Healthcare Disruptor Declares War Is Won Despite More Battles Ahead

“Is it any wonder that when you tell an employer they can return 30% of their number two business expense to the bottom line, stabilize future cost and make their employees raving fans of their healthcare funding plan, they would like to see proof? ” – Tommy Taylor

February 21, 2018

“If We’ve Won the War On Healthcare Cost, Why Are We Still Fighting So Many Battles”

By Tommy Taylor

The above picture and caption reflects the view of a somewhat select but growing group of consultants and brokers within the healthcare cost management community known collectively as Disruptors. It illustrates our feeling about the traditional healthcare funding system and how it has failed those it was to benefit. To all those known as Disruptors I say, “We have more battles to fight but the war is won”.

To you my fellow disruptors and Rosetta friends as well as non-industry readers.  Every day I am amazed about the success stories I share, and the stories shared with me by my fellow disruptors in the Healthcare consulting world. It is now commonplace to hear how long-term cost of care is being controlled, primary care provided at no cost to employees, employees no longer struggling to decide if they can afford to take their child to the doctor. What it means to have real access to your (yes your) primary care doctor. Real access is defined as access to your (yes your) doctor within 15 minutes, 24/7 at their office, your home, your office or by video. Does anyone remember Marcus Welby M.D.? The ability to shop for surgical procedures provided by the best doctors at the best facilities and employees who now see their healthcare funding plan as a real benefit. A benefit worth staying with their employer for and a benefit worth changing for! All of this is accomplished everyday by consultants that have chosen to think outside the traditional “buy insurance” box. Heck, some of you never even saw the box in the first place. It is the success we are having that brings me to the title of this article. “If We’ve Won the War on Healthcare Cost, Why Are We Still Fighting So Many Battles”

You see, it seems counter intuitive to me that answers can be so clear and abundant, yet we continue to struggle in communicating our message of change.

The first struggle I see, is the client who always wants to know who else has done this or tried that. I believe this comes from years of no innovation, real thought or transparency from me and my fellow consultants. Even those of us around before PPOs (that’s you Bill Rusteberg), became numb to the annual increases and the status quo that followed their introduction to the marketplace. We bought into the whole medical trend and discount mindset, allowing our clients to bear increases year after year. All because we believed it was the new normal. Because of this past lack of leadership by the consulting community, why should we be surprised when employers are skeptical and want to know who has done this before. What makes this unique however, is the question very rarely comes up in other employer expense categories. I believe this is because the free market system has continued to flourish in the other categories and been well applied by the business community in all areas other than healthcare. Is it any wonder that when you tell an employer they can return 30% of their number two business expense to the bottom line, stabilize future cost and make their employees raving fans of their healthcare funding plan, they would like to see proof? I think not.

The second struggle I see for us is the thirty plus years we allowed the big insurance companies and hospitals (now healthcare systems), to tell us and employers that you must have access to a PPO to avoid the huge bills the healthcare systems generate. Heaven forbid you have a $500,000 heart surgery and don’t have a PPO to discount it to $250,000. And then, in an Abracadabra “Wizard of Oz” moment, we are told not to look behind the curtain where we would see a cash price of $75,000 to $100,000. So, let’s get this straight, we need a PPO to discount a $500,000 bill to have$250,000 when we could have paid $100,000 cash? Not to forget these same PPOs have exasperated the fee for service model which has led to long wait times and an average time spent with the doctor of 7 minutes. these actions perhaps more than anything else have decimated the primary care doctor. I would encourage the reader to move that process to any other area of their economic lives. The best example I can think of is a furniture sale. We consistently see furniture advertised for 50 to 60 percent off. Yet if you take the time to really shop you will find that just maybe the prices have been increased to allow for the  I mean advertised discounts. The model we have used for so long simply makes no sense when truly reviewed. However, and this is important to understand, it is the system employers and employees know. As a bit of defense to my profession, the access we now have to data did not exist even 10 years ago. For many of us it was that early ability to finally “see behind the curtain” that started the transition to how we do business today. Additionally, the internet, with all its problems, is a remarkable tool for collaboration. It, more than anything else has allowed for innovation and collaboration within our community.

As an additional illustration please view the video from David Contorno a friend and healthcare cost disruptor from North Carolina. Faced with the need for a hernia surgery, David’s effort to find a quality and cost effective solution brought him out West to Oklahoma City. Thanks David, for allowing me to use this video.

Thirdly, we need to be passionate in sharing what we know. Employers are struggling with increasing cost of health insurance. Few of them have realized that the cost of health insurance and the cost of healthcare are two very different things. They are concerned about their employees who watch the increases in health insurance premiums eat up the raises they receive. Many employers have gone to plans with high deductibles and higher out of pocket cost in an effort to control premiums. However, this attempt while initially somewhat effective is no longer having the desired results. High Deductible plans are now increasing at the same or greater rate than traditional PPO plans. Studies show that the number one concern of employees is where they stand financially, and the number one financial concern is the cost of insurance and health care. I want the employees and employers I/we work with to know that those with whom I/we associate are passionate. Passionate about the employee that can’t afford the family premium to cover their spouse and kids, passionate about the single mom that wakes up at 2 a.m. with a child who has a 105 degree temp and has to decide if she can afford a trip to the hospital because she doesn’t have a primary care doctor, passionate about the 50 year old diabetic that ends up with a preventable surgery because they couldn’t afford their diabetic supplies, passionate for the employers that I/we have allowed to over pay into a bloated system, passionate because for so long I/we were a part of the problem but now understand that we can truly make a difference. We damn well need to be passionate. 

Number four. While most of us in the disruptor community have already changed our compensation models, our profession as a whole, must do the same. Being paid a flat percentage of the total cost of the plan simply adds to the problem. How can my goals be aligned with an employer if I receive an automatic pay increase when rates go up? Additionally, if I/we work hard for a client and improve/reduce their healthcare cost why should I be paid less. Better to have an open and honest discussion with the client about compensation. This allows for total transparency and allows for all goals to be aligned. By changing to a fee-based model you can set expectations, provide better service and with time, good works and trust, become trusted member of the employer’s healthcare cost management team.

Finally, to those of you that are not industry professionals. Those employers and employees that have made it through this self-reflection of mine. I want you to know that there are real solutions that can help and there are many nontraditional brokers and consultants who will be glad to show you the way. I would encourage you to simply reach out to any of those named here, Mark Watson with Union County Employer, Marilyn Bartlett State of Montana Employer, Jeff Bernhard Continental Benefits, William Rusteberg Consultant, David Contorno Consultant, Dave Chase Author, Mike Dendy, Asserta Health Vendor, Chas Dummit Higginbotham, any member of Health Rosetta. Some, like me, are consultants, some are employers who have made a change, some are authors and speakers, and some are unique vendors who are making a difference. We are geographically diverse but united in purpose. I know that any of us will be glad to visit. We are all passionate!!!

Tommy Taylor, Vice President and Managing Consultant, Higginbotham

Tommy leads one of the Southwest’s most creative, transparent and aggressive broker operations.  Prior to Higginbotham,
he led practices at HRH, Willis and Fairly Group.