In the second part of this conversation with Jonathan Baran, CEO of Self Fund Health, the focus is on reversing the negative cycle of skyrocketing healthcare costs by shifting from buying discounts to investing in primary care and better benefit designs.
The discussion highlights the current issues with the healthcare flywheel, driven by employers buying discounts, and offers solutions such as investing in direct primary care, incentivizing proper healthcare utilization, and improving patient navigation.
The conversation also explores the potential for direct contracting between employers and health systems, aiming for a paradigm shift where employers, brokers, and health plans work collaboratively to improve member health and reduce costs.
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05:23 Where to start in reversing the flywheel.
06:57 Why investing in primary care is pivotal to containing healthcare costs.
10:02 EP453 with Claire Brockbank.
10:04 EP452 with Cora Opsahl.
10:07 EP457 with Cynthia Fisher.
10:12 EP365 with Scott Haas.
10:13 EP465 with Chris Crawford.
10:14 EP475 with Peter Hayes.
11:11 EP468 with Matt McQuide.
11:13 EP472 with Eric Bricker, MD.
12:14 “The most expensive thing in healthcare is the pen of the primary care doctor.”
13:04 How the role of the broker has to fundamentally change.
16:16 What will the single most challenging aspect of this restructuring become?
20:20 How self-funded employers can be amazing customers in containing the rising cost flywheel in healthcare.
22:56 How do EHRs and other medical record systems play into reversing the flywheel of rising healthcare costs?
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Stacey Richter (00:00):
Episode 483 Part Two.
"Reversing the Healthcare Flywheelto Contain Skyrocketing Healthcare
Costs." This is the second partof my conversation with Jonathan
Baran.
Tom Nash (00:19):
American Healthcare Entrepreneurs and Executives
You Want to Know, Talking.
Relentlessly Seeking Value.
Stacey Richter (00:28):
Okay, to review from Part 1 of this conversation, and if you
didn't listen to it because you thinkyou know how this whole skyrocketing
healthcare costs thing works, letme tell you, I myself had a few
revelations, so go back and listen.
But to be fair, if youdidn't already, sure, fine.
Listen to Part 2 here firstand then do it backwards.
(00:48):
It probably won't makethat much difference.
Except, you'll need to contendwith me totally ruining the Part 1
suspense because here's the negativeflywheel starting with the axel.
Employers and other plan sponsorshave been convinced to buy discounts,
including discounts or discountsby their other aliases, rebates,
(01:09):
and probably shared savings tooI would throw in this category.
This is the grease thatkeeps the flywheel spinning.
What's the why there?
It's a genius idea if you think about it.
And if you're not fully understandingwhat I'm about to say, go back for sure
and listen to part one of this episodebecause this is a very fundamental
concept that has come up over andover and over again on this podcast.
(01:32):
Cora Opsahl, I talked about it.
Claire Brockbank, Eric Bricker,Chris Crawford for just four shows
off the top of my head in thepast, you know, eight months or so.
Here's the concept.
If you buy discounts,your costs will go up.
Am I saying this theoretically?
No, I'm not.
Look at the last 20 years have costsgone up way higher than inflation.
Yes, they have.
What are we doing?
We're buying discounts.
(01:52):
So it's hard to argue.
Renewals every single yearwill just keep going up.
The longer that we buy discounts, we talkabout this Jonathan Baran and I in Part
1, how carriers have created a reallyvery self-serving, buying framework where
employers are trained to buy discounts.
Discounts are the axle and the buying ofdiscounts becomes the top of our flywheel.
(02:14):
And then some so inclined hospital systemexecutives, there are certainly executives
standing 10,000 feet from any bedside,so they really have zero idea how care or
patients or even clinicians or impacted.
But if plan sponsors buy discounts, thoseat health systems who are so inclined
now have no real incentive to reign inprices or focus on appropriate care even.
(02:36):
And if you are so inclined, ifyou're very margin focused as a
healthcare executive, you know, firstthings first, go gut primary care.
That is step one in every playbook,and we definitely talk about
that in Part 1 of this episode.
And also, again, in about 10episodes from earlier this year.
Another thing that you're gonna wannado if your prime imperative is margin
(02:56):
at a healthcare system is maximizethe revenue off of every transaction.
So, hey, hello, EHR systems.
So now you have health system pricescreeping up and up, unfettered, you
know, just exacerbated by consolidationand a bunch of other different things.
But you've got healthcare pricescreeping up, you have volume the same
or higher because we're not preventingchronic disease like you would with
(03:19):
advanced primary care, for example.
And now we're back at the, oh wow,let me sell you another discount.
And renewal is only 9% or whatever.
Thus the flywheel spins.
Alright, so let's turn this wheel around.
Shall we flip it?
180, what's the fix?
This is what Jonathan Baran talksabout in the episode that follows,
but he says, Hey, how about this?
Instead of putting get bigger discountsin the middle of the flywheel, why
(03:41):
don't we put buy better member health?
That's a good start.
Buy a health plan that delivers bettermember health at an affordable price.
Buy the care, not buy a discountoff of a price we can't see
for net price we can't see.
Is it insurance?
I don't know.
Right.
Like just buy the healthcare.
Cutting to the chase, JonathanBaran, advocates for a paradigm
(04:02):
shift where employers invest inprimary care, adopt better benefit
designs, more aligned to cost andquality so that members are incented.
Toward better cost and quality employeenavigation services to guide employees to
make more informed healthcare decisions.
So again, by changing the focusfrom buying discounts to buying
(04:22):
actual healthcare, Jonathan says,we can reverse the negative cycle
and improve overall health outcomes.
As I've said multiple times already,my guest today is Jonathan Baran.
He has been for a long time, ahealthcare entrepreneur today.
He is co-founder and CEO ofSelf Fund Health in Wisconsin.
Committed to challenging the expensivehealthcare system in Wisconsin.
(04:44):
Self Fund Health, I am always sopleased to tell you did make a really,
really kind offer to help out RHV,Relentless Health Value financially.
You and the tribe here are really greatfolks who I truly, truly appreciate.
So please do support Self FundHealth if you are in Wisconsin.
My name is Stacey Richter.
This podcast is sponsoredby Self Fund Health today.
(05:05):
And with that, here is the episode.
Jonathan Baran, welcome toRelentless Health Value.
Jonathan Baran (05:09):
Stacey, thank you for having me today.
Stacey Richter (05:11):
Okay, Jonathan Baran so last week we talked about the
version of the healthcare flywheelwith discounts in the center.
That flywheel spins and itresults in higher and higher
and higher healthcare costs.
If we're thinking about, forthe conversation right now,
how we're gonna reverse thatflywheel, where do you wanna start?
Jonathan Baran (05:29):
You might say that, when I'm gonna talk here, you might
call me idealistic, you might saythat this change is not possible.
And that very well could be theanswer to this, but I also do have
the belief that in the same waythat the incentives are created and
they drive the behavior, we can alsobegin to reverse those incentives.
And then a number of really goodthings can follow up from that.
(05:53):
This is where it has to begin with thebuyer or the purchaser of the healthcare.
Let's begin to think about through theemployer's perspective, because this is
where all dollars originate, how we couldactually set the incentive structure in a
way that actually begins to reverse this.
Stacey Richter (06:10):
So now it's renewal season.
What needs to happen?
Jonathan Baran (06:14):
When we think about reversing this flywheel,
let's begin where we started,which is with the discounts, right?
So alternative world, whathappens if an employer rejected
the concept of a discount?
Every time that it got broughtup, they would say, Nope, this
is not how we buy healthcare.
We actually just want tobegin to understand the
(06:34):
unit cost of these services.
I don't want a reportthat shows me a discount.
I wanna actually see how much did myMRIs cost the actual unit price, right?
I wanna see my surgeries,I wanna see my drugs.
If employers began to think like that, andagain, I would argue they're now buying
healthcare, they're not buying insurance.
What are the types of thingsthat would then fall from that?
(06:57):
The first thing that we have todo is we have to invest in primary
care because if we are still relianton the old referral streams of the
hospital systems, we are gonna beback in the same spot that we are.
We believe that there is a beautifulmovement that is happening right now,
which is around direct primary care.
So we are big believers in thismovement of doctors who are leaving
(07:19):
the big hospital systems and arestarting their own practice where they
go back to what real primary care is.
And they, as a result of changing theirbusiness model from fee for service to
subscription, I would argue if employersstart to invest in primary care, we
would have a primary care renaissance.
Primary care docs wouldcome out of the woodwork.
(07:40):
They would stop goinginto early retirement.
They would go into the profession again.
We would eliminate this primarycare shortage because we would
make primary care a professionthat docs wanna actually get into.
So that's number one.
Stacey Richter (07:52):
Okay, so to reverse the flywheel, huge main
concept is do not buy discounts.
That in and of itself willhave a profound impact.
Beyond that, I'm hearinginvest in primary care.
There's been six shows on the many reasonsthis is the case just this year so far.
There are clinical reasons.
There are plenty of financial reasons,which matter if you happen to be the plan
(08:14):
sponsor actually paying for healthcare,or if you are the patient or member.
What else?
Jonathan Baran (08:19):
If we're gonna buy more, $500 MRIs, we have to create
an incentive structure for the memberto actually make that choice to get
the $500 MRI and not the $5,000 MRI.
This comes back to concept ofplan design, where we have to
align the cost of the healthcareto the cost that the member pays.
Right now, those two concepts aredivorced and the healthcare costs the
(08:42):
same as long as it's quote in-network.
That does not help us.
So we have to create some sort offinancial incentive for our employees
to help them make the right decisions,or at least make the decisions that
align to the cost of the healthcare.
You'd also realize things likehealthcare is really complicated
and it's hard to do it by yourself.
(09:02):
Particularly as a patient.
And so you would have to investin things like nurse navigation.
You would have a nurse sit alongsidea patient and help them through this
process because you realize thatemployees are more than happy to
change the direction or will changethe course of their healthcare,
(09:22):
if you make it simple for them.
And right now it's too complicated.
It's way too complicated for the averagepatient to navigate on their own.
And so these are just some examplesof like the things that you would do,
understanding what I started with,but you're now an employer and you're
thinking about what are the changesthat I would drive practically to
then reverse this incentive structure.
Stacey Richter (09:42):
So just starting with the first thing that you mentioned
about stopping buying discounts.
And I just want to underscore, that'snot some kind of off the wall, wow.
That's some kind ofrevelation sort of theory.
We have had, let, let me justcount the number of people who have
said this unequivocably, right?
We had Claire Brockbank, we had CoraOpsahl off from the 32BJ Union who
(10:06):
are just like, stop by and discounts.
We have had Cynthia Fisher alsosay, stop buying discounts.
Scott Haas.
We have Chris Crawford,we had Peter Hayes.
They all unequivocably,example after example.
So if anyone's just like, I don't knowabout, go back and listen to those
shows because you will not get moreevidence-based rationale for quit
(10:26):
it with the discounts right there.
So what you're saying instead though isokay, if we're not buying on discounts,
then what we need to be focusing on ismanage the actual, we want our employees
to actually get good healthcare.
So what does that look like?
Let's manage the purchase of healthcareto ensure that if our employees are
gonna go into this quagmire we callthe healthcare industrial complex.
(10:50):
If I wanna use the really cynicalname for it, that we're really helping
them, and what you're suggesting isthere's three really big constructs
there to be thinking about.
One is primary care.
Because you got to get them out of asystem right at the very beginning.
Otherwise you're trying to stop atrain that's already left the station.
(11:11):
And we just had Matt McQuide, we had Dr.Eric Bricker say basically, you can't
just be dipping in and saying like, Hey,patient who's just signed up for a really
expensive, unnecessary surgery, or it wasgoing to a known doctor who's operating
on inappropriate, like, you know, you,you can't just pop in subsequently and
(11:31):
then say, no, you shouldn't do that.
They're like, I got myoperation scheduled.
Right.
So like timing is really importantand if you wanna be there from the
very beginning, you have to it isreally important that primary care is
an independent unconflicted entity.
There's a virtuous cycle also thatcould start here just across the country
if we invested in primary care andwrestled control away from some of these
(11:56):
conflicted entities over to the employers.
And you can really seethe rationale there.
Then you talked about benefit design.
We're buying healthcare here.
How are we making smart choices?
How are we helping membersmake smart choices?
And then the navigationis also part of that.
Jonathan Baran (12:12):
Yes, because at the end of the day too, the most
expensive thing in healthcare isthe pen of the primary care doctor.
And so where and how that dollar getsmanaged is ultimately dependent on them.
That's why, as you said, it needsto be independent, needs to be
unconflicted, have the time todo real primary care things.
Chris Crawford (12:30):
Hi, I'm Chris Crawford, CEO, and founder of RxSaveCard.
If you love the Relentless HealthValue podcast like I do, be sure to
follow their LinkedIn page and join theconversation about the topics every week.
Thanks so much for listening.
Stacey Richter (12:42):
Okay, so now the top of our flywheel is employer is managing
benefit design under the framework ofwe are managing spend most of the time.
I mean, there are certainlyissues with high cost claimants
and stop-loss insurance.
So we are changing up benefitdesign more in line with what
the actual underlying costs are,and we are doing some navigation.
(13:04):
Then what happens?
Jonathan Baran (13:04):
So then this is gonna fundamentally change the
role of the EBC or the broker.
This is an important one.
I would argue today most brokers thinkthat their role is to present the options.
So Mr. And Mrs. Employer, I've gotthree different potential plans for you.
Which would you like to choose?
And I would argue if employers start todrive this behavior of buying healthcare,
(13:28):
they will fundamentally see their roleas helping employers on that journey.
Anyone that's done this will know that thesingle hardest thing here is education.
It's helping your members tounderstand all these things
that we are talking about today.
So if I'm a patient and atthe end of the day I have a
healthcare need, how do I know?
How do I know what to go?
(13:48):
How do I know what to do?
Right?
And, that then becomes therole of the broker, in my view.
They become much more responsible,not just for presenting options,
but for driving real outcomes.
Driving down healthcare spend.
Because very practical things likebrokers would then run regular meetings
with employers where they would sit downand they would discuss the value of DPC.
(14:12):
And how to access imaging and whatto do about prescription drugs.
They would literally sit downwith high cost members and help
guide them and answer questionsvery specific to their conditions.
Not in generalities,but very specifically.
And we would have full insight intowhat's going on in the plan, what's
driving it, what are the real claims,what are the real opportunities?
(14:34):
And that becomes then the primaryrole of the EBC is to help that
employer and their population onthis healthcare buying journey.
It's a fundamental shift in the roleof the broker that's driven by this
top level incentive structure change.
Stacey Richter (14:49):
Do you feel like then, I know there's a lot of EBCs who regard,
especially the ones who are transparent,the ones who really, truly want to be,
and it's part of their value prop toemployers that they are, a number of
those EBCs really regard their roleas helping to construct a plan for the
(15:16):
employer to put together a benefit design.
So are you saying that that youfeel like goes back to the employer
or are you saying that's stillpart of the role of the broker?
Jonathan Baran (15:28):
So if you have this new changing behavior, this new
changing paradigm amongst employers,what is going to begin to emerge
is a new type of health plan.
Now, maybe this comes in the form of aTPA or an ASO, many types of potentials
that could fall into this category.
But ultimately, I'm gonna use thephrase health plan, which is an
(15:50):
entity that helps the employerpurchase healthcare in this way.
So what that is now going todrive is that enter the broker
back into the equation, the EBC.
Now they have an option for somethingelse that is different that is how
these employers actually want to buy.
And now we can move fundamentallyaway from these games like discounts
(16:14):
and networks and things like that.
And what the brokers will begin torealize as well as the employers, is
that the single biggest challenge ina model like this is educating the
employees, educating the workforce,because healthcare is complicated.
And so as an employee, you have to knowhow should I consume healthcare rather
(16:35):
than just blindly taking my ID cardand walking in the big hospital system.
What am I supposed to do now?
How do I interact with this?
And this is an ongoing change.
It's an ongoing evolution.
But what this enables is that theemployer, the EBC now is not playing the
role of presenting options like healthplan options, but now they ultimately are
(16:56):
able to really own and control outcomes.
The more that the EBC is able to educatethe workforce, the more costs come down.
The more you could sit down, runeducation meetings with the employees,
educate them on their options, what todo specifically for high cost members.
All of these different things is toultimately allow the employer to get the
(17:20):
best value for their healthcare dollar.
Stacey Richter (17:22):
If I'm just tracking with the reverse of this flywheel
here, we are going from buyingdiscounts to buying healthcare.
And if we think about buying healthcareand you've got enough employers who
are like, I wanna buy healthcare.
Like, stop it with the discounts, quit it.
Talk to me about how I am goingto get my employees the best
(17:43):
healthcare I possibly can get them.
Then that incentivizes a health planand you know, lots of names for health
plans or 3rd party administrators,administrative services only, like
whatever you wanna call it, right?
But like a health plan, let'sjust throw 'em all into one term.
Incentivize a health plan to offera product to improve health, which
might have primary care folded in.
(18:04):
It might have navigation folded in.
It might have benefit design alignedwith costs to really think through.
Because if you wanna, as you just said,if you wanna improve the health of
members, then this is how you do it.
So put a health plan togetherthat offers those things.
Now a broker can say, all right,here's a solution for you.
Employer, instead of spending all ofthis time trying to math our way out
(18:30):
of a very human issue we can focus onreally getting better health for members.
It was interesting because many, manyyears ago I interviewed someone on this
pod who said, you know, there's twodimensions of getting better healthcare.
It used to be the haves and the havenots.
And that sure is still a thing, butit's also the know and the know nots
(18:53):
and you have to be a have and a know ifyou wanna really get better healthcare.
And that definitely sounds likealso what you're suggesting here.
Jonathan Baran (19:02):
Yeah, 100%.
So then that behavior then changes.
Now we have employers thatare learning to buy healthcare
like they buy anything else.
They think of healthcare spend as a keyperformance indicator of their company.
They track it just like theytrack any other expense.
They talk about it at company meetings.
They make it known that the amount ofmoney we spend this year is going to
(19:26):
determine the amount of money that'sgonna come outta your paycheck next year.
They don't take the standard likewe see have a lot of employers when
you talk about healthcare spend,they literally kinda like plug their
ears and they say like, this isnot my job to manage or understand.
?We actually remove that and we talk about these things and we
see it as an opportunity to leanin, better, educate our workforce.
Better able to drive the changethat we're talking about.
Stacey Richter (19:49):
And then if we're thinking about the rest of the flywheel, if you
have enough patients who are walkinginto the door of a hospital with a
navigator at their hip who's like, no,don't send me to the $8,000 MRI, you
know, I'm going over here and then allof a sudden hospital behavior starts
to change and the infrastructures andthe services purchased by that hospital
(20:13):
then therefore are going to align withthe asks of their customers who now
start thinking about things differently.
Jonathan Baran (20:20):
Yeah.
So these hospitals then begin torealize, so first off, we need hospitals.
They're an integral partof our healthcare system.
What we realize, or they realize thatthere's a giant opportunity to be
the hospital of the employers thatcharge fair rates for their services.
But then importantly, skip the middlemanbecause I would argue that self-funded
(20:41):
employers can be amazing customersbecause they can do a lot of things in
a self-funded construct to eliminatea lot of the administrative bloat that
hospital systems are saddled with today.
So the biggest thing that you would hearfrom hospital system executives is that
all the work that they have to do tojust drive the actual patient care is
(21:04):
what bogs them down as an organization.
Things like prior authorizationsbeing a great example.
Well guess what?
When there are employers that areworking with healthcare organizations
that offer fair prices, we've seen manythat waive things like pre-auths or they
will do things like pay for healthcare,literally at the time of service.
(21:25):
This is a lot what MarkCuban talks about, right?
It's crazy that we think healthcareproviders should hold risk and not
get paid for their services for30, 60, 90 days after the fact.
And these are the things thatself-insured employers can do.
They can pay for healthcare at the dayof service, at the time of service.
And if you think about what that coulddo to the hospital cost structure, where
(21:49):
you are eliminating tons and tons of workthat either comes in the form of chasing
prior authorizations, chasing bills,dealing with denials, all of these things,
think about the administrative bloatthat we could remove from the system if
we had hospitals and employers workingmuch closer together than they are today.
Stacey Richter (22:06):
And we do have a couple of shows coming up about direct
contracting and just managing that.
But I think the main point, if you'vegot enough middle people in the middle
of a transaction, just whatever theirprofit margins are of those middle
people, you can just cut that out.
Uh, if, if there's some direct, andI'm not certainly saying that all
of the services offered there areunnecessary, but there's certainly a
(22:30):
better way to do it where the value ofwhat they're doing is designed to accrue
to members and patients as opposed toshareholders of those organizations.
So could be very, very mucha task with a similar name.
But with a goal, which is truly a comingtogether of the purchaser and the clinical
(22:51):
organization without another perverseincentive kind of mixing around there.
Jonathan Baran (22:56):
That then leads us to the last stop on our journey, which
is back to the medical record systems.
So now realizing that the hospitalshave changed their thinking around this.
And doing as they often do, whichis listen to their customers.
They would realize that nowthe incentive structure is such
that it's all about getting goodvalue for that healthcare dollar.
(23:19):
So those medical record systemswould orient around becoming
an operating system of value.
They would give patients and providers,the tools to navigate, coordinate, get
the best value for the healthcare dollar.
And this could then ultimately createa structure whereby like the people,
the providers who are actuallyreferring for the care or prescribing
(23:42):
for the care, understand the cost.
Patients do as well, they understandtheir options and we're, we're in a spot
where value becomes the overwhelminggoal as opposed to lock in and extracting
dollars from the same organization.
Stacey Richter (23:55):
And just on that point, I was just reading a post by
Dr. Ramy Khalil the other day, whowas talking about medical record
systems and one of the things that Dr.Khalil was saying is interoperability.
Is a technical problem is false.
So like the last stop on the chain mightactually be easier than we think because
(24:17):
as he says, you have everybody blamingthe tag, but it's actually not a techno.
There's been the technical capabilityfor many, many years to do many,
many things which are required andnecessary in the healthcare system.
There's also the policy scaffoldingto put all this together.
i.e. the, some of the interoperabilitylaws that have come together.
(24:38):
But yet, oddly, the tech isn'tbeing deployed in this way
because of the incentives.
So flip the incentives and thetechnology is probably already there.
It's just you know, whoever'sgot the data, has got the power.
And so you can definitely see why even ifthere's ability to share, there's every
incentive not to in the current regime.
Jonathan Baran (24:59):
So this is where it's, again, may be viewed as idealistic.
It may be extremely optimistic,but at the end of the day, it comes
down to the employers putting theirmoney where their mouth is and
beginning to drive volume differently.
Because if they do that, there's a wholehost of, at least how I framed it here,
(25:21):
particularly fortuitous things that happenas a result of it that could begin to
change, at least slow down the spinningof this flywheel so we could get to the
spot for some of these better outcomesmight begin to fall out as a result of it.
Stacey Richter (25:34):
Understood.
So Jonathan Baran, tellme about Self Fund Health.
Jonathan Baran (25:38):
Self Fund Health is one of those new age health plans that we
have started here in the Upper Midwestto help bring the complexity of all
this together in a way that's easy tounderstand for employers and brokers.
Because that's our belief is thatthe single biggest challenge that's
preventing real change, particularlyamongst the employers and brokers
(26:00):
is this is really complicated.
And so our job is to makethat as simple as possible.
Offer a plan for employers tobegin to go down this path with
their EBCs and with their brokers.
Stacey Richter (26:10):
So I'm assuming somebody buys the Self Fund Health
plan, you're gonna get primarycare, you're gonna get navigation.
You're going to get a benefit designsolution, which is more aligned with
the actual prices that we're payingfor things as opposed to this whole
crazy buying discounts business.
Jonathan Baran (26:27):
You got it.
And look, we are farfrom the only solution.
There's a lot of solutions outhere to this problem, and everyone
that's listening in my opinion,has an opportunity to either.
Begin to break theflywheel or continue it.
But oftentimes we still hear this islike, I think a lot of employers hear
what we're saying and they say, youknow, yeah, all this sounds great,
(26:50):
but we're just not ready for it.
We're not ready to make the leap.
We're not ready to make the jump intothis, whatever this new world looks like.
And it somehow feels like the statusquo is the safer of the two options.
But the question that we alwayspose is like, based upon everything
that we've talked about today.
If the status quo guaranteeshigher costs and less control,
(27:12):
is it really the safer option?
Is this really the path that's going tolead towards any sort of improvement?
Is the status quo going to get uswhere we desire with healthcare,
which is lower cost, higher quality,or are we delaying the inevitable?
And, um, it's ultimately gonna comedown to the employers taking action and
(27:32):
beginning to do something differentlyif we want this whole loop to change.
Stacey Richter (27:36):
So I, I love how you're saying it, that there is an
opportunity to break the flywheel here,and I think probably one of the first
acknowledgements, it sounds like a 12step program, um, when I'm about to say
this, but just like, I think we all needto recognize that we are on this flywheel.
I think anybody that works fora healthcare organization is
like, yep, we're on the flywheel.
(27:56):
But I think maybe it's a revelationfor some employers that they are too.
You are too, right?
Self Fund Health is one of those entitieswho's like, let's just do this right.
Let's focus on the right issue, whichis better member health, which should
be in the middle of that flywheel.
There's plenty of examples ofpeople doing many of the things
that you're talking about.
I was just talking to Candace Shafferfrom Purdue University who was doing
(28:18):
many of the things that you're talkingabout and the healthcare costs went down.
There's plenty of examples in the, in theMidwest, especially like the Midwest is
really a hotbed of some very innovative.
Activities relative toswitching around that flywheel.
Jonathan Baran, thank you so muchfor being on Relentless Health Value.
Jonathan Baran (28:34):
Thank you, Stacey.
Tom Nash (28:35):
Hi, this is Tom Nash, editor and producer of the
Relentless Health Value Podcast.
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Episode 483 Part Two.
"Reversing the Healthcare Flywheelto Contain Skyrocketing Healthcare
Costs." This is the second partof my conversation with Jonathan
Baran.
Tom Nash (00:19):
American Healthcare Entrepreneurs and Executives
You Want to Know, Talking.
Relentlessly Seeking Value.
Stacey Richter (00:28):
Okay, to review from Part 1 of this conversation, and if you
didn't listen to it because you thinkyou know how this whole skyrocketing
healthcare costs thing works, letme tell you, I myself had a few
revelations, so go back and listen.
But to be fair, if youdidn't already, sure, fine.
Listen to Part 2 here firstand then do it backwards.
(00:48):
It probably won't makethat much difference.
Except, you'll need to contendwith me totally ruining the Part 1
suspense because here's the negativeflywheel starting with the axel.
Employers and other plan sponsorshave been convinced to buy discounts,
including discounts or discountsby their other aliases, rebates,
(01:09):
and probably shared savings tooI would throw in this category.
This is the grease thatkeeps the flywheel spinning.
What's the why there?
It's a genius idea if you think about it.
And if you're not fully understandingwhat I'm about to say, go back for sure
and listen to part one of this episodebecause this is a very fundamental
concept that has come up over andover and over again on this podcast.
(01:32):
Cora Opsahl, I talked about it.
Claire Brockbank, Eric Bricker,Chris Crawford for just four shows
off the top of my head in thepast, you know, eight months or so.
Here's the concept.
If you buy discounts,your costs will go up.
Am I saying this theoretically?
No, I'm not.
Look at the last 20 years have costsgone up way higher than inflation.
Yes, they have.
What are we doing?
We're buying discounts.
(01:52):
So it's hard to argue.
Renewals every single yearwill just keep going up.
The longer that we buy discounts, we talkabout this Jonathan Baran and I in Part
1, how carriers have created a reallyvery self-serving, buying framework where
employers are trained to buy discounts.
Discounts are the axle and the buying ofdiscounts becomes the top of our flywheel.
(02:14):
And then some so inclined hospital systemexecutives, there are certainly executives
standing 10,000 feet from any bedside,so they really have zero idea how care or
patients or even clinicians or impacted.
But if plan sponsors buy discounts, thoseat health systems who are so inclined
now have no real incentive to reign inprices or focus on appropriate care even.
(02:36):
And if you are so inclined, ifyou're very margin focused as a
healthcare executive, you know, firstthings first, go gut primary care.
That is step one in every playbook,and we definitely talk about
that in Part 1 of this episode.
And also, again, in about 10episodes from earlier this year.
Another thing that you're gonna wannado if your prime imperative is margin
(02:56):
at a healthcare system is maximizethe revenue off of every transaction.
So, hey, hello, EHR systems.
So now you have health system pricescreeping up and up, unfettered, you
know, just exacerbated by consolidationand a bunch of other different things.
But you've got healthcare pricescreeping up, you have volume the same
or higher because we're not preventingchronic disease like you would with
(03:19):
advanced primary care, for example.
And now we're back at the, oh wow,let me sell you another discount.
And renewal is only 9% or whatever.
Thus the flywheel spins.
Alright, so let's turn this wheel around.
Shall we flip it?
180, what's the fix?
This is what Jonathan Baran talksabout in the episode that follows,
but he says, Hey, how about this?
Instead of putting get bigger discountsin the middle of the flywheel, why
(03:41):
don't we put buy better member health?
That's a good start.
Buy a health plan that delivers bettermember health at an affordable price.
Buy the care, not buy a discountoff of a price we can't see
for net price we can't see.
Is it insurance?
I don't know.
Right.
Like just buy the healthcare.
Cutting to the chase, JonathanBaran, advocates for a paradigm
(04:02):
shift where employers invest inprimary care, adopt better benefit
designs, more aligned to cost andquality so that members are incented.
Toward better cost and quality employeenavigation services to guide employees to
make more informed healthcare decisions.
So again, by changing the focusfrom buying discounts to buying
(04:22):
actual healthcare, Jonathan says,we can reverse the negative cycle
and improve overall health outcomes.
As I've said multiple times already,my guest today is Jonathan Baran.
He has been for a long time, ahealthcare entrepreneur today.
He is co-founder and CEO ofSelf Fund Health in Wisconsin.
Committed to challenging the expensivehealthcare system in Wisconsin.
(04:44):
Self Fund Health, I am always sopleased to tell you did make a really,
really kind offer to help out RHV,Relentless Health Value financially.
You and the tribe here are really greatfolks who I truly, truly appreciate.
So please do support Self FundHealth if you are in Wisconsin.
My name is Stacey Richter.
This podcast is sponsoredby Self Fund Health today.
(05:05):
And with that, here is the episode.
Jonathan Baran, welcome toRelentless Health Value.
Jonathan Baran (05:09):
Stacey, thank you for having me today.
Stacey Richter (05:11):
Okay, Jonathan Baran so last week we talked about the
version of the healthcare flywheelwith discounts in the center.
That flywheel spins and itresults in higher and higher
and higher healthcare costs.
If we're thinking about, forthe conversation right now,
how we're gonna reverse thatflywheel, where do you wanna start?
Jonathan Baran (05:29):
You might say that, when I'm gonna talk here, you might
call me idealistic, you might saythat this change is not possible.
And that very well could be theanswer to this, but I also do have
the belief that in the same waythat the incentives are created and
they drive the behavior, we can alsobegin to reverse those incentives.
And then a number of really goodthings can follow up from that.
(05:53):
This is where it has to begin with thebuyer or the purchaser of the healthcare.
Let's begin to think about through theemployer's perspective, because this is
where all dollars originate, how we couldactually set the incentive structure in a
way that actually begins to reverse this.
Stacey Richter (06:10):
So now it's renewal season.
What needs to happen?
Jonathan Baran (06:14):
When we think about reversing this flywheel,
let's begin where we started,which is with the discounts, right?
So alternative world, whathappens if an employer rejected
the concept of a discount?
Every time that it got broughtup, they would say, Nope, this
is not how we buy healthcare.
We actually just want tobegin to understand the
(06:34):
unit cost of these services.
I don't want a reportthat shows me a discount.
I wanna actually see how much did myMRIs cost the actual unit price, right?
I wanna see my surgeries,I wanna see my drugs.
If employers began to think like that, andagain, I would argue they're now buying
healthcare, they're not buying insurance.
What are the types of thingsthat would then fall from that?
(06:57):
The first thing that we have todo is we have to invest in primary
care because if we are still relianton the old referral streams of the
hospital systems, we are gonna beback in the same spot that we are.
We believe that there is a beautifulmovement that is happening right now,
which is around direct primary care.
So we are big believers in thismovement of doctors who are leaving
(07:19):
the big hospital systems and arestarting their own practice where they
go back to what real primary care is.
And they, as a result of changing theirbusiness model from fee for service to
subscription, I would argue if employersstart to invest in primary care, we
would have a primary care renaissance.
Primary care docs wouldcome out of the woodwork.
(07:40):
They would stop goinginto early retirement.
They would go into the profession again.
We would eliminate this primarycare shortage because we would
make primary care a professionthat docs wanna actually get into.
So that's number one.
Stacey Richter (07:52):
Okay, so to reverse the flywheel, huge main
concept is do not buy discounts.
That in and of itself willhave a profound impact.
Beyond that, I'm hearinginvest in primary care.
There's been six shows on the many reasonsthis is the case just this year so far.
There are clinical reasons.
There are plenty of financial reasons,which matter if you happen to be the plan
(08:14):
sponsor actually paying for healthcare,or if you are the patient or member.
What else?
Jonathan Baran (08:19):
If we're gonna buy more, $500 MRIs, we have to create
an incentive structure for the memberto actually make that choice to get
the $500 MRI and not the $5,000 MRI.
This comes back to concept ofplan design, where we have to
align the cost of the healthcareto the cost that the member pays.
Right now, those two concepts aredivorced and the healthcare costs the
(08:42):
same as long as it's quote in-network.
That does not help us.
So we have to create some sort offinancial incentive for our employees
to help them make the right decisions,or at least make the decisions that
align to the cost of the healthcare.
You'd also realize things likehealthcare is really complicated
and it's hard to do it by yourself.
(09:02):
Particularly as a patient.
And so you would have to investin things like nurse navigation.
You would have a nurse sit alongsidea patient and help them through this
process because you realize thatemployees are more than happy to
change the direction or will changethe course of their healthcare,
(09:22):
if you make it simple for them.
And right now it's too complicated.
It's way too complicated for the averagepatient to navigate on their own.
And so these are just some examplesof like the things that you would do,
understanding what I started with,but you're now an employer and you're
thinking about what are the changesthat I would drive practically to
then reverse this incentive structure.
Stacey Richter (09:42):
So just starting with the first thing that you mentioned
about stopping buying discounts.
And I just want to underscore, that'snot some kind of off the wall, wow.
That's some kind ofrevelation sort of theory.
We have had, let, let me justcount the number of people who have
said this unequivocably, right?
We had Claire Brockbank, we had CoraOpsahl off from the 32BJ Union who
(10:06):
are just like, stop by and discounts.
We have had Cynthia Fisher alsosay, stop buying discounts.
Scott Haas.
We have Chris Crawford,we had Peter Hayes.
They all unequivocably,example after example.
So if anyone's just like, I don't knowabout, go back and listen to those
shows because you will not get moreevidence-based rationale for quit
(10:26):
it with the discounts right there.
So what you're saying instead though isokay, if we're not buying on discounts,
then what we need to be focusing on ismanage the actual, we want our employees
to actually get good healthcare.
So what does that look like?
Let's manage the purchase of healthcareto ensure that if our employees are
gonna go into this quagmire we callthe healthcare industrial complex.
(10:50):
If I wanna use the really cynicalname for it, that we're really helping
them, and what you're suggesting isthere's three really big constructs
there to be thinking about.
One is primary care.
Because you got to get them out of asystem right at the very beginning.
Otherwise you're trying to stop atrain that's already left the station.
(11:11):
And we just had Matt McQuide, we had Dr.Eric Bricker say basically, you can't
just be dipping in and saying like, Hey,patient who's just signed up for a really
expensive, unnecessary surgery, or it wasgoing to a known doctor who's operating
on inappropriate, like, you know, you,you can't just pop in subsequently and
(11:31):
then say, no, you shouldn't do that.
They're like, I got myoperation scheduled.
Right.
So like timing is really importantand if you wanna be there from the
very beginning, you have to it isreally important that primary care is
an independent unconflicted entity.
There's a virtuous cycle also thatcould start here just across the country
if we invested in primary care andwrestled control away from some of these
(11:56):
conflicted entities over to the employers.
And you can really seethe rationale there.
Then you talked about benefit design.
We're buying healthcare here.
How are we making smart choices?
How are we helping membersmake smart choices?
And then the navigationis also part of that.
Jonathan Baran (12:12):
Yes, because at the end of the day too, the most
expensive thing in healthcare isthe pen of the primary care doctor.
And so where and how that dollar getsmanaged is ultimately dependent on them.
That's why, as you said, it needsto be independent, needs to be
unconflicted, have the time todo real primary care things.
Chris Crawford (12:30):
Hi, I'm Chris Crawford, CEO, and founder of RxSaveCard.
If you love the Relentless HealthValue podcast like I do, be sure to
follow their LinkedIn page and join theconversation about the topics every week.
Thanks so much for listening.
Stacey Richter (12:42):
Okay, so now the top of our flywheel is employer is managing
benefit design under the framework ofwe are managing spend most of the time.
I mean, there are certainlyissues with high cost claimants
and stop-loss insurance.
So we are changing up benefitdesign more in line with what
the actual underlying costs are,and we are doing some navigation.
(13:04):
Then what happens?
Jonathan Baran (13:04):
So then this is gonna fundamentally change the
role of the EBC or the broker.
This is an important one.
I would argue today most brokers thinkthat their role is to present the options.
So Mr. And Mrs. Employer, I've gotthree different potential plans for you.
Which would you like to choose?
And I would argue if employers start todrive this behavior of buying healthcare,
(13:28):
they will fundamentally see their roleas helping employers on that journey.
Anyone that's done this will know that thesingle hardest thing here is education.
It's helping your members tounderstand all these things
that we are talking about today.
So if I'm a patient and atthe end of the day I have a
healthcare need, how do I know?
How do I know what to go?
(13:48):
How do I know what to do?
Right?
And, that then becomes therole of the broker, in my view.
They become much more responsible,not just for presenting options,
but for driving real outcomes.
Driving down healthcare spend.
Because very practical things likebrokers would then run regular meetings
with employers where they would sit downand they would discuss the value of DPC.
(14:12):
And how to access imaging and whatto do about prescription drugs.
They would literally sit downwith high cost members and help
guide them and answer questionsvery specific to their conditions.
Not in generalities,but very specifically.
And we would have full insight intowhat's going on in the plan, what's
driving it, what are the real claims,what are the real opportunities?
(14:34):
And that becomes then the primaryrole of the EBC is to help that
employer and their population onthis healthcare buying journey.
It's a fundamental shift in the roleof the broker that's driven by this
top level incentive structure change.
Stacey Richter (14:49):
Do you feel like then, I know there's a lot of EBCs who regard,
especially the ones who are transparent,the ones who really, truly want to be,
and it's part of their value prop toemployers that they are, a number of
those EBCs really regard their roleas helping to construct a plan for the
(15:16):
employer to put together a benefit design.
So are you saying that that youfeel like goes back to the employer
or are you saying that's stillpart of the role of the broker?
Jonathan Baran (15:28):
So if you have this new changing behavior, this new
changing paradigm amongst employers,what is going to begin to emerge
is a new type of health plan.
Now, maybe this comes in the form of aTPA or an ASO, many types of potentials
that could fall into this category.
But ultimately, I'm gonna use thephrase health plan, which is an
(15:50):
entity that helps the employerpurchase healthcare in this way.
So what that is now going todrive is that enter the broker
back into the equation, the EBC.
Now they have an option for somethingelse that is different that is how
these employers actually want to buy.
And now we can move fundamentallyaway from these games like discounts
(16:14):
and networks and things like that.
And what the brokers will begin torealize as well as the employers, is
that the single biggest challenge ina model like this is educating the
employees, educating the workforce,because healthcare is complicated.
And so as an employee, you have to knowhow should I consume healthcare rather
(16:35):
than just blindly taking my ID cardand walking in the big hospital system.
What am I supposed to do now?
How do I interact with this?
And this is an ongoing change.
It's an ongoing evolution.
But what this enables is that theemployer, the EBC now is not playing the
role of presenting options like healthplan options, but now they ultimately are
(16:56):
able to really own and control outcomes.
The more that the EBC is able to educatethe workforce, the more costs come down.
The more you could sit down, runeducation meetings with the employees,
educate them on their options, what todo specifically for high cost members.
All of these different things is toultimately allow the employer to get the
(17:20):
best value for their healthcare dollar.
Stacey Richter (17:22):
If I'm just tracking with the reverse of this flywheel
here, we are going from buyingdiscounts to buying healthcare.
And if we think about buying healthcareand you've got enough employers who
are like, I wanna buy healthcare.
Like, stop it with the discounts, quit it.
Talk to me about how I am goingto get my employees the best
(17:43):
healthcare I possibly can get them.
Then that incentivizes a health planand you know, lots of names for health
plans or 3rd party administrators,administrative services only, like
whatever you wanna call it, right?
But like a health plan, let'sjust throw 'em all into one term.
Incentivize a health plan to offera product to improve health, which
might have primary care folded in.
(18:04):
It might have navigation folded in.
It might have benefit design alignedwith costs to really think through.
Because if you wanna, as you just said,if you wanna improve the health of
members, then this is how you do it.
So put a health plan togetherthat offers those things.
Now a broker can say, all right,here's a solution for you.
Employer, instead of spending all ofthis time trying to math our way out
(18:30):
of a very human issue we can focus onreally getting better health for members.
It was interesting because many, manyyears ago I interviewed someone on this
pod who said, you know, there's twodimensions of getting better healthcare.
It used to be the haves and the havenots.
And that sure is still a thing, butit's also the know and the know nots
(18:53):
and you have to be a have and a know ifyou wanna really get better healthcare.
And that definitely sounds likealso what you're suggesting here.
Jonathan Baran (19:02):
Yeah, 100%.
So then that behavior then changes.
Now we have employers thatare learning to buy healthcare
like they buy anything else.
They think of healthcare spend as a keyperformance indicator of their company.
They track it just like theytrack any other expense.
They talk about it at company meetings.
They make it known that the amount ofmoney we spend this year is going to
(19:26):
determine the amount of money that'sgonna come outta your paycheck next year.
They don't take the standard likewe see have a lot of employers when
you talk about healthcare spend,they literally kinda like plug their
ears and they say like, this isnot my job to manage or understand.
?We actually remove that and we talk about these things and we
see it as an opportunity to leanin, better, educate our workforce.
Better able to drive the changethat we're talking about.
Stacey Richter (19:49):
And then if we're thinking about the rest of the flywheel, if you
have enough patients who are walkinginto the door of a hospital with a
navigator at their hip who's like, no,don't send me to the $8,000 MRI, you
know, I'm going over here and then allof a sudden hospital behavior starts
to change and the infrastructures andthe services purchased by that hospital
(20:13):
then therefore are going to align withthe asks of their customers who now
start thinking about things differently.
Jonathan Baran (20:20):
Yeah.
So these hospitals then begin torealize, so first off, we need hospitals.
They're an integral partof our healthcare system.
What we realize, or they realize thatthere's a giant opportunity to be
the hospital of the employers thatcharge fair rates for their services.
But then importantly, skip the middlemanbecause I would argue that self-funded
(20:41):
employers can be amazing customersbecause they can do a lot of things in
a self-funded construct to eliminatea lot of the administrative bloat that
hospital systems are saddled with today.
So the biggest thing that you would hearfrom hospital system executives is that
all the work that they have to do tojust drive the actual patient care is
(21:04):
what bogs them down as an organization.
Things like prior authorizationsbeing a great example.
Well guess what?
When there are employers that areworking with healthcare organizations
that offer fair prices, we've seen manythat waive things like pre-auths or they
will do things like pay for healthcare,literally at the time of service.
(21:25):
This is a lot what MarkCuban talks about, right?
It's crazy that we think healthcareproviders should hold risk and not
get paid for their services for30, 60, 90 days after the fact.
And these are the things thatself-insured employers can do.
They can pay for healthcare at the dayof service, at the time of service.
And if you think about what that coulddo to the hospital cost structure, where
(21:49):
you are eliminating tons and tons of workthat either comes in the form of chasing
prior authorizations, chasing bills,dealing with denials, all of these things,
think about the administrative bloatthat we could remove from the system if
we had hospitals and employers workingmuch closer together than they are today.
Stacey Richter (22:06):
And we do have a couple of shows coming up about direct
contracting and just managing that.
But I think the main point, if you'vegot enough middle people in the middle
of a transaction, just whatever theirprofit margins are of those middle
people, you can just cut that out.
Uh, if, if there's some direct, andI'm not certainly saying that all
of the services offered there areunnecessary, but there's certainly a
(22:30):
better way to do it where the value ofwhat they're doing is designed to accrue
to members and patients as opposed toshareholders of those organizations.
So could be very, very mucha task with a similar name.
But with a goal, which is truly a comingtogether of the purchaser and the clinical
(22:51):
organization without another perverseincentive kind of mixing around there.
Jonathan Baran (22:56):
That then leads us to the last stop on our journey, which
is back to the medical record systems.
So now realizing that the hospitalshave changed their thinking around this.
And doing as they often do, whichis listen to their customers.
They would realize that nowthe incentive structure is such
that it's all about getting goodvalue for that healthcare dollar.
(23:19):
So those medical record systemswould orient around becoming
an operating system of value.
They would give patients and providers,the tools to navigate, coordinate, get
the best value for the healthcare dollar.
And this could then ultimately createa structure whereby like the people,
the providers who are actuallyreferring for the care or prescribing
(23:42):
for the care, understand the cost.
Patients do as well, they understandtheir options and we're, we're in a spot
where value becomes the overwhelminggoal as opposed to lock in and extracting
dollars from the same organization.
Stacey Richter (23:55):
And just on that point, I was just reading a post by
Dr. Ramy Khalil the other day, whowas talking about medical record
systems and one of the things that Dr.Khalil was saying is interoperability.
Is a technical problem is false.
So like the last stop on the chain mightactually be easier than we think because
(24:17):
as he says, you have everybody blamingthe tag, but it's actually not a techno.
There's been the technical capabilityfor many, many years to do many,
many things which are required andnecessary in the healthcare system.
There's also the policy scaffoldingto put all this together.
i.e. the, some of the interoperabilitylaws that have come together.
(24:38):
But yet, oddly, the tech isn'tbeing deployed in this way
because of the incentives.
So flip the incentives and thetechnology is probably already there.
It's just you know, whoever'sgot the data, has got the power.
And so you can definitely see why even ifthere's ability to share, there's every
incentive not to in the current regime.
Jonathan Baran (24:59):
So this is where it's, again, may be viewed as idealistic.
It may be extremely optimistic,but at the end of the day, it comes
down to the employers putting theirmoney where their mouth is and
beginning to drive volume differently.
Because if they do that, there's a wholehost of, at least how I framed it here,
(25:21):
particularly fortuitous things that happenas a result of it that could begin to
change, at least slow down the spinningof this flywheel so we could get to the
spot for some of these better outcomesmight begin to fall out as a result of it.
Stacey Richter (25:34):
Understood.
So Jonathan Baran, tellme about Self Fund Health.
Jonathan Baran (25:38):
Self Fund Health is one of those new age health plans that we
have started here in the Upper Midwestto help bring the complexity of all
this together in a way that's easy tounderstand for employers and brokers.
Because that's our belief is thatthe single biggest challenge that's
preventing real change, particularlyamongst the employers and brokers
(26:00):
is this is really complicated.
And so our job is to makethat as simple as possible.
Offer a plan for employers tobegin to go down this path with
their EBCs and with their brokers.
Stacey Richter (26:10):
So I'm assuming somebody buys the Self Fund Health
plan, you're gonna get primarycare, you're gonna get navigation.
You're going to get a benefit designsolution, which is more aligned with
the actual prices that we're payingfor things as opposed to this whole
crazy buying discounts business.
Jonathan Baran (26:27):
You got it.
And look, we are farfrom the only solution.
There's a lot of solutions outhere to this problem, and everyone
that's listening in my opinion,has an opportunity to either.
Begin to break theflywheel or continue it.
But oftentimes we still hear this islike, I think a lot of employers hear
what we're saying and they say, youknow, yeah, all this sounds great,
(26:50):
but we're just not ready for it.
We're not ready to make the leap.
We're not ready to make the jump intothis, whatever this new world looks like.
And it somehow feels like the statusquo is the safer of the two options.
But the question that we alwayspose is like, based upon everything
that we've talked about today.
If the status quo guaranteeshigher costs and less control,
(27:12):
is it really the safer option?
Is this really the path that's going tolead towards any sort of improvement?
Is the status quo going to get uswhere we desire with healthcare,
which is lower cost, higher quality,or are we delaying the inevitable?
And, um, it's ultimately gonna comedown to the employers taking action and
(27:32):
beginning to do something differentlyif we want this whole loop to change.
Stacey Richter (27:36):
So I, I love how you're saying it, that there is an
opportunity to break the flywheel here,and I think probably one of the first
acknowledgements, it sounds like a 12step program, um, when I'm about to say
this, but just like, I think we all needto recognize that we are on this flywheel.
I think anybody that works fora healthcare organization is
like, yep, we're on the flywheel.
(27:56):
But I think maybe it's a revelationfor some employers that they are too.
You are too, right?
Self Fund Health is one of those entitieswho's like, let's just do this right.
Let's focus on the right issue, whichis better member health, which should
be in the middle of that flywheel.
There's plenty of examples ofpeople doing many of the things
that you're talking about.
I was just talking to Candace Shafferfrom Purdue University who was doing
(28:18):
many of the things that you're talkingabout and the healthcare costs went down.
There's plenty of examples in the, in theMidwest, especially like the Midwest is
really a hotbed of some very innovative.
Activities relative toswitching around that flywheel.
Jonathan Baran, thank you so muchfor being on Relentless Health Value.
Jonathan Baran (28:34):
Thank you, Stacey.
Tom Nash (28:35):
Hi, this is Tom Nash, editor and producer of the
Relentless Health Value Podcast.
I bet you're wondering, how canI help Relentless Health Value?
Well, that's pretty easy.
Have you signed up for the newsletter?
The newsletter is great.
It tells you when eachepisode's coming out.
It gives you an introduction to theepisode with all the mention links.
And a way to click throughand listen to the podcast.
(28:55):
But there's more ways to help.
You can always go over to LinkedIn.
Are you following the page?
You should be.
There's great conversationseach week on all the episodes.
So go to LinkedIn, find the RelentlessHealth Value page and follow us.
Have you ever left a review forus on Apple Podcast or Spotify?
That would help greatly?
While you're doing that, be sureyou're following the podcast so
you get notified each week insideof Apple Podcasts or Spotify.
(29:18):
Okay, so you've done allthose things already.
That's great.
Another thing you could do, you could headover to our website and donate to the tip
jar, maybe become a sustaining member.
In many ways, RelentlessHealth runs like an unofficial
nonprofit, a very, very nonprofit.
So anything that you givewould help us pay the bills.
Thanks so much for listening.
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