Healthcare Simplified

On today's episode of Healthcare Simplified, Jeff Toewe, CEO of Medxoom, joins us to talk about healthcare transparency and the state of healthcare delivery today.  Healthcare may be the only service in the economy where you don't know the price until after delivery. Often, providers don't know the cost because they don't know your plan. And you don't know if your cost is reasonable. That's a transparency problem. And it's where Medxoom comes in. They help members discover and have intelligent conversations about what a service should cost before it's delivered. 

On today's episode of Healthcare Simplified, Geb Buchness, vice president of Paladina Health, joins us to talk about Direct Primary Care. Geb describes the two Direct Primary Care models out there, the consumer model and the fee-for-service model. He also talks about what employers need to make Direct Primary Care cost effective for them and the best way to select the right partner. Finally, he discussed measurements, tactics, and strategies for driving engagement.

On today's episode of Healthcare Simplified, Sandy Krauer, director of HR at Total Focus HR Solutions, a wholly-owned subsidiary of Allegeant, LLC, joins us to talk about the new legislation spurred by the COVID-19 pandemic.  With the rash of recent laws and programs, what are some of the key provisions that employers should be aware of? What implications and impacts will these new laws have on employers? And with all the moving parts in both COVID-19 responses and health care, what will affect employers' healthcare plans? 

How many added sugars are there in a Quaker quinoa granola bar? Not many, right? Quaker's a healthy company, and you can't get more nutritious than quinoa, after all. In fact, there's 10 different kinds of sugars sprinkled in. That's just one example of how what we think we know about health may not be accurate. On today's episode of Healthcare Simplified, Al Lewis, CEO at Quizzify, joins us to discuss healthcare literacy  — what don't we know about our health and how is that affecting us? 

On today's episode of Healthcare Simplified, Peter Hayes, CEO Healthcare Purchaser Alliance of Maine, joins us to talk about the relationship between healthcare costs and the quality differentials in healthcare delivery. Desiring to collectively move the dial on healthcare quality and affordability, Pete now leads a coalition of providers, plans, and hospitals to improve the quality paradigm and bring down Maine's high healthcare costs at the same time.

On today's episode of Healthcare Simplified, Charlie Moore, co-founder of DinnerTime, a web-based service that provides highly personalized and automated meal planning, sale-smart grocery shopping, recipe support and nutrition education to improve the health and well-being of its members. Charlie talks about the importance of the family dinner table, a sometimes-lost event, in today's busy family life.

On today's episode of Healthcare Simplified, Jim Hynes, executive administrator for Pipe Trade Services, Minnesota joins us. He'll talk about his career, his goals, and union health plans in general. Jim began his career as a union member and a pipe fitter. He planned to become a contractor, but life took a turn and Jim got hired as assistant administrator of the health and pension funds. That was 31 years ago. Today, he leads a healthcare plan that covers about 18,000 lives.

On today's episode of Healthcare Simplified, Tim Koch, founder of Accarent Health, joins us. He'll talk about healthcare and bundled rates, especially how to use bundled rates to save money and eliminate waste. Tim has been working in this area since the early 1990s so he's got deep experience in it.

On today's episode of Healthcare Simplified, we have the one-and-only Sandy Krauer back with us. Sandy is director of HR for Total Focus HR Solutions. She's been with us on the podcast many times before, and today she's addressing a topic that's paramount in the modern world  — compliance. She'll tell us about the new laws that came out at the end of 2019.

Healthy people are the low-hanging fruit of workplace wellness initiatives. Engaging the unengaged is a lot harder, and the one thing that usually keeps people from engaging is time. I got to interview Alex Haschen from BurnAlong for the second time on Healthcare Simplified and it was even more informative than before (if that’s possible). Here's what we discussed: Workplace wellness misinformation Why money isn’t as meaningful as an incentive as time Solving the engagement problem means solving the time problem Internal vs. external motivation

We often overlook executive compensation. But ArmadaGlobal doesn’t. In fact, they’ve got a solution you should definitely check out. When it comes to executive compensation, their plans are unique, offering a host of benefits to both employees and employers. Nick Limneos, VP National Sales for ArmadaGlobal, came on this episode of Healthcare Simplified to tell us all about it.

The two new HRA plans — the ICHRA & the EBHRA are a bit confusing for employers (and everyone else). So we talked with Sandy Krauer, the HR Services Director at Total Focus HR Solutions on this episode of the Healthcare Simplified podcast to give us all the real info on: The ICHRA (individual coverage health reimbursement account)  The EBHRA (excepted-benefits HRA)  She broke down how they work for employers, how to maximize the tax-savings benefits, and how these new rules can provide advantages for your organization.

On today’s episode of Healthcare Simplified I interviewed Doug Aldeen, a healthcare attorney from Austin, Texas. We talked about the state of healthcare today, particularly about how new plans like bundled payments and reference based pricing are disrupting the healthcare marketplace for the better.

On this episode of Healthcare Simplified, John Glascott shares 8 steps you can take to lower your company’s healthcare costs by 10-30% each year. John is the Chief Commercial Officer at Medxoom, a company that powers modern healthcare marketplaces.

On today’s episode of Healthcare Simplified we are extremely lucky to have, for the third time, employee compliance benefits extraordinaire, Sandy Krauer. She’s back, and this time, Sandy’s here to talk about how you can maximize tax savings by implementing a Section 125 Cafeteria Plan.

Our healthcare system needs some major adjustments. Most everyone agrees with that, but not everyone has solutions. On this episode of Healthcare Simplified, our guest Dr. Andy Lazris joined us to discuss the major issues with our healthcare system. While we are spending more on healthcare than any other nation, our people are getting sicker, and we are nowhere near the healthiest nations. Dr. Andy Lazris is an award-winning doctor, and the creator of the YouTube series, The Running Doctor Unhinged.

Studies have shown that when a company is healthier, employees are happier, more productive and MUCH cheaper to insure. Technologies like machine learning, AI, mobile apps, wellness gamification and social rewarding the site/app BurnAlong is transforming workplace wellness. BurnAlong offers health videos from five-minute stretches to do at your desk to hour-long workouts. They also cover nutrition, mental health, financial health, life coaching and more. When companies use BurnAlong they see big increases in wellness participation. “Kaiser Permanente in Maryland had about a 4% engagement rate, which is pretty typical,” says Alex Haschen is BurnAlong’s Head of Wellness Adherence. “After over a year we've increased their engagement to 21%. So increased it by five times. And these are new people using the platform.”

The Fair Labor Standards Act (FLSA) covers minimum wage standards that are so complicated, you need a flowchart to track them. This is one of the things I learned from my recent podcast with Sandy Krauer, director of HR services with Total Focus HR Solutions. Some things to remember: There is a federal minimum hourly wage -- $7.25/hour was established in 2009 and hasn't changed since then Each state can set its own minimum hourly rate -- it can be higher or the same Counties can establish their own minimum rates Some states have laws that make allowances based on the number of employees

The Family Medical Leave Act works for everybody. It also confuses a lot of people. The FMLA protects employees who are dealing with crisis situations in their immediate family from losing their jobs. And it protects employers from having to give PTO to everyone who darkens their door. The standards are strict, the rules complex, and keeping everyone in compliance is the job of HR experts like Sandy Krauer. If you have questions about your rights and responsibilities, either as an employer or an employee, Krauer has the answers on: What is FMLA? Who has to offer FMLA? Who can take FMLA? What constitutes a FMLA event? What happens after someone comes back from FMLA leave?

Americans pay the highest health care costs in the world and it only continues to increase, year after year. Our guest today is Douglas Aldeen, a healthcare attorney who’s been practicing for more than 20 years. In a survey done by Policygenius, only 4% of Americans could correctly define the four healthcare terms that explain how much you personally pay for services and drugs on your insurance plan. And when a majority of employers rely on “industry experts” to help them make decisions on which plans to purchase, it can be a recipe for disaster. Why don’t these HR professionals make the decision on their own? Well, quite frankly, it’s just too complicated to understand for most.

Now more than ever, Americans are dealing with a variety of chronic diseases which are requiring an unprecedented level of healthcare. In this episode, I sit down with Suzanne Shugg, CEO and Co-founder of Teleplus Healthcare to discuss how her team is changing the way that providers and their teams manage chronic diseases.

Leadership is often lacking today in the business world because leaders are using outdated processes. They rely on old-school methods of leadership that haven’t kept up with the evolution of society. But truly transformational leaders have high emotional intelligence. They help coach their teams. They understand that leadership is a skill that you can develop, and they take intentional steps to improve their skills! As a executive and life coach, Siona Henderson has worked at both small entrepreneurial companies and large organizations like Oracle.  She’s seen good leaders and bad leaders along the way, but she knows regardless of where someone falls on that scale, she can help them improve their leadership. Siona originally got into coaching because she has always had a passion for helping people reaching their potential and goals, so working with leaders seemed like a natural fit. Her mission is to help people build a life and career they love.  Siona helps people become more intentional about the direction their career and personal life is heading.

There is still a stigma surrounding mental health. Americans are quick to dismiss and slow to empathize with those who have mental health struggles. But the reality is that many more of us will deal with a similar struggle at some point in our life than we realize. Matt Marek is the CEO of Good Neighbor Community Services.  Matt has spent his career erasing this stereotype and getting people the help they need.  From in-home care to corporate environments, Matt’s company helps those who need every type of mental health treatment. In this episode of Healthcare Simplified, we sit down with Matt to talk about how Good Neighbor got started, the services it offers, and how the mental health stigma is strongest in a corporate environment.

Are healthcare costs stealing the American dream? According to today’s interview with ScriptSourcing CEO Gary Becker, they are. Though historically benefits have provided employers a means of attracting and retaining employees, now healthcare costs alone are second only in expense to payroll.  And costs continue to rise. The onset of industries like Medical Tourism and growing disruption by companies like ScriptSourcing, are not only helping employers mitigate their expenses relative to prescription drug coverage for employees, they are growing consumer awareness and critical thinking around what can and should be negotiated. Employers shouldn’t have to choose between healthy and productive employees and satisfied shareholders. Wondering about solutions to reduce healthcare spend so you can continue to attract and keep your employees? Hint: Lowering costs doesn’t have to mean less coverage...

Employers want the workforce to be as healthy as possible—but health doesn’t always seem like something the American healthcare system is set up to provide. We recently interviewed Paige Cooke, Assistant Director of Customer Engagement at NCQA (National Committee for Quality Assurance) in Washington D.C., about healthcare delivery and finance—and how employers can navigate this intricate system. Everyone is using a different definition of quality, and nobody is communicating about how to coordinate care. “We’ve been working with a very fragmented system,” Paige said.

We know more now than we ever have about what makes us healthy. Why then do healthcare costs continue to rise? Today we interview Rick Gonzalez from CommuniCare about the evolution of healthcare and the obstacles and solutions facing stakeholders. When it comes to our health, Rick knows that prevention and engagement are two of the most effective means to driving down costs and keeping patients well. The challenge is ensuring that prevention and engagement are aligned with what we know about human nature and the future of healthcare.

How does healthcare payment methodology work in light of the four stakeholders of healthcare finance? How can self-funded employers make the art and science of medicine valuable for themselves and their employees? We recently interviewed Peter Gallitano, a healthcare executive with an academic background in pre-med and finance and professional experience in the clinical, financial, operative, and tactical components of medical providers. With regard to gaining value in healthcare, Peter believes all four stakeholders need a system that creates value for themselves and each other. Complexity is the root of the current problem but the seed of a future solution.

Is there a way to save money from insurance? Will taking a risk end up saving money in the long run? Today we interview Don McCully from Medical Captive Underwriters, and he has a goal to have captive underwriting be as transparent as possible. When it comes to captive underwriting, Don knows that there are risks that need to be measured out when proposing new plans, and sometimes they are risks that employers don’t want to take. That is, until they realize the potential of what they could be saving.

We’re all just asking for a little respect. We all have different backgrounds, cultures, income-levels, and experiences. Our co-workers, bosses, and customers all have different ways of seeing the world than we do. Those differences can divide us and make it harder to work together, or they can be a reminder to treat each other with the same respect we want to receive. That’s why cross-cultural sensitivity in the workplace is and always will be important. In this episode, Lisa DeRoche, VP of Human Resources at Brightpoint Health, discusses how promoting cross-cultural sensitivity and respect for both patients and peers leads to a better healthcare experience for everyone.

If your healthcare provider got a report card, what would it say? Beatriz Coningham from the National Committee on Quality Assurance has the information at her fingertips, but do the decision makers in your Human Resources department? In this episode we interview Beatriz, who is the NCQA’s Assistant Vice President of Human Resources.

Primary care physicians have a time deficit. Rising overhead costs due to the reimbursement system force physicians to take on too many patients. On top of that, unhealthy lifestyles cause massive health concerns that primary care physicians don’t have the time to address. So the problem is pretty obvious, but how do we fix it? How do we give primary care physicians the time required to properly treat patients and positively contribute to a higher quality of life while also mitigating high insurance costs? In this episode, Dr. Stephen C. Schimpff, author of Fixing the Primary Care Crisis: Reclaiming the patient-physician relationship and returning the healthcare decisions to you and your doctor, discusses how to solve the primary care problem through means such as lowering the physician-to-patient ratio and using health insurance properly.

Once upon a time, primary care physicians handled all but the most perplexing specialized cases. Those were the days in which a doctor wasn’t running from room to room for 12-minute (or less) visits. They had the time to actively listen to patient concerns and the familiarity with the patient history to handle the cases without referring to a specialist. It’s hard to find that type of relationship today due to the way that healthcare has changed. The burden of rising overhead costs and the hassle of dealing with multiple insurance companies have contributed to inadequate primary care visits and physician burnout. In this episode, Dr. Stephen C. Schimpff, author of Fixing the Primary Care Crisis: Reclaiming the patient-physician relationship and returning the healthcare decisions to you and your doctor, discusses the problem with primary care that doctors face today.

If you’re an employer struggling with this idea of improving retention and reducing turnover, you're not alone. You need to solve the retention puzzle, ASAP. You need to hear from Todd Tangeman, the Chief Operating Officer and Chief Human Resources Officer for Newton Medical Center. Retention represents a lot of value. “There are costs associated with hiring and training and onboarding folks,” Tangeman said. “There’s a cost when good members leave.”

Everybody in the healthcare continuum should care about AMPS. Because reference-based payment is the future, that’s why. Today’s episode of Healthcare Simplified features John Glascott, Chief Revenue Officer of Advanced Medical Pricing Solutions (AMPS), which offers medical bill review. “We have something we call clinical only medical reviews that review overcharges mistakes—what we call fat finger—a charge that was $710 entered as $71,000,” Glascott said. Find a breakdown of this episode here.

Let’s get the bad news over with first. The number of people who die from hospital mistakes could be as high as 400,000 per year. On today’s episode of Healthcare Simplified, Tyler Willse interviews Leah Binder, President and CEO of the Leapfrog Group. She specializes in helping employers use their leverage to get safer and higher quality care for their employees. “When they looked at their own covered lives, they were stunned to realize that they were potentially losing an employee every other day,” Binder said.

Wouldn’t it be great to walk into a doctor’s office and have them tell you exactly how much a procedure is going to cost? Mechanics do it. Contractors do it. Even veterinarians do it. But, for the most part, doctors don’t. Or, it might be more accurate to say, they can’t. Our healthcare system just doesn’t work that way. In this episode, Karl Ahlrichs, with Gregory and Appel Insurance , breaks down what reference-based pricing is, and how it can help limit post-doctor visit sticker shock. You can find a breakdown of this episode here.

It shouldn’t surprise anyone that daily decisions and lifestyle choices affect health. The next step, of course, is that these decisions in turn affect healthcare costs. The main issue in combating prevalent problems like obesity and prescription costs has been figuring out how to quantify how an individual’s choices cost. The rise of wearable technology and wellness apps are beginning to solve this problem. In this episode, Jim Campbell, President and CEO of BWell, gives some insight into how these developments can change behavior on an individual level and reduce healthcare costs. You can find a breakdown of this episode here.

On today’s episode of Healthcare Simplified, Geb Buchness, Senior Vice President of Business Development at Armada Health, is here to say that overlooking referrals specialists is a huge mistake. “One of the biggest pain points in healthcare is the breakdown between primary care and specialty care—when a member gets a diagnosis and needs a specialist,” Buchness said. Everybody wins when you use advice to achieve quality outcomes and to find good specialty care.

So, you bought some milk online for $15 a gallon, only to go to the store and see that you could have spent $4. Believe it or not, this happens in healthcare all the time. (But with drugs, not milk.) That’s why we’re here talking to Kathy Campagna, Vice President Business Development and Director of Specialty Drug Strategy at Magellan Rx, which has a site of service program to help you save money without a lot of member disruption. She has worked for the last 10 years in the medical pharmacy area for Magellan Rx Management figuring out how to deal with the high trends in spend that occur for medical drugs. Find a breakdown of this episode here.

No matter what your profession, it’s painfully evident that healthcare costs are out of control. From skyrocketing premiums, to erroneous payouts, the healthcare world is confusing, and without the right help, can be ripe with fraud, waste, and abuse. Luckily, this is where Scott Ward and the team at Health Integrity LLC come in. With a team of 75 investigators nationwide, Health Integrity provides data-driven analysis for the healthcare industry, with a particular eye on fraud, waste,& abuse. Today’s guest is Scott Ward, Sr. Vice President at Health Integrity LLC. You can find a breakdown of this episode here.

Pratter, Inc. is bringing real-cost transparency of healthcare to millions of insured Americans, giving them power to spend (or not spend) as healthcare consumers. Today’s guest is Dr. Bill Hennessey from Pratter. Dr. Hennessey is passionate for people to realize their place as consumers, rather than see themselves as patients. Listen as he talks with us about how cost transparency is helping employers and employees understand the true cost of healthcare.

How is a health insurance company like a battleship? This is surprisingly easier to answer than how a raven is like a writing desk. Large national health insurers have all the impressive size and capability of an iconic battleship, but they also have the issues of movement that come with that size. On the other hand, smaller insurers can adjust more quickly to changes in the market. They’re more likely to implement new methods of doing business like focusing on the local life or using data to predict and manage costs. In this episode, Dustin Plantholt, Chief Sales and Marketing Officer of Evergreen Health, Inc., explains why and how a small local company using data to drive decisions can compete with major national insurers.

HCMS Group is a health information service company, who exists to help self-insured employers, health and disability insurance plans, and health service providers. Their cloud-based data solutions are changing the population health management game to the benefit of both individuals and organizations. Today’s guest is Mick Simon from HCMS Group. Here, Mick speaks with us in detail on the how and why behind the HCMS Group mission to reduce healthcare waste, while improving individual health and employer profitability.

Despite being a physician, Dr. Florin Selaru knows the frustrations of a patient. He’s experienced the two to three week wait to get his children to a doctor. He knows what it’s like to see them have only 10 minutes allocated to them once they’re there, and to receive a high-priced bill that doesn’t always clearly match the quality of the appointment. As a physician, he also has recognized the limitations of the system. So his mission was to figure out a system that works better for patients. In this episode, you’ll hear Dr. Selaru discuss how his company, Clarii Health, is trying to revolutionize population health management and employer concierge care.

BHS is redefining occupational health with their innovative employee assistance programs (EAP). They recognize that wellness is both mental and physical and their services remind employers that everyone needs a little help from time to time. Our guest today is Dawn Motovidlak, president and CEO at BHS. She shares with us the industry struggles of current EAP and her mission to affect change within organizations through preventative mental health care for employees.

The Greater Baltimore Medical Center (GBMC) is very progressive with its primary care model. This is especially true in some of their efforts to provide greater access to care. Today’s guest is Mark Lamos from GBMC. Listen in as Mark explains how he has demonstrated wellness in his own life, as well as how GBMC has set up systems to address many of the problems that healthcare centers commonly face.

Imagine going to a restaurant, ordering whatever you want, then getting a mystery-cost bill at the end: that's what the healthcare industry is like today. We're looking to change that. We want to enlighten our audience to transparency, which is now a cliche term in healthcare and many other industries. Still, we really do want to open your eyes up to the real healthcare industry today, which may not be as bleak as you think.