Why Are Employers Still Paying for a Broken Healthcare System

[00:00:00] Where are most of the partners you talk to currently? Control or Chaos? So I think the chaos is ever-present. We're so used to buying healthcare through an insurance company that we don't really even know what it's like to figure out what a fair price is for a service. The only reason that we're as successful as we are is because we're just taking the same purchasing mechanism everybody's using in their daily life and we're just simply applying those principles to healthcare. My name is Ben John. I'm the VP of Sales at CellFund Health. Sales and Partnerships.

[00:00:29] And Partnerships. And CellFunded Health. So what made you want to build relationships in this corner of the industry? Let's talk about that. So Self Fund Health is pretty difficult to do the right way. It takes a lot of strategic partnerships on the stop-loss side, you know, TPA, navigation, PBM, that sort of thing. And there's so many vendors out there. And trying to sustain a CellFunded model as an advisor, as a broker,

[00:00:58] is really difficult to do, especially when you have different components for each employer. And I knew that there had to be a more sustainable way to go about it. And that's when I met Jonathan, our CEO and founder of Self Fund Health, and realized that this was a way to really scale the healthcare purchasing model and push consumerism, you know, in this industry more. And so the partnerships is an important part because we are looking for people that actually

[00:01:25] want to change how healthcare is consumed. We are not just another type of insurance product. We want to be able to partner with people that have the same philosophy on this being the model, the future of where healthcare needs to go in this country. And so I think that's kind of what led me to this and what drew me to this was being able to make more of a mark working through advisors, working through direct primary care providers, working through, you know, the surgical centers,

[00:01:51] independent centers of excellence, and those sorts of partnerships to be able to bring the sustainable model to employers in Wisconsin and now beyond. And specific to something you were mentioning that, you know, it's a, it's a solution that you're bringing to market. It takes a very different approach. It's not a point solution within that, right? So people, are they transitioning to

[00:02:15] you or from some other solution? Or is it more like they're the first time buyers? Where are you like, who are you seeing people buying self-fund, for example? Most of the employers that we work with were formerly fully insured. And then they jumped into self-funding straight with us. But we're seeing more and more larger employers that are already self-funded

[00:02:40] and larger for us would be like, you know, 500 plus employees. And we're seeing more and more of them that are self-funded with, with United, you know, through UMR or with Anthem or one of the larger carriers or, or health system carrier become interested in this because they're feeling more and more forced towards one track, you know, a claim through the health system, limited access, you know, a little bit worse

[00:03:03] quality. And there's not as much opportunity to change the, the, the cost of the care, right? Which is driving everything, right? Insurance is only, is only going to go up because the cost of the care goes up. And so if we influence, you know, the cost of the care, then we're going to be able to influence then the, the pricing and the insurance in very simplistic terms. So, um, when we started, it was,

[00:03:27] you know, groups under 150, 200 that were more interested and they're self-funded or they're fully insured, couldn't find a way to self-fund. Now they're, now they're self-funded with us, but we're seeing more and more traction with the larger cases because they realize they're sort of hitting a wall with their current carrier partners and the networks that they're, they're a part of that they're just really not able to do the cool things we're able to do to introduce steerage and consumerism within, within, you know, their plans, their plans, uh, framework right now.

[00:03:55] And, uh, what's the chaos, I guess, employers and partners come to you most confused with, like what's, what's that chaos about? Oh boy, there are, I mean, so much, right? I think part of it is, is a lack of understanding of what really drives healthcare costs. Um, I think it's a lack of understanding of how health insurance actually works. Um, uh, lack of understanding of how all the partners fit

[00:04:21] together, right? A PBM, a TPA, um, stop loss carrier, you know, navigation, what are those, how do those interact with each other and work with each other? So I think there's a lot of confusion when it comes to, um, when it comes to this type of strategy. And frankly, that keeps a lot of people stuck in where they were because they, they feel like they don't even know the questions to ask. They don't even know how to move forward. And so they just sort of continue to do the same

[00:04:46] old thing because that's what they're used to. Right. And so chaos, I think really comes from a lack of understanding of how incentives are really lined up now. Um, and, and what they can do to actually align incentives in their plan moving forward. That's where most of the chaos comes from is from them thinking somebody else needs to fix my problem. You know, somebody else, some, some vendor or some point solution or some other plan is going to fix my, even self on health,

[00:05:13] right? Hey, self on health is going to fix my problem. No, you know, this is a stewards, this is a stewardship problem. If you're an employer, you need to be a steward of not only the plan funds, but the care, um, you know, the coordination, all of that kind of stuff. And you can get vehicles that help with that. But at the end of the day, I think the employers that are really succeeding are the ones that are taking control and, and understanding their duties as a steward and, um, and, and really pushing that forward. So I think the chaos is, is ever present.

[00:05:40] I'd be lying if I said that wasn't happening with our clients, right. With self on health, because there, there's still a lot of confusion because we're so used to buying healthcare through an insurance company that we don't really even know what it's like to, to figure out what a fair price is for a service. We don't know what it's like to go to a different provider based on costs and quality and access. We don't, you know, we've never done those things. We go to different car dealerships to get a different car. We jump online, we see prices, you know, we can compare different pricings to electronic devices and TVs and that sort of thing. But when it comes to,

[00:06:11] you know, when it comes to healthcare, we don't know how to do that. And it takes a little bit of time, even when you're in this environment to figure out how to manage that well. And, and so it, it, it takes time and it takes effort and leadership. And that's why I tell people, this is not a great fit for everybody because it is disruptive. It is change. We can get you better. You know, we can get you less expensive. We can get you better access, better care, but it comes with behavior change. It comes with behavior change. It doesn't just come because you want it to come. You know, that's like what I tell my kids, you know, you're not going to,

[00:06:39] you're not going to win your wrestling match or your football game because you're not going to get the award just because they want to give it to you. You have to go earn it, you know, and it's very much the same principle. And that brings the question also of the education to employers, right? And, and what I feel, or at least I have captured throughout the industry is, um, it's a, it's a jungle. Like we don't, the person who's making the decision on the employer side, you just don't know

[00:07:08] how they sit in the org, meaning are they more on people process side, whether it's somebody who really has control over or understanding over even the financial or how this thing is connected to health benefits side. So my question to you is, um, I guess, how are you tackling that challenge in your day to day? Um, as at cell phone, like how are you getting over those, especially employers?

[00:07:35] Yeah. It's really important to have the employer leadership on the same page. It really is. And I encourage them not to make any decisions because it is a large decision to come, you know, operate in a, in a framework, like we're telling them to operate because we're giving them all the transparency and the control, but if they're not going to pull the levers that we're giving them, then, then they're not going to be successful because if we can, even if we're self-funded, self-funded does not guarantee

[00:08:03] cost savings, you know, self-funding the right way, right? Independently the way that we're trying to do with the navigation and, and that sort of thing, changing the consumerism is, is not a guarantee of savings. It's a guarantee of getting the transparency and control. Savings is the byproduct of that, right? If people are making better decisions, well, of course, if more people are getting an MRI for $500 versus 5,000 through the PPO network, you know, discount at the, at the hospital, then of course

[00:08:31] you're going to save money. Um, but then you have one person decide not to get their infusion done at the local infusion center that we sent them to, and they choose still to go to the hospital. Well, we just negated all of that hard work with all the other member behavior change. And so it is a process. It's not something that happens overnight. And I tell all the leaders that I think when we first started, we were pretty naive and we thought like, yeah, once we get people in, you know, they'll, they'll start doing the right thing. And, and now we're telling them, you know, the first year,

[00:09:00] because people are not used to this type of environment, they're not used to getting healthcare for free. I mean, we're literally giving them free healthcare, right? Free healthcare, all the way down to specialty prescriptions, surgeries, you know, um, cancer treatments, you know, whatever it is. They're not used to that. There's a lot of pent up demand because they're used to these $2,000, $4,000 deductibles. And, and so they're not going in, they're not getting care. You know, 60% of Americans are undoctored, meaning they don't even have a primary

[00:09:25] care, you know, doctor that they're going to see. And, and so then they're more unhealthy and now they're, you're catching cancers later and you're having, you know, hypertension and, and a lot of these things could have been managed, you know, through lifestyle changes, medication, that sort of thing. So when we introduce, you know, this plan where you have all this access to care, sometimes it actually goes up the first year because there's all this pent up demand, but after three to five

[00:09:48] years, you have so much more, um, you know, reliability using the direct primary care. You have so much more, um, case study and, and culture change using the nurse navigators and going to the, to the places that are going to be charging fair upfront prices and, and giving it a great quality service. And then it starts to level out, you know, that, that, that cost curve starts to level out and really starts getting bent. Um, but it doesn't happen overnight. So the leadership has to be aware

[00:10:15] that this comes with a big culture change. You know, you, you almost have to operate the health plan, like its own mini company, you know? Um, because if you don't, and you don't put somebody, you know, as a steward over it, then things have the potential to go sideways, right? Um, because just, just from changing your payment mechanism doesn't mean you're going to pay me less, right? That's not how this works. You know, if I'm, if I'm shopping for groceries at Whole Foods, you know, it's the most expensive place I could go to, right? If I go there and I say, oh, I'm going

[00:10:43] to save all this money. If I just pay cash today, you know, I'm going to go get all the same groceries. I'm going to go to the cash register, try to pay cash. And then I'm going to pay the same price. I'm gonna go, what happened? Well, you go self-funded, you're with Blue Cross or United or, you know, Cigna, whatever, any big PPO network. And, um, and you're, you're going to have, you're going to have the same amount of costs, you know, if not more. So, um, that's how it goes. And, um, what does a great partnership then look like? Let's talk about that.

[00:11:13] So that, uh, from your experience, of course. I think from, there's a couple of different ways, right? So there's the employer level, there's the advisor and the broker level. Um, I think I'll talk about the broker level first, because we work with a lot of brokers, advisors, consultants, um, whatever they want to be called. And really a good partnership looks like one where we are trying to get the employee buy-in to being a

[00:11:39] better consumer. So, you know, more focus on education, less focus on here are the different vendors. Here are the different point solutions. Here are the different, you know, networks and that sort of thing. We're not, we're not just showing options, you know, and, and showing different, you know, pieces or components. We're starting to say, Hey, we have the right components in place. We have good components in place, right? Through cell phone health. Now let's start partnering with the employer to really drive this education and this behavior change. So people can purchase healthcare

[00:12:07] the same way they purchase everything else and make smarter decisions within the framework of the health plan that we've put together. And I think when it becomes difficult is when, you know, a broker feels like their job is just to try to poke holes in everything and create, create friction or tension when there isn't any, um, currently and, and, and, you know, less, Hey, I think it's great that everybody's accountable, right? We want to be accountable too, but I don't think it needs to be

[00:12:33] completely the broker's job to just try to force self and health or any partner for that matter to, to be accountable. And so, um, that can be, that can be a poor partnership, but on the reverse side, I think that they're willing to say, Hey, this is what the employer needs to do to be successful and really starts to drive that and push that culture change within the organization, doing more educations. Let's do a Medicare education, right? Let's do a health fair once a year. Let's do a monthly employer performance report where we could talk about missed opportunities.

[00:13:02] We can talk about how the nurses are engaging with the members, talk about DPC utilization, you know, talk about these, these trends that are happening within the plan. Um, I think those are great partnerships on the employer side. Even if there's an internal champion, that is kind of driving the majority of the day-to-day work of answering questions and, and getting the buy-in and helping educate the members. I think there still needs to be component of the, the ownership of the business or the, the leadership, whether it's administrative, um,

[00:13:31] staff on, on like a public, you know, entity side, whether it's the C-suite on the, on the private sector side, there needs to be some sort of buy-in at the top in order for them then to allow the staff below to operate the way they need to, to make the plan successful. So without that leadership buy-in, it's going to be very, very difficult. And we've told multiple companies, I don't think you're ready for this yet because of the change management that it takes,

[00:13:59] right? And there might be other priorities, which is okay. You know, we're, we're not a great fit for everybody, but, um, you know, I think on the leadership side, that's, that's one of the more important places to, to make sure that they have a vision for what this is going to look like in the future. And that we're all partnering together to, to run that same way, collaboratively, not pointing fingers, not, not creating friction where there isn't knowing that, you know, we're going to make mistakes. There was going to be bumps in the road. You know, there's going to be people

[00:14:26] that are upset because it's change. That's what happens. Disruption, you know, change comes with change. And so the more we can manage that together collaboratively, um, I think the better off we're going to be in the future. And, and, and I think that's what you've experienced with the groups that have had a lot of success on our plan. They're the ones that have embraced that and really kind of driven that forward. Now the question on, um, the community that's coming in for, especially for

[00:14:52] a self-fun summit. So what gets you most excited where, where the community is going? I love seeing the fact that it's not about self-fun health. It's about people that want to drive change within healthcare, because that's ultimately our why everybody that works here. We want to put healthcare in a better place than it was before we started. We want to be able to actually move the needle and help people understand their options, understand what fair prices are, get better

[00:15:22] access, get better care. I mean, that's what we want for our kids, right? And our, and our grandkids. And so we want for this, this community, our, our society, um, to grow and thrive and, and not be, um, you know, burdened by this, by this huge lack of accountability burdened by this, this, this big, uh, you know, infrastructure that's really pulling a lot of money away from, from working people. And so what really excites me about this is seeing the employers that are getting involved in the game of

[00:15:47] healthcare purchasing and understanding how to look at unit costs, not just looking at network access or discounts, how to frame the conversation in the real way. Um, and I love seeing the employers that, that kind of, they start learning about it. They know something's wrong. They know something's wrong, but they don't really know what, and then you kind of, you explain it to them. And then they, they sort of have a few light bulb moments and they're like, Oh my gosh, yeah. You know, this makes a lot of sense. And they start going down the road and then you see these employers two,

[00:16:17] three years later, and they're the ones now repeating the same things that you've shared. And, you know, I call them my disciples now, you know, and, and there's a lot in that room who, when I first spoke to them, they had no idea, anything we were talking about, they had no idea about self-funding. They had no idea about how stop-loss worked, you know, how pricing structure, you know, worked in, in self-funding, how to get lower costs and better care. And now they're out there talking to other groups saying like, you got to check this out. Right. Because again, it's not

[00:16:43] about self-unhealth. The only reason that we're as successful as we are is because we're just taking the same purchasing mechanism everybody's using in their daily life. And we're just simply applying those principles to healthcare. That's the word. What we're doing is not unique. How we're going about it is unique. I believe, you know, how we're going about it is very unique and trying to streamline that. But what we're doing makes sense within a free market economy. Right. And so to see

[00:17:08] them sort of sprint ahead of these other groups and encourage other employers along, now you're starting to see the ball roll down the hill a little bit because there's momentum. There's people that are as excited about it as we are and, and are starting to kind of shout it from the rooftops. And there's still, there's still barriers. There's still a lot of issues, you know, there's still centers of control that are, they're trying to hold on, but that's, that's slowly starting to change

[00:17:34] and slip. And so it's exciting to see a community come together that, that really wants the same thing, which is a better healthcare future in this country again. And that doesn't necessarily mean it, it happens because of cell phone health, right? We are just a small part of it, but to see them come together because they care about changing it is really what is, I think the most exciting. Yeah. I'm part of that moment too. Fairly new to the world of cell phone, but you know, it's the movement. So that's, uh, that's attractive to know and learn. Um, now I'm going to do

[00:18:02] rapid fire round with you, whatever comes to your mind, go with that answer. Uh, where are most of the partners you talk to currently control or chaos? I would say on the, while on the new sales side, chaos, when it's comes to renewals, it's control. When it's our current partners, it's more control. Okay. One word for the appetite for self-funding right now. Hi.

[00:18:32] Most hyped things in sales conversation that you hear? Captives. Captives. And most underrated? Most underrated. High cost claim navigation. Cool. This has been great. Thanks for your time. Anything, anything you want to add? No, I really appreciate you being here. I love that we're going to get this out to the world

[00:18:57] and help them grow, learn along with us. And, and I'm all for it. This is awesome. The cell phone health team is very appreciative of everybody that's here, of you, Vivek and your team to be able to come here and continue to just spread the word. It's all, it's all education. So the more people we can help understand how this model works and how we think about things, I think we're going to be on the right track to getting some more change. So very appreciative. Thank you.