Making Sense of Digital Health Benefits: How to Create Your Hierarchy of Needs

It's easy for benefits decision makers to feel overwhelmed at renewal time when faced with the vast sea of health care options that exist over a dozen categories. How are they supposed to determine what's best for their organization and their employees? In this whiteboard session, we'll outline the different types of digital health solutions in the marketplace and then build a framework for how to identify what your team needs and how you should vet a potential vendor partner. Our goal for this session is for benefits decision makers to come out of this session equipped to better understand their data and the healthcare ecosystem, and to have some fun along the way as we discuss innovation in healthcare. What you'll learn A better understanding of the digital health landscape for employers A framework for identifying your group's health needs & opportunities How to vet potential vendor partners

Transcription:

John Hansbrough (00:09):

My name is John Hansbrough, I'm a Benefits Consultant with Acrisure. We are an agency, a consultant across the country, across the world. I work in employee benefits, working with employers, and this conversation is something that I find pretty interesting because within the ecosystem of benefits and of healthcare, I think it's just fascinating that if you stay in the benefits and company employer kind of ecosystem on that side of things, there's really just really aware of what comes to you, right? And then I've got some friends who work in the digital health space and getting more involved in that space. And there's so much dynamism, there's so much innovation going on there, but there's this tough layer, there's tough filter. That stuff doesn't necessarily permeate. It doesn't necessarily come over to the employers for a while, and then when it does, it trickles down from largest employers.

(00:57):

The jumbo market lower and lower over time, where we have some employers with 50, a hundred employees, they don't hear about things for years when the jumbo market may have been aware of it for some time. So the idea for today is that we're going to be talking about how to navigate and make sense of digital health benefits and help you craft a hierarchy of needs. So the agenda for today is what we're going to talk about is first what we're calling digital health fatigue, and we're going to talk about how we got here. We're going to walk through shiny object syndrome and what role that plays in working with employers. We're going to talk about the healthcare supply chain, how to build your framework, and then we're going to be applying that in some case studies, and then we'll leave time at the end for a q and a.

(01:38):

Our objective for today is we want to provide benefits managers with a framework to select and evaluate health benefits and specifically digital health solutions in order to be a top performing organization. So before we get started, I want to just define what that means. So when we talk about top performers within the healthcare space, within the context of offering benefits, in our view top performers, they're aggressively understanding and managing their risk. So they know what their risk is and they're aggressively managing it. They're managing the healthcare supply chain, and that's why we're going to talk about it as a section. They're calibrating their benefits to the market and they're making sure that they align with their company's strategy, they're empowering their people to be healthy and to follow through with wellbeing strategies. And then finally, they're making the most of that investment. They're getting the most out of that ROI with effective communications on benefits and how employees can use all of these programs.

(02:32):

So to start with digital health fatigue. I don't know if anyone has heard that term, but over the last couple of years, we're seeing more and more conversation around how benefits managers are just inundated with all of the solutions that are out there today. If you're checking your inbox, I'm sure you're getting emails after emails from various point solutions, all these companies who want to get a little bit of your time to talk about how their point solution can make the biggest difference for your plan. But the problem is that's leading to more and more apps and more and more confusion. So look at your phones. I personally probably have 50, 60 apps on my phone. I'm sure a lot of you are the same way and the same confusion, the same muddling of those apps happens at open enrollment time. You talk to any of your carriers and any of your vendors, they've got tons of solutions.

(03:14):

There's always a new point solution, a vendor that a carrier maybe hasn't informed to you or you're not aware of, and could also be that you're just not getting the most out of it. So we're seeing that there's a lot of confusion as we just stack on more and more and more digital apps and vendors and point solutions. But we got to step back and understand what is it that your priorities are as an employer? You're trying to make sure that you are a top performing organization. Part of that is offering a competitive benefits program. It's doing it in a way that is cost effective for you as an organization, but is also supporting your retention goals and your recruiting goals. So we need to keep that in mind. And one thing is if you Google digital health fatigue, there's a lot of things out there.

(03:57):

I personally follow Christina Farr. She's a really good writer on this topic. So if you want, I can always send you a link to this after the presentation, but she does a good job on expanding that a little bit. But let's talk about how we got here. So one thing I'm going to do in this presentation, by the way, is I've got some memes and some fun stuff here. I wanted to liven it up a little bit is what's going on here is I go to parties. I'm the health insurance person, so I'm obviously not really the most fun to talk to, but that becomes a joke then because whenever I talk to my friends, as soon as they're dealing with an issue with their FSA or their carrier or whatever it is, they come to me and they're bitching and moaning about it. I can't really help because I'm not obviously their broker, but I listen to them and to them, the problem is always the insurance company.

(04:39):

It's always Blue Cross. It's always Blue Shield, it's Aetna, it's Cigna, whoever it is. Those are the bad guys. Then as brokers and there's the brokers in the room, we sit down with insurance carriers and the insurance carriers tell us, no, it's the health systems, it's the providers, it's all this consolidation. It's these rising contracts are making us pass back higher premiums. But then we talk to the health systems and what is their issue? It's the reimbursement payment model. And so that's where there's this chain effect of what's going on here. And so when we talk about the reimbursement payment model that you could also call it the fee for service model, we have a lot of aspects of the American healthcare system that boils down to the fact that we pay medical providers, doctors, nurses, whoever it might be, we pay them to do things, we pay them to intervene.

(05:24):

We don't pay them to maintain health. You could do, there's a lot of literature out there on the issues that we're seeing with a lack of primary care and a lack of investment and not just necessarily primary care is a big umbrella. To me. There's a lot of different aspects of it because right now you go see the doctor and the doctor gets paid to do things. They get paid to intervene. I've got a buddy who's an ER doctor, he's a revenue generating person. That's how he's compensated. If someone coughs, if they've got a lump in their throat, he's trying to figure out how he can refer them for the highest cost test because that's how he gets compensated. He's a revenue generating person. Something that you probably talk about at open enrollment too. Something we always talk about is say dentists, a lot of providers, they're looking to generate revenue.

(06:09):

So the problem that we see is that's just the structure of the system. Incentives. People respond to incentives in response to that. One of the, or I guess understand one of the issues there, the reason that's the case is when we look at medical billing codes, the behind the scenes stuff of you go see the doctor, the doctor submits for reimbursement, they're identifying what they did with codes, with medical billing codes, and we need to see evolution there. Frankly, we need CMS to go in and provide more digital billing codes when it comes to maintenance and these kinds of things, because right now there's just a handful of codes related to maintenance within providing healthcare. A lot of it is did a surgery, did an exam, issued a prescription, whatever it might be. And so to fill that gap, digital health companies have emerged to provide a lot of that kind of maintenance care, a lot of that otherwise billable care that the current payment structure just does not support.

(07:01):

So that's really where we're at today with why there are so many more. There's proliferation of digital health companies is because filling that gap, but it's getting really complicated. There was a research from WTW, they're a consulting firm, and in their survey of large employers, it was something like 80% of large employers have at least 10 point solutions or vendors to manage when it comes to their benefits. So while it's been helpful to have these digital health companies come provide and fill gaps within the healthcare system, it is providing a lot of confusion. It's creating a lot of issues. And one of the things that we run into when working with employers and just from the perspective employers have it's shiny object syndrome, we're not always looking at what we already have. We're just saying, you know what? We want to go get something new, right?

(07:47):

Because personally, I probably could do a better job spring cleaning my closet. I'd rather just go buy new stuff. And we see that in every aspect of life. Buying benefits is no different. We could simplify what we have, but a lot of times employers, it's more fun to go buy stuff. I get it. And so the reality though is that employers, when you're making your benefits decisions and you're considering new offerings out there, new digital health benefits, let's first understand what you have, simplify what you have before you go making buying decisions and really ask yourself, does it sound good or does it really fit our needs? Do we go through a rigorous process to identifying what it is that we're considering and why it is we want to make that purchasing decision. So when we talk about that, that means you need to think differently.

(08:32):

You've got to understand and think about your benefits of how can they help you meet your goals? What is it that our employees need, but even more so than what they need, what do we currently have and we're not getting from it? Ask questions about what do we not getting from the spend that we already have because you're already making a significant investment. We've got some groups that are spending 10, 15, $20,000 or more per employee per year on their benefits. That's a serious ROI that we need to understand, and if it's not working out, we need to figure out how to get more out of that. And then finally, a big piece of this that we'll talk about is how are you communicating these programs? Because if we just prepare a 15 page benefits guide and it's got a list of all these solutions, I know that at stewardship meetings six months a year in, we're going to find that enrollment or that utilization and engagement is just not there.

(09:19):

Communication is a huge aspect of getting what you need out of the benefits that you do choose. So when we think about that healthcare supply chain, I want to go over this really quick just so you understand then how a lot of these solutions fit in. You've got a variety of vendors in the market, right? There's carriers, TPAs, PBMs, and then companies that are working within all those different specialty areas, whether it's high cost claims management, specialty drugs and whatnot. All of that is a supply chain, and that's a term that I don't necessarily see a lot. We like to use that because in the same way that you're buying paper in the same way that I've got this microphone sitting here that came from somewhere, right? Semiconductors, there's a supply chain for a lot of physical goods that we have, but in the same way for healthcare, there's a supply chain for it.

(10:03):

We need to understand that because only once we understand that supply chain and where employees are going to get care and what care you're paying for, can you understand how to attack those financial levers within your plan to generate better results? So when it comes to managing costs, when we look at a group and we're trying to figure out what kind of digital health benefits do we want to bring in, what kind of vendors point solutions do we want to consider? There's really three key areas for cost management. There's your expensive specialty drugs that's driving costs. We've got to support high cost members. We find a lot of groups the 80 20 rule, but within healthcare, it's even more accentuated. It's sometimes in 80 10, right? I've seen some groups where they've got 300 enrolled members and they've got four people driving 90% of the cost.

(10:45):

When that's the case, it doesn't really matter what we do to incentivize ER utilization because you've got a couple people who are huge utilizers. And so in managing costs, it comes down to how can you better manage those high cost members more efficiently and give them better care? And then finally, you want to provide targeted programs for specific conditions and maybe certain populations and demographics, and there's a lot of, I think, pretty cool interesting stuff there. Personally, I've gotten to know a number of people who are building, and we talked about virtual primary care, virtual primary care for specific demographics. I live in Los Angeles, so I go speak to groups. We might have groups that are 90% Hispanic, so they're Spanish only, or almost only in Spanish. A lot of times we need solutions that are going to support them so they better understand how to use the healthcare system and get the most out of it.

(11:33):

So the process that I think is a helpful framework to have, and I always like to come at things from a principles first thinking, so what are the principles we're trying to follow here? We think the process that makes the most sense is you need to first understand your data when it comes to your health plan. Once you have a good grasp of that data and you have a way of interpreting it that allows you to devise healthcare strategy. So when you're managing these health plans, right? As a smaller group, you might just be purchasing a fully insured health plan, but the bigger and bigger you get in, you are managing an eight, a nine figure p and l when it comes to the healthcare system. That's really important for you to understand what clinical indicators are going on in your data to then inform how you're going to attack and manage those costs over time.

(12:18):

Once you have understood and seen what maybe issues you have or your high cost claims are, you're going to want to start picking and selecting tools to then implement to address those financial levers, to address those things, driving your plan costs. And then obviously once you do that, you want to evaluate things. You have to evaluate stuff and understand how well it's performing for you over time before you then make another decision. So this gets back to that buy versus simplify, understand what you have, understand how it's doing, and then that'll inform next what you're going to do about it. And so it becomes this upward spiral to us, this iteration, this iterative process that you can follow to really enhance the value of your plan. And so in building that framework, you're going to do things like getting access to data. That could be systems like spring buck, Artemis, whatever it might be.

(13:03):

That's going to be where you find that clinical insight to tell you, Hey, you know what? We are having issues with pre-diabetics. We are having issues with hypertension. We've had a couple high risk pregnancies in the last year. Do we need to look at something on the fertility basis? The data is going to tell you that kind of stuff. A lot of times HR teams that we're talking to, they really only know what employees have come to them and told them about. Maybe they're aware of things because of leave. That might be really the best information they have on what's going on with their group. If you can get into the data though, that'll tell us things that then can inform and identify what strategies you might want to consider to implement. That's going to come through clinical teams. You might be working with actuaries to really better understand what your data is telling you about, where you then need to look for interventions and point solutions to solve them.

(13:50):

Once you are in the phase of looking and picking at tools, that's where you need to start thinking about engagement, about convenience, about utilization, because as we talked about, and I'm sure all of you can attest to, you've purchased vendors, you've purchased solutions, and people haven't used it, and that feels like a huge waste of time. I personally had a couple of groups that early in covid, they really wanted to buy a mental health and behavioral health solution. They bought it, they invested in it. We talked a ton about it at open enrollment, and then a year later, the utilization was just not that high, so they didn't continue that contract. That feels like a huge waste to us. But a lot of that comes down to communication and how well you drive engagement for those tools. And it comes back to picking the tool because some tools are going to be better engaged with by employees in one population than another.

(14:36):

Finally, you want to measure that success again with your data, but also with surveys and with utilization. One thing that I recommend here is that again, you need to have a data engine that you own to manage your own healthcare data because if we rely on vendors, and I'm sure there's vendors in the media in the room right here, vendor data is honestly always the best possible version of the story for them. What's a visit? What's defined as utilization? What's defined as savings? It's always going to be very rosy when it comes to that vendor and their solution. So we want to have control of that data ourselves. We want to define what success is, and then we want to be the ones measuring success. If I'm going to a trainer and I'm trying to get in better shape and I'm utilizing their tools to measure how well I'm doing, how honest are they going to be about that?

(15:28):

So first, we're going to go through each of those four stages. So leveraging your data. If you're going to sign up with a point solution, we want to make sure it's because of the data. So have that system to implement, have that system to understand what your data is, do regular meetings about it, understand how best to use it. One thing that I think is pretty interesting, we're all aware that AI is playing a big role and almost just, I'm tired of saying the word AI because it comes up so much in conversation and it's such a hot topic. But the reality is that when it comes to your clinical data, AI is playing a role in how you can understand opportunities within your plan to find cost savings, to determine what clinical insights you should be looking at. So that's the first one. Understand and get a data engine in place that you can collect your data and then make informed decisions.

(16:11):

Once you've done that, you need to create strategies. And so that's where employers are really in a position that they can use the clinical insights from their claims data to be much smart about the solutions they're picking, right? So we might have a group that comes to us and says, we really want to look at some kind of musculoskeletal solution, and we got to step back and say, why do you think that's important? What's informing that? It could be right? But we want to understand why you think that's important, because what is the data telling us? What is that storytelling us? Something that's interesting too as you look into that claims data is you're going to start seeing things on where employees are going to get care. You're going to start seeing things on quality metrics ideally. And one thing you're going to find is this ongoing story that we're seeing in the healthcare system, which is that the higher cost of the medical care you're receiving, oftentimes the lower quality, it's there's an inverse relationship here between quality and cost within healthcare.

(16:59):

And it sounds kind of weird, right? Everyone thinks, oh, if I go see the most expensive health system in town, if I go see the most expensive doctor, I'm getting the most for it. And healthcare sometimes just doesn't work that way. A good analogy here is you go see a tailor. Taylor's really known for doing men's suits and that's what he's known for. And you go to him and you bring him a dress and you need the dress to get brought in. You need the dress to get hemmed. That's not what he does. And so in a lot of times we might go see doctors who they do a number of different kinds of surgeries. Maybe they generally do stuff on the back, but they don't specialize in a specific procedure, and therefore we tend to see within the data worst outcomes, more people coming back in for additional follow up services and over times higher costs. So it's very important that you understand where your employees are using care and how you can drive people towards those lower cost, higher quality providers.

(17:51):

Next, once we have identified what kinds of issues we have within the population, what kinds of opportunities they are for us to then go find solutions, those digital health vendors to help provide solutions to that plan, we want to be thinking about two things. What is the prevalence of this issue within our population, and then what is the severity or the average dollar cost of those claims? And so whenever you look at that, within different kinds of conditions, you'll see behavioral health, for example, way prevalent, very prevalent, depending on what's going on. We don't see it as huge necessarily of a cost driver as you have a couple pregnancies that are high risk, you have a couple cancer claims, and so we'll see that there's a curve here between the prevalence and the severity. As you're selecting for those tools, you're going to generally be looking for what kind of impact are we expecting?

(18:38):

GLP ones, for example, is a hot topic right now. I saw a good report that was revealing within your typical PPM for your health plan, what is the impact of GLP ones, right? It maybe has added 15, 20, $50 over the last couple of years to that PEPM. That tells us the impact of a specific issue within your plan. Likewise, you'll be able to see that when you start getting access to your data. Once we have selected those tools, communication is going to be a big aspect of that, and we're going to expand on that in the next slide. But I do want to talk aligned interests because there are interesting trends here, I think for all employers to understand about these point solutions in the market. So when you've talked to vendors, what's the most common form of payment that you are quoted when you say, go get a telemedicine quote, or what is it?

(19:20):

What's the most common format of their payment model? PMPM, what does that tell you? They're just going to get paid a flat amount per employee per month with no promises on success, no promises on utilization, but that's changing because a lot of employers are asking for more. We frankly have just been seeing employers are putting a bigger constraint on costs in the last couple of years. And so what we're seeing within these contracts is there's more at-risk contracts being put in place, and an at-risk contract, if you're not familiar with that, is where there's a fee that's stated, but based on certain performance metrics or KPIs, some of that fee could be given back to the employer if they don't hit those performance benchmarks. We're also seeing utilization based contracts. So if you look at say, a fertility program, that's one that I'm quoting right now for a group.

(20:10):

We're getting utilization based payments for that. What that means is that we've got a hundred employees at a group. You might have one to four employees use that service in a given year. A-P-M-P-M model doesn't make a ton of sense for that when it's a very low utilized program with high costs on the average claim, a utilization based program may make more sense. That also gives you more transparency. So whenever you're looking at contracts, it's very important to try to understand how can I make this more transparent and make this more aligned to our interests? So I mentioned I want to get more expansion on communication.

(20:45):

This is going to get some people really mad. I've got some friends who work in product and they tell me, John, if we have a better product, we're going to win. We're always going to win a sales conversation if we have a better product. And I'm a salesperson and I'm sitting here going, no, it's about the sales, it's about the communication. It's about the engagement with the thing that we are putting in front of people. Unfortunately, if you spend hours building the best possible health plan and you do a terrible job communicating it, employees are going to see and view that they've got quality benefits 26% of the time. But a below average plan that's effectively communicated, employees perceive that as valuable three times the rate, even though it's a below average plan. So ideally, obviously we have an above average plan that's effectively communicated, but the key point here is that communication plays such an overwhelming role within how your benefits are perceived and then ultimately also how they are utilized.

(21:38):

And for the investment you're making in a lot of these programs, you need to be spending the time and understanding how you're going to communicate. This is a lot. We don't need to go through all of it obviously, but really the key thing here is that 86% of employees think they understand their health insurance offerings. But then within that same survey, you ask things like, do you understand quality or qualifying life events? Do you understand your out-of-pocket maximum? Do you understand your deductible? Do you understand how to go through open enrollment? This one at the bottom is crazy to me. 42% of people surveyed did not know that their employer had a benefits portal, and that is of employers that had one. So as much as you think you need to invest in communications with a number of things that a high level for employees, you've got to keep it simple because some of them just really aren't paying attention.

(22:25):

There's other things going on, but the communication is going to be a huge, huge part of how you get the most out of these solutions you're putting in place. Finally, once we have gotten our access to our data and we've identified what kind of strategies we need to put in place to make a dent within the healthcare spend within our organization and get the most out of our benefits, you've chosen tools you need to evaluate the impact of those tools. Evaluation's a huge aspect here because that's going to tell us, Hey, did we make a good investment or not? And if we're not seeing the ROI or the value out of a program, why is that? Do we need to change communication? Maybe we need to send out flyers. Maybe we need to do more physical communications instead of virtual or email based, or is the program just not right for us for whatever reason?

(23:10):

And then understand and step back and do a postmortem on why did we miss here? Why was this maybe not the right solution? When we did think it was, you need to have an ROI timeline, and this depends on the solution. So you might be a group that sees issues with your high cost drug spending. Well, if you put into place a new PBM new contracts, you could see impacts and changes to your drug spending pretty quickly, right? Because you're changing how much you are paying for drugs on the data that you put that contract in place. However, other programs, whether that's virtual primary care, if it's an MSK solution, if you're trying to attack pre-diabetics and hypertension within your population, that can be a 12 month or longer timeline for you to start seeing a positive ROI. And that's okay. You just need to understand that because keep in mind a really important thing for you to keep in mind here.

(23:57):

How long do you plan to be offering benefits to your employees a year, three years, five years indefinitely? Probably a while. The problem that we have here within the healthcare system is a lot of the vendors that you choose to work with, their contracts aren't indefinite. Their contracts are year to year. It might be two to three years at most. And because of that, they are making smart business decisions on how much they're investing in your population or not, because they could make an investment in primary care, they could make an investment in trying to get employees more active, investing in wellness, and you move next year for a one or 2% lower renewal. That's the reality of how the healthcare system works in a lot of these insurance carriers look at things. And that's important to understand because your ROI timeline is much longer than them.

(24:43):

It's much longer than them. So when you're making these choices on which kinds of tools to implement, keep in mind, Hey, are we expecting this to turn on ROI just yet? Maybe not, but have an idea of what that is. And I always equate a renewal presentation. Again, I'm doing a lot of cliches here. I know we're coming up on an election, so you're probably tired of election. Talk to me, a renewal session that we go through a renewal season for a group. It's kind of like a legislative season. And so if you think about it, politicians go into office and they say, we're going to do like 12 things, right? We're going to attack all these different problems. And the reality, if you've watched Veep or House of Cards, and I know there's are very different shows, but if you've watched any of those people get into office, they've only got so much political capital to make some things happen.

(25:27):

You only have so much time within a legislative season to make some of these changes effective. And so what you might need to do is you might need to say, okay, we're under the hood now. We have access to our data. We're seeing all these issues within our clinical data of where our employees are at and what kinds of health indicators we're seeing. We're not going to get to all that right now. Maybe we're going to put into place a better contract. Maybe we're going to do some kind of tiered network. Maybe we're going to put into place virtual primary care and maybe we change our PBM this year. Next year we're going to tackle fertility. Next year we're going to maybe tackle MSK. You're going to have a three to five year timeline for how you're going to look at putting a lot of these solutions in place because you just don't have the bandwidth to do it all right now.

(26:10):

And that's a reality that you have to face. It's tough. We want to obviously do everything, but sometimes we need to look at tools that are going to work immediately. Sometimes they take some time. The other reality too is that sometimes you might see a tool, and this is what this is getting at that uses AI and it does all this fancy stuff. Sometimes it can be a little bit simpler and just changing your plan design a little bit and telling people to go somewhere else. So as you're looking at the tools that are out there, step back and think about is this driven by our data? And then how effectively or how simply does this tool work and how can we drive the most engagement and get the most value out of it? So some self-assessment questions you can ask includes how your employees perceive benefits, how you feel about your spending, how you're actively managing risk in this healthcare supply chain.

(26:57):

These are all questions that we use in our consulting. I think you can take with you and just use as you wish to start getting at the root of what kinds of solutions you might want to consider or how you currently are making decisions about the solutions that do exist or that you are already in contract with. Again, it's super easy to be in a silo and say, yeah, that fertility program sounds cool. I know we've got one of the executives is complaining about IVF not being covered by your health plan. Let's put a fertility program in place. Maybe the data says that that makes the most sense. Maybe an employee survey says that they want that, but understand in context how that feels in how that works in the big picture. So here's a couple of examples that we can talk about is case studies.

(27:42):

The first one I put together is Camilla, the CHRO. She's got 800 enrolled lives. There's a mix of professional and blue collar employees, so we need to cover the bases here. There's a lot of different kinds of employees within this group and a lot of different benefits needs in terms of how we recruit and retain for that population. Unfortunately, they've got some limited insight into claims and they're feeling pressure with cost increases. They're not a high margin business. And one thing that you can think about here is what is your margin per employee? Because that margin per employee tells you what the impact is of saving a dollar in benefits per employee. You can start thinking about how that moves the levers for you from a overall corporate finance perspective. And they've got limited communication channels. So if we were to sit down and talk about a group like this, what are some things that comes to mind?

(28:28):

Get better insider on your claims. So if you're using a TPA, if you're using an a SO model at this group size, how you could you get an outside data engine, right? Again, that's something where you want to own that data because as you move from vendor to vendor over the course of your lifeline with offering benefits, you want to retain as much control as possible. So get access to a data engine. How can you understand then the clinical strategies that you need to put into place here? And how can you though be more prescriptive and intentional about providing benefits that make the most sense for maybe your white collar population that has certain needs as well as your blue collar population with certain needs? And finally, when it comes to communication channels, we see a lot of groups that want to rely on just email. They want to rely on just having a website or a benefits portal. It comes down though a lot of times, do we get booths on the ground? Are we offering bilingual different kinds of services? That's the thing, even in southern California here, we have a lot of groups that we come across. They've not had someone who speaks Spanish just come talk to employees.

(29:25):

And we have just so many different kinds of populations here. Having more communication channels. This is going to get not just at open enrollment time, but throughout the plan year, it's going to get services in front of employees, but be intentional with what you're doing. So one group that I have, for example, they're a trucking group, and so this is kind of based on them. They've got a lot of people working professionally in offices selling their transportation services. They've also got people in warehouses, and then they also have truck drivers. Well, they've got poor enrollment from the truck drivers. Why is that? Well, where are the truck drivers? They're driving the trucks. So we're sending them emails. Okay, cool. We're sending them text messages. Cool. What's one thing we could do? Well, when they come to a site, when they come to a warehouse and they're doing a pickup or a drop off, why don't we get a flyer in front of them?

(30:16):

Why don't we have air fresheners that have a phone number for an enrollment center they can call? All those kinds of things are ways that you can get things in front of people and meet them where they're at. Because the reality is your employees probably aren't going to change overnight. They're just not. And if you just are going to rely on one channel of communication or two channels of communication, you're going to have people slip through the cracks. And so a lot of these vendors that you're going to look at, whatever it is, you want to partner with them and be very intentional with what they can do to drive engagement with your group. One of the trends that we're seeing right now within digital health is that 10 years ago, you would have a TPA, you'd have a PBM, you'd have a telemedicine company, and then maybe one or two point solutions.

(30:59):

Now you probably have a number of point solutions banging down your door to try to work with you. So there's been this huge proliferation of companies. And so in response to that is there's been more companies in that space. We're now seeing more companies coming in to consolidate. So things like transparent accolade, these companies are out there trying to simplify things, trying to give employees one door, one point of access to then triage and tell them where to go, right? Because I see you guys nodding. There's a lot of stuff out there. And so that's something to consider is how are we funneling employees to the right channel to then distribute them through the healthcare system because that can make a big impact on claims. It can make a big impact on engagement. If we move on to Harry, the HR director, he's got mostly white collar employees.

(31:41):

They've got about 200 enrolled lives. They've got a high PEPY cost. But the reason for that is that benefits play a key role in their retention and their recruiting efforts. So they've got a high average salary per employees, and so for them to go out and recruit, it's expensive. It's expensive, and so they need to do everything they can to hold onto employees. In their case, they've got high sensitivity to the care that's available to them, to networks, to cost design and whatnot. We've got some employers. They're employees really are not driven too much by some of the necessary benefits that they're offered to them. It's really more of a per paycheck. Cost is the driving factor of how they make decisions. A group like this though, people are very engaged in their healthcare. You want to have a very intentional way that you're supporting them.

(32:24):

And so point solutions that come in are trying to attack and address healthcare costs by restricting access or decreasing convenience, that's not going to make the most sense. So as part of this framework for how you're going to make these decisions, you need to think about your group and what it is that makes the most sense for them. So convenience is going to be a big factor to a group like this. So that's really what I've got here on case studies. We can go to the q and a, but hopefully this has been a helpful conversation for you on thinking about how to navigate the digital health landscape. There's a lot of choices out there for you just in this time. You've been sitting here in about 45 minutes that we've been sitting here. I'm sure you've probably gotten a couple emails from some vendors trying to reach out to you.

(33:08):

There's a lot of companies, and they're trying to come through us too. We hear all the time about, oh my God, this is the coolest new PBM. This is the greatest new telemedicine company. There's a lot that are out there. And it's important though to understand what it is your needs are. And that again, comes back to get data, do surveys, talk to employees, understand what they need and what fits. Not just what people are telling you they need, but rely on how people act. Rely on what you already know about them. They're your people. You probably know them very well. Use data to then back that up and then go out there and make informed decisions, but then be honest about it. Maybe some things don't work and just iterate on it over time and you're going to get really good results. And I think it's going to help navigate through this maze, this complicated proliferation of vendors that are out there today and simplify things so you can get a lot more success out of those programs. Are there any questions, anything? Or are people just ready to go get a drink?

Audience Member 1 (34:02):

I have a question. In your experience, the Maza vendors, so if you look at the top three conditions driving total costs, MFK, oncology, GI, in your kind of experience, do you have just a few vendors in those space that kind of check all those boxes and are pretty compelling for a specific client who may be struggling with one of those conditions that you're like, this is really good for oncology, or this is really effective.

John Hansbrough (34:33):

So in terms of attacking those MSK is like Hinge is kind of the go-to that's had a lot of success there, but we are seeing some companies like Sword Health has come up there and we are seeing some groups moving to Sword Health. We've got, I think one thing that's kind of interesting is I'm here in California, so I think raise hands who is not from California in this room. Oh wow, okay. So pretty dispersed. So California is a weird market. Yeah, you guys are laughing. California is weird in a lot of ways, I'm sure for you. So California health insurance is like everything else. It's weird. And one of the things that I always have to explain to my partners and my peers that are out of state, we don't have as much self-funding down market as in other states. We've got groups here with a few hundred lives that just, I don't want to do any, I don't want to have nothing to do with self-funding, right? So in California, captives are really big aspect of how we get groups into self-funding and manage their stop-loss costs over time. And so through those captives, those are good ways to aggregate some of these benefits and bring them down. Market Sword Health is one of those. There's a few others. I could do some, I just have to jog my memory, but Sword Health is one within cancer. I think cancer, a really big element of that is the fact that cancer permeates someone's life in every way possible.

(35:49):

One of those is mental and behavioral health. The stress it puts on that stress, it puts on relationships, it does a lot of things. So in that way, centers of excellence are a really big way that you can take care of that. So if we hear of employees who are dealing with cancer, we want to know where are they going to get care? How are they being supported? Because it's not just, yes, it's the cost of where they're going to see doctors and what oncologists they're seeing and the cost of the drugs that they're using, but it's also just the whole big picture around them. What's the support system look like? How can we maybe invest in a little bit of handholding, a little bit of white glove service to get the better results for those employees and really get them to see the right people?

(36:28):

One thing that can come up is a lot of cancer medications. There's a stupid, stupid game of how prescriptions work in this country, which is there's a prescription for a certain kind of cancer. It comes out, they've got a certain term that they have a patent active for that prescription. So then at the end of that term, they say, Hey, we're going to now say that our patent wants to apply this cancer drug to a different kind of cancer, and that prolongs the patents. And so I've had employees where their doctor's prescribing an off-label use for a cancer medication to treat a different kind of cancer, and carriers want to decline that.

(37:04):

So that presents an issue for the employee because then they're not able to get the medications that their doctor thinks will be effective. So working with your PBM, working with your carriers to try to figure out how can we also make sure people are able to get the medications and the drugs they need to get the most out of their care and their care journey so they have a higher positive outcomes. An element of that that I think is really interesting, I thought they were here is Grail. I dunno if anyone's heard of that, but it's this cancer testing that's super interesting, right? TPD only effectiveness, the false talk. That is true, but getting an idea of where we're headed with some of this healthcare is pretty interesting. And then with GI, there's some other GI companies that are out there. I'm trying to think. The testing, it's the same thing. Some of the testing, they're really trying to test and see what they can do. There was one that I did and it told me that I was intolerant to a number of different things that I didn't really know about. I'm forgetting what that one was. It wasn't ever, well, yeah, I'm just blanking on some of those right now. But yeah, it is an interesting thing to have seen where people are having distress and what all it's related to. So yeah. Sorry, that was a long answer. Other questions? Okay. If not, feel free to head out. Thanks for being here, everyone. I appreciate it.