August 20, 2025 • 43 mins
In this episode of Risk and Resolve, hosts Ben and Todd sit down with the renowned Nurse Deb Ault, founder of AIMM – Ault International Medical Management, to discuss how she’s reshaping the broken U.S. healthcare system. Deb shares the pivotal moment that led her to leave bedside nursing, the shocking truth about how money often drives life-and-death decisions in hospitals, and her mission to provide patients with ethical, proactive medical management.
Listeners will learn:
• The life-changing story that inspired Deb to start AIM.
• Why healthcare costs and patient outcomes are often at odds.
• How AIM’s nurses and doctors advocate for patients and employers.
• Deb’s bold executive orders to fix U.S. healthcare if she were in charge.
• Why patient advocacy and “righteous indignation” are key to change.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
You're listening to Risk and Resolve, and now for
your hosts, ben Conner and ToddHufford.
Welcome back to another episodeof Risk and Resolve with your
co-host, ben and Todd.
And today we have a veryspecial guest, deb Alt, who has
a wonderful brand around NurseDeb nation, famous Nurse Deb.
(00:27):
Thanks for being with us today.
Speaker 2 (00:29):
Thanks for having me Happy to be here.
Speaker 1 (00:31):
Yeah, deb is the founder of AIM, alt
International Medical Management.
It's a company focused onproactive medical management,
and there's a key word in there,I feel like.
Speaker 2 (00:43):
Proactive, yeah, yeah there are three key words, but
management is's a key word inthere.
I feel like Proactive, yeah.
Yeah, there are three key words, but management is also another
key word.
Speaker 1 (00:50):
Fair, fair, deb.
Can you give our listeners,viewers, a sketch of AIM and
what you guys do on a day in andday out basis?
Speaker 2 (01:01):
Yeah, absolutely Happy to do that.
So my company is a team ofnurses and doctors.
We come alongside patients,primarily telephonically
although we're expanding thatout recently and we help guide
them through the two mostcumbersome ecosystems in the
universe the health caredelivery system.
So what care is the goldstandard of care?
(01:23):
When should I be getting it?
Where should I be going to getit?
And the health plan system.
Oh my golly, how do I avoidbankrupting my family, my
employer, as I'm going throughthis health event?
So we navigate those two pieceswith them and get them as
healthy as possible, as quicklyas possible.
Speaker 1 (01:43):
God bless your team for doing it too.
That's hard work.
What was the genesis or thereason for you wanting to start
AIM Like?
What's the story behind that oflike, hey, I just, I really
want to start a company thatdeals with the two most
difficult things on the planet.
Speaker 2 (02:02):
I did not want to start a company to do that.
Speaker 1 (02:06):
Let's hear it.
Speaker 2 (02:14):
So this magazine back here actually has the whole
story if anybody cares enough toread it.
But I was a bedside nurse.
I was a ER ICU, predominantlynight shift, predominantly
weekend kind of nurse.
Knew from the time I was bornessentially, essentially that I
wanted to be in medicine,discovered that being a doctor
was probably not the rightanswer for me once I became a
candy striper and saw whatdoctors actually had to do and I
(02:36):
didn't want to live in ahospital.
I wanted to go work at ahospital and go home and have a
family and, you know, do someother things as well.
The problem is, about 30 yearsago now I was working in an ICU
and we had a patient and weshould not have admitted that
patient to our ICU.
We didn't have all the rightequipment, we didn't have the
(02:57):
right skillset.
We reluctantly admitted him tostabilize him so he could be
transferred, and the hospitalchose not to transfer him.
He actually ended up passingaway and it became really
apparent to me in a conversationwith my unit manager when she
(03:18):
finally I mean I was hysterical,I was sobbing, you know when
she called me and said you don'thave to come in tonight and I
was like, oh good, youtransferred him.
She's like no, he passed awaytoday and I lost it.
And she finally, you know, inher attempts to settle me down,
said probably the one thing thatwas more true than anything
(03:38):
else she'd said.
She said do you know how muchmoney we would have lost if we
would have transferred him?
And that was kind of thepivotal moment for me that wait
a minute, we're making life anddeath decisions based on money.
That is not what I signed upfor.
That is not why I became anurse.
(03:58):
I'm not count me out right, butwhat am I going to do?
This is, you know what I feellike I've been called to do.
And so my husband, kind of oncehe dug me out from the couch
cushions in my deep depressionsaid you've got to apply for
this job.
I had a master's in business,minor in math and statistics,
(04:19):
and he said you've got to goapply for this managed care
position.
And I was like no, no, no.
Managed care is evil.
It's all their fault.
You know, they're the ones thatare cutting the money and the
funding so that hospitals can'tafford equipment.
And he's like we need an income, apply for this job.
(04:39):
So that's how I wound up inmanaged care.
And then, as you guys know, inour industry mergers and
acquisitions are rampant, right.
And so finally, it got to thepoint where wait a minute if
somebody is going to do this theright way, we're going to have
to do it ourselves, you know.
We're going to have to take theleap.
(05:00):
No TPA is going to let medicalmanagement be done the right way
, because they have a vestedinterest in different things,
right?
So actually, it was very muchto my chagrin that I started the
company, you know, 20 plusyears ago, but somebody had to
do it and nobody was doing it,and so that's how I wound up
(05:23):
here.
Speaker 1 (05:24):
So you stepped into a calling.
It sounds like.
Speaker 2 (05:27):
I think so.
Yeah, unbeknowing at the time,right, but what nurse?
I had an associate's degree innursing and when I was working
at Ohio State University theyoffered free tuition.
And so I'm like what's theclass that weeds everybody out
when they're trying to get theirbachelor's in nursing
(05:48):
Statistics?
Let me take that class first.
By the way, I hated math up tothat point and a TA made it make
sense for me.
So every quarter I would lookat what math class he was taking
and I'd go take it because Iwas like actually enjoying and
learning math.
And then eventually it's likewait a minute, you have enough
(06:08):
credits to graduate.
We need to kick you off thetuition reimbursement.
And so they graduated me outwith a bachelor's in business
and a minor in math andstatistics.
And then I was like, okay,business, that's it Right.
And then, when this allhappened with at the bedside, I
was like okay, business, that'sit right.
And then, when this allhappened at the bedside, I was
like somebody's got to takecontrol of the purse strings.
(06:31):
Somebody with some ethics andsome morals and who actually
cares about patients has to takecontrol of the money.
That's the only way we're goingto fix the business of
healthcare.
Speaker 1 (06:43):
So you hang a shingle with AIM and register with the
state of Ohio and you're like,okay, we're going to do this,
we're going to solve healthcare.
Now, where's all the clients?
Like how did all that startright?
Like there's a dream, and thenthere's a reality of like we
have to fit ourselves into thishealthcare ecosystem.
Speaker 2 (07:05):
Yeah, that is still the hard part, in reality.
It's interesting because whenmy husband said, let's just do
this for ourselves, right, thepivotal moment, we'll just build
our own company.
First I asked him if he hadsomehow gotten into some drugs
or something, because he didn'tknow what he was talking about,
about starting our own company.
(07:26):
And then I asked him how muchmoney do you have?
Because it's going to take aquarter of a million dollars to
start this company.
He had 12 grand, by the way,and then I said, well, you know,
we spend the 12 grand and wehave to go to work for somebody
else.
We might as well try.
So I called several people inthe industry employers in the
(07:47):
industry that I had known for avery long time, that were
innovative, that were creative,that wanted to do better for
their employees, that wanted toget out of traditional health
insurance type arrangements, andI said, hey, listen, if I do
this, if I build this company,would you hire me?
(08:08):
And eight of them said, yeah, wewould hire you.
Two of them actually came onthe first year.
Four of them still have neverbecome a client, right, but they
kind of gave me the comfortthat, okay, yes, there are
people out there who see it theway I see it, who believe in
(08:28):
what I believe in, who want tosolve it, and so that's why I
decided to kind of take the leapand try it.
And it's really been all aboutthat for us finding people of a
like mindset on the same mission, who see things the way we do
in terms of what's broken, andwho are willing to say.
(08:50):
It probably isn't going to beeasy, it's definitely going to
be uncomfortable, it's going tofeel different, but we want to
fix this, we want to takecontrol of it.
Speaker 3 (09:01):
So, Deb, a lot of our listeners have heard the story
now about how it came to be, butthey're wondering how does her
team save money?
Because I have a doctor andI've got a local hospital I go
to and I have an employer with aplan.
I've never seen anybody get inthe way of what I'm doing.
Help us understand themechanics of the vehicle that
(09:22):
you built and how you do sort of, I guess, stop the car or at
least slow it down to make somechanges.
Explain the technicals of howthat works.
Speaker 2 (09:32):
Yeah, in any and every way that people will allow
us to.
So I mean we have an approachof meeting people where they're
at.
So we have a product for fullyinsured groups of meeting people
where they're at.
So we have a product for fullyinsured groups.
We have a product for groupsthat are not fully insured but
they still need a carrier logoon their card to have that
(09:53):
comfort level right.
So how much we can do dependson where that client is at, how
their broker and consultant andadvisor has walked them down the
glide path toward these likeunbundled, transparent, you know
, vanishing, deductible guidedplans, right, where are they at
(10:15):
in that continuum?
So our goal is really to findpeople who have the same mindset
, mission goals, work ethic, youknow, communication strategies
with their employees and partnerup with them and kind of come
down that continuum with them.
There's a ton of technologythat goes into it.
Todd, if you want to get to atotal unbundled health plan and
(10:39):
have maximum control and highestquality and lowest cost, then
we have to take control of thepre-cert function and when we do
that pre-cert function weincorporate navigation into that
.
So if somebody calls and wantsto pre-certify an MRI and the
place of service they'reproposing is the hospital we're
(11:00):
going to call a timeouttechnical foul.
You should not be doing MRIs ina hospital setting the vast
majority of the time.
Now people will tell you thattechnology or a non-clinician
could probably do that, exceptthere are clinical reasons that
you might want to do thatimaging in a hospital setting.
Right, somebody who weighs 700pounds?
(11:22):
They're probably not going tohave the appropriate equipment
in a non-hospital setting forthat imaging.
So that's why we bring nursesinto it.
But we had to build our ownmedical management software
customization to incorporate theMCG evidence-based care
(11:44):
guidelines, which is the sciencebehind what's going to cure
this person.
Where do the benefits outweighthe risk?
That was a key component and wehad to, you know, had to build
everything to accomplish it.
And now we're licensing 40-plusdifferent quality and cost
transparency tools and my nursescan't get out of our system and
(12:07):
go hunting.
Do I look at this one forimaging or do I look at that one
?
This is a hospital in Indianaversus a hospital in California.
Which tool do I use for that?
So we had to build all of thatinto our systems and tools just
for the nurses who do it everyday, all day long to be able to
navigate it, and now we'rebeginning, especially with AI
(12:29):
and some of the other strategiesthat we're able to use, to get
ready to turn that and startmaking that patient facing so I
was going to say.
Speaker 3 (12:39):
I think about how that example of an imaging where
you're really kind of talkingto the employee, let's say the
person trying to get service,directing them somewhere else I
bet those conversations are awhole lot more easy than the
ones where you're talking to theprovider and maybe telling them
that procedure is not necessaryor we need to go about it a
(13:02):
different way.
How does that work?
I mean, you're talking with notonly doctors and nurses in the
facility, but you know theiroffice managers, who think their
doctors walk on water and don'tmake any mistakes.
What leverage do you have?
What ultimate control do youhave?
And then, what soft tools doyou use in order to sort of
navigate the ultimate bestdecision that you feel and know
(13:25):
that this injured or sick personneeds?
Speaker 2 (13:28):
So all of our nurses that work in our call center go
through training in Procheskamethod, motivational
interviewing and basic DaleCarnegie strategy.
The other thing that we do iswe use a natural language
processing artificialintelligence software do is we
use a natural languageprocessing artificial
intelligence software and so itlistens in to every single call
(13:49):
as it's happening.
We've programmed it to walk ourcall center nurses through the
steps of the process.
It listens for key words.
So if, for example, someone issuicidal, homicidal, unsafe, if
someone is cussing on the call,it will automatically pull one
(14:09):
of the call center managers intothat call so that they can
intervene or they can takeaction.
If somebody says a key wordright, they're going to cancel
my procedure it pops up and ittells that nurse procedure.
It pops up and it tells thatnurse here's what to say, here's
the next step to take.
(14:29):
So it guides them through thatprocess of that interaction.
I wouldn't necessarily say it'seasier or harder based on
provider versus patient.
Some patients just want whatthey want when they want it,
wherever they want it from, andthey feel that they are entitled
to that because they have apremium taken out of their
paycheck.
Speaker 1 (14:49):
Yep.
Speaker 2 (14:50):
Others are very open and receptive.
Oh my gosh, you're going tohelp me.
Ooh, you can help me find theplace that I can best afford.
Oh, you know who the gooddoctors are.
You know what the greatfacilities are.
Others embrace it and love it.
Right, it's almost impossibleto predict which one's going to
be which Same thing on theprovider side.
(15:12):
Lots of times we're talking tosomeone in a provider's office
and they're like there's a wayfor this patient to get this
procedure for free.
How do we make that happen?
Oh, you can help me figure outthe place that's going to get
the best coverage for thepatient.
Let me talk about that, right?
So some will embrace it.
Others will be like no, ourpractice is owned by XYZ
(15:36):
Hospital and everything getsdone at XYZ Hospital and we're
not going to order it at theindependent imaging center, no
matter what you say.
And we're not going to order atthe independent imaging center,
no matter what you say.
The more expensive the medicalprocedure or service is and the
more profit that is being madeon that medical procedure or
service, you often find acorrelation to how aggressive
(15:59):
they're going to be about it.
So, chemotherapy we see markups2, 3, 4, 5, 6,000% on those
drugs.
And we'll say to the businessoffice, the physician you know,
wait a minute, this patient'sgoing to get stuck with that
bill.
That is an excessive charge.
That is not reasonable andcustomary.
(16:21):
You know that's not going tofly with a plan, because we know
you're buying this drug for Xright or even less, depending
you might be a 340B.
You might be getting an evenbetter deal than what we think
you're getting on it.
And we'll say to them okay, ifyou won't negotiate that price
to something reasonable, if youwon't, let us have the drug drop
(16:44):
shipped so that we can controlthe cost.
If you won't do any of thesethings, then write a
prescription for the patient andwe'll have a home infusion
company go out and give the drugand they'll refuse to write the
prescription.
No, if you're not going to letus administer it, we won't write
the prescription.
So then we have to go all theway back to okay, now we have to
(17:06):
find a different doctor becausethat doctor's not willing to
write the prescription.
And even when you call the statemedical board, here's the thing
that really is abhorrent youcall the state medical board and
you walk.
The thing that really isabhorrent.
You call the state medicalboard and you walk them through
that situation and they will saythat's a billing issue.
We don't get involved inbilling issues.
(17:26):
No, that's an ethics issue.
We've already diagnosed thispatient, he's already determined
what the appropriate treatmentis and now they're refusing to
help this patient get thattreatment in a way that the
patient can afford.
That's an ethics issue.
That's a greed issue, but we'reseeing it across the country
(17:49):
and we're seeing providers thatare demanding cash up front from
patients who have 100% coverage.
It makes no sense.
The breed has gotten worse thelast 30 years instead of better.
Speaker 1 (18:02):
As you've worked with health plans, and I think it's
fascinating, even before westarted this call, just in
thinking about where you sit,and you mentioned it in your
intro you sit right in betweenhealthcare and a health plan,
which is ridiculous.
That I mean that's a hard placeto sit, but your client really
(18:24):
is the employer.
What would your ask be for allemployers as they're considering
a health plan?
Speaker 2 (18:31):
I think that employers ultimately have to
examine their heart and theirgut and come to some sort of a
conclusion about why are weoffering health insurance as a
benefit?
Because, if we're doing it forthe wrong reasons, right.
(18:51):
If we're not willing to reallyexamine it and make sure that
it's delivering, then should webe doing it at all?
And I know people probablythink that I'm crazy saying that
, but you're really making alife and death decision for your
employees and their familieswhen you pick the health plan.
(19:12):
And so I understand that youwant to focus on making widgets
because that's your corebusiness.
I totally get and understandthat.
But if your employees don't havegood health care, they're not
going to help you accomplishyour widget making mission,
right?
So if you don't want to focuson health care and making it
(19:35):
work, right, you're in a reallytough spot as an employer, right
?
So your competitors areoffering health insurance and
that's the reason you offerhealth insurance.
Well, that's not a good reason,right you know.
So I think they really have toget down to.
What are our goals andobjectives?
What are we trying toaccomplish by offering health
(19:58):
insurance?
Speaker 1 (20:00):
When you say that's a life and death decision, what
do you mean by that?
Speaker 2 (20:04):
So the problem with US health care right now is that
there are major disparities inhealth care.
We all know that in terms ofquality of care, in terms of
cost of care.
You know we have people who areavoiding their medications
because they need to put food onthe table, right.
So even you know, just offeringa traditional status quo kind
(20:30):
of carrier plan has implications.
Right, you're paying for thecare that those people get.
If they get sub quality care,you're paying for them to be
butchered, maimed and killed,and I hate to be overly blunt
about it, but people come out ofthe health care system hurt by
(20:52):
inadequate quality of care,inadequate quality of care, and
so I don't think that peopleunderstand the seriousness of it
.
I'll tell you.
I walk into employers and aquestion that I ask a lot is is
there anybody in your populationwho has cancer?
And always the answer is yes,right.
(21:14):
What has your insurance done tohelp them through that?
Has anybody from the insuranceeven called them and offered to
help them?
Have they talked to them aboutokay, if you're on chemotherapy,
here's all the nutrition andhydration and you can do a cold
cap to avoid losing your hairand has anybody even called them
(21:34):
and said, hey, I might be ableto help you.
No, nobody's called them right.
So to me, as an employer, when Ihave somebody who's going
through a health issue, I wantsomebody to help them, and right
now that's probably somebody inyour HR department or your
C-suite, if anybody is helpingthem right.
(21:56):
And that's an even biggerliability for you to take on
when you're trying to help themand you don't have the tools and
you don't have the resourcesand you're not a clinician.
But you love your employees andyou want to take care of them
and you're not taking good careof them by putting them into
systems that don't give them anykind of advocacy or information
(22:17):
or support into systems thatdon't give them any kind of
advocacy or information orsupport.
Speaker 3 (22:24):
Deb, there's, you know we've seen a flurry of
executive orders out of ourexecutive branch, of our federal
government.
Let's put yourself as the chiefexecutive of all healthcare in
the country.
That position doesn't quiteexist.
Speaker 1 (22:32):
I would love that.
Speaker 3 (22:34):
Yeah, I know she would oh sign me up and let's
assume you did not have to gothrough the legislative
bartering process.
Can you describe what two orthree executive orders that you
would write and sign?
That would help turn the tideon this thing?
Speaker 2 (22:51):
Absolutely.
I would say that everybody whoscores above a certain level on
the MCATs gets 100% scholarshipinto medical school and as long
as they maintain a 3.0 GPA, theykeep that scholarship so that
when they graduate they havezero debt.
Speaker 3 (23:12):
Okay, go ahead Sorry.
Speaker 2 (23:13):
So that they can go into independent practice rather
than becoming an employee of ahospital or a health system go
into independent practice ratherthan becoming an employee of a
hospital or a health system.
And that medical schools arenot allowed to admit anyone with
a lower GPA or a lower MCATscore unless all of the
available seats have been filledby people that are on
(23:33):
scholarship.
Speaker 3 (23:35):
So let's break that down a little bit before we move
to your next executive order.
We are trying to get the bestand brightest the first part
right and the second part.
We're trying to eliminate theindebtedness which then
motivates these new doctors fromgetting basically encumbered in
situations where they'resolving the debt but they're not
(23:55):
actually practicing themedicine.
Speaker 2 (23:57):
Yeah, they're an employee who has gag orders and
who has RBRVU requirements thathave to be met and who have to
do it the way the employer saysto do it.
They're the nurse in the ICUadmitting the patient that
should have never been admittedbecause they don't have the
equipment and the supplies to doit.
Speaker 3 (24:16):
Right, okay.
So what's your next executiveorder?
Speaker 2 (24:18):
look like Well, I would add to the last one
medical schools must teachevidence-based care pathways,
because right now they don't,and they don't teach anything
about the business of healthcareeither.
They don't teach anything aboutinsurance, what it is, how
healthcare gets paid for, whatthings cost.
That is entirely missing fromthe medical curriculum.
(24:41):
So, number one I would attackthe physician and then, once I
got the physician shortagesolved, I would move on to
nurses and therapies and I wouldmove it on down the chain.
Speaker 3 (24:54):
In the same way.
Speaker 2 (24:55):
In the same way.
Speaker 3 (24:56):
Okay, how about a second executive order that
looks a little different,attacks a different problem.
What would it look like?
Speaker 2 (25:02):
So we're all old enough to have been forced to
read the scarlet letter in highschool, right?
Yep?
So you see this lab jacket Yep,a, b, c, d or F above my name.
That tells you my objectivecase mix, adjusted severity,
(25:23):
risk, indexed quality score, sothat when I walk onto a hospital
floor you can see, coming amile away, whether I'm a great
doctor, an okay doctor or ahorrible doctor.
And I want every facility tohave to post at every instant
entrance, just like across thecountry a lot of restaurants
(25:45):
have to post whether they passedthe health.
I want them to have to post A,b, c, d or F, right.
And if their maternity unit isan A plus, that's great.
Put an A plus on the maternityunit door.
If their cardiac surgery unitis an A+, that's great.
Put an A-plus on the maternityunit door.
If their cardiac surgery is anF put an F on the door to the
cardiac surgery unit, right.
(26:05):
I want that plastered everywhereand I want it available over
the internet.
So I want to know as a normalconsumer does this doctor have
medical malpractice lawsuitsagainst them?
Do they have sanctions againsttheir license?
(26:25):
Are they still board certified,right?
I want all of that data in oneplace where I can go.
Is Dr Ben Connor any good, yesor no?
And I want it to look at all ofthose things right.
And I want the A doctorsreimbursed at 100%, the B
doctors reimbursed at 90%, the Cdoctors reimbursed at 70%,
(26:48):
because the way fee-for-servicesystem is rigged the low-quality
doctors make more money thanthe high-quality doctors.
So, what is the motivation tobecome an A plus doctor?
Because when you do that, youbecome an A plus doctor.
You have fewer services beingdelivered to that patient, so
you get less money.
(27:09):
So now you have to do highvolume in order to make the same
amount of money that a lesserquality physician is making on
fewer patients, because he'sgetting to treat the infections
and the readmissions and thecomplications that you're not
treating, because you solved it.
Because you got them healthier,quicker and healthier people
(27:30):
file fewer claims.
Speaker 3 (27:32):
Yeah, you got one last EO to sign here.
What's it say?
Speaker 2 (27:38):
Oh man, I really wish I had five instead of three.
My third one be, I get two more.
Speaker 3 (27:45):
Sure, I was just giving you a pass, thinking you
might not have more, but itsounds like you've got plenty.
Speaker 2 (27:51):
Yeah, I think that I would get rid of two things.
I would get rid of thereception area at every medical
facility doctor's office and Iwould replace it with a kiosk
and I would automate eligibilityand benefit and coverage
(28:13):
information being deliveredreal-time at point of service.
And I would tell hospitals andhealth systems that you can't
turn away someone who is quoteunquote not participating.
You can't say we only take XYZhealth plan patients.
(28:33):
If a patient walks in your door, you have to take them, you
have to treat them.
You have to treat them, figureout the money on the back end
right, check their eligibility,check their benefits, but you
can't turn somebody away becauseyou don't like the kind of
insurance they're on.
That, to me, is ridiculous.
Speaker 1 (28:53):
Unencumbering the system of networks and the waste
that that is.
Speaker 2 (29:00):
Absolutely, absolutely.
If I had a fourth one, I wouldmandate that everyone who bills
for any kind of medicalprocedure or service has to have
a clear breakdown of what theactual cost of delivering that
care is down, of what the actualcost of delivering that care is
(29:25):
, and that what they charge canbe based on two things the cost
of care and the quality of care.
So if you have a very low costof care and a very high quality
of care, that's great.
I want to reward thatfinancially.
If you have a very low cost ofcare and a very low quality of
care, I want to eliminate thatright.
(29:47):
No, no, no, we don't want thatright.
If you have a low quality and ahigh cost, we don't want that
right.
So, but the problem ishealthcare providers and
facilities.
They don't even reallyunderstand what the actual cost
of care is.
When I call a facility and Italk about a knee replacement
(30:12):
and I have gone to Smith andNephew's website and I see what
the prosthesis is going to costthey don't even know that number
, right?
I'm like, wait a minute.
Why are you charging 30 grandfor this when the prosthesis
only cost eight grand?
What do you mean?
It only costs eight grand.
(30:33):
Well, I'm sitting here lookingat the website and their
published price.
Is this right?
How come I can go to Amazon andfind that back brace for $25,
but you're wanting to charge 500for it?
I know you're buying it for 25or less because Amazon isn't
losing money when they sell it,right.
(30:54):
But practitioners have no clue.
Hospitals, health systems haveno clue what the actual cost of
care is and they want to wrapall kinds of fun stuff into
their cost of care.
Like you know, maintaining thefountain at the entrance and
valet parking in the fine artcollection and the piano player
in the lobby, and all thosethings are wonderful and lovely
(31:17):
and, as a patient, great If youare looking for the four seasons
experience.
But those are not cost of care.
Right, we've kind of lost touchwith what is necessary to
deliver this care and what doesit cost.
Speaker 1 (31:35):
How are insurance companies putting, how are they
involved in the mix for, maybeinfluencing facility, bad
behavior or even a drain on thesystem?
Bad behavior or even a drain onthe system.
What's your take on insurancecompanies' connectivity to what
you just mentioned or, just ingeneral, other problems?
Speaker 2 (32:02):
Well, I think we all know that there's one insurance
company that is the largestemployer of physicians in the
country.
Right, we've all seen whathappens when insurance companies
buy the pharmacy benefitmanagers or get bought by the
pharmacy benefit managers.
I think if you, years and yearsand years ago, watched oh, it
was a comedy skit I can'tremember the name off the top of
(32:24):
my head, but he gets shot withan arrow and he's talking about
how much does it cost?
And oh, doggone it, it'll cometo me.
But you almost have to thinkthat they're in a back room
somewhere winking and noddingand colluding right, and MLR
ratios made that so much worse.
So I don't know.
(32:46):
I've never worked for aninsurance company per se.
I've always worked for thirdparty administrators or on my
own on behalf of self-fundedemployers.
So I don't have a lot ofinsight there, but I just know
that it's not working.
The cost of care, and I wouldthink if anybody could do
(33:11):
something about it Blue Cross,united, cigna, aetna, to some
extent Humana, would have donesomething about it.
If they could, they would have.
The only reason they wouldn'thave is there is some motivation
to not fix it, because if I canfix it and we're fixing it for
(33:32):
companies across the countryright, hundreds of employers who
have found essentially,healthcare nirvana.
It takes a while to get thereright, it's painful, there's
some noise, there's a lot ofwork to get there, but once you
get one of these cutting edgeplans in and it's working well,
(33:54):
get one of these cutting edgeplans in and it's working well,
the solution exists.
So I can't understand why thecarriers haven't embraced the
solution.
There's something there that wecan't see or uncover.
Speaker 1 (34:02):
Yeah, no profit in the cure?
I don't think, unfortunately.
But a question for you isthere's a few books behind you
with your picture on it andyou've been really outspoken
about the ethics of comingalongside someone for good
(34:24):
health care and protecting themfrom danger and you mentioned
that even earlier in the podcastprotecting them from danger,
and you mentioned that evenearlier in the podcast.
Speaker 2 (34:36):
You've stepped out in courage and potentially even
received a lot of flack for that.
Why do you do that?
I would want somebody to do itfor me.
I would want somebody to do itfor my spouse, my children, my
grandchildren.
And the bigger problem is therecomes a point in time where good
enough is not good enough.
Right and that's probably thebiggest criticism that I get
personally is constantlystriving for perfection, and the
(35:02):
noise and the inconvenience andthe alarm that goes into
calling a timeout right andsaying whoa, whoa, whoa, pause.
This is not the best care, thisis not the best place, this is
not the best provider.
Some people are much happierburying their head in the sand,
(35:24):
but I wouldn't be able to sleepat night if I let one of my
patients that I'm working withor that I'm responsible for
caring for be harmed by gettingsomething less than the best.
Now, if the patient makes adecision and often they do right
our success rate in navigationis 84% across our book of
(35:47):
business.
That means 16% of the time Ifail and the patient chooses to
go someplace that's lowerquality, or chooses to get care
or a treatment that is not the Aplus, it's the B minus.
At that point, okay, thepatient made a decision.
They have free will andautonomy to do that, but at
(36:10):
least I know they did it armedwith the information.
Speaker 1 (36:14):
How has that percentage changed over time?
Speaker 2 (36:17):
It's gotten higher, right?
The other thing that I willtell you is, as employers have
begun to embrace this and havebegun to understand it and have
begun to offer incentives, thathas helped quite a bit.
But there are still someemployers that we send out every
two weeks we send outmember-facing promo materials
(36:40):
and we can track how often thoseare opened at the employer
level.
Like, did HR open them and sendthem out?
Well, if 80% of the timethey're not even opening the
message it's not getting out tothe employees.
And then, because they haven'tbeen prepped with these, nurses
love you, they're here to helpyou, they can help in this way
(37:02):
and that way and you know theyhaven't gotten the positive buzz
going.
And let's face it, the onlything that people hate more than
insurance companies are cablecompanies, right?
So if their insurance companyis calling them saying let me
help you, it's kind of like, youknow, a Native American
skepticism about the governmentcoming to help, right, that
(37:26):
doesn't go together.
So there's a lot of work thathas to go into preparing
employers and the employees inthese kinds of plans.
They have to understand themotivation behind it.
But if you went out today andsurveyed your employees and said
how many of you have heard ahealthcare horror story?
(37:47):
How many of you have been thevictim of a healthcare horror
story you or your family?
You would be amazed at thehands that go up when you ask
those questions and would youlike a resource to help do
something about that, to preventthat.
Everybody in concept thinks thatit's good when they're in the
(38:09):
throes of a medical situationand they're emotional and
they're upset and they're scaredand they believe that time is
of the essence.
Calling a time out in themiddle of that can be
disconcerting and the only thingwe can do is approach that
empathetically and to feelconfident that, listen, we have
(38:32):
a responsibility to do this andto kind of protect you from the
things that you don't even knowyou need protected from.
Speaker 3 (38:42):
A lot of people will say when a friend or family has
a sickness, they'll say, well,you need a patient advocate, you
need someone to go to thedoctor with you, which is 100%
true.
But, as you and I know, thereare some of our friends that
would be better than others inthat room.
Some are just note-taking andthey're not pushing, they're not
asking clarifying questions,because when you're that sick
(39:05):
person, you might be still onmedication and not thinking
clearly.
You just don't feel well, youdon't feel like asking questions
, you just want to get better.
What I think about what AIMdoes is you are that patient
advocate.
While you may not literally bethe physical person in the room,
you're probably better becauseyou have more knowledge, more
expertise.
(39:25):
You know where to go to get theanswers.
I've seen you in action in acouple different settings One,
of course, in the movie and thenjust as a client.
We've worked with your team andwhenever I think about you, the
phrase righteous indignationcomes to mind, and I mean that
in the most positive way.
And I feel like when youapproach these things, you do
(39:45):
have this righteous indignationthat you want to fix it, you
want to make it right.
So a personal question for youWhere's that come from?
Was that mom or was that dad?
Speaker 2 (39:56):
Oh boy, probably a good combination of the two.
It's interesting that you callit righteous indignation,
because after my small groupfrom Bible study saw the
documentary, the first thing mypastor said to me was the
documentary.
Speaker 3 (40:13):
The first thing my pastor said to me, was you
cussed on a national television?
I was mad.
Speaker 2 (40:18):
Yes, yes, I did.
It wasn't my best moment, but Iwas really upset about it.
And you know, just for clarity,that patient was in his 30s.
(40:46):
He had lost his wife to COVID.
He had been ignoring a massivewere supposed to be caring for
him and taking care of him andhelping him and prolonging his
life, wanted to leave his twochildren as bankrupt orphans,
cause that's the path that wholescenario was heading down.
(41:07):
Right now you tell me anybodywho has any kind of wherewithal
at all who would not beindignant about that and upset
by it.
Everybody but it happens everyday, every day in our US
healthcare system, thosescenarios play out.
Speaker 3 (41:28):
Well, my encouragement to you is I know
you are teaching your team themechanics of how to work through
the system, but if you can alsoimpart on them just a little
bit of that righteous thing, theindignation, we might actually
have a fighting chance.
Speaker 2 (41:42):
There you go.
That's the part that AI willnever be able to capture.
Speaker 1 (42:05):
That's right.
That's been a significant highsof highs.
But also family business can bedifficult.
But since we're kind of at theend of our time, we'd like to
ask our guests two questions.
The first question is what is arisk that you have taken that
has changed your life?
Speaker 2 (42:24):
Besides cussing on national documentary I think you
know starting the business, allthose things that we've been
talking about but really, everyday, we take risk for our
patients.
We know that a customer canfire us, an employer can fire us
at any point in time.
Speaker 3 (42:43):
So, being committed to our moral compass, Committed
to our moral compass, regardlessof the risk that it might have,
regardless of the money that wemight lose by staying committed
(43:05):
to.
That is probably the biggestrisk that I continue to take
every day, and the second andfinal question what's unfinished
?
Speaker 2 (43:09):
that you have the resolve to complete.
That you have the resolve tocomplete.
We definitely need a wholenother session, because AI and
healthcare and getting into thehands of the patient the
information about what the bestcare is, who the best providers
for that care are, and reversingthe mindset of how people
(43:29):
purchase healthcare, especiallyin the fee-for-service system,
and getting them to understandthat higher quality is cheaper
that is something that I really,really want to resolve.
Speaker 1 (43:41):
It's awesome.
A lot of work to still be done,that is for sure.
Nurse Deb famously Nurse Debthanks for joining us today and
thank you all for listening.
Have a good one.
Speaker 3 (43:53):
Thanks for tuning in to Risk and Resolve.
See you next time.
You're listening to Risk and Resolve, and now for
your hosts, ben Conner and ToddHufford.
Welcome back to another episodeof Risk and Resolve with your
co-host, ben and Todd.
And today we have a veryspecial guest, deb Alt, who has
a wonderful brand around NurseDeb nation, famous Nurse Deb.
(00:27):
Thanks for being with us today.
Speaker 2 (00:29):
Thanks for having me Happy to be here.
Speaker 1 (00:31):
Yeah, deb is the founder of AIM, alt
International Medical Management.
It's a company focused onproactive medical management,
and there's a key word in there,I feel like.
Speaker 2 (00:43):
Proactive, yeah, yeah there are three key words, but
management is's a key word inthere.
I feel like Proactive, yeah.
Yeah, there are three key words, but management is also another
key word.
Speaker 1 (00:50):
Fair, fair, deb.
Can you give our listeners,viewers, a sketch of AIM and
what you guys do on a day in andday out basis?
Speaker 2 (01:01):
Yeah, absolutely Happy to do that.
So my company is a team ofnurses and doctors.
We come alongside patients,primarily telephonically
although we're expanding thatout recently and we help guide
them through the two mostcumbersome ecosystems in the
universe the health caredelivery system.
So what care is the goldstandard of care?
(01:23):
When should I be getting it?
Where should I be going to getit?
And the health plan system.
Oh my golly, how do I avoidbankrupting my family, my
employer, as I'm going throughthis health event?
So we navigate those two pieceswith them and get them as
healthy as possible, as quicklyas possible.
Speaker 1 (01:43):
God bless your team for doing it too.
That's hard work.
What was the genesis or thereason for you wanting to start
AIM Like?
What's the story behind that oflike, hey, I just, I really
want to start a company thatdeals with the two most
difficult things on the planet.
Speaker 2 (02:02):
I did not want to start a company to do that.
Speaker 1 (02:06):
Let's hear it.
Speaker 2 (02:14):
So this magazine back here actually has the whole
story if anybody cares enough toread it.
But I was a bedside nurse.
I was a ER ICU, predominantlynight shift, predominantly
weekend kind of nurse.
Knew from the time I was bornessentially, essentially that I
wanted to be in medicine,discovered that being a doctor
was probably not the rightanswer for me once I became a
candy striper and saw whatdoctors actually had to do and I
(02:36):
didn't want to live in ahospital.
I wanted to go work at ahospital and go home and have a
family and, you know, do someother things as well.
The problem is, about 30 yearsago now I was working in an ICU
and we had a patient and weshould not have admitted that
patient to our ICU.
We didn't have all the rightequipment, we didn't have the
(02:57):
right skillset.
We reluctantly admitted him tostabilize him so he could be
transferred, and the hospitalchose not to transfer him.
He actually ended up passingaway and it became really
apparent to me in a conversationwith my unit manager when she
(03:18):
finally I mean I was hysterical,I was sobbing, you know when
she called me and said you don'thave to come in tonight and I
was like, oh good, youtransferred him.
She's like no, he passed awaytoday and I lost it.
And she finally, you know, inher attempts to settle me down,
said probably the one thing thatwas more true than anything
(03:38):
else she'd said.
She said do you know how muchmoney we would have lost if we
would have transferred him?
And that was kind of thepivotal moment for me that wait
a minute, we're making life anddeath decisions based on money.
That is not what I signed upfor.
That is not why I became anurse.
(03:58):
I'm not count me out right, butwhat am I going to do?
This is, you know what I feellike I've been called to do.
And so my husband, kind of oncehe dug me out from the couch
cushions in my deep depressionsaid you've got to apply for
this job.
I had a master's in business,minor in math and statistics,
(04:19):
and he said you've got to goapply for this managed care
position.
And I was like no, no, no.
Managed care is evil.
It's all their fault.
You know, they're the ones thatare cutting the money and the
funding so that hospitals can'tafford equipment.
And he's like we need an income, apply for this job.
(04:39):
So that's how I wound up inmanaged care.
And then, as you guys know, inour industry mergers and
acquisitions are rampant, right.
And so finally, it got to thepoint where wait a minute if
somebody is going to do this theright way, we're going to have
to do it ourselves, you know.
We're going to have to take theleap.
(05:00):
No TPA is going to let medicalmanagement be done the right way
, because they have a vestedinterest in different things,
right?
So actually, it was very muchto my chagrin that I started the
company, you know, 20 plusyears ago, but somebody had to
do it and nobody was doing it,and so that's how I wound up
(05:23):
here.
Speaker 1 (05:24):
So you stepped into a calling.
It sounds like.
Speaker 2 (05:27):
I think so.
Yeah, unbeknowing at the time,right, but what nurse?
I had an associate's degree innursing and when I was working
at Ohio State University theyoffered free tuition.
And so I'm like what's theclass that weeds everybody out
when they're trying to get theirbachelor's in nursing
(05:48):
Statistics?
Let me take that class first.
By the way, I hated math up tothat point and a TA made it make
sense for me.
So every quarter I would lookat what math class he was taking
and I'd go take it because Iwas like actually enjoying and
learning math.
And then eventually it's likewait a minute, you have enough
(06:08):
credits to graduate.
We need to kick you off thetuition reimbursement.
And so they graduated me outwith a bachelor's in business
and a minor in math andstatistics.
And then I was like, okay,business, that's it Right.
And then, when this allhappened with at the bedside, I
was like okay, business, that'sit right.
And then, when this allhappened at the bedside, I was
like somebody's got to takecontrol of the purse strings.
(06:31):
Somebody with some ethics andsome morals and who actually
cares about patients has to takecontrol of the money.
That's the only way we're goingto fix the business of
healthcare.
Speaker 1 (06:43):
So you hang a shingle with AIM and register with the
state of Ohio and you're like,okay, we're going to do this,
we're going to solve healthcare.
Now, where's all the clients?
Like how did all that startright?
Like there's a dream, and thenthere's a reality of like we
have to fit ourselves into thishealthcare ecosystem.
Speaker 2 (07:05):
Yeah, that is still the hard part, in reality.
It's interesting because whenmy husband said, let's just do
this for ourselves, right, thepivotal moment, we'll just build
our own company.
First I asked him if he hadsomehow gotten into some drugs
or something, because he didn'tknow what he was talking about,
about starting our own company.
(07:26):
And then I asked him how muchmoney do you have?
Because it's going to take aquarter of a million dollars to
start this company.
He had 12 grand, by the way,and then I said, well, you know,
we spend the 12 grand and wehave to go to work for somebody
else.
We might as well try.
So I called several people inthe industry employers in the
(07:47):
industry that I had known for avery long time, that were
innovative, that were creative,that wanted to do better for
their employees, that wanted toget out of traditional health
insurance type arrangements, andI said, hey, listen, if I do
this, if I build this company,would you hire me?
(08:08):
And eight of them said, yeah, wewould hire you.
Two of them actually came onthe first year.
Four of them still have neverbecome a client, right, but they
kind of gave me the comfortthat, okay, yes, there are
people out there who see it theway I see it, who believe in
(08:28):
what I believe in, who want tosolve it, and so that's why I
decided to kind of take the leapand try it.
And it's really been all aboutthat for us finding people of a
like mindset on the same mission, who see things the way we do
in terms of what's broken, andwho are willing to say.
(08:50):
It probably isn't going to beeasy, it's definitely going to
be uncomfortable, it's going tofeel different, but we want to
fix this, we want to takecontrol of it.
Speaker 3 (09:01):
So, Deb, a lot of our listeners have heard the story
now about how it came to be, butthey're wondering how does her
team save money?
Because I have a doctor andI've got a local hospital I go
to and I have an employer with aplan.
I've never seen anybody get inthe way of what I'm doing.
Help us understand themechanics of the vehicle that
(09:22):
you built and how you do sort of, I guess, stop the car or at
least slow it down to make somechanges.
Explain the technicals of howthat works.
Speaker 2 (09:32):
Yeah, in any and every way that people will allow
us to.
So I mean we have an approachof meeting people where they're
at.
So we have a product for fullyinsured groups of meeting people
where they're at.
So we have a product for fullyinsured groups.
We have a product for groupsthat are not fully insured but
they still need a carrier logoon their card to have that
(09:53):
comfort level right.
So how much we can do dependson where that client is at, how
their broker and consultant andadvisor has walked them down the
glide path toward these likeunbundled, transparent, you know
, vanishing, deductible guidedplans, right, where are they at
(10:15):
in that continuum?
So our goal is really to findpeople who have the same mindset
, mission goals, work ethic, youknow, communication strategies
with their employees and partnerup with them and kind of come
down that continuum with them.
There's a ton of technologythat goes into it.
Todd, if you want to get to atotal unbundled health plan and
(10:39):
have maximum control and highestquality and lowest cost, then
we have to take control of thepre-cert function and when we do
that pre-cert function weincorporate navigation into that
.
So if somebody calls and wantsto pre-certify an MRI and the
place of service they'reproposing is the hospital we're
(11:00):
going to call a timeouttechnical foul.
You should not be doing MRIs ina hospital setting the vast
majority of the time.
Now people will tell you thattechnology or a non-clinician
could probably do that, exceptthere are clinical reasons that
you might want to do thatimaging in a hospital setting.
Right, somebody who weighs 700pounds?
(11:22):
They're probably not going tohave the appropriate equipment
in a non-hospital setting forthat imaging.
So that's why we bring nursesinto it.
But we had to build our ownmedical management software
customization to incorporate theMCG evidence-based care
(11:44):
guidelines, which is the sciencebehind what's going to cure
this person.
Where do the benefits outweighthe risk?
That was a key component and wehad to, you know, had to build
everything to accomplish it.
And now we're licensing 40-plusdifferent quality and cost
transparency tools and my nursescan't get out of our system and
(12:07):
go hunting.
Do I look at this one forimaging or do I look at that one
?
This is a hospital in Indianaversus a hospital in California.
Which tool do I use for that?
So we had to build all of thatinto our systems and tools just
for the nurses who do it everyday, all day long to be able to
navigate it, and now we'rebeginning, especially with AI
(12:29):
and some of the other strategiesthat we're able to use, to get
ready to turn that and startmaking that patient facing so I
was going to say.
Speaker 3 (12:39):
I think about how that example of an imaging where
you're really kind of talkingto the employee, let's say the
person trying to get service,directing them somewhere else I
bet those conversations are awhole lot more easy than the
ones where you're talking to theprovider and maybe telling them
that procedure is not necessaryor we need to go about it a
(13:02):
different way.
How does that work?
I mean, you're talking with notonly doctors and nurses in the
facility, but you know theiroffice managers, who think their
doctors walk on water and don'tmake any mistakes.
What leverage do you have?
What ultimate control do youhave?
And then, what soft tools doyou use in order to sort of
navigate the ultimate bestdecision that you feel and know
(13:25):
that this injured or sick personneeds?
Speaker 2 (13:28):
So all of our nurses that work in our call center go
through training in Procheskamethod, motivational
interviewing and basic DaleCarnegie strategy.
The other thing that we do iswe use a natural language
processing artificialintelligence software do is we
use a natural languageprocessing artificial
intelligence software and so itlistens in to every single call
(13:49):
as it's happening.
We've programmed it to walk ourcall center nurses through the
steps of the process.
It listens for key words.
So if, for example, someone issuicidal, homicidal, unsafe, if
someone is cussing on the call,it will automatically pull one
(14:09):
of the call center managers intothat call so that they can
intervene or they can takeaction.
If somebody says a key wordright, they're going to cancel
my procedure it pops up and ittells that nurse procedure.
It pops up and it tells thatnurse here's what to say, here's
the next step to take.
(14:29):
So it guides them through thatprocess of that interaction.
I wouldn't necessarily say it'seasier or harder based on
provider versus patient.
Some patients just want whatthey want when they want it,
wherever they want it from, andthey feel that they are entitled
to that because they have apremium taken out of their
paycheck.
Speaker 1 (14:49):
Yep.
Speaker 2 (14:50):
Others are very open and receptive.
Oh my gosh, you're going tohelp me.
Ooh, you can help me find theplace that I can best afford.
Oh, you know who the gooddoctors are.
You know what the greatfacilities are.
Others embrace it and love it.
Right, it's almost impossibleto predict which one's going to
be which Same thing on theprovider side.
(15:12):
Lots of times we're talking tosomeone in a provider's office
and they're like there's a wayfor this patient to get this
procedure for free.
How do we make that happen?
Oh, you can help me figure outthe place that's going to get
the best coverage for thepatient.
Let me talk about that, right?
So some will embrace it.
Others will be like no, ourpractice is owned by XYZ
(15:36):
Hospital and everything getsdone at XYZ Hospital and we're
not going to order it at theindependent imaging center, no
matter what you say.
And we're not going to order atthe independent imaging center,
no matter what you say.
The more expensive the medicalprocedure or service is and the
more profit that is being madeon that medical procedure or
service, you often find acorrelation to how aggressive
(15:59):
they're going to be about it.
So, chemotherapy we see markups2, 3, 4, 5, 6,000% on those
drugs.
And we'll say to the businessoffice, the physician you know,
wait a minute, this patient'sgoing to get stuck with that
bill.
That is an excessive charge.
That is not reasonable andcustomary.
(16:21):
You know that's not going tofly with a plan, because we know
you're buying this drug for Xright or even less, depending
you might be a 340B.
You might be getting an evenbetter deal than what we think
you're getting on it.
And we'll say to them okay, ifyou won't negotiate that price
to something reasonable, if youwon't, let us have the drug drop
(16:44):
shipped so that we can controlthe cost.
If you won't do any of thesethings, then write a
prescription for the patient andwe'll have a home infusion
company go out and give the drugand they'll refuse to write the
prescription.
No, if you're not going to letus administer it, we won't write
the prescription.
So then we have to go all theway back to okay, now we have to
(17:06):
find a different doctor becausethat doctor's not willing to
write the prescription.
And even when you call the statemedical board, here's the thing
that really is abhorrent youcall the state medical board and
you walk.
The thing that really isabhorrent.
You call the state medicalboard and you walk them through
that situation and they will saythat's a billing issue.
We don't get involved inbilling issues.
(17:26):
No, that's an ethics issue.
We've already diagnosed thispatient, he's already determined
what the appropriate treatmentis and now they're refusing to
help this patient get thattreatment in a way that the
patient can afford.
That's an ethics issue.
That's a greed issue, but we'reseeing it across the country
(17:49):
and we're seeing providers thatare demanding cash up front from
patients who have 100% coverage.
It makes no sense.
The breed has gotten worse thelast 30 years instead of better.
Speaker 1 (18:02):
As you've worked with health plans, and I think it's
fascinating, even before westarted this call, just in
thinking about where you sit,and you mentioned it in your
intro you sit right in betweenhealthcare and a health plan,
which is ridiculous.
That I mean that's a hard placeto sit, but your client really
(18:24):
is the employer.
What would your ask be for allemployers as they're considering
a health plan?
Speaker 2 (18:31):
I think that employers ultimately have to
examine their heart and theirgut and come to some sort of a
conclusion about why are weoffering health insurance as a
benefit?
Because, if we're doing it forthe wrong reasons, right.
(18:51):
If we're not willing to reallyexamine it and make sure that
it's delivering, then should webe doing it at all?
And I know people probablythink that I'm crazy saying that
, but you're really making alife and death decision for your
employees and their familieswhen you pick the health plan.
(19:12):
And so I understand that youwant to focus on making widgets
because that's your corebusiness.
I totally get and understandthat.
But if your employees don't havegood health care, they're not
going to help you accomplishyour widget making mission,
right?
So if you don't want to focuson health care and making it
(19:35):
work, right, you're in a reallytough spot as an employer, right
?
So your competitors areoffering health insurance and
that's the reason you offerhealth insurance.
Well, that's not a good reason,right you know.
So I think they really have toget down to.
What are our goals andobjectives?
What are we trying toaccomplish by offering health
(19:58):
insurance?
Speaker 1 (20:00):
When you say that's a life and death decision, what
do you mean by that?
Speaker 2 (20:04):
So the problem with US health care right now is that
there are major disparities inhealth care.
We all know that in terms ofquality of care, in terms of
cost of care.
You know we have people who areavoiding their medications
because they need to put food onthe table, right.
So even you know, just offeringa traditional status quo kind
(20:30):
of carrier plan has implications.
Right, you're paying for thecare that those people get.
If they get sub quality care,you're paying for them to be
butchered, maimed and killed,and I hate to be overly blunt
about it, but people come out ofthe health care system hurt by
(20:52):
inadequate quality of care,inadequate quality of care, and
so I don't think that peopleunderstand the seriousness of it
.
I'll tell you.
I walk into employers and aquestion that I ask a lot is is
there anybody in your populationwho has cancer?
And always the answer is yes,right.
(21:14):
What has your insurance done tohelp them through that?
Has anybody from the insuranceeven called them and offered to
help them?
Have they talked to them aboutokay, if you're on chemotherapy,
here's all the nutrition andhydration and you can do a cold
cap to avoid losing your hairand has anybody even called them
(21:34):
and said, hey, I might be ableto help you.
No, nobody's called them right.
So to me, as an employer, when Ihave somebody who's going
through a health issue, I wantsomebody to help them, and right
now that's probably somebody inyour HR department or your
C-suite, if anybody is helpingthem right.
(21:56):
And that's an even biggerliability for you to take on
when you're trying to help themand you don't have the tools and
you don't have the resourcesand you're not a clinician.
But you love your employees andyou want to take care of them
and you're not taking good careof them by putting them into
systems that don't give them anykind of advocacy or information
(22:17):
or support into systems thatdon't give them any kind of
advocacy or information orsupport.
Speaker 3 (22:24):
Deb, there's, you know we've seen a flurry of
executive orders out of ourexecutive branch, of our federal
government.
Let's put yourself as the chiefexecutive of all healthcare in
the country.
That position doesn't quiteexist.
Speaker 1 (22:32):
I would love that.
Speaker 3 (22:34):
Yeah, I know she would oh sign me up and let's
assume you did not have to gothrough the legislative
bartering process.
Can you describe what two orthree executive orders that you
would write and sign?
That would help turn the tideon this thing?
Speaker 2 (22:51):
Absolutely.
I would say that everybody whoscores above a certain level on
the MCATs gets 100% scholarshipinto medical school and as long
as they maintain a 3.0 GPA, theykeep that scholarship so that
when they graduate they havezero debt.
Speaker 3 (23:12):
Okay, go ahead Sorry.
Speaker 2 (23:13):
So that they can go into independent practice rather
than becoming an employee of ahospital or a health system go
into independent practice ratherthan becoming an employee of a
hospital or a health system.
And that medical schools arenot allowed to admit anyone with
a lower GPA or a lower MCATscore unless all of the
available seats have been filledby people that are on
(23:33):
scholarship.
Speaker 3 (23:35):
So let's break that down a little bit before we move
to your next executive order.
We are trying to get the bestand brightest the first part
right and the second part.
We're trying to eliminate theindebtedness which then
motivates these new doctors fromgetting basically encumbered in
situations where they'resolving the debt but they're not
(23:55):
actually practicing themedicine.
Speaker 2 (23:57):
Yeah, they're an employee who has gag orders and
who has RBRVU requirements thathave to be met and who have to
do it the way the employer saysto do it.
They're the nurse in the ICUadmitting the patient that
should have never been admittedbecause they don't have the
equipment and the supplies to doit.
Speaker 3 (24:16):
Right, okay.
So what's your next executiveorder?
Speaker 2 (24:18):
look like Well, I would add to the last one
medical schools must teachevidence-based care pathways,
because right now they don't,and they don't teach anything
about the business of healthcareeither.
They don't teach anything aboutinsurance, what it is, how
healthcare gets paid for, whatthings cost.
That is entirely missing fromthe medical curriculum.
(24:41):
So, number one I would attackthe physician and then, once I
got the physician shortagesolved, I would move on to
nurses and therapies and I wouldmove it on down the chain.
Speaker 3 (24:54):
In the same way.
Speaker 2 (24:55):
In the same way.
Speaker 3 (24:56):
Okay, how about a second executive order that
looks a little different,attacks a different problem.
What would it look like?
Speaker 2 (25:02):
So we're all old enough to have been forced to
read the scarlet letter in highschool, right?
Yep?
So you see this lab jacket Yep,a, b, c, d or F above my name.
That tells you my objectivecase mix, adjusted severity,
(25:23):
risk, indexed quality score, sothat when I walk onto a hospital
floor you can see, coming amile away, whether I'm a great
doctor, an okay doctor or ahorrible doctor.
And I want every facility tohave to post at every instant
entrance, just like across thecountry a lot of restaurants
(25:45):
have to post whether they passedthe health.
I want them to have to post A,b, c, d or F, right.
And if their maternity unit isan A plus, that's great.
Put an A plus on the maternityunit door.
If their cardiac surgery unitis an A+, that's great.
Put an A-plus on the maternityunit door.
If their cardiac surgery is anF put an F on the door to the
cardiac surgery unit, right.
(26:05):
I want that plastered everywhereand I want it available over
the internet.
So I want to know as a normalconsumer does this doctor have
medical malpractice lawsuitsagainst them?
Do they have sanctions againsttheir license?
(26:25):
Are they still board certified,right?
I want all of that data in oneplace where I can go.
Is Dr Ben Connor any good, yesor no?
And I want it to look at all ofthose things right.
And I want the A doctorsreimbursed at 100%, the B
doctors reimbursed at 90%, the Cdoctors reimbursed at 70%,
(26:48):
because the way fee-for-servicesystem is rigged the low-quality
doctors make more money thanthe high-quality doctors.
So, what is the motivation tobecome an A plus doctor?
Because when you do that, youbecome an A plus doctor.
You have fewer services beingdelivered to that patient, so
you get less money.
(27:09):
So now you have to do highvolume in order to make the same
amount of money that a lesserquality physician is making on
fewer patients, because he'sgetting to treat the infections
and the readmissions and thecomplications that you're not
treating, because you solved it.
Because you got them healthier,quicker and healthier people
(27:30):
file fewer claims.
Speaker 3 (27:32):
Yeah, you got one last EO to sign here.
What's it say?
Speaker 2 (27:38):
Oh man, I really wish I had five instead of three.
My third one be, I get two more.
Speaker 3 (27:45):
Sure, I was just giving you a pass, thinking you
might not have more, but itsounds like you've got plenty.
Speaker 2 (27:51):
Yeah, I think that I would get rid of two things.
I would get rid of thereception area at every medical
facility doctor's office and Iwould replace it with a kiosk
and I would automate eligibilityand benefit and coverage
(28:13):
information being deliveredreal-time at point of service.
And I would tell hospitals andhealth systems that you can't
turn away someone who is quoteunquote not participating.
You can't say we only take XYZhealth plan patients.
(28:33):
If a patient walks in your door, you have to take them, you
have to treat them.
You have to treat them, figureout the money on the back end
right, check their eligibility,check their benefits, but you
can't turn somebody away becauseyou don't like the kind of
insurance they're on.
That, to me, is ridiculous.
Speaker 1 (28:53):
Unencumbering the system of networks and the waste
that that is.
Speaker 2 (29:00):
Absolutely, absolutely.
If I had a fourth one, I wouldmandate that everyone who bills
for any kind of medicalprocedure or service has to have
a clear breakdown of what theactual cost of delivering that
care is down, of what the actualcost of delivering that care is
(29:25):
, and that what they charge canbe based on two things the cost
of care and the quality of care.
So if you have a very low costof care and a very high quality
of care, that's great.
I want to reward thatfinancially.
If you have a very low cost ofcare and a very low quality of
care, I want to eliminate thatright.
(29:47):
No, no, no, we don't want thatright.
If you have a low quality and ahigh cost, we don't want that
right.
So, but the problem ishealthcare providers and
facilities.
They don't even reallyunderstand what the actual cost
of care is.
When I call a facility and Italk about a knee replacement
(30:12):
and I have gone to Smith andNephew's website and I see what
the prosthesis is going to costthey don't even know that number
, right?
I'm like, wait a minute.
Why are you charging 30 grandfor this when the prosthesis
only cost eight grand?
What do you mean?
It only costs eight grand.
(30:33):
Well, I'm sitting here lookingat the website and their
published price.
Is this right?
How come I can go to Amazon andfind that back brace for $25,
but you're wanting to charge 500for it?
I know you're buying it for 25or less because Amazon isn't
losing money when they sell it,right.
(30:54):
But practitioners have no clue.
Hospitals, health systems haveno clue what the actual cost of
care is and they want to wrapall kinds of fun stuff into
their cost of care.
Like you know, maintaining thefountain at the entrance and
valet parking in the fine artcollection and the piano player
in the lobby, and all thosethings are wonderful and lovely
(31:17):
and, as a patient, great If youare looking for the four seasons
experience.
But those are not cost of care.
Right, we've kind of lost touchwith what is necessary to
deliver this care and what doesit cost.
Speaker 1 (31:35):
How are insurance companies putting, how are they
involved in the mix for, maybeinfluencing facility, bad
behavior or even a drain on thesystem?
Bad behavior or even a drain onthe system.
What's your take on insurancecompanies' connectivity to what
you just mentioned or, just ingeneral, other problems?
Speaker 2 (32:02):
Well, I think we all know that there's one insurance
company that is the largestemployer of physicians in the
country.
Right, we've all seen whathappens when insurance companies
buy the pharmacy benefitmanagers or get bought by the
pharmacy benefit managers.
I think if you, years and yearsand years ago, watched oh, it
was a comedy skit I can'tremember the name off the top of
(32:24):
my head, but he gets shot withan arrow and he's talking about
how much does it cost?
And oh, doggone it, it'll cometo me.
But you almost have to thinkthat they're in a back room
somewhere winking and noddingand colluding right, and MLR
ratios made that so much worse.
So I don't know.
(32:46):
I've never worked for aninsurance company per se.
I've always worked for thirdparty administrators or on my
own on behalf of self-fundedemployers.
So I don't have a lot ofinsight there, but I just know
that it's not working.
The cost of care, and I wouldthink if anybody could do
(33:11):
something about it Blue Cross,united, cigna, aetna, to some
extent Humana, would have donesomething about it.
If they could, they would have.
The only reason they wouldn'thave is there is some motivation
to not fix it, because if I canfix it and we're fixing it for
(33:32):
companies across the countryright, hundreds of employers who
have found essentially,healthcare nirvana.
It takes a while to get thereright, it's painful, there's
some noise, there's a lot ofwork to get there, but once you
get one of these cutting edgeplans in and it's working well,
(33:54):
get one of these cutting edgeplans in and it's working well,
the solution exists.
So I can't understand why thecarriers haven't embraced the
solution.
There's something there that wecan't see or uncover.
Speaker 1 (34:02):
Yeah, no profit in the cure?
I don't think, unfortunately.
But a question for you isthere's a few books behind you
with your picture on it andyou've been really outspoken
about the ethics of comingalongside someone for good
(34:24):
health care and protecting themfrom danger and you mentioned
that even earlier in the podcastprotecting them from danger,
and you mentioned that evenearlier in the podcast.
Speaker 2 (34:36):
You've stepped out in courage and potentially even
received a lot of flack for that.
Why do you do that?
I would want somebody to do itfor me.
I would want somebody to do itfor my spouse, my children, my
grandchildren.
And the bigger problem is therecomes a point in time where good
enough is not good enough.
Right and that's probably thebiggest criticism that I get
personally is constantlystriving for perfection, and the
(35:02):
noise and the inconvenience andthe alarm that goes into
calling a timeout right andsaying whoa, whoa, whoa, pause.
This is not the best care, thisis not the best place, this is
not the best provider.
Some people are much happierburying their head in the sand,
(35:24):
but I wouldn't be able to sleepat night if I let one of my
patients that I'm working withor that I'm responsible for
caring for be harmed by gettingsomething less than the best.
Now, if the patient makes adecision and often they do right
our success rate in navigationis 84% across our book of
(35:47):
business.
That means 16% of the time Ifail and the patient chooses to
go someplace that's lowerquality, or chooses to get care
or a treatment that is not the Aplus, it's the B minus.
At that point, okay, thepatient made a decision.
They have free will andautonomy to do that, but at
(36:10):
least I know they did it armedwith the information.
Speaker 1 (36:14):
How has that percentage changed over time?
Speaker 2 (36:17):
It's gotten higher, right?
The other thing that I willtell you is, as employers have
begun to embrace this and havebegun to understand it and have
begun to offer incentives, thathas helped quite a bit.
But there are still someemployers that we send out every
two weeks we send outmember-facing promo materials
(36:40):
and we can track how often thoseare opened at the employer
level.
Like, did HR open them and sendthem out?
Well, if 80% of the timethey're not even opening the
message it's not getting out tothe employees.
And then, because they haven'tbeen prepped with these, nurses
love you, they're here to helpyou, they can help in this way
(37:02):
and that way and you know theyhaven't gotten the positive buzz
going.
And let's face it, the onlything that people hate more than
insurance companies are cablecompanies, right?
So if their insurance companyis calling them saying let me
help you, it's kind of like, youknow, a Native American
skepticism about the governmentcoming to help, right, that
(37:26):
doesn't go together.
So there's a lot of work thathas to go into preparing
employers and the employees inthese kinds of plans.
They have to understand themotivation behind it.
But if you went out today andsurveyed your employees and said
how many of you have heard ahealthcare horror story?
(37:47):
How many of you have been thevictim of a healthcare horror
story you or your family?
You would be amazed at thehands that go up when you ask
those questions and would youlike a resource to help do
something about that, to preventthat.
Everybody in concept thinks thatit's good when they're in the
(38:09):
throes of a medical situationand they're emotional and
they're upset and they're scaredand they believe that time is
of the essence.
Calling a time out in themiddle of that can be
disconcerting and the only thingwe can do is approach that
empathetically and to feelconfident that, listen, we have
(38:32):
a responsibility to do this andto kind of protect you from the
things that you don't even knowyou need protected from.
Speaker 3 (38:42):
A lot of people will say when a friend or family has
a sickness, they'll say, well,you need a patient advocate, you
need someone to go to thedoctor with you, which is 100%
true.
But, as you and I know, thereare some of our friends that
would be better than others inthat room.
Some are just note-taking andthey're not pushing, they're not
asking clarifying questions,because when you're that sick
(39:05):
person, you might be still onmedication and not thinking
clearly.
You just don't feel well, youdon't feel like asking questions
, you just want to get better.
What I think about what AIMdoes is you are that patient
advocate.
While you may not literally bethe physical person in the room,
you're probably better becauseyou have more knowledge, more
expertise.
(39:25):
You know where to go to get theanswers.
I've seen you in action in acouple different settings One,
of course, in the movie and thenjust as a client.
We've worked with your team andwhenever I think about you, the
phrase righteous indignationcomes to mind, and I mean that
in the most positive way.
And I feel like when youapproach these things, you do
(39:45):
have this righteous indignationthat you want to fix it, you
want to make it right.
So a personal question for youWhere's that come from?
Was that mom or was that dad?
Speaker 2 (39:56):
Oh boy, probably a good combination of the two.
It's interesting that you callit righteous indignation,
because after my small groupfrom Bible study saw the
documentary, the first thing mypastor said to me was the
documentary.
Speaker 3 (40:13):
The first thing my pastor said to me, was you
cussed on a national television?
I was mad.
Speaker 2 (40:18):
Yes, yes, I did.
It wasn't my best moment, but Iwas really upset about it.
And you know, just for clarity,that patient was in his 30s.
(40:46):
He had lost his wife to COVID.
He had been ignoring a massivewere supposed to be caring for
him and taking care of him andhelping him and prolonging his
life, wanted to leave his twochildren as bankrupt orphans,
cause that's the path that wholescenario was heading down.
(41:07):
Right now you tell me anybodywho has any kind of wherewithal
at all who would not beindignant about that and upset
by it.
Everybody but it happens everyday, every day in our US
healthcare system, thosescenarios play out.
Speaker 3 (41:28):
Well, my encouragement to you is I know
you are teaching your team themechanics of how to work through
the system, but if you can alsoimpart on them just a little
bit of that righteous thing, theindignation, we might actually
have a fighting chance.
Speaker 2 (41:42):
There you go.
That's the part that AI willnever be able to capture.
Speaker 1 (42:05):
That's right.
That's been a significant highsof highs.
But also family business can bedifficult.
But since we're kind of at theend of our time, we'd like to
ask our guests two questions.
The first question is what is arisk that you have taken that
has changed your life?
Speaker 2 (42:24):
Besides cussing on national documentary I think you
know starting the business, allthose things that we've been
talking about but really, everyday, we take risk for our
patients.
We know that a customer canfire us, an employer can fire us
at any point in time.
Speaker 3 (42:43):
So, being committed to our moral compass, Committed
to our moral compass, regardlessof the risk that it might have,
regardless of the money that wemight lose by staying committed
(43:05):
to.
That is probably the biggestrisk that I continue to take
every day, and the second andfinal question what's unfinished
?
Speaker 2 (43:09):
that you have the resolve to complete.
That you have the resolve tocomplete.
We definitely need a wholenother session, because AI and
healthcare and getting into thehands of the patient the
information about what the bestcare is, who the best providers
for that care are, and reversingthe mindset of how people
(43:29):
purchase healthcare, especiallyin the fee-for-service system,
and getting them to understandthat higher quality is cheaper
that is something that I really,really want to resolve.
Speaker 1 (43:41):
It's awesome.
A lot of work to still be done,that is for sure.
Nurse Deb famously Nurse Debthanks for joining us today and
thank you all for listening.
Have a good one.
Speaker 3 (43:53):
Thanks for tuning in to Risk and Resolve.
See you next time.
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