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Improving Health Care Value by Pausing and Asking Questions

Friday, August 2, 2019
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We recently had the pleasure of chatting with Stacey Richter on the Relentless Health Value Podcast.

Our “distilled advice” for listeners centered around the value that can be brought to light when patients pause and ask questions. Much of the conversation centered around the merits and value of a concierge-style advocacy solution, but we also explored other more in-depth topics, such as:

  • The challenges that unknowing healthcare consumers face on their healthcare journey
  • The value of concierge style healthcare advocacy programs to Employers and their Employees.
  • The position of health plans relative to network loyalty
  • The question of “who has leverage” in the modern healthcare arena – insurers or health systems and hospitals
  • Tips for insurers, hospitals, and PBM’s as Employers seek to find solutions to rising costs
  • Suggestions for Employers to work toward a plan of action, especially in the event of an economic downturn

You can review the transcript below, or click here to listen to the episode.

Stacey Richter:

00:00

Episode 237, Improving Health Care Value By Pausing and Asking Questions. Today I speak with Derek Winn, co-founder at Distilled Concepts and consultant at the Business Benefits Group.

Announcer:

00:15

American healthcare entrepreneurs and executives you want to know, talking. Relentlessly Seeking Value.

Stacey Richter:

00:32

Bad things have a propensity to occur in health care when patients are placed on a trajectory and then simply follow the yellow brick road to an Oz potentially filled with unnecessary surgeries, MRIs that cost 10 times what they should, low quality providers chasing RVU's like their paychecks depended on it. I could go on. Today I speak with Derek Winn, co-founder at Distilled Concepts and consultant at the Business Benefits Group. His distilled advice is to recognize that every transaction with the healthcare system is a way point on a larger journey, and also an opportunity to pause and ask questions. Payers of healthcare have a profound opportunity and perhaps growing obligation to help employees/members/patients, first of all, to recognize that a, look both ways before you cross the street, modus operandi is safer from both a monetary as well as an actual patient safety standpoint.

Stacey Richter:

01:37

Derek and I discussed the ways to make this happen, when/if it will become standard operating procedure, and the likely impact on providers and insurance carriers and pharma if employers choose to take this route. By the way, BUCAA stands for Blue Cross, United, Cigna, Aetna, and Anthem. We use this acronym in the interview to come. My name is Stacey Richter, and this podcast is sponsored by Aventria Health Group.

Stacey Richter:

02:09

Welcome to Relentless Health Value, Derek.

Derek Winn:

02:11

Hi Stacey. Thanks for having me.

Stacey Richter:

02:14

It's pretty much an accepted inarguable fact that doctors will refer within the same health system. In fact, I just read an article about this yesterday. There's the whole RVU thing and all the consolidation and record numbers of physicians being employed by health systems. So in other words, I don't see this whole referring within network as a trend that's likely to end anytime soon. That being said, the best doctor for a particular patient might not be within the same health system. So if you're an employer and you're trying to get your employees to the best doctor and/or health system to address whatever the issue is, how do you do that? How do you intervene?

Derek Winn:

02:57

Yeah, you nailed it. So what is it, 54% of doctors, I think, are somehow owned by a hospital. Either they're doing their contracting for them or they're working directly for the hospital. Well, guess what? Every hospital that's out there wants to claim to be the best at treating cancer. Every hospital out there wants to claim the best of treating heart conditions. Every hospital wants to be able to be the best in orthopedics. So what they're doing is they're referring within that hospital network. So instead what you do is you try to figure out, okay, what are those engagement points? How can we get members to start to think differently, to think that, hey, you know what, your hospital's probably a great hospital. It may be a great hospital. But the question is, again, are they the best for you and what you have going on? So what we start to do is we start to break that down and say, look, how do we get patients engaged?

Derek Winn:

03:41

How do we get patients to simply be engaged to the point that the ask more questions of those doctors? Are they the best doctor for you? Is what they're recommending appropriate? Are there other alternatives? Do I need a second opinion? You think about that, getting that engagement is really the first step in that and then from there you can reengage at the time of care and even place interventions throughout the health plan just to have a pause point for that patient to check in with the health plan or check in with their options. Because think about it this way, healthcare is a journey. Every doctor's appointment, every surgery, that's just a way point. That's just a way point in the overall journey. How do we connect with the patient more those way points is the, in this case, three and a half trillion dollar question.

Stacey Richter:

04:25

You work with employers. So we're talking about employees here. How do you connect with employees/patients at those way points?

Derek Winn:

04:35

We want to have a concierge style advocacy approach for members so that we can reengage them at the actual time of care. Because sophisticated employers who've seen that over the last 10 years have not seen results in their health plan, in other words, costs continue to go up and quality continues to go down, so on and so forth, they get it. I always look at Walmart is being a great petri dish for some of this stuff. They are the largest health plan in the country. So the question is what are the largest health plans doing? Walmart is a great example of this because Walmart essentially wanted to remove the bottom 5% of their network. It's been cited in Wall Street Journal, Axios, et cetera. They want to do that. The network said no. So instead what they did is they went out and direct contracted with Centers Of Excellence.

Derek Winn:

05:17

So now if you've got a back, knee, hip issue, so on and so forth, you're going to be going to one of the proven Centers Of Excellence to get care, and what they're finding is in the case of back surgeries, for example, 40% of the people that show up who've been told they need a back surgery don't actually need the back surgery. So you think about that, and again, if we can figure out more ways to reengage with the patient when they need the help the most, that's the way you win. We cannot expect people to remember what they learned at open enrollment, which is one hour out of the year, when they've got a lot of other things going on in their life that's stressing them out.

Stacey Richter:

05:54

Yeah, for sure. We had an open enrollment at our company, which I was very intrigued by, and they were like, well, , don't go to the emergency room.

Derek Winn:

06:03

Yeah.

Stacey Richter:

06:04

Oh, okay. So once a year you get that message. It's almost laughable. But that begs the question, how do you do that? You mentioned the concierge style approach. What does that, in its recommended form, look like?

Derek Winn:

06:19

There's a couple of different ways to go about it. One of those ways is through voluntary engagement. So voluntary engagement works the way it sounds, which is you make a phone number, website, app, et cetera, available to members. It needs to be highly communicated out to employees, and you'll typically see 20 to 40% adoption rates. That's in the first year or two. So employees who voluntarily say, hey, that's right, I was told that if I need to get an MRI I should go on or make a phone call and figure out where's the highest quality, lowest cost MRI facility, so I don't end up paying a 5x multiple on my MRI because I've got this deductible and therefore I'm incentivized to do so. One of the other ways you can incentivize through that, it's still voluntary, which is, hey, if you book your appointment through the concierge advocacy solution, we will waive your out of pocket.

Derek Winn:

07:09

You think about that for the average member. I'll use real numbers here for our backyard in northern Virginia, we have one hospital that charges $1,685 with a PPO network contract that's here locally, and exactly seven and a half miles away, there's another MRI facility. It's a freestanding facility, imaging. It's $335 with a PPO plan, so by steering members toward those, even on a voluntary basis, by giving them the carrot instead of the stick, which is, it's $0 in cost, not only can the employers save money, but the employee is getting more value out of the health plan automatically just by having that concierge approach. Again, those are both in a voluntary engagement type of solution.

Stacey Richter:

07:52

Well, the 20 to 40% engagement is not that bad.

Derek Winn:

07:56

Right.

Stacey Richter:

07:56

If you start thinking about it in the terms of that, if you cross off the bottom 5% or 10%, I've also heard, of a provider network, the impact is outsize, that just simply, forget about everybody above the five or 10% threshold. If you just get rid of the worst of the worst, relative to inappropriate care or really high costs or however you're evaluating that, then really good things happen at the group level. That obviously affects employers and employees a whole bunch of different very positive ways.

Derek Winn:

08:33

For sure.

Stacey Richter:

08:33

If you're not wasting money, obviously there's opportunity costs there. You can use the money to a much better end. So what does that specifically look like? There's a 1-800 number? Or is it like the Zocdoc business model where I can go online and-

Derek Winn:

08:46

So here's a couple of different ways to think about that model and what it looks like. Number one, the good news is, is that the bar is set pretty low. I don't know, if you're out on the weekends talking with friends, who opens up the conversation by saying, you know what, let me just tell you how much I love my health plan. Thing to think about with this is when you look at net promoter scores for health insurers, I think on a national average we're at a 13, which is slightly above waiting for the cable guy and slightly below most car insurance companies. The way you think about it is when you provide them with this 1-800 concierge program or you provide them with an app, people are getting a lot more value out of that. So you think about investments for an employer to make.

Derek Winn:

09:25

Why wouldn't we want to introduce more tools, resources, and invest in the overall benefits program, not just the health plan, but the overall benefits program for that employee by giving them additional tools and resources that they can use along the way? That's the way that looks. So again, in the voluntary model providing solution like that to advocate for members at the time of service, that's generally well received for those who'll use it. We'll never see a hundred percent utilization because that essentially means that everyone in the group is sick. So we hope we don't see that. But again, for the people who are using the program, we remind them, we communicate it, we essentially market out to the members that, hey, you have an additional resource to go to when you need it the most.

Stacey Richter:

10:07

So it's an app.

Derek Winn:

10:07

Yeah. So a lot of these that we're using are app based, so they can submit questions, they could submit bills, they can do things like that. But really what we tend to see is, is what's going to resonate the most, especially when it comes down to filtering out noise in what people understand or do not understand about healthcare is human guidance. So let's just use the word deductible. I think the recent statistic is 70% of Americans cannot describe what a deductible is. So if we're in a situation of where we're just telling members, hey, this is subject to your deductible, okay, great, whatever that means. But if we have a human voice that's guiding them, then we can allow them, number one, we can redefine everything as they go, but also at the same time we can have an engaging conversation with that patient and help them to understand why this may or may not be the best option for them.

Stacey Richter:

10:54

I find it interesting, because obviously there are different recommendations relative to network building, and in certain cases the recommendation is not to have a network at all, just to forego any sort of BUCAA involvement. It sounds like what you're saying is that you can keep your BUCAA, and maybe that's, if you're looking at the bell curve, there's going to be more employers who are willing to take the step into a self insured environment, but hang on to the comfort of having a BUCAA network than the ones who are like, we're going to go it alone. What I'm hearing you say is that even with these BUCAA plans, they are amenable to building in a solution which is controlled by the employer that effectively navigates and evaluates their own plan.

Derek Winn:

11:46

Yeah, to be honest, I'd say probably 99% of the time they don't even know it's there.

Stacey Richter:

11:52

Let me play an employer on TV. Obviously this costs money. We're adding fixed costs into the equation here, if we layer on a concierge and an app and a promotional campaign and the things that you're talking about doing. Does it wind up that those fixed costs reduce enough variable costs that this winds up being a good move from a balance sheet perspective while at the same time improving quality?

Derek Winn:

12:22

Absolutely. First, we talk about cost of entry. Cost of entry for an advocacy solution, you can start at $2 per employee per month and work your way up to eight or $10 per employee per month. With numbers like that, you start to think about it like, hey, wait a second, how many $335 MRIs versus $1,685 MRIs is it going to take to pay for this? Depending on the group size, it might be one MRI, it could be a couple of dozen MRIs. But again, that's just a great example. It's almost like you can't afford not to. The step further on that is you think about it in terms of what would the ROI look like on an advocacy service, because again, you think about it, these advocacy solutions need to be able to produce results to be able to retain that client year every year.

Derek Winn:

13:09

We start talking about what is your return on investment? You think about this way, insurance is not an investment. Unless you're actually buying stock in the insurance companies, in which case it would be a very good investment. You think about the balance bills that are going on out there. You think about all of the surprise billing that's going on out there, you think about all of the work hours that are wasted dealing with these and setting appointments and everything else. Think about these advocacy solutions. A good one is being almost like a task rabbit for healthcare. Now you have this own personal concierge that you can use to actually book appointments for you. Now we're talking about restoring lost productivity. So again, we think about this over the last decade, what are the harms that have been caused by health plans and health insurance and the low quality of care that people are receiving? Most of it's because they don't know any better. Well, let's start to fix that. These are just a couple of inroads to be able to start that journey.

Stacey Richter:

13:59

If I'm an insurance carrier, say I am a BUCAA plan, what do I think about this? Is there any negative impact on an insurance carrier of an employer who chooses to take matters into their own hands in this way?

Derek Winn:

14:13

If I'm a health plan, number one, I would ask myself why I'm not doing something like this already. The truth is it's because they can't cause harm with the doctor network. They can't do any network provider relations issues there. They have to avoid that. But you think about where we are with the political environment today and even just playing out a word like transparency. That's the big thing that if I'm an insurance carrier, I'm going to start to be concerned with, because when the day comes when we have to be transparent and I could see all of the bad deals that my network has made for me, and again, using the MRI, why am I going to be willing to pay five times more for an MRI just because it's got hospital in the name, as opposed to going down the street and doing it at a freestanding imaging facility?

Derek Winn:

14:57

The truth is is the cost can be even lower than that too. That's just one example. So if I'm an insurance carrier, I'm probably not as concerned with something like this right now. I'm concerned with the overall big picture of all of these bad deals I've made on behalf of my consumers. Is it time to maybe say, hey, look, let us help with some of this? Let us help show you where some of the better quality doctors are, but again, they're going to start to run the risk of offending their network, and that's always the big question is who has leverage? Is it the insurance company that has leverage over the network or is it the network that has leverage over the insurance company? That's a big question that's out there.

Derek Winn:

15:32

People always talk about how healthcare consolidation is good for consumers. I don't think so, because what that's doing is it's actually empowering these larger hospitals that are growing leaps and bounds to actually have more leverage and more negotiating power over the networks. It goes right back to what we talked about. Employers want to have this big network. Employers want to have good flexibility and choice for their members simply because that's going to produce less noise on their side.

Stacey Richter:

15:56

As it becomes apparent that an insurance carrier didn't negotiate, they allowed one entity to charge $5,000 for an MRI, and there's the $300 entity down the street, and the insurance carrier was like, whatever, I hope the consumer finds this themselves. What percentage of the population do you think is under the illusion that all MRI prices are created equal?

Derek Winn:

16:21

I think it's a high majority still. I'll give you two reasons why. Number one, if I'm covered under a traditional health plan, let's say I don't have a deductible for a second. I'm part of the minority of plans right now that does not have a deductible. Well, for me, my cost for an MRI is whatever the copay is, and the copay might be $250, so, for me, as a consumer, I'm not incentivize to look nor care if my MRI's more expensive because that's what I'm entitled to, is a $250 copay as long as they're, of course, I'm using air quotes, in network. That's issue number one. I think issue number two is, is the fact that we as patients, not a consumer because those are two different categories, as a patient, we are going to do what we need to do based on what our doctor recommends.

Derek Winn:

17:09

If my doctor says, I need you to walk down this hallway here at this hospital to get your MRI, I'm going to walk down that hospital and get my MRI. I'm going to go ahead and do that. But again, that's the touch point. That's the point where we need to interject and say, hey patient, hang on a second. You know you have a $2,000 deductible, and if you walk down the hall, it's $1,685, but if you get in your car and drive a block down the street, it's $300. That's the big thing to think about. A lot of this depends on the overall architecture of the health plan, but I think that's really what it is.

Derek Winn:

17:43

Zach Cooper recently did a study, a true north in healthcare and it was going on a year ago, but the average American drives past six, I think it's six, lower cost MRI facilities before they get to the one they ended up using. Well, why is that? Because when I think where can I find an MRI, I automatically think, oh I bet you a hospital has an MRI. So again, you think about the undue harm that's being placed on patients with the financial issue of again paying five times more than they need to for something as simple as an MRI.

Stacey Richter:

18:14

Insurance carriers and hospitals, and I don't want to necessarily get into the economics of the whole thing, but with the MLR, the medical loss ratios, there is some benefit actually to insurance carriers when costs go up, because if your profit margin is capped, then 20% have a higher number is a higher number of profit. Insurance carriers can probably be held culpable, as you had alluded to earlier, relative to stock prices. The stock prices of every insurance carrier, or let's just say most of them, has gone up considerably in the years since the ACA was passed and with this whole consolidation that has been going on. However, the average American is woefully unaware of all of this, and generally speaking, to educate 300 odd million people, takes a long time. What I'm understanding, based on what we're saying here, is that there's a long runway for insurance carriers to keep doing what they're doing. That's my takeaway from what you said.

Derek Winn:

19:18

You've nailed it, which is, where's the incentive for an insurance company to essentially say, look, we're going to take a stand for a second and we're going to actually side for their patients instead of our shareholders? I'm being blunt in that, but that's really what it comes down to. Because think about this, let's say for example, insurance carriers, because they know where the answers are, they know what to do in a lot of this stuff, let's just say they started to enforce change, and you nailed it with talking about a cap to margin. If I'm a large employer, it's 15 cents on the dollar. Well, imagine if insurance carriers had a shareholder call, and they said, hey, good news. We're going to go ahead and do all of these things that we know actually help to reduce healthcare expenses. We're going to curate our networks, we're going to get rid of the bottom five to 10% of the doctor network of crappy doctors.

Derek Winn:

20:03

We're going to go ahead and go back to hospitals and beat up on hospitals in terms of the charge master rates and the discounts we're actually applying there. What we're going to do is if we do all of these things, we're going to lower healthcare costs by 20%. Imagine what the shareholders end up doing after that, because they know that if they lower healthcare costs by 20% and we do away with this mythical trend number, what's going to end up happening is their stock price is going to plummet. So again, you've got to think about how all of this plays in, in terms of the overall ecosystem, but also in terms of the overall economy.

Derek Winn:

20:31

You're talking about messing with, what, almost 20% of the GDP. What would happen if we had essentially another economic downturn simply spurred by health insurance companies decided to cut their cost by 20% by lowering the actual cost of care? Imagine what that's going to do to the overall economy. So again, we think about this in terms of economic downturns and how everyone reacts in that change. Insurance carriers, they lose money. Hospitals, they lose money. Pharma companies, they lose money because, again, we're just touching on the biggest areas of waste and essentially misuse, which is those three right there.

Stacey Richter:

21:06

Well, let's talk about the 80% of the GDP that is not contained in the 20% with the healthcare label. One of the things that I've heard, which is potentially a counterpoint, is that one of the reasons why things haven't been changing is because actually the economy has been pretty good. It's when belts start tightening that employers start to really, in a way, I don't want to say be forced, but let's just say have a much greater motivation to start scrutinizing line items. What I've heard is that when that starts to happen, let's just say that the opportunities that employers might have to begin to take greater control over optimizing the healthcare of their employees will start to pervade the top of the bell curve in a way that they haven't thus far. Because when life is good, we can all be fat and happy.

Derek Winn:

22:02

For sure. You think about it this way, the overall majority of businesses are pretty comfortable right now. But here's the thing, which is, do you anticipate the next downturn occurring in, let's say, the next five years? Because if you're truly looking to optimize your health system that you have for your employees, optimize the entire ecosystem that you have for benefits program, you need to start planning ahead now, because if that downturn happens in the next five years, you need to be ready to move on it. Even if it's just education. Even if it's just including something like a low level advocacy solution or just knowing what your options are, you have to do it, because here's the cool part. Employers who are on that three to five year plan are going to have time to react. They're going to be able to see what other employers are doing.

Derek Winn:

22:44

They're going to see what they've done to get results and they're going to be ready to move forward. The foundation has been laid by early adopters and first movers, so now it's up to those other employers out there to cross that chasm. The cool part about this, though, is that, in that process, you look at big, large behemoths that are out there, like hospitals. At the end of the day, they're not going to have time to, because these plan renewals happen every month throughout the year, so you've got employers renewing every single month. Change takes a long time for a hospital, but you know what? Employers can move pretty quickly. Those decisions are essentially 12 months apart. It could be even shorter than that.

Derek Winn:

23:21

So again, they have to think about it in terms of, hey, what are we going to do to engage with employers in the community so that we can be partners together, in terms of, again, really doing what we espouse we're doing, which is giving back to the community, being supportive of the community, being supportive of businesses, being a true partner to the business community. That's what I would say, number one, hospitals have to do, and again, we talk about the other big culprit out there, which is pharma. They're going to have to pay attention to this too, because again, the gig is up in many of those areas as well.

Stacey Richter:

23:49

What's going to happen there? So let's take this from, let's just say, a pharma standpoint. If I'm sitting at a pharma company right now, and I'm working on a brand and I'm deciding, generally speaking, how the drugs are priced is what will the market bear, and the market will bear, as John Lynn put it in the podcast that I did with him, historically, if you just look at history as a guide, the market will bear anything when it comes to health care. So why wouldn't I just charge the higher price? I know that you mentioned this counterpoint transparency, but it's also been well shown that you can give consumers a whole lot of data, but then if you ask them to sort through it, that's where the trouble starts to emerge. What is the battle cry or the call to action, is probably the better way to put it. What's the call to action for a pharma company or a hospital or anybody who is basically charging whatever the market will bear at this juncture?

Derek Winn:

24:45

You'll love this one, Stacey, because in this case, they better bring the value. They have to show where the value is of that medication. Here's a good example of this. Does it make sense to charge $1.5 million on a medication for a hemophiliac? Well, if the average hospital stay is $1 million, well, I guess that's where start of the price point conversation comes into play is, hey, if it costs $1 million to hospitalize them, can we charge $1.5 million for the drug if it helps to keep them out of a hospital? That's subjective. Now, I don't know. I would have to take a look at that a little bit further and say, hey, is there value there? Is there clinical evidence that this is actually working? The really challenging part in this is a couple of things. Number one, we, again, as patients want to trust our doctors.

Derek Winn:

25:29

So if our doctor says, this is the drug for you, I may not be as tempted to question that. So you look at what health plans have already done on this is they have, again, checkpoints, way points along the way where we're going to check in and say, hey, is this the right drug for this patient based on what they've got going on and what the drug actually brings to the table in terms of value? You take a drug like, this one has been played out a million times, but Duexis, let's talk about that. It's Prilosec and ibuprofen. Is there really anything phenomenal that's coming from that to make it worth $2,500? Probably not. Lunesta, for non-24, maybe melatonin would work just as well instead of paying an exorbitant amount of money there. But again, for a lot of these other things, we want to check in with the patient and we want to see if it meets those clinical guidelines.

Derek Winn:

26:12

So we have things in place like prior authorization, we might have things in place like step therapy. We want to try to go toward those generic drugs first. As a last resort, then, of course, the name brand drugs. But you better believe we're also finding ways to help patients pay for that too. So we're tapping into the resources that pharma makes available to help make those brand name medications lower in cost for the health plan and for the consumer. So, again, you've got to make sure, number one, you're bringing value. You're bringing evidence-based criteria to show that this drug is the best drug for this person, it's not going to create crazy side effects that outweigh the actual cost or condition itself. But again, at the same time, if I'm pharma, I need to be paying attention to this too. If I'm marketing a plan, I can't just put a cute commercial on TV anymore and show a bunch of happy people. I need to actually bring value on it because, again, we're putting the clamps down on some of that too.

Stacey Richter:

27:00

So what I'm understanding, and I know the HTA does this, the Health Transformation Alliance, which is that group of leading employers, mostly large employers, across the country, but it sounds like what you're suggesting is that employers, or at least the ones that you work with and the plans that you're putting together for those employers, they almost have their own P and T committee, or a Pharmacy and Therapeutics committee, where they are looking at clinical data and assessing whether a particular drug performs over the standard of care commensurate with the pricing. Almost like ICER.

Derek Winn:

27:36

Yup. So we're doing that a couple of different ways. The way you think about it is, every health plan that's put in place, theoretically, they have a PBM in place too. There's over a hundred different PBMs to choose from. Unfortunately, 70% of the market is with the big three. But for many of our clients, what we're doing is we're essentially giving them their own P and T committee by bringing in people with a clinical background, not only at the onset of the formulary, because I'm not a clinician, we're bringing in that expertise when it comes down to building the formulary itself. Then again, we're having the clinicians involved to say, hey look, does this meet clinical evidence based criteria through things like prior authorization? This is really nothing new. This is stuff that health plans have been doing for a long time, but again, all of those are different checkpoints along the journey itself to be able to weigh in and say, hey, is this the best thing for the patient?

Derek Winn:

28:29

Are we causing undue harm? It goes back to one of the first principles in medicine, do no harm. First, do no harm. So those are the things we're looking at in this process is what's in the best interest of the patient first. We want to make sure that we are, again, very people centric, in terms of what we're doing, but at the same time, the reason why all of this is happening is, again, because costs are out of control, so we're also looking to weigh this out for the employer themselves who are the actual payer of those claims.

Stacey Richter:

28:53

So it's not like there's a separate P and T committee that's sitting with an employer. It's that you're recommending these transparent or clearing houses, I've heard them called PBMs, who have that capacity in house there and who are making formulary decisions based on the value of the brand, as opposed to the pay to play model that the big three PBMs tend to deploy, i.e., how big a rebate can I pay you to put my brand on formulary, even if it's Duexis and it's charging $2,200 for two generics that if you want over the counter cost 20 bucks?

Derek Winn:

29:31

Right. Yeah. The way you think about it is, again, there's a huge spectrum in terms of even just the PBMs that are out there. So, there's a million different buzzwords, whether they're fiduciary PBMs, transparent PBMs, et cetera, et cetera. Those are the ones you want to look at. Because, at the end of the day, I need to make sure that I'm bringing the resources to the client to make sure that their needs, whatever those may be, are met.

Derek Winn:

29:53

We're working primarily with mid-market employers. Sure, if I'm a larger employer, I might have my own P and T committee, but at the same time, we'll not only bring in the PBM, but what we'll essentially do is bring in an additional third party, which, again, is paid for in this process by the PBMs themselves, if it comes down to it. We much prefer to go direct to a PBM. We'd rather work through that. But at the same time, we'll bring in additional resources to help hold them accountable, resources with clinical backgrounds, resources that will help to compare the actual costs between multiple PBMs. Then we're, of course, doing that alongside of them as well. So again, you think about all of the checks and balances placed on the system. Healthcare has been void of checks and balances, especially on things like PBMs for a long time. Again, the gig is up. We are actually addressing this and taking it head on.

Stacey Richter:

30:39

So Derek, if someone is interested in speaking with you further or learning more about what you do, where can they get ahold of you?

Derek Winn:

30:45

Thanks. I'm super active on Linkedin and you can also find us at our website, which is www.distilled-concepts.com

Stacey Richter:

30:55

Thank you so much for being on the podcast today, Derek Winn from Distilled Concepts and Business Benefits Group.

Derek Winn:

31:02

Thank you Stacy. Appreciate it. It's a lot of fun.

Stacey Richter:

31:04

Links to everything discussed on the program today can be found at relentlesshealthvalue.com. If you visit the website, relentlesshealthvalue.com, you will also find a complete listing of all of the shows that we have published thus far with leading entrepreneurs and executives in the healthcare space today. Another cool feature is, you can subscribe to the show so that every week the episode is automatically sent to you, so you don't have to remember to go to the website to download it. Thanks so much for listening.

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