to really survive this environment where we are fully integrating work and life is we can no longer view them as separate spheres.”

14:36 “The way to maintain sanity is to say, okay, where am I going to put boundaries up? And it’s not just boundaries of how am I going to divide work and life, it’s how am I going to prioritize work and life?”

19:13 “When I think about a way to get unstuck or to disconnect from that, the first thing I ask myself is, why is this goal important to me?”

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This week’s episode features a conversation with Linda Czuper, Children’s Life Coach at Adventures in Wisdom. WFH is causing stress and fear in kids. Linda gives tips for parents to be present in their children’s lives because the face that parents show kids sets the tone for a good day.

Parents can empower their children to create their own stories in today’s environment and should watch out for negative self-talk, a red flag that highlights the fears that their children may have. Linda also provides actionable tips on how parents can become better teachers, a role they may not have been prepared for pre-pandemic.

What You’ll Learn From This Episode:

  • 02:18 Dragon thoughts and grungies: What are they and why don’t we like them?
  • 04:22 WFH parents: Being consciously present for kids
  • 08:21 Giving kids the power to control their stories
  • 13:30 Warning signs in kids that parents should be aware of
  • 16:45 How parents can become better teachers

Quotes:

06:02 “Everyone is looking through life through really a lot of their subconscious, which is 80% of their thinking. So that 20% of the conscious thought, that is what we really need to be present on.”

06:21 “A lot of our fear comes from our subconscious. We’re worrying about the future based on how we perceive things in the past. And what we’re missing is that middle, the present. So when your child is in the room, put on a smile. Take a deep breath.”

07:58 “If you’re putting on those ‘Power Goggles’ in the morning and you’re looking in the mirror and you’re saying, good morning sunshine and you’re visualizing the positives of your day, that is going to go through to your children.”

14:38 “It’s really, really important to listen to your children and really, that self-talk, if they’re playing, they’re playing with dolls, if they’re playing with other children, how are they showing up?”

17:54 “They really can’t just read a passage and get what a parent would get out of it. You do have to take some time and go through the stuff and have it come alive a little bit.”

References:

Adventures in Wisdom website

Contact Linda at [email protected] or [email protected]

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This week’s episode features a conversation with Bill Stratton, Founder of the Entrepreneurial Leadership Associates, LLC. There are six key components that result in entrepreneurial success: Vision, People, Data, Issues, Process, Traction. Bill also introduces the concept of LMA (Leadership + Management = Accountability) and how this even guides better hiring practices to reach company goals.

What You’ll Learn From This Episode:

  • 03:42 #1 Vision: Using the Vision Traction Organizer
  • 05:53 #2 People: Find the right ones and the right fit
  • 06:57 #3 Data: Implementing the Entrepreneurial Operating System (EOS)
  • 11:35 #4 Issues: Using the Identify, Discuss, Solve (IDS) process
  • 14:18 #5 Process: Doing key processes optimally for consistency and scale
  • 15:35 #6 Traction: Taking your vision and executing on it
  • 16:27 LMA: Leadership + Management = Accountability

Quotes:

08:22 “Vision in that everyone, starting with the leadership team, knows where you’re going and how you’re going to get there. Traction in that they’re working with a hundred discipline and accountability in every single part of the vision. And healthy in that they’re working as a healthy and cohesive team.”

16:43 “Leadership is about working on the business, providing clear direction, creating an opening, and thinking.”

16:51 “Management is about working in the business, setting clear expectations, having two-way clear communications with your direct reports, and doing more executing.”

17:09 “If people are afraid of accountability, maybe they shouldn’t be on the team. The people who love EOS are people who love being held accountable.”

References:

Traction: Get a Grip on Your Business Book by Gino Wickman

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This week’s episode features a conversation with Patrick Schwerdtfeger, Business Futurist, Keynote Speaker, and Author of “Pandemic, Inc.: 8 Trends Driving Business Growth and Success in the New Economy.” The key message to business can be summed in the acronym SALVAGED. Smart businesses can keep pace with the rapid changes of today by adapting to these observations and employing systems to future-proof their operations.

What You’ll Learn From This Episode:

  • 03:20 Self-sufficiency: Catering to the customer desire to become self-sufficient
  • 07:06 Analytics: Using data to optimize your marketing messages
  • 11:37 Liquidity: Becoming particular about how to spend cash right now
  • 14:24 Virtualization: Predicting the propagation of augmented reality
  • 17:17 Automation: Integrating robotics into everyday life
  • 18:37 Decentralization: Using the open-source model

Quotes:

06:02 “This trend towards self-sufficiency and making decisions on their own, that’s going to continue long into the future. So anything we can do to get in front that is going to help us position for tomorrow’s success.”

10:20 “There’s really three pillars to technology. There’s data processing, data bandwidth, and data storage. And the price of all three of those is going down and down and down.”

10:41 “Businesses are able to collect data for cheaper so they can do it on more things. They can process it quicker and they can move it through bandwidth from one place to another quicker.”

12:39 “The number one consideration is, does this add to liquidity or does it detract from liquidity? And if it detracts from liquidity, how quickly do we get to a break-even scenario?”

19:49 “The open-source movement is a great model to follow because open-source software development is a decentralized software development compared to traditional development and that model can be overlaid into things like blockchain.”

References:

Get a copy of the “Pandemic, Inc.: 8 Trends Driving Business Growth and Success in the New Economy” book by Patrick Schwerdtfeger by clicking this link.

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This week’s episode features a conversation with Jordan Hersh, Vice President, Enterprise Solutions at Vālenz. Renegotiating out-of-network claims can provide cost savings to members. On the plans side, Jordan also explains how offering discounts can help ensure timely payments. If insurers communicate the benefits of staying in-network and offering incentives, this can avoid confusion with the EOB and arm members with the knowledge of how post-claims adjudication works.

What You’ll Learn From This Episode:

  • 02:01 Reference-based pricing: Finding the right fit for self-funded plans
  • 04:26 Defining narrow networks and high-performance networks
  • 08:31 Saving money: Renegotiating out-of-network claims and offering discounts
  • 13:42 Communicating costs to members and incentivizing in-network claims
  • 15:44 Transparency in out-of-network claims
  • 18:42 How much savings can a self-funded plan expect?

Quotes:

05:10 “Readmission rates, complication rates, mortality rates, we’re taking that into account and making sure that when people do people stay in-network or go to the panel of those high-performance network partners, they’re getting top tier coverage.”

08:46 “Depending on the primary PPO network regardless of broad network or network of concise nature, there’s going to be out-of-network medical claims. And that can cost self-funded plans a lot of money if it’s not managed correctly.”

09:45 “Some plans we’ve seen pay out-of-network claims at full bill charges, some take a usual customary approach. Having a much more direct and aggressive approach can really be a game-changer for self-funded plans and materially impact the bottom line.”

10:38 “So being able to achieve a discount, that can also assure them that they’re going to be paid and have a little bit more clarity on how the member responsibly can be split up. Oftentimes we see self-funded plans offering some type of incentive.”

19:22 “So a plan with a medical spend with a million dollars, implementing these types of tools into the right education training to the members, could reduce their overall medical spend by about 25%.”

References:

Download a copy of the “Nationwide Evaluation of Health Care Prices Paid by Private Health Plans: Findings from Round 3 of an Employer-Led Transparency Initiative” by clicking this link.

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This week’s episode features a conversation with Tom Loarie, CEO at BryoLogyx, Inc. and Host at The Mentors Radio Show. Mentoring benefits people of all backgrounds and professions and Tom shares his process of coaching that lets people flourish into their highest levels. Trust is the basis of a mentoring relationship and Tom always begins by asking what is it that you really want to do? Whose story are you really living? And if you pursue what you really like and be the best at it, you will always be successful.

What You’ll Learn From This Episode:

  • 01:56 Tom’s professional background
  • 05:37 Mentoring and bringing out the best in people
  • 10:35 The integration of managing, coaching, and mentoring people
  • 13:12 Starting to mentor
  • 17:37 Whose story are you living?
  • 18:46 The best of advice that Tom got

Quotes:

09:21 “If you’re not a coach, you can’t be a manager. And coaching is all about mentoring and growing people. And one of the great rewards for me personally is to see people that I’ve worked with and coached and mentored go off into great things.”

11:46 “As a manager and coach and mentor for those people, it’s a daily event. And you want to be coaching them all the time when they’re doing good and when they need some improvement.”

13:56 “The next part is to really understand where they want to go and what they want to do and when they get up in the morning, what is it that they want to be thinking about, not what they are thinking about but what does a good day feel like and look like.”

14:26 “The individual that you’re working with has to be able to trust you to share everything that they need to share. And you have to be able to trust them as well or you’re not going to have that solid relationship.”

19:04 “Find something you really like and just be the best at it. And he said, you’ll always put a roof over your head and your family’s head, you’ll always be able to put food on the table.”

References:

“The Power of Story” Book by Dr. Jim Loehr – https://www.amazon.com/Power-Story-Change-Destiny-Business/dp/0743294688

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This week’s episode features a conversation with Deb Rubin, Certified Life and Success Coach at Deb Rubin Coaching. Oftentimes successful people base their success on the standards of others while disregarding their own personal happiness and values. Deb teaches her clients how to recognize their limiting beliefs and introduces S.M.A.R.T. goals which stand for Specific, Measurable, Achievable, Relevant, and Time and how this can bring real joy into lives that have become lost in life’s treadmill.

What You’ll Learn From This Episode:

  • 02:00 What version of success are you working on?
  • 05:48 Defining limiting beliefs and its effect on you
  • 10:15 Visualization and overcoming limiting beliefs
  • 15:36 S.M.A.R.T. goals: A strategy to achieve what you truly want
  • 19:27 Using a to-do list effectively

Quotes:

05:39 “Our minds are brilliant, brilliant creations but they’re also the source of a lot of struggle and personal pain.”

09:02 “The mind does things like that to us. So a limiting belief, for example, is one way our minds actually hold us back from achieving what we want most in life.”

14:55 “They’re chasing this goal that doesn’t really align with who they are and what matters to them. And once they bring that into alignment, they take the time to bring it into alignment, life becomes fun again.”

15:57 “S.M.A.R.T. Goals is a process to allow you to achieve your goal. Any goal that you have that you can’t utilize the S.M.A.R.T. process for is a goal that most likely you won’t achieve.”

21:20 “When you put something on your list, you want to determine how important it is. Is it a real goal? Can you create a S.M.A.R.T. element around it? Are you passionate about it? Will it make a difference in your life?”

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This week’s episode features a conversation with Craig Clemente, President & Chief Operating Officer at Specialty Care Management. Specialty care is both a claims exposure and a clinical component and Craig details how plans need to focus on both. He also explains the nuances of the plan document language and the need to have member champions to spread awareness. Finally, Craig discusses the steps plans can take to bring down the extreme costs of specialty drugs and air ambulances.

What You’ll Learn From This Episode:

  • 01:45 Specialty care defined: When do they get involved?
  • 06:36 Explaining the language of the plan document
  • 08:19 Involving patient members and educating about specialty care
  • 14:34 Managing the costs of specialty drugs and air ambulances
  • 18:42 The future of specialty care

Quotes:

06:54 “It is really important that we look at this not as a diagnosis in that you cannot be discriminatory in any way in your plan document, whether that’s for again dialysis or anything else.”

13:28 “Ultimately, I think one other key component is you always try to find that individual within the member population that’s going to be your kind of vocal champion, your internal supporter.”

16:48 “Average cost of an air ambulance ride is about $49,000 and many times, it’s much much higher than that. And there’s no real regulation in this space.”

18:24 “We’re seeing that we’re upwards of 70 to 80 percent off total bill charges in those scenarios even with companies that have never traditionally given anything over and above 30 percent historically.”

19:12 “The overarching theme here is risk management and understanding that risk management works well beyond a single BUCA entity, for example, where you’re just putting one solution in place to manage everything.”

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