The Granite List Live

Today employer health plans, are focusing on self-funded, fully insured, level-funded, and all of the above options. But if you can look at different cash-pay opportunities, prepaid opportunities, having telehealth there, where people aren't just immediately going to urgent care and emergency rooms, you will come out ahead as a company people want to work for and your staff will be better served. Our guests from Medxoom are putting everything in the hand of the member. Leigh and Sally’s guests are Matt Smith and Jeff Toewe from Medxoom. They tell us why cookie-cutter groups aren’t a fit for them because they don’t create enough value for their client base. They want to understand what you're trying to do, the solutions you're trying to utilize to solve, to improve that member experience, and drive down that healthcare spend. Join us for this episode of The Granite List Live, “A unifying experience for plan members is the only way to bring true value.”

About our guests:

Matt Smith - Enterprise Sales, Medxoom

Matt spent the better part of the last decade helping employer groups tackle the challenges of building and executing their employee benefits plans. His focus to balance the needs of employers to avoid increases in benefit costs with the need to reduce the cost burden of the employee led him to his current role working with the Medxoom team as they are continuing to build on their vision of uncomplicating healthcare. Matt draws upon his experience with working with self-funded employer groups, TPAs, Captives, and other digital solutions to help bring best in breed partnerships to his clients as they look for innovative ways to help improve the cost and accessibility hurdles of purchasing healthcare. Matt has a passion for helping to make healthcare the focus rather than the current focus of health insurance for his clients and partners. Matt firmly believes that with healthcare at the center of the purchasing decision rather than health insurance, the power to improve the cost curve is greatly improved through the improved health of employees when they aren’t worried about where to go and how to pay for a doctor’s visit. Working with the team at Medxoom has empowered Matt to be able to help shift that focus back to how to purchase healthcare instead of just health insurance. 

Jeff Toewe - Co-Founder and CEO, Medxoom

As a tech start-up veteran with extensive tech aptitude and experience, Mr. Toewe has demonstrated success in strategy, solution design & execution. He has founded and led multiple Digital, Mobile and FinTech companies, achieving multiple successful exits. Recent deals include Cinergy International in the UK, which provides sophisticated point-of-purchase decision systems to mobile telecoms; M-Dot Network, which led the definition of digital coupon standards, won #1 Amazon Startup of the Year and today is used by nearly 20,000 retail stores; and DoubleBeam/GoPago, a payments solutions provider that is now a leading Tablet POS solution. Deeply active in the tech startup community, Mr. Toewe serves as an advisor and participant to multiple tech companies and enjoys mentoring startups. He has been featured and interviewed for Google #StartupGrind and has been a panelist and speaker for CTIA #LetsTalkPayments. 

Mr. Toewe earned a BA in Politics from Saint Joseph’s University and an MSIS (Master of Science in Information Systems) from Drexel University. He has also completed Open Courseware in Economics from the Massachusetts Institute of Technology.

Now, Mr. Toewe, Co-Founder and CEO, is tackling the task of “Uncomplicating Healthcare” through this Medxoom platform. Medxoom optimizes the healthcare benefits experience for employers and their plan members through its mobile benefits integration platform.

Leigh and Sally sit down with two renowned thought leaders in the benefits space to discuss what’s new and what’s next for plan design. Allison DePaoli was awarded Top Women in Benefit Advising in 2019 and Ed Ligonde was named 2021 Broker of the Year by BenefitsPro. Here, they share their passion for bringing the right solutions at the right time to fit the growing challenges employers are facing. 

About our guests:

Allison DePaoli

Allison DePaoli is a business consultant working with employers who know they have a healthcare problem.

As the daughter and granddaughter of entrepreneurs – manufacturers, car and heavy equipment dealers, insurance! – Allison had a front-row seat on what it takes to run a business and manage risk. She routinely advises employers on how to both control their healthcare budgets and turn their benefit plans into recruiting and retention magnets.

She is also a sought-after speaker and the host of Raising The Bar with Allison De Paoli, a podcast designed to help CEOs and Executive Teams learn and leverage what their peers are doing successfully into their own businesses.

In 2017 Allison was a contributing author to the Amazon Best Seller Breaking Through the Status Quo and is a regular contributor to Employee Benefits News

Edwige Ligonde

Edwige (Ed) Ligonde assists in finding creative ways to blend plan design and cost, enhancing both employer and employee lives. 

Named 2021 Broker of the Year by BenefitsPRO, Ed's journey to success in the benefits space has been used as a model for others. He holds a deep belief in the value of personal connections and leveraging technology for the benefit of humans, rather than replacing them. 

Ed strives towards the goal that healthcare does not have to be what it has in the past, and by making collaborative partnerships we can change the benefits space for the better. In that world, we build businesses that are true partners and advocates for clients rather than having reactive, transactional relationships. 

The computers at Benefits Claims Intelligence (BCI) never get tired. Their goal is to discover ongoing waste, fraud, and abuse not detected after the TPAs or Third Party Administrators have reviewed the data. They work WITH the brokers and count on them to help their clients discover double and triple bills, upbills, and other errors in insurance claims, then take steps to recover those costs. Sally and Leigh's guests from BCI - Edward Cotler and Donald Hutson. Join them for this episode, "Waste, Fraud, Abuse and Level Five Papercuts."

Think of nurse advocacy as a way to connect with all solutions for the plan member. Leigh and Sally's guest, Lauren Roberson Head of Nurse Advocacy for CHC says, "We sit in the middle of the circle to reach all the solutions so that plan members can get access to the things they need at the time to achieve the best outcomes helping them stay at work, feeling better, healthy, and feeling better at home." The question she answers is why would a company that has access to a nurse hotline want to pay for an additional nurse advocacy service? Learn how 30 minutes of true listening has saved lives in this episode of The Granite List Live, "Predication of Health Problems Through Nurse Advocacy".

About our guest:

After working in the fields of patience-centered home care and on the front lines of contracted nurse lines for some of the largest employers in the country, Lauren shifted her career to change the dialog – literally. She brings her deep nursing knowledge to the job each day, leading the nurse advocacy team at CHC. In her role, she helps connect the vendors that have been brought into the health plan by the broker, and steers employee engagement to ensure that plan members use the right resource at the right time for the best care possible.

Corporate athletes are those that haul, lift, push, reach as part of their day-to-day required tasks on the job. Why would you wait until they are injured to treat them? Why not prevent the injuries by having onsite care, as you would for professional sports athletes? If you are already familiar with the term VP of Environment, this episode is for you. If you have regular workers’ compensation claims due to musculoskeletal issues, this is for you too. Your employees want to work, you need them to work, and you need them to be safe and smart with how they work. Join us for this episode of The Granite List Live where Sally and Leigh visit with Nic Patee, CEO of Work Right, "Preventing Workplace Injuries of Your Corporate Athletes."

Drug spend is on track to account for 40% of total annual healthcare spend for commercial plans by 2025 and 2025 is just around the corner. And that's compared to just 4% in 1995. To date, there are 600 new to market drugs seeking FDA approval by 2022 and of those 70% are specialty drugs. Sally and Leigh's guest is Sarah Kline, Partner/Chief Operations Officer at 44 North. This episode covers the supply chain of markups and discounts that are ultimately paid by the employer and employee. You're feeding the supply chain and everyone's taking a little piece of that cost, which really just adds to the cost increase cycle. Listen to this episode: Everyone gets a slice, but who's paying for the specialty drug cake?

Learn about 44 North >

Welcome back to the second half of the interview with  Ryan Rice and Chris Ziemke from Prism Health Group. Our conversation continues, but we switch gears to the topic of rebates themselves that are oftentimes set forth in a proposal from a PBM. And what we've noticed in those rates is there's been such a degree of escalation over the last five years. Chris says, "you're getting bigger rebates, but you're also spending a lot more in stepping over a dollar to pick up a needle. And that's really not the advised direction that we would take with folks. And we're going to see more of this."   

This concept of the aggregator and the way in which a rebate aggregator works with plan sponsors is emerging in the marketplace, along with the emergence of GPOs or group purchasing organizations.  

You will also hear Prism's advice on the one additional question you should ask that is not typically asked in an RFP. Listen to this episode, Bigger rebates aren’t always better.

Ryan Rice and Chris Ziemke from Prism Health Group represent a new breed of healthcare consultants, poised to impact the entire healthcare spectrum versus the traditional, siloed approach. They saw the needs in the pharmacy industry specifically to navigate the pharmacy benefit management space. Employers needed a better understanding of their pharmacy spending from an unbiased source. That's where Prism Health Group comes in. Listen to this episode, "Drugs and Data – How Analytics Truly Impact Claims Spend."

Breast Cancer awareness is 12 months a year if we are to save more lives and have earlier detection. Sally and Leigh's guests today are here to help.  Celbrea® does not replace a mammogram, but gives an interim, non-invasive, radiation-free way to check one of the earliest warning, before feeling a lump and takes only 15 minutes. Every 2 minutes a woman is diagnosed with breast cancer. Every 13 minutes a woman dies IN THE USA. Using liquid crystal thermographic technology, Celbrea basically takes the temperature of the two breasts and compares them. You'll want to hear about this life-saving technology that works alongside other early detection techniques. Sally and Leigh welcome Kelley Ospal and Jaime Pira of Welwaze, the creators of Celbrea, to inspire you to either offer this service in your office, or health plan, or for you the patient to request it. Women, it's the best 15 minutes you can spend between mammograms. You may want to bring your mom, aunt, sister, daughter, cousin, best friends, too. When this is offered as an event in the workplace, the increase in breast cancer screening and preventive measure success increases from 40% to 88%!

Learn more about Celbrea at https://celbrea.com and more about the company behind this technology at welwaze.com.