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. 1H AGO

    EP 549 Building A Better Provider Network - with Jarred Pierce

    We talk with Jared Pierce about why many provider networks run on outdated contracts and why that breaks trust for providers, members, and plan sponsors. We dig into how Unity builds a primary, provider-aligned network for self-funded plans that protects access while still driving real savings.  • Jared’s early start building PPO networks at 17 and how it shaped his view of the system  • Why legacy PPO networks “live off old paper” and what that means for pricing and trust  • How reference-based pricing can create confusion, appeals, and members turned away  • What “RBP-level reimbursement with real contracts” looks like in practice  • Using historical claims data and member nominations to build a customized network  • Why clear, simpler contracts improve provider participation and reduce noise  • Bootstrapping growth without private equity and staying independent longer  • Where Unity is seeing adoption and what advisors should watch next  • The future network model tied to member incentives and smarter plan design

    22 min

  2. MAY 12

    EP 548 All You Can Eat Compliance - with Carol Taylor

    We bring compliance specialist Carol Taylor back to unpack why employers keep getting blindsided by benefit plan obligations like RXDC reporting, PBM disclosures, and fiduciary duties under ERISA. We map the real-world risks, the paperwork traps that cause rejected filings, and the simple audit habits that keep penalties from stacking up.  • RXDC reporting basics and why it exists  • why employers still miss RXDC years later  • where legal responsibility lands even when vendors file  • practical steps for HIOS access and employer uploads  • CAA 2026 expansion of PBM disclosure and rebate rules  • what PBM transparency can reveal about pricing and compensation  • ERISA fiduciary exposure for employers and individual decision-makers  • how advisors draw boundaries to avoid functional fiduciary status  • renewed ACA employer mandate enforcement around 1094 and 1095 filings  • why a mental health parity enforcement pause does not remove MAPEA duties  • ongoing No Surprises Act IDR problems and cost impacts  • using a compliance audit checklist and reviewing E&O coverage limits

    28 min

  3. MAY 5

    EP 547 New "Captivated Health" Book - with Mark Gaunya

    We talk with Mark Gaunya about why employer health insurance often feels like a casino where the house wins and how employers can flip the odds with transparency, ownership, and smarter plan design.  We break down how captive risk sharing works, what it takes to implement, and the real financial and employee-experience wins that come from getting off the less bad renewal hamster wheel.  • Why the US healthcare system “works” as designed for rulemakers, not end users  • How the less bad renewal cycle traps employers without claims data and transparency  • Why Mark wrote Captivated Health and how case studies teach faster than jargon  • Captive insurance versus traditional self-funding, including stop loss and risk layers  • The four pillars of Captivated Health: members first, consumerism, wellbeing culture, self-governance  • How employers can control the SPD, stop loss contract, and TPA agreement  • outcomes from captive ownership: lower trend, pharmacy control, surplus, and rebate distributions  • Practical stories: bundled maternity pricing plus shared savings, adding LASIK through plan design  • The leadership mindset shift from system decision to self-decision  • What implementation really looks like for HR and finance without adding headcount  If you're an employer and you're struggling with these kinds of issues, and most of you are,  or if you're a broker and you have clients who are struggling with these issues, please get the book, "Captivated Health. Take Control. Gain Transparency. Leverage Confidence." CLICK HERE

    34 min

  4. APR 28

    EP 546 Well-Being That Actually Cuts Costs - with Ashley Rutkowski

    We challenge the old wellness playbook and show how coaching, claims integration, and clinical guardrails turn behavior change into measurable cost control. GLP-1s, chronic condition priorities, and realistic timelines come together in a system that bends trajectories instead of chasing fads. • why awareness and incentives fail without habit formation • building coaching into chronic care to shift daily decisions • measuring ROI with leading indicators and claims trends • onboarding with claims to target high-impact conditions • integrating point solutions into a coordinated system • using GLP-1s with coaching, guardrails, and taper plans • setting realistic timelines for years two and three • how AI and claims integration guide next-best actions For more information or to schedule a demo of the Benepower Advantage, go to Benepower.com They absolutely can either call me or they can email me at arutkowski at navigatewell.com

    22 min

  5. APR 21

    EP 345 Medicare Playbook For Agents - with Paige Phillips

    Medicare is full of fine print, fast-changing rules, and enough junk mail to fill a suitcase. So what actually separates the agents who barely survive from the ones who become the trusted name in their community? We sit down with Paige Phillips, founder of the Paige Phillips Insurance Agency and author of Medicare Playbook for Agents, to get practical about what works when the stakes are someone’s healthcare and finances. We talk about the unglamorous details that build a thriving Medicare book of business: relationship-building, client education, and the discipline of doing a true needs analysis. Paige shares why “getting the plan right” means checking doctors and prescriptions down to the dosage, and why the best agents think long-term through retention, renewals, and referrals instead of chasing AEP like a short-term payout. We also dig into year-round touchpoints that keep clients connected, from birthday outreach to thoughtful follow-up after major health events, and how a simple “call me first” mindset protects seniors from confusing ads and sales calls. On the regulatory side, we cover Medicare compliance, CMS oversight, and why cutting corners is the fastest way to lose trust. Paige breaks down IRMAA (the income-related monthly adjustment amount), the two-year lookback, and how to set expectations so clients aren’t blindsided by a premium surcharge. We close by looking forward at technology and AI, and what the next generation of retirees may demand from the Medicare enrollment process. Subscribe for more conversations on the shifts shaping benefits and insurance, then share this with an agent who cares about doing it right and leave us a review with your biggest Medicare question.

    28 min

  6. APR 14

    EP 544 Healthcare Costs Keep Rising Because Prices Stay Invisible - with Katy Talento

    Healthcare stays expensive because the system hides prices and quality from the people paying for care, especially employers. We talk with Katie Talento about how CAA 2026 transparency and Department of Labor fiduciary rules could expose PBM practices, reshape contracting, and give plan sponsors real leverage if enforcement follows. • Why invisible prices and invisible quality break the healthcare market  • How incentives and lobbying protect opacity across hospitals, PBMs, insurers and drugmakers  • Why Washington lacks ERISA and employer-plan expertise  • What CAA 2026 changes for PBM disclosures and fiduciary responsibility  • How “check the box” compliance can fail without enforcement  • How employers can use machine readable files plus claims data for network analysis  • Why cash-pay and direct contracting get blocked by network contract provisions  • What near-term reforms could bend the cost curve, including stronger HSA and ICHRA models You can find me at katytolento.com

    36 min

  7. APR 7

    EP 543 Medical Arbitration Becomes A Profit Center - with Scott Bennett

    Surprise billing for patients is largely gone, so why are so many self-funded employer health plans still getting hammered by out-of-network costs? We sit down with Scott Bennett, Chief Provider Relations Officer at the PHIA Group, to unpack what the No Surprises Act is doing in the real world and why federal arbitration is starting to look less like a safety valve and more like a payment engine. Scott walks us through the mechanics that matter: QPA as the median contracted rate, the short open negotiation window, and the IDR process where an arbitrator picks one of two numbers. Then we dig into the headline signals from PHIA’s national NSA report analyzing more than 1.25 million federal IDR disputes across 23,000-plus providers. When offers land five to six times above QPA and initiating parties win around 80% of the time, it creates a powerful incentive to file early and file often. For employer-sponsored health plans, especially self-funded groups like school districts and public safety employers, that can translate into budget shocks, higher renewals, and rising stop-loss pressure even when members never see a bill. We also explore why a small cluster of providers can drive a disproportionate share of disputes, what hotspots in certain states may be telling us about market power and network penetration, and how brokers and benefits advisors can protect clients with better data, tighter timelines, and a real IDR strategy instead of a reactive scramble. If you advise plan sponsors, this is a must-listen on NSA compliance, healthcare cost containment, fiduciary responsibility, and the evolving economics of out-of-network reimbursement. If this helped you, subscribe, share it with a colleague, and leave a review so more plan sponsors and advisors can find the conversation. What IDR pattern are you seeing in your own claims data?

    25 min

  8. MAR 31

    EP 542 What If Chronic Disease Was Optional? - with Brett Smith

    Employers keep paying for the symptoms of obesity, diabetes, and metabolic syndrome while the root causes go untouched. We unpack why many wellness models fail, how insulin resistance hides for years, and what chronic disease reversal can look like when a physician-led metabolic health team measures the right signals and tapers meds safely.  • metabolic syndrome as a dominant driver of employer healthcare costs  • why low-fat guidance and ultra-processed food worsen hunger and outcomes  • fasting insulin and CGMs as earlier and more actionable markers than glucose alone  • nutritional ketosis versus diabetic ketoacidosis and why the terms get conflated  • GLP-1 medication costs plus the idea of a structured GLP-1 off-ramp  • reported outcomes including weight loss and guaranteed improvements in A1C and blood pressure  • deprescribing as a safety requirement when health improves quickly  • ROI logic for self-funded plans including claims reduction and lower pharmacy spend  Call my cell phone, 262-255-9545. brett@toward.health

    36 min
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4.4
out of 5
20 Ratings

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 - 2026
  • Episodes
    554
  • Rating
    Clean
  • Copyright
    © 2026 The ShiftShapers Podcast
  • Show Website
    The ShiftShapers Podcast

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