Maverick Magazine - Winter 2022

INNOVATIVE BENEFITS SOLUTIONS FOR VISIONARY EXECUTIVES

VOL. II • WINTER 2022

PARADISE FOUND A Florida Resort Rewrites The Rules For Benefits ALL SMILES Flossy Offers A New Way To Save On Dental Care PRAIRIE HEALTH Making Mental Health Care A Priority

HEALING FROM WITHIN

Chris Labrecque shows how increasing employee engagement reduces risk.

FROM THE FOUNDER

THE POWER OF CONNECTIONS THE WORLD TRULY IS A SMALL PLACE. Shortly after we published the first volume of Maverick this past fall, I received a lot of wonderful feedback.

Some of it came from people I had worked with over the years, and some came from folks I hadn’t yet had a chance to meet.

One of those individuals, Chris Labrecque, reached out to me after a copy of Maverick made its way to his desk at Insurance Office of America. Chris is the president of the employee benefits services division at IOA, and he was excited to see us shining a light on folks who think differently about benefits. We ended up chatting at length over the phone, and I was fascinated by the holistic view Chris has of employee benefits.

I particularly appreciated his reframing of the role of a benefits consultant as an integrator of sorts who thinks comprehensively about offsetting commercial risk across five key elements: health, financial viability, professional fulfillment, safety, and a connection to something bigger than yourself. Chris thinks holistically about the integration of these elements from the end state the business is trying to create, viewing the consultant as the architect of an implementation journey.

While plenty of folks in the benefits space are aware of these considerations, I had never heard someone so effectively communicate the overlap and interplay between these elements. I was blown away by his perspective and we decided to feature Chris in this volume of Maverick. You can learn more about him and his unique perspective on Page 38.

This issue also features incredible companies such as Gravie, which was founded by serial health care entrepreneurs Abir Sen and Marek Ciolko. The company features a health plan aptly named Comfort that covers 100 percent of most routine health care services. When it launched back in 2017, the plan was intended to help employers navigate the ongoing issue of increasing costs in health benefits. If you’d like to read more about Gravie, turn to Page 30.

I also appreciate the story of Dutch Rojas, founder and CEO of Sano Surgery. Dutch is driven by a desire to reshape the market from within, providing better cost-saving health care options that benefit consumers, employers, and providers. You can read all about Dutch and Sano Surgery on Page 18.

And that’s just a small sample of the incredible mavericks featured in this volume. I hope you enjoy learning more about them all—I certainly have—and please don’t hesitate to reach out to me to talk about the amazing things you’re doing in this space. Heck, you could wind up on the cover of our next issue!

Best wishes,

Brian Whorley, Founder brian@paytient.com

Winter 2022 • Maverick |

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CONTENTS

34

Prairie Health aims to make mental health care more accessible.

4 | Maverick • Winter 2022

INNOVATIVE BENEFITS SOLUTIONS FOR VISIONARY EXECUTIVES

ABOUT MAVERICK Maverick magazine is published by: Paytient Technologies Inc. 1601 S. Providence Road Columbia, Missouri 65211 (573) 206-9147 hello@paytient.com

Founder Brian Whorley brian@paytient.com Editor Ryan Gauthier

22

Content Strategist Morgan Williams Art Director Carolyn Preul

10

Copy Editor Sandy Selby Contributing Writers Lola Butcher JR Clark Olivia DeSmit Pamela Dimmick Jay Moore Amy Wilder

26

44

6 Get to know four innovative health

22 Flume Health designs coverage

7 Nikhil Krishnan is a Maverick You

26 Big Tree Medical Home provides

8 Dr. Jay Moore challenges us to

30 Gravie’s plan incentivizes smart

10 The Gasparilla Inn & Club offers

38 Chris Labrecque shows how

14 Flossy develops a new way to save

44 Industry leaders gather at the

18 Dutch Rojas brings patients and

46 These five factors will help

care companies.

Should Know.

improve health care from within.

benefits that work for every employee.

on dental care.

providers together.

with a custom fit.

a scalable solution for primary care.

choices.

employee engagement reduces risk.

HLTH 2021 conference.

Photographers Charlie West Christopher C. Lee Photography & Film Euphoria Arts Studio Lauren Eliot Photography Lift Division Philip Rood Sr. Puig Warren TeBrugge Photography Produced by Carriage House Publishers. Copyright Paytient Technologies Inc., 2022. All Rights Reserved. Production or use of any editorial or graphic content without the express written of Paytient Technologies Inc. is strictly prohibited. Postage paid at New Philadelphia, Ohio.

Not responsible for omissions or information which has been misrepresented to this magazine.

benefits managers plan for 2023.

Winter 2022 • Maverick |

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INDUSTRY BRIEFS

hearing :

Tuned, a hearing health service, has been named “the future of hearing health” by Hearing Tracker. The revolutionary company, which was founded in 2020, gives people the ability to take control of their hearing health by providing easy, accessible support. Employees who wear headsets deal with prolonged auditory stimulation, which can lead to tinnitus and hearing loss after just one month of exposure, causing harm to employees and affecting company productivity.

Tuned solves the question of finding the right headset or correct settings for optimum auditory health and it solves it within one hour. Employees can receive a personalized hearing profile and a more supportive headset or adjustment advice through Tuned’s website. With the largest group of private audiologists in the world, Tuned provides personalized advice and counseling with a managed servicesstyle solution. For more information visit Tunedcare.com.

nutrition:

NourishedRx is a digital health company that helps patients and health plan members find high-quality food solutions.

The company, which emphasizes food as an all-encompassing component of health and wellbeing, believes that access to high-quality and nutritious food can help prevent disease and improve the future of health care. Founded in 2019 as Project Well, the company’s AI-enabled platform matches at-risk members with personalized meal offerings vetted by registered dietitians. NourishedRx leverages behavioral science to support lasting dietary changes and improved health outcomes. The company recently launched an expanded offering of culturally relevant grocery bundles and fresh produce to reach new audience and further address food insecurity. For more information, visit NourishedRx.com.

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telehealth :

Founded in 2014 by CEO Kate Ryder, Maven Clinic is the only platform in the market that combines an expansive, specialized telehealth network of more than 30 provider types with individual care navigation to support all parents and all paths to parenthood, from fertility through pregnancy, parenting and pediatrics. Maven, the largest virtual clinic for women’s and family health, recently closed its $110 million Series D funding round, co-led by Dragoneer Investment Group and Lux Capital, with participation from BOND and existing investors Sequoia, Oak HC/FT, and Icon Ventures. Maven also welcomed Oprah Winfrey as an investor in its Series D round. This brings Maven’s total funding to more than $200 million.

Maven will use its Series D financing to expand into new populations and to invest in additional product innovation to improve clinical outcomes. For more information, visit MavenClinic.com.

platform:

Plansight offers a comprehensive RFP platform designed to make it easy to create, bid, and execute employee benefits packages. The company fosters collaboration between brokers and carriers to deliver an efficient, dynamic, and transparent renewal experience. Put simply, Plansight is a tool to help brokers and carriers get work done. For more information, visit Plansight.com. 

Q&A

NIKHIL KRISHNAN

FOUNDER, OUT-OF-POCKET

MAVERICKS you should know

a lot. Everything at Out-Of-Pocket is meant to be understandable at any level of health care experience and entertaining enough that you’ll actually get through the end of the article.

What would you say is the most transformational thing happening in your segment of the industry?

There’s a lot of new health care content that monetizes in new ways like communities, venture funds, recruiting and more, which gives a bit more flexibility in the kinds of health care content that can be created. Instead of algorithm and SEO-optimizing content, it can focus on being in-depth and for more niche audiences.

Most people would be surprised to know that my company ... ... exists.

What’s your favorite health care acronym?

MACRA, which stands for Medicare Access and CHIP Reauthorization Act of 2015. The fact that it has a nested acronym buried in the first one is just indicative of how obsessed the industry is with making things as difficult to understand as possible.

What are you working on right now?

Contact: nikhil@outofpocket.health

Tell us about Out-Of-Pocket.

We are all about teaching people how the business of health care works and where the industry is moving by using humor and accessible language. We have a newsletter, courses, and novelty products all filled with memes to make learning about health care more interesting.

How does your company address the pain points of your customers?

To learn about any part of health care you have to swim through acronyms and people saying ‘interoperability’

I’m launching a health care 101 crash course this year, which will be a new tool to help companies with recruiting. Stay updated by signing up for our e-newsletter at www.outofpocket.health.

What’s the best thing you’ve read lately?

“Catastrophic Care” by David Goldhill is excellent because it talks about health care in an accessible way, but also asks very thoughtful questions about why health care is so different from other consumer-centric industries.

What’s your favorite thing to do on weekends?

I’m a big fan of semi-structured social events and plan a ton. I host a recurring series where people give 15-minute talks on niche interests at a bar, I do lots of walking tours and in the past, I’ve organized a spicy wing competition.  Winter 2022 • Maverick |

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ESSAY

IMPROVING CARE FROM WITHIN The astronomical cost of health care creates a challenge for even the most financially savvy patients.

BY DR . JAY MO ORE

O

n a hot July morning in 2015, my phone rang at 4 a.m. No good news ever comes at 4 a.m., so I answered with a sense of dread.

My brother was on the other end of the phone, breathless.

“We’re in the car following the ambulance,” he said. “Dad’s heart stopped. They’re doing CPR. They’re headed to the ER.” I’m a doctor. My brain snapped instantly from “son mode” to “clinical mode.”

“How long was he down?” I asked.

“I don’t know … 15 minutes?” he recalled. “Is that a long time?”

My silence told my brother everything he needed to know.

“I’ll call you when we know more,” he said. “Get down here as fast as you can.”

It’s a two-hour drive from my home in St. Louis to the hospital where they were taking my dad. I was on the road by 4:15 a.m. As the Missouri countryside slid past my window, I had a lot of time to think. My family needed me. I am the oldest son, the first in my family to go to college, and the only person with medical training in the family. I knew they’d need a lot of me over the next few days.

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Somewhere in the middle of Missouri, I got the phone call that I had been dreading. My clinical training wasn’t needed as my dad had passed away in the emergency room. My brain snapped back into being a son. I pulled the car off to the side of the road and took a few moments to cry. Then I got back on the highway and kept heading deeper into the Ozarks.

HOW DID WE GET HERE?

I grew up in a double-wide mobile home in the little town of Dixon, Missouri, in the 1980s. We lived simply, but we had a lot of pride. When I started kindergarten, I brought home a letter telling my family that we qualified for free lunches.

“We don’t need that,” my dad said. “We aren’t poor. Others need that more than we do.”

My dad was trained as a land surveyor by his father, and he worked for much of his career for a telephone company in Missouri. My mom stayed home to take care of my brother and me, but we always managed to make ends meet on my dad’s salary. After I started college, my dad finally felt the financial freedom to pursue his lifelong dream: In 1995, he cashed in his pension and opened a restaurant. He was a fantastic grill master—he was always in demand at

company picnics and church events to cook up hamburgers and steaks, which he would season with a secret family recipe that he had invented using simple ingredients that he could buy at the grocery store.

The restaurant sat on a bluff overlooking the Gasconade River in Pulaski County.

I was a sophomore undergraduate at the University of Missouri when he opened it, managing to get by on scholarships and student loans. I was worried that he was gambling his future, but the bet seemed to pay off; he was busier than he had ever expected. He could afford to buy a motorcycle and take some trips out West, where he’d ride his bike through the desert and imagine he was a cowboy from one of the westerns he’d grown up watching. Things seemed great.

But trouble was brewing. The stress of running his own business was getting to him. His blood pressure was too high, and the town doctor who we’d been seeing since I was 3 years old noticed his blood sugar was creeping up. My dad couldn’t afford health insurance, and seeing specialists was expensive.

He’d get by with a few cheap generic prescriptions. He felt good, so what could go wrong?

In 2008, the economy tanked. The catering jobs and big parties that the

Somewhere in the middle of Missouri, I got the phone call that I had been dreading.

My clinical training wasn’t needed as my dad had passed away in the emergency room. restaurant depended on to stay afloat dried up. Soon, my dad was skipping bills and dodging calls from the bank.

His blood pressure worsened. His high blood sugar blossomed into full-blown diabetes. By that time, I had finished medical school and was in practice. I knew what my dad should do, but he was stubborn and didn’t want to follow my advice. “You need to see a specialist,” I said. “Come to St. Louis, and I’ll get you set up here.”

His answer was always the same: “Too expensive.” When I offered to pay for his care, he’d mutter that this wasn’t how this was supposed to work. My dad was a proud man who wanted to take care of himself. I did what I could, but it wasn’t enough.

“Don’t worry,” he said. “Your mom and I will be fine. Take care of yourself and your kids. Go someplace nice for vacation. We can get by.”

The restaurant shuttered. My dad finally relented and let me send him money so he could pay the mortgage and heating bill. I convinced him to see some colleagues who got him on some reasonable medications. But the damage had been done. Years of ignoring his health—largely driven by an inability to pay for it—had led him to chronic kidney disease, heart failure, and diabetes. The stage was set for the

call I received that fateful July morning several years later.

HOW CAN WE MAKE THE SYSTEM BETTER?

I eventually decided to leave full-time medical practice and go into health care administration. Watching my dad and his plight—and hearing similar stories from countless patients—had a major effect on me. I was determined to make the system better.

As a physician seeing patients, I could care for one person at a time. As a leader in health care, I could make the system better and help hundreds or even thousands of patients. I started in administration with a hospital, where I created quality programs that ensured each patient received a recommended treatment plan for any condition they had. I also worked with the hospital’s foundation on charity care options to help folks who didn’t have money get the medications and care they needed.

I then transitioned to a role with Anthem, one of the largest health insurers in the U.S. While with Anthem, I built a program with the state of Missouri to ensure Ryan White HIV/ AIDS Program patients received medications to keep their virus counts at zero. My time with Anthem also saw me partner with paramedics to create community health programs that delivered care in patient homes.

At every stage, I worked tirelessly to help others avoid my dad’s tragic fate.

There’s no way to know whether his life would have been saved had he gotten the preventive care he needed much earlier in life, but it certainly couldn’t have hurt.

There are so many people in this country who are in the same position as my dad—proud men and women who want to do what’s right and take care of themselves. But the astronomical cost of health care makes for a challenge for even the most financially savvy patients.

We need services that allow people

to get the care they need even when it’s hard to access or afford. We need answers when they aren’t sure how to pay for a sudden medical bill. We need to solve these ongoing problems while treating patients with dignity.

Thankfully, there are plenty of organizations working to change things for the better. I’m talking about companies like Flossy (featured on Page 14 of this magazine), which provides top-quality dental care at affordable prices for folks who lack dental insurance. There’s also Ro, a health care technology company building a patient-centric health care system that brings together telehealth, diagnostics, and pharmacy services to provide high-quality and affordable health care without the need for insurance. And I’d be remiss not to mention Paytient, my current employer. We partner with employers, brokers, hospital systems, and others to help people access care earlier without financial harm via a buy-now, pay-later option for out-of-pocket costs.

I’m optimistic that together, we can do this. Whether you work for an insurance company, see patients in a practice, design health care benefits for your employees, are about to launch a health care startup, or just have an interest in making things better, you have an important role to play as we meet this challenge. We will explore problems together and find solutions that help everyone, all in honor of my dad and the many patients in similar predicaments.

Let’s get to work.  Dr. Jay Moore is Paytient’s chief clinical officer. He did a combined internal medicine and pediatric residency at the University of Missouri, and maintains board certification in internal medicine. Jay has worked as a hospital administrator and an insurance executive, where he managed a team of physicians and evaluated startups for partnership opportunities. He lives in St. Louis with his wife and a way-too-large collection of hobby games.

Winter 2022 • Maverick |

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WORKING WITH A BENEFITS CHAMPION The Gasparilla Inn & Club Works For Its Employees.

BY OLIVIA DESMIT // PHOTOS BY CHARLIE WEST

O

n an island in Florida that is home to fewer than 2,000 people, a locally owned hotel is offering its employees a radical health care plan—and saving millions of dollars.

The Gasparilla Inn & Club, which has 470 employees, has saved an estimated $200,000 per year since switching to a self-funded health care plan in 2016. Through the FairCo$t Health Plan, which is managed by Mitigate Partners, The Inn has been able to save both its owners and employees money while providing its employees with better, more accessible health care.

BENEFITS CHAMPION

Since the switch, Liz Schrock has been helping employees navigate the self-insured plans; one even has a $0 employee contribution. “I spend a lot of time getting to know each employee,” she says. “I sit them down, ask them about their family and if anyone is managing health issues.”

Because the health plan involves partnerships with local providers, such as a radiological center, local health clinic and a local pharmacy, employees have help on where to go to get the best deal. By choosing The Inn’s insurance plan for their health care needs, employees can receive care for a fraction of the cost of other providers — and with some providers, for free.

“I guide them where they need to go in order to save them and the plan the most money,” Schrock says.

“I’m always available, even nights and weekends.”

The care and attention spent with each employee not only helps Schrock get to know their needs better, but it also results in them having better health care coverage for their families.

“We have a gentleman who, when we originally showed him the plan choices, chose the Silver Plan because the biweekly salary deductions appeared more affordable to him. When I learned he has a child with special needs, together we moved him to

Liz Schrock, benefits manager

10 | Maverick • Winter 2022

Within the FairCo$t Health Plan, The Gasparilla Inn offers three tiers.

The first, most basic coverage’s cost to employees? Free.

were for 2016 to 2021, the estimated savings are $5.9 million—a 61% reduction from what it would have been with a traditional insurance carrierbuilt plan. Speaking to The Gasparilla Inn’s enthusiasm about the plan and their bravery in taking the plunge, Schuessler says, “They removed all barriers to care, creating happier, healthier, and more committed employees who are more engaged in their health care.

All this was accomplished while simultaneously saving both The Inn and its employees significant dollars.”

Within the FairCo$t Health Plan, The Gasparilla Inn offers three tiers. The first, most basic coverage’s cost to employees?

Free.

the gold plan, which was more suited to his daughter’s medical needs and to cover their medical costs,” she says. “We got him on the right plan because we got to know him.”

THE DETAILS

“We were able to cut deductibles, bring copays down, give [employees] better results, and it costs them less money.”

– Glenn Price, chief financial officer

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Glenn Price, the chief financial officer of The Inn, says when he first met with Mitigate Partners, he was looking for a cost-saving solution. He feels that they’ve met that goal. “From an employee standpoint, we were able to cut deductibles, bring copays down, give them better results, and it costs them less money.”

According to Carl Schuessler Jr., The Inn’s benefits advisor with Mitigate Partners, in light of what the traditional insurance carrier projections

“We created our MEC, or Minimum Essential Coverage Plan $0 contribution, and members don’t have to pay for preventive care,” Schrock says. These include annual and routine visits, such as a yearly wellness check and gynecology visits. The other two plans have no deductible associated with them— something almost unheard of with a self-funded plan—and only four items in each plan have coinsurance rather than copay charges. The Gasparilla Inn’s employees were utilizing telehealth services long before COVID-19, and still do.

“The resort closes over the summer.

Some of our employees are seasonal, some from overseas and live in our dorms,” she says. “These employees often don’t have access to vehicles, so they either utilize telehealth, or they visit a clinic on-island that has a partnership with The Gasparilla Inn and can take advantage of a pharmacy nearby that delivers twice a day right to the front desk at no delivery charge.”

While The Gasparilla Inn has partnerships with local clinics that help make costs affordable—or nonexistent— to employees, what about out-ofnetwork?

“They removed all barriers to care, creating happier, healthier, and more committed employees who are more engaged in their health care.

All this was accomplished while simultaneously saving both The Inn and its employees significant dollars.”

– Carl Schuessler Jr., benefits advisor

“If they are out of network and end up with a bill, my job is to reduce that bill to nothing for the employee,” Schrock says. “We have a great legal team and other measures in place to get the bill to a manageable number, then we pay it for them. It’s almost like they’re getting an in-network benefit out-ofnetwork. The basic tier of dental and vision insurance at The Gasparilla Inn is also offered to employees at no cost, though they have an upgrade plan for a manageable $6 per paycheck.”

WORKING FOR EMPLOYEES

“I’ve been in insurance since I was 18 years old and have never seen an employer who actually cares about its employees the way Gasparilla Inn does,” Schrock says.

One notable benefit of The Inn’s plan is the ability to make changes to coverage as they see employees’ needs evolve. A yearly review of the plan document looks for gaps that need to be filled. A recent example involved an employee who was under anesthesia for a routine colonoscopy, a preventive procedure covered by the plan.

But when the surgeon removed a polyp during the procedure, it then changed the CPT code from preventive to diagnostic and therefore billed outpatient procedure, which is excluded under the Silver Plan. After learning of this, Schrock worked with Glenn Price (CFO), Carl Schuessler (plan advisor) and PHIA to add polyp removal under the preventive colonoscopy.

“We work hard at taking good care of employees and I think our plan reflects

that,” Price says. “There is a benefit of being flexible enough to add things to the plan you can’t typically have for a benefit. We want to do it as cost effectively as possible, but our first goal has always been to look out for our employees.”

Although The Gasparilla Inn had a high employee retention rate before switching to the FairCo$t Health Plan, Schrock says she was recently invited to recruitment interviews and saw how the benefits were an effective tool in enticing the right candidate. “I hope that the plan is part of the reason they decide to come work with us,” she says.

Should other human resources professionals considering making the jump to an innovative health plan?

Schrock says, “If you’re brave enough to do it, it pays off exponentially. You’ve got to get a team together that cares, a benefits manager that cares and someone who can teach the members how to use it.”

Although she had not administered a self-funded plan before, Schrock says it really did not take that much new knowledge on her part for a big payout.

“The rewards are incredible—not to mention the feel-good factor,” she says.

“I can say without hesitation this is the best plan I’ve ever administered. When someone says, ‘I have a problem with this claim,’ I get to say, ‘I’ll take care of it.’ It takes the burden off the member and allows them to worry less. That just feels good.” 

HOW WORKING WITH − AND FOR − EMPLOYEES CHANGES HEALTH CARE “There’s been a few times that the employees have had a problem that we had to tackle for them,” Benefits Manager Liz Schrock says. Recently The Gasparilla Inn & Club had an employee who needed a knee replacement. The member could not have the procedure until certain other medical conditions were taken care of.

“His team, which included case management, the network and the third party administrator, all joined together to try to find him the best care to get to where he could have his surgery,” Schrock says.

Between the plan managers, local health care partners, and Gasparilla Inn’s network, they were able to help him get the surgery, and home health care during recovery— something tough to come by on an island. “It really took a village and everybody speaking every day trying to get this done for this guy,” Schrock says, “and now he’s got a new knee.”

Winter 2022 • Maverick |

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All

Smiles Flossy offers a new way to save on dental care.

BY PAMELA DIMMICK

PORTRAITS BY SR. PUIG puigphotography.com

Right: Flossy co-founders Miles Beckett and Steve Seigel

14 | Maverick • Winter 2022

Winter 2022 • Maverick |

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D

ental coverage is expensive and complicated with long waiting periods, confusing deductibles and copays, minimal coverage for major procedures and low annual caps—and Americans are feeling the pain.

Roughly $140 billion is spent on dental care each year in the United States. Nearly 30% of the population is uninsured and pays out of pocket, with the remainder paying for high-cost dental insurance that doesn’t cover their needs. Those with dental coverage often wonder if they’d be better off without it, and those without it want to pay less for care. Miles Beckett and Steve Seigel, cofounders of Flossy, understand.

“We want to bring high-quality, affordable dental care to the masses with upfront transparent pricing, no annual fees, no waiting periods and no deductibles,” Beckett says.

ENTREPRENEURIAL DREAM TEAM Beckett and Seigel are serial entrepreneurs and early-stage technology investors. Beckett is a doctor by training and has been in the technology sector for more than 15 years. This is his third venture-backed company, having exited his previous two. Seigel is a former investment banker and hedge fund professional who has been in the digital health space as an operator and investor for almost a decade. Flossy is their second company together.

They created Flossy as an alternative to dental insurance, offering a simple, pay-as-you-go model that connects consumers to a network of high-quality dentists and discounted prices. Using a mobile app, the Flossy.com website, or a

16 | Maverick • Winter 2022

quick phone call to Flossy’s call center, patients can compare prices, find a great dentist, book an appointment, and save up to 50% off their dental care.

“If you run the numbers and are paying for dental insurance yourself, it’s not really worth it,” Beckett says. “If you just get regular cleanings and X-rays, you’re probably overspending on the insurance relative to the value you receive. You’d have been better off paying cash for those services. On the other hand, if you need extensive dental work, dental insurance caps the amount they’ll pay to around a thousand dollars and most major dental work can run from two to 10 thousand or more dollars. In that scenario, the insurance covers a little but you’re still paying a lot out of pocket.”

Considered a dental discount plan from a regulatory standpoint, Flossy is unique as the first pay-as-you-go plan with no monthly or annual fees and no waiting period for care.

“Our curated network of dentists also sets us apart. To be included, dentists must have an average of four stars or higher on Google, Yelp, and Healthgrades,” Seigel says. “In addition to our quality-based selection process, our negotiated rates deliver transparent pricing and discounts.”

Flossy currently operates in Arizona with near-term plans to expand to New Mexico, Michigan, Wisconsin, and, eventually, all 50 states. The cofounders said Flossy saw immediate adoption upon launch. Within minutes of its closed beta launch, Flossy had its first booking for 9 a.m. the following morning.

“Customers love the app,” Seigel says.

“We have a 5-star rating in the app store, dozens of positive reviews and good word-of-mouth. Our NPS (net promoter score) is almost a perfect 10.

Dental historically has very low NPS scores, but with our curated network and

Considered a dental discount plan from a regulatory standpoint, Flossy is unique as the first pay-as-you-go plan with no monthly or annual fees and no waiting period for care.

“Working with Flossy has been such a good, easygoing experience,” says Karina Najera, office manager of AZ Lifetime Dentistry. “Our new patient numbers have almost doubled, and patients leave with a smile on their face because of the discount they receive.”

Beckett says another advantage for dentists is cash flow. “For insurance patients, reimbursement typically takes from 30 to 90 days, whereas they get paid almost immediately with Flossy. Over time, we’re looking to integrate patient financing, so that would be another perk.”

transparent pricing, both dentists and consumers love us. Our only challenge has been getting the word out, but now that we’ve proven the value of the service, we’re starting to increase our marketing spend to build awareness.”

PROOF IN THE PERCENTAGES Beyond ratings and scores, Flossy uses a variety of metrics to measure its success, including total GMV (gross merchandise value), new patient bookings, organic referrals both from the supply and demand side, and CAC/LTV (customer acquisition cost/lifetime value) ratios. In addition, when a patient gets a treatment plan for future work, they track percentage completion and time to completion.

There’s a lot for dentists to like about Flossy, too. Rather than paying $150 to $250 per new patient from a lead generation service, Flossy sends new patients to participating dentists and specialists for free.

In addition to serving self-employed individuals, freelancers, gig economy workers, seniors and anyone who works for a business that does not offer or cover dental insurance, Flossy helps companies offer yet another option to its contractors or employees.

“For example, we can help companies with lots of gig workers or contractors, such as Uber, DoorDash, or Postmates,” Beckett says. “They may want to provide some sort of a perk or benefit, but they don’t explicitly pay for them. By offering Flossy, they can offer a dental discount plan without having to pay for it.”

Seigel adds, “We would be another alternative option to dental insurance.

A lot of the small-business owners that we’ve talked to only offer health insurance, and health insurance doesn’t cover dental. In these places, Flossy would be a great free offer.”

CHANGING WITH THE TIMES Flossy is venture-backed by Slow Ventures, 8VC, TTV Capital, Clocktower Technology Ventures, and other broad-based and fintechfocused VCs that back innovative tech companies. The company closed on

seed financing when President Trump had just declared a national state of emergency due to the pandemic, causing Beckett and Seigel to switch gears.

“We were originally thinking of ways to make dental insurance better but switched to Flossy’s discount model in light of the number of people who were suddenly unemployed,” Beckett says.

“We felt like having some sort of a free, pay-as-you-go type of a plan—though we didn’t know what that would look like—would be really cool.”

“We wanted to bring high quality, affordable oral health to the masses, specifically the uninsured,” Seigel says.

“I think that sometimes this demographic gets overlooked, and this really addresses that gap. From the beginning, we asked, do you change care delivery? Do you create ancillary products like we’ve seen with aligners from SmileDirectClub? Or do you get into the payment flow and try to bend the cost curve and change the way people pay for oral health? And that’s the core of what we’ve done at Flossy.

Technology that inserts us into the transaction allows us to do that.”

“We’ve been pleasantly surprised to see how many people were looking for an alternative and how much people really like using Flossy,” Beckett says.

“They tell us how much they love the app for booking appointments, getting affordable and accessible treatments from top-rated dentists the next day, paying for care without the hassles of insurance, and the fact that real people reach out to help. We’ve even had people who ended up using Flossy instead of their insurance because, for that procedure, it was much cheaper to go through us. People are saving thousands of dollars using Flossy.”  Winter 2022 • Maverick |

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MAKING CONNECTIONS: DUTCH ROJAS BRINGS PATIENTS AND PROVIDERS TOGETHER. It is cliché to talk about a business owner forging a path in his or her field, but for Dutch Rojas, the trope is surprisingly apt. Rojas is at the helm of a constellation of businesses designed around a central idea: a renaissance in the fiscal workings of the health care marketplace. Sano Surgery, Sano Contracting, Everyone Health, and soon-to-be-realized direct-to-consumer platform Shop Healthcare all emerged from his desire to reshape the market from within, providing better cost-saving health care options for employers, consumers, and providers.

BY AMY WILDER | PHOTOS BY PHILIP ROOD

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AN ACCOUNTANT’S PERSPECTIVE

Rojas came into the industry through an unusual route. He does not have a background in medicine. Instead, he studied accounting. He wrote his master’s thesis on surgery futures and surgery options.

“I basically built a commodities market,” Rojas says. “Every single large industry in the world uses commodities to hedge their industries … and I wanted to create that,” in part with the idea of helping independent doctors sign long-term contracts to raise the value of their businesses and fight inflation.

His interest in the financial arena of health care began early when he was an undergraduate student in the mid-1990s. He went to a Protestant university that sent its students on mission trips around the globe. Rojas took an alternative option to go on volunteer trips, and he spent time helping doctors in Guyana, Kenya, and Indonesia construct temporary surgery centers.

“The first summer I did it, I fell in love with it,” he recalls. “I had no plans to be a physician, but I knew I wanted to help make medical care affordable and accessible. That’s where the whole journey started.”

He went to work for a real estate investment trust right out of college and was assigned to its ambulatory surgery center team.

“I built surgery centers, and then syndicated surgery centers and helped doctors attract cases through alternative means—in other words, not through the carriers,” he says.

Rojas thought transparent pricing could help him get more business to surgery centers, which he wanted to promote because they have lower infection and readmission rates than hospitals. He initially owned surgery centers, but he quickly discovered the cost of ownership was a hinderance to shifting

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the wider market. He had an office for a time in San Francisco, not far from Airbnb. He looked at that company’s business model and realized it didn’t own anything.

“I thought, I could do that,” Rojas says, “And I could do that way faster (than building and owning centers).”

A VISION REALIZED Rojas had a vision: connecting self-insured employers and their employees to medical providers across the country at agreedupon, transparent rates. This would help employers keep costs down, save employees enormous amounts of money, and allow physicians with independent practices to hedge expenses and thrive financially.

He had a challenge: convincing each of those entities to buy into his idea. Without everyone jumping in, it simply wouldn’t work. But he wasn’t daunted. He’s been at it “since 1997,

basically, and it’s super hard,” he says. “You have to be passionate. You have to tell your story over and over again. If you ask my wife, she will tell you that’s the one gift God gave me,” he adds with a laugh.

He learned from the mistakes of other companies doing similar things in the industry. “There are lots of firms with similar strategies to ours that came before we did,” he says, “and their No. 1 mistake, when you talk to the legacy companies, they’ll say, ‘We went to the physicians, and we got contracts.’”

He has had to learn from his own experiences and redesign his approach.

Since the fledgling companies didn’t yet have a consumer base to send their way, physicians often invested significant amounts of time and insurance money into the endeavor without seeing a return quickly enough to make it worthwhile.

“The hardest sale out of all of it is not the employer or the physician,” he says. “It’s the employee, the consumer whose participation is vital for the whole system to work. I can have the best prices, but when you need your ACL repaired and I offer you an option with no copay and no deductible, which is a wonderful financial incentive,” people immediately get suspicious about why this option costs less.

It’s pretty standard consumer psychology.

“They think if something’s $1, it’s not a good product compared to the thing that costs $100. I literally had someone ask me, ‘Are you sending me to a veterinarian?’ and they were not kidding. That’s been the struggle we’ve had.”

One of the pivotal solutions Rojas put forward was introducing employer decision-makers to independent physicians in their area. “We’ll arrange a time for an employer to meet with the physicians.

What this does is create ‘stickiness.’ Within our very complex, industrial health care system, nobody gets to meet anybody, but for people who struggle with chronic problems to finally have 20 minutes with a professional, all of a sudden there’s a relationship.

“I don’t know any hospital CEO—and I know a bunch of them—who would go and see employers,” he adds. “But that’s what independent doctors who run surgical centers in this country are doing with us. That was a huge change.”

“You do that a few times and don’t bring them any cases, and they get upset,” Rojas says. “I never wanted to make that mistake. I’ve been in this business my whole professional adult life, and I knew the surgeons to call. I knew which ones would help me. By the way, I want to tell you, out of thousands, I had maybe one or two who were like, ‘This is a horse-crap idea; get away, don’t bother me.’”

He cooperates with other industry players. One of Rojas’ early connections was Dr. Keith Smith, who was featured in the previous issue of Maverick. Smith, who was committed to helping create a free market in the health care industry, opened the Surgery Center of Oklahoma in 1997 with co-founder Dr. Steven Lantier.

Smith says he published the center’s pricing online in about 2009. “I think that’s when Dutch took notice,” he recalls, “because it was radical. And I didn’t know how radical it was at the time, to post our prices online.”

“I was invited to speak at a Becker’s Conference in Chicago,” Smith says, “I gave a talk about how I create bundles, what I did with them and why I did it. My speech was poorly attended, but when I walked out of the speech, this guy ran across the foyer and just started hugging me. He didn’t say a word. But when he let go, he said, ‘I’m Dutch Rojas. This is awesome! I can’t believe you’ve done this!’ And that’s how Dutch and I met.”

“I saw a problem when I was young,” Rojas says, “and I am heart-led, which is probably very strange for an accountant.”

PERSISTENCE PAYS OFF Rojas finally started seeing traction in 2015 when a couple of employers decided to give his ideas a chance.

Being able to eliminate large deductibles and copays for average families is what draws Rojas and his employees to what they do: things like saving a family $7,000 out of pocket for a 4-yearold’s surgery.

“I think I’d just been bothering them for so long,” he jokes.

“I got on planes every week. I don’t know how my wife did it.

She’s an angel.”

“Things like that used to happen every month, and now they happen every day,” he says. “And it’s a pretty nice way to go to sleep at night.”  Winter 2022 • Maverick |

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Flume Health Creates Personalized Health Plans

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Coverage WITH A CUSTOM FIT

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by pamela dimmick

photos by lauren eliot

early half of all Americans get their health insurance through an employer-sponsored plan. Despite each employee’s unique health challenges, most employers offer similar, one-size-fits-all plans and ancillary benefits that largely fail to address these needs.

The result: rising health care prices and worsening care. One-half of Americans say they have avoided care due to high costs and one-third of insured Americans say they cannot afford their deductible, according to the Kaiser Family Foundation.

Flume Health wants to help change that. Flume is empowering nextgeneration health care companies to design and launch powerful, personalized health plans in record time. Like Shopify did for e-commerce or Squarespace did for web development, Flume is working to create a health-plan-as-a-service platform that makes building health plans simple.

In turn, so-called challenger health plans can customize coverage that caters to different health care needs, demographics, cultural identities, and more.

Dozens of new health care plans have launched in the past several years, with dozens—if not hundreds—more expected in the near future.

“The only hurdle for making this modern health care system a reality is operational complexity that is outsourced to third-party administrators (TPAs), leading to inefficiencies and cost leakage,” says Flume Founder and CEO Cedric Kovacs-Johnson. Kovacs-Johnson is the former co-founder of Spectrum 3D, since acquired by Makerbot.

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“I started Flume in 2017 to empower a massive change in how health insurance operates and makes decisions, ushering in a wave of new health plans better aligned with patients,” Kovacs-Johnson says.

“You can see how the one-size-fits-all, middle-of-the-road plan design leaves a lot to be desired on the fringes,” says Grant Parker, head of sales and marketing at Flume Health.

On the Flume OS platform, innovative health care companies can build and bring to market highly configurable, personalized health plans based on demographics, health conditions, gender, and similar considerations.

Today, more than half of Americans who get their health insurance from their employer are on a plan administered

by TPAs, according to the Society of Professional Benefit Administrators. But TPAs often lack the technological rigor needed to run a modern, customizable health plan that truly meets employees’ needs.

Flume aims to become a modern alternative to TPAs for self-insured employers. Its operating system functions similarly to an API, connecting disparate health care services with employees, and building more personalized experiences to improve care and lower costs.

Kovacs-Johnson explained that TPAs earn $30 to $50 per member per month and are getting crushed by the growing complexity of the fragmented health care system.

The current TPA system is 30 years old and reliant on spreadsheets, pen and paper.

“It’s unsustainable in today’s tech-forward health care disruption landscape,” he says. “A better solution is an operating platform that’s similar to an API, so employers can easily design a marketplace that offers specialty providers and incentives that can serve the needs of all employees and their dependents. This is why Flume has built a platform for every health plan.”

Kovacs-Johnson was inspired to change the health insurance landscape after watching his sister prepare for a major brain surgery. The family faced several unexpected costs.

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According to Parker, health plans built on the Flume OS platform can take advantage of its unique features. The Flume Core, for example, provides an all-in-one managed platform for payments, claims, eligibility, contract management, compliance, and reporting. APIs, webhooks and EDI offer flexibility and customization, allowing for highly flexible, real-time trading with platform customers, vendors and providers. Robust member and client services are also available to provide an outstanding member experience including turnkey customer-facing services, an in-house member app and support integration.

For example, most self-insured employer plans consist of a health network and other benefits, such as telemedicine, fraud protection, mental health, disease management, claims, compliance and more. Each of these benefits is managed by a separate vendor.

The health plan as a service was purpose-built to take on the difficulties of delivering and managing a nextgeneration health plan so that clients can focus on serving their members with a better overall experience.

the health plan as a service was purposebuilt to take on the difficulties of delivering and managing a nextgeneration health plan.

on the complexities this would create and saw an opportunity to take on the role of an insurance company by adjudicating claims, storing sensitive data, initiating all payments—all guided by a proprietary rules engine that serves as the foundation of our TPA health plan as a service.”

Over the past 18 months, Flume launched and operated its own plan as part of the proof-of-concept phase. By all accounts, the launch was a success, proving the platform’s value in the modern marketplace.

With Flume OS, for example, a health plan could create a system to redirect a low-risk patient to telemedicine instead of the emergency department.

“We are the first embedded health plan administration platform, handling the entire payer backend, including claims, payments, compliance, and eligibility,” Parker says.

“We are helping create a new generation of health plans that break down barriers between care modalities and care delivery while bringing down cost of care.”

Kovacs-Johnson envisions a world in which a national retail chain could offer a health plan focused on back and joint pain for its warehouse workers, with another plan focused on disease management for its employees with diabetes. Customized plans can include more local provider options, specific health conditions, or even coverage that addresses culture and identity.

“Consumers will soon pick from hundreds of health plans, each personalized to their unique health and preferences,” says Kovacs-Johnson. “We understood early

Now, Flume is helping new challenger health plans get to market in less time. “We aim to keep that measure to between six and nine months,” Parker says. “A radical departure from the status quo.”

At the beginning of 2022, two health plans became the first to use Flume OS: virtual-first provider Firefly Health and medical stop-loss provider Radion Health.

“Flume has vastly accelerated our path to market. Without it, we couldn’t have launched our health plan in less than a year,” says Fay Rotenberg, Firefly Health CEO. “The rapid launch of the Firefly Health Plan has enabled our mission to deliver health care that’s twice as good at half the price.”

Flume Health is a venture capital-backed health technology company. The company has raised $10.1 million to date from Crosslink Capital, Primary VC, Accomplice, Founder Collective, Route66 Venturer, entrepreneurs, roundtables, accelerators, and various angels. At press time, Flume was wrapping up its Series A fundraising round.  Winter 2022 • Maverick |

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Dr. Adam Wheeler, co-founder of Big Tree Medical Home and the practice’s pediatrician, expects a need for an additional 1,000 primary care providers in Missouri by 2025.

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CUTTINGEDGE PRIMARY CARE Big Tree Medical Home is providing a scalable solution.

• • •

BY OLIVIA DESMIT

PHOTOS BY LIFT DIVISION

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he United States, and the Midwest specifically, has a shortage of primary care providers. Big Tree Medical Home, based in Columbia, Missouri, is trying to solve that problem.

Big Tree offers direct primary care and wholesale-priced pharmaceuticals for a low monthly payment to more than 5,000 patients nationwide. The innovative health care solution, which was founded in late 2017, gives members the majority of their health care coverage for a fraction of the cost of traditional plans.

Big Tree co-founder and practice pediatrician Dr. Adam Wheeler says, “We felt there was an opportunity to create a new type of primary care where the provider and patient have aligned incentives and employers have a lower total cost of care, but a much better experience for employees.”

Wheeler’s past experience as a managing partner of a large pediatric practice in Columbia enabled him to see how drastic the primary care shortage in the Midwest really is. He then created a solution that helps patients see a doctor when and where they need it.

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FILLING A VOID According to Wheeler, 111 of 114 counties in Missouri are primary care shortage areas, and practices are expecting a need for an additional 1,000 primary care providers in Missouri by 2025.

“The model just doesn’t work because the payments to primary care providers are not designed to promote health,” he says. Wheeler says primary care providers are paid a fraction of the cost of their specialist peers, despite requiring almost as much education and training: general practice doctors who work in urgent cares make almost double the salary.

The solution? Nurse practitioners as primary care providers. “That allows us to have a lower price point,” Wheeler says.

Other primary care solutions typically use doctors to provide care, which Wheeler says ultimately exacerbates the problem. “When doctors move from traditional to a more innovative solution, they move from having about 2,500 patients to about 800 on their panel. We are trying to provide a scalable solution that could be used to meet the needs of the entire country.”

While Big Tree has five clinics in Missouri where patients can be seen inperson if needed, their clinics in 40 other states are virtual, with nurse practitioners seeing patients via video or answering questions via text. “What we like to say is virtual care isn’t fundamentally better or worse than in-person—it’s different,” Wheeler says. “It provides better, quicker access but there are some things you need in-person for.”

THE PACKAGE DEAL Another feature of Big Tree Medical Home is its in-house pharmacy. Through most of the membership plans, patients can get generic prescription medications for either free or wholesale costs.

Employers have the option to bundle Big Tree coverage with dental, vision and other specialist plans to provide complete coverage.

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isn’t responsible for the balance due. “It’s the same if they have an easy-for-them but expensive-for-company solution or a hard-for-them—in that it’s different— but less-expensive-for-the-company solution,” he says. “Even though there is published research that something like Big Tree as part of a health plan will lower costs by 20%.”

TEXT SOLUTIONS Ever wonder whether you should take Tylenol or Advil for your headache? Adam Wheeler with Big Tree Medical says you don’t have to.

The access to virtual care via text messaging enables patients to ask common questions such as that with immediate replies.

“Those are the kinds of things we answer all day long. That’s an added value that’s not being given in the traditional health care system.” And if you’re still wondering, the answer is typically Advil.

A primary care solution that’s a fraction of the cost of more traditional care, has access to affordable prescriptions and easier care—why isn’t every company using Big Tree? “Our biggest challenge is helping employers think about health care outside of the box,” Wheeler says.

While traditional health insurance plans have been rising in costs every year, ultimately the human resources employee responsible for deciding the coverage

TAKING THE GAMBLE Wheeler says it can be difficult to convince businesses to try Big Tree, but once they sign up, there is a high retention rate. While they also measure the standard metrics such as net promoter score and other surveys, the biggest goal is patients renewing their monthly plans. “We are a monthly payment that the patient has no commitment to—they have to continue to want to participate and that’s how we want it,” he continues.

Woodhaven, a Columbia-based company that provides support to adults with disabilities, has seen a savings of $750,000 since switching to Big Tree as their employee health plan. Dan Soliday, the chief executive officer of Woodhaven, says with Big Tree as their employee benefit, they’ve gotten nothing but great feedback from employees.

“Before Big Tree, we kept having to raise the staff portion of insurance to a point where staff were then leaving,” he says.

“Working with Big Tree not only saved our organization and staff money, but our employees also get better service.”

In terms of funding expansion, Big Tree has looked into venture funding and private equity, Wheeler says, but instead depends on the profits from its existing clinics. “In our experience, the organizations that provide funding have a tough time grasping our model,” he says. “We haven’t met a partner who is interested in expanding primary care in the way that we are.

“Our goal is how low can we get our prices and then we are going to apply that to everybody.” 

in the comfort zone Gravie creates a plan that incentivizes smart choices.

A

health plan that incentivizes employees to use health care services wisely can lower costs for employers and workers alike. Everybody agrees with that basic idea, but a Minneapolis-based insurance company is showing how it actually works. Gravie, founded by serial health care entrepreneurs Abir Sen and Marek Ciolko, offers a health plan called Comfort that covers most common health care services at 100%.

“Not just preventive care, but office visits, specialist visits, urgent care visits, generic drugs, labs, imaging, X-ray, blood work—all of those things are covered services for free, with no cost-sharing under Comfort,” says Ben Simmons, Gravie’s chief strategy officer. “It gives a lot more value to everybody on Day One, so people don’t feel like they’re getting nickel and dimed from copays and deductibles.”

The health plan, which launched in 2018, seeks to help employers grapple with the ever-increasing challenge of health benefits. According to the most recent Employer Health Benefits Survey conducted

by Kaiser Family Foundation, the average annual premium for employer-sponsored health insurance in 2021 was $7,739 for single coverage and $22,221 for family coverage.

Premiums increased 4% over the previous year, although inflation increased just 1.9%. Because most people do not reach their annual deductible, they see little value from a benefit that costs so much, says Libby Johnson, Gravie’s marketing director.

“Most traditional plans are actually only serving something like 10% or less of the employees who are on the plan,” she says. “So a whole bunch of people are paying a lot of money but only 10% are getting value.”

In the Comfort plan design, the deductible concept is replaced with an out-of-pocket maximum. While doctor visits and other routine care are covered in full, employees must pay for hospital care, procedures, and surgery, up to an out-of-pocket maximum. Most of Gravie’s clients offer their employees three out-of-

pocket maximum options, corresponding to varying premium levels.

“Depending on the client, we have a range of options all the way from $500 out-of-pocket maximum per person on the rich end to $7,900,” Simmons says.

The plan design encourages employees to use services wisely. An urgent care visit is free; a trip to the emergency room carries a $250 copay. Generic drugs are free; brand-name prescriptions have a $75 copay.

Specialty prescriptions carry a $125 copay until the out-of-pocket maximum is reached.

“By encouraging people to get care for free, we are actually saving the plan money because they’re not getting more expensive types of care.” −BEN SIMMONS

An employee with a bad cough, for example, is incentivized to get treated at an urgent care clinic for free, instead of waiting until pneumonia develops, requiring an emergency room visit and hospital admission.

“By encouraging people to get care for free, we are actually saving the plan money because they’re not

BY LOLA BUTCHER // PORTRAITS BY WARREN TEBRUGGE PHOTOGRAPHY

Winter 2022 • Maverick |

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getting more expensive types of care,” Simmons says, citing one customer that saw emergency room use drop by 80% after moving to Comfort. “Even though they were paying a little bit more on urgent care, they saved so much money on emergency room visits that the plan saved money.”

Meanwhile, most covered employees experience lower outof-pocket costs.

“On average, employees save over $100 per month when they’re on a Comfort plan versus a traditional plan design because Comfort provides more comprehensive coverage,” he says. “Being able to do that at a more competitive premium price point makes the financials really work for both the employer and the employee. That’s a dynamic that we’re proud of.”

“A whole bunch of people are paying a lot of money but only 10% are getting value.” −LIBBY JOHNSON

HOW WE GOT HERE Gravie is one of several health care companies that Sen and Ciolko have launched to innovate in the complicated health benefits space. In 1998, Sen co-founded Definity Health, which offered a high-deductible plan with a medical savings account; UnitedHealth Group bought the company in 2004.

Two years later, Sen co-founded RedBrick Health, a digital health and engagement company that merged with Virgin Pulse in 2018. Along the way, Sen and Ciolko co-founded Bloom Health, a private exchange for health insurance, which was sold to Empyrean Benefit Solutions Inc. in 2016.

In a 2020 interview with Thrive Global, Sen says none of the companies he has founded ended up with the same business model envisioned when the company launched.

“The business model is not what makes the company,” he says. “Rather, it’s thoughtful, resourceful people that are determined to solve problems for an industry.”

Gravie continued that pattern. Started in 2013 shortly after the Affordable Care Act passed, the company launched as a marketplace of fully insured individual-market health plans.

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Employers made a defined contribution to their workers, who used the marketplace to choose the plan that best suited their needs.

That concept lost its luster when carriers started pulling out of some markets and premiums rose dramatically.

“We quickly realized that if the product set did not have the innovation and the price point that we were looking for, we weren’t going to be able to deliver on the experience that we wanted,” Simmons says. “That was the impetus for us to start our own insurance company and become our own health plan.”

HOW IT WORKS Depending on the market, Gravie partners with a regional insurer—for example, PreferredOne in Minneapolis—or a national company like Aetna or Cigna to gain access to a provider network for employees covered by Comfort.

Comfort’s “sweet spot” is employers with between 50 and 500 employees. Gravie’s customers, on average, save 19% on premiums when they switch to Comfort, Simmons says.

He attributes that to the plan design that incentivizes use of lower cost services, as well as the company’s underwriting approach.

“We invested in a lot of analytics to help us give credit where credit is due for employers that have good risk profiles,” he says. “That allows us to get more competitive because we can more precisely assess employers’ risk than some carriers do.”

Because workers perceive Comfort’s plan design to be of more value than traditional plans, employers typically see more workers opt into the insurance program.

“They want more people to participate in the health plan, and that also stabilizes the risk pool,” Simmons says. “So Comfort is a tool for employers to make their employees happy and to stand out in the workforce.”

Employers can add an additional benefit for their workers through Gravie Pay, which allows out-of-pocket bills to be paid over time with no interest.

“Oftentimes, having a health event where they have some liability can be a real financial hardship because people just don’t have the reserves to be able to pay,” he says.

Gravie Pay allows Comfort members to create a payback schedule, and payments to providers are made via payroll deduction. Paytient serves as the technology partner and credit source for Gravie Pay. 

survey says ...

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$2,379

PERCENTAGE OF WORKERS WITH EMPLOYERSPONSORED COVERAGE WITH A GENERAL ANNUAL DEDUCTIBLE

THE AVERAGE DEDUCTIBLE FOR COVERED WORKERS IN FIRMS WITH 199 OR FEWER EMPLOYEES. For those in larger firms, the average deductible was $1,397.

Over the past five years, the percentage of covered workers with an annual deductible of at least $2,000 for single coverage has grown from 23% to 29%.

Most covered workers have COPAYMENTS for doctor visits.

$$$

On average, they pay $25 for primary care and $42 for specialty care.

According to the most recent employer Health Benefits Survey conducted by Kaiser Family Foundation

SOME WORKERS HAVE COINSURANCE INSTEAD, PAYING 19%, ON AVERAGE, FOR PRIMARY CARE VISITS AND 20% FOR SPECIALTY CARE.

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BY LOLA BUTCHER

PORTRAIT BY CHRISTOPHER C. LEE PHOTOGRAPHY & FILM

changing minds Prairie Health aims to make mental health care accessible and affordable.

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enson Kung recalls being an energetic, goal-directed teenager before stumbling into the quicksand of depression. “I remember trying to wash some dishes one day, and I just couldn’t,” he wrote in an account of his journey. “It sounds ridiculous, but whenever I would try to wash the dishes, some compulsion would come over me, and before I knew it, the day ended, and the dishes were still dirty.”

He was lucky to find the right psychiatrist, diagnosis, and treatment. But reflecting on his own experience and that of others, he found the process of doing so can be demoralizing: “You have to overcome the stigma that prevents people, especially people of color, from seeking care. You have to find a clinic that can take new patients. You have to act as a middleman between your insurance and the clinic. You have to wait weeks and weeks to see a provider.

And even when you start seeing a psychiatrist, it’s likely that you will end your treatment prematurely.”

That’s why he was eager to join a Stanford University classmate, Maurice Chiang, and start Prairie Health, a telehealth platform delivering personalized, data-driven mental health care.

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Prairie Health’s MindVitals product allows physicians, insurers, employers, and other organizations to conduct technology-enabled behavioral health screenings and connect individuals to the appropriate resources. The company’s Prairie Ecosystem is a network of wellness, therapy and psychiatric resources that can access technology and data to help individuals find the right treatment.

“Our goal at Prairie is to apply data to improve outcomes through improved access and efficacy of care,” Chiang, the company’s CEO, said.

COUNTING THE COSTS Although Prairie Health will not start working with employers until early 2022, Chiang knows many companies are worried about the personal, professional, and financial costs associated with workers’ mental health problems.

Employees experiencing mental distress use nearly $3,000 more in health care services per year, on average, than their peers, according to research published by the National Safety Council and NORC at the University of Chicago in May 2021.

Beyond that, presenteeism, absenteeism, and staff turnover pile on the costs that

Prairie Health provides treatment right from your phone, from highly-trained providers who care.

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employers bear. The cost of workdays lost averages $4,783 per year per employee, according to the analysis. And the cost associated with turnover averages $5,733 per year per employee.

imperative,” Kelly Greenwood, CEO of Mind Share Partners, a nonprofit that focuses on workplace mental health, and a colleague wrote in Harvard Business Review.

The toll on employees goes far beyond the financial costs. Workers who have experienced mental distress in the past year are more likely to report that they drove while under the influence of alcohol, marijuana, or other drugs, the researchers found. Mentally distressed workers are 3.5 times more likely to have substance use disorders.

Chiang and Kung both studied computer science at Stanford, where Chiang combined his interest in entrepreneurship with his concern about the mental health treatment landscape in America. “I’ve seen how the difficulty of accessing care and receiving ineffective care can impact people’s lives,” he said.

ADDED URGENCY The NSC/NORC findings come from combining research on employment costs with data from the 2015 to 2019 National Surveys on Drug Use and Health, a large government-sponsored survey. Thus, the report does not include the impact of COVID-19, which made the situation worse.

In a survey of 1,500 adults conducted in mid-2021, three-quarters of full-time U.S. workers reported experiencing at least one symptom of a mental health condition in the past year, up from 59% in 2019.

“In 2020, mental health support went from a nice-to-have to a true business

He and Kung, Prairie Health’s head of research and development, believe that individuals often suffer through misdiagnoses and ineffective treatment plans for two reasons: They have not connected with the most effective health care provider for their individual situation, or the health care professional does not have enough data about the individual to make an accurate diagnosis and create a successful treatment plan.

“So we teamed up and got started formally early last year,” Chiang said.

“Since then, we have been building solutions for providers, health plans, and consumers to align incentives around improving the quality and access to care.”

The health care professionals who use Prairie Health’s platform have access to data, such as genetic-testing results and population-level insights, driven by artificial intelligence, which allow them to help individuals find the right treatment more quickly than the trialand-error approach typical in mental health treatment.

“There’s an incredible demand for innetwork, high-quality psychiatry and therapy today,” Chiang said. “And we can help both with identifying people who need help, which I think is a big challenge, and then we can follow up by getting those people in with a personalized care coordinator and our data-driven tools to in-network care for them.” 

SCAN QR CODE for a free subscription:

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HEALING FROM WITHIN Chris Labrecque shows how increasing employee engagement reduces risk.

BY PAMELA DIMMICK PORTRAITS BY EUPHORIA ARTS STUDIO

…

In the first half of 2021, 36% of U.S. employees were engaged in their work, according to a Gallup study, leaving 64% not engaged and 15% actively disengaged. Engagement levels affect productivity, profitability, retention, absenteeism, customer satisfaction, and more.

According to Chris Labrecque, president of Insurance Office of America’s Employee Benefits Services Division, employee engagement also affects commercial risk.

Labrecque has been in the insurance industry since 1990. He worked for a small, family-run agency for 18 years. That agency was sold to a friendly competitor, which in turn was sold in 2010 to Insurance Office of America, a privately held, full-service insurance consultant and brokerage serving small and mid-market employers.

“We work with employers who see their employees as their No. 1 asset and recognize that their relationship with employees is their strongest currency,” Labrecque says.

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CAUSE AND EFFECT

…

With health care being the centerpiece of most benefit plans, Labrecque encourages clients to think about how doing business differently with their existing assets could create better results.

“Our job is to put relevant benefits in front of an employer and, by extension, to employees,” Labrecque says. “Despite our best efforts over time, we have seen limited results in cost controls. The industry faces 8.5% to 9.5%, sometimes higher, trend increases every single year.”

“If I’m trying to improve the health of that population, then I need to bring resources to help people rightsize their pay-to-debt ratio and help them become more financially viable,” Labrecque says. “If I don’t do that, then nearly 1 in 3 of the people that I am meant to serve is going to have a health degradation issue or event. And as a result, I’m going to be facing claim spend that I did not address by providing them with financial counseling to help them get their debt in line and help put them on the right path, whether they’re 23 years old or 64.”

Employees’ financial concerns are just one of the five most important things that employers can address to create engagement in the workplace.

“Another thing to do is create a safe work environment, or what I would call ‘table-stakes.’ This includes pandemic-safe surfaces and proper lifting techniques,” Labrecque says. “But it’s much beyond that. We’re taking Maslow’s hierarchy of needs into the workforce.”

Inspired by cost controls in the property and casualty space, Labrecque began thinking about proximate cause, which addresses the trigger of a claim. For example, in a property damage claim, the proximate cause might be a flood or broken pipe.

Labrecque explains that the social contract between employer and employee through the pandemic and beyond is rapidly evolving. “It’s an exciting and wonderful opportunity, and the five elements support an approach like that,” he says.

“When it comes to controlling costs in health care and benefits, it’s not necessarily about controlling premiums because of the frequency of claims,” he says.

“It’s controlling the spend on the back end. If we can control that by controlling the proximate cause, then the products we put in place will perform. The question is, how do we position benefits to support the overall goal of transferring, mitigating, and reducing risk every day, all the time?”

Providing employers with a leadership ability versus a management ability is also key to ensuring that employees feel safe and valued at work, have a sense of belonging, know what they need to do to grow and fulfill their professional aspirations, and feel connected to something bigger than themselves.

Here is where employee engagement comes in. “It’s not the CEO who backs over somebody with a forklift.

It’s the employee who is disengaged,” Labrecque says.

“Part of being engaged is being healthy. Part of being engaged is being financially viable. Part of being engaged is being professionally fulfilled. Part of being engaged is being safe. Part of being engaged is being socially connected to something bigger than yourself.

Those are the five elements that we look at when we want to improve the health of a population.”

These elements are interconnected. For example, according to PricewaterhouseCooper’s Special Report: Financial Stress and the Bottom Line, 28% of surveyed employees says their financial worries had impacted their health.

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BENEFITS OF ENGAGEMENT

…

With the so-called ‘great resignation’ currently underway, employees are asking themselves if they are really doing what they want to do and if they are genuinely connected to the organization in ways beyond punching a clock and getting a paycheck.

“That’s part of the evolution of the social construct that this five-element approach is meant to serve. It has a reverse value proposition,” Labrecque says. “For example, this approach can reduce turnover or training costs for the employer because employees choose to stay at a job for, let’s say, $32,000 versus finding another one for $34,000 to service some Christmas debt they may have taken on. So, the implications are fairly broad but definitely additive.”

Part of being engaged is being ...

HEALTHY

PROFESSIONALLY FULFILLED

FINANCIALLY VIABLE

SAFE

SOCIALLY CONNECTED TO SOMETHING BIGGER THAN YOURSELF

“Those are the five elements that we look at when we want to improve the health of a population.”

– chris labrecque

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Labrecque likens this approach to a quote attributed to naturalist John Muir: “When one tugs at a single thing in nature, he finds it attached to the rest of the world.”

“There is a fabric here in the way that the employer and employee interact socially and professionally that has a direct impact on commercial risk,” he says.

“If you measure your employee engagement and net promoter scores, over time, you’ll see that they dance together very well. So, where are you going to invest your time and resources? Are you going to cut corners and staff or are you going to pour your heart, mind, and professional efforts into your employees, so they feel fulfilled and they feel part of the tribe to deliver on behalf of the organization?”

Labrecque believes employers can positively impact the health of their employees over time by focusing on the five elements. For example, he says providing strong financial advice, creating social bonds at work, and helping people feel professionally fulfilled and part of something bigger than themselves with a sense of future belonging can make a significant impact on commercial risk.

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“But when you take all five and improve each exponentially year over year, that’s a big deal with a substantial impact,” he says. “The ability to look at this in the mid- to long-term is crucial. We need to talk about what we’re going to do tomorrow, next month, and next year. We need to start thinking of this in terms of decades.”

Labrecque entertains the possibility that he might be wrong and encourages others to tell him where it works and where it doesn’t work.

“Ultimately, I think you can never be too humane, and you can never, as an employer, pour enough into your employees because they will repay you in ways that you never thought possible,” he says. “Even if you improve at 10%, your traditionally measured results like EBITDA, profit and loss, top-line revenue, client lifetime value, and net promoter scores would be off the charts. This approach is meant to amplify what we’re already doing and, by the way, reduce risk, reduce turnover, reduce training costs, engage people, and increase your net promoter scores by increasing your employee engagement in a powerful way.” 

CONFERENCE:

HLTH 2021

PHOTOS COURTESY OF HLTH

Top health industry leaders joined with government officials, policy experts, politicians, tech industry influencers, and even a few celebrities in Boston last October for the HLTH 2021 conference. The four-day event brought together senior leaders from all areas to attempt to address some of the health care industry’s most pressing issues, and to seize opportunities to shape the future of health. Through a mixture of one-on-one meetings, group roundtables, sponsor exhibits, and more than 100 informative sessions, attendees learned about the exciting disruptors reshaping the entire spectrum of health. 

Above: Attendees network and take a break in the social media lounge in the exhibit hall.

Above: CNBC reporter Bertha Coombs (left) leads a panel on applying Amazon's culture of innovation to health care with (pictured from left) Heather MacDougall, VP Worldwide of Workplace Health and Safety at Amazon, Dr. Kristen Lloyd Helton, director of Amazon Care, and Vin Gupta, MD, MPA, senior principal scientist and chief medical officer of COVID-19 response at Amazon.

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Left: HLTH was committed to keeping everyone attending HLTH as safe as possible. In addition to being fully vaccinated, attendees needed to test negative for COVID-19 either 72 hours prior to arriving or they could test on-site before picking up their badge. More than 3,700 tests were administered onsite.

Below: Thousands of attendees filled the general session ballroom to hear from keynote speakers.

Above: Guests were interviewed in the podcast lounge for the HLTH Matters podcast.

Episodes will be released in 2022.

Left: Attendees filled the track rooms to hear from 200-plus speakers in more than 15 tracks.

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46 | Maverick • Winter 2022

5

factors:

What Every Benefits Manager Should Consider Before 2023

BY JR CLARK

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1)

Medical and pharmacy costs will rise by about 6.5%.

Medical and pharmacy costs are expected to continue rising.

According to PwC’s Health Research Institute, the medical cost trend—defined as the annual percentage change in the cost of treatment for patients, assuming no year-to-year health benefit changes—ranged from 5.5% to 7% between 2017 and 2021, adjusted for COVID-19 impacts, and is expected to be about 6.5% in 2022. The medical cost trend includes changes in unit cost and utilization for medical services and prescription pharmaceuticals for fully insured and self-funded large employers.

Moving forward, you’ll want to understand your company’s medical cost trend (including its current and future cost drivers), its ramifications for your health insurance costs, and any tools available to contain those costs.

JR Clark

T

he start of any year is a time of massive change. People make resolutions designed to better themselves. Holiday decorations begin to come down. And numerous benefits plans roll over and start anew for members.

While the hustle and bustle of benefits open season is an exciting time for human resources folks everywhere, that chaos has calmed down by the time January rolls around. As a result, the focus shifts toward thinking about benefits for the subsequent year. Although we’re just kicking off 2022, it’s already time to start thinking about employee benefits for 2023. While there are countless considerations about the impact of health benefit decisions on both employers and employees, there are some important factors worth watching as you begin the planning process. Here are five factors to consider as you envision your benefits package for 2023.

48 | Maverick • Winter 2022

For example, embedded within the medical cost trend is specialty pharmacy, which is a class of provider-administered drugs for the treatment of conditions like cancer, autoimmune diseases, and certain rare conditions. Specialty pharmacy spend has been on the rise, increasing by 89% between 2009 and 2019 and 14% in 2019 alone, as shown in the 2020 Magellan Rx Management Medical Pharmacy Trend Report. Specialty pharmacy now accounts for half of the total pharmacy benefit spend although only 2% of the population uses this class of drugs. As the breadth of new therapies increases—some of which have a price tag exceeding $1 million—the impact of specialty pharmacy is expected to further increase medical cost trend.

Likewise, medical cost trend is a foundational component in the overall cost to administer a health plan; it has impacts beyond just the trend amount. Consider this exaggerated example of deductible leveraging: You offer a health insurance benefit with a deductible of $1,000 and 100% coverage after the deductible.

If the medical cost in one year is $1,500, the employee would pay $1,000 toward medical costs, and the health plan would cover $500. Assuming a medical cost trend of 10%, the total cost of care would increase to $1,650 the next year. If the benefit structure remained the same, that means the employee’s out-ofpocket cost would remain $1,000, while the health plan’s liability would go from $500 to $650—a 30% increase.

2)

Expect an average annual employee deductible increase of 5.4%.

In aggregate, employers have been raising health plan deductibles as a means of offsetting higher health insurance costs. Some organizations are increasing deductibles by leaning out existing health plans, while others are adopting high-deductible health plans as a buy-down alternative for employees.

The Kaiser Family Foundation’s 2021 Employer Health Benefits Survey shows the average annual employee-only deductible for all firms with a deductible has increased from $991 in 2011, to $1,669 in 2021, which is an average annual increase of nearly 5.4%. In addition, KFF’s survey shows that the percentage of covered workers in health plans with single out-of-pocket maximums of more than $3,000 increased from 38% to 64% from 2011 to 2021.

3)

Average annual employee health insurance premium contributions should rise by 3.5%.

Employee health insurance premium contributions have seen increases in the same way as deductibles. Per the same KFF survey, annual employee contributions toward single health insurance premiums increased from $921 in 2011, to $1,299 in 2021, averaging out to about 3.5% annually.

That trend will likely continue in the new year.

4)

Per capita annual outof-pocket health care expenditures should hover around $1,200.

According to the Centers for Medicare & Medicaid Services, the 2019 out-ofpocket personal health care expenditure (not paid by health insurers) in the U.S. increased by 4.6%—to $406.5 billion.

This translates to slightly more than $1,200 per capita, or nearly $5,000 for a family of four. Concurrently, a 2021 Bankrate survey showed that only 39% of Americans surveyed would have enough savings to cover an unexpected $1,000 expense.

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5)

Employee retention should be your top focus.

Employees bring ingenuity, productivity, and brand perception to an organization. Typically, employees are also the most significant financial investment for organizations via the cost of salaries and benefits. Additionally, a study by the Society for Human Resource Management stated that an employer’s cost of replacing an employee is between 50% and 75% of their annual salary when considering recruiting, hiring costs, training, and loss of productivity.

The benefits offered (and their administration) to employees are one of the most important components of a successful company. According to a Glassdoor study, 80% of employees would choose

additional benefits over a pay raise; that same study found that 60% of people consider benefits and perks to be a major factor in weighing a job offer.

When selecting benefits, consider both the utilization and effectiveness of each benefit enhancement in terms of outcomes and employee engagement. If employee utilization is low while effectiveness is high (e.g., smoking cessation programs or imaging referral assistance), find ways to increase utilization. Conversely, a benefit with high utilization but low effectiveness should be evaluated in terms of being an employee perk.

If utilization and effectiveness are both low, it’s probably time to remove the enhancement.

Looking Forward: Ultimately, communication regarding your benefits package is the key to success. A 2018 survey showed that 40% of employees have difficulty understanding what benefits their health plan does and does not cover. Similar to how educated consumers are better equipped buyers, benefit-educated employees are better equipped health care consumers. Physical, emotional, and financial health are all essential components of employee well-being. Adopting programs that offer guaranteed financial assistance for employees’ unexpected out-of-pocket health-related expenses can be an efficient way to offer differentiated benefits while improving employee engagement as well as health outcomes. 

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Want to know more about the companies featured in this magazine?

Scan the QR Code, , and we ll send you information about the companies you select!  Tuned (PAGE 6)

 Flossy (PAGE 14)

 Maven Clinic (PAGE 6)

 Sano Surgery (PAGE 19)

 NourishedRx (PAGE 6)

 Flume (PAGE 23)

 Plansight (PAGE 6)

 Big Tree Medical (PAGE 27)

 Out-Of-Pocket, Nikhil Krishnan (PAGE 7)

 Gravie (PAGE 31)

 Paytient Technologies (PAGES 8, 46)

 Prairie Health (PAGE 34)

 Mitigate Partners (PAGE 10)

 Insurance Office of America (PAGE 39)

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