PowerLiving with Kimberlee Langford
PowerLiving with Kimberlee Langford
Why The Insurance Status Quo Fails And What Employers Can Do Today
Woohoo! I can't tell you how excited I am. Today, uh, I'm joined by I'm so excited to get to work with you, Rusty. So as if Rusty wasn't a superstar enough, uh, we get to have a delicious conversation with somebody I hold in my very highest regard as a real um just as a human being and a leader in the healthcare industry. Nelson Griswold is the head of Next Gen Benefits Network. And I would say, I think Russ, you'll agree with me, he's probably one of the most outspoken and respected leaders in the employee benefits uh industry. He's not only a best-selling author and strategist, but he's the architect, if you will, of Next Gen Benefits uh movement, which is really reshaping how employers and advisors really design and build their self-funded uh health plans. He's trained thousands of benefit advisors, spoken in nearly every single state, uh, and is known for helping employers who really are the customer uh in our industry to take control. We hope they take control of the healthcare supply chain. And I come away selfishly, I come away smarter every time I get a chance to listen to Nelson. So he's really made it his mission to call out miss and malaligned incentives in our industry, cut through opaque uh carrier games, and show employers how to reclaim dollars, all while improving outcomes, especially in high-cost conditions like uh things near and dear to our hearts over here, uh specialty pharmacy, cancer, dialysis. And his work really does challenge the status quo, that traditional insurance playbook. And he replaces it with bold, transparent, and outcome-driven models. I I am so happy you're here, Nelson.
SPEAKER_00:Kimberly, I'm I'm blushing from the introduction, but thank you. It's so great to be with two of my favorite ladies uh who are fighting the good fight every day to improve the quality of health care and lower the cost uh for the people who are paying the bill, which is not the commercial payers, also known as the carriers of the BUCAs, uh, but the employers and the employees. So it's great to be here.
SPEAKER_01:Yeah, and I think a lot of times we don't realize that they are now as a nurse, I keep the member in the center. That's my that's near and dear to my heart. But I think we forget in the industry that it's that employer-sponsored health plan, that employer that's putting those things together. That's real, that's they wield the power, and I think a lot of them don't know it.
SPEAKER_00:Well, they absolutely don't know it. They've been lied to in what I call healthcare's big lie, which is you can't control the cost of health care. And the carriers, the the BUCAS, the Blue Cross United Signa etna BUCAS uh will tell you we do our best, we but we we can't control the cost of health care. Uh and so costs healthcare costs will go up every year. So will your premiums get get used to that. And and it's a lie, it's an absolute lie. Of course you can control the cost of health care. When did healthcare become exempt from market pressures, supply and demand, and supply chain management? It's not. It's simply the insurance companies ensuring that they have an excuse to raise premiums next year because they have allowed, even encouraged, healthcare costs to go up, justifying their increase in premiums, which is their revenue, and they have a fixed profit margin because of the MLR clause in Obamacare, capping their profit margin. So a fixed profit margin on a larger number is a larger number. So no, it's it's employers have been lied to, misinformed, misled, uh, and basically, as as one CFO uh said to me, have been treated by the insurance industry like a bunch of mushrooms. Oh, they're kept in the dark, kept in the dark, kept in the dark and fed a steady stream of cow manure.
SPEAKER_01:So I'm just curious, with that in mind, what was it that I mean, was that realization? What was the catalyst for you? Um, you know, when you think about you just what you've built, what you're building, what was the catalyst for you to, you know, embark on this movement that you've created, the next gen benefits?
SPEAKER_00:Until 2016, I had been working with employee benefit agency owners to uh well, before Obamacare just to be more effective for their clients more successful. After 2014, when Obamacare came actually after 2012, Obamacare had been passed, and we were seeing it, you know, in the in the uh headlights coming towards us. Um I've been working with agency owners to survive and thrive in that post-Obamacare era uh as an employee benefits agency. In 2016, I met someone you both know, uh, a woman named Deb ALT, uh, a nurse, and the founder and president of Alt International Medical Management. I was introduced to Deb. I I I said, Hi, how are you? What do you do? And she said to me, Well, uh, we guide employees to the highest quality health care so that we can save the employer money on that care. And in my little brain is is running, going a claim is a claim, is a claim, is a claim, is a claim is a claim. And I said to Deb, You you can't control the cost of health care. And both of you can hear her say this as she took a step back. She said, Well, I never got that memo. And and that was the beginning. It's like, seriously, you can control the cost of health care. Tell me more. So she explained what they do at AIM. Uh, then we I I learned, okay, wait, but the insurance companies won't let you do that. No, you've got to go self-funded, you can't be fully insured. And oh, you can't use the insurance companies as your administrative services only provider because they will not let you control the cost of healthcare that way either. So you have to go with an independent third-party administrator. Yeah. And then you can start to use techniques like, for instance, not the not that you have to, but but reference-based pricing, for instance. Uh you can go carve out pharmacy and go with a fiduciary PBM and do cost containment on specially meds and expensive maintenance drugs. Uh, you can look at surgeries, you can look at dialysis, you can look at infusion uh drugs, you can look at a wide, wide, wide range. It it really if the insurance if if patients need to spend money on it, we can save money on it. Because everything's overpriced in healthcare uh in the status quo world. So that's what started it was Deb all telling me she was doing something that I didn't believe was possible. And once I understood it was, Katie borrowed the door. Let's change the employee benefits space, let's change employer-sponsored health plans, but let's change health care.
SPEAKER_01:Oh, I think uh you can probably hear Mark Testa speaking right now, right? What happens when you bring a seat for a clinician to your benefits table? Things things change quite a bit. It's interesting, you know, as you talk about, you know, this whole space, and and I think there's two paradigms that people consider. You're you're savvy folks, they think about you know, this self this whole self-funded arrangement. And I I don't know, I remember being at a conference with you one time, and you know, when you go to the conferences, you think, oh, there's such an army, and we're all rowing the same direction, and woo-hoo, we're gonna make a big difference, and there's not enough of us. But it does feel like the momentum is slowly picking up pace where I think you know, self-funding is becoming more palatable, especially as we have more savvy advisors out there teaching employers how to take control of their health spend. But there's also the other side of the camp. Uh, and I now I can hear Tom Mueller in my ear, uh, where we we argue sometimes very respectfully on the the uh pros and cons, if you will, of you know, letting government take the helm. You know, won't government what about Medicare for all? That's gonna fix all of our woes. What would you what would you say, you know, in in terms of looking at that dichotomy, if you will? What about you know, putting a lot of momentum in this you know, self-funded uh arena where we're really bolstering, uh bringing in employers and patients to take control? Or should we just throw our hands in the air and let Uncle Sam take care of us as you know he always does? Wink, wink, nod, nod.
SPEAKER_00:Well, government-run health care is something a lot of people seem to want, uh, from Bernie Sanders and uh Senator Warren, uh AOC, whose name I never can remember, but the initials will do, uh, are all calling for the government to take over health care and run health care. If you, if you like the uh efficiency of the post office, the wait times of the DMV, and the compassion of the IRS, you'll love government-run health care. So let's avoid that. The the so next gen, next gen benefits, which is not a benefits agency, it's not a health plan, next gen benefits is just a model, an alternative model for employer-sponsored health care. And what uh next gen benefits really is private sector health care reform in action. This is the private sector doing what government can't and won't do. Certainly we hope they won't do it, but they can't do it. They can't fix health care, they'll they'll just screw it up worse. But the private sector is taking control of the health care spend in that company, it's company by company. This is like urban warfare going from house to house, clearing out the enemy. It's slow going and it's not easy because there's a tremendous amount of inertia, Kimberly. There's a tremendous amount of Stockholm syndrome, the BUCA carriers, again, blue Blue Cross United Signa Aetna BUCA. The BUCA carriers uh have been abusing employers for so long, but holding them captive. Where can I go? I either go to Blue Cross or I can change to Aetna, but they're all the same. Deb Alt calls it just another shade of the body.
SPEAKER_01:Well, they're all running the government plans, too.
SPEAKER_00:Yes, the the they don't give you any options, in part because Obamacare took away all the options. It standardized the plan offering to a large, very large extent. So, but employers go, well, I I only have these four choice. They don't have four choices in most markets. They have maybe two, possibly three uh choices in Blue Cross United, maybe Aetna, but they won't have uh Signa, or maybe they have Sigma they don't have United in a certain market. The the employers see themselves as trapped, as as imprisoned by these choices. And the Stockholm syndrome, if you'll remember, is the phenomenon of someone who has been captured and held captive, falling in love with and and becoming sympathetic with the captor. Yeah, well, they take care of me. And we we we hear employers tell us, well, you know, we've been with Blue Cross for eight years. They do what they do right by us, they they take care of us. I'm thinking, well, how do you define that? Uh the the the the guy in the ski mask that jumps out uh from behind the dumpster in a dark alley and points a gun at you. He's taking care of you too. Well, he's taking your wallet and your watch, but this is exactly what the insurance companies are doing. They're they're actually that what the insurance companies are really good at is separating employers from their money. That's what they're really good at. They're not good at running health care, they're not good at quality of health care, they're certainly not good controlling the cost of health care, but they're really good at separating employers from their dollars.
SPEAKER_01:Well, they're really good at making money. That's a profit, right? That's what they're driven for, is prop profit. And, you know, it used to be people used to think, well, if I call my, you know, the number on the back of my card, they're gonna tell me, you know, how to find a good provider. Well, they'll tell you who's paid to play. They're not gonna tell you, you know, like, you know, your debts will. Uh, where can you go for the high quality care? And I think a lot of people mistakenly think the consumer has been taught to think, if I pay more, I'm gonna get a greater benefit.
SPEAKER_03:And this is a recognizable brand. I think this is where brand and commercialization has really done a disservice to have any type of correlation to quality just because people commercial or they have a great teaching hospital, or they have a great brand presence, as Nelson mentioned, in a specific market as an insurance carrier, that has equated to I have a quality health insurance plan. When in fact, I would define a high quality performing plan based off of satisfaction and clinical outcomes. Um and it is it is misled uh severely, I think, by misrepresenting through commercialization.
SPEAKER_00:Rusty, you make a uh an excellent point, and I'll give you an example. Uh in in the Cleveland market, there are I believe six, five or six healthcare systems. The premier, of course, is Cleveland Clinic. And Cleveland Clinic is renowned internationally. Uh it every year it c it gets the uh uh the the award for the top uh heart uh hospital in the US. And if you look at objective quality data, Cleveland Clinic is excellent when it comes to heart. But if you look at overall quality, and this is objective, this is uh using the Quantros uh system that the Quantrose uses data that the hospitals themselves have submitted uh to CMS, uh Centers for Medicaid and Medicare Services, uh, and then and then risks adjust and and puts in all the right algorithms so you can compare hospital to hospital to hospital. If you if you look at overall quality in the Cleveland market, uh out of five healthcare systems, Cleveland Clinic ranks fifth out of five, maybe fifth out of six. I I I can't quite remember, but it's fifth in overall quality, which means you can get better quality going to something other than the brand name, but everybody wants to go to Cleveland Clinic because it was Cleveland Clinic, and you know, it's interesting. The in every other part of our life, uh, you know, uh, I don't know, Rusty, you get an allowance to go get a new car. And it's it's it's it's it's$90,000. It's like, oh wow, I'm gonna get a nice car. Oh, wait, I'm sorry, we misread that. It's$40,000. You're not gonna get nearly as nice a car. Or if I give you a clothing allowance of, I don't know, ten thousand dollars to go get a new wardrobe. I I bet you could pick a really nice wardrobe, really fine clothing. Oh, what no, I'm sorry, it's a thousand, not ten thousand. Your the quality of the clothes you're gonna get are not as good. The same with food and on and on. Except healthcare. You said it. There's actually uh an inverse relationship. Everything else is a direct relationship. You spend more, you get higher quality. You you spend less, you get lower quality. In healthcare, you spend more, you generally getting lower quality, you spend less, you're generally getting a higher quality. Actually, you get higher quality, you spend less. And there's the correlation. But but nobody understands that, and it has to be explained because everybody, nobody wants to go to the least expensive healthcare facility.
SPEAKER_03:Except us research around uh a lot of the quality metrics and the consumerism associated with healthcare is very okay. And so it's very challenging to your point. How do you define somebody taking care of you? Um, you know, it's very difficult. If I was to purchase a car as a consumer, I can send extensive amounts of research, have unbiased independent review opinions from organizations that are not, you know, entirely related to a specific brand. Um, I can research a lot of information online. It's just all readily accessible. But in healthcare, it is so difficult to find out that information quickly, let alone when you're a patient in crisis. You have very little time or mental capacity to compartmentalize and focus on those metrics with whatever else you're dealing with, um, socially, emotionally, economically, et cetera, um, as well as your actual health care. It is, it is against everyone. And so it's really important to your point to have players like uh devall who are there to advocate, interact in that moment and driven decisions, which I think is really where we're seeing the biggest opportunity in the healthcare market to continue to drive cost transparency and higher quality performance and metric awareness is really going to be in having those folks who have access, sharing that access and that knowledge at a higher level. And it's unfortunately something that we aren't seeing by those who have commercialization of their products because I don't think that they can see that well to them. Um I think a lot of folks misunderstand that by putting in those navigation or advocacy that you're telling a member what to do or a patient, but in fact, that's already happening, but based on whose profitability is going to be maximized, right? So a hospital is not looking at all of the different MRI or surgical centers that are independent versus their own to decide where to direct the patient. They're doing it based off of their own profit center. And so I just always say it's already not a choice. Why not let it be a choice, but based on quality and cost as the final data-driven decision.
SPEAKER_00:You know, most next-gen plans that incentivize employees to utilize the highest quality care would when when they're they're exposed to that through through the navigation, through the nurse advocate.
unknown:Yeah.
SPEAKER_00:Uh it's it's voluntary. And the employee usually has their out-of-pocket deductible and coinsurance waived, which on a on a major procedure is somewhere in the in the eight to nine thousand dollar range, uh, eight to ten thousand dollar range. But they don't have to if they don't want to. But why why wouldn't they? But let me let me say something about the the BUCAS. And I'm gonna make a statement that's incontrovertible, it's inarguable. I challenge anyone to argue this point with me. We know the highest quality uh doctors and the safest hospitals. The quality metrics are out there. Oh, are they perfect? No, they're not perfect, but they are really close to being perfect, they're really good. I've had access to those through my relationship with Deb and AIM. I'm pretty sure that Blue Cross, United Cigna, and Aetna all have access to that data. They know who the best doctors are, they know this who the safest hospitals are. Conversely, they know who the dangerous doctors are and the unsafe hospitals, mostly due to infection rates. But they don't tell their members. They won't give that information to their members. Here's my statement The insurance companies are more concerned with protecting dangerous doctors and unsafe hospitals from their own bad outcomes scores than they are protecting their own members from dangerous doctors and unsafe hospitals.
SPEAKER_01:Gotta protect the provider contracts.
SPEAKER_00:That network is the most valuable asset the insurance companies have. Foolishly, people think it's important to have lots and lots of choice, which means lots and lots of bad doctors. Did you know that almost 40 percent, 39 point something percent, almost 40 percent of paid malpractice claims? I'm not talking about malpractice lawsuits, I'm talking about the malpractice claims that the insurance company said, yeah, we'll pay that, or they lost in court and had to pay it. 40% of those paid malpractice claims are due to three percent of doctors. Now, I want to know who those doctors are because some of them are still practicing. Or they went in the military, everybody will tell you who they are, the insurance companies don't tell you who they are.
SPEAKER_01:Yeah.
SPEAKER_00:What was you what was your comment?
SPEAKER_01:Or they go in the military. Uh we could I could share some stories over pizza and root beer. Yeah.
SPEAKER_00:Are you talking about the VA?
SPEAKER_01:We'll just say, yeah, pizza and root beer conversation. I know a few specific okay, yeah.
SPEAKER_00:And that's the that's the thing. So let me give I'm gonna give our our our listeners some advice. If you don't have access to the data on which are the best doctors and which are the dangerous doctors, here's the here's the shortcut to that. Ask a nurse because the nurse knows, and the nurse will tell you. Now the doctors know too, but the doctors won't tell you, they will tell their family and their close friends, they will not tell their patients. I guess it's professional courtesy.
SPEAKER_01:I don't know. I've heard I've heard a few doctors. When you hear a doctor yelling at another doctor, yeah, I've I've heard a few. So, but you're right.
SPEAKER_00:They they may they may peer-to-peer, but it's there's like this thin white line, just like there's the thin blue line. Yeah, please protect each other. Doctors protect. We see this in in the uh medical board's treatment of egregious physician behavior, and yet that doctor is still practicing. Why?
SPEAKER_01:Yeah.
SPEAKER_00:So it's it ask a nurse. Nurses are a patient's best friend. Can I get an amen, ladies?
SPEAKER_01:You got an amen. Everybody needs a nurse in their pocket.
SPEAKER_03:I always say who helps the doctor if and when something doesn't go right. And it might be a nurse, if you're a surgeon, it might be a physical therapist. There's somebody helping to clean up. Um, and that is really important to ask them who they would recommend as well, because they really see it from the inside out.
SPEAKER_00:That's absolutely right.
SPEAKER_01:So let me let me ask you this question, understanding that you know, there's there's the loss side of things. Where would you, if you're talking with an employer who is being crushed by the cost of healthcare, and I think it's really sad. Matter of fact, my son, my my oldest boy is a nurse as well, and was talking with his family about you know insurance because they still don't have insurance. And um, but for the for their family, for their family of five, healthy family, no comorbids or anything like that. I mean, they bike everywhere they go, their monthly premium would be$1,600 a month. And that's for a high deductible plan. They'd have to blow through$6,000 before they could access anything. So I think we see where, you know, a lot of employers, I mean, largely due to the market forces you just talked about, where we have to shift this cost onto these families who they choose to invest in other things for their families because you know, I can't use this benefit anyway. So, where would you tell an employer in terms of low-hanging fruit? You know, I can think of a few really high when when I think about low-hanging fruit, I think of the high cost, those catastrophic claims, where it's only like maybe three to five percent of your population that's blowing up the plan that you talked about earlier. Where what would your counsel be for an employer who's looking at, you know, how am I going to afford to, you know, keep putting together, you know, benefits that are going to attract the kind of people I want? Where do I cut? Where do I find the low-hanging fruit?
SPEAKER_00:Well, the the lowest hanging fruit with the least amount of noise. And so we we we talk about, and this is Deb's term, she calls it the the teeter-totter. It's a seesaw. The seesaw on one on one end is uh uh per employee per year cost, which is the way we measure the cost per employee per year for a health plan. So divide the the total spend by the number of employees on the plan, and not members, employees, and you get the PEPY. On the other end of that teeter-totter seesaw is noise, employee noise, uh disruption, uh uh unhappy employees. If you if you want less noise, you've got to spend more. If you want to spend less, you're gonna have to tolerate more noise. Because as you change things, people don't like that. And sometimes there are legitimate complaints, my doctor's not in the network. Other times, uh, we had one HR director tell us that the the TPA, their administrator, changed the insurance card from a white plastic card to a cream-colored plastic card, and an employee actually came into her office and complained about it. So noise will happen. Noise is gonna happen. The lowest hanging fruit, the least noise is pharmacy. So if you are self-funded and you've got a BUKA TPA, you've got to go, you've got to be big enough, which is usually like 10,000 lives, unfortunately, to go carve out pharmacy. The much easier way to do it at any size of employer is get an independent third-party administrator. Get one that doesn't require you to use their buddy buddy PBMs where they're in on the graft. But if you get a good independent TPA, then you can carve out pharmacy and put in a fiduciary PBM. What do I mean by fiduciary? A PBM that says, I will not do anything to benefit me at your expense. And I I will disclose everything we're doing. You can see where we're making our money. Uh, I am liable for your money like you are. I'm a fidu uh capital F fiduciary. And then you can also carve out specialty and high cost maintenance drugs. And there are multiple ways to source those outside of the PBM. And we're talking about reducing the employer's cost 70 to 100%. And the employee pays nothing, no out-of-pocket, no$400 monthly copay on some of these expensive drugs. So I would start with pharmacy. And the reason for that is pharmacy includes well, first of all, everybody gets their drugs, so nobody's upset. So there is no noise. Second, there are two groups in pharmacy. One is a few people taking very expensive drugs. So to your point, Kimberly, they they are outliers, but they're very expensive outliers. And then you've got a whole lot of people taking inexpensive drugs, relatively inexpensive drugs, they're still way overpriced. Way overpriced. And so the volume of generic drugs can be cost-saved. And then the expensive drugs, not as many of them, but you're going to save a lot more money on each of those. So there's those those two separate groups. Then outside of drugs, which is actually very easy to do if you have the right administrator and the right advisor. So this goes to who is helping you run your plan. What type of health care consultant or advisor do you have? If you don't have a good one, look for one that is labeled next gen or next gen benefits because they practice these principles. And then you want to make sure you've got an independent third-party administrator that will allow you to bring in your the right pharmacy for you, the right PBM and cost containment on the expensive drugs. Now, that's pharmacy, but let's look at uh uh drugs that don't go through the pharmacy, they go through the health plan. And most of those are the infusion drugs. Can I get an amen, ladies?
SPEAKER_03:Amen. Everyone talks about J Code.
SPEAKER_00:Yeah, data more than just you're talking about J Code drugs. Absolutely. And and these these drugs, uh, I used to have I used to have an employee who before she came to work for Next Gen, uh, she was a practice manager for physician practices. And the and we're talking about like multi-million dollar, fifty hundred million dollar physician practices a year in revenue. And the last one she worked at was an oncology practice. She ordered the the oncology drugs, the infusion drugs. She knew what she paid, she knew what they charged. And the markup is unbelievable. So there are no cost controls when you are buying your oncology drugs through your through the medical plan. There's no PBM. Even if you've got a great PBM, there's nobody looking over the the uh doctor's shoulder on these drugs. So when you can get those drugs administered outside of the physician practice, you know, it's uh uh my friend uh Dr. Kristen Dickerson, uh founder and CEO of Green Imaging, uh, which is a cost-containment program for uh diagnostic imaging tests, uh, she loves to ask the question Do you know where the most expensive diagnostic test is? He goes, Well, how would I know that? She goes, Oh, it's easy. Down the hall.
unknown:Yeah, that's right.
SPEAKER_00:I've heard her say that.
unknown:Yeah.
SPEAKER_00:So when the doctor says, I need you to take an x-ray or I need you to get an MRI, take this order, hands you a piece of paper, and go down the hall. That's so convenient. To their imaging center. It's the most expensive place you can do it. There are freestanding imaging centers. Well, in the same way, if you can get the infusion drugs or the the infusion out of the doctor's office and into an independent infusion center, uh, at the very least, if you can uh source the oncology drugs outside of the doctor or the hospital, that's where you're going to save a tremendous amount of money. And the the same with uh dialysis, which is a huge cost, and it's an ongoing cost, at least infusion drugs aren't taken for years. Although dialysis.
SPEAKER_01:Although a lot of these oncolytics are becoming more maintenance, maybe not infusions as much as the orals, but they're still plenty spinning.
SPEAKER_00:That's a ketruda. Absolutely. As long as you're alive, you're gonna be taking ketruda. Yep. Uh, and so uh, but that's a that's a great point. Uh but but dialysis goes on for the rest of the patient's life.
SPEAKER_01:Uh until they get a transplant or die.
SPEAKER_00:Yeah, for years until they until they can't go on any longer. So if you can get that out, you can carve that out and and send that to a a separate vendor that is looking after the pro the cost. So you you want high quality, but that quality doesn't have to cost as much as it does. The markups are truly. Oh, absolutely. Well, here's a question for you. So many ways.
SPEAKER_01:You know, yeah, absolutely. I mean, we've had folks who are dialyzing outside of the U.S. The average, you know, build charge is about$300 per treatment, where here in the States it's like nine or ten thousand dollars of treatment. But, you know, it's interesting. So here's here's a question for you. Because you bring up where you bring up, we have we're talking about some of the easy, low-hanging fruit. When I think about I I think about pharmacy and I think about dialysis and MSK and cardiac. And dialysis has has a lot of legislative support around it, right? We've got the Supreme Court backing that's allowing the employers standing behind the employers to be able to carve these things up. Where's the legislative support in the pharmacy space? Is there any?
SPEAKER_00:I I have a friend, not say a friend, an acquaintance, who went to see Congressman Paul Ryan when when when Congressman Ryan was Speaker of the House of Representatives in Washington. He was uh a Wisconsin CEO, went to see Paul Ryan at his district office back in Wisconsin. And this CEO is very savvy on health care, and he said, Paul, you know that the ACA Affordable Care Act, for better or worse, was not insurance reform. It was it was not health care reform, it was insurance reform. Paul Ryan said, Yes, I know that. My friend said, Paul, Congress has to address the cost of health care. And Congressman Ryan looked at my friend John and said, John, Congress will never, ever, ever address the cost of health care. Now, my friend John Torinas is a CEO, he's used to getting things done. He looks at Paul Ryan and says, Why the hell not? Paul Ryan looks at him and said, John, there are four healthcare lobbyists in Washington for every member of Congress, and untold hundreds of millions, even billions of dollars available to to uh donate to you or your opponent or fund a primary opponent. The expression is will primary you run someone in the primary against you who's more favorable to their position. Congress will never, ever, ever address the price of healthcare. Well, then when they just in drugs, drugs, you asked about drugs. There's just too much damn money.
SPEAKER_01:Yeah. And the tentacles are the tentacles run so deep to your point, to the very upper chambers. So yeah, it's interesting. And where you look through history where there has been attempted legislative support for that, you just find a way to get back to the money, right? So like the MLR.
SPEAKER_00:So, ladies, the answer is money. Now, what's the question? And that's there, there is just so much money, yeah, and the people who have it want to keep it. The only changes that we're seeing, the only changes that are gonna have any impact are not legislative, right? The transparency rules, uh oh, brokers are re employers are required by law to request a compensation, a full compensation disclosure from their brokers. Do you know how often that's happening? Why it's not why? Because nobody's enforcing it. There's no teeth, there's no penalty for not doing it. Right. And if you look at the transparency around hospital pricing, hospitals have actually posted on their website, we are required by federal law to provide uh actual pricing data for all of our procedures. We feel that doing so would confuse the patient and lead to more problems. So we're going to accept the fines and refuse to do that. They're just saying, no, we're fine us. Yep. Do fine us because it's not it's not enough. Yeah.
SPEAKER_01:Or they'll tell you they post it. I recently went through this at a facility for my mom. They tell you that they're posted, you can't find it anywhere. When you reach out and you call them, nobody calls you back. You can't get any, can't get anything.
SPEAKER_00:Well, even when you put it up, it's a machine readable file. Now, I don't know about you. I've been called many things, but I've never been called a machine. Right, you need a leon. The average person can't read it, it's machine readable, whatever that means. Uh, and and the drug, the the the laws that have been passed to address PBM abuse and and drug pricing abuse, none of those have any teeth if they ever get passed. Here's what does have an impact the courts lawsuits.
SPEAKER_01:If if those fines are meaningful, to Rusty's point earlier, right? If it's not just a cost of doing business.
SPEAKER_00:Well, no, it did no, to some extent, it is just flat out of cost to doing business. Uh, this is not a drug issue, but uh one of the major insurance companies, uh insurance brokers, Gallagher, I will name this because it was a federal lawsuit, it's public record. Gallagher was sued in federal court by Osceola County School District in Florida. Yeah. Large school district, 10,000 employees. They had hired Gallagher to advise them on which insurance company should they hire to manage their self-funded plan. Gallagher agreed to their contract terms, which was we will accept your fee, I think it was around$70,000, something like that, for our services, and we will accept, according to the contract, no additional funds from any party. That was the agreement. Years later, four or five, six years later, Gallagher was dragged into federal court by Osceola County School District for taking. They had recommended Cigna in year one. They were still recommending Cygna three, four, five years later. Gallagher, according to Osceola County's charges, took four million dollars under the table from Cigna, unbeknownst to Osceola County School District. Gallagher took their high-powered attorneys, went into the federal court, told the judge, this is ridiculous, there's no basis to this, you should dismiss this. We we seek summary judgment. Dismiss it. The federal judge issued a ruling, which I have read, where she said, Um, yeah, no, there's plenty here to go to trial. We are going to trial. And Ossiola County School District is seeking damages, not just reimbursement, but damages. And damages require some additional behavior like fraud. And we feel there is plenty of evidence that that may have occurred. That was the federal judge's ruling. I read that and said, Well, they're not going to ever go to court. Gallagher will settle. And they did. Gallagher is accused of taking four million dollars under the table. They settled with Osceola County School District for$500,000. Now, I don't know about you, and then the lawyers cost something, but what were the lawyers? Let's say$500,000.$500,000 plus the$500,000 that they paid Osceola County School District. It's a million dollars. They took$4 million under the table, they netted out three. That's a pretty good deal.
SPEAKER_01:Yeah.
SPEAKER_00:Do you think that will stop them from doing it again? No, it won't. You have to keep going back and keep going back and keep going back to court. But that's the problem. It's a cost of doing business.
SPEAKER_01:Yeah.
SPEAKER_00:And so the only the Richard Branson told me when I he asked to explain uh US healthcare. So I explained misaligned incentives. That's pretty much it. He looked at me afterwards and said, You know, based on my experience, I know for a fact, companies will not change, he said, they will not change their behavior until their incentives change. Right. Um, that's tautological. Yes, of course. But it raises the question: how are you gonna change their incentives? You make what they are doing today not as profitable because you're doing it another way. So bring in the consumer. We're not gonna hire you as a fully insured insurance company. We're gonna go self-funded, and then enough companies do that where it's only the unhealthy companies that are still fully insured. Well, that's not a sustainable uh financial uh uh situation for the insurance companies. They'll have to change how they do business.
SPEAKER_01:Yep, absolutely. That's that's my polite clap.
SPEAKER_03:It's really helpful for folks to join ecosystems, a send-nection being one that is very predominant. Um, but there's you know, numerous organizations out there like Saga, the self-insured Institute of America and so forth. All of these organizations help to educate and help to create awareness in a non-proprietary form. You know, so it's it's not only accessible, but it is supportive to sharing amongst leaders and really helping to bring together business owners, I think is going to be critical because what we're seeing is goes to the hell together, you know, um hospital lobby goes to the hell together. Employers, um, broker agencies and folks on the right side of this healthcare ecosystem if they're not moving that mountain together, it will feel important and it may not have fruitful results, but it's just really important to join into that movement through ecosystems and support groups that are willing to have transparent conversations, educate and move those mountains together. And this is where we see, for example, states trying to lobby that would severely hurt the self-funded market in that area. For example, trying to be in a white bag into hospitals or facilities. I don't know a single hospital who's manufacturing pharmaceutical products have money in some problems. People work through a quality, you know, you're in ACHD specialty pharmacy is the same distribution as the manufacturer uses for patient assistance programs, for example. But we saw, you know, a big effort in states where hospitals were pushing to be in a white body and it wasn't until employees sponsored. And really said no, this would severely hurt the performance of our plan and our ability to provide high-quality, you know, insurance plan offerings to our membership, et cetera. In states where that wasn't activated, that response to combat, you'll see that it was passed. And in other states where the employer groups began to come through ecosystems and education, they've been able to ward it off. So I just highly encourage folks to get in touch with resources like next gen benefits and really become an informed party of this ecosystem. Um, and that will be a key contributor to moving things forward or keeping things at least where they're at today and not worsening the market.
SPEAKER_00:Rusty, the we we talk about the Next Gen Benefits movement, that this is not, we're not just an organization. It is a movement of diverse individuals, organizations that are banding together, banding together very loosely. We don't have membership cards, you know, we're not a membership organization. But the the idea of of making common cause and and well, if nothing else, encouraging one another, because this gets very challenging in the marketplace. Now, uh let me so my background is actually public policy. I ran think tanks, I was a lobbyist, and I know that world pretty well. The role that we have to play, the only role that we can play in the political, not the political, the public policy world, the the lobbying, the legislative, is to stop what's known as rent seeking by interested parties. Rent seeking is simply looking for a financial advantage from the legislature. So eliminating white bagging protects the hospitals and the doctor's offices uh from having their margins cut or eliminated uh on J Code drugs. You're not going to get anything good passed. Their lobby is too strong. But we can, as you pointed out, have an effect and an impact and get positive results by fighting the rent-seeking, fighting the bad legislation that sustains and reinforces the status quo. I don't and what I'm saying here is I don't want us to get off on these because I can tell you it won't be productive. Oh, let's get a bill passed to make it illegal to for the drug companies to do spread pricing, the the PBMs to do that's not going to pass. So we're wasting now. The only reason to do it is maybe to educate the butt but educate who you educate legislators doesn't make any difference because it's not going to pass. If you could educate the public around that at the same time, that's a public relations and and edge and marketing uh initiative. You don't have to go to you don't have to go to Capitol Hill to do that. So I want I want us to be realistic about our expectations so that we can we can marshal our forces and challenge our uh uh uh funnel our energy in ways that are productive.
SPEAKER_01:So fighting bad law or bad ideas, the legislature plug for ethos, Chelsea and Donovan, what they're putting out with their feature films uh to really educate employers and get the consumer arm going. I think it's so I would love to see that. I would love to be able to see that on my Roku or Netflix, where people can people can have their eyes opened and then start to demand because really our industry, healthcare, is the only industry where the consumer has no voice. Um it's kept murky by design, right? Because we don't want them to have a voice, just keep your eyes closed and move along. But some of these movements that we're seeing, I think there's so much, there's a beautiful power there.
SPEAKER_00:So did you ladies see The Matrix, the movie The Matrix?
SPEAKER_03:Oh, absolutely, Channel Reese.
SPEAKER_00:You know, um patients, patients in the U.S. healthcare system are not too different from all of those bodies plugged in, uh providing energy into the uh uh matrix and being fed images that aren't real. Yeah. That's very analogous to that because we are basically, as patients in our healthcare system today, we're basically a transaction. Without us, there is no money that gets passed. Without a patient, there's no money. Uh, but but with patients, there's lots of money. So you are you are a transactional vehicle uh for healthcare. And you they they'll tell you all so watch the Blue Cross and United and Cygna and Aetna commercials, and you go, Oh gosh, they're so wonderful. Oh, throwing the little baby up in the air and catching the grandfather. It's like, oh, I want to live a united healthcare life. So we're fed these these false images, but we're plugged into the system to feed it.
SPEAKER_01:Yeah. Yeah.
SPEAKER_00:You know, and I think fee for service. When you get a uh an a uh uh an IV or you're having blood taken, you literally are feeding the system.
SPEAKER_03:I think it's interesting that we're still paid at large as an ecosystem for fee for service, which when you think about that in any other structure, like if I need feedback to come in and fix something in my home, I understand I have a fee for the service that are there. But when you put fee for service in the concept of health care, fee for some, right? And it's it's really thinking differently to the point that Nelson made earlier in today's conversation that there are disaligned incentives until we change over the incentives, we are not going to be able to, you know, move all these mountains alone. And I think it's really interesting that we've talked about value-based contracting and healthcare as this like proverbial goal that no one has really taken, in my humble opinion, um, severe steps to actually pursue in the fully insured market or in a way that is, you know, not directed by a cell worker with a high-performing health plan with a cell funded employer group using somebody like Abe, for example. It is just it's otherwise unheard of. And I think that it's a really interesting concept that everyone just keeps speaking into this fee for service or fee for sick. Um, instead of thinking about how do we pay based on the performance control of the provider or the healthcare ecosystem. Um, and really thinking about shifting that dynamic so that way there's a skin in the game, not for you know, previous pricing or price gallaging, but actually for the clinical results and the wellness of a patient. Um I love the DPC direct primary care movement, and there are things that are moving towards this, but I have not seen those activities outside of high-performing health plans in an organization or movement like um Next Gen Benefits. It's otherwise just really unknown, unheard of, and unquantifiable within most structures.
SPEAKER_00:In in NextGen, we talk about uh healthcare revolution and that that what we're doing is revolutionary. But in fact, dirty little secret, there's nothing revolutionary about what we're doing in healthcare. It is revolutionary in healthcare, but these are practices that every company uses in every business unit in that company, except healthcare. So uh let's see, managing the quality of what we buy. Oh no, no, we don't care about the quality of those ball bearings, just find the best price. No, they have to be spherical. If ball bearings aren't perfectly round, they don't work. Are there people out there selling ball bearings that are not perfectly? Yes, they are. And you can get them for a good price, but that doesn't serve your purpose. So we look at quality and then we negotiate price. What a novel concept in healthcare. I had a conversation with a supply chain expert. He was managing the supply chain academy at uh the uh Indiana University uh business school and was teaching supply chain uh at uh to the to the graduate students, uh the MBA students. But previously he had spent 30 years in supply chain as an ex uh as a senior executive in large companies in Detroit. I called him because I was looking for someone to manage to manage and build a healthcare supply chain certification program. Get him on the phone. I tell him what I'm looking for. I'm looking for someone to build a healthcare supply chain management certification program. I'm not your guy, he said. Like that quickly. I said, Well, okay, maybe not, but can you tell me why you said that so fast? I don't do hospitals, I'm I'm in manufacturing. Oh, I'm not talking about gauze, syringes, and bedpans. I'm talking about physician visits and surgeries and diagnostic testing and drugs. He said, What are you talking about? I said, I'm not talking about what hospitals buy, I'm talking about what employees purchase in the way of health care. For instance, one of the employees, one of your former employers, will get diagnosed with a heart problem that's going to require open heart surgery. He will go to a surgeon whose quality outcomes no one checks. He will have his surgery done at a hospital where no one has looked to see if they have an infection problem or what their outcomes are for this particular surgery. And six weeks or so later, the company will get an invoice for a price that no one has seen, heard, or negotiated. He said, and I will use the initials for what he said, BS. We negotiate the price of bald bearings, he said, down to one tenth of one cent. And you're telling me no one's negotiating the price of a six-figure heart surgery? I said, that's exactly what I'm saying. He said, Can you prove that? I said, All day long. Keep talking. You know what he's doing today? He did build our certification program. Today he's calling on his old employers, asking them, What are you doing to manage your health care supply chain? And he's serving that function as a consultant. The point is there's nothing new here. It's just new in healthcare. But getting employers to break free of the current system where they delegate anything related to health care to an insurance company and a broker and then assign a line manager in HR oversight of their second or third largest operating expense is insane. But that's common practice. One CEO recently told us that healthcare is just a cost of doing business. Is what it is, cost of doing business. No, no, it's cost of getting screwed.
SPEAKER_03:I was recently speaking with a broker who was trying to explain all this to a self-funded client who's recently transitioned out of the fully insured market. And they were talking through a significant high dollar case where the claimant was going to need continual therapy for the rest of their duration, either in the plan or life. And it was an interesting point where they were discussing, I don't want to make changes to the healthcare decisions. I don't want to tell my member where to go. And, you know, I know that this is high dollars that we're talking about. It was over six figures annually year over year, but you know, I'm just I'm really not comfortable with thinking about this through the current structure. And the broker looked at him and said, you know, if this employee came to you and asked for a raise of six figures year over year, what would you do? How would you equate you to that? And they started changing the dialogue to instead of thinking about making a healthcare decision, make an employee contribution decision. And I just thought that was such an interesting way to think about it because what is spent on healthcare is part of a benefit package with compensation and other factors. And it was just, it was at that moment that the employer, I saw that going off in their minds when this discussion was happening, where I was like, that was such an interesting concept to start discussing it as part of a compensation package, not to, you know, challenge the employee who needs that type of support or help or healthcare service, but to think about it in essence of how do you control it from an employer perspective, looking at it like you would any other part of their compensation package. And I just thought that that was a really interesting view into a different dialogue.
SPEAKER_00:I I love that question. Uh and and that is gonna wake its make its way into some of my presentations. Thank you for that, Rusty. Uh another approach that I take and teach my advisors to use is to ask, because for some reason employers do consider healthcare different than anything else in their company. It's like, well, I don't want to tell my employees which doctor they can use or which hospital they can go to. Okay, well, that's that's fair, I guess. Do you do anything, Mr. CEO, CFO, to control your they call it the mod rate, which is simply the renewal costs, uh new renewal increases on your workers' comp insurance? Oh, yes, yeah, we take that very seriously. Oh, well, what do you do? Well, we make our employees wear uh uh who work in the uh certain areas, they have to wear that big black elastic belt around their waist to help secure their back and eliminate back injuries. I said, Okay, yeah, that's great. What else? Well, we we do drug testing. I said, Oh, how do you do drug testing? Well uh they they they have to urinate in a in a cup. We do a urine sample. Oh, so you make them pee in a cup. That's not intrusive at all. That's that's and so why that why are you willing to to to mandate those sorts of behaviors to reduce an insurance cost that's far less than your health care cost? All right, I'm gonna get on my my uh hottie horse here for just a moment. I believe that employers need to start, we make it voluntary now. I think employers need to mandate certain behaviors around their health care because it's not just that employee's choice and that employee's expense. That expense affects every other employee. Right. They're all subsidizing that bad decision to go to that very expensive doctor in that very expensive hospital, both of which have low quality scores, low outcome scores, poor outcome scores. So that when they have to go in for a second surgery to fix the problem the bad surgeon created in the first surgery, the health plan pays for that. They pay for the readmission to a hospital, which means the employees pay for that. Some of you, you both of you probably are familiar with Walmart's Centers of Excellence program. Absolutely. It's been around for years. Walmart and and and the late Tom Emmerich, who I had a chance to get to know before he passed away. Tom Emmerick came up with this idea. He said, We are going to send our associates to the best possible facility for the best possible care for whatever it is they need help with. So if they need heart, you had to go to Cleveland Clinic back in the day. They have regional centers of excellence now, but back in the day it was just Cleveland Clinic. If you had, I think, neurological issues. I think you went to Johns Hopkins, I think, or Mayo Clinic, someplace. But you had to go. And here's the thing: they would pay for you to fly there with a caregiver, spouse, or friend. They'd pay for your hotel, they'd pay for everything. You don't want to go to Cleveland Clinic, you want to stay here in Bentonville and go to Bentonville Regional? Well, that's fine, you can do that, but you'll be paying for the entire thing out of pocket.
SPEAKER_02:Right.
SPEAKER_00:We're not paying for a penny. We will only pay for the best care.
SPEAKER_01:Well, and look at it, look at how compassion that is, how compassionate that is. Most people, when they have to have a serious procedure done, you know, being a nurse, I've had lots of people say, Well, who should I go to? Is Dr. So-and-so good? Or what do you think of Dr. So-and-so to your point earlier, right? Most people actually want that information, right? They don't want to be told, you know, what to do. But I think when when employees understand, because they don't, right? That model where you're going to save money doesn't equate because they're used to your point earlier. More is better. So as we educate employees, that this is where the best care is, and the best care costs less. It's the exact opposite of any other industry. And I think most people, if they understood that, you know, that that was the the rationale behind, I think most people would appreciate that because they don't have any reliable way to ascertain where do I go to get the best care. But everybody's hungry for that information.
SPEAKER_00:Well, let me let me put a cherry on top of this Sunday. I was I was with Tom Emmerich at an event, and we were both speaking there, and we had a few moments of downtime, and I said, Hey Tom, how did you negotiate pricing in your Centers of Excellence program when you set that up? Did you use Medicare as a reference price? Like reference-based pricing. He looked at me with a funny look. He said, We we never negotiated price. I said, I understand that the Centers of Excellence program has saved Walmart hundreds and hundreds of millions of dollars over the years since you implemented it. He goes, That's right. Then if you didn't negotiate price, how did it save all that money? He said, Oh, that's easy. So the patient in Bentonville, who was told by his doctor in Bentonville, Arkansas, that he needed open art surgery, goes to Cleveland Clinic, and Cleveland Clinic doesn't just do the surgery, they do an exam. They're gonna do a second opinion. And they will look at him after their their tests and their analysis, and they're gonna say, Yes, we're really pleased you came to Cleveland Clinic. Now go home. You don't need open heart surgery. It's the avoided care, not the denied care, the care that should not happen in the first place that has saved us all that money. That and not having second surgeries because the doctor screwed up in the first one, not having readmissions because the patient got MERSA, because it was an unsafe infection-ridden hospital, that's where they saved money. They didn't the price was not even a consideration. High quality was a consideration. And it has proven over decades to pay dividends. The pay oh, by the way, patients are back to work faster. They don't have any complications. Show me a patient that wants to go in for a serious procedure, surgery or otherwise, and gets to go back and do it again. Show me one that says, Yeah, I want to do it again.
SPEAKER_01:Yeah.
SPEAKER_00:Right? But they want it done once and done right. What the old uh the old saying in in carpentry, measure twice, cut once.
SPEAKER_01:Or don't cut at all if you don't have to cut.
SPEAKER_00:Or in healthcare, yes. Do you even need to cut?
SPEAKER_01:Yeah.
SPEAKER_00:And that's that's where so much of health care, misdiagnosis is a huge issue. I have a whole presentation. Uh, in fact, I'm giving it in um uh where in Czechoslovakia and Prague uh next year on misdiagnosis and the value of second opinions. It's not just US healthcare, it's all it's healthcare around the world that has this problem. But misdiagnosis is a huge issue. Absolutely, and you don't catch it unless you do a second opinion. Yep. And without that second opinion, the first opinion rules, and so somebody ends up getting cut or or be or taking a certain drug or getting some procedure that's not necessary, which is often detrimental. It's not just not needed. Who wants to get cut? Absolutely. It's trauma on the body.
SPEAKER_01:Yep, you can never uncut. Absolutely. You know, Nelson, I think uh I could talk to you all night. Uh uh so Rusty, Nelson, next time we all are together, pizza and root beer on me for sure.
SPEAKER_00:I love root beer. I think it's a soft drink.
SPEAKER_01:It's not good for you, but it sounds good. Well, let me ask you this as as we wrap up, if you could, if you could, you know, what would your call to action be, so to say, if you would have an embroker, advisor, uh, an employer who might be listening, what would be one key takeaway that you would most hope that they put in their pocket to bring out at their earliest opportunity to make a difference for their plans?
SPEAKER_03:My personal suggestion would be to get a second opinion on your plan design from independent consultants that are not currently in your broker of record or agent of record basement. Um, and that just helps to bring creativity andor great discussions back if you want to continue with that current relationship, but it also holds folks to an accountable level of staying up to date and market and continuing to perpetuate education. And so I guess the same way that we're asking for second opinions from physicians for we need to think symptomatically and plan design that same way. And so I encourage more to seek out folks who are already acknowledged as excelling in that area. Again, throwing out next-gen benefits, you know, mastermind um consultants. Those are folks who have studied and essentially been credentialed in this space. Um, and they're gonna have a lot of information and ability to educate that you may not be getting currently in the market.
SPEAKER_01:That's a good one. I love that.
SPEAKER_00:That's uh that's a I actually made a note of that, Rusty. That's applying second opinion to your health plan, that's a terrific idea. You know, I think true, and this was a big, big pivot point for next gen benefits, is what what is the conversation that you need to have with the employer, and with whom do you need to have it? HR are wonderful people, but they are operational. They're they are implementation, they do not own a profit and loss statement, they are not strategic, they are not financial. Healthcare is is well, and next-gen benefits, healthcare in in terms of next-gen benefits, is a strategic financial conversation about the healthcare spend, its impact on business objectives, and managing that cost to help it achieve, help that spend achieve business objectives. That's not a conversation you can have with HR. This is a C-suite conversation, CEO or CFO. If it's a large organization, they might have a CHRO, chief human resource officer. But it's got to be with one of those three, or you're talking to the person who's who hired the incumbent broker, yeah, who doesn't know any better and doesn't have any incentive to change the way things are being done. But if you're talking to a corporate decision maker with fiduciary responsibility for the health plan as well as the company who has PL responsibility, financial responsibility, and who isn't married to the current solution? That's who they need to have the conversation with. Then ask, go in and talk about a second opinion on the on their health plan. The question uh here's a question. Uh, this is the question I would give employers or advisors to ask employers, or employers to ask themselves what are the business objectives for spending all of the money you are spending, Mr. CEO or CFO, on your health care for your employees. What are the business objectives for spending that much money? They don't know. They've never thought about it. We have to. No, you don't have to. There is a fine if you're over 50 employees and you don't offer health care. It's a lot less than you're spending on health care. Take the pay the fine, take the rest, put it in your bottom line. No, why not? Yeah, and the reasons are pretty much pretty much at universal. Retention of employees, recruitment of employees, productivity, and I want to take care of my employees. Those are the only four reasons that you spend that money.
SPEAKER_01:Yeah.
SPEAKER_00:Then ask yourself, Mr. Executive, how well your current health plan is helping you achieve those four objectives. High retention, very, very competitive in hiring the best talent, extremely productive employees, and you're really taking care of your employees with a low out-of-pocket, low deductible, low co-insurance, and an affordable premium. If you're getting all of that, congratulations. If you're not, talk to an advisor who can help you get those objectives met with your current health care, not with your current by replacing your current healthcare plan.
SPEAKER_01:So for Nelson and for you, Rusty, um, how Nelson, how do people find you? Like if they if somebody says, hey, I want to learn more about where I can find a good next gen uh type of benefit advisor, how do people find you? How can they get in touch with you and your team?
SPEAKER_00:Extremely easy. Next gen benefits, N-E-X-T-G-E, nextgen benefits.network is our home on the internet, nextgen.net nextgen benefits.network. And you can you can reach me at Nelson at nextgenbenefits.com.
SPEAKER_01:And you're all over LinkedIn, one of my favorite folks to follow too.
SPEAKER_00:Thank you so much.
SPEAKER_01:And Rusty, for folks who want to know more about um, you know, how you can help them with that lowest hanging fruit there, how do people get in touch with you?
SPEAKER_03:Yes, I would say um our website is a great initial start, and it's optimoped h.com, um, or reach out to myself, my first name, Rusty R U S T I dot Grace, G R E I S at Optimidhp.com as well as my email. And we would be honored to support just open dialogue. Um, you know, we're we're a big proponent of educating. And when you already have a great plan design or a great solution, we will be one of the first to say you are achieving, you know, a higher-than-market average or functional content crazy. Um, there's nothing further we can do with the same thought when you're reaching out to a broker. If you have a really strong broker, no one's going to be able to have a new dialogue to that conversation, but at least you've stuck an opinion. You've market checked yourself in the planned performance, and you now have the opportunity to take an education either to continue your current relationship and structure or to make changes that would be positively benefiting you and your membership.
SPEAKER_01:Amen. Um, Nelson, we can't thank you enough for taking time out to talk to us. It's it really is always a treat. Uh I always come away smarter. I still remember the first next gen benefit uh gathering that I got to go to. I asked you for a long time, am I gonna be smarter when I come away? You get it, it was guaranteed. I every time I I speak with you, I really appreciate not just not just selfishly what I learned, but really appreciate the work that you're doing to make an industry I really care about uh so much better. I mean, at the end of the day, if we don't uh if we're not working to make this industry better, someday we're gonna be sleeping in the bed that we made. And I hope, I hope that there's something good there for us when it's our turn.
SPEAKER_00:Well, coming from you and and Rusty, both of whom are doing such great work on the clinical side, and y'all are making it happen in the trenches. So I'm working with the advisors who are helping the employers do the right thing, but you all are the right thing in your business. So it's, you know, and and I'm gonna go back to something you said earlier uh about bringing clinicians into the conversation. Uh, we have found that when, and usually it's usually it's like a direct primary care doctor, is usually who we we end up going into a meeting with, but when you take a clinician into a meeting with a CEO or CFO, not HR, but a CEO or CFO, the conversation changes. It does the attitude because that doctor or nurse, you I could take you either of you in from a clinical standpoint, Deb Alt, I can take Deb in. The conversation is going to be the same. It's about why we spend the money in the first place. It's the care, it's the health care system. And you're not paying for health, you're paying for care. Yeah, and the the clinician can speak to the delivery of that care, the quality of that care, the cost of that care in ways that the advisor or broker cannot.
SPEAKER_02:Right.
SPEAKER_00:So I I strongly urge advisors to find uh a clinician, somebody who can or or someone who works with the clinician uh or clinical organization. Um Rusty, just listening to you talk, uh I mean, you really, really understand what's going on. And it's because you're immersed in that world, and you're really smart. Kimberly, you're really smart, you're a nurse, and you're immersed in that world. So you both bring an incredible amount of knowledge and expertise. So you good. I would take either one of you in to see an executive because you can speak to the speak to the problem. So being on with you guys is a thrill. Thank you for having me.
SPEAKER_01:Thank you so much, Nelson. I can't wait till we talk to you again.
SPEAKER_00:Look forward to seeing you. Uh, January Ascend in Nashville. I hope I I hope you both will be there. You should be getting information on it this week.
SPEAKER_01:Hot dog. It's coming. Gosh, it's less than a quarter. We're a quarter away.