June 20, 2023

Healthcare Disruptors

Healthcare Disruptors

The first episode featuring our Health Plan Heroes was so good – we decided to do a second one. Listen now to see how these businesses have reinvented their health plans to provide top-tier coverage at a fraction of the cost.  Plus, did you...

The first episode featuring our Health Plan Heroes was so good – we decided to do a second one. Listen now to see how these businesses have reinvented their health plans to provide top-tier coverage at a fraction of the cost. 

Plus, did you miss this year’s Fly-In or just want to get a jump on next year’s? Registration is already open for the 2024 event. 

We The Patients Fly-In 2024 Registration Webpage

Health Plan Hero Webpage

CNN News Article: FDA-approved Alzheimer’s drugs will be covered by Medicare, with some limitations, CMS says

Healthcare Policy Pop Episode: CMS Alzheimer's Decisions + No Data


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The views and opinions expressed herein are those of the guest(s)/ author(s) and do not reflect the official policy or position of Patients Rising, nor do the views and opinions stated on this show reflect the opinions of a guest’s current or previous employers.


Speaker 1  0:00  
Have we had been facing double digit increases for several years,

Speaker 2  0:08  
Because in past years, it continues to be double digits.

Speaker 3  0:12  
We couldn't continue to do a double digit increase year after year,

Speaker 4  0:16  
And they had faced multiple years of double digit increases. 

Speaker 5  0:20  
And with a 22% increase in premiums, we did not want to pass that on to our employees.

Terry Wilcox  0:27  
Health care costs are going up and up for companies and their employees. Today, we hear from businesses that have reversed this trend. We're continuing our conversations with companies who are true healthcare disruptors. Our health plan Hero Award winners recently joined us in DC for an event celebrating their victories as they deliver better care at a lower cost for their employees. How they did that is up next. 

Terry Wilcox  0:52  
Welcome to the patients rising podcast. I'm your host, Terry Wilcox, CEO of patients rising. I'm joined by my co host, who had such a good time at the fly in that he says he is camping out at the rotunda forever. He's Bob Goldberg, co founder of the Center for medicine in the public interest. Have you ever stood at that part in the rotunda where you can be whispering in one section and they can hear you?

Bob Goldberg  1:19  
Well, that's where I'm recording from now. Terry? Oh, and I'm talking I'm speaking at a very low whispering voice. So. But in any event, you're right. It was an exciting week, it was amazing to see the work that patients rising does in action. And if you couldn't make it, don't worry. There's always next year. And of course, there's always the podcast to keep you informed.

Terry Wilcox  1:45  
That's right, Bob. And when I say there's always next year, registration has already opened for next year. And there's a link to that in the show notes. I set it on the first health plan heroes podcast episode, and I will say it again, these episodes are some of my favorite because we get to see good things happening in healthcare.

Bob Goldberg  2:02  
Yes, and we're highlighting another round of health plan heroes. Patients rising created this designation that recognizes companies with health plans that expand access to care, while lowering costs for patients.

Terry Wilcox  2:16  
Our first health plan here episode outline how companies are transitioning to this new way of delivering health plan benefits, be sure to give that show a listen. Today, we'll expand on those stories to show the impact on employees. And we'll share more examples of these plans in action. To start us off today is Ben Bohonowicz. He is a benefits advisor that has worked with many companies, including the 10x Corporation and horizon goodwill, for companies ready to take this leap, then comes to an employer with three questions.

Ben Bohonowicz  2:48  
When we started sitting down with employers and describing the intent of breaking down rebuilding the plan design, we really focused on three critical areas. We said how can we improve access? How can we improve quality? And how can we reduce cost?

Bob Goldberg  3:04  
Ben says these three questions can be world shattering for employers, but in a good way. How can all three of those things happen? Well, one, improving access begins by actually knowing what access you do and don't have. And Elizabeth Adler, who is the director of HR for tennis Corporation says it's remarkable that this is always the biggest issue.

Elizabeth Adler  3:27  
The main complaint I get from my employees is when dealing were like trying to care or trying to get precise help or trying to contact like a larger provider say like a care for us or UnitedHealthcare. Like they never can get straight answers. They don't know what's covered. They don't know what the deductible is, what is the deductible. I mean, even getting through all the phone prompts, the amount of time commitment, and really, you know, accessible knowledge that they have to have prepared to even get to a person is really frustrating. So that of her over and over and over and over again, you know, just accessibility to talk to somebody about your care is really difficult with the large providers.

Terry Wilcox  4:15  
Can you imagine a patient calling up and saying I don't know what's covered? I don't know what anything gods. I mean, yeah. This is so crazy. This is the second year we've done this health plan heroes award show. And you know, it's a lot of really small employers that are really feeling the crunch is you heard at the top. I mean, they're just they're feeling the magnitude of the cost of health care on not only their company, but their employees. And how can they reimagine their health plan in such a way that they can better take care of everyone and handhold those that need to be taken care of?

Bob Goldberg  4:56  
Yeah, I mean, you know, it's time ties into patient risings. Now, one of its key missions, and that is promoting transparency. But I would add to that, Terry, convenience and clarity. It's like, just not knowing what you don't and do not have. It should be basic.

Terry Wilcox  5:16  
All right, I mean, to Ben's point, patients should have access to the information so they know what's covered what it's going to cost them. And then they need to know, you know, for employers to be able to better provide for their patients. And when we talk about patients, in our instance, I always like to say, patients rising represents a lot of patients who use their health care every month, or sometimes even every week. And they need it to work. And they need to know what it does and what it doesn't do. And, you know, Ben said it best I mean, how can we know? Or how can an employer know what they can do better for their employees if they don't know what they're giving their employees? And, you know, all of this being a more open, transparent plan that provides better access for patients, you couldn't ask for anything better?

Bob Goldberg  6:09  
Right? I mean, sometimes it's a matter of realizing you have a choice. And then it's a matter of providing the choice for patients to design their own plans, which is becoming increasingly easier and you don't have to accept the status quo.

Terry Wilcox  6:26  
Right. And it's quite sad that we have just grown accustomed to bad insurance plans with high premiums, right, I mean, and high deductibles that often seem impossible to meet, and they do all kinds of games in jujitsu to keep you from meeting them. Luke Francoise Superintendent of Waterford Union High School, he explains how his district got into this situation.

Luke Francoise  6:45  
I was a superintendent in a small rural school district. And in that particular case, we were the only there was only one vendor that could provide health care for us. So there really was no competition. And when there's no competition, there's really no competition for bidding. So the only way to try to control double digit increases year after year, regardless of the medical loss ratio was just simply to start to create plan design changes.

Terry Wilcox  7:09  
letting those double digit increases that Luke mentioned are something we heard across the board. We played some of those clips right at the top of the show.

Bob Goldberg  7:18  
Yeah, listen, competition makes a big difference, and so can innovation. And to give you an idea how big a difference, here's Luke again,

Luke Francoise  7:27  
financially, we were able to quantify that even if every employee hit their stop gap insurance cap across the board, we would still save $330,000 over what the premium was from the year prior. Those are real dollars that can go back into investing in people into equipment and supplies for students. And it really can be used to push your school district forward.

Terry Wilcox  7:53  
While there are varied ways, you know, Bob, that these plans all work in favor of everyone. One way is that knowledge that we talked about most of the time with large insurance plans, they don't want you to have that knowledge. With these plans. That's not the case. Jonathan Coddington is a benefits advisor who worked with Allegheny wood and says that lack of knowledge was costing people in the company. How do you fix that? Hire someone with that knowledge.

Jonathan Coddington  8:21  
A couple of years ago, we were facing some potential significant increases in cost. And, you know, through some of the analytics and data that we had gathered over the previous couple years, we knew part of the problem was employees members, patients were not making good buying decisions when it came to health care. And so the employer is looking at us and what do we do? And I said, Well, I'd suggest we add in a nurse navigator program and had met or had talked to the co founder of that nurse SNAP program a few months earlier, and hired concierge nurse navigators to help out from that point forward. And it's changed honestly has changed the relationship between the members on the health plan and their health insurance.

Terry Wilcox  9:08  
Jamie Branstetter, the spouse of an employee at Allegheny would learned just how important a nurse navigator can be when she saved her life by pushing for treatment that Branstetter originally was told to wait on. 

Jamie Branstetter  9:22  
She was like, No way. We're not waiting. You're too young. She said I think you need to get a second opinion. And I said okay, I trust you if that's what you think. So we did. And she set it all up and got it all done. And I actually had microscopic cancer cells steal all my slides from the pathologist. So I ended up having to have another surgery and chemo and had she not kind of told me you know, I think you should get a second opinion and all that. I probably would have just waited and then it would have been a lot worse because I already had a lymph node involved.

Bob Goldberg  10:00  
Here's another success story Terry David Schuester, the CEO of Horizon Goodwill Industries. Now his company switched to a more patient centered plan while other Goodwill's didn't. And here's how it worked out for them. 

David Schuester  10:15  
The other thing that we realized is that talking with my goodwill colleagues at other another Goodwill's across the country about their challenges in this environment, and what expenses, they're in changes they were seeing in their premium renewals for their more standard insurance plans. In a two year period, where most of them were lamenting somewhere on the order of a 30 to 40%, increase 7% decrease here in our cost. And again, that's because of this combination of factors that have enabled us to reduce the cost both the organization and to the employees for access to care.

Terry Wilcox  10:50  
I honestly can't get over how amazing these stories are. And it's great to hear them in these interviews. But speaking with these folks in person in DC was another level of awesome it was it was really great to be able to have the healthplan heroes at the flyin. We gave some awards for fierce advocates at the flyin and we also gave a few awards to patient champions for members of Congress. So it was a really great overall time for us on Capitol Hill last week.

Bob Goldberg  11:21  
Remember, this was part two of our health plan heroes focused episodes, you can definitely check out the first installment if you missed it. It will be in the show notes.

Terry Wilcox  11:31  
Thank you so much to all of those who joined us today. These health plan heroes are a prime example of health care Dawn right. More information on all the winners can be found in the show notes.

Terry Wilcox  11:48  
While the 2023 we the patient's Capitol Hill week has come to a close, we're already planning for next year's event to be bigger and better. On that note registration for the 2024. We the patient's week on Capitol Hill is officially open. If you want to join us in DC an advocate on healthcare issues that impact you. Here's your chance. Information on registration is in the show notes.

Bob Goldberg  12:18  
Now, Terry, and an example of how much more work we have to do. The Centers for Medicare and Medicaid Services, part of the Health and Human Services Department, CMS for short, has made several decisions that are negatively affecting 1000s of patients living with Alzheimer's. Now, last year, CMS made a national coverage determination, which means they would decide who would get what, for all Alzheimer's drugs. That's something they've never done before. Now, to recap, what the coverage determination means is that you have to be enrolled in a clinical trial to get coverage for care. And not only that, I mean, they they criticize the FDA for approving a drug without all the data, they made this decision without all the data.

Terry Wilcox  13:05  
Well, now data on those treatments is coming out. And it's more positive than usual. In fact, for the first time in 20 years, there are some drugs that are shown to slow the progression of the disease.

Bob Goldberg  13:17  
Yeah, so right. So so so they do a lot of pushback, at least they're going to cover new Alzheimer's treatments that received traditional approval from the FDA. Now physicians still have to participate in a registry, which can still present several barriers to access. You know, there's nothing really here. Nothing really here. That's gonna,

Terry Wilcox  13:37  
I mean, well, one registry, I mean, one registry requires doctors pay $25,000 to join. And then fill out an 11 page form for every patient. You

Bob Goldberg  13:49  
see. Yeah, let's make it convenient. Yeah, let's make it patient friendly. It's

Terry Wilcox  13:53  
$25,000 to join. I mean, that's ridiculous. That severely restricts access. What about small town rural doctors, like they have an extra $25,000 sitting around to join your registry? I just, yeah, I

Bob Goldberg  14:07  
mean, look, the fastest rising segment of Alzheimer's population as minority communities, low income communities, what are they going to emit? Who's going to cough up $25,000 When, you know, a federally qualified health center is trying to keep his doors open.

Terry Wilcox  14:22  
Well, and not to mention that one to 2000 people per day progress beyond the reach of the drugs.

Bob Goldberg  14:29  
Yeah. Well, that's one way of saving money for it, right.

Terry Wilcox  14:32  
I don't know Bob will can we're gonna keep following this, folks. The Alzheimer's treatment coverage is a tough landscape. I have to say. Thank you for listening to today's episode of the patients rising podcast.

Bob Goldberg  14:44  
Now we have more episodes on the way so don't forget to click the Follow button so you don't miss out.

Terry Wilcox  14:50  
We'll be right back here again on Monday with another new episode. Until then, for Bob and everyone a patient's rising. I'm Terry Wilcox, stay healthy.

Ben Bohonowicz

Benefits advisor to Health Plan Hero winning companies, Tenax and Horizon Good Will

Elisabeth Adler

Director of HR at Tenax, a Health Plan Hero winner.

Luke Francois

Superintendent at Waterford Union HS, a Health Plan Hero winner

Jonathan Coddington

Benefits advisor to Allegheny Wood, a Health Plan Hero winner.

Jamie Brandstetter

Health plan beneficiary of Allegheny Wood, a Health Plan Hero winning company.

David Shuster

President and CEO at Horizon Good Will, a Health Plan Hero winning company.