The Pulse By Vital Incite podcast

50:35

Join us for Part 2 of our insightful podcast series dedicated to improving outcomes for those affected by substance use disorders. In this episode, we'll explore effective early intervention strategies and the essential steps for building a robust support structure. Additionally, we’ll discuss how employers can ensure compliance with Mental Health Parity laws while reducing unnecessary medical expenses that contribute to wasteful spending. Panelists will discuss: Strategies for enhancing early treatment of substance use disorders to prevent progression to catastrophic care. Publicly available resources to help identify the most appropriate treatments and high-quality care options. Provisions in current carrier contracts that enable them to retain a percentage of costs as revenue, while limiting access to in-network providers. Understanding the Mental Health Parity laws and your obligations as a health plan provider. This episode includes guest speakers: Kirsten Suto Seckler , Chief Marketing & Communications Officer at Shatterproof Danielle Capilla, JD , SVP of Compliance and Operational Strategy for Alera Group's Employee Benefits division Lisa Kugler, Psy.D. , SVP for Shatterproof’s Treatment Atlas team…

The Pulse by Vital Incite

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The $81 Billion Toll of Substance Use Disorders on the Workplace: Employer Strategies for Cost Effective Care and Treatment 49:05

il y a 16 weeks49:05

49:05

Substance use disorders related to alcohol and drug addiction are having a heavy emotional and financial toll on the workplace. It’s estimated that addiction costs employers upwards of $81 billion per year and employers struggle with how to provide the correct care. Finding in-network providers is challenging and health plans are paying a significant amount in out of network fees and “Shared Savings” that the carrier then takes. Tune into this episode of The Pulse as we examine the health plan impacts of substance abuse, including uncovering why so many facilities are not in network, what the carriers’ role is in this issue and how employers can create better strategies. Panelists will discuss: The advantages and disadvantages of an addiction treatment center setting up in-network contracts. How the laws related to Mental Health Parity influence employers and health plan decisions. How claims for these services are handled when out of network and who may be winning in that negotiation. How employers can improve their strategy to supporting the needs of their plan members This episode includes guest speakers: Tim Clement , VP of Federal Government Affairs at Mental Health America. Chris Deacon, JD , Principal/Founder VerSan Consulting Damon Eisenbrey , Partner, Arnall Golden Gregory LLP Kirsten Suto Seckler , Chief Marketing & Communications Officer at Shatterproof…

The Pulse by Vital Incite

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The GLP-1 Tipping Point: How Skyrocketing Costs Exposed PBM Influence and How Employers Can Take Back Control 58:54

il y a 24 weeks58:54

58:54

GLP-1 medications have been a tipping point in exposing the role that PBM’s have over controlling prescription drug access and cost. Not all PBM’s are created equal and most drive what is easiest and most profitable for the PBM. It’s critical that employers play an active role in controlling their health plan strategy to support improved health outcomes and health plan investments. Tune into this episode of The Pulse as we uncover the role of the PBM in prescription drug access and costs and what employers need to do to redefine expectations and outcomes from PBMs. Panelists will discuss: How a drug is approved by the FDA and if that clinically is providing the most effective approach to leverage medications. PBM prior authorization strategies and what appropriate expectations should be Why and how PBMs and Manufacturers leverage rebates to force formulary restrictions The opportunity for plan savings related to generic medications that are not leveraged by PBMs What strategies related to GLP-1 appear to be most successful in driving improved health outcomes and an ROI on health plan investments This episode includes guest speakers: Ge Bai, PhD, CPA. Professor at Johns Hopkins Carey Business School and Professor of Health Management at Johns Hopkins Bloomberg School of Public Health Dr. Jonathan Bonnet, MD, MPH, CAQSM, FAAFP, FACLM, DipABOM, DipACLM. Associate Professor at Stanford University School of Medicine and Program Director of Medical Weight Loss at the Clinical Resource Hub Weight Management Center at the Palo Alto Veteran’s Affairs Jennifer Perlitch RPh., MBA. Assistant Vice President – Pharmacy at AECRx…

The Pulse by Vital Incite

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The Blue Zones Hype & Your Health Plan - Employer Strategies for Better Outcomes 1:01:21

il y a 33 weeks1:01:21

1:01:21

There’s been a lot of hype around the Blue Zones documentary on Netflix and how following these principles can help you live a full, active life until 100. But did you know these theories can also help you breathe life into your health plan by creating an employer community that is productive, healthy and sustainable? In this episode, we will explore how the Blue Zones theories translate into improved patient care and how an employer’s culture can support improved health outcomes. Tune in as our panelists discuss how the theories behind the Blue Zone can be used to support employer efforts to enhance employee health and contain healthcare costs. This episode includes guest speakers: Wayne Dysinger, MD, MPH Chief Medical Director, Healthly Gretchen Day, MPH VP of Health Innovation & Advanced Strategies, Alera Group Ben Leedle CEO Blue Zones…

The Pulse by Vital Incite

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The Benefits of Tight Contract Management 54:07

il y a 42 weeks54:07

54:07

It's time for Employers to ensure they safeguard their interests and shield themselves with robust contracting language. Carrier and vendor agreements are often crafted by their legal teams to safeguard the interests of the vendors, which may not always align with the needs of the employer. Far too often, employers have simply accepted these standard contracts, granting vendors the authority to dictate billing practices, define services, and even control data sharing. The moment has arrived for Employers—whether they're managing a Health Plan or acting as the payor—to take charge and reshape our delivery system, ensuring they receive the necessary support for their plans. Join our expert panelists as we explore the intricacies of carrier and vendor agreements, often skewed in favor of vendors, and the necessity for Employers to assert their needs. This episode includes guest speakers: Brenda Motheral, RPh, MBA, PhD CEO, Archimedes Marilyn Barlett, CPA, CGMA, CMA, CFA Senior Policy Fellow, National Academy for State Health Policy Stacy Barrow, JD Partner, Barrow Weatherhead Lent LLP…

The Pulse by Vital Incite

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Root Cause Approach to Managing Healthcare Spend 51:05

il y a 50 weeks51:05

51:05

At least 80% of healthcare spend is influenced by our habits, environment and approach to caring for ourselves. Employers invest over $51 billion each year in vendors to empower individuals in making informed choices and alleviating strain on the healthcare system. Unraveling the genuine needs of the population proves to be an intimidating task, and addressing those needs presents an even greater challenge. Join us as we spotlight three forward-thinking employers who have navigated this complex terrain from diverse perspectives. Discover how they have successfully managed to curtail healthcare costs while actively supporting their plan members in enhancing their overall well-being. This episode includes guest speakers: Lisa Allen VP, CHRO, Goodwill Industries of Central & Southern Indiana Roger McMichael Associate Superintendent, Carmel Clay Schools David Hines ED, Benefits, Metro Nashville Public Schools…

The Pulse by Vital Incite

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Leveraging GLP-1s to Improve Health Without Killing Your Budget 1:06:46

il y a 1 year1:06:46

1:06:46

The utilization of GLP-1s has skyrocketed since entering the market. Tune into this latest podcast of The Pulse to discover how you can effectively implement GLP-1 medications while improving the health of your population and lowering the financial impact. This episode includes guest speakers: Denise Fields PharmD, Population Health Pharmacist Robin Rankin, RPh AVP, Clinical Pharmacy, AEC-RX, An Alera Group Company Sean Hashmi, MD, FASN Obesity Medicine Provider…

The Pulse by Vital Incite

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Managing Catastrophic Care and Cost 47:59

il y a 2 years47:59

47:59

The threat of higher cost cases looms as new therapies are brought to market. Certainly, there are advances in healthcare that everyone wants to enjoy. Employers need to make sure their monies are not wasted so they can afford to support their people. What can and should employers do to protect their budgets? Did you know that many carriers pay for catastrophic care as a percentage of billed charges? Who is auditing to make sure those billed rates, or the services are appropriate? This episode includes guest speakers: Marilyn Bartlett Senior Policy Fellow, National Academy for State Health Policy Valerie Saurez Director of Medical Risk, Symetra Life Insurance Company Michael Thompson President & CEO, National Alliance of Healthcare Purchaser Coalitions…

The Pulse by Vital Incite

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Managing Specialty Medications: PBM or Health Plan or Place of Service 1:01:26

il y a 2 years1:01:26

1:01:26

One specialty medication can change the performance of a plan. Employers and Advisors are always trying to solve for if a medication should be limited to the PBM or the health plan and then if on the health plan we find significant differences between delivery of those medications. Unfortunately, the answers to solve this are not a one size fits all. Join us as we explore how to evaluate your solution and provide examples of some significant success stories. This episode includes guest speakers: Julie Kueppers, PhD, FNP, RN Vice President of Clinical Analytics and Services, Relph Benefit Advisors Brenda Motheral, BPharm, MBA, PhD CEO, Archimedes Candace Shaffer, M.S., CWPM Senior Director of Benefits, Purdue University…

The Pulse by Vital Incite

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Provider Quality 42:44

il y a 2 years42:44

42:44

Most people choose their providers based off a recommendation from friends or other providers. Every person wants to make sure they are utilizing a top provider, but the definition of quality varies by every oversite strategy. In this podcast we will explore the components to consider related to quality, and how access to that information should help support your health plan. We will debate different prospectives related to quality metrics, reporting structure and how employers can empower their covered lives. This episode includes guest speakers: Padmaja Patel, MD President Elect, American College of Lifestyle Medicin Nick Reber Chief Executive Officer, Garner Health John Ryan Chief Executive Officer, OrthoIndy Sandeep Wadhwa, MD, MBA Global Chief Medical Officer, 3M…

The Pulse by Vital Incite

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Creating Sustainable Change 58:59

il y a 2 years58:59

58:59

Research shows that only 1 in 5 people are successful in maintaining their resolutions, creating sustainable improved performance, or maintaining significant weight loss. Join us as a panel of experts explore why these attempts fail and how employers can support long-term success.

The Pulse by Vital Incite

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Employer Strategies to Help Reduce Obesity 54:24

il y a 2 years54:24