Advertise on podcast: The ShiftShapers Podcast

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 coverage and access: about 90% of Americans have health insurance, yet only around half believe they can afford the care and prescriptions they need. Ken explains how high-deductible health plans, thinner benefits, and cost shifting can turn insured employees into “functionally uninsured” patients who delay preventive care, skip chronic disease management, and show up later in the ER or ICU with avoidable complications. From there we zoom out to the system-wide pressure. Physicians are increasingly employed by large systems and face heavier administrative load, reduced autonomy, and rising burnout. Employers are “tearing their hair out” as healthcare costs consume more compensation, with small businesses already dropping coverage and larger firms warning the model is unsustainable. Ken lays out a market-based path forward built around “basic care” subscriptions led by scaled primary care groups that compete on cost, quality, and patient experience, and he makes the case that saving primary care is the most urgent first move. If you found this helpful, subscribe, share the episode with a colleague, and leave a review so more employers, advisors, and policymakers can find the conversation.

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 “high-quality motivation” and how patient-centered counseling helps people find their own reasons to change, build confidence, and make plans that fit real life. We also unpack why asking great questions can matter more than giving great answers, and how large language models need to be trained away from default, advice-heavy coaching. From there we move into what makes therapeutic AI different from a basic chatbot, where the legal and ethical boundaries sit today, and how guardrails can reduce risk around hallucinations, high-stakes emotions, diagnosis, and prescribing. You’ll hear practical examples like type 2 diabetes behavior support, between-session check-ins, and just-in-time interventions that meet people in the moment, including in a grocery store aisle. If you advise employers or design benefits, we connect the dots to cost, reach, outcomes, and what’s next: integrating digital coaching with electronic health records like Epic so AI becomes a true teammate to clinicians. If this conversation challenges your assumptions, subscribe, share it with a colleague, and leave a review with your take: where should AI help most in behavioral health?

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 down with Jack Hooper, founder and CEO of Take Command Health, to unpack findings from their 2026 State of Employee Health Benefit Survey and what they suggest about the future of employee benefits. We dig into rising healthcare costs, why benefits anxiety shows up as higher deductibles and shrinking coverage, and how gaps like mental health coverage shape what employees want next. We also talk through why individual coverage paired with a defined contribution approach can change the cost equation, including how employees often choose networks and metal tiers differently than employers do. We then move from theory to execution: where employers should start, why change management makes or breaks an Individual Coverage HRA (ICRA) rollout, and what advisors need to stop assuming if they want to stay relevant as the market shifts. If you’re an HR leader, business owner, broker, or benefits consultant trying to reduce renewal chaos while improving employee choice, this conversation gives you a practical map and clearer language for what’s changing and why.  Subscribe for more interviews on the future of health benefits, share this with a colleague who’s stuck in renewal season, and leave a review with your biggest question about ICRA or defined contribution benefits.

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 the difference between change management tasks and true change leadership: making trade-offs visible, building shared clarity, and developing the capability to execute. Leslie introduces a simple diagnostic that instantly sharpens decision-making: is the constraint ability (skills, tools, bandwidth, execution capacity) or alignment (coherence, commitment, and coordinated action)? We also unpack a critical nuance that saves teams months of wasted effort: alignment is not agreement, and chasing consensus can slow change more than any skeptic. Friction comes up for a reason. Leslie reframes tension as “strategic tension,” the raw material of organizational change, and explains how curious leaders use it to create commitment instead of short-term compliance. You’ll hear a real digital transformation turnaround where everything looked green on the dashboard, yet the team was drowning, and a two-day reset brought clarity, realistic expectations, and better outcomes. If you lead change in the employee benefits industry or any high-stakes environment, you’ll leave with a Monday-morning checklist and a leadership mindset reset. Subscribe for more conversations like this, share the episode with a colleague who’s living through a messy rollout, and leave a review so more leaders can find it.

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 target list, plus the creativity of plaintiffs’ firms applying an established ERISA playbook to health plan cost drivers and vendor relationships. We get practical about what actually creates fiduciary status: discretion, control, and decision-making power over plan assets or administration. A disclaimer in a contract helps only if our behavior matches it. That leads to concrete safeguards brokers can use immediately, like documenting options, clarifying who makes the final call, and keeping our own records so a client can’t later say “my broker made all the decisions.” From there, we connect fiduciary duty to cost containment basics that often get ignored, including subrogation and other recovery programs where leaving money on the table can look like a failure to follow plan terms and a failure of prudent asset management. Finally, we zoom out to what’s next: PBM transparency pressure, out-of-network claims governance, and an emerging No Surprises Act risk where plans pay through the federal process when the claim never qualified. If you advise employer-sponsored health plans, this conversation is a must-listen for staying valuable without accidentally becoming the decision-maker. Subscribe, share this with a colleague, and leave a review with the biggest fiduciary risk you think advisors are underestimating.

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 antivirus alone don’t stop social engineering  • where agencies are most vulnerable today: email credentials and tool connections  • what “layered” user-based protection looks like in real life  • why password managers change the social engineering game  • how ongoing security awareness training finds gaps faster than annual check-the-box training  • why cloud storage is not the same as encrypted backups  • how AI is already being used inside agencies without formal approval  • practical AI wins that avoid sensitive data and improve efficiency  • what client expectations are becoming in an AI world and why relationships still matter

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 leadership norms. We explore why values on a wall don’t matter if the lived experience signals control or suspicion, and how a transactional employer-employee relationship can drain performance even when the perks look generous. Along the way, Lizzie shares practical ways to build trust through authenticity and vulnerability, including the simple power of saying “I don’t know, but I’ll find out.” For employee benefits advisors and small business owners, we get concrete about what to watch for: the phrases leaders use about their teams, the emotional “temperature” when you walk into an office, and the subtle signs that disengagement is baked into the system. We also challenge the “more benefits equals better results” assumption by focusing on intrinsic motivation: autonomy, agency, growth, and meaningful impact. Finally, we look ahead at the AI workplace and why culture, communication, and human connection become even more important as mundane work gets automated. If you want better employee engagement and better benefits ROI, press play, then subscribe, share this with a colleague, and leave a review with the culture signal you think advisors should never ignore.

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  • How reference-based pricing can create confusion, appeals, and members turned away  • What “RBP-level reimbursement with real contracts” looks like in practice  • Using historical claims data and member nominations to build a customized network  • Why clear, simpler contracts improve provider participation and reduce noise  • Bootstrapping growth without private equity and staying independent longer  • Where Unity is seeing adoption and what advisors should watch next  • The future network model tied to member incentives and smarter plan design

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 file  • practical steps for HIOS access and employer uploads  • CAA 2026 expansion of PBM disclosure and rebate rules  • what PBM transparency can reveal about pricing and compensation  • ERISA fiduciary exposure for employers and individual decision-makers  • how advisors draw boundaries to avoid functional fiduciary status  • renewed ACA employer mandate enforcement around 1094 and 1095 filings  • why a mental health parity enforcement pause does not remove MAPEA duties  • ongoing No Surprises Act IDR problems and cost impacts  • using a compliance audit checklist and reviewing E&O coverage limits

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 less bad renewal cycle traps employers without claims data and transparency  • Why Mark wrote Captivated Health and how case studies teach faster than jargon  • Captive insurance versus traditional self-funding, including stop loss and risk layers  • The four pillars of Captivated Health: members first, consumerism, wellbeing culture, self-governance  • How employers can control the SPD, stop loss contract, and TPA agreement  • outcomes from captive ownership: lower trend, pharmacy control, surplus, and rebate distributions  • Practical stories: bundled maternity pricing plus shared savings, adding LASIK through plan design  • The leadership mindset shift from system decision to self-decision  • What implementation really looks like for HR and finance without adding headcount  If you're an employer and you're struggling with these kinds of issues, and most of you are,  or if you're a broker and you have clients who are struggling with these issues, please get the book, "Captivated Health. Take Control. Gain Transparency. Leverage Confidence." CLICK HERE

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 claims to target high-impact conditions • integrating point solutions into a coordinated system • using GLP-1s with coaching, guardrails, and taper plans • setting realistic timelines for years two and three • how AI and claims integration guide next-best actions For more information or to schedule a demo of the Benepower Advantage, go to Benepower.com They absolutely can either call me or they can email me at arutkowski at navigatewell.com

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 book of business: relationship-building, client education, and the discipline of doing a true needs analysis. Paige shares why “getting the plan right” means checking doctors and prescriptions down to the dosage, and why the best agents think long-term through retention, renewals, and referrals instead of chasing AEP like a short-term payout. We also dig into year-round touchpoints that keep clients connected, from birthday outreach to thoughtful follow-up after major health events, and how a simple “call me first” mindset protects seniors from confusing ads and sales calls. On the regulatory side, we cover Medicare compliance, CMS oversight, and why cutting corners is the fastest way to lose trust. Paige breaks down IRMAA (the income-related monthly adjustment amount), the two-year lookback, and how to set expectations so clients aren’t blindsided by a premium surcharge. We close by looking forward at technology and AI, and what the next generation of retirees may demand from the Medicare enrollment process. Subscribe for more conversations on the shifts shaping benefits and insurance, then share this with an agent who cares about doing it right and leave us a review with your biggest Medicare question.

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 drugmakers  • Why Washington lacks ERISA and employer-plan expertise  • What CAA 2026 changes for PBM disclosures and fiduciary responsibility  • How “check the box” compliance can fail without enforcement  • How employers can use machine readable files plus claims data for network analysis  • Why cash-pay and direct contracting get blocked by network contract provisions  • What near-term reforms could bend the cost curve, including stronger HSA and ICHRA models You can find me at katytolento.com

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 open negotiation window, and the IDR process where an arbitrator picks one of two numbers. Then we dig into the headline signals from PHIA’s national NSA report analyzing more than 1.25 million federal IDR disputes across 23,000-plus providers. When offers land five to six times above QPA and initiating parties win around 80% of the time, it creates a powerful incentive to file early and file often. For employer-sponsored health plans, especially self-funded groups like school districts and public safety employers, that can translate into budget shocks, higher renewals, and rising stop-loss pressure even when members never see a bill. We also explore why a small cluster of providers can drive a disproportionate share of disputes, what hotspots in certain states may be telling us about market power and network penetration, and how brokers and benefits advisors can protect clients with better data, tighter timelines, and a real IDR strategy instead of a reactive scramble. If you advise plan sponsors, this is a must-listen on NSA compliance, healthcare cost containment, fiduciary responsibility, and the evolving economics of out-of-network reimbursement. If this helped you, subscribe, share it with a colleague, and leave a review so more plan sponsors and advisors can find the conversation. What IDR pattern are you seeing in your own claims data?

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 outcomes  • fasting insulin and CGMs as earlier and more actionable markers than glucose alone  • nutritional ketosis versus diabetic ketoacidosis and why the terms get conflated  • GLP-1 medication costs plus the idea of a structured GLP-1 off-ramp  • reported outcomes including weight loss and guaranteed improvements in A1C and blood pressure  • deprescribing as a safety requirement when health improves quickly  • ROI logic for self-funded plans including claims reduction and lower pharmacy spend  Call my cell phone, 262-255-9545. [email protected]