“It's the second largest line item that a company has, but they will stroke a check every month for a fully insured program without having data to support what those costs are for.” - Stephanie Koch

Stephanie Koch joined the show to share what it was like to work in benefits and HR in a fully funded company before moving to one that self-funds.

I invited Stephanie on to hear the employer perspective on the industry, but ended up getting so much more, as she’s truly on the cutting edge of healthcare benefits for her company Hendry Marine. We discussed what it’s like to deal with Reference-Based Pricing as an employer, why mobile clinics save lives and are crucial to self-funded plans, and why it’s so important to seek out nontraditional healthcare solutions in the current market.

No matter what aspect of our industry you work in, everything we do is for employers and employees, and there’s so much insight to gain from forward-thinking benefits managers like Stephanie.

Chapters:

00:00:00 Meet Stephanie Koch

00:01:36 Empowering Employers in Self-Funded Healthcare Systems
00:12:37 Challenges in Renewing Fully Funded Healthcare
00:32:44 Maximizing Healthcare Savings Through Reference Based Pricing
00:43:13 Evolving RBP Plans for Employee Benefits
00:51:56 Early Detection Incentives Through Preventive Wellness Exams
01:03:07 Strategic Healthcare Partnering for Self-Funding Success

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286

Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

Key Words:

#SelfFundedHealthcare #ReferenceBasedPricing #EmployeeBenefits #DataAnalysis #PreventiveExams #OnsiteClinics #CostSavings #ConsultingPartners #HealthcareImprovement #RBPStrategies #HealthcareCosts #TransparentSystem #selffunded #podcast

Self Funded Healthcare, Reference Based Pricing, Employee Benefits, Data Analysis, Preventive Exams, Onsite Clinics, Cost Savings, Consulting Partners, Healthcare Improvement, RBP Strategies, Healthcare Costs, Transparent System, self funded, podcast

“I realized that 95% of the scheduled surgeries, like shoulder/knee repairs, back fusions, even some pelvic floor surgeries, they're no more effective than doing nothing at all, on average.” - Heidi Ojha Heidi Ojha, founder of Aware Health and recently a part of our MSK roundtable, joined me this week in studio to talk about why there are so many unnecessary surgeries performed in this country, why these surgeries happen in the first place, and how she’s trying to change that. Heidi’s worked as a clinician before founding Aware and estimates that about 95% of scheduled surgeries led to no more positive outcomes than doing nothing at all. This is especially alarming given that MSK is the biggest chronic spend on most health plans. Heidi and I also expanded on the notion that behavioral health plays a huge part in why and how so many surgeries are performed. Outside of the cost to the plan, unnecessary surgeries are often risky for the patient and can lead to complications, and even other surgeries that add even more risk. Join us this week to find out how we can stop unnecessary surgeries from happening. Chapters: 00:00:00 Meet Heidi Ojha 00:09:14 Exploring Non-Invasive Healthcare Options 00:15:33 MSK Chronic Spend 00:18:14 Managing Surgery Claims for Cost Savings 00:27:11 Incentivize Care, Not Profit 00:35:08 Claims Data Impact on Diagnostic Accuracy 00:41:13 The Necessity Of Imaging 00:50:14 Patient-Centered Approach To Healthcare Key Links for Social: @SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02 Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286 Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/ Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/ Key Words: #MSKHealthcareCosts #ConservativeCare #BehavioralHealthExpenses #EmployerPlanSpend #FeeForServiceModel #DataAccessibility #DiagnosticAlgorithms #PatientEmpowerment #HealthcareSystemsOptimization #AvoidingSurgeries #ChronicHealthcareSpending #PatientCenteredCare #selffunded #podcast MSK Healthcare Costs, Conservative Care, Behavioral Health Expenses, Employer Plan Spend, Fee For Service Model, Data Accessibility, Diagnostic Algorithms, Patient Empowerment, Healthcare Systems Optimization, Avoiding Surgeries, Chronic Healthcare Spending, Patient Centered Care, self funded, podcast

“In what other industry are you just not covered up with business if you're cheaper and better? This is America, for God's sake." - Keith Smith

This is a special episode with a special guest: Dr. Keith Smith from the Surgery Center of Oklahoma. Keith realized in the 1990s that the surgery system in America was exploitative and unfair, and decided to “rebel”, setting up a “parallel market” to sell surgeries direct to consumer at a listed price without any middlemen.

The idea of a consumer knowing the price ahead of purchasing a service (and not being charged afterward!) seems fundamental and obvious in every industry in our country, but it’s a completely revolutionary way of doing business in the healthcare industry. I talked with Keith about what made him realize that there had to be a better way of doing business, what it was like to be such a trailblazer, and why publicly posting his prices on his website was such a big deal.

If you want to hear an amazing conversation with a doctor who’s made real change in curbing price gouging in our industry, tune in this week on Self-Funded with Spencer with Dr. Keith Smith.

Chapters:

00:00:00 Meet Dr. Keith Smith

00:00:20 Spencer’s Son’s ER Trip
00:05:53 Transparent Surgical Bundle Pricing
00:22:17 Setting Surgical Prices Over The Phone
00:24:30 Allowing The Market To Drive Prices
00:40:21 Empowering Consumers By Posting Prices Online
00:42:30 Incentivizing Informed Healthcare Choices
00:53:03 Teaching Consultants On This Model
01:06:34 The Return To Free Market Healthcare

Key Links for Social:

@SelfFunded on YouTube for video versions of the podcast and much more - https://www.youtube.com/@SelfFunded

Listen on Spotify - https://open.spotify.com/show/1TjmrMrkIj0qSmlwAIevKA?si=068a389925474f02

Listen on Apple Podcasts - https://podcasts.apple.com/us/podcast/self-funded-with-spencer/id1566182286

Follow Spencer on LinkedIn - https://www.linkedin.com/in/spencer-smith-self-funded/

Follow Spencer on Instagram - https://www.instagram.com/selffundedwithspencer/

Key Words:

#DirectPricingModel #HealthcareTransparency #BundledSurgicalProcedures #PackagedPricing #SelfFundedEmployers #ZeroDeductible #ConsultantsInHealthcare #FreeMarketHealthcare #HealthcareCostSavings #TransparentHealthcare #BetterHealthcareChoices #ConsumerCentricHealthcare #selffunded #podcast

Direct Pricing Model, Healthcare Transparency, Bundled Surgical Procedures, Packaged Pricing, Self Funded Employers, Zero Deductible, Consultants In Healthcare, Free Market Healthcare, Healthcare Cost Savings, Transparent Healthcare, Better Healthcare Choices, Consumer Centric Healthcare, self funded, podcast