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Healthcare Stole the American Dream. Lets Take it Back
Episode

David Contorno, CEO of E Powered Benefits

Healthcare Stole the American Dream. Let’s Take it Back

In this episode of the Outcomes Rocket, we are privileged to host the outstanding David Contorno. David is a nationally recognized industry speaker in the employee benefits space and employee satisfaction, and today he talks about a creative solution to increase transparency and improve satisfaction. David talks about one of the biggest challenges in U.S. healthcare which is price transparency, what employers can do to curb their steep insurance costs, benefits of direct primary care, and why companies and people prefer insurance. He also shares two suggestions on how to become healthcare consumers.

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Healthcare Stole the American Dream. Lets Take it Back

About David Cortorno

David Cortorno is a thought leader, industry speaker, author, and founder and CEO of E Powered Benefits, a benefit consulting firm. His mission is to deliver better care at lower cost for employers and employees.

David has received many accolades. He was 2015 “40 Under 40” Award Winner presented by Charlotte Business Journal. Most recently, David was Benefits Selling Magazine’s 2015 Broker of the Year and, in March 2016, Forbes deemed him “One of America’s Most Innovative Benefits Leaders.”

David is committed to giving back to his community and actively participates in the membership drive for the United Way, assisting the local chapter of Habitat for Humanity, and supporting The Dove House Child Advocacy Center. When he is not working, he enjoys boating and traveling.

Healthcare Stole the American Dream. Lets Take it Back with David Contorno, CEO of E Powered Benefits: Audio automatically transcribed by Sonix

Healthcare Stole the American Dream. Lets Take it Back with David Contorno, CEO of E Powered Benefits: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Saul Marquez:
Hey everybody! Saul Marquez here and welcome back to the Outcomes Rocket. Today, I have the privilege of hosting the outstanding David Contorno. David has over 21 years of experience in the employee benefits space, and I can assure you his experience doesn't get in the way of thinking outside of the box in this transformative time in health insurance and employee benefits landscape. Today's going to be a great opportunity to do that, to think outside the box, and what he does is that he works with employers that truly care about their employees. I mean, who doesn't? I think most of us do. But they recognize the need for creative solutions, and that's where it becomes a challenge. That's where I think the care comes in. And so, David, I'm excited to touch on the work that you're doing to increase employee satisfaction and really improve outcomes for all of us.

David Contorno:
Thank you for having me Saul. I really appreciate it.

Saul Marquez:
Absolutely. So obviously, you do quite a bit around sharing your perspective online and across, you know, digital channels around your beliefs. But I want to understand and help our audience understand what inspires your work in health care and health benefits.

David Contorno:
Well, that's a great question. So as you mentioned in my opening, I've been doing this for a really long time, but I almost feel like that's a disadvantage because we've been doing it wrong. The country, the industry has been doing health care and health insurance wrong for at least my entire life, and I've been around for 44 years. So for the first 18 years of my career, I did it wrong too. That's how everyone did it. And it really wasn't until the last eight or nine years that I really started to do things differently. And what's really fundamental is when I say different, it's really just the same that people do everywhere else. They buy things. I'm not asking them to do anything different in health care that they don't do elsewhere. It's just they don't do it in health care. And what I mean by that is applying cost and quality to the equation. And we don't do that. We don't have access to that. We're not given that information. It's really tough to make health care decisions on cost and quality, but it is starting to get easier and when it happens, it is transformative.

Saul Marquez:
Man, that's well said. And it is hard. You know, my son got stitches, got this thing. So this is not a bill. So what is this? And where does the bill come? Because I know there's a balance on this thing. So definitely cost quality. That's at the individual level. But then you sort of take some steps back and you look at it at an enterprise level and it becomes an even bigger problem. So talk to us a little bit about what you're doing to add value to a lot of the listeners.

David Contorno:
Well, it becomes a bigger problem, but it also becomes an easier solution when you're talking about enterprise level because you can actually apply this across a much larger population than you could with any one individual. So let me give you a few metrics within health care that some of which will make sense and some of which might sound different than other economies. Number one, cost and quality are inversely related in health care. And I know we're used to them being related in other areas like, you know, as we pay more for a home, we get a better home. As we pay more for a car, we get a better car. As you pay more for clothes, we get better clothes. But in health care, it's different. In health care, it's the opposite. The higher quality providers are almost always at the lower end of the price spectrum, and the reason for this is quite simple. It's frequency. The more frequently they do a particular procedure, the better they tend to do it and surprise surprise, the more efficiently they do it, the more cost effective they do it. And what's really surprising in health care is the variations in cost and quality. And I'll give you an example. Under former President Trump, he signed a price transparency law that required hospitals to post their pricing. Now this was done not quite in the consumer friendly way that I wish it was, but in any event, some hospitals have posted their pricing, and one hospital in particular is a large health system in California called Sutter. They are a monster in Northern California. And what was really interesting was the cost of a knee surgery, the same procedure within the same health system varied from as low as $18000 to as high as $120,000. Now can you imagine if you went from one Honda dealership to another and the Honda Accord that you wanted at the second dealership was five times more expensive than the same Honda was at the car dealership. You just left like we would never accept that, and we would certainly never go to a car dealership that was charging five times the prevailing rate for the same quality car. But yet in health care, we do it all the time. So what really sparked my change in my path, in my career was my own health story, where I needed an inguinal hernia repair like simple, middle aged man kind of thing. And the hospitals near me in North Carolina were reeling after the wonderful discount that the carriers bargained for us. It was ranging in price from nine thousand to forty seven thousand dollars. But here's the really crazy thing, Saul. So I was able to get this surgery done at a hospital that had higher quality outcomes than any of the hospitals in Charlotte. For an all in pre-negotiated bundle price of three thousand sixty dollars. And not only that, but the surgeon actually got paid more in that environment than the environments that cost nine or twenty or forty seven thousand dollars. So here I am, paying far less money than even my deductible. The surgeon is getting more money. I'm getting a better outcome. The hospital is more profitable, and I said to myself, Wait a second, why are we not encouraging people to go to places like this all the time? Why don't we say, Hey, if you go to this high quality, low cost place, we're going to eliminate your deductible because five thousand in the scope of forty seven thousand dollars of savings is nothing, right? But here's the crazy part. The carriers won't allow you to do that, and there's a simple reason for it. When they contract with the local large health system, the health system says to them we'll be part of your network, but you cannot make it beneficial to go to our competitors than you do to us. And the insurance company says, OK, we need you in our system, so we'll gladly do whatever we need to do. And so all of the providers that are quote unquote in-network with your Blue Cross, United, Cigna, Aetna, Humana, whatever, they're all treated the same, but they don't all treat you the same and they don't all cost the same. So why are we treating them the same within our health plan? We shouldn't be. We should be prioritizing the high quality, low cost providers every day, all the time. And when you do that, when you can do that within a health plan, there's two things that happen that are miraculous. Number one, the employees, the members of that plan get better outcomes. They're better employees, they're better people. They're happier, they're healthier, and it costs so much less money for everybody. But what you need to understand is that the large insurance carriers, they don't make money by saving money, they make money by costs going up. And the more claims go up, the more administration goes up, the more overhead goes up, the more money they make. And that's the environment that most employers are in.

Saul Marquez:
Yeah, no, totally. And so let's dig into this moment here. So you were able to identify a lower cost, higher quality place now. Were you still using your insurance or did you negotiate that cash price?

David Contorno:
That was total cash. When you bring insurance into the equation, you not only can't negotiate, but the one thing that I can tell you with a very high degree of certainty is that the highest price paid in health care is with health insurance. A lot of people think, Oh my gosh, my health insurance saves me money. It gets me discounts. No, no. Like, if you look at how hospitals and doctors get paid, you will see that they have charitable care is their least profitable because they normally kind of give that away. And then they have cash pricing and then they have Medicaid and Medicare, and then they have insurance. But insurance is the highest price paid in health care every day.

Saul Marquez:
Yeah. And so for sure, and I figured, but I wanted to clarify that, that there was a cash price. I's a challenge. You know, one of the stats that when I first learned about it and still blew me away is that, you know, out of all bankruptcies that happen, sixty six percent are due to health care related billings. But then that the 50 percent of those sixty six percent, meaning half of all of the bankruptcies that are related to health care, it's people that actually had health care insurance.

David Contorno:
You know, that statistic drives me every day because I kind of liken it back to when I studied for my insurance test back many decades ago. And the one thing that I learned, they went through the history of insurance in general. And what they told you was that insurance was created by humans for one purpose and one purpose only – to protect us from catastrophic financial loss. And if you think of every type of insurance, life insurance, car insurance, homeowner's insurance, disability insurance, every single one of them does exactly that. We try not to use them. We avoid using them until we absolutely have to.

Saul Marquez:
Yes.

David Contorno:
But health insurance is different. Health insurance is the one insurance that we actually go bankrupt when we use it. And it's the one thing that we expect to pay for everything. Or, you know, it's funny. I use the analogy. Imagine if you backed into a dumpster one day. You know you're backing out of your driveway and you hit a dumpster. It's a few hundred dollars worth of damage. And you say to yourself, you know, I'm just going to pay for this because if I try and claim this $800 worth of damage on my car insurance, I have a five hundred dollar deductible anyway, and they might raise my rates. They might drop me. So I'm just going to pay for it. But nobody ever says, you know, it's just a cardiologist appointment. I don't want my health insurance company knowing that I might have heart disease, so I'm just going to pay for this doctor. Nobody ever says that. We think about health insurance fundamentally different. And I will tell you the biggest problem is that we confuse the words health insurance and health care as though they're one thing. We don't confuse the words car insurance with cars, right? We don't confuse life insurance with living. But somehow we confuse health insurance and health care. And a lot of people think that Blue Cross provides health care. Blue Cross provides no health care at all. Zero. Your doctor provides health care. Your nurse. Your pharmacist. Blue Cross doesn't provide any health care at all.

Saul Marquez:
Yep. Yeah, this is great, David. And so, you know, actually just sidebar like I've, because of everything and just costs and all that, this stuff, I'm looking at direct primary care as a way to supplement, you know, benefits because of of the transparent pricing that they offer on things like x rays, MRIs, insurance, et cetera. What's your take on direct primary care?

David Contorno:
Well, what you need to understand about direct primary care, or DPC is it's beyond just the quote unquote value. So I think what people need to understand is our health care system, the system in which higher costs and lower quality prevails is not by accident. It is really intentional and it is really they've the system has found a way to benefit itself in that environment. And if you look at how doctors are paid in general, you will find that they are paid in a way that is contrary to the patient's interests. Just like brokers are paid in a way that's contrary to the employer's interest. Just like health insurance carriers are paid in a way that's contrary to the member's interests, doctors are paid in a way that is contrary to the patient's interests, and I'll tell you specifically how it is. Most doctors are paid at least their incentives to increasing their pay are tied to two metrics. Number one how many patients they see in a day. The more patients they see in a day, the more money they make. But of course, the more patients they see in a day, the less time they spend with each patient. But the other way, and the more damaging thing is something called an RVU or a relative value unit. And it's a measurement of how much that provider that doctor is generating in other parts of the health care system that he works for. So if I'm a primary care doctor and I refer you to a back surgeon who does back surgery, I'm going to maximize my incentive. But back surgery is typically not good for the patient. Back surgery is typically the last resort, not the first resort, but we've kind of made it the first resort. And so when primary care doctors are paid in this way, you get really bad care from the primary doctor. When you go into direct primary care, which is a model in which every patient pays a monthly subscription fee, whether they see the doctor zero or a thousand times in that month, it doesn't matter. And this gives the doctor, number one, the ability to have a much smaller patient panel size. They can actually have fewer patients they can spend more time with because they have a regular revenue coming in that's not tied to people being sick.

Saul Marquez:
Mm hmm.

David Contorno:
Think about that. The revenue of a traditional doctor is tied to patients being sick, so the only way they make money is when you are not well, which means the more unwell you are, the more money the provider makes. That's the system. That's boil it down. Make it basic. That is our health care system in a nutshell. And when you get into direct primary care, as I have a direct primary care provider, as we build direct primary care providers into our health plan, the quality of care goes up so substantially that patients dealing with multiple chronic conditions don't need to see specialists anymore. The medications they take go down. The hospitalizations they've been doing every year goes down, and even though you're spending a little more on this primary care model, you're spending so much less on the bigger buckets of care within a health plan, which are hospitals, specialists and medication. And it's far more than offsets the increase in the primary care. And really, if you look at our country as a whole, we spend less on primary care than every other developed nation in the world.

Saul Marquez:
It's a problem. Well, you're a believer then. We should do it. My wife and I should do it.

David Contorno:
Yes, you should. And I will help you find one. As a matter of fact, as a matter of fact, I saw my direct primary care doctor is in downtown Chicago. He is a fantastic well-known doctor and I will gladly connect you with him if that's who you want to go with.

Saul Marquez:
I love it, man. I love it. This is great. And by the way, folks, if you, if this DPC model direct primary care model is new to you, I don't think it is. But if it is, it's all good. We've done about seven or eight episodes, so go to the website OutcomesRocket.Health, in the search bar type in either DPC or direct primary care. You'll see a list of all the episodes we've done on this. It is. I don't know why it's taken me so long, David, but I'm there. I'm a slow learner sometimes, but eventually I get it. When I get it, I share it if it's good so.

David Contorno:
Well, you're a faster learner than much of America, so I will give you credit for that.

Saul Marquez:
I appreciate you for that.So, David, you know, talk to us about what makes what you do different. I mean, obviously, to begin with, you're starting off by questioning a lot of the assumptions, the ass-umptions. But talk to us about like how you operationalize all this, how how do you make this happen?

David Contorno:
You know, it's funny. I get called an innovator, a disruptor, and people say, Oh my gosh, what you do is so hard. And I guess compared to what I used to do, which was selling just, you know, policies of Blue Cross United, Cigna, Aetna, it is hard, I guess, in comparison, but it is so much more rewarding in what I do today than what I did for most of my career, because I get to help people get really high quality care at a price that both them and their employer can afford. And what I want people to really understand out of this more than anything, is it doesn't take genius. It doesn't take college degrees. Really just what it takes to provide high quality care at a much lower price is the same thing that most businesses are applying to other areas of things that they procure. So if they're a trucking company, you know, have you seen like where some trucks have those little wings underneath the truck that help with the aerodynamics?

Saul Marquez:
Does that really work?

David Contorno:
And I believe that really work. I think it saves like one cent a mile, like it's fractionally. It seems like nothing. But when you add it up to the entire trucking company and of course, the entire country trucking stuff across the country, it really adds up. But yet if I ask that same CFO of that same trucking company, how do you save a penny on knee surgery? What does knee surgery even cost? I mean, the one thing about health care that really drives me nuts is it's the only place in our economy where not only the customer doesn't know the price, but even the provider of the services doesn't know what the price is going to be until after the services are rendered. And I don't care what model you're in, what sector of the economy you're in. If that applied, they'd be able to take advantage of you. I mean, if a restaurant didn't have to give you a price until after you ate the food, you don't think the pricing would start to skyrocket? Maybe not in day one, but week one, month one, year one. The prices would just go up and up and up because they are not being held to being fairly and competitively priced. And that's where our health care system is. So in relation to your question, what do we really change? It's really simple. We demand demand cost and quality before known and planned procedures are rendered. That's it. Like, really, it's that simple, just like, you know cost and quality of literally everything else you consume before you consume it. And when you apply that, you get much, much better care at a much lower price. I know I indict our health care system in this country pretty frequently. I do, because overall it's abysmal. But there are some really great providers. The really hard part is finding them.

Saul Marquez:
So how do we find them? We find them. And you know, I'll tell you, even like if somebody wants to try, they'll run into frustration where they won't tell them the price. And so what do you do then, you know, and also talk to us about this.

David Contorno:
Even worse And I've had this from doctors a lot. I've had a lot of doctors say to me, You know what, David? I went to medical school to treat patients with the most appropriate clinical. Price shouldn't be a factor in my medical advice. And I go, I disagree with that so wholeheartedly, because if you treat a diabetic and you prescribe them insulin that they can't afford, you might as well not prescribe it at all. And the really sad part is is that people frequently can't afford their medication even when they have a job, even when they're getting a regular paycheck. And even when they have what most people would consider, quote unquote good health insurance. Insulin in particular, which is gone off the charts in terms of costs over the last 10 years. It's just it's out of control. And you know, you look at insulin or you look at the EpiPen debacle a few years ago. Do you know why those prices went up so much? It's not because they were some maniacal or, you know, it was because they could. It was because you don't have a choice if you have allergies or you have diabetes, you have to get that medicine. And I read a story in the Wall Street Journal just over the weekend about a woman who literally was debating between dinner for her children or her own diabetes medication. How awful of a situation is that? And it doesn't have to be. So in relation to your question, what do you do? The answer is it's not easy. Now I pay tens of thousands of dollars to have licenses to software that allows me to look at quality so I can actually and cost too, but quality more importantly, so I can look at quality of every provider in the country and every facility in the country. And by the way, those are two very different things, like a really good doctor at a really bad hospital is not really good or vice versa. You want a good doctor at a good hospital and you want to know that both of them are both good quality and fairly priced. And again, I said it before, but I'll reiterate it. The higher quality providers are almost always at the lower end of the price spectrum. So although we validate this, sometimes just pushing people to higher quality is also pushing them to lower cost. And that really is a win win. And again, I know I illustrated for you a cost comparison that was not out of the norm. It is quite common for cost to be 500 percent different from pharmacy to pharmacy, doctor to doctor, hospital to hospital, and again, the higher cost typically means lower quality.

Saul Marquez:
Well, you know, a big part of health care is navigation. So you know, you either get navigated by a carrier or an insurance company or you get navigated by. You really don't know where to go, you know, honestly, if you're not in the business of health care. So how do you guys come in to play here as an alternative?

David Contorno:
Well, the first thing is, and I know this will sound really scary to a lot of employers who might be listening, but we don't utilize the services of any carriers anymore. We used to I mean, heck, I was one of UnitedHealth Care's Golden Boys for, for many, many, many years. But what I recognized was the more successful I was in United's eyes, the less value I was bringing to my clients. As a matter of fact, those two things were related to each other, like directly related to each other. So I got out of that carrier model and that IV drip of commissions because they were paying me so well, Saul. I mean, I was getting monthly commissions of hundreds of thousands of dollars. I was getting annual checks of hundreds of thousands of dollars for bonuses, for writing business and keeping business with them. And then on top of that, I was getting amazing trips like golf to Ireland and private cruise ships rented out for our exclusive use. And just, I mean, just dinners on a Tuesday night, golfing on a Friday, like it was offered to me all the time in a lavish, lavish style. And I really think that if my clients knew how much I was being courted by the carriers that are taking their money, I don't think they'd be very happy about it.

Saul Marquez:
Yeah. Now you've said it, well, it's a challenge and you know, it takes away the competitive edge of American business just wasting a bunch of money that shouldn't be. What would you say is one of the biggest setbacks you've experienced and the key learning that came out of it?

David Contorno:
Well, I mean, I think as I moved into this model, it is. It is really tough. Like it is a real uphill battle because I have to convince employers that this is the right thing for their employees, not just financially, although you would think that would be the bigger thing, but for some of them, it's not. It's, you know, how are my employees going to perceive this? And then when I get to the employee level, it's showing them how the carriers don't have their interests at heart, how they're approving things oftentimes that are not in their interest or make them worse from a health perspective and how costs going up means more profit, most employers think that if an insurance company keeps costs down, their profit goes up, but that is so not true, it's rooted in federal law, so it's getting people to understand the very people that I'm trying to help the most, that you don't need health insurance to get good health care. As a matter of fact, I remember this story of a business coach, and he said that his client was the CEO of a large record store chain back a few decades ago, and their flagship store was in Times Square, New York City, Manhattan. And they had a big boy band that was going to do a live concert one day for their new album. And so thousands of people came out on a weekday. It was a sunny day, it was warm out, it was spring, and thousands of people came out to hear this band play their new hit song. And the business coach said to the CEO, This is amazing, so many people are here. Why do you think they're here? And the CEO said they're here to buy a CD, of course. And the business coach said to him, So really, you think that everybody got out of bed today, took a day off from work so that they could drive into New York City, which is not easy for those of you that live in the New York City area which is where I'm from. And then they could buy this shrink wrapped plastic thing that they have to really difficultly open and undo the plastic to then have these little child protection things to open up this plastic case. And then they reveal around silver disc. Do you think that's what everyone came here to do today? And the CEO looked at him like he was crazy. He's like, What are you talking about? And the business coach looked at me. He said, Let me tell you why people are here. They're here, because last week they heard the song on the radio and they put their windows down and they turn the volume up and they felt good. They're not here to buy a CD. They're here to recreate the feeling. And I use that analogy in health care all the time because nobody wants Blue Cross and Blue Shield. Nobody wants United Health Care. Nobody wants Cigna or Aetna. What they want, even if they don't really recognize it is affordable access to high quality care. And what they don't realize is that not only do they not need the Blue Cross United Cigna Aetna to do that, but actually those things make the care higher cost and lower quality by inserting them into the mix. Whether it's administrative overhead, medical management, whatever. It makes it more difficult and more expensive to access care. And so as soon as you recognize that and you say, OK, I'm an employer and I'm going to provide a way to pay for health care for my employees, which is really what they've been purporting to do all along with their Blue Cross or their Cigna or their Aetna. They've just been deferring that to the carrier and saying, You handle it, I'll outsource it. You do it for me. But what they really want is the ability to provide high quality, affordable care to their employees. And when you look at it from that perspective and you have access to information to identify high quality affordable care, you can create a health plan a truly, you know, ID card in your hand like this feels like a health plan. You can create a health plan customized for the employer that is 30, 40 50, even 60 percent less expensive. Yes, literally 60 percent less expensive than the carriers. And at the same time, those employees and their family members on the plan are getting access to higher quality care at a much lower cost. And it really that's where that's why I push so hard and have to fight every day. Because when I get someone to the right cancer care, the right heart care, the right medication at a 75 percent lower cost than they were going to get otherwise, that's where my reward comes in.

Saul Marquez:
Totally. Yeah, David, I love that. And so, you know, with regard to the layout that you just put out here for us to understand, getting care outside of a carrier is not only possible, but a lot higher quality, potentially, and also lower costs for sure. Like. Is that why a lot of self-insured employers do what they do because they basically can't afford anymore? You got 50 thousand plus employees, you've got to do it on your own.

David Contorno:
Unfortunately, I think that's the methodology, but I don't think that's what actually occurs because you know what most employers do, they get to say they're like, I want to be self-insured, but I'm going to do it with Blue Cross or United or Cigna, right? So they're literally.

Saul Marquez:
Going to say PPA.

David Contorno:
Yeah, yeah, they're literally riding on all the same chasis and platforms that everything that applied to what I said a minute ago applies. And so it's true,

Saul Marquez:
Counterproductive.

David Contorno:
The large employers that are self-funded. So I'll give you an example where I'm right now. Lowe's Home Improvement their headquarters is here in this little town north of Charlotte called Mooresville, North Carolina, and collectively they have a few hundred thousand employees, right? So they're self-funded. And they use Aetna as their administrator and network. So let's pretend for a minute that Joe the Plumber down the road from Lowe's headquarters, he has 10 employees and he has just a fully insured Aetna plan for his own company. So let's pretend that a Lowe's employee and a Joe the Plumber employee both go to the local hospital for the same procedure, with the same provider coded in the same way. Well, they both have Aetna, so they both flow through the Aetna network. So what's the price paid for both of those procedures? They're exactly the same because they both flow through the Aetna network, even though Lowe's has 300000 employees and Joe the Plumber only has 10. It doesn't matter. They both paid the same price for that surgery because they both flow through the Aetna network. And so when you go self-funded just with Blue Cross United, Cigna Aetna and maybe you've cut out to three four, maybe even five percent of the carrier's profit, but that's all you've done. You've literally not changed anything else. And so if you really want different results, you've got to change the process that you go through to get there. And that includes changing how the benefits are provided. Changing how members are educated, changing how the care is paid for. I mean, really, if you really want to summarize what we do differently than what other brokers and even insurance carriers do, we change the way health care is procured and paid for. That is the biggest thing that we change. Well, that's fundamentally different.

Saul Marquez:
Yeah, yeah. And so, you're what's your view of this, David like if you and you've been in this business for a long time.20 plus years, right? So so what's your view? Are we getting better at it? Are businesses smelling the coffee? Are you seeing a trend toward improvement or what are you seeing out there? Be real with us.

David Contorno:
Yeah. Listen, you're either all in or not all in. Like those are the only two choices. As an employer, there's no I wish like employers beg me all the time for a crawl, walk, run and I don't I don't have a crawl, walk run. I have like a jog is the slowest I think I can do because you have to get rid of some of these players because the second you put a Blue Cross in the mix or an Express Scripts or a Caremark or you, you come with all these handcuffs. And so the one or two things that I need to do to release the handcuffs to make common sense, and I go back to my hernia surgery. It was $3000 at one of the highest quality hospitals in the country, versus $47000 at the local lower quality place. If I'm an employer, why would I not say go to the $3000 place? I'll pay the full three thousand, I'll pay to fly you there. I'll put you up in the suite at the Ritz Carlton. I'll get you a Bentley. I'll pay for a private jet to get you there. Like, why would an employer not do that when the cost is forty four thousand difference? But they don't know that. You know, again, I go back to that CFO and ask them, how much does it cost for a box of paper clips? And most CFOs can tell me, but how much does it cost for a knee surgery? And they can't. And that's broken.

Saul Marquez:
It is. Do you feel like so people are asking you for the crawl walk run? But are you starting to see more adoption of your type of model?

David Contorno:
We are. Yeah. I mean, you know, I try and spread the message both in terms of the employers that I work with, but we also partner with brokers and consultants around the country to help them get into this world for their clients because it's not easy. There's so many forces against doing this. The one thing you need to realize is that health care is literally the largest employer in our country. There is no bigger employer. Even it overtook the federal government a couple of years ago for a number of employees. So we have this thing that is 20 percent of our gross domestic product. It is the largest sector of our economy and it is all built on higher costs and lower quality, equal more profit. And so it's fighting this massive economic model, but also the these mental, this psychological, like I feel like the one thing that the carriers have done really well is marketing. They have made people feel that you're going to be safe if you're with Blue Cross. As a matter of fact, there's the Blue Cross is across the country have been doing this advertising campaign for years, billboards and the tagline is Live Fearless. Now I don't know about you, but for most of America, if I had a $5000 deductible, I am scared to crap of using my health insurance. Like, I don't know how that means I can live fearless when I have a deductible that's more five times more than my savings account. That's not living fearless. That's living so fearful that I can't get rid of you because I might actually need you one day or think I do, and if I do, I'm going to make sure you're still there. That's fearful. Not fearless.

Saul Marquez:
Yeah. So who do you find is doing it? Is it the smaller businesses, is it individuals?

David Contorno:
Yeah, I mean, that was really the sad part. You know, I consulted with Haven, which was the company that was formed by J.P. Morgan and Amazon and Berkshire Hathaway, and they just folded a few months ago, as you may have heard. It made some big news. And you know, back a few years ago when I was talking with them, I mean, I was talking with Dr. Atul Gawande, who was the CEO who is a just, I mean, incredibly respected and like, I'm like, OK, this guy can do it right. But the headwinds are so strong that even he couldn't do it and even his team of really capable people, they folded and they couldn't do it. What I believe is the change is not going to occur from the single five hundred thousand employee company. It's going to occur from a thousand five hundred employee companies doing this, or five thousand one hundred employee companies or our smallest client is 17 employees. You don't have to be big to do this, so it's really going to occur from the ground up. It's going to occur from those family owned businesses where the owner is one of the guys or gals in the field and they know their employees. They care. They're not sitting in some ivory tower distanced from the employees population and how much money they make. It's going to occur from those blue and gray collar companies, family owned businesses who really care about their employees who are sick and tired. They see the trajectory. They know it's not sustainable, and they're almost willing to do anything different than what they've been doing, even if they don't fully understand what that difference is. And then hopefully someone like me or as experienced as me comes in and shows them what the different is to take them to a way that is better. And they don't just throw up their hands and give in and give up. But that's what needs to happen. It's going to be those smaller businesses, those family owned businesses that really care about their employees.

Saul Marquez:
I love it, David. Well, look, you're what you're doing is is making an impact. It's definitely not easy. If you had to highlight the one thing that excites you most about what you do, what is it?

David Contorno:
You know, when I first started doing this, it was really saying to an employer, I'm going to save you 40, 50, 60 percent or saying to the employee, I'm going to eliminate your really high cost deductible or co-pay for your chronic medications that you need every month. And that still gives me some satisfaction. But what really, really motivates me today is I have seen like the ridiculous low quality of care that most Americans are receiving. Like I know many people that they had a back injury and so they went to the back surgeon. They got surgery on their back and oh my gosh, it didn't fix it. So what did they do? They went back to the same back surgeon for another back surgery and another back surgery. Like, we would never do that. If we went to a mechanic to fix our air conditioning in our car and we took it back and it wasn't fixed, Maybe we'd give them one more shot, but like that would be it, right? We'd go to someone else after that. But in health care for some reason, and so really, what really gives me a tremendous amount of satisfaction is when I get people the right care, when they're chronic conditions. Oh my gosh, you mean I don't need to suffer with migraines every week? You mean I can control my diabetes in a way that it doesn't negatively influence my life? You mean I can control my heart disease in a way that doesn't lessen my life expectancy? Yes, you can do all those things when you get to the right doctor, and I want to make one comment on that.

Saul Marquez:
Yeah.

David Contorno:
I hear people all the time say, but I've been going to my doctor for 30 years. You know what? So what? That doesn't mean they're good. And I'd argue that if they've been, if you've been going to them for 30 years, they probably went to medical school thirty five years ago. So why, like, what does that mean they're good. Like how does that a quality metric? I've been going to the same mechanic for 30 years and he's been doing a crappy job in my car. Like what? I don't understand. So we need to really look at outcomes. We need to really look at who is, if I'm a diabetic and I'm going to an endocrinologist, then I want to know how well that endocrinologist manages the population of patients that he or she is seeing that have diabetes. What's their A1C levels? Are they taking their medication? Are they eating right? Are they getting nutrition counseling? Are they going to see a podiatrist because they might have diabetic neuropathy? Are they going to an ophthalmologist? Like, those are the things that I want to know. I don't want to know how handsome he is or how his bedside manner is. Like, none of those things matter. You know, I love the show House. I don't know if any of the listeners watched it, but he was an ass. He was not a nice person, but darn it, he was a good doctor and I would take a good doctor over a good personality any day of the week. But I feel like most of America judges the quality of doctors on the personality.

Saul Marquez:
I love it. No, I think you called it out, man. It's a big, big challenge and also an opportunity. So, you know, folks, there's a way for you to do better. There's a way for me to do better, for all of us to do better and the nuggets here that David is is sharing with us, it's just the beginning. The true change happens when you take action about something that you learn. Don't just listen. Something you heard today hit you on the inside hard. Then make sure you act on it. David, if we can share the best place that the listeners could get in touch with you, but also a closing thought that you want us to to part with.

David Contorno:
Sure. The best place to get in touch with me, I think, is LinkedIn. Probably. Luckily, my name is unique enough that there aren't many of me out there. So if you find me on LinkedIn and connect with me, you can message me and I'll definitely reach back out. But I think in the closing, what I think everyone needs to understand and I said part of this before, which is health care and health insurance, are two very different things. But at the end of the day, when you are consuming health care, I would ask that you consume health care in the same way you consume everything else. And so first is care about cost. Second is care about quality. Ask questions and you might not get answers in health care in particular. You might not. But if they can't tell you how well they do it, why are you going there? Go to places that can say this is the cost and this is our quality and care about those things. And when you do and when you think of insurance after the fact, just like we do with cars, we don't call GEICO and say, Hey, GEICO, what car can I buy? What dealership can I go to? What options can I buy and what is it going to cost me when I get there? We go and research the car first, we find the best price in the car and then we deal with insurance. And I know it's really tough in health care. I know it's not as easy as I make it sound, but that's what we need to do in health care. We need to worry about getting the highest quality, most appropriately priced care we can, and then we should worry about insurance. But we've done the opposite in this country. I call it Stockholm Syndrome. We've fallen in love with our captors, the member says to the insurance company. What can I do? What where can I go? And how much is it going to cost me? The doctors say, How can I treat my patients and how much are you going to pay me? The employers say, What benefits can I offer my employees and how much is it going to cost me? We literally have relinquished all control of our health care system to the health insurance carriers that benefit from costs going up and quality going down. And we sit here wondering why do our costs keep going up and quality keep going down every year. It's really simple when you turn those around, even in little ways, you change the outcome dramatically.

Saul Marquez:
Well said, David. And just that analogy of you don't ask Geico what kind of car to buy. That's hit home with me. Just a great parallel to kind of illustrate what we are doing and something for all of us to think about. So David, really appreciate you jumping on and stimulating thought. Keep doing what you're doing, man. You're making the world a better place. Thanks for jumping on with us.

David Contorno:
Thank you.

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Things You’ll Learn

  • Cost and quality are inversely related in health care.
  • The higher quality providers are almost always at the lower end of the price spectrum.
  • The highest price paid in health care is with health insurance.
  • Health insurance is the one insurance that we actually go bankrupt when we use it.
  • If you really want different results, you’ve got to change the process that you go through to get there.
  • Health care and health insurance are two very different things

 

Resources

Connect with David on LinkedIn: https://www.linkedin.com/in/dcontorno/