Podcasts about BCBS

June 18, 2026 ~ Mark Fendrick details how changes from Blue Cross Blue Shield could limit access to private practice mental health providers. Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

June 18, 22026 ~ Full Show: Marie Osborne for Kevin. Peter Trumbore breaks down G7 developments ahead of a potential Iran deal, while Neil Rockind analyzes a high-profile murder case taking a psychiatric defense turn. Patrick Anderson explains what the Fed Chair's latest comments signal for the economy, and Dr. Mark Fendrick outlines concerns over reduced mental health access for BCBS patients. Andy Arena warns of a new crypto scam targeting seniors as Audrey Lopez shares tips to keep kids safe online. Steve St. Juliana reacts to renewed attention on the Oxford school tragedy, Fr. Mario Amore discusses financial struggles facing Detroit parishes, and Congresswoman Lisa McClain joins Burge Young to promote a community effort supporting businesses impacted by the Oakland County water main break. Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

May 27, 2026 ~ Luanne Thomas Ewald, COO of Michigan Medicine's Ann Arbor hospitals, joins Kevin after Michigan Medicine reached an agreement with Blue Cross Blue Shield of Michigan. Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

On today's episode of the America's Work Force Union Podcast, we are covering a massive amount of ground—from the halls of the Ohio Statehouse to the structural healthcare barriers facing union moms across the country. Segment 1: Ohio Labor Under Fire with Melissa Cropper Melissa Cropper, President of the Ohio Federation of Teachers (OFT) and Secretary-Treasurer of the Ohio AFL-CIO, joins the show to unpack three simultaneous attacks on Ohio workers and the democratic process: The Midnight Pension Raid: How a 1 a.m. budget amendment stripped elected educators of control over the State Teachers Retirement System (STRS) board, and the legal battle (plus House Bill 719) fighting to reverse it. HB 698 & Higher Ed Restrictions: How this compliance mechanism is weaponizing state funding to restrict collective bargaining and aggressively police DEI roles. Union Busting in the Stacks: A look at the Columbus Metropolitan Library administration's aggressive anti-union campaign ahead of a critical mid-June election—and details on the June 7 community rally at Franklin Park. Segment 2: Breaking the Silence on Perinatal Mental Health For Mental Health Awareness Month, we sit down with Merrilee Logue, Executive Director of the Blue Cross and Blue Shield's National Labor Office, and Arin McClune, Clinical Quality Senior Program Manager with the Blue Cross Blue Shield Association National, to tackle the leading cause of pregnancy-related deaths in America: maternal mental health disorders. The Stark Reality: Up to 20% of women experience these disorders, yet fewer than 20% are ever screened. The Racial Equity Gap: Why women of color are twice as likely to suffer from maternal mental health challenges but only half as likely to receive care. The Union Solution: With 68% of mothers with young children in the workforce, find out how labor leaders can advocate for remote work, flexible scheduling, and integrated mental health benefits to build a culture of solidarity and support. Go Behind the Scenes of the Labor Movement: Every victory starts with workers standing together. Subscribe to the America's Work Force Union Podcast to get the latest interviews with the leaders, organizers, and advocates building true worker power. If you or someone you know is struggling with mental health or in crisis, help is available. Call or text 988 to reach the Suicide & Crisis Lifeline.

In this episode, Steve Moorehead, Vice President of Product, Strategic Planning and Performance Management at Blue Cross Blue Shield of Massachusett, and Marc Pierce, Principal at ECG Management Consultants, discuss why client retention has become a growing challenge for health plans and how organizations can use data-driven insights to identify risk earlier.This episode is sponsored by ECG Management Consultants.

In this episode, Steve Moorehead, Vice President of Product, Strategic Planning and Performance Management at Blue Cross Blue Shield of Massachusett, and Marc Pierce, Principal at ECG Management Consultants, discuss why client retention has become a growing challenge for health plans and how organizations can use data-driven insights to identify risk earlier.This episode is sponsored by ECG Management Consultants.

No Airman Left Behind. Inside the Air Force Wounded Warrior Program, that promise is more than words. It is a mission that never ends. On this episode of the Your Next Mission® video podcast, SMA Tilley goes inside the Air Force Wounded Warrior Program (AFW2) with MSG (R) Marsha Hoskins of AFW2, Leslie Santiago Rodriguez and CMSgt (R) Jason David of Blue Cross Blue Shield Association Federal Employee Program, and to reveal exactly how this program is changing lives and why no Airman is ever left behind.The Air Force Wounded Warrior Program (AFW2) is the lifeline for wounded, ill, and injured Airmen, Guardians, and their Families. From the moment of injury through every stage of recovery, AFW2 walks alongside warriors with personalized care, advocacy, mentorship, and a community that refuses to let anyone heal alone. And when partners like Blue Cross Blue Shield Federal Employee Program stand shoulder to shoulder with that mission, the impact multiplies. This is the inside look every Airman, Guardian, caregiver, Veteran, and Military Family needs to hear.CMSgt (R) Jason David shares the warrior's perspective. Marsha Hoskins breaks down how the program actually works and who it serves. Leslie Santiago Rodriguez explains how Blue Cross Blue Shield FEP partners with AFW2 to extend care and resources to those who served. Three voices. One mission. Zero filters. Because heroes don't heal alone, and no Airman is ever left behind.LEARN MORE / GET INVOLVEDAir Force Wounded Warrior Program: https://www.woundedwarrior.af.milBlue Cross Blue Shield Federal Employee Program: https://www.fepblue.orgWhat you will hear in this episodeInside the Air Force Wounded Warrior Program and exactly who qualifies for AFW2 supportHow AFW2 walks with warriors and Families from the moment of injury through every stage of recoveryWhy CMSgt (R) Jason David says the Air Force Wounded Warrior Program saved more than just his careerHow Blue Cross Blue Shield Federal Employee Program partners with AFW2 to extend care, advocacy, and lifelong resourcesWhat caregivers and Military Families need to know about the support available to them right nowWhy the transition from active duty to civilian life is one of the hardest battles a wounded warrior fightsThe role adaptive sports, mentorship, and community play in the healing process inside AFW2How the partnership between BCBS FEP and the Air Force Wounded Warrior Program is reaching Airmen who did not know help existedWhy corporate America stepping up matters and what real partnership looks like in actionThe honest truth about what wounded warriors and their Families need most and how you can be part of the solutionHow to connect a wounded, ill, or injured Airman or Guardian to AFW2 todayWhy no Airman is ever left behind and what every Veteran should know about asking for helpWhat is the Air Force Wounded Warrior Program?Who qualifies for AFW2 support?How does the Air Force support wounded, ill, and injured Airmen?What does No Airman Left Behind mean in the Air Force?How does Blue Cross Blue Shield partner with the Air Force Wounded Warrior Program?What benefits do wounded warriors get through Blue Cross Blue Shield Federal Employee Program?How does AFW2 help with the transition to civilian life?What support is available for Air Force wounded warrior families?How do I connect a wounded Airman to the Air Force Wounded Warrior Program?What is the role of caregivers in AFW2?How do adaptive sports help wounded warriors heal?What resources are available for Air Force veterans with PTSD or TBI?How does the Air Force Wounded Warrior Program work with the VA?What is the impact of AFW2 on Airmen and Guardians?How can civilians support wounded warrior programs?What does Blue Cross Blue Shield FEP cover for federal employees and veterans?#NoAirmanLeftBehind #AirForceWoundedWarrior #AFW2 #BlueCrossBlueShield #BCBSFEP #FederalEmployeeProgram #WoundedWarrior #YourNextMission #SMATilley

Segment 1: Building a Healthcare System That Works for Working Families Three decades of experience have given Kari Hedges, Senior Vice President of Market Solutions at the Blue Cross Blue Shield Association, a clear view of what remains broken in American medicine. Joining National Labor Office Executive Director Merrilee Logue, Hedges discusses the urgent need for data interoperability—the ability for different medical systems to share patient records seamlessly. Hedges shares a moving personal story about navigating a fragmented system to save her own mother's life, illustrating why BCBS is building a new interoperability hub to give physicians a real-time view of a patient's history. We also dive into the impact of electronic prior authorization, which has already shown the potential to resolve 84 percent of cases instantaneously and improve provider efficiency by up to 230 percent. Finally, the pair discusses the responsible deployment of Artificial Intelligence and the continued expansion of telehealth and behavioral health services for workers facing shift-work barriers.   Segment 2: Steel Benchmarks, Trade Enforcement, and the Ohio Primary In our second segment, Pat Gallagher, President of the North Coast Area Labor Federation, breaks down the economic signals heading into a pivotal bargaining season for the United Steelworkers. With hot-rolled coil trading above $1,000 per ton, the industry is entering a strong financial position just as contracts with Cleveland-Cliffs and U.S. Steel are set to expire on September 1. Gallagher also addresses the complexities of trade enforcement and the upcoming USMCA renegotiations, highlighting how "trade cheating"—such as routing Chinese steel through third countries—undercuts American workers. Looking toward the May 5 Ohio primary, Gallagher emphasizes the importance of electing labor voices to the statehouse, backing a slate of union candidates including Davida Russell (AFSCME), Scott Demaro (OHEA), and Brian Poindexter (Ironworkers). Subscribe to the America's Work Force Union Podcast for more interviews with the leaders and organizers building worker power across America.

In one of the wildest Power Ranking throwdowns, a white whale from the year 2000 by De Dolle Brouwers finds itself up against barrel-aged barleywines from Brujos Brewing and Dimensional Brewing Company and a locals only single-barrel 2026 BCBS. In the Beer News, beer sales on St. Patrick's Day have bounced back, Chicago claims the American English Mild Ale crown for the three-peat, and Tilray teams up with an American legacy brand Popsicle.  Thanks to Trillium Brewing for sponsoring this episode. Follow them on IG @TrilliumBrewing. Check out their latest releases and collab beers here. Don't sleep on their spirits program either. Look out for their West Coast IPA collab with Sante Adairius, Monkish, and Side Project at the 2026 Firestone Walker Invitational Beer Fest.  For more info about colon cancer and to help support the fight against it check out the Colon Cancer Foundation.  Head to our Patreon for weekly exclusive content. Get the Malt Couture Officially Licensed T-shirt. Follow DontDrinkBeer on Instagram.

Was bedeutet Datenmanagement in einer ECB-regulierten Bank mit rund 55 Milliarden Euro Bilanzsumme? In dieser Folge spricht Jonas Rashedi mit Caroline Grimm, Chief Data Officer der Münchener Hypothekenbank, über den Balanceakt zwischen regulatorischer Pflicht und strategischer Datenarbeit. Caroline gibt Einblicke in den Aufbau eines zentralen Data Office, die Umsetzung von BCBS 239, den Einsatz von Data Lineage-Tools sowie den Greenfield-Aufbau eines neuen Enterprise Data Warehouses. Besonders spannend: Warum sie sich bewusst das Mandat für eine Datenstrategie vom Vorstand geholt hat – statt sie im „Kämmerchen“ zu schreiben. Eine Folge über Entscheidungsqualität, Datenkultur, systemisches Arbeiten und die Erkenntnis: Transformation beginnt im Kopf – nicht im System. Zum Linkedin Profil von Caroline: https://www.linkedin.com/in/caroline-grimm-36927815/ Zur Homepage der Münchener Hypothekenbank: https://www.mhb.de/de Zu allen Links rund um Jonas: https://linktr.ee/jonas.rashedi Du möchtest gezielt Werbung im Podcast MY DATA IS BETTER THAN YOURS schalten? Zum Kontaktformular: https://2frg6t.share-eu1.hsforms.com/2ugV0DR-wTX-mVZrX6BWtxg

Send a textGrinding harder won't fix dysregulation.In this episode, Michael Caulo breaks down why stress impairs decision-making, how cortisol affects executive function, and why recovery is the real performance advantage.We explore:• The neuroscience of stress• Why mobility is foundational• Divorced dads and high-stress fitness• Why motivation fails• Systems vs ego trainingLive replay directly on Amazon!Check out the LOF 2026 retreat replay here. Shop the LOF band flash sale while supplies last!Sign up to start your 100-day comeback. HSA/FSA + Aetna, BCBS, UHC accepted.

Send a textIf you already know what to do for your health but aren't doing it consistently, this episode breaks down the real reason.It's not discipline.It's the nervous system regulation.In this episode, we explore:• How stress weakens executive function• Why sleep deprivation reduces impulse control• How chronic stress shifts behavior into habit mode• Why environment beats motivation• A practical 4-step re-regulation framework

Thursday, January 15th , 2026 - The Charlie James Show HOUR 1 1st - Snow in Western NC coming soon ; We got good unemployment news 2nd - These are not protests anymore, they are full out Insurrectionists 3rd - The airport in Minneapolis has had 6 million/week in luggage pass through 4th - President Trump just introduced his Great Healthcare Plan HOUR 2 5th - SC House District 38 Rep Josiah Magnuson on HB 3343 & 3310 6th - Measles outbreak in Spartanburg; State General Josh Kimbrell's letter 7th - Callers talking about Vaccine talk is the topic on the WORD talk line 8th - The Senate just passed a funding bill 82-15, but shutdown is possible HOUR 3 9th - BCBS put out a how-to Video on how to do a family childcare provider in MN 10th - There is a bill that will close the Primaries here in SC - H3310 11th - The SC G.O.P wants HB S33 ; Corruption in SC Politics 12th - JD Vance voted the tie breaking vote to not ban Trump with a War Powers Resolution HOUR 4 13th- They are here illegally, no matter how the Dems spin it 14th- Minnesota Mayor Jacob Fry saying crazy things in a press conference 15th- Calls on the WORD Talk line - MN Fraud : Brad Totkey is doxing ICE agents 16th- This applies to all sanctuary cities, Trump can use Insurrection act

H3-Thurs1/15/26-TCJS- " BCBS put out a how-to Video on how to do a family childcare provider in MN " , " There is a bill that will close the Primaries here in SC - H3310 " , " The SC G.O.P wants HB S33 ; Corruption in SC Politics" , "JD Vance voted the tie breaking vote to not ban Trump with a War Powers Resolution "

Keep goin' Heels!!

December 2, 2025 ~ Andy Hetzel, VP of Communications for BCBS of MI discusses what to do about the rising cost of healthcare. Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

We hit Goose Island Prop Day 2025, the biggest Bourbon County release event of the year, and we're breaking down everything: the lines, the bottles, the crowd, the variants, the mystery pours, the hits, the misses, and whether the whole thing is still worth the hype.Join Matt, Jason, and Nick as we talk through every BCBS variant, the Chicago-only releases, what impressed us, what didn't, and how this year stacks up against past Prop Days.If you love Bourbon County, barleywine, Chicago beer culture, or just beer fest stories, you're in the right place.#GooseIsland #PropDay #BourbonCounty #BCS2025 #BCBS2025 #BeerReview #CraftBeer #ArsenicCulturehttps://www.youtube.com/@arsenicculturehttps://instagram.com/arsenicculturehttps://tiktok.com/@arsenicculturehttps://www.facebook.com/arsenicculture/https://x.com/arsenicculture

Montana continues to face some of the toughest mental health challenges in the nation — from high suicide rates to limited access in rural communities. On this episode of Voices of Montana, we take a direct look at what's driving […] The post Jason DeShaw and BCBS of Montana Team for Mental Health the Country Way first appeared on Voices of Montana.

On this episode of the America's Work Force Union Podcast, we were joined by Jackie Tate, President, and Imogen Fox, Bargaining Team Member, Steward, with American Federation of State, County and Municipal Employees (AFSCME) Local 88, representing Multnomah County employees in Portland, Ore They discussed the union's current contract negotiations, key workplace challenges such as staffing, wages and trauma support, as well as the growing role and concerns surrounding artificial intelligence in the public sector. On this episode of the America's Work Force Union Podcast, Merrilee Logue, Executive Director of the National Labor Office at Blue Cross Blue Shield Association, and David Yoder, Senior Vice President of the Blue Cross Blue Shield Federal Employee Program (FEP) discussed FEP's commitment to the federal workforce, the details of the current open enrollment period and what the premium adjustments mean for members in the coming year.

October 14, 2025 ~ Tricia Keith, President and Chief Executive Officer of Blue Cross Blue Shield of Michigan, joins Kevin to discuss her op-ed in the Detroit Free Press titled “Health care costs are rising. We need to reform the system.” Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

In this Bright Spots in Healthcare episode, host Eric Glazer brings together an all-star panel of leaders who are reshaping the future of Medicaid and social care. Our guests include: Vanita Pindolia, Vice President, Medicare Star Ratings, Emergent Holdings (BlueCross BlueShield Michigan) Jason Merola, MD, Chief Medical Officer, MVP Health Care Charlotta Eriksson, Lead Director, National VBC Partnerships (Specialty), Aetna Mary O'Connor, MD, Chief Medical Officer & Co-Founder, Vori Together, they explore: How Medicare Advantage plans are embedding Stars, CAHPS, and adherence metrics directly into provider contracts to drive accountability, improve quality, and sustain year-over-year performance gains. How payers like Aetna are expanding value-based care into specialty domains—from CKD and oncology to musculoskeletal and cardiology—by partnering with specialty-aligned organizations rather than converting individual specialists to risk models. How MVP Health Care is designing hybrid incentive structures that reward specialists for closing quality gaps and improving outcomes, without requiring full downside risk. Why MSK care is becoming pivotal to Stars success, as physical and mental health measures grow in weight through 2027, and how holistic, physician-led models are improving activity, satisfaction, and cost savings simultaneously. How digital-first specialty networks are solving access challenges, reducing “ghost network” exposure, and creating new opportunities for plans to meet CMS adequacy standards while improving the member experience. How collaboration across utilization management, Stars, and member experience teams helps avoid trade-offs, ensuring that cost controls don't come at the expense of satisfaction or CAHPS performance. Panelist Bios: https://www.brightspotsinhealthcare.com/events/stars-savings-and-satisfaction-unlocking-msk-and-specialty-care-strategies-for-medicare-advantage-success/ Download the Episode Guide: Get key takeaways and expert highlights to help you apply lessons from the episode. https://drive.google.com/file/d/1a_rX23Ev5VRrJKqb8_UwAYBd9tUBIfWA/view?usp=sharing Resources:  Maximizing 2026 Medicare Advantage Performance with Physician-Led MSK Care This report outlines how Vori's physician-led, virtual-first musculoskeletal (MSK) model helps Medicare Advantage plans:Improve up to 12 Star measures across preventive care, chronic condition management, and member experience Deliver faster access to care—appointments available within 48 hours Enhance outcomes for pain, fall prevention, and osteoporosis care while achieving an NPS of 87 Align with the new 2026 Star measures for Improving and Maintaining Physical and Mental Health To request your copy, email nroberts@brightspotsventures.com. Clinical Quality Performance of Value-Based and Fee-for-Service Models for Medicare Advantage: https://jamanetwork.com/journals/jama-health-forum/fullarticle/2839238 This JAMA Health Forum article compares clinical quality outcomes for Medicare Advantage patients whose care is delivered under value-based payment (VBP) models versus traditional fee-for-service (FFS). It finds that VBP arrangements, especially those with two-sided financial risk—in general are associated with better performance on standardized clinical quality measures than FFS. Thank you to our Episode Partner, Vori: Vori partners with health plans and providers to improve musculoskeletal (MSK) care through data-driven, physician-led solutions. Their approach helps reduce unnecessary surgeries, improve recovery outcomes, and enhance patient satisfaction—supporting plans in achieving better Stars performance and overall member experience. To learn more, visit vorihealth.com. Schedule a meeting with Mary O'Connor Chief Medical Officer, Vori: To dive deeper into how Vori can help your plan improve outcomes, reduce costs, and strengthen Medicare Advantage Star Ratings,or to schedule a meeting with Mary O'Connor. Reach out to nroberts@brightspsotsventures.com  to schedule the meeting. About Bright Spots Ventures: Bright Spots Ventures is a healthcare strategy and engagement company that creates content, communities, and connections to accelerate innovation.   We help healthcare leaders discover what's working, and how to scale it. By bringing together health plan, hospital, and solution leaders, we facilitate the exchange of ideas that lead to measurable impact. Through our podcast, executive councils, private events, and go-to-market strategy work, we surface and amplify the “bright spots” in healthcare, proven innovations others can learn from and replicate. At our core, we exist to create trusted relationships that make real progress possible. Visit our website at www.brightspotsinhealthcare.com.  

Keaton Ross and KOSU's Sierra Pfeifer recently collaborated to report on the Oklahoma Department of Corrections' full-sprint effort to deploy artificial intelligence in state prisons. Paul Monies has an update on how state agencies are faring with Gov. Kevin Stitt's executive order mandating a return to office. Haley Parsley discusses her story on two lawsuits filed by BCBS, alleging a scheme in which recruiters got recovery patients in Oklahoma to attend treatment facilities in California. Ted Streuli hosts.

Rural Health News is a weekly segment of Rural Health Today, a podcast by Hillsdale Hospital. News sources for this episode: Tonya Garcia, Bloomberg, “Cardinal Health to acquire Solaris Health in $1.9B deal,” August 12, 2025, https://www.modernhealthcare.com/mergers-acquisitions/mh-cardinal-health-solaris-health-deal/, Modern Healthcare. Erich Timmerman, “Cardinal Health announces two strategic additions to its portfolio,” November 11, 2024, https://newsroom.cardinalhealth.com/2024-11-11-Cardinal-Health-announces-two-strategic-additions-to-its-portfolio, CardinalHealth. National Rural Health Association, “Fiscal Year 2026 Inpatient Prospective Payment System Proposed Rule,” April 14, 2025, https://www.ruralhealth.us/getmedia/cca11c3e-49da-4cf8-8a63-ec270bc96fb0/FY-2026-IPPS-proposed-rule-summary-4-14-2025.pdf. CMS.gov, “FY 2026 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule — CMS-1833-F,” July 31, 2025, https://www.cms.gov/newsroom/fact-sheets/fy-2026-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective-0. CMS.gov, “Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI) and IRF-PAI Manual,” August 4, 2025, https://www.cms.gov/medicare/quality/inpatient-rehabilitation-facility/irf-pai-and-irf-qrp-manual. Alan Condon, “CMS drops 3 final payment rules for 2026: 15 things to know,” August 4, 2025, https://www.beckershospitalreview.com/finance/cms-drops-3-final-payment-rules-for-2026-15-things-to-know/, Becker's Hospital Review. CMS.gov, “Transforming Episode Accountability Model (TEAM),” https://www.cms.gov/priorities/innovation/innovation-models/team-model.  Emmarie Huetteman et. al, “Kennedy Cancels Vaccine Funding,” August 7, 2025, https://kffhealthnews.org/news/podcast/what-the-health-409-rfk-jr-mrna-vaccine-funding-august-7-2025, KFF Health News. Nona Tepper, “BCBSA antitrust lawsuit reaches $2.8B tentative settlement,” October 14, 2024, https://www.modernhealthcare.com/insurance/bcbsa-antitrust-lawsuit-settlement-alabama/, Modern Healthcare. Nona Tepper, “Nearly 6,500 providers reject Blue Cross antitrust deal,” August 11, 2025, https://www.modernhealthcare.com/insurance/mh-bcbs-settlement-lawsuit-mayo-clinic-henry-ford/, Modern Healthcare. Andrew Cass, “Nearly 6,500 providers opt out of $2.8B BCBS settlement,” August 11, 2025, https://www.beckerspayer.com/payer/nearly-6500-providers-opt-out-of-2-8b-bcbs-settlement/, Becker's Payer Issues. Rural Health Today is a production of Hillsdale Hospital in Hillsdale, Michigan and a member of the Health Podcast Network. Our host is JJ Hodshire, our producer is Kyrsten Newlon, and our audio engineer is Kenji Ulmer. Special thanks to our special guests for sharing their expertise on the show, and also to the Hillsdale Hospital marketing team. If you want to submit a question for us to answer on the podcast or learn more about Rural Health Today, visit ⁠⁠ruralhealthtoday.com⁠⁠. Follow Rural Health Today on social media! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://x.com/RuralHealthPod⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/@ruralhealthtoday7665⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠  Follow Hillsdale Hospital on social media! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/hillsdalehospital/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.twitter.com/hillsdalehosp/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/company/hillsdale-community-health-center/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/hillsdalehospital/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ 

Greg & Sorcerer Chromatic drink and review (2:57) beers from Brouwerij 3 Fonteinen (Beersel, Belgium) and Prairie Artisan Ales (Krebs, OK). In our Beer News (11:02), we talk about 1. Dogfish Head's 30th Anniversary beer 2. The annual Beer Mile 3. 2025 Bourbon County Brand Stout lineup. For our Cöld Brüe List (20:24), Sorcerer Chromatic runs down the top songs by Ozzie Osbourne and the top movies with Hulk Hogan. We rate our beers on Untappd (37:54). And finally, during our Drunken Shenanigans (41:52), Sorcerer Chromatic tells us about his day at 49ers Training Camp, the guys talk about their kids starting school, and recap Happy Gilmore 2.

It's a Trappist beer showdown as Alex sources four Trappist beers from three different Trappist breweries that have never been featured on the show, then he and Stephen put the beers through the Power Ranking treatment. In the Beer News, a huge shakeup goes down in the distribution side of the beer world, Buffalo Trace grasps at straws for their next limited release, and it's the annual GOOSE IT OF LOOSE IT! To get involved with the  "Life" International Barleywine Collab, click the link for info about the recipe, BSG discount, and links to help raise awareness of colon cancer.  If you'd like to make a direct donation to help support Alex, head over to his GoFundMe.  For more info about colon cancer and to help support the fight against it check out the Colon Cancer Foundation.  Head to our Patreon for weekly exclusive content. Get the Malt Couture Officially Licensed T-shirt. Follow DontDrinkBeer on Instagram and Twitter.

Braves Senior Director of Alumni Relations & Growing The Game Greg McMichael returns to Behind the Braves to discuss the effects of extreme heat on big-league ballplayers, what it's like when a team starts building some positive momentum on the field, last weekend's Native American Showcase at Truist Park and the upcoming Braves Country Baseball & Softball Championships!  Learn more about your ad choices. Visit megaphone.fm/adchoices

June 23, 2025 ~ Tricia Keith, President and CEO of BCBS of Michigan and Detroit Police Chief Todd Bettison join Paul and Chris on the rooftop ahead of the 2025 Ford Fireworks.

Portions of the show brought to you by Family Chiropractic of Clark. Portions also brought to you by @paragontapandtable All news edition. Stuff like Kills Boro Pizza Party is back. Lagerfest returns to Icarus. Beer dinner with Roosterspin & Wet Ticket Brewing. Changes to BCBS come release time. Suds and Duds and more. @njcraftbeer @hoppedupnetwork#metalforever #drinklocal #drinkcraftnotcrap #stouts #ipas #lagers #ales #sours #hops #pilsners #porters #gastropub #speakeasy #beer #fcancer #smallbusinessowners #beerfestivals #beertours #music #podcastsSee omnystudio.com/listener for privacy information.

Mental healthcare is more affordable than you think with Mission Connection and BCBS insurance. Call the treatment center at (866) 833-1822 or visit https://missionconnectionhealthcare.com/bcbs-insurance/ to learn more about your coverage options today. Mission Connection City: San Juan Capistrano Address: 30310 Rancho Viejo Rd. Website: https://missionconnectionhealthcare.com/

Cathy Kennedy, a President of National Nurses United, joined the America's Work Force Union Podcast to discuss the potential impact of staffing cuts at Veterans Affairs hospitals, the urgent need for better legislation to prevent workplace violence and the push for Medicare for All. Merrilee Logue, Executive Director of the National Labor Office at Blue Cross Blue Shield Association, joined the America's Work Force Union Podcast to discuss statistics related to cancer diagnoses, the importance of preventive care and screenings and a union's role in supporting members through their cancer journeys.

Billions are on the table, but filing incorrectly—or not at all—could cost your hospital. In this episode, we break down the $2.8 billion Blue Cross Blue Shield Provider Settlement and why getting expert help matters. Join MCAG's Jon Gadd and Patrick Sheehan of Whatley Kallas as they expose the opportunity your in-house team may be missing.

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Host: David Rosenblum, MD Guest: Phillip Kim, MD Date: January 24, 2025 Time: 6:30 AM Episode Summary: In this episode of the PainExam Podcast, Dr. David Rosenblum engages with Dr. Phillip Kim to discuss the Federation Pain Care Access, a newly formed organization advocating for improved access to interventional pain treatments. The episode delves into the challenges posed by restrictive insurance coverage policies and the collaborative efforts needed to address these issues effectively. Key Discussion Points: -Introduction to Federation Pain Care Access: A new entity focused on advocating for emergent and standard care in interventional pain treatments, aiming to enhance access through advocacy and legislative solutions. - Impact of Restrictive Policies: Dr. Kim highlights how insurance carriers like Evicor, AIM, and Optum impose restrictive coverage policies that harm patients and practitioners, particularly amid the ongoing opioid epidemic.AIM, Optum and Evicore are not insurance carriers. these are separate entities which oversee utilization management and prior auth requests for insurance carriers (HMO, TPA's etc) e g. BCBS plans, UHS etc. Prior Authorization Challenges: Discussion on the AMA 2022 Prior Authorization Physician Survey, which indicates significant negative impacts on patient care due to prior authorization processes. - Case Studies: Dr. Kim shares specific cases where patients faced harm due to denied claims, including issues related to medical cannabis and necessary medical equipment.   - Collaboration with Medical Societies: The Federation works alongside various pain societies and stakeholders to address common concerns and push for better coverage policies. - Future Goals Plans for meetings with CMS and Medicare Administrative Contractors (MACs) regarding specific treatments like SI joint radiofrequency ablation, aiming to improve coverage and access.   Fundraising and Outreach: The Federation seeks to grow its membership and funding through outreach to allied health professionals and patient care groups while launching a media campaign to raise awareness of patient struggles  Legal and Advocacy Efforts: Emphasis on the need for legal considerations in advocacy efforts and the importance of public support in achieving the Federation's goals. - The No Pain Act: Discussion on recent legislation aimed at expanding access to non-opioid treatments and alternatives for chronic pain management. Guest Bio: Phillip Kim, MD is a leading advocate for pain care access and a founding member of the Federation Pain Care Access. He brings extensive experience in managing chronic pain patients and navigating healthcare policies. Resources  Federation Pain Care Access Website:  https://www.painfed.org # board Listeners are encouraged to support the Federation Pain Care Access by visiting their website to learn more about their initiatives and consider contributing to help advance their mission. Join Dr. Rosenblum and Dr. Kim in this vital conversation about the ongoing efforts to improve pain care access and the importance of collaboration in overcoming the challenges faced by patients and healthcare providers.   Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.  Patients can schedule a consultation by going to  www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Garden City Office 516 482 7246

Host: David Rosenblum, MD Guest: Phillip Kim, MD Date: January 24, 2025 Time: 6:30 AM Episode Summary: In this episode of the PainExam Podcast, Dr. David Rosenblum engages with Dr. Phillip Kim to discuss the Federation Pain Care Access, a newly formed organization advocating for improved access to interventional pain treatments. The episode delves into the challenges posed by restrictive insurance coverage policies and the collaborative efforts needed to address these issues effectively. Key Discussion Points: -Introduction to Federation Pain Care Access: A new entity focused on advocating for emergent and standard care in interventional pain treatments, aiming to enhance access through advocacy and legislative solutions. - Impact of Restrictive Policies: Dr. Kim highlights how insurance carriers like Evicor, AIM, and Optum impose restrictive coverage policies that harm patients and practitioners, particularly amid the ongoing opioid epidemic. AIM, Optum and Evicore are not insurance carriers. these are separate entities which oversee utilization management and prior auth requests for insurance carriers (HMO, TPA's etc) e g. BCBS plans, UHS etc. Prior Authorization Challenges: Discussion on the AMA 2022 Prior Authorization Physician Survey, which indicates significant negative impacts on patient care due to prior authorization processes. - Case Studies: Dr. Kim shares specific cases where patients faced harm due to denied claims, including issues related to medical cannabis and necessary medical equipment.   - Collaboration with Medical Societies: The Federation works alongside various pain societies and stakeholders to address common concerns and push for better coverage policies. - Future Goals Plans for meetings with CMS and Medicare Administrative Contractors (MACs) regarding specific treatments like SI joint radiofrequency ablation, aiming to improve coverage and access.   Fundraising and Outreach: The Federation seeks to grow its membership and funding through outreach to allied health professionals and patient care groups while launching a media campaign to raise awareness of patient struggles  Legal and Advocacy Efforts: Emphasis on the need for legal considerations in advocacy efforts and the importance of public support in achieving the Federation's goals. - The No Pain Act: Discussion on recent legislation aimed at expanding access to non-opioid treatments and alternatives for chronic pain management. Guest Bio: Phillip Kim, MD is a leading advocate for pain care access and a founding member of the Federation Pain Care Access. He brings extensive experience in managing chronic pain patients and navigating healthcare policies. Resources  Federation Pain Care Access Website:  https://www.painfed.org # board Listeners are encouraged to support the Federation Pain Care Access by visiting their website to learn more about their initiatives and consider contributing to help advance their mission. Join Dr. Rosenblum and Dr. Kim in this vital conversation about the ongoing efforts to improve pain care access and the importance of collaboration in overcoming the challenges faced by patients and healthcare providers.   Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.  Patients can schedule a consultation by going to  www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Garden City Office 516 482 7246

A major agreement between Anthem BCBS and Memorial Sloan-Kettering brings about a major Christmas gift to Cancer patients across NYC. Find out more on Alex Garrett's One Leg Up Network! Link to the article referenced: https://www.lohud.com/story/ne... Please welcome MFI MEDICAL as an affiliate sponsor to One Leg Up On Adapting With Alex Garrett! Affiliate link is here thanks to IMPACT https://mfimedical.sjv.io/c/34...

Nurses Out Loud – This week on *Nurses Out Loud*, we dive into healthcare's biggest headlines, including the shocking United Healthcare CEO murder, BCBS reimbursement controversies, FDA vaccine disclosure orders, and lessons from the COVID crisis. Join us as we explore the moral, legal, and ethical challenges reshaping the future of patient care and advocacy.

Nurses Out Loud – This week on *Nurses Out Loud*, we dive into healthcare's biggest headlines, including the shocking United Healthcare CEO murder, BCBS reimbursement controversies, FDA vaccine disclosure orders, and lessons from the COVID crisis. Join us as we explore the moral, legal, and ethical challenges reshaping the future of patient care and advocacy.

In this episode of the Empowering Plans podcast, attorneys Jon Jablon and Brady Bizarro delve into the details of a recent lawsuit where BCBS of Michigan, in its capacity as a TPA, is alleged to have engaged in anticompetitive practices for charging a fee to a group that chose a stop-loss carrier other than BCBS. This case is in its infancy as of December 2024, but we expect it to have noticeable effects on the stop-loss marketplace regardless of outcome. In this episode, Jon and Brady discuss those potential effects and how a holding either way could impact self-funding as a whole.

CRAFT BEER PODCAST INFO:Ken, Wendy, and Rob chase the beer truck to get some BCBS, discuss alcoholic advent calendars, and lots of beery things.Join us live at our new start time, 8:30pm ET, every other Friday! Live on Twitch, Kick, and Facebook! We'll also be live at 4 Elf Party Dec 14th at Dark Horse Brewery in Marshall, MI.Sponsors:Visit Detroit - The Detroit Brew Trail - https://visitdetroit.com/food-drink/breweries-wineries-distilleries/detroit-brew-trail/Zetouna Liquor - https://www.facebook.com/Zetouna-Liquor-Fine-Wine-Cigars-146021445420374/Craftapped (Code BOD for 15% Off At Checkout) - https://craftapped.com/join-page-by-state/Rochester Mills Beer Co - https://www.beercos.com/Join The Michigan Beer Discord - https://discord.gg/vEEDyzwdjTDownload the MI Beer Map - http://www.mibeermap.comSubscribe to Better on Draft - https://plnk.to/BODSpotify - https://open.spotify.com/show/6AlzP1BH0iykayF856bGRc?si=xXZzdd3CTPqgUq_KYTnBKgiTunes - https://podcasts.apple.com/us/podcast/better-on-draft-a-craft-beer-podcast/id1091124740Facebook - https://www.facebook.com/betterondraftUntappd - https://www.untappd.com/user/betterondraftYouTube - https://www.youtube.com/c/betterondraftInstagram - https://www.instagram.com/betterondraftTwitter - https://www.twitter.com/betterondraftTik Tok- https://www.tiktok.com/@betterondraft

Even though Black Friday doesn't mean what it once did, Bourbon County is still an event - and we have Ryan Tracy with us at Beer on the Wall to help us taste through this year's lineup of six from Goose Island. Sure we were banned from the official media tasting, but we assess the whole group fairly - and find some surprises that are real standouts in the history of BCBS. Also, shenanigans may be afoot at FoBAB in regards to our Fantasy League; Ryan T. and Craig have a proposed wardrobe swap; we discuss BCBS variants that “don't exist”; Tracy shares a Rare Day story that can only lead to bias; we can't help but fondle the box; and we are finally sponsored by Jazz, the style of music. And don't miss out on our annual trip through Bourbon Country. Beers Reviewed Bourbon County Stout 2024 (Imperial Stout aged in bourbon barrels) Bourbon County Brand Bardstown Cask Finish Stout (Imperial Stout aged in Bardstown Rye and Cherry Wood Oak Barrels) Bourbon County Brand Rare Stout 2024 (Imperial Rye Stout aged in King of Kentucky Bourbon Barrels) Bourbon County Brand Vanilla Rye Stout 2024 (Imperial Rye Stout aged in Rye Whiskey Barrels w/ Madagascar vanilla beans) Bourbon County Brand Macaroon Stout (Imperial Stout aged in Bourbon Barrels w/ cocoa nibs, sweet candied ginger, and toasted coconut) Bourbon County Brand Proprietor's Barleywine (Barleywine aged in Bourbon Barrels w/ tamarind, lime, whole Guajillo chiles, and piloncillo)  

Join us on our latest episode where we talk all things Bourbon County.  Not about the actual county in Kentucky, but about the glorious liquid produced once a year from Goose Island Brewery in the form of their Bourbon County Brand Stout.In this episode we talk about the upcoming releases from the Bourbon County Brand portfolio and we also revisit a past botte, 2015 Rare.  From the Bourbon County website, Back in 1979 the folks at Heaven Hill Distilleries filled a handful of new freshly charred American white oak barrels with some of their finest whiskey. It is rare for Bourbon to age in barrels for more than twenty-three years. But these barrels patiently sat for over thirty years. The extra years developed a distinct and complex character that makes them truly one-of-a kind. We filled those barrels with Bourbon County Brand Stout, and then stored them away in our Chicago Barrel House to age for two more years. With these rare barrels from our friends at Heaven Hill we believe this is one of the finest beers we have ever produced. This is Goose Island Rare Bourbon County Brand Stout for 2015Is 2015 Rare still holding up?  it worth it?  What are our thoughts on the newest releases coming Black Friday?  Only one way to find out...https://www.gooseisland.com/bourbon-county-brand-stouthttps://untappd.com/b/goose-island-beer-co-rare-bourbon-county-brand-stout-2015/1230311#newrelease #craftbeerreview #gooseisland #bourboncounty #beer #bourbon #whiskey #drinkreview #podcast #isitworthit #arsenicculture https://www.youtube.com/@arsenicculturehttps://instagram.com/arsenicculturehttps://tiktok.com/@arsenicculturehttps://www.facebook.com/arsenicculture/https://x.com/arseniccultureBourbon County 2024: Anticipating The New, Enjoying The Old-E89https://www.youtube.com/@arsenicculturehttps://instagram.com/arsenicculturehttps://tiktok.com/@arsenicculturehttps://www.facebook.com/arsenicculture/https://x.com/arsenicculture

Andrew Strom, a labor lawyer and contributor to the OnLabor Blog, joined the America's Work Force Union Podcast to discuss the potential impacts the presidential election results could have on the National Labor Relation Board (NLRB). He also discussed holes in the National Labor Relation Act that have been exploited by corporations. Merrilee Logue, Executive Director of the National Labor Office at Blue Cross and Blue Shield Association, and Daniel Yoder, Senior Vice President of the Federal Employee Program (FEP) at Blue Cross and Blue Shield Association, joined the America's Work Force Union Podcast to discuss the open enrollment period for federal employees and how the FEP helps members simplify navigating their healthcare options.

Send us a textValue-based care often focuses on primary care rather than specialties.But can and should that change?Especially when it comes to cardiology.In this HealthBiz Brief, George Aloth, CEO of Chamber Cardio, explains how they are enabling cardiology teams to excel in a value-based system by ensuring providers are rewarded for delivering the right care at the right time.This episode is brought to you by BetterHelp. Give online therapy a try at https://betterhelp.com/caretalk and get on your way to being your best self.As a BetterHelp affiliate, we may receive compensation from BetterHelp if you purchase products or services through the links provided.

Send us a textDiscord: https://discord.gg/QUEp5DBeNew New Facebook Group: https://www.facebook.com/share/g/Ab2ApGdaqRQj1T6c/Medicare and Ozempichttps://qz.com/ozempic-price-cut-medicare-negotiations-1851650680BCBS Demanding Payments from Off Label Ozempic Prescribershttps://www.bloomberg.com/news/articles/2024-09-12/off-label-ozempic-prescriptions-spark-1-million-demand-from-insurerVisit Our Sponsor!Get Connected with Ro Body: https://www.ro.co/otpReport The Shortage: https://www.ro.co/supply-trackerDoes your insurance cover GLPs? https://www.ro.com/checkerOnthepen.TVSupport the showMY WORK RELIES ON YOUR GENEROSITY, WAYS TO SUPPORT:Venmo: OnThePenCa$h App: ManOnMounjaroBECOME A MEMBER:https://www.youtube.com/channel/UCDocQ-4IhVS3ihy_dW7nSKw/joinSOCIAL LINKShttps://www.tiktok.com/@manonthemounjarohttps://twitter.com/ManOnMounjarohttps://instagram.com/manonthemounjarohttps://facebook.com/manonthemounjaro

Blue Cross Blue Shield CEO Sarah Iselin is a great asset for Massachusetts. I admired her work when she ran the Department of Healthcare Finance and Policy and then the BCBS Foundation, and was grateful for her rescue of Massachusetts' implementation of the Affordable Care Act. After a decade-long sojourn to Florida and California she's come back to Massachusetts just in time to address some big challenges. Among the topics we discussed:The Steward Healthcare bankruptcyAccess to care -especially behavioral healthThe health care cost crisisWomen's healthValue based care and the Alternative Quality ContractI also enjoyed learning about how Sarah was inspired by her parents to enter public service and her early dates as an art student.Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. Produced by Dafna Williams.

Funny stuff.

Bryan Flannery, Director of Anthem Blue Cross Blue Shield's Labor and Trust division, joined the America's Work Force Union Podcast to discuss how Anthem is working to keep healthcare costs affordable and accessible for union members nationwide. John Samuelsen, International President of the Transport Workers Union of America, joined the America's Work Force Union Podcast to discuss the long journey to getting Amtrak onboard service workers a historic wage increase and industry-leading paid parental leave in their recently ratified contract.

How can a real estate agent with over two decades of experience leverage their knowledge to become a trusted voice in their community?   This episode is sponsored by Remi Graphics! owned by Dunya Taylor, Remi Graphics offers stunning, personalized mugs perfect for closing gifts or client appreciation. With no minimum order and quick turnaround, it's easy to add a personal touch. Contact Dunya through Instagram or Facebook, or visit her website and make a lasting impression today! Angela Walker, a seasoned realtor with 25+ years of experience, shares her journey from corporate America to real estate success. She discusses understanding client needs, continuous learning, and relationship building. Walker emphasizes the importance of staying informed about market trends and the power of niche marketing in finding clients their perfect homes. Angela Walker, a Jacksonville native, graduated from FSU with an Economics degree focusing on Demographics and a minor in Marketing. This combination proved ideal for her real estate career. After 11 years at BCBS of FL in customer service and management, she became a stay-at-home mom. A move to a smaller home inspired her career change. With a teacher's heart and servant's spirit, Angela's customer service skills and natural aptitude for real estate valuation launched her successful career.   [00:00:00 - 00:15:00] From Corporate to Real Estate: A Journey of Discovery   Angela's transition from Blue Cross Blue Shield to real estate The importance of customer service skills in real estate How Angela's first real estate experience inspired her career change   [00:15:00 - 00:30:00] Building a Radio Presence: The Power of Consistent Communication   The genesis of Angela's real estate radio show How the show has positioned her as an expert in the community The importance of staying informed on various real estate topics   [00:30:00 - 00:45:00] The Art of Client Relations: Understanding Needs and Building Trust   The importance of thorough client interviews How to effectively communicate with clients during property viewings The value of being knowledgeable about different neighborhoods   [00:45:00 - 01:00:00] Navigating the Changing Real Estate Landscape   The importance of staying updated on contract changes How to handle challenging situations with other agents The value of previewing properties and knowing the inventory   [01:00:00 - 01:26:00] Niche Marketing and Continuous Learning: Keys to Long-term Success   The importance of finding a niche in real estate How to price properties effectively in a changing market The value of continuous learning and staying informed about industry changes   Quotes:   "I really care about people. And when you care about people, and the life that they're living, and any little way that you can make a difference that makes their life better, that's worth the journey right there." - Angela Walker   "Knowledge is power. The faster you can get it, the better you're going to be, period." - Angela Walker   Connect with Angela:   Instagram: https://www.instagram.com/angelawalkerrealestate/ Facebook: https://www.facebook.com/angela.e.walker.39/ LinkedIn: https://www.linkedin.com/in/angela-walker-realestate/ If you want to build your business and become more discoverable online, Streamlined Media has you covered. Check out how they can help you build an evergreen revenue generator all  powered by content creation!   SUBSCRIBE & LEAVE A 5-STAR REVIEW as we discuss real estate excellence with the best of the best.  

For a full transcript of this episode, click here. On the show today, I am going to use the term TPA (third-party administrator) and ASO (administrative services only) vendor kind of interchangeably here. But these are the entities that a plan sponsor—for example, a self-insured employer is a plan sponsor—but these plan sponsors will use to administer their plan. And one of the things that TPAs and ASOs administer is this so-called weekly claims wire. Every week, self-funded employers get a weekly claims run charge so they can pay expenses related to their plan in weekly increments. The claims run usually comes with a register or an invoice. This invoice might be just kind of a total (“Hey, plan. Pay this amount.”). Or there might be a breakdown like, “Here's your medical claims, and here's your pharmacy claims.” Maybe there's another level down from that of detail if the plan or their advisor is sophisticated enough and/or concerned enough about the fiduciary risk to dig in hard about what the charges are actually for. I was talking about this topic earlier with Dana Erdfarb, who happens to be executive director of HR at a large financial services organization. Dana I'm definitely gonna credit for inspiring this conversation that I'm having today with Justin Leader. Dana was the first one to really bring to my attention just the level of hidden fees that are buried (many times) in these claims wires … because when I say buried in the claims wire, I mean not charged for via an administrative invoice. These hidden fees are also not called out in the ASO finance exhibit in the contract, by the way. So, yeah … hidden. I don't know … if you have to hide your charges, in my mind that's a pretty big tell that your charges are worth hiding. Now the one thing I will point out is that just because the charges are worth hiding doesn't necessarily mean that the services those charges are for are unwarranted. Some of these services are actually pretty worthwhile to do. There's just a really big difference from a plan sponsor knowingly contracting at a known rate with a third party to do something versus paying for a service knowingly or unknowingly via fees hidden in a claims wire wherein the amount paid is not in the control of the one paying the bill. Anyway, I was talking about all of this earlier, as I mentioned, with Dana Erdfarb. That conversation was exactly the framework that I needed to snag Justin Leader, my guest today, to come on the pod and really dig into the detail level of what's going on with this claims wire. So, in this healthcare podcast, we're gonna talk about the five fees that tend to be tucked in to many claims wires. We also talk about one bonus—not sure if it's a fee—one bonus way that plan sponsors give money to vendors in ways the plan sponsor might be unaware of. Here are the five hidden fees that we talk about at length in the show today, and then I'll cover the bonus: 1. Shared Savings Fees. This is where a member of a plan goes out of network, and the TPA/ASO goes and negotiates a discount from the out-of-network provider and then shares the savings. Get it? Shared savings? This category also might include BlueCard Access fees, which we talk about in the show. But there also could be overpayment recoupment fees lumped in here. This is where the TPA messes up, overpays, and then charges the plan sponsor a percentage of the money they just got back when they corrected their own mistake. I'm just gonna pause here while everyone contemplates how we've all gone so wrong in life to not have figured out a way to charge others when we correct our own mistakes. Here's a link to a great LinkedIn post by Chris Deacon and a deep dive article on this topic. 2. Prior Auth Fees. Lots to unpack with this one, which Justin does in the pod. 3. Prepayment Integrity Fees. This is evaluation of the claim before it's being paid. Listen to the show for how this may (or may not) differ from what the TPA/ASO is supposed to be doing (ie, it's the TPA that's supposed to be [yeah, right] adjudicating and paying claims). 4. Pay and Chase Fees. This is where a bill was paid wrong, and it's not immediately the TPA/ASO's mistake. This is where something like a provider double billed or overcharged or something, and the TPA/ASO later figures this out and then chases the pay to get the money back. 5. TPA Claims Review Fees. Sort of self-explanatory but also not. Again, please listen to the show for more. When I'd been talking about all of this with Dana Erdfarb, as I mentioned earlier, just about this whole thing, she said something that Justin Leader echoes today: Many of these fees are structured as a percentage of savings. This is challenging for a plan sponsor because the savings is vendor reported and not validated. But it also means that if the savings increase annually with trend (as they, generally speaking, do), then the fees will increase with that trend as well—and that is something to keep in mind. Okay … so, here's the bonus thing that didn't get a number in the show today, but it is certainly a way that plan sponsors pay money to vendors. And this is medical claims spread pricing. This is buried in the claims wire and inside the dollar amounts the plan sponsor thinks they are paying a provider for a service. It turns out that it can turn out that the amount the plan sponsor is paying is more than the check that's being written to the provider for the service being delivered. Or the amount the plan sponsor is paying the provider for a service is more than for simply that service that has been rendered, right? The plan sponsor is paying the provider for other stuff as well, as is alleged in the DOL v BCBS of Minnesota lawsuit, which Justin brings up in the show today. It drives me nuts, honestly, when there are people who tout their transparency. But then it turns out if the equation is A plus B equals C, only like one of the numbers is transparent. Sorry, functionally, that doesn't count as transparency except in marketing copy. This is all to say—and here's Dana Erdfarb's actionable advice which sums up points Justin also made—when employers review their medical plan vendor contracts, they should make sure to identify, review, and document all fees being paid to their vendors and incorporate this knowledge into their renewal/RFP (request for proposal) discussions and negotiations. Jeff Hogan echoed this advice on LinkedIn the other day when he commented on this show: “Such a great opportunity for employers to have their administrative services agreements and other documents examined to discover these schemes. It's not hard to do. Also, a great advertisement for the value of having retrospective audits performed. It is eye opening to see not only the amount of arbitrage but often how payers don't even pay according to their contracts. Justin Leader is the perfect guest.” As mentioned a myriad of times already, my guest today is Justin Leader, who is president and CEO of BenefitsDNA. Justin works with plan sponsors, both commercial plans as well as Taft-Hartley plans, across the United States. Before we kick into the show today, I just want to thank By the 49ers for the really nice review on iTunes. By the 49ers calls Relentless Health Value a “leading voice in healthcare” and says he or she always leaves “with intrigue, a new idea or a new approach to problem solving.” Really appreciate that. That is certainly one of our goals around here. So, thank you so much. Oh, also, please subscribe to the weekly email that goes out. You can do that by going over to our Web site and signing up. There are a lot of advantages to doing so, which I've talked about before, so I'm not gonna do so again; but it is a great way to make sure that if you're a member of the Relentless Health Value Tribe, you are aware of the current goings-on. Also mentioned in this episode are Dana Erdfarb, Chris Deacon, Jeffrey Hogan, BenefitsDNA, Rik Renard, Cora Opsahl, Al Lewis, Julie Selesnick, Mark Davenport, Karen Handorf, Dawn Cornelis, AJ Loiacono, and Mike Miele. You can learn more at benefitsdna.com or wefixyourhealthcare.com. You can also follow Justin on LinkedIn.     Justin Leader began his career in the pharmaceutical and financial services industries. By 2011, Justin entered into the group benefits field consulting for many notable Fortune 500 clients. In 2014, he established BenefitsDNA, an objective, independent health and welfare benefit plan consulting firm providing compliance oversight, actuarial services, cost mitigation, and traditional broker services to Group Health Plan Sponsors. As a Certified Health Rosetta Chartered Advisor (eighth advisor to join), he's acknowledged for contributing to healthcare solutions in the United States both in policy as well as practice and is an avid supporter of Patient Rights Advocate. Throughout his career, Justin has been instrumental in introducing successful healthcare benefit solutions to the market, which have been pivotal in solving critical issues and saving millions for employers and their employees. As a mission-driven leader, he and his team are passionate about fixing healthcare one client, one member, and one partnership at a time. Having trademarked We Fix Your Healthcare™, their mission is one that his team takes seriously. Justin, a native of Bedford, Pennsylvania, holds a pre-medicine degree and a master's degree in exercise science from California University of Pennsylvania. His dedication extends to servant leadership, volunteering in the local community including serving on the PA State Council of SHRM (Society for Human Resource Management) since 2016. Justin is a public speaker and owner of Leaders Never Quit, where he dedicates his time to inspiring others with a message of hope, humor, and resilience.   07:55 How is the claims wire typically explained to a plan sponsor? 11:18 What is the whole point of self-funding? 11:27 Why is it so vital to understand what you're paying for? 12:38 What are the five “buried” items that wind up in these claims wires? 13:03 What is a shared savings fee? 17:10 “Rates are important, but so are your rights.” 21:01 What's going on with prior auth fees? 23:35 What is prepayment integrity? 28:16 What is pay and chase? 31:54 What is a TPA claim review? 35:47 Is there medical claim spread pricing?   You can learn more at benefitsdna.com or wefixyourhealthcare.com. You can also follow Justin on LinkedIn.   @JustinDLeader discusses #plansponsor #payments on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia  

For a full transcript of this episode, click here. This show is different, so if you've already listened to or read all about the gory details of the J&J and/or the DOL v BCBS lawsuits, this is not gonna be a repeat of that information. Julie Selesnick, my guest today, does cover the very, very top line about these two cases. But after that, we move on fast—because what I wanted to get to today was not the potential landslide of legal action that may or may not be confronting plan sponsors or payers or even brokers today. I did not want to really even talk about the CAA (Consolidated Appropriations Act) and its inarguable adjacency here. I just feel like there's been a lot of talk about these topics already. What I wanted to get to, and fast, is … now what? If I'm a plan sponsor or actually, again, an EBC (employee benefit consultant) or broker, now what? What should I be doing and thinking about right now? To that end, I could not have been more thrilled to get a chance to talk to Julie Selesnick, who is an attorney deeply entrenched in helping plan sponsors and others understand and comply with fiduciary responsibilities. I want to get to this interview quickly (the conversation with Julie), so this intro is gonna be on the short side; but let me just summarize a few of the points that Julie makes during the interview that follows. First, we talk about the first step for pretty much everybody: Get your data, plan sponsors. But once you have that data, you also kinda have to use it. You can use it to ensure that you're paying claims right, which is what most do. As a result of these two lawsuits, it's also increasingly clear that you also have to use that data to ensure that the prices you're paying for things (like generic specialty meds, for example) are fair and reasonable. To get the data now, you may have to renegotiate administrative services agreements; and you might need to take a closer look at the disclosure agreements you're getting as a result of the CAA. And, by the way, it's not just brokers or EBCs who have to complete these disclosures. It's all covered entities that you, plan sponsors, paid more than $1000 to. Then we get into … okay, once you have the data and you've analyzed it, what are some in general things that could very well need to happen? And if the reason that they don't happen is because they weren't even considered, then plan sponsors have some risk exposure; and the brokers/EBCs who serve them might have some conflicts of interest. And it would be very interesting what would or could happen if a plan sponsor was able to back into those conflicts of interest, because if data clearly shows that something should be happening and it is not—and it is not even on the docket to be considered—if I'm a plan sponsor, I'm for sure gonna be wondering why. And maybe I'm gonna look into that and fast. Listen to the show with AJ Loiacono (EP379) from two weeks ago for more on some of the more egregious broker/EBC conflicts of interest, which could explain, potentially, the J&J lawsuit as well as definitely explains the earlier one in Osceola. And also, by the way, if you're sitting there wondering to yourself how exactly J&J managed to pay upwards of $10,000 for a drug that can be purchased for cash for something like $50, listen to the show next week with Luke Slindee, PharmD. We run through the exact pharmacy supply chain machinations that make all of this (and more) possible. But I got off track. What I was talking about is the things that could easily wind up being called for when the data is analyzed: 1. Carving out specialty generics, especially drugs or infusions, from the larger pharmacy benefit manager 2. Your payment integrity vendor should not be the same vendor who is processing claims. Talk about a conflict of interest. I do not need to be an attorney—and I need to know absolutely nothing about anybody's data—to tell anybody who's listening that if you have the same vendor or two vendors with the same parent company who are both processing your claims and then auditing their own work … yeah, fix that. 3. Shut down any cross-plan offsetting. And we get to this in the show if you don't know what cross-plan offsetting means. Lastly, we get into a bunch of stuff that plan sponsors might want to consider as they consider how to administer their plan, like, for example, setting up a health and welfare committee that has an independent fiduciary expert on said committee. I'm gonna say that's a good idea! As I have mentioned, my guest today is Julie Selesnick. Julie is senior counsel over at Berger Montague's Employee Benefits and ERISA group. Also mentioned in this episode are AJ Loiacono; Luke Slindee, PharmD; Justin Leader; Chris Deacon; Bridget Mulvenna; Mark Cuban; Olivia Webb; and Dawn Cornelis. You can learn more at Berger Montague. You can also follow Julie on LinkedIn.     Julie Selesnick has been practicing law since 2001 and has over 20 years of experience in complex dispute resolution forums representing plaintiffs and defendants. Julie has a wide variety of litigation, arbitration, and mediation practice, including first-chair jury and bench trial experience, representing some of the largest companies in the United States as well as small companies, labor unions, individuals, and classes of plaintiffs. Julie's current practice is a mix of class litigation on behalf of individuals, union funds, and employers, and a legal consulting practice advising self-funded health plans and service providers to self-funded health plans on minimizing litigation and regulatory risk, issues arising under ERISA, fiduciary obligations and best practices, and CAA compliance, including negotiating service provider contracts and business associate agreements, drafting plan documents and advising on plan design; helping health plans gain access to participant claims data, helping service providers draft and plan fiduciaries obtain § 408(b)(2)(B) compensation disclosures, assisting plans with ensuring their prescription drug data collection and reporting is properly conducted and copies are provided to plan fiduciaries, and ensuring proper review, MHPAEA Comparative Analysis reports on nonquantitative treatment limitations.   05:48 What's happening with the J&J lawsuit? 07:38 What's going on with the DOL v BCBS case? 08:49 What do these cases mean for plan sponsors? 09:21 Why is engaging with claims data critical? 12:30 EP408 with Chris Deacon. 14:20 EP379 with AJ Loiacono. 16:58 What's one solution to avoiding a conflict of interest? 18:02 Why there's still not a total understanding about what to do with claims data once acquired. 20:58 NADAC (National Average Drug Acquisition Cost) to check pharmacy prices. 21:31 What advice do plan sponsors need to know that never gets recommended to them when dealing with conflicting interests? 27:02 EP337 with Olivia Webb. 28:41 EP285 with Dawn Cornelis. 30:24 “As a fiduciary, your money should only go to pay your plan's benefits, not to other plan benefits.” 30:59 What's Julie's advice to advisors? 33:17 “Giving nonconflicted advice … is something you really can only do if you have no conflicts.” 35:57 What's Julie's advice for administering whole plans?   You can learn more at Berger Montague. You can also follow Julie on LinkedIn.   Julie Selesnick discusses advice based on the J&J and DOL v BCBS lawsuits on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia, Marshall Allen, Stacey Richter (INBW39), Peter Hayes, Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372)