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 (pharmacy benefit managers) 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.
For a full transcript of this episode, click here.
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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, PhD (EP466) or Eric Bricker, MD (various episodes), Jonathan Baran (EP483, Part 1), Cora Opsahl (EP452), Mark Cuban (EP418).
Just think about the kind of insight you gotta have if you are sitting on the other side of a table from a TPA (third-party administrator) 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.
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).
Also mentioned in this episode are NJ State Policemen’s Benevolent Association (NJSPBA); Vivian Ho, PhD; Jonathan Baran; Eric Bricker, MD; Cora Opsahl; Mark Cuban; Chris Deacon; VerSan Consulting; Claire Brockbank; Susan Hayes; Cynthia Fisher; Justin Leader; and Tom Nash.
You can learn more at njspba.com and follow Kevin on LinkedIn.
Kevin Lyons is a retired police detective from Long Beach Township, NJ, where he served over 25 years in many roles. He is currently the executive director of the New Jersey State Policemen’s Benevolent Association, New Jersey’s largest law enforcement union, representing over 32,000 active and 6000 retired members. His current responsibilities include operating the organization’s legal protection plan, where he manages $4 million worth of claims a year, 500 attorneys, and over $34 million in reserves, advising his members on health benefit issues and managing the staff and day-to-day operations of the organization.
Kevin has a bachelor of arts degree from Richard Stockton College (now Stockton University) and numerous certificates in healthcare-related fields.
In 2012, he was appointed to the NJ State Health Benefit Plan Design Committee, a body that manages plan design for a plan that has over 800,000 lives. In 2017, he was appointed to Governor Murphy’s Task Force on Quality and Affordability.
Kevin has also served on the Southern Regional Board of Education since 1997, where he currently serves as the chair of the finance committee, which manages a budget of over $70 million.
Kevin has done numerous op-ed articles and has been featured in Bloomberg News, the Wall Street Journal, NPR, Fortune magazine, and PBS. He is committed to making healthcare more affordable for his members.
03:53 How asking questions and being prepared can help you identify bad actors when assessing TPAs.
08:07 “If people aren’t guilty, they don’t plead the Fifth.”
08:57 What lessons does Kevin want those in government to learn about navigating health benefits?
09:34 “Never let a good crisis go to waste.”
11:39 EP453 with Claire Brockbank.
Recent past interviews:
Click a guest’s name for their latest RHV episode!
Kevin Lyons (Part 1), Dr Stan Schwartz (EP486), Dr Cristin Dickerson, Elizabeth Mitchell (Take Two: EP436), Dave Chase, Jonathan Baran (Part 2), Jonathan Baran (Part 1), Jonathan Baran (Bonus Episode), Dr Stan Schwartz (Summer Shorts), Preston Alexander, Dr Tom X Lee (Take Two: EP445), Dr Tom X Lee (Bonus Episode)