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Join us as we recap and chat about Once Upon a Time Episode 4x10 "Shattered Sight"Did you know Ingrid's final scene was actor Elizabeth Mitchell's hardest scene she had to film?Wiki page for the episode: https://onceuponatime.fandom.com/wiki/Shattered_SightLinks, articles, and videos mentioned in this episode:Elizabeth Mitchell talking about her hardest scene to filmIngrid and Regina Deleted SceneJoin our Book Club and get access to exclusive content on PatreonFollow us on InstagramFollow us on TiktokFollow us on Bluesky
Join us as we recap and chat about Once Upon a Time Episode 4x09 "Fall"Did you know because of the director's decision to include pebbles from the mine in a scene, he got the nickname Mario Van Pebbles?Wiki page for the episode: https://onceuponatime.fandom.com/wiki/FallJoin our Book Club and get access to exclusive content on PatreonFollow us on InstagramFollow us on TiktokFollow us on Bluesky
On today's Top News in 10, we cover: President Trump hits the economy, immigration, and Iran on Meet the Press. Our White House correspondent Elizabeth Mitchell gets a few questions answered on Air Force One. CNN interviews a member of the Sinaloa cartel. Subscribe to The Tony Kinnett Cast: https://podcasts.apple.com/us/podcast/the-tony-kinnett-cast/id1714879044 Keep Up With The Daily Signal Sign up for our email newsletters: https://www.dailysignal.com/email Subscribe to our other shows: Problematic Women: https://www.dailysignal.com/problematic-women The Signal Sitdown: https://www.dailysignal.com/the-signal-sitdown Follow The Daily Signal: X: https://x.com/DailySignal Instagram: https://www.instagram.com/thedailysignal/ Facebook: https://www.facebook.com/TheDailySignalNews/ Truth Social: https://truthsocial.com/@DailySignal YouTube: https://www.youtube.com/user/DailySignal Rumble: https://rumble.com/c/TheDailySignal Thanks for making The Daily Signal Podcast your trusted source for the day's top news. Subscribe on your favorite podcast platform and never miss an episode. Learn more about your ad choices. Visit megaphone.fm/adchoices
On today's Top News in 10, we cover: President Trump hits the economy, immigration, and Iran on Meet the Press. Our White House correspondent Elizabeth Mitchell gets a few questions answered on Air Force One. CNN interviews a member of the Sinaloa cartel. Subscribe to The Tony Kinnett Cast: https://podcasts.apple.com/us/podcast/the-tony-kinnett-cast/id1714879044 Keep Up With […]
On today's Top News in 10, we cover: President Trump hits the economy, immigration, and Iran on Meet the Press. Our White House correspondent Elizabeth Mitchell gets a few questions answered on Air Force One. CNN interviews a member of the Sinaloa cartel. Subscribe to The Tony Kinnett Cast: https://podcasts.apple.com/us/podcast/the-tony-kinnett-cast/id1714879044 Keep Up With […]
On today's Top News in 10, we cover: President Trump hits the economy, immigration, and Iran on Meet the Press. Our White House correspondent Elizabeth Mitchell gets a few questions answered on Air Force One. CNN interviews a member of the Sinaloa cartel. Subscribe to The Tony Kinnett Cast: https://podcasts.apple.com/us/podcast/the-tony-kinnett-cast/id1714879044 Keep Up With […]
Join us as we recap and chat about Once Upon a Time Episode 4x03 "Rocky Road" Did you know Ingrid being barefoot in the forest scenes was actor Elizabeth Mitchell's choice because she felt otherwise she would have been tripping over every Wiki page for the episode: https://onceuponatime.fandom.com/wiki/Rocky_Road Links, articles, and videos mentioned in this episode: Elizabeth Mitchell talking about getting the offer for Ingrid Lost Blooper Victoria Smurfit talking about not liking to be out of her character's shoes Join our Book Club and get access to exclusive content on Patreon Follow us on Instagram Follow us on Tiktok Follow us on Bluesky
Foe of DEI Explains How Trump Can Make Bans Last Beyond His Term If President Donald Trump uses the full power of the federal government to outlaw diversity, equity, and inclusion policies, his achievements will outlive his administration, according to anti-DEI activist Robby Starbuck. Starbuck joined The Daily Signal's Elizabeth Mitchell to discuss how Trump can make his DEI bans last. Tune in to find out what happens next! Learn more about your ad choices. Visit megaphone.fm/adchoices
Elizabeth Mitchell, White House Correspondent for The Daily Signal All things White House
Frequency (2000) on The Atomic Cinema Experiment. This is a sci fi movie podcast. Frequency is directed by Gregory Hoblit and stars Dennis Quaid, Jim Caviezel, Andre Braugher, Elizabeth Mitchell, Noah Emmerich patreon: https://www.patreon.com/mildfuzztv all links: https://linktr.ee/mildfuzz discord: https://discord.gg/8fbyCehMTy Email: mftvquestions@gmail.com Audio version: https://the-ace-atomic-cinema-experime.pinecast.co
Happy Purge Day (belated)! We're celebrating this year's Purge by watching 2016's The Purge: Election Year in which there's a big argument about whether it's better to fight tyranny from within the system or via a full-on armed rebellion. The escapism of entertainment, everyone!
In March 2021, Paul Vaughn, along with 10 other a pro-life activist, demonstrated outside the Carafem Health Center, an abortion clinic in Mt. Juliet, Tennessee. Vaughn was sentenced to three years of supervised release, including six months of home detention, after a jury convicted him of violating the Freedom of Access to Clinic Entrances (FACE) Act for blocking the entrance to the abortion clinic, according to court documents. The Daily Signal's Elizabeth Mitchell sat down with Vaughn to talk about his efforts to repeal the FACE Act. Since its passage in 1994, 97% of FACE Act arrests have been against pro-lifers, even though, “the law ostensibly is supposed to protect churches and places of worship and reproductive health centers”, argues Vaughn. Paul Vaughn was one of the 23 pro-lifers President Trump pardoned in January 2025. Catch up on the latest interviews in our "Trump's Pardoned Pro-Lifers" series by going to YouTube now: https://youtu.be/HW6Ggw4xh7g Learn more about your ad choices. Visit megaphone.fm/adchoices
On today's Top News in 10, we cover: A historic heated exchange between President Trump and President Zelenskyy plays out in front of the world in the Oval Office. Vice President Vance spoke at the 20th National Catholic Prayer Breakfast in Washington, D.C. The religious liberty legal defense group Alliance Defending Freedom has launched an investigation into censorship of Americans' free speech within the government's science agency. Also on today's show: President Trump signs an executive order declaring English as the official language of the United States. President Trump says he believes that the cocaine found in the White House in 2023 belonged to either President Biden or his son Hunter. BIG Announcement: Some exciting changes are coming to Top News in 10! Starting in March, Top News in 10 will be released as a morning show, and The Daily Signal's Tony Kinnett will be the new regular host of the show. Former hosts Rob Bluey, Elizabeth Mitchell, and Virginia Allen will still appear on the show occasionally, but will be spending more of their time writing the stories you love for The Daily Signal. You can find all their work, and the work of the entire team, at https://www.dailysignal.com/. Links From Today's Show: https://www.dailysignal.com/2025/02/28/exclusive-adf-investigates-free-speech-violations-government-science-agency/ Keep Up With The Daily Signal Sign up for our email newsletters: https://www.dailysignal.com/email Subscribe to our other shows: The Tony Kinnett Cast: https://www.dailysignal.com/the-tony-kinnett-cast Problematic Women: https://www.dailysignal.com/problematic-women The Signal Sitdown: https://www.dailysignal.com/the-signal-sitdown Follow The Daily Signal: X: https://x.com/DailySignal Instagram: https://www.instagram.com/thedailysignal/ Facebook: https://www.facebook.com/TheDailySignalNews/ Truth Social: https://truthsocial.com/@DailySignal YouTube: https://www.youtube.com/user/DailySignal Rumble: https://rumble.com/c/TheDailySignal Thanks for making The Daily Signal Podcast your trusted source for the day's top news. Subscribe on your favorite podcast platform and never miss an episode. Learn more about your ad choices. Visit megaphone.fm/adchoices
Elizabeth Mitchell is a certified Music Therapist who holds her PhD in Music Education from Western University. She is currently an Assistant Professor at Wilfrid Laurier University, coordinating the Bachelor of Music Therapy program, teaching courses, conducting research, and supervising master's students in their research. Elizabeth previously served as the Ethics Chair for the Canadian Association of Music Therapists. Dr. Liz Mitchell's research is grounded in her lived experiences working as a music therapist and psychotherapist, largely in mental health treatment settings.Episode Links: https://www.elizabethlmitchell.com/--Subscribe to the Able Voice Podcast, leave us a review and connect with us (@ablevoicepodcast or @synergymusictherapy) to share your experiences and takeaways. We release new episodes every other Sunday between the end of January and end of August.AVP Theme Music by: Christopher Mouchette. Follow him on Soundcloud (Chris Mouchette).Episode audio edited by: Justis Krar (@immvproductions)Rate and review the podcast on Apple Podcasts here:https://podcasts.apple.com/us/podcast/able-voice-podcast/id1505215850https://screamtherapyhq.com/podcasthttps://screamtherapyhq.com/book
Here's a great case, featuring Dennis Quaid , Andre Braugher, Jim Caviezel and Elizabeth Mitchell - they are all playing roles across a generation with Frequency demonstrating the power of time travel, but in a whole new perspective. If you've lost a loved one, this will be a difficult watch, but it's worth it. Stephen calls it a Hidden Gem - what does Trev think? Find out thanks to Hisense and Fetch.
Elizabeth Mitchell joins the show.
The left freaks out over Trump's funding freeze. RFK Jr. hearings backed by powerful message from Nicole Shanahan. Karoline Leavitt had a strong debut as Press Sec. Elizabeth Mitchell joins the show.
On today's Top News in 10: Reporters peppered White House press secretary Karoline Leavitt with questions on a range of topics during her first briefing. She promised to reverse former President Joe Biden's decision to revoke the White House press credentials of 440 reporters. The Daily Signal's Fred Lucas was among those who lost his credentials in 2023. The White House announced it is freezing federal grants and loans while it undertakes a sweeping review of such spending to ensure it is aligned with the president's priorities. In fiscal year 2024, he said the government distributed more than $3 million in federal financial assistance. That's approximately 30% of the $10 trillion it spent. House Republicans are gathered in Florida for a three-day meeting to sort out their strategy for enacting President Trump's agenda. The Daily Signal's Elizabeth Mitchell is in Miami for the meeting and interviewed several members of Congress about their plans for budget reconciliation and other upcoming legislative debates. Additional headlines: After dominating the news for weeks last year, Levitt announced the drones flying over New Jersey were authorized to be flown by the Federal Aviation Administration. President Trump has another member of his Cabinet today after the Senate voted 77 to 22 for Transportation Secretary Sean Duffy. Sen. Mike Lee of Utah is suggesting that the government enlist private citizens—or privateers—to help combat Mexican drug cartels. Google Maps will comply with President Trump's directive to change the name of the Gulf of Mexico to the Gulf of America, and rename Denali to Mount McKinley. Keep Up With The Daily Signal Sign up for our email newsletters: https://www.dailysignal.com/email Subscribe to our other shows: The Tony Kinnett Cast: https://www.dailysignal.com/the-tony-kinnett-cast Problematic Women: https://www.dailysignal.com/problematic-women The Signal Sitdown: https://www.dailysignal.com/the-signal-sitdown Follow The Daily Signal: X: https://x.com/DailySignal Instagram: https://www.instagram.com/thedailysignal/ Facebook: https://www.facebook.com/TheDailySignalNews/ Truth Social: https://truthsocial.com/@DailySignal YouTube: https://www.youtube.com/user/DailySignal Rumble: https://rumble.com/c/TheDailySignal Thanks for making The Daily Signal Podcast your trusted source for the day's top news. Subscribe on your favorite podcast platform and never miss an episode. Learn more about your ad choices. Visit megaphone.fm/adchoices
In this episode of the Faith Film Fan Podcast, host Alita Reynolds talks with Isaac Norris, producer of the inspiring new film Between Borders. This powerful true story follows an Armenian family living in Baku during the late 1980s, forced to flee their home amidst the escalating conflict between Azerbaijan and Armenia. Their journey of faith, hope, and resilience in seeking asylum in the U.S. is both moving and unforgettable.Isaac, a missionary kid who has known this story for 30 years, shares his passion for honoring it on screen. He opens up about the challenges of balancing historical accuracy with cinematic storytelling and recounts the miraculous moments that made this project possible. Featuring performances by talented actors like Elizabeth Mitchell and Elizabeth Tabish, Between Borders has already received five ICVM Crown Award nominations.Tune in to hear Isaac's behind-the-scenes insights and learn how you can support independent films like Between Borders during its limited theatrical release, January 26–28. This story will deepen your understanding of the refugee experience and inspire you with the transformative power of faith.Get tickets, watch the trailer and more here.
This week on Breaking Battlegrounds, Chuck Warren and Sam Stone are joined by Michael Deibert, who explores the contrasts between Haiti 30 years ago and its current state. He discusses the nation's political collapse, rampant gang violence, and his interview with gang leader Jimmy Chérizier, known as "Barbecue." Michael emphasizes the need for stronger governance, economic opportunities, and enhanced international collaboration to address Haiti's ongoing crisis and create pathways to stability. Later, Elizabeth Troutman Mitchell of The Daily Signal also joins the program to recap recent Supreme Court arguments on state laws banning gender-affirming care for minors. Drawing from her article, What I Saw Outside the Supreme Court Amid Oral Arguments About Whether States Can Protect Minors from ‘Gender-Affirming Care', she shares her firsthand experiences reporting from the scene. Finally, in Kiley's Corner, Kiley explores the chilling case of a man who tampered with his wife's parachute in an attempted murder and highlights a potential police cover-up involving the son of a Suffolk, VA, detective.www.breakingbattlegrounds.voteTwitter: www.twitter.com/Breaking_BattleFacebook: www.facebook.com/breakingbattlegroundsInstagram: www.instagram.com/breakingbattlegroundsLinkedIn: www.linkedin.com/company/breakingbattlegroundsShow sponsors:Invest YrefyYrefy offers a secure, collateralized portfolio with a strong, fixed rate of return - up to a 10.25%. There is no attack on your principal if you ever need your money back. You can let your investment compound daily, or take your income whenever you choose. Make sure you tell them Sam and Chuck sent you!Learn more at investyrefy.com4Freedom MobileExperience true freedom with 4Freedom Mobile, the exclusive provider offering nationwide coverage on all three major US networks (Verizon, AT&T, and T-Mobile) with just one SIM card. Our service not only connects you but also shields you from data collection by network operators, social media platforms, government agencies, and more.Use code ‘Battleground' to get your first month for $9 and save $10 a month every month after.Learn more at: 4FreedomMobile.comDot VoteWith a .VOTE website, you ensure your political campaign stands out among the competition while simplifying how you reach voters.Learn more at: dotvote.voteAbout our guests:Michael Deibert is an author and journalist who has covered Haiti for 25 years and is the author of several books, among them "Notes from the Last Testament: The Struggle for Haiti" and "Haiti Will Not Perish: A Recent History." You can read his work here: Michael Deibert. -Elizabeth Troutman Mitchell is the reporting fellow for The Daily Signal and co-host of "The Daily Signal Podcast." Read her work here. Get full access to Breaking Battlegrounds at breakingbattlegrounds.substack.com/subscribe
Darkness Syndicate members get the ad-free version. https://weirddarkness.com/syndicateInfo on the next LIVE SCREAM event. https://weirddarkness.com/LiveScreamIN THIS EPISODE: If you are into aliens or conspiracies, you've likely heard of the StarChild skull – a strange skull that appears either misshapen, or – as many believe – is the skull of a hybrid between extraterrestrials and human beings. What is the truth behind the StarChild? (What Is The StarChild?) *** In the 1700s life-saving techniques were obviously not as advanced as those we have today. Case in point – one doctor wanted to know if and how a drowned person might be brought back to life. The solution? Go to a hanging and try to revive the executed man. How do you think that went? (The Hanged Man) *** We've spoken often here on Weird Darkness about shadow people – what their purpose is, where they come from, whether they are malevolent or not… but are they ghosts, or something else entirely? (Are Shadow People Considered Ghosts?) *** A Reddit user shares his true story of hiking in the wilderness and suddenly being tracked and hunted over several days by a stranger with unknown intentions. (A Strange Man Hunted Me Through The Park) *** Within the walls of one of England's most picturesque castles, a queen gave birth to her only child and set in motion a chain of events that would become one of Tudor England's most intriguing mysteries. (The Unexplained Disappearance of the Queen's Daughter)CHAPTERS & TIME STAMPS (All Times Approximate)…00:00:00.000 = Disclaimer and Cold Open00:01:45.843 = Show Intro00:04:17.596 = What Is The Starchild?00:23:58.576 = The Hanged Man00:31:45.162 = A Strange Man Hunted Me Through The Dark00:37:30.280 = The Unexplainable Disappearance of the Queen's Daughter00:50:32.958 = Are Shadow People Considered Ghosts?1:00:03.749 = Show CloseSOURCES AND REFERENCES FROM THE EPISODE…“The Hanged Man” by Romeo Vitelli for Providentia: https://weirddarkness.tiny.us/32j6zyb7“Are Shadow People Considered Ghosts?” by Jacob Shelton for Ranker's Graveyard Shift: https://weirddarkness.tiny.us/uej2nyca“A Strange Man Hunted Me Through The Park” by Redditor u/ValyrianJedi: https://weirddarkness.tiny.us/436p34t7“The Unexplained Disappearance of the Queen's Daughter” by Lydia Starbuck for Royal Central:https://weirddarkness.tiny.us/bfhkxthc“What Is The Starchild?” by Dr. Elizabeth Mitchell, posted at Anomalien: https://weirddarkness.tiny.us/ewccfd5c, and from StarChildProject.com: https://weirddarkness.tiny.us/wb8dayddWeird Darkness theme by Alibi Music Library. = = = = =(Over time links seen above may become invalid, disappear, or have different content. I always make sure to give authors credit for the material I use whenever possible. If I somehow overlooked doing so for a story, or if a credit is incorrect, please let me know and I will rectify it in these show notes immediately. Some links included above may benefit me financially through qualifying purchases.)= = = = ="I have come into the world as a light, so that no one who believes in me should stay in darkness." — John 12:46= = = = =WeirdDarkness® is a registered trademark. Copyright ©2024, Weird Darkness.= = = = =Originally aired: April 12, 2021CUSTOM LANDING PAGE: https://weirddarkness.com/starchild
Elizabeth (Troutman) Mitchell is the reporting fellow for The Daily Signal and co-host of "The Daily Signal Podcast.” 26 Medical Societies Have Issued Political Calls to Action on Topics Like Racism, Climate Change
Top News for Friday, Nov. 8, 2024. On today's show, we cover these stories making news: Susie Wiles will serve as the next White House chief of staff after successfully guiding President-elect Donald Trump's winning campaign. Trump tapped Wiles for the job Thursday, making her the first woman in history to hold that role. While the dust is still settling from the 2024 election, Senate Republicans are tasked with choosing who will lead them in their new majority. Republican Mitch McConnell of Kentucky is stepping down from his leadership job after 18 years. Democrats are having a hard time coping with Vice President Kamala Harris' defeat. That's particularly true in Washington, D.C., where she won over 92% of the vote. The Daily Signal's Elizabeth Mitchell and Tim Kennedy hit the streets of D.C. to talk with locals about the loss. Coming tomorrow: An interview with former White House press secretary Sean Spicer on the media's role in the 2024 election. Make “The Daily Signal Podcast” your trusted source for the news. Subscribe today on your favorite podcast platform and never miss an episode.
Elizabeth (Troutman) Mitchell, Reporting fellow for The Daily Signal and co-host of "The Daily Signal Podcast.” ‘Winning Issue'?: Michigan Dems Hope Abortion Will Help Harris Thwart Trump in Swing State
CAPITOL WEEKLY PODCAST: This Special Episode of the Capitol Weekly Podcast was recorded live at Capitol Weekly's conference HEALTH CARE IN CALIFORNIA, which was held in Sacramento on Thursday, October 3, 2024This is PANEL 2 – OFFICE OF HEALTH CARE AFFORDABILITY: TARGETSPanelists: Ben Johnson, California Hospital Association; Lynne Kinst, Hemophilia Council of California; Elizabeth Mitchell, Purchaser Business Group on Health; Dr. Richard Pan, California Health Care Affordability BoardModerated by Sigrid Bathen, Capitol WeeklyThanks to our sponsors:CALIFORNIA HEALTH CARE FOUNDATION, THE TRIBAL ALLIANCE OF SOVEREIGN INDIAN NATIONS, WESTERN STATES PETROLEUM ASSOCIATION, PHYSICIAN ASSOCIATION OF CALIFORNIA; KP PUBLIC AFFAIRS, PERRY COMMUNICATIONS, CAPITOL ADVOCACY, LUCAS PUBLIC AFFAIRS, THE WEIDEMAN GROUP, and CALIFORNIA PROFESSIONAL FIREFIGHTERS
Actress Elizabeth Mitchell joins Frank Mackay on this episode of The Frank Mackay Show!
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)
Tune in as Makayla (Your Friendly Neighborhood Blerd) jumps onto the podcast for a breakdown of First Kill, the 2022 lesbian vampire Netflix series that follows the forbidden romance between two teenagers—one who's of the literally bloodsucking sort, the other who's of the monster-hunting variety. It's a shame that this only had the chance to stream for a couple months before the big red N suddenly decided to cancel it. The sociopathic Elinor quite possibly being the most fascinating character here, the show taking an incredibly dated and MAGA-era stab at political commentary, and the terrifying state of generative and deepfake AI in Hollywood stand out as a few of the talking points for this episode. Created by V.E. Schwab, First Kill stars Sarah Catherine Hook, Imani Lewis, Elizabeth Mitchell, Aubin Wise, Gracie Dzienny, Dominic Goodman, Phillip Mullings, Jr., Jason R. Moore, Will Swenson, Jonas Dylan Allen, MK xyz, Dylan McNamara, Polly Draper, Joseph D. Reitman, Walnette Santiago, Roberto Méndez, and Christopher B. Duncan. Spoilers start at 12:25 Create your podcast today! #madeonzencastr Here's how you can learn more about Palestine and Israel: http://decolonizepalestine.com Here's how you can act to help stop Israel's genocide of Palestine: http://linktr.ee/savegaza Here's how you can send eSIM cards to Palestinians in order to help them stay connected online: https://www.gazaesims.com Good Word: • Makayla: Late Night with the Devil • Arthur: Woman of the Photographs Reach out at email2centscritic@yahoo.com if you want to recommend things to watch and read, share anecdotes, or just say hello! Be sure to subscribe, rate, and review on iTunes or any of your preferred podcasting platforms! Follow Arthur on Twitter, Goodpods, StoryGraph, Letterboxd, and TikTok: @arthur_ant18 Follow the podcast on Twitter: @two_centscritic Follow the podcast on Instagram: @twocentscriticpod Follow Arthur on Goodreads Check out 2 Cents Critic Linktree
Serie: Un viaje para el corazón, con Elizabeth Mitchell. Ep3. Dios usa a personas en circunstancias menos que perfectas para hacer Su trabajo.
Es tu vida menos que perfecta a lo que pensaste o deseas? Elizabeth Mitchell nos dice que, cuando nuestra situacin no es ideal, necesitamos la gracia de Dios. Ella compartir con nosotras palabras de esperanza para esos momentos en los que la vida nos parece injusta. No te pierdas el final de esta serie titulada: un viaje por el corazn, en Aviva Nuestros Corazones. To support this ministry financially, visit: https://www.oneplace.com/donate/1337/29
Serie: Un viaje para el corazón, con Elizabeth Mitchell. Ep2. Dios no es indiferente a tu dolor.
Elizabeth Mitchell experiment la agona y la tristeza profunda que vienen cuando se pierde un hijo. En el episodio de hoy, ella comparte con nosotras ms de su testimonio, sobre los aciertos y desaciertos de vivir un duelo. Seguramente, te ayudar a aprender el arte de vivir el duelo de la manera adecuada. Acompanos en Aviva Nuestros Corazones. To support this ministry financially, visit: https://www.oneplace.com/donate/1337/29
A mother in California lost her daughter to the foster care system in 2016 after she wouldn't support the then-14-year-old girl identifying as a boy. Years later, the daughter regrets attempting to transition. This mother sat down with The Daily Signal's Elizabeth Mitchell to warn other parents against allowing minors to make irreversible changes to their bodies. Listen to other podcasts from The Daily Signal: https://www.dailysignal.com/podcasts/ Get daily conservative news you can trust from our Morning Bell newsletter: DailySignal.com/morningbellsubscription Listen to Heritage podcasts: https://www.heritage.org/podcasts Sign up for The Agenda newsletter — the lowdown on top issues conservatives need to know about each week: https://www.heritage.org/agenda
A mother in California lost her daughter to the foster care system in 2016 after she wouldn’t support the then-14-year-old girl identifying as a boy. Years later, the daughter regrets attempting to transition. This mother sat down with The Daily Signal’s Elizabeth Mitchell to warn other parents against allowing minors to make irreversible changes to […]
Serie: Un viaje para el corazón, con Elizabeth Mitchell. Ep1. Dios usa el dolor para hacernos más como Cristo.
Cuando naci James, el hijo de Elizabeth Mitchell, supieron que l tena graves problemas cardacos. Esta situacin llev a Elizabeth a lo que ella llama: un viaje por el corazn. Ella comparte la esperanza para esos momentos en los que la vida nos resulta injusta e incomprensible. Conoce su historia en este episodio de Aviva Nuestros Corazones. To support this ministry financially, visit: https://www.oneplace.com/donate/1337/29
Cohost: Dr Pamela MacRae is a professor in the Applied Theology and Church Ministry Division at Moody Bible Institute, giving oversight to the Ministry to Women major, as well as the Ministry to Women Online Certificate program. She also serves on an executive team of Naomi's House, a residential program for sexually exploited women in the Chicagoland area, and oversees Moody's Women's Conference. She's married to Bob who is a Professor of Youth ministry at Moody. They have two married daughters and six grandchildren. She's been involved in Ministry to Women in various churches and para-church ministries for over 35 years and has been a guest on the Worthy podcast. Our guest is Elizabeth A. Mitchell (elizabethamitchell.com). She's a Bible teacher, blogger, author, and speaker. She is also part of the leadership team at Boca Raton Community Church, serving alongside her husband Bill. As part of the faculty of WorldLead, she frequently travels overseas to train and mentor leaders involved in the nonprofit world. She's also the author of “Journey for the Heart: Hope When Life's Unfair”, a book for those who are experiencing circumstances that leave them feeling hopeless and discouraged which will be the primary topic of our conversation today.
I was talking to one health plan sponsor, and she told me if she sees any charges for value-based care anything on any one of the contracts that get handed to her, she crosses them off so fast it's like her superpower. 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. What, you may wonder? Shouldn't employers and plan sponsors be all over value-based care–type things to do things preventatively because we all know that fee-for-service rewards, downstream consequences–type medical care, no money in upstream. Let's prevent those things from happening. Listen to the show with Tom Lee, MD (EP445); Scott Conard, MD (EP391); Brian Klepper, PhD (EP437). My goodness, we have done a raft of shows on this topic because it is such a thing. So, why wouldn't a plan sponsor be all over this value-based care opportunity? Now, I'm using the value-based care words and big old air quotes. Let's just keep that very much in mind for a couple of minutes here. I'm stressing right now that value-based care isn't a one-to-one overlap with care that is of value. So, let me ask you again, why wouldn't a plan sponsor be all over this air-quoted value-based care opportunity? Let me count the ways, and we'll start with this one. Katy Talento told me about this years ago. She said, it's not uncommon for dollars that a plan sponsor may pay to never make it to the entity that is actually providing the care to that plan sponsor's plan members. So, I'm a carrier and I say, I'm gonna charge you, plan sponsor, whatever as part of the PEPM (per employee per month) for value-based care or for a medical home, or pick something that sounds very appealing and value-like. Some of that money—not all of it, because the carrier's gonna keep some, you know, for administrative purposes—but whatever's left over could actually go to some clinical organization. Maybe it's the clinical organization that most of the plan's members are attributed to. Or maybe it's some clinical organization that the carrier is trying to make nicey nice with, which may or may not be the clinical organization that that plan sponsor's patients/members are actually going to. Like, the dollars go to some big, consolidated hospital when most of the plan's members are going to, say, indie PCPs in the community, as just one example. So, yeah, if I'm the plan sponsor in this mix, what am I paying for exactly and for how many of my members? I've seen the sharp type of plan sponsors whip up spreadsheets and do the math and report back that there ain't much value in that value-based care. It's a euphemism for, hey, here's an extra fee for something that sounds good, but … The end. Then I was talking to Marilyn Bartlett the other day and drilled down into some more angles about how this whole “hey, let's use the value-based care word to extract dollars from plan sponsors” goes down. Turns out, another modus operandi beyond the PEPM surcharge is for carriers to add “value-based fees” as a percentage increase or factor to the regular claims payments—something like, I don't know, 3.5% increase to claims. These fees are, in other words, hidden within billing codes. So, right, it's basically impossible to identify how much of this “value-based” piece of the action is actually costing. These fees are allowable, of course, because they're in the contract. The employer has agreed, whether they know it or not, to pay for value-based programs or alternative pay, even though the details are not at all, again, transparent. And that not at all transparent also includes stuff like, what if the health systems or clinical teams did not actually achieve the value-based program goals? What if they failed to deliver any value-based care at all for the value-based fees they have collected? How does anybody know if the prepaid fees were credited back to the plan sponsor, or if anything was actually accomplished there with those fees? Bottom line, fees are not being explicitly broken out or disclosed to the employers. Instead, they are getting buried within overall claims payments or coded in a way that obscures the value-based portion. So, yeah, charges for value-based care have become a solid plan to hide reimbursement dollars and make carrier administrative prices potentially look lower when selling to plan sponsors like self-insured employers. Justin Leader touches on this in episode 433 about the claims wire, by the way. Now, caveat, for sure, it's possible that patients can get services of value delivered because someone uses that extra money. And it's also possible that administrative costs go up and little if any value is accrued to patients, right? Like one or the other, some combination of both. It goes back to what Dr. Tom Lee talked about in episode 445. If there's an enlightened leader who gives a “shed,” then indeed, patients may win. But if not, if there's no enlightened leader in this mix, it's value based alright for carrier shareholders who take bad value all the way to the bank. Al Lewis quotes Paul Hinchey, MD, MBA, who is COO of Cleveland-based University Hospitals. And Dr. Hinchey wrote, “Value-based care has increasingly become a financial construct. What was once a philosophy centered on enhancing patient care has been reduced to a polarizing buzzword that exemplifies the lack of alignment between the financial and delivery elements of the healthcare system.” And then on the same topic, I saw William Bestermann, MD, he wrote, “The National Academy of Medicine mapped out a plan to value-based care 20 years ago in detail. We have never come close to value-based care because we have refused to follow the path. We could follow it, but we don't, and we never will as long as priorities are decided by businessmen representing stockholders. It is just that simple.” Okay, now. Let's reset. I'm gonna take a left turn, so fasten your seatbelts. Just because a bunch of for profit and not-for-profit, nothing for nothing, entities are jazz-handing their ways to wealth by co-opting terminology doesn't mean the intent of value-based care isn't still a worthy goal. And it also doesn't mean that some people aren't getting paid for and providing care that is of value and doing it well. There are, for sure, plenty of examples where an enlightened leader was able to operationalize and/or incentivize care that is of value. Occasionally, I also hear a story about a carrier doing interesting things to pay for care that is of value. Jodilyn Owen talked about one of these in episode 421. Justina Lehman also (EP414). We had Larry Bauer on the show (EP409) talking about three bright spots where frail elderly patients are getting really good care as opposed to the really bad care that you frequently hear about when you even say the words frail elderly patient. And all of these examples that he talked about were built on a capitated model or on a model that facilitated patients getting coordinated care and there being clinicians who were not worried about what code they were gonna put in the computer when they helped a patient's behavioral health or helped a patient figure out how they were gonna get transportation or help them access community services or whatnot. There are also employers direct contracting with health systems or PCPs and COEs (Centers of Excellence) and others, contracting directly with these entities to get the quality and safety and preventative attention that they are looking for. And there are health systems and PCPs and practices working really hard to figure out a business model that aligns with their own values. So, value-based care—the actual words, not the euphemism—value-based care can still be a worthy goal. And that, my friends, is what I'm talking about today with Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH). PBGH members are really focused on innovating and implementing change. We talk about some of this innovation and implementation on the show today, and it is very inspiring. Elizabeth argues for for-real alternative payment models that are transparent to the employer plan sponsors. She wants prospective payments or bundled payments, and she wants them with warranties that are measurable. She wants members to get integrated whole-person care in a measurable way, which most health plans (ie, middlemen) either cannot or will not administer. Elizabeth says to achieve actual care that is of value, cooperation between employers, employees, and primary care providers is crucial (ie, direct contracts). She also says that this whole effort is really, really urgently needed given the affordability crisis affecting many Americans. There's been just one article after another lately about how many billions and billions of dollars are getting siphoned off the top into the pockets of the middlemen and their shareholders. These are dollars partially paid for by employees and plan members. We have 48% of Americans with commercial insurance delaying or forgoing care due to cost. If you're a self-insured employer and you're hearing this, don't be thinking it doesn't impact you because your employees are highly compensated. As Deborah Williams wrote the other day, she wrote, “Co-pays have gotten high enough that even higher-income patients can't afford them.” And she was referencing a study to that end. So, yeah … with that, here is your Summer Short with Elizabeth Mitchell. Also mentioned in this episode are Purchaser Business Group on Health; Tom X. Lee, MD; Scott Conard, MD; Brian Klepper, PhD; Katy Talento; Marilyn Bartlett; Justin Leader; Laurence Bauer, MSW, MEd; Al Lewis; Paul Hinchey, MD, MBA; William Bestermann, MD; Jodilyn Owen; Justina Lehman; and Deborah Williams. You can learn more at PBGH and by connecting with Elizabeth on LinkedIn. Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), supports the implementation of PBGH's mission of high-quality, affordable, and equitable healthcare. She leads PBGH in mobilizing healthcare purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts. Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth also served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health, worked within an integrated delivery system, and was elected to the Maine State Legislature, serving as a state representative and chair of the Health and Human Services Committee. Elizabeth served as vice chairperson of the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's (NAM) “Vital Signs” Study Committee on core metrics and now on NAM's Commission on Investment Imperatives for a Healthy Nation, a Guiding Committee member for the Health Care Payment Learning & Action Network. She now serves as an appointed board member of California's Office of Healthcare Affordability. Elizabeth also serves as an advisor and board member for healthcare companies. Elizabeth holds a degree in religion from Reed College, studied social policy at the London School of Economics, and completed the International Health Leadership Program at Cambridge University. Elizabeth was an Atlantic Fellow through the Commonwealth Fund's Harkness Fellowship program. 10:36 What are members and providers actually asking for in terms of value-based care? 10:56 Why won't most health plans administer alternative payment models? 12:17 “We do not have value in the US healthcare system.” 12:57 Why you can't do effective primary care on a fee-for-service model. 13:30 Why have we fragmented care out? 14:39 “No one makes money in a fee-for-service system if people are healthy.” 17:27 “If we think it is not at a crisis point, we are kidding ourselves.” You can learn more at PBGH and by connecting with Elizabeth on LinkedIn. @lizzymitch2 of @PBGHealth discusses #valuebasedcare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation #vbc Recent past interviews: Click a guest's name for their latest RHV episode! Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn, Dr Tom Lee, Paul Holmes (Encore! EP397), Ann Kempski, Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter
Join Jeff Kaufman, attorney, radio host, and comic book writer, as he uncovers the untold tales of celebrities, infamous figures, and unsung heroes. From the glamour of Hollywood to the gritty stories of true crime survivors, every episode of "Under Oath" promises a captivating journey into the lives of those who've made a mark.Listen to the show live on Saturdays, at 7:30am EST, on Real Radio 104.1, or catch the stream on your iHeartRadio app (or wherever you get your shows and podcasts). You can also watch the show on YouTube.
Today is an encore because I am going on vacation next week. It always feels a little bit like a time warp because by the time this show will air, I will be back from vacation. This show with Paul Holmes was one of the most popular episodes of 2023 and definitely is just as relevant now. A lot of the things that Paul talks about are worth repeating or listening to again. For a full transcript of this episode, click here. Before we kick in, though, I'm gonna repeat something that Ge Bai, PhD, CPA, says a lot: There's no angels and there's no devils in the healthcare industry. But we are talking about for-profit entities. And if there's one thing that's generally true about a for-profit entity, especially one that is publicly traded, it's gonna do whatever it can get away with. It becomes up to the customer to set expectations and using the purchasing discipline that they probably use everywhere else in the business because it basically is good business to have purchasing discipline. Before we kick into the episode, just a couple of things. Thing one, if you haven't, do subscribe to the weekly email that goes out describing the show. Here's just one reason to do so. It's really efficient because what is transcribed in that email is the whole beginning half (usually) of the introduction. So, if later on you are trying to remember which episode you heard something in, you can just search your email and find the show. How you subscribe is go to relentlesshealthvalue.com, hang out for probably 15 seconds, and there will be a pop-up. And while you're on the Web site, here's something else you could do. Go to the lower right-hand corner of the Web site. You will notice a little button. It's an orange button. There's a microphone. Click on that; say something like your name, your company name, maybe a word or two about Relentless Health Value; and then encourage others to subscribe to the weekly email that goes out, similarly to what I just did. Then what our team will do is take that recording and potentially use it at the end of some of the shows so we can hear somebody else talk besides myself. So, please do go over to the Web site, click on that little microphone, and record something that you might want to share with the other members of the Relentless Tribe. And with that, here's your encore. If this were a video show, I would stare into the camera with steely eyeballs right now and say that I have a special message for employer CFOs. If you aren't a CFO, pretend that you are so that you get the full effect here. So, now that we're all CFOs, let's pull up the company P&L (Profit and Loss) statement. This is what keeps us all up at night, right? Making sure that the net profit line at the bottom looks good. We could decide to lay off a few people. Reorg something or other. Beat up a vendor. We also could go over and have a strident conversation with sales leadership about what they can do to jack up their sales revenue. Top line begets bottom line and all that. Or, here's another idea: In this healthcare podcast, I am speaking with Paul Holmes, who is an ERISA (Employee Retirement Income Security Act) attorney with a specialty in PBM (pharmacy benefit manager) contracts, especially the PBM contracts from the big PBMs that get jammed in employer plan sponsor faces by whomever and which they are told look fine and that the employer plan sponsor should just go ahead and sign. Now, if we, meaning all of us CFOs, sign that paper, or someone on our benefits team signs the paper … fun fact, our company just spent 30% to 40% over market for our pharmacy benefits. That contract we just signed contains all kinds of expensive little buried treasures—treasures accruing to the PBM and other parties, to be clear, and coming at our expense. There's 17-ish very common treasures in your typical PBM contract, and none of us will ever spot them unless we know what we are looking for. But let's dig into this for a sec, especially for all of us newly minted CFOs because the real ones already did this math. Say our company spends whatever—we're a bigger company, and we spend $100 million a year on our drugs. That's a minimum of $30 million that we got taken for … $30 million a year. Because of the huge dollars at stake (30% to 40% of drug spend), it's certainly the advice of almost anybody that you talk to who's an expert in PBM contracts to have a third party—not your EBC (employee benefit consultant), which we'll get into in a sec, but somebody else (a third party)—review every PBM contract. I mean, what's the worst that can happen for anybody considering having an independent third party review their PBM contract? It costs a couple grand in lawyer fees, and they give it a stamp of approval. Knowledge is power, and now we know. But let's just say this third-party review doesn't happen. We all go with a “devil may care” about this whole PBM overcharging us by 30% to 40% possibility. And let's say the PBM contract is, in fact, a ride on the Hot Mess Express but we don't know it. Here's two pretty bad downsides, especially now, this year, since the passage of the CAA (the Consolidated Appropriations Act). Number one bad thing: Plan sponsors may get sued as per the CAA for ERISA violations. It's not just the company paying that extra $30 million, or 30% to 40%, right? It's also employees. This is risk exposure, bigly. Just like it was on the 401(k) side of the house, which Paul Holmes, my guest today, mentions later on in the interview. He talks about just how much those lawsuits cost and, yeah, exposure. As I mentioned three times already, today I am speaking with Paul Holmes about PBM contracts in all their stealthy glory. The one thing I came to appreciate is that these things are works of art … if you're into those paintings of pretty flowers where, if you look hard enough, you spot a skull tucked in the greenery (memento mori). Paul is a longtime ERISA attorney. He has dedicated his career to helping plan sponsors in their negotiations with PBMs and trying to help them reduce drug spend, especially drug spend that isn't actually paying for drugs. Here's a link to an article we discuss about how a school district in Florida is suing their longtime EBC for taking $2 million a year in alleged secret payments. We also mention an episode with AJ Loiacono (EP379). And along similar lines, Jeff Hogan mentioned on LinkedIn the other day, “It's pretty amazing that just in the course of the [past few] weeks, I'm reading, seeing, and hearing about big new CAA breach of fiduciary duty cases.” So, Paul Holmes says this more eloquently, but if you're a plan sponsor, definitely get your PBM contract reviewed and maybe consider working with an EBC who's happy to sign the disclosure statement that your lawyer has provided without disclaimers. Also mentioned in this episode are Ge Bai, PhD, CPA; AJ Loiacono; and Jeffrey Hogan. You can learn more by emailing Paul at pbh@williamsbarbermorel.com. Paul B. Holmes, JD, is a seasoned ERISA lawyer with nearly 40 years of specialization in that field. Paul joined Williams Barber & Morel Ltd. recently, after 31 years with Nixon Peabody LLP and Ungaretti & Harris LLP. Paul is one of the few ERISA lawyers in the United States, concentrating his practice on PBM contracting and oversight. Paul represents large employers, Taft-Hartley welfare funds, and governmental units in their selection, contracting, auditing, and disputes with large pharmacy benefit managers (PBMs). This work includes active oversight of the request for proposal (RFP) process for selecting a PBM, the negotiation and customization of PBM contracts, and legal audits of PBM compliance with their contracts. Paul provides insightful guidance on the prudent selection of independent pharmacy benefit consulting firms (who do not receive indirect compensation from PBMs), which independence is expressly required under Section 202 of the Consolidated Appropriations Act of 2021 (CAA). Recent efforts have focused on reducing wasteful drug spend promulgated by large PBMs in dozens of categories. These include the preference of Humira® biosimilars, reducing off-label utilization of GLP-1s, reducing huge markups on certain specialty generics, and customizing PBM formularies and clinical protocols to better control spend. He was selected, through a peer-review survey, for inclusion in The Best Lawyers in America® (2020 and 2021) in the field of Employee Benefits (ERISA) Law. Paul received his bachelor's degree from Bradley University and his Juris Doctor degree from the University of Illinois College of Law. 07:41 What are Paul's usual observations when a PBM contract crosses his desk? 08:34 “If you just sign … one of their model contracts …, you're probably gonna pay 30% to 40% above market on your drug spend.” 12:11 What is a PBM lawyer? And why is it important to find an ERISA PBM lawyer? 17:12 EP379 with AJ Loiacono. 17:40 Who is on the hook for the cost of the PBM contracts? 21:05 What's the problem with most ERISA lawyers today? 22:56 Lawsuit about PBM contract. 27:43 What's Paul's advice for benefits consultants? 31:40 How much might a plan sponsor be paying their consultant versus what a consultant might be making from a PBM? You can learn more by emailing Paul at pbh@williamsbarbermorel.com. Paul Holmes discusses #PBMContracts on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Ann Kempski, Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter, David Muhlestein, Luke Slindee, Dr John Lee, Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363)
For a full transcript of this episode, click here. Unintended consequences is a thing. ERCowboy wrote on Twitter a while back, “In any complex system, the likelihood of unintended consequences vastly outweighs the predictability of intended ones.” In this healthcare podcast, we're talking about two state laws where this is apropos: CON (Certificates of Need) laws and then COPA (Certificates of Public Advantage). Turns out, states actually have pretty much power to impact the competitive landscape in their state. They have a lot of levers they can pull. States really can make a difference in terms of improving real competition on value and on cost and quality. So, these two laws are, in a way, their attempt to do so. Before we kick into what's going on here, I think it is important to point out that these laws on their face aren't an obviously and overtly terrible mistake. This isn't like equivalent to accidentally putting ChapStick in the dryer. There were good people who spied a problem and had an idea for how to fix it. I'm reminded of something I read by Nicholas Kristof on a totally different topic, but he wrote, “The central problem is not so much that the effort was unserious as it's more focused on intentions than on oversight and outcomes.” And that pretty much sums up, I think, the gist of what's going on here. And I can say that because here we are in a position to Monday morning quarterback. So, I've invited Ann Kempski on the pod to point out what hindsight may reveal about these well-intentioned efforts, the CON and COPA laws. First up, let's talk about Certificate of Need laws, or the CONs. Currently, we have 35 states and Washington, DC, that operate CON programs with wide variations by state. The National Conference of State Legislatures has a good overview of each state's laws. Why did these laws originally get put into effect? They got put into effect to cut down on supply-driven demand that was considered to potentially raise total cost of care—because in healthcare, unlike Econ 101, more supply doesn't mean lower prices. In the real world, if you have more supply, volume goes up and total cost of care goes up, too. So, it could be considered good thinking to limit the amount of supply. Except there's four problems that wind up happening often enough, which is why some states are busy repealing these CON laws. We cover these four problems in the show that follows. Spoiler alert: What happens a lot of times is that the big get bigger. Consolidated entities have an upper hand, and we all know consolidated entities are generally not known for their competitive prices or their desire to rationalize volume. So, yeah … we dig into this and parse it out into, as I said, four main problems; but this is most commonly where it all winds up (ie, total cost of care does not go down). I have included links that Ann Kempski shared with me, including a statement from the Federal Trade Commission (FTC) and Department of Justice detailing the anticompetitive effects of state CON laws. There's also a document written by a former FTC commissioner that highlights how state CON laws can inhibit competition. And then lastly, a systemic review of 90 studies that find the costs of CON laws exceed their benefits. Okay, so let's move on to our number two state law that often does not go as planned; and this is the Certificate of Public Advantage, or the COPA, laws. Approximately 19 states have them, and these laws attempt to immunize hospital mergers from antitrust laws by replacing competition with state oversight. The idea here is that a state tells the FTC to stand down and gives their seal of approval to a merger to stop it from getting scrutinized for antitrust violations. So, like, a big dominant health system gets an okay to buy a rural hospital. Meanwhile, everybody realizes this will lead to a situation where there is a dominant health system and that dominant health system will reduce competition. But the state may choose to do this because … public advantage, as in the “PA” in COPA, Certificate of Public Advantage. But they'll do this because the state has decided that the public advantage of allowing the possibly problematic anticompetitive merger to move forward, the public advantage is a bigger advantage than having competition. Hmmm … what could go wrong here? Well, several things that Ann Kempski discusses in the show that follows. The Federal Trade Commission strongly advised the states against enacting these laws. Here is a link to this article that was on the FTC Web site. I was so thrilled to get the chance to chat with Ann Kempski, who knows so much about these topics. Ann Kempski is an independent healthcare consultant with a background in the labor movement, advocating for healthcare workers and purchasers for many years. Ann Kempski collaborates with clients to strengthen primary care, enhance union health funds, and reduce commercial prices. She often partners with academics from Johns Hopkins to analyze hospital transparency data for insights into market trends. Before we jump into the episode, we've had a loss in our community. We've had actually several, one of them being Marshall Allen, another one being Suzanne Delbanco. I know our guest today worked alongside of and really admired Suzanne. Ann Kempski says: “Suzanne was a kindred spirit and a real inspiration for me and many others. She founded two very influential nonprofit organizations: first, The Leapfrog Group and then, second, Catalyst for Payment Reform, which is dedicated to empowering purchasers to be more effective purchasers in the healthcare marketplace.” Additional Resources on State Laws and Policies That Promote Hospital Consolidation, Inhibit Competition Certificate of Public Advantage (COPA) Laws A recent story from Tennessee highlights the weak oversight and observed in COPA-related hospital mergers. Competition and Antitrust in Healthcare “Is There Too Little Antitrust Enforcement in the US Hospital Sector?” by Zarek Brot-Goldberg, Zack Cooper, Stuart Craig, and Lev Klarnet, April 2024 Catalyst for Payment Reform publications and white papers The Great Reversal: How America Gave Up on Free Markets, by Thomas Philippon, 2019 Also mentioned in this episode are Nicholas Kristof; Marshall Allen; Suzanne Delbanco; Brian Klepper, PhD; and Gloria Sachdev, PharmD. You can learn more by following Ann on LinkedIn. Ann Kempski is an independent health policy consultant with 30 years of experience as an analyst, advocate, and strategist advancing health reforms related to coverage, quality, and payment in public programs and commercial insurance. She has served in leadership roles in several organizations, including Kaiser Permanente, SEIU (Service Employees International Union), and the State of Delaware. Ann currently supports organizations and efforts to strengthen primary care payment and transition away from fee for service, promote competition in commercial healthcare prices and coverage, and expand access to evidence-based behavioral health services. Ann is especially grateful to collaborate with and learn from talented graduate students and faculty at Johns Hopkins Bloomberg School of Public Health on research and policy analysis to understand commercial market and price dynamics and provider behavior. She has an undergraduate degree in economics from the College of William & Mary and a master's degree in industrial and labor relations from Cornell University. 06:20 Ann remembers Suzanne Delbanco. 06:55 EP224 with Suzanne Delbanco. 07:40 What are state Certificate of Need laws? 08:44 Why are states getting rid of these CON laws? 13:26 Why CON laws are created. 15:43 EP437 with Brian Klepper, PhD. 16:09 What are the conflicts of interest and problems that arise when CON laws are created? 20:55 What happens when states get rid of these CON laws? 24:10 How are Certificate of Public Advantage laws different from CON laws? 27:58 Why does the research show that COPAs don't usually accomplish their goals? 31:34 What encouraging current events are happening in the realm of COPA laws? 32:08 Gloria Sachdev, PharmD, of Employers' Forum of Indiana. You can learn more by following Ann on LinkedIn. @kempann discusses #COPA and #CON state #healthcarelaws on our #healthcarepodcast. #healthcare #podcast #financialhealth #primarycare #patientoutcomes #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Marshall Allen (tribute), Andreas Mang, Abby Burns and Stacey Richter, David Muhlestein, Luke Slindee, Dr John Lee, Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363), Dan Mendelson
California is the latest state to address healthcare affordability through cost growth targets. Elizabeth Mitchell – President and CEO of Purchaser Business Group on Health – Joins us to discuss the nuts and bolts of the 3% cost growth target recently adopted by the state. Healthcare affordability is a big issue across the country. More than half of us skip or postpone care due to cost and medical bills are a leading cause of bankruptcy. Reining in medical costs is also how we'll free up resources for what we know works to build health in America: prevention, addressing the social drivers and fostering health in communities.We discuss:Two proven strategies to reduce healthcare costs: advanced primary care and effective specialty referralsWhy better consumer “shopping” is not the path to healthcare affordability How price transparency gives employers new tools to negotiate, and reveals troubling facts about purchasing intermediariesElizabeth reminds us how troubling it is that we don't have clear prices in a sector that makes up 20% of the economy:“The idea that you can't find out what something is going to cost before you agree to it is outrageous. Name any other industry that refuses to show you a price. It is incredible to me that we are still fighting about transparency when it is 20 % of the US economy. I mean, this is a multi-trillion-dollar industry who feels no accountability to show pricing. So, I just think it is incredible that we do not have meaningful transparency yet.”Relevant LinksCalifornia's Office of Health Care Affordability sets cost growth targetFederal hospital price transparency requirementsPurchaser Business Group on Health (PBGH) websitePBGH white paper on advanced primary careUS Department of Labor clarifies the fiduciary responsibilities of self-insured employers purchasing healthcareAbout Our GuestAs President and CEO, Elizabeth Mitchell advances Purchaser Business Group on Health's (PBGH's) strategic focus areas of advanced primary care, functional markets and purchasing value. Mitchell leads PBGH in mobilizing health care purchasers, elevating the role and impact of primary care, and creating functional health care markets to support high-quality affordable care, achieving measurable impacts on outcomes and affordability.At PBGH, Elizabeth leverages her extensive experience in working with health care purchasers, providers, policymakers and payers to improve health care quality and cost. She previously served as Senior Vice President for Healthcare and Community Health Transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment and community health. Mitchell also served as the President and CEO of the Network for Regional Healthcare Improvement (NRHI), a network...
Are you in need of Christ's comfort in the midst of your pain? Guest Elizabeth Mitchell will point you to hope in this episode of Grounded.
Why would you raw dog when the Preston & Steve Show podcast exists? (00:00:00) News (00:28:56) Entertainment News (00:40:17) Rawdogging (01:10:41) Bizarre Files (01:21:09) Fish or Firework, Murr on Zoom (01:49:28) Elizabeth Mitchell, Totally Presbo (02:33:13) Bizarre Files (02:51:08) Hollywood Trash & Music News (03:01:35) Wrap Up
For a full transcript of this episode, click here. Cognitive dissonance is kind of rampant in the healthcare industry. Cognitive dissonance is when what someone winds up doing, their actions, are in conflict with what they believe in. Cognitive dissonance also can mean when someone holds two contradictory beliefs at the same time. Let's say a person believes they want to do well by patients but their performance review depends on, as just one example, making care less affordable for patients. But somehow, this individual is able to conclude that what they're doing is a net neutral or a net positive despite (in this hypothetical, let's just say) obvious indications that it is not. In this hypothetical, there are, say, clear facts that show that what this person is up to is indisputably a problem for patients. But yet at every opportunity, this person talks about their commitment to patients. This rationalization, or earmuffs don't look, don't see, is cognitive dissonance. Now, it's harder to engage in cognitive dissonance the closer you are to patients because you see the impact up close. This is probably why moral injury and burnout is most associated with clinicians who are seeing patients. Unless these at-the-bedside clinicians enjoy a robust lack of self-awareness, those who are seeing patients don't, a lot of times, have the luxury of pretending that what is going on is good for patients when they can see with their own two eyes that it is not good for patients. The further from the exam room or the community, however, the easier it is to not acknowledge the downstream impact—if you can even figure out what that downstream impact is, which is also worthy of being mentioned. When the machine is really big, sometimes it's legitimately difficult to connect the dots all the way down the line to the customers, members, or patients. Kate Wolin, ScD, talked about this in an episode (EP432) a couple of weeks ago. But this whole dissonance exploration was a big reason why actually I created my manifesto, which is episode 400, because almost everything that we do in healthcare wherein we are making money or helping someone else make money is dissonant to some degree. And it literally keeps me up at night contemplating how much dissonance is too much dissonance or how much self-interest is too much self-interest. This is tough, subjective stuff. So, again … episode 400 for more on at least how I think about this. But in this healthcare podcast, I am talking with John Lee, MD, about what to do in the face of all this when working in the, as I call it, belly of the beast—working for a large healthcare organization such as a hospital. Because hospitals sometimes (and we certainly do not want to put all hospitals in the same category—they are a wildly diverse bunch), but sometimes some people at some hospitals do some things which are not things I think they should be doing anyway. They're fairly egregious breaches of trust, actually. But yet within that same organization, you have doctors and other clinicians or others who are working really hard to serve patients as best they can. This is the real world that we're talking about. And the question of the day is … so, now what? While it would be amazing if someday we build a whole new health system that didn't include some people doing things that I don't think they should be doing, that day is not today. And it's not tomorrow. I'm gonna hope that there's other people in our village who are full-on doing the disruption thing. But if we're not able to do that personally, for whatever reason, but we still want to inch forward within the existing environment and do the things that make us feel like we're achieving our mission, what's the best way to think about this? That is what I asked Dr. John Lee, and that's what our conversation is about today. Summing up his advice, which is really good advice, Dr. Lee talks at length about how it's so important to celebrate the small wins and feel good about care that is a little bit better than it was six months ago. He talks about acknowledging that you can't do everything. He talks about incremental improvement that helps both patients but also colleagues, and that's not insignificant to really consciously consider how to work together and help to support each other. Look, I just finished reading a post on LinkedIn about toxic medical culture and just how brutal and cruel some physicians and physician leaders and others can be to their colleagues. Ann Richardson writes about topics like this a lot. Follow her on LinkedIn if you're interested. So does J. Michael Connors, MD. But just saying, it's pretty cognitively dissonant to talk about the potential of team-based care and then condone or engage in toxic behavior with those same team members. There's like 90 studies on this whole topic linked to this book. But bottom line, fixing cognitively dissonant paradigms in any sort of durable or scalable way is, for sure, going to require a culture that inspires constructive criticism, innovation, and collaboration. It also requires—and this is Dr. Lee's last piece of advice—it's really important to seek out like-minded individuals as sounding boards and as a support network to commit to supporting each other. And I hope, all of you, that you feel like you've found your tribe here at Relentless Health Value. You guys are an amazing bunch, so know that and don't hesitate to reach out to each other when you need help. And I know, I know, I need to create a directory so you can all hook up more easily, so do subscribe to the weekly email because I am inching closer to finally managing to get this done and you won't know about it unless you're subscribed. Go to the Web site relentlesshealthvalue.com. You will be hit with a pop-up window fast enough, but back to easing cognitive dissonance and the why here. I thought Michelle Bernabe put how much of a difference the right culture can make for patients and those who work together really eloquently recently. This is a great why, since we spend so much of our life at work. She wrote, “Each day, we come together [ready to] roll up our sleeves, committed to our own growth, our boundaries, … and our teamwork. This collective dedication resonates throughout our organization and is, I trust, felt by our clients and [our] partners!” In the conversation that follows, Dr. John Lee offers a really nice array of examples of incremental, in the belly of the beast, stuff that might be possible in the real world (at least in the bellies of some beasts), plus some other points of contemplation. Dr. Lee is an ER (emergency room) doc by training, who is also an informaticist and chief medical information officer. I can tell you from personal experience that Dr. Lee is one of the most creative and pragmatic problem solvers that I have encountered. He says he's dedicated to trying to help move the ball forward and changing our healthcare system using information technology and using our ability to be far more transparent with the things that we try to do in a positive way in healthcare. Below are some additional episodes concerning heart failure readmissions: EP326: The Unfortunate News About HRRP, With Insight Into How to Fix It, With Rishi Wadhera, MD, MPP INBW34: The Absence of Collaboration Between Healthcare Stakeholders: What It Means EP361: The Gap in Closing Care Gaps, With Carly Eckert, MD, PhD(c), MPH Also mentioned in this episode are Kate Wolin, ScD; Ann M. Richardson, MBA; J. Michael Connors, MD; Michelle Bernabe, RN, KAT; Scott Conard, MD; Jodilyn Owen; Rob Andrews; Rishi Wadhera, MD, MPP; Peter Attia, MD; Barbara Wachsman; Kenny Cole, MD; and Mark Cuban. You can learn more by following Dr. Lee on LinkedIn. John Lee, MD, is both a practicing emergency physician and a highly regarded clinical informaticist. He has served as chief medical information officer at multiple organizations and has an industry reputation for maximizing the utility and usability of the electronic medical record (EMR) as a digital tool. He was the recipient of the HIMSS/AMDIS Physician Executive of the Year Award in 2019. He has deep expertise in EMRs, informatics, and particularly in Epic. He has multiple analyst certifications, which gives him a unique advantage in delivering solutions to Epic organizations. His vision is a healthcare system that is driven completely by transparent data, information, and knowledge, delivered efficiently. 07:37 What is cognitive dissonance relative to the healthcare industry? 08:57 What are the systems that start to bear down on individuals within the healthcare system? 10:14 EP391 with Scott Conard, MD. 10:48 EP421 with Jodilyn Owen. 10:59 EP415 with Rob Andrews. 12:30 EP326 with Rishi Wadhera, MD, MPP. 13:10 “The system has almost gamed them.” 17:49 EP430 with Barbara Wachsman. 19:07 How can alignment still be achieved in the face of cognitive dissonance? 20:34 EP431 with Kenny Cole, MD. 24:06 Why does it take more than one person to solve the dysfunction in the healthcare system? 26:26 What are some little changes that can help change the cognitive dissonance in healthcare? 28:22 Why is a hierarchal healthcare structure not necessarily beneficial? 30:38 The RaDonda Vaught story. 37:58 “Be happy in the small things.” You can learn more by following Dr. Lee on LinkedIn. John Lee, MD, discusses overcoming #cognitivedissonance on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Brian Klepper, Elizabeth Mitchell, David Scheinker (Encore! EP363), Dan Mendelson, Dr Benjamin Schwartz, Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole
For a full transcript of this episode, click here. “Anyone who isn't confused really doesn't understand the situation.” That's a quote by Edward R. Murrow and very apropos. I started thinking about this conversation that I had had with Brian Klepper, PhD, because so much going on right now—so many discussions and dissections taking place about primary care financial struggles, about what is value in healthcare. And the RUC (Relative Value Scale Update Committee) is, at a minimum, an underlying factor; but yet it doesn't come up. Almost ever. Merrill Goozner called the RUC the AMA's (American Medical Association's) “dark secret,” and I can see why. Just one procedural note before I roll tape with Brian Klepper. We're gonna go a little rogue today because you kind of got to understand what the RUC is before I can get into the two points I really want to make about it. So, here's my outrageous plan, which will shake up our standard Relentless Health Value format. Today, I'm gonna make the points I want to make after the interview, not before, like usual. I will, however, just mention the two points so you can keep them in mind as I talk with Brian. Here's the first point, and it's about the doomed financials of primary care. Why is it that primary care has a lot of times no business model unless part of the business model includes driving profitable downstream utilization? And when I say utilization, do I mean services with bigger RVUs (relative value units)? Why, yes, I think I do. We'll dig into this later. Here's my second point, and it's my view on the nature of any postulations that the “value of healthcare services” is equivalent to the prices that we pay for said services. Again, more on that later, but here is my original conversation with Brian Klepper. Brian Klepper is a longtime healthcare analyst and former CEO of the National Business Coalition on Health. Also mentioned in this episode are Merrill Goozner and Elizabeth Mitchell. People who have written about primary care: Scott Conard, MD; Paul Buehrens, MD, FAAFP; Larry McNeely; Primary Care Collaborative; Nisha Mehta, MD; Dan Mendelson; Tony Lin, MD; Juliet Breeze, MD; Raymond Tsai, MD; Linda Brady; Guy Culpepper, MD; David Muhlestein, PhD, JD You can learn more in this article and on the AMA Web site. Brian Klepper, PhD, is principal of Worksite Health Advisors and a nationally prominent healthcare analyst and commentator. He speaks, writes, and advises extensively on the management of clinical and financial risk, on high-performance healthcare, and on realizing the potential of primary care. His current focus is on high-performing healthcare organizations that consistently deliver better health outcomes at lower cost than usual approaches in high-value niches and how, integrated with advanced primary care, they can be configured into turnkey comprehensive high-value health plans that can disrupt the status quo. 02:29 What is the RUC? 06:26 Why is primary care not the “easy” specialty? 09:42 What are three low-value things per RUC? 10:33 EP436 with Elizabeth Mitchell. 10:38 What is a root cause of why primary care doesn't get paid more? 12:50 Why doesn't value equal money? You can learn more in this article and on the AMA Web site. @bklepper1 discusses #TPA and #primaryhealthcare and #mentalhealth on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Elizabeth Mitchell, David Scheinker (Encore! EP363), Dan Mendelson, Dr Benjamin Schwartz, Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman
For a full transcript of this episode, . The episode today is somewhat of a follow-on to the show with Lauren Vela, which was about employer inertia. If we're talking about inertia, though, we'd be remiss not to get a little circumspect about the whole affair and subject some other stakeholders to our microscope. One of these stakeholders is EBCs (employee benefit consultants), practice leads, and brokers, which AJ Loiacono talked about in to some extent; so we can check that box at least for now. That leaves TPAs (third-party administrators), ASOs (administrative services onlys), and health plans. And this hotbed of inertia is what I talk about today with Elizabeth Mitchell from PBGH, the Purchaser Business Group on Health. Similar to earlier shows, one disclaimer is that I am using the TPA and ASO terms sort of interchangeably here. Again, TPA is third-party administrator, and ASO is administrative services only, which is generally the term used when an insurance carrier offers services to a plan sponsor, like a self-insured employer. And these services don't include insurance, because … self-insured. So, the services are administrative only. One point to make clear before we dive in, this conversation is not about these carriers/payers/health plans in general and what they may or may not be doing. This conversation is very specifically focused on how well are those entities helping jumbo employers deploy their health benefits. And first we talk about the role of a TPA or ASO, both in terms of what a jumbo employer might want them to be doing versus what they are often actually doing. Spoiler alert: What they are often actually doing is acting like a full-on health plan and charging as such, even if the health plan part is not what the self-insured employer wants or needs, especially when somebody figures out exactly how much additional is getting charged for those ancillary health plan services. Listen to the show with Justin Leader () for a bead on just a piece of the how much additional that gets baked into the weekly claims wires many self-insured employers get. Bottom line, right now, there's a gap in the market. What is needed are indie TPAs who are effective and efficient and not owned by a health plan because, if history is any predictor of the future, the second the TPA gets owned by a health plan, the TPA sort of ceases to be a TPA and becomes a health plan—with all the attendant bells and whistles that, a lot of times, an employer can't opt out of. And also, the whole not sharing data becomes a thing, both cost data and also quality data. Now, just because there's a gap in the market, does that mean all jumbo employers are paralyzed into inertia? Well, it makes it harder, for sure. But it's also a reason to start figuring out how to solve for a problem when it has as many zeros at the end of it as this problem has. Have you seen these lawsuits popping up all over the place and just the numbers that are involved? Aramark's lawsuit against Aetna is just one example. Not to single out just this one, but in the interest of time, let's talk about this one. Aramark, a big employer, alleged that since 2018, Aetna has taken more than $200 million from it to pay for medical services that should not have been paid out and retains millions of dollars in undisclosed fees. Mark Flores about this one the other day. Also, there was that Cigna lawsuit where an electrician's union health plan was surprised to learn that the fees charged by Cigna had risen from around $550,000 in 2016 to $2.6 million in 2019. That was from a New York Times . For more on stuff like this, follow Doug Aldeen and/or Chris Deacon on LinkedIn. They're a great resource. I'd also listen to the “Who's Suing Who?” episode with Chris Deacon, which was . Because of all of this, the conversation today with Elizabeth Mitchell pretty quickly gets into the shift toward direct contracting between employers and providers to improve access quality and outcomes. If you can't beat them, get ruthlessly practical is my takeaway. I have to say, I truly admire some of these HR folks and their leadership willing to do what it takes on behalf of protecting the people that work for them. Now, important side note: There are certainly some health plans at least trying here, so I don't want to imply otherwise. There are some interesting initiatives that are afoot at, I'm gonna say, usually regional health plans. Elizabeth Mitchell has talked about some of these and made this clear also elsewhere. Lastly, if you aren't familiar with the CAA, which comes up in the episode today, there's a show () on the Consolidated Appropriations Act, which is what CAA stands for. Elizabeth Mitchell, my guest today, currently serves as the president and CEO of the Purchaser Business Group on Health. PBGH members are really focused on innovating and implementing change. We talk about some of this innovation and implementation on the show today, and it is very inspiring. Stay tuned on this topic, given just the absolute need for TPA services like we discuss in the show that follows, and given the smart, innovative, action-oriented people who are affected—1 plus 1 equals … yeah. Stay tuned. Very, very lastly, I just want to give a shout-out and thanks to Brad Brockbank for posing some great questions, which I pretty much turned around and asked Elizabeth Mitchell in this healthcare podcast. Also mentioned in this episode are ; ; ; ; ; ; ; ; ; ; ; ; ; ; and . You can learn more at and by connecting with Elizabeth on . You can also watch a on success with direct contracting. Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health (PBGH), supports the implementation of PBGH's mission of high-quality, affordable, and equitable healthcare. She leads PBGH in mobilizing healthcare purchasers, elevating the role and impact of primary care, and creating functional healthcare markets to support high-quality affordable care, achieving measurable impacts. Elizabeth leverages her extensive experience in working with healthcare purchasers, providers, policymakers, and payers to improve healthcare quality and cost. She previously served as senior vice president for healthcare and community health transformation at Blue Shield of California, during which time she designed Blue Shield's strategy for transforming practice, payment, and community health. Elizabeth also served as the president and CEO of the Network for Regional Healthcare Improvement (NRHI), a network of regional quality improvement and measurement organizations. She also served as CEO of Maine's business coalition on health, worked within an integrated delivery system, and was elected to the Maine State Legislature, serving as a state representative and chair of the Health and Human Services Committee. Elizabeth served as vice chairperson of the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee, board and executive committee member of the National Quality Forum (NQF), member of the National Academy of Medicine's “Vital Signs” Study Committee on core metrics, and a Guiding Committee member for the Health Care Payment Learning & Action Network. She now serves as a board member of California's Office of Healthcare Affordability. Elizabeth holds a degree in religion from Reed College and studied social policy at the London School of Economics. 06:48 What is the overarching context for health plans in healthcare purchasing? 09:00 with Olivia Webb. 11:44 Why is it important to reestablish a connection between the people paying for care and people providing care? 14:07 What are the needs of a self-insured employer when managing employee benefits? 19:41 Is it doable for employers to set their own contracts? 22:11 Is transparency presumed? 23:25 Will the new transparency upon us actually expose wasted expense? 27:45 “This is not about individual bad actors. … The systems … that is not aligned.” 29:32 Are there providers who want to work directly with employers? 32:46 Why is it important that incentives need to be aligned? 34:25 Why is the quality of care even more important than transparency? 36:29 with Rik Renard. 38:08 What's missing from the conversation on changing health plans? You can learn more at and by connecting with Elizabeth on . You can also watch a on success with direct contracting. @lizzymitch2 of @PBGHealth discusses #TPA and #healthplan inertia on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! , , , , , , , , ,
For a full transcript of this episode, click here. I've been in a couple of meetings lately. In one case, a healthcare company came up with a strategy and deployed it; and the strategy didn't go as planned. The other one, it did go as planned—it worked great. Of course, I'm coming in on the back end like a Monday morning quarterback here; but the plan that failed, I have to say, I wasn't surprised. Had they asked me ahead of time, I would have told them to save their money because the plan was never gonna work, even though the strategy looked like kind of a straight line from here to there. Nor was I shocked by the success of the other plan, even though this one that triumphed had what looked like five extra steps and was slightly counterintuitive if you looked at it cold, without understanding the way the healthcare industry actually works. Here's my point: It might feel like the healthcare industry is chaos monkey central and impossible to predict actions and reactions—and, for sure, there's always unknowns and intersecting variables—but it's not a complete black box. The trick is, as you know and I know, you gotta understand what other stakeholders are up to. You gotta get a bead on what they're doing and what their incentives are because then you can better predict actions and potentially reactions. So, let me state the obvious (that's why listeners tune in to this show as I just said, and it's what we aim to shine a light on here at Relentless Health Value): the pushes and the pulls and the forces. What's going on outside of the organizations or the silos that we work within day-to-day. Because if you're looking to sell to, partner with, not be obstructed by [insert some stakeholder here], then it's very vital to be keyed in on what they're doing or what their customers are doing or what their customers' vendors are doing. This show should feel like it gives you a measure of control (or at least that's my hope) or a method to find the measure of control. And I hope you succeed. That's why I continue to put out these shows. The RHV tribe members want the same thing I want—to fix the healthcare industry for patients and for members—so, thanks for being here and for making actionable the insights that you might find here. I have been so looking forward to doing a show with Ben Schwartz, MD, MBA, orthopedic surgeon and prolific writer of deeply thoughtful and insightful posts on LinkedIn. In this healthcare podcast, we are talking about bundled payments. And today's your lucky day if you think you know a lot about bundles, because most people who listen to this show at least know enough to be dangerous. So, that's our starting point, which is why I asked Dr. Schwartz to talk to me about what most people find surprising about bundles and bundled payments. There are four surprises that we go through in the show today. Listen to the show or read the transcript to find out exactly what they are. So, no spoiler alert alert. But relative to these surprises, we get into the four types of bundles that may or may not be available. And those four types of bundles are: 1. CMS bundles such as the BPCI (Bundled Payments for Care Improvement) and the CJR (Comprehensive Care for Joint Replacement) bundles, and we talk about the current state of said BPCI bundles, which are being sunsetted probably because so many efficient clinical teams are being penalized for getting too efficient. They become victims of their own success the way the program is currently designed, wherein the goalposts keep shifting. 2. Commercial bundles—ie, a bundle that is offered by a commercial carrier such as a BUCA (ie, Blue Cross Blue Shield/UnitedHealthcare/Cigna/Aetna/Anthem) carrier 3. Direct bundle—a bundle that is paid for directly by a plan sponsor such as a self-insured employer 4. Condition- or diagnosis-specific bundle. These types of bundles do not spiral around a surgical intervention at their core, which most of the current bundles do. This may describe CMS's recently announced “Making Care Primary” initiative, but we'll have to see about that. Speaking about the #3 kind of bundle, the employer-direct bundles, especially for musculoskeletal (MSK), let me share a post by Moby Parsons, MD, that I thought captured the entrepreneurial spirit of some of these orthopedic surgeons who are seeking employers to direct contract with and cut out the middleman, etc (which, by the way, is the main topic of an entire show upcoming with Elizabeth Mitchell from the Purchaser Business Group on Health). But Dr. Parsons wrote: “When our bundle business has sufficient growth to ensure the absolute sustainability of our practice against declining reimbursements … in a fee-for-service system, I am getting this tattoo. Don't tell my wife. [And the tattoo is ‘Free Yourself.']” My guest today, aforementioned, is Dr. Ben Schwartz. He's an orthopedic surgeon in the Boston area still in full-time clinical practice. He's grown very interested in healthcare innovation, healthcare technology, and does some advising and investing. Dr. Schwartz also writes a great Substack called Dem Dry Bones. After you listen to this show, please go back and listen to the one with Steve Schutzer, MD (EP294) talking about how to create a Center of Excellence and also the one with Rob Andrews (EP415) about how and why if you are a plan sponsor you might want to consider direct contracting with quantifiably amazing provider groups. Also, if you are an ortho or involved in MSK care, I might suggest following Karen Simonton on LinkedIn, as well as Moby Parsons, MD, and, for sure, of course, my guest today, Dr. Ben Schwartz. Also mentioned in this episode are Moby Parsons, MD; Elizabeth Mitchell; Steve Schutzer, MD; Robert Andrews; Karen Simonton; Peter Hayes; Al Lewis; and Cora Opsahl. You can follow Dr. Schwartz on LinkedIn and read his blog on Substack. Benjamin J. Schwartz, MD, MBA, is a fellowship-trained orthopedic surgeon with over 15 years of experience. He has served numerous healthcare leadership roles on both a local and national level with a focus on developing and implementing evidence-based, high-quality musculoskeletal care delivery pathways. Dr. Schwartz is vice chair of the Practice Management Committee for the American Association of Hip and Knee Surgeons and helps advance knowledge of musculoskeletal conditions as a member of the Hip and Knee Content Committee for the American Academy of Orthopaedic Surgeons and editorial board member/elite reviewer for The Journal of Arthroplasty. Dr. Schwartz has extensive experience in value-based care, having personally achieved over $400,000 in savings during his first year in the CMS BPCI-A program. He has received awards for clinical care and professionalism and was named a Castle Connolly Top Doctor in 2022 and 2023. In addition to his clinical work, Dr. Schwartz maintains a strong presence in healthcare technology and innovation as advisor and investor to early-stage digital health companies. He is frequently sought after by clinicians, founders, and venture capitalists for his ability to bridge the gap between real-world medicine and start-ups/entrepreneurship. Dr. Schwartz's passion is thoughtful implementation of technology and innovation to improve healthcare quality, accessibility, costs, and outcomes. 06:07 Where are we in the development of the bundled payments space? 08:09 What are the four types of bundled payments? 09:52 How can bundled payments create perverse incentives? 11:04 What are the positives in bundled payments, and how can they help push us toward value-based care? 13:02 What is surprising about bundled payments? 18:50 EP415 with Rob Andrews. 27:03 How do Centers of Excellence connect back to bundled payments? 29:00 EP346 with Peter Hayes. 30:29 EP294 with Steve Schutzer, MD. 33:38 EP331 with Al Lewis. 33:43 EP372 and EP373 with Cora Opsahl. 37:13 What does Dr. Schwartz think the future is for bundled payments? You can follow Dr. Schwartz on LinkedIn and read his blog on Substack. @BenSchwartz_MD discusses #bundledpayments on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest's name for their latest RHV episode! Justin Leader, Dr Scott Conard (Encore! EP391), Jerry Durham (Encore! EP297), Kate Wolin, Dr Kenny Cole, Barbara Wachsman, Luke Slindee, Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379)
Let's face it. Your life, my life—never goes the way we think it should. Elizabeth Mitchell helps us keep our focus where it needs to be: on Jesus.
If you are into aliens or conspiracies, you've likely heard of the StarChild skull – a strange skull that appears either misshapen, or – as many believe – is the skull of a hybrid between extraterrestrials and human beings. What is the truth behind the StarChild? (What Is The StarChild?) *** In the 1700s life-saving techniques were obviously not as advanced as those we have today. Case in point – one doctor wanted to know if and how a drowned person might be brought back to life. The solution? Go to a hanging and try to revive the executed man. How do you think that went? (The Hanged Man) *** We've spoken often here on Weird Darkness about shadow people – what their purpose is, where they come from, whether they are malevolent or not… but are they ghosts, or something else entirely? (Are Shadow People Considered Ghosts?) *** A Reddit user shares his true story of hiking in the wilderness and suddenly being tracked and hunted over several days by a stranger with unknown intentions. (A Strange Man Hunted Me Through The Park) *** Within the walls of one of England's most picturesque castles, a queen gave birth to her only child and set in motion a chain of events that would become one of Tudor England's most intriguing mysteries. (The Unexplained Disappearance of the Queen's Daughter) *** (Originally aired April 12, 2021)SOURCES AND REFERENCES FROM THE EPISODE…“The Hanged Man” by Romeo Vitelli for Providentia: https://weirddarkness.tiny.us/32j6zyb7“Are Shadow People Considered Ghosts?” by Jacob Shelton for Ranker's Graveyard Shift: https://weirddarkness.tiny.us/uej2nyca“A Strange Man Hunted Me Through The Park” by Redditor u/ValyrianJedi: https://weirddarkness.tiny.us/436p34t7“The Unexplained Disappearance of the Queen's Daughter” by Lydia Starbuck for Royal Central:https://weirddarkness.tiny.us/bfhkxthc“What Is The Starchild?” by Dr. Elizabeth Mitchell, posted at Anomalien: https://weirddarkness.tiny.us/ewccfd5c, and from StarChildProject.com: https://weirddarkness.tiny.us/wb8daydd= = = = = = = = = = = = = = = = = = = = = = = = = = = = = =Weird Darkness theme by Alibi Music Library. Background music provided by Alibi Music Library, EpidemicSound and/or StoryBlocks with paid license. Music from Shadows Symphony (https://tinyurl.com/yyrv987t), Midnight Syndicate (http://amzn.to/2BYCoXZ) Kevin MacLeod (https://tinyurl.com/y2v7fgbu), Tony Longworth (https://tinyurl.com/y2nhnbt7), and Nicolas Gasparini (https://tinyurl.com/lnqpfs8) is used with permission of the artists.= = = = = = = = = = = = = = = = = = = = = = = = = = = = = =(Over time links seen above may become invalid, disappear, or have different content. I always make sure to give authors credit for the material I use whenever possible. If I somehow overlooked doing so for a story, or if a credit is incorrect, please let me know and I will rectify it in these show notes immediately. Some links included above may benefit me financially through qualifying purchases.)= = = = = = = = = = = = = = = = = = = = = = = = = = = = = ="I have come into the world as a light, so that no one who believes in me should stay in darkness." — John 12:46= = = = = = = = = = = = = = = = = = = = = = = = = = = = = =WeirdDarkness® is a registered trademark. Copyright ©2024, Weird Darkness.= = = = = = = = = = = = = = = = = = = = = = = = = = = = = =PARTIAL TRANSCRIPT: https://weirddarkness.com/starchild-alien-human-hybrid/
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