Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs podcast

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Colin Quinn, President of Included Health Communities, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how Included Health offers tailored care navigation and advocacy solutions to employers and health plans to support their diverse employees and members. Included Health’s aim is to create equity in healthcare, with their first solution creating ways to help support the LGBTQ+ community. As President, Colin strives to raise the standard of healthcare for everyone, no matter what group you belong to or what industry you work in. Colin Quinn received an MBA from Stanford University’s Graduate School of Business and went on to work in the finance and sales side of the pharmaceutical industry prior to launching Included Health. In 2021, Included Health was acquired by Grand Rounds and Doctor on Demand which has created a robust navigation and advocacy platform to support Employers in raising the bar in their recruitment and retention efforts. Here’s a glance at what you’ll learn from Colin in this episode: Why Included Health was launched How Included Health’s broad service offering can improve equity in healthcare How Included Health reached an NPS score of 98% Timestamps: 0:00 – Introduction and welcoming Colin to the show 1:15 – Who is Colin Quinn and what is Included Health Communities? 2:30 – How Colin pivoted from working in finance & sales in the pharmaceuticals industry to launching Included Health 7:15 – How the acquisition of Included Health will allow the company to get to the next level and better serve employers and employees 9:30 – What differentiates Included Health from the marketplace when it comes to healthcare navigations? 12:20 – How will virtual care, digital solutions, and navigation increase the level of equity in healthcare & why is Included Health leading the way? 20:30 – Why Included Health’s approach to equity can help multiple diverse groups 22:15 – How does Included Health drive organizations forward in recruiting and retaining employees? 27:10 – How do employers find out what their workforce wants/needs? 29:10 – What does Included Health’s consumer satisfaction look like? 30:35 – The research & development Included Health does to make iterative improvements to its offering 32:45 – Who is Included in Health’s target market? 34:00 – What exciting developments are coming for Colin? 36:00 – How you can learn more about Included Health Resources: Learn more about Included Health Communities here: https://includedhealth.com/communities/ Included Health’s Twitter: https://twitter.com/IncludedHealth Colin's LinkedIn: https://www.linkedin.com/in/colin-quinn-he-him-04956119/ Podcast Links: Website: http://www.reconstructinghealthcare.com/ Apple Podcasts: https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325 Instagram: https://www.instagram.com/reconstructinghealthcare/ Facebook: https://www.facebook.com/ReconstructingHealthcare/ LinkedIn: https://www.linkedin.com/in/michaelmenerey/…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Denise Shiffman | GroupWell 46:46

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46:46

Denise Shiffman, Founder and CEO of GroupWell, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how their data-driven, online group therapy platform is providing employers with a ground-breaking way to approach mental health. Group Therapy combines the treatment of both mental health and social health to reduce clinical symptoms. GroupWell leverages technology to provide a platform where clinician-led group therapy can be accessed for specific groups of individuals dealing with similar issues and challenges. In addition, GroupWell provides wellness affinity groups led by certified behavioral coaches that can help people with sub-clinical levels of stress and anxiety as well as nutrition, weight loss, parenting, and other topics to support people’s emotional well-being. Denise Shiffman held multiple executive roles at tech start-ups and at multi-billion-dollar tech and healthcare companies prior to starting GroupWell. This previous experience has helped her build a dynamic platform that can increase access to a mode of therapy that can help people learn the skills and behaviors to build connections and quality relationships and aid in the recovery from mental health conditions. Here’s a glance at what you’ll learn from Denise in this episode: The personal experiences that led Denise to start GroupWell How Group Therapy works and is proven to be as or even more effective than individual therapy How GroupWell leverages technology to deliver evidence-based group therapy for Affinity Groups Why employers and care providers must pay more attention to mental health Timestamps: 0:00 – Introducing and welcoming Denise to the show 1:10 – Who is Denise Shiffman and what is GroupWell? 2:35 – How Denise’s experience with chronic anxiety led her to create GroupWell 5:45 – Making it through the pandemic, the state of mental health, and what lessons should employers be taking from the last two years? 11:00 – The issues that people with mental health issues face with current healthcare providers 12:30 – Why is group therapy a relevant mode of treatment and why Denise decided to focus on it 16:45 – How GroupWell works for those seeking mental health support 23:40 – Why Denise works with certified coaches that lead affinity wellness groups and how mental health treatment is larger than just therapy 27:10 – The timeline that GroupWell provides for their care 29:10 – Exploring the data around how group therapy works for those seeking mental health care 31:00 – How GroupWell attracts coaches and therapists to their network 35:20 – The method of tracking and sharing results with employers and how GroupWell keeps members engaged 38:50 – The pricing model for GroupWell 40:55 – How Denise plans to scale GroupWell 44:00 – Why the industry needs to adopt a more holistic approach 45:30 – How you can learn more about GroupWell and connect with them Resources: Learn more about GroupWell here: https://www.groupwell.net/ Podcast Links: Website: http://www.reconstructinghealthcare.com/ Apple Podcasts: https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325 Instagram: https://www.instagram.com/reconstructinghealthcare/ Facebook: https://www.facebook.com/ReconstructingHealthcare/ LinkedIn: https://www.linkedin.com/in/michaelmenerey/…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Veeneta Lakhani | Vida Health 42:55

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42:55

Veeneta Lakhani, the Chief Growth Officer for Vida Health joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how Vida Health is providing care for over 2 Million people through their digital platform that aims to treat both physical and mental illnesses in a combined effort. Vida Health is a modular platform that aims to prevent, manage and even reverse chronic conditions by bringing together mental and physical healthcare through a ground-breaking digital platform that connects patients to therapists and coaches. Vida Health’s clinical outcomes have led them to receive some of the highest customer satisfaction scores that we’ve seen on this podcast. Veeneta joined Vida Health to ensure her work in the healthcare industry leads to a future of care where people are looked after day to day through combining physical and mental health work to achieve sustainable outcomes. Veeneta previously held multiple senior executive positions at Anthem Blue Cross and began her career in the insurance sector with McKinsey and company. Here’s a glance at what you’ll learn from Veeneta in this episode: How Veeneta is working to make an impact on people’s lives every day instead of just when they go to the doctor, and why she couldn’t achieve this at a major national carrier How & why Vida Health combine both physical & mental health treatments Why the healthcare industry made significant progress during COVID-19 as it pertains to mental health, diversity, equity & inclusion. How Vida Health provides instant care when their clients sign up to their service by leveraging their digital platform The secrets behind Vida Health’s high customer satisfaction scores and why digital healthcare may be the way forward Timestamps: 0:00 – Introduction 1:10 – Who is Veeneta Lakhani and what is Vida Health? 2:20 – Why did Veeneta leave a national carrier (Anthem) to join a digital health start up? 4:40 – What are the positive outcomes that can be taken from COVID-19? 9:20 – What is Vida Health and what problems are they attempting to solve? 12:00 – How Vida Health approaches their mental health support & care, and why they are leading the way for measuring the severity of mental health 16:50 – Coaches: How Vida Health is implementing mental health coaches into their service 20:30 – How Vida Health manages their team of clinicians and why they can provide instant care 23:30 – What conditions do Vida Health manage and what resources do they use to provide care 27:25 – The methods Vida Health uses to track the results of their patients’ chronic conditions and does Vida Health consider themselves a wellness product? 30:40 – What is Vida Health’s engagement rate and why is it outperforming their competitors? 33:00 – How are Vida Health tracking their customer satisfaction and what are the results/outcomes for their customers? 37:10 – How many employers/members are currently enrolled in Vida Health’s program? 38:15 – What is next for Vida Health and what is their cost structure? Resources: Veeneta’s LinkedIn: https://www.linkedin.com/in/veeneta-lakhani/ Vida Health’s Website: https://www.vida.com/ Podcast Links: Website: http://www.reconstructinghealthcare.com/ Apple Podcasts: https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325 Instagram: https://www.instagram.com/reconstructinghealthcare/ Facebook: https://www.facebook.com/ReconstructingHealthcare/ LinkedIn: https://www.linkedin.com/in/michaelmenerey/…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Wally Gomaa | SimplePay Health 50:49

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Wally Gomaa, CEO and Co-Founder of SimplePay Health, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how they’re empowering employees with high-quality care through easy-to-understand benefit design structures. SimplePay Health aims to disrupt the healthcare industry by making the complicated elements of traditional health plans (deductible, coinsurance, confusing bills) a thing of the past while providing their members with the highest level of care. Based out of Dallas, Texas, SimplePay Health is taking on the status quo to reward employees for making choices that actually help lower overall costs. As a former President of a national insurance carrier, CFO of a healthcare provider and a benefits consultant, Wally has gained unique insight into the healthcare industry and leverages the SimplePay Health platform to address some of the problematic issues within our healthcare delivery and payment system. Here’s a glance at what you’ll learn from Wally in this episode: The payment system that SimplePay uses to make healthcare a breeze Why Wally wants price transparency to become price CERTAINTY How virtual care providers can provide higher quality care Why simplifying complexities could bring the largest change to the healthcare industry Timestamps: 0:00 – Introduction & welcoming Wally to the show 1:05 – Who is Wally Gomaa and what is SimplePay Health? 2:35 – The Bike Accident: How being hit by a car changed Wally’s perspective on the healthcare industry 4:10 – Why haven’t price transparency tools & high-deductible health plans driven meaningful results? 7:10 – What is SimplePay Health doing to simplify health insurance? 11:20 – How to show patients the disconnect between quality and price for commodity healthcare services 13:35 – Using data to drive down costs whilst providing a higher quality service 17:45 – SimplePay Health’s approach to using networks 19:30 – Pharmacies & Aligning Incentives: How to reduce the formulary waste and price variations found at pharmacies & align incentives with employees 22:50 – Digital Health Providers vs Brick & Mortar Providers: How virtual care providers can provide higher quality care 25:20 – How SimplePay Health is implementing digital mental health services 27:00 – Member Experience: How do employees navigate their healthcare service when using SimplePay Health? 31:50 – Outcomes & Results: What results can employers expect when signing up to SimplePay Health? 35:10 – How payments are managed by SimplePay Health 38:50 – What is the satisfaction level of employers and employees who use SimplePay Health? 42:40 – The evolution, growth, and future of SimplePay Health 49:25 – How can people get connected with Wally and SimplePay Health? Resources: SimplePay Health Website: https://www.simplepayhealth.com/ Call SimplePay Health: 800-606-3564 SimplePay Health Facebook: https://www.facebook.com/simplepayhealth/ Wally Gomaa’s LinkedIn: https://www.linkedin.com/in/wallygomaa Podcast Links: Website: http://www.reconstructinghealthcare.com/ Apple Podcasts: https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325 Instagram: https://www.instagram.com/reconstructinghealthcare/ Facebook: https://www.facebook.com/ReconstructingHealthcare/ LinkedIn: https://www.linkedin.com/in/michaelmenerey/…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Harris Rosen + Ashley Bacot | Rosen Hotels & Resorts 47:13

acum 4 years47:13

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Harris Rosen and Ashley Bacot of Rosen Hotels & Resorts join Michael in this episode of the Reconstructing Healthcare podcast to discuss how they’ve saved over $450 million in healthcare costs by implementing their own self-insured healthcare model. Rosen Hotels and Resorts has over 4,500 employees and turns over $350 million in revenue per year through their multiple hotels and resorts throughout Orlando, Florida. Harris and Ashley have created a healthcare model that not only saves the company in healthcare costs, but also provides healthier lifestyles for their employees, as they can choose their health over their wallet via the cost savings. Harris Rosen is the President and COO of Rosen Hotels & Resorts and has not only seen the growth of his hotel business, but through the success of his healthcare program, has created ProvInsure to implement their healthcare model into other companies. Ashley Bacot is the President of ProvInsure and Risk Manager for Rosen Hotels & Resorts. Ashley was integral in creating the self-insured healthcare model for Rosen that has helped save nearly half a billion dollars in healthcare costs since inception. Here’s a glance at what you’ll learn from Harris and Ashley in this episode: How Rosen Hotels & Resorts implemented their own self-insured healthcare model to save over $450 million since inception. The lessons taken from the Great Depression to survive COVID-19. How to remove the barriers within your healthcare plan to have healthier employees and reduce costs. The steps you can implement to allow your employees to choose their health over their wallet. Timestamps: 0:00 – Introduction 0:20 – Welcoming Harris and Ashley to the show 1:12 – Who is Harris Rosen? 1:50 – Who is Ashley Bacot? 3:00 – The history of Rosen Hotels & Resorts and how they grew into a $361 million per year company. 7:30 – How Rosen’s grandparents lessons on debt helped Rosen Hotels & Resorts survive through COVID-19. 10:30 – Trying an alternate path: How an increase in healthcare costs led Harris to explore ways to provide primary care to his own employees. 15:00 – “Rosen Care”: The initial success that led to over $450 million in healthcare savings. 17:30 – Primary Care: Increasing access to quality primary care to employees via clinic access, benefit design & removing barriers. 23:10 – How having an onsite clinic has impacted the health of employees and has lowered healthcare costs 24:20 – Living by K.I.S.S and P.P.P.P.P.P – Keep It Simple Stupid and Prior Planning Prevents Piss Poor Performance 25:50 – Encouraging Compliance: How to allow your employees to choose health over saving money 29:10 – Why hospitals aren’t interested in competition and why the government and employers should get tough 31:45 – Steering the employee towards high quality health care to create lower costs 33:30 – Saving nearly half a billion dollars and Harris Rosen’s philanthropy 39:00 – Managing a hospitality business and enticing people to work for Rosen Hotels and Resorts 43:00 – If there was one question I should have asked: Fighting back against the insurance companies 44:40 – How you can learn from Rosen’s model and implement it inside your business. Resources: Rosen Hotels & Resorts, Inc.: https://www.rosenhotels.com/ ProvInsure: https://www.provinsure.com/ Podcast Links: Website: http://www.reconstructinghealthcare.com/ Apple Podcasts: https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325 Instagram: https://www.instagram.com/reconstructinghealthcare/ Facebook: https://www.facebook.com/ReconstructingHealthcare/ LinkedIn: https://www.linkedin.com/in/michaelmenerey/…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Marshall Allen 52:09

acum 4 years52:09

52:09

Marshall Allen is an investigative journalist that has spent more than fifteen years exposing the ways that the health care industry preys on vulnerable Americans. Marshall currently writes for ProPublica and was part of the team to be a Pulitzer finalist for their work in covering COVID-19. In this episode, Marshall discusses how his time investigating the American healthcare system has led to writing his new book, titled “Never Pay the First Bill: and Other Ways to Fight the Health Care System and Win.” Marshall’s career has seen him honoured with multiple journalism awards, such as the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting and coming in as a finalist for the Pulitzer for his work at the Las Vegas Sun, where he worked before writing at ProPublica in 2011. In this episode, you’ll hear about real-life victories as employers and employees fight the healthcare industry. From dealing with price gouging, errors in billing, fraud and unnecessary treatments, Marshall has seen it all. Tune in to hear how employers and employees can fight back and protect themselves from being taken advantage of by the healthcare delivery and payment system. Here’s a glance at what you’ll hear from Marshall in this episode: Why Americans pay so much for healthcare whilst getting so little in return How Marshall’s career in investigative journalism led to him writing ‘Never Pay the First Bill’ Why the business side of healthcare was designed to exploit both clinicians and patients How hospitals and insurance companies look after each other rather than the employee/employer. The inefficiencies and errors presented in the majority of medical bills and how to fight back Timestamps: 0:20 – Introduction to Marshall Allen 2:20 – Why did Marshall write: ‘Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win’ 7:08 – “The business side of healthcare was designed to exploit both clinicians and patients” – How the healthcare system takes advantage of Americans 9:00 – The price variation patients deal with when going to hospital 11:35 – Why aren’t hospitals showing transparent pricing and why aren’t insurance companies loyal to the employer/employee? 15:15 – Employers are passing costs onto their employees 16:30 – Increasing health literacy for employees and employers 17:20 – How common are errors in medical bills? 19:20 – The medical debt collecting industry 21:30 – How to deal with medical debt 22:18 – Why would you sue a medical provider for an unfair bill 24:20 – The open price contract rule: Don’t pay more than Medicare would 26:04 – How a hospital would react to a lawsuit in Small Claims Court 28:00 – Using a referenced based pricing plan and why hospitals don’t like it 30:20 – Share your medical finance victories with Marshall 31:10 – Everybody’s Guide to Small Claims Court 31:58 – Being aware of medical finance risks and how to avoid them 33:45 – Avoiding unnecessary care 34:10 – Avoiding immediate care 35:20 – Mammograms: An unnecessary care example? 38:05 – Stories of fraud in medical care and finance 40:40 – The David Williams case 44:00 – Who investigates fraud? 46:30 – Standing up to a bully: How to push back 49:45 – How to connect with Marshall Allen Resources: Follow Marshall Allen on ProPublica: https://www.propublica.org/people/marshall-allen Follow Marshall Allen on Twitter: https://twitter.com/marshall_allen?lang=en Connect with Marshall Allen via LinkedIn: https://www.linkedin.com/in/marshallallen/ Never Pay the First Bill on Amazon: https://amzn.to/3tS01ZQ Marshall Allen’s website: https://www.marshallallen.com/about-marshall Fair Health Consumer: https://www.fairhealthconsumer.org/ Everybody’s Guide to Small Claims Court: https://www.amazon.com/Everybodys-Guide-Small-Claims-Court/dp/1413316883 Podcast Links: Website: http://www.reconstructinghealthcare.com/ Apple Podcasts: https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325 Instagram: https://www.instagram.com/reconstructinghealthcare/ Facebook: https://www.facebook.com/ReconstructingHealthcare/ LinkedIn: https://www.linkedin.com/in/michaelmenerey/…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Dave Jacobs and David Greenberg | Homethrive 50:11

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Dave Jacobs and David Greenberg join the podcast to discuss how Homethrive is providing their customers access to their own master’s level social worker and a digital platform to help provide care for their aging loved ones at home. Prior to Homethrive, Dave and David both served at Medline. Dave Jacobs as President of the Durable Medical Equipment division and Medline’s Post-Acute business that encompassed nursing homes, home health, assisted living and managed care insurance. David Greenberg served as Executive Vice President of Strategy and Group President, defining and supporting strategic priorities, leading business development initiatives to strengthen the Medline portfolio, and M&A. In this episode, you’ll hear why Dave and David decided to leave their high paying Senior-Executive roles at well-respected companies to create Homethrive. You’ll hear how Homethrive is helping people look after their aging parents while allowing them to stay in their own homes, instead of an aged care facility. Here’s a glance at what you’ll learn from Dave Jacobs and David Greenberg in this episode: The foundation story of Homethrive: Why the co-founders left their Senior-Executive roles to create their own company. How Homethrive is helping people look after their aging parents while allowing them to stay at home instead of an Aged Care Home. Why Traditional Benefit Offerings often aren’t enough for employees burdened with care-related responsibilities for their aging parents. How Homethrive is able to provide each customer with their own unique Care Guide and the types of services they offer. The positive impact this can have on employees knowing they have an advocate to address elder care issues for loved ones. Timestamps: 0:22 – Welcoming David and Dave to the show 1:00 – Who is Dave Jacobs? 2:00 – Who is David Greenberg? 3:42 – Why David and Dave left their Senior-Executive roles to create Homethrive 8:20 – The state of traditional benefit offerings in the age of COVID-19 10:50 – How organizations can transition their benefit offerings as employees and their parent's age 12:20 – Diversity, Equity, and Inclusion: Is their inequity in benefits and healthcare? 14:15 – The Homethrive Product: What problems are Homethrive trying to solve? 16:40 – Homethrive’s Unique Product Offering: Your own Care Guide and access to technology 20:55 – A concierge resource for eldercare issues and unique needs 24:20 – The Employee Experience: How do the children of aging parents use Homethrive? 27:00 – The Scope of the Problem: Do companies know that their employees need to have access to aged care? 28:10 – Suffering in Silence: Why aren’t employees bringing aged care up with CHRO’s? 30:10 – How does Homethrive recruit their Care Guides? 33:50 – The outcomes of Homethrive so far: Increasing productivity, reducing stress, increasing quality time 36:30 – How COVID-19 has impacted the Homethrive service 37:10 – Targeted Segments: The fee structure for the employer segment 39:50 – How many employees are managed under Homethrive and the incentives being offered 42:08 – Why Geography isn’t an issue 43:35 – If there was one question that I didn’t ask: How much of a need aged care is in the US? 45:55 – Being a high touch service company whilst utilizing technology 48:00 – How you can find more about Homethrive Resources: Homethrive: https://homethrive.com/ Dave Jacobs LinkedIn: https://www.linkedin.com/in/dave-jacobs-215b702/ David Greenberg LinkedIn: https://www.linkedin.com/in/david-c-greenberg/ Podcast Links: Website: http://www.reconstructinghealthcare.com/ Apple Podcasts: https://podcasts.apple.com/us/podcast/reconstructing-healthcare-innovative-solutions-for/id1240066325 Instagram: https://www.instagram.com/reconstructinghealthcare/ Facebook: https://www.facebook.com/ReconstructingHealthcare/ LinkedIn: https://www.linkedin.com/in/michaelmenerey/…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Nate Murray | Crossover Health 55:57

acum 4 years55:57

55:57

In this episode, Michael interviews Nate Murray, the Chief Business Development Officer at Crossover Health. Crossover Health is a national primary care medical group that connects employees with remarkable care options while helping employers take control of their healthcare spend. In this episode, you’ll hear about some of the deficiencies in primary care today and why many large employers have started to engage in direct contracts with providers to offer improved primary care to their employees. Tune in to hear about the evolution of the Crossover Health primary care model and how they are using a team based approach to deliver extraordinary care for their members. Here’s a glance at what you’ll learn from Nate in this episode: What the Health 2.0 movement is and where it’s going. Why rushed doctor visits equate to poor healthcare and how this impacts costs How deals with Apple, Facebook and Amazon helped Crossover Health design a primary health model. How Crossover Health creates a relationship between patients and doctors How integrating behavioral health and physical therapy into the Crossover model impacts patient care How effective primary care can help companies reduce their downstream costs. Timestamps: 0:22 – Introducing Nate and Crossover Health 2:55 – How Nate got into healthcare 4:38 – Nate’s wife having rheumatoid arthritis exposed the inability between what insurance companies were capable of compared to doctors. 7:16 – It’s less about the health insurance, and it’s more about the quality of healthcare that’s having an impact on costs. 8:12 – The Primary Care Crisis: Primary Care is the speedbump to the expensive healthcare industry. 11:20 – The system is lowering the quality of care. Doctors can’t provide quality if they’re seeing 30 patients a day. 14:48 – Crossover Health: How they transitioned into focusing on primary care by securing a deal with Apple. 18:00 – The Foundation of Primary Health: How Crossover is able to provide virtual primary care in all 50 states. 19:00 – The Triple Aim: Quality Experience Outcome 22:20 – Integrated Care Teams: How to analyze what a patient needs and then deploy a team to create the outcomes needed. 26:00 – Creating “Touch Points” with a patient: “Regular” is about having a relationship with a patient, rather than infrequent check-ups. 30:00 – Sherpaa Acquisition: How Crossover is acquiring companies to help deliver their triple aim. 32:00 – Creating a new offering with virtual primary care 34:12 – How did COVID-19 impact the utilization of virtual primary care?: “We could still operate and serve patients remotely.” 35:40 – Reaching out to 100,000 members to ensure they had care during COVID-19. 37:50 – Primary Care Doctors went above and beyond during COVID: “They were in it for the right reasons and didn’t turn away patients.” 38:34 – Crossover Pricing Studies: How the economics of primary care help companies reduce their downstream costs. 44:08 – The goal is to allow our patients to create trust with our recommended doctors. 45:24 – How Crossover bills for its services 46:35 – ‘Fee for Service’ creates an environment to rush patient visits. Crossover is strongly against fee for service. 47:39 – Implementing a value-based cap to dissuade overbilling. 51:40 – Patient Experience: How Crossover got a Net Promoter Score north of 90. 54:04 – Employers need to take a step back and consider “how can my employees trust our healthcare service?” 55:08 – Conclusion Resources: Crossover Health Website: https://crossoverhealth.com/ Nate Murray’s LinkedIn: https://www.linkedin.com/in/nathanlmurray/…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Christin Deacon | Amino 49:24

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In this episode, Michael moderates a webinar that highlights an employer who took action to help their employees find higher quality, more cost-effective care. The episode highlights two panelists, one with Christin Deacon, the Assistant Director of the New Jersey State Health Plans, and the second with David Vivero, the Co-Founder and CEO of Amino. Christin is a healthcare leader and public sector entrepreneur. She is a former deputy attorney general and private sector restructuring attorney, and her unique background allows her to have a different perspective on the status quo in the realm of healthcare. She engaged with Amino to get ahold of out-of-network spend and make an impact on the trajectory of cost in New Jersey, which is $2B on pharmacy and $5B on medical and growing. When David Vivero spoke with Christin and learned the needs of the state and its members, he learned that staying within the network and better hospital selection were primary concerns. Employers and employees were having trouble finding cost-effective care, and he knew Amino’s platform could solve for that. The state was able to move fast and implement Amino in just eight months, and their first push was the digital experience and matching people with the right provider and tools. David explains that the goal was to solve the three fundamental problems of healthcare guidance: providing the data to inform a good decision, creating an experience that delivers results, and distributing it effectively. The Amino Smart Match label finds the high-performance network by stratifying the network by cost, quality, experience, and appropriateness, and their Integrated Benefits Tool connects the dots in the healthcare system so members cut through the noise and find exactly what they need. Amino is all about “Getting back to it.” They understand that people don’t want to be experts in healthcare and just want to be healthy with the support of quality, cost-effective care. And with an NPS score of over 80, it’s working. On the horizon, Christian sees more engagement in digital health, a spike in telemedicine, new models of delivery, and more opportunities for education. As for Amino, they have an exciting road ahead. They’re following trends in the market, working towards ER avoidance, and getting into retail clinics. Here’s a glance at what we discuss in this episode: 00:30 - Introducing the panelists and discussion. 03:00 – Christin’s unique background, burnout, and draw to public service. 04:15 – The division of pensions and benefits and the health benefits climate in 2018. 05:10 – Status quo, out-of-network spending, and getting ahold of cost and spend. 05:50 – The trajectory of cost: $2B of pharmacy, $5B on medical and growing. 6:35 – One or two large claimants can make or break a year; you can’t assume someone is watching every dollar with such a large plan. 07:00 – Her interest in Amino; she listens to podcasts, including the Reconstructing Health podcast, and heard the interview with David Vivero. 07:45 – David’s first conversation with Christin and how the Amino solution can benefit the state. 08:15 – The first few conversations were about learning the needs of the state and its members, specifically, staying in-network vs. out and hospital selection. 10:05 – They learned the challenges, stakeholders, and experience and the ways Amino could help. 10:50 – Employers and employees have trouble finding cost-effective care; Amino solves for that. 11:30 – They implement Amino in 8 months; Christin’s first step in moving it forward was the digital experience and matching people with the right providers and tools. 13:25 – They integrated Amino through their carrier to be wherever members go to get their information. 14:05 – The obstacles Christin faced when replacing Horizon’s tool with Amino’s. 14:25 – There’s general reluctance and lack of trust when there is a loss of control; they were forced to think differently. 15:00 – The fundamental problem of healthcare guidance in 3 layers and how Amino solves for them in a centralized way: 15:25 – #1: Do you have the data to inform a good decision? 15:45 – #2: Are you able to create an experience that delivers results? 16:05 – #3: How does that get distributed? 16:30 – Amino’s data already saw discharges, claims, what people are claiming and getting, and referral patterns, patient patterns. 17:20 – The Smart Match Label: Finding the high-performance network by stratifying the network by cost, quality, experience, and appropriateness. 18:05 – They are flexible to support any existing platforms. 19:20 – Their unified benefits communication system and central platform have big implications. 20:00 – Quality, communication, and engagement made it a platform member would actually use. 22:05 – The Integrated Benefits Tool: The thing that connects the dots in the healthcare ecosystem. 24:00 – People like Christin may work with benefits consultants, but members don’t; they need integrated benefits/tools layered organically in search results. 26:30 – Christin launched Amino in June of 2020, off-cycle to their benefits year; it wasn’t intentional but lent itself to a lot of opportunities. 28:00 – She believes off-cycle launches are important to help people better engage in the healthcare system and move away from the status quo. 28:50 – The first six months of product launch: 29:15 – Everyone is digital now; they sent out emails and tied a wellness point program to creating an Amino account as an incentive. 30:05 – Their 2021 communications calendar includes educators and is strategic ongoing engagement with micro-populations. 31:30 – What Amino is all about: “Get back to it.” 31:30 – None of us want to be experts in healthcare; we just want to be healthy. 32:25 – The goal is to just get people to use it. Their NPS is over 80 and people will come back if they just use it once. 33:30 – Michael’s personal testimonial for Amino. 34:50 – People just want to do less in healthcare; it should be a benefit, not a trade-off for members, and it should be about quality, not just cost savings. 35:35 – The variance of quality and cost in healthcare: 36:00 – We value choice but we don’t consume a whole network; Amino takes claims data sets and scores them to better guide people to providers. 39:10 – Christin’s learnings with Amino: lots of Musculoskeletal needs, quality delivers on multiple fronts, word-of-mouth is important, member testimonials. 41:05 – What’s on the horizon for Christian: members engaging in digital health, a spike in telemedicine, new models of delivery, opportunities for education. 42:00 – Amino is following the trends in the market, working towards ER avoidance, retail clinics, and backlogging MSK surgeries. 43:30 – Amino Refer: Access to intelligence in real-time. 45:50 – The difference between transparency and guidance: They direct to primary care or virtual care when this kind of guidance is needed – they still request referrals. Resources Amino…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

1
Omar Dawood | Calm 45:20

acum 4 years45:20

45:20

In this episode, Michael interviews Omar Dawood, the Chief Medical Officer and Head of Sales at Calm, the #1 app for sleep, meditation and relaxation. The app has over 100 million downloads and over 1.5M 5-star reviews. Omar is a clinician and stage IV cancer survivor with over 25 years of senior management, medical research and clinical experience, innovating medical devices and digital health products as a senior executive. At Calm, he leads B2B employer and health plan sales and is passionate about helping people around the globe lead healthier, happier lives by building resilience through better sleep and improved mindfulness. While 20% of Americans are dealing with a mental health illness of some sort, Omar believes that we shouldn’t forget about the other 80% of people who experience stress and anxiety without a mental health diagnosis. That’s where Calm comes in to act as a preventative measure to improve behavioral and mental health as well as resilience through mindfulness practices, meditation, and strategies for better sleep. Calm started as a B2C app but is making strides in the B2B sector to support employers, employees, and organizations. And it’s working. The sign-up rate on employer accounts is 30% with 80% engagement, and the experiences it offers – like the “Daily Calm” and “Sleep Story” – are helping employees reduce stress, sleep better, respond better to life, communicate more effectively, and boost immunity around the world. The benefits Calm offers to organizations and employees is clear. For organizations, they provide actionable insights and aggregate trends. For employees, they offer pathways to increased resilience and wellbeing and a “Calm Effect” that touches every area of their life. Calm’s NPS is just over 70 and they do qualitative ratings and satisfaction measurements in a number of ways. The team at Calm is excited for more innovation in behavioral and mental health and encourage collaboration in the field in order to spread health and happiness to billions. Here’s a glance at what we discuss in this episode: 00:50 - Introducing Omar and Calm. 02:30 – His cancer diagnosis changed his view on medicine and the industry’s lack of data; he didn’t appreciate the value of mental and behavioral health until 10 years ago. 04:45 – He saw a need to bring an engaging experience to behavioral health; this is how he came upon Calm and loves his role in bringing that to employers/employees. 06:30 – The 1 in 5 statistic: Omar believes we should consider the preventative health of the other 80% who also experience stress and anxiety but aren’t diagnosed. 08:50 – The pandemic opened up the dialogue that we’re all coping and should do something about it because we’re human, not because we’ve been diagnosed. 10:00 – Most employees experience stress and anxiety; digital health made help easier and more accessible, but still sat downstream in terms of treatment. 12:50 – What was missing was something more upstream and preventative. 13:00 – EAP services 0-3% engagement, Calm’s sign-up rate is 30% on employer accounts and average engagement of 80%; it’s not seen as behavioral health at all. 14:40 – Calm is an experience, not a product, and becomes a part of the user’s life to support better resilience through meditation, mindfulness, and better sleep. 16:30 – They started with B2C and are now working with employers and organizations to broaden their impact. 18:15 – The benefits of meditation: The “Daily Calm” content through the app helps people respond (not react) to life and communicate better. 21:30 – It impacts your immune system, your ability to support yourself through challenges, and shift your perspective. 23:20 – Narrated mindfulness topics: Gratitude, visualization, positive frameworks, communication. 27:00 – Using Calm for better sleep: The “Sleep Story” is a bedtime story told by a narrator of your selection, they now have clinical evidence and studies around it. 30:50 – Calm for Kids: Kids are taught nutrition and exercise early on but should also learn mental and behavioral health skills. 31:40 – It’s best if everyone in the household is on board with healthy habits. 32:30 – There is music, a journal, and a mood tracker in Calm; they see what the market wants then are thoughtful about how they develop it. 36:20 – Calm’s value for organizations: For organizations they provide actionable insights and aggregate trends. 37:30 - Calm’s value for employees: Increased access to behavioral health and the “Calm Effect.” 39:40 – Their NPS is just over 70, they do qualitative ratings (app reviews), and measure satisfaction in a number of ways. 40:30 – It resonates across every sector and is benefitting a huge variety of organizations. 42:00 – Engagement is easy; most people have already used Calm, know someone who has, or has heard of it. 42:30 – Calm is for employers who want to help their employees. 43:10 – What’s next: They don’t sit idle and encourage more innovation in behavioral and mental health. Resources Calm…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

1
Justin Leader | Highlight Health 42:29

acum 4 years42:29

42:29

In this episode, Michael introduces Justin Leader , the CMO of Highlight Health and a self-funded benefits and risk advisor . Early in his career, Justin learned about the major shortcomings of the healthcare and health insurance industry and how it is built for profitability, not value. When he met Josh Spivak, the CEO of Highlight Health, they saw an opportunity to build a better solution for an underserved segment of the population. Highlight Health’s mission is to deliver affordable and accessible healthcare to the nation’s underinsured populations. Their product is not a health insurance product, but rather a healthcare product where in exchange for a fee, an employer’s underinsured employees get access to healthcare, education, and an advocate. The populations they serve typically don’t work enough hours to qualify for full time benefits, can’t afford their traditional benefits, or may be offered limited MEC or Minimum Value plans that really don’t offer access to comprehensive healthcare. Highlight Health’s goal is to systemically help people access 80-90% of their basic healthcare needs through their platform and mitigate risk for catastrophic events. Highlight Health differs from other vendors in the market by providing an advocacy service for members and negotiating with Hospitals to provide inpatient and outpatient care at zero or reduced cost through federally-funded programs. Highlight Health is busy collecting feedback and success stories from members and they look forward to a future full of collaborations and philosophically-aligned partnerships to better serve their members. Here’s a glance at what we discuss in this episode: 01:00 - Introducing Justin and Highlight Health. 02:40 - How he got into benefits consulting. 05:45 - How he became a part of Highlight Health. 07:50 - The political approach to healthcare and the point that’s missed. 09:00 - There’s tremendous pain when trying to navigate the healthcare system. 11:45 - The collective problem in healthcare and the responsibility all must take. 12:40 - The working poor and healthcare illiteracy. 14:00 - The difference between health insurance and healthcare. 14:15 - The Highlight Health product; your friend in healthcare. 15:10 - They focus on accessibility and care; advocacy is a cornerstone. 16:45 - They provide education and value to empower people to make better decisions. 18:22 - They take regulations and laws and leverage them to access care across the country. 19:30 - This is not a health insurance product, it's a healthcare, capitated product. 21:10 - Thoughts on GAP funding. 21:40 - How the drug component of Highlight Health works. 24:30 - Highlight Health’s vision for the future. 25:20 - How community-based programs work and how Highlight Health would help a member get care in a selected hospital system. 28:40 - Their goal is to systemically help people access 80-90% of their basic needs through their platform and mitigate risk for catastrophic events. 29:25 - They can provide compliance components and supplemental products. 32:00 - The employer’s get a simple, consolidated bill from Highlight Health. 33:05 - Employee outreach: They communicate the programs appropriately and offer virtual support. 36:30 - They’re collecting feedback and success stories and are holding big institutions accountable for the community care they’re required to provide. 39:00 - He’s looking forward to getting people excited for something new, collaborations, philosophically-aligned partnerships, and to leave a legacy. Resources Highlight Health LinkedIn…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Doug Aldeen | ERISA Attorney 46:59

acum 4 years46:59

46:59

In this episode, Michael introduces Doug Aldeen , a healthcare and ERISA attorney . He has represented reference-based pricing organizations, PPO networks, medium to small self-funded plans, TPA’s and provider sponsored HMO’s in various capacities. Doug started his career at an insurance defense firm, then worked at a local HMO for years. It was there that he learned the ins-and-outs of the healthcare industry and realized that “discounts” aren’t real, but the prevalence and unsustainability of cost-shifting very much are. He found that in many cases there’s no correlation between what hospitals charge and their cost, and “turbo-charging”—where hospitals raise billed charges at unreasonable rates—is common in commercial insurance yet illegal in the Medicare world. Doug has seen “turbo-charging” of 12-24x, and 30x pricing on prescriptions and implants. Surprisingly, employers are often completely unaware of what’s going on under the hood of their healthcare plan. They’re left in the dark because of limited access to data, billing statements without itemized, line-item costs, and “Revenue Neutrality Agreements” that sometimes allow providers to be paid more than they bill. Doug believes commercial insurance plans serve as an ATM for hospitals at the employers and patients expense, all because no one is monitoring, auditing, and demanding to see what’s getting billed, what’s getting paid, and why. And with the employer fiduciary duty under ERISA, this could be a costly oversight for employers that may lead to lawsuits in the future. Doug works primarily with employers who have self-funded plans and reference-based pricing plans. He develops direct contracts with Hospitals and Providers on behalf of employers and their employees. For Doug, a successful agreement with a provider should be simple; only clean claims are paid, all claims are auditable, price is reasonable and there is a benefit incentive for employees to receive care at the facility. More importantly, a safe harbor has been created where the employee can receive care without having to worry about balance bills which are not allowed under the contract. With his day to day work and advisory position at RIP Medical Debt, Doug is making a positive impact in the healthcare industry and we’re excited to see him keep up the good work. Here’s a glance at what we discuss in this episode: 00:30 - Introducing Doug, a healthcare and ERISA attorney who helps employers and payers offer affordable healthcare to employees and dependents. 02:12 - He’s been a lawyer for 28 years; he worked in an insurance defense firm doing dram shop cases in 1997 and ended up at a local HMO for 7 years. 03:30 - The most fundamental flaw in the industry: discounts aren’t real, overpaying, and cost shifting in the commercial market are unsustainable. 05:45 - There’s no relation between what they are charging and their cost; we need honest conversations and common middle ground. 06:30 - Hospital “turbo-charging”: Hospitals charge X and insurance companies match it with the premium; it’s “chumminess” between providers and insurance carriers. 08:35 - Turbo-charging is expressly illegal in the Medicare-world but not the same in the commercial world; you can see this anywhere from 12-24x. 09:30 - He’s seen 30x pricing on Rx and implants; CFOs need preservation of P&L and need to get motivated to understand how this all works. 11:00 - Turbo-charging is illegal with Medicare; we can’t vilify healthcare providers, it’s not them. 12:40 - Data ownership: Cigna owns the data and allows you to access it on a limited basis; the data should be a part of the plan; you should be able to see bill charges. 14:10 - Anthem has a “Revenue Neutrality Agreement” executed on the side with the hospital system - they found 30% of claims were paid more than the billed charges. 16:05 - Employers don’t know if they’re getting what they’re promised without an audit; they don’t even see itemized, line-item billings. 18:30 - Employers, keep an eye out for agreements where providers can be paid more than they actually bill. 19:40 - Health plan transparency regulations were just recently passed. Insurers must now share cost-sharing estimates at the request of an enrollee and publicly release negotiated rates for in-network providers, including out-of-network allowed amounts, billed charges, and drug price charges. 21:15 - Why a commercial plan is an ATM for hospitals; no one is really monitoring the store and there’s nowhere else to really shop. 22:40 - Employer fiduciary duty under ERISA: Similar to fiduciary responsibility with respect to 401Ks 23:50 - Employers are fiduciaries to make sure they’re paying a fair price for healthcare on behalf of employees—you can’t do that with “network discount” products. 25:30 - Employees could sue an employer for breach of a fiduciary duty and it happens all the time in the 401K world. 26:00 - Doug’s direct contracting work: He works with employers who have self-funded plans and reference-based pricing plans; he gets hospital financials to see their numbers. 26:50 - By doing this, he sees the cost-shifting that occurs by comparing Medicare and commercial costs. 27:50 - He gets the data and their true costs; it’s all available for those who look and can read it. 28:45 - AGB (Average Gross Bill Charge) is all claims divided by all payments; you need the data to know where the gap is. 30:10 - In some cases, they tell you to go somewhere else; they will not base any contract on a percentage of Medicare. 31:00 - Key components of a successful agreement: Paid consistently, a covered benefit, auditable, clean claims only. 32:15 - Waiving co-pays and having a safe harbor provides the right incentive for employees to stay healthy and get care. 34:30 - Hospitals cannot unilaterally charge gross bill charges without first determining eligibility under their financial assistance policies (FAP); this jeopardizes 501R & 501c3. 37:55 - Doug’s fee structure: Flat fee + PMPM for 12-18 months. 39:10 - Start with hospital financials to see which ones are healthy; know the competition. 40:05 - RIP Medical Debt: They buy medical debt on the secondary market to forgive people’s medical debt. Resources Doug Aldeen RIP Medical Debt Doug’s LinkedIn…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Mike Poelman | Apta Health 51:44

acum 4 years51:44

51:44

In this episode, Michael introduces Mike Poelman , the founder and president of Apta Health . Although Mike started his career as an accountant and controller, he quickly realized that he was a salesman at heart so he shifted into the TPA world working on self-funded health plans. This is where he realized that things needed to be done differently. Mike saw that lack of transparency and collusion were the biggest problems in the industry, and legacy solutions simply weren’t designed to provide employers what they needed, which is what inspired him to create a number of companies, including Apta Health. Apta Health aggregates middle market employer groups under one umbrella so they can benefit from care coordination and cost containment solutions that are typically only available to Fortune 500 size companies. This member centric approach allows more effective customer service, higher member engagement by a team of experts/advocates to reduce provider gaps, contain costs, and improve the member journey. In fact, 88% of employees engage with a care coordinator even before a claim enters the system, which is unheard of in the industry. The team at Apta Health has an NPS rating of over 70 for their members, employers, and providers because of their attention to the customer experience first and the TPA second. Apta Health has an exciting future ahead. They’ve recently won the 2020 Health Value Award from the Validation Institute and look forward to continuing their use of analytics and data to empower brokers and employer groups to make easy, cost-effective decisions. Here’s a glance at what we discuss in this episode: 00:45 - Introducing Mike, the founder and president of Apta Health, who is passionate about providing self-insured solutions. 01:05 - Apta Health is a provider of care coordination and cost-containment solutions to optimize self-funded healthcare programs. 02:30 - He started as an accountant and controller but is a salesman at heart; when he first started in the industry, all he had was a phone book and phone. 04:05 - He didn’t intend to be a part of a TPA but he knew he wanted to change things by looking from an employer standpoint first. 04:40 - He started Novo Benefits, a platform where employers are empowered to get direct contacts and unbundle their programs. 05:30 - They’ve evolved into an aggregator with Apta Health; they are changing the industry and empowering employer groups. 06:50 - The key issues in the healthcare industry: transparency and collusion. 09:00 - What Apta Health does: They aggregate employer groups under one umbrella so they can benefit from large group level pricing, solutions, and engagement. 10:36 - They offer Fortune 500-level engagement to the underserved middle-market. 11:00 - The Quantum care coordination model and how it’s different: more effective disease management, better execution, and functionalities done by one pod. 12:30 - Apta is a conglomerate of solutions; they’re getting 200% better engagement 13:50 - The member journey, reduce provider gaps, drive the member experience, and get results and better engagement. 15:47 - A team of experts/nurses help guide and navigate patients through disease management to get them what they need, not just verify coverage. 17:25 - The pod team helps members find more cost-effective solutions they may not know about and create a trusting relationship with members. 21:15 - Stories of above-and-beyond service from the team that is fighting for the member. 22:35 - Deep analytics helps decide what’s best for groups, they use quality metrics, point solutions drive what needs to happen, and an easy number to reach support. 25:15 - Their PCP-centric model helped them avoid wasteful spending; the real-time intercept helps direct members and helps them avoid unnecessary tests. 28:00 - Mike shares his experience with his daughter to illustrate how a navigator can help you avoid certain costs and redundancies. 30:05 - 88% of employees are engaged with real-time intercept/ a care coordinator before claims come into the system - this is unheard of in the industry. 31:20 - They promote preventative care and have a care coordinator review paperwork and post-discharge instructions to ensure accuracy. 35:00 - On tracking the consumer experience (The Net Promoter Score): They track the member, employer, and provider and are above 70 across the board. 36:20 - On integrating with a TPA and expanding into other areas; they have something in every category now. 38:05 - The customer experience is first and the TPA is second. 38:45 - Independent analysis shows a 2.9% compounded annual growth rate (compared to the industry 8.5%). 39:25 - Rough point solutions drive book-of-business cost reductions across the board. 40:28 - Medical and Rx analytics were sent to the Validation Institute for the Health Value Awards. 41:40 - Other main point solutions of the platform: They have over a dozen that people look to, like Quantum, NavRx, second opinions, and cash pay. 44:00 - Fraud waste and abuse: They have trust accounts to get money back to employer groups. 46:35 - The fee structure: A discounted PMPM from Quantum converted to a PEPM. 47:10 - Obstacles: The employers say yes more often than the brokers; the biggest thing to overcome is the cost component. 49:05 - The future of Apta Health: Analytics, data, point-and-click things are coming to empower brokers and employer groups to make easy decisions. Resources Apta Health…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Dr. Simon Mathews | Vivante Health 47:12

acum 5 years47:12

47:12

In this episode, Michael introduces Dr. Simon Mathews , a distinguished researcher, clinician, author, and Chief Medical Officer at Vivante Health . He is also a practicing gastroenterologist at the John Hopkins School of Medicine and the Head of Clinical Innovation at John Hopkin’s Armstrong Institute of Patient Safety and Quality. Simon’s research centers around understanding and improving the quality of digital health for patients. Unfortunately, he finds that the key issues in healthcare revolve around inefficiency, fragmentation, and a lack of a team-based approach that is centered around the patient’s best interest. This inspired him to work with Vivante Health, so patients with digestive issues could get the personalized, tech-forward support they need to heal. And with digestive disorders—everything from reflux to IBS to autoimmune disorders—making up a burden of $136 billion dollars on an annual basis, it’s clear that there’s a serious need. Vivante Health serves the large, underappreciated, and sometimes stigmatized realm of digestive disorders with a comprehensive and personalized digital platform. Patients are provided with a care team, including a licensed dietician and health coach, and their progress is supported with app reminders, appointment support, check-ins, and progress reports. Although tech is leveraged to best support the patient and their results, it’s the care team outreach and their personal touch that bridges the gap for truly positive user experience and improved outcomes. The care team at Vivante Health has an NPS rating of nearly 80. They work primarily with employers and are flexible in the way they integrate with new and existing systems. Although excited for everything currently underway, Simon looks forward to more clinical pathways and screenings in the future to continue to help patients quietly or outwardly suffering from digestive disorders. Here’s a glance at what we discuss in this episode: 01:00 - Introducing Simon, his accolades, and how he came to work with Vivante Health. 03:00 - He studies the space of digital health, it’s gaps, and it’s solutions, which was a perfect fit for Vivante Health. 04:20 - Key issues in healthcare: Inefficiency, fragmentation, and a lack of a team-based approach. 06:45 - On digestive disorders: Nobody has digestive disease in general, they have something specific like reflux, IBS, a type of liver disease, pancreatitis, etc. 08:25 - Digestive disorders make up a burden of $136 billion annually; they come with a stigma and people don’t always feel comfortable with it. 09:38 - How digestive disorders are being treated today and the cost implications vary widely, as the types of disorders vary. 12:30 - The link between gut health and overall health, including immune and emotional health; there’s a connection. 15:05 - The Vivante Health product and service; the space they serve is large and underappreciated. 15:40 - It’s a comprehensive digital platform that addresses the management of the digestive disease and is integrated with common tech and a care team. 16:15 - With a health coach and licensed dietician, patients get a personalized program based on their history, gaps in care, best practices, and evidence. 19:05 - How they improve the customer experience: App reminders, appointment navigation, health coach support, check-ins, assessment tools, and progress reports. 21:30 - The microbiome assessment: Certain diets/lifestyles have certain bacterial compositions and we can manipulate that bacteria, our microbiome. 25:00 - The clinical rigor and evidence are of utmost importance for Simon and Vivante. 27:30 - How progress is tracked with Vivante Health: Assessments, trend anticipation, self-management improvement, and care team outreach. 30:45 - Their care team NPS rating is almost 80 and people appreciate a personal touch. 31:45 - On cost: Over 2x ROI according to a case study, great feedback, and great savings and experience. 33:15 - Marketing the program and getting patients; they have full-spectrum support depending on what a client wants and needs. 34:20 - Fee structure: It’s usually per active member per month, on a quarterly basis; people don’t get billed for something that isn’t used. 35:30 - They have a dozen clients and a great spectrum in terms of the number of employees; they have several thousand active members. 36:30 - The challenge: Many people don’t realize how big a deal digestive disorders are. 42:35 - Exciting things ahead: Clinical pathways and screenings to help people better and more easily; data, research, and analytics that are underway. Resources Vivante Health smathews@vivantehealth.com…

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

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Dawn Cornelis | ClaimInformatics 48:43

acum 5 years48:43