The Innerworkings of Employer Sponsored Health Insurance with James Gelfand, Senior Vice President, Health Policy at The ERISA Industry Committee

The Innerworkings of Employer Sponsored Health Insurance with James Gelfand, Senior Vice President, Health Policy at The ERISA Industry Committee

Thanks for tuning in to the Outcomes Rocket podcast where we chat with today's most successful and inspiring health leaders. I want to personally invite you to our first inaugural Healthcare Thinkathon. It's a conference that the Outcomes Rocket and the IU Center for Health Innovation and Implementation Sciences has teamed up on. We're going to put together silo crushing practices just like we do here on the podcast except it's going to be live with inspiring keynotes and panelists. To set the tone, we're conducting a meeting where you can be part of drafting the blueprint for the future of healthcare. That's right. You could be a founding member of this group of talented industry and practitioner leaders. Join me and 200 other inspiring health leaders for the first Inaugural Healthcare Thinkathon. It's an event that you're not going to want to miss. And since there's only 200 tickets available you're going to want to act soon. So how do you learn more? Just go to outcomesrocket.health/conference. For more details on how to attend that's outcomesrocket.health/conference and you'll be able to get all the info that you need on this amazing healthcare thinkathon. That's outcomesrocket.health/conference.

Welcome back once again to the outcomes rocket podcast where we chat with today's most successful and inspiring health leaders. I thank you for tuning in again and I welcome you to go to outcomesrocket.health/reviews where you could rate and review today's podcast because we have a very special guest. He is an enormous contributor to Health Care in the employer space. His name is James Gelfand. He's a senior vice president, Health Policy at the ERISA Industry Committee. And at this committee they advocate for major employers on health and tax issues related to employer sponsored health insurance being that 40% of our listener base is employers. You're going to care about what you hear today. It's going to be very relevant. He builds policy, he builds relationships. He manages legislative and regulatory projects, coalitions and memberships, service and retention. He works with the 100 very largest businesses out there offering comprehensive health and benefits. I learned from him in one of the previous episodes that I heard him speak was that 178 million Americans get insurance through a job. And so if you're listening more than likely that's you. And if not you probably want to hear this too. So without further adieu, I want to welcome our very special guest James Gelfand and James, why don't you fill in any of the gaps in the introduction that I may have missed. Welcome to the podcast.

Thanks Sol it's it's a pleasure to be with you today. I think the only things that I would add is that I've done a lot of different stuff from being a political strategist and pollster to being a patient advocate and lobbying on behalf of moms and babies. Lobbyist attorney, a staffer for two different senators on Capitol Hill. So I've been in a lot of different areas that all touch on similar aspects of looking at health policy and trying to figure out what do we need to do to make the system work for patients, for payers for providers and everyone else.

Some great, great information there and yeah you know what a great point James it was Senator Olympia Snowe and Tom Coburn that you were able to sort of be on their counsel is that right?

Yes so I often get questions about that because Senator Snowe was probably the most moderate member of the Republican caucus in the Senate whereas Senator Coburn was maybe one of the most conservative member, people will ask, well how could you work for those two because they're so very different? But they both wanted me to do the same job for them which was to understand what was going on on the Senate Finance Committee and make sure that their own policy priorities were moved to the front of the queue and taken into account as well as to advise them on how they should vote based on their principles and their values. And so that was something that I enjoyed doing for about four years.

That's amazing. So folks as you can see James has a very deep rich history in health policy and in his best interest is to help the American people get health care, affordable health care and also help businesses do it as well. Now what got you into health care to begin with James?

You know it's funny because I initially thought that what I wanted to do was foreign policy and write papers about how you know we should be making alliances or having wars and things like that. And what I came to understand is that first of all if you want to do foreign policy you generally have to have a Ph.D. in it or have military experience. But the other thing that I learned was that domestic policy is actually just as sexy and in fact the health care now governs I think close to one fifth of the U.S. economy. And we have to get used to saying that because for the last 10 years or so we've been saying 1/6 and now I think it's getting close enough that we can start saying 1/5 of the economy that is a huge, huge huge amount of money. It's a kitchen table conversation. Absolutely. And not only that but there's a bit of a war on in health care and it's been going on for 20 years now maybe longer which is who's going to pay for who's health care who's going to make a profit in the system and who's going to be a disrupter and go out there and change things that could be really problematic for some very entrenched interests. And the answers to those questions I think are going to determine where trillions of dollars flow over the next several years.

Trillions with a T listeners so no doubt we're looking at at a very important topic. Thanks for sharing how you landed here and it's turned out to be a really fruitful career for you. And I'm delighted to dive into some of the topics that we're going to get into here. Maybe dive into the Cadillac tax, some value based care discussions. Before we dive into that. James what is it that you believe is a hot topic that needs to be on every medical leaders agenda today and how should they be addressing it?

I'm going to cheat and I'm going to give you three because I think that there's three things that every medical leader needs to be thinking about. Number one is value. The days of volume being the key to being successful in healthcare are coming to an end and they're coming to an end swiftly and everybody in every part of the medical sector has to start thinking about value and what can you do to improve the patient's health while at the same time showing that you are being cost effective, efficient and effective. I'm the second one is the balance of innovation and costs. So we're very quickly approaching sort of boiling point where new innovations which are awesome and patients crave will just be out of reach for too many people and unless we find a way to balance the ability of medical device manufacturers and pharma companies to innovate as well as hospital systems etc. but also for patients to be able to afford those treatments, we're not going to be able to move forward we're going to be stuck we're going to plateau and then the third is that there is a global realignment of risk and responsibility. And again look through every single different part of the healthcare sector, healthcare stakeholders are taking on risk because when there is a profit to be made there is a price to be paid. And so doctors and hospitals are deep into this. But you're going to see more from pharma companies and medical device companies, you're going to see insurers taking on risk. You're going to see pharmacists taking on risk. It's going to encapsulate the entire industry and it's going to change everything because everyone is going to suddenly have a new motive, a new incentive.

So James some really really great topics. And on that last one about risk sharing. Where's the pie today? Who shoulders that risk and in your opinion. Where is it going to be where's that pie going to be as far as division of risk?

So right now most of the risk mislaid in the feet of payers. Right. So if you get insurance through your job it's generally your employer in a self-insured situation where if costs go through the roof and that's more than they collected and more than they expected they're on the hook. And if you're in the individual market then it's usually going to be the insurance company who is making some calculations and they're trying to collect the amount of premiums in a given year that are going to cover the expenditures that they're going to have. But if it doesn't work out that way. Well they're going to lose some money but going forward and sure you've had plenty folks talk about things like accountable care organizations.

Yes.

And Care Coordination demonstrations and value based purchasing agreements bundles and these are ways that providers are getting in on the risk but also the reward. So in a sophisticated model there is both upside and downside risk where if a provider group is really successful at controlling costs and keeping people healthy then they're going to get even more money than they would have got before. But if they end up costing more money and they're not successful then they might end up making less money than before. And then you know the least part of it right now is on pharma. But increasingly you do have former companies that are saying you know what we're going to say that if our drug doesn't work for your patient, we're not going to charge you for it. And that's the way of the future. And so I think that you also have other actors getting in on that.

And so at what point James do you think it's going to go from and thank you for that by the way. That's a great picture that you just painted for the listeners. Their risk is being shouldered by payers and the shift is now being weighted a little bit more on the payer still but still the providers are taking a chunk of that. Now industry is starting to walk in a little bit. At what point James do you think it's going to go from volunteering to being voluntold meaning the industry.

Voluntold. love it. So it's only a matter of time. This is the snowball that is rolling down the hill that will gradually get bigger and bigger until it's an unstoppable force. And what that's going to require is a culture change that culture change has already happened at plenty places. Think about if you get injured or sick I think you know where you want to go, right. You want to go to one of these very progressive forward thinking systems like Mayo or Geissinger or Intermountain. They're setting the standard that others are going to follow and that they're going to model. And what's going to happen is that this is going to permeate the entire medical establishment and the you know the federal government is actually really helping to kickstart this as well with changes to the way that Medicare is paying providers and hospitals. It's going to make change happen much much faster than if it had just been on the shoulders of employers trying to you know enact delivery system reform.

That's so insightful James, and it's true right some of these health systems like Intermountain for example the CEO recently put out a goal of 40% reduction in opioid use. There's going to be leaders and there's going to be followers listeners. Be a leader in this space because eventually you're going to have to do it. So James, I want to spend a little bit of time on ERISA Industry Committee. I want to educate the listeners on what this is what you guys do. And then let's dive into what you believe is an example of what you guys are doing to improve outcomes through your work there?

Sure. So the ERISA industry committee or we call it Eric for short is a trade association so that's a 501 c 6 and it's a group that's made up of about 100 of the nation's very large employers. As I sit here in my office on Capitol Hill, I'm looking around and I see products that are made by all of my different member companies. I came to work in a product made by a member company. And when you go on a trip you're using our member companies. Trust me these are all household names. And what we do is we represent them on issues related to employee benefits. So you mentioned that 178 million Americans get health insurance through their job, well that extends not just to our the employees of these companies but also to their families as well as in many cases to retirees who still have some sort of retiree health benefit. And we also represent them on issues related to pensions and retirement or paid sick leave etc.. But the health care guy so I'm gonna talk about health care. We are a team of government affairs professionals so we're registered lobbyist. We go to Capitol Hill and we go to the federal agencies and we urge them to make changes to regulations and the law that will enhance the ability of our member companies to offer high quality employee benefits. One of the projects that I had hoped to bring up today that I'm really excited about it has to do with health savings accounts. And I'm sure that your listeners are probably pretty steeped in health savings account.

Absolutely.

OK so you guys know then that when you have an HSA a health savings account, you pair it with a high deductible health plan and the rules governing what that health plan has to look like, what it can offer, what it can be paired with. They were developed about 15 years ago in 2003 under a bill called the Medicare Modernization Act which created the Medicare Part D prescription drug program.

Yes.

But it also created HSA. That was the last time Congress 15 years ago. And that's the last time Congress messed with HSA. So when you look at the rules governing and HSA and high deductible health plan, HDHP. Their 2003 style rule. They reflect the thinking that we had in 2003 which today we know there was stuff we got wrong. There was stuff we didn't see coming.

So one of the projects that I'm working on in that my organization is working on is an HSA and high deductible health plan modernization project.

Really.

There's a lot more of that. So there's a lot of folks out there who want to make some pretty drastic changes to health savings accounts such as some folks want to give an HSA to everyone who has Medicare or they want to double the amount that you can put into the HSA account in a given year. But what we're saying is we're kind of walking away from some of those really big ticket, really expensive and really controversial items. And instead what we did was we got together with a group of both Democrats and Republicans and said let's talk about what could we agree on that we need to change rates just save, that would make life better for the 22 million people who have them. And we came up with about seven or eight different provisions that we'd like to do. Ssome of them are things that just wouldn't have made any sense in 2003. In 2003,if I said, Saul, what should we do about adult children? You probably would've said WTF is an adult child? It didn't exist right and what wasn't in the concept.

Yeah.

So right now there's this glitch that because the ACA was the ACA was in some respects rushed it didn't and didn't get as much scrutiny as it might have gotten otherwise. They left out a line that they need it for adult children. So you can have a child up to the age 26 on your high deductible health plan but if that child is not a tax dependents of you meaning if they're 21 and they have a job but they're on your health plan they can't use the HSA funds for their health care so they can be on the HDHP, but not use the HSA. Now nobody wanted that to be how it works. It's just that we missed it right when we worked on ACA we missed it.

That's interesting so as it sits right now the adult children cannot access HSA funds if they are employed. Is that correct?

If they're taxpayers and you're not claiming them as a dependent on your taxes.

Yes.

Then No. They can't access those funds.

Interesting.

Another one has to do with supplemental benefits like telemedicine or on site clinics or even a second opinion service where the employer wants to pay for you to be able to get a free consultation. And these experts will say well maybe you do or you don't need that operation right? Under the current rules, f an employer wants to offer those benefits to an employee who's enrolled in a high deductible health plan.

Yes.

The employer cannot subsidize those benefits at all until the beneficiary has hit their deductible. So, let's say the employer has an on site clinic and that onsite clinic, we know that it's going to be cheaper for the patient to go to the onsite clinic than for them to go to the nearby hospital, right?

Yes.

But we can't steer them to it by giving them a discount because under the current rules, they have to be charged a fair market rate for the services that they get until the deductible. But in 2003 we weren't thinking about that. In 2003 but we're thinking about is utilization is bad. We must top down utilization. But today right we know better. We know that there is low value utilization and there is high value utilization and we want to tamp down on the low value services but we want to maximize high value services. We'd rather you go to your primary care provider a hundred times than have to go to the E.R. once and we want to build a system that reflects that. But the rules right now they just don't reflect that. You know I have a number of other things that are in this bill we've put together a bipartisan bill with Representative Mike Kelly and Earl Blumenauer. But it's just a suite of things that it's common sense and it reflects thinking about what do we want health insurance to look like in the modern era in order to maximize value for patients.

Super interesting. James and I assume that you guys are making these updates to the HSA listeners if you have any comments about what we're talking about here. Please drop a line at Outcomes Rockets on Twitter and let us know what you think about this HSA update and I'll start a string out there with James so that we could get a conversation going on Twitter that will be a fun thing to get going. So that's pretty cool. And in a lot of times we don't realize everybody that James and people like him are working hard behind the scenes to modernize these tools that we use everyday. So James a big thank you from all of us my friend.

Hey we're thrilled to do it.

Now you're working on this bill. That's super exciting no doubt that it will bring some outcomes improvements. Can you share with the listeners a time when you had a setback and what you learned from that and what is it that you do differently now because of it?

Yes so I think probably a good example of that would be a number of employer groups were supportive of a piece of legislation that moved through the house that was called the American Health Care Act and Republicans were selling it as repealing and replacing the Affordable Care Act. There were a lot of very controversial parts of that legislation but for employers there were too many things that were positive to ignore. For instance, the bill would have eliminated all of the taxes that were in the Affordable Care Act and for employers. One particular tax in the Affordable Care Act the so-called Cadillac excise tax on high cost insurance. We see that as an existential threat to employer sponsored health insurance. So anything that would get rid of the Cadillac tax for us is priority número uno, not to mention that the bill also contains some improvements to health savings accounts that we were supportive of to. But so you know we got into the mix on this thing and we were trying to be supportive and say that look you know there's probably a lot more conversation that needs to happen on some of the other parts of the bill such as how to reform the Medicaid program or how to ensure that people in the individual market are able to obtain coverage. But for us we want to move forward. We don't want to just do nothing. And what ended up happening was over the course of that debate the bill became worse and worse and worse. So the first thing that happened was folks on the far right who are very concerned about abortion and they want to make sure that public funds could not be spent on abortion. They cost the elimination of one of the most important pieces of the bill which was that if you're in the market, you would get a certain amount of premium credit that you could use and if you chose a plan that was cheaper than the amount of credit that you had the excess funds would roll-in over into an HSA. And this creates an incentive for people to choose only so much health insurance as they need right because if they choose less than they they get more money into their HSA. Well,they stripped that provision out. And what happened then was if that bill had become law individuals would have had every incentive to pick the most expensive health insurance that was covered by their premium which is the exact opposite of what the planners were trying to do. But they still move forward because of politics etc.. There were other things that happened throughout the course of that debate that I'm sure many of your listeners remember that the bill is just got more messed up and it over time and by the end of it many of us who had endorsed the bill were just pretty much saying math. But I think we did learn some lessons from it at least right? Which is first and foremost that abortion politics can ruin everything no matter. And having worked on Capitol Hill I can tell you they pop up all the time on issues that you would never imagine had anything to do with abortion. And my member companies we don't have positions on abortion. That's not something that an employer gets involved in.

All right.

But it doesn't matter because it can still derail the things that you want to work on. But I think more importantly I think a lesson learned from that whole experience about trying to fundamentally redesign the Affordable Care Act was that you got to go in it with more of a consensus. The ACA was passed with only one party and then this repeal and replace attempt was also only one party. And it's just going to be really hard to ever fix the system adequately to where we want it to be unless we get some consensus across the aisle. I think that employers at this point are pretty much tired of the HE SAID, SHE SAID back and forth between the two political parties.

That's a great message James and I think you guys are setting up a good example at ERISA to really kind of do this especially by putting together a group of both Democrat and Republican constituents to make these renovations to the HSA. So great call, out great lesson. Thank you for sharing that.

Yeah. We've got the scars to remind us but you know a going forward we can do better.

I lot it man. Well hey, you know the scars are stories and definitely won't be forgotten. It makes you better. And speaking of better, can you give us a little bit of a glimpse into one of the proudest experiences you've had to date in health care?

You know it I'm going to go back to my previous job. I've mentioned that I worked for a patient advocacy group called the March of Dimes Foundation. And we had a piece of legislation that was aimed at helping babies who were affected by the opioid crisis. So I don't know if you've ever heard of this. It's a condition called neonatal abstinence syndrome.

Hah, never heard of it.

Well what it is is when when a parent is using or abusing opioids during a pregnancy, a baby can actually be born addicted to opioids. And that baby will be in essentially heroin withdrawal and up until recently this was not well established. What are the best practices for caring for these babies. What should be done. How do we ensure that that information is disseminated etc. And so we got together with several other groups including the pediatricians the OBGYNs and a specialist OBGYNs to and we put together this legislation and it was a time of divided government. Barack Obama was the president but the Republicans were in control of the House and Senate. And I'm really proud to say that we managed to pass that legislation and President signed it into law. And right now as we speak there is a task force that is helping to produce and disseminate that information to ensure that those babies who are affected by opioids get the best possible care, and that best practices are used. And I'm really really proud that that was a victory that right now it's making a difference in people's lives.

That's a huge victory. James and one that I didn't know you did. I mean you just get cooler by the minute man.

I appreciate that. Thank you.

I think that is wonderful in an area that is so hard for us right now. Opioids and you've got these innocent kids that are going through it. What a tremendous effort that you and your team did there at the March of Dimes something that is finally you could go to your deathbed thinking wow I left something great behind. So kudos to you my friend.

People want to look it up it's called Protecting our Infants Act. passing the public law.

Awesome awesome. So we're going to go ahead protecting say that again James.

It's called Protecting our Infants Act P O I A, for short.

Awesome and we'll go ahead and link that up for you guys and gals on the show notes so don't worry about writing it down if you're driving or going for a run. We're going to leave that in a show notes for you. James, I know you told us that the HSA is one of the projects you're working on right now. Is there something else you want to share with us or do you want to drill down a little bit more on that exciting project and tell us more about that.

Well let me tell you a little bit about wellness programs as well. It's all the rage to for employers to implement a robust wellness programs that incentivize people to be healthy. And these things tend to grow right like it will start with maybe in year one. All you have to do is fill out a survey, a health risk assessment and you do that and you get some sort of benefit from doing it. But over time these programs grow to the point where you could receive a very significant discount on your health insurance premium costs if you meet certain metrics. You get a physical and you quit smoking etc, etc, etc. This is super super important because again what in modern era thinking what we've realized is that the key to controlling cost is not just interventions with the 20 percent of your employee population that are sick. What's really really important is keeping that other 80 percent on the healthy side.

Totally.

In keeping your healthy people healthy. It's super important so we want to enhance the ability of employers to offer these programs and employees tend to really like the discounts that they get on the premiums, too. But we were running into some pretty serious problems.

Really.

What happened was one of the bipartisan provisions that was contained in the Affordable Care Act had to do with wellness and what it said was it said that prior to the Affordable Care Act you could get as much as a 20 percent discount on health insurance pursuant to participation in a wellness program. And what the ACA did is they said we're going to boost that 20 percent immediately up to 30 percent. And at the discretion of the administration, they could possibly go up to 50%. That's all fine and good. Again we're very supportive of those provisions and that they were written at a time when ACA was actually bipartisan bill. What happened was the Departments of Health and Human Services, Department of Labor and Department of the Treasury put out a regulation that explained well here's how this works for employers. Here's what you have to do to follow the law to make sure that you're in compliance and so like employers always do, we came into compliance. We designed our programs in a way that met the requirements of that regulation. But then income's a different federal agency called Equal Employment Opportunity Commission an EEOC. They weren't sure exactly what it was about these wellness programs they didn't like but they didn't like them and they felt that changing the cost of someone's health insurance by such a significant amount amounted to compulsion. Right. They said that 30% is so much money that people don't really have a choice. And as such they started suing employers serious saying hey we don't like we don't like your wellness program because you're bullying people because 30 percent is too much? And you know the employers are saying "Well, what you want us to do, that's what it says in the law. So EEOC actually then put out their own regulation which says a completely different rule for how the wellness programs have to work. The differences are so fundamental that even their methodology of how to calculate what is 30 percent is completely different.

Oh my gosh that's so backwards.

So we had high hopes that because there was going to be a new administration in Washington. There will be new commissioners on the eve. And that those new commissioners would say you know what we're going to walk this back. This is not having the intended effect and what we what we want to do is we want to enable those wellness programs to work as long as they're fair. But you may not have have heard about this. There are vacancies on the EEOC that remain unfilled and they remain unfilled not because the Democrats are refusing to support the nominees but rather because a small group of Republicans are opposing the nominees.

Really.

This is where it gets really interesting which is the way that independent commissions tend to work is they will have a balance that is reflective of the administration, meaning that under President Barack Obama EEOC, would be three to two Democrats to Republicans or left leaning to right leaning. Whereas under a President Trump it should be three to two Republicans two Democrats or right leaning to left leaning. ,there are four Republican senators who've decided that they don't like the nominee that the Democrats chose.

Oh my gosh.

So there seems since the three have to move through as a package, the Republicans are actually obstructing all three over their resistance to the choice that the Democrats have made.

Because of one person that they don't like.

Well not to mention they're not supposed to like them all right? Your party is your party only supposed to like about half and well, it's like this is tradition. And what's going to happen is you know I don't know what's going to happen in November, but I can make one guaranteed and that is that some day the Republicans will be in the minority in the Senate. Right. Maybe not next year but some day. And when that happens they're going to get their picks still. And the Democrats who are in the majority then will hopefully say well this is tradition. They could choose a couple. But there are in the minority are the ones that are going to control the commissions and boards. So needless to say no action has been taken. And so we are in limbo trying to figure out how to comply with the wellness rules.

That is sad super childish and you just look at stuff like that and just shake your head in. And so it's unfortunate and sort of you know as as employers you left with just a lack of clarity on how to pursue these pretty amazing programs, what are your thoughts on on what the future holds here and in the short versus long term on these programs.

Well you know I think that wellness programs are only going to continue to grow because it's too important. And this actually this country is looking more and more for a culture of health. And employers want to have a part in that. So it's going to be incumbent upon groups like mine to clear the way and to get those nominees through. And I think that while we have our work cut out for us, we're gonna make progress. And before the end of the year we will have at least peeled off two or three of the four senators who are who are standing in the way and hopefully all four, such that we can move through a bipartisan package staff up the EEOC and allow them to actually get back to work and stop missing out on all these opportunities that they're missing out on because the agency lacks a quorum.

James we're rooting for you my friend and for everything that organization does so stay strong stay strong.

Thank you.

This has been a lot of fun and we're getting close to the end here. Wish we had more time but that's definitely a part too. Before we conclude you and I are going to build a medical leadership course through a lightning round. It's the 101 of James Gilfend on the amazing at health care leadership policy. So I've got four questions for you. Lightning round style followed by a favorite book that you recommend to the listeners, you ready?

Go for it.

Awesome. Right here we go. What's the best way to improve health care outcomes through policy?

We have to focus on value accountability and coordination.

What's the biggest mistake or pitfall to avoid?

The health care industry is so big and there are so many entrenched interests that you have got to find a way to find disruptors.

How do you stay relevant despite all the change?

Well I think you've got to evolve with the times and you've got to take on today's problems and not yesterday's.

And year project with the HSA is just that. And what's one area of focus that drives everything else in healthcare.

For us it's maintaining that employer sponsored coverage for the 178 million people. There's 178 million people in employer system. About 100 million in the government sponsored system and then a much much smaller group that in that individual market, why do we spend so much time focused on that much much smaller group?

Great point. Love your feedback here James. What book would you recommend to the listeners on the syllabus?

Does it have to be healthcare related book?

It doesn't have to be, it could be something to get the mind off health care to be more productive later.

I would say if it's a health care book I would recommend Wheat belly which caused me to change my entire diet and think more about how food interplays with health. But if it's not health care and give you an oldie but goodie a classic Frank Herbert's Dune which is an invaluable piece of sci fi because it also helps you understand how people think and why they make decisions that they make.

Amazing some great recommendations there James. Listeners, don't worry about writing any of these down. Just go to outcomesrocket.health/erisa ,that's the place where James right now, E R I S A, and you're going to be able to find all of the show notes transcript links to the book books that he recommended and his organization as well as the resources that we mentioned here at outcomesrocket.health/erisa. James, this is been awesome. I've really just have had a blast that time flew. Before we conclude I'd love if you could just share a closing thought and then the best place for the listeners that follow you or get in touch with you.

Sure. So you know I think closing thought would be that when we're talking about healthcare there are billions and trillions of dollars at stake. And as such we have to be so, so skeptical and we have to be so careful about understanding what are the motives. Who is funding who and who is behind this and why. And unless and until we make those judgments, it's really hard to agree to policy changes and to move forward. Best place to connect with me. Check out our organization's website which is www.eric.org. That's E R I C dot org and you can find information on how to contact us and everything and we're always interested in learning and finding people to team up with and working on projects and finding ways to make the system better.

Outstanding games folks go to that website that's www.eric.org and find ways to collaborate because the folks over there, James and his team are doing some outstanding things for our health care system. So James just want to say thank you again for spending time with us and we're excited to get you back on the show next time.

Awesome thanks so much for having me.

Thanks for tuning in to the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don't forget to check out the amazing healthcare Thinkathon where we can get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is "implementation is innovation". Just go to outcomesrocket.health/conference that's outcomesrocket.health/conference. Be one of the 200 that will participate. Looking forward to seeing you there.

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Recommended Book and Podcast:

Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back to Health

Frank Herbert's Dune

Best Way to Contact James:

LinkedIn:  James Gelfand

Website:  www.eric.org

Mentioned Link/s:

Protecting our Infants Act

Episode Sponsor: