Special Edition Episode: Exposing Healthcare Waste with Mark Cuban

In this episode, Mark Cuban shares insights on transforming healthcare costs through transparency, direct contracting, and innovative strategies. "Every single definition in your contract is being used to take advantage of you." Discover how employers can leverage new models to save money and improve care quality. "Compare your drug prices to the cost plus price to see if you can get it cheaper." Hear Cuban's strategies for employers to make sure they don't get ripped off, his work at mark Cuban's Cost Plus Drugs, and even some Cavs and Mavs chit chat!

Learn about the incredible work Mark Cuban's Cost Plus Drugs Company PBC is doing to improve healthcare medication affordability for everyone.


Chapters
00:00
Introduction to Healthcare Challenges
02:03
The Importance of Insurance Audits
04:56
Cost Plus Wellness: A New Approach
07:59
Understanding PBM Contracts
11:58
Self-Insurance: Benefits and Insights
14:56
Understanding Self-Insurance and Risk Management
17:07
The Shift to Direct Contracting in Healthcare
19:53
Creating Transparency and Accountability in Healthcare Programs
23:09
Strategies for Employers to Reduce Healthcare Costs
25:55
Advocating for Fair Pricing in Pharmaceuticals
28:37

Transcript

SPEAKER_00 0:00

We have to find real solutions, and this is bending the trend. Hello and welcome back to a special episode of Bending the Trend and the digital health heavyweights podcast. I'm gonna introduce someone that doesn't need one, the man, the myth, the legend, Mark Cuban. Mark, welcome to the pod.

SPEAKER_01 0:20

Hey, thanks for having me. I like the gloves on, right?

SPEAKER_00 0:23

Hell yeah, we're fighting rising healthcare costs. So I appreciate you getting in the ring with us and fighting on the same side. And really, like from someone in this digital health industry, thank you so much for the awareness you're bringing to all of the corruption and greed that goes on in the healthcare system.

SPEAKER_01 0:40

Knock them the fuck out. Let's go.

SPEAKER_00 0:41

Let's do it. We'll do it together, one person at a time. And before we jump in, I have to just mention this. A lot of Clevelanders bought this hat and here. Yeah, Mavs can't be. We were rooting for you guys hard as you remember when LeBron left us the summer before. I don't think a city has supported another team's championship run quite like the Clevelanders were rooting for your Mavs.

SPEAKER_01 1:08

Oh, Dan Gilbert and I used to talk all the time that year, and he was like, go get him. You need to, you need to save us.

SPEAKER_00 1:14

It was good versus evil. We loved it. We loved it. It was great. You guys built it from like a family culture, and yeah, we knew Miami fans didn't really care. Who was there the year before when they won 19 games or whatever it was? So Dallas fans deserved it and you brought it home, so thank you. Did you see the trophy back there? I see it. Gives us a lot of good memories as well.

SPEAKER_01 1:37

For sure. Yeah, you guys got a big one too, so that was great.

SPEAKER_00 1:41

We did, we did. We got our one, so it was great. Um, so we'll jump right into it. A few weeks ago, you posted on LinkedIn that if an employer audited their insurance and PBM contracts and didn't find any money that they shouldn't be paying, you would personally pay for that audit. What gave you the confidence to make a very, you know, very generous offer like that?

SPEAKER_01 2:05

One, those audits aren't as expensive as you think. They're not, you know, they might cost $25,000, $30,000. Two, whenever I go speak to different employer groups or benefits people, I always ask them how many people have done benefits, yeah. How many people did not get money back, nobody's ever raised their hand. How many people got too much money, nobody's ever raised their hand? Right? So it's it's a given, right? The insurance companies and the PBMs they own, or vice versa, are smarter, faster at cheating the game than they are at protecting themselves.

SPEAKER_00 2:38

Totally. Yeah. And they know they're gonna get called out a very small percentage of the time, and they're just willing to you know play the odds. Um so if you're a CEO, a CHRO, a benefits leader sitting down with your broker tomorrow, what questions should you be asking that most employers just don't know to ask?

SPEAKER_01 2:57

So first you shouldn't be sitting down with your broker. That's step number one. Right? You should be learning what's involved and what does it take. I mean, look, if you're a small company, you have 5, 10, 25, 50 people, you're probably working through a broker no matter what. You've probably had the same broker for years. I had my guy until we started Cost Plus Drugs, and then I compared what we were selling our drugs for versus what I was getting charged. He's not my guy anymore. But now, particularly with AI, you know, you can take your previous contract and put it into a large language model like Claude and just ask it, where am I getting ripped off? What should I do? How can I improve my benefits, right? And I think that's the first step. But more importantly, you've got to really start to understand what your true risk is. People default to insurance as if the insurance company is going to give them something more than what they put in. That's never the case. Even with you know fully funded plans, whatever it may be, there's no free gifts, right? And so what are the options for you to protect yourself in case of the worst possible scenario? And the reality is the worst possible scenario, typically you've seen four million dollars, five million dollars. Do you have access to four or five million dollars in your company or through your you know ownership group or whatever it may be, or the entrepreneur that runs it? If you do, you may want to consider direct contracting, which is what I do for my companies, right? And we put all of our contracts on costpluswellness.com so that anybody can use them because if you can afford the big hit, then you can negotiate down and you could hire an independent third-party administrator administrator that just processes the claims and helps your members get through the system.

SPEAKER_00 4:48

Totally. Tell us more about cost plus wellness. I think a lot of people know what cost plus drugs does now. I think wellness is a little bit newer on the scene. A lot newer. What problem is cost plus wellness solving? Who should use it, and can large employers leverage it as well?

SPEAKER_01 5:04

Yes, yes, yes. Um, so where it came from is for my companies, we self-insured. And as I looked at what we were being charged for things and the price just kept on going up, I'm like, okay, something's gotta give here. And you know, we had to fight to get claims information, all that stuff. And so I started going around to hospital CEOs and CFOs and telling them, look, my experience with the insurance companies and their PBMs, et cetera, is not positive. What about yours? And they say the same thing. We hate them, right? They're a necessary evil sometimes. And so I'll ask, well, what are the problems? And it'd be like, well, they late pay us, whatever contracted rate, like you see on the website, they don't fully pay that amount. They underpay us. Then they'll ask for pre-authorizations that they charge us or the employer for. Then they'll deny the deny, deny, and delay, delay, delay just to earn the quote. And then there's a cost of denial to the hospital, and then on top of that, there's the patient out of pocket. That $500, $1,000, $2,500 deductible. Well, it's the provider that takes the credit risk. And that turns us, meaning the provider, into a subprime lender. Because if you can't afford your deductible, the money that they're loaning you in order to get access to the insurance company money, you're not going to be able to pay it back, most likely. You know, so it's it's uncollected debt. And so they told me all these things, and I said, okay, let's have a conversation here. What if whatever we contract for amount wise, I pay you within 30 days? I'll even pay you the same day if necessary. What if I take on all the employee out-of-pocket risk so that you don't have to collect it? I'll deal with it internally or I'll pay it myself. Give me a good enough price, I can afford to pay it and not ask the employee for that money and then send them to come work with you instead. No denials. By the time it's gotten to you, it's already been approved. We're not going to have some insurance company hire a third-party independent company, you know, that's based in Slabobia somewhere that goes through the um peer-to-peers with the doctors. All those things I want two things. I want a better price, and I want the ability to publish the contract that we signed on costpluswellness.com so that any other employer can either use it with you or use it as a template with another provider.

SPEAKER_00 7:22

Yeah. And where are you locally specific? I know you've got like a very strong base in Texas. I saw you expand a little bit in the radiology group out in the mountain states. Educate the group of where you are now, where you're going.

SPEAKER_01 7:36

We've got about nine, 10,000 doctors right now across all. Most are in North Texas for obvious reasons. That's where we're based. But I'm going talk to orthopedic groups, I go talk to associations, and we're now starting to get them in Idaho and California and Montana, you name it, right? Florida. One by one, we're getting more providers who are posting their contracts. And not just providers, but auditors. So if you want to audit your claims, TPAs, you name it. We're trying to expand it into other things, but also realize that even if we don't have a provider based in your area, you can take the contract and go to a local hospital and say, hey, I'd like the same deal. Can you offer it to me? And there's a good chance we'll say yes.

SPEAKER_00 8:20

I really, really like that. What clinical services are offered at cost plus wellness today, and where could that expand to over time?

SPEAKER_01 8:27

We don't ourselves offer any clinical services. Yeah. We're just an open source platform. So all different types oncology, cardiology, right? HIPR, a lot of ASCs, um, a lot of DPC, a lot of primary care doctors, you name it. There's a lot of variety.

SPEAKER_00 8:42

I love that. Very, very cool. What should employers understand about what's buried within their PBM contracts that could have a significant impact on what they're ultimately paying?

SPEAKER_01 8:53

Um your PBM contract, your insurance company contract, all of them. Run them all. Every healthcare contract you have, run through CLOT or whatever, and just say, where am I getting ripped off? You will be able to do that.

SPEAKER_00 9:06

Well, there's probably everywhere, but there's everywhere.

SPEAKER_01 9:10

No, it is everywhere, right? So always on spread pricing, the price they pay, the pharmacy versus what they charge you, right? The float, you know, when they charge you versus when you get your rebates back, whether or not they retain any rebates. They'll do things like they'll classify rebates differently from fees. So what they'll say is, yeah, this is what a rebate is, but it only applies to brand medications, doesn't apply to specialty. And now because there's so much scrutiny on rebates, they're getting smaller rebates and they're okay with that because they're charging fees to the brand manufacturers who are paying them this fees, you know, to offset from what they were confiscating from rebates. And so you want to make sure that you go through all the details, and that's why I say use the LLM because our eyes roll back in our heads whenever we try to get into the minutiae and the small print of all these hundred-page contracts or more. They're hundred, you know, they're huge for a reason because they know there's not enough coffee on the planet for anybody to get through all that shit. And so you've got to be able to go through and realize that every single definition, every single word in your contract is being used to take advantage of you. You can't assume that you understand what a word means in that contract. And you can't uh assume that even the numbers that they put in there are going to be accurate and not just there for examples or to try to convince you. There's always such an information asymmetry where they've done this millions of times. This isn't your core competency, it is their core competency. They're looking for every angle they can find to take advantage of you.

SPEAKER_00 10:50

Yeah, they want to make everything opaque and uh confuse people more than anything.

SPEAKER_01 10:55

I'll give you a perfect example of something to ask for that they'll never suggest. Because one of the games they play is, well, we we did everything the company asked for, right? You you don't know what to ask for. That's not your job, right? You're trying to trust a broker or consultant or the insurance company, they're they're not going to do everything, they're gonna take the path of least resistance like everybody else.

SPEAKER_00 11:19

Yeah, and a lot of brokers and consultants, they make significant fees off of keeping certain customers on the same carrier, same PBM.

SPEAKER_01 11:28

Sure.

SPEAKER_00 11:28

When you see how they're actually compensated, some of them, there's some great ones, and I'm friends with a lot of the ones that are thinking innovatively, but the ones that are, you know, work in the legacy business model, they're making more from their PBM or carrier partners than they are their clients. So who are they really?

SPEAKER_01 11:46

Sure, right? Oh, it's crazy. The coalition, I think they call it, right? Those guys, right? Some brokers getting paid per script from the PBMs. I've gotten offered $10,000 a month, you know, if I bring any of the people that come to Cos Plus, you know.

SPEAKER_00 12:02

Don't they know any better by now, Mark? Don't they know any better?

SPEAKER_01 12:04

It's just like, hey, I'm a salesperson. I respect the effort. I said, look, I respect the question, right? Because I'm a sales guy at heart. It doesn't hurt to ask, but come on. And so what is it? Is it the 1100 form? There's a form or 1050, maybe what's it called? I know what you're talking about.

SPEAKER_00 12:20

Julie Solezovic and that crew knows exactly the number.

SPEAKER_01 12:23

Yeah, they know that stuff cold, right? But um, there's a form that your carrier slash PBM has to file that shows all compensation received. And it's an ERISA form, and I think it's 1050. And what they'll do is they're supposed to say every penny that's paid relative to what they're doing for you, whether it's your 401k, whether it's your benefits program. But I had no idea that existed. Literally up until last year, I had no idea that that existed. I didn't know.

SPEAKER_00 12:55

Well, you're a quick learner.

SPEAKER_01 12:56

I love it. I'm trying, right? It's just like most employers are not going to know this stuff. And so, again, I would trust an LLM over a broker that I think doesn't have my best interest at heart. You know, and I would just keep on asking the LLM questions, and it's not always going to be right, but either is your broker, either is your consultant. And you have the opportunity to take, okay, here's Clyde, here's ChatGPT, here's Gemini. You know, take the output of one, put it in there and say, where am I getting ripped off? What did I get wrong? Do it again, and just, you know, circle through. And you'll get to a decent point. And always put your contracts in there. Always, always, always, always.

SPEAKER_00 13:39

Yeah, really, really good advice. Well, just know you have a lot of foot soldiers out there like fighting the fight with you. Uh, quite a bit. So, when you went self-insured, where did you see the most savings and the most value created by going that route? I have my own guesses, but I'm just interested in your organization, your population, what you saw.

SPEAKER_01 14:27

For self-insured, the full plans, you know, we're just too big for that, right? Yeah. And everything I heard, right? If you have a good year this year, okay, great. If you have a bad year and it's expensive, they're more than compensating for it. They're never taking a loss over a multi-year period.

SPEAKER_00 14:43

No, they own the casino.

SPEAKER_01 14:45

Yes, they do. They do. 100%, best way to put it. And then on the self-insured side, yes, there's more risk, but once we understood the stop-loss game, right, and how that's played and did it, and you know, using um a wraparound network, which I hate, but at least we got in there initially, we're starting to go away from that now. Then it gave me more control. And it was really a matter of getting to a TPA, we use Sage that we could trust, right? And making sure it was independent as opposed to one that's owned by the same companies. I mean, like they don't come out and say, hey, we're owned by this company. And because one of the things they all own one, the blues, you know, they all own one for sure.

SPEAKER_00 15:23

Uh you go down the list, they all own a large TPA, and they always try to make it obscure that there's any relationship.

SPEAKER_01 15:30

Always. And like what I learned, and I was so slow, you know how sometimes you figure something out, you're like, how the hell did I not figure that out sooner? Right? How did I miss this?

SPEAKER_00 15:39

We've all been there.

SPEAKER_01 15:40

Yeah, and so it was like I was just look at the PBMs, and the PBMs are bad guys. Yeah, they're affiliated with or owned by. And then it dawned on me like, okay, it's like Shark Tank, right? If one company owns another company, the culture is the same.

SPEAKER_00 15:55

And it's a shell game. If one is regulated, they just shift the profit to the other.

SPEAKER_01 15:59

They just shove it somewhere else, right? That's how they game MLRs, that's how they game a lot of things, right? And so you're right. Once I learned a lot of that stuff and realized that the contracts that I thought might be fair, people I could trust, nah. There's none of them that I'm going to trust. And so that's what got me into self-insuring. And then that quickly, very quickly, led to the direct contracting.

SPEAKER_00 16:24

Direct contracting is the best way to achieve value. And the hospitals were really smart a long time ago, where they made all of their primary care visits free for the patients. And everyone said, Oh, the hospitals are amazing. They want to get everyone primary care. Like they didn't do it out of the goodness of their heart. They knew they'd use it as a loss leader. They'd bring people in, have a very, veryfer to very high margin areas. And the areas that groups have been able to find and you know, vendors have been able to exploit are surgery, cancer, substance use, imaging, specialty infusion. And the jumbo employers have started to achieve direct contracting advantages. The ones that are locally focused and have like a very big hub of employees all in one place can actually directly contract with large health systems or unaffiliated.

SPEAKER_01 17:20

Yeah, and you don't have to you don't have to have a big group like we do here or a hub, right? Because you can do carve outs. That's what I'm telling big companies now, right? You have enough hef, right? You have enough scale that even if you're afraid, your HR people are afraid to move to all direct contracting because that's a lot of work, right? And it's gonna take hiring more people, it's gonna take a great TPA, et cetera. And you might have employees or family members who are afraid of that. You're big enough to say, we're gonna carve up hip replacements, we're gonna carve out direct primary care, we're gonna carve out all these things one at a time, and then next year, after you look at your claims, if you can get them all, you add one more thing, and then the next year another couple things, and then the next thing you know, in five, seven years, you're direct contracting across the board. You have an internal TPA that's you know shopping for you, so even if it's out of network, because you can go out and negotiate a better cash price with no patient out of pocket out of network than your insurance company is offering you in network.

SPEAKER_00 18:20

Yeah, like you mentioned on LinkedIn a couple of weeks ago, why is an MRI $2,000 went down the street at $250? There's actually companies that do that in surgery, cancer, and even imaging. There's actually a group, we've had them on the podcast, um, Elon Adler, CEO of One Imaging. They do exactly that for large enterprise employers. They got 55 national accounts that save. Yeah, they just price out, yeah. They just they just price out radiology based on creating their own carve out network sold to employers. So just wanted you to know there are companies doing it. No, I know.

SPEAKER_01 18:53

No, there's there's more and more and more, right? And that's the whole thing. I want to see employers go to those imaging centers or you know that do the pricing for imaging centers. And when you just put in your zip code and they'll tell you the best price and you know, tell you the quality rating, whatever, right? Yes, and that's what big employers, self-assured employers need to be doing more of.

SPEAKER_00 19:14

I like it. I like it a lot. Any other advice for employers that are probably getting taken advantage of on what steps they can take to create more transparency and accountability within their healthcare programs?

SPEAKER_01 19:27

Um, it really depends on how big you are, uh how much leverage you have.

SPEAKER_00 19:31

You know, most people watching are usually in that self-insured group, probably a couple thousand employers.

SPEAKER_01 19:37

Yeah, a couple thousand, you don't have as much leverage as you hope you would, right, versus two hundred thousand, right? Yes. And so the thing to do is you've got to make sure you get all your claims with all the fields. Because they'll give you claims and they might even show you a number, a dollar number, but they don't show you the DRG codes, the ICD test, whatever it may be, right? They don't show you all that detailed data, which makes it very difficult for you then to go through and analyze your claims to see where you could carve out going forward, right? You want to have access to those claims. If you've got a couple thousand lives, I strongly recommend that in your next deal, you require that any cash pays by a member apply to your deductible.

SPEAKER_00 20:25

Yep.

SPEAKER_01 20:25

It's your choice. Like in eight states, they make sure it's allowed to happen with restrictions, right? But it's your company. You can tell them, I want all my cash pays so that if the out-of-pocket or coinsurance is higher than what they can buy it for from somewhere else, yes. And then the second thing is you want to make sure that any accumulators or maximizer programs on any high-end drugs account towards your deductibles. Members will fall in love with, oh, I had a $25 copay on my $10,000 drug, but wait, what? It ran out in October? And now I got to pay the full $10,000 amount because I'm in my deductible phase for that, right? You've got to be able to do that. Oh, you want to hire somebody that, if you've got at least a thousand employees, maybe even $500,000 one person, their only mission in life is to price out whatever procedure, service, care that your employee gets. Because where they nail you, so if you go to hospital A in Nashville, Tennessee, and you call up and you say, Hey, I've got somebody that works with us and they need a hip replacement. And you don't necessarily have one, right? What's the cash price? I'll take care of the employee out of pocket, all that stuff. Give me the different options. I'm not looking for a contract, I'm just looking for a one off. And they give you a price. Then you compare that price to what shows up on your invoice.

SPEAKER_00 21:57

Yeah, that's uh that's great advice.

SPEAKER_01 22:00

And then part two to that is you do the same thing on drugs, right? Cost plus has got 5,000 drugs. We don't have all the brands because the PBMs do everything possible to keep us from doing that. But any specialty generic in particular, any generic at all, whatever you saw on your bill for that, and whatever the coinsurance is or co-pay, compare it to the cost plus price to see if you can get it cheaper.

SPEAKER_00 22:24

Yeah. Tremendous advice. And just remember, employees, if your employer is getting ripped off, it's coming out of your paycheck somehow. Oh, yeah. Higher deductibles, higher premiums, they're not going to be able to give raises. You're going to have to work longer hours because you can't afford to hire anyone.

SPEAKER_01 22:41

Yeah, I'll give you a perfect example, right? Everybody's terrified of their deductible. I mean, not everybody, but most people are.

SPEAKER_00 22:47

Yeah, a lot of Americans have to decide like, do I pay for this or do I get groceries? Do I get gas? Exactly, right? You can create a zero-copay option where it's still cheaper for the employer, then people don't delay care. Zero out of pocket, yeah. Rationing meds.

SPEAKER_01 23:02

That's exactly right. If it's cheaper for the employer, if the deductible was $2,500 and the employee could or couldn't afford it because the um hospital is probably going to finance it for them. So now they've got $2,500 in debt, right? But $10,000, $2,500 net out, $7,500 to the employer, $25,000. If you get that price down under $5,000, then you can have the employer pay for it, nothing out of pocket. And that's like you just gave a $2,500 raise or whatever your deductible is to the employee. I mean, that's money in their pocket. And, you know, you talk about ways to not only save money for the company, because every dollar you save in your healthcare benefits goes right to the bottom line. That's cash flow right to the bottom line. And every dollar you save for your employees for their out-of-pocket deductible copay coinsurance, that's money right in their part, or did come out of their pocket. That's their bank account saying solid because of something you did. That's your responsibility to your employees and your shareholders. If you're a public company and you don't do these things, or if you're a RISA and you don't do these things, you're going to get sued at some point for not living up to that fiduciary responsibility.

SPEAKER_00 24:14

Yeah, your PBM, your carrier, your broker, they don't have fiduciary to your employees. You can't do that.

SPEAKER_01 24:19

Well the laws are starting to change there, but right, they're now writing into the contracts again. We're not fiduciaries no matter what the law says. If you don't agree, sue us.

SPEAKER_00 24:29

Any final things that you would want to share with people interested in maybe dabbling with cost plus drugs, cost plus wellness. They haven't done it before, but they've heard about it. Any anything you want to leave them with?

SPEAKER_01 24:40

So two options. Yeah, I appreciate the opportunity. One, always go to costplusdrugs.com. What makes us different is when you go there and your medication comes up, if it's one of the 5,000 we sell, right? We'll show you our actual cost. Yep. So we'll show you exactly what we pay, and we show you we only market up 15%. That's it. So you know that you can trust us because it's a fair price. And more often than not, we're cheaper than anywhere else. Almost always, right? Good or X, whoever. And so that's option one. Option two is demand that your PBM at costplusdrugs.com to their network so that it's available within the insurance because we'll work with the PBM to do it and do it via insurance. Now, what the big PBMs are going to tell you, oh, you don't need Cost Plus Drugs because we have this cost plus program, or we have this true cost program, or we have this cost plus whatever program. They're so full of shit, right?

SPEAKER_00 25:36

Yes, they are.

SPEAKER_01 25:37

So full of shit. Because they're gonna take every chance in every game they play. That's another one. And then finally, these PBMs, the big three PBMs, will tell you that their mission is to protect you against the big brand manufacturers. Big pharma rips you off, right? Here's all you have to ask. You just have to say for my employees, I want them to pay the net price during the deductible phase. The literal net price, so that for their out of pocket, that's all they pay. So for Zorelto, which is a $600 list price, $300 rebate, right? Your employees paying $300. Because right now, during their deductible, they're probably paying how much? $600. Right? Absolutely. That's just such a ripoff. This PBM saying that they do a great job negotiating, and they're causing your employees and their families to pay list price for a medication at the pharmacy. So those are the things that you want to ask for. They may or may not give you, and if they don't, bid it out somewhere else.

SPEAKER_00 26:42

Yeah, like the employer is the customer, the biggest customer of the health plans, the biggest customer of the PBMs, biggest customer of the brokers. No one's taking care of them, no one's doing the right thing. And employee benefits leaders don't know how much power they truly have if they actually organize. Health plans, they organize. Health systems, large pharma, big PBMs. The employers, they're getting there, but I appreciate everything you're doing to push things forward and really giving them the courage to advocate. Because we've got a really exciting opportunity in healthcare over the next couple of decades. There's going to be groundbreaking breakthroughs with cancer, Alzheimer's, with dementia. But if we don't change, it's going to be sadly people like us that can afford it and people who can't. And like who lives and who dies should not be about what your financial abilities are. Like you can't put a price on a life, and that's sadly where this industry is headed if we don't see some reforms.

SPEAKER_01 27:44

No, I mean you're exactly, exactly right. Your car insurance doesn't tell you how much it costs to get a gasket fixed in your car, right? Your home insurance doesn't tell you how much it costs to replace the windows. Your healthcare insurance does tell you how much it's going to cost and how much you're going to be charged. That's insane. But to your point, you nailed it, the employers have that leverage. And BG, I always get their name wrong. BBGH or PH, I forget.

SPEAKER_00 28:12

BGH, Business Group on Health.

SPEAKER_01 28:14

Yeah, the professional business group on health, right? Uh-huh. Go join them all, right? And I was just there at their meeting. They're going to hate me if they hear this that I couldn't remember. Because I, all these, there's so many damn acting.

SPEAKER_00 28:24

Well, there's the Midwest one, there's Dallas Fort Worth one. So it's a little confusing, but it's all the same parent organization. So you support one, you support them all.

SPEAKER_01 28:34

Good. So go join, right? Because they're really, really smart. Elizabeth there is really, really smart, and they do a great job. And so be part of those organizations like you brought up because we can't wait for politicians to fix this. All the power is in the hands of employers. Are you going to run, Mark?

SPEAKER_00 28:52

Can we count on you? No.

SPEAKER_01 28:53

No, no, I'm going to let you down. 67% of employees are covered by self-insured employers. And so everybody watching is part of that strength. And you can demand, don't be afraid of it. Hire somebody to manage those economics. Let them be your internal TPA. Let them be your healthcare CFO. If you can schedule it, you can negotiate it.

SPEAKER_00 29:17

If you can schedule it, you can save. And uh ultimately, employers are paying 254% of Medicare rates. That's not a hospitals to lack.

SPEAKER_01 29:27

It's more than that. That number is wrong because that doesn't incorporate the yield, right? So hospitals are making actually less than that. So employers are getting ripped off even more.

SPEAKER_00 29:38

Yeah. So essentially the American employer is floating the American healthcare system.

SPEAKER_01 29:43

And multi-hundred billion dollar companies, your company is floating them.

SPEAKER_00 29:51

Well, hopefully all that you're doing to educate the market is going to allow benefits leaders to be even more brave and CFOs and CEOs to pay more attention because you could try your hardest to increase revenue 33%. But if you just remove trend line, you know, maybe a couple percentage points, you actually get that in your EBITDA.

SPEAKER_01 30:14

And I'm telling you, unless you have something bad happen to somebody, if you go to direct contracting, your cost will go down.

SPEAKER_00 30:21

Yep. Right? We all face that.

SPEAKER_01 30:23

If somebody's in some of the bad circumstances, right, costs go up. But direct contract, your cost will go down. Check out costplusdrugs.com, costpluswellness.com.

SPEAKER_00 30:33

Hell yes, brother. Well, thank you. Really enjoyed getting in the ring with you and keep fighting rising health care costs with us. Thank you for all you do, Mark. You're the best.

SPEAKER_01 30:41

Thank you. Thanks for having me. This was great. I really appreciate it.

SPEAKER_00 30:43

Awesome. 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.