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THE OPIOID CRISIS WAKE-UP CALL HEALTH CARE IS STEALING THE AMERICAN DREAM. HERE’S HOW WE TAKE IT BACK. Dave Chase THE OPIOID CRISIS WAKE-UP CALL-HEALTH CARE IS STEALING THE AMERICAN DREAM. HERE’S HOW WE TAKE IT BACK. www.healthrosetta.org Copyright © 2018 by Dave Chase. All Rights Reserved. Published by Health Rosetta Media, Seattle, WA No portion of this book may be reproduced or transmitted by any means, electronic or mechanical—including photocopying, faxing, recording, or by any information storage and retrieval system, e.g., Internet website or academic eReserves—without explicit permission from the publisher. Reviewers are welcome to quote passages under the rules of Fair Use. Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations of warranties with respect to the accuracy or completeness of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor the author shall be liable for damages arising herefrom. This book’s content significantly overlaps, updates, and expands on content first published in the author’s last book, The CEO’s Guide to Restoring the American Dream. This book’s purpose is to connect the concepts introduced in that book to the human and societal damage caused by the Opioid Crisis, as well as make the content relevant to a wider audience. ISBN: 978-0-9992343-3-4 (Softcover) 978-0-9992343-4-1 (Hardcover) 978-0-9992343-5-8 (E-Book) Printed primarily in the United States of America Publisher’s Cataloging-in-Publication Data The Opioid Crisis Wake-Up Call Health Care is Stealing the American Dream. Here’s How We Take it Back. Dave Chase 1. Health insurance—United States—Costs. 2. Business & Economics—Insurance—Health. 3. Employee—Medical Care—United States—Cost Control. 4. Employer Health Care Benefits. 5. Business & Economics—Management. Dedicated to my family - Coleen, Abby & Cam - who have supported my never-ending passion for reforming health care, and especially to my parents - Barbara & Vern - inspiring role models who have won the Citizens of the Year award in two different towns. Thank you for being exceptional examples of how to positively impact every community you touch. TABLE OF CONTENTS l Preface........................................................................................................................ix Introduction ........................................................................................................... xiii A Note on Reading This Book ............................................................................ xvii Part I: The Current Situation ............................................................1 Chapter 1 The Opioid Crisis Isn’t an Anomaly ....................................................................... 2 Chapter 2 So How Did We Get Here ...................................................................................... 17 Chapter 3 America Has Gone to War for Far Less ................................................................ 25 Case Study Pittsburgh (Allegheny County) Schools .............................................................. 37 Chapter 4 Health Care Costs are Flat Despite What You Have Heard .............................. 42 Chapter 5 What You Don’t Know About the Pressures and Constraints Facing Insurance Executives Costs You Dearly .................................................. 52 Chapter 6 Health Care is Stealing Millennials’ Future – But They Will Take it Back ....................................................................................................60 Case Study Rosen Hotels & Resorts .......................................................................................... 70 v The Opioid Crisis Wake-up Call Part II: How and Why We Are Getting Fleeced ...........................75 Chapter 7 7 Tricks Used to Redistribute Money From Your Organization to the Health Care Industry .....................................................76 Chapter 8 PPO Networks Deliver Value—and Other Flawed Assumptions That Crush Your Budget ..................................................................85 Case Study City of Milwaukee ................................................................................................... 92 Chapter 9 Criminal Fraud is Much Bigger Than You Think ............................................... 95 Chapter 10 Are Workplace Wellness Programs Hazardous to Your Health? ................... 101 Part III: Doing It Right ..................................................................107 Chapter 11 You Run a Health Care Business Whether You Like it or Not ........................ 108 Chapter 12 How to Pick a Benefits Consultant ......................................................................117 Case Study Langdale Industries .............................................................................................. 128 Chapter 13 The 7 Habits of Highly Effective Benefits Professionals ................................. 133 Chapter 14 Centers of Excellence Offer a Golden Opportunity ......................................... 138 Chapter 15 Independent Claims Administrators vs. Insurance Company Claims Administrators –The Trade-Offs ............................................................ 144 Chapter 16 The Future of Health Will Be Local, Open, and Independent ......................... 160 Chapter 17 Health 3.0 Vision and Implications for Providers & Government ................. 173 Chapter 18 Economic Development 3.0: Communities Take Center Stage ...................... 186 vi The Opioid Crisis Wake-up Call Chapter 19 Mayors Must Lead Cities Out of the Opioid Crisis ......................................... 196 Case Study Rural county goes from highest to lowest rate of opioid deaths in two years ............................................................................................................ 206 Chapter 20 Making Sure Opioid Mitigation Plans Mitigate the Right Things ................. 209 Part IV: Restoring Hope, Health, & Well- being in Our Communities .......................................................................221 Chapter 21 Value-Based Primary Care ................................................................................... 223 Chapter 22 Transparent Open Networks ............................................................................... 231 Case Study Enovation Controls ............................................................................................... 238 Chapter 23 Concierge-Style Employee Customer Service ................................................... 243 Chapter 24 High-Value, Transparent TPA ......................................................................................... 248 Chapter 25 Transparent Pharmacy Benefits .......................................................................... 255 Chapter 26 “ERISA Fiduciary Risk is the Largest Undisclosed Risk I’ve Seen in My Career” ....................................................................................... 263 Conclusion ............................................................................................................. 272 Acknowledgments & Author’s Note .................................................................. 281 Appendix A Evidence-Based Services for People with Opioid Use Disorder .................... 289 Appendix B Status Quo Benefits vs. Health Rosetta Type Benefits ....................................293 Appendix C A Practical Handbook for Systems Change ........................................................299 Appendix D Client Notice, Plan Sponsor Bill of Rights, and Code of Conduct ................ 315 vii The Opioid Crisis Wake-up Call Appendix E Sample Compensation Disclosure Form ........................................................... 321 Appendix F Health Rosetta Principles ................................................................................... 327 Appendix G Why Doctors are Running Out of Empathy ..................................................... 341 Appendix H Amazon, Berkshire Hathaway and JP Morgan Chase Can Lead Employer Solution to Opioid Crisis on the Journey to Larger Health Care Reinvention ............................................... 351 Appendix I Decoding a fully insured renewal ....................................................................... 363 Appendix J Benefits Options for Small Businesses and Sole Proprietors ........................ 373 Author Bio .............................................................................................................. 379 End Notes ............................................................................................................... 381 Index ........................................................................................................................ 401 viii PREFACE l y the time I was 35, I had lost ten close friends who were my age or younger. It’s a gut punch to be reminded how short Bour time here is, but one loss hit me harder than any other: a friend died of cancer, and the system failed her in every way. She was a talented tech executive and worked her way to the top lev- els of Silicon