Podcasts about health rosetta

Today I am speaking with Dave Chase from Health Rosetta, and I'm asking Dave Chase three inferno-level burning questions—questions that, across the country, many self-insured employers are trying to find the answers to. 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. Now, an important underlying point that comes across loud and clear but remains unsaid, actually, in the conversation that follows is this: There are amazing brokers and EBCs (employee benefit consultants) and benefits advisors or TPAs (third-party administrators) who put their clients first and have the receipts (ie, they have data and they're willing to share it to prove this). And then there are those with the exact same titles, often enough, who are very much the opposite of this but super charming, I'm sure. I mean, it'd be a stretch to assume that the same roles don't apply to brokers or EBCs that apply for titles like hospital administrators where there's great ones and really not great ones; but everybody often gets lumped into the same category or even the term hospitals. Each of these terms is a broad stroke and contains multitudes. And do listen to the bonus clip from two weeks ago with Jonathan Baran for just more on this point. We dig into it for like 10 minutes or something. I also talk about this same concept in an upcoming episode with Mick Connors, MD. So, keep that underlying and unsaid theme in mind because a lot of these questions do boil down to, How do you figure out who's on the up-and-up and who's not? And if you need an example of the latter category, listen to the show with Ann Lewandowski (EP476) about the whistleblower lawsuit or the show with AJ Loiacono (EP379) about the myriad of brokers taking $7 or $14 per script written payable by the PBM (pharmacy benefit manager) and not reported on, as far as I know. This is very much still going on today, by the way, despite the CAA (Consolidated Appropriations Act) and the 5500 forms. Alright, so, first burning question, Question 1: After seeing J&J (Johnson & Johnson) and Wells Fargo sued for fiduciary breaches, what specific questions do I need to ask my benefits advisor to prove that my benefits advisor actually protects my interests? Okay, paraphrased, this question is employers trying to figure out what they can ask or how they can figure out if their benefits advisor or broker or employee benefit consultant is really as trustworthy as they'd like you to believe they are. There's been a whole bunch of shows that circle up on this. The thing is, though, the stakes are very, very high right now. So, yeah, I can see why this is turning into a burning question for anyone worried they might get sued personally unless they can figure out how to vet, for real in writing, who their broker, EBC, or advisor serves actually at the end of the day. Question 2 that I ask Dave Chase, and I'm not giving you the answers to these questions. You gotta listen to the show. But here's the second question I ask: How do I avoid personal liability when my TPA contract has hidden conflicts that could trigger an ERISA (Employee Retirement Income Security Act) lawsuit? Kind of a continuation of Question 1, but yeah, you can tell that self-insured employer teams are really digging in here and many, many are very aware of, first of all, the extent and depth of middle people doing things like, again, allegedly taking $20 million of employer clients' money and funding their executive bonus pool. So, yeah, definitely this is another doozy of a burning question. Also on these same topics, listen to the show with Justin Leader (EP433) and also the one with Cynthia Fisher (EP457) about spread pricing. Question 3 that I ask Dave Chase: My pharmacy costs keep climbing despite PBM guarantees. How do I tell if I am being systematically overcharged? Well, if your consultants are taking your rebates to fund their executive bonus pools, as I just mentioned there's a whole show about with Ann Lewandowski, or if they're taking $7 a script for every script that gets written for your members, which, yeah, that's afoot. I've seen the contracts and the cease and desists currently flying around our industry about that one. Or read that Osceola County lawsuit against their longtime brokers. Bottom line and end of this intro, informed employer teams are, for sure, wondering these questions. But even more than just wondering, what these questions signify to me, kind of at the macro level, they're realizing the danger of kind of sitting on that knowledge or just assuming that because everybody else is doing whatever, it's somehow safe—though status quo is getting kind of more and more dicey every single day. As some additional foreshadowing, this show finishes up with Dave Chase talking about the open-source resources that are available so that you too can create a high-performance health plan where members get higher-quality healthcare and, as Dave Chase says, the cost savings for free. There are links to many things that you can get from Health Rosetta and their sister company, Nautilus. Again, all the stuff is for free. Go to nautilushealth.org. That's their main Web site. Dave Chase, who has been on this podcast—I think this is his third time, although it has been a while—Dave Chase is co-founder and CEO of Health Rosetta. Also mentioned in this episode are Health Rosetta; Jonathan Baran; Mick Connors, MD; Ann Lewandowski; AJ Loiacono; Chris Deacon; VerSan Consulting; Justin Leader; Cynthia Fisher; Nautilus; Andreas Mang; Blackstone; Jon Camire; Claire Brockbank; Elizabeth Mitchell; Scott Haas; Paul Holmes; Chris Crawford; Luke Slindee, PharmD; Mark Cuban; Marilyn Bartlett, CPA, CGMA, CMA, CFM; Leah Binder; and Dawn Cornelis.   You can learn more at Health Rosetta and follow Dave on LinkedIn.   Dave Chase is on a mission to restore hope, health, and economic well-being to communities through healthcare transformation. As creator of the community-owned health plan (COHP) model, he is building a nationwide movement that turns health plans from drivers of wage stagnation into vessels for well-being and wealth creation. As founder of Health Rosetta, Dave has helped transform healthcare for thousands of employers covering more than five million Americans. What began with identifying just five successful health plans nationwide has grown into a movement with thousands of sustainable successes that deliver superior care at 20% to 50% lower costs. In 2024, his team launched Nautilus Health Institute, catalyzed with $4 million in Health Rosetta intellectual property and investment. Nautilus provides open-source standards, contracting templates, and technology infrastructure (including METL, an open-source healthcare data platform) that establish new market norms benefiting employers, clinicians, and communities. Dave's work in healthcare transformation has reached over 10 million people through best-selling books (The CEO's Guide to Restoring the American Dream, The Opioid Crisis Wake-up Call, Relocalizing Health), media, TED Talks, and TV/film appearances. He has received the World Health Care Congress's Lifetime Achievement Award for Health Benefits Innovation. Dave is dedicated to transforming healthcare through transparency, community ownership, and proven solutions that restore the American Dream.   06:36 What questions does a plan sponsor need to ask their consultant, EBC, or broker to ensure they are protecting the interest of the plan sponsor? 07:59 EP478 with Andreas Mang and Jon Camire. 08:49 EP453 with Claire Brockbank. 09:51 EP433 with Justin Leader. 09:53 EP436 with Elizabeth Mitchell. 11:03 How can plan sponsors avoid personal liability when their TPA has hidden conflicts of interest? 11:40 Tiara Yachts v. Blue Cross Blue Shield of Michigan lawsuit. 13:48 EP483 (Part 1) with Jonathan Baran. 14:18 EP457 with Cynthia Fisher. 16:18 The Marshall-Hickenlooper bill called the Price Tags Act. 16:50 Summer Short with Elizabeth Mitchell. 17:36 How do plan sponsors figure out if they are being overcharged for pharmacy benefits? 18:09 EP365 with Scott Haas. 20:18 EP397 with Paul Holmes. 20:22 EP465 with Chris Crawford. 20:37 EP429 with Luke Slindee, PharmD. 22:56 EP476 with Ann Lewandowski. 28:38 Where to find open-source resources to help guide plan sponsors with making better health plan decisions. 29:47 How the open-source trend is growing for health transparency. 30:48 What to look forward to at RosettaFest.   You can learn more at Health Rosetta and follow Dave on LinkedIn.   @chasedave discusses questions #plansponsors need to ask on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts), Andreas Mang and Jon Camire (EP479)

Back in 2014, I was at a crossroads that every consultant hits: I knew the traditional way of selling benefits was broken, but I didn't have the playbook to build something better. It's a place where you feel stuck, forced to sell the "least bad" option from a carrier while managing the inevitable rate hikes for your clients.Then I read a book that changed the entire trajectory of my career, and this week, I'm sitting down with the man who wrote it. My guest, Dave Chase, is the architect of the Health Rosetta—the blueprint that gives advisors the tools to stop managing symptoms and start fixing the problem. This episode isn't just theory; it's the practical, step-by-step plan that transformed my business and can do the same for yours.Here's the registration link for Rosetta Fest: https://rosettafest.org/#sec10▶▶ Sign Up For Our Social Media Sales Seminar:https://www.completegameu.com/registration-SMSSKEY MOMENTS(00:00:00) The Blueprint for Fixing American Healthcare with Dave Chase(00:00:46) The "Why": From Personal Tragedy to a National Movement (00:09:46) The Generational Shift Forcing the System to Change (00:21:48) The Blueprint in Action(00:25:08) More Than a Broker, a Life-Changing Advisor (00:30:00) The Open-Source Playbook to Change an Entire Industry (00:39:54) How to Implement Real Change Without Creating ChaosCONNECT WITH ANDY NEARY

 In this episode of ShiftShapers, host David A. Saltzman welcomes Dave Chase, co-founder of Health Rosetta, a movement that has become a national force in transforming employer-sponsored healthcare.Dave shares the deeply personal story that drove him to create Health Rosetta and the powerful framework that emerged—one focused on transparency, outcomes, and economic sustainability.The conversation explores how Health Rosetta empowers benefit advisors and employers to break free from the traditional health plan model, the crucial role of data access, and the open-source tools now available through Nautilus Health Institute. Dave also unveils the evolution of RosettaFest from an internal network event into the premier gathering for high-performance health plan innovators across the country.

This podcast is brought to you by Outcomes Rocket, your exclusive healthcare marketing agency. Learn how to accelerate your growth by going to⁠ outcomesrocket.com Open-sourcing healthcare contracting and data infrastructure can unlock massive cost savings while improving outcomes. In this episode, Dave Chase, board president of Nautilus Health Institute and founder of Health Rosetta, dives into the major shift happening in employer-sponsored healthcare. He explains why he gave away $4 million worth of intellectual property to launch Nautilus, with the goal of decentralizing control from entrenched incumbents and empowering employers. Thousands of organizations are now using these models to achieve consistent 20–50% cost reductions while improving care quality, aided by real-time claims data and predictive analytics. Dave also shares his collaboration with Mark Cuban to release hospital contracts and tells inspiring stories, like how one Alabama manufacturer used healthcare savings to fund employee scholarships, illustrating the rise of a “healthcare ownership economy.” Tune in and learn how open-source tools, data access, and local innovation are rewriting the rules of employer health benefits in America! Resources: Connect with and follow Dave Chase on LinkedIn. Follow Health Rosetta on LinkedIn and explore their website. Learn more about Nautilus Health Institute here. Listen to Dave's previous interview on the podcast here! Buy Dave's book Relocalizing Health here. Find out more about this year's RosettaFest here. Register for this year's RosettaFest here

I'd LOVE to hear from you! Now you can send a TEXT MESSAGE! Be sure to leave your contact EMAIL so I can return your message!In this episode of the "My DPC Story Podcast," host Dr. Maryal Concepcion interviews Dave Chase, co-founder of Health Rosetta, about community-driven health initiatives and the Direct Primary Care (DPC) model.  They discuss healthcare reform, celebrating DPC's transformative impact, and the role of the Rosetta Fest in fostering a new healthcare economy. Dave emphasizes the importance of local action in addressing critical community needs such as food deserts, education, and senior loneliness. The discussion also covers the financial burdens of the current healthcare system and the positive impacts of healthcare redesign through DPC. Dave highlights the significance of events like Rosetta Fest in Washington, DC, from September 11th to 13th, and the opportunity for virtual participation. Rosetta Fest will gather clinicians, employers, and policymakers to share success stories and best practices in DPC implementation. Take $100 off your in-person or virtual registration with code MYDPCSTORY100. Visit rosettafest.org to register today!Join the myDPC story Patreon for more exclusive content. For more information, visit the podcast and learn about the Direct Primary Care revolution.The Growth GearExplore business growth and success strategies with Tim Jordan on 'The Growth Gear.Listen on: Apple Podcasts SpotifySupport the Show.Be A My DPC Story PATREON MEMBER! SPONSOR THE PODMy DPC Story VOICEMAIL! DPC SWAG!FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube

In this episode of Healthcare Americana, host Christopher Habig, CEO and co-founder of Freedom Healthworks, sits down with Ben Conner, CEO of Conner Insurance, to discuss health plans and the innovative approaches in Indiana. Ben shares insights into his company's role in spearheading health plan innovation, including their recent involvement in producing a documentary that explores the complexities of the healthcare system.Ben discusses the importance of educating business leaders, who are key funders of healthcare, about the intricacies of the system and how they can make informed decisions to benefit their employees. He also highlights Conner Insurance's strategic initiatives, such as their sponsorship of Indiana's first statewide Health Plan Innovation Conference in collaboration with Health Rosetta, a prominent name in the health plan innovation space.Christopher and Ben discuss the need for employers to take an active role in managing their healthcare supply chains, the challenges and rewards of working with smaller companies, the importance of a supportive regulatory environment, and his advocacy for more competitive practices in the health insurance renewal process.Ben's story is a testament to how thoughtful, strategic innovation can create meaningful change in the healthcare industry, benefitting both employers and their employees.More on Freedom Healthworks & FreedomDocSubscribe at https://healthcareamericana.com/episodes/More on Ben Conner & Conner InsuranceFollow Healthcare Americana: Instagram & LinkedIN

In this episode, Halle speaks with Dave Chase, co-founder and CEO of Health Rosetta, who is on a mission to end the 30-year heist of stolen income from the working middle class. He's working to popularize a new parallel economy: community-owned health plans (COHPs). Dave explains how these plans aim to transform healthcare from a driver of debt and bankruptcy to a driver of well-being and wealth.We cover:- The structure and benefits of community-owned health plans (COHPs)- How these plans can reduce healthcare costs while improving care quality- The role of primary care, including direct primary care models, in reshaping healthcare delivery- Challenges with the current employer-based health insurance system- Recent legal developments pushing for change in employer-sponsored health plansDave shares insights on how community-owned health plans can address issues like misaligned incentives, inefficient spending, and poor health outcomes. He also discusses the potential for these models to redirect healthcare savings into community investments, ultimately improving social determinants of health.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

I'd LOVE to hear from you! Now you can send a TEXT MESSAGE! Be sure to leave your contact EMAIL so I can return your message!In Episode 175 of the My DPC Story Podcast, Dr. Jonathan Bushman joins host Dr. Maryal Concepcion to discuss the transformative impact of Direct Primary Care (DPC) for both patients and healthcare clinicians. Dr. Bushman shares his journey from professional stagnation in the fee-for-service model to finding fulfillment in DPC, highlighting how it benefits not only patient care but also physician work-life balance. The conversation deeply explores the importance of patient-centered care, affordability, and accessibility through DPC.Dr. Bushman addresses working with employers to provide high-quality healthcare and touches on his role as a Health Rosetta advisor, blending clinical expertise with business insights. They discuss the successful Ohio school district model, the significance of DPC lobbying efforts in DC, and upcoming events aimed at educating about DPC. Listeners gain insights into Dr. Bushman's approach to maintaining clinic culture, redefined patient experiences, and his strategy for collaborating with non-physician providers.Join the My DPC Story Patreon community to help support the work the podcast is doing to advocate for DPC!*Click HERE to learn more about DrChrono today!*Nominate a DPC Innovator at Hint Summit HERE -> SPRUCE HEALTH: NEW USERS get 20% off your SPRUCE HEALTH paid plan with code: MARYAL20 BRUIN HEALTH: comprehensive mental health assessments! Mention code MYDPCSTORY to get your FREE TRIAL! FREE 1 month trial - HEIDI HEALTH PRO: As Individualized As Your DPC.Support the Show.Be A My DPC Story PATREON MEMBER! SPONSOR THE PODMy DPC Story VOICEMAIL! DPC SWAG!FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube

To read the full show notes with links mentioned, be sure to visit our episode page and consider signing up for our free weekly newsletter. Episode 443 of Relentless Health Value pays tribute to the late Marshall Allen, an investigative journalist dedicated to exposing injustices within the American healthcare system. Hosted by Stacey Richter, the episode features Dave Chase, founder of Health Rosetta, who shares memories and insights into Marshall's tireless work in investigative reporting. The episode highlights Marshall's impact on healthcare legislation, his significant contributions to ProPublica, and his book 'Never Pay the First Bill,' which empowers patients and employers to fight back against corrupt billing practices. The episode also includes an earlier interview with Marshall, focusing on his perspective as an investigative reporter, the exploitation within the healthcare system, and the importance of patients and employers demanding transparency and fairness. The episode encourages listeners to continue Marshall's legacy by subscribing to the Marshall Health Academy and purchasing access for employees. 09:28 What's the point of view that Marshall is coming from with his investigative reporting? 09:57 “How does this affect the people who are paying for it and the people who are undergoing the care?” 10:49 “There's a lot of good people working within this very messed up system.” 11:03 Why are patients considered outsiders in the healthcare system? 11:45 “What's happened in healthcare is that the stakeholders treat each other more as the customer.” 13:45 What is upcoding? 17:18 “These are schemes that have been created within the industry to increase revenue.” 17:46 “This system is not set up for the benefit of the patient.” 18:13 “On the financial side, the industry is actually oppressing the American people.” 19:14 “We have been expected to pay whatever aggregate sum is thrown at us.” 20:21 Why have patients been so passive toward this crooked healthcare system so far? 22:05 What's the difference between making a profit and profiteering? 29:45 What are the first-order and second-order consequences of what's happening in health care right now, and which of these consequences will actually drive change? 30:45 “When you tell the truth about what's going on … they become so ashamed … that they change their behavior.” 32:00 “The patient … is not their most important customer.” 32:50 “The sleeping giant is the employers.”

In this episode of Healthcare Americana, host Christopher Habig, CEO of Freedom Healthworks, sits down with Dave Chase, the visionary founder of Health Rosetta. Together, they explore the groundbreaking work Health Rosetta is doing to transform the healthcare landscape into a system that is transparent, accountable, and value-driven.Dave Chase shares insights from his journey, starting from the release of his influential book, “CEO's Guide to Restoring the American Dream,” to the establishment of Health Rosetta, a network of benefit advisors committed to delivering world-class healthcare at half the cost. They delve into the critical role of direct primary care (DPC) and how Health Rosetta's approach is making high-quality primary care the centerpiece of healthcare plans.Listeners will gain valuable perspectives on the importance of data in health plans, the challenges of educating workforces about new healthcare models, and the practical steps HR professionals can take to reduce costs while improving care quality. Tune in to learn about the innovative solutions Health Rosetta offers and how employers, advisors, and physicians can collaborate to create a more efficient and effective healthcare system. Whether you're a healthcare professional, an employer, or simply interested in healthcare reform, this episode is packed with actionable insights and inspiring stories.More on Freedom Healthworks & FreedomDocSubscribe at https://healthcareamericana.com/episodes/More on Dave Chase & Health RosettaFollow Healthcare Americana: Instagram & LinkedIN

In this podcast episode, we delve into the transformative journey of Health Rosetta and its co-founder, Dave Chase. Join us as we explore the personal reasons behind the creation of Health Rosetta, driven by a profound mission to change the healthcare narrative. In this episode, Dave shares the powerful motivation behind co-founding Health Rosetta, fueled by a series of impactful personal experiences. We uncover the innovative approach of Health Rosetta in redirecting the currently wasted $1.5 trillion in healthcare towards social determinants of health, such as income and better food. We delve into Health Rosetta's groundbreaking transformation of health plans, turning them from contributors to debt, poverty, and bankruptcy into catalysts for well-being and wealth.

For a full transcript of this episode, click here. I want to kick off this show with a clip from episode 415 with Rob Andrews, wherein he so very eloquently sets the stage here: We think that one of the core problems here is that too many intermediaries and providers in the system, their compensation is not in any way dependent on the outcome. So, let's think about this NICU baby problem again. Looking at the hospital system—and I'm not at all implying or suggesting any hospital system tries to do this—but I think it is clear that they actually benefit commercially from more babies spending more days in the NICU. NICU's usually a pretty good margin business. It's expensive. Lots of money is paid, and margins run pretty well there. So, I don't think there's a hospital system in the country that intentionally says, “Oh, good … let's go out and try to fill up the NICU every day.” But when it gets filled up, they benefit. On the other hand, if the hospital invests significantly in early effective intervention prenatal or even pre-pregnancy, there's no upside to that financially. They don't get rewarded for that. They might win an award from some magazine for best practices, but their margin suffers. Then if you look at the intermediaries, the carriers, and PBMs [pharmacy benefit managers], their outcomes are irrelevant to their performance. If an employee of a self-insured employer has a significant risk prenatal or pre-pregnancy and the carrier does a great job identifying that problem and solving it, they make the same amount of money off that patient or that consumer that they would if they did nothing. So, it's a bit harsh to say this, but the carriers make the same amount of money if every child is born healthy and there's not a day spent in the NICU as if they do if every child's born with severe crises and winds up in the NICU. It's not a big mystery in the US economy that people do what you pay them to do. And if you have a system, which we do now, where the case of maternal health, diabetes management, musculoskeletal management, cholesterol and cardiac management … when you have a system where many, many players in the system, at best, make the same amount of money for bad outcomes as they do for good ones and, at worst, they prosper from the bad outcomes, that explains the problem. So, is this show about improving maternal health outcomes in the US, where it is relatively deadly to have a baby compared to other industrialized nations? Yes. But improving maternal health is also a great case study for what needs to be done to just improve health. You could apply it to primary care. You could apply it to chronic care management. It is a fairly broad-spectrum solution, as it were. I'm thinking right now about how Dave Chase, co-founder of Health Rosetta—how does he put it?—he says every big problem in healthcare already has been solved. The existing challenge is how to massively replicate proven solutions. So, yeah … keep that in mind when we talk about what Jodilyn Owen has accomplished with her team in Washington State with their birth and health center. Also, as you consider how you might replicate, keep in mind the struggles she has faced getting contracts from self-insured employers or payers to pay her clinic and a very interesting encounter she had with a VC/PE (venture capital/private equity) funded maternal health start-up. It's just interesting where the money is flowing and where it's not flowing. But let's talk about Jodilyn's clinic's outcomes. Their zip code is one of the most diverse in the nation. There are 79 languages spoken. There is lots of social determinants of health going on. It is a medically underserved area. It is a federally designated provider shortage area. So, this community has every right to have horrible outcomes. Meanwhile, nearby, there is a wealthy community. In that zip code, they live 17 years longer than in Jodilyn's clinic's zip code. But if you compare the outcomes that Jodilyn's clinic has compared to the outcomes in the hospital in that fancy neighborhood, Jodilyn's group has far less cesarean rates, far less NICU admissions, far less incidence of gestational diabetes, far quicker access to treatment for hypertension. You might be wondering how much their birth bundle costs that they are having trouble getting most payers except one to pay for and getting no VC dollars or funding at all. They're charging $5000 to $7000. So, let's just say $5000 to $7000 compared to … what does one NICU admission cost? So, yeah … this is an exact example of what Rob Andrews was talking about. An EXACT example. So yeah, enjoy this episode; it's as heartwarming and actionable as it is frustrating. And if you are a payer or self-insured employer in South Seattle, please give this clinic a contract. Not to drop a major spoiler alert here, but you know what Jodilyn's “secret sauce” is? Nuances for sure, but bottom line, it's about trust. It's about relationships. It's about listening to the patient. It's being part of the local community. If you're shocked right now, raise your hand. There's gonna be no one with their hand raised. How many times do we have to figure this out? Jodilyn Owen is the clinical director of the Rainier Valley Birth & Health Center. She is a licensed midwife along with a bunch of other credentials. Also mentioned in this episode are Rob Andrews; Dave Chase; Vivek Garg, MD, MBA; and Larry Bauer.   You can learn more by emailing Jodilyn at jodilyno@myrvcc.org. You can also connect with her on LinkedIn.   Jodilyn Owen, LM, CPM, Ma MCHS, is a licensed, certified professional midwife and co-founder of Rainier Valley Birth & Health Center. She was born and raised in Seattle and raised her own family in South Seattle, working as a doula and parenting educator for 13 years before becoming a midwife. This is where she saw healthcare through the lens of observation of hundreds of families and provider experiences of maternal and child healthcare. An avid learner and critical thinker, Jodilyn began to reimagine healthcare and to develop a vision for what access in its truest form might be, not just to healthcare for the deeply underserved and mis-served families of South Seattle but also to quality healthcare delivery for the providers who want to give more than what the system allows. Jodilyn built her practice around the idea that parents know themselves and their babies best, and her direct patient work is designed to promote this first relationship. She provides individualized, gentle, and holistic pregnancy, birth, and postpartum care for families planning a home, birth center, or hospital birth. Jodilyn is currently director of clinical partnerships and staff midwife at the nonprofit–for purpose Rainier Valley Birth & Health Center. She provides infrastructure development, guides clinical programs and partnerships, and supports students from multiple university health professions and public health programs at all levels from high school through doctoral studies.   07:12 How much cost savings is there when you avoid a NICU admission? 09:43 How is “slow care” feasible among an ob-gyn shortage in many communities? 10:42 “Start people at the risk that they are appropriate for.” 11:37 EP407 and Summer Shorts 3 with Vivek Garg, MD, MBA. 13:50 “To effect change, we have to unwind what has been wound so tightly and so carefully through medical … education.” 14:13 “It's not a people problem; it's a system problem.” 18:46 What does relationship-based care mean? 22:32 “Everything in pregnancy at least is a trend.” 28:01 How does Jodilyn's practice work with payers? 31:08 EP409 with Larry Bauer, MSW, MEd. 32:24 Why is it important to address the root of this problem in the education space?   You can learn more by emailing Jodilyn at jodilyno@myrvcc.org. You can also connect with her on LinkedIn.   @essntialmidwife discusses improving maternity #patientoutcomes in our #healthcarepodcast. #healthcare #podcast #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown, Rob Andrews, Justina Lehman, Dr Will Shrank  

A Preview to RosettaFest 2023: A Work of Heart! August 7-9th, 2023 at Navy Pier in ChicagoFeaturing Dave Chase - Global Healthcare Entrepreneur, Author, and Co-Founder of Health RosettaIn today's episode you'll learn about Health Rosetta and RosettaFest, a festival for the healthcare heroes who are restoring the American Dream coming August 7-9th, 2023 to Chicago's Navy Pier!We'll talk about how Health Rosetta Advisors and Solutions Partners are changing lives and making an impact in their communities and how independent direct care doctors are being brought into the fold. The event will be an inspirational, educational, and fun way to connect with the forward-looking benefits advisors, employers, unions and public entities that are literally transforming the health & wealth landscape in their businesses and communities.REGISTER TODAY at: https://www.mydpcstory.com/rosettafest (virtual and in-person attendance options)Support the showVisit the DPC SWAG store HERE!Let's get SOCIAL! Follow My DPC Story! FACEBOOK * INSTAGRAM * LinkedIn * TWITTER * TIKTOK * YouTube

What if healthcare as we know it is stealing the American Dream? Join us on this eye-opening episode  as we welcome Dave Chase, creator and co-founder of Health Rosetta, to discuss the vital role of benefits advisors in preventing medical mistakes and saving the US economy.  Learn how Dave's personal journey to understand a tragic misdiagnosis led him to create a movement aimed at transforming healthcare and restoring the American Dream.Together, we explore the origin story of Health Rosetta, how the ACA sparked the journey to change, and how the 2016 election illuminated the need for a drastic overhaul of our healthcare system. Discover how wage stagnation and rising premiums have contributed to economic depression for the working and middle classes over the past 30 years, and why it's time to take action. Uncover the potential of using LEED standards to accredit and certify health plans, and how focusing on quality and affordability could be the key to reducing healthcare spending. Don't miss this powerful conversation with Dave Chase as we work towards restoring the American Dream through healthcare transformation!SPECIAL NOTE: Join Dave and the Health Rosetta team at ROSETTA FEST August 7-9, 2023 in Chicago. Click HERE for more information.

I hope you enjoy this encore episode of one of the most popular shows in the last 12 months. One of my mentors often said price is irrelevant. He said he would sell anything for any price as long as he could define the terms of the deal. During this conversation today with Scott Haas about PBMs (pharmacy benefit managers), that quote was playing in my head like an earworm. I'm henceforth gonna struggle with the term rebate to define dollars that the PBM gets back from Pharma, because, according to my guest in this healthcare podcast Scott Haas, it turns out “rebates” comprise only about 40% of those back-end dollars that some PBMs manage to score from pharma manufacturers. I don't have any insight really into this, but Scott Haas certainly does—and this is the average that he has seen in his work and that we're going to dig into today. But in sum … wow! Let me just repeat that a mere 40 cents on the dollar of the gross amount that PBMs take in “rebates” from Pharma these days winds up going back to plan sponsors, even plan sponsors who are getting “100% of the rebates.” If you didn't understand what I just said, no worries. I'm gonna explain it right now. If you did and you know the why behind all of this also, you could probably skip ahead about five minutes. Here's the backstory on this whole rebate fandango. Let's start with part one of what is a two-part transaction. So, part one: the deal between pharma manufacturers and PBMs. In general, a pharma manufacturer signs a deal with a PBM to give back whatever percentage of their gross sales revenue to the PBM at the end of the year, say. It's along the same lines as a cash-back coupon for the PBM. Why would a pharma company be up for giving cash back like this? Well, to get on a PBM's formulary, giving cash back is like the price of admission. PBMs have a lot of leverage, after all—at least the big ones. They control access to millions and millions of patient lives. So, if Pharma wants their drug to be accessible to those millions and millions of lives, they have to play the cash-back game, otherwise known as the rebate game. They have to agree to give back to the PBM a certain amount of cash on the back end. So, PBM pays Pharma's list price up front—that's the gross amount paid, based on the list price of the drug—and then after all the cash back gets toted up at the end of the year, there'll be a net price. List price or gross price minus the cash back equals net price. It's this net price that's the true kind of final price which the pharma company gets paid per script by said PBM at the end of the day. These days, most everybody pretty much knows that PBMs are getting these so-called rebates—this cash back from pharma companies that I just explained. And it's pretty common knowledge the so-called gross-to-net bubble (the gross-to-net dollar amount) is pretty huge, meaning the rebate or cash-back amount is pretty huge. And many have also noticed that the gross-to-net dollar amounts seem to be growing bigger and bigger every year. I mean, for one insulin manufacturer, consider this: Their list price, their gross price, is $350 per script. And their net price after cash back/rebates was $52 this past year. Wait ... what? After all the cash back to the PBM, the insulin manufacturer got paid 86% less than their list price—$350 went down to $52 per prescription. The PBM vacuumed up 86% of the dough for every script written for this particular brand of insulin. Okay … so, say Pharma gives $100 back to the PBM based on the terms of their deal. Call that part one of this example transaction. Here's part two: the deal between PBMs and health plans or self-insured employers. Health plans and self-insured employers are customers of the PBM. They hire PBMs to manage the pharmacy benefits for their members or employees. So, because everybody knows this whole rebate thing is going on, as part of the contracts that the PBMs put in place with their customers (meaning the health plans or employers), the PBMs tell their customers that they're going to give 100% of the rebates back to the plan/employer. So, you'd think that if the pharma manufacturer paid $100 to the PBM, that the customers of the PBM (the plan sponsors) would get the $100 back then, right? The PBM would pass on 100% of the savings, as it were, if they're saying that they're gonna give 100% of the rebates. I mean, if this is actually true, that $100 in and $100 out, then the PBM is potentially performing a useful service, right? They're lowering drug costs for their customer, the plan sponsors for their members and employees. Except … turns out, not so much. Because what is a rebate, really? A rebate can be anything the PBM defines as a rebate. And it turns out that, on average, as I said before, according to those in the know, something like $60 of that $100 is not a rebate. It's an administration fee. Or a data fee. Or an education fee. A clinical program fee. Some other name that is not rebate. As my guest Scott Haas says, the term rebate is meaningless because it can mean whatever the PBM wants it to mean. It's like inconceivable from The Princess Bride. I do not think that word rebate means what you think it means. Now it is a tangled web we weave here, and for more on why I say that, listen to the episode with Chris Sloan (Encore! EP216) entitled “How Medicare Part D Plans Became Addicted to Drug Rebates.” There's also a show with Pramod John, PhD (EP353) where we dig into, specifically, specialty drugs and rebating and so-called rebate walls. But net net, all of this probably myopic focus on rebates means that you have to keep an eagle eye out for so-called exclusions in contracts if you are a plan sponsor. So, what are exclusions? This is that whole thing where some cheap generic is excluded from a PBM formulary while some expensive brand for the same condition is on formulary. Why would a cheap generic be excluded from a PBM formulary? Simple. Cheap generics don't have rebates. PBMs lose a lot of money when some high-priced specialty drug, for example, goes generic. They might have made thousands of dollars per script on that high-priced brand by collecting its rebate. Think about that insulin example. The rebate is 86% of the cost of the drug. And everybody wonders why some cheap generic insulin or biosimilar or whatever isn't on formulary. It is not a mystery when you're dealing with for-profit enterprises built around a model of revenue maximization. So, given all this, what's my guest Scott Haas's bottom-line advice in this whole thing? If you're a health plan or employer and you're trying to negotiate a PBM contract where your spend is predictable and your contracted price promises have any meaning whatsoever, Scott Haas's advice is, you have to ensure that the contract defines the actual prices for the drugs in the contract. With absolute numbers. Not percentages off or weird formulas or the empty promise of getting an AWP or a WAC (which means average wholesale price or wholesale acquisition cost) or any of the other various acronyms for some drug pricing schema. All of these are basically shorthand for “this price could change at any moment.” There's a reason in-the-know people say AWP stands for “Ain't what's paid,” meaning ain't what's ultimately going to be paid by plan sponsors. What is necessary in PBM contracts is the final price—that number. Some digits with a dollar sign in front of them and a “per unit” after them. No acronyms and no percentage signs. Whoever gets to define the terms ultimately controls the price. So, get the price up front. As mentioned several times already, I am talking to Scott Haas, who is a senior VP over at USI Insurance Services. He's speaking today from the perspective of a plan sponsor, meaning from the point of view of a health plan, including those health plans managed by and paid for by a self-insured employer and their employees. For more information on PBMs and how drugs get adjudicated, listen to the show with AJ Loiacono (Encore! EP231), which was one of the most popular episodes over here at Relentless Health Value. Somebody on a LinkedIn post the other day commented on how much she appreciated AJ Loiacono's frank assessment of things and how she would love to go to a meeting with more people similarly telling it like it is. That's pretty much what we aim to do at every episode over here at Relentless Health Value, and AJ nails it on that objective for sure in this episode. One last thing, also on the show: Scott Haas brings up GPOs that the Big Three PBMs have been spinning up to aggregate and maximize all of those rebates that we just talked about. I discuss this exact topic at some length in another incredibly popular episode with Mike Schneider (Encore! EP288).   You can learn more at usi.com or by emailing Scott at scott.haas@usi.com.   Scott Haas has over 38 years of employee benefits experience. His background includes the development and validation of care management programs; prescription benefit management solutions; provider network evaluation, valuation, and negotiation; and underwriting. Scott started and operationalized a third-party administrator (TPA) and a pharmacy benefit manager platform from scratch. He has worked in the arena of alternative funding for most of his career. Scott's primary focus is in the area of alternative delivery and financing of healthcare other than fee for service, along with prescription benefit and healthcare risk management consulting. Scott has held officer-level positions within Blues plans and TPAs as vice president of sales and marketing, vice president of underwriting, and president. Scott has also served as a trustee for both union and non-union health and welfare and pension plans. Scott frequently shares his consulting expertise speaking at national events hosted by organizations such as Health Rosetta, the International Foundation of Employee Benefits, the Health and Welfare Plan Management Conference, the Western Pension and Benefits Conference, and the Self-Insurance Institute of America (SIIA). Scott has authored and coauthored articles on various topics over his career. Scott earned his bachelor's degree in business administration and economics from the University of Nebraska at Kearney. Scott also holds Chartered Life Underwriter (CLU) and Registered Health Underwriter (RHU) designations.   10:34 What's the major flaw with the buyer-seller relationship between plan sponsors and PBMs? 12:08 What are the five things that need to be considered in order to get a fair price from a PBM? 13:21 Why does using average wholesale price cause problems for plan sponsors? 15:10 What does it mean to put the network risk on the PBM? 17:15 What's happening with drugs moving from specialty brand to specialty generic? 19:19 “A generic is a generic; in our world, it's binary.” 23:36 “The term 100% of rebates is really irrelevant.” 23:59 What does it mean to have a minimum guarantee in drug rebates? 26:43 “When you do a line-item assessment … is it producing an optimal result in comparison to competitively achieved … pricing for generics … and for specialty?” 27:57 “Plan sponsors need to grow a backbone.” 28:40 EP342 with Christin Deacon. 29:10 Why do you need to understand your consultant's process as a plan sponsor? 29:36 Why do you need to understand formulary exclusions as a plan sponsor? 29:46 Why is it important to create a more equal PBM contract? 30:57 “Rebates inure to the benefit of the plan sponsor; they don't necessarily benefit the consumer.” 31:50 What does Scott do at USI?   You can learn more at usi.com or by emailing Scott at scott.haas@usi.com.   Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400)  

Friends, This is a super interesting and fast paced dialogue about a topic that is poorly understood by most, including healthcare executives and policy experts. The topic is employee health ...

If you want to keep listening, follow and subscribe to Everyone Hates Healthcare, please CLICK HERE The healthcare system may be broken in many ways, but let's talk about some of the existing tools out there that are trying to fix it.  In this episode of Everyone Hates Healthcare, Michael Swartz has a very insightful exchange with Dave Chase, creator, founder, and leader of Health Rosetta. In his late thirties, Dave witnessed how broken healthcare was after a complete system failure led to the passing of one of his friends. He created the Health Rosetta framework to guide public and private employers to reduce their health benefits costs and improve the quality of care for plan members. Listen to this episode to learn more about the Health Rosetta approach to improving health benefits!

The healthcare system may be broken in many ways, but let's talk about some of the existing tools out there that are trying to fix it. In this episode of Everyone Hates Healthcare, Michael Swartz has a very insightful exchange with Dave Chase, creator, founder, and leader of Health Rosetta. In his late thirties, Dave witnessed how broken healthcare was after a complete system failure led to the passing of one of his friends. He created the Health Rosetta framework to guide public and private employers to reduce their health benefits costs and improve the quality of care for plan members. Listen to this episode to learn more about the Health Rosetta approach to improving health benefits! Click this link to the show notes, transcript, and resources: outcomesrocket.health

We got two new reviews this week on the podcast, which I was thrilled to see. The first was from, it turns out, Dave Chase from Health Rosetta, who wrote that “with so many people in healthcare practicing ‘innovation theater' and bloviating versus driving real change, it's a breath of fresh air to listen to Relentless Health Value.” Thank you so much for saying that, Dave. We try really hard to get guests who are actually doing great things such as yourself. And then there's another review from mattiw2002, who says, “For anyone trying to stay abreast of developments in the healthcare space, there's none better than … Relentless Health Value.” Thank you so much to the two of you who took the time to write a review—could not appreciate it more. There have been two inbetweenisodes this year where I get deep into the why behind the “why collaborate.” And when I say collaborate, what I mean is anybody in the healthcare industry working together with and for the patients that we're supposed to be serving here. It's creating alignment amongst stakeholders around what's best for the patient. Here is the nutshell version of the two previous shows. First point: Patients fall into one care gap after another. You hear this from any PCP you talk to who's working in a care setting when there's little, if any, collaboration effort on the front end to ensure a non-fragmented patient journey. So then, all these care gaps wind up getting surfaced, which, by the way—let's not forget this—these care gaps were there all along negatively affecting patient outcomes. It's just, in the past, we didn't know about them. But now that we know about them, it becomes the fee-for-service PCPs' job to mop up all the care gaps while the faucet is still running. So, that's the situation analysis, and if we're going to put an end to this, it means that payers have to align with providers and give enough incentive for those providers to create a non-fragmented patient journey (ie, making sure that the care gaps don't happen to begin with). This also means providers need to talk amongst themselves and collaborate. Keep in mind that a multi-morbid Medicare patient sees something like 5 to 13 doctors, on average, depending on what study you look at … 13! If anybody thinks that a patient can see 13 doctors not collaborating with each other and coordinating care and not wind up with some polypharmacy adverse event or materially conflicting advice … I don't know. Call me. I just do not understand how consistent excellence in patient outcomes or patient care even could be achieved. That whole cliché the left hand doesn't know what the right hand is doing? That's a cliché for a reason, and I seriously suspect the entire field of medicine isn't weirdly excluded from it. So, first point: Collaboration/alignment is required amongst healthcare stakeholders for patients to get decent outcomes, especially patients with multiple chronic conditions. Payers gotta pay for the right stuff, and providers have to coordinate care. Otherwise, you wind up with all of the care gaps that PCPs currently working in systems with fragmented patient journeys are seeing. Here's the second point from earlier episodes: Financial toxicity is clinical toxicity. Patients are forgoing care they need and not taking drugs they need because they cannot afford them. This is not speculation. Trilliant Health just released a report that showed this. Healthcare utilization, if you subtract COVID care and behavioral health, might be permanently down. Other reports speculated that by 2030, a leading cause of death might be nonadherence due to cost concerns. Wayne Jenkins, MD, in episode 358, talks about a whole constellation of negative effects when patients can't afford care; and yeah … here we are. Patients cannot afford their care. They cannot afford premiums, deductibles, out-of-pockets. These are insured patients a lot of times we're talking about here. Also, this is not a “Medicaid” problem, as Dan Mendelson put in episode 385. So, go back and listen to the earlier shows for the who and the what and the why of the above and much more context; but nothing I've just said is stuff that I personally would regard as my personal opinion. There is one study after another that bears all this out. There is just one anecdote after another. Fragmented patient care and care that is way more expensive than a patient can afford is going to result in outcomes that are not, let's just say, super. Alright, all of this being said, does then aligning payers and providers, and providers collaborating with each other and coordinating care … if these things are done, do patient outcomes improve? Do care gaps reduce? Are patients more satisfied with their care? Said another way, when physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? Why, yes. Yes, it does. Why do I say this? First of all, this very much seems to be the conclusion of CMS. Here's from the Center for Medicare & Medicaid Innovation (CMMI). They released a report updating their strategic vision for implementing value-based care. One of the key new strategies focuses on creating greater care coordination between primary care doctors and specialists. What might be some of the success stories that precipitated the CMMI focusing their strategy on exactly what I've been running around squawking about for one to three years now? The ChenMed Case Study: ChenMed focuses on the most vulnerable patients and dramatically improves access for those patients, which has led to a 30% to 50% reduction in hospitalizations. They published there's been a 20% to 30% reduction of stroke. They've doubled six-month cancer survival rates and, in some cases, reduced heart failure readmissions by 50%, 70%, up to 90%. They see evidence that they are extending lives five or more years. How? By the providers being aligned with the payers and then also making sure that there is very coordinated care going on there. Johns Hopkins has a paper in JAMA that concluded that a care coordination model can be associated with improved outcomes, including substantial cost reduction. I was talking to Larry Bauer from FMEC, the Family Medicine Education Consortium; and he sent me probably a 40-page PDF of really great patient results when care is coordinated and payers are aligned to pay for health. As just one example, Dr. Daniel Hoefer from Sharp HealthCare, they have created what they call their Transitions program. And the idea is by moving aggressive care upstream via community-based palliative medicine, they have proven that the vast majority of people never need to see the inside of a hospital during the last year-ish of their life. The revolving door of hospitalization should be considered an archaic residual of a bygone era, as they put it. Again, this is very well-coordinated care with payer alignment. Do patients actually want this stuff? Before I get into our evidence here, just let me remind you that Kaiser is a payvider with a narrow network and also that Centivo is an innovative TPA (third-party administrator) pulling together narrow networks. On the podcast the other week, Dan Mendelson (EP385) from Morgan Health said that 40% of new employees are choosing lower-premium plans with either Kaiser or Centivo benefit designs. They are choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages. This is what happens when payers and providers are aligned. Nobody gets in the middle there. Heard a similar story from Nick Stefanizzi (EP383) from Northwell Direct. They're doing direct contracting with customers like Whole Foods. Everybody I talk to here is surprised how many employees are electing these kinds of plans. So, yeah … The Nuka System of Care in Alaska (EP312), where I get into this with Doug Eby, MD, MPH, CPE, in great detail. But wow, just wow there. With the Nuka ecosystem, they went from basically a failing mess into the health system that many consider to be the best or one of the best in the country at something like half the price per patient than in mainland US. They have this whole thing where they integrate specialty care into primary care. They have established an agreed-upon referral patterns and also an agreed-upon way to work with specialists that very much involves PCPs talking to specialists so that the whole person, the whole patient can be considered. They structure their whole program around paying for health and getting paid for health. Also, Nuka has a 96% patient satisfaction rate. So again, patients are certainly on board with this. If I was gonna sum up these five examples, I would certainly say that any physician practices looking to take better care of patients, rediscover clinical excellence and focus … get aligned with payers (CMS or otherwise). That's step one and certainly easier said than done. After that, work to collaborate with fellow providers. All of these entities that we just talked about who can brag about their patient outcomes and care quality are doing both of the stuff that we just talked about: aligning and collaborating with payers and other providers. They are also, at the same time, folding three other things into their strategy. And this other stuff is required because you kinda can't align with payers and you can't collaborate unless you're doing these three things at the same time: standardizing best-practice care, getting and using data, and using good technology in conjunction with that data. All of this in the service of this last thing, which is turning transactions into relationships. Human relationships. Relationships with patients. As Rebecca Etz, PhD, and her team at The Larry A. Green Center have shown quite crisply (discussed in episode 295), no relationship with a patient means worse outcomes for patients. End of sentence. But then there's also having relationships with colleagues and relationships with other docs who have patients in common. It is really tough to coordinate care without relationships, and it's also not very fulfilling. Alright, moving on to another question: Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care? Well, I can tell you a couple of things. ChenMed has been named to Newsweek's “Most Loved Workplaces” list. Nuka System has a 93% employee satisfaction rating. Considering that elsewhere one out of two family practice docs are burned out, this is pretty striking in contrast. Also, here's another quote from a physician leader about good accountable care where health is being paid for. He said, “This has changed our physicians' lives … the idea that we can get paid to actually take care of people. To actually have data to send people to the best for follow-up care, who we know will continue and contribute to the patients' well-being in the same way. Burnout reduces here because burnout is moral injury in a cheap Halloween costume.” I'm really sorry I can't remember who said that because it's a great quote and so true. Larry Bauer from FMEC also told me the other day that DPC (Direct Primary Care) conferences have never had a session on burnout. Larry says he tells people if they want to see what 350 happy primary care docs look like, they need to come to a DPC summit. They're happy as clams. Now, while DPC isn't the “be entirely responsible for downstream costs” kind of accountable care, what is going on in DPC is, these docs are accountable to their patients and for the care that they are providing. Here's another anecdote which I think, in sum, adds up to a “yes” if the question is “Do docs really like this stuff?” I had a long conversation with Scott Conard, MD, the other day about his work with clinics in Queens. What I learned was, these clinics, they used to have waiting rooms overflowing with patients who had been waiting the entire day to be seen and just ... it wasn't good for anybody. Fast-forward a few years—high-risk patients get seen fast, and there's time for care coordination. Patients are happy; outcomes are better. But here is why I inferred that the docs are happy in this model: There was a new office manager. New office manager starts trying to go back to the old way, the “normal” way that practices are run. And it was mutiny on the bounty. No way no how were those docs going back. I took that as a pretty solid testimonial if I ever heard one. So, I don't know if anybody has done any sort of global physician satisfaction studies to determine if physicians who are in pay-for-health models where they're collaborating with one another are happier and less burned out than doctors in the current fee-for-service (FFS) environment. But I can tell you that if somebody did do this, there's gonna be one really big confounding factor … and this is what it is: There's a world of difference between a well-functioning accountable care model and a very terrible one. I have had a series of (as I said earlier) pretty heartbreaking, honestly, conversations with PCPs around the country who think value-based care pretty much sucks. For the big why on this, listen to the show with Dan O'Neill (EP359). But in short, in “not quite there yet” value-based care models, one's still in the two canoes messy middle (ie, they've got one foot in the value-based care world and one foot firmly in the FFS world). Life can get really hard for PCPs especially because they get the worst of both. They get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding; and they still have seven-minute visits and RVU targets. There's not really great population health. Nobody's figured out how to defragment the care journey. And then there's the whole measurement industrial complex that gets piled on top of their day. I cannot stress this enough. Alright, so let's just check off our last big question here for the money motivated. This especially comes up when talking with especially specialists, who are doing very well, thank you very much—financially, I mean—in the current FFS status quo. So, let's not avoid the elephant in the room. Is taking on risk, getting paid for value, being accountable to deliver great results, deliver health … is it worth it from a financial standpoint? Alright, let's take a look at this. Here's from show 343 with David Carmouche, MD, when he was at Ochsner. He said, “Anything that we can do to convert the effective reimbursement in the Medicare space to something greater than Medicare fee-for-service rates, we think that this is in our best interest. So, we have gone very heavy into moving as much of our Medicare business into risk as we can. And we will take full capitation under a couple of Medicare advantage contracts.” So, that includes primary care as well as specialist care. Let's talk about One Medical for a moment. Five percent of One Medical members account for 51% of the company's revenue. You know which 5% account for that 51% of revenue? Right, the at-risk ones that are part of the Iora value-based medical group with a capitated model. That is a pretty strong financial endorsement there. There's a whole show with Brian Klepper, PhD (EP335), about why private equity is willing to pay $55,000 per patient in a capitated model. So, some actuaries somewhere think this is a very financially sound way to go. I am not sure if I would die on this hill, but I'd also say there's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow. Everything I've just said, not a secret. Not at all. You see CMS moving in the “making providers accountable” direction. I already mentioned this and what CMMI is up to. But this is very much an overall strategy. Currently, 44% of traditional Medicare beneficiaries with parts A and B are in a care relationship with some accountability for quality and total cost of care. CMS aims to boost that number to 60% by 2024 and 100% by 2030. In sum across the industry, it looks like 19.6% of healthcare payments were risk-based in APMs (Alternative Payment Models) that include upside and downside. This is a couple points higher than in 2020, but it's not like it's skyrocketing. So, that might be a curb to our enthusiasm. However, in 2022 here, looking forward to 2023, you know who besides CMS is going heavy on trying to pay for health and not sick care? I have never seen my entire career more CEOs of Fortune 500 companies—CEOs!—who are actively taking a role in their employee health benefits. I think it's because they can't afford not to at this point. Again, financial toxicity is very, very real for employed individuals. Here's something that Jeff Hogan called out from a McKinsey report: “VBC [value-based care] models that show promise in the employer context include high-performance provider networks with cost- and quality-based metrics, episode-based payments for standardized patient-care journeys … , and risk-based contracts for end-to-end management of high-cost conditions.” You know what all those things have in common that I just rattled off? Only high-performing docs are in network—and this includes specialists. I say all this to say, I don't know, if I were a practitioner of healthcare and I knew that all this data was floating around about my practice patterns and given that doctors that don't perform well as per that data are being excluded from networks … I don't know, just given all of the signs that are pointing in a risk-based direction, learning to take on risk just seems like—I was never a Boy Scout, but the whole “Be prepared” seems pretty sound advice right now, especially given how long it takes to get good at this.   For more information, go to aventriahealth.com. To listen to the playlist of the mentioned episodes, click here. Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   05:03 When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? 05:46 What is the ChenMed Case Study? 06:26 Can a care coordination model be associated with improved outcomes, including substantial cost reduction? 06:38 Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health? 07:29 Do patients actually want this stuff? 07:46 Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages? 08:29 What is the Nuka System of Care in Alaska? 09:25 “I would certainly say that any physician practices looking to take better care of patients, rediscover clinical excellence and focus … get aligned with payers (CMS or otherwise). That's step one and certainly easier said than done.” 10:45 Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care? 11:16 “This has changed our physicians' lives … the idea that we can get paid to actually take care of people. To actually have data to send people to the best for follow-up care, who we know will continue and contribute to the patients' well-being in the same way. Burnout reduces here because burnout is moral injury in a cheap Halloween costume.” —Physician leader 13:25 “There's a world of difference between a well-functioning accountable care model and a very terrible one.” 13:59 “Life can get really hard for PCPs especially because they get the worst of both. They get to be care gap cowboys and cowgirls while, at the same time, having to do all of the FFS coding; and they still have seven-minute visits and RVU targets.” 14:43 Is taking on risk worth it from a financial standpoint? 16:05 “There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow.” 17:11 “I have never seen my entire career more CEOs of Fortune 500 companies—CEOs!—who are actively taking a role in their employee health benefits. I think it's because they can't afford not to at this point. Again, financial toxicity is very, very real for employed individuals.” 17:54 “Only high-performing docs are in network—and this includes specialists.”   For more information, go to aventriahealth.com. To listen to the playlist of the mentioned episodes, click here.   Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast When physician practices get paid to deliver health and not paid for sick care, does patient health actually improve? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the ChenMed Case Study? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Can a care coordination model be associated with improved outcomes, including substantial cost reduction? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Are there examples of really great patient results when care is coordinated and payers are aligned to pay for health? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Do patients actually want this stuff? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Are employees choosing lower-cost plans just as much for the lower premiums as for the care coordination and the “I don't want anybody between me and my doctor” messages? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast What is the Nuka System of Care in Alaska? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Are doctors happy in these models where payers are paying for health and where it's a must-have to coordinate across the continuum of care?” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “There's a world of difference between a well-functioning accountable care model and a very terrible one.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast Is taking on risk worth it from a financial standpoint? Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “There's likely a downside to making zero effort on the accountable care front and banking on FFS being a forever cash cow.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast “Only high-performing docs are in network—and this includes specialists.” Our host, Stacey, discusses #collaboration on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Eric Bricker (Encore! EP351), Al Lewis, Dan Mendelson, Wendell Potter, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington  

A Fiduciary's Guide to Data Analytics with Agility Innovation Partners. This episode is a follow-up to my video "The Consolidated Appropriations Act 101 - Comply or Die?" The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care. Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day. In this Episode - Part 2 - we focus on an employer's fiduciary responsibility now that they have access to claims and pricing data due to the CAA regulation, and the power of using an innovative Data Analytics platform to make sense of it. Agility Innovation Partners helps offer a data analytics platform with "at-scale pricing" to small-to-mid-market brokers who may not have the leverage on their own. They also offer consulting after the decision to purchase a data analytics platform called Innovu, so that consultants can make sure they maximize the ROI on their investment. Innovu also offers a CAA fiduciary tool stack with benchmarking against 4 million lives for plan design, claims cost, plan design etc, so that an employer can determine if they are paying reasonable cost for care and are compliant. If not, now they know and can take action! Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant. Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention! https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs --- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

A Fiduciary's Guide to Data Analytics with Agility Innovation Partners. This episode is a follow-up to my video "The Consolidated Appropriations Act 101 - Comply or Die?" The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care. Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day. In this Episode - Part 2 - we focus on an employer's fiduciary responsibility now that they have access to claims and pricing data due to the CAA regulation, and the power of using an innovative Data Analytics platform to make sense of it. Agility Innovation Partners helps offer a data analytics platform with "at-scale pricing" to small-to-mid-market brokers who may not have the leverage on their own. They also offer consulting after the decision to purchase a data analytics platform called Innovu, so that consultants can make sure they maximize the ROI on their investment. Innovu also offers a CAA fiduciary tool stack with benchmarking against 4 million lives for plan design, claims cost, plan design etc, so that an employer can determine if they are paying reasonable cost for care and are compliant. If not, now they know and can take action! Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant. Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention! https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs --- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

This episode was one of the most popular episodes in the past 12 months. Since it aired, there was a show with Kevin Schulman, MD (EP366), that added some context, which I would recommend, and also one with David Muhlestein, PhD, JD (EP364). Those two shows and this one are a good three-pack. And hey, here's something new that we're going to try out. Coming up in December, Dr. Bricker and I will host a smallish virtual chat to discuss the topics covered in this episode. It will be a conversation, not a presentation, so therefore the “why” behind the “smallish.” If you are kinda thinking this is something that you'd like to do, go to our Web site and scroll down to the “Join the Relentless Tribe.” When we get our act together, we'll send out the details for how to sign up in a future email. I'm thinking it will be very cool to get a chance for the great people who support our show enough to actually get a weekly email to talk amongst ourselves! In this healthcare podcast, I'm speaking with Eric Bricker, MD, about how so many entities in healthcare are getting up in other people's business and swimming in other people's traditional lanes. We kick off the conversation talking about the payer, PBM, and hospital system horizontal consolidation that has transpired over the past decades (that's plural). Horizontal consolidation is pretty much the easiest way to decimate all competition in your own swim lane so that you can charge more and not worry so much about patient/customer/member experience because the patients/customers/members have no better alternative. They effectively have nowhere, or few other places at best, to go if they leave you. So, what's the impact of horizontal consolidation? Commercial insurance costs have gone up 4x the rate of other benchmark goods and services. Let's spend a moment, shall we, on the human impact of all this extreme consolidation. The impact is your sister, your neighbor, your son, your friend. So many feel so much pressure financially in our country today because of healthcare costs. Even families earning significantly more than median household income are forgoing care because of costs. This was in a recent paper. (The authors are Alyce S. Adams, Raymond Kluender, Neale Mahoney, Jinglin Wang, Francis Wong, and Wesley Yin.) But the direct observable financial toxicity resulting from high healthcare patient costs is really only the tip of the iceberg here. As Dave Chase from Health Rosetta has said a million times already, high healthcare costs have a multitude of effects on employers, big and small. One big one is, if healthcare costs more, then there's less money for salaries. Dave, citing lots of evidence, has long attributed wage stagnation in this country to accelerating healthcare costs, which became even more rampant during periods of industry consolidation. Dave Chase leads Health Rosetta, by the way. Here's another human toxicity: Listen to episode 337 with Oliva Webb on the impact on her life as a result of the undeniably and unquestionably common non-excellent treatment by the PBMs and SPPs that she has to deal with. Because, as Dr. Bricker also says, no competition means basically not a whole lot of concern about patient experience. Why should a for-profit business spend money to improve something when there's nothing really to be gained for them financially to do so? I mean, the best a patient can do most of the time is hop from the frying pan into the fire. That's what happens when there's no competition or no real competition. Also consider the burned-out clinicians who have to get stuck in the middle of this nobody-really-cares-at-the-monopoly customer service paperwork quagmire. By the way, here's a sidebar that might come as a surprise to some people, but please take this in the spirit with which it's intended. All of us innovators and lifelong learners, we want to update our beliefs when the facts show us an updated conclusion. So, I have learned that all of this consolidation was going on long before the ACA (Affordable Care Act). My point here is to please look into this well-documented trend line before reflexively tweeting that the ACA drove consolidation. Dr. Bricker and others like Dr. Mai Pham have told me that, in their opinion, low interest rates, cheap debt, and a desire to eliminate competition are wildly powerful drivers of consolidation. Anyway, about eight minutes into the interview with Dr. Bricker, if you're one of the ones who knows all you care to know about horizontal consolidation, we get into vertical integration, vertical consolidation—and this is where things get interesting. And when I say interesting, I mean it in a “we live in interesting times” kind of way. The vertical consolidation conversation segues into whose swim lane that the digital health and other innovators or, dare I say, disrupters are diving into and whose lunch they are aiming to eat. Dr. Bricker probably needs no introduction. He is the force behind AHealthcareZ, which you can find online, on Twitter, YouTube, and LinkedIn. He has worked as a clinician, in healthcare finance. If that weren't enough, he's also been an entrepreneur—a very successful entrepreneur, I might add. He started one of the first healthcare navigation firms. You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn.   Eric Bricker, MD, is an internal medicine physician and former cofounder and chief medical officer of Compass Professional Health Services. Compass is a healthcare navigation service that grew to 2000+ clients, including T-Mobile, Southwest Airlines, and Chili's/Maggiano's restaurants. Compass was acquired by Alight Solutions in July 2018. Alight is a 10,000-person employee benefits and HR outsourcing company that separated from Aon in 2017. Dr. Bricker has since started AHealthcareZ.com, with 300+ healthcare finance videos with approximately 120,000 views per month across all platforms. In 2022, he became medical director of SimplePay Health, an alternative health plan that empowers employees with high-quality care, concierge support, and easily understood payment. He is also the author of Healthcare Money Campfire Stories.   05:50 What is this “megatrend” happening in healthcare right now? 07:11 How has consolidation changed the healthcare landscape? 09:41 What is vertical integration within healthcare? 11:07 Why doesn't inorganic growth benefit patients? 12:52 “What is best for the patient does not necessarily make the most money.” 14:02 “It's not that it's above the law … it is just intentionally obscured.” 18:16 “Healthcare is glacial. It is slow.” 22:36 “The largest source of healthcare costs is hospitals.” 25:00 EP330 with John Marchica. 28:20 “What have the historical priorities been of the administrators of those hospitals?” 28:35 “Every hospital CFO knows that they need sick people.” 29:21 EP343 with David Carmouche, MD. 30:01 “The payment change has to come first.” 31:19 “The money wins.” 33:16 “You've got to put the financial incentives in place … to make people actually behave the way that they should.”   You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn.   @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth What is this “megatrend” happening in healthcare right now? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth How has consolidation changed the healthcare landscape? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth What is vertical integration within healthcare? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth Why doesn't inorganic growth benefit patients? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “What is best for the patient does not necessarily make the most money.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “It's not that it's above the law … it is just intentionally obscured.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “Healthcare is glacial. It is slow.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The largest source of healthcare costs is hospitals.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “What have the historical priorities been of the administrators of those hospitals?” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “Every hospital CFO knows that they need sick people.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The payment change has to come first.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The money wins.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “You've got to put the financial incentives in place … to make people actually behave the way that they should.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Al Lewis, Dan Mendelson, Wendell Potter, Brian Klepper (Encore! EP335), Dr Aaron Mitchell (EP382), Karen Root, Mark Miller, AJ Loiacono, Josh LaRosa, Stacey Richter (INBW35), Rebecca Etz (Encore! EP295), Olivia Webb (Encore! EP337), Mike Baldzicki, Lisa Bari, Betsy Seals (EP375), Dave Chase, Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman  

The Consolidated Appropriations Act 101 - Comply or Die?   The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care. Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day.  The goal for employers immediately is not to be perfect by 12/27/22, but to at least show that they made a good faith effort to be compliant. The price transparency component is where the opportunity lies for employee benefits brokers and their employers to uncover the source of their high cost claims, and then take appropriate fiduciary responsibility in order to pay more appropriate unit costs for healthcare.  While there is a cost associated with ensuring you are compliant, the opportunity to retain and win new business for consultants is massive. Right now, opaque network contracts make it difficult for healthcare consumers to know the cost of care prior to receiving it, and it is nearly impossible to make an informed decision as a patient.  The CAA will have a dramatic impact on Americans' ability to price shop on where to go for care, as well as their ability to plan for their out of pocket expense(s). The goal of the CAA is simple: People should be able to know the price ahead of time, shop using that price as well as quality of care metrics, and then they shouldn't be slapped with a giant, surprise balance bill afterward. At the end of the day, the goal is to allow people to have the tools to shop for healthcare the way that they do so for any other product or service. Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant.  Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention! https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs --- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

The Consolidated Appropriations Act 101 - Comply or Die?   The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care. Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day.  The goal for employers immediately is not to be perfect by 12/27/22, but to at least show that they made a good faith effort to be compliant. The price transparency component is where the opportunity lies for employee benefits brokers and their employers to uncover the source of their high cost claims, and then take appropriate fiduciary responsibility in order to pay more appropriate unit costs for healthcare.  While there is a cost associated with ensuring you are compliant, the opportunity to retain and win new business for consultants is massive. Right now, opaque network contracts make it difficult for healthcare consumers to know the cost of care prior to receiving it, and it is nearly impossible to make an informed decision as a patient.  The CAA will have a dramatic impact on Americans' ability to price shop on where to go for care, as well as their ability to plan for their out of pocket expense(s). The goal of the CAA is simple: People should be able to know the price ahead of time, shop using that price as well as quality of care metrics, and then they shouldn't be slapped with a giant, surprise balance bill afterward. At the end of the day, the goal is to allow people to have the tools to shop for healthcare the way that they do so for any other product or service. Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant.  Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention! https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs --- Support this podcast: https://anchor.fm/spencer-harlan-smith/support

Team, this week I'm bringing something a bit different to you. I'm giving you access to a speech that I gave in August. It is an important keynote, and one that I know will challenge. Folks, sometimes you have to take a step back before you take a big leap forward. Most of you know my journey, but this talk is different. I do into details and share tangible ways that you can pivot and move forward in new ways to greater heights. I can't wait for you to have a listen and make your leap forward! Broker Branding Academy: https://apn-consulting-llc.mykajabi.com/bba_online_course LinkedIn: Andy Neary Instagram: @andy_neary Learn more: andyneary.com

This Tuesday we're talking about unconventional healthcare with big time satisfaction. The Walmart - Amazon rivalry takes another step up. We also cover Apple's return to work (finally) and layoffs at Best Buy which could benefit Dealership employee searches.One Florida Dealership provides some very special health care services, including a Dr who sees patients several days a week at the storeAfter a 35% rate increase in 2019-2020, Greg Balasco, owner of Lakeland Automall who is a Ford, Hyundai, and Genesis dealer had enough and began looking for other options"There was sheer frustration over the lack of quality health care and the continual increase in expenses for me and our employees every year," Balasco told Automotive News. "Now, we're managing our health care ourselves instead of allowing these big companies to do it and take advantage of the employee and employer.”Worked with advisor Health Rosetta to find a fit and now manages their own healthSaved 25% for everyoneMany no deductible services and no-cost durable medical equipQuick call/text access to the Dealership doctor anytimeHealth card bears the Dealership logoThe “Dealership Dr” Dr. Christopher Salud, said in an interview w ABC Action News in Tampa, Fla., that he enjoys spending more quality time with fewer patients.The store sold 5200 vehicles last yearTake away: We bet they have a lower than normal turnover rate.Walmart has reached a deal with Paramount + to offer the ad supported version of the streaming platform to all members of Walmart+ subscription service for freeDirect move to remain competitive for its 16 million members with rival, AmazonParamount has had an office in Bentonville for many yearsWalmart+ is $98 per year and includes free shipping, gasoline discounts, and 6 months of Spotify premium. Amazon Prime costs $139 and features a robust streaming offering for video and musicApple tells its employees they will need to return to in-person work 3 days per week starting September 5thEmployees will be required to be in-office Tuesday, Thursday, and one other day of their choiceThe return was originally planned for July of 2021 but was shelved due to employee protestFrom CEO Tim Cook, “We are excited to move forward with the pilot and believe that this revised framework will enhance our ability to work flexibly, while preserving the in-person collaboration that is so essential to our culture. We also know that we still have a lot to learn. And we are committed to listening, adapting, and growing together in the weeks and months ahead.”Best Buy announces layoffs likely including hundreds of jobs at the store levelCiting waning demand and sales down 11%, more than the 3-6% initially estimated, the chain is restructuring to combat persistent inflationGet the Daily Push Back email at https://www.asotu.com/Rock with us LIVE at ASOTU CON! Tickets: https://www.asotucon.comJOIN the conversation on LinkedIn at: https://www.linkedin.com/company/asotu/Read our most recent email at: https://www.asotu.com/media/push-back-emailShare your positive dealer stories: https://www.asotu.com/positivityASOTU Instagram: https://www.instagram.com/automotivestateoftheunion

This week on ENGEGI RXperts we speak with Matt Henderson, Employee Benefits Consultant and a Health Rosetta Associate Advisor, on improving performance with healthcare benefits leading to reduced costs, improved quality and increased satisfaction for the employer and the employee.  Employers that implement these strategies decrease their overall medical spend by 20-40%.  Listen in to hear what Matt has to say.

So, let's put the last, I don't know, 300 episodes of Relentless Health Value into perspective here. The USA wastes about $1.5 trillion a year on some combination of paying way too much for low-value care, fraud, and waste—$1.5 trillion down the drain. As my guest, Dave Chase, says in this healthcare podcast, if this was a country, what we waste would be the 11th biggest GDP in the world. We could call it Healthcare-istan. Meanwhile, outcomes aren't anything to brag about on the world stage, and 41% of American adults have medical debt in this country. Also, all across the country, people making all kinds of healthcare decisions to save money that are clinically toxic. Financial toxicity is clinical toxicity, right? You know this already. You listen to this show. I just saw yet another study the other day—actually this one about cancer outcomes and how they are appreciably worse when patients are worried about how much money their treatment will cost. And a lot of people in this country—many people with a Part D plan, commercial insurance with big deductibles—there's a lot of people in this country who cannot afford tens of thousands of dollars in out-of-pocket spend every year. But let's change gears and talk about some good stuff, some inroads that are being made. Let's talk about Rosen Hotels for a moment. Rosen Hotels is a bright spot, for sure, in all of this. They are a leading indicator of what is possible. Rosen Hotels, which is a hotel chain in Florida, they saved over $450 million in healthcare costs and have healthier, happier employees. They spend 55% less per capita on health benefits despite having an employee population with significant health challenges. They saved so much money that Rosen was able to set up a scholarship fund so that not only kids of employees (and employees themselves) but also kids in the community can go to college. Turnover there is lower. Retention is higher. Employees are healthier. I mean, the ROI of a CEO and a CFO getting engaged and taking back control over their health benefits from third parties? It's huge. Check out this article about Rosen and also Dave Chase's TED Talk about Rosen.   My guest today, Dave Chase, says that what they did at Rosen Hotels was actually an inspiration for Health Rosetta, which is the organization that he founded to help employers take control of the out-of-control dysfunctional health benefits market in this country. Dave Chase says that the Health Rosetta community knows something that most don't (yet). Dave Chase has said that healthcare is fixed/fixable. He said that healthcare actually isn't expensive. Clinicians only receive $0.27 of every $1 that's ostensibly spent on healthcare. What is expensive is price gouging, profiteering, administrative bloat, fraud, and inappropriate treatment. And Dave Chase has also said that we're already investing more than enough money to not only fund world-class healthcare for everyone but also take all that money from Healthcare-istan and fund what drives 80% of health outcomes (ie, income, education, career opportunities, and clean air and water). There's so much money that is being wasted in healthcare. But all of this other stuff could be funded if we simply pay what we should be paying. (See Dave Chase's LinkedIn post to learn more about this.)   Health Rosetta currently has about five million lives stewarded through plans managed by their Health Rosetta advisors. That's probably another bright spot right there—five million lives. Another bright spot is the work of the Nuka System in Alaska. Listen to EP312 with Douglas Eby, MD, MPH, CPE. The Nuka System has won award after award for being one of the best health systems in the country, and it serves a challenging patient population for less money than most Medicaid plans.   So, here you have two entities, Rosen Hotels and the Nuka System, dealing with (on a good day) patient populations with multiple chronic conditions, high maternal mortality … At Rosen, 56% of their pregnancies are categorized as high risk, which not only has generational human consequences, of course, but is also a notorious budget-buster, as Dave Chase has said. There's substance abuse issues. These are patient populations who are doing appreciably better and cost far less than if they were covered by almost any other health plan in this country. Here's yet one more bright spot example company, and that's Pacific Steel. During our conversation, Dave Chase mentioned that the CFO of Pacific Steel said that when they went from spending $8 million in health benefits a year to spending under $3.5 million—basically cutting their healthcare costs in less than half—the CFO said that in order to make that same amount of net income, Pacific Steel would have had to raise their top-line sales revenue by 25% to 30%. So, okay … you're a CEO, and here's your choice to appease your shareholders or make your own bonus. Option A: Go out right now and figure out how to sell 30% more. Or Option B: Get your healthcare house in order, which may also improve retention if you do it right. To me, this doesn't seem like a head-scratcher. Two things that Dave Chase also brought up during our conversation that I thought were thought provoking. First, change is happening regionally and seems to adhere to the so-called “rule of three,” meaning that if three employers have worked with a qualified employee benefit consultant (EBC) and really fixed up their health benefits, then a cascade will start in that region. And secondly—and I never thought about this before—we spend over $4 trillion through various health plans (employer, ACA, Medicare, Medicaid), and yet have little to no objective mark of value for how good any given health plan is. The closest thing, as Dave Chase says, might be Medicare Advantage Star Ratings. To address this problem, Health Rosetta invested seven figures to build a Plan Grader™. This really helps employers make sure that the plan they put in place is a win-win the whole way around. You can learn more at healthrosetta.org or by emailing Dave at dave@healthrosetta.org.   Dave Chase leads the mission for Health Rosetta, which is to empower community-owned health plans (COHPs) with the vision of COHPs everywhere. Health Rosetta's purpose is creating and reinvesting the Health Rosetta Dividend (ie, redeploying the currently wasted $1.5 trillion in healthcare to a higher and better use—the social determinants of health such as income, better food, etc). Health Rosetta makes health plans local, organic, and sustainable transforming health plans from the number one driver of inflation, poverty, and bankruptcy to drivers of well-being and wealth. Health Rosetta ends the 30-year heist of stolen income from the working middle class. Health Rosetta plans have restored the American Dream for tens of thousands of people, giving them raises/bonuses and healthcare they can access without fear of bankruptcy. Individuals that had sky-high deductibles and co-pays no longer have that as a barrier (typically they are $0). School districts that once couldn't give teachers raises or had to have school levies to pay for music, art, and sports programs now have the funds (due to healthcare savings) to pay teachers more, have bigger class sizes, avoid cutting extracurricular programs, and more—all while giving teachers much better care outcomes. Health Rosetta's Plan Grader™ assesses the 40 most important attributes of a health plan “prescribing” proven strategies to transition into local, sustainable, world-class health plans. Health Rosetta community's transparency set a new industry standard and became the law of the land due to changes in laws that represent the largest change in employee health benefits since 1943. Through best-selling books, writing for various media outlets, TED Talk, and TV/film, Dave has reached over 10 million people with the goal of engaging, equipping, and empowering a broad grassroots movement designed to restore hope, health, and well-being to our communities. Dave received the Health Value Awards' Lifetime Achievement for Health Benefits Innovation at the World Health Care Congress. Prior to Health Rosetta, Dave cofounded Avado, which was acquired by and integrated into WebMD/Medscape, and founded Microsoft's $3-billion, 28,000-partner healthcare ecosystem. Outside of work, Dave coaches the next generation of leaders as a high school track and cross-country coach of state champion teams and individuals. Dave was a PAC-12 800 meter and 4×400 competitor. Most importantly, devotion to faith, family, and friends underpin a desire to be a servant leader to the five million lives (and growing) stewarded through the Health Rosetta community. 06:57 Why did Dave Chase start Health Rosetta? 07:42 EP312 with Douglas Eby, MD, MPH, CPE.07:51 How does Health Rosetta deem which health plans are succeeding? 11:07 What are the most important areas and factors for grading health plans? 11:22 EP365 with Scott Haas.11:38 “That $1.5 trillion of waste, how is that possible? Well, it's all codified in the contracts.” 12:18 “You can't manage what you can't measure.” 16:59 “What could be more disruptive than 30 years of wage gains stolen by the status quo health plans?” 17:39 “This is the last major area to modernize inside of corporate America.” 18:15 “This is not small dollars; there's a tremendous opportunity.” 19:04 “Go back to PBM. That's the first thing that starts to get at the care delivery side.” 21:52 “Can we even call it primary care if you can't get in to that doc for weeks?” 25:03 Where does Health Rosetta get their data to assess health plans? 27:00 Who are these self-insured employers, typically? 29:48 “3.5% [is] where the market flips.” 31:57 EP367 with Doug Hetherington.32:03 EP350 with Katy Talento.33:13 “We like to fetishize big in this country.” You can learn more at healthrosetta.org or by emailing Dave at dave@healthrosetta.org.   @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth Why did Dave Chase start Health Rosetta? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth How does Health Rosetta deem which health plans are succeeding? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth What are the most important areas and factors for grading health plans? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “That $1.5 trillion of waste, how is that possible? Well, it's all codified in the contracts.” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “You can't manage what you can't measure.” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “What could be more disruptive than 30 years of wage gains stolen by the status quo health plans?” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “This is the last major area to modernize inside of corporate America.” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “This is not small dollars; there's a tremendous opportunity.” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “Go back to PBM. That's the first thing that starts to get at the care delivery side.” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “Can we even call it primary care if you can't get in to that doc for weeks?” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth Where does Health Rosetta get their data to assess health plans? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth Who are these self-insured employers, typically? @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “3.5% [is] where the market flips.” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth “We like to fetishize big in this country.” @chasedave of @HealthRosetta discusses #healthplans in our #healthcarepodcast. #healthcare #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Cora Opsahl (EP373), Cora Opsahl (EP372), Dr Mark Fendrick (Encore! EP308), Erik Davis and Autumn Yongchu (EP371), Erik Davis and Autumn Yongchu (EP370), Keith Hartman, Dr Aaron Mitchell (Encore! EP282), Stacey Richter (INBW34), Ashleigh Gunter, Doug Hetherington, Dr Kevin Schulman, Scott Haas, David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33)  

Employers are being taken for a massive and costly ride by both insurance brokers and the health insurance companies at large. Andrew Roberts is showing smaller employers that there is a way to avoid the ever-increasing rates offered by the health insurance companies. Enter self-funded insurance plans. You'll learn why your company is being upcharged every year by your broker, how going self-funded can benefit the well-being of your employees, and what the ingredients of the self-funding secret sauce are.   Takeaways Although many entrepreneurs and business leaders accept that health insurance costs going up are a foregone conclusion, this is not the case. They assume the increase will occur because they have been conditioned to, however, there are opportunities to save. Healthcare makes up 20% of the US economy, 50% of which is paid for by employers. The healthcare system is rigged against employers and will stay that way until employers do something to take control back. To take back control, employers need to work with an advisor who is aligned with their objectives. Both parties need to be present when dealing with insurance brokers who are incentivized to sell insurance company products with big commissions and bonuses.  Employers need to be self-funded. While this may seem daunting, it can be done very conservatively, to the point where it can actually be safer than being fully insured. Using a stop-loss insurance policy can protect the business from paying huge amounts. The costs for self-funding can be divided into three buckets which are claims, administration costs, and stop-loss insurance.  By using self-funded insurance, companies can save at least 10% of what they would be paying to an outside insurance company for the same level of coverage. The secret sauce of self-funding requires transparency, a fee-based advisor with a fiduciary mindset that can be an advocate for employees, and an independent TPA also with a fiduciary mindset.   Links:  LinkedIn: https://www.linkedin.com/in/andrew-roberts-090228/ Email: aroberts@amrbenefits.com Cellphone: (781) 799-0653 Company website: https://www.amrbenefits.com/ Health Rosetta website: https://healthrosetta.org/   Quote of the Show “There is a misnomer that if it costs more it's better, not true” - Andrew Roberts    Book Recommendations: The CEO's Guide to Restoring the American Dream by David Chase No Ego by Cy Wakeman Mindset by Carol Dweck    Ways to Tune In: Apple Podcast - https://podcasts.apple.com/us/podcast/leadership-in-action/id1585042233 Spotify - https://open.spotify.com/show/2t4Ksk4TwmZ6MSfAHXGkJI Stitcher - https://www.stitcher.com/show/leadership-in-action Google Play - https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubGVhZGVyc2hpcGluYWN0aW9uLmxpdmUvZmVlZC54bWw Amazon Music - https://music.amazon.com/podcasts/4263fd02-8c9b-495e-bd31-2e5aef21ff6b/leadership-in-action YouTube - https://youtu.be/BYquLlfQNZk

One of my mentors often said price is irrelevant. He said he would sell anything for any price as long as he could define the terms of the deal. During this conversation today with Scott Haas about PBMs, that quote was playing in my head like an earworm. I'm henceforth gonna struggle with the term rebate to define dollars that the PBM gets back from Pharma, because, according to my guest in this healthcare podcast Scott Haas, it turns out “rebates” comprise only about 40% of those back-end dollars that some PBMs manage to score from pharma manufacturers. I don't have any insight really into this, but Scott Haas certainly does—and this is the average that he has seen in his work and that we're going to dig into today. But in sum … wow! Let me just repeat that a mere 40 cents on the dollar of the gross amount that PBMs take in “rebates” from Pharma these days winds up going back to plan sponsors, even plan sponsors who are getting “100% of the rebates.” If you didn't understand what I just said, no worries. I'm gonna explain it right now. If you did and you know the why behind all of this also, you could probably skip ahead about five minutes. Here's the backstory on this whole rebate fandango. Let's start with part one of what is a two-part transaction. So, part one: the deal between pharma manufacturers and PBMs. In general, a pharma manufacturer signs a deal with a PBM to give back whatever percentage of their gross sales revenue to the PBM at the end of the year, say. It's along the same lines as a cash-back coupon for the PBM. Why would a pharma company be up for giving cash back like this? Well, to get on a PBM's formulary, giving cash back is like the price of admission. PBMs have a lot of leverage, after all—at least the big ones. They control access to millions and millions of patient lives. So, if Pharma wants their drug to be accessible to those millions and millions of lives, they have to play the cash-back game, otherwise known as the rebate game. They have to agree to give back to the PBM a certain amount of cash on the back end. So, PBM pays Pharma's list price up front—that's the gross amount paid, based on the list price of the drug—and then after all the cash back gets toted up at the end of the year, there'll be a net price. List price or gross price minus the cash back equals net price. It's this net price that's the true kind of final price which the pharma company gets paid per script by said PBM at the end of the day. These days, most everybody pretty much knows that PBMs are getting these so-called rebates—this cash back from pharma companies that I just explained. And it's pretty common knowledge the so-called gross-to-net bubble (the gross-to-net dollar amount) is pretty huge, meaning the rebate or cash-back amount is pretty huge. And many have also noticed that the gross-to-net dollar amounts seem to be growing bigger and bigger every year. I mean, for one insulin manufacturer, consider this: Their list price, their gross price, is $350 per script. And their net price after cash back/rebates was $52 this past year. Wait ... what? After all the cash back to the PBM, the insulin manufacturer got paid 86% less than their list price—$350 went down to $52 per prescription. The PBM vacuumed up 86% of the dough for every script written for this particular brand of insulin.   OK … so, say Pharma gives $100 back to the PBM based on the terms of their deal. Call that part one of this example transaction. Here's part two: the deal between PBMs and health plans or self-insured employers. Health plans and self-insured employers are customers of the PBM. They hire PBMs to manage the pharmacy benefits for their members or employees. So, because everybody knows this whole rebate thing is going on, as part of the contracts that the PBMs put in place with their customers (meaning the health plans or employers), the PBMs tell their customers that they're going to give 100% of the rebates back to the plan/employer. So, you'd think that if the pharma manufacturer paid $100 to the PBM, that the customers of the PBM (the plan sponsors) would get the $100 back then, right? The PBM would pass on 100% of the savings, as it were, if they're saying that they're gonna give 100% of the rebates. I mean, if this is actually true, that $100 in and $100 out, then the PBM is potentially performing a useful service, right? They're lowering drug costs for their customer, the plan sponsors for their members and employees. Except … turns out, not so much. Because what is a rebate, really? A rebate can be anything the PBM defines as a rebate. And it turns out that, on average, as I said before, according to those in the know, something like $60 of that $100 is not a rebate. It's an administration fee. Or a data fee. Or an education fee. A clinical program fee. Some other name that is not rebate. As my guest Scott Haas says, the term rebate is meaningless because it can mean whatever the PBM wants it to mean. It's like inconceivable from The Princess Bride. I do not think that word rebate means what you think it means.   Now it is a tangled web we weave here, and for more on why I say that, listen to the episode with Chris Sloan (Encore! EP216) entitled “How Medicare Part D Plans Became Addicted to Drug Rebates.” There's also a show with Pramod John (EP353) where we dig into, specifically, specialty drugs and rebating and so-called rebate walls.   But net net, all of this probably myopic focus on rebates means that you have to keep an eagle eye out for so-called exclusions in contracts if you are a plan sponsor. So, what are exclusions? This is that whole thing where some cheap generic is excluded from a PBM formulary while some expensive brand for the same condition is on formulary. Why would a cheap generic be excluded from a PBM formulary? Simple. Cheap generics don't have rebates. PBMs lose a lot of money when some high-priced specialty drug, for example, goes generic. They might have made thousands of dollars per script on that high-priced brand by collecting its rebate. Think about that insulin example. The rebate is 86% of the cost of the drug. And everybody wonders why some cheap generic insulin or biosimilar or whatever isn't on formulary. It is not a mystery when you're dealing with for-profit enterprises built around a model of revenue maximization. So, given all this, what's my guest Scott Haas's bottom-line advice in this whole thing? If you're a health plan or employer and you're trying to negotiate a PBM contract where your spend is predictable and your contracted price promises have any meaning whatsoever, Scott Haas's advice is, you have to ensure that the contract defines the actual prices for the drugs in the contract. With absolute numbers. Not percentages off or weird formulas or the empty promise of getting an AWP or a WAC (which means average wholesale price or wholesale acquisition cost) or any of the other various acronyms for some drug pricing schema. All of these are basically shorthand for “this price could change at any moment.” There's a reason in-the-know people say AWP stands for “Ain't what's paid,” meaning ain't what's ultimately going to be paid by plan sponsors. What is necessary in PBM contracts is the final price—that number. Some digits with a dollar sign in front of them and a “per unit” after them. No acronyms and no percentage signs. Whoever gets to define the terms ultimately controls the price. So, get the price up front. As mentioned several times already, I am talking to Scott Haas, who is a senior VP over at USI Insurance Services. He's speaking today from the perspective of a plan sponsor, meaning from the point of view of a health plan, including those health plans managed by and paid for by a self-insured employer and their employees. For more information on PBMs and how drugs get adjudicated, listen to the show with AJ Loiacono (Encore! EP231), which was one of the most popular episodes over here at Relentless Health Value. Somebody on a LinkedIn post the other day commented on how much she appreciated AJ Loiacono's frank assessment of things and how she would love to go to a meeting with more people similarly telling it like it is. That's pretty much what we aim to do at every episode over here at Relentless Health Value, and AJ nails it on that objective for sure in this episode.   One last thing, also on the show: Scott Haas brings up GPOs that the Big Three PBMs have been spinning up to aggregate and maximize all of those rebates that we just talked about. I discuss this exact topic at some length in another incredibly popular episode with Mike Schneider (Encore! EP288).   You can learn more at usi.com or by emailing Scott at scott.haas@usi.com.  Scott Haas has over 38 years of employee benefits experience. His background includes the development and validation of care management programs; prescription benefit management solutions; provider network evaluation, valuation, and negotiation; and underwriting. Scott started and operationalized a third-party administrator (TPA) and a pharmacy benefit manager platform from scratch. He has worked in the arena of alternative funding for most of his career. Scott's primary focus is in the area of alternative delivery and financing of healthcare other than fee for service, along with prescription benefit and healthcare risk management consulting. Scott has held officer-level positions within Blues plans and TPAs as vice president of sales and marketing, vice president of underwriting, and president. Scott has also served as a trustee for both union and non-union health and welfare and pension plans. Scott frequently shares his consulting expertise speaking at national events hosted by organizations such as Health Rosetta, the International Foundation of Employee Benefits, the Health and Welfare Plan Management Conference, the Western Pension and Benefits Conference, and the Self-Insurance Institute of America (SIIA). Scott has authored and coauthored articles on various topics over his career. Scott earned his bachelor's degree in business administration and economics from the University of Nebraska at Kearney. Scott also holds Chartered Life Underwriter (CLU) and Registered Health Underwriter (RHU) designations. 10:29 What's the major flaw with the buyer-seller relationship between plan sponsors and PBMs? 12:04 What are the five things that need to be considered in order to get a fair price from a PBM? 13:16 Why does using average wholesale price cause problems for plan sponsors? 15:05 What does it mean to put the network risk on the PBM? 17:10 What's happening with drugs moving from specialty brand to specialty generic? 19:14 “A generic is a generic; in our world, it's binary.” 23:31 “The term 100% of rebates is really irrelevant.” 23:54 What does it mean to have a minimum guarantee in drug rebates? 26:39 “When you do a line-item assessment … is it producing an optimal result in comparison to competitively achieved … pricing for generics … and for specialty?” 27:52 “Plan sponsors need to grow a backbone.” 28:36 EP342 with Christin Deacon.29:05 Why do you need to understand your consultant's process as a plan sponsor? 29:30 Why do you need to understand formulary exclusions as a plan sponsor? 29:41 Why is it important to create a more equal PBM contract? 30:52 “Rebates inure to the benefit of the plan sponsor; they don't necessarily benefit the consumer.” 31:45 What does Scott do at USI? You can learn more at usi.com or by emailing Scott at scott.haas@usi.com.  Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast What's the major flaw with the buyer-seller relationship between plan sponsors and PBMs? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast What are the five things that need to be considered in order to get a fair price from a PBM? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast Why does using average wholesale price cause problems for plan sponsors? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast What does it mean to put the network risk on the PBM? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast What's happening with drugs moving from specialty brand to specialty generic? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast “A generic is a generic; in our world, it's binary.” Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast “The term 100% of rebates is really irrelevant.” Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast What does it mean to have a minimum guarantee in drug rebates? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast “When you do a line-item assessment … is it producing an optimal result in comparison to competitively achieved … pricing for generics … and for specialty?” Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast “Plan sponsors need to grow a backbone.” Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast Why do you need to understand your consultant's process as a plan sponsor? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast Why do you need to understand formulary exclusions as a plan sponsor? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast Why is it important to create a more equal PBM contract? Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast “Rebates inure to the benefit of the plan sponsor; they don't necessarily benefit the consumer.” Scott Haas of @USIIns discusses #PBMs and #drugrebates on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! David Muhlestein, David Scheinker, Ali Ucar, Dr Carly Eckert, Jeb Dunkelberger (EP360), Dan O'Neill, Dr Wayne Jenkins, Liliana Petrova, Ge Bai, Nikhil Krishnan, Shawn Rhodes, Pramod John (EP353), Pramod John (EP352), Dr Eric Bricker, Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell  

This week, I'm joined by Dave Chase: the creator and co-founder of Health Rosetta. He and his company are well known for their work to fix the U.S. healthcare system – but today's podcast reveals a more personal side of his life. We talk about being a father that helps his kids grow into confident […] The post Unlocking the Potential in Others with Dave Chase first appeared on Ryan James Miller.

In this healthcare podcast, I'm speaking with Eric Bricker, MD, about how so many entities in healthcare are getting up in other people's business and swimming in other people's traditional lanes. Consider last week's show with Katy Talento, for example. She mentions employers who are not only doing their own direct contracting (ie, cutting out the traditional carriers and negotiating directly with provider organizations) but also employee benefit consultants who are working on setting up their own hospital—an employer-owned hospital. That was episode 350, and while this hospital idea is a little future oriented, right now today, across the country, we have employers and also unions who are owning their own primary care clinics, which I discussed at some length with Mark Blum from America's Agenda (EP248).   In this episode with Dr. Bricker, we start from the beginning. We kick off the conversation talking about the payer, PBM, and hospital system horizontal consolidation that has transpired over the past decades (that's plural). Horizontal consolidation is pretty much the easiest way to decimate all competition in your own swim lane so that you can charge more and not worry so much about patient/customer/member experience because the patients/customers/members have no better alternative. They effectively have nowhere, or few other places at best, to go if they leave you. So, what's the impact of horizontal consolidation? We get into this in the podcast, but subsequent to this recording, there was a study that came out in JAMA: “The Dysfunctional Health Benefits Market and Implications for US Employers and Employees.” This was by David Scheinker, PhD; Arnold Milstein, MD; and Kevin Schulman, MD. This study showed that commercial insurance costs have gone up 4x the rate of other benchmark goods and services. Bottom line, “It is assumed that insurers compete intensely to improve the value received by employers and employees by negotiating to keep prices down and advocating for employers and employees.” Ha ha … NOT.   With peak horizontal consolidation, there is little meaningful competition—so ixnay on that premise. By the way, if anyone knows any of those authors that I just cited in that study, hit me up. I'd love to get one of them on the show. But let's spend a moment, shall we, on the human impact of all this extreme consolidation. The impact is your sister, your neighbor, your son, your friend. So many feel so much pressure financially in our country today because of healthcare costs. Even families earning significantly more than median household income are forgoing care because of costs. Again, this was in a recent paper. (The authors are Alyce S. Adams, Raymond Kluender, Neale Mahoney, Jinglin Wang, Francis Wong, and Wesley Yin.)   But the direct observable financial toxicity resulting from high healthcare patient costs is really only the tip of the iceberg here. As Dave Chase from Health Rosetta has said a million times already, high healthcare costs have a multitude of effects on employers, big and small. One big one is, if healthcare costs more, then there's less money for salaries. Dave, citing lots of evidence, has long attributed wage stagnation in this country to accelerating healthcare costs, which became even more rampant during periods of industry consolidation. Dave Chase leads Health Rosetta, by the way. Here's another human toxicity: Listen to episode 337 with Oliva Webb on the impact on her life as a result of the undeniably and unquestionably common non-excellent treatment by the PBMs and SPPs that she has to deal with. Because, as Dr. Bricker also says, no competition means basically not a whole lot of concern about patient experience. Why should a for-profit business spend money to improve something when there's nothing really to be gained for them financially to do so? I mean, the best a patient can do most of the time is hop from the frying pan into the fire. That's what happens when there's no competition or no real competition. Also consider the burned-out clinicians who have to get stuck in the middle of this nobody-really-cares-at-the-monopoly customer service paperwork quagmire.  By the way, here's a sidebar that might come as a surprise to some people, but please take this in the spirit with which it's intended. All of us innovators and lifelong learners, we want to update our beliefs when the facts show us an updated conclusion. So, I have learned that all of this consolidation was going on long before the ACA (Affordable Care Act). My point here is to please look into this well-documented trend line before reflexively tweeting that the ACA drove consolidation. Dr. Bricker and others like Dr. Mai Pham have told me that, in their opinion, low interest rates, cheap debt, and a desire to eliminate competition are wildly powerful drivers of consolidation. Anyway, about nine minutes into the interview with Dr. Bricker, if you're one of the ones who knows all you care to know about horizontal consolidation, we get into vertical integration, vertical consolidation—and this is where things get interesting. And when I say interesting, I mean it in a “we live in interesting times” kind of way. The vertical consolidation conversation segues into whose swim lane that the digital health and other innovators or, dare I say, disrupters are diving into and whose lunch they are aiming to eat. Dr. Bricker probably needs no introduction. He is the force behind AHealthcareZ, which you can find online, on Twitter, YouTube, and LinkedIn. He has worked as a clinician, in healthcare finance, and currently serves as a chief medical officer. If that weren't enough, he's also been an entrepreneur—a very successful entrepreneur, I might add. He started one of the first healthcare navigation firms called Compass Professional Health Services. Compass had something like 2000 employer clients serving about 1.8 million people when it was purchased in, I believe, 2018.   You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn.  Eric Bricker, MD, is an internal medicine physician and former cofounder and chief medical officer of Compass Professional Health Services. Compass is a healthcare navigation service that grew to 2000+ clients, including T-Mobile, Southwest Airlines, and Chili's/Maggiano's restaurants. Compass was acquired by Alight Solutions in July 2018. Alight is a 10,000-person employee benefits and HR outsourcing company that separated from Aon in 2017. Dr. Bricker has since started AHealthcareZ.com, with 170+ healthcare finance videos with approximately 90,000 views per month across all platforms. He is also the author of Healthcare Money Campfire Stories.  06:30 What is this “megatrend” happening in healthcare right now? 07:52 How has consolidation changed the healthcare landscape? 10:22 What is vertical integration within healthcare? 11:48 Why doesn't inorganic growth benefit patients? 13:33 “What is best for the patient does not necessarily make the most money.” 14:43 “It's not that it's above the law … it is just intentionally obscured.” 18:58 “Healthcare is glacial. It is slow.” 23:23 “The largest source of healthcare costs is hospitals.” 25:48 EP330 with John Marchica.29:17 “What have the historical priorities been of the administrators of those hospitals?” 29:32 “Every hospital CFO knows that they need sick people.” 30:18 EP343 with David Carmouche.30:59 “The payment change has to come first.” 32:17 “The money wins.” 34:12 “You've got to put the financial incentives in place … to make people actually behave the way that they should.” You can connect with Dr. Bricker on Twitter at @DrEricB and on LinkedIn. @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth What is this “megatrend” happening in healthcare right now? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth How has consolidation changed the healthcare landscape? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth What is vertical integration within healthcare? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth Why doesn't inorganic growth benefit patients? @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “What is best for the patient does not necessarily make the most money.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “It's not that it's above the law … it is just intentionally obscured.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “Healthcare is glacial. It is slow.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The largest source of healthcare costs is hospitals.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “What have the historical priorities been of the administrators of those hospitals?” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “Every hospital CFO knows that they need sick people.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The payment change has to come first.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “The money wins.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth “You've got to put the financial incentives in place … to make people actually behave the way that they should.” @DrEricB discusses #healthcare's changing landscape on our #healthcarepodcast. #podcast #digitalhealth   Recent past interviews: Click a guest's name for their latest RHV episode! Katy Talento, Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica  

In this healthcare podcast, I'm talking about direct contracting IRL (in real life) with Katy Talento. This is a conversation that's more about the reality of direct contracting than the theory of direct contracting, and this was not an accident. So much of healthcare transformation is really easy to say and much harder to actually do. So … direct contracting. In the context we discuss in this episode, generally direct contracting means when an employer or their benefits consultant, more likely, hooks up with a provider organization, lots of times a hospital or a health system. Moving forward here, I'm just gonna say employer when I sort of really mean the employer and their TPA and their repricer, the constellation of consultants and other vendors that are working with the employer. So, just for simplicity, the employer says to the provider organization, “Hey, let's cut out the middleman here” (middleman likely being some insurance carrier). “I will just pay you directly, and it will be a win-win because no one is sucking out up to 15% to 20% right out of the middle, and also I'll steer my employees/patients/members your direction, which is great for us as a self-insured plan because money saved and also because I've done some quality analytics and I think you're relatively good at delivering care … so I'm happy to help my members find you.” The employer will, in general broad strokes, pay the provider organization some percentage over the Medicare rate for procedures or codes or bundles. By the way, the dollar amount over Medicare for the bundles or procedures or codes can vary depending on factors like what service line it is because, unlike RBP (reference-based pricing), direct contracting is a negotiation. It's a two-way deal. RBP, a lot of times, is the payer/employer deciding what they're gonna pay and then paying it—without sitting around a table with the provider figuring all this out together. So, if only from this one dimension, direct contracting is something that you'd think that hospitals/health systems/providers would be kind of into and up for. One thing that I didn't really understand before this conversation is that, if we're talking about an employer direct contracting with, say, a hospital, the list of direct-contracted procedures or codes or bundles might include pretty much all of the services that the hospital can perform; but, in general, the employer is only going to steer members there or make it financially attractive to go to the hospital for, for example, emergency or unavoidable procedures. Why? Because no employer wants patients going to the hospital for things that they could get a whole lot cheaper in an outpatient setting with no less quality. So, unless a hospital is willing to compete on price with other care settings, then an employer is not going to steer their members there. If you're a hospital, you might take this as a con. But, on the other hand, consider that if there's a few hospitals in the area, the general direction will be to go to the one with the direct contract. Furthermore, if a plan is gonna steer members, they're gonna steer them whether they have a direct contract with you or not. Katy makes one point early and often throughout this conversation. From a hospital perspective, doing a direct contract is and should be pretty easy. From an employer perspective, too, there should not be a lot of disruption or friction for employees. There doesn't need to be. Done right, it should be a win-win for the employer, provider, and, most of all, the patient who doesn't get stuck with high bills, balance bills, and lower-quality care than might be available to them through their benefits. Katy goes through the steps to create a direct contract and the challenges she has faced along the way. We also get into the wonderful world of payviders, so you could consider this an extension to the episode with Jeb Dunkelberger (EP348) from last month. My guest today, Katy Talento, started out as an infectious disease epidemiologist (which I did not realize). She ended up doing public health policy. She's worked on Capitol Hill for various senators and, in the last administration, as health policy lead. Katy is the CEO of AllBetter Health and works with the Health Rosetta organization. She is a benefits advisor for employers who are looking to create better health plans that reduce costs dramatically while, at the same time, improving benefits. I mean, you can only do that in healthcare, right?—where there's basically no relationship between price and quality. You can learn more at allbetter.health or contact Katy directly at katy@allbetter.health. Katy Talento is an infectious disease epidemiologist, a veteran health policy advisor, and healthcare consultant. She is CEO of AllBetter Health, an insurgent benefits advisory firm building innovative health plans for employers that are free of misaligned financial incentives. Katy served as the health policy lead in the White House on the Domestic Policy Council where her portfolio included public health issues such as eliminating domestic HIV/AIDS, ending secret healthcare prices, lowering prescription drug prices, expanding health IT interoperability, combating the opioids and other drug addiction crisis, and promoting bioethics in the life sciences. Katy has appeared on or been published in a number of media outlets, including CNN, Sky News, Newsmax, The New York Times, The Hill, The Morning Consult, RealClearPolitics, and others. Prior to her White House appointment, Katy served five U.S. Senators over a 15-year period, including as top health advisor and manager of legislative staff and oversight investigators. She also worked in the private sector helping multinational energy companies protect their global workforce from infectious diseases and on the research faculty at Georgetown University Medical School. Katy served as the director of speechwriting for the Republican National Committee and has written a number of published opinion pieces, Web copy, and video scripts. She spent two years as a Catholic nun and has worked with the poorest of the poor from East Africa to industrial Russia and inner-city America. Katy received a master of science degree in infectious disease epidemiology from the Harvard School of Public Health and an undergraduate degree in sociology from the University of Virginia. 05:21 Why are employers direct contracting? 06:37 “When you directly contract … you don't have to chase patients.” 07:43 Why the growing 501(r) movement is making direct contracting more enticing. 10:16 “They're going to be giving better rates, whether they want to or not.” 11:46 “I think it's the future hospitals want, too.” 12:58 What is the primary driver of increased healthcare costs? 14:56 “The fixed costs that the hospitals … have may not be so fixed.” 15:08 “A hospital should not be a freestanding profit center. … The hospital is a failure of healthcare. It alone should not be profitable.” 15:35 “We have the system we have, but why do we have to live with it? We don't have to.” 17:15 What's step 1 of direct contracting? 24:12 What's the TPA's role in direct contracting? 25:21 What's the repricer's role in direct contracting? 33:28 “I think the thing that makes all this work is having a benefits advisor that knows how to do all this.” You can learn more at allbetter.health or contact Katy directly at katy@allbetter.health. @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth Why are employers direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “When you directly contract … you don't have to chase patients.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth Why the growing 501(r) movement is making direct contracting more enticing. @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “They're going to be giving better rates, whether they want to or not.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “I think it's the future hospitals want, too.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth What is the primary driver of increased healthcare costs? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “The fixed costs that the hospitals … have may not be so fixed.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “A hospital should not be a freestanding profit center. … The hospital is a failure of healthcare. It alone should not be profitable.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “We have the system we have, but why do we have to live with it? We don't have to.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth What's step 1 of direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth What's the TPA's role in direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth What's the repricer's role in direct contracting? @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth “I think the thing that makes all this work is having a benefits advisor that knows how to do all this.” @KatyTalento discusses #directcontracting on our #healthcarepodcast. #healthcare #podcast #hospitals #digitalhealth Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW33), Stacey Richter (INBW32), Dr Steve Schutzer (Encore! EP294), Lisa Trumble, Jeb Dunkelberger, Dr Ian Tong, Mike Schneider, Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly

Half of individuals with health insurance are covered by their employer. If you are in this group, this episode is a must-listen. Learn how benefit design impacts your out-of-pocket expenses, your in-network providers, and the care available to you.Host Terry Wilcox is solo this Thanksgiving week, and brings listeners a feature interview with Dave Chase of the Health Rosetta. Together, they explore how to transition high-cost benefit design into transparent, affordable, and accessible healthcare. Plus, how to bring employers into these key healthcare conversations.Hosts: Terry Wilcox, Executive Director, Patients RisingDr. Robert Goldberg, “Dr. Bob,” Co-Founder and Vice President of the Center for Medicine in the Public InterestKate Pecora, Field Correspondent, Patients RisingGuests:Dave Chase, Creator, Health RosettaLinks:Tedx Talks: Healthcare Stole the American Dream - Here's How We Take it BackUnderstanding LOCALNeed help?The successful patient is one who can get what they need when they need it. We all know insurance slows us down, so why not take matters into your own hands? Our Navigator is an online tool that allows you to search a massive network of health-related resources using your zip code so you get local results. Get proactive and become a more successful patient right now at PatientsRisingConcierge.orgHave a question or comment about the show, or want to suggest a show topic or share your story as a patient correspondent?Drop us a line: podcast@patientsrising.orgThe views and opinions expressed herein are those of the guest(s)/ author(s) and do not reflect the official policy or position of Patients Rising.

Friends,Our topic this week is employer-based healthcare, which accounts for nearly 50% of all the healthcare spend in the US. We'll kick off the episode dispelling some surprising misconceptions about how healthcare insurance actually works; which explains, in large part, how the costs of care continue to rise way beyond other costs of living. Our guest today, David Contorno is a nationally recognized expert in employee benefits. After nearly 20 years consulting to large national employers, David created E Powered Benefits: a benefits consulting firm whose mission is to deliver fully transparent, value-based benefit services. David has won numerous recognitions & awards, and has been a major contributor to the work and publications that Dave Chase has produced out of Health Rosetta, and the nationally recognized publications of Dr. Marty Makary. He mentors other benefits managers from across the country to transform their business models as well. In this episode, we'll discover:Some surprising insights into how healthcare insurance companies, insurance brokers and benefits managers are incentivized and bonused - and the conflict-of-interest that is built into the system.The radically different and transparent approach David Contorno takes in creating healthcare benefits programs for employers and employees.How his business model has produced average one-year savings of over 50%, along with substantially reduced out-of-pocket costs for employees - all while improving quality and experience of care.The specific approaches and tactics that David uses, targeted to decrease unnecessary healthcare costs. A real-life example of how David and his colleagues have reduced the costs of a 500 person company by $35 million over the past 5 years. The complexity and lack of transparency in our employer-based healthcare payment and insurance system make it incredibly challenging to understand or do much about - even for the expert employer-based HR benefits managers, whose job is to manage the costs and quality of care for their employees. In an attempt to provide some clarity, I'll summarize three significant take-home messages I gleaned during this interview:(I) the healthcare stakeholders that employers and employees rely on to manage quality & costs are not, for the most part, financially incentivized to lower costs, raise quality or improve outcomes of care.(II) The majority of healthcare insurance costs are actually medical costs; so the way to fix rising healthcare insurance costs is to address the detailed medical costs..  (III) The specific tactics that David focuses on include:(1) finding surgeons and surgical centers with higher quality outcomes and lower costs - centers that offer fixed-price bundled payments.(2) finding imaging centers that deliver state-of-the-art service at a fraction of the cost of high-priced centers.(3) purchasing medications outside of the traditional pharmacy benefits management (PBM) system - thus avoiding huge mark-ups.(4) providing value-based ‘direct primary care' for chronic diseases and preventive services. These models allow a physician to spend more time with their patients rather than be driven by Fee-For-Service, RVU-based, high-volume care.(5) Employers passing the savings onto their employees rather than the more typical employer approach of pass-through cost-shifting.What I truly admire about David Contorno is that he's adopted a radically different approach to the way that he and his company get paid. His compensation and bonus structure are based on lowering costs while assuring high quality care. And, his revenue is completely aligned with employers' and employees' best interests, not with those of corporate shareholders.Healthcare insurance and medical costs are a crippling problem for a significant and growing percentage of American employees and their families. The goal here is not to lay blame on legacy stakeholders in healthcare. Rather, it's to lay out for all to see that the fundamental payment structure and incentives in the system are misaligned and grossly maladapted for the purported purpose of healthcare - that is, of keeping employees and their families healthy. David sums it up in this way, “Every entity that an employer trusts to manage healthcare costs benefits [financially] from healthcare costs going up.”  And so, as many have stated, our healthcare system isn't broken, it's perfectly designed to deliver the results it delivers. Until Next Time, Be Well.Zeev Neuwirth, MD 

In today's episode, Matt chats with Niko Caparisos, Principal of Prosperity Benefits, LLC out of Savannah, GA. They covered a wide range of topics including health and well-being of employees, group health insurance alternatives, why so many companies pay for perceived security, and more. During this insightful episode, Matt and Niko cover the following topics: [02:49] Unique Ways for Companies to Avoid Mistakes in Securing Health Insurance [10:08] Alternative Options for Group Health Insurance [13:03] The Key Differences of the Types of Insurance for Small Businesses [20:18] How Money plays a Role in Long-Term Planning [33:11] How does Intermittent Fasting Boost Your Performance How can your team dominate the competition now and in the future? That is what we want you to do. Let's work together to do this. More about Niko Niko Caparisos is the Principal of Prosperity Benefits, LLC, a boutique firm, offering a high level of care and unique service distinctions that are not typically offered at larger brokerages. He is also a Program Architect of Community-Owned Health Plans and has built a health plan architecture to help Georgia-based employers gain control over their health plan spend, provide amazing benefits to staff, and help their local communities. He is an Accredited Advisor of Health Rosetta, an ecosystem for scaling adoption of practical non-partisan fixes to our health care system by enabling public and private employers and unions to reduce their health benefits spending by 20% or more while improving the quality of care for plan members. How can I support the podcast? If you enjoyed this episode, let us know by clicking the link and sharing what you learned. Click here to share your number one takeaway from the episode. If you have questions about starting or scaling a small business that you'd like for us to cover, please submit your question for an upcoming episode. We'd love to hear from you! --- Send in a voice message: https://anchor.fm/hr-simplified/message

This episode seemed particularly relevant right now because it gives insight into how large self-insured employers are prioritizing their efforts to disrupt health care revenue streams that do not provide adequate health outcomes for dollars spent. This episode’s conversation is with Lee Lewis. This is an encore episode. The original was recorded when Lee was the newly minted chief strategy officer at the Health Transformation Alliance, otherwise known as HTA. The HTA is a group of 50 major corporations that have come together in an alliance to do one thing: fix our broken health care system. Anybody who knows Lee knows he knows a lot about how to improve health and health care benefits for large employers. The most amazing thing I always find about improving health and health care benefits is that it’s like having your cake and eating it, too. On one hand, both employer and employee save money. On the other hand, employees get better care and spend less time away from work struggling to navigate the health care jungle all by themselves. Lee’s playbook consists of three chapters which we get into here. The first chapter covers the “how” of health benefits, including what Lee calls the “administrative superstructure.” The second chapter in Lee’s playbook is the “what,” which usually comprises drug spend and then, on the medical side, how care is delivered for specific clinical conditions like musculoskeletal, cardiometabolic, etc. There are a few conditions that tend to rack up the most costs categorically. The last chapter in Lee’s playbook is the “who,” meaning where employees are steered for care, especially in those high-cost areas. If you’re looking for actual examples of forward-thinking employers doing some—or more than some—of the general categories of things that you’ll hear about in this health care podcast, let me drop a few names. Because they may not get as much credit as they often deserve, I wanted to highlight the amazing progress made by some state employee health plans. So let me spotlight the work being done in New Jersey, Connecticut, and Montana, led by Christin Deacon, Thomas Woodruff, and Marilyn Bartlett and their teams. So, to all of you and everyone else working on these endeavors, thank you very much for your service as both a taxpayer and also someone keenly interested in the other things that that money could be used for instead of low-value care like, for example, teachers and firefighters and students and everything else in the budget. Finally, I just want to toss in a mention here of the upcoming Aspirational Healthcare Conference, which will be held on July 14 and 15, 2021 (virtually). Go to the Relentless Health Value Web site because I got you a promo code for free entry that you’ll find there. Lee Lewis, my guest today, is the keynote moderator for Day 1; and yours truly will step up to the microphone on Day 2. This conference will kind of be a who’s who of employer benefit design for the forward thinking looking to do the best they can for their employees at least, and it’s gonna highlight really the Aspirational Healthcare Systems like Southcentral Foundation’s Nuka System of Care in Alaska, for example. You can learn more by visiting htahealth.com and by connecting with Lee on LinkedIn.  Register here for the July 14-15 Aspirational Healthcare Conference and have the registration fee waived using the promo code: !RICHTER$  Lee Lewis serves as chief strategy officer and GM medical solutions for the Health Transformation Alliance. He leads efforts across over 50 large and jumbo employers and six million employees to save lives and save millions of dollars through improved health delivery, outcomes, and experience. Key initiatives in this role include new models of health benefits administration, curated provider steerage, and improved clinical delivery and outcomes. He has advised health care strategy at Fortune 10 employers, insurance companies and administrators, medical associations, and the Departments of Justice and Labor. He incubated and helped form two dozen health benefit start-up companies and has been quoted and featured in Bloomberg and the Wall Street Journal. Lewis is a founding, charter member of the Health Rosetta organization and is credited as a co-founder of the Health Value Exchange. Before joining the HTA, Lewis was a consultant at Gallagher, where he founded Gallagher’s innovation lab and national jumbo employer practice. In 2019 he was recognized with the industry’s top honor as the Outstanding National Consultant for Large & Jumbo Employers Award by the independent Validation Institute. His consulting clients won Diamond Innovation Awards at the World Healthcare Congress, Innovation Awards from the Texas Business Groups on Health, Top 20 Innovator Awards from Healthcare Revolution Conference, and Financial Innovation and Large Group Management Innovation accolades from the Validation Institute. Lee is a Rhodes Scholar nominee. He graduated second in his class, magna cum laude with university honors in accounting from Brigham Young University. 04:00 A playbook to reduce health care spend and achieve better outcomes. 04:08 The “how,” or “administrative superstructure.” 05:19 What Lee typically does when working with companies. 08:57 The “what” of delivery—connecting the “what” to the “clinical.” 10:52 Overseeing the pharmacy benefit manager (PBM). 12:37 EP241 with Vinay Patel. 12:50 Looking at the medical side of health. 15:46 Improving spend and improving quality simultaneously. 18:10 EP240 with Olivia Ross.18:53 Why centers of excellence make sense. 21:54 The “who”—who is providing the care. 24:06 Enabling and empowering PCPs and improving PCP pay to compensate for that. 26:57 Lee’s advice for brokers. 28:02 Lee’s advice for provider organizations, hospitals, and centers of excellence. 29:07 “Hospital systems are not [a] monolith.” You can learn more by visiting htahealth.com and by connecting with Lee on LinkedIn.  Register here for the July 14-15 Aspirational Healthcare Conference and have the registration fee waived using the promo code: !RICHTER$  Check out our newest #healthcarepodcast episode with Lee Lewis of #HealthTransformationAlliance (#HTA). #healthcare #podcast #digitalhealth #employerhealth Reducing #healthcarespend and improving #healthoutcomes. Lee Lewis of #HealthTransformationAlliance (#HTA) discusses his “playbook.” #healthcare #podcast #digitalhealth #employerhealth #AdministrativeSuperstructure and the “how” of Lee Lewis’s #employerhealth “playbook.” #HealthTransformationAlliance (#HTA) #healthcare #podcast #digitalhealth #employerhealth What does Lee Lewis of #HealthTransformationAlliance (#HTA) do to reduce #healthspend and improve #healthoutcomes when working with large employers? #healthcare #podcast #digitalhealth #employerhealth Connecting the “what” to the #clinical. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth How do you oversee the #pharmacybenefitmanager in all of this? Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Looking at the #medical side of #health. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM How reducing #healthcarespend actually improves #healthcareoutcomes and #healthcarequality. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Why do #CentersofExcellence make sense? Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Enabling and empowering #PCPs. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Lee Lewis of #HealthTransformationAlliance (#HTA) offers his advice for #healthcarebrokers. #healthcare #podcast #digitalhealth #employerhealth #PBM Lee Lewis of #HealthTransformationAlliance (#HTA) offers his advice for #healthcareproviders, #hospitals, and #COEs. #healthcare #podcast #digitalhealth #employerhealth #PBM “Hospital systems are not [a] monolith.” Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM

Bright Spot #13 - Using DPC and Health Rosetta to Renew a School District with Bryce Heinbaugh

In this episode of the Perspectives podcast, sponsored by Artemis Health and hosted on BenefitsPRO, we’ll hear highlights from the April 14th presentation titled, Create holistic benefits strategies: Tips for partnering with the C-Suite and HR. As businesses shift the way they view benefits in light of the past year, CFOs and other members of the C-suite continue to become more involved in benefits decision-making. This emerging trend is good news for advisors who are prepared to take advantage of it. Engaging with more decision makers presents opportunities for education and innovation, but also requires data and transparency to generate buy-in and create more impactful plans. The panelists — Steve Watson, CFO & CHRO at Trendbreakers; Kim Eckelbarger, Founder of Tropical Benefits; James Froschmayer, Director of Product Analytics at Artemis Health; and Paul Wilson, Editor-In-Chief of BenefitsPro — discuss why companies that have a more engaged C-suite tend to be more progressive in managing their benefits plans, as well as how to leverage benefits analytics to identify opportunities, and much more.  The full on-demand webcast can be found here: https://www.benefitspro.com/2021/03/10/partnering-with-the-c-suite-and-hr-to-create-holistic-benefits-strategies/ Steve Watson, CPA, SHRM-SCP |CFO & CHRO | Trendbreakers Steve Watson has a diverse background and a lot of titles that can be put after his name – CEO, CFO, CHRO, and CPA. It could be intimidating, until you meet him. Rather than riding the wave and seeking ever more important positions, Steve looks for ways to give back. He grew up on a sheep farm in Utah, earned his degree in business and international finance at BYU, got married, worked in accounting, and at the age of 26, moved to Brazil and took a job as finance director for a publicly traded company. Five years later, in 2009, he moved his growing family back to the U.S and took a position as a CFO at a mid-sized social work company in Phoenix, Arizona. It wasn’t long before they asked him to take on the role of Chief Human Resources Officer (CHRO). All the different titles he wears could be confusing, but Steve has found a unique way to put them all together and complement each other. This is especially true in his role as CEO of TrendBreakers, a consulting business where his extensive knowledge and skills meet to help other companies break the trend of rising healthcare costs. He is also a nationally known speaker, hosts a podcast three times each week, is a married father of seven, and is bilingual in Portuguese. Kim Eckelbarger | Founder | Tropical Benefits Kim participated in the NextGen Benefits Mastermind Partnership, as well as Health Rosetta and serves as Founder & President of Tropical Benefits in the Tampa/St. Petersburg area.She has been profiled in Employee Benefit Adviser (EBA) magazine and was the cover story in their August 2018 edition. Kim was named “NextGen Benefits Adviser of the Year” at the 2019 ASCEND conference. Kim has been invited to share learned expertise at prestigious industry conferences, including the Workplace Benefits conference, the BenefitsPRO Broker Expo and the World Health Care Congress 2019. Kim is a co-author of the Amazon bestselling book, Breaking Through the Status Quo, which outlines some of the cutting-edge strategies she and other NextGen Benefits Advisers are using to control and lower healthcare costs.She is an early adopter of innovative strategies, including Healthcare Abroad, Direct Primary Care, Second Opinions, and RBP, and has implemented these employer solutions with successful outcomes. Her clients outcomes have been published in industry specific publications and the outcomes are accomplished with data and transparency. James Froschmayer | Director of Product Analytics | Artemis Health As a Director of Product Analytics, James Froschmayer works with product management, user experience, and health analytics experts to meet the needs of benefits teams today and anticipate their needs in the future. James is responsible for developing leading-edge analytic methodologies embedded within the Artemis reporting system. He also performs analyses and supports clients in the implementation of their integrated health, attendance and disability management programs. Having come from the consulting world, James has seen the landscape of employee benefits become increasingly complex. As an analytics expert, he helps self-insured employers to identify opportunities within their data to manage costs, improve program value, and boost employee health and well-being. James is passionate and committed to using industry best practices and technologies to improve the healthcare system from both the patient, provider, and payer perspectives. Paul Wilson | Editor-In-Chief | BenefitPro | Webcast Moderator Paul Wilson is the editor-in-chief of BenefitsPRO Magazine and BenefitsPRO.com. He has covered the insurance industry for more than a decade, including stints at Retirement Advisor Magazine and ProducersWeb.

Continue the conversation with Cristy, Scott Ray, and Heath Potter in understanding current healthcare transparency, hospital negotiations, and reference-based pricing.Timestamps:00:00 Intro05:32 Many employees don't realize their employer is the health plan06:18 Lots of employee education is needed06:38 The irony of change can be comical07:12 Change can also be cyclical. Cycling back to more local care teams rather than "corporate medicine" is happening.10:10 Healthcare Buyers and Sellers don't have to be adversaries, there's an opportunity to work together.14:28 When smart spending happens on the big things, smaller ticket items are easier to afford too.15:12 Local governments should take note, they're hurting their communities by overspending on healthcare17:26 The "outlier provision". Know what that is? You need to because it's eating your health plan alive.19:06 Networks started out as a good idea, but the middlemen got greedy over the years.20:20 Hey, Mr. Hospital. So, you got caught being greedy? Now's your chance to learn a lesson about free markets.21:41 Employers have options now21:45 Health Rosetta + 6 Degrees = High Performing Health Plans where best-in-class solutions can be built on a solid foundation25:51 This is not a get rich quick scheme. We're all mission driven at this point.26:16 Creating happier, healthier, more productive employees...isn't that the whole point of employee benefits?27:30 A lot of us thought HDHPs were a good thing at first, until we didn't.29:00 What does the future hold?31:15 Signing off from beautiful Portland, OR31:49 #letsfixhealthcare www.custombenefits.work

Let’s talk about one aspect of health care that’s not talked about possibly often enough: big national health care players siphoning money out of local communities—potentially a lot of money depending on where you are and considering that health care is inching toward about 20% of the GDP. But besides the money leaving the community, another downside of large national players is that sometimes problems—even kind of seemingly simple problems—can be totally intractable and unsolvable because there’s just so much diversity of need and intricacies if you’re trying to come up with a broad-stroke solution that works for everybody across the land. On the other hand, by thinking and acting locally, these same problems can be solved. Besides, at a local scale, community and relationships within the community can become powerful forces for good. In this context, I was super thrilled to have had the chance to interview Dan Strause from Hometown Pharmacy and Drew Leatherberry from Avergent about a collaboration model they put together pairing up local PCP teams hired by self-insured employers with their local hometown pharmacy. Together, they’re similar to a team-based advanced primary care model that also has a level of navigation built in. Considering that patients visit their local pharmacy something like 35-ish times a year, it’s the expertise right in front of your face to help manage patients with chronic conditions. Add to this equation a pharmacist’s education and a local pharmacy’s position as a member of the community. Local pharmacies who are patient first and entrepreneurial could be a great way to keep health care local and solve for the needs of their communities at the same time. This episode is the first-ever simulcast between Health Rosetta and the Relentless Health Value podcast. It was recorded live at the recent Health Rosetta Summit. Thanks much to the Health Rosetta team, including Dave Chase, for inviting me and Relentless Health Value to be a part of the summit. In this episode, the CPESN Pharmacy Network comes up. Should you wish to learn more about the CPESN Pharmacy Network, listen to the Relentless Health Value interview 129 with Troy Trygstad.  You can learn more at hometownrxpharmacy.com and avergent.com. Dan Strause is a partner at Hometown Pharmacy of Wisconsin, a group of 70+ independent pharmacies focused on personalized patient care. Hometown Pharmacy educates and empowers patients and communities to make informed decisions about their health.     Drew Leatherberry is founder of Avergent, a Wisconsin-based benefits advisement firm serving employers around the country, guiding them to 20% to 40% cost savings on top of next-gen benefits and patient experiences. He has spent over a decade leading employers to restore health care to sustainable levels for their team members.     05:02 What has Avergent’s collaborative care model accomplished? 06:07 How did Drew and Dan connect? 07:08 “We realized that we were missing out [on] … how … to leverage the experience and the expertise of the pharmacist in driving better patient care.”—Drew 07:31 Why would a pharmacy make it their goal to get their patients off their medications? 08:20 “Prescription medicine is the most expensive, most dangerous form of a plant.”—Dan 08:39 “We believe we can help people by giving up prescription medicines.”—Dan 08:45 Is a pharmacy equipped to create a personal relationship with their patients? 12:50 “It’s a spin on traditional navigator-advocate-type roles.”—Drew 16:15 What does helping the patient look like through this partnership program? 19:18 “We’re really unifying the patient health record … and then … cross-referencing all those different data points … on a micro level [and] a macro level.”—Drew 20:53 “Everyone is onboarded into the collaborative care model.”—Drew 21:05 How does this collaborative care model cross the spectrum? 22:13 “Pharmacists are one of the unique professions that doesn’t get paid for time and knowledge [but rather] because of the product they dispense.”—Dan 23:06 “We can see the day where … patients will get a prescription from mail order but still need us.”—Dan 25:46 “We would love to get paid to keep you healthy.”—Dan 27:15 Why are pharmacists wanting to get patients off prescriptions, and how are they involved? 27:36 “In some cases, we are misapplying expertise that’s sitting right in front of our face that can help us deliver a better patient outcome.”—Drew You can learn more at hometownrxpharmacy.com and avergent.com. Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma “We realized that we were missing out [on] … how … to leverage the experience and the expertise of the pharmacist in driving better patient care.” Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma Why would a pharmacy make it their goal to get their patients off their medications? Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma “Prescription medicine is the most expensive, most dangerous form of a plant.” Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma “We believe we can help people by giving up prescription medicines.” Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma Is a pharmacy equipped to create a personal relationship with their patients? Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma “Everyone is onboarded into the collaborative care model.” Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma How does this collaborative care model cross the spectrum? Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma “Pharmacists are one of the unique professions that doesn’t get paid for time and knowledge [but rather] because of the product they dispense.” Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma “We can see the day where … patients will get a prescription from mail order but still need us.” Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma “We would love to get paid to keep you healthy.” Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma “In some cases, we are misapplying expertise that’s sitting right in front of our face that can help us deliver a better patient outcome.” Dan Strause of @HometownRxWi and Drew Leatherberry from Avergent discuss #pharmacy partnerships on our #healthcarepodcast. #healthcare #podcast #pharma

Last year, research at Johns Hopkins showed that healthcare consumes nearly half of all federal spending, which includes funding for Medicare, Medicaid, Social Security, military health benefits, health benefits for federal employees and their dependents, plus interest. Our federal government spends 48% of its money on health care and still healthcare devastates state budgets all across this country, with serious consequences in public health, education and other national priorities. This week's guest, Dave Chase, is the Creator, Co-Founder, and CEO of Health Rosetta. Health Rosetta is an ecosystem enabling public and private employers and unions to reduce their health benefits spending by 20% or more while improving the quality of care for plan members. Dave is also the author of Relocalizing Health: Relocalization is a strategy to build communities based on the local production of food, energy and goods.  When applied to healthcare, a relocalization effort bring about systematic change – it could lead to strengthened local economies, improved population health, higher value in care delivery, and health equity. Dave expounds that health doesn't start with a pill or in a hospital. It starts at home, with parents, with neighborhoods, with workplaces, and communities. Relocalization will be an important key for winning the race to value! Episode Bookmarks: 04:05 Defining the Relocalizing Health strategy and why it needs to be applied to healthcare 05:45 How to create systems change at a grassroots level 06:25 Applying a systems change model that focuses on adaptable replication (not scalability) 07:15 The Nuka System of Care in Southcentral Alaska as an example of a successful effort to relocalize health care 07:25 Rosen Hotels as another example of creating a consumer-oriented redesign of health care 07:40 Learning from the Jönköping Health System in Sweden 08:35 “Transformation moves at the speed of trust, and trust is built on complete transparency.” 08:50 How the legal and economic underpinnings of health plans are ‘completely rotten' and must be made transparent 09:15 Seeking transparency in the way health insurance brokers are paid 09:27 “There is no well-functioning healthcare system in the world not built on proper primary care.” 09:35 “Healthcare isn't expensive -- only 27 cents of every healthcare dollar goes to clinicians who are the value creators. What's expensive is profiteering, price gouging, administrative bloat, and fraud.” 10:00 Dave discusses the advancements of modern-day computing as an example of why we need to work on the fractals of healthcare (i.e. the piece parts) 11:05 Research from Marty Makary showing that the federal government spends 48% of its money on health care 12:55 A broken financing model for hospitals steals from public health, kids, education, social services, and public infrastructure 13:15 Economic Development 3.0: Playing the Health Card 13:35 How considering every hospitalization as a failure is a starting point for reform 14:30 The economic depression of the middle class due to wage stagnation, and how that was caused by healthcare costs 15:30 The Millennial Generation is the first generation in American history where life will not be better for their parents because healthcare is stealing their future 16:35 Referencing David Goldhill's Catastrophic Care: Why Everything We Think We Know about Health Care 16:55 “I believe the Millennial Generation can be the greatest generation of this century.” 17:45 Massive student debt and how healthcare has driven up the costs of Higher Education 19:51 The national opioid epidemic crisis that is devasting communities.  More than 760,000 people have died since 1999 from a drug overdose, and two out of three drug overdose deaths involve an opioid. 21:45 The opioid crisis isn't an anomaly – it is our healthcare system.  The key unwitting enabler is the employer.

Dave Chase leads the vision for Health Rosetta which is to empower community-owned health plans. Health Rosetta’s blueprint and platform powers the health plans of your dreams: high quality, trustworthy, local, affordable care -- that you thought had disappeared forever -- from caregivers we know & trust. We free up compassionate, well-trained, community-based caregivers to rediscover love in medicine so they can do what they have always been called to do: serve their patients not just in disease, but toward their fullest health. A trusted & sacred caregiver-patient bond is built through transparency & openness that equips and empowers patients wherever they can best achieve their unique health goals -- at home or any setting best optimizing their well-being. By avoiding the 50% wasted healthcare spending, we can ensure our caregivers have the independence & resources to address the psychosocial and medical issues their patients face. Human-centered health plans restore health, hope & well-being. Through best-selling books & The Resident (on FOX), where Chase serves as a consultant, collateral damage from the Extractive Era of healthcare is highlighted as well as the tremendous successes & opportunities with Health Rosetta-type health plans. The books, writing for various media outlets, TED talk, and TV/film have reached over 10 million people with the goal of informing, enraging, empowering, and activating a broad grassroots movement designed to restore hope, health & well-being to our communities. Chase received the Health Value Awards' Lifetime Achievement for Health Benefits Innovation at the 2020 World Health Care Congress. EXTRA: Rx for Success Podcast listeners can attend the Health Rosetta Summit: Community Dividends, for FREE as Dave's guests! Feb 24, 6:30PM to Feb 26, 6:00PM EST Use this link and scroll to "Health Rosetta Invited Guests" to register... https://rxforsuccesspodcast.com/summit Show notes at https://rxforsuccesspodcast.com/39 Report-out with comments or feedback at https://rxforsuccesspodcast.com/report  

Dave Chase, creator and co-founder of Health Rosetta, joins host Dr. Bob Kaiser to discuss what has happened since his last appearance on The Business of Healthcare Podcast. Chase provides a refresher on the Health Rosetta, a blueprint for massively replicating fixes he says exist for the healthcare industry but have met with resistance from those who want to maintain the status quo. Chase also explains the organization's new initiative, the Health Rosetta Employer Program, and discusses his new book, Relocalizing Health: The Future of Health Care is Local, Open and Independent (Seattle: Health Rosetta Media, 2020).

Welcome to our 25th podcast! We can't believe that it's taken a year and a half to get here! - TOP NEWS: - Amy Holden Jones will be doing a summit with Health Rosetta titled "Medical Drama as a System Change Driver" on August 5-7. Link here: https://healthrosetta.org/events/virtual-summit/ - Dr. Daniela Lamas will be doing a virtual evening with Dr. Michele Harper for Books & Books. Michele has a book coming out called "Beauty in Breaking" that they will be discussing. Link here: https://www.crowdcast.io/e/micheleharper?fbclid=IwAR1-eNJ2CwNfPM00d4o7f_wYWVBL5UFIM6IX1jdIZj7TdF7D_4waxNWUkiE - In this podcast: "Identity Crisis", episode 1x04 discussion. Episode written by Elizabeth Klaviter. - Conrad gives a death notice to the wrong family because a patient wasn't triaged correctly in the ER by a nurse who had no clue what she was doing. Also, was Conrad too hard on her when the patient died? - Budget cuts are to blame from them helping Louisa in "Comrades in Arms", episode 1x03. Nurse Hundley was let go, and apparently the ER stopped functioning when she left. - We are so glad Nurse Hundley returned and the scene where Irving hugs her is one of our favorites of the episode. - We find Irving to be the unsung hero of this episode. - Mina gets benched because of overstepping Dr. Kays in the OR. Even Bell agrees with this move and keeps her on the bench when she asks to help in a surgery. - We hate to say it, but Mina did this to herself. Don't ever tell your boss you've learned all you need to know to do your job. No matter the profession. Did Mina learn this lesson? - Shirley & Howie - Shirley is diagnosed with gallbladder cancer, but she isn't married to her boyfriend yet, so she proposes. They get married in the hospital chapel by Irving. (Can Irving officiate the #CoNic wedding?) - Bell does Shirley's surgery with Hunter and Devon watching and it is a success. - Bell is on benzodiazepines for his shaky hand and they are working. - Nic's suspicious of Hunter and her clinic when they don't send her Lily's chart. - Nic finds out Lily has a drug sensitivity because she actually went to the clinic and got the chart. It helped her cure Lily of a nasty rash. - Nic begins digging, and her friend, Allie, who works there is no help at all. - Devon & Priya's small scene near the end of the episode - PATREON: -Want to help us keep growing the podcast? Become a patron. Any dollar amount and cancel at anytime. Money will be used for better software, equipment and interviews. (https://www.patreon.com/theresidentpodcast) - Coming up on The Resident Rulebreakers: - August 10 - Bell Podcast to Celebrate Bruce's Birthday - August 17 - Malcolm Interview - August 24 - "None the Wiser", Episode 1x05 Discussion - August 31 - "No Matter the Cost", Episode 1x06 Discussion - Send us your birthday wishes for Bruce or Malcolm. Bruce's birthday is August 12. Malcolm's birthday is August 18. Send us those wishes by the Saturday before their birthday. - SUBSCRIBE! -SoundCloud -Spotify -Apple Podcasts -Google Play -YouTube - Contact us! -Email - theresidentrulebreakers@gmail.com -Facebook (The Resident Rulebreakers Podcast or The Resident Fox Fans) -Instagram (theresidentpodcast, theresidentonfoxfans, kbcountry37) -Twitter (ResidentPodcast) - - Next Week: Bell Podcast to Celebrate the Birthday of Bruce Greenwood

With drug prices steadily rising and the opioid crisis in full swing with no end in sight, it's no secret that America's healthcare system is broken, in crisis, and its lawmakers are struggling to find solutions. Dave Chase, Co-Founder of the Health Rosetta and author of The Opioid Crisis Wake-up Call and the best-selling, The CEO's Guide to Restoring the American Dream, has made it his mission in life to help tackle these issues by providing insight, perspective and hope that these challenges can be overcome. Dave sat down with Don Langsdorf of the Pharma Marketing Network for an insightful discussion surrounding the current condition of healthcare in our country and around the world, and what part we can all play to help.  Covering off on the opioid crisis; its origins and current impact on our society; as well as the employer's role in healthcare, thoughts on how to fix our broken healthcare system, and the call for pharma companies to reduce prices, they also touch on Dave's upcoming crowd-sourced film, The Big Heist. This is a must-listen for anyone interested in understanding and improving our current state of affairs in healthcare in America. For more information about Dave, the Health Rosetta and to download free PDF versions of his books, please visit healthrosetta.org/friends. 

Dave Chase, creator and co-founder of Health Rosetta, joins host Dr. Bob Kaiser to make a provocative claim: that every big problem in healthcare already has been solved. The existing challenge, Chase says, is how to massively replicate proven solutions to reduce costs, improve quality and satisfy all constituents in the healthcare ecosystem. Chase and Kaiser discuss Healthcare Rosetta's blueprint in achieving massive changes and the progress Chase and his team have made so far.

The opioid crisis in America is considered by many to be the worst national public health crisis in the last 100 years. In his new book, The Opioid Crisis Wake Up Call: Health Care is Stealing the American Dream. Here is How We Take It Back (Health Rosetta Media, 2018), Dave Chase dives into the history and causes of the crisis and outlines a path towards fixing it. Dave takes a thoughtful look at our dysfunctional healthcare system and sees ways it can be fixed using technologies and strategies that are already in use at some organizations. He talks about ways to eliminate waste and corruption while restoring hope to the American public. Jeremy Corr is the co-host of the hit Fixing Healthcare podcast along with industry thought leader Dr. Robert Pearl. A University of Iowa history alumnus, Jeremy is curious and passionate about all things healthcare, which means he's always up for a good discussion! Reach him at jeremyccorr@gmail.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

Listen NowListeners may recall, I have previously discussed the opioid epidemic this past February 2 with Dr. Steve Passik concerning abuse deterrent formulations and on November 16, 2016 with Dr. Ann Lembke regarding her work, "Drug Deal MD."  Tragically, the opioid epidemic continues unabated.  In 2017 there were 72,000 drug overdose deaths, among these 29,000 were from synthetic opioids, predominately fentanyl.  While Mr Chase's work examines the cause of the opioid epidemic and what could be done to reduce fatalities, it is moreover a study that attempts to explain what accounts for massive dysfunction in health care delivery that causes, as I note in the podcast's introduction, Americans to spend $1 trillion annually on health care coverage and services that do not improve their health.During this 30 minute conversation Mr. Chase explains what prompted his writing this work and what explains, in his view, the opioid crisis.  Moreover, he explains the problem with health care as one moreover one of pricing failure, how payers, moreover self-insured employers, can more competently purchase more affordable coverage for their employers and provides examples or organizations that have lowered their health care spending.  He also discusses direct primary care, ERISA, insurance risk pool size, medical loss ratios (MLRs) and his efforts at credentialing use of The Health Rosetta blueprint. Mr. Dave Chase is the co-founder of The Health Rosetta, described as an open source blueprint for the next generation's health ecosystem.   Mr. Chase's first book, "The CEO's Guide to Restoring the American Dream: How to Delivery World Class Healthcare to Your Employers at Half the Cost," became a Kindle #1 best seller.  Mr. Chase and The Health Care Rosetta focus on replicating health economies that rebuild hope and community through improved outcomes, lower spending and higher performing models.   Information on Mr. Chase's book is at: https://healthrosetta.org/friends/For more on The Health Rosetta, go to: https://healthrosetta.org/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit www.thehealthcarepolicypodcast.com

This week's episode, on employer-based healthcare, deals with one of the most critically important & rapidly advancing issues in American healthcare today. Our guest this week is Dave Chase. He ...