EP305: The 1% Most Expensive Claimants Racking Up Massive FFS Bills and Still Not Getting the Help They Need From Our Health Care System, With Darrell Moon, CEO of Orriant

My guest in this health care podcast is Darrell Moon, who is the CEO over at Orriant.

I was super intrigued by some of the work that Darrell and his team are doing regarding high-cost claimants. Said a different and probably better way, certain people in need of care were identified because they were costing so much. Year after year after year, these individuals—I call them hyper-users during this episode, but it’s possible I made that term up myself—these hyper-users were getting all kinds of expensive health care, while at the same time, they were not getting any better.

So, Darrell and his team realized that something was afoot here, and it turned out to be a combination of maybe loneliness, maybe low self-esteem and low self-efficacy. And no matter how many times you go to the cardiologist or the rheumatologist or the pulmonologist, none of those things will be cured.

In fact, when someone’s identity becomes their myriad of health issues, they have a sort of perverse incentive, if you think about it, not to follow any of their doctor’s recommendations to take meds or make lifestyle changes. So, while their underlying condition—low self-esteem, low self-efficacy—remains untreated, their physical health tends to actually get worse, not better, despite all the medical attention. What’s necessary to help this type of patient is the best that behavioral science has to offer.

A nuance I found really interesting and important in the work that Darrell is doing is that it’s pretty easy to identify a hyper-user from someone with a horrid chronic condition simply requiring a lot of care. The hyper-users will respond and appreciate the extra attention that a behavioral health coach/program has to offer. In contrast, those with other ailments will just merely get annoyed—usually on the quick—so they exclude themselves from the program.

Sidebar: My guest Darrell Moon is organizing an Aspirational Healthcare Conference for July 14 and 15, 2021. In that virtual meeting, the intent will be to highlight Southcentral Foundation’s Nuka System of Care in Alaska and other similar health care models that achieve much better health care outcomes at half the cost. So, check that out if you are so inclined.

Thanks so much also to Lee Lewis from the HTA (Health Transformation Alliance) for the introduction to Darrell and Orriant.

You can learn more at orriant.com.

Darrell Moon founded Orriant in 1996 to change the dynamics of health care and give employers some control over the ever-increasing costs of the health care benefits they offer their employees. Darrell believed that engaging individuals in the management of their own health was a key that had to be inserted back into the economic equation of health care. Darrell received both his bachelor’s degree in finance and his master’s degree in healthcare administration from Brigham Young University. As the CEO, COO, or CFO, Darrell managed medical and psychiatric hospitals throughout the country for over 10 years prior to creating Orriant. He also has more than a decade of experience managing insurance and managed care products. Darrell is a Forbes leadership contributor.

03:11 What do CEOs want out of the health care system?
04:52 Is it a good strategy to focus on high-cost claimants?
07:04 Who are the people year over year that wind up in the high-cost claimant pool?
07:50 “Really, you have to get to the crux of the problem, which is … they’ve become a victim … to the health care system.”
08:16 Who are these “hyper-users” and how do we define them?
11:35 “Getting that person to have a regular relationship with someone isn’t the hard part; the hard part is then helping them to build their self-esteem.”
13:20 “That’s the key to building self-esteem—is helping people accomplish what’s most important to them.”
14:57 Why helping a patient not to view themselves as a victim helps them manage their care better.
17:45 “It’s often less the training and the right personality of the person.”
18:54 Do health outcomes correlate with the self-esteem of the patient?
19:28 “If you want to identify future claims, ask people two questions: 1) Tell me about your health … and 2) Tell me about your social experience.”
21:21 “They’re the customer/owner of their own health.”
24:23 “How do you help not just the 1% but everybody [in health care]?”
27:16 “The ideal environment is to have a massively powerful primary care team.”
27:47 “Having an influence on that person and what they do and how they behave is more important than getting the diagnosis right.”
29:34 “It’s not about just when [people] reach out … but [getting] people to reach out early.”

You can learn more at orriant.com.