Introduction and Episode Overview
[00:00:00] Stacey Richter: Episode 487 (Part 2): Kevin Lyons Shares What He Learned in Detective Training That He Uses to Follow the Healthcare Dollar
Recap of Part 1: Barriers to Reducing Healthcare Costs
[00:00:25] Stacey Richter: In Part 1 of this episode, we explored the barriers to stopping the flywheel that is driving up healthcare costs for the public sector. In short, and you really should go back and listen to the first part of this episode, but if you didn't these barriers are number one, profit defends profit. In other words, if you have legislatures in charge of the contracts that are being awarded to carriers and PBMs and point solutions and consultants, etc, which is how it works in many states, and if these aforementioned entities make a lot of money, now they have a lot of money to make campaign contributions to the legislatures in charge of their contracts and also lobby. You have a lot of money, you can buy a lot of influence, in short.
The second barrier discussed in Part 1 is when public entities like states or etc, don't have unconflicted experts on their side of the table. That's a problem. As you and me, we know very well.
You're listening to this show, so this is totally self-evident. There is just no way without hearing, for example, episodes with Vivian Ho or Dr. Eric Bricker, Jonathan Baran, Cora Opsahl, Mark Cuban.
Just think about the kind of insight you gotta have if you are sitting on the other side of a table from a TPA or whoever who tells you something like, “You cannot have your data because …, or “No, you can't put in that maternity or doula program because we have a contract and it's impossible and …” Or, “it's fine if we audit ourselves and do our own payment integrity program. We have a great branch of our own company who does this, and it's totally not a conflict of interest. Pinkie swear.”
Imagine if you didn't have the information that you, who listens to the show probably do. And it sort of comes at no surprise if you think about it in this light, the wildly escalating prices that some state and even federal plans have. And this is hard, complicated stuff, and it takes years to figure out.
But think about this. The state of New Jersey that is in 2026 gonna spend $3.5 billion. There is no, among other things, medical director who works for the state. So there's just a lack of unconflicted experts with a for real seat at the table. That is our number two barrier.
And then the third barrier, it's kind of an offshoot of profit defends profit. What profit also does is influence the media when the media's biggest advertisers are often the healthcare industry, how are legislatures and taxpayers and even public employees themselves, how are they gonna get the real story? Okay, so that was Part 1.
Introducing Kevin Lyons: Detective Skills in Healthcare
[00:03:01] Stacey Richter: In the conversation that follows with Kevin Lyons, he shares some of the skills that he learned in detective training to deduce what is going on with his healthcare dollars being spent by and on behalf of his union members, where those dollars are disappearing to. What he writes in that little detective notebook, I'm imagining he still carries around to this very day.
So with that, here is the advice portion of my conversation with Kevin Lyons. Kevin is a former police detective and current executive director, law enforcement, labor employee benefits at the New Jersey State, PBA, Policemen’s Benevolent Association.
My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.
Kevin Lyons, welcome to Relentless Health Value.
[00:03:47] Kevin Lyons: Hello, Stacey. It's really awesome to be here. I'm really excited about this. Thank you for asking me to come on.
Detective Techniques Applied to Healthcare
[00:03:52] Stacey Richter: Let's get to the advice as a former detective, delving into this really opaque, complicated, there's 20 narratives going on, and I'm picturing you with your notepad.
What do you write down? How do you, how do you approach this kind of quagmire as a former detective? What's your advice?
[00:04:12] Kevin Lyons: So two of the best classes I took when I was a cop were statement analysis and facial recognition, so seeing little ticks in people's faces and, and really interesting stuff, right? That's like the TV stuff that everybody likes to see, you know?
But statement analysis, to me, if you're prepared and you ask the right questions, that gives everything away. What I've seen is that when we're getting a presentation from, a TPA or a vendor, nobody in particular, you start asking the questions.
Well, the bad guys leave holes in their statement. Or they don't answer that question, they'll sidestep it. So what I've seen, especially from TPAs, is that they'll sidestep it, sidestep, and then you ask it a different way. Then all of a sudden you get the answer. It's proprietary at the end of the day, right? Oh, that's proprietary. We can't tell you. Well, there's only one reason you hide something.
Now they'll say it's corporate trade secrets and all the other stuff that's BS. The reason is they don't want to give you the answer. What that is, that's a flag, right? That's where you wanna follow. So when you see that omission that lie by omission or that avoidance, that's where you're gonna go.
But the important part to that, and let me say this again, is that be prepared when you go in, when you see that you're getting a presentation from so and so, you know, whatever company, company ABC, then do your homework. You know, if you just go in there and if you're just filling a seat, don't waste anybody's time, but just follow their path. You know, try and win them over. And then well, what about this?
[00:05:40] Stacey Richter: You said statement analysis and what you're looking for there, what I'm hearing is probably most often not what they're saying, but what they're not saying.
[00:05:48] Kevin Lyons: Yes. Without question.
[00:05:50] Stacey Richter: Yes. So you're digging in there, you're asking the why five times I've, I've heard people say, right, like, you're really hammering, trying to circle the wagons around what the “unknown unknown is” to quote Norman Schwarzkopf, right? Because you don't know what the unknown is at the very beginning, but if you ask enough questions, you probably can start drilling in on what is being unsaid.
And as you just said, probably what's gonna happen at that point if you start asking and poking the bear, they're gonna say, oh, it's proprietary. Once they start saying that, though, you know, now you at least have in your view finder what they're not telling you, and you are better equipped than to try to figure out where the money is. Like you just found a honeypot and at least you know there's one that exists.
[00:06:40] Kevin Lyons: That's exactly it.
Challenges and Solutions in Healthcare Transparency
[00:07:03] Kevin Lyons: Because if you go there and it's like putting in an OPRA or a FOIA request, right? If you don't word it just right, they're gonna say, Oh, we don't have to answer that. You have to get everything worded right. But if they're not just answering you at the beginning, they're just not answering you at the beginning, in that case with what we're talking about, yeah, the missing piece, is X marks a spot in my experience.
[00:07:40] Stacey Richter: So you've got the statement analysis, you've got watching them, asking a lot of questions, following the money through those questions to figure out where the dollars are. Where there might be indirect payments. Where there might be. And even if you don't get the details on that, you know now that it exists, like someone just pleaded the fifth, right?
[00:07:58] Kevin Lyons: Right. That's exactly what it is. I was gonna say that same thing, is that when, I know the Fifth Amendment's a constitutional right, not to testify against yourself. But if people aren't guilty, they don't plead the fifth. That's kind of the trigger I use and people may not like hearing that from a former cop, but that's really one of the tools we have.
Then it's my job to go find it after that. If you're not gonna tell me what happened, then it's my job to go find it.
[00:08:23] Stacey Richter: And that's, that's the responsibility that you're taking upon yourself. And I think, again, it's probably a big differentiator between those in government or those at unions who are really courageous and persistent, Relentless, if you will, enough to recognize or count as part of their responsibility and accountability to go chasing down those answers.
Which the lovely vendor who just took you out to lunch does not want you to find.
[00:08:53] Kevin Lyons: That's exactly it. Yeah. You just have, you'd have to keep pushing and going forward.
[00:08:57] Stacey Richter: If I was gonna just say in sum, what are the lessons that you may want those who may also be in similar positions in government to hear?
[00:09:08] Kevin Lyons: I think you have to be fearless and speak truth to power. You have to keep pushing. You know, they're gonna try and push you off. They're gonna distract you. They're gonna try and look over here. You know, there's don't, there's no man behind the curtain, right? I think you have to educate your members by putting out as much information as you can.
You have to continue to do that, and most importantly, you have to follow the money. And then you're ready when the moment comes. Never let a good crisis go to waste. That's what I'm hoping happens here in New Jersey. I hope it wakes the people up. I hope it wakes the elected officials up that, “Hey, we've been telling you this is coming.”
We've been warning you now the day of reckonings here. Don't think you're just gonna push the cost onto us when we told you, because you can't plead the fifth anymore because I know I told you. So I think of those scenarios we have to try and be ready to move forward.
[00:09:57] Stacey Richter: Yeah. Right. Like at a certain point, some teacher's assistant is gonna get their paycheck and be like, oh, you owe us, their salary is gonna be a negative because their health benefits are higher than their salary. I mean, like seriously, if you're talking about 37% rate increases and it's already a thousand dollars a month, this is not something that, there's not an unlimited money pit that public employees sort of have here.
[00:10:23] Kevin Lyons: Yeah, there's a, there's that graph on LinkedIn that shows, that KFF put out, that says the average family's plan is $25,000. Now that's just my member's contribution next year. That's just their contribution. The towns still have to pay the other, the other share.
So it is just, when is enough enough.
[00:10:42] Stacey Richter: Point being the total cost to the state of a family plan is $67,000. So if the teachers and firefighters and police officers and everybody else pay $25,000 or so, the towns and state are still picking up 42k if I just did the math right.
[00:10:58] Kevin Lyons: You know, when when are you gonna start listening and stop saying they don't understand.
That's the constant answer we get from the other side. They don't understand. Well, I'm here to tell you and I hope to hear me. We do understand.
[00:11:08] Stacey Richter: Yeah, for sure. And and especially if you're advocating for like, “Hey, this is how we can do this smarter.” The answer isn't throwing money, it's just you. You just start saying it and it just sounds as ridiculous as it is, right? Like, oh, the answers to our problem is to just throw more money at the people who want more money.
[00:11:23] Kevin Lyons: And we bring solutions members, they're gonna get better care, but it's gonna be a change in the way healthcare is delivered to them.
And the people for the state, the people for management are telling us, oh, that's too disruptive. You can't do that. Your members aren't gonna like it. That's my job. That's not your job.
[00:11:39] Stacey Richter: Claire Brockbank from the 32BJ, was on this pod and said very specifically, she said, that's her tell you were talking about some of your tells. Her tell is if someone brings up the D word, the disruption word, like that's how people have been probably in some manual, how do you shut down anyone who's fighting the status quo, just bust out the D word and then everybody goes hides in a corner, right? Like that's a power word. The the disruption word. And I think at this juncture, people have learned to deploy it. If they wanna shut people down.
[00:12:11] Kevin Lyons: It's just,
[00:12:12] Stacey Richter: It's laughable, right? It's not funny. But it's laughable.
Final Thoughts and Acknowledgements
[00:12:15] Stacey Richter: Kevin Lyons, is there anything I neglected to ask you that you wanna bring up at this time?
[00:12:20] Kevin Lyons: Well, what I would like to say is I am eternally grateful for the leaders like you in this space. You, Chris, Susan Hayes, Cynthia Fisher, Justin, Cora.
The people that have taken me under their wings, it's benefited my members immensely. You know, the New Jersey State PBA represents 33,000 members. I'm proud to serve them and I just really hope that they start getting into the weeds on this because once they're incensed, there's no stopping us. But I'm just more grateful than anything else.
[00:12:51] Stacey Richter: Well, I could not appreciate that more.
And besides Susan Hayes and Cynthia Fisher, it was Chris Deacon, Justin Leader, and Cora Opsahl that you mentioned. Who might go by first names only like Cher or Madonna at this point. But just for the record.
Kevin Lyons, thank you so much for being on Relentless Health Value today.
[00:13:09] Kevin Lyons: Thank you.
Closing Remarks and Podcast Information
[00:13:10] Tom Nash: Hi, this is Tom Nash, editor and producer of the RHV Podcast. You've probably heard me say this podcast is sponsored by Aventria Health Group, and that's true, but there's more to the story.
Aventria is our day job, and the people that make this show happen are Aventria employees generously donating their time and talent on top of everything else they do to get each episode out the door.
So, yes, Aventria underwrites the production, but in many ways, Relentless Health runs like an unofficial nonprofit, a very, very nonprofit. Aside from the occasional and deeply appreciated episode sponsor and our wonderful listeners who donate to the Tip Jar, this show is scrappy and self-funded.
If you wanna keep this podcast independent and laser focused on educating, informing, and driving real change in our healthcare system, we invite you to become a monthly sustaining member of Relentless Health Value. We have a few of you who have already taken it upon themselves to do this already, and we are deeply grateful.
So if you find value in what we do each week, head over to relentlesshealthvalue.com/donate and donate to the Tip Jar. Maybe become a sustaining member. Or if you or your organization wants to sponsor an episode or two, we'd love to chat. Thank you so much for listening and being a part of the movement.