The Pulse of Healthcare

Following the DOJ's massive crackdown on over $6.5 billion in Medicare fraud, we dive deep into the hidden crisis of fraudulent claims threatening the commercial insurance arena. Healthcare fraud isn't just a government problem—it impacts employers, carriers, and families alike. In this episode, we discuss why insurance carriers should take greater responsibility for policing provider claims, and how educated patients can act as the ultimate line of defense.Tune in to learn how smart partnerships and patient advocacy is the key to protecting healthcare funds and ensuring plan integrity.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode of The Pulse of Healthcare Podcast, Dr. John, CEO of Ovation Health, and Nick from Member Services examine the growing problem of healthcare pricing opacity. Inspired by an article from Chris Deacon, they explore how complex hospital payment arrangements and hidden contract language can obscure the true cost of care.The discussion uncovers how employers, health plans, and patients are often billed amounts that may include unrelated fees, retrospective adjustments, incentive payments, and other financial mechanisms that have little connection to the actual services provided. Dr. John and Nick break down why transparent pricing matters, the challenges self-funded employers face in understanding healthcare costs, and what organizations can do to better protect their healthcare dollars.If you've ever wondered why healthcare bills seem impossible to understand, this episode sheds light on the systems and practices that keep the real price hidden.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John and Nick explore the challenges surrounding healthcare pricing and why understanding the true cost of care has become increasingly difficult. The discussion dives into Reference Based Pricing (RBP), cash pay options, and the ongoing issues surrounding hospital cost transparency. Learn how these approaches can help patients and employers navigate rising healthcare expenses, create more informed decisions, and uncover opportunities for meaningful savings. Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John and Patient Advocate Kia Baker discuss the often-overlooked drawbacks of traditional healthcare networks—limited provider access, unexpected out-of-network charges, and rising costs that can catch employers and members off guard.They contrast these challenges with the advantages of an open access network model, which offers greater flexibility, broader provider choice, and more effective cost containment. Tune in to learn how rethinking your network strategy can lead to better outcomes, improved member experiences, and more predictable healthcare spending.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John sits down with Member Services specialist Nick Trapani to talk about his first year on the job and the eye-opening lessons he’s learned along the way. From navigating the complexities of the healthcare system to supporting members in real, meaningful ways, Nick shares a behind-the-scenes look at what it takes to make a difference. He also reflects on just how much there is still to learn—highlighting the ever-evolving nature of healthcare and the importance of staying curious, informed, and committed to helping others every step of the way. Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Ever feel like your healthcare is just one giant shell game? You’re not imagining it. This video pulls back the curtain on how the "Big Players" have basically bought every part of the game. They are big-box insurance conglomerates that own every link in the chain: the doctors, the pharmacies, the data platforms, and even the "middlemen" (Pharmacy Benefit Managers). This is called vertical integration, and it’s a fancy way of saying they’ve rigged the system to keep your money moving in one big, profitable circle. By controlling the entire ecosystem, these big players can funnel patients toward higher-priced services they own—regardless of whether you actually get better.The good news is, there’s a growing movement of doctors and small business owners who are fed up with the corruption and are leading the way with innovative healthcare solutions and slashing costs by 30-50% while providing better outcomes, proving that the solution isn't just a "software patch" for the old system, but a parallel infrastructure built on genuine care.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, we’re diving into the new Trump Rx initiatives and the latest rules focused on PBM price transparency. What do these changes actually mean for employers and plan members? We break down how greater visibility into prescription pricing could reduce hidden markups, improve accountability, and help control rising drug costs.If you’re looking to better understand what’s happening in the Rx space—and how it could impact your benefits strategy—this episode is for you.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John and guest Virginia Groce (Claims Administrator for Ovation Health) explore how Health Savings Accounts (HSAs) empower individuals and employers to save for healthcare with unmatched tax advantages—while also examining the government rules that restrict their full potential. In this discussion, we break down how HSAs work, why they can be a smart long-term financial and healthcare strategy, and how tying HSAs exclusively to high-deductible health plans creates barriers to affordable healthcare.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John and Peter unpack the growing dilemma employers face as healthcare costs continue to rise at an unsustainable pace. Despite mounting pressure on budgets, many brokers still funnel employers toward the same Big Box health insurance carriers—often overlooking newer, more innovative plan options from smaller, regional insurers that can deliver better value. We explore why this happens, what employers aren’t being told, and how forward-thinking companies (like our own) are breaking the cycle by embracing modern solutions that prioritize transparency, flexibility, and real cost savings. This conversation sheds light on the shifts happening in the industry and empowers employers to make smarter, more informed decisions about their benefits strategy.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Do you believe that size equals stability?  In this episode, Dr. John challenges the mindset that “bigger is better” to help employers and employees understand what truly matters when choosing a health plan—value, transparency, and the member experience.  Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John shares his journey from the military—where clear, precise communication can mean the difference between success and failure—to the complex world of healthcare, where miscommunication too often leads to confusion, mistakes, and missed opportunities for better care. Drawing from firsthand experiences on both sides of the system, this podcast explores how a lack of clarity, accountability, and structure in healthcare communication impacts patients, providers, and outcomes.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John discusses the benefits of Telehealth and the changes ahead for those on Medicare with guest co-host John Wileman of Excelsior Higher Care.Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Are your rates going up again this year? For many Americans health insurance premiums are increasing an average of 20-30% in 2026.Great benefits don't have to come with a big price tag. Ovation Health is providing level-funded approved plan rates for small groups in the Greater Houston area that can save you up to 40%.   Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Will you be VICTIMIZED AGAIN by inflated premiums at renewal time? Did you know there are alternatives that can save you up to 35% on medical costs?Don't let fear stop you from lowering your healthcare costs and increasing the financial stability of your company. It's time to do things differently!  We can show you how.Learn more 👉https://ovation.health#GroupHealthInsurance #AffordableHealthcare #grouphealthplans #CostTransparency #HealthcareSavings #SmartCoverageLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

A denied claim can be a financial shock for employers and employees alike. In this episode Dr. John and Peter discuss why claims get denied, how often this happens and how lack of cost transparency fuels surprise bills. Find out how we keep our claims denial rate as low as 2%, compared to the legacy carriers that have a denial rate of up to 35%. If you've ever wondered why healthcare feels like a guessing game until the bill arrives-this one's for you. #HealthcareCosts #ClaimsDenials #CostTransparency #ThePulseofHealthcareLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John and Peter discuss the fears that many employers have about switching to a self-funded plan, thinking mistakenly that they are going to pay for every dollar the group incurs for medical claims. Learn how stop-loss protects against large claims and how tailored benefits, patient advocacy and data driven reports can result in dramatic savings.#SelfFundedPlans #SelfFundedHealthcare #EmployerHealthPlans #affordablehealthcare #HealthcareSavings #LowerHealthcareCostsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

The ACA is on track to raise premiums up to 30% in 2026. This will cause legacy carriers to raise rates as well, with employers and employees ultimately paying the price. The good news is, there are alternative ways to obtain health care for those who are willing to do things differently. Ovation Health is proud to say our groups haven't had a rate hike since 2018! Tune in as we discuss the issues and learn how we can help you find affordable solutions. For a proposal, call 866-549-4199 or visit www.ovation.health#HealthcareSavings #LowerHealthcareCosts #SelfFundedPlans #SelfFundedHealthcare #EmployerHealthPlans #EmployeeBenefits #OvationHealthLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode Dr. John and Peter discuss the issues related to healthcare fraud and how this directly impacts both members and employers. Find out how prior authorizations can help minimize fraud and also lead to better patient outcomes. #priorauthorization #affordablehealthcare #costtransparency #claimsdenials #lowerhealthcarecosts #patientadvocacyLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John explains the real reason preauthorizations are necessary and how this relates to quality of care and cost transparency. #priorauthorization #lowerhealthcarecosts #costtransparency #qualityhealthcare #healthcaresavings #claimsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Why do Americans pay substantially higher costs for prescriptions and medical care than other countries?  Tune into Part 3 of the series on "Understanding US healthcare costs", as Dr. John and Peter explore the issues related to "Price Transparency" in the healthcare system. #HealthcareCosts #PriceTransparency #HealthcareReform #USHealthcare #HealthcarePolicy #HealthEconomics #EmployerBenefits #HealthcareInnovationLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Why do Americans pay substantially higher costs for prescriptions and medical care than other countries?  Tune into Part 2 of the series on "Understanding US healthcare costs", as Dr. John and Peter explore the issues related to "Price Transparency" in the healthcare system.#costtransparency #risinghealthcarecosts #prescriptioncosts #pricetransparency Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Have you ever wondered why Americans pay substantially higher costs for prescriptions and medical care than other countries? Tune into Part 1 of this series on Understanding US healthcare costs, as Dr. John and Peter discuss the healthcare system and what is causing these higher medical costs in the US. #costtransparency #risinghealthcarecosts #prescriptioncosts #pricetransparency Learn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Innovative technologies were designed to streamline and increase efficiency in healthcare, and government regulations put in place to safeguard patients. So why do healthcare costs continue to rise? In this episode, Dr. John and Peter discuss how regulations and technology have affected Primary Care and how they created financial burdens and contribute to the rising costs of medical care.#healthcaresolutions #risinghealthcarecosts #healthcareregulations #innovativehealthplans #costtransparency #grouphealthinsuranceLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

The holidays can be a stressful and anxiety provoking time for many people. Tune into this episode as Peter and Dr. John discuss improved access to mental health services through telemedicine via phone and video chat, and how we can support one another during this holiday season.#mentalhealth #mentalhealthsupport #telemedicinesolutions #telemedicineawareness #wellnessjourney #holidaystressLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John interviews his father Don McCormick who shares the history and evolution of health insurance as we know it today... and the lessons learned from his experience in the healthcare industry.#healthcareevolution #healthcarehistory #healthcareinequality #healthcareindustry #tailoredbenefits #healthcarecosts #healthcareeducationLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Are you expecting a rate increase again? You can't control the rising costs of healthcare but you can choose who you partner with. With tailored benefit plans and active cost containment efforts, Ovation Health has groups that have not seen a rate increase since 2018. Dr. John and Peter discuss the many areas where savings are possible and encourage employers to be proactive. Reach out for a quote today by calling 866-549-4199 or visit www.ovation.health.#risinghealthcarecosts #affordablehealthcare #employerhealthplans #grouphealthinsurance #tailoredbenefits #hrsolutions #ovationhealthLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John shares the history of the first network and the evolution of networks in the healthcare industry. He explains the issues with networks and price transparency, and how they have nothing to do with access to health care or quality of care.#HealthcareAccess #ProviderNetworks #RestrictiveNetworks #HealthcarePolicy #HealthcareReformLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John and Peter discuss the issues of price transparency and why the pricing for a medical procedure or service is so greatly varied, depending on where you go to get your care and how it is being paid for. Find out how true Patient Advocacy can mitigate overpaying for medical costs without sacrificing quality of care.#costtransparency #patientadvocacy #risinghealthcarecosts #risingprescriptioncosts #healthcarecostsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode Dr. John and Virginia, a claims processing expert at Ovation Health, discuss the use of age stratification by legacy carriers in determining health plan rates and the surprising statistics from claims data.#AgeStratification #CostTransparency #HealthcareCosts #ClaimsData #medicalcostsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John and Peter discuss the advantages of integrating Direct Primary Care (DPC) into health care. This model improves the patient experience, lowers healthcare costs, and enhances health outcomes.#directprimarycare #lowerhealthcarecosts #betterhealthcare #healthcaresolutions #innovativehealthplans #affordablehealthcareLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John introduces Hannah, the newest member of the team. They discuss her role in the Care Team, the healthcare industry and work culture, and how this relates to Member Services and positive member experiences.#patientadvocacy #carecoordination #navigatinghealthcare #costtransparency #lowerhealthcarecostsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. McCormick interviewed an expert in veteran benefits who offers a free service to help vets and their spouses access in home care through the Aid and Attendance program.#veteranhealth #veteranhealthcare #veteranbenefits #veteranhomehealthcareLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

In this episode, Dr. John and Peter discuss prescriptions as they relate to coordination of care for better outcomes, costs, side effects, low adherence rates and how to be more proactive in your healthcare.#prescriptionbasics #costtransparency #prescriptioncostsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Deciding between an urgent care center and the emergency room can be tough. In this episode, Dr. John and Peter talk about emergency situations and how to decide when to go to an emergency room and the different costs members may incur.#costtransparency #emergencycare #urgentcare #risinghealthcarecosts #telemedicineawarenessLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John and Peter discuss steerage and referrals, explaining why they are made and how they can be good for members, when price and quality of care are considered in the decision making.#healthcarereferrals #healthcarepolicy #qualityhealthcare #patientadvocacyLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Our host Peter discusses with Dr. John the advantages and disadvantages of prior authorizations and how they relate to member services.#priorauthorization #HealthcarePolicy #HealthPlanDesign #MedicalManagement #EmployeeBenefits #EmployeeHealthPlansLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John is joined by Chad to discuss the benefits of a Health Plan that works directly alongside its TPA and PBM, and how these direct connections can help the consumer know the prices that they will have to pay for their plan and health services.#TPA #PBM #HealthPlanDesign #EmployerHealthPlans #EmployeeBenefits #HealthcareAdministration #BenefitsStrategy #HealthcareInnovationLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John is joined by Patient Advocate Chad to discuss price transparency in the medical market. Listen in to discover why healthcare costs may be increasing and what you can do to get the best service for the best deal just by being a smart consumer.#costtransparency #healthcarecosts #patientadvocacy #risinghealthcarecosts #employerhealthplans #employeebenefitsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Next up in the "Meet the Staff" series, Dr. John talks with Virginia, lead Administrator of the Claims Department at Ovation Health. They'll discuss how Claims processing has changed over the years and how claims can effect anyones health plan.#claims #claimsprocessing #claimsprocess #costtransparencyLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John starts off his "Meet the Staff" series by talking to the lead department head for Member Services as Ovation Health. They will talk about what it's like to help people and how cost savings for procedures can be found by having a hands-on approach to Utilization Review and Care Coordination.#carecoordination #patientadvocacy #lowerhealthcarecosts #healthcaresolutionsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John continues his interviews with some of the best minds in tech healthcare. This time he is joined by Kevin from EZ Digital to talk about how the company is using Remote Patient Monitoring to prevent catastrophic occurrences and they are doing so at the lowest price in the market.#telemedicinesolutions #EZDigital #remotepatientmonitoring #telemedicineawarenessLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John has a Chat with Tim from the Telemedicine platform LASO to discuss what makes their platform unique in the telemedicine space and why you as a consumer should consider Telemedicine for your care needs.#telemedicineawareness #telemedicinesolutions #LASO #healthcaresavings #primarycareLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr John is back with PA Chad to talk about what the various plan type acronyms stand for, how those plans operate, and how you can be a smart consumer.#employerhealthplans #employeebenefits #affordablehealthcare #healthcaresavings #innovativehealthcareLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John is joined by Marketing expert Peter Delehanty to tell you the truth behind tactics used by insurance companies to justify your rate increase.#risinghealthcarecosts #highhealthcarecosts #risinghealthpremiums #highprescriptioncostsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr John and PA Chad sit down to discuss the medical insurance terms every consumer should know before choosing which plan may be right for them.#healthcareeducation #employerhealthplans #grouphealthinsuranceLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John educates you and his guest this week in understanding the benefits and potential risks of Self-insuring your company.#selffundedhealthcare #selffundedplans #selfinsurance #grouphealthinsurance #lowerhealthcarecosts #innovativehealthcareLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John touches on just how important Mental Health services and access to those services are. He and Chad (Patient Advocate with Ovation Health) break down the various aspects of Mental Health care, from the insurance benefit side, all the way to the effects that Mental Health has on your physical well-being.#mentalhealth #mentalhealthsupport #mentalhealthawareness #telemedicineawareness #telemedicinesolutions #behavioralhealthcareLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John sits down with his Patient Advocates this week to talk about how Ovation Health plans combat the rising cost of Pharmaceutical medications in the United States.#patientadvocacy #risinghealthcarecosts #costtransparency #healthcaresavings #affordablehealthcare #prescriptioncostsLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John sits down again with Patient Advocate Chad to go over listener submitted questions. Find out the secrets behind Patient Advocacy, Provider Billing and more. Including how to submit your own questions!#patientadvocacy #providerbilling #healthcarecosts #healthcarepolicyLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]

Dr. John sits down with Patient Advocate Chad to discuss the benefits and usefulness of Telemedicine as the future of healthcare.#telemedicineawareness #telemedicinesolutions #virtualhealthcare #innovativehealthcareLearn more about Ovation Health at www.ovation.health We help employers save up to 35% on their healthcare costs. For a free consultation call 866-549-4199 or email [email protected]