April 29, 2025 • 21 mins
In this REPLAY episode of ShiftShapers, host David interviews Paula Muto, a practicing surgeon and founder of Uber Docs. Paula shares her perspective on the inefficiencies in the current healthcare system, comparing buying health insurance to renting an apartment, and advocates for a direct pay model to improve the situation. She explains how Uber Docs facilitates transparent, direct transactions between patients and physicians, ultimately aiming to lower overall healthcare costs by empowering consumers. Key topics include the significant portion of healthcare costs dedicated to management rather than medical care, and how technology and consumer behaviors can drive positive changes in the healthcare landscape.
00:00 Introduction to Today's Guest and Topic
01:03 Paula Muto's Background and Inspiration
02:19 The Flaws in the Current Healthcare System
13:47 The Direct Pay Model Explained
15:55 How Uber Docs is Revolutionizing Healthcare
20:33 Conclusion and Final Thoughts
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Today's guest believes that buying health
insurance is a lot like rentingan apartment, and that's not a
good thing.
What does she mean and howwould she change things?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:15):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industryshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:37):
And Paula Muto is a practicing surgeon, founder of
Uber Docs, which we'll talkabout as we go along.
In addition to her manyprofessional accomplishments,
she's one of a growing number ofphysicians who are trying
desperately to fix ourBass-Ackwards healthcare system.
And what we're going to betalking about in large is a
direct pay model, and for someof you that's new.
(00:57):
Paula will explain all of that.
Welcome, Paula.
Speaker 3 (01:00):
Nice to be here.
David, Thank you for having me.
Speaker 1 (01:02):
Thanks for being with us.
So tell us just a brief littlebit about your background,
because you've got a reallygreat background.
You didn't grow up inhealthcare, but you grew up on
healthcare.
Speaker 3 (01:11):
Exactly.
Well, so I'm a surgeon by Ilike to say by birth.
My dad was a great surgeon andan inventor actually, and my
brother is a surgeon.
I'm married to a surgeon.
I have two uncles who aresurgeons, all in Massachusetts
for a collective century.
So you kind of get it.
Healthcare is kind of the familybusiness, or I should say
medicine is the family business.
I've been a private practicesurgeon outside of Boston for
(01:35):
over 20 years and I kind of wasrunning my practice in the front
lines in an inner city next toan affluent community, 15
minutes from academic centers.
It's kind of very commonscenario and I realized that the
healthcare system kind ofdidn't work and I thought maybe
we can change it.
So I sort of woke up onemorning and got the bug to
decide to fix it and change it.
And then, as most entrepreneurswill tell you, you can't rest
(01:58):
until you fix it and I just kindof came up with a really simple
solution to make betterconnections between physicians
and patients.
So you know, in my 50s Isuddenly my kids off to college.
I had a third child and that'sUberDoc.
Speaker 1 (02:13):
And everybody who's an entrepreneur which is most of
the folks who are listeningcompletely and totally
understand that.
So when you say that buyinghealthcare or health insurance
is like renting an apartment,what do you mean say?
Speaker 3 (02:25):
that buying health care or health insurance is like
renting an apartment.
What do you mean?
So if you think about it, youknow and again, this came from
frustrating and writing lots ofangry letters to the newspapers
all the time.
You see from the front lineshow things kind of don't work.
It's about money, it's aboutcost.
But over the years as apracticing surgeon I've noticed
that technology hasn't reallymade things more complicated.
(02:46):
Technology made it easier forus, made it easier for us to do
better things for our patientsin more convenient places.
We don't admit our patients tohospitals anymore for long
hospital stays.
We don't operate on the samethings we used to operate on.
I mean, what I used to do inthe operating room for two hours
, I do it in eight minutes in myoffice.
(03:07):
Better, faster, cheaper and mypatients are much happier.
I don't even operate on somethings anymore, like carotid
disease.
You know, I just saw a patient.
You treat it with a statin, youtreat it with medical
management.
So it's always confusing to mehow so much of healthcare has
gotten more expensive when somuch of medical care has gotten
(03:27):
more efficient and accessible.
So when you think about rentinga house versus buying, you know
if you think about healthinsurance, it's a lot like
renting an apartment and nowyour landlord is making you pay
for utilities, making you payfor snow removal, making you pay
for the empty apartment acrossthe corridor and maybe even
making you pay for their mansiondown the street.
(03:47):
But when you buy a house youstill pay money into something.
But then at the end of it youhave equity, and I like to think
of people building theirindividual health equity.
You know, when you know thatyou have family history that
might require sort ofintervention later on in your
life, isn't it good, when you'rehealthy, to put that money away
that you could use in thefuture?
(04:09):
And right now our healthcaresystem is like that rental you
just kind of put money in thatdoesn't come back to you and you
invest that money over timesince probably the age of 15,
when you have your firstpaycheck, and it's not just what
you put into Medicare, it'swhat you put into your
employer-based health plans.
And I just feel like a lot ofthat money never comes back to
(04:29):
the people who need to spend it.
And because our healthcaresystem has diversified, has
decentralized, has become moreaccessible with technology, I
feel it's very strongly thatpatients should be able to have
better options and invest intheir own personal health future
, and I use again rental versusmortgage as an example.
Speaker 1 (04:52):
So it should be more like buying a home where you
have equity and you build valueover time and you get to
customize it to your needs andwhat you want, et cetera.
So that's great, I guess, onthe face of it.
If you're an individual patientand you've got an episode of
care, how do you do that forfolks who are at the other end
of that care continuum and havemultiple chronic conditions?
Speaker 3 (05:13):
Well, some people might be in a high rent district
where it's really expensive tobuy and it's better economically
for them to rent permanently,right?
I mean, that's exactly theanalogy.
And I think that those patientsare easy to identify because in
our system now if you have achronic disease, for example
renal failure, and you requiredialysis, your healthcare
(05:35):
expenses are picked up by theMedicare.
So there's already safeguardsbuilt into the system to allow
you to get sort of like thatpermanent rental.
But I think for everyone else,for the vast majority of
patients, it's hard to pay apremium every month to have a
job where you weren't even totake a job you're not really
that fond of but because of thebenefits.
And then you pay a premiumevery month, and for families it
(05:57):
can be $1 1500.
And that's not even countingwhat the employer's kicking in.
And then you go see me and thenthey say, okay, dr Mito, this is
great, insurance covered this.
But now you're paying me thewhole amount.
And they're like I don'tunderstand.
I've paid my premium, I've beena good doobie, I paid my
premium and I paid my rent andnow you're making me pay you too
.
It doesn't make any sense topatients and as far as the
(06:20):
doctor's concerned.
It doesn't make any sense to useither, because we don't want
to treat a patient unfairly.
Because they have insurance,they have to pay us more out of
their pocket than if they didn't.
It doesn't make any sense.
So I think we've kind of movedinto that illogic world where
patients are very unsatisfiedwith the economic equation when
(06:42):
it comes to health care.
Speaker 1 (06:44):
One of the things that you told me in our
pre-interview that reallyfloored me didn't surprise me,
but it floored me that thenumber was as high is that
two-thirds of health care spendis collecting data and managing
care.
Can you tell us a little bitabout that?
Speaker 3 (06:56):
So this statistic has been rolling around quite a bit
and it's been validated anumber of times.
If you look at the health caredollar as a dollar, 73% of it
actually goes to management.
Only 27% goes to health care.
I look at that pie and I saywe're pretty good, we only need
27% of that pie.
That 73%, however, is goinginto a lot of waste.
(07:17):
I'm going to just say it waste.
Why do you need to managesomething In the days of AI,
algorithms, computerizedefficiency?
Do we really need all of theselayers and layers of complexity
anymore, and in an age oftransparency as well?
I mean, transparency is afederal law and people are
moving toward it.
Do we need all this, andshouldn't some of that 73% be
(07:38):
redirected?
I say back to the patient tohelp manage the social
determinants of health.
When I operate on you, you liveperhaps in a family with a one
floor house with your spouse athome with you to take care of
you.
I operate on someone else.
They might live in a six floorwalk-up.
Their healthcare management isgoing to be difficult and no one
(07:59):
pays for that.
It's not like you're in ahospital recovering, you're at
home.
So those social determinants ofhealth really impact outcomes
and we don't fund those, wedon't talk about those.
But I like to think that 73%,which is management middlemen.
We know how ugly the system iswith the middlemen and the GPOs
and the PBMs and you know thekickbacks here and there.
(08:21):
And the federal governmenttries to come in and say you
know, like with the CCA law, yougot to at least make it
transparent.
You don't have to take it away,but you have to at least tell
people where your money's going.
But if you look at the biggerpicture of healthcare dollar in
the United States, they say it's30, 40% of the federal budget.
It isn't.
It's like 48%, because when youlook at all the federal
(08:41):
employees who have to have theirhealth expenses, you add that
in healthcare makes about 48% ofthe pie.
When you do the math on that,48% is almost half our tax
dollar and then a third of thatgoes to medical care.
Two thirds of it goes tomanagement.
So if you do the math, it'sabout 30% of our tax dollar is
going to middlemen and I thinkthat's probably something the
(09:01):
American public wouldn't want.
Speaker 1 (09:04):
CCA is great, but it seems to me that unless we take
some other actions, all CCA hasdone, at least on the face of it
and early on, is that you'restill being robbed.
The robber's just taken off hismask.
So how do we go about flippingthat ratio, that two-thirds
ratio, so that we getthree-quarters of our care or
(09:24):
two-thirds of our care dollarsinto care and the rest of it
into admin?
Speaker 3 (09:27):
I think it's like everything else it's going to be
driven by the consumer.
Everyone talks about healthcareconsumerism and at first it's
sort of like oh you know, I'mgoing to go online and learn
about, you know, my disease orthe last doctor.
Then I'm going to go online andmaybe I'm going to get a
prescription and we know that'sfraught with all sorts of issues
and maybe I'm going to goonline and do something else.
(09:48):
It's not about going online andjust interacting necessarily.
I mean, yes, virtual health isout there and so forth.
What I mean by healthcareconsumerism is that they're
going online and finding me asurgeon who's nearby and
available and coming to seekcare.
Why?
Because they can't get intotheir primary.
Why?
Because they look down on theirleg and they see something and
(10:08):
they do some research and theysay I'm going to take initiative
and find the doctor that cansolve my problem.
And as soon as, the only thingthat prevents anything in that
equation from occurring is theprice Right.
People have been convinced thatyou need your insurance card to
gain access.
That's your ticket.
You need that ticket, andsometimes that insurance card
limits where you can go and youcan't go to that doctor nearby
(10:31):
and available, you have to go toanother state, you know,
because that's the plan youremployer signed you up for.
That's silly and it's notworking and it's not good.
So patients don't change theirbehavior.
When you have a problem, youwant it solved.
That's why, over 75 years oftrying to limit ER visits, it's
(10:53):
never happened.
The only thing that limited ERvisit is when you thought you'd
get COVID if you went to the ER.
But ER walk-ins, urgent cares,no matter what you do, no matter
how many telehealth solutionsyou have, patients still it's
still.
That number has never changed.
Because that's human nature,because medicine is a contact
sport.
So I think the consumer will endup driving this because they
(11:15):
will see value where there isvalue, when the problem gets
solved.
Because you get into thatorthopedic who's like three
miles from you and they're likeoh my gosh, I hurt my shoulder.
My shoulder doesn't hurtanymore.
It's just that simple.
Versus I hurt my shoulder Now Ihave to go here, now I have to
do this visit.
Now I have to do three roundsof physical therapy before I can
(11:38):
get an MRI.
I mean those are all basicpoint solutions that were sold
to employer plans.
Those aren't based in any kindof like medical medicine.
So I think that the consumerwill drive this.
The consumer you give them thedollar to spend, they will spend
it and luckily, because thecosts are so extreme, there has
to be an alternative, and thisis why we're seeing the rise of
(12:01):
so much direct-to-consumerhealth care.
Speaker 1 (12:06):
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And now back to ourconversation.
We mentioned this in the openthat you are a proponent of the
direct pay model.
Explain to the audience, whomay not be familiar with it.
What is the direct pay model?
And then we can talk about whatimpacts you expect that it will
have.
Speaker 3 (13:57):
So I like to coin the term DPO.
People have HMOs, ppos, dpo.
What's a DPO?
A direct pay option.
What does that mean?
It means that there's asupermarket aisle for cash, that
you can use your insurance card, or perhaps you can go direct.
And when you go direct, it justmeans that I'm going to
potentially buy my medicationfrom, like you know, mark
Cuban's cost plus, or maybe I'mgoing to get an image from like
(14:19):
green imaging, or maybe I'mgoing to make an appointment
with Uber doc or you know.
In other words, I can use myhealth savings account, my FSA
or even my credit card again myown health equity to purchase
medical services.
Again, we're a service industry.
Now you can also use it topurchase products you know, like
the medications and so forth.
(14:40):
So that's the direct pay model,and so sometimes it's worth
using your insurance because youknow that the cost of that care
is complex.
It's going to require multiplelevels.
If you're going to, if I'mgoing to operate on you, david,
you know it needs anesthesia, itneeds pathology, maybe a
hospital stay recovery room.
Those are all costs that areprobably too much to pay out of
pocket or negotiate.
But again, 90% of care isoccurring in outpatient settings
(15:05):
, in offices with experts thatcan handle your problem and
solve your problem.
So again, the direct pay optionis a very logical and practical
solution and it doesn't removeinsurance.
It just gives patients that youknow again, that little health
equity piece, the part that theycan control, and I do believe
(15:26):
it'll lower the cost overall.
Because I always say, like, whydo you use your car insurance
for every oil change?
Shouldn't you just pay out ofpocket for that?
But to pay out of pocket meansthere has to be something the
patient gets back, which meansthat either their premium has to
be reduced or part of thatpremium has to go to a savings
account so that that can go andbuild their health equity.
Speaker 1 (15:47):
So it's almost like what they're talking about with
schools now, which is where themoney follows the student.
This would be the money followsthe patient, rather than the
other way around.
Tell us what role UberDocs isplaying in that.
What does UberDocs do and howdoes it help work towards that
goal?
Speaker 3 (16:01):
So we're a really simple platform.
We just thought wouldn't it benice if you could just make an
appointment with the doctor andnot make a phone call and pay a
transparent price and make thatprice lower than insurance but
above Medicare to be legal?
So basically, that's all we are.
We're an appointment maker anda payment processor, but what
we've done is we've done thenegotiation for you.
(16:23):
We have a price and the doctorscan set their price and they
can't set it too high, theycan't set it too low.
It's that's the price and it'stransparent, and that's it.
You find you have a problem, youhave a rash, you need a
dermatologist, you find onenearby and available, and that's
it.
And the word nearby also meansthat doctors within state lines
who have virtual appointmentscan also be accessed.
(16:44):
So we are both an in-person anda telemedicine platform, but
telemedicine is just thelocation that you're meeting the
specialist.
I like to say all of ourphysicians on the platform are
specialists, because allphysicians are, in fact,
specialists.
That means we do havespecialists in primary care,
internal medicine, familypractice, as well as
(17:05):
neurosurgery, pediatrics.
We have every specialty covered.
What makes us a littledifferent is we're not there
aren't any mid-levels on ourplatform.
We, you know, many times peoplesay I went to go see my doctor
and you know you're seeing that,you know the nurse practitioner
in the office or you knowsomeone else.
These are physicians that areexperienced and, more
importantly, trained, licensedand trained.
(17:26):
We underestimate the importanceof training.
Training is incrediblyimportant.
I can't practice pediatrics.
I have to go back and retrain.
You know, I can't decide I'mgoing to be an ENT surgeon, I'm
a vascular surgeon.
I have to go back and doretraining and it's something
that people underestimate interms of the prescribing
capability versus the treatmentcapability of any one of these.
(17:48):
You know people, so ourplatform is very simple.
So we are giving patients theopportunity to spend their
healthcare dollar, initiatetheir care journey.
It may require insurance at theend.
In other words, you could veeroff and say well, now you need
an MRI, david, and you may notwant to pay for that out of
pocket.
Maybe your insurance will coverthat.
(18:08):
The nice thing is, our app hasan insurance reimbursement tool
as well, so that patients canstart their journey.
Cash reimbursement tool as well, so that patients can start
their journey cash and then, ifthey want to, anywhere in that
journey, submit to insurancelater for reimbursement, that
opportunity will be there, whichkind of makes it really full
circle.
So again, we feel like we're anagnostic model, we are an
(18:28):
add-on, we're an appointmentmaker.
Every doctor can have anUberDoc seat in their waiting
room and I ask every doctorlistening to please give me a
seat in your waiting room nextto your Medicare patient, your
Medicaid patient, your UberDocpatient.
Just leave that seat open.
Speaker 1 (18:42):
I've been at this just long enough to remember
when you went and got medicalcare and you had insurance, you
would pay and then you'd file.
So that option is available.
You don't have to wait to befurther along in the care
continuum.
If you make an appointment andyou see a doctor and it's
something that would have beencovered under your insurance and
you pay that doctor in yourmodel, you can always submit the
claim.
Speaker 3 (19:00):
Right.
Well, we've kind of come fullcircle in the fact that patients
kind of get that doctor visit.
Well, they don't get it forfree.
It's $50, $75 copay.
If you're out of network it'smore and all this.
But then when you have yoursurgery which is the reason you
have your insurance card, or youhave a chronic disease or you
have to buy that medication,you're still paying a lot.
(19:21):
So the insurance you boughtyour insurance for collision,
but now you realize it doesn'tcover collision, it covers your
oil change.
A little bit it's like I don'twant that, I don't need
insurance for that, I needinsurance for the big stuff.
Speaker 1 (19:33):
Right, I can change the oil, I can cover the
windshield wipers et cetera, andI think that that's where
healthcare and medicine areseparated.
Speaker 3 (19:40):
So the practice of medicine is a service industry
that can be handled very nicelyand it is a 100% transaction.
There's no, this concept of nofee for service.
Well, all medical care is, infact, a transaction.
Every time I talk to you in myoffice, it is a transaction
between me and you.
Right, you're coming to me andsharing a private issue about
your health and I'm giving myexpert opinion.
(20:01):
That's transaction.
You can't erase that, no matterhow hard you try.
But healthcare is this wholeother issue.
What's healthcare?
Healthcare is a product, right,you're buying insurance, you're
buying access and you have tobuy insurance.
To perhaps afford yourmedication, you have to buy
insurance.
It's almost like you're payinga toll.
So I like to separate medicinefrom health care.
(20:23):
And UberDoc sits in the medicalside.
We are selling medical services, access to medical services.
We are not selling health care.
Does that make sense?
Speaker 1 (20:33):
It does, and that's a great place to end our
conversation for today, but wedo hope you'll come back,
because I think this issomething that's going to start
gaining more and more traction,because there's no more places
left to go.
There's no more there there, assomebody once said.
So Paula Muto is also apracticing physician, but she is
, most importantly today,founder of UberDocs.
Paula, thanks for sharing yourexpertise with the audience.
(20:54):
Thank you for having me, david.
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 information, visit himat hatchermedianet.
(21:14):
That's H-A-T-C-H-E-R-Medianet.
Speaker 2 (21:19):
This Shift Shapers podcast is copyrighted content
and may not be reproduced inwhole or in part without the
express written permission ofShift Shapers Solutions LLC.
Copyright 2024.
Today's guest believes that buying health
insurance is a lot like rentingan apartment, and that's not a
good thing.
What does she mean and howwould she change things?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:15):
Change either energizes or paralyzes.
The choice is yours.
This is the Shift Shaperspodcast, bringing the employee
benefits industry interviewswith individuals and companies
who are shaping the industryshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:37):
And Paula Muto is a practicing surgeon, founder of
Uber Docs, which we'll talkabout as we go along.
In addition to her manyprofessional accomplishments,
she's one of a growing number ofphysicians who are trying
desperately to fix ourBass-Ackwards healthcare system.
And what we're going to betalking about in large is a
direct pay model, and for someof you that's new.
(00:57):
Paula will explain all of that.
Welcome, Paula.
Speaker 3 (01:00):
Nice to be here.
David, Thank you for having me.
Speaker 1 (01:02):
Thanks for being with us.
So tell us just a brief littlebit about your background,
because you've got a reallygreat background.
You didn't grow up inhealthcare, but you grew up on
healthcare.
Speaker 3 (01:11):
Exactly.
Well, so I'm a surgeon by Ilike to say by birth.
My dad was a great surgeon andan inventor actually, and my
brother is a surgeon.
I'm married to a surgeon.
I have two uncles who aresurgeons, all in Massachusetts
for a collective century.
So you kind of get it.
Healthcare is kind of the familybusiness, or I should say
medicine is the family business.
I've been a private practicesurgeon outside of Boston for
(01:35):
over 20 years and I kind of wasrunning my practice in the front
lines in an inner city next toan affluent community, 15
minutes from academic centers.
It's kind of very commonscenario and I realized that the
healthcare system kind ofdidn't work and I thought maybe
we can change it.
So I sort of woke up onemorning and got the bug to
decide to fix it and change it.
And then, as most entrepreneurswill tell you, you can't rest
(01:58):
until you fix it and I just kindof came up with a really simple
solution to make betterconnections between physicians
and patients.
So you know, in my 50s Isuddenly my kids off to college.
I had a third child and that'sUberDoc.
Speaker 1 (02:13):
And everybody who's an entrepreneur which is most of
the folks who are listeningcompletely and totally
understand that.
So when you say that buyinghealthcare or health insurance
is like renting an apartment,what do you mean say?
Speaker 3 (02:25):
that buying health care or health insurance is like
renting an apartment.
What do you mean?
So if you think about it, youknow and again, this came from
frustrating and writing lots ofangry letters to the newspapers
all the time.
You see from the front lineshow things kind of don't work.
It's about money, it's aboutcost.
But over the years as apracticing surgeon I've noticed
that technology hasn't reallymade things more complicated.
(02:46):
Technology made it easier forus, made it easier for us to do
better things for our patientsin more convenient places.
We don't admit our patients tohospitals anymore for long
hospital stays.
We don't operate on the samethings we used to operate on.
I mean, what I used to do inthe operating room for two hours
, I do it in eight minutes in myoffice.
(03:07):
Better, faster, cheaper and mypatients are much happier.
I don't even operate on somethings anymore, like carotid
disease.
You know, I just saw a patient.
You treat it with a statin, youtreat it with medical
management.
So it's always confusing to mehow so much of healthcare has
gotten more expensive when somuch of medical care has gotten
(03:27):
more efficient and accessible.
So when you think about rentinga house versus buying, you know
if you think about healthinsurance, it's a lot like
renting an apartment and nowyour landlord is making you pay
for utilities, making you payfor snow removal, making you pay
for the empty apartment acrossthe corridor and maybe even
making you pay for their mansiondown the street.
(03:47):
But when you buy a house youstill pay money into something.
But then at the end of it youhave equity, and I like to think
of people building theirindividual health equity.
You know, when you know thatyou have family history that
might require sort ofintervention later on in your
life, isn't it good, when you'rehealthy, to put that money away
that you could use in thefuture?
(04:09):
And right now our healthcaresystem is like that rental you
just kind of put money in thatdoesn't come back to you and you
invest that money over timesince probably the age of 15,
when you have your firstpaycheck, and it's not just what
you put into Medicare, it'swhat you put into your
employer-based health plans.
And I just feel like a lot ofthat money never comes back to
(04:29):
the people who need to spend it.
And because our healthcaresystem has diversified, has
decentralized, has become moreaccessible with technology, I
feel it's very strongly thatpatients should be able to have
better options and invest intheir own personal health future
, and I use again rental versusmortgage as an example.
Speaker 1 (04:52):
So it should be more like buying a home where you
have equity and you build valueover time and you get to
customize it to your needs andwhat you want, et cetera.
So that's great, I guess, onthe face of it.
If you're an individual patientand you've got an episode of
care, how do you do that forfolks who are at the other end
of that care continuum and havemultiple chronic conditions?
Speaker 3 (05:13):
Well, some people might be in a high rent district
where it's really expensive tobuy and it's better economically
for them to rent permanently,right?
I mean, that's exactly theanalogy.
And I think that those patientsare easy to identify because in
our system now if you have achronic disease, for example
renal failure, and you requiredialysis, your healthcare
(05:35):
expenses are picked up by theMedicare.
So there's already safeguardsbuilt into the system to allow
you to get sort of like thatpermanent rental.
But I think for everyone else,for the vast majority of
patients, it's hard to pay apremium every month to have a
job where you weren't even totake a job you're not really
that fond of but because of thebenefits.
And then you pay a premiumevery month, and for families it
(05:57):
can be $1 1500.
And that's not even countingwhat the employer's kicking in.
And then you go see me and thenthey say, okay, dr Mito, this is
great, insurance covered this.
But now you're paying me thewhole amount.
And they're like I don'tunderstand.
I've paid my premium, I've beena good doobie, I paid my
premium and I paid my rent andnow you're making me pay you too
.
It doesn't make any sense topatients and as far as the
(06:20):
doctor's concerned.
It doesn't make any sense to useither, because we don't want
to treat a patient unfairly.
Because they have insurance,they have to pay us more out of
their pocket than if they didn't.
It doesn't make any sense.
So I think we've kind of movedinto that illogic world where
patients are very unsatisfiedwith the economic equation when
(06:42):
it comes to health care.
Speaker 1 (06:44):
One of the things that you told me in our
pre-interview that reallyfloored me didn't surprise me,
but it floored me that thenumber was as high is that
two-thirds of health care spendis collecting data and managing
care.
Can you tell us a little bitabout that?
Speaker 3 (06:56):
So this statistic has been rolling around quite a bit
and it's been validated anumber of times.
If you look at the health caredollar as a dollar, 73% of it
actually goes to management.
Only 27% goes to health care.
I look at that pie and I saywe're pretty good, we only need
27% of that pie.
That 73%, however, is goinginto a lot of waste.
(07:17):
I'm going to just say it waste.
Why do you need to managesomething In the days of AI,
algorithms, computerizedefficiency?
Do we really need all of theselayers and layers of complexity
anymore, and in an age oftransparency as well?
I mean, transparency is afederal law and people are
moving toward it.
Do we need all this, andshouldn't some of that 73% be
(07:38):
redirected?
I say back to the patient tohelp manage the social
determinants of health.
When I operate on you, you liveperhaps in a family with a one
floor house with your spouse athome with you to take care of
you.
I operate on someone else.
They might live in a six floorwalk-up.
Their healthcare management isgoing to be difficult and no one
(07:59):
pays for that.
It's not like you're in ahospital recovering, you're at
home.
So those social determinants ofhealth really impact outcomes
and we don't fund those, wedon't talk about those.
But I like to think that 73%,which is management middlemen.
We know how ugly the system iswith the middlemen and the GPOs
and the PBMs and you know thekickbacks here and there.
(08:21):
And the federal governmenttries to come in and say you
know, like with the CCA law, yougot to at least make it
transparent.
You don't have to take it away,but you have to at least tell
people where your money's going.
But if you look at the biggerpicture of healthcare dollar in
the United States, they say it's30, 40% of the federal budget.
It isn't.
It's like 48%, because when youlook at all the federal
(08:41):
employees who have to have theirhealth expenses, you add that
in healthcare makes about 48% ofthe pie.
When you do the math on that,48% is almost half our tax
dollar and then a third of thatgoes to medical care.
Two thirds of it goes tomanagement.
So if you do the math, it'sabout 30% of our tax dollar is
going to middlemen and I thinkthat's probably something the
(09:01):
American public wouldn't want.
Speaker 1 (09:04):
CCA is great, but it seems to me that unless we take
some other actions, all CCA hasdone, at least on the face of it
and early on, is that you'restill being robbed.
The robber's just taken off hismask.
So how do we go about flippingthat ratio, that two-thirds
ratio, so that we getthree-quarters of our care or
(09:24):
two-thirds of our care dollarsinto care and the rest of it
into admin?
Speaker 3 (09:27):
I think it's like everything else it's going to be
driven by the consumer.
Everyone talks about healthcareconsumerism and at first it's
sort of like oh you know, I'mgoing to go online and learn
about, you know, my disease orthe last doctor.
Then I'm going to go online andmaybe I'm going to get a
prescription and we know that'sfraught with all sorts of issues
and maybe I'm going to goonline and do something else.
(09:48):
It's not about going online andjust interacting necessarily.
I mean, yes, virtual health isout there and so forth.
What I mean by healthcareconsumerism is that they're
going online and finding me asurgeon who's nearby and
available and coming to seekcare.
Why?
Because they can't get intotheir primary.
Why?
Because they look down on theirleg and they see something and
(10:08):
they do some research and theysay I'm going to take initiative
and find the doctor that cansolve my problem.
And as soon as, the only thingthat prevents anything in that
equation from occurring is theprice Right.
People have been convinced thatyou need your insurance card to
gain access.
That's your ticket.
You need that ticket, andsometimes that insurance card
limits where you can go and youcan't go to that doctor nearby
(10:31):
and available, you have to go toanother state, you know,
because that's the plan youremployer signed you up for.
That's silly and it's notworking and it's not good.
So patients don't change theirbehavior.
When you have a problem, youwant it solved.
That's why, over 75 years oftrying to limit ER visits, it's
(10:53):
never happened.
The only thing that limited ERvisit is when you thought you'd
get COVID if you went to the ER.
But ER walk-ins, urgent cares,no matter what you do, no matter
how many telehealth solutionsyou have, patients still it's
still.
That number has never changed.
Because that's human nature,because medicine is a contact
sport.
So I think the consumer will endup driving this because they
(11:15):
will see value where there isvalue, when the problem gets
solved.
Because you get into thatorthopedic who's like three
miles from you and they're likeoh my gosh, I hurt my shoulder.
My shoulder doesn't hurtanymore.
It's just that simple.
Versus I hurt my shoulder Now Ihave to go here, now I have to
do this visit.
Now I have to do three roundsof physical therapy before I can
(11:38):
get an MRI.
I mean those are all basicpoint solutions that were sold
to employer plans.
Those aren't based in any kindof like medical medicine.
So I think that the consumerwill drive this.
The consumer you give them thedollar to spend, they will spend
it and luckily, because thecosts are so extreme, there has
to be an alternative, and thisis why we're seeing the rise of
(12:01):
so much direct-to-consumerhealth care.
Speaker 1 (12:06):
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And now back to ourconversation.
We mentioned this in the openthat you are a proponent of the
direct pay model.
Explain to the audience, whomay not be familiar with it.
What is the direct pay model?
And then we can talk about whatimpacts you expect that it will
have.
Speaker 3 (13:57):
So I like to coin the term DPO.
People have HMOs, ppos, dpo.
What's a DPO?
A direct pay option.
What does that mean?
It means that there's asupermarket aisle for cash, that
you can use your insurance card, or perhaps you can go direct.
And when you go direct, it justmeans that I'm going to
potentially buy my medicationfrom, like you know, mark
Cuban's cost plus, or maybe I'mgoing to get an image from like
(14:19):
green imaging, or maybe I'mgoing to make an appointment
with Uber doc or you know.
In other words, I can use myhealth savings account, my FSA
or even my credit card again myown health equity to purchase
medical services.
Again, we're a service industry.
Now you can also use it topurchase products you know, like
the medications and so forth.
(14:40):
So that's the direct pay model,and so sometimes it's worth
using your insurance because youknow that the cost of that care
is complex.
It's going to require multiplelevels.
If you're going to, if I'mgoing to operate on you, david,
you know it needs anesthesia, itneeds pathology, maybe a
hospital stay recovery room.
Those are all costs that areprobably too much to pay out of
pocket or negotiate.
But again, 90% of care isoccurring in outpatient settings
(15:05):
, in offices with experts thatcan handle your problem and
solve your problem.
So again, the direct pay optionis a very logical and practical
solution and it doesn't removeinsurance.
It just gives patients that youknow again, that little health
equity piece, the part that theycan control, and I do believe
(15:26):
it'll lower the cost overall.
Because I always say, like, whydo you use your car insurance
for every oil change?
Shouldn't you just pay out ofpocket for that?
But to pay out of pocket meansthere has to be something the
patient gets back, which meansthat either their premium has to
be reduced or part of thatpremium has to go to a savings
account so that that can go andbuild their health equity.
Speaker 1 (15:47):
So it's almost like what they're talking about with
schools now, which is where themoney follows the student.
This would be the money followsthe patient, rather than the
other way around.
Tell us what role UberDocs isplaying in that.
What does UberDocs do and howdoes it help work towards that
goal?
Speaker 3 (16:01):
So we're a really simple platform.
We just thought wouldn't it benice if you could just make an
appointment with the doctor andnot make a phone call and pay a
transparent price and make thatprice lower than insurance but
above Medicare to be legal?
So basically, that's all we are.
We're an appointment maker anda payment processor, but what
we've done is we've done thenegotiation for you.
(16:23):
We have a price and the doctorscan set their price and they
can't set it too high, theycan't set it too low.
It's that's the price and it'stransparent, and that's it.
You find you have a problem, youhave a rash, you need a
dermatologist, you find onenearby and available, and that's
it.
And the word nearby also meansthat doctors within state lines
who have virtual appointmentscan also be accessed.
(16:44):
So we are both an in-person anda telemedicine platform, but
telemedicine is just thelocation that you're meeting the
specialist.
I like to say all of ourphysicians on the platform are
specialists, because allphysicians are, in fact,
specialists.
That means we do havespecialists in primary care,
internal medicine, familypractice, as well as
(17:05):
neurosurgery, pediatrics.
We have every specialty covered.
What makes us a littledifferent is we're not there
aren't any mid-levels on ourplatform.
We, you know, many times peoplesay I went to go see my doctor
and you know you're seeing that,you know the nurse practitioner
in the office or you knowsomeone else.
These are physicians that areexperienced and, more
importantly, trained, licensedand trained.
(17:26):
We underestimate the importanceof training.
Training is incrediblyimportant.
I can't practice pediatrics.
I have to go back and retrain.
You know, I can't decide I'mgoing to be an ENT surgeon, I'm
a vascular surgeon.
I have to go back and doretraining and it's something
that people underestimate interms of the prescribing
capability versus the treatmentcapability of any one of these.
(17:48):
You know people, so ourplatform is very simple.
So we are giving patients theopportunity to spend their
healthcare dollar, initiatetheir care journey.
It may require insurance at theend.
In other words, you could veeroff and say well, now you need
an MRI, david, and you may notwant to pay for that out of
pocket.
Maybe your insurance will coverthat.
(18:08):
The nice thing is, our app hasan insurance reimbursement tool
as well, so that patients canstart their journey.
Cash reimbursement tool as well, so that patients can start
their journey cash and then, ifthey want to, anywhere in that
journey, submit to insurancelater for reimbursement, that
opportunity will be there, whichkind of makes it really full
circle.
So again, we feel like we're anagnostic model, we are an
(18:28):
add-on, we're an appointmentmaker.
Every doctor can have anUberDoc seat in their waiting
room and I ask every doctorlistening to please give me a
seat in your waiting room nextto your Medicare patient, your
Medicaid patient, your UberDocpatient.
Just leave that seat open.
Speaker 1 (18:42):
I've been at this just long enough to remember
when you went and got medicalcare and you had insurance, you
would pay and then you'd file.
So that option is available.
You don't have to wait to befurther along in the care
continuum.
If you make an appointment andyou see a doctor and it's
something that would have beencovered under your insurance and
you pay that doctor in yourmodel, you can always submit the
claim.
Speaker 3 (19:00):
Right.
Well, we've kind of come fullcircle in the fact that patients
kind of get that doctor visit.
Well, they don't get it forfree.
It's $50, $75 copay.
If you're out of network it'smore and all this.
But then when you have yoursurgery which is the reason you
have your insurance card, or youhave a chronic disease or you
have to buy that medication,you're still paying a lot.
(19:21):
So the insurance you boughtyour insurance for collision,
but now you realize it doesn'tcover collision, it covers your
oil change.
A little bit it's like I don'twant that, I don't need
insurance for that, I needinsurance for the big stuff.
Speaker 1 (19:33):
Right, I can change the oil, I can cover the
windshield wipers et cetera, andI think that that's where
healthcare and medicine areseparated.
Speaker 3 (19:40):
So the practice of medicine is a service industry
that can be handled very nicelyand it is a 100% transaction.
There's no, this concept of nofee for service.
Well, all medical care is, infact, a transaction.
Every time I talk to you in myoffice, it is a transaction
between me and you.
Right, you're coming to me andsharing a private issue about
your health and I'm giving myexpert opinion.
(20:01):
That's transaction.
You can't erase that, no matterhow hard you try.
But healthcare is this wholeother issue.
What's healthcare?
Healthcare is a product, right,you're buying insurance, you're
buying access and you have tobuy insurance.
To perhaps afford yourmedication, you have to buy
insurance.
It's almost like you're payinga toll.
So I like to separate medicinefrom health care.
(20:23):
And UberDoc sits in the medicalside.
We are selling medical services, access to medical services.
We are not selling health care.
Does that make sense?
Speaker 1 (20:33):
It does, and that's a great place to end our
conversation for today, but wedo hope you'll come back,
because I think this issomething that's going to start
gaining more and more traction,because there's no more places
left to go.
There's no more there there, assomebody once said.
So Paula Muto is also apracticing physician, but she is
, most importantly today,founder of UberDocs.
Paula, thanks for sharing yourexpertise with the audience.
(20:54):
Thank you for having me, david.
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 information, visit himat hatchermedianet.
(21:14):
That's H-A-T-C-H-E-R-Medianet.
Speaker 2 (21:19):
This Shift Shapers podcast is copyrighted content
and may not be reproduced inwhole or in part without the
express written permission ofShift Shapers Solutions LLC.
Copyright 2024.
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