Episode 18: Primary Care Reimagined with Lori Guliano

Join us for another episode of Bending the Trend hosted by Norm Volsky, where we sit down with Lori Guliano to discuss how advanced primary care is helping employers improve employee health, reduce unnecessary healthcare spending, and create better healthcare experiences.

In this episode, Lori shares how relationship driven primary care models are transforming the way employers think about healthcare benefits. From improving access to care and reducing avoidable hospital visits to measuring vendor performance through meaningful outcomes, this conversation explores why investing in primary care creates long term value for both employees and employers.

The discussion also highlights why prevention and accessibility remain two of the biggest opportunities in healthcare today. Lori explains how advanced primary care helps organizations move beyond reactive healthcare by building stronger patient provider relationships, identifying health concerns earlier, and creating more personalized care experiences that improve outcomes while lowering costs.

"The best way to lower healthcare costs is to keep people healthy in the first place."

Lori shares several key principles employers should consider when designing a modern healthcare strategy:

• Advanced Primary Care
• Preventive Care Programs
• Relationship Driven Healthcare
• Vendor Performance Measurement
• Healthcare Accessibility
• Patient Engagement
• Long Term Cost Reduction Strategies
• Employer Healthcare Innovation

Lori Guliano is a healthcare leader focused on helping employers improve healthcare delivery through advanced primary care, preventive health strategies, and outcome driven benefits solutions.

🏥 Advanced Primary Care: Why investing in primary care improves outcomes while reducing long term healthcare costs

📈 Preventive Care: How proactive healthcare helps avoid expensive downstream medical claims

🤝 Patient Relationships: Why trust and continuity of care lead to better employee engagement

📊 Healthcare Performance: The importance of measuring outcomes instead of simply tracking utilization

🚀 Employer Strategy: How innovative primary care models are reshaping the future of employee benefits

Like, comment, and subscribe for more conversations on bending the healthcare cost trend through smarter benefits and better employee experiences!

Transcript

SPEAKER_01 0:00

We have to find real solutions, and this is bending the trend. Hello, welcome back to Bending the Trend with your host, Norm Volski. And today we are thrilled to be joined by the benefits leader over at Oregon, Lori Gugliano. Lori, welcome to the pod.

SPEAKER_00 0:17

Thanks for the invite, Norm.

SPEAKER_01 0:20

Yeah, thank you for joining us. So, Lori, really excited to have you on the pod. You know, on Bending the Trend, we really want to create transparency and have you know benefits leaders come on, talk about some of the amazing vendor experiences they've had in their careers. So walk us through what you've implemented at Oregon that did really great work that you would recommend to others.

SPEAKER_00 0:42

Yeah, so super excited about this topic. Have lots to share, but there's one vendor in particular that I'm really excited to highlight today. So we are a member of the Health Transformation Alliance, which has been a fantastic experience of us being a member organization over there. And through the HTA, we learned about a vendor called Appley.

SPEAKER_01 1:02

So Apple and I'm a big Lee Lewis fan, and we've had him on our podcast before. So uh anything HTA approved is usually a very great thing.

SPEAKER_00 1:13

Absolutely. Absolutely. So yeah, Lee was uh really instrumental in helping us get Apple up and running. So essentially, Apple takes advanced primary care and adds kind of a digital layer to it that makes the direct primary care run through claims. So instead of having to kind of contract separately and pay claims separately for that direct primary care, it's running all through our medical carrier, which means I get all of the claims data and I don't have to kind of manage a whole separate contract and program, which is really great. But the team over there is fantastic. Um, it's led by Dr. Jerry Beinhauer, who is fantastic. And we've overall just had a really great experience. Our employees have really taken to the benefit. They we've had some really great engagement. We're only about nine months in, um, but we've got about 10% of our population engaged, which is um no small feat as other benefits leaders know.

SPEAKER_01 2:11

So it improves and increases access to advanced primary care for your population.

SPEAKER_00 2:17

Yeah, I can talk a little bit about kind of advanced primary care generally and yeah, please.

SPEAKER_01 2:21

I have my own comments, but I want to hear yours first.

SPEAKER_00 2:25

Yeah, yeah. So um listen, when I look at it, and I'm gonna talk about medical specifically, right? Let's let's put pharmacy kind of on the shelf for a minute because that's its own beast. But when I think about medical and and medical trend and what drives trend, right, it's really hospital costs. So when I think about what I want to do from a medical plan perspective to lower my costs, it's two things. One is a bit more short term and maybe one is is longer term. But I want to keep people away from the hospital and I want to keep people out of the hospital. So what does that mean, right? In the short term, I want to be steering people away from the hospital because that's a high cost site of care. So where there are opportunities for people to get infusions at home or at an infusion center, or go to an ambulatory surgical center for a colonoscopy instead of the hospital, or an imaging center for a mammogram instead of a hospital, right? I want to be able to steer people to those lower site costs of care.

SPEAKER_01 3:24

And then when you're speaking my language, I love it.

SPEAKER_00 3:26

Yeah. And then when you think about, you know, kind of the longer term keeping people out of the hospital, I want to catch chronic diseases before they become chronic diseases, right? I want to catch symptoms of things like stage one cancer before I'm catching it at stage four, right? That's good for the plan, but that's good for our people, right? That's what we want. So when I think about solutions and how we make sure we're able to tackle those things, advanced primary care fits right in, right? So essentially I'm providing access to primary care doctors that typically don't take insurance. They're not in network. And they're doctors that have chosen not to take insurance because they're tired of the fee-for-service model, right? They don't want to have to see 30 patients a day in order to just get paid, you know, a reasonable and fair price for what they're doing. These are doctors who care about the patients they're taking care of. They don't look at them as a number or just a means to getting paid.

SPEAKER_01 4:26

They want to have to spend more than three minutes with their patients.

SPEAKER_00 4:31

That's exactly it. So it's really bringing relationships back to healthcare. And I think somewhere along the way, we've lost the plot on that. And healthcare has become really transactional. Relationships are really important. So we feel really fortunate to be able to give that to our members.

SPEAKER_01 4:48

I love that. And I would just go even a layer deeper. So one very, very common misconception of employees is that if it's cheaper, it's worse. And I really want to dismiss you know that narrative because when you look at the healthcare system, the employer is the only entity in the healthcare system that does better when their employees are healthy, happy, and working. Unfortunately, hospitals, health plans, big pharma, PBMs, they tend to make more money when, unfortunately, people are sick. That's how they make money. So I think it's really important to remember that like your employer wants you to be healthy and happy. They are paying extra to get some clinical services offered to you that are less costly for you, the employee, but still incredible high quality, higher quality than your average clinical service going through a health plan. Because if you're not getting quality today, that will be a worse clinical outcome later. And that eventually is more cost to not only you, but also your employer. So you and your employer are completely aligned in wanting you to be healthy, prevent later stage diagnosis, prevent chronic disease. So I think that's just like a very important thing. And by offering an advanced primary care option that is non-hospital affiliated, that allows that physician to have no perverse incentive of where to refer you next. So I think it's really important to know that unless you control the referral, you can't control cost. And having a really strategic advanced primary care strategy allows employers to have like that primary care physician as the quarterback who can then guide you to highest quality, but also most cost-effective care. Because if you don't do this at a really, really strategic level, overpaying for healthcare causes higher deductibles, higher premiums, more money out of your pocket, and your paychecks. And that's money your employer can't use to give you raises, give you promotions, give you more take-home pay. So, like these things do not happen in a vacuum. You know, they all are uh interrelated. And, you know, your employer knows this, you know, a lot of the vendors know this. It's something that motivated me to start this podcast to begin with, because I think employees get the wrong idea that when a new service is offered, they just assume, oh, this must be cheaper and my employer must be saving money. That's not the right way to look at it, and it's just incorrect. They're actually trying to provide you the best quality today so that you're cheaper to ensure later, meaning you're healthier. And that's a really, really good thing. Any other vendors um that you would recommend in addition to Apple?

SPEAKER_00 7:46

Yeah, I would say from a healthcare perspective, Apple is really kind of the standout.

SPEAKER_01 7:53

Love it. Very, very nice. So talk to us just on like what has happened in these last nine months that allowed Apple to, you know, really deserve your praise. You know, what have they done where you're like, hey, we've seen it in clinical outcomes, we've seen it in cost data, that they're just doing a tremendous job. Anything statistically or anecdotally that you can share?

SPEAKER_00 8:18

Yeah, we're still a little early on the data that that's coming in. We've started to see some early indications, a little bit of a dip in some ER utilization, hard to say if it's correlated, but we've seen that. I would say just generally, though, the simplicity of what they're able to do of instead of having to try to figure out how I get my claims data and the idea of direct primary care is that these doctors are practicing at the top of their license, right? So they should be treating a lot more for my members than a typical fee for service primary care doctor. So I want to know what my members are going to the their primary care doctor for. So the way that it works is the primary care doctor, just like they would typically bill for whatever services they're providing, that's still coming through as a claim. It's just a zero dollar claim. So Apple is able to take that from these doctors who typically don't submit to insurance, translate it into a claim, and then submit it to my medical carrier. And then it's paid. So there is no member cost share of this. This is completely paid for by the company. Yeah. But the member still gets the EOB that says you went, it was zero dollars, you know, and then I have all of the data in my data warehouse. So there's this great idea of advanced primary care, but how you operationalize it, right? And I think Apple has really found a way to make this easy and usable for plan sponsors using infrastructure and codes that already exist in your plan today. Um it was really more of a communication to the carrier about how it's going to work and making sure that they understood it, rather than needing to get buy-in, right, to add an additional network or a customized network where you run into a lot of challenges with that just fantastic.

SPEAKER_01 10:10

And you know, you have employees that now get to uh spend like a significant amount of time with their doctor, it's not just like a couple minute visit. They get real quality time, real quality conversation, they're able to ask questions, and it doesn't cost them a penny. Like unbelievable, such an amazing benefit. Um is there anything that doesn't exist today that you wish did? You know, we have a lot of entrepreneurs that watch this and we want to motivate people to you know create things that don't exist today.

SPEAKER_00 10:40

Yeah. So when I think about kind of a long-term strategy of what I'd love to see in the next five years, right? I think the idea of advanced primary care is kind of the foundation of that, right? So I've now got these quality doctors who are referring out to other quality doctors or to um the best hospital in the area, not necessarily the most expensive hospital in the area. But what I'm doing with Apple, how do I do that on a broader scale? So even when I think about, you know, essentially the direct primary care is a cash-based model, right? You typically pay a subscription, you pay the fee, and then you get the service and it's cash-based. It doesn't typically run through insurance. How do I scale that? I would love to see a vendor that offered the same kind of arrangement with imaging centers, the same kind of arrangement with ambulatory surgical centers that has a national network of direct contracts with hospitals that employers could just opt into. They've done the work. I can opt in, I get the benefit of the cash price and helping us operationalize how we pay for that because we're kind of a smaller, a smaller, large employer. Um so it's difficult for us when we've got a national footprint. I can't go out and negotiate direct contracts with hospitals in all of the areas where you know my employees are. But if there's a vendor who's doing that, I know Mark Cuban is starting to kind of do that through cost plus wellness.

SPEAKER_01 12:08

But I would love to see a joining us on the spot very, very soon together.

SPEAKER_00 12:13

Yeah. That we could just kind of sign the contract, opt in, get the benefit of those cash prices at those quality providers and be able to provide really good quality care, not just at the primary care level, but beyond that, and have a really good vetted network to refer people into when they need care beyond primary care.

SPEAKER_01 12:34

Yeah, like essentially benefits leaders not only have to run their own custom health plan, but they almost have to create their own custom health system because of like the cost pressures that exist and the fact that you're paying attention to monopolies cause people to have these like creative alternatives because you know they do price gouge, you know, in certain areas where they know like they're getting the majority of patients regardless of cost. And you know, now there's always innovation needed to be able to drive value in a market that's inefficient. So a lot of excitement to come, but I think a lot of that comes down to just like ease on the patient, ease on the employee. You have all these fragmented systems, like they're great in a vacuum, really hard for an employee to be able to, you know, organize and like keep in mind at all times. So it's like having all these different things that are great, but having a cohesive experience. So it's as easy as just calling a local health system who has everything, you know, you want that same experience at your own quote unquote digital hospital or custom you know, alternative hospital that you've created, you know, within your health plan that's self-insured on the employer side. So real exciting things to come. I think we'll definitely be monitoring all of these trends. And again, thank you for joining us on Bending the Trend, Lori. Thank you for doing everything you can to fight rising health care costs along with us over at Bending the Trend and keep doing the great work. Really appreciate it.

SPEAKER_00 14:07

Yeah, thanks so much, Storm. I appreciate the opportunity.

SPEAKER_01 14:10

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