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How to Get High Quality, Affordable Health Coverage with George Kalogeropoulos, CEO at HealthSherpa

Episode 125

Outcomes Rocket - George Kalogeropoulos

How to Get High Quality, Affordable Health Coverage with George Kalogeropoulos, CEO at HealthSherpa

: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes, and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez

Saul Marquez: [00:00:18] Welcome back to the outcomes rocket podcast or we chat with today’s most successful and inspiring healthcare leaders. I really want to thank you for tuning in again. Really appreciate it. And I invite you to go to outcomesrocket.health/reviews where you could rate and review today’s episode because we have an out standing guest. His name is George Kalogeropoulos. He is the CEO at HealthSherpa. Their mission driven company focused on helping people get high quality affordable health coverage. HealthSherpa has enrolled over one point one million Americans into health coverage and is used by major employers insurance companies and over 23000 agents and brokers. They’re backed by core innovation Capitol Kapoor Capitol and Y Combinator and their leader here is just an outstanding individual and just the most one of the most analytical minds in the business. He’s got several other experiences that include President of other analytic companies in the space. But he landed in health care because he saw it as a place where he could contribute big time. And so what I want to do is open up the microphone to George to fill in the gaps of the introduction and we could get started with the podcast. George welcome.

George Kalogeropoulos: [00:01:34] Saul thanks so much for having me. Really appreciate your giving HealthSherpa for the chance to sort of explain who we are and what we do to your listeners. And I think you actually really covered sort of our background pretty well in your introduction really the way that I think folks should think about us is that we build the last mile of access between the programs that the Affordable Care Act put into place by law and the actual populations communities corporations stakeholders that need to access those programs. So if you’re a large corporation and you have part time employees and you want to help them sign up for affordable health coverage we build the tools and technologies of what you do that if you’re an insurance agent and you want to operate in this market we build the tools to access that and get in there and actually enroll people in your clients in those policies. So really the way I think about us is that plumbing almost if you will for the Affordable Care Act that last mile that lets people actually access the benefits of the law.

Saul Marquez: [00:02:31] That’s beautifully stated George and we had a discussion prior to the podcast everybody and you know we were just talking about yeah you know a lot of the things that happen in health care happened within the four walls of the hospital and so much of that neglects a large portion of the population in this country. And George and his team are very focused very mission driven to getting people the health care that they deserve. So George what you know with your diverse set of experiences what is it that got you into health care.

George Kalogeropoulos: [00:03:02] So I like to say that we didn’t find health care. Health care found us. So we had built a series of entrepreneurial projects startups if you will that were focused on giving people better access to important information that they needed to make choices and decisions for themselves and for their families. So in an earlier iteration actually this company we’ve looked at a hospital and procedure pricing and costs and looked at ways to make that more transparent. And as we were looking at that problem we observed that the way that most people access health care at least in the United States is through some sort of health insurance whether it’s a government sponsored program like Medicaid or whether it’s individual health insurance employer based coverage. And so looking at that landscape we said where is there the most sort of confusion uncertainty a lack of clarity in terms of what people’s options are and how to actually exercise those options. And what we found was this was right when the Affordable Care Act had first sort of taken effect in early 2014 and there were these brand new marketplaces with tremendous potential tremendous amounts of thinking and policy and detailed organization that went into structuring these these marketplaces and then a whole lot of confusion with consumers not really knowing what was available to them and how to access it. And other stakeholders those large corporations we talked about those insurance brokers as being very confused about what their options actually were. And so we said let’s go in here and sort of build the missing layer of it connects on the one hand all these people who are looking to use this law. And on the other what the law actually provides for. So we were sort of looking for ways to help clarify the sort of the the access to health care question and when we were doing this you know it was right when they long shall get up and it’s sort of much publicized issues that sort of came with that launch. We really focused on coming in and trying to address some of those.

Saul Marquez: [00:04:55] Very very interesting and so the opportunity sort of came to you guys by just this implementation right and you know when we think of implementation in healthcare I had a guest previously from Providence Medical Center talk about innovation is actually implementation. And so what George and his team focused on is implementing the law implementing a way for that last mile for the consumer to actually be able to access it and so fast forward to today. George from those days when you guys were just getting this started. How far has it come. What has been your experience.

George Kalogeropoulos: [00:05:31] So it’s been a while I held a wild ride to say the least. I’m sure as people who’ve been following the evolution of the health care policy debate in this country know it’s been there’s been a lot of ups and downs but if you look at the sort of net outcome of that there’s been also tremendous opportunity. I mean four years ago we hadn’t enrolled a single person. Today we’ve rolled actually over one point one million. And it looks like based on the latest figures we’re actually the largest private channel into the federal marketplace and the whole halakha. And that’s the work that are the most 23000 age and brokers those insurance companies of corporations using us. That’s sort of a concerted effort. We’re definitely the pipes that they’re using but there’s been a ton of work behind the scenes by all the stakeholders to really take their populations their eligible employees their customers and plug them into these new sets of benefits because really I think a lot of people who have insurance through their jobs. You know a lot of your listeners perhaps don’t quite understand what a monumental change the Affordable Care Act was for the individual health insurance market. So this is everyone who doesn’t get insurance through their job whether they’re self-employed whether they’re eligible for government program or otherwise responsible for purchasing own insurance their world completely changed in 2014. And there really wasn’t a clear way to help those people access their new option. So it’s been a wild ride and sent a lot of that has been since moved out. There was definitely some uncertainty after the election with the new administration. But what we found is that by and large since then there’s actually been a fairly positive effort by the Administration to streamline and make the programs that are in place work effectively. So what we’ve seen there is just this evolution. I like to say that we’re we’re five years into a 30 year sort of process of transforming how people access care in this country and so it’s still very early and there are still a ton of uncertainty. But structurally when you think about the Affordable Care Act it is very similar in a sense to the Social Security Act in the 1930s or the Medicare in the 1960s which is that it’s a fundamental redefinition of the social contract how people relate to their government. In this case the tenant that the Affordable Care Act brought into play was that people have a right to affordable healthcare and so we’re going to make that possible through this law. So just like you know Social Security and Medicare when it first came out they were viewed as sort of highly politicised potentially contentious programs. You fast forward to today. It’s extremely popular. Obviously there are fundamental sort of pillars of our society. Similarly we think that this concept of access to health care whether it’s called the Affordable Care Act whether it’s called Obamacare or whether it’s called whatever variant Congress wants to pass next it’s all about iterating towards a better state for patients and better access to care.

Saul Marquez: [00:08:18] George that was such so beautifully crafted the way that you just explain that and listeners talk about a succinct way of putting what it was it’s rewriting the fabric of what healthcare means just like we did with the previous iterations of of our system and so George you’re passionate you’re well informed you’re committed in this 30 year journey. What do you think leaders today need to be thinking about as it relates to access and what could they do to help move the ship toward the right direction.

George Kalogeropoulos: [00:08:50] So health care is such a complex organism and there’s so much to be done across both cost access quality that there are a lot of us working I think towards the same fundamental goals which is the provision of high quality low cost health care that is accessible to everyone. But then I think people should be thinking about it particularly leaders in this space should be thinking about as I like to think that we are how to best coordinate our efforts because access and cost are fundamentally linked. So you want to think about that problem in a holistic sense and address it in a holistic sense because on the one hand you know we talk about as a very sort of that’s a very abstract statement so more literal way to think about that is this if we look at the Affordable Care Act and we would sort of remove some of these provisions that give people coverage and then as an example now we’ve seen the individual mandate is actually no longer in effect because of the recently passed tax legislation. The people who don’t get coverage and experienced medical events our health care system will still pay for their treatment right. We’re still going to pay for them because they’re going to go to emergency rooms and under and they’re required to be treated so we’ll incur the cost of that treatment but it will be paid for at Iyar rates rather than at primary care physician rates or specialist at rates that some of the most expensive care you can provide to people and that care will be baked into the cost that all of us pay either through our taxes or through our health insurance premiums or for that treatment. So I would urge the the biggest thing is to think holistically what the problems are facing. It’s easy to get siloed when you’re working on any one aspect of the problem. But the aggregate it’s a sort of multiheaded beast but one that is very tightly linked and so when you’re working on one piece it’s important to think about the impact that your actions and legislation and policy decisions will have on those other pieces.

Saul Marquez: [00:10:38] That’s great. Great words of wisdom. So let’s keep the eye on that big picture. It’s not exactly taken a look at point of care but taking a look at what is happening on a broad perspective. And so George as you and your team start to create different ways to access health care what’s a setback or just thing our failure that has happened that you guys learn a lot from.

George Kalogeropoulos: [00:11:03] So I would say some of this is somewhat idiosyncratic to our business. But there was definitely there were definitely missteps around how we understood the role of regulators and government in our business. So initially coming sort of from the technology and startup world we I think underestimated the importance of working closely with federal government stakeholders and ensuring that they are you know aligned with and understand what we’re doing and how it relates to their objectives. And we’ve gotten a lot better about that. And that’s been quite the journey. So we’ve gone from getting angry letters from federal agencies instructing us ordering us to do things to a consultative relationship where we share sort of our objectives and understand their objectives and see where those align and then coordinate and what we do in a way that ultimately for the end consumer is very valuable impact particularly the transformation I’d say in how the private sector interacts with the Department of Health and Human Services and the Centers for Medicare and Medicaid studies. Those are the folks who actually run health care not us. It’s been phenomenal to watch. Again it’s gone from sort of a very prescriptive regulatory letter type approach to a consultative we are the government we make the rules. But here’s what the objective is here is what the how you can help and where your business could fit into that. And it’s been a very interesting transformation to be a part of for sure.

Saul Marquez: [00:12:26] Wow that’s really interesting. And so now it’s part of your focus probably to to make sure that you keep an open mind to them and that there’s a good communication flow between your organization and those parts of the government right.

George Kalogeropoulos: [00:12:39] Absolutely and we have very structured very regular communication with the appropriate folks and what we find is you know it’s interesting because it’s almost like the is it the Goldilocks approach. The soup is too hot or too cold where if you don’t have enough if you have too much regulation it effectively stifles private sector innovation and prevents things from being done cheaper faster better. Conversely if you have too little regulation you permit a race to the bottom which is where there are certain hacks or shortcuts or misbehaviors that can yield a lot of revenue in the absence of regulation. So the problem is that once one company starts doing those if they’re not stopped everyone else has to go down that path as well or go out of business and so there’s a very specific role for government particularly when we’re talking about people’s access to healthcare where they can step in and ensure that the right incentives exist for the private sector that there is a level playing field and that innovation is being promoted but not at the expense of the consumer always to the consumers benefit.

Saul Marquez: [00:13:42] Love that. Well 30 years from now what is a Solich like George.

George Kalogeropoulos: [00:13:48] So let’s go back to our analogies a bit to sort of explore because that’s a very complicated question. So in the late 50s to the early 60s before Medicare 50 percent of seniors had health insurance which means that 50 percent of seniors did not have health insurance. They had no regular structured access to health care. To put it sort of bluntly you literally had old people dying in the streets for lack of access to care. Fast forward to today. Ninety 95 percent of seniors have access to healthcare. And the difference is Medicare. Now when Medicare first passed it was actually viewed as socialism as communism in disguise and actually a young actor. I think the Amay paid a young actor named Ronald Reagan to record a 10 minute speech about the evils of socialized medicine and it was specific to this proposed Medicare legislation. And then you fast forward to the mid 80s and that young actor turned into of course the legend or President Reagan. He actually signed the biggest expansion of Medicare into law. And his present under his presidency. So that’s the sort of evolution you see when a good when a solid foundation for improving as we say the social contract the access that people have to benefits through their relationship with our government it plays out. So in 30 years we could be in a number of scenarios. One is there is a strong and growing sort of tide in favor of a single payer system in the U.S.. The point you know an interesting trick question is do you know what the largest single payer system of the world is.

Saul Marquez: [00:15:18] The government.

George Kalogeropoulos: [00:15:19] Well so which country has the largest single government when you think about.

Saul Marquez: [00:15:23] That’s a good question. I would say perhaps but in the U.S.

George Kalogeropoulos: [00:15:29] You’re correct actually. Most people think it’s Canada or the U.K. with a national health service but actually Medicare is the largest in terms of dollar spent. Medicare is the largest single payer system in the world. So the U.S. already has the largest single payer system in the world. And generally speaking it’s actually fairly effective when you look at the overhead for the Medicare program. It’s a small fraction of what it is for private insurance or for other programs. So when you look 30 years in the future we could depending on how where the political will rest and what solutions Congress comes to you would either see some form of single payer or some variant of what we see today which is an independent market where in which there’s a lot of private sector initiative but at the same time a lot of guardrails put in place via regulatory means in order to ensure that you know the system works to the benefit of the ultimate sort of person that matters which is that consumer who’s who is actually means access health care because as with health care the reason everything costs so much. But the reason why it’s so important is because we’re literally talking about people’s access to treatment. It’s treatment that improves our lives. It’s treatment could potentially be lifesaving so you don’t want to mess that up. So I think what we see 30 years from now is either we just throw our hands up and say Look Medicare for all is the right path. And you’ll see a system in which you’ve got sort of a certain benefits that are provided by the government via Medicare type structure and then supplemental insurance that gives people either access to additional doctors or manage some of their copays or give them access to perhaps not covered services. That’s one model and the other model is very much along lines of the Affordable Care Act currently which is more of a compromise not quite false you know not not for single payer but heavily regulated private insurance where there are a lot of controls in place. There’s a small possibility of sort of the what we might call the wild west scenario which is unregulated or loosely regulated at the state level. But we’ve sort of seen you know the reason that health reform was a national priority from the early 90s through today was because that system wasn’t working. You had way too many people falling through the cracks either because they were being excluded for their preexisting conditions or their treatment they were uninsurable or their concerns didn’t cover the things they needed to cover. And again going back to our earlier statement collectively we were all still paying for those people were paying through our taxes were paying for health premiums. So I think collectively we arrive at a solution that better manages the enormous cost of health care whether it’s single payer or whether it’s an extension of the Affordable Care Act. I could see either scenario playing out. But like I said we’re five years into a 30 year old very. The ultimate goal and I know I’ve been on this subject for a while but it’s important the ultimate goal is that access to health care should not. When you look at the health Kadak of rollout when you look at what US and other people like us have been doing to try and get people signed up over the last three or four years it boils down to heroics and access to health care should not come down to heroics. It should be an ordinary function where we have the infrastructure in place where we provide this access to people people understand their benefits they know where to go to get them and they know what what’s covered and what isn’t covered and it sort of just works much in the way that say filing your taxes works for much in the way that say getting your Social Security check works. That’s where we want to be not in this sort of weird world that we’re in today in this transitional period where people are so much uncertainty and there’s so much confusion. And at the same time and that leads to negative outcomes both for and most importantly for the patient for the consumer who does or doesn’t understand their treatment options and does or doesn’t pursue treatment accordingly. But then also for the taxpayer who ends up paying for those mistakes and all those mistakes occur long before somebody even sets foot in. To your point in the four walls.

Saul Marquez: [00:19:13] George, a great synopsis there friends you have now been taken to 2048 and are going to be taking the time machine back to your present day. It’s so hard. Thanks for watching us through those scenarios. It’s good to have big picture. And George you do a really great job of zooming in and being able to think strategically in such a way that helps you start thinking about what actions are you taking today that are going to help you build a brighter future for your organization and all the people that are accessing health care. What would you say today is an exciting project that you work in.

George Kalogeropoulos: [00:19:49] Well, where to be given where word so the current top priority is so to my earlier point about working more closely with the regulators in our space. There has been a clear and concerted effort and initiative by the Department of Health and Human Services to permit the private sector to provide basically all of the services that healthcare not gov provides. And so if you think about how you’ve got the IRS has the file system and you can totally file taxes online using file but everyone uses Turbo Tax or engine or Blocher credit card or some other service they’re iterating towards a model like that where you have a common set of federal services which are required in order to do things like determine someone’s eligibility for any subsidies or Catia reductions that the law provides. And then you have private sector entities such as ourselves building that all the rest of the infrastructure all the rest of the branches of the tree that allow us to reach everyone who needs access right. And so to my earlier example what this means is you’re seeing iteration you’re seeing the API being made available by the federal government so that people can plug directly into the federal data hub. You’re seeing detailed sort of security programs being put into place to ensure that everyone’s data is protected and accessible in a way that is reason to opt out and all of that makes it possible. It’s a lot of plumbing work. It’s a lot of infrastructure work but at the end of the day what it gets you is a world in which you are a part timer at any one of the sort of call it retail or food service companies that make up so much of the employment in the U.S. today. You start your job. You go to sign up on their Web site and they say OK what’s your bank information so that we can pay you your hourly wages and then go sign up for health insurance and we know all of these things about you already because we employ you. So just click a couple of buttons and you’ll get low or no cost health insurance because under the law that’s what you’re entitled. So it’s that sort of plumbing that we’re building today and none of it is sexy but it’s all very exciting because of what it makes possible and what it means in terms of who’s going to get coverage and how they can access our coverage.

Saul Marquez: [00:21:52] Yeah that’s for sure and you got to have vision in order to be on a project like this. You’ve got to have a clear understanding of what it is that you’re going to and so I offer this to the listeners that you take a little note of inspiration and an example of what George is doing here is that as a leader you’ve got to have clarity in your vision because if you don’t then it just gets really hard to stay with it. And like George said it’s a very tedious role to have to be doing this but at the end when you have the future that so clear that George does and it becomes just invigorating and so George really appreciate you sharing that with us.

George Kalogeropoulos: [00:22:31] Absolutely. My pleasure.

Saul Marquez: [00:22:32] George we’re getting close to the end here. We’ve got the lightning round. You and I are going to build together a course on what it takes to be successful in health care access. It’s the one on or the ABCs of George. I got four questions for you lightning round style and then we’re going to finish with the book. You ready. Sounds good. Awesome. What’s the best way to improve health care access.

George Kalogeropoulos: [00:22:55] Clear rules and regulations uniformly enforced.

Saul Marquez: [00:23:00] What’s the biggest mistake or pitfall to avoid.

George Kalogeropoulos: [00:23:03] It’s the converse which is confusing people or giving them conflicting views of what is and isn’t currently possible or legal.

Saul Marquez: [00:23:10] How do you stay relevant as an organization. Despite constant change.

George Kalogeropoulos: [00:23:14] Stay close to your customers and ensure that you’re always making every decision with them first in mind in terms of what they need.

Saul Marquez: [00:23:21] What is one area of focus that should drive everything else in healthcare.

George Kalogeropoulos: [00:23:25] It’s the same the same answer the previous question for you. It’s the patient it’s the consumer it’s what’s right for the customer and what gets them the access to the care that they need right. Everything is has to be determined by that. Otherwise you’re you’re in the wrong business if you’re doing health care and not pursuing that yet.

Saul Marquez: [00:23:41] What’s the book that you recommend to listeners George.

George Kalogeropoulos: [00:23:44] So this is a little esoteric but I believe John McDonnell who wrote a book called health care reform. He was one of Senator Kennedy’s aides who helped draft the Affordable Care Act and in it he goes through all of the deliberations and all of the stakeholder conversations that resulted in the law that we see today. And when you understand quote unquote how the sausage is made a lot of the things that are in the law and how they work make a lot more sense.

Saul Marquez: [00:24:10] Love it. What a great recommendation. And so Outcomes Rocket listeners you can find all of this information including links to the book, George’s company. All of the show notes if you go to outcomesrocket.health/George G E O R G E. Now George this has been so much fun. What I’d like to do is just have you share your closing thoughts with the listeners and then the best place where they could get in touch with you or follow you.

George Kalogeropoulos: [00:24:37] Well just mostly wanted to thank all of listeners for taking a little trip down the sort of minutiae of healthcare access and say that the important thing to remember when you look at the complex and ever evolving landscape of healthcare and health care reform is to think about to solve the earlier point what the outcome that we actually want is where we want to be as a country in terms of how we offer people care and how we pay for it and then think about all the steps that need to happen between now and then and focus on delivering those and those outcomes that’s what’s worked for us and that’s how we operate. And I would invite you to your listeners to also think about how that applies to your own efforts whether it’s how you access health care or how you interact with your elected representatives and so on and so forth. So the best way to follow what we’re up to is to just follow her Twitter handle its health Sherpa’s that’s @healthsherpas us and that’s where we regularly post updates on what we’re working on as well as you conduct direct messages and get in touch with us that way.

Saul Marquez: [00:25:40] Outstanding George hey this has been a pleasure. Thank you so much for your time and your insights. I know that they’re going to resonate big time. So looking forward to catching up with you again and seeing how you guys unravel what’s next.

: [00:25:56] Thanks for listening to the outcomes Rockett podcast. Be sure to visit us on the web at www.outcomesrocket.health for the show notes, resources, inspiration and so much more.

Recommended Book/s:

Inside National Health Reform

The Best Way To Contact George:

@healthsherpas

Mentioned Link/s:

https://www.healthsherpa.com/

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Outcomes Rocket - George Kalogeropoulos