Guest: Neal Shah, Co-Founder, Counterforce Health

Have you ever had a medical claim denied for a procedure or service that should have been covered by your insurance? You are not alone. Yet, 99% of people choose not to appeal that denial because of the laborious, manual process required.

After going through this dehumanizing experience with his wife, Neal Shah decided to bring the power of automation to the good guys. Counterforce Health is a service that helps clients leverage the speed and efficiency of AI to prepare their denial letter in literally minutes. Find out more at www.counterforcehealth.org. 

Neal started his career as a hedge fund manager and pivoted to healthcare after the deeply personal experience of caring for his wife during her illness. He is the Founder and CEO of CareYaya Health Technologies, a social enterprise and applied research lab advancing health equity for aging populations and is also the Founder and Chairman of Counterforce Health. He serves as Principal Investigator on multiple federally-funded innovation grants and has recently authored the book, Insured to Death: How Health Insurance Screws Over Americans – And How We Take it Back.

Deborah Ault, known to most as “Nurse Deb”, has been a Registered Nurse for over 30 years.

Before getting into Care Management, her bedside nursing experience included ER, ICU, Doctor’s Office, Home Health, and Telephone Triage. Now she is the President of Ault International Medical Management (AIMM). AIMM’s team of nurses and physicians help patients navigate both the health delivery and the health insurance systems. Her passion and dedication to managed care has driven her success in the industry, saving employer-sponsored health plans countless dollars and improving the quality of patient care.

During this conversation, Nurse Deb and I dive into the hidden complexities of employer-sponsored health insurance. She shares that those in the C-suite are often making “life and death decisions” for their employees by selecting inadequate health plans. Deb relays shocking examples of price gauging in healthcare and explains how her company helps employers and employees navigate this broken system. Her team’s approach of aggregating hundreds of metrics to identify high-quality, affordable care has literally saved companies and individuals hundreds of thousands of dollars in unnecessary expenses. 

This is such important work, and I was particularly taken by Deb’s insistence that this type of patient advocacy requires human clinical expertise, not just technological solutions. It is the combination that is truly the secret sauce. As I tell Deb in the episode, I wish AIMM had more competition because we certainly need many more advocates like her and her team. 

Obesity in America. Is there any other diagnosis as relevant, timely, or important when we think about the impact on our healthcare system? I doubt it.

So, today we are talking with Dr. Meghan Garcia-Webb, who is triple board-certified in internal medicine, lifestyle medicine, and obesity medicine. Her weekly YouTube series, “Weight Medicine with Dr. Meghan,” aims to provide audiences with medically-based information about weight loss drugs and weight management. In addition to being an internist at the prestigious Beth Israel Deaconess Medical Center, Dr. Meghan runs an innovative private practice that combines concierge weight medicine with life coaching. 

This concept of the “one big thing” that Dr. Meghan speaks about intrigued me. She explains during our conversation that what is often missing in her work as an internist is the time to dig into what is actually blocking people from what they want. To help address this, she pursued a certification in life coaching and ultimately began her own self-pay coaching practice to add her extensive knowledge about the medicine of weight loss to the human connection that’s so critical in achieving real behavior change. 

The deck is seriously stacked against us. In this episode, we discuss how Americans are at war for their health and how our society is poised to prevent us from achieving and maintaining health. Dr. Meghan shares some of her own “systems” that allow her to live the life she wants without having to overthink or overdo it.

As someone who spends a lot of time thinking about primary care, this conversation brought back to me how much we’ve missed the boat in American healthcare when it comes to the way we treat health. It’s such a fantastic example of how we can’t medicine our way out of this problem; we must engage with the human side if we want to see real change. 

Chelsea Ryckis is the award winning founder and president of Ethos Benefits, a firm dedicated to advancing health insurance strategies for employers nationwide. Their approach effectively eliminates fraud, waste and abuse from employer healthcare plans while increasing savings for both employers and their employees. Chelsea is the co-host of the Ethos Effect Podcast with her husband, Donovan, and producer of the documentary “It’s Not Personal, It’s Just Healthcare”. Chelsea regularly speaks on the industry’s most coveted stages including: ALM Benefits Pro Expo, SHRM HR Florida, and the ISCEBS Symposium. 

This is one of the most important episodes we’ve ever aired, especially for employers. During this conversation, Chelsea and I discuss how traditional health insurance brokers profit from ever-increasing premiums, and how that traps employers and, subsequently, employees, in a broken system. The downstream effects of astronomical health care costs will inevitably get passed down to consumers when employers are unable to absorb the increase, resulting in lost wages, layoffs, and an inability for workers to contribute to their retirement. This system is unsustainable but it does not have to operate this way. 

At Ethos Benefits, Chelsea and her husband, Donovan, have implemented a revolutionary approach to healthcare consulting. An approach that prioritizes transparency and fiduciary responsibility and which results in significant cost savings. Listen in as they share their methodology and how they can create a system that benefits employers and employees. 

Healthcare will not change until the business of healthcare does, and Ethos Benefits is paving the way. 

On the show today, we are honored to have Dr. John Halamka, the Dwight and Dian Diercks president of the Mayo Clinic Platform, a digital initiative that brings together solution developers, data partners and healthcare service providers to transform healthcare. Trained in emergency medicine and medical informatics, Dr. Halamka has been developing and implementing healthcare information strategy and policy for more than 40 years. He continues to practice emergency medicine and is Professor of Emergency Medicine and the Michael D. Brennan, M.D., President’s Strategic Initiative Professor at Mayo Clinic College of Medicine and Science.

Dr. Halamka has written 15 books and hundreds of articles. He and his wife run Unity Farm Sanctuary in Sherborn, Massachusetts, dedicated to the lifetime care of ill, disabled, senior, orphaned and surrendered farm animals.

The work John and his team at the Mayo Clinic Platform are doing is nothing short of extraordinary. Leveraging their access to Mayo’s massive data set and employing the full breadth of AI capabilities, they have been able to create a platform that allows rapid innovation by de-identifying and sharing medical data while still protecting patient privacy. To give you a sense of the magnitude of this project – the platform currently has 250 predictive algorithms and 8 foundation models in production with a goal of impacting the health of four BILLION people by 2030.

As you’ll realize by the end of this interview, Dr. John Halamka is an extraordinary individual, physician, informaticist and leader. He has a tremendous platform and influence but my hope is that his humanitarian influence expands as far, as wide, and as deep as possible within the national and international healthcare domains. If there is anyone I would trust to guide us into the future of AI in healthcare, it would be Dr. Halamka.  

Our guest today is Jasmine Bhatti, the founder and CEO of Navi Nurses, a rapidly growing, private-duty nursing company that’s redefining at-home care. Navi Nurses has been recognized as one of the top startups to watch in Arizona. Jasmine herself was named Phoenix Female Founder of The Year, a Healthcare Hero of Nursing by the Phoenix Business Journal, and was the recipient of the prestigious Jeannine Rivet award from the American Nurses Association. She was also granted a $1.5 million grant to study her work through the Re-Imagining Nursing Initiative from the American Nurses Foundation. 

At-home care is such a salient issue for many of us these days. In fact, the inspiration for Navi Nurses came from Jasmine’s own experience with her grandmother’s cancer care journey where she recognized significant gaps in the hospital-to-home care transition. NaviNurses offers flexible nursing care, from simple one-hour check-ins to 24/7 in-home support with hospital-based nurses, often the same nurse that worked with the patient during their hospital stay. Beyond just reducing hospital readmissions, NaviNurses aims to support caregivers by quickly and accurately identifying issues so they can be addressed before they become more significant. The service is currently self-pay, but Jasmine and her team are conducting research to demonstrate the cost savings of this type of program.

Beyond the obvious benefit to the patient and their family, I was intrigued by Jasmine’s data regarding the impact on the nurses themselves. Through research with their own nursing staff matched with similarly skilled hospital nurses, Jasmine found that NaviNurses report burnout on the mild end much more frequently than the hospital-based nurses. By providing a more flexible and engaged work environment that demonstrates the full value of nurses, Jasmine hopes to retain more nurses in the workforce.

Jasmine’s data-based approach is both smart and admirable and her enthusiasm for this work is palpable. I look forward to seeing this model make its way across the country. 

Rob Andrews currently serves as the CEO of the Health Transformation Alliance (HTA). The HTA member companies collectively are responsible for more than 8 million employees, dependents, and retirees with an annual healthcare spend of $30+ billion. Through Andrews’ leadership, the HTA has launched value-driven solutions specifically designed to improve patient care and add economic value through world-class data and analytics, pathbreaking pharmaceutical solutions, high-quality medical networks, and robust consumer engagement initiatives. To date, the cooperative has saved its member companies well over $2 billion in healthcare costs. Prior to joining HTA, Rob served as a Member of the United States House of RepresentativesUpon his departure from Congress, President Barack Obama praised Andrews’ service as “an original author of the Affordable Care Act…and a vital partner in its passage and implementation.” 

In our conversation today, Rob and I revisit what feels now like an age-old argument – the move to value-based care, that is, incentivizing outcomes over the number of patients seen or services provided. What’s unique here is that for the past decade, the HTA has been working with its member constituents to demonstrate that this approach is not only economically feasible, but also better for employees and their families. 

Rob points out that while HTA members are certainly interested in lowering healthcare costs, their most immediate concern is employee recruitment and retention. Robust healthcare benefits packages play an important role in being able to attract and keep good talent, so members are invested in being able to provide the most competitive plans and pricing.

Rob believes, and I agree, that healthcare is going to have to become less like Kmart and more like Amazon – what you want delivered in a way that’s convenient and affordable. Pulling together the collective power of these large employers is one way to nudge the market in that direction.

Susannah Fox is a highly accomplished health strategist and technologist. . Her book, Rebel Health: A Field Guide to the Patient-Led Revolution in Medical Care, was recently published by MIT Press. She is a former Chief Technology Officer for the U.S. Department of Health and Human Services, where she led an open data and innovation lab. She has served as the entrepreneur-in-residence at the Robert Wood Johnson Foundation and she directed the health portfolio at the Pew Research Center’s Internet Project.

As someone who firmly believes that we all have to become rebels when it comes to our own health and healthcare, I was excited to talk with Susannah about her new book. In this episode, we discuss how real rebels are creators, not just passive consumers.

Susannah feels strongly, and I agree, that the revolution we need in healthcare should be one where patients and caregivers take an active role in research, treatment, and innovation. She brilliantly identifies four key archetypes that can help guide this patient-led change. These roles remind us that we can all be actors in bettering our own experience of healthcare and the experiences of those we love. As Susannah so aptly says, “Don’t bury your light.” 

Susannah’s message is one of hope, empowerment, and positive action.. I encourage you to listen and proudly take on the role of rebel in your healthcare.

Dr. Farzad Mostashari is the Co-Founder and CEO of Aledade. He has spent his career at the forefront of healthcare policy and health information technology. Dr. Mostashari is the former National Coordinator for Health IT at the Department of Health and Human Services, and served as a distinguished expert at the Brookings Institute’s Engelberg Center for HealthCare Reform. In addition to his work at Aledade, Dr. Mostashari is the chair of the board of directors for Resolve to Save Lives – a global health organization that aims to save millions of lives from cardiovascular disease and infectious disease epidemics. He has spoken and written extensively on issues affecting health IT, ACOs, and health care policy and delivery with publications in the New York Times, the Journal of American Medical Association, and Health Affairs, among others. Dr. Mostashari received his MD from Yale University School of Medicine and his Masters in Population Health from Harvard T.H. Chan School of Public Health.

With such an esteemed background across so many different sectors, I was excited to talk with Farzad not only about his work with Aledade, but also his take on the larger challenge of primary care in this country. In this episode, we discuss the following:

One of the things I most respect about Farzad’s approach is that he values outcome measures that make a real difference in patient lives – decreasing hospital admissions, improving clinical outcomes, enhancing patient experience and engagement. And the results speak for themselves – $800 million in Medicare savings and $548 million in savings shared across their provider groups!

Farzad is an intensely outcomes driven, accomplished leader, and Adelade demonstrates the powerful potential of a value-based care platform. This is a wonderful example of creating a new healthcare.

To find out more about Aledade’s services, please visit them at www.aledade.com.

With years of experience as a PR strategist for healthcare technology companies, Erica Olenski has spent her career working at the intersection of innovation and care. From guiding early-stage startups to consulting with multinational organizations, she developed a unique understanding of how to best use technology to improve healthcare. Her expertise in healthcare, however, extends far beyond her professional roles. As the primary caregiver to her son—a resilient survivor of brain cancer and stroke—Erica has firsthand experience with the challenges patients and caregivers face in today’s healthcare system. 

In this profound conversation, Erica shares the heart-wrenching story of her son’s diagnosis and how her family was thrown into an enduring and complicated relationship with the healthcare system literally overnight. 

I was so struck by how much Erica relied on the health and resilience she built before her son’s diagnosis to help her survive this experience. We talk about the potential impact of pointing primary care in the direction of helping all people achieve that armor in order to better face life’s inevitable struggles. Erica and I also reflect on the significant gaps in hospital environments when it comes to accommodating the needs of caregivers, and the opportunities to reimagine these spaces to better support both patients and their families. 

There are so many takeaways from this interview, some disheartening and frustrating and some just purely inspiring. Throughout our conversation, Erica emphasized the importance of surrender, acceptance, and the power of positive narratives. Her idiom “Words are magic” is something I now repeat to myself daily, a salient reminder that we have the opportunity to shape our own reality even in the midst of tragedy.

* To find out more about August’s Artists, please go to https://www.augustsartists.org/