Podcast appearances and mentions of Cynthia Fisher

Play Episode Listen Later Feb 13, 2025 35:11

Every Gen X'er listening to this is gonna be singing that Clash song in your head for the rest of the day. So, let's turn our attention to Medicare Advantage policy. And on the show today, I grill the one and only Betsy Seals to find out which policies she thinks are going to stay and which are going to go. 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. Obviously, this is very much in the context of a new administration and also just other things that are going on. But today we talk about the following four “stay or go” policy areas. Here's the first policy area we talk about: changes and activities within the Stars program. How will the Medicare Advantage Stars program change or not? Not only with this new administration, but also there are lawsuits and how they will impact the goings-on moving forward. Second policy, will it stay or will it go, that we talk about is risk adjustment and all of the activity in government oversight and focus on recoupment of improper payments as kind of the overarching bucket and what will be the incoming administration's method around risk adjustment. This is certainly on many people's minds. The third “will it stay or will it go” policy that we discuss is the use of AI (artificial intelligence) by Medicare Advantage plans. What does the appropriate oversight of the use in AI look like? Lots of talk about those prior auth AI algorithms and the high levels of denied care. A big topic of everybody's collective mind is looking at how to ensure that oversight is appropriate and that we're using AI for good and that it's not having any adverse impact. So that's the third will it stay or will it go. Fourth, and lastly, the whole agent broker realm—additional CMS and government oversight over misleading or inaccurate information coming from the marketing or the agent broker marketing world. How will that look in 2025 and moving forward? This last one, I'm kind of all over the nuance there after reading posts and comments by Samantha George, and I would recommend following her on LinkedIn would be my suggestion. I am reflecting back on the Ann Kempski episode (EP444), where we talk about the whole, really consider the downstream impact when making any policy changes, because there can be unintended consequences. Now, in a show about carriers—in this case, Medicare Advantage carriers—I'd be pretty tone deaf not to mention the nation's ire at carriers at this exact moment in time, some of it extremely well earned and some of it reflective of an extremely dysfunctional healthcare system. I'd also be tone deaf not to mention the MedPAC (Medicare Payment Advisory Commission) report, which states that Medicare Advantage plans receive payments from CMS that are 122% of spending for similar beneficiaries in traditional Medicare. This translates to an estimated $83 billion in higher spending in 2024. And I would lastly be remiss not to mention how Medicare Advantage plans are most carriers' most profitable service lines, with average earnings of around $1800 per enrollee. All of what I said is not some kind of grand revelation, of course, to most listeners of this show. And it's also not the topic of the conversation today, although some of this did get asked and answered in the earlier shows (EP387, EP375, EP291) with Betsy Seals. One thing I will remind everyone about is that there are regional carriers that are not the big five who may or may not be doing big five types of things. And also, it is actually really difficult to run a Medicare Advantage plan successfully. They call it risk for a reason. One thing I really appreciated about the conversation with Betsy Seals that follows is her advice to contemplate value to the patient and make sure that anybody working on the carrier side, you have enough of a bead on what's actually happening to be able to identify when things are going off the rails, which does not seem to be the case in some instances. This also, by the way, having a bead on what's actually happening on the ground, helps to ensure compliance and that's piece of advice two. Last piece of advice is to learn how to be proactive and not reactive. And this is eminently more possible vis-à-vis data that's available and learning how to use it well. Betsy Seals, my guest today, has had a very busy last couple of years since she was on Relentless Health Value the last time. Betsy is CEO and co-founder of Rebellis Group, a managed care consulting firm focused specifically in Medicare Advantage. Rebellis was actually acquired in February of 2024 and joined as a family of a couple of other consulting firms that now Betsy heads up. So, in short, she's really busy. Also mentioned in this episode are Samantha George; Ann Kempski; Rebellis Group; and Vivian Ho, PhD. You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn. Betsy Seals is the CEO of Alerion Advisors, a family of companies dedicated to delivering unparalleled consulting services across the healthcare spectrum. As a parent organization, Alerion Advisors unites three specialized firms—Rebellis Group, Advent Advisory, and Toney Healthcare—to provide health plans and their partners with comprehensive, innovative, and results-driven solutions. With over 25 years of experience in the managed care industry, Betsy is a nationally recognized leader known for her regulatory expertise and strategic insights. Betsy brings to the table a solid mix of leadership and business acumen, as well as regulatory and strategic knowledge within the managed care landscape. Betsy's expertise is focused in the areas of mergers and acquisitions, compliance, sales and marketing, strategy, supplemental benefit landscape, innovative benefit design that address social determinants of health (SDoH), and health plan operations. 05:09 Will the Star Ratings program stay in this new administration? 08:08 How will the lawsuits against CMS policies play out with this new administration? 10:24 Why is it hard for Medicare Advantage plans to survive, let alone thrive? 16:22 How does AI directly impact beneficiary lives? 21:38 What's going on now with the override payments? 27:08 How is non-collaboration going to impact Medicare beneficiaries moving forward? 31:45 Why is it important to become more technologically savvy in compliance? You can learn more at rebellisgroup.com and alerionadvisors.com and by following Betsy on LinkedIn. @betsyseals discusses #medicareadvantage policies on our #healthcarepodcast. #healthcare #podcast #changemanagement #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Wendell Potter (Encore! EP384), Dr Scott Conard, Stacey Richter (INBW42), Chris Crawford, Dr Rushika Fernandopulle, Bill Sarraille, Stacey Richter (INBW41), Andreas Mang (Encore! EP419), Dr Komal Bajaj, Cynthia Fisher

ceo ai phd stars clash compliance policies medicare seals cms health systems medicare advantage managed care sdoh star ratings chris crawford risk adjustment cynthia fisher medpac vivian ho

INBW42: A Philosophical Rabbit Hole of Considerations for Plan Sponsors and Others

Play Episode Listen Later Jan 23, 2025 27:39

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)

EP459: Cost Containment by Co-Pay Maximizer or Co-Pay Accumulator: Points to Ponder, With Bill Sarraille

Play Episode Listen Later Jan 2, 2025 39:47

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

america university business law new york times patients cpa substack eliminate mph mark cuban pharma crohn allegedly aca glp cma pharmd best lawyers pbm cfm pbms patient access maximizer cgma 340b financial incentives healthcare practice chris crawford tom nash paul holmes sidley austin llp accumulator cost containment leading lawyers points to ponder cynthia fisher deceptive practices maryland francis king carey school brian reid

Encore! EP419: The Financialization of Health Benefits for Boards of Directors and C-Suites of Self-Insured Employers, With Andreas Mang

Play Episode Listen Later Dec 19, 2024 38:38

Are you on the board of directors of a company? Or are you a shareholder of a publicly traded company? Or are you a CEO or a CFO or in-house counsel who reports to a board of directors or these shareholders? Well, this show is for you. And it's about how the healthcare industry has become financialized at the same time that providing health benefits has become the second-biggest line item after payroll for most companies. We talked about that in a recent encore with Mark Cuban (EP418) also, as well as the show with Cora Opsahl (EP452) and Claire Brockbank (EP453) from 32BJ. 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. So, this encore with Andreas Mang is really timely. And even if you've listened to the show when it originally aired a year ago, you may want to take another listen, because in the context of these recent shows, this one really slots right in there. And also, by the way, the one with Julie Selesnick (EP428) from last year talking about the legal jeopardy currently in play. So, this show isn't really about health benefits; it's about the business that these health benefits have become and how, if the CEO or CFO of an employer is not intimately involved in the financial layer wrapping around health benefits, then the company is getting really taken advantage of by those entities who are intimately familiar with the financial layer surrounding those healthcare benefits. And the employees of that company also are getting equally taken advantage of. This is not a case where paying more or less results in better or worse employee health or healthcare. It is a case where not minding the shop in the C-suite means that financial actors just take more of the pie and nobody wins but them. Employer loses; employee loses. Andreas Mang, my guest today, kicks off this interview talking about the conversation that will go down between himself and any CEO whose company gets bought by Blackstone. So, if you're a CEO and you're aspiring for this to happen, yeah … heads up. But he says it's kind of an unnatural act to dig into anything that smells like health benefits or health insurance. Some may not even realize that this whole financial layer has developed that sits above the healthcare benefits themselves. And they also may not think that there's anything that's possible that can be done. As far as both of these points are concerned, Andreas Mang gives a list of, as he calls them, easy things a C-suite can do to save 10% while improving employee satisfaction and health. Saving 10% or more, this can be a really big number. A lot of this is just enforcing purchasing discipline that is being used elsewhere. Here's Andreas's list recapped: 1. Have CFO engagement throughout the year. (We talked about that with Mark Cuban also.) 2. Be self-insured once you have reached a certain size. (Andreas gets into this in more detail during the show itself.) 3. Be very, very careful who you hire as your broker or benefits consultant. There are five things that need to be true: · They have the experience to do the job. · Flat-fee model compensation · No product pushing · Fees at risk (30% or more) · Simple termination provisions 4. Do carrier/ASO/TPA RFPs once every three years or thereabouts. 5. Do dependent eligibility audits. (Cora Opsahl talked a lot about this also in an earlier episode [EP372].) 6. Leverage pharmacy coalitions and stop-loss collectives. (In the show itself, Andreas offers some warnings because some of these coalitions and collectives are great and some are not.) But bottom line, just keep in mind, as Mark Cuban said (EP418), those that are taking your money, your company's money, are advantaged when you are confused. Where there's mystery, there's margin. If you can't convince 'em, confuse 'em and all that. This is a business strategy. Healthcare should not be this complicated. But yet, it has become so; and anyone who doesn't realize that is letting themselves and their employees really get taken advantage of. Unknown unknowns are not benign. As I have said several times already, Andreas Mang is my guest today. He is a partner at Blackstone, the private equity and alternative asset manager. His job is helping portfolio companies manage their U.S. healthcare benefits for their employees. Also mentioned in this episode are Blackstone, Mark Cuban, Cora Opsahl, Claire Brockbank, Julie Selesnick, Lauren Vela, and Tom Nash. You can learn more at Blackstone and by connecting with Andreas on LinkedIn. Andreas Mang is senior managing director, portfolio operations, and chief executive officer of Equity Healthcare, where he is involved in managing medical benefits spend across the Blackstone portfolio. Andreas brings 20 years of healthcare experience to Equity Healthcare, having held various roles in healthcare finance, operations, and strategy. Prior to joining Blackstone, Andreas was the vice president responsible for national provider network operations at CareCentrix, a PE-backed, leading home health benefit-management company. At Blue Cross Blue Shield of Massachusetts, he held a variety of roles, including a leadership role identifying and implementing administrative cost savings opportunities throughout the organization and ultimately designing a new corporate business model. In addition, he held roles as the manager of strategic financial planning at Harvard Pilgrim Health Care and was a senior consultant with Deloitte Consulting's Strategy and Operations group in Boston. Andreas has a bachelor's degree in healthcare management and policy from the University of New Hampshire and an MBA from the University of Rochester's Simon School of Business Administration. He currently serves on the board of DECA Dental. 04:55 Why Andreas starts every conversation with the question, “How's your healthcare company?” 07:38 Why is it important, as a self-insured employer, to treat your business as a small healthcare company? 09:16 Why is it unnatural for companies to be providing health insurance? 10:47 What can be achieved when there is alignment between employers and insurers? 12:41 What things can a company do to reduce spend by 10%? 14:14 Why is it better to have CFO engagement in the benefits plan throughout the year? 16:25 Why does self-insurance save 5% to 9% for companies automatically? 18:14 “The funding isn't a healthcare thing; it's a CFO thing.” 18:27 Why is it vital to have a reliable, trustworthy broker? 25:12 When is the last time your company has RFP'd their health plan? 27:39 Why does changing a health plan feel scary but is necessary? 28:31 What is a dependent eligibility audit? 31:20 Why are employers better together? 34:34 How do employers truly get a flat-fee model with brokers? You can learn more at Blackstone and by connecting with Andreas on LinkedIn. Andreas Mang of @blackstone discusses the financialization of #healthcarebenefits in our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! 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, Claire Brockbank, Cora Opsahl

EP457: It's a Big Thing: Medical Spread Pricing. So, Let's Talk About Contract Transparency, With Cynthia Fisher

Play Episode Listen Later Dec 5, 2024 34:15

I'm putting a meme in the show notes. It's my second meme ever, so I'm clearly on a roll. As you can see, it's a picture of two kids taking a test; and the one kid is cheating off the other kid. It's a How to Do Spread Pricing test, and the kid with carrier has his eyes all over the PBM kid's test. 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. Look, this is a thing now, medical spread. And similar to how PBM spreads adds up to millions, billions of dollars, medical spread is not change in the couch cushions. Did you see the lawsuit against Cigna? Cynthia Fisher mentions it in the conversation that follows. Spoiler alert, here's the numbers: Self-insured employer paid $4 million for a claim. In this case, there's a slide on this Cynthia Fisher gave me, by the way, if you want to see all this written out. So, the employer pays $4 million. The provider was paid—drumroll, please—$876,000. I'm pausing so that sinks in: $4 million paid by the employer; $876,000 of that makes it across the trench to the provider. What happened, you may be wondering, to the $3.2 million in the middle there that the self-insured employer wrote a check to their carrier for? If I'm the employer, I think I would sort of want to know where the $3.2 million went, because … yeah. I think anyone would be hard-pressed to explain how a prudent fiduciary is managing to pay millions of dollars of its plan members' money for services that actually cost a fraction of that. And this is just one claim. But you came here for a show about transparency. Why, you may be wondering, am I talking about medical spread pricing? It's not a super far leap, so many of you are probably there already; but let me quote Chris Deacon. She wrote, “As these conglomerates expand control over healthcare delivery and administration, radical transparency is our only bulwark. Patients and employers deserve to know exactly what they're paying for, without hidden fees disguised as care costs.” I don't think anyone would say that transparency alone is sufficient to transform healthcare, but it's definitely a start for sure. So, yeah … transparency. The reason why lawsuits about overpayments, big ones—and there's a bunch of them afoot right now, not just that Cigna one—but the reason that these are going down in the first place is because hospital prices and carrier prices are now somewhat available. And we have some plan sponsors—the ones who are worried about fiduciary duty, at least—these plan sponsors are able to cobble together the math to catch a glimpse of how much money is vanishing. Dollars they and their members are paying for medical claims that never make it to the care team providing the care. And who is shocked? Are you shocked? I'm not shocked. Let me read a sentence from a carrier contract that Justin Leader sent me the other day. Section 6.3: “Claim administrator's compensation for its services under the agreement shall include the difference between the net claim payments reimbursed to the claim administrator by the employer and the net amounts paid to providers by the claim administrator.” Translation: We are allowed to add spread pricing. We are able to arbitrage. We are able to mark up (or whatever you want to call it) by any amount we want, and you, plan sponsor, just signed up to pay for it. So, that happened. Listen to episode 433 with Justin Leader, by the way. The show is called “The Mystery of the Weekly Claims Wire,” otherwise known as the Not Transparent Weekly Claims Wire. So, look … transparency: We can talk about it in terms of medical prices. We can talk about transparency in terms of contracts. And actually also in terms of quality, but we don't get into that today. Bottom line, plan sponsors need enough access to billing data and hospital prices to calculate how much the middle folks are taking in spread, which is, as aforementioned, quite a thing. For more actual data on the magnitude of spread pricing goings-on, ask Dan Ross. That's my suggestion. He's got spreadsheets he can show you of how much plan sponsors are paying and how much providers are charging and how much is going missing in the middle. For even more on this, read the recent Owens & Minor lawsuit that just got filed, which is just a case study in how hard some of these middlemen/carrier entities are working to obscure and hide what they are doing. Because, yeah, sunshine is a great disinfectant, and that's what transparency is. Sunshine. Here's another interesting link from Chris Deacon. I say all this to say, this is the kind of transparency that Cynthia Fisher and I talk about in the show today: contract transparency, bill charges transparency, and hospital or medical price transparency for plan sponsors. We do not get into today consumers or patients using price information to shop, just FYI. We also do not get into, really, price convergence, which is what happens when hospital and carrier prices become available in a market and is often brought up on or about conversations about transparency. Okay, I will say just one thing about price convergence. There was some chatter in anti-transparency press releases from parties mostly that didn't want to be transparent at all, no way no how. But there was some talk a couple of years ago that if contracted prices became transparent, the healthcare industry would raise their prices to match the highest in the market and the result would be rising healthcare prices and greater total costs. That turns out, it seems, to be false. There's a study that shows that the bottom of the market (those with the cheapest prices) do, in fact, raise their prices but not as much as the top of the market lowers theirs. So, there is actually net savings. Read about the Turquoise Health study and an article that Forrest Xiao and team posted that shows this, and it's the first study of its kind, at least that I have seen. Okay, so contract transparency, data transparency, that's what's on deck to discuss today with Cynthia Fisher, as I have mentioned several times already, who has a long history as an entrepreneur in the healthcare space. So, Cynthia Fisher gets U.S. healthcare, and she gets being a plan sponsor and a fiduciary. She is founder and chairman of PatientRightsAdvocate.org, as well as Power to the Patients. Her focus is on ensuring that all healthcare shows prices up front so that we can have accountability and integrity in billing and at any point of care. Cynthia has said early and often that transparency protects the ultimate purchasers of healthcare—meaning plan sponsors, plan members, and patients—from overcharges, spread pricing, or otherwise. Where there's mystery, there is margin, as Anthony Ciaccia has said often. Cynthia's call to action is as follows, but listen to the show to hear her say it more eloquently. C-suites, CFOs, in-house counsel use purchasing discipline that your company probably uses elsewhere in the procurement of health benefits. Cynthia Fisher also says as part of the call to action, refuse to sign blank checks to the healthcare industry and refuse anti-audit provisions. She also has a call to action for the accounting industry to stop ignoring auditing the health plans. And this matters just given the bald-faced fact right now that overcharges are party sized. Let me wrap up with this: There's a lot of brute force tactics out there being deployed by some plan sponsors that effectively keep plan members from getting the care they need because they are functionally uninsured. I've done multiple shows on this, and I link to some of them below. I just can't help to think, some of this brute force, you know, high-deductible health plans and some pretty savage cost containment strategies, might be unnecessary if middleman excess profits were eliminated. Well, I say this with some evidence, actually. Andreas Mang (EP419) was on the pod. He talked about saving 15% or more by being smart about contracts and plan assets at the financial and purchasing level. Brian Uhlig … was talking to him the other day. He was telling me he saved $80 million just doing contracts right. Also Claire Brockbank (EP453) talks about this; Cora Opsahl (EP452), too, from 32BJ. Those are two recent shows, again, about how much money can be saved by only signing contracts that ensure transparency. Also mentioned in this episode are Patient Rights Advocate, Chris Deacon, Justin Leader, Dan Ross, Forrest Xiao, Anthony Ciaccia, Andreas Mang, Brian Uhlig, Claire Brockbank, Cora Opsahl, Mark Cuban, and Mark Cuban Cost Plus Drug Company. You can learn more at PatientRightsAdvocate.org. Cynthia A. Fisher is founder and chairman of PatientRightsAdvocate.org, a nonprofit organization seeking healthcare price transparency, giving power to American consumers—patients, employers, and unions—to lower their costs of care and coverage through a functional marketplace and choice. Cynthia is best known for her pioneering work as founder and CEO of ViaCord, Inc., a leading price-transparent umbilical cord blood stem cell banking company which she started in 1993. In 2000, she co-founded and was president of the cellular medicines company ViaCell, Inc., of which ViaCord became a division. ViaCell went public in 2005, was acquired by PerkinElmer, and exists today under the ViaCord brand. Cynthia also serves on the public company boards of the Boston Beer Company, Inc. and Easterly Government Properties, Inc. She serves on the Florida Council of 100 and the board of the National Park Foundation, and she previously served on the board of directors of Water.org. Cynthia holds an MBA from Harvard Business School and a bachelor's and honorary Doctorate of Science degree from Ursinus College. 09:03 What is the goal of PatientRightsAdvocate.org? 10:28 Is American competitiveness being affected by healthcare spend? 13:47 Why is transparency a root cause to healthcare costs? 15:11 What's going on across the country to empower transparency in healthcare? 19:31 “I think people are fed up.” 21:22 The Cigna lawsuit in California. 26:36 How do employers navigate contracts against anti-steering? 28:54 EP419 with Andreas Mang. 29:33 EP452 with Cora Opsahl and EP453 with Claire Brockbank. 29:45 EP433 with Justin Leader. You can learn more at PatientRightsAdvocate.org. Cynthia A. Fisher of @PtRightsAdvoc discusses #medicalspreadpricing and #contracttransparency on our #healthcarepodcast. #healthcare #podcast #pharma #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW40), Mark Cuban and Ferrin Williams (Encore! EP418), Rob Andrews (Encore! EP415), Brian Reid, Dr Beau Raymond, Brendan Keeler, Claire Brockbank, Cora Opsahl, Dan Nardi, Dr Spencer Dorn (EP451)

EP452: Fiduciary Duty vs the Healthcare Status Quo, With Cora Opsahl

The Ricochet Audio Network Superfeed

Play Episode Listen Later Oct 10, 2024 39:48

Last time Cora Opsahl was on the show, Michelle Bernabe, RN, KAT, wrote a comment on LinkedIn I thought encapsulated the gist of it all so well. She wrote, “[Cora] first became a mentor/ally through Relentless Health Value episode 372. … It opened a doorway to a whole group of very relentless people.” 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. I want to start there because it's a nice comment, but it's also a call to action. Think about this and think about it not in the context of being a “stakeholder” and not in the context of being an organization but in the context of humans who work at these various organizations who, combined, comprise the bucket of companies that we lumped together using the old stakeholder word. All of these individuals are making choices every day, and all of these choices, they could be made with integrity and with the patient or member in mind … or not. In real life, right now, the overwhelming majority of members/patients in this country get their clinical care and the pleasure of paying for that care or drugs within the current ecosystem we have here in the USA. For any of us, or all of us who work within that traditional ecosystem, it is up to us to choose our own legacy here. It's probably why you listen to this show in the first place, actually. There are so many RHV (Relentless Health Value) listeners who are pushing for patients against the riptide that is the profit motives of the organization that they work for. It's hard. But yeah, it's all about finding our people and supporting each other. Okay, so let's get to the “between a rock and a hard place” portion of this discussion. Hospitals and ASOs (administrative services organizations)/carriers/TPAs (third-party administrators) often enter into or sometimes enter into what amounts to anticompetitive contracts with each other. Listen to episode 395 with Brennan Bilberry for the rundown on that one. But meanwhile, the CAA, the Consolidated Appropriations Act from 2021, holds employer plan sponsors accountable and responsible to ensure that plan assets are spent prudently, that costs paid are reasonable, and that there's no conflict of interest (COI). This is the definition of what a fiduciary is supposed to do, by the way—prudent, reasonable, and no COI. Anticompetitive contracts between a carrier and a hospital are the very definition of COI. And when that COI results in higher, maybe unreasonable, prices and non-prudent spend, well, plan sponsors are put between a rock and a hard place if they stick with their existing vendors. Rosa Novo from Miami-Dade County Public Schools put this really succinctly on a panel at a 32BJ event recently. She said what amounts to, I have no choice but to actually do the right thing here, for many reasons, but one of them is I do not look good in orange. She said, my personal butt is on the line here. And furthermore, who do class action lawsuits make look bad when their company or CEO or CFO are personally sued over conflicted benefits? See the Wells Fargo lawsuit, J&J lawsuit, etc. It sucks that employers or plan sponsors get put into this pickle by their own vendors. And that's what we're talking about today. This is a conversation that starts out talking about rates (ie, prices), edges into rights (ie, plan sponsor rights), and ends up all about power. And by the way, if you're a plan sponsor, especially in New York City, maybe doing the right thing here means hatching a plan to steer and tier in your benefit design, figuring out how to, for reals, help support the efforts of 32BJ to advantage pretty much every patient near and far. The pushback I often hear to doing something like this often involves the perception that plan members are too rich to care about reasonable prices, prudent plan spending, and COI. And yeah, to state the obvious, these same people are also sophisticated enough to smell a fine opportunity for a class action lawsuit; and also, they probably do care, as more and more studies suggest. Sorry if I just stumbled onto a sacred cow. Cora Opsahl, my guest today, is the director of the 32BJ Health Fund, serving over 200,000 folks. Their ability to kick NewYork-Presbyterian, a big, consolidated, very expensive hospital, out of their network in 2018 enabled them to offer maternity benefits for $40 in total out-of-pocket for members. And also, employees got their biggest raise ever; employers got a premium holiday and a 3% rate increase for a bunch of years after that; and yeah … this is where we start the conversation today. And yeah, it's a freakin' tangled web we weave; and this tale is a perfect case study of it. It makes me even more invested in remembering my own manifesto (that was episode 400) to ensure that I can feel good about what I personally have accomplished and what I have been a part of and the net impact of my own personal actions, since I, too, very often work in the belly of the beast. Furthermore, you will find links to a template health savings calculator for plan sponsors and also a template contract (again for plan sponsors) that 32BJ has made available. More on that in the show that follows. Also mentioned in this episode are 32BJ Benefit Funds; Michelle Bernabe, RN, KAT; Brennan Bilberry; Rosa Novo; Marilyn Bartlett; Cynthia Fisher; Zack Cooper, PhD; Claire Brockbank; Andreas Mang; Chris Deacon; Elizabeth Mitchell; and Purchaser Business Group on Health. You can learn more at health.32bjfunds.org and by following Cora on LinkedIn. Cora Opsahl is the director of the 32BJ Health Fund, a self-insured Taft-Hartley benefit fund that sets comprehensive design parameters to ensure the 200,000 members and families of Service Employees International Union 32BJ have easy and sustained access to affordable, high-quality healthcare. Since becoming director of the Health Fund in 2021, Cora has prioritized a data-driven approach to healthcare, focusing on reducing trend; solving the affordability challenge on behalf of union members; and most important, keeping members at the center of every decision. Under her leadership, the 32BJ Health Fund has saved more than $35 million annually—which it has reinvested in new and better benefits, including the first fertility benefit for members—by removing NewYork-Presbyterian hospitals and physicians from its network, transitioning to a new pharmacy vendor and pharmacy group purchasing coalition, and establishing an expanded Centers of Excellence program. Most recently, Cora conducted an innovative medical request for proposal (RFP), stipulating that all finalists must have a signature-ready contract drafted by the Health Fund prior to award. By including the Health Fund–drafted contract in the RFP process, the Fund was able to negotiate an agreement that brought unprecedented visibility and increased accountability to the 32BJ Health Fund benefit. Cora is regarded as an expert in pharmacy benefit management and previously worked at Express Scripts, where she held a variety of roles, ranging from Medicare Part D to operations to strategy and acquisitions. She earned an MBA from Saint Louis University. 06:16 Why is it imperative for employers to do something differently when it comes to being plan sponsors? 09:22 How analyzing claims data allowed 32BJ Health Fund to reshape their benefit design. 12:09 What anticompetitive rights did 32BJ run into that limited 32BJ Health Fund from managing their benefit design? 14:12 How do these anticompetitive rights have quality implications as well as cost implications? 18:43 How did 32BJ Health Fund remove NewYork-Presbyterian from their network, and how much did it save 32BJ Health Fund per year? 19:46 What did the healthcare savings allow the unions and employers to do? 20:46 Study by Zack Cooper, PhD. 21:26 Why rising healthcare costs has pushed 32BJ Health Fund to move beyond benefit design to manage healthcare spend. 24:15 Why 32BJ Health Fund wants to control the contracting process. 26:00 EP419 with Andreas Mang. 27:18 What are 32BJ Health Fund's four non-negotiables? 33:17 Wall Street Journal article on health insurance contract. 35:30 Upcoming episode with Claire Brockbank. 36:14 What is the challenge that exists in our current healthcare environment? 37:43 Cora's advice on how to get high-quality healthcare at an affordable price. You can learn more at health.32bjfunds.org and by following Cora on LinkedIn. @CoraOpsahl discusses #fiduciaryresponsibility in #healthcare on our #healthcarepodcast. #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Dan Nardi, Dr Spencer Dorn (EP451), Marilyn Bartlett, Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn (EP446)

Hub Wonk: Posting Patient Prices: Transparency Cure for Hospital Blank Checks (#196)

Play Episode Listen Later Apr 9, 2024

Joe Selvaggi interviews entrepreneur, philanthropist, and founder of PatientRightsAdvocate.org, Cynthia Fisher, discussing her research and advocacy for enhanced healthcare price transparency. This initiative has the potential to improve life expectancy and save Americans over a trillion dollars annually. Guest: Cynthia A. Fisher is Founder and Chairman of PatientRightsAdvocate.org, a nonprofit organization seeking healthcare price transparency, giving […]

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Episode 196: Posting Patient Prices: Transparency Cure for Hospital Blank Checks

The HubWonk

Play Episode Listen Later Apr 9, 2024 45:56

Joe Selvaggi interviews entrepreneur, philanthropist, and founder of PatientRightsAdvocate.org, Cynthia Fisher, discussing her research and advocacy for enhanced healthcare price transparency. This initiative has the potential to improve life expectancy and save Americans over a trillion dollars annually.

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Multiple GA hospitals accused of not complying with Price Transparency Rule

Closer Look with Rose Scott

Play Episode Listen Later Mar 26, 2024 51:11

Since 2021, the Hospital Price Transparency Rule has required hospitals to make their pricing information publicly available. This allows patients to shop around for the best price for their medical services. On today's edition of "Closer Look with Rose Scott," we hear from an advocacy group that claims that of the 2000 hospitals that were reviewed nationwide, 36 hospitals in Georgia are reportedly not sharing their pricing information. We also hear a rebuttal from an association that claims hospitals in Georgia are compliant with the rule and calls the Patients Rights Advocate report “irresponsible.” Guests include: Cynthia Fisher, the founder and chairwoman of Patients Rights Advocate Brad Dennison, the director of Healthcare Finance Policy at the Healthcare Financial Management Association Shawn Stack, the director of Editorial and Policy Affairs at the Healthcare Financial Management AssociationSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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Improving health care and the patient experience in America

Washington Post Live

Play Episode Listen Later Nov 1, 2023 85:22

Washington Post deputy newsletter editor Paige Winfield Cunningham and senior writer Frances Stead Sellers moderate a series of conversation with Sen. Bill Cassidy (R-La.), USAID assistant administrator for global health Atul Gawande and CEO of ConcertoCare Julian Harris, as well as executive vice president of health care at Arnold Ventures Mark E. Miller and founder of PatientRightsAdvocate.org Cynthia Fisher about ways to improve the health-care system, enhance patient care and rein in costs. Conversations recorded on Wednesday, Nov. 1, 2023.

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06-02-23 Interview - Another Hospital Price Transparency Bill is Being Signed Today

Mandy Connell

Play Episode Listen Later Jun 2, 2023 10:17

ANOTHER HOSPITAL PRICE TRANSPARENCY BILL IS BEING SIGNED TODAY You may not know that Colorado passed a bill preventing hospitals from dinging your credit or using the Colorado court system to collect if they aren't fully compliant with the Trump hospital transparency rules. Now they are going one step further and fining hospitals who don't make their pricing available in an easily searchable and downloadable format. I've got PatientsRightsAdvocate.org founder/chairman Cynthia Fisher on to discuss what this really means at 12:35.

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2-10-23 INTERVIEW Cynthia Fisher Hospitals Complying With Laws Regarding Price Transparency

hospitals laws complying price transparency cynthia fisher

Play Episode Listen Later Feb 10, 2023 17:29

02-09-23_THURSDAY_6AM

Bill Meyer Show Podcast

Play Episode Listen Later Feb 9, 2023 52:10

News Headlines of the morning and then a great talk with Cynthia Fisher of Patient Rights Advocates - new report detailing how most hospitals, including Rogue Valley hospitals, are not follow the law requiring you to easily find their prices.

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PatientRightsAdvocate.org's Cynthia Fisher

Louie b. Free's podcast

Play Episode Listen Later Oct 5, 2022 52:49

PatientRightsAdvocate.org 's Cynthia Fisher /Founder & ChairmanPatientRightsAdvocate.org is a 501(c)(3) nonprofit, nonpartisan organization focused on ushering in systemwide healthcare price transparency. Through advocacy, testimony, media, legal research, and grassroots campaigns, our organization seeks actual, upfront healthcare prices that will greatly lower costs through a functional, competitive healthcare marketplace. Cynthia talks about their Semi-Annual Hospital Price Transparency Compliance Report

healthcare hospitals healthcare system cynthia fisher

Cynthia Fisher interview 9/25/22

John Whitmer Show

Play Episode Listen Later Sep 26, 2022 15:01

John visits with Founder of PatientRights.org Cynthia Fisher about a new federal law requiring hospitals to post medical prices online.

founders cynthia fisher

9-06-22 INTERVIEW Founder of Patient Rights Advocate Cynthia Fisher discusses hospital price transparency

founders hospitals patients advocates rights price transparency cynthia fisher

Play Episode Listen Later Sep 6, 2022 11:29

The Kent Teacher Strike

Seattle's Morning News with Dave Ross

Play Episode Listen Later Aug 25, 2022 32:01

Chris Sullivan's Chokepoint -- weekend 520 closure // Colleen O'Brien on the Kent teacher strike // Dose of Kindness -- help teacher get citizenship > teacher specializes in kindess // Gee Scott on dual language learning // Cynthia Fisher, Patient Rights Advocate, on publishing prices of medical procedures // Rachel Belle on Japan's revenue problem/ leaving notes in library booksSee omnystudio.com/listener for privacy information.

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Episode 12: Pioneering Tech & Transparency

Life After Ursinus

Play Episode Listen Later Jun 27, 2022 37:07

In Episode 12 of the Life After Ursinus podcast, host Johnny Myers '19 sits down with Cynthia Fisher '83, life sciences entrepreneur, independent investor, and corporate board director. She is the founder and CEO of ViaCord, Inc., a leading umbilical cord blood stem cell banking service which she started in 1993. In 2000, she co-founded and was president of the cellular medicines company, ViaCell, Inc. (VIAC). Cynthia also is the founder and chairman of PatientRightsAdvocate.org, a nonprofit, nonpartisan organization focused on ushering in systemwide healthcare price transparency. In this episode, Cynthia discusses her journey from Ursinus to her career in changing lives. · Cynthia dives into her journey founding her company, ViaCord. · Cynthia explains how her Ursinus education and fellow classmates and professors helped her achieve her goals and how she uses the lessons she learned at Ursinus with her employees. · Cynthia provides tips and advice for the adventure of business and entrepreneurship. · Cynthia talks about the difference advising on the boards of both for-profits and non-profits. · Cynthia explains her work in founding Patient Rights Advocate.org, an organization that focuses on advocating for transparent hospital pricing. Music by Kevin MacLeod (incompetech.com) "Inspired" Licensed under Creative Commons: By Attribution 4.0 License http://creativecommons.org/licenses/by/4.0/

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Only 14% Of Hospitals Comply With Price Transparency Rule

The Brian Mudd Podcast on WIOD

Play Episode Listen Later Feb 14, 2022 6:21

Cynthia Fisher, Founder and CEO of PRA talks to Brian about Florida Hospitals being included in a new report that shows just 14% of hospitals are complying with Price Transparency Rule.

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S3Ep6: Future of Healthcare & Telehealth in a Post Pandemic, Work From Home World with Dr. Cynthia Fisher

The Work From Home Show

Play Episode Listen Later Feb 12, 2022 63:08

For decades now patients have been kept in the dark about what their healthcare is actually going to cost them. Rates are shrouded in secrecy and piercing it has been a long, arduous road. There's now a fight going on that is poised to create a system that will give patients power, bolstered by the pandemic and rise of telehealth visits the pandemic forced on us. Adam and Naresh talk about this movement with Dr. Cynthia Fisher, Founder & Chairman of Patients Rights Advocate (PRA); Founder & former CEO of ViaCord, a leading umbilical cord blood stem cell banking service, as well as the Co-founder & former President of the cellular medicines company ViaCell. Website: www.PatientsRightsAdvocate.org www.viacord.com www.Patreon.com/WorkFromHomeShow www.WorkFromHomeShow.com

ceo founders president healthcare rates work from home post pandemic telehealth founder chairman naresh cynthia fisher workfromhomeshow

Cynthia Fisher

Play Episode Listen Later Jan 26, 2022 0:30

Kathryn interviews Author Dr. Bradley Nelson. Modern science increasingly verifies a truth that runs through ancient healing systems: The mind and body are inextricably connected, with our thoughts and emotions exerting a powerful influence on our health. Probing the frontiers of our ability to resolve emotional wounds from the past, Dr. Bradley Nelson is one of the world's foremost experts on natural methods of achieving wellness. Over decades of work as a holistic chiropractic physician, he has discerned that most of the physical discomfort and emotional distress his patients suffered was rooted in trapped emotions—the unseen emotional baggage we carry from hurtful life experiences.Through his studies of ancient medical practices and modern quantum physics, Dr. Brad developed The Emotion Code®, a simple yet effective method anyone can learn to release the trapped emotions that block us from wellness.Kathryn also interviews Founder of PatientRightsAdvocate.org Cynthia Fisher. In the midst of this global recovery effort from the COVID19 Pandemic, PatientRightsAdvocate.org (PRA) is a nonprofit, non-partisan organization that provides a voice for consumers—patients, employees, employers, and taxpayers—to have transparency in healthcare. PRA advocates for patients to have easy, real-time access to complete health information and real price transparency. Price transparency will usher in price, quality, and outcomes differentiation and allow for competition and innovation. Founder Cynthia Fisher shares with us the effects of price transparency in healthcare and why hospitals need to drop their lawsuits and stop using taxpayer money to sue our government. Cynthia has an MBA from Harvard Business School and is best known for her pioneering work as Founder and CEO of ViaCord, Inc. She has been featured in The Washington Post, The New York Post, The Morning Consult, Medical Economics, and The Well News.

covid-19 ceo founders price modern mba washington post harvard business school pra new york post holistic health author dr probing emotion code bradley nelson morning consult internet talk radio cynthia fisher drbradleynelson cynth

Dr. Bradley Nelson

Play Episode Listen Later Jan 26, 2022 0:30

Kathryn interviews Author Dr. Bradley Nelson. Modern science increasingly verifies a truth that runs through ancient healing systems: The mind and body are inextricably connected, with our thoughts and emotions exerting a powerful influence on our health. Probing the frontiers of our ability to resolve emotional wounds from the past, Dr. Bradley Nelson is one of the world's foremost experts on natural methods of achieving wellness. Over decades of work as a holistic chiropractic physician, he has discerned that most of the physical discomfort and emotional distress his patients suffered was rooted in trapped emotions—the unseen emotional baggage we carry from hurtful life experiences.Through his studies of ancient medical practices and modern quantum physics, Dr. Brad developed The Emotion Code®, a simple yet effective method anyone can learn to release the trapped emotions that block us from wellness.Kathryn also interviews Founder of PatientRightsAdvocate.org Cynthia Fisher. In the midst of this global recovery effort from the COVID19 Pandemic, PatientRightsAdvocate.org (PRA) is a nonprofit, non-partisan organization that provides a voice for consumers—patients, employees, employers, and taxpayers—to have transparency in healthcare. PRA advocates for patients to have easy, real-time access to complete health information and real price transparency. Price transparency will usher in price, quality, and outcomes differentiation and allow for competition and innovation. Founder Cynthia Fisher shares with us the effects of price transparency in healthcare and why hospitals need to drop their lawsuits and stop using taxpayer money to sue our government. Cynthia has an MBA from Harvard Business School and is best known for her pioneering work as Founder and CEO of ViaCord, Inc. She has been featured in The Washington Post, The New York Post, The Morning Consult, Medical Economics, and The Well News.

covid-19 ceo founders price modern mba washington post harvard business school pra new york post holistic health author dr probing emotion code bradley nelson morning consult internet talk radio cynthia fisher drbradleynelson cynth

Cynthia Fisher

Play Episode Listen Later Jan 26, 2022 0:30

Kathryn interviews Author Dr. Bradley Nelson. Modern science increasingly verifies a truth that runs through ancient healing systems: The mind and body are inextricably connected, with our thoughts and emotions exerting a powerful influence on our health. Probing the frontiers of our ability to resolve emotional wounds from the past, Dr. Bradley Nelson is one of the world's foremost experts on natural methods of achieving wellness. Over decades of work as a holistic chiropractic physician, he has discerned that most of the physical discomfort and emotional distress his patients suffered was rooted in trapped emotions—the unseen emotional baggage we carry from hurtful life experiences.Through his studies of ancient medical practices and modern quantum physics, Dr. Brad developed The Emotion Code®, a simple yet effective method anyone can learn to release the trapped emotions that block us from wellness.Kathryn also interviews Founder of PatientRightsAdvocate.org Cynthia Fisher. In the midst of this global recovery effort from the COVID19 Pandemic, PatientRightsAdvocate.org (PRA) is a nonprofit, non-partisan organization that provides a voice for consumers—patients, employees, employers, and taxpayers—to have transparency in healthcare. PRA advocates for patients to have easy, real-time access to complete health information and real price transparency. Price transparency will usher in price, quality, and outcomes differentiation and allow for competition and innovation. Founder Cynthia Fisher shares with us the effects of price transparency in healthcare and why hospitals need to drop their lawsuits and stop using taxpayer money to sue our government. Cynthia has an MBA from Harvard Business School and is best known for her pioneering work as Founder and CEO of ViaCord, Inc. She has been featured in The Washington Post, The New York Post, The Morning Consult, Medical Economics, and The Well News.

covid-19 ceo founders price modern mba washington post harvard business school pra new york post holistic health author dr probing emotion code bradley nelson morning consult internet talk radio cynthia fisher drbradleynelson cynth

Dr. Bradley Nelson

Corporate Crime Reporter Morning Minute

Play Episode Listen Later Jan 26, 2022 0:30

Kathryn interviews Author Dr. Bradley Nelson. Modern science increasingly verifies a truth that runs through ancient healing systems: The mind and body are inextricably connected, with our thoughts and emotions exerting a powerful influence on our health. Probing the frontiers of our ability to resolve emotional wounds from the past, Dr. Bradley Nelson is one of the world's foremost experts on natural methods of achieving wellness. Over decades of work as a holistic chiropractic physician, he has discerned that most of the physical discomfort and emotional distress his patients suffered was rooted in trapped emotions—the unseen emotional baggage we carry from hurtful life experiences.Through his studies of ancient medical practices and modern quantum physics, Dr. Brad developed The Emotion Code®, a simple yet effective method anyone can learn to release the trapped emotions that block us from wellness.Kathryn also interviews Founder of PatientRightsAdvocate.org Cynthia Fisher. In the midst of this global recovery effort from the COVID19 Pandemic, PatientRightsAdvocate.org (PRA) is a nonprofit, non-partisan organization that provides a voice for consumers—patients, employees, employers, and taxpayers—to have transparency in healthcare. PRA advocates for patients to have easy, real-time access to complete health information and real price transparency. Price transparency will usher in price, quality, and outcomes differentiation and allow for competition and innovation. Founder Cynthia Fisher shares with us the effects of price transparency in healthcare and why hospitals need to drop their lawsuits and stop using taxpayer money to sue our government. Cynthia has an MBA from Harvard Business School and is best known for her pioneering work as Founder and CEO of ViaCord, Inc. She has been featured in The Washington Post, The New York Post, The Morning Consult, Medical Economics, and The Well News.

covid-19 ceo founders price modern mba washington post harvard business school pra new york post holistic health author dr probing emotion code bradley nelson morning consult internet talk radio cynthia fisher drbradleynelson cynth

Thursday December 9, 2021 Cynthia Fisher on Hospital and Insurance Company Price Gouging

Play Episode Listen Later Dec 7, 2021 1:00

Thursday December 9, 2021 Cynthia Fisher on Hospital and Insurance Company Price Gouging

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07 28 21 Cynthia Fisher Dr Matthew Spalding

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Play Episode Listen Later Jul 28, 2021 135:54

7/9/21 Cynthia Fisher on Health Care Costs

WGTD's The Morning Show with Greg Berg

Play Episode Listen Later Jul 9, 2021 45:32

Cynthia Fisher, founder of Patients Right Advocate, a non-profit that seeks greater transparency in the health care industry.

healthcare costs cynthia fisher

04 21 21 George Brauchler Cynthia Fisher Rob Smith Bruce Baker

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Play Episode Listen Later Apr 21, 2021 126:49

Jim Bohannon 04-06-21

Jim Bohannon

Play Episode Listen Later Apr 7, 2021 118:08

Guests: Noah Weinrich, Press Secretary at Heritage Action for America, On to discuss facts vs. myths regarding the Georgia Election Law. Cynthia Fisher, Founder of Patient Rights Advocate, On to discuss lack of transparency in hospital pricing. And ... Your thoughts on the latest in the news. See omnystudio.com/listener for privacy information.

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Special Guests Discuss Transparency in Healthcare

Healthcare Happy Hour

Play Episode Listen Later Apr 2, 2021

“Transparency” is the word on this week's episode of the Healthcare Happy Hour, as we are joined by special guest Cynthia Fisher, founder and chairman of Patient Rights Advocate, a nonprofit organization focused on transparency in healthcare. In addition to Cynthia, we are also joined by NAHU Legislative Council Vice Chair and staunch transparency advocate Mark Gaunya. The two have a conversation about recent hospital price transparency rules, how transparency can lower healthcare costs and more.

healthcare transparency special guests cynthia fisher

Special Guests Discuss Transparency in Healthcare

Healthcare Happy Hour

Play Episode Listen Later Apr 2, 2021

“Transparency” is the word on this week's episode of the Healthcare Happy Hour, as we are joined by special guest Cynthia Fisher, founder and chairman of Patient Rights Advocate, a nonprofit organization focused on transparency in healthcare. In addition to Cynthia, we are also joined by NAHU Legislative Council Vice Chair and staunch transparency advocate Mark Gaunya. The two have a conversation about recent hospital price transparency rules, how transparency can lower healthcare costs and more.

healthcare transparency special guests cynthia fisher

Special Guests Discuss Transparency in Healthcare

Healthcare Happy Hour

Play Episode Listen Later Apr 2, 2021

“Transparency” is the word on this week’s episode of the Healthcare Happy Hour, as we are joined by special guest Cynthia Fisher, founder and chairman of Patient Rights Advocate, a nonprofit organization focused on transparency in healthcare. In addition to Cynthia, we are also joined by NAHU Legislative Council Vice Chair and staunch transparency advocate Mark Gaunya. The two have a conversation about recent hospital price transparency rules, how transparency can lower healthcare costs and more.

healthcare transparency special guests cynthia fisher

02-26-21 with Guests Cynthia Fisher & Brain Blase - New Rules in Hospital Price Transparency

Health Matters Sonoma

Play Episode Listen Later Feb 26, 2021 50:58

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit healthmatters.substack.com

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Future of Digital Currency David Treat, Patient Rights Cynthia Fisher and Julio Gonzalez Founder of

School for Startups Radio

Play Episode Listen Later Feb 4, 2021

February 3, 2021 Future of Digital Currency David Treat, Patient Rights Cynthia Fisher and Julio Gonzalez Founder of Gonzalez Family Office

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Cynthia Fisher

Success Made to Last

Play Episode Listen Later Jan 5, 2021 8:49

Founder of PatientRightsAdvocate.org unveils price transparency to Americans providing wide open pricing on all surgeries and procedures that debuts January 1, 2021

founders americans cynthia fisher

12-17-20_THURSDAY_6AM

Bill Meyer Show Podcast

Play Episode Listen Later Dec 18, 2020 46:18

Open phones start, Cynthia Fisher from PatientRightsAdvocate.org - New rule, hospitals have to tell you how much your procedure will cost.

open cynthia fisher

Cynthia Fisher, St. Louis Murders & Restraunts with COVID

Overnight America

Play Episode Listen Later Dec 15, 2020 37:31

Ryan Wrecker talks with Cynthia Fisher, Chairman of PRA (Patients Rights Advocate) about what to expect in terms of cost once the COVID vaccine is availble and how medial costs are handled. Then, Ryan discusses the race between the number of murders and the number of COVID deaths in the city of St. Louis. Finally, an Illinois mayor apologizes to his community for going out to eat in St. Louis while having his community on lockdown. See omnystudio.com/listener for privacy information.

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Success Made to Last with Patient Right Advocate Cynthia Fisher.

Success Made to Last

Play Episode Listen Later Dec 4, 2020 8:49

Success Made to Last with Cynthia Fisher. Her Platform: Patientrightsadvocate.org Guest Phone Numbers: 617-694-2333. Office (617-467-4801) home office (617-964-7003) Guest Email: cfisher@biomed2020.com Author Website: Patientrightsadvocate.org Guest Social Media: FaceBook | TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/success-made-to-last-legends--4302039/support.

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Cynthia Fisher 112420

Alabama's Morning News with JT

Play Episode Listen Later Nov 24, 2020 5:43

Cynthia Fisher with PatientRightsAdvocate.org:COVID19 Testing and Treatment Billing Abuses and A Healthcare Billing System In Need of Reform

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Interview: Cynthia Fisher

Abi and The Mustangs

Play Episode Listen Later Nov 20, 2020 47:19

In this interview, I had an amazing conversation with Cynthia Fisher about burro training. She is a wealth of knowledge about owning and training burros/donkeys. We go over TIP training, the burro mentality, the difference between horses and burros, and much more! (episode is listed as explicit only because when talking about burros, they also referred to as "asses".)

tip cynthia fisher

Patient Victory for Price Transparency

Patients Rising Podcast

Play Episode Listen Later Nov 13, 2020 38:03

Power to patients! A new price transparency rule from the U.S. Department of Health and Human Services will allow you to see exactly what you’re paying for. Terry and Dr. Bob discuss the rule that will require private insurers to publish their negotiated rates. Cynthia Fisher shares how the rule will give patients greater control over their healthcare decisions. Guest:Cynthia FisherFounder and Chairman, Patients Rights AdvocateCynthia A. Fisher is a life sciences entrepreneur, independent investor, and corporate board director. She founded WaterRev, LLC to invest in novel technologies that enable sustainable practices in water use. Cynthia is best known for her pioneering work as Founder and CEO of ViaCord, Inc., a leading umbilical cord blood stem cell banking service which she started in 1993. In 2000, she co-founded and was President of the cellular medicines company, ViaCell, Inc. (VIAC). Prior to founding ViaCord, Cynthia ran the Blood Bank Division of Haemonetics Corporation, a medical equipment manufacturer. She began her career in sales at IBM focusing on healthcare IT, insurance, and defense industries. Cynthia holds an MBA from Harvard Business School, as well as an Honorary Doctorate of Science and BS in Biophysics from Ursinus College.Hosts:Terry Wilcox, Executive Director, Patients RisingDr. Robert Goldberg, “Dr. Bob”, Co-Founder and Vice President of the Center for Medicine in the Public Interest.Kate Pecora, Field Correspondent Links:Cynthia FisherPatient Rights AdvocateHHS Finalizes Rule on Insurer Price TransparencyPatients Rising Concierge Need help?The successful patient is one who can get what they need when they need it. We all know insurance slows us down, so why not take matters into your own hands. Our Navigator is an online tool that allows you to search a massive network of health-related resources using your zip code so you get local results. Get proactive and become a more successful patient right now at PatientsRisingConcierge.orgHave a question or comment about the show, want to suggest a show topic or share your story as a patient correspondent?Drop us a line: podcast@patientsrising.orgThe views and opinions expressed herein are those of the guest(s)/ author(s) and do not reflect the official policy or position of Patients Rising.

55KRC Friday Morning Show -- 11-13-20

Brian Thomas

Play Episode Listen Later Nov 13, 2020 132:10

It's Tech Friday with Dave Hatter! Hear about the ever-changing social media environment and what that means for your privacy. Plus, mayor John Cranley and State Rep. John Becker join Brian to talk politics. Finally, hear from Cynthia Fisher of from PatientRightsAdvocate.org, and Andi Johnson from LifeCenter.

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"Patients' Rights Advocates"

Answers for the Family - Radio Show

Play Episode Listen Later Nov 9, 2020 55:00

Hospital Patients are getting slammed with huge bills for COVID19 Testing and Treatment Show Guest: Cynthia Fisher patientrightsadvocate.org The coronavirus has amplified our need to have real-time, complete access to our electronic health information as use of telemedicine increases. But for telemedicine to work best, especially during the telemedicine, patients and their physicians need easy access to patients’ complete medical information. With access to entire electronic health records on their smartphones, patients can share their records with physicians, caregivers, and family members anywhere at any time. According to Cynthia Fisher, founder and president of Patients’ Rights Advocates, this is our moment in time, where we are at a crossroads where we either deliver to America a free market, or Medicare for all. As lawmakers call for a fourth coronavirus relief bill, Congress has an opportunity to cement rules that 91 percent of Americans want – ones that will make complete price transparency the law. Requiring hospitals and insurers to reveal their cash and secret negotiated prices will not only empower patients by putting them in charge, but will also help employers and workers. A Phase IV stimulus package is in the works. It is our hope that this time Congress will listen to what 91 percent of Americans want, despite how much money they get paid to vote otherwise.

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Leaderships 4th Evolution Edward Marshall, Patient Advocate Cynthia Fisher and Lderes Program Win

School for Startups Radio

Play Episode Listen Later Oct 22, 2020

October 22, 2020 Leaderships 4th Evolution Edward Marshall, Patient Advocate Cynthia Fisher and Lderes Program Winner Richard Montez

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Knowledge from the Park Ep 13

98.5 WYTX Rock Hill

Play Episode Listen Later Jul 30, 2020 59:31

Local children's author Derrick Barnes on his new book "Who Got Game: Baseball Amazing but True Stories"; Cynthia Fisher returns with an update on the Healthcare Price Transparency Act; Journalist and biographer Jimmy McDonough; Dr. Robert Hauser and Sarah Jones from the PMD Alliance discuss Parkinson's patients who experience hallucinations and delusions.

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Knowledge from the Park Ep 13

Knowledge from the Park

Play Episode Listen Later Jul 30, 2020 59:31

Local children's author Derrick Barnes on his new book "Who Got Game: Baseball Amazing but True Stories"; Cynthia Fisher returns with an update on the Healthcare Price Transparency Act; Journalist and biographer Jimmy McDonough; Dr. Robert Hauser and Sarah Jones from the PMD Alliance discuss Parkinson's patients who experience hallucinations and delusions.

interview mental health local baseball park journalists parkinson true stories biography public radio sarah jones derrick barnes cynthia fisher

Knowledge from the Park Ep 13

98.5 WYTX Rock Hill

Play Episode Listen Later Jul 30, 2020 59:31

Local children's author Derrick Barnes on his new book "Who Got Game: Baseball Amazing but True Stories"; Cynthia Fisher returns with an update on the Healthcare Price Transparency Act; Journalist and biographer Jimmy McDonough; Dr. Robert Hauser and Sarah Jones from the PMD Alliance discuss Parkinson's patients who experience hallucinations and delusions.

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The Health Care Price Transparency Act. Act now! Cynthia Fisher.

Inspirational Women

Play Episode Listen Later Jul 26, 2020 30:42

Cynthia Fisher joins us once again both to remind and inspire us to "Act"--to contact our Senators Murray and Cantwell to support -- the Health Care PRICE Transparency Act. The vote for another stimulus package is up, happening the beginning of August, so 'this ask' of them to support this bill that allows us to know prices of hospital care before hand, is hugely important. Cynthia is the founder and Chairman of PRA, Patient Rights Advocate.org...a non-profit, non-partisan organization that provides a voice for consumers --you and me, to have transparency in healthcare. www.patientrightsadvocate.org

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July 24, 2020 - Cynthia Fisher

Breakfast Club

Play Episode Listen Later Jul 24, 2020 5:31

July 24, 2020 - Cynthia Fisher

cynthia fisher

Patient Rights Cynthia Fisher, Taxes/Payroll Julio Gonzalez and Credit Report Fraud Jim Francis

School for Startups Radio

Play Episode Listen Later Jul 20, 2020

July 20, 2020 Patient Rights Cynthia Fisher, Taxes/Payroll Julio Gonzalez and Credit Report Fraud Jim Francis

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Cynthia Fisher & Jack Kerfoot

Overnight America

Play Episode Listen Later Jul 8, 2020 36:04

Cynthia Fisher, founder and chairman of patientrightsadvocate.org, joins host Ryan Wrecker to discuss healthcare price transparency. Jack Kerfoot, energy executive and author of “Fueling America: An Insider’s Journey,” explains how the coronavirus pandemic can move us closer to a clean-energy future. Ryan also discusses the curious case, or lack thereof, of Terrence Page, the man caught on video throwing punches at innocent bystanders at Forest Park’s King Louis IX statue. Finally, hear what United States National Economic Council Director Larry Kudlow had to say about another possible recession. Listen to the show on Apple Podcasts? Leave us a 5-star review: apple.co/2Of49Bv and subscribe to Overnight America on other great apps like Radio.com If you like what you hear, we're live weeknights on KMOX 1120AM. We welcome your calls at 800-925-1120. Like and follow on Facebook: www.facebook.com/RyanWreckerRadio/

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Your Working Life with CynthiaFisher

Your Working Life with Caroline Dowd-Higgins

Play Episode Listen Later Jul 6, 2020 45:38

Cynthia Fisher will talk about how the pandemic is testing the US healthcare system.

working life cynthia fisher

Support for the Health Care Price Transparency Act. Cynthia Fisher.

Sunday Morning Magazine

Play Episode Listen Later Jul 5, 2020 30:01

Cynthia Fisher is a life sciences entrepreneur, independent investor, and corporate board director. Cynthia is also the founder and Chairman of PRA, Patient Rights Advocate.org...a non-profit, non-partisan organization that provides a voice for consumers --you and me, to have transparency in healthcare. A perfect conversation on Independence Day weekend, when we can consider contacting our Senators Murray and Cantwell to support -- the Health Care PRICE Transparency Act, which would require hospitals and health insurers to post their discounted cash prices and secret, hidden negotiated rates. www.patientrightsadvocate.org

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78: Hospital Pricing, Patient Rights Advocate (PRA), Stem Cell Banking Dr. Cynthia Fisher

Women Investing Network's Podcast

Play Episode Listen Later Jun 12, 2020 21:18

Dr. Cynthia Fisher, Patient Rights Advocate joins Jason Hartman today to discuss the issue of hospital pricing transparency. If this issue is ever forced into action, will cash pricing or insurance pricing be the better deal in hospitals? As well, how does this issue play into Coronavirus, and have hospitals been hurt or have they benefited from Covid-19? Key Takeaways: [1:00] Hospital pricing transparency? [3:00] Will cash pricing or insurance pricing be the better deal in hospitals? [6:15] What can we fix in this next round of stimulus? [7:30] What’s a charge master rate? [10:00] Sued using the first amendment saying, “we have the right as hospitals and insurance companies to have our gag orders and secret hidden prices as part of our freedom of speech.” [13:00] Have the hospitals been hurt by COVID-19? [16:20] Patient was charged $6,000 for being tested and treated for COVID-19 in a tent outside the hospital. Websites: patientrightsadvocate.org JasonHartman.com/Properties JasonHartman.com JasonHartman.com/Ask Jason Hartman PropertyCast (Libsyn) Jason Hartman PropertyCast (iTunes) 1-800-HARTMAN

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553: Hospital Pricing, Patient Rights Advocate (PRA), Stem Cell Banking Dr. Cynthia Fisher

Holistic Survival Show - Pandemic Planning

Play Episode Listen Later Jun 8, 2020 22:17

Dr. Cynthia Fisher, Patient Rights Advocate joins Jason Hartman today to discuss the issue of hospital pricing transparency. If this issue is ever forced into action, will cash pricing or insurance pricing be the better deal in hospitals? As well, how does this issue play into Coronavirus, and have hospitals been hurt or have they benefited from Covid-19? Key Takeaways: [1:00] Hospital pricing transparency? [3:00] Will cash pricing or insurance pricing be the better deal in hospitals? [6:15] What can we fix in this next round of stimulus? [7:30] What's a charge master rate? [10:00] Sued using the first amendment saying, “we have the right as hospitals and insurance companies to have our gag orders and secret hidden prices as part of our freedom of speech.” [13:00] Have the hospitals been hurt by COVID-19? [16:20] Patient was charged $6,000 for being tested and treated for COVID-19 in a tent outside the hospital. Websites: patientrightsadvocate.org JasonHartman.com/Properties JasonHartman.com JasonHartman.com/Ask Jason Hartman PropertyCast (Libsyn) Jason Hartman PropertyCast (iTunes) 1-800-HARTMAN

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08/08/19 Guest Cynthia Fisher

The Doctor's Lounge

Play Episode Listen Later Aug 9, 2019 59:03

Dr. Hal Scherz and his guest, Cynthia Fisher, talk about Price Transparency in Healthcare.

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Podcast: Post-Xmas Exhaustion? Overcome Holiday Burnout

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Play Episode Listen Later Dec 26, 2018 32:16

Feeling tired, overwhelmed, or just plain burned out from all the Holiday stress? Learn how to manage the day to day drama and emotions in your Real Estate Practice, so they don’t control your income, your attitude or your outcome! Today’s show is an in-depth overview of Cynthia Fisher’s 1997 Bond University study “Emotions at Work: What Do People Feel, and How Should We Measure It?“, and we’re discussing what this study means in terms of stress & emotional well-bring in your own personal workplace as a real estate professional.

#101: A Chat with Cynthia Fisher

Tarot Visions

Play Episode Listen Later Aug 4, 2017 25:23

Cynthia Fisher is a prolific tarot, Lenormand, and oracle creatrix. She has over 20 fantastic and unique decks on her Etsy store at Two Koi Moon and she's got no signs of stopping. Rose Red and Jaymi spent some time chatting to Cynthia about her creativity, processes (she does hand-drawn and digital art), and what's next on her long list of creations.(Editor note: we had some audio issues with this week's episode. We tried our best to fix them, but you'll hear some blips. We apologize but hope you still enjoy this week's episode.)Samples of Cynthia's art at artwanted.com/gonedigitalFacebook groups: the cartomancy club (tarot, oracle, Lenormand) and the black cat altar deck page

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The Amethyst Oracle : Divination with a Queer Twist

SoulVox L*I*V*E!

Play Episode Listen Later Jun 14, 2016 57:00

NEXUS ORACULUM How to be inspired to create constantly in your daily life This month, HiC welcomes to The Amethyst Oracle digital artist, designer and cartomancer CYNTHIA FISHER. Join us to hear how she lets creativity just flow from every pore of her being in a neverending stream ... and how you can be inspired to create constantly in your daily life. She'll also share how she developed a new divination system and what it's like to have a divination system bubble up and flow from idea to realisation that others can see, touch and use for themselves. In addition to numerous Tarot, Lenormand and other Cartomancy decks including the White Star Tarot, the Aether Tarot, the Dark Matter Tarot, the My Dream Lenormand, the Tea Time Lenormand (and many more), Cynthia Fisher has recently released her latest creation, the ORACULUM NEXUS, as well as a newly developed divination system with the Alexandria's Wheel Oracle Cards. You can find Cynthia Fisher's Cartomancy creations here ... and view more of her artwork here

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Overcome Your Holiday Burnout

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Play Episode Listen Later Dec 22, 2015 32:16

Feeling tired, overwhelmed, or just plain burned out from all the Holiday stress? Learn how to manage the day to day drama and emotions in your Real Estate Practice, so they don’t control your income, your attitude or your outcome! Today’s show is an in-depth overview of Cynthia Fisher’s 1997 Bond University study “Emotions at Work: What Do People Feel, and How Should We Measure It?“, and we’re discussing what this study means in terms of stress & emotional well-bring in your own personal workplace as a real estate professional.

Feeling Burned Out? Here is your solution!

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Play Episode Listen Later Apr 21, 2015 32:16

How to manage the day to day drama and emotions in your Real Estate Practice, so they don’t control your income, your attitude or your outcome! Today’s show is an in-depth overview of Cynthia Fisher’s 1997 Bond University study “Emotions at Work: What Do People Feel, and How Should We Measure It?“, and we’re discussing what this study means in terms of stress & emotional well-bring in your own personal workplace as a real estate professional.

Managing your day to day stress and emotions