Bad things have a propensity to occur in health care when patients are placed on a trajectory and then simply follow the yellow brick road—to an Oz potentially filled with unnecessary surgeries, MRIs that cost 10 times what they should, low-quality providers chasing RVUs (relative value units) like their paychecks depended on it … I could go on.
Today I speak with Derek Winn, cofounder at Distilled Concepts and consultant at the Business Benefits Group. His distilled advice is to recognize that every transaction with the health care system is a waypoint on a larger journey—and also an opportunity to pause and ask questions. Payers of health care have a profound opportunity and perhaps growing obligation to help employees/members/patients, first of all, to recognize that a “look both ways before you cross the street” modus operandi is safer from both a monetary as well as an actual patient safety standpoint. Derek and I discuss the ways to make this happen, when/if it will become standard operating procedure, and the likely impact on providers and insurance carriers and Pharma if employers choose to take this route.
By the way, BUCA stands for Blue Cross, United, Cigna, Aetna, and Anthem. We use this acronym in the interview.
You can learn more by contacting Derek on LinkedIn at
DerekWinn or by visiting distilled-concepts.com.
Derek Winn is a lead consultant at the Business Benefits Group, where he has consulted clients regarding employer-sponsored benefit programs for nearly the past decade.
More recently he is a cofounder of Distilled Concepts, a newly created organization that is purpose built to provide more advanced advisory and consulting exclusively for employers of intention and also to counsel on solutions from the industry as a whole. When supporting health plans for clients, they work exclusively with self-insured employers or serving as a bolt-on adviser for the eventual transition to a self-funded health plan, providing distilled client education and strategy.
Derek has been recognized as a Rising Star in Advising by Employer Benefit Adviser magazine and interviewed in Managed Care magazine, and he has also been a contributor to BenefitsPRO magazine. When it comes to social media, he is most active on LinkedIn.
When not addressing and tackling health care concerns for employers, Derek enjoys spending time with his wife and children at home, which doubles as a hobby farm, in Virginia.
02:13 How employers can intervene to get their employees to the right doctors and health system.
04:10 “Health care’s a journey.”
04:25 How Derek connects with employees and employers at waypoints.
05:35 Finding ways to reconnect with the patient.
06:11 What a concierge approach looks like.
08:38 What this model looks like.
11:53 Fixed costs vs variable costs.
13:59 What health plans think about employers taking this initiative.
15:22 “Who has leverage?”
19:18 “Where’s the incentive for an insurance company to … [stand] with [the] patients?”
23:10 “Change takes a long time for a hospital, but … employers can move pretty quickly.”
24:43 Showing where the value is vs setting price points.
26:58 HTA—Health Transformation Alliance.
27:17 P&T committee—Pharmacy and Therapeutics committee.
28:26 “Are we causing undue harm?”
29:29 The spectrum of pharmacy benefit managers (PBMs) and the ones to consider.