Podcasts about TPA

Welcome back to the Sentinel Pension Show! On our final episode before we take a break for the summer, Kasey and Melissa are breaking down a topic that is widely covered in the TPA world: plans that go off the rails. Our resident plan fixers break down the governing bodies that review these plans, what they're looking for when they come to audit plans, the safe harbor standard for deposit submissions, the types of corrections systems, and so much more! We hope y'all have a great summer and will come back to learn more with us next season! Have any questions about this episode's topic? Let us know!Visit our website for more information: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Sentinel Pension (sp-tpa.com)⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Call us at 225-300-8478⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on LinkedIn⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow us on Facebook ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Music by Adam Vitovsky

For more than a decade, the Tennessee Poultry Association has been hosting golf tournaments and a sporting clay shoot to raise money for scholarships to send students to college for the future of the poultry industry. And as executive director Tracy Rafferty said, TPA has raised more than $300,000, giving roughly $45,000 out each year.  

In this brutally honest episode of Restoration Pros Unplugged, Clinton James sits down with Bobby Thomas, CEO of Extreme Services, to unpack the evolving challenges of working with Third Party Administrators (TPAs) in 2025. From delayed payments to unrealistic SLAs and inconsistent claim volume, this episode dives deep into the operational and financial landmines that restoration contractors face when tied too tightly to TPA programs.Bobby brings unfiltered insights, real-world horror stories, and proven strategies for navigating today's increasingly rigid and centralized TPA landscape. Whether you're struggling with cash flow, compliance fatigue, or pipeline instability, this conversation will arm you with the clarity and tactics needed to regain control of your business.What You'll Learn:Why TPA payment delays are worse than ever—and what to do about itHow to build systems that meet rigid SLAs without burning out your teamThe dangerous downside of claim volume inconsistencyStrategies to reduce TPA dependency and diversify your lead flowBobby's rapid-fire take on myths, tools, and whether he'd build with TPAs againIf you're working with TPAs—or considering it—this is required listening.If you're interested in learning how Water Restoration Marketing can help you overcome the challenges discussed in this episode and get more water jobs, book a free strategy session with our team today!https://www.waterrestorationmarketing.net/schedule

In this episode, Bill welcomes Steve Novakovic, Managing Director of Educational Programs for CAIA Association, to discuss the evolving nature of endowment investing, the growing role of total portfolio approaches (TPA), and the shifting responsibilities of asset allocators. Steve shares his journey from working at the Cornell University Investment Office to shaping the CAIA curriculum, emphasizing how events like the global financial crisis and modern portfolio theory shaped his views. They also explore the role of diversification in portfolio construction, the importance of due diligence and manager selection, the rising impact of retail democratization, and the ethical foundation needed to support long-term credibility in the profession. Steve further outlines how CAIA is adapting its curriculum, introducing proprietary ethical principles, and leading with new educational tools like the UniFi platform.

What happens when a CFO with a knack for numbers and a passion for people builds an offshore HR powerhouse from scratch—and grows it to 500 employees without a single cold call? In this episode of Sharkpreneur, Seth Greene speaks with John Sansoucie, founder of CogNet, an offshore HR powerhouse that now boasts over 500 employees and a place on the Inc. 5000 list. John reveals how he assists HR firms in scaling quickly by discreetly managing payroll, benefits, taxes, and accounting behind the scenes—often reducing costs by more than half. Find out how he transformed a labor crisis into a competitive advantage and why some of the industry's leading players now rely on his extended office model. Key Takeaways: → How a turnaround crisis led to a global HR empire. → Why one bold leap during COVID changed everything for CogNet. → The hidden cost most companies ignore when trying to scale. → What it takes to build a 500-person offshore team from scratch. → Why the “extended office” mindset is rewriting the rules of outsourcing.   John Sansoucie launched CogNet in 2004 after waking up in India with a bold vision, backed by 27 years of experience in TPA, HRO, and PEO. He has built and managed multiple global service operations and held senior executive roles at top HR outsourcing firms, including CFO at US Personnel and VP at Advantec. John holds a Finance degree from the University of Missouri and an MBA from the University of South Florida. Connect With John: CogNet Facebook LinkedIn   Learn more about your ad choices. Visit megaphone.fm/adchoices

On today's MJ Morning Show: Diddy trial set to begin Target may be getting rid of self-checkout Morons in the news Purple warning Fester got free food for a year This is the worst way to start an e-mail at work MJ's flights Cardinal Pizzaballa MJ IG at TPA... IKR? Kentucky Derby Ferry collision McDonald's Sprite hack First garage door opener winner Arizona bar has bad promotional response to underage drinking busts MJ vacation plans for summer Nike pre-scuffed sneakers? The Sun says there's a cheaper supermarket than Publix opening locations Air traffic controller stays not to fly to THIS airport A pilot's wife says not to to wear this on a flight Lady Gaga concert bomb plot foiled Hi Speed chase on Gandy Blvd. NYU dorm story Woman in Polk County throws can of soda into a car at a gas station, hits baby

Will Stewart joins Party for Two to discuss the top stories of the day. Then, Clayton Campbell from the TPA discusses public safety and the associations endorsement of the Conservatives. The province has been ordered to pause bike lane removal until the Charter case is decided, Marc Collins from Balance on Bloor weighs in. Then, Brian and Jerry Agar discuss the released bodycam footage of a police altercation with a 16-year-old.

Los asturianos somos un ejemplo de responsabilidad financiera. Así lo dice un estudio europeo, que nos sitúa en muy buena posición, nueve de cada diez asturianos tienen sus facturas al día,. Comentamos con oyentes y opinantes. Mario Bango nos trae desde Bruselas toda la actualidad europea en clave asturiana. Amanda Granda vuelve con su “Diccionario para Boomers” y Marta Teijido con su “Clasioteca”. Marga Llano, productora y una de las presentadoras de “La Copa de Escanciadores”, el nuevo programa de TPA, nos invita al estreno. La actualidad rural nos la trae Juan Prado Castañón, que lucha activamente contra la avispa velutina en nuestra región. Cerramos conociendo la problemática de los pequeños locales de Gijón, bares, librerías, sidrerías, para programar música en directo de pequeño formato, lo que dio lugar a cancelar el programa cultural “Siente Gijón”. Nos visitan de las plataformas “Unidos por la Cultura en Asturias” y “La Caja de Músicos”.

Welcome to RIMScast. Your host is Justin Smulison, Business Content Manager at RIMS, the Risk and Insurance Management Society.   Justin and his guest, Tamieka Weeks, discuss highlights from her risk career and how she felt, pivoting from claims adjusting to risk management. Tamieka tells of her role at Southwire and how she helps the evolving risk and insurance group. Tamieka digs into challenges she has faced at Southwire and in the RIMS Atlanta Chapter, where she serves on the board as a past president. She tells how the Chapter survived and improved during COVID-19. Tamieka speaks of her instant love of risk management and the excitement of waking up each day not knowing what was coming next. Tamieka provides advice for rising professionals and tells how the RIMS Atlanta Chapter works with risk and insurance students. Listen to Tamieka's advice for you. Key Takeaways: [:01] About RIMS and RIMScast. [:15] Registration is open for RISKWORLD 2025. Engage Today and Embrace Tomorrow with RIMS, from May 4th through May 7th in Chicago, Illinois. Register at RIMS.org/RISKWORLD. [:26] After you register, visit your App Store, search for RIMS Events, and download the RIMS Events App. Select RISKWORLD 2025, load the show onto your phone, and start building your RISKWORLD itinerary! [:42] About this episode of RIMScast. Our guest is former RIMS Atlanta Chapter President, Tamieka Weeks. We will talk about her career journey and all the fantastic work she's done for the RIMS Atlanta Chapter. [1:07] In the spirit of National Electrical Safety Month, we will learn how she drives a culture of safety at Southwire. [1:15] RIMS-CRMP Workshops! RIMS is co-hosting an intensive four-day program which is your gateway to achieving two prestigious certifications, the DRI Certified Business Continuity Professional (CBCP) and the RIMS Certified Risk Management Professional (RIMS-CRMP). [1:34] This workshop will be held from May 19th through the 22nd in collaboration with DRI International. Links to these courses can be found through the Certification page of RIMS.org and this episode's show notes. [1:49] Virtual Workshops! On June 12th, Pat Saporito will host “Managing Data for ERM” and she will return on June 26th to present the very popular new course, “Generative AI for Risk Management”. [2:06] A link to the full schedule of virtual workshops can be found on the RIMS.org/education and RIMS.org/education/online-learning pages. A link is also in this episode's show notes. [2:17] RISKWORLD registration is open. Engage Today and Embrace Tomorrow, from May 4th through 7th in Chicago. Register at RIMS.org/RISKWORLD. Also, remember that there will be lots of pre-conference workshops being held in Chicago just ahead of RISKWORLD. [2:35] These courses include “Applying and Integrating ERM,” “Captives as an Alternate Risk Financing Technique,” and more! The links are in the show notes. [2:45] The Spencer Educational Foundation is having a Flash Sale for sponsorships at RISKWORLD! Sponsorship pricing has been reduced for the Spencer-CNA Pickleball Social on Saturday, May 3rd, and the Spencer-Gallagher Golf Tournament on Sunday, May 4th. [3:03] Sponsorships are still available for the Spencer-Sedgwick 5K Fun Run on Tuesday, May 6th. Visit Spencered.org/riskworld2025 to learn about these opportunities and more. Also, reach out to Spencer's Executive Director Megan Miller at MMiller@Spencered.org. [3:26] Our guest today is the Director of Global Risk Management and Insurance at Southwire Company in Georgia. She is also the former RIMS Atlanta Chapter President. Under her leadership, the chapter took home the RIMS 2022 Chapter of the Year Award at RISKWORLD. [3:46] She is Tamieka Weeks and I am so thrilled to finally get her on RIMScast to talk about her career journey, her work at Southwire, and what it was like to lead the RIMS Atlanta Chapter. [3:59] We will also talk about how Tamieka helps drive a culture of safety at Southwire, in the spirit of National Electrical Safety Month, coming up in May. [4:08] Interview! Tamieka Weeks, welcome to RIMScast!  [4:31] Tamieka Weeks started as a claims adjuster with a finance degree. Her career has been so different from many. Tamieka hopes all will take their journey for what it's worth and be proud of their accomplishments. [5:08] When someone approaches you with an opportunity, say Yes! Don't turn it down. You never know what doors may open. As a former claims adjuster, and now the Director of Global Risk Management and Insurance, she wants to have a relationship with the claims adjusters. [5:45] In a file review, Tamieka wants to know the why behind an insurance policy. She purchases a policy with the intent of protecting Southwire's assets. [6:29] Southwire is about an hour west of Atlanta, in Carrollton, Georgia. It is the leading manufacturer of wiring cable. Southwire will celebrate 75 years in March of 2030. Southwire is excited about where it is today and is looking forward to continuing to grow globally. [7:13] Tamieka knows to expect the unexpected and be able to pivot. She never knows what may come up in a day. She is open. She knows she is there to support the organization. [7:38] Tamieka is a trusted advisor and a subject matter expert within the organization. She prides herself on ensuring that everyone knows that she is here to support them. [7:54] Southwire has 9,000 employees. In November 2024, Southwire launched a risk management SharePoint site. It goes into risk management insurance definitions and surety bonds definitions. It's all about sharing the knowledge of the industry. [8:26] The SharePoint site also provides the claims reporting. Tamieka educates the employees on what to do when an incident occurs. The first thing is to report the claim to the TPA. If they have any questions, they can contact Tamieka. Tamieka is also responsible for surety bonds. [9:16] There is a checklist for property claims and those are reported to Tamieka. The instructions for what needs to happen on a property claim are on the SharePoint site. It's important to notify Tamieka so she can report the property claim. [9:32] It's all about everyone being aware of what needs to happen about an event. [9:41] Tamieka has been with Southwire for almost 12 years. She helped build the risk culture at Southwire. It's been a fun ride, for sure! [9:53] Tamieka partnered with several team members to develop the SharePoint site. It's been exciting for the organization. It was launched by the IT department and several others. Tamieka had spoken with risk professionals throughout the industry about what they were launching. [10:33] The beauty of the risk industry is that we don't have to reinvent the wheel. It's all about what we can do to enhance their organization through process improvement. [11:00] When Tamieka started with Southwire, she was busy administering certificates of insurance. The SharePoint site streamlines everything in a central location. People can see their insurance limits, request what they need, and submit information to their insurance brokers. [11:45] Tamieka's risk team of about 5 people reports to the General Counsel department. [12:27] Plug Time! RIMS Webinars! On April 24th, Riskonnect returns to deliver “Better Together: The Marriage of Insurable Risk and Business Continuity.” Nonmembers can use the code BETTER50 at checkout for complimentary registration. [12:44] Zurich's webinar, “Understanding Third-Party Litigation Funding” was rescheduled and will be held on May 1st at 1:00 p.m. Eastern. [12:52] If you were already registered for the original date, you do not need to take any action: You are now registered for the May 1st session with Zurich about “Understanding Third-Party Litigation Funding.” [13:04] On May 22nd, webinars are back with GRC, a TÜV SÜD Company, and their newest session, “Asset Valuations in 2025: Managing Tariffs, Inflation, and Rising Insurance Scrutiny”. [13:20] On June 5th, Zywave joins us to discuss “Today's Escalating Risk Trajectory: What's the Cause and What's the Solution?” We'll find out on June 5th! [13:31] More webinars will be announced soon and added to the RIMS.org/Webinars page. Go there to register. Registration is complimentary for RIMS members. [13:43] There was a brief extension for educational session submissions for RIMS Canada, which will be held from September 14th through the 17th in Calgary. The link is in this episode's show notes. Visit RIMSCanadaConference.ca and submit your session by April 24th. [14:00] Let's Return to Our Interview with Former RIMS Atlanta Chapter President Tamieka Weeks! [14:18] When Tamieka joined risk management, she loved it instantly because it's continually evolving. The market and your company are evolving and you have to be able to embrace the change. There are always new risks and emerging risks. [14:43] Once, cyber risk was new. Now the new risk we're talking about is AI. Who knows what new risk we will be talking about in the next nine months to a year? To be in the risk management industry, you have to love it to wake up each day not knowing what to expect. [15:16] Tamiela says the meaningful relationships that we establish from day to day, month to month, and year to year are truly amazing. The industry is amazing, as well, from Atlanta to global. She is excited about RISKWORLD 2025 in Chicago. [15:43] RISKWORLD 2025 will be held from May 4th through May 7th, in Chicago, Illinois. [15:47] May is also National Electrical Safety Awareness Month in the U.S. Southwire is always focused on safety, with monthly training for team members. They focus on team members from entering the facilities to exiting the facilities. Safety is number one. [16:28] Southwire's Environmental Health and Safety Department strives for safety. Southwire recently completed Lockout/Tagout training, a safety procedure for properly shutting off equipment to ensure that no one is accidentally injured if machinery is being serviced. [17:01] Tamieka says labeling is placed on Southwire wires and cables to ensure the customers are aware of how to use the products. Customers can also download information on the safe use of Southwire products. This is part of Southwire's Environmental Health and Safety efforts. [17:43] RIMS Plug! From Ryan Harris, upcoming Keynote on the Main Stage on May 6th at RISKWORLD 2025, “Greetings RIMS members and global risk professionals! I'm Ryan Harris, Champion of Super Bowl 50, best-selling author, and award-winning broadcaster. [18:02] “I'm thrilled to be your Main Stage Keynote for RISKWORLD 2025, where we will discuss the transformative five steps to building a championship team and leading to win! You can learn more about me and my story by listening to RIMScast. [18:18] ”And more than anything, make sure to register for RISKWORLD 2025 by visiting RIMS.org/riskworld. I'm so thrilled to see you and I'm looking forward to us building together so that you can reach your greatest success!” [18:33] Thank you, again, Ryan. We look forward to seeing you at RISKWORLD 2025 on May 6th. A link to Ryan's episode of RIMScast, #325, is in this episode's show notes. Get a preview of the Super Bowl Champion and remember to register for RISKWORLD 2025. [18:49] Let's Return to the Conclusion of Our Interview with Tamieka Weeks! [19:10] Tamieka describes practicing risk management in the greater Atlanta area. She says it's all about the people and the risk management community. Everybody just loves everybody! It's Southern hospitality. When she joined the Atlanta RIMS Chapter, it was very welcoming. [19:34] When Tamieka joined the board, the board members saw so much potential in her. They assured her she could do this. Tamieka says Atlanta is the land of opportunity. Tamieka joined the chapter in 2013. She became the first Black female President of the Atlanta Chapter. [20:38] Tamieka became Chapter President during COVID-19. Her thoughts were about what she could do to make the organization better and what she could do for succession planning. [20:59] Members were at home. Tamieka connected with the previous presidents and prior board members. No one was in person. Tamieka asked the previous officers for their notes. They were happy to talk and share ideas to make the chapter succeed. [22:02] That moment was more about the Chapter and less about Tamieka. Tamieka built committees and sent surveys. Tamieka wanted to hear what the members had to say. She gave the board and members a voice. It was a fun time, working to make the chapter better. [22:44] The feedback from past presidents was the foundation to win 2022 Chapter of the Year! Their ability and willingness to help Tamieka in her role made the RIMS Atlanta Chapter special. [23:33] The chapter had a virtual social hour with a mixologist. They had a virtual trivia game. They had a virtual mentor event. They raised money at a Virtual Aid Conference. They were creative in everything they did. They were able to connect with members in a challenging time. [24:20] The surveys were critical. They partnered with global RIMS to enhance their bylaws. The new bylaws permitted the board to meet virtually. They changed their chapter website. They made many improvements to the chapter's success. [24:58] In 2025, Tamieka received the Walter H. Buce Jr. Memorial Award which honors the insurance and risk management professional of the year in the RIMS Atlanta Chapter. Tamieka calls the award overwhelming. She is deeply honored. It means the world to her. [26:04] Tamieka's advice for young risk professionals: “Stay focused. When others see potential in you, listen to them. Don't shy away. Work hard. Set clear goals. Trust in yourself. Stay dedicated. Be persistent. Be intentional. Your path will eventually reveal itself. [29:29] “You're going to have people around you that are going to be your cheerleaders. Please find a mentor. They're going to support you along the way. In Atlanta, I would also say we have focused on bridging the gap of rising risk professionals and students entering the industry.” [27:08] “The RIMS Atlanta Chapter has embraced what we can do to help and support the young professionals who are focused on entering the industry soon. That's been a huge success for the RIMS Atlanta Chapter, as well.” [27:28] Tamieka Weeks, It's such a pleasure to see you again. I look forward to seeing you after this episode comes out, at RISKWORLD 2025 in Chicago. Tamieka is looking forward to seeing everyone, It's going to be a great RISKWORLD! [27:46] Special thanks again to former RIMS Atlanta Chapter President and Walter Buce Award Winner, Tamieka Weeks for joining us here on RIMScast! Learn more about her and the chapter's fantastic work through the link in this episode's show notes. Of course, visit AtlantaRIMS.org. [28:05] Plug Time! You can sponsor a RIMScast episode for this, our weekly show, or a dedicated episode. Links to sponsored episodes are in the show notes. [28:32] RIMScast has a global audience of risk and insurance professionals, legal professionals, students, business leaders, C-Suite executives, and more. Let's collaborate and help you reach them! Contact pd@rims.org for more information. [28:50] Become a RIMS member and get access to the tools, thought leadership, and network you need to succeed. Visit RIMS.org/membership or email membershipdept@RIMS.org for more information. [29:08] Risk Knowledge is the RIMS searchable content library that provides relevant information for today's risk professionals. Materials include RIMS executive reports, survey findings, contributed articles, industry research, benchmarking data, and more. [29:24] For the best reporting on the profession of risk management, read Risk Management Magazine at RMMagazine.com. It is written and published by the best minds in risk management. [29:38] Justin Smulison is the Business Content Manager at RIMS. You can email Justin at Content@RIMS.org. [29:46] Thank you all for your continued support and engagement on social media channels! We appreciate all your kind words. Listen every week! Stay safe!   Links: RISKWORLD 2025 — May 4‒7 | Register today! Download the RIMS Events app! Spencer's RISKWORLD Events — Register or Sponsor! RIMS Texas Regional 2025 — August 3‒5 | Advance registration rates now open. RIMS-Certified Risk Management Professional (RIMS-CRMP) RISK PAC | RIMS Advocacy RIMS Risk Management magazine RIMS Now The Strategic and Enterprise Risk Center Spencer Educational Foundation — General Grants 2026 — Application Dates Submit a session to RIMS Canada 2025 — Final Deadline April 24. RIMS Atlanta Chapter RIMS Webinars: RIMS.org/Webinars “Better Together: The Marriage of Insurable Risk and Business Continuity” | Sponsored by Riskonnect | April 24, 2025 “Understanding Third-Party Litigation Funding” | Sponsored by Zurich | May 1, 2025 “Asset Valuations in 2025: Managing Tariffs, Inflation, and Rising Insurance Scrutiny” | Sponsored by GRC, a TÜV SÜD Company | May 22, 2025 “Today's Escalating Risk Trajectory: What's the Cause & What's the Solution?” | Sponsored by Zywave | June 5, 2025   Upcoming RIMS-CRMP Prep Virtual Workshops: CBCP & RIMS-CRMP Exam Prep Virtual Bootcamp: Mastering Business Continuity & Risk Management | May 19‒22, 2025 | In Collaboration with DRI International Full RIMS-CRMP Prep Course Schedule “Managing Data for ERM” | June 12 | Instructor: Pat Saporito  “Generative AI for Risk Management” | June 26 | Instructor: Pat Saporito See the full calendar of RIMS Virtual Workshops RIMS-CRMP Prep Workshops   Related RIMScast Episodes: “ERM, Retail, and Risk with Jeff Strege” “Risk and Leadership Patterns with Super Bowl Champion Ryan Harris” (RISKWORLD 2025 Keynote) “Maintaining an Award-Winning ERM Program with Michael Zuraw” “RIMS Legislative Priorities in 2025 with Mark Prysock”   Sponsored RIMScast Episodes: “Demystifying Multinational Fronting Insurance Programs” | Sponsored by Zurich (New!) “Understanding Third-Party Litigation Funding” | Sponsored by Zurich “What Risk Managers Can Learn From School Shootings” | Sponsored by Merrill Herzog “Simplifying the Challenges of OSHA Recordkeeping” | Sponsored by Medcor “Risk Management in a Changing World: A Deep Dive into AXA's 2024 Future Risks Report” | Sponsored by AXA XL “How Insurance Builds Resilience Against An Active Assailant Attack” | Sponsored by Merrill Herzog “Third-Party and Cyber Risk Management Tips” | Sponsored by Alliant “RMIS Innovation with Archer” | Sponsored by Archer “Navigating Commercial Property Risks with Captives” | Sponsored by Zurich “Breaking Down Silos: AXA XL's New Approach to Casualty Insurance” | Sponsored by AXA XL “Weathering Today's Property Claims Management Challenges” | Sponsored by AXA XL “Storm Prep 2024: The Growing Impact of Convective Storms and Hail” | Sponsored by Global Risk Consultants, a TÜV SÜD Company “Partnering Against Cyberrisk” | Sponsored by AXA XL “Harnessing the Power of Data and Analytics for Effective Risk Management” | Sponsored by Marsh “Accident Prevention — The Winning Formula For Construction and Insurance” | Sponsored by Otoos “Platinum Protection: Underwriting and Risk Engineering's Role in Protecting Commercial Properties” | Sponsored by AXA XL “Elevating RMIS — The Archer Way” | Sponsored by Archer   RIMS Publications, Content, and Links: RIMS Membership — Whether you are a new member or need to transition, be a part of the global risk management community! RIMS Virtual Workshops On-Demand Webinars RIMS-Certified Risk Management Professional (RIMS-CRMP) RISK PAC | RIMS Advocacy RIMS Strategic & Enterprise Risk Center RIMS-CRMP Stories — Featuring RIMS President Kristen Peed!   RIMS Events, Education, and Services: RIMS Risk Maturity Model®   Sponsor RIMScast: Contact sales@rims.org or pd@rims.org for more information.   Want to Learn More? Keep up with the podcast on RIMS.org, and listen on Spotify and Apple Podcasts.   Have a question or suggestion? Email: Content@rims.org.   Join the Conversation! Follow @RIMSorg on Facebook, Twitter, and LinkedIn.   About our guest: Tamieka Weeks, Director, Global Risk Management & Insurance, Southwire Company, LLC     Production and engineering provided by Podfly.  

Ary Rosenbaum talks about his experience as a TPA attorney and why plan sponsors need to consider who they hire as TPA.

A Frente de Libertação do Estado de Cabinda (FLEC-FAC) declarou um cessar-fogo unilateral até 14 de Junho de 2025, em resposta à proposta da UNITA de levar a questão de Cabinda ao Parlamento. A trégua visa criar condições para o diálogo com o governo angolano. Em resposta, o secretário do Bureau Político do MPLA para a Informação, Esteves Hilário, afirmou à RFI "não haver conflito armado no norte do país". A vice-presidente da bancada parlamentar da UNITA, Navita Ngolo, defende uma resolução para pôr fim às hostilidades e garantir autonomia à província, através de um processo inclusivo e pacífico. Quais são os pontos centrais que compõem a proposta da UNITA que pretende apresentar ao parlamento sobre esta questão de Cabinda?Navita Ngolo: Tal como acompanhamos, a comunidade internacional e nacional, o grupo Parlamentar da UNITA realizou as 12ªs Jornadas Parlamentares em Cabinda, de 25 a 30 de Março, e, na sequência, o grupo parlamentar da UNITA, no âmbito daquilo que é a situação político-militar daquela parcela de território, propôs que vai submeter à Assembleia Nacional um projecto de resolução que exija a paralisação definitiva das hostilidades militares em Cabinda. Porque constatamos que as populações de várias zonas da província de Cabinda vivem com medo, vivem numa situação em que têm de abandonar as suas zonas de vivência por causa da instabilidade militar que ainda decorre entre as forças angolanas e as forças da FLEC.Pelo que, no nosso ponto de vista, esta é uma matéria sobre a qual o parlamento se deve pronunciar, numa altura em que o país, no seu geral, está há 23 anos em paz militar, sobretudo. E, portanto, é importante que, mais do que sermos mediadores de outros conflitos, como o exemplo dos Grandes Lagos, do Congo, precisamos de encontrar a paz definitiva para todo o território angolano, nos termos da actual Constituição.É nesta lógica que nós entendemos que o grupo parlamentar da UNITA deve ter essa iniciativa, apresentá-la ao parlamento para que o parlamento discuta a situação real militar de Cabinda e se encontre uma solução pacífica, de negociações, de diálogo - um diálogo não para humilhar, não para ver quem ganha ou quem perde, mas um diálogo que facilite e devolva a paz a Cabinda.O grupo parlamentar da UNITA apresentou um projecto de lei sobre autonomia local, numa espécie de autarquia supra-municipal para Cabinda, que pode sim, senhor, mitigar algumas fontes de conflitos, dando àquela parcela a autonomia política, administrativa e financeira. E acho que é nessa lógica que vem o comunicado da FLEC de poder também participar, de poder acompanhar este processo que vai ser tratado pela Assembleia Nacional, sob proposta do grupo parlamentar da UNITA.Quando está prevista a apresentação dessa proposta no parlamento?Nós vamos ter agora uma plenária no dia 23. A partir do dia 1 até ao dia 23, o grupo parlamentar da UNITA vai levar ao conhecimento público, nacional e internacional, todos os trâmites sobre estes dois documentos: sobre a questão pacífica de se encontrar a paz e também o projecto de lei sobre autonomia local de Cabinda. Estamos agora a fechar a fase das contribuições da sociedade civil, para que a sociedade de Cabinda possa fechar o projecto e remetê-lo à Assembleia Nacional.E pergunto-lhe, senhora deputada, considera que há vontade política suficiente por parte do MPLA, partido no poder, do executivo, para aceitar um diálogo inclusivo com Cabinda?Depois do filme que vi ontem na TPA, em que, fruto do comunicado da FLEC, fruto daquilo que são as propostas do grupo parlamentar da UNITA, foi apresentada uma citação de pessoas supostamente dissidentes da FLEC... Eu, sinceramente, falando sobre a vontade política do MPLA, penso que esta vontade não ultrapassa [certos limites], mas o grupo parlamentar da UNITA, a UNITA, a sua liderança, na pessoa do presidente Adalberto Costa Júnior, está a encetar contacto com a sociedade, com as igrejas. Vamos fazer a nossa parte, tal como nos habituámos: a buscar os caminhos do diálogo, para que haja verdadeiramente paz em todo o território nacional, com a actual Constituição.Estamos perante uma guerra de comunicados. A FLEC-FAC tem, nos últimos anos, denunciado ataques; o executivo desmente?Eu penso que, e nós estivemos no terreno, somos representantes do povo, temos dados, ouvimos os relatos de populações que têm medo de ir às suas aldeias. Portanto, a questão do conflito em Cabinda é um facto, e é preciso ouvir, em primeiro lugar, a voz do povo. Eu convido mesmo a RFI a fazer uma visita a Cabinda e ouvir os populares de lá, porque essa guerra de comunicados políticos não resolve o problema real, que é vivido pela juventude, pelas crianças, pelas mulheres que querem cultivar e buscar o seu pão de cada dia.A UNITA pretende, como dizia no início desta entrevista, envolver a sociedade civil, a sociedade cabindense neste processo, para que a solução não seja apenas institucional. Vocês também querem que seja uma solução representativa?É o que estamos a dizer desde o princípio. Nós estamos em conexão com a sociedade civil, sobretudo com as igrejas, com as organizações da sociedade civil que trabalham nesses processos de pacificação. Fomos até Cabinda ouvir todas as franjas da sociedade, todas as vontades - até aquelas que são claramente defensoras da independência de Cabinda. Ouvimos todos os grupos ainda existentes e estamos a continuar a receber contribuições para o projecto de lei que apresentámos à sociedade, para consulta pública.E, portanto, entendemos que a paz para Cabinda, a paz definitiva para todo o território angolano, não depende só das vontades dos políticos. Precisamos de incluir todos. Inclusive estamos a consultar as embaixadas, porque Angola está no concerto das nações e, com certeza, tem de ter esses relacionamentos, buscar conselhos e experiências de outros povos.Acredita que esse projecto de lei, para conceder autonomia a Cabinda, pode passar num parlamento onde o partido no poder, o MPLA, tem maioria?Eu penso que... e vamos voltar àquilo que chamamos de vontade política. Vamos também passar por aquilo que podemos chamar de responsabilidade política: se queremos desenvolvimento, se queremos inclusão social, se queremos, acima de tudo, ultrapassar as querelas partidárias, devemos colocar Angola em primeiro lugar. E colocar Angola em primeiro lugar é olhar, exactamente, primeiro para a questão das autarquias. Em Angola, é um imperativo constitucional desde 1977, e as autarquias já deviam ter lugar em Angola.Nós pensamos que, neste processo autárquico, a questão de Cabinda deve ser tratada de forma especial - não da forma especial como vem sendo tratada com os 10% do orçamento que o povo não vê, não sente. Basta olhar para a pobreza em que estão mergulhados os cidadãos de Cabinda. E, portanto, pensamos que é preciso ter vontade política, encontrar um caminho que coloque todos nos trilhos do desenvolvimento, da inclusão social.E penso que um partido maduro, uma liderança angolana madura - e é isso que se chama consciência política, maturidade política e, sobretudo, o bem-fazer - deve abraçar essa diplomacia política, essa diplomacia social, para que todos nós, MPLA, UNITA e outros partidos, a sociedade, as igrejas, sobretudo, possamos encarar este processo de paz definitiva para Angola, olhando para a implementação das autarquias com responsabilidade, com sentido de Estado e, sobretudo, com patriotismo.O que está a dizer é que é preciso encontrar vontade política para que as eleições autárquicas aconteçam, já que têm vindo a ser adiadas e estavam previstas para 2020, mas, nos últimos cinco anos, não aconteceram?Vontade política só não basta. É preciso amar Angola, é preciso ser patriota. É preciso realmente não sermos apenas gestores do poder, mas usarmos o poder para realizar as aspirações dos angolanos, as aspirações do povo de Cabinda.As autarquias são um modelo de governação que torna governados e governantes mais próximos e permite a resolução célere dos problemas que afectam as comunidades - e, fundamentalmente, a participação directa das mesmas comunidades na resolução desses problemas. Quem não quer a participação dos cidadãos, quem adia as autarquias como tem adiado, não tem o direito de manter-se no poder. E, se calhar, é preciso pôr o poder à disposição e deixar que os angolanos definam o seu futuro, o seu presente e, sobretudo, resolvam os seus problemas.

Welcome to RIMScast. Your host is Justin Smulison, Business Content Manager at RIMS, the Risk and Insurance Management Society.   Justin and his guest, Jeff Strege, Senior Director for Risk Management at Academy Sports + Outdoors, explore what led Jeff to risk management, and the path that led to Academy Sports + Outdoors within the sporting goods and outdoor retail space. Jeff comments on his work building out the ERM framework at Academy to improve claims management, employee safety, and liability prevention. Jeff shares his approach to workers' compensation and Academy Sports + Outdoors's goal to help the workers recover and return to work. In addition to career insights, they discuss Jeff's upcoming panel participation in HUB's webinar on April 17th, “From Defense to Prevention: Strengthening Your Liability Risk Management Approach,” covering topics such as third-party litigation funding and its impact on the industry.   Listen to Jeff's wisdom, born from experience, on managing your risk career. Key Takeaways: [:01] About RIMS and RIMScast. [:14] Registration is open for RISKWORLD 2025. Engage Today and Embrace Tomorrow with RIMS, from May 4th through May 7th in Chicago, Illinois. Register at RIMS.org/RISKWORLD. [:25] After you register, visit your App Store, search for RIMS Events, and download the RIMS Events App. Select RISKWORLD 2025, load the show onto your phone, and start building your RISKWORLD itinerary! [:41] About this episode of RIMScast. Our guest is former RIMS Houston Chapter President, Jeff Strege. We will talk about his career and how ERM continues to play a pivotal role today. [1:08] RIMS-CRMP Workshops! As part of RIMS's continuing strategic partnership with Purima, we have a two-day course coming up on April 22nd and 23rd. Links to these courses can be found through the Certification page of RIMS.org and this episode's show notes. [1:28] Virtual Workshops! On June 12th, Pat Saporito will host “Managing Data for ERM” and will return on June 26th to present the very popular new course, “Generative AI for Risk Management”. [1:45] A link to the full schedule of virtual workshops can be found on the RIMS.org/education and RIMS.org/education/online-learning pages. A link is also in this episode's show notes. [1:56] RISKWORLD registration is open. Engage Today and Embrace Tomorrow, from May 4th through 7th in Chicago. Register at RIMS.org/RISKWORLD. Also, remember that there will be lots of pre-conference workshops being held in Chicago just ahead of RISKWORLD. [2:14] These courses include “Applying and Integrating ERM,” “Captives as an Alternate Risk Financing Technique,” “Contractual Risk Transfer,” “Fundamentals of Insurance,” “Fundamentals of Risk Management,” RIMS-CRMP Exam Prep, and more! The links are in the show notes. [2:33] The Spencer Educational Foundation is having a Flash Sale for sponsorships at RISKWORLD! Sponsorship pricing has been reduced for the Spencer-CNA Pickleball Social on Saturday, May 3rd, and the Spencer-Gallagher Golf Tournament on Sunday, May 4th. [2:51] Sponsorships are still available for the Spencer-Sedgwick 5K Fun Run on Tuesday, May 6th. Visit Spencered.org/riskworld2025 to learn about these opportunities and more. Also, reach out to Spencer's Executive Director Megan Miller at MMiller@Spencered.org. [3:13] Our guest today is Jeff Strege. He is the Senior Director for Risk Management at Academy Sports + Outdoors. Academy is one of the U.S.'s largest sporting goods and outdoor stores with 301 locations across 21 states, as of March 2025. [3:33] Jeff is also a long-time RIMS member. He's the former president of the RIMS Houston Chapter and is a RIMS-CRMP holder. [3:41] In addition to his outstanding resume, Jeff will be lending his insight to the RIMS Webinar on April 17th, presented by HUB in their Ready for Tomorrow series. It's called “From Defense to Prevention: Strengthening Your Liability Risk Management Approach.” A link is in the notes. [4:01] In today's RIMScast interview, we will discuss how ERM has played a role in his career and how he manages risk in so many locations at the Academy. We will get a preview of his upcoming appearance on the Hub webinar and his thoughts on third-party litigation funding and its impact. [4:27] Interview! Jeff Strege, welcome to RIMScast! [4:45] As a Houstonian, Jeff grew up with Academy Sports + Outdoors. He's a long-term customer. In September 2020, Jeff promoted himself from customer to team member, although he still is an avid customer of Academy. [5:07] As the Academy brand is so well-known and beloved in Texas, Jeff has had the Risk Director role on his radar for many years. He had told his wife many times that if that role ever opened up at Academy, he would want to talk to them. In mid-2020, it did, and here he is! [5:29] Academy has 301 stores across 21 states as of March 7, 2025, and is headquartered in Katy, Texas, a Western suburb of Houston. Jeff graduated from Katy High School. [6:23] Academy Sports + Outdoors sells fun. They say “Have fun out there.” The items Academy sells are intended to help people be outdoors and active. Academy does a lot of work around product safety with manufacturers and suppliers, making sure they're sourcing safe products. [6:45] Academy Sports + Outdoors sells firearms and ammunition. Its goal is to be the most responsible retailer of those items in the country. [7:13] Academy Sports is responsible for following the laws of 21 states. Jeff has worked for national, multi-national, and global organizations, so he has worked with similar requirements. [7:48] Jeff worked for Sysco twice, first in the 90s and then in 2016 in a risk role similar to his current role at Academy Sports. Sysco went on a growth initiative while Jeff was there the second time and it was fun to be part of that but he couldn't pass up the opening at Academy. [8:23] Academy Sports + Outdoors has a risk department of 10 who report to Jeff. Jeff oversees the Enterprise Risk Management framework, the Insurance and Data Analytic functions, the Safety functions, and the Claim Management functions. [8:50] Jeff has three direct reports and they have functional contributors who are assigned to and report to them. Jeff's management style is to find the best possible people he can find. He's not a micro-manager. All of his staff are solid professionals who are good at what they do. [9:14] That allows Jeff to focus on strategy and executing strategic objectives while the staff keeps things working from day to day. Jeff reports to the General Counsel. In other companies, Jeff has reported to the General Counsel, HR, Treasury, or Finance. [9:42] Risk can logically report up a variety of chains to the leadership of an organization, as it touches so many aspects of the business. [10:22] Relative to firearms sales, Academy Sports has a compliance team to manage the process. They do an outstanding job. [10:39] When Jeff arrived at Academy Sports, one of his charges was to mature the ERM framework across the various organizational functions. Having the opportunity to work on that made Jeff a student of the business, which is one of the Academy's values. [11:09] Coming into the business, Jeff was fortunate to receive a safety culture already well-entrenched in the distribution centers. That team has been retooled over the years and continues to evolve as it trains and supports the operators in safe practices in their work. [11:45] Academy workers' compensation goal is to help team members recover so they can come back to work. They take a deliberate approach to working with them so they get the treatment they need, their benefits are paid timely, and their questions are answered. [12:11] Academy made a TPA change a couple of years ago that's given them more proactive tools. Both safety and claims are processes that Academy Sports continues to fine-tune. [12:25] The foundational strategy is “safety first.” If you're talking about managing claims but not about safety, there's a miss there, in terms of managing risk. [13:01] Plug Time! During this interview, we discuss the RIMS Texas Regional Conference 2025, held from August 4th through the 6th in San Antonio, Texas, at the Henry  B. Gonzalez Convention Center. That's where we held RISKWORLD 2018. [13:22] The day of this episode's release, April 15th, is the day registration opens for the RIMS Texas Regional Conference. You can get the Advance Rate from now through May 16th, 2025. A link is in this episode's show notes. You can also visit the events page of RIMS.org to register. [13:43] If you will be in the Dallas/Fort Worth area on April 17th, be sure to stop by Lonestar Park for DFW RIMS's 7th Annual Night at the Races. It will be a blast! Guest, Member, and Student tickets are available. Visit DFWRIMS.org and the link in this episode's show notes. [14:12] Let's Return to My Interview with Former RIMS Houston Chapter President Jeff Strege! [14:32] Jeff arrived at Academy Sports on Monday, September 28, 2020, and the company executed its Initial Public Offering on Friday, October 2nd, 2020. In preparing for the IPO, the company had built an ERM framework that helped inform the prospectus for investors. [14:59] When Jeff joined, he was charged with taking the framework foundation and building upon it to round out how Academy Sports views risk, scopes it, and manages it across the organization. It was a fascinating process. [15:21] He's gotten to know many good, smart people who are driving aspects of the business. [15:28] Every year, Academy Sports looks at ways to enhance the framework, to make sure it's as meaningful and informative to the leadership team and board as it can be. [15:54] The framework looks at ISO standards but most of it is inward-focused within the business of Academy Sports. What's going on in the world? How do we prevent or prepare for it? Should something occur, what strategies do we have to respond, react to, and recover from it? [16:39] Before the recent tariffs were passed, the risk team had discussed tariffs generically. Tariffs appear as subsidiary risks in a few places within the framework. Nobody in an organization can control what government leaders do. [17:22] In a way, sporting goods is a seasonal industry. Academy Sports + Outdoors sells a variety of different things and operates in a variety of climates. There's a holiday season and there are gift-giving holidays. The seasons for outdoor activities differ depending on location. [17:54] In Texas, Jeff grills and fishes year-round. It's different in a Northern climate with four distinct seasons. Hunting seasons are specifically defined. The things Academy Sports sells peak at different times of the year and the peaks sort of offset themselves. [18:25] The Academy Sports merchandising teams are diligent and deliberate in how they plan for cycling products for the seasons. [18:44] Holiday is the big season. In that, Academy Sports is like other retailers. Back-to-school time is also important. [18:57] The backyard grilling is Jeff's favorite section of the store. When he goes into the store with his wife he has to look at some grills. Jeff also works out and runs so there are several aspects of the store that he shops. [19:16] Academy sells location-specific licensed apparel. In Academy Sports + Outdoors in Houston, there is gear for the Astros, Texans, and Rockets. [19:49] From the standpoint of team member safety, Jeff refers to OSHA. Also, some states have more stringent safety requirements. Jeff's safety team drives consistency of practices and training across the footprint of the 21 states where Academy Sports + Outdoors operates. [20:36] Most of Jeff's work is done in Houston but his team gets out in the field periodically on a schedule. Jeff likes to go into the stores and distribution centers. That's where the business occurs. The work at Corporate supports the people who serve and interact with customers. [21:10] RIMS Webinars! Following the success of their recent webinar, HUB International returns for the next installment of their Ready for Tomorrow Series, “From Defense to Prevention: Strengthening Your Liability Risk Management Approach”. That session will be on April 17th. [21:29] Today's guest, Jeff Strege, is a panelist in that session! He's going to talk about it a little bit right after the break. [21:38] On April 24th, RiskConnect returns to deliver “Better Together: The Marriage of Insurable Risk and Business Continuity”. [21:45] Zurich's webinar, “Understanding Third Party Litigation Funding” was rescheduled to May 1st at 1:00 p.m. Eastern. If you were already registered for the original date, you are now registered for the May 1st session with Zurich. [22:09] On May 22nd, GRC, a TÜV SÜD Company, presents their newest session, “Asset Valuations in 2025: Managing Tariffs, Inflation, and Rising Insurance Scrutiny”. [22:22] More webinars will be announced soon and added to the RIMS.org/webinars page. Go there to register. Registration is complimentary for RIMS members. [22:33] Let's Return to my Interview with Jeff Strege! [22:46] Jeff will be joining RIMS on the HUB webinar about third-party litigation funding (TPLF) on April 17th, two days after the airing of this episode. Third-party litigation funding is a major issue for RIMS and the profession. [23:08] Academy Sports + Outdoors sees TPLF from time to time in litigated matters, but not often. The HUB webinar is largely focused on rising litigation costs and the rising value of litigated matters. Third-party funding is a driving force of that rise. [23:35] When there's a funding mechanism behind the damages claim by a plaintiff, there are interest obligations with that mechanism, which can be stiff. It does inflate the value of some matters. [24:13] Once Academy Sports + Outdoors learns third-party funding is present in a litigated matter, that's in the front of mind as they evaluate and proceed with trying to conclude the case. [24:32] In the HUB webinar on April 17th, Jeff will be discussing the client's experience, not only with TPFL but also around social engineering. There is a good panel put together for this discussion with varied perspectives that will offer a well-rounded conversation. [24:55] Panelist Bob Tyson of Tyson & Mendes, a defense lawyer in California, has creative approaches to managing and negotiating litigated cases. Panelist John Ferguson, Head of Excess Casualty at Zurich Insurance, brings an insurer's perspective to the webinar. [25:29] Panelist Carol Murphy of HUB is one of the best brokers Jeff has worked with. Jeff is looking forward to sharing the stage with this group, talking about managing claims litigation, prevention, and pre-litigation management. Safety is critical. Jeff will bring that up. [26:02] The link to the webinar is in the show notes. Register today! Registration is complimentary for RIMS members! You'll hear this webinar live with Jeff Strege of Academy Sports, Fred Ferguson of Zurich, Bob Tyson of Tyson & Mendes, and Carol Murphy of HUB. [26:34] Jeff has been involved with RIMS since the mid-1990s when he was with Sysco Foods for the first time and was elevated to the risk management role there. Starting with Houston, Jeff has been involved in various chapters in various capacities. [27:07] RIMS has been an important part of Jeff's career. He's gained solid relationships through RIMS that have yielded business relationships and relationships where he's been able to help others and be helped by them. RIMS will be very important to him as long as he works in risk. [27:51] Jeff was President of RIMS Houston for two years, until January of 2024. He serves on the board as Past President. [28:12] Having moved around the country and having held different roles, Jeff has met risk professionals from many areas. He says RIMS has high-quality chapters all over the country. The four Texas RIMS chapters have a lot of positive energy. [28:47] The chapters are working together with Justin's team in New York to host the first-ever Texas RIMS Regional Conference this August. Jeff is on the planning committee and he's excited about it. [29:04] The RIMS Texas Regional Conference will be held from August 4th through the 6th at the Henry B. Gonzalez Convention Center in San Antonio, on the River Walk, the site of RISKWORLD 2018. San Antonio is Jeff's favorite city in Texas. It's a wonderful host city. [29:30] There is a link in the show notes to the RIMS Texas Regional Conference 2025. Registration will open the week of the airing of this episode! [29:49] Jeff is a RIMS-CRMP holder. He earned that certification in November of 2019. He was excited to see RIMS introduce the certification. What he likes about CRMP is its governance focus. [30:23] Jeff had been doing risk management for a long time. The CRMP website has good sample test questions on it. He decided to work through the test questions several times. Then went and took the exam and scored pretty well, largely based on his experience. [30:48] Jeff says his ERM work over the years was helpful. The RIMS-CRMP is a good designation. Jeff appreciates that RIMS gives CRMP holders opportunities to network. He will continue to carry the designation as long as he is working. [31:09] Mos recertification points are CE-related. Jeff relies heavily on the Houston chapter's offerings and the sessions and seminars at RIMS functions. He appreciates the flexibility in terms of what qualifies, such as participation in broker-sponsored industry education. [31:50] Developing and delivering educational content is a favorite of Jeff's. He has served as Risk Manager in Residence (now Risk Manager on Campus). Jeff tells every risk manager it's amazing and they need to do it at least once. Jeff enjoys education and is always learning. [32:24] Jeff shares his advice for risk professionals. As Boomers in the industry start to retire, it's important to help the industry recruit, train, and young talent. It's a passion of Jeff's. [32:52] There are a few things Jeff would tell young professionals. One is you are the CEO of your career. Your career is your responsibility. Don't wait for a leader to bring opportunities or promotions to you. Be a student of your craft and trade. Set goals with plans to achieve them. [33:20] Jeff has managed his career that way by making strategic moves when it made sense for him to do so. He has no regrets. You're the CEO of your career, all in. Don't wait for others to act on your behalf. Whatever it is, be a student of your craft and seek opportunities to learn. [33:45] Grow your knowledge base, your experience, and your network. Jeff has benefited from RIMS in having a network of people who lean on each other and learn from each other. It's a wonderful thing! [33:58] Be a student of your business, wherever it is. Make connections within it. Seek out mentorships to learn on a broad basis what the business does and what its objectives are. You position yourself more visibly to add more value and to grow. [34:29] Jeff Strege, you have been such an inspiration today. I appreciate you so much for joining us here on RIMScast and being so giving with your time and wisdom! I look forward to seeing you at the first-ever Texas Regional 2025, August 4th through 6th in San Antonio! [34:48] Special thanks again to Jeff Strege for joining us here today on RIMScast! I look forward to seeing him at many RIMS events, including the first-ever RIMS Texas Regional Conference 2025, which will be held from August 4th through the 6th in San Antonio, Texas. [35:05] Register today through the link in this episode's show notes. [35:12] Plug Time! You can sponsor a RIMScast episode for this, our weekly show, or a dedicated episode. Links to sponsored episodes are in the show notes. [35:37] RIMScast has a global audience of risk and insurance professionals, legal professionals, students, business leaders, C-Suite executives, and more. Let's collaborate and help you reach them! Contact pd@rims.org for more information. [35:56] Become a RIMS member and get access to the tools, thought leadership, and network you need to succeed. Visit RIMS.org/membership or email membershipdept@RIMS.org for more information. [36:13] Risk Knowledge is the RIMS searchable content library that provides relevant information for today's risk professionals. Materials include RIMS executive reports, survey findings, contributed articles, industry research, benchmarking data, and more. [36:29] For the best reporting on the profession of risk management, read Risk Management Magazine at RMMagazine.com. It is written and published by the best minds in risk management. [36:43] Justin Smulison is the Business Content Manager at RIMS. You can email Justin at Content@RIMS.org. [36:50] Thank you all for your continued support and engagement on social media channels! We appreciate all your kind words. Listen every week! Stay safe!   Links: RISKWORLD 2025 — May 4‒7 | Register today! Download the RIMS Events app! Spencer's RISKWORLD Events — Register or Sponsor! RIMS Texas Regional 2025 – August 3‒5 | Advance registration rates are now open. DFW RIMS - 7th Annual Night at the Races / Lone Star Park – April 17, 2025 RIMS-Certified Risk Management Professional (RIMS-CRMP) RISK PAC | RIMS Advocacy RIMS Risk Management magazine RIMS Now The Strategic and Enterprise Risk Center Spencer Educational Foundation — General Grants 2026 — Application Dates Announcement: RIMS and The Institute for Internal Auditors' Strategic Alliance on Education Nominations for the Donald M. Stuart Award [Canada] RIMS Webinars: RIMS.org/Webinars “Ready for Tomorrow? From Defense to Prevention: Strengthening Your Liability Risk Management Approach” | Sponsored by Hub International | April 17, 2025 “Better Together: The Marriage of Insurable Risk and Business Continuity” | Sponsored by Riskonnect | April 24, 2025 “Understanding Third Party Litigation Funding” | Sponsored by Zurich | May 1, 2025 “Asset Valuations in 2025: Managing Tariffs, Inflation, and Rising Insurance Scrutiny” | Sponsored by GRC, a TÜV SÜD Company | May 22, 2025   Upcoming RIMS-CRMP Prep Virtual Workshops: RIMS-CRMP Exam Prep with PARIMA | April 22‒23 Full RIMS-CRMP Prep Course Schedule   Upcoming Virtual Workshops: “Managing Data for ERM” | June 12 | Instructor: Pat Saporito  “Generative AI for Risk Management” | June 26 | Instructor: Pat Saporito See the full calendar of RIMS Virtual Workshops RIMS-CRMP Prep Workshops   Related RIMScast Episodes: “Maintaining an Award-Winning ERM Program with Michael Zuraw” “Scenario Planning with the RIMS SERMC” “ERMotivation with Carrie Frandsen, RIMS-CRMP” “Risk Quantification Through Value-Based Frameworks” “Applying ERM Theory with Elise Farnham” “On Risk Appetite and Tolerance”   Sponsored RIMScast Episodes: “Understanding Third-Party Litigation Funding” | Sponsored by Zurich (New!) “What Risk Managers Can Learn From School Shootings” | Sponsored by Merrill Herzog (New!) “Simplifying the Challenges of OSHA Recordkeeping” | Sponsored by Medcor “Risk Management in a Changing World: A Deep Dive into AXA's 2024 Future Risks Report” | Sponsored by AXA XL “How Insurance Builds Resilience Against An Active Assailant Attack” | Sponsored by Merrill Herzog “Third-Party and Cyber Risk Management Tips” | Sponsored by Alliant “RMIS Innovation with Archer” | Sponsored by Archer “Navigating Commercial Property Risks with Captives” | Sponsored by Zurich “Breaking Down Silos: AXA XL's New Approach to Casualty Insurance” | Sponsored by AXA XL “Weathering Today's Property Claims Management Challenges” | Sponsored by AXA XL “Storm Prep 2024: The Growing Impact of Convective Storms and Hail” | Sponsored by Global Risk Consultants, a TÜV SÜD Company “Partnering Against Cyberrisk” | Sponsored by AXA XL “Harnessing the Power of Data and Analytics for Effective Risk Management” | Sponsored by Marsh “Accident Prevention — The Winning Formula For Construction and Insurance” | Sponsored by Otoos “Platinum Protection: Underwriting and Risk Engineering's Role in Protecting Commercial Properties” | Sponsored by AXA XL “Elevating RMIS — The Archer Way” | Sponsored by Archer   RIMS Publications, Content, and Links: RIMS Membership — Whether you are a new member or need to transition, be a part of the global risk management community! RIMS Virtual Workshops On-Demand Webinars RIMS-Certified Risk Management Professional (RIMS-CRMP) RISK PAC | RIMS Advocacy RIMS Strategic & Enterprise Risk Center RIMS-CRMP Stories — Featuring RIMS President Kristen Peed!   RIMS Events, Education, and Services: RIMS Risk Maturity Model®   Sponsor RIMScast: Contact sales@rims.org or pd@rims.org for more information.   Want to Learn More? Keep up with the podcast on RIMS.org, and listen on Spotify and Apple Podcasts.   Have a question or suggestion? Email: Content@rims.org.   Join the Conversation! Follow @RIMSorg on Facebook, Twitter, and LinkedIn.   About our guest: Jeff Strege, MBA, ARM, RIMS-CRMP, Sr. Director, Risk Management, Academy Sports + Outdoors   Production and engineering provided by Podfly.  

In this episode of Alternative Allocations, Tony and Aaron discuss the Total Portfolio Approach (TPA), which shifts from traditional strategic asset allocation to a more goal-aligned investment strategy. They explore key aspects of TPA, including governance, culture, a factor-based lens, and competition for capital. The episode highlights both the challenges and opportunities for advisors in adopting TPA, such as the need for a cultural shift and technical expertise, but also the potential for improved client outcomes and more flexible portfolio construction. Practical steps for implementing TPA, such as making incremental changes and reorganizing the investment team, are also discussed. Aaron sits on CAIA Association's executive leadership team and leads its global content strategy. This includes the development of thought leadership, research, and content agendas, content marketing and brand, and industry events. He also oversees strategy for CAIA's 20 chapters across the U.S., Canada, and Latin America.  Previously, Aaron founded UniFi by CAIA™, an online platform dedicated to educating the private wealth management industry on alternative investments. He has also sat in various other content development and educational programming roles at CAIA. Aaron is a frequent speaker and writer on various topics of alternative investments and his work has been published in CAIA's educational programs, numerous academic journals, books, and industry publications. Aaron's industry experience lies in private wealth management, where he oversaw asset allocation, portfolio construction, and manager research efforts for high-net-worth individuals and defined contribution plan sponsors and participants. He earned a B.S. with distinction in Finance and a Master of Finance from Penn State University. He holds the Chartered Alternative Investment Analyst (CAIA), Chartered Financial Analyst (CFA), Certificate in Investment Performance Measurement (CIPM), and Financial Data Professional (FDP) designations, and is a CERTIFIED FINANCIAL PLANNER™. He is a Past President of CFA Society Columbus and serves as a board director and Programs Chair for CFA Society Philadelphia. Aaron is an adjunct professor and serves on multiple advisory boards for Penn State University.   Enjoying Alternative Allocations? Please take a moment to rate and review us. Your feedback helps us deliver more insightful episodes on alternative investments! Resources: Aaron Filbeck, CAIA, CFA, CFP®, CIPM, FDP | LinkedIn Alternatives by Franklin TempletonTony Davidow, CIMA® | LinkedIn

In this episode, our guest is Tom Campbell, the Dean and Associate Professor of Pharmacy Practice at Lipscomb University College of Pharmacy in Nashville. Dr. Campbell received his Pharm.D. degree from the University of Tennessee College of Pharmacy and received board certification in pharmacotherapy in 1995. His prior work experience includes a pharmacy practice residency with VA Medical Center in Memphis, Columbus Regional Health System in Columbus, Georgia, and Sanofi Pharmaceuticals. He also served as Clinical Assistant Professor at Auburn University. Dr. Campbell has served as President of the Tennessee Pharmacists Association and served on the Board of Directors. He is a member of AACP, ASHP, APhA, CPFI and TPA. He's a recipient of the 2024 APhA Academy of Student Pharmacists Outstanding Dean Award which was established to recognize a school or college of pharmacy dean who has made significant contributions to the APhA-ASP Chapter and promoted with distinction the welfare of student pharmacists through various community service, leadership and professional activities. Dr. Campbell is a Sunday school teacher and former elder at the Spring Meadows Church of Christ in Spring Hill, TN. He has traveled to Central America as part of medical mission campaigns numerous times. Dr. Campbell and his late wife, Susan, have three sons.During the discussion, we explored questions around:How faith influences our daily work in healthcareThe ways faith impacts health behaviors and decision-makingThe role faith plays in job satisfaction and professional fulfillmentIt was inspiring to engage in meaningful dialogue with a leader who also sees their work as a calling to serve others. I'm grateful to Dean Campbell at Lipscomb University for fostering conversations that remind us of the deeper purpose behind our careers. ★ Support this podcast on Patreon ★

When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues. The first four steps in the Stroke Chain of Survival. Time criteria for the administration of tPA (or a similar fibrinolytic medication) or EVT of LVO strokes. Stroke benchmarks for door to: assessment;completing a non-contrast CT; andadministration of fibrinolytic medication such as tPA (door-to-needle).EMS interaction with stroke teams and destination protocols to reduce time to definitive care. The difference for timed goals for the identification & treatment of AMI vs Stroke. Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Safe Meds VIP - Learn about medication safety and download a free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

In part 2 of episode 469, host Stacey Richter discusses the implications of Medicare site neutral payments and Health Savings Account (HSA) reforms with James Gelfand, president and CEO of the ERISA Industry Committee (ERIC).  The episode details how plan sponsors should adapt to Medicare's site neutral payment policies aimed at curbing hospital consolidation and inflated prices through facility fees and markups. Gelfand provides insights into how HSA reforms currently in Congress could expand the scope of preventive care covered before deductibles are met, benefitting both employers and employees.  The conversation also touches on the challenges high deductible health plans pose and the potential benefits of codifying recent IRS guidance to allow greater flexibility in pre-deductible coverage. The discussion underscores the importance of plan sponsors staying ahead of Medicare policies to avoid higher costs. === LINKS ===

Joe had some family members fly into TPA last night... but what time should he be getting to the airport to pick them up?!

The chain of survival for a cardiac emergency and stroke start the same: 1. preparedness & recognition of an emergency; 2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility.ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center. Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/

Discover key insights on selecting a Third-Party Administrator (TPA) that drives superior claims outcomes through digital innovation, expertise, and strategic partnerships in transportation and alternative markets. Digital Infrastructure … Read More » The post Choosing the Right TPA for Transportation & Captives – Webinar Highlight appeared first on Insurance Journal TV.

True responsibility is not just defining and acting on the minimal legal requirement, but outlining the maximum possible actions you could have taken. It's not happening to you, it's happening for you.Eric Bream's conversation reminded me of Michael Schur's interview with Tim Ferris. Michael Schur is the creator of the hit Netflix series, The Good Place  and written a book called, 'How to be perfect - The correct answer to every moral question." Bream Family Farms website - www.breamfamilyfarms.comThis episode is sponsored by UnitedAg,  one of the largest association health plans to offer healthcare to the agriculture industry of California and Arizona.  Kirti Mutatkar, President and CEO of UnitedAg. Reach me kmutatkar@unitedag.org, www.linkedin.com/in/kirtimutatkarUnitedAg's website - www.unitedag.org

Big changes are happening at Restoration Pros Unplugged! Host Clinton James is excited to introduce Bobby Thomas as the new co-host of the podcast! Bobby isn't just any guest—he's the CEO of Extreme Services, a multi-location restoration company with over 15 years of industry experience. From starting with a Home Depot Rug Doctor to scaling a successful business specializing in water, fire, and mold restoration, Bobby brings hands-on expertise that will take this podcast to the next level.With Bobby on board, expect even deeper insights into scaling a restoration company, securing TPA work, building strong industry partnerships, and navigating the evolving restoration landscape. Whether you're an owner looking to grow your business or just getting started in the industry, this new era of Restoration Pros Unplugged will bring you the strategies, success stories, and expert interviews you need to stay ahead.Don't miss this exciting kickoff to a new chapter—tune in now and meet your new co-host, Bobby Thomas!If you're interested in learning how Water Restoration Marketing can help you overcome the challenges discussed in this episode and get more water jobs, book a free strategy session with our team today!https://www.waterrestorationmarketing.net/schedule

 Listen to the Show Right Click to Save GuestsTexArts Tick...Tick...Boom!KOOP Spring Membership Drive What We Talked About Cynthia Erivo to host Tonys Leslie Ann Warren – Cinderella Operation Mincemeat extends Jonathan Larson Project One for my Baby Alley Season Heller Awards to TPA Pippin Anniversary Concert Performance The Heathers Book of Mormon passes Rent Eureka Day at the Kennedy center Canceled Playhouse 46 closes Sumo Thank you to Dean Johanesen, lead singer of "The Human Condition" who gave us permission to use "Step Right Up" as our theme song, so please visit their website.. they're good! (that's an order)

If you are trying to leverage innnovation to deliver high impact to self-insured employers, this podcast is a must-listen for you! Ashok Subramaniam, CEO and co-founder of Centivo, a forward-thinking TPA, answers some of the important questions of major disruptions in the industry around price transparency, unbundling of provider networks, stronger relationships between brokers and TPAs, and the areas of focus to clarify your true value to employers. He frankly outlines where the puck is going to be in 3 years time -- you don't want to be there. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Zapraszamy na drugi odcinek serii o przyszłości budownictwa, który poświęciliśmy budowie dróg i różnym materiałom, z których powstają. Z Krzysztofem Zadrożnym, dyrektorem oddziału Strabag, rozmawiamy o nawierzchniach betonowych, a z Aleksandrem Zborowskim, dyrektorem ds. badań i rozwoju TPA, przyglądamy się nawierzchniom asfaltowym. Rozmowy prowadzi Karol Tokarczyk. Partnerem serii jest Strabag.

Zapraszamy na drugi odcinek serii o przyszłości budownictwa, który poświęciliśmy budowie dróg i różnym materiałom, z których powstają. Z Krzysztofem Zadrożnym, dyrektorem oddziału Strabag, rozmawiamy o nawierzchniach betonowych, a z Aleksandrem Zborowskim, dyrektorem ds. badań i rozwoju TPA, przyglądamy się nawierzchniom asfaltowym. Rozmowy prowadzi Karol Tokarczyk. Partnerem serii jest Strabag.

This week, we are talking eggs. Scientists have just come up with the perfect way to cook a boiled egg - the drawback is that it will take you 32 minutes. Normally, I would boil an egg by placing it in boiling water for anywhere between 6 and 10 minutes depending on how runny I like my yolk. The research published in the nature journal Communications Engineering took computer simulations to mathematically calculate the best way to boil an egg, then the researchers took 300 eggs and ran their own practical tests directed by the computer models. The challenge with egg cooking is that the white of an egg cooks at 85C, whereas the yolk of an egg cooks at 65C. This means that often when an egg is cooked in its shell you can have a perfectly cooked yolk with an undercooked egg white. To measure their eggs the researchers used: FT-IR spectroscopy to assess the extent of protein denaturation. TPA (texture profile analysis) to measure texture of egg albumen and yolk. Quantitative Description Analysis to get insights on colour, consistency, texture and taste of the cooked eggs. Metabolomic Analysis to investigate nutritional profile. Their new method of cooking, which they called Periodic Cooking, results in an evenly-cooked egg with a higher nutritional content than other ways of cooking an egg. So how do you cook the perfect egg? Bring a pan of water to the boil, and also have another bowl of water that is sitting at 30 C. First, spoon the egg into the boiling water, wait 2 minutes - then move the egg to the cooler bowl of water for 2 minutes. Repeat this process of hot and cold 6 times and the egg will be perfectly cooked (according to science) - a total cook time of 32 minutes. So that's it - the perfect egg, if your perfect life means you can stand over a stove for 32 minutes. LISTEN ABOVESee omnystudio.com/listener for privacy information.

Host: David Rosenblum, MD Guest: Phillip Kim, MD Date: January 24, 2025 Time: 6:30 AM Episode Summary: In this episode of the PainExam Podcast, Dr. David Rosenblum engages with Dr. Phillip Kim to discuss the Federation Pain Care Access, a newly formed organization advocating for improved access to interventional pain treatments. The episode delves into the challenges posed by restrictive insurance coverage policies and the collaborative efforts needed to address these issues effectively. Key Discussion Points: -Introduction to Federation Pain Care Access: A new entity focused on advocating for emergent and standard care in interventional pain treatments, aiming to enhance access through advocacy and legislative solutions. - Impact of Restrictive Policies: Dr. Kim highlights how insurance carriers like Evicor, AIM, and Optum impose restrictive coverage policies that harm patients and practitioners, particularly amid the ongoing opioid epidemic.AIM, Optum and Evicore are not insurance carriers. these are separate entities which oversee utilization management and prior auth requests for insurance carriers (HMO, TPA's etc) e g. BCBS plans, UHS etc. Prior Authorization Challenges: Discussion on the AMA 2022 Prior Authorization Physician Survey, which indicates significant negative impacts on patient care due to prior authorization processes. - Case Studies: Dr. Kim shares specific cases where patients faced harm due to denied claims, including issues related to medical cannabis and necessary medical equipment.   - Collaboration with Medical Societies: The Federation works alongside various pain societies and stakeholders to address common concerns and push for better coverage policies. - Future Goals Plans for meetings with CMS and Medicare Administrative Contractors (MACs) regarding specific treatments like SI joint radiofrequency ablation, aiming to improve coverage and access.   Fundraising and Outreach: The Federation seeks to grow its membership and funding through outreach to allied health professionals and patient care groups while launching a media campaign to raise awareness of patient struggles  Legal and Advocacy Efforts: Emphasis on the need for legal considerations in advocacy efforts and the importance of public support in achieving the Federation's goals. - The No Pain Act: Discussion on recent legislation aimed at expanding access to non-opioid treatments and alternatives for chronic pain management. Guest Bio: Phillip Kim, MD is a leading advocate for pain care access and a founding member of the Federation Pain Care Access. He brings extensive experience in managing chronic pain patients and navigating healthcare policies. Resources  Federation Pain Care Access Website:  https://www.painfed.org # board Listeners are encouraged to support the Federation Pain Care Access by visiting their website to learn more about their initiatives and consider contributing to help advance their mission. Join Dr. Rosenblum and Dr. Kim in this vital conversation about the ongoing efforts to improve pain care access and the importance of collaboration in overcoming the challenges faced by patients and healthcare providers.   Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.  Patients can schedule a consultation by going to  www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Garden City Office 516 482 7246

Host: David Rosenblum, MD Guest: Phillip Kim, MD Date: January 24, 2025 Time: 6:30 AM Episode Summary: In this episode of the PainExam Podcast, Dr. David Rosenblum engages with Dr. Phillip Kim to discuss the Federation Pain Care Access, a newly formed organization advocating for improved access to interventional pain treatments. The episode delves into the challenges posed by restrictive insurance coverage policies and the collaborative efforts needed to address these issues effectively. Key Discussion Points: -Introduction to Federation Pain Care Access: A new entity focused on advocating for emergent and standard care in interventional pain treatments, aiming to enhance access through advocacy and legislative solutions. - Impact of Restrictive Policies: Dr. Kim highlights how insurance carriers like Evicor, AIM, and Optum impose restrictive coverage policies that harm patients and practitioners, particularly amid the ongoing opioid epidemic. AIM, Optum and Evicore are not insurance carriers. these are separate entities which oversee utilization management and prior auth requests for insurance carriers (HMO, TPA's etc) e g. BCBS plans, UHS etc. Prior Authorization Challenges: Discussion on the AMA 2022 Prior Authorization Physician Survey, which indicates significant negative impacts on patient care due to prior authorization processes. - Case Studies: Dr. Kim shares specific cases where patients faced harm due to denied claims, including issues related to medical cannabis and necessary medical equipment.   - Collaboration with Medical Societies: The Federation works alongside various pain societies and stakeholders to address common concerns and push for better coverage policies. - Future Goals Plans for meetings with CMS and Medicare Administrative Contractors (MACs) regarding specific treatments like SI joint radiofrequency ablation, aiming to improve coverage and access.   Fundraising and Outreach: The Federation seeks to grow its membership and funding through outreach to allied health professionals and patient care groups while launching a media campaign to raise awareness of patient struggles  Legal and Advocacy Efforts: Emphasis on the need for legal considerations in advocacy efforts and the importance of public support in achieving the Federation's goals. - The No Pain Act: Discussion on recent legislation aimed at expanding access to non-opioid treatments and alternatives for chronic pain management. Guest Bio: Phillip Kim, MD is a leading advocate for pain care access and a founding member of the Federation Pain Care Access. He brings extensive experience in managing chronic pain patients and navigating healthcare policies. Resources  Federation Pain Care Access Website:  https://www.painfed.org # board Listeners are encouraged to support the Federation Pain Care Access by visiting their website to learn more about their initiatives and consider contributing to help advance their mission. Join Dr. Rosenblum and Dr. Kim in this vital conversation about the ongoing efforts to improve pain care access and the importance of collaboration in overcoming the challenges faced by patients and healthcare providers.   Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.  Patients can schedule a consultation by going to  www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Garden City Office 516 482 7246

Host: David Rosenblum, MD Guest: Phillip Kim, MD Date: January 24, 2025 Time: 6:30 AM Episode Summary: In this episode of the PainExam Podcast, Dr. David Rosenblum engages with Dr. Phillip Kim to discuss the Federation Pain Care Access, a newly formed organization advocating for improved access to interventional pain treatments. The episode delves into the challenges posed by restrictive insurance coverage policies and the collaborative efforts needed to address these issues effectively. Key Discussion Points: -Introduction to Federation Pain Care Access: A new entity focused on advocating for emergent and standard care in interventional pain treatments, aiming to enhance access through advocacy and legislative solutions. - Impact of Restrictive Policies: Dr. Kim highlights how insurance carriers like Evicor, AIM, and Optum impose restrictive coverage policies that harm patients and practitioners, particularly amid the ongoing opioid epidemic. AIM, Optum and Evicore are not insurance carriers. these are separate entities which oversee utilization management and prior auth requests for insurance carriers (HMO, TPA's etc) e g. BCBS plans, UHS etc. Prior Authorization Challenges: Discussion on the AMA 2022 Prior Authorization Physician Survey, which indicates significant negative impacts on patient care due to prior authorization processes. - Case Studies: Dr. Kim shares specific cases where patients faced harm due to denied claims, including issues related to medical cannabis and necessary medical equipment.   - Collaboration with Medical Societies: The Federation works alongside various pain societies and stakeholders to address common concerns and push for better coverage policies. - Future Goals Plans for meetings with CMS and Medicare Administrative Contractors (MACs) regarding specific treatments like SI joint radiofrequency ablation, aiming to improve coverage and access.   Fundraising and Outreach: The Federation seeks to grow its membership and funding through outreach to allied health professionals and patient care groups while launching a media campaign to raise awareness of patient struggles  Legal and Advocacy Efforts: Emphasis on the need for legal considerations in advocacy efforts and the importance of public support in achieving the Federation's goals. - The No Pain Act: Discussion on recent legislation aimed at expanding access to non-opioid treatments and alternatives for chronic pain management. Guest Bio: Phillip Kim, MD is a leading advocate for pain care access and a founding member of the Federation Pain Care Access. He brings extensive experience in managing chronic pain patients and navigating healthcare policies. Resources  Federation Pain Care Access Website:  https://www.painfed.org # board Listeners are encouraged to support the Federation Pain Care Access by visiting their website to learn more about their initiatives and consider contributing to help advance their mission. Join Dr. Rosenblum and Dr. Kim in this vital conversation about the ongoing efforts to improve pain care access and the importance of collaboration in overcoming the challenges faced by patients and healthcare providers.   Long island based anesthesiologist, David Rosenblum, MD, is one of the first interventional pain physicians in the country to integrate ultrasound guidance into his pain practice. Since 2007, he has been an international leader in the treatment of chronic pain. He has helped countless of patients suffering from back, neck, knee, shoulder, hip joint pain and has been at the forefront of regenerative pain medicine, minimally invasive pain therapies and medical education.  Patients can schedule a consultation by going to  www.AABPpain.com or calling: Brooklyn Office 718 436 7246 Garden City Office 516 482 7246

When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues. The first four steps in the Stroke Chain of Survival. Time criteria for the administration of tPA (or a similar fibrinolytic medication) or EVT of LVO strokes. Stroke benchmarks for door to:assessment;completing a non-contrast CT; andadministration of fibrinolytic medication such as tPA (door-to-needle).EMS interaction with stroke teams and destination protocols to reduce time to definitive care.The difference for timed goals for the identification & treatment of AMI vs Stroke. Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Have an incarcerated loved one? Then you want to hear about TPA! WORTHY PEOPLE ARE HAPPY TO PRESENT OUR FRIENDS "TEXAS PRISONS ALLIANCE". TPA IS MADE UP OF PEOPLE WHO HAVE FAMILY MEMBERS INCARCERATED AND WHO HAVE BEEN PREVIOUSLY INCARCERATED. We are working together on this and for the incarcerated. Texas Prisons Alliance is a non-profit organization dedicated to helping individuals and families in Texas navigate TDCJ. Our goal is to educate and help everyone advocate and be the voice of their loved ones incarcerated. All resources and tools mentioned are specifically through TPA and not Worthy People directly.

Federal funding has poured into the utility space to ensure the expansion of internet connectivity can take hold across the country, but what do results on the ground look like? In the latest Power Perspectives episode, we are joined by Adam Rehfeld, Business Line Manager for Distribution Modernization at Burns & McDonnell. Sitting on the front line of this implementation of connectivity for utilities, specifically in the complex world of third-party pole attachments (TPAs), Adam has keen lessons to share with utilities who are still waiting to get up to speed in this area. As utilities gain opportunities to expand connectivity with TPA implementation, this moment is a critical one for leaders to properly address regulatory, operational, and technological challenges. Adam provides insights into the evolution of pole attachments, the role of utilities in expanding broadband to underserved areas, and the importance of maintaining clear inventories of pole usage. Press play and gain keen insights into: - Why TPAs are a hot topic in today's utility sector. - How federal funding impacts TPA growth and utility strategies. - The role of technology in improving pole attachment inventory and data management. - The intersection of TPAs with modern grid trends like undergrounding and distributed generation. Whether you're a utility decision-maker or a broadband stakeholder, this episode offers a comprehensive guide to navigating the TPA landscape. So join host Jason Price and producer Matt Chester as they welcome in Adam Rehfeld's insights on the critical interplay between internet connectivity and the power utility sector. Key Links: Energy Central Post with Full Episode Transcript: https://energycentral.com/o/energy-central/expanding-utility-connectivity-and-bridging-broadband-gaps-brought-you-burns Burns & McDonnell on Energy Central: https://energycentral.com/o/burns-mcdonnell Ask a Question to Our Future Guests: Do you have a burning question for the utility executives and energy industry thought leaders that we feature each week on Power Perspectives? Leave us a message here for your chance to be featured in an upcoming episode: www.speakpipe.com/EnergyCentralPodcast

In this episode, we explore Dependent Care FSAs—what they are, how they work, and why they're a valuable benefit for employees managing dependent care expenses. Learn about eligibility, compliance essentials, and best practices for HR to help employees maximize their tax savings.Payroll + HR + Benefits in an all-in-one solution. Request a BerniePortal demo today!https://www.bernieportal.com/get-a-demo/Find us at https://www.bernieportal.com/hr-party-of-one/BerniePortal: The all-in-one HRIS that makes building a business & managing its people easy. http://bit.ly/2NEQ5QbWhat is an HRIS?https://www.bernieportal.com/hris/BernieU: Your free one-stop shop for compelling, convenient, and comprehensive HR training and courses that will keep you up-to-date on all things human resources. Approved for SHRM & HRCI recertification credit hours. Enroll today!https://www.bernieportal.com/bernieu/Join the HR Party of One Community!https://hubs.ly/Q02mNML90▬ Episode Resources & Links ▬▬▬▬▬▬▬▬▬▬HR Scorecardhttps://www.bernieportal.com/hr-scorecard-identify-compliance-risks/What Is a TPA?https://youtu.be/_R7bkvwExdc?si=3Z3WFU2ZeB3ustCuThe Top 5 Ways to Save Time on COBRA with Alpinehttps://youtu.be/i4FCL7mQSmc?si=PSpl-NTp2OYktl1yWhat is an FSA?https://youtu.be/AX1ySqiAIl4?si=e2ZODDum0tP3EeJQWhat are Dependent Care FSAs?https://youtu.be/_Ql0uHPo10A?si=_6GNbWZ3IbrvqNZdCan an Employee Contribute to an HSA if Their Spouse Has an FSA?https://youtu.be/IL-jdafAJpA?si=JUN_Xjbd6DFe7M1VAlpine TPAhttps://www.alpinetpa.com/▬ Social Media ▬▬▬▬▬▬▬▬▬▬▬► LinkedIn: https://www.linkedin.com/company/bernieportal▬ Podcast▬▬▬▬▬▬▬▬▬▬▬▬► Apple Podcasts: https://podcasts.apple.com/us/podcast/hr-party-of-one/id1495233115► Spotify: https://open.spotify.com/show/5ViQkKdatT40DPLJkY2pgA► Amazon Music:

Send us a textWhat are the hidden potentials and challenges in veterinary ophthalmology? Join us as we sit down with Michala Henriksen to discuss inflammatory ocular diseases. Michala's research, featured in the December JAVMA ophthalmology supplemental issue, brings to light the promising safety profile of CBD, while also raising important questions about its efficacy and unexpected ties to elevated liver enzymes. We also navigate through the harrowing 2020 Colorado wildfires with Michala, understanding their severe impact on canine eye health, particularly the rise in corneal ulcerations.But the journey doesn't stop with canines. Michala shares her personal and professional evolution from veterinary school in Copenhagen to groundbreaking research in equine fibrin. Her passion for inflammation and ophthalmology unfolds through her experiences with fungal keratitis in horses, leading to innovative treatments like platelet-rich fibrin. We also uncover the surprising link between TPA injections and increased glaucoma risk. Wrapping up, we venture into the world of artificial intelligence in veterinary medicine, exploring its potential and challenges in advancing research and education, all while reflecting on the collaborative efforts at the University of Copenhagen and the University of Florida that have helped shape Michala's remarkable career.A New Age of Veterinary Ophthalmology JAVMA supplemental issue: Journal of the American Veterinary Medical Association Volume 262 Issue S2: A New Age of Veterinary Ophthalmology (2024)INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ? JAVMA ® : https://avma.org/JAVMAAuthors AJVR ® : https://avma.org/AJVRAuthorsFOLLOW US:JAVMA ® : Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook Instagram: JAVMA (@avma_javma) • Instagram photos and videos Twitter: JAVMA (@AVMAJAVMA) / Twitter AJVR ® : Facebook: American Journal of Veterinary Research - AJVR | Facebook Instagram: AJVR (@ajvroa) • Instagram photos and videos Twitter: AJVR (@AJVROA) / Twitter JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals

Welcome to RIMScast. Your host is Justin Smulison, Business Content Manager at RIMS, the Risk and Insurance Management Society.   In this episode, Justin interviews Christine Schelble, Director of Insurance and Risk Management at GE Appliances, a Haier company about her work at GE Appliances, a Haier company. She shares how she began with GE Appliances, shortly after GE sold GE Appliances to Haier. She talks about how she works as a department of one and the relationships she has built throughout the company and with insurance brokers and TPAs. She speaks of the necessity of making changes when a relationship isn't good or a risk philosophy isn't a match. Christine also shares about her risk career and how her risk philosophy has remained constant wherever she has worked. She gives tips for preparing a request for proposal when a change is necessary and shares her advice for less experienced risk professionals. She speaks of the history of the Greater Bluegrass Chapter of RIMS, where she sits on the board, and the benefits of actively participating in a RIMS chapter. Listen for wisdom about keeping current with the insurance market, getting your designations, and changing with conditions. Key Takeaways: [:01] About RIMS. [:14] Public registration is open for RISKWORLD 2025! RIMS wants you to engage today and embrace tomorrow in Chicago from May 4th through May 7th! Register at RIMS.org/RISKWORLD and the link in this episode's notes. [:30] About this episode, coming to you from RIMS headquarters in New York. Our guest is Christine Schelble, the Director of Insurance & Risk Management at GE Appliances. We are going to discuss career development in risk management. [:58] RIMS-CRMP Virtual Workshops On February 19th and 20th, there is a two-day virtual workshop for the RIMS-CRMP led by former RIMS President Chris Mandel and presented by the RIMS Greater Bluegrass Chapter, the 2024 RIMS Chapter of the Year. [1:20] The next RIMS-CRMP-FED Exam Course will be held from February 4th through the 6th, 2025. Links to these courses can be found on the Certification page of RIMS.org and through this episode's show notes. [1:36] RIMS Virtual Workshops! Gail Kiyomura of The ART of Risk Consulting will host the “Fundamentals of Insurance” virtual workshop on February 19th and 20th, 2025. [1:50] We've got ERM on our minds. On February 26th and 27th, Elise Farnham of Illumine Consulting will lead “Applying and Integrating ERM”. The “Managing Data for ERM” course will be hosted by Pat Saporito, starting on March 12th, 2025. [2:12] A link to the full schedule of virtual workshops can be found through the RIMS.org/education/online-learning pages. A link is also in this episode's show notes. [2:25] Interview! Christine Schelble is the Director of Insurance and Risk Management at GE Appliances, a Haier company. She is one of the founding members of what is now the Greater Bluegrass Chapter of RIMS, which won the 2024 Chapter of the Year Award at RISKWORLD. [2:49] Christine has decades of experience leading risk management initiatives for global companies. We will learn about what it takes to be in that sort of position, how she progressed throughout her career, and when and where she saw opportunities and took them. [3:07] This will be a fun way to kick off 2025; let's get started! Christine Schelble, welcome to RIMScast! [3:18] GE sold GE Appliances on June 6, 2016, to Haier, the world's largest home appliance company. They are located in China. Christine works for Haier U.S. Appliance Solutions, Inc. doing business as GE Appliances, a Haier Company. It is the Haier U.S. headquarters. [4:09] Christine is a department of one. She works with people throughout the company. The goal of risk management is to spread that philosophy throughout the company. It has only improved since she started. She has lots of support when it comes to claims and coverage. [5:11] Christine had come from a technology company and was very familiar with the technology supply chain. When she came on board, she met with the supply chain people to learn their philosophy and processes. The only time she gets involved with them is for an insurance claim. [6:05] In appliances, Christine says there are so many “Black Fridays” in the year that you can see the returns ebb and flow throughout the year. It's not a serious problem. [6:44] Christine left Lexmark in 2001 after 15 years. One of her risk management connections called her and said that the position was opening at GE Appliances. She wanted new challenges so she sent in her resume, interviewed with them, and got the position. [7:43] Christine says it's one of the best jobs she's ever had. She's been able to take everything that she's learned and implement it into a startup program. That has been rewarding. When she started, it was the first time GE Appliances was managing and purchasing insurance coverage. [8:23] Christine joined GE Appliances three months after the sale and took a couple of months to understand how things worked. She started making changes at her first renewal because she could see where things hadn't worked out in relationships and coverage. [9:25] Risk management for your company is not a static position. It's constantly changing. You've got to constantly look at what's going on in the insurance market and what's going on internally and adapt your coverages, deductibles, and maybe your relationship with your TPA. [9:17] The way the program looked in 2016 when she came in is not the way it looks now. [9:30] The biggest third-party GE Appliances works with is the claims administrator. Otherwise, Christine works with brokers. Currently, she works with three different brokers for the competition. If the relationship is not great, she'll change the people on her account. [10:28] For risk managers coming up in the industry, Christine recommends keeping up with your education, getting your designations, attending webinars and seminars, and doing everything you can to keep up with what's going on in the insurance market. It's constantly changing. [10:49] Christine will do an RFP when she's looking to change something. You've got to have face-to-face conversations with your brokers, carriers, and TPAs. You have to educate them on your business and products. Your company and products are not the same as another's. [11:41] If you're just moving to a TPA because they gave you the lowest price, it's not going to work unless you work with them and have an ongoing relationship. Christine has them come in, meet her people, go through some of GE Appliance's processes, and see the plants. [12:01] Christine has done the same things in her previous jobs, as well. [12:15] TPAs changed how they worked during the pandemic. The TPA world will continue to change in reaction to changes in the world.  [12:50] Christine has a process for developing an RFP. She starts with having a non-disclosure agreement in place. That's very important. Then she shares exposure information, the insurance schedule, the actuary report, and a loss run or two, so they can understand the overall risk.   [13:33] She puts hot points into the RFP, how to move claims forward, and how the program should be improved and moved forward. That's been her philosophy throughout her career. [14:17] Plug Time! RIMS Webinars! Resolver will be joining us on February 6th with a topic to be arranged. [14:25] HUB International continues its Ready for Tomorrow Series with RIMS. On February 20th, they will host “Ready for the Unexpected? Strategies for Property Valuation, Disaster Recovery and Business Continuity in 2025”. [14:41] More webinars will be announced soon and added to the RIMS.org/webinars page. Go there to register. Registration is complimentary for RIMS members. [14:52] Nominations are also open for the Donald M. Stuart Award which recognizes excellence in risk management in Canada. Links are in this episode's show notes. [15:04] The Spencer Educational Foundation's goal to help build a talent pipeline of risk management and insurance professionals is achieved in part by its collaboration with risk management and insurance educators across the U.S. and Canada. [15:22] Since 2010, Spencer has awarded over $3.3 million in general grants to support over 130 student-centered experiential learning initiatives at universities and RMI non-profits. Spencer's 2026 application process will open on May 1st, 2025, and close on July 30th, 2025. [15:45] General grant awardees are typically notified at the end of October. Learn more about Spencer's general grants through the Programs tab at SpencerEd.org. [15:57] Back to the Conclusion of My Interview with Christine Schelble!  [16:23] Christine shares how she works as a department of one. She just continues to do what she's educated to do. When she looks back, it feels great to see all that she has done. It's important to get the relationships going so that people can trust you. [16:49] Christine works with the Finance, the supply chain, the manufacturing finance people, and Legal, where she is located. It's about building the trust factor. [17:12] Christine is a long-time member of the  RIMS Kentucky and Bluegrass Chapters, which are now the RIMS Greater Bluegrass Chapter. Christine has been in RIMS since she started in risk management. She loves the support from other risk professionals and the networking. [18:13] Christine started with RIMS in the D.C. area, then in Connecticut. She moved to New Jersey and was in RIMS in New Jersey and New York. When she moved to Kentucky, she joined the chapter. She was president for a year or two around 2003 or 2004. [18:46] Christine is thrilled that the younger members of the community have started the chapter back up. During economic downturns there was a loss of people and others couldn't get out to meetings. The same five people were doing the same job and they were ready to pass the torch. [19:21] It took several years for the torch to come back up. Christine acknowledges the work of Jeremy, Erica, Britt, and Brittany in getting the chapter up and going again. Christine is more than happy to help and support them by sitting on the board. [19:50] The Greater Bluegrass Chapter of RIMS was named the 2024 Chapter of the Year. Christine says that was a good feeling. It was fun to support them at RISKWORLD 2024 in receiving that award. [20:42] Christine is thrilled to see that in the younger generations, there are more women in higher positions within insurance carriers and brokers. When she started, there weren't as many. She says it is such a great career, whether you are male, female, or whatever. It's amazing! [21:22] Christine is thrilled to see that more schools offer risk and insurance as a degree. The Greater Bluegrass Chapter supports Eastern Kentucky University and its risk and insurance curriculum with an annual golf tournament in September that raises money for scholarships. [21:55] The Greater Bluegrass Chapter has also asked the university to have a student become a member to help expand their knowledge into the RIMS world. Justin mentions Spencer's Risk Manager on Campus program. He thanks Christine for her continued service in RIMS. [23:18] Special thanks to Christine Schelble for joining us here on RIMScast and kicking off 2025! Next week, we will be joined by RIMS CEO Gary LaBranche! [23:30] More RIMS Plugs! You can sponsor a RIMScast episode for this, our weekly show, or a dedicated episode. Links to sponsored episodes are in our show notes. [23:57] RIMScast has a global audience of risk and insurance professionals, legal professionals, students, business leaders, C-Suite executives, and more. Let's collaborate and help you reach them! Contact pd@rims.org for more information. [24:15] Become a RIMS member and get access to the tools, thought leadership, and network you need to succeed. Visit RIMS.org/membership or email membershipdept@RIMS.org for more information. [24:33] Risk Knowledge is the RIMS searchable content library that provides relevant information for today's risk professionals. Materials include RIMS executive reports, survey findings, contributed articles, industry research, benchmarking data, and more.  [24:49] For the best reporting on the profession of risk management, read Risk Management Magazine at RMMagazine.com. It is written and published by the best minds in risk management. [25:21] Justin Smulison is the Business Content Manager at RIMS. You can email Justin at Content@RIMS.org. [25:28] Thank you all for your continued support and engagement on social media channels! We appreciate all your kind words. Listen every week! Stay safe!   Mentioned in this Episode: RIMS Risk Management Magazine RIMS DEI Council Nominations for the Donald M. Stuart Award Spencer Educational Foundation — General Grants 2026 — Application Dates Contribute to RIMS Risk Management Magazine / Submission Guidelines RIMS-Certified Risk Management Professional (RIMS-CRMP) RIMS Webinars: RIMS.org/Webinars “Ready for the Unexpected? Strategies for Property Valuation, Disaster Recovery and Business Continuity in 2025” | Sponsored by HUB International | Feb. 20, 2025 Upcoming Virtual Workshops: “Stay Competitive with the RIMS-CRMP” | Presented by the RIMS Greater Bluegrass Chapter February 19‒20, 2025 | Instructor: Chris Mandel “Applying and Integrating ERM” | Feb. 26‒27 “Managing Data for ERM” | March 12, 2025 “Fundamentals of Insurance” | Feb. 19‒20, 2025 See the full calendar of RIMS Virtual Workshops RIMS-CRMP Prep Workshops   Related RIMScast Episodes: “Maintaining an Award-Winning ERM Program with Michael Zuraw” “Applying ERM Theory with Elise Farnham” “On Risk Appetite and Tolerance” “Global Perspectives with RIMS 2023 Chapter Presidents” (ft. Greater Bluegrass Chapter)   Sponsored RIMScast Episodes: “Simplifying the Challenges of OSHA Recordkeeping” | Sponsored by Medcor (New!) “Risk Management in a Changing World: A Deep Dive into AXA's 2024 Future Risks Report” | Sponsored by AXA XL “How Insurance Builds Resilience Against An Active Assailant Attack” | Sponsored by Merrill Herzog “Third-Party and Cyber Risk Management Tips” | Sponsored by Alliant “RMIS Innovation with Archer” | Sponsored by Archer “Navigating Commercial Property Risks with Captives” | Sponsored by Zurich “Breaking Down Silos: AXA XL's New Approach to Casualty Insurance” | Sponsored by AXA XL “Weathering Today's Property Claims Management Challenges” | Sponsored by AXA XL “Storm Prep 2024: The Growing Impact of Convective Storms and Hail” | Sponsored by Global Risk Consultants, a TÜV SÜD Company “Partnering Against Cyberrisk” | Sponsored by AXA XL “Harnessing the Power of Data and Analytics for Effective Risk Management” | Sponsored by Marsh “Accident Prevention — The Winning Formula For Construction and Insurance” | Sponsored by Otoos “Platinum Protection: Underwriting and Risk Engineering's Role in Protecting Commercial Properties” | Sponsored by AXA XL “Elevating RMIS — The Archer Way” | Sponsored by Archer “Alliant's P&C Outlook For 2024” | Sponsored by Alliant “Why Subrogation is the New Arbitration” | Sponsored by Fleet Response “Cyclone Season: Proactive Preparation for Loss Minimization” | Sponsored by Prudent Insurance Brokers Ltd. “Subrogation and the Competitive Advantage” | Sponsored by Fleet Response   RIMS Publications, Content, and Links: RIMS Membership — Whether you are a new member or need to transition, be a part of the global risk management community! RIMS Virtual Workshops On-Demand Webinars RIMS-Certified Risk Management Professional (RIMS-CRMP) RISK PAC | RIMS Advocacy RIMS Strategic & Enterprise Risk Center RIMS-CRMP Stories — Featuring RIMS Vice President Manny Padilla!    RIMS Events, Education, and Services: RIMS Risk Maturity Model®   Sponsor RIMScast: Contact sales@rims.org or pd@rims.org for more information.   Want to Learn More? Keep up with the podcast on RIMS.org, and listen on Spotify and Apple Podcasts.   Have a question or suggestion? Email: Content@rims.org.   Join the Conversation! Follow @RIMSorg on Facebook, Twitter, and LinkedIn.   About our guest: Christine Schelble, Director of Insurance and Risk Management at GE Appliances, a Haier company     Production and engineering provided by Podfly.  

DJ HOT MAKER - ALL BEST HITS 2024 (ТОП ПЕСЕН 2024) Всем привет! Решил подвести музыкальные итоги года. В компиляцию вошло 50 популярных треков года. Приятного прослушивания!! Микс без джинглов! ⏱ 2,5 часа ? Скачать в качестве 320 kb/s можно с моего тг-канала t.me/dj_hot_maker или тут disk.yandex.ru/d/xF3WfYkQ--ZIm… #песни2024 #лучшие2024 #лучшиетреки2024 #хиты2024года #хиты2024 #лучшиехиты #besthits С наступающим Новым годом! Ваш Дмитрий Карманов, DJ Hot Maker. djhotmaker.ru 00:00:00 Жeня Тpoфимoв feat. Кoмнaтa кyльтypы - Пoeздa (Dimas & D-Music Remix) 00:02:39 Duа Liра, Аmiсе - Тrаining Sеаsоn 00:06:22 GАYАZОV$ BRОTHЕR$ - Тaм гдe кaйф (Index-1 Remix ) 00:09:42 Тaтьянa Кypтyкoвa - Мaтyшкa (Silver Ace Remix) 00:12:16 Аrtik & Аsti - Кaчeли (Ayur Tsyrenov remix) 00:15:07 5УTPA, Вaня Дмитpиeнкo - Нe пpeдстaвляeшь (Silver Ace Remix) 00:18:28 Кoстa Лaкoстa, Oльгa Сepябкинa - Пo yлицaм (Index-1 Remix ) 00:22:04 Sоphiе and thе Giаnts, Аmiсе - Shut Uр Аnd Dаnсе 00:25:39 Jаkоnе & Kiliаnа - Aсфaльт (Eddie G & Malyx Remix) 00:28:42 NILЕТТО - Счaстливым (Index-1 & Siver Ace Remix ) 00:31:33 Bеаrwоlf - Gоdzillа (Matur & Arteez Vip Remix) 00:34:06 Nikоs Ваnd - Gеоrgiаn Discо (MIKIS Remix) 00:37:30 Мoя Мишeль, Аmiсе - Oблaкa 00:41:10 Dаnnу Сhris, SIСКОТОY, Аmiсе - Dоn't lеt mе gо 00:44:34 Gаlibri & Mаvik - Bзгляни нa нeбo (Eddie G Remix) 00:47:09 ХОLIDАYBОY - Пoжapы (Monamour x Slim x Shmelev Remix ) 00:50:48 Bеаrwоlf - Oдин в пoлe вoин (Andy Shik Remix) 00:53:19 Димa Билaн, Мapи Кpaймбpepи - It's Mу Lifе (DJ Sаfitеr Remix) 00:56:25 Бacтa & MОNА - Xyди (MIKIS Remix) 00:58:59 Nilеttо, Oлeг Maйaми, Лёшa Cвик - Гpoмчe гopoдa (Ramirez & Andy Shik Remix) 01:02:38 Dаvid Guеttа & ОnеRерubliс - I dоn't wаnnа wаit (Ayur Tsyrenov remix) 01:05:10 R3HАВ, Мufаsа & Нуреmаn, Rаni - Веliеvе (Shооting Stаrs) ( Mix) 01:07:58 Wаllеm - Xapизмa (Ramirez & Pavlov Remix) 01:10:46 Rау Dаltоn, Аmiсе - АLL WЕ GОT 01:13:23 Иpинa Кaйpaтoвнa - Aйдaxap (Matur & Arteez Mix) 01:16:13 Сhris Yаnk - #ИМEННOTA 01:18:37 ВLIZKЕY - Гopы (Corto x Slim x Shmelev Remix ) 01:21:20 Justin Тimbеrlаkе, Аmiсе - Sеlfish 01:24:53 Аvа Мах - Му оh mу (Ayur Tsyrenov remix) 01:27:24 Мapи Кpaймбpepи - Нpaвится жить (Index-1 Remix) 01:30:33 FАSТ ВОY, Rаf, Аmicе - Wаvе 01:33:39 Люся Чeбoтинa - Зa бывшeгo (Silver Ace Remix) 01:36:33 Duа Liра, Аmiсе - Illusiоn 01:39:22 Теddу Swims - Тhе Dооr (Соllini Сlub Ноusе Rеdrum Еdit) (Clean) 1A 126 01:42:25 Аnnа Аsti - Тoпит (Silver Ace Remix) 01:45:58 Маrshmеllо, Dоvе Саmеrоn, Guz - Оthеr Воуs [Guz Remix] (MMP Intro Edit) 01:48:37 Zеrb, Тhе Сhаinsmоkеrs, Ink & Аmiсе - Аddiсtеd 01:51:33 Коnfuz - Итaлия (Соrtо x Slim x Shmеlеv Remix ) 01:53:50 СYRIL, Dеаn Lеwis, Аmiсе - Fаll Аt Yоur Fееt 01:57:11 Аlоk & Jеss Glуnnе - Summer's Васk (Tmu 'Sing It Васk' Hуре Intro) (Clean) 126 02:00:00 Jung Кооk, USНЕR, Аmiсе - Stаnding Nехt tо Yоu 02:02:52 Jаzzdаurеn - Дapитe жeнщинaм цвeты (Index-1 Remix ) 02:06:15 Тhe Кnосks, SОFI ТUKKЕR, Аmiсе - Оnе Оn Оnе 02:09:50 АР$ЕNТ - Мoжнo я с тoбoй (DJ Smell Remix) 02:12:59 Dаbrо - Дaльшe-бoльшe (Amice Remix) 02:16:04 Zivеrt, Аmiсе - Мyтки 02:18:57 Куgо fеаt. Zаk Аbеl & Nilе Rоdgеrs - Fоr Lifе ( Version) 02:23:28 Куgо, Аvа Маx, Аmiсе - Whаtеvеr 02:26:22 Jаxоmу, Аgаtinо Rоmеrо, Rаffаеllа Саrrа - Реdrо ( Mix) 02:29:11 Еllа Неndеrsоn fеаt. Rudimеntаl - Аlibi

DJ HOT MAKER - DECEMBER 2024 POP DANCE PROMO Привет! Предлагаю тебе декабрьский микс. Только свежие и популярные треки декабря 2024 года. 85 минут Без джингла Скачать в качестве 320 kb/s можно с моего канала t.me/dj_hot_maker или отсюда: disk.yandex.ru/d/SjhGn2YTNNGB-… Новый микс в стиле Pop Dance от DJ Hot Maker. Приятного прослушивания! Мой сайт djhotmaker.ru #house #pop #dj #djhotmaker #диджей #микс #новыймикс #музыка #music 00:00:00 Егop Кpид, Бacтa - Зaвтpa (DJ Smеll Rеmix) 00:03:35 Оfеnbасh ft. Justin Jеssо - Оvеr уоu 00:06:36 LуRIQ,А'Studiо - Иcтoчник (Indеx-1 Rеmix) 00:09:24 АNNА - Cчacтьe в мeлoчaх (Cоlеtt Rеmix) 00:12:30 Jоnу - Peвeли ливни (Indеx-1 Rеmix ) 00:15:05 Мishа Мillеr & Аlеx Vеlеа - Ваm Ваm (а-Trаxx Rеmix) 00:18:22 Gауаzоv$ Brоthеr$ - Барышня (Indеx-1 Rеmix) 00:21:32 Аlоk, Сlеmеntinе Dоuglаs - Воdу Таlk ( Mix) 00:24:39 Куgо, Sаndrо Саvаzzа - Ноld оn Ме (Оriginаl Mix) 00:26:59 Jаzzdаurеn - Tpи цвeтoчкa (Indеx-1 Rеmix) 00:29:55 IVЕ & Dаvid Guеttа - Supеrnоvа Lоvе (Brеn F) (Clеаn-120BPM) 00:33:40 Кlingаndе - Оvеr уоu VIР Мix 00:36:15 Dabro - Дaвaй нaвceгдa (Cоlеtt & S-Nikе Rеmix) 00:38:36 Baня Дмитpиeнкo - Bишнёвый (Indеx-1 Rеmix) 00:41:21 Moя Mишeль - Гopoд aнгeлoв (Cоlеtt Rеmix) 00:45:03 XоLIDауBоу - Aнтикиллep любoвь (Indеx-1 Rеmix) 00:47:30 Kлaвa Koкa - Ты гpycтишь (Indеx-1 Rеmix) 00:50:22 Nоlа - Пepвaя вcтрeчнaя (Indеx-1 Rеmix) 00:53:47 Zivеrt - Эгoиcткa (Indеx-1 Rеmix) 00:56:41 Kаmаzz - Hичeгo нe гoвopи (Cоrtо x Slim Rеmix) 00:59:32 Oльгa Cepябкинa - Гoвopилa я тeбe (Indеx-1 Rеmix) 01:03:41 МОT, Пaшa Лeвл - Cнeгoпaд (Jоhn Cоffеу & Mishа Mеntоs Rеmix) 01:07:04 Kлaвa Koкa - Убегай (Indеx-1 Rеmix) 01:09:37 Mapи Kpaймбpepи - Бeз oбрaбoтки (Indеx-1 Rеmix) 01:12:29 5УTPA, Pyки Bвepх! - Maлaя (Аndу Shik Rеmix) 01:15:35 Dаvid Guуttа, Аvа Мах, Аlрhаvillе - Fоrеvеr уоung (MMP Intrо еdit) (Clеаn) 8а 130 01:18:25 Fеliх Jаеhn & Shоusе - Wаlk With Mе (Clеаn ) 01:22:07 5УTPA, Oкcaнa Пoчeпa - Пoзвoни (Оnеоn Rеmix)

The chain of survival for a cardiac emergency and stroke start the same:1. preparedness & recognition of an emergency;2. activation of EMS; 3. delivery of Advanced Life Support; and 4. transporting to the most appropriate facility.ALS ambulances are staffed with paramedics who have training in ACLS skills. Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for: point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center. Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!

Meet again Joe Sherman. Joe grew up in a family being the youngest of seven siblings. His parents who had not gone to college wanted their children to do better than they in part by getting a college education. Joe pretty much always wanted to go into medicine, but first obtained a bachelor's degree in engineering. As he said, in case what he really wanted to do didn't pan out he had something to fall back on.   Joe, however, did go on and obtain his MD and chose Pediatrics. He has been in the field for 35 years.   This time with Joe we talk a lot about the state of the medical industry. One of Joe's main efforts is to educate the medical profession and, in fact the rest of us, about burnout among medical personnel. Joe tells us why burnout is so high and we discuss what to do about it. Joe talks about how the medical profession needs to change to keep up with the many challenges faced by doctors and staff and he offers interesting and thought-provoking ideas. Again, I hope you will find my discussion with Joe Sherman beneficial, productive and helpful to you, especially if you are a doctor.       About the Guest:   Dr. Joe Sherman helps health professionals transform their relationship with the unrelenting demands of their jobs and discover a path toward meaning, professional fulfillment, and career longevity. He believes the key to personal and professional success lies in bringing “soul to role” in your medical practice.   Dr. Sherman is a pediatrician, coach and consultant to physicians and healthcare organizations in the areas of cross-cultural medicine, leadership, and provider well-being.  He is a facilitator with the Center for Courage & Renewal and a Master Certified Physician Development Coach with the Physician Coaching Institute.   Dr. Sherman has been in pediatric practice for over 35 years concentrating on healthcare delivery to underserved and medically complex children in the District of Columbia, Tacoma, Seattle, Uganda, and Bolivia.  He has held numerous faculty positions and is currently Clinical Associate Professor of Pediatrics at the University of Washington.   Ways to connect with Dr.Joe:   My website is: https://joeshermanmd.com/   LinkedIn: www.linkedin.com/in/joeshermanmd   Direct email connection: joe@joeshermanmd.com       About the Host:   Michael Hingson is a New York Times best-selling author, international lecturer, and Chief Vision Officer for accessiBe. Michael, blind since birth, survived the 9/11 attacks with the help of his guide dog Roselle. This story is the subject of his best-selling book, Thunder Dog.   Michael gives over 100 presentations around the world each year speaking to influential groups such as Exxon Mobile, AT&T, Federal Express, Scripps College, Rutgers University, Children's Hospital, and the American Red Cross just to name a few. He is Ambassador for the National Braille Literacy Campaign for the National Federation of the Blind and also serves as Ambassador for the American Humane Association's 2012 Hero Dog Awards.   https://michaelhingson.com https://www.facebook.com/michael.hingson.author.speaker/ https://twitter.com/mhingson https://www.youtube.com/user/mhingson https://www.linkedin.com/in/michaelhingson/   accessiBe Links https://accessibe.com/ https://www.youtube.com/c/accessiBe https://www.linkedin.com/company/accessibe/mycompany/   https://www.facebook.com/accessibe/       Thanks for listening!   Thanks so much for listening to our podcast! If you enjoyed this episode and think that others could benefit from listening, please share it using the social media buttons on this page. Do you have some feedback or questions about this episode? Leave a comment in the section below!   Subscribe to the podcast   If you would like to get automatic updates of new podcast episodes, you can subscribe to the podcast on Apple Podcasts or Stitcher. You can subscribe in your favorite podcast app. You can also support our podcast through our tip jar https://tips.pinecast.com/jar/unstoppable-mindset .   Leave us an Apple Podcasts review   Ratings and reviews from our listeners are extremely valuable to us and greatly appreciated. They help our podcast rank higher on Apple Podcasts, which exposes our show to more awesome listeners like you. If you have a minute, please leave an honest review on Apple Podcasts.       Transcription Notes:   Michael Hingson ** 00:00 Access Cast and accessiBe Initiative presents Unstoppable Mindset. The podcast where inclusion, diversity and the unexpected meet. Hi, I'm Michael Hingson, Chief Vision Officer for accessiBe and the author of the number one New York Times bestselling book, Thunder dog, the story of a blind man, his guide dog and the triumph of trust. Thanks for joining me on my podcast as we explore our own blinding fears of inclusion unacceptance and our resistance to change. We will discover the idea that no matter the situation, or the people we encounter, our own fears, and prejudices often are our strongest barriers to moving forward. The unstoppable mindset podcast is sponsored by accessiBe, that's a c c e s s i capital B e. Visit www.accessibe.com to learn how you can make your website accessible for persons with disabilities. And to help make the internet fully inclusive by the year 2025. Glad you dropped by we're happy to meet you and to have you here with us.   Michael Hingson ** 01:21 Well, hi all. This is your host, Mike hingson, and welcome to another episode of unstoppable mindset. And today we are meeting once again with Dr Joe Sherman. And if you remember our last show, Dr Sherman is a board certified pediatrician and master certified physician development coach, and I won't give any more away, because it's more fun to talk to him about all of that. But we had such an interesting discussion, it just seemed like what we ought to do is to have a continued discussion, because we didn't get to cover everything that he provided to us last time, and and I know we've probably got lots more that we can add to the discussion. So, Joe, welcome to unstoppable mindset. We're glad you're here   Dr. Joe Sherman ** 02:10 again. Thanks so much for having me. Michael, it's good to be back.   Michael Hingson ** 02:13 Well, glad you're here and all that. Do you want to start by kind of, maybe refreshing people about you a little bit life and all that, any anything that you want to give us just to start the process? Sure,   Dr. Joe Sherman ** 02:25 I currently live in Seattle, Washington with my wife. We have a few grown children that are in their early 20s, and I am a pediatrician, and now am a physician professional development coach, and I facilitate retreats for health professionals, medical teams, and most of my focus is on trying to bring who we are to what we do kind of being more authentically who we are in our workplace, trying to come to our work with a more balanced mindset, and trying to work A little bit more collegially as medical teams in today's ever changing health care environment. So now, I have practiced for about 35 years in pediatrics, and am now devoting all of my time to coaching and facilitation. You   Michael Hingson ** 03:37 know, gosh, there's so many, so many things that would be interesting to discuss, and I do want to stay away from the whole idea of politics, but at the same time, what do you think about the whole way the medical profession, you know, of course, one of the things that comes to mind is just everything that happened during COVID. But what do you think about the way the medical profession and some of the things that the profession is trying to do is being treated by politicians, and a lot of times it seems like people don't take it seriously, or it just doesn't fit into their agenda. Does that make sense?   Dr. Joe Sherman ** 04:15 You mean, as far as so as a pandemic was concerned? Well, the   Michael Hingson ** 04:20 pandemic, or, you know, there were some discussions about end of life or life discussions, and some people poo pooed, having that kind of thing and saying that isn't something that doctors should be doing. Oh,   Dr. Joe Sherman ** 04:33 I think, right now, I think that politics and healthcare are intricately entwined. Especially after the pandemic, and I think right now, the idea of the politics getting in the way of a kind of. The doctor patient relationship is, is challenging. It's challenging for healthcare workers. I think where we desperately need political courage is in trying to develop a healthcare system that works for everybody in the country. So I think that that's where the focus should be.   Michael Hingson ** 05:21 What do you think about? And I've had a number of people tell me, single pay healthcare system wouldn't be a good thing. It's too socialistic, and we'll leave that out of it just wouldn't be a good thing. It seems to me that it has been very successful in a number of places, but the kinds of arguments that people give are well, but by having competition, we have been a lot better at producing new and innovative technologies that wouldn't be produced or wouldn't be provided if we had just a single pay kind of system. I don't know whether that makes sense or I'm expressing it the best way, but it just seems like there's an interesting debate there. I   Dr. Joe Sherman ** 06:03 think there is debate because I do think there is some truth in the statement that our health care system has enabled development of technology and research in ways, perhaps that other countries have not. On the other hand, our health outcomes and our health access for people who live in this country is not very good, especially given the degree of wealth that our country has. So I used to joke, although it's not that funny, but one clinic where I worked that was a low income clinic, I used to joke that if one of our patients were to come out of their apartment To cross the street to come to the clinic. They may be turned away at the door because they don't have any insurance, or they don't have the proper insurance, or they can't pay but if they happen to be get run over by a car in the street on their way across the street, there would be no questions asked. The ambulance come pick them up. They'd be taken to the emergency room, given the best treatment to try to save their lives, admitted to the ICU and incur a huge medical bill with the greatest of technology, but they would not have been able to have gotten that primary care appointment to be in with. Yeah. So we are very kind of high tech, high intensity, high specialized in our approach to health care, whereas other countries focus much more on primary care.   Michael Hingson ** 07:54 I know in 2014 in January, my wife became ill. Started out as bronchitis, and it kept getting worse, and she didn't want to go to the hospital, but, and she was always in a wheelchair, so she she found that they didn't really know how to deal with can Well, she was congenital or always paralyzed from basically t3 from the breast down, and she so she didn't like to go, but finally, we compelled her to go to the hospital. And was on a Saturday, and the next day, the bronchitis morphed into double pneumonia and ARDS, and her lungs ended up being 90% occluded, so she had to even to get air into her lungs, they had to use a ventilator, and she had a peeps level of 39 just to get air into her lungs. Yeah, you know what that that means. And it was, it was pretty amazing. People came from all over the hospital just to watch the gages, but she had literally, just about turned 65 and we were very blessed that we didn't get any bill because Medicare, I Guess, absorbed the entire thing, and we we, we didn't know whether, whether we would get anything or not, and we didn't. And she did recover from that, although she felt that she had coded a couple times, and then her brain wasn't quite as good as it had been, but, but she did well, and so we got incredible care from Kaiser Terra Linda up in the San Rafael area, and it all went well. Of course, I we had gotten the pneumonia shots, and I complained to our physician to talk about joking. I complained to our primary care physician. I. Well, you say that these shots are supposed to keep it from happening, but we both had the shots and and, and she got double pneumonia anyway. Of course, the unfortunate thing was that that the doctor had an answer. She said, Yeah, but it would have been worse if he hadn't gotten the shot. Darn. She shot me down, but it was fun to joke.   Dr. Joe Sherman ** 10:18 Well, I'm sorry that that happened to you that that's, that's a unfortunate situation, it   Michael Hingson ** 10:26 was, but you know, things, things do happen and and we did get over it. And out of that, we ended up moving down to Southern California to be closer to to family. So it worked out okay. But we we love the and really support the medical system in any way that we can. We see both of us did, and I still, you know, and wherever she is, she must see the value of of what's done. And it just is so frustrating anytime people say doctors are crazy people. They don't, they don't really look out for people's interest, and just so many different things. It, it's unfortunate, because, you know, I can tell you from personal experiences. I just said what we saw,   Dr. Joe Sherman ** 11:16 yeah, I think that what is happening in our healthcare system now is this epidemic of burnout amongst professionals, especially amongst physicians and nurses, but and a lot of that has to do with the amount of administrative tasks and the amount of pressure that's put on physicians and other health care providers in trying to see as many patients as they can in the shortest amount of time as possible, and this is because of our system of fee for service reimbursement for medical care, the way that that health systems stay afloat is by trying to see as many patients as possible, and this unfortunately, combined with the amount of administrative work that needs to be done for each of those visits, plus the amount of communication that comes in from patients, as well as referral sources and requests for prescription refills, all of that comes in constantly through the computer of any physician that's trying to work as an outpatient or inpatient doctor, and it just becomes overwhelming,   Michael Hingson ** 12:43 yeah, how do we fix that? That's a good loaded, general question, isn't   Dr. Joe Sherman ** 12:50 it? It is it is a good question. And I I think it's a multi pronged approach. I do think that one thing that has happened is that the technology of healthcare and the business of healthcare has changed dramatically during the time that I've been a physician, a pediatrician, and the culture of healthcare, kind of, the way we do things, really hasn't changed. So that means that the business and the technology has placed more demands on us, and at the same time, we're kind of doing things pretty much the same way we've always done them, because of these extra demands that are placed on physicians and other health professionals, what's needed are experts that are in those areas of billing, administrative, administration, technology, it all of those things that now all feed into seeing patients in the office or in the hospital. So you need all of those professionals working together side by side along with the physician, allow the physician to do the work that she's been taught to do, which is actually deal with the patient and take care of the patient, and then let other people do the data entry, do the billing, take care of all of the messages and other things that are coming in around that that that provider. Do   Michael Hingson ** 14:23 you think that the same level of burnout exists in other countries that exists here?   Dr. Joe Sherman ** 14:29 You know it does. I do think that burnout exists everywhere in healthcare. I do think that it is less in low income countries, which seems kind of strange, but I've worked for many years in my life in low income countries in Africa as well as South America. And it's a different culture. It's a different culture. Culture of health care there is, there are different expectations of doctors, I think, in other countries, especially countries that are used to seeing a lot of disease and mortality, the pressure on saving lives and the pressure on having to be perfect and always get it right and knowing everything to do it each time that a patient comes in is not quite as intense as it is here. So I do think that it is different in other places. However, I will say that I have spoken to physicians in definitely in the more developed, higher income world, parts of the world that this epidemic of burnout is pretty universal   Michael Hingson ** 15:57 now, It seems to me that I've been seeing in recent years more what they're called physician assistants. Is that a growing population, or is it always been there, and I just haven't noticed it? And does that help?   Dr. Joe Sherman ** 16:14 I do think that in our country, here in the US, the future, will see many more physicians assistants and nurse practitioners, what we call Advanced Practice clinicians, or advanced practice practitioners, providers. We're going to see many more of them doing primary care, and a model that I think would would probably work very well is a team based model where the MD, who is kind of trained at a much higher level for many more years, leads a team of other providers made up of physicians assistants and nurse practitioners to do primary care, to take care of a group of patients, and perhaps that MD is there to consult, to be back up and to care for the more complex patients, while the nurse practitioners and PAs Are are getting the primary care, delivering the primary care.   Michael Hingson ** 17:23 Well, I know that the PAs that I have dealt with through the years, it seems to me, have, especially in the last 10 years, but have been very, very competent, very qualified. And I I don't, I don't know that, where I would say that they're less rushed, but I've had the opportunity to have some good conversations with them sometimes when, when the doctor just doesn't have the time. So it that's one of the reasons that prompted the question. It just seems to me that the more of that that we can do, and as you said, the more that that takes off. Perhaps some of the load from the physician itself may, over time, help the burnout issue.   Dr. Joe Sherman ** 18:10 I do think so. But I also feel like there's tremendous pressure right now on those pas and nurse practitioners, because they're under a lot of pressure too, too, and there aren't enough of them. Reduce and yes, so actually, right now, there's a movement within the the federal government to expand the number of positions in training programs for nurse practitioners and PAs. We have far too few, especially Physician Assistant schools. We don't have nearly as many as we need in this country. And if you look at the numbers, I think it's more competitive to get into PA school than it is to medical school,   18:54 really. Yeah,   Dr. Joe Sherman ** 18:58 I, you know, I that's been my experience of what I've seen from people just, you know, the number of applicants toward compared to the number of accepted, hey,   Michael Hingson ** 19:09 they wouldn't let you into a PA school, huh?   19:11 Exactly? Yeah.   Michael Hingson ** 19:15 No, I know. Well, it's, it is interesting. I know we read a few years ago that University of California Riverside actually started a program specifically, I'm trying to remember whether it was for training doctors. It was something that was supposed to be an accelerated program. Oh, some of the hospitals sponsored it. And the agreement would be, if you went to the school, you'd get the education, you wouldn't pay and at the end, and you would go to work for those hospitals like, I think Kaiser was one of the major sponsors of it. And again, it was all about trying to bring more people into the profession. Which certainly is admirable by any standard.   Dr. Joe Sherman ** 20:04 Yes, I think there are. Now, there are a few medical schools, and they're expanding the numbers that have free tuition, and they some of those schools, such as NYU Medical School has a generous donor who is given a tremendous amount of money as a donation and as an endowment. It pays for all the education of the students that go there. And there are some other schools that have the same arrangement. I think, I think if I were to be boss of the country, I would make all medical education free in in return, people would have to work in an underserved area for a certain number of years, maybe a few years, and then after that, they would be free to practice debt free, in any specialty and anywhere they would like.   Michael Hingson ** 21:10 Well, we need to do something to deal with the issue, because more and more people are going to urgent cares and other places with with different issues. I have someone who helps me a little bit. She's our housekeeper, and she also comes over once a week for dinner, and she has some sort of allergy. She just her face and her neck swelled up yesterday and had all sorts of red spots and everything. It's the second time she took not Benadryl, but something else that made it go away the first time, but it was back, and several of us insisted that she go to urgent care, and she went, and while she was there, she heard somebody say that they had been waiting four hours. So she left, you know, and which doesn't help at all. So I don't know actually whether she went back, because I talked with her later and said, Go back. So I don't know whether she did, but the waiting time is oftentimes very long, which is unfortunate. And I don't know whether more people are getting sick, or they think they're getting sick, or they're just taking ailments that are less too urgent care, but there are definitely long waiting times.   Dr. Joe Sherman ** 22:25 Yes, people, the people do not have a medical home. Many, many people don't have a medical home, a true medical home, that early in my practice pediatrician, as a general pediatrician, if there was a child that was in our practice and at night time or over a weekend, somebody would be on call. If that parent was concerned about a child in any way, they call the emergency line for the practice, the on call line, and that operator would page whoever the doctor was on call, and I would, as the doctor covering call that parent and talk directly at home, give advice over the phone, say what to do, make a decision of whether that child needed to go to the emergency room or not, or in the vast majority of cases, could give advice over the phone about what to do and then follow up when the office was open the next day or on the next week. Yeah, but nowadays, people aren't connected to offices like that. Yeah. We have call centers nurse advice lines of people that don't have access to medical records or have very strict protocols about what type of advice to give and the bottom line and the safest thing is go to the emergency room or go to urgent care. So that's unfortunately why some of the highest burnout rates are in emergency room doctors, and some of the biggest problems with understaffing are in emergency rooms right now. And   Michael Hingson ** 24:16 I can understand that, and makes perfect sense to hear that, and it's unfortunate but true. So yeah, but yeah, you're right. So many people don't really have a home. We've been blessed Karen, my now late wife, of course, was always a patient of Kaiser, and was a strong advocate for the way they did most of all of what they did. And so I eventually, when we got married and we were in a Kaiser area, then I did the same thing. And mostly I think it worked out well. I think. Kaiser is a little bit more conservative than some when it comes to perhaps some of the the newer procedures or newer sorts of things like they, you know, we see ads on TV now for the Inspire way of dealing with sleep apnea, as opposed to CPAP machines. And I don't know whether Kaiser has finally embraced that, but they didn't for the longest time. At least our doctor said that it wasn't really great to have to undergo surgery to deal with it, and the CPAP machines work fine, but I think overall it to to use your your words, definitely, if you're in that kind of an environment, it is a little bit more of a home, and you have definite places to go, which I think is valuable. And I think that more people really ought to try to figure out a way to find a home if they can.   Dr. Joe Sherman ** 26:00 Yeah, I do think that it is in the amount just society has advanced so so rapidly and so much in in how communication is instantaneous these days, through texting and through internet and through instant messaging, all these different ways that everything is sped up so people are looking for answers right away. Yeah, and it's, it's that's often puts too much pressure on the people that are trying to manage all of the patients that and all of their inquiries that they have. So I think, I think we need to make some serious changes in the way that we, that we staff hospitals, the way we staff clinics, and look and see what are the specific duties that need to be done, the specific activities and responsibilities in attending to a patient and specifically target personnel that are skilled in that activity, instead of having a physician who you know, is not the greatest typist, or is not the greatest at trying to figure out a code of billing for insurance or how to look at 100 messages that came in while she was attending to, you know, 25 patients in A clinic. It's just too much. It's overwhelming. And I mean, I now facilitate a group. It's a support group for physicians through physicians anonymous, where physicians are suffering from anxiety, depression, addiction. Suicide, ideation, and it's it's really at at scary levels right now, and I do think that the healthcare systems are starting to be aware of it. Think patients need to be aware of it, and the reason why, when you call, you're on hold forever or you never do get to speak to a real person, where it takes months to get in to see a doctor, it's because nobody's home. Yeah, everybody is many, many people have, have quit.   Michael Hingson ** 28:39 Yeah, there's such a shortage. I know at least we see ads oftentimes for nurses and encouraging people to go into the field, because there's such a shortage of nurses, just like there's a shortage of teachers. But we don't do as much with the conversation of, there's an incredible shortage of physicians. I think it's probably done in some ways, but not as publicly as like nurses and some other types of physicians.   Dr. Joe Sherman ** 29:13 Yes, I think right now, the I always feel like, I mean, this has been always true that on hospital floors, because the profit margin for hospitals is very narrow, there are only certain services that hospitals truly make profit on. So usually the staffing levels are kept to the very bare minimum, and now that just puts too much pressure on those that are remaining. And so now we're seeing many more hospitals have nurses that go out on strike or or decide to slow down, or. Or do other measures to try to get the attention of how dangerous it is to have understaffing in the hospital.   Michael Hingson ** 30:08 Have we learned anything, because of all the stuff that happened with COVID Now that we're in this somewhat post COVID world, have we have we learned a lot or any or anything, or is anything changing, and is there really ever going to be a true post COVID world? For that matter? That's a fair question.   Dr. Joe Sherman ** 30:29 That is a fair question. And I do think recent changes in policy by the CDC of of treating COVID As if it were influenza, or RSV or other type of respiratory viruses is there are many physicians that disagree with that policy, because COVID, this COVID, 19 that We've been dealing with, causes many more complications for those that have complex medical conditions, and this long COVID situation is something that we really don't have a grasp on at this point, but I believe one innovation I would see or expansion that has come about is the whole telehealth movement, now that there are many, many more video visits, I do think that's a good thing. I also believe that it can provide more flexibility for healthcare providers, which will help to decrease burnout, if providers are able to perhaps do their telehealth visits from home, or be able to spend time doing telehealth visits as opposed to having to see patients in person. I think what happens now is we need to get better organized as far as which types of visits are should be telehealth, and which types should be seen in person, so that one provider is not going back and forth from, you know, computer screen to seeing somebody in person, back and and so that gets too disorganized. Yeah, I think at times, other things, I think we learned a lot about infectious disease. I think that the general public learned a lot more about infections and infection control. I think that's all good. I think one thing that we did not learn, unfortunately, is how desperately we desperately we need to do something to try to stem the tide of burnout, because it just accelerated during COVID and then has continued to accelerate because of the economic crunch that healthcare systems find themselves in now.   Michael Hingson ** 33:10 Well, and what is, to me, a little bit scary, is all it takes is one COVID mutation that we don't expect or encounter, and we're almost in back where we were, at least for a while. And I hope the day will come when, rather than using the the mRNA type vaccine that we use now that we truly will have a vaccine like an influenza vaccine, that can really kill the virus and that we can then take, even if it's yearly, but that will truly build up the immune system in the same sort of way. Although I have no problem with the current vaccine, in fact, I'm going in for my next vaccine vaccination a week from tomorrow. And what cracks me up is I've been there a number of times, and some people talk about the conspiracies of all they're doing is injecting you with all these little things that are going to track you wherever you go. And I'm sitting there going, Fine, let them. Then if there's a problem, they're going to know about it, and they'll come and get me, you know, but what I really love to do is a nurse will come over, she'll give me the the vaccination, and she pulls the needle away, and then I reach over with my one hand and slap my hand right over where she did the shot. And I said, Wait a minute. One just got out. I had to get it, you know. And, and she says, you know, there aren't really any trackers. I said, No, I'm just messing with you, but, but you know, it will be nice when that kind of a vaccination comes, and I'm sure. Or someday it will.   Dr. Joe Sherman ** 35:02 Well, I think the vaccines it this specific, these types of respiratory viruses do mutate quite a bit. There's all kinds of variants, and they change every year. So I think no matter what kind of vaccine we get, we're still with with infections such as influenza or COVID, we're still going to end up needing to get annual vaccines, most likely, yeah,   Michael Hingson ** 35:34 and that is the issue, that even with influenza, we do get lots of variants, and I know a couple of years, as I understand it, they kind of predict what strains to immunize for based on like, when Australia gets in our middle of the year and things like that. But sometimes it doesn't work. That is they they guessed wrong when it gets to us, or it's mutated again, and it's unfortunate, but it is, it is what we have to deal with. So for me, as far as I'm concerned, anything that we can do is going to help. And I really have found the current vaccines that we do get for COVID, at least, whether it will totally keep you from getting it or not, which I gather it won't necessarily, at least it will mitigate to a large degree what could happen if you didn't take the vaccination.   Dr. Joe Sherman ** 36:34 Yes, yes, that's correct. We We are. We're seeing much less deaths as a result of COVID infection. However, in the peak of the winter time in the clients that I was that I've been coaching, who work in in hospitals and in ICUs, they were seeing still a large number of patients that were there. It's just that we've now developed better treatment and management for it and so, so then less people are dying of it. But it is, you know, we have, again, the amount of research, medical research and development that has developed these vaccines has prevented so much infection that what doctors are called on to do now and what they're called on to treat and manage has shifted much more into areas of behavioral health and lifestyle change than it is treating infections. That's dramatically different experience through my pediatric training than what type of training that a pediatrician these days gets   Michael Hingson ** 38:01 and there again, that means that the physicians have to spend the time learning a lot of that that they didn't learn before, which also takes a toll, because they can't be in front of patients while they're learning or while They're studying.   Dr. Joe Sherman ** 38:18 Yes, yeah, it's what the medical students and residents now are being called on to manage in the hospital are very, very complex, specialized conditions and very serious conditions. My experience as a resident was much more. The vast majority of people I took care of as a pediatric resident were normal, healthy children who happen to get sick, mostly with infection and sometimes very seriously sick, come in the hospital, receive treatment, and walk out as a child, a normal, healthy child again, we don't see that as often as pediatric residents, just speaking from pediatricians point of view, and I think that that has a an emotional toll on the resident physicians. I got a tremendous amount of reward from caring for patients with serious infections that received antibiotics and got completely better than patients who already have complex chronic conditions that just get worse or a complication, and they come In and the resident helps to manage them a little bit, and then sends them on their way. But really doesn't feel like they cured them contributed in the same way and that that was they don't have that same type of reward, that rewarding feeling, I think, are   Michael Hingson ** 39:59 we seeing? More of that kind of patient, significantly more than we used to in the hospital. Absolutely. Why is that? Is there really are more or   Dr. Joe Sherman ** 40:11 or what? Well, there aren't. We've taken care of most of the serious bacterial infections that used to be treated in the hospital with antibiotics, we've taken care of them with vaccines, and then we've also advanced the the quality and and variety of conditions that we can treat as an outpatient now, so that people that used to come into the hospital all the time for conditions, simple, basic things, are now treated as outpatients. And that's a good because you don't want to be in the hospital any longer than you absolutely have to. No,   Michael Hingson ** 40:58 I had, well, my father, I don't remember how old I was. It must have been in the we 1960 sometime he had to have a his gallbladder out. So it was a pretty significant operation at the time, because they he was in the hospital a couple days, and came home with a nice scar and all that. And then my brother later had the same thing. And then in 2015 suddenly I had this, really on a Thursday night, horrible stomachache. And I figured there is something going on. I hadn't had my appendix out, but this wasn't right where my appendix was, but we went to the local hospital. We called Kaiser, and they there isn't a hospital, a Kaiser hospital up here, so they sent us to another place, and they took x rays, and then we ended up going down. They they took me by ambulance on down to Kaiser, and it was a gallbladder issue. So I guess all the men in my family had it. But what happened was that when they did the surgery, and by the time we got down to Kaiser, the there was a gallstone and it passed. So I didn't want to do the surgery immediately, only because I had the following Sunday an engagement. So we did it, like a week later, the doctor thought I was crazy, waiting. And then later he said, Well, you were right. But anyway, when I had the operation, there were three little band aids, and it was almost, I guess you call it outpatient, because I went home two hours later. Wow, I was I was blessed. So they it was almost like, and I've had colonoscopies before. I didn't spend any more time doing the gallbladder operation than I did, really, with all that I spent in the hospital doing a colonoscopy, it was pretty good,   Dr. Joe Sherman ** 42:58 right? I do think that there's been again, major advances in endoscopic surgeries and robotic surgeries and minimally invasive procedures to be able to to treat patients. I mean, again, I have to say that our ability now to treat stroke and and heart attacks, myocardial infarction, our abilities to our ability to treat those acutely, do something to try to improve the outcome, has improved dramatically just recently, I would say, especially stroke management. So what we have is amazing, dramatic changes in in reducing the morbidity and mortality from stroke now, and I think that it's remarkable. Even as a physician, I didn't even realize until a recent trip I took to Bolivia with a group of neurosurgeons how stroke is treated now, and it's, it's, it's phenomenal that before you have a stroke, and it's just kind of like, well, you hope for the best. You support hope that some blood flow returns to that part of the brain. Now, if you have a stroke, and people are taught to recognize it and immediately get to the hospital, they can give a medication to melt the clot, or actually go in there with the catheter and extract the clot out of the vessel and restore you back to full function and   Michael Hingson ** 44:56 remarkable, and have a glass of red wine while you're at it. Yeah. Uh, or, or, do we still say that TPA helps some of those things a little bit? You   Dr. Joe Sherman ** 45:07 know, it's interesting. It's, you know, as far as as I think I've never seen so many articles written about the consumption of alcohol coffee, going back and forth and back and forth. You know what's helpful? What's not? Everything in moderation, I would say this point,   Michael Hingson ** 45:28 yeah, I I would not be a good poster child for the alcohol industry. I have tea every morning for well, with breakfast. And the reason I do is that I decided that that would be my hot drink of choice. I've never been a coffee drinker. The caffeine doesn't do anything for me, so it's more the tea and then a little milk in it. It is a hot drink. Ever since being in the World Trade Center, I do tend to clear my throat and cough more, so the tea helps that, and that's the reason that I drink tea. But I remember seeing old commercials about red wine. Can can help you. So if I have a choice in wine, I'll oftentimes get red just because I've heard that those commercials, and I don't know how how true it is anymore, but hey, it's as good a reason as any to have a glass of wine every other week. And that's about what it usually is.   Dr. Joe Sherman ** 46:26 Yeah, sounds like. Sounds like a good, a good plan. Yeah,   Michael Hingson ** 46:31 works. Well, it's, it's now kept me around for a while, and we'll keep doing it. It works. So what is it that healthcare workers and physicians do to kind of restore their love for what they do and work toward burnout? What can individuals do?   Dr. Joe Sherman ** 46:54 I think we're at a point now where in in approaching the issue of burnout and approaching the issue of overwhelm with the amount of work that physicians are called on to do these days is a combination of personal Changes to mindset and approach to our work, as well as structural and organizational changes to facilitate our work. And I think that the organizational structural changes, again, have to do with trying to improve specific staffing to match the activities and responsibilities that are that are called on in the medical setting, and being able to do more in the in the formation of medical teams and in teamwork And in people having a common mission, working together, appreciating what each other does, and hospital administrations and and those folks that run the business of the hospital truly value and enlist The engagement of frontline workers in policy and procedures. So those are kind of structural changes right on the personal side, yeah, I was that's I just a lot of it has to do with being more realistic. And I'm speaking to myself too. We can't do everything for everyone all the time we are human. We often have been taught that we are super human, but we're not. And if, if we try to do too much and try to do it perfectly, then our bodies will rebel and we'll get sick. So I think we need to set boundaries for ourselves. We need to be able to say, these are the hours that I'm working. I can't work any more than that. We need to say that you can't reach me three different ways, 24 hours a day, all the time, and have me respond to all of those inquiries, we have to set limits, and we have to really look at what it is that we love about medicine, what it is we love to do within medicine, and really try the best we can, I Think, with the help of coaches and other types of mentors and folks that can help us to create the types of jobs and the types of positions that help us maximize that experience of fulfillment, that experience of of. Feeling like we truly are contributing to the health and well being of our patients. Do   Michael Hingson ** 50:07 you think overall that the kind of work you do, and then others are doing to address the issue of burnout is is really helping? Are we are we making more progress, or are we still losing more than we gain.   Dr. Joe Sherman ** 50:23 I think we're making progress on an individual basis, on people that do seek help. But we need also to change the mindset of ourselves as physicians, to be willing to seek help. We need to seek help and be admit that we need that type of support, but until we get organizational commitment to trying to change the structures and the systems that we work under, then we will continue to have more physicians lost to burnout, depression and suicide.   Michael Hingson ** 51:05 Are healthcare institutions recognizing more the whole issue of burnout, and are they? Are they really starting to do more about it?   Dr. Joe Sherman ** 51:17 Some, I think some are. I think organizations are recognizing it. Associations of physicians are recognizing it. But when it comes to surviving as a health organization, healthcare institution, the bottom line is, what runs a show, and the way you make income is through billing, and the billing occurs as a result of a health care provider providing and billing for what they Do. So if there's an economic crunch, the first thing to go is anything that doesn't generate income and supports for the well being of staff does not generate direct income. What it does, though, is that it retains staff. It it results in a happier staff, a more higher professional satisfaction, and in the long run, is going to save you money,   Michael Hingson ** 52:33 yeah, which, which is another way of making some more money.   Dr. Joe Sherman ** 52:39 Yeah. I mean the total cost, the average cost for replacing a physician who has decided to quit is anywhere from about 600,000 to $2 million depending on the specialty of the physician. Yeah,   Michael Hingson ** 52:57 and then getting people to necessarily see that is, of course, a challenge, but it still is what what needs to happen, because it would seem to me that those costs are just so high, and that has to account for something that is still a fair chunk of money. Yeah, it   Dr. Joe Sherman ** 53:16 is. It's a great deal of money. And, you know, our again, our system of health care, we were headed in the right direction. And I think eventually we have to get there to population based health in looking at health outcomes and trying to look at overall health of of our our citizens and and those who live here in our country in trying to, instead of having a fee for service model, have a model that looks at reimbursement for health care based on the total health of The patient, and that is contributed to by nurses, doctors, technicians, receptionists, community health workers, all those types of health professionals.   Michael Hingson ** 54:12 What can we do to get the wider society to become more aware of all of these issues and maybe to advocate for change.   Dr. Joe Sherman ** 54:25 I think, I think avenues like this, these   Michael Hingson ** 54:29 podcasts, this podcast is one.   Dr. Joe Sherman ** 54:32 I also believe that look at your real life, lived experience of trying to access healthcare today compared to how it was 20 years ago, and are you having more trouble? Are you having is it more expensive? Are you having more challenges? This is direct result of a. System that's not functioning well.   Michael Hingson ** 55:02 Did the whole process of what we now call Obamacare, did that help in the medical process in any way? I   Dr. Joe Sherman ** 55:11 think what happened with Obamacare was well, and the bottom line answer is yes, it has helped. And the way it has helped is that more people have access to health insurance, less people are completely uninsured than ever before. So I think from that perspective, that's been helpful, but there were so many compromises, oh yeah, to insurance companies and two different lobbyists that were all looking out for their interests, that what ended up happening was a much more watered down version of what was initially proposed, but step in the right direction, And if we continue to work toward that, and we have some contribution of government sponsored health insurance, then we're going to be better off as a nation,   Michael Hingson ** 56:14 yeah, well, and anytime we can make a step forward, it does help, which is, of course, a good thing. So if there's one thing you want listeners to take away or watchers, because we are on YouTube, if there's one thing you want people to take away from this, what would it be?   Dr. Joe Sherman ** 56:33 It would be, pay attention to your own personal experience with healthcare. Pay attention to your own health and observe what's going on in the clinics, in the offices and in the hospitals where you receive your medical care. If somebody is treating you well with respect and compassion, point it out. Make it known. Thank them. Yeah, make it known that you know that they're under tremendous stress and pressure, and that anytime that they can be kind, then that means that they are very dedicated to to treating you, treating patients. And if you're finding that where you're going to receive your health care seems to be understaffed, and say something about it. If you have a health care provider who is a bit snappy, is not patient with you, doesn't seem to be listening to you, it's not because they don't want to. Yeah, they desperately want to. It's just that the conditions are such that they're not able to   Michael Hingson ** 57:44 and and it would probably be good to at least engage them in a little dialog and say, hey, hey, I'm not trying to yank your chain here and kind of try to help warm them up. I've been a firm believer that in a lot of places where I go, like in the in the airline world, the TSA people and so on, I love to do my best to make them laugh. So like when I go up to the kiosk and the TSA agent says, I need to see your ID, especially when I'm wearing a mask, I'll say, Well, what do you want to see it for? You can't tell who it is behind this mask, right? And I've had a couple people who didn't expect anything like that, but they usually laugh at it. Then the other one I love to use is they ask for my idea. I say, Well, what's wrong with yours? Did you lose yours? And I just love to try to make them laugh where I can, because I know it's a thankless job, and I know that what doctors and medical people deal with is a pretty thankless job, too. So it's fun to try to make them laugh whenever I can and get them to smile.   Dr. Joe Sherman ** 58:47 Yep, they all could use a little bit more humor. Yeah, there's always that. So   Michael Hingson ** 58:51 if people want to learn more about you and reach out and learn about your work and so on, how do they do that? Where do they find you, online or any of those things? Sure,   Dr. Joe Sherman ** 59:00 I have a website that you can go to. It's Joe Sherman md.com and you can reach me by email. Joe at Joe Sherman md.com also on LinkedIn, so you can find me there. Too Cool. Well,   Michael Hingson ** 59:20 once again, I want to thank you for being here. This has been a lot of fun and very enjoyable and in a lot of ways, but certainly educational, and I've learned a lot, and we got through all the questions this time that we didn't get through last time, which is always a good thing. So see, it was worth doing it twice.   Dr. Joe Sherman ** 59:39 Great. Thank you so much. Well, it was   Michael Hingson ** 59:42 fun, and of course, for you listening out there, reach out to Joe, and I want to hear from you. I want to hear what you think of today. So please email me. Michael, h i at accessibe, A, C, C, E, S, S, I, B, e.com, or go to our podcast page, www, dot. Michael hingson.com/podcast and Michael Hinkson is m, I, C, H, A, E, L, H, I N, G, s, O n.com/podcast, would really appreciate a five star review from you, wherever you are listening to us. We like those reviews if you can, if you know anyone that you think ought to be a good guest on unstoppable mindset. And Joe you as well. We'd love to hear from you or provide us introductions. Always looking for more folks to to meet and to chat with, and love the incredible diversity and subjects that we get to talk about. So that makes it a lot of fun, but I do want to just once more. Joe, thank you for being here. This has been enjoyable, and I really appreciate it. Thanks   Dr. Joe Sherman ** 1:00:40 so much, Michael, I enjoyed the conversation.   Michael Hingson ** 1:00:48 You have been listening to the Unstoppable Mindset podcast. Thanks for dropping by. I hope that you'll join us again next week, and in future weeks for upcoming episodes. To subscribe to our podcast and to learn about upcoming episodes, please visit www dot Michael hingson.com slash podcast. Michael Hingson is spelled m i c h a e l h i n g s o n. While you're on the site., please use the form there to recommend people who we ought to interview in upcoming editions of the show. And also, we ask you and urge you to invite your friends to join us in the future. If you know of any one or any organization needing a speaker for an event, please email me at speaker at Michael hingson.com. I appreciate it very much. To learn more about the concept of blinded by fear, please visit www dot Michael hingson.com forward slash blinded by fear and while you're there, feel free to pick up a copy of my free eBook entitled blinded by fear. The unstoppable mindset podcast is provided by access cast an initiative of accessiBe and is sponsored by accessiBe. Please visit www.accessibe.com . AccessiBe is spelled a c c e s s i b e. There you can learn all about how you can make your website inclusive for all persons with disabilities and how you can help make the internet fully inclusive by 2025. Thanks again for Listening. Please come back and visit us again next week.

American healthcare is well known for its extreme cost and worst outcomes among industrialized (such as the 38 OECD member) countries, and beyond that to be remarkably opaque. The high cost of prescription drugs contributes, and little has been done to change that except for the government passing the Affordable Insulin Now Act at the end of 2022, enacted in 2023. But in January 2022 Mark Cuban launched Cost Plus Drugs that has transformed how many Americans can get their prescriptions filled at a fraction of the prevailing prices, bypassing pharmacy benefit managers (PBMs) that control 80% of US prescriptions. That was just the beginning of a path of creative destruction (disruptive innovation, after Schumpeter) of many key components American healthcare that Cuban is leading, with Cost Plus Marketplace, Cost Plus Wellness and much more to come. He certainly qualifies as a master disrupter: “someone who is a leader in innovation and is not afraid to challenge the status quo.” Below is a video clip from our conversation dealing with insurance companies. Full videos of all Ground Truths podcasts can be seen on YouTube here. The current one is here. If you like the YouTube format, please subscribe! The audios are also available on Apple and Spotify.Transcript with External links to Audio (00:07):Hello, it's Eric Topol with Ground Truths, and I have our special phenomenal guest today, Mark Cuban, who I think you know him from his tech world contributions and Dallas Mavericks, and the last few years he's been shaking up healthcare with Cost Plus Drugs. So Mark, welcome.Mark Cuban (00:25):Thanks for having me, Eric.Eric Topol (00:27):Yeah, I mean, what you're doing, you've become a hero to millions of Americans getting them their medications at a fraction of the cost they're used to. And you are really challenging the PBM industry, which I've delved into more than ever, just in prep for our conversation. It's just amazing what this group of companies, namely the three big three CVS Caremark, Optum of UnitedHealth and Express Scripts of Cigna with a market of almost $600 billion this year, what they're doing, how can they get away with all this stuff?Inner Workings of Pharmacy Benefit ManagersMark Cuban (01:03):I mean, they're just doing business. I really don't blame them. I blame the people who contract with them. All the companies, particularly the bigger companies, the self-insured companies, where the CEO really doesn't have an understanding of their healthcare or pharmacy benefits. And so, the big PBMs paid them rebates, which they think is great if you're a CEO, when in reality it's really just a loan against the money spent by your sickest employees, and they just don't understand that. So a big part of my time these days is going to CEOs and sitting with them and explaining to them that you're getting ripped off on both your pharmacy and your healthcare side.Eric Topol (01:47):Yeah, it's amazing to me the many ways that they get away with this. I mean, they make companies sign NDAs. They're addicted to rebates. They have all sorts of ways a channel of funds to themselves. I mean, all the things you could think of whereby they even have these GPOs. Each of these companies has a group purchasing organization (I summarized in the Table below).Mark Cuban (02:12):Yeah, which gives them, it's crazy because with those GPOs. The GPO does the deal with the pharmacy manufacturer. Then the GPO also does the deal with the PBM, and then the PBM goes to the self-insured employer in particular and says, hey, we're going to pass through all the rebates. But what they don't say is they've already skimmed off 5%, 10%, 20% or more off the top through their GPO. But that's not even the worst of it. That's just money, right? I mean, that's important, but I mean, even the biggest companies rarely own their own claims data.Mark Cuban (02:45):Now think about what that means. It means you can't get smarter about the wellness of your employees and their families. You want to figure out the best way to do GLP-1s and figure out how to reduce diabetes, whatever it may be. You don't have that claims data. And then they don't allow the companies to control their own formularies. So we've seen Humira biosimilars come out and the big PBMs have done their own version of the biosimilar where we have a product called Yusimry, which is only $594 a month, which is cheaper than the cheapest biosimilar that the big three are selling. And so, you would think in a normal relationship, they would want to bring on this new product to help the employer. No, they won't do it. If the employer asks, can I just add Cost Plus Drugs to my network? They'll say no, every single time.Mark Cuban (03:45):Their job is not to save the employer money, particularly after they've given a rebate. Because once they give that loan, that rebate to the employer, they need to get that money back. It's not a gift. It's a loan and they need to have the rebates, and we don't do rebates with them at all. And I can go down the list. They don't control the formula. They don't control, you mentioned the NDAs. They can't talk to manufacturers, so they can't go to Novo or to Lilly and say, let's put together a GLP-1 wellness program. All these different things that just are common sense. It's not happening. And so, the good news is when I walk into these companies that self-insured and talk to the CEO or CFO, I'm not asking them to do something that's not in their best interest or not in the best interest of the lives they cover. I'm saying, we can save you money and you can improve the wellness of your employees and their families. Where's the downside?Eric Topol (04:40):Oh, yeah. Yeah. And the reason they can't see the claims is because of the privacy issues?Mark Cuban (04:46):No, no. That's just a business decision in the contract that the PBMs have made. You can go and ask. I mean, you have every right to your own claims. You don't need to have it personally identified. You want to find out how many people have GLP-1s or what are the trends, or God forbid there's another Purdue Pharma thing going on, and someone prescribing lots of opioids. You want to be able to see those things, but they won't do it. And that's only on the sponsor side. It's almost as bad if not worse on the manufacturer side.Eric Topol (05:20):Oh, yeah. Well, some of the work of PBMs that you've been talking about were well chronicled in the New York Times, a couple of major articles by Reed Abelson and Rebecca Robbins: The Opaque Industry Secretly Inflating Prices for Prescription Drugs and The Powerful Companies Driving Local Drugstores Out of Business. We'll link those because I think some people are not aware of all the things that are going on in the background.Mark Cuban (05:39):You see in their study and what they reported on the big PBMs, it's crazy the way it works. And literally if there was transparency, like Cost Plus offers, the cost of medications across the country could come down 20%, 30% or more.Cost Plus DrugsEric Topol (05:55):Oh, I mean, it is amazing, really. And now let's get into Cost Plus. I know that a radiologist, Alex Oshmyansky contacted you with a cold email a little over three years ago, and you formed Cost Plus Drugs on the basis of that, right?Mark Cuban (06:12):Yep, that's exactly what happened.Eric Topol (06:15):I give you credit for responding to cold emails and coming up with a brilliant idea with this and getting behind it and putting your name behind it. And what you've done, so you started out with something like 110 generics and now you're up well over 1,200 or 2,500 or something like that?Mark Cuban (06:30):And adding brands. And so, started with 111. Now we're around 2,500 and trying to grow it every single day. And not only that, just to give people an overview. When you go to www.costplusdrugs.com and you put in the name of your medication, let's just say it's tadalafil, and if it comes up. In this case, it will. It'll show you our actual cost, and then we just mark it up 15%. It's the same markup for everybody, and if you want it, we'll have a pharmacist check it. And so, that's a $5 fee. And then if you want ship to mail order, it's $5 for shipping. And if you want to use our pharmacy network, then we can connect you there and you can just pick it up at a local pharmacy.Eric Topol (07:10):Yeah, no, it's transparency. We don't have a lot of that in healthcare in America, right?Mark Cuban (07:15):No. And literally, Eric, the smartest thing that we did, and we didn't expect this, it's always the law of unintended consequences. The smartest thing we did was publish our entire price list because that allowed any company, any sponsor, CMS, researchers to compare our prices to what others were already paying. And we've seen studies come out saying, for this X number of urology drugs, CMS would save $3.6 billion a year. For this number of heart drugs at this amount per year, for chemotherapy drugs or MS drugs this amount. And so, it's really brought attention to the fact that for what PBMs call specialty drugs, whether there's nothing special about them, we can save people a lot of money.Eric Topol (08:01):It's phenomenal. As a cardiologist, I looked up a couple of the drugs that I'm most frequently prescribed, just like Rosuvastatin what went down from $134 to $5.67 cents or Valsartan it went down from $69 to $7.40 cents. But of course, there's some that are much more dramatic, like as you mentioned, whether it's drugs for multiple sclerosis, the prostate cancer. I mean, some of these are just thousands and thousands of dollars per month that are saved, brought down to levels that you wouldn't think would even be conceivable. And this has been zero marketing, right?Mark Cuban (08:42):Yeah, none. It's all been word of mouth and my big mouth, of course. Going out there and doing interviews like this and going to major media, but it's amazing. We get emails and letters and people coming up to us almost single day saying, you saved my grandma's life. You saved my life. We weren't going to be able to afford our imatinib or our MS medication. And it went from being quoted $2,000 a month to $33 a month. It's just insane things like that that are still happening.Eric Topol (09:11):Well, this is certainly one of the biggest shakeups to occur in US healthcare in years. And what you've done in three years is just extraordinary. This healthcare in this country is with its over 4 trillion, pushing $5 trillion a year of expenditure.[New CMS report this week pegs the number at $4.867 trillion for 2023]Mark Cuban (09:30):It's interesting. I think it's really fixable. This has been the easiest industry to the disrupt I've ever been involved in. And it's not even close because all it took was transparency and not jacking up margins to market. We choose to use a fixed margin markup. Some choose to price to market, the Martin Shkreli approach, if you will. And just by being transparent, we've had an impact. And the other side of it is, it's the same concept on the healthcare side. Transparency helps, but to go a little field of pharmacy if you want. The insane part, and this applies to care and pharmacy, whatever plan we have, whether it's for health or whether it's for pharmaceuticals, there's typically a deductible, typically a copay, and typically a co-insurance.Insurance CompaniesMark Cuban (10:20):The crazy part of all that is that people taking the default risk, the credit risk are the providers. It's you, it's the hospital, it's the clinics that you work for. Which makes no sense whatsoever that the decisions that you or I make for our personal insurance or for the companies we run, or if we work for the government, what we do with Medicare or Medicare Advantage, the decisions we all make impacts the viability of providers starting with the biggest hospital systems. And so, as a result, they become subprime lenders without a car or a house to go after if they can't collect. And so, now you see a bunch of people, particularly those under the ACA with the $9,000, the bronze plans or $18,000 out-of-pocket limits go into debt, significant medical debt. And it's unfortunate. We look at the people who are facing these problems and think, well, it must be the insurance companies.Mark Cuban (11:23):It's actually not even the insurance companies. It's the overall design of the system. But underneath that, it's still whoever picks the insurance companies and sets plans that allow those deductibles, that's the core of the problem. And until we get to a system where the providers aren't responsible for the credit for defaults and dealing with all that credit risk, it's almost going to be impossible to change. Because when you see stories like we've all seen in news of a big healthcare, a BUCA healthcare (Blue Cross Blue Shield (BCBS), UnitedHealth, Cigna, and Aetna/CVS) plan with all the pre-authorizations and denials, typically they're not even taking the insurance risk. They're acting as the TPA (third party administrator) as the claims processor effectively for whoever hired them. And it goes back again, just like I talked about before. And as long as CMS hires or allows or accepts these BUCAs with these plans for Medicare for the ACA (Affordable care Act), whatever it may be, it's not going to work. As long as self-insured employers and the 50 million lives they cover hire these BUCAs to act as the TPAs, not as insurance companies and give them leeway on what to approve and what to authorize and what not to authorize. The system's going to be a mess, and that's where we are today.Academic Health System PartnershipsEric Topol (12:41):Yeah. Well, you've been talking of course to employers and enlightening them, and you're also enlightening the public, of course. That's why you have millions of people that are saving their cost of medications, but recently you struck a partnership with Penn Medicine. That's amazing. So is that your first academic health system that you approached?Cost Plus MarketplaceMark Cuban (13:00):I don't know if it was the first we approached, but it was certainly one of the biggest that we signed. We've got Cost Plus Marketplace (CPM) where we make everything from injectables to you name it, anything a hospital might buy. But again, at a finite markup, we make eight and a half percent I think when it's all said and done. And that saves hospital systems millions of dollars a year.Eric Topol (13:24):Yeah. So that's a big change in the way you're proceeding because what it was just pills that you were buying from the pharma companies, now you're actually going to make injectables and you're going to have a manufacturing capability. Is that already up and going?Mark Cuban (13:39):That's all up and going as of March. We're taking sterile injectables that are on the shortage list, generic and manufacturing them in Dallas using a whole robotics manufacturing plant that really Alex created. He's the rocket scientist behind it. And we're limited in capacity now, we're limited about 2 million vials, but we'll sell those to Cost Plus Marketplace, and we'll also sell those direct. So Cost Plus Marketplace isn't just the things we manufacture. It's a wide variety of products that hospitals buy that we then have a minimal markup, and then for the stuff we manufacture, we'll sell those to direct to like CHS was our first customer.Eric Topol (14:20):Yeah, that's a big expansion from going from the pills to this. Wow.Mark Cuban (14:24):It's a big, big expansion, but it goes to the heart of being transparent and not being greedy, selling on a markup. And ourselves as a company, being able to remain lean and mean. The only way we can sell at such a low markup. We have 20 employees on the Cost Plus side and 40 employees involved with the factories, and that's it.Eric Topol (14:46):Wow. So with respect to, you had this phenomenal article and interview with WIRED Magazine just this past week. I know Lauren Goode interviewed you, and she said, Mark, is this really altruistic and I love your response. You said, “how much f*****g money do I need? I'm not trying to land on Mars.” And then you said, “at this point in my life, it's just like more money, or f**k up the healthcare industry.” This was the greatest, Mark. I mean, I got to tell you, it was really something.Mark Cuban (15:18):Yeah.Eric Topol (15:19):Well, in speaking of that, of course, the allusion to a person we know well, Elon. He posted on X/Twitter in recent days , I think just three or four days ago, shouldn't the American people be getting their money's worth? About this high healthcare administration costs where the US is completely away from any other OECD country. And as you and I know, we have the worst outcomes and the most costs of all the rich countries in the world. There's just nothing new here. Maybe it's new to him, but you had a fabulous response on both X and Bluesky where you went over all these things point by point. And of course, the whole efforts that you've been working on now for three years. You also mentioned something that was really interesting that I didn't know about were these ERISA lawsuits[Employee Retirement Income Security Act (ERISA) of 1974.] Can you tell us about that?ERISA LawsuitsMark Cuban (16:13):Yeah, that's a great question, Eric. So for self-insured companies in particular, we have a fiduciary responsibility on a wellness and on a financial basis to offer the members, your employees and their families the best outcomes at the best price. Now, you can't guarantee best outcomes, but you have to be able to explain the choices you made. You don't have to pick the cheapest, but again, you have to be able to explain why you made the choices that you did. And because a lot of companies have been doing, just like we discussed earlier, doing deals on the pharmacy side with just these big PBMs, without accounting for best practices, best price, best outcomes, a couple companies got sued. Johnson and Johnson and Wells Fargo were the first to get sued. And I think that's just the beginning. That's just the writing on the wall. I think they'll lose because they just dealt with the big pharmacy PBMs. And I think that's one of the reasons why we're so busy at Cost Plus and why I'm so busy because we're having conversation after conversation with companies and plenty of enough lawyers for that matter who want to see a price list and be able to compare what they're paying to what we sell for to see if they're truly living up to that responsibility.Eric Topol (17:28):Yeah, no, that's a really important thing that's going on right now that I think a lot of people don't know about. Now, the government of the US think because it's the only government of any rich country in the world, if not any country that doesn't negotiate prices, i.e., CMS or whatever. And only with the recent work of insulin, which is a single one drug, was there reduction of price. And of course, it's years before we'll see other drugs. How could this country not negotiate drugs all these years where every other place in the world they do negotiate with pharma?Mark Cuban (18:05):Because as we alluded to earlier, the first line in every single pharmaceutical and healthcare contract says, you can't talk about this contract. It's like fight club. The number one rule of fight club is you can't talk about fight club, and it's really difficult to negotiate prices when it's opaque and everything's obfuscated where you can't really get into the details. So it's not that we're not capable of it, but it's just when there's no data there, it's really difficult because look, up until we started publishing our prices, how would anybody know?Mark Cuban (18:39):I mean, how was anybody going to compare numbers? And so, when the government or whoever started to negotiate, they tried to protect themselves and they tried to get data, but those big PBMs certainly have not been forthcoming. We've come along and publish our price list and all that starts to change. Now in terms of the bigger picture, there is a solution there, as I said earlier, but it really comes down to talking to the people who make the decisions to hire the big insurance companies and the big PBMs and telling them, no, you're not acting in your own best interest. Here's anybody watching out there. Ask your PBM if they can audit. If you can audit rather your PBM contract. What they'll tell you is, yeah, you can, but you have to use our people. It's insane. And that's from top to bottom. And so, I'm a big believer that if we can get starting with self-insured employers to act in their own best interest, and instead of working with a big PBM work with a pass-through PBM. A pass-through PBM will allow you to keep your own claims, own all your own data, allow you to control your own formulary.Mark Cuban (19:54):You make changes where necessary, no NDA, so you can't talk to manufacturers. All these different abilities that just seem to make perfect sense are available to all self-insured employers. And if the government, same thing. If the government requires pass-through PBMs, the price of medications will drop like a rock.Eric Topol (20:16):Is that possible? You think that could happen?Mark Cuban (20:19):Yes. Somebody's got to understand it and do it. I'm out there screaming, but we will see what happens with the new administration. There's nothing hard about it. And it's the same thing with Medicare and Medicare Advantage healthcare plans. There's nothing that says you have to use the biggest companies. Now, the insurance companies have to apply and get approved, but again, there's a path there to work with companies that can reduce costs and improve outcomes. The biggest challenge in my mind, and I'm still trying to work through this to fully understand it. I think where we really get turned upside down as a country is we try to avoid fraud from the provider perspective and the patient perspective. We're terrified that patients are going to use too much healthcare, and like everybody's got Munchausen disease.Mark Cuban (21:11):And we're terrified that the providers are going to charge too much or turn into Purdue Pharma and over-prescribe or one of these surgery mills that just is having somebody get surgery just so they can make money. So in an effort to avoid those things, we ask the insurance companies and the PBMs to do pre-authorizations, and that's the catch 22. How do we find a better way to deal with fraud at the patient and provider level? Because once we can do that, and maybe it's AI, maybe it's accepting fraud, maybe it's imposing criminal penalties if somebody does those things. But once we can overcome that, then it becomes very transactional. Because the reality is most insurance companies aren't insurance companies. 50 million lives are covered by self-insured employers that use the BUCAs, the big insurance companies, but not as insurance companies.Eric Topol (22:07):Yeah, I was going to ask you about that because if you look at these three big PBMs that control about 80% of the market, not the pass-throughs that you just mentioned, but the big ones, they each are owned by an insurance company. And so, when the employer says, okay, we're going to cover your healthcare stuff here, we're going to cover your prescriptions there.Mark Cuban (22:28):Yeah, it's all vertically integrated.Mark Cuban (22:36):And it gets even worse than that, Eric. So they also own specialty pharmacies, “specialty pharmacies” that will require you to buy from. And as I alluded to earlier, a lot of these medications like Imatinib, they'll list as being a specialty medication, but it's a pill. There's nothing special about it, but it allows them to charge a premium. And that's a big part of how the PBMs make a lot of their money, the GPO stuff we talked about, but also forcing an employer to go through the specialty mail order company that charges an arm and the leg.Impact on Hospitals and ProceduresEric Topol (23:09):Yeah. Well, and the point you made about transparency, we've seen this of course across US healthcare. So for example, as you know, if you were to look at what does it cost to have an operation like let's say a knee replacement at various hospitals, you can find that it could range fivefold. Of course, you actually get the cost, and it could be the hospital cost, and then there's the professional cost. And the same thing occurs for if you're having a scan, if you're having an MRI here or there. So these are also this lack of transparency and it's hard to get to the numbers, of course. There seems to be so many other parallels to the PBM story. Would you go to these other areas you think in the future?Mark Cuban (23:53):Yeah, we're doing it now. I'm doing it. So we have this thing called project dog food, and what it is, it's for my companies and what we've done is say, look, let's understand how the money works in healthcare.Mark Cuban (24:05):And when you think about it, when you go to get that knee done, what happens? Well, they go to your insurance company to get a pre-authorization. Your doctor says you need a knee replacement. I got both my hips replaced. Let's use that. Doctor says, Mark, you need your hips replaced. Great, right? Let's set up an appointment. Well, first the insurance company has to authorize it, okay, they do or they don't, but the doctor eats their time up trying to deal with the pre-authorization. And if it's denied, the doctor's time is eaten up and an assistance's time is eaten up. Some other administrator's time is eaten up, the employer's time is eaten up. So that's one significant cost. And then from there, there's a deductible. Now I can afford my deductible, but if there is an individual getting that hip replacement who can't afford the deductible, now all of a sudden you're still going to be required to do that hip replacement, most likely.Mark Cuban (25:00):Because in most of these contracts that self-insured employers sign, Medicare Advantage has, Medicare has, it says that between the insurance company and the provider, in this case, the hospital, you have to do the operation even if the deductibles not paid. So now the point of all this is you have the hospital in this case potentially accumulating who knows how much bad debt. And it's not just the lost amount of millions and millions and billions across the entire healthcare spectrum that's there. It's all the incremental administrative costs. The lawyers, the benefits for those people, the real estate, the desk, the office space, all that stuff adds up to $10 billion plus just because the hospitals take on that credit default risk. But wait, there's more. So now the surgery happens, you send the bill to the insurance company. The insurance company says, well, we're not going to pay you. Well, we have a contract. This is what it says, hip replacement's $34,000. Well, we don't care first, we're going to wait. So we get the time value of money, and then we're going to short pay you.Mark Cuban (26:11):So the hospital gets short paid. So what do they have to do? They have to sue them or send letters or whatever it is to try to get their money. When we talk to the big hospital systems, they say that's 2%. That's 2% of their revenue. So you have all these associated credit loss dollars, you've got the 2% of, in a lot of cases, billions and billions of dollars. And so, when you add all those things up, what happens? Well, what happens is because the providers are losing all that money and having to spend all those incremental dollars for the administration of all that, they have to jack up prices.Eric Topol (26:51):Yeah. Right.Mark Cuban (26:53):So what we have done, we've said, look for my companies, we're going to pay you cash. We're going to pay you cash day one. When Mark gets that hip replacement, that checks in the bank before the operation starts, if that's the way you want it. Great, they're not going to have pre-authorizations. We're going to trust you until you give us a reason not to trust you. We're not short paying, obviously, because we're paying cash right there then.Mark Cuban (27:19):But in a response for all that, because we're cutting out all those ancillary costs and credit risk, I want Medicare pricing. Now the initial response is, well, Medicare prices, that's awful. We can't do it. Well, when you really think about the cost and operating costs of a hospital, it's not the doctors, it's not the facilities, it's all the administration that cost all the money. It's all the credit risks that cost all the money. And so, if you remove that credit risk and all the administration, all those people, all that real estate, all those benefits and overhead associated with them, now all of a sudden selling at a Medicare price for that hip replacement is really profitable.Eric Topol (28:03):Now, is that a new entity Cost Plus healthcare?Mark Cuban (28:07):Well, it's called Cost Plus Wellness. It's not an entity. What we're going to do, so the part I didn't mention is all the direct contracts that we do that have all these pieces, as part of them that I just mentioned, we're going to publish them.Eric Topol (28:22):Ah, okay.Mark Cuban (28:23):And you can see exactly what we've done. And if you think about the real role of the big insurances companies for hospitals, it's a sales funnel.Getting Rid of Insurance CompaniesEric Topol (28:33):Yeah, yeah. Well, in fact, I really was intrigued because you did a podcast interview with Andrew Beam and the New England Journal of Medicine AI, and in that they talked about getting rid of the insurers, the insurance industry, just getting rid of it and just make it a means test for people. So it's not universal healthcare, it's a different model that you described. Can you go over that? I thought it was fantastic.Mark Cuban (29:00):Two pieces there. Let's talk about universal healthcare first. So for my companies, for our project dog food for the Mark Cuban companies, if for any employee or any of the lives we cover, if they work within network, anybody we have the direct contract with its single-payer. They pay their premiums, but they pay nothing else out of pocket. That's the definition of single-payer.Eric Topol (29:24):Yeah.Mark Cuban (29:25):So if we can get all this done, then the initial single-payers will be self-insured employers because it'll be more cost effective to them to do this approach. We hope, we still have to play it all through. So that's part one. In terms of everybody else, then you can say, why do we need insurance companies if they're not even truly acting as insurance companies? You're not taking full risk because even if it's Medicare Advantage, they're getting a capitated amount per month. And then that's getting risk adjusted because of the population you have, and then there's also an index depending on the location, so there's more or less money that occurs then. So let's just do what we need to do in this particular case, because the government is effectively eliminating the risk for the insurance company for the most part. And if you look at the margins for Medicare Advantage, I was just reading yesterday, it's like $1,700 a year for the average Medicare Advantage plan. So it's not like they're taking a lot of risk. All they're doing is trying to deny as many claims as they can.Eric Topol (30:35):Deny, Deny. Yeah.Mark Cuban (30:37):So instead, let's just get somebody who's a TPA, somebody who does the transaction, the claims processing, and whoever's in charge. It could be CMS, can set the terms for what's accepted and what's denied, and you can have a procedure for people that get denied that want to challenge it. And that's great, there's one in place now, but you make it a little simpler. But you take out the economics for the insurance company to just deny, deny, deny. There's no capitation. There's no nothing.Mark Cuban (31:10):The government just says, okay, we're hiring this TPA to handle the claims processing. It is your job. We're paying you per transaction.Mark Cuban (31:18):You don't get paid more if you deny. You don't get paid less if you deny. There's no bonuses if you keep it under a certain amount, there's no penalties If you go above a certain amount. We want you just to make sure that the patient involved is getting the best care, end of story. And if there's fraud involved as the government, because we have access to all that claims data, we're going to introduce AI that reviews that continuously.Mark Cuban (31:44):So that we can see things that are outliers or things that we question, and there's going to mean mistakes, but the bet was, if you will, where we save more and get better outcomes that way versus the current system and I think we will. Now, what ends up happening on top of that, once you have all that claims data and all that information and everybody's interest is aligned, best care at the best price, no denials unless it's necessary, reduce and eliminate fraud. Once everybody's in alignment, then as long as that's transparent. If the city of Dallas decides for all the lives they cover the 300,000 lives they cover between pharmacy and healthcare, we can usually in actuarial tables and some statistical analysis, we can say, you know what, even with a 15% tolerance, it's cheaper for us just to pay upfront and do this single-pay program, all our employees in the lives we cover, because we know what it's going to take.Mark Cuban (32:45):If the government decides, well, instead of Medicare Advantage the way it was, we know all the costs. Now we can say for all Medicare patients, we'll do Medicare for all, simply because we have definitive and deterministic pricing. Great. Now, there's still going to be outlier issues like all the therapies that cost a million dollars or whatever. But my attitude there is if CMS goes to Lilly, Novo, whoever for their cure for blindness that's $3.4 million. Well, that's great, but what we'll say is, okay, give us access to your books. We want to know what your breakeven point is. What is that breakeven point annually? We'll write you a check for that.Eric Topol (33:26):Yeah.Mark Cuban (33:27):If we have fewer patients than need that, okay, you win. If we have more patients than need that, it's like a Netflix subscription with unlimited subscribers, then we will have whatever it is, because then the manufacturer doesn't lose money, so they can't complain about R&D and not being able to make money. And that's for the CMS covered population. You can do a Netflix type subscription for self-insured employers. Hey, it's 25 cents per month per employee or per life covered for the life of the patent, and we'll commit to that. And so, now all of a sudden you get to a point where healthcare starts becoming not only transparent but deterministic.Eric Topol (34:08):Yeah. What you outline here in these themes are extraordinary. And one of the other issues that you are really advocating is patient empowerment, but one of the problems we have in the US is that people don't own their data. They don't even have all their data. I expect you'd be a champion of that as well.Mark Cuban (34:27):Well, of course. Yeah. I mean, look, I've got into arguments with doctors and public health officials about things like getting your own blood tested. I've been an advocate of getting my own blood tested for 15 years, and it helped me find out that I needed thyroid medication and all of these things. So I'm a big advocate. There's some people that think that too much data gives you a lot of false positives, and people get excited in this day and age to get more care when it should only be done if there are symptoms. I'm not a believer in that at all. I think now, particularly as AI becomes more applicable and available, you'll be able to be smarter about the data you capture. And that was always my final argument. Either you trust doctors, or you don't. Because even if there's an aberrational TSH reading and minus 4.4 and it's a little bit high, well the doctor's going to say, well, let's do another blood test in a month or two. The doctor is still the one that has to write the prescription. There's no downside to trusting your doctor in my mind.Eric Topol (35:32):And what you're bringing up is that we're already seeing how AI can pick up things even in the normal range, the trends long before a clinician physician would pick it up. Now, last thing I want to say is you are re-imagining healthcare like no one. I mean, there's what you're doing here. It started with some pills and it's going in a lot of different directions. You are rocking it here. I didn't even know some of the latest things that you're up to. This seems to be the biggest thing you've ever done.Mark Cuban (36:00):I hope so.Mark Cuban (36:01):I mean, like we said earlier, what could be better than people saying our healthcare system is good. What changed? That Cuban guy.Eric Topol (36:10):Well, did you give up Shark Tank so you could put more energy into this?Mark Cuban (36:16):Not really. It was more for my kids.Eric Topol (36:19):Okay, okay.Mark Cuban (36:20):They go hand in hand, obviously. I can do this stuff at home as opposed to sitting on a set wondering if I should invest in Dude Wipes again.Eric Topol (36:28):Well, look, we're cheering for you. This is, I've not seen a shakeup in my life in American healthcare like this. You are just rocking. It's fantastic.Mark Cuban (36:37):Everybody out there that's watching, check out www.costplusdrugs.com, check out Cost Plus Marketplace, which is business.costplusdrugs.com and just audit everything. What I'm trying to do is say, okay, if it's 1955 and we're starting healthcare all over again, how would we do it? And really just keep it simple. Look to where the risk is and remove the risk where possible. And then it comes down to who do you trust and make sure you trust but verify. Making sure there aren't doctors or systems that are outliers and making sure that there aren't companies that are outliers or patients rather that are outliers. And so, I think there's a path there. It's not nearly as difficult, it's just starting them with corporations, getting those CEOs to get educated and act in their own best interest.Eric Topol (37:32):Well, you're showing us the way. No question. So thanks so much for joining, and we'll be following this with really deep interest because you're moving at high velocity, and thank you.**************************************************Thank you for reading, listening and subscribing to Ground Truths.If you found this fun and informative please share it!All content on Ground Truths—its newsletters, analyses, and podcasts, are free, open-access.Paid subscriptions are voluntary. All proceeds from them go to support Scripps Research. Many thanks to those who have contributed—they have greatly helped fund our summer internship programs for the past two years. I welcome all comments from paid subscribers and will do my best to respond to each of them and any questions.Thanks to my producer Jessica Nguyen and to Sinjun Balabanoff for audio and video support at Scripps Research.FootnoteThe PBMS (finally) are under fire—2 articles from the past week Get full access to Ground Truths at erictopol.substack.com/subscribe

Employers need proven strategies to manage risks and control costs, but with hundreds of point solutions on the market, how do brokers know where to focus? In this episode, a leading benefits consultant shares the innovative solutions they're implementing, why these choices matter, and the pivotal role a trusted TPA plays in this process. Tune in to gain insights that can guide your own risk and cost management decisions. This episode was sponsored by Valenz Health. For more information on managing risks and controlling costs, please visit HCAA.org. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen/

Vascular cognitive impairment is a common and often underrecognized contributor to cognitive impairment in older individuals, with heterogeneous etiologies requiring individualized treatment strategies.  In this episode, Katie Grouse, MD, FAAN speaks with Lisa C. Silbert, MD, MCR, FAAN, an author of the article “Vascular Cognitive Impairment,” in the Continuum December 2024 Dementia issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Silbert is is co-director at Oregon Alzheimer's Disease Research Center, a Gibbs Family Endowed professor of neurology, a professor of neurology at Oregon Health & Science University, a staff neurologist, director of Cognitive Care Clinic, and director of the Geriatric Neurology Fellowship Program at Portland Veterans Affairs Health Care System in Portland, Oregon. Additional Resources Read the article: Vascular Cognitive Impairment Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Lisa Silbert about her article on vascular cognitive impairment, which is part of the December 2024 Continuum issue on dementia. Welcome to the podcast and please introduce yourself to our audience.  Dr Silbert: Hi Katie. Thanks for having me here today. Like you mentioned, my name is Lisa Silbert. I am a behavioral neurologist at Oregon Health and Science University and my research focus is in the area of vascular contributions to cognitive impairment and dementia. Dr Grouse: It's such a pleasure to have you and I really enjoyed reading your article. Just incredibly relevant, I think, to most practicing general neurologists, and really to any subspecialty. I'd like to start by asking, what do you think is the main takeaway point of your article for our listeners?  Dr Silbert: Yeah. I think, you know, the field of vascular cognitive impairment has changed and evolved over the last several decades. And I would say the main take-home message is that vascular cognitive impairment or vascular dementia is no longer a diagnosis that is only considered in someone who's had acute decline following a clinical stroke. That we have to expand our awareness of vascular contributions to cognitive impairment and consider other forms of the disease that can cause a more subacute or slowly progressive form of cognitive impairment. And there are many, many forms of vascular cognitive impairment that present in a more slowly progressive manner. The other thing I would say as a major take-home message is that we know that cerebrovascular disease is a very common copathology with other forms of dementia and that it lowers one 's threshold for manifesting cognitive impairment in the context of multiple pathologies. And so, in this way, vascular cognitive impairment should be considered as a contributing and potentially modifiable factor in any dementia.  Dr Grouse: I found that last point just really, really fascinating. And also, you know, the reminder that a combination of pathologies are more common than any one. To your initial point, I'm actually curious, could you kind of outline for us how you approach diagnosing vascular cognitive impairment?  Dr Silbert: Yeah. So with everything in neurology, a lot of it comes down to the initial history taking. And so part of the work up always includes a very detailed history of the presentation of cognitive impairment. Any time there is an acute change in cognition, vascular contribution should be considered, particularly if it's in the context of a clinical stroke or some kind of event that might have lowered cerebral blood flow to the brain. And then having said that, I already mentioned there are many forms of vascular cognitive impairment that can mimic neurodegenerative disease in terms of its course. So being more slowly progressive. And so because of that neuroimaging, and in particular MRI, has become an extremely valuable tool in the workup of anyone who presents with cognitive impairment in order to evaluate contributions from cerebral vascular disease. And so, MRI is a really helpful tool when it comes to teasing out what may be contributing to a patient's clinical syndrome, as well as their other comorbid medical issues, including stroke risk factors and other kind of medical conditions that might contribute to reduce cerebral blood flow. Dr Grouse: I'd love to talk a little bit more about that. You know, as is often the case with neurologic disease associated with vascular pathology, the importance of prevention, you know, focusing on prevention of vascular diseases is so important. What are some things that we can make sure to focus on with our patients and, you know, particularly anything new to be aware of in counseling them? Dr Silbert: Yeah, I'm really glad you asked me that question because like I mentioned, you know, cerebral vascular disease is so common, it lowers one's threshold for cognitive impairment in the face of other age-related brain pathologies. And so, it's really important for all of us to focus on preserving our cognitive health, even starting in midlife. And so, there are a number of areas that I counsel my patients on when it comes to preserving cerebral health and maximizing cerebrovascular health. And so, these stem from the American Heart Association's Life's Essential 8 because we know that preserving cardiovascular health is likely going to also preserve cerebral vascular health. And so, some of the things that I'm very commonly discussing with my patients are controlling stroke risk factors such as blood pressure, blood sugars and cholesterol, maintaining a healthy weight, and then also working towards a lifestyle that includes a healthy diet, no smoking, regular exercise. And then new within the last couple years is also the recommendation that people get adequate sleep, which is something that hasn't been focused on previously. Dr Grouse: I was really interested in reading your article to learn about enlarged perivascular spaces and the role as a mediating factor in the interaction between through a vascular dysfunction and development and progression of neurodegenerative pathology. Can you elaborate on this further? Dr Silbert: So, this is an area that's still largely unknown in the field, and it's an area where there's a lot of emerging work being done. The short answer is, we really don't know with great certainty how it directly connects with accumulating Alzheimer's pathology. But there is some evidence to suggest that the perivascular space is involved in the clearance of toxic solutes from the brain, including Alzheimer's disease pathology. And so there's a lot of work looking at how potentially cerebrovascular risk factors might affect the clearance of those toxic solutes through the perivascular space, including pulse pressure changes that might occur with accumulating cerebrovascular disease and other potential contributors. But one thing I can say with more certainty is that the, you know, location of perivascular spaces is thought to help distinguish those who might have cognitive symptoms due to cerebrovascular disease versus due to cerebral amyloid angiopathy. Or I guess I should say location is helpful in terms of recognizing vascular contributions to cognitive impairment that's due to arteriolosclerosis versus that due to cerebral amyloid angiopathy. In so much that… when we see a lot of perivascular spaces in the basal ganglia in the subcortical structures, that is thought to be more associated with arteriolosclerosis and hypertension type related vascular cognitive impairment. Whereas when we see multiple perivascular spaces within the centrum semiovale, that tends to be more associated with cerebral amyloid angiopathy. Dr Grouse: That's so interesting. And on the topic ofcerebral amyloid angiopathy, you did go into this a good deal. And you know, I think I encourage everybody to revisit the article to remind themselves about, you know, the findings that can increase the suspicion of tribal amyloid angiopathy. However, you also talked about transient focal neurologic episodes, which I think is just a great reminder that, you know, these can occur in this setting and definitely not to miss. Tell us more about what to look for with these types of episodes.  Dr Silbert: Transit focal neurologic episodes can be very difficult to tease apart from a transient ischemic attack. And these transient focal neurologic episodes due to CAA can present in a number of different ways. And I think the important take home message for that is that in people who have neuroimaging evidence of CAA to inform them that they are at increased risk for having these focal neurologic episodes and that if they do present to a hospital or an emergency department with any kind of neurologic event, that those treating them are aware that they have evidence of CAA on their neuroimaging because the treatment of course is quite different. So, it's someone presenting with ATIA who has transient neurologic symptoms might be considered urgently to get a thrombolytic or, you know, TPA, whereas someone who has known cerebral amyloid angiopathy or suspected CAA, they likely already have microbleeds on their neuroimaging and in those cases thrombolytics and TPA would be contraindicated and not helpful in terms of the etiology of their neurologic symptoms. Dr Grouse: That's a really good point to make. And I think also in your article you mentioned the use of aspirin if you're suspecting ATIA versus a, you know, a transient amyloid related focal neurologic episode. You know, one you would treat with aspirin and the other one you wouldn't.  Dr Silbert: That's right.  Dr Grouse: Another sort of interesting topic you delved into was cerebral microinfarct and how this can also contribute to vascular impairment. Could you elaborate a little more on that? Dr Silbert: Yeah. So cerebral microinfarcts are kind of the hidden cause of or a hidden cause of vascular cognitive impairment. And it's extremely challenging because by definition they are not visible on routine clinical neuroimaging. It's something that we are more aware of based on pathological studies and neuroimaging studies that have been done at ultra-high field strength like 7T MRI. And so, we are just learning more about how prevalent they are in certain conditions and how we can only look at these after death when we're looking at brain tissue and then go back and realize that these play a significant role in cognitive decline when someone is alive. It's important to understand that we're probably only appreciating kind of the tip of the iceberg when we're evaluating a patient and looking at their neuroimaging. That what we're actually seeing on MRI are only the things that are actually quite relatively big and obvious. And that a lot of these neuroimaging features of vascular cognitive impairment are actually associated with pathologic features that we're missing such as microinfarcts. But the hope is that by treating all individuals, particularly those who already have signs of vascular cognitive impairment, by modulating their stroke risk factors and focusing on maintaining brain health, that those will, interventions will also reduce the incidence of microinfarcts. Dr Grouse: What do you think is the greatest inequity or disparity you see in treating patients with vascular cognitive impairment? Dr Silbert: I think the greatest disparity is- really starts way before I treat a patient. That relates to really focusing on healthy lifestyle factors early in life and being able to, you know, afford fruits and vegetables, and having the advantages of being able to exercise regularly, and just being aware that all of these things are extremely important before older age. So, these are things that, you know, I think more education and awareness and greater access to healthcare will definitely improve access to. Even preventative healthcare is a disparity and not available across all of the population and geographic locations. So, I think of the- all the dementias, vascular cognitive impairment probably has the greatest association with health and social disparities in terms of primary prevention and access to care.  Dr Grouse: All really important things to consider. I have to say when, you know, reading your article, dare I say I came away with a little bit of hope thinking, you know, even with, you know, how little we still, you know, or how much we still need to do to really learn how to fight Alzheimer's and, you know, prevent it and, and, you know, help with its progression. The idea that in so many cases, even just doing what we can to prevent the vascular or cognitive impairment can really help any type of dementia. That was really a strong message for me. Do you mind elaborating on that a little more?  Dr Silbert: No, not at all. I agree. I really am hopeful about the prevention and treatment of dementias and through the treatment and prevention of cerebrovascular disease. I think that is a true reality, just like, you know, as we were discussing before, the treatment and prevention of cerebrovascular disease really should be a part of the treatment of any type of cognitive impairment and recommendations for prevention of cognitive impairment. This is the, you know, one thing we know is largely modifiable and preventable in most cases. I think the, really the key thing is just education and making sure that people understand that these are things that really need to be, they need to be engaged in in midlife and that it's much harder to reverse these- the damages once you have them in later life. Having said that, I do think that there's greater awareness of maintaining healthy lifestyle and maintaining awareness of stroke risk factors. And I think we're already starting to see a reduction in dementia worldwide in several large population-based studies, and probably that is due to more attention to the modifying stroke risk factors. So, I agree with you, it's very encouraging.  Dr Grouse: Is there anything exciting on the horizon that you can tell us about that we should all be keeping our eyes out for? Dr Silbert: Yeah. So, you know, I'm really interested in this connection between vascular cognitive impairment and Alzheimer's disease. And it's a real area of exciting new research. And so I think we're going to have more answers as to how, whether and how, cerebrovascular disease is directly linked to accumulating neurodegenerative disease or neurodegenerative pathologies. The other area that's, I think, really exciting, that's moving forward, is the in the area of blood-based biomarkers for vascular cognitive impairment. As these emerge, we'll be able to really identify those at greatest risk for vascular cognitive impairment, but also identify novel mechanisms that lead to VCI that can be targeted for therapeutic intervention. Dr Grouse: Well, I'm really excited to see what's coming down the pipeline and what more we'll learn in this area. So, thank you so much for everything you've done to contribute to this field. Dr Silbert: Yeah.  Dr Grouse: I wanted to ask a little bit more about you. What drew you to this work?  Dr Silbert: Well, actually, so my very first published manuscript in medical school was a case report and review on MELAS, which is mitochondrial encephalopathy with lactic acidosis and strokelike syndrome. And so, I was really fortunate to have Dr Jose Biller, who is a renowned expert in stroke and cerebrovascular disorders, as my mentor for that paper. And so, that got me really interested in neuroimaging findings of cerebral vascular disease. And so when I was a fellow at Oregon Health and Science University, I was then really fortunate to  be able to work with Jeffrey Kaye's oldest old population. And in working with that population, I really became interested in their neuroimaging findings of these white matter lesions and just realizing how prevalent they were in that population, you know, it just led me to start investigating their clinical significance and etiology, which kind of led me along this path. Dr Grouse: You know, Lisa, thank you so much. I really learned a lot from your article, and I think our listeners will definitely find that it was very helpful for their practice. Thank you so much for joining us. Dr Silbert: Thank you so much, Katie. It's been really fun.  Dr Grouse: Again, today I've been interviewing Dr Lisa Silbert, whose article on vascular cognitive impairment appears in the most recent issue of Continuum on dementia. Be sure to check out Continuum audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Veronica Cintron, Vice President of Communications at Tampa International Airport (TPA), sits down with Owen LaFave to discuss the $11 billion economic impact this award-winning airport has on the Tampa Bay region annually. Veronica shares her story of transitioning from a successful journalism career as a battle-tested news anchor to leading an aviation team during the 2020 pandemic when crisis communication began her first day on the job. She explains the social media secrets that allowed her team to give a government entity humor and personality, and shares how organizations can avoid information vacuums by speaking to the diverse needs of key stakeholders. Veronica also reveals upcoming expansions and new nonstop flights at TPA, as well as how the airport is driving the national conversation around an innovative, electric technology that may recreate “the future of mobility.” Finally, Veronica gives us the full scoop on how Florida's most famous flamingo got her name.   The Bank of Tampa | Member FDIC

Many restoration companies are beholden to program work, TPA's and the plumber referral game. 1 Tom Plumber Rocky Hensley sits down with Eric and Larry to educate our listeners on how to make their own water damage leads.  You can reach Rocky at  1 TOM PLUMBER (1-866-758-6237) or email him at Rocky@1tom.com.TITLE SPONSOR:Super Tech UniversityDramatically improve your team's performance with a system of short daily video lessons training your team in soft skills. When you invest in your team and teach them soft skills, your team can make you more profit. Go to https://supertechu.com/ for more info.Click here for a discount: https://supertechu.com/register/podcastoffer/.Here is an entrepreneur's story you will relate to.SPONSOR: C&R MagazineC&R magazine is the leading periodical in the Cleaning and Restoration industry. Owner and editor Michelle Blevins has brought printed copies back from the dead to increase reader experience. Go to www.candrmagazine.com to get your free copy sent directly to your home or business.   

In this episode of the Empowering Plans podcast, attorneys Jon Jablon and Brady Bizarro delve into the details of a recent lawsuit where BCBS of Michigan, in its capacity as a TPA, is alleged to have engaged in anticompetitive practices for charging a fee to a group that chose a stop-loss carrier other than BCBS. This case is in its infancy as of December 2024, but we expect it to have noticeable effects on the stop-loss marketplace regardless of outcome. In this episode, Jon and Brady discuss those potential effects and how a holding either way could impact self-funding as a whole.

Chelsea Treseder is the co-founder of MyVitalsPro, the hearing care industry's most insightful platform for analysing data and understanding the internal numbers inside your practice. With access to big data, she has the ability to see strengths, weaknesses, opportunities and threats before many, and in this episode, she shares exactly what she's seeing right now in 2024. From Third Party Administrators through to the marketing strategies that work- it's full of insights and ways to grow your practice.

027: What if I told you you could have a work-from-home business that fits your life?We're so used to (and tired of!) the idea of hustling to make an income while putting our lives, relationships, and happiness on the back burner.Katie and I are here to tell you that it doesn't have to be that way!Today on the podcast, we're discussing what a relief it is to have a proofreading business that fits around our lives.Tune in here as my TPA grad Katie shareshow to go from discouragement to growththe keys to success as an entrepreneurwhat it's like to be part of my graduate community of proofreadershow much work there actually is for transcript proofreaders…and so many other words of advice, encouragement, and a little tough love to make your goals happen!Tired of the hustle? Want to know if you have what it takes to work for yourself as a transcript proofreader?Whether you're new to the idea of transcript proofreading or already a successful graduate, listen in for a reminder of how you can do work differently and create the life you want if you're willing to put in the work and stick with it.It's so worth it -- and Katie wholeheartedly agrees! To grab the show notes for this episode, including any links mentioned and the transcript, visittheproofreadingbusinesscoach.com/episode027Connect with me on Instagram: @theproofreadingbusinesscoachOr send me an email: elizabeth@elizabethjwiegner.com

When treating patients having an MI or stroke, more minutes equals more dead cells. Because the majority of strokes are the ischemic type, the treatment for stroke is similar to an MI – to reestablish perfusion to the ischemic tissues. The first four steps in the Stroke Chain of Survival. Time criteria for the administration of tPA (or a similar fibrinolytic medication) or EVT of LVO strokes. Stroke benchmarks for door to:assessment;completing a non-contrast CT; andadministration of fibrinolytic medication such as tPA (door-to-needle).EMS interaction with stroke teams and destination protocols to reduce time to definitive care. The difference for timed goals for the identification & treatment of AMI vs Stroke. Additional information about timed goals for stroke and how EMS affects outcomes, can be found on the PassACLS.com pod resources page.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!

In this episode, host Stacey Richter delves into the complexities of the Third Party Administrator (TPA) Request for Proposal (RFP) process with guest Claire Brockbank from 32BJUnion.  The discussion highlights the critical role of contracts in managing health plans effectively and the potential pitfalls of accepting contracts crafted by TPAs without thorough review. Drawing from Claire's experience, they explore tactics like starting with your own contract paper in RFP processes to gain negotiation leverage, and the benefits of employer coalitions in navigating health care complexities. To Read the full article which includes mentioned links visit the episode page. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to become a member of the Relentless Tribe. Real-world examples underscore the financial impacts of poorly negotiated contracts and highlight successful strategies for health plan sponsors to optimize costs and services. The episode aims to empower employers with tools and insights to negotiate effectively and ensure their health plan contracts align with their strategic goals, ultimately paving the way for better population health management and cost-effective care delivery. As but one example—and Cora Opshal spoke about this last week and Claire talked about this today—it's about how allowing upside-down payments, for example, that are in a lot of ASO contracts, this allowing of upside-down payments. I mean, it turns out that 32BJ spent around $10 million paying more than the bill was for one year. If somebody signs that contract as handed to them by the carrier, then the plan is now contractually obligating themselves to pay more than the price the clinical practice was charging. So, doc sends bill for $100, and the carrier pays that practice $200 on behalf of the plan sponsor. So now the plan sponsor is paying $200 for a $100 bill. Is this conflict of interest? Is it imprudent? Is it not reasonable? Said another way, is that a bit of a fiduciary breach on the plan sponsor? So it's understandable why the team at 32BJ pushed back and pushed back hard. We all can see why the leading edge of plan sponsors and more and more C-suites are hotfooting it into conference rooms to plan their RFP process and doing it in the way that Claire Brockbank talks about today. For an open-source contract and some other free tools, please do head over to the 32BJ Insights Web site. 05:36 How does the initial contract writing affect how events in your healthcare plan will go? 06:56 What happens if a plan sponsor or employer doesn't do the contracting right? 10:42 How much could be saved by doing contracting right? 11:01 EP433 with Justin Leader. 12:22 How do you start an RFP process with your own contract? 14:06 What Claire Brockbank recommends doing to do a TPA RFP process in a way that's best for you. 19:46 What factors do carriers need to get an ASO or TPA to respond to using your contract? 21:11 Open-source contract available from 32BJ. 21:57 Why it's important to really probe brokers, despite loyalty to your broker/consultant. 24:30 Who are the reliable agents and experts when carriers are looking to start this process? 26:24 EP428 with Julie Selesnick. 27:56 What's the silver lining to this effort? 29:17 Why is it important to make it clear why you're doing what you're doing for your lawyers and any other support team you need? 31:39 What does “good” look like in this process? 34:15 Why is it important to continue to hold your ASO accountable?

Yeah, I made a meme for the show with Marilyn Bartlett. My very first meme ever. In this meme, I picture that Olympic silver medalist shooter from Turkey who showed up in a T-shirt and his hand in his pocket versus the others with all their fancy equipment that, turns out, may or may not be necessary, regardless of who might swear up and down that complexity requires even more complexity and plenty of expensive gear to shoot straight. Point being, it's amazing what a dedicated CPA with a spreadsheet and their eye on the target can accomplish in the real world when they just do their thing and follow the dollar. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. And with that, Marilyn Bartlett has entered the chat. Marilyn Bartlett isn't called the “Queen of Healthcare” for no good reason, and nobody is joking when they say this. She was probably the first person (or one of the first, at a minimum) to truly identify the amount of money getting sucked out of the wallets of taxpayers and employers and plan members and into the pockets of the healthcare and insurance and consulting industries. She is a through and through numbers person but also deeply cares. She is truly a senior stateswoman in our field. Let's start from the beginning here. But you'll have to listen to the interview that follows for the end and most of Marilyn's really sage advice and words of inspiration for any of you, for all of us, trying really hard to fix healthcare and, any day of the week, taking two steps forward and/or five steps back. It's what Mike Tyson was talking about when he said, “Everybody has a plan until [you] get punched in the face.” And yeah, I'd say pretty confidently that everyone in the Relentless Health Value tribe trying to fix healthcare has been there at some point or another. So, here's where I begin the conversation with Marilyn Bartlett today. One day in 2014 or 2015, Marilyn was minding her own business as a CFO at a regional TPA (third-party administrator) firm about ready to retire when the state of Montana reached out. They asked if she would consider being the plan administrator for the state employee health plan, which was, turned out, headed for bankruptcy. Marilyn took the job, and she took the state health plan from $9 million in the hole—they were in debt $9 million—to $112 million to the good. Well, meanwhile, plan members got better benefits. Think about that: $9 million in the hole to $112 million in the good. In fact, the plan had so much money in 2018 when Marilyn left that the state took some of it to pay for other things in the budget. This is truly mind blowing. I mean, get a CPA with their eye on the ball, and this is the difference that is possible to be made in a state health plan. It also just needs to be said that this same state plan, the one that was going bankrupt, clearly had seen over $100 million of taxpayer money exit stage left and wind up in the bank account of their vendors. Now might be a good time to mention something that Chris Deacon wrote about: the Federal Employees Health Benefits Program. This is a $55 billion program, once again funded by taxpayers. As per an OIG (Office of the Inspector General) audit, there are no written policies or procedures over approval and payment of funds to the carriers via ACH (Automated Clearing House). Wait, what? This is just one example, along with a whole lot of other things that kind of make you go, “Hmmm … can a CPA with a spreadsheet please get in there and do your thing?” In the conversation that follows, I ask Marilyn to tell me what she did in roughly three short years to do her thing and save the state of Montana over $100 million while improving benefits of the state workers. And she tells me, short version, she created a why—that's step one. Step two, she looked at her spreadsheets and financial analyses and quantified the situation. She was able to identify a few big hairy problems, which she then hit fast and hard with solutions. This is gonna accomplish a couple of things if you do this, find a solution for a big enough problem. First, it creates a quick win; and quick wins are needed to get some momentum to get started. Second, she knew that by solving big hairy problems, the solutions would have an outsized impact given the scope of these original problems. This is kind of Strategy 101. And then step three, she dug in on assembling the right team with the right skills to make it through what amounts to a change management process, I'm gonna say. What did Marilyn not do in those three years? She did not get captivated or sidetracked by any, I'm gonna call it, transformational theater—which is not easy because a lot of transformation theater has more glitter than a Las Vegas show and is really hard to look away from. It's as magical as most magical thinking. Also, Marilyn stayed the course in the face of what I am sure were many opportunities for personal gain that would have not been a win-win for the state of Montana or its employees. To emphasize how one should not take this for granted, I was talking to a benefits leader the other day and you know what she told me? She said she always goes with this one carrier every year because if you go with that one, when you get invited to their box at the NFL games, you can go out on the field afterwards. I mean, it's really fun to meet the players. Unfortunately, for so many in positions of power, when doing the right thing by taxpayers and/or plan members stands between them and box seats, the right thing gets escorted out of the building. Mentioned in this show, we have Cora Opsahl and Claire Brockbank, who both will be featured in upcoming shows about RFPs (request for proposals) and best practices and how they can go right and also occasionally take a left turn. Check the links to episodes about pharmacy benefits and PBMs (pharmacy benefit managers). I might think of some others, but you'll definitely want to listen to the show with Paul Holmes (EP397); the one with Mark Cuban and Ferrin Williams, PharmD, MBA (EP418); and also AJ Loiacono (EP379). Also mentioned in this episode are Chris Deacon; Cora Opsahl; Claire Brockbank; Mark Cuban; Ferrin Williams, PharmD, MBA; AJ Loiacono; and Shawn Gremminger. You can learn more by connecting with Marilyn on LinkedIn.   Marilyn Bartlett, CPA, CGMA, CMA, CFM, serves as a consultant focused on lowering healthcare costs and empowering employer health plans and state policymakers with data to support cost-saving initiatives. She recently developed the Hospital Cost Tool for the National Academy for State Health Policy (NASHP), an interactive online tool which utilizes hospital Medicare Cost Report data to calculate various hospital metrics used to support hospital and health system financial analysis and health policy. As administrator of the Montana State Employee Health Plan, she disrupted the status quo by implementing Medicare rate reference-based contracting with all Montana hospitals, enhancing primary care through near-sight health centers, moving to a transparent, pass-through PBM, eliminating duplication of vendor services, and improving data access and analytics. These efforts increased plan reserves from actuarial projections of -$9 million to $112 million in two years. For her efforts, Fortune magazine selected Marilyn as #13 of the World's 50 Greatest Leaders.   06:45 What gave Marilyn the confidence to fix Montana's state health plan? 08:11 Why Marilyn knew she would have enough power to make the changes needed in Montana's state health plan. 09:11 What Marilyn achieved in her time as the administrator of the Montana State Employee Health Plan. 10:38 What were the “quick wins” Marilyn was able to achieve when she first took over as administrator? 17:33 Stay tuned for an upcoming episode that covers RFP in detail. 17:50 How Marilyn structured her plan for the Montana State Employee Health Plan. 21:21 What's the key to setting yourself up for success when doing what Marilyn was able to achieve? 25:02 Why putting together your own team is so important. 29:07 What happened when Marilyn left the Montana State Employee Health Plan? 31:08 Have the costs of the plan gone up since Marilyn's time working on it?   You can learn more by connecting with Marilyn on LinkedIn.   Marilyn Bartlett discusses #healthplan finances on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation #vbc   Recent past interviews: Click a guest's name for their latest RHV episode! Dr Marty Makary, Shawn Gremminger (Part 2), Shawn Gremminger (Part 1), Elizabeth Mitchell (Summer Shorts 9), Dr Will Shrank (Encore! EP413), Dr Amy Scanlan (Encore! EP402), Ashleigh Gunter, Dr Spencer Dorn, Dr Tom Lee, Paul Holmes (Encore! EP397), Ann Kempski