Lester Morales, CEO at Next Impact

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Intro:
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Saul Marquez:
Welcome back to the Outcomes Rocket, Saul Marquez’s here, and today I have the privilege of hosting Lester Morales. He is a true consultant in the Human Capital and Employee Benefits Arena and currently serves as CEO of Next Impact LLC. Focused on innovation and changing the status quo, Next Impact is a full-service employee benefits and Human Resource Marketing and consulting company committed to helping other companies grow and add value to their clients. Before he founded Next Impact, he co-founded Incela of Benefits Administration company focused on helping advisors support their clients with ACA compliance. Prior to becoming an entrepreneur, Lester served nearly three years as executive vice president and chief growth officer for Willis’s Human Capital Practice, one of the largest insurance brokerages in the world. In this role, Lester led over 200 producers, consultants and 40 plus offices as part of a three hundred and fifty million dollar practice. Well, it’s the single largest practice in North America during a previous eight year stint at Willis. Lester was consistently among the top five consultants nationally. Between those assignments, Lester served as national vice president of Sales for Health Start, a leading provider of worksite clinics and disease management services. Lesters, a thought leader in the benefits space.

And I had just the opportunity to connect with him before this. And his passion for making health care more equitable for employers and the employees is palpable. He’s he’s he’s all in. And I’m privileged to have him here on the podcast today. Lester, I’m really looking forward to our discussion.

Thank you. I appreciate. I’m happy to be here.

Absolutely. So, Lester. Before we dive into what you guys do at Next Impact and the quote here on the front of your site, Starbucks spends more on health care than they do on coffee. Wow. All right. We’re going to dive into that and what your you and your team is doing to help prevent that or turn it around to something more sustainable. Tell us a little bit about what inspires your work in health care. Yeah.

Yeah. You know, most people that end up in the insurance advisory space kind of fall into it.

The mind is I’m doing this on purpose. I have a very things why? Unfortunately, I have been a product, health care, health insurance, employee benefits when I was 16 years old. My dad was diagnosed with multiple myeloma. For your listeners that don’t know what that is. That’s what kids have, your bone marrow.

So I was 16 that got diagnosed. Bone marrow transplant, chemo, radiation several years back, back.

That’s unfortunately ends up being that we become a statistic. So 60 to 67, depending on which report you read, a personal bankruptcy because of medical reasons? Well, fortunately, we were part of that statistic. So my parents had to file bankruptcy in order to make ends meet that they put in. What’s interesting about that is they both that health insurance, both employer based insurance. But, you know, when an out-of-pocket maximum is ten, fifteen, twenty thousand a year for family, you know, you do that two, three, four years in a row. How many families have extra thirty, forty, fifty thousand dollars sitting in the bank? You know, when you’re trying to send your kid baseball camp, when you get on the new Jordan and all the things that wonderful parents, the I had two wonderful parents did not want me down the road, you know, interested in understanding the value of health insurance. But it also makes you understand how they’re using the system is. And that although you got insurance, although theoretically that insurance is supposed to be there to support and help, it was it was really more of the hoop jumper. And, you know, that will overcome years. So that going to be down the field. And then the last part of really what drives me and my why, unfortunately, I’m a big I’m a big momma’s boy, as is most Latin men are. I’m a big mama’s boy. And fortunately, in 2014, my mom was diagnosed with pancreatic cancer and she passed away August eleven thousand seventeen. So. Man, I’ll tell you, I get up every day, fired up to fight for change because I have seen the two most important people of my life like cancer. The amount of money we spend is the amount of confusion, the amount of just uncertainty and hoops that you have to jump in the system just doesn’t make sense. And so that’s that’s what we get up every morning to fight against.

Wow. Lester, thank you for. Just sharing that, first of all, and know a very personal story, and, you know, it’s real.

And, you know, I appreciate you being being vulnerable here and sharing this to help us understand your why and what you do. Yeah. And I agree with you. I don’t think that we should be forced to choose between our life savings and our life. And the system’s broken and we shouldn’t have to choose between our company and our employees health.

And it’s if it’s possible to have both. So. So talk to us a little bit about what you and next impact your business is doing to add value to the health care ecosystem and in particular, employers.

Yeah. So, you know, having been on the advisory, decided a very large level. So, you know, I worked at Willison total of 13 years. And the reality of that is we advise some of the largest companies in the world. Largest insurance firm, the world’s. And, you know, I figure that routs, you know, allows you to make the biggest impact. So my degrees and risk management insurance, I started this in college. I have done it my entire career. So I’m thinking I need to get to one of the big companies. That’s where you make the biggest splash. And, you know, I learned very quickly that although a wonderful organization treated the amazing, you know, unfortunately, the best solutions and the quickest way to success and success being defined is truly making an impact sometimes isn’t coloring inside the lines. And I know you can appreciate that. And so the only way to color outside the lines is, is to make sure that you own your own coloring book. So, you know, that’s that’s kind of what we did. That’s the impact. It all came from being able to see what the difference is, is when you talk about reimbursement for services that are being provided. So if if you think about it, how much does a flying’s your employer, you sponsor a plan. So you provide health care coverage for your employees. How do you know how much that knee surgery costs? And I became fixated on that question after having my knee surgery. So I was 30 years old. I saw my eyes. Yeah, I’m Zielke ECL. I’m on a sixty five hundred dollar deductible.

And if you call to the hospital and ask them how much because they can’t tell you. And I became Right. say that on how and why.

If health care separately ace the second largest expenditure for an employer is such a big number. How does one not tell you how much it costs? And you start to understand how rates are set and the differences between what a hospital takes from Medicare versus what they’re billing at. And it’s four, five, six, seven, eight, nine hundred percent difference. And you become flabbergasted. So I learned about, you know, the structuring and the building of health plans not using a traditional insurance companies are stepping outside of the PPO contracts and using direct contracting, using bundled and cast payments, using reference based pricing, using some transparent model of reimbursing for services so that we can do the one key word that is completely missing in this very opaque industry, which is transparency.

Yeah. And so and so that that point in time where you had to do your surgery, Lester, you can find the price. And you said this is unacceptable. We need to figure this out. And now there’s insight that you’re able to provide. You know, your employees, but also the employers that you serve around these health plans that use that direct contracting. Just the different methodologies that are different than the traditional ways. Can you can you share some insights with us about what some of those tools are and then maybe how how leveraging those tools and ways has helped some of your clients?

Yeah. So I’ll I’ll tell you, this has been, you know, three and a half, four years now of on this on this journey.

And it is definitely the subsegment of the world. But when you start thinking about very large employers, Wal-Mart, Amazon, you know, the car manufacturers up in Michigan, they set up their own arrangements, bypassing the insurance companies with local health care providers. It’s interesting you start seeing on the news Right. typically around Christmas time, on the years that hospital A insurance company B R at GET are ending their four year, three year, five year, whatever is contract. And you start to see them have that Birbal and or in the news, you know, match year back and forth that the insurance company is trying to not reimburse us. And then the insurance company is claiming, oh my gosh, they build more than well, you start to really understand that. You start to realize that’s. The two people, and I don’t mean this in any disrespect when people say that the system is broken. You know, I tend to try to correct people and say that the system is not broken. It’s designed wrong. It’s working quite well the way it’s designed. Right. But there is a significant amount of misaligned incentives. So when you think about an insurance company and insurance companies, revenue is what we all call premium. Well, if you’re a public company, what is your job?

Well, to grow your revenue, well, revenue equals premium. What’s the incentive for an insurance company to lower their premium numbers? Now, expand on that. With the ACA and the MLR, the minimum loss ratio rule that now caps how much an insurance company can make. Well, I mean, again, it’s just economics, one to one, if you’re capped on the percentage of a dollar you can make from an employer based plan that is based on good times experience. Well, how do you make more dollars? Well, the only way to make more dollars when you’re capped is to charge more. So when you realize that you have to get out of the system.

So what we do is use a more transparent model to be able to build a health plan. So, again, still a employer sponsored plan where we use Medicare, plus we use direct contracting, we use cash payments, we use bundles. All in all. This is averaging a savings between 18 and 25 percent. And when I use the word savings, I often joke to say, you know, I made a nice living redefining the word savings Right. I used to go to an employer and say, well, you’re renewal came out at, you know, fifteen percent. But we got it down to five. We saved you 10 percent. Well, last night, my check saving means you’re actually paying less in health care today than you paid yesterday. And that’s truly what it is we’re doing. Our clients actually go backwards and spend less on health care next year than they’re doing this year. How we do that is basically to step out of the networking scenario so we no longer use for the facility based claims where you’re spending 80 percent of your dollars that you can think about that. Where do you spend the most amount of money in the hospital, in the imaging? The big claims that the doctor’s office claims those things that the hospital type claims.

So we make it a win win win for the hospital. We try to use a basis point that we understand how much it costs that hospital to run their business. So typically, Medicare or cost data, which is all public data, is available to understand that hospital A, B, C, you know, needs to make a dollar in order to make this, you know, work.

So let’s just use Medicare as the basis point. Well, if they make a dollar off of Medicare. Well, under a pay PPO scenario, they might be making four dollars after the PPO, quote unquote, discount. What we end up doing is offering that hospital to an economic reasons to take a lesser reimbursement. One is speed. So depending on the service provider we’re partnering with, some payments are made within 72 hours, but less than 30 days, typically to a hospital. Well, time value of money would tell us if you can get paid faster, that’s more beneficial for the hospital themselves.

The other and this is where the magic happens, is a hospital tends to spend between 30 and 40 cents on the dollar collecting that dollar.

So if you could think about it, deductibles continue to go up and up and up, but employee salaries don’t go up and up and up. So the burden that is placed on the employees for that two thousand dollar deductible, that five thousand dollar deductible means that when they go have that knee surgery, they can’t pay that deductible all at once. So what does that mean? That hospital now becomes a collection agency? So the reality of it is we have the conversation with the hospital to say not only will we pay you faster if you agreed to this, we’re going to waive the deductible and coinsurance altogether. You’re not going to have to chase at all. And we’re using both cost and quality data to make those recommendations and conversations with the employee. So the hospital wins because they get paid faster. They don’t chase the employee wins because they don’t have now an out of pocket deductible or coinsurance anymore. And they have an advocate to help them understand where to go, how to shop, how to navigate. And the employer wins because this is providing a better benefit for their employees while saving them a significant amount of money. So that’s kind of the Cliff Notes magic of the program.

Yeah, it makes a lot of sense. And just working directly with the hospitals to to circumvent the traditional system. Are all hospitals willing to do this?

So that’s a very great question. I would tell you on the surface, yes, depending on who you talk to at a hospital. Know what I mean by that? In a very easy way of understanding. This is called any hospital today and say, I don’t have insurance, but I have cash. How much does an MRI? And each hospital has a cash pay price. Well, call back that same hospital and ask them I’m on a five thousand dollar deductible with insert carrier here. How much is an MRI? Because I’d like to know how much I’m going to have to pay out of my pocket because I might have an HSA or something. And either one they won’t tell you. Which goes back to that opaque, non-transparent conversation we had earlier. But if they tell you the price difference between the cash pay price and what they so-called negotiated with the insurance company is drastically different.

So what that tells you is that hospital recognizes the various functions. You know how to finance a service, but not always. Do they want to have that question on a mass conversation or maybe person that’s job is to, you know, do X, Y, Z versus the CFO of that hospital versus the person in charge of networking. So it definitely takes some finesse. But in all cases, hospitals already today take a variety of forms of reimbursement and or a variety of amounts of those reimbursements for the same service.

Now, that’s great. Mustard, thank you for for for offering some insight there. Did you ever find out how much your knee surgery cost?

Oh, I use this. I use this example all the time. It. Ninety thousand dollars a build charges. So very bandstands bill charges. And I’m going to throw out your audience and watch that. Help me. You’re really teach people this. There is a mockumentary called Adam Ruins Everything. It’s on shoot TV. Adam Ruins Everything has one. Why hospitals are so expensive. I suggest that people go out and watch that because it explains the problem perfectly and a very easy way of understanding it. But Adam ruins everything. Why? Hospitals are expensive, so. Ninety thousand dollars is the bill. Charge the insurance company allowable. So that difference is there. This couch was forty five thousand. So let’s say there’s a 50 percent discount there. Well, Medicare reimburses at fifteen thousand seven hundred or something like that, Joe. Medicare reimburses fifteen thousand seven hundred. The allowable amount. So what the insurance company was going to have to pay for, that was forty five thousand. So I had a five thousand dollar deductible. So I pay five. The insurance policy or because my employer was self-insured, which you need to be in order to get creative. They paid for it. So my employer pays 40. I pay for what I know now today and in the plans that we can sraw. South Tampa Orthopedic, which is a orthopedic surgery center that only does, as the name suggests, orthopedic surgeries will do that. Bundle professional charges, anesthesia. The screws that are now in my knees all together for ninety thousand three hundred in the program. If I would have had the surgery in the programs that I now constructs my AB, they get my fancier would have instructed me that, hey, did you know and if you’re okay going to that place, that only does orthopedic surgeries that have better results and better success if you’re willing to go there.

They’re going to waive the deductible and culture. So I would have saved my five thousand. So let’s do that math. Ninety thousand three hundred plus five Right. 19 plus five to twenty four or twenty four three plus the version of the employers, 40. So the plan in that scenario, the employer, let’s call it, would have saved fifteen thousand while allowing, supporting and helping their employee get better health care and to have a five thousand dollar lesser expense, which if your average workforce is making forty fifty thousand dollars, we’re talking about ten, fifteen, sometimes 20 percent of their Take-Home Pay Satans. That’s a significant dollar, that is.

Now, this is great. I appreciate you walking us through this. And you definitely found out and all the folks in the show notes for today’s podcast.

I’ll make sure to find the right link for Adam Ruins everything. The real reason the hospitals are charging you too much or something like that. So, Lester, you and I all connect to get that to people. I want to watch that.

It will be the best six minutes education that you watch, I promise.

I love it. I love it, Lester. There’s no doubt there’s ways to work outside of the system with a variety of forms of reimbursement to get a win for everyone that everyone involved.

And so talk to us about maybe one of the biggest setbacks you’ve experienced as you’ve been putting plants together. What was the key learning that came from that that has made you guys better and just, you know, and maybe just the innovation that came out of it?

I would tell you, my biggest competition personified that question. I hired a new guy in the sales and marketing company and I gave him a handful of proposals to reduce I can B and C and ask questions. And I wanted to see how he interpreted it. So he comes as I’m really confused.

We are fifteen, twenty, twenty five, sometimes forty percent less expensive than the choice that they made. I don’t get it. How come everybody’s not doing this. And so, you know, I would tell you the number one reason that health care isn’t making moral progress is the status quo. It is just so significantly easier to do what it is we did yesterday.

And whether that’s an insurance advisor who loves to go play golf with their Blue Cross rep or, you know, I’m not trying to pick on anybody, but, you know, it is what it is where the status quo is super comfortable. I made a significant amount of money being an insurance adviser, and it’s a heck of a lot easier to do it the old way than it is the new way. But for me, once you know something, you can’t unknow. And so I know right now we are getting people to higher quality, lower cost health care, waiving their deductibles and back to the conversation we had in the beginning. Honoring my why? Because you know what that does that prevents any other family from having to file bankruptcy because of medical issues. And, you know, if that’s the last breath I take being able to go down that road, it’s going to be a big deal. So I would say my biggest setback has been, you know, I’m a I’m a hip hop guy. So there’s a term you get high on your own supply. I tend to look at our numbers and look at our proposals and be like, why are people buying more of this? Like, it’s such a no brainer. And you forget that there is such an emotional buy on emotional thing with health care. So whether it’s a trust in the warm and fuzzy you get with that logo that’s on the top right corner of your I.D. card, whether it’s just the, well, you know, status quo, whether it’s the ear of the person making the recommendation of, oh, my gosh, I’ve never heard of this before.

If I do something wrong, I might get fired, so there’s a whole lot of hesitancy and emotion that goes into it. So I would tell you, although my answer to your question is not overly innovative from a sophistication level. It is from an approach level. Sure. And I would tell you, the the way we turned it around is by bringing more emotion into the conversation and throwing out the types of people which let me tell you. So I’m so grateful that that was the case. But it’s you know what? Stop trying to chase. What is not Chase? Bill, why don’t you just throw out the kinds of people you’re trying to do business with China, companies that you want to work with, the kind of, you know, leaders you want to be associated with. Stop trying to chase the ones you don’t want to just because you have 100 offices. And maybe they might start doing more business of me and rather gravitate to the people that are going to be your your wow your wow clients and my business calls and wild plants and the people that you want to work with. So my innovation or my learning of this is throw out to the universe the things that you’re doing and why you’re doing it. And the people that really believe in that will naturally find their way to you. And honestly, I was listening to the podcast. You were on with Jay Oudeh and I heard what you were saying. I’m like this guy I gotta be. I reached out and called all you. So that’s why we’ve even met.

Yeah. Yeah, that’s great. Lester. Yeah. I appreciate you reaching out.

When folks, you know, you’re listening to this, you have employees, you have a business. Now’s the time. If you if you’re curious and you you you. Somewhere deep down inside believe that there’s actually a better way because there is. I would encourage you to definitely look into what Lester and his team are doing. Their website is Next Impact LLC dot com. But Lester will also show the best way to get in touch with him. If you don’t explore new options and get out of the system, you’re just going to continue to paying more money than you have to. And I would hate to see you do that unless, Szary, your inspiration and all the things that you’re doing is making a huge difference. You’re you’re helping other people avoid what you and your family went through. And I admire your work for that. So thank you for. For what you do.

Thank you. Now, I appreciate that. I appreciate the things that you do. I mean, again, that’s why people that throw out their mission based and their end, they’re why, you know, need to be working together. So it’s just that’s just the deal.

Absolutely. So so, Lester, obviously today is just the tip of the iceberg, right? I mean, there’s so much that we can learn. But, you know, as we focus on learning, I always love to hear what thought leaders like yourself are reading. Can you share a book that you would recommend to us?

I can. And I would tell you, I have severe ADT. The non diagnose is so far. It doesn’t happen to book all the time. So yeah, actually bought a set of headphones that are waterproof so I can be listened to books and podcasts like yours while I’m in the shower while I’m sitting on all sides. That’s. Yeah. So the, the, the two that I’ve been my my my my wow’s lately I just finished Simon Sinek start with why. Yes. And you know, I never read it before. I was so passionate about my why, but I literally have read done some of the things in our marketing and our conversations. And quite honestly, I have met one on one with every single one of my employees that truly understands that, you know. And they did this during the interview process. They understood what my wife is. But I really challenge them to understand why they’re why is and so that they get fired up to do their piece of the bigger puzzle and that our end client isn’t necessarily the adviser we might work with, even the employer. It’s that person that accessing health care. It’s that human life that we are impacting, whether it’s saving them money, whether it’s giving them a second opinion, whether it’s getting their prescription drugs cheaper or whatever it might be.

But that’s that’s our why. That’s their why. And really focus on that. And the other one that was amazing was never split the difference. Chris Voss. Yeah. And what that really means is when you know your why. When you think and know your value. None. This isn’t a price conversation. We’re see 20, 25 percent off of their second largest PNL expense. And people are like, oh, you do your fee for ten thousand dollars. No is the answer because the value that we’re having. So that just basically means that client doesn’t appreciate that value. And at the end of the day, you become an entrepreneur to not have to work with people you don’t want to. And that’s a liberating feeling. I’m sure you can appreciate the same thing. But after working in corporate America for, you know, fifteen years, eight, 16 years. I got to tell you, being able to just make a decision that I don’t want to work with that guy or gal is is quite liberating for sure.

That’s awesome. Now, I totally agree, Lester. And some some great recommendations never split the difference. And and also the Simon Sinek book, you know, the never split the difference. You guys have probably heard it recommended maybe once or twice before. A hostage negotiator and some of the really impressive ways to to be able to get a as Lester mentioned in this in this podcast, a win win win so that everybody grows and the pie gets enlarged through the negotiation. Some outstanding recommendations there, my friend. Why don’t you just leave us with a closing thought here? And before we part just also give us the best way that the listeners could connect with you and your team to explore some options.

So, like you said, the the Web site is next impact. L.L.C. impact is my favorite word. So it’s in everything that I do with my work. And so Next Impact LLC is the Web site.

Feel free to check that out and you can actually follow our journey towards transparency. I’m very active on LinkedIn. So Lester J. Moralez, it’ll be the guy who runs the impact. And my email address is Lester. Doc Moralez, next Impact LLC dot com. And you know, my parting shot, my drop, my my moment, whatever you want to call it, is a saying that I’ve been saying a lot lately is you can’t pay less for health care unless you pay less for health care. And it’s such an interesting, you know, kind of dumb statement. But the reality of it is employers continue to do the same thing. So we’re saying our buddy Albert Einstein said the definition of insanity is continuing to do the same thing, expecting different results. If it’s the quote that you said in the beginning about Howard Schultz and Starbucks and you know that they spend more on health care. I really would encourage your listeners if their employers or anybody that has influence over an employer or look at your health care spend, it is going to be number two. Typically right behind employees salaries.

So you talk about your human capital cost employees plus salaries plus plus your your back. It’s cost you spend more than any other thing. Well, people don’t want to take any pay decreases. So the next thing that you can actually control and yes, I am telling you, health care is a controllable cost. We, the industry have screwed your mind thinking that you can’t control this you 100 percent. And so it’s only until people think about health care the same way they think about every other consumer purchase that there is out there. We shop, we research, we ask questions. We might drive three hours to say three thousand dollars on a car. But the thought process of maybe going from this city to that city for the best surgeon to do my hip replacement seems asinine. Are we kidding? So, you know, again, having two parents that have been through the wringer in health care, I would have loved these type of plans where they would have, you know, look outside of the information that we are receiving and one geography and really expand that reach.

So I would say you can’t pay less for health care unless you pay less for health care. Be the change. Because if not, unfortunately, you know, I don’t know what the solution is and I’m not going to get into politics. But at the end of the day, I would rather create the change with the tools that we have rather than give my health care up to somebody else to decide.

So I really appreciate this time. I am so glad you were on that podcast. I’m glad I was listening to it. I’m glad you returned my e-mails. So I’m super grateful for for you being the innovator and the noise maker that you are as well.

I appreciate it, Lester. And folks, again, you know, the call to action is is check.

Check out the the opportunity that you could potentially have. You don’t lose anything by exploring next impact. They’ll see that come for all of the show notes and full transcript of our discussion with Lester, including the video that I’m really curious about. Adam ruins everything. Go to outcomes, rocket that health and in the search bar type in next impact and you will find it all there. Lester, thank you so much, man. This is. Great.

Appreciate the body. Have a good rest of the day.

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