This week’s The Broker’s Voice I am joined by Mike Rohlmeier and Bob McCollins.

Mike from Carepath Benefits and Bob from Edison Health Solutions are two thought leaders in healthcare benefits. They are here to make an announcement that will have an impact for any health insurance broker out there who has small to midsize business. Something that promises to be “A Level-Funded Solution Like No Other”

Mike Rohlmeier – LinkedIn

Bob McCollins – LinkedIn

 

Resources:

 

Video Transcript:

Andy
Hey, Hey. Welcome back to the brokers voice. I am excited today because we not only have one person on the episode today, we have two thought leaders. So I’m excited because these two are making an announcement right now that I think is going to be a very, very impactful announcement for any broker, any insurance health insurance broker out there who has small to midsize business, you know, groups with anywhere from 5 to 50 employees.

Andy
And so if that’s, you, this is an episode you definitely want to listen in to because this is a big, big announcementEdison Health Solutions. So without further ado, Mike Rohlmeier from Carepath Benefits, Bob McCollins from Edison Health. Welcome aboard, my friends.

Mike and Bob
Thank you and good to see you.

Andy
And so, well, let’s just kick this thing off. Who wants to make the announcement? Mike?

Mike and Bob
Let’s go and do it. Let’s do it. Well, Carepath As of as many may have seen, as of 9/1, Carepath has partnered with Edison Health Solutions to be their TPA of choice. It is a heck of a partnership. The way we see it, What Edison’s going to offer for our members or for Carepath members is access to benefits that they don’t have elsewhere.

Mike and Bob
You know, something different in the market. And to your point, small groups from, you know, 2 to 50 now have access to benefits that Fortune 500, even Fortune 100 Bob might say, down to that they have access to benefits similar to those a very large company. So we’re we’re pleased and excited to make the announcement.

Andy
Well, before we dive into more about what this is going to mean, let’s actually take a step back. And Bob, I’m going to throw it over to you first, because Edison Health Solutions is going to be a big, big part of this, this solution that’s going to be offered to the small to midsize client employers out there for the folks listening in who are like, okay, wait, hold on.

Andy
Edison Health Solutions. Not sure what that is. Why don’t we start with what is? Tell us a little bit about the Edison health. How was it started? What when was it found? Who founded it? And what are you guys doing today?

Mike and Bob
Well, thanks. It is a story that goes back many, many years. And it actually goes back to 1992 when our founder of Edison Health Care, Tom Emerick, was handpicked by Sam Walton of Walmart to come in and address Wal-Mart’s health care costs issues, risk management issues and health improvement issues. And Tom, as he is very well known for and Wal-Mart is known for, built the first destination Centers of excellence, meaning he went out and created direct contracts for care for cardiac and cancer and complex pediatric musculoskeletal with entities like the Mayo Clinic, the Cleveland Clinic, Boston Children’s, the Andrews Institute.

Mike and Bob
So these are the best of the best. These are bringing the best the best health care solutions to the members of Wal-Mart. That’s what Tom’s known for. When Tom retired from Wal, he had several companies reaching out to him. So in 19 in in 2012, Tom started Edison Health Care, and that’s probably the name. Most of the brokers and benefit advisors are aware of.

Mike and Bob
Edison Health Care, Destination, Centers of Excellence, Tom Emerick And then in 2014, Tom brought in partners Jared Frye and Sean Rutledge to really build and grow Edison Health Care. And that was the exposure again. And that’s where we’re working with people like Dillard’s and and Amazon and Valparaiso University and Kindred at Health, Kindred at home, health care. But they saw a gap in the delivery and the value of Edison health care.

Mike and Bob
So a little over a year ago, they purchased the TPA that was the claims administrator for the Edison Health Care claims, the TPA out of Tulsa, Oklahoma. We rebranded it Edison Health Solutions last July, and now we’re in the market as a full service health care plan, replacement operation, working with benefit advisors. And what’s really exciting for us with Mike and David of Carepath is we are a solution for all size employers and that’s something that often we got asked about and now we have a way to help the small and mid-sized employer with the Partnership with Carepath.

Andy
That’s awesome. I can remember in 2014 I was at a UVA conference back in Chicago and I was that typical average broker at that point, not knowing a whole lot about self-funding and all these other cost containment ideas that existed. Right. And I remember listening to Tom speak and I said in my head, I’m going, I don’t know who this guy is, but wow, like, talk about smart.

Andy
Like it it almost overwhelmed you how much he knew about benefits and how to develop an effective health insurance ecosystem. So, yeah, I remember the first time I met him is he’s a game changing individual for sure. Mike, how about you? Carepath benefits. You guys are probably a little newer on the scene than Edison, right? Tell us a little bit about who Carepath is and who you serve.

Mike and Bob
So yeah, we’re working on just past our first year, about 14 months in. We serve small to midsize businesses. We want to serve the broker that serves those groups as well too. To 50 is really our niche, but we certainly serve, you know, serve larger groups as well. We want to offer choices to those small groups, right? A lot of times those small groups get overlooked because brokers either don’t have time for them, they may not make the money that they’re they expect to make or want to make.

Mike and Bob
So they feel those small groups feel left out. And the brokers that serve them feel like all they can do is say, Here’s the Blue Cross, here’s the Cigna and move on. Care Back wants to be the option that they go to the give the small groups what they deserve, a choice in their in their health benefits and you know and give them quality benefits that they can afford.

Andy
Yeah no I this is why I am going to love this episode because I think a lot of brokers in our industry loves to commoditize things. Right. And so they hear you. Mike. You talk about care, but oh, okay. So you are another level funded solution, right? And great. You’re one of the dozens I know now. But with this partnership, again, we said it at the beginning of the episode, this is going to provide or bring a solution that small businesses just did not have access to.

Andy
So let’s talk about that a little bit. And either one of you, either one can can chime in here. Let’s just start diving into okay, what are we talking about? What are some of these opportunities that these companies are going to have that they didn’t even have a choice to look at just a few years ago?

Mike and Bob
I can start with that. Well, first and foremost, again, go back to the beginning of the story. You know, Wal-Mart’s destination, centers of excellence. And then with Tom left there started Edison Health Care. So a two employee life group has access to the same centers of excellence, The same concept of the patient comes first, get the diagnosis correct, and get them to the highest quality care provider quickly to optimize the outcome for the patient and for themselves.

Mike and Bob
As the employer now taking on the value of the risk and risk management. So the ability for it to the 50 life group that just that just doesn’t exist out there for nobody really. Analysts say nobody really cares. But that really is foundational part of the program. Then on top of that, we also have over 200,000 contracted right now, direct contracts with physicians to support the pre care for that patient and the post care back in their community.

Mike and Bob
Again, that favors nicely high quality providers with a direct contract in place 200,000 so far. With more to come, we’re going to continue to build that out. Being able to take that and again, partner with Mike and David in the care path folks, and deliver that value to the small to midsize employer. Again, I just don’t know of any other level funded program out there that has that value added in from a robust organization like that.

Mike and Bob
US in health care and some health solutions.

Andy
Yeah, and one thing I love about doing these episodes, guys, when I’m sitting on the side, I get to be the I get to play the ignorant individual that’s going to ask like the question that I need the basic answers for. So Bob, let’s start here. What is a center of excellence for somebody who’s listening going, I don’t even know what a center of excellence means to find that.

Mike and Bob
Well, I’m going to use the word smart care center in defining Edison Health Care, because there’s a number of centers of excellence. If you look at any national carrier PPO, you’ve got stars, you got different things that designate a centers of excellence. But what Tom built and brought to Edison Health Care was a certain profile of a health care delivery system.

Mike and Bob
It’s a multidisciplinary team. You have peer upon peer to peer reviewing that individual’s health care issue. What Tom found and what we still have today is an epidemic and misdiagnosis, overutilization and suboptimal care. And critical to what Tom built and what we believe today is we have to get the diagnosis correct. So that multidisciplinary team, for example, is going to address the fact that 30% of all cancer diagnosis, initial diagnosis are either completely wrong or have the wrong care path treatment for the type of cancer that you have.

Mike and Bob
60% of all spine surgeries are unnecessary. You don’t need to be cut 40% of cardiac events. There’s other forms of treatment or another diagnosis that would have been appropriate. So when you take Tom’s approach of a multidisciplinary team, get the diagnosis correct and bring that together with getting them to the highest quality care provider quickly, That’s what makes the Smart Care center different from a centers of excellence.

Mike and Bob
These folks go through a two year vetting process and then annually they’re audited to continue to meet the demands and the needs that we expect to see them deliver care for our patients.

Andy
All right, Mike, I’m gonna throw the tough question over to you. You’re ready?

Mike and Bob
Absolutely.

Andy
I’m a small business owner listening in or an advisor who’s got a book full of them. Great centers of excellence. You’re going to. You’re going to send employees to better health care facilities. What does that do for me? I’m staring at premiums that keep going up every year. How is that going to help me control my health insurance cost?

Mike and Bob
Absolutely. On top of the, you know, the choices that the carepath plan just inherently have built in just 12 different options that we have the bolt on of the the centers of excellence that we are now able to access with Edison allows for negotiated pricing with those high end great performing service centers. It has an outcome percentage that is higher than most or better than most.

Mike and Bob
So you’re getting your employee healed quickly at a you know, at a set price. You know what you’re getting. And on top of all of that, we’re working to get it so that it’s a $0 cost to the member. So the is getting healed quickly. They’re getting healed by great doctors at a great facility and it’s not costing them anything to go to these centers of excellence.

Mike and Bob
So if you want to know what you’re providing for your employees, I mean, you can’t do much better than that.

Andy
No, you’re absolutely right. I think with level funding, the carrot’s always been you get the opportunity to get money back from unused premium. Right. And Mike, you know this very well. Let’s be honest. Some level funded plans are what I would call rigged. Your opportunity to get money back are very, very low. And what you’re doing with centers of excellence is the better care you give, the better outcomes, the lower cost they’ll have, which gives that employer a better opportunity to get money back, which is the whole point.

Andy
So, Bob, talk a little bit about I believe there’s also direction tracting involved, right?

Mike and Bob
There is direct contracting with our smart care centers. But then we also have a network of a growing network of ancillary service providers, MRI’s, x rays, ambulatory surgical centers, direct contracts with physicians and specialists. That’s our evolution network. Currently, it’s over 200,000 providers out there. We continue to look to grow and add to that and really strategically in markets where Carepath is having success, but to grow that network out so we can continue to build on again, getting people to the highest quality care provider that’s going to take care of them, but also incent them with no out-of-pocket costs, you know, no co-pay, no deductible.

Mike and Bob
That’s the incentive for the person to go to that high quality care provider. But again, those direct contracts are also going to allow Mike and the Care Pat team to deliver a very competitively priced product and maximize that opportunity, deliver that big old check at the end.

Andy
Well, and so I’m going to ask the question some might be thinking again, talk to or walk us through briefly walk us through what’s a direct contract? What does that mean?

Mike and Bob
Well, it means that we have gone in not unlike, but similar to a medicare Plus type, A reference based pricing type, an agreement that says when our patients come to you to see you for these services, this is what we’re going to pay you. This is what you’re going to be reimbursed. And the providers like it because, quite frankly, they’re not chasing dollars, they’re not chasing dollars from the patient.

Mike and Bob
They know what they’re going to get paid. We believe that if you’re a high quality provider, you should be paid appropriately. We’re not trying to nickel and dime. We want to pay you reasonably, reasonably being the key. So we have a reasonable agreement to pay you what you’re worth for the quality of care that you’re going to deliver.

Mike and Bob
And with that contract in place, when somebody goes to see you, boom, that’s it. It’s a no noise type of situation.

Andy
That’s awesome. Yeah. No, I think that’s really important with direct contracting for people to understand that, because when you go to a health care facility and you agree to a certain price that is guaranteeing that employer who offers the plan, if an employee goes there, you know exactly what you are going to pay, which is what we have all asked for from the health care system.

Andy
And Mike, you said it. If that employee does it, guess what? They don’t pay anything. The employee does not pay anything. So, Mike, I’ve got a question for you. I’m listening and I’ve gone. This is great. Like how my how are my employees going to know how to use this? You guys have an added feature in the program that really helps make sure employees have an easy access to, let’s call it a human so that they can make the right decisions to go to the right places for care.

Andy
Talk about that for a little bit.

Mike and Bob
Sure. So we have actually a couple of different programs, but that actually talk to humans and work work with one on one patients, whether it be through benefit navigation, finding the right place of service. You know, that that is one of the lowest cost, highest quality for and appropriate for what they need. Additionally, they walk them through from, you know, from any episode of care from the beginning through the end.

Mike and Bob
So it’s not just a wild goose chase. Where do I go? How does this work? And we communicate that one with the member. We communicate that with the broker and with the group so the group can be aware the person at the group, which sometimes when it’s a two or three or four life group, might be the same person that’s having the service.

Mike and Bob
Or maybe the wife or husband of the person. So it’s good to have everyone know how that works. So if there’s questions, which is always going to be questions in that time of stress, you’re trying to get healed and something’s wrong and things are just going on. There’s always it’s always good to have somebody to fall back to you, to talk to a real person and and you get those the next guidance to the steps that you need to do.

Andy
Yeah, I wanted everybody to hear everything we just talked about because at the end of the day, what you guys are now opening the door to is brokers who have smaller clients that forever have been shown the spreadsheet of fully insured carriers in their market. They’ve been told to pick one, pick the cheapest this year, and next year will pick the other cheapest.

Andy
Now we have an option to give them something different, an option to get to control their cost, to get money back. If they don’t use all of their premium. But on top of that, there’s an opportunity for these employers to give their employees access to the right health care at very affordable prices. Like you said, Bob, you’re not penny pinching.

Andy
You’re not trying to nickel and dime them, just an agreed upon affordable price. But you’re also incenting employees by eliminating their out-of-pocket limits when they make these choices and giving them access to somebody to help them make those choices like this could not be easier. So the million dollar question, both of you either one can answer. I’m an advisor listening in.

Andy
I got Q4 coming up, ton of renewals, small group. How the heck do I get started with you guys.

Mike and Bob
Easy so we are carepath benefits dot com and go to our website there is all of there’s a RFP page so you can drop information for find the information to submit to us census current rates and and an employer app and we’re off so it all can all be done through email. We’re available on either apps or form fire or health apps are so we’re out there.

Mike and Bob
Easy to get another way. Just shoot me an email, make it care about benefits dot com and we’ll get started.

Andy
So even for 10/1 renewals Mike we’re going to go?

Mike and Bob
10/1 is pushing it but we can we can certainly work it but yeah 11/1 and working 12/1 and 1/1’s now so we’re we’re moving.

Andy
I’m giving you the mic two to leave your last golden nugget. If, if you’re out talking to advisors who this is a fit for knowing they are about to head into their most stressful, anxiety inducing season, what advice would you give them?

Mike and Bob
Certainly reach out and take a look at care. Pet benefits from the standpoint is, as Mike said, you need options. You kind of been doing the same old same old every year. This is a great option for the small and midsize employer. And I will say that that what attracted me and Edison Health Solutions to work with Mike and David and Stephanie at care pet benefits you’re good people and and the type of advisors we want to work with I use the term plus or people like us.

Mike and Bob
We’re good people. We want to do the right thing. Mike and David and Stephanie really have a heart and passion to help the small and midsize business owner and that really resonated with me. And so benefit advisors, if you want people who care to support you, be in your corner, have your back for your employer prospects and clients, you need to consider Carepath Benefits.

Andy
Couldn’t have said it better myself. So guys, I want to thank you for your time. If you are listening in again, if you have a book of business that is made up of those groups, 2 to 50 specially, this is the year you got to give them something different. Quit showing them the same stuff every single year. It’s that stuff no longer works. You’re putting a Band-Aid on the real problem. So take a look at a program like Carepath. It is a completely different solution, something your clients have never seen, and it’s giving them an option that they didn’t even know was available. So, guys, thank you one more time. This has been awesome. And for everybody else listening and reach out to these guys, look at what they’re doing this fourth quarter season because you know what happens when you mix clarity with confidence? You do massive things. You need to do some special things for your clients. Is fourth quarter. Take care.