Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

Colin Quinn, President of Included Health Communities, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how Included Health offers tailored care navigation and advocacy solutions to employers and health plans to support their diverse employees and members.

Included Health’s aim is to create equity in healthcare, with their first solution creating ways to help support the LGBTQ+ community. As President, Colin strives to raise the standard of healthcare for everyone, no matter what group you belong to or what industry you work in. 

Colin Quinn received an MBA from Stanford University’s Graduate School of Business and went on to work in the finance and sales side of the pharmaceutical industry prior to launching Included Health. In 2021, Included Health was acquired by Grand Rounds and Doctor on Demand which has created a robust navigation and advocacy platform to support Employers in raising the bar in their recruitment and retention efforts. 

Here’s a glance at what you’ll learn from Colin in this episode: 

• Why Included Health was launched
• How Included Health’s broad service offering can improve equity in healthcare
• How Included Health reached an NPS score of 98%

Timestamps:

• 0:00 – Introduction and welcoming Colin to the show
• 1:15 – Who is Colin Quinn and what is Included Health Communities?
• 2:30 – How Colin pivoted from working in finance & sales in the pharmaceuticals industry to launching Included Health
• 7:15 – How the acquisition of Included Health will allow the company to get to the next level and better serve employers and employees
• 9:30 – What differentiates Included Health from the marketplace when it comes to healthcare navigations?
• 12:20 – How will virtual care, digital solutions, and navigation increase the level of equity in healthcare & why is Included Health leading the way?
• 20:30 – Why Included Health’s approach to equity can help multiple diverse groups
• 22:15 – How does Included Health drive organizations forward in recruiting and retaining employees?
• 27:10 – How do employers find out what their workforce wants/needs?
• 29:10 – What does Included Health’s consumer satisfaction look like?
• 30:35 – The research & development Included Health does to make iterative improvements to its offering
• 32:45 – Who is Included in Health’s target market?
• 34:00 – What exciting developments are coming for Colin?
• 36:00 – How you can learn more about Included Health

Resources:

• Learn more about Included Health Communities here:

Denise Shiffman, Founder and CEO of GroupWell, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how their data-driven, online group therapy platform is providing employers with a ground-breaking way to approach mental health.

Group Therapy combines the treatment of both mental health and social health to reduce clinical symptoms. GroupWell leverages technology to provide a platform where clinician-led group therapy can be accessed for specific groups of individuals dealing with similar issues and challenges. In addition, GroupWell provides wellness affinity groups led by certified behavioral coaches that can help people with sub-clinical levels of stress and anxiety as well as nutrition, weight loss, parenting, and other topics to support people’s emotional well-being. 

Denise Shiffman held multiple executive roles at tech start-ups and at multi-billion-dollar tech and healthcare companies prior to starting GroupWell. This previous experience has helped her build a dynamic platform that can increase access to a mode of therapy that can help people learn the skills and behaviors to build connections and quality relationships and aid in the recovery from mental health conditions.

 Here’s a glance at what you’ll learn from Denise in this episode: 

• The personal experiences that led Denise to start GroupWell
• How Group Therapy works and is proven to be as or even more effective than individual therapy
• How GroupWell leverages technology to deliver evidence-based group therapy for Affinity Groups
• Why employers and care providers must pay more attention to mental health

Timestamps:

• 0:00 – Introducing and welcoming Denise to the show
• 1:10 – Who is Denise Shiffman and what is GroupWell?
• 2:35 – How Denise’s experience with chronic anxiety led her to create GroupWell
• 5:45 – Making it through the pandemic, the state of mental health, and what lessons should employers be taking from the last two years? 
• 11:00 – The issues that people with mental health issues face with current healthcare providers
• 12:30 – Why is group therapy a relevant mode of treatment and why Denise decided to focus on it
• 16:45 – How GroupWell works for those seeking mental health support
• 23:40 – Why Denise works with certified coaches that lead affinity wellness groups and how mental health treatment is larger than just therapy
• 27:10 – The timeline that GroupWell provides for their care
• 29:10 – Exploring the data around how group therapy works for those seeking mental health care
• 31:00 – How GroupWell attracts coaches and therapists to their network 
• 35:20 – The method of tracking and sharing results with employers and how GroupWell keeps members engaged

Wally Gomaa, CEO and Co-Founder of SimplePay Health, joins Michael in this episode of the Reconstructing Healthcare podcast to discuss how they’re empowering employees with high-quality care through easy-to-understand benefit design structures.

SimplePay Health aims to disrupt the healthcare industry by making the complicated elements of traditional health plans (deductible, coinsurance, confusing bills) a thing of the past while providing their members with the highest level of care. Based out of Dallas, Texas, SimplePay Health is taking on the status quo to reward employees for making choices that actually help lower overall costs.

As a former President of a national insurance carrier, CFO of a healthcare provider and a benefits consultant, Wally has gained unique insight into the healthcare industry and leverages the SimplePay Health platform to address some of the problematic issues within our healthcare delivery and payment system.   

Here’s a glance at what you’ll learn from Wally in this episode: 

• The payment system that SimplePay uses to make healthcare a breeze
• Why Wally wants price transparency to become price CERTAINTY
• How virtual care providers can provide higher quality care
• Why simplifying complexities could bring the largest change to the healthcare industry

Timestamps:

• 0:00 – Introduction & welcoming Wally to the show
• 1:05 – Who is Wally Gomaa and what is SimplePay Health?
• 2:35 – The Bike Accident: How being hit by a car changed Wally’s perspective on the healthcare industry
• 4:10 – Why haven’t price transparency tools & high-deductible health plans driven meaningful results? 
• 7:10 – What is SimplePay Health doing to simplify health insurance?
• 11:20 – How to show patients the disconnect between quality and price for commodity healthcare services
• 13:35 – Using data to drive down costs whilst providing a higher quality service
• 17:45 – SimplePay Health’s approach to using networks
• 19:30 – Pharmacies & Aligning Incentives: How to reduce the formulary waste and price variations found at pharmacies & align incentives with employees
• 22:50 – Digital Health Providers vs Brick & Mortar Providers: How virtual care providers can provide higher quality care
• 25:20 – How SimplePay Health is implementing digital mental health services
• 27:00 – Member Experience: How do employees navigate their healthcare service when using SimplePay Health?
• 31:50 – Outcomes & Results: What results can employers expect when signing up to SimplePay Health?
• 35:10 – How payments are managed by SimplePay Health

Harris Rosen and Ashley Bacot of Rosen Hotels & Resorts join Michael in this episode of the Reconstructing Healthcare podcast to discuss how they’ve saved over $450 million in healthcare costs by implementing their own self-insured healthcare model.

Rosen Hotels and Resorts has over 4,500 employees and turns over $350 million in revenue per year through their multiple hotels and resorts throughout Orlando, Florida. Harris and Ashley have created a healthcare model that not only saves the company in healthcare costs, but also provides healthier lifestyles for their employees, as they can choose their health over their wallet via the cost savings.

Harris Rosen is the President and COO of Rosen Hotels & Resorts and has not only seen the growth of his hotel business, but through the success of his healthcare program, has created ProvInsure to implement their healthcare model into other companies.

Ashley Bacot is the President of ProvInsure and Risk Manager for Rosen Hotels & Resorts. Ashley was integral in creating the self-insured healthcare model for Rosen that has helped save nearly half a billion dollars in healthcare costs since inception.

Here’s a glance at what you’ll learn from Harris and Ashley in this episode:

• How Rosen Hotels & Resorts implemented their own self-insured healthcare model to save over $450 million since inception.
• The lessons taken from the Great Depression to survive COVID-19.
• How to remove the barriers within your healthcare plan to have healthier employees and reduce costs.
• The steps you can implement to allow your employees to choose their health over their wallet.

Timestamps:

• 0:00 – Introduction
• 0:20 – Welcoming Harris and Ashley to the show
• 1:12 – Who is Harris Rosen?
• 1:50 – Who is Ashley Bacot?
• 3:00 – The history of Rosen Hotels & Resorts and how they grew into a $361 million per year company.
• 7:30 – How Rosen’s grandparents lessons on debt helped Rosen Hotels & Resorts survive through COVID-19.
• 10:30 – Trying an alternate path: How an increase in healthcare costs led Harris to explore ways to provide primary care to his own employees.
• 15:00 – “Rosen Care”: The initial success that led to over $450 million in healthcare savings.
• 17:30 – Primary Care: Increasing access to quality primary care to employees via clinic access, benefit design & removing barriers.
• 23:10 – How having an onsite clinic has impacted the health of employees and has lowered healthcare costs
• 24:20 – Living by K.I.S.S and P.P.P.P.P.P – Keep It Simple Stupid and Prior Planning Prevents Piss Poor Performance
• 25:50 – Encouraging Compliance: How to allow your employees to choose health over saving money
• 29:10 – Why hospitals aren’t interested in competition and why the government and employers should get tough
• 31:45 – Steering the employee towards high quality health care to create lower costs
• 33:30 – Saving nearly half a billion dollars and Harris Rosen’s philanthropy
• 39:00 – Managing a hospitality business and enticing people to work for Rosen Hotels and Resorts
• 43:00 – If there was one question I should have asked: Fighting back against the insurance companies
• 44:40 – How you can learn from Rosen’s model and implement it inside your business.

Resources:

• Rosen Hotels & Resorts, Inc.: https://www.rosenhotels.com/
• ProvInsure: https://www.provinsure.com/

Podcast Links:

• Website: http://www.reconstructinghealthcare.com/
• Apple Podcasts:

Marshall Allen is an investigative journalist that has spent more than fifteen years exposing the ways that the health care industry preys on vulnerable Americans. Marshall currently writes for ProPublica and was part of the team to be a Pulitzer finalist for their work in covering COVID-19. In this episode, Marshall discusses how his time investigating the American healthcare system has led to writing his new book, titled “Never Pay the First Bill: and Other Ways to Fight the Health Care System and Win.”

Marshall’s career has seen him honoured with multiple journalism awards, such as the Harvard Kennedy School’s 2011 Goldsmith Prize for Investigative Reporting and coming in as a finalist for the Pulitzer for his work at the Las Vegas Sun, where he worked before writing at ProPublica in 2011.

In this episode, you’ll hear about real-life victories as employers and employees fight the healthcare industry. From dealing with price gouging, errors in billing, fraud and unnecessary treatments, Marshall has seen it all. Tune in to hear how employers and employees can fight back and protect themselves from being taken advantage of by the healthcare delivery and payment system.

Here’s a glance at what you’ll hear from Marshall in this episode:

• Why Americans pay so much for healthcare whilst getting so little in return
• How Marshall’s career in investigative journalism led to him writing ‘Never Pay the First Bill’
• Why the business side of healthcare was designed to exploit both clinicians and patients
• How hospitals and insurance companies look after each other rather than the employee/employer.
• The inefficiencies and errors presented in the majority of medical bills and how to fight back

Timestamps:

• 0:20 – Introduction to Marshall Allen
• 2:20 – Why did Marshall write: ‘Never Pay the First Bill: And Other Ways to Fight the Health Care System and Win’
• 7:08 – “The business side of healthcare was designed to exploit both clinicians and patients” – How the healthcare system takes advantage of Americans
• 9:00 – The price variation patients deal with when going to hospital
• 11:35 – Why aren’t hospitals showing transparent pricing and why aren’t insurance companies loyal to the employer/employee?
• 15:15 – Employers are passing costs onto their employees
• 16:30 – Increasing health literacy for employees and employers
• 17:20 – How common are errors in medical bills?
• 19:20 – The medical debt collecting industry
• 21:30 – How to deal with medical debt
• 22:18 – Why would you sue a medical provider for an unfair bill
• 24:20 – The open price contract rule: Don’t pay more than Medicare would
• 26:04 – How a hospital would react to a lawsuit in Small Claims Court
• 28:00 – Using a referenced based pricing plan and why hospitals don’t like it
• 30:20 – Share your medical finance victories with Marshall
• 31:10 – Everybody’s Guide to Small Claims Court
• 31:58 – Being aware of medical finance risks and how to avoid them
• 33:45 – Avoiding unnecessary care
• 34:10 – Avoiding immediate care
• 35:20 – Mammograms: An unnecessary care example?
• 38:05 – Stories of fraud in medical care and finance
• 40:40 – The David Williams case
• 44:00 – Who investigates fraud?
• 46:30 – Standing up to a bully: How to push back
• 49:45 – How to connect with Marshall Allen

Resources:

• Follow Marshall Allen on ProPublica: https://www.propublica.org/people/marshall-allen
• Follow Marshall Allen on Twitter: https://twitter.com/marshall_allen?lang=en
• Connect with Marshall Allen via LinkedIn:

Dave Jacobs and David Greenberg join the podcast to discuss how Homethrive is providing their customers access to their own master’s level social worker and a digital platform to help provide care for their aging loved ones at home.

Prior to Homethrive, Dave and David both served at Medline. Dave Jacobs as President of the Durable Medical Equipment division and Medline’s Post-Acute business that encompassed nursing homes, home health, assisted living and managed care insurance. David Greenberg served as Executive Vice President of Strategy and Group President, defining and supporting strategic priorities, leading business development initiatives to strengthen the Medline portfolio, and M&A.

In this episode, you’ll hear why Dave and David decided to leave their high paying Senior-Executive roles at well-respected companies to create Homethrive. You’ll hear how Homethrive is helping people look after their aging parents while allowing them to stay in their own homes, instead of an aged care facility. 

Here’s a glance at what you’ll learn from Dave Jacobs and David Greenberg in this episode: 

• The foundation story of Homethrive: Why the co-founders left their Senior-Executive roles to create their own company.
• How Homethrive is helping people look after their aging parents while allowing them to stay at home instead of an Aged Care Home.
• Why Traditional Benefit Offerings often aren’t enough for employees burdened with care-related responsibilities for their aging parents.
• How Homethrive is able to provide each customer with their own unique Care Guide and the types of services they offer.
• The positive impact this can have on employees knowing they have an advocate to address elder care issues for loved ones.

Timestamps:

• 0:22 – Welcoming David and Dave to the show
• 1:00 – Who is Dave Jacobs?
• 2:00 – Who is David Greenberg?
• 3:42 – Why David and Dave left their Senior-Executive roles to create Homethrive
• 8:20 – The state of traditional benefit offerings in the age of COVID-19
• 10:50 – How organizations can transition their benefit offerings as employees and their parent's age
• 12:20 – Diversity, Equity, and Inclusion: Is their inequity in benefits and healthcare?
• 14:15 – The Homethrive Product: What problems are Homethrive trying to solve?
• 16:40 – Homethrive’s Unique Product Offering: Your own Care Guide and access to technology
• 20:55 – A concierge resource for eldercare issues and unique needs
• 24:20 – The Employee Experience: How do the children of aging parents use Homethrive?
• 27:00 – The Scope of the Problem: Do companies know that their employees need to have access to aged care?

In this episode, Michael interviews Omar Dawood, the Chief Medical Officer and Head of Sales at Calm, the #1 app for sleep, meditation and relaxation. The app has over 100 million downloads and over 1.5M 5-star reviews.

Omar is a clinician and stage IV cancer survivor with over 25 years of senior management, medical research and clinical experience, innovating medical devices and digital health products as a senior executive. At Calm, he leads B2B employer and health plan sales and is passionate about helping people around the globe lead healthier, happier lives by building resilience through better sleep and improved mindfulness.

While 20% of Americans are dealing with a mental health illness of some sort, Omar believes that we shouldn’t forget about the other 80% of people who experience stress and anxiety without a mental health diagnosis. That’s where Calm comes in to act as a preventative measure to improve behavioral and mental health as well as resilience through mindfulness practices, meditation, and strategies for better sleep. 

Calm started as a B2C app but is making strides in the B2B sector to support employers, employees, and organizations. And it’s working. The sign-up rate on employer accounts is 30% with 80% engagement, and the experiences it offers – like the “Daily Calm” and “Sleep Story” – are helping employees reduce stress, sleep better, respond better to life, communicate more effectively, and boost immunity around the world. 

The benefits Calm offers to organizations and employees is clear. For organizations, they provide actionable insights and aggregate trends. For employees, they offer pathways to increased resilience and wellbeing and a “Calm Effect” that touches every area of their life.

Calm’s NPS is just over 70 and they do qualitative ratings and satisfaction measurements in a number of ways. The team at Calm is excited for more innovation in behavioral and mental health and encourage collaboration in the field in order to spread health and happiness to billions.  

Here’s a glance at what we discuss in this episode: 

• 00:50 - Introducing Omar and Calm. 
• 02:30 – His cancer diagnosis changed his view on medicine and the industry’s lack of data; he didn’t appreciate the value of mental and behavioral health until 10 years ago. 
• 04:45 – He saw a need to bring an engaging experience to behavioral health; this is how he came upon Calm and loves his role in bringing that to employers/employees. 
• 06:30 – The 1 in 5 statistic: Omar believes we should consider the preventative health of the other 80% who also experience stress and anxiety but aren’t diagnosed.
• 08:50 – The pandemic opened up the dialogue that we’re all coping and should do something about it because we’re human, not because we’ve been diagnosed. 
• 10:00 – Most employees experience stress and anxiety; digital health made help easier and more accessible, but still sat downstream in terms of treatment.
• 12:50 – What was missing was something more upstream and preventative.
• 13:00 – EAP services 0-3% engagement, Calm’s sign-up rate is 30% on employer accounts and average engagement of 80%; it’s not seen as behavioral health at all. 
• 14:40 – Calm is an experience, not a product, and becomes a part of the user’s life to support better resilience through meditation, mindfulness, and better...