The ShiftShapers Podcast

In this REPLAY episode of ShiftShapers, host David interviews Paula Muto, a practicing surgeon and founder of Uber Docs. Paula shares her perspective on the inefficiencies in the current healthcare system, comparing buying health insurance to renting an apartment, and advocates for a direct pay model to improve the situation. She explains how Uber Docs facilitates transparent, direct transactions between patients and physicians, ultimately aiming to lower overall healthcare costs by empowering consumers. Key topics include the significant portion of healthcare costs dedicated to management rather than medical care, and how technology and consumer behaviors can drive positive changes in the healthcare landscape.00:00 Introduction to Today's Guest and Topic01:03 Paula Muto's Background and Inspiration02:19 The Flaws in the Current Healthcare System13:47 The Direct Pay Model Explained15:55 How Uber Docs is Revolutionizing Healthcare20:33 Conclusion and Final Thoughts

In this episode of ShiftShapers, host David A. Saltzman sits down with David Blair, founder and CEO of LucyRx, to explore a growing crisis in American healthcare: pharmacy deserts. As rural and underserved communities lose access to local pharmacies, millions are left without a vital link in the healthcare chain. David unpacks the economic and systemic challenges driving pharmacy closures and shares how LucyRx is stepping in to reshape the future of pharmacy care.From the SPARK program to the push for federal regulation, David outlines what it takes to restore pharmacy access, reduce costs, and deliver more integrated care. This conversation also highlights the importance of aligning pharmacy locations with care providers—a proven strategy for improving outcomes and affordability.

In this episode of ShiftShapers, host David A. Saltzman welcomes compliance expert Carol Taylor, JM, of BenefitMall, for a deep dive into the rapidly evolving world of employer compliance. From court rulings and legislative penalties to HIPAA security updates and AI-driven benefit denials, Carol offers critical insights for anyone navigating today's tangled regulatory landscape.She unpacks the latest on ERISA preemption battles, mental health parity lawsuits, and the real-world impact of complex compliance rules on small agencies and employers. With rising penalties and tech-driven claim denials making headlines, Carol arms listeners with strategies to stay compliant—and stay out of court.

In this episode of ShiftShapers, host David A. Saltzman sits down with Neal Shah, co-founder of Counterforce Health, to explore how artificial intelligence is transforming the fight against denied health insurance claims.Shah shares his personal journey from finance into healthcare advocacy, shaped by firsthand experiences navigating the broken healthcare system for his family. That path ultimately led to the creation of Counterforce Health—a free AI-powered platform that's helping patients and small clinics appeal insurance claim denials with unprecedented efficiency.With millions of claims denied each year—and most never appealed—Shah explains why automation is the key to leveling the playing field and giving patients back their voice. He also introduces Maxwell, Counterforce's next-gen AI assistant, and previews the platform's expanding capabilities for tackling insurers head-on.

In this episode of ShiftShapers, host David A. Saltzman sits down with Vinay Patel, PharmD, founder of MakoRX, to expose why prescription pricing remains so confusing—and what can be done to fix it.Patel breaks down how pharmacy benefit managers (PBMs), vertical integration, and opaque pricing structures are driving up costs for patients—while limiting access and undermining local pharmacies. From subscription pharmacy programs to cash-pay and compounding models, Patel shares bold, practical solutions for bringing real transparency back into the healthcare system.

Part 2 of our deep dive into  Disability Insurance (DI) on the ShiftShapers Podcast goes beyond the basics—diving into strategic implementation, evolving underwriting standards, and revenue-generating opportunities for advisors.In this episode, host David Saltzman continues the conversation with Don Schamay, Regional Director of Executive Benefits at The Principal, to explore how disability insurance can be a transformative tool for both clients and advisors. Don shares his insights on how DI is becoming more accessible and relevant across demographics—from young professionals starting their financial journey to high-income executives looking to protect complex compensation packages. He explains how advisors can offer real value by aligning DI solutions with life stages, business needs, and long-term financial goals.Whether you're an advisor looking to enhance your client relationships or a business owner considering executive benefits, this episode is packed with actionable insights and forward-thinking strategies.✅ Key Takeaways from the Episode:Young Professionals and DI DI isn't just for high earners—young professionals stand to gain the most by locking in coverage early, when they're healthy and premiums are lowest. Don shares how DI can be a cornerstone of early-stage financial planning.Business & Executive Solutions Business owners and C-suite professionals have unique income protection needs. Learn how DI solutions can be customized to protect not only personal income but also business continuity and executive benefits.Underwriting Improvements Traditional DI policies were often viewed as complex and hard to secure, but times have changed. With faster, more flexible underwriting options, advisors can now help clients get covered more efficiently than ever before.Revenue Potential for Advisors DI is more than a risk management tool—it's a practice-building opportunity. By positioning themselves as income protection strategists, advisors can deepen trust, retain clients, and grow revenue.Advisor Education and Client Communication Don emphasizes the advisor's role as an educator—helping clients truly understand the risks of income loss and the powerful ways DI can protect what they've worked so hard to build.⏳ Episode Timestamps:

Welcome to Part One of our deep dive into Disability Insurance (DI) on the ShiftShapers Podcast! In this two-part series. In this episode, host David Saltzman converses with Don Schamay, Regional Director of Executive Benefits at The Principal, about the often-overlooked importance of disability insurance in a comprehensive health insurance strategy. Don shares his journey from military service to a seasoned expert in disability insurance, emphasizing the critical need for both individual and group disability insurance to protect one's income. The discussion covers the prevalence of disability, how group and individual disability insurances differ, and the significance of educating clients about income protection and insurance options.Key Takeaways from the Episode:✅ Importance of DI – Disability insurance (DI) is an often-overlooked but crucial component of a comprehensive health insurance strategy. It provides financial protection if one is unable to work due to illness or injury.✅ Group vs. Individual DI – Group disability insurance often covers basic salary and is a cost-effective, foundational benefit for businesses. Individual DI can supplement group coverage by filling in gaps and covering additional forms of income.✅ Coverage and Income Protection – Properly structured DI ensures that individuals have a safety net that covers up to 80% of their income, considering both salary and other compensations like bonuses and K1 distributions.✅ Market Trends – The DI market has become more competitive and robust, improving the quality and affordability of coverage. Newer carriers have entered the marketplace, stabilizing and enhancing the options available.✅ Advisor's Role – Advisors must educate clients on the significance of DI, ensuring that they understand the risks and the options for mitigating them. This includes both group and individual solutions tailored to the client's specific needs.Episode Timestamps:⏳ 00:00 Introduction to Disability Insurance 

In this episode of ShiftShapers, Host David Saltzman  interviews Dave Toeben, president of Insight Insurance Services, about how insurance professionals can enhance their business through business continuation planning. Dave shares his journey from focusing on group health insurance to specializing in buy-sell agreements, key person, and deferred compensation plans. They discuss the importance of reviewing buy-sell agreements, including recent legal changes such as the Conley case, and explore collaborative opportunities for health insurance advisors to expand their services and solidify client relationships.This Episode is Sponsored by BenepowerBenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders. Learn more at Benepower.com.Scaling Your Insurance Practice: Insights from Business Continuation PlanningShift Beyond Group Health Insurance: Business continuation planning, buy-sell agreements, and key person insurance are essential for scaling a business beyond group health insurance.Importance of Buy-Sell Agreement Review: Regularly reviewing and updating buy-sell agreements is crucial to avoid unintended liabilities and ensure smooth business transitions in case of catastrophe.Disability Insurance Parallel: Often overlooked, disability insurance can be as crucial, if not more so, than life insurance in buy-sell agreements, providing necessary funds if a business owner becomes disabled.Partner Collaboration Opportunities: Health insurance advisors can partner with specialists in business continuation planning to offer comprehensive services without needing to master every aspect themselves.Educational and Revenue Potential: By engaging in business continuation planning, health insurance advisors can not only solidify client relationships but also significantly boost their revenue streams.In This Episode00:00 Introduction and Guest Welcome00:45 Dave Toeben's Career Journey01:13 Transition to Business Continuation Planning02:30 Understanding Business Continuation Planning03:55 Importance of Disability Insurance06:18 Opportunities for Health Insurance Advisors08:27 The Connolly Case and Its Implications10:25 Partnering and Mentorship in Business Continuation18:05 Choosing the Right Carriers20:50 Conclusion and Contact Information

In this episode of Shift Shapers, Susan Thomas, Chief Commercial Officer at LucyRx, discusses how LucyRx is addressing the issues and conflicts within the traditional Pharmacy Benefit Manager (PBM) landscape. The conversation delves into the structural problems of traditional PBMs, the role of misaligned incentives, and how LucyRx aims to eliminate these conflicts to benefit plan sponsors and patients. Key topics include formulary management, specialty pharmacy networks, and the importance of transparency and true net cost evaluations.This Episode is Sponsored by BenepowerBenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders. Learn more at Benepower.com.Key Takeaways**Misaligned Incentives in PBMs**: Traditional PBMs have misaligned incentives due to their vertical integration with large insurance companies and ownership of mail and specialty pharmacies. This drives up costs for plan sponsors.**Transparent Formulary Management**: LucyRx offers a formulary marketplace that eliminates exclusive arrangements with Group Purchasing Organizations (GPOs), allowing plan sponsors broader access to formularies and more flexible utilization management.**Independent Pharmacy Network**: LucyRx contracts with independent pharmacy networks, such as Amazon, to provide a more efficient and cost-effective mail delivery service, ensuring quicker access to medications.**Educational Initiatives**: LucyRx is actively educating advisors and plan sponsors on the benefits of their new pharmacy care model through a robust roadshow and sharing real-world case studies. **Future of Pharma**: With advancements in AI and machine learning, precision medicine can help in developing more effective targeted treatments. However, skepticism remains about whether large PBMs and pharma companies want a smaller, more precise target population.In This Episode00:00 Introduction to PBM Issues00:39 Meet Susan Thomas from LucyRx00:50 Susan's Journey into Healthcare02:06 Problems with Traditional PBMs02:28 LucyRx's Approach to PBM Conflicts06:23 Formulary Management Innovations13:55 Network and Specialty Pharmacy Solutions16:17 Educating Advisors and Plans20:23 Future of Pharmacy Benefits and AI22:07 The Story Behind LucyRx23:25 Conclusion and Farewell

In this episode of Shift Shapers, David interviews Ross Bjella, founder and CEO of Alithias, Inc., to discuss the challenges of changing health care behavior and the inaccuracies in measuring those changes. They explore the complexities of helping patients understand their health care options and costs, and advocate for transparent, actionable data to aid in more informed decisions. This Episode is Sponsored by BenepowerBenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders. Learn more at Benepower.com.Transforming Health Care Behavior: Insights from Ross Bjella, CEO of Alithias, Inc.Ross shares his journey into the health care sector, the importance of data-driven strategies, and how incentives can help patients choose high-value care providers. He also delves into the impact of consumer-directed health plans and how different company cultures affect health care engagement.Key Takeaways**Carrots Over Sticks:** Positive incentives (carrots) work better than punitive measures (sticks) in driving desired behavioral changes in healthcare.**Challenge of Accurate Data:** Current tools and survey methods for measuring behavior changes in healthcare are not as accurate as desired. Ensuring accurate data collection and utilization is critical.**Impact of Cost on Patients:** High deductibles and out-of-pocket responsibilities can lead to patients being functionally uninsured, causing them to delay care and potentially leading to more severe health outcomes and increased costs.**Importance of Actionable Data:** Access to clean, normalized data that is understandable and actionable for patients and their families is crucial for making informed healthcare decisions.**Effective Communication and Incentives:** Effective communication strategies and financial incentives (like waiving deductibles or providing cash rewards) can significantly improve patient engagement and lead to cost savings for both providers and patients. Tailoring communication and benefits to the culture of the organization is essential for success.In This Episode00:00 Introduction to Healthcare Behavior Challenges00:47 Meet Ross Bjella: Journey to Healthcare Solutions01:03 Understanding the Problem: High Costs and Insurance Issues04:43 The Role of Data in Healthcare Decisions08:33 Actionable Data for Patients and Plans16:02 Engaging Employees and Employers21:20 Measuring Success and Future Outlook27:15 Conclusion and Final Thoughts

In this episode of Shift Shapers, we explore strategies to enhance the growth and adoption of Direct Primary Care (DPC) with Dr. Bernard Bubanic, CEO and President at Integrated Source One. Dr. Bubanic shares his journey and insights into creating a multidisciplinary approach to healthcare, ensuring access to comprehensive care without the financial hurdles. We discuss the integration of various services such as telehealth, behavioral health, and musculoskeletal services, as well as the importance of building relationships with patients for better health outcomes. The episode also covers how this model can provide measurable savings for employers and improve plan designs.Key TakeawaysMultidisciplinary Approach:  Dr. Bernard Bubanic's practice, Integrated Source One, focuses on direct patient care rather than just direct primary care. This includes primary care, health coaching, musculoskeletal options, and behavioral and mental health services, all offered under one umbrella.Employee and Family Coverage: Integrated Source One covers not only the employees but also their dependents at no additional cost. This approach is helping with better engagement and substantial cost savings for employers over time.Brick-and-Mortar and Virtual Care Integration: The practice combines onsite, near-site, and mobile clinics with telehealth services. This ensures continuity of care and immediate attention, making sure patients get timely and efficient care without the traditional wait times.Savings and ROI for Employers: By integrating direct patient care services into employee benefit plans, employers witness reduced healthcare costs and premiums over time, with a higher engagement rate by the third year, leading to significant long-term savings.Future Expansion and Technology: Moving forward, the practice is looking to incorporate new technologies, including AI, to enhance patient care quality and efficiency. This will continue to lower costs while improving health outcomes for patients.In This Episode00:00 Introduction to Direct Primary Care00:37 Guest Introduction: Dr. Bernard Bubanic01:15 The Journey to Integrated Source One02:59 Challenges in Traditional Healthcare04:11 Direct Patient Care: A Multidisciplinary Approach05:35 Innovations in Healthcare Delivery06:11 Seamless Integration of Onsite and Virtual Care09:11 Measuring Success and ROI12:30 Plan Design and Employee Benefits19:54 Future of Direct Primary Care21:14 Conclusion and Final Thoughts

Join us on this episode of ShiftShapers as host David Saltzman sits down with former New Jersey Congressman Rob Andrews, one of the key authors of the Affordable Care Act (ACA). Fifteen years after the ACA's passage and ten years since its implementation, Rob shares his journey from aspiring sports writer to influential lawmaker, his role in drafting the ACA, and thoughtful reflections on its successes, shortcomings, and future prospects. We delve into topics such as healthcare coverage expansion, consumer protections, cost control, value-based healthcare, mental health parity, and the ongoing provider shortage. Currently serving as the CEO of the Health Transformation Alliance, Rob continues to advocate for value-based health arrangements. Don't miss this insightful conversation for a deep dive into the evolution and future of U.S. healthcare.Key Takeaways:Journey to Congress and ACA Involvement: Rob Andrews initially aspired to be a sports writer but ended up in politics, driven by a mix of early professional exposure and personal family experiences. He was significantly involved in drafting portions of the Affordable Care Act (ACA).ACA Achievements: The ACA successfully expanded coverage to millions, with Medicaid expansion and subsidies being critical components. It improved patient rights, eliminating pre-existing condition exclusions, extending coverage for young adults, and removing lifetime and annual policy limits.Shortcomings and Future Goals: ACA did not sufficiently address healthcare costs. The prevailing issue is that the system rewards the number of procedures over the quality of outcomes. There's a need for more focus on preventive health measures, behavioral health services, and better alignment of payment to performance.Healthcare Provider Shortage: There is a significant shortage of primary care providers and behavioral health professionals. Proposed solutions include increased compensation and incentives such as debt relief programs for medical students who work in underserved areas.Value-Based Healthcare: Value-based healthcare is crucial for better outcomes, involving rewarding providers based on risk-adjusted, clinically sound outcomes Both quantitative metrics (e.g., reduced A1C levels in diabetics) and qualitative measures (e.g., patient self-evaluation) should be considered to assess quality effectively.Current Role: Rob Andrews is the CEO of the Health Transformation Alliance, focusing on pooling resources to buy healthcare more efficiently and promoting value-based arrangements among member companies.In This Episode00:00 Introduction and Guest Welcome00:41 Rob Andrews' Journey to Congress03:14 Involvement in ACA Drafting04:53 ACA Successes and Shortcomings07:03 Future Improvements and Value-Based Healthcare10:07 Addressing Primary Care and Behavioral Health Shortages16:13 Measuring Quality in Healthcare17:47 Rob Andrews' Current Role and Conclusion

Are you struggling to navigate the complex world of gag clause attestation requirements? In this must-watch episode of Shift Shapers, Jennifer Berman, JD, CEO of MZQ Consulting, provides a comprehensive breakdown of everything plan sponsors and advisors need to know about these critical compliance requirements.From the Consolidated Appropriations Act of 2021 to today's implementation challenges, discover how these regulations are reshaping healthcare plan transparency. Jennifer explains why many contracts still contain illegal gag clauses in 2024 and what this means for your organization. Learn about the crucial differences between fully-insured and self-funded plans, and how these differences impact your compliance obligations.Key topics covered:Detailed explanation of gag clauses and their impact on healthcare plansStep-by-step guide to annual CMS attestation requirementsUnderstanding potential penalties and enforcement mechanismsNavigation of the HIOS system reporting processCritical differences between fully-insured vs. self-funded plan requirementsPractical strategies for verifying gag clause complianceTips for accessing and utilizing plan data effectivelyReal-world challenges in contract review and complianceThis episode delivers essential insights for anyone involved in healthcare plan administration and compliance. Whether you're managing benefits for your organization, advising clients on their healthcare plans, or ensuring regulatory compliance, you'll gain valuable knowledge about navigating these complex requirements. Jennifer's expertise provides actionable guidance for insurance professionals, consultants, and organizational leaders who need to understand and implement these critical transparency regulations.In This Episode00:00 Introduction to Gag Clause Attestation00:45 Understanding Gag Clauses01:39 Legal Requirements and Compliance03:00 Challenges and Real-World Implications04:58 Access to Plan Data and Its Importance07:11 Reporting and Documentation07:33 Understanding Certification and Penalties10:02 Annual Reporting Requirements10:18 Advisor's Role in Compliance10:40 Self-Funded vs Fully Insured Plans13:03 Ensuring No Gag Clauses13:20 Final Thoughts and Key Takeaways14:39 Conclusion and Farewell

Unlocking Post Claim Adjudication: Insights with Jordan HershIn this episode of ShiftShapers, host David explores the complex world of post claim adjudication with Jordan Hersh, Vice President of Enterprise Solutions at Vālenz. They discuss the intricacies of self-funded plans, reference-based pricing, and the potential savings associated with renegotiating out-of-network claims. The conversation delves into high performance networks, the inverse relationship between cost and quality in healthcare, and methods for improving transparency and cost containment. Learn about the strategies that can lead to significant cost savings while maintaining high-quality care.In This Episode:00:00 Introduction to Post Claim Adjudication00:34 Meet Jordan Hirsch from Vālenz01:29 Understanding Post Claim Work02:13 Reference Based Pricing: Pros and Cons03:55 Narrow Networks vs High Performance Networks08:14 Out of Network Claims and Cost Containment15:23 Transparency in Medical Care Costs and Quality17:18 Incentives for Care Coordination18:28 Wrapping Up: Savings and Final ThoughtsQuotes:“Readmission rates, complication rates, mortality rates, we're taking that into account and making sure that when people do people stay in-network or go to the panel of those high-performance network partners, they're getting top tier coverage.”“Depending on the primary PPO network regardless of broad network or network of concise nature, there's going to be out-of-network medical claims. And that can cost self-funded plans a lot of money if it's not managed correctly.”“Some plans we've seen pay out-of-network claims at full bill charges, some take a usual customary approach. Having a much more direct and aggressive approach can really be a game-changer for self-funded plans and materially impact the bottom line.”“So being able to achieve a discount, that can also assure them that they're going to be paid and have a little bit more clarity on how the member responsibly can be split up. Oftentimes we see self-funded plans offering some type of incentive.”“So a plan with a medical spend with a million dollars, implementing these types of tools into the right education training to the members, could reduce their overall medical spend by about 25%.”

What if technology could bridge the gap in healthcare access for underserved communities? Join us on this episode of ShiftShapers as we explore the intersection of healthcare technology and underserved communities with Kornelius Bankston, Managing Partner at TechPlug. Discover how innovative solutions are being tailored to meet the unique challenges faced by marginalized populations. Learn about the role of economic factors, geographical disparities, and the historical context affecting these communities, and see how grassroots efforts and collaborations with local health departments are paving the way for better healthcare access. Dive into the specifics of projects like SensorMed, which offer remote patient monitoring and other tech-based health solutions, and understand the foundational work that TechPlug is doing to bridge gaps in healthcare through specialized tech incubation.We'll explore the real-world challenges faced by marginalized populations, such as transportation hurdles, prescription adherence, and food security, and how innovative solutions like remote patient monitoring are making a difference. Using New Orleans as a case study,Kornelius reveals how TechPlug collaborates with local health departments to assess and meet community needs effectively.As we journey through TechPlug's early initiatives, Kornelius shares insights from his diverse career path, from aspiring physician to biotech recruiter and beyond. Learn about the grassroots efforts crucial for educating communities on healthcare technology and the challenges of building trust around data security. Cornelius's unique perspective underscores the importance of continuous innovation tailored to diverse populations' needs. Don't miss this thought-provoking conversation on making healthcare accessible for everyone.Key Moments In this Episode:“We identify an ambassador in a city, and typically it's the department of health, to partner with to bring these innovative solutions to the community.” “As opposed to developing solutions in a vacuum, we're able to bring real data, real time, quantitative and qualitative information back to the companies within our portfolio so they can provide the best possible solution to these populations.”“I really don't think a lot of companies that have innovative health solutions are really conscientiously having their innovation addressing the population.”“There's a lot of distrust within the healthcare system.”“In tech, there's this whole idea around privacy and data security and a lot of populations of underserved and marginalized communities really don't understand where the data is going and who's keeping data and how they get empowered by the data.”00:00 Introduction to Healthcare Technology for Underserved Populations01:52 Understanding Underserved and Marginalized Communities03:02 Challenges Faced by Underserved Populations04:55 Innovative Solutions and Technology in Healthcare05:48 Community Assessment and Partnerships09:57 The Role of TechPlug in Healthcare Innovation14:37 Building Trust and Overcoming Skepticism16:11 Future Prospects and Challenges in Healthcare Technology18:43 Addressing Privacy and Data Security Concerns20:07 Conclusion and Acknowledgments

In this episode of the ShiftShapers Podcast, host David Saltzman chats with Marissa Rufo, JD, MBA, a subject matter expert from MZQ Consulting, to demystify the complexities surrounding Medicare Creditable Coverage. They discuss why it's significant for employers and employees alike, particularly in light of recent legislative changes and the growing number of older employees in the workforce. The conversation addresses compliance requirements, methods for determining creditable coverage, and practical steps employers need to take to avoid penalties and lawsuits.Medicare creditable coverage is a requirement for group health plans to be comparable to an average Medicare Part D plan. The consternation and confusion around creditable coverage has increased due to recent changes in legislation and the growing number of Medicare-eligible individuals still working full-time. Employers have a fiduciary duty to ensure compliance with creditable coverage requirements, as failure to do so can result in lawsuits and penalties. While employers are not required to have actual creditable coverage, they must determine the creditability of their prescription drug plans, provide notices to Medicare-eligible employees, and report their credibility status to CMS annually. Failure to provide accurate notices can result in financial costs and penalties for employees. There are two methods for calculating creditable coverage: the simplified determination method and the actuarial analysis method. Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals. MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.TakeawaysMedicare creditable coverage is a requirement for group health plans, comparable to an average Medicare Part D plan.Employers have a fiduciary duty to ensure compliance with creditable coverage requirements.Failure to provide accurate notices can result in financial costs and penalties for employees.Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals.MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.

In this episode of Shift Shapers, host David Saltzman sits down with Alycia Riedl, the new National President of NABIP, to discuss the future of the healthcare advisory industry. Alycia  shares her personal journey from reluctance to passion in the industry, following the legacy of her innovative father. They explore key issues on NABIP's radar, such as transparency, technology, and advocacy against single-payer systems. Alycia emphasizes the importance of evolving the role of advisors and her vision for a consumer-centered healthcare system. Additionally, they address leadership values and the strategic goals of NABIP for the coming years. Tune in to learn about the upcoming developments and strategic initiatives aimed at supporting healthcare advisors and improving the overall healthcare landscape.Key Takeaways From This interview:Career Journey: Alycia Riedl's unexpected path to the insurance industry fueled by a passion for helping others.Innovation and Adaptability: The importance of continuous improvement and innovation in the insurance industry.Consumer-Centered Healthcare: NABIP's commitment to a transparent, consumer-focused healthcare system.Advisor Challenges: Addressing the difficulties advisors face with restrictive laws and compensation issues.Leadership and Empathy: Reidl's emphasis on empathetic, data-driven leadership that supports team well-being.

The focus of this week's episode is on how modern healthcare system innovations utilize throwback TPA. Bob McCollins, vice president of sales at Edison Health Solutions, explains what's happening in the TPA industry today and how a throwback TPA can help combine all the fantastic solutions out there to provide top-notch services.What You'll Learn From This Episode:2:34 What throwback TPA means and how it works with current healthcare systems.4:35 Keeping all of the various solutions together for the benefit of clients and potential clients.7:57 TPAs need to be adaptable or focused on a single path in order to provide best-in-class services.11:10 Changes to offerings and support in reference-based pricing.14:48 Tasks they outsource to third parties.16:39 Factors affecting claims' automatic adjudication.20:35 TPA in the coming years.This episode originally aired September 26, 2022

This week's episode delves into the world of pharmacogenomics (PGx) and how it is changing the way we approach medication management. We sit down with a leading expert in the field to discuss the current state of PGx adoption, the challenges it faces in gaining wider acceptance in the medical community, and the potential impact it could have on our healthcare system in the future. From the role of direct-to-consumer testing to the importance of involving clinicians in the decision-making process, we explore the complexities of this emerging field and what it could mean for patient care. Join us for this informative and thought-provoking conversation on the cutting edge of personalized medicine.What You'll Learn From This Episode:1:54 Overmedication: A systemic problem in healthcare.4:16 The evolution and future of pharmacogenetics (PGx) as a standard of care.12:44 Implementing pharmacogenomics testing in employer healthcare plans: Overcoming adoption challenges and practical applications.14:51 The adoption curve of pharmacogenomics testing in healthcare: A bottom-up mission.17:34 The future of PGx: Adoption by early adopters and the role of payers.This Episode Originally Aired March 13, 2023

In this episode of ShiftShapers, host David Saltzman discusses the recent Supreme Court decision to overturn the 40-year Chevron Deferment precedent and its implications for advisors and their clients. Joined by Jennifer Berman, ERISA attorney Jennifer Berman, the NABIP (National Association of Benefit Insurance Professionals) Legislative Vice Chair and CEO of MZQ Consulting, the discussion explores the decision's potential long-term effects on federal regulations and compliance in the healthcare sector. They delve into how this ruling shifts the responsibility from federal agencies to the judiciary in interpreting ambiguous statutes and assess the impact on specific regulations like compensation disclosures under the Consolidated Appropriations Act. Berman emphasizes to advisors and employers the importance of maintaining fiduciary duties and regulatory compliance while staying informed about future changes.More from MZQ ConsultingKey Takeaways:SCOTUS Decision Impact: The Supreme Court recently overturned the Chevron Deferment, shifting the power of interpreting ambiguous federal statutes from federal agencies to the judiciary. This major change may lead to increased challenges to existing regulations.Immediate Effects on Law: Currently, the ruling doesn't change existing laws or regulations. However, advisors should anticipate more court challenges to federal regulations based on ambiguities in the underlying statutes.Advisors' Immediate Actions: Advisors should communicate to their clients that no immediate changes are necessary. They should continue to follow current laws and regulations and focus on fulfilling their fiduciary duties.Potential Healthcare Changes: Specific areas in healthcare, such as compensation disclosures and mental health parity, may become more contentious and face judicial challenges. However, statutory requirements like HIPAA, COBRA, and ACA reporting remain intact.Need for Robust Fiduciary Processes: Advisors should emphasize the importance of maintaining documented fiduciary processes, including setting up committees, meeting regularly, and properly documenting actions to demonstrate compliance and best efforts.

In this episode of the ShiftShapers Podcast, host David Saltzman chats with Ashley Reid, founder and CEO of Wellist, to explore how companies can better connect employees to vital health and well-being resources. Reid discusses her transition from a marketing career to corporate strategy and the inception of Wellist. Driven by personal experiences with cancer care, she sheds light on the current challenges employers face in meeting wellness needs and how Wellist's Precision Resource Matching Platform uses AI to address these issues. They delve into practical examples, the financial impact of optimized benefits, and the importance of whole-person support. Reid shares how actionable data can help employers make informed decisions, and also the future aspirations for Wellist to become a standard support system across diverse industries.Key TakeawaysOrganizations are increasingly focusing on connecting employees to the right wellness resources and benefits at the right time to boost overall well-being and engagement.The use of AI and data-driven platforms is transforming the employee benefits industry by providing personalized and efficient access to support resources.Employers can optimize their health benefits investments by leveraging data analytics to identify redundancies and gaps in their current offerings.Comprehensive employee support addressing a wide range of needs, including mental health and daily living aids, is becoming essential for maintaining workplace productivity and employee satisfaction.There is a growing trend toward standardizing integrated support systems to ensure employees can easily access the health and wellness assistance they need, particularly during critical life events.

In this episode of the ShiftShapers Podcast, host David Saltzman engages in a deep conversation with Matt Loper, CEO and co-founder of Wellth. They explore how healthcare plans can leverage behavioral economics to achieve better outcomes. Loper recounts his journey from aspiring biotechnologist to a leader in healthcare technology, emphasizing his efforts to increase patient engagement and improve health outcomes by using behavioral science and technology. The insightful discussion for business leaders also focuses on the core issues Wellth aims to solve, the importance of daily member engagement, and the need for consistent, trust-based relationships to drive better health behaviors and quality metrics. Loper shares insights on the methodologies employed, including targeted outreach and personalized communication strategies. He also touches on the future goals and expansions of Wellth.Key Takeaways:Innovative Problem-Solving: Embracing behavioral economics offers innovative solutions to longstanding healthcare engagement challenges.Engagement is Key: Recognizing the engagement gap in healthcare underscores the importance of leveraging behavioral science and technology for patient involvement.Personalized Approaches Matter: Tailored communication and daily engagement strategies prove essential for nurturing healthier behaviors and improving overall healthcare outcomes.Financial Benefits of Engagement: Quantifying the financial impact of behavioral interventions highlights significant cost-saving opportunities for healthcare providers.Trust and Expansion Drive Success: Building trust-based relationships and expanding services are crucial components of achieving long-term success in healthcare innovation.From from Wellth: https://www.wellthapp.com/

In this episode of the ShiftShapers podcast, host David Saltzman welcomes Stephen Sokoler, founder and CEO of Journey, to discuss the importance of mental health care in the workplace. Stephen shares his personal journey, from entrepreneurial beginnings to discovering meditation and ultimately founding Journey in 2015. They delve into pressing mental health challenges including stigma, therapist shortages, and the inefficiency of traditional EAPs. Stephen outlines Journey's proactive and inclusive approach to mental health care, emphasizing the importance of early intervention, awareness, and cultural competency. Tune in to learn how Journey is making mental health care more accessible and effective, and boosting EAP utilization through innovative strategies.Key Takeaways:Daily Integration: Embedding mental health resources in workplace tools like Slack improves accessibility.Cultural Competency: Providing multilingual and culturally relevant content ensures effective support.Confidentiality: Strong privacy measures are crucial for employee trust and usage of mental health services.Thorough Evaluation: Comprehensive assessments help tailor support to individual needs.Awareness: Increasing awareness and reducing stigma around mental health resources is vital.More From Journey

In this episode of the ShiftShapers podcast, we're joined by Daniel Cobb, Vice President of Sales and Strategy at Strategic Benefit Resources, to discuss the evolving landscape of Stop Loss Self Funding and the tech and data solutions supporting it. Cobb shares his journey from the mortgage business to insurance, emphasizing the significant changes and opportunities in self-funded health benefits plans. We discuss how the expansion of self-funded plans is now reaching groups as small as 25 employees. Cobb also explains the role of artificial intelligence in pricing stop loss, as well as the increasing demand for transparency and flexibility in health benefits management. Cobb also offers insights into how advisors can help clients transition to self-funding, the importance of understanding client needs, and other future trends in the industry. Business owners and executives - from large and small firms alike - stand to benefit from the important insights in this business podcast. Key Takeaways:The expansion of self-funded health plans now includes smaller groups, with as few as 25 employees participating.Artificial intelligence and advanced data tools are crucial in pricing stop loss and expanding self-funded health plans to smaller groups.Advisors need to understand whether their clients are savings buyers or quality buyers to effectively present self-funding options.Transparency and access to first-dollar claims data are key benefits of self-funding, allowing for better management of healthcare costs.The future of self-funding involves greater access to data, regional variations in plan management, and continued evolution of high-performance health plans.Strategic Benefit Resources: https://www.strategicbenefitresources.com/Thank you for tuning into this insightful episode of Shift Shapers. If you enjoyed our conversation with Daniel Cobb, please rate, follow, share and review our podcast. Stay tuned for more episodes where we explore the latest trends and innovations in the health benefits industry.

In this episode of the ShiftShapers podcast, host David Saltzman welcomes Steven Amiel, CMO at NextGen Benefits, to explore why marketing has become more challenging, costly and less effective in terms of ROI than ever before. They delve into the new regulations on tracking and targeting prospects, discussing how the move toward double opt-ins has changed the landscape of data collection. The importance of authentic communication is highlighted through real-world examples, emphasizing why marketing messages need to be genuine and aligned with personal branding. They also discuss the pitfalls of overextending marketing efforts, particularly on platforms like LinkedIn, and the need to focus on conversions rather than likes or opens. Steven provides insights on the shift from mass advertising to an account-based marketing approach and the crucial role of first-party data in effective marketing. He addresses how different strategies apply to small versus large companies and emphasizes the importance of building executive credibility and personalized engagement in sales. Steven also talks about future marketing trends, including interactive webinars and storytelling, as key strategies for 2024 and beyond.Key Takeaways:1. Government regulations have changed how health benefits marketers can track and target prospects, emphasizing the need for authentic communication.=2. Authenticity is crucial in marketing communication to establish a personal connection and engage prospects effectively.3. Emphasize conversions over likes or opens to drive meaningful results in marketing efforts.4. Shift toward building first-party data through engaging strategies and personalized interactions to improve deliverability and lead quality.5. Focus on differentiating yourself by understanding prospects, establishing executive credibility, and aligning messages with the target audience for successful marketing campaigns.More from NextGen Benefits: https://www.nextgenbenefits.com/

This episode of the ShiftShapers Podcast features a discussion with David Mordo, Senior Compliance Officer at MZQ Consulting, focusing on essential legislative and regulatory knowledge advisors need to possess, especially pertaining to offering health benefit packages. The conversation highlights the recent FTC ruling on non-compete clauses, emphasizing its potential impact on employers and the broader implications for your workplace. Mordo and our host David Saltzman also delve into a pressing lawsuit against Johnson & Johnson related to fiduciary duties and prescription drug pricing, forecasting a rise in similar legal challenges. Furthermore, the interview underscores the importance of advisors understanding their role in ensuring employer clients comply with fiduciary responsibilities, especially in relation to employee health plans and benefits to meet complex compliance regulations.Key Takeaways from the episode of the ShiftShapers Podcast:The Federal Trade Commission banned non-compete clauses, aiming to boost employee wages and opportunities.Lawsuits over fiduciary responsibilities in benefit plans are increasing, underscoring the importance of acting in employees' best interests.Advisors are pivotal in educating employers on fiduciary duties and compliance to navigate benefit complexities.Compliance professionals help translate regulations for brokers and employers to ensure adherence to regulations and to avoid risks.Fiduciary care under ERISA is crucial for all employers to comply with regulations and protect employees.https://www.mzqconsulting.com/

In this episode of ShiftShapers, host David Saltzman invites David Mordo, Senior Compliance Officer at MZQ Consulting, to discuss the intricacies of prescription drug reporting (RxDC) as mandated by the Consolidated Appropriations Act of 2021. The conversation delves into the transparency requirements for employers regarding their prescription drug plans, encompassing the scope of reporting, deadlines, submission processes, and implications of non-compliance. With a focus on the pivotal role of employers, insurance carriers, third-party administrators (TPAs), and Pharmacy Benefit Managers (PBMs) in this process, the talk highlights the collaborative effort needed to ensure compliance. Mordo offers valuable insights are offered on how brokers and advisors can assist their clients in navigating the complexities of RxDC reporting, the selection of vendors for report preparation, and the importance of timely action to meet regulatory deadlines.Key Takeaways From This Episode:RxDC is part of the Consolidated Appropriations Act of 2021, requiring employers to provide prescription drug plan information.Employers have to comply with multiple reporting requirements related to prescription drug plans annually.Reports for 2024 regarding prescription drug plans are due on June 3rd.Employers are responsible for ensuring compliance with prescription reporting, even if they use TPAs or PBMs for assistance.Brokers need to ensure vendors for reporting have experience, are reasonably priced, and can deliver timely and accurate data.

Welcome to this episode of the ShiftShapers podcast, where we explore the journey of Donovan Ryckis, CEO of Ethos Benefits. Here, we discuss fiduciary responsibility in healthcare as Ryckis tell us the story of his personal evolution. From managing a Gold's Gym to working in securities advising, he ultimately established a flourishing healthcare agency. His narrative unveils the hurdles and triumphs encountered when transitioning from a commission-driven approach to fee-based consulting. Throughout our conversation, Ryckis underscores the pivotal role of fiduciary duty and transparency in cultivating client trust in the healthcare industry.Ryckis sheds light on the intricacies of reference-based pricing, highlighting its potential in managing healthcare expenses while acknowledging the accompanying need for heightened administration and employee communication. Moreover, he articulates how Ethos Benefits' commitment to ethical standards and delivering genuine value has been instrumental in its ascent. Business executives and other organizational leaders, we invite you to tune in to this episode of ShiftShapers and learn the importance of selecting a benefits vendor who acts with the healthcare recipients' best interests at heart. After all, you deserve a healthy workforce that appreciates the best possible benefits..  Takeaways:Adopting a fee-based consultancy model and embracing fiduciary responsibilities are key for tailoring optimal healthcare solutions for clients.Embracing radical transparency, including commission disclosures, fosters candid dialogues and fortifies client relationships.Reference-based pricing emerges as a potent strategy for cost control in providing healthcare benefits, albeit requiring meticulous administration and communication efforts.Storytelling not only shapes agency culture, but also nurtures robust client connections.While the momentum behind fee-based models is palpable, the industry still grapples with the gradual acceptance of compensation disclosure.

In this episode of the ShiftShapers podcast, Jon Shooshani, co-founder of JOON, discusses the concept of lifestyle spending accounts (LSAs) and their impact on health and well-being. Shooshani shares his journey from being deeply interested in health and wellness to the founding of his company, JOON, which offers personalized wellness and lifestyle benefits for employees. LSAs are employer-funded accounts with flexible spending on well-being-related items and experiences. They may vary in name and structure across different companies. Shooshani explains the value of LSAs in promoting employee health, satisfaction and retention, while also covering practical aspects like budgeting, implementation and the unique features of JOON's platform. The story concludes with a touching background on the company's name and vision to provide meaningful employee benefits. Throughout this podcast, business executives and owners, big and small, will receive expert insights on how to provide competitive benefits packages that serve their employees well.ShiftShaper Episode Takeaways- A lifestyle spending account (LSA) is an employer-funded fund that allows employees to spend on items and experiences that contribute to their well-being.- LSAs can be customized and flexible, offering a range of categories such as health and wellness, professional development, work-from-home purchases, and family care.- LSAs can have a positive impact on employee well-being and satisfaction, and can be used as a tool to attract and retain employees.- Employers can determine the amount and reset frequency of LSAs based on their budget and goals. LSAs can be administered and streamlined through platforms like JOON.

This episode of the ShiftShapers Podcast features host David Saltzman interviewing John Clay, president of Better Source Benefits, about unique health plan solutions for small and mid-sized groups. John shares his background in the insurance industry, highlighting the journey from working in materials control to discovering innovative health plan solutions. Despite challenges, such as a lack of options beyond traditional insurance providers, John discusses how attending conferences and learning from others in the industry transformed his approach to offering health plans. He emphasizes the importance of understanding the needs of smaller businesses and how custom, level-funded health plans can offer significant benefits. The conversation also delves into the future of health plans for small and mid-sized businesses and how creative solutions can positively impact employee health outcomes and financial security.

This episode of the ShiftShapers podcast features an interview with Yoona Kim, the CEO and co-founder of Arine, a company focusing on medication intelligence via AI to improve clinical and financial outcomes in healthcare. In this episode, Kim shares insights from a healthcare background into the challenges surrounding drug prescriptions including accessibility, cost, and the impact of incorrect or suboptimal medication on patient outcomes. Arine leverages large-scale data analysis to provide actionable recommendations, aiming to correct discrepancies in medication use, particularly in polypharmacy (multiple medication) cases. The technology not only promises to significantly reduce hospitalizations and overall healthcare costs within a short period, but also enhances patient adherence to prescribed medication regimes. Kim elaborates on the collaborative process with healthcare providers and insurers to implement these changes effectively, highlighting the potential for widespread improvement in healthcare management and outcomes.

In this episode of the ShiftShapers podcast, we explore the complex world of Pharmacy Benefit Managers (PBMs) and their impact on healthcare costs, sparked by the Johnson & Johnson lawsuit. Our guest, USRxCare President Renzo Luzzatti, with a 30-year healthcare background, discusses the Consolidated Appropriations Act of 2021, which is aimed at shifting power back to payers from vendors by enhancing transparency and fiduciary responsibilities. The episode sheds light on the lawsuit against J&J for excessive pharmaceutical payments through their PBM, Express Scripts, highlighting the issue of overpayment in the industry. Luzzatti emphasizes the necessity of fiduciary PBMs, devoid of conflicts of interest, and the importance of transparency and beneficiary interests. We also discuss how employers can strategically manage their pharmacy benefits to avoid overpayment and ensure compliance with fiduciary duties, emphasizing the role of advisers in navigating this complex territory. The conversation also touches on current trends and future outlooks for managing pharmacy benefits more effectively and ethically. Each of these insights are critical to business owners and other organizational leaders who must manage healthcare benefits to be cost-effective while providing for employee health needs.  USRxCare: https://usrxcare.com/

In this episode of the ShiftShapers podcast, David Sloves, CEO of Nonstop Health, discusses the evolution and impact of Medical Expense Reimbursement Plans (MERPs) in the healthcare industry. He explains how MERPs differ from traditional health reimbursement arrangements (HRAs), HSAs, and FSAs by offering first-dollar coverage and customizable financial outcomes for both employers and employees. Sloves outlines the historical context of MERPs, their tax benefits, and how they aim to address the skyrocketing costs of healthcare and improve access to medical services. The conversation also covers the challenges of implementing MERPs, their role in enhancing employee satisfaction, recruitment, and retention, and the broader implications for the healthcare system in the United States. Through anecdotes and data, Sloves makes a case for MERPs as an ethical and effective solution to the current healthcare crisis.We wrap up by celebrating the successes of mission-driven companies in the healthcare industry, specifically how they've introduced advanced healthcare programs to employers. David Slove recounts overcoming initial skepticism and the strategies that led to significant financial benefits for clients, thanks to the MERP model. As we close, we reflect on the cascading impact of such inclusive healthcare initiatives. These efforts aren't just reshaping employee benefits—they're empowering businesses, stimulating the consulting community, and fostering a culture of retention and recruitment excellence from the heart of conservative states to the broader national arena.

Bill Snyder, CEO of Vivante Health, discusses the importance of digestive health and its impact on healthcare spend. Digestive health issues like irritable bowel syndrome and GERD affect a significant portion of the population, leading to high claim spend and unnecessary utilization. The medical establishment is becoming more aware of these conditions, but diagnosis and treatment can still be challenging. Vivante Health aims to supplement traditional care with digital interventions to improve patient outcomes. By leveraging data and predictive modeling, Vivante Health can provide personalized care and identify trigger foods that cause inflammation. Snyder, with a background in healthcare and a personal connection to digestive disorders, highlights the widespread impact of conditions such as irritable bowel syndrome, ulcerative colitis, and GERD on individuals and healthcare spending. The discussion covers the lack of awareness, diagnosis challenges, and the potential of digital interventions to improve care. The importance of the gut-brain connection and its relation to stress, anxiety, and possibly Alzheimer's disease is also explored. Snyder shares insights into how Vivante Health is addressing these issues through pattern recognition, personalized care pathways, and dietary adjustments to manage symptoms, significantly improving patients' lives. The conversation also touches on the future of digestive health care, the role of data in advancing treatment, and Vivante Health's approach to integrating with the healthcare ecosystem.

Welcome to another insightful episode of ShiftShapers! Join host David Saltzman as he delves into a conversation with Maya Perl, the visionary co-founder of Zorro. Together, they unravel the intricacies of the Individual Contribution Health Reimbursement Arrangement (ICHRA) and its profound impact on both employers and employees.Discover how ICHRA empowers employers to revolutionize healthcare benefits by offering a defined contribution model, granting employees the autonomy to select tailored health plans that cater to their unique needs. Maya shares her inspiring journey in the healthcare realm, unveiling the genesis of Zorro and how their innovative platform, infused with AI prowess, simplifies plan selection, making healthcare more accessible and cost-effective than ever before.In this discussion, explore the unparalleled advantages of ICHRA, including substantial cost savings, enhanced flexibility, and a plethora of personalized healthcare options. Learn how Zorro's cutting-edge technology educates employees, streamlines allowance calculations, and facilitates seamless enrollment into ICHRA plans, irrespective of employer size or geographical boundaries.Join us as we uncover the transformative potential of ICHRA in reshaping the healthcare landscape, fostering higher retention rates, and paving the way for a healthier, more empowered workforce. Don't miss out on this enlightening exploration into the future of healthcare—tune in now and embark on a journey towards a healthier tomorrow!

On this episode of ShiftShapers, a podcast focused on the employee benefits industry, host David Saltzman discusses the secrets of business growth with Kevin Trokey and Wendy Keneipp from Q4 Intelligence. The ShiftShapers Podcast is brought to you by MZQ Consulting, offering concierge-level service for all your benefits compliance needs, and the agility to keep up with the changing landscape.In this enlightening discussion, Kevin and Wendy share their experiences and lessons learned which are also included in their book, “The Salesperson's Guide to Growing a Business.” The conversation touches on the importance of shifting from accidental to intentional business strategies, the role of marketing, effective prospecting in sales, the impact of technology, and the crucial role of leadership in an organization. They emphasize the need for viewing sales as a relationship and advice-based endeavor, while providing great insights regarding industry practices and strategies.

In this episode of the ShiftShapers Podcast, host David Saltzman interviews Ryan James Miller, a performance coach, consultant, keynote speaker and author of the book “Wounds.” Miller shares his professional journey and the adversities he had to overcome, including his father's abandonment, his fight for acceptance during his adolescence, the layoffs during the 2011 recession, and surviving the Route 91 Harvest Festival shooting in Las Vegas in 2017. The ShiftShapers Podcast is brought to you by MZQ Consulting, offering concierge-level service for all your benefits compliance needs, and the agility to keep up with the changing landscape.Ryan talks about how these experiences led to his realization of the link between personal wounds and unlocking one's unique greatness. He stresses on the importance of acknowledging wounds, understanding the rippling impact, finding the good and unlocking the greatness within oneself. Ryan presents “Wound Analysis Framework” that helps in personal transformation based on these principles.

What are the compliance issues that you should be aware of and what's coming down the pike legislatively for your business?In this episode of the ShiftShapers podcast hosted by David Saltzman, ERISA attorney Jennifer Berman, the NABIP (National Association of Benefit Insurance Professionals) Legislative Vice Chair and CEO of MZQ Consulting, discusses various compliance issues that employers and their advisors must know.00:00 Introduction to Compliance Issues and Legislative Updates00:49 Understanding Mental Health Parity02:51 Changes in Mental Health Parity Law03:47 Annual Reporting Requirements08:04 Understanding Prescription Drug Data Collection (RxDC)12:42 The Complexity of ACA Reporting16:57 Understanding Gag Clause Attestation25:28 The Importance of Fiduciary Responsibility33:39 Legislative Updates: Employer Reporting Bill and More39:21 The Future of Telehealth and Virtual Care41:09 Conclusion and Final Thoughts

Ever wanted to know what consumers really desire from their brands? Then you won't want to miss this episode with our phenomenal guest, Kurt Bartolich, the founder of Brand Certain. Kurt's bi-annual survey of 1,600 consumers provides precious insights into shifting consumer preferences, shattering the old paradigm of 'uniqueness' in favor of genuine qualities like honesty and authenticity. We unearth the importance of convenience and originality to consumers and scrutinize case studies: Bed Bath and Beyond's failure to meet consumer desires and Verbo's triumphant brand positioning.Can CEOs master the art of public speaking? Kurt's years of experience lend us invaluable advice on this topic. With a focus on honesty, transparency, and authenticity, he discloses practical tips to enhance unscripted, natural conversation, ensuring your brand message resonates with consumers. We also delve into a crisis management case, examining how Toyota navigated troubled waters. This episode is a treasure trove of practical takeaways on building consumer trust and shaping successful brands - a must-listen for anyone invested in understanding and meeting consumer needs.

Want to revolutionize your company's healthcare experience? Tune in as we welcome Ryan Robbins, the dynamic co-founder of LO Benefits, who is here to discuss the transformative power of direct primary care (DPC) and its potential to significantly impact medical costs, improve employee experiences, and manage chronic conditions. Ryan offers an insider's perspective on how his team is shaking things up in the healthcare industry, providing tailored solutions to enhance efficiency and effectiveness in underserviced markets. Shifting gears, we delve into the role our physicians play in the healthcare equation, highlighting the importance of understanding patients' insurance status. Ryan shares how they are educating employees on optimal use of medical insurance through open enrollment meetings, with physicians playing a vital role. We also touch on the benefits of DPC from the perspective of both physicians and employees, and the advantages of level funded plans for employers with fewer than 300 employees. Don't miss out on this eye-opening conversation as we unpack these innovative ideas and strategies leading to a better healthcare experience for all.

Want to crack the secret to building enduring business relationships? What if we told you that the key is not hidden within complex strategies but lies in simplicity, authenticity, and selflessness? This awe-inspiring conversation with Andre Davis, a respected communication specialist and public speaker, brings that theory to life.You'll be fascinated as Andre unravels his approach to forming meaningful connections, emphasizing genuine interest in understanding someone's story, needs, and goals over pushing an agenda. Andre also breathes life into the concept of servant leadership, challenging traditional thoughts and showing how helping others when they can offer you nothing in return is a powerful tool for long-term success. Prepare to be deeply moved and influenced by Andre's perspective. Furthermore, Andre sheds light on the compelling influence of 'Go-Giver' on his business philosophy and how it shapes his strategy in forming authentic connections on platforms like LinkedIn. He also emphasizes the immense power of effective communication in building trust, standing out, and establishing a strong business presence. Filled with Andre's enlightening anecdotes and practical tips, this episode is an invaluable guide to anyone willing to step up their relationship-building game in business. Be ready for an incredible journey that combines the power of communication, authentic leadership, and the magic of giving in the world of business. Enjoy the ride!

Are you tired of feeling lost in the complex world of healthcare? Ever wish you had a guide to navigate you through it all? Well, meet Keith Somers, co-founder and CRO of HealthCorum, a company that's revolutionizing the healthcare sector, giving you the power to make informed decisions. Keith shares his personal journey of how his encounters with wasteful and low-value care inspired him to tackle these issues head-on, advocating for high-value, high-quality care.HealthCorum's approach is simple yet innovative - transparency and data-driven insights. This episode reveals how risk adjustment using data analytics can provide a fair comparison of healthcare providers, leading to potential massive cost savings. Keith also explains how HealthCorum is fighting to improve patient outcomes at a grassroots level, marrying price transparency and data-driven scores to empower you, the consumer. No more feeling left in the dark when making healthcare decisions, tune in to understand how HealthCorum is lighting the way!

Do you often find yourself wrestling with the myriad of challenges in benefits administration? Tune into our fascinating conversation with Shannon Goggin, co-founder and CEO of Noyo, as we traverse the landscape of benefits experience enhancement for customers. Shannon shares the inception story of Noyo, a visionary company that simplifies data exchange across divergent systems and how their mission is to enable secure data sharing with the goal of delivering the right information to the right people, at the opportune time.Ever felt exasperated by the industry's stumbling blocks such as the absence of universally accepted standards or the herculean task of processing an ocean of information? We've got you covered! We dive into the heart of these issues and discuss how Noyo provides comprehensive solutions for companies longing to integrate a seamless benefits experience into their software. We also unravel the knotty issue of premium leakage and delve into the transformative potential of technology, particularly AI, in boosting operational efficiency and reducing the burden on employers. Catch the wave and join us in exploring the monumental influence of AI in managing data and the urgent requirement for speedy carrier set-up and how Noyo's pioneering technology simplifies this process.

Imagine a future where health plans come with no deductibles and no copays, doesn't it seem like a fantasy? But what if it's not? In our enlightening conversation with James Millaway, the CEO of Zero Health, we unpack the concept of health plans without the burden of deductibles and copays. We trace the history of these cost-sharing measures and their effect on overall healthcare costs. We also highlight the idea of insurance and how it should be a guard against catastrophic risks, not everyday events. Moving onto the second half of our discussion, we delve into the realm of efficient healthcare purchasing and its potential for significant cost savings. We ponder on how employers and brokers can enable their employees to make informed decisions about their care. The talk also covers the integration of care management and the potential savings in medical expenditure. Our discussion reaches its peak as we talk about the future of healthcare and the vital role of trust. We explore Zero Health's impact on this future, and the importance of creating a trustworthy product. Don't miss out on this insightful conversation where we reimagine the future of healthcare.

Have you ever wondered about the hidden layers of healthcare costs? Today, we bring you insights from an eye-opening conversation with Dr. Keith Smith, co-founder of the Surgery Center of Oklahoma. Dr. Smith shares his personal journey of navigating the healthcare industry, and the shocking discovery that hospitals were not always the best advocates for patients or surgeons. He and his colleague dared to change this by establishing their own facility, a radical move that influenced the Trump Executive Order Mandating Price Transparency.We're also discussing the rising trend of self-funded healthcare plans and why employers are looking for alternatives to traditional ones. Imagine a zero-deductible and zero-copay approach to healthcare; it's happening, and it's giving companies a competitive advantage in the labor market. But it's not all smooth sailing; there are important regulations to consider like CAA notifications and ERISA. Plus, we highlight why quality assurance remains crucial when choosing healthcare facilities.Rounding off, we question traditional quality metrics and argue for the value of price transparency in measuring the quality of care. We draw on insights from Marty McCary's book Unaccountable to challenge the reliability of existing quality metrics. Finally, Dr. Smith shares his thoughts on the future of healthcare and the ongoing need for more transparency and patient advocacy. So, sit back and join us for a compelling discussion filled with revelations about the evolving healthcare industry.

Ever wondered how the Pharmacy Benefit Management (PBM) industry really works? Join us for an enlightening chat with our guest, Dave Parker, the Vice President of Sales and Marketing at TrueScript, as we unravel the intricacies of the traditional PBM relationship. Gain insight as Dave dissects key terms like average wholesale price and net cost, and unveils the ways PBMs make their money. We also delve into the trend of manufacturers moving closer to employers to shake off spread pricing models. More importantly, discover why it's crucial to ask the right questions in a PBM relationship.We also step into the fascinating world of pharmacogenomics testing for prescription drugs, a game-changing approach that could redefine the healthcare industry. Picture this - a one-time test that prevents the misprescribing of medications, saving patients and doctors from hefty medical bills and hospital stays. Indeed, such a test already exists, and some PBMs are benefiting from the potential savings it brings. We'll also investigate the prospect of making this a routine test for newborns and what it could mean for stop loss carriers. Last but not least, Dave returns to introduce us to the emergence of transparent PBMs - a revolutionary shift that is transforming the industry and proving particularly appealing to younger consumers. Tune in for an episode packed with industry insights and thought-provoking discussions.

Prepare yourself to be fascinated by Dr. Kyle Rickner, co-founder and chairman at Primary Health Partners, as he takes us on an inspiring journey of how direct primary care became his answer to physician burnout and subpar patient experiences. Step into the world of evolving healthcare models as we dissect the barriers that prevent more physicians from transitioning to this progressive model. Together, we untangle the web of the traditional fee-for-service system and how it has stagnated the growth of direct primary care. We also unpack the implications of misused health insurance and sky-rocketing premiums leading to a precarious cycle of healthcare costs.In the latter half of our enlightening conversation, we journey across state lines to understand how direct primary care physicians unite in their mission to deliver patient care. Listen to Dr. Rickner narrate the challenges and triumphs of coordinating care for a substantial client base, all while pushing the scalability model forward. We also shine a spotlight on the significance of data collection in establishing the value of direct primary care and highlight the urgent need for educating people about its benefits. Join us and share our curiosity, as we discover how direct primary care is revolutionizing the healthcare industry.

Ever wondered if your business is really understanding the true cost of healthcare? Join us as we pick the brain of Kelly McDevitt, the President of the Nonprofit Integrated Benefits Institute (IBI). With a whopping 40 years of industry experience, Kelly unpacks how IBI assists businesses in deciphering the often-complex healthcare costs beyond just medical and pharmacy expenses. We dive into the increasing curiosity around self-insured plans and the pivotal role of data in employer decision-making. Plus, you'll discover how IBI's benchmarking data provides a panoramic view, setting the stage for strategic planning.Then, as the conversation deepens, we navigate the murky waters of delayed healthcare and the difficulties it presents in sourcing relevant claims data. Our journey takes us into the heart of the pandemic's impacts on health and disability claims - including prolonged health issues related to COVID-19. Kelly sheds light on how businesses can utilize this data to craft well-informed decisions, the significance of benchmarking, and the unique challenges HR teams are currently facing. Tune in for an insightful conversation packed with valuable insights for employers seeking to understand the labyrinth of healthcare costs.

Have you ever wondered about the balance between empowering employees and maintaining control as a leader? Get your answers as we have an enlightening conversation with Kristen Hadeed, author of Permission to Screw Up and Leadership Thought Leader. Kristen takes us on her leadership journey, a journey that began when she was 21 and saw 45 of her employees walk out on her, a pivotal event that reshaped her leadership approach. She shares how this experience transformed her into an advocate for fostering an environment of trust, empowerment, and psychological safety.What if your team could solve problems without micromanagement? Would it be more effective? Kristen takes a deep dive into these questions and unravels the delicate balance between supporting employees and giving them ownership of their work. She also shares her insights on how to avoid micromanagement and the impact it can have on your team's morale and your own wellbeing. At the heart of her message is the importance of cultivating a culture of trust that encourages constructive feedback. Can vulnerability be a game-changer in the workplace? Let's find out from Kristen's personal experience. She unveils how her honesty and vulnerability with her team not only led them to trust her but also gave her a second chance. Listen in as she passionately talks about the value of fostering an environment of vulnerability in the workplace. You'll learn the importance of striking a balance between guiding and supporting employees and giving them ownership of their work. It's time to explore the creation of human workplaces where vulnerability is embraced. This episode is loaded with wisdom, practical advice and a fresh perspective on leadership. Don't miss out!GET KRISTEN'S BOOK: Permission To Screw Up

You ever wonder why the current healthcare system is so expensive and seemingly broken? Get ready to explore the potential of innovative healthcare plan designs that seek to reduce out-of-pocket costs and increase access to care with our special guest, Kevin Kickhaefar, President and Chief Growth Officer at Gravy.  We'll learn about Kevin's fascinating journey from the Midwest to leading a healthcare startup and his vision of a redesigned healthcare system that works for everyone. We'll investigate the integration of direct primary care with plan design, and the challenges that brokers and advisors face in the current climate.Thinking about level-funded and self-funded plans? Our insightful discussion with Kevin also covers their impact on employers and traditional health insurance carriers. We'll explore how these plans provide employers with more control over their healthcare costs, leading to a more sustainable model for the future. Learn about how direct primary care can bridge the healthcare gap in underserved communities, and how innovative partnerships like the Gravy Pay card and Teladot are simplifying the payment process and virtual visits for patients and providers alike. If you're curious about the future of health insurance, this is one episode you won't want to miss.

Join us for a riveting conversation with our guest, Daniel Grun, Chief Marketing Officer at Leading Edge Administrators.  From nonprofit to insurance, he brings a unique perspective to our discussion about the key factors keeping the market static - cost, access, and education of care.  Daniel drops knowledge on the benefits of strong partnerships and the increasing influence of self-funded plans in the industry. We also dig into the vital role of training and establishing a bond of trust in selling and keeping insurance businesses afloat.Stay tuned as we navigate the terrains of data lakes, benchmarking, and reference-based pricing, technologies that are radically altering outcomes. Get an inside look at how Artificial Intelligence, guided by correctly labeled data, is bridging the underwriting gap.  Join us as we tackle the responsibilities attached to selling insurance plans, the necessity for proper education, and the thrill (and risk) of being on the cutting edge.  Buckle up for an enlightening discussion on the ever-changing insurance panorama and how to master the art of navigating it.