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Healthcare Simplified: Clarity | Transparency | Solutions

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23: How Employers Can Encourage Whole Patient Care w/ Paige Cooke

Employers want the workforce to be as healthy as possible—but health doesn’t always seem like something the American healthcare system is set up to provide. We recently interviewed Paige Cooke, Assistant Director of Customer Engagement at NCQA (National Committee for Quality Assurance) in Washington D.C., about healthcare delivery and finance—and how employers can navigate this intricate system. Everyone is using a different definition of quality, and nobody is communicating about how to...


22: Stakeholder Insights Into Healthcare’s Evolution and Future w/ Rick Gonzalez

We know more now than we ever have about what makes us healthy. Why then do healthcare costs continue to rise? Today we interview Rick Gonzalez from CommuniCare about the evolution of healthcare and the obstacles and solutions facing stakeholders. When it comes to our health, Rick knows that prevention and engagement are two of the most effective means to driving down costs and keeping patients well. The challenge is ensuring that prevention and engagement are aligned with what we know...


21: Understanding Healthcare Payment Methodology w/ Peter Gallitano

How does healthcare payment methodology work in light of the four stakeholders of healthcare finance? How can self-funded employers make the art and science of medicine valuable for themselves and their employees? We recently interviewed Peter Gallitano, a healthcare executive with an academic background in pre-med and finance and professional experience in the clinical, financial, operative, and tactical components of medical providers. With regard to gaining value in healthcare, Peter...


20: Getting to Know Medical Captive Underwriters w/ Donald McCully

Is there a way to save money from insurance? Will taking a risk end up saving money in the long run? Today we interview Don McCully from Medical Captive Underwriters, and he has a goal to have captive underwriting be as transparent as possible. When it comes to captive underwriting, Don knows that there are risks that need to be measured out when proposing new plans, and sometimes they are risks that employers don’t want to take. That is, until they realize the potential of what they...


19: How Cross-Cultural Sensitivity Leads to a Better Healthcare Experience w/ Lisa DeRoche

We’re all just asking for a little respect. We all have different backgrounds, cultures, income-levels, and experiences. Our co-workers, bosses, and customers all have different ways of seeing the world than we do. Those differences can divide us and make it harder to work together, or they can be a reminder to treat each other with the same respect we want to receive. That’s why cross-cultural sensitivity in the workplace is and always will be important. In this episode, Lisa DeRoche,...


18: Report Cards for Healthcare w/ Beatriz Coningham

If your healthcare provider got a report card, what would it say? Beatriz Coningham from the National Committee on Quality Assurance has the information at her fingertips, but do the decision makers in your Human Resources department? In this episode we interview Beatriz, who is the NCQA’s Assistant Vice President of Human Resources.


17: Solutions to the Primary Care Problem w/ Stephen Schimpff

Primary care physicians have a time deficit. Rising overhead costs due to the reimbursement system force physicians to take on too many patients. On top of that, unhealthy lifestyles cause massive health concerns that primary care physicians don’t have the time to address. So the problem is pretty obvious, but how do we fix it? How do we give primary care physicians the time required to properly treat patients and positively contribute to a higher quality of life while also mitigating...


16: The Problem with Primary Care w/ Stephen Schimpff

Once upon a time, primary care physicians handled all but the most perplexing specialized cases. Those were the days in which a doctor wasn’t running from room to room for 12-minute (or less) visits. They had the time to actively listen to patient concerns and the familiarity with the patient history to handle the cases without referring to a specialist. It’s hard to find that type of relationship today due to the way that healthcare has changed. The burden of rising overhead costs and...


15: How to Not Lose Employees w/ Todd Tangeman

If you’re an employer struggling with this idea of improving retention and reducing turnover, you're not alone. You need to solve the retention puzzle, ASAP. You need to hear from Todd Tangeman, the Chief Operating Officer and Chief Human Resources Officer for Newton Medical Center. Retention represents a lot of value. “There are costs associated with hiring and training and onboarding folks,” Tangeman said. “There’s a cost when good members leave.”


14: Self-Funded Employers: Quit Losing Money to Hospitals w/ John Glascott

Everybody in the healthcare continuum should care about AMPS. Because reference-based payment is the future, that’s why. Today’s episode of Healthcare Simplified features John Glascott, Chief Revenue Officer of Advanced Medical Pricing Solutions (AMPS), which offers medical bill review. “We have something we call clinical only medical reviews that review overcharges mistakes—what we call fat finger—a charge that was $710 entered as $71,000,” Glascott said. Find a breakdown of this...


13: 3 Ways You Can Prevent Hospital Error w/ Leah Binder

Let’s get the bad news over with first. The number of people who die from hospital mistakes could be as high as 400,000 per year. On today’s episode of Healthcare Simplified, Tyler Woolsey interviews Leah Binder, President and CEO of the Leapfrog Group. She specializes in helping employers use their leverage to get safer and higher quality care for their employees. “When they looked at their own covered lives, they were stunned to realize that they were potentially losing an employee...


12: The Pros and Cons of Reference-Based Pricing w/ Karl Ahlrichs

Wouldn’t it be great to walk into a doctor’s office and have them tell you exactly how much a procedure is going to cost? Mechanics do it. Contractors do it. Even veterinarians do it. But, for the most part, doctors don’t. Or, it might be more accurate to say, they can’t. Our healthcare system just doesn’t work that way. In this episode, Karl Ahlrichs, with Gregory and Appel Insurance , breaks down what reference-based pricing is, and how it can help limit post-doctor visit sticker...


11: How Much is Your Lifestyle Costing You? w/ Jim Campbell

It shouldn’t surprise anyone that daily decisions and lifestyle choices affect health. The next step, of course, is that these decisions in turn affect healthcare costs. The main issue in combating prevalent problems like obesity and prescription costs has been figuring out how to quantify how an individual’s choices cost. The rise of wearable technology and wellness apps are beginning to solve this problem. In this episode, Jim Campbell, President and CEO of BWell, gives some insight...


10: What to Do about the $29 Billion in Specialty Care Waste w/ Geb Buchness

On today’s episode of Healthcare Simplified, Geb Buchness, Senior Vice President of Business Development at Armada Health, is here to say that overlooking referrals specialists is a huge mistake. “One of the biggest pain points in healthcare is the breakdown between primary care and specialty care—when a member gets a diagnosis and needs a specialist,” Buchness said. Everybody wins when you use advice to achieve quality outcomes and to find good specialty care.


9: Psst! You Are Spending Too Much on Drugs w/ Kathy Campagna

So, you bought some milk online for $15 a gallon, only to go to the store and see that you could have spent $4. Believe it or not, this happens in healthcare all the time. (But with drugs, not milk.) That’s why we’re here talking to Kathy Campagna, Vice President Business Development and Director of Specialty Drug Strategy at Magellan Rx, which has a site of service program to help you save money without a lot of member disruption. She has worked for the last 10 years in the medical...


8: Utilizing Good Data to investigate fraud, waste, and abuse w/ Scott Ward

No matter what your profession, it’s painfully evident that healthcare costs are out of control. From skyrocketing premiums, to erroneous payouts, the healthcare world is confusing, and without the right help, can be ripe with fraud, waste, and abuse. Luckily, this is where Scott Ward and the team at Health Integrity LLC come in. With a team of 75 investigators nationwide, Health Integrity provides data-driven analysis for the healthcare industry, with a particular eye on fraud, waste,&...


7: How Cost Transparency Is Giving Power Back to Healthcare Consumers w/ Dr Bill Hennessey

Pratter, Inc. is bringing real-cost transparency of healthcare to millions of insured Americans, giving them power to spend (or not spend) as healthcare consumers. Today’s guest is Dr. Bill Hennessey from Pratter. Dr. Hennessey is passionate for people to realize their place as consumers, rather than see themselves as patients. Listen as he talks with us about how cost transparency is helping employers and employees understand the true cost of healthcare.


6: How Small Insurers Can Use Big Data to Get Massive Results w/ Dustin Plantholt

How is a health insurance company like a battleship? This is surprisingly easier to answer than how a raven is like a writing desk. Large national health insurers have all the impressive size and capability of an iconic battleship, but they also have the issues of movement that come with that size. On the other hand, smaller insurers can adjust more quickly to changes in the market. They’re more likely to implement new methods of doing business like focusing on the local life or using...


5: How Data Integration Is Reducing Healthcare Waste w/ Mick Simon

HCMS Group is a health information service company, who exists to help self-insured employers, health and disability insurance plans, and health service providers. Their cloud-based data solutions are changing the population health management game to the benefit of both individuals and organizations. Today’s guest is Mick Simon from HCMS Group. Here, Mick speaks with us in detail on the how and why behind the HCMS Group mission to reduce healthcare waste, while improving individual health...


4: Revolutionizing Population Health Management and Employer Concierge Care w/ Dr. Florin Selaru

Despite being a physician, Dr. Florin Selaru knows the frustrations of a patient. He’s experienced the two to three week wait to get his children to a doctor. He knows what it’s like to see them have only 10 minutes allocated to them once they’re there, and to receive a high-priced bill that doesn’t always clearly match the quality of the appointment. As a physician, he also has recognized the limitations of the system. So his mission was to figure out a system that works better for...


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