The-Shift-Shapers-Podcast-(Rough-Comp-2)

Josh Luke is a man with many vantage points on our health care system: author, public speaker, healthcare futurist, and hospital administrator. He believes that the current healthcare system is irreparable. So, what are his thoughts about how we move forward and craft something that actually works?

What You’ll Learn From this Episode:

  • Why affordability + greed + millennial culture = today’s dysfunctional system.
  • Telehealth as a driver.
  • Lack of transparency in the acute hospital sector.
  • The current system makes no sense – especially to millennials.
  • The four largest lobbying groups don’t want change.

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The-Shift-Shapers-Podcast-(Rough-Comp-2)

David Snow is Chairman and CEO of Cedar Gate Technologies and a self-described “health care junkie” whose career has touched nearly all facets of the health care system. As such, David has a very unique view that informs how he works with and helps companies use data to drive better decision-making.

We discuss the notion that data provides multiple levels of analysis, from focusing on the patient through the other elements and constituencies in the system. David explains why there is a steep learning curve, but how we are getting better at understanding and acting on data in a timely manner that affects care and spend.

What You’ll Learn From this Episode:

  • Is data the piece of the puzzle that helps us make sense of the whole picture?
  • What are the opportunities for plan savings?
  • How is data different than analytics – and why do both matter?
  • Where do actuaries and underwriters fit in the future?
  • Why is there often an inverse relationship between cost and quality in healthcare?

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The-Shift-Shapers-Podcast-(Rough-Comp-2)

In the 40’s we hired hands. In the 80’s we hired hearts and minds. Today we hire every bit of every employee – and that includes issues they deal with in their private lives. Savvy employers understand the drag on productivity that causes, and are providing information to help employees make smarter and more informed decisions. This week’s guest, Anna Mittag, has spent her career studying this problem and crafting solutions that resonate with employees and their employers.

What You’ll Learn From this Episode:

  • Anna’s Canadian perspective has been valuable.
  • What modalities work best when delivering this information.
  • Why it is important to meet people where they are.
  • What are the most frequently searched topics.
  • Why some employees prefer anonymity over a clinician-driven approach.

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The-Shift-Shapers-Podcast-(Rough-Comp-2)

Employers are beginning to move the needle on healthcare, and advisors have their ear. There is a lot of debris from old models that needs to be cleared, and on this episode we explore how that is happening and what is coming in its place. New and innovative models of care delivery and payment models are being incorporated into health plans. More importantly, many employers and employees are beginning to realize that they are the ones who are really in charge.

What You’ll Learn From this Episode:

  • Why HDHPs have not delivered as hoped.
  • How misaligned incentives have driven irrational markets.
  • Why the entrenched bureaucracies keep getting more entrenched.
  • ASOs with the BUCAs is not the solution most are looking for.
  • How to serve customers and get EBIDTA.

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The current health care environment is complicated, convoluted and fraught with misaligned incentives, care decisions that focus on a single price point and doesn’t help consumers plan based on a desired final outcome. Scott Schoenvogel, CEO at Compass Professional Health Services, believes that healthcare navigation programs that account for benefits, consumer decision making and clinical decision points is the way through.

What You’ll Learn From this Episode:

  • How we got into such a confusing mess of a system.
  • What kind of help consumers really need.
  • How to help employees understand the often-inverse relationship between cost and quality in healthcare.
  • Why bundled pricing coupled with appropriate advisement helps employees and plans.
  • How and why patients need to take control of their care.

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The-Shift-Shapers-Podcast-(Rough-Comp-2)

We have been talking about consumers in healthcare since the turn of the century, but real health care consumers – in the true sense of the word – are still apparently hanging out at the unicorn farm somewhere far away. Eric Haberichter, Co-founder at Access Healthnet knows why – and is working hard at creating a consumer environment in health care that approximates our consumer engagements in every other industry.

What You’ll Learn From this Episode:

  • Why we must stop focusing on network discounts.
  • Why is the typical shopping experience still opaque in healthcare?
  • How we create a more normal market.
  • The three immutable characteristics that must be present.
  • How to move beyond surgical and include diagnostic and therapeutic.

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Not too many years ago, the role of a TPA was fairly straightforward: Pay claims, handle eligibility and make a network connection. In today’s fast-paced and rapidly growing self-funding world, a TPA has to be flexible, nimble and multi-faceted. Jeff Bernhard, President of Continental Benefits, represents a TPA built for today’s commerce. We talk about what to look for in a TPA relationship and how your TPA is now an integral part of the client experience.

What You’ll Learn From this Episode:

  • How Jeff’s carrier background informed his choices when building his TPA.
  • New ways TPAs can help clients reduce medical and pharma spend.
  • Population health matters more now than ever.
  • Why your TPA’s strategic partnerships may matter more than the network.
  • Changes in PBMs and DPC are integral to a successful TPA relationship.

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The-Shift-Shapers-Podcast-(Rough-Comp-2)

Travel for treatment used to be an esoteric benefit reserved for only the largest of employers. Today, the benefits are as much quality as cost driven and most often involve fully-accredited facilities. Some even use U.S. physicians and are attached to teaching hospitals. Yet for many employers and employees it still remains mysterious.

Jim Polsfut, CEO and Chairman of North American Specialty Hospital, helps us to understand the changes and how to help clients embrace a benefit that is advantageous to both employer and employee.

What You’ll Learn From this Episode:

  • What problems can travel for treatment overcome?
  • Why it has taken so long to catch on with average employers.
  • How quality now drives the decision.
  • New patient-centric features.
  • Should plans rewrite SPDs to require travel for treatment?

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The-Shift-Shapers-Podcast-(Rough-Comp-2)

According to our guest, Erica Kiefer, VP of Sales and Marketing for AgencyBloc and a tech veteran in a number of sectors, we often neglect to investigate some critical questions when choosing software. In addition to looking at the user interface or the sheer functionality of any tool, Erica cues us in on the questions behind the questions that will ensure we end up with the right tools.

What You’ll Learn From this Episode:

  • Why tech we purchase often creates more confusion than it resolves.
  • Are demographic shifts changing advisors’ expectations and vendors’ offerings?
  • How can buyers get beyond the product when evaluating choices?
  • The critical importance of owner engagement.
  • How does your choice of tech inform your brand integrity?

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The-Shift-Shapers-Podcast-(Rough-Comp-2)

Jessica Waltman is principal at Forward Health Consulting and one of the most in-demand healthcare political and regulatory analysts in the country. She is also a ShiftShapers regular contributor. As we approach the mid-term elections, you may not be hearing much healthcare discussion on the legislative front, but the regulatory environment has been chock full of initiatives, advices and changes.

Jessica joins us to sort it all out and to let us know what we should expect in the coming months.

What You’ll Learn From this Episode:

  • New CMS Guidance on Medicare Advantage Plans.
  • Short-term and AHP rules.
  • What’s happening in Idaho and Iowa and what does it mean for the nation?
  • Will Congress do anything before the end of the year?
  • Should advisors “shelter in place” until next year?

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