🎧 Replay Episode: Rethinking Healthcare Costs with Direct Pay Models

As healthcare expenses continue to rise and insurance premiums stretch beyond affordability, more Americans are exploring alternatives. In this replay episode, we're revisiting a powerful conversation with Dr. Jawad Arshad, CEO of WoW Health Solutions, on how direct pay models could reshape ambulatory care.

Dr. Arshad breaks down the benefits, challenges, and potential of a direct pay approach — offering insights into a future where patients and providers interact more freely, transparently, and affordably.

Whether you're a healthcare professional, policymaker, or patient, this episode offers a thought-provoking look at how the healthcare system could work better.

🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com

In this REPLAY episode of ShiftShapers, host David interviews Paula Muto, a practicing surgeon and founder of Uber Docs. Paula shares her perspective on the inefficiencies in the current healthcare system, comparing buying health insurance to renting an apartment, and advocates for a direct pay model to improve the situation. She explains how Uber Docs facilitates transparent, direct transactions between patients and physicians, ultimately aiming to lower overall healthcare costs by empowering consumers. Key topics include the significant portion of healthcare costs dedicated to management rather than medical care, and how technology and consumer behaviors can drive positive changes in the healthcare landscape.

00:00 Introduction to Today's Guest and Topic

01:03 Paula Muto's Background and Inspiration

02:19 The Flaws in the Current Healthcare System

13:47 The Direct Pay Model Explained

15:55 How Uber Docs is Revolutionizing Healthcare

20:33 Conclusion and Final Thoughts

In this episode of ShiftShapers, host David A. Saltzman sits down with David Blair, founder and CEO of LucyRx, to explore a growing crisis in American healthcare: pharmacy deserts. As rural and underserved communities lose access to local pharmacies, millions are left without a vital link in the healthcare chain. David unpacks the economic and systemic challenges driving pharmacy closures and shares how LucyRx is stepping in to reshape the future of pharmacy care.

From the SPARK program to the push for federal regulation, David outlines what it takes to restore pharmacy access, reduce costs, and deliver more integrated care. This conversation also highlights the importance of aligning pharmacy locations with care providers—a proven strategy for improving outcomes and affordability.

📌 Related Resources:

• AMA: Physician Shortage is a National Emergency
  https://www.ama-assn.org/press-center/press-releases/ama-president-sounds-alarm-national-physician-shortage?utm_source=chatgpt.com
  
  
  
• HCSC: Linking Medical and Pharmacy Benefits Improves Care
  https://www.hcsc.com/newsroom/category/affordability/connecting-medical-pharmacy-benefits-improve-care-lower-costs?utm_source=chatgpt.com
  
  
  

🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com

🔑 Key Takeaways from This Episode

📌 Pharmacy Deserts Are a Healthcare Emergency
Millions live without convenient access to a pharmacy, leading to delays in care and worsening health outcomes. David Blair explains how this silent crisis is affecting rural and underserved populations.

📌 SPARK: A Scalable Solution for Pharmacy Access
LucyRx’s SPARK program brings pharmacy services back into communities through a hybrid of innovation, advocacy, and strategic partnerships.

📌 Federal Regulations Could Reverse the Trend
David advocates for smarter, centralized policy to address industry-wide economic challenges and ensure that pharmacies remain viable in low-density areas.

📌 Integrated Care Saves Money—and Lives
Blair highlights how co-locating care and pharmacy services leads to better health outcomes and significantly reduced costs.

📌 The Future of Pharmacy Is Local + Digital
The industry is evolving toward community-based pharmacy care that is supported by modern tech infrastructure and national reform.

⏱️ In This Episode

00:00 – Introduction to Rural Pharmacy Challenges
00:09 – Meet David Blair of LucyRx
01:07 – The Role of Pharmacists in Healthcare
01:48 – Understanding Pharmacy Deserts
02:41 – The Impact of Pharmacy Closures
05:31 – LucyRx's SPARK Program
07:18 – Advocating for Federal Regulations
09:58 – Economic Challenges for Pharmacies
17:05 – Integrated Specialty Care Network
20:58 – Future of the Pharmacy Industry
22:47 – Conclusion and Final Thoughts

In this episode of ShiftShapers, host David A. Saltzman welcomes compliance expert Carol Taylor, JM, of BenefitMall, for a deep dive into the rapidly evolving world of employer compliance. From court rulings and legislative penalties to HIPAA security updates and AI-driven benefit denials, Carol offers critical insights for anyone navigating today’s tangled regulatory landscape.

She unpacks the latest on ERISA preemption battles, mental health parity lawsuits, and the real-world impact of complex compliance rules on small agencies and employers. With rising penalties and tech-driven claim denials making headlines, Carol arms listeners with strategies to stay compliant—and stay out of court.

🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com

🔑 Key Takeaways from This Episode

📌 Penalties Are Rising—And Enforcement Is Too
Missing a CHIP notice or 5500 filing? That could cost thousands per day. Carol outlines the latest penalty increases and why the IRS is stepping up enforcement.

📌 HIPAA Security Changes Are Coming
From encryption rules to breach simulations, the proposed HIPAA security updates raise the bar—especially for small agencies who now face enterprise-level expectations.

📌 Compliance Risks from AI-Powered Claim Denials
Carol explains how AI is being used inappropriately by some carriers—and why plan sponsors need to examine how these tools align with ERISA.

📌 ERISA, MIA, and Legal Landmines
With court cases mounting over PBM regulation and mental health parity, Carol breaks down what’s at stake and how employers can avoid becoming the next headline.

📌 Future-Proofing Your Compliance Strategy
From updated plan docs to tighter internal protocols, Carol shares best practices that can help advisors and agencies stay ahead of evolving rules.

⏱️ In This Episode

00:00 – Introduction to Compliance Challenges
02:01 – Legislative Updates and Penalties
09:25 – HIPAA Security Rule Changes
18:11 – Court Cases and Legal Battles
23:20 – Mental Health Parity and Addiction Equity Act
27:00 – Future of Compliance and Final Thoughts

In this episode of ShiftShapers, host David A. Saltzman sits down with Neal Shah, co-founder of Counterforce Health, to explore how artificial intelligence is transforming the fight against denied health insurance claims.

Shah shares his personal journey from finance into healthcare advocacy, shaped by firsthand experiences navigating the broken healthcare system for his family. That path ultimately led to the creation of Counterforce Health—a free AI-powered platform that’s helping patients and small clinics appeal insurance claim denials with unprecedented efficiency.

With millions of claims denied each year—and most never appealed—Shah explains why automation is the key to leveling the playing field and giving patients back their voice. He also introduces Maxwell, Counterforce’s next-gen AI assistant, and previews the platform’s expanding capabilities for tackling insurers head-on.

🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com

🔑 Key Takeaways from This Episode

Why 450 Million Claims Get Denied—and Go Unchallenged
Despite the high success rate of appeals, fewer than 2% of denied claims are contested. Shah explains how complexity, red tape, and lack of awareness keep patients and providers from fighting back.

From Wall Street to Healthcare Warrior
Shah’s journey from finance to elder care—and ultimately to launching a mission-driven tech company—reveals how personal pain points can inspire powerful innovation.

How Counterforce Health Uses AI to Automate Appeals
The platform generates detailed appeal letters using legal precedents, medical journals, and historical data—empowering users to overturn denials without legal or medical expertise.

A 70% Win Rate That’s Beating the Odds
While national appeal success rates hover around 40–50%, Counterforce Health is seeing over 70% success—thanks to smart automation and a deep understanding of insurer tactics.

Introducing “Maxwell”: AI That Talks Back to Insurers
Neal reveals a sneak peek at Maxwell, an AI-powered voice assistant designed to handle phone calls with insurance companies—reducing workload and stress for patients, caregivers, and providers.
🎥 Watch the Maxwell demo: https://drive.google.com/file/d/1qckxAYx10cMvA_rL_vfSHxCktF19a9Qa/view

⏱️ In This Episode
00:00 Introduction: The Problem with Denied Claims
00:59 Meet Neal Shah: A Journey from Finance to Healthcare
03:22 The Birth of Counterforce Health
06:44 Understanding the Health Insurance Crisis
11:58 Counterforce Health: How It Works
14:42 The Role of AI in Fighting Denied Claims
22:42 Future Prospects and Final Thoughts

In this episode of ShiftShapers, host David A. Saltzman sits down with Vinay Patel, PharmD, founder of MakoRX, to expose why prescription pricing remains so confusing—and what can be done to fix it.

Patel breaks down how pharmacy benefit managers (PBMs), vertical integration, and opaque pricing structures are driving up costs for patients—while limiting access and undermining local pharmacies. From subscription pharmacy programs to cash-pay and compounding models, Patel shares bold, practical solutions for bringing real transparency back into the healthcare system.

🤖 Sponsored by BenePower

BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com

🔑 Key Takeaways from This Episode

1. The Truth About Prescription Pricing
   Patel explains how PBMs and vertically integrated systems distort drug pricing—making it difficult for patients to know what they’re really paying and why.
   
   
   
2. The Power of Local Pharmacies
   Community pharmacies often serve as the most frequent healthcare touchpoint for patients. Their role in building trust, offering consultations, and providing accessible services is critical to public health.
   
   
   
3. How MakoRX’s Subscription Pharmacy Program Brings Real Cost Transparency
   Patel details a model offering 300 commonly prescribed medications for a flat monthly fee—providing predictable costs and supporting a national network of independent pharmacies.
   
   
   
4. Breaking Up Healthcare Oligopolies
   To fix what’s broken, Patel supports breaking up vertically integrated giants, allowing regional players to compete on quality, service, and fair pricing.
   
   
   
5. The Role of Compounding and Cash-Pay Pharmacies
   With growing demand for affordability, Patel highlights how compounding and cash-pay pharmacies are offering lower-cost alternatives and bypassing insurance constraints.
   
   
   
6. A Vision for Integrated, Transparent Care
   Patel explores a future where technology enables collaboration between pharmacists and medical providers—creating a more coordinated, transparent, and patient-focused care model.
   
   
   

⏱️ In This Episode

00:00 Introduction and Guest Welcome
00:54 Vinay Patel's Career Journey
04:28 Challenges in the Healthcare System
05:49 Political Perspectives on Healthcare Reform
14:17 The Role and Importance of Community Pharmacies
20:02 Subscription Pharmacy Programs
25:30 Future Trends in Pharmacy and Healthcare
27:20 Conclusion and Farewell

Part 2 of our deep dive into Disability Insurance (DI) on the ShiftShapers Podcast goes beyond the basics—diving into strategic implementation, evolving underwriting standards, and revenue-generating opportunities for advisors.

In this episode, host David Saltzman continues the conversation with Don Schamay, Regional Director of Executive Benefits at The Principal, to explore how disability insurance can be a transformative tool for both clients and advisors.

Don shares his insights on how DI is becoming more accessible and relevant across demographics—from young professionals starting their financial journey to high-income executives looking to protect complex compensation packages. He explains how advisors can offer real value by aligning DI solutions with life stages, business needs, and long-term financial goals.

Whether you’re an advisor looking to enhance your client relationships or a business owner considering executive benefits, this episode is packed with actionable insights and forward-thinking strategies.

✅ Key Takeaways from the Episode:

• Young Professionals and DI
  DI isn’t just for high earners—young professionals stand to gain the most by locking in coverage early, when they’re healthy and premiums are lowest. Don shares how DI can be a cornerstone of early-stage financial planning.
  
  
  
• Business & Executive Solutions
  Business owners and C-suite professionals have unique income protection needs. Learn how DI solutions can be customized to protect not only personal income but also business continuity and executive benefits.
  
  
  
• Underwriting Improvements
  Traditional DI policies were often viewed as complex and hard to secure, but times have changed. With faster, more flexible underwriting options, advisors can now help clients get covered more efficiently than ever before.
  
  
  
• Revenue Potential for Advisors
  DI is more than a risk management tool—it’s a practice-building opportunity. By positioning themselves as income protection strategists, advisors can deepen trust, retain clients, and grow revenue.
  
  
  
• Advisor Education and Client Communication
  Don emphasizes the advisor’s role as an educator—helping clients truly understand the risks of income loss and the powerful ways DI can protect what they’ve worked so hard to build.
  
  
  

⏳ Episode Timestamps:

📌 00:00 – Introduction to Disability Insurance
👩‍⚕️ 01:03 – Understanding the Needs of Young Professionals
🏢 04:52 – Business Solutions for Disability Insurance
💼 09:07 – Executive Benefit Solutions Explained
📝 13:14 – The Underwriting Process and Its Evolution
💰 15:17 – Revenue Opportunities for Advisors
🎓 18:27 – Learning Resources and Final Thoughts

📢 This Episode is Sponsored by BenePower

BenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders.
🔗 Learn more at Benepower.com

Welcome to Part One of our deep dive into Disability Insurance (DI) on the ShiftShapers Podcast! In this two-part series. In this episode, host David Saltzman converses with Don Schamay, Regional Director of Executive Benefits at The Principal, about the often-overlooked importance of disability insurance in a comprehensive health insurance strategy. Don shares his journey from military service to a seasoned expert in disability insurance, emphasizing the critical need for both individual and group disability insurance to protect one's income. The discussion covers the prevalence of disability, how group and individual disability insurances differ, and the significance of educating clients about income protection and insurance options.

Key Takeaways from the Episode:

✅ Importance of DI – Disability insurance (DI) is an often-overlooked but crucial component of a comprehensive health insurance strategy. It provides financial protection if one is unable to work due to illness or injury.

✅ Group vs. Individual DI – Group disability insurance often covers basic salary and is a cost-effective, foundational benefit for businesses. Individual DI can supplement group coverage by filling in gaps and covering additional forms of income.

✅ Coverage and Income Protection – Properly structured DI ensures that individuals have a safety net that covers up to 80% of their income, considering both salary and other compensations like bonuses and K1 distributions.

✅ Market Trends – The DI market has become more competitive and robust, improving the quality and affordability of coverage. Newer carriers have entered the marketplace, stabilizing and enhancing the options available.

✅ Advisor’s Role – Advisors must educate clients on the significance of DI, ensuring that they understand the risks and the options for mitigating them. This includes both group and individual solutions tailored to the client's specific needs.

Episode Timestamps:

⏳ 00:00 Introduction to Disability Insurance
🛡️ 00:48 Don Schamay's Journey into Disability Insurance
💡 02:47 The Importance of Disability Insurance Today
📊 05:57 Understanding Disability Income Protection
🔍 06:57 Group vs. Individual Disability Insurance
📈 11:41 Coordinating Group and Individual Coverage
🎯 17:44 Advisors' Role in Disability Insurance
📉 20:44 Market Stability and Competition

📢 This Episode is Sponsored by BenePower

BenePower is an AI-powered platform that helps advisors build high-impact, self-insured health plans quickly and seamlessly by integrating the best point solutions, eliminating inefficiencies, and improving collaboration. It streamlines plan creation, reduces costs, enhances member outcomes, and positions advisors as industry leaders.

🔗 Learn more at Benepower.com.

Resources & Links:

🌐 Council for Disability Income Awareness: https://thecdia.org/