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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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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