Today I am speaking with Dave Chase from Health Rosetta, and I’m asking Dave Chase three inferno-level burning questions—questions that, across the country, many self-insured employers are trying to find the answers to.
For a full transcript of this episode, click here.
If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe.
Now, an important underlying point that comes across loud and clear but remains unsaid, actually, in the conversation that follows is this: There are amazing brokers and EBCs (employee benefit consultants) and benefits advisors or TPAs (third-party administrators) who put their clients first and have the receipts (ie, they have data and they’re willing to share it to prove this).
And then there are those with the exact same titles, often enough, who are very much the opposite of this but super charming, I’m sure. I mean, it’d be a stretch to assume that the same roles don’t apply to brokers or EBCs that apply for titles like hospital administrators where there’s great ones and really not great ones; but everybody often gets lumped into the same category or even the term hospitals.
Each of these terms is a broad stroke and contains multitudes. And do listen to the bonus clip from two weeks ago with Jonathan Baran for just more on this point. We dig into it for like 10 minutes or something. I also talk about this same concept in an upcoming episode with Mick Connors, MD.
So, keep that underlying and unsaid theme in mind because a lot of these questions do boil down to, How do you figure out who’s on the up-and-up and who’s not?
And if you need an example of the latter category, listen to the show with Ann Lewandowski (EP476) about the whistleblower lawsuit or the show with AJ Loiacono (EP379) about the myriad of brokers taking $7 or $14 per script written payable by the PBM (pharmacy benefit manager) and not reported on, as far as I know. This is very much still going on today, by the way, despite the CAA (Consolidated Appropriations Act) and the 5500 forms.
Alright, so, first burning question, Question 1: After seeing J&J (Johnson & Johnson) and Wells Fargo sued for fiduciary breaches, what specific questions do I need to ask my benefits advisor to prove that my benefits advisor actually protects my interests?
Okay, paraphrased, this question is employers trying to figure out what they can ask or how they can figure out if their benefits advisor or broker or employee benefit consultant is really as trustworthy as they’d like you to believe they are.
There’s been a whole bunch of shows that circle up on this. The thing is, though, the stakes are very, very high right now. So, yeah, I can see why this is turning into a burning question for anyone worried they might get sued personally unless they can figure out how to vet, for real in writing, who their broker, EBC, or advisor serves actually at the end of the day.
Question 2 that I ask Dave Chase, and I’m not giving you the answers to these questions. You gotta listen to the show. But here’s the second question I ask: How do I avoid personal liability when my TPA contract has hidden conflicts that could trigger an ERISA (Employee Retirement Income Security Act) lawsuit?
Kind of a continuation of Question 1, but yeah, you can tell that self-insured employer teams are really digging in here and many, many are very aware of, first of all, the extent and depth of middle people doing things like, again, allegedly taking $20 million of employer clients’ money and funding their executive bonus pool.
So, yeah, definitely this is another doozy of a burning question. Also on these same topics, listen to the show with Justin Leader (EP433) and also the one with Cynthia Fisher (EP457) about spread pricing.
Question 3 that I ask Dave Chase: My pharmacy costs keep climbing despite PBM guarantees. How do I tell if I am being systematically overcharged?
Well, if your consultants are taking your rebates to fund their executive bonus pools, as I just mentioned there’s a whole show about with Ann Lewandowski, or if they’re taking $7 a script for every script that gets written for your members, which, yeah, that’s afoot. I’ve seen the contracts and the cease and desists currently flying around our industry about that one.
Or read that Osceola County lawsuit against their longtime brokers.
Bottom line and end of this intro, informed employer teams are, for sure, wondering these questions. But even more than just wondering, what these questions signify to me, kind of at the macro level, they’re realizing the danger of kind of sitting on that knowledge or just assuming that because everybody else is doing whatever, it’s somehow safe—though status quo is getting kind of more and more dicey every single day.
As some additional foreshadowing, this show finishes up with Dave Chase talking about the open-source resources that are available so that you too can create a high-performance health plan where members get higher-quality healthcare and, as Dave Chase says, the cost savings for free.
There are links to many things that you can get from Health Rosetta and their sister company, Nautilus. Again, all the stuff is for free. Go to nautilushealth.org. That’s their main Web site.
Dave Chase, who has been on this podcast—I think this is his third time, although it has been a while—Dave Chase is co-founder and CEO of Health Rosetta.
Also mentioned in this episode are Health Rosetta; Jonathan Baran; Mick Connors, MD; Ann Lewandowski; AJ Loiacono; Chris Deacon; VerSan Consulting; Justin Leader; Cynthia Fisher; Nautilus; Andreas Mang; Blackstone; Jon Camire; Claire Brockbank; Elizabeth Mitchell; Scott Haas; Paul Holmes; Chris Crawford; Luke Slindee, PharmD; Mark Cuban; Marilyn Bartlett, CPA, CGMA, CMA, CFM; Leah Binder; and Dawn Cornelis.
You can learn more at Health Rosetta and follow Dave on LinkedIn.
Dave Chase is on a mission to restore hope, health, and economic well-being to communities through healthcare transformation. As creator of the community-owned health plan (COHP) model, he is building a nationwide movement that turns health plans from drivers of wage stagnation into vessels for well-being and wealth creation.
As founder of Health Rosetta, Dave has helped transform healthcare for thousands of employers covering more than five million Americans. What began with identifying just five successful health plans nationwide has grown into a movement with thousands of sustainable successes that deliver superior care at 20% to 50% lower costs.
In 2024, his team launched Nautilus Health Institute, catalyzed with $4 million in Health Rosetta intellectual property and investment. Nautilus provides open-source standards, contracting templates, and technology infrastructure (including METL, an open-source healthcare data platform) that establish new market norms benefiting employers, clinicians, and communities.
Dave’s work in healthcare transformation has reached over 10 million people through best-selling books (The CEO’s Guide to Restoring the American Dream, The Opioid Crisis Wake-up Call, Relocalizing Health), media, TED Talks, and TV/film appearances. He has received the World Health Care Congress’s Lifetime Achievement Award for Health Benefits Innovation.
Dave is dedicated to transforming healthcare through transparency, community ownership, and proven solutions that restore the American Dream.
06:36 What questions does a plan sponsor need to ask their consultant, EBC, or broker to ensure they are protecting the interest of the plan sponsor?
07:59 EP478 with Andreas Mang and Jon Camire.
08:49 EP453 with Claire Brockbank.
09:51 EP433 with Justin Leader.
09:53 EP436 with Elizabeth Mitchell.
11:03 How can plan sponsors avoid personal liability when their TPA has hidden conflicts of interest?
11:40 Tiara Yachts v. Blue Cross Blue Shield of Michigan lawsuit.
13:48 EP483 (Part 1) with Jonathan Baran.
14:18 EP457 with Cynthia Fisher.
16:18 The Marshall-Hickenlooper bill called the Price Tags Act.
16:50 Summer Short with Elizabeth Mitchell.
17:36 How do plan sponsors figure out if they are being overcharged for pharmacy benefits?
20:22 EP465 with Chris Crawford.
20:37 EP429 with Luke Slindee, PharmD.
22:56 EP476 with Ann Lewandowski.
28:38 Where to find open-source resources to help guide plan sponsors with making better health plan decisions.
29:47 How the open-source trend is growing for health transparency.
30:48 What to look forward to at RosettaFest.
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode), Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts), Andreas Mang and Jon Camire (EP479)