B-Time with Beth Bierbower

Description: According to the US Census, the projected growth in the number of Americans living alone between 2016 and 2034 is 57%.  In addition, an AARP study shows that between 1994 – 2014 there was a 46% reduction in the number of adults who live within 10 miles of an adult child.  So we have more people living alone many of whom don’t have immediate family members living near them. 

What do these trends mean in the context of someone aging in place.  Most caregiving is unpaid and provided by family members but if there isn’t a family member nearby what’s a person to do?  Our guest today is Karl Ulfers, Co-founder & CEO of Duos, a company that provides the elderly with a personal assistant and trusted resource to help them with their everyday needs.

Karl discusses the needs of the elderly adult and how he is tapping into the 9 – 3 economy to help. 

Show notes: Favorite Podcasts: B-Time with Beth Bierbower; This Week In Startups; Joe Rogan

Favorite Books: The Age of Dignity: Preparing For The Elder Boom In A Changing America by Ai-jen Poo.       Greenlights by Matthew McConaughey

The book 2030:  How Today’s Biggest Trends Will Collide and Reshape the Future of Everything by Mauro F. Guillen is packed full of data and information about how differently the world will look in less than 10 years.  Even though it contains a lot of statistics, it’s a compelling read. 

Guillen tells us who will hold most of the wealth, which countries will have the largest populations and where there will be a population drought.  He tells us why retailers must pay attention to the elderly and why millennials aren’t so bad.  He talks about network effect, Blockchain and more.  While reading this I kept reminding myself how important it is to stay on top of emerging trends and 2030 is just around the corner. 

If you are a leader in any industry, this should be at the top of your list and keep a copy handy as you might want to reference it again and again. 

When the Affordable Care Act became effective in January 2014, a New York based startup called Oscar Health entered the fray with individual health plan products offered on the Federal Health Insurance Marketplace.  Oscar Health was considered unusual for a few reasons including everything from its name to the fact that its cofounders, Mario Schlosser, Kevin Nazemi and Josh Kushner were not healthcare or insurance executives.  While offering a High Deductible Health Plan, the team at Oscar created a unique design providing first dollar coverage for telemedicine visits with their staff to encourage new members to call the Health Plan early in their membership.  Many Industry experts expressed skepticism at the idea of a startup entering the market at such a volatile time in the nation’s health coverage journey.

Six years later, the team as Oscar Health seems to have quieted its critics.  While many of the large national health insurers exited the public health exchanges quickly, Oscar Health has grown its presence beyond New York and is currently offered in 18 states. In addition, the team at Oscar Health expanded into the Small Group and Medicare Advantage markets. 

With us today is the cofounder and CEO of Oscar Health, Mario Schlosser to share the rationale behind the startup and to share where they are in their vision of fixing a broken healthcare system and improving outcomes.

Shownotes:  Book Mario recently read is Adventures of a Computational Explorer by Stephen Wolfram.

Website: www.hioscar.com

One of the most valued components of a Health Plan’s offering is its provider network. At the same time, it’s also a major pain point for consumers.  Over the years, the provider network directory has been a source of confusion for patients and providers alike.  Determining whether a provider is participating in the network and at which office can be a challenge.  Also, the issues of surprise billing looms large – the hospital is in network, but the anesthesiologist is not.

Management of this dynamic feature in a Health Plan offering is a challenge for the Health Plan as well.  Providers move and don’t update their profiles or practices merge and simply list every provider at every office location.  Maintenance of the provider directory can be a logistical nightmare.

With us today to share how his organization is addressing these and other network issues is Steve Levin, CEO of Quest Analytics.  Quest Analytics helps health plans and other organizations manage access, adequacy and accuracy of networks to help Health Plans not only be compliant, but also to help them maintain a competitive edge.

Show notes:  Life in a Jar: The Irena Sendler Project.  Several books on the civil war, focusing on reconstruction. Remembering the Civil War by Caroline Janney And  Armies of Deliverance by Elizabeth Var

On Episode 35 of the B-Time podcast, Dr. Paul Grundy recommended a book titled: The Healing of America by T.R. Reid.  While the book is 10 years old, it still provides valuable information on the workings of healthcare across the world.  The premise of this book is twofold.  Firstly, the author lays out a case that covering all citizens as a moral issue.  Secondly, Mr. Reid believes that rather than replicating another country’s system exactly, that we can learn from the mistakes and best practices of others. 

On the first issue, the author shares stories of people that have fallen through the cracks in the American Healthcare system and as a result, have suffered greatly and even died.  Reid repeatedly makes the case that Americans must look past the cost issue and provide universal coverage rather than having many different programs with different criteria for qualification.

Reid’s approach to the second premise – that we can learn from other country’s systems is unique in that Reid becomes a patient in each system.  By placing himself in the middle of the healthcare delivery system, he gets perspectives from healthcare providers, government officials and other consumers as to their opinion as to how well the system works.  As a patient he gets and relates a firsthand view to the reader as to how the system truly works.  Throughout the book and his world travels, Reid asks for opinions on his shoulder.  Does he need surgery or not?

As Reid takes us around the world and explains and names the various models, he points out that the US has several different models:  The Bismarck System for the employed; the Canadian Medicare system (yes, the Canadians coined the term Medicare first) and the Beveridge system for vets, known as the VA system.

Although have been in the health insurance industry a long time, I enjoyed refreshing my perspective on these other systems and dispelling some of the myths that go along with each system.  Healthcare leaders should ensure they have a deep grounding in all models that are offered in the US and make sure they are staying in touch with updates to other systems.

Over the last several years there has been a trend of self-funded employers overlaying Centers of Excellence networks on top of their broad Health Plan networks.  These COE networks are typically focused on high cost or complex procedures.  But why is an employer purchasing access to a separate network?  Doesn’t the Health Plan offer a comprehensive network that covers these procedures?  Isn’t this overlay confusing to the patient?

Here today to share with us how these COE solutions benefit both employers and consumers is Sach Jain, CEO of Carrum Health, a national Centers of Excellence solution focused on high volume surgeries such as coronary bypass, hip and knee replacements and more.  Founded in 2014, Carrum Health offers a platform that includes everything from provider contracting to member engagement.  Sach is a computer scientist and engineer by training and is one of the leading national experts in the value based care space, especially bundled payments.

Show Notes:  Favorite Book:  Sapiens: A Brief History of Humankind by Yuval Noah Harari.

Podcast: How I Built This with Guy Raz

I was surprised to discover that individuals who aspire to become therapists often find it difficult to meet the clinical supervisory requirement. These new therapists must have clinical supervision for a several years and they are left on their own to find that supervisor. Some of these new therapist live in rural America where there is a dearth of behavioral health supervisors so the new therapist may have to travel long distances several times per week to get supervision.

As with most founders, our guest, Rachel McCrickard encountered these challenges and decided they needed to be addressed.  Rachel is the founder and CEO of Motivo, which connects new therapists with experienced clinical supervisors through an online virtual platform. New therapists can choose from many clinical supervisors and select the one that meets his or her needs. On the other hand, participating in the Motivo platform allows clinical supervisors to earn additional income.

As a new graduate, Rachel found herself traveling several hours each week to get the clinical supervision need to practice and then become licensed. Rachel knew that many states allowed for “tele” clinical supervision but the problem of connecting individuals and ensuring appropriate documentation still existed. Today, Rachel will share her personal and professional journey with us and tell us how she is helping others avoid the hassles she encountered and help ensure therapy graduates are able to obtain licensure.

Show notes:  Website:  wearemotivo.com  Amerigroup Collaboration Press Release:  https://www.prweb.com/releases/amerigroup_and_motivo_collaborate_in_joint_effort_to_expand_access_to_counseling_services_in_texas/prweb17732254.htm

No Rules Rule: Netflix and the Culture of Reinvention by Reed Hastings & Erin Meyer

Untamed by Glennon Doyle

Podcasts: Unlocking Us with Brene Brown

Armchair Expert with Dax Shepherd and Monica Padman

Smartless with Will Arnett, Sean Hayes and Jason Bateman

Our out of industry guest, Simon Weaver, is Co-founder and Chief Technology Officer of HomeX.  Simon is determined to reimagine and build quantifiably better experiences for HomeX customers by solving previously unsolved problems in the home services industry through technology, engineering and science.  Simon demonstrates his deep understanding of the consumer’s Jobs To Be Done and has real empathy for the concerns that individuals have with home maintenance.  He also strives to solve problems for the service technician as well.  When competent technicians delight their customers, it’s a game changer for sure!  Listen to the similarities between Home Maintenance Services and Healthcare.  Surely there is something to be learned and applied from the Home Maintenance industry in the delivery of high quality healthcare.

Show Notes:  Favorite Books include: The Infinite Game by Simon Sinek; Start With Why by Simon Sinek; LifeSpan: Why We Age and Why We Don’t Have To by David Sinclair; Measure What Matters by John Doerr; Getting Things Done: The Art of Stress Free Productivity by David Allen; Crucial Conversations: Tools For Talking When Stakes Are High By Kerry Patterson and Joseph Grenny; Creativity, Inc.: Overcoming The Unforeseen Forces That Stand In The Way Of True Inspiration by Ed Catmull and Amy Wallace; Drive The Surprising Truth About What Motivates Us by Daniel Pink.  Simon also states that Daniel Pink’s RSA Lecture is very good.  Finally, Simon shared the “Simon Test” which is wouldI work for this individual?  If the answer is “yes or one day” – good.  If the answer is “no” then that individual should not be part of your team

Beam Dental is shaking up the dental insurance industry with a new business model.  Alex Frommeyer co-founder and CEO of Beam Dental shares how Beam Dental is changing the game in oral health.  Beam Dental positions itself as a PPO with a twist.  The company provides its members with an electronic toothbrush which collects data on members’ tooth brushing habits.  The more the members of a particular employer group use the toothbrush, the more the employer can save on dental premiums.  We have seen this model in other industries such as auto insurance, but this is a first for dental insurance.

Show Notes: Books:  Americana: A 400 Year History of American Capitalism By Bhu Srinivasan; No Rules Rules: Netflix and the Culture of Reinvention By Reid Hastings & Erin Meyer; Podcast: Differential   Article from The Atlantic:  https://apple.news/Aw8tMZ9ujTfyg_rsuRRYb1w

Listeners, as you know, I started these brief book reviews to share what I am reading.  Typically, I only share reviews on this podcast for non-fiction books, but I am making an exception today and I think you will appreciate why in a minute.

Like many of you, I began watching the Netflix series, The Queen’s Gambit a few months ago.  I don’t typically binge watch dramas, so I have a few more episodes to watch.  And while I do typically prefer to read the book prior to watching a show, the show piqued my interest enough midstream to cause me to pick up the book and I am glad I did.

I want to share some information on the author, and you will soon see how some of the author’s personal experiences have been integrated into the book.  The Queen’s Gambit is written by the late Walter Tevis.  Tevis developed a rheumatic heart condition as a child and his parents placed him in a convalescent home where the patients were given sedatives.  During this stay at the home, Tevis’s parents moved to Kentucky and Tevis was reunited with them a year later.

Tevis learned how to play pool in high school through a friend who went on to own a pool hall. You’ll see why this bit of information matters in a minute.  Tevis attended college at the University of Kentucky and received a Master’s Degree in English Literature from the University.  Tevis played chess and he was an alcoholic.

Tevis taught in a Kentucky High School as well as the University of Northern Kentucky and then at Ohio University.  He wrote several successful novels that you will recognize including: The Hustler, The Color of Money and The Man Who Fell to Earth.  Impressive to say the least.

For those of you who have not watched the Netflix series, the Queen’s Gambit is a coming-of-age story about Beth Harmon, a young girl who is also a chess prodigy.  Beth is orphaned when her mother dies in a car wreck.  Beth is sent to an orphanage which provides the children sedatives daily.  Apparently, this was legal at the time.  Beth learns how to play chess from the janitor at the orphanage and she steals away to the basement as often as she can to play the game that has captivated her.  The janitor quickly realizes that Beth is talented and asks the local high school chess club teacher to play a game of chess with Beth.  Seeing Beth’s talent, the chess club teacher invites Beth to play chess with the members of the club.  As one would hope, Beth beats every other player in the chess club and then goes on to win several tournaments.

When it is no longer legal to give the children a daily sedative, Beth steals some pills from the orphanage pharmacy and overdoses.  While she recovers, her punishment is that she may no longer play chess.  A year later, Beth is adopted by Mr. and Mrs. Wheatley who live in Lexington (a nod to Tevis’s time at the University of Kentucky).  The reader quickly learns that Beth was adopted to be a companion to Mrs. Wheatley since her husband travels for work.  But the marriage is floundering, and the couple soon separate.  While far from perfect, Mrs. Wheatley is a kind woman and desires to be a good mother to Beth. 

Upon realizing that Beth is a good player, Mrs. Wheatley sees Beth’s talent as a way to keep herself and Beth afloat financially.  Mrs. Wheatley arranges all the travel and Beth plays chess.  The book takes the reader to tournaments in Mexico, Las Vegas, Paris and eventually Russia for the ultimate test.  Tevis shows us some interesting characters along the way and gives us a glimpse into the Russian fascination with chess.  He also helps us understand what it must be like to intuitively comprehend such a complex game and be in love with the game.

While the book covers many scenes where Beth is playing chess, in her head, while practicing or at a tournament, I didn’t find this as a deterrent for someone who doesn’t know the game.  In fact, I found these scenes to be riveting.  I have read that the sales of chess sets have gone through the roof since the release of the Queen’s Gambit on Netflix and I can certainly appreciate people’s enthusiasm for the game.  Whether you choose to read the book, watch the series or both, the Queen’s Gambit will move you and stay with you for a long time.