Benefits with Friends - The Rise of the American Healthcare Consumer

Marshall Allen’s book, "Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win," shows individuals and employers how they can push back against the high cost of health care. It's led to Allen Health Academy, which takes the principles of the book and communicates them through an engaging series of health care literacy videos for consumers. The videos are currently in production.

Marshall’s stories have been featured by the New York Times, Washington Post, USA Today, The Today Show and other outlets. Speaking engagements include AcademyHealth, the Association of Health Care Journalists, the Michigan Hospital Association, the National Patient Safety Foundation and Stanford's Medicine-X.

Before journalism, Marshall spent five years in full-time ministry, including three years in Nairobi, Kenya. My Master's degree is in Theology. I am currently working as an Assistant Regional Inspector General with the Office of the Inspector General - HHS.

Lou and Marshall with share true stories of success including how real patients fought the system and won. Health care and insurance are overly complex by design. Learn what enhancing your IQ can mean for the average American and their employers

Emma Fox is Partner and COO of E-Powered Benefits.

Her firm helps employers throughout the US customize health plans using alternative health care models that are capable of significantly enhancing benefits for members while at the same time lowering the cost by 20-40% (or more).

The key is increasing awareness and resetting customer expectations through education. The current fee-for-service delivery system ensures a misalignment between plan sponsors/members and all other stakeholders.

An informed consumer is capable of breaking status quo results. That's why Emma help create the Certified Health Value Advisor education module for employers and consultants.

This episode of Benefits with Friends will feature Patrick Moore, President of Axim Fringe Solutions.

Patrick is an Emerging Star in the benefits arena nationally who recently retired from the United States Marine Corps. How ironic that he will be appearing on our show on the 247th Birthday of the US Marine Corps...Oorah!

AXIM Fringe Solutions Group, LLC (AXIM FSG) is the nation’s first and only health and welfare administration and compliance firm that is also a government contractor.

In addition to being a Jarhead, Patrick is also self-proclaimed Geriatric Millennial. We'll find out what that means to him.

Lou is very much interested in getting Patrick's perspective on the current state of employer sponsored health plans and the fee-for-service healthcare system. An industry in complete disarray must be quite alarming for someone so used to regime and discipline.

What tools does Patrick's past lend to help him help others threw the great unknown?

Our host Lou *BOO* Bernardi and guest Nancy Giacolone discuss the Role of HR Leaders in the Post COVID era.

Lou and his guest Dave Chase discuss the Health Rosetta, high-performance health plans, the Quadruple Aim, and the results when a shift in mindset takes place that takes the attention off the insurance costs and places it on the quality of health care. 

Please join me and my guest Dale Sagen Vice President, Group Captive Solutions at Risk & Insurance Strategy Collective (RISC). Dale is responsible for leading and collaborating with benefit advisors and plan sponsors to develop and implement captive strategies for employers’ health & welfare plans.

Dale has specialized in the support of successful self-funded health plans with the facilitation of a group captive strategy that is customized for the sponsor and employers.

Captives are becoming a more sought-after stop loss solution for employers that wish to self-insure their group health insurance plans. Dale will share his insights with our audience.

Episode 19 of Benefits with Friends was the showdown of the century as the reigning Broker of the Year Josh Butler squared off against his buddy and rival Adam Berkowitz.

Our host Lou Bernardi had to keep these two fierce competitors under control as they fought tooth and nail.

Adam took off with a sizeable lead, but Josh came back and tied it up.  Who won?  You'll have to tune in to find out.

My guest Eric Silverman of Voluntary Disruption and I discussed Marketing & Media for the Enrollment Win.

Employers desperately need to reengage with employees in the post COVID era. The battle to attract and retain talent is real!

DIS-RUP-TION, N. - a radical change in an industry (or) business strategy.

"Words are very powerful things that have incredibly intense meaning. By simply changing your verbiage, you're truly able to disrupt the status quo an amazing and unexpected ways." - Eric Silverman

Eric is also the host of the hugely successful Rockstars Rocking podcast available on Spotify, Apple and Google Podcasts.

EZaccessMD provides employers and employees alike with what they call the EZ Difference: comprehensive, convenient care that comes right to the doorstep. Their members can consult with a doctor in minutes and receive on-site assessment and diagnostics – all in under 2 hours. For the employee, this means no time spent traveling and sitting in waiting rooms, no money spent on a copay, and no added stress. For the employer, this means money saved on insurance claims, loss of productivity, turnover, and absenteeism.

In recognition of Mental Health Awareness Month, I can't think of a better guest to have on than CEO of Orriant and Founder of Aspirational Healthcare than Darrell Moon.

Darrell is passionate about population health, behavioral health and can help employers address this very important topic.

Kelly D Webb of Exclusive Surgeries Solutions and Lou Bernardi discuss how employers that self-insure their group health plan can save significantly while at the same time improve outcomes and helping patients avoid unnecessary procedures and rampant infections that plague hospitals.   

ESurgeries, as they are better known, contracts with the very best surgeons that perform thousands of surgical procedures at ambulatory surgery centers (ASC's).  They negotiate prices for bundled surgeries that includes facility, provider and in some cases aftercare such as physical therapy.   

This episode is specifically focused on self-insured health plans.

Lou and Aaron had a great conversation on the topic of the 'Functionally Uninsured'.

Managed Care's promise of enhancing care and controlling insurance costs clearly expired long away.  Instead, it was replaced with Pay More, Get Less and numerous flawed strategies.  Employers and their members fell victim to a health care and insurance system that on the surface seem broken.  A keen eye understanding that they are, in fact, working exactly as designed to the benefit of these two monopolies.

Aaron discussed the distinction between equity and equality and how the plans offered by many employers today leave the lowered earners in dire straits.  

In fact, an overwhelming majority of hard-working Americans have less than $1,000 in the back, yet they have deductibles and out-of-pocket costs 5 to 10 times that each year.

One solution that Aarons firm, E Powered Benefits, has had great success with is Direct Primary Care which eliminates barriers to care and offers a superior patient/doctor experience.

Thanks for listening!

Dennis Hartin and Lou discussed the role mental health plays in benefits and what employers can do to help their most vulnerable employees.

Listen in as my guest Paul "Joey" Stone (Director of Strategic Partnerships- Burnalong) and I discuss Life, Wellness and Wellbeing.

The Burnalong Difference

BurnAlong is built on that simple yet industry-changing philosophy that if you want to help people achieve their health and wellness goals, the way to do it is to bring them:

1. Programming they find relatable and inspiring.
2. Social support to keep them active and engaged

The inaugural 'Battle of the Benefit Specialists' between advisors Cristy Gupton and Nancy Giacolone was an epic success.  These two benefit powerhouses showcased their in-depth knowledge of employer sponsored health plans at a level that was incredibly impressive.

They went back and forth on topics ranging from medical cost trends, stop loss, pooling charges, claims corridors, population health, No Surprises Act, Compensation Disclosure and so much more.  

In the end, the heated battle ended in a tie but the real winners were the benefit decision makers that perhaps have a better understanding of what it takes to better manage a health plan, health care costs and that it is indeed possible to lower costs while improving outcomes.

Thank you Cristy and Nancy!!

Lou Bernardi, CHVA and the Original Benefit Optimization Officer

Rachel is the Director of Strategic Development for EHIM an independent Pharmacy Benefit Managemer (PBM) that helps self-insured medical plan sponsors eliminate the artificial costs that drive up claims and stop loss premiums.

Rachel and I discussed stop loss, the importance of proper Drug Formulary structure, spread pricing on generic drugs, the impact of rebates on plan costs and members and so much more.

Rachel was a fantastic guest and great ambassador for a changing benefits landscape!

I hope you enjoy the broadcast.

To view the video of the episode visit us at https://vimeo.com/showcase/benefitswithfriends

Episode 9 of Benefits with Friends will take a deeper dive into Price Transparency and the No Surprises Act of 2022.

Dr. Kaplan and our host Lou Bernardi will discuss the opportunity both can have on the American Healthcare Consumer, Medical Providers and Group Health Plan Sponsors.

Dr. Kaplan, a plastic surgeon, has a depth of knowledge on both subjects that is incomparable.  See how he helps other clinicians leverage price transparency with his BuildMyHealth platform.  Learn how Dr. Kaplan came to know US Senator Bill Cassidy MD who was the co-author of the legislation that may sneak up on my employers.

This episode of BwF featured Joana M. Ames (Ruano), Senior Sales Executive at Garner Health.  

Garner's goal is to change how our healthcare system works at its core. Using a new approach to data science and novel financial incentives, they help patients identify the highest-quality doctors and help doctors improve how they practice medicine.   

Garner is a next-generation benefits tools that ensures patients are matched with the highest-quality providers; and when they are they are rewarded with lower out-of-pocket costs.

At it's core, Garner is a technology company that provides much needed 

Listen as my guest Tim Ott of Roundstone and I discuss self funding, stop loss and medical group captives.

Roundstone captive is an innovative and proven funding model that effectively shares risk and offers transparency, flexibility, and significant cost-savings over traditional fully-insured programs.

Founded in 2003, Roundstone came together because of a shared belief in quality, affordable healthcare for all.

The evolving healthcare industry has brought opportunities for benefit plan stakeholders to come together and develop plans that not only address cost containment, but also enhance their employee value proposition through more robust benefit offerings

Roundstone helps small and midsize companies deliver high-quality, affordable health benefits that attract and retain the best employees. They do this through their self-funded health insurance solution that leverages a group medical captive, the first of its kind. The captive bands together employers in a pool so they can have the same scale and resources of a large company.  Lou and Tim will discuss the core functions of a medical captive and how the world of alternative funding is changing rapidly.

This episode of Benefits with Friends will feature Kari L. Niblack, Esq., CEO of ACS Benefit Services, LLC.

ACS is an independent third-party administrator (TPA) and vital component to any High-Performance Health Plan.

Lou and Kari discussed the core functions of a TPA and how the world of alternative funding is changing rapidly in the wake of price transparency and enhanced fiduciary responsibilities of employer sponsored health plans.

Independent TPA's offer the unique opportunity for plan sponsors and their members to enhance benefits, improve outcomes and population health while at the same time lowering the health care and insurance spend.

This is done by taking control of the plan document, plan design, partnering with pass-through Pharmacy Benefit Managers and Clinical Case Management and eliminating the hidden profits and misaligned incentives of the traditional insurance markets.

This episode will feature my guest Michelle Bounce.  Michelle is the Chief Operating Officer of The J.P. Farley Corporation.  

J.P. Farley is a premier Third-Party Administrator that is leading the way in the fight to rid employer sponsored group health plans of the artificial costs and hidden profit centers that plague the status quo.   

J.P. Farley has over 40 years-experience making competitive employee health plans simpler; with solutions you need, services you want, and savings that drive real change.  

Informed benefit decision makers and their advisors use J.P. Farley to obtain results that defy conventional wisdom.

This episode featured my guests Kimberlee Langford, BSN RN CCM CRMT CPC and Crystal Kowalesky of Specialty Care Management.

This dynamic duo help manage high-cost claims for the most vulnerable members resulting in enhanced care, lower OOP costs and improved outcomes.

Specialty Care Management (SCM) provides an innovative risk solution that normalizes claim costs and brings them back under control. Specializing in program designs for renal claims, cancer management, transplants, clinical underwriting consulting and negotiation services, SCM doubles your savings compared to typical network discounts, delivering maximized savings every time

The first BwF episode of 2022 will feature my guest Mark Testa, DC, MHA and currently EVP of Regenexx.

Regenexx helps self-funded employers save on their orthopedic spending and helps patients avoid elective orthopedic surgery.

We'll discuss the magnitude of MSK costs, importance of actionable data and the advantages of collaborating with the right TPA to enhance care and improve outcomes and eliminate unnecessary surgeries.

BwF's episode #2 will feature guest Jervis DiCicco of Prosperbridge.

Lou and Jervis will discuss turning compensation and benefits into Progress for Employers & Employees, Financial Wellness & Talent Strategy.

BwF's episode #1 will feature guest Trevor Daer of Granite Peak Analytics.

Lou and Trevor will discuss the Pharmacy benefit ecosystem and the opportunities that exist for employer sponsored health plans to optimize their Rx benefits and trim off the unnecessary costs.