Episode # 173 – Scott Haas and Erik Davis are SVPs at USI, a Top 10 National Health Benefits Firm. They Have Vast Experience Designing Plans for Larger Employers Using DPC and Advanced Primary Care as the Center of a Future Where Everyone Wins.

In this episode Ron chats with Scott Haas & Erik Davis, Senior Vice Presidents at USI on their Healthcare Operational Risk Consulting Team. USI has served over 500,000 clients meeting their property & casualty, employee benefit, personal risk and retirement needs nationwide. USI works to understand the specific needs of their clients, to provide an unparalleled local service experience, and to innovate with cutting edge solutions so their clients can continue to invest and grow. Here, they do a deep dive into what makes their approach stand out from the competition to make them a top 10 national benefits firm. They also discuss how they work to design optimal plans, negotiate advantageous pricing, deliver preferred services and keep clients aware of market changes.

Erik has over 30 years of experience in the insurance and risk management industry.  Erik works to create an environment that supports the strategic managed care risk goals of an organization, while maintaining focus on compliance and financial accountability.

Erik is instrumental in vendor negotiations, data benchmarking, population

health strategies, claims analysis, recommendations in plan design and communication strategies. In this capacity, Erik has been involved with development of rates, payment structures and recommendations of changes in processes, policies and procedures. He has a broad understanding of contract analysis, evaluating risk, auditing for correct payment and structuring of excess loss and pharmacy programs.

Erik’s experience extends from overall employee benefits consulting to workers’ compensation, commercial risk, and Medicaid and Medicare Managed Care Organizations.

Erik earned his B.S. in economics from Oregon State University. He holds Accredited Advisor in Insurance (AAI), Certified Insurance Councilor (CIC), and Certified Risk Manager (CRM) designations.

Scott has over 35 years of employee benefits experience. His background includes the development and validation of care management programs; prescription benefit management (PBM) solutions; provider network evaluation, valuation, and negotiation; and underwriting. Scott started and operationalized a third-party-administrator (TPA) and a pharmacy benefit manager (PBM) platform from scratch. He has worked in the arena of alternative funding/risk management for most of his career.  Scott’s current role within USI is focused on consulting with entities at risk for Medicaid, Medicare and Commercial health insurance.

Scott has held officer-level positions within Blues plans and TPAs as Vice President of Sales and Marketing; Vice President of Underwriting; and President. Scott has also served as a trustee for both union and non-union health and welfare and pension plans.

Scott frequently shares his consulting expertise speaking at national events hosted by organizations such as the International Foundation of Employee Benefits; Health and Welfare Plan Management Conference; Western Pension and Benefits Council; and the Self-Insurance Institute of America. Scott has authored and co-authored articles on various topics over his career.

Scott earned his B.S. in Business Administration and B.S. in Economics from the University of Nebraska at Kearney. Scott also holds Chartered Life Underwriter (CLU) and Registered Health Underwriter (RHU) designations.

Episode # 172 – PBGH is the Largest Employer Healthcare Purchasing Alliance with $350 Billion in Spend. Meet Randa Deaton, Who Leads Member Value and Engagement and Where Primary Care Indicates a 10:1 ROI.

This episode features Randa Deaton, Vice President of Purchaser Engagement at Purchaser Business Group on Health (PBGH). PBGH is a nonprofit coalition representing nearly 40 private employers and public entities across the U.S. that collectively spend $350 billion annually purchasing health care services for more than 21 million Americans and their families. PBGH has a 30-year track record of incubating and scaling new, disruptive operational programs that lower health care costs and increase quality across the U.S. she discusses the work PBGH does, the importance of strong relationship with a primary care provider, direct primary care, and more.

As Vice President of Purchaser Engagement, Randa Deaton leads the PBGH Member Value team to engage purchasers in high-impact solutions to improve health care quality, affordability and equity.

Prior to joining PBGH, Randa served as the President and CEO of the Kentuckiana Health Collaborative (KHC), bringing more than 17 years of experience working directly with health care purchasers. She led the Corporate Community Health Initiative as part of the benefit strategy team for Ford Motor Company from 2004 to 2020. In her previous roles, Randa led the development of Kentucky’s first multi-payer primary care quality and public reporting, the Kentucky Core Healthcare Measures (KCHMS) and the KCHMS purchaser priority measurement set. She also launched the Healthcare Equity Advisory Committee.

Randa served as Vice Chair of the National Alliance of Healthcare Purchaser Coalitions, Advisory Board Member of the University of Louisville’s School of Public Health and Information Sciences Advisory Board and Taskforce Member of the National Quality Forum’s (NQF) Driving Value through the Next Generation of Quality. Randa earned her bachelor’s degree in psychology from Indiana State University and her master’s in industrial/organizational psychology from Middle Tennessee State University.

Episode # 171 – Dr. Benjamin Clinton as the Assistant Superintendent Has Taken the Poorest School District in Texas with 1/3 of its Employees Uninsured to Fully Insured at a Fraction of the Cost by Opting Out of the State Provided Legacy System. 130 School Districts are Following Their Model.

In this episode Ron chats with Benjamin Clinton, Deputy Superintendent of Raymondville ISD. Here, they discuss Raymondville ISD’s journey to find the right benefits for their district. Benjamin discusses how now that they found a super affordable and innovative package for their employees, they do much better with recruiting and employee retention. He also discusses some of the great healthcare innovations they have planned for their employees going forward.

Benjamin Clinton has been an educator for 18 years and the Deputy Superintendent of Raymondville ISD since 2018.  Before becoming Deputy Superintendent, he served as a Special Programs Director, High School Principal, and Social Studies teacher.  Dr. Clinton earned an Ed.D. in Educational Leadership from Lamar University, and his research focused on providing employees with affordable group health coverage.  Benjamin holds a B.A. in Economics from Rice University and is a TASBO Registered Texas School Business Administrator.

Episode # 170 – Dutch Rojas of Sanos Surgery has a New Offering for Consumers. Buckle Up for a Big Dose of Wisdom From a Direct Contract Thought Leader.

In this episode Ron brings Dutch Rojas back on the show. Here, they do a deep dive into the current state of healthcare benefits, digital health, venture backed healthcare startups, and many other aspects of American healthcare.

Dutch Rojas is a healthcare entrepreneur dedicated to making medical treatments affordable and accessible to all. Currently, he is the Chief Executive Officer of Sano Surgery, a bundled priced network as well as the Founder of Everyone Health, a consumer marketplace to purchase medical treatments. Dutch immigrated to the United States from the Netherlands and served in the US Marine Corps from 1995 to 2002.

Episode # 169 – Welcome Back Doug Aldeen, an ERISA Healthcare Attorney Serving Self-Funded Employers Who Speaks Plainly and Tells the Truth About New Transparency Regs That will Expose Big Broker Gaming of Employers and More.

In this episode Doug Aldeen, General Counsel and ERISA Health Care Attorney, returns to the show. Here they do a deep dive into the current state of the healthcare industry and the impact COVID-19 has had on it. They also discuss the transparency laws, large employers finding better benefits brokers, and more.

Doug is an Austin, TX based health care and ERISA attorney who recently served as ERISA counsel on behalf of the Berkeley Research Group in New York City to the $7.7 billion May 2016 acquisition of Multiplan and its medical bill repricing product Data Isight by the private equity firm Hellman and Friedman. Since 1997, he currently and has represented reference base pricing organizations, a bundled payment software platform, PPO networks, medium to small self-funded plans, TPA’s and provider sponsored HMO’s  in various capacities including Herdrich v. Peagram which was argued before the United States Supreme Court in 2001. Moreover, he currently serves as a resource to national news organizations regarding issues on health care and in addition as a consultant with the Governmental Relations Committee at the Self Insured Institute of America in Washington D.C. and as an advisor to RIP Medical Debt which has abolished over $1.2 billion in medical debt.

Episode #168 – Sean Mehra is Founder & CEO at HealthTap, a Nationwide Virtual Primary Care Clinic with a Focus on the Consumer Experience.

This episode features Sean K Mehra, Founder & CEO at HealthTap. Here they discuss HealthTap and their focus on being a virtual primary care platform that gives patients long term relationships with their doctor so that the doctor can focus on the holistic and ongoing care of each patient.

Sean is currently Founder & Chief Executive Officer at HealthTap, a nationwide virtual primary care clinic enabled by a leading consumer technology experience to provide a personal relationship to an affordable, long-term primary care doctor equitably nationwide to all Americans, with or without good insurance. Over the decade, Sean served various leadership roles at the organization, including COO and CPO, responsible for building the technology, team, and clinical operation which allow the company to deliver trusted doctor care and knowledge scalably and cost-efficiently.

Episode #167 – Dr. Mary Talley Bowden is a Shy, Humble, Double Boarded ENT Who Graduated Top of Her Medical School Class. She Logged 3,900 COVID-19 Treatment Success Stories in Her EHR-99.7% Effective with Her Panel in Houston. Yet She is in 4 Lawsuits – Primarily Because Bigs and Federal Agencies Interfered with this Immensely Successful Care Plan. “My Dad says They Stepped on the Wrong Hornet When They Met Me…” Meet a Courageous Heroine to Millions.

 

In this episode Ron chats with Mary Talley Bowden, Owner of BreatheMD. Here, they do a deep dive into how Mary stood up to the healthcare establishment and the Bigs to treat COVID-19 patients how she felt they should be treated and how she asked all the right questions when it came to treatments, vaccines, and censorship. She also discusses how the pandemic has shed light on many of the issues in the American healthcare system and how independent and direct care leads to better outcomes.

Dr. Bowden completed her residency at Stanford University and is board-certified in both Otolaryngology and Sleep Medicine. In 2003, she moved to Houston and worked with Drs. Kyle McCutcheon and Alasdair Gilchrist at Memorial Northwest Otolaryngology. She specializes in sinus, sleep and allergy disorders and treats both children and adults.

As a mother of four boys, Dr. Bowden has spent many years being on the other side of the doctor-patient relationship. Her frustrations with the traditional medical system inspired her to open BreatheMD in 2019, with the goal to simplify and improve patients’ office visit experiences. To optimize efficiency, she has included multiple therapeutic diagnostic modalities on-site so patients can leave her office with a treatment plan and feeling better. Access to her clinic is easy with ground-level parking and online appointment scheduling. Patients are expected to leave the visit feeling better, with medications and procedures available in her clinic.

BreatheMD is a cash-pay facility, and Dr Bowden has opted out of all insurance plans but keeps her prices fair and transparent. All prices for clinic appointments and surgeries are listed on our website. Patients are given an itemized receipt to submit to their insurance companies for reimbursement. If you are an employer who self-insures, please talk to us – we love working directly with businesses to help them provide affordable high-quality care to their patients.

Dr. Bowden is also interested in research and is currently working to publish her findings from recent COVID-19 testing. For a list of Dr. Bowden’s publications, please click here.

She is on the advisory team of FLCCC, is co-leader of the Houston chapter of the Free Market Medical Association, and serves on the advisory board at the Validation Institute.

Episode #166 – ScriptCo is in 47 States. 4.9 Stars. Same Day Shipping. Average 90 Day Fill is About $4, Under $.04 a Pill! Subscription Fee Less Than Spotify. Zach Zeller, ScriptCo’s Co-Founder & President Returns to The Show.

In this episode, Ron chats with Zach Zeller, Co-Founder and President of ScriptCo Pharmacy. Here, Zach returns to the show to discuss subscription-based wholesale pharmacy and the incredible value it offers to employers and patients. They also discuss the issues with PBMs, how to sidestep the bigs, and they incredible prices they can offer for generic drug prices.

Zach Zeller grew up in Flower Mound, Texas, and attended the University of Texas on a Track and Field scholarship. Zach’s work ethic led to him to become a school record holder, All American, and multiple time Big 12 Champion.

After graduating from UT, Zach took a role with DePuy Orthopedics as Trauma Representative, where he earned the second-highest percentage increase growth in the United States in 2006. After being in the operating room just shy of 10 years years and offering guidance to surgical teams and surgeons in over 5,500 surgical procedures, Zach chose to move out of the surgical space and into the pharmacy market.

In 2017 Zach co-founded Texas-based ValueScript Pharmacy.

As a pharmacy owner he saw firsthand the intentionally designed lack of transparency in the marketplace created by pharmacy benefit managers that surrounds access and cost of medications when using health insurance. Zach and the ValueScript team were trying to figure out a better way to provide access and value to consumers.

After exhaustive research we felt that the best way to reach our goal of solving the cost and access problems that revolve around prescription medications could be solved by starting the first and only membership-based wholesale pharmacy in America, ScriptCo.

Episode #165 – Chris Habig created a 100% success model providing branding and marketing muscle,budgetary discipline ,network affiliation and capital for today 80 PCPs in 30 states wanting to start Direct Primary Care. Then supports with back end ops and group purchasing and vendor selection. Hello Freedom Healthworks.

In this episode Ron talks to Chris Habig, Co-Founder and CEO of Freedom Healthworks. Here they discuss the Freedom Healthcare model and how they help providers start their dream practice. Chris does a deep dive into how their practices focus on the doctor patient relationship and enable doctors to practice the art of medicine in a way that gives them the fulfillment they want out of their careers.

Christopher Habig has been active across a wide range of functions and industries during his career. Possessing an entrepreneurial mindset and a focus on problem-solving, Chris has developed his personal style of leadership to drive forward company visions, missions, and strategies. He is skilled at bringing concepts to life and into the market.

Educated in Indianapolis at Butler University, he earned a BS in finance as well as completion of pre-med course work. He went on to run companies in retail, publishing, and small business consulting before becoming a partner within a real estate investment and property management firm. While working in real estate, Chris earned his MBA in entrepreneurship from Indiana University’s Kelley School of Business.

He Co-Founded one of the largest single-family residential property management companies in the United States, Home River Group. Upon exiting to private equity, Chris turned his focus to his real passion, improving the healthcare industry in the United States. At Freedom Healthworks, Chris ensures progress in key performance areas while adhering to the company’s core values. To help educate and spread the message of Freedom Healthworks, Chris hosts the company podcast, Healthcare Americana. This podcast serves as a way to discuss important issues with stakeholders across the country.

Episode #164 – Meet Jeff Wells MD, Co-Founder and CEO of Marathon Health. 800,000 Members; 40 States; Pushing 200 Employers; Over 700 Providers; 89 NPS and an ROI to Employers of 2:1 EOY 3

This episode features Dr. Jeff Wells, CEO and Co-Founder of Marathon Health. Here Ron and Jeff do a deep dive into Marathon’s model, what makes it different, and the savings it creates for its members, and more. Jeff shares his passion for passion for transforming primary care in a way that puts patients and outcomes first while keeping providers and employers happy. Marathon Health truly differentiates itself from the legacy model and offers on onsite health centers, Marathon Health Network, and Marathon Health Anywhere.

Jeff Wells, MD, is the CEO and Co-Founder of Marathon Health, a modern health company that partners with employers, benefit consultants and unions to deliver a healthcare experience that focuses on driving real behavior change, resulting in better employee health and financial savings. Marathon Health’s model consists of onsite health centers, Network health centers and virtual advanced primary care. Wells, who earned his MD in internal medicine from Indiana University, was president and co-founder of OurHealth, which merged with Marathon Health in January 2020. He is the former director of Indiana’s Office of Medicaid Policy and Planning.