Self-Funded

Brian is an AVP of Business Development at Goodroot.

"Goodroot is a community of companies committed to reinventing healthcare one system at a time."

In this episode, we specifically focus on two of the solutions that Brian represents:

1. AlignRx, which is their pharmacy consulting arm for larger employers who need individualized expertise for their unique situations.

2. CoeoRx, which has prenegotiated Pharmacy benefit contracts and custom pharmacy benefit solutions for employers that offers "choice, leverage, and savings".

Interestingly, Brian has a condition known as hemophilia, a medical condition in which the blood's ability to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury.

Anyone who operates in the world of self-funding knows how expensive this condition can be to an employer, but it was incredibly interesting to hear the human side directly from Brian.

The crux of this episode focused on the world of PBMs, where we discuss everything from PBM contracts, to spread pricing, price transparency, claims repricing, specialty medications, and so much more!

Chapters:

1:25 Getting to Know Brian

8:45 Life as a Hemophiliac

19:00 What is Goodroot

27:20 Sifting Through the PBM Noise

34:45 PBM Best Practices for Employers

39:52 What Data is Required

44:13 Specialty Meds

48:25 Alternate Sourcing of Meds

54:29 Pharmacogenomics 

58:30 Closing Thoughts

I sat down with the CEO and Founder, Priscilla Romans to discuss the origin story of Graith Care, and how they are fighting every single day on behalf of Americans to ensure they are getting the best possible care for their unique situation.

Patient Advocacy is all about empowering patients to regain control of their healthcare decisions.  When they have informed consent, and are presented with all of their options, the patient should ultimately be able to make the decision that is best for them.

"Graith Care’s mission is to bring back control and transparency to the consumer.

Graith Care breaks down healthcare barriers and provides a holistic view of the patient journey. This care model ultimately improves outcomes and efficiency along with saving time and money.

As your Independent Patient Advocate, we provide medical advocacy, consultation, advice and recommendations in US and Internationally."

Chapters:

0:00 Intro

2:57 Who is Priscilla Romans

11:30 Graith Care Origin Story

17:40 What is "Patient Advocacy"

22:00 How Graith Care Works

31:28 The Story of "Molly & Jim"

37:30 Going Viral on Tik Tok

43:05 The Future of Advocacy

49:00 Closing Thoughts

A Fiduciary's Guide to Data Analytics with Agility Innovation Partners.

This episode is a follow-up to my video "The Consolidated Appropriations Act 101 - Comply or Die?"  

The Consolidated Appropriations Act, otherwise known as the CAA, established protections for consumers related to surprise billing and transparency in health care.  Upcoming fines can and will be heavy, amounting to $100/day PER EMPLOYEE, which is substantially greater than the fines hospitals receiving for being non-compliant, which was only $300 total day. 

In this Episode - Part 2 - we focus on an employer's fiduciary responsibility now that they have access to claims and pricing data due to the CAA regulation, and the power of using an innovative Data Analytics platform to make sense of it.  

Agility Innovation Partners helps offer a data analytics platform with "at-scale pricing" to small-to-mid-market brokers who may not have the leverage on their own.  They also offer consulting after the decision to purchase a data analytics platform called Innovu, so that consultants can make sure they maximize the ROI on their investment.  Innovu also offers a CAA fiduciary tool stack with benchmarking against 4 million lives for plan design, claims cost, plan design etc, so that an employer can determine if they are paying reasonable cost for care and are compliant.  If not, now they know and can take action!  

Here is a recent article covering the CAA in greater detail, and outlining the employer obligation to be compliant.  Hat's off to Dave Chase, co-founder and CEO of Health Rosetta for bringing it to my attention!  

https://docket.acc.com/erisa-covered-companies-must-disclose-health-plan-costs

Sarah is the Founder and CEO of Predictabill, a company that allows you to "compare the health insurance you have with what you could get, and see what’s different since last year."   With Predictabill you can analyze options from your employer (including COBRA), your spouse’s employer, healthcare.gov, and more.   

Sarah spent 8 years in investment banking, and her area of expertise during this time was evaluating the impact that an organization's insurance expenses had on the valuation of the business.  

She jokes that insurance company is "a pile of cash and a bunch of promises", and I am not sure I have heard a better definition than that!

A personal experience with high deductible health plans soon after moving to New York on her own, where she was hit with a $400 out of pocket expense she didn't expect, led to an epiphany about the complexity of health insurance plan design that ultimately sent her down the path of creating Predictabill.

Cariloop provides coaching and support for the caregiver.     

Cariloop has been recently recognized as number 40 in the "Dallas 100", which means they are the 40th fastest growing company in Dallas/Fort Worth! 

In this episode, I sat down with their co-founder and CEO, Michael Walsh to learn more about Cariloop, as well as to hear his personal story of entrepreneurship. 

The Cariloop tagline is "take care of your loved ones with an experienced Care Coach in your corner." and they consider themselves the "World's First Human-Powered Caregiver Support Platform"   

Anyone who has ever found themselves tasked with taking care of a loved one, be it an ailing parent, or a child that needs continual mental or physical care, knows just how emotionally difficult that role can be.   

Cariloop seeks to provide coaching and support for anyone who finds themselves in that position.  

Whether you need logistical support to coordinate care, assistance navigating the complex healthcare world, or simply just someone to talk to, Cariloop is there to help.

Sales Mastery - Part 3 - Ryan Miller - Sales Performance Coach  

Ryan Miller is a highly sought after sales performance coach, and I am grateful that he helped me close out the 3-part miniseries of my podcast on "Sales Mastery"  

Ryan started off selling high-end wheels/rims for custom cars, and didn't discover the world of benefits until later in life.  He also has overcome numerous personal challenges, from having a strained relationship with his father, developing bad habits in his teens and 20's that nearly lead to jail time, and even being present with his wife at the infamous Las Vegas mass shooting where a bullet went straight through his wife's trucker hat without hitting her!  

Ryan eventually found his way to God, was able to salvage a marriage on the brinks, and to eventually building a successful sales and performance coaching business infused with his faith in Christ.  

He is a master of real authenticity, and this episode is absolutely loaded with great advice.

Chris Hamilton is a Partner at Hotchkiss Insurance.  He is also one of the best sales consultants I have met in the employee benefits industry, for which many of his peers agree.

Chris, like me, didn't get into sales until his 30's, having spent the bulk of his career before that in investment banking.  His ability to discuss financials, coupled with his experience in Mergers and Acquisitions, helped prepare Chris to have very complex conversations with business owners.  

Chris is the antithesis of your "stereotypical" salesperson.  He doesn't speak so fast you can't follow his words.  He doesn't use sales tricks or focus on always closing the deal.  He simple brings expertise, along with a deep level of integrity, to his prospects to build rapport and trust.  

In short, Chris is a modern benefits consultant, and our entire industry could learn from the example he has set!

Sales Mastery - Part 1 - Jennifer Bryson - Mercer

This is the first installment of a 3-part series dedicated to sales mastery.

Not only is Jennifer Bryson an absolutely lovely human being, she is always a killer producer!

Although Jennifer and my next two guests come from the employee benefits industry, each of the 3 conversations is focused on universal sales best practices.

Enjoy