Dysrupt Healthcare Podcast

On this episode of Impact Healthcare, Lester is joined by Ben Conner, CEO of Conner Insurance. Together, they discuss Ben’s start in the industry and how he developed into the leader he is today. He also touches on ‘mission-driven benefits’ and shares an impactful story about one of his client’s self-funded journeys. Ben also leaves a word of advice for both employers and advisors looking to achieve similar results. Show Notes: Welcome to Impact Healthcare! Ben begins by explaining what got him into the insurance business (1:05) and highlights a few key individuals that played a part in his success as a leader (3:52). He speaks about ‘mission-driven benefit’ and how it applies to his business everyday (7:50). Ben also tells a story about a small firm that has achieved significant cost savings with their health plan, showing that all companies are eligible for self-funded insurance. (14:22). Together, the pair discuss the importance of employee buy-in throughout the self-funding process and how it affects recruitment and retention. (26:00). Lastly, Ben shares some advice with advisors and employers in the industry (32:08).

Welcome to Season 2 of Impact Healthcare! On this episode, Lester sits down with John Quinn, CEO of Wellnecity. Together, they discuss his transition from management consulting to health insurance. John explains how healthcare cost are more controllable then ever and the importance of data in reducing expenditure. He also provides employers with actionable strategies they can implement to improve quality of care at a fraction of the cost of their current health plan. Lastly, he leaves listeners with a few words of wisdom for employers and advisers based on his experience in the industry. Show Notes: John kicks off the episode by discussing his company (1:09), as well his past role as a management consultant. (2:40) They then dive right into how healthcare costs are now more controllable than ever (5:08) and how carriers are not incentivized to help employers save money. (13:55) John walks through exactly how he helps organizations optimize their health benefits (16:00) and how certain employers were able to positively impact their employees healthcare during the COVID pandemic. (22:00) They then discuss the importance of having access to data and how it impacts decision making and business strategy. (26:50) Lastly, John leaves the audience with a few proactive strategies employers can implement to impact healthcare (34:35) and a few words of wisdom (41:15).

In this episode of the Dysrupt Healthcare Podcast, host Lester J. Morales sits down with Heath Potter, Chief Growth Officer and founding member of Six Degrees Health, one of the leading innovators in reference-based pricing (RBP) and transparent cost-containment solutions.Heath shares how a personal family tragedy—his father’s life-changing injury—became the spark behind his mission to make healthcare affordable, transparent, and fair for every patient and employer.Together, Lester and Heath unpack how Six Degrees Health uses data, analytics, and negotiation—not litigation—to redefine RBP, allowing employers to save an average of 30–40 % on medical claim spend while improving member experience and access to care.From the evolution of RBP 1.0 to today’s member-first model, this episode explores:Why most employers are still overspending on healthcareThe myths about balance billing and access issuesHow transparency and independent negotiation build trust between plans and providersReal case studies where employers saved millions without sacrificing careIf you’re a self-funded employer, benefits advisor, or HR leader who’s ready to rethink healthcare costs, this conversation will show you what true disruption looks like.Dysrupt Healthcare Podcast (yes—with a Y) is where Lester J. Morales talks with leaders who are challenging the status quo of American healthcare.Each episode digs into the WHY—the purpose behind the movement—to make healthcare more transparent, affordable, and human.Timestamps00:00 – “This podcast has been disrupted”00:07 – Welcome to Dysrupt Healthcare: Why the Y matters00:52 – Meet Heath Potter, Chief Growth Officer at Six Degrees Health03:02 – The personal story that ignited a mission to fix healthcare04:26 – How transparent pricing helps families and employers05:36 – Real impact: saving $12 million for a client plan06:43 – A physical therapy story that proved the model works08:28 – Reference-Based Pricing (RBP) explained in simple terms10:56 – Lester’s $90K knee surgery example vs. RBP pricing13:34 – Why hospitals accept fair RBP rates15:40 – RBP 1.0 vs. the Six Degrees model: what’s changed18:21 – Data and analytics as the core of modern RBP21:10 – The real stats: 99 % claim acceptance rate first pass24:00 – How negotiations resolve balance bills without litigation26:10 – The next frontier of RBP: member access to care28:02 – Open access plans and real family examples31:00 – Average employer savings of 25–40 %32:54 – Sustainability and flattening the renewal curve34:50 – Case studies: firefighters, manufacturers, and local communities37:13 – Where to learn more and get a free savings analysis39:21 – Final message to employers: “These are real dollars, not smoke and mirrors”Connect with the GuestsGuest: Heath Potter – Chief Growth Officer, Six Degrees Health📧 Heath.Potter@6degreeshealth.com🔗 LinkedIn: Heath PotterHost: Lester J. MoralesFollow on LinkedIn, YouTube & Spotify for more conversations that #Dysrupt the status quo.

Welcome to the first guest episode of the newly rebranded Dysrupt Healthcare Podcast, hosted by Lester J. Morales.Formerly known as Impact Healthcare, this show has evolved with a clear mission to remember the WHY behind disrupting healthcare.In this episode, Lester sits down with Kimberly Carlson, CEO and founder of US Beacon, a company transforming how medical billing integrity is handled in America. Kimberly shares her powerful story — from advocating for her husband during his battle with stage IV cancer to building a company that helps employers and patients uncover costly billing errors that most people never even notice.They expose shocking facts about the system — like why over 90% of medical bills contain errors, how self-funded employers can save millions, and why independent claim reviews are the hidden key to fixing a broken healthcare system.Whether you're an employer, advisor, or healthcare professional, this episode will change how you see medical billing, fiduciary responsibility, and the real cost of care in America.🔹 Learn how to protect your organization from overpayments🔹 Discover what “Disrupt with a Y” really means🔹 Get practical insights from real case studies saving millionsHosted by Lester J. Morales, Dysrupt Healthcare (yes, spelled with a “Y” on purpose) highlights the WHY behind fixing a broken system. Each episode shares stories of leaders, innovators, and disruptors making healthcare more human, transparent, and affordable.00:00 – Attention: This podcast has been disrupted00:10 – From Impact Healthcare to Dysrupt Healthcare: the WHY behind the rebrand00:46 – Meet Kimberly Carlson, CEO of US Beacon03:04 – The personal story that started US Beacon03:48 – 99% of medical claims have errors — why it happens06:14 – Understanding medical coding and billing complexity08:16 – The mechanic analogy: bundling vs. unbundling in healthcare10:30 – Patients’ right to request an itemized bill12:20 – Why every consumer should care about billing errors13:43 – How billing errors drive up premiums14:43 – Real-world example: $12,000 a night for a semi-private room15:43 – Self-insured vs. fully insured: who’s responsible?17:17 – Fiduciary risk and why employers should audit claims18:20 – $5.5 million in savings: real case results20:16 – “Fox guarding the henhouse”: when carriers audit themselves21:44 – Why independent audits matter22:45 – Contracts, RFPs, and clauses that protect employers26:00 – Billing under CMS guidelines and avoiding illegal charges28:10 – How one surgery led to $70,000 in avoidable costs30:13 – Healthcare billing = buying a car without knowing the price31:38 – City government case study: recovering taxpayer money33:11 – Why you need an independent TPA34:39 – The human side: the system isn’t evil, just broken35:26 – The role of AI and automation in claims integrity36:45 – US Beacon’s 1% appeal rate and what makes them different37:00 – The meaning behind “US Beacon” and being a light in darkness37:41 – Final thoughts and call to actionGuest: Kimberly Carlson – CEO, US BeaconLinkedIn: Kimberly CarlsonHost: Lester J. MoralesFollow on LinkedIn, YouTube, and Spotify for more stories that disrupt the status quo.🧠 About Dysrupt Healthcare Podcast🕒 Timestamps🔗 Connect with the Guests

In this quick recap of the Dysrupt Healthcare Podcast, host Lester J. Morales distills key takeaways from his interview with Heath Potter, Chief Growth Officer at Six Degrees Health—a leader in reference-based pricing (RBP) and transparent reimbursement.Lester challenges the industry’s fear of RBP, calls out incentive conflicts that keep employers in the dark, and explains (in plain English) how bottom-up “Medicare-plus” pricing gets to a fair price—without the games behind “big network discounts.” He also shares real-world wins, access myths vs. facts, and why collaboration (not litigation) is the sustainable path.You’ll learn:Why many advisors still resist RBP—and how to sanity-check that biasTop-down (billed charges minus “discount”) vs. bottom-up (Medicare-plus) pricingHow modern RBP uses data + negotiation to reach fair provider paymentsAccess & member experience: what’s changed from RBP 1.0 to todayCase stories: open access, community contracts, and keeping dollars localHow to request a no-obligation impact/savings analysis to compare modelsIf you’re a self-funded employer, HR/benefits leader, or advisor, this recap gives you the essentials in minutes—so you can decide whether to dive into the full episode.00:00 – “This podcast has been disrupted.”00:07 – What these recap episodes are (and why)00:40 – Guest context: Heath Potter, Six Degrees Health (RBP leader)01:03 – Love it? Hate it? Why advisors feel strongly about RBP02:24 – Gut-check your bias: incentives, overrides, and “follow the money”03:27 – Hundreds of RBP implementations: wins vs. rare rough patches05:23 – The core value of RBP: transparency and bottom-up pricing06:38 – “Discount off what?” Charge master, billed charges, and the game06:55 – RBP in one line: get to the price (Medicare-plus)07:05 – Why Six Degrees’ data-driven, collaborative model works09:17 – Many hospitals already use RBP-ish logic internally10:10 – Imagine a fair-price roundtable… and the reality today10:39 – Six Degrees’ posture: start fair, show data, negotiate10:51 – Real examples: open access, family stories, local community wins11:37 – When carriers and hospitals fight… the member/employer loses11:58 – Strategy: collaborate with good actors; limit exposure to bad ones12:21 – Employers: if your advisor won’t teach RBP, reconsider12:45 – If we don’t solve it, government will—lead the change13:09 – CTA: request an impact analysis to compare savings13:46 – Listen to the full episode with Heath Potter; share/like/feedback14:00 – Thanks for listening to the Dysrupt recapGuest: Heath Potter, Chief Growth Officer — Six Degrees HealthHost: Lester J. Morales — Dysrupt Healthcare Podcastreference based pricing, RBP, Medicare plus pricing, Six Degrees Health, Heath Potter, Lester J Morales, self funded employers, healthcare transparency, cost containment, medical claims, employer health plans, open access, negotiation not litigation, benefits advisors, Dysrupt Healthcare Podcast🕒 Timestamps🔗 Guest & Host🔍 SEO Keywords / Tags

In this special recap episode of the Dysrupt Healthcare Podcast, host Lester J. Morales breaks down the key lessons from his powerful conversation with Kimberly Carlson, CEO of U.S. Beacon — an independently owned medical claims integrity review company helping employers reclaim millions lost to billing errors.Using a simple grocery-store analogy, Lester exposes the shocking truth: nearly every medical bill in America contains mistakes — and most employers never audit them.He shares actionable strategies for self-funded employers and advisors to take control, demand transparency, and protect their plan dollars.You’ll learn:Why 99% of healthcare bills have errors — and how much that’s costing you.How independent audits recover 2–6 % (or more) of total claim spend.The contractual traps that limit employers’ ability to audit their own data.How to write “audit-friendly” RFP clauses that guarantee full access to your claim data.Why transparency and leadership are essential to fixing a broken system.💡 Whether you’re an employer, HR leader, or benefits advisor, this quick recap gives you the insights — and the “why” — to disrupt the way healthcare billing has always been done.00:00 – “This podcast has been disrupted.”00:07 – What are Dysrupt Healthcare recap episodes?00:53 – The Kimberly Carlson conversation in context01:03 – The grocery-store analogy: transparency in billing02:39 – What if every checkout had errors?03:05 – Translating that to healthcare03:41 – 99 % of medical bills contain errors04:05 – How U.S. Beacon audits hospital claims05:10 – The employer’s right (and responsibility) to audit06:26 – Why large hospital stays create bigger audit opportunities07:03 – Taking back control: this is your money08:17 – How to write audit clauses into your RFPs09:02 – The hidden gag clauses in contracts09:25 – Consolidated Appropriations Act (CAA) and data ownership09:42 – Make audits a condition to win the bid09:57 – Free resources from Kimberly Carlson in the show notes10:25 – Why independent claim reviews matter for every employer10:37 – Auditing your plan = protecting your people10:54 – Final call to action: Disrupt the status quo🎧 Full Interview: [How Kimberly Carlson Is Fixing Broken Medical Billing | Dysrupt Healthcare Podcast]with Lester J. Morales & Kimberly Carlson, CEO of U.S. Beacon🕒 Timestamps🔗 Referenced Episode

In this inaugural episode of the Dysrupt Healthcare Podcast, Lester J. Morales opens up about rebuilding not just the podcast, but the entire company and mission behind it. After years of leading Impact Healthcare Podcast, Lester realized that the vision had outgrown the name. “Impact” was never the limit it was just the beginning.The new Dysrupt Healthcare Podcast was born with purpose: to go deeper, to reach farther, and to create real change in how we see and experience healthcare. This isn’t just a new season it’s a reawakening of a movement.Lester shares what this transformation means, personally and professionally from redefining his company’s purpose to reimagining how conversations in healthcare should sound. The new format will bring you closer to the real stories, the emotional journeys, and the case studies of leaders who are dysrupting the system for good.This episode sets the tone for what’s to come: honest dialogue, bold ideas, and stories that remind us that healthcare isn’t just about numbers it’s about people.The movement continues louder, deeper, and more human than ever before.

In this powerful solo episode, Lester Morales reflects on the journey of the Impact Healthcare Podcast and shares why it’s time for an evolution. For years, Impact Healthcare has been a platform to highlight innovative ideas, bold strategies, and the leaders willing to push against the broken healthcare system. But as Lester explains, the word “impact” was never big enough to capture the true scale of the movement he and so many others are building.This is not an ending — it’s a transformation. The podcast is entering a new chapter as the Dysrupt Healthcare Podcast. With a sharper focus and a fresh format, this next phase will go deeper into the conversations that matter most: how employers, advisors, and changemakers can dysrupt the status quo, lower costs, and deliver better care for employees and their families.In this transitional episode, Lester shares:Why the shift from “Impact” to “Dysrupt” represents more than just a name change.What listeners can expect from the new content, structure, and tone of the podcast.How the larger movement for healthcare disruption is growing — and why your voice and participation matter now more than ever.This episode isn’t a goodbye. It’s an invitation to continue forward — to be part of the movement, to challenge what’s broken, and to help create a system that truly works for people. The Impact Healthcare Podcast opened the door. The Dysrupt Healthcare Podcast will break it wide open.

What if burnout didn’t have to be the norm?In this powerful episode of The Impact Healthcare Podcast, host Lester Morales dives deep with John Troutman, Vice President of Business Development at Mind Club America, a revolutionary mental health platform built for prevention—not just crisis response.John shares his raw, personal story of burnout, the months-long journey through recovery, and how it became the catalyst for helping others. Together, they expose the flaws of traditional EAPs, debunk the “we’re here when you need us” myth, and offer a clear, proactive solution for employers, advisors, and leaders who want to make mental health truly accessible and impactful.✅ Learn how Mind Club helps organizations reduce turnover, improve productivity, and provide fast access to real mental health professionals✅ Discover the simple 3-minute assessment that sets a new standard for self-awareness and care✅ Explore how leadership buy-in transforms employee engagement with mental wellness tools✅ Understand how stigma, accessibility, and outdated networks are failing today’s workforce—and what to do about itThis isn’t a feel-good conversation—it’s a real conversation with real tools to make mental health a business strategy, not an afterthought.Take the free assessment or learn more: https://mindclubamerica.com🫶 If you know someone silently struggling—or a leader ready to do something different—share this episode. You could save a life.#mentalhealth #burnout #leadership #employeewellbeing #healthcarestrategy #impactpodcast #mindclub

What if you could avoid invasive orthopedic surgery using your own cells?In this eye-opening episode of the Impact Healthcare Podcast, host Lester Morales talks with Dr. Mark Testa—chiropractor, acupuncturist, and Regenexx expert—about the groundbreaking procedures helping thousands of patients skip expensive surgeries and recover faster with regenerative treatments like bone marrow concentrate and PRP (platelet-rich plasma).You’ll learn:How Regenexx helps patients avoid knee, shoulder, and spine surgeriesReal-life patient success stories and outcomesThe massive cost savings and faster return-to-work for employersWhy musculoskeletal issues are a top cost driver in health plansHow self-funded employers are integrating Regenexx into their benefitsWhether you're an advisor, employer, or patient seeking alternatives to surgery, this episode delivers valuable insights into the future of orthopedic care.👉 Learn more: https://regenexxbenefits.com📩 Contact Dr. Mark Testa: mtesta@regenexx.com🔗 Connect with Lester Morales on LinkedIn

In this powerful episode of *Impact Healthcare*, host LesterMorales sits down with a true industry whistleblower  Wendell Potter, former Cigna and Humanaexecutive turned healthcare reform advocate. Wendell pulls back the curtain onhow health insurance really works, exposing the profit-driven machine thatprioritizes stock prices over patient care.From defending high-deductible plans to becoming a fierce critic of them,Wendell shares his personal transformation, his fight for a more transparentand fair system, and why the healthcare system isn’t broken — it’s workingexactly as designed... for Wall Street.🔥 Inside this episode:- What the Medical Loss Ratio (MLR) really means for employers and patients- How health insurers and hospitals maintain a profit-first alliance- The unethical broker-carrier dynamic no one wants to talk about- Why Wendell walked away from a high-paying C-suite role to expose industrycorruption- Real stories of hope and disruption in healthcare happening *right now*Whether you're an employer, advisor, or just someone who’s tired of risingpremiums and shrinking benefits, this is a must-listen.📩 Connect with Wendell: [HealthcareUncovered](https://healthcareuncovered.substack.com)📽️ Watch the documentary: *It’s Not Personal, It’s Just Healthcare*(featuring Wendell)🎧 Don’t forget to subscribe and share this episode if you believe increating a better healthcare system.

In this high-impact solo episode of Impact Healthcare, host Lester Morales recaps the key takeaways from April’s conversations — and it all comes down to one powerful word: strategy.From exploring the costly trap of reactive renewals to redefining how employers, brokers, and hospitals collaborate through direct contracting, Lester challenges the status quo of the healthcare benefits industry. He also revisits his powerful interview with Seppa from Motive, VP of People & Learning, who shares how her organization transitioned from fully insured to self-funded — resulting in improved employee benefits, cost savings, and deeper employee engagement.🔥 You’ll learn:Why most employers operate on a faith-based model with no real healthcare planHow direct-to-employer strategies and captives are reshaping cost controlThe real-life ROI of benefits aligned with the employee lifecycleWhy KPIs in healthcare are dangerously misaligned — and what to do about itHow one company used healthcare savings to expand parental leave and elder careWhether you’re an advisor, HR leader, or employer, this episode delivers the roadmap to move beyond the annual renewal scramble and build a benefits plan that actually works.🔗 Connect with Lester: lester.morales@nextimpactllc.com📬 Got a topic or guest suggestion? We’re listening. Let’s impact healthcare — together.

What if healthcare wasn’t broken—but simply built wrong?In this episode of the Impact Healthcare Podcast, Lester Morales sits down with Rob Andrews, CEO of the Health Transformation Alliance and former U.S. Congressman, to explore how large employers are fixing healthcare—not through policy alone, but through bold action, cultural alignment, and smarter benefits design.Rob shares his personal “why,” rooted in his father’s death and the lessons that continue through his work today. Together, they dive into decades of insights from Rob’s leadership in both government and the private sector, including:The foundational flaws in fee-for-service and the urgent need for value-based careHow self-funded employers are improving outcomes by aligning benefits with talent retentionThe true ROI of investing in navigators, virtual care, and benefit educationWhy personal accountability is key to improving health outcomes—and how incentives must evolveHow major organizations like American Express retain talent through human-first healthcare designCreative strategies like 0 copays for engagement and charitable rewards for smart healthcare choicesFrom policy debates like the MLR rule in the Affordable Care Act to real-world success stories—like a walking club that grew out of a doctor’s concern for her lonely patients—this episode challenges you to rethink what’s possible in employer healthcare.If you’re an employer, advisor, or HR leader ready to:Design benefits that actually improve livesAlign healthcare spend with business and cultural goalsShift from reactive to proactive care modelsCreate long-term impact beyond cost containmentThis episode is a masterclass in how to lead with vision, humanity, and strategy.Listen, take notes, and share this episode with someone who needs to stop waiting for the system to fix itself—and start doing something that works.Keywords:Rob Andrews, Health Transformation Alliance, value-based care, healthcare navigation, self-funded insurance, outcomes-based payment, healthcare cost control, employer healthcare strategy, employee benefits innovation, healthcare incentives, benefits design, personal accountability, primary care, employee retention, impact healthcare podcast, Lester Morales

What if your healthcare benefits did more than check a box—what if they changed lives?In this episode of the Impact Healthcare Podcast, host Lester Morales is joined by Sepa Sete, VP of People + Learning at Mocean, for a candid and practical conversation about how HR can take the lead in creating people-first organizations through intentional benefit design.Sepa shares the journey that led Mocean to move from a traditional fully-insured model to a self-funded healthcare plan that not only reduced costs but dramatically improved the employee experience. She breaks down how her team:Mapped the entire employee lifecycle to align every stage with meaningful supportReimagined healthcare benefits to match their company culture and evolving talent needsAdded family planning coverage after losing key candidates due to outdated benefitsIntroduced virtual healthcare with Galileo to improve access and reduce unnecessary costsExpanded paid parental leave and began building support for employees caring for aging parentsUsed listening and data to guide strategy and improve employee satisfactionThis episode includes powerful real-life stories, including how one benefit decision helped a couple become parents, and how a personalized approach to healthcare made all the difference for a team member battling cancer.If you're an HR professional, benefits advisor, or business leader looking to:Improve talent retention and recruitmentOffer better healthcare without raising costsCreate alignment between company culture and benefitsExplore whether self-funding is right for your organizationThis conversation will challenge the status quo and offer a roadmap to meaningful change.Listen now and subscribe to the Impact Healthcare Podcast for more stories and strategies from leaders redefining the future of employee benefits.

Description: In this solo episode, Lester Morales shares his recent travel experiences, uncovering powerful insights from various healthcare markets across the United States. From groundbreaking direct-to-employer strategies in Southern California to employer-driven captive insurance solutions in Napa Valley, and proactive healthcare coalitions in North Carolina, Lester reveals how forward-thinking employers and advisors are reshaping the healthcare landscape.Discover the immense benefits of direct contracting, innovative captive structures, and collaborative approaches to healthcare management. Lester challenges employers and advisors alike to adopt new strategies, prioritize patient care, and reimagine compensation models based on true value delivered.Top 5 Key Moments:02:35 - Transformative Direct-to-Employer Strategies10:50 - How Hospitals and Employers Can Both Win16:20 - The Power of Captive Insurance Programs21:45 - Employers’ Hunger for Healthcare Innovation27:50 - A Challenge for Advisors to Create True ValueListen in to learn actionable strategies and foster meaningful healthcare innovation in your community.Subscribe to the Impact Healthcare Podcast for groundbreaking insights into the future of employer-sponsored healthcare.#HealthcareInnovation #DirectContracting #CaptiveInsurance #HealthcareStrategy #EmployerHealthcare #AdvisorInsights #LesterMorales

Reference-Based Pricing (RBP) often gets a bad rap, but is it really the healthcare villain many believe it to be? In this Impact Healthcare Podcast recap episode, host Lester Morales dives into the reality of RBP, debunking common myths and clarifying misconceptions about this innovative healthcare pricing strategy.Discover how reference-based pricing, when implemented effectively, can benefit employers, employees, and even healthcare providers. Lester shares insights and real-world stories, illustrating why understanding this approach is crucial for employers looking to lower healthcare costs responsibly.📌 Key Takeaways:How RBP differs fundamentally from traditional PPO programs.Why traditional healthcare pricing methods may incentivize higher costs.The surprising parallels between RBP and existing healthcare payment models.Real-life examples of successful implementations of reference-based pricing.If you're an employer, healthcare professional, or simply someone interested in learning effective ways to reduce healthcare costs, this episode provides essential insights.👉 Subscribe to the Impact Healthcare Podcast for more powerful insights and actionable tips to revolutionize your healthcare strategies.#ReferenceBasedPricing #HealthcareCosts #ImpactHealthcarePodcast #CostManagement #EmployeeBenefits #RBPEducation #HealthcareInnovation #LesterMoralesHere are the 5 most important timestamps from your episode:1:18 - The Problem with How RBP is Currently Viewed2:42 - Why Insurance Companies May Not Want Lower Costs5:06 - How Reference-Based Pricing Works6:40 - Debunking Myths about RBP & Hospital Acceptance9:15 - The Importance of Claims Auditing

In this solo episode of the Impact Healthcare Podcast, Lester Morales tackles the critical conversation around the value of directly connecting healthcare providers and employers. Lester highlights why traditional network-based approaches might not be the most effective way to manage healthcare costs, explaining why closer relationships between employers and hospitals could revolutionize how healthcare costs are controlled, benefiting everyone involved.Discover how employers, employees, and healthcare providers can all win through direct contracting, eliminating unnecessary financial burdens and collection risks. Lester breaks down real-world scenarios to showcase the tangible benefits of bringing healthcare closer to home.📌 Top 5 Key Moments:02:06 - Who Actually Decides Healthcare Prices?05:00 - The Hidden Problem with Healthcare Pricing08:46 - Building Direct Relationships Between Employers and Hospitals10:09 - Real-world Example: Employer and Hospital Collaboration Benefits15:40 - Why More Employers Should Consider Direct ContractingExplore the power of collaboration in healthcare and find out how you can foster meaningful change in your community.👉 Subscribe to the Impact Healthcare Podcast for impactful strategies and valuable insights into innovative healthcare solutions.#HealthcareCosts #DirectContracting #ImpactHealthcarePodcast #EmployeeBenefits #EmployerBenefits #HealthcareInnovation #HealthcareStrategy #LesterMorales

In this episode of Impact Healthcare, host Lester Morales dives deep into the world of Reference-Based Pricing (RBP) with Omar Arif, Senior Vice President of Growth at Claim DOC. Together, they explore how RBP is disrupting the health benefits industry by replacing traditional PPO networks with a more transparent, cost-effective approach.Omar shares real-life examples of how organizations can save millions while improving access to care, debunking myths surrounding RBP and addressing common challenges. Whether you’re an employer, benefits consultant, or healthcare professional, this episode provides actionable insights to rethink your healthcare strategy.Key Takeaways:   What is RBP? A simplified breakdown of how RBP determines fair, transparent pricingfor healthcare services.      Overcoming Misconceptions: Tackling fears and addressing the perceived complexity of adopting RBP.        The Role of Advocacy: How proactive communication with providers ensures a seamless transition for employees and minimizes disruptions.      Audit and Fiduciary Responsibility: How Claim DOC’s rigorous auditing process safeguards plan assets andensures fair pricing.      Real-World Success: A case study highlighting a 41.4% reduction in healthcare costs for a 300-employee agricultural company.     Employee-Centric Focus: The importance of lowering employee contributions while improving healthcare access.This episode is a must-listen for anyone seeking innovative solutions to reduce healthcare costs without sacrificing quality.Connect with Claim DOC: Visit claimdoc.com, follow them on LinkedIn, or check out theirpodcast, Claim Talk, available on Spotify and YouTube.Listen now to discover how you can take control of your healthcare costs and create a lasting impact!

On this episode of Impact Healthcare, Lester Morales dives deep into the revolutionary model of Direct Primary Care (DPC) with Dr. Eric Crall, a pioneer in transforming primary care. From the challenges of traditional healthcare to the incredible impact of DPC on employers, employees, and the healthcare system, this episode is packed with actionable insights. Key Takeaways:        What is DPC? A subscription-based healthcare model that eliminates insurance reimbursement and focuses on patient care.      The Employer Advantage: Learn how businesses like car dealerships and restaurants have reduced healthcare costs by up to 25% while improving employee satisfaction.      Why Employees Love It: No more waiting rooms, rushed visits, or financial barriers—DPC provides personalized care with unlimited access to doctors.      Lifestyle Medicine at the Core: Dr. Kroll explains how addressing root causes like stress, sleep, and nutrition prevents chronic diseases and improves overall well-being.    How DPC Scales: Whether your employees are spread across states or constantly on the go, discover how DPC ensures seamless, high-quality care. Real-Life Impact: Dr. Crall shares success stories, including a car dealership that saw substantial cost savings while offering better benefits. Employees gained access to care without out-of-pocket expenses, creating a healthier and more engaged workforce. Who Should Watch? This Episode?      Employers looking to cut healthcare costs and attract/retain top talent. Advisors seeking innovative ways to optimize health plans. Employees curious about how DPC can revolutionize their healthcare experience. What You’ll Learn:       The pitfalls of traditional fee-for-service models.      Why DPC is the future of primary care.         How employers can implement this model to benefit everyone involved. Take Action Now: If you're ready to explore DPC for your organization or want to connect with Dr. Aaron Kroll, visit Subscribe for More: Stay ahead of the curve with the latest strategies to disrupt the health benefits industry. Hit like, share, and subscribe to Impact Healthcare today!

In this episode of Impact Healthcare, host Lester Morales welcomes Josh Butler, President of Butler Benefits and Consulting and High Plains Health Plan, to discuss the game-changing Texas House Bill 711—the "Tier and Steer Bill." This new legislation allows self-funded employers to customize health plans and incentivize employees to choose high-quality, lower-cost providers through financial benefits like $0 deductibles and co-pays. Josh shares how High Plains Health Plan has pioneered this approach, proving that transparent, direct contracting reduces costs while improving care quality. What is HB 711? Texas is leading the way by legally recognizing tiered healthcare models that reward smarter healthcare choices. How "Tier and Steer" Works: Employees pay less (or nothing) when they choose high-quality, cost-effective providers in Tier 1 networks. The Big Insurance Companies’ Role: Why traditional carriers don’t fully adopt these models—premium equals revenue. Direct Contracting Advantage: How negotiating with hospitals directly results in better deals, without hidden network fees. Employer Action Steps: Start with a risk assessment, analyze your claims data, and shift to cost-effective healthcare solutions. Bottom Line: If you’re still managing healthcare benefits the old way, you’re missing out on significant savings and better employee outcomes. Subscribe now for actionable strategies that lower costs and impact healthcare for the better!