The ShiftShapers Podcast

In this episode of the ShiftShapers Podcast, host David Saltzman chats with Marissa Rufo, JD, MBA, a subject matter expert from MZQ Consulting, to demystify the complexities surrounding Medicare Creditable Coverage. They discuss why it's significant for employers and employees alike, particularly in light of recent legislative changes and the growing number of older employees in the workforce. The conversation addresses compliance requirements, methods for determining creditable coverage, and practical steps employers need to take to avoid penalties and lawsuits.

Medicare creditable coverage is a requirement for group health plans to be comparable to an average Medicare Part D plan. The consternation and confusion around creditable coverage has increased due to recent changes in legislation and the growing number of Medicare-eligible individuals still working full-time. Employers have a fiduciary duty to ensure compliance with creditable coverage requirements, as failure to do so can result in lawsuits and penalties. While employers are not required to have actual creditable coverage, they must determine the creditability of their prescription drug plans, provide notices to Medicare-eligible employees, and report their credibility status to CMS annually. Failure to provide accurate notices can result in financial costs and penalties for employees. There are two methods for calculating creditable coverage: the simplified determination method and the actuarial analysis method. Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals. MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.

Takeaways

• Medicare creditable coverage is a requirement for group health plans, comparable to an average Medicare Part D plan.
• Employers have a fiduciary duty to ensure compliance with creditable coverage requirements.
• Failure to provide accurate notices can result in financial costs and penalties for employees.
• Brokers can help employers navigate the compliance requirements and ensure they are providing the necessary notices to all Medicare-eligible individuals.
• MZQ Consulting offers affordable testing services to help employers determine the creditability of their prescription drug plans.

In this episode of Shift Shapers, host David Saltzman sits down with Alycia Riedl, the new National President of NABIP, to discuss the future of the healthcare advisory industry. Alycia  shares her personal journey from reluctance to passion in the industry, following the legacy of her innovative father. They explore key issues on NABIP's radar, such as transparency, technology, and advocacy against single-payer systems. Alycia emphasizes the importance of evolving the role of advisors and her vision for a consumer-centered healthcare system. Additionally, they address leadership values and the strategic goals of NABIP for the coming years. Tune in to learn about the upcoming developments and strategic initiatives aimed at supporting healthcare advisors and improving the overall healthcare landscape.

Key Takeaways From This interview:

Career Journey: Alycia Riedl’s unexpected path to the insurance industry fueled by a passion for helping others.

Innovation and Adaptability: The importance of continuous improvement and innovation in the insurance industry.

Consumer-Centered Healthcare: NABIP’s commitment to a transparent, consumer-focused healthcare system.

Advisor Challenges: Addressing the difficulties advisors face with restrictive laws and compensation issues.

Leadership and Empathy: Reidl's emphasis on empathetic, data-driven leadership that supports team well-being.

The focus of this week's episode is on how modern healthcare system innovations utilize throwback TPA. Bob McCollins, vice president of sales at Edison Health Solutions, explains what’s happening in the TPA industry today and how a throwback TPA can help combine all the fantastic solutions out there to provide top-notch services.

What You’ll Learn From This Episode:

2:34 What throwback TPA means and how it works with current healthcare systems.

4:35 Keeping all of the various solutions together for the benefit of clients and potential clients.

7:57 TPAs need to be adaptable or focused on a single path in order to provide best-in-class services.

11:10 Changes to offerings and support in reference-based pricing.

14:48 Tasks they outsource to third parties.

16:39 Factors affecting claims' automatic adjudication.

20:35 TPA in the coming years.

This episode originally aired September 26, 2022

This week's episode delves into the world of pharmacogenomics (PGx) and how it is changing the way we approach medication management. We sit down with a leading expert in the field to discuss the current state of PGx adoption, the challenges it faces in gaining wider acceptance in the medical community, and the potential impact it could have on our healthcare system in the future. From the role of direct-to-consumer testing to the importance of involving clinicians in the decision-making process, we explore the complexities of this emerging field and what it could mean for patient care. Join us for this informative and thought-provoking conversation on the cutting edge of personalized medicine.

What You’ll Learn From This Episode:

1:54 Overmedication: A systemic problem in healthcare.

4:16 The evolution and future of pharmacogenetics (PGx) as a standard of care.

12:44 Implementing pharmacogenomics testing in employer healthcare plans: Overcoming adoption challenges and practical applications.

14:51 The adoption curve of pharmacogenomics testing in healthcare: A bottom-up mission.

17:34 The future of PGx: Adoption by early adopters and the role of payers.

This Episode Originally Aired March 13, 2023

In this episode of ShiftShapers, host David Saltzman discusses the recent Supreme Court decision to overturn the 40-year Chevron Deferment precedent and its implications for advisors and their clients. Joined by Jennifer Berman, ERISA attorney Jennifer Berman, the NABIP (National Association of Benefit Insurance Professionals) Legislative Vice Chair and CEO of MZQ Consulting, the discussion explores the decision's potential long-term effects on federal regulations and compliance in the healthcare sector. They delve into how this ruling shifts the responsibility from federal agencies to the judiciary in interpreting ambiguous statutes and assess the impact on specific regulations like compensation disclosures under the Consolidated Appropriations Act. Berman emphasizes to advisors and employers the importance of maintaining fiduciary duties and regulatory compliance while staying informed about future changes.

More from MZQ Consulting

Key Takeaways:

SCOTUS Decision Impact: The Supreme Court recently overturned the Chevron Deferment, shifting the power of interpreting ambiguous federal statutes from federal agencies to the judiciary. This major change may lead to increased challenges to existing regulations.

Immediate Effects on Law: Currently, the ruling doesn't change existing laws or regulations. However, advisors should anticipate more court challenges to federal regulations based on ambiguities in the underlying statutes.

Advisors' Immediate Actions: Advisors should communicate to their clients that no immediate changes are necessary. They should continue to follow current laws and regulations and focus on fulfilling their fiduciary duties.

Potential Healthcare Changes: Specific areas in healthcare, such as compensation disclosures and mental health parity, may become more contentious and face judicial challenges. However, statutory requirements like HIPAA, COBRA, and ACA reporting remain intact.

Need for Robust Fiduciary Processes: Advisors should emphasize the importance of maintaining documented fiduciary processes, including setting up committees, meeting regularly, and properly documenting actions to demonstrate compliance and best efforts.

In this episode of the ShiftShapers Podcast, host David Saltzman chats with Ashley Reid, founder and CEO of Wellist, to explore how companies can better connect employees to vital health and well-being resources. Reid discusses her transition from a marketing career to corporate strategy and the inception of Wellist. Driven by personal experiences with cancer care, she sheds light on the current challenges employers face in meeting wellness needs and how Wellist's Precision Resource Matching Platform uses AI to address these issues. They delve into practical examples, the financial impact of optimized benefits, and the importance of whole-person support. Reid shares how actionable data can help employers make informed decisions, and also the future aspirations for Wellist to become a standard support system across diverse industries.

Key Takeaways

• Organizations are increasingly focusing on connecting employees to the right wellness resources and benefits at the right time to boost overall well-being and engagement.
• The use of AI and data-driven platforms is transforming the employee benefits industry by providing personalized and efficient access to support resources.
• Employers can optimize their health benefits investments by leveraging data analytics to identify redundancies and gaps in their current offerings.
• Comprehensive employee support addressing a wide range of needs, including mental health and daily living aids, is becoming essential for maintaining workplace productivity and employee satisfaction.
• There is a growing trend toward standardizing integrated support systems to ensure employees can easily access the health and wellness assistance they need, particularly during critical life events.

In this episode of the ShiftShapers Podcast, host David Saltzman engages in a deep conversation with Matt Loper, CEO and co-founder of Wellth. They explore how healthcare plans can leverage behavioral economics to achieve better outcomes. Loper recounts his journey from aspiring biotechnologist to a leader in healthcare technology, emphasizing his efforts to increase patient engagement and improve health outcomes by using behavioral science and technology. The insightful discussion for business leaders also focuses on the core issues Wellth aims to solve, the importance of daily member engagement, and the need for consistent, trust-based relationships to drive better health behaviors and quality metrics. Loper shares insights on the methodologies employed, including targeted outreach and personalized communication strategies. He also touches on the future goals and expansions of Wellth.

Key Takeaways:

• Innovative Problem-Solving: Embracing behavioral economics offers innovative solutions to longstanding healthcare engagement challenges.
• Engagement is Key: Recognizing the engagement gap in healthcare underscores the importance of leveraging behavioral science and technology for patient involvement.
• Personalized Approaches Matter: Tailored communication and daily engagement strategies prove essential for nurturing healthier behaviors and improving overall healthcare outcomes.
• Financial Benefits of Engagement: Quantifying the financial impact of behavioral interventions highlights significant cost-saving opportunities for healthcare providers.
• Trust and Expansion Drive Success: Building trust-based relationships and expanding services are crucial components of achieving long-term success in healthcare innovation.
  
  

From from Wellth: https://www.wellthapp.com/

In this episode of the ShiftShapers podcast, host David Saltzman welcomes Stephen Sokoler, founder and CEO of Journey, to discuss the importance of mental health care in the workplace. Stephen shares his personal journey, from entrepreneurial beginnings to discovering meditation and ultimately founding Journey in 2015. They delve into pressing mental health challenges including stigma, therapist shortages, and the inefficiency of traditional EAPs. Stephen outlines Journey's proactive and inclusive approach to mental health care, emphasizing the importance of early intervention, awareness, and cultural competency. Tune in to learn how Journey is making mental health care more accessible and effective, and boosting EAP utilization through innovative strategies.

Key Takeaways:

• Daily Integration: Embedding mental health resources in workplace tools like Slack improves accessibility.
• Cultural Competency: Providing multilingual and culturally relevant content ensures effective support.
• Confidentiality: Strong privacy measures are crucial for employee trust and usage of mental health services.
• Thorough Evaluation: Comprehensive assessments help tailor support to individual needs.
• Awareness: Increasing awareness and reducing stigma around mental health resources is vital.

More From Journey

In this episode of the ShiftShapers podcast, we're joined by Daniel Cobb, Vice President of Sales and Strategy at Strategic Benefit Resources, to discuss the evolving landscape of Stop Loss Self Funding and the tech and data solutions supporting it. Cobb shares his journey from the mortgage business to insurance, emphasizing the significant changes and opportunities in self-funded health benefits plans. We discuss how the expansion of self-funded plans is now reaching groups as small as 25 employees. Cobb also explains the role of artificial intelligence in pricing stop loss, as well as the increasing demand for transparency and flexibility in health benefits management. Cobb also offers insights into how advisors can help clients transition to self-funding, the importance of understanding client needs, and other future trends in the industry. Business owners and executives - from large and small firms alike - stand to benefit from the important insights in this business podcast. 

Key Takeaways:

• The expansion of self-funded health plans now includes smaller groups, with as few as 25 employees participating.
• Artificial intelligence and advanced data tools are crucial in pricing stop loss and expanding self-funded health plans to smaller groups.
• Advisors need to understand whether their clients are savings buyers or quality buyers to effectively present self-funding options.
• Transparency and access to first-dollar claims data are key benefits of self-funding, allowing for better management of healthcare costs.
• The future of self-funding involves greater access to data, regional variations in plan management, and continued evolution of high-performance health plans.

Strategic Benefit Resources: https://www.strategicbenefitresources.com/

Thank you for tuning into this insightful episode of Shift Shapers. If you enjoyed our conversation with Daniel Cobb, please rate, follow, share and review our podcast. Stay tuned for more episodes where we explore the latest trends and innovations in the health benefits industry.

In this episode of the ShiftShapers podcast, host David Saltzman welcomes Steven Amiel, CMO at NextGen Benefits, to explore why marketing has become more challenging, costly and less effective in terms of ROI than ever before. They delve into the new regulations on tracking and targeting prospects, discussing how the move toward double opt-ins has changed the landscape of data collection. The importance of authentic communication is highlighted through real-world examples, emphasizing why marketing messages need to be genuine and aligned with personal branding. They also discuss the pitfalls of overextending marketing efforts, particularly on platforms like LinkedIn, and the need to focus on conversions rather than likes or opens. Steven provides insights on the shift from mass advertising to an account-based marketing approach and the crucial role of first-party data in effective marketing. He addresses how different strategies apply to small versus large companies and emphasizes the importance of building executive credibility and personalized engagement in sales. Steven also talks about future marketing trends, including interactive webinars and storytelling, as key strategies for 2024 and beyond.

Key Takeaways:

1. Government regulations have changed how health benefits marketers can track and target prospects, emphasizing the need for authentic communication.=

2. Authenticity is crucial in marketing communication to establish a personal connection and engage prospects effectively.

3. Emphasize conversions over likes or opens to drive meaningful results in marketing efforts.

4. Shift toward building first-party data through engaging strategies and personalized interactions to improve deliverability and lead quality.

5. Focus on differentiating yourself by understanding prospects, establishing executive credibility, and aligning messages with the target audience for successful marketing campaigns.

More from NextGen Benefits: https://www.nextgenbenefits.com/