Healthcare Solutions

Dr. Marcelo Hochman, an accomplished Facial Plastic & Reconstructive surgeon, extends his expertise to a diverse patient base, encompassing both pediatric and adult individuals, irrespective of insurance status—be it insured, self-pay, or pro-bono.Known for his advocacy in legislative initiatives, Dr. Hochman has spearheaded projects such as the repeal of the Certificate of Need, the prohibition of economic credentialing and non-compete clauses, and the promotion of tax incentives for doctors offering pro-bono medical care. He crafted the Action PPE project, which evolved into a nationwide movement that supplied 6 million units of PPE to independent practices during the pandemic. His humanitarian efforts have earned him accolades, including The Order of the Palmetto.Healthcare professional and host, Cristy Gupton, interviews Dr. Hochman about IndeDocs' upcoming event. The two discuss the benefits of pro-bono medical care, along with the benefits of owning a practice which isn't tied to a larger figurehead. Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

Health Plan Fiduciary Compliance, LLC will save you time and money on CAA compliance.Tony Sorrentino is the President of Health Plan Fiduciary Compliance, LLC. He has served within the business community providing professional services in accounting, law, and employee benefits consulting to hundreds of Nebraska based businesses for over 40 years. Sorrentino wants to save employers time and money through his business.Healthcare professional and host, Cristy Gupton, interviews Tony Sorrentino about his company, Health Plan Fiduciary Compliance, LLC. They discuss the ERISA and CAA compliance, along with how to save employers money.Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

American HealthScare is now available for purchase.Dr. Richard Young is an author and researcher. He wrote the book: American HealthScare. It discusses the efficiency and capability of American businesses, and the disconnect employees feel within the companies. Within the book, he discusses the grim possibility of a bleak feature if we don't work to fix things now. The book also features various solutions that American society could take to begin countering the 2060 dystopia. Healthcare professional and host, Cristy Gupton, interviews Dr. Young about his latest book, along with discussions on the approaching 2060 American Healthcare dystopia. They attempt to find solutions, and discuss the effectiveness of these solutions in countering that possible future. Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

Blackwell Captive Solutions offers self-funded solutions with their Diamond Standard. Kari Niblack is the President of Blackwell Captive Solutions. She has served as an ERISA and employee benefits attorney involved in U.S. healthcare for more than 25 years. Niblack holds unique perspectives on healthcare, health administration, and health management. Healthcare professional and host, Cristy Gupton, interviews Kari Niblack about her company, Blackwell Captive Solutions. They discuss the importance of custom plans for unique workforces, and how BCS provides the best care for your company.Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

Are hospitals overcharging you? Do you feel stuck with your bad healthcare?Christy Vago serves as Vice President of Business Development at Upland Advocacy. She is a dynamic, accomplished self-insurance leader with a successful track record of driving bottom line growth in new business revenue.Healthcare professional and host, Cristy Gupton, interviews Christy Vago about the current healthcare crisis in the United States. They discuss common healthcare debts, along with ways to get funding and avoid health debt.Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

Healthcare has evolved to make a profit at the expense of reliable, accurate healthcare.Chip Harvey serves as the Regional Vice president for Homestead Smart Health Plans. Harvey studied Economics at the University of South Carolina. He uses his financial knowledge to help with healthcare cost containment. Healthcare professional and host, Cristy Gupton, interviews Chip Harvey about providing issues plaguing the current healthcare industry. They discuss the fiduciary responsibilities of companies and doctors. They discuss ways to contain costs and tear down the barriers in the healthcare industry.Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

Should the law impact healthcare?Healthcare professional and lawyer, Chris Deacon, is known for her work as a public sector leader who oversaw the New Jersey State Health Plan. In this position, Deacon created positive change for the state of New Jersey and saved 2 billion dollars for the plan's members. North Carolina Commissioner of Insurance Mike Causey a politician that has served in his position since 2017. His goal is to fight for more competition in the healthcare industry and combat insurance fraud. He proudly serves the people of North Carolina.Healthcare professional and host, Cristy Gupton, interviews Chris Deacon and Mike Causey on the upcoming North Carolina bill, H346. They discuss the shady happenings behind the bill and their fears of how the bill will harm the people of North Carolina should it be passed.Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

Should the cost of scans stop you from taking care of yourself? No!Dr. Cristin Dickerson is a founding partner of Green Imaging. Healthcare professional and host, Cristy Gupton, interviews Christin Deacon on the Mass. Health and Welfare Fund v. Blue Cross Blue Shield of Mass. During the interview, the two discuss and clarify confusion related to ERISA Fiduciary Duties. Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

Can the law impact healthcare?Healthcare professional and lawyer, Christin Deacon, is known for her work as a public sector leader who oversaw the New Jersey State Health Plan. In this position, Deacon created positive change for the state of New Jersey and saved 2 billion dollars for the plan's members. Healthcare professional and host, Cristy Gupton, interviews Christin Deacon on the Mass. Health and Welfare Fund v. Blue Cross Blue Shield of Mass. During the interview, the two discuss and clarify confusion related to ERISA Fiduciary Duties. Learn more about the healthcare industry by following the Healthcare Solutions Podcast. Need healthcare consultation, retirement strategizing, wellness consultation, or benefits enrollment? Custom Benefits Solutions has your back.

In part 2 with Doug Aldeen, we get into more commentary about hospitals and how being honest and fair with people has the makings of a very good payday if you approach it with integrity. But will they do that? We also drop a bombshell called for in Section 501R of the internal revenue code. Find out more on this episode of Healthcare Solutions!Timestamps:00:00 Intro01:25 From last week's episode…04:00 No barriers to having “your personal physician on speed dial”04:40 DPC—start with it first!05:27 Hospital CFOs—listen up…you can make a good living just dealing fairly with people06:00 Insurance companies + hospitals OR insurance companies vs. hospitals...which is it?07:15 Who has offshore accounts? WTH!07:52 EMTALA was passed in 1986, if you show up at an ER you must be treated09:23 Can hospitals have non-profit status revoked?10:00 Hospital market conduct will see more scrutiny from federal regulators10:45 Suing someone based on a fake price? Scumbags!11:00 501R…oh SNAP! Why isn't anyone talking about this?12:00 Not winning the mother of the year award, I procrastinated on getting my kid's bloodwork14:00 Mommy becomes a secret shopper, $951.00 for A1c, lipid panel, metabolic panel14:52 25x on Rx and supplies at hospitals15:55 Time for the smelling salts, transparency bill may be just what the doctor ordered17:00 Give hospitals the opportunity to fulfill their charitable mission18:00 Pre-qualify employees on your census for your local hospital's financial assistance policy18:50 1-2% is earmarked for charity care? That can't be right.20:00 Dr. Marty Makary at 2021 Health Rosetta Summit in Dallas, TX. This video is similar to the talk I heard in Dallas last year.21:00 Financial harm is happening every day and doctors need to stand up and return to their roots23:45 Article on rural hospitals closing—Schuessler LinkedIn post25:00 Anything is possible, maybe those shuttered hospitals can someday reopen under new management26:00 Thank you Doug! Employers + Doug + a good advisor = a winning combination! www.dougaldeen.com27:00 #letsfixhealthcare www.custombenefits.work

Cristy Gupton and Doug Aldeen have a great discussion about fiduciary duty and how the new transparency law is going to make it easier for those charged with that task to honor their duty.Timestamps:00:00 Introduction02:20 Doug Aldeen's background03:28 So, what is the price?04:30 If you're uninsured or underinsured you need to be asking for your hospital's Financial Assistance Policy05:50 Quizzify's emergency consent is a gift to all people who might need emergent care...thank you, Al Lewis!07:14 If you're being asked to sign something in the ER you must advocate for yourself or there's no turning back08:00 No judge in the country would disagree with paying a fair price for ER services09:11 Mark Watson of Union County, NC--a true fiduciary. Go back and listen to this episode https://www.custombenefits.work/news/2019/3/28-episode-6-t955b-362c710:18 Leon Wisniewski of Health Cost Labs, he's publishing hospital pricing online.10:50 Information seeing the light of day means fiduciaries can't sit on their hands much longer11:33 ERISA--the 2 faced law of convenience for health plan fiduciaries13:00 Hey fiduciary! Start today!13:46 "Turbocharging"...what's that?14:55 Coming out of COVID, self-preservation efforts should lead CFOs to start looking at their health plans as ground zero15:30 The transparency bill...should we get excited or roll our eyes?16:10 The fine is no biggie, that's why eye-rolling might commence16:40 But if hospitals really thumb their nose at it, will it jeopardize their Medicare status?17:50 In light of value-based payments from Medicare, why do hospitals work so hard to get better payments from Medicare if it doesn't cover the costs?18:43 So, does Medicare actually cover the costs or not? 7-9% margin in the aggregate.19:30 Medicare Payment to Cost Report21:21 Can't we all just get along? Willing buyers and willing sellers in mutually beneficial exchange. I could get behind that.22:05 Employers come to the table...that's what starts the conversation.22:30 Having some market intelligence when you come to the table at least gets the conversation started.23:10 DPC rose from the underground during COVID, see also this video from Custom Benefits Solutions23:55 First patients in the door are usually uninsured24:23 Referrals are going to need to happen at some point24:47 Never say "what do you charge"25:08 Instead say "what would you accept if I pay cash"25:55 A quasi-contract seed was planted right then26:31 Employers can benefit from this arrangement without having to do all the work26:52 The contracts are pretty straight forward especially when there are 2 willing partners27:30 This is why being an independent doctor is so important28:21 The ACA gave hospitals the license to steal28:40 DPC is the smartest cost-containment strategy and if you start with it first it leads to many other innovations29:00 Thank you! #letsfixhealthcare, www.custombenefits.work.

Tune in for the continuation of my conversation with Dr. Keith Smith, medical director of Surgery Center of Oklahoma and co-founder of the Free Market Medical Association.Timestamps:00:00 Intro02:20 From last week's episode04:55 This trend started by Surgery Center of OK is growing06:09 What is it like to come to SCO?06:18 Side note: the first patients who came to SCO were from Canada, Alaska, Wisconsin...areas that are ridden with no access to care09:00 First you'd reach out online via SCO's website (surgerycenterOK.com) and click on "request a specialist"09:29 Dr. Smith himself matches the patient with the right specialist, then the surgeon calls you directly10:45 When you arrive in Oklahoma, you meet with the surgeon in their office to confirm that everything is a go, then go to SCO the next day for your procedure.11:05 Depending on the need, you may have a home health nurse come visit you a couple times per day in your hotel room.11:23 When you arrive home your surgeon stays in contact with you, your primary care doctor and your physical therapist...whatever is needed.12:58 If patients can't travel or wouldn't make good medical tourism candidates, Dr. Smith can coach them on how to get a better deal locally using his prices in OK13:08 And with Atlas Billing Company, Dr. Smith can act as the guarantor of his pricing in your local area15:36 Sounds like concierge treatment at bargain basement prices17:00 How do we influence tomorrow's doctors with this movement?18:09 Start with supporting the Benjamin Rush Institute, donate here: https://benrush.wufoo.com/forms/r5pz5a306b4933/.20:07 Remember, it's an ethical issue. If you work for a hospital, it's very unlikely you can always put the patient first21:45 The "Do No Harm" oath is possibly a thing of the past22:24 Read Dr. Marty Makary's book "Unaccountable" or watch the series "The Resident" inspired by that book to see validation that what Dr. Smith describes is true24:00 If you really want to know where to get the best quality in a hospital setting you need to interview the staff who work there24:30 Let's talk about the Free Market Medical Association--an organization composed of willing buyers and willing sellers27:37 Who can argue with both cheaper AND better?29:00 The true enemy of the free market is the government30:44 See FMMA's upcoming Annual Meeting in August 2021 in Dallas, TX31:17 Talk about cheaper and better! DPC + Sedera is cheaper and better than any insurance policy I've ever seen for individuals35:21 You must leave behind the insurance status quo if you expect to be treated quickly and treated well in healthcare like if you were a celebrity36:43 Insurance is not necessary for 85% of a person's healthcare needs38:10 Watch "The Big Short". You'll find so many parallels to the healthcare industrial complex as were happening in the banking crisis of the late 2000s39:33 What's a day in the life of Dr. Keith Smith46:00 Thank you! #letsfixhealthcare, www.custombenefits.work.

Dr. Keith Smith literally changed my life. As a "broker" selling employee benefits I stumbled on another podcast (way back when) where Dr. Smith was the guest and transparency was the subject of the day. It shook me out of my comfort zone and led me to the advisor I am today.Timestamps:00:00 Intro01:27 How I came to know Dr. Keith Smith03:05 The Shiftshapers Podcast, Episode 164. That's where I heard the shot Dr. Smith fired around the world.04:36 This story may surprise you05:07 Pardon the misspeak there...I meant to say January of 2019. My bad!07:00 Compare your surgery claims data to the fairly priced, free market, undiscounted, bundled and guaranteed cost on the Surgery Center of Oklahoma's website.08:39 OMG! The insurance carrier fired the client! What?10:05 Your insurance carrier has a lot to hide. Trust me.10:40 What is employer-built healthcare? Find out here: mitigatepartners.com11:09 Insurance companies hang their hat on their PPO network. But is that even a real benefit to you?11:25 PPO networks are the ultimate participation trophy12:25 Dr. Smith and I share the distinct honor of being fired by a carrier14:23 Joining a PPO network was not only a mistake, it was like inviting a cancer into our organization.15:10 Generally, prices at Surgery Center of OK (surgerycenterok.com) are about 1/5 of what insurance companies charge to the plan.15:39 Most of the time the carriers don't want high quality and fair pricing because it's counterproductive to their revenue model16:11 SCO will file claims as a courtesy but many times patients find that the entire fee they paid at SCO is lower than their deductible on their insurance plans17:06 When the ACA was passed deductibles were allowed to skyrocket and those patients are "functionally uninsured"17:22 Check out SHOPHEALTH at fmma.org20:00 Watch this webinar21:26 Don't believe the balance billing lie22:15 Well, they were partially right24:22 Now the client agrees their plan is actually a benefit, as opposed to before when their plan was only benefitting the insurance company26:50 Waiting room story. BTW, I don't wait in waiting rooms any longer. I have Direct Primary Care.30:00 State of Oklahoma could have saved $200M but they caved to special interests32:15 A good lesson to learn is to just NOT work with entities who are dishonest (aka not transparent)32:53 There's a gold nugget here! Instead of using "leverage" to get better prices (like your broker or insurance company is telling you), it's much smarter to engage in a mutually beneficial exchange33:13 That's all for today! Join us again next time to #letsfixhealthcare, www.custombenefits.work.

Tune in for part 2 of the conversation with investigative healthcare journalist Marshall Allen and Cristy Gupton in the world of medical bills and Marshall's path through the industryTimestamps:00:00 Intro02:25 On last week's episode03:00 Marshall's new book "Never Pay the First Bill: and other ways to fight the healthcare system and win" will be available June 22 (earlier than expected)! It's a step-by-step guide to coaching employees on how to save money in today's confusing and opaque healthcare system.03:45 Introducing Professor Allen! Now conducting employee education meetings for your employees who have a vested interest in keeping your health plan sustainable for decades to come.04:52 Remember, health plan dollars are ALL employee dollars! That's why there's a fiduciary duty in the first place. We need "woke" employers. If employers don't wake up, Marshall's book can at least help employees.07:45 Since healthcare is considered employee money, employees will need to go through their own awakening. Employees will need to learn how paying reasonable charges for healthcare is helping them on all levels.09:29 Dr. Eric Bricker, get to know his daily video teachings at AHealthcareZ, he describes our healthcare system as a national crisis and calls out price gouging.10:44 The government is not going to help change the healthcare system. We're on our own and that's OK. Marshall's book helps us learn how to fix our own problems.11:18 One in six Americans are dealing with medical debt collectors which is shameful since we spend twice as much as most other countries.12:30 The supercharged, overly inflated starting prices only exist to game the system and let's not mince words...that's dishonest! and it's discriminatory!14:00 Why do we accept the age discrimination of charging more to employees with health insurance more than what's charged to Medicare patients14:15 Marilyn Bartlett's new work with NASHP is giving states a Medicare cost analysis so that they can see that a hospital's medicare revenue is adequately covering their costs (not that they want you to know that).14:47 A local hospital's director of managed care even admitted to me that they rely on employer-sponsored plans to cover what they report as their loss on Medicare business. Truth is, they make plenty of money on Medicare and they way they gouge employers for the same services needs to be exposed.15:30 Medicare rates are established in the first place by hospitals who self-report what it costs them to do a procedure. Using the NASHP hospital cost tool local communities can hold their hospital accountable for what they are charging.17:43 The real payers--the employers in those communities can use that tool to establish prospective cost agreements with their local hospitals about what their employees will be charged if they seek care locally.18:35 Does Marshall Allen ever lose? Does he have to give up without getting the story?20:30 BUT! One story Marshall wrote about ended up influencing lawmakers and has fingerprints on the last major piece of legislation from the Trump Administration--The Consolidated Appropriations Act. Among other things, it requires insurance brokers to disclose their compensation to their clients.24:30 Disclosing my revenue to my clients is not a new thing for me (I've been doing it since 2017), but now that it's required I'm thinking of it as a new opportunity to show my clients the expense side of my balance sheet; thereby showing them how I reinvest the revenue I earn into the services that help their health plan operate more efficiently than others.27:27 What's a day in the life of Marshall Allen?29:50 Go to www.marshallallen.com and place a bulk order for his employee education series that goes along with his new book.31:14 Connect with Marshall on LinkedIn and follow him on Twitter31:40 Thank you! #letsfixhealthcare, www.custombenefits.work

Tune in to investigative journalist Marshall Allen & Cristy Gupton as they delve into the world of Medical bills in the greater healthcare system.Timestamps:00:00 Intro02:20 Side note: release date for Marshall's book "Never Pay the First Bill: and other ways to fight the healthcare system and win" got pushed up to June 22, 202103:10 I skipped Marshall's bio because you can read about it yourself on his own Wikipedia page...that's pretty awesome right there!03:34 I first learned about Marshall Allen when he wrote a story about Marilyn Bartlett, the phenom who fixed the Montana State Health Plan04:00 Marshall got the story from Carl Schuessler who's always on the front lines fighting the good fight.04:38 ProPublica's mission to bring about change by telling stories but it takes a lot of dedication to make sure the facts check out11:00 Another story about a mom who had a premature baby and was billed over $800K by her own employer14:57 While my words "civil disobedience" are a bit strong, Marshall's description is more fitting..."people should not take advantage of other people" and his book gives every American the confidence to advocate for themselves15:47 25% of healthcare spending is wasted, what if we could reduce our own healthcare costs by 25% if this waste didn't exist16:27 Unfortunately, we're in a situation where there have to be winners and losers, right now the employers and employees are on the losing side17:54 Marshall asks me if I'm seeing that same thing in my world, my answer? I see more individuals standing up and saying "I don't need this anymore"20:22 Unnecessary care: here I go telling this DPC story again...but it's a good one22:22 In "Never Pay the First Bill" there's a chapter on avoiding unnecessary care and asking questions like "what's the worst that could happen if I don't follow your recommendations"25:56 Employees who have the blank check that is the insurance plan ID card in their wallet would do so much good for their fellow employees to ask the right questions27:09 We finally say the name of the book. Order here: https://www.amazon.com/Never-Pay-First-Bill-Health/dp/0593190009/ref=sr_1_2?crid=223PO7G0SN3RA&dchild=1&keywords=marshall+allen+book&qid=1622391946&sprefix=marshall+allen%2Caps%2C191&sr=8-227:30 Thank you! #letsfixhealthcare www.custombenefits.work

Continue the conversation with Cristy, Scott Ray, and Heath Potter in understanding current healthcare transparency, hospital negotiations, and reference-based pricing.Timestamps:00:00 Intro05:32 Many employees don't realize their employer is the health plan06:18 Lots of employee education is needed06:38 The irony of change can be comical07:12 Change can also be cyclical. Cycling back to more local care teams rather than "corporate medicine" is happening.10:10 Healthcare Buyers and Sellers don't have to be adversaries, there's an opportunity to work together.14:28 When smart spending happens on the big things, smaller ticket items are easier to afford too.15:12 Local governments should take note, they're hurting their communities by overspending on healthcare17:26 The "outlier provision". Know what that is? You need to because it's eating your health plan alive.19:06 Networks started out as a good idea, but the middlemen got greedy over the years.20:20 Hey, Mr. Hospital. So, you got caught being greedy? Now's your chance to learn a lesson about free markets.21:41 Employers have options now21:45 Health Rosetta + 6 Degrees = High Performing Health Plans where best-in-class solutions can be built on a solid foundation25:51 This is not a get rich quick scheme. We're all mission driven at this point.26:16 Creating happier, healthier, more productive employees...isn't that the whole point of employee benefits?27:30 A lot of us thought HDHPs were a good thing at first, until we didn't.29:00 What does the future hold?31:15 Signing off from beautiful Portland, OR31:49 #letsfixhealthcare www.custombenefits.work

Join Cristy with Scott Ray and Heath Potter in understanding current healthcare transparency, hospital negotiations, and reference-based pricing.Timestamps:00:00 Intro00:39 2020? See ya, wouldn't wanna be ya!01:25 Intro to 6 Degrees, Scott Ray and Health Potter02:37 Better for Less $$? Sign me up!02:57 Medicare Rate Sausage? How is it made?04:08 So, hospitals CAN cover their costs with Medicare reimbursement rates? Huh, that's not what they've been telling us.05:18 And there's a wide variation in costs between hospitals nationwide.06:14 So, if Medicare doesn't cover a hospital's reported costs you have to ask the obvious question...WHY?07:50 The short answer is due to lack of transparency and lack of competition.08:34 It's counterintuitive but higher quality costs less in healthcare.09:20 It took RBP (reference-based pricing) to start the conversation around quality and fair pricing.10:23 Back in the day, hospital's first knee-jerk reaction was to fight transparency. Wait, that's still happening today.10:56 Now, if you don't present a PPO network card then you're considered cash pay. Which frankly helps employers pay a fair price.11:22 Hey Mr. Hospital? Ever heard of the free market? It still exists.12:22 Transparency alone is not the total solution.13:26 FL Case Study.18:24 In NC, people are getting "heated" over this discussion.19:42 Balance billing isn't exclusive to RBP plans. What do you think a deductible and coinsurance is? Duh!21:43 What happens when an employee has an accident? How does RBP work then?21:58 First of all, don't forget about EMTALA. You can't be turned away at an ER.22:39 If we have to, we'll show you the data to shame you into being fair.23:17 But once in a blue moon you have to stand up to the bullies...with the help of 6 Degrees.23:51 Even hospital VIPs admit their gross billed charges are meaningless numbers.24:38 Smart plans are done with this.25:00 2020 was supposed to be the year employers pushed back. I don't wanna talk about 2020.26:32 Don't forget about quality. Is your broker using MediVi?26:55 Proactive vs. Reactive.27:26 Employees need to go on the same "learning journey" that the decision-makers went on.28:29 Employers need to be transparent with their employees too. Just tell them the cold hard truth about the healthcare system.29:48 See you next time! #letsfixhealthcare www.custombenefits.work

00:00 Intro00:40 Vinay Patel of Self-Insured Pharmacy Networks01:25 In last week's episode02:38 A day in the life of a community pharmacist03:32 Pharmacists in a big box format want to cater to patients just like community pharmacists do03:53 We're replicating the same model on the pharmacy side as DPC has done on the medical side04:41 Care coordination needs to happen all throughout the local care team (healthcare supply chain)05:41 Community pharmacist is just that--part of the community07:00 More tools, more attention to detail, more customization07:38 Less overspending, overtreatment, example = mail order07:58 Smaller is better, especially if you're trying hard not to overspend12:00 Is mail order even all it's cracked up to be?14:30 Those dealing with healthcare challenges could benefit by having another member of the local care team to help "tag team" with the physician18:24 When you have a chronic disease you need high-touch support and accountability19:00 Getting back to the basics might not be a bad thing20:00 We drifted away from relationship-based primary care but we're coming back to it20:32 www.sipharmacynetwork.com, Self-Insured Pharmacy Networks based in Raleigh, NC21:00 vinay.patel@sipharmacynetwork.com21:41 No one definition of "specialty drug". The definition your PBM gives it is in your contract22:15 Get an actual list of what specialty drugs are on your formulary22:26 Make sure you ask lots of questions22:47 There shouldn't be any generic drugs in the specialty category23:37 Allocate much more time to the PBM contract25:00 Spend more time to the upfront education about the prescription drug benefit and what goes into that design27:00 Crawl, walk, run strategy28:30 Employers need a co-fiduciary to be their partner30:00 Carriers glossed over Rx like there was "nothing to see here"31:00 Rockford, IL story32:00 You MUST read your PBM contract33:43 This is people's lives we are dealing with34:00 Municipality resources are deficient today because of the drainage into the healthcare system35:00 Thank you, www.custombenefits.work, #letsfixhealthcare

00:00 Intro00:40 In today's episode00:58 Vinay Patel of Self Insured Pharmacy Networks02:16 What is a PBM?02:32 PBM = claim processor just like a TPA on the medical side03:15 but also rebate management, clinical management, etc.04:17 what about the cost?04:42 episode 8, "transparency" 05:08 Tim Thomas, quote on transparency05:50 There's money in here, if you can find it--it's yours06:02 Do we just need transparency? Or do we need a fiduciary?08:00 It all depends on what's in the contract08:56 Fiduciary principles mean I'm acting in the best interests of my client09:57 NADAC = National Average Drug Acquisition Cost11:09 University of Lynchburg Master's Program in Health Benefits Design12:06 All things being the same, the price fluctuates by hundreds of dollars13:00 Supply & Demand still exists but Rx prices can still be normalized13:13 Manufacturers adjust brand names twice per year14:17 Average Wholesale Price (AWP) means wholesalers are setting the prices14:55 A little disruption might be in order here15:25 We should have a buyer's market, not a seller's market15:50 Direct Primary Care doctors are also dispensing Rx onsite16:40 Let's step back and highlight DPC17:20 Patients want a relationship with their providers, Providers want that too18:12 Now that DPC has primary care handled, let's give them better access to Rx18:57 A subscription model for Rx also20:00 How many pharmacies are locally owned?20:39 Answer = one third, about 22,000 pharmacies21:47 A superior customer experience with care catered to the patient23:40 Pharmacists in big box stores want to cater to patients but can't because of the system25:30 A "concierge" pharmacist? Yes, it's possible26:39 Local care team like Carl Schuessler says in the "Marcus Welby days"28:12 Quadruple Aim means the physician/provider experience is important too29:01 Cliffhanger--What's a day in the life of a community pharmacists?29:08 That's all for today29:16 Thank you, visit us at www.custombenefits.work, #letsfixhealthcare

00:00 Intro01:00 Doctors entertain concepts of cash payments with patients01:06 Dr. Jordan Johnson, DC—Morganton Chiropractic01:30 In last week episode…04:00 Let’s talk about diet05:00 Food Guide Pyramid05:30 What we define as “food” is key05:37 Michael Pollan06:25 What is “real food” anyway06:46 Food, Inc., documentary-directed by Robert Kenner07:25 Farmer’s Market First!07:54 Plant-Based Diet09:25 Don’t put Chiropractors in the “spine only” box10:25 Most issues result from chronic, repetitive misalignment12:00 Goal is to give the patient the skills to stay in alignment longer on their own12:56 Who pays you?13:00 David Contorno, “You work for whoever pays you”13:25 Article, “My personal dilemma”13:40 It’s very similar for physicians who are paid by insurance companies14:14 Third party payment system in between the doctor-patient relationship14:26 Doctors working at the discretion of an insurance company14:51 If the patient is actually paying then the doctor works for them15:05 The interaction between doctor and patient is a relationship15:48 Patients stop receiving care once an insurance policy stops paying16:12 The third party distorts the relationship and creates a barrier to care17:08 Found myself out of town without medicine, just decided to go without19:28 Third party payers lend patients to feel that care just isn’t worth the trouble21:35 Average patient is 40 years old with low-back pain21:45 First visit is about 1 hour long21:57 Second visit is about 30 minutes long25:00 Divert major surgery with better “joint care”25:09 Or, have to treat because surgery was performed but results were not achieved25:56 Once you have surgery, you can’t undo it26:57 Employers could pay Chiropractors directly as a preventive measure28:43 Health plan design should provide incentives for steerage29:30 Don’t just give your employees a provider directory and no other direction than that31:24 Ask the question, “do you accept cash”32:27 drjohnsonmorgantonchiropractic@gmail.com32:57 Thank you!33:00 www.custombenefits.work

00:00 Intro01:07 Dr. Jordan Johnson01:28 Cash-based practice02:14 My first interaction with Dr. Johnson at Morganton Chiropractic04:14 One way doctors keep their own overhead down and spend more time with patients06:38 Reverse-engineered pricing based on what was needed to have a healthy work-life balance07:30 First appointment is one hour long, subsequent treatment visits08:48 Why pay a higher price through an insurance company when the cash price is lower?08:57 Are the premiums we pay for PPO “networks” really worth it?09:12 Free MarketMedical Association, David Contorno, Shane Purcell09:25 Dr. Keith Smith, Jay Kempton founded the FMMA09:56 Faster access to care, more frequent care, less costly care lives in an environment where transparency and free market competition thrives10:19 Dr. Johnson’s story brought him to NC13:20 Insurance proved to be a costly model to administer which distracts doctors from patient care14:22 It’s just too much to expect doctors to understand insurance policies in addition to the skilled knowledge they must have to treat patients15:20 Direct Primary Care doctors felt similarly about overhead and time with patients17:20 Doctors still want to be advocates and direct patients toward better health, not just more healthcare17:40 Patients who pay high costs for ex. MRIs where the image isn’t even explained18:07 My first patient encounter with Dr. Johnson18:50 Pain! What a can of worms…19:20 Pain is just your body’s response to something wrong, covering it up with medication is not going to solve it20:17 You can’t beat gravity, you just have to counteract it21:16 My own symptoms and how they were relieved over time and never returned23:23 Patient education is key but having time to do that is MORE key27:04 Physical activity takes a back seat when pain exists

00:00 Intro00:45 Mark Watson and Kent Thomas01:47 In last week’s episode04:48 Now for more with our guests05:00 Plan design is SO important! Learn how to design your plan from the bottom up06:16 In what other part of our economy would we conduct our affairs this way…NOWHERE!08:06 You’re not in control until you know where the dollars are going09:00 Lots of plans are including DPC as an option but they’re paying double09:08 Primary care physicians can perform 85% of what patients need10:30 In DPC, a fixed, capitated cost is mutually agreed upon11:50 Do I have $10 today?12:39 That medical home becomes the “healthcare hub”13:00 Professional oversight is weaved in13:43 Can DPC show a natural reduction in the prescribing of opioids?16:00 Primary care oversight helps protect employees18:32 Local governments filing class action lawsuits19:42 If you don’t know where your dollars are going you can’t manage it21:15 I want to know why the costs are coming in the way they are12:32 Transparent pricing model, with audit rights, etc.23:05 We have an embedded pharmacist in our plan to provide consulting on costs24:28 DPC is incentivized to provide healthcare on behalf of the employer, who pays them28:45 “keys to the kingdom” you have to understand where the money is going and you have to get consistency in consumer behavior30:09 What is next?31:08 RBP, when implemented and managed correctly, puts employers in the driver’s seat31:36 Hospitals have purchased entry practices to “feed” the rest of the system32:36 So many hospitals were founded as non-profit, public entities…but today what have they become?33:56 RBP gives you license to start asking “do I really need a PPO network”?35:26 PPO networks…do we need them anymore?36:30 RBP loves rural hospitals so long as they have high quality37:46 Medicare is the “reasonable profit” benchmark38:56 Local Governments should hear this message39:17 Thank you!! #letsfixhealthcare www.custombenefits.work

00:00 Intro00:40 In today’s episode00:53 Mark Watson01:14 Kent Thomas01:34 What is a fiduciary?02:55 Our story started in 200203:33 County Commissioners knew status quo didn’t work any longer04:23 Consumer-driven healthcare was new at the time04:54 Transparency was a new question? How do you know you are getting the real answers?05:23 When your advisor is only giving you part of the picture, that is a problem.06:08 Dissecting the financial picture of the plan became a problem because of missing info06:44 2003, we implemented a CDHP, did away with copays, moderate deductibles, etc.07:29 We actually looked at the impact on the employee’s bottom line08:27 We made generic prescriptions available at no cost to employees09:31 Generic penetration jumped immediately and paid for itself10:24 Employee meetings brought success stories to the table13:00 Cute story about retiree realizing $200 per month savings14:00 2003, the first year of new strategies, yielded $1M in cost offsets to the plan15:20 Understanding the financials is important but you have to work at getting the data16:05 We’ve maintained a stable health plan since 200316:28 We stay within 1% of our annual projections17:21 As long as you can “see” the math that goes into it17:56 You’re always looking to “sharpen the pencil”19:05 Shiny new objects…don’t be fooled by them, especially wellness plans21:35 We kicked the tires on DPC for about a year and a half22:38 Maybe we wouldn’t even have ever needed wellness programs if we hadn’t undervalued the primary care relationship in the first place25:25 Eliminating barriers always leads to savings when the patient gains unlimited access to their doctor26:33 Data is great but what are the “action steps”28:12 Medical home model29:49 This case study should become a model to the rest of the public entities that need to adhere to a fiduciary standard30:44 Non=integrated silos are costing so much excess money32:01 The data exchange, so long as it’s good data, is key33:47 Join us next time! #letsfixhealthcare www.custombenefits.work

00:00 intro00:42 welcome Carl Schuessler01:18 in last week's episode02:16 absolving employee's of out-of-pocket cost burden02:54 low income + maximum OOP = recipe for bankruptcy03:30 employee's who go to their hospital employer have no OOP03:49 "friends of family" network04:22 removed all barriers to care04:35 what was the magic sauce?05:39 340B eligibility makes them unique05:58 Marshall Allen--ProPublica article06:48 keep more dollars in the community07:30 critical access hospital has

00:00 intro00:42 who is Carl Schuessler00:50 rural health is in jeopardy01:08 community healthcare gets a boost with Carl's new client01:33 hospital systems are employers too...and they need help02:24 started in 201702:36 Lee Gross, DPC guru and visionary03:05 rural hospitals all over the country are struggling03:28 demographics and local economy are huge factors04:25 even sending their own employees were having to go elsewhere for certain procedures05:05 some hospitals haven't learned how to think outside their own box05:32 hospitals need to get their own house in order06:28 current systems were not minding the store06:48 Carl identified a variety of risks that were not being attended to07:19 remove ALL barriers to employees who need to do better 07:40 be like George Costanza and do the opposite!08:03 made the hospital their own PBM08:20 pharmacy spend should see dramatic reduction09:00 pharma savings should outpace Reference-Based Pricing savings by a lot in this case09:23 avoidance of care because of disconnected care is a problem09:47 bringing Direct Primary Care right into the hospital setting for hospital employees was important11:00 integrating DPC right into the plan design11:43 partnering with a DPC provider is key11:56 80% of employees enrolled in the DPC option12:27 identified specific employee needs that were resolved immediately14:21 preconceived notions don't apply here15:07 Carl talks about his early steps with new client16:09 Fair Co$t Health Plan effective 1/1/2019 for new client16:31 hospital should see increased revenue just because of this change16:45 community outreach planned16:58 community built healthcare vs. insurance company built healthcare17:17 partnering with local, independent pharmacy17:43 plan design steerage17:53 assemble the local care team18:16 dis-intermediate the players and create the love triangle18:42 employers paying extra for so many layers of extraneous intermediaries19:17 it only took a 157-employee group to get it done19:40 local employers within vicinity will benefit20:20 pregnancy claims mitigated with cash based negotiating22:20 social determinants of health? quit talking and start doing!22:43 wrap up22:51 thank you and #letsfixhealthcare visit us at www.custombenefits.work

00:00 introduction00:42 welcome Mark Pew01:27 recap02:13 employer wake-up call03:34 whole person well-being programs03:52 absenteeism vs. presenteeism04:21 progress we've seen just in the last 5 years, like standing desks05:04 workplace culture change even affects what is in vending machines06:23 resilient thinking is a positive byproduct that results from positive workplace "whole person" well-being program fostered at work06:37 call it yoga? call it stretching? hey..whatever helps dude!07:09 the big lie of the 1990's--that we shouldn't feel pain07:45 pain is just part of the human condition08:08 we process pain in the brain08:46 attitude change, instant gratification has no place here10:30 employers are part of the messaging on the "whole person" healthy image11:43 employee wellness programs vs. employee total well-being culture13:15 local governments jumping on the class action lawsuit bandwagon14:15 public employers need to get their own houses in order15:27 we all had a role and we all need to help #cleanupthemess17:07 opioid prescribing decline began in 2012, now we are dealing with fentanyl crisis18:05 the lost generation18:25 functional restoration programs being paid for by Worker's Comp19:12 #preventthemess20:00 PBMs need to track the pharmacy trend and act on the "polypharmacy" issue when they see it happen20:42 withdrawal from benzos is worse than opioids22:13 anxiety associated with opioid use even after 3 days22:39 DisposeRx22:58 "Opioid Crisis Wake-Up Call" by Dave Chase23:31 speaking of hastags? #letsfixhealthcare23:45 where in the world is Mark Pew?24:46 blogger on LinkedIn, 2-3 articles per day25:08 @rxprofessor25:19 SIIA (Self Insurance Association of America) platform for advisors who serve self-funded health plans25:57 Announcing, Mark's new YouTube channel!27:02 he's the son of a preacherman28:19 wrap up28:30 thank you and #letsfixhealthcare www.custombenefits.work

00:00 Intro00:42 Mark Pew introduced01:26 Welcome02:00 How it started in 200302:40 "Poly pharmacy" problem03:40 Trends in data presented illogical conclusions04:21 First presentation to audience in 201305:12 Mark Pew on LinkedIn05:50 Most connections are not related to Worker's Comp07:18 Worker's Comp beat the healthcare insurers to the punch08:00 Own the care for life08:35 No "long view" on the healthcare side09:15 Medicare set asides10:40 Math is easy but not realistic11:47 Superbowl commercials14:33 Get a moral compass15:27 Social determinants play a huge role16:00 BioPsychoSocialSpiritual -- whole person model of care16:41 We've changed the dialogue in Worker's Comp17:40 Long journey which started as a financial issue18:30 Makes sense to eat an anti-inflammatory diet, functional medicine20:00 Vitamin D deficiency20:43 Press Ganey satisfaction surveys21:08 Get back to basics21:55 What we didn't know in the 90's22:30 Employee education is so necessary23:30 What's it gonna take?24:07 Infographic in the disability check24:41 Increased focus on well-being26:00 Employees need to "own" their healthcare journey26:42 Thank you, please subscribe at www.custombenefits.work #letsfixhealthcare

Cristy talks with David Contorno, Founder of E-Powered Benefits, about how he is helping an upstate SC County with about 1,000 employees break free from status quo healthcare and try something new.  They discuss the many moving parts of affecting change in a positive way even if everyone is not on board at first.  Learn from their experience and get excited about what you can achieve in your own community.

00:10 intro00:44 welcome and what's up?01:10 primary care revolution02:16 what does direct primary care cost?02:40 Free Market Medical Association--Carolinas Chapter03:17 it's just like paying for a gym member03:50 what if employers knew what they were missing?05:00 PCPs are overworked and underpaid by insurance companies06:40 direct pimary care includes a lot more than the office visit08:18 DPC docs don't need no stinkin' insurance09:25 the reveal--my own personal story11:16 "I need to see you back in 90 days"11:55 I had a bad attitude but I needed support13:25 sugar dependency--the struggle is real14:30 I was trying too hard and failing miserably15:29 maybe I could have triumphed but we will never know16:15 healthcare freedom16:53 thank you! #letsfixhealthcare www.custombenefits.work

00:10 intro00:44 welcome and what's up?01:14 cost containment? Is that a thing?02:10 do healthcare costs just "go up"?02:45 there is a new normal out there waiting for you03:07 pay healthcare just like any other bill03:59 "fair trade healthcare"05:52 no need to be dependent on insurance companies06:21 disassemble then reassemble07:21 consumer driven healthcare---LOL :)08:00 we got infrastructure but no transparency08:30 self-funded health plans bring transparency09:28 CFO conundrum09:53 you're a fiduciary for a reason11:19 nurse advocate services11:38 upfront, bundled surgical agreements12:11 money talks13:30 savings per employee13:51 thank you! #letsfixhealthcare www.custombenefits.work