The Healthcare Hangover

In this eye-opening episode, David Contorno and Emma Fox dive into the harsh realities many face in accessing life-saving medications for chronic conditions. They share a heartfelt story of an 11-year-old boy desperate to help his mother, who lost access to her crucial MS medication due to an unexpected change in her health insurance plan. The discussion sheds light on the complexities of health insurance, the hidden options available, and how unaffordability can strike without warning. Emma and David provide practical advice on navigating these challenges, from leveraging manufacturer assistance programs to sourcing medications internationally. Join them as they unravel the tangled web of healthcare, offering hope and actionable strategies for those struggling with similar issues.

TIMESTAMPS:

[01:06] Story of an 11-year-old boy asking for help for his mother

[04:33] High-deductible HSA plans vs. copay PPO plans

[07:28] Manufacturer assistance programs, coverage issues, qualification requirements

[10:33]How drug coupons work and their impact on self-insured plans

[17:31] GLP-1 drugs (e.g., Trulicity, Ozempic) pricing and sourcing strategies

[24:49] Importance of consulting doctors when considering medication alternatives

[29:14] Emphasis on the responsibility of benefits consultants to impact company and employee finances

QUOTES

• "It has these horrific downstream effects, like eleven year old boys who are asking practical strangers to help his mom. You know, it really hurt my heart."- Emma Fox
• "But I wanted to explain that because coupons are, if you're in a fully insured plan, I, when I say I don't care, I do care a little, but I don't care nearly as much as when you're in a self-funded plan." - Emma Fox
• "Imagine if you were compensated for figuring out the things that we're talking about here. [...] You're impacting the money coming into their house and the money coming out of their house to a very large degree." -David Contorno

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

[email protected]

In this episode, Emma Fox and David Contorno explore the intertwined complexities of fiduciary responsibility and the hidden costs in healthcare. As employers face increasing scrutiny under ERISA and rising lawsuits, the conversation unpacks the critical roles of pharmacy benefit managers (PBMs) and healthcare carriers in shaping healthcare pricing. They discuss spread pricing, the importance of transparency, and the evolving responsibilities of employers and advisors. With insider insights and real-life examples, Emma and David offer a comprehensive look at how to navigate the delicate balance of fiduciary obligations while exposing systemic flaws that burden both employers and employees.

TIMESTAMPS:

[00:28] David and Emma discuss the increasing use of the term 'fiduciary' in healthcare

[04:36] Employers are fiduciaries for their health plans but often unaware

Fully insured plans & fiduciary duties

[11:21] PBMS -spread pricing, revenue, lack of transparency

[24:52]Recent lawsuits against Johnson & Johnson and Wells Fargo for mismanaging drug costs

[26:38] Fiduciary responsibilities under ERISA

[33:26] Payment integrity departments in carriers often lack true integrity

[37:44] Younger generations may drive change in healthcare systems

QUOTES:

• "You have to choose the right consultant, and finding the right consultant can be really hard because... there are a lot of people that you can find on LinkedIn who are saying all the right things, but that does not mean that they are doing the right things."- Emma Fox
• “I don't know, but I think transparency, they say that a spotlight is the best disinfectant or transparency is what really opens it up. And I think that's what we need to focus on. We need to focus on, most employers can't even access the information they need to be a fiduciary. So we need to really talk about transparency.” -David Contorno
• "If you are an employer listening to this, it is now crucial that you make a right selection... you have to be brave enough to say that being with a bucca, being with the CEO, increases my risk of violating my fiduciary responsibility." -Emma Fox

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

[email protected]

In this eye-opening episode, Emma Fox and David Contorno dive deep into the often-overlooked mechanisms that drive healthcare costs higher year after year. Emma shares her viral LinkedIn post about being "anti-BUCA" (Blue Cross, United, Cigna, Aetna) and the heated debate that followed. The conversation unveils the truth behind medical loss ratios, pre-certification practices, and the intricate systems that benefit insurers at the expense of employers and employees. Tune in to understand why challenging the status quo is essential for creating fair and transparent health plans.

TIMESTAMPS

[01.22] The anti-BUCA (Blue Cross, United, Cigna, Aetna) stance

[04.42] David explains how pre-certification is used to control care and ensure claims go up

[10.36] Discussed an article about Aetna's former medical director ignoring patient records

[11.15] Correlation between premium increases and carrier stock prices

[16.43] Higher standards their plans are held to compared to traditional carriers

[19.19] History and purpose of pre-certification in healthcare

[24.27]Story of a physician-owned hospital system preferring non-BUCA payers

[28.47 The role of doctors in current healthcare system

QUOTES:

• "None of this is by accident. When I meet with employers and we talk about how we build health plans, we talk about medical management... the initial decisions are made by largely non-clinical administrative people who are following a series of checkboxes." -Emma Fox
• "You know, carriers put out messages that they provide great care, that they want costs to be lower, that they want to control costs, but that's not how they operate." -David Contorno
• "I feel like when I come in with the plan that I have demonstrated is higher quality going to lower out of pocket, it's going to save the money. I'm held to a much higher standard than Blue Cross and United is." -David Contorno

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

[email protected]

In this episode, Emma Fox and David Contorno dive into the whirlwind of 2024, a year that began with optimism but quickly spiraled into a series of unexpected health challenges. David opens up about his harrowing experience with chronic pain, a spiritual trip to Costa Rica that led to a cascade of health issues, and the discovery of acute kidney failure. The duo discusses the importance of understanding the risks of long-term NSAID use, the critical role nurses play in patient care, and the reality of navigating a flawed healthcare system. Tune in to hear about resilience, medical advocacy, and the next steps in David’s health journey.

TIMESTAMPS

[00.49] David Contorno experienced a severe health crisis

[02.25] Emma’s point of view

[05.52] Rushed to Mission Hospital ER in Asheville, NC

[10.42] Diagnosed with acute kidney failure

[13.42] Experienced frustration with hospital holding area

[17.07] Learned about dangers of long-term NSAID use 

[18.09] Discussed potential need for back surgery

[18.50] Mentioned the hospital's attempts to qualify David for Medicaid

[19.47] Emma managed hospital paperwork and consent forms

[23.39] Friends in the medical industry offered guidance

[27.41] The community showed strong support during recovery

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

[email protected]

In episode 20 of The Healthcare Hangover, David Contorno and Emma Fox discuss alarming healthcare facts, including the US's high healthcare spending, lack of guaranteed health coverage, and avoidable deaths. They also touch on the impact of COVID-19 on life expectancy and vaccination rates.

Tune in to gain insights into the healthcare system's financial challenges and the need for reform.

TIMESTAMPS

[00:03:08] Healthcare System's Avoidable Deaths.

[00:05:45] Universal Healthcare Debate.

[00:08:49] Life Expectancy and Healthcare Disparities.

[00:12:00] Acceptance of Preventable Deaths.

[00:17:33] Perverse Incentives in Government.

[00:21:23] Little Community Making Big Waves.

[00:23:54] Life-Changing Impact of Cost Savings.

In this episode, David Contorno and Emma Fox discuss how the US spends a significant amount on healthcare, far exceeding the average spending of other developed nations. Despite this high expenditure, the country continues to experience a troubling number of avoidable deaths. 

Furthermore, David and Emma highlight the urgent need for systemic change in the healthcare industry, emphasizing the importance of accountability, responsibility, and legislative action to address disparities, improve access to care, and enhance outcomes for individuals. By advocating for reforms, engaging with policymakers, and prioritizing patient-centered care, the healthcare system can evolve to better serve the needs of the population.

QUOTES

• "We've become accepting of hundreds of thousands of people dying every year, needlessly, unnecessarily, the huge majority of them could have been prevented. That's not even including those preventable medical errors, which is an even higher rate than that. Like we've become numb to death. Unless it's like our immediate family, We don't care about it anymore, which is right. No wonder we're not fixing our healthcare system because that involves caring about other people. And it feels like there's such a lack of that." - David Contorno
• "I think the key to finding something that's actually passable in this country is to make sure that both sides don't like it. If one side loves it and one side hates it, it's never going to get done." - David Contorno
• “I don't know what's going to happen if the administration changes hands. But I do feel at least that it's getting on some radars, you know, like some important people are realizing that we exist. And I think that's, the days when my optimism is lacking, I think those are the things that kind of lean on. And if I step out of this industry, I'm leaving that burden for somebody else to carry. And that's why I feel like it's a big responsibility.” - Emma Fox

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

In episode 19 of The Healthcare Hangover, David Contorno and Emma Fox delve into the complexities of the healthcare system, touching on issues such as access to care, the influence of lobbyists, and the future of healthcare entities.

Tune in as they explore the challenges and nuances of the healthcare industry.

TIMESTAMPS

[00:01:25] Disappointing Experience with Direct Primary Care (DPC).

[00:06:55] DPC Values and Healthcare Choices.

[00:07:58] DPC in Health Plans.

[00:13:33] Our Healthcare System's Financial Incentives.

[00:16:39] Influence of Pharmaceutical Lobbying.

In this episode, David Contorno and Emma Fox discuss the importance of strategically integrating Direct Primary Care (DPC) into health plans to maximize its benefits and avoid diluting its value. They highlight the need to carefully assess DPC providers before including them in health plans to ensure alignment with the values and needs of the employees or members.

Furthermore, David and Emma underscore the complex interplay of financial interests, lobbying power, and resistance to change that continue to impede efforts to improve the healthcare system in the U.S. Addressing these challenges will require a concerted effort to prioritize the well-being of individuals over financial gains and to advocate for reforms that prioritize preventive care, transparency, and patient-centered approaches.

QUOTES

• "I think having a deeper relationship means that it gets a little more personal. I think it's okay to ask those things. So we try and get a broad spectrum of DPCs in the plans, at least as broad as we can so that people can find the one that they're most comfortable with." - David Contorno
• "I think a lot of people think that DPC is really for individuals or small groups. But there are ways, especially when you're assessing the tolerance of the group that you're representing and the DPC's value proposition, that you can marry those together with what looks like a traditional health plan. but provides this direct care component right up front. And I would say those are our most successful plans." - Emma Fox
• "For those of you that don't know, when you go to a DPC doctor, you never pay a copay, you never pay deductible, you never pay coinsurance. It doesn't matter if it's preventive or diagnostic. So there's zero barriers. There's no time barrier. There's no 3,000 other patient barrier, and there's no cost barrier to getting primary care. And one of the things that we've lost sight of is that primary care is called primary care because it's where we are supposed to go primarily." - David Contorno

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

In episode 18 of The Healthcare Hangover, David Contorno and Emma Fox discuss their recent trip to Dallas and a new project they've been working on. They also talk about the challenges of the healthcare system and the need for a holistic approach to fixing it.

Tune in to hear their insights and find out how you can get involved in making a difference in your own community.

TIMESTAMPS

[00:02:43] Lack of Access to Healthcare.

[00:08:14] Prescriptions and Financial Assistance.

[00:11:45] Financial Assistance Programs at Nonprofit Hospitals.

[00:15:02] Providing Healthcare to the Uninsured.

In this episode, David Contorno and Emma Fox delve into the pressing issue of individuals in certain communities who are unable to afford essential medications and healthcare. They even highlight that as individuals age, they often require maintenance prescriptions for common health issues like blood pressure. However, the cost of these medications can be exorbitant, leading many to forgo necessary treatments and appointments.

Overall, David and Emma emphasize the importance of understanding the various assistance programs available and the distinction between medical and prescription coverage. While some programs require individuals to be uninsured, others may still be accessible to those with insurance. Taking a holistic approach to healthcare is crucial, addressing the issue from all angles simultaneously to prevent the problem from resurfacing in more detrimental ways.

QUOTES

• "The goal is to bring direct primary care into these communities for short periods of time, kind of like pop-up DPC, to serve these folks who don't have access to health care." - Emma Fox
• “the most common misconception around these programs when people find out about it, is that it doesn't matter if you have insurance. It is not for only the uninsured. It's also for the underinsured." - Emma Fox
• "I feel like I have the opportunity and our plans do that every day when I can get someone who does have a job who's clearly doing the right thing, but they still can't afford their medication or their surgery or their tests, and then I can get it done for them. that feels really good. And it doesn't feel like charity. It feels like getting them what they should have been entitled to anyway." - David Contorno

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

In episode 17 of The Healthcare Hangover, David Contorno and Emma Fox discuss their frustration with employers giving up on finding effective healthcare plans. They delve into the importance of retention rates in the industry and express their concerns with consultants who seem to be giving up too easily. 

Tune in to hear their passionate discussion about the need for persistence in finding alternative healthcare solutions.

TIMESTAMPS

[00:00:20] Employers Giving Up.

[00:02:36] Leadership in Healthcare Financing.

[00:07:57] Cancer Care Mistreatment Rates.

[00:09:25] Failing Health Care System.

[00:13:41] Employers and Healthcare Innovation.

In this episode, David Contorno and Emma Fox express frustration with employers who are giving up on finding alternative healthcare plans. They believe that employers are too focused on retention rates and are not willing to put in the effort to explore and implement alternative options. 

Moreover, David and Emma believe that employers should dedicate the same effort to healthcare as they do to their core business. They argue that while the core business unit may be challenging and competitive, employers have had to make innovative decisions and value propositions to be successful in that area. Therefore, they suggest that employers should apply the same level of dedication and resource allocation to healthcare because it is equally important and costly. They believe that if enough employers prioritize healthcare and make informed decisions, it can lead to positive changes in the healthcare system.

QUOTES

• “I think that they don't consider doing the hard thing when it comes to health care financing as part of their responsibility when it comes to being good leaders.” - Emma Fox
• "Nothing pisses me off more than an employer who's not willing to do the right thing because they're getting pushback from people who don't understand what the right thing is." - Emma Fox
• "Sometimes you got to make people emotional on this. And oftentimes it's just a negative emotion that's going to get them to change something considerably so radically." - David Contorno
• “Put the right insurance in place by asking the right questions, by working with the right people, by paying people in a way that's aligned with those outcomes. And if enough employers did that, the system would change.” - David Contorno

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

In episode 16 of The Healthcare Hangover, David Contorno and Emma Fox discuss their experiences with political influences in the healthcare system. They share their frustrations with trying to make change through traditional channels and how they found themselves in high-level political circles. They talk about their background in lobbying and the lack of impact they felt. 

Tune in to hear about their unexpected journey and their thoughts on the intersection of healthcare and politics.

TIMESTAMPS

[00:04:27] Politicians' Focus on Health Insurance.

[00:07:27] Politicians' Misunderstanding of Healthcare.

[00:11:38] Running for Office.

[00:12:51] Pro-Life vs. Pro-Choice as Policy.

[00:19:55] Holding Healthcare Entities Accountable.

In this episode, David Contorno and Emma Fox have been grappling with the challenge of making a meaningful impact on the healthcare system through political influences. Despite their attempts to engage with political influencers, both individually and collectively, they have found it to be an ineffective endeavor. 

Moreover, David and Emma emphasize the importance of treating all individuals equally and ensuring that healthcare is recognized as a fundamental human right. They argue that while the government does not need to fully provide healthcare, it should play a role in guaranteeing equitable access to care.

QUOTES

• "Insurance doesn't solve the problem. It actually makes it worse, at least as it exists today." - David Contorno
• “I was going to say is politicians don't seem to understand that. They have this idea that as long as someone has health insurance, they'll be OK. But it's never the case." - Emma Fox
• "Republicans are for less government, not more government. They're for less interference in our lives, less interference in how parents educate and with the lifestyles and the religious beliefs. I don't believe that I should be making the right medical choice for your children or any politician should. I believe that me and my wife love my children no more than anyone else. And we are best suited to make medical decisions for them above and beyond everybody else." - David Contorno
• “I think Republicans are actually a little bit more rebellious, especially in the last few years. But Democrats, they're very much a united front.” - Emma Fox
• “I have some ideas, some legitimate ideas that I think are very doable that would provide healthcare to some extent and also still maintain the privatized insurance market and the employer-employee relationship. And I think that there's a compromise out there that truly brings value to the country, to its citizens, to the doctors that are miserable.” - David Contorno

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

In episode 15 of The Healthcare Hangover, David Contorno and Emma Fox dive into the topic of GLP-1 weight loss drugs, exploring their effectiveness, financial implications, and the debate surrounding their accessibility for weight loss.

Tune in as they navigate and share their insights through this issue.

TIMESTAMPS

[00:00:30]  Introduction to GLP-1 Weight Loss Drugs

[00:01:00]  Weight Loss and Financial Perspective

[00:03:00]  Personal Weight Loss Experiences

[00:05:00]  Coverage and Accessibility

[00:06:30]  Patient Assistance Programs (PAPs)

[00:09:00]  Proposed 12-Month Program

[00:11:30]  Additional Benefits of GLP-1 Drugs

[00:13:00]  Employer's Perspective

[00:14:20]  Pharmaceutical Industry Considerations

[00:16:30]  Addiction Analogy

In this episode, David Contorno and Emma Fox focus on GLP-1 weight loss drugs, as they share their experiences with employers interested in covering these drugs under self-funded health plans. They explore the efficacy of these drugs, emphasizing that they are not a silver bullet and require complementary lifestyle changes for sustained results.

In addition, David and Emma share personal weight loss journeys and debate whether access to these drugs should be expanded to make weight loss more achievable for individuals struggling with obesity. They discuss the financial aspects, including the high costs and varying coverage percentages across health plans. They also address potential benefits beyond weight loss, such as reducing cravings for other addictive behaviors. Thus, expressing concerns about the affordability of these drugs and the pharmaceutical industry's motivations. 

QUOTES

• "It's very long term. It's not a silver bullet. You still need to do other things that if not done means you have to be in the medicine forever." - David Contorno
• “And the one thing that's bothering me is people claiming that these drugs are new, which is, I mean, some of them are new, don't get me wrong, but the formula has been around for a long time. We've been using these drugs to treat diabetes.” - Emma Fox
• "If this was available to me and I could have afforded it back then, I don't know why we wouldn't make it easier when I see people say that overweight people shouldn't have access to GLP ones." - Emma Fox
• "If you're an anti-GLP-1 person, I'd really encourage you to look at it from a more human perspective as somebody who was very, very overweight my whole life."  - Emma Fox
• "I think everybody is addicted to something. I have the luxury of being addicted to multiple things." - David Contorno

SOCIAL MEDIA LINKS

David Contorno

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

Emma Fox

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

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/