…most people spend more energy and engagement purchasing a new cell phone than they do in purchasing healthcare. And that Americans are generally passive participants in the healthcare experience — even though 50% of U.S. healthcare costs are related to personal lifestyle choices. Part of our system encourages that. American healthcare is a “third party” system; much of the deciding is done for us. The insurers, hospital organization, pharmaceutical player and own government agencies negotiate amongst themselves regarding access, coverage, cost and outcomes. We as individuals are not at the table. Our objectives and needs are not necessarily at the table. Our personal budgets are certainly not at the table. The result is that we get and pay for what is decided for us, at that table. I’m convinced that we need to turn that table over to make any difference in healthcare outcomes and costs. I do not believe putting fewer at that table is the answer; instead, I think that individuals need to get at that table. My book starts at telling how that can happen, and what the direct cost and outcome impact can be if even just a few start taking proactive steps in the decision making that goes into healthcare choices. Healthcare is a consumer good and we are consumers. As consumers, we are disconnected form the price. No wonder the costs have sky rocked.
Asa part of my interview series with leaders in healthcare, I had the pleasure to interview Scott Heiser. Scott has more than twenty years’ experience as a consultant for clients in the insurance and healthcare system. Scott was a partner and owner of a commercial insurance brokerage, in which he led and developed an employee benefit practice that managed more than half a billion dollars in health benefits. Scott is a strategic innovator who knows the ins and outs of what can feel like the overwhelming world of healthcare and insurance. Today, he is dedicated to sharing his knowledge to help educate and empower his readers. His goal is to improve your health outcomes while lowering your costs. To get started, visit www.UncoveredHC.com.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
Afew years ago, I was meeting with a large multi-state client representing 16,000 employees. We were discussing ways to reduce costs for their prescription benefit program. In attendance was the client’s prescription benefit vendor (often referred to as “PBMs”) and their health insurer. And while I chose not to name these outside providers, I want you to understand that these are major companies that everyone would know. The client and I were reviewing programs presented by these companies to stem escalating drug costs. I recently had discovered a Patient Assistance Program that provides coupons capable of reducing pharmacy costs for financially challenged individuals, or people on high deductible health plans. The savings on these plans can be significant- for example, you might be able to get an Eliquis prescription for $10 rather than $430 a month! That’s a $5,000 savings in a year. But neither the prescription benefit vendor or the health insurer presented this option, even when it was clear that a large part of my client’s population would qualify for the assistance. Nor could I get my client to agree to consider it, which was my real “aha” moment. My client, and his prescription benefit vendor, and his insurer all agreed the program — which requires employees to call the pharmaceutical manufacturer and apply for the coupons — was potentially too disruptive and therefore too difficult to manage administratively. It was at that point that I realized the people most in need weren’t getting help. I was pretty sure that if you asked one of those employees if they would like to save $5k per year on their drug costs, they’d be all in. But no one was willing to even ask. I therefore began focusing my attention not on the gatekeepers — the employers, the insurers, the government or the industry providers — but instead on the people who have to actually consume what is currently being fed to them without their input. I could see that my inside perspective had the chance to empower people to become more in control of their own healthcare, enhancing their outcomes and costs.
Can you share the most interesting story that happened to you since you began leading your company?
I have been really energized by how new approaches are really getting in position to positively shake up the Healthcare industry. A big move like the one Amazon is promising — can you imagine buying insurance on Amazon? — can potentially disrupt everything about the current insurance marketplace. But that is in the future, and I like to focus on what is happening now, so that individuals can improve their healthcare experience now. So my most interesting story is about a small current innovation. There is a healthcare advocacy company (Quantum) that hires people with hospitality and service backgrounds rather than health insurance backgrounds. What Quantum discovered was that individuals with that kind of training are just better at understanding what a person really needs rather than just answering what question a person asks. Let me give an example, and tell you how this helps control costs and improve outcomes. When someone calls an insurance agency to replace a lost healthcare ID, the typical protocol is to simply send a replacement ID. Case closed. But what Quantum’s people understand is that there is a reason someone needs that ID, right now. As an advocate company, Quantum not only replaces the card promptly, but they also ask the customer what they would be using it for in the event there was some further way to assist. This allows Quantum to help the customer find a cost appropriate provider, or facilitate second opinions, or discuss treatment compliance, or recommend discount pharmacy programs; even identify whether the customer had medication compliance questions or needs. This approach inevitably develops trusted relationships between the Quantum employee and the customer, which increases engagement and ultimately improves healthcare outcomes at a potentially much lower cost.
Can you tell our readers a bit about why you are an authority in the healthcare field?
I have spent more than 20 years working on behalf of employers and their employees in the healthcare industry. My clients have ranged from Fortune 500 companies, to Universities, to mid and small employers. Through the years I have developed customized programs which address healthcare and insurance access, how behavioral modification can be used to impact health outcomes and healthcare costs, and how to employ best practices across very different employee populations. I have done a fair amount of negotiation on behalf of my clients, whether with insurance providers or healthcare providers such as hospitals. I have always tried to bring practical applications to my client’s needs.
What makes your company stand out? Can you share a story?
My goal is to cajole, coddle, prompt, motivate, encourage, and even chastise people — by whatever means possible — to convert them into becoming active consumers of healthcare.
I do that first by helping people understand that, potentially, they are a part of the problem. Let me explain.
The average individual spends more time researching, comparing, and/or seeking peer input when buying a new phone than they do on their own health! Think about it. Buying a new phone engages you in understanding what works best for you in terms of style and benefits; you’ll evaluate rates and contract terms; and you’ll consider access, reach, added services, and payment plans — all before you finalize your decision. Does that happen with the average healthcare experience? Not typically. Some of that is due to access — it’s just a lot easier to get information about phones than it is about healthcare. But it’s also because we, as patients, are passive participants in our healthcare system. We let others make decisions for us in ways we would never consider doing for “important” items like phones, or even athletic shoes.
Think about it this way: what’s the greatest asset any of us have ever been presented? I would argue it’s our lives. And yet, how much time do we spend on that asset, giving it the right fuel, the right maintenance, meeting its needs so that it operates at its maximum capacity?
Some are better at this than others; some may have chronic or genetic issues where this doesn’t apply. But 50% of all U.S. medical expenses are life-style related — what you eat, how much exercise you get, the stress in your life, smoking habits, sleeping habits. These are choices that are within our own control. It begs the question: if we change our behavior, how much expense can we avoid? Are we willing to try?
“Don’t get sick” isn’t as absurd as it sounds.
Then I walk people through a healthcare continuum so that they can see how pro-active decision making will impact their results and their costs.
I want people to approach healthcare decisions like any other important decision.
Our healthcare-continuum solution walks people through an organized process that starts with first things first. Individuals should develop health profiles, including family history, so that they understand the healthcare issues they face or may face. Then we connect them to the retail cost of services they may need; to finding the appropriate health services for them; to funding healthcare short-falls and defer the cost through tax incentivized techniques; to saving on prescription drugs; to working through the “alphabet soup” of insurance programs. The book also covers how the health profile can empower individuals to select healthcare plans and providers (doctors and hospitals); to talk about what the doctor should be providing, including plan of treatments with the most cost-effective best outcomes; and to negotiate with providers on costs and payment plans.
One of the best stories of the process working is from an individual I have worked with on this project. Before she started, I think shed agree that she was just like everyone else when it comes to their healthcare- a bit overwhelmed, uninformed, confused and angry. I’ll let her tell you in her own words how the process changed her. “Scott’s book has been a game changer for me in terms of how I approach the world of healthcare and insurance. I feel empowered to make the right decisions now, not as confused or passive about these issues as I have I the past. I understood how to chooses a plan right for me instead of just automatically opting for the lowest deductible. I knew what questions to ask and what to looking for when reviewing plan information. Plus, I wasn’t afraid to call ask if something wasn’t clear. A couple months later, I had a procedure done that I knew my insurance would not cover, I negotiated with the provider for a discount because I was paying in cash. None of these would have happened had I not read the book”.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
First and foremost, I am all about providing a process that an individual can use to manage their own healthcare journey. The “pain point” for most is that they feel stuck in a system they don’t understand and have no control over. I want to provide them with ways to get prepared, to know what to expect, and to see how choices they make can improve their results and their costs.
Second, and perhaps most disruptive about my approach, is that I wish to expose the differences in healthcare costs and quality in the same city, across their state and across the country. Once people know that differences do exist, that they are not “beholden” to what someone at one office tells them, then I am convinced their personal healthcare, the services they engage and the drugs they need, will come with better results and at better costs.
Third, I want to educate individuals on where to find and how to use technology to deliver cost/outcome transparency. Once the tools that are currently available, and are sure to come with our wired culture, are within reach, individuals will be in a better position to improve their healthcare treatments.
Forth, I want individuals to select their insurance plans, base on their health profiles, what issues they may have, and doing the math to minimize their cost output on insurance. They should not make choices solely based on the lowest premiums or deductibles.
Fifth, I am actively creating an environment where individuals can share their success stories. I think that this will be motivating to each other to build on the solutions and demand more from the healthcare market.
What are your “Things I Wish Someone Told Me Before I Started” and why.
I do wish someone would have told me how challenging it is to write a book; namely, how challenged I am as a typist. I should have known better having been kicked out of my high school typing class!
Otherwise, I was all in from the beginning. The challenges I knew about and the ones I uncovered coupled with the desperate need of people for assistance drove me throughout the project.
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
Earlier in our conversation, I mentioned that most people spend more energy and engagement purchasing a new cell phone than they do in purchasing healthcare. And that Americans are generally passive participants in the healthcare experience — even though 50% of U.S. healthcare costs are related to personal life style choices.
Part of our system encourages that. American healthcare is a “third party” system; much of the deciding is done for us. The insurers, hospital organization, pharmaceutical player and own government agencies negotiate amongst themselves regarding access, coverage, cost and outcomes. We as individuals are not at the table. Our objectives and needs are not necessarily at the table. Our personal budgets are certainly not at the table. The result is that we get and pay for what is decided for us, at that table.
I’m convinced that we need to turn that table over to make any difference in healthcare outcomes and costs. I do not believe putting fewer at that table is the answer; instead, I think that individuals need to get at that table. My book starts at telling how that can happen, and what the direct cost and outcome impact can be if even just a few start taking proactive steps in the decision making that goes into healthcare choices. Healthcare is a consumer good and we are consumers. As consumers, we are disconnected form the price. No wonder the costs have sky rocked.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
The book organizes and aggregates approaches and services in the existing market place. Remember this is not about theory but practical applications. What I have recommended is road tested. It works in the real world. So, the key is to start becoming a consumer of healthcare. Whether you buy the book use the website or do it on your own. You need to start. Once you’ve started the journey, we’d love to hear from you about what worked for you and why. What did we not address that you’d like addressed? Share it with others. Most of the projects I have worked on only got better when dedicated participants shared their findings with each other geometrically expanding the outcomes.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
There are a few books that have really inspired me. The first is Malcom Gladwell’s Outliers.
His book is about exceptionalism, and how “outliers” go about making great changes in society.
Both Michael Pollan’s The Omnivore’s Dilemma, and Mark Schatzker’s The Dorito Effect inspired me to understand you are what you eat — and how you can manage your health by putting the right fuels in your body.
On-line, I’m using KFF.org (which is the Kaiser Family Foundation), the Mayo Clinic and the Cleveland Clinic on-line resources, The National Institutes of Health (NCIH) and many other technically based resources.
How can our readers follow you on social media?
Health care changes every day. That’s why we are launching Uncoverdhc.com to continue uncovering ways to take control of our healthcare. We welcome you to try the site and tell us how we can help you. You can also follow us on Facebook at Facebook/UncoverdHC.
Thank you so much for these insights! This was so inspiring!