Go to any shopping mall, garage sale or swap meet and you will see prices for any number of goods or services. Then its up to you the consumer to decide if you want it or not. This example of the free market in action somehow doesn’t apply to health care. Even though some new rules were enacted to give it some transparency, we’ll take a closer look as to how that’s going.
PLUS...health care costs are NOT just the only problem...its also how the system is run. We’ll talk to my guest who has made it his mission to disrupt the way US health care costs are determined and administered.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Follow. The profit is a production of Gingwich three sixty
and I Heart Radio. So if you go anywhere, if
you go shopping or even a garage sale, or even
if you buy something online, you're gonna see a price
right like, this is what it costs, and then it's
up to you to decide whether you want to buy
it or not. And this is something that's you know,
(00:21):
common sense, free market principles. But somehow healthcare doesn't work
that way. Nobody quite knows why. We're going to talk
about that. And even though the government is enacting some
new rules to see if they can do something about
it and make it more transparent, we still have a
long way to go. We're gonna take a closer look
at that sector and what an absolute unmitigated disaster it's become. Plus,
(00:47):
healthcare costs aren't the only problem, it's also how the
system is run. We'll talk to my guests who has
made it his mission and his company's mission to disrupt
the way we do healthcare. So really interesting and the
way they figure out how to reduce costs and make
it a win win for everyone, including employers and employees.
(01:09):
I'm David Grasso, and this is followed the profit. If
you're looking to get rich quick, well you probably shouldn't
get sick because that's really expensive. So let's talk about
(01:31):
the cost of healthcare, because this is like a hot
button issue that we probably should be talking about more
instead of these wedge issues that we mostly see in
the media. When you buy a car, it's pretty simple.
There's a price on the sticker. I mean, when you
buy a Tesla, a Tesla is a Tesla is a Tesla,
and that is the price. But you're either gonna buy
it or you're gonna walk away. And the same thing.
(01:53):
If I go into a store and a good place
like that doesn't screw around with pricing. A lot is
like the Apple store. You know what an apple product cost.
You go, you order your product, and you either want
to deliver it or you go pick it up. And
I bought an iPhone the other day and it was
and I went and I picked it up and it
is lovely, and my husband loves the gift. And this
(02:15):
happens every day across the economy, right. I made a
conscious decision to give my US dollars in exchange for
this lovely iPhone, which my husband now loves. And whether
I order a pizza or the guy cuts my lawn,
we pretty much have a price in mind. And then
comes healthcare. Healthcare is an absolute wreck. You need an
(02:37):
m r I, you go into the hospital, God forbid,
you need a transplant, Well, everything's gonna happen, and then
they're going to decide how much the service costs. And
in the meantime, you're gonna pay through the roof for
insurance unless you're on some sort of government plan, and
you're gonna get surprised billing, you're gonna get variable billing.
(02:57):
And everything is an ongoing negotiation in and it's so
out of control that the credit rating agencies don't even
take healthcare debt into account because basically everyone has healthcare
debt now because who hasn't received a surprise bill from
healthcare provider, hospital, etcetera. And meanwhile, the price of insurance
is completely through the roof. Now I pay more than
(03:20):
two thousand dollars a month in insurance because you know,
it's just the way it is. Now. My rent and
my insurance are almost the same price. This is the
world we live in, folks. So what is anyone doing
about this? Does anyone care are we too busy fighting
over whether we're liberal or conservative, or libertarian or woke
or progressive, and when really this is an issue that
(03:41):
affects all of us. Let's really talk about this. Let's
talk about transparency. Why don't we bring transparency to healthcare pricing.
Why don't we have the ability to shop around? If
my grandma needs a knee replacement, shouldn't she see that
there might be a difference between the two hospitals that
are in our zip code. Well, in January, the Transparency
(04:03):
and Coverage Law went into effect, and it was meant
to allow to have patients to have control over the bills.
And the problem is not many people now have control
over it. And prices for medical care are like all
over the map. So let's talk about like something. We
all take ibprofit advil. One pill on Amazon costs two cents.
(04:24):
You got a CBS is a lot more than two cents,
But hospitals charged sixty dollars for that same IB profit
and insurance companies step in and they say, well that
ib profans not sixty bucks. We're going to talk to
the price down to free, and then they renegotiate, and
you know, the hospitals come up with these inflated prices
and the insurance companies fight them to bring down the price,
(04:46):
and in the end, the consumer gets screwed because our premiums, deductibles,
and co pays just seemed to always be going up.
But the problem is, this new transparency rule isn't really
shaking out because no one really knows how to figure
it out. Hospitals make it difficult to find pricing, and
once you do, prices are not simple to determine because
(05:08):
the price of something is perhaps covering for losses elsewhere.
So one journalist actually went out and tried to price
out an m R I between hospitals, and one wanted
three and the other wanted two thousand dollars. This is
an identical procedure. And oh, I mentioned one more rule.
So the transparency rule only applies to hospitals. It doesn't
(05:30):
apply to our patient clinics in doctor's office. But don't worry,
a new rule will be implemented. It will require insurance
companies to provide a quote unquote good faith estimate to
patients to know more before they receive medical care. Well,
I'm gonna believe that when I see it, because right now.
What we have is a situation is that we are
terrified of interacting with the health care system. In every
(05:52):
American's brain, there is a fear of going to the doctor,
not because we might find out we have a health problem.
In fact, technologies progress so much that you know it's
probably solvable. Right. We have some of the best solutions
in the world, the best innovation. If even if you
have a rare cancer or you know, some sort of disorder,
there's probably a therapeutic for it or even a you know,
(06:14):
a solution for it. No, we're not afraid of that.
We're afraid of the cost. And no one seems to
advocate for you when you walk into that situation. And yeah,
these these people are you know, the Washington's doing this
transparency rule. But the incentives are all in the wrong place.
Follow the profit. The hospitals want to charge the most
(06:34):
they can, and they really control what's going on. And
there's market concentration. Right. Do you think pharmaceutical companies are
interested in making less money? Probably not, And that's their right,
that's their right to maximize their profit. Whether all these
organizations are not making a cardinal sin and maximizing their
profit who is asleep at the wheel is the regulator.
(06:58):
The regulator is supposed is to play a role in this,
and that doesn't mean socialize all of healthcare. We want
to keep the best of the private system while giving
people who cannot afford health insurance a chance at receiving
the proper health care they need. So this is where
the conversation about healthcare comes off the rails. It's neither
left wing nor right wing. It's going to need a
(07:18):
healthy mix of both left and right wing ideas in
order to really make this work. And ladies and gentlemen,
the stakes are high. Healthcare is almost a fifth of
our economy and it affects every single one of us,
and the cost of care seems to be something that
no one seems to be willing to confront. And that
is going to be one of the greatest challenges of
(07:41):
our time is figuring out how Americans can have access
to good, quality and affordable medicine without any of the
politics and really doing the right thing is going to
be extremely challenging because right now, all the incentives are
in the wrong place. We're gonna take a quick break here,
(08:05):
be right back. If you ask people what would be
the one thing they would like to have for their
entire life. You'd be surprised by the answer. It's not fame,
it's not fortune, and it's not a thousand shares of
apple when they first started and they had their I
p O asillion years ago. It's actually good health. And
(08:26):
in order to have good health, you need to be
in good health. If you think back a few hundred
years ago, healthcare and overall hygiene was fairly limited. And
if you look at medical history here in the United States,
the first medical society was formed in Boston in seventy five,
and the first hospital and medical college in Philadelphia a
few years later in seventeen, and really in sev get this,
(08:49):
those a prepaid healthcare system and it charged people who
went to see twenty cents a month to ensure against
sickness and disability. And over the decades, health insurance was
available for war veterans certain industry workers, but whenever a
compulsory or a required healthcare system was proposed, plenty of
(09:10):
people came out of the woodwork to fight against it.
And despite that, there were some advances. Employers sponsored healthcare
took hold during World War Two, with someone who's still
a big player. I have a friend of mine who
works over there Kaiser Permanente, and seriously, employer sponsored healthcare
is one of the greatest success stories in American healthcare.
And then we have the more socialized versions of healthcare
(09:32):
that exists in our system, which came during the Great
Society Programs of the nineteen sixty from President Johnson, which
we now know as Medicare, which is of course for
old people, and Medicaid, which is for low income people. Today,
healthcare and health insurance in the US is a big
part of our life and it's our economy folks somewhere
(09:53):
between eighteen. But it's a huge mess and people want
to fix that. So to talk about healthcare, which is
a lot to impact. Steve Presser, he works for Benny
coomp Health Solutions. He's looking too, along with his team,
disrupt the health care industry, just like Netflix, Uber or
Airbnb have done in their field. Healthcare is the number
(10:16):
one social impact in the US and it's the sixth
largest industry as it pertains to gross domestic product. It's
larger than education and military combined. And people always talk
about the military industrial complex, but they never talked about
the biggest complex you've never talked about, which is, of course,
the healthcare complex. And that's what Steve is here to
(10:38):
talk about. How you doing today, Steve, I'm doing well.
How are you good? So healthcare is something I care
a lot about, not only because I was a sick
child constantly and had to go to the doctor law,
but also my parents are healthcare professionals. How did you
fall into one of the most challenging corners of the
economy healthcare? Well, and that's kind of a bizarre story
(10:59):
because I had my undergrad and art and business and
got my masters in three D animation. But my father
was a software developer, owned his own company, and he
built systems to run hospitals and surgery centers. And so
I think that I grew up in that space. And
then as I was doing animation and multimedia projects, I
(11:20):
found a niche inside of healthcare. And Bennekomp was one
of my first clients almost twenty years ago, and I
reconnected with them about five or six years ago when
I sat down and decided that I needed to forge
a path for the rest of my life, and I
came to the conclusion that it was going to be
in health education and technology and this just was, you know,
(11:43):
a wealth time thing, you know, in my lifetime and
with benecom. So let's talk about healthcare in the United States.
It's kind of this like mess that's free for some people,
really expensive for others, subsidized for certain employees. So how
do we even make sense of this whole mess? We
know something's wrong, but we really don't know what to
(12:06):
do about it. And that's a loaded question, right because
as you said, it's a huge mess, and there are
so many moving parts. It's an incredibly complex space. So really,
then if you were to fix health at the like
at the most simplest level, you would have healthy people.
And if you had healthy people, then you wouldn't have
(12:27):
a whole lot of health problems. So I think at
the root of it where we've gone wrong is we've
built an entire system around diagnosed and prescribe and wait
until people are sick, and we've lost focus on looking
at health preventively and making sure that we have healthy
people in society. And there's a big cost motivator to this.
(12:48):
An ounce of prevention prevents a pound of pain or
some sort of saying that I'm messing up. Can you
tell us a little bit more about that? So I'll
give you an example. One of the things that we
do is we will do annual health screenings for our
groups and we get about participation in those screens. When
we do that, we see almost all of the pre
(13:10):
diabetics and the unmanaged diabetics. Those pre diabetics are sometimes weeks, months,
and maybe a couple of years away from becoming a diabetic,
which is somewhere between ten and fifteen thousand dollars a
year for the rest of life. It is. I don't
want to say it's very easy, but it is significantly
(13:31):
easier at a pre diabetic stage to adjust your diet
and exercise and never become a diabetic. So you've now
saved the health system hundreds of thousands of dollars and
like that. There are so many diseases and conditions, whether
it's mental health or physical health, that preventive health can
(13:54):
actually help you from going over the cliff. It actually
seems like our health care system is designed to do
the opposite. Like once you fall in and you go
off the cliff, it seems like there's a lot of
incentives to just throw everything in the kitchen sink at
these problems, but not solve the actual problem. Yeah, and
you're pointing out, I mean, there's so many problems within
(14:15):
the health care industry. But but what you said is true.
There's a couple of things that I think we don't
do very well in the United States because things are
so expensive and there's a huge lack of transparency. People
are terrified to see the doctor because they don't know
if they open that door to the hospital or the
surgery center, whatever happens to be um if they're going
(14:37):
to end up with a hundred thousand dollar bill. And
so what happens is they just let things go on
until they reach that point where it's like, oh my gosh,
I am so sick or it's so apparent that I
have some major problem, I'm now going to rush the er.
It all goes back to what you said before. But
we really need to find ways to educate patients and
(15:00):
then make it easy for them to take those first
steps weekly, monthly, annual steps towards living a healthier lifestyle.
So what do you do at your company to disrupt
the healthcare industry? Because the healthcare industries kind of run
like a cartel like, you have these insurance companies, and
then you have these hospitals that have their territories. And
(15:20):
I'm not saying any of them are immoral actors or anything,
but they definitely control their little slice of the pie.
So how do you disrupt something where never mind trying
to get a slice of pizza, the pizza has already
been sliced up and eaten by all these actors. Let's
point out to pretty obvious sides. You have the side
of the providers, you know, the hospitals and the and
(15:42):
the doctors, who are trying to charge as much as
humanly possible. And then on the insurance side and the
employer and employee side, they're trying to reduce the costs
and get the best care. And which you end up
with is a system built largely around origin as much
as possible, and then fighting those charges and trying to
(16:03):
lower cost the approach that we take. So we we
certainly do our due diligence and partner with the best
vendors in the country on the cost containment side. But
I think what we do differently than everybody else. We
do these annual health screenings where we achieve participation in
those annual health screenings, and then we receive all of
(16:26):
that underlying blood data so that we can see these
underlying health risks that people aren't aware of, and then
we approach that when they are early and much more affordable.
We offer free health coaching for all of those employees,
so they're not worried about opening that door and getting
(16:46):
a hundred thousand dollar bill. They can instead start talking
to a healthcare professional at no cost to them. So
I think what we do differently is is rather than
focus on cost, we focus on cause and prevention. So
who pays you exactly? Is it insurance companies? Is it employers? Like,
what is your revenue model? We work with larger employer groups,
(17:08):
which could be anywhere from you know, thirty or forty
employees up to thousands, who are offering healthcare to their employees.
These are usually the employers who have seen year over
year these massive increases to where it's become so unaffordable
that they've now had to then pass those monthly premiums
(17:29):
to their employees, you know, a large percentage, and then
they continue to raise the deductible and they do everything
that they can to try to offer at least some
benefit without bankrupting the company. So those are the employer
groups that we work with. They are our clients, but
then our focuses on their members. And you know, despite
(17:51):
what some people may think, almost every employer group that
we have ever talked to cares deeply about their employees
and they want to offer the best possible healthcare. They
just don't know what's possible, what's out there, and they
can't afford it. When they come to us, we sit down,
we show them things that they didn't even know it
was available, and then we put together a personalized, customized
(18:16):
health plan that's right for the health of their population.
We're gonna take a quick break here, be right back.
I understand your business now better, but I guess I
want you to step away from your role, Steve, and
let's talk more about the grand scheme of health care
in this country and really put on your personal Steve
(18:38):
hat instead of your corporate hat. If this is such
a pervasive problem, why is everyone putting up with this?
And at this point I can tell you from the
healthcare provider side, because my parents that's their business, as
is my brother, as are my uncle's. That's our family business.
My grandma's a nurse. Like that's I'm like the only
one who is in a medical professional. Our reimbursement rates
(18:59):
are going down on the medical side, and then from
a consumer standpoint, my insurance is more expensive than ever.
So this podcast is called follow the Profit. Where in
tarnations is all this profit going the nurse and the doctor.
That's really not where it's going on the provider side,
it's those hospital systems. So let's say you're an E.
(19:19):
N T doctor and you were providing a service, you
were putting in tubes for kids or something like that.
It might be on a Tuesday and Thursday, it might
be two thousand dollars, and on a Monday, Wednesday, Friday
it's six thousand dollars. And why would that possibly be
because on Monday, Wednesday Friday they're in the hospital. So
(19:40):
what you've seen is a huge consolidation of surgery centers
and providers inside of large hospital systems. So there is
a pretty big expense there. And then what you're alluding
to is the repricing on the insurance side of taking
on all those bills. You know, you'll get a hundred
(20:01):
thousand dollar bill and then you'll reprice that down to
five thousand dollars or something. You'll look at what medicare
pricing is and try to do a multiple of that.
So there's waste, certainly on the providers side, But it's
it's not what people think. They think that these doctors
and nurses are are getting rich, and it's it's not
(20:23):
that it's a that people are going to the emergency
room or hospital systems to get care, and it's it's
not the most cost effective way to get that care.
You don't want to go to the er when you
have a cold, So you would think that there's balance
in our system. So if people are using the e
(20:44):
R as there, you know, basically first h touch point
with the health care system, wouldn't insurance companies be concerned
about this and try to introduce preventative medicine And wouldn't
it behoof I've been a client to Florida Blue forever
since I was born. Like, they're a great insurance company.
What did it believe them to help promote you know,
(21:04):
good health among their policy holders. Absolutely, and that is
actually one of the biggest things that we do is
work on communication education, move people to tell medicine as
an example, which is an amazing tool UM that is
now shot through the roof since COVID hit. It's been
around for several years, but it's really become more popular
(21:25):
in the last fifteen months or so. And then UM
we try to push them to their primary care doctor
if that's the appropriate place. UM and and the what
I'm describing as member advocacy, So you'll you'll start to
see UM much more intelligent member advocacy across the board
(21:46):
to avoid people going to the wrong place and getting
expensive types of care. But even as just I'm a
member and I don't feel like I've been manhandled by
my insurance company. But you know, here in the state
of Flora, uh, if I go to the hospital, they
can send some out of network doctor into my room
and then I get some surprise bill later. In New York,
(22:08):
they can't do that to me because there's a law
against it. Why don't we have nationwide rules about the
cost of health care and specifically it's different prices for
different folks. There's no transparency. It's like walking into a
store and not knowing the price of anything. And it's
even worse you walk out with the merchandise and you
(22:29):
still don't know what it costs, and you might pay
and then you might have to pay again in the future.
So how is that allowed when it's if I did
that as a media company, or as a car dealership
or as you know, a widget salesman, I would be
immediately shut down. Yeah, what what you're saying is crazy.
(22:49):
It's like you're going into a hamburger joint and asking
for a hamburger and saying how much is this and
that they say, well, we'll let you know, and then
you at a bill for you know, but on a
different day, depending on where you went, it might be
six dollars. So that that is one of the biggest
problems in the United States. You said earlier, why isn't
(23:12):
there a national pricing system, Well, there is. It's it's
called Medicare. So they have on a national level decided
what fair pricing is. And it's it's so difficult because
what you'll find is some of those receipts that you
see where providers, you know, the physicians, will post on
getting paid less than minimum wage because of how Medicare charges.
(23:37):
But but that is, you know, a national pricing system,
and what you will start to see is several companies
Hours included will work with reference based price vendors. And
what that means is they're looking at medicare pricing and
charging a hundred of medicare as an example, so they're
(23:58):
actually charging what more more than what has been recognized
as nationally fair pricing. But they're looking at a moving
in that direction so that there is some consistency around
pricing and some transparency. But Steve, this is so pervasive.
I'll give you an example. My doctor in New York
is so much better than my doctor down here. I
(24:19):
will replace her. And she's an endrochronologist and she works
at this group practice. It doesn't matter if I pay
my copay. They send me a bill for my copay.
They try every time to double price me for the
copay and I've never fallen for it. My husband fell
for at once and I said, honey, please don't pay this,
and then you call the office and they go, oh,
(24:40):
this was an error, really an error ten times. So
if my mother did that as a chiropractor and consume
me Florida, I think the patients would go away. But
somehow people do this and it's allowed. And by the way,
everybody does this. It's like they try and and credit
rating agencies don't even healthcare debt seriously anymore. If you
(25:02):
don't pay your healthcare bills, you can still get a mortgage.
So clearly the entire healthcare system in terms of billing
is wacky and out of control. Where is Washington on this?
Where is my congressmen? Like? Where are the regulators? Why?
Why haven't we done anything about this? I think that
we are. They are trying to remove surprise billing. They
(25:25):
are trying to make it illegal to balance bill patients.
It's something that we've been fighting for years. I think
that they're moving in the right direction. But everything that
you're saying is true and I completely agree with it. Um,
we we fight this on a daily basis. So we
constantly get these bills and find out that the patient's
been double billed, or we get some outrageous pricing. We
(25:48):
lower the bill to something that that is nationally recognized
as a fair price, We pay the bill based on
the reprice, and then those the hospital system or whoever
it may be, will turn and balance bill the patient.
And so then we've had to put measures in place
to say, if you ever get this balance Bill, send
(26:09):
it right back to us. We will put a team
on this. You will never have to deal with it. Um,
these are some of the measures that we're taking. But
you're not wrong. I mean, what you're saying is is
completely true. It's but it's all over the place, Steve.
At Walgreen's, if I go one day, they charge me
a dollar for my medication, the next day it's five.
If my husband and I go to the same clinic,
(26:30):
we have the same insurance, somehow we get charged different copays.
And I'm like, honey, we are the same we are married,
we have the same healthcare plan. We are here for
the same thing, and somehow you're charging us different copies.
How he is does any of this past muster? No
other best Buy can't do that to you. How does
(26:50):
you know City m D in New York do that
to you? I don't. I don't get it. I also
don't get it. I think that some of it has
to do with just know this extreme complexity, and you
have people hired on the provider side who their entire
job is to find out how many different codes they
can charge and up charge, and then they'll max out
(27:13):
all those prices. Knowing that those prices are, that that
that bill is going to get to the insurance company
who's gonna look at it and say, okay, this is
going to take us a wilder review. But you know
this shouldn't be on there, This is miscoded, This needs
to be repriced. And and so what you're doing is
addressing a major problem that we deal with on a
(27:35):
daily basis. What you're asking for is, you know, how
do how do we fix this? And and really the
only thing that I can think of is removing a
lot of the complexity, you know, saying that is medicare
fear pricing? And if it is, then let's agree on
this as the standard rather than what's the relationship that
(27:58):
anthem has with these doctors, what's the relationship that signal
has with these doctors? And then let's let's figure out
like it, is there some sort of system in place
that that can reward you know, we've we've done accountable
care organizations and things like that, you know, tried those
in the past, But is there a way to to
(28:19):
reduce sending in as many codes as possible and trying
to up charge for every single service? And if I
knew the answer, and if and if someone else knew
the answer and could make this simple, then we wouldn't
have this issue. But it is incredibly complex. There's no
way to make everything black and white. They tried to
do that by going from their I c D nine
(28:41):
codes to the I c D ten codes, which I
c D nine might have been hit in the head,
and then I c D ten might have been hit
in the head by duck. This is really you can
look it up, um, but it's what they try to
do is say, let's get super specific and in in
some ways that helped. In other ways, that added eight
oats and you know, CODs, and you had to to
(29:04):
now deal with several more codes and and hire more
people to review all of those thousands of codes. Oh,
I've heard all about I c D ten from my mother,
so I know all about that. And they just have
a computer software that pulls up the code. So I
understand why the providers have to play that game. It's
just I'm just annoyed as a consumer that I have
(29:24):
to deal with this. So I guess I'd be amiss
to not talk about. Let's say I'm diabetic, my friend
owns a pharmacy and we've created some of these measures
called pharmacy benefit managers, and they were supposed to control costs,
and in fact they facilitate the inflation of costs these days,
So a lot of times in healthcare, when we try
to do something, it actually produces the opposite. Like Obamacare
(29:47):
intended to help control the cost of healthcare, and it
actually made the cost of healthcare go up. So how
can we make sure that like we're trying to fix
it and not break it even more? Which it seems
like every time we try to control something or or
try to do anything with healthcare or try to change
it in any way, it actually makes it worse. Yeah, well,
(30:07):
and what you said is is really true. So take
Obamacare is an example where before and I don't know
if you if you go back and you can remember this,
but you might have health insurance and your and it
might max out at five thousand dollars and next thing
you know, it shoots through into the millions in your
(30:28):
bankrupt What what Obamacare did was say no, we're you know, unlimited,
there is no max. And of course that was great
for all of these members who were becoming bankrupt, but
then they had to take all those massive bills, spread
them across the entire population, and what it did was
it raised the bills for everyone. That's an example of
(30:48):
trying to end in succeeding in fixing a problem, but
creating several other problems. Right. And I don't think and
let me stop, so I don't get Hey, I don't
think anyone was against denying people or denying people with
pre existing conditions was morally wrong. So I think everyone
was for these reforms. I just no one understood the
(31:09):
cost of these reforms. Yeah. Well, and and some of
those things, you know, like pre existing conditions, there are
some things that are a little tough. Like, for example,
if if you went to get car insurance, they would
look at your history, right, But let's say you, you know,
they treated everybody equally, right, and they just gave everybody
the same car insurance, and then you jumped in the
(31:31):
car and then just started ramming into trees every week
because you had a big pickup truck and you thought
it was fun. Well, it's all right, you know, the
insurance is just going to cover it. And there's rules
in place for these these kinds of people, these let's
call them bad actors, who are ramming into trees every day.
And that's in some ways, We've got a lot of
(31:53):
people who have fallen victim to that where it's like,
you know what, um it is, what it is. The
insurance is just going to cover this though. I'm going
to get a really low deductible and then it really
doesn't matter what I do, It'll just be covered. And
I think that that's a bad approach. You know that.
That's why you need to have this good driver discount.
That's why you need to focus on prevention and put
(32:15):
measures in place so that that we do our best
as a society to not be rammn into trees every week. Right, Basically,
with Obamacare, you're charging the guy with the red Lambeau
and the blue keya the same thing because there's no
such thing as as pre existing anymore. So it creates
some incentive issues. But what about this whole idea that
(32:38):
healthcare is a right though, Steves, So, we don't want
people dying in the streadat obviously, So how do we
balance these market first reforms without like socializing everything? Like
our neighbors are friendly neighbors in Canada and basically every
single European country, Western European countries. Yeah, you know, so
one of the things that we've talked about is using
medicare as a standard pricing, you know, or some some
(33:01):
measure of of medicare as the standard pricing. I completely
agree with you healthcare. You know, everybody should have healthcare,
and I think the answer is to continue to get smarter,
to to look at the biggest areas of waste. Um,
if you've got somebody that's getting those ear surgeries and
one of them is costing with the same provider, one
(33:22):
of them is costing, you know, in one place, and
it's costing five thousand dollars in a in another place,
there has to be standardized pricing. And I don't know
if that's demographically would make sense. You've got people who
are trying to run the same sort of practice, but
it's different to run it in New York versus a
(33:43):
small town Indiana. Right. I think those are some of
the ways I think that you in general, Um, you
have to create standards, but you have to simplify the process,
and you have to work like crazy to make everything transparent. Yeah, Steven,
let's talk about that though, because there are some pluses
(34:03):
to the American health care system right when people get
really sick from Canada and from the UK, they come
straight here. So and if you talk to UH, I
have the unique experience of living amongst many British people
here in Florida, and they tell me that they live
here half the year, but they make sure that they
have the baby here not there, because they say it's
a horror show in the United Kingdom. But then you
(34:25):
talk to other people and they love the system over
there because it's free or free you know air quotes.
How do we harness the best of those right to
make sure that everyone's covered, but additionally that we don't
lose that innovation that we have here in the United States,
which has made us have in some ways the best
health care system in the world. Yeah, it's it's a
(34:45):
great question. And I don't know if there's some hybrid
form where we continue, Like some of the things that
we've done is subsidized healthcare, So you know, based on
on how much somebody makes, they may pay less for healthcare.
The government subsidizes some of those things. But in general
(35:06):
I think that what you need to do is focus
on cost containment strategies, prevention, and then there may be
something where you get a standard of care, but if
you need some innovative, high level, expensive type of care,
you know that you're going to be paying extra or
ensuring extra for those types of of uh innovative places. Well,
(35:32):
in most cases in nature, hybrids too better. So that
would make sense instead of talking about completely socializing healthcare
having a completely private market. So I'd like to finish
this off by talking about the future of healthcare because
that's really like what you all do every day. So
you're in Tampa, Florida, which I've written many op eds
about this. I'm a Central Florida resident. I feel like
(35:53):
the demographic future of this country is in this region.
So welcome to the party. But you guys are also
talking about how how health care needs to be different
and how and you're doing the hard work every day
making healthcare different. So tell me a little bit about that.
So what we do is we work with employer groups.
We take the time to listen to their needs. They
tell us about their populations because every population is not
(36:15):
the same. You know, you do have some populations where
you have but predominantly young employees who are healthy. Let's
say that you're working with a set of gems or
something like that. And then you have other populations where
based on their lifestyles, maybe their truckers or something like that,
you have an unhealthy population. So one of the things
(36:37):
that we try to do is personalize our healthcare offer
offering based on the makeup of the employer group. We
also try to look at, as I alluded to, medicare
pricing when it's the right fit, which is a good
cost containment strategy. We have tried to push technology with
tele medicine and other tools like that. Mental health has
(36:58):
always been very important, but I think it's been extremely
recognized since COVID hit. We've seen it in our data.
It's it's become a massive issue and and something that
we need to continue to strategize about inside of the
health plan. And then one of the biggest things that
we do is we have outcome based deductible incentives where
(37:20):
somebody can earn from you know, as an example, a
three thou dollar deductible down to zero dollar deductible based
on an annual health screening. But when we do that,
we receive all of the underlying health data inside of
their blood screening and then proactively engaged with our preventive
health management team, which is so much more cost effective
(37:42):
than sending everybody to a hospital or sending everybody to
get that blood screening at a hospital where it might
be twenty times more expensive. So through that data, you're
learning how to make better healthcare decisions in the future.
Correct And by opting into this ecosystem, you're using these
people's own healthcare challenge is to inform future decisions. Is
that correct? Absolutely? And and it's personalized based on the population.
(38:05):
So as an example, we might do an annual health
screen on a population, get the data back and find
out that they have almost no smokers, so it's not
as important to push huge smoking cessation programs for that population.
At the same time, we might find that they have
a huge number of pre diabetics or unmanaged diabetics. We
(38:27):
would make diabetes management one of the core focuses for
that population over the next year or two. So it's
very personalized and it's and it's very preventive. We're looking
at the data and we're making smart decisions based on
those populations and letting employer groups know that they actually
have a say in their healthcare. They can choose what's
right for their population. Well, that's really fascinating because it
(38:50):
seems like it's always boiler plate, especially the bigger the
company gets. It's like, oh, you shouldn't smoke, and oh,
you shouldn't need sugar, and oh like if you go
to the gym, we'll give you you know, I don't
know what, and and it seems like it's very boiler play.
And obviously for a personal training, you know, a crunch gym,
(39:10):
you're not gonna need to to push the health they're
working out component. You're gonna probably need to have a
good relationship with some physical therapists and chiropractice because they're
probably in pain. It's it's the such a big problem
in healthcare where it's one size fits none, and it's oh,
here are three boxes, you have to fit in one
(39:30):
of those. And so that's one of the major things
that we work on. And then what you were saying
about wellness, which is funny, it's but it's you know,
I think that these wellness companies have tried really hard
to show a good return on investment in the biggest
problem overall is they're giving all of these crunch gym
memberships and everything else, like that as one of the incentives,
(39:53):
But do you know who uses those that already worked?
So that is one of the biggest Like at our company,
we don't provide a gym membership because I run it
and I already have one, so it'd be like, oh, thanks,
Like you know, imagine, it's like, oh, and what we're
gonna do with a five K? Who runs the five k?
It's all the people who already run five ks, and
(40:15):
they're like, oh, thank you, You're paying for the five
K that I would have paid for anyway. And so
what we've done to change that is create a tool
that addresses the right audience. So once you get those
results back, it's like, hey, let's focus on those on
the people with high blood pressure, or let's focus on
those pre diabetics and diabetics and not just blanket give
(40:38):
everybody five k's and and let's count your steps. Yeah,
well that sounds like it makes too much sense. But
in healthcare it seems to be down as up and
up as down and money is a suggestion, and I
wish it were different, Steve, but it's not. Well, unfortunately,
and it's like the race straight into the gutter with healthcare.
But it's big well because the insurance company is bad,
(40:59):
the spitals bad so, the providers bad so, and in
the end we're the ones left holding the bag. And
I I have nothing but the greatest respect for insurance companies, hospitals,
you know, providers, but it seems like the summation of
all of this is just a terrible healthcare system. So Steve,
thank you so much for your time. All the best
(41:20):
to all of you at Benny Camp over there in Tampa, Florida.
Thank you, smush, David, and thanks to all of you
for joining me as we Follow the Profit. And a
big thanks to Steve Pressor over in Tampa, Florida from
Benny Comp. We really appreciate his time and that was
a great conversation and a shout out to our team
(41:42):
of producers and Meleano Lemon, Scott Handler, Cheyenne Reid and
new King Rich and Debbie Meyers. I'm your host, David Grosso.
If you like the show, give us five stars and
give us a review so that others can learn what
this show is all about. Follow the Profit is a
production of Being Ridge three sixty and I Heart Radio
for More podcast for my Heart Radio because it the
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(42:10):
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or another medium. You should not treat any opinion expressed
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(42:30):
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Productions nor its affiliates and or subsidiaries warrant its completeness
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(42:52):
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(43:13):
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(43:34):
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(43:55):
seeking advice from your own financial or investment advisor.
Follow. The profit is a production of Gingwich three sixty
and I Heart Radio. So if you go anywhere, if
you go shopping or even a garage sale, or even
if you buy something online, you're gonna see a price
right like, this is what it costs, and then it's
up to you to decide whether you want to buy
it or not. And this is something that's you know,
(00:21):
common sense, free market principles. But somehow healthcare doesn't work
that way. Nobody quite knows why. We're going to talk
about that. And even though the government is enacting some
new rules to see if they can do something about
it and make it more transparent, we still have a
long way to go. We're gonna take a closer look
at that sector and what an absolute unmitigated disaster it's become. Plus,
(00:47):
healthcare costs aren't the only problem, it's also how the
system is run. We'll talk to my guests who has
made it his mission and his company's mission to disrupt
the way we do healthcare. So really interesting and the
way they figure out how to reduce costs and make
it a win win for everyone, including employers and employees.
(01:09):
I'm David Grasso, and this is followed the profit. If
you're looking to get rich quick, well you probably shouldn't
get sick because that's really expensive. So let's talk about
(01:31):
the cost of healthcare, because this is like a hot
button issue that we probably should be talking about more
instead of these wedge issues that we mostly see in
the media. When you buy a car, it's pretty simple.
There's a price on the sticker. I mean, when you
buy a Tesla, a Tesla is a Tesla is a Tesla,
and that is the price. But you're either gonna buy
it or you're gonna walk away. And the same thing.
(01:53):
If I go into a store and a good place
like that doesn't screw around with pricing. A lot is
like the Apple store. You know what an apple product cost.
You go, you order your product, and you either want
to deliver it or you go pick it up. And
I bought an iPhone the other day and it was
and I went and I picked it up and it
is lovely, and my husband loves the gift. And this
(02:15):
happens every day across the economy, right. I made a
conscious decision to give my US dollars in exchange for
this lovely iPhone, which my husband now loves. And whether
I order a pizza or the guy cuts my lawn,
we pretty much have a price in mind. And then
comes healthcare. Healthcare is an absolute wreck. You need an
(02:37):
m r I, you go into the hospital, God forbid,
you need a transplant, Well, everything's gonna happen, and then
they're going to decide how much the service costs. And
in the meantime, you're gonna pay through the roof for
insurance unless you're on some sort of government plan, and
you're gonna get surprised billing, you're gonna get variable billing.
(02:57):
And everything is an ongoing negotiation in and it's so
out of control that the credit rating agencies don't even
take healthcare debt into account because basically everyone has healthcare
debt now because who hasn't received a surprise bill from
healthcare provider, hospital, etcetera. And meanwhile, the price of insurance
is completely through the roof. Now I pay more than
(03:20):
two thousand dollars a month in insurance because you know,
it's just the way it is. Now. My rent and
my insurance are almost the same price. This is the
world we live in, folks. So what is anyone doing
about this? Does anyone care are we too busy fighting
over whether we're liberal or conservative, or libertarian or woke
or progressive, and when really this is an issue that
(03:41):
affects all of us. Let's really talk about this. Let's
talk about transparency. Why don't we bring transparency to healthcare pricing.
Why don't we have the ability to shop around? If
my grandma needs a knee replacement, shouldn't she see that
there might be a difference between the two hospitals that
are in our zip code. Well, in January, the Transparency
(04:03):
and Coverage Law went into effect, and it was meant
to allow to have patients to have control over the bills.
And the problem is not many people now have control
over it. And prices for medical care are like all
over the map. So let's talk about like something. We
all take ibprofit advil. One pill on Amazon costs two cents.
(04:24):
You got a CBS is a lot more than two cents,
But hospitals charged sixty dollars for that same IB profit
and insurance companies step in and they say, well that
ib profans not sixty bucks. We're going to talk to
the price down to free, and then they renegotiate, and
you know, the hospitals come up with these inflated prices
and the insurance companies fight them to bring down the price,
(04:46):
and in the end, the consumer gets screwed because our premiums, deductibles,
and co pays just seemed to always be going up.
But the problem is, this new transparency rule isn't really
shaking out because no one really knows how to figure
it out. Hospitals make it difficult to find pricing, and
once you do, prices are not simple to determine because
(05:08):
the price of something is perhaps covering for losses elsewhere.
So one journalist actually went out and tried to price
out an m R I between hospitals, and one wanted
three and the other wanted two thousand dollars. This is
an identical procedure. And oh, I mentioned one more rule.
So the transparency rule only applies to hospitals. It doesn't
(05:30):
apply to our patient clinics in doctor's office. But don't worry,
a new rule will be implemented. It will require insurance
companies to provide a quote unquote good faith estimate to
patients to know more before they receive medical care. Well,
I'm gonna believe that when I see it, because right now.
What we have is a situation is that we are
terrified of interacting with the health care system. In every
(05:52):
American's brain, there is a fear of going to the doctor,
not because we might find out we have a health problem.
In fact, technologies progress so much that you know it's
probably solvable. Right. We have some of the best solutions
in the world, the best innovation. If even if you
have a rare cancer or you know, some sort of disorder,
there's probably a therapeutic for it or even a you know,
(06:14):
a solution for it. No, we're not afraid of that.
We're afraid of the cost. And no one seems to
advocate for you when you walk into that situation. And yeah,
these these people are you know, the Washington's doing this
transparency rule. But the incentives are all in the wrong place.
Follow the profit. The hospitals want to charge the most
(06:34):
they can, and they really control what's going on. And
there's market concentration. Right. Do you think pharmaceutical companies are
interested in making less money? Probably not, And that's their right,
that's their right to maximize their profit. Whether all these
organizations are not making a cardinal sin and maximizing their
profit who is asleep at the wheel is the regulator.
(06:58):
The regulator is supposed is to play a role in this,
and that doesn't mean socialize all of healthcare. We want
to keep the best of the private system while giving
people who cannot afford health insurance a chance at receiving
the proper health care they need. So this is where
the conversation about healthcare comes off the rails. It's neither
left wing nor right wing. It's going to need a
(07:18):
healthy mix of both left and right wing ideas in
order to really make this work. And ladies and gentlemen,
the stakes are high. Healthcare is almost a fifth of
our economy and it affects every single one of us,
and the cost of care seems to be something that
no one seems to be willing to confront. And that
is going to be one of the greatest challenges of
(07:41):
our time is figuring out how Americans can have access
to good, quality and affordable medicine without any of the
politics and really doing the right thing is going to
be extremely challenging because right now, all the incentives are
in the wrong place. We're gonna take a quick break here,
(08:05):
be right back. If you ask people what would be
the one thing they would like to have for their
entire life. You'd be surprised by the answer. It's not fame,
it's not fortune, and it's not a thousand shares of
apple when they first started and they had their I
p O asillion years ago. It's actually good health. And
(08:26):
in order to have good health, you need to be
in good health. If you think back a few hundred
years ago, healthcare and overall hygiene was fairly limited. And
if you look at medical history here in the United States,
the first medical society was formed in Boston in seventy five,
and the first hospital and medical college in Philadelphia a
few years later in seventeen, and really in sev get this,
(08:49):
those a prepaid healthcare system and it charged people who
went to see twenty cents a month to ensure against
sickness and disability. And over the decades, health insurance was
available for war veterans certain industry workers, but whenever a
compulsory or a required healthcare system was proposed, plenty of
(09:10):
people came out of the woodwork to fight against it.
And despite that, there were some advances. Employers sponsored healthcare
took hold during World War Two, with someone who's still
a big player. I have a friend of mine who
works over there Kaiser Permanente, and seriously, employer sponsored healthcare
is one of the greatest success stories in American healthcare.
And then we have the more socialized versions of healthcare
(09:32):
that exists in our system, which came during the Great
Society Programs of the nineteen sixty from President Johnson, which
we now know as Medicare, which is of course for
old people, and Medicaid, which is for low income people. Today,
healthcare and health insurance in the US is a big
part of our life and it's our economy folks somewhere
(09:53):
between eighteen. But it's a huge mess and people want
to fix that. So to talk about healthcare, which is
a lot to impact. Steve Presser, he works for Benny
coomp Health Solutions. He's looking too, along with his team,
disrupt the health care industry, just like Netflix, Uber or
Airbnb have done in their field. Healthcare is the number
(10:16):
one social impact in the US and it's the sixth
largest industry as it pertains to gross domestic product. It's
larger than education and military combined. And people always talk
about the military industrial complex, but they never talked about
the biggest complex you've never talked about, which is, of course,
the healthcare complex. And that's what Steve is here to
(10:38):
talk about. How you doing today, Steve, I'm doing well.
How are you good? So healthcare is something I care
a lot about, not only because I was a sick
child constantly and had to go to the doctor law,
but also my parents are healthcare professionals. How did you
fall into one of the most challenging corners of the
economy healthcare? Well, and that's kind of a bizarre story
(10:59):
because I had my undergrad and art and business and
got my masters in three D animation. But my father
was a software developer, owned his own company, and he
built systems to run hospitals and surgery centers. And so
I think that I grew up in that space. And
then as I was doing animation and multimedia projects, I
(11:20):
found a niche inside of healthcare. And Bennekomp was one
of my first clients almost twenty years ago, and I
reconnected with them about five or six years ago when
I sat down and decided that I needed to forge
a path for the rest of my life, and I
came to the conclusion that it was going to be
in health education and technology and this just was, you know,
(11:43):
a wealth time thing, you know, in my lifetime and
with benecom. So let's talk about healthcare in the United States.
It's kind of this like mess that's free for some people,
really expensive for others, subsidized for certain employees. So how
do we even make sense of this whole mess? We
know something's wrong, but we really don't know what to
(12:06):
do about it. And that's a loaded question, right because
as you said, it's a huge mess, and there are
so many moving parts. It's an incredibly complex space. So really,
then if you were to fix health at the like
at the most simplest level, you would have healthy people.
And if you had healthy people, then you wouldn't have
(12:27):
a whole lot of health problems. So I think at
the root of it where we've gone wrong is we've
built an entire system around diagnosed and prescribe and wait
until people are sick, and we've lost focus on looking
at health preventively and making sure that we have healthy
people in society. And there's a big cost motivator to this.
(12:48):
An ounce of prevention prevents a pound of pain or
some sort of saying that I'm messing up. Can you
tell us a little bit more about that? So I'll
give you an example. One of the things that we
do is we will do annual health screenings for our
groups and we get about participation in those screens. When
we do that, we see almost all of the pre
(13:10):
diabetics and the unmanaged diabetics. Those pre diabetics are sometimes weeks, months,
and maybe a couple of years away from becoming a diabetic,
which is somewhere between ten and fifteen thousand dollars a
year for the rest of life. It is. I don't
want to say it's very easy, but it is significantly
(13:31):
easier at a pre diabetic stage to adjust your diet
and exercise and never become a diabetic. So you've now
saved the health system hundreds of thousands of dollars and
like that. There are so many diseases and conditions, whether
it's mental health or physical health, that preventive health can
(13:54):
actually help you from going over the cliff. It actually
seems like our health care system is designed to do
the opposite. Like once you fall in and you go
off the cliff, it seems like there's a lot of
incentives to just throw everything in the kitchen sink at
these problems, but not solve the actual problem. Yeah, and
you're pointing out, I mean, there's so many problems within
(14:15):
the health care industry. But but what you said is true.
There's a couple of things that I think we don't
do very well in the United States because things are
so expensive and there's a huge lack of transparency. People
are terrified to see the doctor because they don't know
if they open that door to the hospital or the
surgery center, whatever happens to be um if they're going
(14:37):
to end up with a hundred thousand dollar bill. And
so what happens is they just let things go on
until they reach that point where it's like, oh my gosh,
I am so sick or it's so apparent that I
have some major problem, I'm now going to rush the er.
It all goes back to what you said before. But
we really need to find ways to educate patients and
(15:00):
then make it easy for them to take those first
steps weekly, monthly, annual steps towards living a healthier lifestyle.
So what do you do at your company to disrupt
the healthcare industry? Because the healthcare industries kind of run
like a cartel like, you have these insurance companies, and
then you have these hospitals that have their territories. And
(15:20):
I'm not saying any of them are immoral actors or anything,
but they definitely control their little slice of the pie.
So how do you disrupt something where never mind trying
to get a slice of pizza, the pizza has already
been sliced up and eaten by all these actors. Let's
point out to pretty obvious sides. You have the side
of the providers, you know, the hospitals and the and
(15:42):
the doctors, who are trying to charge as much as
humanly possible. And then on the insurance side and the
employer and employee side, they're trying to reduce the costs
and get the best care. And which you end up
with is a system built largely around origin as much
as possible, and then fighting those charges and trying to
(16:03):
lower cost the approach that we take. So we we
certainly do our due diligence and partner with the best
vendors in the country on the cost containment side. But
I think what we do differently than everybody else. We
do these annual health screenings where we achieve participation in
those annual health screenings, and then we receive all of
(16:26):
that underlying blood data so that we can see these
underlying health risks that people aren't aware of, and then
we approach that when they are early and much more affordable.
We offer free health coaching for all of those employees,
so they're not worried about opening that door and getting
(16:46):
a hundred thousand dollar bill. They can instead start talking
to a healthcare professional at no cost to them. So
I think what we do differently is is rather than
focus on cost, we focus on cause and prevention. So
who pays you exactly? Is it insurance companies? Is it employers? Like,
what is your revenue model? We work with larger employer groups,
(17:08):
which could be anywhere from you know, thirty or forty
employees up to thousands, who are offering healthcare to their employees.
These are usually the employers who have seen year over
year these massive increases to where it's become so unaffordable
that they've now had to then pass those monthly premiums
(17:29):
to their employees, you know, a large percentage, and then
they continue to raise the deductible and they do everything
that they can to try to offer at least some
benefit without bankrupting the company. So those are the employer
groups that we work with. They are our clients, but
then our focuses on their members. And you know, despite
(17:51):
what some people may think, almost every employer group that
we have ever talked to cares deeply about their employees
and they want to offer the best possible healthcare. They
just don't know what's possible, what's out there, and they
can't afford it. When they come to us, we sit down,
we show them things that they didn't even know it
was available, and then we put together a personalized, customized
(18:16):
health plan that's right for the health of their population.
We're gonna take a quick break here, be right back.
I understand your business now better, but I guess I
want you to step away from your role, Steve, and
let's talk more about the grand scheme of health care
in this country and really put on your personal Steve
(18:38):
hat instead of your corporate hat. If this is such
a pervasive problem, why is everyone putting up with this?
And at this point I can tell you from the
healthcare provider side, because my parents that's their business, as
is my brother, as are my uncle's. That's our family business.
My grandma's a nurse. Like that's I'm like the only
one who is in a medical professional. Our reimbursement rates
(18:59):
are going down on the medical side, and then from
a consumer standpoint, my insurance is more expensive than ever.
So this podcast is called follow the Profit. Where in
tarnations is all this profit going the nurse and the doctor.
That's really not where it's going on the provider side,
it's those hospital systems. So let's say you're an E.
(19:19):
N T doctor and you were providing a service, you
were putting in tubes for kids or something like that.
It might be on a Tuesday and Thursday, it might
be two thousand dollars, and on a Monday, Wednesday, Friday
it's six thousand dollars. And why would that possibly be
because on Monday, Wednesday Friday they're in the hospital. So
(19:40):
what you've seen is a huge consolidation of surgery centers
and providers inside of large hospital systems. So there is
a pretty big expense there. And then what you're alluding
to is the repricing on the insurance side of taking
on all those bills. You know, you'll get a hundred
(20:01):
thousand dollar bill and then you'll reprice that down to
five thousand dollars or something. You'll look at what medicare
pricing is and try to do a multiple of that.
So there's waste, certainly on the providers side, But it's
it's not what people think. They think that these doctors
and nurses are are getting rich, and it's it's not
(20:23):
that it's a that people are going to the emergency
room or hospital systems to get care, and it's it's
not the most cost effective way to get that care.
You don't want to go to the er when you
have a cold, So you would think that there's balance
in our system. So if people are using the e
(20:44):
R as there, you know, basically first h touch point
with the health care system, wouldn't insurance companies be concerned
about this and try to introduce preventative medicine And wouldn't
it behoof I've been a client to Florida Blue forever
since I was born. Like, they're a great insurance company.
What did it believe them to help promote you know,
(21:04):
good health among their policy holders. Absolutely, and that is
actually one of the biggest things that we do is
work on communication education, move people to tell medicine as
an example, which is an amazing tool UM that is
now shot through the roof since COVID hit. It's been
around for several years, but it's really become more popular
(21:25):
in the last fifteen months or so. And then UM
we try to push them to their primary care doctor
if that's the appropriate place. UM and and the what
I'm describing as member advocacy, So you'll you'll start to
see UM much more intelligent member advocacy across the board
(21:46):
to avoid people going to the wrong place and getting
expensive types of care. But even as just I'm a
member and I don't feel like I've been manhandled by
my insurance company. But you know, here in the state
of Flora, uh, if I go to the hospital, they
can send some out of network doctor into my room
and then I get some surprise bill later. In New York,
(22:08):
they can't do that to me because there's a law
against it. Why don't we have nationwide rules about the
cost of health care and specifically it's different prices for
different folks. There's no transparency. It's like walking into a
store and not knowing the price of anything. And it's
even worse you walk out with the merchandise and you
(22:29):
still don't know what it costs, and you might pay
and then you might have to pay again in the future.
So how is that allowed when it's if I did
that as a media company, or as a car dealership
or as you know, a widget salesman, I would be
immediately shut down. Yeah, what what you're saying is crazy.
(22:49):
It's like you're going into a hamburger joint and asking
for a hamburger and saying how much is this and
that they say, well, we'll let you know, and then
you at a bill for you know, but on a
different day, depending on where you went, it might be
six dollars. So that that is one of the biggest
problems in the United States. You said earlier, why isn't
(23:12):
there a national pricing system, Well, there is. It's it's
called Medicare. So they have on a national level decided
what fair pricing is. And it's it's so difficult because
what you'll find is some of those receipts that you
see where providers, you know, the physicians, will post on
getting paid less than minimum wage because of how Medicare charges.
(23:37):
But but that is, you know, a national pricing system,
and what you will start to see is several companies
Hours included will work with reference based price vendors. And
what that means is they're looking at medicare pricing and
charging a hundred of medicare as an example, so they're
(23:58):
actually charging what more more than what has been recognized
as nationally fair pricing. But they're looking at a moving
in that direction so that there is some consistency around
pricing and some transparency. But Steve, this is so pervasive.
I'll give you an example. My doctor in New York
is so much better than my doctor down here. I
(24:19):
will replace her. And she's an endrochronologist and she works
at this group practice. It doesn't matter if I pay
my copay. They send me a bill for my copay.
They try every time to double price me for the
copay and I've never fallen for it. My husband fell
for at once and I said, honey, please don't pay this,
and then you call the office and they go, oh,
(24:40):
this was an error, really an error ten times. So
if my mother did that as a chiropractor and consume
me Florida, I think the patients would go away. But
somehow people do this and it's allowed. And by the way,
everybody does this. It's like they try and and credit
rating agencies don't even healthcare debt seriously anymore. If you
(25:02):
don't pay your healthcare bills, you can still get a mortgage.
So clearly the entire healthcare system in terms of billing
is wacky and out of control. Where is Washington on this?
Where is my congressmen? Like? Where are the regulators? Why?
Why haven't we done anything about this? I think that
we are. They are trying to remove surprise billing. They
(25:25):
are trying to make it illegal to balance bill patients.
It's something that we've been fighting for years. I think
that they're moving in the right direction. But everything that
you're saying is true and I completely agree with it. Um,
we we fight this on a daily basis. So we
constantly get these bills and find out that the patient's
been double billed, or we get some outrageous pricing. We
(25:48):
lower the bill to something that that is nationally recognized
as a fair price, We pay the bill based on
the reprice, and then those the hospital system or whoever
it may be, will turn and balance bill the patient.
And so then we've had to put measures in place
to say, if you ever get this balance Bill, send
(26:09):
it right back to us. We will put a team
on this. You will never have to deal with it. Um,
these are some of the measures that we're taking. But
you're not wrong. I mean, what you're saying is is
completely true. It's but it's all over the place, Steve.
At Walgreen's, if I go one day, they charge me
a dollar for my medication, the next day it's five.
If my husband and I go to the same clinic,
(26:30):
we have the same insurance, somehow we get charged different copays.
And I'm like, honey, we are the same we are married,
we have the same healthcare plan. We are here for
the same thing, and somehow you're charging us different copies.
How he is does any of this past muster? No
other best Buy can't do that to you. How does
(26:50):
you know City m D in New York do that
to you? I don't. I don't get it. I also
don't get it. I think that some of it has
to do with just know this extreme complexity, and you
have people hired on the provider side who their entire
job is to find out how many different codes they
can charge and up charge, and then they'll max out
(27:13):
all those prices. Knowing that those prices are, that that
that bill is going to get to the insurance company
who's gonna look at it and say, okay, this is
going to take us a wilder review. But you know
this shouldn't be on there, This is miscoded, This needs
to be repriced. And and so what you're doing is
addressing a major problem that we deal with on a
(27:35):
daily basis. What you're asking for is, you know, how
do how do we fix this? And and really the
only thing that I can think of is removing a
lot of the complexity, you know, saying that is medicare
fear pricing? And if it is, then let's agree on
this as the standard rather than what's the relationship that
(27:58):
anthem has with these doctors, what's the relationship that signal
has with these doctors? And then let's let's figure out
like it, is there some sort of system in place
that that can reward you know, we've we've done accountable
care organizations and things like that, you know, tried those
in the past, But is there a way to to
(28:19):
reduce sending in as many codes as possible and trying
to up charge for every single service? And if I
knew the answer, and if and if someone else knew
the answer and could make this simple, then we wouldn't
have this issue. But it is incredibly complex. There's no
way to make everything black and white. They tried to
do that by going from their I c D nine
(28:41):
codes to the I c D ten codes, which I
c D nine might have been hit in the head,
and then I c D ten might have been hit
in the head by duck. This is really you can
look it up, um, but it's what they try to
do is say, let's get super specific and in in
some ways that helped. In other ways, that added eight
oats and you know, CODs, and you had to to
(29:04):
now deal with several more codes and and hire more
people to review all of those thousands of codes. Oh,
I've heard all about I c D ten from my mother,
so I know all about that. And they just have
a computer software that pulls up the code. So I
understand why the providers have to play that game. It's
just I'm just annoyed as a consumer that I have
(29:24):
to deal with this. So I guess I'd be amiss
to not talk about. Let's say I'm diabetic, my friend
owns a pharmacy and we've created some of these measures
called pharmacy benefit managers, and they were supposed to control costs,
and in fact they facilitate the inflation of costs these days,
So a lot of times in healthcare, when we try
to do something, it actually produces the opposite. Like Obamacare
(29:47):
intended to help control the cost of healthcare, and it
actually made the cost of healthcare go up. So how
can we make sure that like we're trying to fix
it and not break it even more? Which it seems
like every time we try to control something or or
try to do anything with healthcare or try to change
it in any way, it actually makes it worse. Yeah, well,
(30:07):
and what you said is is really true. So take
Obamacare is an example where before and I don't know
if you if you go back and you can remember this,
but you might have health insurance and your and it
might max out at five thousand dollars and next thing
you know, it shoots through into the millions in your
(30:28):
bankrupt What what Obamacare did was say no, we're you know, unlimited,
there is no max. And of course that was great
for all of these members who were becoming bankrupt, but
then they had to take all those massive bills, spread
them across the entire population, and what it did was
it raised the bills for everyone. That's an example of
(30:48):
trying to end in succeeding in fixing a problem, but
creating several other problems. Right. And I don't think and
let me stop, so I don't get Hey, I don't
think anyone was against denying people or denying people with
pre existing conditions was morally wrong. So I think everyone
was for these reforms. I just no one understood the
(31:09):
cost of these reforms. Yeah. Well, and and some of
those things, you know, like pre existing conditions, there are
some things that are a little tough. Like, for example,
if if you went to get car insurance, they would
look at your history, right, But let's say you, you know,
they treated everybody equally, right, and they just gave everybody
the same car insurance, and then you jumped in the
(31:31):
car and then just started ramming into trees every week
because you had a big pickup truck and you thought
it was fun. Well, it's all right, you know, the
insurance is just going to cover it. And there's rules
in place for these these kinds of people, these let's
call them bad actors, who are ramming into trees every day.
And that's in some ways, We've got a lot of
(31:53):
people who have fallen victim to that where it's like,
you know what, um it is, what it is. The
insurance is just going to cover this though. I'm going
to get a really low deductible and then it really
doesn't matter what I do, It'll just be covered. And
I think that that's a bad approach. You know that.
That's why you need to have this good driver discount.
That's why you need to focus on prevention and put
(32:15):
measures in place so that that we do our best
as a society to not be rammn into trees every week. Right, Basically,
with Obamacare, you're charging the guy with the red Lambeau
and the blue keya the same thing because there's no
such thing as as pre existing anymore. So it creates
some incentive issues. But what about this whole idea that
(32:38):
healthcare is a right though, Steves, So, we don't want
people dying in the streadat obviously, So how do we
balance these market first reforms without like socializing everything? Like
our neighbors are friendly neighbors in Canada and basically every
single European country, Western European countries. Yeah, you know, so
one of the things that we've talked about is using
medicare as a standard pricing, you know, or some some
(33:01):
measure of of medicare as the standard pricing. I completely
agree with you healthcare. You know, everybody should have healthcare,
and I think the answer is to continue to get smarter,
to to look at the biggest areas of waste. Um,
if you've got somebody that's getting those ear surgeries and
one of them is costing with the same provider, one
(33:22):
of them is costing, you know, in one place, and
it's costing five thousand dollars in a in another place,
there has to be standardized pricing. And I don't know
if that's demographically would make sense. You've got people who
are trying to run the same sort of practice, but
it's different to run it in New York versus a
(33:43):
small town Indiana. Right. I think those are some of
the ways I think that you in general, Um, you
have to create standards, but you have to simplify the process,
and you have to work like crazy to make everything transparent. Yeah, Steven,
let's talk about that though, because there are some pluses
(34:03):
to the American health care system right when people get
really sick from Canada and from the UK, they come
straight here. So and if you talk to UH, I
have the unique experience of living amongst many British people
here in Florida, and they tell me that they live
here half the year, but they make sure that they
have the baby here not there, because they say it's
a horror show in the United Kingdom. But then you
(34:25):
talk to other people and they love the system over
there because it's free or free you know air quotes.
How do we harness the best of those right to
make sure that everyone's covered, but additionally that we don't
lose that innovation that we have here in the United States,
which has made us have in some ways the best
health care system in the world. Yeah, it's it's a
(34:45):
great question. And I don't know if there's some hybrid
form where we continue, Like some of the things that
we've done is subsidized healthcare, So you know, based on
on how much somebody makes, they may pay less for healthcare.
The government subsidizes some of those things. But in general
(35:06):
I think that what you need to do is focus
on cost containment strategies, prevention, and then there may be
something where you get a standard of care, but if
you need some innovative, high level, expensive type of care,
you know that you're going to be paying extra or
ensuring extra for those types of of uh innovative places. Well,
(35:32):
in most cases in nature, hybrids too better. So that
would make sense instead of talking about completely socializing healthcare
having a completely private market. So I'd like to finish
this off by talking about the future of healthcare because
that's really like what you all do every day. So
you're in Tampa, Florida, which I've written many op eds
about this. I'm a Central Florida resident. I feel like
(35:53):
the demographic future of this country is in this region.
So welcome to the party. But you guys are also
talking about how how health care needs to be different
and how and you're doing the hard work every day
making healthcare different. So tell me a little bit about that.
So what we do is we work with employer groups.
We take the time to listen to their needs. They
tell us about their populations because every population is not
(36:15):
the same. You know, you do have some populations where
you have but predominantly young employees who are healthy. Let's
say that you're working with a set of gems or
something like that. And then you have other populations where
based on their lifestyles, maybe their truckers or something like that,
you have an unhealthy population. So one of the things
(36:37):
that we try to do is personalize our healthcare offer
offering based on the makeup of the employer group. We
also try to look at, as I alluded to, medicare
pricing when it's the right fit, which is a good
cost containment strategy. We have tried to push technology with
tele medicine and other tools like that. Mental health has
(36:58):
always been very important, but I think it's been extremely
recognized since COVID hit. We've seen it in our data.
It's it's become a massive issue and and something that
we need to continue to strategize about inside of the
health plan. And then one of the biggest things that
we do is we have outcome based deductible incentives where
(37:20):
somebody can earn from you know, as an example, a
three thou dollar deductible down to zero dollar deductible based
on an annual health screening. But when we do that,
we receive all of the underlying health data inside of
their blood screening and then proactively engaged with our preventive
health management team, which is so much more cost effective
(37:42):
than sending everybody to a hospital or sending everybody to
get that blood screening at a hospital where it might
be twenty times more expensive. So through that data, you're
learning how to make better healthcare decisions in the future.
Correct And by opting into this ecosystem, you're using these
people's own healthcare challenge is to inform future decisions. Is
that correct? Absolutely? And and it's personalized based on the population.
(38:05):
So as an example, we might do an annual health
screen on a population, get the data back and find
out that they have almost no smokers, so it's not
as important to push huge smoking cessation programs for that population.
At the same time, we might find that they have
a huge number of pre diabetics or unmanaged diabetics. We
(38:27):
would make diabetes management one of the core focuses for
that population over the next year or two. So it's
very personalized and it's and it's very preventive. We're looking
at the data and we're making smart decisions based on
those populations and letting employer groups know that they actually
have a say in their healthcare. They can choose what's
right for their population. Well, that's really fascinating because it
(38:50):
seems like it's always boiler plate, especially the bigger the
company gets. It's like, oh, you shouldn't smoke, and oh,
you shouldn't need sugar, and oh like if you go
to the gym, we'll give you you know, I don't
know what, and and it seems like it's very boiler play.
And obviously for a personal training, you know, a crunch gym,
(39:10):
you're not gonna need to to push the health they're
working out component. You're gonna probably need to have a
good relationship with some physical therapists and chiropractice because they're
probably in pain. It's it's the such a big problem
in healthcare where it's one size fits none, and it's oh,
here are three boxes, you have to fit in one
(39:30):
of those. And so that's one of the major things
that we work on. And then what you were saying
about wellness, which is funny, it's but it's you know,
I think that these wellness companies have tried really hard
to show a good return on investment in the biggest
problem overall is they're giving all of these crunch gym
memberships and everything else, like that as one of the incentives,
(39:53):
But do you know who uses those that already worked?
So that is one of the biggest Like at our company,
we don't provide a gym membership because I run it
and I already have one, so it'd be like, oh, thanks,
Like you know, imagine, it's like, oh, and what we're
gonna do with a five K? Who runs the five k?
It's all the people who already run five ks, and
(40:15):
they're like, oh, thank you, You're paying for the five
K that I would have paid for anyway. And so
what we've done to change that is create a tool
that addresses the right audience. So once you get those
results back, it's like, hey, let's focus on those on
the people with high blood pressure, or let's focus on
those pre diabetics and diabetics and not just blanket give
(40:38):
everybody five k's and and let's count your steps. Yeah,
well that sounds like it makes too much sense. But
in healthcare it seems to be down as up and
up as down and money is a suggestion, and I
wish it were different, Steve, but it's not. Well, unfortunately,
and it's like the race straight into the gutter with healthcare.
But it's big well because the insurance company is bad,
(40:59):
the spitals bad so, the providers bad so, and in
the end we're the ones left holding the bag. And
I I have nothing but the greatest respect for insurance companies, hospitals,
you know, providers, but it seems like the summation of
all of this is just a terrible healthcare system. So Steve,
thank you so much for your time. All the best
(41:20):
to all of you at Benny Camp over there in Tampa, Florida.
Thank you, smush, David, and thanks to all of you
for joining me as we Follow the Profit. And a
big thanks to Steve Pressor over in Tampa, Florida from
Benny Comp. We really appreciate his time and that was
a great conversation and a shout out to our team
(41:42):
of producers and Meleano Lemon, Scott Handler, Cheyenne Reid and
new King Rich and Debbie Meyers. I'm your host, David Grosso.
If you like the show, give us five stars and
give us a review so that others can learn what
this show is all about. Follow the Profit is a
production of Being Ridge three sixty and I Heart Radio
for More podcast for my Heart Radio because it the
Heart radio, app, Apple podcasts, or wherever you get your podcasts.
(42:10):
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or another medium. You should not treat any opinion expressed
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(42:30):
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(42:52):
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(43:34):
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