Latest / The SEANC View / Lantern Health: State Health Plan launches free surgery program to offset costs

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Lantern Health: State Health Plan launches free surgery program to offset costs · The SEANC View

0:00
Hello, and welcome to another edition of the Scenic View podcast.
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I'm Jonathan Owens, the host alongside Artis Watkins, Suzanne Beasley,
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and Sammy Klein, the usual crew.
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And we have our fifth beetle in here today, the regular Scenic View guest now.
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We need to get you a uniform.
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Thomas Friedman, the executive administrator of the state health plan.
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He's going to talk to us a little bit more about what's going on with the plan.
0:29
First off, I guess we always start with a little talk of the budget. So what is going on?
0:33
Anything, probably nothing, right? Yeah, there's no budget.
0:38
No budget. You mean they didn't sneak in like over the weekend?
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No, they did not. And like we told you last week, you know, Speaker Hall announced
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on the floor at the end of session that he did not anticipate any more votes this year.
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So that leads us to believe that it likely will be short session before we get back to budget.
0:56
Okay. Well, that's all that can be said about that. At the moment, yes, sir.
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So with that in mind, no raises on the horizon.
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Members are kind of starting to think, well, my insurance premiums are going
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up, so I'm going to be in the hole less money in my check than I did last year.
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Thomas, that's why we bring you in.
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Now we want to talk about, you know, ways that maybe we have a program that
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can help save some folks some money. And we've touched on it in several different
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podcasts with you and the Treasurer,
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Treasurer Brad Briner, about this Lantern program that's coming.
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And we haven't been able to really dig deep into it, so we thought we'd get
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Thomas back on the program and talk a little bit more about it.
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When is it going to be implemented?
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Last Monday. Oh, okay. So last Monday, we had our soft launch.
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We've had over a hundred members call already with very light promotion.
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So I really credit y'all. Thank you for pushing the message out there.
1:53
It's been in our open enrollment material, but we've launched it for orthopedic
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and bariatric surgery, effective 1020.
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So, you know, I think they were
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expecting maybe five, 10 calls and we're getting closer to 100 a weekend.
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Caroline Smart, who's the deputy executive administrator of the plan,
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always says, people always want us until they get us because they don't realize
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how big we are and how engaged our folks are.
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And so I think they're like, wow, folks are really interested in engaging with this program.
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Take one big step back, though, and let's remind people what Lantern is and what it does. Sure.
2:24
That's great. So Lantern is a program we've partnered with to provide state
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employees and teachers, non-Medicare prime,
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free options for free elective surgeries across the state of North Carolina
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with the only the highest quality clinicians at those practices.
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So if you need a hip replacement, think about practices like Emerge Ortho,
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Ortho Carolina, those top practices throughout the state.
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Your surgery if you go to one of their highest performing
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doctors in those practices your knee replacement your shoulder
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replacement hip replacement you can get those for
2:59
free your surgery is free the consult beforehand
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is free they'll get you in as fast as
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they can with their highest quality providers and i
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think that is a really exciting step we continue to build out
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the program to provide more and more options throughout
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the health systems throughout the state of north Carolina so we're
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making great headway there i think something that's important to
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highlight not just the free component of it and we
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can kind of provide some more details why we can make it free but we
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also want to pay folks if they need to travel right
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you know if you're in murphy you might not have the same options
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we do here in white county so if you got to
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fly to where you need to go north carolina we're gonna
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pay for it if you need a hotel you can bring your spouse
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or a family member or a guardian or whomever we cover
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the hotel if you're in a drive i drive wherever i can go
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we're going to pay for mileage to get that done because we recognize
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there's not equal access to health care everywhere across
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the state of north carolina but all state employees and teachers deserve the
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highest quality care and we want to invest in that so we want to make even the
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travel to get there we're going to pay you you know we'll take care of that
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for you probably thinking the same thing suzanne but i'm thinking that for rural
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health care which is such that that remains the problem people in rural areas having the same access.
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To health care, at least for the surgical parts of that, it seems like this
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is somewhat of an answer.
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I know everybody doesn't want to travel away from their hometown necessarily
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to have something done, but if you live in a rural area, you're kind of used
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to traveling out of your hometown for a lot.
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And if the health plan's picking up the tab for that and a spouse to go with
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you so that you have somebody, an advocate for you.
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When y'all first told us about it, I was shocked. I think it's a really, really cool thing.
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It's pretty amazing that the plan could save money. It just shows the variance
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in costs across the state, that the plan could save money by paying folks to
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travel and to get a hotel and still save money over like a local provider.
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Well, and I think it goes to something y'all have been banging the drum on for
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a long time around price transparency.
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When you don't have to be transparent, you don't have to compete on price and
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you don't have to compete on quality, people become takers of health care.
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I think an example I showed the last time I was here was in one of the northern counties.
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There's a place where 37 members got diagnostic colonoscopy last year. It was $8,100.
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If they travel to one of the higher quality centers in Raleigh,
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so that's not that far, it's $1,500.
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So, you know, the example I used was I could pick all those folks up in a limo
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drive them down here, take them to the Umstead afterwards for a few days,
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pick them up in the limo and drive them back, and we would still save thousands
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of dollars every encounter.
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And, you know, that's really the consequence of not having transparent prices.
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And the consequence of not asking folks to compete on price is,
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you know, I think a lot of providers go into their rate negotiations every year
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and be like, 5% more, or 4% more, or pick a number of percent more,
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but without really commitments to quality or access.
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Is the price the right number in the first place? Yeah.
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And we want to kind of shift that paradigm that if you're willing to do something
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at such a rate that our members get it for free and we can save money,
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we should try to get all our members to go to those providers.
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And again, only because they're the high-quality providers.
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I know, kind of going back to your rural example, if we said we'd pay for you
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to go to a doctor who's brand new or is not very good at things,
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that's not very respectful to employees.
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So we kind of have to further that commitment of who's a really high-quality
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provider, Who has the fewest accidents? Who has the fewest readmissions?
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Who's done the procedure the most times?
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And, you know, we still pay more than Medicare. We still pay more than Medicaid, a decent amount more.
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And those folks have done the math. They're good enough business people to realize,
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like, hey, I'm still making a decent margin on this.
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And so I'm willing to invest in a population that serves the state.
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Continues to serve the state, folks stay in state government.
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Some of us come back, but, you know, folks stick around and,
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you know, you can build a longstanding relationship with patients and they're
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willing to make that investment into employees and teachers.
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And I think that those are the folks we should want to work with.
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Those would be the point we should kind of point at and say,
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like, you should go here.
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So I think it's important that we talk about what you mean by free.
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So if someone like a state employee has to have a hip surgery,
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what would it cost them without this program.
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They would have their copay, right? So there'd be a few things.
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So they would have, if it was in an outpatient surgical setting,
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they'd have a copay that is a few hundred dollars.
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Then they'd pay wherever they are on their deductible. So, and we know the deductibles
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are going up on all the plans.
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And then after they hit their deductible, they would get into their coinsurance.
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So, I mean, the range is really going from free to, early in the year,
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it could be several thousand dollars, like a several thousand dollar difference.
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Okay, so if they do take advantage of this Lantern plan, they would save at
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least their copay and whatever it was left in their duct.
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That's right. So it would be literally zero, you know, when you go sit down.
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But their follow-up visits after surgery and, like, their medication...
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That wouldn't be free. Yeah, correct. That is correct. And the plan is to get
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to that broader set of bundles and services.
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We kind of got to build some wins here and some prospects. So it is the surgery that's free.
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That's right. The PT, we are working really hard on to try to figure out how
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to get that to a single copay or one or two copays.
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Yeah, they just didn't want anybody thinking, everything about it's going to
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be right. Yeah, that's wonderful clarification. That's absolutely right.
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But the goal is to build towards. Right. Start with the big ticket item, which is the surgery.
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Right. And so over the weekend, I saw something that made me think about the
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ingenuity y'all are using by doing this program.
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And it was a hospital in Miami.
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One of the doctors at that hospital was very proud of this new construction.
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And it's a nonprofit hospital.
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The lobby was, it really was pretty.
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It was a vibe, you know, and looked kind of like a high-end hotel or maybe a large restaurant.
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Had a piano player in there playing. And I mean, he wasn't playing Billy Joel.
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This guy was playing like Chopin.
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This was a really nice, well-done thing.
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And the disconnect of the industry, the healthcare industry with the needs of
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patients kind of just jumped off the page at you because it said,
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we'll be so much better able to serve our patients with this.
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And immediately there was a lot of pushback on that from mainly physicians saying,
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what in the world? This is not, you know, and some of us said this looks like
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an exercise in vanity from hospital administrators rather than something to help people.
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At first, the hospital folks there fought back and said, well,
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you've got to give patients an environment that gives them hope and is nice to be in.
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But too many people were coming back saying, look, what they want is to be able
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to go get their health care and then afford the rest of their bills.
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That's what they want. Right. They don't care about the piano player.
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That's nice, but that's not what they want. They ended up taking the post down,
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and they seemed so shocked, though, at first, when they were fighting back in the comments.
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And I realized, man, this really is a disconnect in this country.
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And this being a nonprofit hospital, a lot of people were saying,
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I want you to look into their taxes and everything else.
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For us, as advocates for members, we don't even care about all that stuff.
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Somebody else will figure that out. We just want people to know that somebody
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honestly does care whether they can go get the surgery and pay their light bill this month.
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And so I am really excited about this Lantern program, and I immediately thought about it.
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Like, wow, so if you could go get your surgery, and you know it's from people
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who've been vetted out, so they may not have an opulent lobby,
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but you know that they've been vetted out as effective and well-trained.
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They've got good, whatever you call the follow-up results after surgery.
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Like post-op care? Thank you. Yeah.
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And that you can be comfortable. I think that's all people care about.
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It's all they want. People aren't asking for a lot. But especially when they
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don't get a raise and their prices are going up.
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They want to see something, and I think y'all are doing something pretty creative
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without spending extra money to try to keep money in people's pockets.
11:03
Well, thank you. And I think the nice thing about this is the more successful
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we are, the more everyone's costs go down.
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And the more pressure we can put on the system to not build those fancy lobbies,
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the more we kind of show them, we're not going to go to your fancy lobby.
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We are going to go to high-quality providers that want to compete on price,
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that want to compete on access.
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That creates more competition, and then we can go to the next phase,
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which I think is a maternity program that, you know, values the time and efforts
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of state employees and teachers.
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And it makes them be more competitive on all of these things.
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We have the opportunity to, as an individual, make our costs zero and help the
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rest of our costs go down as well. And that is a unique opportunity.
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We talk about, y'all have banged the drum for a long time, that we're spending too much money.
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The best way to spend less money is to show that we're willing to do it.
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And I think the more successful we are, the more pressure we put on them to
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be like, I don't care what your lobby looks like.
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I want to be able to pay my light bill. I want to be able to see my family.
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I want a good doctor. And that's it.
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So I would love to work with everyone to make a statement of,
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like, those are the things we care about.
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And if you want to see any state employees, economic downturn,
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no matter what happens, state employees show up for work. Yeah. Every day.
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We can be everyone's lifeline and benefit each other across the board.
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And that's going to change how they think. And I think that's going to take some time.
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But we can continue to show them, like, we value quality. We value access.
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We value transparency and low cost.
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And this is a chance to hit those who don't want to participate in their wallets
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rather than them hitting us in our wallets.
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Well, you know, we used to hear in the halls of the legislature,
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we have razor-thin margins.
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Razor-thin margins. Well, you can have razor-thin margins, obviously,
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for all kinds of reasons. Sure.
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And I think this will test, did you have razor-thin margins because you were wasting too much money?
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Or did you have razor-thin margins truly? because even with volume,
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you know, and we expect hospitals to pay physicians and other medical professionals appropriately.
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But what we're hearing from physicians and other medical professionals is that's
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not where the money's going.
13:07
No, I mean, you look at any chart and the amount of money that goes to the actual
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doctor or the nurse is relatively low.
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It's going to a lot of other different things. And to your point,
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I don't have a problem with doctors making money if it's going to doctors to
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providing high quality care and investing in our patients. That sounds great.
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Right. I want them paid well. I want them comfortable in their life.
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You know, I want them happy, healthy, low stress.
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That's what I want my doctor to be. And, you know, we want them to be in North Carolina, right? Yeah.
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And that's how we're going to do it. And so I think, again, we're going to align
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our incentives with the provider, the plan, and the member.
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We want you to be comfortable. We want to be comfortable, too.
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Right? And that seems fair and that seems reasonable.
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And then as long as there are folks that don't want to do that,
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the folks that do want to do the right thing have a tremendous opportunity to succeed. Yeah.
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So this is not a requirement.
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There's always that question from members and state employees.
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You know, they're worried that they're going to be required to get treated.
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And that may be that your doctor is already in the Lantern Network,
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but you are not required to use the Lantern Network.
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Can you talk about that a little bit? So for bariatric surgeries, you will be. Okay.
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Because the cost difference is so significant. We're continuing to grow that network.
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I mean, 10x in some cases difference.
14:21
Wow. If we can give it to you for free and save that much money, we're going to do that.
14:25
But orthopedic surgeries and all the other surgeries we're talking about,
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no, you're not required to do it.
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The same benefit you had last year, again, cost sharing up a little bit,
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you still have access to those doctors.
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But I think there's something to be said for if you want to access whomever
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you want, it's going to be more expensive. If we are giving you the option,
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if we're doing the work for you to understand who is a high quality provider,
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that's really hard to figure out.
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Like if I had to figure that out on my own for when I'm in a time of crisis
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and like when I need surgery, like trying to find who the best person is,
14:53
I don't know if I personally would go through that legwork.
14:56
And y'all have their specific metrics that you use to vet out these.
15:00
And they're different by specialty, right? We're going to look at orthopedic
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surgeons, what they do at orthopedic surgery and cardiovascular surgeons and
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what they do for heart care.
15:07
So we're not taking away access. Candidly, I don't think a system could bear it.
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So I think people talk about, well, you can save a bajillion dollars if you
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go to a narrow network product. I'd be like...
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Yeah, we have hundreds of thousands of people in the Triangle area,
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no hospital. They've told me can't take on another couple hundred thousand people.
15:25
Yeah, that would be wild. And, you know, we're not going to break the system.
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We're going to push it. So you can still use whomever you would like.
15:32
It is transparently going to be more expensive than it was last year.
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And it's more expensive than options you have.
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And folks very well may make the decision to use Lantern after they've compared the two.
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They just don't want to feel like they've got to put this in at this point anyway.
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And I think that the goal is, you know, you can call and say.
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Hey, X, Y, and Z is happening.
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And they'll set you up with a pre-op visit with a surgeon.
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And at that point in time, if you don't feel like that person's the person for
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you, you can still go back the right you were on.
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We hope you don't. We hope you have a good experience. But just because you
16:04
meet and do that kind of appointment doesn't mean you have to then go do that.
16:07
We're not doing have tos.
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But I would encourage everyone, if they're having that surgery,
16:11
at least take that step to be like, hey, let's meet this person. Let's meet this team.
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For that pre-op visit. Because they might say, hey, we don't know if you need surgery.
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You might need PT through Hinge Health that the state health plan is going to
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pay the entirety of the care for.
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And then you might not need surgery because they are rewarded for saving money
16:28
on the surgery, but also avoiding surgeries that are unnecessary.
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I think we all know some surgeries are done more often than it might could be. That's scary.
16:35
So we've empowered their team to say, like, here's some other options for surgeries.
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But I would encourage you, if you have it, I know you love your doctor,
16:41
but at least check out what the option might could be.
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If it doesn't work, You are going to pay more, but again, your choice is your
16:48
choice, but we would encourage you to at least have that first conversation.
16:50
So I have a couple questions, and I think I'll ask this one,
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building off what you just talked about.
16:55
So when someone goes to the doctor and they need a procedure.
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Usually they don't even think to ask around or to find someone else.
17:03
Or even, how do we spread the word about this program?
17:07
Like, where do you even start to get people to ask questions like that?
17:11
So that's a great question, and I think there's three or four paths.
17:14
One, we are rolling out our preferred provide network of primary care providers
17:18
where your co-pay for primary care is going to be $10 or $15.
17:22
Through shared savings programs with them, they are going to be incented to
17:25
partner with those systems that are participating in the program.
17:28
So if you don't trust me, please trust your primary care physician.
17:31
In general, I think that's probably pretty sage advice.
17:34
So we're trying to align incentives, kind of how to share savings across the board.
17:38
And those are generally speaking independent primary care providers.
17:41
I think once you get in a health system, they're going to tell you to go.
17:42
You're ushered, too. That's right. Ushered is a good word.
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Two, you know, if you are referred to, hey, you need to see a specialist for
17:50
the surgery, please call Lantern.
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And they can help kind of coordinate, do all that work for you,
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make the appointment on your behalf for those people.
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Third, for some of the younger folks, there's an app that you can use the app
18:01
to figure out who are the providers in the area.
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You don't want to talk on the phone to someone. That is a plan of choice as well.
18:07
They never do. So we've made that option available for folks as well.
18:10
You can search for a provider, search for it by specialty.
18:14
You can do that route as well. And fourth, whenever you have questions,
18:17
please call the state health plan.
18:19
Yeah, and I think we can serve a role as well, you know, to spread the word,
18:23
obviously with this podcast and then, you know, to get. We're going to do a few town halls. Yes.
18:28
And hopefully that'll lead to even more people. They're going to be resistant.
18:32
I'm that way. And I think most public employees tend to be risk averse.
18:36
That's why they choose public service, because you kind of have more stability in the job.
18:40
But it's just a matter of getting everybody used to it. Now,
18:44
Lantern, my memory of talking to the folks from Lantern is that they have worked with quite a number.
18:49
Y'all aren't the first people they've worked with. They've done this.
18:53
Other states have, yeah.
18:54
Give us examples. Can you remember any of the companies? Yeah, absolutely.
18:58
So the state of Florida, they're on their second cycle with Lantern.
19:01
So they selected Lantern several years ago, then did an RFP for a bundle of
19:04
surgical services, selected them again.
19:06
I believe they're also working with the state of Delaware, where I went to school.
19:10
So that's great. And I believe Alaska as well. And then they have some other
19:14
large employers. So we are never going to be someone's first client.
19:18
And I chatted with the folks in Florida. They're actually rolling out more services through the land.
19:23
It's been successful enough that they not only picked them again,
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but they're rolling out more services like medical infusion,
19:28
which we are paying in astronomical.
19:31
You want to get angry about prices. I got some data for you.
19:34
Uh-oh, don't get me angry. And then we, you know, that goes to much more of
19:38
like a reference pricing fixed cost model for those drug costs that are,
19:42
you know, a commodity to buy.
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I think it's one thing to charge a lot for a complex surgery.
19:46
It's another thing if you buy a drug for $1,000 and charge me $5,000,
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I'm not sure that's the same.
19:51
So other folks are moving a little because they've
19:55
partnered with them longer rolling out more services to your point because i think you
19:57
know state employees are going to be a little reticent and i think the job we
20:02
have to do at the state health plan is change the dynamic around free at the
20:06
state health plan low cost of the shade health plan means high quality better
20:10
access because usually when you hear something's free in health care or in anything
20:14
in your life like i don't know.
20:16
Yeah. Like, you get what you pay for, right? In addition to,
20:19
like, the normal reticence that folks have and kind of risk aversion,
20:22
that's a conversation you have to really change the language around.
20:25
That's going to take some time. And we, you know, the treasurer comes from a
20:28
business background. He's like, I bet you we'll get to X percent in the first
20:31
year. I'd be like, I divide that by four.
20:34
Because it's just going to take time and evolve. Well, think about it.
20:37
It's taken so many years to have a system that's become so convoluted in health
20:43
care that patients, consumers, whoever you want to call us, we've started to
20:48
just accept the perverse as normal.
20:51
That's right. And only now in recent years where it's reached levels that we
20:55
can't tolerate it anymore is everybody waking up and saying,
20:59
wait, it doesn't seem like we have a free market health care system.
21:04
No, we absolutely don't. And everybody kind of wants to go back to that.
21:08
So I feel like, you know, hey, go treasurer's office, you know,
21:11
bringing capitalism back. One hospital, it's done.
21:13
But I think that this is something I would wonder, would you go beyond surgeries
21:19
at some point if this is successful and look for ways to do this with primary
21:23
care or with anything else in the industry? Yes.
21:26
So we are partnering with a group of physicians across the state to do this
21:30
for maternity care next.
21:31
Oh, wow. Cool. So trying to get it to one copay from your first OB appointment.
21:36
To delivering a baby oh wow wow that is
21:39
where you know north carolina has one of the worst infant mortality
21:42
rates in the country with huge racial and
21:45
economic disparity differences it's probably gonna solve so i think that's the
21:49
next organic one i think primary care is a good example of where we should be
21:54
going right as much care as we can get there cancer care that doesn't require
21:57
surgery that is really confusing is really hard to navigate i think is another
22:01
kind of natural area way to go.
22:04
Well, the last two, I think, are a little trickier and more nebulous,
22:08
but probably there are things to do.
22:09
You know, I think we do a really good job on behavioral health copays and behavioral health access.
22:14
A lot of those folks are one or two care clinician practices,
22:18
them having to submit a bill every time, charge a copay every time.
22:21
You know, if you've been with your behavioral health provider for a year and
22:25
some change, you're probably in a good group of things.
22:26
How do we bundle those services? So it's maybe one copay, they got to file claims one.
22:30
Because once you get in a groove with someone, you're probably going to stick
22:32
around with those people.
22:33
And then we do not have competitive chiropractic or PT copays at all.
22:37
Like, they're very comfortable saying bad. They're uncompetitive. I pay cash instead of.
22:42
And we got to do something there. And I think that is an opportunity when we
22:45
have a diagnosis that has a predictable kind of care pattern to say, it's X.
22:50
You know, it's X dollars for the copay, for the entirety of your treatment of care.
22:54
And provider, you're responsible for taking care of all those adjustments and
22:57
all of those things, to get the person healthy.
23:00
Right now, at the transaction level, I don't think that is an effective way
23:03
to do some of those programs.
23:05
One, it puts a lot of administration on that, takes time away from delivering healthcare.
23:09
Three, you know, it's a generally predictable set of amount of time you need someone.
23:13
And then with the behavioral health one, I think that's the right thing to do,
23:16
right? You know, if you're focusing on your behavioral health,
23:18
doing the thing we want you to do,
23:19
Making you pay every time is probably, like, not the right answer to the question.
23:22
We've made it very affordable.
23:24
But those are kind of the evolutions I see sort of through all this.
23:28
So I don't know where this fits in with all of those categories.
23:32
But we see a lot of things on social media, Facebook. I sent you guys one this
23:37
morning about scans, like CT scans, MRIs are very expensive.
23:42
And they range in price dramatically. Would that be included somehow?
23:46
Scans will definitely. And we are providing, kind of going back to that primary
23:49
care example, we are trying to incent insurance savings for folks that refer
23:53
to those lower cost places, not for the referral, but for the savings that they generate for the plan.
23:58
And again, they can still refer to whomever they want to.
24:01
But if we want to share in the savings, we got to make it available for members.
24:05
And I think about it's also the parking lot experience.
24:08
You know, if you go to Raleigh Radiology, it's cheaper. It's easier to get in
24:11
and out of. It's not some big, gross deck.
24:13
I had one more bundle example that we are going to be rolling out next year.
24:17
Right now, it is really complicated for primary care providers to do multiple
24:22
things in a visit, just because kind of how the copay structure works.
24:25
So if you go in there because your shoulder is bothering you,
24:28
but you also got a fever, they often have to say like, hey, we can only treat one thing.
24:33
And I think a lot of folks don't come back or the doctor doesn't get compensated
24:37
for it or it just creates this whole series of chaos.
24:40
So in our preferred provider network, we are working out an arrangement with
24:43
those primary care providers. You can do more.
24:45
It's not a bundle per se, but it is under that one copay for the memory.
24:49
Please do, and we will compensate you for doing the things you need to do for
24:53
the patient versus asking someone.
24:55
That's a big deal. I've heard that a lot. That's a big deal with me because
24:58
I go to the doctor and I drop like five different things on her.
25:01
Yeah, and they'll tell you, no, you're here for this.
25:04
And so we're trying to work on a structure right now that works for the primary.
25:08
And it's going to be those in the preferred provider kind of arrangement.
25:10
Okay. They're the ones that are going to have the prior office getting taken
25:13
away, the Don Croning taken away. Just make it a little bit easier for the member. Yeah.
25:17
I mean, I wouldn't go back, to be perfectly honest with you.
25:20
I'd be like, I'm going to ride this out. And like, that's what DayQuil is for.
25:23
But, you know, a lot of people have more complicated problems than that.
25:26
So being able to treat the patient while they're there and compensate the provider
25:29
for the time, that's an antiquated part of insurance of health care that doesn't
25:32
make a tremendous amount of sense to me.
25:33
So we're going to try to make incremental progress on that. Awesome.
25:37
I have a couple other health plan questions since you're here,
25:40
but before we wrap up the section about Lantern, tell people exactly where you
25:44
want them to go to learn more about Lantern and the health plan.
25:47
So, first, you should be receiving card in the mail shortly,
25:50
so when something comes up.
25:51
In your open enrollment material, there is the Lantern website and a way to get to the Lantern app.
25:56
And if you ever, ever have questions, it is on our website on the state health plan, and please call.
26:01
If you ever have questions, please call. We will get you where you need to go.
26:04
You could do like a tie-in with Halloween, like don't fear the lantern.
26:09
Go toward the lantern. Which, by the way, we're recording this on Wednesday,
26:12
but it will come out on Halloween.
26:15
So don't let healthcare be spooky. Yeah.
26:19
Speaking of Halloween, that is the end of the open enrollment.
26:22
So I guess when this comes out, you'll have like maybe five hours to do your
26:25
open enrollment. But how has that gone?
26:28
You know, I think it's going well. I think fewer folks are making changes than
26:32
we might have thought. because everyone's got a lot of life going on.
26:36
So I would encourage everyone to take a look at where they are because copays are different.
26:41
Now, I've had some tell me they're going to 70-30 because of the premiums.
26:45
Fewer folks than we would have thought are going to 70-30.
26:48
I can tell you I am going to the 70-30 plan. Yeah, but with Lantern out there as well, yeah.
26:53
And a $15 PCP visit and, you know, $15 behavioral health visit.
26:57
I think that can help for my specific set of circumstances.
27:00
Is i think so i totally understand folks going
27:03
between plans i think the folks were most concerned aren't
27:06
seeing changes is in the medicare retirees staying in the
27:09
70 30 plan because that is so materially less
27:13
rich now than the medicare advantage plan i'm a little surprised more folks
27:16
haven't gone to the medicare advantage plan but again kind of going back to
27:19
like there's an initial reticence of things so that would be i would say it's
27:22
probably the biggest surprise right now but we also it's kind of like a upside
27:25
down bell curve we get a lot of folks enroll in the first couple of days and
27:28
a lot of folks enroll in the last couple of days and the middle is a little bit
27:32
That's true. Yeah. People realize, oh, deadline's up. Yeah. You got the early
27:37
achievers and the folks that try to get in under the bell. Yeah.
27:40
So recently with Humana and UNC, there had been this big dispute and state employees,
27:48
I'm sure they were calling y'all.
27:49
Oh, yeah. They were called, we're retirees. We're calling us who had the Humana
27:53
Medicare Advantage plan.
27:54
And we're convinced. And thank you for clearing it up for us so we could try
27:58
to get the word out to them that Humana, through the health plan,
28:02
was not affected by that dispute with UNC. 100% correct.
28:06
If folks get mailers to the contrary, please, please send them to us.
28:10
Yeah. Because y'all have been great partners. They were just getting mailers from Humana.
28:14
You know, it's one of those things. You want everybody to call,
28:16
so you send it to everybody. Yeah.
28:17
But Humana, for the state health plan, UNC remains a network, no changes.
28:22
So that brings me to my next question. And I had asked Treasurer Briner about
28:25
this a few weeks ago when he was here.
28:27
And I won't tell you what he said. I want to make sure y'all say the same thing. Okay.
28:30
It's a test. Okay. Y'all are a pretty great team, so I'm thinking you're going to pass.
28:34
Okay. Here we go. You ready? No pressure. Loretta's not going to like this.
28:37
Yeah, Loretta won't let it fly.
28:40
So I asked him, since Medicaid is asking providers, look,
28:45
we need to give you less because we have such a gap to fill.
28:49
I asked him, did he think that's going to put us in a position of more situations
28:53
like we faced with Duke, where they wanted more from the health plan or from
28:57
the health plan's third-party administrator?
28:59
I mean, do you think that's what we might be looking at, that hospitals are
29:03
going to say, if I'm getting less for Medicaid, I'm going to try to fill that
29:07
hole somewhere, so I'm going to ask a little more from some of my other customers,
29:11
including the health plan?
29:13
I wouldn't be surprised if they try.
29:17
But remember, we got contracts with a lot of those entities for the next couple
29:20
of years already flushed out, and we're not going to go back to the negotiating table.
29:24
They're like, oh yeah, we'd love to give you more money. I think what we're
29:26
pushing for and where the Duke piece landed was, you've got to perform to make more money.
29:31
You've got to get folks healthier if you want to make more money.
29:34
So I think the days of us just being very fine with like, you know what,
29:38
we will, our job isn't to offset that.
29:40
Our job is to make sure healthcare is sustainable and something I'm really excited
29:43
about that is through the Federal Rural Health Transformation Program.
29:48
Section that the department is going to be working on is how do you with independent
29:52
and smaller rural providers lower the unit cost delivery of healthcare,
29:56
help them with their EHRs, help them with their rev circle, help them with AI.
29:59
So maybe your reimbursement in some areas are going down but let the treasurer
30:03
help you as one of the best business people I know.
30:05
Lower the cost to deliver the care And so we are more focused on how can we help you lower the cost?
30:10
So if your revenue is not going to go up, how can we help you lower the cost side of things?
30:15
Because I do not want to be, and I don't think we will be the ones who are being
30:18
like, we're going to plug the gap. That's just not how this is going to work from my point of view.
30:22
Well, and I think in 10 months, y'all have had to deal with an awful lot. Yeah.
30:27
You know, the final thing that I can think of that was so huge being the recent
30:31
negotiations y'all had with CVS Caremark, the pharmacy benefit manager, the PBM for the plan.
30:38
And I just went last night to something that IOPL, the Institute of Political
30:42
Leadership in North Carolina, are such a great organization.
30:44
And they do these hometown forums and they've been on health care.
30:48
Last night's was on pharmaceuticals and PBMs. And it was fascinating to me that
30:53
10 years ago, that discussion would have been a completely different discussion.
30:57
Than it was last night. And the treasurer's office, your office.
31:01
Particularly in the treasurer's office, the health plan, was complemented in
31:06
the way you have dealt with trying to control your pharmaceutical costs for the plan.
31:10
So, I mean, I thought that was really nice. It is really nice.
31:13
Yeah, I'm glad to hear that's getting out there.
31:15
You know, our job is to fight for teachers and state employees and the costs
31:19
associated with those things.
31:20
And we're going to continue to do that. And I think, I'm glad we got to a good
31:24
place with the CBS pieces.
31:26
And now the big challenge for us with that is now we got to go get great deals
31:31
on GLP-1 so we can bring those back in some capacity for members in an affordable, sustainable way.
31:36
So we cleared that hurdle, but now we create, you know, you clear a hurdle to
31:39
create a challenge. But I feel like, you know, that's where we're going to be
31:41
marching towards is how do we bring those back?
31:43
They are necessary, not for everyone who took them. You know,
31:47
I had a couple too many calls about you're messing up my bikini season.
31:51
But we have some folks that truly do need them. That was me. I'm sorry. Yeah.
31:56
HIPAA, I couldn't say that. But, you know, we have a lot of folks that need
31:58
them, and it's our job to bring them back. And those drugs provide a lot of
32:02
value to people's lives, and they improve health, which lowers costs.
32:06
Right. So we cleared that hurdle, and now we've got to clear this next hurdle.
32:09
And I think we can do it. We're just going to start meeting with manufacturers
32:12
the next few weeks to what kind of deal can we figure out to bring these back
32:15
for state employees? And I'm pretty excited about that.
32:18
Just an aside on that, are you seeing those costs go down at all?
32:21
Like, it's been out now for a few years, right? So the cost of GLP-1s have gone
32:25
down pretty dramatically.
32:27
But if you look at kind of the data that we're seeing, because we don't cover
32:31
them right now. So this is not our experience.
32:34
They're, you know, driving costs up in some plans 10 to 20% a year.
32:38
And it's less so when it's a narrower kind of set of offerings.
32:41
But, you know, kind of after the last 10 months to kind of open the floodgates
32:44
to let's raise our cost 20%.
32:46
It's probably not where we're going to shoot, but if we can work out an arrangement
32:49
where they share the value, much like the Lantern providers are sharing the
32:52
value that they generate, you know,
32:54
there's value not just from a health point of view to people having less heart
32:57
disease, to being in better shape,
32:59
to, you know, not having to go to the hospital and have heart attacks.
33:02
Like, there's a financial value to that, and we're happy to share that value
33:05
with manufacturers, but they've got to take risk, too, up front.
33:08
You know, I think part of this thing with Lantern is these folks are taking
33:11
risks and a chance, too, right?
33:13
But if we're going to have to— That's capitalism. That's right.
33:15
But if we're going to take, we're going to align our incentives.
33:17
If we're going to take risks and our members are taking risks and costs,
33:20
y'all are going to take risks too. And that's just what it is.
33:23
Well, and we're the only country in the world getting charged those prices. That's right.
33:27
So it's just too much to swallow that. It's gross. Yeah.
33:31
Well, thanks for joining us, Thomas. Does that have any other questions?
33:35
You look like you have a question. No, I'm good. Okay. You covered everything I had on my mind.
33:39
I do want to give a quick shout out to Loretta Benitti, who is the communications
33:43
director. at, is that what her title is? Sounds right. Okay.
33:47
At the treasurer's office, who helps us set these interviews up.
33:50
I noticed that we've done like four or five so far, and I haven't given her
33:53
a shout. You probably remember her from Spectrum News.
33:56
Yeah, she was a legend at Spectrum. Yes. She was one of the first reporters
33:59
I ever worked with in this job.
34:01
And I was really nervous, and she helped me along. So shout out to her. She's a nice lady.
34:06
And thank you to you and everyone in your office for coming over.
34:09
Fun Loretta story. So she had the black mugs that she gave legislators for doing
34:14
the interviews with her, and they still have them up.
34:16
So wherever we're downtown, we sneak pictures of the mugs and send them over
34:20
to Loretta. Well, that's awesome. Yeah.
34:21
Oh, you never got it. Did you get a mug from her? I went to a legislator,
34:24
only in my mind. You're important, though.
34:25
We could have gotten a mug, Loretta. No mug. I never got a mug.
34:30
I wasn't mug worthy either. All right. So we will entrap, Thomas,
34:34
with our question of the week.
34:36
So play my music. John's Wacky Week.
34:43
It is spooky Halloween season. My daughter and I watched Hocus Pocus last night.
34:48
But I won't ask the movie question because we had that in an upcoming episode.
34:52
So the question this week is, what was your favorite Halloween costume growing up?
34:57
So my dad wasn't a particularly handyman by any stretch of the imagination.
35:01
But one year he put on a cardboard box two milk jugs that he put scary masks
35:06
on, cut a hole outside. It got to be a three-headed monster.
35:09
I love it. One year, and that was my favorite one. Yeah. Unfortunately,
35:13
my kids will not even have that level of handiness from their father.
35:16
So what are your kids going as? My son is going as the Grim Reaper for the second year in a row.
35:21
His dad runs a health plan. Yeah.
35:25
And my daughter, Maeve, who is a force of nature, is going as Galinda,
35:29
who she refers to as Belinda.
35:33
So it's Glenda. It's not Glenda. She changes it. Oh, I haven't seen Glenda.
35:38
In case y'all haven't seen Wicked.
35:39
I haven't seen it. Okay, I'm sorry. It's awesome. That's always been the Glenda the Good Witch, right?
35:44
Are y'all going to do trick-or-treating the whole nine yards?
35:46
Oh, yeah. I saw our neighborhood does a really good job kind of clearing out
35:49
so everyone can trick-or-treat.
35:50
Everyone kind of agrees to not drive and the kids can just kind of run around.
35:53
Like when we were younger, you could just kind of run around in neighborhoods.
35:56
Yeah, that's awesome. So my neighborhood, I used to live in like the popular
36:01
neighborhood in town for Halloween. Popular neighborhood?
36:05
Yeah, so everyone from the whole city, from Sanford, came to our neighborhood
36:10
because it was like an enclosed loop and you could just let the kids go and it was awesome.
36:14
I'm going to ask you offline what neighborhood that is because I got no idea
36:16
what you're talking about.
36:18
But our new neighborhood, no one trick-or-treats. So we never get any trick-or-treaters.
36:23
So it's so disappointing. That's very depressing.
36:25
Yeah, it's really sad. Well, what was your Halloween costume, though?
36:28
So my brother is like 10 years older than me. So like anything he did was awesome
36:33
when I was growing up. Right.
36:35
So he bought me Sergeant Slaughter. Remember him from WWF? Sure do. Yeah.
36:40
So the costume from Walmart that was like a cape.
36:44
You remember those? Yeah, yeah. It was like a little plastic mask.
36:47
I thought I was something when I was like five with the Sergeant Slaughter costume.
36:51
I think that's like one of the only ones I can really remember.
36:53
But what about you folks?
36:56
Sammy, you've probably got a bunch of good ones. So what? I do.
37:00
When I lived in Tennessee, we used to go to a neighborhood called Sleepy Hollow,
37:04
and we would walk around there.
37:06
Walk around slash my dad would bring the truck, and we'd put a bunch of hay
37:10
bales, and all of our friends who didn't live in neighborhoods as well would
37:13
also come, and we'd just jump in and out of the truck with the hay bales. That's funny.
37:18
And I remember my last year living in Tennessee, I dressed because I finally
37:22
had a dog of my own. That was a small dog. So I was Dorothy, and my dog was Toto.
37:30
What about you, Suzanne? Oh, God. I don't know. I was definitely a little girl.
37:36
You remember the mask where it had a little hole in it?
37:38
You know, you always stick your tongue through that little hole.
37:40
That's what we had, those hard plastic off the mask.
37:42
It was Barbie. You know, anything Barbie.
37:46
So when you were Barbie, I was a Houston Oiler. Awesome.
37:50
With the helmet and everything. Nice. Yeah, that kind of says it all,
37:54
doesn't it? But that was when the Oilers still existed before they moved to
37:58
Tennessee to be the Titans.
38:00
How do you feel about Tennessee wearing the Oilers uniforms now?
38:03
I just repress it. Yeah, it's kind of weird, huh?
38:06
So two other honorable mention costumes that I've seen. So at Chapel Hill,
38:12
you know, Halloween is the big deal, right?
38:14
The best costume I ever saw was, and it's probably not even that great,
38:19
but it made me laugh a lot, was the guy was just a table.
38:22
Like he just wore a table. Oh, the Chapel Hill costumes are the best.
38:26
Yeah, yeah. A group of my friends. I was Vanna.
38:29
This was back when Wheel of Fortune was a big deal. I was Vanna.
38:32
One of our friends was Pat Sajak.
38:35
And the third was the wheel. And we made the wheel. It was really elaborate.
38:39
That's awesome. Oh, yeah. That was a fun. I actually didn't do much during college
38:43
for Halloween. Oh, the hair was big. Yeah, it was the hair.
38:45
I was more of a stay in my dorm room because...
38:49
My brain just went to, everyone does dumb things on Halloween.
38:53
We didn't have Ubers in my college town. So it wasn't like you had to either
38:57
rely on a designated driver or you were walking in the freezing cold.
39:02
So I was like, I'll stay in my dorm room. I'm good right here.
39:05
So did you go to Delaware?
39:07
I went to Delaware for graduate school. I went to the University of Arizona for undergraduate.
39:10
Ubers didn't exist back when I was in college. Yeah.
39:13
The only other costume I wanted to mention was one time my son was,
39:18
he was like nine and he was playing in a baseball tournament in Goldsboro and
39:23
they had a game Halloween night.
39:26
And so after the game, we took the whole team to a neighborhood and they all were baseball players.
39:32
So it was like 12 baseball players shows up. Yeah.
39:36
And so he was a baseball player for like three straight years after that because
39:39
he was too cool for dressing up. And once I moved to North Carolina,
39:44
my costumes got a lot less extravagant because we just went camping.
39:48
We would just go camping Halloween weekend and just tradition. It's a great tradition.
39:53
Yeah, so I would still dress up and we'd be riding horses around and I'd just
39:57
be like Harley Quinn with my double pigtails and just some colored hair.
40:02
Well, if you're out there, if you happen to be driving around,
40:06
be careful of these trick-or-treaters. Watch out for them.
40:09
And everybody have a great one. Great.
40:12
We'll put some spooky music. The Monster Mash at the end. That's going to be
40:16
our theme song this week. It's just spooky music.
40:18
Well, thanks for joining us, and we'll see you next week. Thanks so much.