Janis Powers, Founder and CEO of Longitudinal Health Care

Tying Preventive Care with Personal Cost Savings to Improve Health with Janis Powers, Founder and CEO of Longitudinal Health Care 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 here, and today I have the privilege of hosting Janis Powers. She is the founder and CEO of Longitudinal Health Care. It’s a B2C Digital Health Company based in Austin, Texas. The company’s long term goal is to replace traditional health insurance. Longitudinal is paving the way for consumers to use their health care dollars for catastrophic insurance, with the remainder allocated to direct to provider payments based on predicted patient outcomes. The companies go to market features called the Over Under or the O. U. It is an automated calculator that helps consumers determine whether they are over or underpaying for their health care. And we all know that the problem of bankruptcy in this country, over 60 percent of it comes from health care. It’s an important measure. And the companies ideas are inspired by Powers’s Amazon best-selling book, Health Care Meet the American Dream. She commentates on health care via numerous channels, including her podcast, the Powers Report podcast, speaking engagement at South by Southwest, an extensive library of published articles. Prior to founding the company, Powers spent over two decades in health care strategy consulting, starting with Deloitte ninety five. She’s got an undergraduate from Yale, master’s from the University of Michigan in architecture, which is really interesting, and she’s here to spend some time with us. So, Janis, it’s such a pleasure to have you here.

Janis Powers:
Thank you. And I have a business degree from Michigan, too. So.

Saul Marquez:
And a business degree, too.

Janis Powers:
It’s all out there.

Saul Marquez:
All right. There we go. You’re busy. You’re a scholar. So before we dive into Longitudinal and by the way, I mean, the opportunity is ripe for disruption in how we pay for health care. So there’s going to be a really great talk. But what inspires your work in health care? I mean, it’s been a very long time in the business, but what inspires you to do it?

Janis Powers:
Well, I think all of us are inspired because health care impacts all of us right? So it’s a pleasure. It’s sort of a calling to work in the industry because the work is helping others. It’s also helping you or your family. So that’s just sort of I think anyone who is involved in the industry feels that. All my years of consulting have been fantastic. But when you do consulting, you realize that you really see just how hard it is to make any change and how intractable it is. A lot of on the provider side, the hospital side where I did a lot of my work is not for profit. And so it’s really slow going making decisions. And our whole M.O. and the different consulting companies I worked for was like, if we can get five percent of the change that we’re proposing, it’s five percent that wouldn’t have happened. And you get to a point, you’re like, I would like to do more than five percent. And the only way to do that is to really, at least for me, like go out there and try something really alternative and take all these years of observation and all this writing I’ve been doing to package it into something really different. And that’s what we’re doing with longitudinal.

Saul Marquez:
I love it. I love it. And so talk to us about longitudinal. What exactly are you guys doing and how are you adding value to the health care ecosystem?

Janis Powers:
Yeah, well, thank you for the opportunity to describe it. I wrote, as you mentioned before, this book, Health Care, Meet the American Dream. And it’s really a business plan for the company. I had been writing about health care. I started actually my first article came online in twenty twelve, and it was all about how I thought that employer-sponsored insurance was an entitlement because half of Americans get their insurance from their employer. It’s not taxed. It’s very inequitable how it’s distributed. And it’s interesting that that was the first thing I chose to write about. And for almost a decade I was trying to take these ideas and put them into something that was going to challenge how the payment system in health care works. And so that’s what really our company is all about. We want to take the payment model and put it on its ear because right now consumers don’t have control of their health care dollars really at all. They have a very small sort of area of control and they’re out of pocket spending and even that they don’t control all that much. And to me, in the last 10 years, we’ve had so much radical change. I mean, we couldn’t do this concept ten years ago. But the ideas that we’ve had, these amazing advancements with genetic testing, we’ve had a sort of global acceptance of genetic information. 23 and me transformed that whole concept. So if you look at your outcomes, 20 to 30 percent of them are based on your genetics.

Janis Powers:
And now we’ve started to consumerize that information. We’ve got these really cool tools, these predictive analytics. So it makes no sense at all for all of us to be in these collective insurance pools anymore. At this point, we all know that everybody has preexisting conditions because we have genetic testing. So this idea that we’re putting everybody together an insurance pool to mitigate the risk, it’s so flawed. So we are trying to transform that and say, hey, instead of all the money going out to these third parties, employers sending it to insurance companies or to the government, really for us, we’re going after the employer dollars. Why don’t we have that money go directly to the patients, to the customers, and have a company like US Longitudinal basically be the fiduciary agent that helps people spend their money better by giving them their own customized health care based on their health status and their genetics? So that’s what we’re trying to do. There’s a lot of ways that can add value to the health care ecosystem. Obviously, this thing is very visionary and it’s not out to market yet. I don’t think the market is quite ready for it. But one of the big areas we are trying to push is this directed provider payment model, which is really gaining ground, especially with high deductible health plans and so much being pushed out to people. We really want to get people that are pricing and really understand how they should be spending their money.

Saul Marquez:
For sure. And so awesome thoughts. And the idea that the collective insurance pool is a business of the past is hinged on genetics and understanding your very personal medicine picture. And so is the model that you’re proposing hinged on that?

Janis Powers:
Yeah, precisely. I think if you look at health care spending, when I first have been socializing this idea and I’ve been doing it for a couple of years, explaining it to people, they sort of have this knee jerk reaction like, well, what about the people who are really sick? This is not ethically fair. And if you look at how the health care dollars are spent, there’s a great resource. The Kaiser Family Foundation has partnered with the Peterson Foundation and they have these really cool analyses that they do. And one of them is a distribution of health care spending. And if you take the person who spends the most on health care on one end of the spectrum and then you go all the way down to the other end to the person who spends the least amount of money, which is zero, the top five percent of people, the top five percent of high spenders account for 50 percent of our health care costs. Then if you go to the bottom 50 percent of people, they only account for three percent of our health care costs. So there is a tremendous concentration of spending among the elderly and among the very, very sick. And these folks are, generally speaking, going to be on government programs, Medicaid and Medicare. So the rest of us, you know, it’s just there’s so much waste that’s out there that we just want to start raising the shade on that and just saying we got to take another look at this because this is just not working. And that’s not to say that people who need health care shouldn’t have it or that we’re trying to take money away from helping others. I mean, this is a community. We are a civilized nation. It is insane that we don’t have coverage for everybody, but we have a lot better coverage if we could lower our health care costs and make the system more efficient.

Saul Marquez:
Yeah, some great thoughts here. So talk to us a little bit about what makes the model different and better than what we have today.

Janis Powers:
Well, better, obviously, because we think that the money is going to be spent much more efficiently. If you look at the United Health Care and even HCA stocks like lately, it’s just insane with this COVID crisis. Health care has made a ton of money because people are not accessing health care. That is ridiculous. We want that money to go into people’s pockets. And so that’s just that in itself is different. But the real change for us, and this is from years of thinking about this, is that we are targeted towards the consumer. That is our customer. And if you look at other health tech companies, we’ve had a decade or so of real focus on health care investing. I mean, it’s been going on for a long time, don’t get me wrong. But billions and billions of dollars have been spent and they’ve been spent on companies that have had two different markets. One of them has been the hospitals.

Janis Powers:
And if you’ve ever worked in a hospital, you or for a hospital like I have, you understand that trying to sell a tech solution into a hospital, unless you’re an electronic medical records company selling an EMR, like forget it, it’s just a startup going in the hospital is is a pipe dream. And even though a lot of these startups have really cool ideas, a lot of the founders didn’t have a deep understanding of how the health care industry works. So those things flopped. The other thing that we’re seeing now is that there was a pivot then, well, let’s sell to the employer because the employer gives. They contribute 70, 80 percent of the dollars for your health care if you get your insurance through your employer. And like I said, over half of Americans do so they want to lower their health care costs. Those costs have been skyrocketing. And you’ve probably heard about all these wellness programs that are being sold to employers as a means to reduce health care costs. And the problem with these wellness programs is that it’s really difficult to measure outcomes. I mean, this is the Outcomes Rocket. I’m sure you’ve talked about how challenging it is to measure outcomes and for a company to come in and say, I’m going to make your employee base healthier, like in a year. Tt’s so impossible to measure that? And we’re seeing that there are some employees that just don’t want to be healthy, just like some Americans don’t want to be. And so those models are sort of falling by the wayside. And so we’re like, why are we not talking to the people? You know, why are we Americans?

Saul Marquez:
The consumer.

Janis Powers:
Right? Why how come we’re not front and center in this conversation? And so that’s a major differentiator for us.

Saul Marquez:
Got it. All right. So I appreciate that. And so talk to us about how this is going to work and what’s the entry point? Is this a consumer solution, an employer solution?

Janis Powers:
Awesome. So we are going to market in the next few months with a free health care cost calculator called the OverUnder. We’re then going to move to a subscription model, which I’ll explain a little bit about. And that’s going to have sort of all the elements we’ll need to get to know our customers so that ultimately we can do this insurance replacement product so that the insurance replacement thing is years out. But that’s definitely where we’re headed. And if I have the idea someone else has the idea, which is good, because then we can all push it forward. But out of the gate, we’re doing a free it’s like a health care cost calculator. It’s called the overunder. You basically put in your insurance information, your age, sex, where you live, and how much you pay for insurance. And then we can sort of back into some of these things like if you don’t know how much your employer pays, we can estimate it for you. And then it calculates if your total comprehensive health care costs, it says, are you paying too much or too little? And then it talks to you about how you can control that or not because quite honestly, you can’t control a lot of it. But no one’s talking to consumers about, like holistically how much money actually goes into the system on their behalf and then how much is actually spent on them. And so that’s what the overunder does. And what’s cool about it, aside from just that, is that each time you answer a question like we asked you about your utilization, like did you go to the emergency department, the over under it recalculates. So when we ask you where you live is you’re probably aware health care costs vary widely across the United States.

Janis Powers:
So when you put that information in, we’re really trying to educate people on what factors are driving their health care costs above and beyond basic health assessment questions like what’s your BMI, what’s your blood pressure, what your cholesterol level is, or so many other factors. So that’s what the over under does. It’s a basic calculator. And at the end of it, we want people to realize how much money is going in because the macro view is if you’re like young, single, young, single male, probably age between twenty-six and forty-four, they quote-unquote overpay into the system about three thousand five hundred dollars a year. So that money is just going away for like a woman who’s aged fifty-five to sixty-four, she underpays by about the same amount. So the way the system works is that you overpay when you’re young to sups and you hope that you’re going to help yourself later, that at some point you’re putting all that money in and you’re like, you know, at some point I’m going to need that myself. And so you kind of feel good about it. But it’s just with health care costs rising, like we’re seeing that people who put money in for Medicare, they can’t in any way have funded the amount of care that they’re using right now. So we’re trying to make that connection for people and say what? Instead of giving this money away and letting the system sort of explode and balloon, wouldn’t you want that money for yourself? Like what would happen if that was yours? So that’s the conversation we want to have by doing the over under.

Saul Marquez:
Got you.

Janis Powers:
The subscription then takes this over under a concept and it’s got three or four different parts to it. There’s a health assessment. We’re basically trying to do a light assessment about you, learn your age, sex, and background, genetic information, but basically make like a five-year prediction on probably what you’re likely to get and then sort of preload that into the app and have a navigation element that says you were a high school athlete, you’re really active. You’re probably going to have a shoulder injury. You’re a football player. Yeah. So what happens when that happens because people are so health illiterate and they just have no idea what’s supposed to happen, so we preload all that stuff in and then preload the pricing. If this is going to be out of pocket, we give folks some ideas about how to spend it. But the cool part is we take this free overunder and then we’re customizing it to you. So every time you go to the doctor or have one of these episodes, you sort of scan the information in and we can automatically tell you we’re automatically tracking how much you’re spending. So that’s the cool aspect where no one is doing that right now. And it’s sort of like, gosh, all this money’s going in. Here’s how much is going out through the year. It’s just a totally different way of looking at health care.

Saul Marquez:
Yeah, it’s interesting. And so we’re doing more by tracking and understanding and then maybe even forecasting in some respects. And then I guess, how does it get paid for? Does this become a plan or do the covered people have? Are you cash-paying patients like. Tell me more about that.

Janis Powers:
Yeah. So the app is a flat subscription, probably going to wind up around 10 bucks a month. And we definitely think that people are going to get value out of that because they’re going to get all the navigation stuff. And it’s navigation customized to you like Saul if you had it. And I wanted to know or say I had it and you said to me, hey, Janis, I need to get a prostate exam, like, where do I go? What are the good doctors who do it? Well, I’m never going to need a prostate exam. It’s not loaded in my app, so I couldn’t tell you. Right. This thing is customized to you. And then the pricing is local market pricing. And I have had a catastrophic plan for the last 18 months. So I have had to go direct to the provider and ask for prices for things and know it’s hard enough for me. And I like doing this sort of negotiation, but most people do not and don’t want to and shouldn’t have to. So a lot of that’s preloaded in, which is why we think there’s value in the app for people to pay for it. We’d love to cut deals with employers if they want to fund it for their employees, but we’re not sharing any of the information with the employers.

Janis Powers:
Later what we’d like to do is say we move to this replacement model. We’d like to say, hey, employer, instead of you having to craft an insurance plan for your employees, why don’t you just give them the cash? They can go on the open market and buy health insurance on their own. In fact, when they implemented the Affordable Care Act, they thought a lot of employers were going to do that and they didn’t. And so I have been advocating for this for years. And there are now legal structures to do that, to enable employers to do that, because the way it is now, you can still give the employee the money and it’s still tax-free for the employee. We’d like to take that money and say we’re going to get you catastrophic insurance, but then we’re going to take this chunk of money and help you spend it direct-to-provider and help you be well. So we’re saying you hey, you’re a smoker. We’ve allocated this amount of money for you, for all of these different things that could happen to you based on the fact that you have this habit. If you were to quit, here’s how much money you could save because you would be forgoing all of these future health care encounters that we predicted you would have. That’s great for the individual. And then they get to save that money and then we get to invest it for them. And our business model is then we’re really an investor and a fiduciary agent for our customers.

Saul Marquez:
Gotcha. Gotcha. OK,

Janis Powers:
It’s a big plan. It’s a lot.

Saul Marquez:
Yeah. And it a while until it gets there. Right. So there are different stages.

Janis Powers:
It is. Yeah. I mean it’s funny because a lot of what we are doing is already out there. Right. I mean there’s a ton of health assessments that are out there. And they, by the way, I’ve done like all of them and they’re it’s so painful. And ours is much cooler because when we talk about someone’s diet, we can connect to all of these apps that already capture the foods you’re eating. But ours has a library of foods with images. And it’s a little bit gamified where you can select pictures of food and then we tell you why you should eat it. There’s a lot of these cruciferous foods. I think it is like cauliflower and kale and stuff that have a really cool chemical in them that helps your cells repair themselves or helps the DNA repair itself. And as a result, it helps you lower your chances of getting cancer because your cells are just better at it, basically not getting damaged. So that’s why you need to eat this food. I mean, so it just we’re trying to get people to think about things and educate people instead of just saying, like a doctor, here’s what you need to do.

Janis Powers:
Just do it because we said so. People want to know why they want to be motivated. So we’re trying to do a lot of these things a little differently. There’s navigation stuff out there, but it’s not preloaded. There’s pricing stuff out there, but it’s kind of like good. Our access is great for drug pricing. I mean, I think they’re awesome, but. The rest of it, there’s like health care, blue book, there’s just it’s not easy and it’s not we want to spoon-feed this information to people. They don’t want to say, hey, go to this site and look this stuff up, and then you’ll get like this range of prices for carpal tunnel syndrome. That’s like from two thousand six thousand dollars. I mean that it’s totally useless. So we would like to repackage a lot of the stuff that’s out there. And then by doing this ongoing over under calculation, we’re reinforcing this concept of just how much money is being wasted each year and helping people understand how much these encounters cost, and just making people more literate.

Saul Marquez:
Well, I think it’s important. Education is key and it sounds like the app. So is the app available yet or not yet?

Janis Powers:
Not yet. We’re like an early angel funding, which we’re about to close, which is exciting, but with something this big. Obviously, I have been talking about this for a long time. And so I’ve had to be designing this for a long time because it is a really huge concept. But as you and I talked briefly before we kicked this thing off, this whole concept is going to evolve really based on what our customers, what consumers are going to react to, and the market. It really is fascinating year over year how it changes and it’s essential to be in touch with your customers, which is why it’s so cool to actually be focusing on the consumer for this.

Saul Marquez:
And so stage one is through the app is education and navigation.

Janis Powers:
Right. and better pricing.

Saul Marquez:
And better pricing, I guess access to the different prices. I guess through it you could get some price transparency.

Janis Powers:
Yeah, I mean, there are a lot of companies out there that are doing like, they’re having you subscribe to them and they’re cutting rates with a selected narrow network of providers.

Saul Marquez:
Right.

Janis Powers:
I am not doing that. I am all about free market pricing because it’s just how is that fair for people? But it is we are going to take the time to be contacting providers for their pricing. That’s a very labor-intensive thing to do, which nobody wants to do, which is one of the reasons we’re doing it because there’s so much value in spending the time actually connecting with providers to get this information because it’s not available online. You get to call in for it. But it is getting like leaps and bounds. Easier to get access to that information. So there’s definite transparency there, but we’re not publishing the stuff to the open public because we need to make money off the fact that we’re spending the time doing this so and that’s a sort of prostate exam example. I couldn’t give you pricing for that sort of stuff because it’s not in my app. You’d have to have it. So we have to protect ourselves that way.

Saul Marquez:
Yeah. And so and you guys getting cash prices.

Janis Powers:
So there’s going to be. Yes. Cash prices. But I think a big challenge for people is understanding when they need to engage in cash pricing or not. And that is going to really depend on the literacy of our customers. And we’re going to try and make it as easy as possible for people because it really depends on the insurance plan. And we’ll be able to try and help people understand that. But the big issue for out-of-pocket spending, if you haven’t hit your deductible yet, is you can go with a contracted rate that your insurer has negotiated for the pricing or you can get a cash price. And if we have the cash price preloaded, then the consumer can say, well, my insurance plan is saying it’s going to be three thousand dollars for this carpal tunnel syndrome. But I see here another provider is going to do it for two. That gives you if you want leverage to negotiate with the provider on your plan or go somewhere else or just it just gives you more information. But we definitely are going to call the claims database and get sort of the basic pricing that’s available via contracted rates as much as we possibly can, because obviously, that stuff is all hidden. So we’re going to be providing both. How we do that has to be it’s going to take a really good user interface.

Saul Marquez:
And then what you do with the information is up to you as the end-user right. But at least you have it.

Janis Powers:
Right. I mean, for us, we want to get to know our customers. I mean, the app ultimately is going to be called Know Thyself. And the idea is that we’re going to get to know you because you’ll be scanning your health encounters, we’ll have that information about how much what your health activities actually were so we can make better projections for you as this moves along. It is astonishing to me and I think we all understand why. But like that electronic medical record isn’t on your phone. Like, ultimately it’s going to be like a microchip that’s in your body because you are the one common denominator for all of your encounters. And so that’s why this whole idea that we were going to make all these EMRs and have all these people talk to each other, well, we know that’s never happened. That’s not going to happen. And so when we get that information, it just helps us get to know you better so that when we get to this insurance replacement product, we have a pretty good idea of who you are and how you engage with the health care system because we want to be saying to you, look, if you like to take medications, we want to be giving you like clinical protocols that align with the kind of medicine you want. I can’t stand medication, so I will go to an acupuncturist before I take a pain pill. We’ll learn about that kind of person. And we’d like to be making recommendations to people that correspond with what they want. So that’s how we’re planning to use the information. We sure as heck are not going to sell it to third parties. No, that’s just we’re not doing that. It’s not part of our model.

Saul Marquez:
Well, super interesting, Janis. And I think if we’re not pressure testing new ideas to reinvent how we pay for our health care or how we get our health care, I think that would be the problem. So I think it’s great that you’re thinking through this. Folks, the work that Janice and her team are doing is super interesting. She also has a cool podcast, the Powers Report podcast. I definitely encourage everybody to check that out. We’ll be leaving links to all that inside of the Show notes today. Janice, I’m thrilled for you and what you guys are doing. I hope your round of funding goes through successfully. What are you most excited about today?

Janis Powers:
Well, again, I appreciate your having me on the show, and thanks to everybody for listening. The more I talk about this and the more real it becomes, the most exciting thing is people’s reactions. I sent out when we finally landed on this over-under concept after thinking we’re going to go to market in three or four different ways. I mean, people are messaging me. I want to do that. I want to try that. And because it’s just there’s so much that people don’t know and they’re clamoring for it and that is so much fun. That is a real thrill. And I feel like we’re really going to help people and get people to think about things differently. And I’m just thrilled about that.

Saul Marquez:
It’s just really exciting.

Janis Powers:
Yeah, keep it on. Yeah.

Saul Marquez:
And it’s not easy. And so the journey of a thousand miles does begin with one step. You guys are way beyond that first step and we’re excited to see where this goes. So leave us with the closing thought, Janis. And then the best place for the listeners to get in touch with you if they want to learn more or even contribute.

Janis Powers:
Yeah, I have a couple of thoughts. I definitely want people to, I think, be a little more patient with some of the providers. I feel like there’s been a lot of frustration and anger at the health care system. Some of it’s justified. But there are so many good providers, doctors out there who are quitting because the health care system is such a beat down. My mother was a nurse at Bellevue in New York City in the nineteen fifties, and it was like a doctor was one step from God. And that is part of the problem. But there are just some really, really great people. On the flip side, we have to realize that we are our own best advocates and we are trying to help our customers be the best advocates they can be. But they’ve got to work with the physician. They’ve got to find somebody they trust. And I think that so much of consumerism today is having people sit at home isolated and be disassociated from the world. And nobody’s made that so much worse. And you cannot do that with your health care. You can’t. So I encourage people to seek out providers they like when they’re well, not when they’re sick when they’re desperate, but when they’re well so that you can get on top of the system and be open to new ways of looking at this. So I encourage folks to reach out to me. I’m on Twitter at Janis underlined Powers. I’m on LinkedIn and it’s Janice like Joplin Powers. And then folks can hit the longitudinal health care website and reach out to me there. Or of course, through the Powers Report podcast. I’m sort of all over the place. So if you Google me and health care.

Saul Marquez:
There’s a lot of ways to get in touch with you, Janis.

Janis Powers:
Right, I’m happy to interact with people because I love it. So thank you.

Saul Marquez:
Oh, that’s great. Well, they have it, folks. If it’s something that we talked about or Janice mentioned during this interview resonated with you, reach out. She’s open to conversations as she’s on her mission to eliminate health care insurance. So just want to thank you again for spending time with us and certainly looking forward to staying in touch.

Janis Powers:
My pleasure. Thank you.

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