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Stacey Richter (00:00):
Episode 487 Part Two.
"Kevin Lyons Shares What He Learnedin Detective Training That He Uses
to Follow the Healthcare Dollar."
Tom Nash (00:17):
American Healthcare
Entrepreneurs and Executives
You Want to Know, Talking.
Relentlessly Seeking Value.
Stacey Richter (00:25):
In Part One of this
episode, we explored the barriers to
stopping the flywheel that is driving uphealthcare costs for the public sector.
In short, and you really should go backand listen to the first part of this
episode, but if you didn't these barriersare number one, profit defends profit.
In other words, if you have legislaturesin charge of the contracts that are
(00:50):
being awarded to carriers and PBMs andpoint solutions and consultants, et
cetera, which is how it works in manystates, and if these aforementioned
entities make a lot of money, now theyhave a lot of money to make campaign
contributions to the legislatures incharge of their contracts and also lobby.
You have a lot of money, you canbuy a lot of influence, in short.
(01:12):
The second barrier discussed in partone is when public entities like states
or et cetera, don't have unconflictedexperts on their side of the table.
That's a problem.
As you and me, we know very well.
You're listening to this show,so this is totally self-evident.
There is just no way without hearing,for example, episodes with Vivian
Ho or Dr. Eric Bricker, JonathanBaran, Cora Opsahl, Mark Cuban.
(01:36):
Just think about the kind of insight yougotta have if you are sitting on the other
side of a table from a TPA or whoeverwho tells you something like, You cannot
have your data because dot, dot, dot, orno, you can't put in that maternity or
doula program because we have a contractand it's impossible and dot, dot, dot.
Or, it's fine if we audit ourselves anddo our own payment integrity program.
(02:00):
We have a great branch of our owncompany who does this, and it's
totally not a conflict of interest.
Pinky swear.
Imagine if you didn't havethe information that you, who
listens to the show probably do.
And it sort of comes at no surpriseif you think about it in this light,
the wildly escalating prices that somestate and even federal plans have.
(02:20):
And this is hard, complicated stuff,and it takes years to figure out.
But think about this.
The state of New Jersey that isin 2026 gonna spend $3.5 billion.
There is no, among other things, medicaldirector who works for the state.
So there's just a lack ofunconflicted experts with a
four real seat at the table.
That is our number two barrier.
(02:41):
And then the third barrier, it's kindof an offshoot of profit defends profit.
What profit also does is influence themedia when the media's biggest advertisers
are often the healthcare industry,how are legislatures and taxpayers
and even public employees themselves,how are they gonna get the real story?
Okay, so that was part one.
In the conversation that follows withKevin Lyons, he shares some of the skills
(03:05):
that he learned in detective trainingto deduce what is going on with his
healthcare dollars being spent by andon behalf of his union members, where
those dollars are disappearing to.
What he writes in that little detectivenotebook, I'm imagining he still
carries around to this very day.
So with that, here is the advice portionof my conversation with Kevin Lyons.
(03:28):
Kevin is a former police detectiveand current executive director,
law enforcement, labor employeebenefits at the New Jersey State,
PBA, Police Benevolence Association.
My name is Stacey Richter.
This podcast is sponsoredby Aventria Health Group.
Kevin Lyons, welcome toRelentless Health Value.
Kevin Lyons (03:47):
Hello, Stacey.
It's really awesome to be here.
I, I'm really excited about this.
Thank you for asking me to come on.
Stacey Richter (03:52):
Let's get to the
advice as a former detective, delving
into this really opaque, complicated,there's 20 narratives going on, and
I'm picturing you with your notepad.
What do you write down?
How do you, how do you approach thiskind of quagmire as a former detective?
What's your advice?
Kevin Lyons (04:12):
So two of the, the best
classes I took when I was a cop were
statement analysis and facial recognition,so seeing little ticks in people's faces
and, and really interesting stuff, right?
That's like the TV stuff thateverybody likes to see, you know?
But statement analysis, to me, ifyou're prepared and you ask the right
questions, that gives everything away.
What I've seen is that when we'regetting a presentation from, a TPA
(04:37):
or a vendor, I, nobody in particular,you start asking the questions.
Well, the bad guys leaveholes in their statement.
Or they don't answer thatquestion, they'll sidestep it.
So what I've seen, especially from TPAs,is that they'll sidestep it, sidestep,
and then you ask it a different way.
Then all of a sudden you get the answer.
It's proprietary at theend of the day, right?
(04:59):
Oh, that's proprietary.
We can't tell you.
Well, there's only onereason you hide something.
Now they'll say it's corporate tradesecrets and all the other stuff that's BS.
The reason is they don'twant to give you the answer.
What that is, that's a flag, right?
That's where you wanna follow.
So when you see that omission thatlie by omission or that avoidance,
that's where you're gonna go.
But the important part to that, andlemme say this again, is that be
(05:21):
prepared when you go in, when you seethat you're getting a presentation from
so and so, you know, whatever company,company ABC, then do your homework.
You know, if you just go inthere and if you're just filling
a seat, don't waste anybody'stime, but just follow their path.
You know, try and win them over.
And then well, what about this?
Stacey Richter (05:40):
You said statement
analysis and what you're looking
for there, what I'm hearing isprobably most often not what they're
saying, but what they're not saying.
Kevin Lyons (05:48):
Yes.
Without question.
Stacey Richter (05:50):
Yes.
So you're digging in there, you'reasking the why five times I've, I've
heard people say, right, like, you'rereally hammering, trying to circle the
wagons around what the unknown unknownis to quote Norman Schwartzkoff, right?
Because you don't know what the unknownis at the very beginning, but if you ask
enough questions, you probably can startdrilling in on what is being unsaid.
(06:15):
And as you just said, probably what'sgonna happen at that point if you start
asking and poking the bear, they'regonna say, oh, it's proprietary.
Once they start saying that, though,you know, now you at least have in your
view finder what they're not tellingyou, and you are better equipped than
to try to figure out where the money is.
Like you just found a honeypot and atleast you know there's one that exists.
Kevin Lyons (06:40):
That, that's exactly it.
Because if you go there andit's like putting in an OPRA
or a FOIA request, right?
If you don't word it justright, they're gonna say, Oh,
we don't have to answer that.
You have to get everything worded right.
But if they're not just answeringyou at the beginning, they're just
not answering you at the beginning,in that case with what we're talking
about, yeah, the missing piece,X marks a spot in my experience.
Chris Deacon (07:05):
Hi, I'm Chris
Deacon with Verson Consulting.
If you're listening to RelentlessHealth Value, we already have
something important in common.
You care about fixingwhat's broken in healthcare.
This isn't just a podcast I tune into.
It's one that I revisit reflecton and highly recommend.
Stacey's conversationsdon't stop at the mic.
They spark ideas, challengeassumptions, and fuel the work so many
(07:28):
of us are doing to fix healthcare.
If you're here for real change,you're in the right place.
Subscribe to the podcast, signup for the newsletter, and
let's keep the momentum going.
Thanks for listening.
Stacey Richter (07:40):
So you've got the
statement analysis, you've got watching
them, asking a lot of questions, followingthe money through those questions
to figure out where the dollars are.
Where there might be indirect payments.
Where there might be.
And even if you don't get the details onthat, you know now that it exists, like
someone just pleaded the fifth, right?
Kevin Lyons (07:58):
Right.
That's exactly what it is.
I was gonna say that same thing, isthat when, I know the Fifth Amendment's
a constitutional right, not to testifyagainst yourself, but if people aren't
guilty, they don't plead the fifth.
That's kind of the trigger I useand people may not like hearing
that from a former cop, but that'sreally one of the tools we have.
Then it's my job to go find it after that.
(08:20):
If you're not gonna tell me whathappened, then it's my job to go find it.
Stacey Richter (08:23):
And that's,
that's the responsibility that
you're taking upon yourself.
And I think, again, it's probably abig differentiator between those in
government or those at unions whoare really courageous and persistent,
Relentless, if you will, enough torecognize or count as part of their
(08:43):
responsibility and accountabilityto go chasing down those answers.
Which the lovely vendor who just took youout to lunch does not want you to find.
Kevin Lyons (08:53):
That's exactly it.
Yeah.
You just have, you'd have tokeep pushing and going forward.
Stacey Richter (08:57):
If I was gonna just
say in sum, what are the lessons that
you may want those who may also be insimilar positions in government to hear?
Kevin Lyons (09:08):
I think you have to be
fearless and speak truth to power.
You have to keep pushing.
You know, they're gonnatry and push you off.
They're gonna distract you.
They're gonna try and look over here.
You know, there's don't, there'sno man behind the curtain, right?
I think you, you have to educateyour members by putting out as
much information as you can.
You have to continue to do that, and mostimportantly, you have to follow the money.
(09:31):
And then you, you're readywhen the moment comes.
Never let a good crisis go to waste.
That's what I'm hopinghappens here in New Jersey.
I hope it wakes the people up.
I hope it wakes the electedofficials up that, Hey, we've
been telling you this is coming.
We've been warning you nowthe day of reckonings here.
Don't think you're just gonna pushthe cost onto us when we told you,
because you can't plead the fifthanymore because I know I told you.
(09:53):
So I think of those scenarios we haveto try and be ready to move forward.
Stacey Richter (09:57):
Yeah.
Right.
Like at a certain point, some teacher'sassistant is gonna get their paycheck and
be like, oh, you owe us, their salary isgonna be a negative because their health
benefits are higher than their salary.
I mean, like seriously, if you'retalking about 37% rate increases and
it's already a thousand dollars amonth, this is not something that,
(10:19):
there's not an unlimited money pit thatpublic employees sort of have here.
Kevin Lyons (10:23):
Yeah, there's a, there's
that graph on LinkedIn that shows,
that KFF put out, that says theaverage family's plan is $25,000.
Now that's just my member'scontribution next year.
That's just the, their contribution.
The towns still have to paythe other, the other share.
So it is just, when is enough enough.
Stacey Richter (10:42):
Point being the total cost
to the state of a family plan is $67,000.
So if the teachers and firefightersand police officers and everybody
else pay $25,000 or so, the townsand state are still picking up
42k if I just did the math right.
Kevin Lyons (10:58):
You know, when when
are you gonna start listening and
stop saying they don't understand.
That's the constant answerwe get from the other side.
They don't understand.
Well, I'm here to tellyou and I hope to hear me.
We do understand.
Stacey Richter (11:08):
Yeah, for sure.
And and especially if you'readvocating for like, Hey, this
is how we can do this smarter.
The answer isn't throwingmoney, it's just you.
You just start saying it and it justsounds as ridiculous as it is, right?
Like, oh, the answers to our problemis to just throw more money at
the people who want more money.
Kevin Lyons (11:23):
And we bring solutions
members, they're gonna get better
care, but it's gonna be a change in theway healthcare is delivered to them.
And the people for the state, thepeople for management are telling
us, oh, that's too disruptive.
You can't do that.
Your members aren't gonna like it.
That's my job.
That's not your job.
Stacey Richter (11:39):
Claire Brockbank from
the 32BJ, was on this pod and said very
specifically, she said, that's her tellyou were talking about some of your tells.
Her tell is if someone brings up theD word, the disruption word, like
that's how people have been probablyin some manual, how do you shut down
anyone who's fighting the status quo,just bust out the D word and then
(12:00):
everybody goes hides in a corner, right?
Like that's a power word.
The the disruption word.
And I think at this juncture,people have learned to deploy it.
If they wanna shut people down.
Kevin Lyons (12:11):
It's just,
Stacey Richter (12:12):
It's laughable, right?
It's not funny.
But it's laughable.
Kevin Lyons, is there anythingI neglected to ask you that you
wanna bring up at this time?
Kevin Lyons (12:20):
Well, what I would like
to say is I am eternally grateful for
the leaders like you in this space.
You, Chris, Susan Hayes,Cynthia Fisher, Justin, Cora.
The people that have takenme under their wings, it's
benefited my members immensely.
You know, the New Jersey StatePBA represents 33,000 members.
I'm proud to serve them and I justreally hope that they start getting
(12:44):
into the weeds on this because oncethey're incensed, there's no stopping us.
But I'm just more gratefulthan anything else.
Stacey Richter (12:51):
Well, I could
not appreciate that more.
And besides Susan Hayes andCynthia Fisher, it was Chris
Deacon, Justin Leader, andCora Opsahl that you mentioned.
Who might go by first names onlylike Cher or Madonna at this point.
But just for the record.
Kevin Lyons, thank you so much forbeing on Relentless Health Value today.
Kevin Lyons (13:09):
Thank you.
Tom Nash (13:10):
Hi, this is Tom Nash, editor
and producer of the RHV Podcast.
You've probably heard me say thispodcast is sponsored by Aventria
Health Group, and that's true,but there's more to the story.
Aventria is our day job, and the peoplethat make this show happen are Aventria
employees generously donating their timeand talent on top of everything else
they do to get each episode out the door.
So, yes, Aventria underwrites theproduction, but in many ways, Relentless
(13:33):
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Aside from the occasional and deeplyappreciated episode sponsor and our
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If you wanna keep this podcast independentand laser focused on educating,
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(13:57):
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