Nexus of Care: Fulfilling the Promise of Employer-Sponsored Health Centers

By Phillip Berry and Kevin Craig

Author and Entrepreneur Phillip Berry contends that self-funded employers have many options to address the healthcare

challenges we face and that the health centers in which we've invested present our most powerful option for healthcare costs and outcomes.

Using lessons learned from working with hundreds of employer-spons

• Language: English
• Publisher: Cross Stone Creative, LLC
• Release date: Sep 10, 2021
• ISBN: 9780998168982

Book preview

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Dedication

This book is dedicated to the brilliant, hardworking, caring, and virtuous individuals with whom I am blessed to work every day on the mission of making a difference for those we serve. Thank you for showing up and leaving this world better than you found it.

Thank You

Thank you to the following leaders for sharing their insights for this book. Your efforts for your organizations, clients, patients, and communities inspires us all to keep working hard on the hardest problems.

Greg Bellomy, CEO, CareATC

Brian Cappel, Vice President—Taft Hartley Plans, Everside Health

John Collier, CEO, ProactiveMD

Lisa Day, Benefits and Wellness Specialist, Kimball International

Jerry Ford, Advisor & Former CEO, Marathon Health

Todd Foushee, Vice President, PMR Healthcare

Linda Goeppner, Director Corporate Compliance and Healthcare, Jasper Holdings Inc.

Robert Lockwood, MD, Co-Founder & Medical Director, Primary Health Partners

Donna Milavetz, MD, Executive Vice President and Medical Director, Steward Health

Chris Miller, CEO, Everside Health

Chad Perkins, MD, Medical Director, Ascension Health

Tony Purkey, Vice President, Aon

Kyle Rickner, MD, Co-Founder & CEO, Primary Health Partners

Richard Sutton, Executive Vice President, Brown & Brown of Indiana

Foreword

Nexus of Care: Fulfilling the Promise of Employer-Sponsored Health Centers

Stephanie Eckerle, Partner, Krieg DeVault LLP

Nexus of Care: Fulfilling the Promise of Employer-Sponsored Health Centers by Phillip Berry is a refreshing, innovative, optimistic, and honest reflection on the state of the healthcare industry and the impact that it has on employers and, more importantly, the impact that employers can have on the healthcare industry and the health of their employees. Mr. Berry is a recognized leader in the healthcare industry whose experience in the pharmaceutical, employee benefits, and self-funded health plan arena allow him to effectively explain the current problems with our healthcare industry from an employer viewpoint.

The common-sense, practical approach that Mr. Berry takes does not call for a complete overhaul of the healthcare system, but rather encourages employers, especially those that are self-funded, to stop settling for mediocrity and the status quo and instead to instigate a true evolution through transparency and stewardship. As stated by Mr. Berry, good stewardship for employers involves shifting an employer’s paradigm to focus on investing in healthcare as opposed to simply spending on healthcare that results in a summary report once every twelve months.

Nexus of Care is a must-read for both those who are new to the healthcare and benefits industry as well as industry stalwarts. Novices will learn from the fundamental explanations and history of employer-driven care, including the evolution of worksite clinics. Both healthcare veterans and novices will benefit from the tackling of complex issues, such as price transparency, health information portability, the competitive utilization of data, and the continuous problem of physician burn-out. Through this book, employers are reminded that they are an integral part of the healthcare mission and story for their employees and, with the right tools, knowledge, and data, can truly be part of the nexus of care.

If there is one takeaway from Nexus of Care, it is the call to action for all stakeholders participating in the healthcare industry, including employers, healthcare providers, healthcare consultants, and healthcare consumers. As stated by Mr. Berry, in order to evolve, we must capture, document, and share successes, ideas, and encouragement. I would add to this list that we must also share our challenges, frustrations, and failures within the healthcare industry.

Instead of putting Nexus on a shelf after you finish reading it, utilize this book as a call to action. We should all be looking for creative solutions, innovative ideas, and increased transparency to benefit all healthcare stakeholders and, most importantly, healthcare consumers in achieving better outcomes. Mr. Berry and each of the healthcare experts introduced throughout this book point to a bright healthcare future while reminding us that we can do better.

Introduction

We’ve got a problem.

That was the opening line to a presentation I made to a room of brokers, advisors, consultants, employers, and clinic management companies gathered at a worksite health clinic conference in January 2020. Though I proceeded to outline a host of health benefits issues facing self-funded employers, my message was really directed at their advisors and the clinic management companies operating the onsite/nearsite health centers serving their employees.

My message: if you don’t stop playing the status quo low-value, me-too, race-to-the bottom game with your health benefits services and instead focus on higher value, lower cost, outcomes-driven solutions, you are going to be replaced.

For those of us spending lots of money to provide health benefits to our employees, frustrations are high. Very high. We’re tired. Tired of the costs. Tired of the complexity. Tired of the obfuscation. Tired of the broken promises. Tired of the annual message that our health benefit costs or premiums will be increasing 10%, 15%, or 20%-plus with no additional value or improvement of health for our employees. Tired of being told that all we can do to combat those increasing costs is shift more cost to our employees, remove benefits, raise deductibles and co-pays, or somehow restrict access to care.

If you’re like me, you’re asking, Can’t we do better?

Some might think, Maybe not, thanks to headlines reporting on failures like Haven, the joint venture formed by industry titans Amazon, Berkshire Hathaway, and JP Morgan Chase vto combat the issues outlined above. As the venture was dismantled, many thought, If those massive, visionary companies can’t do better, who can?

More than 150 years ago, French poet Charles Baudelaire wrote, The greatest trick the Devil ever pulled was convincing the world he didn’t exist. In many ways, we are living a similar ruse as we look at our $4 trillion health economy and believe there is nothing we can do to change it. We have been convinced that the seemingly intractable problems affecting our healthcare system are beyond our ability to influence and that we must simply grin and bear its costs and inefficiencies, year after year after year.

Well, don’t believe it. We can—and we are—doing better. The movement toward change is happening all around. New ideas. New approaches. New players. New technology. New energy. Though the process is slow and resistance is high, things are beginning to shift. This book is written to summarize the issues and progress we’ve made while also drawing a map to an even better place further down the road. We’re slowly claiming territory for the change we need, and we, as employers, strategists, advisors, and innovators, must capture, document, and share successes, ideas, and encouragement.

Thank you for joining me on this journey. This book offers no silver bullets, easy answers, or quick fixes. However, it does offer a point of view, a model for influencing healthcare costs and outcomes, and affirmation that there are compelling options beyond the traditional status quo approaches that are making our current system unsustainable. And better yet, those options don’t have to be high risk, bet-the-farm, all-or-nothing gambles on the unproven.

More specifically, this book is about leveraging elements of the system in new ways to meet our objectives. We don’t have to reinvent everything; we just need to reimagine how we engage with and utilize the existing system to remove excess costs while increasing value. Then we need to be willing to do the hard work to foster and sustain necessary change. First within our organizations, and then within our communities. It’s already happening. This book will help clarify the challenges, provide reference points to help you understand options, and then present a roadmap to help you navigate the possibilities.

A little about me:

I’m an entrepreneur who has built a business helping employers solve their healthcare/health benefits problems.

Often, I’m solving problems they do not recognize or realize they can solve.

I’m unapologetically optimistic about our country, our people, and our possibilities.

I’m frustrated with how we, as businesses and employers, procure and provide health benefits.

I believe we can do much better when it comes to the economics and the outcomes of the health benefits we provide to our employees.

This book is written for the people and organizations managing health benefits for employees and their families. Though the book focuses on organizations with self-funded health plans, much of its message applies to anyone offering health benefits to employees. If you have a perfectly functioning set of health benefits, are 100% satisfied with costs and outcomes, and feel there are no possible improvements to be made, then please pass this book on to someone else. You will find little value in it.

If you derive your income from the status quo healthcare and health benefits world, then I encourage you to read on; your way of life is changing, and you need to be looking toward the horizon.

If you are pushing the boundaries with new ideas, executing on creative concepts, and still searching for novel perspectives, please join me on this journey. Perhaps there is an opportunity for us to collaborate. At the very least, we might cheer one another on.

The structure of this book is straightforward. We’ll start by reviewing the problems in more detail—including some of the underlying problems that are not as obvious but structurally important. From there, we’ll explore the employer’s quest for influence as it relates to healthcare costs and outcomes for our employees and their families. Then we’ll present an employer-centric point of view for addressing some of the fundamental issues and the nexus of care opportunity. Finally, we’ll offer some suggestions on the way forward.

These are exciting times, full of possibility. The challenges remain and the mountains are high, but the rewards are worth the effort. There are many great options available to address the myriad issues. Start by believing you have choices. Don’t get frustrated by the noise and obfuscation, those are just signs that it’s time to pivot. Recognize the noise for what it is: resistance. Resistance to change. Resistance to innovation. Resistance to anything that might reduce control or margin. Remember, the resistance always uses the same tools to maintain the status quo. You’ve probably heard some of these before: No you can’t, That won’t work, The contract says so, That report will cost extra, That’s proprietary, I don’t know, or That’s their fault. These negative, closed, grasping, and controlling answers almost always point to systemic points of control that maintain the status quo and cost you money. It’s time for something different.

Chapter 1: The Employer Healthcare Problem

Before we can really understand how to make meaningful change, we need to unpack the big black bag of healthcare and benefits to get to the root cause behind today’s challenges.

In this chapter, we’ll explore the why and the how of healthcare benefits from an employer’s perspective and get to the heart of the issues of cost and outcomes.

Some Definitions

One of the first problems we face when discussing the challenges of healthcare is language. With complex challenges come complex words. Words matter, so we’re going to begin this chapter by defining some terms typically used to characterize, obfuscate, or enlighten within the healthcare universe.

If I use some of them slightly differently than what you normally hear, that’s okay. At least you’ll have a clear sense of what they mean within this book. A common base of understanding is a good place to start.

Healthcare/Healthcare System: this is the broad word for all things health, health system, health plan, and health services related, encompassing how we deliver