Episode 9: RBP, Transparent PBMS & Direct Primary Care with Stephanie Porrino

In this episode of Bending the Trend, Norm Volsky sits down with Stephanie Porrino, CEO and Founder of Empower Healthcare Insights, to discuss practical strategies employers can use to control rising healthcare costs. Stephanie shares lessons from her 30 years in HR and benefits leadership, including how reference-based pricing, transparent PBMs, and direct primary care models can dramatically reduce healthcare spend while improving employee outcomes. The conversation also explores the growing disconnect between HR leaders and insurance advisors, the importance of controlling referrals through primary care, and why better healthcare consumer education remains one of the biggest gaps in the employer benefits ecosystem.

Key Takeaways

🏥 Healthcare cost containment strategies
 🧩 Vendor selection for benefits optimization
 🩺 Innovations in primary care and pharmacy benefits
 📉 Reference-based pricing and claims cost reduction
 💊 Transparent PBMs and pharmacy cost management
 👨‍⚕️ Direct primary care and controlling healthcare referrals
 🤝 Bridging the gap between HR leaders and insurance advisors
 📚 The need for better healthcare consumer education

Chapters

00:00: Introduction and meeting at U Powered Symposium

01:05: Stephanie’s background and founding Empower Healthcare Insights

02:10: Vendor strategies that drive healthcare cost savings

03:40: Reference-based pricing and $21M in claims savings

05:00: Transparent PBMs and pharmacy cost reduction

06:10: Direct primary care and controlling healthcare referrals

08:10: Why consumer healthcare education is still missing

09:45: Nomination for the next Bending the Trend guest

10:40: Bending the Trend Outro Season 

Transcript

SPEAKER_01 0:00

We have to find real solutions, and this is bending the trend. Hello, and welcome back to Bending the Trend with your host, Norm Bolski. And today we are thrilled to be joined by Stephanie Perino. Stephanie, welcome to the pod.

SPEAKER_00 0:18

Good morning. Really excited to be here.

SPEAKER_01 0:21

Yeah, I got to do it.

SPEAKER_00 0:21

It's fun meeting you in uh Savannah.

SPEAKER_01 0:24

At Epowered Symposium, which was the best conference I've ever been to in the benefits space. So anyone watching, highly recommend that conference. And it's must attend next year. And for all of our viewers and listeners that aren't as familiar with Stephanie as I am, she is the CEO and founder of Empower Healthcare Insights. So tell us a little bit about your new company that you just founded.

SPEAKER_00 0:48

Yeah, it's really super exciting. So I've been in the HR space for 30 years. But the last 10 years, I spent a lot of time on healthcare strategy and cost containment. Now I need to put that in a little bit of context because I was not on board originally with changing the traditional healthcare system. So I did kick and scream a bit. But once I learned, you know, it I always call it now the choose your heart, right? Yeah. So once I really learned what it meant and it answered the questions I always had internally, I really started digging into it. But what I also learned in the last few years, surrounding myself with intelligent people in the healthcare strategy space, is the connection or lack of communication between insurance advisors and HR executives is lacking. And fortunately, I have both of those sides covered. So it's really creating the conduit to make more successful connections and give more opportunity for companies to thrive in the healthcare strategy space from someone who's been doing it a long time.

SPEAKER_01 1:56

That's fantastic. Well, you've been fighting rising healthcare costs longer than most. So that's why we wanted you on. So, first question I'll ask is in your experience as a benefits leader, what vendors have you implemented over the years that drove cost savings or just drove like incredible results that you would recommend others?

SPEAKER_00 2:18

So the first one that came to mind, um, you have to have a solid TPA, you know, as far as you know, who is looking at your claims, who's processing, who's looking at the you know, additional pricing or balance billing issues. So the first one I would say is Imagine 360.

SPEAKER_01 2:36

Okay.

SPEAKER_00 2:37

So not only are they a strong healthcare program, you know, they do the repricing on the back end. So we saw significant savings with them.

SPEAKER_01 2:46

They do RBP, reference-based pricing, really, really well.

SPEAKER_00 2:49

They do it extremely well. And because their system is integrated with the PBM space, and they're able to really give you strong data to build a strategy that's long-term. The other one that I would recommend highly is for us, it's Walk-on Clinic, and that's a direct primary care program that we have on site. It's mobile healthcare that's really taking care of our employees. And then, of course, you know, the pharmacy folks, you know, we work with Veros Rx, and they've been extremely service-oriented, and we've seen tremendous savings.

SPEAKER_01 3:25

And that's a transparent PBM, correct? Awesome. And what were the results of some of those implementations? Like, why do you recommend them? What were the uh results of implementing them and you know why you recommend them in the first place?

SPEAKER_00 3:42

So what's interesting is a lot of folks are concerned about reference-based pricing. It's disruptive, but again, it's choose your heart. So, you know, for us, we saw tremendous results not only on the savings for the claims, the out-of-pocket costs. You know, a few years in, we were 21 million plus in savings on the spend. As far as bill charges are concerned, we've seen a reduction in out-of-pocket costs for our employees because they're not we're not spending as much on the service side for claims. Um, so that's been a tremendous impact and tremendous impact on our financials. On the PBM space, what's interesting is when I got to um my current company, Hendry Marine, back in 2019, they were with um a big uh BUCA PBM. And fortunately I was able to take them to an independent PBM and 30% savings off the top. And then we moved over to VarisRx and had an additional 25% savings on yes, some of the special patients. Yeah, I mean, the typical national average for pharmacy costs is between what 20 and 25%. We're somewhere between 8 and 10% of our total spent.

SPEAKER_01 4:58

Unbelievable.

SPEAKER_00 4:59

Yeah, and then with Walk on Clinic, we, you know, our company decided to make the investment in the primary care direct to employees. And not only have we saved lives, but we have, you know, analytics and software built in that we can do predictive modeling. So even more to come on that. But we have been very grateful to have them here.

SPEAKER_01 5:22

Yeah, and I think primary care is always the uh strong foundation of a strong self-insured um benefits plan because ultimately, if you can't control the referral, you can't control cost. And I've discussed this a little bit on the podcast before. Health systems are smart. Like they created primary care as their loss leader, and they realized if patients just listen to what we tell them, which they typically do, for them after that primary care visit. Let's make the primary care visit like zero barrier to entry, zero copay, and then we'll make it up on the back end and then some, you know, at radiology, at you know, surgery, at specialty, at a lot of those different places. And if you have direct primary care, that direct primary care physician will still recommend the right clinical next step, but they're also going to be mindful of hey, where can we get great quality at effective pricing? Because if that's done at scale, that's more money in the pockets of the employees, lower premiums, lower deductibles. No one wants more taken out of their paycheck so they can go to a very specific site of care if there's somewhere just as good, if not better, that will result in them getting more take-home pay. So I think that's just something that isn't discussed enough. And I'm so glad that you mentioned that.

SPEAKER_00 6:56

Yeah, I mean, it is critical to the and no pun intended, like the health and well, the long-term well-being not only of your health care plan, but the employees. You know, when we take care of them, there's more presenteism at work, there's more connected culture when the employees know you're taking care of them. And you know, what I found interesting is where it used to be there were more private, you know, primary care doctors, now 80 or 90 percent of them are now part of a hospital system, so it actually reversed. And that's really creating more of this cost and momentum and and driving more spend for companies, and that's why we decided to do on-site.

SPEAKER_01 7:38

Yeah, absolutely. There's a lot of physicians that don't think they could start their own private practice locally, they think the local health systems would put them out of business. And I've talked to tons around the country, and that's a pretty common thought. So um, you mentioned some great solutions. Are there any solutions you wish existed that just don't or haven't materialized yet that you think in your many years and benefits would be a great company for some entrepreneur to build because there's a major need for it, and there's obviously an upside in doing that?

SPEAKER_00 8:13

Well, I mean, the one thing that everyone across the country, no matter what demographic, economic situation you're in, consumer education about healthcare is sorely lacking. And, you know, as employers, we do as much as we can to bring the messages to the employees, but we don't know if those messages make it home to the spouses. You know, so it's always that ability to stay connected with the whole family to make the more educated consumers. So I think that's still really lacking. And, you know, I know there are vendor solutions that have an app, but not everybody is app friendly. You know, there's four generations. And people have enough apps.

SPEAKER_01 8:58

There's enough things they already have on their phone. Like the last thing they need is another thing.

SPEAKER_00 9:05

Yeah. So with four generations in the workforce, you know, some you know want to do texting, some want to do email, some still love face-to-face. So it's got to be, you know, there's no one size fits all. I don't know if there will be, but that is something companies really struggle with. And then of course, there's always the issue with the GLP ones. Are there programs that are going to put you know, guardrails in place for organizations that want to roll these out, but not make it a la carte or for as long as people need them? Because that's where the cost goes off the rails if it's not managed.

SPEAKER_01 9:41

Absolutely. Well, this was great. Who would you nominate to join us on bending the trend next? Any other benefits leaders that you think highly of that you think their opinions and you know recommendations should be shared with others?

SPEAKER_00 9:57

If you haven't met Cora Upsall, she's incredible. So I would definitely recommend that you talk to her because she is paving a path for huge employers, and I so admire the work she's doing. Surprise, Cora, sorry.

SPEAKER_01 10:13

No, I think nominations are good things. So again, if you're interested, we'd love to have you. And again, Stephanie, thank you so much for joining us on Bending the Trend. You know, congrats about everything you're building and doing over at Empower. And uh keep us posted on all the amazing progress, and maybe we'll have you back for a follow-up episode in the next few years so that you can tell us new things you've uh implemented and would recommend because you've been in this space a long time and you're always innovating. So thank you for all you do.

SPEAKER_00 10:44

Thank you.

SPEAKER_01 10:45

Great being here. Thanks for watching Bending the Trend, where we are looking to fight rising healthcare costs. We are asking benefits leaders what digital health solutions they've implemented that has helped them bend the trend.