Episode 11: Direct Contracting and Direct Primary Care Leading the Way with Kristina Ewing

Join us for another great episode the Bending the Trend  Podcast, this week our host Norm Volsky sits down with Kristina Ewing, Director of Health and Wellbeing at Shoestring Valley Holdings. Kristina shares innovative strategies for reducing healthcare costs while improving employee outcomes. Her favorite strategies right now are Direct Primary Care and Direct Contracting. Sharing her positive experiences with Hint Health, HealthMe, and Regenexx.

From the power of Direct Primary Care (DPC) to smart direct contracting and cutting-edge orthopedic alternatives, Kristina explains how employers can take control of healthcare spending without sacrificing quality.

As she puts it, “Direct primary care has the biggest impact.” By focusing on proactive, personalized care, organizations are seeing meaningful improvements in both cost and experience.

You’ll also hear a powerful real-world example: “We saved $50,000 on that ankle surgery.” By leveraging alternative orthopedic treatments like Regenexx, unnecessary procedures can often be avoided—leading to major savings and faster recovery times.

Ultimately, these strategies are making a real difference: “Members are saving significant dollars.” Join us for this quick but informative episode!

Takeaways:
💡 How Direct Primary Care (DPC) improves access, lowers costs, and delivers better outcomes
💰 How direct contracting with providers creates transparency and significant savings
🦴 How alternative orthopedic treatments can help avoid expensive surgeries
📈 How innovative healthcare strategies are transforming employer health benefits

Transcript

SPEAKER_00 0:00

We have to find real solutions, and this is Bending the Trend. Hello and welcome back to Bending the Trend Podcast with your host, Norm Volski. And today we are thrilled to be joined by Christina Ewing, the director of health and well-being at Shoestring Valley Holdings. Christina, welcome to the pod.

SPEAKER_01 0:23

Thanks. Wish I didn't bring my boxing gloves, but uh ready to go.

SPEAKER_00 0:28

No need. We are fighting rising healthcare costs together, so we're not fighting each other, we're fighting on the same team. Christina, you and I met at UPowered Symposium, and we shared, you know, a strong passion for employer fiduciary duty and driving cost savings, you know, for employers, for employees. So, first question I will ask as director of health and you know well-being at Shoestring, tell me about some solutions that you've offered your employees that you would recommend to others.

SPEAKER_01 1:01

Probably the most recent ones, which I think are um they're a little bit newer in concept, which would be direct contracting and direct primary care. Those are some of my favorite solutions that really have the biggest impact, especially for employee out-of-pocket cost. But also when you're looking at you know planned fiduciary responsibilities, it also has a tremendous effect on the overall planned outcomes and member health outcomes. So it's not just a nice to have for the members in terms of what it gets them access, ease of care, no out-of-pocket cost, but it also does really great things downstream to prevents you know kind of that inflation that everyone's seeing in the in the healthcare plan year over year. So those are two are my favorite, uh, although they're a little kind of newer and and less utilized, I would say.

SPEAKER_00 1:48

Okay. I love it. I'm a big believer that if you can't control the referral, you can't control costs. So kind of walk through what you're doing from a direct primary care standpoint, what you're doing from a uh direct contracting standpoint, that has already just you know started to bear some fruit.

SPEAKER_01 2:07

Yeah, so we work with Hint on the DPC direct primary care space. Uh we are in a multi-region organization, multi-business unit organization. So we have eight entities across three states, and that's hard to you know create all these direct contracts ourselves. So a lot of companies have one location, super easy to do this stuff. Please do it right away if you're not already. But for those companies that have multiple places, it becomes really cumbersome to manage all those contracts. So that's one of the reasons that we partnered with Hint to start that direct primary care in all of our areas. And one of the things that we've been able to do with them is kind of create this playbook, so to speak. We had a training for all the providers that are in our network or that have patients of ours and a webinar essentially, and we told them exactly what we want them to do if they need a referral for X, Y, and Z. And then that fed nicely into our direct contracting vendor. We use Health Me. And so they do imaging, uh, they're really specialist in MA, so any kind of orthopedic surgery, but also things like colonoscopies and mammograms, which normally are free under health plans anyway. But if you can get the same thing for less, whether it's free or not for the member, why wouldn't why wouldn't you do that, right? So it really is utilizing DPC not just for better prevention, better kind of health outcomes, but also, like you said, we're managing that referral funnel because they know when they need something outside of that DPC office, their first step is to go to Health Me, and then Health Me works to contract whatever's needed. Mental health, whether it's infusions, all these different things. So we've seen some significant savings. Uh, one of the most recent ones was $50,000 savings on a surgery. Wow. And it was, you know, an ankle surgery. So right in their wheelhouse MSK. The patient already had been scheduled for surgery, went to go see their DPC for like a follow-up visit. And the DPC's like, wait a second, like you're supposed to try to use these folks. Let's see what they can do. And sure enough, same provider, even. They didn't have to switch surgeons, they just switched locations and got a bundled price with this provider, saved the company $50,000 and the member their entire out-of-pocket maximum. They would have maxed out. So it's not just us, it's not just the employer, but the members are saving significant dollars in this process as well. So really cool to just see exactly how it was supposed to work. The DPC actually intervening when something was already in place. So that was just a real testament to like this is working how it's supposed to work.

SPEAKER_00 4:32

I love it. Any other vendor solutions that you've identified that have been really good value ads for you and we have a lot of vendors actually.

SPEAKER_01 4:41

We have a lot of vendors kind of working in the backgrounds. But uh, one of my other favorites is Regenix, which is an injection-based orthopedic alternative. We've been doing that for a couple years now. Most people don't know about 70% of orthopedic conditions or surgeons, I should say, sh can be avoided through using regenix, which is your body's own platelets and stem cells. So it's it's nothing artificial that's being injected as your own body's substance right into the site of injury, you know, all the different places, necks, backs, shoulders. And about 70% of people can avoid surgery altogether, which is the whole point, right? You're not having surgery after surgery for conditions. And for us specifically in construction, is most of our entities are construction manufacturing. Opioid use is huge, right? Our people have a lot of wear and tear on their bodies, and our opioids are overprescribed. So if you can avoid a surgery, you're also avoiding exposure to opioids. So it's a huge thing for us, not just saving money. It's quality of life for the member. The recovery is so much easier and faster, and the exposure to opioids is non-existent. So it's a win-win-win, and we pay less, the member pays less. So it's really one of my favorite solutions out there, too.

SPEAKER_00 5:53

I love it. And what are some of the results? You mentioned like the $50,000 saved on that one surgery. Any other like results from either DPC, direct contracting or regenix that you would just say, like, hey, here's the proof in the pudding of not only I recommend them, but here's why, here were the results.

SPEAKER_01 6:13

Yeah, regenix has a ton of those stories. We've avoided full knee replacements. We've had people who avoided fusions, spinal or neck fusions, which are some of the worst even orthopedic surgeons will say they'll never get a fusion. Like it's one of the worst things you can do if you can avoid it. So they're, you know, just from a quality of life perspective, but also plan-wise, like knee replacements can be 80 grand, right? So right there you're saving roughly 80 grand. The cost of the injections is a couple thousand dollars. And that's, you know, that's 10, 20, 30 times a year. So that's pretty significant for those things right there.

SPEAKER_00 6:50

I learned in my early years in recruiting on behalf of a good client of mine over the years, Hinge Health, that the greatest predictor of a future surgery is a past surgery.

SPEAKER_01 7:02

I know. It's true. It you know, scar tissue, whatever, surgery begets surgery. And so, yeah, if we can avoid the first one, you avoid subsequent. And and think about all the you know, the things that go wrong. Wrong, wrong limb gets operated, wrong body part, all these things that you hear about, those are real stories. Like someone experienced that. Infections and readmittances, all those get avoided when you avoid the surgery altogether. I I sound like I make commission off this, and I promise you I don't.

SPEAKER_00 7:31

I'm just I know you don't, you know, you're a you-powered fan, and you know, we're all about like trans.

SPEAKER_01 7:37

Well, I used it myself before we had it on our health plan, and it it was expensive but worth it. And so once I realized like it really does what it says, then I looked for a way like how do we get this for everyone else? Wow. Where they don't have to read it.

SPEAKER_00 7:54

Only then you'll allow your employees to uh try it. So I really like that. We know a lot of entrepreneurs watch this podcast. So are there any solutions that you wish existed that don't exist yet that might incentivize and motivate like an entrepreneur to build a new company that solves for something that just isn't addressed today?

SPEAKER_01 8:17

Yeah, I think you know, obviously we have direct primary care that's a really good funnel, but outside of that, we don't there's not a really good solution that exists that does all the things that we would want. Like I said, we have a lot of solutions. We basically have a custom health plan at this point. And it can be hard to navigate. People don't always know where to go when. Um, and and it's not just you know what they need, but also saving them money, right? How do they get the best care, the lowest price? And that doesn't exist. One or something to point them to, okay, here's your scenario, here is the exact things that Shoestrings Plan offers, and here's where you go for this. So without like a human doing it, which is hard to scale, that I haven't found that solution that is as robust as what I would have to do for every single member.

SPEAKER_00 9:04

Yeah, well, maybe there's something coming. Fingers crossed that you know there's a solution that can solve for that in the not just the future. So again, Christina, thank you for being like one of these like benefits heroes out there. Thank you for sharing all of your insights and your success, you know, in your current role, so that others in the industry can learn from you and we can all learn from each other. So thank you so much for joining us on Bending the Trend. You know, please keep us posted on all the new innovative things you're doing that the entire industry would benefit from knowing about. So thank you so much. 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.