Tuesday Morning With Justin: Healthcare, Leadership & Life

Downstream Effect of the ACA Subsidies that Went Away

Send us Fan Mail [https://www.buzzsprout.com/1949549/fan_mail/new] Healthcare costs keep climbing because utilization is rising and high-cost drugs are changing the baseline, not because of a one-time post-COVID bump. We break down what the end of enhanced ACA subsidies means for the individual market and why employers feel the pressure next.  • employer-sponsored health plans facing 8% to 9% cost increases  • inflation not the only driver, with wages and hospital consolidation raising costs  • higher utilization as the lasting shift, including more screenings and more prescriptions  • specialty drugs and new therapies reshaping pharmacy spend, including GLP-1s and gene therapy  • ACA subsidy expiration triggering major premium spikes and more uninsured people  • tighter individual market making employer coverage more critical  • cost shifting dynamics that will hit employer plans  What can employers do? Practical employer moves, including challenging renewals and reviewing loss ratios. Focus on value through utilization management and a clear pharmacy strategy. Curious to explore what's possible? Let's connect.  Music by Alex Lambert. Support the show [https://www.buzzsprout.com/1949549/support] Contact Justin via text 740-525-5259 or via email JFutrell@TrueNorthCompanies.com I welcome the opportunity to hear your feedback from this episode! Thanks again to my musically gifted friend Alex Lambert for the music. Also thanks to Kevin Asehan for the edits.

Gene Therapy Part Two: Miracle of Medicine & Financial Landmine 💥

Send a text [https://www.buzzsprout.com/twilio/text_messages/1949549/open_sms] Gene therapy can cure diseases that once felt untouchable, but it can also trigger the biggest claim a self-funded employer may ever face. We focus on the hidden costs around the drug, why network contracting matters, and how transparency and preparation protect the health plan when rare cases hit. • Gene therapy risk for self-funded employers beyond the drug price • Hidden cost drivers like hospital stays, administration, and follow-up care • Contract loopholes and vague network terms that inflate total allowed cost • Why specialized gene therapy networks can run cheaper on average • The real-world math on how often gene therapy and transplant cases occur • Preparing for financial earthquakes with better planning and transparency The urgency that gene therapy is already here, not years away. Let me know if you want to discuss how to get more control of your outstanding risk.  Music by Alex Lambert. Support the show [https://www.buzzsprout.com/1949549/support] Contact Justin via text 740-525-5259 or via email JFutrell@TrueNorthCompanies.com I welcome the opportunity to hear your feedback from this episode! Thanks again to my musically gifted friend Alex Lambert for the music. Also thanks to Kevin Asehan for the edits.

Gene Therapy Part One: Sticker Shock, The Price of a Cure

Send us Fan Mail [https://www.buzzsprout.com/1949549/fan_mail/new] We unpack the shock of multi-million-dollar gene therapies and why a one-time cure can collide with a self-funded plan’s budget. We explain in vivo versus ex vivo approaches, where care happens, and how employers can think about coverage choices and preparation. • the cost reality of one-time gene therapies  • who pays on a self-funded plan  • tradeoffs of excluding versus covering therapies  • why centers of excellence matter  • differences between in vivo and ex vivo models  • examples including hemophilia and sickle cell  • operational needs for case management and stop-loss  • a preview of hidden employer risks next week Music by Alex Lambert. Support the show [https://www.buzzsprout.com/1949549/support] Contact Justin via text 740-525-5259 or via email JFutrell@TrueNorthCompanies.com I welcome the opportunity to hear your feedback from this episode! Thanks again to my musically gifted friend Alex Lambert for the music. Also thanks to Kevin Asehan for the edits.

You Might Pay Zero, But Your Company Pays $7,600 Per Shot

Send us Fan Mail [https://www.buzzsprout.com/1949549/fan_mail/new] We break down how a “$0 copay” specialty drug can cost an employer $7,600 per injection and why that gap exists. Then we show how transparent sourcing cut Enbrel from $38,000 a year to about $2,000 without sacrificing care. • how Enbrel is marketed versus what it treats • the hidden employer cost behind copay programs • five fills adding up to roughly $38,000 • plan risk thresholds and why unit cost matters • sourcing the same medication for $400 per fill • scaling savings across more specialty drugs • why healthcare needs real price transparency Let me know if there's any topic we want to cover in the future Music by Alex Lambert. Support the show [https://www.buzzsprout.com/1949549/support] Contact Justin via text 740-525-5259 or via email JFutrell@TrueNorthCompanies.com I welcome the opportunity to hear your feedback from this episode! Thanks again to my musically gifted friend Alex Lambert for the music. Also thanks to Kevin Asehan for the edits.

Multi-Million Dollar Claims are up 50% over last 4 Years

Send us Fan Mail [https://www.buzzsprout.com/1949549/fan_mail/new] We break down why 1% of employees drive a third of healthcare costs and how multi‑million dollar claims are rising. We show how site of care, quality data, and smart incentives can cut spend without cutting outcomes, including a $72k infusion savings case. • 1% of employees driving a third of spend • Multi‑million dollar claims rising 8% year over year and 50% over four years • High‑cost conditions including neoplasms, NICU, cardiovascular, sepsis, leukemia, lymphoma, multiple myeloma • Inpatient stays as the biggest cost driver • Traditional cost shifting failing to control trend • Site of care strategy for specialty drugs and infusions • Transparent imaging and surgical steerage with $0 options • Using infection rates and outcomes to build trust • Designing benefits that guide members to high‑value care Drop a comment, shoot me a text, let me know your thoughts. Music by Alex Lambert. Support the show [https://www.buzzsprout.com/1949549/support] Contact Justin via text 740-525-5259 or via email JFutrell@TrueNorthCompanies.com I welcome the opportunity to hear your feedback from this episode! Thanks again to my musically gifted friend Alex Lambert for the music. Also thanks to Kevin Asehan for the edits.