Latest / The SEANC View / State Health Plan Shakeup: Premium Hikes and Lantern’s Plan

Transcript

State Health Plan Shakeup: Premium Hikes and Lantern’s Plan · The SEANC View

0:00
Hello, and welcome to another edition of the Scenic View podcast.
0:03
I'm your host, Jonathan Owens, the communications director here at Scenic,
0:07
joined as always by the executive director, Artis Watkins.
0:12
Hey, John. The government relations director, Suzanne Beasley,
0:16
and podcast producer extraordinaire, Sam Klein. Woo-hoo.
0:21
We got a lot to get into about the state health plan this week,
0:24
so let's jump right into it.
0:26
Music.
0:35
So today is august 21st is no september is the beginning of fall right so uh
0:43
it's not september 22nd is the official first day so we're still in summer sam
0:49
always knows these things you know when kids start going back to school and
0:52
everything that's when libra season also starts.
0:56
There you have it When the kids start going
0:59
back to school You start thinking fall There's football practice going on To
1:02
me it's when we walk out of convention Oh you're right At the end of that first
1:06
week of September The air always feels different already It does There was one
1:10
year It was like hot When we walked into that building A week later We don't
1:15
leave that building for a whole year,
1:17
I think that's part of it Yeah and it was kind of cold When we walked out Yeah
1:21
I remember that Okay Refreshing after all of that Yeah.
1:24
So speaking of that, that will be going on in two weeks. We hope to have some
1:28
cool things lined up that week for our podcast.
1:31
Fingers crossed last year we tried and failed to get some cool things.
1:35
I thought we'd find some time there to record. But we did not.
1:38
But we're going to make it happen. Sam's bringing the stuff again. Yes.
1:42
We're going to figure it out. Because we have some very interesting things from
1:47
members that I think the public would be fascinated to hear about their public
1:52
service and how it affects the public when the public may not know it.
1:55
I kind of want to do like some impromptu man on the street type interviews too.
1:59
Yeah, do it. Yeah, I love those.
2:01
Folks have been going to that convention for 70 years, you know, just some of those.
2:05
There's a lot of experience. Lots of great stories out there.
2:08
Yeah. Stay tuned for that.
2:09
But speaking of podcasts, artists, I heard that you cheated on us this week.
2:14
I did. You did some adultery. Tell us what happened.
2:18
Is there podcast adultery?
2:21
Get you a Scarlet A to wear. Yeah, I did. With New Frame, they have a podcast, Do Politics Better.
2:27
And it's, gosh, I think it's the most popular political podcast in the state. It's really good.
2:32
And I'm a fangirl of it. They know it. So I think they took pity on me and had me as a guest for that.
2:38
But no, I take that back. They had me as a guest because Scenic is awesome and interesting.
2:44
And I am lucky enough to be the executive director. So I got to go on the podcast.
2:49
And it was really good questions.
2:51
You know, they cover so much ground. They're very good at what they do.
2:54
And they talked about our podcast there.
2:58
Towards the end, they're very complimentary of the work y'all are doing.
3:01
So thank y'all. They were like, who's that redneck guy you got?
3:05
Lord, I am. I can't understand him most of the time. There's something about Sanford.
3:09
I feel like there is a possibility that I could make a whole podcast episode
3:12
of you talking about how much you love do politics better. You probably could.
3:17
It's embarrassing. But, yeah.
3:18
There wasn't the top five on that list that we were talking about.
3:21
Something insane. We moved up on that list. We're up.
3:24
We overtook the top sole insider. We overtook a bunch of people.
3:28
Oh, wow. We're up to like 66 now. Oh, yeah. We're in the big time.
3:32
Cool. Yeah, moving on up. That puts more pressure on me. It does, Sam.
3:36
Well, this week's topic, du jour, I think I'm using that word right,
3:41
is the state health plan with the announcement of the increases in premiums
3:45
for next year that came out on Friday after their board of trustees meeting.
3:50
You probably read about that in our weekly scoop email that goes out.
3:55
And it looks like increases are $25 to up to like $110 a month for some people.
4:01
Yeah, since it's going to be based on tiers, so it's going to be based on your salary.
4:06
After conversation, we've learned that you won't technically know exactly what
4:10
that amount is until open enrollment in October.
4:13
Our members don't like that. No, they don't. And we talked to Tom Friedman about it in a minute,
4:19
but it's class warfare among state employees when there's 41 percent raises
4:25
being given to people running hospitals in this state, doing business with the health plan.
4:30
And they're, so far, they're scot-free.
4:33
They haven't had to put any skin in the game and yet we've got state employees
4:36
fighting over who makes more when they all make way less than they would in the private sector.
4:41
Plus, no pay raise coming. And pay raises that have been under that of the private sector forever.
4:48
Yeah, they're so far behind.
4:50
I mean, they go in the hole. Yeah, the whole thing about the state health plan,
4:54
has been that it's a benefit and that if you pay less than the private sector,
4:59
You try to provide better benefits to make things even out for employees.
5:03
And we just can't say that anymore.
5:06
Yeah. So, as you mentioned, we do have Executive Administrator Thomas Friedman
5:11
on this episode. You'll hear from him in a few minutes.
5:13
He was nice enough to come back, maybe our first non-member return guest.
5:20
He said we were exclusive for him.
5:23
Yeah, we were his first and only podcast. I'm not exclusive with this podcast. Yeah, really.
5:29
Yeah, he's more loyal than you are.
5:32
No, but we really appreciate him coming back and facing the fire,
5:35
especially after this topic, because it has drawn a lot of criticism and comments
5:41
on our social media and Facebook page.
5:44
And as a matter of fact, when you guys listen to this, some of the questions
5:47
that we ask of Thomas are directly from you.
5:51
They're questions we pulled from your social media contacts and from phone calls,
5:56
conversations we had out in the field. So be sure to listen.
6:00
Yes, stay tuned. And then after you listen to our podcast, we will allow you
6:03
to go listen to artists on the Do Politics Better. Thank you again.
6:09
So like you were saying about the benefit, you know, that it is a benefit.
6:13
Like I've heard a lot of people say, well, everyone's premiums are going up.
6:18
Why would state employees be any different? You know, like this just makes.
6:21
And I think it seems like that's kind of the logical conclusion that Treasurer Briner reached.
6:26
You know that everyone's premium is going up but it is it's a benefit to entice
6:31
people to be state employees and earn lists there's two things about that number one,
6:37
okay, if you want to treat us like everyone, then let's get raises that are
6:41
at least average with what the private sector gets every year. We're not.
6:46
We're under that. So people want us to be like everyone else when it's not to our members' benefit.
6:54
But they don't want us to be like everyone else if it means it costs money.
6:58
And you simply can't have it both ways and retain employees.
7:00
And that's why we've got an over 20% vacancy rate in state government.
7:04
People don't want to come work for state government. And then you have taxpayers
7:08
complaining because of poor service.
7:11
Of course, you're getting poor service. You're getting, at this point,
7:15
people coming into state government
7:16
are many times not at all what used to come into state government.
7:21
Yeah, so like a lower cost, stable state health plan is part of a broader package
7:26
to entice people to work.
7:28
You had a good health plan, a good retirement plan, which has been,
7:31
the retirement plan's been changed a lot, too.
7:34
You used to be able to count on COLAs, the cost of living adjustments if you were a retiree.
7:39
That's not anything anybody's been able to count on in years, decades.
7:43
And you don't have health care when you retire anymore. That got taken away a few years ago.
7:48
And so those things used to be huge benefits.
7:52
And then finally, the stability of state government. That's gone,
7:55
too, because now everybody wants to cut state government.
7:57
And then they want to take you off the SHRA protections and take even more protections.
8:03
Yeah, so you're going to have people coming here to work for just a very short
8:06
time, not care if they're doing a great job.
8:09
That's not what the taxpayers deserve or want.
8:13
Yeah. So. And just as an aside, you would think someone like Briner,
8:17
who is coming from the private sector and probably made lots more money than he does as treasurer.
8:22
Well, I think he deeply appreciates his state employees he deals with.
8:27
And I'm sure he appreciates state employees generally. You know, he's up against it.
8:31
Let's face it. He is up against, as we call it, or I called it, Goliath.
8:36
The health care industry controls everything.
8:39
All right. And they're hand in hand with private equity more and more these days.
8:44
Private equity is buying more health care. Health care is buying everything.
8:49
Little league teams, stadiums, you know, the naming rights of stadiums.
8:53
Health care is everywhere.
8:55
They're the biggest sponsor of most media.
8:57
So what kind of coverage are you going to get when you're doing a story saying,
9:00
hey, we're paying these health care providers too much.
9:03
It's not going to doctors and nurses. It's going to deep, deep levels of admin
9:08
and executives at these hospitals. So we're getting 41% raises.
9:13
Getting 41% raises according to them.
9:15
So that's problematic.
9:18
That's what Briner's up against. So I'm sure this first year,
9:22
his head's got to be swimming.
9:24
What do I do with this? You know, he sees it very much as a problem he inherited
9:28
from Treasurer Falwell.
9:30
And look, Treasurer Falwell tried to do something about this by saying,
9:36
as a state, we should put a cap on what we're going to pay folks.
9:39
We shouldn't overpay folks by four times what it takes to make a profit.
9:43
The legislature at that time was not open to that.
9:47
They gave him grief for days. And
9:50
of course they did. Health care owns everything here in North Carolina.
9:54
And we're the most expensive state in the nation. The most expensive in the
9:58
country with the worst outcome.
10:02
Yeah, it'd be different if we were ranking really high on outcomes and we're not.
10:07
So patients aren't doing better here. They're doing worse, but they're paying
10:11
more for that privilege.
10:12
Well, I think that's a good backdrop to launch our interview with Thomas.
10:17
I think that was a good primer for it. So let's turn to our recorded interview
10:21
with Thomas Friedman, and we'll return afterwards for a few parting thoughts.
10:31
Back by popular demand, we have a returning guest to our podcast this week.
10:36
Thomas Friedman from the State Health Plan, executive administrator of the State
10:40
Health Plan, was gracious enough to return after the announcement on Friday
10:45
of new premium structure for the plan. Thank you for coming back.
10:50
Volunteered to come back. Yeah. Thank you.
10:52
I'm exclusive with y'all for podcasts. There you go. I love this.
10:56
What did we pay? Do we pay?
10:59
Well, we thank you so much for coming back and allowing us to grill you with questions.
11:05
And with that in mind, I'll turn it over to Suzanne. Yeah. Thanks, John.
11:08
And Tom, thank you for being here today. I'm just going to plow through some
11:12
of the questions that we've been getting from our members and just a couple that we have as scenic.
11:17
Can I back it up a second before you even get to these questions from our social media?
11:23
So we had a number of questions around something that Treasurer Briner said
11:28
in a video that went to all state employees just to set the stage for this.
11:32
And in that video, and we can play a snippet from it here, John, you can insert that.
11:38
Simply put, this means starting in 2026, state health plan coverage will be
11:43
more expensive for many members.
11:45
But this burden is not only on you. It is also shared with the state,
11:50
which has invested an additional $100 million in tax dollars next year to offset
11:55
some of those rising costs.
11:56
Thank you to our state lawmakers who prioritize this funding in a tight budget here.
12:00
But also, health care providers from Murphy to Manio have stepped up and gotten
12:05
their costs down for our plan members. That means they are taking less for the same services.
12:10
This three-pronged approach is the only way we're going to get on track.
12:15
That was important. Thank you. It's okay. So that's where we're starting from
12:18
because we had a lot of people saying how much from providers.
12:23
So based on the treasurer's statement about where we're getting the money recouped
12:28
and how, you know, it's coming from employees, it's coming from the legislature,
12:31
and it's coming from providers.
12:32
Just touch on how much we're getting back from providers, what that looks like.
12:37
Yeah. So before I jump into that, I want to say whenever, Jonathan,
12:41
you splice in like the audio from things, I've never been a part of a podcast
12:45
before that's done that.
12:46
So I'm sure Brad sounded great on it from the clip. But so thank you.
12:50
So I think we're getting money back from providers in two ways.
12:53
One is short-term and immediate and very, very predictable.
12:57
And the other one, I think, you know, the good side is we're hoping for,
13:00
continually hoping for a bigger number.
13:02
One, I think y'all remember in our February and March board meeting,
13:06
we talked about the clear pricing project and how it was budgeted to save a
13:10
few hundred million dollars and it wound up costing $150 million.
13:13
And the cost was we were paying providers more money.
13:16
So phase one of recouping money for providers is ending the clear pricing project.
13:22
So those providers will be getting a rate cut somewhere between 40% of Medicare
13:27
down to 70% of Medicare, depending on what their base rate with Aetna is today.
13:33
And that will show up 1-1-26.
13:36
So we could count on maybe around $100 million and some change there,
13:40
depending kind of on where members go.
13:43
The bigger and more exciting kind of pool of money we've been negotiating with
13:47
providers, and I think the treasure was really specific on that 8-15 date for a reason.
13:52
So part of our partnership with Lantern is purchasing an existing network of
13:57
providers that will be, you know, going from the mid 200% of Medicare to,
14:02
you know, between 115 and 147-ish, I think is the number.
14:06
That is kind of the standard Lantern offering. So all of our folks who are using
14:10
those providers already, somewhere between 100% and maybe a little bit higher cut in rates.
14:16
What is exciting and unique and kind of specific to what Treasurer Briner was
14:20
talking about is we're doing something a little bit different on top of that.
14:24
And this is something I think pretty unique. So providers generally don't compete
14:28
on prices for things, right?
14:29
They kind of negotiate in a closed door with health insurance companies.
14:33
And, you know, it's like, well, give me 3%. No, give me 4%. Give me 5%.
14:37
No, how about 2%? And it just up, up, up, up, up.
14:40
And the prices are kept pretty secret from one another. You guys have been really
14:44
out in front of the transparent, like the issues with price transparency.
14:47
So we've asked them to do something different. So Lantern has a good size network
14:50
in place, but we want more procedures, more doctors, more access for state employees.
14:56
So what we have done is we've broken the state into six regions.
15:00
We're using the Medicaid regions for simplicity's sake and said, okay,
15:04
We want to add more services that Lantern does not currently offer with more
15:08
providers that Lantern doesn't currently offer.
15:11
But health systems, only one of you are getting it by service line.
15:15
So we're not going to say the difference, and I'm going to kind of pivot to
15:18
the difference between this and CPP.
15:19
CPP, anyone who wanted to participate could come in.
15:24
And the challenge was that people were making less signed up,
15:26
and so they got raises, and no one, generally speaking, was making more signed up.
15:30
That doesn't spur competition, and that's, I think, part of the reason why folks didn't sign up, right?
15:34
It's because they weren't going to, doctors weren't going to get anything for
15:37
it, right? It was just give us a discount or you're the cartel. And they said, no.
15:41
So where we are saying is if you want more volume from state health plan members,
15:45
and I think it is the best, most predictable volume in the state.
15:48
Companies leave North Carolina all the time.
15:50
People switch their TPAs all the time. People switch jobs all the time,
15:54
not state employees, not teachers.
15:56
We are consistent, predictable, reliable public servants. And we continue to be.
16:01
So in the face of all this uncertainty, these health systems should want nothing
16:05
more than to take care of state employees.
16:07
Full stop. I can't stand any planner.
16:11
If they are being financially responsible, they should want state employees
16:14
coming to their facilities.
16:15
So to that end, we are asking them right now, and the intent to participate
16:20
was due the day of the board meeting.
16:22
And I'm happy to say that every single health system in North Carolina agreed
16:27
to bid and participate to try to drive down the lowest price.
16:31
So we are negotiating with them right now on rates.
16:35
So they commit to an initial offer by service line.
16:39
So, you know, UNC might be our ortho partner in the triangle,
16:42
but Duke might be the heart partner. And I'm going to circle back to Duke on purpose in a minute.
16:47
Or we'll say in Charlotte, Novant might do general surgery, but Atrium might
16:52
do GI services. So under Lantern?
16:56
Yes. All of these systems could be in a different region. Correct.
17:00
And have Novant in this region offering services under the Lantern model and
17:05
then UNC here in our part of the state. That's right. Okay.
17:08
And I get it's a little tricky, but I think about it this way.
17:11
It's tricky because they've never been asked to compete before.
17:14
Right. Ever. I think this is a wholly new concept.
17:17
And it's tricky, and where I get the questions, and I appreciate the question,
17:20
is this too good to be true?
17:22
Because we are giving it to the member for free. And that is how we've got them to compete.
17:27
Because, again, if you go to the most predictable group of folks in the state,
17:31
state employees show up to work every day. Teachers show up to work every day.
17:34
Once you retire, you're on the state health plan. You're sticking around on
17:36
the state health plan for those non-Medicare folks.
17:37
Well, you realize it's not too good to be true if you think about how much we've
17:41
been overpaying. You are exactly right. People have asked me, are we?
17:44
We must be crazy overpaying if we can provide something for free and
17:49
And still do better than we were under existing contracts. That's insane.
17:54
But on the other side, too, we have members that I've talked with in this past
17:58
week who are, you get what you pay for.
18:01
So if it's going to be zero, you know, are we getting quality care?
18:06
And that is a fair, that would be the first question I'd ask.
18:09
And that is a fair question to ask.
18:11
We, it is not every provider at UNC.
18:15
They are then filtered on by the highest quality providers based on their credentialing.
18:19
The number of times they've done something, right?
18:21
Like, I think about it as I don't want to be the first person someone does knee
18:24
surgery on. I want to be the 10,000th person they've done it on.
18:27
So we're looking at how their readmission rates, the other kind of general quality
18:32
scores, where did they go to school?
18:34
Like, what are their kind of different credentialings of things?
18:37
So the vetting process is... Is robust. It's not lowest bid or win. Right.
18:42
Quality is the front door. Right. So it is the lowest price for the highest
18:46
quality providers wins. Yeah. And I think that's an important distinction.
18:49
So we will take a little guff from our listeners for being supportive of this.
18:54
But we are, because as we've told you in talks together, scenic,
18:59
state employees, we can't say no to everything.
19:02
And this lantern approach seems to be a good approach to try to bring some competition
19:08
to things, some actual, you know, in our capitalist society to actually have
19:12
some competition in what has been a very,
19:15
not just secret, but monopolistic almost,
19:18
you know, industry as it related to the state health plan.
19:21
So that being said, that's not money right now.
19:24
That's all conjecture as far as how many people will participate.
19:28
And then the CPP is not something that was negotiated. People were told you're no longer in the CPP.
19:33
So I think the issue people are taking is that legislature put in $150 million.
19:39
The premiums and out-of-pocket expenses are going up on the employees.
19:43
Those two things are for sure.
19:45
Providers haven't given anything yet. Well, I would say I'm going to invite
19:49
you to any of the state, like the provider stakeholder groups I'm going to with
19:53
like the different associations. Gosh, please.
19:55
When their rates are being, you know, we are hearing loud and clear from them.
19:58
You are literally taking hundreds of thousands of dollars out of our pocket by ending this program.
20:04
So those folks. No, no, CPP. Yeah.
20:08
Again, that wasn't negotiated. They were just told. Yeah. But here's the thing
20:11
about that, though. Yeah. So the CPP was the people that were kind of underpaid.
20:16
You know, we knew the range was anywhere from just shy, I think,
20:18
of 90% at one time of Medicare to over 800%. And it was the people in the CPP
20:24
were the ones who were getting, you know, not even 100% of Medicare reimbursement in many cases.
20:31
So it was folks who were kind of underpaid, often in rural areas.
20:35
I think there's a little bit of that. And I would also say where I bristle a
20:38
little bit is some of the folks who called me and said, this is ending,
20:41
is like, you're taking my cash cow away from me.
20:43
But think of that, though. If the ones who were so underpaid,
20:47
it was a cash cow, then how in the world can we pay somebody else seven times
20:52
what they were doing? And we shouldn't be, and that's why we need to start.
20:55
But they're not giving up anything.
20:56
The seven times more people aren't giving up anything right now.
20:59
I think that what they are going to give up is volume.
21:02
I think, and so you could set the rate at a bajillion dollars or $1.
21:05
If no one goes there, you don't make any money.
21:07
And I think that is where we are kind of structuring the incentive.
21:10
And that's where we need the help of CNIC and CAE and like every other association
21:14
is we want to folks to go where they are folks that value state employees and
21:20
value the contribution state employees do with their highest quality providers.
21:24
So we want people to go to the providers that are providing those lower rates
21:29
and they're negotiating hard and strong and giving us a lot for it.
21:34
So I'm less concerned with the rate of people that no one is going to go to
21:38
and trying to make it really attractive, really easy to access from the best
21:43
quality providers, folks that do want to work with us.
21:46
And if there's a point in time where we have to narrow that network,
21:49
I think that's a discussion to be had.
21:51
But for every 20% utilization of
21:55
our lantern providers, we literally save hundreds of millions of dollars.
21:59
So not just does the member save money at the point of care.
22:02
Right. You think about what $200 million would mean in terms of premiums not
22:07
going up, cost sharing improving, different kind of points of things.
22:11
So I think of it slightly differently.
22:13
There are some providers who aren't going to bend on their rates. That is their decision.
22:17
My decision is to make it so burdensome for our members to get there because
22:21
those folks aren't trying to help sustain our state employees.
22:24
They are not worried about the cost and quality of our state employees.
22:26
So while I can't force anyone to take a lower rate,
22:30
what I can do is make it so easy for folks to not go to those providers and
22:35
go to the providers where they are going to save so much money that we can charge it for free.
22:41
I want to do one analogy here because with the most one of the most obscene
22:45
ones we've seen, there is a hospital that charges money.
22:49
I'm not going to name names, seven and a half times more for a colonoscopy than
22:54
an ASC center in Raleigh.
22:57
I could go in a limo, pick all the folks up, drive them to their colonoscopy,
23:03
put them up for three days at the Umstead, come back and pick them up in the
23:07
limo and drive them home.
23:08
And we'd still save thousands and thousands of dollars a case.
23:11
So we could spend a lot of time negotiating with that group or just say,
23:15
this isn't who you want to work with. It's going to be really expensive,
23:18
or you can go here and it's free.
23:19
And it's probably a better quality care looking at the volume we have.
23:23
And I think that is how we make them be more competitive in a high-spirited way.
23:28
I think cutting their, one, I cannot unilaterally cut rates within a net in
23:31
a contract. The CPPI could end because that is something the previous administration have done.
23:36
I think how we get folks to lower rates and higher quality care is to recognize
23:41
the value of state employees, which I think we can all agree is not happening
23:44
right now. Well, no, and jacking their rates up when they're not,
23:48
probably not getting a pay raise this year.
23:51
They certainly don't have one on the table at this point. We don't know if we'll get a budget.
23:54
That doesn't make them feel appreciated either when they know,
23:57
because we've been telling them there are health care executives getting 41% raises.
24:02
They have, these health care executives reported it, or the entity that hires
24:06
them, reported that they're top folks.
24:09
Not just one or two top folks. They're, you know, they're deep with top folks at these hospitals.
24:15
We're getting 41% raises. State employees are looking, and retirees, at nothing.
24:21
And their costs are going up. But they don't see the 41% raised people giving
24:26
anything in this scenario.
24:27
And I think we're with you that we hope this Lantern program works.
24:34
But all state employees have still is hope that something changes.
24:37
And we're not right back here a year from now saying, well, that didn't work
24:40
either, so we're coming back to y'all again. because these increased costs on
24:44
employees would have to be increased again if Lantern doesn't work, right?
24:48
No, I think Lantern is going to be the thing that pushes things forward in the next direction.
24:53
I think we are going to do a lot of different things to make sure we are sustainable
24:57
through 2027 and 2028 and beyond.
25:00
We're going to continue to evaluate investing in members' health and looking
25:03
at other ways to keep folks healthier.
25:05
I think we have a pathway to retain on that good footing. I think Lantern is
25:11
going to be exceedingly helpful, but we are not banking on any one thing.
25:15
I think that would be a little foolish to bank on kind of one strategy.
25:18
We're kind of looking at how are different ways to get people to lower cost
25:22
imaging that has nothing to do with Lantern.
25:24
It has lower cost other procedures that have nothing to do with Lantern.
25:27
And that's through partnering with independent primary care.
25:30
That's through partnering with independent specialties at reduced co-pays to
25:33
members. So, again, I think our responsibility as good stewards of the plan
25:37
is to make it as affordable as possible.
25:41
For our members to see the providers that are committed to working with state health plan members.
25:46
And I think we've got great footing there for primary care.
25:50
We've got great footing on there for specialty care. And part of what we're
25:52
sharing savings with those providers on is by helping us refer to being aware.
25:58
And I think providers have not done a great job of being aware of cost differences
26:02
outside of their own practice.
26:04
Giving them and empowering them data at the point of that referral to say,
26:07
hey, if you go to this ASC for a colonoscopy, and I don't know why I keep picking
26:12
on colonoscopies. It's something we all have to have.
26:14
It's on your mind. Yeah, they're higher quality, and it's a third of the cost of somewhere else.
26:19
And when Thomas says ASC, he means ambulatory surgery center. Yes, thank you.
26:23
So we're putting more data out, and we are requiring providers who want to work with us.
26:31
Again, be data-driven, be transparent, focus on quality. Quality is the front
26:35
door for everything for Sand Boys.
26:37
We will share in the savings with you. And before we share in savings with you,
26:41
we're sharing in savings with our members to get them there as cheap as we can.
26:44
So I think, again, I think we'd all agree healthcare is broken.
26:48
And we're going to continue to make incremental steps forward.
26:51
But I think the lesson of CPP is, if we want our members to change our behavior,
26:55
we have to help them in their pocketbooks.
26:57
We have to do it. And so... See, I think the lesson of CPP was the legislature wouldn't support,
27:04
Treasurer Falwell, when he said, I want to incentivize folks who are willing
27:09
to see employees at a reasonable rate and actually pay them.
27:15
Well, there can be more than one lesson, right? There can be.
27:18
Fair. But you've got the comments. I shouldn't. And we've covered a lot of information
27:24
there, but let me break it down and correct me if I'm wrong,
27:27
just from my conversations with members lately.
27:30
So there are some concerns that the state health plan will be telling them where
27:34
they need to go for care now because of the Lantern Program.
27:37
But it may be, if I'm understanding this correctly, that UNC or Atrium,
27:42
whatever system is in your area, it may already include doctors that you see.
27:48
So, and even if they're not part of the Lantern Program, someone can still make
27:53
the choice to go see whoever they want to see.
27:55
So I think about this as more, you know, as many carrots as we can.
27:59
You can still go see whoever you want to go see in network. That is not changing.
28:04
How we're going to, you know, we're using Lantern as incentive for free.
28:07
We're going to pay for your travel to get to those providers,
28:09
whether it be miles, whether it be airplane flights, whether it be hotels.
28:13
Because, again, going back to putting you up at the umpest, it's a better deal for us.
28:18
I don't think it is fair to start day one, start taking away choice from members.
28:22
I think if we're really, really successful and everyone starts using these providers
28:26
organically and it's their choice, Then we can sort of like discuss it at that point in time.
28:31
But this is something new. And I think so you can go see if your provider is in network now.
28:36
And there's a Duke conversation as part of this. It's adjacent.
28:40
But we're not taking anyone out of our network right now. This is a benefit
28:44
enhancement. Your network is your network as it is today.
28:47
As long as they agree to be the network. We can talk about Duke.
28:50
That's a huge point. Yeah. Thank you for clarifying that. And while we just
28:53
touched on Duke, a little update on what's happening between Duke and the plan?
28:57
Yeah, so Aetna, who is our third-party administrator, negotiates a good number
29:03
of contracts on our behalf.
29:04
I think the treasurer and I are trying to take more of that in internally so
29:07
we can own the contract and kind of make our goals on quality and price specific
29:12
to state employees, like use our leverage.
29:14
So Aetna, as our third-party administrator, negotiates with health systems on rates.
29:19
Right now, and I'm sure all members have received this, if you use Duke,
29:22
that Duke has said if they don't get a rate increase, they are going to go out
29:26
of network in middle-late October.
29:29
Gave me a lot of pause when I heard that, obviously, because they're our big in-network provider.
29:33
You know, I've talked to leadership at Duke every couple of days.
29:36
I've talked to leadership at Aetna every couple of days. They continue to work on it.
29:39
I remain optimistic that they are going to get something done that is of benefit
29:45
for state employees. And I think this is another area where the Lantern stuff
29:48
keeps us on the offensive.
29:51
So I've articulated to leadership at duke if you are not part of our overall
29:56
network you will not be part of the lantern network it is not one or the other
30:01
you don't just get to pick the surgical volume that is most profitable that
30:04
you can drive margin on you're either all in or you're not in and i think that has been an effective.
30:10
Negotiating point and i think it articulates the value of lantern a little bit
30:13
then you're like oh what if we just go this right like no it's both it is both
30:17
or neither so but i do remain confident that they are moving in the right direction
30:22
to get something accomplished beforehand.
30:25
And we should know who wins the Lantern Contracts is going to be announced middle September.
30:30
So they really have to, from my point of view, till middle September to figure
30:33
something out beforehand.
30:35
Yeah, it's coming up. And to be clear, that's the whole Duke network,
30:39
not just like the places in Raleigh and Durham, right?
30:42
No, so the one thing that is exempt from that, is my understanding,
30:46
is the Lake Norman Hospital.
30:47
Okay. Because that had a separate contract with Aetna that is just on separate
30:52
time periods, is my understanding.
30:54
And the reason I ask is because our local hospital in Sanford is a Duke hospital.
30:58
So the Duke LifePoint hospitals are different. Oh, they're different?
31:01
Or Sanford moment. We have at least one. Yes.
31:03
They are on a different contract. Oh, okay. So it is Duke Regional,
31:08
Duke Raleigh, Duke Health Carey,
31:10
Duke University, and all the primary and specialty practices in the area.
31:13
See, it was a good question, Artis. I'm telling you that at Stanford.
31:16
It's just, we love you, Sam.
31:18
Okay, so moving right along because I want to cover some of the questions that
31:22
I got from folks this week.
31:23
So touch on non-Medicare eligible retirees and how the premium increases will affect them.
31:30
And also a question that I've gotten a lot is when will I know how much my premium
31:34
is since it's going to be based on my salary?
31:37
And I know open enrollment is in October.
31:39
I'm assuming at that point is when they will find out the exact amount.
31:43
Well, because I don't think folks are going to have their raises in October, November,
31:48
I think folks who have a sense of what their salary is now, what their benefits
31:52
loaded salary is, when you think about your life insurance, when you think about
31:55
your, that is the number there. So I think that will be a good marker.
31:58
So when you're in open enrollment, you'll see what kind of bucket you're in
32:01
and that will populate for you from there.
32:04
Obviously, non-Medicare retirees don't have a salary and it is not based on
32:08
their pension. It is a kind of flat, regular increase across the board.
32:13
Family premiums, touch on that. Okay, two things to touch on there.
32:17
So as a matter of policy, I think for a long time, folks have agreed we need
32:20
to get more children on the plan and we need to make it more competitive to cover children.
32:25
So we did that a couple ways. So for our folks in our first two salary bands,
32:30
we've actually reduced premiums to cover your children.
32:34
And we have then on the family plan made it no different than the employee spouse plan.
32:39
So you can functionally think of the difference from employee spouse to employee
32:42
family is no premium difference. your incrementally cost of covering your kids
32:46
is going to be included in the plan.
32:48
So we are trying to get, you know, I think generally speaking,
32:52
the more kids you have is a good thing for lots and lots of reasons.
32:54
Generally speaking, they're also a little bit healthier.
32:57
Changes the risk pool. Changes the risk pool. And so we're going to make that
33:00
investment to expand and kind of hopefully improve the risk pool over time.
33:05
And, you know, candidly, our family premiums are too high anyway.
33:09
I don't think anyone would argue that.
33:11
And so this is a first step and how do we make these more competitive over time
33:16
and make them more affordable over time.
33:18
And I think that is really the goal and the intent. And I think we will see
33:21
the, obviously we're not going to see, everyone is not going to see the fruits
33:24
of that 1-1-26, but we think, you know, the folks that are just covering their
33:27
kids, they will see the fruit of that in the beginning.
33:30
And hopefully as we get, are able to kind of push the needle more and more,
33:34
we will make it more and more competitive.
33:36
And I think, you know, so we've got to put our stake in the ground somewhere
33:39
in terms of what we're trying to accomplish. All right, that's helpful.
33:41
Thank you. And this, we just hear it a lot. So I'm just curious to what you
33:46
guys are saying to people when you're getting complaints about Aetna.
33:50
We are getting so many complaints about claims not being paid.
33:54
They're automatically, you know, rejected.
33:57
So I know transition is not easy.
34:01
What are you guys saying to folks who are contacting you who are having those kinds of issues?
34:06
Well, I think the first thing I'd say is please contact us.
34:09
We will make it right for members, but we don't. Candidly, there are a lot of
34:13
issues within the transition, so we don't know about everyone.
34:16
And y'all have been great partners alerting us to issues. So when there are
34:18
issues, don't think twice.
34:20
Call. Because that's how we've corrected a lot of issues with labs and copays and deductibles.
34:25
And folks can call us, but they can also call. Please do.
34:28
Call either path, right? And I will go ahead and, you know, tell everybody right
34:32
now, you guys are awesome.
34:33
You're always accessible and always open to answering the questions as quickly
34:37
as possible. And we appreciate that. It helps us on this end.
34:41
There, I think the transition continues to be a challenge. And we're not hearing
34:45
it just from members. We're hearing it from providers as well.
34:48
And we continue, we're going to continue to hold accountable for getting,
34:51
you've got to get this right, right?
34:53
It is, the state health plan is a specific way of doing things.
34:56
We are a little different plan than a lot of large plans, right?
34:58
We listen to our stakeholders more.
35:01
We listen to our providers more because they're not our members.
35:04
They also are voters in the state of North Carolina. And that is a little bit different, I think.
35:08
You know, I try to tell them, you know, if Bank of America, their employees'
35:12
premiums go up, it's like, what are you going to do?
35:15
State employees, they're not afraid to articulate their challenges and issues.
35:19
And they shouldn't be, right? Like, that's the right thing to do.
35:21
So we have to be responsive.
35:23
And improving customer experience is something we need to be focusing on every
35:27
single day. And I think our team is really committed to it.
35:30
We are working with Aetna every day. When a problem comes up,
35:32
that's how we try to fix it.
35:33
And we are continuing to work with them to get back to, this is what our members
35:37
expect from a service point of view.
35:39
This is what our providers expect from a service point of view.
35:42
And they got to continue to keep improving and marching towards that.
35:46
All right. I'm going to give you one last question here. And I've gotten it
35:50
a lot across the weekend. And I don't know how to answer it.
35:53
Is it legal to charge premiums on the tiered basis? And how is that not discriminatory
35:58
for employees who have worked all these years and are now making a higher income?
36:03
They feel like they are being punished.
36:05
A lot of them have told me I hardly ever go to the doctor, so I don't use the
36:09
state health plan. You know, why am I having to pay more to supplement that?
36:13
Someone making less money. Yeah, and we've gotten that question.
36:18
And I get it and I understand it.
36:20
We are not the first people to do salary-based premiums. It would be considered
36:24
discriminatory if we charged lower-income people more money.
36:27
But we are trying to target a percentage of salary, which is,
36:30
I think, how we're driving that.
36:32
But we have broad authority to do it from a state point of view.
36:35
And federally speaking, it is something that is very commonplace right now.
36:39
And I get that. I could see where people would ask if it's legal.
36:44
It's really not so much a legal question, but I think is it a smart thing to do?
36:50
Because it's kind of pitting some state employees against other state employees
36:54
in this scenario, while the 41% fat cats that run hospitals,
36:58
41% raised guys go unscathed so far, and state employees are mad at each other.
37:04
And some of our biggest pools of vacancies are in professional positions.
37:08
And so you already have, especially the universities, struggling to even halfway
37:14
compete to find people who will take a job with the state in professional positions.
37:19
And so are you worried that might create more of a problem for those people hiring?
37:25
You know, I think it's a fair question and a fair concern, and I try to think about it a couple ways.
37:29
We're trying to get the standard plan for individual coverage to about right
37:33
around one and some change percent of pay and the enhanced plan to somewhere around 2% of pay.
37:38
And I think that is easier to do premium, predict in premium increases,
37:42
because if your salary doesn't go up, your premium shouldn't go up either from my point of view.
37:45
And I think that's Treasurer's point of view as well. Definitely our people's point of view.
37:48
Right. And so I think I'm just kind of going to speak plainly.
37:52
You're sort of damned if you do and you make it progressive this way because
37:54
otherwise it's regressive and you're doing a higher percentage of salary to
37:57
lower paid state employees as well. So I think that the challenge with insurance
38:02
premium pricing is someone is going to pay more.
38:05
And that is sort of how insurance risk pooling kind of works, right?
38:08
You know, if you had your, if we did a flat increase of, let's call it $50.
38:13
Just pretend that's the number, then we are putting a lot more pressure on our
38:16
lowest paid state employees.
38:19
You know, a different amount of pressure than the highest paid state employees.
38:22
And that wasn't something the treasurer was comfortable with doing.
38:25
I think he recognized folks on the lower end of the income scale.
38:29
20 bucks or 30 bucks means a different amount of money to them. That's right.
38:33
And was trying to be responsive and reflect that.
38:36
Again, it is, I would not pretend to tell you it is a perfect system,
38:39
but it is trying to rebalance premiums around a principle around,
38:43
you know, that one to 2% of salary and help us kind of set, Here's how we should
38:48
be thinking about this going forward.
38:50
But again, totally recognize it is not perfect.
38:53
You know, my wife was not terribly happy when she saw how much family premiums
38:57
were increasing for me. You're probably going to hear from some of the agencies,
38:58
to be honest, because they are having a tough time. It's a legitimate problem.
39:04
As far as the legislature's $150 million contribution, you were wildly complimentary to them.
39:11
And Treasurer Briner in his video that we referenced earlier to employees was wildly complimentary.
39:17
And in fact, he said, especially in light of the shortage of money for things
39:22
that he referenced because of Hurricane Helene and the obvious stress that puts on the state budget.
39:29
That kind of made me think back to when Hurricane Floyd happened decades ago.
39:34
And at that time, the legislature pulled money for Hurricane Floyd relief,
39:38
a portion of it, from the health plan result.
39:41
And it just that when I heard Treasurer Briner mention, you know,
39:45
they don't have much money because of Hurricane Helene. So $150 million is really good.
39:49
That made me bristle a minute because I thought, oh, goodness,
39:53
absolutely Hurricane Helene really had to be front and center for the policymakers,
39:58
the politicians in this state, without question.
40:00
We've got to put our state back together. But then after that,
40:03
it always feels to state employees, and I think it feels that way for good reason,
40:07
that, okay, so we don't have as much money for things, so we're going to do
40:11
less for state employees.
40:12
Do you think $150 million is truly a good contribution?
40:17
You know, I think if you look at how much premium the employer contribution
40:20
has increased the last several years, it's definitely below 5%.
40:23
So this is, I think about it, this is the most money they have put into the
40:28
state health plan and is the highest percentage increase they've put in the
40:31
state health plan in several years. And I think that is fantastic.
40:34
I think the second part of that that is fantastic, because I'm,
40:37
someone described me yesterday, is I'm very unpopular in a popular way.
40:41
That is kind of universally unpopular. If we had to do premium votes last year
40:45
that were $100 more per member per month, I'd probably be a little less popular.
40:50
And so I think where I think we're coming from is we are going to ensure the
40:55
plan is financially solvent.
40:57
That would have been, I think, you know, I totally appreciate on the high end
41:00
how high premium increases are.
41:02
Another $100 per member per month would have been.
41:04
Beyond backbreaking, right? And so I am so grateful that while they can't agree
41:09
on much right now, they agreed on this.
41:12
And I think that is something to be grateful for because it took a lot of work
41:16
from our legislative team of Amy and Colin to make sure everyone knew how important
41:20
this was to state employees and teachers.
41:22
And I think it is a testament, given everything going on, given all the challenges,
41:26
that this was one of the six or seven things they could do and agree on.
41:31
And so I have no problem saying I'm exceedingly grateful for that.
41:34
I am not in the state budget office. I am not in the revenue office.
41:37
I can't tell you exactly how much money there is for everything.
41:41
But those are the things I'm grateful for. Okay. What about the COVID money?
41:44
Because I know at the health plan board meeting, Treasurer Briner really made
41:49
kind of a strong statement about feeling, and I don't know about whom he was making this reference.
41:54
I don't know if he He meant the former treasurer. I don't know if he meant active
41:57
advocate groups like us.
41:59
But he said he was very upset that people had been made to believe the hole
42:06
in this health plan was caused.
42:08
And I think he might have even used the word solely by the COVID money not being repaid.
42:13
And what I'm talking about, y'all, is the federal government sent billions of
42:17
dollars to the states for expenses directly related to COVID.
42:21
Well, nothing would be more directly related to COVID for a state than the state's
42:25
own health plans, COVID expenses.
42:27
And I think it was $200 million-ish that wasn't ever paid to the health plan.
42:33
Now, we put a lot of COVID money in a lot of places, but not the most obvious.
42:39
So I was confused by that statement about how it had become put out there as
42:44
the only reason. I never heard anyone put it out there.
42:47
Definitely we and other groups have said, that's part of your $500 million hole right there.
42:53
Yeah. So I think the point the Treasurer is making is that is best case scenario,
42:58
which I think we've heard pretty loud and clear that money is not coming our way.
43:01
No, that money got, and that's a bipartisan thing. Yeah. There was a Democrat
43:05
who was governor and a legislature controlled by Republicans,
43:08
and none of the above thought that that money needed to, we were told after
43:12
the first wave of COVID money, we'll get you in the next wave.
43:16
Nobody made sure that happened, either party. So I think his point is more,
43:21
best case scenario, we got $200 million. That is one-time money.
43:25
If you think about the 1.4, you know, you use that $200 million this year, it's $300 million.
43:31
Then the deficit next year instead of 1.4 is $1.2 billion.
43:35
So one-time money can soften something, but it exacerbates money.
43:40
The impact of the things you have to do in the future going forward.
43:43
I think the legislature continues to say if there's money left at the end of
43:46
the year, like, you know, TBD, but I don't think that money is coming.
43:49
So I think his point of view is more around. No, just like the tobacco settlement
43:52
fund money, none of it ever made it to the health plan and, you know, any number of things.
43:56
I'm sure the opioid money won't make it to the health plan.
43:58
We, and maybe the insulin money, you know, you never know.
44:02
So we aren't going to kind of run on hopes and dreams. We're going to run on
44:05
how do you do sustainable improvement? I think sustainable reductions to provider
44:10
reimbursements. Is it a hope and dream or is it IOU?
44:12
I don't know. I mean, my opinion on that doesn't terribly matter.
44:15
I think the money is going to come or it's not going to come.
44:18
And it seems like every indication is it's not. And so we are going to run the
44:22
health plan on how do we be sustainable, not with one-time one-off solutions,
44:27
but kind of sustainable growth and sustainable improvement and reimbursement rates.
44:31
We have a cost problem at the state health plan. Healthcare costs too much.
44:34
So the unit cost has cost too much. And we have, as
44:37
a state health plan invested nothing the past eight years in helping
44:40
folks get healthier looking at different options to do
44:43
that so part of the money the savings we get
44:46
from lantern like i'm not going on a vacation with that money we are
44:49
going to invest that money and how do we get our members help them get healthier
44:52
help them get care closer to their home look at we're looking at food as medicine
44:57
programs because getting healthy nutritious food in a lot of parts of the state
45:00
either isn't affordable or isn't accessible so how do we reinvest the savings
45:04
in improving our members' health.
45:06
That between cutting unit cost and getting folks healthier, that's how we're
45:10
going to solve our cost problem.
45:11
And I think a lot of the revenue, whether it be premiums, whether it be money
45:15
from legislature, those problems resolve themselves a lot better if we tackle
45:20
the cost, right? If we need less revenue, if we have less costs.
45:23
And that is where you're going to see our focus being, whether it be through
45:27
Lantern, whether it be through kind of different storage programs,
45:29
is addressing the two-prong cost problem we have, because that will benefit
45:33
state employees at the point of care, and it will benefit them from a quality of life point of view.
45:37
But that takes a little bit of time, and that is where we are lasered in on right now.
45:42
I think you'll see at our November board meeting, how can we further reduce
45:46
cost sharing for some members to utilize our lantern providers?
45:49
Because you have cost before you have surgery. We totally acknowledge that.
45:52
How do we get those providers, make it easier for members to go see those providers
45:57
the first time, not just waiting until they have surgery?
46:00
And that's how we're going to tackle the cost side, right, is by reducing cost
46:03
to members, maybe we get a little less revenue, but we're going to get a lot
46:05
more cost savings because we're going to drive members to those practices.
46:09
Our commitment and what we need to do is tackle the cost problem of health care
46:13
and not just make it about a revenue increase problem in health care.
46:17
Because where we started, and I want to kind of circle back to,
46:19
the General Assembly and our members have done more than providers have to solve
46:23
that cost problem. Exactly.
46:24
Yeah, I would never suggest you get more from the General Assembly,
46:27
except I would like the COVID money paid back.
46:29
But I would never suggest you get more from the General Assembly,
46:32
because that just is leaving less for public services and raises and things for retirees. COLAs.
46:39
You know, I think it does boil down to the cost. And so y'all have got the bully pulpit.
46:43
And you're, what, eight months into this? Yeah.
46:47
Eight months or eight years. I can't tell it at this point. Yeah.
46:48
And so we all look forward to seeing the things.
46:52
We know you're all working hard over there. And we thank you again for coming again.
46:56
Always have an exclusive. And here are the tough questions from the ones our
46:59
members had and the ones we still have as staff.
47:02
I think this is going to be an incredibly difficult thing.
47:05
But at the end of the day, it's almost impossible to stand up to Goliath in
47:10
a way that will make a difference.
47:13
But you've got our support in doing what you need to stand up to Goliath.
47:17
And like I said, anywhere y'all need me to be, I will be there in front of members
47:20
and having a conversation with them.
47:21
Well, that's great because we've got convention in a couple of weeks.
47:23
And just so everybody knows, yeah, the state health plan and Lantern will be
47:28
coming to a convention so you'll get more information there.
47:30
But keep an open mind to that, y'all.
47:33
Please. Thank you, Thomas. Thanks, y'all.
47:39
Okay, we're back from that interview. It was a great interview with Mr. Friedman.
47:43
Mr. Friedman. I always appreciate his accessibility and willingness to have
47:46
these conversations with us. He is not scared of tough questions.
47:49
Stepping to the lion's den.
47:50
And you guys peppered him a little pretty good with some questions from our members.
47:54
I'm sure they'll appreciate that. Yeah, tried to get some of your concerns answered
47:57
straight from the horse's mouth, so to speak. Well, as one of my police officer
48:01
cousins once said to me, he knew the job was dangerous when you took it.
48:06
So one thing I just want to go back to, and it's a very small thing,
48:10
but I was not courageous enough to ask when he was here.
48:14
I just didn't think it would fit in the moment. But like when he's talking about
48:18
some procedures costing seven times what it would to go somewhere else and do it.
48:22
And he was talking about, well, I could pick them up in a limo and take them
48:25
to the place and get it and still be cheaper. How is that legal for a place to charge?
48:32
It's the free market. It's whatever you're willing to pay. That's our point.
48:36
You shouldn't be willing to pay it.
48:38
Yeah, but doesn't it kind of venture into the realm of price gouging at some point, though?
48:43
Like, when we have a hurricane, the attorney general gets out and talks about,
48:47
you know, don't overcharge for gasoline or something like that.
48:50
There are laws against price gouging, right? Yeah.
48:53
I mean, I don't think from a legal standpoint that it would be a neat enough
48:57
box you could put that in.
48:59
However, you can certainly put it in the this is not right.
49:03
And the way we keep saying this to people is, look, if this were widgets,
49:07
it's capitalist society. We're cool with that.
49:10
Everybody charges what they want to for widgets. And you choose where you want to buy the widgets.
49:14
And so you choose where you shop every day. You choose where you get groceries.
49:18
And if you think somebody overcharges, you just, oh, I don't go there. They're too much.
49:22
But with your health care, there's somebody else negotiating that for you if
49:26
you're a state employee.
49:27
You're relying on the health plan, the third-party administrator, and the providers.
49:33
And people generally aren't thinking when your doctor says, all right,
49:36
we're going to set you up for an MRI.
49:37
I need to get you checked out. And the doctor's office sets it up.
49:41
Most people just go wherever they set it up. Well, of course,
49:44
because you are relying on people to negotiate this for you.
49:47
So, as I was telling Tom, the treasurer has a huge thing in front of him.
49:52
He has to either just watch this continue under him like it has for decades
49:57
and get worse and worse, or he's going to have to take on Goliath.
50:01
So, you know, he seems like he's up for a challenge. I will tell you,
50:04
though, like today, literally while we were interviewing Tom Friedman,
50:07
the executive administrator of the health plan, a story came out.
50:10
This one was in USA Today.
50:12
A $101,000 knee replacement? Why some hospitals charge far more than others.
50:18
And the way this was presented was the cost of employer health insurance premiums
50:23
has nearly tripled over the last 25 years for all employers. The main cause?
50:28
Economists say hospital prices. And as you're looking at the article that's
50:33
attached, it says a new report from Trilliant Health, a health care analytics
50:38
company, shows how much medical services can vary.
50:42
It gives a knee replacement as an example.
50:45
Says it can cost as little as $12,870 or as much as $101,527.
50:52
So that's, you know, a $90,000 difference for one knee replacement.
50:58
So that's, I think, what Thomas means when he says, look, there are times we
51:03
could pick you up at a limo and put you up at the nicest place in town.
51:06
And if you get it from a certain provider, we still would save the health plan tons of money.
51:12
That's crazy. It really is. So Treasurer Briner has a huge task before him.
51:19
Treasurer Falwell tried to take this task on, to be honest.
51:23
Other politicians weren't willing to get in that fight with Treasurer Falwell.
51:27
The question for Treasurer Briner is, can he do that?
51:31
Can he get other politicians to be willing to take on health care?
51:35
And, you know, we've gotten a lot of questions and you brought them up,
51:39
Suzanne, about what Lantern is going to mean for the employees.
51:43
Is it going to lead to them telling the state health plan, telling you where
51:48
you can have procedures and things like that?
51:50
I think that we're cautiously optimistic about the program, though.
51:54
It seems, at least from our... It's like Artis said, things are changing. The world is different.
51:59
And if we don't go in some direction to try to realize some types of cost savings,
52:04
then we're just going to stay stuck where we are. Yeah, we can't say no to everything.
52:07
And I get it. What they're trying to do is, because there is this price differential
52:12
that's insane out there, they're trying to drive people towards the lower cost
52:17
ones, but not just lower cost.
52:20
They do seem to be trying to put enough protections in there that you're not
52:24
just going to somebody who's cheaper. Yeah, they're well vetted.
52:27
Right. They're well-qualified, well-vetted. They're just willing to do it cheaper
52:31
because they want the volume. Yeah.
52:33
And that is when capitalism is working beautifully.
52:36
So we are cautiously optimistic, and we have to play ball on some things. Yeah.
52:41
We just think that's not the 100% answer. You definitely still have to get the
52:46
rest of those costs down.
52:47
Yeah, it doesn't fix the problem that's already there. It's not the total fix,
52:50
but it's a good step. Yeah.
52:52
I would kind of question whether that's a good motivator for providers, though.
52:58
Volume as to put like we have no way of knowing you know what i mean never had
53:02
any motivation because no one has required that their contracts be public public
53:09
dollars billions of public dollars billions with a b.
53:13
That nobody can see. So why would you be motivated in any way?
53:18
Yeah. I was just thinking, like, would you rather do 70 knee replacements for
53:23
$10,000 each or one for $700,000? You know what I mean?
53:28
Like, I think... Well, because I think the goal is you want them to then come
53:32
back when the shoulder hurts to you.
53:34
Use their physical therapy services. Get comfortable with you.
53:38
So we're at a wait and see on the program, but we are supportive and hopeful.
53:43
Yeah, and they're coming to conventions to present, so you'll get more information soon.
53:47
Yeah. And as always, though, if we see problems, we will call them out,
53:51
right? And please call us if you've got questions.
53:53
We're happy to... Sam looks like she's trying to say something over here.
53:56
Are you trying to say something?
53:57
No. Well, then it's time to get to the Gen Z moment so you can say something. Woo-hoo!
54:03
So since today we were talking all about health care and that industry,
54:07
we are going to be talking about a little bit, based on a quick search from
54:10
the World Economic Forum, found an article about how Gen Zs are reshaping the healthcare industry.
54:17
Tell us. The top three points in this article address that Gen Z are the most
54:21
tech-savvy generation yet, and we are already using digital tools to manage health and fitness.
54:27
The generation born between 1997 and 2012 are also the most open-minded about
54:33
mental health and are more likely to seek help.
54:36
And healthcare companies that embrace Gen Z's preferences will be better positioned
54:40
to attract and retain patients in the years to come.
54:44
So this article was in 2023.
54:47
However, it does tell us that Gen Z makes up about 20% of the U.S.
54:52
Population and 25% of the global population.
54:55
However, they are only accounting for about 3.3% of total health care spending.
55:02
Primarily because we are probably the youngest and healthiest generation at
55:05
the moment. But at the same time, it's because we don't seek out the traditional healthcare as much.
55:12
Because we are already using tech to essentially track our workouts,
55:18
track our sleep patterns, as well as tracking our diet, we take a much more
55:24
holistic view of health.
55:27
And like to look more at preventative as well as what can I do better in my
55:34
own personal life so that I don't have to go on medication.
55:37
And they look at a lot more alternative methods.
55:41
I think that's true. It also says that Gen Zs are 20% more likely than others
55:46
to talk about their mental health in the workplace.
55:49
I know that's true. I know that's true.
55:53
But no yeah although you know here at
55:56
scenic we're all very open yeah yeah seriously
55:59
if we feel anxiety we talk about we do we don't hold
56:03
your feelings in try to be a good group for each other too yeah yeah you're
56:08
probably also more likely to google your symptoms right no because we learned
56:13
doesn't matter what you google you according to google it doesn't matter what
56:18
you Google, you're going to die. Yeah.
56:20
Whatever you have, you have cancer. That's basically what Google says. It's awful.
56:24
But it kind of addresses that these shifting generational preferences challenge
56:29
today's health care model, which is based on treating specific problems when they arise.
56:36
Meanwhile, we are focused on the future and focused on more wellness prevention
56:42
and outcomes and overall health.
56:45
Well, you know, Thomas talked about, you know, how the state health plan is
56:48
going to want to invest in wellness initiatives.
56:51
So, you know, maybe this is all playing together.
56:54
That'll be good. Yeah, for the younger employees, they'll especially like that.
56:57
So my mind just went down a rabbit hole that I discovered recently.
57:02
Is it a Reddit rabbit hole? Well, yeah, kind of. No, it's Neil deGrasse Tyson.
57:06
I was watching a video from him and he said, from the caveman years until the
57:12
1800s, the life expectancy of humans increased three years.
57:18
From like 30 to 33 or something like that.
57:21
Fascinating. And from then until now, it's been 50 years. Goodness.
57:26
And that's kind of mind-blowing, right? Yeah, it is. So what do you think,
57:30
like, these Gen Z folks, they're probably planning to live till they're 150, right?
57:34
Like, what does the future hold for them, you know? No telling.
57:40
I don't know. I think we've actually started, haven't we, in the U.S.?
57:45
Regressed. Our numbers actually came down in the last couple years?
57:47
Possibly. Probably, yeah.
57:49
I will say, I just don't think a lot of Gen Zs want to live that long.
57:55
We made health care advances, but now we've made it to where people can't access
57:59
because of cost. It's not accessible, so it doesn't really matter that it exists.
58:03
That's true. I remember there was a Time magazine cover a few years ago that
58:07
was like, will this baby live to 130? Right. Remember that? Yep.
58:12
Because of all the advances. How many times will this baby have Botox?
58:17
But it's like, I mean, it's a real issue for societies. I'm getting really deep.
58:22
But like people are living longer. Are you having anxiety? Let's talk about
58:26
it. Yeah, I really am. I mean, I think about these things. I'm going to cry. No.
58:31
It wouldn't be the first time someone's cried on this podcast.
58:33
That's true. Fair point.
58:36
Okay, well, that was a good topic, and it can splinter into a million directions,
58:40
so I will just reign it in right now.
58:42
And we'll go to our final thing, the question of the week. Play my theme song.
58:48
Music.
58:54
So this week, we kind of brainstormed, and I think we're going to go with if
58:59
time and money were not an object,
59:00
if it was not an issue, what would be one thing that you would do for yourself
59:05
or maybe a trip you would take or a self-care thing you would do?
59:11
I think mine, I've always wanted to see all seven lighthouses in North Carolina.
59:16
That's kind of lame, right? But I think I would do that, though.
59:19
I don't think that's lame. I'd do like a trip. If time and money were not an
59:22
issue at all. Obviously.
59:24
You would go to seven different places in North Carolina?
59:27
I'm just talking about, like, random things. Like, of course,
59:30
if time was not an issue and money was not an issue, I would buy,
59:33
like, front row seats at season tickets to Carolina basketball.
59:38
Like, obviously, right? That would be my first purchase.
59:41
Still. But I was trying to bring something wholesome that I would do.
59:44
And I've always wanted to do that.
59:46
So that's my—stop it, Artis. You cheated.
59:50
I'm raining on your dreams. Well, I think if time and money were not an object,
59:55
I would take care of my little family first.
59:58
We would have sort of a compound where we lived, you know, the kids,
1:00:03
their own family home and somewhere on that property, there's going to be a tiny home for Gibi.
1:00:07
And I would just live there and find my joy, which is self-care. Find your joy.
1:00:13
I'm the queen of dissociating, so finding actual joy is important.
1:00:19
So those babies are my joy, so that's what I would do.
1:00:23
But if time and money weren't an object, then I could take them traveling or,
1:00:26
you know, we could experience all kinds of things. So, yeah,
1:00:29
I just think finding the love.
1:00:31
Find the love, y'all. Okay, so Suzanne would start a cult.
1:00:35
Sam, what would you do?
1:00:40
So I do have a dream that I've had since I was like 10, 11.
1:00:44
I would take my mom to Italy and Greece.
1:00:48
Nice. And we would just go on a trip to Italy and Greece. But Italy didn't come about until later.
1:00:52
Greece has always been a dream just to be able to afford to take my mom to Greece.
1:00:56
Again, find the love. I think, eat, pray, love.
1:00:58
I think that Italy enters the
1:01:01
conversation for everyone when they start thinking about all the pastas.
1:01:04
I bet I would gain like 30 pounds if I went to Italy. I actually convinced my
1:01:08
mom to read a book. It's called One Italian Summer.
1:01:11
I had just finished it whenever I convinced her to read it. And it's a cute
1:01:14
little love story, but it's not like your traditional love story.
1:01:18
And it talks a lot about the love between
1:01:20
a mother and a daughter and the relationship that can be held there.
1:01:24
And it takes place in Italy. And after reading it, my mom was like,
1:01:28
you just made me want to go to Italy now.
1:01:29
And it's like, it's okay. I wanted to go to Italy too after reading that.
1:01:32
So you should get in meatballs all day long, man. It's on our list now.
1:01:36
Instead of just a week in Greece, a two week long trip one day and go to Greece
1:01:41
and Italy. I love that experience.
1:01:45
Yeah i would see the world that's what i would do if you if time and money were
1:01:50
just not a problem sure yeah absolutely go see everything you wanted to yeah
1:01:54
you know go see the lighthouses,
1:01:56
i would probably start with the lighthouses not the seven wonders of the world
1:02:01
the seven lighthouses of north carolina yeah and when we're speaking of the
1:02:06
coast a little bit there you know we've got this hurricane here and who's causing
1:02:09
a little bit of issue here in north carolina so They'll be safe.
1:02:13
We're thinking of it. Yeah, I saw that it was kind of turning out to sea there, right? Yeah.
1:02:16
I think they're still expecting some. But I know Highway 12 already had that.
1:02:20
Yeah. That's what I was going to talk about. So DOT, y'all be good. Highway 12.
1:02:23
Didn't they rebuild it recently? They rebuilt it all the time.
1:02:26
I mean, but they thought it would withstand a little more.
1:02:29
It's a strip of concrete on the ocean. My grandpa used to say,
1:02:33
Army Corps of Engineers ain't going to ever outsmart God.
1:02:37
So we have to put things back together the best we can. But we have to know
1:02:41
that we're probably going to have to put them together again.
1:02:43
Yeah. And that's why we have capable state employees to do that. Yes. Shout out to DOT.
1:02:48
Whoop whoop. Yeah. I believe Currituck County just had their evacuation notice
1:02:55
entered last night saying, like, get out.
1:02:59
And they have to drive, like, four miles on the beach just to get to their homes. Wow.
1:03:04
So. And hopefully those people. Yes. Get out safe. Yeah, there were people who
1:03:08
live in that area who were posting saying, hey, if you're a visitor here,
1:03:12
these are times that tide is high.
1:03:15
This is the times that it's best to not leave. And here's the low tide times.
1:03:19
This is when you should get off. Yeah.
1:03:22
Are there any other hurricanes out there? Usually when there's one,
1:03:24
there's like three others storming.
1:03:26
I've heard that there's another one following after Aaron, but boom,
1:03:31
boom, haven't seen much.
1:03:33
Just in time for us to be in Greensboro. Yeah.
1:03:36
All right. Well, that was a great show. Thanks for joining us.
1:03:39
Music.