The ShiftShapers Podcast

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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