Ep #475: Revolutionizing Company Healthcare: The Power of Direct Primary Care - with Ryan Robbins

David Saltzman: 0:01

What happens when two industry benefits veterans who believe the market is a mess, set out to build a matter of mousetrap. We'll find out on this episode of Shift Shapers.

Host: 0:14

This is the Shift Shapers podcast, connecting benefits advisors with thought leaders and entrepreneurs who are shaping the shifts in the industry. And now here's your host, David Saltzman.

David Saltzman: 0:27

And to help us answer that question, we've invited Ryan Robbins. Ryan is a co-founder at Ello Benefits. Ryan, welcome to the podcast. Thanks for having me.

Ryan Robbins: 0:37

I appreciate it Big time.

David Saltzman: 0:39

Hey, one of the places that we always like to start because almost nobody has a straight line to you know story to this is what's your journey been like? How do you end up being doing what you're doing today?

Ryan Robbins: 0:49

It's been a wild ride. It's been a lot of fun. I jokingly say that I entered the healthcare business because as a kid I broke 18 bones, had three concussions, 30 stitches, three surgeries and knocked my front teeth out three times. So I was like you know what I'm going to help people be able to afford how to fix their body when they heard it and jokingly, that's why I say that I got into the business and ultimately it was for somebody that wants to help people but also can loves to talk numbers and data and statistics. This industry is really the perfect blend of being able to use both of those skill sets and really that's how I landed in this business and I absolutely fell in love with it and have now been in the business for a little over a decade now.

David Saltzman: 1:43

That's great. So what was the problem that you saw that caused you guys to start thinking about gee, we've got a better mousetrap, We've got a better paradigm.

Ryan Robbins: 1:55

I think the biggest thing was really our heart really went out for the underserviced market. And underserviced market really it varies based off of which city and which state you're working out of being in the heartland region. Groups that were under 100 employees were just underserviced. It didn't have a lot of extra support. Really helping people think outside the box and be creative and strategic, and that was where we were most passionate. That was where we felt like we were able to make such a big difference.

Ryan Robbins: 2:43

And so one of the things, one of the concepts that has just been a foundation and a foundational principle for our boutique benefits consulting firm, is being able to bring some of those big ideas downstream to the smaller employers and to the mid-market, and Oklahoma is. You know, oklahoma City is where we're located. It's not a huge large employer type of state. There's a lot of business that's under 250 employees and so many people were just kind of you know, here's a sheet of paper, pick what you want and go from there.

Ryan Robbins: 3:26

Um, when I realized how much opportunity there was to really bring some of those big ideas downstream to smaller groups, that just became what we were so passionate about. And so you know it sounds a little bit cliche, but I mean we've got a 2,000 employee group and a two employee snow cone stand, you know, it's like we've got the heart for the small groups and we've got the knowledge and the experience for the large. And when we realized that there's so many different opportunities for savings available, that's when we were like we can really focus in on this and really be a part of the movement of trying to kind of flip a broken healthcare system for businesses.

David Saltzman: 4:17

So, as you educate folks about what you're doing and what your thought process around the business is, what are the top three or four things that you talk about?

Ryan Robbins: 4:29

I think that the top things that we talk about. We've been a big proponent of direct primary care and kind of the free market movement into the healthcare world, and we've seen more and more employers that are finally fed up with the buccas of the world controlling their healthcare experience, and so for the first time we've started to see a significant blend of employers marrying the concept of major medical insurance for major medical insurance needs and then kind of a free market concierge approach for all the day-to-day medical needs, and so that's been something that we've been very, very passionate about. We've got some fantastic partners in the DPC space and ironically we probably receive more referrals from physicians than we do any other business-to-business consultant in the business, because physicians that have a direct primary care-based practice they're thrilled to have the opportunity to be integrated into employer group health plans. So we've been really focused on trying to build out a way that makes logical and financial sense to be able to bolt on the direct primary care benefit on top of the core benefits programs, and the awesome part about that is it's a fantastic healthcare experience for the employees where they can go to the doctor as often as they want for no copay, for no charge. They're spending, you know, 20, 30, 40 minutes with their physician, versus two, three, four minutes in the traditional healthcare world.

Ryan Robbins: 6:26

But on top of that, it's been one of the best integrations into the benefits plan to actually bend the trend of healthcare costs down, because you're pulling all of those day-to-day acute medical service claims off the insurance whenever they're going to their direct primary care physician, and not only are they preventing emergency room visits, they're preventing urgent care visits. All of the day-to-day acute and generic medications are covered. None of that touches the insurance. And on top of that, the management of chronic conditions is significantly improved when there's a personalized relationship with their physician, where it's trustworthy, it's convenient, it's free to be able to talk to their doctor, and so we see just a significant improvement of the claims.

Ryan Robbins: 7:23

And so for us to be able to bolt on a strategy like that on top of a self-insured plan, a level-funded plan or even a fully-insured plan that is rated based off of experience and claims, when you're pulling the DPC and the day-to-day out of the mix, I mean we're seeing rate reductions and we're seeing, on the level-funded side, we're seeing huge surpluses going back to employers because, frankly, their claims are just not showing up there.

Ryan Robbins: 8:00

And so the direct primary care concept has been something that is really exciting for us and, being in Oklahoma City where there is a movement in the free-market healthcare world, there's a lot of there's a lot of excitement around kind of that concierge approach and ironically a lot of brokers run away from it and they view it somewhat as competition because, you know, because they're not making a commission on it or they're that you know they're not familiar with it or that's taking away from what the insurance company builds together. And so we're kind of on an island from a benefits consulting perspective, as being consultants who have really pursued integrating direct primary care on top of the major medical. So that's been kind of a unique concept that's been very, very successful over the last couple of years.

David Saltzman: 9:05

Well, I think you know, I think you'll agree with this Direct primary care also solves the problem of folks who are functionally uninsured. Right, if you know, if you've got somebody who's making thirty, six, forty thousand dollars a year and as a family they may have a card in their wallet, but if they're deductibles for grand, they can't afford to use it, and so I guess you also see I don't know, you know there's anecdotal evidence of this. If you have any empirical evidence I'll be glad to take it. But you also don't see the claims that result from delayed care, because people will. Well, I can just call Dr X and they can see me today, and, and, and, and, and. Have you been able to capture any of that, or is it still kind of mostly anecdotal, even though we all know that it makes sense?

Ryan Robbins: 9:42

Um, I so on some of the larger groups that we have. We've had some fantastic data that has been pulled of, just just the savings of being able to have immediate access to two year physician. Um, I mean, we've had, we had a new employee that started with us and two months after she started and she's on a six thousand dollar deductible plan, um, and she, she fell rollerblading and it was on a Sunday evening and she was like let me give this DPC thing a try and FaceTime the physician and the physician literally met her at the clinic on a Sunday evening to get her stitched up and paid zero dollars and it's just you know what that prevented, you know from the claim side of things, but what that also prevented from the employee having to pay out of pocket. Like that's a big deal, um, and so you know, in the in the past we've seen, you know um, I think every you know benefits consultant that's gone out and done open enrollment meetings and education meetings with their team, with their, their clients, has has received a lot of pushback from employer employees over the last five, 10 years, where costs costs are getting more expensive and carriers are taking more benefits away, deductibles are going up, coinsurance is going down, all these different things, and you know, it almost seemed like there was more horror stories, um, or question marks on the insurance than success stories.

Ryan Robbins: 11:11

And now, with this integration, it seems like seems like every time we go back out there someone's got a new exciting story to tell about something that they needed from a healthcare perspective and they were able to contact their physician, get care immediately. And you can just see, you know, you can just see the HR and the executive and the leadership team of groups whenever that's happening and their employees are actually exchanging positive healthcare stories amongst each other. You can just see the weight lifted off their shoulders. They just are, they're just lean back and they're like this is the right answer for us. And so that's been a paradigm shift from what I've seen, where it's kind of tense of I hope the employees are going to be okay with passing more cost and the deductible went up this year. You know, I hope no one's going to storm out of this open enrollment meeting and so just the positive experience that we've received and feedback that we've received has been fantastic.

David Saltzman: 12:10

Do you find when you do employee education, do you find that there's an initial confusion? They're not quite sure how, because it doesn't seem like. It seems like this is like showing them a carrot and a cucumber and saying they're the same thing and they're not used to this. How do you? A better question is how do you educate employees to understand that this is really like a two-layered plan?

Ryan Robbins: 12:34

Yeah, that's a great point and that's been something that has been a challenge that we've worked with these physicians on for the last several years, and the problem with it was that five years ago, dpc physicians viewed insurance companies as the enemy and they wanted to integrate into group health plans and be considered an employer group sponsored benefit. But meanwhile their entire mantra was bashing insurance companies, and so for the last three or four years I've been working with physicians to be able to say guys, you're not enemies, but a marriage between the two of you is better is it's a one plus one equals 10 situation. So we've been having these conversations and really we spend a lot of time with the physicians and encouraging them to understand whether or not the employee has insurance or, if they don't have insurance, are they on a high deductible health plan? Are they not on a high deductible health plan? So we encourage all of our physicians to house in their system whether or not a patient is insured or not insured, and we put a big focus on it. We actually, when we go out and do enrollment meetings with our clients, we will actually bring physicians to the open enrollment meetings with us, and that's something that no other broker I've really seen do before and we had a meeting last month and we had three separate physicians show up and each physician represented an area by where their employees were majority lived and we went out there and we were able to talk.

Ryan Robbins: 14:18

I go out and my team talks about how the when and how the core medical insurance should be used, and then the DPC physicians go in and they talk about what they can accommodate within their clinic and when you should use that, and then we kind of open it up for scenarios of just making sure that there's no overlap and making sure that everybody truly understands that. And a good example of that is if you've got somebody who's at age for colonoscopy or for a mammogram, where that's covered at 100% and the preventive services will. A lot of DPC doctors, their entire network is filled with cash pay physicians and specialists, and so they're like, oh, you need a colonoscopy. Well, I got a guy who does the cheapest colonoscopy in town 450 bucks a pop. You know, at the hospital they're going to charge $2,000. Well, if they understand that they have insurance and that it's a 100% preventive service, rather than sending them to a non-insurance free market provider, they encourage the employee to use their insurance and get that free benefit.

Ryan Robbins: 15:32

So it's kind of a two pronged answer on this. On one hand is we're we're very hyper focused on a a positive enrollment education experience by bringing physicians with our team to go out and do the open enrollment meetings, but then also, on the back end of that, actually working with also educating the physicians on hey be kind of their point of care. There they're concierge of understanding if it's not something that you can handle in your clinic and there needs to be any sort of follow up, Do a little bit of due diligence and check to see if they have insurance and and be able to direct based off of that scenario. Because ultimately we all are working for the same common goal, which is getting access to affordable health care and helping the physicians to understand that. And by doing that we've seen a significant improvement because they can rely on their physician to kind of help direct them for the care.

Ryan Robbins: 16:35

And the physicians now are playing a lot more friendly and understanding that that they have their sandbox of the DPC and what they cover, but fully knowing that if they're going to sell this and offer this on a group sponsored level, there still is a place in the sandbox for the major medical insurance, for the things that they can't do internally.

Ryan Robbins: 16:57

So that's just kind of been a an ongoing development and over the last year I feel like we've we've gotten to a place where everybody is working so well together and built some extremely beneficial relationships and and it's a blast going out to these groups and just being able to talk about you know a new way of being able to get it. And the cool thing about where I'm from is you know the top five. You know best employers in our state use this program for their employees and they Attract and retain incredible employees because of this. They're they're really proud of it and it's it. I love being able to go into a group and be able to say, yeah, we've got that exact same solution and we can bring that downstream to your Ten employee business, to your 300 employee business. You don't have to be a 5000 employees self funded employer to be able to to access this, like this level of care.

David Saltzman: 17:58

You know it's fascinating. On the employee education, I was having a conversation with a friend because I don't sell I haven't for a long time now, I'm just in the marketing space but they're they need an MRI. Their backs been bothering them and their doctor is sending them for an MRI, of course at the local hospital. And I said why are you going there? Just curious. Well, that's where my doctor recommended. But, more important, they take my insurance.

David Saltzman: 18:21

I said what's your deductible? I said $4000, so it's so you're paying for this yourself, yeah. And you see the light dawn slowly and they say, well, yeah, I guess so. Well, if you're going to pay for it yourself when you rather go someplace where it's 600 bucks. And then then all of a sudden, the eyes slam open and it's it's like when people use the good Rx cards, right, they go to the pharmacy and they realize they can buy their prescription for less, paying a few bucks in cash. Then they can using their, their, their their pharmacy plan, that's on their core plan. I have a question about data, though. I know one of the things that employers like to see, especially self funded employers, is data. It's one of the reasons that they buy those plans. Are you finding that? I know it's been tough for a while to find direct primary care docs who actually aggregate or data the data for their practice and then are able to send it back over to the plan? Is that starting to change?

Ryan Robbins: 19:19

Yeah, I do think that I do think, at least, at least geographically located, where I am, the physicians have some, some relationships with some tech companies that help to be able to pull data and because the movement is pretty strong in Oklahoma and the kind of the heartland area they're, they're gathering data to be able to help tell the story and so, but I will say that that a lot of these groups have, you know, like probably one of the most long tenured group sponsored DPC is only probably three to four years old, and so it's taken a little bit of time to be able to get some of that data.

Ryan Robbins: 20:07

One of the partners that we work with they work with a large employer and the employer actually aggregated all of the data and was able to basically prepare report. The said this is what we project, that we were able to save by incorporating your, your DPC strategy, and the numbers were astronomical, and so the fact that it came from the employer and not from the physician's office was a big deal, and so we do leverage, using some of that data whenever we're out meeting, especially with some of the larger groups that are, of course, rated based off of their claims, experience and then, of course, self-funded as well, because that's just money directly saved by the employer and for every time an employee actually has a better experience with healthcare.

David Saltzman: 20:59

Well, there's no question in there. There's also no question that DPC is almost in every way a better healthcare experience. There, right, you don't have a doc who needs to see a patient every seven or eight minutes to meet some quota that they've got a punch on. You know their reports and whatnot. You know the whole DPC movement is so fascinating because it's not a new concept, right, you know it was the American Academy of Pediatrics Pediatricians, I believe, years ago that came up with this idea of a medical home and then the HMOs thought, well, that's really cool, we can do that and it was great until the accountants got involved and some of the quants like you know, the Allen and Tovens of the world and those people, and that kind of went away and now it's coming back again.

David Saltzman: 21:39

But I think what's interesting is it's physician driven. And it's physician driven for a reason because nobody goes to medical school and and aspires to practice the way physicians are made to practice in a hospital setting. Right, you'd be, you'd be insane to do that, to rack up the debt and the amount of time and effort and dedication. And I think you know the DPC docs that I talked to are also more satisfied themselves. It's a better way for them to practice. It's the way they had envisioned doing medicine, so they're happier, their teams are happier and that transmits to the employees. Are you finding that as?

Ryan Robbins: 22:14

well, 100 percent, and you know it's. There are certain people that you can meet with and you know you're done meeting with them and you're exhausted. And there's other people that you meet with and you feel like you're just recharged, ready to conquer the world. And that's kind of what I felt with some of the physicians that that work in the DPC space, because our foundational missions between with our company and with theirs they're so aligned. It's that they care so much about people and they care about doing their part to make the health care experience better for them and we, every time I meet with them, it's just like it's. It's amazing and again, like we've developed so many strong partnerships that that whenever we pick up the phone and be like, hey, can you, can you come out and do you know three hours worth of employee education meetings, how many physicians would you know would move their schedule around to go and do that? You know not many, but just the positive energy that that comes with that they're. They're so passionate about their practice and the employees feel that I mean we, we have. We have employees that are that are thanking their employers at the end of open enrollment meetings for for bringing our team to the table and providing them with this level of health care, and like there's sometimes where it's like I had to pick my job off the ground because I'm like this is so not what I'm used to, but it's awesome, you know. And so, yeah, 100%, the physicians that are in this space are so aligned, you know, are so aligned, with kind of a people first mentality, which is what we, which is what we like to have as well, and and and and again, I mean their, their quality of life is better, the quality of the health care they provide is better. And so you know, of course, you know, being a benefits consultant, you know the, the, the, the, the sweet spot was being able to determine when to integrate the DPC benefit. That makes financial and logical sense, and it's not going away with the insurance companies, it's going. It's, it's going forward with finding that marriage between the two. And so kind of a good, a good kind of, I guess, segue into.

Ryan Robbins: 24:42

You know, your initial question of things that we're talking about would be here. We talk with every client and with every prospect that we meet with about, about level funded, of course, the larger ones, self insured, but when I'm talking, you know, a group that has under 200, 300 employees and it blows my mind how many people are not familiar with the level funded model. So A lot of times it kind of comes in tandem where we're talking about the DPC and they love the concept of the DPC and, like I had said earlier, we get a lot of referrals from physicians because the DPC benefit, especially back in the day, was reserved for more kind of the executives, the owners, and they would supplement their medical insurance with kind of their own doctor on demand, you know. And so a lot of owners and executives from companies have these long-standing DPC partnerships and now that we have built out that benefit to be able to provide it on a group level, like executives are like, wait, we can build this out in our benefits. So they're like, oh yeah, you got to talk to Ryan and we'll go and we'll integrate it.

Ryan Robbins: 26:06

One of the first things is, yeah, we can talk about how their standalone value to the DPC the better quality of health care, the convenience, the fact that it's no copay, and then what that can do to the claims. But if you're on a fully insured plan, you're kind of leaving some money on the table. You're basically supplementing a cost on top of what's already kind of built into the premium created by the insurance company. So we segue into the conversation around looking at the level-funded world, looking at reference-based pricing, looking at all of those things, and nowadays I mean there's carriers that will go down to groups that are under 10 employees for level-funded, under five even, I've seen and so that's now available and businesses are ready to take their chances. They're ready to hedge their bet against the pooled plans of the insurance companies and take a chance on their own people and their own claims for the opportunity to get a surplus at the end of the year With little risk involved at all.

Ryan Robbins: 27:15

And so anytime that I have somebody who engages with me in the sense of I'm really interested in the direct primary care, I think this would be great for my employees.

Ryan Robbins: 27:25

So they've already basically, like they've already established that they are a forward thinker and that they would be 100% on board for helping their employees to be good consumers of their healthcare, and so I already know that, with them being interested in that, that they're going to be a fantastic fit for a level-funded or a self-insured plan, because they're already willing to invest more into their people, to make them well and to lower their cost of healthcare.

Ryan Robbins: 27:56

So by pulling them off of the big fully-insured pools, they're going to win nine times out of 10. We have very few groups that don't get surpluses on the level-funded side, because the combination of taking control of your own health and then integrating strategies like DPC and then following that up with a robust education experience of helping the employees understand how best to use it that series of events yields very, very positive results, and so it doesn't matter if they're a five-employee group or if they're a 150-employee group. We're seeing significant success transitioning into the level-funded space and being able to capture some of these new concepts like DPC that are going to pull some of those claims off the table to help reinforce that surplus at the end of the year, and that's a great place to end our conversation today.

David Saltzman: 28:59

Ryan Robbins, co-founder at Ello Benefits. Ryan, thanks so much for sharing your thoughts with us.

Ryan Robbins: 29:04

Thank you so much. I really appreciate you having me. It's been awesome.

Host: 29:11

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