Latest / The SEANC View / Tackling the State Health Plan's Challenges: An In-depth Interview with Thomas Friedman

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Tackling the State Health Plan's Challenges: An In-depth Interview with Thomas Friedman · The SEANC View

• 0:00
  Hello, everyone, and welcome to this week's episode of the Scenic View podcast.
• 0:04
  I'm your host, Jonathan Owens, Communications Director here at Scenic,
• 0:07
  joined by Artis Watkins, Executive Director of Scenic, Government Relations
• 0:12
  Director, Suzanne Beasley, and Podcast Producer, Sam Klein.
• 0:16
  How are you guys holding up against the heat?
• 0:19
  Shoo! Okay, we'll get into that and more.
• 0:23
  Huh? I'm not holding up against the heat. We complain every week now about the
• 0:28
  heat, but come on. And this week, it just keeps getting worse.
• 0:33
  And with that in mind, let's have a great podcast.
• 0:37
  Music.
• 0:46
  Today is June 25th. It is a Wednesday.
• 0:50
  We're here in the podcast studio. We have an extra special guest this week,
• 0:55
  Thomas Friedman from the State Health Plan, dropped by for a long interview.
• 0:59
  On lots of important topics to state employees and retirees.
• 1:03
  Yes, you're going to want to stick around and listen because Thomas runs the health plan.
• 1:07
  I mean, he hit the ground running when Treasurer Briner tapped him to be the
• 1:11
  executive administrator of the state health plan.
• 1:13
  There is a lot going on there and you're going to want to listen to this.
• 1:16
  Yeah, lots of information. We talked about the CVS Caremark debacle that's going
• 1:21
  on with the PBM plans, which we'll explain in a few minutes here on the interview.
• 1:25
  Also, we talked about the premium increase That's expected later in the summer
• 1:29
  and starting in January.
• 1:32
  He was a good sport. We did not hold back, y'all. Yeah. We asked him every single
• 1:36
  thing we thought y'all would want.
• 1:37
  You know Artis is not going to hold back. But she was nice about it.
• 1:41
  He knew coming in we're going to ask those questions. But that's what I appreciate
• 1:45
  about Thomas and about Treasurer Briner.
• 1:47
  They're not afraid of answering hard questions.
• 1:50
  They know that running the health plan is really complicated and there's going
• 1:53
  to be some hard questions involved.
• 1:54
  And I noticed that he didn't really skirt the issues either.
• 1:57
  He took it on, and that's what you need in someone at the state health plan.
• 2:01
  So before we get into that, we always start with the budget.
• 2:05
  But since it is so hot out, I want to just address quickly a story from the News and Observer.
• 2:11
  I think it was today about the several of the state's correctional institutions
• 2:16
  still do not have air condition, or I'm not sure if it meant they were broken
• 2:21
  or if they just never have had them.
• 2:23
  Some of them have just never, never had them. Yeah.
• 2:26
  Do you think those are mostly in the mountain areas or is that like... No.
• 2:30
  It just seems like in the last 50 years, they would have gotten air conditioned,
• 2:35
  right? It says in the article...
• 2:36
  By the way, to give free credit here. That's just another shout out to Don Vaughn
• 2:39
  again. No, this is actually Ronnie Butts from News and Observer. Oh, good job, Ronnie.
• 2:43
  And it says that more than one in five of the state's prison beds,
• 2:46
  or 21%, still don't have air conditioning, according to the DAC website.
• 2:50
  That's a double-digit drop from a year ago.
• 2:53
  So almost all prisons now, it says, have either air conditioning systems or
• 2:58
  installation projects in progress. But Johnston and Lincoln Correctional Institutions
• 3:03
  are the only prisons in North Carolina that have made no progress towards installation.
• 3:08
  Well, that's obviously super dangerous, but 10 prisons are undergoing the installation process.
• 3:13
  Brown Creek in Polkton, Columbus in Whiteville, Craven in Craven,
• 3:18
  Franklin in Franklin, Harnett in Lillington, Lumberton in Lumberton, NCCIW here in Raleigh.
• 3:26
  Warren in Warren County, Craggy in Woodfin, and Terrell Work Farm in Columbia.
• 3:31
  So our first vice president, Wendell Powell, works at Harnett Correctional.
• 3:35
  So I can't even imagine right now. No.
• 3:38
  Can you imagine? Yeah. No, so, I mean, you're trying to do your work and you're
• 3:42
  having to wear what they have to wear.
• 3:45
  And then the offenders are not going to be in a good mood. They're living without air conditioning.
• 3:50
  So if you're just trying to keep a place peaceful, it's going to be that much harder.
• 3:54
  As we know, crime waves go up during heat waves and everything else because
• 3:57
  human beings become very hair trigger about our emotions.
• 4:01
  So if you're working in a prison that is not air conditioned,
• 4:05
  bless your heart, we're thinking of you right now. We cannot do what you do,
• 4:09
  and you don't get paid enough to do it.
• 4:11
  And you can't go outside to get any kind of relief.
• 4:14
  Yeah, and you can't close. We were talking about this earlier today because
• 4:17
  the way this story was being reported, you know, was inmates are in these prisons
• 4:22
  without air conditioning.
• 4:23
  I get that because they are, and they didn't choose to be there.
• 4:26
  But you know what? The staff's without air conditioning as well,
• 4:29
  and I just thought it'd be nice of somebody.
• 4:31
  Yeah. I didn't like the way these things were titled or captioned on social
• 4:35
  media. Everybody's in there together.
• 4:37
  Not good for anybody, but nobody can leave.
• 4:40
  On Twitter, we pointed out that they can't just close down the prison and leave
• 4:44
  for the day, you know? Exactly.
• 4:46
  And so this kind of brings us to a budget issue, because who knows where that's
• 4:51
  going to end up? And Suzanne will get into it in a minute.
• 4:53
  But even the biggest amount that's been recommended for folks like folks who
• 4:57
  work in prisons, correctional personnel, the biggest raise that was recommended
• 5:01
  in any of these budgets was less than what was being recommended for teachers and principals.
• 5:06
  You could get into who deserves more or who do we need more.
• 5:11
  We need all of those people, and we need them to be good quality people because
• 5:16
  other citizens are relying on those people.
• 5:19
  And all of us are relying on them to do a good job. But how can you possibly say...
• 5:24
  People who work in a prison or an HHS facility that doesn't close down necessarily.
• 5:31
  I don't know about HHS facilities, but prison that's not going to close down
• 5:34
  because of no AC should get less of a raise than somebody who works in a place
• 5:39
  that is going to for safety reasons, because it's our children they've got in
• 5:43
  there, closed down in that situation.
• 5:45
  So not to take one thing away from teachers or principals, but to say,
• 5:49
  for goodness sake, if this doesn't drive home the point that There's a lot of
• 5:53
  other people in state government that cannot.
• 5:55
  DOT, they're out there working on these roads and dealing with things no matter
• 6:00
  what the temperature, no matter what's going on.
• 6:03
  So it is absolutely wrong to pick winners and losers.
• 6:07
  If you've got a limited amount of funds, disperse those across the group. Equity.
• 6:12
  Unless there is a huge public safety issue. That's my rant.
• 6:16
  Was a good one. If anything, you need to reward those people for sticking it
• 6:20
  out, especially in places like these prisons where there's no air conditioning.
• 6:25
  And I'm assuming this. I spoke with a former prison warden this morning who
• 6:29
  said, you know, back in his day, he's retired now, but back in his day,
• 6:33
  they had like these five by five huge fans, you know, and that was it.
• 6:37
  That was all they had. Yeah. I just can't even. Oh, I wonder how the air circulates
• 6:42
  in some of these places, too.
• 6:44
  And you're talking about hiring someone to work in a prison. Yeah.
• 6:48
  At barely above $15 minimum wage that state employees have a $15 minimum wage.
• 6:53
  Why are they going to do that? Yeah.
• 6:56
  Why are they going to you know who's going to do it? Who's going to be really
• 6:59
  likely to do it is somebody who might want that job to start a criminal enterprise. Mm hmm.
• 7:03
  I'm not kidding, because obviously this happens. Well, if you're not paying people your pool of...
• 7:08
  Yeah, you're going to end up running a higher risk of having more people come
• 7:13
  in who are only taking that job to do something that's not right.
• 7:17
  And if you're not... Put everybody at risk.
• 7:19
  And if you're not paying substantial raises, what is the incentive to stay once
• 7:23
  you've already taken a job?
• 7:25
  So speaking of budget, there was some talk this week about the mini-budgets
• 7:29
  that maybe come out. One of, I guess, the House's mini-budget included information on raises.
• 7:35
  The Senate's did not, right? The Senate did not. Most of the language in the
• 7:38
  Senate's mini-budget, you know, was like continuation spending.
• 7:42
  And the House budget today, you know, they released something,
• 7:46
  too, in the form of a mini-budget. And it did include first-year pay raises.
• 7:50
  Two and a half percent was in there first for actives and a one-time bonus for retirees.
• 7:56
  None of that was spelled out in the Senate mini-budget. But at the end of the
• 8:00
  day, they're going home this week, folks.
• 8:02
  They're wrapping up and they're going home. So at the end of the day,
• 8:05
  those many budgets are in no more of a position to pass than the big budget
• 8:10
  is right now. They're so far apart.
• 8:12
  Yeah, I think I saw a tweet from Colin Campbell that it may not have been Colin. It may have been.
• 8:18
  I'm sorry that they did these in an effort to reach some sort of compromise.
• 8:23
  And then they're even farther apart on these.
• 8:26
  So it doesn't look like these things are going to pass. Right.
• 8:28
  But there was a group that we take a lesson from this week. Oh, man.
• 8:33
  Indeed. So it was Shrimp Trawling Week. Which, if you are saying shrimp trawling...
• 8:39
  Because I never hear that term. You know, obviously, it's what most of us grew
• 8:43
  up calling shrimpers. Yeah.
• 8:45
  That's all it is. And there were a ton of them in the building yesterday,
• 8:48
  my understanding today, too. They won. They won. Yeah, they won.
• 8:53
  They did. Yeah. If that's not the people speaking. It said the shrimp bill is dead.
• 8:57
  I had to get some. One person did get arrested in the process.
• 9:00
  Yeah, well, you know, there's got to be one in every bunch, right?
• 9:02
  We got to have shrimp puns. Can y'all work on?
• 9:06
  There's plenty of shrimp puns. So huge cheers erupted from the people hanging
• 9:11
  around who were there in the crowd. The crowd is ecstatic. The shrimp bill is dead.
• 9:15
  House Republicans proclaim after coming out of caucus meeting.
• 9:18
  Bill will be held in rules and go nowhere. Several members tell me this is Brian
• 9:21
  Anderson who was posting this.
• 9:23
  Look, the shrimpers came down there and they got hurt.
• 9:27
  Now, state employees and retirees, listen up. You came down there on House Bill
• 9:32
  549, the one that would have given auditor the powers to make every single person
• 9:36
  in his office a political appointee.
• 9:38
  You came down and you said, this is flat out wrong.
• 9:41
  And that didn't end up happening because you came down there and said, this is flat out wrong.
• 9:46
  You need to call every House member, every senator, the governor, your neighbor.
• 9:53
  Everybody, and tell them that this is nuts to propose on either side, one, two,
• 10:01
  three percent raises for state employees and next to nothing,
• 10:05
  one percent one time for retirees after taxes.
• 10:08
  It's nothing. No kidding. That's going to be about 15 bucks a month for them
• 10:12
  if you average it out over the year.
• 10:14
  If you think this is wrong, while we have right now in this state almost 700
• 10:20
  million going towards scholarships for people to send their kids to private
• 10:24
  school, no matter how rich they are, no income cap.
• 10:28
  On getting some of that money. So if you think we've got 700 million as a state
• 10:32
  to spend on sending rich people's kids to private school, which by the way,
• 10:37
  everybody who's got kids in school is telling me these private schools are increasing
• 10:41
  their costs, like you said a few weeks ago, John, by an amount that kind of covers that bonus.
• 10:46
  So we're handing money to an industry that's private schools for no apparent reason.
• 10:51
  Only 8% of the people who have moved their kids have moved from public to private
• 10:56
  school, the rest of them already had their kids in private school.
• 10:59
  That probably equates to about a 5% raise.
• 11:02
  So we either have money as a state, and we're so rich as a state,
• 11:06
  we can throw almost a billion dollars towards people who are already rich to
• 11:10
  send their kids to go to private school, or we don't have that kind of money as a state.
• 11:14
  We got to tighten our belt, which means we have to give piddly raises.
• 11:18
  But this is nuts to me. This is nuts.
• 11:21
  And you can't tell me, the taxpayers would say, I'm cool with that.
• 11:26
  As long as you put the word choice in front of it, I am cool with you giving
• 11:29
  rich people my tax dollars.
• 11:31
  Yeah. And so retirees, if you really want a COLA, that's, you know,
• 11:34
  that's a source you need to point out.
• 11:38
  Well, it's $561 million for 1% of COLA. So, okay. But yeah, I mean, it's obviously.
• 11:45
  But you know what? Here's what gets me. We're told, hey, we're all about parents having the choice.
• 11:50
  Okay. I'm fine with that too. But But how many years have we been told as lobbyists,
• 11:53
  state employees have a choice. They don't have to work for the state.
• 11:56
  If they work there, they know it's going to be like this. Yeah. Okay.
• 12:00
  Choice for them is supposed to mean avowal poverty, apparently. Yeah.
• 12:04
  Yeah. But choice for parents means no matter how rich you are,
• 12:06
  we'll hand you the money. Choice for private school parents.
• 12:10
  Well, just take a lesson, state employees. Yeah. All those big transfer trucks
• 12:14
  going down the street this week with shrimp.
• 12:17
  Excellent job, shrimpers. I'm telling you. When you take action,
• 12:21
  nothing is shrimp possible.
• 12:22
  Oh, no, you didn't. I worked on that one hard. I'm happy hearing about that
• 12:27
  because yesterday when I saw it, when I was looking at the news, I was like,
• 12:31
  Well, even as they stated, if you push them further off the coast,
• 12:34
  that's not where they're going to find the shrimp.
• 12:36
  They're not going to find the shrimp there. See, I had to get a lesson from
• 12:38
  both Artis and Suzanne on this bill because it was very complicated to me, too.
• 12:43
  Now, apparently it's the inland waterways, right?
• 12:47
  Yeah, but my understanding is, well, I don't want to get deep into it because
• 12:51
  we have Tom Friedman coming on.
• 12:52
  It's going to be a long podcast already. Yeah, we don't want to get too deep.
• 12:54
  So I don't want to get deep in the shrimper podcast issue.
• 12:56
  I just want to say the shrimpers did it right. We need to do this.
• 13:00
  Members, if you're hearing this, make those phone calls today.
• 13:03
  Come down here. We've got lobbyists down there all the time. Shell, yeah.
• 13:08
  Oh, he's going to keep going with the puns. We're done with the shrimper conversation.
• 13:11
  I'm just happy that that kind of failed because my thought was,
• 13:15
  well, if they're not catching as much shrimp, shrimp prices are going to go
• 13:18
  up. And I like shellfish.
• 13:20
  I do like shrimp. I do like shrimp. I love a good shrimp boil.
• 13:23
  Anyway, let's get to Mr. I didn't ask him if he had a title like doctor. He's executive.
• 13:29
  Oh, don't like that. So I just assume Mr.
• 13:32
  Thomas Friedman, executive administrator of the state health plan.
• 13:35
  It was a great interview and I hope you enjoy it.
• 13:41
  So we're pleased to be joined today by a special guest in the podcast studios.
• 13:46
  Do we have a name for the podcast studios yet? No.
• 13:49
  The Petey Pablo podcast studio.
• 13:52
  My everything got to be Petey Pablo. Thomas Friedman, the executive administrator
• 13:58
  of the state health plan, is here with us today to talk about some exciting
• 14:02
  things with the state health plan.
• 14:04
  Thank you all for having me. This is also my first podcast. Oh.
• 14:07
  Yay. Cracking a lot of ground here today. Oh, wow. Perfect. Man,
• 14:11
  I can't believe we beat do politics better to this. But yeah.
• 14:14
  I know. There's got to be a lot of people. Take that, Brian and Scott.
• 14:18
  I don't think you're selling yourself enough. You should get out there and do some podcasts.
• 14:23
  You're a celebrity. I've got to speak to the folks on the plan before I speak
• 14:26
  to anyone else. That's right. Fair point.
• 14:28
  Fair point. Yeah. So he is here today because, well, obviously,
• 14:32
  the state health plan is paramount interest for our members.
• 14:36
  What do you have, about 750,000 people on the plan now? About 776.
• 14:40
  Wow, that's a lot of people. That's about, what, one in 10 people in North Carolina, almost 10%?
• 14:46
  Isn't it 10% of the commercially insured? I think there is about 11 million-ish
• 14:51
  people in North Carolina, so just under 10%. but we are 10% of the commercial
• 14:55
  population in the state.
• 14:56
  And I believe, other than Mecklenburg-Carney, where I think we're fifth,
• 14:59
  we're no lower than the third largest commercial provider in any county in North Carolina.
• 15:04
  That's amazing. And are there any private insurance companies that are close to that?
• 15:10
  Well, you know, Blue Cross was still the biggest.
• 15:13
  There's no employer that's even directionally close to us.
• 15:16
  Bank of America is pretty big, but they're all throughout the country.
• 15:19
  In North Carolina where order is a magnitude yeah kind of bigger than everyone else
• 15:24
  And we've always argued that with that becomes a lot of buying power,
• 15:28
  a lot of power to make changes in health care in North Carolina.
• 15:33
  North Carolina ranks as the lowest state in the nation for health care,
• 15:37
  according to Forbes, right?
• 15:38
  Meaning it's the most expensive. Most expensive, yeah. Not lowest, worst.
• 15:42
  Yeah. The worst. Worst. My direction. Well, I mean, aren't there three things
• 15:46
  they look, the Forbes one, there's three things.
• 15:48
  The cost, the effectiveness of the care, right?
• 15:51
  And the access to it. Yeah. We got a lot of care. That's good.
• 15:55
  Can't always get that care. Yeah. But the cost is the worst,
• 15:59
  the most expensive in the country. It's just terrible.
• 16:02
  And with that in mind, it was earlier this month, around June 8th or 9th,
• 16:05
  there was a story that came out that you guys were kind of at odds with CVS Caremark, correct?
• 16:10
  Yes. And it's our pharmacy benefits manager.
• 16:13
  Can you explain a little bit about that? Well, just you'll have to explain.
• 16:16
  Somebody listening may not even know why do we have a pharmacy benefits manager?
• 16:20
  What does it mean? Yeah, so thank you for that primer, because I would have
• 16:23
  jumped way into the deep end.
• 16:25
  We've had to learn. I do that too. It's best to begin at the beginning.
• 16:28
  So a pharmacy benefit manager, when our members go to the pharmacy,
• 16:32
  there is someone who has to negotiate what the price is for the drug,
• 16:36
  pay the claim, and then dispense the claim.
• 16:39
  So when a pharmacist buys a drug, they pay a price, and then the PBM negotiates
• 16:46
  with both local pharmacies, and sometimes they're on, so like CVS has their
• 16:50
  own pharmacies. and then local pharmacies on the price for that drug.
• 16:53
  And that's one area where scale comes into play in a good way for us.
• 16:57
  You know, the bigger the PBM, in theory, I'm going to say in theory,
• 17:00
  the cheaper the drug price would be for our members and for the plan.
• 17:05
  It's kind of fundamentally their role and responsibility that is,
• 17:08
  you know, generally speaking, probably pretty useful. Someone's got to process those transactions.
• 17:12
  That's where that industry started.
• 17:13
  It has evolved into them doing care management, formulary management.
• 17:18
  A bunch of other services that I couldn't tell you in good faith,
• 17:21
  I'm entirely convinced, are the right things to be doing for members.
• 17:24
  But at a point in time that I think they sensed an opportunity to generate more revenue, more profit.
• 17:29
  So they started as someone who just processes the claims. Very useful.
• 17:33
  We can't do that ourselves.
• 17:34
  When you think about, like, Stripe or something like that with Apple.
• 17:37
  But you need someone to do the step of processing it.
• 17:40
  And, you know, that's definitely worth a couple cents a transaction.
• 17:43
  Unfortunately, that business has ballooned into a bigger set of services.
• 17:45
  And something I know our members hear a good bit about is rebates on drugs.
• 17:51
  So if our member goes to get a drug, we've negotiated a price through CVS for the drug.
• 17:57
  So let's say CVS said, hey, this drug's going to be $100.
• 18:00
  Then the company that manufactures the drug says, for every time you give our
• 18:04
  drug out, we'll give you some money back, CVS, on that $100.
• 18:08
  So now the drug only costs the state health plan $50.
• 18:11
  I think the first logical question would be, why wasn't it just $50 in the first place?
• 18:15
  And that's sort of the crux of the issue we got into with our PBM in some ways.
• 18:20
  And first, I want to give credit where credit's due. I think Treasurer Falwell
• 18:22
  and the team did a tremendous job negotiating our most recent PBM contract.
• 18:27
  And because it was so ironclad is a lot of the reason we have so many problems today.
• 18:31
  So how rebates usually work in a contract is we, the state health plan,
• 18:36
  get 100% of the rebates for those drugs directly passed over to the state health plan.
• 18:41
  A few years back, PBMs created additional companies called group purchasing
• 18:47
  organizations that would aggregate the aggregation of rebates.
• 18:51
  And I say it sort of in jest, but it's true.
• 18:52
  And now they're making companies that aggregate the aggregate of the aggregating.
• 18:55
  And that is an actual statement.
• 18:57
  And so they interpreted the contract to me in PBMs general, not specific to
• 19:01
  CVS, said, you get 100% of the rebates that CVS gets. And so these companies
• 19:06
  that were bigger than CVS said, well, we got you a better deal on the rebate.
• 19:11
  So we're going to keep some of that money before it gets to CVS. So...
• 19:18
  Any PBM would say, hey, in good faith, we're giving you 100% of the rebates
• 19:21
  we got. And they're not technically the same company.
• 19:25
  The health plan doesn't see that money back. They don't see a rebate.
• 19:29
  Correct. From that trip. Correct. There's some money kept there.
• 19:31
  And our contract was pretty clear that we didn't say 100% from y'all. We said 100%. Right.
• 19:37
  And so when the previous treasurer found out that this was happening,
• 19:41
  he's like, time out, time out.
• 19:43
  We're in a pretty tough financial situation here. We'd like our money.
• 19:47
  So I think that is one of the bigger issues is, are we getting the full value of our rebates?
• 19:52
  There are some other issues about, I think you hear about PBMs trying to change
• 19:57
  contracts and not telling folks that they've changed the contract.
• 20:01
  Our team, and again, credit to Treasurer Falwell and his team,
• 20:04
  our contract we think is really ironclad.
• 20:06
  You can't make changes without us saying so. And I haven't said so.
• 20:10
  So we have some disagreements about, they think they do have some room to make
• 20:15
  some changes. We're like, no, we don't agree, and y'all agreed to these terms.
• 20:18
  And we negotiated them in good faith. There were several rounds of best and
• 20:21
  finals, and we didn't change what the words meant.
• 20:24
  So not a completely unusual situation, honestly, with state contracts that somebody
• 20:28
  says, I'd like to change it.
• 20:30
  And now you're in the position of having to weigh this big hole the health plan
• 20:34
  has, a half a billion dollar hole, and can't waste any money.
• 20:39
  You never would want to waste money as a fiduciary of the plan.
• 20:42
  But what do you do in your situation? Yeah, this is a good question.
• 20:46
  So we're asking them, one, to honor the contract.
• 20:49
  And two, honor the contract in totality.
• 20:53
  So some of the more technical stuff that they're trying to work around and be like, no, no, we agreed.
• 20:58
  So they owe us some money for that. And it's in the tens of millions of dollars.
• 21:01
  I would certainly take it and retire happily. I know we got a bigger hole.
• 21:05
  We got a near billion dollar hole in a couple of years. But it's either...
• 21:09
  The taxpayers pay it, the members pay it. And so we said, no,
• 21:11
  it's ours. Yeah, that's right.
• 21:13
  And then for the group purchasing things, we said, you know,
• 21:16
  you got to pass all of that money to us.
• 21:18
  And so that's where we are. And I think we're getting to a good place with them. I do.
• 21:22
  I think we are going to be in a better place than before when we started.
• 21:26
  Because, again, we're holding them to it. I think one thing I really give the
• 21:29
  Treasurer Briner credit for is he's also calling this out because there aren't
• 21:32
  plans of our size throughout the state of North Carolina who have this much
• 21:36
  time and this much staff to identify these challenges. and identify these problems.
• 21:40
  And if someone's so bold enough to go after, you know, 700,000 person plan,
• 21:45
  800,000 person plan, what's happening to the 25, 35 person plans?
• 21:51
  I can't imagine they're any less bold would be my guess. So I think we're getting
• 21:54
  to a good spot to make sure that they're going to honor their contract.
• 21:58
  Our members are going to be in a better place financially.
• 22:01
  And it's a contract they can live with because the challenge is we,
• 22:04
  we're fiduciaries, but I think our first three is make sure members can get drugs on January 1st.
• 22:08
  Right so we have to work with them and come to a solution that we can get to,
• 22:13
  we have a great staff a really smart staff a lot of people i don't think we
• 22:16
  can dispense drugs to 775 000 people by ourselves we need a partner so we're
• 22:21
  working with them to get to a solution that's better for us and that they can live with to,
• 22:25
  administer the contract because again if we are not getting members drugs you
• 22:28
  know fiduciary aside i think we've already failed a bigger duty yeah so you
• 22:32
  just to return to something you just said it seems to me like from the release
• 22:36
  that you put out and everything that
• 22:38
  They're already in breach of that contract, right?
• 22:41
  So they're... Yes, I feel very confident we're going to be made whole on that situation.
• 22:44
  And then when I talked about that kind of big group purchasing thing,
• 22:47
  I think we'll probably end up in a more favorable situation there than we would have thought.
• 22:52
  So, and we had members who were convinced, at least on social media,
• 22:56
  that this is an Aetna situation.
• 22:59
  It's because the health plan now uses Aetna for third-party administrator just
• 23:05
  for the plan. And we were trying to explain to people, this is actually.
• 23:09
  A separate contract. Yeah, so this is a separate contract and some of the challenges
• 23:13
  we have identified started in 2023 before Aetna was on board.
• 23:17
  So that kind of back money stuff that precedes Aetna being involved.
• 23:20
  Yeah, that was our understanding. But that's why we said, hey,
• 23:24
  we'd love to have y'all come on and explain this because we're trying to explain
• 23:27
  it and... Well, it's complicated stuff. It is. Yeah.
• 23:30
  But also, people were getting mad at Treasurer Briner who's not done anything here.
• 23:36
  So we felt like y'all needed to come and let's hear it from the horse's mouth.
• 23:41
  Yeah, so I think we're hopefully going to get some resolution on it by the end
• 23:44
  of the month. And I recognize it's the 25th or 20th, depending on what day this comes out.
• 23:48
  But I do feel confident we're getting very close to resolution here.
• 23:51
  And, you know, really full credit to the treasurer and the staff for holding
• 23:55
  people accountable, managing our contractor. We have a great legal team.
• 23:59
  I mean, state employees are great because they're great. And they've really
• 24:01
  demonstrated here state employees working on behalf of state employees to really
• 24:04
  drive towards what we were promised and what we believe were owed.
• 24:07
  So to build off what Artis was saying about our Facebook comments and things like that.
• 24:12
  It seems to me that Aetna came in at the exact wrong time for a lot of these things.
• 24:17
  It seems like they're being blamed for clear price of project going away.
• 24:21
  I know we've gotten a few comments about that. And now this whole play,
• 24:25
  how is that relationship going and how is the transition going?
• 24:29
  I would say with respect to CPP, that was 100% the treasure,
• 24:33
  not my decision for that to go away. So Aetna is going to administer the benefit.
• 24:36
  They are different. So they deserve critical feedback on a lot of things
• 24:39
  but to be clear the clear pricing project going away was
• 24:42
  zero percent them 100 the treasure and i kind of given our
• 24:45
  current financial situation i would say you know how the transition is going
• 24:49
  i think everyone tries to make a marriage analogy to your second marriage you
• 24:53
  know you've been married to someone for 40 years and then you yeah get shotgun
• 24:57
  wed to someone else the second time around and you don't realize they snore
• 25:00
  because you didn't know them that well maybe 20 years younger yeah yeah.
• 25:04
  So there's definitely been bumps along the way.
• 25:08
  I think one of the big causes for, I think, some of the confusion is the messaging
• 25:12
  before the treasurer and I came in was nothing is going to change.
• 25:15
  And I would argue if nothing was going to change, then there was no reason to
• 25:18
  switch, right? If something is exactly the same, why stop?
• 25:21
  You know, I think I can't speak for
• 25:22
  treasurer of Falwell, but I think they thought it was time for a change.
• 25:25
  The board thought it was time for a change. And so things are definitely different.
• 25:28
  They contract with providers a little bit differently.
• 25:30
  They have different processes, some good, some bad. You know,
• 25:34
  I would be, I think Blue Cross is a tremendous partner.
• 25:36
  I wouldn't say they were perfect. So, you know, some things that Edna is doing
• 25:40
  different are probably different for the better. Some things that they're doing are different.
• 25:43
  Caroline and my team gives them a hard time about every day.
• 25:46
  And then we're trying to like get towards the right path.
• 25:48
  Caroline's great. Y'all got good people over there, period. I always get responses
• 25:53
  when I have a member with an issue very quickly.
• 25:57
  With respect to Edna and those issues, I think we really do lean on y'all when
• 26:01
  issues come up to let us know and we'll try to solve them as fast as we can,
• 26:04
  particularly if it's a member's health at the point of things,
• 26:07
  you know. We will try to fix things same day.
• 26:09
  But, you know, with tens of thousands of claims coming in every day,
• 26:12
  you know, the goal is 100% correct and we're going to get there.
• 26:15
  But when we can hear from our members if something's going wrong,
• 26:17
  it is infinitely helpful. If they're doing something wrong, we deserve that
• 26:21
  feedback. We got to fix it.
• 26:22
  You know, I don't want people to feel that they're putting us out or being ruled.
• 26:26
  Honestly, for anybody listening, I have to say anything that,
• 26:29
  It's usually Suzanne or me that somebody will get hold of and Siena can say,
• 26:34
  this person has a problem.
• 26:35
  And we'll ask the questions about whatever the issue is.
• 26:38
  And honestly, the treasurer's staff in terms of the health plan.
• 26:42
  Well, and the retirement system too, is always very, very, like most state employees,
• 26:48
  on the ball, conscientious immediately on it. So we love that.
• 26:51
  And I know that you have to deal with a lot of other guff from us,
• 26:54
  and it's around the transparency issue. So I think we need to dig into that
• 26:58
  just a bit because people would be shocked if I didn't ask you those questions. I would be shocked.
• 27:03
  I know. So if you're listening, you've obviously heard us talk a lot about the
• 27:08
  fact that these contracts between Aetna and Blue Cross before them are contracts
• 27:14
  that the public can't see.
• 27:16
  They're spending public money on behalf of public employees to get health care,
• 27:20
  but the public cannot see the contracts.
• 27:22
  Again, North Carolina is the most expensive place to get health care in the
• 27:25
  nation. the health plan is the biggest plan by a mile in North Carolina.
• 27:29
  We feel like we're paying too much and we can't.
• 27:33
  Prove it because we can't get the contracts. Well, I would tell you you're paying too much.
• 27:37
  I would agree with you. We're paying too much. And kind of going back to something
• 27:40
  you said, Jonathan, at the beginning, we have not been effective at using our
• 27:43
  scale on either making costs more affordable or making costs more transparent.
• 27:47
  And that's something we have been spending quite a bit of time working on.
• 27:51
  And I think providers will have different challenges with transparency.
• 27:54
  But where we're trying to go and something you and I have talked about a couple
• 27:56
  times is I think the treasurer and I are committed not just to transparency,
• 28:00
  but actionable transparency.
• 28:01
  We know in a lot of cases we are paying too much. I'm going to use surgical
• 28:06
  services because that's where a lot of our money is going.
• 28:08
  We have a lot of choice. Not only do we have a lot of scale,
• 28:10
  but we have a lot of choice. And when you have those things,
• 28:12
  you should be paying less.
• 28:12
  So we've partnered with a company called Lantern Healthcare that's starting 1-1-26.
• 28:18
  We are going to use that scale more broadly and more transparently to drive down prices.
• 28:23
  And they have a good number of contracts negotiated on our behalf.
• 28:27
  Below that 160% of Medicare care mark, Those will be posted, what those rates are.
• 28:32
  And I think the best thing for the members, the member cost is going to be zero.
• 28:35
  So that's really the carrot we're going to provide those providers.
• 28:39
  Like, we know you can make money below what you're charging us.
• 28:42
  So in exchange for giving us a discount that we can publish and discuss with our membership.
• 28:48
  Okay, I'm going to stop you right there. Yes, ma'am. Because I know we're going
• 28:50
  to have people on our social media say, what's the difference between that and
• 28:53
  the Clear Pricing Project? Which was also, hey, if you'll take less than whatever
• 28:57
  number it was, you can be in this special plan. Fair stop.
• 29:02
  I think it's a couple things are different. One, anyone could join the Clear
• 29:05
  Pricing Project. Right.
• 29:06
  Regardless of access or quality or services you're providing or what your existing contract is.
• 29:12
  And the challenge with the Clear Pricing Project was because it applied to everybody,
• 29:16
  The people that signed up, more often than not, people that made less than $160
• 29:20
  got an increase for services.
• 29:23
  And the folks that made more don't want to be part of it. Don't want to be part of it.
• 29:26
  So where it's different is a couple of things. One, not everyone can join in two different ways.
• 29:31
  One, we kind of have to narrow the funnel so we can use our scale to drive volume to those folks.
• 29:36
  And two, the program is really predicated on quality. I think MRIs and labs,
• 29:41
  those things are commodities.
• 29:42
  We should just pay less because there's no reason to pay more.
• 29:44
  There are differences in quality of surgeons and providers for some of that care.
• 29:50
  And the front door for the treasurer and I is always going to be quality.
• 29:53
  Who determines the quality?
• 29:54
  So the company we're partnering with, Lantern, has a national panel of surgeons that define quality.
• 30:00
  And we look at quality in a few ways. Where were you credentialed?
• 30:03
  How many times have you done the thing that you were going to have surgery?
• 30:07
  I'm going to use shoulders because it's easy. How many shoulder surgeries have you actually done?
• 30:11
  And what are the outcomes of those surgeries? Did someone have to go back to the hospital?
• 30:15
  Like, what was their pain thresholds afterwards? Like, how are the patients doing afterwards?
• 30:20
  So we're using data to determine what quality is, because I think a lot of times
• 30:23
  in some of these programs, kind of going back to any provider who's going to
• 30:27
  take the rate, you know, I would rather have someone who's done a thousand surgeries
• 30:31
  in the past year operate on my shoulder than someone who's done it three times.
• 30:35
  And I don't want to steer state health plan members to someone who's done it
• 30:38
  three times. You know, all respect to folks fresh out of school,
• 30:41
  I'd rather state employees get the kind of the cream of the crop surgeon who's
• 30:44
  done it the most times because I think that's the right thing to do.
• 30:47
  So we've narrowed it by quality and kind of in a way we can measure that makes sense.
• 30:52
  And two, making it such that our members are going to get better access for
• 30:57
  things. So they got to be able to get in faster, too.
• 30:59
  And so that wasn't really a condition of the Culver Housing Project.
• 31:01
  I think it worked out that way in a lot of cases because we're like,
• 31:04
  well, I get more money every time I do a thing. So let's get the people in where
• 31:07
  we get more money every time we do a thing.
• 31:09
  So it'll look a little bit different in that respect. So you're still can use
• 31:13
  your normal benefit as it exists today.
• 31:15
  We're not taking away who's in your network. But if you want to pay nothing
• 31:19
  or pay as close to zero as you can for your surgery, we're going to create a
• 31:23
  path there. And the rate is so much less for a couple of reasons.
• 31:25
  One, providers think they're going to get to do more volume because I think
• 31:28
  our state employees are pretty price sensitive.
• 31:30
  They don't get paid the most. And what we learned through the Clear Pricing
• 31:33
  Project is 30 to 40 percent of folks are willing to change their primary care
• 31:37
  provider to save $25 or $30.
• 31:39
  We're saying, what if you can save $3,000 or $4,000 on a surgery from a higher
• 31:44
  quality provider who's committed to getting you in faster?
• 31:47
  We think that is a compelling proposition to members.
• 31:50
  And again, because it's healthcare, we're not certain everything's going to
• 31:53
  work 100% the way we think it all the time.
• 31:55
  We're not taking away anyone's existing benefit. You know, I do appreciate cost
• 31:59
  sharing is going up, but we look at, you know, somewhere between 25% and 30%
• 32:03
  of our members would not have had to change their doctor last year and would just pay zero.
• 32:07
  No deductible, no coinsurance, nothing towards our out-of-pocket.
• 32:11
  We're going to cover the costs. That would be good. I mean, so that sounds like
• 32:15
  a positive step for most people. And some people are going to hate that idea
• 32:19
  just because they want their doctor, period.
• 32:22
  And we get that. But we know the costs are going up in terms of premiums and
• 32:26
  out-of-pocket everything for the members of the plan. Mm-hmm.
• 32:29
  We know there's going to be an option which takes away some of their choice.
• 32:33
  The final thing they're going to ask about is, all right, so what are we going
• 32:38
  to do about anybody that doesn't belong to this network that Lantern is going to outline?
• 32:43
  Are we going to continue just to overpay them when state employees choose them as a provider?
• 32:48
  So I think there's two ways to answer that question. One, I appreciate folks
• 32:52
  having a choice on who they use. I would have a very hard, and I've been doing
• 32:56
  this for a long time in a lot of detail, picking who is the,
• 32:59
  you know, the quote unquote right doctor who's going to do the best job.
• 33:02
  So part of the reason we want to differentiate in their prices,
• 33:04
  y'all can use however you want, but if they're going to continue to be more
• 33:07
  expensive, won't commit to access, won't commit to quality requirements,
• 33:11
  you're going to pay a little bit more.
• 33:13
  So I think the step we're trying to do is make it clear to members.
• 33:16
  But it's not just the patient that's going to pay more. The plan.
• 33:20
  That's right. And I think over time, we're going to try to push it a little
• 33:24
  bit more towards the member, because we need to create paths across the state
• 33:28
  for members to pay as close to zero for possible for getting high-quality, low-cost care.
• 33:33
  Well, could you not do it by saying, hey, all of you providers,
• 33:37
  we won't pay you more than 250% of Medicare reimbursement rate?
• 33:41
  I think the Clear Pricing Project targeted that. And so we could say,
• 33:45
  no one, we're going to give more than 250.
• 33:47
  Or we could say, for the best of the best, we're going to give 125.
• 33:50
  So the member is going to pay more, The taxpayer, the plan is going to pay less
• 33:54
  and the care is going to be better.
• 33:55
  So we're not making it just about the transparency of price,
• 33:58
  but what are we getting for the money we can pay for as well?
• 34:01
  And this is step one, right?
• 34:04
  It's starting with surgery because that's where most of our spend is,
• 34:06
  where most of the choice is and where most of our folks are candidly getting
• 34:09
  hit the hardest from deductibles and out-of-pocket maxes are those key areas.
• 34:13
  So I think when we're successful, overall prices will go down because people
• 34:20
  will realize if I don't lower my prices or get better at my job or provide better access,
• 34:24
  my next contract negotiation is going to be real tough because I think a lot
• 34:28
  of the higher priced providers can say it's like, well, I have 2,000 state health
• 34:33
  plan members, so you need me in your network, so I'm not really willing to budge on the price.
• 34:37
  We need a mechanism to take folks away from those arrangements.
• 34:41
  Say, hey, you're getting better care over here. You're getting it quicker.
• 34:44
  You're not paying anything.
• 34:45
  So when those folks come to the table and say, I need 475% of Medicare,
• 34:49
  I'd be like, you guys only got four or five patients left. Sorry.
• 34:52
  Like, that's just not what we're going to do.
• 34:54
  Yeah, but shouldn't it work the other way? If they've got 2,000 patients on the health plan,
• 34:59
  That should be more incentive for them to want to keep the health plan in as
• 35:03
  something there in the network.
• 35:04
  And I think this is how they're going to feel it, that we've proven over time,
• 35:09
  I think, that they're not willing to kind of just give a discount.
• 35:12
  So we've got to pressure them and force them to do it.
• 35:16
  And hit them where it hurts is taking state employees away from them if they're not willing to do it.
• 35:20
  Because I think, you know, with the Clear Pricing Project, we saw providers
• 35:23
  are willing to do stuff for more money.
• 35:25
  They're not necessarily willing to do it for less unless there's an incentive for them to do it.
• 35:30
  So we are really trying to use market forces to say, hey, guys,
• 35:32
  if you don't want to do this, you are not going to get access to state employees
• 35:36
  and teachers and state employees.
• 35:37
  And you've all said a lot of times that's your mission and that's a problem
• 35:40
  you're trying to solve for.
• 35:42
  So you haven't shown me yet. And so what we're going to do is say,
• 35:46
  if you don't want to show us yet and you haven't, we are going to work with the folks that do.
• 35:51
  And we're going to make it as clear to our members as you can.
• 35:54
  That's where we would prefer you go. It's going to be cheaper for you.
• 35:57
  It's going to be better for you.
• 35:58
  And if you have to travel for things, we're going to help pay for the travel
• 36:02
  of things. Again, like things are expensive, right? Yeah, they are.
• 36:05
  I wish I knew the exact mileage breakdown and hotel breakdown,
• 36:07
  but we recognize that if we're asking you to do something, we've got to be part
• 36:11
  of that as well. Yeah, especially out west. That's exactly right. Yeah.
• 36:14
  And I think that's, out west is a great point. There aren't as many providers
• 36:18
  or systems throughout the state as there are in the triangle or the triad.
• 36:22
  And so not everyone is going to have access to high-quality providers who are
• 36:26
  engaged with the program, but they don't have access to those providers now.
• 36:30
  So I think some folks are going to have to travel a little bit more if they
• 36:35
  want to take advantage of this program, which, again, we're going to try to pay them for.
• 36:38
  And I'm a very cheap person, just in full transparency. You know,
• 36:41
  if you could tell me I got to travel an hour or two to save $200, I would do it.
• 36:45
  If you told me I'd save $3,000 to travel a couple hours I'd be like I am I hope
• 36:50
  I hope I hope that our members are willing to do that as well and again we're
• 36:55
  We're going to help you with gas and the travel because I recognize I make a
• 36:59
  lot more money than a lot of people. And even though I'm cheap, I still do.
• 37:01
  I still have the resources and we got to help folks get there.
• 37:04
  And hopefully this helps drive more practices into more rural areas because
• 37:09
  they see the opportunity for them to do better financially, to support their communities better.
• 37:15
  Yeah, because that's a huge issue in North Carolina is the rural areas.
• 37:19
  Yeah, it really is. I think that, obviously, there's millions of problems with
• 37:22
  the American health care system.
• 37:26
  I think you kind of touch on one thing, though, is that people really don't shop around for care.
• 37:31
  You know, if your doctor tells you you need a surgery, that person does your surgery, you know.
• 37:38
  So I guess you're saying we need to be a little more cognizant of that,
• 37:41
  right? Well, I think shopping for health care is really hard.
• 37:44
  Like I said, I've been doing this for a long time, but I got two kids,
• 37:47
  a job. I got dogs. I got a lot of other stuff to do.
• 37:51
  And asking our members to do a lot of shopping when it's all really confusing,
• 37:55
  it's not going to happen.
• 37:56
  So we're trying to say we're going to do that step as best we can for you,
• 38:00
  not ask you to go on a website and look at 58 different things. Just say, we hear you.
• 38:04
  This is expensive. This is free. We are vetting it for quality and access to
• 38:08
  hopefully simplify that because consumerism and shopping and health care has
• 38:12
  not worked. It is not true.
• 38:14
  It might be at a point in time, but we got to make it so simple.
• 38:18
  And to your provider point, and then we've got to tell the providers,
• 38:21
  because this is where transparency kind of goes both ways, our primary care
• 38:24
  providers throughout the state,
• 38:26
  this is where you've got to refer members because you know i think about
• 38:29
  trust and i'm going to use a hand gesture here you know
• 38:32
  people trust insurance companies the least they trust
• 38:35
  us a little bit more but not that much they trust y'all more and they'll listen
• 38:39
  to y'all more but not that much but people trust their doctor the most you know
• 38:44
  if you the primary care provider said yeah hey suzanne yeah you're gonna need
• 38:48
  hip surgery i can send you here i can send you here where you've been going for stuff,
• 38:53
  I think it's going to cost you about $3,000 and it's getting anywhere.
• 38:56
  Or you can go here, high quality care, and that's part of what we're community
• 39:00
  providers, and it's going to be free to you.
• 39:02
  Again, it's one thing to find. As a member of the state health plan.
• 39:05
  That's where transparency isn't just between the plan to the member,
• 39:09
  but from the plan to the provider and incenting and telling the provider,
• 39:13
  like, y'all have a role in this too.
• 39:14
  Because again, they'll listen to us sort of, but they'll listen to their doctor
• 39:17
  and we got to make it not just clear to the member, but clear to the doctors
• 39:21
  on the front lines that we need you to be part of this because people trust you.
• 39:27
  You haven't been given that data. We heard you loud and clear.
• 39:29
  Like when I tell doctors, I'm
• 39:31
  going to use pretend numbers, but real practices, but not actual prices.
• 39:35
  You know, if you go to Raleigh Radiology for an imaging MRI,
• 39:38
  it's 800 bucks. If you go to one of the large health systems, it's 2,400 bucks.
• 39:41
  A lot of providers in the moment where they're referring out,
• 39:44
  they don't know that. That's not the math they're doing. That's not what they're thinking about.
• 39:47
  And for a member, it's like, you're worried about like, do I have cancer? Do I need back surgery?
• 39:52
  That's a hell of a time to ask someone to be like, I need you to go on the internet
• 39:55
  and do some shopping for some of this stuff.
• 39:57
  So what we need to do is get those providers to be like, send them to the lower
• 40:02
  cost place where they can get in faster. It's easier to park.
• 40:05
  It's easier to get in and out. They do one thing and they do it well.
• 40:08
  And I think the easiest way to do that is two ways. Make it,
• 40:11
  free as we can for the member and reward the doctor for doing the right thing
• 40:15
  and eventually tell the doctors who don't want to do the right thing because
• 40:18
  they're part of some arrangement.
• 40:20
  Well, they, the doctors have all but been forced to be gobbled up. That's right.
• 40:25
  By systems. And so we are, we're committing to partnering with those folks that
• 40:28
  haven't been gobbled up with systems because they're the ones who really have the choice.
• 40:32
  Yeah. And they are in, you know, local independent primary care is in 100% of
• 40:36
  the counties of North Carolina.
• 40:38
  Yeah. And those are the folks we got to partner with because they're going to
• 40:40
  be the folks on the front line helping our state employees in all 100 counties
• 40:44
  like, hey, this is a hard and scary time.
• 40:47
  Here's where you can go. Because not only are you worried about your health,
• 40:50
  but health care bankruptcy is one of the biggest issues in the country.
• 40:53
  I think it's the leading cause of bankruptcy still in this state is health care costs.
• 40:57
  So if we can get this system up and going, we can let the folks worry about
• 41:01
  their health and their health process and make sure the cost is well-managed for them.
• 41:05
  It's still going to be a concern because, again, medication is expensive,
• 41:08
  all these interesting things. But we really want to get to that path of this
• 41:11
  is as free as it possibly can be.
• 41:14
  And we want you to go to doctors who are engaged in taking you on that journey
• 41:18
  to those lower cost, higher quality places.
• 41:22
  Because, again, if we ask you to shop for it, one, it's not going to happen.
• 41:25
  And two, I don't think that's necessarily fair or the right thing to do when
• 41:28
  you're going through a health care crisis.
• 41:29
  So that's why we got to set up a plan that really rewards people for doing those
• 41:33
  things and really rewards providers for going down that road. I hope that.
• 41:37
  I mean, it sounds good. I hope that works. You know, again, the worry for us
• 41:42
  is we've been talking about this health plan for nearly 20 years at this point.
• 41:46
  But what we've watched is Wall Street become health care.
• 41:51
  I mean, 10 years ago, even we there was just a tiny number of private equity
• 41:57
  owned health care systems.
• 41:58
  And now it's just getting bigger and bigger and bigger. And the issues we used
• 42:03
  to have with Wall Street transparency on the retirement system side proliferated
• 42:07
  on the health plan side. And here we are.
• 42:09
  So what do you think? And Treasurer Falwell famously called them the cartel,
• 42:14
  talking about hospitals and the way they would band together to kind of fight efforts like this.
• 42:20
  Well, the good news is, one, full transparency, I worked at a health system
• 42:25
  for six years. My experience, I was pretty senior.
• 42:28
  I would not describe it as cartelly. I get that they are very price controlling.
• 42:32
  So not language I would use. And I think part of the reason we've gotten them
• 42:35
  to come to the table is we've sort of steered clear of that language and try
• 42:39
  to say this is really about economics and market forces.
• 42:42
  Like, you want more commercial volume. We have the most commercial volume.
• 42:46
  To get this, you got to give us a discount.
• 42:48
  So where it's gone from kind of the theoretical stuff we've talked about in
• 42:52
  March and tax rules is a lot of those contracts are already signed with ASCs
• 42:55
  across the state. So, and we are going to show the health systems and all the
• 42:59
  other entities, like if you want to play, this is the number.
• 43:02
  It's not a target based on something. It is, this is a contract that's been negotiated and signed.
• 43:08
  We're only going to let one of you in from a health systems perspective regionally.
• 43:11
  This is the, but this is the number you're shooting towards.
• 43:14
  And if you say no and you all say no, then I'm going to use,
• 43:17
  pick on the Mecklenburg area.
• 43:18
  Then if we do 100% of our surgeries with OrthoCarolina and our members pay $0
• 43:23
  out of pocket, you're going to be losing all that volume. Okay. That's your decision.
• 43:28
  So I think it's less theoretical because some of these contracts are already done and signed.
• 43:32
  And they range, you know, from 120 to 155 of Medicare.
• 43:36
  So it's less a theoretical exercise and more of a kind of tangible exercise.
• 43:41
  And that's part of the reason we invite you over tomorrow to talk to them so
• 43:43
  you can kind of see underneath the hood a little bit more.
• 43:46
  Because like I said, it's one thing if I say it. I think it's another thing
• 43:48
  if we could say it together. And I appreciate you're trying to approach this
• 43:51
  in a more, well, maybe a less confrontational way, maybe, than Treasurer Falwell
• 43:57
  liked to approach him. I mean, he was pretty doggone frustrated.
• 44:01
  But I have to say, when we see the headlines like we talked about recently where
• 44:05
  a health care system, one of the biggest ones in the state, was giving 41 percent
• 44:10
  raises on average to its leaders.
• 44:14
  And we know state employees are crossing their fingers for two and a half percent
• 44:18
  plus their health care is going to go up.
• 44:20
  They're just having a really hard time understanding how this system,
• 44:24
  of course, it's our whole country, really.
• 44:27
  But how can we have a system where we don't think something is wrong?
• 44:32
  With it in terms of how the hospitals operate if they're able to give 41 percent
• 44:37
  raises to their top folks.
• 44:38
  I wish I had a perfect answer for that. Where I will give the Treasurer Falwell
• 44:42
  a lot of credit, you know, this takes momentum over time.
• 44:44
  You know, I think Treasurer Kyle had a point of view and we built some momentum
• 44:47
  there. I think Treasurer Falwell built some momentum there. So we have to continue
• 44:50
  to build on the good work. Yeah.
• 44:52
  They didn't. I think the tactics just shift and evolve over time.
• 44:54
  So I don't want to be critical of his approach. I think it just it helped us
• 44:57
  get to where we can be today, where it's, you know, we tried this approach.
• 45:01
  Now we Like, now we've got to kind of come back and kind of negotiate on it.
• 45:04
  Like, you don't get folks to the table to negotiate a problem unless they understand
• 45:07
  it's a problem and are pressured into accepting it's a problem.
• 45:09
  So, give them a lot of credit there.
• 45:10
  I'm going to give you a lot of credit for, like, what you point out with the raises piece.
• 45:14
  You know, I get it. We have people on our staff who have been here a long time
• 45:17
  and probably cumulatively have not had a 41% raise in 10, 12 years.
• 45:21
  So, I get that that is not palatable.
• 45:24
  I can't solve how they distribute money to their top executives versus their
• 45:28
  nurses versus the folks that are janitors. Right.
• 45:31
  I wish they'd let me kind of chip in because I got to work with a lot of really
• 45:34
  high-quality folks over there that also didn't get raises.
• 45:37
  But we're going to put pressure on them. If you want to participate,
• 45:40
  you are going to have to make more money in volume than per case.
• 45:44
  So this is Treasurer, Briner, Tom Friedman style. Yes, it is.
• 45:48
  But we're shooting for the same goal. Our members should pay less and the prices
• 45:51
  should be more transparent.
• 45:52
  I don't know if we would be as successful as we have been to date or are going
• 45:55
  to be without kind of what happened before us, right? So I think we're going
• 45:59
  to try to treat this like economics and kind of market forces.
• 46:03
  Use our scale and offer something for the scale. I think there was more of pressure and shame.
• 46:08
  And now it is more like, hey, oh, you want more money? This is your path to
• 46:11
  get more money. This is your path to get more members. If you don't,
• 46:14
  someone else is going to.
• 46:15
  And we hope that capitalistic principles work. And like I said,
• 46:18
  I wish I could change executive compensation because there are a lot of folks,
• 46:22
  state employees and not, that aren't even close to that. and how you could ask
• 46:25
  folks that change bedpans and do all these things to not get raises and to do that on top shelf.
• 46:30
  Not how I would handle things. And so we're going to try to put pressure on
• 46:33
  them to do the right things by our state employees.
• 46:34
  And hopefully that ekes out into a broader set of system of things.
• 46:37
  But I'm going to control what I can control. Exactly.
• 46:40
  So it's time to put you on the spot. The question everyone...
• 46:42
  You haven't put me on the spot yet. You don't think any of those questions,
• 46:45
  but I think... No, the big spot. Oh, the big spot.
• 46:47
  Now the question all of our members kind of want to know, obviously...
• 46:51
  There's a lot of talk about premiums going up for the next year.
• 46:53
  Can you explain a little bit about what's happening?
• 46:56
  I believe the vote's happening in August, correct? Yeah, it is.
• 47:00
  I'm going to look on my phone because I have the date. I think it's August 6th. Drum roll, please.
• 47:04
  Yeah, I think it's the next week. It is August 15th. August 15th.
• 47:08
  But they won't take effect until January 1st, right?
• 47:10
  So, yes, a couple of things about premiums. While they haven't gone up in a
• 47:14
  long time, we recognize any increase is hard and hits people disproportionately.
• 47:19
  So I think the treasurer, the first commitment he made was we are going to make
• 47:23
  sure the premium increases are the lowest on our lowest paid state employees.
• 47:27
  So that was commitment one. So I think right now we are trying to keep for the
• 47:31
  70-30, for our lowest paid state employees, the premium increases to around
• 47:36
  five-ish dollars a month.
• 47:38
  When he came in in January, we thought that number looked more like 20,
• 47:43
  but we've been able to make a lot of progress in some areas.
• 47:46
  And we think we feel comfortable in that mid-five-ish range is what we're shooting
• 47:50
  for, for the lowest tiered folks on the 70-30 plan.
• 47:54
  What it's going to look like at the higher tiers, we're still trying to work out and figure out.
• 47:58
  It's going to be materially different. It's going to be $30 to $50 in some cases
• 48:01
  per month on some of those plans.
• 48:03
  And recognize that's a big change. So yes, they're going up.
• 48:07
  I think that's the approximate range, 50, 60, kind of, we'll see where we can
• 48:11
  get on that. I think it might be higher on the highest paid state employees.
• 48:14
  But if someone told me they didn't mind if my premiums or Bill Belichick's premiums
• 48:19
  went up too I just that's the first thing I thought Bill Belichick didn't care
• 48:23
  so I think some folks are a little bit more okay with that he's probably got NFL pension right
• 48:27
  Yeah, he's got, I'm sure, yeah. But I think something the treasurer is really
• 48:30
  committed to and thought about after this is like, we have to rebase because
• 48:33
  we're in a financial crisis.
• 48:35
  His goal, and I think is very achievable and realistic and fair,
• 48:39
  is to tie premium increases going forward to salary growth.
• 48:43
  So I think something we learned, kind of looking back at things,
• 48:47
  you know, how do we raise premiums 2% a year the past eight years?
• 48:51
  We would not be in the financial situation we're in today. And,
• 48:54
  you know, rather than talking $60, $70, $50 premiums, we'd be talking three
• 48:58
  or four, or the numbers would be $10.
• 49:01
  And so what we are working on and working with the General Assembly on is,
• 49:05
  let's say you make $100, your paycheck goes up $10, your premiums go up the
• 49:09
  same percentage of things. So if it was $5, you know, if your premium was $10, now it's $11.
• 49:15
  So we're trying to keep them kind of commensurate so what you get from your
• 49:19
  raise isn't consumed. Because we've heard y'all.
• 49:21
  Because one of the things you've said a lot of times— You hadn't heard it all
• 49:24
  the way. You hadn't heard it all the way. Or else it wouldn't be just state employees.
• 49:29
  If you get a raise, then it goes up a little bit. We're not seeing anything.
• 49:34
  There's no sharing in the pain from the hospitals at all. Well,
• 49:38
  and I think that's where, kind of where we started. that's where they're going
• 49:40
  to start sharing in this.
• 49:41
  You know, when we hold the PBMs accountable for a few hundred million dollars,
• 49:45
  that's them. Yeah, absolutely.
• 49:47
  And when we, you know, when this starts in 2026, there's going to be a lot of
• 49:51
  hospitals that not just their rates go down, that they're going to get no volume.
• 49:54
  And it's not just going to be less revenue, it's going to be zero.
• 49:56
  So that, you know, our strategy for 2026 and beyond is really why we think we
• 50:00
  can be comfortable saying your premium increases will be tight,
• 50:03
  your salary increases, because we are going to go after continually at this
• 50:06
  approach, go aggressively after provider reimbursement.
• 50:09
  And if we're successful... Now, that makes sense to me.
• 50:12
  If you're saying we're going to do this thing, and it's definitely going to
• 50:14
  have an impact on them because they can play ball or not.
• 50:17
  But if we could, if we could try to avoid saying, if we had just increased premiums
• 50:22
  this whole time a little bit, we wouldn't be in this mess.
• 50:25
  Because that really makes a visceral reaction for me of how about if we didn't
• 50:30
  pay people four times what it takes to make a profit to run a hospital,
• 50:34
  we wouldn't be in this mess. Yeah.
• 50:35
  I think both things are true, 100%. Okay. Yes, yes. Fair enough.
• 50:38
  So I would say, and where we really need Scenic's help and y'all's help,
• 50:41
  we're literally talking about hundreds of millions of dollars of savings if
• 50:45
  we can get our members to choose $0 surgeries from high-quality providers.
• 50:50
  One of our goals is it's going to take it out of the system more,
• 50:52
  and that's going to help lower all of our costs.
• 50:55
  So when we start rolling the programs out, help us communicate,
• 50:59
  help us clarify, because I think sometimes, fair or unfair, when someone hears
• 51:02
  something's free, they think it's not good.
• 51:05
  Correct. And we are trying to really take the opposite route of it's free and it's higher quality.
• 51:10
  And like, again, you don't trust your health plan the most on Planned Earth.
• 51:13
  And I think that's reasonable and fair.
• 51:14
  But help us communicate that like, and we got to show it. We got to prove it
• 51:17
  to you. We can't just ask you to say it.
• 51:19
  But that's where we're going to literally get hundreds of millions of dollars
• 51:22
  out of providers in North Carolina.
• 51:24
  Just in reimbursements. And so that is the less we are going to pay.
• 51:28
  That is not even accounting for. Some folks are just going to get zero if we're
• 51:31
  really successful in this, right? You know, if you want to, you can charge me
• 51:34
  900% of Medicare, but if no one goes there, that's not a good number for you, right?
• 51:39
  So I think that's where we need y'all's help and we need to do a good job of
• 51:44
  communicating this because it's going to take a lot of communicating because
• 51:46
  it's really different. So that's where y'all got to tell me where I need to be.
• 51:49
  We absolutely will try to be a good partner in that. Y'all are hearing it right now.
• 51:52
  So we'll try to continue to give you information on this, but you hear that
• 51:57
  they have a plan. Are there other outside-the-box ways you're trying to save money for the plan?
• 52:02
  Yeah, I do think our members are very savvy healthcare consumers and utilizers,
• 52:06
  you know, despite it being very complicated.
• 52:07
  I think some of the outside-of-the-box ways, we're trying to make them more in the box.
• 52:12
  Okay. I think, you know, we, I fully admit, and I said this the first time I
• 52:15
  worked at the State Health Fund, we got a lot of work to do on co-pays and cost-sharing
• 52:19
  for chiropractors, PTs, and some of those folks.
• 52:21
  You know, I'm embarrassed to say, like, I pay cash at that side of care because
• 52:24
  I think our benefit is not where it needs to be. It is something we definitely
• 52:27
  need to tackle at a point in time, but kind of given the deficit and where we
• 52:30
  are, they just can't tackle everything in 12 months, let alone six. Yeah.
• 52:35
  I pay cash for my chiropractor. Again, I'm in a different financial situation
• 52:38
  than everyone else. And I would never want to say, you know,
• 52:41
  like, ask your doctor what they'll take for cash.
• 52:42
  Some people do that. Sometimes it's effective. But we know we have to do better
• 52:45
  there. We're having meetings this week to figure out how we can do better there.
• 52:49
  But, you know, where you can shop for things in commodity service,
• 52:53
  I think, is generally speaking, a good rule of thumb is the bigger the building
• 52:57
  and the bigger the parking lot, the more expensive it is going to be.
• 53:00
  And if you can ask, do I need to do this thing today or can I go to somewhere
• 53:05
  not in the house where they're going to charge us a facility fee?
• 53:07
  If you have this mental space and bandwidth and time, and again,
• 53:10
  that's a hard thing to ask someone in the moment.
• 53:12
  It's generally cheaper in a lower, less invasive setting. I mean,
• 53:16
  if I'm having chest pains, I don't care.
• 53:18
  Yeah. Please don't leave. If you're having chest pains, stay where you are.
• 53:21
  You know, I know a lot of things aren't chest pains, but you know,
• 53:23
  if you're scared at all. Yeah.
• 53:25
  And so that's where we have to make more access points.
• 53:28
  And so So something we're looking at is how do we bring care to those communities
• 53:33
  so folks can see a doctor? You know, there's a lot of advantages to working for the state.
• 53:37
  One of them is we have a lot of property across the state, whether it be universities,
• 53:41
  community colleges, elementary schools, state buildings, DSS sites.
• 53:46
  Could we start bringing health care there quarterly? Yeah.
• 53:49
  I don't expect folks, I'm not going to pick on Yancey County again,
• 53:51
  but, you know, in Ash County, there's not an endocrinologist in Ash County.
• 53:55
  There's not that many. But diabetes doesn't necessarily care where you live.
• 53:59
  So how do we bring quarterly some amount of time doctors to those people?
• 54:03
  Love that. Because we can't ask our members to drive.
• 54:05
  And folks, I think, are excited and want to do that.
• 54:08
  Because kind of going back to what we talked about, scale and being one of the
• 54:11
  largest commercial entities, like those folks all need commercial volume too.
• 54:14
  So that is an opportunity where we scale together. Again, I'm going to make
• 54:17
  you charge me a little bit less, but nowhere else is going to be able to say,
• 54:20
  I can give you a full panel of commercial patients for three days in a row.
• 54:24
  But you got to help us out a little bit there because we're going to try to
• 54:27
  cover some of the other costs of the labs. I think LabCorp is always willing to be a great partner.
• 54:31
  Every imaging center in North Carolina wants to be a great partner.
• 54:34
  So I think that's the next phase of this where we can use scale and drive prices
• 54:38
  down and make it better for members.
• 54:39
  That just takes time and logistics. And again, we're going to try it.
• 54:42
  We will get to everything. It's just not going to be everything tomorrow.
• 54:45
  Scenic can partner with you on those health fairs. We can send some folks.
• 54:49
  We're happy. Yeah, we're happy to do anything we can to help get the word out
• 54:53
  or put you in front of Scenic people as much as we can. I will be wherever you need me to be.
• 54:57
  Well, thanks so much for joining us. We'll tell Loretta to send you out to other
• 55:01
  podcasts because you did a great job.
• 55:03
  I can just be local here, right? Can we just be exclusive? Yeah,
• 55:06
  there's a lot right here in Raleigh.
• 55:07
  Yeah, we could have an exclusive deal. No one else can talk to it. Yeah.
• 55:11
  Hey, you could be the fifth beetle here if you want to. Yeah.
• 55:15
  If you give me a stuffed animal of my favorite animal, we'll talk.
• 55:18
  What's your favorite animal? Oh, God. Now you put me on the spot.
• 55:22
  Healthcare is way easier than favorite animal. Oh, yeah, yeah.
• 55:24
  My kids will hear this. I'll be remiss if I pick the wrong ones. Aw.
• 55:28
  Well, kids, your dad's doing a great job running the health plan,
• 55:30
  and we are really thankful to have him there.
• 55:33
  And he's a patient man as well. I will say that.
• 55:36
  And thankful for him giving us time. And also, he came to our board meeting a few weeks ago.
• 55:41
  Yeah. And thank you, Treasurer Briner, for letting him and for just the commitment
• 55:45
  the department seems to have to solving what are perhaps the most complex problems
• 55:50
  in state government. And that is even counting DMV.
• 55:55
  Oh, we don't want to. Do you want to ask him a DMV question?
• 55:57
  I'm just going to say thank you for your time. I appreciate it.
• 56:01
  All right. Well, thank you.
• 56:04
  All right. That was an awesome interview. I hope you learned a lot from it,
• 56:07
  and we'll probably have him back on maybe August after the premium information
• 56:12
  comes out. Yeah, after the World of Christians meets.
• 56:14
  Or maybe January when the S has hit the fan and everyone's upset.
• 56:18
  We'll have to check in with Thomas frequently.
• 56:20
  Maybe quarterly since periodically.
• 56:22
  Yeah, we'll have him his own stay-off plan moment. I like it.
• 56:26
  He's a good guest. He was very informative.
• 56:28
  Yes, he was. Speaking of moments, it's time for the Gen Z moment.
• 56:32
  Yeah. How's it? What's going on in Gen Z world over there?
• 56:36
  Yesterday, I was looking at some different articles and I actually found one
• 56:39
  that was about how millennials and Gen Zs are redefining the American dream.
• 56:44
  Talk to you. Which I thought was really interesting.
• 56:46
  And it talks a lot about how the American dream is still important to Gen Zs and millennials.
• 56:52
  But for us, it's changed because of the changing challenges.
• 56:58
  And we have kind of created our own modernized version of it.
• 57:02
  While 73% of Gen Zs and millennials say that it's still important to them,
• 57:08
  over 70% of those people who said it's still important believe that personal
• 57:13
  fulfillment is more important than material success in today's American dream. Go young people.
• 57:18
  Go young people. And they also, in this article, compared the generations and
• 57:22
  what's changed and why we've had to kind of create this evolved American dream.
• 57:27
  So some of the things that were easier for older generations,
• 57:30
  84% said it was easier for boomers and older generations to own a home.
• 57:34
  79% believed it was easier for them to start a family.
• 57:37
  And a majority agreed that financial stability in retirement was more accessible to boomers.
• 57:43
  So I don't think it would be any easier for them to start a family.
• 57:47
  It would be harder for Gen Z folks to afford a family. It's pretty easy to start a family, right?
• 57:55
  But I know what you're saying. And I was going to get to this,
• 57:58
  like, that was my initial thought was, is the American dream changing for Gen
• 58:03
  Z because of these other things?
• 58:05
  Or is it like a concerted effort on your generation's part to actually care
• 58:11
  more about things like that?
• 58:13
  It's partially that we are reshaping it to align with modern challenges opportunities
• 58:18
  because some of the things that are
• 58:20
  deemed easier for our generation and millennials is starting a business.
• 58:26
  71% said it's easier to start a business today than it used to be.
• 58:30
  Entrepreneurships and side hustles, the digital economy has removed traditional
• 58:34
  gatekeeps, and it's easier to make money in non-traditional ways.
• 58:40
  And so we are kind of prioritizing more of a choice and flexibility to create
• 58:45
  that personalized lifestyle.
• 58:47
  I would agree with that. Yeah. There's a way, yeah, you can definitely work
• 58:52
  more independently than you could in our generation. Yeah.
• 58:56
  So overall, we aren't really waiting for permission, but are adapting to the
• 59:01
  economic realities and creating our own opportunities for our version of the American dream.
• 59:07
  Very cool. Very, very good find there. It is. I think y'all will be happier.
• 59:12
  I mean, I hate y'all are our children and we don't want things to be harder for y'all.
• 59:19
  They are. Yeah. But we don't want that more than anything as parents. You don't want that.
• 59:25
  But I also just hope at the end of this that all of that is true,
• 59:29
  that y'all are figuring out what to value.
• 59:32
  And we didn't figure that out for a long time. I think for me personally and
• 59:36
  my friend group personally, a lot of us do view it more as we prefer the personal
• 59:43
  fulfillment over material success.
• 59:45
  And being like, oh, well, I may not have the fanciest house or the biggest,
• 59:50
  most important, like most fun things one day.
• 59:53
  But I'll be able to say that I lived and I did a lot of things and experienced
• 59:57
  a lot of things. That's living.
• 59:59
  That's living right there. That's right. Which is why I spend all my money on vacations.
• 1:00:03
  Well, you're working to live. Yeah. We grew up living to work.
• 1:00:07
  So, you know, maybe still do. I don't know.
• 1:00:10
  What else is new in Gen Z world? I did see Taylor Swift at the Tight End University.
• 1:00:17
  Charity event. I think, John, you used this whole Gen Z thing to talk about Taylor Swift.
• 1:00:21
  Yeah, I think so. And have it be acceptable. I was way more excited about seeing
• 1:00:25
  that video than Clara was.
• 1:00:27
  I was like, look, she's on stage with Kane Brown. who I don't know either.
• 1:00:32
  Oh my gosh, I love Kane Brown. Love him. He's the one that got lost in the woods,
• 1:00:36
  right? Did you hear that story? Anyway. No.
• 1:00:39
  Yeah, this is going to be a long episode. No, I think I was super happy to see
• 1:00:45
  those videos of Taylor there.
• 1:00:46
  Yeah. She seemed like she was having a great time. I don't think she gets to
• 1:00:50
  do many venues like that for performances anymore.
• 1:00:52
  Like just super small, intimate, have a good time.
• 1:00:55
  I could see her going back to that, though. I think that once you do a tour,
• 1:00:59
  like the Aras tour, which is like three years of craziness.
• 1:01:02
  Of 30, 40,000 people in front of you. I think that she'll be going to these.
• 1:01:08
  And she was in Nashville, too, which is her hometown, right?
• 1:01:10
  Yes. Well, not technically. I mean.
• 1:01:13
  Taylor Smith, minute. Prince used to do those little intimate concerts.
• 1:01:16
  She moved to Tennessee when she was like 14, and she wanted to start the music career.
• 1:01:20
  Okay. Well, I guess we'll wrap up with our question of the week. Play my theme song.
• 1:01:26
  Music.
• 1:01:31
  Okay, so Scenic is once again partnering with our pet insurance provider,
• 1:01:36
  I think, on a pet photo contest that we're going to be unveiling the winner
• 1:01:42
  at our convention in a few months.
• 1:01:45
  That's fun. Yeah, I think we did this about, what was it, 2021,
• 1:01:48
  and it was a huge success, and we wanted to do it.
• 1:01:52
  I think the thing I remember most about this contest was that somebody sent
• 1:01:56
  out a picture of a donkey or a goat, and that won, like, one of the categories. Yes! Very cool.
• 1:02:04
  So in honor of the pet contest that we'll be announcing in a few days,
• 1:02:08
  what is your favorite pet of your whole life? I'll start first.
• 1:02:13
  I've had lots of dogs because I lived in the country and we just had dogs and
• 1:02:18
  we like dogs would come up and just live with you. And that's your dog now.
• 1:02:22
  Right. The first dog was a beagle named Jake.
• 1:02:25
  And he lived from first grade all the way to my junior year of college.
• 1:02:31
  He was 17 when he died. And he got ran over in my driveway. Oh, my God.
• 1:02:35
  That's how he died. Not even a natural dad. That's pitiful. That's the most
• 1:02:38
  country of endings for a few years. Yeah, it really is.
• 1:02:41
  I thought my border collie died. A pottery shopper.
• 1:02:44
  They always ruined all the pets. But anyway, so shout out to Jake.
• 1:02:49
  But he's probably not my best because, you know, I don't really remember him that much.
• 1:02:52
  But then I... He was most of your life. How do you not remember him?
• 1:02:58
  I don't remember much of anything.
• 1:03:00
  Well, for goodness sakes. Makes me feel better.
• 1:03:03
  When I first went to work at the newspaper and I was very poor and I did not
• 1:03:07
  make much money. And I lived in probably the seedy section of Sanford.
• 1:03:11
  And I went to the pound and I got this huge black lab.
• 1:03:16
  Well, he was going to be huge. He was a puppy at that time, but his mom was there and she was big.
• 1:03:21
  And so I got this black lab that became like an 80-pound black lab dog.
• 1:03:26
  And he took care of me. And he, like, made sure that I was safe every day. And I loved him.
• 1:03:33
  But he passed away. So that's my favorite dog. His name was Bo.
• 1:03:37
  What about you, Suzanne? So I had to say goodbye to my girl about a year ago. Lily?
• 1:03:44
  Was a red, miniature dachshund. She was 11 pounds of sass and attitude.
• 1:03:50
  And, yeah, she was my best friend for a long time. Yeah, I miss her.
• 1:03:54
  She made many appearances here in the scenic office. And I knew that that would
• 1:03:58
  start tears, so I did prepare you a little bit for the question.
• 1:04:01
  She did come to visit. Yeah.
• 1:04:03
  She would sit up on my desk and just, you know. She was a very sweet little dog. She was.
• 1:04:08
  What about you, Artis? Had a mutt named Bella.
• 1:04:12
  Bella. She was the best. My cousin described her perfectly.
• 1:04:17
  She looked like the body of the donkey from Shrek with like a German shepherd's
• 1:04:24
  puppy head. Like her parts didn't go together.
• 1:04:27
  She had some dachshund in her. She had dachshund. She was funky looking,
• 1:04:31
  but in that way that it makes it cute, cute, cute. A little underbite.
• 1:04:34
  Yeah, underbite. That can go either way. It can be really cute or not cute.
• 1:04:38
  She was very adorable.
• 1:04:41
  Yeah, yeah. But she was a good, good dog. And I think, you know,
• 1:04:44
  when you have pets and kids at the same time, if that pet, like you talked about
• 1:04:49
  your lab looking out for you.
• 1:04:52
  There's a picture I love of my son with his back. He was sitting on the deck
• 1:04:56
  with his little legs underneath him.
• 1:04:57
  He was probably about seven and just sitting on the deck looking at the backyard
• 1:05:01
  and that little dog sitting right next to him. A boy and his dog. Yeah, a boy and his dog.
• 1:05:05
  Oh, that's the greatest. So I always think of that, those moments.
• 1:05:08
  Yeah. What about you, Sam? I feel like I should say my current dog,
• 1:05:13
  Snoopy, because he is like my sole dog that I truly believe my Boston Terrier
• 1:05:17
  sent to me after she passed away.
• 1:05:19
  But my horse, Destiny, she was the first horse I ever sat on. I wasn't even a year old.
• 1:05:26
  And my dad was up there on the horse and said, give me the baby and had me ride
• 1:05:31
  her when I was like six months old. That's so sweet.
• 1:05:34
  And she was the best horse anyone could ever have. She was with me until I was 23.
• 1:05:41
  She passed away. Yeah, I was going to say, she just recently passed away. Yeah, November of 2023.
• 1:05:45
  And she was so amazing. If I was riding her and I felt even the slightest thing
• 1:05:51
  off in the saddle, she would stop before I even noticed.
• 1:05:56
  She was like, I'm not moving. Something's wrong. Animals are interesting.
• 1:05:59
  If I was not sitting on her the way she viewed I should be sitting on her,
• 1:06:03
  even if I was trying to do some side saddle stuff, she was like, I'm not moving.
• 1:06:07
  You're not sitting properly. Sit properly. Horses are very intuitive. And I will move.
• 1:06:11
  Horses are very intuitive. So I have pictures of me like standing on top of
• 1:06:15
  her barefoot and all doing a bunch of different stuff because she just would
• 1:06:20
  not move if I was not doing what I'm supposed to, according to her. Well, that's awesome.
• 1:06:25
  We still have her son, though. Okay. Yeah, that's my dad's word.
• 1:06:29
  Some fam in the fam. Yeah, he's just.
• 1:06:33
  And shout out to my dogs, Louie and Ollie.
• 1:06:36
  They're still awesome. Louie is a great dog. Yeah, a cat, too. Ollie, man, he's okay.
• 1:06:42
  And I have a cat, Lucy. Meow. Yeah. So that's pet moment here on the podcast. Big full podcast.
• 1:06:50
  Golly, what is going to be like an hour? Yeah, I hope y'all have enjoyed the
• 1:06:53
  last hour. This clip is also 30 minutes. If you're still with us, you get, like, swag.
• 1:06:57
  It's a long episode, but the health plan stuff makes it worth it.
• 1:07:00
  Yeah, the health plan stuff is definitely more important than pet talk.
• 1:07:04
  It's okay. You know nobody's still here for this part. It's okay.
• 1:07:06
  I got 10 hours to sit in the car and edit it tomorrow. We're good.
• 1:07:10
  She's going to be driving to where? Indiana? Yes.
• 1:07:13
  We'll be safe. Safe travels. Everybody stay cool in this weather.
• 1:07:16
  All right. Thank you for joining us.
• 1:07:18
  Music.