Podcasts about cost containment

There have been two episodes lately that have sent me down a rabbit hole that I wanted to bring to your attention. Now, disclaimer: I know you people; you're busy. You listen on average to, like, 26 minutes of any given episode. So, yeah … look at me being self-aware. I say all this to say welcome to this inbetweenisode, otherwise known as The Rabbit Hole. But it's like a 20-something-minute rabbit hole, not a day-and-a-half retreat; so just be kind if you email me and tell me I forgot something or failed to dredge into a nuance or a background point. It might be that I just could not manage to pack it in. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. This rabbit hole really, really matters for anybody creating benefit design. It really matters for anybody trying to optimize the health that can be derived from said benefit design. It also probably matters for a whole lot of operational decisions involving patients or members, nothing for nothing. But it really matters for anybody trying not to, by accident, as an unintended consequence, hammer plan members or patients with some really blunt-force cost containment measures that do a lot of harm in the process of containing costs or, flip side, accidentally cost a whole lot but don't actually improve member health. Nina Lathia, RPh, MSc, PhD, kind of summed up this whole point or gave an adjacent thought really eloquently in episode 426. She said there's better or worse ways to do things and doing the worst kinds of cost containment may not actually contain costs. You squeeze a balloon, and that works great for some, like pharmacy vendors who don't really have any skin in the game. (See me using the “skin in the game” term for other people besides plan members? That's some really good foreshadowing right there, by the way.) So, squeezing the balloon works for some when they don't have skin in the game, in the place where the air goes when you squeeze the balloon—like a pharmacy vendor who makes it super unaffordable for patients to get meds so the patient doesn't take their meds and winds up in the ICU, or the patient's formerly controlled with meds condition that is now newly uncontrolled and requires all kinds of medical interventions to get said condition back under control. Like, these are the reasons and the why behind why some cost containment efforts don't actually contain costs at the plan level. But not at the vendor level. You see what I mean? Most pharmacy vendors don't get penalized if medical costs wind up going up. And I'm picking on pharmacy vendors a little bit here, but it's true for a lot of siloed entities. But, you know, balloon squeezing can also work, actually, at the plan level if where the air goes, it's to a place where the member or the patient has to pay themselves. Like, if there's a huge, I don't know, max out of pocket or deductible, does it really matter to a very mercenary plan that's running on a very short time horizon? Do they really care, that plan, if the patient's formerly controlled condition gets uncontrolled? Maybe not, I guess, as long as it doesn't cost more than the max out of pocket that the patient is on the hook for, for any given plan year. So, yeah … again, there are better or worse ways to do things; and a lot of questions kind of add up to, What kind of plan do we want to be? What are our values, and does the plan align with them? But that's not the rabbit hole I wanted to go down today—the aligning with our values rabbit hole—so let us move on. The Relentless Health Value episode that kicked off the rabbit hole for me on multiple levels was the show with Bill Sarraille (EP459) about co-pay maximizers and accumulators. And don't get me wrong, that is a complicated topic with lots of pros, lots of cons; and I am not weighing in on the inherent lawfulness or value of any of this. I am also not weighing in on the fact that there are forthright and well-run maximizers and really not good ones, which cause patients financial, for sure, and possibly clinical harm. But not talking about that right now at all. Go back and listen to the show with Bill Sarraille if you are interested. Where my “down the rabbit hole” spiral started was when I started noticing the very, very common main plan pushback that was given right out of the gate so often when talking about the problems that any given plan sponsor has with these pharma co-pay programs—that if these pharmacopeia card dollars count toward the plan deductibles, then the patient's deductible gets met and the plan member will then often overuse healthcare and cost the plan excessive dollars from that point forward. So again, if you ask any given plan sponsor what I was gonna say their main issue but a main issue that they have with these pharma co-pay programs, that's gonna be it—that if these pharma dollars count toward the plan deductible, then the patient's deductible is met and from that point henceforth, the patient goes nuts and overuses healthcare services and it costs the plan a lot of money. The second episode causing this rabbit hole to open up is the one coming up actually with Scott Conard, MD. So, check back in a couple of weeks for that one. But in the show with Dr. Conard, we get into the impact of high-deductible health plans or just big out of pockets, however they transpire in the benefit design. Both of these scenarios, by the way, the maximizer meets the deductible scenario and the very, very high-deductible plan scenario are to blame, in other words, for this rabbit hole of an inbetweenisode. So, let's do this thing. Let's talk about the moral hazard of insurance to start us off. In the context of health insurance, if you haven't heard that term moral hazard before, it's an economics term; and it is used to capture the idea that insurance coverage, by lowering the cost of care to the individual, because their plan is paying for part of said care, by lowering the cost of care to the individual, it increases healthcare use. So, you could see why this may be related to having a deductible fully paid or not. Pre-deductible, the plan is not paying for a part of said care or paying a much smaller part. And after the deductible is paid for, then the plan is paying for a much larger percentage of care. So, moral hazard kicks in bigger after the deductible is fully paid, when the plan is paying for a bigger percentage or a bigger part of the care. So, before I proceed, let me just offer again a disclaimer to the many economists who listen to this show that this is a short inbetweenisode; so I am 100% glossing over some of the points that, for sure, have a lot of nuance. For anyone who wants a thick pack of pages for background reading, I have included some links below. Because you see, a few weeks ago, my Sunday did not go as planned. And instead of running errands, I wound up reading eight papers on moral hazard. So, my lack of groceries is your gain. You're welcome. I am happy to send you these links if you really want to dig in hard on this. Okay … so, moral hazard is the concept that individuals have incentives to offer their behavior when their risk or cost is borne by others. That's the why with deductibles, actually. We gotta give patients skin in the game because once a member has their deductible paid, it's like member gone wild and they will get all manner of excessive care. Again, I hear that a lot from plan sponsors—a lot, in all kinds of contexts but almost always, again, whenever the conversation has anything to do with manufacturer co-pay card programs and a lot when it has to do with just, you know, high-deductible plans and what happens when the patient meets their deductible. Once a patient or family has a fully paid deductible, their medical trend is like a spike, I hear over and over again. And again, this is the reason why many insist—and again, no judgment here, maybe they're right, I'm just rehashing the conversation—but this is why many insist the moral hazard of letting people have their deductible paid for them by Pharma or whatever is the reason why some believe it is imperative to have maximizers or accumulators where pharma dollars can absolutely not apply to patient deductibles. Because then we have sick patients who now have their deductibles reached, who have very few financial disincentives to go seek whatever care they want. Right. Moral hazard has entered the building. I've beaten this point to death, so let's move on. One time, I asked a plan sponsor, What exactly is it that these plan members are going wild spending plan money on once their deductible gets paid off? And he said, well, you know, they go get their suspicious-looking moles checked. Did you hear that silence just now? Yeah, that was my reaction. I don't know. I would consider getting suspicious moles checked kind of high-value care. There are posters all over the place saying if you have a suspicious-looking mole, it might be melanoma. Cancer. So, you should get ahead of that before you have a metastasized cancer. I'm no doctor, but yeah, this feels like high-value care. So, let's just, in arguendo, say it is high-value care and follow this thread for a sec. Once members reach their deductible, let's say they run around and get high-value care, care they actually need but haven't gotten before because they couldn't afford it earlier or were putting it off until they saved up enough, right? Like, this is the other side of the moral hazard coin. If patients delay or abandon care—and, by the way, there was a survey (it's in the Wayne Jenkins, MD, show from a while ago [EP358])—but 46% of patients with commercial insurance these days have delayed or abandoned care due to cost. But if they delay or abandon care that is high value and medically actually necessary and they put it off or abandon that high-value care because they cannot afford said care, then yeah, we have, again, the opposite of the moral hazard problem. We have members paying a whole lot for insurance that they cannot afford to use, they're functionally uninsured, and it's not gonna end healthfully if they need high-value care and they're not getting it. It's not. Functionally uninsured patients who have chronic conditions that really should be managed will, as per evidence, wind up with health problems if those chronic conditions are not managed. I read another study about this just recently. This is why members with chronic diseases on high-deductible health plans tend to have worse health, by the way. Now, I need to say, same rules do not always apply for healthy patients who, at least at this point, don't need regular healthcare. But do keep in mind, as it comes up in the Dr. Scott Conard show, 30% of patients who think they're healthy, they feel fine—actually they are not fine and will become sick and costly in the coming years. So, yeah … tune back in for that discussion if you are interested, but you get the gist of this whole thing, right? So, that's scenario 1 as to what patients may choose to buy once they're in the moral hazard zone and have met their deductible. They go get high-value care. So, let's move on from the high-value care case study where patients reach their deductible and get high-value care or they haven't met their deductible and fail to get care they actually need. I want to circle over to the other moral hazard potential situation: patients who meet their deductible. And in this scenario, they again embark on a health system jamboree; but they don't get a whole lot of high-value care in this scenario. They run around getting all manner of all kinds of stuff that is well outside of any evidence-based pathway. Like, weird example, I went to a doctor recently asking a question about something that everyone ultimately agreed was nothing. At which point, the doctor asked if I wanted an MRI. I was like, “What?” We and everyone else just agreed this was a big nothing burger. Why would I want an MRI? Is there something else that we didn't discuss to indicate that I need imaging? Like, why are we going there? And the doc said, “Oh, well, everyone in New York City has an anxiety problem. So, I thought you might just want to get an MRI.” Yeah, low-value stuff like that is now not financially prohibitive. So, someone who had met their deductible, in a similar situation to my example, might have shrugged and said, “Sure, I do have some anxiety. Let's go get that MRI.” Or if they hadn't met their deductible, then the whole skin-in-the-game, market-driven approach may work, I guess, to prevent them from getting low-value care that was clearly excessive and pretty wasteful. So, summing up these two scenarios, the implications of the moral hazard issue are, if it's expensive, people don't do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are not good at discerning low-value care from high-value care. And because patients are not good at discerning high-value from low-value care, moral hazard is not mitigated with any sort of binary kind of vote for moral hazard or against moral hazard types of brute-force, broad-stroke tactics. Like, say I'm a moral hazard full-on believer. I assume all or most of the care a patient will go for is low value, right? Because if I try to prevent moral hazard from happening, then by default, what I'm effectively saying is, whatever they choose to buy on the basis of moral hazard is low value. So, I make basically everything I can pretty unaffordable so as not to invoke any moral hazard. But right, the problem with that is that some of the care is actually high value. And it's also expensive for the patient, so they don't get it. And patients are harmed, and balloons might get squeezed. Or the opposite, against moral hazard, right? Like, I'm against the concept of moral hazard. I don't believe in it, so I don't set up absolutely anything to combat it. Maybe because I assume all care that a patient might want to get is actually high value and totally worth it. That's gonna be a problem for the opposite reason. Plans can waste a lot of money this way. Random example, in 2014, the Commonwealth of Virginia reported spending $586 million on unnecessary costs from low-value care. I mean, they say something like a third of all care is waste and unnecessary, so … yeah. Plan sponsors can waste a lot of money on low-value care, and a bunch of that may happen when patients have less skin in the game because they reach their deductible, as one example, and the care is not financially prohibitive and moral hazard is realized. So, yeah … as I said, a couple of weeks ago, I did not spend my Sunday as planned. I spent my Sunday reading papers about moral hazard in insurance and how financial incentives impact patient decision making. And I'm gonna repeat the grand takeaway because this is a podcast and you might be multitasking. So, once again, here's the sum of it all: If it's expensive, people tend not to do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are simply quite bad at distinguishing high-value care from low-value care. Once their deductibles are met, most patients will—due to moral hazard—they will, in fact, go on a spending spree; and part of what they will get done will be really, really important and necessary stuff, like getting their unusual moles looked at or their heart pain checked out or going for that follow-up visit or lab work that their doctor told them they need to come in for. And the other part of what they will do will be things that are outside the best-practice, evidence-based pathway guidelines by the length of the Appalachian Trail—you know, doing what appears to be a tour of specialty medicine physicians for unclear reasons but which lead to a cascade of testing and who knows what else. Why do they do this, these members? Do they do this on purpose? No. There is study after study that shows, again, members/patients do not, most of the time, have the chops to figure out if some medical service is high-value or low-value care. And no kidding. Most members and patients have no clinical training. They're not doctors. They're not nurses. They're not physician assistants. They're humans whose uncle died of cancer, and now they have a pain in their foot and they're convinced it's a tumor. Right? Like, do we blame them when they finally go see a doctor because they crushed their budget that particular year paying thousands and thousands of dollars out of pocket for whatever earlier in the year, and now they've made it to their deductible—do we blame them for taking the very rational step of getting the most out of those thousands of dollars of sunk costs? At that point, it's a “let me get my money's worth” situation because they can't afford to do this again next year. I mean, we hire employees because they're smart and rational, and this is really actually a pretty smart and rational thing to do. It's not somebody trying to commit fraud. Okay, sure … some people are. There's always bad apples. But the vast majority are just trying to live their life and not spend all of their vacation money next year on medical services like they did this year. I'm saying all this because it's actionable, by the way. And I'm getting to that, but indulge me for like 60 more seconds because I want to acknowledge you, listeners of this show, are probably nodding along to this whole thing this whole time and thinking all of this is pretty obvious. Well, yeah … maybe. Except here's the reason I decided to do an inbetweenisode about this rabbit hole instead of doing my normal thing, which is just ranting about it over dinner for three days straight—and God bless my husband for sitting through it—is the bottom line. But the reason we are here together today is the number of emails and posts and et cetera that cross my desk where it doesn't seem like these dots have been connected on all of this or at least connected in magic marker. Like fat, indelible magic marker, which is what I think is necessary for these dots to be connected with the ones between moral hazard and patients not being able to discern high- and low-value care. There are so many ways and places these dots will show up. Like, here's another moral hazard issue with those maximizers or accumulators, which apparently are on my mind right now—the not good ones I'm talking about now, where patients find themselves on the hook for hundreds or thousands of dollars midyear if they want to pick up the meds that they've been prescribed. If you need more details on how that might happen to understand what I'm saying fully, listen to the show again a couple of weeks ago with Bill Sarraille (EP459). But even if you're a little confused, it doesn't matter because the question is this: Do we justify having programs that make drugs really expensive for patients? Do we put in place one of these pretty darn punitive types of accumulators or maximizers, right? Like, there's different kinds, and I'm talking about the punitive ones of accumulators or maximizers. Do we justify putting one of those into place and figure that if a patient really wants the med, they'll pay a whole lot of money for it? Because if they're willing to pay a whole lot of money for it, then, right? It must be high-value care, so they'll figure out how to pay for it. Keep in mind, as I said earlier, if it's expensive, people don't do it. If it's free or cheap, they will overutilize. And the issue with both of these patient choices is, patients are not good at discerning low-value care or meds from high-value care or meds. So, look, Pharma can be up to all kinds of crap, and list prices are really expensive. No arguments here. That isn't the point. The point is, What is the actual problem that we're trying to solve for, for our plan and our patients and our members? And if that problem is making sure that the right patients get the right high-value meds or care, then not letting members get co-pay assistance such that all drugs—the good ones and the too-expensive ones and the ones that we don't really want our members to take for whatever reason—if we make all of them way too expensive with a maximizer or accumulator designed to make all the drugs really expensive … dots connected. We wind up with the all-in to prevent moral hazard issue we just talked about, where patients could easily be harmed and the plan can easily get into a balloon squeezing situation. All I'm saying is that there's a big-picture view of moral hazard here that we need to be looking at and over-indexing into binary, moral hazard black and white, where we attribute malice to members, some of whom, some of the time, may actually be trying to get high-value care, or the flip side, the plan's paying too much for low-value care and causing financial difficulties and not understanding the root cause. Going black and white or over-indexing to prevent outlier kind of stuff is probably not gonna end well. Not seeking a middle way can easily result in a solution that is possibly worse than the problem. So, look, moral hazard is actually a thing. There are lots of implications to patients not being able to distinguish high-value and low-value care. But if we know this, then, philosophically at least, how do we conceptualize a solve? What should we be doing? If we're not doing black and white, what does the gray in the middle look like? Alright, we don't want to be a solution looking around for a problem. So, let's think about the problems that we want to solve for. I would start with, What's the goal? The goal of plan sponsors providing insurance most of the time is attract and retain talent. Also, I was at the HBCH (Houston Business Coalition on Health) Conference at the beginning of December 2024. And there was a poll question. There was a bunch of employers in the audience, and the poll question asked the audience, “What's your biggest plan goal this year?” Main answer by a mile: Cut costs. Okay … so, we want to attract and retain, and we want to control costs. Obviously, you can go about achieving these three things a bunch of different ways, and they will all be tradeoffs. As Luke Prettol reminded me of the other day, there are no solutions, only tradeoffs. And so, with that, right now, I want to introduce the second concept that I have been ruminating over in my rabbit hole lately, that I've kind of been hinting at for this whole time. But here's a word we've been waiting for to solve all of our problems in a good kind of way, not the bad black-and-white ways that are so often either financially a problem or deploying brute force and harming patients in the name of solving something else: Pareto optimality. Pareto optimality is the state where resources are allocated as efficiently as possible so that improving one criterion will not worsen other criteria. It's essential to consider this, that Pareto optimality is the ideal we should at least be striving for when attempting to overcome any challenge but, in particular, the moral hazard issue, when we know that patients do not know what care is high value and what care is low value. Because if we don't try to at least Pareto optimize (if that's a word), if we try to fix the moral hazard problem and wind up with a new problem or new problems that might be worse than the old problem, that's not optimal. We have improved one criterion and worsened another. So, fixing the members going wild after they meet their deductible by slamming the lid on the fingers of members trying to get high-value care as well as low-value care, well … not sure about this, but I'd assume if not the attract but at least the retain criterion might be compromised by member dissatisfaction. But also, as I've said nine times, we might not actually cut costs. We might be doing a squeeze of the balloon. Especially that could be true when, as we all probably know or suspect, what's driving costs at the plan level is rising hospital prices. There's a show coming up on rising hospital prices as a primary driver of rising plan costs, and it's pretty hard to argue with. So, it's financially pretty advantageous to keep patients from needing to go to the hospital. So, yeah … I'd strongly suggest not squeezing balloons when hospitalizations are where the air goes. I'm not gonna belabor this. My only suggestion is, do the Pareto optimality math. A lot of you already are, I'm sure, and do a great job. But just for any given policy plan change, or decision, keep in mind moral hazard and then really go through the whole cascade of likely impact on other factors based on likely member/patient behavior. It's so easy to get sucked into kind of these philosophical, “those are my enemies” kinds of conversations that are actually philosophically sort of interesting, but they aren't the goal. I mean, there's always unintended consequences; but not all unintended consequences should come as some kind of, like, wild-ass surprise. They were pretty predictable, actually. Let me also mention that when considering Pareto optimal solutions, advanced primary care starts to get really compelling. It's because having a PCP team with data and a relationship to the patient helps patients stay on the high-value care bus. And that can minimize the bad that comes from lowering the barrier to care and inviting in a little bit of moral hazard. Just saying. Okay, so this has been going on a little bit longer than I had originally intended, but I do want to remind you of the so-called theory of second best. It's probably really appropriate here, and one of the reasons why I'm mentioning this and not finishing the show right now is that, in a very synchronistic moment, I was writing up my outline for this inbetweenisode and—how random is this?—Steve Schutzer, MD, wrote an email that included something about the theory of second best. Great minds and all of that. Anyway, the theory of second best is really aligned with Pareto optimality. It's just that sometimes you gotta be really practical. You gotta be a little scrappy. If you cannot achieve the best option, either because you just can't or because the best option for one thing results in too many negative consequences elsewhere, then don't do the best option. Forget it. Do the second best (ie, the theory of second best). There is nothing wrong with that. Don't be a hero. Okay, so in summary, moral hazard is actually a thing and so is the opposite; and it's even more of an impactful thing because most people cannot distinguish high-value from low-value care. And if they meet their deductible that they have paid a lot of money to reach, of course, they are going to want to try to get through their checklist of medical appointments that they have been putting off. This is not a surprise. And it's not all bad, as long as the care that they are trying to go get is high value; and that matters if we're trying to cut costs. Because to cut costs for real and not in a squeezing of the balloon way, we need to direct or limit somehow what gets done to high-value care. And we got to do that without accidentally causing other problems, meaning think through Pareto optimality and possibly consider the theory of second best. I hope this has been helpful at some level. It's helped me. I feel better having vented. Also mentioned in this episode are Nina Lathia, RPh, MSc, PhD; Bill Sarraille; Scott Conard, MD; Wayne Jenkins, MD; Houston Business Coalition on Health (HBCH); Luke Prettol; and Steve Schutzer, MD. Additional studies mentioned: Moral Hazard in Health Insurance: What We Know and How We Know It Do People Choose Wisely After Satisfying Health Plan Deductibles? Evidence From the Use of Low-Value Health Care Services Healthcare and the Moral Hazard Problem Distinguishing Moral Hazard From Access for High-Cost Healthcare Under Insurance   For more information, go to aventriahealth.com.   Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   04:05 Where did Stacey's rabbit hole spiral start? 05:40 What is the moral hazard of insurance? 09:31 EP358 with Wayne Jenkins, MD. 12:49 Why isn't moral hazard mitigated in insurance? 18:16 EP459 with Bill Sarraille. 20:51 “How do we conceptualize a solve?” 22:24 Why should we be striving for Pareto optimality? 25:20 What is the theory of second best?   For more information, go to aventriahealth.com.   Our host, Stacey Richter, discusses considerations for #plansponsors and others. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher, Stacey Richter (INBW40), Mark Cuban and Ferrin Williams (Encore! EP418), Rob Andrews (Encore! EP415)  

If you have zero clue what co-pay maximizers and/or co-pay accumulators are and the financial incentives involved for PBMs (pharmacy benefit managers) and plan sponsors here, after you're done listening to this episode, go back and listen to the show with Joey Dizenhouse (EP423). Also, the episode called “Game Theory Gone Wild” with Dea Belazi, PharmD, MPH (EP293). Both these shows could fill in some blanks. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Here's the micro mini of the co-pay maximizer/accumulator deal. These are vehicles that are designed by vendors who are also sometimes called maximizers or sometimes they're also PBMs. But these programs are designed to get as much money out of Pharma as possible in the form of co-pay support. So, here's how the maximizers are supposed to maximize plan sponsors getting pharma money. Say, for some drug, the pharma company has, I don't know, $12,000 max in co-pay support available to patients in total per year. Pharma does always cap the dollars that are available for patients. So, in this hypothetical, $12k a year is available. What a forthright or well-run maximizer will do is figure out, you know, if there's $12k max available, then they'll set a co-pay—so there's variable co-pays for patients—so they'll set a patient co-pay of, like, $1000 a month, which adds up to $12k over 12 months of the year. Get it? Every single month, the patient has a $0 co-pay, but the plan maximizes the dollars that the plan gets. Or, you know, maybe they'll charge $1,025 a month so the patient has some small “skin in the game,” and the plan sponsor just banked $12k. Sounds great, right? Well, sure, when it works as promised … and we'll get to this in a moment. Accumulators, on the other hand, have no such “Hey, let's make sure the patient actually gets their meds” guardrails. They hear that the Pharma is offering $12k, and the accumulator vendor and their plan sponsor clients also are like, “Cool, let's get that money as fast as possible.” So, they make the co-pay for that drug, I don't know, like hypothetically $3000. Great, now the patient runs out of that co-pay money in May. And don't forget and/or let me inform you, for both maximizers and accumulators, dollars paid by the Pharma generally don't count to the plan deductible for the patient. So now, the patient walks into the pharmacy, if in an accumulator or in a poorly run maximizer program, they walk into the pharmacy in May and are told that if they want their drug, they're gonna need to pay the $3000 co-pay that was set out of pocket every month until they reach their deductible. With some of these co-pay maximizer/accumulator plans, the plan sponsor may be a little bit out of the loop relative to what is actually going on here. The plan sponsor may think that members are doing fine—you know, they're getting their drug every month—so they may be surprised to learn about this running out of money in May issue. And what is true more often than it's not true, this $3000 or whatever—hundreds or thousands of dollars—payment due co-pay, the patient learns about it at the pharmacy counter or while trying to get chemo. It comes as a complete surprise, the fact that they owe three grand or whatever. What patient just shrugs and pays up in that moment because they happen to have their entire deductible or thousands of dollars lying around and at the ready? What a shock to find this out at the pharmacy counter or at the infusion clinic. Some of these maximizer programs are also starting to veer back into accumulator zones, like they're doing things such as saying that the member must pay their out-of-pocket max or their deductible or 30% of the cost of the drug, right, like some number before the plan will allow the patient to use the co-pay reimbursement program to begin with. So, there's other things that are emerging right now, which, again, cause the patient to have a very, very large out of pocket in order for them to get a drug which they have been prescribed and—ostensibly, at least—need. Allegedly, and sometimes for sure, dollars raked in from Pharma make it across the PBM/maximizer, vendor, middleman trench all the way over to the plan sponsor. For sure, especially for the administrative only maximizer vendors … yeah, you're gonna have the dollars actually making it to the plan sponsor. But sometimes the vendor running these programs is paid spread, right? So, the more expensive the drug and the richer the co-pay card program, the more the vendor will make because they take a percentage of savings. So, the more expensive, the more savings, therefore, the more the vendor is gonna make. In these cases where the vendor is paid a spread, can I take Perverse Incentives for $600, Alex? Right? But in sum, again, there's a lot to this conversation with Bill Sarraille, so please do listen to the whole thing. Bill offers five main pieces of advice, so I'm just gonna cover them right here up front—spoiler alert, I guess, but just to keep them all in one place. 1. Look into what is going on with a maximizer and/or accumulator program. First of all, is the plan sponsor paying spread? And also, how are these programs being marketed to members and how aggressively? Because there are a lot of plan sponsors having way more negative impact than they suspect they are. So, that's point of advice #1: Really look into actually what is happening on the grounds with some of these programs. 2. Eliminate surprise. Any plan sponsor listening, and Brian Reid also says this very crisply in an episode a month or so ago (EP456). If a plan sponsor wants to do stuff like this—like force a patient to pay hundreds or thousands of dollars out of pocket—if at any point during the year they are gonna wind up with thousands of dollars in co-pay or coinsurance to get their Crohn's disease med or cancer med or whatever, be really up front about this at least. It's really important if we really want to make sure that patients are taking maintenance meds and getting the medications that they're prepared for the reality that, at a certain point during the year, they are going to have a really big bill. 3. There is legal risk here. So also, Bill's advice is check into whether accumulators and/or maximizers are unlawful under the ACA (Affordable Care Act) and/or by deceptive practices rules when maximizers or accumulators are teed up as a benefit. And it, again (reference point of advice #2), it's not explained that dollars they get from Pharma will be taken by the plan and not applied to the patient deductible. I was just reading about the crazy aggressive marketing tactics that some of these vendors are using to get members to sign up and … yeah, definitely look into deceptive practice rules. 4. If it's utilization management that we're trying to achieve here, then your utilization manager should be utilization managing. These maximizers are not meant to impact utilization management. Patients really cannot differentiate, as per study after study, it's very difficult for patients to differentiate high-value from low-value care or meds. So, pretty much the impact of having a patient with thousands or hundreds of dollars of out-of-pocket spend to get a med isn't going to be to ensure that the right people are taking the right med. Point is, use the right tool for the right job. So, if we're trying to keep patients away from low-value meds, the tool for that is utilization management. Also be aware, if the PBM says it cannot do utilization management or you'll lose your rebates and/or is pushing into a maximizer accumulator program to do this instead, that's kind of a clue that they cannot do it because they are taking money from Pharma to not have any restrictions on a drug. Read the article in the New York Times (you're welcome) about how PBMs took secret payments for the free flow of opioids, and Chris Crawford also talks about this sort of same-ish thing in an upcoming show relative to GLP-1s. But if you're trying to do utilization management, then do utilization management. 5. Use our understanding of this whole goings-on as a rationale or a way to tamp down perverse incentives. We want to wind up with patients getting charged a percentage of net prices, not a percentage of some wildly inflated list price with this whole accumulator maximizer contributing to, you know, just more wildly inflated list prices so the co-pay programs can be bigger and someone can make even more money off of the percentage of savings. And plan sponsors addicted to rebates now have another bucket of cash. Like, this is just another example of how perverse incentives pervade the system. And we should certainly be aware of that. Bill Sarraille was a healthcare attorney for many years. He retired from his law firm on the first of last year, and now he's doing the things he wanted to do before but couldn't because his billable rate was too high. Bill is teaching at the University of Maryland Law School and doing some regulatory consulting, etc. He's working with a variety of patient groups. Also mentioned in this episode are University of Maryland Francis King Carey School of Law; Joey Dizenhouse; Dea Belazi, PharmD, MPH; Brian Reid; Chris Crawford; Marilyn Bartlett; Scott Haas; Paul Holmes; and Tom Nash. You can learn more at University of Maryland Francis King Carey School of Law and by following Bill on LinkedIn. You can also sign up for his Substack.   Bill Sarraille is a professor of practice at the University of Maryland Francis King Carey School of Law, a regulatory consultant, and a retired senior member of the Healthcare Practice group at Sidley Austin LLP. Bill is a nationally recognized expert in healthcare, life sciences, drugs, medical devices, and patient access to treatments. He is widely known for his expertise in a broad array of healthcare matters, including rare disease treatment access barriers, pharmaceutical pricing, Anti-Kickback Law compliance, the 340B program, and managed care and PBM issues. During his years practicing law, Bill was recognized repeatedly by The Best Lawyers in America in both healthcare law and administrative law. He was also consistently listed as a leader in the field of healthcare law in Chambers USA: America's Leading Lawyers for Business. Bill also serves as the general counsel of the charity the Pharmaceutical Coalition for Patient Access, as an advisor to multiple patient advocacy groups on patient access issues, a compliance advisor to a coinsurance patient assistance foundation, and as the director of a rare disease society and Kalderos, Inc., a health IT firm with a focus on effectuating pharmaceutical discounts and rebates.   09:31 What should plan sponsors be aware of right now? 14:01 What is the justification for maximizers, and why is this at odds with the purpose of insurance? 18:05 Where does the issue of “fairness” land within cost containment? 20:00 Brian Reid's LinkedIn post on insurance company access challenges. 21:30 What are the real legal issues presented by some of these co-pay maximizers and co-pay accumulator programs? 27:06 How are these programs creating perverse incentives? 29:28 EP450 with Marilyn Bartlett, CPA, CGMA, CMA, CFM. 32:16 “If you're covered by the ACA, I think this is unlawful.” 32:57 What advice does Bill have in regard to these programs? 33:49 What potential litigations does Bill see coming in the near future in regard to these co-pay maximizers and co-pay accumulator programs? 38:38 EP365 with Scott Haas. 38:45 EP397 with Paul Holmes.   You can learn more at University of Maryland Francis King Carey School of Law and by following Bill on LinkedIn. You can also sign up for his Substack.   @HCLAWComment discusses #costcontainment on our #healthcarepodcast. #healthcare #podcast #pharma #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher, Stacey Richter (INBW40), Mark Cuban and Ferrin Williams (Encore! EP418), Rob Andrews (Encore! EP415), Brian Reid, Dr Beau Raymond, Brendan Keeler  

This show is going to be a little bit different because what we're going to do today is offer some advice to those who may work at a pharma company. But before we get into this advice portion of the discussion, let's start here. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. Probably we're gonna have people listening to this episode who maybe are not in our normal tribe of Relentless Health Value listeners. While there are, for sure, regular listeners who work at pharma companies, there might be some newbies on the scene here. And to you, I say welcome. I hope that you feel right at home here. You know what, though? Many of us, including myself often enough, are slightly uncomfortable. Because this is the place where we all kind of look at ourselves in the mirror. We all live in glass houses, after all—everyone in the healthcare industry. There's no devils and no angels here. And the trick is maximizing the good and minimizing the not so good so that we all wind up with the highest net positive possible for patients. So, around here, we do not shy away from saying what needs to be said so that we all can find a way forward to serve the patient. We cannot solve problems, after all, that we have not taken a cold, hard look at. Yeah. So, today I am speaking with Brian Reid. I have been very much looking forward to speaking with Brian Reid, who many may know from his really great newsletter and really insightful LinkedIn posts. Brian Reid's advice, which he delivers in the episode that follows in sum. Spoiler alert here, but I also will say that he is much more eloquent than me, and the nuances are a thing. So, please do listen to the whole show. But Brian's piece of advice number one for Pharma (and really any product or service frankly), but piece of advice number one is this: Get a really solid bead on what value means—not just to PBMs (pharmacy benefit managers) or contract pharmacies or wholesalers who are middlemen but to the ultimate purchasers, the ones whose wallets the money is actually coming out of to pay the bill. Meaning, plan sponsors, such as self-insured employers or unions, patients themselves or members, and taxpayers. Again, how does value accrue to the ultimate purchasers like plan sponsors, patients/members, or taxpayers? Everybody else in the drug supply chain, let's be clear, is in the middle pushing money around that came out of somebody else's wallet. These middlemen have their own interests that may, for sure, may or may not be aligned with the interests of the ultimate purchasers. Getting value realized by patients will depend on understanding what the value is to these ultimate purchasers and then not getting derailed by any middleman who may not be so aligned. As a sidebar on this number one piece of advice, the whole “what's your value” and influence coloring this value equation made by ultimate purchasers is the prevailing beliefs of these ultimate purchasers, relative to Pharma, how they perceive the pharma industry. Whether it's earned or not—and this is not what we're gonna discuss today—but earned or not, Pharma does not have a great reputation with these folks right now. And this matters. Brian has a lot to say on this topic, which is fascinating. So, you should listen. Number two piece of advice that Brian Reid delivers in the podcast that follows that we talk about: Consider inching into the fray around benefit design. Rightfully so, there's always a lot of talk about patient affordability at pharma companies; but if I was gonna point to one thing that impacts affordability more than anything else, it'd be benefit design. There's only a small, underfunded cadre right now of folks out there (Mark Cuban aside, actually); but there's only a really small number of folks who never have any money who are really helping plan sponsors understand the impact on patients of some of the choices that they are making. I mean, personally, I could think of 10 things to do right off the top of my head that could help plan sponsors not get inadvertently screwed in this realm alone, just thinking they're saving money when, in reality, they are harming patients and not saving money. There's probably a lot of opportunities to communicate these kinds of things that are really win-win collaborations. Number three piece of advice that we talk about in the conversation that follows with Brian Reid: Keep an eye on hospital consolidation and vertical integration in the payer space. Consolidation raises prices and impedes patient affordability. This is as per study after study after study. Consolidation raises prices and sometimes considerably. Here's a part B to this third piece of advice about consolidation. There's sometimes wild swings in prices at different large, consolidated health systems in the exact same geography. Listen to the show with Cora Opsahl (EP452) for more about how their health plan, as just one example, saved $30 million a year just pushing a huge expensive health system, consolidated one, out of their network and navigating patients to more affordable sites of care. This matters to pharma companies because hospital system prices are currently crushing in many areas of the country, really impacting patient affordability. But there are better or worse options from an affordability standpoint in some of these geographies. To state the obvious, if an infusion of the same drug costs 10 times more if a patient shows up in one care setting versus another, that latter place, not affordable for patients. And by the way, that is not hyperbole of any kind. There are plenty of examples where literally an infusion of the same drug, same dosage will cost 10 times more if a patient goes one place versus another. But, again, it's not affordable. The patient cost share might be 10 times higher if it's coinsurance, if the patient goes to that latter place. And that latter 10x more of the cost place also just added 10x the cost to the PAP program or the foundation debit column. All of this is really relevant to Pharma. And just to pile on here because now I'm on a roll, another reason why this matters, these striking price variations between care settings, if we're talking about product value, and if the price the patient or the plan sponsor is paying is 10x the cost of the ingredients, nobody's doing that math and separating out the cost of ingredients from the, you know, total cost of the infusion. It is one lump sum number. So, if we're defining value as outcomes divided by cost and now the cost to the plan sponsor is 10x, product value just got reduced by 10x. Just in case anyone is confused here, and you probably know this, but many forget that the whole ASP (average selling price) plus 6% provider reimbursement—so, if that's what you're thinking and you're wondering how the 10x transpires—that ASP plus 6% provider reimbursement is only for Medicare kinds of plans. Hospitals can and do negotiate much higher reimbursements for commercial plans, and those carriers that have commercial lines of business and also MA (Medicare Advantage) books of business even allegedly actually negotiate higher commercial reimbursements so that they can get lower Medicare Advantage rates. Right, and you can see why, because the MA dollars are coming out of their own capitated pockets, whereas the commercial rates are being paid for by the ultimate purchasers, the plan sponsors. Also mentioned in this episode are Reid Strategic; Mark Cuban; Cora Opsahl; Bruce Rector, MD; Shawn Gremminger; Nina Lathia, RPh, MSc, PhD; Autumn Yongchu; Erik Davis; and Marty Makary, MD, MPH. Additional related episodes: EP380 with Mark Miller, PhD, on pharma communications. EP371 with Erik Davis and Autumn Yongchu on buy and bill versus pharmacy bagging. EP426 with Nina Lathia, RPh, MSc, PhD, on cost containment versus value-based drug purchasing. EP435 with Dan Mendelson from Morgan Health on how employers should consider pharma purchasing. EP365 with Scott Haas on PBM contracts and drug rebates. EP293 with Dea Belazi, PharmD, MPH, from AscellaHealth on co-pay cards, co-pay accumulators, and co-pay maximizers.   You can learn more by subscribing to Brian's newsletter and by following him on LinkedIn.   Brian Reid has nearly three decades of experience in healthcare journalism, public affairs, and public relations with a specialty in explaining the economics of the healthcare system. He is the founder of Reid Strategic, a communications consultancy, and a senior fellow at the Center for the Evaluation of Value and Risk in Health (CEVR) at Tufts Medical Center. At Reid Strategic, Brian counsels industry leaders on the best way to communicate on complex policy, access, pricing, and reimbursement issues in ways that critical audiences can understand. Brian's core belief is that we can't build a better healthcare system until everyone understands the system we have today. Reid Strategic offers communications strategy and execution around corporate, brand, and policy challenges, from prelaunch approaches to lifecycle management. Prior to founding Reid Strategic, Brian built and led Real Chemistry's Value+Access Communications practice, the largest such group dedicated to issues of value. Brian has written extensively for a range of audiences. At Reid Strategic, he publishes the daily Cost Curve newsletter; and his past experience includes coverage of the health science/policy beat for Bloomberg News, creation of patient education materials for the National Institutes of Health, and features in publications ranging from the Washington Post to Nature Biotechnology to Men's Health. He has a bachelor's degree in biology and political science from Emory University and a master's degree from the Columbia University School of Journalism.   08:29 Why is it important to understand the term “value” in respect to medicine? 10:07 Why is it important to consider all the players affected by the idea of this “value”? 11:06 Who are the ultimate purchasers in Pharma? 12:23 Findings of the Kaiser Employer Health Benefits Survey. 14:52 Why does it matter that we consider what value looks like to all players affected by Pharma? 16:46 EP300 with Bruce Rector, MD. 18:38 EP448 (Part 1) with Shawn Gremminger. 20:04 What does Pharma need to do to showcase their value when PBMs are often “locked in” at the moment? 23:11 Why Brian is celebrating companies that put their prices in their press releases. 32:31 Why does Pharma have an obligation to explain their value? 33:16 EP426 with Nina Lathia, RPh, MSc, PhD. 33:39 Why is it important for Pharma to keep an eye on hospital monopoly behavior? 35:55 EP370 with Erik Davis and Autumn Yongchu. 37:44 Why Pharma needs to capitalize on alignment.   You can learn more by subscribing to Brian's newsletter and by following him on LinkedIn.   Brian Reid, of Reid Strategic, discusses #pharma and #patientaffordability on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Beau Raymond, Brendan Keeler, Claire Brockbank, Cora Opsahl, Dan Nardi, Dr Spencer Dorn (EP451), Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9)  

https://youtu.be/qklxt9XNYFkToday I speak with Brandon Rael, an experienced retail and e-commerce professional and a RETHINK Retail Top Expert, about the role of a trusted advisor in digital transformation. Brandon emphasizes the importance of understanding the root cause of challenges and prioritizing transformation initiatives.We discuss the need for agility and customer-centricity in today's market and explores the motivations for transformation, such as profitability, cost containment, agility, and becoming more customer-centric.Brandon also discusses the challenges of multi-channel strategies and the opportunities in supply chain regionalization, social commerce, physical stores, and retail media networks.Brandon shares tips for enhancing company resiliency and advises e-commerce leaders to seek external help to drive transformation. He concludes by discussing his excitement about his new role at Kyndryl and his passion for continuous learning and embracing change.Website: https://www.vimmi.netEmail us: info@vimmi.netPodcast website: https://vimmi.net/ecom-pulse-podcast/Talk to us on Social:LinkedIn Vimmi: https://il.linkedin.com/company/vimmiLinkedIn Eitan Koter: https://www.linkedin.com/in/eitankoter/YouTube: https://www.youtube.com/@VimmiCommunicationsGuest: Brandon Rael, Strategy & Operations Leader at KyndrylLinkedIn: https://www.linkedin.com/in/brandonrael/Takeaways:Understanding the root cause of challenges and prioritizing transformation initiatives is crucial in digital transformation.Agility and customer-centricity are key in today's market.Motivations for transformation include profitability, cost containment, agility, and becoming more customer-centric.Multi-channel strategies present challenges but also opportunities for brands and retailers.Enhancing company resiliency requires self-disruption and continuous adaptation.E-commerce leaders should consider seeking external help to drive transformation.Supply chain regionalization, social commerce, physical stores, and retail media networks are emerging trends and opportunities in the industry.Chapters:00:00 Introduction and Background03:02 Becoming a Trusted Advisor in Digital Transformation10:00 The Importance of Agility and Customer-Centricity14:33 Motivations for Transformation: Profitability, Cost Containment, and Customer-Centricity23:22 Enhancing Company Resiliency through Self-Disruption26:03 The Role of External Help in Driving Transformation28:40 Emerging Trends and Opportunities: Supply Chain Regionalization, Social Commerce, Physical Stores, and Retail Media Networks31:27 Conclusion and Fun Fact

Andy Anderson, MD, chief medical officer and chief quality officer at RWJBarnabas Health, discusses cost containment issues such as pharmaceutical stewardship, lab testing stewardship, and length of stay management.

In this episode of the HealthLeaders Podcast, we're joined by Monica Richey, VP of Physician Revenue Cycle for Grady Health System in Atlanta, Georgia. Throughout our conversation, we'll be discussing cost containment within in the revenue cycle, with Richey sharing some of the strategies and technology she's implemented to assist in the system's efforts.

Gail Vozzella, Senior Vice President and System Chief Nurse Executive at Houston Methodist, chats with nursing editor G Hatfield about cost containment and how CNOs can implement technology and redesign workflows to keep costs down. To register for the Nurse Compensation and Labor NOW sessions, click here: https://event.on24.com/eventRegistration/EventLobbyServlet?target=reg20.jsp&eventid=2316043&sessionid=1&key=C43345E26DB1E1C464082F44BC6FC8A2&groupId=1695635&partnerref=enl&sourcepage=register

For a full transcript of this episode, click here. Here's something Randy Vogenberg, PhD, wrote the other day; and I made some light edits: Research has documented the unintended impacts of poor pharmacy benefit strategy. Examples include increasing costs of care, bankruptcies, and member satisfaction declines. And, yeah … agreed. Also, probably health problems if we're talking about a member unable to access a drug they really need. I heard the other day about how so many patients who have had organ transplants have a hard time getting their transplant rejection meds. What?! I just can't even with that one. On the other hand, you could have a plan that pays for all manner of drugs, cost-effective or not, appropriate or not. And now we have premiums that no one can afford, and everybody loses for the exact opposite reason. These are the downsides that happen when pharmacy purchasing gets itself into a suboptimal place. And this can happen for many reasons, but one of them is when there is not a concerted effort to buy pharmaceuticals in a value-based way. Now, here's some reasons why employers may have a rough time paying for value (ie, paying a fair price for drugs that work). Here's one reason: Most employers do not have the power to influence the price of a medication. So, any given employer could decide, based on some cost-effectiveness analysis, that the price of a drug is too high. But it's not like they can march into Pharma HQ and haggle. It's more of a take-it-or-leave-it kind of thing. Here's a number two reason why value-based pharmacy purchasing can be tough: Pharmacy spend is siloed a lot of times from medical spend. So, the pharmacy vendor is only concerned about cost and denies access to even drugs that are proven to reduce medical spend. Why wouldn't they do that? The PBM (pharmacy benefit manager) was hired to reduce pharmacy spend. The end. Who cares how many ER visits or disease exacerbations transpired? That's the medical director's problem, not theirs. Here's the number three reason why value-based purchasing is rough: The time horizon an employee is with an employer, which is not one day—and it's not a lifetime. Why did I say one day? I have heard more than once that the actuarial time horizon that some pharmacy plans use to determine if a drug is cost-effective is one day. If the drug doesn't accrue any benefits in one day, well then, it's a cost. It's not effective. On the other hand (and also problematic in the real world), sometimes cost-effectiveness analyses are done with a timeframe of the patient's lifetime. And, yeah … there aren't many employers who have employees for a lifetime—like, they're 85 years old and still on the employer's dime—so the time horizon can't be too short. But if it's a really expensive med that will, at most, prevent something that's not gonna happen anytime soon (heart failure, kidney failure, a stroke), these are things that an employer may pay for but likely is never gonna see the cost benefit of because that benefit will happen 30 years from now when the patient is on Medicare. And here's a fourth reason why value-based purchasing is tough: The FDA is approving drugs based on evidence from one study (ie, not a ton of evidence). And these drugs are also really expensive. So, some of the above issues are solvable; some are less solvable. With this in mind, let's tick through some advice that my guest today, Nina Lathia, suggests if you want to offer members a value-based formulary. 1. Have a stated goal. And maybe that stated goal is to meaningfully improve health of plan members while maintaining access, satisfaction, and affordability for said plan members and the plan. 2. Think holistically about healthcare spend, not just pharmacy spend. 3. Know what the value-based price of a drug has been calculated to be. I talked about this at length in the show with Anna Kaltenboeck (EP303). Also, Bryce Platt, PharmD, has written about this a lot. 4. Look into risk-based deals with Pharma and/or installment payments and/or some of these other interesting payment models that are emerging. Luke Prettol linked to one of them the other day. 5. Set good decision-making precedents that include shared decision-making with members/patients. This means communicating with employees and plan members about what you are doing to make good drug purchasing decisions and evaluate the clinical pros and cons of expensive drugs for any given patient. There are genetic tests now that can be done to determine if a drug is ever going to work for a patient, were these tests even done. I mean, from a patient standpoint, some of these drugs have horrible side effects; and they might be being prescribed by a doc who's not an expert in that condition. If I'm a patient and there's a genetic test I could take before I pay a ton of my own money and subject myself to what might be some pretty nasty side effects (you know, all the things that you hear about at the ends of those pharma ads on TV, right?), this could be, in the right hands, a patient benefit. This feels very different from prior auths administered by a vendor doing all kinds of stuff, where it's hard to make any connections to clinical value or patient upside, even if you squint at it sideways and use your imagination. And, yeah … this is easy to say and really hard to do. One definition I want to chuck in here for you: If we're talking about a cost-effectiveness analysis, cost-effectiveness analyses calculate how effective is the drug, minus side effects at diminishing the so-called burden of illness—burden of illness meaning the financial and health costs of the disease itself or its exacerbations. Nina Lathia, my guest today, is a pharmacist by training who has worked in hospital pharmacies. She earned a PhD in health economics. Currently she's doing consulting work, helping purchasers make value-based decisions about pharmacy spend and managing formularies. Specialty Pharmacy Playlist: https://lnns.co/uNZ3moCaQMb Hit the subscribe button to add it to your podcast player. Also mentioned in this episode are Randy Vogenberg, PhD; Anna Kaltenboeck; Bryce Platt, PharmD; Luke Prettol; Olivia Webb; Pramod John, PhD; Scott Haas; Aaron Mitchell, MD, MPH; Keith Hartman, RPh; Erik Davis; Autumn Yongchu; and Berkley Accident and Health.   You can learn more by emailing Nina at nina.lathia@healthcaredecisionmaking.com. You can also connect with her on LinkedIn.   Nina Lathia, RPh, MSc, PhD, has spent over 15 years helping healthcare payers achieve value on their drug spend. As the chief executive officer of Healthcare Decision Making, Nina works with public and private healthcare payers, helping them to make evidence-based decisions about their pharmaceutical benefits that lead to improved health outcomes and long-term financial sustainability of their health plans. Her focus is on providing independent, actionable advice for healthcare payers on reimbursement decisions related to expensive new drug therapies. Nina is a frequent public speaker and commentator on employer-sponsored pharmacy benefits design, value-based healthcare decision-making, and evidence-based medicine. Nina honed her skills in value-based assessment of drug therapies when she was a senior technical advisor at the National Institute for Health and Care Excellence (NICE) in the United Kingdom from 2014 to 2017. She has also worked as a clinical lecturer at the University of Toronto. Her work has been published in a number of high-impact peer-reviewed journals. Nina holds a master's degree and doctorate in health economics from the University of Toronto.   06:34 What does cost containment mean? 07:43 Why is it important to consider health outcomes? 10:00 What does value-based purchasing mean in Pharma? 11:09 What are the principles of cost-effectiveness analysis? 12:50 Pharmacy plan time horizons versus employer time horizons. 14:42 Why is it increasingly important for payers to take a more global look at health and cost outcomes? 16:14 Why is the first step establishing a value-based price for drugs? 16:43 Why is the second step thinking about risk-sharing agreements with manufacturers? 18:57 LinkedIn article by Bryce Platt, PharmD. 19:20 What should an employer do if there's only one drug option and the price is too high? 21:20 What's a specialty carve-out solution? 21:26 EP352 and EP353 with Pramod John, PhD, of VIVIO. 22:10 Why should employers get more comfortable with saying “no” to certain drugs? 25:36 Why is patient engagement key? 28:23 What does “good” look like for employers implementing drug-spend changes? 29:51 EP337 with Olivia Webb.   You can learn more by emailing Nina at nina.lathia@healthcaredecisionmaking.com. You can also connect with her on LinkedIn.   Nina Lathia discusses #costcontainment and #valuebasedpurchasing in #pharma on our #healthcarepodcast. #healthcare #podcast #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Marshall Allen, Stacey Richter (INBW39), Peter Hayes, Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang  

The American health insurance system, a complex and costly issue, is a topic that has been the subject of much debate and controversy. Many Americans struggle to afford health insurance, and the system is largely profit-driven, with pharmaceutical companies and insurance providers reaping billions in profits. However, there are alternatives and potential solutions to these challenges. David Contorno and Emma Fox, both experts in the field, argue that the system is flawed and in need of alternatives. They believe that insurance should not cover primary care or physical therapy, as these services could be paid for in cash at a much lower cost than insurance premiums. They criticize the current system for being profit-driven and advocate for building health plans that prioritize cost containment and incentivize high-quality providers. They also question the role of insurance carriers, suggesting that they serve no purpose, and that the intention of insurance should be to protect individuals from catastrophic loss. Join David Contorno and Emma Fox on this episode of The Healthcare Hangover podcast as they delve deeper into the challenges and alternatives in the American health insurance system.Timestamped Outline:(00:00:34) The High Costs of Health Insurance(00:05:03) The Impact of Charity Care Programs on Nonprofit Hospitals(00:09:14) The Impact of Healthcare Costs on Bankruptcy(00:12:22) Maryland's Successful Healthcare Cost Reduction Experiment(00:21:05) Inflated Bills and Decreased Quality of CareSocial Posts:

David Cerf, Chief Data Evangelist at GRAU DATA generously lends us his in-depth knowledge on data protection, tape solutions. Through our conversation, you'll learn the significance of a layered approach to data protection, the key steps towards a zero trust environment with application firewalls, and the realities of obtaining ransomware insurance in the current landscape.

No matter where you live or what kind of work you do, fuel prices have probably been a source of concern at some point in the past few years. The focus of this episode of Leading the Way at Leonard's is fuel economy and business strategies for managing costs to offset higher prices at the pump. Host Dwayne Knepper is joined by Leonard's Express CEO Ken Johnson, VP of Operations Kevin Adriaansen, and Cost Containment Manager Mitchell Johnson.

If you're like most employers, you're constantly making decisions about the best way to allocate scarce resources. This is a difficult and high-stakes task that has only been made more important by rising costs, a down economy, and a red-hot labor market. OneDigital is here to help with the Moneyball Benefits Podcast.In this series, Director of Compliance and Innovation Scott Wham takes inspiration from the "Moneyball" philosophy that revolutionized professional sports in the 2000s and applies it to the world of human capital management. In episode two, Bob Simeone returns to discuss the pros and cons of self-funding your employer health insurance plan.

Somebody wrote on Twitter the other day that he was gonna give a talk on the use of evidence in drug policy, and Barrett Montgomery replied, “That'll be a short talk then!” So, let's talk about the IRA (Inflation Reduction Act) for a moment, specifically the “CMS can negotiate for drugs for Medicare patients” part of the IRA. There's one topic I don't hear discussed what I would consider maybe often enough. Will these negotiations result in pricing that is evidence based? Will good drugs that companies developed using less taxpayer money for R&D, drugs that positively impact the patient lives or have spillover benefits for society or save downstream medical costs, drugs that have solid comparative evidence data, drugs that are a meaningful therapeutic advancement over competitors ... will these drugs be priced in line with that value? Everything I just mentioned, by the way, are things that CMS is supposed to take into account during its negotiations. So, that's what this show is all about. To have this conversation, I invited Dr. Peter Neumann on the podcast because Dr. Neumann (along with his two coauthors, Joshua Cohen and Daniel Ollendorf) just wrote a book about pharmaceutical pricing entitled The Right Price. I convinced Dr. Neumann to come on the show and talk about what the likely impact the IRA will have on these right drug prices. And short version, Dr. Neumann told me that “presumably drugs that offer more therapeutic advances will do better under these negotiations.” Here's a really, really top-line summary of the negotiation provisions that are in the IRA: CMS will negotiate prices on the highest gross spend top 10 Part D drugs in 2026, 15 Part D drugs in 2027, and 15 drugs from Medicare Part B and D for 2028. Small molecule drugs become negotiation contenders after 9 years, and biologics after 13 years. Once a generic or biosimilar comes out (ie, the patent is well and truly expired), then this negotiation provision is no longer in play. Now, CMS is given some discretion over how it's going to do things, and they will issue guidance and figure out how to implement the law over the next couple of years. As with so many things (and Chris Deacon talked about this recently on LinkedIn), it's how that law is operationalized that actually determines if it achieves this “right price” goal and/or—and Dr. Neumann, my guest in this healthcare podcast, makes this point really clearly, too—maybe the point of the law is as much about cost containment, frankly, as it is about achieving value-based “right” prices. And cost containment and value-based pricing are not the same thing. I'm gonna do a show on this coming up. So, what are the likely effects of the IRA pharma price negotiation provisions? And not talking about the whole IRA here and the cadre of other stuff like patient out-of-pocket caps and inflation caps. This show is complicated enough just talking about the negotiation portion and just talking about its potential to achieve pricing based on “value.” Here's a summary of likely impact of Medicare drugs being negotiated, some of which we talk about in this episode. There's “seven-ish” main implications: 1. “Some Medicare patients will benefit substantially from negotiations …, as a reduction in the drug's price will result in lower coinsurance and liability during the deductible phase.” Okay … this makes sense. 2. “Overall, negotiations are projected by the CBO [Congressional Budget Office] to reduce premiums, resulting in lower costs for all Medicare beneficiaries.” References: CBO estimates drug savings for reconciliation. Committee for a responsible federal budget. Accessed April 11, 2023. https://www.crfb.org/blogs/cbo-estimates-drug-savings-reconciliation  Congressional Budget Office. Estimated budgetary effects of Public Law 117-169, to provide for reconciliation pursuant to Title II of S. Con. Res. 14. Published 2022. Accessed April 11, 2023. https://www.cbo.gov/system/files/2022-09/PL117-169_9-7-22.pdf Okay … so, this #2 here is kind of thought provoking, especially when it's unclear at this time whether the negotiated price will refer to the list price, the AWP (average wholesale price), or the rebated price (ie, the price after rebates are applied). There are many, many implications if the negotiated price is before or after rebates, just given how “addicted” plans are to rebates and use the rebates, and cost shifting to patients, in a convoluted and super-inefficient way to try to keep premiums down. Listen to the show with Chris Sloan (EP216) for more on this. 3. There's more incentive to go after biologics than small molecule drugs—obvious, due to the 9-year versus 13-year thing. There's additionally some incentive for rare-disease and orphan drugs, most of which are biologics, in other parts of the IRA. 4. More interest in drugs for non-Medicare markets (ie, drugs for diseases of younger populations, perhaps) 5. Possibly less pharma innovation, fewer drug launches Oh, boy, with this one. Listen to the show with Mark Miller, PhD (EP380), for many, many nuances here. But let me give you a few things to think through, and I'd start with four words: We are chasing Goldilocks. There are two ends of the spectrum, and neither are good. On one end, Pharma charges way too much and the system gets bankrupted while pharma shareholders get rich. On the other side of the spectrum, there's not enough returns for any investors to invest in new drug development. It's all about moderation—finding the sweet spot in the middle—something the healthcare industry has a super hard time with. Bottom line, we want to incent meaningful innovation, drugs that actually work. If we pay a ton of money for drugs that don't work particularly well, then what's the incentive to find good drugs? As per my earlier point, if this legislation does as was intended, then good drugs should get rewarded and less comparatively effective drugs should be less rewarded. Let's cross our fingers, shall we? 6. Will Pharma raise its launch prices because the negotiations center on discounts? A higher price times the discount means a higher discounted price, after all. This one could be exacerbated by the part of the IRA that mandates inflation caps. There is some evidence that higher launch prices are already happening. 7. Manufacturers wait to launch until they have all their indications ready to go. If you didn't understand this, we explain in more detail during the interview. 8. There are incentives for Pharma to jack up commercial prices. Because they're making less money in Medicare, they try to make more money in the commercial market. But as Dr. Neumann says, you'd think that if Pharma could do that, they already would have done it. Or let me say that a different way: You'd think that if Pharma could have raised their commercial prices more than they already have been raising their commercial prices, they would have already done it. So, I think whether cost shifting actually increases here is a sizable question mark. 9. There's also less incentive for Pharma to innovate me-too kinds of drugs. If a drug in the same class for the same disease is being negotiated, then a new drug coming out in that same category might sort of have to charge a price similar to the negotiated price of the other drug. Dr. Peter Neumann, my guest in this episode, has a background in health economics and currently directs a research center that's focused on health economic issues. His group does a lot of work trying to understand the cost effectiveness of drugs and other health interventions. Other shows you should, for sure, listen to here are the ones with Mark Miller, PhD (EP380); Anna Kaltenboeck (EP303); Bruce Rector, MD (EP300); Scott Haas (EP365); and Chris Sloan (EP216). These shows offer context and adjacencies that are extremely relevant right now if you're gonna understand the potential impact of the IRA. Here's a quote from the book The Right Price (written by Dr. Peter Neumann and his coauthors, Joshua Cohen and Daniel Ollendorf) that I thought summed up some of the issues here very nicely: If there existed a Rorschach test for drug prices, it might conjure one of two images. Some people might perceive prices as a compass directing companies to invest in products that people value most. Aligning prices with value is akin to a “true north” orientation of the compass's arrow. Failure to link prices with value sends misleading signals to drug producers. Others might regard drug prices as a wall preventing patients from accessing the drugs they need. For them, the barrier should be as low as possible. But aligning prices with value might have little effect in lowering the wall. How then to accomplish that goal?   You can learn more at cevr.tuftsmedicalcenter.org or by reading The Right Price.   Peter J. Neumann, ScD, is director of the Center for the Evaluation of Value and Risk in Health (CEVR) at the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center and professor of medicine at Tufts University School of Medicine. He is the founder and director of the Cost-Effectiveness Analysis Registry, a comprehensive database of cost-effectiveness analyses in healthcare. Dr. Neumann has written widely on the role of clinical and economic evidence in pharmaceutical decision-making and on regulatory and reimbursement issues in healthcare. He served as co-chair of the 2nd Panel on Cost-Effectiveness in Health and Medicine. He is the author or coauthor of over 300 papers in the medical literature and the author or coauthor of three books: Using Cost-Effectiveness Analysis to Improve Health Care (Oxford University Press, 2005); Cost-Effectiveness in Health and Medicine, 2nd edition (Oxford University Press, 2017); and The Right Price: A Value-Based Prescription for Drug Costs (Oxford University Press, 2021). Dr. Neumann has served as president of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). He is a member of the editorial advisory board of Health Affairs and the panel of health advisors at the Congressional Budget Office. He has also held several policy positions in Washington, DC, including special assistant to the administrator at the Health Care Financing Administration. He received his doctorate in health policy and management from Harvard University.   09:33 Is it imperative that drugs whose patents are expiring have their prices negotiated? 10:50 “We need innovation; we want to encourage innovation.” 11:01 Does this new law strike a balance between innovation and price regulation? 11:21 How are we assessing cost effectiveness and innovation in the drug space? 12:29 What's the problem with the current drug markets? 13:14 Why can't you rely on the drug market for the cost effectiveness of a drug? 14:13 Why very expensive drugs do not equate to poor value. 15:06 What are the likely outcomes of the IRA? 18:33 How does pharmacy budget factor into high-value drugs? 19:26 “Value-based pricing doesn't mean necessarily lower spending overall.” 22:59 What are the types of drugs that will be excluded from the IRA? 23:22 Who will the law create problems for? 24:44 What have pharmacy benefit managers (PBMs) been doing to move forward with the new law? 26:04 What are plan sponsors doing right now? 28:32 What are the most important value metrics according to Dr. Neumann?   You can learn more at cevr.tuftsmedicalcenter.org or by reading The Right Price.   @PeterNeumann11 discusses #drugprice #negotiations on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein  

If you're like most employers, you're constantly making decisions about the best way to allocate scarce resources. This is a difficult and high-stakes task that has only been made more important by rising costs, a down economy, and a red-hot labor market. OneDigital is here to help with the Moneyball Benefits Podcast.In this series, Director of Compliance and Innovation Scott Wham takes inspiration from the "Moneyball" philosophy that revolutionized professional sports in the 2000s and applies it to the world of human capital management. In episode one, Scott sits down with Bob Simeone, Senior Managing Principal of the Greater New York market, to discuss how organizations like yours can optimize their benefits spending without compromising on their employer value proposition. 

TODAY - A group that's been gathering petition signatures near the Hereford Post Office won't be allowed to do so anymore following a complaint to the Cochise County elections office.Support the show: https://www.myheraldreview.com/site/forms/subscription_services/See omnystudio.com/listener for privacy information.

The 134th State of the Fleet Industry video produced by Automotive Fleet offers insights into the state of the fleet market as presented by AF Editor Mike Antich. Today's topics include: Fleet managers report increasing pressure from their management to identify areas to control fleet costs. Total fleet costs are proportional to total fleet size. Fleet costs are directly proportional to the total number of vehicles in operation, which, in turn, drives all fixed and operating costs, such as fuel, maintenance, depreciation, accident repair costs, etc. Fleets need to identify low-utilization vehicles and consider whether a driver should be shifted to a monthly allowance or cents-per-mile reimbursement program. “Vehicle hoarding” is occurring at some fleet operations because out-of-service or low-utilization vehicles are being retained “just in case” they are needed. Fleet inventory management must be an integral part of any cost containment fleet strategy. Make sure you're signed up for the AF newsletter so you don't miss another State of the Fleet Industry video.

In this "Best of 2022" throwback HCI Podcast episode, check out the popular episode: Employers Offer More Flexible Benefits But Eye Cost Containment, with Maria M. Trapenasso. Please consider supporting the podcast on Patreon and leaving a review wherever you listen to your podcasts! Check out Ka'Chava at www.Kachava.com/HCI. Check out the HCI Academy: Courses, Micro-Credentials, and Certificates to Upskill and Reskill for the Future of Work! Check out the LinkedIn Alchemizing Human Capital Newsletter. Check out Dr. Westover's book, The Future Leader. Check out Dr. Westover's book, 'Bluer than Indigo' Leadership. Check out Dr. Westover's book, The Alchemy of Truly Remarkable Leadership. Check out the latest issue of the Human Capital Leadership magazine. Each HCI Podcast episode (Program, ID No. 592296) has been approved for 0.50 HR (General) recertification credit hours toward aPHR™, aPHRi™, PHR®, PHRca®, SPHR®, GPHR®, PHRi™ and SPHRi™ recertification through HR Certification Institute® (HRCI®). Learn more about your ad choices. Visit megaphone.fm/adchoices

Key Trends in Cost Containment Space and How Employers Are Going to Benefit On this episode, Ramesh sits down with Rob Gelb from Valenz and Jeff Bak from Imagine360 to discuss the key trends in the cost containment space. Some of the questions that will be answered include; What are the different ways employers can contain costs? What is going to be effective in the post-price transparency future? Where does RBP sit in the spectrum of solutions? Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

EPISODE QUOTE: “Bulls and bears make money, pigs get slaughtered.”Tune in for this sensible conversation at TalkRadio.nyc

In this HCI Podcast episode, Dr. Jonathan H. Westover talks with Maria M. Trapenasso about recent NFP data about how employers are offering more flexible benefits but carefully eying cost containment. See the video here: https://youtu.be/ienxg9NT_No. Maria M. Trapenasso (https://www.linkedin.com/in/maria-m-trapenasso-shrm-scp/) is the VP, National Practice Leader of HR Solutions for NFP. Maria leads the HR consulting practice and offers NFP's clients strategic guidance on HR related functions such as organizational harmonization, leave management and employment practices. Her expertise is in the areas of HR audits and compliance and assists clients in identifying and creating strategic HR policies and procedures. Maria also has extensive expertise in assisting start-ups create a solid HR infrastructure to accommodate rapid growth and expansion. Maria has over 26 years of Human Resources experience working in various industries such as Corporate and Residential Real Estate, Non-Profit, Technology Consulting, Finance and Insurance. In her prior roles, Maria specialized in assessing HR organizations to create strategic alignment with company goals, implementing comprehensive and compliant policies and procedures and developing dynamic training programs to meet developmental goals. Maria holds a Senior Certified Professional designation from the Society of Human Resources Management, and she has been a professional member of SHRM and the National Association of Female Executives since 1998. Having extensive practice in the corporate benefits market, Maria also holds a NY State Insurance license for Health, Life and Accident Insurance. NFP HR Solutions provides clients with access to HR consulting professionals and information systems expertise. We assess and recommend workforce practices, policies and technology so our client's organizations will run more efficiently and effectively. Please consider supporting the podcast on Patreon and leaving a review wherever you listen to your podcasts! Check out BetterHelp.com/HCI to explore plans and options! Go to cardiotabs.com/innovations and use code innovations to get a free Mental Health Pack featuring Cardiotabs Omega-3 Lemon Minis and Curcumin when you sign up for a subscription. Check out Zapier.com/HCI to explore their business automations! Check out the HCI Academy: Courses, Micro-Credentials, and Certificates to Upskill and Reskill for the Future of Work! Check out the LinkedIn Alchemizing Human Capital Newsletter. Check out Dr. Westover's book, The Future Leader. Check out Dr. Westover's book, 'Bluer than Indigo' Leadership. Check out Dr. Westover's book, The Alchemy of Truly Remarkable Leadership. Check out the latest issue of the Human Capital Leadership magazine. Each HCI Podcast episode (Program, ID No. 592296) has been approved for 0.50 HR (General) recertification credit hours toward aPHR™, aPHRi™, PHR®, PHRca®, SPHR®, GPHR®, PHRi™ and SPHRi™ recertification through HR Certification Institute® (HRCI®). Learn more about your ad choices. Visit megaphone.fm/adchoices

“What we've seen in the last 10 to 15 years … is a juggernaut of costs from specialty medicines, usually wonderful medicines with great cures, but that come at a significant cost. … And whereas the split between medical and pharma used to be that we spent some of our time on utilization of pharmacy and prescriptions and generics and mail order versus retail, now specialty medicine is just blowing everything out of the water from a cost perspective.” With that, healthcare industry thought leader Dr. Ron Leopold launched into an engaging conversation about macro trends in employee benefits, covering the ever-evolving effects of COVID, the proliferation of point solutions, the major cost drivers for employers, and how those employers should be using data to contain their costs.“There's a whole lot that we can measure if we're smart and understand this requires both looking at the data and then really thinking through cause and effect,” said Dr. Leopold.Listen to the full conversation.Connect with Dr. Leopold on LinkedInVisit RonLeopold.comConnect with our co-hosts Jennifer Jones and Mike Pattengale Subscribe so you don't miss an episode: Apple Podcasts, Spotify, and other popular podcast playersHave feedback, questions, or suggestions for show ideas? Send them to us at podcast@springbuk.com.Please rate and review us on your favorite podcast platform, and share it with your friends and colleagues. We appreciate you and thank you for listening!Produced by David PittmanTheme music: "Overboard" by Stay Outside

One of the first strategies I like to work on with my clients is helping them lower their costs. Sometimes, professionals like my guest on this show are great to help aid in that process because they have the relationships and teams to review the various bills and programs in place to see if there may be a better solution to the procurement of said service/product. On today's show, we're talking with Kevin O'Shaughnessy who is a cost-containment expert who helps businesses find savings on services like telecom, waste management solutions, shipping services, and more. But it's not just about the savings - after all, if a program is not going to be good for the business, it would not make sense. This is where Kevin works alongside the business to ensure everything works out according to plan. Listen in and see how you might start saving some money today on the services you're using! About Kevin: Kevin O'Shaughnessy is the owner of Schooley Mitchell of Red Bank. Schooley Mitchell is one of the largest cost reduction consultancy firms in North America. Kevin works with mid-to-large size companies to improve profitability with proven cost reduction strategies. He brings over 30 years of experience to Schooley Mitchell specializing in finance, sales/trading, and general management. His diverse Wall Street experience includes working for banking stalwarts JP Morgan and Bankers Trust, well-regarded hedge fund firm Harbert Management Corp, and the premier international brokerage firm TP Icap. Kevin spent more than 20 years at TP Icap/Tullet Prebon fighting to bring the best price for his clients in the commodity markets, ranging from interest rate products to energy. His responsibilities included general management of operations, strategic business development, and client relations. Connect with Kevin on Facebook, LinkedIn, Instagram, and on the web at https://www.schooleymitchell.com/koshaughnessy/

In Part 2 of our 3 Part Series on Health Plan Financing & Cost Containment, Host Dorothy Cociu interviews Brad Gossen, President, and Dan Baker, Vice President, Sales, of EBA&M Corporation, a Third-Party Administrator specializing in self-funded health plans. In this post-COVID world, employers are trying to get back to what they do, and in order to do that, they are looking at long-term cost containment in their health plan financing. Is Self-Funding the way to help your company's bottom line and help long-term growth? As employers look at reducing their long-term spend, but need good benefits to attract and retain employees, the self-funding alternative is looking more and more promising. Join us as we discuss the Risk vs. Reward. website https://advancedbenefitconsulting.com/s3e17-is-self-funding-your-health-plan-the-way-to-help-your-companys-bottom-line-and-long-term-growth

Johnette Van Eeden and Mike Coffey discuss how employers' attitudes toward employee wellness has changed over the last two decades due to changes in financial incentives, regulations making outcome-based programs more difficult for employers to implement, and healthcare reform.They also talk about how an employer can establish a baseline for measuring their employee population's health and interventions that employers can implement to encourage healthier lifestyles.They also discuss vaccine mandates, booster shots, Covid variants, and breakthrough Covid cases.Good Morning, HR is brought to you by Imperative—premium background checks with fast and friendly service. For more information about our commitment to quality and excellent customer service, visit us at https://imperativeinfo.com.If you are an HRCI or SHRM-certified professional, this episode of Good Morning, HR has been pre-approved for half a recertification credit. To obtain the recertification information for this episode, visit https://goodmorninghr.com.About our Guest:Johnette Van Eeden is the CEO of Star Wellness, a leading national provider of on-site medical screening and biometric services in the US, helping organizations control healthcare costs by alerting individuals to undetected health conditions. She has also been at the forefront of Covid vaccine distribution both at her clinic and in workplaces across North Texas. She's the author of Solving the Big FAT Puzzle: How to Create a Sustainable Solution That Works for YOU! and Navigating Wellness: Creating an Effective Strategy for Cost Containment.Johnette can be reached at https://starwellnessusa.com or 800-685-5572.About Mike Coffey:Mike Coffey is an entrepreneur, human resources professional, licensed private investigator, and HR consultant.In 1999, he founded Imperative, a background investigations firm helping risk-averse companies make well-informed decisions about the people they involve in their business.Today, Imperative serves hundreds of businesses across the US and, through its PFC Caregiver & Household Screening brand, many more private estates, family offices, and personal service agencies.Mike has been recognized as an Entrepreneur of Excellence and has twice been named HR Professional of the Year. Additionally, Imperative is included in the prestigious Best Places to Work in Texas list and has been named the Texas Association of Business' small business of the year.Mike is a member of the Fort Worth chapter of the Entrepreneurs' Organization and volunteers with the SHRM Texas State Council.Mike maintains his certification as a Senior Professional in Human Resources (SPHR) through the HR Certification Institute. He is also a SHRM Senior Certified Professional (SHRM-SCP).Mike lives in Fort Worth with his very patient wife. He practices yoga and maintains a keto diet, about both of which he will gladly tell you way more than you want to know.

This episode discusses cost containment and process efficiencies for hospital and health system emergency departments.

The rising costs of prescription medications in the U.S. are top of mind for anyone who relies on daily doses for their health. Between 2000 and 2017, some studies put the prescription drug cost increases in the U.S. as high as 76%. So, what are consumers to do?

Pharmacy benefits management is one of the most promising cost-containment methods that a self-insured health plan sponsor can employ to rein in the fastest-growing segment of healthcare spending. But success is often predicated upon targeting a small percentage of specialty medications that drive the lion’s share of cost. Although only 1% to 2% of the U.S. population have conditions that require these drugs, which account for 2% of all prescriptions, these scripts account for roughly 30% of all Rx spending, according to Corri Holcomb, senior vice president care management, customer solutions at UMR, a United Healthcare Company. Nearly half of these drugs cost more than $100,000 per patient each year to treat complex or rare conditions that require ongoing or intensive care coordination, she says in an interview, noting how costly they can be. Many specialty drugs are known as biologics that are derived from living cells and very difficult to manufacture. Holcomb explains that this makes them much more expensive than traditional drugs. Significant differences in the reimbursement methodology of these specialty drugs “can result in wide disparities in cost,” she adds. Some of the most expensive and cutting-edge treatments include cellular and gene therapies totaling more than $2 million per administration and requiring repeated treatments. This is why she says an important consideration is the total cost over a lifetime of that disease process. Given these challenges, there are a number of multiple cost-savings strategies that can be employed. Among those programs that UMR uses: prior authorization, step therapy, preferred products, medical necessity criteria, built-in management, file reviews, claims adjudication, site-of-care redirection and special-investigation units. Other efforts include carving out specialty medication management and point solutions.

How has Highmark Blue Cross Blue Shield achieved an industry-leading 27:1 ROI on their payment accuracy and FWA operations? Join us for a live webinar on Thursday, April 8 when Kurt Spear, VP Financial Investigation and Provider Review for Highmark, will share how an integrated technology ecosystem powered by Pareo is driving real results. Learn: How to make the business case for adopting a payment integrity technology platform How advanced technology allows health plans of all sizes and types to achieve value Why it’s important to connect pre- and post-pay avoidance and recovery operations How you can address medical savings pressures from outside stakeholders to better compete nationally What finding the right partner means for your innovation goals Register: https://www.clarishealth.com/resources/highmark-pareo-for-integrated-payment-integrity-webinar/ --- Send in a voice message: https://anchor.fm/payment-integrity-podcast/message

Dale Cooper is the Founder and CEO of Xact Communications a technology company providing superior cloud-based, wireless, and traditional IP voice and data technology. Xact also has entered into the Security services, Managed Services & IOT Dale is also the Founder and President of eSquared communications a business consulting company specializing in Cost Containment & Recovery with emphasis on Business Communications, such as Local Voice, LD, Data Networks, Cloud, VOIP, Phone Systems, & Internet Security About The Funding University: The mission of The Funding University to Enable Funding around the world. Hosted by Seth Block, CPA. Visit The Funding University: https://www.thefundinguniversity.com Get Access To: 1. Blog: https://www.thefundinguniversity.com/blog 2. CPE Courses & Modules: https://www.thefundinguniversity.com/cpe 3. TFU Masterclass: https://www.thefundinguniversity.com/masterclass 4. Funding Expert Certification: https://www.thefundinguniversity.com/certification

This week's episode features a conversation with Niko Caparisos, Principal at Prosperity Benefits. Employers struggle with controlling costs and balancing innovation with tried and tested tactics. For a more strategic and less fragmented approach, having buy-in from the c-suite is critical. On the employee side, empowering them with information and initiative can make them use the plan with as little friction as possible. You can find show notes and more information by clicking here: https://bit.ly/3sYDYQ1

AHC Cost Containment System v. USHHS

Our podcast discussion today between Michael Andrade and Douglas Aldeen, Esq.  If you don't know Doug that doesn't mean he hasn't helped you.  Doug is an ERISA attorney and has been in the healthcare space for more than two decades. If you've not considered value based provider payment and some form of direct contracting, [...] The post Douglas Aldeen, Esq: The MVP of Cost Containment appeared first on Solving Healthcare.

The audio version of the weekly webinar series "Successful Strategies for Shaping Your Future," in partnership with Club Solutions Magazine, REX Roundtables and IHRSA. This week's topic surrounds cost containment and budget planning, sponsored by Wexer. Panelists included: *Brent Darden, interim president and CEO of IHRSA, and chair of REX Roundtables *Paula Neubert, president & general manager, Club Greenwood *Laurie Smith, senior vice president, VillaSport Athletic Club and Spa *Bill McBride, the co-founder, president and CEO of Active Wellness *Blair McHaney, the CEO of MXM and owner of WORX health clubs

Ahin Thomas, VP of Marketing @ Backblaze provides tons of cloud cost containment tips, the most efficient ways to migrate data to the public cloud, and some of the other tools that would be needed for personal or business backup.

Host Dorothy Cociu interviews Larry Thompson, Chief Revenue & Strategy Officer for Advanced Medical Pricing Solutions (AMPS), one of the pioneers in reference based pricing and medical bill review that has been in business since 2005. Starting as a medical bill review company, AMPS takes a unique approach to cost savings for self-funded employers. Their basic reference-based pricing package includes medical bill review, identifying potential billing and coding errors, and provides peer review by premier physicians to keep hospital claim costs in line. This, combined with RBP, provides employers with great overall savings.. AMPS also provides something that most RBP providers do not… They accept fiduciary liability in the employer’s health plan, so that their employer clients know that they are always working with the best interest of the health plan in mind when negotiating with providers and settling claims if there is provider push-back. Listen to this unique approach to RBP and why it works.

Len Testa & Jim Hill start off this week’s episode by sharing some cost savings tips when it comes to staying on WDW property. Then they offer up the long-awaited conclusion to a feature piece about the construction of Kali River Rapids at Disney’s Animal Kingdom theme park Learn more about your ad choices. Visit megaphone.fm/adchoices

Len Testa & Jim Hill start off this week’s episode by sharing some cost savings tips when it comes to staying on WDW property. Then they offer up the long-awaited conclusion to a feature piece about the construction of Kali River Rapids at Disney’s Animal Kingdom theme park Learn more about your ad choices. Visit megaphone.fm/adchoices

Original air date: April 29, 2020 As college athletics departments confront the COVID-19 pandemic and the resulting budgetary crisis, it is crucial to ensure equity across your department's budget cuts. In this session, Dan Cohen of Nelson Mullins and NACDA Hall of Famer Cheryl Levick discuss important topics such as: Possible sport eliminations and staff reductions – avoiding crucial legal risks; Cost containment measures such as decreasing travel expenses and support services – beware of Title IX equitable treatment issues; Implementing spring sport scholarship changes – no fundraising cure, but creative solutions may help you legally. Click here to view the presentation slides in PDF format.

We have all turned, to some degree, to a short-term focus in both our personal & business lives. We must deal with reality.How do you address both short & long term issues & opportunities? In the short term, identify areas for optimization, while understanding the effects in future operations.We outline a two-week Enterprise Architecture Immersion approach that identifies short-term prioritized opportunities for cost optimization, & sets the stage for the eventual return to normalcy.

In this special edition episode of The Wrap, Hanny Akl CPA, CFE, CEPA, CVGA, a Member of Warren Averett and the Firm's Transaction Advisory Services Practice Leader, and Roger Spain, CPA, CFA, a Principal in Warren Averett's Outsourced CFO practice, re-join our hosts to discuss how businesses can contain costs in this financially stressful season. Our guests bring actionable ideas and advice for reducing spending and discuss important considerations for businesses looking to cut costs. This podcast episode features discussion about:·       How companies should approach cost containment during the COVID-19 pandemic·       Considerations for slowing your business's cash burn rate·       How to best evaluate where your business can cut costs ·       Considerations for reducing spending, including reducing labor costs·       Adapting your approach to your revenue stream

Join our dynamic employee benefits attorneys as they tackle compliance issues with cost containment measures such as changing employer contributions to premium and account-based plans.

Host Dorothy Cociu interviews Rick Paul, President of US Benefits, a self-funded stop loss underwriting firm, who shares his somewhat unique and sometimes controversial views on how to contain costs in a self-funded health plan. Rick is frank, to the point, and not afraid to state, in real world terms, what’s wrong with the healthcare system! In this podcast, he also shares his ideas on how to solve the healthcare crisis in the USA. Join us for this fascinating discussion!

Host Dorothy Cociu is interviewed on the topic of mid-size to large group health plan cost containment, where she shares her insights and ideas on the best ways to reduce costs in a group health plan, by managing the highest cost factors in a health plan: facilities cost, chronic claims cost and prescription drug expenditures. She will also discuss plan funding and financing methods that can seriously reduce your health plan cost. Join us for this informative and timely informational podcast!

Episode Summary The Change Leader CEO and President Drumm McNaughton and Aurora University Vice President for Marketing and Communications Deb Maue share their insights during the second annual wrap-up of happenings in higher education. This show notes offers a follow-up on the pair’s predictions for 2019 as well as insights on what to prepare for in 2020. Mergers, Consolidates and Closures 2018 Prediction for 2019: There would be an acceleration of mergers, consolidations and closures in higher education. What happened: This proved to be true. In November 2019, Education Dive reported that from 2014-2018, there were 1,234 colleges and universities that closed, including 129 non-profits, 11 publics and 1,094 for-profits. It shows that higher education is in a mature or declining market and will continue to experience headwinds in the future. The most surprising example of this was University of Alaska, where the governor initially wanted to cut $80 million from the budget, but dropped the amount to $40 million. This level of cuts is unheard of and it had to do with campaign promises. The university system was looking at consolidating three campuses into one, but geographically, this made no sense. System leaders also are looking at programmatic and faculty cuts. This will have far-reaching consequences, and may put the institution’s accreditation into jeopardy. However, several mergers made strategic sense. For example, National University System acquired Northcentral University, which is fully online with masters and doctoral programs. This merger allows the system to provide more programs for its students. Another example is Arkansas System, which absorbed Henderson State, a private non-profit. This opportunity to share services helps Henderson financially; in addition, its brand equity will increase by being part of the system. In both cases, these institutions moved quickly instead of waiting. They viewed the opportunity to merge as a strategic decision instead of being forced into making the move as a last resort. Neg Reg 2019 2018 Prediction for 2019:  The Neg Reg 2019 process would begin a transformation of higher education and its business model. What happened: This process proved to be groundbreaking in many ways. For instance, the Neg Reg negotiators came to consensus on every topic, which is unheard of. The Department of Education did put forward a number of ambitious goals and participants pushed back on a number of them before coming to consensus. The negotiators put the items under consideration into three buckets – accreditation agencies, innovation (including distance education and CBE), and teach grants and religious schools. The Department published the rules on accreditation agencies on November 1 in the Federal Register so these rules will go into effect July 1.  Some of the critical things include Accreditors are no longer delineated as regional or national and they now can compete against each other. Accreditors also can now reach out beyond the state or region they initially were restricted to and work with institutions in other parts of the nation. Student transfers should become much easier because of these changes. However, the innovation bucket was not finalized. People are anticipating that new guidance will come out for discussion shortly because the Department of Education just ended its Competency-based Education (CBE) experiment. However, because this guidance wasn’t published by November 1, these changes won’t go into effect on July 1, 2020. If President Trump is not re-elected, these changes will be up for reconsideration. A major issue for this bucket is how to measure learning. Right now, accreditors and institutions primarily measure learning by credit hours. However, this isn’t truly a good measure of learning.  Competency-based education looks at the knowledge and skills that a student acquires (or has coming into a program). Moving toward this way of measuring learning would be a major shift for higher education, especially for distance education. There also is talk coming out of Washington, D.C. about how to engage the business community more to identify the proficiencies that students need. This could also be put in the innovation bucket, The future of the third bucket -- TEACH grants and guidance for religious colleges and universities – is still unclear. Online Education 2018 Prediction for 2019: Online education will continue to grow in the next 2-3 years, spurred by consolidations and strategic alliances with online providers. What happened: This happened over the last year with the increase of online students; however, the rate of increase slowed. Western Governors and Southern New Hampshire University both topped 100,000 students and Grand Canyon University topped 90,000. However, there also have been major drops, including Phoenix (which was at 490,000 students at the beginning of the decade but now has about 90,000, a significantly lower enrollment). The most interesting thing is online program management (OPM). Bridgepoint Education continues to expand into this market as is Grand Canyon. Then there is Online Degree, which is turning the OPM marketing on its head. This company, which is growing, is attracting college dropouts to earn their GE requirements for free. Additionally, the movement from for-profit to non-profit is in a disarray. Grand Canyon illustrates this, having received approval for non-profit status by the IRS. However, the institution will still be treated as a for-profit by the Department of Education for the purposes of receiving federal funding. Universities that got into online education thought they would draw students nationally. However, online is now becoming hyper-local outside of the big players. The student base for online is the same as the prospective student base who would attend classes in person. This makes the marketing to these students easier. The number of post-traditional students is decreasing. Whether this will continue will be based on the economy. If it sours, people will go back to school to distinguish themselves. On a positive note, Moody changed its outlook from negative to neutral because they’ve seen some growth in some sectors. However, the demographic changes are beginning to be felt and will culminate in The Cliff in 2025.  Additionally, 1 in 3 higher ed CFOs believe that the sector is in trouble, and they are the ones that know what is going on the best. Tenure and promotion 2018 Prediction for 2019: Changing faculty tenure and promotion policies as a result of universities needing to cull programs that are not financially viable. What happened: This is still emerging. We believe that faculty are not getting tenured as quickly, especially at private institutions. Additionally, tenure doesn’t mean lifetime employment anywhere given that low-performing programs will be cut, putting faculty at risk for losing jobs.  One way this may play out is through alliances that may allow faculty to be shared between institutions. Market Research 2018 Prediction for 2019: Market research will increasingly have a place in higher education as they focus on identifying where students are coming from. What happened: We agreed that this hasn’t come true. Deb noted that there are some institutions that are doing a solid job in doing market research using statistical methods and other research methods to position the institution. However, there are still “haves” (which are big institutions) and “have-nots” based on funding being available to do this type of research. Cost Containment 2018 Prediction for 2019: Cost containment will accelerate, especially in private schools. This will find its way to the C suite where there will be a reduction of presidential salaries, especially in private universities. What happened: There wasn’t a reduction in salaries, but cost containment is becoming more evident. One-third of CFOs are concerned about their finances. Student debt exceeds $1.5 trillion, the highest ever. Low income students must work 15+ hours a week to afford their education. The discounting rate is commonly at 60 percent. Higher education enrollments are under 18 million, the first time since the Great Recession. However, institutions can’t cut their way to grow; instead, it’s important – and CFOs are increasingly trying to find ways -- to put money into areas that will give a good return on the investment. These include market research and proactive boards to steer the institution. Additionally, faculty and staff are starting to understand that higher education is a business and there is a relationship between revenues and expenses. Presidents are being more transparent about budgets as a way to education the institutional stakeholders. 2018 Prediction for 2019: We will start to see more interesting ways for education to be funded. Part of this will come from the NegReg process. More cities, state and companies will invest in their employees’ future. What happened: While there hasn’t been much movement on this, we note that the movement in the OPM markets, as well as the changing accreditation process. There has been growth but not as far as funding of education. This is part of the reason why there have been so many mergers and closures – institutions still are too reliant on tuition for their budgets. Higher education is beginning to partner with businesses to provide stackable and micro credentials for employees. However faculty buy-in is needed because they will be responsible for providing the content. 2019 Surprises We also note a number of things that happened in 2019 that surprised us. These included: Varsity Blues. This represents the worst in higher education and U.S. society when people with money can buy dishonesty at universities. Admissions lawsuits. The federal judge upheld Harvard’s use of affirmative action in its admission decisions, but it’s going to be appealed. There’s a similar lawsuit against UNC from the same group. Title IX. Three undergraduate women from Yale filed a class action lawsuit against Yale and its fraternities alleging that the fraternities control the campus social scene in a biased manner against women and fostering a culture of sexual harassment runs rampant. Lawsuits about false marketing. Career Education Corporation settled a five-year lawsuit brought by 49 state attorney generals over its marketing. A similar lawsuit happened to Phoenix, which is now considered to have a toxic brand. These lawsuits taint the for-profit education sector. Title IX. New guidance, which is at OPM, is coming out that changes the criteria from preponderance of evidence instead of clear and convincing evidence, the same as what is required in civil suits. This process had over 100,000 comments on this and will have major landmines. Predictions for 2020 Changes are coming in how fundraising is done at major institutions. Donor relations are changing in that people are returning donations and unnaming buildings. Institutions are going to be far more wary of accepting donations without doing significant background checks. There will be an acceleration of closures and mergers. There were big ones in 2019, such as Purdue with Kaplan and Strayer with Capella. There will be more closures in private non-profits. There is an overabundance in the market and a correction. Rising costs and discount rates of 60 percent or more will be common. Institutions will increase their partnerships with businesses to develop curriculum and credentials tailored to the businesses. Free tuition will not be the norm. Otherwise, taxes will need to be increased. More lawsuits about free speech, admissions policies and sexual assault will be filed. The Title IX rollout will be a mess. NCAA will need to look at restructuring, such as paying Division I athletes. This has other ramifications. For instance, this decision would give student-athletes the status of employees, which then gives them disability. That has additional cost ramifications for institutions. NegReg 2019 will turn into NegReg 2020 and things won’t be rolled out in a timely basis. If there is a new president, there could be significant rollbacks in the guidelines. There will not be any resolution in credit hours vs. competency-based education in relation to learning. The Department of Education will punt this issue to the accreditors. With the changes to the NACAC regulations, there will be decreased ability to predict the size of incoming fall class. May 1 will be less of a critical date in knowing what the fall enrollment will be and the recruiting cycle will change.   Links to Articles, Apps, or websites mentioned during the interview: Guests Social Media Links: Guest Linkedin: https://www.linkedin.com/in/deborahmaue/ https://www.linkedin.com/company/the-change-leader/about/ The Change Leader’s Social Media Links: LinkedIn: https://www.linkedin.com/in/drdrumm/ Twitter: @thechangeldr Email: podcast@changinghighered.com

Host Dorothy Cociu interviews Michael Hansen, Regional Sales Manager and Anna Hansen, Director of Sales & Client Solutions, Hines & Associates on how a good UR/UM program can save dollars for your health plan, while giving the best possible care to your health plan participants with Case Management and more.

Host Dorothy Cociu interviews Robert Shelly, PBM Consultant from LeafWing, who shares ways you can lower your health plan RX costs by finding the best PBM contracts, improving plan design and employee communications.

Professor Buzz Scherr joins the show to discuss the busy New Hampshire Legislative Docket, including Fair Chance Hiring, reforms to the NH Office of Cost Containment, bail reform, and DNA in abandoned materials. Episode on Fair Chance Hiring: https://unhlaw.podbean.com/?s=fair+chance Episode on Bail Reform: https://unhlaw.podbean.com/e/poverty-and-the-justice-system/   Learn more about Buzz: https://law.unh.edu/person/albert-scherr  https://law.unh.edu 

In addition to enjoying the holidays, December is a good time to pause and take stock of the past year. This also is an opportune time to get out the crystal ball to contemplate what might happen in 2019. 2018: The Year in Review There were a number of very nice gifts under the tree this year, but also a lot of lumps of coal. In 2018, we saw four big themes: marketplace dynamics; Washington follies; higher ed governance failures (which includes higher ed’s version of #MeToo); and the Harvard admissions lawsuit. Marketplace Dynamics: The Maturing and Decline of Higher Ed Markets In our previous blog and podcast on M&A activity in higher ed, we discussed the product life cycle and where higher ed stands in relation to this concept.  To briefly recap, the product life cycle (PLC) is a marketing tool that is applied to products, but also is relevant when examining market segments or industries. The PLC is made up of four stages: The introduction stage, which is characterized by the organization building brand awareness; The growth stage, which is characterized by strong growth as the organization builds brand preference and increases market share; The maturity stage, which is characterized by diminishing growth as “competition” increases and competitors offer similar “products.” This results in the implementation of multiple marketing strategies, such as cutting prices, rethinking positioning and branding, and market consolidation; and The decline stage, which is characterized by a decline in sales (which may be potentially significant). In many cases, the product (or organization) goes out of business or, as a last result, finds a buyer (leading to a merger or acquisition). Higher ed finds itself straddling the stages of maturity and decline, which is characterized by decreasing enrollment, lack of differentiation in the higher ed marketplace, and an increase in market consolidation and/or college closings. Which brings us to now. Breaking Down the Numbers.  Over the last few years (2016-2018), more than 100 colleges haves closed. Many can be directly attributed to the decertification of ACICS by the Obama administration. However, the more relevant reason for many of these closures is the lifecycle and current operating environment of higher education.  Over the past few years, 65 for-profits closed and seven merged with other institutions. Some of those mergers were huge (Purdue acquiring Kaplan, Strayer acquiring Capella, National University System acquiring Northcentral). In addition, 14 nonprofit universities closed and five merged while 36 public institutions merged or consolidated. This merger and acquisition activity makes perfect sense given that higher education is in the maturing to declining portions of the lifecycle. Transfer Students and Reducing Costs. We’ve also seen community colleges assume more of a role in reducing the costs of higher ed, as well as in degree completion.  State (and other) colleges are beginning to put more emphasis on attracting transfer students.  For example, Gov. Jerry Brown (D-Cal) is withholding $50 million from the University of California system until the system increases the acceptance and enrollment of transfer students while also meeting auditor requests to fix accounting issues. Brown’s decision was based on his commitment to a 2-to-1 ratio of freshmen to transfer students. However, several system’s institutions reported a ratio closer to 4-to-1. Privates are also emphasizing outreach to transfer students due to the costs to both the institution and the students.  Some privates are renting space at community college, thus giving students an easily available and direct track to a four-year degree.   This makes a lot of sense, especially given the current high cost of private education (e.g., one California private is charging $55,000 a year for undergraduate programs, amounts we see at Ivy League schools).  Thus, students find more affordable options by first attending a community college and then transferring to a public or private institution. This approach reduces the amount of student loans needed to complete a degree. This type of approach is especially important with students who start college without a clear idea of what they want to study or their pathway to earning their degree and end up dropping out due to cost.  This accounts for why we are seeing so many post-traditional students in higher education; they initially started college without understanding what they wanted to study and now are returning to complete their degrees. Having this community college low-cost option that transfers coursework to four-year colleges and university makes good sense because it minimizes the student’s time to completion and cost. College Closures and Rejuvenation. We continue to see higher education closures. While higher education leaders may point to the resurrection of Sweet Briar, those types of reemergence are few and far between.    Sweet Briar was an interesting case. Although the school had a substantial endowment (unlike most schools), those funds were legally earmarked for specific things and could not be used for operating funds.  This is an interesting (and possibly unique) situation and will make a great case study for future grad students who want to study the process of bringing a school back from the dead. Department of Education and Washington The second theme for 2018 is all about Washington, D.C. Frankly, there are so many things, it’s hard to know where to start. ACICS. ACICS is (in)famous for its accreditation of Corinthian and ITT, both of which folded, leaving 100s of 1000s of students stranded. Not surprisingly, ACICS was decertified by the Obama administration in 2016. At its height, ACICS accredited 200+ universities, but in the time between 2016 (when ACICS lost its accreditation) and now, most of the institutions accredited by ACICS have moved to other accrediting bodies.    However, the Trump Administration has other ideas on accreditation. Secretary of Education Betsy DeVos reinstated ACICS’ accreditation authority this year in a process that had many missteps. However, the most egregious was that the department’s senior official who made the case for ACICS’ reinstatement is a former lobbyist who worked with for-profit universities, a clear conflict of interest. In her justification for reinstatement, the former lobbyist, Diane Auer Jones, said the Department of Education determined that ACICS was in compliance on 19 of the 21 applicable criteria. Equally as important, she stated that ACICS was likely in compliance with these criteria when President Obama’s Education Secretary John King, Jr. removed ACICS’ accreditation certification. According to the Education Department, ACICS is still “out of compliance” with federal standards in the remaining two areas but has been given another 12 months to come back into compliance.  The carnage from ACICS’ original accreditation still continues. Just this month, the Education Corporation of America (ECA), which was once accredited by ACICS and oversaw Virginia College, shuttered its doors, leaving 20,000 students up a creek without a paddle. In fairness to ACICS, they removed Virginia College’s accreditation, but only after the college attempted to get accreditation from another accreditor and failed miserably. Gainful Employment and Borrower Defense. Changes in gainful employment and borrower defense also emerged in 2018. In relation to the former, the Education Department missed the filing deadline for the gainful employment rule so these changes cannot come into play until mid-2020. Furthermore, the Social Security Administration -- which provides the earnings data needed to calculate gainful employment -- decided not to renew the information-sharing agreement that expired in May. Because of this, the Education Department will not have the data they need to calculate earnings data. So, in essence, gainful employment is dead for now. Borrower defense is another area on which Washington gets raspberries. Regulations put in place by the Obama administration protected students whose colleges (e.g., Corinthian and ITT) closed, leaving them with degrees that were considered worthless. However, the Ed Department under Secretary DeVos rejected the vast majority of the claims. It took Congressional pressure to turn the process around, and although the process has gotten better, it still not where it needs to be. I think we can expect to see some new regulations coming out of Washington over the next year in this area. Title IX and Sexual Abuse. The Education Department put out their draft ruling on new Title IX guidance in November and, overall, colleges are not happy. The revisions make major changes to the standard that, in many cases, are as clear as mud and/or will discourage victims from coming forward. New Title IX Guidance. The first of the changes narrows the definition of sexual assault. The old standard was “unwelcome conduct of a sexual nature,” and the new standard is “unwelcome sexual conduct; or unwelcome conduct on the basis of sex that is so severe, pervasive, and objectively offensive that it effectively denies a person equal access to the recipient’s education program or activity.” The Ed Department justified this by saying it is in line with the Supreme Court guidance, but survivors’ advocates have come out forcefully and said that this new definition will put survivors’ education at risk. The second major change is the standard by which sexual assault is adjudicated. Previously, the standard was that the assault was “likely to have happened.” However, the new guidance provides for a higher standard, i.e., “preponderance of evidence,” the same standard that is used in civil suits. This is lower than “beyond a reasonable doubt,” the standard which is used in criminal trials, but it still creates a higher burden on the victim to prove that the incident happened. In its guidance, the Ed Dept stated that institutions can use either standard, but this potentially opens the institution up to lawsuits, e.g., institutions may face a lawsuit by the accused if they use the lower standard or the victim if the institution uses the higher standard. The third major change has to do with holding universities responsible. Under the previous guidance, universities and colleges could be held responsible if they “knew about or reasonably should have known” about an incident. However, under the new guidelines, the institution must have “actual knowledge” of the incident in order to be held responsible; this requires the victim to make a formal complaint through official channels. Telling a professor or resident adviser isn’t sufficient – it must be reported to someone who can do something about it, such as a school official who is involved in enforcement. Additionally, schools can only be held responsible for incidents that happen on school property or at school-sponsored events, not at private, off-campus residences. Thus, if a fraternity house is located off-campus and an assault takes place there (as was the allegation in the Judge Kavanaugh – Christine Blasey Ford incident), the institution cannot be held liable, even if they have knowledge that these events have taken place in the past. Lastly, the accused will have the chance to cross-examine the victim under the new guidance, and many feel this will discourage victims from coming forward and reporting incidents. Whenever you get into sexual assault or similar types of accusations, the resolution process must be more than he said/she said. However, that is what it could come down to because of the cross-examination requirement. Many victims’ advocates and lawyers are concerned that we will revert to a previous time when a woman who accused a man of sexual assault would ultimately be the one on trial because of her dress or behaviors or whatever. MSU and Sexual Assault / Harassment in Education. A subset of this area brings to light the #MeToo movement in higher ed, especially in the aftermath of the Supreme Court hearings with Justice Kavanaugh.  It took a tremendous amount of courage for Christine Blasey Ford to bring up what happened to her after so many years and in such a public venue. Sadly, look at what ultimately happened – the good ol’ boys network derailed the investigation before it was able to go through to a conclusion. We also are seeing the fallout from the Michigan State sexual assault case. MSU’s former president has been brought up on felony charges for lying to the police, and the institution’s undergraduate applications have fallen by almost 8.5 percent in the wake of the scandal. Not only is this situation tarnishing MSU’s reputation, it is hitting them in the pocketbook. And maybe that's what has to happen for people to change. Higher Ed Governance Failures and the Role of the Board We are seeing a failure in the governance process in many higher ed schools. Three cases fall into this area at the following institutions: Penn State, Michigan State, and the University of Maryland. We must ask ourselves in all these situations, “Where were the Board of Directors/Regents/Trustees?” In the Penn State scandal, some Regents were brought up on criminal charges. We haven't seen that yet in the Michigan State scandal, but I believe we will.  MSU’s interim president has not done a great job in reaching out to the victims – it has been pretty nasty in many respects, but one must ask where are their Board of Regents? Same with the University of Maryland football coach after the player died – the board directed the university president to retain the football coach, but the president refused (rightly so). From all appearances, the majority of boards and Regents do not understand what their role is. Regents at state schools generally are political appointees, and it is considered to be a feather in one’s cap to be appointed to a Board of Regents/Trustees for a state university.  However, just because one is a political appointee to a board doesn’t remove their fiduciary duties as a board member.  More training needs to be done to ensure Regents understand their duties as well as how governance has changed over the years. This also goes for boards of private universities. The vast majority of these types of higher ed boards are made up of “friends of the president” or other large donors. This is especially egregious with many Christian colleges, whose boards are made up of religious affiliates or ecumenical personnel who have no experience sitting on the board of a multimillion-dollar organization and/or an understanding of higher ed. Fallout from the Harvard Admissions Lawsuit The Harvard lawsuit, in which a group of Asian Americans sued the university over its admissions policies, ultimately will impact a majority of higher ed institutions. Even though Harvard says that they are following the guidance from the Supreme Court, they get sued. Same with UCLA – they have been sued as well. Although a ruling is still forthcoming on the Harvard case, I think there will be ripple effects and we haven’t seen the end of this. Predictions for 2019 While much of the crystal ball’s foretelling for 2019 is cloudy, there are some clear indications of what lies in the future. An Acceleration of Consolidation and Closures First, we will see an acceleration of consolidations and closures in higher ed. For example, just in the last couple weeks, Moody's Investors Service and Fitch ratings both have declared a negative outlook for the higher ed sector for 2019. This is huge. We have a marketplace that is saturated. In these types of markets, smarter institutions focus on economies of scale (mergers), as well as positioning and differentiation (why is my university and/or degree different)? Carnegie Mellon and MIT have done this very well. This is one way to combat saturation, but not a lot of schools understand marketing positioning and differentiation. Consolidation (mergers) occurs for one of three reasons. Acquisition of a new technology; Market expansion and/or growth; or Eliminate competition and/or create market efficiencies. Consolidation will continue to accelerate. One need not look any further than what is happening with Pennsylvania’s 21 state universities. These institutions are vying for a smaller number of students graduating from high school, so are closing multiple campuses and realigning programs to eliminate duplication. This impacts the towns in which they are located since they are the major employers, and any change they make in consolidating degrees and/or reorganizing the system affects jobs, creating a ripple effect. Closures will also increase, but we think there will be far more consolidation rather than outright closings. The trend will continue toward the mega universities -- the merger of Strayer and Capella or Purdue and Kaplan -- or more shared services between universities. We will start to see far more of this with the privates as they struggle to survive. The biggest challenge is going to be for the smaller universities that don’t have strong endowments. What are they going to do? Most of these universities rely solely on tuition and/or state and federal funding to keep their doors open. They have limited research dollars coming in as compared to the Tier 1/R1 institutions. Right now, the closure rate is below 1%, but it will accelerate. The one wildcard in this is a potential recession, which could result in people going back to school to gain new skills and earn a different degree. Maybe that will help universities. The other trend that we have not talked about is how many people are disparaging higher ed, saying a college degree is not worth the money that you pay for it. This is going to hurt higher ed and its ability to bring in more students. This too may lead to more mergers and closures. Changing the Higher Ed Business Model The business model for higher ed must change. We don’t see rapid transformational change in the next year. However, there will be many changes in the next five years that people will realize was part of a changing higher ed landscape as they look in the rearview mirror. Neg Reg 2019 and its Implications.  The upcoming negotiated rulemaking process by the Ed Department focusing on accreditation and innovation could be very impactful, especially with its focus on credit hours and online education. Credit Hours. Moving away from credit hours as a measure of learning could be one of those breakthrough transformations that could spur the changing of higher ed’s business model. Once the Ed Department makes these changes, we will begin to see more institutions using CBE and giving credit for previous learning and life experiences. If you take a look at the three colleges that have done very well using these models (Western Governors who is the poster child for CBE, Capella, and Southern New Hampshire), they have seen tremendous growth while reducing the cost to students. This is a win-win and I think we’ll see more of this.  Online Education.  Although online education is an area that is beginning to get saturated because of for-profits, we will see far more privates and state schools moving into this area, as well as continued consolidations with online providers (OPMs), such as Learning House. Because so many OPMs exist, some of the smaller colleges will be able to expand into this area at a reasonably low-cost investment, and more for-profits will be acquisition targets. We will start seeing institutions embrace the opportunity to share online courses. This too will require changes from the Neg Reg process with respect to accreditation, but once these types of changes come out, we will start seeing sharing of courses and services as we have not seen in the education industry. Negotiations with Faculty. We will begin to see higher ed leaders toughen their stance with faculty. Market saturation with institutions and programs has resulted in price discounting, sometimes at a rate of more than 60%. This is not sustainable. According to Inside Higher Ed’s 2018 Annual Survey of Chief Business Officers (CFOs), 48% of respondents strongly agree or agree that their college tuition discount rate is unsustainable. This is up from 34% in 2017. Furthermore, two-thirds of CFOs at the privates say the same thing. This is huge. Institutions must start cutting programs that are not “profitable,” but in doing this, they must deal with faculty. Unfortunately, faculty look at programmatic cuts through the lens of job security instead of what graduates need to be attractive in the job market.  When faculty start to do this, there will be security and jobs for nearly all.  Faculty Promotion and Tenure. We will start seeing changes in how faculty are promoted and assessed.  Currently, faculty are promoted and assessed by their publication records. Going forward, we’ll see less reliance on citations and publications and more on teaching. Additionally, faculty hiring and tenure will change. We will start seeing a review of tenured faculty every 5 to 10 years, instead of having a job for life. I don’t see tenure going away anytime soon – it is too institutionalized – but employment for life will become a thing of the past in five years. Knowing Who Your Customers Are and What They Need. Many higher ed leaders have locked themselves in the ivory tower for too long, and it's time they understood what students need to be taught and what industry needs to be successful. Texas A&M is another really good example of this. They talk with stakeholder groups on a regular basis, including just completing a values survey. The institutional leaders currently are engaging in what they call Aggie 2030 to understand the future of higher education as a whole and where Texas A&M is going. This is the type of strategic planning that universities need to be doing with their alumni, stakeholders and the people who hire their graduates. Student Enrollment and Impact on Marketing Research and Spending. Another trend involves students making enrollment decisions based on their own proximity to a college. This is important for universities to realize and understand. Unless you are a R1 or major university, your students are more than likely going to come from a limited geographical pool. This has implications as to how and where you spend marketing dollars, but unfortunately, many institutions are wasting marketing dollars. As much as institutions would like to draw from a larger geographical area, institutions must put a greater emphasis on doing market research to understand where their students live and then spend the marketing dollars to get more students from that area. As the saying goes, fish where the fish are, because it's a waste of money otherwise. Harvard Lawsuit and Admissions. The Harvard lawsuit has the potential going all the way to the Supreme Court, and who knows how that will be decided with the current makeup of the Court. Cost Containment. We also will start to see far more cost containment as institutions no longer have the same level of disposable income. I think we will also start seeing the salaries of chief executives start to come down, especially as transparency hits the budgeting process. Higher Ed Funding. Cities and states will begin to fund college for students. The City of Chicago recently announced a new program where students will receive scholarships to cover costs of associate degrees that will be set up through DePaul University. And in another example, Starbucks is funding college for their people. We will start to see more of this as an employee benefit, but also as a way for businesses to invest in and retain quality employees. International Students. International students attending U.S. universities will continue to be an issue so long as the Trump administration continues to mess with immigration. This will continue to impact U.S. institutions as international students pay full tuition and universities use those funds to keep their bottom lines in the green. This is especially true with Chinese students.  Because of trade wars and increased emphasis on background checks, we will see fewer Chinese students enrolling in the nation’s higher education institutions. HBCUs.  I think the other one to look at HBCUs. I think there could be some really good things to come out of the HBCUs over the next few years. I've no idea what it is, but the crystal ball says to keep an eye on them.    Wrapping Up So long as the Trump administration is in office, we will continue to see turbulence coming out of the Department of Education and the rest of the government.  One thing is for sure: it will not be boring! Merry Christmas / happy Hanukkah, and wishing all the very best for 2019. Bullet Points Looking Back – The Highlights from 2018 Higher ed finds itself in the maturity to declining stages as characterized by declining enrollments, lack of differentiation in the higher ed marketplace, and an increase in market consolidation (M&A activity) and/or college closings. Over the last few years, 2016-2018, more than 100 colleges haves closed. Many can be directly attributed to ACICS being decertified by the Obama administration, but more relevant is where education is in the lifecycle and current operating environment.  State (and other) colleges are beginning to put more of an emphasis on attracting transfer students.  Privates are also getting into this space due to costs to both them and their students.  Some privates are co-locating at community colleges, renting space from them, and this gives their students a direct track to a four-year degree.    ACICS was decertified by the Obama administration in 2016, but Secretary DeVos reinstated its accreditation authority this year. There were many missteps with this whole process, but the most egregious of these was because of a conflict of interest (or appearance thereof) of the department senior official who made the case for ACICS’ reinstatement. Gainful employment is essentially dead for two reasons: The Education Department missed the filing deadline for the gainful employment rule so the changes that they want to make to gainful employment cannot come into play until mid-2020. Because of an inter-agency dispute over data sharing, the Ed Dept cannot get the data it needs to calculate gainful employment, thus essentially killing gainful employment. The Ed Department in November put out their draft ruling on new Title IX guidance. Overall, colleges and victims’ advocates are not happy with the changes. There are four major changes: The narrowing of the definition of sexual assault. Suggesting a higher standard for adjudication be used, i.e., “preponderance of evidence,” the same standard that is used in civil suits. Lessening the culpability of institutions and narrowing the reporting requirements. Giving the accused the right to cross-examine the victim. There is a failure in the governance process in many higher ed schools as exemplified by the Michigan State University sexual abuse scandal, and the death of a University of Maryland football player and the retaining of the football coach. More training needs to be done to ensure Regents understand their duties, and how governance has changed over the years. Looking Forward – Predictions for 2019 We will see an acceleration of mergers, consolidations and closures in higher ed. The 2019 Neg Reg process will begin a transformation of higher ed and its business model. Online education will continue its growth over the next 2-3 years. Much of this will be spurred by consolidation and strategic alliances with online providers. We will begin to see faculty promotion and tenure processes changing as a result of the need for universities to cull programs that are not financially viable. Market research will increasingly take root in higher ed, as institutions need to make smarter use of their marketing dollars by determining where their true prospective students are. Cost containment will continue to accelerate in higher ed, especially in privates where discounting has been the norm. This will find its way to the C suite and we will start to see a reduction of presidential salaries, especially at privates. We will start seeing more “interesting” ways for education to be funded. Part of this will come out of the Neg Reg process, but more city, state, and private entities will invest in their residents’ and employees’ futures. Links to Articles, Apps, or websites mentioned during the interview: Product Lifecycle: http://www.quickmba.com/marketing/product/lifecycle/ National University System: https://nu.edu Department of Education: https://www.ed.gov/ Neg Reg 2019 Process: www2.ed.gov/policy/highered/reg/hearulemaking/2018/index.html Your Social Media Links: LinkedIn: https://www.linkedin.com/in/drdrumm/ Twitter: @thechangeldr Email: podcast@changinghighered.com

Today we have with us Phillip a Lewis, the co-founder of Profit Enhancement Group, a cost containment consulting firm focused on reducing healthcare cost for employers and health plans.His goal is to significantly reduce healthcare costs from 10% to 40% without making the benefit plan less robust or requiring the employees to assume greater financial liability by utilizing innovative strategies and platforms.Phil has owned and led a number of businesses in the real estate, retail and healthcare industries. He's always fighting to reverse the increase in healthcare costs which continue to erode the quality of life in the USA.Phil lives in Atlanta and enjoys cooking with his fiancee Stacey while pursuing his hobbies of golf and fly-fishing.

Today we have with us Phillip a Lewis, the co-founder of Profit Enhancement Group, a cost containment consulting firm focused on reducing healthcare cost for employers and health plans.His goal is to significantly reduce healthcare costs from 10% to 40% without making the benefit plan less robust or requiring the employees to assume greater financial liability by utilizing innovative strategies and platforms.Phil has owned and led a number of businesses in the real estate, retail and healthcare industries. He's always fighting to reverse the increase in healthcare costs which continue to erode the quality of life in the USA.Phil lives in Atlanta and enjoys cooking with his fiancee Stacey while pursuing his hobbies of golf and fly-fishing.

On this episode, LOC lobbyist Wendy Johnson discusses part one of the League’s second legislative priority, Revenue Reform and Cost Containment.  For cities, revenue reform is focused on property tax reform. Property taxes are the largest source of revenue for cities, with $1.39 billion collected in FY 2017-18. The League’s ultimate goal is a constitutional referral to voters and a companion bill that makes statutory changes to reform the property tax system. Show note links: Wendy’s email address 2017-18 Oregon Department of Revenue Property taxes statistics

In this episode, hosts Brady Bizarro and Adam Russo discuss the recent webinar’s success, hot topics impacting the industry today, and new methods to contain rising costs by taking advantage of changes in law and policy. If you like spending too much on healthcare, stay away. If you want to trump rising costs and achieve cost containment greatness, come on in.

Health Care is a major issue for everyone regardless of what they do or how they access services. Quality of service and cost of service together reflect the quality of health care. If you offer health insurance to your employees, you run a healthcare business whether you realize it or not. How you set up and maintain your healthcare program has a direct impact on your organization, your employees, and your community. During this session, get an inside look at how public entities and private employers around the country are reducing their spending 20-40% while improving the quality of care by adopting practical, proven, non-partisan solutions. We will cover real life examples of organizations big and small, rural and urban, public and private along with a blueprint to replicate their successes. Join this conversation to get involved and sign-up for the 2-day conference at https://www.agacgfm.org/Chapters/GreaterChicago/Training-Events/Event-Calendar.aspx to continue the dialogue.

Carl Schuessler/Mitigate Partners Mitigate Partners is an intentionally small "concierge" consulting firm offering a unique approach to benefits management to a select group of clients. Mitigate Partners provide insurance, risk management, cost containment, and employee benefits consulting services. They have chosen collaboration over competition and maintain healthy relationships with a cadre' of like-minded consultants and […] The post Carl Schuessler with Mitigate Partners and Susan Boland Butts & Keith Fenton with Hi-Hope Service Center appeared first on Business RadioX ®.

Howard Teibel recently sat down with noted educator and prolific writer Dr. Bill Massy talk about our changing perception of universities as complex human systems. The advanced modeling work that Dr. Massy has over his distinguished career has helped institutions around the world to better understand pedagogical performance improvement and the relationship of that work to administration and leadership through sound operational models.  The mix of tradition, culture, rules, norms, finance, pedagogy, and how we collaborate across the aisle — all of these elements contribute to the mix of our higher ed learning institutions. Dr. Massey is an award winning author, emeritus professor and former vice president of Stanford University and the perfect guest to help us navigate the web of today’s university. Links & Notes Course-Level Activity-Based Costing as an Academic and Financial Tool (PDF) — William F. Massy Are U. S. Colleges becoming less productive? — Bill Massy Improving Measurement of Productivity in Higher Education — Change: The Magazine of Higher Learning Honoring the Trust: Quality and Cost Containment in Higher Education — By William F. Massy William Massy criticises university decision-makers’ data use — The Australian

Brad and Cort return to the Green Zone to discuss everything that went down in the latest episode of Incorporated. Laura is all about making a baby with a hubby who secretly goes on the pill. Oops. We find out more about Ben’s past with Elena and his grifting ways. Theo has some hard decisions to make in his new role as one of Terrence’s lackeys.

Dr. J. Michael McWilliams is an associate professor of health care policy and medicine at Harvard Medical School. Stephen Morrissey, the interviewer, is the Managing Editor of the Journal. J.M. McWilliams. Cost Containment and the Tale of Care Coordination. N Engl J Med 2016;375:2218-20.

Healthcare costs have been the subject of policy and political conversations in the US since the early 1970s. With the implementation of the Medicare and Medicaid programs in 1965-66, the rapid expansion of private, employer-based health insurance plans, and the explosive growth of the “medical industrial complex”, the US has faced relentless and unprecedented growth in healthcare cost inflation and expenditures. Efforts to contain costs under reforms proposed by successive presidents - Nixon, Carter, Clinton and now Obama - have failed or, in the case of the Affordable Care Act, are being seriously questioned. This presentation will discuss the driving forces behind the problem of rising healthcare costs, recent progress in cost containment, and the prospects for achieving a sustainable growth rate. Maine has been and continues to be a leader in pursuing strategies to transform the financing and delivery of healthcare to achieve the goal of better care, better health, for less cost. While these efforts are necessary they are not likely to be sufficient to produce sustainable change. The remaining, unaddressed and seemingly intractable challenges will be a primary focus of this presentation.

Running a law firm, as many USLAW members are well aware, can be a very costly proposition. And as with most things, prices aren’t going down – quite the opposite. That’s why the subject of law firm cost containment is one that’s garnering plenty of attention lately. USLAW Member Neil Goldberg is a founding partner in the firm Goldberg Segalla in upstate New York and joins us now to share some ideas on running a fiscally leaner, meaner law firm.   CLICK TO LISTEN

Cost containment implies both reducing costs and making them more predictable. As the volume of data rises, legal departments face increasing pressure to reduce their budgets, while law firms are under pressure to deliver greater value by offering more services at lower fees and providing greater visibility of the costs incurred throughout the entire discovery process. The need to balance costs against risks is so crucial, that corporations are willing to live with a certain degree of quantified and managed risk in order to reduce their cost of e-discovery. So, how can costs be significantly reduced and yet balanced against risk?

Savvy school business officials have already cut school budgets to the bone. But these financial times are requiring more radical strategies for cost containment. Our guest today has helped many school districts develop these radical cost-cuttings plans and shares his insights on today's program

Savvy school business officials have already cut school budgets to the bone. But these financial times are requiring more radical strategies for cost containment. Our guest today has helped many school districts develop these radical cost-cuttings plans and shares his insights on today's program.

IT expert Dominic Breen joins us. Dom has carvved out an business niche in the charter school market and shares with us his experise. 

Host: Jack Lewin, MD Guest: Mark McClellan, MD, PhD Defensive medicine and medical liability concerns create a symbiotic relationship that costs everyone in the medical system. Has healthcare reform legislation addressed the medical malpractice issue, and will it do enough to contain healthcare costs? Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, former commissioner of the FDA and administrator of the Centers for Medicare and Medicaid Services, discusses the impact of defensive medicine on the healthcare system. Dr. McClellan also suggests that health information technology will play a significant role in bending the healthcare cost curve by ensuring safety, as well as increasing coordination of care and effective communication. Among states have taken up tort reform, how successful have these reforms been at reducing liability pressure and overall healthcare costs? Hosted by Dr. Jack Lewin. Produced in Cooperation with

Host: Jack Lewin, MD Guest: Mark McClellan, MD, PhD Defensive medicine and medical liability concerns create a symbiotic relationship that costs everyone in the medical system. Has healthcare reform legislation addressed the medical malpractice issue, and will it do enough to contain healthcare costs? Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, former commissioner of the FDA and administrator of the Centers for Medicare and Medicaid Services, discusses the impact of defensive medicine on the healthcare system. Dr. McClellan also suggests that health information technology will play a significant role in bending the healthcare cost curve by ensuring safety, as well as increasing coordination of care and effective communication. Among states have taken up tort reform, how successful have these reforms been at reducing liability pressure and overall healthcare costs? Hosted by Dr. Jack Lewin. Produced in Cooperation with

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Switchboard for May 29 2007 from VPR. Bob Kinzel hosts a discussion of the Education Cost Containment bill and how it will affect school budgets and your taxes.