Employers are not “stuck” with a broken healthcare system because it’s too complicated. They are choosing to hand over control of something that hurts their workers and wastes money. The answer isn’t more wellness programs or better deals with insurance companies. The real answer is to treat employee healthcare like what it is: a broken business system that needs to be fixed, just like any other supply chain problem. In this episode, Dr. Eric Bricker challenges common myths about employer healthcare. He explains why healthcare apps can’t work as easily as booking a vacation online and how powerful companies and complex rules keep the system from changing. He shares how one company kept its healthcare costs steady for five years by taking ownership and focusing on what really matters: putting employees first.
Employers are not “stuck” with a broken healthcare system because it’s too complicated. They are choosing to hand over control of something that hurts their workers and wastes money. The answer isn’t more wellness programs or better deals with insurance companies. The real answer is to treat employee healthcare like what it is: a broken business system that needs to be fixed, just like any other supply chain problem.
In this episode, Dr. Eric Bricker challenges common myths about employer healthcare. He explains why healthcare apps can’t work as easily as booking a vacation online and how powerful companies and complex rules keep the system from changing. He shares how one company kept its healthcare costs steady for five years by taking ownership and focusing on what really matters: putting employees first.
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“ That's why creative destruction is so important in healthcare because new entities need to come in and rejuvenate the space. The amount of creative destruction in healthcare is abysmally low. All of the existing institutions in healthcare have been there for decades, if not centuries. You look at industries where the customer actually is doing really well, those industries are defined by creative destruction. Whenever you have these healthcare discussions, you're like, Well, we have to look out for the interests of all stakeholders. No, that's a bunch of malarkey. You need to look out for one stakeholder, and that stakeholder is the patient.” – Dr. Eric Bricker
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Episode Timestamps:
*(00:44): What motivated Dr. Bricker to pull back the curtain on healthcare issues
*(03:04): The two broken incentives destroying healthcare
*(06:12): Why healthcare navigation requires human conversation
*(16:26): Creative destruction and the death of regulatory capture
*(23:54): Practical steps for employers to take control
*(33:24): AI’s role in healthcare (beyond the hype)
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Links:
Connect with Dr. Eric Bricker on LinkedIn
Connect with Kirk McConnell on LinkedIn
Learn more about Collective Health
Learn more about Caspian Studios
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[00:00:00] Kirk McConnell: Healthcare costs are rising. Benefits are confusing, and the system doesn't always work for the people who need it most, but it doesn't have to be that way. Smart employers and their brokers are flipping the script, cutting costs, making things simpler. In creating a health benefits experience their people love.
[00:00:23] Kirk McConnell: Welcome to the Benefits Playbook. I'm Kirk McConnell, and in each episode we uncover the bold strategies that are rewriting the rules of self-funded health benefits. Today I'm really excited to be joined by Dr. Eric Bricker, Chief Medical Officer at AHealthcareZ. Eric, thank you so much for joining us today.
[00:00:41] Eric Bricker: Thank you for having me on, and thank you to everybody for listening.
[00:00:44] Kirk McConnell: Well, Eric, your, your face is known to many and many know you from your, he your explainer videos on YouTube that do such a, a fascinating and effective job getting to the core of so many healthcare issues. What motivated you to start pulling back the curtain on all these dynamics?
[00:01:01] Eric Bricker: So I was the co-founder of a healthcare navigation company called Compass Professional Health Services, which we ran from 2007 to 2018 when we then sold the business and we contracted with employers to help their employees and their family members navigate the US healthcare system for 11 years. And we did it for
[00:01:23] Eric Bricker: 1.8 million people. So when you do, when you navigate the US healthcare system for 1.8 million people for 11 years, you learn a thing or two. And so I had been essentially outside of the office for almost the entire 11 years working with employers and broker consultants and we with, you know, HR heads up benefits, even CFOs and CEOs as well across the country.
[00:01:48] Eric Bricker: I mean, literally we had customers in San Diego and Boston and Seattle and Miami and everywhere in between. And so I was able to be privy to a lot of conversations that frankly revealed a lot of the financial sausage making or machinations that really goes into healthcare and health insurance. And so when we sold the business in 2018, I'd be like, look, I don't have a boss.
[00:02:14] Eric Bricker: Would be really good for me to kind of shoot people straight and kind of share with them what I had learned. Because as a physician I was in a pretty unique position to have learned about all of this, and so it really just began as a passion project. And because at the end of the day, healthcare finance is super boring.
[00:02:34] Eric Bricker: So saying this idea of people who are gonna watch this or not, and that's why to a certain extent I kinda like try to yuck up my videos and make 'em as enthusiastic as possible. 'cause the topic is incredibly dry. But shockingly, like my videos have had like millions of views over the years and never in a, in a million years when I think that that, that healthcare finance videos would have millions of views.
[00:02:57] Eric Bricker: But, but that's how it got started. Hm.
[00:03:00] Kirk McConnell: You know, as you traveled from San Diego to Boston, to Seattle and everywhere in between, what were some of the misconceptions that you identified that, be it benefits teams or chief people, officers or CFOs had about how the healthcare system worked?
[00:03:13] Eric Bricker: You know, the, the surprising thing is that I thought it would be fairly obvious to people, but I think at the end of the day, a lot of things in healthcare are kind of hiding in plain sight.
[00:03:26] Eric Bricker: And so what I'm about to say is, is no new rev re revelation, but just that, you know, healthcare is screwed up. 'cause the financial incentives are all wrong. I mean, that's, so that's the famous Charlie Munger quote, right? Incentives are superpowers. And so Charlie Munger actually was on the board of directors for a hospital in Los Angeles for 35 years.
[00:03:48] Eric Bricker: There's two main incentives that are messed up incentives for the docs in the hospitals and the providers where, listen, fee for service incentivizes providers to do things that shouldn't necessarily be done. To charge prices that are too high, so they do too much and they charge too much for it. Okay?
[00:04:12] Eric Bricker: Because they're financially incentivized to do that. They're not financially incentivized to maximize the patient's health. They're financially incentivized too. Do stuff. Sometimes doing stuff is not helpful to the patient and just costs money. Sometimes doing stuff is downright hurtful. Doing a procedure, prescribing a medication, what have you.
[00:04:34] Eric Bricker: So you have this financial bias for doing more and charging more than should be done. So that's number one incentive. That's wrong. And then you have incentive number two, that's wrong for the insurance carriers, and that is. And this is more of an an, so the, the providers have an error of commission, they're doing too much, and then the insurance carriers have an error of omission, which is they deny payment for things that they should actually pay for.
[00:05:03] Eric Bricker: There's perfectly reasonable services that are completely medically appropriate that the insurance companies like. We're just not gonna pay for that, or we're just not gonna pay on time. We're just gonna drag, drag this out as much as possible. Now, in a perfect world, one would think well. If the docs in the hospitals are doing too much, then the insurance companies just need to deny the stuff that the docs in the hospitals shouldn't have done in the first place.
[00:05:28] Eric Bricker: Right? So essentially the docs in the hospitals do things they shouldn't do, and they get paid for it. And then the insurance companies then deny things that the docs in the hospitals shouldn't be doing. So they, so there's a complete mismatch in terms of the financial incentives. And so you end up with a patient and their, their family members in the middle who essentially get screwed.
[00:05:49] Eric Bricker: That's why everybody in America is so frustrated with the US healthcare system.
[00:05:54] Kirk McConnell: Hey, I wanna get to how to fix the US healthcare system in a couple minutes, but let's start with kind of that patient that you just mentioned. You spent a lot of time on navigation. What were some of the key things that you figured out really helped ION as those patients tried to navigate those really poorly aligned incentives?
[00:06:11] Eric Bricker: So I'm, I'm a big Stephen Covey fan. So he wrote Seven Habits of Highly Effective People. It's a very popular book in the eighties and the nineties, and one of his seven habits is Seek first to understand and then be understood. So if you're gonna help somebody navigate healthcare, then you at first, you need to understand them and it at a very basic level, you need to understand them verbally.
[00:06:36] Eric Bricker: Okay? So it's really a conversation. It is not un, unfortunately. It's not through text, and I say quote unquote, unfortunately, because of course all the aire startups in Silicon Valley, it does. It doesn't matter where they're located, et cetera, et cetera. Like verbal conversations don't scale very well. And so everyone's like, we need to have a scalable, AI driven solution.
[00:06:59] Eric Bricker: And so then that needs to be text driven. At the end of the day, you gotta remember that the average reading level, excuse me, not the average, the median reading level in America for an adult is only about the sixth or seventh grade. Okay? So at the end of the day, and healthcare is super complicated, so to expect a person to be able to articulate in writing what's actually going on is an unreasonable expectation.
[00:07:27] Eric Bricker: So just know that like anybody who's out there trying to provide solutions in healthcare via a startup business, of course you want some sort of like financial, you know, huge gross margins, hockey stick growth, yada, yada, yada. I also would like to invent a teleportation app, right? I'm sure teleportation apps have huge gross margins and teleportation apps would, would skyrocket, right?
[00:07:53] Eric Bricker: Teleportation apps don't work. There's no such thing as a teleportation app. So just keep in mind as you're building your digital health solution, it might look good on paper and on slides, but is it going to actually work or is it just a teleportation app?
[00:08:08] Kirk McConnell: So Eric, I, I have to admit, I worked at one of those startups 15 years ago in the navigation space, and what you're saying hits home because one of the things that we tried to pitch was, Hey, look, people don't use travel agents anymore.
[00:08:21] Kirk McConnell: They like to solve everything themselves. When planning a vacation, healthcare should still be the same way. You don't need to talk someone, give people the information and they'll self-serve. I think we quickly learned that there's a bunch of fallacy in that. What do you think makes healthcare so different?
[00:08:36] Kirk McConnell: Whereas most patients, or most people like to self-serve for every other part of their life, but in healthcare, you still need to talk to somebody.
[00:08:43] Eric Bricker: The answer is, is because when people go on a vacation to the Amazon Rainforest, they do not self-serve. You better believe they have a travel agent for that.
[00:08:56] Eric Bricker: Why? Because going to the Amazon rainforest is dangerous. Going to the Amazon rainforest is a unique situation that most people don't go on that is not highly repeatable. If you go on a flight from San Francisco to Chicago, people do that all the time. It's highly repeatable with care is highly intermittent.
[00:09:18] Eric Bricker: People will have these episodes where they need a whole bunch of care, where they go in and they have a spine surgery or a knee replacement, or they have an acute pneumonia and they're in the hospital, and that experience is very complex and very dangerous, and it's very emotional. Your trip to the Amazon jungle is likely going to be filled with all types of emotions of fear and joy and elation and wonder.
[00:09:41] Eric Bricker: The reason why self-service doesn't work in healthcare is the exact same reason why self-service for Amazon Jungle Vacations, it doesn't work either. You need somebody who, who is a guide, who knows the lay of the land, who knows where the piranhas and the boa constrictors are. Who knows where the friendly natives are.
[00:09:59] Eric Bricker: Someone that you can trust, some that someone that when you're emotional, they can help you kinda unwind that emotion and get back to being rational. And as, as far as I know, that's the nature of the beast. And so, so again, it's important for us to, to not build teleportation apps.
[00:10:15] Kirk McConnell: Hmm. You know, if we were to zoom out a half step.
[00:10:19] Kirk McConnell: Where should that navigation live? You're making it sound, and I agree with you, it's so important, but should the health plans be doing a better job? Should employers take responsibility for it by nature? Does it need to be a third party advocacy program? What do you think?
[00:10:34] Eric Bricker: So there's a, there's an ideal state, and then there is various gradations of, you know, we, we live in an imperfect world, so let's do the best we can with that, right?
[00:10:46] Eric Bricker: Don't, don't let better be the enemy of good enough, right? So in an ideal world, you have a primary care physician who you have a relationship with and continuity with who has. Navigation resources within their practice, whether it's in the form of a nurse, case manager, or people even have the title of navigation.
[00:11:09] Eric Bricker: But the problem is, is that historically reimbursement was never created to pay for that. So the physician would need to have a smaller patient panel in order to be able to have the time to do the navigation work with the individual. And then two, you have to then pay for the additional FTEs for the salaries for people to actually do that.
[00:11:31] Eric Bricker: So this is where that model exists typically today in America with. Capitated Medicare Advantage plans. So sort of the prototypical one is ChenMed, where they're a hundred percent capitated. They're at full risk for all healthcare costs, and they deliver the navigation services for their seniors through their primary care centers.
[00:11:52] Eric Bricker: And guess what? It works great. It's awesome. I mean, they have, they're so much healthier. They stay outta the er, they stay outta the hospital. It costs so much less. I mean, it is a fantastic solution now in an employer sponsored plan. If you have a geographically concentrated group of employees, you can have it live within primary care, onsite clinic, near site clinic, direct primary care, et cetera.
[00:12:18] Eric Bricker: But so many employers have their employee populations spread out that it's really hard to then have primary care because there's, there's so many different the locations for employees. You're not gonna have one primary care clinic that can facilitate all those folks. So then the question becomes, how would you fully conduct.
[00:12:36] Eric Bricker: Navigation within a fee for service, highly fragmented provider environment. And so there, it's interesting is I've seen it work in either one of two places. So one, it's actually done by the job, by the employer themselves. Or two, it's done by the actual insurance carrier or TPA, that's adjudicating the claims.
[00:13:07] Eric Bricker: Now there's a big problem with both of those, and it's a bigger problem for the carrier than it is for the employer. And the problem is, is that the insurance carrier. The insurance industry is the second least trusted industry in America after the tobacco industry. So you have this entity, and they could be completely honest, they could be completely competent, they could be completely ethical, but unfortunately the well for insurance companies has been poison.
[00:13:41] Eric Bricker: And so unless you can come up with some sort of solution for un poisoning that well, then the, the correctness of your navigation information coming from an health insurance company is likely to fall on deaf ears because they do not trust you. So trust facilitates communication, which then facilitates behavior change.
[00:14:01] Eric Bricker: So if there's no trust, it doesn't matter how, quote unquote correct, your recommendation in navigation is, it is not gonna work. And in the employer side, they're challenged because believe it or not, they, there's, there's this annual Gallup study around how well employees like their job and a third of employees like their job.
[00:14:24] Eric Bricker: Another third of employees are just kind of tuned out. They're just kinda showing up and going through the emotions, and then literally third of employees in America actively detest their employer. How you solve that, in my opinion, is you gotta start new. Which, you know, frankly, is a big reason why new companies and new TPAs, I won't mention any names.
[00:14:52] Eric Bricker: That's why creative destruction is so important in healthcare because new entities need to come in and rejuvenate the space. The space, the amount of creative destruction in healthcare is abysmally low. All of the existing institutions in healthcare have been there for decades, if not centuries.
[00:15:13] Eric Bricker: Hospitals in America have been around, like the same hospital system has been around for over a hundred years. Okay? I don't look at that as a good thing. I look at that as a bad thing, right? You look at industries where the customer actually is doing really well. Those industries are defined by creative destruction.
[00:15:34] Eric Bricker: Where the companies only survive if they're serving the customer, and if they don't serve the customer, they die. And that needs to happen in healthcare as well. If the patient's not being served, then the organization that's in the job of serving them, they need to go out of business. So I know that sounds hard, but we are not in a situation where, because whenever you have these healthcare discussions, you're like, well, we have to look out for the interests of all stakeholders.
[00:16:01] Eric Bricker: No, that's a bunch of malarkey. You need to look out for one stakeholder, and that stakeholder is the patient. So if you, I, every physician takes the Hippocratic Oath. The physician does not take the Hippocratic Oath to the stakeholders of US healthcare. They take the Hippocratic Oath to the patient. So to the extent that there are organizations that are serving the patient, they should win.
[00:16:24] Eric Bricker: All right. I'll get off my soapbox.
[00:16:25] Kirk McConnell: Love it. What I'm gonna ask you to get back on the soapbox real fast, creative destruction. You said the rate is abysmally low. How do you increase the rate of creative destruction in healthcare?
[00:16:35] Eric Bricker: Healthcare is a highly regulated business, both on the provider side for docs and hospitals and on the insurance carrier side.
[00:16:45] Eric Bricker: And so there's a concept called regulatory capture. Which an economist named George Stigler, I believe his name actually won the Nobel Prize in the 1970s in economics for identifying this and regulatory capture is when regulations are actually created by the industry being regulated so as to favor that industry itself.
[00:17:11] Eric Bricker: So people think, oh, regulation that is really keeping insurance companies and hospitals in check. No, no, no, no, no regulation is put in place. By the insurance carriers and the hospitals to safeguard and provide political moats so that outside organizations cannot compete. So regulation and regulatory capture is ultimately anti-competitive.
[00:17:42] Eric Bricker: And we see this in America. One. Insurance is regulated at the state level, which means that if you wanna be a nationwide insurance carrier, you need to go to each individual state. Which is incredibly time consuming and expensive to do. And guess what? The people that are the insurance commissioners, the head of the Professional Association for Insurance Commissioners, used to be an insurance company lobbyist.
[00:18:07] Eric Bricker: Only in America, right. Hospital systems have lobbied states to have what are referred to as certificate of need laws, which says that look in your state, you can't just build a hospital. You can't just build an ambulatory surgery center. You have to get quote unquote permission from the government to do that.
[00:18:22] Eric Bricker: The state government. Hospitals are like, well, I don't want the state to give permission to a competitor to build a hospital. There's only a handful of states that don't have certificate of need loss. Texas is one of them. So like states should get rid of their certificate of need loss to encourage competition.
[00:18:39] Eric Bricker: The amount of regulation in health insurance should actually go down because all regulation is going to do, it's going to allow the incumbent organizations to capture their rules. Even more so and prevent even more competition.
[00:18:58] Kirk McConnell: And so if you think about then the employer, you know, they can be knowledgeable about those topics.
[00:19:03] Kirk McConnell: They're probably not going to drain the regulatory moat themselves overnight, but they play a role in the drumbeat. That's going to inspire change. I think right now we're seeing more and more questions ever before about independence in healthcare, transparency in healthcare. Why do you think those two forces, if employers start thinking about those topics, can help speed up change as well?
[00:19:29] Eric Bricker: Because employers are responsible for ensuring the largest number of Americans they insure. Over 60% of Americans get their job, get their insurance through employer sponsored healthcare, so employees have the power of the purse, right? It's sort of the facetious golden rule. He or she who has the gold, makes the rules.
[00:19:54] Eric Bricker: And so the employers, they spend, it's about 1.5 trillion, right? So the total US healthcare spend is, is about 5 trillion. And then employers actually spend 1.5 trillion of that. The head, the CHRO of International Paper, which has kept their healthcare costs trend flat for like five years.
[00:23:04] Eric Bricker: He said, look, the supply chain. For healthcare for our employees is broken. And so we as a company need to take ownership of identifying where specifically that supply chain is broken and then what we can do as an employer specifically to address those broken areas of the supply chain. Right. So it, it gets to again, the Stephen Covey habit number one, which is.
[00:23:33] Eric Bricker: Be proactive. This problem is not going to solve itself. And so employers like International Paper are like, look, we are going to take responsibility. And that's just the first step. You just have to take responsibility, and if you do, that begins the process of finding a solution.
[00:23:52] Kirk McConnell: I think so many employers hear things like take control of the supply chain, and they think, great.
[00:23:58] Kirk McConnell: If you're Fortune 20, you can do that. If you have 1500 people, I can't do that. What are some ways that you can still do that, even if you are a large or mid-size employer, maybe not Fortune 20.
[00:24:11] Eric Bricker: I'll tell you the, the very first thing you do is as soon as this podcast is over. You go to Amazon and you buy the book.
[00:24:19] Eric Bricker: The company that solved healthcare by John Corness, T-O-R-I-N as in Nancy, US as in Sam, they had about 1600 employees. They had about 3000 people on their plan, and they kept their trend flat for nine years, not as a Fortune 20 company. So. He did this, by the way, he wrote that book 15 years ago, which means he did this close to 20.
[00:24:49] Eric Bricker: He started doing this close to 25 years ago. He started doing this like 2001, 2002. So the playbook is out there and literally all you have to do is read that book and then literally just do what that book says like, and so like the answers are out there. The issue is will not skill. So if you even know how to do it, just read that book.
[00:25:08] Eric Bricker: He tells you exactly how to do it.
[00:25:10] Kirk McConnell: Beyond reading the book, what are some of the other things that you would encourage CHROs or even CFOs who you mentioned? We've been in a time of economic prosperity, but this is the first time that I think costs are growing so quickly. Granted, we've said that for the last 10 years, I do feel like we're getting to a place where costs are growing so quickly that even the FO is saying, whoa.
[00:25:31] Kirk McConnell: Tell me how we're gonna fix this if you're a CFO beyond reading that book, what else would you encourage them to start pushing on that?
[00:25:37] Eric Bricker: That's right. And so that's where when you look at the supply chain, you really have to look at, okay, you, you break it down by, okay, you've got the patient at one end, you've got the actual health plan at the employer that's writing the checks on the other end, and then you go step by step in between, let's work from the plan and go backwards.
[00:25:51] Eric Bricker: Okay. Okay. At the level of adjudication, can you do free pay audits of claims? And if you use an independent TPA, you can do prepay audits of claims. Groups can save about three to 6% on their total cost by doing prepay audits. There's bobs of junk claims that have stuff on there that that shouldn't exist and shouldn't be paid for.
[00:26:13] Eric Bricker: Okay, so that's number one. Then you work your way back to the, to the networks. Okay? This is where the network contracting, some of those networks have horrible deals with providers. I mean, it's ridiculous. You're paying 600% of Medicare for some of these things, and that's where you as an employer, can you set up direct contracts.
[00:26:27] Eric Bricker: Hundred percent. You can set set up direct contracts. So if you just go to Mark Cuban Cost Plus Wellness, he has. Published contracts that he has directly set up. You're like, I don't know where to get started, not be Mark Cuban's contracts. Then you work your way back to hospitalizations. Okay? Most employers that put in some sort of primary care solution, whether it be onsite clinic, near site clinic, direct primary care, or if you're a dis dispersed employer, you do virtual primary care, that can lower hospitalizations up to 40%, and the way you lower hospitalizations by 40% is to lower ER visits by 75% because about 80 people that end up hospitalized.
[00:27:03] Eric Bricker: Come through the er. So the way that you decrease hospitalizations is you gotta keep people out of the er, and the way that you keep people outta the ER is with primary care. So unless you have a primary care strategy, you will not see your hospitalizations go down. Okay. Then the next step before that is you have, and then this is the last thing I'll say, and then I'll stop because I could go on forever about this topic, right?
[00:27:24] Eric Bricker: Is that you have a generally unhealthy employee population, right? Ultimately. The initial spark that drives this entire thing is disease, and the a number one thing that causes that disease in the employee population is metabolic dysfunction or metabolic syndrome, is a combination of obesity, diabetes, pre-diabetes, hypertension, dys, dyslipidemia.
[00:27:53] Eric Bricker: The point is, is that if you are going to have incredibly unhealthy employees, then. To a certain extent, there's only so much you can do. So the place that I would start is the food. Okay. Because essentially a lot of the food that listen and I eat it too, a lot of the food that we eat is so incredibly, I mean, it's literally poisoned.
[00:28:18] Eric Bricker: Okay, so I'll give you a quick example. There's an air, an HVAC company in Jacksonville. I presented at a conference and the CEO of this company, you know, you know, classic HVAC company, you know, like 250 employees, right? Guys driving around in vans around Jacksonville fixing air conditioners, right? They that, what did they do?
[00:28:36] Eric Bricker: They all had lunch at the local seven 11 at the convenience stores, right? Garbage, eating garbage, okay. They. Built a kitchen in their headquarters and they made free healthy lunches for all the guys going out in the trucks. And so they didn't control their breakfast, they didn't control their dinner, they didn't control what they ate on the weekends, but they said, by golly, for lunch during the week, you're gonna have free healthy food from us as a company.
[00:29:03] Eric Bricker: I mean, hu huge win. Does it? Does it solve all your problems? No, but you absolutely have to address what your employees are eating. If you don't address, and there are ways you can do it, like it's not a nanny state, blah, blah blah. So just know that those are things that you can actually do to address the supply chain for healthcare.
[00:29:23] Kirk McConnell: Let, let's pick up that metabolic disorder thread. What do you think GLP-1 will look like at Steady State maybe five years from now? Will employers be covering it more? Will they be more common? Less common? What do you think that steady state will look like?
[00:29:40] Eric Bricker: Great question. I have no crystal ball. I can just tell you what what's happening now, and I can tell you what's happening now is it's too expensive.
[00:29:47] Eric Bricker: And so the big movement now is the employers are not paying for it for obesity anymore. They'll pay for it for diabetes, but they're not gonna pay it for just for obesity. Like should they, should they not? Will it help the employee population's health overall? Will it bend the cost curve overall? Doesn't matter.
[00:30:02] Eric Bricker: The overall trend is that the percentage of employers that offer GLP-1s for, for people with diabetes is north of 80%, but the percent of employers that offer GLP-1s for obesity treatment, it's 60% and it's shrinking. Okay, so will that trend continue? Is that trend, you know, clinically justified or unjustified?
[00:30:20] Eric Bricker: Like, I don't know. And here's the problem. Okay. The problem is, is that with all. Medications that goes through what are called phase four trials and a phase four trial. After phase three, you can start selling it to people and doctors can start prescribing it. And phase four is post-market surveillance and a lot of, if there are adverse side effects, yada, yada, yada.
[00:30:41] Eric Bricker: They don't come out until the post-market surveillance, and a lot of times it takes years of post-market surveillance, right? So this is where, you know, it was found that Vioxx, you probably remember this from the early two thousands, like Vioxx increased your risk of heart attacks and it was used in arthritis.
[00:30:58] Eric Bricker: Arthritis medication. Okay? So. What, what the doctor, I did my residency at Johns Hopkins. What the doctors at Johns Hopkins said is that, look, if there is a new medication, if you have a condition that cannot be treated any other way and you are obviously suffering the physical consequences of this disease, then yes, it makes a hundred percent sense to take a new medication.
[00:31:25] Eric Bricker: But if you have a condition that can be treated with an existing, well-known medication or and or lifestyle modification, then frankly, we know about that a lot more than we know about this new medication. And so it might make sense for you to do the existing medication or the lifestyle modification first.
[00:31:48] Eric Bricker: So then the question becomes, I think, for every individual. For GLP-1s, it's really an individual decision because there, frankly, there are some people that are so obese that they, it really is a life or death situation that they, they literally could be within a year or a handful of years of death. And at, at which point, maybe that a hundred percent is the right choice for them, but I'd say that's really an individual choice for them and their physicians.
[00:32:14] Eric Bricker: So I can tell you what's happening today. Mm-hmm. But I don't have a crystal ball.
[00:32:17] Kirk McConnell: It sounds like though, it'll be a very different conversation and call it five to seven years, when you have more phase four data, hopefully the cost comes down a little bit. Do you think there's gonna be a separate conversation to be had at that point?
[00:32:29] Eric Bricker: Time is gonna help, right? At the end of the day. Time is super helpful and time is helpful not only in terms of a better understanding, the side effect, you know, profile, you know, long-term consequences, yada, yada, yada. But then also in terms of, of competition and prices coming down. And listen, the prices for GLP-1s have already started coming down.
[00:32:46] Eric Bricker: So, I mean the, the fact, right? So like Novo Nordisk and Eli Lilly, they have their own direct pharmacies now, and like you can direct source the, the GLP-1 medications from those pharmacies oftentimes for half of what you would get it through the plan. So I'm not gonna, I'm not gonna start talking about PBMs during this, but I'm just gonna tell you that there are other ways to get these medications that are much less expensive.
[00:33:09] Kirk McConnell: Let's kind of build off that. Let's finish by looking towards the future a little bit. What are some of the ideas out there? That you're most excited about? Is it things like direct access to medications or where are a lot of the innovations gonna be sparked from, do you think?
[00:33:23] Eric Bricker: So one, at the end of the day, there is a very positive impact of AI in healthcare and health insurance.
[00:33:34] Eric Bricker: And so I don't think you can look at this tsunami of change from artificial intelligence and say that we. As a health plan cannot, or, or as an employer, cannot take advantage of that. What are some ways to do that? AI is very good at financial and actuarial analysis. So are you gonna hire an actuary? Are you gonna do financial analysis through your consultant?
[00:34:04] Eric Bricker: Of course, but now you have an opportunity to check their work. Isn't that wonderful? Who was it that said trust but verify You as an employer have a verification method. Now, I would use that all day long. Number two plan documents are typically in PDF form. No one accurately knows what those plan documents say.
[00:34:32] Eric Bricker: How does my plan cover a CPA machine and actually use AI to get that answer in seconds. Do you need to rely on customer service at the carrier? Do you need to rely on the doctor's office? Do you need to even rely on hr? Every employee should have immediate access to the accurate information for their plan documents.
[00:34:54] Eric Bricker: The physician, quote unquote, shortage in America really limits. People's access to doctors. Okay. I will tell you that a nurse practitioner or a physician's assistant armed with AI is just as good, if not better than a doctor. Why is that? 'cause you can be seen what's better. A nurse practitioner with AI or not seeing a doctor for nine months.
[00:35:26] Eric Bricker: Okay, so there has been a stranglehold. The, the number of dermatologists in America was decreased by the American College of Dermatology. Okay. It's hard to get a dermatologist appointment. It's really hard, blah, blah, blah, blah, blah, right? Because the Dermatology Association literally, intentionally decreased the number of dermatologists.
[00:35:50] Eric Bricker: Why? Because it raises the price, it raises their reimbursement. Right? It's, it's simple economics. If you decrease supply, demand stays the same, the price goes up. Okay. So are there opportunities to use AI in the specialties as well to improve access for, for patients, a hundred. A hundred percent. So on this podcast today, and for employers, like you don't need to solve every one of those problems like right now, but just know that like these are all solvable problems.
[00:36:18] Eric Bricker: Like if there's anything that I can just give people as a takeaway from this, it's like, listen, don't, don't despair and just give up your hands and say it's impossible. It is 100% possible, like you can do this. In my mind, the biggest problem is, is that employers have thrown their hands up and said it's too complicated to deal with it, so I'm just not going to, okay.
[00:36:41] Eric Bricker: So I know that's harsh. I know that's going to be an unpopular opinion with many people, but just, just roll up your sleeves and do it. Okay. Last thing I'm gonna say about that. Okay. How, how are you? How are you? How are you gonna do that? All right. Like I would argue the first thing that you should ask as a benefits person is you go to your CFO or whatever and you're like, look, like, look, you want me to solve this problem.
[00:37:02] Eric Bricker: I need more FTEs. Okay. Highly successful employee health plans have more employees running the health plan than unsuccessful employee health plans, and you'll more than make up for it in a lack of claims costs. So your very first step is, Hey, I've got a team of three. For an employee benefit span, an employee benefit span of a hundred million dollars, that is ridiculous.
[00:37:25] Eric Bricker: Okay. You need to immediately double the size of your staff, if not triple the size of your staff. So that's the very first thing that you do. And if your CEO or CFO pushes back, I'll talk to ‘em, gimme a call. Look, message me on LinkedIn. Be like, Eric, can we go talk to our CEO together? Happy to.
[00:37:40] Kirk McConnell: I think it's a wonderful place to end.
[00:37:42] Kirk McConnell: So Eric, I appreciate both the passion and soapbox, but also the tangibility. We have some books to buy, we have some conversations to have. If people want to continue the conversation with you, what's the best way to do that?
[00:37:56] Eric Bricker: Yeah, it's supposed to be on LinkedIn, Eric Bricker. Yeah, you can connect with me and you'll see my videos or you can message me or what have you.
[00:38:02] Eric Bricker: So yeah. Thank you everybody for listening and, and Kirk, thank you so much for having me on.
[00:38:07] Kirk McConnell: Excellent. Thank you very much. Thank you, Eric. If you're enjoying the Benefits Playbook, we'd love your support. Take a moment to rate and review the show wherever you listen. It really helps others discover us and join the conversation.
[00:38:19] Kirk McConnell: And while you're there, don't forget to hit subscribe, so you never miss an episode. If you know a colleague or friend who'd enjoy the conversation, share it with them too. Thanks so much for listening, and we'll see you next time.