The Healthcare Heist - Rise of the American Healthcare Consumer

This episode rips the cover off one of the biggest myths in employee benefits: that your broker has everything under control. The truth? Most brokers only know what carriers want them to know—leaving employers in the dark about the data, options, and strategies that could truly transform their plans. Join Lou Bernardi as he exposes how this lack of expertise and transparency keeps companies stuck on “renewal autopilot,” making decisions based on carrier spreadsheets instead of real insight. Lou also shares the essential questions every CEO, CFO, and HR leader should be asking to break free—and what happens when you finally stop letting the blind lead the blind. If your renewal meetings feel rushed, shallow, or endlessly repetitive, you won’t want to miss this conversation.

Every business decision follows a process, define the goal, gather the data, evaluate the options, and make an informed choice. Except, it seems, when it comes to health insurance. Why do companies that analyze every penny of their P&L turn around and renew multi-million-dollar health plans without a real evaluation? Today, we will break down how business decision-making is supposed to work and what goes wrong when the same logic isn’t applied to healthcare.

Does your health insurance work for the best benefit of your well-being, or is it simply another blatant cash grab? Louis Bernardi believes that the “machine” of healthcare and insurance must be significantly reworked, not just for the sake of the patients but the doctors as well. He explains what must be done to address the ever-blurring lines between insurance and healthcare, putting the patients’ needs above anything else. Louis also emphasizes the need for transparency in the insurance industry and why 340B pharmacy programs must be put under investigation.

There are five main segments of health CARE and health INSURANCE. Those five segments are riddled with misaligned incentives and hidden profits for insurers, pharmacy brokers, and the healthcare systems. The American Healthcare Consumer must be aware of the pitfalls and possibilities that exist within their plans. Informed consumers are seeking aligned partnerships with TPA's, PBM's, and Population Health Companies and achieving remarkable results with the help of a new breed of benefits specialist that sells more than insurance. Lou and Paul will discuss these and other solutions that are helping plan sponsors change the trajectory of healthcare and insurance costs, allowing these employers and their members to reach new heights.

Transparency in healthcare isn't just about revealing costs; it's about empowering employers to navigate a complex system, save on inflated expenses, and truly prioritize their employees' well-being. In this episode, Jamie Greenleaf discusses the complex world of fiduciary responsibilities within healthcare plans. She dissects and reveals the challenges faced by plan sponsors, CEOs, CFOs, and HR directors. Wendy emphasizes the importance of transparency in healthcare and how tools like Fiduciary in a Box are changing the way we navigate these complexities. Learn the surprising discoveries about secret payments, higher prices, and the deliberate tricks in the healthcare system. Tune in now!

Paytient makes it easier for your employees to afford the care they need – regardless of their credit history. Lou and Chris discuss the impact skyrocketing out-of-pocket costs have on people financially and medically. Paytient is a simple plan addition that ensures members do not have to avoid necessary medical care, and can fill ALL their medications. The results? Happier and healthier employees, lower healthcare costs because treatable conditions do not go untreated and become high-cost claims.

Employers have a tremendous opportunity to take control of health care spending with the incredible growth of technology in the healthcare space. The recent legislation also increases the fiduciary responsibility of plan sponsors, and companies like Talon can unleash actionable data like never before. In this episode, Lou and Mark Galvin discuss healthcare's challenges, opportunities, and future. The day the Transparency in Coverage Rule was finalized, most existing healthcare price transparency tools became obsolete. Legacy tools with legacy architectures become non-compliant when real prices and patient out-of-pocket responsibilities must be displayed rapidly and accurately to comply with the Rule. It is, therefore, necessary to partner with TALON to provide accurate negotiated rates to the consumer in a fully individualized user experience that supports consumers' essential information needs when healthcare purchase decisions are being considered and made. Join Mark and Lou in this conversation to find out more.

Marshall Allen is the second two-time guest of Benefits with Friends. He and Lou previously discussed his book "Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win." This time, the conversation focuses on Marshall's project aimed at empowering the American Healthcare Consumer: The Never Pay Pathway. The Never Pay Pathway is an educational platform with 16 videos, averaging 5 minutes. The videos will help the listener analyze medical bills, contest inaccurate and unreasonable bills, win appeals, avoid unnecessary care, and much more. They are also now available to insurance brokers and HR Leaders for continuing education credits. So, don't waste your time and tune in to this episode with Marshal and Lou today!

Consumerism in healthcare should empower patients to make better medical choices. Instead, it penalizes them with higher hospital prices when making bad decisions and forces them to acquire extremely costly services. Leo Wisniewski, Co-Founder and CIO at Health Cost Labs, does not want such unethical practices to thrive in this space. In this episode, he joins Louis Bernardi to share the mobile application he and his team developed to address the consumerism problem in healthcare: Billy.app. He presents how it can help patients find lowest-cost medical alternatives in the market and confirm that they are not being overcharged, bringing back the buying power to the people. Leo also explains how they aim to disrupt the status quo through this app, turning the insurance industry around for the benefit of healthcare space and giving a competitive edge to independent facilities.

Ironically, this episode aired live on the 4th of May, which is commonly referred to as "May the Force", a play on the iconic line from Star Wars, "May the Force be with you!" Fittingly, we are joined by Allison De Paoli, the Founder of Altiqe Consulting, who is a "Force" in the benefits arena, having received recognition from many industry organizations. Our conversation focuses on actionable data versus numbers. Most health plan sponsors are familiar with numbers, especially at renewal time to support the inevitable premium increases. Unfortunately, far too many aren't familiar with the impactful data that is finally available in abundance. Data can help plan sponsors and their members make informed healthcare decisions rather than blind health insurance decisions usually based on premiums. Tune in to this episode with Allison De Paoli today.

After working as an employed physician in a major hospital system for 8 years, Dr. Jeffrey Gold began to get increasingly frustrated with the bureaucracy of insurance-based medicine that resulted in less of his time spent on caring for his patients in the way he envisioned since he was considering medicine as a career. In 2014, he opened the first independent Direct Primary Care practice in Massachusetts – Gold Direct Care PC. Based in Salem, MA he currently cares for 700 patients and has an Internal Medicine physician partner and recently added a Family NP. He has also formed a side business called the Starseed Group LLC which hopes to have DPC doctors, benefits advisers, TPAs, and self-funded employers collaborate to build employer sponsored plans that have DPC as the “seed” of the plan with direct contracting for all other services. Dr. Gold has been intimately involved in helping other MA primary doctors escape the fee for service world and MA now has approximately 15 independent DPC physicians. He is a co-founder in both the New England DPC Alliance as well as National DPC Alliance. He also is a member of the Direct Primary Coalition. Join this conversation as he shares more of his story and what his advocacy is all about.

Lou will be joined by Korb Matosich, Co-Founder, CEO and Board Member of Asserta Health. Korb has an unusual depth of experience managing all sides of health care payment. He oversaw both Revenue Cycle Management and Payment Integrity businesses at Ingenix, now Optum, at UnitedHealth Group. He also served as the CEO of AAPC, an organization that certifies billers and coders. Asserta Health: Bulit on the foundation that the only way to make healthcare affordable is to pay for it the same way we pay for everything else – direct, transparent, immediate. Asserta Health, has created a real-time cash payment platform, called medEcash, that allows self-funded employers to pay a cash price at the time of service for high-cost medical care for covered members. This payment strategy results in dramatically reduced prices from network rates and saves money for both the employer and the member. It also eliminates the risk balance bills and helps ensure access for needed care. Asserta Health has processed over 40 million dollars across more than 21 thousand transactions using the medEcash platform to service 30,000 employee lives eligible for the cash payment program.

Lou and his guest, Brian Del Savio will discuss the issues employers have addressing the real struggles their employees face such as mental health and affordable access to fundamental healthcare. The benefit strategies (Pay More, Get Less) many employers have been forced to swallow leave many employees struggling to access care when they need it the most. Technology can help address this issue by putting benefits with real-time access to solutions at their employees' fingertips. Brian Del Savio Bio As Vice President of Sales, Brian helps employee benefit advisors develop a clear path to success by enhancing benefit plans with innovative, fully customizable, best in class benefit and technology solutions. Employee benefit advisors have access to 35+ of the most highly vetted non-insured enhanced benefit vendors at discounted wholesale pricing, without having to juggle multiple vendor contracts. Solutions include Virtual Mental Health, Advocacy & Transparency, Virtual Health, Fertility, Health Discounts, Pet Discounts, ID Theft Protection and more. The benefit programs can be branded to the employee benefit firm or even to each employer group. Employees access all benefits in a single membership through a mobile app and member portal, increasing utilization drastically. Before coming to New Benefits, Brian worked in the financial services industry as a financial and health insurance advisor, creating individualized plans to improve financial security for individuals, families, and businesses. In his personal time, Brian enjoys exercising, which usually involves chasing around his 6 year old son and 3 year old daughter on bikes, at the pool or at the beach. Ice Hockey has played a major role in Brian’s life, so you can also catch Brian watching, playing or even officiating hockey as a USA Hockey Referee. Brian has been married to his wife Christy for 9 years and they currently reside in Southwest Florida. New Benefits Bio Pioneers of the non-insured benefits industry for 32+ years. New Benefits has been disrupting the benefits marketplace since 1990 with innovative products, cutting-edge technology, and first-class service. As the leading wholesaler of non-insured benefits, we aggregate the most sought-after healthcare and lifestyle solutions for over 4,000 groups and millions of members. Our clients strengthen their health plans with a customized blend of 30+ non-insured benefits to help members navigate healthcare, find affordable care, reduce stress, and save time — all conveniently packaged in an easily accessible mobile app and web platform. Through regular use of their benefits, our members save millions of dollars annually on healthcare and everyday living expenses, increasing their happiness and productivity at work and home.

Streamlined and automated processes not only help save time and effort but also money. For patients, this means having to save and avoid the unnecessary costs caused by errors and overcharging. Pranov Duggasani and Zoe Holderness founded Slingshot Bills, a company that automates the patient advocacy process and saves individuals and their employers’ money. In this episode, they join Louis Bernardi to tell us what led them to start their company along with the problems and solutions they found in the healthcare system. In particular, they take a deep dive into the value of leveraging technology to help manage healthcare spend. Pranov and Zoe discuss the many issues they encountered while auditing, from bundling issues to EOB errors and more. As consumers, we have the right to information that is so often not given to us. Follow along to this great conversation and learn important insights that could help you pay less for your health care without more work.

For the past three decades, the American healthcare consumer has been the leverage used by insurance carriers and healthcare systems against each other. Which strategies must be implemented to give them back this leverage and simply settle with the lowest plans? Louis Bernardi talks with Chris Hamilton of Hotchkiss Insurance about the best approaches in mending the gap between health insurance and healthcare. They break down how to create an ecosystem that allows employers to give consumers a choice and drastically lower insurance costs. Louis and Chris also talk about the importance of educating employees about getting the right health plan instead of assuming they wouldn’t care about such a complicated matter.

There is probably no aspect of healthcare that has changed as dramatically over the last few years as insurance claims data. For every C-Suite leader or HR manager to justify their next rate increase, they must have the right amount of data at their disposal, gathered from the clients themselves. However, most employers do not have any access to this information. Jacob Sheridan of TPA Stream aims to make this process a lot more convenient through their product, Beacon. Joining Louis Bernardi, he explains how this simplified and standardized process helps collect historical claims data. He discusses how it can help business owners deliver better plans and guide consumers to make better insurance decisions. Jacob also talks about how the right gathering of such data can give back leverage to the people so they can stop being mere spectators.

Lou and Sims Tillirson will discuss the strategies and solutions that forward thinking HR teams are utilizing to keep their employees engaged and connected. HR leaders have to balance the time it takes to engage with members and the time they need to get stuff done. The extent of the remote work force today makes this even more challenging. Technology is great...when it works. So, what works and what doesn't? Who is Sims Tillirson? Sims Tillirson has worked in a variety of leadership positions at Fortune 500 insurance carriers, enrollment firms, and benefits technology firms. He currently serves as Head of Sales for Showcase, an employee engagement and benefits education platform. Outside of the office, he is an avid Community Volunteer, Tattoo Enthusiast, Recording Artist, Multi-Instrumentalist, Singer/Songwriter, and People Connector. He lives in Forest Acres, SC with his wife Brianne, son Jack, and dog Doc. We'd love to share our thoughts with you and hope you'll share yours with us too.

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 healthcare 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 helped 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?