Issuu on Google+

Business Owner’s Guide to

Fighting Healthcare Making Healthcare a Smart Advantage for Your Business

By David Berg and Paul Johnson Version 1.0 We invite you to share your ideas and comments at FightingHealthcareBook@redirecthealth.com


Business Owner’s Guide to Fighting Healthcare Making Healthcare a Smart Advantage for Your Business

By David Berg and Paul Johnson

1


Copyright Š 2016 by David Berg & Paul Johnson All rights reserved. This book or any portion thereof may not be reproduced or used in any manner whatsoever without the express written permission of the publisher except for the use of brief quotations in a book review. Redirect Health 13430 N Scottsdale Road, Suite 200 Scottsdale, AZ 85254 redirecthealth.com ISBN-13 978-1523253760 Printed in the United States of America First Printing, 2016 2


Table of Contents Who We Are Dear Business Owner/Executive/ Entrepreneur

4 6

The Brief Story of a Company that has Already Saved Millions of Dollars off its Healthcare Bill

13

Section 1 – Things to Know

17

• The root cause of why companies and individuals pay too much for healthcare

18

• Three facts you need to know in order to start 21 controlling unnecessary costs and solving your company’s healthcare problems • Five expensive healthcare rip-offs to avoid

28

• Two misconceptions about healthcare we should all think differently about if we want to lower costs

37

Section 2 – Action You Can Take

45

• Two important things to always ask your 46 broker and insurance company for regardless of which healthcare option you choose • Three next steps to transform your healthcare 51 costs into a smart advantage for your company 3


Who We Are Paul Johnson / Paul.Johnson@redirecthealth.com Paul Johnson was the Phoenix Mayor from 1990-1994. He has been highlighted in the New York Times, Forbes Magazine, Healthstyle Magazine and People Magazine, and his administration received the Bertelsmann Award as the “Best Run City in the World�. Paul has served as Chairman of the Board of Arrowhead Health Centers, a network of comprehensive and integrated health centers in the Phoenix metro area (with Patient Centered Medical Home NCQA Level 3 Recognition). Making sure that healthcare always feels easy, convenient, accessible and affordable has been key. He is a cofounder and leader of Redirect Health, a company that is helping businesses change the way they think about their employer healthcare plans. In an environment of skyrocketing health insurance costs and frightening uncertainty for business owners and employees alike, Redirect Health provides control for business owners who want to affordably take care of their companies and their people.

4


David Berg / David.Berg@redirecthealth.com David Berg is a physician entrepreneur and owner/ founder of various healthcare companies, including Arrowhead Health Centers. A strategic focus on extreme customer experience always drives predictable and measurable clinical results and lower costs throughout his organizations. He has a successful track record for “smart” system design and process development that have served his companies well. David is also a co-founder and Chairman of Redirect Health with Paul. This unique relationship and the strategic and outside-the-box way of thinking abut healthcare that you’ll learn in this Guide have allowed his companies to lower their own healthcare costs significantly and keep costs low year over year. His companies have not seen a rise in healthcare costs for many years. In fact, his companies have their healthcare plans working so well, and so inexpensively, that his companies provide all employees and their families with free healthcare. Obviously, this gives great competitive advantage for attracting the best and most productive workforces. David holds a Hon. B.Sc., degree from the University of Toronto in physics and human biology, and a Doctor of Chiropractic degree from the Canadian Memorial Chiropractic College. His mindset and thinking have been greatly influenced by the Strategic Coach®, Abundance360, Genius Network® and Entrepreneurs’ Organization communities. 5


Dear Business Owner/Executive/Entrepreneur, Healthcare is a mess. It’s too expensive. No small or medium sized company even tries to argue this point anymore. There are so many moving parts and nothing in healthcare is transparent. No apples to apples comparisons. The Affordable Care Act, and the partisan media coverage aren’t making it easier. Big Brother of the status quo tells us we have to expect rates to go up every year. He tells us that our only option is to listen to the experts. So, how can your business possibly challenge the status quo? Start by understanding that without your leadership, it can’t happen. This Guide is designed to help you as the owner or the CEO, the real change agents of your company, discover how to question key healthcare assumptions that just aren’t true. Learn about 5 healthcare rip-offs and 2 common misconceptions that will save your company tens or even hundreds of thousands of dollars every year. In fact, we’ve saved millions in our companies and others’ already. It’s just not that hard if you know a few key things. This guide will help you better understand healthcare and your company’s healthcare options. With this information, you will be able to make more informed and financially prudent decisions. Discover that you have more power to challenge the experts, to challenge Big Brother, to challenge the status quo. All you have to do is choose to use your power. 6


Do any of us really imagine that our governments or the other status quo players will solve our companies’ healthcare problems? We don’t either. Rather, we know it will be a free market solution that emerges from business owners and leaders like you and us that will get healthcare turned around and working well. Our goal is to help you understand why it is beneficial to think differently about healthcare, and to change the discussion you are having today with your employees and your broker. We want to help you have clarity, confidence and new capability about your company’s healthcare decisions and potential. We hope you learn something valuable to use in your company. That you will demand more from your insurance companies, hospitals, doctors and brokers, or maybe you’ll just start asking different questions. We are evangelical in our desire for a real healthcare revolution. But it starts with one, and then a few, and then many companies. We know entrepreneurs can totally transform healthcare into a tool that gives their companies a strategic competitive advantage that will help them grow. Isn’t this what it is about after all – growing your business, creating jobs, helping our economy AND taking care of people? If you don’t do it nobody will — at least that’s how we see it. As you read this Guide keep in mind these three things if you are going to successfully lower your costs and turn your company’s healthcare plan into something more meaningful and impactful than it is today: 7


1. You will need to think the Unthinkable. Challenge the self-interest of the experts, and demand much lower costs than you are paying now. 2. You must have a health plan designed and built to specifically serve your company, one that uses data to help you and your employees make smarter and smarter decisions every month and every year. You must own your employees’ data and be able to legally and safely learn from it and then use this knowledge to help them get the care they need when they need it. You can make sure they get a great customer experience for their families and use this to drive better health outcomes AND lower costs. With the right strategy and results-oriented execution it’s easier than you probably imagine. 3. There is low hanging fruit for cost savings and creating value that is easier to get at than you might be thinking – but only if you have a smartly designed company health plan. Use real data to focus on the 10% of your employees who will predictably spend 90% of the money. For the rest, just make it easy, accessible and convenient. And make it affordable for all your employees to use your health plan. Don’t be crazy and nickel and dime them with annoying copays and expensive deductibles for routine care. This only makes it more likely that they will use emergency rooms and urgent cares where the costs to you will always be much, much higher. Keep them happy and 8


productive. Make it easy to not have to miss work for doctors’ appointments. No one makes money when employees are sitting in doctors’ waiting rooms or emergency rooms…except the doctors and hospitals. We can show you how. We believe in the “Triple Aim”. This means that a great customer experience for your employees should drive best possible health outcomes, and lower costs. Meaning, if we can make healthcare convenient, truly affordable, accessible, fast, helpful & friendly, use technology better, and create an understandable and doable care plan for your employees, then you can achieve a healthier, happier and more productive workforce AND spend less money than you are now. But as Americans, we can also buy into a higher Triple Aim. The one that believes if we improve the lives of our employees, if we lower the costs to our businesses, we make for a more competitive America. We believe small businesses, the people who work for them, and the families who rely on them drive America forward. Today, their healthcare experience just isn’t that great. In fact, it can be downright daunting and overwhelming to navigate. It’s safe to say everyone agrees that healthcare costs, waste and unnecessary administration have gotten out of hand. It doesn’t have to be this way. Waste can be eliminated. Administration can be streamlined. You don’t have to accept the status quo. There are better solutions if you want them. 9


Redirect Health is disrupting the status quo. Every day, we help employers take back control. We enable them to offer their employees the high-quality healthcare they will need and use at a price they can really afford. We’re transforming healthcare from a high-cost burden into a competitive smart advantage. Our Massively Transformative Purpose Making healthcare a Smart Advantage for business. Today small and medium-sized business have tremendously unfair disadvantage when it comes to buying healthcare. Why “unfair”? Well, today big corporations are able to leverage their massive sizes to shift their healthcare costs over to smaller companies who foot part of their bill. This gives smaller companies an unfair disadvantage in our view. We want to totally undo this in a way that gives them the advantage in a way that makes them the preferred place for people to work. The game totally changes for a smaller company when its leader chooses to learn how to transform the expensive burden of healthcare into a strategic and competitive advantage for their company and their people. We’ve seen this many times. This is what we’ve done it for our companies, and what many others have already done. There will be a tipping point one day. We believe it will be very soon. And when it happens, when enough small and medium sized business entrepreneurs take charge, it will be 10


a game changer for America. Our Moonshot We imagine a day when any American company that wants it can have healthcare working so well and so inexpensively that they will want to provide it for free to their employees and families because of the free-market advantages they will gain in their local and global marketplaces. They will utilize healthcare to attract the most talented and productive workforces from within their communities and around the world that will further fuel their growth. They will be ready when new technologies and capabilities like inexpensive gene sequencing, proteinomics, artificial intelligence, sensors, and many other healthcare innovations become available. We hope that this Guide gets you thinking and feeling differently about healthcare, and gets you on the path towards your company’s solution for today and for the future. If you have questions about your healthcare, you’re invited to call on us. We’ve dedicated our business to educating the Purchasers and Users of healthcare…in your case, the Companies and their Employees. We’ll be happy to help you in every way. Sincerely, David Berg & Paul Johnson Redirect Health Founders

11


Start with keeping it simple and practical. This guide is a short version of how to fix your company’s healthcare problems. It is designed to be read by the “change agents” in a company. Usually, the CEO or owner. We get most excited when a business leader uses this information to expand their business by challenging the things that are in the way. You don’t have time to waste so let’s hit the most important things you need to know to lower your healthcare costs while improving the health and productivity of your employees. If you already know you want to get started then jump right to page 51 and find out the next steps.

12


Our Story: “Thinking the Unthinkable” & Challenging the Status Quo By 2007 we both realized that the escalating cost of healthcare insurance for our several businesses (and all the uncertainty we experienced) had to stop. It was threatening our businesses and the businesses of our friends. Economists were pointing out that for businesses to remain competitive in the national and global economy, for Arizona and America to regain their economic strength, we had to get a handle on healthcare costs. We decided that we couldn’t just sit back and accept what was happening. We decided to do something about it. We had to. We couldn’t afford not to. We started with our own companies. With our own employees. With our friends’ companies and employees. With our own money. And this is an important difference from what you’ve heard before. We learned. And what we learned is teachable. Any company can do it. Redirect Health began not as a theory or an idea. It didn’t begin in the office of an actuary. It began humbly when we became tired of, and frightened about, our own companies’ healthcare insurance costs rising too much every year, usually over 20% annually. In 2007 we started on the path of transforming the initial failure we felt for having been beaten by the very healthcare system we worked in. In our own entrepreneurial way we began analyzing our companies’ healthcare plans with the intent of fixing them. 13


We learned that our companies’ healthcare problems were just like any other business problem that needed typical business thinking and a business solution. De-mystifying the complexity took some time, and was a lot harder that we thought it should be, but it was otherwise just the same – and it was worth it. We took a chance. We moved away from allowing our insurance company to manage our healthcare. We started paying doctors and hospitals directly for our employees’ healthcare. What we learned blew us away. We never could have imagined the huge differences in cost between a doctor’s visit or a service in a hospital versus the same doctor’s visit or service across the street outside the hospital. We learned how easy it was to pay 5-20x more for the same service just based on the place of service. Our eyes were opened when we learned what our employees’ care was actually costing and how much less it could cost if we used some basic business strategy and common sense – if we just paid attention. We still had insurance with the insurance carrier we had used for years, but only to protect us if anything super catastrophic happened. We soon learned that healthcare was never as expensive as we thought unless we went to certain hospital systems. Our management teams focused on helping our employees understand their healthcare options and costs. We educated our employees and incentivized them when they used providers and hospitals who would collaborate with us 14


and who were reasonable with their pricing. But mostly, we began to manage our own data, tracking and monitoring our initially rudimentary system and our costs. In our first year, because we were looking at our data in a strategic way for the first time, we saw that our insurance company had spent nothing on our employees’ healthcare claims that year. There were administration costs, but no claims exceeded the deductible. Their costs had fallen through the floor. Naively, we believed that this would result in lower premiums for the first time ever. But then the big surprise. Our insurance company sent us a 23% increase in premiums after they had just paid nothing in claims! They did lower the increase to “only 17%” a few days after we complained and asked for some rationale. Strangely, they did not see our lowered cost as a benefit they saw it as a risk. We were astonished, but now, more than ever, resolved that we needed to fix this problem – that we really wanted to fix this problem. Through more intense analysis, and by asking many questions of many types of people in the health insurance, hospital, specialist and broker businesses, we created a new healthcare system for our companies, the early prototype for Redirect Health. In the chart on the next page, you can see how our costs per employee have changed. You can also compare that to the Kaiser National Average to see historical and projected costs. We began to save our companies lots of money. 15


Money we re-invested back into our companies, back into the Arizona economy. We grew our businesses, and it was growth that required more employees and served more people. Our new healthcare savings provided more than enough funding for adding better care for more of our employees and their families. Today, we wouldn’t even think of giving up the advantages our companies realize by having fixed healthcare for our employees and their families. When we saw the beauty of this system we had created, we wanted to share it. So we created Redirect Health to help other companies lower their costs and help small business succeed. Total Healthcare Costs Per Person, Per Year Employer & Employee Costs $ 10,000 $ 8,000 $ 6,000 $ 4,000

16

14

15

20

20

13

20

11

12

20

20

10

Our Employee Health Plan

20

09

20

20

08

07

20

06

20

05

20

04

20

03

20

20

20

02

$ 2,000

National Average

Figure 1 | Healthcare Costs for Our Employees vs. National Averages 16


Section 1 Things to Know

17


The root cause of why companies and individuals pay too much for healthcare After many years of studying the healthcare problem and learning with our own companies and our friends’ companies, we find ourselves somewhat reflective. How is it that we can now predictably have lower healthcare costs AND a much-improved healthcare experience for employees and their families when it was so abstract and difficult for us to imagine ourselves for so long? To understand this we have to start with where our mindsets used to be. What was the reason we were both so stuck, and our businesses were burdened with high costs, low service levels and projected increases in premiums years into the future? Our conclusion? Somewhat embarrassingly, we had relied on the industry experts to tell us the answers. The experts who profited from higher costs. We had only ourselves to blame.

Upton Sinclair was so right when he said: “It is impossible to prove something to someone whose salary depends on believing the opposite.”

It really is explained that easily. We had delegated our own thinking to others – to our brokers, to our insurance 18


companies, to our hospitals, to our doctors, to our politicians, and to our media! And we had done it in a way we never would have even considered given the size of the expense. For some crazy reason we had expected them to effect change that would benefit us most and them less… when their interests weren’t aligned financially with ours. In essence, we had bet against human self-interest. Wow, were we dumb about this. But challenging the experts in healthcare was unthinkable back then for us. Before you can fix your problems you have to do step #1: think the unthinkable, and challenge status quo thinking! Here is just one unthinkable thought according to the experts: you want to lower your healthcare costs, increase your employees’ benefits and service levels, and then use the savings to grow your business. This demands commitment, courage and innovation, but no different than what every business leader is already used to. Please don’t misunderstand us. We believe that listening to and gathering information from the various traditional experts will always be important, and they really are experts in most cases. But, to successfully get a healthcare plan that truly serves your company you must design your own plan around your needs. This is what Redirect Health does, but it is not necessary to use us. You can do it yourself like we did, but of course we’d be happy if you used us to help. What is necessary is you must decide for yourself: what strategies, what services and what kind of value do you want for your employees and your 19


company healthcare plan? Then, you must demand that the system deliver this to you. Definitely, you will have to go around some of the experts and make your own important decisions. With the help of Dan Sullivan and his Strategic CoachŽ System, we’ve created a Health Plan Scorecard to help business leaders understand and improve their mindsets so they can get clear on what they want to get from their company health plan, no matter the size of their business. You can assess yourself for free at redirecthealth.com/ HealthPlanScorecard, or by using the Scorecard in the back of this book.

20


Three facts you must know to control unnecessary costs The 3 most important facts you need to know if you want to lower your costs are described here. Of course there are more things and there will always be debate over which are most important. If you understand these three and create meaningful solutions for them, though, you will definitely see a huge impact for your company. #1: Your sickest 10-15% will spend 85-90% of your company’s healthcare claims dollars. Be strategic. Be smart. Stop for just 30 seconds and think hard about the implications of this fact. It is the single most important thing to know to design and execute your company healthcare plan if you want to lower your costs and keep them from rising. Hardly anyone knows this, except the experts. It’s obvious, isn’t it, that if you want to meaningfully impact healthcare costs for your company you will need to lower costs for this 10-15% of your employees (and their families) who are the sickest. After all, they will predicatively spend 85-90% of your company’s healthcare money. It’s just simple budgeting math isn’t it? A typical business problem with a business solution. You’ve ‘been here done that’ before. Now here is what you probably do not know: The vast majority of these people who are part of this 1015% typically have asthma, diabetes, psychological and 21


pain issues. That’s usually it. And many times you never meet them because they are the spouses or kids of your employees. But sometimes they could have heart and cancer issues, especially if you have an older workforce. But the good news is that we can predict who the 10-15% are before they have issues and spend nearly all your money. Then, we can make sure that the money that is spent is spent wisely so that much less is spent. On top of that, the healthcare experience of these people can be even better. This is the definition of value after all. Knowing your people and how they spend your healthcare dollars is so important. Look at the illustration on the next page and we’d bet that you can figure out where the greatest opportunity to lower costs and improve health lies. Hint – look at the red.

22


+ 20%

“Insurance” & Administrative Costs

100%

90% High Risk (10-15%) “Please help me, I’m scared.” Diabetes, asthma, cardiac, cancer, narcotic use, major trauma.

88% Hospital ER Visits & Admits for Diabetes, Asthma, Cardiac Worries, Pain, Cancer Treatment Major Trauma, Babies (High Risk)

At Risk (25%) “Leave me alone, but be available right away if I need you.” High blood pressure, high cholesterol, BMI over 35, over age 50, smoker, alcohol use, sedentary.

Low Risk (60-65%) “Don’t waste my time or money.”

12% Primary Care & Rehab (incl. Chiro)

5% 88% Hospital, Specialists, Pharmacy, Lab Babies, Gall Stones, Kidney Stones 12% Primary Care & Rehab (incl. Chiro) 5% 88% Hospital, Specialists, Pharmacy, Lab Babies, Broken Bones 12% Primary Care & Rehab (incl. Chiro)

0%

Your People & What They Care About

Money They Spend

Figure 2 | Understanding Where Your Healthcare Dollars Go

23


#2: Approximately half of all healthcare costs occur in hospitals. Here is the second most important thing you need to know. When a service is preformed in a hospital it will typically cost 5-20 times more than if that exact same service were performed across the street outside the hospital. For example, in Arizona, a low back MRI done in a hospital will cost around $1,500-3,600 (and even more if you don’t know better). This exact same MRI performed across the street, outside the hospital, will cost only $300-$500! A foot X-Ray can cost you over $1,000 in a hospital emergency room. Similar ranges of immense differences are seen with almost every other service that could be done outside a hospital (i.e. blood tests, specialist consults, breathing treatments, chest x-rays, etc.). We’ll show you some later. It will shock you like it did us. Now, here is something else that you probably do not know: The large majority of your costs for your sickest people (the 10-15%) will happen in hospitals. And much of their care can actually be proactive and performed at a fraction of the cost outside the hospital. But only if timely resources are available to these people. We know you’re wondering, “Why on Earth would one of your employees go for a $3,600 MRI at a hospital when an equally good MRI existed across the street for $400? Or why would they be willing to be charged $1,200 in an emergency room for an x-ray for a sprained ankle when 24


across the street it would cost $50?” Now, if your health plan worked well, and the data and pricing transparency existed and was available to you (which it can be), and your employees and their doctors knew and were incentivized accordingly, then of course your employees would go for the best value. But if you’re in a health insurance system that actually benefits from your people not having the data and transparent prices so they know better, well, how could your employees really make any other decisions. And you probably didn’t know this, but more and more often your employees’ doctors now work for the local hospital system and they have somewhat of an obligation to send your employees to the higher priced MRI and specialist at the hospital they work for. More on this major problem that you want to avoid later. #3: The law mandates that insurance companies spend 85% of your premiums on paying providers and suppliers of healthcare (i.e. hospitals, doctors, labs, pharmaceutical companies, etc). This is the third most important thing we think you need to know. Read this again: “The law mandates that insurance companies spend 85% of your premiums on paying the providers and suppliers of healthcare (i.e. hospitals, doctors, labs, pharmaceutical companies, etc.).” This means that only 15% of your premium is all your insurance company gets to keep by Federal law. It also means that if the healthcare costs are not high enough, then your insurance company has to give back some of its money at 25


the end of the year. Ok, here is another place where we need you to slow down for 30 seconds and really think for yourself about this fact and the important implications. Just 30 seconds. If it’s not coming to you, it’s ok. It took us almost a year to see this one, and virtually no one gets this at first. Ask yourself: “What is the benefit to an insurance company if they actually decreased the likelihood that services would be done in higher cost hospital settings? Don’t higher hospital costs also result in their 15% being a larger amount?.” Yes it does. There is no long-term incentive for insurance companies to lower costs because their profits are tied to higher costs. The common way to grow insurance profits is to charge higher premiums to you and then allow medical costs to use up 85%, but not more, of your premium amount. This way the 15% they get to keep is maximized. After asking these questions you may realize what this means: Your insurance company’s financial interests cannot be aligned with yours. After all, what would Wall Street and shareholders say, and how would insurance company stock prices react, if the cost of care actually decreased and the 15% they got to keep was actually lowered? We all know the answer. The lowering of healthcare costs cannot really benefit the insurance industry in the long term. At least not with today’s laws. In fact, we see many hundreds of billions of dollars of incentive every year for the health insurance industry keeping the costs of care for your employees as 26


high as you and other businesses will tolerate. We also know that when our own companies dramatically lowered the actual cost of our claims the insurance company had to pay, they actually tried to increase our rates! The nuanced full explanation for this far exceeds the scope of this Guide, but suffice it to say that no reasonable business owner would consider it to be fair or common sense. We’ve since learned that there are many non-traditional insurance companies who will insure healthcare risk, and they benefit from keeping claims costs low. They are AAA rated, but most brokers don’t tend to recommend them often so they remain unknown. These solid companies don’t spend much on TV commercials and broker commissions. These insurance companies are focused on stop loss coverage for real risk, just like life insurance or auto insurance. But we do believe in the power of a free market. We believe that once enough businesses begin to demand this type of insurance, imbedded in a better healthcare plan, even the traditional insurance companies will adapt. They are not today, because they don’t need to yet.

27


Five expensive healthcare rip-offs to avoid (or at least minimize) In this section it may seem like we are picking on hospitals a bit harshly. We agree, but this is where the bulk of your healthcare claims dollars go, and this is the place your company could use the most protection. The vast majority of hospital leaders and workers we know are very caring and honest people. They are also smart and doing exactly what they have to do to survive in the current healthcare environment described earlier. They are good people in a bad system. They have no choice or ability to do otherwise. You do have a choice about whether or not you continue to play this rigged game. #1: Hospitals with the greatest market share successfully demand and negotiate much higher prices. With no added quality or value, hospitals can negotiate much higher payments from every insurance company if they have stronger negotiating power in a region. The table on the next page shows what one major insurance company pays for various services at different hospital systems in Arizona in 2015. This data is all available online, though it is difficult for the average person to find and assemble. We have looked at similar data for other US cities and states and have seen similar differences in pricing and value. Transparency is definitely lacking, and we can’t help 28


but at least question the integrity of the way hospital pricing occurs when we look at this data in Arizona and around the country. You are likely saying, “No way this can be true. This would be illegal, or at least the media would be reporting it!” Well, it is true, and maybe it is illegal someday. The media is starting to ask more questions and we’re seeing more and more stories exposing this kind of price discrepancy. The problem is that the media seldom knows how to really ask the right questions and to connect the dots in the most meaningful ways. Remember, the experts who control healthcare are very smart and have lots of financial incentive to stay a few steps ahead of the investigative reporters.

Why?

Non Hospital

Hospital W

Hospital X

Hospital Y

Hospital Z

Lumbar MRI

$400

$1,291

$1,351

$1,707

$3,469

Colonoscopy

$734

$2,000

$2,100

$3,200

$3,500

$3,200

$6,000

$6,100

$7,800

$13,900

Vaginal Childbirth

N/A

$7,400

$9,500

$12,000

$10,500

Cesarean Childbirth

N/A

$12,000

$15,000

$19,000

$18,000

Knee Replacement

$15,600

$29,000

$32,000

$46,500

$44,000

Laminectomy

$5,000

N/A

$16,500

$22,500

$20,000

Spinal Fusion

$17,000

$30,000

$33,000

$44,000

$38,000

N/A

N/A

$77,000

$89,000

N/A

Gall Bladder Removal

Coronary Bypass

Figure 3 | Comparing Hospital Pricing in Arizona

A recent December 2015 study by researchers from Yale, University of Pennsylvania, and Carnegie Mellon University 29


analyzed billions of hospital clams paid by commercial insurance companies to hospitals. It concluded that costs could be up to 12x higher for hospitals systems with larger market share that could negotiate higher prices. This study is condemning enough and the media should be applauded for picking it up for a couple of days. But the real story was totally missed in our opinion when no mention was made between the costs differences for procedures that never had to be done in a hospital system in the first place - the more routine services like MRI’s, x-rays, lab tests, colonoscopies, etc.. Our experience shows us that this is where the greatest waste is, and this is exactly where every business will find the greatest opportunity for savings that could end up on their company’s bottom-line. #2: Hospitals are ‘buying’ doctors so that they can fill beds and raise prices. It’s true. Hospitals in the United States are buying up control of both primary care physicians and specialists around their hospitals. These doctors are then ‘encouraged’ (obligated?) to make sure that their patients (who are your employees) have services referred to the hospitals that employ them, and at a cost to you that is always significantly higher than if done across the street outside the hospital. Hospitals directly lose about $165,000 per year for every primary care doctor they hire, and about $300,000 per year on average per specialist they hire. Think about why they 30


might want to buy a doctor’s practice. Increased market share so they can negotiate higher prices and fill operating rooms, MRI machines and overnight beds is surely part of the answer.

31


#3: Urgent Cares now owned by hospitals. Urgent cares haven’t always been owned by hospitals, but they are now more and more. Just look as you drive around town and you’ll notice it. And when urgent cares are owned by a hospital system, they can be a perfect entry point for funneling services and profitable patients (again, your employees and your money) to the hospitals and doctors who are employed by the hospitals. And, as we’ve seen, services done at hospital rates are always much higher, 5-20x higher. Also, don’t be surprised if many more services will be performed once a routine matter is assessed in a hospital. And if the urgent care can help increase hospital market share, that will mean the hospital should be able to negotiate the ability to charge the higher hospital rates for urgent care services AND to “mine” your sicker employees for the best profits. Of course they do this. They are a business and need to boost profits like every business does. Again, good people run and work in hospitals. They’re just doing what a bad system makes them do to survive. But we do understand your frustration of spending your company’s money on this.

32


#4: Huge price differentials in common prescriptions. The medications that are prescribed to your employees and their families (paid for by you) always have price differentials that are frequently very large depending on the pharmacy selected, the insurance company contract, and how the doctor writes the prescription. For example, a simple antibiotic prescription can range from $12 to over $50 for the generic form and to over $1000 if your employees don’t know better and allow their doctor to prescribe or their pharmacy to switch the prescription to the brand name. There are easy ways to get the lowest price (and the best value) if your plan is designed with this protection in mind. There are free apps and websites that will supply your employees and their families with free coupons that can guide them to the best value and lowest prices, and at the same pharmacies they are using now. GoodRx is currently a free app that does this excellently. Of course, having smart incentives in your health plan structure that reward everybody for caring is an important part of lowering costs and ensuring best value for your company.

33


#5: High-deductible insurance plans that partner with a hospital. Beware insurance plans that seem too cheap and have large deductibles or many restrictions for using services. Often these insurance plans have $3,000-$6,000+ deductibles (up to $10,000-$12,000 for families) and require that the services are performed exclusively at a particular hospital chain’s facilities (imaging centers, specialist offices, urgent cares, ambulatory surgical centers, operating rooms, primary care offices, etc). This would not be a big deal except you now understand that the costs of services at the hospital rates can be 5-20 times higher in many instances. And where do you think the doctors who work for the hospital will be encouraged to send your employees for services? Probably to the hospital owned facilities that have been able to negotiate higher prices. With the higher deductible plans you chose, it will be your employees and their families who have to pay the first part of these higher prices. Don’t be surprised if your employees can’t afford to use the insurance you provide for them and start getting upset when they get into financial trouble. At the very least, ask the insurance company you are considering for its negotiated fee schedule with the hospital systems your employees will have to use. With so much personal bankruptcy being caused by medical debt, this is important to understand and ask about. At least give your employees a fighting chance by letting them know where the value is in the system so they can get to it themselves. 34


Tip: At the very least, ask the insurance company you are considering for its negotiated fee schedule with the hospital systems your employees will have to use.

The reason for the cheap premiums is often because the hospital associated with the insurance plan is expecting to make money through the deductibles of your employees for services that are priced much higher than would be seen outside the hospital. This lack of transparency makes it very easy for your employees to be tricked into higher prices. It really does happen all the time. We believe that employers will soon see these plans using low co-pays (or no co-pays) for routine primary care to encourage people to stay inside the hospital system. This could be great except when it leads to services being referred to a hospital when they could be done outside the hospital for a small fraction of the cost. Your employees will have to go to this hospital system and you don’t want them to be surprised by huge fees that will be charged before their deductibles are reached. We have seen many times with these high deductible hospital plans that it is less expensive for your employees to not use their insurance card and more simply pay cash for their services at lower priced facilities, and with even better overall customer experience. Why should your employee pay $1,500-$3,600 out of their own pocket for an MRI when 35


they could get one for $400 by not using their insurance? The answer is that the bad system only allows them to know this after they receive the higher priced MRI at the hospital. At the very least, if you are going to select this kind of health plan for your employees demand to know the prices your insurance company has negotiated with the various hospitals and facilities so your employees and their families don’t get stuck with an unexpected medical bill they can’t afford. If your insurance company will not give you this negotiated pricing in writing, ask your broker to find you another insurance company that will. You will be surprised at how much power you can gain back when you are ready to switch brokers or insurance companies. We would encourage you to exercise your power to switch if you can’t get the prices your employees will be asked to pay before you sign up and enroll. This is a very reasonable request.

36


Two misconceptions about healthcare that we should all think differently about Misconception #1: Americans spend nearly $3 Trillion per year on healthcare (and rising) $3 Trillion is about 18% of our GDP and ranks us terribly when compared to other developed countries for overall healthcare system cost. Well, we believe there is a major problem with these stats. Canada ranks much better than the United States, spending less than 12% of its GDP on healthcare. But we are calling this one out. David lived in Canada for 23 years. He trained there, practiced there, owned a company there, and was a patient several times there. He has many family members and friends there. We see many Canadians who come to us for routine healthcare because it simply is not available to them. We can tell you that it can really be bad to need healthcare quickly in Canada. In our opinion there is no way that the Canadian healthcare system matches up to the US healthcare system for quality and accessibility and true effectiveness. Not even close from our experience. The most privileged people in Canada wait (and sometimes die waiting) for services that the poorest and most average Americans get right away very successfully every hour of every day. Americans wouldn’t tolerate for one day what we’ve seen the most advantaged Canadians tolerate routinely before coming to the US for care. 37


So how can Canada’s higher world ranking relative to GDP be explained? Well, let’s challenge this belief and ask this question: Do we really spend $3 Trillion on healthcare? Or is a large portion of this money spent on something that isn’t really healthcare but is simply just called “healthcare”. Are there healthcare industries that count on revenue and profits caused by something other than real healthcare? Yes there are. Here’s our take, but do your own research and use your own mind because there will be lots of disagreement on this opinion from the status quo players in healthcare… remember Upton Sinclair’s quote about getting someone to believe something that would affect their paycheck?

$1 Trillion Real Healthcare

$1 Trillion Healthcare Waste

$1 Trillion Administration

Figure 4 | Breaking Down Healthcare Spending

We believe that true healthcare costs in the United States are only about $1 Trillion (6-8% of GDP), and that there is lots of profit to be made by industries that know how to be smart by organizing and structuring their systems to capitalize off predictable waste, administration, inefficiencies and designed poor planning. This simply isn’t the case in Canada. 38


We’re not saying that there isn’t any waste, administration, inefficiency and poor planning that lead to extra costs in Canada – we’re just saying that the financial incentives are much different such that these things don’t pay as profitably in Canada like they do in the United States. We’re also not saying that the Canadian healthcare system is better than here in America. Again, we believe that it is far superior in America. We’re just saying that in the United States, we allow big industries to earn humongous profits off waste, administration, inefficiency and poor planning, and Canada does not. “Waste” is a bit abstract so let us try to give only two examples that are representative of this. In Canada, an MRI that was done for $300-500 outside a hospital is not performed again a week later in a hospital down the street at a much greater cost. And a gall bladder surgery that can be performed for $3,200 will not be allowed to be performed at another hospital for $14,000. This happens in the United States many times every day and many dollars of these extra costs get added to our $3 Trillion number. We call this difference in cost “waste”, not “real healthcare”. And “poor planning” is also a bit abstract. But imagine the diabetic child of one of your employees running out of their 90 cent glucose monitoring strips that are essential for knowing the dose of insulin for her. It would not be uncommon for this situation to lead to a $20,000+ hospital admission. So, you tell us, was this $20,000+ of revenue that the hospital made because of a need for “healthcare”, 39


or was it really because of “poor planning” designed into a system that limits diabetic supplies? Maybe we’d be going overboard if we claimed that this design was on purpose, but the fact remains that the limiting of basic inexpensive primary care, education and diabetic supplies benefits the status quo players in healthcare. This amount is also added to America’s $3 Trillion healthcare spend. Canadian private insurance companies simply cannot demand double digit premium increases from employers every year to pay for this waste, administration, inefficiency and poor planning like is tolerated by most businesses in the United States. As soon as you decide that you won’t tolerate it any longer you will find that your company’s “waste and administration” bills will decrease dramatically.

40


Misconception #2: The Healthcare System is broken and it actually exists to serve YOU Like most people we used to agree with the commonly stated premise that the healthcare system was broken. We now have concluded that the American private healthcare system is working very well for what it was designed to do. We know that this sounds a bit contrarian so let us explain. It is our belief that the healthcare system of today in America is run and controlled by trillion dollar industries with multi-hundred billion dollar companies that are publicly traded and have lots of influence over the look and action of our governments. With all the media and talk about the expense due to Obamacare it surprises most when they learn that the very best sector in the world to have invested in from 2011-2015 is US insurance, pharmaceutical, hospital and other related healthcare stocks. For the most part, the percent growth in these stocks during that period surpassed the Dow and Google by 2-3x. And the Dow and Google did very well during that period. These public companies have a goal (and fiduciary duty) to grow revenue and profits (and share prices) by any legal means. Since these companies can easily leverage their size and influence to have control, we believe it is reasonable to conclude that today’s US healthcare system is working perfectly for what it is designed to do – return share holder value to these companies. It’s just not working that well for the rest of us, but that doesn’t mean it’s broken. Maybe it’s just not designed for us. 41


Are there any business owners or their employees who still really feel that the healthcare system exists primarily to serve them? If the system did exist for you, wouldn’t you expect to see much more transparency in pricing, and premiums that did not go up 10-40% every year? Actually, wouldn’t we expect technology to lower our costs like it does in every other industry? And your employees would be able to get their appointments easier, they would have more access to their doctors via the phone, their appointments would be on time, etc., etc. In a nutshell – healthcare would be much easier, more convenient, more affordable and more accessible when your employees needed it. You wouldn’t have the hassle, frustration and feeling that you were being taken advantage of at every renewal time. Clearly, the system is not designed to serve the employer and employee. But this doesn’t mean it isn’t doing what those with the power want it to do. Share prices don’t lie. The more we have studied it the more we see that the only two stakeholders in the entire healthcare system who are aligned for costs, quality and customer experience are the Purchaser of healthcare (the Employer) and the User (the Employee and their family). All other stakeholders (hospitals, doctors, insurance companies, brokers, pharmaceutical companies, and even our politicians) are incentivized to do things and make decisions that are not aligned with the employer and employee. At the very least, there are many things that happen in the healthcare system 42


that do not benefit the employer and employee, but do benefit these other stakeholders in the system. But there is a secret that is not commonly known: When an employer and employees team up together, and recognize their aligned interests, they gain great new capability for lowering healthcare costs, getting better quality and results, and having the customer experience they want. Even though it could seem that the more organized stakeholders of healthcare (the hospitals, insurance companies, brokers, doctors, etc.) are conspiring to take advantage of employers and their employees, we would encourage you to instead at least consider that the people running the system are most times very good people who want the best and want to help people. Most times it is why they got into healthcare in the first place. It is just unfortunate that the system they work in essentially forces them to do what they do, often without even knowing that they are doing it. The good news is that your company doesn’t have to play in that system if it doesn’t want to.

43


44


Section 2

Action You Can Take

45


Ask your broker and insurance company for these two things regardless of which healthcare option you choose #1: Negotiated prices with the hospital systems For the reasons already stated in this Guide, and this is worth repeating, always ask for the prices that your employees and your plan will be charged at the various hospital systems. Your employees will consider you a hero if you can help them get better value by proactively directing them to the best prices. We hear continually from business owners who have done this about the endless thank you’s they get from their people. It’s kind of common sense isn’t it, that we should all be able to know what something costs before choosing a facility or doctor? We think so too. You will probably be told that this pricing information is not available, or it depends on what procedures are preformed, or that the information is proprietary. Keep asking, and encourage other business owners and leaders to ask, and encourage your politicians to ask for you. We believe that it is your broker’s job to get this for you and your employees… if you want it of course. Every day, we get as close to the real pricing as we can for our clients’ companies and employees before any commitment to a service or procedure in a hospital or anywhere else, so it is possible.

46


#2: Access to YOUR data Now, here is the most important thing your company can ask for and has to get that will have the greatest impact on your company getting fair healthcare costs now and in the future… your complete data in actionable format. Nothing is more important. This is the single most important thing to lower healthcare costs, and this is what can give you the confidence that you can safely budget for healthcare costs to stay relatively level year over year. This one thing should be absolutely non-negotiable: You must own your own data. If an insurance company will not agree in writing that all your data belongs to you, regardless of whether you renew with them in future years (especially if you don’t renew), then walk away. You cannot let yourself be held hostage to not having your past data when you want to price your company’s healthcare plan with another insurance company in future years.

Tip: You must own your own data. If an insurance company will not agree in writing that all your data belongs to you, regardless of whether you renew with them in future years (especially if you don’t renew), then walk away.

When you rebid your insurance, if competing insurance companies do not have your data they guess at the risk, 47


placing them at a disadvantage relative to your current insurance company. This causes the competing insurance company to price in a buffer to protect themselves. A new insurance company may decide to ‘buy’ your business and take a chance without seeing the prior data. Why not? They can always just raise your rates more next year to make up for it since the data will then be theirs. Most traditional insurance companies will tell you they can’t give you this data. If you dig deeper and demand it, they may say Federal law prohibits them releasing it because of the HIPAA privacy laws and the possibility that you as an employer might use it for retribution or treat an employee unfairly. They may tell you it’s in your best interest not to have it. It is such an easy way for them to keep control… to be like ‘Big Brother’. They don’t want you to have the data because they don’t want it given to competitors to see if you could lower your costs. Push harder. Challenge the status quo. You can have your data. Unfortunately, it is likely that you won’t be able to get your past data from your current traditional carrier. If this is the case, don’t get mad. We understand. It infuriates us too. Just make sure you gain the right to your data with your next contract, whether or not it is with the same insurance company. And, please remember, the data needs to be in actionable format, meaning that it needs to be able to be stratified 48


and separated in any format you may want now and in the future. As your company’s health plan grows and as your understanding of better ways to analyze your data improves, you will always want lots of flexibility. In your contract, make sure that your complete data will be delivered in Excel format, or other standardized format that any insurance company can use to give you competitive pricing. It is ok if it is just raw transactional data, but make sure that it will be complete. Giving you incomplete data or in PDF format is not acceptable. There could be thousands of lines of data. Again, watch out for Big Brother saying that privacy laws prevent you from having this data. This is only partly true. There is nothing wrong with you having the data so long as the identifying information like name, age, sex, address, department, etc. is not seen by you and is properly protected. It is perfectly appropriate for another insurance company (or a third party administrator) to see this data, or for you to hire another company like Redirect Health to help you analyze your data. It is common for insurance companies and third party administrators to know how to safely take possession of this data so that privacy laws and just plain common sense are respected. A common trick is to only give you “de-identified data�, meaning that the names have been stripped off. This might help the next insurance company understand the risk a little better, but not a lot since they would not know if a sick employee (or family member) was still on the plan or 49


if they have left the company. You must always get your complete transactional data that is fully identified so that you can get the best pricing at renewal time, especially if you are considering a different carrier. Never, never accept de-identified data. But also, never look at any part of your data that could allow you to identify who an employee is and match with any medical records. Privacy should be respected. It’s the right thing to do. Only by having your employees’ data available to you in actionable format will you or your broker be able to negotiate fair pricing in the future, know where the low hanging fruit exists for year-to-year savings, and protect your company from unfair pricing.

50


Three steps you can take now to transform your healthcare costs into a smart advantage for your company Think differently, think the unthinkable, challenge the status quo, realize that the problem never was what you thought it was…and then decide to do something about it. #1: DECIDE TO THINK DIFFERENTLY Decide that you are done with the status quo healthcare system. Decide that it is time to at least consider what your company would look like if you were to take on a different mindset about healthcare and what you will tolerate and pay for. Consider the difference if you were to apply an entrepreneurial mindset and skillset to your healthcare problem. Want help learning how to instantly change your mindset about what your healthcare should be? First, head over to redirecthealth.com/HealthPlanScorecard or flip to the back cover of this book and complete the free Health Plan Scorecard. In under 10 minutes you’ll be able to score your current healthcare mindset and then improve immediately. You won’t think about your company’s health plan the same after you know your score. #2: UNDERSTAND THE LAW AND WHAT YOU HAVE TO DO Most business owners do not truly understand the difference between what the law mandates that they HAVE 51


to do vs. what they might WANT to do for strategic reasons. Watch an easy to understand 5 minute video online at redirecthealth.com/ZeroCostObamacare to easily understand how to get the free and easy parts of the new healthcare laws complied with completely. In fact, have your broker watch it also so that you’re both on the same page. Despite what you’ve likely been told, it doesn’t have to cost your business that much to comply. #3: DESIGN AND BUILD A HEALTH PLAN THAT WORKS FOR YOUR COMPANY Most company health plans are structured so that most of the savings and benefits stay with the insurance plan if all works well. This doesn’t need to happen. We believe your best company health plan will be designed and built so that your company and your employees pocket the savings if costly waste, inefficiency, administration and poor planning are eliminated. Here is a summary of some key things that you will always want to have in your health plan to make sure that it can work for your company and your employees predictably. • $0 Co-pays for Routine Care (the “Routine 90%”) Charging co-pays for routine care will cost you much more money and employee satisfaction than might seem intuitive. Do not allow these routine co-pays in your health plan. By routine care we mean the 90% of the care, that 90% of your people will need and use, 90% of the time. Let’s call this the “ Routine 90%”. 52


This means primary care, physical medicine & injury care, rehabilitation (including chiropractic), and basic labs, x-rays and immunizations. It would also include preventive services. Making these services easily and affordably available is necessary to avoid the high costs of healthcare. But don’t be tricked. The reason for having no co-pays is to help keep your people away from hospital services whenever possible. Don’t be fooled – This ‘no co-pay’ tactic can just as easily be used as a ‘lost leader’ to guide your people toward the more expensive hospital services. • Real Insurance for Non-routine Services (the “Other 10%”) For the more expensive and less predictable “Other 10%” (i.e. hospital services, specialists and brand name prescriptions), this is where you will want the right kind of stop-loss insurance that lets you own your employees’ data. You don’t have to analyze the data yourself, but, as explained below, you do want to control who can do it for you. The “Routine 90%” represents only about 10% of your total health plan claims costs. Insuring it, especially with the wrong type of insurance, is not wise if value is your goal. Self-insuring this part will almost always make the most sense. • Plan Design that Guides and Rewards Wise incentivization matters. Your people really have no reasonable way to know or remember how to use 53


the healthcare system smartly. Show them the way with incentives that make sense to them. Giving them $0 co-pays for the “Routine 90%” is a great and practical way to start. But there are so many other ways that can be designed into a health plan that will save you a lot of money and help your people the most. For example, a smart health plan design will always discourage the quick use of elective orthopedic surgeries and procedures until inexpensive $0 co-pay conservative actions in the “Routine 90%” are shown to not be working. And it will always reward for the use of generic prescriptions over expensive brand names that provide no extra benefit. • Data Analytics A great health plan always has a mechanism for continuous and daily learning about who the small percentage of people are who will incur almost all the claims costs in any particular year, month or day. Why daily? Well, because even your sickest diabetic employee is not at great risk of incurring costs today if they have all their diabetic supplies/medications and their blood glucose is well controlled today. It will be your healthiest young person who just broke his leg yesterday falling off a ladder at work that your health plan should be focusing on intensely. This is were the greatest impact on health and pocket book exists today. Having your data will give you the advantage you need to keep your renewal costs from rising like they do. It probably will be a long time before it is practical for 54


businesses to analyze their data themselves, but once your company decides to own and control its own data the game totally changes and other experts can be easily and inexpensively hired to do this for your benefit. • Free Protection and Support Have your health plan designed so that your human resource manager and your employees always know where to call first when they have a healthcare need or a question. It is wise to acknowledge that there are many ways for your company and your people to be guided by the status quo players of healthcare to the more expensive places of service like hospitals. Especially if the incentives are confusing or wrong, or if your employees’ doctors work for a hospital. This is why it is also wise to make sure that your people always have 24/7/365 free and reliable support and the protection from the system that they will need. Knowing what things cost and where the value and waste are in the system BEFORE a service is needed is a critical part of the protection and support your people will need and appreciate. It is also a reliable way to dramatically lower Workers Compensation EMods and premium costs for injury prone workforces. Sooner or later, all business owners will design their plans this way. But there is no reason that you have to wait.

55


That’s it. Thank you sincerely. We are very grateful that you found this interesting enough to get to this point. This tells us that you are probably more engaged than most, and/or just more tired of the current status quo way of doing healthcare than most. Congratulations. We sincerely hope that you will help us change the discussion about healthcare, beyond as it relates to your company. And that you will have your own discussions with your employees, friends, family, colleagues, brokers, elected officials and anyone else interested or being frustrated by healthcare. We really do believe that despite the negativity that surrounds the topic of healthcare, many will eventually come to see it like we do. Healthcare can be a valuable tool that can give entrepreneurial business owners and leaders a competitive strategic advantage that can help them attract the most talented, happiest and most productive workforces that help grow their businesses. And that easy, convenient, accessible and affordable healthcare is good for people, for business and ultimately for America. We hope that this Guide has got you thinking and feeling differently about healthcare. There really is so much that business owners and their employees can do to totally control their healthcare experience. 56


You’re invited to contact us with your ideas, comments and questions at FightingHealthcareBook@redirecthealth.com. And if you’d like to explore having Redirect Health help your company build a smarter health plan, then drop us a note at nextsteps@redirecthealth.com. We’ve dedicated our business to educating the Purchasers and Users of healthcare… in this case, you and your employees. We’re happy to help. Sincerely, David Berg & Paul Johnson Redirect Health Founders

57


Notes

58


Notes

59


HEALTH PLAN SCORECARD 1

NAME:

2

3

4

5

Mindsets Failing

Frustrate

Control Company Costs

You have no control of health insurance costs. No transparency. Costs rising dangerously.

You can lessen the in increases by passing employees

Recruit & Retain Best Talent

Your employees sometimes leave for competitors with better health insurance.

Your company's lim insurance makes employees harder. Yo salaries to recruit adequatel

Easy Doctors' Visits

Your employees thin Your employees are confused and doctor and understan anxious. They use urgent cares and are overly complex. emergency rooms they can't afford. deductibles are too

Increase Productivity & Profits

Your productivity & profits are Your employees' pro threatened by unnecessary doctors sometimes interrupte appointments, work injuries, and work due to doctors' a frustrated employees. or work injur

Continual Improvement

You are frustrated due to the decreasing value of health insurance every year and there is nothing you can do about it. You are losing ground.

Your health insu complicated and expe has not gotten worse some added c

Easy Renewals

You feel rushed and taken advantage of at renewal time. All insurance choices seem poor and worse than last year.

You find switching in save money is frustra consuming

Increase Company Growth

Your profits are declining due to Your company's g growing health insurance costs and stagnanted due to hea rules and co complexity.

Eliminate Waste

You feel powerless to control waste Your employees' cop in the system, and you can't count deductibles are used from getting the hea on your employees, insurance really need companies, or doctors to do it.

Scorecard

TM & © 2015. The Strategic Coach Inc. All rights reserved. No part of this work may be reproduced in any form, or by any m TM & © 2015. The Strategic Coach Inc. All rights reserved. No part this work may Coach®, Strategic Coach® Program, 10x Mindset™, 4 C's Formula™, and Self-Multiplying Company™ areoftrademarks of Tb Canada. November 2015. Strategic Fax:416.531.1135. Coach®, Strategic Coach® 10x Mindse Coach® services and products, please call 416.531.7399 or 1.800.387.3206. Email: Program, info@strategiccoac

information about the Strategic Coach® Program or other Strategic Coach® services


MINDSET SCORE

DATE:

6

ed

nsurance cost g them on to s.

7

8

9

10

11

12

Conventionally Successful

Transformative

Your broker helps control cost increases by switching insurance companies every 2-3 years.

Your company has complete control of costs and value. Complete transparency. Costs decrease and then stay level.

TODAY

WANT IN FUTURE

mited health Your employees are satisfied with Your team recruits talented people recruiting their health insurance, which ou use higher matches what others provide in the for you. They brag about the free t & retain marketplace. They don't turn you healthcare your company provides. y. down because of it.

Your team feels protected and nk finding a Your employees have good access nding the bills to care when needed, and good guided. It's easy to get care with no Copays and protection from devastating costs if copays or deductibles. They thank expensive. something goes wrong. you routinely.

Your company's superior health oductivity is Your productivity & profits do not benefits help attract many talented ed by missed people to choose from. This seem to be affected negatively or appointments positively by employee healthcare. creates great core value alignment ries. and high productivity.

urance is ensive, but it e except for costs.

nsurance to ating and time g.

Your company's health insurance has improved a bit, but improvements have always come at more cost.

Your health plan continually learns and becomes better. Due to this your company gains new capabilities & value continually.

Your company's multi-year Your broker is helpful, but you tend planning means you and your HR to stay with the same insurance manager do not have to think about carrier to minimize hassle for your renewals every year. Renewals are HR manager. easy.

Extra profits from decreased Your insurance matches what your growth has healthcare costs & increased market expects, so you can retain alth insurance the employees you need to run and productivity are reinvested toward osts. company growth. grow your business.

Your company culture detests pays and high Your employees are incentivized to waste in its health plan. Your team to keep them stay healthy and avoid wasteful has 24/7 concierge protection & althcare they unnecessary use of the healthcare guidance. d. system.

means whatsoever, without written permission from The Strategic Coach Inc. Made in Canada. November 2015. Strategic be reproduced in any form, by any means whatsoever, withoutabout writtenthe permission The Strategic Inc.Strategic Made in The Strategic Coach Inc. Iforyou would like further information Strategicfrom Coach® ProgramCoach or other et™, 4 C's Formula™, and Self-Multiplying Company™ are trademarks of The Strategic Coach Inc. If you would like further ch.com.

s and products, please call 416.531.7399 or 1.800.387.3206. Fax:416.531.1135. Email: info@strategiccoach.com.

Last Revised: 1/15/2016


David Berg

Paul Johnson

9781523253760 ISBN 978-1523253760

Healthcare is a mess. It’s too expensive. No small or medium-sized company even tries to argue this point anymore. There are so many moving parts and nothing in healthcare is transparent. No apples to apples comparisons. The Affordable Care Act, and the partisan media coverage aren’t making it easier. Big Brother of the status quo tells us we have to expect rates to go up. He tells us that our only option is to listen to the experts. So, how can your business possibly challenge the status quo? Start by understanding that without your leadership, it can’t happen. This Guide is designed to help you as the owner or the CEO, the real change agents of your company, discover how to question key healthcare assumptions that just aren’t true. Learn about 5 healthcare rip-offs and 2 common misconceptions that could save your company tens or even hundreds of thousands of dollars every year. In fact, we’ve saved millions in our companies and others’ already.

Better for People. Better for Business. Better for America. redirecthealth.com


Business Owner's Guide to Fighting Healthcare