Lee Lewis, Chief Strategy Officer & GM Medical Solutions at Health Transformation Alliance

How Employers are Transforming Healthcare with Lee Lewis, Chief Strategy Officer & GM Medical Solutions at Health Transformation Alliance transcript powered by Sonix—easily convert your audio to text with Sonix.

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Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez is here and today I have the privilege of hosting Lee Lewis. He serves as Chief Strategy Officer and General Manager for Medical Solutions for the Health Transformation Alliance. He leads efforts across over 50 large and jumbo employers and six million employees to save lives and save millions of dollars through improved health delivery outcomes and experience. He’s advised health care strategy at Fortune 10. Employers, insurance companies, administrators, medical associations and the Departments of Justice and Labor incubated and helped form two dozen health benefits startup companies and has been quoted and featured in Bloomberg and The Wall Street Journal. Lewis is a founding charter member of the Health Rossetta Organization, which seeks to open source employer health benefits strategy for the public good, and is credited as co-founder of the Health Value Exchange, a free online contributor database with over a thousand health benefit vendors democratizing industry access to greater care solutions. Before joining HTA Lewis was a consultant at Gallagher, where he founded Gallagher’s innovation lab and national jumbo employer Practice. Just an extraordinary individual all around, and I’m privileged to have them here to discuss the role of employers in health care, but also how to best get value out of our health care dollar in a time when it’s never been more important. So, Lee, such a great pleasure to have you here today. Thanks so much for joining us.

Lee Lewis:
Hey, my pleasure. Thanks for having me.

Saul Marquez:
Yes, sir. So before we dive into the great work that you do at HTA, tell me a little bit about what inspires your work in health care, for me, it’s really a sense, almost a sense of injustice and a desire to make a difference.I have that, like millennial defect where I’m always wanting to try and make the world a better place, right. I’m sort of silly enough to believe that we can accomplish some of it. And that kind of sticks with me is that I really do want to leave a legacy and help to make things better. My personal connection to it, I guess, of ways that I’ve experienced health care in my life. When my grandfather died, he had some 19 pills he was taking every day, and one of them was a blood thinner and another one was a blood thickener. And it’s like, health care’s just so complicated, so challenging. How do we change things and make it better?

Saul Marquez:
And I appreciate that. And it’s a challenge. And stories like your grandfather’s and my grandfather went through some stuff, too. We all have a story and there is a lot of discontent and a lot of the discontent is really not just on the individual level, but also at the large employer level. We’re dependent on health care being paid for by our employers or the government. And really, it leaves a lot of the hits in health care that they get absorbed by employers. So that being your main stakeholder over there, what would you say that you guys are doing at the VA to help the health care ecosystem for employers?

Lee Lewis:
Yeah, our mission is pretty broad right.. It’s transforming American health care, which means creating better health outcomes for everybody, more equal health outcomes for everybody, no matter who you are, as well as compelling savings for the employers and the people on their health plans. Shorthand is we’re trying to save lives and save millions, even billions of dollars that ideally can revert back to the middle class and the working class to be able to make access to health care possible again. So ways that we’re doing this are many. We’re working to analyze claims every day to find the fake claims or fully fictitious, fraudulent claims that might be occurring inside of our claims feeds. They’re coded in such a way to beat the carrier system or to sort of beat the claims administration system. We are looking and finding doctors and hospitals and locations that are delivering much better quality at a reasonable or low price. But we’re also looking at the appropriateness of care. There are surgeons in the country today who have very reasonable prices, who do really high volume, who never have complications. But if you look at how aggressively they’re performing surgeries, there’s a lot of people that are getting surgery that don’t need it, right. And so we’re looking at that appropriateness and we’re looking at the invasiveness. We’re saying, are you using the best possible technology? Are you using cameras and little scopes and very, very small incisions to sort of enter the body, to perform a procedure that does not require opening up the chest cavity right and exposing that patient to a lot more trauma, all of that to get a better deal and better outcomes.

Saul Marquez:
And it’s critical. And having that balance between somebody that has those outcomes, which usually comes with volume and then showing that they don’t over operate, it’s just the balance, right? It’s hard. It’s a hard balance to strike. And so curious what makes a different and better than what’s available. And more importantly, what are some of those core offerings that you guys give to these large employers?

Lee Lewis:
Yeah. So I guess some of your listeners might be thinking, look, if you’re a large employer, you’re a hospital, you’re you’re already part of a business group on health. You’re already part of a an association or consortium. You may be thinking, well, what’s different about the Health Transformation Alliance? What makes us different are a few things. First is that we are a nonprofit co-op that is fully owned and exclusively owned by our employer member owners. So it’s not just an association that we collect sponsorship dollars in order to continue to provide education or webinars or something like that. But we are a fully owned organization that only serves our members. There’s no outside sponsors. We’re not taking fees or advertising fees or pay to participate kind of revenue from from different incumbent parts of the system just to have to be a part of things. But we are only reporting to our employers, our employers determine whether or not and how much that we get paid. We earn too much. We just give it back to our employers. It makes it so that it’s a very different organizational structure that allows us to do things with them and for them that have never been done before. For instance, we are working right now to set up the first ever high frequency data feeds where about a year ago we realized that like the first major challenge that every employer has is how do I get access to my data right. How do you get access to your data?

Lee Lewis:
How do we use it to better find quality and to better serve our patients, our employees? And we realized this was a huge challenge and the thought that came to our minds was we’re in 2020, 2019. What is it that we could do to get real time access to our data instead of with like a six week delay? And so we went to all of the data warehouses and said, hey, could we get data to real time on daily? And they said, no, you’re up in the night. There’s a ton of like manual scrubbing and manual interventions that have to go into the data. So we want it once a month. That is it. No more than once a month. And then we went to the carriers and said, hey, do you think you could send us data real time? And they all said, no, nobody’s ever asked for that. We send it once a month. And so we said to both parties, well, we want to do, if not real time. We want it daily. And they both said we were crazy. But now, nine months later, we have access to some software that just connects us to Amazon Web Services, that is enabling us to any employer to be able to receive a daily data feed. And we’ve gone to the carriers and are working with them to get those feeds built and established. We’re not all the way there yet, but probably by the end of twenty twenty we will have the major carriers sending us either daily or weekly data that’s come straight into a secure server that’s fully encrypted and protected, that is under the control of the employer whose data it is or whose data is shared.

Saul Marquez:
Well, firstly, that’s awesome, right? I mean, that you guys are able to say, actually, no, this is what we want. And there’s millions of lives that we’re talking about here. That’s so actually, yeah, this is what we want. The power of leverage, right? Right. Oh, OK. Monthly. We want a daily so huge call-out right. to the scale and the benefits of scale that you guys are able to provide. And the other thing that’s neat is the challenge that a lot of associations have is that they become a servant to the dollar. And when that money comes in, it becomes a conflict to the members. Sometimes you guys don’t have that right. So this is great stuff. I appreciate you highlighting those very important features of what membership looks like there. So let’s get back to the data. So what data are employers receiving and why is that meaningful?

Lee Lewis:
So first, we’re getting ultimately as close to a universal feed as possible. We kind of grade data by the sort of analytics grade data where you can use it to study. You know, is my incidence of diabetes increasing or decreasing right. as sort of understanding basics around clinical? And that’s generally the data that goes to a data warehouse. What we’re looking for is what I’d characterize as audit grade data, which includes everything that you would need for analytics, as well as additional information around transactions that would allow you to perform due diligence and the reason we do that is that every employer and we’re working with really large companies, right. really large employers, is that each employer has a need under their duty, their fiduciary duty to be aware of, aware of how their dollars are spent, right.. And so that is if there’s ever a question that comes up, if you read through the contracts, that they’re all very clear that, hey, employers need to be aware of and performing due diligence around their transactions. And unfortunately, it’s really hard to do that if you don’t have access to the transactions or of having access represents so much risk there. Like I don’t even want them. It’s like the nuclear launch codes, like you could offer them to me. But I don’t want that. Like, it’s just it’s too much risk, so I don’t want to have any of it all. And so you’re caught in between either taking on too much risk or just not having enough insight to be able to make good decisions because you just don’t have the data. right. And so with the higher level of data that does have some of the financial attributes all kind of protected under a data use agreement with the carrier.

Lee Lewis:
And we have the same agreements that generally that other employers will have, although because we’re large employers and we’re using the data to perform diligence, we generally get we get a lot of it and we’re able to look at it in ways that others generally are not or our employers are able to look at in ways that some are not. And that allows them to perform diligence around that data, in addition to the clinical analyses that that they’re able to perform as well, to be able to make sure that we’re doing what’s right for our employees.

Saul Marquez:
I love it. Yeah, you know, it’s certainly an important aspect of making those changes and assessing where you sit today, this data and on a daily basis. I mean, that is very current, you know, and I mean, you think you could get somewhere with the data one month at a time. Why did you guys want a daily?

Lee Lewis:
I thought there was.. Ok, so we’re here to transform right. like it’s in our name. Are we the Health Minor Modification Alliance or are we transforming? So the idea was, OK, well, what what is it that is that is big. And we knew that big is is sort of moving health care into the same expectations that we have in other fields. Examples right. If I were to buy a fleet of trucks, say, purchase one hundred trucks, each one costs seventy five thousand dollars or in that neighborhood I would have a whole committee that would just be focused on that for many months at a time, especially if I were doing it every year. You’d have you’d have teams of people that are just focused around that. Yet we might purchase one hundred back surgeries a year. The cost the same as those trucks on average. And and we can’t tell you where we want to go, what a good price is, what good quality is, what kind of user experience we’d like for our employees who are receiving that service that anything along those lines. And so we need to bring that same level of diligence into the way that we manage our it, our health care supply chain, our health care provider network that we that we would do in any other area of business. And so we’re getting data to enable good decision making. We’re getting data and we’ve been asking really around getting data daily, because the other thing we ran into is say we find a purchase that we don’t want to happen.

Lee Lewis:
I was doing an audit for a major airline and we did it once a year and we found some claims that had been overpaid. And that’s no problem. We sent those back to the carrier and the carrier said, yeah, we can get your money back, right. We’ll do some offsets on some of the other transactions that are going out this month and we can return that money. And so we followed up with them 90 days later and they had gotten back about 70 cents on the dollar for us, which was good. We thought that was OK. But then we said, well, what about the other 30 cents? Like, how is it that we could get that? And why is it that we weren’t able to recover everything? And the response was, well, eh, sometimes there it’s a really rare transaction and there’s just no way for us to get money back and then b-some of our contracts. Don’t allow for recovery after 90 days and we’re only looking at it once a year like holy smokes. Well, 90 days after the bill, it takes me six weeks to even have that data appear right on my kind of registry, let alone doing an audit. So even if I was doing an audit that began the day a claim was paid and we collected it, in the best case scenario, we’re still probably three to six months out from having any knowledge and being able to recover it. And it would be impossible at that point. So then it turned into, well, we need to go to another level. We need to be getting data daily to be able to make decisions. The other piece that I didn’t mention that we’re getting is that we are just now starting to get from what I’ve been able to understand, maybe the first time ever is that our employees will be receiving eligibility data each day. So we’re getting this data each day that shows when members checked in with which physicians. So we’ll be able to see if an employee checked in at an oncology office yesterday or if an oncologist did a check and eligibility check on an employee, which means potentially setting up a new appointment. But if you think about it, having just that data, which is a little bit like the exhaust going out of the health care system, there’s not a lot of people that are doing anything with that particular data. But if we have access to that, if I were to suspect that I have cancer and I call over to a specialist to make an appointment and they ping my ID card to see if I’m eligible, and then they make an appointment three weeks later for me to see the specialist. And then after that specialist visit a month or two later, they send an invoice over and that invoice gets paid within a two week period and then it gets bashed in with that month’s claims, which go out the following month to the data warehouse. It takes three weeks to scrub it. You get the idea that it’s way out there when I’ll know about this. Oh, yeah. So I could be moving upstream six months in knowing the kinds of visits and the specialists that my members are visiting with and the types of either surgeries or visits or services or specialists that they’re looking to consume and not imagine what we can do with that. So we don’t yet know everything that we’re going to be able to do with that. But having access to that data feed gives us a pretty good idea of we’ll be able to see which doctors were visiting that are that our members are using. We’ll be able to potentially identify major issues like visiting a nephrologist, which could be that somebody is in late stage chronic kidney or they’re visiting a cardiologist where we might have a new person who’s high risk for a heart attack or diabetes with an endocrinologist. We’re going to be able to know so much more and additional data that we’re really excited about that.

Saul Marquez:
That’s awesome. Lee, I appreciate you explaining that to us all. It makes a lot of sense. And there’s a whole. Lagging effects in the way things are reported, and by the time you learn something, it might be too late and it becomes both an outcomes impact to an employee’s health, but also a bottom line impact. And getting ahead of it is huge. So congrats on being able to get agreements to get this type of data flow on a daily basis. That’s a huge win. And you also mentioned, gosh, to the one hundred trucks and hundred back surgeries. I mean, like that is just such a great example. You’ve got committees on trucks, but what about the back surgeries? Know what are we doing? Let’s bring our due diligence up to par. And the other thing I heard somebody else say, if you go to a restaurant, you have a reservation. If they’re five, 10 minutes, they make you wait. You’re mad, but you go see a doctor and you’re waiting for half an hour. And that’s OK. We got to bring the same expectation around due diligence and returns and health care and sounds like you guys are helping your employer partners do just that.

Lee Lewis:
That’s right.

Saul Marquez:
All right. Very cool. This is great. And so let’s talk about just setbacks. Can you share a learning that’s come from maybe a project you guys have done or something else that you guys learned a ton from that’s made you even better?

Lee Lewis:
Yeah. So one of my talents, I guess, is that I’ve I’ve lost so many battles and run up the white flag so many times that I’ve learned a lot about stuff that doesn’t work. So one thing that I’ve learned is that I think, like the educated health care consumer is like it’s just a full unicorn. I’ve tried for a decade to either make or find educated health care consumers, and they’re so rare as to be nearly impossible. That’s something that I’ve given up on that now. I just I try to make health care so simple, so simple, that you don’t have to be an educated consumer to get to get great care, great access. One of my favorite kind of anecdotes around this was a I think a report that was done, I think was by Accenture that said that ultimately millennials and the generation after will reject any product or service that is designed more poorly than their smartphone. And I look at my smartphone and you can kind of go in reverse and say, if health care became a telephone, what would it look like? And I imagine one of those old like 1948 Edisons with a bunch of cords plugging into it. And I call my mom and I get a bill two weeks later because she was out of network or something. Just you can imagine what health care would look like if it turned into a telephone. And so the idea is we’ve got to we’ve got to design it and make it better because it’s like impossible to make people get really good at it or spend time thinking about it. We need to make it easy and simple, other setbacks. We did a big thing when we first began. We said, you know what? We’ve got to go city by city. right. We need to find the right hospitals, the right doctors. We need to find good quality. We need to reward those who are doing the right thing and we need to steer people in. So we partnered with a couple of carriers. We chose some pilot cities, Dallas, Chicago, and we went to all our members and said, hey, you’ve got to sign up for this. We have one carrier who’s our partner up in Chicago and another carrier down in Dallas and get your people to go into this narrow network of really high quality doctors. And almost nobody took us up on it. And it was such a disappointment. It was after a year, year and a half of work trying to to set this whole program up and nobody signed up for it.

Lee Lewis:
The takeaway was, well, you know, guys, we don’t want to switch our whole carrier in our infrastructure and our all the vendors and the ecosystem. If it’s too disruptive to the ecosystem, we just we can’t do it no matter how well intentioned it is. And so our fix to that is what we’re doing right now where we’re saying, OK, we just need to find great quality regardless of who the carrier is. Yeah. So if you have Blue Cross, if you have Cigna, if you have Aetna, you’re in Dallas and you’ve got employees in Dallas, that you have an objective third party set of data that you can look at to determine where there is low cost and high quality care. And then we need to work to just refer people into that. And presumably, hopefully it’s in network with everybody. And if it’s not, well, then let’s pressure them to get a network with everybody, but that we can then create sort of a network or a list of great providers totally independent of your carrier is so that we can do something that’s scalable to every employer, that they don’t have to swap out all their vendors to make something work.

Saul Marquez:
That’s a big one, huh? I hope so.

Lee Lewis:
I’ll let you know I’ve got my white flag ready, but I’m hoping, you know, I mean, and really, you’re more or less leaving the infrastructure alone. You are empowering the employers to have that data, to make decisions based off of what’s available to them without having to disrupt the entire ecosystem.

Lee Lewis:
That’s right. That’s what we have to do. I mean, it’s a lot of sense I’m you to adopt a city, it’s like transformed, like cleaning one hundred million miles of freeways and overwhelming thought, but giving one hundred yards to a Boy Scout troop. I can do that. Right. I can wrap my head around that right. The idea being that, OK, if we have a ton of employers who acting in their own self-interest, are figuring out where to go to get quality in the cities that are important to them. And the problem, those that ultimately say take Dallas, if I have a large employer in Dallas that figures out where all the quality is in Dallas, they’re referring there people really well, if ultimately I’m going to transform American health care, which means I have to find and refer my people into high quality, low cost, high appropriateness, low invasiveness, physicians in that city, I’ve got to reinvent that wheel over and over and over and over again as every employer eventually gets around to Dallas and or Chicago or New York, doesn’t matter where, and starts running through the game of figuring out where quality is or if my employers can each take different cities and we can take the work and open source it, make it available for anybody.

Lee Lewis:
Here’s where all the great physicians are. They’re all kind of a network with every network. Just refer your people here. It rewards the doctors who are doing the right thing. It rewards the systems with new business or new patients that are not charging us an arm and a leg we’re trying to get to value. It rewards the primary care doctors who are independent and just trying to survive and not get gobbled up by the system or by by large interests. And we can support all that out. We can start to rebuild and insulate and protect a high quality network that floats on top of the broad system. And once we do that, everybody who’s not doing what’s right will change and it will start to change the output, the cost, the prices and the practices of the whole system. The reason hospitals tell us that they don’t make major overhauls and major changes is because the customer isn’t asking for it. If the customer, if the patient, if they’re not demanding that we use low invasiveness technologies in order to perform surgery, then why on earth would we spend millions of dollars doing it right? Our job is to get the customer asking for it, and we can do that. We can change the system.

Saul Marquez:
And it’s clear right. you guys are all about transformation. And so what makes you most excited today, Lee?

Lee Lewis:
There’s a ton. So everything I’ve been talking about is mostly let me tell you one example. That is my favorite story out of many, many favorite stories. Hero. My name Bryce. If you call me separately, I’ll tell you which Bryce it is the legend is is he was the head of purchasing for a big gas station chain and was head of the beverage purchasing. So Coke, Pepsi, Anheuser-Busch, you get the idea. And as the purchasing person over beer and liquor, alcohol and sodas, he had like a sweet gig right. it was like 18 holes of golf, followed by a five course steak dinner, maybe going out to Wimbledon every now and again. I mean, it was the legit, like, great purchasing job. Yeah. As I understand it. And then he got this big promotion that he was going for the second or third largest purchasing line item to the very highest purchasing item, which was health care. I’m so excited. So he gets his big promotion. He’s now over health care, which from a supply chain standpoint, the biggest budget in the whole company. And he starts and he’s like, OK, when do we go meet all the X? And we do some golf and some steaks and they’re like, no, it doesn’t work. It doesn’t work like that. He’s like, what do you what do you mean? Certainly. Certainly we I looked at the numbers. We’re spending millions of dollars with these local hospitals. Of course, they’ve got to be, you know, taking us out to the big games, the box seats, the stakes, etc., right. because I mean, how else on earth are they getting all this money from us? Of course, they’re going to be wining and dining us. I don’t know. It’s health care that none of that happens. It’s all gone now. Wow. So he’s like, well, I can’t I can’t do purchasing like this. And so rather than just conforming to the system, he wanted to make the system conform to what he knew how to do. And so he set up a meeting, went to the local hospital, went to the twenty eighth floor and this big glass room with a bunch of old guys in suits. And he walked in there in jeans and he’s a millennial with his black polo and, you know, and he sat down and said, hey, I wanted to set up a meeting. We want to have one contract with one hospital supplier here in our city. There’s three of you. We just we just want to choose one as our supplier or at least have a direct contract with you. And they kind of laughed and said, oh, you know, it just kind of doesn’t work like that. And they were dismissive of him. And then he pulled out his wallet and he held it up and he said, I think you have forgotten who holds the checkbook.

Lee Lewis:
We treat people who come into our gas stations to buy a 70 cent drink better than you treat my employees who come into your system where we spend millions of dollars. That ends today. I’m going to have a direct contract and I’m going to have a direct relationship with those who are serving my people and things change. And ultimately that room, the people there didn’t make a contract with them and he moved millions of dollars in services out of that system one year later. And then he went and did that at a number of other places and he radically simplified the way the care was being done. Him and his team wasn’t just him, obviously. But this is company has a great team over there running health care. And today, not today, today, but like within the last year, just to see how it is working, I went over to one of their gas stations, one and waited till nobody was there. And I asked the gal at the front desk that are not desk, but at the cashier, young gal she’s probably twenty twenty one years old. I said, Hey, I hear you guys have cool health care. Can you tell me about it? And my job basically dropped as this twenty one year old gal said, Yes, I love our health care. Let me tell you about it. She said, I can go to any primary care doctor I want within our little network.

Lee Lewis:
We have there’s like four or five different locations for primary care. I can go to any of them and I go in and I don’t pay anything. It’s totally free for me to be able to use those doctors. And then if I need something more serious, we go to the local hospital. There’s one hospital that we work with. I don’t go to the others, but I go to the one and I can get the services that I need there. And I don’t have to get anything out of pocket. Just two hundred dollars comes out of my next paycheck and two hundred comes out of the paycheck after that. And I never get any bills or anything like that. It’s all taken care of. And I said, well, doesn’t it bother you that you have to go to those doctors or that you have to go to that hospital? And she said, no, I love knowing where I’m supposed to go. And they’re expecting me and they take great care of me. And I told you, she said I had a baby last year. I told all my friends I had a baby for four hundred dollars and never had to get my wallet out once. That’s that’s what’s exciting to me, is I want to get experience similar to that or even better for every employee, every one of our employers.

Saul Marquez:
That’s awesome. What a great story. Lee and Bryce and HTA, you guys are doing some great stuff. And at the beginning we covered you were part of health care, Rose, that had Dave Chase here as well. It’s a strong mission and it’s getting done. And you don’t get what you deserve. You get what you negotiate and you’re not asking the right questions. You’re not going to get it, especially in health care. And I certainly appreciate the passion you bring to this. And you’re a large employer looking to make changes, looking to get more for your health care dollar. I think you want to have a conversation with Lee and the team at the Health Care Transformation Alliance. Lee, I mean, incredible insights that you’ve shared with us today. I’m super thankful for those. What closing thought would you leave us with and work in the listeners get in touch with you.

Lee Lewis:
Closing thought would be that if your a self-funded employer or if you’re a hospital system, you’re probably also a self-funded employer and you’re wanting to be a part of the change. If you’re wanting to make amazing health care for your employees or you want to deliver more and better amazing health care for your local employers in your town, we’d love to talk. I’m non-profit. I don’t have an NDA. I’ll share with you everything I can, whether you’re a member or not, because I want to be able to help you out. And if you want to be a part of the solution and a part of what we’re doing, then we would love to invite you to participate. All it takes is a desire to want to make health care better and we can help you with baby steps to achieve it. Please reach out to me. Would love to talk to you. Just email me. It’s LLewis@HTAHealth.com. LLewis@HTAHealth.com and we’d love to chat. Let me know that you heard this and any feedback or thoughts.

Saul Marquez:
Thank you, Lee. And folks, take action. It’s one thing to listen and to be inspired, but it’s another thing to act on that inspiration. It’s that action that’s going to create results for you and and your employees. And maybe it’s not you that makes the decisions. But you know, that person, you know, let them know about this podcast. Have them listen to it because it’s a ripple effect and you will be the cause that leads to better health care for millions. And so I encourage you to take me up on the outreach opportunity that he’s been so gracious to offer. And so Lee just want to say thanks again. Really appreciate all that you’ve shared with us today.

Lee Lewis:
My pleasure. Thanks so much for having me. And keep doing what you’re doing. I appreciate your mission and your the outreach that you’re taking care of for everybody.

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