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"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together."What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-retired into a role he believes the industry desperately needs: the fiduciary co-pilot.He won't take your broker of record letter; he doesn't want it. Instead, he partners with brokers, consultants, and C-suite executives to build health plans from scratch, the way an owner would.If you're a broker who knows you have a ceiling on your self-funding expertise, this episode is your permission slip to get help. Tune in.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Behind the Curtain of Self-Funding(00:00:55) The Fiduciary Co-Pilot: Why Charlie Won't Take Your BOR(00:02:58) Charlie's Background: First-Generation TPA in the Late '70s(00:04:46) Napkin Underwriting and $2,000 Aggregate Stop-Loss(00:06:18) The Two Sales: Selling the Employer AND the Underwriter(00:07:20) Why the TPA Business Is So Hard to Do Right(00:11:27) The Fiduciary TPA: Accountant of the Health Plan(00:13:32) The 401(k) Parallel: Fiduciary Standards Are Coming for Brokers(00:14:43) Building Custom Plans vs. Buying the Box(00:16:25) Stop Haggling Over Stop-Loss — Solve the Claims Instead(00:18:46) Owning Your Stop-Loss Through a Group Captive(00:21:25) The 3-6 Month Setup: Finding Fiduciary Partners First(00:23:34) The One Question to Ask Every TPA(00:26:07) Why PBMs Need the Fiduciary Standard Too(00:28:01) Eating the Elephant: Meeting Employers Where They Are(00:30:56) Winning Over the C-Suite Before the HR Director(00:34:42) Claims Negotiators, Re-Pricers, and the Lost Art of the Phone Call(00:39:11) Do You Still Need a Carrier Network?(00:41:51) The Quality Anomaly: Why the Best Care Costs Less(00:43:34) DRG Bundles and the $20,000 Burn Unit That Never Was(00:46:52) Wellness, Behavioral Health, and the Loyalty Dividend(00:55:31) Building the Utopian Health Plan: The Blueprint(01:01:03) What's Missing? Belief.(01:04:18) The Future: Adoption in the Mid-Market(01:06:33) Closing Thoughts: The System Won't Fix ItselfKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/
"I relate it to one of the Wizard of Oz characters... I've seen behind the curtain. I know how it's all put together."What happens when a man who spent nearly five decades inside every corner of the self-funded industry decides his final act is to give the playbook away?My guest this week is Charlie Gragg, a true first-generation veteran of self-funding. Charlie started in the late 1970s underwriting stop-loss cases on napkins from payphone booths, went on to run his own TPA, and has now semi-retired into a role he believes the industry desperately needs: the fiduciary co-pilot.He won't take your broker of record letter; he doesn't want it. Instead, he partners with brokers, consultants, and C-suite executives to build health plans from scratch, the way an owner would.If you're a broker who knows you have a ceiling on your self-funding expertise, this episode is your permission slip to get help. Tune in.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit https://www.paretohealth.com/fully-insured-vs-self-funding-with-paretohealth-spencer-podcast/?utm_source=youtube&utm_medium=referral&utm_campaign=SelfFundedwSpencer to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Behind the Curtain of Self-Funding(00:00:55) The Fiduciary Co-Pilot: Why Charlie Won't Take Your BOR(00:02:58) Charlie's Background: First-Generation TPA in the Late '70s(00:04:46) Napkin Underwriting and $2,000 Aggregate Stop-Loss(00:06:18) The Two Sales: Selling the Employer AND the Underwriter(00:07:20) Why the TPA Business Is So Hard to Do Right(00:11:27) The Fiduciary TPA: Accountant of the Health Plan(00:13:32) The 401(k) Parallel: Fiduciary Standards Are Coming for Brokers(00:14:43) Building Custom Plans vs. Buying the Box(00:16:25) Stop Haggling Over Stop-Loss — Solve the Claims Instead(00:18:46) Owning Your Stop-Loss Through a Group Captive(00:21:25) The 3-6 Month Setup: Finding Fiduciary Partners First(00:23:34) The One Question to Ask Every TPA(00:26:07) Why PBMs Need the Fiduciary Standard Too(00:28:01) Eating the Elephant: Meeting Employers Where They Are(00:30:56) Winning Over the C-Suite Before the HR Director(00:34:42) Claims Negotiators, Re-Pricers, and the Lost Art of the Phone Call(00:39:11) Do You Still Need a Carrier Network?(00:41:51) The Quality Anomaly: Why the Best Care Costs Less(00:43:34) DRG Bundles and the $20,000 Burn Unit That Never Was(00:46:52) Wellness, Behavioral Health, and the Loyalty Dividend(00:55:31) Building the Utopian Health Plan: The Blueprint(01:01:03) What's Missing? Belief.(01:04:18) The Future: Adoption in the Mid-Market(01:06:33) Closing Thoughts: The System Won't Fix ItselfKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/
Finn didn't come from insurance. He came from startups — real estate, entertainment, a TPA. But when he looked at the Canadian Insurtech landscape and saw how much was being left on the table, he decided to do something about it.He took over InsurTech Canada. And then he started rebuilding it from the ground up.In the latest episode of the Leadership in Insurance Podcast, host Alex Bond sits down with Finn for a wide-ranging conversation about what it really takes to build an insurtech ecosystem — not just talk about one.Finn shares how he transformed InsurTech Canada from a non-profit meetup organisation into a for-profit, deal-flow-focused platform with a curated membership of 27 companies. And he opens up about his next move: launching an InsurTech investment fund, focused primarily on Canadian companies but with eyes on the US and UK markets too.They also get into:✅ Why Canada lags 2–3 years behind other markets — and what needs to change✅ The talent drain pulling founders and operators south of the border✅ How to evaluate founders (and why people skills matter as much as product)✅ His vision for Canada to become a genuine global hub for InsurTech innovation✅ What it means to have "skin in the game" when you're championing an ecosystemWith a clear commercial mindset, a growing network across carriers, brokers, MGAs, and capital providers — and a fund on the horizon — Finn is one to watch.#LeadershipInInsurance #Podcast #Insurtech #InsurtechCanada #VC #Innovation #Insurance #Canada Hosted on Acast. See acast.com/privacy for more information.
What does it take to move from fixing one broken corner of healthcare to reimagining the whole thing? On this episode of Astonishing Healthcare, host Justin Venneri sits down with two of his favorite guests together for the first time: Judi Health's CEO, AJ Loiacono, and Chief Commercial Officer, Kristin Begley, PharmD.The catalyst for this special episode is the company's rebrand, the evolution from Capital Rx, the transparent PBM that built Judi®, into Judi Health, a unified health technology company. AJ and Kristin explain why the "Rx" designation remains a core piece of the company's identity but no longer fully reflects the organization's evolving mission. They also describe the difference between "little T" transparency and the real thing, why incentive alignment matters so much, and what it took to build the first platform to process medical, pharmacy, dental, and vision claims on one system. They also express gratitude to the team and share bold predictions for where health benefits go next.Key TakeawaysThe rebrand reflects an expanded mission, not a new one. Capital Rx launched as a transparent PBM, with "Rx" signaling its focus on pharmacy. Over eight years, the company broadened its administrative capabilities, including medical claims processing, and much more - all powered by Judi. Thus, the primary brand: Judi Health, with services harmonized as Judi Rx (pharmacy), Judi Care (medical administration, TPA, navigation), and Judi Cloud (platform licensing for health plans and TPAs).There's a real difference between "little T" transparency and true transparency. AJ argues that true transparency means an auditable workflow: full disclosure of all compensation, proof that every customer receives the same pricing and benefit, and no hidden earnings. He calls out the "little H" holding company trick and explains why alignment yields better outcomes for plans and their members.Nobody had built unified claims processing before. AJ recalls initial skepticism around unified claims. His response: "If Netflix had kept mailing DVDs, we wouldn't be talking about Netflix." To date, no other organization has built a unified claims processing platform. Judi is the exception.Unified claims processing will become the standard. Once employers realize they have options, markets shift quickly. AJ, who predicted the rise of transparent PBMs, makes a new call: unified claims will be the industry norm.Related ContentJudi Health™ Announces Capital Rx is Now Judi Rx™, Launches Judi Care™ and Judi Cloud™ to Power the Next Era of Health Benefits Administration and Patient CareAH100 - The End of the Age of Confusion, It's Time for Acceptance, with AJ LoiaconoAH067 - Aligned Health Benefits and the Freedom to Unbundle, with Kristin Begley, PharmDWhat is a Core Administrative Processing System (CAPS) in Healthcare Payer Operations?AH111 - Building a Single Source of Truth for Medical and Pharmacy Benefits, with Kevin Sundquist & Liya LomsadzeFor more information about this episode, please visit Judi Health Insights.
Send us Fan MailSend us Fan MailSchedule an Rx AssessmentWhat if your team held the best ideas for growing your pharmacy and you just needed to get out of the way?On this episode of the Bottom Line Pharmacy Podcast, we sit down with Dr. Jay Phipps, owner of Phipps Pharmacy and founder of the Phipps Tank concept, to break down:What Phipps Tank is and how to run it in your pharmacyWhy culture is a bottom line strategy, not just a feel-good initiativeHow psychological safety drives team performance and real revenue growthWhy your fear of change might be your biggest financial liabilityAnd more!More About Our Guest: Dr. Jay Phipps is a Pharmacy Gladiator, Pharmacy Doctor, Founder, Entrepreneur President, and CEO with over 29 years of experience in pharmacy. At Phipps Pharmacy, Dr. Jay leads a team of dedicated and professional Pharmacy Doctors and technicians who provide personalized and high-quality care for patients. Phipps Pharmacy, Inc. is an independent pharmacy with 5 locations in Tennessee and Mississippi. Dr. Jay is also the President and CEO of PhippsCare that focuses on Pharmacy Doctor provided healthcare and Health Insurance Solutions who specializes in medical and pharmacy plans for seniors. Dr. Jay currently serves on multiple Boards of Directors and committees on the national, state, and local levels. He has served as the American Pharmacist Association-Academy Students of Pharmacy National President, on the APhA Board of Trustees, President of the Tennessee Pharmacists Association (TPA), on the Board of Directors for TPA, Chair, Tennessee Pharmacy Research Education Foundation, Co-Chair, Carroll County Drug Prevention Coalition and a District 8 County Commissioner. Dr. Phipps received a Doctor of Pharmacy degree from The University of Tennessee Health Science Center, where he also completed a residency in Drug Information and Pharmacotherapy and is currently pursuing an MBA with a major in Leadership and Strategy from the #1 ranked online MBA program at Indiana University - Kelley School of Business. Dr. Phipps plans to graduate in the fall of 2024. Connect with Dr. Jay Phipps, PharmD:Jay Phipps LinkedInPharmacy Gladiator WebsitePharmacy Gladiator InstagramPharmacy Gladiator TikTokPharmacy Gladiator YouTubeStay connected with us:FacebookTwitterLinkedInScotty Sykes – CPA, CFP LinkedInScotty Sykes – CPA, CFP TwitterBonnie Bond – CPA LinkedInBonnie Bond – CPA Twitter More resources on this topic: Podcast - Becoming a Pharmacy GladiatorPodcast – Driving Independent Pharmacy Profitability in 2026 with Nicolette Mathey, PharmD, CEO of Atrium24Podcast – 2026 Quarter 2 Pharmacy UpdatePodcast – America 250, The history of Pharmacy, Q&A
Some guests just drop bombs for an hour straight, and Griffin Brand is one of them. Griffin is a former 75th Ranger Regiment special operator who, at 26, found himself as the lone military advisor to the U.S. ambassador in Kabul, wrangling 20 different three-letter agencies into one room. Now he's in private equity with High Ground, working deals across the restoration industry. If you caught last week's episode with Griffin and his co-author Dan Casey on their book Bring Your Own Pencil, this is the deep dive into the man behind it. This conversation is loaded for anyone leading a business in the trades: restoration, roofing, HVAC, you name it. We get into General McChrystal's "fast and flat" philosophy and how to break down the silos killing your company's speed. Extreme ownership, owning the inputs so the outcomes take care of themselves, why veterans are the best hires in blue collar, and a story Griffin had never told before about an insider attack at the embassy and what it taught him about empathy and leadership. Trust me, you'll want a notebook. Owning a business in the trades can be the loneliest job there is. Head, Heart, & Boots exists to change that, because the best leaders don't go it alone, and neither should you. Why You Should Listen: [11:03] The third door: how Griffin got through every door he was told was closed, including Ranger Regiment [15:09] The leadership move that built instant trust with the highest-ego room on the planet [18:53] Fast and flat: McChrystal's team of teams, and one practical way to run it in your shop tomorrow [34:07] The insider attack story Griffin processes live for the first time, and the empathy lesson he took from it [52:39] Why veterans are the hire your business needs, and how to find them Grab Bring Your Own Pencil on Amazon, Audible, or bringyourownpencil.com. Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Stroke in children and younger adults differs significantly from adult stroke, with varied presentations and a broader range of underlying causes such as congenital heart disease and arteriopathies. This episode highlights key diagnostic considerations and evolving approaches to treatment in these younger populations. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Thalia S. Field, MD, FRCPC, MHSc, coauthor of the article "Stroke in Children and Younger Adults" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Dr. Field is a professor at the University of British Columbia and the Sauder Family Heart and Stroke Professor of Stroke Research, and a stroke neurologist at the Vancouver Stroke Program, Vancouver Coastal Health in Vancouver, British Columbia, Canada. Additional Resources Read the article: Stroke in Children and Younger Adults 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 Host: @AaronLBerkowitz Full episode transcript available here Dr Berkowitz: Most neurologists are used to evaluating and treating adults with stroke since it's one of the most common neurologic conditions. But stroke can also occur in children, in infants, and even in utero. Today, I have the privilege of interviewing Dr. Thalia Field to talk about pediatric stroke. Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Berkowitz: This is Dr. Aaron Berkowitz, and today I'm interviewing Dr. Thalia Field about her article on stroke in children and younger adults. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, Dr. Field, and could you please introduce yourself to our audience? Dr Field: Well, thanks so much. It's a pleasure to, uh, be speaking to you. I'm a stroke neurologist, and I treat adults generally. My wonderful colleague, Thivya Selvanathan, who's a neonatal neurologist, co-wrote the chapter with me. We do, unfortunately, have to treat some children with stroke collaboratively and I do advise on those cases. My practice is about one-quarter clinical, so I treat patients with acute stroke, look after them on the wards, see patients in stroke prevention clinic, and the rest of my time is mainly research and some administrative work and teaching. I run the clinical trials program for the Vancouver Stroke Program, and I do research of my own, mainly focused on stroke in younger adults. We previously did a trial and registry on cerebral venous thrombosis, and more recently, I've been running a national study looking at brain health in adults and children with congenital heart disease. Dr Berkowitz: Fantastic. Wow, that is a lot that you do, and we'll look forward to the results of some of those studies. So, when adults suffer a stroke, they typically present with sudden onset focal neurologic deficits, very common scenario we're consulted on. And one thing you and your colleague talk about in the article is that strokes can present differently in infants and in young children. Can you talk a little bit about the differing clinical presentations of stroke in the youngest young as compared to our usual experience treating the older adults? Dr Field: Sure. So, you know, speaking about this as someone who doesn't see the children directly but has had the opportunity to discuss these patients with my colleagues and, like we all do, learn about it during our training, I think one of the distinctions, especially with neonates, is that it's generally not a presentation with focal neurologic deficits. Often these babies will have seizures or encephalopathy as their main presentation, and sometimes we're only finding out after the fact if they're presenting with developmental delay or early preference for handedness and hypotonia, things like that. So, in very young children, that's a distinction. And in older children, there can be sudden onset deficits and, and unfortunately, sometimes these are mistaken for other conditions that are more common in children, like seizures. But sometimes you can have a more indolent course, say, with something like a focal cerebral arteriopathy or something like that. So, it depends on the scenario, but the big difference primarily is in neonates, as far as I understand. Dr Berkowitz: Perfect. That's very helpful. So as an adult neurologist, when I think about causes of stroke or teach sort of the categories of causes of stroke to our residents and students, when we think about the evaluation of stroke, I divide them broadly into causes related to the heart, causes related to the blood vessels, and causes related to the blood with, in the adult world, the most common things, of course, being atrial fibrillation for the heart, atherosclerosis for the blood vessels, and then risk factors for atherosclerosis in the blood, diabetes, hyperlipidemia, very rarely picking up a hypercoagulable disorder in the blood column. And reading your article, it seems that, correct me if I'm wrong, stroke in young adults, stroke in the pediatric population can basically be organized into those same broad categories, heart, blood vessels, and blood, just that there's many more conditions on the differential diagnosis that you would consider in young adults to begin with and then children and then neonates as we get into the younger and younger population. So, I'd like to talk about each of these sort of buckets of etiology in turn and ask you about some of the causes we would consider in young adults and children in each of these, and then as they come up, probably ask you more questions about how frequently we find these sorts of things, how frequently they're the cause of stroke treatment, et cetera. So, let's start with the heart. As I said, in adults, we're mostly looking for rhythm disorders, right, atrial fibrillation. Sometimes we'll pick up a patent foramen ovale or PFO or other structural abnormalities, but mostly we're thinking about atrial fibrillation. But reading your paper, I was struck by the huge variety of conditions that you might be looking for in the heart in children or infants with stroke. So, can you tell us a little more about cardiac etiologies of stroke in the young? Dr Field: Yeah. So, I'd say unlike in older adults, where it tends more often to be a rhythm disorder, in children and adults who are younger, it's primarily a structural cause, and congenital heart disease being the most common. And it changes a little bit from younger adults shifting downwards in age to younger children in terms of the fact that often if we're seeing an adult with stroke related to congenital heart disease, it can be a paradoxical embolism from a previously undiagnosed PFO. Not in all cases, but fortunately this is improving over time. You know, generally people with diagnoses of more severe congenital heart disease are followed up from childhood and people are aware of the diagnosis, and hopefully they're being managed and watched for things like premature arrhythmias or depressed heart function or other things that can develop and require their own distinct antithrombotic management, for example. In young children, however, more severe causes of congenital heart disease tend to more frequently be associated with stroke. And in many cases, those strokes can be early on in life or associated, say, with perioperative complications or other iatrogenic-related causes in, in that way. Again, congenital heart disease can be associated with stroke at, at any point in the life course. But as adult neurologists, most frequently we're seeing very simple lesions like PFO with large shunts, and in children, it tends to be the more complex causes of congenital heart disease. Dr Berkowitz: Got it. So, let's move on to the blood vessels. Again, in adults, we're usually thinking about atherosclerotic disease, be that of the cervical arteries or of the intracranial arteries. But in your paper, a lot of discussion about the various vasculopathies, arteriopathies that can be cause of stroke in younger adults and in children. Could you talk a little bit more about some of the vasculopathies and vascular conditions that are causes of stroke in the younger population? Dr Field: Sure. Before I do that, I will say that especially in older younger adults, particularly over the age of thirty-five, and you know, kind of makes me shudder that that's an older younger adult. But, um, in, in any case, certainly conventional vascular risk factors are more common in this population with stroke, especially in those who don't have PFO-associated stroke. Like conventional atherosclerosis, you know, certainly is a cause of stroke in younger adults. But that being said, certainly other vascular causes and vasculopathy in particular is a much more common cause of stroke in younger adults and, and children than it is in older adults. In particular, dissection is an extremely common cause of stroke in younger adults. Generally cervical artery dissection from non-inflammatory vasculopathy, usually on, sometimes on the FMD fibromuscular dysplasia spectrum and, and sometimes, you know, provoked by minor trauma or something post-infectious that may make the vessels a little bit more susceptible. And in younger children, this inflammatory focal cerebral arteriopathy is a distinct cause that is a common cause of stroke in, in young children. There are other causes that can affect the blood vessels, you know, rarer things like vasculitis and vasculopathies that can develop in the context, say, of sickle cell anemia. But in general, as a bucket, vessels are still very important, but the pathology tends to shift. Dr Berkowitz: Got it. And you, um, alluded to a point that I wanted to ask you about. You mentioned the sort of, there's stroke in the young, and then where do you draw the line at young? Less than sixty, less than thirty-five, and then we've also talked about strokes as young as before the age of birth. Yeah, I'm remembering, is it the Helsinki study, one of the early large series of stroke in younger individuals? I think that, was it eighteen to forty-nine in that or fifty-nine? I don't remember the exact age, but being struck reading that paper as a resident and thinking about the workup for exotic causes we do, right, and when a young patient has a stroke. And correct me if I'm wrong, the most common etiologies of stroke in that series, and I'm curious the other large series yourself have been involved with, have still been vascular risk factors and arrhythmias and things that we, even common, quote unquote, common things in the young, such as dissection or hypercoagulable states. Uh, the things that we sort of tend to think about first are actually less common. But acknowledging that that paper has folks up to the late forties when the vascular risk factors may be, um, unfortunately kicking in earlier, uh, and earlier due to dietary and lifestyle factors. So is that true, or do you have sort of an age cutoff when it's, we say stroke in the young, people sort of think, "Oh, they'd work someone up differently if they're less than sixty, and they have no vascular risk factors or few vascular risk factors." When do we start getting into the kind of younger population where atherosclerosis and cardiac arrhythmias are not number one and two? Dr Field: I'd say first of all, you and I must have trained around the same time because I was also in my training, really struck by the results of the Helsinki study going, "Wow, I, I really didn't know how much of a role these conventional vascular risk factors still play." And I think we're seeing that information reiterated, unfortunately, like even with higher prevalences and more attributable risk in some of the newer series. There are newer European series looking at stroke in younger adults, and more recently, there's been one that we mentioned in the article from the Florida Stroke Registry. And it's true that generally the burden is in the older younger adults. But what I would say overall in terms of kind of how things guide the workup, you need to look at the patient and consider things. I mean, obviously you don't want to miss things that can be treated differently and identified by tests easily. You know, things like ruling out syphilis or antiphospholipid antibody disease in, in younger patients. You really want to make sure that that's not something that, that you'd miss because, you know, obviously your treatment is going to change. However, certainly we start with the basics for stroke workup in any patient that's coming in. At my center, CT angiography. Some centers it may be MR angiography and echocardiography. We take a careful history. We look at the blood work. We look at the vascular risk factor burden. We find out if there's kind of any worrisome personal history, family history, look at their general health context. I think that really helps to guide how far we go in a particular workup, and it also helps to direct the other investigations and types of follow-up we need to do. For example, if a patient has a fairly suspicious story for dissection, let's say they're getting over a cold, and they went to the gym, and, you know, there was a sudden movement that they did that really produced headache and neck pain, and there's an obvious cervical artery dissection. I'm not going to go too far down testing them for rare infections and doing advanced cardiac imaging unless something shows up on their initial echo, for example. But I will make an effort to do more detailed vascular imaging of the rest of their body, find out careful family history. If there's additional manifestations of a non-inflammatory vasculopathy elsewhere, say consider sending them to medical genetics, or obviously, if this is, you know, a second event, your flags raise even more. So, it really depends on the patient. If I find out that there's, you know, a family history of premature cardiac disease and things like that, you know, obviously we're gonna be keeping a close eye on their cholesterol, making sure that we're not identifying, for example, familial hypercholesterolemia, which is, you know, something that comes up not infrequently where we'll see an LDL in an untreated patient of more than five. I apologize, you're gonna have to do the conversion to American units on that. But there are things we identify and, you know, again, you don't want to fall solely on heuristics and your preconceived notion of, of the patient. You do have to consider the results of the investigations that you do order. But I think you can certainly be mindful in terms of how you direct your workup and in turn, how you direct your follow-up. Dr Berkowitz: That's great to hear your approach. Yeah, as you said, our approach always begins with the same, coming back to these three categories, right? Doing some type of structural imaging of the heart, rhythm monitoring for the heart, and then vascular imaging of the head and neck. And then I was going to ask you, and you sort of began to answer this question. Yeah. What's next and how far do you go? I think most people think the expanded stroke workup in the young is at a minimum, a TEE if there's been no signal thus far on the original workup. I just mentioned and you spoke about, and then probably hypercoagulable testing and only sending arterial side if there's no shunt and venous and arterial side if there's a shunt. Is that your second pass approach or did I miss anything, or are there other nuances there that are helpful to discuss? Dr Field: No, I think that's generally in keeping with what I do. I think with TEE being very important. I mean, the first pass are arterial stuff. Really, it's antiphospholipid antibodies and, and making sure there's no cancer. Like you said, only if there's a shunt do I pursue other venous hypercoagulability testing. Again, you [chuckles] kind of reiterate, go through with the history, make sure there's kind of no red flags. And sometimes, obviously, you do your best reasonable job with the first pass workup, and you will find out when someone presents with a second event that it's something very unexpected. Maybe first manifestation, someone with no obvious history and very initially normal-looking imaging, say with, with CATASL or something like Fabry's disease or something where you would consider it if there was kind of a more classical picture. But it wouldn't be something you would do kind of on your first or even second pass workup in the absence of any sort of clinical suspicion, family history, or something along those lines. Dr Berkowitz: I'm curious just as far as rough percentage. I feel like many of these patients we see it's a patient who's young and who's had a stroke, and the initial first pass has been unremarkable, and we do our TEE, and we do our hypercoagulable workup. Again, antiphospholipid antibodies only if it's-- there's no shunt. And if there's a shunt, adding on some of the venous hypercoagulability protein C, protein S, factor five, Leiden, et cetera. A lot of the times I feel like we don't find anything. What's your sort of general gestalt? Again, as a general neurologist who does a lot of inpatient neurology, I feel like when these cases come up, it's not that common that you say, "Oh, I actually diagnosed protein S deficiency." Or every once in a while, diagnose an antiphospholipid antibody, or you'll find a PFO on TEE. You didn't find on TT. I've maybe found one fibroelastoma in many years. How often do you find something? How often is it just as an adult a cryptogenic stroke in a young adult or child? Dr Field: So much of what we see is PFO-related, dissection-related, conventional vascular risk factor-related. We do send referrals to medical genetics. Sometimes we'll do testing for rare things like Fabry's or consider other diagnoses. But I mean, those tend to be the exceptions. About one in four to one in five young adults with stroke end up with this cryptogenic label. I like to keep them on my radar for a few reasons. I think, one, it produces tremendous anxiety for them to not have a cause of stroke identified and just to kind of have a generic approach to secondary prevention. So, I think just to kind of keep an eye on them, manage their anxieties each year, make sure there's kind of no updates in, in terms of general secondary preventionAnd sometimes just things dawn on you later or there are new conditions, say things like, you know, DADA2, this, you know, adenosine deaminase deficiency. You know, there are new diagnoses that, that come on the radar. And sometimes treatments change. You know, for example, when I was starting my early career, the evidence hadn't yet been in place for PFO closure, and then all of a sudden, the paradigm completely changed. And you want to make sure that you can get in touch with those patients to reconsider your approach at the time. So I realize that not everybody has the luxury of extended follow-up with their patients, but I think often you can kind of encourage them or their healthcare team or just, you know, patient themselves to keep in touch periodically just to make sure that there haven't been any changes in treatment paradigms or just with your own awareness of particular, you know, diagnoses or, or just kind of readdressing the situation, uh, a year after and seeing if there's anything that may have occurred to you in the interim. Dr Berkowitz: Perfect. Really illuminating to hear your approach to these challenging cases. And as you said here and then a couple of times, I think, in this interview is in many of these cases it's your first pass, maybe even your second pass, you haven't found anything. And the key is, unfortunately, as distressing as it may be for the patient as well as for us to not have an answer, to just keep following these patients. And sometimes you really can't sort it out until something else happens, either neurologically or systemically, where you say, "Oh, that's what this was." But there would've been no way to know it from the first presentation. So, we've talked a lot about the diagnosis of causes of stroke in younger adults and children. And in the last minute or two here, I just wanted to talk a little bit about treatment. You mentioned early on that you're involved in thrombectomy cases in children. What's the state of evidence or at least state of practice in terms of offering therapies like thrombolysis and thrombectomy in our patient population? I guess it would be under 18, right, who is not studied in the major trials. Do we have evidence and, or in the absence of evidence, what's sort of the, the expert guidance on treating young adults under 18 and children with some of these acute therapies? Dr Field: So, trying to keep up with the literature on this. You know, certainly the evidence has been more established in a small trial and pediatric registries for use of tPA, tissue plasminogen activator, in children just because, you know, it's been around much longer. In terms of tenecteplase, which I, I really think signifies a, a practice shift in adult stroke because of its, you know, non-inferior efficacy and ease of use and potentially better rates of recanalization over time. In children, to my knowledge, that evidence base is, is limited to case series and anecdotal shifts in availability of drug and, and different practices. So, the evidence base is not particularly strong for tenecteplase in children who are identified within a reasonable amount of time who are still otherwise candidates for thrombolysis, you know, thrombolysis in children. Children who are a little bit older, I think, can't remember the exact age, but generally very young, like neonates, children who are under the age of two, I believe. I would want to double-check that thrombolysis is less commonly used and just because the safety has not really been that well-established. And for thrombectomy, it's now recommended to use thrombectomy in otherwise eligible children in the newest AHA guidelines. It gets a little bit more controversial in very young children. Under the age of six, there's less of an evidence base and, and often it will depend on people's level of comfort in terms of the size of the arteries. It's my understanding that once you get to about age six, the artery diameter is similar to that in fully grown people. But in younger children, I think just because of the catheters, there can be risk of, of injury. So, it's more of a case-by-case conversation with your interventionalist for younger children. And again, the evidence to intervene is not there for very, very young babies, for example. Dr Berkowitz: That's very helpful to hear the current state of the evidence and the current state of practice, acknowledging, of course, there's not that much evidence, and these are relatively uncommon occurrences, fortunately, for children, but making it challenging for practitioners and practices may, um, vary based on different institutional protocols. So again, today I've been interviewing Dr. Thalia Field about her article on stroke in children and younger adults. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining us 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 the 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.
Analizamos con opinantes y oyentes el siguiente titular: "Educación achaca a las faltas de ortografía y una preparación insuficiente, los suspensos masivos en las oposiciones de maestro" Conocemos el estado del tiempo en distintas localidades asturianas con nuestras mujeres y hombres del tiempo. Seguimos con la sección de "3 planes para un banco" para el fin de semana como, campeonato de petanca, torneo de fútbol, festival de la sidra o visitas guiadas al Castillo de Gauzón, de la mano de José Luis Rodríguez. Mer Mediavilla, Pdta. de la Asociación de "Filósofas en la Historia" no hablará de la coeducación. Hoy se estrena "Un verano de restallu" en la TPA, sus presentadores no contarán esta aventura veraniega. Los "cotidiofonos" con David Varela y la VI edición de "Porrúa en bolas" cierran el programa de hoy.
Every once in a while you record an episode and you know, before you even hit stop, that it's a top-tenner. This is that one. Chris and I sat down with Dan Casey and Griffin Brand - a football coach turned historian and an Army Ranger, to talk about their book Bring Your Own Pencil, the leadership playbook of the legendary Bill Walsh. But this isn't a football episode. It's a masterclass for anyone leading a crew or building a business in the trades - roofing, HVAC, restoration, you name it. How to hold a standard without becoming a tyrant. How Walsh turned betrayal into the greatest coaching tree in NFL history. Imposter syndrome, self-belief before the evidence shows up, and why you should never quit a hit show. Grab a notebook - and bring your own pencil. Owning a business in the trades can be the loneliest job there is. Head, Heart, & Boots exists to change that, because the best leaders don't go it alone, and neither should you. -Brandon Why You Should Listen [10:19] The Hacksaw Reynolds story behind the title — one sentence that set the standard for a dynasty [18:31] Holding standards without a toxic, maniacal culture (their answer punched me right in the face) [21:49] Bill Walsh's origin story is failure — and what he built from it [43:20] The four most powerful words a leader can say [54:53] Lightning round: the books and daily habits every leader should steal Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Menteri Lingkungan Hidup, Jumhur Hidayat, meninjau langsung lokasi kebakaran di TPA Jatiwaringin, Kabupaten Tangerang, Banten. Pemerintah menargetkan api segera padam setelah sisa titik bara tinggal sekitar 3,6 persen. Upaya penanganan diperkuat dengan penambahan helikopter water bombing serta langkah antisipasi untuk mencegah kebakaran serupa di berbagai tempat pemrosesan akhir (TPA) di Indonesia.
The ASO vs. TPA Decision That Quietly Costs Self-Funded Employers More What's the real difference between an ASO and a TPA — and why does it matter that self-insured employers working with an ASO pay, by one referenced estimate, about 4.7% more than the insured book of business for the same care? In this Ask Me Anything, Stacey Richter puts a listener question from Dr. Alex Sommers, MD, ABEM, DipABLM, president of Astia Health, to Claire Brockbank, newly appointed director of the 32BJ Health Fund, who breaks down how ASO and TPA models diverge on ownership, networks, and incentives. WHAT YOU'LL LEARN ✅ How an ASO (administrative services only) arrangement differs structurally from a TPA (third-party administrator) — in Claire Brockbank's words, an ASO is essentially "a TPA that's owned by one of the big insurance carriers" ✅ Why bringing your own network, doing carve-outs, or direct contracting is typically much easier with a TPA than with an ASO, since an ASO's network comes bundled in ✅ How ASO incentive structures can lead carriers to charge self-funded employers more to offset thinner margins on their insured book — and why a study referenced by Luke Prettol found self-insured ASO clients pay roughly 4.7% more on average ✅ Why many TPAs, as newer market entrants built around technology, can move faster on things like claims-audit integrations than legacy carrier systems that can take up to 18 months to implement changes ✅ A real-world example of how network rigidity under an ASO made it difficult for one employer to remove 40 identified unsafe physicians from its network ✅ Why reading a TPA contract carefully still matters, since aligned incentives are a structural possibility with a TPA, not a guarantee WHY THIS MATTERS ASO and TPA are routinely used interchangeably across the industry, but as Claire Brockbank lays out, the distinction isn't just terminology — it's what determines how much actual control a self-funded employer has over its own health plan. An ASO bundles in the carrier's network and legacy systems, often with built-in incentive misalignments that can show up as higher costs than the insured book of business pays. A TPA leaves more room to bring your own network, negotiate direct contracts, and move quickly when something needs to change. For any plan sponsor sorting out vendor options, knowing which model is actually on the table is foundational to getting the rights, rates, and flexibility they're after. MENTIONED IN THIS EPISODE Post by Luke Prettol EP453 with Claire Brockbank: Apple Podcasts | Spotify | Other Apps EP498 with Mark Noel: Apple Podcasts | Spotify | Other Apps === LINKS ===
Family businesses come with incredible opportunities, but they also come with unique challenges. In this episode, I sit down with Keri Jones, whose family built Utah Disaster Kleanup into one of the most respected restoration companies in the country. We talk about what it was like growing up in the business, learning from industry pioneers, and eventually helping lead the company through rapid growth and a private equity acquisition. Keri shares lessons on leadership, developing people, building a strong company culture, and why creating systems for growth matters just as much as technical expertise. We also dive into what private equity really looks like from the inside, the mistakes they avoided, and the changes that helped the business scale from $22 million to $35 million. As Keri closes one chapter after spending her entire career with her family's company, she reflects on burnout, identity, and the courage it takes to pursue what's next. Whether you're building a family business, preparing for an exit, or simply trying to become a better leader, there's a lot to learn from her journey. Hope you enjoy. Chris Why You Should Listen: [00:06:20] Hear how Keri Jones grew up inside Utah Disaster Kleanup and the leadership lessons she learned from one of restoration's pioneering families. [00:20:30] Discover how UDK built a technician development program that transformed hiring, training, and career growth long before it became common in the industry. [00:30:15] Learn why diversifying sales channels and building intentional business development strategies created a stronger, more resilient restoration company. [00:39:55] Get an insider's perspective on selling to private equity, preparing a leadership team for acquisition, and what really changes after the deal closes. [00:55:10] Listen as Keri shares why she's leaving the only company she's ever worked for, what burnout taught her, and how leaders know when it's time for their next chapter. Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Few careers in military medicine trace an arc as wide as that of CAPT (Ret) Kimberly Elenberg, DNP, RN. In this episode she sits down with WarDocs to map a journey that began as an ROTC cadet who joined because she saw students rappelling down a building in Philadelphia, and that has since carried her from the bedside at Walter Reed Army Medical Center to the role of principal investigator on a Carnegie Mellon University team competing in the DARPA Triage Challenge. Along the way she changed uniforms, disciplines, and altitudes of responsibility, but never lost the thread that ties it all together: people first, and the relationships that make hard things possible. CAPT (Ret) Elenberg describes how early mentors shaped her. Colonel Graham showed her that putting people first is a practice, not a slogan. Major McGee backed her instinct for innovation, and as a young nurse on Ward 51 she built one of the first patient education centers in a military treatment facility, learned to set up networks and hardware, and pursued nursing informatics before the field was common. She recounts moving to research at NIH, where her work on TPA for clearing central line catheters was later adopted as best clinical practice, and her decision to volunteer as an EMT and medic so she would understand field medicine as well as hospital medicine. From there the conversation follows her into the U.S. Public Health Service, where after 9/11 the Surgeon General asked her to help build the nation's deployable response teams from concept to operation, training them in real communities facing real crises. She explains how anthrax and zoonotic disease drew public health into agriculture and food security, how her long relationship with Carnegie Mellon's Auton Lab began with a bus trip and a phone call, and how that mathematical grounding in probabilistic modeling resurfaced when she was asked to model the effects of policy during COVID and, later, to track military security assistance flowing to Ukraine. The episode closes on the present and the future: autonomous triage payloads that can read a casualty's physiological state without touching them, robotic snakes that might pack non-compressible hemorrhage, swarms of drones and ground robots that find the wounded and feed the right information to the right echelon. Throughout, CAPT (Ret) Elenberg returns to her core lessons — trust your chain of command, define what success really looks like, build on small wins, and never limit yourself to your military occupational specialty. From an orphanage and a food-service background to teaching at the National Defense University, hers is a story about doors held open and relationships that endure. Chapters (00:54-07:11) From Rappelling Cadet to Innovating Army Nurse (07:11-16:48) Building the Nation's Public Health Response Teams (16:48-22:24) Biosurveillance Modeling COVID and Ukraine Aid (22:24-32:32) The Power of Relationships Across a Career (32:32-37:37) Autonomy Confidence and Knowing When to Explore (37:37-51:33) The DARPA Triage Challenge and Lessons That Last Chapter Summaries (00:54-07:11) From Rappelling Cadet to Innovating Army Nurse The guest traces her start as an ROTC cadet drawn in by students rappelling down a Philadelphia building, her commissioning as an Army nurse, and her first duty station at Walter Reed Army Medical Center. Early mentors, including Colonel Graham and Major McGee, taught her that people truly come first and backed her instinct for innovation. On Ward 51 she built one of the first patient education centers in a military treatment facility while teaching herself websites, networking, and nursing informatics. (07:11-16:48) Building the Nation's Public Health Response Teams Her NIH research on TPA for central line catheters was later adopted as best clinical practice, and she volunteered as an EMT and medic to learn field medicine. After moving to the U.S. Public Health Service for family stability, she answered the Surgeon General's call following 9/11 to build the nation's deployable response teams from concept to operation. Anthrax and zoonotic disease pulled public health into agriculture and food security across the federal enterprise. (16:48-22:24) Biosurveillance Modeling COVID and Ukraine Aid Tasked to advise on detecting events and discerning intent, she leaned into probabilistic modeling and a long relationship with Carnegie Mellon's Auton Lab that began with a bus trip and a phone call. As Director of Population Health at the Defense Health Agency she modeled total force fitness, then was asked to model the effects of policy during COVID rather than the disease itself. The work forced coordination across agencies, departments, and services on a scale not seen since World War II. (22:24-32:32) The Power of Relationships Across a Career Describing herself as an introvert, she explains why relationships are the engine of accomplishment, recalling a Ranger literally pushing her up a mountain during advanced camp after a car accident. Those bonds endured and resurfaced decades later in Texas during the DARPA Triage work. She recounts retiring out of Poland after 28 years, where she stood up a secure network to coordinate 26 non-doctrinal partners supporting aid to Ukraine. (32:32-37:37) Autonomy Confidence and Knowing When to Explore She makes the case for military service as a path to clinical autonomy and the chance to think, decide, and do research that civilian roles often do not allow. She reflects on how to know when to pursue a new opportunity: trust your chain of command, negotiate and listen when you are the one in charge, and act on principles of doing no harm. Confidence, she says, means not being afraid to fail. (37:37-51:33) The DARPA Triage Challenge and Lessons That Last She gives a plain-language tour of her team's autonomous triage work — payloads that read physiological state without touching a casualty, visual reasoning models tempered by Bayesian rigor, and platforms that deliver the right information to each echelon. Using a DoD-wide tobacco policy as a case study, she explains the art of the doable and building success on small wins. She closes with advice on confidence, integrity, and holding doors open for the next generation. Take Home Messages Cross disciplines to scale care: The greatest gains often come from teaming up outside your own specialty. Pairing clinical insight with engineering, informatics, and operations lets a single provider extend capability and capacity far beyond what one profession can deliver alone. People first is a practice, not a slogan: Leaders who genuinely put people first earn the trust that makes hard missions possible. The example of a leader who recognized her team while facing her own serious illness shows that the principle is proven in action, not in words. Relationships are the engine of accomplishment: No one knows everything, and progress depends on the people willing to push you up the mountain. Networks built early endure for decades and can be called on when the mission needs them most. Define what success really looks like: Insisting on the perfect outcome can stall progress entirely; agreeing on the art of the doable moves the mission forward. Real success is often a series of small wins that build on one another over time. Confidence means not being afraid to fail: Growth lives outside the comfort zone, and everyone fails sometimes. Acting with honesty, integrity, and your best effort each day — then trusting tomorrow brings another chance — is what builds lasting confidence. Episode Keywords military medicine, Army nurse, military nursing, WarDocs, military medicine podcast, public health service, USPHS, DARPA Triage Challenge, autonomous triage, battlefield medicine, combat casualty care, Carnegie Mellon University, Auton Lab, nursing informatics, biosurveillance, COVID modeling, population health, Defense Health Agency, Walter Reed, military innovation, medical robotics, drone medicine, military mentorship, veteran leadership, military medical research Hashtags #MilitaryMedicine, #WarDocs, #ArmyNurse, #PublicHealth, #BattlefieldMedicine, #DARPA, #MilitaryInnovation, #VeteranLeadership Biography Dr. Kimberly Elenberg, a retired USPHS Captain, is the Director of Data and Mission Partner Sharing at ECS. A distinguished leader in biosurveillance and emergency response, she applies data science to enhance national security. Notably, she served as the incident response commander for modeling and analytics for the Secretary of Defense COVID Task Force. Previously, as a principal scientist at Carnegie Mellon University, she advanced autonomous systems for biosurveillance. Dr. Elenberg consistently bridges theoretical research with practical healthcare delivery, leveraging her clinical expertise and military discipline to safeguard public health. Her exceptional contributions have earned her several highly prestigious awards, including the 2022 Defense Superior Service Medal, the 2022 USPHS Distinguished Service Medal, and the 2020 National Emergency Preparedness Award for her outstanding operational acumen. Honoring the Legacy and Preserving the History of Military Medicine The WarDocs Mission- WarDocs exists to honor the legacy of Military Medicine, preserve its history, and inspire every generation — across all Services, Corps, and Ranks — to serve with excellence and pride. Through mentorship, coaching, and education, we equip those considering, entering, and serving in military medicine with the knowledge, connections, and community they need to thrive. We celebrate Who we are, What we do, and, most importantly, How we serve Our Patients, the DoW, and Our Nation. Find out more and join Team WarDocs at https://www.wardocspodcast.com/ Check our list of previous guest episodes at https://www.wardocspodcast.com/our-guests Subscribe and Like our Videos on our YouTube Channel: https://www.youtube.com/@wardocspodcast Listen to the “What We Are For” Episode 47. https://bit.ly/3r87Afm WarDocs- The Military Medicine Podcast is a Non-Profit, Tax-exempt-501(c)(3) Veteran Run Organization run by volunteers. All donations are tax-deductible and go to honoring and preserving the history, experiences, successes, and lessons learned in Military Medicine. A tax receipt will be sent to you. WARDOCS documents the experiences, contributions, and innovations of all military medicine Services, ranks, and Corps who are affectionately called "Docs" as a sign of respect, trust, and confidence on and off the battlefield, demonstrating dedication to the medical care of fellow comrades in arms. Follow Us on Social Media Twitter: @wardocspodcast Facebook: WarDocs Podcast Instagram: @wardocspodcast LinkedIn: WarDocs-The Military Medicine Podcast YouTube Channel: https://www.youtube.com/@wardocspodcast
Fawry’s healthcare TPA license. Office rents face VAT test. FRA delays carbon mandate. Morning Drive is your daily download of the essential headlines shaping Egypt. From business policy and finance to the latest in tech, all in under 10 minutes. Hosted by ‘Synthetic Salma’ — an AI-powered version of our own Executive Editor Salma El-Saeed. You can read the full newsletter on the website. Morning Drive is brought to you by: Madinet Masr GRANITE Financial Holding Bonyan for Real Estate Investments And check out our other show Making It, where we speak to CEOs and entrepreneurs about building a great business in the region.See omnystudio.com/listener for privacy information.
CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov. The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.
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Do the benefits really outweigh the risks when it comes to the use of thrombolytic drugs for central retinal artery occlusion (CRAO)? Drs. Amanda Henderson and Michael Carper weigh in on the recently published Tenecteplase in Central Retinal Artery Occlusion Study (TenCRAOS) and how ophthalmologists should proceed in their management of CRAO with tenecteplase (TNK) or another tissue plasminogen activator (tPA). For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.
AAD PARTE 1: Esta semana se cumplen veinte años del inicio de las emisiones regulares de TPA. El aniversario coincide con la elección en la Junta General del Principado de la periodista Azahara Cañedo como nueva directora general de RTPA. ¿Se refleja la sociedad asturiana en los distintos programas de la cadena? Es la pregunta que hacemos a Ricardo Fernández (PSOE) Manuel Cifuentes (PP) Gonzalo Centeno (Vox) Xabel Vegas (IU/CA) y Adrián Pumares (Foro). AAD PARTE 2: En la entrevista falamos de la publicación de Da-yos caña. El tiempu y el contestu d’una banda de Rock Astur, la obra cola que Xune Elipe algamó’l II Premiu «Yolanda Huergo», convocáu pola Asociación Grana. AAD PARTE 3: Cerramos el programa hablando de la ansiedad que genera la situación política actual en algunas personas con el psicólogo Daniel Suárez.
Mentorship gets talked about a lot in business, but what does it actually look like in practice? In this episode, Brandon and I unpack the difference between teaching, coaching, and true mentorship, and why most leaders struggle to develop people effectively. We explore the two ingredients every great mentor needs: experience and visibility. It's not enough to know what good looks like, you have to understand what's actually happening in someone's day-to-day work before you can help them improve. That conversation leads us into how technology is changing leadership, coaching, sales management, and technician development in ways we couldn't have imagined a few years ago. We also share lessons from our own families, the mentors who shaped us, and the responsibility leaders have to intentionally pass knowledge, perspective, and wisdom to the next generation. Whether you're leading a sales team, managing technicians, or raising kids, the principles are surprisingly similar. If you're trying to build stronger people, stronger teams, and a stronger culture, this conversation will challenge the way you think about leadership and mentorship. Hope you enjoy Chris Why You Should Listen: [00:08:01] Why entrepreneurial success often disappears by the second generation and what leaders can do to intentionally pass on mindset, not just resources [00:17:17] The difference between teaching, coaching, and true mentorship, and why visibility is the missing ingredient in developing people [00:29:42] What listening to 100 real customer conversations revealed about sales performance, close rates, and frontline leadership [00:39:28] How top organizations are using technology to create better accountability, faster learning, and more effective employee development [00:46:10] Why human connection, customer experience, and mentorship may become the most valuable skills in an AI-driven future Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Sungai Watch co-founder Gary Bencheghib said Bali is on "red alert" after the closure of South Bali's main landfill triggered open burning and illegal dumping, while a waste-to-energy plant remains over a year away. - Pendiri Sungai Watch, Gary Bencheghib, mengatakan Bali dalam kondisi "siaga merah" setelah penutupan TPA utama di Bali selatan memicu pembakaran terbuka dan pembuangan sampah ilegal, sementara pembangkit listrik tenaga sampah (PLTSa) baru akan beroperasi lebih dari satu tahun lagi.
Nate Cisney of Restoration Made Simple shares TPA vs non-TPA work, how it affects your operations, profitability, diversifying your work, and long-term growth for restorers.
In this episode, I sit down with former NCAA champion and Olympian Les Gutches for one of the most fascinating conversations we've had on the show. What started as a conversation about wrestling quickly turned into a masterclass on resilience, discipline, business, leadership, and life. Les shares stories from his childhood in Southern Oregon, growing up fast while helping care for his sick mother, and how those early experiences shaped his mindset forever. We dig into the relentless work ethic that carried him from local wrestling clubs all the way to undefeated NCAA championship seasons and the Olympics. Les talks about getting thrown into practices with older, tougher athletes from a young age, and how constantly being pushed beyond his comfort zone became one of the biggest advantages of his career. But what really surprised me was hearing how much of his success in business came from lessons learned off the mat. Les explains how working as a commercial lender taught him to read financials, recognize patterns, and learn directly from wealthy business owners. We also unpack his framework for successful partnerships, why every business needs a gas pedal, a brake pedal, and a transmission, plus some incredible stories from his real estate, gym, and liquor store ventures. We finish with a conversation about health, longevity, and discipline as a business owner. At 53, Les is still training consistently and thinking long-term, not just about money or success, but about having the energy and physical capacity to enjoy life decades from now. This episode is packed with practical wisdom and stories I know you'll remember. Hope you enjoy -Chris Why You Should Listen: [00:05:00] Les shares the responsibility and pressure of helping care for his sick mother as a young child — and how those early experiences shaped his mindset [00:08:30] How constantly training with older, tougher wrestlers built the resilience that eventually carried him to NCAA and Olympic success [00:17:20] A powerful story about quitting wrestling, learning ownership, and the parenting lesson that changed his trajectory [00:27:45] Why real confidence comes from preparation — and how that applies in sports, business, and leadership [00:44:50] Les breaks down his “gas pedal, brake pedal, transmission” framework for business partnerships and why most entrepreneurs build teams the wrong way [01:00:20] A practical conversation on health, longevity, and why successful business owners can't afford to neglect their physical fitness Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
In this episode of Head, Heart and Boots, Brandon and I sat down with J. Brad Britton for one of the most meaningful conversations we've had on the podcast. J. Brad spent decades leading inside the Cutco and Vector organizations, but this episode centers on something far deeper - his relationship with his son Sam and how that journey completely changed the way he thinks about leadership, communication, and human potential. What stuck with us most was hearing J. Brad talk about realizing Sam understood far more than anyone had assumed for years. It forced him to rethink not only his parenting, but the way we all judge people based on surface behavior instead of curiosity and empathy. We also dug into leadership lessons from Cutco, coaching young salespeople, and why presence and encouragement matter so much when developing people. This episode is thoughtful, emotional, and packed with perspective that applies far beyond business. Hope you enjoy Chris Why You Should Listen: [00:05:42] The moment J. Brad realized his son understood far more than anyone had believed for years [00:14:18] How raising a child with apraxia reshaped his perspective on leadership, patience, and communication [00:24:07] Why curiosity and empathy matter more than assumptions when working with people [00:36:12] Leadership lessons from decades inside the Cutco and Vector organizations developing young salespeople [00:49:03] A powerful conversation about fatherhood, encouragement, and learning to truly see the people in front of you Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Superb melodic and symphonic progressive rock. Album reviews from TPA and our fun proggy quiz!
In this episode of Head, Heart, and Boots, Brandon and I sit down with our teammate Clinton Tierney to talk sales, leadership, and the mindset it takes to win in today's restoration market. Clinton's story is incredible—college athlete turned mold technician turned multi-million dollar producer and sales leader—and you can hear how every season shaped the way he approaches business development today. We spent a lot of time unpacking what actually creates successful salespeople. Not gimmicks or scripts, but consistency, volume, discipline, and learning how to fall in love with the process instead of obsessing over the outcome. Clinton shares some really practical insight from his years in the field, including how he built relationships, uncovered customer pain points, and developed the habits that made him successful. One of my favorite parts of this conversation was hearing Clinton talk about coaching sales reps. So many companies promote great producers into leadership roles, only to realize later that coaching people requires a completely different skill set. Clinton has a real gift for developing others, and that comes through loud and clear in this episode. If you lead a sales team, own a restoration company, or are just trying to become better at business development, this conversation is packed with practical takeaways and a ton of encouragement. Hope you enjoy Chris Why You Should Listen: [00:07:08] How Clinton went from an $8-an-hour mold tech to a multi-million-dollar producer in restoration sales [00:10:20] The sales culture lessons he learned inside a company that scaled from $3M to over $50M [00:21:22] Why great salespeople fall in love with the process—not just the outcome [00:24:26] The two sales disciplines Clinton says matter most: volume and face-to-face meetings [00:35:03] What Clinton learned transitioning from top producer to sales leader—and why most reps struggle in management roles Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
In this episode of IM: Unfiltered, Lindy Tentinger (President, VGM & Associates) and Ike Isaacson (SVP of Government & Regulatory Relations, VGM Group) sit down with Joel Gallion, CEO of Bellevue Healthcare in Washington, for a candid conversation about the urgency of advocacy in the home health and DME industry.They unpack the real risks behind new payer and TPA models reshaping care delivery — from sole sourcing and network restrictions to the erosion of quality and competition — drawing a stark parallel to what the PBM model did to independent pharmacies.Joel shares how Bellevue Healthcare went from advocacy bystanders to active champions of change through their state association PAMES, and why he believes the time to act is now, not tomorrow. Whether you're a large supplier or a small independent provider, this episode is a call to step up, get involved, and own your role in shaping the future of the industry.Watch on YouTube: https://youtu.be/6TTJ4e7ch5g
In this episode of Head, Heart and Boots, Brandon and I sit down with Nick D'Urbano again- this time not to talk AI, but to dig into branding. And honestly, this one hit different. Nick's built and scaled multiple 8- and 9-figure brands, and what stood out is how clearly he sees something most of us miss: brand isn't your logo, your colors, or your website- it's how people feel when they interact with your business. We spent most of the conversation unpacking that idea. What does it actually mean to build a brand? It starts way deeper than marketing. It's your principles, your standards, how your team behaves, how you treat customers, and whether all of that is consistent. If you ask 10 people what your company stands for and get 10 different answers, you don't have a brand. Nick also challenged the way most restoration companies think about this. In an industry where people are going through some of the hardest moments of their lives, there's a massive opportunity to build a brand around how you show up for them, not just the job you do. That idea of being “human-centered” stuck with me. We wrapped this by connecting it back to execution- how communication, consistency, and even AI tools like Distance play a role in reinforcing your brand at scale. Because at the end of the day, your brand is being built whether you're intentional about it or not. Hope you enjoy Chris Why You Should Listen: [00:02:10] Why most people misunderstand branding and how it goes far beyond logos, colors, or marketing [00:08:34] How to define real company principles that actually guide decisions instead of just sounding good on a wall [00:16:12] Why consistency across your team and customer experience is what truly builds a strong brand [00:27:45] The opportunity restoration companies have to create a human-centered experience in high-stress situations [00:38:20] How communication, systems, and even AI tools can reinforce your brand as you scale Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
We talk with Mark Gaunya about why employer health insurance often feels like a casino where the house wins and how employers can flip the odds with transparency, ownership, and smarter plan design. We break down how captive risk sharing works, what it takes to implement, and the real financial and employee-experience wins that come from getting off the less bad renewal hamster wheel. • Why the US healthcare system “works” as designed for rulemakers, not end users • How the less bad renewal cycle traps employers without claims data and transparency • Why Mark wrote Captivated Health and how case studies teach faster than jargon • Captive insurance versus traditional self-funding, including stop loss and risk layers • The four pillars of Captivated Health: members first, consumerism, wellbeing culture, self-governance • How employers can control the SPD, stop loss contract, and TPA agreement • outcomes from captive ownership: lower trend, pharmacy control, surplus, and rebate distributions • Practical stories: bundled maternity pricing plus shared savings, adding LASIK through plan design • The leadership mindset shift from system decision to self-decision • What implementation really looks like for HR and finance without adding headcount If you're an employer and you're struggling with these kinds of issues, and most of you are, or if you're a broker and you have clients who are struggling with these issues, please get the book, "Captivated Health. Take Control. Gain Transparency. Leverage Confidence." CLICK HERE
JD sits down with Chad Hixon, Executive Director of the Trails Preservation Alliance, for a deep conversation about off-road access, single-track trails, public lands, trail closures, and the future of motorized recreation. Chad shares how growing up in Howard, Colorado, a lifetime of motorcycles, kayaking, skiing, and stewardship eventually led him into full-time trail advocacy. The episode digs into the origins of TPA, the importance of single-track and two-track connectivity, and why Jeep trails, dirt bike routes, ATV access, and public land roads are all tied together. JD and Chad also break down the Public Lands Access Restoration Act, MVUM confusion, Hackett Gulch, trail signage, volunteer agreements, and why national groups and local clubs both need support. If you care about trail access advocacy and keeping public lands open for future generations, this one is worth your time.
In this episode of Head, Heart, and Boots, Brandon and I sit down with Rocky Hensley to break down his latest exit and what actually drove the valuation behind the deal. Rocky shares how private equity approached the opportunity, why he chose his partner, and what most owners misunderstand about timing a sale. We dig into the simple framework he uses to build valuable companies, centered around strong profitability and removing owner dependency. Rocky explains why these two factors matter more than anything else when it comes to scaling and eventually selling a business. The conversation also dives into growth strategy, including why sales is the true driver of scale and how plumbing and restoration can work together when executed the right way. Rocky challenges the way most operators think about expansion and where they spend their time. This episode is a look at where the industry is heading, from private equity trends to the shift toward owning the full customer relationship. If you are building, scaling, or thinking about an exit, this one will give you a clearer lens on what actually matters. Hope you enjoy Chris Why You Should Listen: [00:00:43] Inside Rocky Hensley's latest exit—and why private equity paid future earnings at an 18x multiple [00:07:12] The simple 2-rule framework Rocky uses to decide when to sell a business (and why most owners get it wrong) [00:12:10] The “20% net profit + no owner dependency” formula that makes a company instantly valuable [00:25:19] Why sales—not operations—is the real driver of scale (and the costly mistake most owners make) [00:33:00] Why most restoration companies fail to leverage plumbing—and how the top operators actually win with it [00:45:53] Where private equity is really going: owning the entire customer, not just one service line [00:54:41] The hiring philosophy that got validated in a massive PE deal—and why “good” employees are a liability Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
In this episode of Head, Heart, and Boots, Brandon and I sit down with Chris Matts, founder of Marketing Ninjas, to talk about what actually drives growth in restoration and why most marketing misses the mark. Chris shares his path into entrepreneurship, how he found the restoration industry, and why he chose to focus on helping companies generate more opportunities through outbound and relationship-driven strategies. We dig into the difference between branding and direct response, why business development reps are still one of the most important roles in a restoration company, and how marketing should support, not replace, relationship building. This conversation is a practical look at how work really flows in this industry and what it takes to stand out in a crowded market. Hope you enjoy Chris If you're interested in Marketing Ninjas - check out more at this LINK Why You Should Listen: [00:06:12] How Chris Matts found the restoration industry and why he saw it as a massive, underserved opportunity [00:14:27] Why most restoration marketing fails and the common mistake of relying too heavily on ads instead of relationships [00:21:05] The real role of business development reps and why they are still the most consistent driver of revenue [00:30:18] The difference between branding and direct response and how to use both effectively in your market [00:42:11] How top restoration companies actually generate work by owning referral relationships, not just waiting on inbound leads Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Do you own more than one business? Even if they seem completely unrelated, the IRS may still consider them a single employer when it comes to your retirement plan — and that distinction could cost you.In this episode of The Sentinel Show, Melissa Terito and Kasey Melancon break down one of the most commonly misunderstood areas of retirement plan compliance: controlled groups and affiliated service groups. From parent-subsidiary structures to brother-sister controlled groups, Melissa walks through the real-world scenarios she sees done wrong every day — including the classic mistake of setting up a separate plan specifically to avoid covering employees.The conversation covers what actually triggers a controlled group or affiliated service group, why business owners assume they're in the clear when they're not, what happens when you're only covering 50% of your total employee population instead of the required 70%, and why the "but my companies have nothing to do with each other" argument doesn't hold up the way most people think it does.If you own multiple businesses, have partners who own other entities, or have ever wondered why your TPA keeps asking so many questions about ownership — this episode is exactly why. Getting this wrong isn't just a technicality. It can mean funding corrective contributions for employees who never had the chance to participate in your plan.Don't wait until someone finds the problem for you.
Ronen Eckhouse, Co-Founder and CEO of Rapid Medical, identifies the limitations of current stroke treatments, which are primarily effective for large vessel occlusions. The Rapid Medical TIGERTRIEVER device is designed to safely and effectively treat strokes and remove clots in smaller vessels deeper in the brain. The unique adjustability of the device allows physicians to control the size and force during a procedure, allowing for precise and safer clot removal in complex anatomies. Ronen explains, "So the quicker or the less time there is between the stroke and the ability to open the occlusions and resupply the brain with oxygen, the better. There are two types of treatments. One is a drug called TPA. It's a clot buster, and that can be administered up to four and a half hours. And then there's what's called thrombectomy, which is basically using a catheter to get to the clot and then removing the clot with a catheter or stent, kind of in mechanical terms. But today, that's only applicable to what's for the bigger arteries in the brain, what's called large vessel occlusions. And these account for about 15% or 20% of the population. So there are good solutions, but they are limited in when they can be used." "That's exactly where we come in. The reason it's difficult to treat these kinds of smaller vessels in the brain, or what we call the medium-vessel occlusion, is that the deeper you go into the brain, on the one hand, the complexity of the procedure increases. So the vessels are a little bit more fragile. There are more turns and tortuosity. So getting to the clot is a little bit harder, and pulling it out as well." "At the same time, the benefit is a little bit smaller. So now we're not saving half of the brain. Maybe we're saving 30% of the brain, which is still very significant, but the benefit is a little bit smaller. So the risk-benefit ratio, which is critical and everything we do in medicine, changes when you're going deeper into the brain. And as a result, you need new tools." #RapidMedical #DMVO #MeVO #Stroke #StrokeCare #Neurology #MedTech #DISTALS #Neurovascular #MedicalDevices #HealthcareInnovation #Thrombectomy #PatientCare #MedicalTechnology #StrokeAwareness #HealthcareProfessionals rapid-medical.com Download the transcript here
Ronen Eckhouse, Co-Founder and CEO of Rapid Medical, identifies the limitations of current stroke treatments, which are primarily effective for large vessel occlusions. The Rapid Medical TIGERTRIEVER device is designed to safely and effectively treat strokes and remove clots in smaller vessels deeper in the brain. The unique adjustability of the device allows physicians to control the size and force during a procedure, allowing for precise and safer clot removal in complex anatomies. Ronen explains, "So the quicker or the less time there is between the stroke and the ability to open the occlusions and resupply the brain with oxygen, the better. There are two types of treatments. One is a drug called TPA. It's a clot buster, and that can be administered up to four and a half hours. And then there's what's called thrombectomy, which is basically using a catheter to get to the clot and then removing the clot with a catheter or stent, kind of in mechanical terms. But today, that's only applicable to what's for the bigger arteries in the brain, what's called large vessel occlusions. And these account for about 15% or 20% of the population. So there are good solutions, but they are limited in when they can be used." "That's exactly where we come in. The reason it's difficult to treat these kinds of smaller vessels in the brain, or what we call the medium-vessel occlusion, is that the deeper you go into the brain, on the one hand, the complexity of the procedure increases. So the vessels are a little bit more fragile. There are more turns and tortuosity. So getting to the clot is a little bit harder, and pulling it out as well." "At the same time, the benefit is a little bit smaller. So now we're not saving half of the brain. Maybe we're saving 30% of the brain, which is still very significant, but the benefit is a little bit smaller. So the risk-benefit ratio, which is critical and everything we do in medicine, changes when you're going deeper into the brain. And as a result, you need new tools." #RapidMedical #DMVO #MeVO #Stroke #StrokeCare #Neurology #MedTech #DISTALS #Neurovascular #MedicalDevices #HealthcareInnovation #Thrombectomy #PatientCare #MedicalTechnology #StrokeAwareness #HealthcareProfessionals rapid-medical.com Listen to the podcast here
In this episode of Head, Heart, and Boots, Brandon and I sit down with Sam Chapman, owner of Merit Restorations and partner in CaseCo and 1-Tom Plumber, to talk about building businesses, leading people, and the real work behind growth. Sam shares his journey from a blue collar upbringing to building multiple companies, and how he's approached scaling through partnerships, culture, and intentional leadership. We also get into the hard lessons. From avoiding accountability to rebuilding a broken culture, Sam walks through what it took to reset his team and raise the standard across the business. This is a conversation about ownership, discipline, and doing the internal work required to lead well at home and in business. Hope you enjoy Chris Why You Should Listen: [00:02:48] Sam's origin story growing up in a blue collar family and how watching his dad build a business shaped his drive to create something of his own [00:16:14] How CaseCo evolved from flipping houses into a high end custom home and commercial construction company and the strategic decisions behind that growth [00:22:32] Why Sam partnered with 1-Tom Plumber and how he's using it to drive more mitigation opportunities and expand his restoration business [00:29:42] The moment his restoration company's culture broke and what it took to rebuild the team, reset standards, and create real accountability [00:46:43] A raw look at the mental and emotional toll of entrepreneurship and the personal work required to lead well at home and in business Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Stacey Richter interviews Jerry DiMaso, CEO of Payerset, about how hospital and carrier price transparency data (mandates beginning with hospitals in 2019 and carriers in 2022) is being used by plan sponsors and providers. For self-insured employers and unions, DiMaso highlights three key uses: benchmarking against competitors via EIN to compare negotiated rates and carve-outs, identifying high-cost billing codes, and exposing "discount shell games" by validating whether claimed discounts reflect real savings. Employers can use the insights to guide TPA negotiations, implement service carve-outs/direct contracts and calculate objective savings, and model alternative plan types (e.g., PPO vs HMO) while maintaining access. For clinics, transparency data can level information asymmetry by enabling rate benchmarking, revealing new contracting opportunities with previously unknown carriers, and supporting rate increases by pairing price comparisons with quality/outcomes; the discussion also addresses concerns about prices rising and an emerging transparency "arms race." === LINKS ===
Tampa International Airport is redoing its ticketing area for the first time since the 1970s. Read Shepherd speaks with the airport's Josh Gillin. See omnystudio.com/listener for privacy information.
On this episode of Voices of Self-Funding, host Ramesh Kumar welcomes Jonathan Socko, President of East Coast Underwriters, LLC, a Managing General Underwriter (MGU) specializing in Stop Loss insurance. Jonathan shares his perspective on stop-loss underwriting for small groups and unveils the blueprint for a remarkable success story: a 30-life employer group that has been successfully self-funded for 10 years with their PMPM costs increasing only 10% over that decade. You'll learn: - The crucial role of partner cohesion between the broker, TPA, and stop-loss carrier to manage claims proactively. - Why data transparency and a specific data flow are non-negotiable for effective claim prediction and management. - The essential mindset shift—and commitment to aggressively attacking costs—that ensures a small group's self-funded plan remains successful and sustainable. Don't miss this conversation for an insider's view on stop-loss and the strategy that delivers long-term savings. At zakipoint Health, we are transforming the healthcare experience by delivering transparency, direction, and personalized support to members of self-insured plans. Our powerful platform unifies all benefit services, data, insights, and tools into one intelligent ecosystem empowering members to make informed decisions and take proactive steps toward better health outcomes. With AI at its core, zakipoint Health functions as the “Intel Inside” of healthcare navigation driving engagement, reducing risk, and delivering measurable cost savings. Employers and partners benefit from robust reporting, actionable insights, and tools that not only identify healthcare risks but also guide members toward high-value care. By bridging the gap between complexity and clarity in the U.S. healthcare system, we help organizations lower costs, improve outcomes, and support healthier, more engaged populations making healthcare less stressful and more effective for millions. 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
In this episode of Head, Heart, and Boots, I sit down with Lane Larsen, founder of Clean Claims, to unpack what is happening at the intersection of restoration, technology, and insurance. As the industry continues to evolve, Lane brings a unique perspective on how software, data, and process are reshaping the way claims are handled and how contractors can position themselves to win in a more complex environment. We dig into the origin of Clean Claims, the problem it was built to solve, and how improving claim quality, documentation, and communication can create better outcomes for contractors, carriers, and homeowners alike. Lane shares how fast technology is moving, what that means for operators on the ground, and why those who embrace better systems and cleaner processes will have a major advantage in the years ahead. This conversation is both strategic and practical. From reducing friction in the claims process to building stronger relationships with carriers and adjusters, it is a look at how the right tools and mindset can elevate the entire business. If you are trying to stay ahead of where the industry is going, this one will help you think differently about what comes next. Hope you enjoy. Chris Why You Should Listen: [00:03:15] How Clean Claims is simplifying field documentation, remote monitoring, and process enforcement by replacing multiple apps with one technician-friendly system [00:08:17] Why “process enforcement” matters so much in restoration and how removing human inconsistency can improve documentation, compliance, and payment speed [00:17:09] What it looks like to onboard new technicians fast and why simple, intuitive software can dramatically shorten the learning curve [00:31:10] A look at where AI, estimating, ESX integration, and automated rebuild scoping are headed and how quickly field operations may change [00:38:29] Why Lane believes restoration still operates like the Wild West and how better standardization could improve trust between contractors and carriers Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
In this episode of Head, Heart, and Boots, Brandon and I sit down with Nick Rahn, founder of Warriors Next Adventure, for one of the most intense and powerful conversations we've had on the show. Nick shares his journey from a turbulent childhood and multiple combat deployments in the Air Force to hitting rock bottom after leaving the military, battling addiction, and nearly ending his life in the Boundary Waters of northern Minnesota. What follows is a story of transformation. Nick walks us through the moment that changed everything, the internal work required to rebuild his identity, and how he developed a set of principles that helped him move from survival to purpose. We explore how those same principles now serve as the foundation for Warriors Next Adventure, a nonprofit dedicated to helping veterans navigate PTSD, mental health struggles, and life after service through deep conversations, jiu jitsu, and challenging outdoor experiences. This episode is raw, emotional, and ultimately hopeful. From stopping suicides through a 24/7 crisis line to taking veterans into the mountains to confront their past and reclaim their future, Nick's work is a powerful reminder that healing is possible and that purpose often comes from the hardest chapters of our lives. Hope you enjoy. Chris Why You Should Listen [00:03:14] How Nick's military career and post-service struggles led to a loss of identity, purpose, and direction that many veterans quietly face [00:10:18] The powerful story of a failed suicide attempt that became the turning point for rebuilding his life and redefining who he wanted to become [00:15:04] How the “six principles” were developed through real experience and became a framework for overcoming trauma, addiction, and self-doubt [00:31:44] Why letting go of resentment, taking ownership, and dropping the “anchors” from your past can radically change your present and future [00:56:56] How Warriors Next Adventure is helping veterans through crisis intervention, jiu jitsu, and extreme outdoor experiences that force real transformation Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
In this episode of Head, Heart, and Boots, we sit down for a conversation to unpack a fresh perspective on leadership, pressure, and the internal narratives that shape how we show up in business and in life. This episode is less about tactics and more about awareness. It is about recognizing the stories we tell ourselves when things get hard and how those stories either limit us or push us forward. We talk through how easy it is to default into frustration, comparison, or self-doubt when results do not match expectations, and why so much of leadership growth comes from learning to reframe those moments instead of reacting to them. From the pressure to perform, to the temptation to measure progress against others, to the quiet ways we avoid responsibility by externalizing problems, this conversation challenges listeners to take a more honest look at what is really driving their decisions. This episode is a reminder that leadership is not just about strategy or execution. It is about ownership, perspective, and the discipline to choose a better narrative when the default one is working against you. If you have felt stuck, frustrated, or out of alignment, this one will give you something real to wrestle with. Hope you enjoy. Chris Why You Should Listen [00:02:11] How the stories you tell yourself under pressure shape your decisions, your leadership, and your long-term outcomes [00:06:48] Why comparison and unmet expectations quietly create frustration, and how to reframe them into something productive [00:12:03] The difference between reacting to problems and taking ownership of your role in them [00:18:27] How internal narratives can either limit your growth or become the fuel that drives better performance [00:25:10] A practical way to catch yourself in negative patterns and choose a more intentional response in real time Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
In this episode, Robin Merttens is joined by Martha Dreiling, Co-founder and President of Reserv, to explore how AI is actually transforming claims, and why the biggest breakthroughs are happening in places most people overlook. With a background spanning FinTech, InsurTech and risk analytics, Martha brings a practical perspective on how data and technology can improve decision-making, not just automate existing processes. At Reserv, she's helping build a claims model that combines operational efficiency with quality, while challenging long-standing assumptions about how claims should be handled and paid for. In this conversation, Martha shares: Why the most valuable AI in claims is “boring but brilliant”, not flashy How continuous monitoring is quietly improving claims outcomes at scale Why efficiency alone is no longer enough, and what it takes to deliver quality alongside it How claims data is becoming a critical input into underwriting and pricing decisions The challenge of legacy systems and why data fragmentation still holds the industry back What real AI adoption looks like, and why execution is starting to outpace strategy How AI is exposing misaligned incentives in traditional time-and-expense TPA models Why insurers need to rethink how they pay for claims services in an AI-driven world The shift from technology transformation to human and workflow transformation How reducing administrative burden can refocus claims handlers on empathy and judgement Why better claims operations ultimately matter for affordability and customer outcomes If you like what you're hearing, please leave us a review on whichever platform you use or contact Robin Merttens on LinkedIn. Sign up to the InsTech newsletter for a fresh view on the world every Wednesday morning.
In this episode of Head, Heart, and Boots, Brandon and I dig into something that feels bigger than business but is showing up inside every business anyway: loneliness, disconnection, and the emotional fragility many people are carrying into work right now. We unpack how remote work, constant digital distraction, and the erosion of real face-to-face relationships are reshaping not only mental health, but also trust, confidence, and the way teams respond to pressure and change. We talk candidly about what it feels like to lead in an environment where people seem more depleted, more anxious, and less resilient than they did just a few years ago. From the loss of natural boundaries between work and home, to the challenge of building genuine relationships with employees while still holding clear standards, this conversation wrestles with the tension every owner and leader feels but rarely names out loud. This episode is not about easy answers. It is about recognizing the reality in front of us and asking better questions about how we lead, hire, communicate, and create environments where people can actually feel seen without losing accountability. If you have felt the weight of leading tired people while being tired yourself, this one will hit close to home. Hope you enjoy. Chris Why You Should Listen [00:03:12] Why loneliness and social disconnection are quietly reshaping workplace behavior, resilience, and team dynamics [00:09:48] How remote work and digital life have blurred the lines between personal identity, relationships, and professional performance [00:17:26] The leadership challenge of balancing empathy with accountability when employees are struggling emotionally [00:24:41] Why many leaders feel exhausted trying to carry the emotional weight of their teams while still pushing for results [00:33:05] A candid look at how rebuilding real connection and trust inside teams may be one of the most important leadership skills moving forward Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
In this episode of Head, Heart, and Boots, Brandon and I tackle a shift that many restoration companies are starting to feel but may not fully understand yet. The traditional flow of insurance work is changing. Claim volumes are tightening, TPAs are producing fewer opportunities, and customers are becoming more cautious about filing claims due to rising deductibles and policy pressure. That shift is forcing restoration companies to confront something the retail contracting world has been dealing with for decades: selling. We unpack what it means to operate more like a retail contractor and why learning to earn the customer's trust, present real numbers, and guide clients through decisions is becoming a core skill set for the industry. We talk through practical examples like offering financing, training teams to present rough order of magnitude estimates, using tools like Loom for better communication, and building a process that gives customers confidence before asking for their commitment. This conversation is less about tactics and more about mindset. The companies that embrace the shift toward proactive sales, better communication, and stronger client experience will be the ones that continue to win as the landscape evolves. Hope you enjoy. Chris Why You Should Listen [00:02:27] Why claim volumes and TPA lead flow are tightening and how insurance industry changes are forcing restoration companies to rethink their business model [00:04:49] How offering financing solutions can remove friction for customers and help companies close jobs that might otherwise disappear [00:07:10] What restoration companies can learn from retail contractors about selling, presenting estimates, and winning work in competitive environments [00:18:51] How better communication tools like Loom can dramatically improve customer trust and engagement during the sales and project process [00:23:39] Why the future of restoration will require teams that are skilled at relationships, persuasion, and customer experience rather than just task execution Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews.More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST.Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it.Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle.See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
"We don't view ourselves as a TPA, we view ourselves more as a platform... our goal is to simplify and reduce the barriers of entry into the TPA space."The role of the Third-Party Administrator is undergoing a massive evolution. No longer just a back-office claims processor, the modern TPA is being asked to serve as the high-tech, high-touch "nucleus" of the entire health plan.My guest this week is Vinny Esposito, CEO of Reflect Health (formerly S&S Health). Drawing on a decade of experience in the hedge fund world, Vinny recognized a massive opportunity to bring scalable, asset-light infrastructure to the self-funded market. Today, Reflect Health acts almost like the "Intel Inside" of the industry, licensing its proprietary claims technology to other TPAs and health plans.In this episode, we explore exactly what it takes to build the TPA of the future. We discuss how to solve "point solution fatigue" through a centralized marketplace, the mechanics behind infusion drug carve-outs, and how to successfully deploy dynamic deductibles to incentivize better care routing. Vinny also shares his bold vision for "frictionless claims" paid instantly at the point of service, moving us closer to an Amazon-style shopping experience for healthcare.If you want to understand the technological and administrative innovations driving the self-funded market forward, this episode provides the blueprint.Thank you to our 2026 sponsors!ParetoHealth: ParetoHealth empowers midsize employers with a long-term solution to reduce volatility and lower overall health benefits costs. Visit ParetoHealth.com to learn more.Samaritan Fund: A program that connects those who need help to the support they need. We are proud to offer the Samaritan Fund Program. Visit SamaritanFundProgram.com to learn more.Vālenz Health: We're Vālenz Health, your partner in improving health literacy, reducing plan spend, and delivering high-value healthcare. Visit ValenzHealth.com to learn more.Imagine360: Imagine360 helps self-funded employers save on healthcare with smarter health plans. Cut expenses by 20-30% with custom solutions. Contact us today at Imagine360.com.Chapters:(00:00:00) Intro: Competing on Service in the TPA Market (00:01:56) Meet Vinny Esposito & Reflect Health (00:03:35) Rebranding from S&S Health (00:07:32) From Hedge Funds to Healthcare Disruption (00:11:05) The Platform Model: Licensing Tech to Other TPAs (00:15:05) The Marketplace & Infusion Drug Carve-Outs (00:19:14) How the TPA Role is Expanding (The "Nucleus") (00:24:12) Direct Contracting, RBP, and DPC Integration (00:29:15) Dynamic Deductibles & Tiered Networks (00:33:25) Curing "Point Solution Fatigue" (00:41:09) The Future of Stop-Loss and Preventative Care (00:45:44) The Fiduciary Breaking Point & 80% Renewals (00:50:26) Frictionless Claims & Amazon-Style HealthcareKey Links for Social:@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFundedListen/watch on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/
In part on of this series, Dr. Andy Southerland and Dr. Seemant Chaturvedi discuss two trials highlighted at the 2026 International Stroke Conference. Show citation: Read more about the CHOICE-2 trial. Show transcript: Dr. Andy Southerland: Hello everyone. This is Andy Southerland. And for this week's Neurology Minute, I have just been speaking once again with my colleague, Seemant Chaturvedi, about his impressions from this year's 2026 American Heart Association, American Stroke Association International Stroke Conference. We've discussed a number of the very exciting pivotal trials presented at this year's meeting that occurred just a couple of weeks ago. But for the minute today, we want to just highlight two that were represented as late breaking trials in the world of acute stroke treatment. And the first was OPTION, which was a trial looking at extended window thrombolysis patients between four and a half and 24 hours. And the second was in the use of thrombolysis as an adjunct local treatment in patients receiving thrombectomy. So Seemant, to the best of your ability in our brief snippet today, what were the main highlights from these studies? Dr. Seemant Chaturvedi: In the OPTION trial, 570 patients were enrolled from China, and these were patients in the four and a half to 24 hour window with no evidence of large vessel occlusion. And they had a mismatch present at baseline imaging, median NIH score was seven. And when the tenecteplase was administered in this select group of patients, there was improvement in the excellent outcome of about 44% with tenecteplase and 34% with placebo. And there was a slight increase in hemorrhage of about 3%, but no increase in mortality. The second trial, CHOICE-2, also looked at thrombolysis, but it looked at local intraarterial thrombolysis following thrombectomy. And they enrolled patients with a median NIH score of 15 and the patients were enrolled from Spain and they gave a local TPA versus placebo following successful thrombectomy. And they also reported improved outcomes with about 57.5 having an excellent outcome with intraarterial TPA compared to 43% with placebo. There was slightly increased mortality in the TPA group, but this didn't seem to be explained by intracerebral hemorrhage. And so I think both of these were very intriguing and they add some complexity to acute stroke treatment. And so primary stroke centers and comprehensive stroke centers need to discuss the results with their teams and see if they want to embrace these treatment options. Dr. Andy Southerland: Fantastic, Seemant. So bottom line is thrombolysis is much more than it used to be in that very narrow time window and that very narrow indication. There are now patients who may benefit in that extended time window, and it's also being shown to have benefit in cases in which we get incomplete reperfusion with our traditional mechanical thrombectomy. So take that and run with it. Hopefully we can apply it to our stroke systems of care and help patients. Thank you again, Seemant for being with us on today's Neurology Minute. Seek out the full interview and also the primary publications as well.
In this episode of Head, Heart, and Boots, we sit down with Johnny Gabe for a raw and deeply personal conversation about redemption, reinvention, and what real leadership transformation looks like over time. Johnny shares his journey from growing up in a violent environment in Philadelphia, surviving being shot at fourteen, and carrying that trauma into adulthood, to building multiple successful home service companies grounded in culture, accountability, and service. We unpack the early years of his construction and restoration businesses, the ceiling he kept hitting, and the pivotal decision to launch a 1-Tom Plumber franchise that changed the trajectory of his growth. Johnny opens up about nearly losing his marriage, battling crippling anxiety and panic attacks, and the hard internal work required to become a steadier husband, father, and leader. The conversation dives into culture meetings, mentorship inside the company, hiring for character over experience, and Johnny's long-term vision to build a trades-based training pipeline that gives young people a different path forward. This is not just a business growth story. It is a story about confronting your past, doing the work to change, and building something meaningful enough to impact the next generation. Hope you enjoy. Chris Why You Should Listen [00:05:54] How Johnny broke through the million-dollar ceiling in restoration and what finally changed when he embraced coaching and accountability [00:08:34] The plumbing catalyst story that exposed a massive opportunity gap and led to launching a One-Tom Plumber franchise [00:24:22] A raw look at battling severe anxiety, panic attacks, and nearly losing everything before rebuilding from the inside out [00:31:36] How surviving violence at fourteen shaped his early leadership style and the transformation that followed years later [00:45:20] Why culture meetings, mentorship, and hiring for character over experience are now the backbone of his company's explosive growth Did you know... Only 30% of businesses listed for sale actually find a buyer? Even more striking, just 10% of those sell for the price their owners anticipated or higher, meaning only 3% of all business owners achieve their desired sale price. By focusing on understanding and enhancing your enterprise value, you can significantly boost your chances of joining that successful 3%. Business Health & Value Assessment Start Assessment Know Your Enterprise Value. See Your Potential Gaps. Complete this assessment in less than 15 minutes and receive a free assessment for your business that includes: A Lite Valuation Of Your Business Your Value Multiplier Per Your Industry Health Assessment Per Our PYB Methodology Business Value & Growth Roadmap Tailored For You Value Acceleration Strategies Spotlight on Floodlight: Your Secret Weapon for Sales & Scaling This isn't a paid plug. It's real talk from the front lines. If you've ever thought, “How do I get a VP-level sales leader or even a sales team without hiring full-time?” Floodlight has the answer. Fractional Sales Leadership They act as your outsourced VP of Sales, taking full responsibility for training, managing, and growing your sales team. No six-figure hire needed. Clients often close 20 to 50 percent more deals within six months, thanks to data-driven coaching, CRM setup, scripts, and performance reviews. More at floodlightgrp.com/sales Commercial Sales MasterCourse A self-paced, video-driven B2B sales course designed specifically for restoration teams. Perfect for building commercial revenue and getting free from TPA handcuffs. ● Covers mindset, prospecting, pipeline building, LinkedIn lead generation, and includes a $250 discount with code SALESBOOST. Details at floodlightgrp.com/courses Tailored Consulting & Coaching Floodlight's Propel Your Business methodology offers a full-circle roadmap: financials, sales, marketing, leadership, recruiting, productivity. All built for contractors. These aren't “life coaches.” They're former restoration owners who've lived the chaos and know how to scale out of it. Explore more at floodlightgrp.com Live Training, Tools & Strategic Partnerships Floodlight also delivers live onsite and virtual training, keynote speaking, and leadership tracks covering operations, project management, and strategic growth. Bonus: They've vetted tools like Xcelerate, Liftify, and Sureti. Floodlight clients get access to exclusive discounts on tech that actually moves the needle. See all partnerships at floodlightgrp.com/partners Why it matters for you as a listener You don't need to figure this stuff out alone. If you're serious about sales growth, operational clarity, exit readiness, or leadership development, Floodlight is already helping folks like you scale smarter. And you get it from industry insiders. People who've sat in your chair, survived the fires, and built systems that actually work.
Stephen Gilmore is the Chief Investment Officer of CalPERS, which at $600 billion is the largest public pension fund in the U.S. and one of the largest institutional pools of capital in the world. Stephen joined CalPERS eighteen months ago from a career spanning Wall Street, the IMF, and two of the most innovative sovereign wealth funds, where he was Chief Investment Strategist at Australia Future Fund and CIO at New Zealand Super Fund. Our conversation dives into the theory and implementation of the Total Portfolio Approach, drawing on Stephen's experience at Australia and New Zealand, and his plans for CalPERS. We cover the TPA mindset, its fostering of sound governance and accountability, comparisons to Strategic Asset Allocation, challenges of implementation, and the adaptation of the model at CalPERS. Stephen is one of the most experienced practitioners of TPA in the world. Our discussion pairs well with my recent conversation with Ashby Monk, as more allocators learn and consider this approach to managing assets. Learn more about our Strategic Investments: Thema. Learn More Follow Ted on Twitter at @tseides or LinkedIn Subscribe to the mailing list Access Transcript with Premium Membership Editing and post-production work for this episode was provided by The Podcast Consultant (https://thepodcastconsultant.com)
In Episode 498, host Stacey Richter converses with Mark Noel of ClaimInsight about the critical aspects of payment integrity within self-insured employers and plan sponsors, focusing on the arms race with revenue cycle management (RCM). The discussion reveals three main insights: the substantial impact of small claim errors, the inherent flaws and conflicts within prepayment analysis by TPAs, and the problematic financial incentives influencing claim processing. Noel emphasizes the importance of prepayment integrity for both plan savings and protecting members, underscoring the need for meticulous oversight and proactive management in payment processes. === LINKS ===
In part one of Red Eye Radio with Gary McNamara and Eric Harley, Minnesota and the cities of Minneapolis and St. Paul sued the Trump administration Monday, seeking to block a massive federal immigration enforcement surge they say has flooded the Twin Cities with armed agents, sparked fear and unrest, and interfered with state and local authorities, according to court filings. The lawsuit names Department of Homeland Security (DHS) Secretary Kristi Noem, top officials with DHS, U.S. Immigration and Customs Enforcement (ICE) and U.S. Customs and Border Protection (CBP), including Acting ICE Director Todd Lyons and Border Patrol Commander Gregory Bovino, along with the federal agencies themselves. Also federal prosecutors open a surprise investigation into Fed Chair Jerome Powell, audio from CNN on what law enforcement officials knew about the Portland shooting involving TPA gang members, and how the left seems to want violence. For more talk on the issues that matter to you, listen on radio stations across America Monday-Friday 12am-5am CT (1am-6am ET and 10pm-3am PT), download the RED EYE RADIO SHOW app, asking your smart speaker, or listening at RedEyeRadioShow.com. Learn more about your ad choices. Visit podcastchoices.com/adchoices
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