Helping Employers Add Predictability and Control to their Healthcare Spend with Allison De Paoli, Founder of De Paoli Professional Services
Welcome to the outcomes rocket podcast where we inspire collaborative thinking improved outcomes and business success with today's most successful end, inspiring healthcare leaders and influencers and now your host so Marquez. And welcome back to the podcast saw here. And I have a special guest for you. Her name is Allison Polly. She's the founder of Polly professional services where they help employers add control and predictability to their employee benefits. Spend we know this is probably one of the single largest line items outside of labor in employer. Spend. So it's important. She's one of the few who knows how to manage your benefits budget to reduce health care costs, which will drive Ebba to your bottom line, successfully challenging the benefits and healthcare status quo is what she does she's a contributing author of a new book called breaking through the status quo. How innovative companies are changing the benefits game to help their employees and boosting their bottom line? She's a veteran of the insurance and benefits industry, and she's going to cover all the things healthcare and benefits that you're gonna wanna hear as an employer, but also as a provider. So without further ado, Alison, welcome thanks for having. Me pleasure to be with you today. And it's a pleasure to have you on now that I leave anything out in your intro that you wanna cover with the listeners. Now, I think you've got it. All awesome. Well, how about this? Why did you decide to get into the healthcare sector? So I've been in the benefits world for way longer than I like to admit, my family owned ABC cheek benefits firm, and we did a lot of we helped middle market, which is sort of as an industry is of a group of employers about one hundred to five thousand lives, and we did a lot to help them control their costs and that kind of provide good benefits control their costs us a benefits plan. How it should be used as a recruiting retention tool to drive employee engagement morale and to help employees, and I moved to Texas about twenty years ago when into another part of the industry, and as as the years went on I started seeing things happening. And I just thought we'll know that shouldn't be that way. And why are we doing it this way, and we can do this? Thing now. And generally just decided that I had to do something about it. The increase in health care costs is killing businesses. It's killing the middle class employers offer benefits as a benefit, and there are so many employees that are effectively uninsured because they can't afford their own. They're part of the cost. It's not working for anybody. And I have to fix it. And I think that needs to happen. Now, I think you are touching on something that's very important for a lot of people listening so within this realm of of benefits from the employees as well as the employer perspective. What do you think a hot topic that needs to be on every leader's agenda? Today. What is that hot topic? And how are you and your organization approaching it? I think the number one problem in health insurance today is misaligned incentives. I think there's an incredible distance between the pair of care in the user of care. And if you can shorten that distance, you generally eliminate some of the middleman costs and you ensure a better user experience for your employees and a lower cost for yourself. Excellent. So so let's dive a little bit deeper into that. Right. You know, a misaligned incentives. Give us an example of how your company and the work that you guys are doing has created results by shortening this distance. Sure. So there are couple of ways that you can shorten the distance one is by reviewing contracts and making sure that all of as the employer that all of your providers have fiduciary responsibility to you. Meaning that they will you. They're obligated to you to provide the lowest cost and the best quality at the same time. And let me give you an example. And I'm gonna pick on everybody's favorite within boy right now, which is pharmacy benefit manager. Yeah. We had an experience not too long ago where and the TPA brought it to our attention where an employee was taking a generic medication that cost fifty cents a pill. It was a fifty milligram medication. And that's fine. And all of a sudden the price just went out of control, and it took a little digging to figure out what had happened, and what had happened is that the employees needed to increase the dosage and the dosage for the fifty milligram pill was fifty cents and the dose the cost for the hundred milligram dose with ten dollars. Why? Now, and why can't the employees just take two and there's a couple of things at play here. So one almost never is a physician aware that that the difference in dosage is going to cause that kind of price increase, right? How is it that they're going to be aware of that the employee is not aware of that? Because their co pay has. Not changed their co pay for generic medication is the same. So they're not aware of it either. But when you pointed out both parties kinda go, oh, we'll just take two fifty milligram. That's fine. Yeah. Which would be the smart thing to do. Exactly. But unless that come through your claims, you don't know to be looking at that or asking why. And I think that's the biggest thing why why is this this way? Why can't it be that way? What happened? And then you kind of go back and peel back the layers of the onion and figure out what happened and find a better solution. So fiduciary contracts will help you do that. And that is your pharmacy benefit manager, your cheap PA your ASO provider. If you've got one and any other services that you have attached. And I am a huge believer in care management. It does cost a little bit. Generally, it will save you a significant amount of money in two ways. It will provide better care to your employees or make sure that they have access to better care and that they're following their protocols, and generally better care is not the most expensive care. I'm thinking, that's such a great thing to point out Allison, and some very great ideas. Here, you know, tip. Typically, I think of a fiduciary contract and my mind goes to to finance, right? Like a fiduciary adviser. I think a lot of people minds go there. But to think about fiduciary contracts within healthcare, I think, hey, let's just face it. It's kind of like a novel concept that shouldn't be a novel concept. You know, so tell us a little bit more about this educate us on fiduciary contracts, and how these can be drafted. Sure. So I think one of the biggest one of the ways to get the most ahead of that is to use independent providers. I work with a number of third party administrators or TPA's that are independently owned and have written already into their contracts that they are transparent in their pricing men transparent in the information that they pass back to the employer. And I think that's so important you get full claims detail almost on demand basis and as an employer. If you are funding your claims, and really, even if you're fully insured, your funding your claims and everybody else's. You wanna see that? You wanna have a handle on? What's coming? You know with the advent of big data you can start to track. What's happening in your plan? And compare it to what's happening with you with your locality, and perhaps on a state nationwide level, and you can start to tailor initiatives to help educate employees about diabetes. I live in south, Texas, diabetes and metabolic disease are one of the biggest problems we have here you can start educating employees in helping them maintain their medication regimens and start eating better. And understanding the role that exercise plays in that without a lot of expense. And without a lot of drama. And if your pharmacy benefit manager has a fiduciary responsibility to you as the employer not to insurance company, not to the TPA not to any other party. Then you know, that you. You are paying one the best cost and you're paying that over time. And that the medication is correct on. I've read some contracts not too long ago, where the pharmacy benefit managers responsibility was to the TPA not to the employer paying the Bill. Gotcha. And I'm a little challenged by that totally. And there there in lies the missing misaligned incentive. Absolutely apple as some great examples here in and as you've been working through this. You guys have obviously a great amount of experience year family business was into this from a different angle. Now, you're taking a different spin on it with the time. When you had a setback a big lesson that you learned that now you apply over and over again as a result of what happened. So I think that you have to meet people where they are. You know, I can talk to an employer and say, well, we can do this and we can do this. And we can do this. You can do this. And I'm a little bit of a nerd, so. Oh, that's very appealing and exciting to me. And really all an employer may want to know is that, you know, what can you just take care of my employees and make sure that this cost is an increase at all. Yeah. And I've had many conversation where I have literally bold somebody over with enthusiasm for this subject and not met them where they are. And totally unnerved them. Yeah. And I think many of us have had that experience before. That's a great call out. And so how do you meet them where they are? I ask a few more questions. Now. I don't assume that I know what their challenge is. They're challenged maybe something different entirely. I mean, you know, healthcare is a pretty health insurance is a pretty broad and diverse subjects make sure to get to the root of the problem and just take a minute and listen to people, and it has helped tremendously, and I've I've helped more employers that way starting that way than by just bowling them over which I think is with somebody who's engaged in her subject and in the sales arena, a pretty common problem buffet. What a great example. And yeah, you know, we tend to get excited for our ideas. And the things that we are sort of me deepen doesn't mean that our customers are going to be as excited about it. I've been a great call out there. Alison, what would you say? One of your proudest. Medical leadership experiences has been to date. I've been asked to lead in my past. Life. As an owning an enrollment firm, some pretty large enrollments, and I've been pretty fortunate to be able to pry people away from other opportunities to come work in my enrollments. And that means that I'm providing good work for my enrolling. And it also means that I'm providing a quality enrollment experience for both employers, and employees, and I think that one thing that employers forget is that employees have budgets to. And if you teach them how to use a health plan to their best advantage almost all of them will do it. And that is your first line of defense, a greenfield some pretty significant savings. That's a great call out. And and today with rising deductible costs. I think it's that more doable. When degree absolutely it is much more important today than it was, you know, even five years ago when you had a two hundred and fifty dollars. One thousand dollar out of pocket max that was not as scary as having a fifteen hundred or twenty five hundred or five thousand dollar deductible and a sixty three hundred sixty five hundred or thirteen thousand dollar out of pocket. Maximum when eighty percent of employees have less than a thousand dollars to cover an unexpected expense, let alone and unexpected medical expense and the fallout from that is not just that they don't seek care. They're often non compliant with their medication and that will lead to bigger claims down the road. So the sort of oxymoronic thing is that the way to control your cost is actually to deliver care and make sure your employees are getting and using care. So you avoid the unexpected spikes, so true. And you know, I was I was doing an interview Allison with a gentleman from Denmark, and you know, we got into a conversation about taxation bid their tax rate is pretty high but unit. Versity in healthcare is included. And we got an on this conversation. Like, hey, you know, what I mean, what is our net tax here in this country when sixty six percent of bankruptcies are happening because of healthcare related issues. You said eighty percent of people don't have more than a thousand bucks to pay for out of pocket stuff. I mean, that's scary. That is scary, particularly if you're the employees, right? And then as the as the employer, you know, what are you doing to because when people get into the situation, I it becomes stressful, and you could lose talent. So definitely a very important topic. That Allison is is is approaching with us here today. Alison, what about your book? Tell us a little bit about your book. What gems can people find in their obviously, we only have thirty minutes today. But what kind of a preview could you give them? The book is a collaborative effort of a group of advisers that want to remain relevant and useful to their clients. And we're all independent we all do things a little bit differently. But we all have. A common theme. And that is we want to help employers offer the best benefits that they can at the best possible price and there's a ton of ways to do that. So my take is in there, and there's twenty eight other takes in there. And there are how to manage yourself funded plan. How to move along the healthcare glide path into further control of your plan and all the strategies to do that there are ways to manage short-term disability programs. So that your employees are getting the best benefit with the least possible tax consequence in the least possible premium there are ways in their chew use enhanced or voluntary benefits to help pad packages and not overburden the employees because that's a real problem. Sometimes there's tools in there or discussion about how to enter a captive or a coalition when you should be self funded. What things you can do as? Fully insured employer to help control your costs. How to manage an enrollment effectively how that is really a year long effort and not a two day effort. And if you make it a year long effort, the two days will not be nearly as stressful as they typically are all kinds of statistics about how employees is used benefit. How important care management is and helping direct people to the best places for care and best does not necessarily mean the least expensive it does mean the highest quality. And that is normally not the most expensive awesome. Folks. This is like a desk reference that you can have and bottom line is this you, you know, you hire an accountant to do your books you hire an attorney to do your contracts today's age, if you're not investing in a professional to help you with your healthcare benefits, you're leaving money on the table and MS the bottom line. So the book is breaking through the status. Quo will leave a link to that on the show notes. So that you could take a look and buy it for best reference for you or whoever's helping you with these benefits and fear provider something to think about too, right? You gotta be understanding how to work with employers today. Tell us about an exciting project that you're working on today. Alison, well, we're doing a couple of exciting things. But one thing I do want to talk about is direct contracting, and how helpful that can be to both of a provider a hospital facility or a large physician group as it can be to an employer, and we have a couple of systems in San Antonio that have direct contracts with some of the larger employers, and what that looks like is let's say that a large employer contracts with a particular facility to handle all of their knee surgeries. And that's just a a small specific example. Yeah, what that means. Is that the facility and the provide and the? The employer have agreed on a protocol and a cost and the facility has to meet the requirements of the employer and when an employee needs a knee surgery. The price is agreed upon a head of time. The employee goes to the facility has the knee surgery gets all their follow up care physical therapy. Whatever it is that is part of the protocol. The provider is paid quickly usually just on an invoice without providing any notes or having any sort of negotiation about what was done. What wasn't done the employer pays a lower cost for that? And may pass some of those savings and often passes those savings onto the employees. So the employee may pay nothing or a much smaller copay rather than their full deductible. So it's a win for the employees. It's a win for the employer. And it's a win for the local facility, which is probably delivering good care anyway to go direct and receive quick payment and a regular stream of patients being a great. Great to consider these these types of contracts in you know, what is the sweet spot Alison gives you know. I I hear that the numbers twenty five hundred three thousand employees type companies are can smaller companies do this with their providers. It depends on the TPA. And I think that's where a well-qualified advisor can be so important those contracts with the larger employers are managed direct, but with mid-size employers those contracts can be managed through the third party administrator. So that a smaller employer one hundred eighty two hundred five hundred even down to fifty lives sometimes can have access to those sorts of benefits. And there's a big difference. If you're gonna pay thirty six thousand dollars for surgery or seventy five that's a lot of money huge. So it's kind of like a pooling type of mechanism through the TPA. So TPA is third party administrator. And they administer your plant. So they act sort of like your insurance company. They follow the rules that you've established. And there some pretty standardized sets of rules, would you can cost Mayes and to make sure that claims are being paid appropriately and in a timely fashion. And that the diagnoses are correct. And that the service was actually delivered. So all that fiduciary kind of stuff, and then they provide if they have direct contracts with that they have other cost containment solutions that all happens in the third party administrators office, not the employer because most employers have enough to do. And then when you're self insured that claims run just goes to the employer, the employer will review it. They generally review it in a diagnosis and cost containment cost way. Only not necessarily identifying who the employee is. And they then they release the funds. So a TPA can do a lot of things for an employer. Whereas when you're fully insured, you pay your premium, and you hope for the best. I got it makes a lot of sense definitely valuable review here wish we had more time to dive in Allison, maybe we'll do a part to we're going to head into a part of the podcast where we do a lightning round with you. It's the syllabus on Allison's Polly being amazing at your health care plan. And so I've got four questions for you lightening around style. Alison, followed by a book that you recommend listeners ready. Sure, what is the best way to improve your healthcare outcomes with your insurance? Eliminate the misaligned incentives in your plan. What's the biggest mistake or pitfall to avoid thinking that you are controlling your risk by remaining, fully insured? All you are doing is managing the financing of the risk. You're not managing the risk itself. Which is riskier so good. How do you stay relevant as an organization despite constant change. Always be learning. What is one area of focus that drives everything in your organization employees have budgets chew? To love that and besides breaking through the status quo. What book would you recommend the listeners? I think anything by Malcolm glad well outliers is one of my favorites. Blink. I think is particularly useful in our conversation today following your gut and practice practice practice low that I am big fan of Gladwin as well. Check those out folks if you want to access the show notes, go to outcomes, rocket dot health slash paulie, at P A O L I P A O L I outcomes rocket dot health slash Polly. And you're gonna find all that bear Alison this has been a ton of fun. I love a time today if you can just share a closing thought, and then the best place with the listeners could get in touch with her interact with you sure, it has been a lot of fun today. Thank you. So as a closing thought, I would say don't be afraid of taking on your health plan, and you managing it and not. Got it managing you. Amen. Love. And to get a hold of me. You can go to my website Alison to Polly dot com. A L L. I S O N D E P A O L I dot com forward slash rocket. I've got an e book there that people can download if they wish all the steps the five steps that I use to help employers gain control and predictability, and there's some video on there that talks about that as well. Sometimes that's a little bit easier. And I'm happy to answer any questions that anytime outstanding. And hey, we appreciate your time. And folks take Allison up on that he book go to her website and will provide a link on our show notes as well outcomes, rocket dot health slash, paulie. And that's P A O L I, you're gonna find that. So check out any book Allison is has been a true, pleasure preciado. You're spending time with us. Thanks for having me. Thanks for listening to the outcomes rocket podcast, be shoot. A visit us on the web at WWW dot outcomes walking dot com for the show notes resources inspiration and so much more.