Short Stuff: AAirpass

When paperboys stopped delivering a couple of very big newspapers in 1899 it was a big deal. Big enough that the two biggest publishers in the world got pretty scared. But did it actually accomplish anything? 

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The story of what happened to the car that James Dean crashed.

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Whistling is pretty cool when you think about it because it can mean many things, from simple happy tunes to legit communication. Learn all about this ubiquitous skill today. 

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Long before slide rulers and pocket protectors, civilizations across the world used their noggins to build some impressive structures. Almost all have crumbled to ruins over the millennium, but thanks to the earliest tourists, we admire them still today. Explore some of them with Josh and Chuck in this classic episode.

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Wikipedia changed the world. Before it came along, you had to go to the library to get the answers you sought. And you and your friends had to just agree to disagree on facts. And as the internet grew and commercialized, Wikipedia remains free and open.

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Those armrests in the middle of benches aren’t just for your comfort, they’re intended to keep the homeless from laying on them. Cities are filled with these mean-spirited inconveniences. But who’s to say how a person should use a bench?

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In almost every part of the world, in some form or fashion, widows have things harder than they did when their spouses were alive. In some places it means they pay higher taxes, in others it means they’re ostracized to live on the margins of society.

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About 5,300 years ago a Copper Age shepherd was murdered. He just happened to die in a place where his body was so well preserved that gave researchers an actual shot at determining the course of his final day on Earth. Josh and Chuck take you through their reconstruction in this classic episode.

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Today we take to the friendly skies to detail the fascinating history of air travel. From planes with piano bars and lounges to the current no frills varieties. 

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The peace sign is one of the most globally recognized symbols around today, but it’s only a few decades old. And it wasn’t the hippies who created it, it was a group of Brits dedicated to nuclear disarmament in the 50s.

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Yonhee Choi Gordon is a Principal and the Chief Operating Officer of JMG Financial Group, an independent RIA based out of Chicago that oversees nearly $5 billion in assets under management for close to 1,500 households. What sets Yonhee apart is how, with her nearly four decades at JMG Financial Group, she has been instrumental in the company's succession plan and has personally recruited, trained, and retained the majority of the company's employees through a stringent hiring process to ensure alignment with the company's expectations and values.

Listen in as we delve into Yonhee’s career, including how she has been such an integral part of the hiring, training, and development systems, and how she evaluates potential candidates based on the actual tasks of the job, and how JMG structures its leadership roles and share of ownership. We also discuss why Yonhee believes that inconsistent definitions of advisor roles are contributing to the financial industry's rising level of M&A deals, why she teaches younger advisors to find their ideal role by first understanding their personal values and culture, and how her definition of success has evolved over time to focus on the impact and value she provides in the lives of the employees she leads.

For show notes and more visit: https://www.kitces.com/323

For most, the thought of testifying in Court is terrifying.  Regardless of whether you are a party or simply a witness, the anticipation of getting on the stand can stir up a high level of anxiety.  In this show, Todd and I discuss courtroom testimony and the top tips on how to prepare.  We also discuss some of the challenges lawyers face in helping witnesses get ready and how to take control of the situation to make sure you are prepared.   

For a full transcript of this episode, click here.

This show is different, so if you’ve already listened to or read all about the gory details of the J&J and/or the DOL v BCBS lawsuits, this is not gonna be a repeat of that information. Julie Selesnick, my guest today, does cover the very, very top line about these two cases. But after that, we move on fast—because what I wanted to get to today was not the potential landslide of legal action that may or may not be confronting plan sponsors or payers or even brokers today. I did not want to really even talk about the CAA (Consolidated Appropriations Act) and its inarguable adjacency here. I just feel like there’s been a lot of talk about these topics already.

What I wanted to get to, and fast, is … now what? If I’m a plan sponsor or actually, again, an EBC (employee benefit consultant) or broker, now what? What should I be doing and thinking about right now?

To that end, I could not have been more thrilled to get a chance to talk to Julie Selesnick, who is an attorney deeply entrenched in helping plan sponsors and others understand and comply with fiduciary responsibilities.

I want to get to this interview quickly (the conversation with Julie), so this intro is gonna be on the short side; but let me just summarize a few of the points that Julie makes during the interview that follows.

First, we talk about the first step for pretty much everybody: Get your data, plan sponsors. But once you have that data, you also kinda have to use it. You can use it to ensure that you’re paying claims right, which is what most do. As a result of these two lawsuits, it’s also increasingly clear that you also have to use that data to ensure that the prices you’re paying for things (like generic specialty meds, for example) are fair and reasonable.

To get the data now, you may have to renegotiate administrative services agreements; and you might need to take a closer look at the disclosure agreements you’re getting as a result of the CAA. And, by the way, it’s not just brokers or EBCs who have to complete these disclosures. It’s all covered entities that you, plan sponsors, paid more than $1000 to.

Then we get into … okay, once you have the data and you’ve analyzed it, what are some in general things that could very well need to happen? And if the reason that they don’t happen is because they weren’t even considered, then plan sponsors have some risk exposure; and the brokers/EBCs who serve them might have some conflicts of interest. And it would be very interesting what would or could happen if a plan sponsor was able to back into those conflicts of interest, because if data clearly shows that something should be happening and it is not—and it is not even on the docket to be considered—if I’m a plan sponsor, I’m for sure gonna be wondering why. And maybe I’m gonna look into that and fast. Listen to the show with AJ Loiacono (EP379) from two weeks ago for more on some of the more egregious broker/EBC conflicts of interest, which could explain, potentially, the J&J lawsuit as well as definitely explains the earlier one in Osceola.

And also, by the way, if you’re sitting there wondering to yourself how exactly J&J managed to pay upwards of $10,000 for a drug that can be purchased for cash for something like $50, listen to the show next week with Luke Slindee, PharmD. We run through the exact pharmacy supply chain machinations that make all of this (and more) possible.

But I got off track. What I was talking about is the things that could easily wind up being called for when the data is analyzed:

1. Carving out specialty generics, especially drugs or infusions, from the larger pharmacy benefit manager

2. Your payment integrity vendor should not be the same vendor who is processing claims. Talk about a conflict of interest. I do not need to be an attorney—and I need to know absolutely nothing about anybody’s data—to tell anybody who’s listening that if you have the same vendor or two vendors with the same parent company who are both processing your claims and then auditing their own work … yeah, fix that.

3. Shut down any cross-plan offsetting. And we get to this in the show if you don’t know what cross-plan offsetting means.

Lastly, we get into a bunch of stuff that plan sponsors might want to consider as they consider how to administer their plan, like, for example, setting up a health and welfare committee that has an independent fiduciary expert on said committee. I’m gonna say that’s a good idea!

As I have mentioned, my guest today is Julie Selesnick. Julie is senior counsel over at Berger Montague’s Employee Benefits and ERISA group.

You can learn more at Berger Montague. You can also follow Julie on LinkedIn.

Julie Selesnick has been practicing law since 2001 and has over 20 years of experience in complex dispute resolution forums representing plaintiffs and defendants. Julie has a wide variety of litigation, arbitration, and mediation practice, including first-chair jury and bench trial experience, representing some of the largest companies in the United States as well as small companies, labor unions, individuals, and classes of plaintiffs.

Julie’s current practice is a mix of class litigation on behalf of individuals, union funds, and employers, and a legal consulting practice advising self-funded health plans and service providers to self-funded health plans on minimizing litigation and regulatory risk, issues arising under ERISA, fiduciary obligations and best practices, and CAA compliance, including negotiating service provider contracts and business associate agreements, drafting plan documents and advising on plan design; helping health plans gain access to participant claims data, helping service providers draft and plan fiduciaries obtain § 408(b)(2)(B) compensation disclosures, assisting plans with ensuring their prescription drug data collection and reporting is properly conducted and copies are provided to plan fiduciaries, and ensuring proper review, MHPAEA Comparative Analysis reports on nonquantitative treatment limitations.

05:48 What’s happening with the J&J lawsuit?

07:38 What’s going on with the DOL v BCBS case?

08:49 What do these cases mean for plan sponsors?

09:21 Why is engaging with claims data critical?

12:30 EP408 with Chris Deacon.

14:20 EP379 with AJ Loiacono.

16:58 What’s one solution to avoiding a conflict of interest?

18:02 Why there’s still not a total understanding about what to do with claims data once acquired.

20:58 NADAC (National Average Drug Acquisition Cost) to check pharmacy prices.

21:31 What advice do plan sponsors need to know that never gets recommended to them when dealing with conflicting interests?

27:02 EP337 with Olivia Webb.

28:41 EP285 with Dawn Cornelis.

30:24 “As a fiduciary, your money should only go to pay your plan’s benefits, not to other plan benefits.”

30:59 What’s Julie’s advice to advisors?

33:17 “Giving nonconflicted advice … is something you really can only do if you have no conflicts.”

35:57 What’s Julie’s advice for administering whole plans?

You can learn more at Berger Montague. You can also follow Julie on LinkedIn.

Julie Selesnick discusses advice based on the J&J and DOL v BCBS lawsuits on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation

Recent past interviews:

Click a guest’s name for their latest RHV episode!

Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia, Marshall Allen, Stacey Richter (INBW39), Peter Hayes, Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372)

Indoor football has had hundreds of defunct teams or franchises switching leagues. The practice is considered almost common place. Yet when the Bloomington Edge decided to depart the Champions Indoor Football League for another, they were sued. Edge general manager Charles Welde talks as much as he can about the lawsuit and where the team sits today, as well as how it trains its staff and interns to sell experiences in such an uncertain environment.