Avsnitt
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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.
Mixed & Edited by Next Day Podcast
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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
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Saknas det avsnitt?
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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 FoxSOCIAL 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/
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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 ContornoSOCIAL 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/
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In episode 18 of The Healthcare Hangover, David Contorno and Emma Fox discuss their recent trip to Dallas and a new project they've been working on. They also talk about the challenges of the healthcare system and the need for a holistic approach to fixing it.
Tune in to hear their insights and find out how you can get involved in making a difference in your own community.
TIMESTAMPS
[00:02:43] Lack of Access to Healthcare.
[00:08:14] Prescriptions and Financial Assistance.
[00:11:45] Financial Assistance Programs at Nonprofit Hospitals.
[00:15:02] Providing Healthcare to the Uninsured.
In this episode, David Contorno and Emma Fox delve into the pressing issue of individuals in certain communities who are unable to afford essential medications and healthcare. They even highlight that as individuals age, they often require maintenance prescriptions for common health issues like blood pressure. However, the cost of these medications can be exorbitant, leading many to forgo necessary treatments and appointments.
Overall, David and Emma emphasize the importance of understanding the various assistance programs available and the distinction between medical and prescription coverage. While some programs require individuals to be uninsured, others may still be accessible to those with insurance. Taking a holistic approach to healthcare is crucial, addressing the issue from all angles simultaneously to prevent the problem from resurfacing in more detrimental ways.
QUOTES
"The goal is to bring direct primary care into these communities for short periods of time, kind of like pop-up DPC, to serve these folks who don't have access to health care." - Emma Fox“the most common misconception around these programs when people find out about it, is that it doesn't matter if you have insurance. It is not for only the uninsured. It's also for the underinsured." - Emma Fox"I feel like I have the opportunity and our plans do that every day when I can get someone who does have a job who's clearly doing the right thing, but they still can't afford their medication or their surgery or their tests, and then I can get it done for them. that feels really good. And it doesn't feel like charity. It feels like getting them what they should have been entitled to anyway." - David ContornoSOCIAL 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/
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In episode 17 of The Healthcare Hangover, David Contorno and Emma Fox discuss their frustration with employers giving up on finding effective healthcare plans. They delve into the importance of retention rates in the industry and express their concerns with consultants who seem to be giving up too easily.
Tune in to hear their passionate discussion about the need for persistence in finding alternative healthcare solutions.
TIMESTAMPS
[00:00:20] Employers Giving Up.
[00:02:36] Leadership in Healthcare Financing.
[00:07:57] Cancer Care Mistreatment Rates.
[00:09:25] Failing Health Care System.
[00:13:41] Employers and Healthcare Innovation.
In this episode, David Contorno and Emma Fox express frustration with employers who are giving up on finding alternative healthcare plans. They believe that employers are too focused on retention rates and are not willing to put in the effort to explore and implement alternative options.
Moreover, David and Emma believe that employers should dedicate the same effort to healthcare as they do to their core business. They argue that while the core business unit may be challenging and competitive, employers have had to make innovative decisions and value propositions to be successful in that area. Therefore, they suggest that employers should apply the same level of dedication and resource allocation to healthcare because it is equally important and costly. They believe that if enough employers prioritize healthcare and make informed decisions, it can lead to positive changes in the healthcare system.
QUOTES
“I think that they don't consider doing the hard thing when it comes to health care financing as part of their responsibility when it comes to being good leaders.” - Emma Fox"Nothing pisses me off more than an employer who's not willing to do the right thing because they're getting pushback from people who don't understand what the right thing is." - Emma Fox"Sometimes you got to make people emotional on this. And oftentimes it's just a negative emotion that's going to get them to change something considerably so radically." - David Contorno“Put the right insurance in place by asking the right questions, by working with the right people, by paying people in a way that's aligned with those outcomes. And if enough employers did that, the system would change.” - David ContornoSOCIAL 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/
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In episode 16 of The Healthcare Hangover, David Contorno and Emma Fox discuss their experiences with political influences in the healthcare system. They share their frustrations with trying to make change through traditional channels and how they found themselves in high-level political circles. They talk about their background in lobbying and the lack of impact they felt.
Tune in to hear about their unexpected journey and their thoughts on the intersection of healthcare and politics.
TIMESTAMPS
[00:04:27] Politicians' Focus on Health Insurance.
[00:07:27] Politicians' Misunderstanding of Healthcare.
[00:11:38] Running for Office.
[00:12:51] Pro-Life vs. Pro-Choice as Policy.
[00:19:55] Holding Healthcare Entities Accountable.
In this episode, David Contorno and Emma Fox have been grappling with the challenge of making a meaningful impact on the healthcare system through political influences. Despite their attempts to engage with political influencers, both individually and collectively, they have found it to be an ineffective endeavor.
Moreover, David and Emma emphasize the importance of treating all individuals equally and ensuring that healthcare is recognized as a fundamental human right. They argue that while the government does not need to fully provide healthcare, it should play a role in guaranteeing equitable access to care.
QUOTES
"Insurance doesn't solve the problem. It actually makes it worse, at least as it exists today." - David Contorno“I was going to say is politicians don't seem to understand that. They have this idea that as long as someone has health insurance, they'll be OK. But it's never the case." - Emma Fox"Republicans are for less government, not more government. They're for less interference in our lives, less interference in how parents educate and with the lifestyles and the religious beliefs. I don't believe that I should be making the right medical choice for your children or any politician should. I believe that me and my wife love my children no more than anyone else. And we are best suited to make medical decisions for them above and beyond everybody else." - David Contorno“I think Republicans are actually a little bit more rebellious, especially in the last few years. But Democrats, they're very much a united front.” - Emma Fox“I have some ideas, some legitimate ideas that I think are very doable that would provide healthcare to some extent and also still maintain the privatized insurance market and the employer-employee relationship. And I think that there's a compromise out there that truly brings value to the country, to its citizens, to the doctors that are miserable.” - David ContornoSOCIAL 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/
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In episode 15 of The Healthcare Hangover, David Contorno and Emma Fox dive into the topic of GLP-1 weight loss drugs, exploring their effectiveness, financial implications, and the debate surrounding their accessibility for weight loss.
Tune in as they navigate and share their insights through this issue.
TIMESTAMPS
[00:00:30] Introduction to GLP-1 Weight Loss Drugs
[00:01:00] Weight Loss and Financial Perspective
[00:03:00] Personal Weight Loss Experiences
[00:05:00] Coverage and Accessibility
[00:06:30] Patient Assistance Programs (PAPs)
[00:09:00] Proposed 12-Month Program
[00:11:30] Additional Benefits of GLP-1 Drugs
[00:13:00] Employer's Perspective
[00:14:20] Pharmaceutical Industry Considerations
[00:16:30] Addiction Analogy
In this episode, David Contorno and Emma Fox focus on GLP-1 weight loss drugs, as they share their experiences with employers interested in covering these drugs under self-funded health plans. They explore the efficacy of these drugs, emphasizing that they are not a silver bullet and require complementary lifestyle changes for sustained results.
In addition, David and Emma share personal weight loss journeys and debate whether access to these drugs should be expanded to make weight loss more achievable for individuals struggling with obesity. They discuss the financial aspects, including the high costs and varying coverage percentages across health plans. They also address potential benefits beyond weight loss, such as reducing cravings for other addictive behaviors. Thus, expressing concerns about the affordability of these drugs and the pharmaceutical industry's motivations.
QUOTES
"It's very long term. It's not a silver bullet. You still need to do other things that if not done means you have to be in the medicine forever." - David Contorno“And the one thing that's bothering me is people claiming that these drugs are new, which is, I mean, some of them are new, don't get me wrong, but the formula has been around for a long time. We've been using these drugs to treat diabetes.” - Emma Fox"If this was available to me and I could have afforded it back then, I don't know why we wouldn't make it easier when I see people say that overweight people shouldn't have access to GLP ones." - Emma Fox"If you're an anti-GLP-1 person, I'd really encourage you to look at it from a more human perspective as somebody who was very, very overweight my whole life." - Emma Fox"I think everybody is addicted to something. I have the luxury of being addicted to multiple things." - David ContornoSOCIAL 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/
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In episode 14 of The Healthcare Hangover, David Contorno and Emma Fox discuss the challenges and headaches of the healthcare system. They dive into the busy season and the lack of breaks they’re experiencing. They also talk about their upcoming conference and the exciting topics and speakers they have lined up, including discussions on psychedelic therapy, infertility support, and the correlation between lack of healthcare access and gun violence.
Tune in to learn more about the challenges and joys of navigating the healthcare system.
TIMESTAMPS
[00:00:45] Celebrating Jewish holidays.
[00:05:09] You Powered Symposium and Puerto Rico.
[00:09:42] Lack of Access to Healthcare.
[00:12:41] Attending the Powered Symposium virtually.
In this episode, David Contorno and Emma Fox delve into the challenges and frustrations encountered within the healthcare system. They discuss the perpetual busyness of the healthcare industry and the lack of breaks they experience. While the industry used to have a designated busy season known as the fourth quarter, they express that it now feels busy throughout the entire year.
Furthermore, while they enjoyed meeting new people, they felt that the educational aspect was lacking. Consequently, they sought to create a different experience with their symposium. Their goal was to establish an environment where competitors could come together and teach one another, thereby diversifying their education, as it aims to unite individuals who are currently engaged, attempting, or aspiring to be part of the industry, fostering collaboration and mutual support in their respective fields.
QUOTES
“It (Symposium) can be a platform for teaching and learning. And I strive to teach and learn something every day. And so what it quickly became, even at the very first one, was just this getting together of people that actually felt like they're doing different things instead of saying different things and going back to the office Monday morning and not doing anything different.” - David Contorno“The best part of all of those conferences for me is the people, which is great.” - Emma Fox “I wanted to create something where people could still enjoy each other and each other's company and networking. But I really wanted to create an environment where we could have a bunch of competitors in the room. And instead of competing with each other, we could teach each other how to do what the other person does and completely diversify our education.” - Emma Fox “It's coming together of all the people that are doing it, trying to do it, want to do it, and helping us do it. And that's that's the goal.” - David ContornoSOCIAL 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/
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In episode 13 of The Healthcare Hangover, David Contorno and Emma Fox discuss the deceptive practices of hospitals and the importance of consumer education in the healthcare system. They dive into topics such as the lack of transparency in hospital pricing, the need for consumers to ask the right questions, and the benefits of direct primary care.
Tune in to hear their insights on this issue in the healthcare system.
TIMESTAMPS
[00:01:37] Self-Professed Healthcare Quality Metrics.
[00:06:07] Misleading Hospital Billboards.
[00:07:30] University of Pittsburgh Medical Center (UPMC) and Healthcare Quality.
[00:11:29] Deceptive Drug Advertising.
[00:14:28] Joining the (AFCA) association.
In this episode, David Contorno and Emma Fox discuss the importance of advisors in the healthcare industry, including solution providers, advisors, and doctors. They also highlight the recent federal laws that require advisors to disclose their compensation, urging advisors to comply with this requirement. Although enforcement of this law appears to be lacking, they maintain that it is still the right thing to do.
Moreover, David and Emma emphasize the significance of educating consumers and empowering them to advocate for themselves within the healthcare system. They believe that many people are unaware of or fail to recognize the deceptive practices prevalent in the healthcare industry. Thus, stressing the importance of asking the right questions and being well-informed about appropriate tests and treatments.
QUOTES
"One of the things that we identify is that frequency is a big indicator of quality and not just high quality, but it's also a good indicator of reasonable pricing because they're efficient at doing it because they do that type of procedure so frequently." - David Contorno“That's one of the reasons why we heavily promote direct primary care. Even if you're not an employer, just for yourself, it's really worth the 40, 50, 70 bucks a month that gives you access to a doctor that you can ask those questions to even in a crunch situation.” - David Contorno“Just because it says it somewhere, just because it's in the paper, just because there's a magazine or an ad or a billboard doesn't mean that what it says is true.” - Emma Fox“The only thing that we do is validate that you are disclosing your compensation. Period. That's it. It doesn't even matter if you're a commissioned advisor, as long as you can prove that you disclose the amount of commission in every contract that you're executing.” - Emma FoxSOCIAL 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/
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The healthcare system is often a source of frustration for many, with a lack of respect and transparency being at the forefront of these grievances. David Contorno and Emma Fox, two advocates for healthcare reform, share their perspectives on this issue. They express their frustration over doctors' overbooking, rising rates, and worsening benefits, attributing these issues to unrealistic productivity standards imposed by the systems doctors report to. They believe that this lack of respect for patients' time and the absence of transparency in pricing are driving doctors, especially primary care physicians, away from the traditional healthcare system. Contorno and Fox emphasize the importance of patients taking control of their healthcare decisions, encouraging them to ask questions, seek second opinions, and be informed consumers. Join David Contorno and Emma Fox as they delve deeper into these issues on this episode of The Healthcare Hangover podcast.
Timestamped Outline:
(00:04:10) Lack of Communication and Respect in Healthcare
(00:07:49) The Burden of Healthcare Delays on Working Individuals
(00:10:08) The Impact of Overbooking on Patient Care
(00:16:13) Taking an active role in healthcare decisions.
Social Posts:
📢 "Have you ever waited for hours at a doctor's appointment without explanation or apology? 🤔 David and Emma share their frustration with the lack of communication and respect they experienced during a delayed appointment. Join the conversation on the impact of delayed appointments on patients' lives! 🏥 #HealthcareHangover #PatientExperience
📢 New episode alert! 🎧 In this week's episode of #TheHealthcareHangover, David and Emma dive into the frustrations of healthcare delays and the impact on working individuals with inflexible schedules. 💼💔 Tune in to hear their thoughts on the financial implications and the disregard for humanity displayed by healthcare providers. Let's discuss the hypocrisy of the system! #HealthcareDelays #WorkingIndividuals #PatientAdvocacy
📢 New episode alert! 🎧 Tune in to The Healthcare Hangover as hosts David Contorno and Emma Fox discuss the prevalent issue of overbooking in the healthcare system. Discover how this practice leads to long wait times, frustration for patients, and strains on doctors. Let's demand improved efficiency and communication! #HealthcareHangover #OverbookingIssues
📢 "Advocating for yourself as a patient is crucial in healthcare decision-making. Doctors, despite their expertise, can be wrong due to various incentives. It's time to get sassy and talk about it! Join @HealthcareHangover as we discuss the importance of being an informed consumer. #PatientAdvocacy #HealthcareHangover
Blog Post:
Frustration Over Lack of Respect and Transparency in the Healthcare System
In a recent episode of "The Healthcare Hangover" podcast, hosts David Contorno and Emma Fox expressed their frustration over the lack of respect and transparency in the healthcare system. They specifically highlighted the issue of delayed appointments and the hypocrisy of doctors charging fees for missed or late appointments while not valuing their patients' time. This issue is particularly burdensome for working individuals who cannot afford to lose wages due to long wait times and overbooking in the healthcare system. The lack of transparency in pricing and scheduling further exacerbates the problem.
One of the key factors contributing to frustration in the healthcare system is the lack of communication and respect for patients' time. David and Emma shared their personal experiences of waiting for extended periods without any explanation or apology from the healthcare providers. They questioned why doctors' time is considered more valuable than their patients' time, especially when patients can also have high-paying jobs and lose significant amounts of money due to delays.
The hosts also discussed the irrational pedestal on which doctors are often placed in society. They emphasized that doctors are human beings just like everyone else and should be held accountable for their actions and the way they treat their patients. They highlighted the importance of advocating for oneself in healthcare decisions and not blindly accepting the care provided by doctors. Patients should seek second opinions, question the care they receive, and understand the risks and side effects associated with their treatments.
Another factor contributing to frustration is the lack of transparency in pricing and scheduling. Hospitals and healthcare providers often claim that publishing their pricing would be unfair competition or a burden. However, David and Emma pointed out that other industries, such as Amazon, can display pricing for millions of products that often change hourly. They argued that the excuses given by healthcare providers for not being transparent are simply a reflection of their lack of interest in serving the best interests of patients.
The hosts also shared an example of a gynecologist who openly admitted to being overbooked and consistently running late. While they appreciated the doctor's transparency, they highlighted the systemic issues that lead to such situations. Doctors have control over the time they book patients and the amount of time they spend with each patient, yet they often fail to accurately estimate their schedules. This lack of timeliness and accuracy can cause frustration and inconvenience for patients.
The impact of frustration over the lack of respect and transparency in the healthcare system goes beyond personal inconvenience. It can have serious consequences for individuals who cannot afford to take time off work or who rely on hourly wages. The financial burden of missed wages due to delayed appointments can affect their ability to afford necessary medications or even enjoy simple pleasures like going out to dinner with loved ones.
In conclusion, frustration over the lack of respect and transparency in the healthcare system is a significant issue that needs to be addressed. Patients should not have to tolerate long wait times, lack of communication, and hidden pricing. It is crucial for individuals to advocate for themselves, seek second opinions, and question the care they receive. Healthcare providers need to prioritize respecting their patients' time and being transparent about pricing and scheduling. Only through open dialogue and a commitment to transparency can we hope to improve the healthcare system and provide better care for all.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
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The topic of promoting transparency and ethical conduct in healthcare benefits advising is a critical one in today's healthcare industry. David Contorno and Emma Fox, both advocates for this cause, believe that by verifying the transparency and ethical conduct of benefits advisors, employers can be directed to the right advisors, ultimately solving issues such as bad insurance and inflated healthcare costs. Their experiences have led them to launch an association aimed at creating a population of advisors who are ethical and transparent in their practices. They emphasize the importance of advisors and organizations being transparent about their fees, costs, and contracts with clients, acknowledging that while not all brokers are unethical, there are some who engage in unethical practices. Join David Contorno and Emma Fox on this episode of The Healthcare Hangover podcast as they delve deeper into this important topic.
Timestamped Outline:
(00:01:22) Transparency and Ethical Conduct in Healthcare
(00:04:23) The Impact of Financial Transparency on Professionals
(00:08:06) Uncovering Unethical Broker Revenue Practices
(00:12:57) The Importance of Transparent Broker Fees
(00:18:01) The Role of Brokers in Providing Unbiased Recommendations
(00:26:21) Employer Health Plan Analysis and Optimization
Social Posts:
📢 Exciting news! David Contorno has launched an association to ensure transparency and ethical conduct among benefits advisors in the healthcare industry. By connecting employers with verified advisors, they aim to tackle bad insurance and inflated healthcare costs. Let's discuss the importance of transparency and ethical behavior in improving our healthcare system and individuals' lives. Join the conversation! #HealthcareHangover #TransparencyMatters #EthicalConduct
💥 New episode alert! 💥
🎙️ In this episode of #TheHealthcareHangover, David and Emma dive deep into the impact of financial incentives and influence on brokers and doctors. 💰
🔍 Discover the importance of transparency in revenue models and how it can transform the healthcare industry. Listen now! 🎧
#HealthcareTransparency #EthicalPractices #HealthcareCosts
📢 New episode alert! 🎧 In "Hidden Ways Brokers Get Revenue," David and Emma expose the undisclosed methods brokers use to earn extra income in the self-funded health plan market. They discuss unethical practices and the lack of transparency in the industry. Tune in to learn more about broker compensation and the need for transparency in the broker-client relationship. #HealthcareHangover #BrokerCompensation #Transparency
💬 "Fees and negotiation in the insurance industry are a topic of concern. David and Emma stress the significance of transparency when it comes to broker fees. Interestingly, no client has ever attempted to negotiate their fees down. When brokers are upfront about their fees and value, clients recognize and appreciate their efforts. Let's discuss the importance of open conversations about fees in building trust. #HealthcareHangover #TransparencyMatters
Blog Post:
Promoting Transparency and Ethical Conduct in Healthcare Benefits Advising
In the complex world of healthcare benefits advising, promoting transparency and ethical conduct is crucial to ensure that employers and individuals receive the best possible guidance and support. In a recent episode of "The Healthcare Hangover" podcast, hosted by David Contorno and Emma Fox, the importance of transparency and ethical conduct in healthcare benefits advising was discussed at length. The episode highlighted the need for verified advisors who prioritize the best interests of their clients and the challenges associated with financial incentives in the industry.
David Contorno, a prominent figure in the healthcare industry, has launched an association with the goal of verifying the transparency and ethical conduct of benefits advisors. The association aims to connect employers with verified advisors who can address issues such as bad insurance and inflated healthcare costs. By ensuring that employers have access to trustworthy advisors, Contorno believes that many of the problems in the industry can be solved over time.
One of the key issues discussed in the episode is the influence of financial incentives on the decisions of brokers and doctors. While not all brokers and doctors are unethical, the financial incentives within the system often lead to results that align with those incentives. Contorno shared his personal experience of transitioning to a fully aligned and transparent revenue model with his clients, which involved disclosing how he was paid and how much he earned from their accounts. This transparency had a significant impact on his approach to advising and the programs he offered.
The discussion also shed light on the prevalence of unethical practices, such as undisclosed additional income and reliance on carrier-based plans, particularly in the self-funded health plan market. To address these issues, the speakers emphasized the importance of transparency in broker fees and advocated for brokers to be paid directly by the clients they serve. This would help ensure unbiased recommendations and eliminate the conflicts of interest that arise when brokers are paid by insurance carriers.
Promoting transparency and ethical conduct in healthcare benefits advising is not without its challenges. The episode acknowledged that many brokers, especially those working with small businesses, have limited control over how they are paid due to the commission structure tied to premiums. However, the speakers emphasized the need for change in the industry and the importance of employers demanding transparency from their advisors.
The impact of promoting transparency and ethical conduct in healthcare benefits advising goes beyond financial considerations. As Contorno and Fox highlighted, this is about people's lives and their ability to afford essential care. The decisions made in healthcare benefits advising can have a profound impact on individuals' access to life-saving treatments and their overall financial well-being. Therefore, it is crucial for advisors to take their responsibility seriously and prioritize the best interests of their clients.
To help employers gain insights into their health plans and ensure transparency, the episode highlighted Signal Health Consulting's Health Plan Diagnostics service. This service offers a comprehensive audit of health plans, including an assessment, diagnosis, and treatment plan. By examining contracts, compensation structures, and plan utilization, employers can gain a better understanding of where their healthcare dollars are going and identify any potential issues or hidden revenue streams.
In conclusion, promoting transparency and ethical conduct in healthcare benefits advising is essential for ensuring that employers and individuals receive the best possible guidance and support. The episode of "The Healthcare Hangover" podcast emphasized the need for verified advisors who prioritize their clients' best interests and the challenges associated with financial incentives in the industry. By demanding transparency and ethical conduct, employers can make informed decisions about their healthcare benefits and ultimately improve the well-being of their employees.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
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The American health insurance system, a complex and costly issue, is a topic that has been the subject of much debate and controversy. Many Americans struggle to afford health insurance, and the system is largely profit-driven, with pharmaceutical companies and insurance providers reaping billions in profits. However, there are alternatives and potential solutions to these challenges. David Contorno and Emma Fox, both experts in the field, argue that the system is flawed and in need of alternatives. They believe that insurance should not cover primary care or physical therapy, as these services could be paid for in cash at a much lower cost than insurance premiums. They criticize the current system for being profit-driven and advocate for building health plans that prioritize cost containment and incentivize high-quality providers. They also question the role of insurance carriers, suggesting that they serve no purpose, and that the intention of insurance should be to protect individuals from catastrophic loss. Join David Contorno and Emma Fox on this episode of The Healthcare Hangover podcast as they delve deeper into the challenges and alternatives in the American health insurance system.
Timestamped Outline:
(00:00:34) The High Costs of Health Insurance
(00:05:03) The Impact of Charity Care Programs on Nonprofit Hospitals
(00:09:14) The Impact of Healthcare Costs on Bankruptcy
(00:12:22) Maryland's Successful Healthcare Cost Reduction Experiment
(00:21:05) Inflated Bills and Decreased Quality of Care
Social Posts:
📢 Join the discussion on the complex issue of health insurance in the healthcare system! 💬💭 In our latest podcast episode, David and Emma shed light on the high costs of health insurance. Is it really necessary for accessing healthcare? 🏥💰 Let's explore alternatives and ways to make healthcare more affordable for everyone. Tune in now! 🎧 #HealthcareHangover #HealthInsuranceDebate
📢 Join the discussion on nonprofit hospitals and their charity care programs! 🏥🌍 Discover how these programs reduce healthcare costs for uninsured individuals and ensure access to affordable care. Listen to our latest episode of #TheHealthcareHangover now! 💊💡 #Healthcare #AffordableCare
📢 Check out the latest episode of The Healthcare Hangover! 🎧💊 We dive into the complex dynamics of healthcare costs, bankruptcy, and the role of insurance carriers and hospitals. Discover why having health insurance doesn't always protect against medical bills. Tune in now for eye-opening insights! #HealthcareHangover #MedicalBills #Insurance #Bankruptcy
📢 Join the discussion on the Maryland Experiment! 🏥💰 Discover how government-mandated price controls have reduced healthcare costs and improved efficiency. Tune in as David and Emma dive into this unique approach. #HealthcareHangover #MarylandExperiment #HealthcareCosts
Blog Post:
Challenges and Alternatives in the American Health Insurance System
The American health insurance system is a complex and costly issue that affects millions of Americans. With rising healthcare costs and limited access to affordable coverage, many individuals and families struggle to obtain the care they need. In this episode of "The Healthcare Hangover" podcast, hosted by David Contorno and Emma Fox, the challenges and alternatives in the American health insurance system are explored in depth.
One of the key factors impacting the challenges in the American health insurance system is the profit-driven nature of the industry. Pharmaceutical companies and insurance providers make billions of dollars, often at the expense of individuals who are unable to afford expensive plans. This profit-driven approach can lead to higher costs for consumers and limited access to quality care.
However, alternatives to expensive health insurance plans do exist. Nonprofit hospitals, for example, play a crucial role in providing affordable healthcare to uninsured individuals through charity care programs. These programs not only offer lower costs for patients but also allow nonprofit hospitals to qualify for tax breaks. This demonstrates the importance of considering alternative approaches that prioritize affordability and accessibility.
Contrary to popular belief, health insurance does not always protect against bankruptcy. Many bankruptcies in the United States are due to medical bills, even for those with insurance. This highlights the need for a comprehensive evaluation of the impact of health insurance on individuals' financial well-being. It is essential to consider the true cost of care and the financial obligations that come with insurance coverage.
The Maryland Experiment is an example of a state system that has successfully addressed some of the challenges in the American health insurance system. This experiment mandated price controls for commercial insurance companies, resulting in reduced healthcare costs and increased efficiency. This approach demonstrates the potential benefits of implementing regulations to control costs and improve the overall quality of care.
One of the major challenges in the American health insurance system is the decision-making process by insurance carriers. Often, these carriers make care and payment decisions without clinical training or evidence-based guidelines. This can lead to inappropriate care decisions, lower reimbursements for healthcare providers, and increased costs for patients. It is crucial to address this issue and ensure that decisions regarding care and payment are based on sound medical evidence and expertise.
In conclusion, the challenges and alternatives in the American health insurance system are complex and multifaceted. Balancing factors such as affordability, accessibility, and quality of care requires careful consideration and evaluation. It is important to recognize the impact of health insurance on individuals' financial well-being and explore alternative approaches that prioritize affordability and accessibility. Additionally, addressing the decision-making process by insurance carriers and implementing regulations to control costs can contribute to a more efficient and effective health insurance system. By understanding these challenges and exploring alternatives, we can work towards a more equitable and sustainable healthcare system for all Americans.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
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In the complex world of healthcare, issues of inauthenticity and deceptive practices are becoming increasingly prevalent. David Contorno and Emma Fox, seasoned professionals in the industry, offer a unique perspective on this issue. They express their frustration with individuals and companies who claim to support certain healthcare practices without any substantial experience or evidence to back up their claims. Their insights stem from their extensive experience and continuous learning in the healthcare field, which they believe is crucial to navigate the complexities of the industry. They offer their Certified Health Value Advisor course as a solution for those seeking to enhance their knowledge and expertise. Join David Contorno and Emma Fox in this episode of The Healthcare Hangover podcast as they delve deeper into these issues and offer valuable insights and solutions.
Timestamped Outline:
(00:00:02) direct primary care benefits
(00:01:46) Certified Health Value Advisor Course
(00:05:06) Congress reforms
(00:14:54) bad players in the industry
Social Posts:
🎙️ New episode alert! 🎧 Tune in to The Healthcare Hangover podcast as David Contorno and Emma Fox discuss the rise of direct primary care benefits in the healthcare industry. They shed light on the importance of transparency and authenticity when it comes to consultants. Don't miss out on this eye-opening conversation! #HealthcareHangover #DirectPrimaryCare #TransparencyMatters
Looking to level up your healthcare industry knowledge? The Certified Health Value Advisor Course is your go-to resource! Learn from industry experts like David Contorno and Emma Fox, who emphasize the importance of continuous learning. Gain insights on pharmaceutical history, PBMs, and more. Uncover bad practices and solutions. Whether you're a newbie or a pro, this course will keep you engaged and informed. #HealthcareIndustry #ContinuousLearning
📢 Attention all! Congress is discussing reforms to tackle the profit-driven practices of pharmacy benefit managers (PBMs). David Contorno and Emma Fox reveal the deceptive tactics used by PBMs, like claiming to pass on 100% of rebates when they actually keep a significant portion for themselves. These practices have led to inflated costs for employers and patients. PBMs have even generated more profit than entire insurance companies! While reforms are underway, concerns remain about potential higher costs. Stay informed on The Healthcare Hangover podcast! 💊💰 #HealthcareReforms #PBMs #TheHealthcareHangover
Blog Post:
Issues with inauthenticity and deceptive practices in healthcare have become a growing concern in the industry. In a recent episode of "The Healthcare Hangover" podcast, hosted by David Contorno and Emma Fox, the topic of inauthenticity and deceptive practices in healthcare was discussed in detail.
One of the key issues highlighted in the episode was the promotion of direct primary care benefits by consultants who do not have any direct primary care business themselves. This raises questions about the authenticity and honesty of these consultants, especially when they are advising clients who are seeking their expertise. While direct primary care benefits are considered to be beneficial, it is important for consultants to be transparent about their own involvement in such practices.
The episode also shed light on the role of Pharmacy Benefit Managers (PBMs) in health plans and the potential deceptive practices associated with them. PBMs are middlemen who process transactions related to prescription drugs. However, there are concerns about the lack of value they provide and the inflated costs they impose on employers and patients. The financial incentives of PBMs often outweigh other considerations, such as the well-being of patients or the effectiveness of drug purchasing. This can lead to higher costs for employers and health plans.
The lack of transparency and misleading claims made by some PBMs further contribute to the issues of inauthenticity and deceptive practices in healthcare. The episode emphasized the need for reforms to address the profit-driven practices of PBMs. Congress is currently discussing reforms that aim to tackle these issues and reduce costs for employers and patients. However, there are concerns that these reforms may inadvertently lead to even higher costs.
To navigate the complexities of the healthcare industry and address issues of inauthenticity and deceptive practices, the episode recommended the Certified Health Value Advisor (CHVA) course. This course, created by David Contorno and Emma Fox, provides valuable knowledge and solutions for individuals seeking to enhance their understanding of the healthcare industry. The CHVA course covers various topics, including the history of pharmaceuticals and the role of PBMs in health plans. It is a comprehensive resource for those looking to navigate the complexities of the industry and make informed decisions.
In conclusion, the episode of "The Healthcare Hangover" podcast highlighted the issues of inauthenticity and deceptive practices in healthcare. It emphasized the importance of transparency, authenticity, and the need for reforms to address these issues. The Certified Health Value Advisor course was recommended as a valuable resource for individuals seeking to enhance their knowledge and expertise in the healthcare industry. By considering the impact on patients and making informed decisions, healthcare professionals can work towards a more authentic and transparent healthcare system.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
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In this thought-provoking podcast episode, hosts David Contorno and Emma Fox delve into the flaws of proposed healthcare reforms. They express doubt about the effectiveness of Health Savings Accounts (HSAs), cautioning that they can lead to higher out-of-pocket costs and discourage necessary care. The hosts also point out the lack of employer contributions to HSAs in many plans. Furthermore, they criticize expanding waiver authority under the Affordable Care Act (ACA) to the state level, arguing that it may hinder healthcare access. They also question the idea of allowing state healthcare exchanges to offer a wider range of plans, asserting that it is not the exchanges but the carriers that limit variety. The hosts argue against low-cost catastrophic care plans and the idea of placing more responsibility on patients to navigate the system. They stress the need for comprehensive and effective healthcare reform that prioritizes affordability, transparency, and patient choice. The podcast suggests potential solutions such as expanding telemedicine reforms, granting nurse practitioners an expanded scope of practice, and recognizing medical licenses across states. However, they express reservations about reversing restrictions on physician-owned healthcare facilities. The podcast underscores the importance of addressing payment processes, improving access to care, and ensuring that healthcare facilities maintain a clinical focus.
Episode Outline:
(00:00:02) Repackaging HSA Plans
(00:04:43) Issues with HSAs and Proposed Healthcare Reforms
(00:09:41) Flaws in Proposed Healthcare Reforms
(00:14:31) Improving Healthcare Choices
(00:19:38) Misconceptions about Healthcare Costs
Quotes:
(00:02:57) I want people to know in no uncertain terms that I think HSA compatible health plans are the most damaging strategy that my industry has ever put upon the unsuspecting American public.
(00:05:48) But the problem is those tools are not available to consumers.
(00:13:47) The American healthcare system will remain broken until patients see prices before they receive care, not weeks after when their insurance company or the government decides what they will pay.
(00:14:47) We disagree on choices for all. We offer reforms that expand consumer choices while improving the incentives embedded in our healthcare system.
(00:23:03) We need to get away from what's currently available and start building something that's alternative.
Social Post:
🎧 Attention all healthcare enthusiasts! 🩺📢
Have you ever wondered about the hidden truths behind HSAs and the spiraling costs of healthcare? 💸💊
In a thought-provoking episode of The Healthcare Hangover podcast, David Contorno and Emma Fox dive deep into the data, revealing shocking insights about the current state of healthcare. From people avoiding care due to financial constraints to the lack of resources for consumers, this episode uncovers it all! 😱
But that's not all! They also discuss the need for tax deductibility on medical payments and the importance of widening the available supply of healthcare. 🏥💡
And if you're curious about the impact of Medicaid and the Affordable Care Act, they've got you covered too! 🤝
So, if you're ready to challenge your perspective on healthcare and gain valuable insights, tune in to The Healthcare Hangover podcast now! 🎙️🔊
Don't miss out on this eye-opening episode! Trust us, you won't regret it! 🙌✨
#HealthcareHangover #Podcast #HealthcareInsights #EyeOpeningDiscussion #TuneInNow
🎧 Are you tired of being unsatisfied with your healthcare choices? 💔 Look no further! The Healthcare Hangover podcast with David Contorno and Emma Fox has got you covered! 🏥💪
In their latest episode, they discuss how to expand consumer choices and improve incentives in our healthcare system. 💡💊 They dive deep into the payment side of the equation, addressing the need for changes in how doctors, hospitals, and drug companies get paid. 🏥💰
But that's not all! They also explore exciting reforms like expanding telemedicine, recognizing medical licenses across states, and reversing restrictions that prevent new physician-owned healthcare facilities. 🌐🩺
And guess what? They even touch on the importance of allowing payments to direct primary care providers to count as qualified medical expenses. 🏥💳
If you're looking for better access to information, quality data, and cost transparency, this episode is a must-listen! 📚💡
Don't miss out on this eye-opening discussion! Tune in to The Healthcare Hangover podcast now! 🎧🔥 #HealthcareChoices #IncentiveImprovement #HealthcareReforms
🎧 Attention all healthcare enthusiasts! 🩺🎙️
Have you ever wondered why larger employers don't necessarily pay less for healthcare? 🤔 In the latest episode of The Healthcare Hangover podcast, David Contorno and Emma Fox dive into the fascinating world of healthcare costs and debunk some common misconceptions. 💡
They discuss how even though Joe the plumber and Lowe's both have Aetna plans, the cost of a procedure remains the same, regardless of the number of employees. 🏢💰 They also explore proposed reforms, the expansion of direct primary care, and the potential impact of allowing "copper plans" on state exchanges. 📈
But that's not all! They touch on the importance of understanding the intent behind regulations, the effectiveness of telemedicine, and the need for alternative solutions in the healthcare industry. 🌐📲
If you're curious to learn more and join the discussion, tune in to The Healthcare Hangover podcast now! 🎧 Don't forget to subscribe, leave a review, and share your thoughts with us. Let's tackle the healthcare hangover together! 🙌💊
#HealthcareHangover #Podcast #HealthcareCosts #DirectPrimaryCare #Telemedicine #HealthcareReforms #AlternativeSolutions #JoinTheDiscussion
Blog Post:
Introduction:
Welcome back to "The Healthcare Hangover" podcast, where we delve into the challenges and headaches of the healthcare system. In this episode, hosts David Contorno and Emma Fox critically analyze proposed healthcare reforms and their potential flaws. Join us as we explore the effectiveness of Health Savings Accounts (HSAs), the impact of low-cost catastrophic care plans, and the importance of addressing payment processes and improving access to care.
The Pitfalls of Health Savings Accounts (HSAs):
Let's start by addressing the skepticism surrounding the effectiveness of HSAs. While these accounts were designed to give employees "skin in the game," the lack of necessary tools for consumers to make informed decisions about pricing and quality has led to unintended consequences. Data shows that people in HSAs are splitting prescription drugs and skipping prescriptions to save money, which can have detrimental effects on their health.
Furthermore, the hosts highlight the problem of individuals avoiding necessary care due to high out-of-pocket costs in HSA-compatible plans. Many employers no longer contribute to employees' HSAs, exacerbating the financial burden on individuals. It's clear that HSAs, in their current form, can lead to higher out-of-pocket costs and deter individuals from seeking the necessary care they need.
Exploring Alternative Solutions:
To address the shortcomings of HSAs, the hosts propose expanding telemedicine reforms, allowing nurse practitioners to have an expanded scope of practice, and recognizing medical licenses across states. These solutions aim to improve access to care and empower individuals to make informed healthcare decisions. Additionally, reversing restrictions on physician-owned healthcare facilities and counting payments to direct primary care providers as qualified medical expenses could also enhance the healthcare landscape.
The Need for Comprehensive Reforms:
While some elements of the proposed reforms make sense, the hosts argue that they may not fit together effectively and could simply be repackaging existing ideas. They emphasize the importance of comprehensive reforms that address payment processes, improve access to care, and ensure that healthcare facilities have a clinical focus. Merely expanding insurance choices without considering healthcare choices may not lead to the desired outcomes.
Shifting the Focus to Payment Processes:
The hosts advocate for changing the payment side of the equation, rather than solely focusing on insurance. By empowering individuals with information on pricing and quality before receiving care, they can take control over their healthcare from third-party payers. This shift in focus can lead to more transparency and enable patients to make cost-effective decisions that suit their needs.
Expanding Access and Incentives:
To improve the healthcare system, the hosts propose expanding COVID-era telemedicine reforms, allowing for more providers and facilities to be accessible. They also suggest expanding the scope of practice for nurse practitioners and recognizing medical licenses across states to address the physician shortage. Additionally, they support the reciprocity of medical licenses for foreign-trained physicians, which can contribute to alleviating the shortage.
The Importance of Market-Oriented Reforms:
The hosts mention a policy plan from the Hoover Institution that aims to deliver lower cost, better quality, and more accessible healthcare for Americans. This plan proposes market-oriented reforms to empower individuals and protect vulnerable populations. One of the proposed reforms is the creation of Individual Health Accounts (IHAs), similar to HSAs. However, the hosts remain skeptical about the effectiveness of these accounts, given the flaws associated with HSAs.
Conclusion:
As we navigate the complexities of healthcare reforms, it's crucial to critically analyze proposed solutions and their potential impact. While HSAs have their flaws, alternative approaches such as expanding telemedicine, recognizing medical licenses across states, and empowering individuals with information can pave the way for a more accessible and patient-centric healthcare system. Let's strive for comprehensive reforms that address payment processes, improve access to care, and prioritize the needs of patients. Remember, your voice and feedback are essential in shaping the future of healthcare.
We invite you to share your thoughts, comment, and provide feedback on this podcast episode. Together, let's work towards a healthcare system that delivers better outcomes for all.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
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The podcast episode "The Dangers in Healthcare" explores the alarming trend of violence within the healthcare system, citing a specific incident in Portland where a security guard was shot and killed. The hosts discuss how hospital administrators often encourage staff to placate aggressive visitors and patients to avoid negative reviews, impacting federal reimbursement rates. They also delve into the connection between gun violence and the lack of affordable healthcare, suggesting that financial implications contribute to people's fear and defensiveness. Another episode discusses the frustration and anger that arise from denied healthcare claims and the lack of understanding in the current healthcare environment. The hosts shed light on the role of insurance carriers in denying claims and the financial incentives behind it. They also highlight issues with medical management in insurance plans and the prioritization of profits over patient care. Additionally, the podcast touches on the frustration individuals face with insurance coverage and healthcare expenses, and the increase in lawsuits related to these issues. Lastly, the hosts discuss the evolving landscape of healthcare referrals and the need for collaboration between different stakeholders.
Episode Outline:
(00:00:02) Violence in Healthcare
(00:04:32) The Impact of Denied Claims
(00:08:50) Issues with Medical Management in Insurance Plans
(00:13:08) Insurance Coverage and Healthcare Expenses
(00:17:18) Change in Healthcare Referrals
Quotes:
(00:03:43) There's a lot of gun violence in the US. It doesn't really matter what side of the fence you sit on. I don't think you could possibly deny that we have heightened gun violence in the US. And you and I have talked through how much of that is related to the lack of affordable and accessible health care.
(00:07:18) I think it was done by the insurance industry for the purpose of making it difficult for people to access high value care that is relatively inexpensive, therefore making it more likely that you're going to need low value care that's very expensive.
(00:12:00) Every stakeholder in this country has fallen in love with their captor, which is the insurance company.
(00:15:23) I do think that there are more people that are waking up to hold on a second, this is the big bad monster under the bed. I still don't think it's enough, though.
(00:17:57) But it really is great to really build a health plan with a doctor involved at every step along the way.
Social Post:
🎧 Introducing "The Healthcare Hangover" podcast! 🏥🍻
Are you tired of the headaches caused by our healthcare system? Well, we've got the cure for you! Join hosts David Contorno and Emma Fox as they dive into the shocking realities of the healthcare industry that will leave you feeling a little hungover. 🤯
In their latest episode, they discuss a startling statistic: healthcare workers have more non-fatal injuries than law enforcement! 😱 But what's causing this violence? Tune in to find out as they explore a recent incident at a hospital in Portland, Oregon, where a man opened fire due to concerns about his newborn baby. 😮
But that's not all! They also uncover a disturbing trend where shootings occur around the birth of a child. 🤔 Could the lack of affordable and accessible healthcare be contributing to the heightened gun violence in the US? 🇺🇸
Join David and Emma as they delve into this thought-provoking topic and discuss the impact of patient reviews on hospital administrators' decisions. 📋 Is patient satisfaction prioritized over patient well-being? 🤔
Don't miss out on this eye-opening episode of "The Healthcare Hangover" podcast! 🎙️ Click the link below to listen and discover why healthcare is one of the nation's most violent fields. 🩺💥
#HealthcareHangover #Podcast #HealthcareViolence #PatientSafety #ThoughtProvokingDiscussion
🎧 Are you tired of the healthcare system leaving you with a hangover? 🤕💊
Introducing "The Healthcare Hangover" podcast by David Contorno and Emma Fox! 🎙️
In this episode, they dive into the issues of bad care, bankruptcy, and the lack of understanding in our healthcare system. 😱💔
But it doesn't stop there! They also explore the mental health crisis and the impact of insurance denials on patients. 🧠💔
With thought-provoking insights and eye-opening data, this podcast will make you question everything you thought you knew about healthcare. 🤔💡
Don't miss out on this enlightening conversation! Tune in to "The Healthcare Hangover" podcast now! 🎧🔥
#HealthcareHangover #Podcast #HealthcareSystem #MentalHealth #InsuranceDenials #ThoughtProvoking #EyeOpening #TuneInNow
🎧 Are you tired of the nonsensical healthcare system? Look no further! 🏥
Introducing "The Healthcare Hangover" podcast, hosted by David Contorno and Emma Fox. In their latest episode, they dive deep into the flaws of the current healthcare model and how it's affecting your wallet. 💸
They discuss the unfair financial burden placed on individuals and the misleading promises made by insurance companies. 🤔
But it's not all doom and gloom! They also shed light on the growing number of doctors and nurses who are joining their cause, fighting for a better system. 👩⚕️👨⚕️
And if you think lawsuits against big corporations won't make a difference, think again! They explore a major lawsuit worth $3 billion, proving that change is possible. 💪
So, if you're ready to uncover the truth behind the healthcare industry and join the movement for a fairer system, tune in to "The Healthcare Hangover" podcast now! 🎙️
#HealthcareHangover #Podcast #HealthcareReform #FairSystem #JoinTheMovement
Blog Post:
Introduction:
Welcome back to "The Healthcare Hangover" podcast, where we dive deep into the challenges and issues plaguing the healthcare system. In this episode, hosts David Contorno and Emma Fox shed light on the alarming trend of violence in healthcare settings, emphasizing the need for affordable and accessible healthcare in the US. Join us as we explore the causes and consequences of this crisis, backed by practical advice and data-driven insights.
The Financial Implications of Healthcare:
One of the key factors contributing to the escalating violence in healthcare is the financial burden placed on individuals. It's disheartening to hear stories of hardworking individuals forced to file for bankruptcy despite having health insurance. The hosts express frustration with the current healthcare system and the lack of understanding among individuals. The combination of dealing with serious illnesses and navigating a complex healthcare system creates a highly charged situation that can lead to fear and defensiveness.
The Mental Health Aspect:
In addition to the financial strain, the lack of affordable access to mental health resources exacerbates the crisis. The hosts question what could have happened if individuals had access to primary care or counseling throughout their lives, emphasizing the need for data on this topic. The current system's low reimbursement rates for primary care providers and mental health professionals lead to a reliance on patient volume and selling out to large health systems. This, in turn, hampers the availability of high-value, relatively inexpensive care, potentially contributing to the mental health crisis.
The Role of Insurance Carriers:
The hosts criticize insurance carriers for prioritizing their own profits over patient care. They highlight a lawsuit against Cigna for allegedly illegally denying claims, leaving patients with unexpected bills. The confusion surrounding claim denials and the fee-for-service system's flaws have led to unnecessary billing of services, causing harm. The hosts argue that carriers may benefit when individuals seek more expensive and acute care due to difficulty accessing certain categories of care. This highlights the need for oversight and collaboration between different stakeholders in the industry.
The Impact of Violence on Healthcare Workers:
The podcast discusses the violence healthcare workers face, citing an incident in Portland, Oregon, where a security guard was shot and killed. Healthcare workers have the most non-fatal injuries of any profession in the US, according to an article from the Associated Press. The lack of resources and support for dealing with violent incidents in healthcare settings is a pressing concern. Moreover, the hosts mention that some hospital administrators encourage staff to placate aggressive visitors and patients to avoid bad reviews, which can impact federal reimbursement rates.
The Connection Between Gun Violence and Accessible Healthcare:
The hosts delve into the connection between gun violence and the lack of affordable and accessible healthcare in the US. They mention a movie where a character takes a hospital hostage to get treatment for his son, highlighting the financial implications of healthcare. It's clear that the fear and desperation caused by limited access to healthcare can lead to extreme measures. This emphasizes the urgent need for comprehensive healthcare reform.
Conclusion:
As we conclude this episode, it's evident that violence in healthcare settings is a symptom of a broken system. The lack of affordable and accessible healthcare, coupled with the financial implications faced by individuals, creates a highly charged environment. It's crucial for insurance carriers, healthcare providers, policymakers, and individuals to collaborate and work towards a solution. By addressing the root causes of this crisis and prioritizing patient care over profits, we can build a healthcare system that truly serves the needs of all individuals.
Thank you for tuning in to "The Healthcare Hangover" podcast. Don't forget to subscribe and leave a review. Remember, there's always a hangover with healthcare, but together, we can work towards a healthier future.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
-
In this podcast episode, hosts David Contorno and Emma Fox expose the frustrations and unethical practices of UnitedHealthcare, one of the largest healthcare insurance providers in the US. They share personal experiences and highlight UnitedHealthcare's dominance in the market, prioritizing their own interests over those of employers and employees. The hosts discuss the rigged profit strategy of UnitedHealthcare and its manipulation of revenue and costs. They also emphasize the need for transparency, accountability, and reform in the insurance industry. Overall, this podcast sheds light on the challenges faced by individuals and businesses dealing with UnitedHealthcare and calls for action to disrupt the profit-driven healthcare system.
Episode Outline:
(00:00:02) UnitedHealthcare's Impact on the Healthcare System
(00:04:06) UnitedHealthcare's Profits Soar
(00:09:05) UnitedHealthcare's Profit Strategy
(00:13:35) Manipulation of Healthcare Costs
(00:17:54) Profit Motivation in UnitedHealthcare
Quotes:
(00:02:54) When I started to talk about these alternative plans, the carriers, and not just United, but certainly United, rightfully understood that if this picks up steam, that it's not good for their interests.
(00:04:57) I don't believe that brokers are inherently unethical people. I do believe that the landscape we've been given to conduct our business is unethical.
(00:10:54) They also figured out a way to make money from every single tax paying American because the second place that their profit came from was the Medicare side. The government side of the house, which is fully funded by taxpayers.
(00:15:07) You can't convince me at this point that these people are not criminals, that they're not just thieves.
(00:18:12) The medical loss ratio provision, which is an incentive for costs to go up to fully insured carriers, does not apply on the Medicare side. On the Medicare side, the lower the costs are, the more money United makes. On the commercial side, the higher the costs are, the more money United makes.
Social Post:
🎧 Are you tired of the headaches in the healthcare system? Introducing "The Healthcare Hangover" podcast with hosts David Contorno and Emma Fox! 🏥💊
In their latest episode, they dive into the controversial topic of UnitedHealthcare and its impact on the industry. David shares his personal history with the company, from being in bed with them to facing threats when advocating for clients' best interests. 😱
If you've never heard of "The Healthcare Hangover," this is the perfect episode to start with! Get ready for some fiery discussions and eye-opening insights. 🔥👀
Don't miss out on this must-listen podcast! Tune in now and join the conversation. 🎙️🔊 #HealthcareHangover #UnitedHealthcare #Podcast
🎧 Are you tired of the healthcare system leaving you with a hangover? Introducing "The Healthcare Hangover" podcast with David Contorno and Emma Fox! 💊💼
In their latest episode, they dive into the unethical practices of insurance carriers and how brokers are getting the short end of the stick. 😱
Discover how carriers like Blue Shield are cutting broker's paychecks, leaving them to work for pennies on the premium they bring in. 😤
But that's not all! They also discuss UnitedHealthcare's jaw-dropping profits and how their revenue and profit have skyrocketed. 📈
If you've never heard of "The Healthcare Hangover" podcast, now is the time to tune in! Get ready for eye-opening insights and thought-provoking discussions. 🧠💡
Don't miss out on this must-listen episode! Click the link below to listen now. 👇🔊
#HealthcareHangover #Podcast #InsuranceCarriers #UnethicalPractices #EyeOpeningInsights #MustListen
🎧 Are you tired of being fooled by the healthcare industry? Well, we've got the podcast for you! Introducing "The Healthcare Hangover" with David Contorno and Emma Fox. In their latest episode, they uncover the shocking truth about how large carriers and PBMs are ripping us off. 💰
Did you know that even with an 80% discount on generics, pharmacies are still overcharging us by FIVE times? 😱 These so-called "spread pricing" tactics are just the tip of the iceberg when it comes to the criminal activities happening in the healthcare industry.
But it doesn't stop there! The hosts also reveal how carriers reward fraudulent claims and make money by clawing it back from the very pharmacies dispensing the drugs. It's practically theft! 😡
If you've ever wondered why your premiums keep going up, despite carriers making billions in profit, this episode will blow your mind. 🤯 David and Emma expose the lies and manipulation that keep us in the dark.
Don't be fooled any longer! Join us on "The Healthcare Hangover" and discover the truth behind the healthcare industry's dirty secrets. Tune in now and let's fight back against these thieves! 💪🔥
Listen to the full episode here: [insert podcast link] #HealthcareHangover #UncoverTheTruth #FightBack
Introduction:
Welcome to "The Healthcare Hangover," where we delve into the headaches and challenges of the healthcare system. In this episode, hosts David Contorno and Emma Fox shed light on the disturbing practices of UnitedHealthcare (UHC), one of the largest healthcare insurance providers in the US. Join us as we uncover the truth behind UHC's dominance, resistance to change, and their prioritization of profit over the wellbeing of employers and employees.
Understanding the Profit-Driven Healthcare System:
The podcast dissects how insurance carriers manage their medical loss ratio and aim for profitability. One of the key players in this equation is Optum, a company that helps carriers maximize profits by managing their loss ratio. However, the lack of understanding among employers and self-funded employers about the pricing mechanisms in the pharmacy benefit management (PBM) space is a cause for concern.
The Dark Side of Spread Pricing:
The hosts shed light on the concept of spread pricing, where pharmacies receive significantly less than the discounted price paid by employers for prescription drugs. Large carriers, many of whom own PBMs, allegedly use spread pricing to manipulate loss ratios and adjust prescription prices accordingly. These practices are deemed unethical and akin to theft, leaving employers and employees at a disadvantage.
Unveiling the Profit Game:
David and Emma share their personal experiences working for carriers and brokers, where they were trained to sell plans and increase business for the carriers. They criticize the explanations given to clients about premium increases, attributing them to trends and pooling. They argue that carriers' profits should result in premium decreases, rather than burdening individuals and businesses.
The Call for Transparency and Reform:
The hosts express their frustration with employers and brokers for not being more outraged by these practices. They call for transparency, accountability, and reform in the insurance industry. It is time to question what can be done to address these issues and fight against the profit-driven healthcare system. They invite listeners to join their group of disruptors and innovators called "antibuca" and vow to uncover more details about UnitedHealthcare and other healthcare companies.
Data-Driven Insights:
UnitedHealthcare, the country's largest insurer by revenue, reported a significant increase in profit driven by its Optum division and the Medicare side of the business. The profit increase from Optum offset a smaller increase in profit on the insurance side. This unique business model allows UnitedHealthcare to make money from every tax-paying American through its profit from the Medicare side, which is fully funded by taxpayers. The sheer volume of dollars involved is now becoming unfathomable.
Conclusion:
The podcast episode "The Healthcare Hangover" provides valuable insights into the unethical practices and profit-driven healthcare system perpetuated by UnitedHealthcare. The hosts, David Contorno and Emma Fox, shed light on the manipulation of loss ratios, spread pricing, and the lack of transparency in the industry. It is time for individuals, employers, and employees to unite and demand transparency, accountability, and reform in the insurance industry. Join the movement of disruptors and innovators fighting for a fair and patient-centric healthcare system. Together, we can challenge the status quo and create a better future for all.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
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In a lawsuit that has shed light on the risks associated with self-funded healthcare plans, Kraft Heinz has accused Aetna and Willis Towers Watson of failing to act in a fiduciary capacity and protect them from overcharging for inpatient open heart surgery. Fraud, Waste, and Abuse (FWA) is an ever-present issue in the healthcare industry, and Slingshot Bills can help detect it. As employers look for attractive options to insurance for their employees, it is essential that they are aware of their rights and make sure their insurance companies are acting in their best interests. Not only does this ensure that employees are getting the most out of their healthcare plans, but it also safeguards employers from overspending and ultimately getting taken advantage of.
Episode Outline:
(00:00:02) Kraft Heinz Lawsuit
(00:03:58) Carrier Fraud Incentives
(00:08:13) Kraft Heinz Lawsuit
(00:12:36) Fraud, Waste, and Abuse
(00:16:47) Self-Funded Plans
Quotes:
(00:03:41) If they're looking to make an example, if they're looking to be the face of other employers, mostly smaller employers, who are struggling even more with this than they are, who don't have the sophistication to understand they're getting screwed, nor the resources to do anything about it, even if they did, then we have a shot.
(00:07:32) But think about this dynamic even more. If they allow fraud, waste and abuse, that means the hospital is getting more money, which is keeping the hospitals happy.
(00:11:45) If you are acting as one, then you are one. And if you agree to be held to the same standards of care, then you have to be held to the same standards of punishment when it doesn't occur.
(00:16:31) We don't give our plan partners enough credibility, but yeah, we've partnered with some fantastic people and organizations in the industry.
(00:17:26) Don't, uh, don't get yourself up in a lawsuit, but sue when your employees are being taken advantage of and that's what they're doing.
Social Post:
Are you tired of the same old healthcare conversations? Tune in to the Healthcare Hangover podcast with David Contorno and Emma Fox to hear a fresh take on the healthcare industry. From discussing the multi-layer problems of lawsuits against Aetna to the incentives for fraud, waste, and abuse, you won't want to miss this episode! #HealthcareHangover #Aetna #Fraud #Waste #Abuse
Are you tired of being taken advantage of by healthcare providers? Tune into the latest episode of The Healthcare Hangover to learn how employers and brokers can help protect you from medical billing errors. 97% of hospital bills have errors, and we'll discuss the responsibility of Willis Towers Watson and how they could have prevented Kraft Hines from meeting their fiduciary responsibility. Don't miss out on this important conversation! #HealthcareHangover #MedicalBillingErrors #FiduciaryResponsibility
Are you curious about how to save money on healthcare costs? Tune into the latest episode of The Healthcare Hangover podcast to learn how Kraft Heinz is trying to get paid and how you can audit your own healthcare plan for fraud, waste, and abuse. David Contorno and Emma Fox discuss how to lower the severity and frequency of claims and how to save double digits on healthcare costs. Don't miss out on this valuable information! #TheHealthcareHangover #HealthcareCosts #FraudWasteAndAbuse
Blog Post:
Kraft Heinz is currently in the midst of a lawsuit filed against their insurance company, Aetna, for not acting in a fiduciary capacity. This is a complex situation that has been in the news recently, and it is important to understand the implications of the lawsuit for employers and healthcare consumers.
David Contorno and Emma Fox plan to write to Kraft Heinz and convince them to let David give expert testimony before the trial begins. They have done an analysis of their clients' fraud, waste and abuse percentages, and they have found that on average, 10% of total spend in a plan is fraud, waste and abuse, and their average fraud, waste and abuse was 0.8% of spend. This is an order of magnitude of about 92% better or less than the average plan. The average error in billing results in a $2,000 overpayment per error, while their plan was $180 per error.
Aetna is responsible for acting as a fiduciary for their clients, even though the client is self-funded. Carriers look for improper claims and identify fraudulent, wasteful, and inaccurate claims. When carriers find an overpayment or a claim that shouldn't have been paid, they pay themselves a finder's fee and only give the employer a portion of what they recover. Hospitals have more leverage over carriers than brokers or employers do, and certainly more than patients do. Carriers don't want to hassle the hospitals and don't want to have to ask for money back, so they have audit restrictions. Most provider contracts at the hospital level have audit prohibitions. Pediatricians have to put more information on a claim form for a Strep test than a hospital has to put for a weeklong.
Kraft Heinz is claiming that Aetna engaged in fraud or concealment to prevent and interfere with Kraft Heinz's efforts to investigate and understand Aetna's conduct. They were looking for a big claims dump to see what was being billed, what was being allowed, and if it was in line with the terms that they're supposed to be. Every decision that's made in a company's 401k must be for the benefit of the participants and must not allow the employer or other participants to abuse the plan. Kraft Heinz is looking to make an example and be the face of other employers, mostly smaller employers, who are struggling even more with this than they are.
Willis Towers Watson is mentioned in the complaint, but they are neither the defendant nor the plaintiff. Willis Towers Watson did not have a fiduciary responsibility but could have prevented Kraft Hines from meeting their fiduciary responsibility. The Administrative Services Agreement between Kraft and Aetna stated that Aetna would discharge their obligations with the level of reasonable care which a similarly situated service provider or plan administrator under ERISA as applicable, would exercise under similar circumstances in connection with fiduciary powers and duties. Aetna agreed to observe the standard of care and diligence required of a fiduciary under ERISA section 404 AIB.
The outcome of the lawsuit will depend on who is driving it at Kraft Heinz and how much they know about what's going on, as well as their motivation in doing it. Kraft cannot have a Kraft employee on the jury due to a conflict of interest. Employers should be running checks and balances to ensure their employees are not taken advantage of. David and Emma suggest using Slingshot Bills to analyze self-funded plans.
Empowered has been tackling healthcare for five years and has found a sweet spot in what works and what doesn't. 97% of hospital bills have errors, which are always in favor of the provider. Healthcare can be complicated and there is always a hangover. Employers should take the time to thoroughly understand their healthcare plan and make sure that they are not taking advantage of their employees. This episode of the podcast provided helpful insight into the complexities of healthcare and the importance of staying informed.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
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Healthcare transparency is essential for patients to make informed decisions, yet price disparities in the industry remain a major issue. In this podcast episode, we explore how financial incentives and contracts between hospitals and insurance companies can misalign the incentives of brokers, employers, doctors, and patients. We discuss the importance of understanding the influence of these incentives and the need for accountability in developing an equitable healthcare system. Through transparent communication and a focus on an equitable system, we can help ensure that patients receive the care they need and deserve.
Episode Outline:
(00:00:02) Healthcare Transparency
(00:04:42) Price Disparity in Healthcare
(00:09:37) Health Insurance Incentives
(00:14:21) Doctor Compensation Metrics
(00:19:05) Incentive Misalignment
Quotes:
(00:03:21) The thing that boggles my mind about healthcare is that in most of healthcare, neither the consumer, which in healthcare is the patient, nor the provider of the goods or services, which in most cases is the doctor, neither one of those parties know what the price is going to be until long after the services are already rendered.
(00:09:10) You might only be paying a copay or you might only be paying your $200 and $5500 out of pocket that's falling off of your coinsurance. And they have no idea until they get the EOB what the build charges were and what the allowed charge was. So I think they're so disconnected from how much health care actually costs.
(00:12:23) But I'm going to put it really bluntly and I think I got this from Dave Chase, this little metaphor here. But imagine for a minute if fire departments only got paid when there was a fire, they would want as many fires to occur as possible. And the bigger the fire, the more money they get.
(00:17:22) And not only that, I think to deny that you're influenced by the financial incentives is to deny you're human. I mean, we've operated on financial incentives long before currency even existed.
(00:21:08) I challenge you, if you are not already, if you're a consultant, even if you're a patient, if you're an employer, figure out what you can do. What one thing can you do differently to turn that incentive around?
Social Post:
Are you tired of feeling like you have a healthcare hangover? We've all been there. That's why we created the Healthcare Hangover podcast. We dive into the headaches we've been encountering in the healthcare system that are leaving us feeling a little hungover.
In our latest episode, we talk about the importance of healthcare transparency. We heard a story about a patient who was charged $475 for an X-ray at a hospital, when they could have gotten the same X-ray at a chiropractor's office for less than $75. We also spoke with a hernia surgeon who was able to do the same procedure for $7,200 instead of the $20,000 quoted by a local general hospital.
Tune in to the Healthcare Hangover podcast to learn more about the importance of healthcare transparency and how it can save you money.
Are you curious about how doctors are paid? Tune in to the latest episode of The Healthcare Hangover podcast to find out! From patient volume to RVUs, David Contorno and Emma Fox break down the complex system of doctor pay and how it influences health care decisions. Plus, they discuss how traditional brokers are put in an unfair position and how financial incentives can be used to deliver better outcomes. Don't miss out on this eye-opening episode! #TheHealthcareHangover #DoctorPay #Healthcare
Are you tired of the broken healthcare system? Tune in to the latest episode of The Healthcare Hangover to learn how the system was designed to benefit certain people and how you can help turn the incentives around! From the perverse incentives of commission-based compensation to the Cigna CEO's 20 million dollar salary, David Contorno and Emma Fox will take you through the details of the current system and how you can help build an alternative. Don't miss out! #TheHealthcareHangover #BrokenHealthcareSystem #Incentives
Blog Post:
The healthcare system is broken, and it's time to start fixing it. In this episode of Healthcare Hangover, hosts David Contorno and Emma Fox explore the lack of price transparency in healthcare, and how providers are taking advantage of patients by charging them more than necessary.
Insurance companies make money by renewing plans every year, regardless of how much they pay out, and people often think that more expensive care results in better outcomes, which is not true. Unfortunately, people often cannot afford their out-of-pocket costs, leading to debt or even lawsuits. Insurance companies do not provide any positive benefits to doctors, employers, or patients, and people have been led to believe that they need health insurance to get quality health care, which is false.
The hosts also discuss how fire departments operate on a fixed budget, while health care systems make more money the sicker people are. Health insurance companies have a massive workforce that they pay very little to, and they have bonus programs for brokers that are available on their websites. Hospitals are not changing their practices due to lack of consumer demand, and MRF (Machine Readable File) is not human readable, requiring a middleman to translate the data. Additionally, hospitals often put programming on their website to prevent spiders from finding the data.
David Contorno and Emma Fox also discuss how cash prices are almost always the lowest prices on hospital spreadsheets, and the disparity between prices for the same procedure from different carriers is outrageous. Commercial carriers pay the highest reimbursement rate to hospitals, and patients are disconnected from the cost of healthcare due to copays and coinsurance. To illustrate this, David Contorno visited a chiropractor for an X-ray of his shoulder and was asked if he was okay with the price before the X-ray was taken. The X-ray cost $75 at the chiropractor's office, but the same X-ray would have cost $475 at Atrium, the hospital system next door. Michael Reinhorn, a hernia surgeon in the Boston area, charges $7,200 for hernia surgery, while a local general hospital charges $20,000.
The hosts also compare the healthcare system to the veterinary system, noting that veterinarians often give customers options and prices up front before giving any treatment. Doctors, on the other hand, are typically paid based on two metrics: patient volume and RVU (Revenue Value Unit). Patient volume is the number of patients seen in a day, with some doctors having minimum patient volume requirements of up to 30 patients per day. RVU is a measurement of how much revenue a doctor is helping generate for the health system, often in areas outside of their office. Doctors are incentivized to prescribe opioids to deal with pain, and to send patients to the most expensive care, regardless of whether it is the appropriate treatment. The most likely outcome of back surgery in the US is a second back surgery.
Additionally, traditional brokers are paid more when they retain their book of business and cross-sell additional products that benefit the carrier they represent. Healthcare and health insurance employees often think they are doing good, even though the results they keep delivering are bad. The company bills their clients and has a performance bonus for achieving the client's goals of paying less for healthcare.
Ultimately, the hosts conclude that people should focus on changing one thing at a time to build an alternative system that is more affordable. The Cigna CEO made 20 million dollars last year, and the sicker people are, the more money they make. It's time to start demanding more transparency and accountability from health insurance companies, and for patients to take control of their own healthcare. We have the power to create a system of trust between providers and patients, and to make healthcare more affordable and accessible.
Episode Links:
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
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The US healthcare system is plagued by corruption, and Pharmacy Benefit Managers (PBMs) are taking advantage of it. Express Scripts, the largest PBM, is sending out letters to dozens of clinicians and provider practices warning them of fraud, waste, and abuse for off-label prescribing of FDA-approved drugs. PBMs are making more money than the insurers that own them, and they engage in spread pricing and clawbacks. To become a good consumer of healthcare, David Contorno and Emma Fox suggest price shopping pharmacies, exploring manufacturer assistance programs, using coupons, and international sourcing. Consumers should also be their own advocates and ask their doctor what other options are available.
Episode Outline:
(00:00:00) Express Scripts Fraud
(00:18:21) Prescription Drug Costs
(00:04:45) PBM Profits
(00:13:56) Pharmaceutical Pricing
(00:09:29) Negotiating Drug Prices
Quotes:
(00:07:57) It's a long game, right? It's expensive right now. I get that. But if we're able to cure obesity along with who knows how many other comorbidities, what does that look like ten years from now, right?
(00:21:31) Be your own advocate, because at the end of the day, you're the only one who pays clinically and financially for not being an advocate for yourself.
(00:03:17) But I wish we could find something where literally they were defrauding people. I think that's ultimately what they're doing.
(00:13:17) Every single other country negotiates drug pricing. They say you cannot bring that drug into this country unless you agree to this price. And not only does the US. Not do that, but there's a federal law that says we can't do that.
(00:15:59) The hard part is not having coverage for it, because if you have coverage, but a deductible you can't afford, you don't qualify for this program.
Social Post:
Are you tired of the healthcare system's corruption? Tune in to the Healthcare Hangover podcast with David Contorno and Emma Fox to learn about the shady practices of PBMs (Pharmacy Benefit Managers). Did you know that PBMs are making more money than the insurers that own them? Or that Express Scripts alone manages the pharmacy benefits for nearly a third of the US population? Don't miss this eye-opening episode and learn how to fight back against the healthcare system's corruption. #HealthcareHangover #PBMs #HealthcareSystem
Are you tired of the healthcare system telling you what you can and can't do? Then you need to listen to the latest episode of The Healthcare Hangover podcast! In this episode, David Contorno and Emma Fox discuss the frustrations of dealing with insurance companies and how to get around them. Did you know that you can get the same medication for up to 70% less by importing it from a different country? Tune in to find out more about how to get the most out of your healthcare experience! #TheHealthcareHangover #HealthcareSystem #InsuranceCompanies
Are you struggling to afford your medications? Did you know that there are ways to get name brand drugs for free or at a discounted rate? On the latest episode of The Healthcare Hangover, David Contorno and Emma Fox discuss how the Part D law and Prescription Assistance Programs can help you get the medications you need at a price you can afford. Tune in to learn more about how to get the best deal on your medications! #TheHealthcareHangover #PrescriptionAssistancePrograms #AffordableMedications
Blog Post:
The US healthcare system is in a state of disarray. Pharmacy Benefit Managers (PBMs) are taking advantage of this by sending out letters to dozens of clinicians and provider practices warning them of fraud, waste, and abuse for off-label prescribing of FDA-approved drugs. Express Scripts, the largest PBM, alone manages the pharmacy benefits for roughly 100 million people. It's no surprise that PBMs are making more money than the insurers that own them. They get an admin fee every time a transaction is processed, mark up the drugs, and do clawbacks. Optum, which is owned by UnitedHealthcare, accounts for the majority of their profit.
Doctors are outraged that a PBM would have any right to tell them how to make clinical decisions for their patients. Alex Lickerman supports GLP-1 for weight loss, and it is effective. However, GLP-1 is a lifelong medication, and there are some concerns about it, such as muscle mass loss. Education is missing from these medications. Express Scripts is accusing some providers of falsifying diagnosis of type two diabetes in order to get through the prior authorization process.
It's up to us to become good consumers of healthcare. David Contorno and Emma Fox suggest price shopping pharmacies, exploring manufacturer assistance programs, using coupons, and international sourcing. Consumers should also be their own advocates and ask their doctor what other options are available.
Membership with a PBM such as Drexi can be a great way to save money. Drexi does not do spread pricing or clawbacks, but requires a small monthly fee. When using the Drexi card, the system looks like the consumer has insurance, but the insurance is not paying for anything. Manufacturer assistance programs and coupons are also a great way to save money. It's important to price out pharmacies as prices can vary widely. Employers are making choices for their health plans that can affect the cost of prescription drugs.
The US healthcare system makes money when people are sick, unlike other countries. This is why the pharma industry charges high prices for drugs because they can and still make a profit. However, there are Prescription Assistance Programs (PAP) for name brand drugs for those who don't have coverage. Income limits for PAP vary by drug and number of people in the household. Good RX and Script Co offer discounts on drugs even if you have insurance.
Express Scripts is threatening doctors for trying to get cheaper drugs for patients. Pharmacists have had their clinical roles stripped away due to PBMs deciding what is covered and what is not. Pharmacists can help those without insurance get name brand drugs for free or at a discounted rate. Doctor tweeted a pediatric oncologist in Texas saying he was "sick and tired of these insurance companies telling me what I can prescribe and what I can't prescribe." Insurance companies don't tell doctors what they can and can't prescribe, they just tell them what they're willing to pay for.
Pre-certification and prior authorization are two processes that doctors and patients have to go through. Doctors are burned out because they're "sick and tired of insurance companies telling me what I can do and what I can't do." People can import medications from other countries, such as Canada, UK, New Zealand, or Australia, which are 40-70% less expensive than in the US.
At the end of the day, it's important to be an informed consumer. Ask your doctor what other options are available, look into manufacturer assistance programs and coupons, price out pharmacies, and explore international sourcing. It's also important to be your own advocate and fight against the corruption in the US healthcare system.
Episode Links
Connect with Emma Fox
WebsiteEmma’s WebsiteConnect with David Contorno
LinkedInWebsiteOther Materials
These materials help you promote your podcast. Quotes can be used for audio & video grams or quote cards. Blog and social posts will help your website and social media presence.
- Visa fler
