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Mark Gaunya and Jennifer Borislow continue their discussion from last episode about why healthcare is so expensive and share their ideas to slow rising prices. With the release of the second edition of their book Bend the Healthcare Trend, Mark and Jennifer are advocating for consumer-driven healthcare as the solution to rising expenses.

In analyzing the healthcare system, inflation greatly outpaces the general economy. Our guests explain why the industry’s prices rise so much faster than those of other industries, largely due to a lack of transparency or tangible competition.

Opportunity will grow from greater industry transparency and responsibility, as consumers will save money and maintain better health. We need to look beyond physical health and appreciate mental, spiritual, and financial health as well.

What You’ll Learn From this Episode:

  • The three essential principles of healthcare’s oncoming trend: Transparency, Responsibility, and Opportunity.
  • Why healthcare is the only industry where consumers don’t shop around.
  • What opportunities flow from responsibility and transparency.
  • The difference between wellbeing and wellness.
  • Why there has been an uptick in interest around self-insured plans. 
  • How companies of all shapes and sizes can approach a self-funded health plan, and how an advisor can approach that conversation.

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Mark Gaunya and Jennifer Borislow continue their discussion from last episode about why healthcare is so expensive and share their ideas to slow rising prices. With the release of the second edition of their book Bend the Healthcare Trend, Mark and Jennifer are advocating for consumer-driven healthcare as the solution to rising expenses.

In analyzing the healthcare system, inflation greatly outpaces the general economy. Our guests explain why the industry’s prices rise so much faster than those of other industries, largely due to a lack of transparency or tangible competition.

Opportunity will grow from greater industry transparency and responsibility, as consumers will save money and maintain better health. We need to look beyond physical health and appreciate mental, spiritual, and financial health as well.

What You’ll Learn From this Episode:

  • The three essential principles of healthcare’s oncoming trend: Transparency, Responsibility, and Opportunity.
  • Why healthcare is the only industry where consumers don’t shop around.
  • What opportunities flow from responsibility and transparency.
  • The difference between wellbeing and wellness.
  • Why there has been an uptick in interest around self-insured plans. 
  • How companies of all shapes and sizes can approach a self-funded health plan, and how an advisor can approach that conversation.

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Listen to the Full Interview:

This Episode is Sponsored by:

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Dr. Keith Smith believes that healthcare pricing in the United States is “scam” — and he’s working to change that. He is the medical director and managing partner of the Surgery Center of Oklahoma. Keith’s outlook on transparent healthcare pricing is a valuable one, especially since he’s had several years putting it into practice. This is part 2 of our two-part episode series on transparency – find part one here!

Over 7 years working in big hospitals, Keith saw the price of medical care rising while the quality of care suffered. This inspired Keith and his business partner to start a private practice founded on transparency, with prices and outcomes shared with everyone. To remain true to their pricing, Keith and his business partner decided they could not work with government programs. They firmly believe that the only way to move to a truly free market is to be completely transparent with healthcare prices, and to deliver better quality care at a lower cost.

Keith discusses his journey as well as the challenges he and his partner had to overcome along the way. We also explore the disruptive consequences that his transparency is having across the country, leading patients (who bid for their non-emergent surgical care) to Oklahoma.

What You’ll Learn From this Episode:

  • How Keith started his transparent pricing surgery center.
  • The pricing structure Keith and his partner use for their medical services.
  • Why current pricing practices are a scam.
  • Why hospitals should not have non-profit status.
  • The disruptive effect of posting his prices.
  • How the Free Market Medical Association works.

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This week, our subject matter expert Daniel Wells, Executive Vice President of Business Development for Endeavor Plus, joins us to discuss emerging trends in consumer-directed health care plans. We investigate what’s working well, what can work better, and the tools available that will help self-insured consumers make effective decisions about their health care options.

Join us as Daniel shares his takes on the overall state of consumer-directed health care plans. We also discuss why the network-driven, fully-insured marketplace is no longer sustainable. As an alternative, the outcome-based reimburse model may offer solutions that commercial insurance providers can leverage to increase medicare reimbursements and make more money.

Daniel explains how and why the recent election may force a pivot by insurance providers to an outcome-based reimbursement model. We wrap up the conversation by discussing his predictions on just how the initiatives in a President Trump administration will impact the way consumers approach their health care decisions.

It’s been said that when you engage consumers by their wallets, their hearts and minds will follow. Daniel’s expertise in driving health care related behaviors in a direction that saves money and improves the consumer experience will be a valuable insight for advisors.

 

What You’ll Learn From this Episode:

  • Whether CDHP Plans are working or not.
  • What the burden of consumer education will be if reference-based pricing becomes more widespread.
  • Trends on the horizon concerning networks.
  • Whether selling across state lines is actually a significant cost saver in the consumer marketplace and which groups most benefit from this concept.
  • Whether the network-driven fully insured marketplace is viable for groups.
  • Various ways HSAs might expand.

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Steve Kelly is the President and Co-Founder of ELAP Services. He’s the foremost expert in a field that a lot of people are talking about – reference-based pricing.  As our guest on this episode of ShiftShapers, Steve will help us understand the ins and outs of reference-based pricing, why it’s important, and where it will take our industry in the future.

There is a resurgence of interest in self-insured plans as companies look for ways to keep healthcare costs down for employees. Advisors can help guide their clients through the type of support and advocacy position necessary to complete a transition with the practical tips discussed on this episode.

Advisors will want to closely examine a metric-based pricing model as they’ve been shown to provide significant, year-over-year savings. Stop-loss carriers are showing significant credits on their premiums at this point. The savings will undoubtedly help employers control the facility costs – the largest component of medical expenses. You’ll learn just how to take action on today’s episode.

What You’ll Learn From this Episode:

  • An explanation of metric-based pricing.
  • Where metric-based pricing applies.
  • What we can learn from the CalPERS example.
  • The unfortunate employer dilemma.
  • The source of most high dollar claims.
  • Whether there is applicability to pharma spend.

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The-Shift-Shapers-Podcast-(Rough-Comp-2)On this episode of ShiftShapers, we’re pleased to welcome Sally Poblete, the CEO of Wellthie, to discuss how consumer expectations are influencing technology trends in the health care industry. Since everyone from millennials to baby boomers is eagerly adopting tech tools and mobile devices to manage their daily affairs, it stands to reason that consumers would gravitate toward tools that simplify their health care decision-making process.

Sally shares why she believes the eCommerce movement in health care upon us. Benefit advisors who embrace technology can play an integral role helping their clients make the best decisions. She provides tips for advisors looking for obvious starting points to incorporate technology as they seek to connect with a broader audience.

A recent study found that only 14% of consumers are proficient regarding their ability to make health care decisions. Useful software tools are being developed. Savvy advisors will position themselves to help consumers bridge the knowledge gap. Sally shares what advisors should know and how they can adequately prepare to address that need.

What You’ll Learn From this Episode:

  • Sally’s background and how that lead to her current career.
  • An explanation of the retailization of health care markets.
  • How benefit advisors can encourage health care engagement vs avoidance.
  • The level of health care knowledge within the general population.
  • The transition away from spreadsheets as advisors embrace technology to better serve clients.
  • How millennial consumer behavior will impact health care decision-making trends.

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This week on ShiftShapers, Paul Gable, President of IBX, lends his expertise on technology tools in the benefits industry to the discussion. Benefits advisors are being challenged to meet the demand of delivering a higher quality of service with more efficiency to remain profitable. Paul highlights the affordable resources available to help small and mid-sized agencies recapture efficiencies in their businesses and thus save money.

Paul points out that most agencies waste time with inefficient processes. Two-thirds of an advisor’s time is routinely consumed with non-client facing or back-office administrative duties. When these processes are restructured, advisors can spend more time with clients.

The cost of basic customer relationship management tools available can be financed in a variety of ways that make them affordable for a wide range of agencies – regardless of size. Paul highlights how advisors can best take advantage of the off-the-shelf products available and what you need to know to evaluate potential vendors.

What You’ll Learn From this Episode:

  • Why advisors need to create operational efficiencies.
  • The percentage of an advisor’s time that is actually spent selling.
  • The steps needed to creating effectiveness at lower cost and with a higher return.
  • What a CRM is and how it differs from an Agency Management System.
  • The opportunities to automate the RFP process in a way that delivers higher sales percentages.

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This week on ShiftShapers, we wrap up our two-part discussion with Brooks Goodison, President of Diversified Group.  Last week, Brooks helped us sort through the changes underway that target groups that want to move away from fully-insured plans. This week, he highlights strategies that employer groups are using to fight the rising cost of health care as a result of the Affordable Care Act.

Health care expenses can easily become one of the largest expenses for families and the rising costs have a direct impact on a consumer’s ability to plan for their financial future. Given this reality, employers are actively looking for ways to control health care costs. Brooks points out the pros and cons of reference-based pricing and provides case studies on how these programs compare to traditional PPO contacts.

He also clarifies whether allowing consumers to purchase health care across state lines will produce tangible savings. Is this just an election year talking point or can this strategy actually bring down costs without sacrificing health care quality?

What You’ll Learn From this Episode:

  • An introduction to reference-based pricing.
  • How widespread reference-based pricing is today and whether it will gain traction.
  • Whether reference-based pricing could fundamentally change our notion of “networks”.
  • Why politicians keep talking about selling across state lines.
  • The new techniques and challenges with employee engagement.

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Healthcare costs are rising and as we discussed in episode 48, most employers are still using cost shifting as a hedge. Ryan Day, our guest in this episode, believes that a better – and more sustainable – solution is Reference Based Pricing (RBP).  We discuss the growing interest in reference based pricing and how it can put a serious dent in health care costs in the post-ACA environment.

Ryan is the President of H.S. Technology, and a subject matter expert in reference based pricing. We begin with the basics and then explore how this methodology fits in with today’s plans, who it is for, and how advisors can discuss it with clients.

What You’ll Learn From This Episode:

  • The problem with traditional pricing.
  • What RBP is.
  • Whether all constituencies need to collaborate to make RBP work.
  • Whether RBP is currently a carrier or self-funded tool.
  • The challenges of RBP.
  • The impact of CMS’ data release.

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