Nick Shutwell

A great read in the Star Tribune — reporter Christopher Snowbeck nailed it on the challenge of sky-high Rx costs for consumers. The fact is it’s not always easy to save on prescriptions through your pharmacy benefit manager alone. One solution I often recommend is to use discount cards like GoodRx to find lower prices at the same pharmacy. At HealthEZ we have several convenient solutions to help consumers shop and find the lowest cost for their medications:   Our pharmacy solutions help members set up copay assistance to lower their out-of-pocket costs. All of our Pharmacy Benefit Partners offer a cost comparison tool so consumers can look at the contracted price of drugs within their pharmacy network. HealthEZ encourages members to use discount cards when necessary and provide a reimbursement form for our membership. Be on the lookout for more innovative solutions from HealthEZ!   Read the Star Tribune’s article: https://lnkd.in/gbGnbdhc

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Thakn you Chris deacon for pointing out the importance of understanding the true motivations behind many healthcare systems' interest in "improving care". As Chris states, "It's crucial to recognize that these "opportunities" may be less about patient outcomes and more about maximizing revenue through increased patient engagements." She references one hospital system CFO's recent comment, "As we look at the future landscape, the competition for customers will take this industry to another level. We're investing now to be ready to compete." Notice that he did not use the term patient, but rather customer. At least to me, this would seem to indicate more concern for a person's "business" versus their care. The top concern being how do they attract and retain the "customer's" business to maximize the financial opportunity. Instead of how do we deilver high-quality care at a reasonable price. Chris concludes quite accurately that, "This perspective counsels against any optimism that patients as people, rather than patients as profit, are at the center of this strategy."

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Curious about alternative ways to buy health insurance for your employees? Lots of great content here on value based insurance design (VBID). s/o to Mark Fendrick for his work at the Center for Value Based Insurance Design at the University of Michigan. Link in first comment!

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@KevinGarret Thank you for shedding light on this critical issue, highlighting the challenges many employers face with rising prescription drug costs. It's clear that tackling these expenses requires innovative solutions, and at Drexi, we are leading the charge in reshaping how companies manage their pharmacy benefits. Our mission at Drexi is to empower employers with effective strategies to navigate the complexities of #prescription drug spending. By partnering with us, businesses can benefit from a tailored approach that prioritizes total cost transparency and efficiency, ultimately leading to significant savings. A poignant illustration of our success lies in a recent case where one of our clients realized staggering annual savings exceeding $460,000 on a single drug. The significance of this achievement cannot be overstated. While it may seem like just one medication to some, the impact it has on an organization's financial health is monumental. By effectively managing the cost of this drug alone, our client experienced an immediate and profound positive shift in their bottom line, allowing them to allocate resources more efficiently and invest in other critical areas of their business The key to these substantial savings was our strategic approach that prioritizes tangible savings opportunities over elusive rebate promises commonly offered by larger pharmacy benefit managers (PBMs). Unlike traditional models that often lead to excessive spending with uncertain returns, we focus on delivering measurable and immediate benefits to our clients. By partnering with Drexi, this client made a conscious shift towards a more transparent and efficient pharmacy benefit strategy. Our tailored solutions enabled them to optimize their prescription drug spending, resulting in significant cost reductions without compromising the quality of care for their employees. And this is just the beginning for them! To all the Brokers and TPAs looking for a solid PBM Partner, we understand that the key to effective management is informed decision-making. With Drexi by your side, you can measure and manage your pharmacy benefits with confidence. Let's navigate this healthcare battle together and secure a healthier, more cost-effective future for your organization. #Drexi #PharmacyBenefitManagement #HealthcareCosts #Innovation #EmployeeWellness #HealthcareStrategy #PrescriptionDrugCosts #PBM #everydollarcounts

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Thought provoking conversation between our CEO, Mike Desjadon and CNBC's Tyler Mathisen on The Exchange yesterday discussing the role of #AI in driving #transparency and #predictability into #healthpayment. With the technological horsepower of #AI applied to #healthpayment, its now possible to know in advance what benefits are in a plan, what these plans cover and what needs to be done to make sure payments are adjudicated correctly (the first time), and people get the care they need without the anxiety of what what might wind up in their mailbox 30 days later. This is better for everyone, provider, payer and patient alike. We're here for that future. "Payers and providers can partner together on transparency using these technologies" - Mike Desjadon https://lnkd.in/gNinRjXK

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Very much of a changing landscape for GLP-1 insurance coverage for obesity. Employers need to have a completely separate carved out wholistic program addressing mental health, nutrition, exercise, with medications used as a tool when members get stuck in their health journey with their disease of obesity. #GLP1 #obesitycoverage #wegovy #zepbound #healthinsurance #employeebenefits #PBMs #weightlossmeds #burnhambenefits #theBaldwinGroup

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“It’s like being the UN of Healthcare, because we connect all of the constituencies… and are trying to align incentives to improve every life.” —Andrew Toy, President & CTO, Clover Health The follow up to the best-seller "The Future of Insurance: From Disruption to Evolution, Volume I. The Incumbents," by Bryan Falchuk. The second volume features the first-hand journeys of 8 InsurTech startup insurers so we can learn and grow. Available from Amazon and at https://lnkd.in/ekWrTBhv #insurtech #insurance #startup #innovation #disruption #insurancebook

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“It’s like being the UN of Healthcare, because we connect all of the constituencies… and are trying to align incentives to improve every life.” —Andrew Toy, President & CTO, Clover Health The follow up to the best-seller "The Future of Insurance: From Disruption to Evolution, Volume I. The Incumbents," by Bryan Falchuk. The second volume features the first-hand journeys of 8 InsurTech startup insurers so we can learn and grow. Available from Amazon and at https://lnkd.in/ekWrTBhv #insurtech #insurance #startup #innovation #disruption #insurancebook

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“It’s like being the UN of Healthcare, because we connect all of the constituencies… and are trying to align incentives to improve every life.” —Andrew Toy, President & CTO, Clover Health The follow up to the best-seller "The Future of Insurance: From Disruption to Evolution, Volume I. The Incumbents," by Bryan Falchuk. The second volume features the first-hand journeys of 8 InsurTech startup insurers so we can learn and grow. Available from Amazon and at https://lnkd.in/ekWrTBhv #insurtech #insurance #startup #innovation #disruption #insurancebook

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Use case on cost variability within the LA market. Below is the Average PPO Rate for an MRI of your low back. This is comparing 7 LA hospitals contracted/allowed amount average PPO rates across Aetna, Anthem, Cigna, and UHC with Medicare as the benchmark. Huge variances over Medicare and displays why employers need to gain access to this information and take action to steer members away from hospitals that are not a fair market price. Unfortunately, LA is not a unique city as there is cost and quality variability by facility, by provider, by procedure code across all states and all networks. Good news is that there are proven solutions to reduce cost, improve quality of care, decrease or eliminate members out-of-pocket cost, and enhance benefit offerings. If you do what you’ve always done, you’ll get what you’ve always gotten.

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Join us for an enlightening session on Provider Enablement in the realm of Value-Based Care (VBC). Dive deep into the evolving landscape where third-party companies are revolutionizing VBC by managing risks and enhancing care outcomes. View the SOA Health Meeting agenda here: https://optumin.co/jgzooj #Optum #SOA #providers #ProviderEnablement #VBC 

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Four in 10 adults in the United States have medical debt, highlighting the pressing issue of healthcare affordability. Last Wednesday, the Ohio Senate took a step towards transparency by passing a bill mandating hospitals to publish the cost of their services for public access. If it takes a bill to be passed to require posting your prices, it suggests you don't want anyone to see them. Every hospital, urgent care, surgical center, etc., should be required to post their pricing on their website in a downloadable PDF. Why wouldn’t you? Do you order a steak without knowing the price? Do you buy a car without knowing the price? Do you buy a home without knowing the price? Every single item we own came with a transparent price tag. So, why is medical pricing so secretive? Because they want to charge you as much as they can get away with! Don't let them raise your premiums. Stop the unbundling, upcoding, and phantom charges, and put that money back into your employees' pockets! us-beacon.com Read more about this initiative here: https://lnkd.in/gw8QbxpQ

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