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Business groups on health are helping employers understand and use data while they transition from volume purchasing to value purchasing.

Jessica Brooks, CEO and Executive Director of the Pittsburgh Business Group on Health, shares her expertise on health-focused business groups; potentially a new topic for many listeners. In the past, business groups formed primarily to leverage purchasing power. Today, these coalitions are expanding their focus by using education and advocacy, in addition to the power of the purse, to push for changes in the health care industry at the macro level while bringing new insights and tools to their member employers at the local level.

Jessica explains the history behind health-focused business groups and why they formed initially. She shares how these groups are bringing together key stakeholders to address challenges with health care cost, quality, and access in the marketplace. Business health care groups bring relevant parties to the table in search of workable solutions in this era of complexity surrounding the Affordable Care Act and public and private exchanges.

We explore the ever-more-important role of data in employers’ decision-making as well as their latest focus to moving beyond leveraging group size for volume purchasing to a more value-based approach. Jessica also discusses the role benefit advisors play in the PBGH and how they can work together to bring about better outcomes for their mutual clients.

What You’ll Learn From this Episode:

  • A history of and need for health-focused business groups.
  • How PBGH interacts with advisors.
  • The four pillars of the PBGH.
  • How the PBGH has transitioned from volume to value.
  • The role data plays in transforming how the PBGH works with vendors.

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Under ACA, companies are being penalized for growth, perverse incentives abound and risk adjustments are creating . . . risk!

This week,  Tom Policelli, CEO of Minuteman Health, joins us to discuss the unintended consequences of risk adjustment in the Affordable Care Act. Although it may not have crossed your radar yet, it’s important to understand the market uncertainty triggered by the federal government’s risk adjustment mechanisms and how that will impact advisors and the clients they serve.

Tom walks us through the three Rs established by the ACA: Risk adjustment, Reinsurance, and Risk corridor. While these were developed to foster market stabilization, we discuss how each program is actually producing the reverse effect – sometimes with disastrous consequences.

Tom also talks about his work with the advocacy group, Choices Coalition, which is having some success bringing an awareness to the industry problems created by the ACA. He covers the practical solutions that have been proposed and the strategies some organizations are undertaking to address the little-known perverse incentives created by risk adjustment.

What You’ll Learn From this Episode:

  • What risk adjustment is and how it impacts pricing and market stability.
  • How Massachusetts had a head start responding to the unintended consequences.
  • The three Rs as defined in the Affordable Care Act.
  • How companies are being penalized for growth.
  • The impact of risk adjustment on carriers and the plans they offer.

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Accustomed to knocking on the C-Suite door, many advisors are finding success by using the HR door instead. Leveraging ACA-related changes and technology creates compelling conversations advisors can use to grow their businesses.

Our guest this week is George Reese of Employee Navigator who helps us explore shifts in the industry that makes oft-neglected HR departments a target rich environment for advisors looking for new strategies to expand their practices. Today more than ever, George tells us, HR departments are searching for solutions to streamline ACA-mandated compliance processes. Advisors armed with knowledge and technology can offer a compelling argument market – if they know how to have that conversation.

Benefits administration is one of the most complex systems for organizations to manage. As this area morphs into an HR-driven field, advisors can help their clients simplify a complicated network of rules and compliance requirements. George highlights exactly how advisors can best capitalize on the upcoming changes and avoid being left behind.

What You’ll Learn From this Episode:

  • The most recent updates in BenAdmin systems.
  • The 5 things shaping advisors’ interactions with technology.
  • Whether systems have become “table stakes” for advisors since Zenefits.
  • The impact that channel conflict will have.
  • How brokers can think strategically about using HR departments as a door opener.
  • The future of BenAdmin systems and how quickly the changes will materialize.

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This week on the ShiftShapers podcast, Sal Campanile stops by to help us explore the world of voluntary benefits. Sal is the Vice President of Workplace Voluntary Benefits and Group Sales for 5-Star; the insurance company for the Armed Forces Benefits Association.

Voluntary benefits create a more enriching and satisfying experience for the consumer. They exist to support an insurance package, not detract from it. However, in a market where consumers primarily differentiate between services based on price, Sal provides practical tips for advisors who want to grow their business by incorporating  voluntary benefits.

There are plenty of options available to consumers when it comes to benefits packages. Sal speaks to the shifts on the horizon as well as the opportunities that advisors can leverage by offering voluntary benefits. We’ll talk about just how advisors can help clients understand the need for these services from a holistic approach that relies heavily on education.

What You’ll Learn From this Episode:

  • How the military market 5-Star serves has informed their work in commercial markets.
  • 3 core elements advisors need to be successful.
  • 3 additional components advisors need to keep in mind.
  • How advisors can help consumers see their benefits as a whole package rather than non-related coverages.
  • Some of the key differentiators that resonate with consumers.
  • The pros and cons of running your agency as a general practitioner or hiring a voluntary benefits specialist.

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A generational shift has created several generations of Americans who are financially unprepared for retirement, which represents an opportunity for advisors. We explore that and other changes going on at The American College on this episode of ShiftShapers.

On this episode of the ShiftShapers podcast, we go back to school with Dr. Robert Johnson, President and CEO of The American College. Dr. Johnson began his career as a traditional college professor before transitioning to the Association for Management and Research where he was instrumental in enhancing the CFA program curriculum. All of this experience led Bob to what he calls “Prac-Ademics”, a merger of the practical and the academic that may be the key for advisors seeking add or increase this practice area in their businesses.

Join us as Bob shares his insight on a new crisis looming in this country due to a lack of retirement planning readiness among Americans. The shift away from Baby Boomers’ defined-benefit plans to defined-contribution and 401(k) plans without the necessary financial education will leave a large number of retirees in a precarious predicament. Under Bob’s leadership, The College is working to move the needle on financial preparation by training financial advisors who work with the general public. We explore how the college’s Retirement Income Certified Professional (RICP) designation is its most popular field of study for today’s advisors.

Traditional benefits advisors can fill a need in society and incorporate a value-added service by implementing retirement planning into their practice. This episode will help you discover just how serious this crisis is and will outline the opportunities and best practices for all size agencies.

What You’ll Learn From this Episode:

  • How Bob transitioned from private industry to becoming the President and CEO of The American College.
  • The opportunity that exists for traditional benefits advisors in holistic planning.
  • How the lack of financial readiness for retirement will create a financial crisis in the US.
  • How millennials approach saving for retirement and how advisors can better service this population group.
  • The pros and cons of robo-advisors.

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This week on the ShiftShapers podcast, Eric Parmenter outlines the differences between the HMOs of the past and value-based care at the provider and hospital level.  Eric is the VP of Employer Solutions at Evolent Health. His vast experience at all spectrums of the insurance industry makes him the perfect guest to identify the benefits and potential in store with a value-based approach to pricing.

We begin our conversation with a definition of value-based care. Ultimately, this approach is a shift away from a fee-for-service model which allows providers more control in how they interact with patients. The changes won’t be immediately noticeable by patients, but it has the potential to revolutionize the way doctors deliver care.

Eric provides a wealth of information that is sure to help you understand how value-based care differs from the HMO model and the benefits it provides.  Listen in to discover just how value-based care will impact the future of healthcare pricing models.

What You’ll Learn From this Episode:

  • Eric’s path to working at the provider and hospital level.
  • What value-based care is and how it differs from value-based pricing.
  • How three different types of providers are reacting to value-based care.
  • Whether current networks as we know them will survive.
  • How the incentive-based payment structure is being realigned to account for the quality of care.
  • What the next generation of ACOs will look like.

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Providing compliance advice and services is table stakes for today’s advisors. How do you build a compliance practice and should you create it in-house or contract it out?

On this week’s episode of ShiftShapers, we chat with Peter Lewenson, the Founder and President of Compliance Bug, who has 20 years of experience with regulated industries including healthcare, financial services, insurance and employee benefits. Peter believes what while compliance is a complicated field, it is a strategic conversation that businesses must be having.

We explore how compliance can be both a prospecting and a client retention tool. We ask Peter about the pros and cons of building an in-house practice or whether a single advisor should try to go it alone. Peter says that there can be significant liability for the advisor as well as for clients and suggests methods to mitigate that exposure.

In this engaging conversation, Peter provides excellent advice about finding strategic partners and for staying current with the latest updates in the ever-changing area of compliance regulations. Listen in to hear his suggestions for providing your clients and prospects with the best possible service.

What You’ll Learn From this Episode:

  • How compliance can be a foot in the door for advisors.
  • What owners, directors, and officers need to know about their personal liability for compliance decisions.
  • The liability that advisors have and whether it is covered by their E&O policies.
  • What Wrap Docs are and why are they important.
  • What advisors should look for when selecting a strategic partner.

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It’s all about risk management! Learn how today’s successful plans incorporate clinical expertise, financial understanding, and cutting edge cost containment strategies to deliver outstanding year-over-year results.

Peter and Dr. Stacy Borans, provide the tools, techniques, strategies and tactics self-insured plans and their advisors need. The founders of Advanced Medical Strategies, they have over a decade of experience including independent medical reviews, claims cost containment, hospital negotiations, oncology services and claims repricing.

On this two-part series Peter and Stacy begin with a discussion of how the self-funded landscape has changed and what opportunities that provides for advisors – even those working in the smaller mid-market segment. We explore the high-level concepts and strategies that clients are finding successful and the concepts needed to have that initial and on-going self-insurance discussion with first-time self-insured groups.

Then we dig into a look at the biggest cost drivers: high-dollar claims, chronic disease and pharmacy spend. We also look to the future – a day when we will be doing more prospective than retrospective review, where predictive modeling will be far enough in front of potential claims so illness can be managed by looking out the windshield rather than viewed through the rear-view mirror. We also touch on the growing impact of reference-based pricing and the future of networks as we know them.

Join us on this second part of the conversation as we discuss how the fully insured vs. self-funded landscape is changing, as well as the essential concepts advisors need to understand in that arena. Don’t miss this opportunity to find out how you can deliver more value by bringing together clinical expertise, financial understanding, and cost containment.

What You’ll Learn From this Episode:

  • Whether the fully insured vs. self-funded landscape is changing, and how.
  • What concepts advisors need to understand.
  • How a plan can handle high-dollar claims.
  • The impact of chronic disease.
  • How closely advisors should watch drug spend and what drives that component of claims costs.
  • How we can start looking out the windshield rather than out the rear view mirror.
  • How reference based pricing and narrow networks will impact claims.

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It’s all about risk management! Learn how today’s successful plans incorporate clinical expertise, financial understanding, and cutting edge cost containment strategies to deliver outstanding year-over-year results.

Peter and Dr. Stacy Borans, provide the tools, techniques, strategies and tactics self-insured plans and their advisors need. The founders of Advanced Medical Strategies, they have over a decade of experience including independent medical reviews, claims cost containment, hospital negotiations, oncology services and claims repricing.

On this two-part series Peter and Stacy begin with a discussion of how the self-funded landscape has changed and what opportunities that provides for advisors – even those working in the smaller mid-market segment. We explore the high-level concepts and strategies that clients are finding successful and the concepts needed to have that initial and on-going self-insurance discussion with first-time self-insured groups.

Then we dig into a look at the biggest cost drivers: high-dollar claims, chronic disease and pharmacy spend. We also look to the future – a day when we will be doing more prospective than retrospective review, where predictive modeling will be far enough in front of potential claims so illness can be managed by looking out the windshield rather than viewed through the rear-view mirror. We also touch on the growing impact of reference-based pricing and the future of networks as we know them.

Join us on this conversation as we discuss how the fully insured vs. self-funded landscape is changing, as well as the essential concepts advisors need to understand in that arena. Don’t miss this opportunity to find out how you can deliver more value by bringing together clinical expertise, financial understanding, and cost containment.

Make sure to tune in next week for the second part of this insightful conversation!

What You’ll Learn From this Episode:

  • Whether the fully insured vs. self-funded landscape is changing, and how.
  • What concepts advisors need to understand.
  • How a plan can handle high-dollar claims.
  • The impact of chronic disease.
  • How closely advisors should watch drug spend and what drives that component of claims costs.
  • How we can start looking out the windshield rather than out the rear view mirror.
  • How reference based pricing and narrow networks will impact claims.

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Communication and consumerism tools are especially important in smaller groups that lack the resources of their larger counterparts. This presents a challenge for advisors and their clients.

Saravanan Chettiar, the founder of STRIVE Benefits, joins us on this week’s episodes to share his expertise on how new tools and technology help benefits advisors to deliver effective services in an easily scalable way.

It’s difficult for a benefits advisor to communicate with employees on an on-going basis because most advisors only have access to employees once or twice a year around open enrollment. This is compounded by an interesting phenomenon that occurs shortly after each and every open enrollment – regardless of client size or industry.

Saravanan describes how healthcare literacy in the new employee population is best achieved by utilizing technology platforms to deliver your message in a simple and compelling fashion. Join us as we learn what tools advisors should focus on for both small businesses and large groups and how to easily implement this new technology.

What You’ll Learn From this Episode:

  • Whether small businesses need even more help than large groups.
  • What happens almost immediately after open enrollment.
  • What should advisors focus on with so much noise in this space.
  • Why mobile solutions are important for health care.
  • Why portable and carrier-agnostic tools are  important.
  • How we can combat the lack of health care literacy.

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