The ShiftShapers Podcast

David Saltzman
  • 4.4 (20)
  • MANAGEMENT
  • UPDATED WEEKLY

Change either paralyzes or energizes - the choice is yours. Hear from businesses and entrepreneurs who have become energized and who have profited by shaping the shifts in their markets and practices. Become a SHIFTSHAPERS INSIDER and get our latest download, advance notice of all podcasts, podcast summaries, and special INSIDER-ONLY content. INSIDER SIGN UP

  1. 12/30/2025

    EP 534 ENCORE: Choice Without Chaos - with Chad Schneider

    We revisit how employers can control healthcare spend while expanding employee choice through ICRAs, with Chad Schneider of Thatch sharing what works, what breaks, and what’s next. We dig into change management, decision tools, dynamic contributions, and the broker’s evolving role. • Why ICRAs surged after 2020 and boomed in 2024 • Carrier expansion and a stronger individual market • The real barrier being change management and fintech • Decision support that mirrors travel-style shopping • Dynamic contributions that create equity across markets • Carve-out classes to manage renewals and strategy • Common misconceptions among brokers and employers • Data, APIs, and real-time enrollment tracking • Emerging perks, localized networks, and future trends Please feel free to go to our website, which is thatch.com, reach out to me on LinkedIn. I’d love to chat with you, and we can happily go through our process, quoting, show you all the cool bells and whistles, and we’d love to be able to engage further. This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

    25 min

  2. 12/23/2025

    EP 516 ENCORE: Rethinking Provider Networks - with Scott Smith

    We revisit how PPOs got built on discounts and show why total value beats sticker price. Scott Smith joins us to explain nationally curated high-performance networks that rank providers on effectiveness, appropriateness, and cost, and how that changes renewals, member experience, and fiduciary risk. • why traditional PPO discounts miss total cost of care • how consolidation and narrow networks increase abrasion • claims-based scoring at the provider NPI level • quality metrics that matter: effectiveness, appropriateness, cost • member tools: stars, plain-language summaries, mobile access • plan design that waives cost sharing for high-quality choices • PEPM pricing without shared savings games • national footprint for TPAs and large employers • faster ROI and improved MLR through reduced waste • roadmap to a true BUCA alternative This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

    26 min

  3. 12/16/2025

    EP 518 ENCORE: Quality Without Guesswork - with Kate Grohall

    We explore how reducing variation in cost, outcomes, and experience creates real value, and why deep provider metrics and real-time member support outperform box-checking credentialing. Kate Grohal shares a playbook for aligning incentives without repeating the mistakes that soured HMOs. • defining quality as reducing variation across cost, outcomes, experience • Kate’s path from patient escort to quality leader • why NCQA alone falls short for measuring provider performance • additional metrics: infection rates, readmissions, team engagement, co-management • building value-based networks that screen out low-performing providers • real-time care navigation via nurses, MAs, and app-based prompts • behavior change through waived cost-sharing and premium reductions • the downside of PEPM fees and paying for non-performance • differentiating value-based care from old-school HMO denial tactics • employers moving from back seat to driver’s seat • tech adoption gaps and the next five-year horizon Visit BenaPower.ai or email info@BenaPower.com to schedule a demo For more information, visit HatcherMedia.net — that’s H A T C H E R Media.net This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

    27 min

  4. 12/09/2025

    EP 531 ENCORE: Solving The Health Payment Puzzle - with Tom Policelli

    We revisit the rising problem of the “functionally uninsured” and ask how to restore real access for employees who delay care because of confusion and cost. Paymedix CEO Tom Policelli shares how a super EOB, upfront provider payment, and 0% financing change behavior and bend trend. • confusion outranking cost as the top barrier to care • hospitals pushing prepayment and the access wall it creates • income-tier patterns driving ER and inpatient overuse • super EOB mechanics and single monthly reconciliation • provider payment upfront and revenue-cycle relief • employer savings of two to three trend points annually • advisor positioning and retention benefits • partnerships with EXO Health to improve network economics • TempoPay for pharmacy access and first-dollar fills • risk management via broad pooling and automatic eligibility • national expansion through aligned partners and TPAs • a third path beyond prepay or bill-and-pray collections “Go to PayMedix.com.” This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

    24 min

  5. 12/02/2025

    EP 505 ENCORE: Fixing PBM Conflicts - With Susan Thomas

    Pharmacy benefits shouldn’t feel like a black box. We sit down with Susan Thomas, Chief Commercial Officer at Lucy Rx, to unpack why drug costs keep rising and what it takes to build a benefit that serves patients and plans—not middlemen. Susan started as an oncology nurse and moved into PBM leadership, and that dual lens shows up in everything we cover: from the real-world stress of waiting days for an oral chemo to the hidden economics of rebate chains and vertically integrated networks. We dig into the two biggest levers for change. First, formulary autonomy: instead of being locked to a single, opaque GPO, a marketplace approach lets employers compare multiple rebate contracts, see drug-level net cost, and choose the best path for categories like Humira biosimilars or GLP-1s. That shift enables utilization management that protects value without opening the floodgates. Second, network independence: when PBMs own specialty and mail, steering is inevitable. By contracting with integrated health systems for specialty and modern mail partners for home delivery, plans can speed therapy, reduce waste from 30-day auto-ships, and improve member experience at a lower overall cost. We also talk fiduciary duty, policy momentum, and technology. Employers need verifiable net-cost math—not averages—to defend decisions in a post–J&J lawsuit world. Washington’s scrutiny is rising, and incumbents are signaling changes, but structural misalignments remain. On the tech front, AI-driven reporting and specialty navigation are already here, while precision medicine and pharmacogenomics promise to target high-cost drugs to the patients who will benefit most. The question is whether the industry will embrace smaller, smarter populations when volume shrinks and outcomes improve. If you care about cutting pharmacy spend without compromising care, this conversation is a practical roadmap: ask for drug-level net cost, insist on formulary choice across GPOs, require independent specialty and mail, and set utilization criteria that put patients first. Subscribe, share this episode with a colleague who manages pharmacy benefits, and leave a review with the one PBM metric you wish you’d had sooner. This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

    25 min

  6. 11/18/2025

    EP 538 From Buggy Whips To AI - with Julian Lago, Benepower

    What if benefits work leaped from horse‑and‑buggy speed to highway pace? We sit down with Julian Lago, co‑founder and CEO of BenePower, to explore how AI is already compressing days of quoting, enrollment, and service into minutes—and what that means for brokers, HR leaders, and members who need clear answers right now. We dig into the practical side of agentic AI and retrieval‑augmented generation: how specialized models fetch plan rules, accumulators, and pending claims to answer real‑world questions like “what’s left on my deductible?” with accuracy. Julian explains why virtual care is no longer just telemedicine, how ambient documentation can free clinicians to focus on patients, and why unified front‑door experiences beat a jumble of point solutions. Along the way, we talk about emotion AI that detects stress, switches languages seamlessly, and brings empathy to urgent moments—like getting an ID card to a parent driving to urgent care—without losing speed or precision. For employers, the conversation moves from tools to outcomes: steering to high‑value care, reducing surprise bills, and designing plans people actually use. For advisors, it’s a playbook for differentiation—showing clients how to use data, automation, and hyper‑personalization to improve health and lower costs while keeping a human in the loop for sensitive decisions. We also address the hard edges: privacy, HIPAA alignment, model hallucinations, and emerging state regulations that set boundaries around clinical advice. If you’re ready to trade legacy friction for clear, measurable gains, this episode lays out where to start, what to watch, and how to scale. Subscribe, share with a colleague, and leave a review telling us which workflow you want AI to fix first. This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

    25 min

  7. 11/10/2025

    EP 537 Enhanced Benefits Evolution - With Eric Silverman, Voluntary Disruption

    Change can energize or paralyze—so we chose energize. We sat down with Eric Silverman, founder of Voluntary Disruption and a four-time guest, to unpack what’s actually moving the needle in enhanced benefits today. The surprise? Products haven’t radically shifted, but execution has. Simple, high-interest options like pet insurance, ID protection, legal plans, and life paired with long-term care continue to win attention. The real breakthroughs are how teams communicate, guide choices, and run enrollment with less friction and more trust. We dig into decision support tools and their mid-market roadblocks, then map how AI can personalize choices with Amazon-like clarity. Think smart nudges that connect plan design to real life: a high-deductible plan paired with accident coverage, or young families steered toward urgent care-friendly options. We also trace a major distribution shift—from carrier direct to advisor-led strategies—where brokers step up to own the full package: medical, pharmacy, disability, life, and voluntary. That move isn’t just good practice; it’s how you reduce risk across absenteeism, presenteeism, and unexpected costs. Communication is where results jump. Text-first outreach beats inbox fatigue. Short, captioned videos from HR leaders outperform generic vendor clips. Family-focused messaging, including the emergency contact, turns open enrollment into a shared decision. We share a practical playbook: launch midweek, keep enrollment windows short, host content on a 24/7 microsite with searchable chapters, and go off the January 1 cycle to escape fourth-quarter chaos. Virtual, self-service enrollment replaces one-on-one sales pressure and leaves a clean digital trail that cuts buyer’s remorse and HR headaches. If you advise employers—or lead HR—and want better participation without arm twisting, this conversation gives you the modern blueprint. Subscribe, share with a colleague who needs a smarter enrollment strategy, and leave a review with your top takeaway so we can dive deeper next time. This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

    28 min

  8. 11/04/2025

    EP 536 On-Site Wins - With Chris Yarn, Walk On Clinic, Inc.

    What if the clinic your team actually uses is the one parked outside the office? We sit down with Chris Yarn, CEO of Walk On Clinic, to unpack why on-site and mobile primary care crush near-site options on utilization, trust, and measurable savings—often with fewer clinic days. The story begins with a simple truth: convenience wins. When clinicians are visible and familiar, employees engage more, follow through on care, and keep the relationship going virtually with the same people they see in person. We break down a standout case: a near-site clinic three days a week just over a mile away versus a mobile clinic two days a week on-site. After ten months and 800 employees, 515 chose on-site, only 15 went near-site. That utilization shift powers tangible outcomes: lower urgent care and ER visits, time savings measured against payroll, and pharmacy strategies that can offset clinic costs. Chris explains how zero-dollar ghost claims at Medicare rates create conservative ROI models, and how plan-aligned referrals remove the “we don’t take your insurance” friction that derails self-funded plans. You’ll hear a practical framework for choosing the right model: headcount thresholds, geographic routing for distributed workforces, and which plan designs benefit most. We also explore how a broker’s mindset shaped Walk On Clinic’s approach—quarterbacking imaging, specialty, and pharmacy decisions so plan assets get used. Along the way, Chris shares lessons on branding and visibility, from creative content to educating the market on why hybrid care—on-site plus virtual continuity—outperforms stand-alone telemedicine. If you’re a benefits leader, broker, or operator hunting for real-world ROI and a better member experience, this conversation is a playbook for turning primary care into the true front door of the plan. Subscribe, share with a colleague, and leave a review with your biggest question about building on-site access at scale. This episode is sponsored by Benepower, the platform of choice for a modern benefits experience. Benepower is an AI-powered benefits platform offering access to top products and services, enabling consultants and employers to create customized plans, optimize usage, and measure effectiveness. www.benepower.com

    26 min
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About

Change either paralyzes or energizes - the choice is yours. Hear from businesses and entrepreneurs who have become energized and who have profited by shaping the shifts in their markets and practices. Become a SHIFTSHAPERS INSIDER and get our latest download, advance notice of all podcasts, podcast summaries, and special INSIDER-ONLY content. INSIDER SIGN UP

Information

  • Creator
    David Saltzman
  • Years Active
    2014 - 2025
  • Episodes
    543
  • Rating
    Clean
  • Copyright
    © 2025 The ShiftShapers Podcast
  • Show Website
    The ShiftShapers Podcast