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Mike Dendy is CEO and Founder at Advanced Medical Pricing Solutions (AMPS) and a student of the irrational pricing and misaligned incentives that drive today’s US healthcare system. We begin our conversation by discussing the widely-held myth of the PPO discount. From there we explore the general pricing methodologies and incentives in healthcare.

Once you wrap your head around all of that, the discussion of how often claims are incorrectly priced and what can be done about it will bring us to a conversation around a concept known as Direct Contracting. We will also find out why Mike thinks that healthcare is like the OPEC oil cartel.

What You’ll Learn From this Episode:

  • What is the myth of the network discount?
  • Why does that matter to patients and payers alike?
  • Will networks be eliminated or replaced with personal networks?
  • How accurate are most claims?
  • What is Dzdirect contractingdz and what problems can it solve?

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Our guest on this episode, Mark Seghers, Chief Sales Officer at Healthio, helps individuals, their families and their providers to fill in the blanks during the 5000 hours they spend away from their doctors. For the last several years we have been talking about how The Internet of Things (IOT) will change medical care – and today that conversation is becoming real.

Aging Baby Boomers who insist on remaining at home even while they manage chronic conditions, combined with a shortage of 90,000 physicians is combining to drive technology to fill the gaps. Learn about the latest and greatest on this episode.

What You’ll Learn From this Episode:

  •  What is the need?
  • Which populations are the target?
  • Is compliance better?
  • What information is captured?
  • How, and to whom, is the information sent or shared?

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Dr. Marc Grossman, Founder and CEO at PriceMDs, has a unique 30-year perspective on the industry, having spent time as a surgeon, an administrator and a hospital owner. Over that time he has developed a keen sense of the chaotic and often adversarial pricing system that is prevalent in today’s medical and insurance industries.

He believes that “Episode Of Care” pricing for non-emergency procedures can help all constituencies operate in a more intelligent, effective and efficient manner, while driving significant cost savings without sacrificing quality of care or outcomes.

What You’ll Learn From this Episode:

  • How did the current state of pricing become so chaotic?
  • What is “Episode of care” pricing
  • Is it important for patients to know the costs up front (spoiler alert: the answer is not) what you may think).
  • How do you drive understanding, employee engagement and employer take up?
  • Can offshore medical facilities also play a role?

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Bob Gearhart Sr. and Bob Gearhart Jr. – known simply as “Senior” and “Junior” (or “The Bobs”) to their clients and friends – have found the formula for a highly successful multi-generational agency. Combining a depth of knowledge and an application of technology, they have built a next-generation agency that keeps it simple.

They believe that as the industry has become more complex, clients really want simple explanations and clear pathways to their goals. They have taken another leap and put their fees at risk, which they feel puts them on the same side of the table as the client. Learn how they do it on this episode of ShiftShapers.

What You’ll Learn From this Episode:

  • How do you handle the complexities of today’s market?
  • What is health care chain management?
  • How can advisors reframe correctly who is driving costs?
  • What are the four strategic areas they focus on?

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Many of us make personal resolutions at the new year, but corporate resolutions can be an even more powerful way of keeping your eye on the big picture during the coming business year. Amy Evans, President of Colibri Insurance writes annual resolutions for her firm, but she goes a step further – she publishes them!

We caught up with Amy to discuss her feeling that this is a key part of her agency’s success. We explore last year’s list and the impact it had on her practice and we chat about this year’s resolutions, too. It isn’t too late for you to make your firm’s resolutions for the New Year. Listen in and learn from Amy.

What You’ll Learn From this Episode:

  • What’s the difference between a goal and a resolution?
  • How many resolutions make sense and when are you going overboard?
  • How you can keep the resolutions list high-level, but practical
  • How to assess your business’ success during and at the end of the year

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Twenty million Americans are employed by firms with 20 or fewer employees – many of which do not provide health care coverage for their employees. Josh Hilgers, Director of Enterprise Sales at Quotit says that despite all the usual excuses, the “21st Century Cures” Act signed two years ago is offering those employees and employees options while creating a huge opportunity for benefit advisors.

Josh is one of the organizers of a free virtual conference called the “Benefit Success Summit.”  Shiftshapers is participating, along with a number of other thought leaders and practice shapers. Click the link below for more information about how you can sign up.

What You’ll Learn From this Episode:

  • How the Act created QSEHRAs
  • What you can do with a QSEHRA from a defined contribution platform
  • Why this is amazing opportunity to serve an often overlooked market
  • How this can help <20 employers attract and retain top talent

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In Part 2 of this 2-part episode we will ask David Contorno, President of Lake Norman Benefits and Benefit Selling’s 2015 Broker of the Year about Performance-based Compensation and his belief that it puts advisors in a much better long-term position.

Forbes Magazine called our guest, David Contorno, one of America’s most innovative benefits leaders. As he works with clients and travels the country consulting with prospects and other advisors, he has come to the conclusion that if you use today’s tools and techniques in a whole-benefits strategy, the best model to differentiate yourself is with Performance-based Compensation.

We explore that concept – what it is and what it is not – and it helps advisors deliver a better overall experience for clients while helping to drive significant non-product revenue to their practices.

What You’ll Learn From this Episode:

  • What performance-based compensation is and it’s advantages
  • Where the concept can be applied in our industry
  • The value-adds that can drive PBC, and what is more important than costs
  • How to achieve demonstrable, repeatable ROI

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Forbes Magazine called our guest, David Contorno, “One of America’s most innovative benefits leaders.” So, what’s he up to and what tools, techniques and strategies is he bringing his clients? We discuss why the “old way” just isn’t working and how this leads employers to a dilemma. We also explore whether the advisor community is moving to a completely different delivery model.

David explains why talking to the C-Suite is the way to provide 21st-century advice to clients. We chat about how rationing of care has changed and how it has moved the industry and what questions advisors need to ask their clients. (Spoiler alert: those questions are VERY different than the traditional conversation).

What You’ll Learn From this Episode:

  • Why the old way isn’t working when it comes to the way we deal with benefits
  • The employee benefits see-saw and what that means to their well-being
  • Rationing of care and why it’s a real problem
  • Is CDHP a real thing that makes a real difference
  • The role of real ROI and what questions we need to ask

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Although the concept behind Direct Primary Care (DPC) is more than 10 years old, more and more physicians are opting out of the insurance-based world for a practice model that is old-fashioned but in the best sense of the word. Our guest on this episode – Dr. Jeffrey Gold – explains the attraction from the physician side of the equation.

What You’ll Learn From this Episode:

  • Why patient experience is a key driver of DPC popularity.
  • How some take up differentials are regional.
  • Why DPC is like the old “family doctor” relationship.
  • How physicians practice medicine instead of insurance.
  • Why ensurance is more important than insurance.

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Is a PBM a gatekeeper and whose interests are they serving?

Renzo Luzzatti is an expert on how and why pharmacy costs are growing at an exponential rate and driving an ever-more significant portion of claims spend. He explains that there are multiple vantage points to consider if benefit advisors and fiduciaries are to gain a good overall understanding of the problem and its possible solutions.

We explore the rebates shell game and learn how advisors can arm themselves to make better recommendations to prospects and clients. The conversation also spotlights the starting line for this problem – the physician’s prescription pad and discusses who, if anyone, is educating the physician.

What You’ll Learn From this Episode:

  • What is driving pharmacy spend to such high levels.
  • Whether PBMs have an inherent conflict of interest.
  • The current role of the PBM and what that role should be.
  • Who’s educating physicians about pharmacy costs, choices, and efficacy.
  • The meaning of “specialty pharmaceuticals” and why they are being approved at a faster rate.
  • Potential solutions for fully-insured plans.
  • What advisors need to know.

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