June 16, 2025 • 15 mins
Healthcare costs have doubled in the past decade, reaching a crushing $26,000 annually for families—with individual contributions now matching what the total premium used to be two decades ago. This financial reality is what gets Dr. Alex Sommers out of bed each morning.
Live from the American College of Lifestyle Medicine Conference in Orlando, we sit down with Dr. Sommers, a board-certified emergency physician who's now leading a healthcare revolution through direct primary care. His Wisconsin-based practice bypasses traditional insurance models to work directly with employers, creating what he calls a "value-based ecosystem" that integrates primary care, mental health services, and lifestyle medicine under one roof.
The results speak volumes: Dr. Sommers' approach is generating savings of $115-120 per member per month—nearly double the national average for direct primary care practices. By focusing on preventive care, measuring meaningful biomarkers, and addressing root causes rather than symptoms, his team is demonstrating that better healthcare doesn't have to mean higher costs.
We dive deep into the tension between our reactive "sick care" system and what actually works for preventing disease and optimizing health. Dr. Sommers shares his journey from healthcare executive to innovator, explaining how he's collaborating with the Health Rosetta community to redesign employer health plans from the ground up. As he puts it, "When you align personal stake, professional stake, and the finances for all stakeholders, you get better outcomes."
Whether you're an employer drowning in healthcare costs, a provider seeking more meaningful ways to practice, or simply someone concerned about the unsustainable trajectory of American healthcare, this conversation offers hopeful insights into what's possible when we're willing to reimagine the system. Connect with us to continue the conversation and discover how these principles might transform your approach to health and wellness.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Justin Politti (00:02):
Welcome to the Reverse Wallet Healthcare
Podcast from BP2 Health.
We are live at the ACLMConference in Orlando, Florida.
I'm your host, Justin Politti.
I'm Dave Pavlik.
Ellen Brown (00:12):
And I am Ellen Brown and we're here with Dr
Alex Sommers, who it's fun toactually meet live and in person
.
We've talked before virtuallyvideo.
It's always different wheneveryou could see this 3D form of
someone.
But is it AI?
Dave Pavlik (00:23):
Yeah, yeah, yeah, it's always different whenever
you see the 3D form of someone.
But is it AI?
Yeah, yeah, yeah, it's real.
Ellen Brown (00:27):
Yeah, is it real or are we in some?
Dave Pavlik (00:29):
sort of matrix, I don't know.
Ellen Brown (00:31):
So yeah, so thanks for joining us.
So tell us about what you'reworking on, tell us about
yourself.
Alex Sommers (00:36):
Yeah, thanks for having me.
It's great to be here.
This is a great conference,great to see you guys here and
sort of democratizing lifestylemedicine.
So I'm a board-certifiedemergency medicine physician and
became board-certified inlifestyle medicine last year.
We run a direct primary carepractice in Wisconsin and also
in Missouri and are growing thatpractice as in a value-based
(00:56):
ecosystem.
I know you guys talk about thata lot.
So we've noticed a lot oftraction in the space and
direct-to-employer mainly Directprimary care can be direct to
community and direct to employer, but we specifically target
group health plans.
As you know, ellen, I'm excitedabout trying to innovate that
space.
I think it all starts there, aswe all know the payer, the true
payer is the patient, thetaxpayer and the employer,
(01:16):
exactly, and some combinationthereof.
But employers are sort of I mean, their health plans are wrecked
right.
So the costs have gone up from$13,000 for a family of four for
a premium and $13,000 to$26,000 plus this coming year
without any access to service.
So to me, that gets me up inthe morning.
That's the fulfillment piece.
They talked about the BlueZones.
Talk with Dan Buechner is youknow what's your purpose?
(01:37):
So trying to develop avalue-based ecosystem around
that.
So we developed a mental healthpractice it's integrative,
collaborative model based onWashington's model 15 years ago
into our practice to try toprovide as much primary care and
build the best experience thatpatients need to get health
prevention, health maintenance,problem-based visits taken care
of, really trying to encapsulateas much care as they possibly
(02:00):
need 90% or so more in thatecosystem.
And then bringing lifestylemedicine.
And then we also have alifestyle medicine in there.
We also have a lifestylemedicine practice where we've
done some diabetes preventionprograms and some comprehensive
health improvement programs withour partner Pivio.
I've had some great successes.
I know you've seen some of thaton LinkedIn, and so now we're
trying to grow that with othertechnologies and AI and build
our tech stack out.
So on the backside non-memberfacing we can optimize that
(02:22):
whole value ecosystem to reallysort of what we see is seeing
the fruition like the bestpossible value per member per
year cost an employer could see,which also is tied to value,
quality over cost, and reallydevelop that value-based
ecosystem that I think we allwant to see.
You know that's the utopia.
You know we hope we get thereand, as you know as well, I've
gotten involved withemployer-sponsored health plan
(02:42):
design and there's probably lessthan a handful of us that are
physician health Rosettaadvisors in the health Rosetta
community, which is really sortof getting on the plan-facing
side and designing health plansthat really bring in
transparency, data planinfrastructure, independent
partners that are accountable totheir own silo, and so
everyone's doing their job, soeveryone's rolling in the right
(03:04):
direction, as PJ Fleck says.
So I'll roll the boat togetherand hopefully we get to the
outcome we're trying to get to.
Ellen Brown (03:10):
I know you guys have so many questions.
Now I just want to make twoquick comments and then let you
guys weigh in on questions.
Is one you know your statistic.
You shared about the $26,000for a family that's the total
health insurance spend.
But I think what really hit meabout that study was 10 years
ago right, when the statistic$13,000, even if you go back
(03:31):
further it wasn't too much.
Before that it was $6,000.
And what's crazy is now justthe personal portion of that,
24,000 is 6,000.
So something that 20 years agowhat we are responsible for
right is at the personal level,not what the employer is paying
for, is the same amount that thewhole nut used to be right.
(03:52):
So it's like this huge amountof burden, financial burden
that's being put on us on top ofthe employer that's paying for
it.
It's pretty wild.
And then the other piece is, asyou know, I'm very intrigued
and excited by the work ofRosetta.
I think that has the potentialto sort of help push us out of
this benefit consultant HR space.
(04:14):
That kind of keeps us frominnovation, I think.
Dave Pavlik (04:16):
And collaborate together.
I want to hear more aboutRosetta, because I was thinking
the same thing.
Alex Sommers (04:22):
I mean employee wellness programs are After
listing, I'm trying to bringthem here and bring these guys
there.
Ellen Brown (04:26):
Yeah, well, I've been trying to connect with them
too, so yeah, no because I meanyou've taken it.
Dave Pavlik (04:31):
I mean applaud the work.
Obviously, the employeewellness is one thing, but now
taking it to the next level,writing it into the benefit plan
, is a whole nother level.
And the benefit plan is a wholenother level.
And then what about beyond theemployer groups, you know,
non-employer sponsored Are youseeing any movement there?
So I mean outside of employersponsored health plans or like
(04:53):
government payers or MedicareMedicaid.
I haven't.
Alex Sommers (04:55):
I figured that if we figure it out ourselves,
we'll externalize it to thegovernment.
That's the way I've seen otherplayers that have gotten to that
grand scale do it.
So because the ecosystem is soripe right now in the
employer-sponsored space, Ithink you know, and the
government kind of can reflectthat.
But you know, as I hate to say,as Keith Smith says, the
government drives the getawaytruck here.
So you know, we have to sort ofyou know, reinvent things on
(05:16):
our own and not wait for them tosolve the problem for us.
That's in front of us and sothat's really.
It's sort of like you know.
You know this is about theperson here and the clinician
and lifestyle medicineconference and person to plan If
you can optimize that ecosystem.
Now we bring in blue zones tomake the healthy choice, the
easy choice, and it just becomeslogical how you compound wins
in from a personal level to agroup in an employer space,
(05:38):
whether it's, you know, asingular employer or captive, or
or a captive or larger groupsor coalitions.
And I think if we start to worktogether, collaborating in
those situations, we'll be moresuccessful.
Justin Politti (05:46):
Can you speak to some of the financial savings
that you've achieved thus farwith the work you've been doing?
Alex Sommers (05:51):
Yeah, on the backside we're pretty data
focused.
I mean, I think everyone wantsto see data, so that's really
important for us, for ourclients, so we externalize that
to our clients in dashboardingand reporting.
I work with a lot of goodpartners on the back side that
allow us to really, on thechannel, reach our clients to
get high engagement for diseasemanagement, et cetera, et cetera
.
But we keep track of CPTs tothe old trite and true AMA
billing system and ICD-10s formultiple reasons.
(06:13):
That's one of them is on thefinancial piece.
In the ROI.
Last year we achieved in ourdirect primary care model about
$115, $120 per member per monthsavings just on the services we
provided and procedures in ourclinic office visits, labs,
immunizations, imaging et ceterawhich far supersedes what was
sort of promulgated by theSociety of Actuaries when
Milliman was commissioned in2020 to do a DPC study where
(06:35):
they saw an average across thenation in all flavors of DPC,
about $60 per member per monthsavings.
It's a double.
Justin Politti (06:40):
So yeah, yep, and also, can you speak to any
of like unique, I guess,engagement approaches within the
benefit plans themselves thatyou're, I guess, working with in
order to, like I always viewedlike wellness is like all right,
is there a way that we can paypatients to, or members to, get
healthier, right?
So those not just hey, on anincentive of like a discount on
(07:01):
the benefit plan, but otherthings that are, you know you're
kind of thinking of?
Alex Sommers (07:04):
I think everyone wants to get healthier, you know
at their core and we need thatknowledge, and I think it's
continuous learning.
For clinicians and I knowEllen's really big into this too
is the wellness space, and thewellness space by itself has a
bad rap, and so I don't want toconfuse wellness for lifestyle
medicine.
But you know, can we look at,you know, new biomarkers and
(07:29):
things such as ApoB, LP, littlea and other things that really
sort of move the needle onhealth, prevent cardiovascular
disease, lower the risk ofcancer and dementia,
cardiometabolic diseases and soon and so forth.
So we typically have, we have awellness program that we embed,
and we believe that if it's inthe continuum of the care and
embedded in the clinic side,with the clinicians and the
patients as sort of co-creatingthat environment, that wellness
(07:49):
does become important when youmeasure the right things and you
manage them.
As we all know, measure whatyou manage, manage what you
measure, and then you'll get theoutcome you desire.
So when you bring the continuumand build the ecosystem with
wellness as part of that, Ithink you can achieve that.
Ellen Brown (08:01):
Yeah, so it's interesting you brought up the
diagnostic component, becausewhen Justin and I were out in
health last week, we were withthe team at Pranovo which a lot
of people don't do or don't knowabout but full body scans and
there's a lot of debate aroundthat and we ended up in this
really fun situation of we hadAdam Carew, brendan Keeler and
(08:22):
Graham Walker we were alltogether, justin and I were with
them and we were justdebriefing around health and
then-.
Justin Politti (08:29):
Were they wearing mullets at the same time
?
They were, they were, and wewere in a limo.
I mean, it was really like-.
Dave Pavlik (08:34):
Hummer limo.
Yeah, it really should havebeen there.
They were in a Hummer wearingmullets.
Alex Sommers (08:37):
Yeah, it was pretty spectacular.
Ellen Brown (08:42):
Sorry, I let you down.
Graham Disconnected, yeah, yeah, yeah.
So, but we were having a reallygreat conversation and it just
ended up timing-wise that we allthey just stayed and they were
like we're going to jump in theconversation too.
And so Dan Duran, who's the CMOof Pernuvo, we go way back with
Dan, and so luckily he was likeall right, I'm in, like we'll
do it.
But in that conversation whatreally struck me because
(09:04):
obviously I wasn't saying much,which I know is odd, but Oddly
quiet, which was-.
Justin Politti (09:10):
Yes, I was observing the whole thing unfold
.
Ellen Brown (09:13):
But what I observed , which was really powerful to
me, was the debate that wasensuing was actually stemming
from kind of your point aboutwellness, about 3.0, which was
we were debating the efficacyand necessity of those
diagnostic tools like Pranova orlike the level of testing that
you're talking about you know,in blood markers Screening like
(09:34):
Grail, Exactly Grail things likethat and what was so
fascinating, we were arguingagainst it.
When we put the sick care, acutecare system that we've built
filter on it.
It makes no sense.
It's like why would I spend allthis money to know that the
system is designed to try andkeep you alive and treat it when
it happened, not the other.
But when you took that away andsaid what's the best thing for
(09:55):
the person?
Is it better to know thatyou've got these things that are
coming down the pike, that youknow if we did something now it
wouldn't be like that then, thenthe answer was totally
different and it was sointeresting to watch that like
sort of ping pong.
It's like, well, if I put mysick care hat on, then I have
this answer.
But if I step back and say,what if I didn't have to work in
(10:17):
the construct that we'vecreated?
What's the best thing for theperson?
It really changes.
And I guess I kind of do theeconomic parallel to DPC Say
again, like if I just givedemocracy and you know and
license for the person to forthe treatment to happen the way
it should, as opposed to on thisRVU fee for service basis, it
changes.
Alex Sommers (10:39):
For sure.
Yeah, no, I think those are allvalid points.
I think you know, is it thepersonal level we're looking at
which is part of that?
Medicine 3.0, or the populationhealth 40,000 view level?
And that really is who's youraudience, right, and that's I
think you really have toresonate with when you make
these decisions about the valueof new technology or innovation
and how it influences thatsphere.
But you know, of course, if wecould predict the future in a
crystal ball and knew we weregoing to get X, y or Z
(11:00):
malignancy and those tests wouldhave, you know, caught it at an
earlier stage, we'd be all in.
So I think you really have tolook at the data.
Unfortunately, medicine's alittle slower than other
industries and it's typically 17years before we see adoption as
standard of care in theindustry.
So that holds.
I mean, that's good and bad,right.
So we don't want toover-testing, unnecessary
(11:21):
anxiety and things that willharm patients, but we certainly
would love to find those thingsthat make a difference and can
really impact outcomes in acost-effective manner.
And then, really, as far ascost goes, I mean, what is it
worth to you to save your life,a family member's life?
So that's a very nuanced,complicated discussion, so that
I don't have the answer to whatwas the answer.
Dave Pavlik (11:40):
Oh, there's not one , no there's consensus that
there's the consensusdifferences of opinion.
Yeah, okay, yeah.
So no answer is the rightanswer?
Justin Politti (11:47):
No, but Alex is coming at it from a different
viewpoint, but.
Ellen Brown (11:52):
I appreciate your perspective on it, like that's
why I asked, like there's somepeople that just don't even
think about healthcare 3.0.
They don't even you know.
It's like this is what, this isthe lane.
I'm in this is what we have, andbut you're one of those people
and that's why we connected waswe're both, we both are really
looking at how do we?
You know, I think, like yousaid, like I've even moved from
originally, I'm going to try andfix the system to really say
(12:14):
like the system is the systemand it's designed to do certain
things, and, yes, we can makethat system better in some ways,
but we just really need adifferent parallel.
You know we need another and itdoesn't.
I'm not.
When I say parallel, I thinkpeople sometimes think I mean
like these two completelyseparate silos, and I don't mean
that, you know, it's just wedon't have a function.
That's why lifestyle medicineis so powerful, because it does
(12:36):
address the root cause, whichmedicine doesn't do today.
Alex Sommers (12:40):
Yeah, it's complicated.
I think you have to unwind andalign the incentives so that
everyone wins, and I think whenyou align personal stake,
professional stake, the financesfor all stakeholders, you get
better outcomes right.
And so a lot of people aretrying to do the right thing in
their wheelhouse, whether it'sas an advisor, a brokerage, a
health plan, a healthcare systembut they only can play within
(13:01):
the rules of the game, and I wasthere as an executive in the
bureaucratic system.
One of the reasons I left ishard to sleep at night knowing
how we're making money andpeople aren't getting better and
you're not seeing the outcomesyou're hoping to achieve.
And so I think you start movingin that value ecosystem, you
can start to think of things interms of how it affects
ultimately the outcome of theaudience you're working with,
(13:21):
whether it's the individualpatient at the bedside or it's
the employer sponsored healthplan.
And then now we have the rightconversation and can move the
needle in the right directionfor better health and better
financial outcomes, which Ithink is what we're all want
yeah, we all want to get.
Ellen Brown (13:34):
Yeah, so I will make a shout out.
I think it's Dave with Rosetta,right, so we should have we.
I'm going to, I'm going to makea plug right now that we need
to have you and Dave Chase onthe podcast.
We'll do like a full episode.
We'll really dive into thisfrom all the way through.
I think it'll be a superinteresting conversation.
It'll be exciting.
Alex Sommers (13:51):
I think they're doing great things and that's
what drew me into that.
We've been working in thosetypes of plans in our business
and you know I've done well, wonsome awards for some employers
on innovation andtransformational health plans,
on costs and improved healthmetrics, et cetera.
You know, and you know fun factis my brother and I business
have the only um two bookswritten on employer sponsored
health plan transformations inthe country.
You know.
(14:11):
So, looking for moreinformation and people want to
learn more about Rosetta Davewrote a book, the CEO's guide to
the healthcare and um andrestoring the American dream,
and then um, the company thatsolved healthcare.
John's arena is this book thatwas written on the serigraph
model that my brother, um,helped them establish.
Ellen Brown (14:26):
And your books are the names of your books.
Alex Sommers (14:29):
And then the name of the book um the uh how to
save your company.
Ellen Brown (14:33):
Okay.
Alex Sommers (14:34):
Um, don't feed the beast that matter road which
the HR executive of Merrillsteel, which is based on the
Meryl Steele story that wehelped design on the clinical
side.
Ellen Brown (14:42):
Okay.
Alex Sommers (14:42):
Nice and we can get those books on Amazon.
Amazon, if you reach out andconnect to us, we can get you
one.
Ellen Brown (14:48):
Okay, awesome.
Alex Sommers (14:49):
Autographed copy, I think.
Ellen Brown (14:51):
I really appreciate you coming on.
Dave Pavlik (14:52):
Yeah, it was great, thanks for being here.
Ellen Brown (14:54):
I look forward to trying to get that other
conversation and just furtherconversation.
I appreciate your thinking andthought leadership.
Alex Sommers (15:00):
I love the think tank and we need things like
this to really move the needles.
Thanks again, yeah yeah, yeah,awesome.
Ellen Brown (15:06):
Have a great day, all right, all right, see you.
Welcome to the Reverse Wallet Healthcare
Podcast from BP2 Health.
We are live at the ACLMConference in Orlando, Florida.
I'm your host, Justin Politti.
I'm Dave Pavlik.
Ellen Brown (00:12):
And I am Ellen Brown and we're here with Dr
Alex Sommers, who it's fun toactually meet live and in person
.
We've talked before virtuallyvideo.
It's always different wheneveryou could see this 3D form of
someone.
But is it AI?
Dave Pavlik (00:23):
Yeah, yeah, yeah, it's always different whenever
you see the 3D form of someone.
But is it AI?
Yeah, yeah, yeah, it's real.
Ellen Brown (00:27):
Yeah, is it real or are we in some?
Dave Pavlik (00:29):
sort of matrix, I don't know.
Ellen Brown (00:31):
So yeah, so thanks for joining us.
So tell us about what you'reworking on, tell us about
yourself.
Alex Sommers (00:36):
Yeah, thanks for having me.
It's great to be here.
This is a great conference,great to see you guys here and
sort of democratizing lifestylemedicine.
So I'm a board-certifiedemergency medicine physician and
became board-certified inlifestyle medicine last year.
We run a direct primary carepractice in Wisconsin and also
in Missouri and are growing thatpractice as in a value-based
(00:56):
ecosystem.
I know you guys talk about thata lot.
So we've noticed a lot oftraction in the space and
direct-to-employer mainly Directprimary care can be direct to
community and direct to employer, but we specifically target
group health plans.
As you know, ellen, I'm excitedabout trying to innovate that
space.
I think it all starts there, aswe all know the payer, the true
payer is the patient, thetaxpayer and the employer,
(01:16):
exactly, and some combinationthereof.
But employers are sort of I mean, their health plans are wrecked
right.
So the costs have gone up from$13,000 for a family of four for
a premium and $13,000 to$26,000 plus this coming year
without any access to service.
So to me, that gets me up inthe morning.
That's the fulfillment piece.
They talked about the BlueZones.
Talk with Dan Buechner is youknow what's your purpose?
(01:37):
So trying to develop avalue-based ecosystem around
that.
So we developed a mental healthpractice it's integrative,
collaborative model based onWashington's model 15 years ago
into our practice to try toprovide as much primary care and
build the best experience thatpatients need to get health
prevention, health maintenance,problem-based visits taken care
of, really trying to encapsulateas much care as they possibly
(02:00):
need 90% or so more in thatecosystem.
And then bringing lifestylemedicine.
And then we also have alifestyle medicine in there.
We also have a lifestylemedicine practice where we've
done some diabetes preventionprograms and some comprehensive
health improvement programs withour partner Pivio.
I've had some great successes.
I know you've seen some of thaton LinkedIn, and so now we're
trying to grow that with othertechnologies and AI and build
our tech stack out.
So on the backside non-memberfacing we can optimize that
(02:22):
whole value ecosystem to reallysort of what we see is seeing
the fruition like the bestpossible value per member per
year cost an employer could see,which also is tied to value,
quality over cost, and reallydevelop that value-based
ecosystem that I think we allwant to see.
You know that's the utopia.
You know we hope we get thereand, as you know as well, I've
gotten involved withemployer-sponsored health plan
(02:42):
design and there's probably lessthan a handful of us that are
physician health Rosettaadvisors in the health Rosetta
community, which is really sortof getting on the plan-facing
side and designing health plansthat really bring in
transparency, data planinfrastructure, independent
partners that are accountable totheir own silo, and so
everyone's doing their job, soeveryone's rolling in the right
(03:04):
direction, as PJ Fleck says.
So I'll roll the boat togetherand hopefully we get to the
outcome we're trying to get to.
Ellen Brown (03:10):
I know you guys have so many questions.
Now I just want to make twoquick comments and then let you
guys weigh in on questions.
Is one you know your statistic.
You shared about the $26,000for a family that's the total
health insurance spend.
But I think what really hit meabout that study was 10 years
ago right, when the statistic$13,000, even if you go back
(03:31):
further it wasn't too much.
Before that it was $6,000.
And what's crazy is now justthe personal portion of that,
24,000 is 6,000.
So something that 20 years agowhat we are responsible for
right is at the personal level,not what the employer is paying
for, is the same amount that thewhole nut used to be right.
(03:52):
So it's like this huge amountof burden, financial burden
that's being put on us on top ofthe employer that's paying for
it.
It's pretty wild.
And then the other piece is, asyou know, I'm very intrigued
and excited by the work ofRosetta.
I think that has the potentialto sort of help push us out of
this benefit consultant HR space.
(04:14):
That kind of keeps us frominnovation, I think.
Dave Pavlik (04:16):
And collaborate together.
I want to hear more aboutRosetta, because I was thinking
the same thing.
Alex Sommers (04:22):
I mean employee wellness programs are After
listing, I'm trying to bringthem here and bring these guys
there.
Ellen Brown (04:26):
Yeah, well, I've been trying to connect with them
too, so yeah, no because I meanyou've taken it.
Dave Pavlik (04:31):
I mean applaud the work.
Obviously, the employeewellness is one thing, but now
taking it to the next level,writing it into the benefit plan
, is a whole nother level.
And the benefit plan is a wholenother level.
And then what about beyond theemployer groups, you know,
non-employer sponsored Are youseeing any movement there?
So I mean outside of employersponsored health plans or like
(04:53):
government payers or MedicareMedicaid.
I haven't.
Alex Sommers (04:55):
I figured that if we figure it out ourselves,
we'll externalize it to thegovernment.
That's the way I've seen otherplayers that have gotten to that
grand scale do it.
So because the ecosystem is soripe right now in the
employer-sponsored space, Ithink you know, and the
government kind of can reflectthat.
But you know, as I hate to say,as Keith Smith says, the
government drives the getawaytruck here.
So you know, we have to sort ofyou know, reinvent things on
(05:16):
our own and not wait for them tosolve the problem for us.
That's in front of us and sothat's really.
It's sort of like you know.
You know this is about theperson here and the clinician
and lifestyle medicineconference and person to plan If
you can optimize that ecosystem.
Now we bring in blue zones tomake the healthy choice, the
easy choice, and it just becomeslogical how you compound wins
in from a personal level to agroup in an employer space,
(05:38):
whether it's, you know, asingular employer or captive, or
or a captive or larger groupsor coalitions.
And I think if we start to worktogether, collaborating in
those situations, we'll be moresuccessful.
Justin Politti (05:46):
Can you speak to some of the financial savings
that you've achieved thus farwith the work you've been doing?
Alex Sommers (05:51):
Yeah, on the backside we're pretty data
focused.
I mean, I think everyone wantsto see data, so that's really
important for us, for ourclients, so we externalize that
to our clients in dashboardingand reporting.
I work with a lot of goodpartners on the back side that
allow us to really, on thechannel, reach our clients to
get high engagement for diseasemanagement, et cetera, et cetera
.
But we keep track of CPTs tothe old trite and true AMA
billing system and ICD-10s formultiple reasons.
(06:13):
That's one of them is on thefinancial piece.
In the ROI.
Last year we achieved in ourdirect primary care model about
$115, $120 per member per monthsavings just on the services we
provided and procedures in ourclinic office visits, labs,
immunizations, imaging et ceterawhich far supersedes what was
sort of promulgated by theSociety of Actuaries when
Milliman was commissioned in2020 to do a DPC study where
(06:35):
they saw an average across thenation in all flavors of DPC,
about $60 per member per monthsavings.
It's a double.
Justin Politti (06:40):
So yeah, yep, and also, can you speak to any
of like unique, I guess,engagement approaches within the
benefit plans themselves thatyou're, I guess, working with in
order to, like I always viewedlike wellness is like all right,
is there a way that we can paypatients to, or members to, get
healthier, right?
So those not just hey, on anincentive of like a discount on
(07:01):
the benefit plan, but otherthings that are, you know you're
kind of thinking of?
Alex Sommers (07:04):
I think everyone wants to get healthier, you know
at their core and we need thatknowledge, and I think it's
continuous learning.
For clinicians and I knowEllen's really big into this too
is the wellness space, and thewellness space by itself has a
bad rap, and so I don't want toconfuse wellness for lifestyle
medicine.
But you know, can we look at,you know, new biomarkers and
(07:29):
things such as ApoB, LP, littlea and other things that really
sort of move the needle onhealth, prevent cardiovascular
disease, lower the risk ofcancer and dementia,
cardiometabolic diseases and soon and so forth.
So we typically have, we have awellness program that we embed,
and we believe that if it's inthe continuum of the care and
embedded in the clinic side,with the clinicians and the
patients as sort of co-creatingthat environment, that wellness
(07:49):
does become important when youmeasure the right things and you
manage them.
As we all know, measure whatyou manage, manage what you
measure, and then you'll get theoutcome you desire.
So when you bring the continuumand build the ecosystem with
wellness as part of that, Ithink you can achieve that.
Ellen Brown (08:01):
Yeah, so it's interesting you brought up the
diagnostic component, becausewhen Justin and I were out in
health last week, we were withthe team at Pranovo which a lot
of people don't do or don't knowabout but full body scans and
there's a lot of debate aroundthat and we ended up in this
really fun situation of we hadAdam Carew, brendan Keeler and
(08:22):
Graham Walker we were alltogether, justin and I were with
them and we were justdebriefing around health and
then-.
Justin Politti (08:29):
Were they wearing mullets at the same time
?
They were, they were, and wewere in a limo.
I mean, it was really like-.
Dave Pavlik (08:34):
Hummer limo.
Yeah, it really should havebeen there.
They were in a Hummer wearingmullets.
Alex Sommers (08:37):
Yeah, it was pretty spectacular.
Ellen Brown (08:42):
Sorry, I let you down.
Graham Disconnected, yeah, yeah, yeah.
So, but we were having a reallygreat conversation and it just
ended up timing-wise that we allthey just stayed and they were
like we're going to jump in theconversation too.
And so Dan Duran, who's the CMOof Pernuvo, we go way back with
Dan, and so luckily he was likeall right, I'm in, like we'll
do it.
But in that conversation whatreally struck me because
(09:04):
obviously I wasn't saying much,which I know is odd, but Oddly
quiet, which was-.
Justin Politti (09:10):
Yes, I was observing the whole thing unfold
.
Ellen Brown (09:13):
But what I observed , which was really powerful to
me, was the debate that wasensuing was actually stemming
from kind of your point aboutwellness, about 3.0, which was
we were debating the efficacyand necessity of those
diagnostic tools like Pranova orlike the level of testing that
you're talking about you know,in blood markers Screening like
(09:34):
Grail, Exactly Grail things likethat and what was so
fascinating, we were arguingagainst it.
When we put the sick care, acutecare system that we've built
filter on it.
It makes no sense.
It's like why would I spend allthis money to know that the
system is designed to try andkeep you alive and treat it when
it happened, not the other.
But when you took that away andsaid what's the best thing for
(09:55):
the person?
Is it better to know thatyou've got these things that are
coming down the pike, that youknow if we did something now it
wouldn't be like that then, thenthe answer was totally
different and it was sointeresting to watch that like
sort of ping pong.
It's like, well, if I put mysick care hat on, then I have
this answer.
But if I step back and say,what if I didn't have to work in
(10:17):
the construct that we'vecreated?
What's the best thing for theperson?
It really changes.
And I guess I kind of do theeconomic parallel to DPC Say
again, like if I just givedemocracy and you know and
license for the person to forthe treatment to happen the way
it should, as opposed to on thisRVU fee for service basis, it
changes.
Alex Sommers (10:39):
For sure.
Yeah, no, I think those are allvalid points.
I think you know, is it thepersonal level we're looking at
which is part of that?
Medicine 3.0, or the populationhealth 40,000 view level?
And that really is who's youraudience, right, and that's I
think you really have toresonate with when you make
these decisions about the valueof new technology or innovation
and how it influences thatsphere.
But you know, of course, if wecould predict the future in a
crystal ball and knew we weregoing to get X, y or Z
(11:00):
malignancy and those tests wouldhave, you know, caught it at an
earlier stage, we'd be all in.
So I think you really have tolook at the data.
Unfortunately, medicine's alittle slower than other
industries and it's typically 17years before we see adoption as
standard of care in theindustry.
So that holds.
I mean, that's good and bad,right.
So we don't want toover-testing, unnecessary
(11:21):
anxiety and things that willharm patients, but we certainly
would love to find those thingsthat make a difference and can
really impact outcomes in acost-effective manner.
And then, really, as far ascost goes, I mean, what is it
worth to you to save your life,a family member's life?
So that's a very nuanced,complicated discussion, so that
I don't have the answer to whatwas the answer.
Dave Pavlik (11:40):
Oh, there's not one , no there's consensus that
there's the consensusdifferences of opinion.
Yeah, okay, yeah.
So no answer is the rightanswer?
Justin Politti (11:47):
No, but Alex is coming at it from a different
viewpoint, but.
Ellen Brown (11:52):
I appreciate your perspective on it, like that's
why I asked, like there's somepeople that just don't even
think about healthcare 3.0.
They don't even you know.
It's like this is what, this isthe lane.
I'm in this is what we have, andbut you're one of those people
and that's why we connected waswe're both, we both are really
looking at how do we?
You know, I think, like yousaid, like I've even moved from
originally, I'm going to try andfix the system to really say
(12:14):
like the system is the systemand it's designed to do certain
things, and, yes, we can makethat system better in some ways,
but we just really need adifferent parallel.
You know we need another and itdoesn't.
I'm not.
When I say parallel, I thinkpeople sometimes think I mean
like these two completelyseparate silos, and I don't mean
that, you know, it's just wedon't have a function.
That's why lifestyle medicineis so powerful, because it does
(12:36):
address the root cause, whichmedicine doesn't do today.
Alex Sommers (12:40):
Yeah, it's complicated.
I think you have to unwind andalign the incentives so that
everyone wins, and I think whenyou align personal stake,
professional stake, the financesfor all stakeholders, you get
better outcomes right.
And so a lot of people aretrying to do the right thing in
their wheelhouse, whether it'sas an advisor, a brokerage, a
health plan, a healthcare systembut they only can play within
(13:01):
the rules of the game, and I wasthere as an executive in the
bureaucratic system.
One of the reasons I left ishard to sleep at night knowing
how we're making money andpeople aren't getting better and
you're not seeing the outcomesyou're hoping to achieve.
And so I think you start movingin that value ecosystem, you
can start to think of things interms of how it affects
ultimately the outcome of theaudience you're working with,
(13:21):
whether it's the individualpatient at the bedside or it's
the employer sponsored healthplan.
And then now we have the rightconversation and can move the
needle in the right directionfor better health and better
financial outcomes, which Ithink is what we're all want
yeah, we all want to get.
Ellen Brown (13:34):
Yeah, so I will make a shout out.
I think it's Dave with Rosetta,right, so we should have we.
I'm going to, I'm going to makea plug right now that we need
to have you and Dave Chase onthe podcast.
We'll do like a full episode.
We'll really dive into thisfrom all the way through.
I think it'll be a superinteresting conversation.
It'll be exciting.
Alex Sommers (13:51):
I think they're doing great things and that's
what drew me into that.
We've been working in thosetypes of plans in our business
and you know I've done well, wonsome awards for some employers
on innovation andtransformational health plans,
on costs and improved healthmetrics, et cetera.
You know, and you know fun factis my brother and I business
have the only um two bookswritten on employer sponsored
health plan transformations inthe country.
You know.
(14:11):
So, looking for moreinformation and people want to
learn more about Rosetta Davewrote a book, the CEO's guide to
the healthcare and um andrestoring the American dream,
and then um, the company thatsolved healthcare.
John's arena is this book thatwas written on the serigraph
model that my brother, um,helped them establish.
Ellen Brown (14:26):
And your books are the names of your books.
Alex Sommers (14:29):
And then the name of the book um the uh how to
save your company.
Ellen Brown (14:33):
Okay.
Alex Sommers (14:34):
Um, don't feed the beast that matter road which
the HR executive of Merrillsteel, which is based on the
Meryl Steele story that wehelped design on the clinical
side.
Ellen Brown (14:42):
Okay.
Alex Sommers (14:42):
Nice and we can get those books on Amazon.
Amazon, if you reach out andconnect to us, we can get you
one.
Ellen Brown (14:48):
Okay, awesome.
Alex Sommers (14:49):
Autographed copy, I think.
Ellen Brown (14:51):
I really appreciate you coming on.
Dave Pavlik (14:52):
Yeah, it was great, thanks for being here.
Ellen Brown (14:54):
I look forward to trying to get that other
conversation and just furtherconversation.
I appreciate your thinking andthought leadership.
Alex Sommers (15:00):
I love the think tank and we need things like
this to really move the needles.
Thanks again, yeah yeah, yeah,awesome.
Ellen Brown (15:06):
Have a great day, all right, all right, see you.
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