TIMESTAMPS:

[00:20] Health Insurance Misconceptions

[02:27]Health insurance perceived differently compared to other types of insurance

[04:14] - Insights from a hospital CEO about billing challenges and frustrations with payers.

[07:09] - Exploration of the complexities of premiums, deductibles, and copays.

[10:39] - Examination of U.S. health outcomes compared to other countries.

[22:00] - Direct primary care as a potential solution in healthcare.

QUOTES:

• "If you want different results, employers, employees, patients, do the opposite. Instead of following the traditional paths that have led to frustration and inefficiency in the healthcare system, consider taking a bold step back and re-evaluating how you approach healthcare and health insurance. Challenge the norms that have been ingrained in us and explore alternative methods that could lead to better outcomes for everyone involved." -David Contorno
• “And so another way to think about that is when you go and get care and you throw down your BUca based id cardinal that has a buccal logo on it, you are preordaining contractually, not subjectively, not hypothetically, but contractually preordaining you and your health plan to paying the highest price, not just in healthcare, not just in the US, but frankly, known to humans ever in the history of humankind.” -David Contorno
• "It is not impossible to build a health plan that allows an employer to pay 100% of the air quotes premium for that plan and make it so that there is no deductible and no out of pocket, and they would still save more money than signing that contract with a Buca." - Emma Fox

SOCIAL MEDIA LINKS:

David Contorno
LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox
LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE:

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

TIMESTAMPS:

[01:38] Discussion on compensation

[05:01] Conference Insights

[11:09] Importance of representation & transparency

[14:49] - Employer responsibility regarding their healthcare plans.

[22:20] Awakening brokers and consultants to the realities of the healthcare system

QUOTES:

• "At the end of the day, I think the entity, the stakeholder with the most leverage is the one who's the most quiet, which is the employer, because they're not only managing the dollars they're spending, but they're essentially responsible for managing the dollars that the employees are spending, whether it's the contribution out of their paycheck or their out of pockets." -David Contorno
• "And I think you're absolutely right. Severity is not so much of an issue. Really? Right? And so one of the talking points around, specifically around GLP one, because it was a big topic. And so it was a very big point of discussion. But someone brought up the rebates. And I said on the stage, I think you mean bribes, because rebates only benefit those that they get returned to." -Emma Fox
• "And so many have said that that awakening changed their path, and that's really what we need at the employer level, at the doctor level, and at the broker level, because if we can get a large enough group to change their path, then we can actually make a difference in how the system works."- David Contorno

SOCIAL MEDIA LINKS:

David Contorno

LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox

LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE:

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

In this eye-opening episode, David Contorno and Emma Fox dive into the harsh realities many face in accessing life-saving medications for chronic conditions. They share a heartfelt story of an 11-year-old boy desperate to help his mother, who lost access to her crucial MS medication due to an unexpected change in her health insurance plan. The discussion sheds light on the complexities of health insurance, the hidden options available, and how unaffordability can strike without warning. Emma and David provide practical advice on navigating these challenges, from leveraging manufacturer assistance programs to sourcing medications internationally. Join them as they unravel the tangled web of healthcare, offering hope and actionable strategies for those struggling with similar issues.

TIMESTAMPS:

[01:06] Story of an 11-year-old boy asking for help for his mother

[04:33] High-deductible HSA plans vs. copay PPO plans

[07:28] Manufacturer assistance programs, coverage issues, qualification requirements

[10:33]How drug coupons work and their impact on self-insured plans

[17:31] GLP-1 drugs (e.g., Trulicity, Ozempic) pricing and sourcing strategies

[24:49] Importance of consulting doctors when considering medication alternatives

[29:14] Emphasis on the responsibility of benefits consultants to impact company and employee finances

QUOTES

• "It has these horrific downstream effects, like eleven year old boys who are asking practical strangers to help his mom. You know, it really hurt my heart."- Emma Fox
• "But I wanted to explain that because coupons are, if you're in a fully insured plan, I, when I say I don't care, I do care a little, but I don't care nearly as much as when you're in a self-funded plan." - Emma Fox
• "Imagine if you were compensated for figuring out the things that we're talking about here. [...] You're impacting the money coming into their house and the money coming out of their house to a very large degree." -David Contorno

SOCIAL MEDIA LINKS

David Contorno

LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox

LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

info@nextdaypodcast.com

In this episode, Emma Fox and David Contorno explore the intertwined complexities of fiduciary responsibility and the hidden costs in healthcare. As employers face increasing scrutiny under ERISA and rising lawsuits, the conversation unpacks the critical roles of pharmacy benefit managers (PBMs) and healthcare carriers in shaping healthcare pricing. They discuss spread pricing, the importance of transparency, and the evolving responsibilities of employers and advisors. With insider insights and real-life examples, Emma and David offer a comprehensive look at how to navigate the delicate balance of fiduciary obligations while exposing systemic flaws that burden both employers and employees.

TIMESTAMPS:

[00:28] David and Emma discuss the increasing use of the term 'fiduciary' in healthcare

[04:36] Employers are fiduciaries for their health plans but often unaware

Fully insured plans & fiduciary duties

[11:21] PBMS -spread pricing, revenue, lack of transparency

[24:52]Recent lawsuits against Johnson & Johnson and Wells Fargo for mismanaging drug costs

[26:38] Fiduciary responsibilities under ERISA

[33:26] Payment integrity departments in carriers often lack true integrity

[37:44] Younger generations may drive change in healthcare systems

QUOTES:

• "You have to choose the right consultant, and finding the right consultant can be really hard because... there are a lot of people that you can find on LinkedIn who are saying all the right things, but that does not mean that they are doing the right things."- Emma Fox
• “I don't know, but I think transparency, they say that a spotlight is the best disinfectant or transparency is what really opens it up. And I think that's what we need to focus on. We need to focus on, most employers can't even access the information they need to be a fiduciary. So we need to really talk about transparency.” -David Contorno
• "If you are an employer listening to this, it is now crucial that you make a right selection... you have to be brave enough to say that being with a bucca, being with the CEO, increases my risk of violating my fiduciary responsibility." -Emma Fox

SOCIAL MEDIA LINKS

David Contorno

LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox

LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

info@nextdaypodcast.com

In this eye-opening episode, Emma Fox and David Contorno dive deep into the often-overlooked mechanisms that drive healthcare costs higher year after year. Emma shares her viral LinkedIn post about being "anti-BUCA" (Blue Cross, United, Cigna, Aetna) and the heated debate that followed. The conversation unveils the truth behind medical loss ratios, pre-certification practices, and the intricate systems that benefit insurers at the expense of employers and employees. Tune in to understand why challenging the status quo is essential for creating fair and transparent health plans.

TIMESTAMPS

[01.22] The anti-BUCA (Blue Cross, United, Cigna, Aetna) stance

[04.42] David explains how pre-certification is used to control care and ensure claims go up

[10.36] Discussed an article about Aetna's former medical director ignoring patient records

[11.15] Correlation between premium increases and carrier stock prices

[16.43] Higher standards their plans are held to compared to traditional carriers

[19.19] History and purpose of pre-certification in healthcare

[24.27]Story of a physician-owned hospital system preferring non-BUCA payers

[28.47 The role of doctors in current healthcare system

QUOTES:

• "None of this is by accident. When I meet with employers and we talk about how we build health plans, we talk about medical management... the initial decisions are made by largely non-clinical administrative people who are following a series of checkboxes." -Emma Fox
• "You know, carriers put out messages that they provide great care, that they want costs to be lower, that they want to control costs, but that's not how they operate." -David Contorno
• "I feel like when I come in with the plan that I have demonstrated is higher quality going to lower out of pocket, it's going to save the money. I'm held to a much higher standard than Blue Cross and United is." -David Contorno

SOCIAL MEDIA LINKS

David Contorno

LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox

LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

info@nextdaypodcast.com

In this episode, Emma Fox and David Contorno dive into the whirlwind of 2024, a year that began with optimism but quickly spiraled into a series of unexpected health challenges. David opens up about his harrowing experience with chronic pain, a spiritual trip to Costa Rica that led to a cascade of health issues, and the discovery of acute kidney failure. The duo discusses the importance of understanding the risks of long-term NSAID use, the critical role nurses play in patient care, and the reality of navigating a flawed healthcare system. Tune in to hear about resilience, medical advocacy, and the next steps in David’s health journey.

TIMESTAMPS

[00.49] David Contorno experienced a severe health crisis

[02.25] Emma’s point of view

[05.52] Rushed to Mission Hospital ER in Asheville, NC

[10.42] Diagnosed with acute kidney failure

[13.42] Experienced frustration with hospital holding area

[17.07] Learned about dangers of long-term NSAID use

[18.09] Discussed potential need for back surgery

[18.50] Mentioned the hospital's attempts to qualify David for Medicaid

[19.47] Emma managed hospital paperwork and consent forms

[23.39] Friends in the medical industry offered guidance

[27.41] The community showed strong support during recovery

SOCIAL MEDIA LINKS

David Contorno

LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox

LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

Mixed & Edited by Next Day Podcast

info@nextdaypodcast.com

In episode 20 of The Healthcare Hangover, David Contorno and Emma Fox discuss alarming healthcare facts, including the US's high healthcare spending, lack of guaranteed health coverage, and avoidable deaths. They also touch on the impact of COVID-19 on life expectancy and vaccination rates.

Tune in to gain insights into the healthcare system's financial challenges and the need for reform.

TIMESTAMPS

[00:03:08] Healthcare System's Avoidable Deaths.

[00:05:45] Universal Healthcare Debate.

[00:08:49] Life Expectancy and Healthcare Disparities.

[00:12:00] Acceptance of Preventable Deaths.

[00:17:33] Perverse Incentives in Government.

[00:21:23] Little Community Making Big Waves.

[00:23:54] Life-Changing Impact of Cost Savings.

In this episode, David Contorno and Emma Fox discuss how the US spends a significant amount on healthcare, far exceeding the average spending of other developed nations. Despite this high expenditure, the country continues to experience a troubling number of avoidable deaths.

Furthermore, David and Emma highlight the urgent need for systemic change in the healthcare industry, emphasizing the importance of accountability, responsibility, and legislative action to address disparities, improve access to care, and enhance outcomes for individuals. By advocating for reforms, engaging with policymakers, and prioritizing patient-centered care, the healthcare system can evolve to better serve the needs of the population.

QUOTES

• "We've become accepting of hundreds of thousands of people dying every year, needlessly, unnecessarily, the huge majority of them could have been prevented. That's not even including those preventable medical errors, which is an even higher rate than that. Like we've become numb to death. Unless it's like our immediate family, We don't care about it anymore, which is right. No wonder we're not fixing our healthcare system because that involves caring about other people. And it feels like there's such a lack of that." - David Contorno
• "I think the key to finding something that's actually passable in this country is to make sure that both sides don't like it. If one side loves it and one side hates it, it's never going to get done." - David Contorno
• “I don't know what's going to happen if the administration changes hands. But I do feel at least that it's getting on some radars, you know, like some important people are realizing that we exist. And I think that's, the days when my optimism is lacking, I think those are the things that kind of lean on. And if I step out of this industry, I'm leaving that burden for somebody else to carry. And that's why I feel like it's a big responsibility.” - Emma Fox

SOCIAL MEDIA LINKS

David Contorno

LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox

LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/

In episode 19 of The Healthcare Hangover, David Contorno and Emma Fox delve into the complexities of the healthcare system, touching on issues such as access to care, the influence of lobbyists, and the future of healthcare entities.

Tune in as they explore the challenges and nuances of the healthcare industry.

TIMESTAMPS

[00:01:25] Disappointing Experience with Direct Primary Care (DPC).

[00:06:55] DPC Values and Healthcare Choices.

[00:07:58] DPC in Health Plans.

[00:13:33] Our Healthcare System's Financial Incentives.

[00:16:39] Influence of Pharmaceutical Lobbying.

In this episode, David Contorno and Emma Fox discuss the importance of strategically integrating Direct Primary Care (DPC) into health plans to maximize its benefits and avoid diluting its value. They highlight the need to carefully assess DPC providers before including them in health plans to ensure alignment with the values and needs of the employees or members.

Furthermore, David and Emma underscore the complex interplay of financial interests, lobbying power, and resistance to change that continue to impede efforts to improve the healthcare system in the U.S. Addressing these challenges will require a concerted effort to prioritize the well-being of individuals over financial gains and to advocate for reforms that prioritize preventive care, transparency, and patient-centered approaches.

QUOTES

• "I think having a deeper relationship means that it gets a little more personal. I think it's okay to ask those things. So we try and get a broad spectrum of DPCs in the plans, at least as broad as we can so that people can find the one that they're most comfortable with." - David Contorno
• "I think a lot of people think that DPC is really for individuals or small groups. But there are ways, especially when you're assessing the tolerance of the group that you're representing and the DPC's value proposition, that you can marry those together with what looks like a traditional health plan. but provides this direct care component right up front. And I would say those are our most successful plans." - Emma Fox
• "For those of you that don't know, when you go to a DPC doctor, you never pay a copay, you never pay deductible, you never pay coinsurance. It doesn't matter if it's preventive or diagnostic. So there's zero barriers. There's no time barrier. There's no 3,000 other patient barrier, and there's no cost barrier to getting primary care. And one of the things that we've lost sight of is that primary care is called primary care because it's where we are supposed to go primarily." - David Contorno

SOCIAL MEDIA LINKS

David Contorno

LinkedIn: https://www.linkedin.com/in/dcontorno/

Emma Fox

LinkedIn: https://www.linkedin.com/in/emmamariefox/

WEBSITE

E-Powered Benefits: https://www.epoweredbenefits.com/

Emma Fox: https://emmamariefox.com/