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Learn how to maximize company health benefits while minimizing cost [Podcast]

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Health Insurance, for small business owners as well as individuals, can be difficult to navigate. There are tons of options in the market and outside of it, so where do you start? Our guest on this episode of the Capitalist Sage, is Erica Dumpel, founder of CDA, Inc., an insurance solution provider that helps both individuals and small businesses. She’s got over 40 years of experience in the healthcare insurance industry and she’s here to share some tips and information on how to make better decisions and start asking the right questions of your insurance providers.

With you hosts Karl Barham and Rico Figliolini

Resources:
CDA Inc. Website: http://cdainc.net
Erica’s Email: Erica@CDAINC.net
Business Phone: (770) 449-7369

Timestamp:

[00:00:30] – Intro
[00:02:11] – About Erica and Her Business
[00:02:58] – Group Coverage and How It Changes
[00:09:48] – Differences in Coverage Across the Country
[00:11:29] – The Affordable Care Act
[00:14:18] – How Employers are Handling Insurance
[00:17:18] – HMO vs. PPO
[00:19:15] – Physicians Outside of Networks

“If you sit down with a coffee cup on a Saturday morning and a yellow pad, and you go back and say, okay, last year, what did we use? What did we do? Pull up whatever checkbooks, credit cards, EOBs, whatever you have. Go back a year earlier, if it was different. Look forward. And I’ve told everybody, please ask your doctor what is on the horizon… We are saving people all kinds of money with a little bit of homework.”

Erica Dumpel

Podcast Transcript

[00:00:30] Karl: Welcome to the Capitalist Sage Podcast. We’re here to bring you advice and tips from seasoned pros and experts to help you improve your business. I’m Karl Barham with Transworld Business Advisors, and my co-host is Rico Figliolini with Mighty Rockets, Digital Marketing, and the publisher of the Peachtree Corners Magazine. Hey Rico, how are you doing today?

[00:00:47] Rico: Good Karl. I hope you’re well.

[00:00:49] Karl: I’m doing very well. We’ve got a rainy day out there today. It’s fall, it’s finally here. And why don’t you introduce our sponsor for today?

[00:00:59] Rico: Sure. Peachtree Corners Magazine, which we just put out our latest issue, is the sponsor of this podcast. Along with Peachtree Corners Life and Prime Lunchtime with the City Manager. So you can check us out on LivinginPeachtreeCorners.com or check out the Capitalist Sage website at TheCapitalistSage.com as well.

[00:01:18] Karl: Excellent. Well, today we are going to talk about health insurance and various options, especially for small business owners and individuals that are trying to navigate all these options in the market or with other plans. Today’s guest is Erica Dumpel. She is the founder of CDA, Inc., an insurance solution provider that helps both individuals and small businesses. She’s got over 40 years of experience in the healthcare insurance industry. And she’s here today to share some tips and information so that people that have to make decisions over the next you know, 90 odd days are informed with various options and at least start to asking the right questions of your insurance providers and the folks that help you with that. Hi Erica, how are you doing today?

[00:02:08] Erica: I am doing great. Thank you so much for inviting me.

[00:02:11] Karl: Oh, it’s my pleasure, my pleasure. Why don’t we jump right in and you share a little bit about yourself and what you do, and tell us a little bit about your business?

[00:02:19] Erica: We are a small business in Norcross, Georgia. We are a party of six, with a couple of dogs as extras, our security crew. Since 1975, we have had an agency that focuses on small companies, individuals, and seniors. So we work primarily with companies of less than 50 employees. Where sometimes individual products are appropriate, sometimes the group products are appropriate. And then we layer in there, all of the issues related to Medicare, because we have an increasing senior population that is continuing to work. So that has become an extra layer of conversation.

[00:02:58] Karl: Oh wow. I know that everyone this past 18 plus months, everyone’s health has become a critical point of discussion in family. And there are people that may not have had health insurance before, or had less health insurance, that are probably looking at the future differently than they have in the past. And so why don’t we start off with just talking about when you see individuals and small businesses, just high level, what are some of the options they have if they want to get better health insurance and healthcare?

[00:03:30] Erica: Let’s start with the groups, okay? So whether you are two people or 49 people, you are in a specific category called small group. You can do the guaranteed issue, affordable care act plans, which means they are cookie cutter. They are predetermined. The rates are the same, whether you are healthy or sick, whatever industry you are in. It’s a great starting point. Especially if someone has some medical issues in their group. If on the other hand, that same group of people can answer medical questions positively. There is an improvement in rates by going into medically underwritten coverage. The next level beyond that is, if you can do that and you can qualify for one of the programs that gives you an opportunity to get back any claims dollars that you haven’t used, that becomes even more attractive. And then there’s some other layers beyond that. But what we are finding now, and we have found it, the pendulum swings back and forth. What happens is, a couple of years ago, group rates were significantly less expensive than individual rates. Well, the pendulum has swung. And in the state of Georgia, individual rates are swinging more and more cost-effectively away from group. So all of a sudden we are talking to our employers, whether they are 49 or whether they are two and saying, does it make sense to unbundle the group product and look at an individual coverage, HRA? An ICHRA, you may have heard of that, or a QSEHRA is another one that’s out there. Does that make sense? Number one. Number two, does that get you away from some of the compliance issues? You put in a medical group plan and you have responsibilities that someone may not tell you about, or you may not be aware of how important this is. The penalties can be $110 a day times the number of employees, times the number of days since the infraction. These are real numbers. So we look at it from that side, then with some of our clients where some of the incomes are lower, and we’re talking the nonprofits and some of the nursery schools. What if we look at completely unbundling it? What happens if we help these people look at marketplace policies? Where suddenly now we have subsidies, which means we are able to reduce premiums based on income. If the incomes are low enough, you get that plus you get an improvement to a lower deductible, a lower out of pocket. And the employer rather than funding, or having to fund a portion of it, simply steps away. And says, Erica and her crew or whoever the broker is, is going to come in is going to do the guidance. Is going to do the education, is going to help with the enrollment. We are getting out of the group business right now because it is more cost-effective, it is better coverage for our employees. So that in a nutshell is what’s going on right now. And it is a busy time.

[00:06:22] Karl: Let me ask you some questions to see if I understand this correctly. If I’m an employer that have, maybe relatively low earning employees in my plan, and I want to offer some form of health coverage for them. Can you describe the name of that? The last one that you mentioned. And am I understanding it right where they can opt in? I can offer the plan, but I’m not required to contribute into it?

[00:06:50] Erica: You are not offering the plan, you are stepping away. You’re saying I have historically paid X dollars. I paid 200, $300 a month for everybody’s coverage. We either cannot afford to do that anymore. With COVID that has been a very common comment. Or we find that it’s not as cost effective. We have in particular a daycare center, the employee premium is going from four 40 to $480 a month for a $6,700 deductible. Okay? These folks are making very low income. If we take the employer out of the picture and say, we are dismantling the group. Okay, you are not going to pay anything. You are simply going to do steerage. We take the employees to the marketplace and determine as an example, Rico, you’ve got this age, this zip code, these doctors, these drugs, these family members. These plans make the most sense for you. Karl, you’re in a different zip code. You’ve got different needs. Everybody picks what they want. And it may be, Rico, you need a high deductible health plan. You don’t use this stuff much. Karl, you may have young kids running around. You may need co-pays. I don’t know. But you can finally fit the right product to the person instead of, and I’ve said for years, if I do my job right on a group product, everybody’s unhappy because I have to find the average. So here we finally have the opportunity to get the right fit for the employee.

[00:08:14] Karl: What changed to make that happen?

[00:08:16] Erica: It was the marketplace subsidies many years ago. Then those became less attractive. And now with the COVID, especially in the Atlanta market, we have more people looking for individual health coverage. We have carriers who’ve been here now, six carriers who have been here for a couple of years with good numbers. Good results. Four more carriers are coming into town and these are not small carriers. Aetna is coming in under the CVS banner. United Healthcare is coming in. Friday Health Plans is coming in from Colorado, they’re a good player. And Bright Health Plans is coming in, they’re already in North Carolina. So there’s an expansion of opportunity. But the biggest thing, so we focus on premiums, obviously the cost. We focus on the benefits, because if I can get you a lower deductible for the same or less money than you were paying before, you win. But the biggest change this year has been, these plans started as skinny HMO’s. So the reimbursement rate through the providers was very low. So doctors said, we’re not playing this game. We can’t afford to do that. So each of the plans had one or two hospital networks. So all of a sudden, I don’t know if you’ve noticed, but a lot of doctor practices are selling out to hospital groups. The Laureate Group is now owned by someone else. So everybody’s being bought and the Piedmont Clinic is expanding and magically those are all now participating providers under the hospital system. So our network has blossomed. That’s been our concern, is if I can’t find you the right doctor, then everything else is meaningless.

[00:09:48] Rico: Doesn’t it get a little, I remember when the ACA came through. There were, I think only three, insurance companies in the state of Georgia at one point. Because they didn’t want to participate. They actually left. I forget if it was United Health Care, one of them decided, that’s it I’m not doing it anymore. So now you’re saying that, I mean, most people that are, have gone through the system, north of 50 years old, figured that group insurance would be cheaper. Because you’re taking advantage and leveraging people. But what you’re saying is that’s not the case anymore. That I can go out, buy my own individual insurance. Yes, customize it to me, but it would still be competitive in the marketplace. Even if I don’t have a group behind it.

[00:10:33] Erica: It depends where you are in the country. And I found this wonderful map that goes from dark blue to dark brown. And the dark blue is where the group products are more competitive. And the dark brown is where the individual is. So if you’re in Texas, it’s this shade of blue behind me, okay. Don’t go looking for individual contracts there. The Savannah area, Macon and south, is a dark tan. The Atlanta market is a gray going into a nice shade of tan telling us that right now, this is the place to be. You’ve got to be fleet of foot. You guys are paying health insurance premiums, this stuff is heinously expensive. You know, we spend more time pricing our groceries than we do our health insurance. And how much does this stuff cost us to use? That’s the other part. It’s great, I have a $6,700 deduction. That’s like having no insurance for most of America. That’s a problem.

[00:11:22] Rico: Yeah. And especially if you don’t have copay or you’re paying per doctor visit and stuff like that. Yeah. I could see that.

[00:11:29] Karl: So I’m going to take this moment to re-introduce Erica Dumpel with CDA Inc. Health Insurance. Helping people find health insurance solutions. I want to kind of start back and maybe you could help me with the history. When Obamacare, which the marketplace, these terms we’re using them interchangeably. When that became available early on, I know there were fewer options of insurance. People were unsure about it. And they also, to be able to participate, there were certain requirements that had to be met to qualify for a marketplace plan. Are you saying now that the marketplace, there’s more plans available in the marketplace and you can customize them to yourself, but they still meet those initial requirements?

[00:12:17] Erica: I’ve done this for 46 years. So we were back to the hospital surgical days, before there even were PPOs and networks. What happened when the Affordable Care Act came in was, a bunch of companies got very excited and said, oh, this is a great opportunity. And so they came into the market. The Humanas, the Aetnas, the United Healthcare. They all jumped in. The Affordable Care Act, qualified plans had to meet certain requirements. They had to have the federally mandated wellness and preventive guidelines. So there are all kinds of little things that were required. What happened was, you could qualify for a marketplace plan or you could qualify for an ACA plan, period. I mean, you were buying a cookie cutter plan from originally 6, 7, 8 companies. You would qualify for a subsidy based on income. So they look at the family size, they look at the income and they say that your premium cannot exceed X percentage of your income. If you are between 250 and 400% of the federal poverty level. There were different buy downs on and on. Fast forward to the COVID issue. The government realized we had a whole bunch of people running around with no insurance because they couldn’t afford it. So not only did there appear or does there appear to have been an increase in the subsidy amount that people are getting, but where everything seemed to stop at 400% of the federal poverty level, now it’s going beyond that. If you are above 400%, you are not going to have as big a help. But you’re still going to have some help, if the premiums exceed a certain percentage of your income. So it’s an effort by the government, in my opinion, to get as many people covered as possible. The more people we have who are not showing up at emergency rooms or at hospitals without a negotiated network, the less the rest of us are going to be paying for their costs that are being written off and passed onto the rest of us.

[00:14:18] Karl: Got it. So in the scenario that you described where employers don’t offer group plans, is it the idea that they can offer them some kind of cash bonus credit or something as they choose their own to help them offset their costs? What do you see employers doing? Or are they just stepping away from it completely?

[00:14:37] Erica: Many employers, I suspect are just going to step away completely. Our clients are not like that. Our clients are taking those dollars and saying, okay, rainy day. Because in two years, this all may shift the other way. So let’s kind of bank that for the moment. But let’s look at things that individuals cannot purchase cost effectively. Dental, vision, disability products. You cannot buy a cost-effective disability product. But on a group basis, it’s pennies. Life insurance, cancer, accident. All of those workplace products become an uninteresting thing. In some cases, some of our employers are saying we are not allowed to pay for the health insurance, but we can bump. This guy has been with me for 15 years, I’d like to give him $300 a month. This fellow is brand new, I’d like to give him a hundred dollars a month. I’m just going to raise the salary, and make it clear to them that it is because of this. At some point, we may need to take this money back, if we go back into the group business. Please don’t forget why you’re getting this money. Because that’s very easy to forget, unfortunately. A lot of companies right now are fighting to attract and retain their employees. So anything that improves a situation, maybe saves a little money for the employer for a rainy day. Maybe allows, I don’t know, a bigger Thanksgiving dinner or whatever. I don’t know. There are all kinds of things that can be done with those dollars.

[00:16:02] Rico: There’s a friend of mine. His company provides group insurance. But he’s also told his individual employees, if you don’t want to be on this group insurance, this agent that I use, this company to use, can provide options for other insurance that you can purchase separately. Now he’s not bumping salaries per se to cover that, but he’s giving options. Because he’s saying you may be able on your own to get it cheaper than what I’m able to give to you as a group. Because like you said, everyone’s a little different, right? It could be a 25 year old working for him versus a 40 year old with two kids.

[00:16:39] Erica: The thing to be careful of is, when the employer says, go work with this broker and go get a subsidy. Okay? So we have to be very careful. One of the kick outs is if you are eligible for coverage under a group plan through your employer or any other employer, to whom you are affiliated, spouse as an example, you cannot have a subsidy. And what’s happened is that people were not told that or are gaming the system. At some point, they’re going to get caught on that. And there will be certainly a return of that money. Certainly there’ll be some kind of penalty. Right now, not. But in the future, there’s going to be some kind of penalty for that.

[00:17:18] Karl: So I’ve got another question about the, in Georgia locally here, the options in the marketplace, ACA. Most of them in 2020, I remember seeing something. Over the last several years, they’ve mostly been HMO options. I don’t know if there was many PPOs and then there might’ve been a few HSA, high deductible HSA plans. In this coming, do you have any insight of is there any change in options for folks? And just generally your thoughts on the pros and cons of HMOs versus PPOs when people are trying to select what’s right for their particular situation.

[00:17:52] Erica: Everything on the individual market is an HMO. So that simply means that unless you have a life or limb threatening emergency, you need to stay in your network. And generally it is a hospital driven network because a carrier will have a relationship or a contract with North Side and Emory, as an example. So we do not have PPOs in this market and we have not in a very long time. There were point of service plans for awhile. They do not exist on the individual side right now. I don’t see them coming back. The big risk with the point of service that people, I don’t think really understand, is if I go to a non-participating provider. Yes, I have a separate deductible and yes, I have a higher co-insurance amount. I see that. What I don’t see is, what the accepted rate, the usual and customary, the negotiated, whatever you want to call it is. So if I go to a non-participating provider and that doctor runs up a thousand dollar bill, and my plan is going to pay 60% and I’m going to pay 40%. It’s not necessarily of that thousand dollars. If a participating provider would have accepted $150, I will get 60% of the 150. The rest of it is all on me. So that’s the big concern with the point of service plans.

[00:19:15] Rico: Is that because when you get explanation of benefits, the doctor’s bill is $1,500, but the contracted or agreed upon by the insurance could be a thousand dollars. And by the way, we’ll pay 60% of that. And you’re responsible for the other 40 of that discounted rates.

[00:19:31] Erica: That’s if you’re in network. If you go out of network, you now get a $10,000 bill negotiated down. And the in network would have paid, would have negotiated a thousand, but you’re getting 600 on a $10,000 bill. That’s the trick. And that’s where people get caught.

[00:19:49] Rico: Yeah. My daughter was in Berry college. She got hurt. She fell off a horse, equestrian rider. Had to go to Rome’s emergency hospital room out of network. I mean, had to go. That was the only hospital in the whole place. And then we get a bill like a month later, I think it was. And it was just horrendous. I mean, nothing happened with her. She just needed a scan to make sure everything was okay. But yeah, it was not good.

[00:20:13] Erica: But it should have been in network because it was life or limb threatening. So was it coded properly? I just joyfully walk into the Rome hospital cause I happened to be there, versus I just fell off a horse. That’s a whole different feeling, so that should have been treated in network, but that brings us to a whole different issue. There are, in the participating hospitals, physicians primarily radiologist, pathologist, and anesthesiologists, who are not participating. And those are the surprise bills. You may have had a surprise bill. That’s what all the legislation is discussing now, because what are you supposed to do? You can’t ask? I don’t know who’s the anesthesiologist, you know, when I’m getting my head cut open. I don’t know. So that’s going to be a real interesting discussion

[00:21:02] Rico: Because they’re individual like subcontract. This is the way I looked it. The hospitals, the shell, they like the hair salons. They have a chair and they need to make money. And that’s what they’re doing. And you’re right. And I think that was part of that issue was the, it was that part of it that really got us.

[00:21:17] Karl: If I could ask you then, what do people do about that? If you need to go for a procedure for something, are you supposed to ask? What’s best practice? Ask, is everybody that’s providing medical care to you during your surgery and post-surgery in this plan? Or how do ordinary people avoid getting those surprises?

[00:21:39] Erica: Most of it when you pre-certify a surgery, and if it’s an emergency obviously it’s a whole different story. But if I pre-certify a surgery, I’m going to the insurance company and saying, I’m having this done. And checking is the surgeon in, is the assistant surgeon? Because that’s where the problem is, the assistant surgeon. Is the hospital? You can’t really check the anesthesiologist. So that’s a big problem. But I have one client who delivered a baby. And it was about a month or so after a friend of hers that delivered a baby. And the husband took it upon himself to not have the same mistake that their friends had. He stood at the door, the entry to her room, and everybody who walked in, he asked, are you a participating provider? Because his, their friends had gotten hosed. Because every time a doctor sticks his or her head in, cha-ching, there’s a bill. So that’s the extreme, but they were so proud of themselves because they had no surprise bills.

[00:22:33] Karl: That’s fabulous. I could see someone making a shirt for that as they come in and have people sign in. I’m pretty sure that’s not how healthcare is supposed to be for most people. That’s the world that we live in. If I can come back to when you look at the options, you had mentioned new providers coming in? I don’t remember who was in last year, but there were, maybe there were more than the year before. Are there more options coming in this, do you have any insight into that yet?

[00:23:02] Erica: We had the core six, which was Ambetter, CareSource, Anthem Blue Cross, Kaiser. I’m blanking out. Oscar and somebody else. This year being added in, oh, Allied. This year, being added in are United Healthcare, Aetna as CVS. I don’t know who bought who, but they’re under CVS now. Bright Health Plans, and Friday Health Plans.

[00:23:24] Karl: Now, can I ask a question? How do people navigate, they change jobs or they move or change. They have a doctor that they like that’s in one plan. The kids have another doctor in another plan. Everyone has doctors. Either they’re dealing with chronic stuff or things that have been going on for awhile, and then they have to change insurance providers with different groups of these groups. How do people, how do you suggest people navigate that?

[00:23:54] Erica: It’s a difficult thing, especially when we have, call it skinny networks or call it limited doctors lists. In the old days, if you went from an employer plan with Aetna to an employer plan with Humana. Yeah, it was the same doctors. It was no big deal. What we’re finding now is if I’m in a plan that has a Piedmont base, it’s going to be a different set of doctors than a North Side base. So you have to be oh so careful. If someone is in the middle of something, very extensive cancer, heart condition, whatever. Many of the plans will allow that particular problem to finish with the existing doctor, as long as there’s notification. But then you do have to switch from one provider to another. And that’s a problem. So this year I’m with this pediatric group and the next year I’m with that pediatric group. And the lock-in to a doctor is a real problem. I got lucky. I found a doctor who takes everything and it’s just an incredibly wonderful old fashioned doctor. But when you’re in these practices that sell to or sell out to a hospital chain, they’re only going to be in one hospital. It’s a system. That is going to be a big problem.

[00:25:01] Karl: Got it. The other thing is in, when they’re looking at it, the different levels, gold and platinum and silver and blue and all the different levels that people have. Any thoughts on, differences between? Is it just about the dollars? Are they really worth that being distinct from each other?

[00:25:19] Erica: It depends on very specifically on what your needs are going to be for the next year. So a gold plan is going to have a higher reimbursement on your expenses than a silver or bronze or whatever. So those actuarial levels were all calculated. If you qualify for subsidy, start by looking in the silver plans. Because that’s where you may get your best bang for your buck. If you are below a certain level of the poverty level, you get that improvement in benefits, is what I call it. They have some other term, but your premium comes down. You’re out of pocket comes down, potentially. If you are very young and you never use this stuff, and there’s a young woman who called me and we’re working on her stuff right now as a Guinea pig, we have the opportunity to put in a catastrophic policy. And the thing is going to have an $8,500 deductible. This child is 26 years old, but she’ll have all of her preventative stuff covered and three primary care office visits. She doesn’t have anything. This is perfect. And the premium is $206 a month. She can afford that at that age. If I have a bunch of kids running around with antibiotics and tubes in their ears and constant this and that, I’m going to need to get a richer plan. But if you sit down with a coffee cup on a Saturday morning and a yellow pad, and you go back and say, okay, last year, what did we use? What did we do? Pull up whatever checkbooks, credit cards, EOBs, whatever you have. Lineup all the people in your family and figure out who did what. Go back a year earlier, if it was different. Look forward. And I’ve told everybody, please ask your doctor what is on the horizon. Sometimes people are just in denial, but if I’m carrying a lot of weight and I have blood pressure problems and I’m having trouble losing that weight, I’d better be aware that there’s something on the horizon for me. If I have diabetes and I don’t have it under control, what is the next level of insulin I’m going to? What does that cost? Nevermind, what can I do to push the time backwards? Bring it down to scale, but you need to be aware of how much you use it. The advantage is every year you can make a change. We are no longer medically underwritten. So the fact that you do get sick, next year, go ahead and change. And same thing with the Medicare folks, with their drug plans, oh my gosh. They need to every single year, look at their drug list and compare it in terms of what their plan is this year to what it could be next year. We are saving people all kinds of money with a little bit of homework.

[00:27:46] Rico: I mean, some insurance companies don’t want to cover certain medications. They might cover the generic. They might decide to cover the brand, but not the generic. I’ve seen that. I’m an individual business owner, right? Just me. I don’t have, I have 1099 employees, if you will. They’re subcontractors, freelancers and stuff. I would be looking at an individual policy then, versus a company policy or group policy, because there’s just me. So no different than anyone else that would be looking for themselves, pretty much. The way it used to be.

[00:28:16] Karl: What about outside of the marketplace? Who would you recommend look outside the marketplace? I understand if you have pre-existing conditions and so on, but when is that a good option for individuals, small business owners?

[00:28:31] Erica: The marketplace has all 10 carriers. In the Atlanta market, okay? Has a series of products with a pricing structure. If you are going to look for a subsidy, you have to enroll through that and get your subsidy there. On the other hand, if an employer is putting in an ICHRA, in individual coverage HRA, where they are more involved and they’re saying no, no, we still want to manage this. We just want everybody to have their own choice. There we have to be careful because standing alongside the 10 carrier marketplace plans, are 10 carrier non marketplace plans. So they’re going to be usually a little bit richer, a little bit less expensive because you can’t get the subsidy on it. But the trick now is if I put in an ICHRA, and I want my employees to be able to pre-tax their portion of the premium because now I’m paying a part of it, I have to make sure that the decisions and choices are made off the non marketplace policies. A lot of people don’t know that I’m just waiting to see what blows up next year on this, because they’re going to say Johnny went over to the marketplace and they signed up and it looks the same as off marketplace. Different coding, different rules. So it’s a little bit more complex than people realize, but the difference between the two is marginal. But it could be that the non marketplace plans could be a little richer and a little less expensive. They were this year for some carriers.

[00:29:56] Karl: So if you could share some of the dates that are coming up, I know enrollment periods are starting. Can you highlight some of the key dates people should pay attention to?

[00:30:04] Erica: Medicare open enrollment, which is for Medicare Part D Drug Plans and Medicare C, Medicare Advantage Plans, October 15th through December 7th. Unless you have a qualifying event, which means you’ve lost coverage or something else, that is your only window for a January one effective date. And you are locked in for 12 months, essentially. There are some parameters, but consider you are locked in for 12 months. The individual marketplace starts November one, next Monday. And for everybody who enrolls between Monday and the 15th of December, they will have a January one effective date. And that’s where it stopped last year. This year, the government is expanding it an extra 30 days going to January 15 for a February one effective date.

[00:30:51] Karl: Got it. Got it.

[00:30:51] Erica: Those are your key things. For many people who have group plans that seem to enroll, or it seemed to renew January one, which is a large proportion of the United States. Right about now is when everybody’s being handed their open enrollment packets and being told, make your decisions. So again, doing the little exercise, getting the yellow pads, sitting down and figuring out how do we use this stuff? In the past, you would want to get the richest plan you possibly could, because if you got sick, you could not make a change. Those days are gone. So now, what size shoe do I need this year? What size shoe do I need next year? And what size shoe did I have last year? So we really need to start paying attention to how we spend our money, premium wise and claims wise.

[00:31:36] Karl: Wow. Those dates are coming up quickly. But that’s some good tips as far as starting to look at your past spend and asking the questions of what your future spend may look like depending on your family situation, there’s pregnancies or dealing with knee surgeries or back surgeries and things of that nature. It’s the right time to make those decisions. I know there’s a lot more we can cover and talk about. And I’d love to have you back again and we can talk some more about different changes as things evolve. But if someone wanted to reach out to contact you, what’s the best way to reach Erica?

[00:32:11] Erica: Easiest, probably is my email. It’s Erica, Erica@CDAINC.net. And the office phone number is (770) 449-7369. There are six of us here, support staff and sales reps. Anybody can get the conversation started, whether it’s group or individual or Medicare, it doesn’t matter. We’re happy to help any way we can.

[00:32:37] Karl: Well, excellent. Well, it’s the fall season and going to fourth quarter, which I could imagine is a, busy time for you. Do you have anything coming up? What do you got keeping you busy this next few months?

[00:32:47] Erica: Exactly what I just discussed. Seeing a lot of clients and a number of folks who have been referred to us are coming with questions. Because there’s a lot to digest this year. More than in prior years, there are a lot of options. People really need to take a peek at what their options are because this stuff is incredibly expensive.

[00:33:08] Karl: I’d also like to add a shout out to the Southwest Gwinnett Chamber Friday coffees. You come there, you’ll meet folks like Erica. Several other folks that can help you through insurance issues and other issues for your business or for your individual self. Stop by on a Friday at 8:30 in the morning for Friday coffees with the Southwest. And Erica, I know you’re often there and that’s a good way to meet her and some of the other folks that work in this space. I want to thank you so much for joining us today and just helping with tips and helping people become more aware and every time Rico, we do this right, we learn something else.

[00:33:44] Rico: This was great. Thank you, Erica.

[00:33:46] Erica: You’re very welcome.

[00:33:46] Karl: We’re all just a little bit smarter about, just the options and the decisions that we have to face. Open enrollment is starting up soon. I think November 1st for most people. Do those exercises, talk with your families, talk with your employers about some of the plans that are outside the marketplace. And just try to do the best thing for your family. If anything, we learned over this last year is taking care of your health is really important. And you can’t plan for when you’re going to need health insurance and deal with it. All the people that got COVID, whether they have to get well at home or go out and go to a hospital. And there’s going to be some time before people recover from the health costs that were incurred. The costs to their livelihoods, their employers and so on. So it’s a smart time to think about what choices you’re making for next year. And Erica, thank you so much for helping us through that. Today we had Erica Dumpel with CDA Inc. Just sharing some of those insights on the healthcare options for folks that are out there. I’m Karl Barham with Transworld Business Advisors of Atlanta Peachtree. Our business advisors are available to help you consult on your business. Whether you’re looking to improve your business, to grow your business, or when you’re ready to exit your business. You can contact and schedule a consultation with us. My email is KBarham@TWorld.com. Or you can visit our website at www.TWorld.com/AtlantaPeachtree. Our goal is to help support the local business community in any way we can. Even if it is connecting them to experts in different areas that can help them with their business or when they’re ready to exit or sell their business, we can help them with that as well. Rico, why don’t you tell us about what you’ve got going on?

[00:35:31] Rico: Sure. We’re working on the next issue for Peachtree Corners Magazine. That actually comes out in December. But we just started working on editorial now. Lots of good stuff we’re planning on. And the latest issue is out now. You can go to LivinginPeachtreeCorners.com to check out the digital version of that. And doing the normal things that I always do. Mighty Rockets is my company. So if you’re looking for branding, marketing, social media, online management of your presence there. Just contact us and we’ll be more than happy to help you with managing your social media, video production, and podcasts even. So check us out at MightyRockets.com. So all good. It’s a great day. It stopped raining too I think.

[00:36:14] Karl: Yeah, it did. Well, thank you everybody for joining us on the Capitalist Sage Podcast, we’re going to continue to bring you local experts and business owners and just continue the conversation. So everyone have a great rest of the week. And for those get ready for Halloween this weekend. Be safe out there and watch out for the kids. Take care of everyone.

[00:36:33] Rico: Take care.

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Finnish Company Moves U.S. Headquarters to Peachtree Corners

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Valmet’s corporate mission of sustainable energy and carbon-neutral production fits in with local goals.

The appealing aspects of Peachtree Corners led leaders of Valmet, a Finnish-based global developer and supplier of process technologies, automation and services for the pulp, paper and energy industries, to move its headquarters to the city.

“In about March of last year, we started thinking about relocating our office from Duluth to somewhere else,” said Jukka Tiitinen, Valmet area president, North America. “To find a new home for our North American headquarters that represents our values and represents the flavor and nature of our company, we took quite a bit of time to go and visit different neighborhoods, different areas and looked at different buildings. And we settled here. …I don’t see how we could have done any better. This is fantastic.”

The company cut the ribbon on its new offices on May 11 with local dignitaries, media and the Valmet CEO Pasi Laine, who came in from Finland for the occasion.

Laine explained how Valmet didn’t have early successes in the North American pulp and paper industry. In 1988, the company had some business interests here, but the capital activities were on the decline and continued that way for decades.

“We weren’t selling too many machines and didn’t have too many partners,” he said, adding that Valmet didn’t give up on North America and kept strengthening the business through several mergers and acquisitions.

Part of the issue, Laine said, was that there were a lot of small businesses in the group that wanted their own processes and procedures. They wanted to maintain their old identity, offices and even logos. “It was practically impossible to get the people even in automation,” he said, adding that the North American customers weren’t seeing any continuity.

But the company continued to invest and improve production through technological advances and a management style that had come together in a “learning cluster” of sorts. Now, 30 years later, Valmet has added some of the state’s and the country’s major players in the industry as partners. Household names like International Paper and Georgia Pacific have Valmet machines and staff working in their plants and mills.

“Now, currently, we have about 2,000 people here, we have big business under civilian revenue and a lot of lot of customers and good personnel as well,” said Laine. “Now we have learned how important it is to work with each other, talk with each other and learn from each other. And I think that’s the big change that has happened over the decades in the company.”

Like-minded neighbors

The collaboration Valmet has seen with Curiosity Lab and other endeavors in Peachtree Corners is the exact business model the company projects. Laine’s interactions with local CEOs have shown that maintaining the status quo isn’t good enough any longer.

“They were saying that it’s not a good strategy anymore just to maintain the old machines and run them out. They started to say that they have to start to invest to make a difference. And today, we have a totally different situation than 10 years ago. Most of our customers are believing that it’s worthwhile to invest in North America,” said Laine.

The company isn’t limited to paper products like tissue, boxes and the like. Valmet is organized around five business lines: services, pulp and energy, paper, automation systems and flow control. The company serves five geographical areas, North America, South America, EMEA (Europe, Middle East and Africa), Asia Pacific and China.

With more than 220 years of industrial history, Valmet has a strong track record in continuous improvement and renewal, and has more than 17,000 employees worldwide. The combined company net sales in 2021 were approximately 4.5 billion euros which converts to about $4.7 billion in U.S. currency.

Valmet’s continuing mission is to convert renewable resources into sustainable results. This means that its technology and services make it possible for customers to manufacture sustainable products from renewable resources.

“We believe that technology plays a crucial role to mitigate climate change and global warming. Our target is to enable 100% carbon-neutral production for all our pulp and paper customers by 2030,” according to corporate statements. “We believe that technology plays a key role in mitigating climate change and global warming in the transition to a carbon-neutral economy. Valmet has a long track record in providing solutions that convert biomass into renewable energy and recyclable products such as pulp, paper, board and tissue. We have also developed and commercialized new biomass conversion technologies for producing new bio-based end products such as biogas, biofuels and biomaterials.”

Peachtree Corners Mayor Mike Mason agreed that Valmet fits in with the local business climate of companies that are working to change the world for the better.

“Welcome to the community — and most importantly, thank you for making the decision to come here,” Mason said. “And from talking with your leadership, hearing what you do, you make, what’s important to you about this decision, you made the right decision.”

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PCBA Panel Gives Insights into City’s Growth, Development

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Visionaries see smart expansion for Peachtree Corners.

In a city that’s a hotbed of economic development, technological advancement and residential properties, it’s important for residents and stakeholders to keep informed about what’s going on today and what’s planned. To aid with that undertaking, Peachtree Corners Business Association convened a panel of local influencers at its April Business After Hours Speaker Series at Atlanta Marriott Peachtree Corners.

Moderated by Amanda Pearch, the CEO and principal of Forsyth Business RadioX, a community focused company that produces, promotes, distributes and markets online radio shows and podcasts for businesses, the panelists were a diverse mix of local movers and shakers which included:

  • Joe Sawyer, Peachtree Corners City Councilman at Large, a resident of Peachtree Corners since 1994. He recently became the first person of color elected to the City Council. Sawyer has owned Alpha & Omega Carpet Cleaning in Peachtree Corners since 2001 and has been a preacher since 1998.
  • Sue Storck, with North American Properties, the general manager for the Forum on Peachtree Parkway. She has been in property management since 2007 in Florida and Georgia.
  • James Winston, the director of construction at AHS Residential, a company that develops, builds and manages multifamily housing in metro Atlanta. He has 17 years of experience in real estate development.
  • Michael Pugh, a partner at the law firm of Thompson, O’Brien, Kappler & Nasuti, P.C. He concentrates his legal practice on the representation of businesses, banks, credit unions and commercial finance companies in secured transactions, financial workouts, asset recovery and liquidation and lender liability defense in both state and federal court, including federal bankruptcy court.
  • Louis Svehla, communications director for the city of Peachtree Corners.He has years of experience in journalism and public relations.
  • Rico Figliolini, a longtime Peachtree Corners resident and the publisher and executive editor of Peachtree Corners Magazine. He is also a creative director and social media strategist, three-time magazine publisher and podcast host.

Growth opportunities

The group started off discussing some identifiable opportunities for growth in Peachtree Corners. With so much emphasis on what’s happening in the northern part of the city, Sawyer said developers need to start looking to the city’s south side.

“There’s a lot of opportunity for growth on the south side,” he said. “You see the townhomes going up and you haven’t seen houses going up for a long time. That’s where the next wave of growth will come.”

Svehla agreed. “I think redevelopment is really the big thing. Joe got it completely right. Housing is probably not going to happen unless it’s redevelopment of older neighborhoods,” he said. “Just like what’s happening with The Forum, the future is multi-use type facilities.”

Pearch parlayed that response into a question for the home builder. “Well, the prediction is we’re going to find very efficient and innovative ways of finding solutions for this housing problem that we have,” Winston responded. “We know everybody is looking for…  housing that’s reasonably priced. We have a way of building and approaching our projects that I think is going to fit into the fabric of what this whole community is looking for. They’re trying to be innovative, looking for something that’s going to have an impact to the community. And we’re doing just that by rehabbing, basically, an existing property.”

Storck expanded on that concept with what’s happening right now with The Forum. “On our side, it’s experiential. …This is probably a very overused phrase, but ‘live, work and play’ is a trend that works,” she said. “With our tenants, we have a built-in customer base. The restaurants have built-in patrons, but it’s about an experience. Shopping is not… what it used to be. You don’t go window shopping anymore; you have a destination. So, our plan and our goal are to bring that opportunity to the property, to be able to host larger events and gatherings, whether it’s a tailgate party… or the Christmas tree lighting or concert series or a fitness series.”

Talking about developers dove-tailed into Pugh’s business. “One of the biggest advantages for Peachtree Corners is that it’s close enough to the city [of Atlanta] so that people inside the perimeter are comfortable coming here, and since it’s not in downtown Atlanta, we get people who don’t want to fight traffic in town,” he said.

All those factors feed into each other, said Figliolini. Having a publication that’s focused on the lifestyle of a community that fulfills the demand for a high quality of life with entertainment, retail and employment opportunities nearby allows him to put more emphasis on the message than the medium.

“Print is sort of a dying business. I can say this because I’ve been in the business for a long time,” Figliolini said. “We curate news in the community and people consume it in a variety of ways. Whether it’s Twitter, Instagram, Facebook, Tik Tok, it doesn’t matter. …Advertising is a long game. …Companies come to us. We have several corporate sponsors that are supporting local journalism, for example, so they’re not necessarily buying advertising as much as supporting news.”

Accolades and suggestions for the city

The panelists gave their perspective on what Peachtree Corners is doing right and what the city should do more of. Among the top recommendations is preparing the area for changes that have already been indicated. For example, the uptick in highly skilled jobs is affecting employment rates. Supply chain issues are challenging consumerism and access to technology is making a difference on how people live their lives.

“Roughly 65% of the existing labor force is almost set to retire,” said Winston. “So, we have to replenish that, and we also have to find ways to manage that and to find innovative ways of doing construction. We know we’re going to have challenges with the labor, in addition to all the materials. …Everybody is reading the articles about how prices are going up.”

Sawyer pointed out that Peachtree Corners is growing in smart ways and every new development is people centered. “I think we are probably one of the smartest cities, as far as technology. …What other city in the South has an app that, when you sit at a red light, the app on your phone tells you when the light is changing?” he said.

“A couple of months ago, we had Transportation Secretary Pete Buttigieg here to study our transportation sector,” added Svehla. “Everybody wants to come to Peachtree Corners because of all the innovative things that are going on here. I’m working to try to give Raphael Warnock an opportunity to see Curiosity Lab. …We don’t really have to reach out to anyone anymore because the word is out that we’re the most diverse city in the state.”

Perspectives on the future

In looking ahead, all the panelists agreed that Peachtree Corners has a solid future outlook and growth strategies. Pearch asked the panelists where Peachtree Corners, in general — and their industry, specifically — will be in three years, five years and 10 years.

Storck said, “The retail world is different, because some ways, the retail world hasn’t changed. We still have the brick and mortar as well as Amazon, so there are parts that will stay the same. But I think in three years, we are we are going to be fully redeveloped and we are going to be moving at a very fast pace. [The Forum] is going to be hosting 200-plus events a year and we are going to have opened quite a few new retailers. In five and 10 years, we’ll still continue that course. Because everything is cyclical and we go through changes, we have to adapt as well.”

Pugh added, “The legal industry is the dinosaur of all industries. If the legal world has adopted something, it’s been adopted across the board. I think that law firms’ sizes are going to shrink. I think that office space is going to shrink, and I think more and more attorneys and more and more businesses are going to go paperless. …I think that more and more are going to start incorporating the use of [artificial intelligence] in their in their work, where typically you would have a new associate coming out of law school doing research eight hours a day. You now have a computer program that does it for you.”

Winston noted, “Nowadays, with an age of social media, [job seekers] are able to see so many other options more easily, and people are able to tailor it to make it more marketable. That’s not always what you see in the construction industry. …You could start off learning mechanical, HVAC work, plumbing or electrical and branch off into a completely different sector of that same industry, or branch off more into real estate, because it really is part of the same pie at the end of the day.”

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Peachtree Corners Partners With Israeli Startup To Advance Smart City Technology

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Peachtree Corners and Israeli Startup ACiiST

ACiiST will help the city with a connected infrastructure without tearing up roads or investing in miles of cables.

As one of the country’s first smart cities powered by real-world connected infrastructure, Peachtree Corners recently announced a partnership with Israeli startup ACiiST – Smart Networks, the manufacturer of SD-LAN network solutions optimized for connecting outdoor cameras and sensors through a robust networking system. This partnership provides Peachtree Corners with connected infrastructure network solutions via fiber that allow various mobility technologies on Peachtree Corners’ smart city streets to communicate with minimal digging, saving the city and residents time and money.

Peachtree Corners and Israeli Startup ACiiST

Installed in Technology Parkway earlier this year, ACiiST’s technology spans across a half-mile of Peachtree Corners’ “city street of the future,” allowing deployed technologies and smart infrastructure with cameras, wireless links and other communication equipment, to be streamed directly to the Curiosity Lab’s IoT Control Room, the first of its kind to be implemented in a city in the United States. Communication between the smart infrastructure and the IoT Control Room is possible via self-managed ACiiST Polarity units that create a low latency, high performance and fully manageable network.

“Working with ACiiST to demonstrate their technologies at Curiosity Lab is another great example of how international companies are showing great interest in the most unique real-world smart city ecosystem in the country,” said Brandon Branham, Peachtree Corners Assistant City Manager and CTO. “We are able to demonstrate to other cities across the country the unique network connectivity, redundancy and monitoring capabilities of ACiiST’s technology through this implementation on public infrastructure. This is a true testament of how the partnership between Israel and Curiosity Lab offers startups a one-of-a-kind experience to bring their products to the North American market.”

ACiiST’s network solutions allow Peachtree Corners to have a more secure smart city environment and make informed decisions based on data, such as traffic management. This solution also makes it easier for new edge devices such as cameras, radar sensors, digital signs, V2I access points and more, to be deployed and installed as smart infrastructure across the city street of the future, supporting the Curiosity Lab and Peachtree Corners’ position as one of the leading smart cities in the United States.

“It was clear from the very first time we met with the Peachtree Corners management team that we are talking with leaders who want to promote positive change – with smart roads and streets as a platform to better manage their public spaces. They are open-minded to the implementation of new technologies, and we are happy to have our network solutions in action at the most unique smart city environment in the USA,” said Sagi Gurfinkel, ACiiST Co-Founder and CEO. “The ACiiST network is already installed as the connectivity platform for multiple cities in Israel, Africa and the European Union, and we are excited to now add the United States to this list.”

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