Latest / Bill of Health / Your Doctor Says You’re Fine. What If You’re Not? With John Goldman (Bill of Health Ep.11)

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Your Doctor Says You’re Fine. What If You’re Not? With John Goldman (Bill of Health Ep.11) · Bill of Health

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Beyond politics and warfare, a rebel is described as anyone who breaks
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away from societal conventions, traditions, or expectations, anyone
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that resists conformity and refuses to follow established rules or norms.
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Now, anyone who's listened to the previous episodes of this podcast
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knows that rebels, especially in the healthcare and health insurance
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space, are desperately needed.
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Disruptors should be welcomed.
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I have a friend in this space who's fond of saying that any real or true lasting
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change is gonna come from outside of the traditional fee-for-service healthcare
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space and the traditional insurance space.
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Reform rarely, if ever, bubbles up from legacy institutions.
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And when I run across a rebel, you know I'm gonna give them the platform
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Welcome back to The Bill of Health.
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I'm your host, Bill Feigh, the health insurance guy.
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Today, I wanna spend just a little bit of time talking with someone who was
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brave enough, sick enough, and frankly enough enough to break the cycle.
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Took his own health in his hands first, and in doing so, had an
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idea that is changing people and the industry for the better.
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Now, folks, I've said this before and I'll keep saying it, I've always been
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client-facing, meaning I am across the table from the employer or the employee.
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I'm helping them make tough decisions, and one non-negotiable for me is that
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I insist on making sure the people helping me bring a proposal to life,
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the companies and institutions I represent, are the smartest, most
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ethical and trustworthy that I can find.
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And consequently, I absolutely love talking to smart people doing it right.
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Smart people like today's guest.
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Ladies and gentlemen, please welcome to The Bill of Health podcast, Mr. John
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Goldman from Rebel Health Alliance.
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As Forrest would say, he hails from our nation's capital.
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He is a graduate of Georgetown University.
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Go Hoyas.
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After college, he entered the private equity and hedge fund space, then took his
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expertise over to the real estate industry for several years before taking a turn
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at basically all of the C-suite roles you can have in the charter school systems.
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He's a dad of two Division I athletes, a former Muay Thai, I'm sure I'm
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not saying that right, champion, and something I can't wait to
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talk to him about, he's currently training for the Boston Marathon.
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Ladies and gentlemen, welcome Mr. John Goldman.
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John, it's great to have you.
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Hey, great to have you, Bill.
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I could sit there and listen to introductions like that
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about me all day long.
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Nice work.
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I'm glad.
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I'm so glad that you're here.
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John, this program, this whole platform, is centered around helping
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people become smarter healthcare consumers, and that's not just in
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terms of dollars and cents, but also how they think about their health.
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That's why having you on is absolutely so important.
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I want you to give us a rundown of your journey, your health situation,
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what brought you into the direct primary care space, and actually what
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brought about Rebel Health Alliance.
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Yeah.
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Great, Bill.
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Thanks so much for the introduction.
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Got me really pumped about our mission just now, and love being on the same
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side as the good guys in this fight that is, I think, existential for the
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United States of America on so many different levels: fiscally, spiritually,
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mentally, physically, national security.
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On every level, I don't think anyone, barely, except for guys like you and
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me, are sounding the alarm loud enough as to what this ticking time bomb is
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doing within our country on every facet.
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I came to healthcare as an outsider, so when you were describing change
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coming from the outside and not from industry titans and standards,
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it really resonated with me.
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And we have been approaching healthcare from first principles, like your
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doctor should make you healthier.
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You should have a direct relationship with your physician.
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Yeah.
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We should be doing preventative care and early screening and early detection
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Strength training and cardiorespiratory fitness are probably two of the best
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medicines we can prescribe to anybody.
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Food is a medicine.
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If we can get you off of a prescription, we'd rather do that than put you
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on another one These are the basic first principles that we have come to
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provide our direct primary care, which we call high-performance healthcare.
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And so we've not been limited by IC, what I don't even know the name of the mark
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'cause I've never used one in my life.
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An insurance code, never used one of those in my life.
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Never done a pre-authorization, never done anything having to do with insurance
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at all because we immediately built our product and service outside of the reach
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of what I call the health gangsters or the medical industrial complex.
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I got to this point where I became completely fed up with
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my traditional healthcare.
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I had one medical, which back then in the day I thought I was like, "Whoa, I got
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some fancy healthcare here. I can make an appointment, I can talk to people,
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I can come in, see somebody the next day." But it didn't dawn or, on me or
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become obvious to me that it was just a nice wrapper and a lobby wrapped around
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the same old traditional healthcare.
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And by that, what I mean is that my doctor would see me year after year with elevated
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liver enzymes, with elevated cholesterol, with elevated sugars, with hypertension.
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Obviously obese.
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Even though I was lifting and working out all the time, like I was still
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like seriously excess adiposity.
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Plenty of excess adiposity.
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And that was just on the surface, and had they done anything to dig into my visceral
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fat content or my fasting insulin, or checked out my DNA or done an ultrasound
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on my liver or a coronary calcium score on my heart and arteries, they would've
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found all kinds of other stuff going on.
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But after years and years of going to the same doctor and him
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just being like, "That's fine.
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It's fine.
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Oh, you wanna do a little blood pressure medicine?
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That's fine.
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It's fine.
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Just, we'll keep an eye on that.
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It's fine." But you know, my AST, ALT has been elevated for like 10
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years. They're like, "Ah, it's fine.
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It's no problem.
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Don't worry about it." But I woke up one day at 44, 45 or
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so, just feeling like crap.
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Just every day I was feeling like crap and every day I was feeling worse and
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worse, and I realized to myself, I was like, "If I'm gonna feel like this,
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have I peaked?" It's like I'm 45.
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Is this it?
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Am I gonna actually feel this way or worse every single day for the rest of my life?
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'Cause if so, that is just misery.
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I was like looking down the barrel of a gun.
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Misery.
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So I asked a friend who was in the nascent like biohacking now turned longevity
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space, and I said, "Buddy, if there are guys my age out there who say, 'I feel
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better than ever,'" and I say, "Those guys are completely full of it, aren't they?
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They're lying.
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They're totally lying.
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There's no 50-year-old dude who wakes up every day and is like,
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'I feel better than ever.'" And he's like, "Actually, there are.
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They do feel better than ever, then they're gonna feel better tomorrow."
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And I was like, "Man, if that is the case, then I'm doing something wrong."
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And that is when he introduced me to the world of functional medicine, advanced
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diagnostics, deeper dive into your who you are, DNA testing, lab work that goes
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beyond a basic metabolic panel, DEXA scans, VO2 max testing, liver ultrasounds,
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CAC, CT angiograms, et cetera.
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And we did that whole battery on me.
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All of a sudden, boom.
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Wow.
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I'm Pre-diabetic.
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My CRP is over five.
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I'm basically just like a giant ball of inflammation.
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My fasting insulin was through the roof My cholesterol was too high.
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I had early signs of fatty liver disease.
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I had five pounds of visceral fat content.
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I was basically like a metabolic disaster on my way to getting my left foot
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chopped off, and I had no idea really, because my doctor that I trusted at
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One Medical, who I was paying the extra money for, told me every year, "That's
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fine, we'll just keep an eye on it." I realized that this was a big problem.
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And so at the time, I had some availability, and I dove just headfirst
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into… Back then, remember, this is like four or five years ago, so this is like
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before this longevity real explosion.
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And I was like, "Let me learn everything I can about this." And so I did,
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and I met with some physicians and some strength coaches and dieticians
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and epigenetic counselors, and I put together a plan that was like a
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360-degree healthcare plan for myself.
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And I implemented that plan, Bill, and I, in six months, had lost all the weight,
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six-pack was back, my sleep was dialed in.
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I had sleep apnea that I didn't even know about, had that taken care of.
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My sugars were good, my lipids were good, my liver was clear, my
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visceral fat was under a half a pound.
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My C-reactive protein was down.
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I transformed myself from being on the verge of diabetes and with
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hypertension and hypercholesterolemia and hyperlipidemia and hyperinsulinemia
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and the whole thing, to a fit and active and optimized, well, not
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quite optimized, but say healthy guy.
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And when I put all that together, it took me like six months to figure
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it out and to do it, and better part of a year really of a journey.
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At the end of the day, I was like, "Man, there have gotta be other guys and
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women out there like me in their 40s, professional, married, busy, thought
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everything was fine, maybe former athletes, wanna get back in the game,
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don't know what to do, told the lie of fine," which is what we call it, "and
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who would love this type of approach."
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Let's do all the diagnostics.
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Let's build the most comprehensive health dossier on you ever assembled.
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Let's give you a full care team and care coordination, and then let's give
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you a full plan of action and all the coaching and support that goes into
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it, and all of the dynamic programming that goes into progressing and making
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progress, and let's give that to people.
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And man, I had an inkling, and it was right.
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And people have been super into it, and they have seen tremendous results, and
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our clinical data speaks for itself.
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All the cholesterol, good cholesterol up, bad cholesterol down, C-reactive protein
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down, insulin down, sugars down, A1C down, visceral fat down, adiposity down.
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Across the board, hypertension down, all of it.
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We have a 10-tier longevity protocol.
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It starts with metabolic health.
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But if you do the thing, can't guarantee anything, but I can say pretty sure
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if you do the thing, as we tell you to do the thing, within a year, you are
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going to be a completely transformed individual, and people seem to like it.
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And that's just phase one.
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We can get to phase two in a minute, but I'm gonna take a breath.
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Yeah.
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Oh, that's fantastic.
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So I'm glad you mentioned the lie of fine.
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That was something I kept reading, and I just loved it.
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And when I read that line, I was like, "Oh, that, that just
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hits." Like a ton of bricks.
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Now, I know that you're not a publicly traded company or anything like that,
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and you may not be disposed to provide answers for this, but I am curious
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because I believe, I don't know the number, but I think my listeners are
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gonna be pretty excited to hear this.
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How long have you been actively in the Rebel Health Alone?
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How long has it been actively going?
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We are in our fourth year now.
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So we didn't just get started.
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We're not just fumbling around at this point.
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Right.
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We have a full MSO PC model.
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We are licensed in all 50 states.
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We've got doctors that can treat you in any jurisdiction.
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We have about 25-ish people working with us.
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We've had about 1,000 people come through the program.
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About 60% to 70% of people, yeah, that sign up stay with us year after year.
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And then we've really evolved it, too, to really do the big thing that I want
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to get to, but this was phase one.
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Phase one is optimizing the individual, right?
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Let's start with that.
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Let's start with optimizing the individual.
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And then this is the first part in what I call the optimization flywheel
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that we are trying to build, and we are doing a crawl, walk, run process here.
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And this optimization flywheel that I'm talking about is optimize the individual
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health first and foremost, right?
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A novel, crazy idea.
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Let's make the patient healthy.
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Whoa, crazy.
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So let's do that.
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And then second, let's optimize the payment process.
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How do we do that?
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Well, in our perspective, we think cash pay is the future, and we think
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cash pay, negotiated pricing, direct purchasing with your providers,
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radiology centers, surgical centers, specialists, all of it, that's the
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future, and that's where we should be.
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So we negotiate cash pay prices for specialists and procedures
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and labs and diagnostics, and we pass those along to our members.
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And the third thing is optimize the delivery mechanism, and we think that
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virtual is the optimized delivery mechanism because then you don't
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have to come into the office, and you don't have to wait in line, and we
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don't have to carry a big office space with machines and this and that that
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adds to our overhead and it makes us want to run tests that we don't need
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to do and all this kind of stuff.
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So we've optimized the individual, the payments, and the delivery mechanism.
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And then the fourth thing is where I'm really trying to get my hands in here.
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It's optimizing the risk pool We wanna make it so that the only thing that hits
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the risk pool are freak accidents, strange genetic malfunctions, pregnancies, large
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and unexpected financial events that could not be anticipated, prevented.
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We want it to be like insurance, like it should be, in case something bad happens.
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Not, not using insurance in the risk pool to fund my lifetime of diabetes treatment
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or my chronic diseases of 50 different ones of them, and all the medications, and
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all the specialists, and all the money.
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As you know, when I tell people how much money we spend on diabetes care
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in a day, their minds are blown.
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I say like, "Ah, we spend billions of dollars a day," not
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a year, a day, on diabetes care.
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And so we wanna optimize the risk pool so that fewer and fewer events hit the
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risk pool, so the risk prices come down, the reinsurance and the backstop rates,
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and the whole stack comes down and compresses so that there's more money
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available to optimize the individual so that we have a flywheel of optimization.
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And so the way that we've gone about doing that on this second phase
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is we've currently have partnered with community health shares.
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And we have found that community health shares are a terrific way
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to provide the financial protection for the large and unexpected events.
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And now, if you're in the biz, you know I have to watch my language on how I'm
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describing these community health shares 'cause you're not allowed to say coverage
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or catastrophic or premium or whatever.
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You can't say any of those things.
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Why?
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Because the insurance companies are scared of them, and they've got the lobbyists
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to regulate the language, and if you know you can't talk about something, then
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you know you're onto something, right?
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So we've found that community health shares are a terrific way to provide
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that financial backstop for people in cases of large and unexpected.
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And in our practice, with our high-performance healthcare, where
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you get a doctor, you get a strength coach, you get a dietician, you get
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a genetic counselor, we are covering 80 to 90% of your medical needs on
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a membership basis with unlimited access, a direct relationship with
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all of your providers, same-day communication, next-day appointments.
14:13
We're there, and we know everything about you, and we know how much you're
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lifting and how much you're eating and what your blood pressure is and how
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many steps you got and how much you slept and what supplements you're on
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and what medications you're on, and your strength coach knows, and your
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dietician knows, and everybody knows.
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And we can really serve everybody.
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For most people, in case they get an injury, in case they get hit by
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a truck, or on the upside, they have a pregnancy, we've got you covered.
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And so the health share has been a really effective partner for us.
14:39
But ultimately, Rebel Health is gonna be an insurance product.
14:42
Ultimately, Rebel Health will be some level of insurance where I don't have
14:47
to go through this vocab session and mechanic introduction, because I'll
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tell you, the number one obstacle to companies, and I pitch businesses all
14:56
the time, we do tons of businesses, small, medium businesses, please
14:59
call me, we'd do a great job for you.
15:01
The biggest obstacle, roadblock in getting a company to sign on the
15:04
dotted line is not the CEO, it's not the CFO, it's maybe HR. It is the
15:10
spouse of a senior vice president whose wife is like, "Well, I don't know,
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that doesn't sound like insurance.
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I don't want that.
15:17
That sounds too confusing.
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It's too hard."
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And then the senior vice president tells the CEO, and the CEO's like, "Well,
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I can't have people be unhappy." And they're like, "Ah, maybe not this year."
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So ultimately, I think we're gonna be at some level of insurance product.
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But right now, we've got our high-performance care, the whole team.
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We're gonna keep you healthy.
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We're gonna prevent, early detect.
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We've early detect cancers, leaky valves, lung cancers, leukemias in
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other- otherwise healthy people, too.
15:44
And then we'll partner with… We like Sedera, S-E-D-E-R-A.
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We like Sedera.
15:47
They're tremendous, and I use it personally, and my wife does, too.
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So that's where we are right now, Bill.
15:52
Yeah.
15:53
So, oh, there's so much to unpack there.
15:55
Now I'm getting excited.
15:57
I'm a Sedera affiliate.
16:00
Oh, same.
16:00
Yeah.
16:01
One of the things that I tell my clients, individuals, is that, "Listen,
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I wanna be a consultant. I don't wanna be prescribing solutions. I
16:09
wanna be as I'll give you the pros and the cons, and we'll find what fits."
16:12
However- The more this insurance nonsense goes on, the more the prices
16:17
increase, the, the deductibles increase, the out-of-pocket maximums increase.
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I'm becoming less and less capable of being quiet.
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I want an army of 1,000 individuals who do just exactly what you're talking
16:30
about, have a great relationship with their DPC provider, where 80 to 90% of
16:34
your healthcare takes place, actually seeing improvements, not just providing
16:38
care, but seeing improvements, and then backstop is the health share.
16:42
And overall, your health is better, your outcomes are better, and I
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believe almost always you're saving.
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You're saving money.
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And I can't talk to enough people about it.
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I sound like a one-trick pony, John, and I know it drives people
16:56
crazy, and I don't want this show to be an extended sales piece.
17:00
It's not a sales pitch, okay?
17:02
But man, I want 1,000-person army for Sedera.
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I want 1,000-person army, and I'm becoming more and more convicted
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that is where we need to be.
17:11
A couple other things that you touched on I wanna make sure that we get to.
17:14
When I look at your website, scroll through all the posts in the conversation
17:17
that we just had, that data collection, that bio health data collection is key
17:22
to your practice, and you're quoted as obviously saying, "Hey, you know what?
17:25
AI can never or tech can never replace that human element and that direct primary
17:29
care provider." But how are you leveraging data right now to empower patients
17:33
without necessarily overwhelming them?
17:36
Or tell me where the human and the tech meet and live.
17:39
Sure.
17:39
I'm gonna answer that question, Bill, but I'm gonna say one comment on what you just
17:43
said recently there When good people find good solutions that do good people for
17:48
other good people, it's not sales, man.
17:51
It is a mitzvah, as my grandma would say.
17:54
You're doing them a good deed.
17:55
And when I was a kid, you always kind of have like a negative viewpoint
17:58
of sales, 'cause sales always sounds like you're trying to get somebody
18:02
to do something that's not good for them or that they don't want to do.
18:05
I'm in sales my whole life.
18:06
The only thing I've ever sold are things that I believe in, that I do
18:10
for myself, that I genuinely believe are a good thing for good people.
18:14
Yeah.
18:14
And so I will just preach day in and day out about it
18:17
because you're absolutely right.
18:18
You get better health outcomes.
18:20
It's more predictable.
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There's less risk for the employer, especially.
18:24
Prices are more stable.
18:26
You don't have to deal with insurance companies.
18:27
We can go on and on, but I just wanted to say, don't hold back on
18:31
being a one-trick pony when you find something that works really well, man.
18:34
So when it comes to AI and technology for us, so we do collect a ton of data, right?
18:39
We know everything from your DNA to what your resting heart rate is right now,
18:42
what supplement you're taking, how much you're lifting, the most comprehensive
18:46
blood work you'll ever see in your life.
18:48
And what we do is we share it all with the people, and we talk
18:51
through everything, but we really distill it down to one next step.
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What's the one next step that you can do right now in order to make progress?
18:58
And so we map out a one-year, a three-year, and
19:01
a ten-year plan for people.
19:03
Some people are gonna come in, and the idea of giving them a
19:05
VO2 max test is just absurd.
19:06
So we're not gonna do that for everybody.
19:08
We do it for most because most people that come to us are
19:10
generally in good health already.
19:12
But if you're 40 to 50% body fat and you're clearly metabolically
19:15
distressed, we don't have to do a VO2 max test, and we know you're not good.
19:18
So we kinda limit it to what is appropriate for each person at that time.
19:23
And then when it comes to AI, we are an AI-native company.
19:27
ChatGPT-3 came out right when we were first getting started.
19:31
We've been using these tools ever since they launched.
19:33
We use them in every aspect of our business from top to bottom.
19:36
The only place that we don't use AI is in between the provider and the patient.
19:43
We use it for analysis, we use it for research, we use it for report
19:47
preparation, we use it even for doing additional medical research.
19:52
We use it operationally, internally.
19:54
It's enabled us to go from zero to hundreds and hundreds and hundreds
19:58
of members in all 50 states without blowing up the staff, keeping our
20:01
operations lean, keeping our prices down.
20:05
And we know that AI is the future in so many different areas, but I firmly believe
20:11
that people with means, unfortunately, there's gonna be a dichotomy here.
20:18
There's gonna be two groups There's gonna be the people with means, and even
20:23
just moderate means, that will maintain their relationships with their physicians
20:27
because the question I always put to people, especially all these AI tech
20:31
startups who are like, "Oh, health agents are the future, and oh, da, blah, blah."
20:35
Like, okay, all right, hear me out.
20:37
Let's go through a scenario.
20:39
A patient gets a cancer diagnosis from an AI.
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What is the very next thing 100% of people are gonna wanna do?
20:47
Talk to a doctor.
20:48
They're gonna wanna talk to a person, no matter what.
20:51
Maybe in 50 years when we've just been blown away and taken over by this super
20:56
intelligence or whatever, but at least for the foreseeable future, because by
20:59
the way, don't forget, 98% of America doesn't use AI or thinks of it as just
21:04
being a better Google search, okay?
21:07
Very few people really do understand the power of what's going on here.
21:10
So we believe that the human empathy, the care and the compassion, the feel
21:17
that comes from practicing medicine for a long time, and especially the
21:21
human part of it, where you're doing a history or you're talking to somebody
21:25
and you hear them hesitate for a half second, or they look away when they
21:30
answer, or they're slightly evasive.
21:33
Doctors who have done this thousands of times know when to probe deeper
21:39
and how to get and elicit the response that's gonna give them the
21:42
information that they really need in order to give them a proper diagnosis.
21:46
And so our goal is to superpower our physicians, not so that they
21:51
can see more patients, right?
21:52
There are folks like Doctronics and others out there who believe that the future of
21:56
the physician is to be but a node on a network that's measured by throughput Our
22:01
vision is that the doctor uses the tools in order to free up more time and energy
22:07
and cognitive ability to spend more time with each patient rather than a fraction
22:13
of time with as many patients as possible, or really turning themselves into an
22:18
autopen, which is really what is happening like in Utah and whatever with the AI
22:23
can prescribe it, fine print, except for the doctor signs off on everything still.
22:28
And so that's our perspective, and we're building a new app right
22:31
now, and we're gonna throw in AI.
22:33
You can talk to the AI.
22:34
We're gonna have MCP for it, API connections, 'cause most of
22:37
our members are pretty AI savvy.
22:39
We're gonna let them have as much of the data as they want, our
22:42
protocols, talk to it as much.
22:44
But they all are already still coming to us with the AI tools like,
22:47
"Oh, I talked to Chad about this," and our doctor's like, "Great.
22:49
What did Chad say?" Right.
22:51
And we have a whole conversation about it.
22:53
And, you know, it reminds me of that sign that you used to see.
22:56
It was like, Google doesn't have a medical degree or whatever,
23:00
you know, that kind of attitude.
23:01
We don't have that kind of attitude.
23:02
And so it's just a way to facilitate a deeper discussion, and we use it to
23:07
collect data and present reports and do after-visit summaries and listen to the
23:11
transcripts and turn them into soap notes and just do all these things that are
23:14
so much faster so that our doctors- Yes
23:15
can spend more time with the patients because it is a personal relationship, and
23:21
we believe that the personal relationship is the source of accountability
23:26
that leads to actual change.
23:28
You get to know somebody, that person invests time and energy in you, then they
23:33
schedule, "All right. We're gonna meet up in six weeks to go over your progress."
23:38
I don't know about you, dude, but for me, if I commit to a human being that
23:41
I know and respect, who knows and respects me, who's invested in me and
23:44
my health I am not gonna come to that meeting in six weeks and be like, "Oh,
23:48
dude, I just didn't do it." There's a real pressure, an intrinsic pressure
23:52
that people feel, which is great.
23:53
So that's the accountability.
23:55
And tell me, who feels accountable to an AI?
23:58
Nobody.
23:58
Nobody at all, and it just doesn't matter.
24:00
Plus, even in the best scenarios, Google DeepMind's research and whatever, they're
24:05
still in the 60s and 70% in diagnosis.
24:08
They'll completely hallucinate things.
24:10
They'll make up entire histories.
24:12
Once it has an idea of what it thinks that the diagnosis is, it literally
24:15
just makes up the history and whatnot.
24:17
And the most advanced researchers are still telling us that there's no way that
24:21
it's anywhere near as good as doctors.
24:23
It's not.
24:23
On a multiple choice question, maybe, but in actually dealing
24:27
with humans and whatnot, it's nowhere near where it needs to be.
24:29
It probably will be at some point, and that's the other group.
24:32
The other group of people are the ones that don't have enough money,
24:36
who are financially challenged, who would be on Medicaid anyway.
24:41
They're gonna get stuck in front of an AI bot, likely, or backstop
24:44
by a physician who is just settling to be a node on a network.
24:49
And the other question I ask these people like Doctronics and whatnot are, what kind
24:53
of physician wants to be in position where they're judged by the size of their panel?
25:00
Like, how many people can you serve?
25:02
No good doctor wants that.
25:04
All good doctors want the same thing.
25:06
They want more personal time.
25:07
They want to have in-depth relationships with their patients.
25:10
They wanna do good healthcare.
25:12
They don't wanna just be an autopen clicking on approved, approved,
25:15
approved, approved, approved.
25:16
So even with AI and the doctors, it's gonna naturally select for the
25:21
lower-tier provider, and we want the best providers giving the most amount
25:25
of time to the patients that are gonna be the most agentic about it.
25:29
And that's where the change is gonna happen.
25:30
Yeah, I love that.
25:31
Okay, one other question real quick, and then we're gonna get into do some
25:34
business here, is I wanted to circle back.
25:36
Not only are you helping individuals, so yes, if you're an individual listening
25:40
to this and you wanna go to their website… By the way, all of this is
25:43
gonna be in the show notes, his contact information, the website, everything.
25:46
I encourage you to go and look at that website.
25:49
But not only are you helping individuals, but you're going into the C-suite,
25:52
you're going into the HR, to the benefits coordinators, and you're saying, "Listen,
25:55
let's do this different. Stop spending the way you've been spending. Let's work
26:00
together and boost the health of your people, and we'll give them this direct
26:04
primary care and health share bundle."
26:06
Yep, 100%.
26:07
In fact, I'm looking at my B2B dashboard right over here, as a matter of fact.
26:11
We've got about 90 seats or so that are about ready to close right now.
26:15
We love talking to people about this.
26:17
What we've found is that There's pushback in all areas of organization.
26:22
The irony to me is that this is oftentimes one of the business's
26:26
biggest line items, and yet they just sign off on this bull crap package
26:30
that's up 15% every year, and they feel like they don't have any choices.
26:35
And then when you do tell them they have choices, they're like, "What?
26:37
How do I have a choice? I never thought I had a choice." And there's
26:39
a little ego investment involved in that, which is like they thought
26:43
for sure they only had no choice.
26:45
Then you tell them they do have a choice, and then they have to
26:46
reconcile with the fact that they weren't aware of all the options.
26:49
There's like a, a ego element, whether it's conscious or not,
26:52
that gets in the way as well.
26:54
But what we've found is that if you combine three things, you can
26:57
get a really good package together away from not even talking about
27:01
self-funded or anything else like that.
27:04
Double-funded traditional group.
27:05
Yeah, none of that.
27:06
Yeah.
27:06
Which is use ICHRA ICRA as the payment rail.
27:10
Give people the choice if they really super-duper love United or, you
27:15
know, Blue Cross or whatever, God bless them, but you have the choice.
27:19
Go ahead, get your individual plan on that.
27:22
And if you don't wanna do that, then here we got the Sedera Rebel Health
27:26
package that is gonna be cheaper for you.
27:29
You can pocket the excess money, and you've got a concierge-level physician
27:33
and the financial backstopping that's gonna save you money.
27:35
If you go with the 2,500 IUA for a family at Sedera, you're capped at 7,500 out of
27:42
pocket for your entire family, no matter how many times you get run over by a
27:46
truck in your family, could be 100 times.
27:49
And you compare it to, like, a standard Blue Cross package
27:52
with a $3,500 deductible and, like, a $19,000 out of pocket.
27:57
You're saving a ton of money in the high-risk zone.
28:00
You're getting a ton better service on your day-to-day care, and you
28:05
don't have to deal with the hemming effers at the insurance companies.
28:08
And I pitch it to people, and oftentimes their first reaction is, "It's too good
28:12
to be true. What's the catch?" You know?
28:14
And, like, the one catch here and there in some states is
28:18
ACA compliance and ACA mandate.
28:20
Sedera being grandfathered in with the health share that they bought that was
28:24
pre-ACA and this and that, you can use it to get exemptions in many states, and
28:29
the federal mandate has been removed.
28:31
And then legislatively, it looks like at least this administration
28:34
is moving towards, like, greater independence and choice and HSA funding
28:38
and DPC as part of HSA, et cetera.
28:41
And so the future is trending in our direction.
28:44
And then we do a proposal.
28:46
I bring in the ICRA guy.
28:47
I bring in Richard Walton at Sedera.
28:50
I make the pitch on Rebel, and it's just like the only obstacle is, you know,
28:55
that guy's wife generally or another man, doesn't have to be a woman, I
28:58
don't mean to bash on wives, or, like, the HR department who's like, "Oh my
29:01
God, I'm gonna have to answer so many questions, and they're all gonna come to
29:05
me." I'm like, "Look, we have a liaison.
29:07
Just push all the questions to us.
29:09
Just push it to us." You've never experienced onboarding like this
29:11
from any other insurance company.
29:13
You know why?
29:13
Because we're not insurance, and we don't act like it, and it's personal.
29:16
So just pass it all off onto us.
29:18
ICRA will take care of everything.
29:20
It's automatic deductions out of the paycheck.
29:22
We get paid.
29:23
They get paid.
29:23
It's all good and easy.
29:25
Sedera is easy to use if you have a medical need.
29:28
And I met with the founder of Sedera once, and he told me something that
29:34
stood out, and I've used this quite a bit, and he's absolutely true.
29:38
And he said that the revolution in healthcare will only be won
29:42
through the CEOs of corporations.
29:45
The CEO of the corporation has to be the one that has the vision Has to have
29:50
the stamina and the willpower and the energy to enact it in their company
29:56
and to use a strong word, force people if they need to, into making this hard
30:00
decision, which is a leap into an unknown.
30:02
It's a better unknown.
30:03
Why?
30:04
This is what's called leadership.
30:05
They have to exhibit leadership and lead their organization and
30:08
their people into it, and that's gonna be the primary driver.
30:11
Our ICP when it comes to finding somebody that's a good fit for this,
30:14
is a CEO who's very health conscious already, who's already doing the thing.
30:19
They're running, they're cycling, they're triathletes.
30:21
You know how it is when CEOs, for some reason they love that Ironman.
30:24
I think it's the fifteen thousand dollar bikes that they love.
30:27
And so, you know, they have to be the ones that are already interested.
30:30
They've already got a Whoop.
30:31
They've already had a CGM.
30:33
They understand concierge care.
30:35
And when you tell them that you can give their staff concierge care at an
30:39
affordable rate cheaper than what they're paying now, then they're like, "Oh, this
30:42
is good for recruitment, this is good for retention, this is good for our overall
30:46
health, you know, population health."
30:48
Unfortunately, it's the sixty to seventy percent of CEOs out there
30:52
that want cheapest above all.
30:55
They don't care.
30:56
They wanna do the bare minimum, and they're not really looking at
31:00
their own health at the same time.
31:02
So those are the folks we love to talk to, and when we get the right magic…
31:06
God bless all my B2B customers, but I'll tell you, probably the most difficult
31:10
part about the whole job is after the CEO's convinced, the CFO's convinced,
31:14
and then they pull this one bill.
31:15
"Well, I'd like you to, you know, do a Q&A with the staff." All right, there we go.
31:21
And then you sit there with thirty people, and they're asking you every
31:25
question under the sun, which is great, and I gotta convince them,
31:27
and we gotta share, and we gotta explain, but they're so hyper-focused
31:31
on, "Am I gonna get this one thing?
31:33
What about this one thing?
31:34
What about this one thing?
31:35
What about this one thing that may or may not happen?" And you gotta go
31:37
through every scenario, every edge case, and make them feel comfortable.
31:41
But when they get on board, they realize that you're not gonna
31:44
even interface with Synero.
31:46
Get run over by a truck, call Synero.
31:48
Everything else, call us, and it's like super easy.
31:51
So you know the pain, Bill.
31:52
I do.
31:53
I do.
31:54
People that have listened to this podcast before know I'm fond of this example,
31:57
but it's a family of four on a bronze ACA plan, each of them with a seventy-five
32:01
hundred dollar deductible and a fifteen thousand dollar out-of-pocket maximum,
32:05
which they'll probably never hit.
32:06
They think, "Well, you know, I wanna have to go to this MRI, and I don't wanna
32:11
have to pay out of pocket, and then I wanna have to go get this X-ray, and I
32:14
just wanna give them my insurance card." But they don't understand already, John,
32:17
that they are cash pay patients anyway.
32:20
And you know what Rebel Health's gonna do?
32:23
You know what my DPC provider is gonna do?
32:25
They're gonna send me to go get that X-ray, and instead of sending me to the
32:27
hospital, they're gonna send me someplace where instead of being $100, it's 35.
32:32
Instead of the MRI being 750, it's 350.
32:35
And so all these things, we could talk on and on and on,
32:37
and I gotta do some business.
32:39
I'm so excited that you are here.
32:40
I know it's a lot like confirmation bias for me.
32:45
I need it.
32:46
All right, my friends, now it's the time on the program, we're
32:48
gonna open up the Jargon Jar.
32:51
This is where we take a confusing, intentionally muddy topic or language of
32:55
the insurance and medical field, and we're gonna translate it into plain English.
32:59
These two topics may send John into some sort of apoplexia, but we're gonna
33:04
try to keep him in his chair here.
33:06
The first thing we're gonna talk about is value-based care.
33:09
Now, the legacy definition of that is healthcare delivery where providers,
33:13
like your hospitals, your medical groups, your doctors, are paid on
33:15
patient outcomes rather than just the number of people they see.
33:20
What's the reality?
33:21
Well, value-based care has become just an administrative compliance headache, right?
33:25
Instead of freeing the doctor, it wraps all of those practices in layers
33:29
of different kind of metrics and coding audits and reporting software
33:32
mandates, all kinds of things that they have to do in order to continue
33:36
to offer this value-based care.
33:39
It's basically insurance companies saying, "Well, we're gonna push off
33:42
all of the risk now to the doctors, and you know what? We're not gonna
33:45
take any responsibility." The flip side, the true value of value-based
33:49
care doesn't require complicated algorithms or doctors fighting middlemen.
33:56
The true value is in transparent pricing, direct access, and zero middlemen
34:02
standing between you and your doctor.
34:05
That's what real value-based care is.
34:08
The second thing is continuum of care, another definition.
34:10
Here's what they want to tell you it is.
34:12
It's an integrated system of care that guides and tracks a patient
34:15
over time through a comprehensive service or a comprehensive array of
34:19
health services, spanning all of those interdisciplinary types of practices.
34:23
In the real world, the continuum is a closed loop.
34:26
It's designed for customer retention.
34:28
They're gonna send you to the hospital chain that they're affiliated with.
34:30
They're gonna send you to the system they're affiliated with.
34:33
They're gonna send you to what they've negotiated the best contracts with, right?
34:36
Here's the flip side.
34:37
For the consumer, a real continuum of care looks like a trusted primary care
34:41
physician, like a direct primary care acting like a quarterback and giving
34:47
you access to the entire landscape.
34:50
"Go get your X-ray here at this freestanding facility. Don't go to the
34:53
hospital. Go get your labs over here where it's gonna be $45 instead of $150."
34:57
They're gonna bundle all of that expertise together, bundle all of the
35:00
interdisciplinary practices together so there is truly an actual seamless
35:05
continuum of care not designed to maximize contract value, maximize your health.
35:13
Value-based care, continuum of care, John, any of those things
35:15
wanna make you fight somebody?
35:17
Ah.
35:17
You know what's funny is you describe them in their ideal form,
35:22
and I say, "Hey, that's us Right?
35:25
Direct relationship with your primary care doctor, continuum of care.
35:28
We're gonna know.
35:29
That's a phrase that we use, healthcare quarterback.
35:32
We become your healthcare quarterback.
35:34
We are judged on outcomes.
35:36
I want to introduce just one other element to this, which is free markets.
35:40
So we have one way of getting paid, okay?
35:45
And that is membership fee.
35:47
We don't sell labs, we don't sell tests, we don't sell supplements,
35:50
we don't mark anything up.
35:51
If we get a discount, we pass it along directly to you.
35:54
Our lab work is five grand if you go through insurance, it's 500
35:57
bucks if you go through Cash Pay, and this is for, like, the big
36:00
mamba jamba longevity package.
36:02
Right.
36:02
You know, it's like 150 versus 25 for the standard panels.
36:06
And we only get paid if you stay with us, and the only reason you
36:12
stay with us is because you're happy.
36:14
And generally, you're only happy if you're getting better or you're healthy
36:19
or you're getting tremendous care.
36:21
And so there doesn't need to be a whole array of monitoring and compliance
36:27
and coding and systems and whatever.
36:30
It's are you happy?
36:31
What is your retention rate?
36:33
Are you going to stay with us?
36:34
And if you stay with us, we make more money and you're happy.
36:38
And so everything is perfectly aligned.
36:41
It's the incentive alignment.
36:43
And again, I've come to this as a total healthcare outsider.
36:47
I am still learning every single day the intricacies and the inner workings
36:51
and the sausage in this factory, right?
36:54
We came to this from just first principles.
36:57
Meet with your doctor directly.
36:58
Have your doctor call you when he needs to let you know about something.
37:02
Get you healthier, and stick around only when you're happy and healthy.
37:06
And don't be afraid that we're gonna be issuing you tests and labs and
37:10
supplements and drugs that for no reason other than to make additional profit.
37:14
None of those things are here for us.
37:16
And so it's very interesting you brought up those two things which apply
37:20
directly to us, doing them in their platonic form, absent of all of the BS
37:25
where they distort these concepts into rent-seeking and ability to extract
37:30
greater and greater money with 15 hands in the way of the three-party system
37:34
that keeps you away from your physician.
37:37
Oh, man, not quite apoplectic, but, you know, definitely enraged maybe.
37:41
We're getting you there.
37:42
Okay.
37:42
All right.
37:43
All right, my friends, now is the time of the program where we do Five for Fighting.
37:49
This is a surprise, John, you didn't know was coming.
37:51
I'm gonna ask you five rapid-fire questions.
37:54
Don't think, just answer.
37:55
We'd love to get your take, and sometimes it's a little controversial.
37:58
Question number one: Detroit style, Chicago deep dish, New
38:01
York thin, St. Louis Provel.
38:02
John Goldman, who has the best pizza?
38:05
I do love a New Haven, Connecticut style pizza
38:08
Okay.
38:09
I'm not familiar with that.
38:10
Yep, it's a little bit thinner, a little crispier crust, and a little
38:14
wider range of toppings on there.
38:16
New Haven white with clams is one of my favorite pizzas.
38:20
But born in Chicago, I do have a soft spot for Chicago.
38:23
Thing is, you can't get the good stuff outside of the city.
38:26
It's all fake.
38:27
Even Uno's outside of Chicago is not real Chicago.
38:29
You gotta go to the original place and get the original Chicago.
38:32
And that, you only need one piece of that, man.
38:34
Oof.
38:35
You're good.
38:35
Yeah, you're good.
38:36
Second question.
38:37
Kansas City, North Carolina, Memphis, or Texas, John Goldman two-parter,
38:42
who has the best barbecue and why is the answer always Kansas City?
38:46
That's hilarious.
38:47
So I have been to all of those places and I've tried all of those barbecues, and I
38:52
still don't remember which one is which.
38:54
Whichever the one that is vinegar based spicy-
38:58
Okay.
38:59
Yeah … that's the one for me.
39:01
I think you're talking about North Carolina.
39:02
North Carolina's got the vinegar on there.
39:04
Yep.
39:04
Okay.
39:05
Yep, very good.
39:06
Number three, John Goldman, if you're sitting across the table from an employee
39:09
or an individual on the fence about direct primary care, what are you saying to them?
39:14
When was the last time you could text your doctor and get a same response
39:17
that day from somebody that knows everything about you and is materially
39:21
invested in your health outcome?
39:23
Yeah.
39:24
Probably never.
39:25
Probably never.
39:25
Probably never.
39:26
I love it.
39:27
Next question.
39:27
Royals, Dodgers, Cubs, Yankees, Red Sox, Nationals, John Goldman, who's
39:34
gonna win a World Series first?
39:36
Oh, geez.
39:38
Probably Dodgers, unfortunately.
39:40
I am a Nationals fan.
39:41
2019 was one of the best falls of my life.
39:44
There's no question about that.
39:46
Mm-hmm.
39:46
I do have a soft spot in my heart for the Cubbies.
39:48
I grew up listening to them on WGN Radio when I was a child.
39:52
You know, Wrigley Field before the lights.
39:54
I'm that old.
39:56
So you're a Cubs fan, right?
39:58
Yeah.
39:58
Well, my family's from Chicago, north side and south, so I've got Sox fans, and
40:04
I got a, an Irish Sox side of the family and a Jewish Cub side of the family.
40:10
So I grew up in a split household, but personally, definitely a Cubbies fan.
40:14
Ryne Sandberg, Andre Dawson, those guys back in the day.
40:17
I love it.
40:17
I love it.
40:18
John Goldman, I want you to look into your crystal ball.
40:21
Where is the DPC relationship versus traditional fee for
40:25
service model in five years?
40:27
Where's it at?
40:28
Well, easiest statement of all is bigger.
40:30
It's bigger than it is today.
40:31
The growth is undeniable.
40:33
The aha moment that happens when people get it, and there's
40:37
two phases to getting it.
40:38
There's getting it in the pitch, and then there's getting it eight months
40:41
later when they need the doctor in that certain way, and they get the service,
40:44
and then they're like, "Oh man, that was completely different." And then there's
40:47
getting it later too when you realize that the bill next year actually goes down.
40:51
We go down in price in year two rather than up because we've already
40:54
onboarded everybody, you know?
40:55
And so I think- For sure, the future.
40:59
My blueprint for a new American healthcare is DPC, cash pay, community-based health
41:05
share, and I am materially invested financially and just spiritually and
41:10
mentally into this as the future.
41:12
And something is going to happen, who knows when, but it just cannot continue
41:20
in the way that it's continuing.
41:22
And so I tell people the alternative system is already here.
41:26
It's already built.
41:28
It's already growing.
41:29
And, you know, it's sort of like these sprouts are coming up, and the
41:33
big horrible thing up here eventually is just gonna crack and crumble,
41:37
and then it's just gonna blossom.
41:40
There doesn't have to be any massive push.
41:43
It just has to be like, just let it out.
41:45
Just let the tension out of the system.
41:47
It'll shatter, and these things which have already been growing will get even bigger.
41:51
So the future, I think, is very bright there.
41:54
I am a convicted, sold-out believer that something has to change, and I
41:57
think I'm on the right side of this.
41:59
I really do, and I just want more and more people to hear the story.
42:02
So I do appreciate you being here.
42:04
I've got one more bonus Five for Fighting question One more bonus question.
42:11
This is important to me.
42:12
How close are you to your three-hour 15-minute mark for Boston?
42:16
Ha.
42:17
I see the medals over your shoulder there.
42:19
I'm guessing you're a bit of a runner yourself.
42:21
I have been training now for one year straight after my previous marathon.
42:26
It was five hours.
42:27
It was kind of a disaster.
42:29
Hit the wall at mile 20, totally fell apart.
42:32
I decided then to go all in.
42:33
What would happen if I go all in, if I use my team at Rebel to completely optimize
42:37
myself and go all in, like close to a professional athlete, just heavy amateur?
42:43
I've been running 45, 50 miles a week now for about a year, cross-training,
42:48
on the bike, swimming, rowing, lifting.
42:51
I literally just finished a lift and a row right before I got on this.
42:55
Remember I said I had to change 'cause I just finished working out.
42:58
And so I have taken my easy pace from a 12:30 pace at a 135 heart
43:03
rate down to about 9:15 now at 135.
43:07
So I'm logging 50 miles a week easy at 9:15.
43:11
Wow.
43:11
You know, super conversational, nice and chill.
43:14
I'm in a two-week mini off-season right now, which has been really
43:17
hard to do where I'm not running.
43:19
Coach convinced me that I needed to just take a break so that I
43:23
can restart and hit a higher high.
43:25
And so starting in about a week or so, I'll begin my new build.
43:30
We'll be approaching 75 miles a week, plus another six to seven
43:35
hours of cross-training per week.
43:37
And I'm headed towards Jersey City Marathon on April 17th
43:41
to do my BQ attempt there.
43:43
And you know, I think right now if you put a gun to my head, I'm probably pulling
43:48
like a 3:45, but I've got another six months of building and then four months
43:53
of race prep, which we've done none of.
43:55
We've done no threshold, no tempo, no speed work.
43:58
It's been all base building to get me to the 3:15, which
44:01
is gonna be a stretch, bro.
44:02
It's gonna be a stretch.
44:03
It is the same level qualifier as the professional 18 to 34 women, right?
44:08
At 50 years old, I have to be as fast as the fastest of all women, and
44:13
it is a stretch, but we're gonna do our best, and if I come in at 3:16,
44:18
it's fine 'cause I've completely transformed my health through this, Bill.
44:21
Rebel got me from fat and sick and inflamed to very healthy,
44:26
very strong, totally good place.
44:28
Now we've gone from good to, you know, my VO2 max is like 55.
44:33
I am running all the time.
44:35
My cardiorespiratory fitness has changed.
44:37
My mitochondria has completely changed.
44:39
My heart has improved.
44:40
My resting heart rate's in the low 40s.
44:42
I'm just a completely different person, so like I've already
44:44
won, you know, in that sense.
44:46
But the competitive athlete in me is still striving for that 3:15,
44:52
and I can't wait to do that and then to see what happens from there.
44:55
Oh, I love it.
44:56
The reason I'm so interested, my son came to us last year and said, "Mom and Dad,
45:00
I wanna run a marathon in every state."
45:02
Oh, wow
45:03
And I had been running just a little bit, and this kid has inspired me.
45:06
Now I'm not gonna be anywhere close to him.
45:08
He just finished the Kansas City Garmin race here at 350.
45:12
So my first marathon, I've never done a marathon.
45:14
My first marathon is in March.
45:15
I'm going down to Little Rock with my son, Evan, so that we can get
45:18
Arkansas crossed off the list.
45:20
So Arkansas has got a nice long runway in terms of cutoff times, so
45:24
for us fatties, it's gonna be great.
45:27
I'm gonna keep up with you.
45:27
I'm gonna watch, so I'm gonna find out what that time is.
45:30
Thank you so much.
45:30
Hang tight.
45:31
We're gonna do a little business, then I'm gonna get you out of here on your way.
45:33
Sure.
45:34
Folks, this is an amazing topic today.
45:36
You know that I've been singing this song before.
45:39
Smarter healthcare consumer isn't just about where you spend your
45:42
dollars or how you spend your dollars.
45:43
It's thinking about maximizing that spend and making sure
45:46
you're maximizing your health.
45:48
You got lots of different ways that you can do it.
45:50
Special thanks to our guest today, John Goldman from Rebel Health.
45:53
I love talking to smart people who are clearly, clearly, clearly
45:57
have the expertise worth sharing.
45:59
John's contact information's gonna be in the show notes.
46:01
Rebel Health's information's gonna be in the show notes.
46:03
If you are done, and I love this, if you are done with the lie of fine,
46:08
get on his website, become a Rebel.
46:10
If you're an employer, a benefits coordinator, or an employee, and
46:13
you've ever thought about shopping for insurance or just alternates,
46:17
this thing can't continue.
46:18
Let's talk about what's available to you.
46:21
If you wanna talk about becoming a smarter healthcare consumer, be sure to follow
46:23
along on TikTok, YouTube, and Insta at Bill 5, the Health Insurance Guy.
46:27
Subscribe to the pod on Apple, Spotify.
46:29
Give us a review.
46:29
We'd love to have you follow along.
46:31
And if I can personally help you explore your options, head over
46:33
to core360benefitsgroup.com, schedule a 30-minute consultation.
46:37
Thank you for listening to The Bill of Health.
46:39
Be smart, shop smart, protect your wealth, and we'll see you next episode.
46:51
This podcast is provided for educational purposes only and
46:53
should not be considered legal, tax, investment, or insurance advice.
46:55
Individual circumstances vary, and the listener should consult qualified
46:57
professionals regarding their specific healthcare and financial situation.
46:59
Opinions expressed are those of the host and guests and do not necessarily
47:01
reflect the views of any insurance carrier or affiliated organization