The ShiftShapers Podcast

25:36

EP 556 When Health Spending Slows For The Wrong...

The ShiftShapers Podcast ·

2026/10/06

A “slowdown” in healthcare spending sounds like relief until you ask one uncomfortable question: what if the numbers look better because people are quietly priced out of care? We sit down with award-winning healthcare journalist and author Ken Terry to unpack why CMS spending projections can hide a worsening healthcare affordability crisis, especially as disposable income drops and families rank housing and groceries ahead of doctor visits they still need. We dig into the growing gap between...

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31:57

EP 555 Why AI Can Expand Behavioral Healthcare Access...

The ShiftShapers Podcast ·

2026/09/29

You can have the best doctors in the world and still feel alone at 3 a.m. when anxiety spikes, motivation collapses, or a hard habit shows up again. That’s the gap we tackle with Dr. Ken Resnicow, one of the world’s leading behavioral scientists and a pioneer of motivational interviewing, now building therapeutic AI at Chronologics to extend care beyond the clinic. We get specific about what actually changes behavior and why health information alone usually isn’t enough. Ken breaks down “hig...

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27:33

EP 553 Why Employees Want Control Of Health Insurance...

The ShiftShapers Podcast ·

2026/09/22

The traditional group health plan has been the default for decades, but the people using it are sending a loud signal that the model is wearing thin. When we look at employee sentiment, the headline is simple and disruptive: a majority of workers want control over their health insurance choices, and only a small slice say their employer should be the one deciding. That shift gets even sharper with younger employees who walk into work expecting options, not a single plan and a shrug. I sit do...

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34:07

EP 553 Change Leadership That Actually Works - with...

The ShiftShapers Podcast ·

2026/09/15

Your plan can be “on time and on budget” and still be headed for failure. We sit down with Leslie Ellis, founder of Meaningful Change Consulting, to get brutally clear on why complex change initiatives derail even when leadership teams believe they’re doing everything right. If you’ve ever watched a transformation turn into a flurry of templates, communications, and training while the real problems stay untouched, this conversation names what’s missing and what to do about it. We dig into th...

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35:53

EP 552 When Brokers Become ERISA Targets - with Ron Peck

The ShiftShapers Podcast ·

2026/09/08

The next big lawsuit headline in employee benefits may not name the employer first. It may name the broker. We sit down with Ron Peck, Chief Legal Officer at The PHIA Group, to make sense of rising ERISA fiduciary liability pressure on self-funded health plans and the advisors who support them. The twist Ron keeps coming back to is that the legal “ingredients” have been around for years, from retirement plan cases to suits targeting TPAs and other service providers. What’s changing is the ta...

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33:24

EP 551 Cybersecurity Reality Check - with Daniel Metcalf

The ShiftShapers Podcast ·

2026/06/02

Cybercriminals don’t need to “hack” our systems when they can trick someone into handing over access, and AI is making those tricks more realistic and scalable. We talk with Daniel Metcalfe of Cyberfin about where benefits advisors are most exposed and the layered, practical steps that reduce breach risk while still letting teams use AI responsibly. • why employee and employer data is “gold” to attackers • how advisors get used as a pathway to bigger targets • why MFA and a...

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24:44

EP 550 Mindset Over Benefits - with Lizzie Benton

The ShiftShapers Podcast ·

2026/05/26

The fastest way to waste a benefits budget is to ignore the beliefs running the workplace. If employees aren’t engaging with expensive benefits plans, the problem may not be the coverage or the vendor list. It may be the everyday mindset that shapes trust, motivation, and how safe people feel speaking up. We sit down with Lizzie Benton, founder of Libertymind, to unpack what “mindset” really means inside an organization and how it quietly becomes culture through habits, language, and leaders...

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22:22

EP 549 Building A Better Provider Network - with...

The ShiftShapers Podcast ·

2026/05/19

We talk with Jared Pierce about why many provider networks run on outdated contracts and why that breaks trust for providers, members, and plan sponsors. We dig into how Unity builds a primary, provider-aligned network for self-funded plans that protects access while still driving real savings. • Jared’s early start building PPO networks at 17 and how it shaped his view of the system • Why legacy PPO networks “live off old paper” and what that means for pricing and trust • H...

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28:16

EP 548 All You Can Eat Compliance - with Carol Taylor

The ShiftShapers Podcast ·

2026/05/12

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...

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34:07

EP 547 New "Captivated Health" Book - with Mark Gaunya

The ShiftShapers Podcast ·

2026/05/05

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 ...

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21:38

EP 546 Well-Being That Actually Cuts Costs - with...

The ShiftShapers Podcast ·

2026/04/28

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...

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28:10

EP 345 Medicare Playbook For Agents - with Paige...

The ShiftShapers Podcast ·

2026/04/21

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...

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35:48

EP 544 Healthcare Costs Keep Rising Because Prices...

The ShiftShapers Podcast ·

2026/04/14

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...

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24:30

EP 543 Medical Arbitration Becomes A Profit Center -...

The ShiftShapers Podcast ·

2026/04/07

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...

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36:28

EP 542 What If Chronic Disease Was Optional? - with...

The ShiftShapers Podcast ·

2026/03/31

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...

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26:47

EP 537 When CFOs Treat Healthcare As Any Other Cost -...

The ShiftShapers Podcast ·

2026/03/24

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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32:35

EP 536 Ethics As The Competitive Edge - With Adam...

The ShiftShapers Podcast ·

2026/03/17

We dig into who truly makes claim decisions in self-funded plans and why that matters when ethics and compliance collide. Adam Russo shares how fiduciary prudence, transparent compensation, and NSA arbitration are reshaping risk, trust, and costs. • plan sponsors as final decision makers on claims • plan documents lagging laws and mandates • compliance versus ethics as distinct obligations • transparent compensation, performance fees, and caps • fiduciary prudence in subrogation and settleme...

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19:47

EP 535 From Founder Hustle To Scalable Structure -...

The ShiftShapers Podcast ·

2026/03/10

We dig into why growth stalls when roles blur and the founder stays the bottleneck. Forrest Durer shows how clear seats, weekly scorecards, and steady leadership cadence create accountability and make scaling calm and repeatable. • common founder-led bottlenecks and warning signs • seats defined by 5–7 responsibilities not titles • building a simple pyramid with an integrator or COO • activity-based KPIs and weekly scorecards • busy work versus productive work • weekly one-to-ones and leader...

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24:45

EP 534 ENCORE: Choice Without Chaos - with Chad...

The ShiftShapers Podcast ·

2025/12/30

We revisit how employers can control healthcare spend while expanding employee choice through ICRAs, with Chad Schneider of Thatch sharing what works, what breaks, and what’s next. We dig into change management, decision tools, dynamic contributions, and the broker’s evolving role. • Why ICRAs surged after 2020 and boomed in 2024 • Carrier expansion and a stronger individual market • The real barrier being change management and fintech • Decision support that mirrors travel-style shopping • ...

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25:37

EP 516 ENCORE: Rethinking Provider Networks - with...

The ShiftShapers Podcast ·

2025/12/23

We revisit how PPOs got built on discounts and show why total value beats sticker price. Scott Smith joins us to explain nationally curated high-performance networks that rank providers on effectiveness, appropriateness, and cost, and how that changes renewals, member experience, and fiduciary risk. • why traditional PPO discounts miss total cost of care • how consolidation and narrow networks increase abrasion • claims-based scoring at the provider NPI level • quality metrics that matter: e...

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