This episode features an interview with Sara Richards, Director of Benefits at Red Bull. With experience spanning the consulting, TPA, and in-house side of benefits, Sara’s experience gives her a unique perspective around what’s possible when it comes to developing and administering customized health and welfare solutions. In this episode, Kirk and Sara explore strategies for simplifying and effectively communicating benefits, the practical implementation of point solutions, and utilizing AI to improve employee engagement and fraud prevention.
This episode features an interview with Sara Richards, Director of Benefits at Red Bull. With experience spanning the consulting, TPA, and in-house side of benefits, Sara’s experience gives her a unique perspective around what’s possible when it comes to developing and administering customized health and welfare solutions.
In this episode, Kirk and Sara explore strategies for simplifying and effectively communicating benefits, the practical implementation of point solutions, and utilizing AI to improve employee engagement and fraud prevention.
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“ I am optimistic for those who are willing and able to not stop fighting to change the status quo. I'm optimistic as long as you are willing to put in the work to not just keep going with things and to get ahead of trends and to look at the unconventional solutions. If you dare and you don't give up, then I am optimistic that we will be able to make this better, and that we as the employers have this ability to bring our buying power to truly impact change. With a layer of pessimism of, and if you don't dare, then it's not gonna be a fun ride for you in the next five, six years.” – Sara Richards
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Episode Timestamps:
*(00:51): Sara’s career journey
*(06:28): Innovative communication strategies
*(13:06): Direct contracting and primary care
*(21:41): Shared savings and fraud prevention
*(32:26): The role of AI in benefits
*(36:41): Optimism for the future
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Links:
Learn more about Collective Health
[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, and creating a health benefits experience their people love.
[00:00:24] 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. Welcome back to the Benefits Playbook, and today I'm really excited. We're joined by Sara Richards, Director of Benefits at Red Bull, someone who I have had the luxury of knowing for a long time.
[00:00:46] Kirk McConnell: Sara, thank you so much for being with us today.
[00:00:48] Sara Richards: I am super excited to be doing this with you, Kirk.
[00:00:51] Kirk McConnell: Well, you know, one of the things, not only are you a delightful person, but I think your background gives you a lot of insight. You were a broker and then you worked for a TPA, and now you're the Director at Benefits at Red Bull.
[00:01:03] Kirk McConnell: Kind of walk me through that journey. What have been some of the themes that have kept you going?
[00:01:07] Sara Richards: Yeah, I think the perspectives I've had over the years have been somewhat unique just because of the variety of things that I've seen. Starting back when I was working on the broker side, what was really cool is I got to see so many strategies from so many different clients, different considerations, different populations they were trying to serve, and how they were all trying to solve this issue of how do we make this better, easier, and more understandable for our employees.
[00:01:32] Sara Richards: Then when I went to the TPA side, again, it was that same mission of how do we make this better? Because healthcare, it's freaking complicated. Our average employee does not understand it. They go in for services, they have no idea what it's gonna cost them, and that can be really scary. And so then on the TPA side it was, what else can we do with the tools?
[00:01:50] Sara Richards: What else can we do with our processes to make this easier for employees and their families to understand? And that team has carried through over into Red Bull. Because for me here, it's, it's again, all about how am I communicating this with them? How am I making them, giving them that literacy to understand their benefits in an actually useful and meaningful way, but then also making them aware of all of their benefits?
[00:02:14] Sara Richards: Because I'm one of those people who absolutely believes in the partner ecosystem. And what that means is I have a lot of amazing benefit programs in place. That also means, that's a lot of names to remember. That's a lot of pieces of information to pull up when it's important to that particular individual.
[00:02:32] Sara Richards: And so I would say that since moving on the employer side, it's really now become more a, okay, how do I turn myself into a marketing tool for my own benefits to make sure that these things are top of mind. At that moment of need for that employee where they're like, wait, I think we have a benefit for this.
[00:02:50] Sara Richards: I remember something about this. Let me go find out what that benefit is. So theme, always trying to make it easier and simpler, but also that's the biggest challenge because it is not simple, nor has it easy to understand.
[00:03:04] Kirk McConnell: Yeah. You talk to some people and they almost say we're in the post point solution era because there were so many point solutions, and then there was the communication challenge and the low engagement.
[00:03:14] Kirk McConnell: It feels like you haven't given up on them. What have you learned about making point solutions work?
[00:03:19] Sara Richards: So I think I understand what people are saying about point solution fatigue, and that's a real thing, and that is absolutely a consideration that at least most of the employers I talk with we're all going through where we're starting to go.
[00:03:31] Sara Richards: Okay, now how can I consolidate so that I have one name that they get to know for three or four different things. But the reality is the point solutions. In the majority of cases are still actually the better care, the better outcomes. You know, when you think about the standard networks, right? Like your big medical carriers, your big PBMs, what they're great for is they're great for broad coverage, they're great for giving you accessibility.
[00:03:58] Sara Richards: What they don't do well is making sure that you're getting the best care for the scenario that you are in, and especially when you're self-insured and you're the one paying for the claims. We know that complications coming out of things that readmissions are a huge driver of claim costs, and we also know that
[00:04:16] Sara Richards: for the member's experience, getting that white glove service with whatever that point solution is often drives better adherence and better outcomes than when they're just going through the standard medical rigamarole that they have to go through if they're just going through their neighborhood doctor.
[00:04:34] Kirk McConnell: Let's get tactical for a second because I think a lot of people would agree with you that point solutions exist because they do add value to the ecosystem. As you mentioned, they fill out a round out a lot of the rough edges of the medical networks, but a lot of folks have said, but I just can't get them to work 'cause my people don't use them.
[00:04:50] Kirk McConnell: How have you tried to crack that now?
[00:04:53] Sara Richards: So this, and this actually comes back to I have turned into a benefits marketer. I never thought that I was gonna get into marketing, and lo and behold, here we are. Really what I started doing is actually taking a lot of the lessons I learned when I was on the TPA side and seeing how we were putting together marketing campaigns.
[00:05:10] Sara Richards: And now in my current role, what we've created is this thing called Always on benefits. The idea is that every month we are creating benefit ads, and these go up on our digital screens, and these go out in slides that our distribution warehouse guys go through like once a month in their huddles that they have.
[00:05:29] Sara Richards: And basically these are bite-size, very catchy little ads for a specific type of benefit that have a fun, well, I mean, I'm very lucky that Red Bull is a funny company, so therefore I can be a little bit funnier in the ads that I make. But it's a little funny thing about why would you maybe wanna use this service?
[00:05:47] Sara Richards: Like one of the ones I recently did, the tagline is Layups Got Ya Limpin’? And it was for our virtual physical therapy service, right, 'cause we have a lot of guys that like playing basketball. And so by creating these one or two or three ads during a month and that get put around in various places through the company, you're just starting to create general awareness and an ongoing reminder of the cool things that are available to them outside of open enrollment.
[00:06:14] Sara Richards: Right? Because I think it's so easy to think of open enrollment as your one chance to get in front of people, but I actually think that's the wrong paradigm, especially for employers that do have the kinds of ecosystems that we have.
[00:06:28] Kirk McConnell: Flesh that out a little bit more. If open enrollment is the wrong paradigm, what would you say is the right paradigm for communication?
[00:06:35] Sara Richards: So again, I think it's that constant bite-sized pieces of information in as many different places as you can do it. I think it's also things like making sure that your intranet has that kind of UX friendliness. So one of the things that we did this last year is we changed the entire layout of our intranet.
[00:06:53] Sara Richards: To make it more occasion based. And what I mean by that is, are you looking for free stuff under the medical plan? Are you looking for the supports that we have for complex conditions? Are you looking for things outside of the medical plan where we still offer you additional support for other things that might be going on in your life?
[00:07:11] Sara Richards: And really, if you think about it, like the game of life, right? Really starting to try and put it into bundles of, Hey, are you in your early twenties and you are looking at having a house, kids, all that kind of stuff. Here are the things that might be more relevant to you. Okay. Are you in the planning or parenting phase?
[00:07:28] Sara Richards: Here are the things that might be more relevant to you. And just finding ways to bundle it so that it resonates with people well, when they see something, they're like, oh, I identify with this persona and so therefore I am gonna take a second to look at these benefits.
[00:07:43] Kirk McConnell: As someone with two young kids, I totally understand what you mean by the game of life somehow.
[00:07:47] Kirk McConnell: My son always ends up with like six kids. I love that. As you think about that, you're making it sound like put the information there so it's easy to find. How do you think about the proactiveness of it? Do you want the vendors point solutions to reaching out? How do you think about that?
[00:08:03] Sara Richards: So I think that that is still the nut that everyone's trying to crack.
[00:08:08] Sara Richards: I think really what it comes down to is, again, finding those people in that moment of need where whoever the outreach is coming from, whether it's the vendor, whether it's the TPA, it's happening right as they are about to either get that service or you know, start down this path of, hey, they've just been diagnosed with something.
[00:08:28] Sara Richards: I think that where you have to kind of play a fine line is in the difference between it feeling supportive versus it feeling weird where the person is like, how do you even know that I just got diagnosed with this thing? Or, where did you get this information that's making you reach out to me? And quite honestly, I think that's where
[00:08:47] Sara Richards: TPAs can come into play because they are normally reaching out to the members anyway for various things, and it would be natural for them to have this information. And so this is why, you know, I mean, candidly we have collective health and so the care suggestions, right? Those have been huge for us.
[00:09:02] Sara Richards: Because we can customize them where when certain claim codes, et cetera come in, that triggers a suggestion to go to the member to say, Hey, did you know you also have these additional supports? And I personally think that is actually more effective than any flyer coming in the mail. And certainly anything that we are doing on the benefits side, where again, we're just doing a broad shot, give it out to everybody and hope that some people who are going through this read the thing that we're sending out in that particular month.
[00:09:31] Kirk McConnell: I think you make such a good point there. You have to be realistic about, I'll call it the creep factor of how do they know this? How are they reaching out? And if it's a vendor you've already established trust in, I think it feels less creepy and more useful. Whereas a vendor, you don't even know who they are.
[00:09:47] Kirk McConnell: Why are they reaching out to you?
[00:09:49] Sara Richards: Exactly, and I think part of what we've tried to do, even for our vendors that do direct outreach because of information that they get from our TPA from Collective Health, we have the communications be co-branded where they say, Hey, we are so and so. We are part of your system with Collective Health.
[00:10:05] Sara Richards: So it's even referencing the fact that this is happening, this outreach is happening. In connection with your overall plan, not because we got your information off the dark web somewhere, or because your employer knows that this thing is happening to you. And I think that does help establish trust or at least remove some of that creep factor when it is coming from a vendor that they might not typically get outreach from.
[00:10:30] Kirk McConnell: I wanna push you a little bit on that because sometimes you hear the counterpoint that an employee doesn't want to think about their employer knowing everything going on in their life. So how do you think about the employer brand being a source of trust versus some people saying, I don't want my employer knowing I'm going through this medical condition.
[00:10:52] Sara Richards: For us, we're pretty thoughtful in how it is phrased in any communications because the outreach is actually tagged as more in connection with Collective Health as part of your Red Bull benefits, not as Red Bull's partner. Which again, can just open that door for, okay, how did you get this information?
[00:11:12] Sara Richards: And so that's where I think relying on that trusted relationship of the TPA can help reduce that in a way that doesn't make them think that the employer has had anything to do with this. Instead, it's just, oh, this is part of my bigger benefits that are available to me that are being offered because my TPA knows this, not because my employer knows this.
[00:11:34] Kirk McConnell: You've been on the broker side, you've been on the TPA side, now you're on the employer side. Is there anything that's harder than you thought it was gonna be that when you're at like the TPA, a broker, you're like, man, why can't benefit leaders just do this? And now you're like, now I understand 'cause I'm the benefit leader.
[00:11:49] Sara Richards: There's two things that are harder than I thought it would be getting employees to read is shockingly hard. I think it's why I have really changed my strategy and my tactics to move away from super long emails or super detailed emails to now move it to bullet points. 'cause I'm like, listen, I don't actually need to explain this to you in the email.
[00:12:10] Sara Richards: I just need to generate enough interest that you click on the thing to learn more. But it does constantly shock me how little people breed what we send them. And then I think the other thing that has surprised me in how hard it is, is really those limitations around what I, the plan sponsor, can do to make sure that I am driving members to the right care.
[00:12:32] Sara Richards: Like I know where the right care is. I've partnered with the vendors for the right care, but because of contracting language or because of other, you know, kind of, I'm gonna call 'em handcuffs that are in some of these things, I might not be able to drive them as efficiently as I would like. In an ideal world, that has been a surprise to me to see how clunky some of the things like utilization management,
[00:12:54] Sara Richards: prior authorization, like how clunky all of that is when you actually start trying to change how it's working to be something that's a better experience for the members, not a quick or easy change I'm discovering.
[00:13:06] Kirk McConnell: Tell me a little bit more about that, because on one hand, the self-funded employer bears the financial risk has ownership of the program, but you're right, it's not carte blanche to go do anything.
[00:13:16] Sara Richards: Mm-hmm.
[00:13:17] Kirk McConnell: What have you learned about navigating contracts?
[00:13:20] Sara Richards: So for me, and again, ecosystem, you know, supporter, someone who really believes that. Getting members to these specific players is better for my population in the long run and for the health of my plans. But what I discovered early on is that there was language in my contracts that was like, Hey, you can't do this.
[00:13:40] Sara Richards: You cannot carve out a section of the population and say, for these services, you have to go here because the contract that we had in place at the time, that put them in breach of their contracts with their doctors. And so those are the kind of clauses where I was like, but this makes no sense. 'cause what you're telling me is that I have to use your very broad, but not necessarily quality driven networks.
[00:14:05] Sara Richards: I can't force people in certain scenarios where I know they'll get better outcomes, I can't push them into these other streams. And so I quite honestly, it's been something whereas we've gone back for contract renewals, we are now pushing a lot harder to say, listen, I require this language to be in there because I need to be able to manage my plans effectively.
[00:14:26] Sara Richards: Especially with things like, you know, we know that primary care physicians, that shortage is only gonna grow, but we also know that when you have a relationship with your primary care physician. You get ahead of the chronic conditions, you get ahead of it much sooner, and you have better outcomes. Well, that means that I'm dealing with two competing things, a scarcity of actual people to do the services and an absolute need from the plan's perspective to get people to engage with these services more regularly.
[00:14:55] Sara Richards: So the only solution I have as an employer is, okay, then I need to go find a third. A company of some type that does these kind of services, that has a broader network or that enables more virtual things and push people to go use that, because I want them to develop those relationships. But I can't do that if I have the language in my contract that doesn't allow me to do that.
[00:15:15] Sara Richards: And so this is where I think the next stage, at least for me, is really getting deep on contract language, which is never something I thought, like I'm already in marketing, I don't need to be in legal as well, but apparently I'm, I'm in legal too.
[00:15:30] Kirk McConnell: But you make a great point, which is, even if it's scary to dive into the contracts and even if it's frustrating to realize the limitations you've already signed, it gives you that much more power and perspective going into the next set of contracts.
[00:15:44] Sara Richards: Exactly, and I think the big thing and, and the one piece of power that employers have is the RFP, right? It is that, hey, I'm not only gonna ask you for your renewal, but I'm gonna ask a couple of other people and I'm gonna make these key clauses. A requirement of all of these RFPs where it's like, you don't even get to play in my RFP until you agree to these clauses.
[00:16:08] Sara Richards: And so I think that is, that's the one time of the year or within the contract that we have the power to kind of shift that dynamic. 'cause to your point, once it's signed. They have no incentive to give you those things after the fact. They're like, yeah, you're already a client. We're just gonna keep it as is.
[00:16:24] Sara Richards: You signed the language.
[00:16:25] Kirk McConnell: I don't think I've ever heard anyone articulate it that beautifully. Which is the RFP is actually one of your first strategy documents. Because it sets the tone for everything. Yeah, you said a lot of interesting buzzwords. I heard direct contracting, I heard primary care. You haven't said AI yet, but we'll get to AI.
[00:16:44] Kirk McConnell: Let's take a minute on each of those primary care. How would you articulate how you are thinking about primary care and what you think better looks like?
[00:16:51] Sara Richards: So, how I think about primary care is I truly feel like this needs to be something that all of our members are regularly engaging in beyond just their wellness check.
[00:17:04] Sara Richards: Or even, quite honestly, when I think about our population, if all of them would just get their wellness check every year, that's a great place to start. But to me, primary care is about more than that. It's about having a person who gets to know you, know your family, know your dynamics. And you're talking with them regularly throughout the year about any of the questions you might have about your health.
[00:17:24] Sara Richards: Because again, sometimes in those very innocuous conversations, something will come up and they're like, oh, wait a second, let's talk about that a little bit more. And they might actually get ahead of a condition you didn't even know that you were developing. And so for me, primary care shouldn't be this.
[00:17:40] Sara Richards: Once a year wellness check, it should be this ongoing relationship with someone that you're seeing a couple of times a year that you're talking through all of the things with to make sure that you're getting ahead of things. The other piece for me, especially with the cancer rates that we are seeing across the US, that we are seeing cancers hit at these younger ages than we've ever seen it before.
[00:18:02] Sara Richards: It is that piece of really getting members to. Engage in those testings. Finding ways to offer them non-invasive things. Like, you know, 'cause look, no one in their right mind wants to go for that colonoscopy. No one is like, yeah, let's go do this. Of course they don't wanna do that. It's not fun. It's not a fun process, you know.
[00:18:22] Sara Richards: Same for prostate exam, cancer exam, same for, you know, there's so many, like pap smears are awful. And I do think that there is a new set of vendors that are actually now offering non-invasive cancer tests that, and this is something that we're doing where it's like, Hey, this is free. It is non-invasive.
[00:18:41] Sara Richards: It's super easy to do, so I've done all the right things. Now I just have to get people to actually use it, which is part of the always-on benefits, but also part of the challenge because you can offer all the things in the world, and if people aren't using it, then you know you're still not accomplishing your goals.
[00:18:58] Kirk McConnell: It's clear that primary care is incredibly important. He also mentioned scarcity. How are you trying to address scarcity for your population?
[00:19:07] Sara Richards: So this comes back to kind of that direct contracting conversation of, okay, so if we know that standard like primary care within the standard medical networks, like doctors are just not signing up to be primary care physicians.
[00:19:21] Sara Richards: It's not enough money for all the medical debt that they come out of college with. But what you do find is that there are some vendors out there that are starting to, because they pay a little bit more or what have you, they're able to pull together a more robust primary care network that makes the experience a lot more accessible, a lot easier.
[00:19:41] Sara Richards: And so a really good example that we have today is one medical. I love the one medical model. I just need it to be in more places. And so for instance, for the scarcity piece, what I'm looking at doing is how can I either bring together one medical plus other vendors that are doing similar things, or a vendor that
[00:19:58] Sara Richards: does, you know, that does the one medical model, but a little bit more broadly, how can I double down on that and then make it easier and less expensive for my employees and members to use that service to again, try and encourage them to actually interact more regularly without being worried about how much it's gonna cost them.
[00:20:18] Kirk McConnell: Do you envision direct contracting on things outside of primary care?
[00:20:22] Sara Richards: Ooh, yeah. I mean, if it was up to me, yeah, absolutely. So, you know, today we have a version of direct contracting for surgeons. And we do that through Lantern, and that's been pretty amazing. But you know, even when we're talking about prescriptions, right?
[00:20:37] Sara Richards: There is the concern around GLP-1s, and then you had this whole thing where HIMS and HERS were able to offer these GLP-1s, and granted it was through a loophole that then closed, but they weren't able to offer them at a fraction of the cost of what employers were paying for these GLP-1s. So I do think that even potentially in the future on the pharmaceutical side, there might be opportunities to direct contract with certain manufacturers to get better rates.
[00:21:03] Sara Richards: Again, this is a, I think because I haven't actually started going down that path, but I think, you know, for other areas like the surgeries that are high risk, high cost, high complications, that's a natural one where, you know what? I don't want you to go to just anybody. I want you to go to the best. Cancer would be another area where you're like, you know what?
[00:21:22] Sara Richards: I wanna make sure that you are with the best specialist that is going to get you the best services for your specific type of cancer. I think those are just natural synergies where you want to prioritize or direct contract with a subset rather than just the standard ones through the network.
[00:21:41] Kirk McConnell: For a lot of these programs, if you listened
[00:21:44] Kirk McConnell: just purely to their sales pitches, benefits would become like a profit center 'cause everyone's gonna save you so much money. Where are you actually seeing hard dollar savings?
[00:21:54] Sara Richards: I'm seeing hard dollar savings in the contracts that are set up as shared savings contracts, which is a kind of newer thing that I love and it makes it so much easier to get a yes from my internal teams because again.
[00:22:07] Sara Richards: When the pitch is we're gonna save you money, and then the payment is, and we're just gonna keep a percentage of what we save you, then that's a kind of no-brainer in some ways, as long as you have vetted how they're calculating those shared savings. But anything like that where the vendor has skin in the game to make sure that I am saving money, that's an easy way to do it.
[00:22:30] Sara Richards: I think the other thing that, again, is one of the next areas that we're gonna get into that we haven't done quite yet is, you know, that fraud, waste and abuse. Getting vendors that can go through our claims to find those moments and actually go back to whether it's the hospital, the provider's office, and challenge them on what they're billing.
[00:22:49] Sara Richards: That's not something my team is big enough to be capable of doing. We just, we run too small and lean. But that is something where I think there is, we know it's happening. And so it's just making sure that we have a vendor that can easily, efficiently and effectively. Find those claims and then actually pursue them to the point of either getting money back for us, or maybe even in some cases saying we're not gonna pay claims above a certain threshold until it's past that fraud, waste and abuse run.
[00:23:19] Sara Richards: And then as long as there are no issues with that claim. Okay, then go ahead and release the payment. And so, you know, again, these are just things where it, that does net you savings if you can do it well, and I, I know this 'cause I've talked with so many other employers who have successfully implemented it and saved a lot of money through it.
[00:23:37] Kirk McConnell: For things like fraud, waste, and abuse, when do you look for your network partners to do it versus when do you say I need to go above and beyond?
[00:23:46] Sara Richards: So technically all network partners do this. Technically the TPA might offer services that do this as well. And what I think I've seen in the data is, but it's not broad enough or it doesn't catch all of them.
[00:24:02] Sara Richards: And that's because these are kind of add-on services that they're doing and they're using very specific criteria, or they're using maybe limited, you know, they only look at X type of claims or Y type of claims. And so for me, that's where I think it's great that they're doing this. I don't think it's as effective as it could be.
[00:24:21] Sara Richards: And so again, ecosystem, right? I would rather work with a company where this is what they do. And have them do it across a much broader set of my claims, where they're looking at much more details such as what is being charged for cotton balls? Like is this a duplicate claim? Is this a duplicate charge?
[00:24:40] Sara Richards: Are they charging for two things that don't make sense within the one single surgery? And I don't know that those always get caught with the standard fraud, waste, and abuse things that get looked at, you know, just through your standard carrier or TPA.
[00:24:53] Kirk McConnell: One of the dynamics that I'm seeing is when you think about point solutions or ecosystem as being member facing, you know, the diabetes programs, the cancer programs, I think there's a growing set of point solutions or ecosystem that are actually administrative tools
[00:25:06] Kirk McConnell: that you can plug in fraud, waste, and abuse. Are you looking at it that way as well?
[00:25:10] Sara Richards: Absolutely. So I mean the, when it comes to actually changing my medical trend. What we know, what I've learned over the last four years is that trying to make members change where they're getting their services, by doing their own research on the, whether it's the tool, the Doctor Finder or some other tool that's like, Hey, this prescription is cheaper.
[00:25:34] Sara Richards: If you go two miles down the road, that doesn't net changes because people will. Pay more for convenience. Where I think there is this opportunity to make a difference is on the stuff that is completely invisible to the member, or that works in tandem with both the member and the providers, such as utilization management, so the beauty of fraud, waste, and abuse.
[00:25:55] Sara Richards: Is that it is completely behind the scenes. This is just a net, you know, positive to the plan when it discovers that this is happening and successfully challenges it. Utilization management is one of those things where when it's done right, what should happen is that it gets ahead of the member booking that surgery with the surgeon that their friend at the golf club told them was the best surgeon for it, who is not in fact the best surgeon for it.
[00:26:18] Sara Richards: And so, if utilization management is done properly and can get to both the doctor that's referring for whatever the procedure is and to the member, you have a much higher chance of changing where they're going. Part of the problem with utilization management today and prior authorization is number one, you're getting the final green light.
[00:26:39] Sara Richards: A day to three days before the surgery. Right? Like at that point you've already booked it, you've packed your bag, you're, you are in the mindset of this is where I'm going for this procedure. The other piece is that they only talk to the doctors for the most part. There is no transparency oftentimes to the member of what is going on with that prior authorization or the utilization management.
[00:26:59] Sara Richards: Whereas to me, I think that if you are truly trying to get certain members that are. Engaging in certain types of services to change their trajectory. You have to communicate both with the member and with the doctor to get them on board of why they might want it, like why this is in their best interest.
[00:27:17] Sara Richards: And you have to do, you know, more than three days before the surgery is supposed to be happening. Like you just can't, that's, no one's gonna change their plans when they already had this set in stone and took their PTO for it, you know?
[00:27:29] Kirk McConnell: You know, you talked a lot about the member facing ecosystem, the communication challenges there.
[00:27:35] Kirk McConnell: On the administrative solutions though, there's a whole nother set of challenges. There's getting eligibility flowing, claims flowing, data flowing, dollars flowing. How are you thinking about making sure that doesn't turn into a nightmare?
[00:27:50] Sara Richards: So fortunately for us, uh, and you know, plug for Collective Health when it comes to eligibility, flowing claims, flowing, data flowing, money flowing, we haven't had those issues.
[00:28:01] Sara Richards: Now, when I talk about potentially wanting to do utilization management differently, where I am actually asking the provider to change what almost ingrained knee-jerk process is for submitting a prior authorization to the standard networks versus. Someone else that I wanna use, or when I'm talking about asking the main network carrier to exchange a file with a utilization management vendor that I am choosing, that's where again, you can end up with these roadblocks or challenges where they don't wanna share it, for whatever reason.
[00:28:35] Sara Richards: And so again, that becomes something that you absolutely need to do your due diligence on and not just go based on the sales pitch of whatever the um, vendor is like for me, I'm immediately going to, okay. Walk me through the detailed flows of this beautiful thing that you're describing of how does the doctor know to reach out to you, or how do you get that information from
[00:28:57] Sara Richards: the network in what kind of timeliness? What is the outreach that happens after that? Like you have to get so granular on these things. Otherwise, I think you're gonna end up putting something in place that does not net what you were expecting when you were doing the, you know, the call with the sales team.
[00:29:14] Kirk McConnell: Yeah. Speaking of the call with the sales team, you said a word, but you spoke positively about what other people think of as a dirty word, shared savings. Some people say shared savings. That's like, that's dirty money. That's like people taking my money. That's like a tax I have to pay. How do you think about the good version of shared savings without, I think the industry connotation sometimes, which is, man, that's just, they're finding ways to monetize everything that I do.
[00:29:42] Sara Richards: I guess the reason that I think about it positively is the shared savings, as I know it is based off of what I would pay for this under the standard plan. So literally the shared savings is, it is the money that I would have to pay for the same service under the traditional network versus the money that I'm paying for it.
[00:30:03] Sara Richards: Under this, you know, with this other vendor, it, it's only a positive thing because if these same services had been happening under the, the traditional plan, I would've been billed this other amount that I have no control over. I have no ability to say no because those are the negotiated rates. So my face, when you were saying that, I'm like, wait.
[00:30:22] Sara Richards: People think that's a dirty thing. I can understand what you mean though, where people are like, okay, you know, where are you? Like what game of walnuts are you playing where you're shuffling something around to net yourself savings? And I would say that there, there is a game of walnuts being played, but it is not being played at the employer side.
[00:30:38] Sara Richards: It is being played at the, whether it's the network side or whatnot. And this is true across the board. These are black boxes that we don't have visibility into. And. So therefore what I'm trying to do is I am trying to go, you know what, but let me do something where I do have visibility into it and I can compare it to what would've happened under the medical end that again.
[00:30:59] Sara Richards: I have no control over whether I'm willing to pay those amounts or not. 'cause those have already been agreed. So for me, shared savings, I guess in that respect, and again, this comes back to how are they calculating what those savings are. It's much easier when they can run an analysis of this is what you would've paid, this is what you did pay.
[00:31:17] Sara Richards: That's super clean. When you get into other things where they're like, well, we assume that people being present at work is worth X amount of money. Okay, now we're in. Philosophical discussions that will be a little bit harder to get my CFO on board with, but you know, I think there's something there too.
[00:31:32] Sara Richards: You just have to have the data for it.
[00:31:34] Kirk McConnell: And I think you actually hit that pretty articulately, which is shared savings can be okay if you can clearly show incremental value being delivered. I think you're saying you're fine sharing the upside as long as there's clear incremental value being delivered.
[00:31:47] Sara Richards: Absolutely, and I think for me then there's also something that I, it's, I put in a stop, a backstop to it as well where a, you know, always retain the right to audit. Any shared savings that they're estimating, right, where I can get my consultants or whoever in to be like, okay, but do we agree with this?
[00:32:02] Sara Richards: But, you know, if the savings does not equal the initial percent that they were sales-ing us with, then you know what? Then you're gonna gimme that additional money back because you sold me one thing, it delivered on something different. That's not my fault. And change your sales pitch to be more realistic or be willing to put your money where your mouth was.
[00:32:20] Sara Richards: If it doesn't deliver on the type of savings that you were saying it would.
[00:32:26] Kirk McConnell: Speaking of sales pitch, AI. AI is gonna solve everything.
[00:32:29] Sara Richards: It is.
[00:32:30] Kirk McConnell: What are you excited about with AI and benefits?
[00:32:33] Sara Richards: I'm excited about the fact that I think that AI is going to solve the problem of the fact that people don't read.
[00:32:40] Sara Richards: And what I mean by that is that the biggest frustration that, I would say most employers that I talk with have is that, you know, employees aren't self, like we give them all the information if they would just go out there and find it. But as a busy employee who has millions of hours of meetings is traveling all over the place, you don't, it doesn't even occur to you to go look for something.
[00:33:03] Sara Richards: And so I think that really where we're gonna see just a massive initial lift from AI. I think AI is gonna solve a bunch of other things as well, like the fraud, waste, and abuse and all that other stuff. It's gonna be amazing, but. At least to start with, I think it is gonna become this amazing tool where whether it's on your own intranet at your company, whether it's on the TPAs tool or whatever, instead of being like, I'm looking for a family therapy counselor.
[00:33:27] Sara Richards: When you think about the average lay person and the way that they talk and think about benefits, they are saying, Hey, I'm having trouble with my wife. And for the tool to then pull back, Hey, then here's all the stuff that's available to you. Or, Hey, I hurt my knee, right? As opposed to, I would like to find a musculoskeletal, physical therapy. No one knows these phrases, you know?
[00:33:48] Sara Richards: And so being able to translate and make it more like an assistant. Where all you do is you tell it what your problem is and then it tells you what your various options are. I think that is gonna be an amazing moment where it just becomes this, like in the same way that you text with friends, you're texting with, you know, whether it's depending on the tool, but like that's how you start using it.
[00:34:09] Sara Richards: Where you don't have to search for anything anymore. You just tell it what's going on and it'll figure out what benefits it needs to tell you about.
[00:34:17] Kirk McConnell: You know, as I think about all the things we've talked about, you bring such a sharp perspective to understanding contracts, being able to go outside the system, thinking about primary care, fraud, wasting, abuse, um, what coaching would you have for other benefit leaders who say, I wanna do something similar?
[00:34:36] Kirk McConnell: It just feels really hard. Where should they start?
[00:34:39] Sara Richards: Well, my, I don't know if I'm allowed to do this because this is totally a plug, but I, you know, for me, I think where all of this, I was able to start taking ideas from stuff I knew was an issue to actually talking with other employers that not only had recognized the same issues but had actually.
[00:34:58] Sara Richards: Solved it in some cases where I can now just take their playbook and I'm like, Hey, what contract language did you use? Okay, thanks. I'm gonna use that in mine is groups like Purchaser Business Group on Health, right? It, these are groups where it is groups for employers. It is not ones that are, you know, kind of done by consultants, where then you have to have sales pitches, but you're literally getting together with like-minded employers and you're solving it together.
[00:35:20] Sara Richards: Because to your point, if you are trying to do this and create this wheel on your own, completely overwhelming, none of us are like. Smart enough, myself included, to do that. But there are people that are super smart who have done it before, and so being able to share those learnings with other counterparts in that employer space.
[00:35:39] Sara Richards: So finding whatever that type of group is that applies to your sector, your type of company. That's one of the first places I would start because it's just. That mind share where you're able to connect with people across the country who have potentially tried things before, who can call out, tried this didn't actually work the way I thought it would.
[00:35:57] Sara Richards: Great. Tell me more about that. So I can avoid that same pitfall.
[00:36:00] Kirk McConnell: And I think that's one of the great things about the benefits community is very rarely do people want to keep their successes to themself as secrets. Yeah. 'cause I think if you make your peers better, the whole healthcare system gets stronger.
[00:36:11] Sara Richards: Exactly, and I think that's why it's so important for employers to be able to come together within groups where it is not funded by the point solutions where literally we're coming together and we're just talking amongst ourselves because that's where the learning gets done, is where we just have chances to showcase or talk about specific issues and talk about how each of us is thinking about it.
[00:36:37] Sara Richards: That's where the learnings really happen.
[00:36:41] Kirk McConnell: When you think about the future, we'll think at five, 10 years out, do you find yourself more optimistic about where things are going or more pessimistic?
[00:36:51] Sara Richards: I am gonna choose optimism because I refuse to go pessimistic because that's just, at that point it gets hard to get up.
[00:36:59] Sara Richards: But I think it's more, I think that optimism is coated with a layer of determination. I am optimistic for those who are willing and able to not stop fighting to change the status quo. I'm optimistic as long as you are willing to put in the work to not just keep going with things and to get ahead of trends and to look at the unconventional solutions.
[00:37:28] Sara Richards: I think that for people who are at that point where they're like, I just can't, I can't, I don't have the capacity. I can't look into this. I think those are gonna be the employers where they will then have the experience of whether it's those higher claims where, okay, now you suddenly are having to make your plan less and less rich.
[00:37:47] Sara Richards: 'cause it literally is not affordable. I'm optimistic for those who dare. And maybe that's, that's a good way of framing it up. Like, if you dare and you don't give up, then I am optimistic that we will be able to make this better. And that we as the employers have this ability to bring our buying power to truly impact change with a layer of pessimism of, and if you don't dare, then it's not gonna be a fun ride for you in the next five, six years.
[00:38:20] Kirk McConnell: Well, Sara, I think talking to people like you make me optimistic that these problems are solvable if you have the appetite to go solve them. So this has been a fantastic conversation. If people want to kinda learn from your wisdom or just be part of the conversation with you, how can people reach out to you to learn more?
[00:38:38] Sara Richards: Yeah, absolutely. I mean, feel free to just connect with me on LinkedIn. I would say, please give me a little, give me a note about why you're connecting with me, because I get a lot of salespeople that are connecting, which I don't usually accept those, but when you're benefits professionals, I'm always open to connecting you to the resources I've found.
[00:38:55] Sara Richards: Totally happy to talk more about any of that.
[00:38:58] Kirk McConnell: Well, Sara, thank you so much for not only the energy you put into solving these problems, but just joining me today and sharing this conversation.
[00:39:06] Sara Richards: Thanks for inviting me. This was so much fun.
[00:39:08] Producer: This podcast is brought to you by Collective Health, a health benefit solution that guides employees toward healthier lives and companies toward healthier bottom lines. Check us out at collectivehealth com.