Tag: Healthcare reform

$11M on a $996K Bill? Dave Chase of Health Rosetta Unpacks the Hidden Trap (Ep. 17)

$11M on a $996K Bill? Dave Chase of Health Rosetta Unpacks the Hidden Trap (Ep. 17)

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Most employers have no idea what’s really driving their skyrocketing healthcare costs, and it’s not just medical inflation. It’s the contracts they’ve already signed.

In this episode of The Benefit Whisperer, Ralph Weber sits down with Dave Chase, founder of Health Rosetta, to uncover the hidden clauses and incentives that enrich insurers, PBMs, and hospital systems at the expense of your people and your bottom line.

You’ll learn:

  • How one employer paid $4 million on a bill originally priced at $996,000, all because of contract loopholes

  • Why anti-steerage clauses prevent you from guiding employees to safer, higher-value care

  • How access to your own data is the single biggest predictor of plan performance

  • The dirty truth behind PBM rebates, offshore GPOs, and the 50+ revenue streams you never see

  • What it takes to cut your per employee costs by 35%, without compromising care

If you’re a CEO, CFO, HR leader, or benefits advisor ready to stop feeding a system that’s rigged against you, this is the episode to hear.

🔍 Learn more at thebenefitwhisperer.com

📞 Book a free consultation: bit.ly/4nNI4I3

Connect with Ralph Weber
LinkedIn: Ralph Weber
Email: ralph@thebenefitwhisperer.com

Connect with Dave Chase
Health Rosetta: healthrosetta.org
LinkedIn: Dave Chase

Why Insurers Profit from Complexity and you Pay the Price with Guest David Scheinker (Ep. 14)

Why Insurers Profit from Complexity and you Pay the Price with Guest David Scheinker (Ep. 14)

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🎧 Episode 14: Dr. David Scheinker on Why Healthcare’s Complexity Isn’t an Accident

This week on The Benefit Whisperer, Ralph Weber is joined by Stanford’s Dr. David Scheinker, a leading voice in healthcare engineering and reform, to break down the $1 trillion in administrative waste baked into the U.S. healthcare system.

From vague insurance denials to year-long billing delays, Dr. Scheinker explains why these inefficiencies aren’t glitches, they’re features of a system designed to protect profits, not patients.

🔍 In this episode:

  • Why it took a year to bill for a pre-approved procedure

  • How AI is being used to fight appeals and deny claims

  • What the mortgage industry can teach healthcare

  • The root cause of system-wide complexity—and who benefits from it

If you’ve ever wondered why fixing healthcare feels impossible, this conversation offers rare clarity—and hope.

For benefits plans that eliminate waste and put employers back in control, visit routethree.com

Podcast episode thumbnail for The Benefit Whisperer featuring Dr. Don Berwick. Text reads: "The $5 Trillion Lie: Why U.S. Healthcare Fails Us ALL – With Guest Dr. Don Berwick." Includes headshots of Dr. Berwick and host Ralph Weber with Route Three branding and a microphone.
The $5 Trillion Lie: Why U.S. Healthcare Fails Us All With Guest Dr. Don Berwick (Ep. 12)

The $5 Trillion Lie: Why U.S. Healthcare Fails Us All With Guest Dr. Don Berwick (Ep. 12)

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In this powerful episode of The Benefit Whisperer, host Ralph Weber is joined by legendary health policy expert Dr. Donald Berwick, former CMS administrator, Harvard-trained pediatrician, and co-founder of the Institute for Healthcare Improvement, for a candid and urgent conversation about what’s really broken in American healthcare.

Dr. Berwick pulls no punches as he exposes the systemic greed, institutional profiteering, and regulatory loopholes that continue to drive costs up while delivering subpar outcomes. From Medicare Advantage overpayments and PBM manipulation to private equity’s quiet takeover of hospitals and autism care, Berwick breaks down how a system designed to heal has become a $5 trillion machine that transfers wealth from the poor to the rich.

They also discuss the global models that prove a better way is possible, and why American employers, lawmakers, and voters must step up if we want real reform. If you’ve ever felt that our healthcare system isn’t working for you, this episode is essential listening.

Chapters

00:00 Introduction to Healthcare Reform

01:01 Dr. Berwick’s Journey in Healthcare

03:34 The Impact of Profit-Seeking in Healthcare

06:25 Defining Greed in Healthcare

10:27 Healthcare as a Human Right

14:28 The Role of Legislation and Public Activism

18:38 Aligning Incentives with Patient Outcomes

20:57 Employer Responsibility in Healthcare

22:48 Global Perspectives on Healthcare Systems

24:31 Myths About Choice in Healthcare

26:54 Urgent Changes Needed in Congress

28:09 The Role of AI in Healthcare

34:11 Reflections on Leadership Changes in Healthcare
Julie Selesnick on the Lawsuit that Should Terrify Every Employer and Why You Could Be Next (Ep. 10)

Julie Selesnick on the Lawsuit that Should Terrify Every Employer and Why You Could Be Next (Ep. 10)

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In this must-watch episode of The Benefit Whisperer, Ralph Weber sits down with ERISA attorney Julie Selesnick to unpack one of the biggest legal stories in employee benefits: the JP Morgan healthcare lawsuit—and why it should matter to every employer and plan sponsor.

Julie brings 25+ years of legal experience and explains:
✅ What the JP Morgan case is really about
✅ Why PBMs (Pharmacy Benefit Managers) are under bipartisan fire
✅ How employers unknowingly violate fiduciary duties
✅ Why your broker might be working against your best interests
✅ What you must do now to protect your business and employees

This episode is essential for:

  • CFOs, HR Leaders, and Benefit Managers

  • Business owners with self-funded health plans

  • Anyone responsible for healthcare plan compliance

🎯 Learn how to safeguard your company from costly lawsuits and build a benefits plan that actually works.

🔔 Subscribe now for insider insights, unfiltered truths, and actionable strategies to reduce healthcare costs and improve employee benefits.

👉 Contact Ralph Weber:
📧 Ralph@TheBenefitWhisperer.com
📞 832-924-3330
🌐 www.thebenefitwhisperer.com

00:00 Introduction to Healthcare Law and ERISA

03:01 The Impact of the CAA on Healthcare Plans

05:58 Legal Trends in Pharmacy Benefit Managers (PBMs)

08:53 Understanding the JP Morgan Lawsuit

12:04 Fiduciary Duties in ERISA and Non-ERISA Plans

14:56 Potential Ripple Effects of the JP Morgan Case

17:59 Lessons for Employers from Recent Lawsuits

23:55 Understanding Controlled Groups and ERISA

26:28 Best Practices for Health Plans

31:15 The Future of Healthcare Litigation

37:48 Advice for HR Leaders and CFOs

39:54 The Importance of Benchmarking in Healthcare

#JPmorgan #HealthcareLawsuit #ERISA #PBMs #HealthPlanCompliance #EmployeeBenefits #JulieSelesnick #TheBenefitWhisperer #RalphWeber #TransparencyInHealthcare