Podcast appearances and mentions of rachel reid

We're talking about the worst possible thing that can happen to a romance heroine today (it's always the heroines) -- ruination! Whether the hero did it, another man did it, or society simply decided that she's ruined, there's simply nothing to be done about it...except revenge, a triumphant return, or the crowning of a new reigning queen. We cover all three here, with almost entirely new to the pod books, and even get some contemporaries into the mix!If you want more Fated Mates in your life, please join our Patreon, which comes with an extremely busy and fun Discord community! Join other magnificent firebirds to hang out, talk romance, and be cool together in a private group full of excellent people. Learn more at patreon.com.Our next read along is Rachel Reid's Heated Rivalry, which you can get in print, ebook, audiobook or with your monthly subscription to Kindle Unlimited. Find it at Amazon, Barnes & Noble, Kobo, Apple Books or wherever you get your books. Books Mentioned In This EpisodeChasing Cassandra by Lisa KleypasThe Duchess Hunt by Lorraine HeathA Scot in the Dark by Sarah MacLeanWicked & The Wallflower by Sarah MacLeanMarrying Winterborne by Lisa KleypasThe Magic of You by Joanna LindsayA Little Bit Wild by Victoria DahlThe Harlot Countess by Joanna ShupeAgain the Magic by Lisa KleypasTempt Me at Twilight by Lisa KleypasWild Rain by Beverly JenkinsThe Rake by Suzanne EnochCompromised by Kate NobleRide Steady by Kristen AshleyAfter Hours on Milagro Street by Angelina M LopezNotesThe space domination of Katy Perry is depressing compared to the

How are countries reckoning with their role in the Afghanistan conflict and allegations of war crimes? We discuss various types of investigations currently taking place and what justice might look like going forward. With Iain Overton, Thijs Bouwknegt, Ben Saul & Rachel Reid. Want to find out more? Check out all the background information on our website including hundreds more podcasts on international justice covering all the angles: https://www.asymmetricalhaircuts.com/ Or you can sign up to our newsletter: https://www.asymmetricalhaircuts.com/newsletters/ Did you like what you heard? Tip us here: https://www.asymmetricalhaircuts.com/support-us/ Or want to support us long term? Check out our Patreon, where - for the price of a cup of coffee every month - you also become part of our War Criminals Bookclub and can make recommendations on what we should review next, here: https://www.patreon.com/c/AsymmetricalHaircuts Asymmetrical Haircuts is created, produced and presented by Janet Anderson and Stephanie van den Berg, together with a small team of producers, assistant producers, researchers and interns. Check out the team here: https://www.asymmetricalhaircuts.com/what-about-asymmetrical-haircuts/

Yes, Sarah has a longtime fantasy of being on the lam, but let's be honest, she'd be caught reading a book in the nearest diner as soon as anyone got serious about looking for her. This week, we're talking about books in which characters are much more serious about being on the run! We break the category into people on the move and people in hiding, but also talk about secrets, about lies, and about how love really is about telling something all the truths you've got. If you want more Fated Mates in your life, please join our Patreon, which comes with an extremely busy and fun Discord community! Join other magnificent firebirds to hang out, talk romance, and be cool together in a private group full of excellent people. Learn more at patreon.com.Our next read along is Rachel Reid's Heated Rivalry, which you can get in print, ebook, audiobook or with your monthly subscription to Kindle Unlimited. Find it at Amazon, Barnes & Noble, Kobo, Apple Books or wherever you get your books. The Books The Master by Kresley ColeRun Posy Run by Cate WellsClaiming the Courtesan by Anna CampbellBurn Down the Night by M. O'KeefeDragon Bound by Thea HarrisonTycoon by Joanna ShupeSomething Wilder by Christina LaurenIf I Told You, I'd Have to Kiss You by Mae MarvelHunter by Emmy ChandlerStranded by Jennifer D. BokalThe Harpy and the Dragon by Marie LiscombWyoming Double Jeopardy by Juno RushdanBourbon and Lies by Victoria WilderHunted Through Italy by Delaney DiamondDalliances & Devotion by Felicia GrossmanKiss the Girl by Zoraida CordovaUnder Her Skin by Adriana AndersWhiteout by Adriana...

We're crossing off a classic romance novel structure this week -- the list! Whether life changing to-do lists, bucket lists, or lists for kinky exploration, these romances take characters and readers on remarkable rides, reminding us all that sometimes it really does pay to be organized. If you want more Fated Mates in your life, please join our Patreon, which comes with an extremely busy and fun Discord community! Join other magnificent firebirds to hang out, talk romance, and be cool together in a private group full of excellent people. Learn more at patreon.com.Our next read along is Rachel Reid's Heated Rivalry, which you can get in print, ebook, audiobook or with your monthly subscription to Kindle Unlimited. Find it at Amazon, Barnes & Noble, Kobo, Apple Books or wherever you get your books. The Books Nine Rules to Break when Romancing a Rake by Sarah MacLeanGet A Life, Chloe Brown by Talia HibbertThe Last Days of Lilah Goodluck by Kylie ScottWicked Nights with a Lover by Sophie JordanWhat Heals Us by Maggie GatesThe Ending I Want by Samantha TowleCamera Chemistry by Chelsea Curto30 Days and 30 Nights by Christine d'AboThe Seal's Rebel Librarian by Anne CalhounHow to Fail at Flirting by Denise WilliamsRockaway Bride by Pippa GrantMr. Swoony by Piper RayneThree Little Mistakes by Nikki SloanAll Played Out by Cora CarmackShow NotesWe're excited about these author and listener created lists at the Fated Mates Collections Department. And in case you want to see the one from Competitive Yam about Skinny dipping, here it is.

It's our quarterly discoverabilibuddy episode! Get your TBR piles structurally sound and excercise that preorder clicking finger, because here are more than 40 books coming out in the next three months that we're excited to read! Eric said next time we have to split it into two if we're going to keep talking about what's coming for hours... In the meantime, we're ungovernable! Tell us about the books you're waiting for...and if you're a romance novelist and have a book coming this year, please head over and fill out our handy Google form to let us know!If you want more Fated Mates in your life, please join our Patreon, which comes with an extremely busy and fun Discord community! Join other magnificent firebirds to hang out, talk romance, and be cool together in a private group full of excellent people. Learn more at patreon.com.Our next read along is Rachel Reid's Heated Rivalry, which you can get in print, ebook, audiobook or with your monthly subscription to Kindle Unlimited. Find it at Amazon, Barnes & Noble, Kobo, Apple Books or wherever you get your books. The Books MARCHWitch of Wall Street by MJ EtkindA Wager at Midnight by Vanessa RileyLush by Tinia MontfordAPRIL Royal Bride Demand by LaQuetteWyoming Double Jeopardy by Juno RushdanAny Trope but You by Victoria LavineWhisk Me Away by Georgia BeersPlaying for Keeps by Lainey DavisThe Nanny is Off Limits by QB TylerMarriage Bargain with the Comte by Parker J. Cole A Lady's Guide to London by Faye DelecourThe Duke and the Widow by Christina DianeNaked in Naknek by Lolu SinclairFly by Night by Kelly CainThe Matchmaker by Aisha Saeed

Sierra Nicholson is joined by Rhys McWhirter and Rachel Reid to reflect on part 1 and provide additional insights into expectations for growth in the digital assets market, balanced regulation and rulemaking, consumer expectations driving investor appetite for emerging tech.

In this episode, I'm sharing my top 10 most anticipated new romance book releases of March 2025 that deserve a spot on your must-read list. With so many choices of new romance books to read, I've narrowed down this month's new releases to the best worth reading…because life is better with a love story!BOOKS MENTIONED:Unlikely Story by Ali Rosen: https://amzn.to/4jXIOIAWild Side by Elsie Silver: https://amzn.to/3CKSYvAThe Shots You Take by Rachel Reid: https://amzn.to/4gLoVC0The Last Guy on Earth by Sarina Bowen: https://amzn.to/3QbvGCaPromise Me Sunshine by Cara Bastone: https://amzn.to/3EzUPE2Go Luck Yourself by Sara Raasch: https://amzn.to/3Covz2gStory of My Life by Lucy Score: https://amzn.to/4efsoHxFan Service by Rosie Danan: https://amzn.to/4gBX0USSave Your Breath by Kandi Steiner: https://amzn.to/3COewHxJust Our Luck by Denise Williams: https://amzn.to/3NXdvPsLINKS MENTIONED: New Releases: https://www.shereadsromancebooks.com/upcoming-book-releases/Amazon First Reads: https://amzn.to/40WOJVzRomance Book Reading Challenge: https://www.shereadsromancebooks.com/reading-challenge-2025/Book Club: https://www.shereadsromancebooks.com/bookclub/SpeakPipe: https://www.speakpipe.com/shereadsromancebooks FOLLOW ME! Join My List: https://www.shereadsromancebooks.com/joinPodcast: https://www.shereadsromancebooks.com/podcast/ Facebook: https://www.facebook.com/shereadsromancebooks Pinterest: https://www.pinterest.com/shereadsromancebooks Instagram https://www.instagram.com/shereadsromancebooksblog/LEAVE A REVIEW!If you liked this episode, please leave a review on Apple Podcasts or your favorite podcast platform. Thanks!This post may include affiliate links. As an Amazon Associate, I earn from qualifying purchases. Hosted on Acast. See acast.com/privacy for more information.

In today's episode, I'm sharing 10 steamy romance books that will turn up the heat this month. If you are a fan of spicy romance books and love a bit of open-door action, then these are the romance novels for you to add to your must-read list.BOOKS MENTIONED:Beautiful Bastard by Christina Lauren: https://amzn.to/3EsWECAAct Your Age, Eve Brown by Talia Hibbert: https://amzn.to/4hwHhHVTwisted Hate by Ana Huang: https://amzn.to/4122bZJHIM by Sarina Bowen & Elle Kennedy: https://amzn.to/42PWBLrHeated Rivalry by Rachel Reid: https://amzn.to/42HoHbpAmerican Queen by Sierra Simone: https://amzn.to/4gq1QVfGive Me More by Sara Cate: https://amzn.to/4gvf6YFThe Bet by Max Monroe: https://amzn.to/4aR04LnHalo by Ella Frank and Brooke Blaine: https://amzn.to/4aPTtB5Wicked Lust by Sawyer Bennett: https://amzn.to/415QhOgLINKS MENTIONED: Join the She Reads Romance Books Book Club: https://www.shereadsromancebooks.com/bookclubLeave me a message: https://www.speakpipe.com/shereadsromancebooksFOLLOW ME! Join My Email List: https://www.shereadsromancebooks.com/joinBlog: https://www.shereadsromancebooks.com/ Podcast: https://www.shereadsromancebooks.com/podcast/ Facebook: https://www.facebook.com/shereadsromancebooks Pinterest: https://www.pinterest.com/shereadsromancebooks Instagram https://www.instagram.com/shereadsromancebooksblog/LEAVE A REVIEW!If you liked this episode or got a book recommendation you can't wait to read, please give a star rating and leave a review on Apple Podcasts or your favorite podcast platform. It helps me know what you like and want to hear. Thanks!This post may include affiliate links. As an Amazon Associate, I earn from qualifying purchases. Hosted on Acast. See acast.com/privacy for more information.

We talk with romance enthusiasts Jordon and Nell about romance novels. They discus Ali Hazelwood, Emily Henry, Rachel Reid and collaborators Eden Finley and Saxon James. Broadcast on OAR 105.4FM Dunedin oar.org.nz

Forbidden love and queer hockey players - what more could you want? This episode is the culmination of years of Cat trying to convince Val to read her favourite book series so we really hope you enjoy and love these books and characters as much as we did!

Disclosure: We are part of the Amazon Affiliate/LTK Creator programs. We will receive a small commission at no cost if you purchase a book. This post may contain links to purchase booksPlease note that this episode was originally released in 2022. We have newly edited it for your enjoyment. In this episode, we chatted with Torry from Ready to Be Romanced in 2022 when she started her romance journey and provided her with a starter guide of recommendations on various romance tropes and sub-genres of interest. BOOKS RECOMMENDED Twisted Emotions by Cora Reilly  https://amzn.to/3QlIGppThe Deal by Elle Kennedy  https://amzn.to/3Jf29DXCampus Nights by Rebecca Jenshak https://amzn.to/49w6eynPucked Series by Helena Hunting https://amzn.to/3W1qViqA Lie for  a Lie by Helena Hunting  https://amzn.to/4420j36Heated Rivalry by Rachel Reid https://amzn.to/4aSIhm7The Locker Room by Meghan Quinn https://amzn.to/4aQjkYaRule by Jay Crownover https://amzn.to/3PZpY6vFortunate Son by Jay Crownover https://amzn.to/4cWekU3 Wilde in Love by Eloisa James https://amzn.to/4auO3KHHow the Duke Was Won by Lenora Bell  https://amzn.to/49DqUV3Waiting for Scot Like You by Eva Leigh https://amzn.to/4auP2L2The Duke Goes Down by Sophie Jordan https://amzn.to/4cMceWJThe Boss by Abigail Barnett https://amzn.to/3JgWeyuOn Dublin Street by Samantha Young https://amzn.to/4cRWtNMThe Most  Eligible Billionaire by Annika Martin https://amzn.to/43TWDA9The Not So Secret Crush  by Jayci Lee https://amzn.to/3Jf1DpKThe Stopover by T.L. Swan  https://amzn.to/3UcwOIrSeven Husbands of Evelyn Hugo by Taylor Jenkins Reid https://amzn.to/3VTZB5ZIt Ends WIth Us by Colleen Hoover https://amzn.to/3xEC6U8Ice Planet Barbarians by Ruby Dixon https://amzn.to/4auAgnzThe Kingmaker by Kennedy Ryan https://amzn.to/3vM9rw2Skin of the Night by CK Bennett https://amzn.to/3UdscBX Don't have Kindle Unlimited? Click here to see if you have access to free or a low-cost offer to Kindle Unlimited (https://whattoreadnextblog.com/ku) Affiliate LinkCONNECT WITH TORRYReady to Be Romanced PodcastReady to Be Petty PodcastInstagram Want to check out more book recommendations?Visit What to Read Next Blog for reader tips, popular books like recommendations and many more posts. Music from #Uppbeat (free for Creators!): https://uppbeat.io/t/mood-maze/trendsetterLicense code: IP29FC0QKB6DV2UE

Historical fiction buffs Janie Change and Kate Quinn discuss their novel The Phoenix Crown, legendary Montreal Canadiens goaltender and author Ken Dryden answers the Proust questionnaire, hockey romance writer Rachel Reid dishes on her novel Time to Shine, sportswriter extraordinaire Morgan Campbell talks about writing his debut memoir, and more.

Everyone has a love language - the way that they like to receive and express love. In this episode, I share 5 romance book recommendations where the characters express love through the 5 love languages of Acts of Service, Words of Affirmation, Gift Giving, Quality Time, and Physical Touch.BOOKS MENTIONED The Five Love Languages by Dr Gary Chapman https://amzn.to/3S67dPdProtective Heart by Brighton Walsh https://amzn.to/3HWgTsbFinal Proposal by K Bromberg https://amzn.to/3CZnOhvMile High by Liz Tomforde https://amzn.to/3RWGJj0People We Meet on Vacation by Emly Henry https://amzn.to/3tSc9yYHeated Rivalry by Rachel Reid https://amzn.to/48I7NKcRomancing Mr. Bridgerton by Julia Quinn https://amzn.to/3S5MpaDMoonlighter by Sarina Bowen https://amzn.to/3vJZkaILovelight Farms by BK Borison https://amzn.to/47CaV93The Kiss Quotient by Helen Hoang https://amzn.to/3RXsXwoLINKS MENTIONED IN THIS EPISODE:A Year of Reading Romance Card Deck, Grab Your Copy: https://www.shereadsromancebooks.com/a-year-of-reading-romance/Unputdownable Books: https://www.shereadsromancebooks.com/unputdownable-books/If you're a romance book lover like me, then join my email list so you never miss a podcast episode or new book list, and I'll instantly gift you my list of Top 10 Book Boyfriends. https://www.shereadsromancebooks.com/join/ Every romance book reader needs a Romance Book Reading Journal. Grab your copy today! Buy Now on Amazon: http://www.amazon.com/dp/B09RV37H3ZFOLLOW ME! Blog: https://www.shereadsromancebooks.com/ Instagram https://www.instagram.com/shereadsromancebooksblog/LEAVE A REVIEW!If you liked this episode or got a book recommendation you can't wait to read please give a star rating and leave a review on Apple Podcasts or your favorite podcast platform. It helps me know what you like and want to hear. Thanks!** This episode may include affiliate links. As an Amazon Associate, I earn from qualifying purchases. Hosted on Acast. See acast.com/privacy for more information.

Happy monday and merry christmas for those that celebrate! This months book club is Time to Shine by Rachel Reid and NO NOTES we loved it!!! Now maybe Jen will finally read Heated Rivalry.. enjoy xoxo

Jeff and Will talk about their favorite reads of 2023, including books by Ari Baran, Leta Blake, Sarina Bowen, Sarah Rees Brennan, Kacen Callender, Slade James, LaQuette, Sher Lee, Dominic Lim, C.S. Pacat, David Valdes, N.R. Walker, and M.A. Wardell. Jeff reviews "Time to Shine" by Rachel Reid and then talks to Rachel about this hockey romance that is set during the holiday season. Rachel talks about the inspiration for Landon and Casey and this opposites attract, forced proximity story. RacRachel also discusses  her holiday traditions, offers some reading recommendations, and details on what she's working on next. Complete show notes for episode 443 along with a transcript of the show are at BigGayFictionPodcast.com. Look for the next episode of Big Gay Fiction Podcast on Monday, January 1. Big Gay Fiction Podcast is part of the Frolic Podcast Network. Find many more outstanding podcasts at frolic.media/podcasts!

Join Bethany, Izzy, and guests as we conclude our Dark Olympus Readalong for the year! This is a book discussion of Cruel Seduction by Katee Robert.   GUESTS Shae from Shaegeeksout: https://www.youtube.com/@Shaegeeksout Brianna from Four Paws and a Book: https://www.youtube.com/@FourPawsandaBook   Looking for a book mentioned in the episode? Check here! *Note that all links are affiliate links from which we earn a commission to support the podcast   Book Cruel Seduction by Katee Robert: https://amzn.to/3r3YzHs Books from On My Radar A Shot in the Dark by Victoria Lee: https://amzn.to/3RatPze Cleat Cute by Meryl Wilsner: https://amzn.to/3R6DYgl Iris Kelly Doesn't Date by Ashley Herring Blake: https://amzn.to/3Leu8Fj Kiss and Spell by Celestine Martin: https://amzn.to/3EtjYNm My Rogue to Ruin by Erica Ridley: https://amzn.to/4862Uua Time to Shine by Rachel Reid: https://amzn.to/45Fvlxs Most Ardently by Gabe Cole Novoa: https://amzn.to/3sIjikw The Pomegranate Gate by Ariel Kaplan: https://amzn.to/486Fe96 You Again by Kate Goldbeck: https://amzn.to/3Pa6z1G     Follow us on Instagram, Twitter and TikTok @Chapter3Podcast or watch episodes on YouTube https://www.youtube.com/channel/UCy6yRiktWbWRAFpByrVk-kg Interested in early access to episodes, private Discord channels and other perks? Consider joining the Chapter 3 Patreon!  Co-Hosts  Bethany: https://www.youtube.com/c/beautifullybookishbethany Liene: https://www.youtube.com/c/LienesLibrary Izzy: https://www.youtube.com/c/HappyforNow

Back at the beginning of this year, I was so sad when I had to edit out the clip that follows from the original and extremely popular episode 391 with Scott Conard, MD. In the literally probably three minutes that follows in this clip with Dr. Conard after I finish my ramblings here, Dr. Conard introduces the impact that changing the practice model in a PCP practice in Queens, New York, had on the staff and patients alike. Spoiler alert: No way no how were they going back to the old way of doing things. The “Before” here was a clinic where the waiting room was filled to overflowing out into the hall with patients waiting to be seen, and this included a mix of really sick people who really needed to be seen and also … others. And thus they had, among a whole host of other bad things going on, the whole issue of suboptimal ER (emergency room) visits and urgent care usage. Anyone who couldn't wait just headed elsewhere. Also, as it is so many places, care was pretty transactional. A patient who wasn't in clinic had an “out of sight, out of mind” relationship with their PCPs. There was no systemic way for the clinical teams to really think about the “in between spaces,” as Amy Scanlan, MD, put it (EP402)—the spaces in between office visits. But then as a result, of course, we wind up dealing with uncontrolled chronic conditions and the failure to prevent preventable disease. We wind up with urgent needs for care and acute situations that had, frankly, no business getting to that stage in the first place. So, Dr. Scott Conard and his team worked on practice transformation, including focusing on operational excellence. I say all that to say, here's Dr. Scott Conard: DR. CONARD: We went and did one pilot clinic, which is, I think, the right way to do it. And then the practice manager was recruited by a competing group. They put another person in the clinic, another practice manager. And she immediately came in and thought that her job was to go back and put the old way of doing things in place, and within literally four or five days, they got together and sat down and said, “Look, we understand where you're coming from, but we will never go back. We are not going back to that old system. We are going to do things in this new way because it makes our lives—and we work together—so much better. And we enjoy being together, and we're seeing … we like not having 30 people waiting to get here at work. We like people getting … having a waiting room be close to empty as we just have one or two of the next people coming in. And we will never go back to that old system.” And, to her credit, she's like, “Okay … cool. Let me understand this.” And she's now one of the strongest leaders in that organization for this transformation. STACEY: So, the PCPs … it was like mutiny on the bounty. They were like, “No way no how are we going back.” DR. CONARD: Oh, it was the entire team: their receptionist, the telephone operator, the MAs. They have a patient navigator, which is another part of the equation we haven't talked about that's really important. And so, the whole team said no. Listen to the full episode 391 to learn more about Dr. Scott Conard and his team's approach to practice transformation. But in the meantime, Peter Watson, MD, captured a few learnings from the original episode really nicely on LinkedIn; so let me quote him here: Dr. Watson has some other really great posts on the topics of value-based care and primary care. I would highly recommend following him on LinkedIn. Should you continue to be interested in this topic of transformational primary care, additional shows on transforming primary care—including bright spots and challenges—are the shows with Eric Gallagher (EP405) and, as aforementioned, the show with Dr. Amy Scanlan (EP402). Also check out the upcoming show with Larry Bauer, which will be approximately episode 409, should I get my act together. And Vivek Garg, MD, MBA (EP407), who, by the way, is coming up in next week's summer short talking about the common rebuke of comprehensive primary care, which is that it diminishes patient access because PCP patient panel sizes tend to be smaller in comprehensive primary care models. Since the original show with Dr. Scott Conard aired, his new book Which Door? came out. I'm gonna say that this book is relevant. It's written for employers but still relevant here because employers have a terrible track record for helping (ie, paying for healthcare) in a way that enables PCPs who want to do comprehensive primary care to actually do comprehensive primary care. When an employer lets the status quo prevail, employees get fragmented care provided by PCPs struggling under the weight of brutal administrative burden and often nasty and counterproductive incentives.   You can learn more by emailing Dr. Conard at scott@scottconard.com.     Scott Conard, MD, DABFP, FAAFM, is board certified in family and integrative medicine and has been seeing patients for more than 35 years. He was an associate clinical professor at the University of Texas Health Science Center at Dallas for 21 years. He has been the principal investigator in more than 60 clinical trials, written many articles, and published five books on health, well-being, leadership, and empowerment. Starting as a solo practitioner, he grew his medical practice to more than 510 clinicians over the next 20 years. In its final form, the practice was a value-based integrated delivery network that reduced the cost of care dramatically through prevention and proactive engagement. When this was acquired by a hospital system, he became the chief medical officer for a brokerage/consulting firm and an innovation lab for effective health risk–reducing interventions. Today, he is co-founder of Converging Health, LLC, a technology-empowered consulting and services company working with at-risk entities like self-insured corporations, medical groups and accountable care organizations taking financial risk, and insurance captives to improve well-being, reduce costs, and improve the members' experience. Through Dr. Conard's work with a variety of organizations and companies, he understands that every organization has a unique culture and needs. It is his ability to find opportunities and customize solutions that delivers success through improved health and lower costs for his clients.   02:15 Why a transformed PCP practice didn't want to go back to the old way of doing things. 03:39 Dr. Peter Watson's takeaways from Dr. Conrad's EP391. 04:02 Can fee for service in the short term still benefit primary practice? 04:43 EP405 with Eric Gallagher; EP402 with Amy Scanlan, MD; upcoming episode with Larry Bauer; and EP407 with Vivek Garg, MD, MBA. 05:24 Scott Conard's new book, Which Door?   You can learn more by emailing Dr. Conard at scott@scottconard.com.   @ScottConardMD discusses #PCP transformation on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Brennan Bilberry, Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid

May I just take a moment and thank the Healthy economist for leaving a super nice review on iTunes? The title of the review is “Best podcast on the healthcare industry,” and the Healthy economist writes, “There's no one simple fix [for the healthcare industry], but [Relentless Health Value] contains valuable insights on what actions can be taken to make things better for consumers and patients.” Thank you, Healthy economist. In this summer short, I am talking with Brennan Bilberry; and we're talking about why everybody isn't suing health systems for behaving badly in sometimes pretty egregious ways. Why isn't anybody stepping in to prevent all of this consolidation that we all know, at this point, is pretty bad news? FTC, where are you? Brennan Bilberry cites three reasons for the way fewer antitrust lawsuits than you'd think would be going on: 1. A continuing lack of transparency. It's tough to sue someone when you aren't really sure what they're up to, and, even if you do, it's hard to prove because you can't get the data you need to prove it. 2. Political power of hospitals means legislatures have a hard time telling their major donors to kiss off and pass laws that actually enable legal recourse. 3. Turns out the FTC is a little toothless when it comes to those with tax-exempt (ie, nonprofit) status. Nobody expected nonprofits to act the way that some nonprofits are acting, and the laws haven't caught up with the reality of the situation. My guest in this healthcare podcast as aforementioned is Brennan Bilberry, who is a founding partner over at Fairmark Partners, which is a law firm litigating some of these antitrust lawsuits against some of these hospital chains. The original pod with Brennan (EP395) is entitled “Consolidated Hospital Systems and Cunning Anticompetitive Contracts.” Here's a link to an article I was thinking about while recording this show about Daran Gaus's hypothesis for how mergers will impact hospital prices. And here's a link to an article about how commercial prices for outpatient visits were 26% higher for patients receiving care at a health system than those visiting nonsystem physicians and hospitals. Covering some of the consequences of consolidation and what it tends to do in local markets is the show with Cora Opsahl (EP373) and also the encore with Dale Folwell, state treasurer in North Carolina. One last link is to the conversation I had with Scott Conard, MD (EP391), where the local hospital bought a local ACO (accountable care organization) physician organization and the community paid an additional $100 million to the hospital the following year.   You can learn more at fairmarklaw.com.   Brennan Bilberry is a founding partner of Fairmark Partners, LLP, a law firm focused on fair competition issues, especially in the healthcare industry. Fairmark has filed numerous antitrust cases against dominant hospital systems, seeking to tackle anticompetitive practices that lead to higher prices for businesses, consumers, and unions. Prior to founding Fairmark, Brennan worked as a policy consultant and political operative whose work included overseeing environmental public policy campaigns in numerous countries, providing international political intelligence for US investors, advising political campaigns around the world, and designing consumer and legal advertising. Brennan also worked on numerous US political campaigns, including serving as communications director for Terry McAuliffe's 2013 successful campaign for Virginia governor, serving as deputy executive director of the 2012 pro-Obama Super PAC Priorities USA, and developing research and policy communications for the House Democrats. Brennan is a native of Montana and South Dakota and has lived in Washington, DC, for the past 15 years.   00:23 Healthy economist's review of Relentless Health Value. 00:52 Why aren't more people suing hospitals? 01:16 How is the lack of transparency diminishing the number of lawsuits? 01:41 Why is the FTC a “little toothless” when it comes to nonprofits? 02:12 EP395 with Brennan Bilberry. 02:35 Why aren't there as many antitrust cases as there are instances of antitrust laws being broken? 03:10 Has consolidation of hospitals systems been good or bad? 03:45 What quirk in the law creates an impediment for FTC? 04:17 What are certificates of public advantage? 05:03 Why is private antitrust litigation important?   You can learn more at fairmarklaw.com.   @brbilberry discusses #hospital #antitrust cases on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Stacey Richter (INBW38), Scott Haas, Chris Deacon, Dr Vivek Garg, Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan  

Thanks for joining me as we kick off the summer season. Here's what we're gonna talk about today in our 10-ish-minute conversation. Keeping it short and sweet. First up, we got three super interesting voice messages left by your fellow members of the Relentless Tribe that I wanted to share with you. Next up, I will cover plans for the summer, because this summer, we have plans. And then after that, just wanted to chat a little bit about what I am up to right now. Agenda item #1: Episodes 399 and 400 of Relentless Health Value were me sharing my manifesto as it were. At the end of the show, I said that if you have a manifesto of your own, to share it by going to relentlesshealthvalue.com and hitting the orange leave a voice mail button. Doug Pohl, CEO of HealthTech Content, did so; and here is what he had to say: “My name is Doug Pohl. I'm the founder and CEO of HealthTech Content, and I'm pretty frustrated by the lack of progress toward making the improvements we need for healthcare. So, I put this out there to sort of be a bat signal for anyone else who feels the same way I do but to also hold myself accountable to be congruent outwardly with how I feel inwardly. No longer will I accept healthcare's prioritization of the bottom line. No more will I ignore the flagrant victimization of our society. I won't sit silently while shortsighted greed ruins families. I don't accept a profit-first model that kills people daily. I can't let complacency keep me from taking action. I won't let my voice wither away in fear. I can't—and I won't—remain quiet. I believe in the potential of regular people. I know how powerful we can be working together. Every one of us is affected by healthcare eventually, and it will take all of us to create the healthcare we deserve. The first step is rejecting the status quo. I'm tossing it out the window. How about you?” And now let me share two more voice mail messages, and here's why they both are meaningful. We know that this journey to transform the healthcare industry in this country can be long and slow and, at times, lonely. But together we are stronger and more able to help patients receive the care that they need and deserve at a price that we all can afford. So, thank you for being part of our community, and here's two perspectives on why you being here matters. Here's a voice mail from Justina Lehman from the Infinite Health Collaborative (iHealth): “When you are in the work of creating change in healthcare and really working to align with value for the patient, value for the physician, the clinician so they have an environment that they can thrive in, the work can feel hard. And it can feel lonely, and you can feel on an island. And Relentless Health Value podcast is your people. We often say this in our team of … when you look to that podcast, you're reminded of all the amazing people across this country doing incredibly meaningful work. And linking up with one another can create that strength and help you with your resiliency, especially on those days where you're feeling down and that the work is hard and that you're doing it alone. And sometimes you may even question: Is this work of value? Will it be valued of others? The Relentless Health Value podcast, Stacey, all of her guests have really been those people for us. Not uncommon for us to share podcasts amongst each other during the work of reminding each other of the people out there doing great things. So, so incredibly grateful for what Stacey's built and for all the guests that have been on her show and the value it's adding and the support it's giving to those of us who are out in the trenches trying to make this happen. So, thank you, Stacey.” And here's a message from Amy Scanlan, MD, who was also a guest on episode 402: “Hi, Stacey. It's Amy Scanlan. Wanted to say thank you for your latest episode. It's so helpful to be reminded that, even though we're making little steps, we are making progress and we're part of a greater movement. Thanks so much for the inspiration and for always doing the good work. Bottom line, here's my point and call to action: Share this show, especially with colleagues, with anybody trying to find a path forward who may be helped by a little companionship along the way. I just got a note, in fact, from Rajiv Patel, MD, MBA, FACP, from Bluestone Physician Services, and he wrote, “I am only a six-month listener and pretty upset to have not found this podcast earlier.” So, help spread the word and there are some people out there—not everybody, but some people—who you would be doing, frankly, a great service to. It sucks to feel alone. Agenda item #2: Let's talk about our summer plans here at Relentless Health Value. These plans are made possible because I am a collector. I grew up in Pennsylvania Dutch country. What can I say? We don't throw things away. We get a recycled jar and start throwing, I don't know, old keys into it until—it's like a magic trick, really—suddenly we have a collection of old keys. You know you're a collector when you have to buy a Brother P-Touch label maker because you have so many collections you require fancy labels to keep track of them all. Here's why this is relevant to you: Over the past year or so, I started collecting the sound bites that we had to cut from our episodes. I'm not talking about bloopers. I'm talking about really good insights and information but on a topic that maybe was slightly off-topic from the main thrust of the episode or sometimes just a little too long. I try to keep our shows around the 32-ish-minute mark because … yeah, you people are busy. At a certain point, though, I realized I had maybe half a dozen of these 5- to 10-minute clips. So, that's what we're doing this summer. We're going to play a drawer of, I'll call them, “Summer Shorts.” Get it? Summer shorts? These shorts are all with previous guests, and each short shares one or two very concise insights. I have about seven shorts in this drawer, so this will take us through most of the summer. There will be an episode or two sprinkled in. We have one on deck from Larry Bauer, who goes through some really heartwarming bright spots in the delivery of healthcare, and another one from Dan Serrano talking about CKD (chronic kidney disease) from a financial modeling standpoint. We'll see how it goes. Feedback is welcome. Speaking of bloopers, though, after 400 or whatever shows, I have to say I'm very blasé about bloopers as you will discover if you ask me about them, which many people do. I've heard them all what feels like a thousand times each: the ambulances, the helicopters, the lawn guys, the kids screaming about not wanting to give their germs to the dog (come to think of it, I should have saved that one), squirrels in the mini blinds, dogs barking, obviously the cat on the keyboard, the ice machine, the doorbells, things beeping, an occasional rooster. I always just delete them because guests get embarrassed. But yeah, I probably have enough audio to put together a game show entitled Where Is the Guest Working From— Home, Hospital, Office? Answer correctly and win prizes. That was a detour. Back on track now. One of the other reasons for doing summer shorts is because … wow, I am really busy. QC-Health®, the benefit corp that I'm co-president of, is working really hard in the CKD space. Right now, we are collaborating with several provider organizations—amazing ones, if you ask me—trying to co-design with PCPs in a very helpful way (ie, a way that is intrinsically motivating) to diagnose CKD earlier, slow disease progression, and help their colleagues do so, too. Considering that 50% (five-oh percent!) of patients who go into dialysis crash into dialysis in the ER (ie, they go to the emergency room for something or other and, while there, they are told that the root cause of their problem is “Oh yeah, you have end-stage renal disease [ESRD] and need to be on dialysis,” which costs, what, a quarter million dollars a year [according to a study in JAMA Network Open]). Oh, and also, two out of five of those patients who crash into dialysis—this is sad—had no idea they even had CKD, meaning they had no chance to slow their disease progression even if they wanted to. So, lots of work to be done there. This said, if you are working on anything that has to do with CKD, hit me up. There may be some alignments that we could explore. The process that we are using here to address and try to level up CKD outcomes is the same process that we used in the chronic liver disease (CLD) space, in which we improved the use of clinical guidelines for end-stage liver disease by 23% in about six months nationwide. Yeah, I know. I actually have a day job and do real work. Now, I will say that if you have a drug in the CKD space or a device or you are an ESRD value-based provider … yeah, call me kinda quick. It's humbling and nice validation the number of folks who are interested in working with us, but we don't want to bite off more than we can chew. Moving on, here's some more news about me. Thanks so much to the Validation Institute for awarding me Healthcare Influencer of the Year. That was a really cool surprise, and I am looking forward to picking up the award in DC at thINc360. So, that happened. I'm also looking forward to giving the keynote at the Pittsburgh Business Group on Health Symposium in September. Please come and see me there. I would love to meet you.   For more information, go to aventriahealth.com.   Each week on Relentless Health Value, Stacey uses her voice and thought leadership to provide insights for healthcare industry decision makers trying to do the right thing. Each show features expert guests who break down the twists and tricks in the medical field to help improve outcomes and lower costs across the care continuum. Relentless Health Value is a top 100 podcast on iTunes in the medicine category and reaches tens of thousands of engaged listeners across the healthcare industry. In addition to hosting Relentless Health Value, Stacey is co-president of QC-Health, a benefit corporation finding cost-effective ways to improve the health of Americans. She is also co-president of Aventria Health Group, a consultancy working with clients who endeavor to form collaborations with payers, providers, Pharma, employer organizations, or patient advocacy groups.   01:14 Doug Pohl's manifesto. 02:43 Justina Lehman's thoughts on why our podcast listeners are important. 04:05 Dr. Amy Scanlan's voice mail. 04:39 Note from Rajiv Patel, MD, MBA, FACP. 05:01 Relentless Health Value's plans for the summer. 09:18 Stacey's plans for the summer.   For more information, go to aventriahealth.com.   Our host, Stacey, discusses our #healthcarepodcast plans for the summer. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Scott Haas, 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  

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)  

I couldn't resist the “who's suing who” because, yeah, you can't go wrong with Aretha Franklin references. Back on the pod we have Chris Deacon, who is going to give us a rundown of the legal goings-on going on right now that impact self-insured employers, carriers, hospitals, and taxing authorities like cities. Chris breaks down the legal activity into three main categories, and then we discuss some examples of lawsuits in each category. So, here's the outline of our upcoming conversation: 1. Breach of Fiduciary Line of Cases Against Carriers a.    Bricklayers vs Anthem Class Action b.    Mass Laborers vs Blue Cross Blue Shield c.     Member vs Cigna 2. Carrier vs Hospital (upcoding) and Hospital vs Carrier (underpayment) a.    United vs TeamHealth b.    TeamHealth vs United 3. Taxing Authority vs Nonprofit Hospitals a.    Tower Health line of cases in Pennsylvania b.    Pittsburgh vs UPMC This episode itself is a little on the longer side—and I didn't want to edit too many of Chris's words of wisdom—so I'm gonna make this a little bit shorter, this intro. But just one point that I'll make, and this is about the first category of legal activity wherein self-insured employers mostly try to pass the “who is actually the fiduciary” hot potato to carriers, ASOs (administrative services only), and TPAs (third-party administrators). And the carriers, ASOs, and TPAs are like, “It ain't us.” Moving forward here, I'm just gonna say carriers as a catchall for carriers, ASOs, and TPAs to save myself a mouthful. But bottom line on this topic, I just want to underscore something that Chris makes clear later on in the show: Plan sponsors (ie, self-insured employers) are the fiduciary, the sole fiduciary, at least according to the carriers who are getting sued right now. This is the position that you can see them taking in every lawsuit that I have seen. What the carriers say also, as a follow-on, is that if there is any contractual language between the carrier and the employer that violates the CAA (Consolidated Appropriations Act) or any other regulations, it is or was the employer's responsibility to not sign the contract. It's not the carrier's responsibility to point out that there's stuff in their own contract that's in violation for the employer to sign. And this includes contracts that don't give self-insured employers the right to their own data, which is pretty much a rate critical for any and all CAA compliance. As Justin Leader wrote the other day in reference to the bricklayer case, “To get to the point of filing the suit, there was a solid 2 years of failed negotiations [for the bricklayers to get their own claims] data.” Two years trying to get claims data that is necessary for a fiduciary to have from a carrier who is saying essentially, “Good luck with that. You're the ones that signed our contract.” Here's one of Chris Deacon's latest LinkedIn posts about this topic. And here's another one from Jeff Hogan that was interesting. Also, here's the link to the earlier episode with Chris (EP342), where we dive into the deep end on the topic of the CAA, which was signed into law at the beginning of 2022 and states that self-insured employers have certain rights and responsibilities based on their role as the fiduciary of their health plan. For more on the Member vs Cigna case, check out the encore episode with Dawn Cornelis (Encore! EP285). The show with Vikas Saini, MD, and Judith Garber, MPP (EP394) comes up where we talked about hospitals and their charitable giving. And lastly, I mention the show with Suhas Gondi, MD, MBA (EP404) about who is on the board of directors of hospitals, big nonprofit hospitals in particular. My guest in this healthcare podcast, Chris Deacon, is a lawyer by training. She ran the state health plan for the state of New Jersey, which covered about 820,000 public-sector lives. She now has an independent consulting firm, VerSan Consulting.   You can learn more at versanconsulting.com and connect with Chris on LinkedIn. You can also email her at cdeacon@versanconsulting.com.   Chris Deacon has a deep understanding of the fiduciary role health plan administrators hold and should be leveraging in order to drive value for their plan sponsors and members. An attorney by training, Deacon formed VerSan Consulting, LLC, in order to educate and engage employers to be more prudent purchasers of healthcare. From creative procurement methodologies and demanding contracts to population health initiatives and primary care investment, Deacon believes that large employer-sponsored health plans have not only an opportunity but an obligation to drive healthcare transformation that delivers value for the market. Prior to founding VerSan Consulting, Deacon ran one of the largest health plans in the country for the New Jersey Department of Treasury, which covered over 820,000 public-sector lives, including state employees, teachers, and uniformed professionals. During her tenure, Deacon was credited with helping the state save over $3 billion through a number of initiatives, including enhanced oversight, payment integrity programs, procurement strategy, and strict accountability for the vendors with which the state engaged. Deacon has also served as a deputy attorney general and then special counsel to Governor Christie where she oversaw the Department of Banking and Insurance, Economic Development Authority, and Treasury. She holds a JD from Rutgers Law School and bachelor's degree in international affairs from The George Washington University.   04:47 What does the current legal landscape look like, and how does it bode for the future? 07:24 “We need to catch the legal framework up with the current reality.” 19:53 How is this first circuit decision affecting who might be found liable in future cases? 21:38 What happened in the Member vs Cigna case? 24:49 Are we heading in the direction of the employer having fiduciary responsibility? 25:47 What's happening in the Carrier vs Hospital cases? 28:49 Who's really paying the price for the current business practices being examined in court? 30:00 What's happened in the Tower cases?   You can learn more at versanconsulting.com and connect with Chris on LinkedIn. You can also email her at cdeacon@versanconsulting.com.   @VerSan_cdeacon discusses current legal affairs in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #hcmkg #healthcarepricing #pricetransparency #healthcarefinance   Recent past interviews: Click a guest's name for their latest RHV episode! 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), Dawn Cornelis (Encore! EP285)  

Okay … let me get real here for a sec. For a few reasons, I wanted to chat with Vivek Garg, MD, MBA. Dr. Garg is CMO (chief medical officer) of primary care at Humana. Dr. Garg is an inspiring and incredibly articulate individual, and I like to both learn from and also be kept on my toes by the likes of such folks. But also, yeah, I'm suspicious of vertically consolidated payers. I mean, you listen to this podcast. I don't need to recap what the financialization of the healthcare industry has done to patient care. But you heard my manifesto in episode 400. It's about trying to find the right path forward and being open to exploring options here. It's considering what doing well by doing good actually means. It's contemplating whether to celebrate some good stuff going on in the industry even if there's some not-so-good stuff going on in that same sector or even in that same company. Bottom line: We're living in the real world here, and utopia is not on the table, at least anytime soon. So, that means there is always going to be one thing that we are always going to have to have to weigh in our consideration set, in our assessment equation that I talked about in my manifesto in episode 400. What's this one thing? It's self-interested, shareholder-centric goal setting. In other words, just because I spot a self-interested, shareholder-centric goal doesn't mean I'm automatically gonna get out my red Sharpie and cross off the whatever with a sour expression on my face because … yeah, if I did that, a whole lot of Americans are not gonna get, even incrementally, better healthcare. The right equation to determine if something is net-net good is always going to be nuanced. The equation should weigh the impact of the self-interest, which is always going to be there, against the impact on patient care and patient financials and how the whole thing impacts clinicians at a local level or maybe a national level, depending on what's going on. I'd also suggest that there's no real broad strokes here, because the equation for any given initiative or pilot or approach is really singular. I think it'd be a big mistake to lump together, for example, all payviders across the country and assume that their impact is all the same. Or all Medicare Advantage plans. Or anybody doing advanced primary care. All of these words/groups I just referenced are relevant to the conversation today. You have some payviders, for example, doing all kinds of crap with dummy codes and/or anticompetitive contracts and/or steering only to their own medical groups which they staff inadequately and/or blanket denials of anything that will throw off their medical trend calculations and/or prescribing and care pathways coinciding with their own highly financialized PBM (pharmacy benefit manager) formularies. But then, on the flip side, you also have some interesting things going on that help patients and their communities. A key ingredient of these interesting things is taking into account longer time horizons. Longer time horizons are actually pretty key here for anybody trying to do anything preventative or anything involving forming patient relationships. Also, of course, you have those who are doing some combination of the good stuff and the not-so-good stuff; and one of the reasons why the not-so-good stuff becomes so ingrained is that risk adjustment (especially if you're a payvider) across the board has anything but a longer time horizon. So, let's dig into what Dr. Vivek Garg has going on at Humana Primary Care, which includes CenterWell Senior Primary Care and also Conviva Care Center. I ask Dr. Garg some pretty hard questions about balancing the tension between being a payer with a PBM with an incentive to deny care and a provider organization seeing patients that is also beholden to those same shareholders. Dr. Garg taught me a new term, and that's the “dyad model,” where you have doctors and admins working together or clinicians and admins working together. You get the clinical team to shadow the administrative team, and you get administrative team to shadow the clinical team. You teach doctors and others the business of medicine, and you teach admins what it's like to be a clinician or a patient on the other end of some of those policies. Now, if you have a good memory, you are probably also recalling that Eric Gallagher from Ochsner (EP405) talked about this exact same concept (ie, working together, ie, the scrubs and the suits coming together into this dyad leadership model). There's a quote from Denver Sallee, MD, in episode 402 with Amy Scanlan, MD, talking about pretty much this exact same thing. And furthermore, this whole getting doctors up to speed on the business of medicine is gonna be the topic of an upcoming episode with Adam Brown, MD, MBA. So, yeah … this is becoming a thing—the idea of teaching clinicians the business of medicine. But the opposite should also get some focus—teaching admins the medicine of medicine. Dr. Garg cites three pillars to improving an organization's ability to sustainably deliver better healthcare, and these three pillars are (1) to focus on the patient experience, (2) to focus on outcomes, and then (3) to engage the clinical teams and really protect them, to protect this precious resource that doctors and other clinicians actually are. Taken together, these three pillars coincide with the pivotal question here. And that pivotal question is: How much is any given entity actually investing in clinical leadership? Because in combination, great clinical leadership plus the three pillars (ie, a focus on experience, outcomes, and clinical engagement), you put all those things together and it adds up to each individual who works in the place to harness their own intrinsic motivation—to be able to explore and double down on and actually achieve the reasons why they went into healthcare to begin with and spent years of their lives in school in order to do so. Dr. Garg mentions the latest Humana report in the show. And then I mention how I interviewed Steve Blumberg from Guidewell (AEE12) about the 2020 Humana report. Also mentioned on this show is episode 312 with Doug Eby, MD, MPH, CPE, from the Nuka System, and episode 405 with Eric Gallagher from Ochsner.   You can learn more at humana.com, centerwellprimarycare.com, and the Humana report.     Vivek Garg, MD, MBA, is a physician and executive dedicated to building the models and cultures of care we need for loved ones and healthcare professionals to thrive. He leads national clinical strategy and excellence, care model development and innovation, and the clinical teams for Humana's Primary Care Organization, CenterWell and Conviva, as chief medical officer (CMO), where they serve approximately 250,000 seniors across the country as their community-based primary care home, with a physician-led team of practitioners, including advanced practice clinicians, nurses, social workers, pharmacists, and therapists. Dr. Garg is the former chief medical officer of CareMore and Aspire Health, innovative integrated healthcare delivery organizations with over 180,000 patients in over 30 states. He also previously led CareMore's growth and product functions as chief product officer, including expansion into Medicaid primary care and home-based complex care. Earlier in his career, Dr. Garg joined Oscar Health during its first year of operations as medical director and led care management, utilization management, pharmacy, and quality, leading to Oscar's initial NCQA accreditation. He was medical director at One Medical Group, focusing on primary care quality and virtual care, and worked at the Medicare Payment Advisory Commission, a Congressional advisory body on payment innovation in Medicare. Dr. Garg graduated summa cum laude from Yale University with a bachelor's degree in biology and earned his MD from Harvard Medical School and MBA from Harvard Business School. He trained in internal medicine at Brigham and Women's Hospital, received board certification, and resides in New Jersey.   07:27 What does comprehensive primary care look like, and what can we expect from it? 07:39 Is the comprehensive primary care model the single biggest tool to help improve health? 10:41 How does a competitive ecosystem affect a comprehensive primary care model? 15:44 What is the impact of physicians and clinicians on the delivery of comprehensive care? 19:25 EP312 with Doug Eby, MD, MPH, CPE, of the Nuka System. 20:22 “What we need to do with the technology is actually support and enable the team.” 21:42 Why it's important to create “space” in your comprehensive care model. 24:56 What three areas does every organization need to pay attention to? 31:03 Why the opportunity for alignment is greater than the potential for conflict. 32:48 Why long-term orientation is a key to success, even in an ecosystem that's more short-sighted. 34:30 AEE12 with Steve Blumberg.   You can learn more at humana.com, centerwellprimarycare.com, and the Humana report.   @vgargMD of @Humana discusses comprehensive #primarycare on our #healthcarepodcast. #healthcare #podcast #digitalhealth #hcmkg #healthcarepricing #pricetransparency #healthcarefinance   Recent past interviews: Click a guest's name for their latest RHV episode! Lauren Vela, Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399)  

I'm gonna run through the five reasons Lauren Vela talks about in this healthcare podcast for the “why” with the inertia in benefits departments of self-insured employers. But before I do, let me report that, in sum, they add up to … in many cases, benefits folks sit between a rock and a hard place. You really can't poke fingers at benefits teams who don't have the bandwidth, the resources, the expertise, or the organizational power to, in essence, run a small insurance company in-house and also do the rest of their jobs. This is especially true when benefits teams get no help or air cover from the CFO or CEO of their companies. So, the bosses are, in effect, telling benefits teams to manage the second-biggest company expense—this uncontrolled thing growing at multiples of the rates of inflation. They say, “Go get a handle on that but also don't make any noise, don't disrupt anything.” And meanwhile, I don't know, is the CFO under the impression that all he/she needs to do is pop by once or twice a year, issue some nastygrams about renewal rates to people who have no training in any of the financial and probably other skills required to manage this huge spend? And/or, on the other hand, the CHRO doesn't report to the CFO—so, same result, opposite problem. Here's the five pillars for the “why” with the inertia that I explore pretty deeply with Lauren Vela on the show today: 1. Transforming the healthcare industry is not actually in the job description of benefits professionals. 2. Outsourcing to consultants. Benefits departments a lot of times don't have the resources or adequate staffing to get deep into the complexities of healthcare, which means that lots gets outsourced to consultants. If you have listened to the episode with Paul Holmes (EP397) or AJ Loiacono (EP379), the problem here is that many traditional EBCs (employee benefit consultants) and brokers have a very vested interest to maintain the status quo. Currently, some are able to skim commissions of up to 30% of pharmacy spend, of employer healthcare spend, into their own pockets. These consultants have zero interest in upending absolutely anything. Employer inertia is paying for their vacation home, after all. 3. Nobody gets fired for hiring the same ASO (administrative services only) or TPA (third-party administrator) or PBM (pharmacy benefit manager) or whomever as their predecessor hired or they've been using for years. But they might get fired for doing something new that doesn't go so well. There might be no patience for even the shortest of learning curves or the smallest amount of disruption. There's also the aspect of a benefits team being capable of selling a transformational idea up the organizational ladder. Does the benefit department really know what the goals of the C-suite are? And if they aren't crystal clear on C-suite goals and aren't the best presenters in the world, it's gonna be a no-go on the new idea and then, yeah … inertia. 4. There's no obvious solution, no magic bullet, or easy answers. It might be hard to even figure out what to do that might have the positive impact a benefits team might be looking for. And then we get into the “is the juice worth the squeeze” discussions. 5. There is a status quo bias. Inertia is human nature. But at the same time, employers are wasting up to 30% or more of their healthcare benefits spend. That's a lot of money. These dollars are getting siphoned right off the top and going into someone's pockets in ways that do not help employees get better health. Dollars that could have been used to give tens of thousands of dollars in raises. Dollars wasted by the employer. But also, the employee gets ensnared in this financial lack of oversight because employees have deductibles and coinsurance. So, it's everybody sagging under the current model of some EBCs and payers and providers and PBM executives getting rich and hardworking Americans paying for it. So, let's cut to the chase. What are two solves? There's many more, but here's two. And Lauren Vela and I sort of ran out of time before we could adequately explore more, but these two will get anyone who wants to started: 1. C-suites. Yeah … you. Get involved. Provide adequate air cover for your benefits teams to move in new directions and also resource and staff your benefits teams with the kind of stuff and skills that they desperately need right now. Attracting and retaining employees has a whole new reality and opportunity, and a benefits team staffed for the market environment 10 years ago but not for the market today is a growing competitive and financial disadvantage. 2. There is a playbook for how to go about this. Listen to the show with Lee Lewis (EP244) for his, but step one of almost everybody's playbook is to find the right consultants working at the right consultant organizations. These right consultants and companies are the ones who are not taking indirect money under the table from an employer without that employer's knowledge. And if you're sitting right there thinking, “Oh no, that's not me,” unless you've very deliberately changed consultants so that it isn't, don't kill the messenger here. Again, listen to the shows with AJ Loiacono (EP379) or Paul Holmes (EP397). Ignorance is not bliss in this case like many others. Also, Eric Bricker, MD, just did a video on EBCs and broker types. So, do these solves mean spending more on a department that is already a cost center? Yeah, good question … wrong question, as the conversation with Lauren Vela today really gets into. The actual question is: Can you afford not to spend more on a department so that you aren't getting wildly taken advantage of in the current market environment. If you spend one dollar and save more than one dollar and also get employees better health, that does not seem to be a bad deal. As I've mentioned several times, today I am speaking with Lauren Vela. Lauren is a very experienced consultant working with coalitions, groups of employers, physician organizations, and also in the PBM space.   You can learn more about Lauren's work by connecting with her on LinkedIn.   Lauren Vela is a passionate advocate for a more rational and sustainable healthcare system and recognizes the influence had by employers and other commercial purchasers through their oversight of employer-sponsored insurance plans. As an independent consultant, she partners with entities that are committed to changing the ineffective status quo. Previously, Lauren was the director of health care transformation with Walmart, where she partnered with the Walmart Benefits team to identify solutions concerning low-value care, site of care, and vendor evaluation. Prior to her tenure at Walmart, Lauren led market strategy and member initiatives for the Purchaser Business Group on Health, where she cumulatively spent two decades working within various healthcare sectors, including health information technology, provider organizations, and pharmacy benefit management. Lauren also served, for seven years, as the executive director of the Silicon Valley Employers Forum, a trade association of high-tech employers collaborating on innovative delivery of both domestic and international benefits.   07:16 What does inertia actually mean in the healthcare benefit space? 08:02 “Fixing healthcare is not really the benefit manager's job.” 08:22 How could a benefit manager's job actually do the opposite of making healthcare better? 10:56 EP358 with Wayne Jenkins, MD. 11:56 “Americans are in pain.” 13:31 Why do benefits managers partner with consultants, and why is that bad? 14:17 “Benefit departments are cost centers; they're not revenue centers.” 15:30 “Every single company is in the healthcare business.” 16:40 EP397 with Paul Holmes. 18:12 Why relationships with consultants can make it very difficult for benefits departments to change. 22:46 Is the juice worth the squeeze? 23:12 “There's not one silver bullet that fixes healthcare.” 27:42 What is status quo bias? 28:56 Why employers may not be able to stay with their legacy vendors and also change for the better. 30:56 EP244 with Lee Lewis.   You can learn more about Lauren's work by connecting with her on LinkedIn.   @laurenvela1 discusses #benefitdepartments and #selfinsuredemployers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #hcmkg #healthcarepricing #pricetransparency #healthcarefinance   Recent past interviews: Click a guest's name for their latest RHV episode! Dale Folwell (Encore! EP249), Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher  

So, let's talk about North Carolina. What a weird outlier of the direction of other states getting active on their healthcare spend. I'm talking about Texas, Indiana, Wisconsin ... I'm naming so-called red states because the legislature in North Carolina is a Republican majority. Gotta say, normally I'm down for a little weird. I find it mostly charming. But with the information I have at present about what's going on in North Carolina, I don't love this for you. And when I say “you,” I pretty much mean any family who happens to live in North Carolina or any businesses in North Carolina trying to afford their employee health benefits right now. This whole shebang and the reason I'm covering this on Relentless Health Value is that it is also extremely relevant to anybody else in this country as a case study or a cautionary tale, depending on your point of view. So look, there's two pieces of legislation running through North Carolina's Senate and House right now, but both of these pieces of legislation—one that Blue Cross Blue Shield (BCBS) is angling for and the other one that UNC, a big hospital chain in North Carolina is all hachi machi to get passed—both of these have precedents. Both of these things were done elsewhere, and the results were not great, to put it mildly. BCBS wants to be able to open up a holding company that is able to take BCBS policyholder payments and invest them in for-profit ventures—BCBS being a nonprofit and all. Here's a quote Chris Deacon mentioned on LinkedIn from an article on this topic: “A 2019 examination of the aftermath of 11 conversions of BCBS affiliates showed that fully insured premiums increased roughly 13 percent … suggesting a post-conversion exercise of market power. Significantly, rivals of these large converting insurers also raised their prices following the conversions.” And here's a link to a Health Solutions podcast with Cristy Gupton, Chris Deacon, and North Carolina Commissioner Mike Causey. So, that's one of the pieces of legislation on the docket. Then, on the hospital side of the equation, we also have a proposed bill that could give UNC Health Care a green light to expand and buy more physician practices and hospitals without as much oversight. Proponents of the bill say that this will better enable UNC to take over struggling rural hospitals in danger of closing. Considering that UNC has already taken over rural hospitals in danger of closing, not exactly sure how or why basically removing federal and state antitrust scrutiny is helpful here. I went around looking for evidence that if you reduce antitrust scrutiny and enable more unfettered consolidation and expansion that population health outcomes improve. I could not find any. I did find lots of great talking points, but all of them seemed a little light on the evidence. There is, however, an insane amount of evidence at this point that shows unfettered hospital chain consolidation harms local communities from a financial standpoint without improving the quality or outcomes of patient populations, especially when hospital chains, in conjunction with third-party payers, are not willing to share their pricing, even with their largest customer. But I'm getting ahead of myself, because this is exactly what I'm talking about in this 2019 interview with Dale Folwell, the state treasurer of North Carolina. And it is a doozie of a frustrating story, just to cut to the chase. Look, you might be able to hear I definitely have an opinion formed on this topic, and I don't want to sway yours until you look into all of this yourself. But I loved what Jeff Leston wrote the other day. He wrote, “The North Carolina Legislature proves that they report to the healthcare industry in the State, not the people who actually elected them.” Okay … teeing up the interview today, this whole thing started when the North Carolina State Employees Health Plan (SEHP) crafted a proposal to pay network hospitals based on a transparent pricing schedule. Considering that SEHP purchases benefits for 720,000 people in North Carolina at a cost to taxpayers of billions of dollars, this seems reasonable. When you're the fiduciary of thousands of dollars, let alone add six more zeros, it would seem to be nonnegotiable to actually see the numbers and not write a check to a black box. Nonetheless, a few of North Carolina's largest hospital chains disagreed. They wanted to bill whatever they wanted to bill shrouded in a cloak of secrecy. In this healthcare podcast, as I mentioned earlier, I am speaking with North Carolina State Treasurer Dale Folwell. This is a rebroadcast from an interview in 2019 but still, somewhat sadly, completely relevant.   You can learn more at nctreasurer.com. You can also connect with Treasurer Folwell on Twitter at @DaleFolwell or on Facebook at Dale Folwell.     Dale R. Folwell, CPA, was sworn in as State Treasurer of North Carolina in January 2017. As the keeper of the public purse, Treasurer Folwell is responsible for a $100 billion state pension fund that provides retirement benefits for more than 900,000 teachers, law enforcement officers, and other public workers. Under Treasurer Folwell's leadership, the pension plan was rated among the top five highest funded in the country and won accolades for proactive management and funding discipline. In 2018, the state's coveted AAA bond rating was reaffirmed by every major rating agency, making North Carolina one of only 13 states in the country to hold that distinction. Treasurer Folwell also oversees the State Health Plan, which provides medical and pharmaceutical benefits to more than 720,000 current and retired public employees and is the largest purchaser of healthcare in North Carolina. Folwell was first elected to public office as a member of the Winston-Salem/Forsyth County Board of Education. He brought his problem-solving skills to the North Carolina General Assembly in 2004, where he served four terms in the House of Representatives, including one term as Speaker Pro Tempore. Treasurer Folwell began his career as a blue-collar worker and became a Certified Public Accountant and investment advisor after earning bachelor's and master's degrees in accounting from UNC-Greensboro.   05:59 The North Carolina state spend on healthcare. 07:21 “In medical terms, why has this become acute?” 08:00 One week of work for starting North Carolina troopers and teachers out of every four is going to family healthcare costs. 09:14 The problem of health insurance vs healthcare. 09:59 “If they can do this to the largest customers in this state … imagine what they can do to them.” 10:20 “This is about the industry whose whole business model is based on secrecy.” 11:47 “We've already focused on the why, and now we're [focusing] on the how.” 12:46 “We're trying to attack a problem.” 15:46 What the Clear Pricing Project aims to do. 18:08 “We're not trying to be disruptive; we're trying to fix a problem.” 19:55 Why the Clear Pricing Project went the self-insured route and how that's worked for them. 24:14 Who's behind the institutions fighting transparent pricing in North Carolina. 25:15 Instances where the Clear Pricing Project could actually stand to help rural hospitals make more money. 27:29 Dale's advice for other states trying to do this. 28:49 Dale's message to healthcare providers out there who want to see this change to price transparency.   You can learn more at nctreasurer.com. You can also connect with Treasurer Folwell on Twitter at @DaleFolwell or on Facebook at Dale Folwell.   @DaleFolwell discusses #financialtoxicity in #healthcare on our #healthcarepodcast. #podcast #digitalhealth #hcmkg #healthcarepricing #pricetransparency #healthcarefinance   Recent past interviews: Click a guest's name for their latest RHV episode! Eric Gallagher, Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes  

Let's cut to the chase. You've gotten to the point where you have a gang of physicians/clinicians/physician practices who have expressed a desire to work together. What do you need to know right now? Eric Gallagher, CEO of the Ochsner Health Network, is my guest in this healthcare podcast; and I largely asked him the same question that I had asked Amy Scanlan, MD, from the UCHealth/Intermountain clinically integrated network in Colorado in episode 402 a couple of weeks ago. The question I asked both Eric and Dr. Scanlan is: What are you doing to help align physician practices into an integrated model? How are you going about that? Now, let me remind you, Ochsner Health Network is practically long in the tooth when it comes to clinically integrated networks; and it also exists in an environment that is unique, as are most local markets. But Ochsner's local market is mostly Louisiana, which has an older population and a huge Medicare Advantage penetration. That is quite a different local market from what's going on in Colorado, which is the location of Dr. Scanlan's joint. As we all know, different stages of any journey require different solution sets; and different local markets certainly require different solution sets. But what was so interesting to me was to notice that despite the market differences and the where-are-we-in-the-transformation-journey differences, how many of the things that you'll hear about in this episode are in the same spirit as the stuff that we talked about in that earlier show with Dr. Scanlan. Eric Gallagher lists three things that he says are essential in the transformation journey: 1. Making sure that physicians, care teams, and those working directly with patients are part of the transformation process, both from a practice standpoint but then also from a financial standpoint. This makes so much sense when I state it explicitly here, but so frequently, it doesn't happen. So frequently there's a value-based care team that tinkers around in a silo and then an announcement comes over the loudspeaker one day that henceforth we shall add some more clicks … but trust us, it's important for some reason we aren't going to bother to tell you about … you'd be bored by it or you wouldn't understand it. Even if this was not the intention (and it probably wasn't), the result is going to be the bad taste in your mouth that I just left you with. Eric Gallagher's #1 here, that everybody be part of the transformation, might be the umbrella really over the first thing that Dr. Scanlan talked about in that earlier episode, which was to make sure to give practices the tools that they need to succeed—not what you think they need but what you've discerned they actually need because you've listened to them. It's a bidirectional exchange here with everybody working together. Eric adds some new ground to that. He says that to make sure that everybody can productively contribute to this transformation process (and probably know what tools they may need), it's vital that everybody understands the “why” behind what the organization needs to do, meaning educating physicians and other clinicians in the business of medicine and the financial reasons for the “why” with the whatever. Insulating docs from the real world here helps no one, and it's not really viable actually in the world that we live in today … … which is a callback to the point that Denver Sallee, MD, made also in episode 402, which, in a nutshell, was that he thinks that unless docs, as a gang, start learning a lot more about the business of medicine, that we'll continue to see this value extraction and financial toxicity and moral injury–inducing environments that we see right now. Dr. Sallee wrote, “I needed more education in order to truly help patients.” So, let me posit that this “everybody works together and gets educated together” step can help the practice and help patients in a myriad of ways, both at the practice level and at the patient level and also probably at a national level. 2. A recognition that practice transformation requires process transformation and thinking about things very differently. Now, all of a sudden, we are getting paid to coordinate care. We must work as a team because there are people on staff who can influence social determinants of health, for example. We have a vested interest to create a community board advocating for food banks and sidewalks and air pollution controls so all the kids who play soccer don't wind up with asthma. Ochsner actually set up a school because they realized educated communities are healthier communities. Dr. Scanlan's clinically integrated network? They're much earlier in the journey. They're at the point where they're working hard to get participating practices the tools that they need to succeed and help doctors and other clinicians help patients through what Dr. Scanlan calls the “in-between spaces”—the times between appointments. But all of this really rolls up to the point that Eric Gallagher is making about everybody working together and recognizing that practice transformation requires process transformation. 3. The culture change that's necessary among physicians and other clinicians (pretty much everybody), and Dr. Amy Scanlan leaned into this one, too—hard. Both brought up the same nemesis: inertia. And the requirement to change culture can't be underestimated, and the change management that's required here cannot be phoned in. Culture eats strategy for breakfast, lunch, and dinner, as they say. My two macro-level takeaways after talking with Eric Gallagher today and Dr. Amy Scanlan earlier are that, even though the local market and the nuances of any given particular practice have such a huge impact on what's going to work at an operational and tactical level, if we stay up in the strategic zone, there's some best practices and points to ponder which are likely possible to universalize. Now, emphasis on the “stay up in the strategic zone.” I was just talking to another person today with yet one more story amounting to “it didn't work because it never was going to work,” wherein, in this case, apparently a very large payer is running around attempting to do a pilot in an attempt to learn exactly and specifically how to operationalize something, and then their plan is to roll out this one model nationwide. So, something works in one local market at one practice, and we're just gonna assume if it worked there, it's gonna work everywhere. And, yeah … good luck with that. After you listen to this show, listen to episode 402 with Amy Scanlan, MD, as I have mentioned multiple times. Episode 343 and episode 316 with David Carmouche, MD, would be good to check out. Also episode 393 with David Muhlestein, PhD, JD, and episode 394 with Vikas Saini, MD, and Judith Garber, MPP.   You can learn more at Ochsner Health Network.     Eric Gallagher, chief executive officer for Ochsner Health Network (OHN), is responsible for directing network and population health strategy and operations, including oversight of performance management operations, population health and care management programs, value-based analytics, OHN network development and administration, strategic program management, and marketing and communications. Prior to joining Ochsner in 2016, Eric held leadership positions in healthcare strategy and execution—including roles at Accenture, Tulane University Health System, and Vanderbilt University and Medical Center. A New Orleans native, Eric earned a bachelor's degree in human and organizational development from Vanderbilt University and an MBA from Tulane University.   08:14 What does everyone need to be on the same page about when it comes to clinical integration? 13:42 “For physicians, we really have to overcome this threat to physician autonomy.” 16:52 “Health inequity is really just societal inequity.” 19:24 What is the principal agent problem? 20:00 “There are things health systems can do that are probably outside of their traditional field of responsibility.” 20:09 Why did Ochsner Health Network start a couple of schools? 20:42 What can empower a care team in a value-based care model? 21:53 Why is it important to transform into a team-based model? 23:24 “In the DNA of our organization, resiliency runs strong.” 26:01 Why is building an effective care model easier than building trust with patients? 26:14 What is Eric's advice to physicians trying to integrate right now? 28:50 How do you get everyone on the same side of aligning for integration?   You can learn more at Ochsner Health Network.   Eric Gallagher of @OchsnerHealth discusses #clinicalintegration for #physicians on our #healthcarepodcast. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Suhas Gondi, Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde  

So much of this episode (and this podcast as a whole, really) is about one consistent theme: How do we reset or redesign our healthcare industry, including hospital chains—mostly talking about the big consolidated ones that have a lot of money here—but how do we redesign these leviathans to be more consistent with our values as a country and the values of the doctors and other clinicians and others who work in these places and who went into the healthcare profession for a reason that had, you know, something to do with patients? And I mean something to do with patients that doesn't involve dressing up for Halloween as a giant cardboard dollar sign, like some finance department guy did at one large nonprofit hospital in the spirit of shaking money out of poor patients (see article here). Or listen to previous episodes about hospitals raising prices way higher than the rates of inflation. Not to belabor this because we've already talked about it so very often, but you also have the whole thing with big, well-funded, nonprofit hospital chains going on cost-cutting extravaganzas and, at least in one case, basically creating their own staffing crisis. Do these activities have a familiar ring to them? Do they strike you as a page out of a playbook you may have seen elsewhere? I don't know about you, but they remind me of things that private equity or financial folks run around doing. I mean, the classic stepwise for how to maximize the financial value of an “asset” from a financial industry standpoint is to cut costs and raise prices. Piling on this “kind of sounds like a B-school group project” thesis, what about the thing with a bunch of these big, consolidated hospital systems with rich endowments crying crocodile tears about how much money they lost last year? Except … in a whole bunch of cases, the money they lost—some of which came from the COVID CARES relief act funds they got, by the way—but this money was lost when their risky stock market investments tanked. Those are their losses. Stock market losses. From speculative investments. Are you kidding me? But hospitals are charities, right? They are nonprofits. They aren't owned by private equity. They aren't owned by an investment bank or a team of financiers, so you wouldn't expect them to be acting like they are owned by Wall Street. But … oh, wait … how weird. You know who is on the boards of some of these very well-known nonprofit hospitals? If you don't, I'm not surprised, because in too many cases, if you ask me, you have to dig around in tax filings and other bureaucratic paperwork to unearth the names of these members who have quite a large amount of power (it turns out) over what goes on in the hospital. But you know who is on these boards? Yeah … almost half of board members tend to have a financial background. Almost none of them are nurses. And what about doctors? Are physicians on these boards? Well, almost one-third of hospital boards did not have a single physician member. So, there's that. Here's a quote from a STAT news article written by my guest in this healthcare podcast, Suhas Gondi, MD, MBA, and also Sanjay Kishore, MD, about a study that the two of them coauthored about who is on hospital boards. Here's the quote: Our findings are cause for concern. If hospital executives are largely held accountable by finance professionals and corporate leaders, instead of by clinicians and patients, might they focus more on revenue and expenses than the needs of their communities or staff? While some argue that margin facilitates mission, the measure of a nonprofit organization is how these priorities are balanced by leaders who ultimately answer to their board. So, I get there's balance. You have to be financially sustainable. But I also get that, apparently, tigers don't change their pinstripes. The pin-striped suit remains even when the finance tigers become the board members of a charitable organization that's supposed to be serving the surrounding community paying its freight in the form of its tax exemptions. This is what this conversation is about today: Who is on these hospital boards? How much power do these hospital boards have? And what might be done to switch it up some so that we can get hospitals that are reflective of our values as a nation and what we want for ourselves and our families? Today, as aforementioned, I'm speaking with Suhas Gondi, MD, MBA, who, along with his coauthor Sanjay Kishore, MD, wrote a paper on this exact topic. Check out some great Tweets and comments. Following are some suggestions that Dr. Gondi makes in this podcast interview that follows to help us get a little less misaligned. Here's one mandate and three suggested models for current hospital boards, which (let's get real) are currently comprised a lot of times of a group of people making decisions in closed boardrooms that impact a whole lot of people. First of all, there should be transparency about who is on the board and what they are doing in those closed rooms—what decisions they are making. Second of all, the IRS could surely mandate that for anybody looking to get tax-exempt status, certain requirements are in order for the boards of said organizations. Then here's three suggested models to consider: 1. At other kinds of charities and even healthcare organizations with clear missions, like Federally Qualified Health Centers (FQHCs), the composition of the boards is mandated; and for FQHCs, 50% of the board has to be patients who are patients at the FQHC, for example. And, yeah with this. Hospitals are tax-exempt entities. That means that others in the community are paying more in taxes so that this hospital isn't paying taxes. This hospital, therefore, is in debt to the community. Having a board that is reflective of the community could be one way to ensure that this hospital has an accountability to that community and can serve its needs adequately. 2. NASDAQ requires that two members of every board have some “under-represented” diversity, so that could be a thing. You could add to that professional background diversity. I was looking at a Web site the other day featuring a team photo with the caption something like “Here's our diverse team,” and the entire photo was of, I'm going to say, literally 30+ white men. The caption clarified that they all had different experiences … in the pharmacy benefit administration space. So, nothing against white men, but … yeah, it might be a good idea to align as a community on a broad definition of diversity and what “reflective of the community” means. 3. Accountable capitalism. This was originally suggested by Senator Elizabeth Warren, who argued that 40% of boards should be elected by workers. So, not the majority of the board but enough of the board that it becomes accountable to frontline workers and others.   You can learn more by connecting with Dr. Gondi on Twitter and LinkedIn.     Suhas Gondi, MD, MBA, is a resident physician in internal medicine and primary care at Brigham and Women's Hospital. As an EMT in his hometown in Virginia, he saw how structural barriers impact access to healthcare for vulnerable patients. He dedicated himself to studying medicine and policy together with the goal of building a healthcare system that delivers better outcomes and prioritizes equity. His academic work focuses on incentives in our healthcare system and how they shape the behavior of providers and payers. His work on healthcare payment and delivery system reform has been published in the New England Journal of Medicine, JAMA, and The Lancet and has been cited by the Medicare Payment Advisory Commission. His advocacy and writing have been featured by CNN, NPR, New Yorker, and USA Today. He graduated from Harvard Medical School and Harvard Business School and previously served on the White House Health Equity Leaders Roundtable.   05:26 What's a hospital board, and how much power do they have over goings-on? 06:51 How big is a hospital board typically? 07:45 How powerful is a hospital board actually? 09:12 What percentage of these board members have roles within the finance industry? 10:04 What percentage of these hospital board members are health professionals? 10:47 How do these hospital boards work? 12:44 Have hospital boards always been made up of financial board members, or is this a recent thing? 18:12 “The private equity model … fundamentally changes the incentives of the organization.” 23:21 Are hospital boards a potential place to create change within the healthcare industry? 25:16 “It's about who has power.” 30:55 What's the hope with diversifying hospital boards?   You can learn more by connecting with Dr. Gondi on Twitter and LinkedIn.   @suhas_gondi discusses on our #healthcarepodcast who is on #hospitalboards. #healthcare #podcast Recent past interviews: Click a guest's name for their latest RHV episode! Dr Rachel Reid, Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293)

This is a conversation about physician compensation, which is often oddly misaligned from the way that the whole physician or provider organization is getting paid. Now, first thing to point out: There are lots of different kinds of physicians doing all kinds of different things. As with most everything in healthcare, lumping everybody together and making general proclamations about what is best is a really cruddy idea. With that disclaimer, if you think about the main models of physician compensation, there are two; and this is oversimplified, but let's call one fee for service (FFS), which is really getting paid for generating RVUs (relative value units)—in short, getting paid for volume. The more you do (especially the more expensive things you do), the more you get paid. And then we have getting some kind of capitation payment. A capitated payment is some kind of per member per month-ish flat payment to ideally keep patients healthy, and you will make the most money if you can figure out how to have the least volume of expensive stuff. As an individual doc getting a salary to care for a patient panel of a certain size, let's just consider commensurate with that. These incentive models obviously have a big impact on any given doctor's ability to get paid to do things that they think they should be doing. For example, the current fee-for-service RVU fee schedule frequently rewards those doing the stuff a lot of specialists do much more than those doing primarily cognitive work, including those doing work for patients who aren't sitting in the exam room at the time—like a PCP arranging for a patient to go to hospice or answering patient portal questions. In my opinion, the goal here should be to pay docs and others fairly for providing high-value care. These payments also should actually be proven to actually incent that high-value care. Here's the obvious problem: Neither of these two things, either the quantifiable definition of high-value care and/or the best way to pay for it, has any kind of canon. There are no rules which are considered to be particularly authoritative and definitive here, really. So, what is the downside of not aligning physician compensation models to what good looks like, meaning to the kind of care that patients really need in that particular community? A couple of downsides for you: One is moral injury. Not the only reason, but a reason for moral injury is getting paid in misalignment with what is best for patients. That sucks. You want to help your patients as best you can, and then you can't earn a living and/or you get in trouble with the boss if you do what you think is right. This can cause real mental anguish for especially PCPs but also others who see the need to do anything that doesn't have a billing code. Here's another downside to not worrying about physician compensation, and it's for plan sponsors (employers, maybe) who are trying to get integrated care or a medical home for their employees. I was talking to Katy Talento about this. She was telling me that in ASO (administrative services only) contracts, there are often line items for value-based care and for capitated payments. So, good news? Well, let's follow the dollar here, because we wind up with a disconnect that doesn't help patients but certainly can earn a nice little kitty for those who can get away with it. Here's where that dollar goes: This VBC (value-based care) or capitated payment kitty may go to a health system that the ASO says is to be a medical home for employees or plan members. But the PCPs mainly who are treating members in those medical homes are getting paid, it often turns out, fee for service with maybe some quality kickers. So, the plan is paying a value-based care payment, but the PCPs are getting paid FFS. Is anyone shocked when the members report that they don't actually feel like they are getting integrated care, that they are getting rushed in and out because maximizing throughput becomes a thing when you're getting paid for volume? Dan O'Neill also talks about this at length in episode 359, because IPAs (independent physician associations) are doing kinda the same thing. Getting so-called value-based care contracts with MA (Medicare Advantage) plans or CMS or employer groups, I'd imagine, and then paying all the individual practices or the solo practitioners fee for service and scooping up the excess payments themselves, most docs manage to provide high-enough-quality care that the contract holder can scoop up the profit off the capitation without actually having to share the capitation to achieve this high-enough-quality care. In this healthcare podcast, I am digging into all of this physician compensation ballyhoo with Rachel Reid, MD, MS. She was an author on a study at the Center of Excellence on Health System Performance at RAND. This study specifically set out to look at how health systems and provider organizations (POs) affiliated with those health systems incentivize and compensate the physicians who work there. Short version: Yeah, it's confirmed. Most docs are paid using the classic RVU productivity measures representing a big chunk of their compensation, even PCPs. There's frequently some kickers or extra payments to achieve some kind of quality metric, but this is the icing, not the cake. The cake is still very fee for service-y. This is true regardless of how the physician organizations, the provider organizations themselves are getting paid by payers. I asked Dr. Rachel Reid a bunch of questions about this, but one of them was (this seems weird, a weird misalignment), Why is this happening? And Dr. Reid listed out five reasons beyond the macro existential question of what is value and do we even know how to change human behavior to get it. 1. The payment is not big enough from the payer for the physician organization to go through all the time and trouble and risk frankly of changing the whole comp model. 2. The value-based payment arrangements that do exist at the organizational level often have a fee-for-service chassis with an icing of quality payments or some kind of value payment on top of it. So, maybe there's actually more alignment than we might think. 3. It's hard to try to change comp models—it's a thing. And there is risk in messing it up. 4. Inertia. The ever-present inertia. 5. We know what we want to move from, but what exactly are we moving to? And this “What do we want to move to?” is going to change for PCPs and for every single different specialty and could even vary by patient population. I then also asked Dr. Reid what could be done by plan sponsors, for example, to pay docs in alignment with the goals of the contract; and she said, write physician comp expectations into the contract. Something to think about. We dig into all of this today. Shows that you should, for sure, listen to for additional insights include the one with Dan O'Neill (EP359) as aforementioned. Also the show with Brian Klepper, PhD (AEE16), where we dig into how the RUC is behind some of these FFS rates. Also episode 391 with Scott Conard, MD. My guest today is Rachel Reid, MD, MS. She is a physician policy researcher at RAND Corporation and a primary care physician at Brigham and Women's Hospital.   You can learn more about Dr. Reid, her publications, and the work she has done on the RAND Web site.     Rachel Reid, MD, MS, is a physician policy researcher at the RAND Corporation. Also a practicing primary care physician, her research focuses on measuring cost, quality, and value in healthcare. She has particular interest in the primary care delivery system, physician payment and compensation, and delivery and payment system reform. Dr. Reid has been engaged in the RAND Center of Excellence on Health System Performance, assessing health systems' compensation and incentives for physicians, leading work related to assessing low-value healthcare delivery, and measuring primary care spending. She is the principal investigator on an NIH-funded grant assessing novel Medicare billing codes for transitional care provided after hospital discharge. Prior to joining RAND, Dr. Reid worked in the Research and Rapid Cycle Evaluation Group at the Centers for Medicare & Medicaid Services' Innovation Center. Her clinical work has included ambulatory primary care and hospital-based internal medicine. She is an associate physician at Brigham and Women's Hospital and an instructor in medicine at Harvard Medical School. Dr. Reid received her AB in biochemical sciences from Harvard University and her MD and MS in clinical research from the University of Pittsburgh School of Medicine.   07:13 What did Dr. Reid's recent study show about how doctors are currently being paid and incentivized? 08:11 Why Dr. Reid decided to do the study in the first place. 09:49 What are the main foundations of what doctors are paid on? 10:31 Why is value-based compensation still just the “icing” on the cake? 13:08 What is the biggest value add for doctors, and does it vary between specialties? 14:32 Why wouldn't a physician organization change their comp models? 19:55 Are we at a moment of evolution? 20:20 “Tying dollars to measured quality gaps doesn't necessarily produce results.” 20:42 EP295 with Rebecca Etz, PhD. 22:04 “I don't think there's a current gold standard for how to pay doctors.” 25:37 Job one: What are we trying to incent? 31:28 From the payer or insurer perspective, what's the leverage they have to change doctor compensation?   You can learn more about Dr. Reid, her publications, and the work she has done on the RAND Web site.   Rachel Reid, MD, MS, of @RANDCorporation discusses on our #healthcarepodcast how doctors get paid. #healthcare #podcast   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Amy Scanlan, Peter J. Neumann, Stacey Richter (EP400), Dawn Cornelis (Encore! EP285), Stacey Richter (EP399), Dr Jacob Asher, Paul Holmes, Anna Hyde, Dea Belazi (Encore! EP293), Brennan Bilberry

Disclosure: We are part of the Amazon Affiliate/LTK Creator programs. We will receive a small commission at no cost if you purchase a book. This post may contain links to purchase books & you can read our affiliate disclosure here. In this episode, I chatted with author Brianna about her journey from journalism to writing psychological thrillers and historical fiction. This spring, Brianna will have two books out: The Librarian of Burned Books* (Historical Fiction) and See It End* (Psychological Thriller, Book 3 in the Dr. Gretchen White series) We discussed the importance of research in both genres and how her background in journalism has helped her transition into fiction writing. We also touched on the timely topic of book banning and censorship, drawing parallels between the 1930s and today, and the power of controlling information. We then dived into discussing our favorite books in the Game Changers series by Rachel Reid*, a male/male hockey romance collection with comforting aspects and deeper issues such as anxiety, mental health, and redemption. We also recommended other books, including The Golden Spoon by Jessa Maxwell(, The House of Eve by Sadeqa Johnson*, and The Lost English Girl by Julia Kelly*. Be sure to support your local bookstores through Librofm and take advantage of our special promotion for new members in Canada and the US. Happy listening!*Affiliate LinksSHOWNOTES AND BOOK LINKShttp://WhattoReadNextBlog.comCheck out our YouTube Channel;https://www.whattoreadnextblog.com/youtubeMusic from Uppbeat (free for Creators!):https://uppbeat.io/t/hartzmann/sunnyLicense code: 0RDRBKGH6NGQCAXR

Ashley joins us today from Australia sharing her three birth stories and how she learned to truly trust herself. Driven out of the hospital due to discrimination and not being able to find support from home birth midwives, Ashley decided to go for a free birth. With a special scar, two previous Cesarean surgeries, a big baby, a high BMI, and a history of gestational diabetes, Ashley accepted all of the risks and was able to reap the beautiful benefits of undisturbed home delivery. Ashley shares with us her journey to acceptance when things didn't go the way she planned, but also how to persevere through to fight for the story she wanted. She now hosts The VBAC Homebirth Stories podcast and is a Homebirth/Freebirth Mindset Coach inspiring other women to have the courage to take back control of their birth stories!Additional LinksAshley's InstagramThe VBAC Homebirth Stories podcastHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode DetailsFull TranscriptMeagan: Hello, hello. Welcome to The VBAC Link. This is Meagan Heaton and we have Ashley here with you. Can I just tell you? She is amazing and you're going to want to listen to this episode 5 million times and then when you're done listening to it 5 million times, you're going to want to check out her Instagram and watch her videos 5 million more times because she is amazing and such a wealth of knowledge. We reached out and said, “Hey, we want to share your story on the podcast. We think it's going to be an amazing episode.” I don't think. I know it's going to be an amazing episode. Review of the WeekBefore we do that, I'm going to get a review per usual and remind you that if you would like to leave a review, we are on Google and Apple Podcasts. You can email us. Shoot us a message on Instagram. We love to add your reviews to the queue and read them on the podcast. This specific review is from Ana Neves and it says, “I've been preparing for my VBAC ever since my C-section, and listening to the stories in this podcast has not only taught and informed me all about the different options, but also inspired me. I know that when the time comes, I will be prepared and feel the power of the great and courageous people who shared their stories here.” Oh, I love that. “The great and courageous people.” Oh, I love that. I love that so much. Thank you so much for sharing your review and like I said, if you have a review to share and you want us to know how you feel about the podcast and all of these great and courageous people, please leave us a review. Ashley's StoriesMeagan: Okay, Ashley. I am so excited that you are here. It's been interesting from now in recording, we've had Australian people on the podcast a lot. It warms my heart and makes me so happy and makes me feel like I probably need to go to Australia now because one, I am obsessed with all of the knowledge you guys have on birth and I actually really like the way that birth is in Australia in a lot of ways. But I am just so honored to have you here with us. Ashley: Thank you. I am so excited to be here. That was such a beautiful, warm welcome so thank you very much for having me. Meagan: Yes, oh my gosh. I'm serious. I just love listening to you too. I just love your guys' accents. My Utah accent is pretty lame, but yeah. So let's turn the time over to you. I am so excited because I feel like I've heard little things, but I'm excited to just hear it right now with you. Go ahead. Ashley: Okay. So let's start from the first babe then. Basically, I went into that one expecting that I was going to have a vaginal birth because my mum had vaginal births, and all of the women before me did too. My mum had me in 7 hours. I was the first baby. My sister is two, so mum said, “If you have medication, you're weak. You've just got to suck it up.” So I had this, “If she could do it, I can do it.” I had this, “I'll have the epidural if I need it” sort of vibe. A lot of my friends had babies before me. They had children when they were 17-18. By the time I had mine, I was 28. I was newly married and I had watched all of my friends. They told me all of their birth stories and things. They had all had vaginal births. I thought that Cesarean birth was really for celebrities basically because when I was in high school, it was Posh Spice who was having this C-section and things like that. It was a trendy thing to do. It wasn't something that normal people did. It was an expensive thing that rich people did. Meagan: Like in Brazil. That's how it's viewed in Brazil. You are high-class if you have Cesareans. Ashley: Yeah. I mean, I went to the GP before I got pregnant and checked on my levels to make sure. I have always had a high BMI, so the doctor said to me, “The only thing I recommend is that you lose some weight because you might struggle to conceive,” so I went in knowing that there may be a hardship there. Some of the women in my workplace at the time had multiple miscarriages. My mother-in-law had 7 before my husband, so I went in with that kind of, “We'll see what happens, but it could take a while.” So I conceived within the first month of trying so that was a shock, but also so exciting. Super exciting. It was a month before my wedding, so I got sick just after my wedding for my honeymoon and all of the fun games and after that, I was just like a sloth dying because I got HG. I got HG and it was just 20 weeks of basically a challenge. Meagan: Yeah, miserable. Ashley: It was hard. I was so excited to be a mom. I couldn't wait from the time I conceived to birth the baby and have the baby in my arms. That's all I wanted. I went to the hospital and there was a bit of a mix-up between when I went to the GP and had the GTT, the test for gestational diabetes. The doctor told me that I didn't have it. I went to a hospital because that's what they do. You go to a GP and they just send you to the local public hospital and that's the one that you are allowed to go to, but they didn't really discuss any of the other avenues like private, or midwives, or homebirths or anything like that. So I went excitedly to my first appointment. I waited for over an hour and I saw some random gyno-obstetrician and they said to me, “You've got gestational diabetes so you'll be seeing us.” I was like, “No I don't. I don't have gestational diabetes.” “Yes you do,” she said and I burst out crying. It was this big thing. Basically, the difference was if I had birthed or if I had gone to the hospital in Brisbane which is the next suburb over, I wouldn't have had gestational diabetes but in the hospital that I went to, they were up with the times with the lower numbers because that was cycling at the moment. It was 2014. I had gestational diabetes and that meant that I had so many more appointments. It meant that I was only with obstetricians. It meant that I had to go to nutrition or a dietician. It was just so many appointments. It was out of control. From a very early stage, I was told, “You're going to be induced and you're going to be on insulin.” As soon as I was diagnosed, I was told, “You're going to be on medication.” Meagan: No talking about it. Ashley: “Yeah, let's see how this unravels and we're not going to start you on the pill, we're just going to go straight to insulin for you,” so it was kind of like they had already decided my fate. I was really excited to have an induction. It meant that I got a date for my baby and I was going to have my baby early. When I spoke to the other ladies in the GD who were getting induced, the lady said to me, “It's all good. I was induced and I had my baby in 5 hours.” I was like, “Awesome. Awesome.” I don't know what number baby that was for her because when it comes to induction, I know now that it really matters whether it's your second or if you've had a vaginal birth before, then an induction probably isn't going to land you with a C-section. I ended up getting my date, coming into hospital, and having no discussion. I kept asking, “Can we have a birth discussion?” It was always, “Next week. Next week. Next week.” There was no discussion about what happens at birth or really what to expect or any niceties or anything. It always felt quite cold. It was like the people didn't even want to be there, the junior obstetricians, it was like they were doing their time so to speak. It just wasn't a pleasant experience. I was expecting my first baby and I just felt like another number. Meagan: Yeah. It wasn't warm and fuzzy at all. That's for sure. Ashley: No. I just felt like it didn't feel right. It just felt really not nice. Meagan: Yeah, impersonal. Ashley: Yeah, exactly. I basically went in for my induction and my husband came in with me. That was a couple of days of having gels and people putting their fingers up and continued monitoring and just very uncomfortable. I found after they had done all of that process that my cervix was right shut up. It wouldn't open up. They said, “Okay. We are going to try and put the balloon in there.” That was the most excruciating pain. Meagan: Especially when you're not dilated. Ashley: It was excruciating and I was in so much pain. The doctor and midwife made out that I was making a big fuss because I was responding that it was painful, so they gave me a lot of gas and I was pretty much tripping out. It was really trippy. Meagan: Like nitrous oxide?Ashley: Yeah. I just felt like if this is how painful it is to put this thing in, how painful is labor going to be? How am I going to handle that if I've just been through two days of this? I think that I had a cannula in my hand as well because I couldn't really go to the bathroom without assistance from my husband. It was really getting uncomfortable. I had something up inside me. Meagan: Or poking you or something all of the time. Ashley: Yeah, exactly. So another night in the hospital we slept and then they said, “If it doesn't open and it doesn't drop out by the morning, then we'll talk about it.” I wasn't allowed to eat. I had to fast. Meagan: That's going to serve your body well. Ashley: I know. It's really cool. It's like they give you so much amazing care in the hospital to set you up for this amazing birth, and I woke up and it was still in there and nothing had changed. I felt really defeated and I felt like my body was broken like there was something wrong with me. Nobody had ever discussed or told me that there is a high failure rate to this or that this procedure can fail or that you may not be a great candidate for this procedure. Meagan: Or more time. More time can make you a different candidate statistically and raise your BISHOP score. Ashley: Yeah, they obviously did the BISHOP score and they would have seen that I wasn't a good candidate for this. They would have known that when they did all of these things to me. Now I see that as my body is so amazing that you tried to do all of this stuff to my body and my body was like, “Hell no.” Meagan: Nope. I'm keeping this baby in. Ashley: Clam shut, yeah. The junior doctor came in and she said, “Look. We recommend that you come in tomorrow for more monitoring. Go home and come back on Monday and we'll start the process again.” I was like, “What do you mean you're going to start the process again? This was really torturous.” I said, “What's the difference between a day or two? My body's not going to respond any differently. Can I just come back in two weeks?” I'm 38 weeks at this point and I'm like, “I'm not even 40 weeks. Can I come back in 2 weeks when I'm in labor?” Meagan: And a first-time mom.Ashley: Yeah, because my mom had me and my sisters right on 40 weeks, so I'm just expecting the same. She said, “No. You can't.” I was like, “Oh, okay.” She said, “No, you can't do that.” I said, “Okay.” She said, “You know what? We're just about to have an obstetrician meeting, so I'll go in there and I'll ask the consultants what they think and I'll come back with a plan.” “Okay,” I said because she also did talk about my option of being a Cesarean on the Monday and I said to her, “Look. I'm going to be honest with you. There's no way in hell that you're going to get me to come in for elective surgery. It's just not going to happen. I never wanted to birth like that and I don't want to.” She came back and she said– they obviously spoke about what I had said and they made for me later a plan to push me in the way they thought that I was going to bend the most, so they said, “Look. We've bumped all of the surgeries for the day and we're going to book you in as priority because we feel like you should be having this baby now.” I was kind of like, “Okay.” So they were bumping all of these surgeries. There were people sitting out in the waiting room waiting to have their babies, but they were going to bump me to have my baby first. I had my sister in the room who was a surgery nurse who had been pushing me to have surgery the whole time because she was traumatized. I'd been fighting her the way through like, “No. I don't want to do that. I want to have a vaginal birth.” I was so exhausted and my husband only had 5 days off of work, so he had to return in a couple of days. I had my in-laws at my house babysitting my dog and I was promised a baby. I feel like at that point, I was just like, “Okay, well if that's what you think, then okay. I'll do it.” I signed this 3-page waiver form by the way, which I was really scared of. I was like–Meagan: What am I doing? What am I signing?Ashley: My sister is getting me prepared. She just finished a shift from working upstairs in nursing and she organized for herself to get in there, so it was going to be my husband and her. They never allowed a third person, but because she worked there and knew people, she was able to weasel in. She's getting me ready like a good nurse. She's so excited. She gets to be a part of it and I'm just recording a video of, “If I die, tell my baby I love my baby.” I am so petrified. I've got video and photos and I just look at the photo and it's like me trying to look excited, but actually, I'm like, “Holy crap. This is really scary and I don't want to do this.” Meagan: Why is everybody so excited and I'm terrified? And why is no one talking to me about this? Ashley: Because I'm giving up control. They're not getting the knife, but I am. It's really scary if you've never had surgery. It's not something that we do every day and it's not something that I had ever gone through before. So off I go into surgery and it's really good that my sister was there because she got to take a lot of photos and she got to be a part of it. Meagan: That would bring some comfort maybe. Ashley: Yeah, I felt like they would step up a bit as well because they knew that it was one of their own in there and I was one of their own. She took a lot of photos and things like that, but when they were doing the spinal, no one can be in the room. I just remember feeling so petrified and shaking and looking into this big man's eyes who was holding me and thinking, “You look like a nice man. Keep me safe.” This midwife came around and she was like, “You look like a deer in headlights” because it was like all of these lights shining down at me. I'm in this crazy room with surgery stuff. I'm really scared. I'm petrified, but I went through the whole process and the obstetrician and everyone, it was Christmastime. It was early Christmas. It was December 5th and they were all having their Christmas party that night, so they were all very happy talking about the Christmas party. “You're going to the Christmas party? I'm going to the Christmas party.” I thought, “Well, they're not fast. They're not stressed. They're very happy. They're starting their day. I'm the first one. They're excited about the Christmas party.” It didn't feel very personal. I definitely didn't feel included in the process. They were just talking among colleagues. Meagan: I can so relate. So relate. Ashley: It's horrible. Meagan: Yeah. They were talking about the snow outside and how depressing it was because the one just gotten back from Hawaii. He was like, “Oh, I came back to snow.” I was like, “I'm right here. Can we talk about my baby? Can we talk about me?” Ashley: Yeah, it's very impersonal. I mean, it's one thing at the dentist to be chatting it up. I don't mind it at the dentist if they're chatting or something, or the orthodontist or something, but yes. I thought, “At least they're calm.” The baby was born in no time and then announced, “It's a baby girl.” I just thought, “Oh, can I go to sleep now? I'm not really interested in this. I'm very time. I'm shaking. This is not a great experience.” I just turned around and said, “Can I go to sleep? I don't want to hold the baby.” It's uncomfortable anyways, but I can't really hold the baby. I'm shaking. I've never really had that many drugs in my system before and off to recovery we go basically. That's a new experience as well. Yeah, it wasn't a great postpartum experience in the hospital. It was quite a negative experience with the night midwives, so I was really excited to get out. I left a day early because I just did not want to have to put up with the night staff. My husband wasn't allowed to stay. Meagan: Oh, why? Ashley: So in our hospital in the public system, some of them have got 4 or 5 to a room, so I was in a 4 or 5 to a room. They don't allow husbands to stay. I couldn't get out of bed. Meagan: I didn't know that. That's like old school.Ashley: It is old school. A lot of them are getting upgraded now because obviously, it's better to have your own room and stuff, but that's where I was lumped. No one wants to birth there because no one wants to share a room, but if you're in the catchment, that's where you get stuck unless you go private. So he got booted out at 10:00 at night, and then I was left with this witch of a midwife who every time my baby cried, she was like, “Oh, look. You're just going to have to sleep with the baby on your belly because I can't be coming back here to get the baby all of the time.” I was like, “But it's not guidelines. I'm not allowed to sleep with my baby with my chest. I can't sleep and it's stressing me out.” In my head, I'm saying those things, but yeah. It was horrific. The next morning, my husband came and I was letting loose at him. I was like, “Why weren't you here? The baby and I haven't slept.” I was so stressed. I mean, think about it. Being awake for 3 days, having been in the hospital for a long time, and then having gone and had major surgery, you're left on your own with this baby with barely any support. No one telling you what to do, trying to breastfeed with your nipples getting ripped by the way. Meagan: Pretty much abandoning you. Pretty much. Ashley: Basically. So the second night, I stayed and sorted that out, then I went home the next day. I did have a bit of a thing with the midwife. She was on again, so I ran down to the bathing room and I hid from her because– okay. One thing you should know about me is that I am a highly sensitive person, so something that someone might say to someone may not affect them as much as it would affect me. Meagan: It triggers you. Ashley: It really upsets me and being in a vulnerable position, I need someone who's gentle, nurturing, and loving. So I ran away and I hid in the bathing room with my baby. I was trying to work out why she was crying. I had fed her. I swaddled her. I changed her. I was really trying to work it out. She could hear the baby screaming and obviously thought that I was not looking after my baby. I said, “Look, I'm just trying to figure out what's happening here.” She's like, “You just need to hold her.” I was like, “No, I just need to figure out what's happening because I've got to go home with this baby and work this out.” She's like, “Why don't I take the baby and I'll look after the baby so you can get some sleep?” I'm like, “No. That's not happening.” I was so against this woman. She was like, “Here's your medication. Take your medication. I've been looking for you,” and then she sent another colleague down to come and check on me and try to convince me to give the baby up. But what I discovered by sticking to my guns and doing what I felt was intuitively right for me was that my baby was pulling her arms out of the swaddle and that was waking her up. So I put her in a little zip-up and from then on, she slept through the night. My husband came the next morning right on the dot. I had a shower. Baby was sleeping. He's like, “Where's the baby?” I'm like, “She's sleeping,” feeling like a million dollars. “I've got this. I've got this and we're checking out today.”Meagan: Yep. Get me out of here. Ashley: I went home and we struggled with breastfeeding. I got some really bad advice from one of the nurses that came to my house so I felt like a double failure. By 6 months time, I was mixed feeding to just formula feeding and I felt like a real failure. I let her down. I hadn't birthed her the way– I didn't feel like I birthed with, “When I had my baby,” or “When my baby was born.” I didn't say “When I birthed,” because I didn't feel a part of the experience. It happened to me. It wasn't inclusive to me. I just felt completely excluded. So I knew when I was going to have my second, I was having a VBAC for sure because I knew there was a thing possible. I knew about VBACs and I said to my GP, “What's the timeframe between babies?” She said, “24 months between birth and birth.” That was the thing then or whatever. I said, “Fine. I'm having 24 months.” I literally started trying within 24 months, whatever it was, 15, or whatever. I fell pregnant the second time. I was having a VBAC and I think I joined the VBAC group in Australia. I started learning all of the stuff, becoming informed and advocating. I knew that this time I wasn't having an induction because that's what caused me a C-section. I knew that I wanted to try to avoid GDM because that's what I thought was the lead-up for the induction rush. I didn't realize that my weight was obviously pushing against me so much. I didn't understand the reasons why or some of the discrimination that happened in the hospital at that point. I did the early GTT test and I passed that. I was like, “Yes. Maybe this is going to be different.” I'm going to show them. I'm educated. I know what I want. I'm informed. I'm also a people pleaser so I'm trying to get them on board with me. I'm trying to get them to agree with my decision. I'm trying to get them to be a part of my team and cheer me on and get excited.I'm just kind of getting met with obstetricians who were like, “VBAC is great and it's the best way to birth your baby.” I'm like, “Yes. This is amazing.” Meagan: You're like, “Thank you. This is what I want to hear.” Ashley: “But not for you.” I'm like, “What? Not for me?” “Well, for you, we recommend a planned Cesarean.” “Okay.” They never really spoke in plain language or explained it to me. It was only through digging and digging and digging and asking and asking and asking that I was finally able to get some answers. I essentially ended up getting gestational diabetes at 20 weeks, so then I wasn't allowed to see midwives because I had asked to see midwives and they said, “If you get GD, we won't release you.”Meagan: It disqualified you. Ashley: It disqualified me from seeing midwives. I said, “Look, you're a surgeon. Can I just see you if I need surgery?” The thing with GD is that there is a GD counselor and somebody that you report to outside of them, so why do I need to see you because you're not a GD expert or specialist? I actually see somebody. Why is a midwife not capable of looking after me? It doesn't make any sense. They're just trying to pull in all of the patients to keep their bellies full and make sure they've got jobs. I was gutted. I was absolutely gutted. I only failed by .1 on one of the tests and I wish I had known back then that I could have redone it and I probably would have passed it. It was really disappointing and I was like, “Oh, goodness me.” So I was diet-controlled through that time. I say diet-controlled because that's the readings that I gave them. I wasn't really diet-controlled but I was being a bit of a rebel because I was getting the same numbers as I was with my first baby and I was on insulin with her and insulin didn't do much. I thought, “Well, what's the difference going to be if they're the same numbers? She came out healthy and had no sugar problems or anything.” I kind of started to think, “Is this GD thing a bit overrated? If I was in a different hospital or a different country—”Meagan: I was going to say if you went somewhere else like last time, would it have been different or would it actually have been GD as well? Ashley: If I had gone somewhere different and I knew this because I was part of the GD community and I had friends that were birthing in Brisbane who were even having to keep below higher numbers than me. They had much higher numbers than me, so I thought, “You're with a private obstetrician and you're getting different information than me,” so I started to clue on that. And then also, when I was doing my readings on my fingers, I would get a different reading on this one to this one, so I started questioning, “If this one's .5 difference to this one, how accurate is this measuring?”Meagan: Yeah, interesting. Very interesting. Ashley: So it was very scary for me to do that because nobody's doing that and every time you're going there, they're like, “Dead baby. There was a woman who had gestational diabetes and her baby died.” And I was like–Meagan: You hear these and you're like, “What?” Ashley: I was like, “How did she die? How did the baby die?” They said, “Oh, we can't disclose that information. You're telling a room full of women with gestational diabetes that a baby died and the mum had gestational diabetes. She could have been hit by a car for all we know and you're using it to fearmonger us, but you're not willing to tell us how the baby died. It could have been negligence on the hospital's part. It may not have been GD related at all.” Meagan: Yeah, she just had it. Ashley: She just had it, so I found that quite disgusting and all of those things started to really add up. The more that I saw in the VBAC community, the more that I saw this was happening around Australia, the more I was determined to advocate and fight which is really hard for a highly sensitive person, but I got a student-midwife. I got the head midwife to come to my appointments. I had a student-doula who was a dear friend of mine and I started to grow a team around me. I refused to see one of the doctors at one point and wanted to speak to the best, most amazing doctor in the hospital, so the midwives set me up with the nicest obstetrician who still didn't support me to have a vaginal birth, but he was nicer to deal with. I mean, I had some crazy conversations with some of the obstetricians during that time. One of them was a junior and she said to me because I didn't want to have continuous monitoring. I just wanted to have the doppler. She said, “You know what my boss says? He says that if you don't have continuous monitoring, then you're basically free birthing in the hospital.” I looked at her and I was like, “You're crazy.” At this point, free birth to me was crazy and she was telling me that because I'm in a hospital and if I'm not doing that, then I'm free birthing. And I thought, “But I'm getting checked with a doppler by a midwife. I'm with obstetricians.” That is absolutely insane, but it goes to show the kind of mentality and the thought process that goes through the fact that they don't know how to be with women. They don't know how to observe and watch a woman. Now, my mindset is the complete opposite way. I see things in a different light than how they would see. They rely on machines whereas they don't rely on that connection. I'm the type of person that relies on human-to-human connection and I've listened to people and I love stories. That's how we learn. We don't learn about humans by watching machines. I started to learn about the inaccuracies of their machines and some of the equipment that they were using. It made no sense to me to have continuous monitoring when I knew that one obstetrician would send me to surgery for the reading whereas another one with maybe more experience who may be older and more chilled would be like, “Yeah, that's nothing.” If the results are at that rate, then that's not beneficial to me because then I'm putting my fate on whether I get a choppy-choppy obstetrician or a chilled, relaxed one on the day. So that was kind of my thinking. I didn't do growth scans this time. I didn't see the point in me having a growth scan to tell me that I was having a big baby. My first was 3.7 at 39 weeks. I knew this one was going to be 4 kilos and I said, “Look, I'm happy to birth a 4.5-kilo baby out of my vagina,” which is almost 10 pounds for your listeners and they just wanted to do Cesareans on 4-kilo babies as well as inductions. It was always about induction and I found out the reason why they wanted to do induction. They wanted to manage me. They weren't a tertiary hospital, one of the bigger ones, and so I found out that the junior obstetricians wouldn't be comfortable doing or maybe confident or capable of doing an emergency Cesarean on someone of my size, so I said, “That's fine. Just send me to that hospital or that hospital. Let's just do this. If it's a staffing issue, I don't want to stretch it out.” They just laughed at me. It can't be a big deal then, can it? If they're not willing to send me to a different hospital. We had so many conversations and it was anxiety-inducing. I would cry on the way to the hospital. I would cry on the way home. I'd have to get my fight on and I even had a conversation with an obstetrician that said to me, “We'll fight about that later.” I said, “That's exactly right though isn't it? It's a fight, the fight.” Meagan: Yeah, we'll fight about that later. That right there. Ashley: He goes, “Oh, I didn't mean fight. I don't mean fight.” I go, “Yeah, but no. You do.” Meagan: But you just said that. Ashley: But you do. Meagan: You're like, “Yeah, I can tell that you're not agreeing with me and you're telling me that if I want something else, I'm going to have to fight with you.” Ashley: And so I'm hearing about this informed consent and I'm like, “Informed consent.” I'm fixated on what would get them to be on my side. I've learned about informed consent. They legally have to support me, right? But that is just the fast in my opinion, in my experience, they wouldn't know what informed consent or working with a woman, it just blows my mind. I didn't realize that at the time, but there were a lot of conversations that were happening about my weight. “You're not going to be able to. It's harder for bigger women like you.” I would leave conversations thinking, “I'm not going to be able to birth my baby out of my vagina because I'm big.” Meagan: They were shaming you. Ashley: Yeah, basically I was told by an obstetrician that, “She's not a fatist, but—.” I was like, “I've never heard someone say ‘I'm not a fatist.'” I don't even know what that means. I had some really interesting conversations because I was asking questions and I was asking questions because I was asking so many questions. Every time I went to an appointment, the obstetrician would say to me, “Ah, I see you're having a repeat Cesarean,” and that would spike adrenaline. Read my book. Read my book. You would know that I'm having a VBAC and then, “Oh, well do you know the risks of VBAC?” Yes, I do. “Oh, you really do know the risks, but we still recommend that you have a repeat Cesarean,” and I would have to go through that every single time. Meagan: So discouraging. Ashley: It was a nightmare. By 36-37 weeks, I had received a phone call and they said, I could feel the smugness and a smile through the phone, “Oh, we're not willing to take the risk. You're going to have to go to a different hospital.” I was just horrified. I was so scared. I've just been kicked out of hospital because nothing has changed with me.”Meagan: But because I won't do what they want me to do and I'm being stern in following my heart. Ashley: Yeah, because I won't submit. I've told you from day one what I'm going to do, but I suppose the rate of success with that tactic is probably 99%, I'm probably the 1% of women who actually says, “No. I actually will not fall for your trickery.”Meagan: Yeah, okay fine. I'll leave. Ashley: I was so determined, so then I went to a different hospital and it was a newer hospital. They had birthing pools. I was hopeful that I might get in a birthing pool. You get your own room in the postpartum. I was excited. They had informed consent signs. The receptionists weren't fighting each other. This first one that I went to was pretty rough down there. They were lovely and polite. I thought, “Oh, this feels nice. Maybe I'm going to have a different response,” and I did. I saw an amazing midwife on entry. She was like, “If they're not going to allow you to do this, you advocate and you can make a complaint. That's disgusting how you were treated.” I thought, “Oh, wow. This is the best thing.” I saw an obstetrician. They were supportive. They wanted to do some of the same things, but they respected me. I felt like I was seen as a human. They would ask me questions and they would go and ask a consultant and the consultant would agree with me. I was like, “Wow, I am ticking boxes here.” I made some compromises because I was vulnerable. I did a growth scan and they found out that baby was about 4 kilos. Meagan: Like you already guessed. Ashley: I knew that at 39 weeks. I said, “That's fine.” “Oh, we recommend induction.” I said, “Yeah, I know you do. I'm not doing it.” That's what caused me the C-section last time. I'm not doing it. We went through the study at 39 weeks. I said, “That doesn't apply to me. It doesn't apply to me. I'm not in that study. It doesn't mean anything to me.” I don't know how you can have a study saying that it's going to work better on someone at 39-41 because you're not doing the same people. You're not doing induction on someone at 39 weeks and then going, “Hey, let's try it again at 41 or whatever it is.” You're doing different people. I don't want to know about it. I don't care about it. They said, “Okay, well I'll talk to the consultant. We'll look at the scan,” and then she came back and said, “Yep, you're fine. There's no fat on the shoulders, so yep. That's fine.” But if I hadn't said that, I would have been booked in for an induction, right? I would have just said, “Let's go, yep.” I sat there on the weekend with my husband shaking like a leaf again having to advocate for myself. It isn't an easy thing to do. Every time I have to raise my voice, I'm putting adrenaline into my body. I'm not raising like screaming, but I'm having to raise my voice. My baby would have been under attack the whole pregnancy essentially. I eventually get to the due date. A week before my due date– it was a couple of days before my due date– my midwife turns to me at the last appointment. She was training in the hospital last time, so I was really grateful that she was willing to come with me and support me even though she wasn't going to get her book signed off for this birth. And on that appointment, she said to me, “Look, my daughter's booked a holiday for me, so I'm going away on your due date. Are you going to have this baby soon now?” I was like, “Oh my goodness. You've just fought with me the whole time and now you've turned into them trying to get me to have my baby before my due date because it suits you.” Yes. I was heartbroken and I was so angry. I decided then and there I was not going to invite her into my birth space even if it was sooner because she had betrayed me on every level. I went into that appointment and the obstetrician didn't recommend it, she said, “Do you want to do a cervical stretch?” A sweep and I said, “No, I don't.” I turned to the midwife and said, “What do you think?” She was like, “Yeah, why not?” Of course, she said that because it gets the baby out quicker. So again, you've got to be careful about who you're with because if you're relying on people who've got a different agenda, you've got to take their advice or their opinion with a grain of salt. But I was a little bit interested myself. I'd never had a stretch or a sweep like that before. I was a bit interested. I was worried that I was going to go over due dates and I was willing to wait for 40+10 and I was getting a bit stressed like, “Oh, what if it goes longer?” You start to freak out at that point. There's a bit of pressure and with what I'd been through, I had the stretch and sweep. She said, “You're 3 centimeters and you're stretchy.” I was like, “Wow. Wow. Last time, they couldn't even– I was closed up.” Meagan: Get a Foley in. Ashley: Yeah. So I was so excited. I started to get some niggles and lose some mucus and a bit of blood and things like that. Two days later, I went into labor. She said to me, “If it does nothing in the next couple of days, then the baby wasn't ready to come. If it happens, then the baby was always going to come,” sort of thing. Now, obviously, what's the point in doing them if the baby is going to come and it does nothing but disturb? I mean, my complete mindset changed and flipped. But yeah, I went into straight labor. I was so excited and so proud of myself. I'm in labor this time. I never knew if my body was broken after all of the fearmongering and talk. I was just so proud of myself. It was exciting. I had adrenaline pumping through me. I was shaking with fear and excitement. I was going to wait the whole day to go in. I was going to essentially go to hospital when my baby's head was coming out. As soon as I went into labor, I was like, “Yeah. I think I should go to the hospital.” I was adamant the whole time I wasn't going in until I was ready to push and as soon as I was in labor, I was like, “Yep. Okay, it's time.” Meagan: Let's go. It's exciting. You're like, “Okay, let's go have this baby.” Ashley: Yeah, and it was fast and hard. When I go into labor, it's not any prelabor, it's just that this is on. I dilate pretty quickly. When I got to the hospital, I was 5 centimeters. They were really surprised at how I was doing because I was quite calm and quiet. They were like, “Oh.” I got eventually into the birthing suite. My doula came and set up the room really pretty. I went into the shower and had a midwife assigned to us. She just sat down and read my birth plan and was happy with everything. She wouldn't let me in the birthing pool of course because I was over 100 kilos even though they've got a hoist for bigger people if they need to. They're just not comfortable with bigger people in the birthing pool. I just did my thing and I said, “I don't any doctors to come in. I don't want anyone annoying me or harassing me.” And I just labored for a few hours until I felt like there were some waters or something I could smell and feel. The midwife said, “Do you want me to check you?” I said, “Yeah. Yeah, we'll see if the waters have gone.” She said, “Yeah, the waters have gone and yeah, this is a little fore bag so would you like me to break that?” I said, “Well, if you think so, okay.” At this point, my education had gone to the point of getting past the induction. If I had gotten into spontaneous labor and I saw a midwife because everything was raving about midwives, I'm going to be fine. This baby's going to come out of my vagina okay. I didn't know anything about birth really. I just knew what not to do. I'm probably not going to have an epidural, but I'm open to it. You shouldn't break the waters, but I don't really understand why. But I wasn't having my waters broken. I was just having a little bit of my waters broken. And then came the tsunami and it was my entire waters. It was all over the bed and it was all warm. I was like, “What is happening?” She had either–Meagan: So your bag never really did break until then. Ashley: No, yeah. Yeah. Yes. And there's some other information. She's like, “Oh, we'll put the screw on the baby's head.Meagan: The FSC, fetal scalp electrode? Ashley: We call it the clip. Meagan: A clip. Ashley: Yeah, some call it the screw. I call it the screw. It's a little clip and it barely hurts. That was one of my compromises from not having continuous monitoring. I said, “If I have that, then I can be mobile.” That was the compromise and negotiation. Then, I found myself locked to a machine by the way because it wasn't mobile at this point. Then as soon as I got off the bed, there was a decel, so I was back on the bed. I was in excruciating pain at this point. I come out of my nest in the shower where I was able to breathe through everything and I was standing upright. Now there was a bit of fear happening because there was a decel that she didn't recover from quickly enough, so then the obstetricians and everyone had to come in. They were kind of like, “Oh, C-section,” talking about it already. I said, “No. I don't want to talk about it. The baby's fine. Just let me do my thing.” “Okay, okay,” and then they hounded me to get a catheter in my arm even though I didn't want one. I said, “No, I don't want one.” It's really painful and I don't want it. She said, “Oh, come on. We'll just get one in.” I said, “Okay, fine. Just do it then. Just leave me alone.” So she put it in and I'm walking around with this thing coming out of my vagina, this thing in my hand and I'm out of the zone and really finding it hard to get back into how I was feeling. Meagan: Your space. Ashley: Yeah, my space. I must have been in there for an hour or two, maybe a bit longer. By this point, they've told me that I'm 10 centimeters on one side, 8 centimeters on the other and there were a couple more decels and maybe one more and they were saying things to me that I don't understand. They were like, “You've got an anterior lip. It's swollen. You're 10 centimeters on this side and 8 centimeters on that side. Your baby's asynclitic. Your baby's up high.” They're looking at me and I'm like, “I don't know.” Meagan: You don't know what any of that means. Ashley: I'm 10 centimeters. The baby is going to come out right any minute. I'm just like, “Is the baby's going to come out soon?” I was starting to feel some pushy pains as well, so my body was pushing a little bit too and then I think I went back into the shower and I called in my husband because he was a weak link and I knew he would do what I said. I was like, “I want an epidural.” And the epidural was there within 10 minutes. I knew that would happen. They wanted me to have an epidural on arrival because of my said. I went to the anesthesiologist appointment and they looked at my back and said, “No, you've got a fine back.” What they're worried about with bigger people is that there can be fat over the spine. I said, “Okay, well I've got a fine back,” which I thought would be fine because I never had any problems with the C-section. They said, “But we still recommend an epidural on arrival.” I was like, “Okay. Well, at least I understand why.” The thing is that I'm trying to get information from them so I can make informed choices, so if it's in my best interest, then I will say yes and I will do it. But if it's in the best interest of you to make your life easier, then I'm not going to do it. I'm not going to put myself or my baby at risk to make your life easier. I understood that an emergency C-section was a higher risk than a planned C-section. I understood that induction was a higher risk. I knew all of the before things and the choices. What I got stuck with is I didn't understand physiological birth. I hadn't done any research on that. So they were talking to me gobbledygook, all of these things were happening. I just never thought that this could happen. I never ever thought this would happen to me. My mom had me in 7 hours. What is happening? What are these things that are happening? Now I'm on the bed. I'm stuck on the bed because I've chosen to have an epidural and now I've negotiated because we have had a couple of decels. I've negotiated for myself what I think is a pretty sweet deal which I realize is actually a really bad deal of vaginal examinations every hour. The normal standard practice is about every 4 hours and I'm like, “Okay. How about if we just check every hour and see if there is any progress?” They're like, “Yeah, that sounds great.” Every hour, they come into me and they're saying, “No change. Baby's up high. No change. We recommend C-section. These are the risks if you wait.” They were talking to me about the risks that would happen in a Cesarean, not about the risks that would happen in a vaginal birth if I wait. So it was very biased. I was like, “Okay, so what happens if I wait to have a vaginal birth?” They were like, “Well, we just recommend a Cesarean.” I feel like I'm in a room stuck with the enemy. I said to my doula, “I don't trust them. I feel like they know what they're talking about, but I don't know any different either.” My doula was a student doula and it's not like I came in there with a midwife who is on my team. I'm looking at the midwife and I'm like, “Are you going to help me?” I'm realizing that she's team obstetrician. I mean, I've never met her before. She was just working there. I'm thinking, “This is not what was sold to me in the VBAC group if I see a midwife. Midwives are amazing, blah blah blah blah.” What I actually missed was that independent midwives that are not working in hospital have more free reign are the midwives that everyone's raving about. I'm thinking it's just random midwives, any midwives are awesome. And not every midwife's awesome because you've got different personalities. You've got different experiences. You've got different passions and every person is different just like you can find an amazing obstetrician. You can find an amazing personal trainer, but they're not going to suit everybody or everyone's needs. And they have a bias against different people based on color, based on gender, based on size, based on the way that you look. If they can identify with you, they are going to be more attached to the story and fight and advocate a bit more. If they're not really into you, they're going to be like, “Oh well. I'm not going to lose my job over this,” sort of thing. I've learned all of these things since. Eventually, after about 6 hours, I had another decel. I think I had about 3 in total. It wasn't a huge amount. Meagan: Yeah, and how low were they? Do you remember? Ashley: I don't remember. The problem was that she wasn't coming back as quickly as they would have liked. Meagan: Prolonged. Ashley: Yeah, it was prolonged. I also didn't know at the time that the epidural also slowed down my contractions too. I only know this from getting the hospital notes which is quite common with epidurals as well. Eventually, I just said, “Okay, fine. I'm fine. I'll go.” After the last one, it felt like my baby was at risk. If someone is coming to you every hour saying, “This is the risk. We recommend that,” eventually, you just give up. I think I had been in labor for a total of 12 hours at that point. The first labor I had ever had and off I went. As I was going out, the midwife said to me, “It's okay. I had a home birth planned, but I ended up in a Cesarean. You'll be okay.” I was like, “See? You never would have been on my team because you hadn't even had a vaginal birth yourself.” I looked at her and I was like, “That was the worst thing you could have ever said to me at that point.” I was like, “Just because you had one and you're okay with it doesn't mean that I'm okay with it.” It was the worst thing. She obviously thought it was really supportive, but I felt so betrayed. So off I went and I had my surgery. Everything started to go downhill. My husband got rushed out of the surgery with my baby and you could just feel that it was intense. I said to my husband, “I love you. Look after the baby. I think I'm either going to lose my uterus or I'm going to die.” Meagan: Were you hemorrhaging? Ashley: Basically, the story that they tell me, I'm not sure if I believe it, but even if it is true, it is what it is at the end of the day. One of the risks that they were worried about is when a baby descends too much, there's a– you know this yourself– there's always a risk of a special scar happening because there's more risk of a tear or them having to cut more. So that's what they were informing me about the whole time. They knew about the risk and they were trying to stop– Meagan: But they kept saying that baby was high, right? Ashley: They told me that baby was high. They said that when the baby came out, she flung her arm up and ripped it down to my cervix. Meagan: Oh, okay. Ashley: Now, how does that happen when a baby is up high? If she's up high, how is she ripping down to my cervix? Now I think about that. How does that happen? Because my cervix was fully dilated. Meagan: Yeah, except on that one side. Did it ever finish? That swelling, that edema, did it go down? Ashley: Not that I know of. What they told me was nothing had changed positioning in that. Then when I looked at the notes when I got the notes, he laid out, “I saw that the positioning had changed.” She had come down a station, but they never communicated that to me. I have a feeling that she was probably down a bit further than they had put because, on the paperwork, they also said I was only 7 centimeters. There was no mention of an anterior lip, so they fudged the papers a little bit and weren't honest. I mean, if you're going to make a few little changes, then obviously, there's a reason for that. It obviously looks better on paper. Meagan: That's what happens all of the time. The patient will hear one thing, then on the op reports, it's a little different. So we always encourage you to get your op reports. It's sometimes hard to read but get your op reports. Ashley: It is hard to read. You know, they put it on the board too here in Australia what you are and at what time, so the information is there for me to look at the whole time while I'm in labor, so it's not that one person just said it, it's literally on the board for you to see. I was quite upset when I saw some of the notes. I went through the notes. I've been through them multiple times now and I was just trying to learn. I was Googling, “What does this mean and what does that mean?” because I don't know the medical jargon. I'm learning all of the things and I'm looking at Spinning Babies. I'm looking at everything and trying to learn after the fact, but essentially what had happened was apparently, she had flung around there, tore my uterus down to the cervix and then they needed to call in a specialized team to come in and resolve that problem that they had created. The surgery went on for a number of hours and it was a very challenging surgery. I wanted to crawl out of my body essentially because I had been laying there for so long. It was just a horrible experience. I was reunited with my baby. She was born at 6:30. I was reunited with them at about 12:00 at night, so I had been in labor from 4:00 in the morning and then I was breastfeeding her because my husband advocated for her to be breastfed. So that meant that she had her sugars checked. They were fine, so they were happy for her to wait for me. I was really, really glad that my husband advocated for me. I was so tired when I got out of surgery and I was back in this hot room. I was sweating profusely. There was no aircon. Some of the rooms, even though it was new, didn't have aircon. I ended up in a room with no aircon and it was so hot. I had to have a midwife stay with me and do observations every 15 minutes to check me. I didn't end up in the ICU, but I lost 3.1 liters of blood. I had blood transfusions in the surgery, all of the stuff in the surgery to keep me awake, and all of that. I really wanted to go under, but they wouldn't put me under because I had been eating. It wasn't a great experience and I came out very traumatized from that experience. I ended up having PTSD with flashbacks. I was crying for months. I felt broken. They told me to never have a vaginal birth again, and that I could have two more babies so that was amazing. I was like, “Well, you must have done a good job if you think I could have two more,” but they must be born Cesarean. I was like, “Okay, no problems.” I was so grateful to be alive after that experience. I was trying to make sense of what had happened. The next few years, that was my mission to try to make sense because I've gone from a space of you're not allowed to have a vaginal birth to what happened, trying to understand what happened, and then planning our future because we wanted four children total. So I almost never had any more children. For 6-12 months, I was done. I was never going to go through that again. I was a broken person. I was really struggling, but I trained as a postpartum doula and I started to want to help women in breastfeeding and the things that I knew that I could support because I ended up breastfeeding that baby for 12 months and I felt like a success at that regard. I learned a lot about breastfeeding. I wanted to share my voice and help women, but I wasn't well enough to help women in the birth space because I felt like a failure. I was trying to learn and I wanted to be in a space where I felt safe. This was trauma and challenges were happening and this was me being able to help people and make a positive out of a negative essentially. And then I found you guys. I found your podcast and I was like, “This is amazing,” because you were the first place that was promoting VBAC after two Cesareans. Back then, nobody was having VBAC after two Cesareans let alone multiple now that we see happening. I think a lot of it has to do with your podcast because when you hear women's stories and you hear the statistics and you can actually hear other women doing it, that was the start of me getting hope and realizing that there was another way. Meagan: Oh, that just gave me the chills. Ashley: Thank you so much for your podcast. Meagan: I have a sweater on right now, but literally it just went up my arm. Ashley: Awesome. It is really nice to know that if I didn't come across your podcast, I probably wouldn't have taken that next step, so it is life-changing to hear other women's stories and have that resource. The fact that you guys had the stats and everything, I was very much in the stats trying to move through special scars. I eventually had gone onto Special Scars, Special Hope. Meagan: Such a good group. Ashley: Yeah, so amazing and started to connect with other women who were having worse scars than me. They were birthing on classical scars. I was like, holy moly. I think it was ACOG or maybe RANZ of New Zealand and Australia. They said it was okay to labor on a scar like mine because I had a vertical scar down to my cervix. That's the low-risk special scar. I was like, “If it's good enough for them, it's good enough for me.” Look at these people saying that. All of the obstetricians that I had spoken to because I had a meeting with an obstetrician. I had met with so many midwives who knew about the system. They said to me, “Look. They are going to be petrified of you coming to the system.” It was really good to get that feedback and from my own experience, they wouldn't allow me to have a VBAC let alone a VBAC after two Cesareans with a special scar and high BMI. I started to really try to uncover, so I met with an obstetrician from that hospital and she basically said to me, “Look, you're a square peg trying to fit in a round hole or a round peg in a square hole.” I looked at her. I didn't understand that. I had never that and I have never been referred to as that kind of person. I quite like doing what normal people do. I was looking at her. I'm like, “What are you talking about?” She just said to me, “Basically, I ended up with this surgery because the surgery who was working had decided that because of my weight, that that was all that I was capable of or that was the path that I was going through.” That was really the first time that I've felt like my weight has actually held me back or I've been discriminated against. When I look back at the fact of how I was treated and the conversations I was having, it was obvious that it was happening the whole way through, I just was so naive to it that it was happening in my face and I didn't even realize it because the thing is that I understand that being of high weight can put you at risk for all of these things. I'm looking at it from their point of view, but I'm not actually sometimes looking at it from Ashley's point of view. I understand their concern and I understood all of the medical stuff because I had listened to them. I had asked questions. I had read their policies for obese people. I understood that it was discrimination. I didn't understand it at the time. I didn't understand that they probably weren't seeing me as a human as maybe they would have if I was a skinny version of myself. We probably would have had a different conversation. They probably would have been cheering me on and holding my hand and saying, “You're an amazing VBAC candidate. We support you. We probably still want to do all of these things to you, but we're not going to kick you out of hospital.” That's the difference when I hear women's stories. Oh, she's allowed to get in the water bath and she's allowed to have a beautiful birth. She doesn't have to bend over backward and do a cartwheel and it's because she looks a certain way or she was really lucky because she got an obstetrician that was amazing. There are all of these things that have to line up. That's what has propelled me on my journey to find home birth as an option. Meagan: Home birth, home birth. So you talked about stats. You were on this mission of stats, so you went out and you found the stats about VBAC after multiple Cesareans, two Cesareans, special scars, found some stuff, said, “Okay, this seems acceptable,” and then you started a home birth. Based off of your own research, for you, you felt completely comfortable starting this journey. Ashley: No, I didn't. Meagan: Okay. Ashley: I didn't. I mean, I had to work through the fears with the stats and I was comfortable with home birth and the idea of home birth. I understood that home birth was as safe as birthing in a hospital and I understood that if I was birthing with a midwife I would have a medical person with me. Now, the next challenge that came for me was that I couldn't find a home birth midwife who would support me. I feel like I leveled up. I was leveling up the whole time. It was like, now you've got a VBA2C. Now you've got a special scar. Let's work through this. What do I feel comfortable with? What am I willing to take on? Okay, okay. That's doable. That's doable. I can work through that. What's the next thing? Oh yeah, the next thing is this. Okay, what am I going to do with that? A home birth. Okay, a home birth feels like a safe option. I can do this. I can do that. I can do that. Okay, that's going to be the best thing for me. I'm not going to go back to hospital. Meagan: I love that you said that. I can do this. I'm comfortable with this. You kind of have to go through that with anything. In life in general, but especially with this birth, you went through it and you were like, “Okay, yep. Yep. Yep. Yep. Yep. Yep. Okay. Now, here I am.” Ashley: Yeah and I was seeing a psychologist at the time for all of the things to help me lose weight actually. My GP, I wanted to lose weight. I've been overweight my whole life. I wanted to lose weight. I went to a nutritionist and she was like, “You know everything. I think it's emotional.” I've got childhood stuff going on. I worked with him and I said, “The way that I feel about the hospital system, is this right?” He's normalizing my experience for me and saying, “You're perfectly normal.” I'm trying to say, “Am I having a trauma response here? I don't want to go into a home birth because I'm having a trauma response,” because the obstetrician said to me, one of them, she's like– she wasn't the best obstetrician for the debrief. She said to me, “You've got a risk of special scar, a 7% rupture rate.” I said, “That's a little bit different from what I found in Special Scars, Special Hope where they are looking at women.” I said, “Have you got any statistics?” She's like, “No.” I'm like, “So how can I trust that what you're saying is correct then?”Meagan: Well then, where'd you get 7%?Ashley: Exactly. She's like, “Look, if you find any doctor who's willing to support you, then they're not the doctor for you. I'm telling you what is the safest thing for you.” I was challenging her because at this point, I'm angry. I'm so done. I'm so done. I've just been through hell because of you people and I want to get information. I don't want to hear your judgments. She said to me, “If you find a doctor, then basically they're not right. They're doing the wrong thing.” I said, “So you're the best doctor in the whole world? You know everything right? You're the best and you know the best then? So if I find another doctor who says yes then they're wrong and you're right, that's what you're saying?” She was just looking at me. She was like, “I just feel like what you're going to do is you're going to keep looking until you're going to find someone and then you're going to put yourself at risk.”I'm like, “That is exactly what I'm going to do.” Meagan: You're like, “Well, I'm glad you feel that way.” Ashley: I should have sent her a postcard after my free birth and said, “I freebirthed. Thank you for driving me to this.” It is amazing the conversations you have when you really do have conversations. You can see where they're coming from and how very different their views are. Some of the fears and worries that they have are not about you and your baby. They are about themselves and their career, but the information I didn't know about her was that she was actually the head of obstetrics and she just lost her title and her job. She'd been bumped down. The reason why I went to her was because she supported breech birth in hospital and she was very vaginal friendly. She did support me. She was the consultant I saw on the paperwork that supported me to have a vaginal birth, but in the timeframe of me organizing to meet up with her, the information that I didn't know that I found out later was that she lost her job because she had supported somebody to have a breech and there was a poor outcome that the parents accepted, but somebody else had basically complained about. The only thing is that breech is so risky they say even though it's not. She's one of the radical obstetricians so she had been punished and so she was coming from a space of where she was. It's really important to know that information. You never know where they are in their career or how they are feeling, so she might have been really bitter at the time and negative and feeling like there was doom and gloom in the world. It was really shameful when I was speaking to my doula friends and they were like, “Oh really? She was so amazing.” I'm like, “Yeah, well maybe she is amazing but not for people like me. Maybe she supports this person because they've got a thin body and because of me, she's like, ‘No. I wouldn't touch you with a 10-foot pole,'” because it's too risky for her and for her job also. They are up against it as well in the system and that's something I have learned. My next mission was that I needed to find a midwife who was going to bat for me, not somebody who was going to be worried about losing their career because they come after the midwives too that are home birthing. So I had gone to the free birth podcast as well and I was listening to their stories. I was like, “They're a bit out there for me. I'm not brave enough to do that. That's a bit radical.” Eventually, my husband was the one that talked me into a free birth when we couldn't have a midwife to support me. It

Jeff & Will wrap up 2022 with an episode packed with reviews and recommendations. The guys start off talking about some seasonal programming they loved, "The Holiday Sitter" on Hallmark Channel, "A Christmas to Treasure" on Lifetime, and "Smiley" on Netflix. They also discuss their recent reads, including books by L Eveland, KJ Charles, Zac Bissonnette, and Kosoko Jackson. Looking back at 2022 Favorite Reads, Jeff & Will share some from the Patreon community, and then talk about what was on their favorites list, which includes books from Roe Horvat, Kosoko Jackson, Anna-Marie McLemore, Rachel Reid, Julie Murphy & Sierra Simone, Lev AC Rosen, Charlie Novak, Max Walker, Phil Stamper, and Anna Zabo & L.A. Witt. Complete shownotes for episode 410 along with a transcript of the show are at BigGayFictionPodcast.com. Big Gay Fiction Podcast is part of the Frolic Podcast Network. Find many more outstanding podcasts at frolic.media/podcasts!

On Thursday's Tipp Today, Fran spoke to Andrew Stokes following their meeting with the Justice Minister on concerns about growing crime in the South Tipp area. Christine, Ediwna and Annmarie spoke about the pressure of buying presents for Christmas, Joanne spoke about her concerns for road safety in Thurles. Andrew Laste was live on the phone from Kiev, Caitriona from the Farmers Journal was back for the farming slot and Tipp carer of the year Rachel Reid was live in studio. Muriel spoke about binge eating for this weeks Health slot, we heard about the upcoming drama productions from Thurles and Mullinahone and Dr Mary Ryan gave her take on reports that we are at the precipice of a cancer epidemic.

Family Carers Ireland, the national charity supporting Ireland's family carers, is delighted to announce that this year's Netwatch Tipperary Family Carer of the Year is Rachel Reid from Clonmel. Family Carers Ireland's local Manager Richie Molloy presented the award to Rachel in the Family Carers Centre in Clonmel. Richie and Rachel, joined Fran in studio this morning.

Today, I bring you my interview with my newest friends and Dzogchen experts, C von Hassett and Rachel Reid Wilkie.  In our talk we expound on the benefits of nature and the principles behind Dzogchen. Sponsors: Amazon.com - Shop Amazon using this link and a portion of what you spend will go back to the show. Become a Super-Fan of the Show Support ZEN commuter and get access to patron bonuses THANKS FOR LISTENING! Thanks again for listening to the show! If it has helped you in any way, please share it using the social media buttons you see on the page. Also, reviews for the podcast on iTunes are extremely helpful, they help it reach a wider audience.  The more positive reviews the higher in the rankings it goes.  Of course that means more peace in the world.  So please let me know what you think.  I read ever one of them. Did you enjoy the podcast?

Interview with C von Hassett and Rachel Reid Wilkie. riotmaterial.com@riotmaterialC Von Hassett's book is Entering the Mindhttps://www.amazon.com/s?k=entering+the+mind&i=stripbooks&crid=35XGMJY7DGA7N&sprefix=entering+the+mind%2Cstripbooks%2C155&ref=nb_sb_ss_ts-doa-p_1_17C von Hassett and Rachel Reid Wilkie are, as they say, co-conspirators in all things – with heavy emphasis on spirit – which together they've been exploring since the day they met. Throughout the years they have collaborated on numerous projects in the Arts, both in Los Angeles and New York City. Their time in the East Village culminated in a monumental exhibition, Documents of Love, at the famed Hosfelt Gallery in Chelsea, where the couple exhibited a diverse body of work – poetry, paintings, photography, a short film – to the attendance of thousands. Upon returning to Los Angeles, C von & Rachel founded Riot Material magazine, a now thriving and widely read literary-cultural magazine with its eye on Art, Word, and forward-aiming thought. Zen Success is a podcast hosted by Charissa Sims, an entrepreneur, corporate consultant, best selling author, meditation teacher and healer who has found her own Zen Success.This show is for entrepreneurs, business owners and anyone who struggles with stress, balance or burnout and simply feels discouraged. The mission of Zen Success is to inspire millions to live their best lives in the areas of health, relationships, parenting, creativity and wealth. Find your unique “Zen Success” as an employee, entrepreneur or artist and thrive in your life. Let go of what society measures as successful and find your own path.Charissa Sims, together with inspiring people she interviews, will share their vibrational alignment principles that will help you shift from force to flow and enjoy the ultimate “Zen Success” in life. --- Send in a voice message: https://anchor.fm/zen-success/message

This episode is being brought to you by Forecast located in Homewood Alabama. Forecast is a hair salon on a mission to shape a movement in the beauty industry focusing on education, fashion and creativity. Forecast strives to train stylists with the latest in education to provide their guests with the latest trends. Follow them on instagram @forecastsalon or find them online at https://www.forecastsalon.com/ As this podcast goes to air, we in the midst of at Full Moon Lunar eclipse in Scorpio. Lots of intensity this week and maybe some magic in the air.  Scorpio is one of the most transformative signs of the zodiac. The full moon combined with the lunar eclipse offers a time for revelation, change, and immense psychological breakthroughs. There will be no hiding from the vibrations of this eclipse. It may not feel particularly good but the change that can occur ultimately opens the door for your highest energetic potential. Scorpio is deep.. it's water ... it's emotional... it's shadow work - facing the depths of your soul can be intense... but it is needed to move through this energy. Pay attention to your feelings, your intuition, and signs from the universe over these next several days.  Honor your emotions... cry... scream... laugh.  Just be kind to yourself and others and careful of any manipulative energy. It's also the Wesak moon which holds very spiritual energy.  Gathering in the Himalayas are many spiritual teachers.  This is one of the most important Buddhist festival, commemorating the birth, enlightenment, and death of the Buddha. And so I offer... Let Light and Love and Power restore the Plan on Earth... The Great Invocation is a world prayer translated into over 80 languages and dialects. It was given to Alice Bailey in April 1945 in a message for all people at this time. Knowing  your energy,  your truth,  your voice, your Spirit is so valuable at this time. That's where the RITES come in to help you move through all this stuff! Rites being Reiki... Intuition... Tarot.. EFT and Stones and crystals. Energy Focus for the Week – live on Sunday nights on Instagram and FB. We talk about what's going on, we align our energy, set intentions  for the week and I pull the Tarot cards for guidance. Join us or catch the replay! As we move through these comic transitions, now is the time to clean up your energy with an Energy Clearing session.  Schedule one now... in person or online. When you work with the energy body, it helps to release the old patterns and all that old stuff you carry around.  Empowered Spirit Private Mentoring Program. Schedule a Spiritual Upgrade Breakthrough call with me and let's talk about how my programs can help you. In today's episode, I speak  with C von Hassett and Rachel Reid Wilkie.  They are, as they say, co-conspirators in all things – with heavy emphasis on spirit – which together they've been exploring since the day they met. In this episode we talk about C von's new book, Entering the Mind. a poetic, illuminating and deep-diving volume of intense, higher consciousness. C von Hassett shows you how to access it—and why you must—if your purpose is to seek more than what the “conceptual mind” offers—the transactional, the material, the emotional. We talk about the human condition, the natural state, out there vrs within, sitting still, the resting point, awareness, meditation, breathlessness, separating out the mind, healing and how to work with the practice of Dzogchen. Throughout the years, C von Hassett and Rachel Reid Wilkie have collaborated on numerous projects in the Arts, both in Los Angeles and New York City. Their time in the East Village culminated in a monumental exhibition, Documents of Love, at the famed Hosfelt Gallery in Chelsea, where the couple exhibited a diverse body of work – poetry, paintings, photography, a short film – to the attendance of thousands. Upon returning to Los Angeles, C von & Rachel founded Riot Material magazine, a now thriving and widely read literary-cultural magazine with its eye on Art, Word, and forward-aiming Thought. Rachel and C are the rare married couple who not only work and create together, but practice together day after day, side by side, often knee to knee, in the singular pursuit of knowing the deeper self beyond the conceptual self – that timeless, eternal Being which births forth the temporal one. To that end, the Pandemic Years saw the couple in contemplative retreat at their high-desert ranch in the Northern Mojave, a sacred landscape which sits just below the 12,000-foot peaks of the Eastern Sierra Nevadas. Here, beyond their full immersion into meditative practice, C von wrote Entering the Mind, while Rachel delivered to the world her inaugural spoken-song album, titled XI. Website Entering the Mind Podcast  Book  Instagram  C von Rachel Facebook       "Entering the Mind, brings forward an ancient buddhist teaching for becoming aware of your awareness, where you become your awareness, where you are immersed in it, where you rest in it, where you experience the totality of space, freedom, and oneness with infinity. Where your ego, your “I”-ness, your labels or your addictions just disappear. You transcend all else to just BE the awareness." As C von shares with us, "Once you've stepped over the threshold, to experience this awakened state, it is easier and easier to attain it—and there is no going back! Being bogged down in the “conceptual mind” pales in comparison and holds no attraction." Meditation is not mystical... it is a physical and mental exercise. Anyone can do it. Commit to your practice each day. As you find that awareness of rest you will find a peace and joy within you. Entering the Mind is a guidebook, but it is also a lyrical call to seek that which we are, to know the US beyond the physical plane. As Rachel says, "Ride the waves without judgement". Don't get caught in the Tsunamis. If you never start trying... you never start. Reach out to C von and Rachel for their work and get his book, Entering the Mind. If you need help creating a Spiritual Practice, reach out and schedule a Spiritual Upgrade Breakthrough call with me. Everybody has the capacity to experience this gentle peacefulness...  If you liked this episode, please be sure to share this podcast with someone else that might need to hear this message right now.  And leave me a review on Apple Podcast. Be sure to schedule a Spiritual Upgrade Breakthrough call with me. My Reiki schedule has been posted starting with a one day (in person) self care Reiki Day of Bliss! Thanks again for listening. To your Spirit, Terri PS…..Get the Energy Mastery App Follow Terri on Instagram Find her on LinkedIn Episode Credits: Sound Engineer: Laarni Andreshttps://www.facebook.com/laarni.andres.7

Jeff & Will kick off the show with an announcement: The Big Gay Fiction Fest is back for Pride Month. They've got all the details on the Fest's line up and where to purchase tickets. The guys discuss what they've been watching recently, including the movies "Spider-Man: No Way Home" and "The Lost City," as well as the historical drama series "The Gilded Age" on HBO Max. A dozen books coming in May are previewed, including titles by Michael Craft, H.L. Day, Timothy Janovsky, Charlie Novak, Beth Bolden, Kate Hawthorne, Annabelle Greene, J.R. Gray, S.C. Wynne, S.R. Lane, Matt Cain, and Frank Anthony Polito. Jeff also reviews "The Long Game" by Rachel Reid. Complete shownotes for episode 375 along with a transcript of the show are at BigGayFictionPodcast.com. Big Gay Fiction Podcast is part of the Frolic Podcast Network. Find many more outstanding podcasts at frolic.media/podcasts!

We sit down to discuss the first two volumes of HEARTSTOPPER, Alice Oseman's graphic novel sensation, as well as the adaptation on Netflix! We talk adaptation choices, casting, the importance of queer joy stories, and more! Stick around til the end where we announce what we're covering next time, and don't forget to rate and review us on iTunes! As always, thanks to Martha Riley for our art and Djempirical for our music. Find us on the internet if you like: www.actyaage.com actyaagepod@gmail.com instagram.com/actyaage twitter.com/actyaage Find Corinne at instagram.com/rinne_reads Find Tasia at instagram.com/rageycakes Mentions: Our Flag Means Death on HBO Max Black Sails on Starz/Hulu The No Show by Beth O'Leary The Long Game by Rachel Reid

Today I have a special episode, an interview with author C von Hassett, and his wife and partner in all things, Rachel Reid Wilkie. We discuss C von's new book, Entering the Mind, available through Amazon as well as on their website, www.enteringthemind.com. In this book, Hassett introduces the reader to the ancient Tibetan Buddhist meditation practice, Dzogchen. An exploration of his journey in engaging with this practice for several decades, Hassett "enables you to travel the inner path to this place of non-duality using the practices that have freed him from what most people still experience daily--depression, fear, anxiety, aggression, anger, worry and more." Our interview goes behind the scenes into what drew Hassett and Reid to these practices, insight into how the practice is done, as well as practical application into who can benefit, and why one would begin such an endeavor as embarking on a spiritual path. Artists, activists and healers through their mission to bring these teachings to a wider audience, C von and Rachel are truly sincere and devoted in their desire to help others awaken to their true nature and release their suffering. I hope you enjoy this interview as much as I did! As always, you can find me at www.juliabernbaum.com. Thank you again for tuning in. --- Support this podcast: https://anchor.fm/julia359/support

@rachelreidwilkie@reidwilkie@xi.spokensong@riotmaterial@enteringthemindThe scene:We are sitting together on a rocking bench in the “secret garden” backyard of Rachel's LA home, surrounded by a high wall of ivy and a loaded lemon tree. Though this is an idyllic oasis in the middle of the city, we are made very aware of what's just over the wall as we hear sirens and industry and later are surrounded by helicopters. As well as a gorgeous birdsong. The contrast really emphasizes what humans normalize constantly. Join us in the garden as we “create” our life together to share with you.Highlights:+ We share the high of coming from a 4-day spiritual retreat in Joshua Tree+ First pony at fourteen, falling in love with the care and freedom+ “Mini Muscle” the naughty and very fast pony+ Harnessing things often creates resistance and reaction+ Releasing control, choosing trust+ The liberation of traveling further outside your village+ Viewing “The Arts” objectively, then embodying “The Art of Being”+ Creating your life with intention, being a co-creator every second+ Meditation and yoga practices for a mindful creation of life+ XI: a new poetic musical collaboration+ Turning personal poetry into public spoken song+ Creating improvisational recordings together on the fly+ “Woman” was made from one improvised take+ Telling the story completely - creating music videos+ Six-track album launched in September 2021+ First professional live performance+ Lifelong recurring nightmare of being unprepared to perform+ The genre of poetry vs. the genre of spoken word+ The divine transmission of writing poetry+ Never edited any poems with the human intellect+ Your past self communicating to your future self through poetry+ The interpreter becomes the deliverer/translator+ Living in a “golden triangle” - rotating homes every few months or weeks+ Growing up in a village in nature and craving the anonymity of the city+ Land that embraces the individual vs. land that embraces the group+ Macro-dosing on mushrooms for intentional spiritual journeys+ Surrendering and allowing is the ultimate strength of a person+ You can't helps others if you're broken inside+ Preparing yourself to contribute to others' journeys+ Not editing ourselves for others+ Removing all considerations to focus on self work+ A dad who encouraged independence for all women+ Unconditional love and selflessness for others+ When do you surrender independence for love?+ Having stability and support to grow+ “Kindness,” “being unoffensive and soft,” setting boundaries+ Suffering silently and martyrdom - thousands of years of oppression+ Cultivating compassion - the new artistic endeavor+ Over-zealous self-reliance is a lack of trust and self-confidence+ Everything is intertwined+ Doing a shamanic journey session to heal your young self+ Gratitude prayer can purify the energy of water+ Neglect is worse than hatredA taste:“Please don't dump your luggage in the middle and ask others to fix it.”“Trust begins with yourself. […] It creates a natural calmness and confidence in your self-reliant capabilities, but it also creates a calm, trusted confidence in your community.”Favorite daily ritual:Morning gratitude ceremony blessing the Japanese tea she and her husband then put into their bodies.Support the show

There's a lot of teens getting into shenanigans in this episode. Driving on haunted roads that might not exist, accidentally turning themselves into urban legends, and singing karaoke with ghosts. Teen shenanigans!   Content Warning: This episode contains conversations about or mentions of death, child endangerment/death, hanging, sexual innuendo, ableism, trauma, sexual assault, cancer, enslavement, divorce, and animal death. Housekeeping - CTA: See us this weekend at HavenCon!  - Recommendation: This week, Amanda recommends The Game Changer series by Rachel Reid.  - Books: Check out our previous book recommendations, guests' books, and more at spiritspodcast.com/books - Call to Action: Check out Exolore: Helping you imagine other worlds, but with facts and science! Every other week, astrophysicist/folklorist Moiya McTier explores fictional worlds by building them with a panel of expert guests, interviewing professional worldbuilders, or reviewing the merits of worlds that have already been built.   Sponsors - Calm is the #1 app to help you reduce your anxiety and stress and help you sleep better. Get 40% off a Calm Premium subscription at calm.com/spirits. - Brooklinen delivers luxury bed sheets, pillows, comforters, & blankets straight to your door. Go to Brooklinen.com right now and use promo code “spirits” to get $25 off when you spend $100 or more, PLUS free shipping. - BetterHelp is a secure online counseling service. Get 10% off your first month at betterhelp.com/spirits   Find Us Online If you like Spirits, help us grow by spreading the word! Follow us @SpiritsPodcast on Twitter, Facebook, Instagram, and Goodreads. You can support us on Patreon (http://patreon.com/spiritspodcast) to unlock bonus Your Urban Legends episodes, director's commentaries, custom recipe cards, and so much more. We also have lists of our book recommendations and previous guests' books at http://spiritspodcast.com/books. Transcripts are available at http://spiritspodcast.com/episodes. To buy merch, hear us on other podcasts, contact us, find our mailing address, or download our press kit, head on over to http://spiritspodcast.com.   About Us Spirits was created by Julia Schifini, Amanda McLoughlin and Eric Schneider. We are founding members of Multitude, an independent podcast collective and production studio. Our music is "Danger Storm" by Kevin MacLeod (http://incompetech.com), licensed under Creative Commons: By Attribution 3.0.

C von Hassett and Rachel Reid Wilkie are, as they say, co-conspirators in all things – with a heavy emphasis on spirit – which together they've been exploring since the day they met. Throughout the years they have collaborated on numerous projects in the Arts, both in Los Angeles and New York City. Their time in the East Village culminated in a monumental exhibition, Documents of Love, at the famed Hosfelt Gallery in Chelsea, where the couple exhibited a diverse body of work – poetry, paintings photography, a short film – to the attendance of thousands. Upon returning to Los Angeles, C von & Rachel founded Riot Material magazine, a now thriving and widely read literary-cultural magazine with its eye on Art, Word, and forward-aiming thought. Rachel and C are the rare married couple who not only work and create together but practice together day after day, side by side, often knee to knee, in the singular pursuit of knowing the deeper self beyond the conceptual self – that timeless, eternal Being which births forth the temporal one. To that end, the Pandemic Years saw the couple in contemplative retreat at their high-desert ranch in the Northern Mojave, a sacred landscape that sits just below the 12,000-foot peaks of the Eastern Sierra Nevadas. Here, beyond their full immersion into meditative practice, C von wrote Entering the Mind, while Rachel delivered to the world her inaugural spoken-song album, titled XI.  Listen & Subscribe on: iTunes / Stitcher / Podbean / Overcast / Spotify Contact Info Website: www.enteringthemind.com Podcast: Entering The Mind Book: Entering the Mind By C von Hassett Most Influential Person Norbu Rinpoche, Sonia Rinpoche, and MinGi Rinpoche Effect on Emotions I have found during the last two years  where we have really emerged ourselves into this practice during the pandemic, my emotions have transformed completely. I'm a very passionate person. I spent many years in Italy, so I learned from the best. I get ecstatically happy and I get very emotionally sad, but I have an incredible new relationship with them [my emotions]. My emotions are almost like an old friend, you know, waving at me saying, Hey, Rachel, I'm back again. This is happy, this is me, this is happy. What happens at that moment is that I'm still within that ecstatic happiness and I'm also calm in the center of that ecstatic happiness. When I feel really, really sad; if I hear some sad news, I get a sense of the deep sorrow within me. But it's still within a calm container. So I've learned that without even trying too hard, this is the practice that has definitely installed itself within me. I've become less much reactive and I don't react instantly to those emotions. On the rare occasion, when I do react instantly without a thought, then I recognize it immediately. And I go, oops, okay, I see you, I see where you're coming from. It's okay, let's just sit down. Let's just take a moment. Let's hold hands. Let's see where we're going with this. And so bringing mindfulness to my emotions has been one of the biggest transformational experiences I have had in the last few years. Thoughts on Breathing Up until a few years ago, I really kind of poo-pooed the whole breathing practice. I didn't put much stock in it. I've always been intellectual and I love the intellectual approach to meditation. Over The past year I've just come to recognize the utter importance of the breath. And in fact, the breath is the one thing that transitions between the body and the mind, body and the spirit, the body and awareness. You can be sitting down in a meditation practice and still be fully involved in your day and in your world. You have your breath. Then as you settle, and you move into your awareness, the breath is still there. The breath is the beautiful bridge between the two beings. I'm now just absolutely certain that the breath is one of the keys to moving from one perspective to the next. It's like the rope that you pull through in the darkness to get you to the other side if you need it. Suggested Resources Book: Entering the Mind By C von Hassett Book: The Boundary Stone By C von Hassett Book:The Tibetan Book of Living and Dying App: onecommune.com Bullying Story It's a personal story. I was brought up by my parents in the countryside of Cambridge. My brother and I were both expected to go to private schools. He went to the private school, which is actually a castle, and at the young, bright age of 11, I wanted to go my own way. I asked my parents if I could go to the state school, because not only did I not want to walk in the footsteps of my brother, but I wanted my own space, and I wanted my own independence. So they also had a great art faculty as well, that I really wanted to get into. And so my parents said, yes. So at the age of 11, I went to a public [state] school. I spoke differently from others, I had a rather nice accent. A lot of my colleagues at school, my fellow students, they had some really cool accents. [The way they talked] involved a lot of rude words, so I can't do it here. So I experienced bullying firsthand. And I started very subtle, and I made friends, I had this really lovely close girlfriend, and we used to walk around together. And you know, these long corridors that go on forever, and gangs of girls would be in wait as you walk through this corridor of girls waiting for you. Something's going to happen, you just don't know what's going to happen. And you just brace yourself and you walk through that corridor of girls. Then someone would stick their foot out and you'd fly on your belly down the corridor. So I did actually have one other incident, which was where I was actually pinned up against a locker. Then she lost her temper, and she did actually punch me in the face. At this moment, it wasn't so much her actions towards me, but it was the little crowd of other children behind her, as she punched me in the face, that cackled with laughter. One person's act of bullying can be one thing, but the humiliation and the shame that I felt from the others witnessing it, and then laughing at it. That contributed to this bullying experience. Related Episodes Learning the Language of Spirit With India Leigh Intuition, Spirituality, and Our Inner Voice; Mary Ann Bohrer Modern Spirituality with Ben Decker Special Offer Are you experiencing anxiety & stress? Peace is within your grasp. I'm Bruce Langford, a practicing coach, and hypnotist helping fast-track people just like you to shed their inner bully and move forward with confidence. Book a Free Coaching Session to get you on the road to a more satisfying life, feeling grounded and focused. Send me an email at bruce@mindfulnessmode.com with ‘Coaching Session' in the subject line. We'll set up a zoom call and talk about how you can move forward to a better life.

Jeff & Will kick off the show with the announcement of the Spring Big Gay Fiction Book Club selection, Kosoko Jackson's "I'm So (Not) Over You." They also introduce the Rainbow Romance Reader Report, the official newsletter of the Big Gay Fiction Podcast. The recent "New York Times" article about LGBTQ romance is also discussed. Will chats about his recent binge of the "Angélique" movie collection, and the movie "Werewolves Within." Jeff talks about his recent trip to New York, the Broadway revival of "Company," and the new Disney+ film adaptation of "Better Nate Than Ever." The guys reveal nine books they're looking forward to in April, including titles by Elizabeth Hollows, CD Rachels, Jordan L. Hawk, V.L. Locey, Emmy Sanders, Eden Winters, Rachel Reid, Kris Ripper and Liz Bowery. Jeff also reviews the forthcoming book by Ariella Zoelle, "Play by Heart." Complete shownotes for episode 369 along with a transcript of the show are at BigGayFictionPodcast.com. Big Gay Fiction Podcast is part of the Frolic Podcast Network. Find many more outstanding podcasts at frolic.media/podcasts!

Here’s Katherine Center, author of soon-to-be 9 bittersweet comic novels that have been described as “the best medicine for human souls,” on her relatively late-in life discover of romance novels: “I felt like I’d discovered chocolate cake after a lifetime of eating boneless skinless chicken breasts.”We dig deep into the process of figuring out what you love in a book and how to find it in your own work, from analyzing other books to the importance of the reading journal, and then we get into the craft of writing books that satisfy the readerly urges you share, embracing unifying tropes, finding the compelling hook and how to ground a story that seems to big to be true by creating real characters with relatable problems in familiar settings. I took some serious notes here, people. I’m going to have to listen again!#AmReadingKatherine Center :Something Wilder, Christina Lauren (Also mentioned The Unhoneymooners)Book Lovers, Emily HenrySarina:The Long Game, Rachel Reid (sequel to Heated Rivalry)KJ: Boyfriend Material, Alexis HallAre you serious about writing a nonfiction book this year? Author Accelerator is offering a nonfiction book incubator starting February 28th. There are only a few seats in this intensive program because you will get 1:1 coaching on every single step of the process AND you will have the chance to pitch your proposal to a pool of agents and publishers at the end -- a fabulous opportunity. Apply for the program HERE -- and get a strategic session with Jennie Nash to kickstart your work. We think Jennie and her book coaches are terrific -- tell her we sent you! This is a public episode. Get access to private episodes at amwriting.substack.com/subscribe

Rachel Reid — aka Rachelle Goguen — has been writing the Game Changers series out of Bedford for the past three years. Role Model, the fifth book in her gay hockey player anthology, dropped earlier this month and is about a closeted player who's traded to Ottawa (the horror) and is gently moved toward coming out by a new co-worker, while also grappling with a Me Too fallout courtesy of his former best friend. Rachelle — once upon a time Tara's co-worker — stops by the show to chat secret projects, romance, the politics of sports, and the series' real-life parallels.

Jeff shares the news that the first three audiobooks for his "Codename: Winger" young adult series, narrated by Kirt Graves, are now available everywhere. The hockey romances "Heated Rivalry" and "Role Model," both by Rachel Reid, are reviewed by Jeff before Rachel joins us to talk about the "Game Changers" series. She shares what got her started writing the series, how she decides the type of guy to pair her hockey players with, and what's still to come for the next book in the series. Rachel also discusses how writing about hockey when she was 12 set her on the path to becoming the author she is today. We also get some excellent book recs too. Complete shownotes for episode 329 along with a transcript of the show are at BigGayFictionPodcast.com. Big Gay Fiction Podcast is part of the Frolic Podcast Network. Find many more outstanding podcasts at frolic.media/podcasts!

Join Rachel Reid as she talks about what our response to reading God's Word should be!

To kick off the month, Jeff has news about a discussion he's moderating with authors Penny Aimes and Verity Lowell in association with Carina Adores and Buffalo Street Books for Bookstore Romance Day coming on August 21. The guys talk about some great programming they've been watching recently, including the documentary "Summer of Soul," the crafting shows "Making It" and "All That Glitters," musical comedies "Central Park" and "Schmigadoon!" They also look at the teen dramas "Gossip Girl" and "Young Royals" plus the horror trilogy "Fear Street." For the August book preview, Jeff and Will look at upcoming books by K.M. Neuhold, Macy Blake, Lauren Blakely, Annabeth Albert, Haven Hadley, Dahlia Donovan, Frederick Smith & Chaz Lamar Cruz, and Rachel Reid. Jeff also reviews "Out of Character" by Annabeth Albert and "Flash Fire" by TJ Klune. Complete shownotes for episode 325 along with a transcript of the show are at BigGayFictionPodcast.com. Big Gay Fiction Podcast is part of the Frolic Podcast Network. Find many more outstanding podcasts at frolic.media/podcasts!

Recent television work includes playing the female lead, Beth Winters, opposite Jamie Dornan and Matthew Rhys in DEATH AND NIGHTINGALES, an adaptation of the novel written and directed by Allan Cubitt (creator of THE FALL), which aired on BBC2 early in 2019. Ann's latest feature film, ROSIE PLAYS JULIE sees her opposite Aiden Gillen and Orla Brady playing the lead role of Julie, directed by Joe Lawlor and Christine Molloy and was released late 2019. Ann appeared in the title role of independent feature film KISSING CANDICE (2017) directed by Aoife McArdle for which she was nominated for a Rising Star Award and Best Actress In A Lead Role at the 2018 IFTA's (Irish Film and Television Awards) and which went on to win nominations and awards at the Berlin, Prague, Boston, Dublin and Toronto International Film Festivals. In thesame year Ann appeared as Annie Moffat in the BBC/PBS mini-series LITTLE WOMEN directed by Vanessa Caswell. She made her screen debut in the recurring role of Rachel Reid in the IFTA award winning serialised Irish drama, RED ROCK for TV3 produced by Element Pictures and Angel Station, later appearing on BBC & Amazon Prime, from 2015 to 2017. Ann also appeared as Biddy Lambert in the RTE Drama REBELLION (2016) and more recently as Ethelfled in VIKINGS Season 5 for History/MGM. In 2016 Ann appeared as Hannah Baylor in the Blackpills series PLAYGROUND for Apple TV France, a series created by Luc Besson. Ann will grace television screens this year, playing one of the leads in the HBO series THE NEVERS.

Joining Mia for this week's ep is an actor whose career is skyrocketing at the moment...  Ann Skelly. Ann is currently featuring in the brand new series for HBO 'The Nevers' due for release on the 11th of April on HBO. "PLEASE consider Supporting FNI by becoming a member of Fni on www.BuyMeACoffee.com/fni or simply just buy us a coffee or two as a gesture to help us keep the kettle on for everyone. Get ahead of the pack as we're shortly announcing a very cool membership programme for Fnier's on Buy Me A Coffee. We will have over 20 professional Film, Broadcast, Animation and TV legends taking part to mentor our blossoming community in Ireland". Ann also appears in the leading role of "ROSE" in Rose Plays Julie,   Directed by Desperate Optimists, opposite Aiden Gillen. Ann was most recently seen playing the female lead, Beth Winters, opposite Jamie Dornan in DEATH AND NIGHTINGALES, an adaptation of the novel written and directed by Allan Cubitt, the creator of THE FALL, which aired on BBC TV early in 2019. Ann appeared in the title role of independent feature film KISSING CANDICE (2017) directed by Aoife McArdle for which she was nominated for a Rising Star Award and a Best Actress In A Lead Role at the 2018 IFTA's. Ann appeared as Annie Moffat in the BBC/PBS mini series LITTLE WOMEN directed by Vanessa Caswell which aired in 2017. Ann appeared as the recurring role of Rachel Reid in the IFTA award winning serialised Irish drama, RED ROCK for TV3 produced by Element Pictures and Angel Station, sold into BBC & Amazon prime from 2015 to 2017. Ann also appeared as Biddy Lambert in the RTE Drama Rebellion (2016) and more recently as Ethelfled in VIKINGS Season 5 for History/MGM.Ann appeared as Hannah Baylor in the Blackpills series Playground for Apple TV France, a series created by Luc Besson. You can also support Wrap Chat by joining Headstuff+ on HeadstuffPodcasts.com  #WeAreFni #YouAreFni Learn more about your ad choices. Visit megaphone.fm/adchoices

Recent television work includes playing the female lead, Beth Winters, opposite Jamie Dornan and Matthew Rhys in DEATH AND NIGHTINGALES, an adaptation of the novel written and directed by Allan Cubitt (creator of THE FALL), which aired on BBC2 early in 2019. Ann's latest feature film, ROSIE PLAYS JULIE sees her opposite Aiden Gillen and Orla Brady playing the lead role of Julie, directed by Joe Lawlor and Christine Molloy and was released late 2019. Ann appeared in the title role of independent feature film KISSING CANDICE (2017) directed by Aoife McArdle for which she was nominated for a Rising Star Award and Best Actress In A Lead Role at the 2018 IFTA's (Irish Film and Television Awards) and which went on to win nominations and awards at the Berlin, Prague, Boston, Dublin and Toronto International Film Festivals. In thesame year Ann appeared as Annie Moffat in the BBC/PBS mini-series LITTLE WOMEN directed by Vanessa Caswell. She made her screen debut in the recurring role of Rachel Reid in the IFTA award winning serialised Irish drama, RED ROCK for TV3 produced by Element Pictures and Angel Station, later appearing on BBC & Amazon Prime, from 2015 to 2017. Ann also appeared as Biddy Lambert in the RTE Drama REBELLION (2016) and more recently as Ethelfled in VIKINGS Season 5 for History/MGM. In 2016 Ann appeared as Hannah Baylor in the Blackpills series PLAYGROUND for Apple TV France, a series created by Luc Besson. Ann will grace television screens this year, playing one of the leads in the HBO series THE NEVERS.

Joining Mia for this weeks Ep is an Actor who's career is sky rocketing at the moment, and for good reason...  Ann Skelly. Ann is currently featuring in the brand new series for HBO The Nevers due for release on the 11th of April on HBO. "PLEASE consider Supporting FNI by becoming a member of Fni on www.BuyMeACoffee.com/fni or simply just buy us a coffee or two as a gesture to help us keep the kettle on for everyone.  Get ahead of the pack as we're shortly announcing a very cool membership programme for Fnier's on Buy Me A Coffee.Where we will have over 20 professional Film, Broadcast, Animation and TV legends taking part to mentor our blossoming community in Ireland". Ann also appears in the leading role of "ROSE" in Rose Plays Julie,  Directed by Desperate Optimists, opposite Aiden Gillen.Ann was most recently seen playing the female lead, Beth Winters, opposite Jamie Dornan in DEATH AND NIGHTINGALES, an adaptation of the novel written and directed by Allan Cubitt, the creator of THE FALL, which aired on BBC TV early in 2019.Ann appeared in the title role of independent feature film KISSING CANDICE (2017) directed by Aoife McArdle for which she was nominated for a Rising Star Award and a Best Actress In A Lead Role at the 2018 IFTA’s.Ann appeared as Annie Moffat in the BBC/PBS mini series LITTLE WOMEN directed by Vanessa Caswell which aired in 2017.Ann appeared as the recurring role of Rachel Reid in the IFTA award winning serialised Irish drama, RED ROCK for TV3 produced by Element Pictures and Angel Station, sold into BBC & Amazon prime from 2015 to 2017. Ann also appeared as Biddy Lambert in the RTE Drama Rebellion (2016) and more recently as Ethelfled in VIKINGS Season 5 for History/MGM.Ann appeared as Hannah Baylor in the Blackpills series Playground for Apple TV France, a series created by Luc Besson.You can also support WRAPCHAT by joining Headstuff+ on HeadstuffPodcasts.com  #WeAreFni #YouAreFni

Welcome everyone to Episode 2 of Out in the Wilds! We are pumped to take you through Day 2 on the Island, including a deep dive into Rachel Reid (all puns intended). We'll talk physical and symbolic journeys, word games, whether we are secretly Leah stans, Dot's pharmacist alter ego and the phenomenal job Reign Edwards did portraying Rachel. This one is a bit longer, but we had so much to say! Follow us on Instagram @outinthewildspodcast and get in touch at outinthewildspodcast@gmail.com.

Editor's Note: This interview was recorded back in June 2020. Merry Christmas and Happy Bridgerton Day! Today I have a fun interview with the co-hosts of the podcast What would Lady Danbury Do? In this chat, we talk about the Bridgerton series, historical romance recommendations and some contemporary romance recommendations.    BOOKS RECOMMENDED: Bridgertons series by Julia Quinn - https://amzn.to/3pmmoUu First Comes Scandal by Julia Quinn - https://amzn.to/2KXYEqU Jennifer Cruisie- https://amzn.to/3rt5bdG Amanda Quick - https://amzn.to/3nPn4B8 Get a Life Chloe Brown by Talia Hibbert - https://amzn.to/2M7FJub The Wall of Winnipeg and Me by Mariana Zapata- https://amzn.to/3rsSDTO The Hating Game by Sally Thorne- https://amzn.to/3pmaQjT Red White and Royal Blue by Casey McQuinston - https://amzn.to/2M9Zamh Act Like It by Lucy Parker-  https://amzn.to/3aHJBfE Pretty Face  by Lucy Parker - https://amzn.to/34E8pBd Dear Enemy by Kristen Callihan- https://amzn.to/3heHr8u Merry Inkmas by Talia Hibbert - https://amzn.to/3pjsR2k Chaos Reigning by Jessie Mihalik - https://amzn.to/37OAFmZ Temporary Wife Temptation by Jayci Lee - https://amzn.to/3nMpuAM Rebekkah Weatherspoon - https://amzn.to/37JE4mX Brooklyn Bruisers series Sarina Bowen- https://amzn.to/2WFE0hP Hot Jocks by Kendall Ryan- https://amzn.to/2WKsodq Briar U by Elle Kennedy - https://amzn.to/2KXZBQ0 Pucked by Helena Hunting - https://amzn.to/34E8Mf5 Rachel Reid- https://amzn.to/2M71x9i  Heated Rivalry by Rachel Reid - https://amzn.to/3rsNzP1 Jessica Clare - https://amzn.to/3rBF30u A Conspiracy of Whispers  by Ada Harper - https://amzn.to/2WFwqUm Radio Silence by Alyssa Cole - https://amzn.to/38votXq CONNECT WITH BRIDGERTON PODCAST Website Twitter: @bridgertonpod
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  PODCAST HIATUS Please note, the podcast will be going on a short two months break this January and February, 2021. We will return with brand new episodes on March 1, 2020. I will  be releasing new episodes on the Patreon feed while the show is on hiatus.     SUPPORT THE WHAT TO READ NEXT PODCAST! If you’re enjoying the show, please subscribe and leave a rating and review on Apple Podcasts. Spread the love. And if you liked this episode, share it with your friends   JOIN PATREON COMMUNITY  Get weekly romance recommendations, early access to author interviews, monthly meetups and exclusive Patreon audio series by joining the Patreon community. Want to join the fun? Sign up today; http://www.whattoreadnextblog.com/patreon   ETSY SHOP ALERT- QUEEN BEE READS   Romance lovers: check out Queen Bee Reads Etsy Shop for cute & comfortable bookish apparel! The shop also features social justice apparel and fun items from some of your favorite TV shows like Schitt’s Creek & The Office. Items are designed and made by Megan of @queenbee_reads. Use code: WHATTOREAD10 to save! http://www.whattoreadnextblog.com/queenbeereads FROLIC PODCAST NETWORK  What to Read Next Podcast is part of the Frolic Podcast Network. You can find more outstanding podcasts to subscribe to at Frolic.media/podcasts!    AFFILIATE DISCLOSURE If you purchase a book through my Amazon or Bookshop link, I will receive a commission at no cost to you that will help cover the cost of the podcast    CONNECT WITH LAURA YAMIN  WhattoReadNextBlog.com Instagram  Goodreads

Suggested by friend of the show Rachel Reid, a Halifax-based author of wonderful gay hockey novels, this one stars Haligonian hockey-haired hero Steve Lund as a guy who we think may have been in the Air Force, but he is discharged and returns to his small hometown for Christmas, where he meets an attractive orthopedic surgical resident. They both receive a series of riddles designed to unlock their Christmas spirit, if not their libidos.Did you watch this movie too? Tell us what you think in our Instagram comments @APodcastInAQueerTree or by emailing apodcastinaqueertree@gmail.com. Haven't watched it yet but you're thinking about it? Try one of our Holiday Movie Bingo cards at apodcastinaqueertree.com. Let us know if you have any suggestions for them! Hosted on Acast. See acast.com/privacy for more information.

Who has the flashest post box on your street? Writer, photographer and travel blogger Rachel Reid has spent the last twenty years documenting the novelty and designed letterboxes around New Zealand. She's put them together in a book titled 'It's in The Post'. Robert Kelly spoke to her about her epistolary obsession.

Welcome to the What to Read Next Podcast. Today’s guest is Amanda from Escape in a Book. In this episode, we dive into Queer Romance witth a list of authors to check out and some fun Kindle Unliminted recommendations.    BOOKS RECOMMENDED: Cat Sebastian - https://amzn.to/3eiSbRC TJ Klune- https://amzn.to/2GiDG3P Green Creek series by TJ Klune- https://amzn.to/2JsU3vZ Him/Us duology by Sarina Bowen and Elle Kennedy - https://amzn.to/2TIJdnp Heated Rivalry by Rachel Reid- https://amzn.to/2JswOCg  Rachel Reid - https://amzn.to/322wP6o Adriana Herrera - https://amzn.to/2HRsgVa Rainbow Rowell- https://amzn.to/3kU6rmI  Casey McQuinston- https://amzn.to/3jPrzJ8  Eden Finley-  https://amzn.to/34L7U8X KM Neuhold- https://amzn.to/34L7Vtx A E Via- https://amzn.to/2TKniMI N R Walker - https://amzn.to/3oP5sGL Captive Prince by CS Pacat - https://amzn.to/2HRTJGw Thrown Off the Ice by Taylor Fittzpatrick -  https://amzn.to/2HRTJGw   CONNECT WITH AMANDA Instagram   SUPPORT THE WHAT TO READ NEXT PODCAST! If you’re enjoying the show, please subscribe and leave a rating and review on Apple Podcasts. Spread the love. And if you liked this episode, share it with your friends   JOIN PATREON COMMUNITY  Get weekly romance recommendations, early access to author interviews and exclusive Patreon audio series by joining the Patreon community. Monthly perks start at $1  a month. Want to join the fun? Sign up today; http://www.whattoreadnextblog.com/patreon   ETSY SHOP ALERT- QUEEN BEE READS   Romance lovers: check out Queen Bee Reads Etsy Shop for cute & comfortable bookish apparel! The shop also features social justice apparel and fun items from some of your favorite TV shows like Schitt’s Creek & The Office. Items are designed and made by Megan of @queenbee_reads. Use code: WHATTOREAD10 to save! http://www.whattoreadnextblog.com/queenbeereads FROLIC PODCAST NETWORK  What to Read Next Podcast is part of the Frolic Podcast Network. You can find more outstanding podcasts to subscribe to at Frolic.media/podcasts!    AFFILIATE DISCLOSURE If you purchase a book through my Amazon or Bookshop link, I will receive a commission at no cost to you that will help cover the cost of the podcast    CONNECT WITH LAURA YAMIN  WhattoReadNextBlog.com Instagram  Goodreads

Welcome to What to Read Next Podcast. Today’s guest is Erica from When do they Kiss? Instagram account. Erica’s favorite trope is marriage of convenience and enemies to lovers. In this episode, we chat when do they kiss and some awesome romance recommendations.   BOOKS RECOMMENDED:  Sweet Briar Summit by Christine Rimmer - https://amzn.to/34pPfzo Only When It’s Us by Chloe Liese- https://amzn.to/35vR1OR Heated Rivalry by Rachel Reid- https://amzn.to/31BAyHR  Kiss Quotient by Helen Hoang- https://amzn.to/34pPsCG The Kingermaker and The Rebel King (duet) by Kennedy Ryan- https://amzn.to/35vSS6q You Deserve Each Other by Sarah Hogle - https://amzn.to/2HvYZiO The Charmer in Chaps by Julia London- https://amzn.to/34oIxtA 40-Love by Olivia Dade- https://amzn.to/3mizyjG Chloe Liese - https://amzn.to/35vRXml Talia Hibbert https://amzn.to/31GmlcE Alisha Rai - https://amzn.to/3motlTc Wall of Winnipeg and Me by Mariana Zapata- https://amzn.to/2TqY3il Lush Money by Angelina M. Lopez - https://amzn.to/3mo6asy Hate Crush  by Angelina M. Lopez - https://amzn.to/3dVZPkL The Hating Game by Sally Thorne- https://amzn.to/3orEdSo  Asking For Trouble by Tessa Bailey - https://amzn.to/3kztSS8 Spoiler Alert by Olivia Dade- https://amzn.to/34rFMaK     CONNECT WITH ERICA Instagram Goodreads   JOIN PATREON COMMUNITY  Get weekly romance recommendations, early access to author interviews and exclusive Patreon audio series by joining the Patreon community. Monthly perks start at $1  a month. Want to join the fun? Sign up today; http://www.whattoreadnextblog.com/patreon   FROLIC PODCAST NETWORK  What to Read Next Podcast is part of the Frolic Podcast Network. You can find more outstanding podcasts to subscribe to at Frolic.media/podcasts!    AFFILIATE DISCLOSURE If you purchase a book through my Amazon or Bookshop link, I will receive a commission at no cost to you that will help cover the cost of the podcast    CONNECT WITH LAURA YAMIN  WhattoReadNextBlog.com Instagram  Goodreads  

Welcome to What to Read Next Podcast. Today my guest is Taima from ShadesandPage Instagram account. In this episode, we chat about Black Romance Authors and finding books on Amazon. This episode is full of book recommendations.    BOOKS RECOMMENDED: Heated Rivalry by Rachel Reid - https://amzn.to/2GNOQh9 Brenda Jackson- https://amzn.to/3lxecPh Alexandria House- https://amzn.to/30TrptI Christina C. Jones- https://amzn.to/30V0Vb8 Sheryl Lister - https://amzn.to/3iRfAKC Stephanie Nicole Morris- https://amzn.to/3iPW0P4 Birthday Girl by Penelope Douglas - https://amzn.to/34La5bA His Weekend Special by Endiya Carter - https://amzn.to/3dgeE1t Let Me Love You by Alexandia House - https://amzn.to/2SNaVii The Forbidden Man by Karina Halle - https://amzn.to/3dmt3ZR On the Island by Tracey Garvis Graves - https://amzn.to/2IkIfve The Idea of You by Robinne Lee - https://amzn.to/3lB8A6B Love Unsolicited by Alexandra Warren - https://amzn.to/3lALMnA Go Deep by Rilzy Adams - https://amzn.to/3lu6KUW Entangled Pursuits by Breda Jackson - https://amzn.to/36TZaih Legendborn by Tracey Deonn- https://amzn.to/3iXVUVP CONNECT WITH TAIMA Instagram   JOIN PATREON COMMUNITY  Get weekly romance recommendations, early access to author interviews and exclusive Patreon audio series by joining the Patreon community. Monthly perks start at $1  a month. Want to join the fun? Sign up today; http://www.whattoreadnextblog.com/patreon   FROLIC PODCAST NETWORK  What to Read Next Podcast is part of the Frolic Podcast Network. You can find more outstanding podcasts to subscribe to at Frolic.media/podcasts!    AFFILIATE DISCLOSURE If you purchase a book through my Amazon or Bookshop link, I will receive a commission at no cost to you that will help cover the cost of the podcast    CONNECT WITH LAURA YAMIN  WhattoReadNextBlog.com Instagram  Goodreads

Welcome to the What to Read Next Podcast. Today we have an author interview with Rachel Reid. Rachel writes one of my favorite hockey romance series. For this interview, I invited my friend Amanda from Escape in a Book to join me. She is also a Rachel Reid superfan. In this interview, we chat about Rachel’s source of inspiration, her upcoming books and some fun book recommendations. Now let’s go to the interview.    BOOKS RECOMMENDED:  Game Changer by Rachel Reid - https://amzn.to/2FTo1aE Heated Rivalry by Rachel Reid - https://amzn.to/2ZVYJQy Tough Guy by Rachel Reid - https://amzn.to/3iQCByl Common Goal by Rachel Reid - https://amzn.to/32PdSF6 Olivia Waite - https://amzn.to/3hR7zFh Cat Sebastian- https://amzn.to/3cgvooR KJ Charles - https://amzn.to/2ZVQuDW The Last Kiss by Sally  Malcolm - https://amzn.to/3iPFyPv   CONNECT WITH RACHEL REID  Twitter  Instagram Website  JOIN PATREON COMMUNITY  Get weekly romance recommendations, early access to author interviews and exclusive Patreon audio series by joining the Patreon community. Monthly perks start at $1  a month. Want to join the fun? Sign up today; http://www.whattoreadnextblog.com/patreon   FROLIC PODCAST NETWORK  What to Read Next Podcast is part of the Frolic Podcast Network. You can find more outstanding podcasts to subscribe to at Frolic.media/podcasts!    AFFILIATE DISCLOSURE If you purchase a book through my Amazon or Bookshop link, I will receive a commission at no cost to you that will help cover the cost of the podcast    CONNECT WITH LAURA YAMIN  WhattoReadNextBlog.com Instagram  Goodreads

Today our guest is the producer and author of a fun romance podcast called Consensual Podcast. This is a fun interactive audio experience. In this interview, we chat about what inspired them to get started,  about the story and of course a round of book recommendations.   BOOKS RECOMMENDED: Get a Life, Chloe Brown by Talia Hibbert - https://amzn.to/31HXzt0 You Should See Me in a Crown by Leah Johnson -https://amzn.to/2QFyust Take a Hint, Dani Brown by Talia Hibbert - https://amzn.to/3hGW18l Wish You Were Here by Renee Carlino - https://amzn.to/3jtwgbS Conversations with Friends by Sally Rooney - https://amzn.to/2Ew1Bfu In the Dream House by Carmen Maria Machado - https://amzn.to/2YPUMfv Him by Sarina Bowen and Elle Kennedy - https://amzn.to/3bbUIMg Democracy and Black by Eddie Glaude Jr. - https://amzn.to/3lwbla6 Us by Sarina Bowen and Elle Kennedy - https://amzn.to/2YLUaaT WAGs series by Sarina Bowen and Elle Kennedy - https://amzn.to/34KLCEK Epic by Sarina Bowen and Elle Kennedy - https://amzn.to/3jpKaMc Heated Rivalry by Rachel Reid - https://amzn.to/3hLbhkr The Vanishing Half by Brit Bennett - https://amzn.to/3jtM3aJ The Wedding Party by Jasmine Guillory - https://amzn.to/34LfO2E Soft on Soft by Mina Waheed - https://amzn.to/2EDRchG CONNECT WITH CONSENSUAL PODCAST  Instagram  Podcast  JOIN PATREON COMMUNITY  Get weekly romance recommendations, early access to author interviews and exclusive Patreon audio series by joining the Patreon community. Monthly perks start at $1  a month. Want to join the fun? Sign up today; https://bit.ly/WTRNRomanceBookClub   FROLIC PODCAST NETWORK  What to Read Next Podcast is part of the Frolic Podcast Network. You can find more outstanding podcasts to subscribe to at Frolic.media/podcasts!    AMAZON AFFILIATE DISCLOSURE If you purchase a book through my Amazon link, I will receive a commission at no cost to you that will help cover the cost of the podcast    CONNECT WITH LAURA YAMIN  WhattoReadNextBlog.com Instagram  Goodreads  

In this 6th Anniversary Valentine's Day Special Ken finally welcomes his wife to the show to do an entire episode as the only guest. They look at an issue of the UK TV Times from 1986 and struggle with keeping their dogs under control. 

This week we welcome Julie Craft as a new host to Monday Meetings as well as guest, Rachel Reid from Gunner in Detroit, MI. Julie and Rachel talk about Rachel's background, her style, how to work with cel animators like herself, and take questions from the meeting participants. As always, you can find the full show notes or join in a future meeting at https://www.mondaymeeting.org

HAPPY HALLOWEEN! It's a super sized 2019 Halloween Special.   This year Ken welcomes back Lamont Price, Sam Furst (Monsters are Good) and Rachel Reid to the show. We watch the first three Halloween episodes of Roseanne (Season 2, 3 and 4) and discuss it and all things Halloween.

Ann has just wrapped filming on a new feature film, Rose Plays Julie opposite Aiden Gillen and Orla Brady and due for release in 2019. Ann was most recently seen playing the female lead, Beth Winters, opposite Jamie Dornan in DEATH AND NIGHTINGALES, an adaptation of the novel written and directed by Allan Cubitt, the creator of THE FALL, for BBCTV and due to air later this year. Ann appeared in the title role of independent feature film KISSINGCANDICE (2017) directed by Aoife McArdle for which she was nominated for a Rising Star Award and a Best Actress In A Lead Role at the 2018 IFTA’s. Ann appeared as Annie Moffat in the BBC mini series LITTLE WOMEN. Ann appeared as the recurring role of Rachel Reid in the IFTA award winning serialised Irish drama, RED ROCK for TV3 produced by Element Pictures and Angel Station, sold into BBC & Amazon prime. Ann also appeared as Biddy Lambert in RTE Drama Rebellion. Ann appeared as Hannah Baylor in the Blackpills series Playground for Apple TV France, a series created by Luc Besson.

Rachel Reid founded her cosmetics company, Subtl Beauty, to better serve women on the go. Her line of makeup products comes in compact, customizable stacks that can be easily thrown into a purse or bag.   Rachel first realized this need when she was consulting during the summer of 2016. Since she wasn’t even spending 2 nights a week in her own home, she needed a beauty solution that traveled well and could fit in a small clutch.   Now, she is challenging the status quo of lazy, bulky cosmetic design. In this conversation, Rachel shares how she does extensive A/B testing to get the most out of her ads, why she studies companies like Stitch Fix, and the goals she is pursuing.   Never miss one of our best episodes by subscribing to the newsletter.   Rachel’s Challenge; Start your day with consuming good information.   Resources Daily Carnage Shopify Blog Adweek Newsletter Marketing School   Connect with Rachel Linkedin Facebook Instagram Website Rachel’s Instagram   If you liked this interview, check out episode 352 with Kate Zarvis where we discuss running a nail salon, how to retain talent, and how to create a space where clients can relax. Underwritten by Piper Creative A digital agency that provides strategy, delivery, and analysis specializing in a few key service offerings. Documentary-as-a-Service (Vlogging 2.0) Instagram Content Production & Account Building Podcast Production, Strategy Consulting, and Guest Acquisition   If you aren’t creating or curating content regularly, your clients and customers might forget you’re open for business. YouTube Instagram Subscribe on iTunes | Stitcher | Overcast | PodBay

The show kicks off with the guys wishing everyone a Happy New Year. Jeff talks about the nomination that Schooled (Codename: Winger #2) received in the Goodreads M/M Members' Choice Best of 2018 awards. Christmas movies are quickly discussed as Jeff & Will wrote about their favorites in blog posts this week. The Kennedy Center Honors, featuring Adam Lambert making Cher cry, is also called out. The review section kicks off with the Netflix film Dumplin'. Will reviews Peppermint Spiced Omega by Susi Hawke and Better Not Pout by Annabeth Albert. Jeff reviews Game Changer by Rachel Reid. The reading of 2018 is recapped, including a look at trends and favorites for Jeff & Will. There's also a peek into their plans for 2019. Complete shownotes for episode 169 are at BigGayFictionPodcast.com.

It's the 2018 TV Guidance Counselor Halloween Special! This year Ken reunites the Halloween TV Special Forces A-Team of Monsters are Good's Sam Furst and Ken's Wifes is Great's Rachel Reid to watch and discuss the 1986 Sunday Night Disney Made-for-TV Special Mr. Boogedy.   Happy Halloween!  

This week we hear from Rachel Reid, the young and driven founder of Subtl Beauty (subtlbeauty.com), and then starting tomorrow (9/20/2018) we will all be able to follow along in real life, in real time to see how her Kickstarter product launch fares.  Rachel's an open book. She shares a number of useful anecdotes about how a fairly risk-averse corporate employee moved on to build a company, a product line and a pitch out of a hack she put together just for her own life. Listen to the show and then - starting tomorrow - follow Rachel's journey through Kickstarter to find out whether that pitch resonates with real customers.

What's it take to be a master of hand-drawn animation? In this interview we sit down with Rachel Reid, one of the best animators in the Motion Design world. Rachel's work at Gunner, one of the hottest Motion Design studios on the block, has been seen all over the world. Her animation work has been staff picked by Vimeo, picked-up on Motionographer, and we frequently talk about her work here on School of Motion. Rachel was kind enough to sit down and chat with Joey about her experience in the industry. In the podcast Rachel get’s into all of the details about her equipment and process. It’s fantastic insight into one of the most challenging disciplines in art. Enjoy! https://www.schoolofmotion.com/podcast/rachel-reid-animator-interview

For our annual Halloween special Ken welcomes returning guest Sam Furst (Monsters are Good) and surprisingly first time guest Rachel Reid (Ken's wife) to discuss the long thought lost made-for-TV Nickelodeon movie Cry Baby Lane, which aired on October 28, 2000.     

Ann Skelly is a young up and coming actress currently starring as a Rachel Reid in Red Rock the fifteen year old that has a relationship with a friend’s Dad. She is a 19 year old with a lot of opinions on the drawbacks of the educational system in Ireland and the benefits of home […] La entrada Episode 47 – Ann Skelly se publicó primero en Headstuff.