64 episodes

Our Healthcare and Health Insurance System is broken. Healthcare costs continue to rise at the expense of employers and employees who often end up paying more each year for reduced levels of benefit and service. If you’ve had enough, then you’ve come to the right place. In this show, we explore what is wrong with the current system and examine what drives higher healthcare costs. We interview companies that are providing innovative services and solutions designed to not only disrupt the health insurance marketplace but deliver lower costs and better value for your employees.



Who is this show for? It’s for employers, CEO’s, CFO’s, HR Directors and Benefit Managers and anyone else who is tired of the same poor results that we continue to get from our Health Insurance and Healthcare System. It’s for those who are suspect of the same old answers for why healthcare costs go up and want actionable strategies to get better results.



Join us! Get educated and get ready to take action!

Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs Reconstructing Healthcare: Innovative Solutions For Employers To Lower Their Healthcare Costs

    • Business
    • 4.9, 50 Ratings

Our Healthcare and Health Insurance System is broken. Healthcare costs continue to rise at the expense of employers and employees who often end up paying more each year for reduced levels of benefit and service. If you’ve had enough, then you’ve come to the right place. In this show, we explore what is wrong with the current system and examine what drives higher healthcare costs. We interview companies that are providing innovative services and solutions designed to not only disrupt the health insurance marketplace but deliver lower costs and better value for your employees.



Who is this show for? It’s for employers, CEO’s, CFO’s, HR Directors and Benefit Managers and anyone else who is tired of the same poor results that we continue to get from our Health Insurance and Healthcare System. It’s for those who are suspect of the same old answers for why healthcare costs go up and want actionable strategies to get better results.



Join us! Get educated and get ready to take action!

    Jason Hellickson | Regenexx

    Jason Hellickson | Regenexx

    In this episode, Michael introduces Jason Hellickson, the CEO of Regenexx, a global provider specializing in interventional orthopedics. Regenexx partners with self-funded employers to significantly reduce their orthopedic spending while providing employees a choice in care. Regenexx orthopedic procedures leverage the body's natural healing ability to repair damage to bones, muscles, cartilage, tendons, and ligaments non-surgically and with great outcomes.


    Jason is a long-time athlete who underwent shoulder surgery in 2008. Although the surgery was deemed “successful”, the fact that it took him 12 months to recover, 12 months to swim again, and lasting pain caused him to question whether there were better alternatives. Years later, when he received the same prognosis on his other shoulder, he insisted on an alternative. With Regenexx he was able to swim again just 6-8 weeks after the procedure. He learned that Regenexx could be offered through a self-funded health plan, so he partnered with them as an affiliate and then later became the CEO.


    Jason believes that our orthopedic care continuum needs a reinvention because surgery is no longer the only option. With almost 6% of GDP spent on elective orthopedic surgeries a year and about 50% deemed ineffective, the reinvention includes new and advanced “interventional orthopedics” that cut costs, are less invasive, and frequently allow patients to avoid surgery altogether. 


    Regenexx is backed by clinical research, saves employers up to 70% on elective surgeries, and saves patients the pain, recovery time, and uncertainty of surgery. And with a research-based and outcomes-monitored model, they are transparent, ensure a high standard of care and have a comprehensive accreditation process to be part of their provider network. They work with employers as a direct contractor and help educate members on the benefits of interventional orthopedics so members are informed and know it’s an option to consider in lieu of invasive surgery. 


    With a Net Promoter Score of 74, their education and service are clearly working. In addition to high member satisfaction, Regenexx has also recently been awarded the Traction Award at the Employer Health Innovation Roundtable. Just from the event, 12 large employers agreed to move forward with Regenexx - a big win that seems to be just the beginning of an exciting road ahead.


    Here’s a glance at what we discuss in this episode: 


    01:00 - Introducing Jason, Regenexx, his background, and his unique journey. 


    03:00 - He got one surgery and began looking into alternatives for his other injuries.


    04:00 - He found Regenexx, entered into an affiliate partnership, and became the CEO.


    06:30 - Issues from a care and cost standpoint in orthopedics: almost 6% of GDP is spent on elective orthopedic surgeries a year, yet 50% are deemed ineffective procedures.


    08:20 - Many people put off surgery for an average of 5 years; this “gap in care” leaves them in pain which is where “interventional orthopedics” comes in. 


    09:30 - Interventional orthopedics is a less invasive and needle-based procedure using orthobiologics (your natural healing cells). 


    12:30 - The healing happens at a cellular level and allows the body to unleash its natural healing powers.


    13:30 - Efficacy rates: Orthopedics used to be the only option, so efficacy was not considered; Regenexx clinical research and studies prove its efficacy. 


    16:15 - Regenexx is research-based and outcomes-monitored; proper diagnosis, a well-executed procedure by a skilled physician, and orthobiologics.


    18:00 - They vet and constantly educate their physicians and lab techs to ensure a standard of care that is monitored within a transparent outcomes database.


    19:20 - They have 75 locations and over 100 physicians across the country, and growing.


    19:50 - The average cost o

    • 37 min
    Sachin Jain | Carrum Health (Rebroadcast of Episode 3)

    Sachin Jain | Carrum Health (Rebroadcast of Episode 3)

    Topics


    Revenue Cycle Management


    Rising healthcare costs


    Bundled Pricing


    Cost Savings


    Centers of Excellence


    Improving Employee Experience


    In this episode, Michael introduces you to Sachin ‘Sach’ Jain, CEO of Carrum Health. Join us as we discuss how Carrum Health has created an alternative marketplace for lower-cost surgical procedures with a focus on creating an exceptional employee experience.


    Here’s a glance at what you’ll learn in this episode:


    Who Sachin Jain is, and how he found his way into the healthcare field.


    The Healthcare Marketplace – Why supply and demand play such a vital role in costs, and why the healthcare marketplace doesn’t interact or operate like any other marketplace for service and goods in the country.


    How Carrum Health is working to solve two systemic issues in Healthcare payments today


    How Carrum Health created a marketplace for select surgical procedures that sits outside of traditional HMO/PPO network to allow providers to compete directly for the employer’s business.


    Why the bundled platform that Carrum offers runs 40-50% cheaper than pricing through traditional insurance carrier networks.


    The screening process – What Carrum does to ensure their Centers of Excellence providers meet the highest level of quality.


    What geographical regions Carrum is available for employers


    How Carrum is geared towards the patient experience, and how they strive to remove the stress of surgery and hospital stays so that patients can focus on healing.


    Costs to participate in the Carrum platform


    www.carrumhealth.com (http://www.carrumhealth.com/)    

    • 39 min
    Marek Ciolko | Gravie

    Marek Ciolko | Gravie

    In this episode, Michael introduces Marek Ciolko, the CEO of Gravie, a unique health plan that offers employers a shared savings model and employees the opportunity to personalize their insurance to meet their needs. Gravie does this by helping employers control costs while still providing employee-selected coverage and a better experience throughout the process.


    Marek has a long history of operations management for Deloitte and companies within the healthcare industry. It was on this journey that he realized that there are only so many ways to bend the curve and reduce healthcare costs for everyone with incentives alone. He realized that the core of health insurance needed to be tackled, which is why now, through Gravie, he strives to level the playing field between the group and individual marketplace of health insurance within their platform. 


    The current state of the world with the COVID-19 outbreak makes it painfully obvious that the consumer is underserved in our current system. Gravie’s mission is to improve the way people purchase and access healthcare. They focus on an underserved area of the market, which is group sizes with between 100 and 1,000 lives. Gravie works with employers to establish a defined contribution and then provides a platform of plan design options for employees to select from that meets their individual needs. In essence, Gravie is a marketplace and a decision support system for employees.


    In addition to offering a marketplace to employers, the Gravie product is a level-funded offering that helps small employers self-fund, manage risk and share in excess surplus when claims are less than expected; to date, 30% of customers are receiving refunds at the end of the year. As a startup with 3 years of experience, Gravie is already taking massive strides to control healthcare costs for middle-market employers and employees and we look forward to seeing them grow and expand their offering. 


    Here’s a glance at what we discuss in this episode: 


    01:00 - Introducing Marek, his background, and his motivation for launching Gravie. 


    02:30 - He worked for Deloitte and RedBrick Health and learned the challenges with healthcare costs. 


    04:00 - With Bloom Health, they worked to make insurance customizable so employees could shop and the market could provide what they need. 


    05:05 - Gravie levels the playing field between group and individual insurance marketplace by granting true consumer involvement in the selection process. 


    06:55 - Health insurance is very expensive - our current global climate is highlighting that issue. 


    09:00 - Sometimes companies don’t have enough choices for their employee’s diverse needs; people end up getting more than they need or not having enough.


    09:50 - Consultants and brokers oftentimes see the employer as their client, not the employee. 


    10:30 - Customization and tailoring allow the consumer to pay for what they need and leave out what they don’t.


    12:00 - Employees have to go through their employers for health insurance, which makes it expensive for employers to attract and retain employees year over year.  


    15:20 - Employers need a way to cap (fix) their healthcare liability while keeping their employees happy - that’s where Gravie comes in. 


    17:11 - Gravie offers cost predictability and management of the entire system, including insurance, the administrative process, savings benefits, and employee customer service. 


    20:00 - It leverages stop-loss and helps small employers self-fund easily; Gravie gets a share of savings when claims are less than expected, so they’re incentivized to keep costs below the employer’s cap.


    24:00 - They’ve been in business for 2-3 years and have seen 95% retention and 30% of customers receiving refunds at the end of the year. 


    25:30 - The resources and programs they offer are medical

    • 48 min
    Steve Watson | Trendbreakers

    Steve Watson | Trendbreakers

    In this episode, Michael introduces Steve Watson, a CFO/CHRO and founder of Trendbreakers, a community of finance, human resources, and benefit advisor professionals that are on a mission to break the trend of rising employee healthcare costs. Trendbreakers helps CFOs, CHRO’s and business owners make the best employee benefit decisions by offering support, education, and consulting. 


    Steve is a unique guest because he’s on the payor side of business...i.e., he is working for an employer who ultimately pays for healthcare via their insurance. He recognizes that the current healthcare system is lucrative for organizations and certain people, but also sees the problem with employers and families paying heavily for benefits they may not even use. A few years ago, his employer had a million-dollar claim that was going to increase premiums by 30% - and his broker’s commission by 30%, too. Through deeper investigation and learning, he recognized the incentive imbalance and that the system was rigged against employers.  


    He was able to slash his company’s benefits costs, save thousands, and allow employees to enjoy no increases and better benefits - all while drastically reducing the administrative burden of enrollments and changing plans. After doing it for his own company, Steve realized that others in his position needed the network, strategies, and best practices to do the same. So he built Trendbreakers, the educational platform that helps inform business owners, CFOs and CHROs make the best healthcare decisions for their company and its people. 


    Steve believes that a lack of accountability across the board has been a detriment to the system as a whole. He believes brokers must be transparent, accountable and have a high level of expertise in the exact areas their clients need so they can offer the best solutions. He also recommends brokers be conscious of the way they communicate with employers and use words and comparisons they can understand. 


    Brokers have an excellent opportunity to educate and be a fiduciary for the employers they serve. And it’s important that employers have a plan in place that they’re confident in and has room for continued growth and savings down the road. Trendbreakers has a promising road ahead bridging the gap between peers and colleagues to create a system where everyone benefits.


    Here’s a glance at what we discuss in this episode: 


    01:00 - Introducing Steve, the CFO, CHRO, and founder of Trendbreakers. 


    05:30 - What Steve thinks about our healthcare system and when the reality sunk in. 


    09:30 - He transitioned into a self-funded plan to address the issues. 


    12:00 - Now, he can impact the results, get data, and benefit from no claims.


    13:05 - Employees have benefited from no increases, better benefits, and they lifted the administrative burden of having to have an enrollment.


    13:30 - Trendbreakers provides education to company leaders, executives, and HR leaders so they understand the industry and speak the same language. 


    14:50 - Broker/Consultant must-haves: Transparency, accountability, expertise.


    17:05 - Brokers don’t always share new solutions with their clients that could save them significant dollars. 


    20:00 - Brokers must communicate concepts in a way that the CFO/CHRO/owner understands because in many cases, they’ll need someone else to sign off on it, too.


    22:20 - CFOs want to know the internal risk and meet other people who are self-funding to feel confident about their decision. 


    24:10 - It takes peers, stories, and a group for people to feel confident about making a decision - just listening to a broker isn’t enough.


    25:05 - If an HR leader needs to get the rest of the leadership on board, they must first do things on the back-end that won’t change anything for the employees. 


    26:30 - Have a 3-5 year plan and make in

    • 32 min
    Robert LeCureaux & Amy Bandy | ScoutRx

    Robert LeCureaux & Amy Bandy | ScoutRx

    In this episode, Michael introduces two partners of ScoutRx, Robert LeCureaux, the VP of Client Development and Amy Bandy, the VP of Operations. ScoutRx helps employer groups and members maintain affordable prescription drug costs through the use of their three core cost containment strategies. 


    When previously working in the pharmacy and PBM industry in very different roles, Rob and Amy both recognized that it was very profit-driven and not much thought was given to the consumer and the burden of cost. They didn’t like this status quo - and how members had no voice and too many roadblocks - which is what inspired them to team up with other partners to create Scout Rx.  


    With a lack of marketplace options to address the rising price and utilization of specialty medications, ScoutRx has made it their mission to bring overall costs down and create a better member experience. To date, they have been able to drive an average savings of about 43% for their clients, a sign that they are succeeding in their mission thus far. To be clear, ScoutRx is not a pharmacy benefit manager or administrator. They’ve partnered with a PBM to administer their program while they use their own core strategies autonomously. 


    ScoutRx operates using three core strategies: Their Specialty Pharmacy Program, Copay Optimization Program, and International Pharmacy Program. Through their Specialty Pharmacy Program, they help members pay little to no money out-of-pocket for specialty drugs by finding drug manufacturer foundations and financial programs that patients can qualify for to offset the entire cost of the drug. The Copay Optimization Program takes advantage of drug manufacturer coupon cards to reduce the cost of the drug and potentially eliminate the patient’s copay altogether. The International Pharmacy Program allows members in the U.S. to get their high-cost or specialty medications from Canada at a substantially lower cost with eliminated copays and reduced cost to the group. The amazing part about all of this is that most of the logistics are done behind-the-scenes at ScoutRx with little effort needed from the patient. 


    And as far as savings go? Some groups that they’ve worked with had a 96% generic utilization rate and were still able to save over $100,000 in their first year. The savings range in the first year is vast - from 16% all the way up to over 70% - and these savings continue into future years which will lead to lower inflation than employers would see with typical PBM’s and insurance carriers in the industry. ScoutRx is paid a percentage of savings which they outline in regularly distributed, fully-transparent, line-by-line reports.


    ScoutRx is a good fit for small-to-midsized self-funded companies with 2,000 employees or less. While ScoutRx is a new company, its leadership team is experienced and its methodologies are proven. ScoutRx has a bright future ahead disrupting our healthcare system by making high-cost prescriptions more easily accessible to patients. 


    Here’s a glance at what we discuss in this episode: 


    00:30 - Introducing Rob and Amy, two partners for ScoutRx.


    03:00 - The inspiration for ScoutRx: Rob saw that the industry was profit-driven and that not much thought was given to the consumer. 


    04:30 - Amy saw all the roadblocks between members and their prescriptions in the traditional setting and wanted members to have a better option. 


    06:00 - The key issue with the drug delivery and payment system of today is that specialty medications are often inaccessible to groups and patients. 


    10:30 - Their specialty pharmacy program addresses accessibility so that patients can get pharmaceuticals for little or no cost. 


    11:50 - The Patient Assistance Program - It’s a financially-based program where the manufacturer offers its medication free of charge for those who qualify. 


    13:3

    • 45 min
    Matt McCambridge | Eden Health

    Matt McCambridge | Eden Health

    In this episode, Michael introduces Matt McCambridge, the co-founder, and CEO of Eden Health, a virtual primary care and navigation platform centered around care teams. Eden Health helps employees navigate today’s complicated healthcare landscape across insurance, primary care, and mental healthcare so they can make smart, well-informed and cost-conscious decisions. 


    Matt had a personal situation that influenced his decision to move out of the venture capital space to launching a start-up in healthcare. When Matt’s sister was sick as a kid, Matt and his family personally witnessed the broken components of the healthcare system. Now, Matt is seeing how the “coordinated care” offered by Eden Health has made a difference in the lives of patients like his sister.   


    Eden Health is a certified Primary Care Medical Home - the top-of-the-line quality certification in the country for primary care; this model emphasizes team-based care, communication, and coordination, which has been shown to lead to better care and why Eden has integrated specialties like behavioral health and physical therapy. The reason for including behavioral health, Matt explains, is that many other health issues are rooted in mental health conditions and these must be addressed to make meaningful progress with the patient’s health conditions. 


    Matt’s company is different than other in-person or virtual primary care solutions in that it is highly integrated with a core focus on eliminating the employee’s hassle as a patient. Typically, it’s very confusing for employees to figure out where to go and for what, which is why Matt believes you simply cannot separate navigation from primary care and delivery. For this reason, they have an app with the accessibility to virtually chat with a doctor 7/365, and this connection enhances the solutions offered. By leveraging technology, they’ve been able to provide their users with the appropriate instant and personalized care. 


    Eden Health also offers physical locations across the country for those who need it, and will even send a provider from their pool on-site to the workplace. Matt understands that the key to helping patients is engagement - and that engagement is more likely to occur if patients are receiving high-quality care through an integrated platform that they can easily use. Eden Health tracks their patients’ satisfaction with star ratings, and they proudly report an average of 4.95 out of 5 stars with a 75% response rate. 


    Employers can engage with Eden Health in two ways: They can either fully-cover Eden Health for unlimited access or fully-insured with a fee that is reduced when insurance is taken into account since they would be considered an in-network provider. Eden Health has an exciting road ahead as they expand into new geographies and continue to grow and serve. 


    Here’s a glance at what we discuss in this episode: 


    00:30 - Introducing Matt, the co-founder and CEO of Eden Health. 


    03:00 - The insights Matt received about healthcare from doing venture capital.


    04:50 - The problems with the current primary care model. 


    10:00 - How Eden health is different from other primary care solutions. 


    13:20 - The importance of engagement that’s backed up by quality. 


    14:30 - Why behavioral health is integrated into the program.


    17:00 - On their certification as a primary care medical home.


    18:50 - Why it’s important that Eden Health makes 66% fewer referrals to specialists.


    21:20 - The process behind their specialist “closed-loop referrals” and how they short-cut the patient journey. 


    24:45 - Pop-up on-site visits, permanent brick and mortar clinics, and the experience they create in the workplace. 


    27:30 - On the trusted patient-provider relationship, how it keeps patients healthy over time, and a case study. 


    32:00 - On the integra

    • 47 min

Customer Reviews

4.9 out of 5
50 Ratings

50 Ratings

ScoutRx ,

A must listen!

Michael’s ability to focus on the forefront and innovation of a broken system to educate and inform not only consumers but industry professionals is much needed in today’s challenging times.

He sees the forest through the trees and brings key influencers and disrupters to the table to show there are people out there looking out for people’s best interest and there is a path forward.

Looking forward to hearing more!

healthcare hacker ,

What an important podcast

As a new podcaster myself, I never miss an episode of Reconstructing Healthcare! I am more informed and aware because of the content I hear on this podcast. Thank you, Michael! #letsfixhealthcare

Andreas_193 ,

Quality Insights and Information

I like how many innovative companies are being represented on this podcast! For those people that care about tackling the American healthcare problem, this podcast is a great place to start to introduce resources and ideas of how to reduce healthcare costs in the US. I only gave 4 stars since there are interrupting laptop sounds/poor audio quality in some of the earlier episodes. Keep up the good work!

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