May 13, 2025 • 21 mins
🎧 Replay Episode: Rethinking Healthcare Costs with Direct Pay Models
As healthcare expenses continue to rise and insurance premiums stretch beyond affordability, more Americans are exploring alternatives. In this replay episode, we're revisiting a powerful conversation with Dr. Jawad Arshad, CEO of WoW Health Solutions, on how direct pay models could reshape ambulatory care.
Dr. Arshad breaks down the benefits, challenges, and potential of a direct pay approach — offering insights into a future where patients and providers interact more freely, transparently, and affordably.
Whether you're a healthcare professional, policymaker, or patient, this episode offers a thought-provoking look at how the healthcare system could work better.
🤖 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.
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Episode Transcript
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Speaker 1 (00:00):
What would happen if ambulatory care moved to a
direct pay model?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:11):
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 industry'sshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:31):
And to help us answer that question, we've invited
Jawad Arshad, who's CEO of WOWHealth W-O-W, just the way it
sounds, he's one of a growingnumber of physicians, using
their experience and theirperspective to try to solve some
of the challenges that patientsface in today's really siloed
and crazy marketplace, and we'lltalk more about that.
(00:51):
Welcome, jawad.
Speaker 3 (00:52):
Thank you so much, David, for having me.
Speaker 1 (00:54):
It's our pleasure A little bit about your background
, because you know, nobody everends up in this business.
Nobody ever ends up doing whatthey set out to do.
So how do you get to be doingwhat you're doing today?
Speaker 3 (01:03):
Yeah, no, absolutely.
So I'm an ER physician bytraining right After residency.
I was really lucky.
I worked for a large healthsystem and ended up working for
corporate, so to speak, was thedirector of my department and
really held almost every jobthere is in the emergency
department along the way.
But about gosh, about six,seven years ago, you know, I had
(01:26):
an opportunity, really didn'tfeel that we were making a
difference when it comes todelivery of care in our
communities and decided to leavesort of employed position right
and in that process, started aclinic here in Southeast
Michigan.
That, of course, made me anemployer.
I was buying healthcarebenefits for my employees and
(01:50):
for the very first time gosh 15years into my career, I became a
provider who was directlyinterfacing with our payer
system.
Neither of these is an enviableposition to be in, right, as
everyone knows, and that reallystarted the journey right.
Thinking about what is it thatwe are doing wrong when we are
(02:11):
providing care in ourcommunities and to our members?
Speaker 1 (02:15):
So let's level set a little bit for the audience.
First of all, I think everybodyknows what ambulatory care is,
but I'm not sure that everybodyreally understands a direct pay
model, except for people who arefossils, such as myself, who
remember when that's the way thesystem was before we improved
it.
So talk about what is a directpay model?
How does it work?
Speaker 3 (02:34):
Yeah, so ambulatory model, right, is essentially
anything outside the four wallsof the hospital.
So if you think of, you know ofhospitalizations, er visits,
surgeries, that kind of stuffwe're going to put it to the
side.
But when you look at everythingelse outside office visits,
medications, imaging tests,ultrasound, mri, your routine
(02:58):
labs, even going to the dentist,maybe getting your eyes checked
, and so on all of theseservices are sort of in the
ambulatory bucket.
What we find is that, becauseof the quote-unquote improvement
, as you refer to the healthcarepayment model, what we find is
that the consumer, the patient,ends up paying the same, if not
(03:24):
actually usually more, out ofpocket if they are using the
traditional insurance paradigm.
What that means is between yourco-pay when you show up at the
doctor and then getting a bill,usually four to six weeks later,
because you haven't met yourdeductible or you have a
co-insurance with your plan andso on.
When you add all of those up,you know you may end up paying
(03:44):
$150, $200 for an office visit.
If you just pay directly to thedoctor at the time of service,
they'd probably charge you about$150 anyways, right?
So then what is the point ofhaving all of this opaqueness
and not really having anycontrol as a consumer, if I can
(04:05):
call the office, make anappointment, pay them at the
point of service, at the time ofcare, and that's the end of
that financial transaction andrelationship.
So that's what direct pay isright.
Direct pay is basically payingthe medical provider for the
service they're providing you atthe time of service, so you,
the consumer, has fullvisibility and control and of
(04:29):
course the provider doesn't haveto jump through the hoops of
documentation, unnecessarilysubmitting claims and paperwork
and so on, right?
I mean, we find, for example,that you know there are many
statistics out there, butprobably I would say you know
the ones that say about 70 to 80percent of a clinician's time
(04:50):
is spent in clerical activity,not in taking care of you as a
patient.
That's about accurate.
Many times you go in to see thedoctor and they're actually
looking at their computer thewhole time, right, because
they're too busy documenting tomake sure that they've, you know
, crossed all the T's andchecked all the I's and so that
you know they can submit aproper bill, right for that
(05:12):
visit.
So that's the idea of directpay, right?
Is that you're going to knowwhat you're going to pay.
The medical provider will getpaid at the time of service and
they can really focus on youinstead of the paperwork of
service, and they can reallyfocus on you instead of the
paperwork.
Speaker 1 (05:24):
This goes to, I think , a larger issue and I'd like
your thoughts about it.
We've gotten people conditionedover all these years to say
well, yeah, but yeah, but if Ido that I'll never meet my
deductible and then if somethingserious happens I'll have to
come out of pocket my entiredeductible.
Is this, in part, theopportunity, perhaps for a
(05:46):
conversation with those patientsto say your insurance policy
was never really meant to payfor all of these low dollar
items.
It's there in case you have acatastrophic event and, trust me
, if you have a catastrophicevent in this country, $5,000 is
pocket change.
How do you have thatconversation and get past that?
We've kind of taught people howto do that.
(06:07):
Now we have to unteach them.
Speaker 3 (06:09):
Yeah, and I think, as you know, change is difficult,
even when it's a good change,right, it's really hard to get
people to kind of break awayfrom habits.
So you're absolutely right, itisudgingly, literally one
conversation at a time that theproviders need to have with
their patients, right.
(06:30):
That employers need to have HRneeds to have with their
employees and really benefitadvisors need to have with their
clients, with the employers,with the employers, right.
So it falls on a lot of us tosort of bring that message down
to the consumer, so that they'rehearing it from different
venues and when they're hearingthe same point, it's going to
(06:54):
hopefully drive that change Toyour point.
Yes, I understand that.
I mean, if you think about it,how many times in the past 10
years did you actually meet yourdeductible?
It is exceedingly rare, unlessyou had a major medical event,
unless you had some surgery,unless you ended up in the
hospital for some reason or whathave you right?
(07:15):
But really, I mean, especiallywhen you're looking at age 65
and under, those numbers areeven more sort of alarming,
right, in a way that you know atiny, tiny percentage is hitting
your deductible and everyoneelse is just sort of kind of
moving along sort of in thatherd mentality.
Speaker 1 (07:33):
You know, I had a direct primary care physician
that I was speaking to at ameeting that you and I recently
attended in Miami and one of thethings that he said that just
floored me was that 85% ofdirect primary care claims over
(07:54):
the course of a 12-month periodnever hit $5,000.
And you know, given that that'skind of the out-of-pockets that
a lot of people have, it's aninteresting tale to tell In Wow
Health.
Do you help the benefitsadvisors learn how to tell that
story?
Speaker 3 (08:03):
We do.
That's one of the many thingsthat we do right.
So our goal is to not onlyeducate the benefit advisors but
, more importantly, give themtools, give them solutions that
they can put in front of theirclients, and then that is going
to allow them to have thatconversation more meaningfully
right.
Not just philosophically thisis how we should do it right,
(08:25):
but practically this is how wewould execute it.
We do the same thing with ourmembers.
Once you, for example, a benefitadvisor, an employer, does
decide to move with our solution, we are going to make it, make
a full effort in reaching out tothe members.
We text messages, we sendemails, right, really getting
(08:47):
the member to understand that,hey, you know, this is the
better way for you to get yourcare.
And I have to say that, youknow, it's really heartening
because we do see so many of ourmembers who come in with
accepting that this new paradigmright, and I think it's
wonderful to kind of see thatchange taking place.
We're probably not quite atthat tipping point, but I feel
(09:11):
that there are so many goodpeople in the industry providers
and benefit advisors andemployers and even individuals
right, who are saying this isnot quite right, we need to do
something about this and kind ofreally taking it on, and I feel
like that we're getting closeto that tipping point.
Speaker 1 (09:33):
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And now back to ourconversation.
Do you see the day, or is itclose, or even maybe here and I
don't know about it where apatient can, with all the new
transparency requirements, wherea patient can go online and
look at what it would cost meand look at what it would cost
(11:26):
me and calculate easily what itwould cost me out of pocket if I
use the insurance company, thetraditional one logo, one card
deal, versus paying you guys orpaying a clinic or an ambulatory
care center direct.
Speaker 3 (11:39):
I think that it requires you to pull up a
spreadsheet and put thosenumbers in.
Unfortunately, the transparencylaws really meant well but have
not been executed well.
So we see, for example, largesystems and not necessarily
entirely their own fault, but attimes I feel that they could
(12:01):
definitely make a better effort.
Just put out this reams of data, which is not really something
that's digestible andunderstandable by the average
person.
So I think it can be a bit of achallenge, but I think having
something like Vow Health havingand then really thinking it
through, you know OK.
So if I'm going to pay a premiumwith an insurance, then let's
(12:25):
say I'm going to go see thedoctor three times in a year,
maybe once for a wellness, acouple of times because I've got
the sniffles or I'm sick, andthen I am going to have my labs
done.
What else did I have done in thelast five years?
Right, average speaking, andput those numbers down and then
(12:57):
come to our website, which ismyvalhealthcom,
m-y-w-a-w-a-g-l-t-hcom, and youknow, and then my labs are going
to be about 65 to 70 dollars.
Maybe my blood pressuremedication that I take is going
to be two to three dollars.
Right, and add all of thosenumbers up and then see where am
I sitting.
Well, what am I missing?
That I don't get with WowHealth, that I do get with a one
(13:18):
card no good card versus howmuch money am I going to end up
putting back in my pocket, whichreally is going to help me
decide when and if I need to usethose funds?
And I honestly, david, I'vedone this numerous times right,
and we have never found ascenario where a member came
(13:40):
ahead in the traditionalinsurance paradigm.
Speaker 1 (13:44):
It's a burden, though Not a burden, but it's an
obligation.
I think that a benefits advisorwould have to undertake either
to come up with some casestudies to give to folks,
because, it's as you know, humanbehavior is the hardest thing
to change, and we're also inthis.
Well, my insurance doesn'tcover it, so I can't get it.
(14:06):
And then people get sickerinstead of saying, okay, you
know, can I afford this?
How do I pay for it?
I think it's going to be aninteresting conversation for
benefits advisors to have,whether it's at open enrollment
or at you know some other time,to say look, you have to change
your thinking.
And do you think that maybe theground has been plowed a little
bit by some of these RXdiscount cards?
(14:26):
Not how they work on the backend, because that's a whole
other story.
But you know, wait, you mean,if I use this card, I can get
the prescription for less thanmy insurance company's copay.
You bet I'm in.
Is that?
Did that crack the door opensome?
Speaker 3 (14:40):
It sure did.
And I think you know we don'twant to hold out.
You know, as they say, don'tlet better be the enemy of good,
right, and I think that thesediscount cards companies, like
maybe GoodRx, what have youright?
They've done a great job at atleast changing the conversation
right and opening up the mind.
(15:00):
And this is where I mean I'vealways told our advisors look,
you guys play an incrediblyoutsized role in the lives of
people, right, which we I don'tknow if everyone appreciates
that right, because if you thinkabout it, by the time you are
going to present a plan in frontof an employer, right, the
employer is going to be paying adecent percentage of that plan,
(15:23):
and then the employee is goingto be paying a decent percentage
of that plan, and then theemployee is going to be paying
some of that as well, and then,when that employee gets sick,
and you know, they are going tobe financially taxed, right?
So I think that the fingerprints, so to speak, of the advisor,
and how much they have thoughtthrough and provided something
that's actually meaningful tothe employee, go all the way
(15:47):
into the pocket of theindividual, right, and their
family.
And then what are they going tohave to cut out because someone
got sick in the family, andwhat vacation?
Or maybe you know, what arethey going to have to put off
till next year because they haveto pay for that expense.
So I think that you know,taking that sort of really
(16:09):
larger than what perhaps the jobappears role, I think you know
advisors are in that position toreally make a big difference.
Speaker 1 (16:17):
Let's go in the Wayback Machine for a minute.
For a minute.
Is there any reason why, if Igo and I use this kind of a
direct pay model and I pay my$150 rather than the $200 and a
quarter that it would be if I'dused my insurance card, is there
any reason why I know this isan old-fashioned concept, but is
there any reason why I can'tstill file that $150 that I've
spent with my insurance companyand let that accumulate toward
(16:40):
my deductible?
Speaker 3 (16:41):
You certainly can, however from and I don't know
this definitively, I guess itmay depend on carriers and you
know, and perhaps the personwho's kind of looking at this
submission and adjudicating it.
But you know many of them willsay, oh no, you know you have,
we need to have a claim on fileto have that counted against it.
(17:04):
That's just my gut feeling,because of course the insurance
companies are going to feel thatthey are losing the value
proposition.
Because if you say that, yeah,you know what, 95% of the time I
don't really need this cardthat I'm carrying around because
I can just take care of it andI'm only going to pull it out if
I end up in the hospital, if Iend up in the ER, right, right,
(17:27):
you may start looking at thecost of that and saying, is
there another way for me to takecare of those what ifs of life
at a much better price point?
So I think that you know thereis some fear and some
misconceptions that are thrownout there at times maybe
innocently, but I thinkcertainly at times purposely, to
(17:51):
make sure that the consumerdoesn't really start to become
fully engaged and aware.
Speaker 1 (17:57):
Well, we want consumers, but we don't want
real consumers, we just wantkind of consumers, the way we
define them.
Jawad, we've got about a minuteand a half or so left.
How do you see the next fiveyears in terms of the
progression of this kind of amodel and maybe other things
that you guys are maybe workingon down the road?
What are you seeing?
Speaker 3 (18:15):
Yeah, I think the biggest thing that we will
continue to see because of thefinancial pressures on employers
, because of the inflationarystress on people's wages, right,
we know, for example, thathealth systems have, across the
board, raised salaries by about15 to 20 percent at the
(18:36):
beginning of 2023.
We know that, as the federalemergency statute expires in May
for the COVID relief, the CMSis talking about cutting
hospital reimbursements by 20percent.
So now you have this dilemma asa hospital, you're losing
reimbursement on one hand andyou've raised salaries on the
other.
Where are you going to get themoney from?
(18:58):
Certainly not from CMS, right,because they'll do what they do.
So it's going to come down tocommercials, right?
And then is that going to cause, come 2024, renewals to be up
30, 40% from where they are.
They're already fairlyuntenable for most employers,
right?
Is that something that's reallyjust going to break the dam, so
(19:18):
to speak?
Right?
So I think those stressors inthe market are going to cause
more people to look at alternatearrangements for more employees
, to look at more meaningfulbenefits, right?
You know?
Where can I get something for20 bucks a month?
You know, one of our plans is$20 a month, which just gives
you access to our whole discountnetwork.
(19:40):
Yeah, you know, if I need to gosee the doctor, I'll know who
to go see and then I'll pay forit at that time of service.
And 20 bucks a month is a lotdifferent than a premium of
maybe $400 a month.
So I think that it just isgoing to come down to these
market stressors more so, in myopinion, than legislation,
(20:00):
because we know that thegridlock in DC isn't really
going to allow any meaningfulchange, at least in my opinion,
in the near future, and the bestwe can hope from the government
is not necessarily to come upwith new legislation.
But how about just enforcingwhat you have already passed?
Right, if it is abouttransparency, then really
forcing those transparentpricing to be available, but in
(20:25):
something that's digestible bythe individual right, not in
some nonsense.
You know 10,000 lines of codeand CPT codes and what have you.
So I think that that, to me, iswhat's really going to
hopefully tilt the market in thedirection of this direct pay
models and come up with evenmore creative solutions.
Speaker 1 (20:45):
And that's a great place to end our conversation
for today.
Jawad Arshad, ceo of Wow Health.
Jawad.
Thanks so much for sharing yourinsight with us.
Thank you so much, david, forhavingad.
Ceo of Wow Health.
Jawad.
Thanks so much for sharing yourinsight with us.
Speaker 3 (20:53):
Thank you so much, David, for having me.
It's a pleasure.
Speaker 1 (21:01):
I want to give a quick shout out 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 him at HatcherMedianet.
That's H-A-T-C-H-E-R Media dotnet.
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.
What would happen if ambulatory care moved to a
direct pay model?
We'll find out on this episodeof Shift Shapers.
Speaker 2 (00:11):
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 industry'sshifts.
And now here's your host, davidSaltzman.
Speaker 1 (00:31):
And to help us answer that question, we've invited
Jawad Arshad, who's CEO of WOWHealth W-O-W, just the way it
sounds, he's one of a growingnumber of physicians, using
their experience and theirperspective to try to solve some
of the challenges that patientsface in today's really siloed
and crazy marketplace, and we'lltalk more about that.
(00:51):
Welcome, jawad.
Speaker 3 (00:52):
Thank you so much, David, for having me.
Speaker 1 (00:54):
It's our pleasure A little bit about your background
, because you know, nobody everends up in this business.
Nobody ever ends up doing whatthey set out to do.
So how do you get to be doingwhat you're doing today?
Speaker 3 (01:03):
Yeah, no, absolutely.
So I'm an ER physician bytraining right After residency.
I was really lucky.
I worked for a large healthsystem and ended up working for
corporate, so to speak, was thedirector of my department and
really held almost every jobthere is in the emergency
department along the way.
But about gosh, about six,seven years ago, you know, I had
(01:26):
an opportunity, really didn'tfeel that we were making a
difference when it comes todelivery of care in our
communities and decided to leavesort of employed position right
and in that process, started aclinic here in Southeast
Michigan.
That, of course, made me anemployer.
I was buying healthcarebenefits for my employees and
(01:50):
for the very first time gosh 15years into my career, I became a
provider who was directlyinterfacing with our payer
system.
Neither of these is an enviableposition to be in, right, as
everyone knows, and that reallystarted the journey right.
Thinking about what is it thatwe are doing wrong when we are
(02:11):
providing care in ourcommunities and to our members?
Speaker 1 (02:15):
So let's level set a little bit for the audience.
First of all, I think everybodyknows what ambulatory care is,
but I'm not sure that everybodyreally understands a direct pay
model, except for people who arefossils, such as myself, who
remember when that's the way thesystem was before we improved
it.
So talk about what is a directpay model?
How does it work?
Speaker 3 (02:34):
Yeah, so ambulatory model, right, is essentially
anything outside the four wallsof the hospital.
So if you think of, you know ofhospitalizations, er visits,
surgeries, that kind of stuffwe're going to put it to the
side.
But when you look at everythingelse outside office visits,
medications, imaging tests,ultrasound, mri, your routine
(02:58):
labs, even going to the dentist,maybe getting your eyes checked
, and so on all of theseservices are sort of in the
ambulatory bucket.
What we find is that, becauseof the quote-unquote improvement
, as you refer to the healthcarepayment model, what we find is
that the consumer, the patient,ends up paying the same, if not
(03:24):
actually usually more, out ofpocket if they are using the
traditional insurance paradigm.
What that means is between yourco-pay when you show up at the
doctor and then getting a bill,usually four to six weeks later,
because you haven't met yourdeductible or you have a
co-insurance with your plan andso on.
When you add all of those up,you know you may end up paying
(03:44):
$150, $200 for an office visit.
If you just pay directly to thedoctor at the time of service,
they'd probably charge you about$150 anyways, right?
So then what is the point ofhaving all of this opaqueness
and not really having anycontrol as a consumer, if I can
(04:05):
call the office, make anappointment, pay them at the
point of service, at the time ofcare, and that's the end of
that financial transaction andrelationship.
So that's what direct pay isright.
Direct pay is basically payingthe medical provider for the
service they're providing you atthe time of service, so you,
the consumer, has fullvisibility and control and of
(04:29):
course the provider doesn't haveto jump through the hoops of
documentation, unnecessarilysubmitting claims and paperwork
and so on, right?
I mean, we find, for example,that you know there are many
statistics out there, butprobably I would say you know
the ones that say about 70 to 80percent of a clinician's time
(04:50):
is spent in clerical activity,not in taking care of you as a
patient.
That's about accurate.
Many times you go in to see thedoctor and they're actually
looking at their computer thewhole time, right, because
they're too busy documenting tomake sure that they've, you know
, crossed all the T's andchecked all the I's and so that
you know they can submit aproper bill, right for that
(05:12):
visit.
So that's the idea of directpay, right?
Is that you're going to knowwhat you're going to pay.
The medical provider will getpaid at the time of service and
they can really focus on youinstead of the paperwork of
service, and they can reallyfocus on you instead of the
paperwork.
Speaker 1 (05:24):
This goes to, I think , a larger issue and I'd like
your thoughts about it.
We've gotten people conditionedover all these years to say
well, yeah, but yeah, but if Ido that I'll never meet my
deductible and then if somethingserious happens I'll have to
come out of pocket my entiredeductible.
Is this, in part, theopportunity, perhaps for a
(05:46):
conversation with those patientsto say your insurance policy
was never really meant to payfor all of these low dollar
items.
It's there in case you have acatastrophic event and, trust me
, if you have a catastrophicevent in this country, $5,000 is
pocket change.
How do you have thatconversation and get past that?
We've kind of taught people howto do that.
(06:07):
Now we have to unteach them.
Speaker 3 (06:09):
Yeah, and I think, as you know, change is difficult,
even when it's a good change,right, it's really hard to get
people to kind of break awayfrom habits.
So you're absolutely right, itisudgingly, literally one
conversation at a time that theproviders need to have with
their patients, right.
(06:30):
That employers need to have HRneeds to have with their
employees and really benefitadvisors need to have with their
clients, with the employers,with the employers, right.
So it falls on a lot of us tosort of bring that message down
to the consumer, so that they'rehearing it from different
venues and when they're hearingthe same point, it's going to
(06:54):
hopefully drive that change Toyour point.
Yes, I understand that.
I mean, if you think about it,how many times in the past 10
years did you actually meet yourdeductible?
It is exceedingly rare, unlessyou had a major medical event,
unless you had some surgery,unless you ended up in the
hospital for some reason or whathave you right?
(07:15):
But really, I mean, especiallywhen you're looking at age 65
and under, those numbers areeven more sort of alarming,
right, in a way that you know atiny, tiny percentage is hitting
your deductible and everyoneelse is just sort of kind of
moving along sort of in thatherd mentality.
Speaker 1 (07:33):
You know, I had a direct primary care physician
that I was speaking to at ameeting that you and I recently
attended in Miami and one of thethings that he said that just
floored me was that 85% ofdirect primary care claims over
(07:54):
the course of a 12-month periodnever hit $5,000.
And you know, given that that'skind of the out-of-pockets that
a lot of people have, it's aninteresting tale to tell In Wow
Health.
Do you help the benefitsadvisors learn how to tell that
story?
Speaker 3 (08:03):
We do.
That's one of the many thingsthat we do right.
So our goal is to not onlyeducate the benefit advisors but
, more importantly, give themtools, give them solutions that
they can put in front of theirclients, and then that is going
to allow them to have thatconversation more meaningfully
right.
Not just philosophically thisis how we should do it right,
(08:25):
but practically this is how wewould execute it.
We do the same thing with ourmembers.
Once you, for example, a benefitadvisor, an employer, does
decide to move with our solution, we are going to make it, make
a full effort in reaching out tothe members.
We text messages, we sendemails, right, really getting
(08:47):
the member to understand that,hey, you know, this is the
better way for you to get yourcare.
And I have to say that, youknow, it's really heartening
because we do see so many of ourmembers who come in with
accepting that this new paradigmright, and I think it's
wonderful to kind of see thatchange taking place.
We're probably not quite atthat tipping point, but I feel
(09:11):
that there are so many goodpeople in the industry providers
and benefit advisors andemployers and even individuals
right, who are saying this isnot quite right, we need to do
something about this and kind ofreally taking it on, and I feel
like that we're getting closeto that tipping point.
Speaker 1 (09:33):
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And now back to ourconversation.
Do you see the day, or is itclose, or even maybe here and I
don't know about it where apatient can, with all the new
transparency requirements, wherea patient can go online and
look at what it would cost meand look at what it would cost
(11:26):
me and calculate easily what itwould cost me out of pocket if I
use the insurance company, thetraditional one logo, one card
deal, versus paying you guys orpaying a clinic or an ambulatory
care center direct.
Speaker 3 (11:39):
I think that it requires you to pull up a
spreadsheet and put thosenumbers in.
Unfortunately, the transparencylaws really meant well but have
not been executed well.
So we see, for example, largesystems and not necessarily
entirely their own fault, but attimes I feel that they could
(12:01):
definitely make a better effort.
Just put out this reams of data, which is not really something
that's digestible andunderstandable by the average
person.
So I think it can be a bit of achallenge, but I think having
something like Vow Health havingand then really thinking it
through, you know OK.
So if I'm going to pay a premiumwith an insurance, then let's
(12:25):
say I'm going to go see thedoctor three times in a year,
maybe once for a wellness, acouple of times because I've got
the sniffles or I'm sick, andthen I am going to have my labs
done.
What else did I have done in thelast five years?
Right, average speaking, andput those numbers down and then
(12:57):
come to our website, which ismyvalhealthcom,
m-y-w-a-w-a-g-l-t-hcom, and youknow, and then my labs are going
to be about 65 to 70 dollars.
Maybe my blood pressuremedication that I take is going
to be two to three dollars.
Right, and add all of thosenumbers up and then see where am
I sitting.
Well, what am I missing?
That I don't get with WowHealth, that I do get with a one
(13:18):
card no good card versus howmuch money am I going to end up
putting back in my pocket, whichreally is going to help me
decide when and if I need to usethose funds?
And I honestly, david, I'vedone this numerous times right,
and we have never found ascenario where a member came
(13:40):
ahead in the traditionalinsurance paradigm.
Speaker 1 (13:44):
It's a burden, though Not a burden, but it's an
obligation.
I think that a benefits advisorwould have to undertake either
to come up with some casestudies to give to folks,
because, it's as you know, humanbehavior is the hardest thing
to change, and we're also inthis.
Well, my insurance doesn'tcover it, so I can't get it.
(14:06):
And then people get sickerinstead of saying, okay, you
know, can I afford this?
How do I pay for it?
I think it's going to be aninteresting conversation for
benefits advisors to have,whether it's at open enrollment
or at you know some other time,to say look, you have to change
your thinking.
And do you think that maybe theground has been plowed a little
bit by some of these RXdiscount cards?
(14:26):
Not how they work on the backend, because that's a whole
other story.
But you know, wait, you mean,if I use this card, I can get
the prescription for less thanmy insurance company's copay.
You bet I'm in.
Is that?
Did that crack the door opensome?
Speaker 3 (14:40):
It sure did.
And I think you know we don'twant to hold out.
You know, as they say, don'tlet better be the enemy of good,
right, and I think that thesediscount cards companies, like
maybe GoodRx, what have youright?
They've done a great job at atleast changing the conversation
right and opening up the mind.
(15:00):
And this is where I mean I'vealways told our advisors look,
you guys play an incrediblyoutsized role in the lives of
people, right, which we I don'tknow if everyone appreciates
that right, because if you thinkabout it, by the time you are
going to present a plan in frontof an employer, right, the
employer is going to be paying adecent percentage of that plan,
(15:23):
and then the employee is goingto be paying a decent percentage
of that plan, and then theemployee is going to be paying
some of that as well, and then,when that employee gets sick,
and you know, they are going tobe financially taxed, right?
So I think that the fingerprints, so to speak, of the advisor,
and how much they have thoughtthrough and provided something
that's actually meaningful tothe employee, go all the way
(15:47):
into the pocket of theindividual, right, and their
family.
And then what are they going tohave to cut out because someone
got sick in the family, andwhat vacation?
Or maybe you know, what arethey going to have to put off
till next year because they haveto pay for that expense.
So I think that you know,taking that sort of really
(16:09):
larger than what perhaps the jobappears role, I think you know
advisors are in that position toreally make a big difference.
Speaker 1 (16:17):
Let's go in the Wayback Machine for a minute.
For a minute.
Is there any reason why, if Igo and I use this kind of a
direct pay model and I pay my$150 rather than the $200 and a
quarter that it would be if I'dused my insurance card, is there
any reason why I know this isan old-fashioned concept, but is
there any reason why I can'tstill file that $150 that I've
spent with my insurance companyand let that accumulate toward
(16:40):
my deductible?
Speaker 3 (16:41):
You certainly can, however from and I don't know
this definitively, I guess itmay depend on carriers and you
know, and perhaps the personwho's kind of looking at this
submission and adjudicating it.
But you know many of them willsay, oh no, you know you have,
we need to have a claim on fileto have that counted against it.
(17:04):
That's just my gut feeling,because of course the insurance
companies are going to feel thatthey are losing the value
proposition.
Because if you say that, yeah,you know what, 95% of the time I
don't really need this cardthat I'm carrying around because
I can just take care of it andI'm only going to pull it out if
I end up in the hospital, if Iend up in the ER, right, right,
(17:27):
you may start looking at thecost of that and saying, is
there another way for me to takecare of those what ifs of life
at a much better price point?
So I think that you know thereis some fear and some
misconceptions that are thrownout there at times maybe
innocently, but I thinkcertainly at times purposely, to
(17:51):
make sure that the consumerdoesn't really start to become
fully engaged and aware.
Speaker 1 (17:57):
Well, we want consumers, but we don't want
real consumers, we just wantkind of consumers, the way we
define them.
Jawad, we've got about a minuteand a half or so left.
How do you see the next fiveyears in terms of the
progression of this kind of amodel and maybe other things
that you guys are maybe workingon down the road?
What are you seeing?
Speaker 3 (18:15):
Yeah, I think the biggest thing that we will
continue to see because of thefinancial pressures on employers
, because of the inflationarystress on people's wages, right,
we know, for example, thathealth systems have, across the
board, raised salaries by about15 to 20 percent at the
(18:36):
beginning of 2023.
We know that, as the federalemergency statute expires in May
for the COVID relief, the CMSis talking about cutting
hospital reimbursements by 20percent.
So now you have this dilemma asa hospital, you're losing
reimbursement on one hand andyou've raised salaries on the
other.
Where are you going to get themoney from?
(18:58):
Certainly not from CMS, right,because they'll do what they do.
So it's going to come down tocommercials, right?
And then is that going to cause, come 2024, renewals to be up
30, 40% from where they are.
They're already fairlyuntenable for most employers,
right?
Is that something that's reallyjust going to break the dam, so
(19:18):
to speak?
Right?
So I think those stressors inthe market are going to cause
more people to look at alternatearrangements for more employees
, to look at more meaningfulbenefits, right?
You know?
Where can I get something for20 bucks a month?
You know, one of our plans is$20 a month, which just gives
you access to our whole discountnetwork.
(19:40):
Yeah, you know, if I need to gosee the doctor, I'll know who
to go see and then I'll pay forit at that time of service.
And 20 bucks a month is a lotdifferent than a premium of
maybe $400 a month.
So I think that it just isgoing to come down to these
market stressors more so, in myopinion, than legislation,
(20:00):
because we know that thegridlock in DC isn't really
going to allow any meaningfulchange, at least in my opinion,
in the near future, and the bestwe can hope from the government
is not necessarily to come upwith new legislation.
But how about just enforcingwhat you have already passed?
Right, if it is abouttransparency, then really
forcing those transparentpricing to be available, but in
(20:25):
something that's digestible bythe individual right, not in
some nonsense.
You know 10,000 lines of codeand CPT codes and what have you.
So I think that that, to me, iswhat's really going to
hopefully tilt the market in thedirection of this direct pay
models and come up with evenmore creative solutions.
Speaker 1 (20:45):
And that's a great place to end our conversation
for today.
Jawad Arshad, ceo of Wow Health.
Jawad.
Thanks so much for sharing yourinsight with us.
Thank you so much, david, forhavingad.
Ceo of Wow Health.
Jawad.
Thanks so much for sharing yourinsight with us.
Speaker 3 (20:53):
Thank you so much, David, for having me.
It's a pleasure.
Speaker 1 (21:01):
I want to give a quick shout out 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 him at HatcherMedianet.
That's H-A-T-C-H-E-R Media dotnet.
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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