Voices of Self Funding

Prepare yourself for a transformative exploration as we delve into the critical realm of Musculoskeletal (MSK) programs. In this eye-opening discussion, long-time orthopedic surgeon, Dr. Steven Schutzer examines the exorbitant costs associated with unnecessary surgeries and how self-funded employers could scale models to tackle the MSK issue head on. We talked about how Virtual Diagnosis could be...

Employers want a new solution every quarter and expect the TPA to integrate, share data, enroll and support the member. This makes it difficult to not only evaluate the impact of point solutions, but also to access data across solutions and drive substantial value. How should you address this? And how should you approach the explosion of point solutions? This episode was sponsored by Ikigai Growth...

In this podcast, we talked with two experienced private equity investors in the self-funded space and learned about their 25-year history. The discussion delves into how each PE firm's investments help to differentiate and grow businesses. We explore failures and changes in the self-insured market, including cost containment, alternative contracting, and member experience. The podcast also covered...

Surgeries are hard on everyone involved. Patients, family, providers, and employers as they have to foot the bill. There are many things that go wrong in our fee-for-service healthcare system. Gatorade can help fix this for everyone involved. Yes, listen to how a specialized surgery management program uses Gatorade drink and their secret sauce to make this a great experience for everyone involved...

With increasing complexity self-insured employers select TPAs or carriers based on a number of criteria. And decide to work with the partner if they deliver value, and can showcase it. How do you deliver and communicate value to self-insured employer? And how can a TPA capture the value? This episode was sponsored by Ikigai Growth Partners . For more information on capturing value or other topics...

In this podcast we sit down with Spencer, the host of "Self-funded with Spencer," the other podcaster serving the self-insured employer industry. We both reflect on what we learned from talking to experts in 2022, and what we are seeing in 2023 for RBP, captives, stop loss, care navigation, price transparency, and cost containment. This is a highly impactful podcast that synthesizes the 2021 and g...

Member engagement is increasingly challenging with the fragmentation of solutions being offered. While more solutions should be an opportunity, Joe Hodges from CareValet goes deeper into the topic of member engagement and healthcare benefits. Join in on the conversation as Ramesh and Joe uncover specific ideas on how to increase engagement, the value of it, and the steps TPAs should take to start...

Nurse navigation and advocacy have become very popular topics, but we don't know what aspects of nurse navigation are key in reducing costs and delivering a good member or patient experience. In many cases, the connection between nurse navigation and reduction in healthcare cost reduction has not been investigated properly. In this episode, Casey and John break down the key steps of nurse navigati...

In this episode, Ramesh sits down with Rob Gelb from Valenz and Jeff Bak from Imagine360 to discuss the key trends in the cost containment space. Some of the questions that will be answered include; What are the different ways employers can contain costs? What is going to be effective in the post-price transparency future? Where does RBP sit in the spectrum of solutions? This episode was sponsored...

Do you want to know how to drive value from DPC? In this episode, Ramesh sits down with Dr. Jeremy Smith and Katelynn Smith from MyMDConnect, as well as David Jacobson VP of Sales at Entrust to discuss DPC and care navigation. How do you ensure members are using it, and using it appropriately? What has been the ROI of DPC and concierge programs? For more information on DPC or other topics related...

Everyone has talked about price transparency, and how much it is going to change. In this episode, Ramesh sits down with the Founder of Launchpad, Mike Orth, to discuss brass tacks and price transparency. What does the plan sponsor need to provide? What are the fines? Why is it difficult? How can you simplify it? What is a three-step approach to delivering value to plan sponsors and capturing valu...

Every innovation that aims to improve healthcare costs, access, or outcome for self-insured employers can be pressure tested by the broker community and possibly vetted. Tune into this episode featuring Chris Fisher of BenefitsAlly, about the secrets to engaging brokers with your solution. Chris has done more than 125 messaging videos for different solutions to garner interest from brokers and has...

Dr. Makary, surgeon, public policy expert, and author of the book "Price we pay" talks passionately on this episode about how to bring disruption to the healthcare system. And how to go underneath the areas of focus to address the inappropriateness of care and the higher prices we pay for healthcare. What is ahead in 2022? How can you help shape the plans and programs to deliver value to your memb...

Post pandemic, mental health issues and substance abuse have reached a critical stage in our communities. Employers are asking, employee's families are experiencing a lot of challenges. Learn from Julie Meuller, an innovator in the self-funded space, who has put these mental health and substance abuse programs at her company and is helping 10s of other self-funded employers. This episode was spons...

In this episode, Ramesh goes to a higher level with the author of Never Pay the First Bill, Marshall Allen, to talk about how employers can educate their members about healthcare prices and the upcoming price transparency. This conversation provides a unique perspective on actions employers can take to leverage price transparency. This episode was sponsored by The Phia Group . For more information...

Care navigation programs are incredibly valuable in delivering a great experience for patients and significantly lower costs for employers. But why aren’t they the norm? Tune into this episode as our guest, Michelle Bounce, COO at J.P. Farley, a leading TPA, describes a life-changing personal encounter with our healthcare system, where she lost her child and faced the cold and impersonal healthcar...

If you are trying to leverage innovation to deliver high impact to self-insured employers, this podcast is a must-listen for you! Ashok Subramaniam, CEO and co-founder of Centivo, a forward-thinking TPA, answers some of the important questions of major disruptions in the industry around price transparency, unbundling of provider networks, stronger relationships between brokers and TPAs, and the ar...

Healthcare consumers don't trust our healthcare system. COVID-19 has brought this into sharp contrast. However, building trust is vital for effective care, reducing population risk, and driving down costs. Why should you care about building trust with employees and members on your self-insured employer plan? Listen to Kirti Mutakar, CEO of UnitedAg, a healthplan and TPA, on their approach to build...

TPAs are increasingly facing a challenge around customer service, stuck doing tactical interactions with members, and seeing churn from their customer support team. Employers want more from their benefits and the support to their employees. Technology can help - but how? What is available? How are big health plans leveraging data and technology? Come and find out from Vijay Bhatt, Deputy CTO at Ha...

In this episode, Ramesh interviews Matthew Albright, Chief Legal Officer at Zelis, who has been involved in various healthcare regulatory issues, having worked at CMS. In this podcast episode, we will answer key questions such as what is the intent of price transparency regulation? What are the key requirements that TPAs and Employers need to worry about? What is the simplified version to worry ab...

In this episode, Ramesh interviews Dallas Scrip, CEO of Benefit Management LLC from Wichita, KS, and Ashok Subramanian, CEO of Centivo, from Buffalo, NY. This episode dives into questions about the challenges TPAs face in competing against BUCA carriers, what investments TPAs need to make, and what the advantages TPAs have in their business model. (Please Note: The episode was recorded before the...

In this episode, Ramesh interviews Dr. Keith Smith, founder of the Surgery Center of OK, one of the pioneering firms that have published their fixed prices down to the dollar for surgeries for more than 10 years. This podcast episode will touch on what a specialized surgery network means, what type of surgeries can be directly steered to specialized centers, what kind of savings to expect, and whe...

In this episode, Ramesh talks with Brian Klepper, an expert, and consultant on contracting to create high-performance provider contracts. The podcast will answer questions like: What are the issues with the way providers deliver care or programs, which category of services can employers put in outcome-based/high-performance contracts, what data is needed to contract and manage these outcome-based...

In this episode, Ramesh talks with Ernie Clevenger, someone who has dedicated his entire entrepreneurial career to bringing better care, managing risks and leveraging healthcare technology. He is founder of CareHere, a successful worksite clinic, now part of Premise Health. Ernie also runs and distributes MyHealthGuide, a newsletter bringing latest developments in the self-insured employer space....

Honest discussion on Reference Based Price with Steve Rasnick: Steve is a veteran of the TPA space, having built and sold multiple TPA businesses, and more importantly a strong believer in the value of bringing innovation and better solutions to the self-insured employer industry. Today's podcast will answer questions about where RBP works, who is the right employer, what happens to the employee a...