Are you struggling to navigate the complex world of gag clause attestation requirements? In this must-watch episode of Shift Shapers, Jennifer Berman, JD, CEO of MZQ Consulting, provides a comprehensive breakdown of everything plan sponsors and advisors need to know about these critical compliance requirements.From the Consolidated Appropriations Act of 2021 to today's implementation challenges, discover how these regulations are reshaping healthcare plan transparency. Jennifer explains why many contracts still contain illegal gag clauses in 2024 and what this means for your organization. Learn about the crucial differences between fully-insured and self-funded plans, and how these differences impact your compliance obligations.Key topics covered:Detailed explanation of gag clauses and their impact on healthcare plansStep-by-step guide to annual CMS attestation requirementsUnderstanding potential penalties and enforcement mechanismsNavigation of the HIOS system reporting processCritical differences between fully-insured vs. self-funded plan requirementsPractical strategies for verifying gag clause complianceTips for accessing and utilizing plan data effectivelyReal-world challenges in contract review and complianceThis episode delivers essential insights for anyone involved in healthcare plan administration and compliance. Whether you're managing benefits for your organization, advising clients on their healthcare plans, or ensuring regulatory compliance, you'll gain valuable knowledge about navigating these complex requirements. Jennifer's expertise provides actionable guidance for insurance professionals, consultants, and organizational leaders who need to understand and implement these critical transparency regulations.In This Episode00:00 Introduction to Gag Clause Attestation00:45 Understanding Gag Clauses01:39 Legal Requirements and Compliance03:00 Challenges and Real-World Implications04:58 Access to Plan Data and Its Importance07:11 Reporting and Documentation07:33 Understanding Certification and Penalties10:02 Annual Reporting Requirements10:18 Advisor's Role in Compliance10:40 Self-Funded vs Fully Insured Plans13:03 Ensuring No Gag Clauses13:20 Final Thoughts and Key Takeaways14:39 Conclusion and Farewell

Unlocking Post Claim Adjudication: Insights with Jordan HershIn this episode of ShiftShapers, host David explores the complex world of post claim adjudication with Jordan Hersh, Vice President of Enterprise Solutions at Vālenz. They discuss the intricacies of self-funded plans, reference-based pricing, and the potential savings associated with renegotiating out-of-network claims. The conversation delves into high performance networks, the inverse relationship between cost and quality in healthcare, and methods for improving transparency and cost containment. Learn about the strategies that can lead to significant cost savings while maintaining high-quality care.In This Episode:00:00 Introduction to Post Claim Adjudication00:34 Meet Jordan Hirsch from Vālenz01:29 Understanding Post Claim Work02:13 Reference Based Pricing: Pros and Cons03:55 Narrow Networks vs High Performance Networks08:14 Out of Network Claims and Cost Containment15:23 Transparency in Medical Care Costs and Quality17:18 Incentives for Care Coordination18:28 Wrapping Up: Savings and Final ThoughtsQuotes:“Readmission rates, complication rates, mortality rates, we’re taking that into account and making sure that when people do people stay in-network or go to the panel of those high-performance network partners, they’re getting top tier coverage.”“Depending on the primary PPO network regardless of broad network or network of concise nature, there’s going to be out-of-network medical claims. And that can cost self-funded plans a lot of money if it’s not managed correctly.”“Some plans we’ve seen pay out-of-network claims at full bill charges, some take a usual customary approach. Having a much more direct and aggressive approach can really be a game-changer for self-funded plans and materially impact the bottom line.”“So being able to achieve a discount, that can also assure them that they’re going to be paid and have a little bit more clarity on how the member responsibly can be split up. Oftentimes we see self-funded plans offering some type of incentive.”“So a plan with a medical spend with a million dollars, implementing these types of tools into the right education training to the members, could reduce their overall medical spend by about 25%.”

What if technology could bridge the gap in healthcare access for underserved communities? Join us on this episode of ShiftShapers as we explore the intersection of healthcare technology and underserved communities with Kornelius Bankston, Managing Partner at TechPlug. Discover how innovative solutions are being tailored to meet the unique challenges faced by marginalized populations. Learn about the role of economic factors, geographical disparities, and the historical context affecting these communities, and see how grassroots efforts and collaborations with local health departments are paving the way for better healthcare access. Dive into the specifics of projects like SensorMed, which offer remote patient monitoring and other tech-based health solutions, and understand the foundational work that TechPlug is doing to bridge gaps in healthcare through specialized tech incubation.We'll explore the real-world challenges faced by marginalized populations, such as transportation hurdles, prescription adherence, and food security, and how innovative solutions like remote patient monitoring are making a difference. Using New Orleans as a case study,Kornelius reveals how TechPlug collaborates with local health departments to assess and meet community needs effectively.As we journey through TechPlug's early initiatives, Kornelius shares insights from his diverse career path, from aspiring physician to biotech recruiter and beyond. Learn about the grassroots efforts crucial for educating communities on healthcare technology and the challenges of building trust around data security. Cornelius's unique perspective underscores the importance of continuous innovation tailored to diverse populations' needs. Don't miss this thought-provoking conversation on making healthcare accessible for everyone.Key Moments In this Episode:“We identify an ambassador in a city, and typically it’s the department of health, to partner with to bring these innovative solutions to the community.” “As opposed to developing solutions in a vacuum, we’re able to bring real data, real time, quantitative and qualitative information back to the companies within our portfolio so they can provide the best possible solution to these populations.”“I really don’t think a lot of companies that have innovative health solutions are really conscientiously having their innovation addressing the population.”“There’s a lot of distrust within the healthcare system.”“In tech, there’s this whole idea around privacy and data security and a lot of populations of underserved and marginalized communities really don’t understand where the data is going and who’s keeping data and how they get empowered by the data.”00:00 Introduction to Healthcare Technology for Underserved Populations01:52 Understanding Underserved and Marginalized Communities03:02 Challenges Faced by Underserved Populations04:55 Innovative Solutions and Technology in Healthcare05:48 Community Assessment and Partnerships09:57 The Role of TechPlug in Healthcare Innovation14:37 Building Trust and Overcoming Skepticism16:11 Future Prospects and Challenges in Healthcare Technology18:43 Addressing Privacy and Data Security Concerns20:07 Conclusion and Acknowledgments

In this episode of the ShiftShapers Podcast, host David Saltzman chats with Marissa Rufo, JD, MBA, a subject matter expert from MZQ Consulting, to demystify the complexities surrounding Medicare Creditable Coverage. They discuss why it's significant for employers and employees alike, particularly in light of recent legislative changes and the growing number of older employees in the workforce. The conversation addresses compliance requirements, methods for determining creditable coverage, and practical steps employers need to take to avoid penalties and lawsuits.Medicare creditable coverage is a requirement for group health plans to be comparable to an average Medicare Part D plan. The consternation and confusion around creditable coverage has increased due to recent changes in legislation and the growing number of Medicare-eligible individuals still working full-time. Employers have a fiduciary duty to ensure compliance with creditable coverage requirements, as failure to do so can result in lawsuits and penalties. While employers are not required to have actual creditable coverage, they must determine the creditability of their prescription drug plans, provide notices to Medicare-eligible employees, and report their credibility status to CMS annually. Failure to provide accurate notices can result in financial costs and penalties for employees. There are two methods for calculating creditable coverage: the simplified determination method and the actuarial analysis method. Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals. MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.TakeawaysMedicare creditable coverage is a requirement for group health plans, comparable to an average Medicare Part D plan.Employers have a fiduciary duty to ensure compliance with creditable coverage requirements.Failure to provide accurate notices can result in financial costs and penalties for employees.Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals.MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.

In this episode of Shift Shapers, host David Saltzman sits down with Alycia Riedl, the new National President of NABIP, to discuss the future of the healthcare advisory industry. Alycia  shares her personal journey from reluctance to passion in the industry, following the legacy of her innovative father. They explore key issues on NABIP's radar, such as transparency, technology, and advocacy against single-payer systems. Alycia emphasizes the importance of evolving the role of advisors and her vision for a consumer-centered healthcare system. Additionally, they address leadership values and the strategic goals of NABIP for the coming years. Tune in to learn about the upcoming developments and strategic initiatives aimed at supporting healthcare advisors and improving the overall healthcare landscape.Key Takeaways From This interview:Career Journey: Alycia Riedl’s unexpected path to the insurance industry fueled by a passion for helping others.Innovation and Adaptability: The importance of continuous improvement and innovation in the insurance industry.Consumer-Centered Healthcare: NABIP’s commitment to a transparent, consumer-focused healthcare system.Advisor Challenges: Addressing the difficulties advisors face with restrictive laws and compensation issues.Leadership and Empathy: Reidl's emphasis on empathetic, data-driven leadership that supports team well-being.

The focus of this week's episode is on how modern healthcare system innovations utilize throwback TPA. Bob McCollins, vice president of sales at Edison Health Solutions, explains what’s happening in the TPA industry today and how a throwback TPA can help combine all the fantastic solutions out there to provide top-notch services.What You’ll Learn From This Episode:2:34 What throwback TPA means and how it works with current healthcare systems.4:35 Keeping all of the various solutions together for the benefit of clients and potential clients.7:57 TPAs need to be adaptable or focused on a single path in order to provide best-in-class services.11:10 Changes to offerings and support in reference-based pricing.14:48 Tasks they outsource to third parties.16:39 Factors affecting claims' automatic adjudication.20:35 TPA in the coming years.This episode originally aired September 26, 2022

This week's episode delves into the world of pharmacogenomics (PGx) and how it is changing the way we approach medication management. We sit down with a leading expert in the field to discuss the current state of PGx adoption, the challenges it faces in gaining wider acceptance in the medical community, and the potential impact it could have on our healthcare system in the future. From the role of direct-to-consumer testing to the importance of involving clinicians in the decision-making process, we explore the complexities of this emerging field and what it could mean for patient care. Join us for this informative and thought-provoking conversation on the cutting edge of personalized medicine.What You’ll Learn From This Episode:1:54 Overmedication: A systemic problem in healthcare.4:16 The evolution and future of pharmacogenetics (PGx) as a standard of care.12:44 Implementing pharmacogenomics testing in employer healthcare plans: Overcoming adoption challenges and practical applications.14:51 The adoption curve of pharmacogenomics testing in healthcare: A bottom-up mission.17:34 The future of PGx: Adoption by early adopters and the role of payers.This Episode Originally Aired March 13, 2023

In this episode of ShiftShapers, host David Saltzman discusses the recent Supreme Court decision to overturn the 40-year Chevron Deferment precedent and its implications for advisors and their clients. Joined by Jennifer Berman, ERISA attorney Jennifer Berman, the NABIP (National Association of Benefit Insurance Professionals) Legislative Vice Chair and CEO of MZQ Consulting, the discussion explores the decision's potential long-term effects on federal regulations and compliance in the healthcare sector. They delve into how this ruling shifts the responsibility from federal agencies to the judiciary in interpreting ambiguous statutes and assess the impact on specific regulations like compensation disclosures under the Consolidated Appropriations Act. Berman emphasizes to advisors and employers the importance of maintaining fiduciary duties and regulatory compliance while staying informed about future changes.More from MZQ ConsultingKey Takeaways:SCOTUS Decision Impact: The Supreme Court recently overturned the Chevron Deferment, shifting the power of interpreting ambiguous federal statutes from federal agencies to the judiciary. This major change may lead to increased challenges to existing regulations.Immediate Effects on Law: Currently, the ruling doesn't change existing laws or regulations. However, advisors should anticipate more court challenges to federal regulations based on ambiguities in the underlying statutes.Advisors' Immediate Actions: Advisors should communicate to their clients that no immediate changes are necessary. They should continue to follow current laws and regulations and focus on fulfilling their fiduciary duties.Potential Healthcare Changes: Specific areas in healthcare, such as compensation disclosures and mental health parity, may become more contentious and face judicial challenges. However, statutory requirements like HIPAA, COBRA, and ACA reporting remain intact.Need for Robust Fiduciary Processes: Advisors should emphasize the importance of maintaining documented fiduciary processes, including setting up committees, meeting regularly, and properly documenting actions to demonstrate compliance and best efforts.

In this episode of the ShiftShapers Podcast, host David Saltzman chats with Ashley Reid, founder and CEO of Wellist, to explore how companies can better connect employees to vital health and well-being resources. Reid discusses her transition from a marketing career to corporate strategy and the inception of Wellist. Driven by personal experiences with cancer care, she sheds light on the current challenges employers face in meeting wellness needs and how Wellist's Precision Resource Matching Platform uses AI to address these issues. They delve into practical examples, the financial impact of optimized benefits, and the importance of whole-person support. Reid shares how actionable data can help employers make informed decisions, and also the future aspirations for Wellist to become a standard support system across diverse industries.Key TakeawaysOrganizations are increasingly focusing on connecting employees to the right wellness resources and benefits at the right time to boost overall well-being and engagement.The use of AI and data-driven platforms is transforming the employee benefits industry by providing personalized and efficient access to support resources.Employers can optimize their health benefits investments by leveraging data analytics to identify redundancies and gaps in their current offerings.Comprehensive employee support addressing a wide range of needs, including mental health and daily living aids, is becoming essential for maintaining workplace productivity and employee satisfaction.There is a growing trend toward standardizing integrated support systems to ensure employees can easily access the health and wellness assistance they need, particularly during critical life events.

In this episode of the ShiftShapers Podcast, host David Saltzman engages in a deep conversation with Matt Loper, CEO and co-founder of Wellth. They explore how healthcare plans can leverage behavioral economics to achieve better outcomes. Loper recounts his journey from aspiring biotechnologist to a leader in healthcare technology, emphasizing his efforts to increase patient engagement and improve health outcomes by using behavioral science and technology. The insightful discussion for business leaders also focuses on the core issues Wellth aims to solve, the importance of daily member engagement, and the need for consistent, trust-based relationships to drive better health behaviors and quality metrics. Loper shares insights on the methodologies employed, including targeted outreach and personalized communication strategies. He also touches on the future goals and expansions of Wellth.Key Takeaways:Innovative Problem-Solving: Embracing behavioral economics offers innovative solutions to longstanding healthcare engagement challenges.Engagement is Key: Recognizing the engagement gap in healthcare underscores the importance of leveraging behavioral science and technology for patient involvement.Personalized Approaches Matter: Tailored communication and daily engagement strategies prove essential for nurturing healthier behaviors and improving overall healthcare outcomes.Financial Benefits of Engagement: Quantifying the financial impact of behavioral interventions highlights significant cost-saving opportunities for healthcare providers.Trust and Expansion Drive Success: Building trust-based relationships and expanding services are crucial components of achieving long-term success in healthcare innovation.From from Wellth: https://www.wellthapp.com/

In this episode of the ShiftShapers podcast, host David Saltzman welcomes Stephen Sokoler, founder and CEO of Journey, to discuss the importance of mental health care in the workplace. Stephen shares his personal journey, from entrepreneurial beginnings to discovering meditation and ultimately founding Journey in 2015. They delve into pressing mental health challenges including stigma, therapist shortages, and the inefficiency of traditional EAPs. Stephen outlines Journey's proactive and inclusive approach to mental health care, emphasizing the importance of early intervention, awareness, and cultural competency. Tune in to learn how Journey is making mental health care more accessible and effective, and boosting EAP utilization through innovative strategies.Key Takeaways:Daily Integration: Embedding mental health resources in workplace tools like Slack improves accessibility.Cultural Competency: Providing multilingual and culturally relevant content ensures effective support.Confidentiality: Strong privacy measures are crucial for employee trust and usage of mental health services.Thorough Evaluation: Comprehensive assessments help tailor support to individual needs.Awareness: Increasing awareness and reducing stigma around mental health resources is vital.More From Journey

In this episode of the ShiftShapers podcast, we're joined by Daniel Cobb, Vice President of Sales and Strategy at Strategic Benefit Resources, to discuss the evolving landscape of Stop Loss Self Funding and the tech and data solutions supporting it. Cobb shares his journey from the mortgage business to insurance, emphasizing the significant changes and opportunities in self-funded health benefits plans. We discuss how the expansion of self-funded plans is now reaching groups as small as 25 employees. Cobb also explains the role of artificial intelligence in pricing stop loss, as well as the increasing demand for transparency and flexibility in health benefits management. Cobb also offers insights into how advisors can help clients transition to self-funding, the importance of understanding client needs, and other future trends in the industry. Business owners and executives - from large and small firms alike - stand to benefit from the important insights in this business podcast. Key Takeaways:The expansion of self-funded health plans now includes smaller groups, with as few as 25 employees participating.Artificial intelligence and advanced data tools are crucial in pricing stop loss and expanding self-funded health plans to smaller groups.Advisors need to understand whether their clients are savings buyers or quality buyers to effectively present self-funding options.Transparency and access to first-dollar claims data are key benefits of self-funding, allowing for better management of healthcare costs.The future of self-funding involves greater access to data, regional variations in plan management, and continued evolution of high-performance health plans.Strategic Benefit Resources: https://www.strategicbenefitresources.com/Thank you for tuning into this insightful episode of Shift Shapers. If you enjoyed our conversation with Daniel Cobb, please rate, follow, share and review our podcast. Stay tuned for more episodes where we explore the latest trends and innovations in the health benefits industry.

In this episode of the ShiftShapers podcast, host David Saltzman welcomes Steven Amiel, CMO at NextGen Benefits, to explore why marketing has become more challenging, costly and less effective in terms of ROI than ever before. They delve into the new regulations on tracking and targeting prospects, discussing how the move toward double opt-ins has changed the landscape of data collection. The importance of authentic communication is highlighted through real-world examples, emphasizing why marketing messages need to be genuine and aligned with personal branding. They also discuss the pitfalls of overextending marketing efforts, particularly on platforms like LinkedIn, and the need to focus on conversions rather than likes or opens. Steven provides insights on the shift from mass advertising to an account-based marketing approach and the crucial role of first-party data in effective marketing. He addresses how different strategies apply to small versus large companies and emphasizes the importance of building executive credibility and personalized engagement in sales. Steven also talks about future marketing trends, including interactive webinars and storytelling, as key strategies for 2024 and beyond.Key Takeaways:1. Government regulations have changed how health benefits marketers can track and target prospects, emphasizing the need for authentic communication.=2. Authenticity is crucial in marketing communication to establish a personal connection and engage prospects effectively.3. Emphasize conversions over likes or opens to drive meaningful results in marketing efforts.4. Shift toward building first-party data through engaging strategies and personalized interactions to improve deliverability and lead quality.5. Focus on differentiating yourself by understanding prospects, establishing executive credibility, and aligning messages with the target audience for successful marketing campaigns.More from NextGen Benefits: https://www.nextgenbenefits.com/

This episode of the ShiftShapers Podcast features a discussion with David Mordo, Senior Compliance Officer at MZQ Consulting, focusing on essential legislative and regulatory knowledge advisors need to possess, especially pertaining to offering health benefit packages. The conversation highlights the recent FTC ruling on non-compete clauses, emphasizing its potential impact on employers and the broader implications for your workplace. Mordo and our host David Saltzman also delve into a pressing lawsuit against Johnson & Johnson related to fiduciary duties and prescription drug pricing, forecasting a rise in similar legal challenges. Furthermore, the interview underscores the importance of advisors understanding their role in ensuring employer clients comply with fiduciary responsibilities, especially in relation to employee health plans and benefits to meet complex compliance regulations.Key Takeaways from the episode of the ShiftShapers Podcast:The Federal Trade Commission banned non-compete clauses, aiming to boost employee wages and opportunities.Lawsuits over fiduciary responsibilities in benefit plans are increasing, underscoring the importance of acting in employees' best interests.Advisors are pivotal in educating employers on fiduciary duties and compliance to navigate benefit complexities.Compliance professionals help translate regulations for brokers and employers to ensure adherence to regulations and to avoid risks.Fiduciary care under ERISA is crucial for all employers to comply with regulations and protect employees.https://www.mzqconsulting.com/

In this episode of ShiftShapers, host David Saltzman invites David Mordo, Senior Compliance Officer at MZQ Consulting, to discuss the intricacies of prescription drug reporting (RxDC) as mandated by the Consolidated Appropriations Act of 2021. The conversation delves into the transparency requirements for employers regarding their prescription drug plans, encompassing the scope of reporting, deadlines, submission processes, and implications of non-compliance. With a focus on the pivotal role of employers, insurance carriers, third-party administrators (TPAs), and Pharmacy Benefit Managers (PBMs) in this process, the talk highlights the collaborative effort needed to ensure compliance. Mordo offers valuable insights are offered on how brokers and advisors can assist their clients in navigating the complexities of RxDC reporting, the selection of vendors for report preparation, and the importance of timely action to meet regulatory deadlines.Key Takeaways From This Episode:RxDC is part of the Consolidated Appropriations Act of 2021, requiring employers to provide prescription drug plan information.Employers have to comply with multiple reporting requirements related to prescription drug plans annually.Reports for 2024 regarding prescription drug plans are due on June 3rd.Employers are responsible for ensuring compliance with prescription reporting, even if they use TPAs or PBMs for assistance.Brokers need to ensure vendors for reporting have experience, are reasonably priced, and can deliver timely and accurate data.

Welcome to this episode of the ShiftShapers podcast, where we explore the journey of Donovan Ryckis, CEO of Ethos Benefits. Here, we discuss fiduciary responsibility in healthcare as Ryckis tell us the story of his personal evolution. From managing a Gold's Gym to working in securities advising, he ultimately established a flourishing healthcare agency. His narrative unveils the hurdles and triumphs encountered when transitioning from a commission-driven approach to fee-based consulting. Throughout our conversation, Ryckis underscores the pivotal role of fiduciary duty and transparency in cultivating client trust in the healthcare industry.Ryckis sheds light on the intricacies of reference-based pricing, highlighting its potential in managing healthcare expenses while acknowledging the accompanying need for heightened administration and employee communication. Moreover, he articulates how Ethos Benefits' commitment to ethical standards and delivering genuine value has been instrumental in its ascent. Business executives and other organizational leaders, we invite you to tune in to this episode of ShiftShapers and learn the importance of selecting a benefits vendor who acts with the healthcare recipients’ best interests at heart. After all, you deserve a healthy workforce that appreciates the best possible benefits..  Takeaways:Adopting a fee-based consultancy model and embracing fiduciary responsibilities are key for tailoring optimal healthcare solutions for clients.Embracing radical transparency, including commission disclosures, fosters candid dialogues and fortifies client relationships.Reference-based pricing emerges as a potent strategy for cost control in providing healthcare benefits, albeit requiring meticulous administration and communication efforts.Storytelling not only shapes agency culture, but also nurtures robust client connections.While the momentum behind fee-based models is palpable, the industry still grapples with the gradual acceptance of compensation disclosure.

In this episode of the ShiftShapers podcast, Jon Shooshani, co-founder of JOON, discusses the concept of lifestyle spending accounts (LSAs) and their impact on health and well-being. Shooshani shares his journey from being deeply interested in health and wellness to the founding of his company, JOON, which offers personalized wellness and lifestyle benefits for employees. LSAs are employer-funded accounts with flexible spending on well-being-related items and experiences. They may vary in name and structure across different companies. Shooshani explains the value of LSAs in promoting employee health, satisfaction and retention, while also covering practical aspects like budgeting, implementation and the unique features of JOON’s platform. The story concludes with a touching background on the company's name and vision to provide meaningful employee benefits. Throughout this podcast, business executives and owners, big and small, will receive expert insights on how to provide competitive benefits packages that serve their employees well.ShiftShaper Episode Takeaways- A lifestyle spending account (LSA) is an employer-funded fund that allows employees to spend on items and experiences that contribute to their well-being.- LSAs can be customized and flexible, offering a range of categories such as health and wellness, professional development, work-from-home purchases, and family care.- LSAs can have a positive impact on employee well-being and satisfaction, and can be used as a tool to attract and retain employees.- Employers can determine the amount and reset frequency of LSAs based on their budget and goals. LSAs can be administered and streamlined through platforms like JOON.

This episode of the ShiftShapers Podcast features host David Saltzman interviewing John Clay, president of Better Source Benefits, about unique health plan solutions for small and mid-sized groups. John shares his background in the insurance industry, highlighting the journey from working in materials control to discovering innovative health plan solutions. Despite challenges, such as a lack of options beyond traditional insurance providers, John discusses how attending conferences and learning from others in the industry transformed his approach to offering health plans. He emphasizes the importance of understanding the needs of smaller businesses and how custom, level-funded health plans can offer significant benefits. The conversation also delves into the future of health plans for small and mid-sized businesses and how creative solutions can positively impact employee health outcomes and financial security.

This episode of the ShiftShapers podcast features an interview with Yoona Kim, the CEO and co-founder of Arine, a company focusing on medication intelligence via AI to improve clinical and financial outcomes in healthcare. In this episode, Kim shares insights from a healthcare background into the challenges surrounding drug prescriptions including accessibility, cost, and the impact of incorrect or suboptimal medication on patient outcomes. Arine leverages large-scale data analysis to provide actionable recommendations, aiming to correct discrepancies in medication use, particularly in polypharmacy (multiple medication) cases. The technology not only promises to significantly reduce hospitalizations and overall healthcare costs within a short period, but also enhances patient adherence to prescribed medication regimes. Kim elaborates on the collaborative process with healthcare providers and insurers to implement these changes effectively, highlighting the potential for widespread improvement in healthcare management and outcomes.

In this episode of the ShiftShapers podcast, we explore the complex world of Pharmacy Benefit Managers (PBMs) and their impact on healthcare costs, sparked by the Johnson & Johnson lawsuit. Our guest, USRxCare President Renzo Luzzatti, with a 30-year healthcare background, discusses the Consolidated Appropriations Act of 2021, which is aimed at shifting power back to payers from vendors by enhancing transparency and fiduciary responsibilities. The episode sheds light on the lawsuit against J&J for excessive pharmaceutical payments through their PBM, Express Scripts, highlighting the issue of overpayment in the industry. Luzzatti emphasizes the necessity of fiduciary PBMs, devoid of conflicts of interest, and the importance of transparency and beneficiary interests. We also discuss how employers can strategically manage their pharmacy benefits to avoid overpayment and ensure compliance with fiduciary duties, emphasizing the role of advisers in navigating this complex territory. The conversation also touches on current trends and future outlooks for managing pharmacy benefits more effectively and ethically. Each of these insights are critical to business owners and other organizational leaders who must manage healthcare benefits to be cost-effective while providing for employee health needs.  USRxCare: https://usrxcare.com/

In this episode of the ShiftShapers podcast, David Sloves, CEO of Nonstop Health, discusses the evolution and impact of Medical Expense Reimbursement Plans (MERPs) in the healthcare industry. He explains how MERPs differ from traditional health reimbursement arrangements (HRAs), HSAs, and FSAs by offering first-dollar coverage and customizable financial outcomes for both employers and employees. Sloves outlines the historical context of MERPs, their tax benefits, and how they aim to address the skyrocketing costs of healthcare and improve access to medical services. The conversation also covers the challenges of implementing MERPs, their role in enhancing employee satisfaction, recruitment, and retention, and the broader implications for the healthcare system in the United States. Through anecdotes and data, Sloves makes a case for MERPs as an ethical and effective solution to the current healthcare crisis.We wrap up by celebrating the successes of mission-driven companies in the healthcare industry, specifically how they've introduced advanced healthcare programs to employers. David Slove recounts overcoming initial skepticism and the strategies that led to significant financial benefits for clients, thanks to the MERP model. As we close, we reflect on the cascading impact of such inclusive healthcare initiatives. These efforts aren't just reshaping employee benefits—they're empowering businesses, stimulating the consulting community, and fostering a culture of retention and recruitment excellence from the heart of conservative states to the broader national arena.

Bill Snyder, CEO of Vivante Health, discusses the importance of digestive health and its impact on healthcare spend. Digestive health issues like irritable bowel syndrome and GERD affect a significant portion of the population, leading to high claim spend and unnecessary utilization. The medical establishment is becoming more aware of these conditions, but diagnosis and treatment can still be challenging. Vivante Health aims to supplement traditional care with digital interventions to improve patient outcomes. By leveraging data and predictive modeling, Vivante Health can provide personalized care and identify trigger foods that cause inflammation. Snyder, with a background in healthcare and a personal connection to digestive disorders, highlights the widespread impact of conditions such as irritable bowel syndrome, ulcerative colitis, and GERD on individuals and healthcare spending. The discussion covers the lack of awareness, diagnosis challenges, and the potential of digital interventions to improve care. The importance of the gut-brain connection and its relation to stress, anxiety, and possibly Alzheimer's disease is also explored. Snyder shares insights into how Vivante Health is addressing these issues through pattern recognition, personalized care pathways, and dietary adjustments to manage symptoms, significantly improving patients' lives. The conversation also touches on the future of digestive health care, the role of data in advancing treatment, and Vivante Health's approach to integrating with the healthcare ecosystem.

Welcome to another insightful episode of ShiftShapers! Join host David Saltzman as he delves into a conversation with Maya Perl, the visionary co-founder of Zorro. Together, they unravel the intricacies of the Individual Contribution Health Reimbursement Arrangement (ICHRA) and its profound impact on both employers and employees.Discover how ICHRA empowers employers to revolutionize healthcare benefits by offering a defined contribution model, granting employees the autonomy to select tailored health plans that cater to their unique needs. Maya shares her inspiring journey in the healthcare realm, unveiling the genesis of Zorro and how their innovative platform, infused with AI prowess, simplifies plan selection, making healthcare more accessible and cost-effective than ever before.In this discussion, explore the unparalleled advantages of ICHRA, including substantial cost savings, enhanced flexibility, and a plethora of personalized healthcare options. Learn how Zorro's cutting-edge technology educates employees, streamlines allowance calculations, and facilitates seamless enrollment into ICHRA plans, irrespective of employer size or geographical boundaries.Join us as we uncover the transformative potential of ICHRA in reshaping the healthcare landscape, fostering higher retention rates, and paving the way for a healthier, more empowered workforce. Don't miss out on this enlightening exploration into the future of healthcare—tune in now and embark on a journey towards a healthier tomorrow!

On this episode of ShiftShapers, a podcast focused on the employee benefits industry, host David Saltzman discusses the secrets of business growth with Kevin Trokey and Wendy Keneipp from Q4 Intelligence. The ShiftShapers Podcast is brought to you by MZQ Consulting, offering concierge-level service for all your benefits compliance needs, and the agility to keep up with the changing landscape.In this enlightening discussion, Kevin and Wendy share their experiences and lessons learned which are also included in their book, “The Salesperson's Guide to Growing a Business.” The conversation touches on the importance of shifting from accidental to intentional business strategies, the role of marketing, effective prospecting in sales, the impact of technology, and the crucial role of leadership in an organization. They emphasize the need for viewing sales as a relationship and advice-based endeavor, while providing great insights regarding industry practices and strategies.

In this episode of the ShiftShapers Podcast, host David Saltzman interviews Ryan James Miller, a performance coach, consultant, keynote speaker and author of the book “Wounds.” Miller shares his professional journey and the adversities he had to overcome, including his father's abandonment, his fight for acceptance during his adolescence, the layoffs during the 2011 recession, and surviving the Route 91 Harvest Festival shooting in Las Vegas in 2017. The ShiftShapers Podcast is brought to you by MZQ Consulting, offering concierge-level service for all your benefits compliance needs, and the agility to keep up with the changing landscape.Ryan talks about how these experiences led to his realization of the link between personal wounds and unlocking one's unique greatness. He stresses on the importance of acknowledging wounds, understanding the rippling impact, finding the good and unlocking the greatness within oneself. Ryan presents “Wound Analysis Framework” that helps in personal transformation based on these principles.

What are the compliance issues that you should be aware of and what's coming down the pike legislatively for your business?In this episode of the ShiftShapers podcast hosted by David Saltzman, ERISA attorney Jennifer Berman, the NABIP (National Association of Benefit Insurance Professionals) Legislative Vice Chair and CEO of MZQ Consulting, discusses various compliance issues that employers and their advisors must know.00:00 Introduction to Compliance Issues and Legislative Updates00:49 Understanding Mental Health Parity02:51 Changes in Mental Health Parity Law03:47 Annual Reporting Requirements08:04 Understanding Prescription Drug Data Collection (RxDC)12:42 The Complexity of ACA Reporting16:57 Understanding Gag Clause Attestation25:28 The Importance of Fiduciary Responsibility33:39 Legislative Updates: Employer Reporting Bill and More39:21 The Future of Telehealth and Virtual Care41:09 Conclusion and Final Thoughts

Ever wanted to know what consumers really desire from their brands? Then you won't want to miss this episode with our phenomenal guest, Kurt Bartolich, the founder of Brand Certain. Kurt's bi-annual survey of 1,600 consumers provides precious insights into shifting consumer preferences, shattering the old paradigm of 'uniqueness' in favor of genuine qualities like honesty and authenticity. We unearth the importance of convenience and originality to consumers and scrutinize case studies: Bed Bath and Beyond's failure to meet consumer desires and Verbo's triumphant brand positioning.Can CEOs master the art of public speaking? Kurt's years of experience lend us invaluable advice on this topic. With a focus on honesty, transparency, and authenticity, he discloses practical tips to enhance unscripted, natural conversation, ensuring your brand message resonates with consumers. We also delve into a crisis management case, examining how Toyota navigated troubled waters. This episode is a treasure trove of practical takeaways on building consumer trust and shaping successful brands - a must-listen for anyone invested in understanding and meeting consumer needs.

Want to revolutionize your company's healthcare experience? Tune in as we welcome Ryan Robbins, the dynamic co-founder of Ello Benefits, who is here to discuss the transformative power of direct primary care (DPC) and its potential to significantly impact medical costs, improve employee experiences, and manage chronic conditions. Ryan offers an insider's perspective on how his team is shaking things up in the healthcare industry, providing tailored solutions to enhance efficiency and effectiveness in underserviced markets. Shifting gears, we delve into the role our physicians play in the healthcare equation, highlighting the importance of understanding patients' insurance status. Ryan shares how they are educating employees on optimal use of medical insurance through open enrollment meetings, with physicians playing a vital role. We also touch on the benefits of DPC from the perspective of both physicians and employees, and the advantages of level funded plans for employers with fewer than 300 employees. Don't miss out on this eye-opening conversation as we unpack these innovative ideas and strategies leading to a better healthcare experience for all.

Want to crack the secret to building enduring business relationships? What if we told you that the key is not hidden within complex strategies but lies in simplicity, authenticity, and selflessness? This awe-inspiring conversation with Andre Davis, a respected communication specialist and public speaker, brings that theory to life.You'll be fascinated as Andre unravels his approach to forming meaningful connections, emphasizing genuine interest in understanding someone's story, needs, and goals over pushing an agenda. Andre also breathes life into the concept of servant leadership, challenging traditional thoughts and showing how helping others when they can offer you nothing in return is a powerful tool for long-term success. Prepare to be deeply moved and influenced by Andre's perspective. Furthermore, Andre sheds light on the compelling influence of 'Go-Giver' on his business philosophy and how it shapes his strategy in forming authentic connections on platforms like LinkedIn. He also emphasizes the immense power of effective communication in building trust, standing out, and establishing a strong business presence. Filled with Andre's enlightening anecdotes and practical tips, this episode is an invaluable guide to anyone willing to step up their relationship-building game in business. Be ready for an incredible journey that combines the power of communication, authentic leadership, and the magic of giving in the world of business. Enjoy the ride!

Are you tired of feeling lost in the complex world of healthcare? Ever wish you had a guide to navigate you through it all? Well, meet Keith Somers, co-founder and CRO of HealthCorum, a company that's revolutionizing the healthcare sector, giving you the power to make informed decisions. Keith shares his personal journey of how his encounters with wasteful and low-value care inspired him to tackle these issues head-on, advocating for high-value, high-quality care.HealthCorum's approach is simple yet innovative - transparency and data-driven insights. This episode reveals how risk adjustment using data analytics can provide a fair comparison of healthcare providers, leading to potential massive cost savings. Keith also explains how HealthCorum is fighting to improve patient outcomes at a grassroots level, marrying price transparency and data-driven scores to empower you, the consumer. No more feeling left in the dark when making healthcare decisions, tune in to understand how HealthCorum is lighting the way!

Do you often find yourself wrestling with the myriad of challenges in benefits administration? Tune into our fascinating conversation with Shannon Goggin, co-founder and CEO of Noyo, as we traverse the landscape of benefits experience enhancement for customers. Shannon shares the inception story of Noyo, a visionary company that simplifies data exchange across divergent systems and how their mission is to enable secure data sharing with the goal of delivering the right information to the right people, at the opportune time.Ever felt exasperated by the industry's stumbling blocks such as the absence of universally accepted standards or the herculean task of processing an ocean of information? We've got you covered! We dive into the heart of these issues and discuss how Noyo provides comprehensive solutions for companies longing to integrate a seamless benefits experience into their software. We also unravel the knotty issue of premium leakage and delve into the transformative potential of technology, particularly AI, in boosting operational efficiency and reducing the burden on employers. Catch the wave and join us in exploring the monumental influence of AI in managing data and the urgent requirement for speedy carrier set-up and how Noyo's pioneering technology simplifies this process.

Imagine a future where health plans come with no deductibles and no copays, doesn't it seem like a fantasy? But what if it's not? In our enlightening conversation with James Millaway, the CEO of Zero Health, we unpack the concept of health plans without the burden of deductibles and copays. We trace the history of these cost-sharing measures and their effect on overall healthcare costs. We also highlight the idea of insurance and how it should be a guard against catastrophic risks, not everyday events. Moving onto the second half of our discussion, we delve into the realm of efficient healthcare purchasing and its potential for significant cost savings. We ponder on how employers and brokers can enable their employees to make informed decisions about their care. The talk also covers the integration of care management and the potential savings in medical expenditure. Our discussion reaches its peak as we talk about the future of healthcare and the vital role of trust. We explore Zero Health's impact on this future, and the importance of creating a trustworthy product. Don't miss out on this insightful conversation where we reimagine the future of healthcare.

Have you ever wondered about the hidden layers of healthcare costs? Today, we bring you insights from an eye-opening conversation with Dr. Keith Smith, co-founder of the Surgery Center of Oklahoma. Dr. Smith shares his personal journey of navigating the healthcare industry, and the shocking discovery that hospitals were not always the best advocates for patients or surgeons. He and his colleague dared to change this by establishing their own facility, a radical move that influenced the Trump Executive Order Mandating Price Transparency.We're also discussing the rising trend of self-funded healthcare plans and why employers are looking for alternatives to traditional ones. Imagine a zero-deductible and zero-copay approach to healthcare; it's happening, and it's giving companies a competitive advantage in the labor market. But it's not all smooth sailing; there are important regulations to consider like CAA notifications and ERISA. Plus, we highlight why quality assurance remains crucial when choosing healthcare facilities.Rounding off, we question traditional quality metrics and argue for the value of price transparency in measuring the quality of care. We draw on insights from Marty McCary's book Unaccountable to challenge the reliability of existing quality metrics. Finally, Dr. Smith shares his thoughts on the future of healthcare and the ongoing need for more transparency and patient advocacy. So, sit back and join us for a compelling discussion filled with revelations about the evolving healthcare industry.

Ever wondered how the Pharmacy Benefit Management (PBM) industry really works? Join us for an enlightening chat with our guest, Dave Parker, the Vice President of Sales and Marketing at TrueScript, as we unravel the intricacies of the traditional PBM relationship. Gain insight as Dave dissects key terms like average wholesale price and net cost, and unveils the ways PBMs make their money. We also delve into the trend of manufacturers moving closer to employers to shake off spread pricing models. More importantly, discover why it’s crucial to ask the right questions in a PBM relationship.We also step into the fascinating world of pharmacogenomics testing for prescription drugs, a game-changing approach that could redefine the healthcare industry. Picture this - a one-time test that prevents the misprescribing of medications, saving patients and doctors from hefty medical bills and hospital stays. Indeed, such a test already exists, and some PBMs are benefiting from the potential savings it brings. We’ll also investigate the prospect of making this a routine test for newborns and what it could mean for stop loss carriers. Last but not least, Dave returns to introduce us to the emergence of transparent PBMs - a revolutionary shift that is transforming the industry and proving particularly appealing to younger consumers. Tune in for an episode packed with industry insights and thought-provoking discussions.

Prepare yourself to be fascinated by Dr. Kyle Rickner, co-founder and chairman at Primary Health Partners, as he takes us on an inspiring journey of how direct primary care became his answer to physician burnout and subpar patient experiences. Step into the world of evolving healthcare models as we dissect the barriers that prevent more physicians from transitioning to this progressive model. Together, we untangle the web of the traditional fee-for-service system and how it has stagnated the growth of direct primary care. We also unpack the implications of misused health insurance and sky-rocketing premiums leading to a precarious cycle of healthcare costs.In the latter half of our enlightening conversation, we journey across state lines to understand how direct primary care physicians unite in their mission to deliver patient care. Listen to Dr. Rickner narrate the challenges and triumphs of coordinating care for a substantial client base, all while pushing the scalability model forward. We also shine a spotlight on the significance of data collection in establishing the value of direct primary care and highlight the urgent need for educating people about its benefits. Join us and share our curiosity, as we discover how direct primary care is revolutionizing the healthcare industry.

Ever wondered if your business is really understanding the true cost of healthcare? Join us as we pick the brain of Kelly McDevitt, the President of the Nonprofit Integrated Benefits Institute (IBI). With a whopping 40 years of industry experience, Kelly unpacks how IBI assists businesses in deciphering the often-complex healthcare costs beyond just medical and pharmacy expenses. We dive into the increasing curiosity around self-insured plans and the pivotal role of data in employer decision-making. Plus, you'll discover how IBI’s benchmarking data provides a panoramic view, setting the stage for strategic planning.Then, as the conversation deepens, we navigate the murky waters of delayed healthcare and the difficulties it presents in sourcing relevant claims data. Our journey takes us into the heart of the pandemic's impacts on health and disability claims - including prolonged health issues related to COVID-19. Kelly sheds light on how businesses can utilize this data to craft well-informed decisions, the significance of benchmarking, and the unique challenges HR teams are currently facing. Tune in for an insightful conversation packed with valuable insights for employers seeking to understand the labyrinth of healthcare costs.

Have you ever wondered about the balance between empowering employees and maintaining control as a leader? Get your answers as we have an enlightening conversation with Kristen Hadeed, author of Permission to Screw Up and Leadership Thought Leader. Kristen takes us on her leadership journey, a journey that began when she was 21 and saw 45 of her employees walk out on her, a pivotal event that reshaped her leadership approach. She shares how this experience transformed her into an advocate for fostering an environment of trust, empowerment, and psychological safety.What if your team could solve problems without micromanagement? Would it be more effective? Kristen takes a deep dive into these questions and unravels the delicate balance between supporting employees and giving them ownership of their work. She also shares her insights on how to avoid micromanagement and the impact it can have on your team’s morale and your own wellbeing. At the heart of her message is the importance of cultivating a culture of trust that encourages constructive feedback. Can vulnerability be a game-changer in the workplace? Let's find out from Kristen's personal experience. She unveils how her honesty and vulnerability with her team not only led them to trust her but also gave her a second chance. Listen in as she passionately talks about the value of fostering an environment of vulnerability in the workplace. You'll learn the importance of striking a balance between guiding and supporting employees and giving them ownership of their work. It's time to explore the creation of human workplaces where vulnerability is embraced. This episode is loaded with wisdom, practical advice and a fresh perspective on leadership. Don't miss out!GET KRISTEN'S BOOK: Permission To Screw Up

You ever wonder why the current healthcare system is so expensive and seemingly broken? Get ready to explore the potential of innovative healthcare plan designs that seek to reduce out-of-pocket costs and increase access to care with our special guest, Kevin Kickhaefar, President and Chief Growth Officer at Gravy.  We'll learn about Kevin's fascinating journey from the Midwest to leading a healthcare startup and his vision of a redesigned healthcare system that works for everyone. We'll investigate the integration of direct primary care with plan design, and the challenges that brokers and advisors face in the current climate.Thinking about level-funded and self-funded plans? Our insightful discussion with Kevin also covers their impact on employers and traditional health insurance carriers. We'll explore how these plans provide employers with more control over their healthcare costs, leading to a more sustainable model for the future. Learn about how direct primary care can bridge the healthcare gap in underserved communities, and how innovative partnerships like the Gravy Pay card and Teladot are simplifying the payment process and virtual visits for patients and providers alike. If you're curious about the future of health insurance, this is one episode you won't want to miss.

Join us for a riveting conversation with our guest, Daniel Grun, Chief Marketing Officer at Leading Edge Administrators.  From nonprofit to insurance, he brings a unique perspective to our discussion about the key factors keeping the market static - cost, access, and education of care.  Daniel drops knowledge on the benefits of strong partnerships and the increasing influence of self-funded plans in the industry. We also dig into the vital role of training and establishing a bond of trust in selling and keeping insurance businesses afloat.Stay tuned as we navigate the terrains of data lakes, benchmarking, and reference-based pricing, technologies that are radically altering outcomes. Get an inside look at how Artificial Intelligence, guided by correctly labeled data, is bridging the underwriting gap.  Join us as we tackle the responsibilities attached to selling insurance plans, the necessity for proper education, and the thrill (and risk) of being on the cutting edge.  Buckle up for an enlightening discussion on the ever-changing insurance panorama and how to master the art of navigating it.

Are you ready to tackle the trust problem impacting organizations across all industries? Join us as we unravel the secrets to building trust with our exceptional guest, Corey Sheer, founder and CEO of TrustCentric Consulting. Corey shares his journey and research on the structure of trust, and reveals the three vital building blocks that can make or break trust within an organization: organizational competencies, problem-solving skills, and demonstrating care for others.Dive into the world of trust with us as we examine the importance of making trust a key performance indicator (KPI) to become more strategic. Corey highlights five critical priorities for organizations seeking to build trust: regular employee feedback, honest conversations, a clear strategy, transparency, and clear ownership of tasks and projects. We explore how prioritizing these elements can help create a culture of trust and the impact of a lack of trust on key performance indicators like employee productivity, retention, loyalty, and advocacy. Corey even shares some practical advice for leaders eager to start rebuilding trust in their organizations. Don't miss this insightful conversation that will help you transform your organization's trust landscape!

Are you a Type A personality?  Discover how our guest, a fellow Type A individual, managed to transform their career journey to find meaning and fulfillment in their work. We dig deep into the need for variety and engagement for easily bored Type A personalities, the impact of early childhood experiences on our tendencies, and the role societal influences play in shaping our career choices. Plus, we reveal how understanding our coping mechanisms is essential to finding a career that truly works for us.    Feeling trapped in a role that doesn't suit your personality?  Find out how to self-assess what you're tolerating and not accepting in your life, and how making small decisions can help shift your experience for the better. We also discuss the significance of being aware of your emotions throughout the day, so you can reach that tipping point where it becomes less painful to make a change than to stay stuck in a lane that doesn't work for you. 

What if there was a way to revolutionize musculoskeletal care while reducing unnecessary procedures? Discover how Dr. Michael Greiwe, founder of OrthoLive, is using telemedicine to ensure patients receive the right treatment. In our engaging conversation, Dr. Greiwe shares his journey from medical school to creating OrthoLive and the importance of listening to patients' stories in making informed diagnoses.   We also explore the power of shared decision-making in healthcare, empowering patients to become informed and communicate with their physicians for better compliance and outcomes. Learn how coming together and creating a plan benefits both patients and physicians while potentially transforming the way we approach musculoskeletal care. Join us as we discuss the future of OrthoLive as a network of surgeons providing efficient and cost-effective healthcare solutions.

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

Why is self-funding becoming a popular choice for small businesses, and how can you implement it effectively? Join us in an engaging conversation with Chris Corkran, President and CEO of Creative Benefits Consultants, as he shares his journey and expertise on this innovative benefits solution. We dive deep into the level-funded healthcare plans approach , discussing strategies for helping employers save money while providing improved benefits for their employees. Learn about the crawl, walk, run continuum and taking a holistic approach to benefits consulting. Chris also shares valuable insights on the importance of working with an independent benefits consultant to navigate these decisions. Don't miss this opportunity to gain practical knowledge on creative benefits solutions for small groups.

This week's episode explores the fascinating intersection between the traditional agency model and the gig economy. In a rapidly changing world where frictionless relationships and instant, on-demand services are sought after, how can the insurance industry adapt to attract younger generations and diverse talent? Join us as we delve into the potential of platform-as-a-service solutions and their role in revolutionizing the employee benefits landscape, offering opportunities for both advisors and employees alike.What You’ll Learn From This Episode:0:45 From unexpected beginnings to the insurance industry.1:32 Addressing the failure of employee benefits: Enroll-a-five’s mission.5:13 The first gig economy play in insurance: Monetizing expertise and expanding reach.7:16 Meeting the needs of a changing workforce: Fragmentation, friction, and the call for streamlined solutions.9:07 A pathway for engaging the youth and diverse populations.11:57 The role of benefit advisors in driving engagement and care.14:19 Presenting a customized solution for employers.15:50 Balancing relationships and technology in the industry.Enjoy The Show?Don't miss an episode, subscribe via iTunes, Stitcher or RSS.Leave us a review in iTunes (here's how)Join the conversation by leaving a comment below!

This week's episode delves into the revolutionary advancements in genetic testing and its transformative impact on healthcare. With the advent of precision medicine, the ability to analyze an individual's genetic makeup has become a total game changer. By understanding how genes influence drug response and metabolism, healthcare providers can tailor treatment plans for optimal effectiveness while minimizing risks and costs. Join us as we explore the potential of genetic testing to revolutionize patient care and address concerns surrounding privacy and discrimination fears.What You’ll Learn From This Episode:1:04 Journey to expanding offerings: Antimicrobial stewardship and medication adherence programming. 2:42 Addressing inefficacy and personalized medicine: Leveraging genetic information. 5:13 Educating payers for improved outcomes and cost reduction. 6:22 The process of genetic testing and how the various pieces come together. 8:12 How the integration of genetic test results works in the doctor-patient interaction and its broader implications. 11:31 Improving patient outcomes and cost-efficiency.Enjoy The Show?Don't miss an episode, subscribe via iTunes, Stitcher or RSS.Leave us a review in iTunes (here's how)Join the conversation by leaving a comment below!

This week's episode explored the intriguing realm of modernizing ancillary benefits, shedding light on the shifting landscape of employee benefits and the profound impact it has on employers and their workforce. The discussion emphasized the increasing significance of ancillary benefits, such as dental, vision, and life insurance, in today's competitive market, where employers strive to attract and retain top talent. The conversation delved into the evolving expectations of employees, the role of technology in streamlining benefits administration, and the growing recognition of the interconnectedness between benefits, company culture, and overall employee experience. Join us as we uncover the transformative power of modernizing ancillary benefits and its profound implications for businesses of all sizes.What You’ll Learn From This Episode:0:49 Unexpected path: From engineering to employee benefits.1:41 Unveiling a forgotten corner: Addressing dental insurance gaps.3:14 From connected toothbrushes to building an insurance company.7:27 Beam’s mission to empower brokers and enhance customer experience.12:12 The strategic connection between benefits, culture, and measurable outcomes.15:38 Enrollment, participation, and employee happiness outcomes.Enjoy The Show?Don't miss an episode, subscribe via iTunes, Stitcher or RSS.Leave us a review in iTunes (here's how)Join the conversation by leaving a comment below!

In this week's episode of the ShiftShapers Podcast, the spotlight shines on the evolving landscape of self-funded plans and the critical role of third-party administrators (TPAs). Jay Kempton, President and CEO of the Kempton Group, discusses the increasing demand for TPAs and the education gaps among advisors. From discussing the industry's growth and the need for knowledgeable TPAs to navigating regulatory boundaries and understanding ERISA, this episode provides valuable insights for advisors and industry professionals alike.What You’ll Learn From This Episode:0:56 Increased business opportunities and growth for TPAs in a challenging industry.2:56 Deficits among advisors in understanding ERISA and self-funded plans.3:57 Expanded scope of fiduciary responsibility for plan administrators and sponsors.6:15 Liability and accountability: The role of advisors in addressing unethical vendor practices.8:27 Lack of patient engagement: Disempowerment and limited decision-making rights.11:17 Empowering patients as healthcare buyers: Changing perceptions and social challenges.13:56 Shifting healthcare behavior: Unfulfilled expectations of patient engagement.15:55 The power of bundled healthcare for informed decision-making.Enjoy The Show?Don't miss an episode, subscribe via iTunes, Stitcher or RSS.Leave us a review in iTunes (here's how)Join the conversation by leaving a comment below!

As healthcare costs continue to rise and insurance premiums become increasingly unaffordable for many Americans, the concept of direct pay models has gained traction.In this episode, we sit down with Dr. Jawad Arshad, CEO at WoW Health Solutions, to explore the idea of a direct pay model for ambulatory care. We dive into the benefits and challenges of such a model for ambulatory care and explore how it could potentially transform the healthcare industry.Join us for a thought-provoking conversation on the future of healthcare in the United States.What You’ll Learn From This Episode:0:47 ER physician turned CEO: An insight into the challenges faced by providers and payers in healthcare delivery.2:09 Understanding direct pay model for ambulatory care: A transparent and consumer-centric approach to healthcare payment.5:17 Addressing misconceptions about insurance policies and direct pay models.7:25 Benefits of Direct Primary Care and Challenges in the Current Healthcare System11:55 The role of benefits advisors in changing employee behavior and reducing healthcare costs.11:47 Exploring the direct pay model and insurance deductibles: Can you still file for reimbursement?16:07 Alternative arrangements and market stressors driving direct pay models.Enjoy The Show?Don't miss an episode, subscribe via iTunes, Stitcher or RSS.Leave us a review in iTunes (here's how)Join the conversation by leaving a comment below!