July 8, 2025 • 28 mins
In this episode of ShiftShapers, host David A. Saltzman welcomes Dave Chase, co-founder of Health Rosetta, a movement that has become a national force in transforming employer-sponsored healthcare.
Dave shares the deeply personal story that drove him to create Health Rosetta and the powerful framework that emerged—one focused on transparency, outcomes, and economic sustainability.
The conversation explores how Health Rosetta empowers benefit advisors and employers to break free from the traditional health plan model, the crucial role of data access, and the open-source tools now available through Nautilus Health Institute. Dave also unveils the evolution of RosettaFest from an internal network event into the premier gathering for high-performance health plan innovators across the country.
👉 Join RosettaFest 2025 in Denver: https://rosettafest.org/
👉 Explore open-source tools from Nautilus Health: https://www.nautilushealth.org/
🤖 Sponsored by BenePower
BenePower is an AI-powered platform helping advisors build high-impact, self-insured health plans quickly and seamlessly. By integrating best-in-class point solutions and eliminating inefficiencies, BenePower reduces costs, improves member outcomes, and positions advisors as industry leaders.
🔗 Learn more at BenePower.com
🔑 Key Takeaways from This Episode
📌 A Personal Tragedy Sparked a Movement
A system failure that devastated a friend’s life inspired Dave Chase to create a new framework for health plans.
📌 It All Starts with the Health Plan Contract
Perverse incentives and system dysfunction stem from opaque, outdated plan contracts—Health Rosetta sets a new standard.
📌 Training a New Class of Benefit Professionals
Health Rosetta focuses on empowering benefit advisors with the tools and standards to drive measurable change.
📌 The TPA, PBM, and Hospital Contracts Matter Most
Dave breaks down the three most critical contracts and how employers can renegotiate smarter, data-driven deals.
📌 Nautilus Health Is Open-Sourcing the Playbook
With $4M+ of legal, contracting, and tech investment, Health Rosetta is giving away the tools others would keep locked up.
📌 Unfettered Data Access Is a Game Changer
Claims transparency isn’t optional anymore—especially under the Consolidated Appropriations Act.
📌 RosettaFest Is the Epicenter for Innovation
Once closed-door, RosettaFest now brings together employers, advisors, clinicians, and tech innovators for radical collaboration.
⏱️ In This Episode
- 00:00 Introduction to Health Rosetta
- 01:02 Founding Story and Inspiration
- 02:11 Building the Framework and Ecosystem
- 08:28 Challenges and Pushbacks
- 16:08 New Developments and Future Plans
26:20 Conclusion and Final Thoughts
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Health Rosetta was founded in 2016 to create a
framework and an ecosystem aimedat transforming the US
healthcare system.
What's happened since then isamazing, but what's next for the
group?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:17):
Change either energizes or paralyzes.
The choice is yours.
Paralyzes the choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industry'sshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:38):
And to help us answer that question, we invited Dave
Chase, a prominent voice onhealthcare reform and co-founder
of Health Rosetta.
Welcome, Dave.
Speaker 3 (00:48):
Thanks so much for having me on.
I listen to every one of yourepisodes, and so it's a real
honor to finally be on.
Speaker 1 (00:54):
Well, thank you, that's very kind of you.
We're here to talk about HealthRosetta and all the cool things
that have happened and all thecool things that are happening.
So let's go in the WaybackMachine for a few minutes and
let's talk about what theimpetus was for founding Health
Rosetta.
Speaker 3 (01:10):
How did you get there ?
Yeah, it's really started witha personal deal where I was in
health care from a health techstandpoint, but it was basically
a system failure, is theshorthand, for what happened to
a friend of mine Wasn't a baddoctor, wasn't bad people, it
was a system failure and it wassomething that was brutal to
watch.
She was destroyed physically,mentally, financially, leaving
(01:36):
behind a 10-year-old daughter,and I'm one who tries to find
meaning in sad situations.
Why this was why we're all.
I certainly was aware of someperverse incentives in
healthcare, and when I did that,it became very clear that
there's no accident that allthese things that we tend to
complain about they're sittingin the most boring thing you
(01:58):
could imagine health plancontracts and health plans
really govern everything inhealthcare contracts and health
plans really govern everythingin healthcare.
And so it was with that of,okay, that's important to know
what do you do about it.
And so I ended up basicallystudying social movements and
revolutions and big new productcategory things like smartphones
(02:19):
to pull out lessons that wecould draw in, and probably the
one I used the most was with theUS Green Building Council LEED
standards, because the builtenvironment to me is kind of
like healthcare.
It's this very local, veryentrenched thing.
It's not like there was someday where all the old polluting,
inefficient, bad air buildingsgot raised and the next day
(02:41):
they're all magically green,built and better efficiency and
all that kind of thing.
And while no analogy is perfect, there was some lessons to be
learned there.
They trained professionals likearchitects to design buildings
with this new framework and thenthey certified buildings and
created a market demand.
And I thought there was somereally good analogies and put my
(03:02):
head together with some otherfolks and said healthcare goes
through major shifts every 50 to70 years.
It's overdue.
And we've certainly said for along time this isn't sustainable
.
And it was kind of funny.
I had written about directprimary care.
I actually wrote the seminalpaper on direct primary care
before this and some people ranwith it and I'd met a bunch of
(03:26):
doctors like oh, I left myfee-for-service hellscape and
went into direct primary carebecause your article was like
cool and I thought that's whatwould happen with Health,
rosetta, I just write about thisconcept and people would go do
it.
And then they're like no, youshould do it.
I'm like no, you should do it.
And eventually it's like okay,actually, the things that it
(03:47):
would take to pull off somethingthis audacious right.
What we're trying to do ispretty audacious.
Maybe we'll prove to bedelusional, but somebody's got
to give it a shot and weactually have some of the skills
in our team to do that.
And the old saying the two mostimportant days of your life are
the day you're born, the dayyou figure out why it really
(04:10):
became my, why and as Iunderstood the extent of the
damage, but the amazing thingsthat could happen when you got
it right.
And that is what keeps me goingevery day.
Speaker 1 (04:24):
So, from 10,000 feet as you started to build this
organization, what were thethings, the more tangible things
that you focused on?
What came first?
Chicken, egg, chicken and eggColonel.
Speaker 3 (04:34):
Sanders.
Speaker 1 (04:35):
What was the progression like?
Speaker 3 (04:36):
Yeah, I'm trying to remember when I wrote it, but it
was probably 2013, 2014.
I had written a piece in Forbeswhen I was doing writing for
them.
It was called this.
The headline was this job couldsave America.
I was talking about benefitconsultants, benefit brokers,
and it was like these people arethe most underestimated people
in the entire health care systemprobably the entire economy and
(04:58):
when they're at their best,they're incredibly impactful.
Incredibly impactful and Irealized the in air quotes.
The architects of health plansare these benefit brokers, these
benefit professionals, and Ilooked at how do you do this?
And certainly people areproblem solvers everywhere.
Somebody's cracked the code andthat's when I found Rose and
Hotels.
(05:18):
I found people like Scott Haaswho'd been doing it.
There were people, maybeagainst their own economic
interests, who were doingamazing things.
That kind of became thistemplate, actually wrote about
David Contorno and sort ofstarted getting enmeshed in that
benefit consultant communitywhich I, frankly, barely even
knew existed for a while, andsaid, if we take the best of the
(05:43):
best and train other people onit and then make it easier to
actually do what they're doing,we'd be onto something, because
the difference between what'shappening in many of the health
plans in America, where they'rereally not getting the job done.
Given the amount of money thatwe're spending, versus the ones
(06:05):
like a Rosen.
It's like practically dystopiaversus utopia.
Right?
This is just a marketingproblem, right?
Who wouldn't want that?
Of course, it's a toughmarketing challenge.
So, yeah, we thought the tip ofthe spear has got to be the
benefit consultant, benefit,advisor, whatever moniker you
want to put on it.
They have the trustedrelationships with the biggest
(06:26):
category of how people gethealthcare in America employers
and unions and so I've beenwriting about some of this stuff
, and there's this concept oflean startup where, like, just
put out ideas, maybe you runGoogle ads and see if anybody
responds to it, even maybebefore you built anything.
And so we're well, I'm comingout with this book, and that was
(06:46):
like Labor Day 2017.
Let's see if anybody wouldactually want to do this, sign
up for this advisor program and,happily, within two months, we
had more people raise their handthan we thought we'd get in
maybe two years.
And we're like, oh boy, webetter build this thing.
And so we started diving in.
And then one thing led toanother and it became're like,
oh boy, we better build thisthing.
And so we started diving in andthen one thing led to another
and it became clear that, oh, ifyou're going to basically say
(07:13):
an entirely new industry supplychain needs to emerge, like
that's a big statement, ofcourse there's no technology
infrastructure for that.
No software startup guy wouldever build for a market of five
employers or whatever it was atthe time.
But being very mission oriented, like, okay, we're going to
build that because, while theseplans are very impactful, it's
(07:39):
too much work to do that it's.
It will be the year 3000 beforeeverybody gets to these things.
And so that sort of was thereally third kind of leg of the
table.
Like it was like, okay,framework, ecosystem platform to
lower that burden, and thenwe'll talk about the fourth leg
(08:00):
to that table, I'm sure, later.
But that got us, got us prettyfar and happily, where there
were five successes that thathad sustained themselves for a
long period of time.
So you couldn't get lucky ifyou've been doing it 10 or 20
years.
We have thousands now and soit's pretty hard to get lucky
over many years all over thecountry, thousands of times.
(08:20):
And so then we felt like, okay,we're at the kind of next
inflection point on what needsto happen in the industry.
Speaker 1 (08:28):
They often say that you can tell who the pioneers
are because they're the oneswith the arrows sticking out of
them.
Did you guys get any pushback?
Speaker 3 (08:35):
Oh my gosh.
Yeah, I mean, and it's just.
There's pushback for sure, butit's just hard work, let's just
face it.
This is hard, but it's justhard work, let's just face it.
This is hard, hard work, and weget kicked in the teeth all the
time.
And there's a very insightfulwoman in the tech industry named
Esther Dyson, and she has aquote that I like always make
(08:59):
new mistakes and we made plentyof mistakes.
Our communities made plenty ofmistakes.
We tend not to repeat them, andif you just get a little less
stupid every day, you get mildlysmart over time, and the bar is
pretty low.
Somebody said the bar is so lowa snake could jump over in
terms of some of the currentbehaviors.
(09:19):
And one thing led to another.
We launched with this idea of ofwe should be like financial
services, where there's fulldisclosure of direct and
indirect compensation, likethat's what a professional
industry does, and it's the sameregulatory environment in terms
of retirement part of it, and abunch of people signed up for
(09:43):
that, and then it became thetemplate for the Consolidated
Appropriations Act, which is areal, and there's a few other
things that are really importantin that that, as we did get to
the next level because we reallywent in with a beginner's mind
we were in healthcare but nothealth plans.
Fortunately, we've alignedourselves with a lot of really
bright people who've really doneit well, and we've never
(10:03):
claimed to have inventedanything.
I mean, I joked, I'm anarchaeologist.
I could just go dig around forhealthcare's Rosetta Stone to
decode this indecipherablesystem and if we make sense out
of that, make it easy.
It's basically repeatabilityand verifiability is what we do,
like how do we make it a loteasier to repeat these things
and then verifying that it'sactually working, and so that's
(10:25):
been a real game changer interms of accelerating the whole
movement.
Speaker 1 (10:33):
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And now back to our conversation.
You know, I wonder if we aren'tabout to come upon another
tipping point, another hugeinflection point.
Arguably.
The system's been broken for along time, although jokingly, I
(12:24):
always tell people it's notbroken.
It's working exactly the way itwas designed.
That's the problem.
But Obamacare broke a lot ofstuff that needed to be broken.
It caused a complete turnaroundin the self-funded market.
I mean, when I was a TPA, ifyou told me that we were going
to self-fund a group of 14, Iwould have thrown you out the
window, and if I didn't do it,the stop-loss carriers would
(12:45):
have done it.
And now it's kind of a prettymuch fair game.
But I'm watching all of theconversation going on around HB1
and some of the changes thatit's going to make, assuming
that they get through thereconciliation process.
As we record this, that stufflooks like it's a few days away
and kind of coupled that with asecond wheel that's running,
which is this malarkey?
That people are starting tofight against carriers that are
(13:07):
dropping commissions.
And I've wondered for a longtime, why would you want to be
part of a system that pays bycommission?
It just seems kind of likeyou're not in control and I
think I wonder do you think thatthese things are all starting
to come together so that we'remaybe about to take a kind of
another big step.
Speaker 3 (13:24):
Yeah, absolutely, and I couldn't agree more.
When I learned there was peoplewhere their earnings maybe 30,
40% of their earnings could getripped away in 30 days by a
carrier if they weren't happy,it's like, oh my God, I could
never work in that, have thatsort of damocles sort of hanging
over, and so yes, and then Iwould also say maybe an
(13:46):
underestimated.
Another driver of thatinflection point is look at the
makeup of the workforce.
Look at the makeup of theworkforce.
Today it's about 70% aremillennials and Gen Z, 70% right
.
And you know, to my earlierpoint, like we're overdue for a
big shift.
I mean, the current healthplans are really just
(14:07):
descendants of what was builtfor the greatest generation and
boomers.
Guess what Things change?
They evolve.
We have different challenges.
That was more acute conditionfocused.
This is now more about chronicdisease and mental health.
And you look at the oldestmillennials they're mid-40s now.
They're in decision-makingauthority and guess what
(14:30):
Generations have differentexpectations.
And the oldest millennials,they're kind of in that sandwich
generation.
They have kids, most likely,undoubtedly have elderly parents
that are aging, and so they'renow paying attention to factor.
That's this there's.
And the lawsuits, right, thelawsuits that have come out
(14:50):
against J&J and JP Morgan.
If you look in the retirementspace, there's up to 200 suits a
year on the retirement spaceand so, love it or hate it, it
definitely has changed thedynamic for employers on the
(15:13):
401k, 403b side and I think thatthat is like the first waves
are just starting to crash, butit is a tsunami that's going to
have a huge ripple effect.
Speaker 1 (15:24):
And yet it started in 1975 because that was
ostensibly the reason for ERISAin the first place.
But now we've got so manypeople, so many health plans
that are subject to ERISA thatit's a target rich environment.
And I read someplace that thefirm that is doing most of the
early suing is the same firmthat started doing all the suing
with the tobacco legislation.
(15:46):
It's just scary.
It's also scary absent.
Maybe you know your cohort anda couple of others around the
country.
Advisors aren't talking aboutfiduciary responsibility and how
you manage that, and I thinkthat's also, you know, going to
heat up.
But it is an interesting newuniverse and things are
(16:06):
definitely changing.
Things are changing with Health, rosetta, too, and I know
there's some new stuff on thehorizon and you've been nice
enough to share that with me.
Would you share it kind of withthe audience, what's happening?
Speaker 3 (16:17):
Yeah, I mean the idea really from day one was if we
could prove this is actuallybetter and as I studied
different industry ecosystemshifts some I'd been a part of
it really is.
There's three things that arereally critical.
One you got to have proof yourthing is better, ideally 10x
(16:39):
better than the status quo.
Number two and this is wherewe're really getting into now is
you got to have standards tolower the barriers to adopt the
tool.
And then three, you got toeducate the market on it.
And so the idea was if we couldprove that with that whole
repeatability verify, then asmuch as we want to have success,
we are a for-profit company,we're a public benefit
(17:00):
corporation, so that means youcan have a social purpose and a
shareholder purpose.
But the idea is, even if we're10x our wildest dreams, we'll be
far from 100% of the market.
Our wildest dreams will be farfrom 100% of the market If you
want to pull off something likean entirely new industry supply
chain and new norms and again,you don't have to like dream
(17:22):
this stuff up.
It's happened in otherindustries, certainly saw a lot
in tech, but really in financialservices, like interest swaps,
the transaction costs have gonedown 97.5% because of
established industry standards.
So we said what we learned wasthe secret sauce to
(17:43):
repeatability was this virtuouscycle.
The right procurementmethodologies will lead to
number two the best contracts tocodify that.
Number three prove it in datarinse and repeat.
I mean you might have a goodcontract but whether it's an
honest mistake or malfeasancedoesn't mean they're going to
(18:03):
adhere to it.
And on the data use so we havebasically taken what we've
learned through there's about10,000 employers collectively
stewarded by the Health ResetAdvisors.
There's 400 that we've workeddirectly with.
It's our performance lab.
So our Q4 is just as hellaciousas any other benefits
(18:25):
professional because we're inthe trenches with them and it
gives us a we don't want to beivory tower.
We're in the trenches, we'regetting kicked around and all
the difficult things that we'reactually pretty confident.
It's always hard, never takethings for granted, but if we
can then make that secret sauceavailable and the technology and
(18:46):
the data use that we actuallylearned, we came up with this
concept of a plan creator and wefound the 40 most important
questions to be predictive ofhigh-performance health plan,
because much of what healthcaredoes to me is driving down the
road looking at the river,mirror claims.
They're important and we reallydo believe claims are important
.
But there's things that thoseof us who've been in the
(19:10):
industry know that the high costclaimants drive the vast
majority of spend.
It's a small number and it'salways almost always different
people every year, right.
So knowing who had cancer lastyear or who had a heart attack
last year isn't going tonecessarily be that predictive
going forward.
Tufts University did a study ofthe.
(19:38):
Now we have 2,000, 3,000 plangrades.
The most predictive thing of ahigh-performance plan is full,
unfettered access to claim data.
That's actually codified in theConsolidated Appropriations Act
as a no-gag clause is thephraseology Okay, great, and
what we saw was okay.
This is not just about how somedata analytics and create some
pretty reports.
You need to have unfetteredaccess to the data.
(20:01):
We could go into why that is,but that is really critical.
And what we saw over and overwas different.
It might be an employer, butusually it might be a benefits
consulting firm, but mostcommonly like point solutionspas
that to do it well, to get inthat claims data, clean it up,
transform it, make it availableto other systems.
(20:23):
You easily would be into it fortwo to three million dollars,
because it's this combination oftech knowledge, tech capability
, with domain knowledge, andthat layer wasn't what some
diabetes solution wasdifferentiating on, but they
were in it.
If they did it well, two tothree million dollars.
So we're like, hey, we need it.
(20:44):
We actually partnered withanother organization.
We're going to build this thingfor ourselves, but then we're
going to make it available toeverybody and then they don't
have to build in that price formaking that big investment.
And so that's the tech piece ofNautilus Health Institute is we
call it METL for medical ETL.
(21:05):
Etl is a term in kind of dataland, of extract transform load,
so our acronym is METL withoutthe A.
And so we've open sourced thattech and so we now have seven
companies.
We launched that at our lastRosetta Fest back in September.
We launched that.
We have seven companies inproduction and this limited beta
(21:28):
, another 20 in evaluation,given the resources we have.
But we're changing that, we aregoing to, we're raising some
nonprofit dollars to supportthat level of infrastructure.
But it's really really critical.
And then you can havepredictability and these things
become budgetable, that we'resort of out of control spend.
(21:49):
So again, you had to if you gointo, say, our TPA field guide
and you would just get used andgo to our, the nautilushelporg
website, fill out a little form.
It's going to send you.
I tell people, look at the tpafield guide and you will see the
level of detail one needs tosweat to win here.
None of its rocket science, butit's a lot.
(22:12):
This is like it starts withlike a 64 page document, links
to like eight or 10 otherspreadsheets or documents,
contract language, procurementmethodologies, how to negotiate
these things, dah, dah, dah,that know-how, and so it's about
$4 million of investmentbetween the technology and
basically legal experts,essentially assembling the dream
(22:32):
team of risk attorneys andcontracting attorneys.
And you know, we battle, testedit with the 400 employers and
we're saying here it is, take itand run with it.
Now, health Reset Advisors youknow they had a five-year
headstart.
It's the stuff we've beentraining on but we had to prove
it worked.
You know we weren't going toopen source it five years ago
but now we're quite confident.
So we're starting to.
(22:53):
You know, come out in the PBMfield, and so we're starting to.
You know we're coming out witha PBM field guide at the next
Rosetta fence.
So that's a big body of work.
(23:15):
Of course that's you.
We have other fellow travelerslike Mark Cuban he's been vocal
about.
He's an employer too.
They're going to open sourcethe direct contracts they're
doing also in August, and sowe've spent quite a bit of time
with Mark's team.
They actually got a early lookat the TPA field guide when they
were going out to RFP, whenthey kind of changed who they
(23:36):
were working with.
So we're really excited aboutit.
And it's pretty shocking topeople who've been in the
industry because, like, wait asecond, you have this big
information demand.
You made all this investment.
Why are you giving that away?
Well, there's plenty ofcommercial opportunity beyond
that.
It's not like, okay, who'sgoing to verify those contracts?
Who's going to do the datawarehouse?
There's plenty of ways we canstill make money in a good,
(24:02):
ethical way, but if we're goingto level up the industry, you
can't do it without establishingnew standards, and that's one
of the things that you can seein financial services and
technology, and so it's justoverdue.
Healthcare is this weird $5trillion cottage industry the
way it's operated, and so we'retrying to change that.
Speaker 1 (24:18):
Yeah, it is a big, big lift.
Now.
You alluded to Rosetta Fest alittle while ago.
That's typically been membersonly it was until like 2022.
Speaker 3 (24:32):
We were in Denver, we had a little over 200 people.
It just was our community, andso that was basically benefit
advisors and then some of thesolutions that we work closely
with.
But then ultimately like, hey,this is a team sport, we can't
do it without clinical leaders.
We need the employers andunions, yes, we need the
advisors and we need thesolution and tech company.
And it was something where werealized, yeah, I call it
(24:54):
connective tissue, sean myco-founder calls it grout, like
the gaps between the companiesreally matter and you can go to
an event with a bunch oforthopedic surgeons or PTs or
health tech people or benefitsprofessionals, but having it all
together.
So then we opened it up andsaid all of that.
So if you look at, like lastyear, we it was pretty evenly
(25:16):
split.
We had about 250 employers andunions, about 250 benefits
advisors and consultants,including non-health Rosetta
ones were like hey, check us out.
Right, there's different myths,different gaps in knowledge.
Get a little taste of whatwe're about.
If it's your cup of tea,awesome.
If not, you'll get an eye outof the conference.
(25:36):
And then we had the clinicalleaders.
This year, the biggest DPC eventhas been the Hint Summit.
Hint Summit's actually part ofRosetta Fest.
We have a ton of DPC docs wehad a bunch last year and as
well as the direct specialtycare because they're really key
those surgery centers andimaging centers and all that and
then the solutions and techcompanies.
(25:56):
Right, we can't do it withoutTPS, we can't do it without PBMs
we can't, and so on, and soit's all those folks together.
So last year I think we had alittle over a thousand folks.
We'll probably have a similarnumber.
We're not trying to turn itinto a hundred thousand people,
but we really wanted to walk thetalk in terms of being more
open for saying walk the talk,in terms of being more open for
(26:16):
saying, hey, we need out ofthese open source standards.
How could you claim that andnot invite other people?
Speaker 1 (26:20):
Well, and we'll be sure to put a link in the show
notes so that folks who areinterested in checking out the
meeting and learning what youall are up to and all the new
stuff.
There's a tide in the affairsof men which, taken at the crest
, leads on to victory.
Shakespeare said it a long timeago.
I think that we're kind of atthat inflection point.
I may be out singing by myselfand looking like a lunatic, but
(26:42):
I think there's lots of myfriends who have finally figured
out that status quo just isn'tgoing to keep working, that it's
just not literally.
We've been saying it's notsustainable for a long time, but
it's kind of in a tagline Now.
It's really not sustainable anylonger and we've got you've got
chronic conditions, and thegood news on that is that what
used to kill us doesn't.
You know all kinds of differentthings, and predictive modeling
(27:03):
will start coming into its ownas well.
So instead of, as you pointedout, looking into that rearview
mirror all the time, we'll beable to look out the windshield.
Dave, a fascinatingconversation.
Thank you so much for sharingthis with us.
We look forward to touchingbase with you again soon and
kind of hearing how this allrolls out.
Speaker 3 (27:20):
Yeah, well, really again appreciate being on your
show, love it.
It's a real honor andappreciate you taking the time
to talk with me today.
Speaker 1 (27:28):
Thank you very much, dave Chase.
Co-founder of Health.
Rosetta, dave, we'll see you,maybe in Denver.
Awesome, in Denver, awesome.
I want to give a quick shoutout to our sponsor and our
producer, hatcher Media.
Hey, if you need podcastproduction or professional
graphic design, josh Hatcher isthe expert to contact For more
(27:55):
information.
Speaker 2 (27:56):
Visit him at hatchermedianet, that's
H-A-T-C-H-E-R media dot net.
This Shift Shapers podcast iscopyrighted content and may not
be reproduced in whole or inpart without the express written
permission of Shift ShapersSolutions LLC.
Copyright 2024.
Health Rosetta was founded in 2016 to create a
framework and an ecosystem aimedat transforming the US
healthcare system.
What's happened since then isamazing, but what's next for the
group?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:17):
Change either energizes or paralyzes.
The choice is yours.
Paralyzes the choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industry'sshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:38):
And to help us answer that question, we invited Dave
Chase, a prominent voice onhealthcare reform and co-founder
of Health Rosetta.
Welcome, Dave.
Speaker 3 (00:48):
Thanks so much for having me on.
I listen to every one of yourepisodes, and so it's a real
honor to finally be on.
Speaker 1 (00:54):
Well, thank you, that's very kind of you.
We're here to talk about HealthRosetta and all the cool things
that have happened and all thecool things that are happening.
So let's go in the WaybackMachine for a few minutes and
let's talk about what theimpetus was for founding Health
Rosetta.
Speaker 3 (01:10):
How did you get there ?
Yeah, it's really started witha personal deal where I was in
health care from a health techstandpoint, but it was basically
a system failure, is theshorthand, for what happened to
a friend of mine Wasn't a baddoctor, wasn't bad people, it
was a system failure and it wassomething that was brutal to
watch.
She was destroyed physically,mentally, financially, leaving
(01:36):
behind a 10-year-old daughter,and I'm one who tries to find
meaning in sad situations.
Why this was why we're all.
I certainly was aware of someperverse incentives in
healthcare, and when I did that,it became very clear that
there's no accident that allthese things that we tend to
complain about they're sittingin the most boring thing you
(01:58):
could imagine health plancontracts and health plans
really govern everything inhealthcare contracts and health
plans really govern everythingin healthcare.
And so it was with that of,okay, that's important to know
what do you do about it.
And so I ended up basicallystudying social movements and
revolutions and big new productcategory things like smartphones
(02:19):
to pull out lessons that wecould draw in, and probably the
one I used the most was with theUS Green Building Council LEED
standards, because the builtenvironment to me is kind of
like healthcare.
It's this very local, veryentrenched thing.
It's not like there was someday where all the old polluting,
inefficient, bad air buildingsgot raised and the next day
(02:41):
they're all magically green,built and better efficiency and
all that kind of thing.
And while no analogy is perfect, there was some lessons to be
learned there.
They trained professionals likearchitects to design buildings
with this new framework and thenthey certified buildings and
created a market demand.
And I thought there was somereally good analogies and put my
(03:02):
head together with some otherfolks and said healthcare goes
through major shifts every 50 to70 years.
It's overdue.
And we've certainly said for along time this isn't sustainable
.
And it was kind of funny.
I had written about directprimary care.
I actually wrote the seminalpaper on direct primary care
before this and some people ranwith it and I'd met a bunch of
(03:26):
doctors like oh, I left myfee-for-service hellscape and
went into direct primary carebecause your article was like
cool and I thought that's whatwould happen with Health,
rosetta, I just write about thisconcept and people would go do
it.
And then they're like no, youshould do it.
I'm like no, you should do it.
And eventually it's like okay,actually, the things that it
(03:47):
would take to pull off somethingthis audacious right.
What we're trying to do ispretty audacious.
Maybe we'll prove to bedelusional, but somebody's got
to give it a shot and weactually have some of the skills
in our team to do that.
And the old saying the two mostimportant days of your life are
the day you're born, the dayyou figure out why it really
(04:10):
became my, why and as Iunderstood the extent of the
damage, but the amazing thingsthat could happen when you got
it right.
And that is what keeps me goingevery day.
Speaker 1 (04:24):
So, from 10,000 feet as you started to build this
organization, what were thethings, the more tangible things
that you focused on?
What came first?
Chicken, egg, chicken and eggColonel.
Speaker 3 (04:34):
Sanders.
Speaker 1 (04:35):
What was the progression like?
Speaker 3 (04:36):
Yeah, I'm trying to remember when I wrote it, but it
was probably 2013, 2014.
I had written a piece in Forbeswhen I was doing writing for
them.
It was called this.
The headline was this job couldsave America.
I was talking about benefitconsultants, benefit brokers,
and it was like these people arethe most underestimated people
in the entire health care systemprobably the entire economy and
(04:58):
when they're at their best,they're incredibly impactful.
Incredibly impactful and Irealized the in air quotes.
The architects of health plansare these benefit brokers, these
benefit professionals, and Ilooked at how do you do this?
And certainly people areproblem solvers everywhere.
Somebody's cracked the code andthat's when I found Rose and
Hotels.
(05:18):
I found people like Scott Haaswho'd been doing it.
There were people, maybeagainst their own economic
interests, who were doingamazing things.
That kind of became thistemplate, actually wrote about
David Contorno and sort ofstarted getting enmeshed in that
benefit consultant communitywhich I, frankly, barely even
knew existed for a while, andsaid, if we take the best of the
(05:43):
best and train other people onit and then make it easier to
actually do what they're doing,we'd be onto something, because
the difference between what'shappening in many of the health
plans in America, where they'rereally not getting the job done.
Given the amount of money thatwe're spending, versus the ones
(06:05):
like a Rosen.
It's like practically dystopiaversus utopia.
Right?
This is just a marketingproblem, right?
Who wouldn't want that?
Of course, it's a toughmarketing challenge.
So, yeah, we thought the tip ofthe spear has got to be the
benefit consultant, benefit,advisor, whatever moniker you
want to put on it.
They have the trustedrelationships with the biggest
(06:26):
category of how people gethealthcare in America employers
and unions and so I've beenwriting about some of this stuff
, and there's this concept oflean startup where, like, just
put out ideas, maybe you runGoogle ads and see if anybody
responds to it, even maybebefore you built anything.
And so we're well, I'm comingout with this book, and that was
(06:46):
like Labor Day 2017.
Let's see if anybody wouldactually want to do this, sign
up for this advisor program and,happily, within two months, we
had more people raise their handthan we thought we'd get in
maybe two years.
And we're like, oh boy, webetter build this thing.
And so we started diving in.
And then one thing led toanother and it became're like,
oh boy, we better build thisthing.
And so we started diving in andthen one thing led to another
and it became clear that, oh, ifyou're going to basically say
(07:13):
an entirely new industry supplychain needs to emerge, like
that's a big statement, ofcourse there's no technology
infrastructure for that.
No software startup guy wouldever build for a market of five
employers or whatever it was atthe time.
But being very mission oriented, like, okay, we're going to
build that because, while theseplans are very impactful, it's
(07:39):
too much work to do that it's.
It will be the year 3000 beforeeverybody gets to these things.
And so that sort of was thereally third kind of leg of the
table.
Like it was like, okay,framework, ecosystem platform to
lower that burden, and thenwe'll talk about the fourth leg
(08:00):
to that table, I'm sure, later.
But that got us, got us prettyfar and happily, where there
were five successes that thathad sustained themselves for a
long period of time.
So you couldn't get lucky ifyou've been doing it 10 or 20
years.
We have thousands now and soit's pretty hard to get lucky
over many years all over thecountry, thousands of times.
(08:20):
And so then we felt like, okay,we're at the kind of next
inflection point on what needsto happen in the industry.
Speaker 1 (08:28):
They often say that you can tell who the pioneers
are because they're the oneswith the arrows sticking out of
them.
Did you guys get any pushback?
Speaker 3 (08:35):
Oh my gosh.
Yeah, I mean, and it's just.
There's pushback for sure, butit's just hard work, let's just
face it.
This is hard, but it's justhard work, let's just face it.
This is hard, hard work, and weget kicked in the teeth all the
time.
And there's a very insightfulwoman in the tech industry named
Esther Dyson, and she has aquote that I like always make
(08:59):
new mistakes and we made plentyof mistakes.
Our communities made plenty ofmistakes.
We tend not to repeat them, andif you just get a little less
stupid every day, you get mildlysmart over time, and the bar is
pretty low.
Somebody said the bar is so lowa snake could jump over in
terms of some of the currentbehaviors.
(09:19):
And one thing led to another.
We launched with this idea of ofwe should be like financial
services, where there's fulldisclosure of direct and
indirect compensation, likethat's what a professional
industry does, and it's the sameregulatory environment in terms
of retirement part of it, and abunch of people signed up for
(09:43):
that, and then it became thetemplate for the Consolidated
Appropriations Act, which is areal, and there's a few other
things that are really importantin that that, as we did get to
the next level because we reallywent in with a beginner's mind
we were in healthcare but nothealth plans.
Fortunately, we've alignedourselves with a lot of really
bright people who've really doneit well, and we've never
(10:03):
claimed to have inventedanything.
I mean, I joked, I'm anarchaeologist.
I could just go dig around forhealthcare's Rosetta Stone to
decode this indecipherablesystem and if we make sense out
of that, make it easy.
It's basically repeatabilityand verifiability is what we do,
like how do we make it a loteasier to repeat these things
and then verifying that it'sactually working, and so that's
(10:25):
been a real game changer interms of accelerating the whole
movement.
Speaker 1 (10:33):
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And now back to our conversation.
You know, I wonder if we aren'tabout to come upon another
tipping point, another hugeinflection point.
Arguably.
The system's been broken for along time, although jokingly, I
(12:24):
always tell people it's notbroken.
It's working exactly the way itwas designed.
That's the problem.
But Obamacare broke a lot ofstuff that needed to be broken.
It caused a complete turnaroundin the self-funded market.
I mean, when I was a TPA, ifyou told me that we were going
to self-fund a group of 14, Iwould have thrown you out the
window, and if I didn't do it,the stop-loss carriers would
(12:45):
have done it.
And now it's kind of a prettymuch fair game.
But I'm watching all of theconversation going on around HB1
and some of the changes thatit's going to make, assuming
that they get through thereconciliation process.
As we record this, that stufflooks like it's a few days away
and kind of coupled that with asecond wheel that's running,
which is this malarkey?
That people are starting tofight against carriers that are
(13:07):
dropping commissions.
And I've wondered for a longtime, why would you want to be
part of a system that pays bycommission?
It just seems kind of likeyou're not in control and I
think I wonder do you think thatthese things are all starting
to come together so that we'remaybe about to take a kind of
another big step.
Speaker 3 (13:24):
Yeah, absolutely, and I couldn't agree more.
When I learned there was peoplewhere their earnings maybe 30,
40% of their earnings could getripped away in 30 days by a
carrier if they weren't happy,it's like, oh my God, I could
never work in that, have thatsort of damocles sort of hanging
over, and so yes, and then Iwould also say maybe an
(13:46):
underestimated.
Another driver of thatinflection point is look at the
makeup of the workforce.
Look at the makeup of theworkforce.
Today it's about 70% aremillennials and Gen Z, 70% right
.
And you know, to my earlierpoint, like we're overdue for a
big shift.
I mean, the current healthplans are really just
(14:07):
descendants of what was builtfor the greatest generation and
boomers.
Guess what Things change?
They evolve.
We have different challenges.
That was more acute conditionfocused.
This is now more about chronicdisease and mental health.
And you look at the oldestmillennials they're mid-40s now.
They're in decision-makingauthority and guess what
(14:30):
Generations have differentexpectations.
And the oldest millennials,they're kind of in that sandwich
generation.
They have kids, most likely,undoubtedly have elderly parents
that are aging, and so they'renow paying attention to factor.
That's this there's.
And the lawsuits, right, thelawsuits that have come out
(14:50):
against J&J and JP Morgan.
If you look in the retirementspace, there's up to 200 suits a
year on the retirement spaceand so, love it or hate it, it
definitely has changed thedynamic for employers on the
(15:13):
401k, 403b side and I think thatthat is like the first waves
are just starting to crash, butit is a tsunami that's going to
have a huge ripple effect.
Speaker 1 (15:24):
And yet it started in 1975 because that was
ostensibly the reason for ERISAin the first place.
But now we've got so manypeople, so many health plans
that are subject to ERISA thatit's a target rich environment.
And I read someplace that thefirm that is doing most of the
early suing is the same firmthat started doing all the suing
with the tobacco legislation.
(15:46):
It's just scary.
It's also scary absent.
Maybe you know your cohort anda couple of others around the
country.
Advisors aren't talking aboutfiduciary responsibility and how
you manage that, and I thinkthat's also, you know, going to
heat up.
But it is an interesting newuniverse and things are
(16:06):
definitely changing.
Things are changing with Health, rosetta, too, and I know
there's some new stuff on thehorizon and you've been nice
enough to share that with me.
Would you share it kind of withthe audience, what's happening?
Speaker 3 (16:17):
Yeah, I mean the idea really from day one was if we
could prove this is actuallybetter and as I studied
different industry ecosystemshifts some I'd been a part of
it really is.
There's three things that arereally critical.
One you got to have proof yourthing is better, ideally 10x
(16:39):
better than the status quo.
Number two and this is wherewe're really getting into now is
you got to have standards tolower the barriers to adopt the
tool.
And then three, you got toeducate the market on it.
And so the idea was if we couldprove that with that whole
repeatability verify, then asmuch as we want to have success,
we are a for-profit company,we're a public benefit
(17:00):
corporation, so that means youcan have a social purpose and a
shareholder purpose.
But the idea is, even if we're10x our wildest dreams, we'll be
far from 100% of the market.
Our wildest dreams will be farfrom 100% of the market If you
want to pull off something likean entirely new industry supply
chain and new norms and again,you don't have to like dream
(17:22):
this stuff up.
It's happened in otherindustries, certainly saw a lot
in tech, but really in financialservices, like interest swaps,
the transaction costs have gonedown 97.5% because of
established industry standards.
So we said what we learned wasthe secret sauce to
(17:43):
repeatability was this virtuouscycle.
The right procurementmethodologies will lead to
number two the best contracts tocodify that.
Number three prove it in datarinse and repeat.
I mean you might have a goodcontract but whether it's an
honest mistake or malfeasancedoesn't mean they're going to
(18:03):
adhere to it.
And on the data use so we havebasically taken what we've
learned through there's about10,000 employers collectively
stewarded by the Health ResetAdvisors.
There's 400 that we've workeddirectly with.
It's our performance lab.
So our Q4 is just as hellaciousas any other benefits
(18:25):
professional because we're inthe trenches with them and it
gives us a we don't want to beivory tower.
We're in the trenches, we'regetting kicked around and all
the difficult things that we'reactually pretty confident.
It's always hard, never takethings for granted, but if we
can then make that secret sauceavailable and the technology and
(18:46):
the data use that we actuallylearned, we came up with this
concept of a plan creator and wefound the 40 most important
questions to be predictive ofhigh-performance health plan,
because much of what healthcaredoes to me is driving down the
road looking at the river,mirror claims.
They're important and we reallydo believe claims are important
.
But there's things that thoseof us who've been in the
(19:10):
industry know that the high costclaimants drive the vast
majority of spend.
It's a small number and it'salways almost always different
people every year, right.
So knowing who had cancer lastyear or who had a heart attack
last year isn't going tonecessarily be that predictive
going forward.
Tufts University did a study ofthe.
(19:38):
Now we have 2,000, 3,000 plangrades.
The most predictive thing of ahigh-performance plan is full,
unfettered access to claim data.
That's actually codified in theConsolidated Appropriations Act
as a no-gag clause is thephraseology Okay, great, and
what we saw was okay.
This is not just about how somedata analytics and create some
pretty reports.
You need to have unfetteredaccess to the data.
(20:01):
We could go into why that is,but that is really critical.
And what we saw over and overwas different.
It might be an employer, butusually it might be a benefits
consulting firm, but mostcommonly like point solutionspas
that to do it well, to get inthat claims data, clean it up,
transform it, make it availableto other systems.
(20:23):
You easily would be into it fortwo to three million dollars,
because it's this combination oftech knowledge, tech capability
, with domain knowledge, andthat layer wasn't what some
diabetes solution wasdifferentiating on, but they
were in it.
If they did it well, two tothree million dollars.
So we're like, hey, we need it.
(20:44):
We actually partnered withanother organization.
We're going to build this thingfor ourselves, but then we're
going to make it available toeverybody and then they don't
have to build in that price formaking that big investment.
And so that's the tech piece ofNautilus Health Institute is we
call it METL for medical ETL.
(21:05):
Etl is a term in kind of dataland, of extract transform load,
so our acronym is METL withoutthe A.
And so we've open sourced thattech and so we now have seven
companies.
We launched that at our lastRosetta Fest back in September.
We launched that.
We have seven companies inproduction and this limited beta
(21:28):
, another 20 in evaluation,given the resources we have.
But we're changing that, we aregoing to, we're raising some
nonprofit dollars to supportthat level of infrastructure.
But it's really really critical.
And then you can havepredictability and these things
become budgetable, that we'resort of out of control spend.
(21:49):
So again, you had to if you gointo, say, our TPA field guide
and you would just get used andgo to our, the nautilushelporg
website, fill out a little form.
It's going to send you.
I tell people, look at the tpafield guide and you will see the
level of detail one needs tosweat to win here.
None of its rocket science, butit's a lot.
(22:12):
This is like it starts withlike a 64 page document, links
to like eight or 10 otherspreadsheets or documents,
contract language, procurementmethodologies, how to negotiate
these things, dah, dah, dah,that know-how, and so it's about
$4 million of investmentbetween the technology and
basically legal experts,essentially assembling the dream
(22:32):
team of risk attorneys andcontracting attorneys.
And you know, we battle, testedit with the 400 employers and
we're saying here it is, take itand run with it.
Now, health Reset Advisors youknow they had a five-year
headstart.
It's the stuff we've beentraining on but we had to prove
it worked.
You know we weren't going toopen source it five years ago
but now we're quite confident.
So we're starting to.
(22:53):
You know, come out in the PBMfield, and so we're starting to.
You know we're coming out witha PBM field guide at the next
Rosetta fence.
So that's a big body of work.
(23:15):
Of course that's you.
We have other fellow travelerslike Mark Cuban he's been vocal
about.
He's an employer too.
They're going to open sourcethe direct contracts they're
doing also in August, and sowe've spent quite a bit of time
with Mark's team.
They actually got a early lookat the TPA field guide when they
were going out to RFP, whenthey kind of changed who they
(23:36):
were working with.
So we're really excited aboutit.
And it's pretty shocking topeople who've been in the
industry because, like, wait asecond, you have this big
information demand.
You made all this investment.
Why are you giving that away?
Well, there's plenty ofcommercial opportunity beyond
that.
It's not like, okay, who'sgoing to verify those contracts?
Who's going to do the datawarehouse?
There's plenty of ways we canstill make money in a good,
(24:02):
ethical way, but if we're goingto level up the industry, you
can't do it without establishingnew standards, and that's one
of the things that you can seein financial services and
technology, and so it's justoverdue.
Healthcare is this weird $5trillion cottage industry the
way it's operated, and so we'retrying to change that.
Speaker 1 (24:18):
Yeah, it is a big, big lift.
Now.
You alluded to Rosetta Fest alittle while ago.
That's typically been membersonly it was until like 2022.
Speaker 3 (24:32):
We were in Denver, we had a little over 200 people.
It just was our community, andso that was basically benefit
advisors and then some of thesolutions that we work closely
with.
But then ultimately like, hey,this is a team sport, we can't
do it without clinical leaders.
We need the employers andunions, yes, we need the
advisors and we need thesolution and tech company.
And it was something where werealized, yeah, I call it
(24:54):
connective tissue, sean myco-founder calls it grout, like
the gaps between the companiesreally matter and you can go to
an event with a bunch oforthopedic surgeons or PTs or
health tech people or benefitsprofessionals, but having it all
together.
So then we opened it up andsaid all of that.
So if you look at, like lastyear, we it was pretty evenly
(25:16):
split.
We had about 250 employers andunions, about 250 benefits
advisors and consultants,including non-health Rosetta
ones were like hey, check us out.
Right, there's different myths,different gaps in knowledge.
Get a little taste of whatwe're about.
If it's your cup of tea,awesome.
If not, you'll get an eye outof the conference.
(25:36):
And then we had the clinicalleaders.
This year, the biggest DPC eventhas been the Hint Summit.
Hint Summit's actually part ofRosetta Fest.
We have a ton of DPC docs wehad a bunch last year and as
well as the direct specialtycare because they're really key
those surgery centers andimaging centers and all that and
then the solutions and techcompanies.
(25:56):
Right, we can't do it withoutTPS, we can't do it without PBMs
we can't, and so on, and soit's all those folks together.
So last year I think we had alittle over a thousand folks.
We'll probably have a similarnumber.
We're not trying to turn itinto a hundred thousand people,
but we really wanted to walk thetalk in terms of being more
open for saying walk the talk,in terms of being more open for
(26:16):
saying, hey, we need out ofthese open source standards.
How could you claim that andnot invite other people?
Speaker 1 (26:20):
Well, and we'll be sure to put a link in the show
notes so that folks who areinterested in checking out the
meeting and learning what youall are up to and all the new
stuff.
There's a tide in the affairsof men which, taken at the crest
, leads on to victory.
Shakespeare said it a long timeago.
I think that we're kind of atthat inflection point.
I may be out singing by myselfand looking like a lunatic, but
(26:42):
I think there's lots of myfriends who have finally figured
out that status quo just isn'tgoing to keep working, that it's
just not literally.
We've been saying it's notsustainable for a long time, but
it's kind of in a tagline Now.
It's really not sustainable anylonger and we've got you've got
chronic conditions, and thegood news on that is that what
used to kill us doesn't.
You know all kinds of differentthings, and predictive modeling
(27:03):
will start coming into its ownas well.
So instead of, as you pointedout, looking into that rearview
mirror all the time, we'll beable to look out the windshield.
Dave, a fascinatingconversation.
Thank you so much for sharingthis with us.
We look forward to touchingbase with you again soon and
kind of hearing how this allrolls out.
Speaker 3 (27:20):
Yeah, well, really again appreciate being on your
show, love it.
It's a real honor andappreciate you taking the time
to talk with me today.
Speaker 1 (27:28):
Thank you very much, dave Chase.
Co-founder of Health.
Rosetta, dave, we'll see you,maybe in Denver.
Awesome, in Denver, awesome.
I want to give a quick shoutout to our sponsor and our
producer, hatcher Media.
Hey, if you need podcastproduction or professional
graphic design, josh Hatcher isthe expert to contact For more
(27:55):
information.
Speaker 2 (27:56):
Visit him at hatchermedianet, that's
H-A-T-C-H-E-R media dot net.
This Shift Shapers podcast iscopyrighted content and may not
be reproduced in whole or inpart without the express written
permission of Shift ShapersSolutions LLC.
Copyright 2024.
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