Tag: Healthcare

The Truth About PBMs and Rising Costs + What You Can Do About It (Ep. 19)

The Truth About PBMs and Rising Costs + What You Can Do About It (Ep. 19)

Healthcare costs are spiraling out of control, but most employers don’t realize they have the power to change the game.

In this episode of The Benefit Whisperer, Ralph Weber explains why CFOs and CEOs must step into the role of health plan architects because fiduciary responsibility doesn’t stop at payroll.

Ralph and co-host Bill Tucker dig into the truth about PBMs (pharmacy benefit managers) and how these companies profit from a system that drives up premiums and hides real costs. 

Ralph breaks down the critical differences between fully insured and self-insured plans, why transparency is key, and how tools like MediPay.ai give companies leverage to save money while improving care for employees.

Here’s what discussions you can expect in the episode:

  • Why fiduciary lawsuits are changing employer responsibilities
  • How self-insured plans offer control and cost savings
  • Why PBM pricing remains a hidden threat
  • Practical steps to start designing smarter benefits
  • And more!

Resources:

Connect with Ralph Weber:

Why “Good Discounts” Are Costing You a Fortune. Inside a Smarter Healthcare Model: Reference-Based Pricing with Adam Russo, Esq. (Ep. 9)

Why “Good Discounts” Are Costing You a Fortune. Inside a Smarter Healthcare Model: Reference-Based Pricing with Adam Russo, Esq. (Ep. 9)

Is your PPO network actually saving you money—or just selling you a myth?

In this eye-opening episode of The Benefit Whisperer, host Ralph Weber sits down with Adam Russo, co-founder and CEO of The Phia Group, to expose the broken economics of traditional healthcare pricing. They dive deep into the real story behind Reference-Based Pricing (RBP), why most brokers avoid it, and how smart employers are slashing costs without cutting care.

✅ The truth about PPO “discounts”
✅ Why laziness—not logic—drives plan design
✅ How RBP protects patients from surprise billing
✅ What AI and price transparency mean for the future of healthcare

🎧 Whether you’re a CEO, benefits advisor, or just tired of rising deductibles and shrinking benefits, this episode will change how you think about cost, quality, and control in healthcare.

🔗 Learn more about Adam Russo and The Phia Group: https://phiagroup.com
📩 Contact Ralph: Ralph@thebenefitwhisperer.com
📞 Call: 832-924-3330

Chapters

00:00 Introduction to Healthcare Challenges

02:36 Understanding Reference-Based Pricing

06:40 The Necessity of Reference-Based Pricing

12:47 Consumerism in Healthcare

18:41 Addressing Balance Billing Concerns

22:22 The Power of Representation in Healthcare Billing

24:18 Understanding Healthcare Pricing Variance

26:40 The Importance of Patient Education

28:15 Challenges in Educating Employers and Employees

32:24 Implementing Reference-Based Pricing

34:54 Analyzing Healthcare Data for Cost Reduction

36:33 The Role of AI in Healthcare Transparency

👇 Drop a comment, share with a friend, and hit subscribe to never miss an episode of The Benefit Whisperer.

#healthcarecosts #RBP #benefitsstrategy #healthcaretransparency #thebenefitwhisperer #AdamRusso #employeebenefits #healthcarepodcast