Latest / The Advancing Healthcare Innovation Show / E193 | What Happens When Patients Are Afraid of the Bill? | Brian Marsella

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E193 | What Happens When Patients Are Afraid of the Bill? | Brian Marsella · The Advancing Healthcare Innovation Show

• 0:11
  Hello and welcome back to the Advancing
• 0:12
  Healthcare Innovation Show. I am your
• 0:15
  host, Michael Staminos. And if you're
• 0:16
  new to us, welcome. We're super excited
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  passionate about having curious
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  conversations with leaders that are
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  painstakingly reshaping the future of
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  healthcare. And we're really passionate
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  about a few different areas. We're
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  access, leadership, and and the adoption
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  of those innovations. And if it's your
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  first time tuning in, let me just sort
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  of take a quick step back to give you a
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  little bit more on what we're trying to
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  reading in headlines, but like people
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  amazing action-packed here. If you
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  the new interviews come directly to you.
• 1:14
  So, look, I've been doing the show for
• 1:15
  for a little while now, and there's a
• 1:18
  pattern that continues to emerge, and
• 1:22
  it's this. It's that the the clinical
• 1:24
  side of healthcare uh gets a lot of
• 1:26
  attention and there are certain parts of
• 1:29
  healthcare that everybody knows are
• 1:31
  broken but they just don't get talked
• 1:34
  about enough and money is one of them.
• 1:38
  And I'm not talking about like policy or
• 1:41
  you know reimbursement models. I'm
• 1:43
  talking about what does it actually feel
• 1:46
  like for a patient to pay for care and
• 1:51
  that part to me has been left alone. So
• 1:55
  today's guest has spent more than 30
• 1:59
  years inside of the ecosystem of
• 2:02
  healthcare and fundamentally is focusing
• 2:04
  in on that exact problem. So Brian
• 2:06
  Marcella is the president of HPS pay
• 2:10
  medics and tempo pay. So what the
• 2:13
  platform does is it's generally
• 2:17
  different. It guarantees payment to
• 2:19
  providers upfront. So it takes every
• 2:22
  bill that a patient owes and turns it
• 2:25
  into one clean monthly statement.
• 2:28
  Brian's going to go into a little bit
• 2:29
  more in this, but it but it gives every
• 2:31
  single patient um a path to pay because
• 2:36
  no one kind of gets turned away because
• 2:38
  their financial situation uh doesn't fit
• 2:41
  the model. So, like just think about
• 2:42
  that. Like, no one gets turned away. And
• 2:44
  and here's the number that really got me
• 2:46
  in kind of preparing for this
• 2:47
  conversation is that one in four people
• 2:50
  on the pay platform uh would fail a
• 2:54
  standard credit check. So, they would be
• 2:56
  denied financing anywhere else, but they
• 3:00
  still, you know, need care. So Brian's
• 3:02
  held I mean his CV is ridiculous but uh
• 3:05
  he's held senior leadership roles at
• 3:06
  Sigma and Etna and honestly he's been
• 3:10
  inside those rooms where you know risk
• 3:13
  gets priced and decisions get made at
• 3:15
  scale um and he knows exactly where the
• 3:18
  patient gets lost in the middle of it.
• 3:20
  So so in addition actually he also
• 3:22
  serves um as a board chair uh for the
• 3:25
  last what is it Brian 15 or 16 years
• 3:27
  it's it's it's been quite some time for
• 3:29
  Erie Family Health Center. So, this is a
• 3:31
  federally qualified health center in
• 3:33
  Chicago. And honestly, where the
• 3:36
  communities that are walking through
• 3:37
  that door, they don't have the luxury of
• 3:39
  of putting off care in many instances.
• 3:42
  And and honestly, a confusing bill is
• 3:44
  the difference between someone that's
• 3:47
  coming back uh and someone that actually
• 3:49
  disappears, you know, from that
• 3:52
  situation and system for entirely. So,
• 3:55
  Brian, it's great to see you. Welcome to
• 3:58
  the show.
• 3:59
  >> Thank you, Michael. appreciate being
• 4:00
  here.
• 4:01
  >> Yeah. So, listen, um I want to start off
• 4:05
  way back. Go all the way back. I think
• 4:08
  it was like 1992.
• 4:10
  Um you're young. You just started at
• 4:12
  Sigma. Uh what did you actually think
• 4:17
  you were walking into and what did
• 4:20
  reality look like?
• 4:23
  >> Yeah, boy. I you know, I'll tell you
• 4:24
  what. I took the job mainly because it
• 4:26
  was, you know, a couple hours from my
• 4:28
  house. It was a six-month training
• 4:29
  program and I felt like it was a good a
• 4:32
  good way to get engaged in uh in
• 4:34
  healthcare and uh you know to start a
• 4:36
  career and uh I just thought I was going
• 4:39
  to be helping people price how much it
• 4:42
  costs to have healthcare right I started
• 4:44
  my career
• 4:45
  >> financial under right
• 4:47
  >> and um it was one of the you was a great
• 4:50
  job um quite frankly I don't think I've
• 4:52
  been as good at anything as I was at the
• 4:53
  beginning of my my career at uh at
• 4:56
  pricing things but uh you It was
• 4:58
  interesting. We would sit down with
• 4:59
  employers and just tell them they had to
• 5:01
  continue to increase their deductibles
• 5:02
  in their out of pockets to bring the
• 5:04
  cost the cost down. And you know, we
• 5:07
  believed back then that, you know,
• 5:09
  everybody was going to overutilize care
• 5:12
  if we didn't make them financially
• 5:14
  responsible. And we also didn't have all
• 5:16
  these clinical programs to help keep the
• 5:18
  providers from, you know, right,
• 5:21
  >> basically, you know, you know, ordering
• 5:23
  on, you know, tests and everything. And
• 5:25
  this was back 34 years ago. the system
• 5:28
  is like, you know, 50fold more, you
• 5:31
  know, convoluted now than it ever was
• 5:34
  back then. Uh, you know, back then you
• 5:36
  would say a high deductible plan back
• 5:37
  then was a $1,000 deductible and a
• 5:40
  $3,000 out of pocket.
• 5:42
  >> So, very different. Like that's
• 5:43
  considered a rich plan today in today's
• 5:46
  world. Uh, but
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  >> uh you know, I I just um it it was great
• 5:51
  start to my career. I actually went and
• 5:52
  got my MBA ostensibly to get out of
• 5:54
  healthcare. And when I got was getting
• 5:56
  my MBA, I realized that healthcare was
• 5:58
  20% of GDP. Why would I get out of it?
• 6:01
  >> That's right.
• 6:01
  >> And uh you know, so here I am another 25
• 6:04
  years later and uh you know, still
• 6:06
  involved and I've been involved in every
• 6:08
  aspect. I've been on the consulting
• 6:10
  side, the national carrier side, the as
• 6:12
  a I own a, you know, am I running a
• 6:15
  small business now, so purchasing our
• 6:17
  benefits and then, you know, also as my
• 6:20
  uh my my board chair position and I
• 6:23
  often time will go back to the Kellogg
• 6:25
  Healthcare School and tell them that
• 6:26
  nobody would build the system the way
• 6:28
  it's been built if they knew it what was
• 6:30
  happening today.
• 6:32
  >> Yeah. But it's going to be very hard to
• 6:34
  unravel the system with, you know, the
• 6:36
  vast majority of the health care
• 6:37
  companies and the pharmaceutical
• 6:39
  companies being such a huge component of
• 6:41
  GDP and of of the the Dow Jones uh and
• 6:46
  all that that uh we got to find a way to
• 6:48
  actually solve it. And one of the ways
• 6:51
  is to help people become better
• 6:52
  consumers. And
• 6:55
  >> you know, we we we thought we were going
• 6:56
  to drive consumer-driven health plans 25
• 6:59
  years ago. We really haven't. We've
• 7:01
  gotten to the point where, as you said,
• 7:03
  a lot of people can't afford care. And
• 7:05
  so what's happening is they're just
• 7:06
  avoiding getting care. Kaiser Foundation
• 7:08
  says four and 10 people are not getting
• 7:10
  care because they can't afford it. So
• 7:14
  >> such a big number, man.
• 7:16
  >> You know, and you mentioned at the
• 7:17
  beginning, the clinical program, we
• 7:18
  focus in the clinical, well, you can
• 7:19
  never trigger a clinical program if you
• 7:22
  don't actually go get care in the first
• 7:23
  place.
• 7:25
  >> And so, you know, I mean, think about
• 7:27
  even just getting a preventive care.
• 7:28
  That's free for most Americans and most
• 7:30
  people still aren't getting it done
• 7:32
  because they're afraid there's going to
• 7:33
  be all sorts of costs that'll come out
• 7:35
  of that. They'll have to be on drugs or
• 7:37
  they'll need other procedures or they'll
• 7:39
  need testing or
• 7:40
  >> or you know maybe they actually get
• 7:42
  charged for the free care because they
• 7:44
  didn't somebody asked about hypertension
• 7:46
  and you know flagged and and and coded
• 7:49
  the wrong way. Well, it's amazing
• 7:53
  unintended consequences of the things we
• 7:55
  do have impact people's behavior.
• 7:58
  >> Exactly. Exactly. So, so seeing that um
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  I'm just sort of curious like what what
• 8:05
  drew you to this fintech company? Um was
• 8:11
  it back in 22 or something like that? I
• 8:13
  mean, was it was it was it that problem
• 8:15
  in and of itself that you kind of looked
• 8:17
  in and you're like, "Wow, like this is
• 8:18
  actually super intriguing." And as you
• 8:20
  start kind of running the math and
• 8:22
  looking at numbers, I'm just sort of
• 8:24
  curious, what was it that really kind of
• 8:26
  brought you to that that decision?
• 8:29
  Obviously, I think, you know, look, you
• 8:31
  you spent over a decade at Etna. You you
• 8:34
  left for Mercer as a consultant, you
• 8:35
  know, then you went back to Sigma market
• 8:37
  president. I mean most people would call
• 8:39
  that a career but like you you shifted
• 8:42
  from that to go into this. What what's
• 8:44
  the thinking behind that?
• 8:45
  >> Yeah. You know when I when I left Sigma
• 8:47
  I started doing consulting for a number
• 8:49
  of uh uh what people might call it for
• 8:52
  for his point solutions. You're solving
• 8:54
  a specific issue in the industry
• 8:58
  >> fertility mental health centers of
• 9:01
  excellence diabetes reversal. I was
• 9:03
  talking to all those folks digital
• 9:04
  mental health. And what I was really
• 9:07
  intrigued by was unlike the big
• 9:08
  carriers, they could spin on a dime. You
• 9:10
  know, you could give them suggestions on
• 9:11
  their value proposition or on uh how to
• 9:14
  how to how to show their ROI differently
• 9:16
  or how to price things differently and
• 9:17
  they would make changes and move things
• 9:19
  forward. So that got me intrigued by
• 9:21
  getting out of the large, you know, um
• 9:25
  stable company world and saying, "Let me
• 9:27
  try something unique and different." And
• 9:29
  if an individual I had known from back
• 9:30
  to the beginning of my career, we both
• 9:32
  started underwriting together had come
• 9:34
  in as the CEO of of HBS Pamedics and
• 9:38
  really started throwing some statistics
• 9:39
  at me. You know, the four out of 10
• 9:41
  people are delaying care and 25% of
• 9:43
  prescriptions aren't picked up and that,
• 9:46
  you know, 50% of Americans can't afford
• 9:48
  a $500 bill. Um, and that, you know, you
• 9:53
  know, the average out of pocket, you
• 9:54
  know, at the time I think was like $800
• 9:56
  that people were paying. So those lines
• 9:58
  didn't cross, right?
• 10:00
  >> Yeah.
• 10:00
  >> I started thinking about what happened
• 10:02
  with COVID. With COVID, when people
• 10:05
  physically couldn't get in to see their
• 10:07
  doctor or they couldn't get into a
• 10:09
  hospital or they were afraid to go see
• 10:11
  that doctor, right?
• 10:13
  >> Yeah.
• 10:13
  >> So many people put off care just I mean
• 10:16
  people that had no problem getting care
• 10:17
  before put off care. And at the time I
• 10:20
  was still at Sigma, we were talking
• 10:21
  about the third wave of COVID, which was
• 10:24
  really the people that were showing up
• 10:26
  with stage two cancer instead of stage
• 10:28
  one. They were showing up diabetes
• 10:31
  instead of pre-diabetes. They were
• 10:33
  showing up with, you know, COPD that
• 10:35
  had, you know, or asthma that had gotten
• 10:36
  worse.
• 10:37
  >> Um, and it was all because they couldn't
• 10:40
  get care. Well, what this individual
• 10:42
  explained to me was, you know, for 50%
• 10:45
  of Americans, just not having access to
• 10:47
  cash is just like a door you can't get
• 10:50
  into or you're afraid to walk through.
• 10:53
  And those people are also having the
• 10:55
  same sort of situations happen where
• 10:56
  they enter the system in the wrong
• 10:58
  setting. they'll enter it at, you know,
• 11:01
  emergency room rather than uh, you know,
• 11:03
  the the primary care or they'll just
• 11:06
  enter it, you know, by the time they
• 11:07
  enter it, they're just sicker and you
• 11:09
  have a lot more work you have to do. If
• 11:11
  you think about not only the cost of
• 11:13
  stage two cancer versus stage one or
• 11:15
  stage zero,
• 11:16
  >> but it's also the mortality rates of
• 11:18
  those.
• 11:19
  >> It's dramatically different. So, be able
• 11:22
  to get people up front and I inherently
• 11:23
  knew that from my days of trying to
• 11:25
  drive people into clinical programs and
• 11:28
  get people into programs. But again, if
• 11:30
  you don't find that they have this
• 11:32
  issue, it's hard to ever, you know, deck
• 11:35
  up resources to help them get better.
• 11:37
  And then I started thinking about my
• 11:38
  nonprofit and and my nonprofit has the
• 11:42
  highest quality statistics in all of
• 11:44
  Illinois and is the top 10% of the
• 11:46
  country. And in large part that I
• 11:49
  believe is because most of our folks are
• 11:51
  on Medicaid. And so we may have to work
• 11:54
  really hard to make sure they come in
• 11:55
  and get care. But once they're in,
• 11:58
  >> you know, we deal with them in a
• 11:59
  culturally competent manner. They don't
• 12:02
  have these bills they have to pay. And
• 12:04
  we, you know, we have to earn their
• 12:05
  trust to keep them in the system, but we
• 12:08
  do some amazing work. And I started
• 12:10
  thinking that the company I'm in now, if
• 12:12
  I we can help solve some of the
• 12:13
  financial issues with people that we can
• 12:16
  get them in the front door and we can
• 12:17
  actually take care of uh take care of
• 12:19
  them the way we would in in my
• 12:21
  nonprofit. And so that's where it really
• 12:23
  intrigued me. it it feels like a small
• 12:25
  sliver of the system. Um, you know, and
• 12:29
  there's that great quote, if you if you
• 12:31
  if you sub if you optimize all the
• 12:33
  subcomponents of a system, you're going
• 12:35
  to suboptimize the overall system,
• 12:37
  right? Well, you know, we we are trying
• 12:40
  to not trying to optimize that. We're
• 12:42
  trying to just make it easier for people
• 12:44
  to get in to get care
• 12:46
  >> to then be able to work through all of
• 12:48
  the other, you know, great solutions
• 12:51
  that their employer has has has put
• 12:53
  forth for them or that their provider is
• 12:55
  included.
• 12:56
  >> Um, and make sure they're getting care
• 12:58
  in the right setting. And we've seen
• 13:00
  good results. We've seen more care in
• 13:03
  the in the physician's office, in the
• 13:04
  outpatient than in the in the hospital.
• 13:07
  We've seen lower trend. And we actually
• 13:09
  see across all
• 13:11
  credit scores that people are accessing
• 13:13
  the system similarly. Not only the
• 13:15
  number of enter the system, but their
• 13:17
  dollar amount. We wear that with a badge
• 13:19
  of honor because I think you normally
• 13:21
  will see particularly lower f lower
• 13:23
  income folks or lower um credit score
• 13:27
  individuals accessing the system
• 13:28
  differently. Um you know this the stat I
• 13:31
  put earlier, 40% of all Americans are
• 13:33
  delaying care.
• 13:34
  >> Yeah. of Americans making less than
• 13:36
  $90,000 a year, 67% of them are avoiding
• 13:40
  or delaying care.
• 13:42
  >> So you see a rapid increase when
• 13:44
  >> 67% are delaying
• 13:47
  care
• 13:47
  >> or avoiding care. Yeah.
• 13:50
  Yeah. And then you start seeing people
• 13:53
  that are, you know, 5% of people are
• 13:55
  taking medical withdrawals from their
• 13:57
  401k to pay for care. you know, that's
• 14:00
  meant to be your, you know, that's meant
• 14:02
  to be there for your later in life and
• 14:04
  and your ability to retire and and a lot
• 14:07
  of people are having to to take money
• 14:09
  out of that just to pay for their
• 14:10
  medical care. So, if you you know, I
• 14:12
  could cite a million stats. They all
• 14:14
  fundamentally get to the point that
• 14:17
  Americans can't afford $1,000 bill,
• 14:20
  period.
• 14:22
  They're then going to delay it and, you
• 14:24
  know, put it off. And then the average
• 14:26
  right now that people are spending is
• 14:28
  1,100 per person. So a family of four,
• 14:32
  you know, 60% of those folks can't
• 14:34
  afford $1,000 and yet on average they're
• 14:37
  paying $4,400 in medical care. You know,
• 14:40
  it's just it's just logic and math that
• 14:42
  don't don't add up to having people
• 14:45
  access care in the right setting at the
• 14:47
  right time and feeling confident that
• 14:49
  they aren't going to go into worse
• 14:52
  medical debt that causes problems back
• 14:54
  end.
• 14:55
  um you know when that happens
• 14:57
  >> in in a sense do you feel like your
• 14:58
  board work at Erie Family Health Center
• 15:00
  has sort of humanized the problem for
• 15:03
  you to sort of see it? I mean, I guess
• 15:04
  maybe walk walk me through like are
• 15:06
  there any specific situations like a
• 15:08
  real story that you can share um that
• 15:12
  that kind of really made this
• 15:15
  crystallize this for you in terms of
• 15:16
  what you're what you're doing on the
• 15:18
  day-to-day, but obviously with your with
• 15:20
  your board work because I feel like
• 15:22
  those they cross paths for a reason. I
• 15:25
  just don't think that it just sort of
• 15:26
  happened by coincidence.
• 15:28
  >> Yeah. No, you're absolutely right. You
• 15:30
  know, so one of the interesting things
• 15:32
  about a federally qualified health
• 15:33
  center board is that 51% of the board
• 15:36
  members need to be patients.
• 15:39
  Okay. So we have 22 folks on our board.
• 15:42
  So I think I think right now 13 of them
• 15:44
  are patients and nine are you know
• 15:47
  non-patient business type people. Right.
• 15:49
  >> Right. Right.
• 15:50
  >> And then even in that world only a
• 15:51
  certain can generate their their income
• 15:53
  from the healthcare industry. So, it's
• 15:54
  very, you know, very highly highly
• 15:56
  reviewed in large part to make sure that
• 15:59
  the patients are the ones that are
• 16:01
  really helping to try and determine how
• 16:03
  the health center is going to operate.
• 16:04
  >> Yeah. And there's been many times when
• 16:07
  you know we when we look at the actual
• 16:09
  dollar dollars of running a a program of
• 16:12
  what you know whether it's a u you know
• 16:14
  some of our community based programs
• 16:16
  where we're doing life you know healthy
• 16:17
  cooking classes or you know some of our
• 16:20
  clinical oversight uh of you know people
• 16:23
  going into the home to to look at the
• 16:24
  home and making sure that you know
• 16:26
  people have access to things or all the
• 16:28
  work that we do outside of it. It costs
• 16:31
  us money times to do that.
• 16:33
  >> Yeah. That's right.
• 16:34
  >> But the patients will walk us through
• 16:36
  how much that helped them with their
• 16:38
  with their overall care
• 16:40
  >> and they'll say we can't look at this as
• 16:41
  a dollar and cents issue and that's
• 16:43
  unfortunately how most businesses look
• 16:46
  at things. We're going to say, you know,
• 16:47
  we have to look at this as what's the
• 16:49
  best overall health of the community.
• 16:52
  And then we're going to have to go find
• 16:54
  the resources potentially to make sure
• 16:56
  we can drive that. That could be
• 16:57
  fundraising dollars. it could be um you
• 17:01
  know a different different way to get
• 17:02
  people in for care um you know that that
• 17:05
  the kind of thing. So it really started
• 17:07
  helping me understand that we have to
• 17:11
  look at the overall issue
• 17:14
  and we need to really determine what's
• 17:16
  the best interest of the overall health.
• 17:18
  And so it's the same for an employer in
• 17:20
  my mind. You have to think about for
• 17:22
  that employer. I don't begrudge them for
• 17:24
  having to increase their deductible out
• 17:25
  of pockets, right? That's something that
• 17:28
  you they have to think about doing to
• 17:30
  make sure that the their sh their fair
• 17:32
  share of what is is people pay out of
• 17:34
  their paycheck is reasonable.
• 17:37
  >> Um but then they have to realize that if
• 17:39
  you when you're trying to build a
• 17:40
  one-sizefits-all for your employer base,
• 17:43
  you're going to have a subset that are
• 17:44
  going to be really suboptimized. So you
• 17:46
  have to find things you can bring to
• 17:47
  them that will help them if nothing
• 17:50
  else, you know, extend the time horizon
• 17:52
  of when they need they could pay back
• 17:54
  those bills, right? And so those kind of
• 17:56
  things really help me understand that
• 17:59
  you know again suboptimizing a piece of
• 18:02
  the equation can or you know or
• 18:04
  optimizing you know for a certain
• 18:06
  financial component can suboptimize the
• 18:08
  overall health and employers need to
• 18:10
  look at things their absenteeism their
• 18:12
  presentism their health care costs their
• 18:16
  you know other benefits and are people
• 18:18
  using those the way they want them to be
• 18:20
  used to really be able to think about
• 18:22
  you know are you delivering the right
• 18:24
  overall component to people.
• 18:26
  >> No, I've just been as you're mentioning
• 18:28
  this, I've just been thinking, man, you
• 18:30
  have
• 18:32
  so much experience on the payer side,
• 18:34
  you know, 30 plus years inside of the
• 18:37
  system. And a part of me, I guess I'll
• 18:40
  say the the inner cynic in me is like,
• 18:43
  well, you're inside of those systems
• 18:45
  that, you know, in essence birthed this
• 18:48
  opportunity for pays to to solve this
• 18:52
  issue. Does that does that feel like
• 18:56
  ironic to you or or do you think about
• 18:59
  it differently?
• 19:00
  >> You know, it feels a little bit ironic,
• 19:02
  but in all honesty, you know, some of
• 19:04
  these it it's such a big issue at a at a
• 19:08
  uh a macro level. You know, Medicaid and
• 19:12
  Medicare don't pay their fair share to
• 19:14
  the providers. So, they need to go get
• 19:16
  more of the money from the employers.
• 19:17
  Right now, we could have a lot of
• 19:19
  debates on whether the providers are
• 19:21
  using that money properly and we can
• 19:23
  have a lot of debates on, you know, when
• 19:25
  you see all the land grab that's have
• 19:26
  that's happening out there. In large
• 19:28
  part, consumers are demanding that
• 19:30
  >> you everybody's doing it for a reason,
• 19:32
  right? Um
• 19:34
  >> but uh you know, back in the day when we
• 19:36
  started consumerdriven health plans, we
• 19:38
  really believed that that was going to
• 19:39
  be the thing that allowed more employers
• 19:41
  to continue to offer care or to continue
• 19:44
  to subsidize care at the right level.
• 19:46
  And it worked for a little while. It
• 19:49
  really did. It brought trend down. It,
• 19:51
  you know, helped helped along the way.
• 19:53
  But then as costs have continued to go
• 19:55
  up, it's really gotten to a teeter, you
• 19:58
  know, the seessaw has gone too far in
• 20:00
  the other direction. And the unintended
• 20:01
  consequences of that have stepped. Um,
• 20:05
  there was even a recent study that
• 20:07
  showed, you know, people on that that
• 20:09
  that had cancer that were on a
• 20:11
  consumer-driven plan had worse outcomes
• 20:13
  than people that weren't on a
• 20:14
  consumer-driven plan. Interesting.
• 20:17
  >> They can't blame that on the
• 20:18
  consumer-driven plan. We all believe we
• 20:21
  were going to get people to be able to
• 20:22
  behave more rationally,
• 20:24
  >> right?
• 20:24
  >> The whole concept behind this was you do
• 20:27
  more research to buy a car than you do
• 20:29
  to go find your surgeon for a heart
• 20:32
  transplant, right? You do more.
• 20:34
  >> Isn't that interesting? This is this is
• 20:36
  mindboggling to me. And we really
• 20:39
  believed at the time in the health care
• 20:41
  world and I still some some people still
• 20:43
  believe it that you know if we make it
• 20:45
  you know people have the skin in the
• 20:47
  game that they're going to ultimately
• 20:50
  start doing more research and more care.
• 20:52
  Well some of it is the tools haven't
• 20:54
  progressed as fast as they should. Um
• 20:57
  some of it is pro you know providers
• 20:59
  they say it takes 19 years for a
• 21:01
  provider in a given subsp specialty
• 21:04
  >> to know for everyone in that subsp
• 21:06
  specialy to be delivering care at what
• 21:09
  that subsp specialy delivers to be the
• 21:11
  the most appropriate way to deliver care
• 21:14
  >> right
• 21:15
  >> so yeah you know carriers play a role in
• 21:17
  making sure that we you know that they
• 21:19
  they try to make sure that that doesn't
• 21:21
  happen right some of it is they're
• 21:23
  giving information to these providers
• 21:24
  that they can't get because people are
• 21:26
  going to multiple prov providers, right?
• 21:29
  >> So, there's really there's still value
• 21:31
  in what all of these groups do. It's
• 21:33
  just gotten to the point where, you
• 21:36
  know, increasing deductible out of
• 21:38
  pocket is is is making the system worse
• 21:41
  at this point in time. You know, the
• 21:43
  business group on health says that they
• 21:44
  believe increas
• 21:46
  costs are going up 9%.
• 21:49
  And employers are going to buy down
• 21:51
  about 1.4% 4% of that, you know, by
• 21:53
  increasing deductibles out of pockets or
• 21:55
  putting in other initiatives
• 21:57
  >> that will that will that will move more
• 21:58
  of that onus to the to the patient.
• 22:02
  You know, a lot, you know, employers
• 22:04
  can't, you know, asking them to to take
• 22:06
  even 7.6% is a lot. They're not able to
• 22:08
  get
• 22:10
  >> increase in all their good, you know,
• 22:12
  across all of their uh programs at
• 22:14
  times, right? So, you can't point to
• 22:16
  them and say they're the problem. You
• 22:18
  can't point to the carrier and say
• 22:19
  they're the problem. You can't point to
• 22:20
  the provider, but you have to point to
• 22:22
  everybody and say there's got to be some
• 22:24
  things that we can do differently. And
• 22:25
  I'm a big believer in driving people to
• 22:27
  high quality care, maybe even through,
• 22:29
  you know, lower co-pays, lower
• 22:31
  deductibles, or even free. Um, but
• 22:34
  ultimately, you know, skin in the game
• 22:36
  is valuable, but you got to actually
• 22:38
  then have some tools and resources for
• 22:41
  people to um, uh, to be able to afford
• 22:44
  that over time and give them a time
• 22:46
  horizon to pay that back like you would
• 22:49
  have them have a time horizon to pay for
• 22:50
  their car or their house or things like
• 22:53
  that. It's crazy that we have to think
• 22:55
  sometimes that healthcare is a,
• 22:58
  you know, a purchasing decision like a
• 23:00
  house or a car. But, you know, someone I
• 23:03
  was on a panel recently that said to
• 23:05
  somebody, you should let your employees
• 23:07
  know that on average you're buying them
• 23:10
  a Toyota every year. And I started
• 23:13
  thinking, what is this person saying?
• 23:15
  And if you think about it, the average
• 23:17
  now for, you know, per per employee is
• 23:19
  well over $25,000
• 23:22
  is the total cost per employee for
• 23:23
  healthcare, right? That's you can buy
• 23:27
  for $25,000. And you see you're buying
• 23:29
  them a new Toyota every year,
• 23:31
  >> right? Like we need people to understand
• 23:33
  that
• 23:35
  >> and we need employees in particular to
• 23:37
  understand that that's important. They
• 23:39
  need to get start paying more attention,
• 23:41
  right? But unfortunately, we've shut
• 23:43
  them off. We shut them off by thinking I
• 23:45
  can't even go get care
• 23:47
  >> or sometimes on the back end I can't
• 23:49
  have any understanding of what I owe,
• 23:51
  who I owe it to, when I owe it.
• 23:54
  >> There's rework of bills. There's all
• 23:56
  this stuff that happens and and
• 23:58
  unfortunately to some extent we've
• 23:59
  programmed people to ignore things. Um
• 24:02
  >> when I started my care at my at at my
• 24:05
  started getting my care at my nonprofit,
• 24:07
  I've been on the board for 19 years. I
• 24:08
  became the board chair 16 years ago.
• 24:10
  When I became the board chair, I said, I
• 24:11
  should get my care here.
• 24:14
  So, I started getting my care there.
• 24:15
  Quite frankly, it's the best care I've
• 24:17
  ever gotten. And I used to get care at
• 24:18
  some of the most prestigious, you know,
• 24:20
  facilities.
• 24:22
  >> Um,
• 24:24
  >> I wasn't paying I wasn't paying my bill
• 24:26
  until I got a red final due notice.
• 24:30
  >> You know, be like 180 days later, you're
• 24:32
  finally getting a bill that says final
• 24:34
  due. And sometimes it was, you know,
• 24:36
  $150 that I owe. I could afford it, but
• 24:40
  I had been pre-programmed to say, "I'm
• 24:43
  not paying Northwestern Healthcare until
• 24:46
  I get my red final due because I'm not
• 24:48
  sure if it's been paid, if there's been
• 24:50
  everything's been paid for
• 24:52
  >> and do I owe?" And then I would go and I
• 24:54
  would look when I got that red final
• 24:55
  due, I'd go look and say, "Do I owe the
• 24:57
  money?" Right?
• 24:59
  >> Well, the reality is my CF the CFO at
• 25:01
  the the nonprofit said, "You know, is
• 25:03
  there something we can do better in
• 25:04
  billing?" I'm like, "No, it's great. You
• 25:05
  guys do a great job." said, 'Well, this
• 25:08
  is kind of embarrassing for me to ask
• 25:09
  you, but why aren't you paying us in 30
• 25:12
  days like we'd like you to? And I said,
• 25:14
  'Oh my goodness, this is I've been
• 25:17
  pre-programmed to not pay attention to
• 25:18
  any bill until I got red final due.
• 25:21
  >> Yeah.
• 25:21
  >> And so, I didn't realize how much I was
• 25:23
  harming them. In essence, they were
• 25:25
  giving me a loan for 180 days for that
• 25:27
  $150.
• 25:29
  >> That's right.
• 25:29
  >> Nonprofit didn't have the money to do
• 25:31
  that. You know, they don't they're
• 25:32
  nonprofit.
• 25:32
  >> They got they got to float it, right? So
• 25:34
  it's like you you magnify that by
• 25:35
  however many thousand patients are on
• 25:37
  the panel, right? So it's like that that
• 25:38
  adds up. And if Northwestern I owed them
• 25:41
  3,000, they were giving me six months to
• 25:43
  pay for it too. That's bad for them,
• 25:45
  right? They should be, you know, they
• 25:46
  shouldn't be floating that money to
• 25:48
  people. They should be putting that into
• 25:50
  providing the best doctors and the best,
• 25:52
  you know, call centers and all that sort
• 25:54
  of thing, right? And so, you know,
• 25:56
  here's me in the industry. You know,
• 25:58
  back then I'd been in for 24 years or
• 26:00
  whatever. 20 30 almost 30 is not
• 26:03
  understanding the unintended
• 26:04
  consequences of my actions. Right.
• 26:06
  >> Yeah.
• 26:07
  >> And that's what happens with a lot of
• 26:09
  things in this industry. It's people
• 26:11
  don't understand the unintended
• 26:12
  consequence of whatever you do is going
• 26:14
  to come back ultimately in the back end.
• 26:16
  It's going to hurt your provider. It's
• 26:18
  going to hurt your employer. It's going
• 26:19
  to hurt your you as an employee. And you
• 26:21
  know, we got to find a way to help
• 26:23
  people make better decisions overall. um
• 26:26
  you know and and and and see the picture
• 26:28
  the whole picture of the system. Um I
• 26:31
  don't have an elixir for that but in our
• 26:33
  but what we try to do in our small way
• 26:35
  here is give people a time horizon to
• 26:38
  pay their money back that they owe so
• 26:41
  they feel more confident in getting the
• 26:43
  care at the right time in the right
• 26:45
  setting.
• 26:46
  >> Um
• 26:47
  >> so wait a second. So walk me through
• 26:48
  this. So, so walk me through like this
• 26:50
  this this super EOP like like I'm a
• 26:52
  patient who who just saw the doctor you
• 26:54
  know for like the first time like what
• 26:56
  used to happen is that what you
• 26:58
  described about you know getting care
• 27:00
  then getting that bill final bill is
• 27:01
  that what used to happen like versus
• 27:03
  what happens now now that you know pay
• 27:06
  medics uh temple pay like that now that
• 27:09
  you've sort of infused yourself into
• 27:11
  that scenario.
• 27:12
  >> Yeah. So we've got two distinctly
• 27:14
  different products, but the main product
• 27:16
  which we've been doing for 20 years is
• 27:17
  HBS Pay Medics. We're actually a network
• 27:20
  of providers that all of them have
• 27:22
  agreed to not ask the patient for any
• 27:25
  money upfront,
• 27:26
  right? And right now nowadays 43% of
• 27:29
  hospitals are asking for a form of
• 27:31
  payment before they'll give an elective
• 27:32
  s, you know, anything elective
• 27:34
  procedure, right? I literally was
• 27:36
  talking to a buddy of mine last week who
• 27:38
  was scheduled to go in for a procedure
• 27:41
  at a surgery center and and literally he
• 27:44
  was like
• 27:46
  they had to move the surgery because
• 27:49
  they wanted him to pay like it was I
• 27:53
  think it was like 10 grand or it was not
• 27:55
  a small number.
• 27:56
  >> Yeah.
• 27:56
  >> And he's like
• 27:57
  >> I wish they would have told me that
• 27:58
  beforehand,
• 27:59
  >> right?
• 28:00
  >> Like because and he had the money to pay
• 28:02
  it but he delayed it anyway. But that's
• 28:04
  besides the point. But he's like, "I
• 28:05
  just I just wasn't ready to pay that."
• 28:07
  Like right there. He's like, "I was
• 28:09
  getting ready to go in." He's like,
• 28:10
  "They couldn't have told me that maybe
• 28:12
  like a day or two ago for me to like
• 28:13
  mentally process this."
• 28:15
  >> No.
• 28:16
  >> Well, and that's the reality that the
• 28:18
  standard system is you have no idea what
• 28:21
  you're going to pay because you don't
• 28:22
  really know where you are in your
• 28:23
  deductible or out of pocket or what the
• 28:24
  actual procedure is going to cost. They
• 28:26
  ask you to put a, you know, many of them
• 28:28
  will ask you to put money down upfront.
• 28:30
  >> Yeah. um or at least a form of payment.
• 28:33
  So, that's going to also, you know,
• 28:35
  exacerbate my my desire to go in. Then,
• 28:38
  I'm going to go in and have the
• 28:39
  procedure done. I'm gonna get a bill.
• 28:42
  I'm typically going to get a bill from
• 28:44
  the provider before anything's been done
• 28:46
  by the carrier.
• 28:48
  >> So, it might say, you know, you owe
• 28:49
  $2,2500 for this. I'm going to ignore
• 28:53
  that. And I should ignore that because
• 28:55
  it doesn't, you know, the provider, the
• 28:57
  carrier hasn't determined what my
• 28:58
  deductible was, what my co- insurance
• 28:59
  was, were some of the pieces on the bill
• 29:02
  actually not legit. And so then they're
• 29:05
  going to process a bill. Then they're
• 29:07
  going to send me an explanation of
• 29:08
  benefits or most time now it's going to
• 29:10
  be you have to go online and look for it
• 29:12
  online.
• 29:14
  >> I'm going to look at that and I'm going
• 29:15
  to be able to say, "Okay, I was build
• 29:19
  this just happened. My daughter had an
• 29:20
  appendecttomy. We were build $52,000 for
• 29:23
  the for the bill. There was a $20,000
• 29:27
  reduction for cost. Most of the rest of
• 29:30
  it went out of I owed I think I owed
• 29:32
  $1,800 for my you deductible and out of
• 29:34
  pocket. Right.
• 29:35
  >> Yeah.
• 29:36
  >> So now I will wait till I get a bill
• 29:38
  from the provider that says there's
• 29:41
  $1,800 owed.
• 29:42
  >> Yeah.
• 29:43
  >> And then I will determine how long it is
• 29:45
  before I have to pay that bill because I
• 29:47
  would like to not pay it until I have
• 29:49
  to. Right.
• 29:51
  >> And that's how a standard system works.
• 29:53
  Okay.
• 29:54
  >> Yeah.
• 29:54
  >> In our world, it's very different. You
• 29:56
  never ask for money upfront by the
• 29:58
  provider. You shouldn't be. Right.
• 30:00
  >> The provider sends the sends it into us.
• 30:03
  We repric it to whatever discounts look
• 30:05
  like. We send it to the the third party
• 30:07
  administrator.
• 30:08
  They adjudicate the bill and then they
• 30:11
  send it back to us.
• 30:14
  We then pay the provider
• 30:17
  both what the employer owed the provider
• 30:20
  and what the employee owed,
• 30:22
  >> right?
• 30:22
  >> And so the provider gets that and checks
• 30:24
  it off and will stop sending you a bill
• 30:26
  every two weeks, you know, while while
• 30:29
  you haven't paid it. You maybe you've
• 30:30
  been waiting, you know, been waiting to
• 30:32
  see what happened in the old world. They
• 30:34
  just they're, you know, they're paid in
• 30:35
  full, so they stop billing you.
• 30:37
  >> Yeah.
• 30:38
  >> We take that, we aggregate it with any
• 30:40
  other other claims that you had that
• 30:42
  month.
• 30:43
  and we'll send you out a statement that
• 30:44
  is both a bill and an explanation of
• 30:48
  benefits. And it will say, Michael, for
• 30:50
  you and your family, there were six
• 30:52
  claims this this month.
• 30:56
  >> You know, after all was said and done,
• 30:58
  you know, you owed of that $10,000 in
• 31:01
  claims, you owed uh $2,200.
• 31:04
  >> How would you like to pay that? Would
• 31:06
  you like to pay that in full right now?
• 31:09
  Would you like to pay that with your uh
• 31:11
  with a credit card, with your bank
• 31:12
  account, with an HSA account, with an
• 31:14
  FSA account, or would you like to take
• 31:16
  out a not an interest free uh fee free
• 31:20
  loan?
• 31:21
  And you, Michael, you have good credit,
• 31:23
  so you you you may decide I don't, you
• 31:26
  know, I can pay it off right now. Or you
• 31:27
  may decide, yeah, I'll take that. No, I
• 31:30
  if I'm going to buy a refrigerator, I
• 31:31
  might want to and I they're going to
• 31:33
  give me zero interest and I can pay it
• 31:34
  off. I'm going to take that. Mhm.
• 31:37
  >> Um, so you have the option to decide
• 31:39
  what you want to do and you pay us once
• 31:41
  instead of paying those six different
• 31:43
  providers.
• 31:44
  >> That's right.
• 31:45
  >> So you also save some money and time and
• 31:47
  energy, you know, matching up the bills
• 31:48
  and everything like that. If you take a
• 31:50
  loan out, again, it doesn't matter,
• 31:53
  Michael, you may have somebody else at
• 31:54
  your company that is making low dollars,
• 31:57
  has a very low credit score. That person
• 31:59
  with us still has qualified to have
• 32:02
  credit up to whatever their out of
• 32:03
  pocket limit is. So we look at an entire
• 32:06
  group of uh you know entire population
• 32:08
  of employees. So you we you know you you
• 32:11
  you've got that person has credit also
• 32:13
  and they'll they'll do term terms with
• 32:15
  us. Right now our average payment plan
• 32:18
  >> Yeah.
• 32:18
  >> people $3,900 and it's taking that 22
• 32:21
  months to pass back.
• 32:24
  >> So when you go back I talked about
• 32:27
  earlier.
• 32:28
  >> Yeah.
• 32:28
  >> You know that most people don't have
• 32:30
  $1,000,
• 32:32
  right? So, you know, it's no wonder
• 32:34
  that, you know, a lot of folks are going
• 32:35
  to need a lot of time to pay that back.
• 32:37
  And what we'll do is, you know, new
• 32:39
  claims come in, we can't automatically
• 32:42
  add them to your payment plan. We still
• 32:44
  have to have a conversation with you to
• 32:45
  add them to plan, but we can add them to
• 32:47
  that plan.
• 32:48
  >> And for us, long as people are paying us
• 32:50
  a reasonable amount of money
• 32:52
  >> and we might ask, you know, Michael, if
• 32:54
  you call up and say, "Look, I'd like to
• 32:56
  take this thousand dollars and you know,
• 32:58
  how what can you do to to uh give me
• 33:00
  credit for that?" We might look at you.
• 33:02
  we know a lot about you and we're going
• 33:03
  to say, "Hey, how about if you paid $250
• 33:05
  over the next four payments?" And you
• 33:07
  might say, "That's totally fine." We
• 33:09
  might look at that same, you know,
• 33:11
  somebody else that has the same thousand
• 33:13
  that's making $40,000 a year. Um, and we
• 33:17
  might say, "How about if you pay us $50
• 33:19
  for the next 20 payments,
• 33:21
  >> right?" So, we'll start off with a
• 33:23
  payment.
• 33:23
  >> So, it's like it's like a give and take
• 33:25
  there because, you know, because, you
• 33:27
  know, when I read the stat that there
• 33:28
  was like, you know, one in four of your
• 33:29
  members would fail a standard credit
• 33:31
  check. I'm like, "Wait a second. You
• 33:33
  serve them anyway, which is great,
• 33:35
  right? But every other financial
• 33:36
  product, at least to my knowledge, in
• 33:38
  America, they would turn those people
• 33:40
  away."
• 33:40
  >> Yeah.
• 33:41
  >> And and yet, you know, you've kind of
• 33:43
  gone against conventional logic and
• 33:46
  you've made it work. But it sounds like
• 33:48
  what you're doing is it's like you have
• 33:50
  like a relationship with the patient and
• 33:52
  you have an understanding with them and
• 33:54
  and and as a result of level setting, it
• 33:57
  just it it doesn't become transactional.
• 33:59
  It's like, "All right, man. like I hear
• 34:00
  what's going on, you know, do this. So,
• 34:03
  some sort of like a live negotiation.
• 34:06
  >> Is that meant to be like that?
• 34:07
  >> Yeah, it really is. I mean, because
• 34:08
  again, what we are here for is to make
• 34:11
  sure people get care.
• 34:13
  >> That's the bottom line. And to help
• 34:14
  simplify them, right?
• 34:16
  >> The providers actually pay us something
• 34:18
  to do this because they're no longer
• 34:21
  having to build. They're no longer
• 34:22
  having to collect and they no longer
• 34:24
  have any bad debt. We take on all the
• 34:25
  bad debt. And then the employers may at
• 34:28
  times pay us something depending on, you
• 34:30
  know, their plan design and their um uh
• 34:33
  and and the industry that they're in.
• 34:34
  But at the end of the day, we always
• 34:37
  never ask the patient for for any
• 34:39
  interest or any uh you know on their on
• 34:41
  their on their dollars because what
• 34:43
  we're here to is to make sure that they
• 34:45
  get care. Ultimately for the employer,
• 34:47
  it's going to be a good thing, right?
• 34:49
  Our trend is significantly lower in the
• 34:51
  market average every year and the
• 34:54
  utilization of the hospitals is
• 34:55
  significantly lower in our market every
• 34:58
  year when we do our studies. And so the
• 35:00
  you know there's very few things in this
• 35:02
  in life in my mind that the provider
• 35:03
  gets the provider is is gets a positive
• 35:06
  outcome, the employer gets a positive
• 35:09
  outcome and the employee gets a positive
• 35:12
  outcome and we do it by looking at a
• 35:14
  groupbased product. You know, there are
• 35:16
  some great solutions out there that, you
• 35:18
  know, you can get at the provider. You
• 35:20
  know, if you owe $5,000, you you know,
• 35:23
  they'll actually have people at your
• 35:24
  bedside asking you if you want to get a
• 35:27
  medical credit card, right? Which could
• 35:30
  be zero interest, but two things. One is
• 35:32
  you'll only qualify for what you qualify
• 35:34
  for. So, you might only qualify 2,000
• 35:36
  that 5,000 or a thousand of it. The
• 35:38
  other is if you miss a payment
• 35:40
  >> I mean they kill you on the interest
• 35:42
  >> 23% interest back to the beginning you
• 35:45
  know of the you know the group consumer
• 35:47
  financial protection board was really
• 35:49
  looking at that a few years ago and was
• 35:51
  trying to find ways to make sure that
• 35:52
  stuff didn't happen.
• 35:54
  >> Ours when you look at a group basis we
• 35:56
  can we can handle that. We have another
• 35:58
  product that's really more of a credit
• 36:00
  card solution. And basically an employer
• 36:02
  can say, "I'd like to or a health plan,
• 36:05
  you know, we we sell to different folks.
• 36:07
  They could say, I'd like to extend
• 36:09
  $2,500 or $1,500 to all of my employees,
• 36:13
  >> no matter what their credit score is."
• 36:15
  And and I'd like that to cover medical,
• 36:18
  pharmacy, dental, vision, maybe even vet
• 36:21
  care, right? So, I'm gonna extend
• 36:23
  everyone a level of credit that maybe,
• 36:25
  you know, again, your high paid people
• 36:27
  probably didn't need that,
• 36:28
  >> but your low paid people did, and you're
• 36:30
  trying to offer something across the
• 36:31
  board, so it's really going to be
• 36:32
  valuable to your lower paid folks.
• 36:34
  >> And that doesn't have, you know, that
• 36:36
  can go nationwide, and that can be very
• 36:39
  simply set up. And the employer actually
• 36:42
  pays us to do that. They pay us per
• 36:45
  month,
• 36:45
  >> um, you know, to cover our loan and to
• 36:47
  cover our bad debt and to cover the
• 36:49
  administrative costs. but they can then
• 36:51
  offer this very, you know, good benefit
• 36:53
  across the board um to everybody in
• 36:55
  their population. And it's it it builds
• 36:58
  health equity into their plan, you know,
• 37:00
  because
• 37:01
  >> the two people I was talking about
• 37:02
  earlier when I said they might have
• 37:04
  different needs on the loan,
• 37:06
  >> they have the same plan design,
• 37:09
  >> right? And so $1,000 means something
• 37:11
  very different to somebody making 40,000
• 37:13
  than somebody making 400,000. Yet, you
• 37:16
  know, typically you have the same plan
• 37:17
  design across the board. Well, our our
• 37:20
  plan becomes so much more valuable to
• 37:22
  that person making 40,000 that had that
• 37:25
  same thousand dollar bill. So, we're
• 37:26
  bringing health equity into the
• 37:28
  equation. Again, try our mission really
• 37:31
  is to simplify health care through, you
• 37:34
  know, easier statements as well as
• 37:36
  providing financing to get people to get
• 37:38
  care.
• 37:38
  >> And listen, you're creating more access,
• 37:40
  right? So, I mean, I'm all about that. I
• 37:41
  mean, who's resistant to this? Because I
• 37:45
  mean, it's it sounds elegant, right? I
• 37:47
  mean the data is strong. There's a few
• 37:50
  things that I read that was like I don't
• 37:53
  know I think you guys had just released
• 37:54
  data that your your employer groups are
• 37:57
  are are growing healthcare costs at 4
• 38:00
  and a half% compared to like the
• 38:02
  national benchmark which I think was
• 38:03
  like almost 9%.
• 38:05
  >> Right.
• 38:06
  >> I'm just wondering who's who's pushing
• 38:09
  back like why why are they pushing back?
• 38:12
  >> Yeah. I mean, one of the issues we have
• 38:14
  today is we're really, you know, here in
• 38:15
  Wisconsin mainly. We've got a few other,
• 38:17
  you know, locations, but, you know, a
• 38:19
  lot of employers want a consistent
• 38:20
  program across the board and they're not
• 38:22
  saying, I'm gonna I'm gonna optimize my
• 38:24
  regional solution, right? Um, so that
• 38:27
  could be could be some of it. Some just
• 38:28
  don't know about it. As much as we're
• 38:30
  out in front of brokers, consultants,
• 38:32
  we're trying to put things out there,
• 38:33
  they a lot of them don't know about it,
• 38:35
  right? Um, and uh some think maybe it's
• 38:39
  too good to be true at times, right? Um,
• 38:41
  you know, underwriter in me has always
• 38:43
  said, you know, increased deductibles
• 38:45
  out of pockets drives lower utilization
• 38:46
  which allows a lower cost,
• 38:48
  >> right? A lot of people have a trouble
• 38:50
  flipping that that you know, actually
• 38:52
  some utilization is really important and
• 38:54
  is good utilization, right?
• 38:57
  >> And you know, and the way we do it where
• 38:59
  people will have to pay it back, they're
• 39:00
  just giving them a time horizon to do
• 39:02
  that really should it really should only
• 39:04
  help that good utilization. it shouldn't
• 39:06
  promulgate, you know, utilization that's
• 39:09
  frivolous, right? So, um, so there's a
• 39:12
  still a lot that we needed to get to get
• 39:14
  the message out there. And then our
• 39:16
  other program is, you know, again, it's
• 39:18
  nationwide. We're we're pretty new. We
• 39:20
  just bought that company about a year
• 39:21
  and a half ago.
• 39:22
  >> Um, so we're out there getting the
• 39:24
  message out. And again, it's really,
• 39:26
  >> you know, do people understand this
• 39:27
  issue that has is the unintended
• 39:31
  consequence of your plan design choice
• 39:33
  that's come into play? And do they even
• 39:35
  know that there's a solution out there
• 39:36
  that can that can impact it? And then
• 39:39
  how you know then they have and how can
• 39:41
  that fit into the myriad of solutions
• 39:43
  they put on the table.
• 39:45
  >> Some are just reluctant to add anything
• 39:46
  else. You know at this conference I was
• 39:49
  at last week. You know that one of the
• 39:51
  biggest things they were talking about
• 39:52
  was
• 39:53
  >> we've overrotated to all of these
• 39:55
  solutions that you're implementing
• 39:56
  because the system isn't working
• 39:58
  properly today
• 39:59
  >> with any music. And you know that is you
• 40:03
  know you only add value when people are
• 40:05
  using them
• 40:07
  about diabetes. There are so many
• 40:09
  companies are doing amazing work in
• 40:11
  diabetes right and we have all these DLP
• 40:15
  ones that are also helping with
• 40:16
  diabetes. You would think diabetes
• 40:18
  should be gone when you look at
• 40:19
  everybody's results but diabetes
• 40:22
  continues to grow because you just don't
• 40:24
  have enough people accessing those great
• 40:26
  programs and those great initiatives. um
• 40:29
  or they're never being diagnosed upfront
• 40:32
  the way they should or you know they're
• 40:33
  diagnosed too late because they never
• 40:34
  went and got their care because they
• 40:36
  were afraid to go see that doctor
• 40:38
  because of the financial implications
• 40:39
  that could come into play.
• 40:42
  >> What do you think most
• 40:44
  financial executives
• 40:47
  fundamentally misunderstand about like
• 40:50
  the patient financial experience?
• 40:54
  Um,
• 40:56
  I think there are some that don't feel
• 40:59
  that anything they do is going to change
• 41:01
  the way people consume care. And that
• 41:03
  may not be wrong. We have to find a way.
• 41:06
  I mean, part of this is, you know,
• 41:08
  people have to start engaging, right?
• 41:10
  Um, I look at myself. I've lost 94
• 41:12
  pounds since the beginning of last year
• 41:14
  without using any medication. I I feel
• 41:18
  better. I'm I'm gonna have le I all my
• 41:20
  numbers are now in line, right? I had to
• 41:24
  make a conscious effort to do that. I
• 41:25
  had to think more like a uh you know,
• 41:28
  somebody that was thinking about my care
• 41:30
  versus somebody that just thought, well,
• 41:32
  I'll wait till the system covers me when
• 41:34
  I have something that happens later on.
• 41:37
  Right.
• 41:37
  >> Yeah.
• 41:38
  >> And don't have to always get care, you
• 41:40
  know, at the at the Cadillac of
• 41:43
  locations. you can go to an urgent care
• 41:45
  facility and get as good a care or go
• 41:47
  see your primary care when you need to.
• 41:48
  Like you have to change the mindset of
• 41:50
  members and they have to be held
• 41:51
  accountable. Um but
• 41:55
  but you can't always just do that
• 41:57
  through benefit plan design which is the
• 41:59
  easiest thing to do because it could be
• 42:00
  consistent across the board. It can be
• 42:03
  you know you can help try and think make
• 42:05
  people make right decisions. So you know
• 42:07
  you really have to think about it from a
• 42:09
  holistic perspective.
• 42:12
  what can I do to, you know, help as many
• 42:16
  people access the most the care at the
• 42:18
  right cost in the right setting? Um, and
• 42:22
  I and that may have to be different
• 42:24
  solutions in different areas. Um, you
• 42:26
  know, I feel bad for employers that, you
• 42:28
  know, you look at a Walmart, it's got
• 42:30
  500,000 people that they're trying to
• 42:32
  set a plan design for in, you know, 50
• 42:35
  different states and well, you know,
• 42:37
  even globally, right? Right. They're
• 42:39
  trying to make decisions, you know, that
• 42:41
  that that that that optimizes. And I've
• 42:43
  never worked with Walmart, so I'm not
• 42:45
  using them as an example of anybody
• 42:47
  right or wrong, but if you think about
• 42:49
  their, you know, their, you know, the
• 42:51
  decisions that they have to make,
• 42:53
  they're difficult. And how do you how do
• 42:56
  you how do you offset what people pay
• 42:57
  out of their paycheck versus what they
• 42:59
  pay at point of care? How do you offset,
• 43:01
  you know, how do you try and find ways
• 43:03
  to get people to to do things? Well, one
• 43:05
  thing is just, you know, find ways to
• 43:07
  help them be accountable for the
• 43:10
  dollars, but not accountable immediately
• 43:13
  to have to pay those dollars. It's a
• 43:14
  small component that I think has a big
• 43:16
  impact on how people consume care. So
• 43:20
  then if let's just say fast forward 10
• 43:23
  years from now if pays tempo pay HPS if
• 43:27
  they're working at the scale that you
• 43:30
  believe they can be working
• 43:33
  what does healthcare look like in that
• 43:37
  future like paint paint the picture for
• 43:39
  me.
• 43:40
  >> Yeah I mean quite frankly we'd love it
• 43:43
  to be over all networks. We don't really
• 43:45
  have a desire to build new networks. We
• 43:47
  want to have our financial solution
• 43:49
  that's baked in Wisconsin and and a few
• 43:50
  other places included um you know with
• 43:53
  the providers I with the carriers. I
• 43:55
  think the carrier provider relationship
• 43:57
  would be better. I think the member
• 43:59
  provider relationship would be better.
• 44:01
  You'd have people getting care at the
• 44:03
  right setting which ultimately will
• 44:05
  start to lower costs. I mean there's so
• 44:07
  much more that needs to be done to lower
• 44:09
  costs. I mean as you know 2% of people
• 44:11
  are typically driving 60% of the overall
• 44:13
  care. Um but you know finding way to you
• 44:17
  know to help make sure people are are
• 44:18
  doing the right decisions. Um the more
• 44:21
  you can take friction out of the system
• 44:24
  without just simply making everything
• 44:26
  free because that's some people's deci,
• 44:28
  you know, way to take friction out is
• 44:30
  we'll make everything free. Um when you
• 44:32
  can take some of that friction out, you
• 44:33
  can do it in a way that helps all three
• 44:35
  stakeholders, the employer, the
• 44:37
  provider, and the member. You can start
• 44:39
  to rein in costs. you can start to have
• 44:41
  a more health, you know, equitably
• 44:42
  health, you know, a health plan that's
• 44:44
  more equitable and, you know, hopefully
• 44:47
  we can start really making an impact on
• 44:50
  this trend because it's unsustainable.
• 44:52
  It's unsustainable the way it is to now.
• 44:55
  I mean employers again, how do you know
• 44:57
  how if you can only get 2% co you know a
• 45:00
  cost increase from your your your your
• 45:03
  consumers your your customers you know
• 45:06
  and you're getting a dime 10 15 30% from
• 45:09
  your health care which is one piece of
• 45:11
  your cost
• 45:13
  you know how do you how do you stay
• 45:15
  afloat and you know the the employer
• 45:18
  health care system a lot of people are
• 45:19
  thinking about you know we're hearing
• 45:21
  more and more about people trying to get
• 45:23
  out of the health care system, but the
• 45:25
  problem with that is there's not a great
• 45:27
  individual
• 45:28
  plan to put people towards. And so you
• 45:30
  and then you lose control of any of that
• 45:33
  that you know to help think about
• 45:34
  presentism and absenteeism. So you know
• 45:37
  find a way to bring a health an
• 45:38
  equitably uh you know an equitable
• 45:40
  health plan to your customers. Find a
• 45:43
  way to partner more with providers. Some
• 45:45
  of it may be off you know there may be
• 45:46
  some subsegment direct contracting with
• 45:48
  providers and we become a conduit to
• 45:51
  help with that. Um, that's that's how
• 45:53
  we're going to change the system. I
• 45:54
  think, you know, we're we're a piece of
• 45:56
  the equation, but I think we're an
• 45:58
  important piece.
• 45:59
  >> And before I let you go, just share
• 46:02
  with, you know, with the audience what
• 46:04
  what's the best way for people to follow
• 46:06
  you and the work that you and the team
• 46:07
  are doing. So, kind of give us like a
• 46:09
  like a commercial before we before we
• 46:11
  wrap.
• 46:12
  >> Yeah. Know, we'd love people to connect
• 46:13
  with us. Uh, you know, our our payix.com
• 46:16
  or hps.mmd
• 46:18
  are our websites. we follow me. We put
• 46:23
  out a lot of thought leadership pieces.
• 46:25
  We do about six to 10 a year that are
• 46:28
  really about the issue. Um and and and
• 46:31
  how people need to think about it. Yes,
• 46:32
  we'll talk about our products as part of
• 46:34
  it at sometimes. Sometimes we don't even
• 46:36
  talk about our products. U but really
• 46:38
  try to follow us on uh on you know
• 46:40
  follow us on LinkedIn. We do a lot
• 46:42
  through that channel. Um take a look at
• 46:44
  our websites and uh um you know just
• 46:47
  understand the issue. Go to some
• 46:49
  conferences. is we're at a lot we're at
• 46:50
  a lot of conferences and we're trying to
• 46:51
  help people understand the the impact of
• 46:54
  avoidance of care and how you know that
• 46:57
  that's that's causing problems and you
• 47:00
  know one way to try and find you know to
• 47:03
  solve that is to is to find a way to
• 47:05
  include financing either directly uh
• 47:08
  through one of our products and and we
• 47:10
  have number of competitors doing
• 47:11
  something similar or try and help your
• 47:14
  your network carriers to think about the
• 47:17
  way they can build uh patient financing
• 47:19
  into their overall solution.
• 47:22
  You know, it's just been I don't know,
• 47:24
  it's been really delightful to chat with
• 47:26
  you just because I think what makes your
• 47:28
  perspective super valuable is that
• 47:30
  you've been inside of the system long
• 47:33
  enough to know exactly where things kind
• 47:35
  of fray and you've made this
• 47:39
  you've made this conscientious choice to
• 47:43
  fix it from a different angle and very
• 47:47
  grateful that you came on to the show
• 47:49
  and just just being great conversation
• 47:51
  today. So for those of you that are
• 47:54
  listening to this, if you found it
• 47:58
  interesting, if you liked something,
• 48:01
  comment on it, engage with us, like it,
• 48:04
  share it with a friend. Um,
• 48:08
  we're a pretty interactive community, so
• 48:10
  this is a living, breathing ecosystem.
• 48:13
  Sometimes you got to give and share uh
• 48:15
  before you take. So, and if there is a
• 48:18
  topic that you would like for us to
• 48:19
  explore or maybe a leader that you want
• 48:21
  to hear from, um, drop me a note, drop
• 48:24
  me a line. And remember, it's a platform
• 48:26
  about community, not just content. So,
• 48:28
  thanks for listening, keep building with
• 48:30
  purpose, and we will see you next time
• 48:33
  on the Advancing Healthcare Innovation
• 48:34
  Show.