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by David Saltzman
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- 1 weeks ago28 min
EP 548 All You Can Eat Compliance - with Carol Taylor
We bring compliance specialist Carol Taylor back to unpack why employers keep getting blindsided by benefit plan obligations like RXDC reporting, PBM disclosures, and fiduciary duties under ERISA. We map the real-world risks, the paperwork traps that cause rejected filings, and the simple audit habits that keep penalties from stacking up. • RXDC reporting basics and why it exists • why employers still miss RXDC years later • where legal responsibility lands even when vendors...
- 2 weeks ago34 min
EP 547 New "Captivated Health" Book - with Mark Gaunya
We talk with Mark Gaunya about why employer health insurance often feels like a casino where the house wins and how employers can flip the odds with transparency, ownership, and smarter plan design. We break down how captive risk sharing works, what it takes to implement, and the real financial and employee-experience wins that come from getting off the less bad renewal hamster wheel. • Why the US healthcare system “works” as designed for rulemakers, not end users • How the ...
- 3 weeks ago21 min
EP 546 Well-Being That Actually Cuts Costs - with Ashley Rutkowski
We challenge the old wellness playbook and show how coaching, claims integration, and clinical guardrails turn behavior change into measurable cost control. GLP-1s, chronic condition priorities, and realistic timelines come together in a system that bends trajectories instead of chasing fads. • why awareness and incentives fail without habit formation • building coaching into chronic care to shift daily decisions • measuring ROI with leading indicators and claims trends • onboarding with cla...
- 4 weeks ago28 min
EP 345 Medicare Playbook For Agents - with Paige Phillips
Medicare is full of fine print, fast-changing rules, and enough junk mail to fill a suitcase. So what actually separates the agents who barely survive from the ones who become the trusted name in their community? We sit down with Paige Phillips, founder of the Paige Phillips Insurance Agency and author of Medicare Playbook for Agents, to get practical about what works when the stakes are someone’s healthcare and finances. We talk about the unglamorous details that build a thriving Medicare b...
- Apr 14, 202635 min
EP 544 Healthcare Costs Keep Rising Because Prices Stay Invisible - with Katy Talento
Healthcare stays expensive because the system hides prices and quality from the people paying for care, especially employers. We talk with Katie Talento about how CAA 2026 transparency and Department of Labor fiduciary rules could expose PBM practices, reshape contracting, and give plan sponsors real leverage if enforcement follows. • Why invisible prices and invisible quality break the healthcare market • How incentives and lobbying protect opacity across hospitals, PBMs, insurers and...
- Apr 7, 202624 min
EP 543 Medical Arbitration Becomes A Profit Center - with Scott Bennett
Surprise billing for patients is largely gone, so why are so many self-funded employer health plans still getting hammered by out-of-network costs? We sit down with Scott Bennett, Chief Provider Relations Officer at the PHIA Group, to unpack what the No Surprises Act is doing in the real world and why federal arbitration is starting to look less like a safety valve and more like a payment engine. Scott walks us through the mechanics that matter: QPA as the median contracted rate, the short o...
- Mar 31, 202636 min
EP 542 What If Chronic Disease Was Optional? - with Brett Smith
Employers keep paying for the symptoms of obesity, diabetes, and metabolic syndrome while the root causes go untouched. We unpack why many wellness models fail, how insulin resistance hides for years, and what chronic disease reversal can look like when a physician-led metabolic health team measures the right signals and tapers meds safely. • metabolic syndrome as a dominant driver of employer healthcare costs • why low-fat guidance and ultra-processed food worsen hunger and outco...
- Mar 24, 202626 min
EP 541 When CFOs Treat Healthcare As Any Other Cost - with Carl Schuessler, Jr.
We explore how employers can manage healthcare like any other cost by shifting from insurer-built, passive plans to employer-built, actively managed designs. Carl Schuessler, Jr. shares candid tactics on data, precision testing, and honest change management that help advisors become true risk partners. • defining a health plan mission that aligns to EBITDA and predictability • focusing on data hot spots such as MSK, imaging, pharmacy, and facilities • using billing audits and cost containmen...
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About The ShiftShapers Podcast
Change either paralyzes or energizes - the choice is yours. Hear from businesses and entrepreneurs who have become energized and who have profited by shaping the shifts in their markets and practices. Become a SHIFTSHAPERS INSIDER and get our latest download, advance notice of all podcasts, podcast summaries, and special INSIDER-ONLY content. INSIDER SIGN UP
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