The Hidden Cost Leak in Home Health — And How to Fix It | Max McMullen

“A deep dive into workforce health systems, payroll inefficiencies, and the overlooked financial leaks impacting home health agencies.”

What if the real issue driving rising healthcare costs… isn’t cost at all?

What if it’s a system most leaders have never been shown how to see?

In this episode of TalkStory Media, we sit down with Max McMullen—Managing Partner, Patriot Preventive Care, LLC ... whose career has been defined by building and scaling workforce benefit systems across city, state, and county governments, as well as major school districts.

Max isn’t just a founder. He’s a systems operator.

From training and leading hundreds of agents nationwide to redesigning enrollment infrastructures during one of the most disruptive periods in modern healthcare, his work has consistently centered on one principle: alignment between employer strategy and workforce reality.

During the pandemic, while most organizations struggled to adapt, Max engineered a transition from traditional face-to-face enrollment into a fully operational call center model—earning trust, maintaining continuity, and laying the foundation for what would become Patriot Preventive Care.

A platform not built to sell benefits—
 but to correct the system behind them.

In this conversation, we explore:
 • Why most healthcare organizations misdiagnose their cost challenges
 • The hidden inefficiencies inside payroll and workforce structures
 • How workforce health directly impacts retention, utilization, and financial stability
 • The shift from “benefits” to infrastructure—and why it matters now more than ever

This episode honors not just Max’s experience—but the discipline behind it.

Because the leaders who understand the system…
 are the ones who ultimately reshape it.

If you’re leading a home health, hospice, or caregiver organization, this conversation may change how you see your entire operation.

📅 Schedule a Workforce Health Strategy Session:
 https://calendly.com/kaizengroup

William Peetoom, Commissioner - Executive Producer & Host: Business Dev. Advocate - A Modern-Day Urban Robinhood | Blue Zone Living Benefits Insurance - Broker/Agent, Licensed Life & Health Insurance Professional | CA License #4347307
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TalkStory Media Presents our Business Edition Podcast is an intimate interview setting with leaders of our shared global business communities, offering best practices and hacks to achieve success. Inspire, Empower & Impact is our mission with a Vision to uptick the world we contribute to.

Together, share and simplify the latest research and best practices from award-winning business owners, entrepreneurs, and professionals to educate and empower you on how to make money, save money, and compound the interest of earned revenue to thrive happier, healthier, and improve your business practices for greater efficient impact. The end result is that you understand alternative pathways to roads less traveled to success that the daring duo share on the show.

Together with ignite San Diego, sparked by the Better Business Bureau (BBB), we resolve the challenges and obstacles of growing a successful business to be victorious in a new era of inno...

Transcript

SPEAKER_00 0:03

Trends, current affairs, and pathways to success. On the Talk Story Business Edition podcast. On this podcast, Austin Pedney, an award-winning mortgage real estate group, and William P2, a modern-day urban robinhood. Share and simplify the latest research and best practices from award-winning business owners to entrepreneurs and professionals. Educate and empower you on how to make money, save money, and come on the interest of urban revenue. I'm happier and healthier. Improve your business practices with greater efficient impact. The end result is to let you understand pathways to road travel to success. The daring devotion on the show. Together with Ignite San Diego, sparked by the BBB, we resolve the challenges and obstacles of growing a successful business to be victorious in a new era of innovation. This production is supported by the Better Business Bureau, Kaisen Group International.

SPEAKER_01 1:08

Welcome to Talk Story Media Business Edition. I'm William P. Toomb, your host. I want to welcome you to another impactful episode of Talk Story Media, the podcast where we bring you closer to solutions and the best practices that drive the success of small businesses worldwide. In each episode, we dive into the real challenges business owners face and explore how discipline strategy, expert guidance, and thoughtful financial structures help navigate those challenges effectively. Our mission is to inspire, empower, and impact those conversations that provide practical insight, real stories, and meaningful industry perspective. For those new to the show, I'm often described as a modern-day urban Robin Hood and small business advocate. My work centers on protecting margins, strengthening workforce resilience, and helping entrepreneurs build systems that support both people and profitability. Let me begin with a question for every business owner listening. If your health insurance plan hasn't changed, why do your premiums keep rising? Most assume it's inflation, carrier pricing, regulation. But what if the real driver is close to home? Healthcare costs is not just a policy issue, it's a behavior issue. Utilization patterns, emergency room misuse, chronic condition progression, engagement gaps. When those variables compound quietly inside your workforce, renewals don't just increase. They destabilize your margins. If claims are behavior driven, then stability must be engagement driven. Let's unpack that. Joining us today is Max McMillan, managing partner of Patriot Preventive Care. Max has built high-performance enrollment systems across government and school markets nationwide. And now it leads a federally compliant wellness and integrated medical model focused on improving employee engagement while helping employers stabilize healthcare cost structures. Max, welcome to Talk Story. Thank you, William. It's a pleasure to be here. Pleasure to have you. So we're talking about renewals. So why do renewals increase even when the plan hasn't changed?

SPEAKER_02 4:00

That's a great question. And it's so frustrating to employers to see so much of their hard-earned money go out the door to increases year after year. I once had a carpet distributor tell me he didn't start this company so he could give all of his profit to Blue Cross from Shield. And that was 15 years ago. Just imagine how he feels today. We've all seen big increases since then. And primarily it's the utilization.

SPEAKER_01 4:34

So what we're seeing is the premiums reflect utilization patterns, not just carrier pricing. That is correct. Yes.

SPEAKER_02 4:43

Something very, very unique happened in 2015 when the Affordable Care Act mandated that health insurers accept everyone. I was in a meeting with the state insurance commissioner, and he said, before we get to the health insurance subject, let's talk about what just happened on a federal level for car insurance. He said, the feds just housed a new law that allows you to get in a car wreck, go across the street to the insurance guy, state farm, all state. They they have to accept your application and they have to cover that wreck that just happened. And we're like, no, how can that be true? He said, I'm just kidding. But that's what the ACA did to the health insurance market. Oh crazy. So you met someone coming in that has never paid insurance premiums their entire life, and they just had a car wreck, and now you you have to accept that application. The insurer has to cover that car wreck that just happened. Yeah, but that's what happened to the insurance industry. And they have done their best on trying to cost contain and bring premiums within line, but it's now up to the consumer. Health insurance is now a consumer product, and that's what they mean. You have to be educated on how you use your health insurance to keep that claim down. And that's what we do. We help with our partners. We do cost containment because we don't want people to be unhealthy and go without coverage, but we want you to use your coverage in the proper way. Sure.

SPEAKER_01 6:31

Now, in our previous conversation, you had talked about an increase case of 42%. Could you share with the audience what you saw in that claims data reveal?

SPEAKER_02 6:44

Yes, this goes back several years ago, about 10 years ago, a an employer, a defense contractor in Salt Lake City, Utah, got a 42% increase. Now, I don't know if you know anything about defense contracting, but you just can't go out and increase the sale of your widgets to make up that difference. You're under contract. So you have to deliver those widgets at the price you promised. So that was going to put the company out of business. So this went to the insurer and begged and pleaded, and they did a little something for them, but it just wasn't enough. And they had to redesign and increase the co-payments and deductibles, putting the cost sharing more on the employee than ever before. He was so afraid that he was going to lose his staff because he kind of prided themselves on having great health insurance. And in that area, it's a very competitive marketplace, and especially in the defense contracting industry, the specific type of skill sets that are needed. So his spouse, who happened to be an RN, looked at it and said, Well, let's take a look at your claims. And they found that the employees were using the ER as a place for snipples and colds and earache and pink eye. And that's not the place to go. You should use some type of other lower cost service. And through the out the next year, the wife and her came in and re-educated the staff. And they went from $31 million a year in just 24 months down to $3 million a year and same people, same group, just re-allocating the way that they use their health insurance, how they bought their RX and their meds, and went through some behavioral coaching and understood that you're not going to die if it's a hangnail. You don't need to go to the ER. It's a heck of a good story. And now that company does the thing for others, and we've partnered with them, and they come in and do the cost containment. And then we come in and help avoid the illnesses altogether with holistic two, the systematic use of their health insurance as it relates to where they are today in their life. Because every time we start a new case with a new company, there's going to be differences between all the individuals. And you just can't have one system that works for everybody. You've got to be flexible. And that's what our coaches do. They communicate, they create personal relationships. And we convince that the employer that the health of your people will become eventually the health of your company. And you can go the old-fashioned.

SPEAKER_01 9:34

So where does payroll tax efficiently fit without turning this into a tax strategy discussion?

SPEAKER_02 9:43

Well, I think with dealing with any employee benefit program, there are plans available that are perfectly designed for a tax advantage situation. When you look at the ways that the you've got federal government has helped employees over the years, dating back to 1979 with the Tax Relief Act, their employees were given an opportunity to purchase certain benefits and regular expenses on a pre-tax basis. And therein lies one of the major questions that an employer has is which is how do I attract and retain employees without spending a lot of money? In fact, this program doesn't cost a lot of money to set up. In fact, most providers will pay for the fees to build your plan documents so that they can market the benefits that the employees want and need. You might be thinking of things like cancer plans or accident or hospital plans that help employees get through tough times when they've been sick or hurt. And but one of the most common ones is daycare. Daycare can be pre-taxed from an employee's check and save the employee hundreds of dollars in taxes, and the employer saves money on the matching FICA. Oh, William, we could talk all day about the different ways that you could set up tax strategies for employers. But the bottom line is they're available and with just a little bit of research and a good advisor that understands that his fiduciary responsibility is to you, the employer, to help attract and retain good quality employees. It can be done.

SPEAKER_01 11:40

Yeah. So the you've talked about the structure and the technical aspects of it, but let's let's reel it in. Say I'm a home health hospice agency with 150 mobile nurses and caregivers. Could you illustrate from inception to hitting that green light, making it all possible and go? What is the business owner's responsibilities for compliance purposes? And what is it will it disrupt the workflow that's currently going on? Because these healthcare agencies here in San Diego are busting at the seams. So anything new can kind of offset where they are. Does this work congruently with the association or organization so that they can meet the qualifications and eligibility and reap the benefits without having to reallocate resources?

SPEAKER_02 12:45

Oh, yes, of course. These programs are managed primarily by the payroll clerk, and it takes her about an extra three to five minutes, literally, each payroll, to make sure that the program is running smoothly. Now, setup might take an extra couple hours out of her day, but the programs have to be in it very easy to run. Otherwise, the busy HR person wouldn't be willing to add them. They're already overworked and underpaid. If you don't believe me, just ask the HR person. They'll tell you. They just got way too much to do. And that's one of the things about our program that people like is that it doesn't take much time to implement. And the implementation, emails, and education, it's all done automatically for them through the wellness vendor. It's incumbent upon the wellness vendor to build that first relationship with each and every employee and get them to open up and share things and build that trust between them and their coach so that they get the most out of the program that's available. It's APO compliant. They'll get a global report at the end of the first year, at the beginning of the year, so that they have a benchmark to look at. And then the first 12 months, this is where we're going. We might see that at the beginning of the session, there were nine people out of the 150 that were of severe risk for congestive heart failure. And at the end of the year, that's dropped down to only two people. And we now have avoided other diseases and chronic illnesses that are mentionable, such as gout and diabetes and high blood pressure. These are things that most of us walk around with. Did you know that the first heart attack in America didn't happen until 1912? What? Now 600,000 Americans every year have heart disease. So it's a lifestyle. We need to, and that's what our identifying those risks before they become a problem. So if we can save just one congestive heart failure patient from making a claim, then we just saved over a quarter of a million dollars on that health plan. Whether you're fully insured or self-insured, that's a number. It helped reduce the rate at which your health insurance is increasing every year.

SPEAKER_01 15:25

Yeah, and it's not coming down. So, Max, this is this is such an amazing turnkey system that you've shared with us. But I have to admit, it it sounded too good to be true when you first told me about it, and it still sounds too good to be true. So, where did this all come from? And how come we haven't heard of it? And why didn't my CPA or my HR department tell me about this? Well, they're not employee benefit brokers, uh, number one.

SPEAKER_02 15:52

And number two, they're so busy keeping up with you know, health and human resources and department of labor and audits and oceans bringing it down to you know the safety meetings. There are so many things that HR has to do just to maintain, keep their head above you know above water, and then recruiting and and training, that's all in their department. So as a business is expanding, or you know, struggling to survive, and it they're they're so busy and swamped, they don't have time to go and dig into the ACA in section 2705 that was passed 15 years ago and realize, oh my gosh, this is the first time the Congress of the U.S. lawmakers ever put into law that employers could put people into a wellness program and pay them cash, real dollars, to as an incentive to be in that wellness program. Now, why would the Congress of the U.S. make a law saying that we can put employees in a wellness program? You think it was because they know that we're not in good shape and that we probably couldn't build an army if we needed to? We're not in good shape. We have got to do a better job of taking care of ourselves. So that's one, of course. It's a security reason, a financial reason, because too many of us are going out early in our careers on Social Security disability, and we end up on Medicare way before our time. So, yeah, absolutely. Congress passed into law so that we could incentivize employees to be in a wellness plan. But most employers don't have the wherewithal to write checks for $50, $60, $100 for doing some kind of wellness activity. So it just didn't, it kind of fell on deaf ears until the creativeness of our insurance industry came up with a way for an everyday hospitalization type plan to have a premium and then have that wellness reimbursement come out of that policy. There's other plans that are self-insured plans that have a premium that have a wellness reward that pay the employee out of that premium. And that made the business of health and wellness grow rapidly across the country. And now there are hundreds of distributors that are marketing these wellness plans and plans that actually provide medical care. Now, I know there might be some out there that aren't providing medical care, and they might want to be cautious of those. But if you're dealing with a company that is actually providing medical care and CPT-coded advice and medical advancements that will mitigate and reduce the onset of disease, then you are dealing with a company that is legitimate and compliant and will bring you your employees' benefits at no net cost and provide the employees with an increase in take-home pay. These are things that have been truly tested and are weathering the storms. And now we have some major brands, U.S. companies across the country that are implementing these at a rapid pace. And if you haven't learned about it, set a meeting with your local advisor and take a look at implementing a health and wellness plan for you and your company.

SPEAKER_01 19:37

That is some great information, Max. So what I hear you saying is this is a federally backed IRS-approved program at a no net cost to the employer or the employee. Exactly. Oh my God. And so how compliant is this? So here in California, we have a minimal essential care component, the MEC program and the ACA, we got to be compliant with. How does this fit in?

SPEAKER_02 20:06

Your plans out there in California are very stringent. And I love the way that California protected the average consumer and ensuring that they have the medical care that they need. And minimal essential coverage is just that. It's minimal essential coverage. It's typically not going to take care of a broken leg or your cancer, God forbid. But it does provide you with abilities to see a doctor, have all the preventive care taken care of, including a $5,000 colonoscopy, your mammogram pap's mirror, all of those preventive disease events that are free of charge and no co-payment, no deductible to each and every American. You pay a small monthly fee, and that minimal essential coverage will be there for those luggage how that can happen.

SPEAKER_01 21:15

We have a shortage of them, but to help retain them and to invest in their workforce, this is game-changing. So tell us what's the workflow? How easy is it to get it get started? What are the what are the steps and and what can someone do today for a better tomorrow?

SPEAKER_02 21:36

Well, yeah, it it does just starts with the data. Data drives the census, the census drives the savings and who is eligible, and then implementation along with the education to the employees of how to use the plan, where to log in, how to create their account. And it even comes with IDTAP. So we want them to activate that just as soon as they get their account. And it Does also monitor their title on their home. Even if they've inherited a home or they have a second home, those will all be covered as well. So it all begins with that initial sentence. Will help us determine who might be eligible in the plan and who won't be. And eligibility to us means that the employee doesn't have a negative impact on their take-home pay. And once that's determined, then the employee will decide whether or not it's a plan for them. It's a completely voluntary plan. They are provided with the information and they're permitted to opt out before the effective date of the plan. Then once the plan is started, because it is a and it's an arisable document, so we must follow those guidelines, and we have created an IRS compliant plan. We must apply to all the rules and regulations of the IRS code when setting up these plans. And we give our employees ample time to learn about it and opt out if they choose to. I'm proud to say that we have maybe three percent of our employees opt out. It is always that person who participates no matter what it is, they're not interested in wellness. I am proud to say that 97% of our employees are participating and they are interested in the benefits and reaping the rewards, saving money, and taking home an increase in entrepreneur pay.

SPEAKER_01 23:35

Those are some great numbers. We're running out of time. I just want to share or have you share with us nuggets of knowledge that your last 30 seconds you can pour into a new business owner or entrepreneur.

SPEAKER_02 23:52

Started this business, whatever it is, whether you're making pies or you're building skyscrapers, started this business for you and your family. Let's take steps to retain as much as we can and not give it all away to the health insurance. And we can do that, and we can become your partner and be there for you at no net cost and help you build a dynasty that will last a lifetime.

SPEAKER_01 24:22

So good. So good, Max. Thank you so much. Max McMillan, the managing partner at Patriot Preventive Care. Today we've discussed renewals that rise when utilization rises. Utilization reflects behavior. Monthly engagement changes behavior. Stability requires structure and discipline. The health of your employees ultimately determines the health of your company. This has been Talk Story Media Business Edition. Until next time.