Dr. David Berg and Dr. Janice Johnston of Redirect Health: “Create a national stop loss”

Create a national stop loss — I would forget about the concept of Medicare that takes care of everything for somebody. I think Medicare should just take care of the elderly (like it does today), and then only the catastrophic situations for everyone else. Then let the free-market handle everything else underneath it. This would eliminate the […]

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Create a national stop loss — I would forget about the concept of Medicare that takes care of everything for somebody. I think Medicare should just take care of the elderly (like it does today), and then only the catastrophic situations for everyone else. Then let the free-market handle everything else underneath it. This would eliminate the fear of the big expenses that scares everyone into paying so much for insurance they will never need to use, and it would cost considerably less.

The COVID-19 Pandemic taught all of us many things. One of the sectors that the pandemic put a spotlight on was the healthcare industry. The pandemic showed the resilience of the US healthcare system, but it also pointed out some important areas in need of improvement.

In our interview series called “In Light Of The Pandemic, Here Are The 5 Things We Need To Do To Improve The US Healthcare System”, we are interviewing doctors, hospital administrators, nursing home administrators, and healthcare leaders who can share lessons they learned from the pandemic about how we need to improve the US Healthcare System.

As a part of this series, I had the pleasure to interview Dr. David Berg and Dr. Janice Johnston.

Dr. David Berg has served as President and Co-Founder since Redirect Health was founded in 2013. Prior to co-founding Redirect Health, Dr. Berg established and maintained successful healthcare clinics both in Canada and the United States. With Redirect Health he has leveraged his decades of healthcare leadership experience to make healthcare simple and affordable for businesses throughout the country. Dr. Berg is the author of The Business Owner’s Guide to Ending the Fight with Healthcare, a how-to guide that helps business owners leverage healthcare as a competitive advantage. In 2018, the Phoenix Business Journal honored Dr. Berg with the “Healthcare Heroes Innovator Award” for creating a transformative healthcare member experience that eliminates barriers for people to get affordable healthcare. Dr. Berg was also the finalist for three best-in-class awards at the 2018 World Health Care Congress in Washington DC. He holds degrees in Physics and Biology from the University of Toronto as well as a Doctor of Chiropractic degree from The Canadian Memorial Chiropractic College.

Dr. Janice Johnston has served as Chief Medical Officer and Co-Founder since Redirect Health was founded in 2013. She oversees all medical operations as well as patient experience, spearheading efforts to enhance quality of care while improving administrative efficiencies. Dr. Johnston is integral to both the virtual-first and in-person clinical operations, continually advancing strategies to improve member service and ensure positive patient outcomes. She has been recognized numerous times by AZ Business Magazine in the categories of “Most Influential Women Business Leaders,” “Outstanding Medical Director” and “Telehealth Leader.” She was also recognized as a “Keeping the Blues Alive” award recipient for her work advocating for musicians’ health. Additionally, Dr. Johnston is part of the MusicCares Provider Network through the Grammy Foundation. She holds an M.D. from the University of Toronto and is currently a Health Insider for ABC15.

Thank you so much for joining us in this interview series! Before we dive into our interview, our readers would like to get to know you a bit. Can you tell us a bit about your backstory and a bit about what brought you to this specific career path?

Dr. David Berg: Janice and I met at the University of Toronto. Janice wanted to be a doctor and I was leaning toward engineering and computer sciences. However, I ended up following the pretty girl into medicine and became a chiropractor.

We worked in Canada for a while before moving to the U.S. to start our own practice. We thought that we had it all figured out but we brought some assumptions that we had about the Canadian healthcare system over to the U.S. that didn’t apply here — particularly around people’s confidence that they have access to care.

In Canada, there is a great amount of confidence that you have access to care, but the level of care is not quite as robust. However, the U.S.’s healthcare system is very robust and has huge capabilities, but people don’t have access to it, or the confidence that they have access to it, due to the cost.

We couldn’t make the math work for our team’s healthcare as we were trying to build our medical and chiropractic practices. We needed to offer health insurance in order to be competitive as an employer but the cost to us was too high. We couldn’t subsidize enough but even if we could, our employees could not afford the deductibles, copays, or even the time off work to see a doctor. Larger competitors would then poach our employees because they had lower deductibles.

As immigrants trying to understand the American healthcare system, there was so much that just didn’t make sense to us. From understanding deductibles, copays versus coinsurance, in-network versus out-of-network, and more — there was so much that just didn’t add up or seem logical and easy enough to understand. We quickly realized it was nonsensical, yet everyone around us just seemed to accept it. After realizing that the system would never work for us and our employees, we created a new one. That was 2007.

Now with Redirect Health, we help thousands of businesses all over the nation make sense of this healthcare system and enable them and their employees to have meaningful access to affordable care.

Can you share the most interesting story that happened to you since you began your career?

Dr. Johnston:

This isn’t an uplifting story, but it does highlight some of the major flaws in the system. One aspect of healthcare that didn’t make sense to us was something called “at-risk contracts.” This meant that if the pool of patients that I looked after cost the insurance company a lot of money, then the insurance company could come back years later and take money back for the services I performed years earlier.

An example of this was when a man came in to visit me for the first time, and he had a headache. I had him scanned and it turned out that he had a sizable brain tumor that was causing issues and putting pressure on the back of his neck. I sent him to the emergency room, and he had to undergo radiation and chemotherapy. He lived for another year or so and it cost the system a lot of money.

But what happened after his passing, was another example of where the math doesn’t add up. With our contract, the insurance company was able to recoup money from us for 25% percent of the total payments for the patients who had purchased healthcare policies from that specific insurance company. So, even though I only saw this patient one time and was able to diagnose this individual quickly, the way the contract was set, our business took a big hit. This kind of trickery is rampant in insurance contracts with very little any doctor can do still today.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us what lesson you learned from that?

Dr. Johnston:

While it’s not necessarily a mistake, I definitely brought over some Canadian characteristics and terminology when I started working here. For example, you never would say “butt” in Canada, it was pretty much the equivalent of saying “ass.” When I came to the U.S., I would say “scoot your bum down the table” which would sometimes get me some funny looks, but others would immediately recognize that I am Canadian.

There were other aspects of the system that I had to get used to as well, such as adjusting to understand that some over-the-counter medications that were available in Canada are not available here. I was accustomed to ordering CT scans of the head because that’s what was readily available in Canada at the time, whereas over here you order an MRI right off the bat.

Dr. Berg:

We also thought that the mandatory holidays were the same in the U.S. and Canada so when we started our business, we gave our employees Good Friday and Boxing Day off. The next year, we realized that it was a mistake, but our employees didn’t want us to take them away. Now, 25 years later, we still give our employees these Canadian holidays off!

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

Dr. Johnston:

“The best medicine is love. If it doesn’t work, just increase the dose.”

At Redirect Health, we practice this mindset each and every day. We treat our patients and members as family. As I work, I often think to myself “if my mom were going through this, how would I treat her? How would I want her to be treated?”

Dr. Berg:

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” — Theodore Roosevelt

This quote speaks to me because everything that we have done with Redirect Health has been about continuously stacking capabilities on top of each other. We started as a family doctor and chiropractic practice. With this, we were able to help patients get the care that they needed in one place. Then people needed more capabilities, meaning they needed labs done, they needed x-rays done, they needed specialty care, and more. We continued to stack these capabilities on top of one another.

In the process of doing this, there’s a lot of criticism and pushback because the first iteration can be clunky and clumsy. We had to decide to tune out the outside world and deal with the naysayers who were reluctant to change. We committed early on to serving the customer better and better, which means we can’t stay comfortable.

We wouldn’t be able to make the positive impact that we have in people’s lives if we weren’t ready and willing to get into that arena and fight.

Are you working on any exciting new projects now? How do you think that will help people?

Dr. Berg:

In order to make the customer healthcare journey work better, we have created our own mutual insurance company for our policy owners. We did this so we don’t have to ask for permission from other insurance carriers. We also created our own third-party administrator (TPA) which means that we can pay claims according to the policies. From there, we can create only logical policy rules for our members without the need to ask permission from a huge insurance company that we know will always say “no.” Doctors and hospitals love the Redirect Health model because we can pay the claims quickly and accurately (even at the time of service), and we never recoup money from them years later.

Due to this, we have entrepreneurs who are creating their own new agencies to sell our healthcare model throughout the country. These entrepreneurs are creating broker agencies and getting broker licenses because they want to sell our solutions into existing relationships. But really, they are doing this because they want to help the people they’ve already been helping for a long time.

I am confident that if you put Redirect Health’s capabilities in front of any healthcare insurance, we can make the healthcare experience better, faster, and less expensive. The number one reason that holds individuals back from starting their own small business is the cost and risk associated with hiring. They are intimidated by the obstacle of finding employees, as well as the overall cost of having employees. By having the ability to offer free healthcare to their team, it gives small businesses equal footing, if not advantageous footing, over major corporations.

How would you define an “excellent healthcare provider”?

Dr. Johnston:

To me, an excellent healthcare provider is someone who listens. When someone connects with us through our App, over the phone, or comes in to receive treatment, we listen to the full parameters of what they need and look at them as a whole — not just focusing on the one problem at hand. On top of that, a great provider is someone who follows through and checks in to ensure that the patient is on track to getting healthy again. They will follow up to make sure the treatment is working, they’ll check-in to see if you need another appointment, and more.

Dr. Berg:

On top of that, being an excellent provider means helping people along their healthcare journey through the system. This means helping them understand what the cost of the recommendation is in terms of time, money, attention, and more. If we recommend something that is not affordable, it is a meaningless recommendation.

Unfortunately, in a traditional medical model run by traditional insurance it doesn’t usually make good business sense to do for your patient what you would do for your own family. Though it would often make most sense to take small steps along the journey and see what happens, to watch something get better with less intervention and unnecessary cost, it usually makes financial business sense to do as much testing and as many procedures that the insurance contract will allow. With Redirect Health, what we help our members through is a complete healthcare journey, without these conflicting incentives, because we are thinking about it from a “what would we do with our family” mindset.

Ok, thank you for that. Let’s now jump to the main focus of our interview. The COVID-19 pandemic has put intense pressure on the American healthcare system. Some healthcare systems were at a complete loss as to how to handle this crisis. Can you share with our readers a few examples of where we’ve seen the U.S. healthcare system struggle? How do you think we can correct these specific issues moving forward?

Dr. Johnston:

The issues that the U.S. healthcare system faced during the peak of the pandemic were endless. There was a huge fear that COVID was everywhere, and it made people afraid to go to the doctor for routine care. People didn’t want to go to the hospital even if their appendix burst because they thought that if they went to the hospital that they would catch COVID-19 and die. The major problem was that these medical issues didn’t suddenly stop happening when the pandemic hit, heart attacks didn’t magically disappear, but people were too scared to go and get the help that they needed.

With Redirect Health, we coordinate for our members the care that they need all over the country. However, this became extremely difficult when the pandemic hit. Medical offices didn’t know how to practice safe medicine during this time, and many didn’t offer telemedicine services.

Moving forward, in order to be better prepared for future crises, our medical community has learned that we must be flexible and adapt quickly. On top of that, we need to continue to inform the public about the importance of maintaining their health and continuing to come in for checkups.

Of course the story was not entirely negative. Healthcare professionals were true heroes on the front lines of the crisis. The COVID vaccines are saving millions of lives. Can you share a few ways that our healthcare system really did well? If you can, please share a story or example.

Dr. Johnston:

Overall, the healthcare industry adapted quickly in order to overcome the obstacles of the pandemic. Fortunately for our team at Redirect Health, we had been practicing Virtual-First medicine with our Virtual Primary Care program for a long time prior to COVID-19. Others within the industry had to become familiar with the new technology and workflows and learn to integrate it into their practices fairly quickly. It was a difficult hurdle to overcome but having telemedicine readily available is not only beneficial now during the pandemic, but it will also really pay off in the long run if done right.

In order to keep our patients and staff safe, Redirect Health was also one of the first facilities in Phoenix to offer drive-through COVID-19 testing. Doing this helped to limit potential exposure as much as possible. I also work frequently with musicians and before COVID-19 I would hold clinics in local bars because we realized we needed to bring healthcare to where the people were in order to make it as easy for them to access care.

On top of that, the medical industry learned to lean on one another and support each other. Pharmacists would reach out to me to ask if we had any masks they could use because they didn’t have any way to protect themselves. Earlier on during the pandemic, I was called directly by the State Health Department because they heard that we had COVID-19 tests. They reached out to me because there was a couple that had just come back from a trip to Egypt and everyone that they had been in contact with contracted COVID-19 and died. They had reached out to hospitals and urgent cares and were turned away, most likely because they didn’t have the capabilities or capacity to assist them. I drove into the clinic on a Saturday specifically to see this couple. I suited up in the only suit we had at the time and met them in the parking lot. It was very easy to tell that they had a disease that I had never seen before.

In preparation for seeing them, I had called them ahead of time and did everything that I could do virtually first. All I did when they were in the room was test their vitals and run the tests. After that, I decontaminated the room and the elevator — at that point during the pandemic no one had taught us how to do that yet. Seeing them really touched me. I called them every day for weeks because at that time, it took a long time to get the tests back. Every family dinner that we would have, David would ask me about the couple and how they were doing. It turned out that they did have COVID-19 but fortunately, they did well and were able to recover fully.

Later on, my own family and I ended up catching COVID-19 and even though I was sick, I felt like I couldn’t stop helping others. I would still see patients through telemedicine with our Virtual Primary Care. I felt like because I was sick too, I could empathize and even better understand what people were going through.

Here is the primary question of our discussion. As a healthcare leader can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

Dr. Berg:

If I were in charge and they asked me to fix the American healthcare system, here are the five easy changes that I would make:

  1. Create a national stop loss — I would forget about the concept of Medicare that takes care of everything for somebody. I think Medicare should just take care of the elderly (like it does today), and then only the catastrophic situations for everyone else. Then let the free-market handle everything else underneath it. This would eliminate the fear of the big expenses that scares everyone into paying so much for insurance they will never need to use, and it would cost considerably less.
  2. Disallow price gouging and legislate true transparency in pricing — In theory, hospitals can charge as much as they would like for services, and this is what scares everybody about healthcare in America. Then, they can sue you, and force you into bankruptcy because you really don’t have a choice if you’re going into labor or your appendix bursts, you have to receive care. A government cap on hospital and drug pricing, even if it were high, would remove a lot of this fear that makes us buy insurance we don’t need or will ever use.
  3. Allow direct contracting and encourage innovation — All the big guys in healthcare, including the drug companies and insurance companies, give so much money to the government. If someone wants to go out into the healthcare system and be innovative, like our team at Redirect Health, you have to go out and do it on your own. There is no government money for what we do and there are countless barriers. Even the concept of Direct Primary Care is illegal in about half of the states today. It is extremely difficult to create a more sustainable model with all of this red tape in place.
  4. Expand the meaning of telehealth — We need to get rid of some of the restrictions that require doctors to have to have a video meeting or see a patient in person first before you can talk to them on the phone. Every state is different, and it becomes too difficult to navigate all of the restrictions.
  5. Expand telehealth licenses — We need to get rid of the rules that limit doctors from helping someone virtually who has traveled across state lines because that provider doesn’t have a license to practice medicine in that state. If a doctor in Arizona is treating someone virtually and they cross over the state line into New Mexico, it becomes technically illegal for them to assist them anymore, even if that doctor might be the best person for the job because they know the patient and have the medical record right in front of them. These rules might have made sense in the past, but they certainly don’t make sense anymore with the technology that is available and with the current state of the pandemic.

Let’s zoom in on this a bit deeper. How do you think we can address the problem of physician shortages?

Dr. Johnston:

Depending on location across the country there can be not enough access to physicians to provide the care needed. Certainly, we see this in rural communities. It’s also becoming more and more difficult for a solo doctor to practice due to high overhead and lots of administrative red tape. We need to focus on streamlining the healthcare experience for physicians — eliminating unnecessary documentation would be where I would start.

How do you think we can address the issue of physician diversity?

Dr. Johnston:

There has been a definite shift in physician diversity over the past decade, but we still have a long way to go to see similar diversity in physicians as we do in the general population. Medical schools can focus on recruiting from diverse backgrounds to encourage diversity, offering partial and full scholarships and mentorship programs.

The percentage of women physicians has grown in recent years to about 43% but there is not the presence of women in leadership positions in healthcare. In order to have better representation of women and physicians of underrepresented minorities, we need to prioritize professional development.

How do you think we can address the issue of physician burnout?

Dr. Johnston:

I have seen almost everyone dealing with burnout to some extent, not just physicians. We bring so much home with us and continue to work beyond our normal hours. For example, I can access electronic medical records from home and due to that I feel like I constantly have to be checking — this eliminates the distinction between work time and home time.

Dr. Berg:

In the past, the doctor was at the center of everything. Due to that, if a doctor needed to take time off, the whole engine would stop — all of the coordination of a patient’s healthcare journey would pause, and follow-ups would stop. For more than 20 years at Redirect Health, we have been focused on creating teams and a system with protocols around the providers so that if a doctor takes a week off, they will come back to a clean slate because their work continued while they were out.

Doing this helps to eliminate some of the obstacles that cause physician burnout so that our providers can take a break and take care of themselves.

What concrete steps would have to be done to actually manifest all of the changes you mentioned? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

Dr. Berg:

By focusing on the five processes and regulations that I would change within the industry, we would see dramatic and positive changes that would benefit providers and patients alike. A universal stop loss and standardized pricing would eradicate lots of the unnecessary fear. Then let doctors, entrepreneurs and innovators do direct contracting so they can build systems that work better for different groups of people.

Next, let us take care of people over the phone and not force the technology and rules that are different in every state get in the way of us offering our services. On top of that, we need a federal telehealth licensing law.

There are countless rules and regulations that are not even for the benefit of the consumer, they are meant to protect the insurance companies. If we worked to overcome these restrictions, it wouldn’t solve everything, but it would create a solid foundation that we can build on.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

Dr. Berg:

If we could create a movement, it would be about inspiring businesses to come together to collaborate and innovate collectively, as opposed to being protective of their own goals and ideas. We want them to instead think “how can we lift each other up and support one another?” Overall, at Redirect Health, we want to help small businesses work together to solve healthcare.

How can our readers further follow your work online?

Thank you so much for these insights! This was very inspirational and we wish you continued success in your great work.

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