May 7, 2025 • 38 mins
Wayne Lowry talks with industry veteran Rich Hess about how employers can unbundle insurance and integrate direct primary care. From TPAs to cafeteria plans, they explore practical strategies to improve employee health outcomes and reduce costs.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Rich HessYeah, I truly believe direct primary care is at the forefront and needs to be on top of mind for every employer.
(00:07):
Rich HessRight? Because long term, they reduce the overall spend of their employees and it helps employees become better consumers once they're able to have those conversations with their direct primary care physician.
Rich HessAnd, Wayne, we need more people being good physicians.
(00:29):
Rich HessWe need good hospitals. Hospitals take the brunt of a lot of our angst.
Rich HessAnd rightfully so, because there's good hospitals and there's bad hospitals, but we need more physicians and nurses. We need good people and healthcare getting in, not getting out.
Rich HessAnd we need the employees and their members to become better consumers.
(01:06):
Wayne LowryHello and welcome to the Best DPC podcast, the world's number one show, covering all things direct primary care. I am your host Wayne Lowry, and today I am honored to have Rich Hess with us. Rich is the VP of Business Development of the Plexus Groupe, bringing in over 30 years of employee benefits and insurance experience to the table.
(01:29):
Wayne LowryToday, he's going to tell us how we can unbundle insurance and provide direct primary care as a part of that package. So, we're excited to have Rich with us. Welcome, Rich, to the show.
Rich HessThanks, Wayne. Glad to be here. Always love talking direct primary care.
Wayne LowrySo tell me, Rich, a little bit about yourself. Where did you start your insurance journey?
(01:54):
Rich HessWow, so…
Rich HessProbably like most folks in the insurance business, I was tricked into it.
Rich HessRight. I don't know that anyone grows up thinking they'll be in the insurance business.
Rich HessBut my senior year of college, I started going on job interviews.
(02:19):
Rich HessAnd I ended up on one of those interviews at a third party administrator, TPA.
Rich HessAnd at the time they were very small, local.
Rich HessAnd my thinking as a 21 year old—22, whatever I was—was that by getting in early, being on the ground floor, right, that I would have more opportunities to grow with the company.
(02:46):
Rich HessAnd so I started out at a third party administrator, learned how to pay claims, do billings, and really do anything required.
Rich HessAnd ultimately ended up hiring a sales force and growing the sales team and expanding lines of coverage and so forth to the point where I decided to just go out on my own.
(03:14):
Wayne LowrySo you're talking about TPA. Let me jump in for a second. So for our listeners who are not familiar with what a TPA is, I I know you mentioned it briefly, a third party administrator, a TPA is obviously very crucial if you're going to have some sort of, I guess, self-funded plan.
Wayne LowryTell me a little bit about what you were doing. Were you working with self-funded plans primarily or what were you doing with that company?
(03:44):
Rich HessYeah, great question, because there are in fact very different types of TPA’s, right, third party administrators.
Rich HessIn this case, we specialized in section 125, cafeteria plans.
Rich HessOr flex plans, right? And ultimately we got into COBRA administering COBRA, et cetera.
(04:05):
Rich HessBut in my case, we were administering and selling the Section 125 cafeteria plans, so my role was to work with employers and help them understand how the cafeteria plan was advantageous to both of them and their employees.
Rich HessIronically, I had a really good friend—we're still good friends today.
(04:31):
Rich HessWe went to school together.
Rich HessAnd when he graduated from college, went to work for his father at a TPA who administered health plans.
Rich HessSo, we've both gotten the TPA business.
Wayne LowryOK.
Rich HessMe, focused on cafeteria plans. Him, focused on health plans. Wayne Lowry Totally different directions.
(04:53):
Rich HessAnd so oftentimes, we were competing for the same employers.
Rich HessRight, having grown up together since like fifth grade, we would go to lunch and catch up and lie to each other.
Rich HessAbout what we were working on because we didn't want the other one to really know.
Rich HessBut oftentimes we end up in the same exact employers as competitors.
(05:21):
Wayne LowrySo, you say as competitors, so how could y'all coexist for your group?
Rich HessSo there were times where the TPA he was working for was administering their self-funded medical plan.
Rich HessAnd they had a lot of clients who were in MEWA’s or Trust.
Rich HessA banker’s trust, for example, where multiple employers could join to an extent the same plan.
(05:46):
Rich HessBut we would administer the cafeteria plan for that same employer.
Wayne LowryAnd now for our listeners at home, a cafeteria plan, we're not talking about your meal plan. We're not talking about your fruits and veggies. So, what is the cafeteria plan in the role of TPA.
Rich HessSo the gist of it is, the reason the IRS calls it “cafeteria plan” is because you can have multiple benefits that an employee can pick and choose from.
(06:14):
Rich HessMuch like when you go through a FERS or a Luby's, hopefully most of our listeners are familiar with FERS or Luby's.
Wayne LowryWell, if you live, if you live in like the Oklahoma Dallas area, I think you know it first so…
Wayne LowryWhy don’t you do a Brahms reference? Let's keep it ultra-like hyper local.
Rich HessYeah, well, unfortunately, Brahms doesn't offer cafeteria style, right? You only get what you pay for.
(06:40):
Wayne LowryOhh.
Rich HessI love—I might have had Brahms yesterday as a matter of fact.
Rich HessSome chocolate almonds.
Wayne LowryWell, thanks for rubbing that in. So they call the cafeteria plan ‘cause you can pick and choose. So is this typically—these are typically your voluntary products, right?
Rich HessYeah.
Rich HessWell, certainly voluntary products can be a piece of it. They can be something that the employer offers to their employees at their own expense.
(07:08):
Rich HessWhat we were responsible for as the TPA was administering what's called flexible spending accounts.
Rich HessOne for medical expenses, one for daycare or child care expense s.
Rich HessTechnically dependent care expenses, because it can also be used to pay for the care of an elderly parent, for example.
(07:30):
Rich HessSomething that my wife is going through right now with her dad, all those expenses related to an aging parent.
Rich HessBut what we did is we would educate employees on Section 125 and how they could have money taken out of their paychecks prior to ending withholding tax and then be reimbursed tax free for those expenses for out of pocket medical expenses.
(07:56):
Rich HessSuch as deductibles, eyeglasses, dental work, copayments, prescription drugs, et cetera, et cetera.
Rich HessAnd as the TPA, that's what we did.
Wayne LowrySo not to bury the lead too far, with the TPA side and what you're talking about, those selections, what are your thoughts on how to involve DPC in those types of plans?
(08:26):
Rich HessWell, So what I've been recommending for some time now—and I love the popularity of the DPC, how it's grown just in the last few years.
Rich HessFrom my vantage point, it's grown.
Rich HessCurrently, I think employers still have reservations.
Rich HessRight? And those are some things that we talk about all day, every day is how DPC can help them.
(08:55):
Rich HessAnd help their employees and help the overall health plan.
Rich HessBut to me, most of the conversations that I'm having are how and why should we have direct primary care at work?
Rich HessAnd I've been a fan for some time.
Rich HessI think years ago we got away from primary care physicians.
(09:17):
Rich HessAnd I know using my sons as an example, I have two sons, both one is 29, one is 25.
Rich HessAnd their age group, it's all technology, right?
Rich HessAnd it's all cell phones.
Rich HessAnd from one of my sons, when they don't feel well or they feel like they've reached a point that they might need a doctor or a prescription, their tendency is to just grab their cell phone, find the nearest urgent care, “what time can I get in?”, pay the 75 bucks, go to Walgreens or CVS, fill the script and off they go. They don't have primary care physicians.
(10:04):
Rich HessRight, in an employer setting, Wayne, the thing that I hear the most is. So I'm talking to a CFO, let's say.
Rich HessAnd I'm looking at their plan. And I start having the conversation about direct primary and how it can keep people out of the emergency room for things that aren't an emergency. They can get certain services in the primary care physician's office without the added expense of the hospital.
(10:39):
Rich HessOr in some cases even the pharmacy, because some DPC’s, as you know, have a lot of the drugs in house.
Rich HessAnd they can just—anyway…
Wayne LowryYeah.
Wayne LowryYeah, depending on the state because you don't down here in Texas, we've kind of covered this a few times down here. It's always a talking point because in Texas you can't just, you can't dispense at your clinic.
(11:11):
Wayne LowrySo I think it's us and Massachusetts if I remember correctly are the two states with the strictest regulations on that front, but I guess Oklahoma, it's just free Willy nilly, I mean y'all legalize marijuana now, you can just get drugs anywhere. Is that what you're telling me?
Rich HessHey, Oklahoma is, in the right, one of the freest, most conservative independent states in the Union. Isn't that right?
(11:34):
Wayne LowryIt is and boy, you can still get high.
Rich HessI love Oklahoma. I think one of the reasons we've remained the way we are is because people just don't care about Oklahoma. Like…
Rich HessRight when I was in the Marine Corps and I was all over the world, people would go, “You live where?”
(11:56):
Rich Hess“I'm in Oklahoma.”, “Do they even have roads?”
Rich HessRight. So we just kind of sat here and mind our own business.
Wayne LowryYeah, they plugged you right out of the field in your bare feet, right? And send you off…
Rich HessYeah, we ride horses to work and…
Wayne LowryWell, I think it's interesting because I, you know, recently got a chance to go see the…
(12:24):
Wayne LowrySee each other at the FEMA conference and to see all the DPC innovation that's going on in that area. And there's a lot of excitement in that area around DPC. So one thing that I can tell people listeners at home, whatever your thoughts are about Oklahoma, they're wrong.
Wayne LowryOklahoma really is, especially in Oklahoma City area, is really thriving in a lot of different fronts, economically speaking. And so maybe a lot of that freedom you're talking about is bringing in some unique new business opportunities. So that's exciting.
(12:56):
Rich HessRight, good point, capitalism.
Wayne LowryThat's capitalism. Good. Good for you guys. As long as y'all aren't, you know, beat us at football. We'll be OK. So let me ask you, when you're talking to employer groups now and you are, you know, trying to bring up DPC, what are some of the challenges or what are some of the education points that you deal with in those conversations?
(13:23):
Rich HessYeah. So that's what's interesting.
Rich HessThe number one thing that I hear is, “So you want me to spend more money to fix my health plan?”
Rich HessRight?
Rich HessAnd oftentimes, I'll just kind of chuckle because I get it. It does sound counterintuitive, right?
(13:49):
Rich HessBut Wayne, it's also so much like any wise investment.
Rich HessAnd I could go on and on about different scenarios. You know, we all here, it takes money to make money or you have to spend money to make money, right?
Wayne LowryOh yeah.
Rich HessOne example that I give often and people laugh at 1st and then they go, ”well, yeah, now I do get it.”
(14:13):
Rich HessBut I don't know if you're familiar with Lululemon, the brand.
Wayne LowryYes, yes I am.
Rich HessHave you ever worn a pair of pants from Lululemon?
Rich HessOK, good. Well, you're in South Texas, right?
Wayne LowryI'm gonna say no.
Rich HessSo, I have lululemon pants on right now.
(14:37):
Rich HessHere, here's where this story gets interesting. I'm known to be very frugal.
Rich HessI don't like to spend too much money. I don't like to waste money. I'm not fancy. I'm very conservative.
Rich HessI have clothes in my closet that I've had for years and years and years. Just can't get rid of them.
(14:58):
Rich HessI wear old shoes until they literally fall apart.
Rich HessLike I am very conservative and frugal.
Rich HessI don't spend money, OK?
Rich HessAnd I have taught my sons to pay yourself first, put money in the bank, save, be conservant, don't overspend, all that stuff. Right? No credit card debt.
(15:22):
Rich HessA few years ago, I went into a Lululemon and tried on a pair of pants.
Wayne LowryNow let me ask you real quick, do the Lululemons come in Levi, that's really my question.
Rich HessI have Levi’s too. They do not, I suspect, Lululemon and Levi are two very, very different companies.
Wayne LowryOK, OK, OK. OK.
Rich HessI'm only speculating.
(15:43):
Wayne LowryOK. All right.
Wayne LowryOK. All right. This is just checking. Rich Hess And I promise there's a point to the story.
Rich HessBut when I'm talking about direct primary care—
Wayne LowryJust to be clear, when we go to a commercial break, we're not going to break for Lululemon commercial, so not a sponsor.
Rich HessThat's right, they are not a sponsor. We are not endorsing Lululemon.
Rich HessI would have been the last person you would ever expect to go buy a pair of lululemon pants, is my point, but I went in one day.
(16:11):
Wayne LowryGot you.
Rich HessAnd I tried them on.
Rich HessAnd I literally looked at the young lady helping me and I go, “There's no chance I'm spending $158 on a pair of pants. No chance,”—maybe 128 I don't remember.
Rich HessBut I won't do it.
Rich HessOK, few days later, went back, tried them on again, bought ‘em.
(16:35):
Rich HessOK, Since then I decided you know what I'm going to do, I'm just going to buy four or five different colors and it'll save me a lot of time and a lot of effort just knowing exactly each day. Here's what I'm putting on.
Rich HessTold my oldest son about it, he laughed. No chance I'm spending $128.00 on a pair of pants. I go, “I get it. You're just going to have to trust me.”
(17:08):
Rich HessAnd that's where I end up with a lot of these CFOs, Wayne.
Rich HessBecause now my oldest son, he has every color of those, and that's all he wears for work. He can dress them up, dress them down, put on a golf shirt, wear a blazer.
Rich HessBut they're flexible.
Wayne LowryAll right. So yeah. So for those that are watching, I found an option. Now the guy is holding a bag and a handbag but besides that looks very masculine, very masculine pair of pants right there.
(17:42):
Wayne LowryRight. They look alright. I just wanted… Rich Hess So they're very comfortable, they're flexible.
Rich HessBut here's the thing. Like when I told my oldest son, you're just going to have to trust me.
Rich HessThe moral of the story was we've all skimped on stuff where we bought the right something cheap or inexpensive or etcetera and it either doesn't last, doesn't look good, not comfortable, whatever. And I'm the world's worst, right? I'm guilty.
(18:12):
Rich HessBecause I don't like to spend money.
Rich HessI prefer to save money.
Rich HessBut it saves my son, and me for that matter, so much time and effort on going back to other stores, shopping, being frustrated, blah blah blah, and with DPC so many times now, when a CFO or business owner says, “so, you want me to spend more like now you're telling me I got to pay X amount per employee per month when my health insurance already covers doctors?”
(18:44):
Rich HessYes, you're just going to have to trust me.
Rich HessBecause what that's going to end up doing is reducing your overall cost of your health insurance.
Wayne LowrySo what do they say when you use that approach?
Rich HessWell.
Rich HessA few years ago they would go. Yeah. I don't know if I trust you that much.
(19:05):
Rich HessRight? Is there something else we can do?
Wayne LowryYeah, well but you know, 10 percent, 10% year over year increase of their premiums may have something to do with some motivation.
Rich HessWell, it's funny you say that because I've come to the point in healthcare where I truly believe that the only way employers are going to make real change is when the pain of what they're doing now becomes more than the pain of the unknown.
(19:39):
Wayne LowryI want to take a quick break to talk about BestDPC.com. Are you a doctor looking to break free from the headaches of insurance and take control of your practice? Or maybe you're an employer searching for an affordable healthcare solution that actually works?
Wayne LowryAt BestDPC.com we cut through the noise and connect you with the country's best direct primary care clinics. Whether you're a patient tired of surprise medical bills or A physician ready to build a thriving membership based practice. We've got the tools and resources you need.
(20:12):
Wayne LowryFind the Best DPC doctors near you. Get expert advice and take the first step towards a better healthcare visit BestDPC.com today and see why direct primary care is the future of medicine. That's BestDPC.com because great healthcare should be simple, affordable and built around you.
Wayne LowryWell, what we say is no one gets fired recommending one of Buca.
(20:33):
Rich HessRight.
Wayne LowryI mean, so when you're talking to, you know, an HR department or you're talking to some of the decision makers that maybe aren't the CEO's, if you're talking about a private sector, you know, company the CEO might be willing to take the risk, maybe willing to roll the dice, take the gamble,
(20:55):
Wayne Lowrybut you know the HR department maybe sitting there going, “hey, I've never been fired for looking at a fully insured stack from one of the big carriers. So I'm going to keep doing that because hey, I'll have a job tomorrow”,
Wayne Lowrybut it sounds to me you're getting to talk to some of the decision makers and, you know, y'all are again Oklahoma y'all are y'all are still the wild Wild West, right. So I mean, you've got some gunslingers that are willing to give it a shot.
(21:22):
Rich HessRight.
Wayne LowrySo what have you seen and obviously getting in the front door or you build that relationship, you have those clients that you're integrating with DPC, what are some of the results that you're showing from that?
Rich HessThat's the answer to your question. It used to be “You're just going to have to trust me”, right? And while I might have overspent on a pair of pants five years later, I'm still wearing those. And so I didn't have to buy more pants.
(21:56):
Rich HessNow we have statistics on DPC. We can show here your claims before DPC and here's your claim since. And we can show where the claims may be, maybe it's emergency room visits, right? Maybe it's high dollar claims.
Wayne LowryYes.
(22:19):
Rich HessYeah. Now we have employees who are using direct primary care instead of urgent care and emergency rooms.
Wayne LowryUrgent care, yeah.
Rich HessAnd one of my favorites to show is so If an employee who goes in and the doctor says, well, we might ought to X-ray this just to be safe, right? Or you need to get an MRI. Or whatever they suggest.
(22:49):
Rich HessWell. When you have DPC, they aren't incentivized to run extra tests and so we have those diagnostic bills coming down. So that we now can show overall claim spin coming down on employers who have DPC versus those who don't, whereas before I used to have to say, well, you're going to have to trust me because I think it's going to lower your claims. We can now show them.
(23:21):
Wayne LowryWell yeah, and changing the discussion from a ‘trust me bro’ to here's the data, I mean that obviously you go from the hunch to the success. I don't know if you were at the presentation, but it was pretty cool listening to Frontier Direct Care present their success with the city of McAllen
Rich HessAbsolutely.
(23:45):
Wayne LowryAnd what's going on there and you know I was a part of that organization when some of those initial conversations were going on and to hear and to see, you know, changing the conversation from ‘trust us’ to ‘here it works’.
Wayne LowryAnd so let me ask you, so as a DPC, so let's just say they're in Oklahoma City or Kansas or Montana or Florida or wherever you have a client and you're putting together a plan for that client. How would a DPC either reach out to you or or do you reach out to them? How do you identify the right fit?
(24:28):
Wayne LowryBecause I mean, let's be honest, not every DPC is ready for this, nor maybe they don't want to and you got to respect, you know, a lot of the DPCs that I've talked to and know they want, for lack of a better term, a lifestyle business.
Rich HessYeah.
Wayne LowryThey want to have their business. They might have one MA that helps them out. But other than that, they don't want to take, you know, take on more administrative. They don't want to have reporting, they don't want to have to be a part of an employer plan.
(24:57):
Rich HessAnd good for them.
Wayne LowryAnd exactly like God bless you. That's a great thing. You provide a great service to your community and you take care of your family. But there are others that are more, maybe entrepreneurial-minded. Maybe they have one or two clinics, one or two locations.
(25:20):
Wayne LowryAnd they're saying, “hey, we want to take on some employers. We think we can serve them very well. How do you find those DPC's?” I mean, obviously go the bestdpc.com to to check the directory. Obviously the first step, but you got to start there but after that how can you narrow down the choices to find the right DPC partner?
Rich HessYou have. Rich Hess Start there.
Rich HessMan, that's a great question because it's not a one-size-fits-all. I'm fortunate to have been in the business a long time.
(25:51):
Rich HessAnd to have been in this community.
Rich HessAnd so I know some of the folks who have gotten in the business.
Rich HessAnd we just started having conversations several years ago.
Rich HessAnd then the last seven years prior to me joining the Plexus group, I was actually on the network side of the House.
(26:12):
Rich HessSo I worked for a company that created a regional narrow, high performance network.
Rich HessAnd so I was having conversations with Frontier.
Rich HessRight. I was having conversations with AGB.
Rich HessThe grocery store, who has their own clinics and now they've gotten into DPC, right?
Rich HessIn Oklahoma, Primary HealthPartners as an example.
(26:33):
Wayne LowryRight.
Rich HessSo it all depends. We have to as a consultant vet them out, right? Like what are their goals? Where are they located? I always try to keep in mind that Healthcare is and should be local.
Wayne LowryRight.
(26:54):
Rich HessSo it's funny. About two years ago, I put something on social media, maybe LinkedIn, about primary HealthPartners in Oklahoma. I think they're a great outfit. I love the people over there.
Rich HessAnd when they first started and I was visiting with them, we'd go to lunch or we'd go have coffee. And I was asking 1,000,000 questions about “how does this work?”, and “how do you do this?”, and “how do you do that?”, “Why would somebody join?”
(27:23):
Rich HessAnd we just became friends and allies in the healthcare arena, but anyway, a couple of years ago I put something on probably LinkedIn if I guessed and somebody called me and they were with the TPA. A self funded TPA.
Rich HessAnd they said, “hey, why are you talking about them on your social media?” “I go look cause I think they're good people and it's a great service.” He goes. “Oh, no, I agree. We think they're great. But what's in it for you?”
(27:55):
Rich HessAnd I said, “well, there's nothing in it for me”, right?
Rich Hess“Oh, come on there. I mean, why are you talking?” Listen, there is nothing in it for me to recommend direct primary care. It's where Healthcare is headed and it's what we should be doing.
Wayne LowryYeah. Rich Hess So if I'm going to be a consultant in this arena, this is how I make a living, then I'm going to point people in the right direction.
(28:20):
Rich HessSo, to your question, I try to do my homework, vet them out. Oftentimes I will recommend DPC to your point. Like if there's a DPC practice and they don't want employer groups necessarily.
Rich HessThey just want—hey, go check them out, see if they're taking new patients. If they are, sign up, there's nothing in it for me.
(28:47):
Rich HessIt's a matter of finding the right DPC practice for the right employer.
Wayne LowrySo let's say you have a DPC that they have a patient panel of. Well, let me let me backup a step.
Wayne LowryWhat are you seeing most of your employer size? Like what is in your book of business? Are you typically talking to 300 member groups or 1000 member groups? What's kind of your sweet spot?
(29:16):
Rich HessI will talk to any size employer.
Wayne LowryThat's the right answer. Good job.
Rich HessAnd I don't, I mean somebody called me last week they were referred to me and they have two employees.
Rich HessRight. And so I went through the normal questioning, you should probably just be with somebody right now with somebody who focuses on the individual, right? You can check the exchange, you can get a small group plan, etc. But I'll talk to any size employer. If you talk about our sweet spot, it's probably between 100 and 1000.
(29:56):
Rich HessWe certainly have several groups over 1000. In fact, you mentioned one of them earlier. They're a client.
Wayne LowryOh.
Rich HessThey might do ice cream.
Rich HessAnd so we have several over 1000 lives, and of course we have offices in Dallas and Chicago as well. So we have many large—but I would say that sweet spot is really where it's catching on, if you will, is between 300 and 1000 lives.
(30:25):
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(30:47):
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(31:10):
Wayne LowrySo a lot of these employer groups that you're dealing with, I'm sure they're not necessarily isolated in one vicinity. So if you've got a large employer group, you may have 30 people in one town and 50 people in another town. Like how are you integrating DPC when you've got clients that are that spread out or or is most of what you're finding is it really works if they are a municipality or a school district or just a large centralized employer? What are you seeing as far as integrating DPC?
(31:44):
Rich HessNo, you're exactly right. And again, I have a little bit of a unique advantage in that the last seven years I was on a regional high performance network side of the House.
Rich HessAnd we were oftentimes focusing on municipalities, counties, public entities, schools where employees were consolidated, if you will, within 25 or even 50 miles.
(32:12):
Rich HessWe have in Oklahoma, of course. We're blessed to have the oil and gas and energy businesses.
Rich HessGood news, bad news.
Rich HessGood news is lots of jobs and well-paying jobs, bad news is they will oftentimes be in 13 or 14 states.
Rich HessSo DPC, they kind of might not be super excited about DPC.
(32:39):
Rich HessMaybe not super excited about a high performance network because they need to be able to cover everyone in the other states.
Rich HessSo what I see normally is, to your point, they will be consolidated in most cases.
Rich HessMaybe even have a direct primary care entity who wants to build them their own clinic.
(33:02):
Rich HessRight. I I talked to an oil and gas company in Oklahoma and I said, “Hey, we could, you could have an on site or near site clinic and or DPC?”
Rich HessAnd they—well, they loved the concept, said “Well, we don't want to do something different for those folks than our folks up in North Dakota”
Rich HessFair. But then we can get telemedicine, right? Maybe even traveling nurses for them.
(33:29):
Wayne LowryYour site you know or or maybe a maybe not the same DPC, but maybe a DPC in that community.
Rich HessCorrect.
Rich HessYeah. And so that's mostly what I'm seeing is they either either employees are consolidated within a certain geographic area or they find other entities or services for the ones in the outlying.
(33:51):
Wayne LowryGotcha, gotcha. So let me ask if you were to reach out to DPC's. What do you need from a DPC? Like, what do you need as far as reporting, do you need certain data? What? What do you look for? If you're going to even start a conversation with the DPC?
Rich HessWell, so early on, I just want to know about their culture. I want to know why they're in the business.
(34:13):
Rich HessRight. And I don't care if they want to charge $50.00 or $150.00, but I want to know that they're in it for the right reasons.
Rich HessAnd then what are their long term plans?
Rich HessDo they plan on scaling and going to other communities or do they have plans to just be in a certain community and this is it? Here's the max number of employees. Either way is fine.
(34:39):
Rich HessI just need to know what their plans are, right, so that when I am talking to a Prospector client I know how to line them up and we need good hospitals. We should partner up with the hospitals.
Rich HessIf we can get direct primary care in health insurance and good hospital contracts direct with good TPA’s, then the cost of healthcare goes down.
(35:01):
Wayne LowryYeah, yeah.
Wayne LowryThere you have it. We solved it. We solved it today. Right here. We solve it. Now, if we can just convince people now, we can take our show on the road and and and and yeah, and push the education. Well, I want to say how much I appreciate you being on the podcast today. Rich, this is very insightful.
(35:24):
Wayne LowryI want to encourage all DPC's everywhere to be mindful of what a health plan is and how they can be integrated into a health plan because you know, we're all taxpayers. You know, I've done a lot of work in public sector.
Wayne LowryAnd you know, when you're talking to a public sector, these are tax dollars that work. I'm not sure if you've worked specifically in that sector, but in public sector, these are tax dollars we're talking about. Like, let's not waste our money paying for something to help, you know—
(36:00):
Wayne LowrySome suit in New York City or Chicago. Let's try to help our teachers, our city employees, and let's try to provide a benefit that keeps it healthy, keeps it local. DPC can be the front door of that access. And so I've loved this conversation. I hope you'll come back some time and maybe sit down on a panel with a couple other people in this in this community and see how we can drive some change.
(36:32):
Rich HessYeah, I'd love to do that.
Wayne LowryAwesome. So how can people find you?
Rich HessRhess@plexusgroupe.com “Group” has an E on the end.
Wayne LowryOhh an “e”! So it's time for me to tell my joke.
Rich HessTell it.
Wayne LowryThere's no “e” in Lowry. I let you have the E for groupe.
(36:57):
Wayne LowrySo there you go. Rich Hess We appreciate it.
Rich Hess4405-823-1127.
Wayne LowryWhat are those random digits that you're spouting?
Rich HessI give my cell phone to every client. Call me. Text me. I've had that cell phone number for thirty years.
Wayne LowryAlright, so you can reach them by phone also I I imagine I'll have a website plexusgroupe.com. Is that right?
(37:19):
Rich HessWe do, we do.
Rich HessPlexusgroupe.com, “Groupe” has an E on the end of it.
Wayne LowryAll right, Plexus Groupe with an e.com to check it out and you can find Rich. What about LinkedIn? Are you on LinkedIn?
Rich HessAbsolutely you can. You'll be able to find me on LinkedIn.
Wayne LowryAll right.
Rich HessEven on Facebook.
Wayne LowryOh, man. Facebook, don't age yourself. I thought you're going to say TikTok. So either way, we'll make sure to have his contact information in the show notes again. Thank you, Rich, for joining us and for more DPC insights. Head over to bestdbc.com. Don't forget to follow us on social media.
(38:00):
Wayne LowrySubscribe to your favorite podcast platform. Make sure you give us all those likes and those stars.
Wayne LowryWe live on those things, so we appreciate it. And until next time, your health matters. So demand the best with direct primary care. Bye bye.
Rich HessYeah, I truly believe direct primary care is at the forefront and needs to be on top of mind for every employer.
(00:07):
Rich HessRight? Because long term, they reduce the overall spend of their employees and it helps employees become better consumers once they're able to have those conversations with their direct primary care physician.
Rich HessAnd, Wayne, we need more people being good physicians.
(00:29):
Rich HessWe need good hospitals. Hospitals take the brunt of a lot of our angst.
Rich HessAnd rightfully so, because there's good hospitals and there's bad hospitals, but we need more physicians and nurses. We need good people and healthcare getting in, not getting out.
Rich HessAnd we need the employees and their members to become better consumers.
(01:06):
Wayne LowryHello and welcome to the Best DPC podcast, the world's number one show, covering all things direct primary care. I am your host Wayne Lowry, and today I am honored to have Rich Hess with us. Rich is the VP of Business Development of the Plexus Groupe, bringing in over 30 years of employee benefits and insurance experience to the table.
(01:29):
Wayne LowryToday, he's going to tell us how we can unbundle insurance and provide direct primary care as a part of that package. So, we're excited to have Rich with us. Welcome, Rich, to the show.
Rich HessThanks, Wayne. Glad to be here. Always love talking direct primary care.
Wayne LowrySo tell me, Rich, a little bit about yourself. Where did you start your insurance journey?
(01:54):
Rich HessWow, so…
Rich HessProbably like most folks in the insurance business, I was tricked into it.
Rich HessRight. I don't know that anyone grows up thinking they'll be in the insurance business.
Rich HessBut my senior year of college, I started going on job interviews.
(02:19):
Rich HessAnd I ended up on one of those interviews at a third party administrator, TPA.
Rich HessAnd at the time they were very small, local.
Rich HessAnd my thinking as a 21 year old—22, whatever I was—was that by getting in early, being on the ground floor, right, that I would have more opportunities to grow with the company.
(02:46):
Rich HessAnd so I started out at a third party administrator, learned how to pay claims, do billings, and really do anything required.
Rich HessAnd ultimately ended up hiring a sales force and growing the sales team and expanding lines of coverage and so forth to the point where I decided to just go out on my own.
(03:14):
Wayne LowrySo you're talking about TPA. Let me jump in for a second. So for our listeners who are not familiar with what a TPA is, I I know you mentioned it briefly, a third party administrator, a TPA is obviously very crucial if you're going to have some sort of, I guess, self-funded plan.
Wayne LowryTell me a little bit about what you were doing. Were you working with self-funded plans primarily or what were you doing with that company?
(03:44):
Rich HessYeah, great question, because there are in fact very different types of TPA’s, right, third party administrators.
Rich HessIn this case, we specialized in section 125, cafeteria plans.
Rich HessOr flex plans, right? And ultimately we got into COBRA administering COBRA, et cetera.
(04:05):
Rich HessBut in my case, we were administering and selling the Section 125 cafeteria plans, so my role was to work with employers and help them understand how the cafeteria plan was advantageous to both of them and their employees.
Rich HessIronically, I had a really good friend—we're still good friends today.
(04:31):
Rich HessWe went to school together.
Rich HessAnd when he graduated from college, went to work for his father at a TPA who administered health plans.
Rich HessSo, we've both gotten the TPA business.
Wayne LowryOK.
Rich HessMe, focused on cafeteria plans. Him, focused on health plans. Wayne Lowry Totally different directions.
(04:53):
Rich HessAnd so oftentimes, we were competing for the same employers.
Rich HessRight, having grown up together since like fifth grade, we would go to lunch and catch up and lie to each other.
Rich HessAbout what we were working on because we didn't want the other one to really know.
Rich HessBut oftentimes we end up in the same exact employers as competitors.
(05:21):
Wayne LowrySo, you say as competitors, so how could y'all coexist for your group?
Rich HessSo there were times where the TPA he was working for was administering their self-funded medical plan.
Rich HessAnd they had a lot of clients who were in MEWA’s or Trust.
Rich HessA banker’s trust, for example, where multiple employers could join to an extent the same plan.
(05:46):
Rich HessBut we would administer the cafeteria plan for that same employer.
Wayne LowryAnd now for our listeners at home, a cafeteria plan, we're not talking about your meal plan. We're not talking about your fruits and veggies. So, what is the cafeteria plan in the role of TPA.
Rich HessSo the gist of it is, the reason the IRS calls it “cafeteria plan” is because you can have multiple benefits that an employee can pick and choose from.
(06:14):
Rich HessMuch like when you go through a FERS or a Luby's, hopefully most of our listeners are familiar with FERS or Luby's.
Wayne LowryWell, if you live, if you live in like the Oklahoma Dallas area, I think you know it first so…
Wayne LowryWhy don’t you do a Brahms reference? Let's keep it ultra-like hyper local.
Rich HessYeah, well, unfortunately, Brahms doesn't offer cafeteria style, right? You only get what you pay for.
(06:40):
Wayne LowryOhh.
Rich HessI love—I might have had Brahms yesterday as a matter of fact.
Rich HessSome chocolate almonds.
Wayne LowryWell, thanks for rubbing that in. So they call the cafeteria plan ‘cause you can pick and choose. So is this typically—these are typically your voluntary products, right?
Rich HessYeah.
Rich HessWell, certainly voluntary products can be a piece of it. They can be something that the employer offers to their employees at their own expense.
(07:08):
Rich HessWhat we were responsible for as the TPA was administering what's called flexible spending accounts.
Rich HessOne for medical expenses, one for daycare or child care expense s.
Rich HessTechnically dependent care expenses, because it can also be used to pay for the care of an elderly parent, for example.
(07:30):
Rich HessSomething that my wife is going through right now with her dad, all those expenses related to an aging parent.
Rich HessBut what we did is we would educate employees on Section 125 and how they could have money taken out of their paychecks prior to ending withholding tax and then be reimbursed tax free for those expenses for out of pocket medical expenses.
(07:56):
Rich HessSuch as deductibles, eyeglasses, dental work, copayments, prescription drugs, et cetera, et cetera.
Rich HessAnd as the TPA, that's what we did.
Wayne LowrySo not to bury the lead too far, with the TPA side and what you're talking about, those selections, what are your thoughts on how to involve DPC in those types of plans?
(08:26):
Rich HessWell, So what I've been recommending for some time now—and I love the popularity of the DPC, how it's grown just in the last few years.
Rich HessFrom my vantage point, it's grown.
Rich HessCurrently, I think employers still have reservations.
Rich HessRight? And those are some things that we talk about all day, every day is how DPC can help them.
(08:55):
Rich HessAnd help their employees and help the overall health plan.
Rich HessBut to me, most of the conversations that I'm having are how and why should we have direct primary care at work?
Rich HessAnd I've been a fan for some time.
Rich HessI think years ago we got away from primary care physicians.
(09:17):
Rich HessAnd I know using my sons as an example, I have two sons, both one is 29, one is 25.
Rich HessAnd their age group, it's all technology, right?
Rich HessAnd it's all cell phones.
Rich HessAnd from one of my sons, when they don't feel well or they feel like they've reached a point that they might need a doctor or a prescription, their tendency is to just grab their cell phone, find the nearest urgent care, “what time can I get in?”, pay the 75 bucks, go to Walgreens or CVS, fill the script and off they go. They don't have primary care physicians.
(10:04):
Rich HessRight, in an employer setting, Wayne, the thing that I hear the most is. So I'm talking to a CFO, let's say.
Rich HessAnd I'm looking at their plan. And I start having the conversation about direct primary and how it can keep people out of the emergency room for things that aren't an emergency. They can get certain services in the primary care physician's office without the added expense of the hospital.
(10:39):
Rich HessOr in some cases even the pharmacy, because some DPC’s, as you know, have a lot of the drugs in house.
Rich HessAnd they can just—anyway…
Wayne LowryYeah.
Wayne LowryYeah, depending on the state because you don't down here in Texas, we've kind of covered this a few times down here. It's always a talking point because in Texas you can't just, you can't dispense at your clinic.
(11:11):
Wayne LowrySo I think it's us and Massachusetts if I remember correctly are the two states with the strictest regulations on that front, but I guess Oklahoma, it's just free Willy nilly, I mean y'all legalize marijuana now, you can just get drugs anywhere. Is that what you're telling me?
Rich HessHey, Oklahoma is, in the right, one of the freest, most conservative independent states in the Union. Isn't that right?
(11:34):
Wayne LowryIt is and boy, you can still get high.
Rich HessI love Oklahoma. I think one of the reasons we've remained the way we are is because people just don't care about Oklahoma. Like…
Rich HessRight when I was in the Marine Corps and I was all over the world, people would go, “You live where?”
(11:56):
Rich Hess“I'm in Oklahoma.”, “Do they even have roads?”
Rich HessRight. So we just kind of sat here and mind our own business.
Wayne LowryYeah, they plugged you right out of the field in your bare feet, right? And send you off…
Rich HessYeah, we ride horses to work and…
Wayne LowryWell, I think it's interesting because I, you know, recently got a chance to go see the…
(12:24):
Wayne LowrySee each other at the FEMA conference and to see all the DPC innovation that's going on in that area. And there's a lot of excitement in that area around DPC. So one thing that I can tell people listeners at home, whatever your thoughts are about Oklahoma, they're wrong.
Wayne LowryOklahoma really is, especially in Oklahoma City area, is really thriving in a lot of different fronts, economically speaking. And so maybe a lot of that freedom you're talking about is bringing in some unique new business opportunities. So that's exciting.
(12:56):
Rich HessRight, good point, capitalism.
Wayne LowryThat's capitalism. Good. Good for you guys. As long as y'all aren't, you know, beat us at football. We'll be OK. So let me ask you, when you're talking to employer groups now and you are, you know, trying to bring up DPC, what are some of the challenges or what are some of the education points that you deal with in those conversations?
(13:23):
Rich HessYeah. So that's what's interesting.
Rich HessThe number one thing that I hear is, “So you want me to spend more money to fix my health plan?”
Rich HessRight?
Rich HessAnd oftentimes, I'll just kind of chuckle because I get it. It does sound counterintuitive, right?
(13:49):
Rich HessBut Wayne, it's also so much like any wise investment.
Rich HessAnd I could go on and on about different scenarios. You know, we all here, it takes money to make money or you have to spend money to make money, right?
Wayne LowryOh yeah.
Rich HessOne example that I give often and people laugh at 1st and then they go, ”well, yeah, now I do get it.”
(14:13):
Rich HessBut I don't know if you're familiar with Lululemon, the brand.
Wayne LowryYes, yes I am.
Rich HessHave you ever worn a pair of pants from Lululemon?
Rich HessOK, good. Well, you're in South Texas, right?
Wayne LowryI'm gonna say no.
Rich HessSo, I have lululemon pants on right now.
(14:37):
Rich HessHere, here's where this story gets interesting. I'm known to be very frugal.
Rich HessI don't like to spend too much money. I don't like to waste money. I'm not fancy. I'm very conservative.
Rich HessI have clothes in my closet that I've had for years and years and years. Just can't get rid of them.
(14:58):
Rich HessI wear old shoes until they literally fall apart.
Rich HessLike I am very conservative and frugal.
Rich HessI don't spend money, OK?
Rich HessAnd I have taught my sons to pay yourself first, put money in the bank, save, be conservant, don't overspend, all that stuff. Right? No credit card debt.
(15:22):
Rich HessA few years ago, I went into a Lululemon and tried on a pair of pants.
Wayne LowryNow let me ask you real quick, do the Lululemons come in Levi, that's really my question.
Rich HessI have Levi’s too. They do not, I suspect, Lululemon and Levi are two very, very different companies.
Wayne LowryOK, OK, OK. OK.
Rich HessI'm only speculating.
(15:43):
Wayne LowryOK. All right.
Wayne LowryOK. All right. This is just checking. Rich Hess And I promise there's a point to the story.
Rich HessBut when I'm talking about direct primary care—
Wayne LowryJust to be clear, when we go to a commercial break, we're not going to break for Lululemon commercial, so not a sponsor.
Rich HessThat's right, they are not a sponsor. We are not endorsing Lululemon.
Rich HessI would have been the last person you would ever expect to go buy a pair of lululemon pants, is my point, but I went in one day.
(16:11):
Wayne LowryGot you.
Rich HessAnd I tried them on.
Rich HessAnd I literally looked at the young lady helping me and I go, “There's no chance I'm spending $158 on a pair of pants. No chance,”—maybe 128 I don't remember.
Rich HessBut I won't do it.
Rich HessOK, few days later, went back, tried them on again, bought ‘em.
(16:35):
Rich HessOK, Since then I decided you know what I'm going to do, I'm just going to buy four or five different colors and it'll save me a lot of time and a lot of effort just knowing exactly each day. Here's what I'm putting on.
Rich HessTold my oldest son about it, he laughed. No chance I'm spending $128.00 on a pair of pants. I go, “I get it. You're just going to have to trust me.”
(17:08):
Rich HessAnd that's where I end up with a lot of these CFOs, Wayne.
Rich HessBecause now my oldest son, he has every color of those, and that's all he wears for work. He can dress them up, dress them down, put on a golf shirt, wear a blazer.
Rich HessBut they're flexible.
Wayne LowryAll right. So yeah. So for those that are watching, I found an option. Now the guy is holding a bag and a handbag but besides that looks very masculine, very masculine pair of pants right there.
(17:42):
Wayne LowryRight. They look alright. I just wanted… Rich Hess So they're very comfortable, they're flexible.
Rich HessBut here's the thing. Like when I told my oldest son, you're just going to have to trust me.
Rich HessThe moral of the story was we've all skimped on stuff where we bought the right something cheap or inexpensive or etcetera and it either doesn't last, doesn't look good, not comfortable, whatever. And I'm the world's worst, right? I'm guilty.
(18:12):
Rich HessBecause I don't like to spend money.
Rich HessI prefer to save money.
Rich HessBut it saves my son, and me for that matter, so much time and effort on going back to other stores, shopping, being frustrated, blah blah blah, and with DPC so many times now, when a CFO or business owner says, “so, you want me to spend more like now you're telling me I got to pay X amount per employee per month when my health insurance already covers doctors?”
(18:44):
Rich HessYes, you're just going to have to trust me.
Rich HessBecause what that's going to end up doing is reducing your overall cost of your health insurance.
Wayne LowrySo what do they say when you use that approach?
Rich HessWell.
Rich HessA few years ago they would go. Yeah. I don't know if I trust you that much.
(19:05):
Rich HessRight? Is there something else we can do?
Wayne LowryYeah, well but you know, 10 percent, 10% year over year increase of their premiums may have something to do with some motivation.
Rich HessWell, it's funny you say that because I've come to the point in healthcare where I truly believe that the only way employers are going to make real change is when the pain of what they're doing now becomes more than the pain of the unknown.
(19:39):
Wayne LowryI want to take a quick break to talk about BestDPC.com. Are you a doctor looking to break free from the headaches of insurance and take control of your practice? Or maybe you're an employer searching for an affordable healthcare solution that actually works?
Wayne LowryAt BestDPC.com we cut through the noise and connect you with the country's best direct primary care clinics. Whether you're a patient tired of surprise medical bills or A physician ready to build a thriving membership based practice. We've got the tools and resources you need.
(20:12):
Wayne LowryFind the Best DPC doctors near you. Get expert advice and take the first step towards a better healthcare visit BestDPC.com today and see why direct primary care is the future of medicine. That's BestDPC.com because great healthcare should be simple, affordable and built around you.
Wayne LowryWell, what we say is no one gets fired recommending one of Buca.
(20:33):
Rich HessRight.
Wayne LowryI mean, so when you're talking to, you know, an HR department or you're talking to some of the decision makers that maybe aren't the CEO's, if you're talking about a private sector, you know, company the CEO might be willing to take the risk, maybe willing to roll the dice, take the gamble,
(20:55):
Wayne Lowrybut you know the HR department maybe sitting there going, “hey, I've never been fired for looking at a fully insured stack from one of the big carriers. So I'm going to keep doing that because hey, I'll have a job tomorrow”,
Wayne Lowrybut it sounds to me you're getting to talk to some of the decision makers and, you know, y'all are again Oklahoma y'all are y'all are still the wild Wild West, right. So I mean, you've got some gunslingers that are willing to give it a shot.
(21:22):
Rich HessRight.
Wayne LowrySo what have you seen and obviously getting in the front door or you build that relationship, you have those clients that you're integrating with DPC, what are some of the results that you're showing from that?
Rich HessThat's the answer to your question. It used to be “You're just going to have to trust me”, right? And while I might have overspent on a pair of pants five years later, I'm still wearing those. And so I didn't have to buy more pants.
(21:56):
Rich HessNow we have statistics on DPC. We can show here your claims before DPC and here's your claim since. And we can show where the claims may be, maybe it's emergency room visits, right? Maybe it's high dollar claims.
Wayne LowryYes.
(22:19):
Rich HessYeah. Now we have employees who are using direct primary care instead of urgent care and emergency rooms.
Wayne LowryUrgent care, yeah.
Rich HessAnd one of my favorites to show is so If an employee who goes in and the doctor says, well, we might ought to X-ray this just to be safe, right? Or you need to get an MRI. Or whatever they suggest.
(22:49):
Rich HessWell. When you have DPC, they aren't incentivized to run extra tests and so we have those diagnostic bills coming down. So that we now can show overall claim spin coming down on employers who have DPC versus those who don't, whereas before I used to have to say, well, you're going to have to trust me because I think it's going to lower your claims. We can now show them.
(23:21):
Wayne LowryWell yeah, and changing the discussion from a ‘trust me bro’ to here's the data, I mean that obviously you go from the hunch to the success. I don't know if you were at the presentation, but it was pretty cool listening to Frontier Direct Care present their success with the city of McAllen
Rich HessAbsolutely.
(23:45):
Wayne LowryAnd what's going on there and you know I was a part of that organization when some of those initial conversations were going on and to hear and to see, you know, changing the conversation from ‘trust us’ to ‘here it works’.
Wayne LowryAnd so let me ask you, so as a DPC, so let's just say they're in Oklahoma City or Kansas or Montana or Florida or wherever you have a client and you're putting together a plan for that client. How would a DPC either reach out to you or or do you reach out to them? How do you identify the right fit?
(24:28):
Wayne LowryBecause I mean, let's be honest, not every DPC is ready for this, nor maybe they don't want to and you got to respect, you know, a lot of the DPCs that I've talked to and know they want, for lack of a better term, a lifestyle business.
Rich HessYeah.
Wayne LowryThey want to have their business. They might have one MA that helps them out. But other than that, they don't want to take, you know, take on more administrative. They don't want to have reporting, they don't want to have to be a part of an employer plan.
(24:57):
Rich HessAnd good for them.
Wayne LowryAnd exactly like God bless you. That's a great thing. You provide a great service to your community and you take care of your family. But there are others that are more, maybe entrepreneurial-minded. Maybe they have one or two clinics, one or two locations.
(25:20):
Wayne LowryAnd they're saying, “hey, we want to take on some employers. We think we can serve them very well. How do you find those DPC's?” I mean, obviously go the bestdpc.com to to check the directory. Obviously the first step, but you got to start there but after that how can you narrow down the choices to find the right DPC partner?
Rich HessYou have. Rich Hess Start there.
Rich HessMan, that's a great question because it's not a one-size-fits-all. I'm fortunate to have been in the business a long time.
(25:51):
Rich HessAnd to have been in this community.
Rich HessAnd so I know some of the folks who have gotten in the business.
Rich HessAnd we just started having conversations several years ago.
Rich HessAnd then the last seven years prior to me joining the Plexus group, I was actually on the network side of the House.
(26:12):
Rich HessSo I worked for a company that created a regional narrow, high performance network.
Rich HessAnd so I was having conversations with Frontier.
Rich HessRight. I was having conversations with AGB.
Rich HessThe grocery store, who has their own clinics and now they've gotten into DPC, right?
Rich HessIn Oklahoma, Primary HealthPartners as an example.
(26:33):
Wayne LowryRight.
Rich HessSo it all depends. We have to as a consultant vet them out, right? Like what are their goals? Where are they located? I always try to keep in mind that Healthcare is and should be local.
Wayne LowryRight.
(26:54):
Rich HessSo it's funny. About two years ago, I put something on social media, maybe LinkedIn, about primary HealthPartners in Oklahoma. I think they're a great outfit. I love the people over there.
Rich HessAnd when they first started and I was visiting with them, we'd go to lunch or we'd go have coffee. And I was asking 1,000,000 questions about “how does this work?”, and “how do you do this?”, and “how do you do that?”, “Why would somebody join?”
(27:23):
Rich HessAnd we just became friends and allies in the healthcare arena, but anyway, a couple of years ago I put something on probably LinkedIn if I guessed and somebody called me and they were with the TPA. A self funded TPA.
Rich HessAnd they said, “hey, why are you talking about them on your social media?” “I go look cause I think they're good people and it's a great service.” He goes. “Oh, no, I agree. We think they're great. But what's in it for you?”
(27:55):
Rich HessAnd I said, “well, there's nothing in it for me”, right?
Rich Hess“Oh, come on there. I mean, why are you talking?” Listen, there is nothing in it for me to recommend direct primary care. It's where Healthcare is headed and it's what we should be doing.
Wayne LowryYeah. Rich Hess So if I'm going to be a consultant in this arena, this is how I make a living, then I'm going to point people in the right direction.
(28:20):
Rich HessSo, to your question, I try to do my homework, vet them out. Oftentimes I will recommend DPC to your point. Like if there's a DPC practice and they don't want employer groups necessarily.
Rich HessThey just want—hey, go check them out, see if they're taking new patients. If they are, sign up, there's nothing in it for me.
(28:47):
Rich HessIt's a matter of finding the right DPC practice for the right employer.
Wayne LowrySo let's say you have a DPC that they have a patient panel of. Well, let me let me backup a step.
Wayne LowryWhat are you seeing most of your employer size? Like what is in your book of business? Are you typically talking to 300 member groups or 1000 member groups? What's kind of your sweet spot?
(29:16):
Rich HessI will talk to any size employer.
Wayne LowryThat's the right answer. Good job.
Rich HessAnd I don't, I mean somebody called me last week they were referred to me and they have two employees.
Rich HessRight. And so I went through the normal questioning, you should probably just be with somebody right now with somebody who focuses on the individual, right? You can check the exchange, you can get a small group plan, etc. But I'll talk to any size employer. If you talk about our sweet spot, it's probably between 100 and 1000.
(29:56):
Rich HessWe certainly have several groups over 1000. In fact, you mentioned one of them earlier. They're a client.
Wayne LowryOh.
Rich HessThey might do ice cream.
Rich HessAnd so we have several over 1000 lives, and of course we have offices in Dallas and Chicago as well. So we have many large—but I would say that sweet spot is really where it's catching on, if you will, is between 300 and 1000 lives.
(30:25):
Wayne LowryTake a quick break to talk about scalebyseo.com
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(30:47):
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(31:10):
Wayne LowrySo a lot of these employer groups that you're dealing with, I'm sure they're not necessarily isolated in one vicinity. So if you've got a large employer group, you may have 30 people in one town and 50 people in another town. Like how are you integrating DPC when you've got clients that are that spread out or or is most of what you're finding is it really works if they are a municipality or a school district or just a large centralized employer? What are you seeing as far as integrating DPC?
(31:44):
Rich HessNo, you're exactly right. And again, I have a little bit of a unique advantage in that the last seven years I was on a regional high performance network side of the House.
Rich HessAnd we were oftentimes focusing on municipalities, counties, public entities, schools where employees were consolidated, if you will, within 25 or even 50 miles.
(32:12):
Rich HessWe have in Oklahoma, of course. We're blessed to have the oil and gas and energy businesses.
Rich HessGood news, bad news.
Rich HessGood news is lots of jobs and well-paying jobs, bad news is they will oftentimes be in 13 or 14 states.
Rich HessSo DPC, they kind of might not be super excited about DPC.
(32:39):
Rich HessMaybe not super excited about a high performance network because they need to be able to cover everyone in the other states.
Rich HessSo what I see normally is, to your point, they will be consolidated in most cases.
Rich HessMaybe even have a direct primary care entity who wants to build them their own clinic.
(33:02):
Rich HessRight. I I talked to an oil and gas company in Oklahoma and I said, “Hey, we could, you could have an on site or near site clinic and or DPC?”
Rich HessAnd they—well, they loved the concept, said “Well, we don't want to do something different for those folks than our folks up in North Dakota”
Rich HessFair. But then we can get telemedicine, right? Maybe even traveling nurses for them.
(33:29):
Wayne LowryYour site you know or or maybe a maybe not the same DPC, but maybe a DPC in that community.
Rich HessCorrect.
Rich HessYeah. And so that's mostly what I'm seeing is they either either employees are consolidated within a certain geographic area or they find other entities or services for the ones in the outlying.
(33:51):
Wayne LowryGotcha, gotcha. So let me ask if you were to reach out to DPC's. What do you need from a DPC? Like, what do you need as far as reporting, do you need certain data? What? What do you look for? If you're going to even start a conversation with the DPC?
Rich HessWell, so early on, I just want to know about their culture. I want to know why they're in the business.
(34:13):
Rich HessRight. And I don't care if they want to charge $50.00 or $150.00, but I want to know that they're in it for the right reasons.
Rich HessAnd then what are their long term plans?
Rich HessDo they plan on scaling and going to other communities or do they have plans to just be in a certain community and this is it? Here's the max number of employees. Either way is fine.
(34:39):
Rich HessI just need to know what their plans are, right, so that when I am talking to a Prospector client I know how to line them up and we need good hospitals. We should partner up with the hospitals.
Rich HessIf we can get direct primary care in health insurance and good hospital contracts direct with good TPA’s, then the cost of healthcare goes down.
(35:01):
Wayne LowryYeah, yeah.
Wayne LowryThere you have it. We solved it. We solved it today. Right here. We solve it. Now, if we can just convince people now, we can take our show on the road and and and and yeah, and push the education. Well, I want to say how much I appreciate you being on the podcast today. Rich, this is very insightful.
(35:24):
Wayne LowryI want to encourage all DPC's everywhere to be mindful of what a health plan is and how they can be integrated into a health plan because you know, we're all taxpayers. You know, I've done a lot of work in public sector.
Wayne LowryAnd you know, when you're talking to a public sector, these are tax dollars that work. I'm not sure if you've worked specifically in that sector, but in public sector, these are tax dollars we're talking about. Like, let's not waste our money paying for something to help, you know—
(36:00):
Wayne LowrySome suit in New York City or Chicago. Let's try to help our teachers, our city employees, and let's try to provide a benefit that keeps it healthy, keeps it local. DPC can be the front door of that access. And so I've loved this conversation. I hope you'll come back some time and maybe sit down on a panel with a couple other people in this in this community and see how we can drive some change.
(36:32):
Rich HessYeah, I'd love to do that.
Wayne LowryAwesome. So how can people find you?
Rich HessRhess@plexusgroupe.com “Group” has an E on the end.
Wayne LowryOhh an “e”! So it's time for me to tell my joke.
Rich HessTell it.
Wayne LowryThere's no “e” in Lowry. I let you have the E for groupe.
(36:57):
Wayne LowrySo there you go. Rich Hess We appreciate it.
Rich Hess4405-823-1127.
Wayne LowryWhat are those random digits that you're spouting?
Rich HessI give my cell phone to every client. Call me. Text me. I've had that cell phone number for thirty years.
Wayne LowryAlright, so you can reach them by phone also I I imagine I'll have a website plexusgroupe.com. Is that right?
(37:19):
Rich HessWe do, we do.
Rich HessPlexusgroupe.com, “Groupe” has an E on the end of it.
Wayne LowryAll right, Plexus Groupe with an e.com to check it out and you can find Rich. What about LinkedIn? Are you on LinkedIn?
Rich HessAbsolutely you can. You'll be able to find me on LinkedIn.
Wayne LowryAll right.
Rich HessEven on Facebook.
Wayne LowryOh, man. Facebook, don't age yourself. I thought you're going to say TikTok. So either way, we'll make sure to have his contact information in the show notes again. Thank you, Rich, for joining us and for more DPC insights. Head over to bestdbc.com. Don't forget to follow us on social media.
(38:00):
Wayne LowrySubscribe to your favorite podcast platform. Make sure you give us all those likes and those stars.
Wayne LowryWe live on those things, so we appreciate it. And until next time, your health matters. So demand the best with direct primary care. Bye bye.
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