Profits

Ep #58: Price and Quality Transparency In Action – With Dr. Keith Smith

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Dr. Keith Smith believes that health care pricing in the United States is “a scam” that he was determined to change. Continuing with our 2-part series on transparency, we thought it would be interesting to talk to someone who has a few years’ experience in taking transparency and is putting it into effect.  Keith is the medical director and managing partner of the Surgery Center of Oklahoma.

While working in big hospitals for 7 years, Keith witnessed the quality of medical care sinking and the prices rising. This inspired Keith and his business partner to start a private practice with a difference: they would post their prices and outcomes for everyone to see. To remain true to their pricing, they decided they could not deal with government programs. They are firm in their belief that the only way to move to a real free market is to be completely transparent and provide better care and outcomes than big box hospitals, and to do it for a fraction of the price.

We asked Keith about his journey as well as the challenges he and his partner had to overcome along the way. We also explore the disruptive consequences that his transparency is having across the country, leading patients (who bid for their non-emergent surgical care) to Oklahoma.

What You’ll Learn From This Episode:

  • Keith’s journey to starting his transparent pricing surgery center.
  • How Keith and his partner began pricing their medical services.
  • Why he believes current pricing is a scam.
  • The farce of hospital’s non-profit status
  • The disruptive effect of posting his prices.
  • What the Free Market Medical Association is.

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Ep #57: Can Transparency Change the U.S. Healthcare System? – With Ralph Weber

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Perhaps more than any other single topic, transparency has the potential to be transformational to every aspect of health and health insurance. With that in mind, we are doing our first ever 2-part episode.

This week, on part one, we’re excited to welcome Ralph Weber, President and CEO of MediBid. Ralph is a passionate subject matter expert and serves as a member of NAHU’s Healthcare Cost and Quality Transparency Workgroup. We explore his belief that the current pricing schemes withhold information by design and why Millennials (in particular) will not accept the status quo on transparency.

Ralph shares his perspective about the effects transparency has on the U.S. healthcare system, the marketplace, and the competitive environment, and why transparency alone is not enough to effect the needed changes. We also learn why some hospitals charge more for the same type of treatment than others as we discuss the differences between static and dynamic pricing.

What You’ll Learn From This Episode:

  • Ralph’s journey.
  • The difference between “dynamic” and “static” pricing.
  • How Ralph defines transparency.
  • Whether the most expensive care is the best care.
  • What Ralph sees happening in the future around the issue of transparency.

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Ep #56: How to Mitigate Your Clients’ Pharmacy Costs – With Tery Baskin

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We’ve waited a long time to find exactly the right person to talk to about the ever-increasing portion of our overall spend – pharmacy. Our today’s guest, Tery Baskin, founder, president and CEO of RxResults has been in the pharmacy field for over 30 years.  He’s owned 3 community pharmacies, worked in a tertiary care hospital before he got involved in the managed care side of things.

Today, Tery joins us to talk about the driving factors behind pharmacy costs and what we can do to help bring those costs down. We discuss how reference pricing can help guide employees toward optimal choices of medicine that cost less, but essentially do the same thing. Terry also shares how benefits advisors can design better plans and advise their clients, as well as how specialty pharmacies and genetically-engineered drugs are affecting the current market. Don’t miss this value-packed episode!

What You’ll Learn From This Episode:

  • Tery’s journey.
  • How “Evidence Based Pharmacy Benefits Risk Management” can help keep your costs down.
  • Whether that affects payers, members or both.
  • What  “Medication Therapy Management” (MTM) is.
  • How specialty meds are affecting the market
  • The intricacies of Genetically-engineered drugs.

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Ep #55: Shifting from Commissions to Fees – With Mike Grinnell and Kirsten Tudman

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Commission compression is causing advisors to rethink their business model – especially looking a few years out. One option is to shift to a more consultative fee-based motif. Our guests, Mike Grinnell and Kirsten Tudman of CPI-HR, are among the handful of advisors at the forefront of this shift.

They join us today to discuss the impetus for the change as well as some lessons learned along the way. They also take us through what the employer conversation sounds like and what kind of questions and objections advisors can expect. We also explore some of the current state regulatory barriers and how those might change. Listen in to learn more and to kickstart the fee-based discussion in your practice or agency.

What You’ll Learn From This Episode:

  • Mike and Kristen’s background as traditional commission-based producers.
  • Their “Aha!” moment.
  • How ACA affected their practice.
  • Their typical client.
  • Whether the shift to fees work with all clients.
  • How the state statutes and regulations play in the process.
  • Whether they have a written agreement and what is included.

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Ep #54: How to Have a Self-Funding Conversation with Employers – With Adam Russo

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In this episode, we explore some of the most common questions advisors ask about self funding and discuss concerns ranging from minimum group size to tools and techniques. Our guest on this episode of ShiftShapers is Adam Russo, Esq., co-founder and CEO of The Phia Group, as well as the founding and managing partner at a law firm, Russo & Minchoff. He believes that, in light of the healthcare reform, the current environment is full of exciting opportunities that many brokers can take advantage of.

We also have a frank exchange about what is behind recent efforts by some Departments of Insurance to try to put the brakes on certain segments of self funding and the potential impact that may have on employers seeking an alternate to the fully insured marketplace.

What You’ll Learn From This Episode:

  • Adam’s journey and how The Phia Group came about.
  • How advisors can remain relevant in the current environment.
  • The minimum size for a successful self-funded group.
  • Why the government wants to stop or severely limit self-funding.
  • How can advisors begin the self-funded conversation.
  • What you need to devise a properly constructed client plan.

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Ep #53: Reinventing the Sales Cycle – With Matthew Wood

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Our guest this week believes that to it is time to reinvent the sales cycle. If we look at the employee benefits distribution process over the past fifty years, we’ll discover that it has not changed much and is still very manual, inefficient, and time consuming.

Matthew Wood, VP of Sales & Technology at Lidac, believes that technology and an end-to-end managed sales cycle is the answer for advisors who are being asked to do more with less.  On this program we explore the opportunities presented when the process is completely reimagined.

What You’ll Learn From This Episode:

  • Whether the traditional product-to-sale model is obsolete.
  • How technology can help with the sales cycle.
  • Post enrollment considerations.
  • Whether this is a new motif for core medical or just for voluntary benefits.
  • If the total cycle can be shrunk to a few days.

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Ep #52: Using Innovative Solutions to Contol Costs – With Christopher Fisher

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In today’s market, employers expect their benefit advisors to bring them new ideas to control costs. Our today’s guest, Christopher Fisher, Founder & President of BenefitsAlly, finds companies that are doing unique things that can take employers beyond the traditional method of increased employee responsibility.

We discuss the three hallmarks of “intelligent health care solutions”. Chris believes that advisors who use those ideas and come up with creative solutions are going to thrive, and those who continue on the same old path will soon fade away.

Our conversation also explores new ways that benefits advisors can leverage historical data and make strategic recommendations to reduce future costs. Since this is a new conversation for many advisors we talk about how to broach that discussion with employers and how to provide them with concrete solutions based on the analysis of that detailed, granular data.

What You’ll Learn From This Episode:

  • Whether or not cost shifting is a dead strategy for dealing with employer spend.
  • What “intelligent health care solutions” are.
  • How billions in venture capital will change tools in our markets.
  • The 3-step process for evaluating employers’ benefits.
  • How we can transition from a rear-view mirror use of data.
  • How to help employers use cost data at the employee level.

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Ep #51: Mastering the ACA Compliance and Regulatory Maze – With Arthur Tacchino

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ACA and its blizzard of ever-changing regulations has created a challenging environment for even the most proficient advisors. We asked Arthur Tacchino, Chief Innovation Officer & Principal of Sync-Stream Solutions, to discuss those challenges and to examine some of the ways advisors can master and profit from providing their clients with expert and timely advice.

Arthur is a lawyer by education and also serves as an assistant professor of health insurance at The American College. His concentration has been highly focused on this area of practice and has made him one of the leading subject matter experts on this ever-changing area.

In addition to discussing the compliance process, we also learn about the three phases of the process at the client level: analysis and modeling; decision making and documentation, and implementation and monitoring. Don’t miss this informative discussion that will give you some insight on how to operate in today’s evolving marketplace and help you prepare yourself and your clients in case of an audit.

What You’ll Learn From This Episode:

  • How Arthur went from a J.D. to Health Insurance.
  • The unique challenges ACA has created.
  • Supporting client discussions.
  • The three phases of compliance.
  • The impact and imprint of ERISA in ACA.

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Ep #50: Is Reference Based Pricing The Future of Sustainable Health Plans? – With Ryan Day

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Healthcare costs are rising and as we discussed in episode 48, most employers are still using cost shifting as a hedge. Ryan Day, our guest in this episode, believes that a better – and more sustainable – solution is Reference Based Pricing (RBP).  We discuss the growing interest in reference based pricing and how it can put a serious dent in health care costs in the post-ACA environment.

Ryan is the President of H.S. Technology, and a subject matter expert in reference based pricing. We begin with the basics and then explore how this methodology fits in with today’s plans, who it is for, and how advisors can discuss it with clients.

What You’ll Learn From This Episode:

  • The problem with traditional pricing.
  • What RBP is.
  • Whether all constituencies need to collaborate to make RBP work.
  • Whether RBP is currently a carrier or self-funded tool.
  • The challenges of RBP.
  • The impact of CMS’ data release.

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Ep #49: The Intersection of Property & Casualty and Employee Benefits – With Frank Pennachio

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Today, we discuss the crossover between the often separate worlds of property and casualty and employee benefits. Our guest Frank Pennachio is partner & co-founder of Oceanus Partners. Frank believes that the overlap in these two areas provides some challenges for employers and opportunities for advisors who can bridge the gap.

In this wide-ranging discussion, we begin by exploring workers compand they key for advisors to understand how to maintain eligibility during a claim. We also cover other federal laws such as FMLA, and how advisors can help to identify significant and completely avoidable risk to clients.

We also talk about the new discoveries in neuroscience and how they relate to the ability of advisors to create new sales channels and the strategies to fully profit from them.

What You’ll Learn From This Episode:

  • The crossover areas between property & casualty and employee benefits.
  • Significant and avoidable risks and threats faced by employers
  • The role of neuroscience in sales.
  • New disruptive sales channels.
  • Why ACA is not the driver of change.

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