In this powerful episode of *Impact Healthcare*, host LesterMorales sits down with a true industry whistleblower  Wendell Potter, former Cigna and Humanaexecutive turned healthcare reform advocate. Wendell pulls back the curtain onhow health insurance really works, exposing the profit-driven machine thatprioritizes stock prices over patient care.

From defending high-deductible plans to becoming a fierce critic of them,Wendell shares his personal transformation, his fight for a more transparentand fair system, and why the healthcare system isn’t broken — it’s workingexactly as designed... for Wall Street.

🔥 Inside this episode:
- What the Medical Loss Ratio (MLR) really means for employers and patients
- How health insurers and hospitals maintain a profit-first alliance
- The unethical broker-carrier dynamic no one wants to talk about
- Why Wendell walked away from a high-paying C-suite role to expose industrycorruption
- Real stories of hope and disruption in healthcare happening *right now*

Whether you're an employer, advisor, or just someone who’s tired of risingpremiums and shrinking benefits, this is a must-listen.

📩 Connect with Wendell: [HealthcareUncovered](https://healthcareuncovered.substack.com)
📽️ Watch the documentary: *It’s Not Personal, It’s Just Healthcare*(featuring Wendell)

🎧 Don’t forget to subscribe and share this episode if you believe increating a better healthcare system.

In this high-impact solo episode of Impact Healthcare, host Lester Morales recaps the key takeaways from April’s conversations — and it all comes down to one powerful word: strategy.

From exploring the costly trap of reactive renewals to redefining how employers, brokers, and hospitals collaborate through direct contracting, Lester challenges the status quo of the healthcare benefits industry. He also revisits his powerful interview with Seppa from Motive, VP of People & Learning, who shares how her organization transitioned from fully insured to self-funded — resulting in improved employee benefits, cost savings, and deeper employee engagement.

🔥 You’ll learn:

• Why most employers operate on a faith-based model with no real healthcare plan

• How direct-to-employer strategies and captives are reshaping cost control

• The real-life ROI of benefits aligned with the employee lifecycle

• Why KPIs in healthcare are dangerously misaligned — and what to do about it

• How one company used healthcare savings to expand parental leave and elder care

Whether you’re an advisor, HR leader, or employer, this episode delivers the roadmap to move beyond the annual renewal scramble and build a benefits plan that actually works.

🔗 Connect with Lester: [email protected]
📬 Got a topic or guest suggestion? We’re listening. Let’s impact healthcare — together.

What if healthcare wasn’t broken—but simply built wrong?

In this episode of the Impact Healthcare Podcast, Lester Morales sits down with Rob Andrews, CEO of the Health Transformation Alliance and former U.S. Congressman, to explore how large employers are fixing healthcare—not through policy alone, but through bold action, cultural alignment, and smarter benefits design.

Rob shares his personal “why,” rooted in his father’s death and the lessons that continue through his work today. Together, they dive into decades of insights from Rob’s leadership in both government and the private sector, including:

• The foundational flaws in fee-for-service and the urgent need for value-based care

• How self-funded employers are improving outcomes by aligning benefits with talent retention

• The true ROI of investing in navigators, virtual care, and benefit education

• Why personal accountability is key to improving health outcomes—and how incentives must evolve

• How major organizations like American Express retain talent through human-first healthcare design

• Creative strategies like 0 copays for engagement and charitable rewards for smart healthcare choices

From policy debates like the MLR rule in the Affordable Care Act to real-world success stories—like a walking club that grew out of a doctor’s concern for her lonely patients—this episode challenges you to rethink what’s possible in employer healthcare.

If you’re an employer, advisor, or HR leader ready to:

• Design benefits that actually improve lives

• Align healthcare spend with business and cultural goals

• Shift from reactive to proactive care models

• Create long-term impact beyond cost containment

This episode is a masterclass in how to lead with vision, humanity, and strategy.

Listen, take notes, and share this episode with someone who needs to stop waiting for the system to fix itself—and start doing something that works.

Keywords:
Rob Andrews, Health Transformation Alliance, value-based care, healthcare navigation, self-funded insurance, outcomes-based payment, healthcare cost control, employer healthcare strategy, employee benefits innovation, healthcare incentives, benefits design, personal accountability, primary care, employee retention, impact healthcare podcast, Lester Morales

What if your healthcare benefits did more than check a box—what if they changed lives?

In this episode of the Impact Healthcare Podcast, host Lester Morales is joined by Sepa Sete, VP of People + Learning at Mocean, for a candid and practical conversation about how HR can take the lead in creating people-first organizations through intentional benefit design.

Sepa shares the journey that led Mocean to move from a traditional fully-insured model to a self-funded healthcare plan that not only reduced costs but dramatically improved the employee experience. She breaks down how her team:

• Mapped the entire employee lifecycle to align every stage with meaningful support

• Reimagined healthcare benefits to match their company culture and evolving talent needs

• Added family planning coverage after losing key candidates due to outdated benefits

• Introduced virtual healthcare with Galileo to improve access and reduce unnecessary costs

• Expanded paid parental leave and began building support for employees caring for aging parents

• Used listening and data to guide strategy and improve employee satisfaction

This episode includes powerful real-life stories, including how one benefit decision helped a couple become parents, and how a personalized approach to healthcare made all the difference for a team member battling cancer.

If you're an HR professional, benefits advisor, or business leader looking to:

• Improve talent retention and recruitment

• Offer better healthcare without raising costs

• Create alignment between company culture and benefits

• Explore whether self-funding is right for your organization

This conversation will challenge the status quo and offer a roadmap to meaningful change.

Listen now and subscribe to the Impact Healthcare Podcast for more stories and strategies from leaders redefining the future of employee benefits.

Description:

In this solo episode, Lester Morales shares his recent travel experiences, uncovering powerful insights from various healthcare markets across the United States. From groundbreaking direct-to-employer strategies in Southern California to employer-driven captive insurance solutions in Napa Valley, and proactive healthcare coalitions in North Carolina, Lester reveals how forward-thinking employers and advisors are reshaping the healthcare landscape.

Discover the immense benefits of direct contracting, innovative captive structures, and collaborative approaches to healthcare management. Lester challenges employers and advisors alike to adopt new strategies, prioritize patient care, and reimagine compensation models based on true value delivered.

Top 5 Key Moments:

• 02:35 - Transformative Direct-to-Employer Strategies

• 10:50 - How Hospitals and Employers Can Both Win

• 16:20 - The Power of Captive Insurance Programs

• 21:45 - Employers’ Hunger for Healthcare Innovation

• 27:50 - A Challenge for Advisors to Create True Value

  
  

Listen in to learn actionable strategies and foster meaningful healthcare innovation in your community.

Subscribe to the Impact Healthcare Podcast for groundbreaking insights into the future of employer-sponsored healthcare.

#HealthcareInnovation #DirectContracting #CaptiveInsurance #HealthcareStrategy #EmployerHealthcare #AdvisorInsights #LesterMorales

Reference-Based Pricing (RBP) often gets a bad rap, but is it really the healthcare villain many believe it to be? In this Impact Healthcare Podcast recap episode, host Lester Morales dives into the reality of RBP, debunking common myths and clarifying misconceptions about this innovative healthcare pricing strategy.Discover how reference-based pricing, when implemented effectively, can benefit employers, employees, and even healthcare providers. Lester shares insights and real-world stories, illustrating why understanding this approach is crucial for employers looking to lower healthcare costs responsibly.📌 Key Takeaways:How RBP differs fundamentally from traditional PPO programs.Why traditional healthcare pricing methods may incentivize higher costs.The surprising parallels between RBP and existing healthcare payment models.Real-life examples of successful implementations of reference-based pricing.If you're an employer, healthcare professional, or simply someone interested in learning effective ways to reduce healthcare costs, this episode provides essential insights.👉 Subscribe to the Impact Healthcare Podcast for more powerful insights and actionable tips to revolutionize your healthcare strategies.#ReferenceBasedPricing #HealthcareCosts #ImpactHealthcarePodcast #CostManagement #EmployeeBenefits #RBPEducation #HealthcareInnovation #LesterMoralesHere are the 5 most important timestamps from your episode:1:18 - The Problem with How RBP is Currently Viewed2:42 - Why Insurance Companies May Not Want Lower Costs5:06 - How Reference-Based Pricing Works6:40 - Debunking Myths about RBP & Hospital Acceptance9:15 - The Importance of Claims Auditing

In this solo episode of the Impact Healthcare Podcast, Lester Morales tackles the critical conversation around the value of directly connecting healthcare providers and employers. Lester highlights why traditional network-based approaches might not be the most effective way to manage healthcare costs, explaining why closer relationships between employers and hospitals could revolutionize how healthcare costs are controlled, benefiting everyone involved.

Discover how employers, employees, and healthcare providers can all win through direct contracting, eliminating unnecessary financial burdens and collection risks. Lester breaks down real-world scenarios to showcase the tangible benefits of bringing healthcare closer to home.

📌 Top 5 Key Moments:

• 02:06 - Who Actually Decides Healthcare Prices?

• 05:00 - The Hidden Problem with Healthcare Pricing

• 08:46 - Building Direct Relationships Between Employers and Hospitals

• 10:09 - Real-world Example: Employer and Hospital Collaboration Benefits

• 15:40 - Why More Employers Should Consider Direct Contracting

Explore the power of collaboration in healthcare and find out how you can foster meaningful change in your community.

👉 Subscribe to the Impact Healthcare Podcast for impactful strategies and valuable insights into innovative healthcare solutions.

#HealthcareCosts #DirectContracting #ImpactHealthcarePodcast #EmployeeBenefits #EmployerBenefits #HealthcareInnovation #HealthcareStrategy #LesterMorales

In this episode of Impact Healthcare, host Lester Morales dives deep into the world of Reference-Based Pricing (RBP) with Omar Arif, Senior Vice President of Growth at Claim DOC. Together, they explore how RBP is disrupting the health benefits industry by replacing traditional PPO networks with a more transparent, cost-effective approach.

Omar shares real-life examples of how organizations can save millions while improving access to care, debunking myths surrounding RBP and addressing common challenges. Whether you’re an employer, benefits consultant, or healthcare professional, this episode provides actionable insights to rethink your healthcare strategy.

Key Takeaways:

   What is RBP? A simplified breakdown of how RBP determines fair, transparent pricingfor healthcare services.

      Overcoming Misconceptions: Tackling fears and addressing the perceived complexity of adopting RBP.

        The Role of Advocacy: How proactive communication with providers ensures a seamless transition for employees and minimizes disruptions.

      Audit and Fiduciary Responsibility: How Claim DOC’s rigorous auditing process safeguards plan assets andensures fair pricing.

      Real-World Success: A case study highlighting a 41.4% reduction in healthcare costs for a 300-employee agricultural company.

     Employee-Centric Focus: The importance of lowering employee contributions while improving healthcare access.

This episode is a must-listen for anyone seeking innovative solutions to reduce healthcare costs without sacrificing quality.

Connect with Claim DOC:

Visit claimdoc.com, follow them on LinkedIn, or check out theirpodcast, Claim Talk, available on Spotify and YouTube.

Listen now to discover how you can take control of your healthcare costs and create a lasting impact!

On this episode of Impact Healthcare, Lester Morales dives deep into the revolutionary model of Direct Primary Care (DPC) with Dr. Eric Crall, a pioneer in transforming primary care. From the challenges of traditional healthcare to the incredible impact of DPC on employers, employees, and the

Key Takeaways:

Real-Life Impact:

Dr. Crall shares success stories, including a car dealership that saw substantial cost savings while offering better benefits. Employees gained access to care without out-of-pocket expenses, creating a healthier and more engaged workforce.

Who Should Watch?

This Episode?     

Employers looking to cut healthcare costs and attract/retain top talent.

Advisors seeking innovative ways to optimize health plans.

Employees curious about how DPC can revolutionize their healthcare experience.

What You’ll Learn:

Take Action Now: If you're ready to explore DPC for your

Subscribe for More: Stay ahead of the curve with the latest strategies to disrupt the health benefits industry. Hit like, share, and subscribe to Impact Healthcare today!

In this episode of Impact Healthcare, host Lester Morales welcomes Josh Butler, President of Butler Benefits and Consulting and High Plains Health Plan, to discuss the game-changing Texas House Bill 711—the "Tier and Steer Bill."

This new legislation allows self-funded employers to customize health plans and incentivize employees to choose high-quality, lower-cost providers through financial benefits like $0 deductibles and co-pays.

Josh shares how High Plains Health Plan has pioneered this approach, proving that transparent, direct contracting reduces costs while improving care quality.

What is HB 711? Texas is leading the way by legally recognizing tiered healthcare models that reward smarter healthcare choices.

How "Tier and Steer" Works: Employees pay less (or nothing) when they choose high-quality, cost-effective providers in Tier 1 networks.

The Big Insurance Companies’ Role: Why traditional carriers don’t fully adopt these models—premium equals revenue.

Direct Contracting Advantage: How negotiating with hospitals directly results in better deals, without hidden network fees.

Employer Action Steps: Start with a risk assessment, analyze your claims data, and shift to cost-effective healthcare solutions.

Bottom Line: If you’re still managing healthcare benefits the old way, you’re missing out on significant savings and better employee outcomes.

Subscribe now for actionable strategies that lower costs and impact healthcare for the better!