12. Fixing Healthcare from the Outside In: A New Model for Cost & Care | David Huerta

Hey, Victor Cho here in this episode of the Victor Cho podcast. One key thing you're going to walk away with, actually it's two things crammed into one. I think you will get a deep appreciation for the complexity and the chaos and the intricacy of the healthcare system. Why healthcare costs are so high? I learned a ton from this wonderful guest, David Huerta. And maybe more importantly, you're going to learn that there are some really interesting new technology-based approaches that can help solve this. That'll be towards the end of the episode. So please stay tuned. Listen in. It's a great conversation. Also, you'll see below there is a QR code that will be up for several minutes. This is to do two things. One, to verify in case you're the first time to the show that I'm in fact a real human being. This is not some kind of AI-generated podcast. So this is the business that I run called Mobyd. So this is a verified human communication. If you scan that QR code, you will actually get the verification and bonus. You could even send me a message. Click for Paulie Delacquim. We can be in a protected and secure back and forth. So hope you enjoy the show. Hey guys, welcome to another episode and conversation on the Victor Choe Podcast. I am super excited to be chatting with David Huerta today. Mainly because he is a deep expert in something I have almost no knowledge of, which is the health care or many things I have no knowledge of. But in particular, health care, the health care system, health care technologies, he has been a veteran of this space for decades. He has founded three different companies in this space. He has won the Excellence Award for Health Risk Management from Berkeley. He's a speaker. But what I love most is he has a deep, a deep passion for helping to bring health care costs down. And so today we're going to have a conversation with him. I'm going to learn, you're going to learn why are costs so expensive? How does technology play a role in that? Is there anything that we can do? I think you're in for a treat. So David, such a pleasure having you on and can't wait to jump into this conversation. Well, thank you, Victor, for asking me to be a guest on your podcast. I look forward to shedding some light on this industry that is broken, but also on solutions that can be had both as some of your listeners or CFO CEOs, things that they can do for their company to reduce claim spend and things for people, your listeners. What they can access now that you're truly announcing to them. So I'm excited about this too. Thank you, Victor. No, no, no, such a treat. Let's just jump into it. You've been a founder, a co-founder, and more. I think you have so much insight into the underworkings of the beast and how this works and why there's so much cost. I know that's a deep topic, but let's just get started. What have you learned over these decades? Why are costs so high? Why is this thing broken? Well, that's a great question. It is really and truly deep. Being in the industry, like you mentioned, for over 30 years, got a lot of insights to a lot of people know there's issues out there. They know hospital costs are high. They know pharmacy drugs are expensive. They just don't understand what's going on behind the mechanics of it all. And so I would, it's almost a little scary to bring a lot of this out, Victor, because a lot of what we're about to discuss cannot be changed by the individual people. This is systematic. Okay. It's systemic. Yeah. And there can't be changed by the patients themselves or like any single person or it's it. It can't be changed by like a given hospital or a given entity. It's like a broader problem. It's a broad problem, but there are some things, Victor, that can be engaged, especially as employers, there's things that, you know, CFOs and CEOs can do for their company in regards to their medical plan. If they're self-insured, I'm talking specifically. They can do to make a lot of this change happen for reducing costs because that's what I did before I retired. You know, we created a healthcare delivery model to compete against the insurance companies and that was based on our model was based on transparency. The proper contracts for reimbursement, but more importantly on the people's side, it was important to Bob, my former business partner and still very good friend of mine. It was very important for us to design plans that were employee friendly for people to be able to get access to care when they need it regardless of the time of day and quickly timely. But no, there's a lot of systemic issues in here that I don't mind discussing and more than happy to bring to the table. Yeah. No, no, it would love, you know, maybe a high level picture of that dynamic because I think I understand it from our past chats. All right, yeah, you want to work on two of them. We'll talk about, Austin and pharmacy costs, okay? Yeah, yeah. It was talked about pharmacy first because that's easy. A lot of people go to the pharmacy and get their prescription at the doctor's order. But inside the contract on the pharmacy side, there's a deliverer or there's an administrator called the pharmacy benefit manager, a PBM for short. So all insurance companies, whether you're Blue Cross United, Sigma, and a Humana, a regional health plan, you're going to engage and folks, you can look on the back of your ID card, your insurance ID card, it'll say, you know, pharmacy benefit manager, express scripts, opt them, you know, there's, there's a number of them. But depending on the contract you have with the pharmacy benefit manager is going to, that's going to determine how, how, what you pay. And pharmacy benefit managers, just like most companies in the United States, you know, are driven to make a profit. And they develop inside of those contracts, Victor, lines of revenue that are scary. You know, give you a couple of quick examples. Inside a pharmacy benefit contract, the pharmacy benefit manager gets to decide when a generic is a generic. Yeah. So you're thinking, what do you mean? It's really? Yeah. Hey, your generic drug. Okay. Great. Well, no, according to these PBM contracts, you know, some of them will say if there's two or fewer or if there's three or fewer generic drugs in that category, we're going to, we're going to call it a name brand drug. Well, that's not fair to the people because the generic drug is a generic drug. But yet the PBM says, okay, I'm going to call it a name brand drug. Now here's the reasons why they're calling it a name brand drug and somebody signed off on that contract, typically an insurance company or if you're self-insured as a plant sponsor and folks, if again, if you're CFO, CEO and you're the fiduciary for your health plant, be careful what you're signing because a generic should be a generic because it's a lower co-payment for the member. But when a PBM says a generic is a name brand, a, there's a higher co-payment to the member. So instead of paying a $10 co-pay, you're going to pay a $40 or $50 co-payment. And b, the hidden part, PBMs give a lower discount purchase price for a name brand drug versus a generic drug. So the industry jargon is AWP, so average wholesale price. So for a generic drug, it's the price point for the plant is AWP minus, let's say for example, 65%. So big discount off a lower price. On a name brand side, Victor, it's AWP minus 20%. So they're giving up a lower discount, they're keeping more money. So that's just, is a generic a generic number two is these plans are written on the pharmacy side. Our plans were written if you were going to get a prescription, let's say you were prescribed a Moxasillin or Z-Pack. So you have a name brand co-pay of $30. So people would pay $30 for that drug and for that prescription. However, if the cost of the drug was $21, most contracts are written for the member to still pay their $30. Our program was written for the member to pay the lower of cost or the co-pay. So our members were paying $21. I have two, two, I mean many examples, but two come to mind where we, and again, I'm not a consultant anymore. I'm not, I'm an advocate for employers, okay? Very important and it's so fun to be speaking without the interest of getting business. But if people are looking for a reference, I'd be more than happy to guide them on that, but I'm an advocate. So, I had a group in Tampa, Florida. A member went to the CFO a week after being on this new contract and he says, "Steve, I can't believe it. I paid $7 for prescription. I used to pay $25 for it." It's the same drug. So again, these are the hidden things inside of it, Victor, that are bad. And even on rebate, okay? So then on that one, David, like the co-pay I assume is just a teeny tiny fresh, like someone's paying like hundreds or thousands of dollars for that somewhere, is that true? Oh, Victor, people are paying. you know it's it's it's and then And here's a big one, and I'd be a failure if I didn't mention this. So when a car dealership purchases a car, they buy it for $12,000 and they sell it for $13.5. So that $1,500 is the spread. They make the difference on it. So on the pharmacy world, these PBM contracts allow PBMs to increase the price that the member pays. It's called spread pricing and it's very, very, I don't want to say subtle because some of the spread pricing is huge. And this was identified, I believe it's a Forbes magazine article and I'll get you the information for you. But it was a hospital system somewhere USA, the CFO chose to do business with a PBM, okay, that his consultant recommended because they would have lower prices. And so they were spending $10, $12 million in pharmacy cost because it was a big hospital system. Well he looked at the report coming in a quarter later and his trend was increasing instead of decreasing. So he's like, you know what, I can look at this myself because my plan makes my employees go to the pharmacies within the hospital. So he took five employee or five claims and so here's what happened. So he knows and again, I'm illustrating, okay, Victor had a claim for a Moxasillin. So Victor, Victor, the claim came in from the PBM for Victor's claim at $35. $35, okay. However, he looked at the cost at the pharmacy, what the cost of the drug was and the cost of the drug was $19. So his plan paid $35. The cost of the pharmacy was $19. The pharmacy was paid $19. The PBM kept the difference. So spread pricing is allowable. I don't know what's the thing to cost. It's horrible. Victor is absolutely horrible. Yeah. Okay. And my understanding is there are some examples where doubling would be a good uplift. There are places maybe in the hospital system or where do you get the crazy, the truly insane uplift on costs? Because I know that's out there. I've heard stories about that. Is that in the hospital world? Yeah. That would make me mad when I hear about it. I'm like, this is like usurus pricing going on somewhere. I'll jump to the hospital after one more. Yeah. Thing because this is very important, especially for your listeners because they're bombarded with ads every night on specialty drugs. You know, you can't go anywhere in the United States without seeing a specialty drug add on TV. Now, watch this, Victor. The United States is the only or one of the only countries in the world that allows for specialty drug advertising on TV. How much do you think? When I was in the industry, I used to use this illustration all the time. If you're following your hockey team and you're taking a West Coast trip. So now we're in Seattle watching the Tampa Bay Lightning, what the Colorado Avalanche played, played the Seattle, got cracking. So we're over there and you see all these ads on TV for specialty drugs. And then our team goes over to Vancouver. We're sitting there watching TV up in Vancouver. No ads for specialty drugs. Specialty drugs are the highest cost impact right now on many health plans. Yes, there's the exotic hospital claims, but specialty drug costs and I'll give you one example. It illustrates a point I want to make. Yeah. So everybody's heard of Humera, right? Humera. That's it. That's all the time. Everybody needs Humera, right? All right. Humera is a specialty drug. Now the specialty pharmacy world is very unique. The manufacturers have to protect or need to protect the retail price of those drugs. So they don't discount the cost of specialty drugs. Instead, what they do is they'll go to DC or Congress and they'll say, we donate cash and product to all of these foundations so that people can afford our drug. Let's use Humera as an example. So they protect the retail price because they have to. It's a profit center. And so this good will for Mindy, for lack of a better word that's specialty to us. There's over 10,000 silos, 10,000 different silos of cash and product that are donated. This way they can sit in front of DC and say, this is what we're doing to solve the issue. Now access to that free product and cash is limited and very difficult to navigate. You have to engage a specialist in it, which is what we did at cost plus and encourage any self-funded plan to look into this is called patient assistance programs. And it's not the same as what you see advertised on TV because this is not advertised. So here's the cost of Humera. I did a recent AI search. What caused free Humera for one person for one year is north of $80,000, Victor, $80,000 for Humera for one person. That's 12 sticks because they're their their their pens. All right, so that's the reason we need all of them. That's the price that they're protecting. There's a who's charging that that is the drug company charging $80,000 for those 12 slugs. Yes. You're charging either the insurance company or if you're self-funded, they're charging the self-funded plan that. Okay, so so we could bankrupt companies that are self-insured if you have a bunch of these and all of these other new ones that you see advertising. Yeah. Victor, you've heard the term rebate, I assume, right? Yeah. You know, you buy a washer and you get a $250 rebate. Hey, that's great. The rebate that's returned because of the purchase of Humera is between $35,000 and $45,000. That's a big rebate. That rebate, if it go we'll go back to the pharmacy benefit manager, the the middle person involved. Sometimes that's partially shared with the plan sponsor or the insurance company. But when you think about it, why even overcharged to give back a rebate, the net cost, right? With that with that scale of a rebate, that means the actual cost of that drug is going to be tiny because like you're not going to give up all the profit, I mean that's half the profit margin. Sorry, that's half of the net margin. Yeah. It's suddenly going poof. So I have a you if you could throw up the slide or for sure. Yeah, we can present either. Humera has a retail cost of $85,000. The rebate is 55 to 65% of that for so the net cost should be 34,000ish. It makes a significant difference to to to plants, okay, especially, you know, to self-insured plants. I'm sorry if I get carried away on that. It's a hurtful pain point because this shouldn't be allowed. Yeah, yeah, yeah. That's insured. God, that's fascinating. What does have to happen there? Is it government legislation has to come in and set boundaries or how does that get rectified? Because if you've got a profit engine of that magnitude, like there's a lot of incentives for that business to continue to operate that. I appreciate that. Question. And I wasn't planning on going here, but in my past life as a consultant, as a disruptor to this industry, I had a slide, the top lobbies in the United States. You know, 10, 9, 8, 7, all the way up to number one, right? And it would go up, starting at the bottom, it would go up incrementally. And then when you go from number two to number one, it goes out exponentially. The number one lobby in the United States is the pharmaceutical lobby. And there's another platform put into that category. But four of the top 10 lobby sizes Victor are in the insurance and medical industry and pharmaceutical industry. It's going to take a significant change in DC if it was ever to happen to make this kind of stuff impact costs. The other thing too that we didn't talk about, and I think this is very important because a lot of people are not aware of this, Victor, you talked about increasing costs, right? And everybody thinks that healthcare reform was a good thing because it helped people get coverage. It had, and in many ways it was good because there was some subsidies attached to it for people to afford care, you know, offset some of the premiums, offset the ductables. Inside that legislation, there's a small provision that's not discussed publicly. It's called the medical loss ratio provision, MLR for short. There's understand this a little bit because it requires an insurance company, this MLR provision, Victor, allows an insurance company, gives permission to insurance companies to make money. It limits the amount of money that they could make for administration costs for groups under 100 lives. The maximum amount they're allowed to Kate for administration and other expenses is 20%. So they're trying to cap the profit margin for that segment in that group. And exactly, you nailed it, you nailed it for groups over 100. at 15%. And employers, some employers are seeing this magic, magical benefit because they get some money back at the end of the year. You know, if all claimed dollars weren't spent, the other remaining portion, if it's all not spent. And so what that does in essence is there's a, it's a perverse relationship. Now for the insurance company, the only way they can make more money is to control the cost of claims, which they don't want to do because they're in alignment with hospital systems, right? They're allowing hospital systems to do what they want to do. They're allowing pharmacy benefit managers, especially manufacturers do what they want to do. But so what they do because they don't want to reduce the cost of claims is they have to increase premium. So you're, so because in order to make more money, they have to charge more money. And so, so they're, they're, they're charging employers, unsustainable increases, double digit increases. You know, there was, there was a couple of cases I heard this year in the Tampa area, over 70% increases with no justification. All California increases were 45, 50%. So David, we talked about this the other day. I thought this was a great example of, I call these second order impacts, right? Second order impacts of technologies or laws, right? It systems are complex. Right. Let me play this out. Make sure I got this right because at least this is my understanding. It makes complete logical sense, which is if you give a system, in this case, that kind of that medical system of profit minimum, it also becomes a profit maximum. And so yes, maybe there were some areas where people reduce costs to get below the minimum, but there were a whole bunch of other areas where people were like, Oh, I'm not making that much. Right. I want to go make more. And I'm just, and the only way they can do that because of this complexity is they have to raise prices. Is that was that a? So it has this horrible secondary effect of it actually. Right. I don't know what happens on that, but yeah, it's got this people like, Oh, great. There's a new goal for it. If you give a business a number, they strive to the number. So it's like, right. Right. That's the number I can go hit. Now is that accurate? Is that a? Well, and technology is good in many ways, okay? Because technology improves efficiencies, which in essence should reduce cost. But, but because there is no, there are no rules or regulations for a hospital, for instance, to limit the amount they can upcharge, you know, even though technology is coming in, yeah, there's a cost basis to technology. But they're going to significantly increase the cost for whatever the technology is that they're engaging. Yeah. It's a challenge. If you'd like, I'm more than happy to give you an example of how hospitals upcharge and what in how I think literally I just had a friend. I just had a friend who went to the hospital for it was an ER. While there was no, I know we talked about this. There's no place to go. They shouldn't have gone to the ER, but they did. Right. And I think their bill was 20 or $30,000. They ended up paying like three thought, but it was, it was, it was not a serious thing. I was like, holy cow, so that, yeah, my thought was like, that's insane that this cost was associated with this. Yeah. One time, Bob in into the ER that was actually not an ER. Yeah. But, you know, hospitals, hospitals are not the enemy because they provide care that people need. They provide a place for surgeries. They provide the people and the professional services that are needed to overcome issues. Okay. But what the enemy is, Victor, it's the way bills are generated and the markup set there are. Now, yes, facilities have to offset a lot of costs that there are a lot of charges that they're not getting reimbursed for because there's people that will walk into the emergency room without insurance. And hospitals, emergency rooms are required to cover people. And, you know, even if they have, whether they have insurance or not. So there's, there's a lot of cost being absorbed by hospitals. Yeah. But, but when you look at the people, what is it fair to pass these on to insurance companies, is it fair to pass on to self-insured plans? There has to be a limit to markup. And I'll go over some things with you in a second. I just learned this two days ago. The message I used to bring to the country, you know, there's an updated slide that was mind-blowing. But the slide you're looking at now, okay, on the screen, it's something that people do not know is done. Okay. When a hospital accepts one dollar of reimbursement for Medicare patient for Medicaid patient or military type care patient, anything from the government. Okay. The overseeing entity within the government is called the Centers for Medicare and Medicaid Services. I'm going to shorten it CMS. Okay. So with the hospital accepts one dollar reimbursement from CMS, they are required by CMS to file a certified cost for each line item that they would bill for. This is a transparency. Bring transparency into the process. And, and, and, I'm not, let's have fun with this. Why does, why does CMS ask for that, Victor? Yeah. I'm assuming to root out hidden costs, hidden illegitimate costs that people are trying to cram in. Well, no, that would be an audit. That would be an audit. Okay. All right. You know, so, so the reason why Medicare asks for this is because they know retail charges are absorbed and unreal. Okay. There. And, and so they, they want to get the cost of a hospital and make a fair and reasonable reimbursement. The hospital should be profitable this much, not, you know, from ceiling to floor. And so if, if you're going to receive money from CMS, they're going to pay you a fair and reasonable profit. All right. So, so the cost to charge ratio is filed every year. And it's certified by the chief financial person within that hospital. So these are certified costs. What you're looking at at the screen is an excerpt from one. It's a hospital in the Tampa Bay area. I lived in Tampa 30 years. I know that market very well. But this is the CMS filing that they did. And so there's there's let's want to go over the categories quickly. So the operating room line line number one, as we go to the right, it shows square foot 40,000 square foot. Why is that important for the next for one of the categories? So if the hospital was a million square foot and the operating room is 40,000 square foot, that's 4% of total square feet, correct? So global charges attached to the hospital, you know, electricity, water, other services that's given over to the operating room by the percentage of square foot. All right. So operating room square foot, 40,000 dollar of 40,000 square foot, the salaries attached to the operating room, nurses, other other salary expenses, the global charges that come back to the operating room is $23 million. So you have your total cost over here of approximately $30 million dollars. That's your cost associated with the operating room. Go to the next two categories in patient bill, in patient charges and outpatient charges. Inpatient charges for hospital, I'm if for inpatient was 213 million outpatient for operating room was 109 million. So now you have your total charges associated with the operating room, which is what $222,000, right? No, $322,000. All right. So now you look at what the cost is versus what the charges are. In the far right hand column, the cost to the hospital for every dollar charged is 7.2 cents. All right. 7.5. 15,500 percent. It's horrible. Let's slide your eyes down for a little bit. Anisee theology. I love Anisee's eologists. They're there to protect you, right? But in the hospital in that area, you know, cost basis is two cents. If you look at CT scans, here's the technology part. I wanted to bring to the table. I'm just got a CT scan. So yeah, super interested in this. Oh, yeah. So people, the cost basis for every dollar charge on CT Victor is less than a penny, less than a penny for every dollar charge. It's just crazy. And this is allowable. There's no rules or regulations against how it can upcharge. Hey, somebody would. Yeah, I had a reasonably close relative. We're having this discussion on cost. And this makes a ton of sense now because we were having this discussion on why our healthcare costs so high. And he said, you know, one of the biggest issues is all of these technologies that we've built that are one, they're positive, right? They're delivering good value. But at the same time, he's like our incentive as doctors. And he didn't say the financial. He just said our incentive. So maybe he was referring to the financial, but he's like, we overuse these tools when we don't have to. And now that makes a ton of sense because is this accurate? Like if it's no skin off of a doctor's back to say, like, hey, you need a CT scan, that becomes a large profit generator for the hospital. And it might be useful, right? I think his point was like, look, maybe that was like a 10% chance you needed it. Like, it's called, the downside in me as a doctor, right? Telling you go get a CT scan, there's only positive upside from all dimensions. Is that kind of some of the dynamic, which is you've got these weird profit pools within the hospital that are doing good, right? They do perform a good service, but. Victor, I can't comment on the mentality of a hospital. You know, it's just, you know, defensive medicine is practiced. Yeah, yeah, yeah. All of those charges accrue, you know, medical malpractice insurance for these providers continue to skyrocket as well. It's a litigious society. So they have to, I mean, it's just, it's just, it's, I'll, yeah, he mentioned those things. Let's do it. Yeah, I love that term, that defensive, like in his mind, he almost needed to do those things for some of those reasons he mentioned, yeah. Right, exactly, exactly. So, so I want to share with your audience, Victor, because this is very eye opening, very eye opening to the fake discounts that are out there to the fake charges that are out there. So what, what this next slide illustrates, these are, these are four hospitals in the Tampa Bay area. And they're within, they're within 15 miles of each other, okay? And so this is for CT scan. And you can see the retail charge for CT scan back when I was consulting. So this slide might be four, five years old. You know, one hospital with charge $6,300 for CT scan, $8,300 in $10,000. Why, why the Delta? Why such a big difference? Well, because the one hospital can charge more, right? There's, they can. And, and, and then so, so these insurance carriers go out and negotiate discounts. And everybody, you know, looking for a big discount. And discounts that carriers negotiate, Victor, very by state. I mean, hospital discounts in hospital are going to be significantly higher than what they might be in, in Iowa or North Dakota. Okay. And it's just, it varies by state. So in hospital, it was about a 50% discount. So you could see what carriers now are doing re, you know, this is what insurance carriers are negotiating for network discounts. Yeah. And everybody's happy. I got 50% off. This next slide is going to show you two statistics backed up to it. What their cost is and what CMS determined was a fair and reasonable profit. So if you look at the self reported cost, it ranges from $140, I'm sorry from, yeah, $140 down to $124. Much closer in Delta, right? Much closer. That makes sense. It's coming from the same place, probably, right? Right. And the reason why it's at $124 is because that particular hospital has significantly more volume. So, so they're, they're using business, you know, negotiation, which is fine. But look at what Medicare reimbursed. Medicare understands what the cost basis is on a CT scan. And they say, we're going to pay you a fair and reasonable profit. And so, so the disparity between what insurance companies are allowing versus what cost is and Medicare is paying significantly different, significant opportunity to reduce the cost of premiums, if insurance companies or self insured plans would use these metrics as a basis of reimbursement. You know, what Bob and I did with Cost Plus is we use these two metrics as a basis of reimbursement. It's called reference-based pricing. It's, it's, it was a game changer in the industry. You reimburse the hospital, the greater of their cost plus a reasonable profit, which was 12% at the time, or Medicare plus 20%. And typically it was Medicare plus 20%. Medicare, right? So Victor, there's, there's things that can be changed by, by some entities, like self insured plans. But most of us out there, most, most of your listeners who are, you know, listening as individuals, this can't be changed. It's systemic, it's systemic, okay? But it is, but it does connect, it's a good segue into this, kind of maybe the last question we can touch on, which is I do know there are this idea of cost plus providers or new, new entities, whether it's Amazon or, you know, Mark Cuban's business or the business that you're working in now or, or assisting, right? That are kind of, I almost feel like they're, they're building this like, in some ways, outside the healthcare system value layer that can be much more efficient. Can you talk a little bit about those? Absolutely, well. And kind of what's happening there. Because that, that almost feels like something that an individual can make a decision on. I'm like, hey, I'm gonna use one of these things. And if enough people did that, it might actually create a systemic change. Well, I agree with you on all comments, okay? Mark Cuban's very smart and proven businessman, you know, his methodology is fantastic. The challenge for people would be to be able to engage that and have your insurance company pay for it. Okay, that's where that comes in. But Mark Kudos to Mark in his vision, that's incredible. I think you were referring to Amazon as out there advertising now. You know, put your whole family for $5 a week, have access to care. That's totally, totally different than that. It's a different thing. So what I'd like to do if you don't mind is topic or have a discussion on telemedicine, which is a solution. So telemedicine came around back in the 80s and Teladoc was the, they developed that model which was great. Okay, however, telemedicine Victor is becoming, basically a check box for insurance carriers. It's, they have to offer telemedicine because it's new and improved and it's good for employees. And you have a high deductible plan. The IRS finally said, you know, you can have a zero copay on telemedicine before you meet your high deductible plan. You know, it was a qualifying thing. You used to have to meet your deductible for telemedicine services. Not anymore. Thank goodness they got smart up there. But, you know, telemedicine's become a check box like I mentioned, you know, for carriers to offer and insurance agents will highlight this. Oh, you carry your has this. XYZ, carry your has that. It's a commodity, Victor. Okay. It's a commodity. It's transactional. People are going to use it. They have to go through a plethora of questions to finally get diagnosed. There's a lot of things about it. But what I realized after coming out of retirement or after retiring, Sarah Grimberg, my co-founder, other co-founder, it was like, you know what? People need access to care, Victor. You know, they're being overcharged. We understand the broken healthcare system. Premiums continue to rise while a quality of benefits continue to decrease. Employers are coached by their agents to absorb a smaller part of this double digit increase and pass it on to employees with higher payroll deductions. Well, poor employees are out there saying, oh my God, I got a huge deductible. I got higher co-payments. I got higher payroll deductions. I can't afford this anymore. What am I going to do? And then they end up being confused. So telemedicine is not the same as virtual care. All right, virtual care is something that we're very passionate about that we're bringing to the market if you don't mind going in that. Oh, yeah. Yeah, please. Please share a little bit about it. We're going to have to do it. Then the two drivers that people need, this is what it's a simple solution, Victor. They need access to care timely and affordably. You know, they're afraid to go and use the healthcare plan because they don't know, you know, there's so many rules inside of it by carriers. You know, sometimes these plans are written not to pay claims. You know, that's true on the disability side for long-term disability. You have to be very careful of the contract you buy. But we wanted to simplify it. We wanted to bring a solution to everyday people that said, you know what, if you get a subscription to this virtual medical practice that's staffed by lied people, there's three medical practices in here. You're going to be able to get care within 20 minutes of reaching out. It's a $0 co-payment affordable. And there's no rules or confusion. Oh, go figure, right? Let's make care accessible. So that's what we're doing at whole-person virtual care. I love the model. And going back to our conversation is there's a whole slew of things that don't need to go to this massively complex hospital care system. And if we can blow them into a business like yours or a network like yours, one, you get better care. You get predictable dollars. It'll take-- I think that'll be a cost-pressure that changes the system over time, potentially, right? Because you'll no longer have that perverse incentive of let's get all these people flowing through an ER and charging up $10,000. You know. Victor, that's what our goal is to give everybody access to the care they need and deserve, right? Because going back to an earlier conversation that we were having, I have a lot of friends who are our doctors. In fact, I think it's important historically to go over how this virtual-- we're not a virtual medical practice. No. Whole-person virtual care is an administrator. We have a national marketing agreement with this virtual practice, right? We do not provide medical advice or diagnosis, right? That's not us. My purpose, Sarah's purpose, Chris's purpose, our purpose is to get the word out to what's available, and you can access it through a whole-person virtual care. But this medical practice, this virtual practice, Victor, very important distinction. In 2013, two ER providers, I'm going to name first names Keith and Mike. They worked together in the emergency room for over 12 years together. And they realized that people were going to the emergency room for perceived emergencies. There's a gunshot wound under curtain one, there's a heart attack under curtain two, and then David walks in with pink eye because my eyes crusty and the curtain three. And I want to get treated now, and I don't want to wait three days or four days or week from my primary care doctor. So Keith and Mike set back and said, you know what? We have to do something for the people. Let's create a virtual urgent and urgent and acute care practice that has a following model. Number one, we want it easy to access. We don't want people confused. So right now it's app paced, it's going to browser based, coming July, July ish. So easy to access 24/7 weekends. They want people to have access to care anytime, any day, regardless of location in the United States of America. So I live in Colorado. I went to Detroit to visit, Sarah and I went up there to visit my stepson, guy next door's blowing, mowing his yard. My asthma flared up. I didn't have my asthma spraying. So I use this to get a refill. So Keith and Mike, let's keep it simple. Let's keep it affordable, zero dollar co-pay all of the time. And there's no limits to visits. There's no rules to access, right? It sits above any insurance plan if a person is covered by insurance. And if they don't have insurance, at least it's access to professional services. So they said, and most important part, Victor was the training of these physicians were high level. And they said, well, they're trained providers and staff teams. So accessing this type of virtual medical practice on the urgent acute side has-- I love it. I mean, is this the right metaphor? You basically have a 24/7 group of doctors and folks who can actually prescribe to handle the, I don't know, that 90% of health issues that really don't require an ER visit. It would be a waste of money, and it would actually be way too long. And that's kind of at your fingertips now. Using technology, because it's all online base. It's all this. Using technology, exactly. No, no, I mean, it wouldn't be possible without the internet, right? Without ubiquitous connectivity. No, no, I love the model. We'll be sure to get links on this so we can put that in the bottom of the notes so people can go check that out. And we'll also love your contact info, David. If anybody has questions or would love to reach out, please feel free to contact David. I'll ask you a question, because I know we're running light on time one is-- actually, I typically ask people how they stay up to speed on just the technology wave that's happening, but I want to morph mine for you because there's so much health change happening. Like, at every layer of the system, how do you stay abreast of the changes in that industry? It's got to be so massive or does it move slow enough when you're like, "I can stay abreast of the changes." Like, how do you keep on top of an industry that complex? Well, you surround yourself with smart people, right? Right answer. My focus, Victor, in the past, it was about the different components of healthcare spend. It was hospital, pharmacy, what we talked about today. And I have that knowledge embedded. It was my niche. It was my expertise. That will never go away. I'll get updates every now and then, like, the update I got yesterday on the average mark up by state. But my focus right now is strictly to get the message out to people, to individuals, to companies, employers out there, that you can supplement whatever plan you're on with access to a virtual medical clinic. I use the term "conceeers medical practice" Victor, because it's not only as urgent and acute care, right? But there's also virtual primary care. That's the end thing right now in the industry, virtual primary care EC, right? So for primary. And for primary. I love that. I can remember that. You're initials, you know what? I'll make a t-shirt for you. And then the third practice that's included with the conceeer subscription, Victor, is access to mental health care for talk counseling, right? It's not incredible. It's not the intense PTSD or autism, right? But for people that just need to talk, you go through with divorce. There's explosions in your head. You're a stay-at-home mom. You have a three-year-old and an infant. You know, what am I going through? I need to talk therapy type stuff. And so that's my message these days, Victor. So focused on getting word out that there is. If you can change your thinking about health insurance, we're not insurance. But if you change your thinking and buy insurance for, you know, for what you need it for, you know, a hot big hospital stay is exotic, like that. Supplement your coverage with something so simple as this. Yeah, let's get the word out, Victor. I appreciate you having me part of your show. No, no, no, no. If it's been such a pleasure, I learned a ton. I have a new appreciation for the complexity of the system, which is non-tribial. Final question for you. What outside of your world? What inspired you recently? A show, a book, anything that you recommend to the audience of, you know, this has left an imprint on me. You know? I love questions like that that come out of the ear, you know? What has inspired me recently? What's inspired me recently is compassion. You know, it's a very personal thing for me. Meeting the right person for myself, waiting life to understand what true love is about. And then when you're on the same page, right, with heart and soul, the changes you could make for people, the changes that you could, when you're aligned, right? And you have that same purpose. It's amazing the energy you inspire each other with. I love what I love about your last two, both of your last answers were about connection. Right, they're about people, which of course is my, you know, my whole ethos, all the businesses I run, Eva, I'm a Moved Now, right, is all about bringing people together to have actually like trusted communication in this crazy world of A. So I love the fact there was people dimensions to both of those answers, David. And again, I wanted to thank you so much for your time and you're super busy, but every hour has been a treat. So thank you so much for being willing to come on and have a conversation. Well, thank you, Victor, I appreciate the opportunity and the developing friendship we have. Thanks, David. In addition to running this podcast, I'm also the CEO of the Moved. In business today, it's impossible for anyone to tell what digital communication is real versus AI generated or modified. This is a huge issue that we have actually solved in the Moved. The Moved is the only guaranteed authentic asynchronous communication platform that has been built for business. If your business relies upon relationship and trust building, this is a must have platform for you and your teams. Please check out imovid.com at emovid.com or even better if you can see it, scan the QR code and you'll get to see the product in action and even get a special podcast offer. Thank you again for listening.