Dr. Jack Forbush, DO is the owner of the Osteopathic Center for Family Medicine, Maine's first Direct Primary Care practice offering comprehensive, full-spectrum medical care for all ages including obstetrical and hospital care. He is also a founding member of both the Direct Primary Care Alliance and New England Direct Primary Care Alliance. Dr. Forbush has been and remains actively involved in "all things" related to Direct Primary Care.  In addtion to the Direct Primary Care community, he serves in several leadership capacities in local, state, national and international organizations including the Andrea Ritz Clinics in Paraguay.

In this episode of the Business of Health podcast, Mike Martens sits down with Dr. Jack Forbush to discuss his unique perspective on medical practice and the concept of direct primary care. Dr. Forbush challenges the traditional healthcare system, encouraging listeners to think differently about how medical care is provided. He shares his personal journey and the benefits he has seen through implementing a direct primary care model in his own practice.

Dr. Jack Forbush begins by highlighting the frustrations he experienced with the system based on self-feeding and colluding arrangements. He shares how he discovered that medications and lab tests can be much cheaper than expected, and how negotiating and paying upfront for services without relying on insurance can be a refreshing change. He emphasizes the patient-centric approach in direct primary care practices, prioritizing accessibility and timely appointments.

The conversation delves into the growth of direct primary care organizations and their goal of providing resources, education, and support to physicians who practice this model. Dr. Forbush explains how more physicians are adopting direct primary care and how employers are becoming increasingly interested in this approach to provide affordable and accessible healthcare to their employees.

Throughout the episode, Dr. Jack Forbush highlights the benefits of direct primary care, including cost savings on medications, lab testing, and diagnostic procedures. He differentiates direct primary care from concierge medicine, emphasizing that it eliminates the complexities of insurance and enables a direct relationship between patients and physicians.

Join us in this informative episode as Dr. Jack Forbush shares his insights and experiences with direct primary care, challenging the traditional healthcare system and offering a new approach to providing high-quality, cost-effective care.

Three Takeaways

1. Direct primary care offers a patient-centric approach.
2. Employers are increasingly interested in direct primary care.
3. Direct primary care models eliminate the complexities of insurance.

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“We really wanted to provide an avenue to get more physicians doing direct primary care and serve as resources.” -Dr. Jack Forbush

Resources
Email Dr. Jack Forbush: [email protected]
LinkedIn: www.linkedin.com/in/jforbush

Email Mike Martens: [email protected]
LinkedIn: linkedin.com/in/firststaffbenefits
Website: www.firststaffbenefits.com

Krista Martens, MS, RD, CDN is a registered dietitian nutritionist who has seven years of professional experience as a registered dietitian. Her graduate school experience allowed her to practice in clinical, research, food service and community settings. Krista aims to provide culturally appropriate, science based, and compassionate care to help others identify and succeed in reaching their long- term nutrition goals.

In this episode of the Business of Health podcast, Mike Martens speaks with Krista Martens about the crucial role of nutrition in overall wellness. Krista, with her expertise in nutrition and experience working with clients, sheds light on the difference between 'hashtag wellness' and true wellness, emphasizing the significance of mental health in adopting a healthy lifestyle.

In today's social media-driven world, there is a perception of wellness propagated by diet programs promising quick results. However, true wellness encompasses various factors, including social well-being, mental health, physical health, and dietary lifestyle. Krista also highlights the importance of recognizing real wellness beyond its superficial portrayal on social platforms.

Krista Martens points out that mental health plays a vital role in individuals' journey towards a healthy lifestyle. When it comes to nutrition, many clients have underlying issues such as anxiety, depression, or disordered eating. This necessitates collaboration between dieticians and mental health professionals to address these complex challenges comprehensively.

The concept of a sustainable lifestyle is introduced as an alternative to fad diets. Krista emphasizes the need for long-term changes in diet and exercise that are personalized to individual needs. Unlike diets that promise quick weight loss, a healthy lifestyle leads to sustainable outcomes, preventing disordered eating behaviors and promoting overall wellness.

By focusing on mental health, adopting personalized lifestyle changes, and seeking professional guidance, individuals can achieve holistic wellness.

Three Takeaways

1. Understand the changing needs of the aging population.
2. Advocate for comprehensive long-term care coverage.
3. Promote aging in place with dignity.

Quote
“If we eat and exercise a certain way, then we get to look a certain way.” -Krista Martens

Resources
Email Krista Martens: [email protected]
LinkedIn: www.linkedin.com/in/krista-cunningham-ms-rdn-cdn-037955ba

Email Mike Martens: [email protected]
LinkedIn: linkedin.com/in/firststaffbenefits
Website: www.firststaffbenefits.com

Dr. Char Hu is the Co-Founder and CEO of The Helper Bees, an insurtech company successfully improving the home care experience for the payer and care recipient. They work with some of the world’s largest insurance carriers to deliver transformative experiences in digitization, sourcing great care options, and applying machine learning to power intelligent care and claim analytics and processing

In this episode of the Business of Health podcast, Mike Martens welcomes Dr. Char Hu to discuss the topic of Aging in Place with Dignity. Dr. Char Hu, who has personal experience caring for aging parents, shares insights and expertise on the challenges and opportunities in the aging care industry. They delve into the importance of long-term care insurance, the evolving landscape of in-home caregiving, and the need for human-centered design in the aging population.

As the average age in the US rises and the baby boomer generation enters their senior years, the topic of aging care has become more critical than ever before. Dr. Char Hu emphasizes the importance of long-term care insurance in ensuring a dignified aging experience. With the costs of in-home care, assisted living facilities, and skilled nursing facilities soaring, long-term care insurance provides financial security and peace of mind.

Dr. Char Hu also highlights the significance of open dialogue with aging relatives and loved ones about their preferences and needs. By prioritizing choice, dignity, and well-being, we can ensure that aging individuals can age in place with the support and resources they require.

Another crucial aspect discussed in the episode is the limited coverage provided by Medicare for long-term care facilities and caregivers. While Medicare does not cover custodial care, some Medicare Advantage plans have started incorporating certain non-medical services. This expansion of coverage is a positive step forward, but there is still work to be done to ensure comprehensive support for the aging population.

By understanding the challenges and opportunities in the aging care industry, we can ensure the dignity and well-being of our loved ones as they navigate their golden years.

Three Takeaways

1. Understand the changing needs of the aging population.
2. Advocate for comprehensive long-term care coverage.
3. Promote aging in place with dignity.

Quote
“Since 1960, life expectancy has grown by 20 years.” -Dr. Char Hu

Resources

Email Dr. Char Hu: [email protected]
LinkedIn: www.linkedin.com/in/charhu

Email Mike Martens: [email protected]
LinkedIn: linkedin.com/in/firststaffbenefits
Website: www.firststaffbenefits.com

Adam Butcher is the owner and Vice President of Fred's Appliance LLC, an appliance repair service company that provides field service for all major home appliances in northeast Ohio  with over 50 years of combined experience working on every make and model of appliance from such leading manufacturers as Whirlpool, KitchenAid, Maytag, GE, Frigidaire, Kenmore and countless others. They also offer a diverse technical training program that covers all aspects of appliance repair through the Fred’s Appliance Academy.

In this episode of the Business of Health podcast, Mike Martens engages in an insightful conversation with Adam Butcher and shares his success story of utilizing Individual Coverage Health Reimbursement Arrangements (ICHRA). Adam's experience sheds light on the challenges faced by small businesses in providing affordable and flexible health insurance options to their employees.

By implementing ICHRA, Adam and his team found a solution that not only addressed these challenges but also empowered their employees to choose the coverage that best suits their individual needs. Join us as we dive into the details of Adam's journey and explore the key benefits and considerations of ICHRA.

Three Takeaways

1. Choose ICHRA for diverse, affordable plans.
2. Use ICHRA to predict yearly health costs.
3. Enjoy uninterrupted benefits with ICHRA.

Resources

Email Adam Butcher: [email protected]

LinkedIn: linkedin.com/in/adam-butcher-98a78016

Email Mike Martens: [email protected]

LinkedIn: linkedin.com/in/firststaffbenefits

Website: www.firststaffbenefits.com

Quote

“In a traditional group policy, we're all experiencing incredible increases every year.” -Adam Butcher

Matt Noe is a benefits consultant and business development executive at OneDigital with over 26 years of industry experience. Matt works with existing clients as well as develops new relationships in the challenged industry market. He works with employers to align their employee benefits programs with the employer’s goals and that high performing business leaders need to compete in the market.

In January 2020, the Individual Coverage Health Reimbursement Arrangement (ICHRA) began to make waves in the group health marketplace. The ICHRA allows employers of all sizes to provide a tax-free health benefit to employees while allowing employees to select and purchase individual insurance policies that are suited to their unique needs. ICHRA can revolutionize the way businesses approach healthcare, offering a new solution for employers struggling with rising health insurance premiums.

Matt Noe talks about ICHRA and its potential for reducing group health insurance costs. Matt believes that every employer has different objectives when it comes to ICHRA, and it's not always just about cost savings. Employers can modernize their approach to healthcare to attract and retain younger generations while still providing choices for Gen X and boomers. Matt also suggests that employers look at ICHRA from a global 3 to 5 year strategy and find a balance between employer objectives and cost savings.

Education and communication are key in helping employees make informed decisions about their healthcare plan. Many employees have little knowledge of their current group health insurance plan and obtain information through utilization during open enrollment. Shifting the employee's understanding to know what they need and that it is different from others is simple. Although, the hardest part of ICHRA is not modeling benefits, but rather relating the information to employees who have never thought about health insurance before.

Overall, ICHRA offers a new solution for employers who are tired of going through the same cycle every year to contain costs. It can help stabilize group health costs by putting employees in massive risk pools and offers various applications for businesses of any size.

Employers who are challenged by the construct of their current medical plans and have reached a ceiling in certain states, regardless of vertical, become potential candidates for ICHRA. With ICHRA, healthcare should be treated like retirement plans, and employers should be given tools and a bucket of funds to make decisions on employee healthcare.

Three Takeaways
1. Stabilize group health care costs.
2. Provide choices in health benefits.
3. Don’t be in the risk business.

“The fact that an ICHRA plan has no participation requirement is a beautiful thing for a staffing firm..” -Matt Noe

Resources

Email Matt Noe: [email protected]
LinkedIn: www.linkedin.com/in/matt-noe-251aab4a

Email Mike Martens: [email protected]
LinkedIn: linkedin.com/in/firststaffbenefits

Nancy Giacolone is a seasoned insurance broker with over 30 years of experience in the industry. As the President of Olympic Crest Insurance, she specializes in providing health insurance solutions for small businesses. As a certified Health Rosetta Benefits Associate Advisor, Nancy is committed to providing her clients with exceptional service and transparency, educating her clients on making informed decisions about their health plans, and advocating for cost-effective solutions.

The world of health insurance can be complex and confusing, especially for small business owners trying to navigate their options. In this episode of the Business of Health Podcast, host Mike Martens is joined by Nancy Giacolone, President of Olympic Crest Insurance, to discuss innovative health insurance solutions for small businesses.

Nancy shares her insights on self-funding, an alternative to traditional health insurance plans that allows employers to take control of their healthcare expenses. By understanding their employees' healthcare needs and working with a knowledgeable broker, small businesses can benefit from self-funding and achieve significant cost savings.

Direct primary care is another innovative solution that Nancy is a huge advocate of. She explains how this model offers unlimited visits, conversations, and open access to healthcare providers, making it a simple and valuable addition to any benefits package. However, there may be challenges in some states where medical cost sharing is not allowed.

In addition to these innovative solutions, Nancy highlights the importance of understanding and complying with the Affordable Care Act (ACA) requirements, especially when transitioning to self-funded plans.

Ultimately, small business owners can navigate the complex world of health insurance by staying engaged, working with a knowledgeable broker, and exploring innovative solutions like self-funding and direct primary care. By utilizing resources and fostering relationships with healthcare professionals, employers can make informed decisions about their health plans and help their employees access the care they need.


Three Takeaways

1. Understand client needs first.
2. Present change as a long-term plan.
3. Compare prices for savings.

Resources

Book a Call with Nancy: www.calendly.com/nancygiacolone-oci

LinkedIn: www.linkedin.com/in/nancy-giacolone

Website: www.olympiccrest.com

Email Mike Martens: [email protected]

LinkedIn: linkedin.com/in/firststaffbenefits

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“Look at your group health plan with a long-term focus, not short.” -Nancy Giacolone

Al Kushner is a recognized Financial Educator, Author, Speaker, Retirement Specialist, and the Founder of Superior Mutual Inc. He specializes in Medicare plans and represents national and regional carriers. Today, he joins Mike today to talk about Medicare. They highlight the most common mistakes made by individuals during the Medicare sign-up process and provide insights on how to avoid them. They also touch on the importance of understanding Medicare plans and representational carriers.

Medicare is a great option for individuals over the age of 65 who need health insurance. The coverage is comprehensive and there are many different plans to choose from. However, it is important to remember that plans and coverage can change from year to year. This means that it is important to review the plan annually to make sure that it still meets the needs of the individual.

Al explains that there are many mistakes that people can make when selecting a plan. He recommends that individuals seek help from someone who is knowledgeable about Medicare and can help them choose the best plan. He also points out that independent agents like himself do not charge for their services and can provide unbiased advice.

He also continues to explain that telemedicine has become much more popular during the COVID-19 pandemic. This has allowed people to access medical care from the comfort of their own homes. Telemedicine can be a great time and money saver, and in some cases, even a lifesaver.

Finally, Al emphasizes the importance of reviewing the plan annually. He warns that procrastinating or making the wrong decision could lead to permanent penalties. He encourages people to become knowledgeable about the different plans available and to seek help from an independent agent. 

Overall, it is important to review Medicare plans annually to ensure that the plan still meets the individual's needs. Doing research and speaking to an independent agent can help people make an informed decision and get the best coverage possible.

Three Takeaways

1. Review Medicare plans annually.
2. Sign up for Medicare timely.
3. Evaluate options for best coverage.

Resources

Todd Archer
Email: [email protected]

LinkedIn: www.linkedin.com/in/todd-e-archer-a311588

Website: www.cbscas.com

 
Mike Martens
Email: [email protected]

LinkedIn: linkedin.com/in/firststaffbenefits

Quote

“Make sure you sign up for Medicare within the designated enrollment period.”-Al Kushner

Todd Archer is the President of Concierge Third Party Administrator, a company recognized as one of the nation’s premier industry leaders in third-party administration of self-funded health benefit plans for employer groups of all sizes. With over 35 years of experience, Todd has a proven track record in the field of health benefits third-party administration. He joins Mike today to delve into the topic of reference-based pricing, a reimbursement approach that relies on Medicare allowable rates. They discuss the origins and evolution of this concept.

Reference-based pricing (RBP) is gaining traction as an effective method for employers to reduce their healthcare expenses. This pricing model emerged as a solution to the flawed US healthcare system, where consumers often remain uninformed about the cost of treatments until after receiving them.

RBP operates by establishing treatment prices based on Medicare allowables. This enables employers to pay a fixed amount for treatments instead of depending on the carrier's explanation of benefits. As a result, employers have a clear understanding of treatment costs upfront, allowing them to plan accordingly. Moreover, it empowers employers to negotiate better discounts with healthcare providers, as they are aware of the maximum payable amount.

In summary, reference-based pricing offers employers a viable way to cut healthcare costs while maintaining quality care for their employees. This approach gives employers greater control over expenses, facilitates better discounts with providers, and ensures upfront knowledge of treatment costs, aiding in effective planning. Due to these advantages, reference-based pricing is becoming an increasingly sought-after option for employers looking to save on healthcare costs.

Three Takeaways

1. Reference-based pricing saves money.
2. Implement RBP with care.
3. Communicate effectively for success.

Resources

Email Todd Archer: [email protected]

LinkedIn: www.linkedin.com/in/todd-e-archer-a311588

Website: www.cbscas.com

Email Mike Martens: [email protected]

LinkedIn: linkedin.com/in/firststaffbenefits

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“Reference-based pricing tends to have a larger pricing impact on urban areas than rural areas.”

Stacy Barrow is a Partner at Barrow Weatherhead Lent LLP, and one of the nation’s leading experts on the Affordable Care Act.  He uses a practical, business-focused approach to counsel his clients on all matters related to employee benefit plans. Today, Stacy and Mike discuss the complexities of mergers and acquisitions, particularly how two groups may end up a control group and the compliance requirements of such a situation.

When it comes to mergers and acquisitions, it is important to pay attention to control groups. Control groups are created when two groups come together, and they require companies to be treated as a single unit for certain purposes of federal tax law and ERISA. This allows a single entity, treated as a single employer for ERISA purposes, to offer a single employer group health plan. 

There are various types of control groups. A parent-subsidiary control group is typically created when one company purchases all the stock of another, or at least 80% of it. Brother-sister control groups also require at least 80% common ownership between five or fewer of the same individuals, trusts, or estates. Additionally, there are affiliated service groups or management organizations, which can exist at an ownership of less than 80%, down to 25% or even 0%. 

From an HR and benefits professional perspective, they can merge the health plans into one of the existing company's plans. It is also important to pay attention to 401K plans, as there may be certain yellow flags that need to be addressed. 

Overall, it is important to pay attention to control groups when it comes to mergers and acquisitions. Understanding the various types of control groups, and what their implications can be, is key to ensuring a smooth transition.

Three Takeaways

1. Stay in front of your client’s acquisition.
2. ICHRA has been growing exponentially.
3. Know your MEWA risks.

Resources

Email Stacy Barrow: [email protected]

LinkedIn: linkedin.com/in/stacy-barrow-21a9133

Website: marbarlaw.com

Email Mike Martens: [email protected]

LinkedIn: linkedin.com/in/firststaffbenefits

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“Make sure that you have access to all of the payroll Information that you have.”

Dr. Josh Umbehr is a board-certified family practice physician and the Founder and Owner of Atlas MD, a membership-based direct primary care practice company providing family healthcare that is immediate, thorough, comprehensive, specific, easily affordable, and personal. Today, Dr. Josh and Mike discuss how the U.S. healthcare system is broken and talks about the benefits of Direct Primary Care (DPC).

DPC is a healthcare model that eliminates the need for health insurance and provides direct access to a primary care physician. It is an innovative approach to healthcare that emphasizes preventive care, personalized care, and cost savings.

Dr. Josh Umbehr believes that there are measurable outcomes from DPC. Members of a DPC practice have access to healthcare immediately, without having to wait weeks or months for an appointment. They also have access to more affordable meds and labs, which helps to reduce the cost of healthcare.

Overall, DPC is a great solution to the problem of high medication costs. By providing direct access to healthcare and more affordable medications, DPC allows patients to get the care they need without having to worry about high costs.

For these reasons, DPC is becoming an increasingly popular option for those looking for a better way to access healthcare.

Three Takeaways

1. Cut healthcare costs with Direct Primary Care.
2. Access to healthcare is important.
3. Save money on medications with DPC.

Resources

Email Dr. Josh Umbehr: [email protected]

LinkedIn: https://www.linkedin.com/in/joshumbehrmd/

Website: https://atlas.md

Email Mike Martens: [email protected]

LinkedIn: linkedin.com/in/firststaffbenefits

Quote

“With Direct Primary Care, you have access to your provider whenever you need it.”