REPLAY: The Shifting State of Healthcare Consumerism

The next episode in our greatest hits playlist comes from the Innovation Accelerator Podcast by Innovaccer. Host Steve Ambrose facilitates a panel discussion with Gary Druckenmiller, Beth Bierbower, and Jared Johnson about where consumerism has been, where it is now, and most importantly, where it’s headed and how to thrive in an industry that’s changing faster than ever. 

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Episode Transcript

Jared (00:04):
Welcome to Health Care Mixtape, where we're curating the ultimate
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Subscribe to Shift Forward Health on your favorite podcast app

(00:26):
and you'll be subscribed to our entire Library of Shows
one subscription all the podcasts you need and it's all
for free. I'm Jared Johnson, your playlist curator, and it's
time to mix it up. All right. The next in
our Greatest Hits playlist is an episode of the Innovation
Accelerator podcast by Innovator. The topic was the shifting state
of health care Consumerism. It was hosted by Steve Ambrose,

(00:48):
and I was a member of the panel, along with
Gary Druckenmiller and Beth Bierbauer. Gary is the managing director
of PRM at Innovation. And you heard Beth on our
last episode. She's the host of the B Time podcast
we shared where consumerism has been, where it is now,
and most importantly, where it's headed and how to thrive
in an industry that's changing faster than ever. I encourage
you to subscribe to the Innovation Accelerator Show and I
hope you get a lot out of this episode. Check

(01:09):
it out. Let the mix begin.

Steve (01:12):
Welcome back to the Innovation Accelerator podcast. I'm your host,
Steve Ambrose. Many industries across America are driven through cost,
quality and convenience, and they engage with consumers through free
market forces such as supply and demand. So what happens
when the biggest industry in America meets up with a

(01:33):
growing surge of consumerism, as well as new expectations from
its purchasers and its users? Well, today's show is going
to help answer that question, along with many others that
are in the minds of patients, employers and health care organizations.
On our panel today are Beth Bierbauer, a sought after
thought leader in consumerism. Beth is served for more than

(01:55):
30 years for many of the top payers across the country,
including her most recent role as president of Humana's Employer
Group segment. Joining Beth is Gary Druckenmiller, patient relationship manager
at Innovate. And rounding out the panel is Jared Johnson,
the founder of Shifty health and influential Thought Leadership Network

(02:19):
for B2B health care and health tech communities. Really happy
to have you all on today. And before we get started,
I'd like each of you to share a little bit
about yourselves with our listeners and our viewers. And we'll
start with you, Beth.

Beth (02:38):
Thanks, Steve, and I am thrilled to be here. As
you mentioned, my career has really been on the payer side.
I have worked for organizations such as Coventry Health Care,
Humana and Highmark Blue Cross Blue Shield and have served
in a variety of roles. And now I serve as
a strategic advisor working with startups mostly.

Steve (03:01):
Thanks for that, Gary.

Gary (03:04):
Thanks, Steve. Yeah. Gary Druckenmiller. And I'm the GM at
Innovator for our category. Some might call it CRM, but
essentially it's all about consumer experience. And for the past
12 years or so, I've been at this intersection of consumerism,
starting with an organization called Invariant, which was one of
the first startups in the CRM space dating back to 2009,

(03:28):
and that eventually got acquired by health careers. And that
got me an innovator. But prior to that, I spent
my time outside of healthcare and hospitality, and that was
the ringer for me actually entering into healthcare. It was
to kind of bring real consumerism into the hands of
those that need it most on the healthcare side. So
best time to be in healthcare is right now, thanks

(03:48):
to you and Jared.

Jared (03:51):
Thanks for having me on, Steve, and great to be
on this panel with Beth and Gary. Most recently I've
been involved with a lot of a podcast production figured
out the other day, have produced over 500 episodes of
various podcasts, all in the healthcare space and some with
some amazing guests and perspectives, all having to do with
how to make health care more consumer focused. Personally, what

(04:13):
drives me is besides more than 15 years in various
health care organizations, payer provider, health tech companies, what drives
me personally is to try to make health care easier,
less expensive, more convenient. All the things that we hope
are the hallmarks of our customer experience in other industries.

(04:35):
That keeps me going.

Steve (04:38):
All right. Well, thanks, everyone, for that. Let's jump right
on in. And first question I have really is it's
going to be for you, Beth, and that is that
with respect to design and function in today's health care system,
what's really been keeping it from being truly consumeristic in nature?

Beth (04:59):
Great question, Stephen. There are a couple couple issues. The
first one is there isn't a direct exchange between the
provider and the consumer, right? The health plans involved, employers
are involved. So there's not that that complete transparency like
we have in every other aspect of our lives. Go
to the grocery store, we see how much the price is,

(05:20):
we know how much money we have in our wallet
and whether or not we want to buy that product
or good with health care. We don't have that. We
don't know what the price is going to be until
after the service is rendered. And we don't always quite
feel the pinch of the price because it's being funded
by our employer. Now, obviously some of that is changing
with high deductible health plans, but I think the biggest

(05:41):
thing is there isn't that direct relationship. The second thing
is that lack of transparency, really understanding how much something
costs is really critical to being able to make good decisions.
And I think the last thing I'd say quickly here
is when you don't have transparency, you don't have truly
that direct relationship. The consumer then is really not the

(06:04):
one determining value. We have health plans that are determining
on behalf of consumers whether something's a value. And quite frankly,
there isn't always alignment between what a health plan believes
or provider believes of value and what the consumer believes
is a value. So several key things that I think
are really a challenge to bringing true consumerism to the

(06:28):
health care ecosystem.

Steve (06:29):
Yeah, you brought up some great points and I guess
the follow up to that would be, you know, all
that said and certainly all that known. And do you
really see, Beth, that there is going to be a
way to overcome this?

Beth (06:43):
I think it can. I think we can make progress
first by just bringing additional transparency to the table. And
when I say transparency, it isn't just price transparency, but
it's even transparency, for example, for employers to understand the
the flow of the money. Right. How does a PBM
make money? How does the health plan make money? How

(07:06):
does pharma make money? A lot of that information is
obscured and as a result, all the players in the
ecosystem aren't necessarily making the best decisions because they really
don't know, because they don't have complete transparency, they don't
know the money flow. And again, if you go back
to a traditional transaction, you go in to buy a car,

(07:29):
you understand that there's a manufacturer, a car dealer, and
then you and you know that that car dealer is
an intermediary. But they do show you what the manufacturer suggested. Prices, right?
Which may very well differ by retail, the retail price.
So I think it's really bringing transparency to the table

(07:50):
about where the money flows and also that pricing is
really critical. And we have to simplify, too. I don't
see any reason why we have literally hundreds of thousands
of diagnosis codes, procedure codes. Why? Why? This is just
absolutely crazy. There's a real opportunity to simplify transactions. And

(08:12):
if we can do that, I think we can start
to have people that really become more competitive and people
can still compete on quality and cost.

Steve (08:22):
Jared, I got a question for you specific to providers
and payers, because I don't think this is really gone
unnoticed by providers and payers. And in the last couple
of years, one of the things that we're seeing more
of is this term of being patient centered, that care
is patient centered or services patient centered. And I'd like

(08:45):
to ask you, is there a difference the way you're
looking at it between patient centered and consumer centered?

Jared (08:54):
I think so. I think patient centered was a good
start to thinking with the service mentality in terms of
not being institution centric. And I think consumer centered is
more encompassing than that. I think it includes everything that
happens when you're patient, what that experience is. But then
I also think it includes the health behaviors and choices

(09:16):
that are made prior to and after your patient. And
for the majority of people, that is when we're making
a lot more choices. It's not necessarily when we consider
ourselves a patient, which is often when you're you're encountering
or experiencing any any time, whether it's virtual or face
to face with the health care professional, maybe it's an

(09:38):
inpatient stay. You know, you're an overnight stay at a
hospital or maybe you're just visiting the doctor, but having
an encounter with the health care professional. That's when if
we if we're really, you know, drilling down on the wording,
that's what I envision is patient centered. Your patient when
those things are happening. But consumer centered implies that there's
a lot happening before and after that. It's it's it's

(10:02):
more in line with the consumer's standpoint because most people,
depending again, depending on their their disease state and what
conditions and what their health is like aren't necessarily waking
up in the morning and thinking about health care choices
are going to make they are going about their day
and things that affect their health care come and go

(10:24):
either expected or unexpected. And so consumer center to me
just implies that that a lot that has to do
with and affects our choices for care happens when we're
not being served as a patient at that time.

Steve (10:37):
Gary, I know this is a topic that that's a
bit near and dear to your heart. You got some
thoughts on it?

Gary (10:44):
Yeah. First off, I just want to say to Beth
that you can now buy cars that have a gumball machine, too. So,
I mean, we've transcended into an entirely different reality. Yeah.
The notion of a consumer and patient centricity. Jared and
I are going to give probably the same answer throughout
the podcast and just varying different ways. But is. Is

(11:07):
concentric to the history that got us here. Right. And
if you talk to a chief marketing officer over the
last ten years, they would say, oh, it's all about consumerism.
But they very rarely found their inputs into the administration.
And the supply chain of a health system kind of
stopped when their job was over. And then it became
patient centered care that we get caught up on the linguistics.

(11:28):
But make no mistake, these worlds are now blurring right
in front of us. And why? Why would that happen? Well,
it's not just Jared said. It's not an episodic thing.
It's something much longer. And we take a step back
and take a look at the big picture. Just like
Steve Jobs used to say. You have to start with
the full experience and back your way into everything else,

(11:48):
into the technology, into the process. And we just can't
do that as an industry. It's starting to change now.
There's a reason I'm here at Innovators because we're abiding
to this this law of consumer dynamics, which says, you
have to know me, you have to show me, you know,
me essentially as the term. And in doing so, you
have to know every single step I'm going to go through.

(12:09):
And that's when the term patient, which by the way,
is an eejit term that says, I'm only there to
cure you when you're to take care of you when
you're sick, like Jared said, like that could be a
window this this big. What about everything else? The term
patient having a very limited lifetime. You know, it's got
to to get to the best the world, the best

(12:29):
described transactional commerce oriented. It's it's like oxygen. You're just
in your health. And your health has a thousand different permutations.
You're a consumer of your health, plain and simple. So, see,
we're still in that world right now. There's still a
consumer experience officer There's still a patient experience. Officer But
eventually they have to combine to become one thing.

Steve (12:52):
Beth When we're looking at the different segments of health care,
the different major segments of health care, your providers, your payers,
your drug companies as well. Where do you see them?
Maybe on a broad scale here? Where do you see
them getting consumerism right today? And then where do you
really see them really just missing the mark on consumerism altogether?

(13:13):
Do you have maybe thoughts on that?

Beth (13:17):
Well, from a health plan perspective, for example, I do
see improvements in technology, self service technology available so you
don't always have to pick up the phone. Providers are
still lagging there. I mean, they do have their portals,
but they're not still there, still relying on the facts,
which I struggle to believe that we continue to to
use that kind of technology. But they are trying to

(13:40):
bring a little bit more technology to make things easier
to the table. But where I still see problems is
there's too much friction in the system. USA Today just
released did an article on a report that came out
of HHS and they had an investigation done. And basically

(14:01):
1 in 5 claims were denied by Medicare Advantage payers
that would have been paid under Medicare fee for service.
1 in 5 claims it was 18%. Furthermore, they said 13%
of authorizations that Medicare fee for service would approved managed
care companies denied. That's astounding. Now, we know that CMS

(14:24):
gives some flexibility to health plans, but if you want
individuals to come over to Medicare Advantage plan, it isn't
just about giving them some extra benefits like dental and vision.
It's about making sure that I'm getting the Medicare coverage
that I would get if I was on fee for service.
And there's just too much friction in the system where

(14:45):
we put it on the backs of the consumer to
appeal the claim. Right. Appeal the authorization appeal, the claim.
And I'm I'm telling you, I just went through this
myself and it was a six month ordeal. And guess what?
I know what I'm doing. I know the codes. Right.
I get it. I, I understand it. It's a it's
a real challenge. And consumers are feeling that. And that's

(15:09):
why I think some consumers are saying maybe I should
just stay in fee for service. Medicare and other ones
are saying, wait a minute, maybe I should try one
of these newer health plans that say that they're going
to give me a different experience or they're going to
give me a patient navigator or or a member. Navigation assistance.
We really have to step back and remove that friction

(15:32):
from the system. I'll just share one thing really quickly.
I moved to Florida. In Florida, apparently you have to
get a referral to get a routine mammogram. Now, I
have not received a referral to get a routine mammogram.
No health plan payer requires a referral for years. But
not only was I told that I needed a referral

(15:54):
by three different sites here in Florida, I was told
to go to the primary provider and get a CD
Rom and physically bring the CD rom into the provider.
And I'm like going, Well, can't you get can't you
get this for me? And I was told we're too busy.

(16:16):
That's the other thing. From a provider perspective, patients are
tired of hearing members and individuals are tired of hearing
that their time is not as valuable as yours because
their time is valuable. Right? It's why you have patient
no shows. Because if somebody knows they're going to sit
in a doctor's office for three hours and miss three

(16:37):
hours worth of work, many people won't get paid for
those three hours. Right? So this friction just continues to exist. And,
you know, Gary, you talked about it. You talked about it.
We need a consumer experience. It respects the consumer share,
share shares information that they know. We know them and
care and care about them. And our health care system

(16:59):
just isn't isn't there. We talk that we want to
get there, but we're just not there.

Steve (17:05):
Yeah. Jared, you have some thoughts about this?

Jared (17:09):
I do think they're pretty in line with Beth in
terms of where where it seems like we're seeing some
success is that we are seeing more access in general
to care. We are in general, seeing providers and traditional
health systems using more digital tools to to make it

(17:29):
easier to get a hold of of a provider. That's
not the case across the board. But in general, you know,
you compare that to even a couple of years ago
or several years ago, there's more access, there is more
digitization of existing processes. And I make that distinction rather
than calling that digital transformation because digitizing the existing processes,

(17:52):
while it can be better, those processes still might not
be where where we want them to be to be
consumer grade processes. Meaning there's still the thought of, in
a lot of cases to for for admissions when you
check in instead of having to fill out all the

(18:14):
paperwork by hand, now you're filling it out on an iPad.
But the question is, I mean, this is an example
that's been used in the industry lately. You know, if
if that still takes you just as much time to
fill out all the paperwork and you just happen to
be doing it on an iPad, is it really any better?
And so I think you see the difference with with

(18:34):
one of those is really just digitizing an existing experience
that is cumbersome. And so I feel like where we're
falling short is still there are so many cases where
encountering the health care system is still too hard, like period.
It's just too hard, it's too inconvenient, it is scary
and it's expensive. And that means people are putting off

(18:58):
their care. We could go through many, many, many, many experiences.
We all probably have personal experiences of people who did
not seek care. People who we know and that affected them.
And the reasons why I don't put on I don't
blame them for not wanting to seek care. It's hard.
And like Beth just said, even when you know the

(19:19):
cheat codes, even when you know the language, you know
what you're doing, it's still challenging. And so I think
we have a long way to go. I think part
of that recognizes that that there needs to be more
cross-functional collaboration for that to happen because it's not happening
the way we are now.

Steve (19:36):
You know, this brings me to an area that I
wanted to address with with you all, and that is
particularly value based care. And Gary, I know it's a
it's a big initiative, obviously an innovator. I know that
it's a big initiative in the industry. But I'd like
to see how how does consumerism tie into value based care? Gary,

(19:58):
I'd like to throw that question your way.

Gary (20:01):
Yeah, sure. It's a it's a great question and one
that I don't think has been fully realized just yet.
The promise of value based care was to improve because
the tied term to that is the population health was
to improve the health and the sanctity of a given population,
whether it be an underserved community, whether it be a

(20:24):
a non fee for service like a Medicare and Medicaid
type of environment, or a particular service that a health
system provided that they had a greater they had a
contingency for going after that service, whether it's in ecology
or some others. Maybe there's clinical trials or there's research
that's coming up through an academic, whatever it is. The
goal was always to then eventually bring that to those

(20:46):
to whom they serve. Well, that really hasn't happened yet.
Most of the values and the metrics that are coming
through are to support system the hospital or the health system.
When we talk about reducing readmissions by 20%, that's a
hospital value. When we talk about improving quality outcomes by 10%,
that's a hospital value. Why? Why did those things happen?

(21:08):
The next big push for those that have taken on
as a going concern, which is incredible. Right. And we're
just getting started. And this has got a long way
to go to find some harmonics and balance between fee
for service because everybody would agree, like even that's that's
teetering off the edge a little bit. So we have
to find some sort of balance between these two worlds.

(21:28):
But in order to do that, you have to eventually
communicate to your consumers. Much of what Beth was prescribing
and some of the previous questions was this nature of
having the consumer having to respond to you and having
to react to you. That's and can't think of an

(21:50):
industry where that's worse. Right. And in every other I
can get my hair cut and my my haircut guy
reaches out to me and he's like, Hey, you got
to do this. You got to do that. That's my
haircut guy. Like, Well, how can the health system not
be proactively monitoring my health in some sort of, you know,
mash up of different data sets that draw a persona
and an X on that persona and say, that's you,

(22:12):
and we're going to help guide you through this Is
that's a that was supposed to be the rally cry.
So the next big movement of that for consumerism is
layering over communication on top of communication protocols that are
contingent to a journey within those worlds, within a given,
and personalize that. You know what that so that they

(22:34):
know you're there, they know that you're listening and that
there's not only a clinical correspondence to that, but as
kind of Jared alluded to some perhaps they're behavioral and
there's the stuff that are on the outer perimeters and
we're bringing those in as well that that has to happen.
And that's the next big movement for value based care.
Everybody kind of knows that people are kind of struggling
the best way to do it. But, you know, communication proactively,

(22:59):
not reactively. Is that next big shift that.

Steve (23:02):
You know, Beth, I'd like to get your perspective on
that same question, particularly having, you know, many years on
the payer side. You know, what are your thoughts around
value based care and and consumerism that tie in?

Beth (23:17):
Yeah, there are two things that I really appreciate that
value based care can can bring to the table. Number one,
if you're thinking about a bundle or an episode now,
you can have a very transparent flat fee for the member, right?
And they know what they're going to get. Think about
a pregnancy. You know, if you are pregnant, you are
going to go to the the ob gyn. You know,

(23:39):
they're going to deliver your baby. You know, you're going
to get 1 or 2 ultrasounds. It's all included in
that bundle. Right. And you know what your copay is?
Your copay applies across that bundle. I think there's a
real opportunity here as opposed to, gosh, I get the
surgery and now I'm going to get something from an
anesthesiologist and then the surgeon and then something called a hospitalist.
What is that? What is that? Right? Because you're in

(24:01):
the hospital. You don't know all these people that are
that are seeing you. That's number one. The second thing
I love about value based care is it affords the
provider the opportunity to do what's right without having to
worry about whether he or she can Bill for it.
Because if you're taking global risk, as an example, like
many of these primary care providers do, especially for the elderly, right.

(24:24):
There are things you're permitted to give to a member,
one of your members that a health plan can't, because
if the health plan did it, it would be considered
an inducement. But if you're a provider, you can, you know,
you can buy somebody a meal. You can actually pay
for pest control. You can you can do their laundry

(24:45):
if if that is literally a problem or a barrier
as a social determinant to them being able to get
get better under a health plan. There are many things
like that you still can't do. So value based care
really aligns what the provider truly needs to do to
help that individual with the ability to do it without

(25:07):
any repercussions, that there's some type of inducement going on.
And so I just really think that is so powerful
because that's what you want. You want the provider to
do the right thing and not say, I can't do
it because I can't bill for it or because Medicare
won't allow me or the health plan won't allow me
to do it. It's just the you're doing the right

(25:28):
thing for the right reason. And I think we'll see
more of that as we see value based care.

Steve (25:33):
Yeah, it's so interesting you bring that up. It's today
when they talk about or when it's talked about personalized medicine,
personalized care, it always seems to be sort of framed
around personalized clinically. But in here you're really talking about
personalized for the barriers that an individual would have and
then really kind of recognizing. Right. And, and sort of

(25:55):
filling those gaps to get things started to catalyze, you know,
the efforts that need to be done. Am I that's
what you're saying, right?

Beth (26:04):
Yeah. Let me give you one really quick example. Oftentimes
we think transportation, that's a social determinant. And so what
we plan for is I can take Mrs. Bierbauer, I
can get her ride to the grocery store. Well, maybe Mrs.
Bierbauer can drive. But what Mrs. Bierbauer can't do is
lift those heavy cans of ensure that her doctors ask

(26:26):
her to take and carry them into her house. When
you're operating in value based care, you can actually pay
somebody to go and take the groceries out of the
car and take them into the house. Right. You don't
because Mrs. Bierbauer doesn't need the transportation. So that's the
personalized care that's truly solving. And Jared was getting this

(26:46):
the true problem that the customer has. Right. And that's
what value based care allows you to do to to
truly meet that individual's need in a way that makes
sense to help improve their health.

Steve (27:01):
Gary, I know that it innovation you're you're heading up
patient relationship management and I'd like you to connect the
dots if you could, on on where you see patient
relationship management, not just serving patients but really meeting and
serving the needs of the health care consumer.

Gary (27:21):
These sorts of tools are meant to serve as patient
relationship management as what are meant to serve as an
umbrella over countless, countless processes and subprocesses that cut across
three primary domains. And when it's kind of rationalising itself
out to be the notable consumer experience, which in the
hospital world and the health system world use a term

(27:43):
like access, like these big scary words, nobody knows what
they mean and get access, get access to granted access
into the into the system. Right. And then when I'm
in there, I'm in the clinical arena. And then after that,
I'm in some sort of wellness arena. And again, these
and we use terms like value based care and population
health to satisfy that interest. But how do all those
three get united? Because there's countless handoffs throughout that entire process.

(28:10):
And if and if the North American health system has
proven one thing, it doesn't do a good job of
handing off the transition. So the terms we use, those
transitions might as well be canyon esque valleys that you're
left to your own druthers. You have to figure it out.
You have to call back several times. You have to
remind them that this is what happened on the last call.

(28:31):
You have to do X and then go back. It's
like a wonky Vader, go up and go down and
go all over the place. Right. That there has to
be a mechanism that cleans that and satisfies that. That's
what CRM tools, patient relationship management tools are meant to do,
where they establish a longitudinal connectivity from action to action

(28:52):
to action. And they and they, they jump in and
jump out of several different departments simultaneously. They might start
with marketing moved to a contact center. It might go
into insurance. Insurance might go into coordinated care, coordinated care
might go back to insurance, then into referral management and
so on down the line. All these terms are now
getting in all these departments and all the data and
all the processes are now getting connected in a sequence.

(29:13):
And it's and it's the backbone of that patient relationship.
Management or CRM system is data infused and it's not
just on screen. Then it becomes malleable. And that's when
it really gets interesting because once you're able to create malleable, longitudinal,
again using that term journeys, then they build on the fly.
And then you don't. Then you don't need to really

(29:35):
be mapping journeys anymore because that's a big thing. They
just happen. But you have to. You have to find
which for which service line and for which system they
need to be designed accordingly for because everybody does it
just a little bit different. But that's what those tools
are meant to be. And then communications, content messaging and
process all get aligned and they're driven by some sort

(29:55):
of backbone of data that's just ironclad and almost never wrong.
That's that's where all the that's where the next three
years is heading, is to kind of rationalize to that
kind of solution to deliver what we've been waiting almost
a decade to be able to do.

Steve (30:10):
Beth, I'm going to throw this question at you. And
having been in health care myself for over 30 years
and seeing the changes that have happened. One of the
areas in health care that appears to be almost taboo
to talk about, to address with health care leaders is
prices or pricing the level of pricing. And in particular,

(30:35):
I wanted to address this with you, Beth. Do you
see a time where prices in health care, whether we
talk about health care services, health care coverage, drugs? Do
you see a time where prices are ever going to
come meaningfully lower? And if they don't get lower? Can

(30:56):
we really have true consumerism existing in health care?

Beth (31:01):
I think the prices will get lower once we start
sharing them. And I know a lot of folks are
very nervous about sharing prices, which they are now obligated
to do. As as as we know. But do you
know of any other industry when prices became transparent or
the prices went up? No, no. People said, wait a minute,

(31:22):
my competitor on the street has a lower price. What
can I do to be more efficient? What can I
do to be differentiating and at least share my value? Right?
So I really believe this transparency of posting prices, number one.
And then number two, truly playing on the the retail

(31:43):
game as opposed to rebating. And again, what I said earlier,
things that happen behind the scenes and I'm not saying
that that's wrong, so don't misinterpret me, but when when
you really can't see where each of the pieces of
the money go, you can't you can't compete. So I
think bring it into a true retail environment that says,

(32:07):
here's how much we charge or here's the discount we
give to your to your health plan. Yes, That means
that health Plan A will be able to see what
Health Plan B pays a particular hospital. But my guess
is going to be when that happens, they're going to
start to say, wait a minute, I either have to
justify my higher price or I have to become more

(32:28):
efficient because what we really want and the way that
to me is optimal is that you really want to
make sure that you're going to the facility or to
the provider that is the best at something, right? So
you're willing to pay more for that because you know
that it's better outcomes. You don't always have to pay

(32:50):
more for better, for better quality, but get the price
out there, get the quality statistics out there and you
will see I think the market exploded. We're already seeing
this in consumers with companies like GoodRx. Right. How many
consumers are not using their Medicare plan, are not using
their health plan because it's less expensive to go pay

(33:12):
cash through, go to X for a drug than it
is through their health plan, because the health plan you're
paying your copay or coinsurance offer the retail price and
there's a rebate happening on the back end. So oftentimes
what you're paying out of pocket is higher under your
health plan than what you're paying under God, especially when

(33:33):
you're talking about specialty drugs and things like that. So
bring the prices out, bring the qualities out, show your outcomes.
And I think it's a game changer. I really do
think it's a game changer because providers are very competitive. Yeah,
they want to be the best, right? And they will
compete when they know that they're not as good as

(33:53):
somebody else. They'll either sit there and say, You know what?
Maybe we should stop doing heart surgeries here and focus
more exclusively on maternity and orthopedics because we're really, really
good at that. And that's where you'll start to have
what some of you may remember Regina Herzen at Harvard,
those focus factories, people will get better at what they
do and the market will, I believe, will will be

(34:17):
better off for it.

Steve (34:18):
Yeah, You know, it just brings me just to a
very quick follow up, and that is that, you know,
we use this term consumer and it it seems to
me that it seems to always be attributed to patients,
but it almost rarely, if ever, gets framed around self-insured employers,
which obviously, you know, they're just as much and certainly
probably more of a payer than the average individual, um,

(34:42):
you know, best. So I guess my, my thought would
be when you talk about transparency, how do you see
self-insured companies, you know, being able to really have leverage
on that as well as, you know, individuals.

Beth (34:55):
Their self-insured employers have been buying services over and above
what their health plan offers these point solutions because they
believe their health plans are not necessarily bringing to the
table what they want. So a large self employer will
have their health plan who will pay claims, but then
they bring in an accolade, right, to help their employees

(35:16):
navigate the health care system. They will bring in a
third bridge or a Karam Health to bring these very
specific networks around orthopedic surgery or heart surgeries or things
like that. They will bring in their own telehealth provider.
They'll bring their own mental health providers. In so large,
self-funded employers have been trying to bring transparency and improve

(35:39):
the health care system on their own, where they've seen
these deficits with their with their health plans. And again,
this is not a knock on health plans. I come
from the pair perspective. I'm just sharing with you that
when people see a gap and large employers are seeing
that they're not going to sit back and do nothing,
they're going to start to bring in these point solutions.
And we have just seen it. And I don't see

(36:00):
any end in sight for now because they're just saying
I need focus on these areas. Where do your point, Steve?
Cost or or skyrocketing. So they are consumers as well
and they are taking action.

Steve (36:15):
Jared I know on do you have a background, especially
with your show health care rep, you talk quite a
bit about the retail companies, the non health care retail
companies that have really grown in terms of providing care services.
You look at Amazon, Walmart, CVS, although you could argue

(36:37):
CVS might certainly have been health care before. And you know,
you're seeing more and more of this from the retail end.
You know, as a whole, I'd like you to maybe
explain from your perspective why this is really grown out
and just maybe elaborate a little bit more on on
retail companies getting into health care.

Jared (36:59):
You bet, Steve. The reason, in short, why retail companies
are coming in and succeeding in capturing market share is
that they know how to meet and exceed consumers expectations
for the experience they're going to have. They come in
with a consumer centered mindset and a business model and data,
and they use those retail chops to come in and
address just the part of the value chain that benefits them.

(37:21):
They don't often have the same restraints and constraints as
a medical institution. You know, Walmart Health could was free
to come out when they opened up their their initial
clinics and just they just posted all their cash prices.
And right off the bat, everyone knew exactly what it
was going to cost. And this was it. It was
a posted price. You could go to their website beforehand.

(37:42):
You actually knew what it was going to cost you
and they were competitive prices. You know, Amazon has an
online pharmacy that they you can go and check the
prices for the same the same prescriptions that you'd get elsewhere.
A lot of times their their cost less but they
have it all right there you can you can shop
it you can look online. You know, a lot of
these retailers, they use this mindset. They have decades of

(38:05):
experience addressing consumers. And when they were not in the
health care game, some of these players, they still they
knew exactly what they were doing. So they're in the
habit of communicating, engaging with gaining the attention, of making
it clear what they're doing to help serve somebody. It's
clear in the majority of their their communications and their

(38:26):
marketing and advertising. And what's interesting is that people in general,
with a with any kind of health care experience, with
with any encounter with the provider, generally give high scores
to the care itself. So the encounter with the care
they actually received from their health care professional, in large
part they give high scores for that. Where they rank

(38:49):
things lower is other parts of the experience. So I
didn't get my bill until weeks later. I didn't know
how much it was going to cost. It was really inconvenient.
Someone was rude to me. It was hard to schedule
the doctor. I couldn't get in for 30 days, you know.
So other parts outside of the care itself, these retailers

(39:09):
can come in. They know exactly how to address those
parts where they're seeing these low scores across the board,
you know, across the board for for providers. So what
we've seen on the other side of that is an
acceleration of the expectations that we bring in to any
health care encounter. And we can point to any number

(39:32):
of circumstances that have happened over the last couple of
years that have led us to have a higher expectation.
You know, all of a sudden, our favorite restaurant that
we went into a couple of years ago that we
that we couldn't go into anymore, they all of a
sudden turned around and offered curbside service and they made
it easier to deliver to you. And they created digital

(39:53):
experiences and digital versions of the things you're used to.
You know, even banks, you know, a traditional institution or
industry like banking and financial services, they figured out how
to make things easy. They still needed you to engage
with them. And they they figured out a lot of
digital tools to use to make that possible. So I
think there's a lot to be said for it. You know,

(40:15):
when you think about what these retailers offer outside of
health care as well, convenience, ease, personalization, transparency, yeah, those
aren't necessarily the historical priorities for health care providers and
medical professionals. So I think there's there's a lot to
keep your eye on. And I don't even know if
it'll be the current slate of players that ultimately succeeds,

(40:38):
but we need to keep an eye on cumulatively what
does that doing to our expectations as as health care consumers?

Steve (40:45):
Gary, one of the things that I particularly have an
interest in is certainly data in how health care is transforming.
How do you see data as a whole playing a
role in. Empowering or strengthening consumerism in health care.

Gary (41:03):
There was a period in late 2018 into 2019 and
think accelerated where the where you saw companies, large data
warehouse companies driven by significant amount of machine learning and
next generation data models, companies like Snowflake and Databricks. These
are some of the largest IPOs ever for for software

(41:24):
companies began to kind of shatter not to use that
term again, but kind of break ceilings of acceptability in
terms of what you needed to do to reach consumers better.
And these are large super brands working with these organizations,
and they're supposed to know what they're doing. So I
think that movement now is happening here. And you're talking
about rebuild, not rebuilding, but kind of consolidating and standardizing

(41:47):
for 30 years of fragmented data repositories. You're talking hundreds
of different data centers across your average health system that
basically all have a different interpretation of you that is
all now coming together, has to be cleansed, kind of
ratified to a degree, to a quality matrix that allows
you to do everything that we're talking about. You don't

(42:10):
do that first. There is not one thing on the
table that we're discussing today that you can perform. It
has to be rooted in some sort of consistency and
reliability when it comes to, again, show me, you know, me.
In order to do that, you have to have a
single record of who you are. Like, this is just
table stakes, bottom of the first inning kind of stuff.

(42:30):
But here we've passed the line so far in terms
of its feasibility, in terms of it being correct, that
we're having to go kind of back in time and
then coming forward again. So it's it's huge. It's everything
right now. It's we're almost all of my focus is
and will be probably for the next 12 to 18 months.

Steve (42:49):
And do you see the single longitudinal record for patients?
Do you see that? Containing consumer data. Consumer data where person,
let's say, does their grocery shopping or what they buy
when they grocery shop or what they buy when they
make other purchases outside of health care? Do you see
all that wrapping into that that longitudinal record?

Gary (43:11):
Absolutely. It absolutely. And I'll go back to what Jared said.
Jared talked about like the the middle window, that clinical window,
which constitutes a very narrow percentage of your health time. Right.
That acute and that's how we've always labeled it. Well
what happens before and after that that's that's your life.
That's your health life. That's far more important than how

(43:34):
you got fixed. I mean, don't get me wrong, that's important.
But how do you prevent that from happening again? What
is your mental state and status? What is your family status?
How do all of these intersections of where you live,
how you travel, all the little nuances we talked about
back in to become a you that they can interact
with on a 1 to 1 basis and and that

(43:56):
so it's not just consumer data, it's mental health data.
It's behavioral data. It's you know, shopping data, commerce, data.
You're the speed of urgency, Like all of these things
go into a fabric of you and understanding you. And
nowhere is it more important than here. And and it's
just it's just lagging forever. So that persona of you

(44:18):
does have to include a consumer centric version and a
patient centric version at the highest of standards, working on
multiple levels simultaneously. And then and only then can a
lot of the machines that we're building in the background,
you know, designate that how to interact with you. There's
no more greater focus right now than kind of bringing

(44:39):
all of that together, no matter where you are in
this space. This is job number one, hands down.

Steve (44:44):
Beth, I'd like to get your point of view on
pay visitors and in particular, maybe just giving a very
high level explanation of what a provider is. And then ultimately,
do you see the emergence of pay visitors helping or
hurting consumerism in health care?

Beth (45:04):
Sure a pay Vidar is a provider that that assumes
risk and they can either become a full blown health
plan or they could be accepting global risks, for example,
from from the payer. We're seeing more and more pay
writers enter the into the system. As an example, for
January this year, Ochsner Health Plan or Ochsner used to

(45:28):
have a health plan. Now they reinstated and created a
new health plan. They had sold their their previous health plan.
They have a new one for Medicare Advantage members. So
they are provider Intermountain, Kaiser, UPMC. These are all all
classic providers that have the full blown health plan. But
I also look at companies like Oak Street Village, MD.

(45:50):
I consider them pay Viatris as well because they're taking
global risk and consumers typically really like their pay plans,
especially Kaiser. That's been doing it for a really long
time because they don't see it as their health plan.
They see it as going to their doctor, right? And
it's a very seamless experience. Like Jared and Gary we're

(46:10):
talking about. I pay my copay and off, off my go.
They also allows you to, I think, to have that flexibility,
particularly the providers like the Village MDs, the oak streets
that are taking global risk gives you that flexibility to
do what it is you need to do for the
the member. One other example really quickly. Geisinger. Right. Geisinger

(46:34):
Health Plan is both a health plan and a health system.
They've been able to do some really innovative things over
a year, over the years. Right. They were one of
the first to get out there and start helping folks
with diabetes by actually giving them food. Right. And to
help manage their diabetes. They were, I think, the first
out there that said we are not going to charge

(46:54):
back to our health plan if we have to readmit
you for certain conditions within 30 days. That's on us
and we're not going to charge the health plan again. Right.
So I think there's a lot of really neat things
that providers can do. So I think it's really exciting
and I think competition is always a good thing.

Steve (47:13):
Jared I know on your podcast you talk quite a
bit about, you know, changing sort of changing the design
of health care. And a lot of times, as I've
heard you say it, it starts within the companies itself.
And so with that being said, what sort of changes
in business roles or role titles or responsibilities do you

(47:36):
see as as really needing to happen to help catalyze
consumerism even more, whether it's with providers or payers or
or any organization in health care, what what sort of
roles do you see needing to evolve more?

Jared (47:52):
So, you know, think back to the early days of
before we had chief digital officers or before we had
certain roles within marketing organizations. And and you know, SEO
used to be just one tiny thing that a marketing
leader would be involved in. And now that's there are
roles and teams and entire industries dedicated to that. I

(48:15):
feel like we're at the cusp of of something like
that that will take some time to to be adopted
in a widespread way. But there's something to be said
for having a role for consumer strategy, and especially when
we're talking about traditional provider organizations where that is not

(48:36):
typically covered as its own function. And so the need
right now is to develop leaders who have a very
cross-functional mindset. I mean, you think about the the competencies
and skills that you need to provide a greater consumer experience.
It's a cross-functional role. It's equal parts, human centered design,

(48:58):
digital and tech, finance and marketing. And you might ask
why those four things? Well, human centered design, because first
and foremost, we have to design something better, which means
that you're putting the consumer at the center of the
change management process. There's a whole set of skills and
and frameworks that are used with under that umbrella of
human centered design. And it's typically something that happens in pockets,

(49:19):
but it's not widespread and mainstream across an organization. But
that's what you need as, as a skill at the
very least to design a product or experience or a
service that does have the consumer in the middle. Then
once you've designed it, you need very deep understanding of
the digital and tech tools to build that experience and

(49:42):
build that service or product that you're talking about. You're
almost always connecting data sources like like Gary's mentioned, and
you are the building is very robust, so you need
a very specialized set of skills and understanding there. Then
you need finance because the economics have to make sense.
You have to provide a growth track like the the

(50:03):
service or product that you're talking about. All the players
involved have to benefit from it or else it won't
make business sense. It has to make business sense in
order to be justified. And then finally, you need marketing
chops because you're going to be influencing consumers behaviors. You
need to understand them and be able to engage them,
open a conversation and explain to them what their choices
are and you need to listen to them and know.

(50:25):
So all these basic functions of marketing. So wherever that sits,
I think I think this conversation is just now beginning
to happen in the industry. But I expect to hear
more about it, about what a consumer strategy role might
look like and see that enter the conversation. They'll probably
be called something different. You know, it'll probably be something
related to that. But this combination of parts that have

(50:46):
traditionally been housed in different departments that don't talk to
each other a lot, I think we'll see a lot
more of that.

Steve (50:54):
If you could snap your fingers and have just one
change made that could strengthen consumerism and health care. What
would that one single change be? Beth, start with you.

Beth (51:08):
Well, I'd probably go back to my transparency statements, really
saying show me the prices. Show me the quality as
you define quality and then show me that you will
incorporate my opinion of quality as the person who's going
to be consuming the the services. So I just think

(51:30):
that transparency is so, so critical. I want to know
how much you're going to charge me. I want to
know how good you are at it. And I want
to know how how you're going to treat me as
a customer. Very simple premise, Jared.

Jared (51:42):
I think I would just say.
That the industry will welcome the changes that are coming
and will take the lead rather than resist it. You know,
we saw organizations resist digital transformation for decades and we
saw where that got them. It didn't get them to
where they they just thought it was going to be
a fad or something that went away and they could
just stick with business as usual. And so I'd love

(52:05):
to see it happen sooner rather than later. And I'd
love for the existing players and leaders in the industry,
whether that is the medical profession, you know, the medical
institutions of of the world or other players who are
incumbents and in strong market positions right now, that they
would see the value of partnering together and taking the
lead and and not resist it because that'll get us

(52:28):
there a lot sooner.

Steve (52:30):
And Gary.

Gary (52:33):
Yeah. For me, it's. It's always a little bit of
go big or go home but I would love. For
every single person in the US, all 350 million of them.
To know that they are in charge of their own health.
A top down. And what does that And what does

(52:54):
that mean? It's not your provider. It's not your payer.
It's not CVS. It's none of them. Although they stake
claim to be the greatest practitioner and the greatest supporter
and administrator of your health. They don't own your health.
You do. Don't everybody don't think everybody gets that. And

(53:15):
it's and it's for and it's and it's again, it
comes back to all the things that we've talked about
in terms of things being more open. And when things
are open, the control comes back to the consumer and
controls a strong word. But it's really what it is,
particularly when it comes to your health. And it's not
just riding on a peloton. It's not just having your
Apple Watch and working out and tracking all of that.
Like people like, well, that's what I do and that's

(53:37):
part of my health. Yeah, but managing your health is
a lifelong exercise that cuts across a significant number of boundaries,
both known and unknown for them. For those born and unborn,
because your, your, your life can become somebody else's life
and then so on down the line. And how does
that get kind of controlled and owned by you? What

(53:59):
mechanisms are most put in your hands for you to
be able to do that? And we are far, far,
far from allowing that to happen. There's no killer app.
There is there is no transcendence universally across the country
on a standard model that is that is again, 100%
customer centric. Many are trying and dabbling in it and

(54:21):
beginning to say that they're on that movement. But it's slow.
It's got a lot of broken parts that continue to
kind of show up again and again and again, but again,
snapping the figure. It would make life a lot easier
if the culture of the US and globally, quite frankly,
knew that they were in charge and to begin to
kind of force that chain from that angle, that would

(54:42):
help speed things up significantly.

Steve (54:44):
I want to thank the panel today for taking their
time and sharing their great insights. Beth, Gary and Jared.
It has been a privilege and a pleasure. Thanks so
much for coming on the show today and definitely looking
forward to doing it again.

Beth (54:59):
Thanks for having me, Steve. I really enjoyed.

Jared (55:01):
It. Thanks for letting me be a part of this.

Gary (55:02):
Thanks, Steve. Great job as usual.

Jared (55:06):
Thanks for tuning in. If you like what you heard,
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(55:28):
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There faster together.
Thanks again.