In Episode 468, host Stacey Richter engages in a conversation with Matt McQuide, CEO of Synergy Healthcare. This episode delves into the critical assumptions surrounding member engagement within the healthcare industry.
Key points discussed include the role of employers in steering plan members, the importance of member engagement for navigating the healthcare marketplace, and Matt’s three major misconceptions about health plan membership.
Matt also presents real-life examples of how engagement significantly impacts health outcomes, emphasizing that relationships and trust are paramount. The episode concludes with practical strategies for employers to enhance engagement and manage employee health effectively.
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You can learn more at Synergy Healthcare and by following Matt on LinkedIn.
Matt McQuide is the founder and CEO of Synergy Healthcare, a role he has held since launching the company in 2012. Under his leadership, Synergy has made significant strides in improving member health, enhancing the health insurance experience and the financial integrity of health plans.
06:28 What are Matt’s three common assumptions that employers make about member engagement?
07:08 “Health is actually hard.”
08:19 Why is it important to meet people when their need for healthcare sparks their interest in their health?
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Episode 468,.
"Very Common Assumptions That Aren'tActually True About Member Engagement
and the Healthcare Industry".
Today, I speak with Matt McQuide.
American Healthcare Entrepreneurs andExecutives You Want to Know, Talking.
(00:26):
Relentlessly Seeking Value.
This conversation today with Matt McQuideis such a follow on to the episode from
last week where I encapsulated a majortheme from the past five or six episodes.
I know I'm on a roll.
The thing is, if an employer doesn'ttake the initiative and steer members or
(00:47):
help them navigate through our currenthealthcare marketplace, this marketplace
can be a very dangerous place to be.
But if the employer doesn't steer planmembers, somebody else is going to, right?
Big consolidated health systemsare going to steer for one.
They're trying to drive volumeto high revenue service lines.
They're trying to prevent, inair quotes, network leakage.
(01:09):
I mean, what does that even mean?
It means they're systematicallytrying to get specialist referrals.
That's steerage.
This comes up big time in a showabout high cost claimants coming
up with Dr. Christine Hale.
And it also comes up in a show with Dr.Eric Bricker, who is back by popular
demand, talking about exactly the contractmachinations that health systems often
(01:34):
use to enable high cost claimants.
So that is interesting.
But Dr. Bricker says on that show,he reiterates these exact points.
He says, not figuring out how to steerplan members and helping said members
find the highest quality and most costeffective care settings, including
good primary care, by the way, but plansponsors who aren't steering plan members
(01:58):
should realize that then somebody else is.
Somebody else is driving the busfilled with members and steering
that bus based on their owninterests which quite possibly are
misaligned with the plan sponsors.
Okay, so, sounds great, steer the members.
But, devil's in the details,how exactly do we go about
this, steering plan members?
(02:20):
It is clear to many that you can'tsteer members without engaging them.
In fact, I had a whole conversationwith Dr. Kate Wolin about this today,
how if you try to steer membersthat aren't engaged, they just,
they either don't pick up your phonecall or they don't listen to you.
So how exactly do we go aboutthis engaging with members?
(02:40):
These members, as manyhave said, don't engage.
They don't want to engage.
And I guess, look, there's a lotthat may or may not be possible to be
done with financial incentives, butat the core of it all, it would just
be a whole lot easier if we couldfigure out better member engagement.
Well, welcome Matt McQuide to the podbecause that is what we talk about today.
(03:01):
The first topic that we're going to getinto in the pod that follows is what are
the assumptions that we are inadvertentlymaking about member engagement.
And assumptions, keep in mind,that are incorrect are bad, right?
You know, you wind up eithersolving for the wrong problems.
And or in the process often miss thesolutions that might actually work.
(03:24):
So that's why it's just an issue tohave assumptions in the first place,
but this can sometimes transpire becauseoftentimes we don't even realize our
assumptions are in fact assumptions.
Like if there's this bedrockof conventional wisdom
that gets so ingrained.
That we do things without evenrealizing what we're doing is based
on assumptions in the first place.
(03:45):
That was my feeling during thisconversation with Matt today.
Because he brings to lightthree very common assumptions.
The first two abouthealth plan membership.
And when he goes through them, I'm goingto bet many of your first reactions
are going to be the same as mine.
Oh, right.
These things are all conventional wisdom,and they are actually assumptions.
(04:06):
And when stated outright as assumptions,they even sound a little suspect.
So, the first chapter, I guess youcould say, of this episode coming
up that you're going to hear runsthrough both the assumptions that
we're inadvertently maybe making andthen the reality of the situations.
And then after that, we get intoif you consider the reality of the
situations and not the assumptions,what's possible to be done differently
(04:30):
and the results that can be achieved.
This episode was, in fact,sponsored by Matt McQuide's
company, Synergy Healthcare.
But I want to say that howthe show came to be was this.
Matt asked if he could simplysponsor a show for somebody else.
He said he was part of the tribe andhe wanted to support our mission.
I said, thank you.
That is unbelievably kind.
Let's just have a chat about who youmight want to sponsor or the topic
(04:53):
that you'd like to be talked about.
Then we got to discussing this wholebusiness with assumptions and they're
really not good impact that can result.
And I was like, yeah, theguest, it should be you, Matt.
So here we are.
And thanks so much to SynergyHealthcare for their generosity and
for Matt for sharing his insights.
(05:13):
Matt McQuide is, as he says, areformed benefits consultant.
Today he is CEO over at SynergyHealthcare, which serves plan sponsors
with a hundred to about 4,000 members.
My name is Stacey Richter, andas I just said, this episode is
sponsored by Synergy Healthcare.
Matt McQuide, welcome toRelentless Health Value.
Oh, so excited to be here, Stacey.
(05:34):
I am so excited to talk with youabout this term member engagement.
And let me tell you, you walkinto a group of people who have
anything to do with benefits and youthrow the engagement word into the
conversation, wow, you'll hear stories.
I know you have advice and some thoughtsabout assumptions that could potentially
(05:56):
not be correct or not be accurate.
And the problem is if you've gotassumptions that aren't accurate, then
you're either solving for a problemthat doesn't exist or solving for the,
just nothing changes and gets better.
I'm not a medical person.
I'm a finance, economics,insurance person.
I wouldn't even put health as oneof my top things in my life, right?
(06:17):
It's towards the bottom.
I think that's uniquely made meunderstand the assumptions of sort of
real people and what's going on out there.
And I think that's sort of my superpowerin life is understanding real people.
If we're thinking about anassumption that you commonly hear
employers make, what's one of them?
I've got three of them thatI sort of run my business on.
And the first one is, peoplethat struggle with their health
(06:40):
don't care about their health.
And I think the reality is that mostpeople actually care about their health.
They just need a little help.
The first assumption that we'regoing to tackle here is people aren't
engaging because they don't care.
They don't care about their health.
So that's why they're not engaging.
The reality of the situationis that people actually do
care about their health.
(07:01):
It's just, as you said, youneed a little bit of help.
And why don't you dig in on that?
Like, what do you meanby a little bit of help?
The first thing ishealth is actually hard.
Managing multiple healthconditions is hard.
Each condition is its own thing.
It's complicated.
And that's where people think likethey don't care, but the reality is
is people are drudging through it.
And, you know, if you lookat health literacy stats.
(07:24):
They say that 50 percent of thepopulation has a capacity to
understand basic health informationto make appropriate health decisions.
And this isn't good, of course, butone of the things I think about is
what assumptions are we making evenfrom the health literacy stats?
People with good health literacyare engaged in their health.
I think that's its ownassumption, like not everyone is.
(07:47):
And then people that don'thave good health literacy, they
can't make their own decision.
The help is what's needed.
They need someone walking with them andnot us assuming that they don't care.
Only 50 percent of people in this countryare what could be considered over the
threshold of literate, but the levelof literacy may predict whether they're
(08:07):
able to navigate the health care systemor whether they're able to know what to
do once they get there, but it's not apredictor of engagement, particularly.
Is that the point that you're making?
Yeah, it's definitely notthe predictor of engagement.
But I think the big thing thatI've learned over the years is
like everyone has their moment.
Their moment where all of asudden health becomes important.
(08:28):
And if we're all thinkingthat maybe they don't care.
Or whatever.
They just don't want to work hard enough.
We're going to miss that moment.
You got to be there at the momentwhere they are able to prioritize this.
What I'm reminded of right nowis Adult Learning 101, honestly.
Which is now we're kind ofencroaching into my day job here.
(08:50):
So I say this with allthe research behind it.
If I walked into a room andsaid, let me tell you all about
your, the stove in your kitchen.
Gather round.
Let's finally learn whatconvection actually means.
You know, like, nobody is gonnasit down and engage with me.
But if I said your stove isbroken, let me show you how to
(09:12):
fix it so you can make dinner.
Now all of a suddenit's a different story.
So, it's definitely, it's notlike people don't care about
their stove in the kitchen.
It could be just whatthe moment in time is.
That's what's important is like,we have to be there at the time
where they actually meet theirneed, you know, at that moment.
So what's an example maybeof what you're talking about?
(09:35):
So for me, like, how did I learn thisand how did I learn this assumption?
I mean, literally 20 years ago,I had my first large client,
textile firm, average age of 50,not very healthy, claims going up.
They hire me and they say, weneed to lower costs, but I don't
want to cost shift to employees.
They can't afford anymore, but I needto figure out other ways to do this.
(09:59):
And so one of the first thingsthat we did, and frankly, at
2004, this was not a known thing.
Like this was new.
I put in my first on site medicalclinic in, and you know, this
isn't advanced primary care.
This is mid level provider, 20 minuteappointments, free to employees, give
a small incentive to have a healthrisk assessment and see the nurse.
(10:19):
And what was interesting is, a group thatyou would consider basically doesn't care
about their health for the most part.
We went from 37 percent of themembers being hypertensive when
we first opened the clinic down tolike 14 percent a few years later.
Cut in half.
And then even last year, we stillwork with them 20 years later,
we were down to about 12, 13percent of people hypertensive.
(10:42):
This is major change for a group, and itfrankly opened my eyes, it blew my mind,
really, it was like, how did this happen?
And you realize that just peoplebeing engaged with someone who has
time with them can make a difference.
And that was the start ofit for me for 20 years now.
If they can do that, if that textilefirm can do that, anybody can do it.
(11:03):
And then we're all makingassumptions that aren't there.
A lot of times people think, oh,well, people aren't engaged because
they don't care or maybe they'renot health literate enough to even
understand what we're talking about.
And the point that you're makingis you can cut hypertension rates
in half and that's a huge deal.
And obviously people have tobe engaged in order to do that.
(11:24):
So I guess, money question here.
How'd you do it?
You know, that's the thing,is it didn't take much.
That's what we try to tell employers.
It just takes time, right?
Takes time with someone thatknows what they're doing.
Let me give you an example.
So, Teresa, one of our nurseadvocates, emails me and says, Hey,
I have a member who lost 45 pounds.
I'm super stoked.
And I give her a call, like, Iwant to know why this happened.
(11:46):
And what I found out was Teresa'sbeen working with them for a
couple years, working on healthrisks with very limited results.
And then all of a sudden,the member ends up in the ER.
And through our data notifications,Teresa knows he's in the ER.
She calls him.
And like, has a realconversation right away.
This is affecting you.
Your health conditions are affecting you.
You're going to be in the hospitalmultiple times if you're not
(12:08):
making changes in your life.
But she built over a couple years,even though he wasn't having
results, she built a relationship.
And then she was able tomeet him at the right moment.
Then all of a sudden,he's managing his weight.
He's managing his conditions.
And he's completely changed his life.
Like, she was there for his moment.
And this can happen if wedon't make the assumption that
he didn't care for two years.
(12:28):
And that's important.
Yeah.
It's interesting.
And I think it goes back to that sortof adult learning principle that you
got to be there at the moment where thisbubbles to the top, someone they are
able to prioritize this in a life thathas busy with many, many other things.
But even more than that, it goesback to something that we talk about
(12:52):
a lot on this podcast, just theimportance of relationships and trust
and having the time and the cognitivebandwidth to really work with people.
Because, you know, if someone's justpops in out of the blue, that somebody
has no idea, has never heard from thembefore, does no idea who this person is,
then you also kind of don't have thatfoundation of trust and relationships
(13:15):
so that you are at the right place atthe right time when that moment arrives.
Yeah, I mean, no one really makeschanges because some really smart
nurse provider calls them out ofthe blue from an 800 number, right?
People don't make changes with that.
And if you go back 30 years ago,why did people make changes when
we had like general practitioners?
It's because it was a relationship.
(13:36):
They knew him for years.
And then when they tell him thisis serious, they started to listen.
And that just doesn'texist the same way today.
Yeah, absolutely.
And there's the show with Rebecca Etzfrom a couple of years ago, where the
Larry Greenberg Center, like they provethat there's literature to this effect.
This isn't just something thatmight be an interesting hypothesis.
This is very well validated.
That relationships and trust arethe bedrock that will underpin
(13:59):
any sort of behavior change.
And if you think about it,it's even more important today.
It's less evident, it's less possiblejust with our current healthcare
ecosystem, but it's even moreessential if somebody's watching TikTok
videos all day or they're watchingsomebody's YouTube channel all day.
Who knows what that influencer'smedical credentials are?
(14:21):
It might be nothing, but we've gotpatients and members who are forming
relationships with those individuals,which may be at a counterpoint to, you
know, sound medical advice, just saying.
There's lots of informationout there, right?
It's not that people don't know whatto do and what not to do a little bit.
It's that it's caught up inthe world of life, right?
It's just a lot of things going on.
(14:42):
Health is a long term problem andwe all have short term problems.
It's so easy to kickthe can down the road.
And so when the moment comes forsomeone, you just have to have the
right person there and you certainlycan't push them away because then
they're not going to see their momentif they're getting pushed away.
And I think that's what's critical here.
Got it.
Okay.
So summing up assumption numberone, people that struggle with their
(15:03):
health don't care about their health.
The reality is most peopleactually care about their health.
They just need a little bit of help.
And just adding a little context, whichyou've said, the important part, and
I love how you just said that, thatbecause health is a long term problem
and we all have short term issues, whatthe important part is, is to be at the
right place at the right time, but tobe at the right place at the right time,
(15:25):
there has to be a bedrock of relationshipand trust that has already been built.
Otherwise you might show up at theright place at the right time, but the
patient may not be so inclined to listento you and to move forward from there.
And I love the example that you gaveabout knowing that someone was in the
ER because that's a moment for sure.
Definitely.
(15:45):
Listen to the show with Al Lewis.
If we are thinking about assumptionnumber two, what might that be?
The first one is creating harm.
This one just irritates me.
So, all right, people willwant optimal health if we just
communicate or inspire them better.
We're just going to continue to tell themthat optimal health is the way to go.
And the reality is most peopledon't want optimal health.
(16:07):
They just don't want to be a large claim.
People want to eat chicken wings.
They want to eat ribs.
They want to drink beer.
They want to do this as long asthey can and get away with it.
I personally love ice cream.
I would eat it like every day if I couldget away with it three times a day.
But I've learned overtime I can't do that.
But the reality is most peopledon't want optimal health.
(16:29):
They just want to live their life.
So what happens wheneverybody's just under this?
Maybe just because they haven't eventhought about it, that what members
are striving for is to, I don'tknow, run marathons or something.
Well, I think it comes down tolike, who are the people who
are actually communicating this?
Because they've dedicatedtheir lives to being healthy.
They know the outcome.
They know the outcome of constantchicken wings your whole life.
(16:52):
They know this.
So they, they want to help someone,but this is basic behavioral economics.
The problem is people generallychoose simple over complex.
They choose adequate over optimal.
This is a normal, basic human thing.
And the problem is when you go to the end,like, hey, we all want optimal health.
(17:13):
I think of me as a person, right?
Like, what does that look like?
And that doesn't sound very fun.
And, and, and so we'reall marketing wrong.
We're marketing to peoplethis extreme thing.
You're, you're really pushing people away.
And I have to talk to our ownhealth coaches about this, our own
marketing materials that go out.
Let's talk to real people, not whowe wish they were, who they are.
What are the health coachesactually doing, that is an example
(17:35):
of what you're talking about?
Like literally get rid of theword optimal health for one thing.
Like, hey, please come to this webinar.
We're going to discuss optimal health.
This will push people away.
So what we want to do is we want totalk about how to meet people with
where they really are today, the thingsthat are dealing with them today and
start them off where they are, right?
How do I start off basics?
And we think we're motivating them.
(17:56):
Like, I'm going to give them this picture.
One of our clients is a lumber company.
And could you imagine showing apicture of a 20 something yoga
person on the beach at sunrise?
This is not going to engage my lumber guy.
But my lumber company has less than 10percent of their people hypertensive.
So there's a way to do this,but we're all marketing wrong.
(18:17):
We're trying to go to the end game andnot starting where people are today.
You're showing people picturesof someone that they really don't
relate to or even aspire to be.
And maybe I'm just dealing in clicheshere, but I just can't picture most
people who work at a lumber company whohave some kind of aspiration to get up
at sunrise and do yoga on the beach.
(18:37):
It just, it doesn't seem likesomething that's going to connect.
And it could actually also be daunting.
If you show a picture likethat, is someone going to go
to the onsite exercise class?
Because what do they think?
They're going to be asked to take off alltheir clothes and do some kind of crazy
pose that they're just going to look likefools in front of everybody, you know.
(19:00):
Like, I could also see thatit could be really daunting.
Yeah, that's a great way to say thatbecause the lumber thing is, you
know, obvious, sort of like that'snot going to engage them because
they don't actually know they can.
And most people want to be successfuland they don't see themselves that way.
One of the things I look atover time is wellness programs.
(19:22):
Like if you have a voluntarywellness program with no incentives
at an employer, who joins?
Only the healthy people.
So the healthy people cometo the wellness program.
And the problem with that is obvious,like they're not my claim issue anyways.
But why do they come?
They come because healthypeople do successful healthy.
Yeah, so the assumption numbertwo that we're we're talking about
(19:42):
here is that people want optimalhealth and they're gonna be inspired
by images of optimal health.
And it's just a matter of showingthem the way, because this is
what everybody's looking for.
We just gotta communicate better.
And the reality is, it's nota question of optimal health.
They know, I mean, most people at thisjuncture are fully aware of the fact
(20:05):
that like a full stack of nachos withall the stuff is probably not great.
But it's really good.
So the idea is they don'twant optimal health.
They want to just live their lives, butthey don't also want to be a large claim.
So I think
Yeah, who does?
Like, if you ask people,like, who does, right?
Who wants to be theperson in the hospital?
No one does.
They just can't envisionthemselves from point A to point B.
(20:28):
Also, like, people don't like to fail.
So probably if you give them this, like,oh, well, this is what good looks like.
And it's, again, somesunset beach yoga thing.
They know they're gonna fail.
I think it pushes people awaymore than brings them in.
There's just there's there's so muchthat's sort of wrapped up in this.
The idea is let's inspire them to notbe a large claim or said another way.
(20:49):
Let's inspire them to do whatthey need to do to not wind up
hospitalized and curtailing thingsin their life that they are looking
to do this is really a win win here.
Yeah, absolutely.
I mean, even look at commercials thesedays, they're starting to change.
So they're starting to show normal people.
Yeah, I think the middle wayis the perfect way to say it.
So the middle way is not eitherextreme meeting people where they are.
(21:11):
What's the third assumptionthat you have your eye on here?
The assumption that healthcaresystems are paid to manage disease.
That they're paid to meet someone inthe middle way, that a nine minute
appointment can do something like that.
It just doesn't happen that way.
What's the reality?
The reality is only the employer has theincentive to support disease management.
Because healthcare systemsaren't paid to do it.
(21:33):
And employers, it's their people.
It's their people.
Their productivity, you know, theirhealth, what they think about the company,
what they think about the benefits.
They're the ones that havethe incentive to do it
. So the assumption is, okay, let's just say we figure out that it's the middle way.
Like we know that thisis, is the way to go.
We handle assumption one, wehandle assumption two, we're,
(21:54):
we're very reality based here.
But yet then we think that the healthcareecosystem or the healthcare marketplace
is gonna achieve success or help ouremployees and members achieve success.
And the point that you're making is,and Rob Andrews has said this over and
over, people do what you pay them to do.
And what we are not doing right now,most of the time is paying to keep
(22:18):
people healthy and clearly not sayingthat there are not some docs and
nurses and others out there doingtheir all to keep patients healthy.
Just saying it is generally hard tofigure out how to get paid to do so.
One of the other, I wouldn't callit an assumption, but let's just say
one of the things out there that,uh, that I think is just true is
(22:38):
employers don't want to fix health care.
They don't want to.
They're drug into it sometimes,but they don't really want to.
So health systems want tothink they manage disease and
employers want to believe them.
But the reality is it's not happening.
And so this is an employer assumptionthat they have to realize that
they have to fix this problem.
No one else is going to do it for them
(22:59):
. Yeah, when Lauren Vela was on the pod maybe this was last summer, she
said on no one's job descriptionis fixing the healthcare industry.
And every time I say that ata conference, I just all the
employers start laughing, right?
Because it's really true.
It's nobody's job to fix healthcare.
But I think the point that you'remaking is, however, if we're trying
(23:22):
to ensure that we have a productiveworkforce, Barbara Wachman from
Disney was on the pod a while ago,she said, you know, protecting our
human capital or something like this.
Like if we want to protect our humancapital, if we want to make sure
that we don't have large claims.
Dr. Scott Conard was on the podtalking about how every year, like
the high claims are usually newpeople who were low cost but high
(23:45):
risk before and now they're high cost.
High risk.
It's like, how do you find these peopleand prevent them from becoming high cost?
Like it's all about making surethat we're engaging and keeping
people in that middle way, likeexactly like you are talking about.
And that is not going to happen unless theemployer is doing something on their own.
It sounds like you're saying.
(24:06):
When I talked to employersabout in meetings is when
you think of a claim, right?
A claim is a person.
People are like, Hey, claims are up9%, but this is real people having
real problems and real harm that couldhave been avoided to some degree.
So when we just think about the finances.
We got to think about people onthe backside of this, because
(24:26):
it's not just inflation, right?
It wasn't like the claimjust cost a little bit more.
Now, this is more things happeningto more people and more utilizations.
They're people, it's harm that just didn'thave to happen if they took a few steps.
And yeah, if anyone listened to the podfrom a few weeks ago, where I quoted
Dr. Steve Schutzer, quoting me, quotingBetsy Seals from that earlier show.
(24:47):
This is exactly that same point, really.
The second that we lose our NorthStar, which is what is of value or
harm that is accruing to patientsby whatever it is that we're doing,
ultimately at some point we're goingto make very suboptimal decisions.
So much of our spend depends reallyon what people choose to do or not
(25:08):
to do, meaning patients or members.
Yeah.
You know, weird and obviousto say out loud, though.
Yeah.
And employers like they know their people.
So when it comes down to it, likethey know what works for their people.
They know if it's working or not working.
They're the perfect people to actuallyassess whether a program's working or not.
And are you saying that because sometimesthe, the brochures with the yoga at
(25:29):
sunrise, like, that didn't actuallycome from the employer themselves?
Not usually.
Usually it's someone else giving theminformation and they send it out and then
everyone wonders why no one participated.
Or why, why no one wasmaking improvements.
I think at the end of the day,I actually think employers
sort of know it a little bit.
But they just would rather not getinvolved that they didn't have to.
Yeah.
And it's, it's interesting that you saythat, that the employer usually knows
(25:51):
what engages with their employees.
And probably if it was a seminar onsomething else and like, no one showed
up, the employer would have some kindof postmortem and think it through
and be like, Oh, the brochure, right?
Like They would be highly competentat figuring out what the issue is, but
somehow you throw the word healthcare inthis mix and, and it almost sounds like
the best practices are the things thatmost employers will know to be true.
(26:14):
They sort of delegate elsewhere andthen wind up with all the problems that
they probably would have expected tohave had if it had been anything else.
They don't have the solution.
I mean, it's not like this is easy to do.
So you just sort of do what everyone does.
And, you know, when we talk to employers.
And our model of what wedo, they usually get it.
They usually get why we could bedifferent than what's been done now.
(26:36):
And that's what I spent most of mytime doing is talking to employers
about how do you solve the middleway and what's a model that can work.
So how do you solve the middle wayand what's a model that can work?
Once again, it comes down to trust.
I believe our model is set up.
We're a care navigation company.
There's lots of carenavigation models out there.
And you're talking aboutSynergy Healthcare.
Synergy Healthcare, yeah, we'rea care navigation company.
(26:59):
Like I said, there'slots of models out there.
Our model is we're a oneemployer, one nurse model.
We believe to get true engagement, theyshould not even remember who Synergy
is, they should remember who Teresa is.
What I want is everyone from the CEOto the new hire to know who Teresa is.
And I want them to be ableto email her, call her, text
(27:19):
her, come to open enrollment.
This is what's going to matterat my moment that happens.
I need to think about who that is.
And so that's our model.
Does that work for someonewith a million employees?
No, but it does work for peoplewith 4000 to 100 employees.
That model can work andit's been very successful.
And then, what we do with that.
So like, I'm going to get engagement.
They're going to know who Teresa is andwe have three functions that we believe
(27:43):
help solve health care for that employer.
And by the way, I get a lot of thesethings from your podcast, right.
So what do my nurses need to be doing?
It's it's perfect.
So the first thing we do is wehave to simplify health care.
I have to get prescriptions to go through.
I have to get surgeries approvedif they need to be approved.
If they don't need to be approved, someoneneeds to tell them why and what's my path.
(28:05):
The first thing we do, and Teresadoes, is solve all problems.
Like texture.
If you're at Walgreens or AChain, whatever it is, if it
doesn't work, call Teresa.
And so 30 percent of what we do is we haveto solve all problems and I'll tell you
what, that creates relationship instantly.
So we're all talking abouthealthcare and health engagement,
(28:27):
but there's so many problems rightnow that it instantly creates trust
because Teresa solved my issue.
It's been said any number of times, likeif what you're going to do is just chuck
people into the healthcare marketplaceat this juncture without the guidance and
the support and relationships and trust.
It just, it doesn't end wellunless someone, again, going back
to our first assumption is reallyhealth literate and really engaged.
(28:50):
Secondly, so I now have the trust, right?
People know who Teresa is.
They know she solves problems.
We use data to make outreachto the members that need
it most at the right time.
So you were talking about who'sthe large claimant next year.
We use predictive modeling too.
We know who the 15 percent arewho are going to be the 5 percent
next year, and they could have$1,000 in claims right now.
(29:11):
But because they saw thisspecialist not taking that
medication, it hits the number.
They could be in the ER, like Igave in my example with Teresa.
The idea that at that moment, weneed to have someone that they know
that follows up with them, thatcalls them, that's been creating a
relationship, that's able to have areal conversation at the right time.
So we're going to mitigaterisk for the employer.
And the final thing that we do Is thereso many great point solutions out there?
(29:36):
There's good carrier programs too.
There's specialty drug programs.
There's musculoskeletal programs.
There's great mental health programs.
These are all out there.
But once again, the member is not goingto remember them at the right time.
By using Teresa, she can find the rightmember, the right solution and make
other products, their ROI better from it.
And it all comes down to engagementand engagement has to be easy.
(29:57):
And that's why we do this model.
We have to have Teresa be easy for people.
Going through your three points, thefirst point is both simplify and also be
around to solve problems when they arise.
An example that you gave was someone'strying to pick something up at Walmart
or Walgreens and having an issue.
There's probably any number of thingswhich wind up happening on a day to
(30:20):
day basis, especially if someone isinching probably toward being part
of the 15 percent that becomes the,
We need to be talkingto you anyways, right?
One quick story.
We had, uh, one of our constructionclients, they work with Monica.
Literally they have a safetymeet in the safety meeting.
One of the employees starts complainingabout some problem with insurance.
(30:41):
Two other guys at a constructioncompany, two other guys say,
Why didn't you call Monica?
Like what's your problem?
And they started making fun of him.
He's like, Oh, my bad.
I forgot.
I'll get with Monica.
And that's engagement with anemployee population that Monica
knows all 300 construction guys andthey for the most part know she is.
So it probably in a very interestingway, self selects the individuals
(31:08):
that most need the support to wind uphaving the relationship with a Teresa
or a Monica, which really matterswhen the data predicts someone does,
in fact, need to be doing somethingto stay in that middle way right now.
And I can also see it's beensaid so many times that like, Oh,
nobody, they just ignore our calls.
(31:30):
They don't pick up.
But I can see how this is a flywheel,because if they've already called Monica
four times because of something orother that happened, and then Monica
reaches out to them, like now it's avery different gig then if this Monica
person who nobody ever heard of iskeeps leaving messages on the phone.
So I can definitely see that sort ofa flywheel that's developing here.
(31:51):
And then lastly, there are, as yousaid, there's point solutions, there's
programs, there's lots of stuff that maybe available, but, um, just chucking them
out and hoping that someone's going tofigure out which one is right for them
is just, not simple to go back to thefirst thing that you said, it could be
confusing, it could be contradictory.
So then having someone really help saylike, Hey Pete, you should, you know,
(32:15):
look into this and I'm going to helpyou sign up, et cetera, as opposed to
just throwing them onto the intranet andhoping they figure it out themselves.
They trust Monica, right?
So they trust Monica.
Yeah.
So they almost don't even like, they'relike, if you think it's okay, I'm good.
Just enroll me.
That's how they, that's how they are.
And if you go back to the textilefirm I first talked about, it wasn't
just about an onsite clinic, right?
(32:36):
There's lots of solutions, lots ofhigh value things that they did and
their nurse managed them through it.
20 years ago, their costswere roughly about 30 percent
more than the average costs.
And that's why they calledus in the first place.
Like I have to do somethingabout this to stay in business.
20 years later, lots of high valueprograms, specially drug programs,
(32:56):
musculoskeletal programs, onsite PT.
You name it, now their costs areroughly 30 percent below average.
So they went from way above to way below,just really solving for actual problems
as opposed to sort of making assumptionswhere, and you know, we just went through
these three assumptions and in a way,when you say them out loud, you're
(33:17):
like, huh, they don't even sound right.
It's just, they're unspoken kinds ofthings, which I just feel like, are kind
of this conventional wisdom that maybeis underpinning a lot of this and maybe
perpetuated by like I've heard it saidso many times by actually brokers and
kind of like middle people themselves.
(33:37):
At a certain juncture, they'rereally they get really far
removed from the actual patients.
So the one thing that I do feel likeemployers do have an opportunity to do
is like they actually know the patients.
Employers like, you know, thesepeople and that really matters.
They're the employees.
They see them every single day.
Yeah.
They know their people.
And when they find out a way to do it.
(33:58):
Most of them do it if theycan realize what can be done.
So if someone is interestedin learning more about Synergy
Healthcare, where would you directthem for more information, Matt?
Go to LinkedIn, look me up, MattMcQuide, Synergy Healthcare my main
thing is I'm just trying to encouragepeople to know that there are
ways out there to do these things.
And we post lots of articles, um, and youcan certainly message me through LinkedIn.
(34:22):
Matt McQuide, thank you so much forbeing on Relentless Health Valued today.
Oh, thank you so much, Stacey.
Hey, this is Matt McQuidewith Synergy Healthcare.
I listen to Stacey and RelentlessHealth Value every single week.
There's valuable informationevery single week to take from it.
And I just so appreciate this is around.
Episode 468,.
"Very Common Assumptions That Aren'tActually True About Member Engagement
and the Healthcare Industry".
Today, I speak with Matt McQuide.
American Healthcare Entrepreneurs andExecutives You Want to Know, Talking.
(00:26):
Relentlessly Seeking Value.
This conversation today with Matt McQuideis such a follow on to the episode from
last week where I encapsulated a majortheme from the past five or six episodes.
I know I'm on a roll.
The thing is, if an employer doesn'ttake the initiative and steer members or
(00:47):
help them navigate through our currenthealthcare marketplace, this marketplace
can be a very dangerous place to be.
But if the employer doesn't steer planmembers, somebody else is going to, right?
Big consolidated health systemsare going to steer for one.
They're trying to drive volumeto high revenue service lines.
They're trying to prevent, inair quotes, network leakage.
(01:09):
I mean, what does that even mean?
It means they're systematicallytrying to get specialist referrals.
That's steerage.
This comes up big time in a showabout high cost claimants coming
up with Dr. Christine Hale.
And it also comes up in a show with Dr.Eric Bricker, who is back by popular
demand, talking about exactly the contractmachinations that health systems often
(01:34):
use to enable high cost claimants.
So that is interesting.
But Dr. Bricker says on that show,he reiterates these exact points.
He says, not figuring out how to steerplan members and helping said members
find the highest quality and most costeffective care settings, including
good primary care, by the way, but plansponsors who aren't steering plan members
(01:58):
should realize that then somebody else is.
Somebody else is driving the busfilled with members and steering
that bus based on their owninterests which quite possibly are
misaligned with the plan sponsors.
Okay, so, sounds great, steer the members.
But, devil's in the details,how exactly do we go about
this, steering plan members?
(02:20):
It is clear to many that you can'tsteer members without engaging them.
In fact, I had a whole conversationwith Dr. Kate Wolin about this today,
how if you try to steer membersthat aren't engaged, they just,
they either don't pick up your phonecall or they don't listen to you.
So how exactly do we go aboutthis engaging with members?
(02:40):
These members, as manyhave said, don't engage.
They don't want to engage.
And I guess, look, there's a lotthat may or may not be possible to be
done with financial incentives, butat the core of it all, it would just
be a whole lot easier if we couldfigure out better member engagement.
Well, welcome Matt McQuide to the podbecause that is what we talk about today.
(03:01):
The first topic that we're going to getinto in the pod that follows is what are
the assumptions that we are inadvertentlymaking about member engagement.
And assumptions, keep in mind,that are incorrect are bad, right?
You know, you wind up eithersolving for the wrong problems.
And or in the process often miss thesolutions that might actually work.
(03:24):
So that's why it's just an issue tohave assumptions in the first place,
but this can sometimes transpire becauseoftentimes we don't even realize our
assumptions are in fact assumptions.
Like if there's this bedrockof conventional wisdom
that gets so ingrained.
That we do things without evenrealizing what we're doing is based
on assumptions in the first place.
(03:45):
That was my feeling during thisconversation with Matt today.
Because he brings to lightthree very common assumptions.
The first two abouthealth plan membership.
And when he goes through them, I'm goingto bet many of your first reactions
are going to be the same as mine.
Oh, right.
These things are all conventional wisdom,and they are actually assumptions.
(04:06):
And when stated outright as assumptions,they even sound a little suspect.
So, the first chapter, I guess youcould say, of this episode coming
up that you're going to hear runsthrough both the assumptions that
we're inadvertently maybe making andthen the reality of the situations.
And then after that, we get intoif you consider the reality of the
situations and not the assumptions,what's possible to be done differently
(04:30):
and the results that can be achieved.
This episode was, in fact,sponsored by Matt McQuide's
company, Synergy Healthcare.
But I want to say that howthe show came to be was this.
Matt asked if he could simplysponsor a show for somebody else.
He said he was part of the tribe andhe wanted to support our mission.
I said, thank you.
That is unbelievably kind.
Let's just have a chat about who youmight want to sponsor or the topic
(04:53):
that you'd like to be talked about.
Then we got to discussing this wholebusiness with assumptions and they're
really not good impact that can result.
And I was like, yeah, theguest, it should be you, Matt.
So here we are.
And thanks so much to SynergyHealthcare for their generosity and
for Matt for sharing his insights.
(05:13):
Matt McQuide is, as he says, areformed benefits consultant.
Today he is CEO over at SynergyHealthcare, which serves plan sponsors
with a hundred to about 4,000 members.
My name is Stacey Richter, andas I just said, this episode is
sponsored by Synergy Healthcare.
Matt McQuide, welcome toRelentless Health Value.
Oh, so excited to be here, Stacey.
(05:34):
I am so excited to talk with youabout this term member engagement.
And let me tell you, you walkinto a group of people who have
anything to do with benefits and youthrow the engagement word into the
conversation, wow, you'll hear stories.
I know you have advice and some thoughtsabout assumptions that could potentially
(05:56):
not be correct or not be accurate.
And the problem is if you've gotassumptions that aren't accurate, then
you're either solving for a problemthat doesn't exist or solving for the,
just nothing changes and gets better.
I'm not a medical person.
I'm a finance, economics,insurance person.
I wouldn't even put health as oneof my top things in my life, right?
(06:17):
It's towards the bottom.
I think that's uniquely made meunderstand the assumptions of sort of
real people and what's going on out there.
And I think that's sort of my superpowerin life is understanding real people.
If we're thinking about anassumption that you commonly hear
employers make, what's one of them?
I've got three of them thatI sort of run my business on.
And the first one is, peoplethat struggle with their health
(06:40):
don't care about their health.
And I think the reality is that mostpeople actually care about their health.
They just need a little help.
The first assumption that we'regoing to tackle here is people aren't
engaging because they don't care.
They don't care about their health.
So that's why they're not engaging.
The reality of the situationis that people actually do
care about their health.
(07:01):
It's just, as you said, youneed a little bit of help.
And why don't you dig in on that?
Like, what do you meanby a little bit of help?
The first thing ishealth is actually hard.
Managing multiple healthconditions is hard.
Each condition is its own thing.
It's complicated.
And that's where people think likethey don't care, but the reality is
is people are drudging through it.
And, you know, if you lookat health literacy stats.
(07:24):
They say that 50 percent of thepopulation has a capacity to
understand basic health informationto make appropriate health decisions.
And this isn't good, of course, butone of the things I think about is
what assumptions are we making evenfrom the health literacy stats?
People with good health literacyare engaged in their health.
I think that's its ownassumption, like not everyone is.
(07:47):
And then people that don'thave good health literacy, they
can't make their own decision.
The help is what's needed.
They need someone walking with them andnot us assuming that they don't care.
Only 50 percent of people in this countryare what could be considered over the
threshold of literate, but the levelof literacy may predict whether they're
(08:07):
able to navigate the health care systemor whether they're able to know what to
do once they get there, but it's not apredictor of engagement, particularly.
Is that the point that you're making?
Yeah, it's definitely notthe predictor of engagement.
But I think the big thing thatI've learned over the years is
like everyone has their moment.
Their moment where all of asudden health becomes important.
(08:28):
And if we're all thinkingthat maybe they don't care.
Or whatever.
They just don't want to work hard enough.
We're going to miss that moment.
You got to be there at the momentwhere they are able to prioritize this.
What I'm reminded of right nowis Adult Learning 101, honestly.
Which is now we're kind ofencroaching into my day job here.
(08:50):
So I say this with allthe research behind it.
If I walked into a room andsaid, let me tell you all about
your, the stove in your kitchen.
Gather round.
Let's finally learn whatconvection actually means.
You know, like, nobody is gonnasit down and engage with me.
But if I said your stove isbroken, let me show you how to
(09:12):
fix it so you can make dinner.
Now all of a suddenit's a different story.
So, it's definitely, it's notlike people don't care about
their stove in the kitchen.
It could be just whatthe moment in time is.
That's what's important is like,we have to be there at the time
where they actually meet theirneed, you know, at that moment.
So what's an example maybeof what you're talking about?
(09:35):
So for me, like, how did I learn thisand how did I learn this assumption?
I mean, literally 20 years ago,I had my first large client,
textile firm, average age of 50,not very healthy, claims going up.
They hire me and they say, weneed to lower costs, but I don't
want to cost shift to employees.
They can't afford anymore, but I needto figure out other ways to do this.
(09:59):
And so one of the first thingsthat we did, and frankly, at
2004, this was not a known thing.
Like this was new.
I put in my first on site medicalclinic in, and you know, this
isn't advanced primary care.
This is mid level provider, 20 minuteappointments, free to employees, give
a small incentive to have a healthrisk assessment and see the nurse.
(10:19):
And what was interesting is, a group thatyou would consider basically doesn't care
about their health for the most part.
We went from 37 percent of themembers being hypertensive when
we first opened the clinic down tolike 14 percent a few years later.
Cut in half.
And then even last year, we stillwork with them 20 years later,
we were down to about 12, 13percent of people hypertensive.
(10:42):
This is major change for a group, and itfrankly opened my eyes, it blew my mind,
really, it was like, how did this happen?
And you realize that just peoplebeing engaged with someone who has
time with them can make a difference.
And that was the start ofit for me for 20 years now.
If they can do that, if that textilefirm can do that, anybody can do it.
(11:03):
And then we're all makingassumptions that aren't there.
A lot of times people think, oh,well, people aren't engaged because
they don't care or maybe they'renot health literate enough to even
understand what we're talking about.
And the point that you're makingis you can cut hypertension rates
in half and that's a huge deal.
And obviously people have tobe engaged in order to do that.
(11:24):
So I guess, money question here.
How'd you do it?
You know, that's the thing,is it didn't take much.
That's what we try to tell employers.
It just takes time, right?
Takes time with someone thatknows what they're doing.
Let me give you an example.
So, Teresa, one of our nurseadvocates, emails me and says, Hey,
I have a member who lost 45 pounds.
I'm super stoked.
And I give her a call, like, Iwant to know why this happened.
(11:46):
And what I found out was Teresa'sbeen working with them for a
couple years, working on healthrisks with very limited results.
And then all of a sudden,the member ends up in the ER.
And through our data notifications,Teresa knows he's in the ER.
She calls him.
And like, has a realconversation right away.
This is affecting you.
Your health conditions are affecting you.
You're going to be in the hospitalmultiple times if you're not
(12:08):
making changes in your life.
But she built over a couple years,even though he wasn't having
results, she built a relationship.
And then she was able tomeet him at the right moment.
Then all of a sudden,he's managing his weight.
He's managing his conditions.
And he's completely changed his life.
Like, she was there for his moment.
And this can happen if wedon't make the assumption that
he didn't care for two years.
(12:28):
And that's important.
Yeah.
It's interesting.
And I think it goes back to that sortof adult learning principle that you
got to be there at the moment where thisbubbles to the top, someone they are
able to prioritize this in a life thathas busy with many, many other things.
But even more than that, it goesback to something that we talk about
(12:52):
a lot on this podcast, just theimportance of relationships and trust
and having the time and the cognitivebandwidth to really work with people.
Because, you know, if someone's justpops in out of the blue, that somebody
has no idea, has never heard from thembefore, does no idea who this person is,
then you also kind of don't have thatfoundation of trust and relationships
(13:15):
so that you are at the right place atthe right time when that moment arrives.
Yeah, I mean, no one really makeschanges because some really smart
nurse provider calls them out ofthe blue from an 800 number, right?
People don't make changes with that.
And if you go back 30 years ago,why did people make changes when
we had like general practitioners?
It's because it was a relationship.
(13:36):
They knew him for years.
And then when they tell him thisis serious, they started to listen.
And that just doesn'texist the same way today.
Yeah, absolutely.
And there's the show with Rebecca Etzfrom a couple of years ago, where the
Larry Greenberg Center, like they provethat there's literature to this effect.
This isn't just something thatmight be an interesting hypothesis.
This is very well validated.
That relationships and trust arethe bedrock that will underpin
(13:59):
any sort of behavior change.
And if you think about it,it's even more important today.
It's less evident, it's less possiblejust with our current healthcare
ecosystem, but it's even moreessential if somebody's watching TikTok
videos all day or they're watchingsomebody's YouTube channel all day.
Who knows what that influencer'smedical credentials are?
(14:21):
It might be nothing, but we've gotpatients and members who are forming
relationships with those individuals,which may be at a counterpoint to, you
know, sound medical advice, just saying.
There's lots of informationout there, right?
It's not that people don't know whatto do and what not to do a little bit.
It's that it's caught up inthe world of life, right?
It's just a lot of things going on.
(14:42):
Health is a long term problem andwe all have short term problems.
It's so easy to kickthe can down the road.
And so when the moment comes forsomeone, you just have to have the
right person there and you certainlycan't push them away because then
they're not going to see their momentif they're getting pushed away.
And I think that's what's critical here.
Got it.
Okay.
So summing up assumption numberone, people that struggle with their
(15:03):
health don't care about their health.
The reality is most peopleactually care about their health.
They just need a little bit of help.
And just adding a little context, whichyou've said, the important part, and
I love how you just said that, thatbecause health is a long term problem
and we all have short term issues, whatthe important part is, is to be at the
right place at the right time, but tobe at the right place at the right time,
(15:25):
there has to be a bedrock of relationshipand trust that has already been built.
Otherwise you might show up at theright place at the right time, but the
patient may not be so inclined to listento you and to move forward from there.
And I love the example that you gaveabout knowing that someone was in the
ER because that's a moment for sure.
Definitely.
(15:45):
Listen to the show with Al Lewis.
If we are thinking about assumptionnumber two, what might that be?
The first one is creating harm.
This one just irritates me.
So, all right, people willwant optimal health if we just
communicate or inspire them better.
We're just going to continue to tell themthat optimal health is the way to go.
And the reality is most peopledon't want optimal health.
(16:07):
They just don't want to be a large claim.
People want to eat chicken wings.
They want to eat ribs.
They want to drink beer.
They want to do this as long asthey can and get away with it.
I personally love ice cream.
I would eat it like every day if I couldget away with it three times a day.
But I've learned overtime I can't do that.
But the reality is most peopledon't want optimal health.
(16:29):
They just want to live their life.
So what happens wheneverybody's just under this?
Maybe just because they haven't eventhought about it, that what members
are striving for is to, I don'tknow, run marathons or something.
Well, I think it comes down tolike, who are the people who
are actually communicating this?
Because they've dedicatedtheir lives to being healthy.
They know the outcome.
They know the outcome of constantchicken wings your whole life.
(16:52):
They know this.
So they, they want to help someone,but this is basic behavioral economics.
The problem is people generallychoose simple over complex.
They choose adequate over optimal.
This is a normal, basic human thing.
And the problem is when you go to the end,like, hey, we all want optimal health.
(17:13):
I think of me as a person, right?
Like, what does that look like?
And that doesn't sound very fun.
And, and, and so we'reall marketing wrong.
We're marketing to peoplethis extreme thing.
You're, you're really pushing people away.
And I have to talk to our ownhealth coaches about this, our own
marketing materials that go out.
Let's talk to real people, not whowe wish they were, who they are.
What are the health coachesactually doing, that is an example
(17:35):
of what you're talking about?
Like literally get rid of theword optimal health for one thing.
Like, hey, please come to this webinar.
We're going to discuss optimal health.
This will push people away.
So what we want to do is we want totalk about how to meet people with
where they really are today, the thingsthat are dealing with them today and
start them off where they are, right?
How do I start off basics?
And we think we're motivating them.
(17:56):
Like, I'm going to give them this picture.
One of our clients is a lumber company.
And could you imagine showing apicture of a 20 something yoga
person on the beach at sunrise?
This is not going to engage my lumber guy.
But my lumber company has less than 10percent of their people hypertensive.
So there's a way to do this,but we're all marketing wrong.
(18:17):
We're trying to go to the end game andnot starting where people are today.
You're showing people picturesof someone that they really don't
relate to or even aspire to be.
And maybe I'm just dealing in clicheshere, but I just can't picture most
people who work at a lumber company whohave some kind of aspiration to get up
at sunrise and do yoga on the beach.
(18:37):
It just, it doesn't seem likesomething that's going to connect.
And it could actually also be daunting.
If you show a picture likethat, is someone going to go
to the onsite exercise class?
Because what do they think?
They're going to be asked to take off alltheir clothes and do some kind of crazy
pose that they're just going to look likefools in front of everybody, you know.
(19:00):
Like, I could also see thatit could be really daunting.
Yeah, that's a great way to say thatbecause the lumber thing is, you
know, obvious, sort of like that'snot going to engage them because
they don't actually know they can.
And most people want to be successfuland they don't see themselves that way.
One of the things I look atover time is wellness programs.
(19:22):
Like if you have a voluntarywellness program with no incentives
at an employer, who joins?
Only the healthy people.
So the healthy people cometo the wellness program.
And the problem with that is obvious,like they're not my claim issue anyways.
But why do they come?
They come because healthypeople do successful healthy.
Yeah, so the assumption numbertwo that we're we're talking about
(19:42):
here is that people want optimalhealth and they're gonna be inspired
by images of optimal health.
And it's just a matter of showingthem the way, because this is
what everybody's looking for.
We just gotta communicate better.
And the reality is, it's nota question of optimal health.
They know, I mean, most people at thisjuncture are fully aware of the fact
(20:05):
that like a full stack of nachos withall the stuff is probably not great.
But it's really good.
So the idea is they don'twant optimal health.
They want to just live their lives, butthey don't also want to be a large claim.
So I think
Yeah, who does?
Like, if you ask people,like, who does, right?
Who wants to be theperson in the hospital?
No one does.
They just can't envisionthemselves from point A to point B.
(20:28):
Also, like, people don't like to fail.
So probably if you give them this, like,oh, well, this is what good looks like.
And it's, again, somesunset beach yoga thing.
They know they're gonna fail.
I think it pushes people awaymore than brings them in.
There's just there's there's so muchthat's sort of wrapped up in this.
The idea is let's inspire them to notbe a large claim or said another way.
(20:49):
Let's inspire them to do whatthey need to do to not wind up
hospitalized and curtailing thingsin their life that they are looking
to do this is really a win win here.
Yeah, absolutely.
I mean, even look at commercials thesedays, they're starting to change.
So they're starting to show normal people.
Yeah, I think the middle wayis the perfect way to say it.
So the middle way is not eitherextreme meeting people where they are.
(21:11):
What's the third assumptionthat you have your eye on here?
The assumption that healthcaresystems are paid to manage disease.
That they're paid to meet someone inthe middle way, that a nine minute
appointment can do something like that.
It just doesn't happen that way.
What's the reality?
The reality is only the employer has theincentive to support disease management.
Because healthcare systemsaren't paid to do it.
(21:33):
And employers, it's their people.
It's their people.
Their productivity, you know, theirhealth, what they think about the company,
what they think about the benefits.
They're the ones that havethe incentive to do it
. So the assumption is, okay, let's just say we figure out that it's the middle way.
Like we know that thisis, is the way to go.
We handle assumption one, wehandle assumption two, we're,
(21:54):
we're very reality based here.
But yet then we think that the healthcareecosystem or the healthcare marketplace
is gonna achieve success or help ouremployees and members achieve success.
And the point that you're making is,and Rob Andrews has said this over and
over, people do what you pay them to do.
And what we are not doing right now,most of the time is paying to keep
(22:18):
people healthy and clearly not sayingthat there are not some docs and
nurses and others out there doingtheir all to keep patients healthy.
Just saying it is generally hard tofigure out how to get paid to do so.
One of the other, I wouldn't callit an assumption, but let's just say
one of the things out there that,uh, that I think is just true is
(22:38):
employers don't want to fix health care.
They don't want to.
They're drug into it sometimes,but they don't really want to.
So health systems want tothink they manage disease and
employers want to believe them.
But the reality is it's not happening.
And so this is an employer assumptionthat they have to realize that
they have to fix this problem.
No one else is going to do it for them
(22:59):
. Yeah, when Lauren Vela was on the pod maybe this was last summer, she
said on no one's job descriptionis fixing the healthcare industry.
And every time I say that ata conference, I just all the
employers start laughing, right?
Because it's really true.
It's nobody's job to fix healthcare.
But I think the point that you'remaking is, however, if we're trying
(23:22):
to ensure that we have a productiveworkforce, Barbara Wachman from
Disney was on the pod a while ago,she said, you know, protecting our
human capital or something like this.
Like if we want to protect our humancapital, if we want to make sure
that we don't have large claims.
Dr. Scott Conard was on the podtalking about how every year, like
the high claims are usually newpeople who were low cost but high
(23:45):
risk before and now they're high cost.
High risk.
It's like, how do you find these peopleand prevent them from becoming high cost?
Like it's all about making surethat we're engaging and keeping
people in that middle way, likeexactly like you are talking about.
And that is not going to happen unless theemployer is doing something on their own.
It sounds like you're saying.
(24:06):
When I talked to employersabout in meetings is when
you think of a claim, right?
A claim is a person.
People are like, Hey, claims are up9%, but this is real people having
real problems and real harm that couldhave been avoided to some degree.
So when we just think about the finances.
We got to think about people onthe backside of this, because
(24:26):
it's not just inflation, right?
It wasn't like the claimjust cost a little bit more.
Now, this is more things happeningto more people and more utilizations.
They're people, it's harm that just didn'thave to happen if they took a few steps.
And yeah, if anyone listened to the podfrom a few weeks ago, where I quoted
Dr. Steve Schutzer, quoting me, quotingBetsy Seals from that earlier show.
(24:47):
This is exactly that same point, really.
The second that we lose our NorthStar, which is what is of value or
harm that is accruing to patientsby whatever it is that we're doing,
ultimately at some point we're goingto make very suboptimal decisions.
So much of our spend depends reallyon what people choose to do or not
(25:08):
to do, meaning patients or members.
Yeah.
You know, weird and obviousto say out loud, though.
Yeah.
And employers like they know their people.
So when it comes down to it, likethey know what works for their people.
They know if it's working or not working.
They're the perfect people to actuallyassess whether a program's working or not.
And are you saying that because sometimesthe, the brochures with the yoga at
(25:29):
sunrise, like, that didn't actuallycome from the employer themselves?
Not usually.
Usually it's someone else giving theminformation and they send it out and then
everyone wonders why no one participated.
Or why, why no one wasmaking improvements.
I think at the end of the day,I actually think employers
sort of know it a little bit.
But they just would rather not getinvolved that they didn't have to.
Yeah.
And it's, it's interesting that you saythat, that the employer usually knows
(25:51):
what engages with their employees.
And probably if it was a seminar onsomething else and like, no one showed
up, the employer would have some kindof postmortem and think it through
and be like, Oh, the brochure, right?
Like They would be highly competentat figuring out what the issue is, but
somehow you throw the word healthcare inthis mix and, and it almost sounds like
the best practices are the things thatmost employers will know to be true.
(26:14):
They sort of delegate elsewhere andthen wind up with all the problems that
they probably would have expected tohave had if it had been anything else.
They don't have the solution.
I mean, it's not like this is easy to do.
So you just sort of do what everyone does.
And, you know, when we talk to employers.
And our model of what wedo, they usually get it.
They usually get why we could bedifferent than what's been done now.
(26:36):
And that's what I spent most of mytime doing is talking to employers
about how do you solve the middleway and what's a model that can work.
So how do you solve the middle wayand what's a model that can work?
Once again, it comes down to trust.
I believe our model is set up.
We're a care navigation company.
There's lots of carenavigation models out there.
And you're talking aboutSynergy Healthcare.
Synergy Healthcare, yeah, we'rea care navigation company.
(26:59):
Like I said, there'slots of models out there.
Our model is we're a oneemployer, one nurse model.
We believe to get true engagement, theyshould not even remember who Synergy
is, they should remember who Teresa is.
What I want is everyone from the CEOto the new hire to know who Teresa is.
And I want them to be ableto email her, call her, text
(27:19):
her, come to open enrollment.
This is what's going to matterat my moment that happens.
I need to think about who that is.
And so that's our model.
Does that work for someonewith a million employees?
No, but it does work for peoplewith 4000 to 100 employees.
That model can work andit's been very successful.
And then, what we do with that.
So like, I'm going to get engagement.
They're going to know who Teresa is andwe have three functions that we believe
(27:43):
help solve health care for that employer.
And by the way, I get a lot of thesethings from your podcast, right.
So what do my nurses need to be doing?
It's it's perfect.
So the first thing we do is wehave to simplify health care.
I have to get prescriptions to go through.
I have to get surgeries approvedif they need to be approved.
If they don't need to be approved, someoneneeds to tell them why and what's my path.
(28:05):
The first thing we do, and Teresadoes, is solve all problems.
Like texture.
If you're at Walgreens or AChain, whatever it is, if it
doesn't work, call Teresa.
And so 30 percent of what we do is we haveto solve all problems and I'll tell you
what, that creates relationship instantly.
So we're all talking abouthealthcare and health engagement,
(28:27):
but there's so many problems rightnow that it instantly creates trust
because Teresa solved my issue.
It's been said any number of times, likeif what you're going to do is just chuck
people into the healthcare marketplaceat this juncture without the guidance and
the support and relationships and trust.
It just, it doesn't end wellunless someone, again, going back
to our first assumption is reallyhealth literate and really engaged.
(28:50):
Secondly, so I now have the trust, right?
People know who Teresa is.
They know she solves problems.
We use data to make outreachto the members that need
it most at the right time.
So you were talking about who'sthe large claimant next year.
We use predictive modeling too.
We know who the 15 percent arewho are going to be the 5 percent
next year, and they could have$1,000 in claims right now.
(29:11):
But because they saw thisspecialist not taking that
medication, it hits the number.
They could be in the ER, like Igave in my example with Teresa.
The idea that at that moment, weneed to have someone that they know
that follows up with them, thatcalls them, that's been creating a
relationship, that's able to have areal conversation at the right time.
So we're going to mitigaterisk for the employer.
And the final thing that we do Is thereso many great point solutions out there?
(29:36):
There's good carrier programs too.
There's specialty drug programs.
There's musculoskeletal programs.
There's great mental health programs.
These are all out there.
But once again, the member is not goingto remember them at the right time.
By using Teresa, she can find the rightmember, the right solution and make
other products, their ROI better from it.
And it all comes down to engagementand engagement has to be easy.
(29:57):
And that's why we do this model.
We have to have Teresa be easy for people.
Going through your three points, thefirst point is both simplify and also be
around to solve problems when they arise.
An example that you gave was someone'strying to pick something up at Walmart
or Walgreens and having an issue.
There's probably any number of thingswhich wind up happening on a day to
(30:20):
day basis, especially if someone isinching probably toward being part
of the 15 percent that becomes the,
We need to be talkingto you anyways, right?
One quick story.
We had, uh, one of our constructionclients, they work with Monica.
Literally they have a safetymeet in the safety meeting.
One of the employees starts complainingabout some problem with insurance.
(30:41):
Two other guys at a constructioncompany, two other guys say,
Why didn't you call Monica?
Like what's your problem?
And they started making fun of him.
He's like, Oh, my bad.
I forgot.
I'll get with Monica.
And that's engagement with anemployee population that Monica
knows all 300 construction guys andthey for the most part know she is.
So it probably in a very interestingway, self selects the individuals
(31:08):
that most need the support to wind uphaving the relationship with a Teresa
or a Monica, which really matterswhen the data predicts someone does,
in fact, need to be doing somethingto stay in that middle way right now.
And I can also see it's beensaid so many times that like, Oh,
nobody, they just ignore our calls.
(31:30):
They don't pick up.
But I can see how this is a flywheel,because if they've already called Monica
four times because of something orother that happened, and then Monica
reaches out to them, like now it's avery different gig then if this Monica
person who nobody ever heard of iskeeps leaving messages on the phone.
So I can definitely see that sort ofa flywheel that's developing here.
(31:51):
And then lastly, there are, as yousaid, there's point solutions, there's
programs, there's lots of stuff that maybe available, but, um, just chucking them
out and hoping that someone's going tofigure out which one is right for them
is just, not simple to go back to thefirst thing that you said, it could be
confusing, it could be contradictory.
So then having someone really help saylike, Hey Pete, you should, you know,
(32:15):
look into this and I'm going to helpyou sign up, et cetera, as opposed to
just throwing them onto the intranet andhoping they figure it out themselves.
They trust Monica, right?
So they trust Monica.
Yeah.
So they almost don't even like, they'relike, if you think it's okay, I'm good.
Just enroll me.
That's how they, that's how they are.
And if you go back to the textilefirm I first talked about, it wasn't
just about an onsite clinic, right?
(32:36):
There's lots of solutions, lots ofhigh value things that they did and
their nurse managed them through it.
20 years ago, their costswere roughly about 30 percent
more than the average costs.
And that's why they calledus in the first place.
Like I have to do somethingabout this to stay in business.
20 years later, lots of high valueprograms, specially drug programs,
(32:56):
musculoskeletal programs, onsite PT.
You name it, now their costs areroughly 30 percent below average.
So they went from way above to way below,just really solving for actual problems
as opposed to sort of making assumptionswhere, and you know, we just went through
these three assumptions and in a way,when you say them out loud, you're
(33:17):
like, huh, they don't even sound right.
It's just, they're unspoken kinds ofthings, which I just feel like, are kind
of this conventional wisdom that maybeis underpinning a lot of this and maybe
perpetuated by like I've heard it saidso many times by actually brokers and
kind of like middle people themselves.
(33:37):
At a certain juncture, they'rereally they get really far
removed from the actual patients.
So the one thing that I do feel likeemployers do have an opportunity to do
is like they actually know the patients.
Employers like, you know, thesepeople and that really matters.
They're the employees.
They see them every single day.
Yeah.
They know their people.
And when they find out a way to do it.
(33:58):
Most of them do it if theycan realize what can be done.
So if someone is interestedin learning more about Synergy
Healthcare, where would you directthem for more information, Matt?
Go to LinkedIn, look me up, MattMcQuide, Synergy Healthcare my main
thing is I'm just trying to encouragepeople to know that there are
ways out there to do these things.
And we post lots of articles, um, and youcan certainly message me through LinkedIn.
(34:22):
Matt McQuide, thank you so much forbeing on Relentless Health Valued today.
Oh, thank you so much, Stacey.
Hey, this is Matt McQuidewith Synergy Healthcare.
I listen to Stacey and RelentlessHealth Value every single week.
There's valuable informationevery single week to take from it.
And I just so appreciate this is around.
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