Initial meeting with VI’s Chief Data Scientist to unlock the areas to potentially validate.
Why is this designation for those working in employee benefits?
Our team at Gibson has prioritized this designation in an effort to stay in front of a rapidly changing industry and to ensure that the strategies and solutions we introduce to our clients are legitimate and proven. Our industry has way too many vendors that lack substance and over promise on deliverables.
Which of the 11 courses would you recommend to colleagues?
For colleagues largely serving a fully-insured book of business or market, I’d recommend the ‘Self Funding: Risk vs. Reward’ module, as it discussed the factors that go into self-funding versus fully-insuring. There are so many misconceptions around self-funding within the industry and within employers that this is a really important concept to understand. For those already serving a heavy self-funded book of business, I recommend the ‘Optimizing Drug Spend’ module. Pharmacy is low hanging fruit for nearly every organization and there highly impactful strategies to address the rising spend.
Improving healthcare is a big challenge, what inspires you to keep at it?
I worked inside the healthcare industry for over a decade and know that there are great people who wake-up every day and try to do the best for their patients. Unfortunately, I’ve seen firsthand how the current environment hinders patient care and negatively impacts ideal health outcomes. Employer-sponsored health care represents a huge opportunity to influence healthcare in the United States and I’m excited to be in a position to guide and shape that influence within our communities.
Why was the Certified Health Value Professional program appealing to you?
It was great for me because while I’m a healthcare professional/pharmacist and have worked in some managed care settings in the past (such as Medicaid), I did not work in commercial healthcare until now. The CHVP program did a fantastic job as a high-level overview of the parts of medical and healthcare benefits that I wasn’t as exposed to in the past: such as stop loss or reinsurance, population health validation, etc. I even learned a few things from the pharmacy benefits management module.
You have quite the background, pharmacist, podcaster, author – what got you interested in healthcare?
Back in high school, I was hooked on pharmacy after general chemistry. I knew healthcare was for me because of the science and ability to help people. Since then, I went to Butler University College of Pharmacy and Health Sciences and worked in a variety of areas of pharmacy – such as community practice pharmacy, the pharmaceutical industry, academia, managed care, and now serving commercial plans buying the best healthcare, medical, and pharmacy benefits for their members. As a tenacious caregiver, I love finding the best, future-focused and next services for pharmacy and for our clients – like pharmacogenomics, real-time remote monitoring, infusion centers closer to home for medical drugs, MTM on-demand or from your smartphone, etc. coupled with elevating the profession of pharmacy. I do believe we have opportunities to create more win-win-wins here: for the plans, for the members and for the profession of pharmacy which is changing. Podcasting and books are just other channels by which to share knowledge in healthcare and discuss the positive changes in health.
Is there one thing employers should consider when trying to manage costs?
Many commercial self-funded employers do not know the extent of the current and coming maintenance-infused drugs, their high costs, and how they can be effectively managed for the benefit of the members and plans. Sixty percent of drugs approved by FDA in 2020 were orphan drugs as just one example, and many of them are infused, high-dollar medications that a member will not be picking up at their local pharmacy. They’ll need to coordinate and schedule an infusion for these. There are many budding opportunities for cost savings programs on these drugs as well – but many commercial plans again have no idea that there is a better way to manage these high-cost medical drugs.
As Vice President, Employee Benefits at Brown & Brown Insurance of CT, how will this designation help you in that role?
I believe that value-based healthcare will play a major role in benefits & plan design strategy used by the broker community in the years to come. With that being said, trends like this usually precede a crowded marketplace of consultants, and this certification will help me differentiate myself from the crowd as a credible subject matter expert.
Which of the 11 courses would you recommend to colleagues?
I would recommend the “Direct Contracting for High-Value Healthcare Services” module, as it is very relevant to the models we are seeing today in the marketplace with respect to the focus on primary care. Employers are tired of being at the mercy of carriers and technological advancements are now allowing them to have more flexibility in plan design and where they receive healthcare.
Improving healthcare is a big challenge, what inspires you to keep at it?
It is a challenge that all of us face every day, and as a broker I see it from many different perspectives – as an advisor, from my clients’ perspectives, and as a consumer. The system is broken and needs to be changed. The modules in this course are a great foundation for where we should start.
What advice would you have for others considering taking the CHVP?
I would recommend that as others go through this course, they work to incorporate what they are learning into their everyday approach in the field. In doing so, it enabled me to truly grasp the concepts being taught. I would also recommend keeping the courses “handy” as a reference down the road, as I referred back to them several times for unique solutions to existing client and prospect concerns that differentiated me from my competition.
Why was the CHVP of interest to you?
The CVHP designation provides proof positive of a deeply rooted commitment to my profession and practice. The certification, coming from an organization that is obsessed with objective evaluations of vendor claims, is testament itself to recognizing not all vendors are created equal, are of similar effectiveness, or that their claims are necessarily backed by real data. Going through the certification process appealed to me as it would help to further my ability to truly vet vendors in the market by using methodologies that were rooted in unbiased truth.
How does it help you when working with clients?
In my meetings, I like to point out that not all people in a profession possess the same level of skill or ability. This can be quite a fun exercise. I generally tend to point out competitors in their own field and then add in others like accountants, attorneys, athletes, and physicians to help illustrate that working in a field doesn’t mean there is a set standard of talent. Clients readily recognize the logic, and it can be amusing to ask them if the most clever CPA’s always work for the largest entities, or the most brilliant professors at the largest universities, or the best athletes with the most winning team (perhaps eventually though…). The CVHP designation speaks for itself when it is showcased, and it holds considerable weight when the client realizes the data-driven mission of Validation Institute.
Do you have any advice for those considering pursuing their CHVP?
I would, in CVHP fashion, have them model the ROI for the designation. The cost is nominal in comparison to other expense items in our field and because the certification endures, it has heft that other projects may not have. It may be a good idea to ask some clients if they believe there is value in this, given they will be the beneficiaries of the knowledge attained and practices enacted regarding the health plan recommendations. It is not a common certification, though it may become one, which helps differentiate you from competitors who have not made similar investments in their education or pursuit of truth.
Donovan Pyle, a recent recipient of the Validation Institute’s Certified Health Value Professional program is on the quest to help organizations and their employees reclaim the nearly $1 Trillion dollars wasted on healthcare and health insurance every year in the United States.
Pyle is the founder and CEO of Health Compass Consulting in Orlando, Florida, and we recently sat down with him to spotlight his experience in pursuing the Health Value Professional Certification.
Why did you decide to become a Certified Health Value Professional?
“Fixing our country’s dynamic and often complex healthcare system requires continuous study, and I found the opportunity to learn from professionals who help make purchasing decisions for fortune 100 companies irresistible. The collective resources available to benefits professionals through the Validation Institute cannot be found anywhere else”.
What got you into the employee benefits space?
I spent 10 years playing drums professionally in Manhattan after college, and while opening for the rock band “Heart” in Detroit, I fractured a bone in my kick-drum foot. It was my first interaction with the medical industrial complex as an adult, and it didn’t go very well. Making things worse, my band’s record label went bankrupt shortly thereafter, and I decided it was time to take on a bigger societal challenge. Throughout my time in New York, I saw first-hand how distortions in our healthcare system negatively affected my artist friends and created inequities in the marketplace. Although I originally wasn’t sure how I could help improve the vertical, opportunities became more self-evident as I moved throughout the industry and saw how the pieces fit together.
Improving our healthcare system can be a daunting challenge. What inspires you to keep going?
Three things: my wife who is a constant source of love and energy — our one-year-old son who teaches us to see things in a different light — and, lastly, the American people who are hungry for viable solutions to their everyday problems.
Describe your certification experience in one word.
Matt Thibault is a Project Director with Kansas Business Group on Health and recent graduate of the CHVP professional. We caught up with him to talk about his role and what advice he has for those interested in the program.
How did you get started in the healthcare purchasing and/or benefits space?
My career started in the field of worksite wellness, where I managed the wellness program for one of our local hospital systems. After starting a new position at our local medical society, we assumed control over an existing organization that was focused on helping employers increase the value of their employee health benefits. Through this new role I was able to learn more about what goes into benefit plan design, in addition to what I’d learned in my worksite wellness role.
Why were you interested in pursuing your CHVP?
Having worked in the field of employee benefits for several years, I wanted to deepen my understanding on particular components of benefit design so I could be more informed and educated on the topics that we seek for our employer members to understand. I also knew that the Validation Institute’s certification for health professionals was well-respected and would dive deep into the concepts that I needed to understand to help me be successful in this field.
How will you apply what you have learned to your day to day job?
Through my role with the Kansas Business Group on Health, educating employers on various topics and strategies related to employee benefits is a key element of our work. With the knowledge I’ve obtained through the CHVP process, I feel much more confident in sharing these concepts with our employers and other stakeholders with the goal of driving meaningful change.
For those considering taking the CHVP, my advice would be to set out a schedule for completing the modules and stick to the process. It is not easy, but things that are valuable rarely are.
Can you describe your role in the health care purchasing marketplace?
As a product manager my role with Nova is to understand market needs both broadly and for specific clients, investigate point solutions, collaborate with vendors on goals and outcomes, and serve as “the hub of the wheel” between operations, analytics, sales, and marketing to keep all areas connected.
Why did you think the CHVP classes would be useful in your role?
While Nova is technically a TPA, what we provide goes beyond the everyday services employer groups expect from their plan administrators. We know that effective benefit design and plan management exist at the intersection of art and science in understanding needs and providing solutions. In my role I need to understand the needs of CFOs, HR departments, brokers, etc and connect our company or our individual clients to solutions that deliver value. The CHVP classes offered a useful framework for both of these objectives.
What surprised you most from your CHVP classes?
I was really pleased with how much I recognized the work Nova is already doing to provide value and deliver results. What I was not surprised by was the quality of instruction, which was the same standard of excellence and thought leadership that I always associate with the Validation Institute.
How long did it take you to complete your courses?
I did them over about a month when I was at a slower time of the year and could focus on it on Friday afternoons when I was done with meetings. The certification project took a couple of weeks to complete but I was analyzing an existing vendor, so it was useful both for the CHVP and for my work processes.
Do you have any advice to those who may be on the fence about pursuing their CHVP?
I enjoyed the classes and appreciated the opportunity for professional development that I could put to use right away—even before I was done with the classes. It isn’t about studying to pass a test or regurgitate facts; it is about shifting your approach to evaluation and analysis. Take the time to really absorb the materials and the lessons, and then go out and use it in the real world!
I run the healthcare department at Grady Legal, PA. We assist employers in meeting their fiduciary responsibilities in selecting their health care benefits.
How did you get involved?
I was running a wellness department for 8 years and even though the employees were becoming healthier, the employer’s premiums continued to skyrocket. So I educated myself to find out why healthier employees did not equate to better health insurance and lower premiums. After discovering the fraud and conflicts of interest, I moved to the legal industry so I could enact change.
I was most surprised to learn that brokers, agents and consultants are not taught the concepts in the CHVP classes. In fact, brokers are paid so much for so little work.
I was able to complete the course in under 3 months even though I was working full time.
We have a saying at Grady Legal, PA, “Are your health care premiums making you sick?” CHVP provides a great foundation for you to assist employers in finding not just benefits, but how to develop the right plan design.
You have been in the healthcare industry for many years, why was the Certified Health Value Professional a designation you were interested in?
I view CHVP as a continuation of a commitment to our clients, to stay on the leading edge of healthcare innovation and education.
In your opinion, is the CHVP valuable to healthcare purchasers at all levels of careers?
Absolutely, the curriculum is very diversified and broad in scope. I think the program would be very enlightening and empowering for employers, vendors as well as advisors.
Improving healthcare can be overwhelming at times, what keeps your motivated?
It’s our belief that we are the only thing standing between our clients and unaffordable healthcare for their employees and families. We feel is it our duty to share our knowledge, process and techniques with as many people as possible.
What advice would you give to anyone thinking about pursuing their CHVP?
I believe this designation truly validates a commitment on the part of the candidate to rise above the status quo of their industry and to establish themselves as a leader in their field.
How did you get involved in healthcare?
As a premed student, I took a “Health Professions Seminar” class which deeply impacted my career. I was struck by how much patient and physicians alike were impacted by the way in which healthcare was organized. Although this didn’t dissuade me from wanting to become a physician, from that point on I wanted to have a positive impact on how healthcare was purchased and delivered so that both patients and doctors could succeed. I practiced as an OB/GYN for 9 years, and then chose to concentrate full time in nonclinical positions at Optum, and then at Activate Healthcare.
You have a diverse background in the healthcare industry, as doctor and now a healthcare solution provider, why was the Certified Health Value Professional program of interest to you?
In my opinion, a significant “language barrier” exists between those whose primary focus is the financial aspects of healthcare and those whose primary focus is quality—both of which are key to value. I chose to take the Certified Health Value Professional Program to improve my ability to speak the language of those whose focus is on costs.
How did the CHVP help you in your role as founder of BenefitsDoc?
First, the course improved my understanding of the complexity of the decisions that must be made when attempting to purchasing healthcare in a manner that optimizes value. It gave me a better understanding of terms and concepts related to healthcare purchasing that were previously vague to me. Second, I connected with several course lecturers who have been invaluable to helping me understand how BenefitsDoc could add value to brokers and healthcare purchasers. Finally, the course reinforced in my mind the potential for market forces to transform healthcare when purchasers are able to differentiate low from high value care.
Fun fact: What was your favorite city to run a marathon?
Work through the steps we took you through in previous modules and create a plan for your workplace.
We’ll use the first person “I” to identify the things you should consider. This list is not all-inclusive and your situation may require different approaches.
Your employees and what to consider.
Risks perspectives based on industry type
Following industry segments available: