The ShiftShapers Podcast David Saltzman

In this episode of ShiftShapers, host David Saltzman invites David Mordo, Senior Compliance Officer at MZQ Consulting, to discuss the intricacies of prescription drug reporting (RxDC) as mandated by the Consolidated Appropriations Act of 2021. The conversation delves into the transparency requirements for employers regarding their prescription drug plans, encompassing the scope of reporting, deadlines, submission processes, and implications of non-compliance. With a focus on the pivotal role of employers, insurance carriers, third-party administrators (TPAs), and Pharmacy Benefit Managers (PBMs) in this process, the talk highlights the collaborative effort needed to ensure compliance. Mordo offers valuable insights are offered on how brokers and advisors can assist their clients in navigating the complexities of RxDC reporting, the selection of vendors for report preparation, and the importance of timely action to meet regulatory deadlines.


Key Takeaways From This Episode:
RxDC is part of the Consolidated Appropriations Act of 2021, requiring employers to provide prescription drug plan information.Employers have to comply with multiple reporting requirements related to prescription drug plans annually.Reports for 2024 regarding prescription drug plans are due on June 3rd.Employers are responsible for ensuring compliance with prescription reporting, even if they use TPAs or PBMs for assistance.Brokers need to ensure vendors for reporting have experience, are reasonably priced, and can deliver timely and accurate data.

Welcome to this episode of the ShiftShapers podcast, where we explore the journey of Donovan Ryckis, CEO of Ethos Benefits. Here, we discuss fiduciary responsibility in healthcare as Ryckis tell us the story of his personal evolution. From managing a Gold's Gym to working in securities advising, he ultimately established a flourishing healthcare agency. His narrative unveils the hurdles and triumphs encountered when transitioning from a commission-driven approach to fee-based consulting. Throughout our conversation, Ryckis underscores the pivotal role of fiduciary duty and transparency in cultivating client trust in the healthcare industry.


Ryckis sheds light on the intricacies of reference-based pricing, highlighting its potential in managing healthcare expenses while acknowledging the accompanying need for heightened administration and employee communication. Moreover, he articulates how Ethos Benefits' commitment to ethical standards and delivering genuine value has been instrumental in its ascent. Business executives and other organizational leaders, we invite you to tune in to this episode of ShiftShapers and learn the importance of selecting a benefits vendor who acts with the healthcare recipients’ best interests at heart. After all, you deserve a healthy workforce that appreciates the best possible benefits..  

Takeaways:


Adopting a fee-based consultancy model and embracing fiduciary responsibilities are key for tailoring optimal healthcare solutions for clients.Embracing radical transparency, including commission disclosures, fosters candid dialogues and fortifies client relationships.Reference-based pricing emerges as a potent strategy for cost control in providing healthcare benefits, albeit requiring meticulous administration and communication efforts.Storytelling not only shapes agency culture, but also nurtures robust client connections.While the momentum behind fee-based models is palpable, the industry still grapples with the gradual acceptance of compensation disclosure.

In this episode of the ShiftShapers podcast, Jon Shooshani, co-founder of JOON, discusses the concept of lifestyle spending accounts (LSAs) and their impact on health and well-being. Shooshani shares his journey from being deeply interested in health and wellness to the founding of his company, JOON, which offers personalized wellness and lifestyle benefits for employees. LSAs are employer-funded accounts with flexible spending on well-being-related items and experiences. They may vary in name and structure across different companies. Shooshani explains the value of LSAs in promoting employee health, satisfaction and retention, while also covering practical aspects like budgeting, implementation and the unique features of JOON’s platform. The story concludes with a touching background on the company's name and vision to provide meaningful employee benefits. Throughout this podcast, business executives and owners, big and small, will receive expert insights on how to provide competitive benefits packages that serve their employees well.

ShiftShaper Episode Takeaways
- A lifestyle spending account (LSA) is an employer-funded fund that allows employees to spend on items and experiences that contribute to their well-being.
- LSAs can be customized and flexible, offering a range of categories such as health and wellness, professional development, work-from-home purchases, and family care.
- LSAs can have a positive impact on employee well-being and satisfaction, and can be used as a tool to attract and retain employees.
- Employers can determine the amount and reset frequency of LSAs based on their budget and goals. LSAs can be administered and streamlined through platforms like JOON.

This episode of the ShiftShapers Podcast features host David Saltzman interviewing John Clay, president of Better Source Benefits, about unique health plan solutions for small and mid-sized groups. John shares his background in the insurance industry, highlighting the journey from working in materials control to discovering innovative health plan solutions. Despite challenges, such as a lack of options beyond traditional insurance providers, John discusses how attending conferences and learning from others in the industry transformed his approach to offering health plans. He emphasizes the importance of understanding the needs of smaller businesses and how custom, level-funded health plans can offer significant benefits. The conversation also delves into the future of health plans for small and mid-sized businesses and how creative solutions can positively impact employee health outcomes and financial security.

This episode of the ShiftShapers podcast features an interview with Yoona Kim, the CEO and co-founder of Arine, a company focusing on medication intelligence via AI to improve clinical and financial outcomes in healthcare. In this episode, Kim shares insights from a healthcare background into the challenges surrounding drug prescriptions including accessibility, cost, and the impact of incorrect or suboptimal medication on patient outcomes. Arine leverages large-scale data analysis to provide actionable recommendations, aiming to correct discrepancies in medication use, particularly in polypharmacy (multiple medication) cases. The technology not only promises to significantly reduce hospitalizations and overall healthcare costs within a short period, but also enhances patient adherence to prescribed medication regimes. Kim elaborates on the collaborative process with healthcare providers and insurers to implement these changes effectively, highlighting the potential for widespread improvement in healthcare management and outcomes.

In this episode of the ShiftShapers podcast, we explore the complex world of Pharmacy Benefit Managers (PBMs) and their impact on healthcare costs, sparked by the Johnson & Johnson lawsuit. Our guest, USRxCare President Renzo Luzzatti, with a 30-year healthcare background, discusses the Consolidated Appropriations Act of 2021, which is aimed at shifting power back to payers from vendors by enhancing transparency and fiduciary responsibilities. The episode sheds light on the lawsuit against J&J for excessive pharmaceutical payments through their PBM, Express Scripts, highlighting the issue of overpayment in the industry. Luzzatti emphasizes the necessity of fiduciary PBMs, devoid of conflicts of interest, and the importance of transparency and beneficiary interests. We also discuss how employers can strategically manage their pharmacy benefits to avoid overpayment and ensure compliance with fiduciary duties, emphasizing the role of advisers in navigating this complex territory. The conversation also touches on current trends and future outlooks for managing pharmacy benefits more effectively and ethically. Each of these insights are critical to business owners and other organizational leaders who must manage healthcare benefits to be cost-effective while providing for employee health needs.  

USRxCare: https://usrxcare.com/