Shareable Video Clips from this episode:

Why does 30% traditionally go to prescriptions?

https://youtube.com/clip/UgkxCKM0KU4RKAnCteupF4HEAFQZDkPgVthy?si=k8Z3p2WbG95jbhiz

Tie in with of Dr Firouz Daneshgari and Bowtie Medical

https://youtube.com/clip/UgkxCs_1WG9-GftcV79XZN5be0rB8x_k0_Ad?si=9NwVjr3otIR-SPTv

Our new Guardianship for Small Businesses product has no copay, the help of Dr Firouz Daneshgari, Bowtie Medical and no cost Manjaro or Ozempic for plan members

https://youtube.com/clip/UgkxjdWG290AfATN8l30ja8jpNzgijePXiF0?si=3QwHROMm63ebi6zS

With the new administration in place, going forward from winter 2025, what’s the future in healthcare? Here is Rich’s take

https://youtube.com/clip/UgkxtcndY94Y2r_r31clgnye2RwZ3V4bnQQi?si=Xtu3CXRufj-FHNXg

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Episode 2102 Transcript:

00;00;01;14 - 00;00;05;24

Announcer

And now America's Healthcare Advocate, Cary Hall.

00;00;05;27 - 00;00;22;17

Cary Hall

Hello, America. Welcome to America's Healthcare Advocate show broadcasting coast to coast across the USA. Here on the HIA Radio Network, my producer, Mr. Dave Thiessen, behind the camera, the man who puts all these shows up on our podcast YouTube channels as well. And Mr. Garner Cowdrey, in studio here at Cumulus Radio.

00;00;22;22 - 00;00;45;25

Cary Hall

We are very happy to be here at Cumulus Radio. This is our newest flagship here in Kansas City. We're very happy to be here on 95.7 FM and 710 AM, KCMO. I also want to welcome one of our newest affiliates, KMAJ 95.3 FM and 1440 AM in Topeka, Kansas. They're also a Cumulus station and we are very happy to be on the air in Topeka, Kansas.

00;00;45;27 - 00;01;15;09

Cary Hall

If you are chronologically challenged and you're looking for health insurance, specifically Medicare, Carolee Steele, the lovely Carolee Steele at Benefits by Design, RPS Benefits by Design can help you. She can also help you with any ACA issues you may have. If you're looking for individual coverage. 877-385-2224 anywhere in the country, they are happy to help you also, if you are looking for employer sponsored health care or health insurance, Maria Ahlers at RPS Benefits by Design.

00;01;15;09 - 00;01;31;12

Cary Hall

She is the chief operating Officer and she is more than happy to help you. She just did a group for us in Texas that they couldn't find good coverage, and she was able to do a great job of it. You know, they have something unique plans that are not necessarily available from some of the other some some of the other brokers around the country.

00;01;31;12 - 00;01;41;00

Cary Hall

And I think you might find it worth exploring if you, especially if you're looking on the group side. All right. Joining me in studio today, Richard Haldeman CEO of Detego Health. Welcome.

00;01;41;02 - 00;01;41;27

Richard Haldeman

Good morning.

00;01;41;28 - 00;02;02;11

Cary Hall

I'm glad to have you here. Flew in here from Texas today to do this show with me. A little disclaimer as we start there are three founding partners for Detego Health myself. Rich Haldeman and Alan Wilson. Rich is the CEO. He is the former, former CEO of Cancer Treatment Centers of America in Tulsa, Oklahoma, and has a long history in the health care industry.

00;02;02;14 - 00;02;18;23

Cary Hall

And it was Rich, Alan and myself that brought Detego to life. And we're going to talk about that today. In the first few segments, all I want to do is I want to explain to you what Detego does as a TPA, a third party administrator, and why we are different than what else is in the marketplace.

00;02;18;23 - 00;02;36;02

Cary Hall

That's really what I emphasize in the last two segments of the show. I think you're going to find this very interesting. I'm going to ask Rich to go into what he anticipates is going to happen with the incoming administration. Are we going to see a loosening of the rules? Are we going to see more private plans being allowed to go into the marketplace?

00;02;36;05 - 00;02;51;19

Cary Hall

What are we going to see? I think he's pretty well dialed in on that. So I think we're going to have a very interesting show. So I'm going to start off with a quote that I learned from you. Detego Healthcare is a TPA that doesn't want to be a TPA. Okay. Now what he means by that.

00;02;51;24 - 00;03;10;27

Cary Hall

And I do this in broker briefings every day when I have these conversations is we are unique in what we do. We don't sell other people's plans okay. So we're very, very unique in that respect. We create our own plans in-house. We design them, we take them through the regulatory process. We put them together, and then we put them out in the marketplace.

00;03;10;29 - 00;03;24;02

Cary Hall

So Rich, just expand on why we chose to do this so much different than other TPAs that are doing Pareto or the Berkeley Captives which are all great, but we have a different model that's targeted at a very different group.

00;03;24;05 - 00;03;52;02

Richard Haldeman

You know, we started working on this idea back in 2018 and 2019, and it was really, it came out of the notion that there was, a need for small businesses. That was the beginning. You know, so I owned some franchises. I wanted, to have health care for the people that work in the franchises, but really, the carriers weren't interested in single owners.

00;03;52;05 - 00;04;26;18

Richard Haldeman

And, maybe 1 or 2 employees. So we saw that as an opening for us. Number one. Number two, what we saw very quickly was there's a misalignment between the carriers and the ultimate recipient of the service, which is the our member. You, the health care consumer. So we wanted to build a system of care, a system of delivery, a system of support so that it focused and aligned our interests with the health care consumer.

00;04;26;21 - 00;04;42;13

Cary Hall

And that's unique because the approach that was the approach and the approach is an out of the box approach. We're going to talk about what makes it an out of the box approach to some of the things that we talk about here, but that that really was what started this whole thing down the path that we're on.

00;04;42;15 - 00;04;42;25

Richard Haldeman

Correct.

00;04;42;25 - 00;05;04;09

Cary Hall

Yeah. And and when Rich talks about serving the part of the market that's not being well served or underserved, that is the small employer, the small group, the 1099 individual, the people that either don't qualify for a subsidy or can't afford these premiums that they're saying that are coming up from some of the carriers. And that's not necessarily the fault of the carrier.

00;05;04;16 - 00;05;22;14

Cary Hall

Keep in mind that all of the ACA, everything you see out there on the individual side and on the small group side, is is dictated by the federal government in terms of what they can charge, what they can do and what they can't do. We are very different in that respect. So let's talk a little bit about that and some of the differences between us and the typical BUCA carrier.

00;05;22;14 - 00;05;23;00

Cary Hall

Yeah.

00;05;23;03 - 00;05;28;17

Richard Haldeman

So what after the ACA, and I worked on the ACA.

00;05;28;19 - 00;05;30;09

Cary Hall

You did. Let's see your chagrin.

00;05;30;09 - 00;05;51;26

Richard Haldeman

Yes. There were some really great ideas and great, benefits for people in the ACA. And I do think some of them kind of got through, but I think they left behind, really? Those individuals that are self-employed or small company, they really just it was left behind. And I think there was some real estate in the ACA, to take care of that.

00;05;51;26 - 00;06;18;12

Richard Haldeman

But nobody ever acted on it. And ultimately I feel like, we deal with all the different states, their departments of insurance, and each one has their own strategy. And, and they're ideology about what should happen in health care. And some feel like, you know, people should be, or everybody should be on the ACA. Others feel like they invite and want innovation that lowers the cost of health care.

00;06;18;15 - 00;06;26;12

Richard Haldeman

And so, across the board, we, we once we got the lay of the land, we knew where we wanted to run with this company.

00;06;26;15 - 00;06;28;15

Cary Hall

And we have done that.

00;06;28;18 - 00;06;32;07

Richard Haldeman

We have. Yeah, we have. And we continue to do so.

00;06;32;09 - 00;06;34;19

Cary Hall

It's an evolving process.

00;06;34;21 - 00;06;39;23

Richard Haldeman

Yeah. It's kind of like changing the tire on your car while it's running.

00;06;39;26 - 00;06;41;00

Cary Hall

Believe me, that's a trick.

00;06;41;02 - 00;07;03;04

Richard Haldeman

All right. Yeah it is. It's a trick. And what you're trying to do is put in new benefits, new, systems to help, our health care consumers, our members, while we take care of everything that came before it. And so it is it is quite a feat. And it requires, it requires systems that most people don't have.

00;07;03;06 - 00;07;18;16

Cary Hall

Yeah. And we have built systems like that. We're going to talk about those, as we continue with the broadcast today. But the idea here is and what I'm trying to do is paint a picture for you. Most specifically, if you are a broker out there, I really urge you to take a look at what we have in place.

00;07;18;16 - 00;07;34;15

Cary Hall

Go up to the Detego website and take a look at what you'll see up there, and send us, an email or contact sheet and let us know you'd like to talk to us. We'd be happy to get you involved and show you that we're offering different solutions, especially to your clients. Under five, That’s the area.

00;07;34;15 - 00;07;48;22

Cary Hall

We see a lot of cut off that they don't have coverage or they can't get coverage or or if a 1099 employee, if you're a contract anesthesiologist, you're making $300,000 a year or you're you're you're a contract, or.

00;07;48;22 - 00;07;54;15

Richard Haldeman

You're a partner in a, in a, in a company where there's it's set up like a partnership.

00;07;54;17 - 00;08;14;28

Cary Hall

Right? You you may not qualify for an ACA subsidy. And you may find that, you know, our program offers better benefits at lower cost, specifically in certain areas when we get into the 44 plus. But the point I'm making here is that we have really separated ourself, and we're trying to fill a niche here that is not being filled, and we think we're doing a pretty good job with that.

00;08;14;28 - 00;08;40;26

Cary Hall

We're certainly seeing a lot of growth in that area. We'll talk a little bit about that. But it's something it's very, very different in the way that we do this. And again, if you're an employer, if you're a 1099 person out there, you know, or you're a broker out there, if you go up to the website, just go up there and take a look at our information and send us an email or the contact sheet, and we'll be happy to reach out to you and get you into one of our briefings and have a conversation with you about what we do and how we do it.

00;08;41;03 - 00;09;04;05

Cary Hall

When I come back from the break now, I'm going to get into several areas level funded, fully insured and self-funded. We're going to talk about one of those terms mean all right. And how does that roll over into Detego Health. What do we all do. We offer products in all three of those categories. We'll talk about that. And then in the next segment I'm going to talk a little bit of what we call FAQs frequently asked questions.

00;09;04;05 - 00;09;24;09

Cary Hall

By the way all of this is up on the website. You can see it up on the website. And if you go to detegohealth.com, it's up there on our website. We'll be right back after the break. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast across USA. If you want to send me an email, go to that website.

00;09;24;09 - 00;09;31;26

Cary Hall

AmericasHealthcareAdvocate.com. You got a question or comment? We'll be happy to take it. Thank you very much. We'll be right back after the break.

00;09;31;29 - 00;10;01;29

Steve Kuker

The golden rule treat others as you want to be treated. I'm Steve Kuker and this is one of the founding principles of my firm, Senior Care Consulting. Since 2002, a value statement has included. Honor our mother and father. Respect our elders. Care for those in need, and treat your family as our own. We've been honored to help hundreds of families make one of the most difficult decisions they could ever make.

00;10;02;04 - 00;10;37;22

Steve Kuker

Serving them in their greatest time of need. If you're looking for someone who can provide you experienced and objective guidance when searching for a senior care community, reach out today and discover the services of Senior Care consulting at 913-945-2800. Know your options and choose with care at seniorcareconsulting.com.

00;10;37;24 - 00;10;55;16

Cary Hall

Welcome back to America's Healthcare Advocate show broadcasting coast to coast across coast USA here on the HIA Radio Network. You know, you listen to these shows and go, gee, that's really kind of interesting. I want to tell somebody about that. Or maybe you missed one. Go up on the podcast platform. There are 16 of them now that we post all these shows on.

00;10;55;16 - 00;11;10;04

Cary Hall

Actually, Dave does that. That's why they get up to the right way. In addition to that, they're also put up on our YouTube channel, America's Healthcare Advocate. So all the shows are up there. Go up and listen to them. You can even go up to watch by Trump Dance if you really want to see it. It's up there, I tell you.

00;11;10;06 - 00;11;28;01

Cary Hall

I did one right here in the studio. So. All right. So welcome back. I got Rich Haldeman in studio with me today. CEO of Detego Health. Everybody's laughing about the Trump dance okay. Remember that one. Yeah. And, so let's go back to what we were talking about. We were talking about differences between us and typical TPA's.

00;11;28;03 - 00;11;53;11

Richard Haldeman

Well, so carriers aligned obviously to make money and they have and they have, regulation around how much they have to, you know, put towards your claims, etc.. So after the ACA, I think I started there where I talked about the ACA, after the ACA, they had to change their business model because there were restrictions placed on how much money you had to apply to, members, depending on if it was a state admin, a product or whatever.

00;11;53;14 - 00;12;04;23

Richard Haldeman

And we can talk about that later. But, they, they bought PBM. So, the biggest and most, apparent one you might know.

00;12;04;26 - 00;12;19;13

Cary Hall

Yeah, that would be Aetna and CVS says PBM that's pharmacy benefit manager. And what they did was they shifted over to PBMs to make up for the losses they felt they were going to experience as a result of ACA. So that's the big secret. It's not really a secret.

00;12;19;19 - 00;12;39;06

Richard Haldeman

Yeah. And and they're they're reeling from it. They're having all kinds of issues. They're they're going to get scrutinized in the coming year, the coming administration, because there's a whole lot of misaligned incentives that hurt the member. So let's talk about that as an example. So the first thing we did was we found what they call White Hat PBM.

00;12;39;09 - 00;13;03;10

Richard Haldeman

This PBM takes no rebates. Any rebates that come through go back into our claim fund for our members. Everything is pre negotiated. So there's not a ridiculous markup on drugs. There's no incentive to move one person from one medication to another. It is the best medication at the best price. And they have an incredibly good clinical and customer service for our members.

00;13;03;14 - 00;13;26;10

Richard Haldeman

So we pick them to work with the name of the company. Just I'll say it out in my free plug. It's called Ventegra out of California. They've been an incredibly helpful partner to us, and this is part of the whole I'm changing a tire while the car is doing 60. So we started moving people on top Ventegra because they they actually look out for our members dollars.

00;13;26;10 - 00;13;49;08

Cary Hall

And if you're wondering, how does this relate to what health care costs. 25 to 30% of your spend of every dollar that goes out for health care revolves around prescription drug medication? So there's a reason that a drug store bought a health insurance company. I'm talking about CVS. They're not having a very good time of it. Okay. There's a reason why United Health Care owns their own pharmacy benefit manager.

00;13;49;13 - 00;14;06;03

Cary Hall

They don't want you getting those medications outside of their system because they are making money on that. And that's part of the problem. And when Rich talks about some and we'll talk about this when we get into the third and fourth segment, what we anticipate from this incoming administration, there going to be some changes in this area.

00;14;06;07 - 00;14;23;01

Richard Haldeman

Yeah, I believe there's going to be changes. I think, they are looking at this from a true consumer standpoint. And right now we're really dealing with, with an oligopoly of sorts, where you have very few companies controlling a good portion of the market.

00;14;23;04 - 00;14;46;20

Cary Hall

And that's exactly right. And, and the people in Washington, the bureaucrats in Washington, the people at HHS and CMS, they like this structure because they have total control, okay. And they're the ones that allowed these mergers and allowed these companies to go out and do this. And now, unfortunately, depending on how you want to look at it, this is where people are reaping what's been sown by the carriers and the government.

00;14;46;20 - 00;15;04;09

Cary Hall

This is why if you're a small group client out there and you've got five, ten, 15, 20 employees, you may have got a 20% increase this year or 30% increase this year. If you're on ACA and you don't qualify for a subsidy. And let me say something here, I think ACA helps a lot of people with that.

00;15;04;10 - 00;15;12;19

Cary Hall

Have the subsidies get health insurance. They wouldn't have. Yeah. What we're talking about is that segment of the market they completely ignore. That's the ones that fall through the cracks and.

00;15;12;24 - 00;15;14;29

Richard Haldeman

They're the ones that are paying for them.

00;15;15;01 - 00;15;35;07

Cary Hall

And that's another part of this. And so I had a I had an insurance company. Executives say to me, we can't get young people to come on our plans. Yeah, I because the costs are so high and they're being made to pay for things they don't want or need. If I'm 22 years old and I'm a male and I'm not married, why do I want Children's Mercy Hospital in my network?

00;15;35;10 - 00;15;53;10

Cary Hall

Because that's that raises the cost for access to that hospital. Those are the kinds of things that are blanket deals that come through. And that's part of the problem. And that's where what we're doing is very, very different. We are focused on the small employer, the individual that 1099 person that we've talked about.

00;15;53;10 - 00;16;16;11

Richard Haldeman

Cary, there's a conversation nobody is having. So in my history, I worked for medical schools and building out new medical programs, etc.. Right out of the chute. The medical industry is what they call cartelized. Do you know what that means? It's a cartel. The medical schools across country I forget how many there are. I, I want to say there's like 120 medical schools in the country.

00;16;16;13 - 00;16;40;11

Richard Haldeman

Those folks open up a certain number of seats every year. So before we ever get into the before we get into some of the economic incentives or disincentives and alignment that's out there at its base, we have a problem with the number of physicians that are in the marketplace. So you're right out of the chute. Hospitals are faced, and I ran hospitals for a living.

00;16;40;14 - 00;17;04;27

Richard Haldeman

Hospitals are faced with paying top dollar for specialists. And, multi-specialty practices and primary care providers, which is why one of the best careers, young people can get into these days, given the demand and the aging population is to become an NP, or PA a physician assistant or a nurse practitioner, because those folks can be extenders of physicians.

00;17;04;27 - 00;17;09;14

Richard Haldeman

But there are not enough physicians, especially family and primary care physicians.

00;17;09;14 - 00;17;30;11

Cary Hall

It's a huge problem. Yep. The other part of that problem is that these physicians, these primary care practices, and I talked about this when I did the show with John Stockton here. Who is that? He's been in the health care industry for a very long time, 25, 30 years. Is it that the hospitals and and the insurance carriers, in a lot of cases, went in and gobbled up the primary care practices?

00;17;30;11 - 00;17;43;18

Cary Hall

So there are not independent primary. There used to be independent primary care practices here in the Kansas City metro. There were at least a dozen. Blue Valley, I mean, there was a whole list of them. Okay. They they've all gone away. They've all been acquired by the hospital.

00;17;43;18 - 00;17;44;26

Richard Haldeman

I was part of the problem, Cary.

00;17;44;28 - 00;18;08;16

Cary Hall

It's a huge part of the problem because they're the ones that are setting the priorities, then, and the average time that you spend with the primary care physician in this country is 7.5 minutes. That's another reason why we are seeing models like ours come into play, where we have programs for people that did get rid of those issues, and we'll talk about some of those in the upcoming segments as we go through this.

00;18;08;16 - 00;18;27;08

Cary Hall

But we have programs we had doctor Firouz on here. He's gotten a lot of response to those shows where he talked about Guardian and how we're partnering with Guardian, and how you have a totally different model in terms of how people access health care and do it in a way that makes a lot more sense and cost a lot less that has better results, much better.

00;18;27;08 - 00;18;47;25

Richard Haldeman

And in fact, as you know, I'm we're very close with Firouz and Bowtie. We believe in their model. We've made an investment in their company. Yes. And we've created a joint management system with them so that our members are all of our people on our plans, close to 35,000. Now, benefit from this, and we can talk about that in another segment.

00;18;47;25 - 00;18;49;01

Richard Haldeman

But, it's very exciting.

00;18;49;01 - 00;19;04;19

Cary Hall

It is exciting. And this is what I mean by changing the way, changing the face of health care. If you want to learn more about us or just engage with us and talk to us, if you're a broker, if you're a small employer, for somebody looking for health insurance or health care, go to detegohealth.com.

00;19;04;19 - 00;19;29;18

Cary Hall

We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. Coast to coast across USA. When I come back, we're going to get into those FAQs frequently asked questions. I think you'll find this fascinating. Stay tuned.

00;19;29;21 - 00;19;47;25

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show, broadcasting coast to coast across the USA here on the HIA Radio Network. Once again, if you want to listen to one of these shows or tell somebody about it, go up to the podcast platform. There are 16 of them now, or you can go to our YouTube platform and AmericasHealthcareAdvocate.com.

00;19;47;25 - 00;20;07;06

Cary Hall

We get a lot of feedback. I think we've had 504 hundred. Is it 450,000 450,000 views podcast and our YouTube channels. And it's really quite remarkable the number of people that are listening to what we're doing and, and what we're trying to bring forth in the marketplace to separate fact from fiction on the subject of health care. All right, Rich.

00;20;07;12 - 00;20;27;01

Cary Hall

So let's switch gears a minute. So departments have insurance because sometimes be much maligned and they have a very difficult job. They're trying to represent the consumer. They're also trying to to make sure that what's coming into the marketplace is fair. It's regulated. It's what is supposed to be. Now, there are different departments of insurance that deal with that different ways.

00;20;27;01 - 00;20;46;04

Cary Hall

There are some that just go. If it's not ACA, it's not a government plan. We're not going to let it in here, but we're going to make it very damn difficult. Yes. Then you've got other departments of insurance, like Florida, you know, like like some of the red states where they have a different approach. So let's just talk about that a little bit so people understand, why there are all these differences from state to state.

00;20;46;04 - 00;20;47;17

Cary Hall

Because there are differences.

00;20;47;19 - 00;21;06;24

Richard Haldeman

There are differences. And this year we really made a big investment, with a company that I believe is at the top of their game called NTG. They have worked with us on understanding what each state needs and wants. But I have to give a kudos. We went to the NAIC meeting in Colorado.

00;21;06;24 - 00;21;08;10

Cary Hall

And would you say what the NAIC is.

00;21;08;10 - 00;21;34;27

Richard Haldeman

The National Association of Insurance Commissioners. There we go. I was really impressed overall with their concern about protecting the consumer and they've got their hands full. So I'm going to tell you this. There are a number of bad actors in the market. And they have to figure out pretty quickly whether or not any particular, organization that's offering something in their state is a bad actor or not.

00;21;34;27 - 00;22;01;09

Richard Haldeman

And that is a difficult job. So I have to give them all kudos. They all go about it a little differently, which is fine. We went in just to say we're an open book and we're happy to share and support, any any questions you have about what we do. But I was impressed with, how, serious they take their mission and how they're really at the end of the day, each one is looking out for the consumer.

00;22;01;09 - 00;22;21;11

Cary Hall

And that's what their job is supposed to do. And as Rich said, our what we try to do is make sure we're as transparent as we can be with these different departments of insurance. I want to switch gears now, but I was up on the website. One of the things that I saw that I thought was really great that we do are the FAQs, and the FAQs are frequently asked questions.

00;22;21;18 - 00;22;42;00

Cary Hall

And there are a whole series of these up there. There are videos up there. It's just except you, you won't see this on a typical carrier website. So I'll give you a couple of examples. What is reference based pricing. So we explain that what what is balanced billing. That's a result of reference based pricing. Alicia, one of our staff members does the welcome kit.

00;22;42;00 - 00;23;01;04

Cary Hall

Welcome to Detego. What do you get. What's it look like? How do you interact? Okay. How does how does our telemedicine, “my live doc” work, all of that is up there. And again, I'm telling you this so that if you're really looking for something different and you're a broker or you're an employer, individual, this is an example of what we do here.

00;23;01;04 - 00;23;06;02

Cary Hall

So let's just talk about, I think those FAQs, which took a lot of work.

00;23;06;04 - 00;23;09;18

Richard Haldeman

Yeah they're probably on their fifth iteration.

00;23;09;19 - 00;23;10;20

Cary Hall

Yeah. At least. Yeah.

00;23;10;21 - 00;23;30;27

Richard Haldeman

It's real work. There are a lot of work. And what we try to do is based on the kinds of questions we get from brokers or members in terms of what they need. That's really the focus of them. So some of them will be more focused words, you know, member type questions. Some will be focused on what a broker might ask.

00;23;31;00 - 00;23;33;25

Richard Haldeman

So they come through. They come at it from different points of view.

00;23;33;27 - 00;23;52;12

Cary Hall

So let's just use a couple of these real quick. So reference based pricing we have a product that is a small group product. And we offer its a reference based pricing product. Yep. That scares a lot of people sometimes because they don't understand it. That's what that particular FAQ does. But go ahead and talk about that a little bit and explain what is right.

00;23;52;13 - 00;23;56;26

Cary Hall

Well why is that a good option for some employers and how do we handle this different.

00;23;56;28 - 00;24;13;16

Richard Haldeman

Well, I think we need to unpack some of the history here. So the history was at some point when, when before the ACA, even, when the market cost hit a fever pitch and so people started looking for any type of, cost.

00;24;13;16 - 00;24;14;27

Cary Hall

Relief, relief.

00;24;15;00 - 00;24;37;23

Richard Haldeman

So back in the day and I don't, you know, I can give you a multiple number of years, but back in the day, you could buy a reference base price, reference based pricing product that didn't have a formal network on it that, basically was a negotiated exchange between the provider and the either the carrier or the individual member.

00;24;37;25 - 00;25;07;00

Richard Haldeman

And, providers weren't ready for it. There was a there was a minority, and there's more and more each year. More more providers are realizing that they have to see the patient, code the bill, enter it into a billing system, upload it to a clearinghouse. That clearinghouse then sends it to the carrier. So literally before a provider gets a single dollar, that bill has been touched by up to ten people.

00;25;07;03 - 00;25;08;24

Cary Hall

What do you think that does to cost?

00;25;08;27 - 00;25;34;08

Richard Haldeman

Yeah, it drives up costs. So we have to pay clearinghouse to do all that stuff. Every time we add a new feed of data, we pay them. So it all. If it's our cost, you can bet that it's the same cost across the board. So reference based pricing was basically says I will pay you some percentage above Medicare because Medicare right now, good or bad, is the only clear benchmark that people can go by.

00;25;34;08 - 00;25;54;05

Cary Hall

And so talk about what the typical the typical markup is off of from. So we have Medicaid, Medicare, which are the two lowest paying government systems along with the VA. And then you move into private health care. And private health care pays a much different rate to what Medicare reimburses a provider at. Talk a little bit about that.

00;25;54;05 - 00;26;21;08

Richard Haldeman

Let's just say something cost $100 under Medicare. So if you're a Medicare recipient and you go to the doctor and it cost $100, most, most hospitals and providers set their charge, meaning what you would see at McDonald's when you buy a burger, that's their charge to you. They would set it at eight times that. That's a national average between 6.5 and 8 times that.

00;26;21;08 - 00;26;27;22

Richard Haldeman

And for some services it's as high as 12. So 1200 times Medicare.

00;26;27;24 - 00;26;30;03

Cary Hall

You find that hard to believe. It's not okay.

00;26;30;03 - 00;26;30;24

Richard Haldeman

Well I did it.

00;26;31;00 - 00;26;47;26

Cary Hall

Yeah I know. And he did because he was in the hospital side that this is where there's a breakdown of the system. This is where innovations like reference based pricing come in. Talk a little bit about the model we have because the model we have is significantly different. It takes the risk out of it. On the balanced billing side.

00;26;48;00 - 00;26;50;18

Cary Hall

Just describe that before we go to break here in about three minutes.

00;26;50;18 - 00;27;12;12

Richard Haldeman

Yeah. Just quickly. So what we realize that the pure but I call the pure reference based pricing where you do everything through a reference based pricing model was just too noisy for people. Our, our country's not used to going in and negotiating or doing anything with a physician. It's all a mystery, right? It's all of a fugazi .

00;27;12;12 - 00;27;36;08

Richard Haldeman

It's all in the smoke and mirrors. Nobody knows what something actually costs. So, it was too noisy. So what we did was we found a network that supports networks that support reference based pricing. And what we do is we include everything. Everything, including emergency except elective surgery. So, last week, I fell, I hurt my shoulder, went to my doctor.

00;27;36;09 - 00;27;52;25

Richard Haldeman

Now we have to have a surgery to repair something. We use reference based pricing in our products. If you pick one of our reference based pricing products for that segment of care only, everything else feels, looks, smells, acts like a regular network.

00;27;53;01 - 00;28;04;16

Cary Hall

And how much of a difference does this make to employers brokers out there in cost versus putting an employer on a standard ACA level premium, whatever the case may approximate.

00;28;04;19 - 00;28;07;21

Richard Haldeman

I mean, generally we see 15 to 20% difference in price.

00;28;07;23 - 00;28;09;09

Cary Hall

That can make a huge difference.

00;28;09;12 - 00;28;15;28

Richard Haldeman

Because because less than 10% of your utilization accounts for nearly 70% of cost.

00;28;16;02 - 00;28;36;14

Cary Hall

And that's what people don't understand. Well, we know there's an old adage in this industry that 20% of the people drive 80% of the claims, and that's exactly what we're talking about here. And using this system allows, allows us to go in and negotiate that upfront. So it's understood when you go get that surgery, this is what the hospital's going to get paid.

00;28;36;16 - 00;28;41;16

Cary Hall

You're you have no responsibility for that. We take care of that. That's the way that it works.

00;28;41;18 - 00;29;04;00

Richard Haldeman

Yeah. I always tell people, and I give talks, you know, all the time. I always tell people that want to manage their own health care, to take an HSA plan and to walk into any physician's office and don't tell them you have a network and say, give me the cash price and what I know is the cash price is going to be better than the network.

00;29;04;02 - 00;29;07;01

Cary Hall

If they can give it to you, if they can give it.

00;29;07;07 - 00;29;18;02

Richard Haldeman

A yes, if they can give it to you. But a lot of offices now because of this shift, this response to high cost health care, you can get the cash price when you walk in.

00;29;18;05 - 00;29;27;17

Cary Hall

The biggest place you're going to have a problem with that is when you try to get the hospital to tell you, what's it going to cost me for? They won't tell you, okay. And if you try to go up on their chargemaster and figure it out, good luck.

00;29;27;17 - 00;29;33;28

Richard Haldeman

Yeah. Well let's talk about that in the next segment because we have cash pay bundles that we offer our members and we don't charge them a deductible.

00;29;33;28 - 00;29;49;08

Cary Hall

When we come back to the break we will talk about that. If you want to learn more about all these things we're talking about, go up to the website detegohealth.com. All of that's up there. You can simply send us a quick contact sheet if you're an employer, if you're an individual or if you are a broker if you're a broker.

00;29;49;15 - 00;30;07;08

Cary Hall

This is a product line that you probably don't have that you really should take a look at. So once again, I urge you to do that at the website detegohealth.com. We'll be right back after the break. You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast across the USA. Don't go anywhere.

00;30;07;09 - 00;30;13;05

Cary Hall

We're going to be right back.

00;30;13;08 - 00;30;31;25

Cary Hall

Welcome back to America's Healthcare Advocate show, broadcasting coast to coast across the USA here on the HIA radio network. These shows are all posted on our 16 podcast platforms and the YouTube platform. If you want to send me an email, you've got a question. Comment if I can help you. I get people to come to me all the time that have a specific issue they need help with.

00;30;32;02 - 00;30;40;01

Cary Hall

Feel free to do it. Go to the website AmericasHealthcareAdvocate.com. Send me the email myself or Dave will get it and we will get back to you.

00;30;40;02 - 00;30;40;12

Richard Haldeman

I need a.

00;30;40;12 - 00;30;47;02

Cary Hall

Dave. Yeah, yeah. You do need a Dave. Yeah. Trust me. Yeah. We would not be where we are with this show without Dave Thiessen.

00;30;47;06 - 00;30;48;17

Richard Haldeman

Oh, I know that. Yeah, right. You know.

00;30;48;17 - 00;30;54;28

Cary Hall

That. Yeah. So let's go into a little bit more about this where we were going with this topic, reference based pricing and some of the other things.

00;30;55;00 - 00;31;17;15

Richard Haldeman

Yeah. So bottom line is we built products. We don't want noise for members. We just want to make sure we're focused on the right things. So we're not going to walk over dollars to pick up pennies. We're going to focus on the major procedures. We, some of our programs, we just we just launched a new product called the Guardianship for Small Businesses, starting at three subscribers.

00;31;17;16 - 00;31;35;29

Richard Haldeman

Okay. And that is a optional like it's a it's a new version of an HMO. So what it is is that if you don't want to go through guardianship, which we waive all cost out-of-pocket costs for, you can decide to go and get care in a network. We wrap it with.

00;31;36;01 - 00;31;39;04

Cary Hall

But if you go through guardianship, we cover it all.

00;31;39;04 - 00;31;53;06

Richard Haldeman

Yeah. No copay. If you need a surgery, we place you with one of our bundled service providers that we have across the US. And we waive your deductible and co-insurance and we pay for a caregiver if you have to travel a little bit.

00;31;53;07 - 00;32;12;19

Cary Hall

And when I had Doctor Firouz Daneshgari here and he talked about this, we got a lot of response to that show, I mean, a lot of response. And he is a partner of ours. Now. This is what I mean. This is why I'm urging you, if you're a broker specifically, look at what we have to offer, because what we have is very different than what you will see out in the marketplace.

00;32;12;26 - 00;32;29;11

Cary Hall

Simply go to the website detegohealth.com, send us a quick email and we'll be happy to connect you. But these are the kinds of programs that can knock down costs significantly and still make your client happy with what they're getting, because they're getting a different level of care at a cost they can afford.

00;32;29;14 - 00;32;52;06

Richard Haldeman

And within the, the joint venture that we've done with, Bowtie Medical, we have a weight loss clinic, we have a cardiac clinic. We're developing other type specialty clinics where people can get help. And we're about to launch a program that helps get, if you're a type two diabetic and you're paying a lot of out-of-pocket for, like.

00;32;52;08 - 00;32;53;04

Cary Hall

Metformin.

00;32;53;09 - 00;33;02;28

Richard Haldeman

Or might know that Metformin is cheap, but Manjaro for Ozempic, ours literally is free for our members.

00;33;02;28 - 00;33;03;24

Cary Hall

Because you hear that.

00;33;03;26 - 00;33;25;27

Richard Haldeman

We have a special compounding pharmacy out of Arizona, and we're launching this within the next 60 days that, it's so less expensive. And this is the only one that ships them in pens, so you don't have to draw medication. You just it's shipped and set to the right dose. And so you just sticking it just like you get with Manjaro or Ozempic.

00;33;26;00 - 00;33;42;12

Cary Hall

That's amazing. I get the whole idea of, the broadcast today was to explain some of this innovation. There is innovation in this marketplace. We think we bring some pretty strong innovation to the party. And that's why I asked for Rich to fly in here today and do this. So I'm going to shift gears to this last five minutes.

00;33;42;12 - 00;33;58;27

Cary Hall

The show to what do you anticipate is going to happen with the new incoming administration, which, you know, by the time this show airs, they will be the administration. Yeah. But I think we're going to see some difference in terms of the way that health insurance, health care, health benefits are approached. Would you agree with that?

00;33;59;03 - 00;34;04;25

Richard Haldeman

I would I think, not to sound like I'm from Texas, but I think it's going to be a rodeo.

00;34;04;27 - 00;34;06;26

Cary Hall

He is from Texas, by the way. Just in case you're.

00;34;06;26 - 00;34;30;26

Richard Haldeman

Wondering, and I think every state's going to have a different think about it, okay? You're going to have states that have that welcome innovation and free market. Are you going to states that don't. And at the end of the day, whenever you hear the word Medicare for all, you should not walk but run in the other direction because we don't have the systems to support Medicare for all.

00;34;30;26 - 00;34;52;23

Richard Haldeman

You will be in line until you're blue in the face. The reality, what we really need and some of the things I hope to see. And I have no, no sway on this, but I, I, I have been in the industry for a number of years. One is we need a high risk pool because there needs to be some place for people to land so that they can take that cost out of employer plans.

00;34;52;23 - 00;35;13;08

Cary Hall

We had high risk pools before ACA. They were different in every state, and some of them weren't very good, and some of them were good, but we had them. But what he's talking about here is bringing back some kind of a high risk pool. So you could drop the level of the costs, okay. And the government could say, okay, every procedure over $1 million, we're going to cover that under a high risk pool somehow.

00;35;13;14 - 00;35;18;05

Cary Hall

And what would that do to the cost? These are the kinds of things we hope they're going to be some conversation around.

00;35;18;05 - 00;35;24;07

Richard Haldeman

Or the other 20 to 30% of every dollar you pay is for reinsurance.

00;35;24;09 - 00;35;25;26

Cary Hall

You explain that we've got three minutes.

00;35;25;26 - 00;35;30;10

Richard Haldeman

So somebody has to. So when you have a catastrophic claim, a $5 million claim.

00;35;30;10 - 00;35;31;21

Cary Hall

Preemie baby, 1 million.

00;35;31;21 - 00;35;38;08

Richard Haldeman

Dollars preemie baby, I could go on and on. When you have drugs that are so expensive that they're on for life growth hormones.

00;35;38;09 - 00;35;38;27

Cary Hall

Yep.

00;35;38;29 - 00;35;48;17

Richard Haldeman

So bottom line is you need to have some place to place those folks that, that allows the free market to work in a more efficient way.

00;35;48;19 - 00;36;12;17

Cary Hall

And really, when you stop and think about it, reintroducing the free market into this system, which is what we are hoping we see and we're doing some of that ourselves. But hopefully reintroducing the free market into the system will allow these costs to become much more manageable and more under control. Because if we don't do that, this this whole idea of Medicare for all, be careful what you wish for people.

00;36;12;22 - 00;36;25;24

Cary Hall

I've done multiple shows I've talked about it till I’m blue in the face. You know, if you want to wind up in a situation like they have in the UK, where you've got 34,000 people waiting to see physicians for surgical procedures they can't get.

00;36;25;27 - 00;36;40;27

Richard Haldeman

How about an MRI? There are only two MRI facilities on the western side of Canada. So in Buffalo, where they have a major cancer center, their people come out of Canada just to get their MRI because cancer doesn't wait.

00;36;40;29 - 00;36;59;06

Cary Hall

No. And and you're told to wait. You can't get an MRI because you're like, this is the kind of thing that people need to get this to their head, that if you go the way the government's to control access when you go to Medicare for all. Excuse me, got to control cost is they're going to control access. That's the way it works in the UK.

00;36;59;12 - 00;37;00;26

Cary Hall

That's the way it works in Canada.

00;37;00;26 - 00;37;23;28

Richard Haldeman

One other thing, one other thing I would recommend is that we do need sort of a national wellness program where people can go for their annual visits and they can get chronic illness management, whether they're in a group employer plan or not. That is something we can do, and that is attainable through both the amount of physicians we have now and the extenders we have.

00;37;24;00 - 00;37;25;26

Richard Haldeman

That would be a smart thing to do.

00;37;25;29 - 00;37;40;27

Cary Hall

Yeah, it would be. And you know, a here we go though, you know, how many people in government are going to want to do something like that. And we hope that we're going to see some innovation like that as, as we move into this current administration and what they're going to bring to the party in terms of health care.

00;37;40;27 - 00;37;42;20

Cary Hall

Thank you for coming up here and doing this today.

00;37;42;27 - 00;37;43;16

Richard Haldeman

It's my pleasure.

00;37;43;22 - 00;37;59;14

Cary Hall

Well, I and we're going to have Rich back. We'll we'll dive into some of these other topics. And in upcoming shows. But again the idea here is to familiarize you with Detego Health. We have a whole suite of products, a whole series of things that we do that are very, very different than a lot of things in the marketplace.

00;37;59;20 - 00;38;17;14

Cary Hall

And we think that they can make a difference for the individual consumer. And specifically, if you're that employer out there and you're struggling, you want to take a look at this because they could make a big difference for you, especially if you're a small group employer. The website, once again is DetegoHealth.com

00;38;17;14 - 00;38;18;14

Richard Haldeman

One favor, Cary.

00;38;18;14 - 00;38;19;23

Cary Hall

go ahead. Can you do can.

00;38;19;23 - 00;38;21;22

Richard Haldeman

We do the radio show someplace warmer next.

00;38;21;22 - 00;38;22;18

Cary Hall

Time? Yeah, probably.

00;38;22;20 - 00;38;24;09

Richard Haldeman

Is I am freezing.

00;38;24;14 - 00;38;27;08

Cary Hall

He's coming out of Texas a little colder here than is in Texas.

00;38;27;08 - 00;38;28;05

Richard Haldeman

Something warmer.

00;38;28;05 - 00;38;49;09

Cary Hall

There we go. And now I want to leave you with this thought from Winston Churchill. Private health insurance is the worst kind. Except for all the others. Thank you for listening to America's Healthcare Advocate broadcasting coast to coast across USA. Goodbye, America.

00;38;49;11 - 00;38;53;15

Cary Hall