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On part two of this special, post-election edition of the ShiftShapers podcast, we discuss policy ideas that may be seeing a resurgence based on the election outcome and whether these ideas can really bring down costs in the healthcare marketplace.

Jessica Waltman, Principal at Forward Health Consulting and our resident expert on all things legislative and regulatory joins us for part 2 of our look at healthcare in this post-election period.

We discuss the theory being floated that an individual healthcare marketplace will control costs better than the employer-based system currently in place.  We are also hearing a great deal about selling across state lines. Jessica walks us through a practical example of how that theory actually performed in the Georgia market. And finally, we touch on the third rail in healthcare: dealing with hyperinflated and runaway costs on the supply side.

We also explore whether to expect any initiatives that address one of the largest cost drivers – prescription drugs. We wrap up with a serious discussion of the timing – and the time – it will take to unravel PPACA and make meaningful serious reforms, as well as the possible perils of acting too quickly.

What You’ll Learn From this Episode:

  • Policy ideas being proposed from conservative economists on how best to structure the health care system.
  • A practical example of whether purchasing healthcare across state lines encourages competition and brings down the price.
  • Why rural markets are inherently difficult to serve by healthcare providers.
  • What President-elect Trump has hinted about controlling drug prices.
  • The strategies in place to address the main cost drivers on the supply side.
  • Whether value-based pricing is the first step in reigning in runaway facilities costs.
  • What advisors should do in preparation for the upcoming enrollment period.

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On part one of this special, post-election 2-part edition of the Shift Shapers podcast, we look at the reality of the “Repeal and replace” strategies and tactics being discussed by the new administration and other health care constituencies.

Jessica Waltman, Principal at Forward Health Consulting and our resident expert on all things legislative and regulatory joins us for a two-part wrap-up on how November’s election results will affect the health care and employee benefits universe.  In part 1,  we focus on whether full-scale repeal and replace will happen or if other realities will make large-scale change a more complex and messier process.

For six years, the Republican party has put forward the idea of replacing the ACA and replacing it with a suitable option. With control of the Executive and both houses of Congress, the Republican majority will have an opportunity to make their move. How will HHS Chairman-designate Dr. Tom Price change the debate? Will the House Republican’s plan gain wide acceptance? And how can these changes be effected without disinsuring millions?

There are various schools of thought in play when it comes to making changes to the ACA. Jessica walks us through the opposing viewpoints and discusses the pros and cons of the various proposals. She provides context on just how they will impact consumers, businesses, and advisors alike.

Changing the law will not be a simple process. The ACA is an extensive and complex piece of legislation. Abrupt changes can have unintended consequences that impact health care access, the economy, and potentially the mid-term elections.

Listen in to find out what Jessica suggests the Trump administration can do right away that would positively impact businesses.

What You’ll Learn From this Episode:

  • The strategies and tactics that are being considered for “repeal and replace”.
  • How the appointment of Dr. Price as new Secretary of HHS will impact the “repeal and replace” discussion.
  • How Dr. Price’s “Empowering Patients First Act” will meld into any new plans.
  • Whether selling across state lines is a practical idea in today’s environment.
  • The strategies in place to address the main cost drivers on the supply side.
  • How regulatory changes can be made without eliminating effective provisions that are working well.

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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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In this episode, we explore some of the most common questions advisors ask about self-funding and discuss concerns ranging from minimum group size to tools and techniques. Our guest on this episode of ShiftShapers is Adam Russo, Esq., co-founder and CEO of The Phia Group, as well as the founding and managing partner at a law firm, Russo & Minchoff. He believes that, in light of the healthcare reform, the current environment is full of exciting opportunities that many brokers can take advantage of.

We also have a frank exchange about what is behind recent efforts by some Departments of Insurance to try to put the brakes on certain segments of self-funding and the potential impact that may have on employers seeking an alternate to the fully insured marketplace.

All of us at ShiftShapers thank you for you continued support. We hope you enjoy Thanksgiving with Family, Friends, great food, and this encore episode:

What You’ll Learn From this Episode:

  • Adam’s journey and how The Phia Group came about.
  • How advisors can remain relevant in the current environment.
  • The minimum size for a successful self-funded group.
  • Why the government wants to stop or severely limit self-funding.
  • How can advisors begin the self-funded conversation.
  • What you need to devise a properly constructed client plan.

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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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A quiet battle at the state level may make it more difficult for you to be creative in the small and mid-market spaces.

In this week’s episode, Brooks Goodison, President of Diversified Group joins us to discuss how renewed interest in partially self-insured plans in the small to mid-market has drawn the attention of state regulators. In this first segment of a two-part discussion on ShiftShapers, Brooks helps us sort through the changes underway that target groups that want to move away from fully-insured plans.

New York, Maryland, Connecticut and other state regulators are changing stop-loss insurance regulations in ways that would severely impact the number of employers able to take advantage of partial self-insurance options. Some believe that these regulatory moves are nothing more than an attempt to force membership into state exchanges. Others believe that only large and jumbo groups should be permitted to partially self-insure.

Employers looking for strategies to move the needle on healthcare costs will find this discussion valuable. The ACA and other external pressures are forcing groups to look carefully at all options. This episode highlights technology that can help employers with better decision making and control cost without sacrificing health care quality for employees.

 

What You’ll Learn From this Episode:

  • Why the renewed interest in self-funding is drawing the states’ attention.
  • How the general election is apt to affect this incursion.
  • What private exchanges are and whether they are a new panacea.
  • The latest strategies and tactics to move the needle on costs.
  • How TPA can become a strategic partner with an advisor generalist.

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This week, we welcome Patrick Irving, Managing Director of Covala Group, to The ShiftShapers podcast to help us explore the overlooked opportunities available with disability income. With only 30% of Fortune 1000 companies (and fewer in other segments) providing coverage in this area, advisors willing to develop a DI expertise will be in a prime position to expand their practices while providing invaluable coverage for their clients – often at a discount!

This episode is packed with useful information for benefit advisors: Patrick clarifies some of the DI terminology that can often be confusing.  He goes into detail about the taxation of DI benefits so advisors can better serve their clients while saving them money. He also tackles the classic chicken or the egg question regarding whether Group or Individual coverage is the best first option.

Advisors dealing with commission compression or looking for additional revenue streams will definitely want to leverage the opportunities available in DI coverage and you should begin with this episode. Patrick provides a wealth of information and specifics on how to help your clients seamlessly integrate DI benefits into their existing plans.

What You’ll Learn From this Episode:

  • The market opportunity available with disability income.
  • The difference between multi-life, group, GSI and individual plans.
  • An expert perspective on whether an Individual or Group plan should be purchased first.
  • Why it is important to understand the taxation of disability.
  • Which items are generally not covered by Group DI.

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