Episode # 182 – Lee Gross MD Back for Another Round. A DPC Pioneer for 20 Years. Advocate at the Highest Levels of State and Federal Government. He Explains Cheaper, Faster, Better Primary Care where Everyone Wins in Hurricane Aftermaths and Pandemics as the Ultimate Stress Tests.

In this episode, Ron is joined again by thought leader Lee Gross, Co-Founder of Epiphany Health Direct Primary Care, President of Docs 4 Patient Care Foundation, & Chairman of DPC Action. Lee discusses seeing firsthand just how much care delivery can be improved through his transition from a traditional fee-for-service practice to one of the pioneering direct primary care practices. He also answers the questions of whether or not DPC models make for happier physicians, how he feels about massive scaling DPC firms, what he’s been lobbying for since the last time was on the show, and more.

Originally from Cleveland, Ohio, Dr. Gross is a graduate of The Ohio State University and Case Western Reserve University School of Medicine. He was elected chief resident of his family medicine residency program at University Hospitals of Cleveland.

After years in private practice in Florida, he and his colleagues had an “epiphany” about an affordable health care solution, free of insurance and government intrusion. Now, a Direct Primary Care revolution is sweeping across the nation, providing access to health care for those who have been neglected by the system for decades.

Dr. Gross is a pioneer in the Direct Primary Care delivery model, frequently speaking at national meetings, conducting media interviews about free-market health care innovations and writing articles for national publications. He is a health care consultant to physician practices, medical organizations, insurance groups, hospitals and private businesses. He is consulted by lawmakers and policy leaders on local, state and federal health policy initiatives, including formal testimony for the United States Senate and consultation with leadership at CMS, HHS, Labor, Treasury and The White House.

He serves as the president of the Docs 4 Patient Care Foundation, a national health policy think tank of practicing physicians committed to the establishment of an American health care economy which preserves the sanctity of the physician-patient relationship, promotes quality care, supports affordable access to care for all Americans and protects patient’s personal health care decisions.

D4PCF is the leading educator of DPC physicians. It has trained over 1,000 physicians in the Direct Primary Care delivery model through grant-supported national conferences since 2016.

Dr. Gross serves on the Board of Trustees of an HCA Hospital and as a Delegate to the Florida Medical Association. He is President of his county Medical Society. He is appointed to the FMA Council on Medical Economics and Practice Innovation. Dr. Gross is a recipient of HCA’s Frist Humanitarian award. He has received the Free Market Medical Association’s Beacon Award for his leadership in healthcare market reforms.

Episode # 181 – Eric Starkman is Among the Best Investigative Reporters in Healthcare Today. He Shines a Bright Light on the Massive Cracks in Regulation and Delivery of Care in America.

This episode, Ron is joined by Eric Starkman, an investigative journalist that uses his experience in crisis counseling, public relations, and financial reporting to help bring to light the threatening practices done by the BIGS in healthcare. Here, he answers the questions of how he picks the stories he writes, what obstacles faces in his reporting, why there aren’t many people doing the work he does, and more.

 Eric Starkman is a veteran journalist and former executive of a New York City PR and crisis communications firm.

Starkman previously worked as a reporter and editor at major newspapers in the U.S. and Canada, including the Toronto Star, the Montreal Gazette, The Detroit News, and American Banker. For more than two decades, he ran a well-known New York-based agency where he advised some very high-profile clients on media and other matters.

In 2020, Starkman returned to journalism and covered the implosion of Michigan’s Beaumont Health, for which his investigative reporting garnered an award from the Society of Professional Journalists. He publishes a blog called Starkman Approved for which he has extensively written critical articles about the corporatization of healthcare and the marginalization of doctors and other health professionals. Having grown up in Canada with socialized medicine, Los Angeles-based Starkman has naturally viewed U.S. healthcare through a different prism.

Episode # 180 – Dutch Rojas Just Sold Two of His Companies and Now is Offering Everyone Health – A Free App to Easily Contract in 300 Metros and 48 States Labs, Imaging, Surgery and Specialists for Cash Pay Customers. About 30-60M of Us.

In this episode Dutch Rojas returns to the show for a third time to discuss what he has been up to and how healthcare has changed since the last time he was on the show. Dutch is the Senior Vice President of Network at Nomi Health. Here he does a deep what is missing in the ecosystem of direct contracting, his investing in healthcare cutting edge healthcare companies as a way to improve healthcare, helping patients who are “functionally uncovered” due to high insurance costs, the trend of more patients wanting to pay cash, and more.

Dutch Rojas is Senior Vice President of Network at Nomi Health. Prior to being acquired by Nomi Health in July of 2022, Dutch was the founder of Sano Surgery and Everyone Health where he was building a brokerage, marketplace, and exchange for medical treatments and services resulting in affordable and accessible care for all. From 1995 to 2002 Dutch served in the United States Marine Corps Reserve.  He is a graduate of Oral Robert’s University.

Episode # 179 – Mike Botta of Sesame Introduces Healthcare Shopping into an Expedia-Like Marketplace. Fair Pricing Meets Care Slots Open and Available. Consumer Navigation Made Easy to Find Independent Docs, Imaging, and More.

In this episode Ron chats with Dr. Michael Botta, Co-founder and President at Sesame, a healthcare marketplace that works with patients that are uninsured or priced out of care by connecting them with high quality physicians at the best price. In this conversation, he discusses their target consumer, how they can connect patients with the right physicians offering the best prices, how they are improving outcomes, and more.

Everything Michael has done in his career has led to the Sesame moment, where his role is to oversee all sales, partnerships, and clinician relationships.

Michael spent five years at McKinsey & Co, leading multi-million-dollar projects to find solutions to healthcare’s biggest problems: pricing; quality measurement; catalyzing competition in the US and abroad to drive better results. Michael received his PhD in Health Economics and Policy from Harvard and has advised The White House Office of Management and Budget, Brookings Institution, and the State of Massachusetts on health reform legislation and implementation.

Episode # 178 – Mike Bechtol with Redirect Health is a National Expert in Patient Assistance Programs – A Secret Way to Pay for Much of Your Care – Your Employee’s Too – and Half of Us Qualify? True! Round 2.

In this episode Michael Bechtol, Vice President of Membership at Redirect Health, returns to the show. Redirect Health provides employers & individuals with affordable healthcare plans. Here, Michael shares the ways they can provide simple to use & affordable access to healthcare. He also answers the questions of who is eligible, how the consumers win, how they can bring down costs & provide better outcomes for patients, and more.

Michael Bechtol has served as Vice President of Membership and Enrollment since January 2015. He drives nationwide initiatives to educate employers and individuals about Redirect Health’s healthcare solutions. Since joining the company, Mr. Bechtol has made operations member-centric, allowing for greater efficiency, streamlining and affordability. His efforts have helped the company expand membership nationwide. Mr. Bechtol innovates new processes and program benefits to bring more value to members, ensuring they have a positive healthcare experience and that all needs are met. Prior to joining Redirect Health, he served as Tournament Director at Vanguard Golf Management.

Episode # 177 – Dr. Daniel Paull is an Orthopedic Surgeon. Founder of America’s First Mobile Cash Based Orthopedic Practice… Whaaat? Here’s a Model to be Happier, Make More, and Stay True to Your Calling. Surgeons, PCPs Already Get This.

In this episode Ron chats with Dr. Daniel Paull, Orthopedic surgeon, Founder and CEO of Easy Orthopedics. He is bringing the clinic to your house and keeping insurance out of it. He’s disrupting healthcare in a way that values your time and provides transparent cash pricing. Here, he dives into what made him switch gears into cash pay, how much he’s saving by cutting out the middlemen, how he finds his patients, how he decides his prices, and more.

Daniel Paull MD is an orthopedic surgeon. He is the Founder and CEO of Easy Orthopedics, America’s first mobile cash based orthopedic practice. Dr. Paull is an orthopedic surgeon by training and medical disrupter by passion.

Episode # 176 – Brad Kirkpatrick is CCO of Hydrogen Health – A Partnership of Anthem, Blackstone and K Health with Upside Engagement Potential of 9 million Employees. 500,000 Engaged Today. 250 Providers. Advanced Primary Care Designed for Employers and Carriers Never Had Deeper Pockets Nor a Better Rolodex.

In this episode Ron chats with Brad Kirkpatrick, Chief Commercial Officer at Hydrogen Health. Here, Brad does a deep dive into the founding and mission of Hydrogen Health. They offer virtual primary care that focuses on chronic condition management, urgent health, pediatric health, and mental health. He also discusses the importance of providing cost effective primary care that offers deep relationships with the provider and improves health outcomes.

With over 30 years in the healthcare industry, Brad has played key roles at healthcare start-ups and publicly traded companies, including Best Doctors, Healthways and Anthem. As Anthem’s Chief Client Officer, he led a team responsible for 300 national account clients and 4 million members. Brad brings his deep industry knowledge to Hydrogen to help lead employers and insurers in transforming the healthcare ecosystem.

Episode # 175 – The Jefferson Network Allows DFW and North Texas Employers a Significant Direct Primary Care Offering. Grady Gibbs is Growing It. He Has Interesting Takes on ACOs as Dinosaurs, Bigs as Self-Referrers, Not Consumer Centric, and More.

In this episode, Ron has chats with Grady Gibbs, Product Manager & Strategic Relationship Development at Evolve Medical Consulting, a consulting company that assists healthcare companies engage more doctors and helps doctors sell more products and procedures. Here, they dive into the reason why Grady loves the direct primary care model. He also discusses why he feels that ACOs are “dead”, what the Consolidated Appropriations Act is going to do to brokers that have to disclose all the millions they have been sweeping under the rug for themselves, and much more.

Grady Gibbs helps healthcare companies engage more doctors and he helps doctors sell more products and procedures. After a career in investment banking and finance, and a return to graduate school, Grady became an expert in applying statistics and research to consult on brand strategy for some of the largest marketers in the United States.

After launching a direct-to-consumer ad campaign for a drug company, he realized doctors needed more help than drug companies and began what is now an almost 20 year career serving doctors and helping them achieve the triple aim: good for the patient, good for the system, good for the doctor.

Episode # 174 – Peter Hayes is Back to Tell Us What Purchasing Alliances are Best At and How an Ideal Plan Design Shapes Up.

In this episode Peter Hayes returns to the show to do a deep dive into his thoughts on the current state of CMS, hospitals, and more. He also discusses with Ron how purchasing alliances work and his thoughts on the ideal health plan design.

Peter Hayes currently the President & CEO of the Healthcare Purchaser Alliance of Maine and formerly a principal of Healthcare Solutions and Director of Associate Health and Wellness at Hannaford Supermarkets. He has been recognized as a thought leader in innovative, strategic benefit design for the past 25+ years. He has received numerous national awards in recognition of his commitment to working collaboratively with healthcare providers and vendors in delivering health benefits that are focused on value (high quality efficient care). He has been successful in this arena by focusing on innovative solutions for patient advocacy, chronic disease management, and health promotion programs.

Peter has also been involved in health care reform leadership roles on both the national and regional levels with organizations like Center for Health Innovation, Care Focused Purchasing, Leapfrog, co-founder of the Maine Health Management Coalition, and been appointed by two different Maine Governors to serve on Health Care Reform Commissions to recommend public policies to improve the access and affordability of health care for Maine citizens.

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.