Dysrupt Healthcare Podcast

Most CFOs would never tolerate sloppy spending anywhere else in the P&L… except in the second-largest expense of the business: healthcare.In this episode of the Disrupt Healthcare Podcast, host Lester J. Morales sits down with Dean Jargo, former CFO and founder of Fair Market Health, to unpack why the traditional fully-insured model is structurally misaligned — and how employers can use free-market, direct contracting strategies to pay less while giving employees better access to care.Dean shares how his perspective shifted after his wife’s cancer and emergency heart surgery threw his family deep into the healthcare system. From there, he breaks down why insurance networks aren’t really negotiating “for” employers, how minimum loss ratio rules (MLR) incentivize higher claim costs, and why CFOs must get directly involved instead of delegating everything to HR and big brokerage firms.You’ll also hear how Fair Market Health helps employers buy services like MRIs, surgeries and other procedures directly from providers at a fair price, often:Saving 35–45% on individual services purchased directReducing total plan spend by 10–20%Waiving member out-of-pocket costs while still paying providers fairly and quicklyIf you’re a CFO, CEO, HR leader or advisor, this conversation will change how you think about your health plan, your broker — and your responsibility to your people.Show NotesWhy fully-insured carriers are structurally incentivized for higher claim costs, not lowerWhat a fair market, direct-pay model looks like for hospitals, employers and employeesHow deductibles & out-of-pocket for employees show up as accounts receivable on the hospital sideWhy hospital systems obsess over revenue instead of net profit, collection costs and time value of moneyThe biggest mindset blocks for hospital administrators and employer C-suitTimestamps00:00 – 01:04 | Intro: From Impact to Disrupt Healthcare — and why the Y matters01:05 – 03:21 | Meet Dean Jargo: finance background, free-market mindset, and his wife’s cancer + emergency heart surgery story03:22 – 04:57 | What is Fair Market Health? Creating a truly “fair price” marketplace between buyers and sellers of healthcare04:58 – 08:32 | Who really decides the price of an MRI? The illusion of “negotiated discounts” in traditional networks08:33 – 12:08 | Why carriers don’t benefit from lowering costs: MLR rules, revenue growth and misaligned incentives12:09 – 14:06 | Dean’s biggest surprise: how many high-quality vendors already exist to run better, partially self-funded plans14:07 – 17:46 | The “cost of change” myth and why disruption is actually what employees are begging for17:47 – 20:20 | Transparent pricing + waived out-of-pocket: how buying direct actually increases access to care20:21 – 22:43 | Deductibles vs A/R: the moment Lester realized member cost-sharing is just hospital accounts receivable22:44 – 25:04 | Hospitals chasing revenue vs. focusing on net profit, collection costs and time value of money25:05 – 27:26 | The win–win–win triangle: hospital, employer and employee all benefit in a direct model27:27 – 29:38 | The emotional toll: EOBs, confusing bills and stress stacked on top of serious illness29:39 – 32:00 | On the provider side: revenue myopia and “we’ve always done it this way” thinking32:01 – 33:05 | On the employer side: how CEOs & CFOs delegate benefits decisions into misaligned hands33:06 – 35:08 | Claims analysis 101: what Dean finds when he reprices 12–24 months of claims data35:09 – 36:19 | Access advantage: why direct-pay patients move to the top of the schedule36:20 – 37:36 | Dean’s message to CFOs: get engaged — your health plan is probably your highest-ROI project37:37 – 38:22 | Lester’s example: $3.5M in Rx savings vs $25–30M in extra sales38:23 – 39:23 | Where to find Dean and final call to action for financial leaders39:24 – 40:23 | Closing: why we must disrupt healthcare before it breaks

In this quick recap of the Dysrupt Healthcare Podcast, host Lester J. Morales distills key takeaways from his interview with Heath Potter, Chief Growth Officer at Six Degrees Health—a leader in reference-based pricing (RBP) and transparent reimbursement.Lester challenges the industry’s fear of RBP, calls out incentive conflicts that keep employers in the dark, and explains (in plain English) how bottom-up “Medicare-plus” pricing gets to a fair price—without the games behind “big network discounts.” He also shares real-world wins, access myths vs. facts, and why collaboration (not litigation) is the sustainable path.You’ll learn:Why many advisors still resist RBP—and how to sanity-check that biasTop-down (billed charges minus “discount”) vs. bottom-up (Medicare-plus) pricingHow modern RBP uses data + negotiation to reach fair provider paymentsAccess & member experience: what’s changed from RBP 1.0 to todayCase stories: open access, community contracts, and keeping dollars localHow to request a no-obligation impact/savings analysis to compare modelsIf you’re a self-funded employer, HR/benefits leader, or advisor, this recap gives you the essentials in minutes—so you can decide whether to dive into the full episode.00:00 – “This podcast has been disrupted.”00:07 – What these recap episodes are (and why)00:40 – Guest context: Heath Potter, Six Degrees Health (RBP leader)01:03 – Love it? Hate it? Why advisors feel strongly about RBP02:24 – Gut-check your bias: incentives, overrides, and “follow the money”03:27 – Hundreds of RBP implementations: wins vs. rare rough patches05:23 – The core value of RBP: transparency and bottom-up pricing06:38 – “Discount off what?” Charge master, billed charges, and the game06:55 – RBP in one line: get to the price (Medicare-plus)07:05 – Why Six Degrees’ data-driven, collaborative model works09:17 – Many hospitals already use RBP-ish logic internally10:10 – Imagine a fair-price roundtable… and the reality today10:39 – Six Degrees’ posture: start fair, show data, negotiate10:51 – Real examples: open access, family stories, local community wins11:37 – When carriers and hospitals fight… the member/employer loses11:58 – Strategy: collaborate with good actors; limit exposure to bad ones12:21 – Employers: if your advisor won’t teach RBP, reconsider12:45 – If we don’t solve it, government will—lead the change13:09 – CTA: request an impact analysis to compare savings13:46 – Listen to the full episode with Heath Potter; share/like/feedback14:00 – Thanks for listening to the Dysrupt recapGuest: Heath Potter, Chief Growth Officer — Six Degrees HealthHost: Lester J. Morales — Dysrupt Healthcare Podcastreference based pricing, RBP, Medicare plus pricing, Six Degrees Health, Heath Potter, Lester J Morales, self funded employers, healthcare transparency, cost containment, medical claims, employer health plans, open access, negotiation not litigation, benefits advisors, Dysrupt Healthcare Podcast🕒 Timestamps🔗 Guest & Host🔍 SEO Keywords / Tags

In this special recap episode of the Dysrupt Healthcare Podcast, host Lester J. Morales breaks down the key lessons from his powerful conversation with Kimberly Carlson, CEO of U.S. Beacon — an independently owned medical claims integrity review company helping employers reclaim millions lost to billing errors.Using a simple grocery-store analogy, Lester exposes the shocking truth: nearly every medical bill in America contains mistakes — and most employers never audit them.He shares actionable strategies for self-funded employers and advisors to take control, demand transparency, and protect their plan dollars.You’ll learn:Why 99% of healthcare bills have errors — and how much that’s costing you.How independent audits recover 2–6 % (or more) of total claim spend.The contractual traps that limit employers’ ability to audit their own data.How to write “audit-friendly” RFP clauses that guarantee full access to your claim data.Why transparency and leadership are essential to fixing a broken system.💡 Whether you’re an employer, HR leader, or benefits advisor, this quick recap gives you the insights — and the “why” — to disrupt the way healthcare billing has always been done.00:00 – “This podcast has been disrupted.”00:07 – What are Dysrupt Healthcare recap episodes?00:53 – The Kimberly Carlson conversation in context01:03 – The grocery-store analogy: transparency in billing02:39 – What if every checkout had errors?03:05 – Translating that to healthcare03:41 – 99 % of medical bills contain errors04:05 – How U.S. Beacon audits hospital claims05:10 – The employer’s right (and responsibility) to audit06:26 – Why large hospital stays create bigger audit opportunities07:03 – Taking back control: this is your money08:17 – How to write audit clauses into your RFPs09:02 – The hidden gag clauses in contracts09:25 – Consolidated Appropriations Act (CAA) and data ownership09:42 – Make audits a condition to win the bid09:57 – Free resources from Kimberly Carlson in the show notes10:25 – Why independent claim reviews matter for every employer10:37 – Auditing your plan = protecting your people10:54 – Final call to action: Disrupt the status quo🎧 Full Interview: [How Kimberly Carlson Is Fixing Broken Medical Billing | Dysrupt Healthcare Podcast]with Lester J. Morales & Kimberly Carlson, CEO of U.S. Beacon🕒 Timestamps🔗 Referenced Episode

In this episode of the Dysrupt Healthcare Podcast, host Lester J. Morales sits down with Heath Potter, Chief Growth Officer and founding member of Six Degrees Health, one of the leading innovators in reference-based pricing (RBP) and transparent cost-containment solutions.Heath shares how a personal family tragedy—his father’s life-changing injury—became the spark behind his mission to make healthcare affordable, transparent, and fair for every patient and employer.Together, Lester and Heath unpack how Six Degrees Health uses data, analytics, and negotiation—not litigation—to redefine RBP, allowing employers to save an average of 30–40 % on medical claim spend while improving member experience and access to care.From the evolution of RBP 1.0 to today’s member-first model, this episode explores:Why most employers are still overspending on healthcareThe myths about balance billing and access issuesHow transparency and independent negotiation build trust between plans and providersReal case studies where employers saved millions without sacrificing careIf you’re a self-funded employer, benefits advisor, or HR leader who’s ready to rethink healthcare costs, this conversation will show you what true disruption looks like.Dysrupt Healthcare Podcast (yes—with a Y) is where Lester J. Morales talks with leaders who are challenging the status quo of American healthcare.Each episode digs into the WHY—the purpose behind the movement—to make healthcare more transparent, affordable, and human.Timestamps00:00 – “This podcast has been disrupted”00:07 – Welcome to Dysrupt Healthcare: Why the Y matters00:52 – Meet Heath Potter, Chief Growth Officer at Six Degrees Health03:02 – The personal story that ignited a mission to fix healthcare04:26 – How transparent pricing helps families and employers05:36 – Real impact: saving $12 million for a client plan06:43 – A physical therapy story that proved the model works08:28 – Reference-Based Pricing (RBP) explained in simple terms10:56 – Lester’s $90K knee surgery example vs. RBP pricing13:34 – Why hospitals accept fair RBP rates15:40 – RBP 1.0 vs. the Six Degrees model: what’s changed18:21 – Data and analytics as the core of modern RBP21:10 – The real stats: 99 % claim acceptance rate first pass24:00 – How negotiations resolve balance bills without litigation26:10 – The next frontier of RBP: member access to care28:02 – Open access plans and real family examples31:00 – Average employer savings of 25–40 %32:54 – Sustainability and flattening the renewal curve34:50 – Case studies: firefighters, manufacturers, and local communities37:13 – Where to learn more and get a free savings analysis39:21 – Final message to employers: “These are real dollars, not smoke and mirrors”Connect with the GuestsGuest: Heath Potter – Chief Growth Officer, Six Degrees Health📧 Heath.Potter@6degreeshealth.com🔗 LinkedIn: Heath PotterHost: Lester J. MoralesFollow on LinkedIn, YouTube & Spotify for more conversations that #Dysrupt the status quo.

Welcome to the first guest episode of the newly rebranded Dysrupt Healthcare Podcast, hosted by Lester J. Morales.Formerly known as Impact Healthcare, this show has evolved with a clear mission to remember the WHY behind disrupting healthcare.In this episode, Lester sits down with Kimberly Carlson, CEO and founder of US Beacon, a company transforming how medical billing integrity is handled in America. Kimberly shares her powerful story — from advocating for her husband during his battle with stage IV cancer to building a company that helps employers and patients uncover costly billing errors that most people never even notice.They expose shocking facts about the system — like why over 90% of medical bills contain errors, how self-funded employers can save millions, and why independent claim reviews are the hidden key to fixing a broken healthcare system.Whether you're an employer, advisor, or healthcare professional, this episode will change how you see medical billing, fiduciary responsibility, and the real cost of care in America.🔹 Learn how to protect your organization from overpayments🔹 Discover what “Disrupt with a Y” really means🔹 Get practical insights from real case studies saving millionsHosted by Lester J. Morales, Dysrupt Healthcare (yes, spelled with a “Y” on purpose) highlights the WHY behind fixing a broken system. Each episode shares stories of leaders, innovators, and disruptors making healthcare more human, transparent, and affordable.00:00 – Attention: This podcast has been disrupted00:10 – From Impact Healthcare to Dysrupt Healthcare: the WHY behind the rebrand00:46 – Meet Kimberly Carlson, CEO of US Beacon03:04 – The personal story that started US Beacon03:48 – 99% of medical claims have errors — why it happens06:14 – Understanding medical coding and billing complexity08:16 – The mechanic analogy: bundling vs. unbundling in healthcare10:30 – Patients’ right to request an itemized bill12:20 – Why every consumer should care about billing errors13:43 – How billing errors drive up premiums14:43 – Real-world example: $12,000 a night for a semi-private room15:43 – Self-insured vs. fully insured: who’s responsible?17:17 – Fiduciary risk and why employers should audit claims18:20 – $5.5 million in savings: real case results20:16 – “Fox guarding the henhouse”: when carriers audit themselves21:44 – Why independent audits matter22:45 – Contracts, RFPs, and clauses that protect employers26:00 – Billing under CMS guidelines and avoiding illegal charges28:10 – How one surgery led to $70,000 in avoidable costs30:13 – Healthcare billing = buying a car without knowing the price31:38 – City government case study: recovering taxpayer money33:11 – Why you need an independent TPA34:39 – The human side: the system isn’t evil, just broken35:26 – The role of AI and automation in claims integrity36:45 – US Beacon’s 1% appeal rate and what makes them different37:00 – The meaning behind “US Beacon” and being a light in darkness37:41 – Final thoughts and call to actionGuest: Kimberly Carlson – CEO, US BeaconLinkedIn: Kimberly CarlsonHost: Lester J. MoralesFollow on LinkedIn, YouTube, and Spotify for more stories that disrupt the status quo.🧠 About Dysrupt Healthcare Podcast🕒 Timestamps🔗 Connect with the Guests

In this inaugural episode of the Dysrupt Healthcare Podcast, Lester J. Morales opens up about rebuilding not just the podcast, but the entire company and mission behind it. After years of leading Impact Healthcare Podcast, Lester realized that the vision had outgrown the name. “Impact” was never the limit it was just the beginning.The new Dysrupt Healthcare Podcast was born with purpose: to go deeper, to reach farther, and to create real change in how we see and experience healthcare. This isn’t just a new season it’s a reawakening of a movement.Lester shares what this transformation means, personally and professionally from redefining his company’s purpose to reimagining how conversations in healthcare should sound. The new format will bring you closer to the real stories, the emotional journeys, and the case studies of leaders who are dysrupting the system for good.This episode sets the tone for what’s to come: honest dialogue, bold ideas, and stories that remind us that healthcare isn’t just about numbers it’s about people.The movement continues louder, deeper, and more human than ever before.

In this powerful solo episode, Lester Morales reflects on the journey of the Impact Healthcare Podcast and shares why it’s time for an evolution. For years, Impact Healthcare has been a platform to highlight innovative ideas, bold strategies, and the leaders willing to push against the broken healthcare system. But as Lester explains, the word “impact” was never big enough to capture the true scale of the movement he and so many others are building.This is not an ending — it’s a transformation. The podcast is entering a new chapter as the Dysrupt Healthcare Podcast. With a sharper focus and a fresh format, this next phase will go deeper into the conversations that matter most: how employers, advisors, and changemakers can dysrupt the status quo, lower costs, and deliver better care for employees and their families.In this transitional episode, Lester shares:Why the shift from “Impact” to “Dysrupt” represents more than just a name change.What listeners can expect from the new content, structure, and tone of the podcast.How the larger movement for healthcare disruption is growing — and why your voice and participation matter now more than ever.This episode isn’t a goodbye. It’s an invitation to continue forward — to be part of the movement, to challenge what’s broken, and to help create a system that truly works for people. The Impact Healthcare Podcast opened the door. The Dysrupt Healthcare Podcast will break it wide open.

What if burnout didn’t have to be the norm?In this powerful episode of The Impact Healthcare Podcast, host Lester Morales dives deep with John Troutman, Vice President of Business Development at Mind Club America, a revolutionary mental health platform built for prevention—not just crisis response.John shares his raw, personal story of burnout, the months-long journey through recovery, and how it became the catalyst for helping others. Together, they expose the flaws of traditional EAPs, debunk the “we’re here when you need us” myth, and offer a clear, proactive solution for employers, advisors, and leaders who want to make mental health truly accessible and impactful.✅ Learn how Mind Club helps organizations reduce turnover, improve productivity, and provide fast access to real mental health professionals✅ Discover the simple 3-minute assessment that sets a new standard for self-awareness and care✅ Explore how leadership buy-in transforms employee engagement with mental wellness tools✅ Understand how stigma, accessibility, and outdated networks are failing today’s workforce—and what to do about itThis isn’t a feel-good conversation—it’s a real conversation with real tools to make mental health a business strategy, not an afterthought.Take the free assessment or learn more: https://mindclubamerica.com🫶 If you know someone silently struggling—or a leader ready to do something different—share this episode. You could save a life.#mentalhealth #burnout #leadership #employeewellbeing #healthcarestrategy #impactpodcast #mindclub

What if you could avoid invasive orthopedic surgery using your own cells?In this eye-opening episode of the Impact Healthcare Podcast, host Lester Morales talks with Dr. Mark Testa—chiropractor, acupuncturist, and Regenexx expert—about the groundbreaking procedures helping thousands of patients skip expensive surgeries and recover faster with regenerative treatments like bone marrow concentrate and PRP (platelet-rich plasma).You’ll learn:How Regenexx helps patients avoid knee, shoulder, and spine surgeriesReal-life patient success stories and outcomesThe massive cost savings and faster return-to-work for employersWhy musculoskeletal issues are a top cost driver in health plansHow self-funded employers are integrating Regenexx into their benefitsWhether you're an advisor, employer, or patient seeking alternatives to surgery, this episode delivers valuable insights into the future of orthopedic care.👉 Learn more: https://regenexxbenefits.com📩 Contact Dr. Mark Testa: mtesta@regenexx.com🔗 Connect with Lester Morales on LinkedIn

In this powerful episode of *Impact Healthcare*, host LesterMorales sits down with a true industry whistleblower  Wendell Potter, former Cigna and Humanaexecutive turned healthcare reform advocate. Wendell pulls back the curtain onhow health insurance really works, exposing the profit-driven machine thatprioritizes stock prices over patient care.From defending high-deductible plans to becoming a fierce critic of them,Wendell shares his personal transformation, his fight for a more transparentand fair system, and why the healthcare system isn’t broken — it’s workingexactly as designed... for Wall Street.🔥 Inside this episode:- What the Medical Loss Ratio (MLR) really means for employers and patients- How health insurers and hospitals maintain a profit-first alliance- The unethical broker-carrier dynamic no one wants to talk about- Why Wendell walked away from a high-paying C-suite role to expose industrycorruption- Real stories of hope and disruption in healthcare happening *right now*Whether you're an employer, advisor, or just someone who’s tired of risingpremiums and shrinking benefits, this is a must-listen.📩 Connect with Wendell: [HealthcareUncovered](https://healthcareuncovered.substack.com)📽️ Watch the documentary: *It’s Not Personal, It’s Just Healthcare*(featuring Wendell)🎧 Don’t forget to subscribe and share this episode if you believe increating a better healthcare system.