The Payer Revolution: Recent Episodes
Kwin Peterson
The employers of America have more power than they realize. The Payer Revolution provides tools, ideas, and inspiration to help you exercise that power.
Zane Woolstenhulme is the Business Administrator of the Ogden City School District and he epitomizes the payer revolution.
Find the show notes at https://www.payerrevolution.com/podcast/episode-10.
For the first half of 2021, the podcast has focused on the question, "Why should a business leader pay attention to her employee medical benefit?" We have answered that question and it's time for a new focus.
But first, here are my five big take aways from our first season. Show notes are at: https://www.payerrevolution.com/podcast/episode-8.
The guest on this episode is John Anderson of MotivHealth, an insurance company that gives refunds to employers whose employees save money. For show notes and links, click here.
Scott Brown is the CEO of Sterling Medical, and innovating urgent care-based healthcare system in Northern Utah, Southern Idaho, and Wyoming.
Find the show notes at https://www.payerrevolution.com/podcast/episode-7.
Over the course of this series, we have heard different numbers associated with the success of self-funding. In this short episode we take a deep dive on the question: "How many employees do I need in order to self-fund?" The answer turns out to not be obvious.
Our experts on this topic are Nicole Goodwill and Gwen King. You can find their information and show notes at https://payerrevolution.com.
Self-funding was the key to some companies' survival during the pandemic. In this episode, Katie Wood talks about the power of self-funding, partial self-funding, and level-funding.
Katie is a benefits broker, expert on self-funding and all-round generous and enthusiastic person. You can find show notes for this episode at https://payerrevolution.com.
Surgical care is a huge driver of costs. Scott Huff, MD is a board-certified anesthesiologist and the founder of Epic Surgical—an ambulatory surgical center designed specifically for self-funded employers.
Podcast highlights:
1:26 Why Dr. Huff thinks that business owners should pay attention to their employee medical costs. 2:27 Why a health plan is not health care 4:07 Why Dr. Huff focuses on his healthcare saving efforts on surgical procedures instead of primary care. 7:20 How primary care works now 8:40 How Dr. Huff realized that he could move some surgical procedures to lower cost environments 12:34 The difference between a high-cost and low-cost environment 13:35 What is an ambulatory surgical center and why did Dr. Huff start one 18:05 How insurance companies have reacted to the savings offered by his surgical center 18:56 What Dr. Huff's surgical center offers to employers 20:43 How employers are using Epic Surgical Center 22:35 Why Dr. Huff offers prices that leave so much money on the table 23:43 The cost of a knee replacement at a hospital versus at Epic Surgical Center 24:58 One thing a business leader can do today to start saving money
Managing claims lowers premiums better than managing premiums does.
Dennis McCormack is a benefits industry veteran of almost 30 years. He is both a broker and consultant and the owner of McCormack Insurance Consulting. He specializes in outside-the-box solutions for self-funded employers and brought some great insights to conversation.
Dennis' joins us to show us how to manage claims instead of managing premiums.
The show notes are at The Payer Revolution.
Revolutions are about power. The establishment tries to retain power and the revolutionaries try to obtain power. For the payer revolution, power derives from information and checkbooks, which is why Self-Funding and Partial Self-Funding is so important.
In this episode I talk about three kinds of medical plans:
- The "regular" kind: full insurance
- The "other" kind: self-funding
- The "new" kind: partial self-funding
With the regular kind, employers trade away their choice and ownership in exchange for promises of risk reduction and ease. In some cases, it is a good trade, but for many, it is the tool of oppression, where terms, options, and conditions are dictated by a system who functions as a landlord to your plan.
The other kind gives employers power, but it has traditionally been reserved for very large employers.
With the new kind, smaller employers finally have access to many of the tools, power, and control previously reserved for employers with thousands of people. The development of this new kind of medical plan is a "power to the people" movement that really enables a revolution in how medical plans are paid for and managed.
We have waited for politicians, health care institutions, and insurance companies to fix health care...and they haven't. But I know two secrets:
- Because American employers pay for the health care of more than half of all Americans, they have the power to change the system.
- Employers can exercise that power without heroic efforts—simply in the course of doing what's best for their business.
Medicare and Medicaid are not going to be fixed. But out-of-control costs, ridiculous rules, and lack of choice are all in your power to fix.
Why? Because healthcare spending in the U.S. is about $2.7 trillion and about half of the costs are being paid by employers. That's about $1.3 trillion worth of market power.
They will tell you that that market power doesn't exist because all of the employers in America can't combine and coordinate their efforts; and that is true; it has been tried repeatedly with disasterous results.
But we don't need coordinated efforts—individual, self-interested efforts will accomplish change better.
In the Payer Revolution podcast, I hope to convince you of your power. Check out this introductory episode and this draft manifesto:
The healthcare system in the United States of America is broken. It has been broken for years and our politicians and healthcare institutions have proven themselves unable or unwilling to fix it. Instead they have thrown the burden of managing the healthcare of half of all Americans upon America’s employers.
We, the employers of America’s workers, declare that we will use the power vested in us by virtue of the fact that we pay for all this care, to bring about a revolution in how care is paid for and managed. We warn insurance companies, healthcare institutions, and anyone else who tries to hold too tightly to the current way of doing things that they will feel the weight of our economic power.
The Payer Revolution