Healthcare And What It Means To You with Fred Meijering

JFS 21 | Changes In Healthcare

JFS 21 | Changes In Healthcare


Healthcare is changing very fast, and the industry is trying to figure out which way this sector is going to go. It is important more than ever for healthcare professionals to move together with this change to avoid being in the losing end of the stick. In this episode, Fred Meijering, the Market President at Echelon Advisors, LLC, covers the healthcare industry – from what is happening now to the amazing opportunities it has in store for CEOs and CFOs who are looking for a better way to provide coverage without reducing the needed benefits. Fred starts by going right into the Affordable Care Act and how it affects the American worker, employer, and business. Moving on to the positive aspects, he talks about the captive market and the salient opportunities it offers.

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Healthcare And What It Means To You with Fred Meijering

This show is for CEOs, CFOs, human resource department heads and professional salespeople. In this episode, we will be covering financial products, insurance products, risk management, professional employer organizations, administrative services only, commercial real estate, mergers and acquisitions and financing of M&A activities. We will interview CEOs that are making a positive change for the American workers. Our program is designed to rediscover what made America the greatest country in the world. It is also designed to help keep America great. America has its problems and you can spend decades to find out the whos, the whats, the whens and the hows because you already know where. The question is, “Are you going to spend all your time wallowing in the problems of America or are you going to be the answer and be part of the new American Revolution that is at our doorsteps?”

America is going through a lot of changes right now and you can sit on the sidelines and complain where you can get in the game and make things happen. If you don’t like your direction, then change. You do have free will and you can change. Just like a switch turns on the light, that quick. Change happens that quick, once you make up your mind to do it. You now will need to make a decision, a real conscious thought, “Can I learn what made people rich? More importantly, can I learn and do the true secret that made them rich?”

I would like to read something to you from Earl Nightingale. If you’re not familiar who Mr. Nightingale was, let me read a little bio on this great American leader. Earl Nightingale was an American radio speaker and author dealing mostly with the subjects of human character development, motivation, and meaningful existence. He was the voice during the early 1950s of the Sky King, the hero of a radio adventure series and was a WGN radio program host from 1950 to 1956. Earl Nightingale was the author of The Strangest Secret, which economist Terry Savage has termed one of the greatest motivational books of all time. You can find out more about Earl Nightingale at Mr. Nightingale was also a United States Marine.

In this particular recording that I’m going to read just a part of, the value of the numbers have changed, but the percentages have not changed much at all. It’s that information in which I would like to visit with you about. We live in a world of consumerism and we have forgotten one of the greatest secrets out there for success and successful living. I’m going to cover some of the greatest men and women in American history and this might give you an idea that will change your life for the better forever. It only takes one idea that could totally change your life. You see, the laws of nature are without change. If you learn these laws, you can have anything you want in life. The law of lift was and has always been here. We just discovered it when the Wright brothers grabbed that thought out of the ether. The question is, “Why?” The answer might surprise you. They were looking for it, that’s the answer. What is the next great discovery the whole world is looking for and the idea could come to you if you’re looking for it?

There is a story about two shoe salesman that were sent to a far country. As soon as the first salesman saw that no one had any shoes, he telegraphed home and said, “Get me the first flight out of here. No one wears shoes here.” The second salesman also sent a telegraph and said, “Send me more shoes. The market is wide open.” The second salesman had an attitude. He was looking for an opportunity. The field is ripe for the harvest, but the laborers truly are few.

Let me read you this little piece from one of Earl Nightingale’s great recordings. From the earliest writings of men, we know that the human race has been comprised of the haves and have nots. When I was a kid back during the Great Depression, I observed with a great desire to know the invisible is something that separated the haves and the have nots, being a have not myself. I wanted to know why so few manage to be well-off financially in this country for success is available to everyone. For example in checking, the statistics abstracts of the United States published by the Bureau of Census, I discovered that only 10% of the men in this country, 65 years of age and older, have incomes of $6,000 or more.

[bctt tweet=”We are going to see in 2019 and 2020 mergers and acquisitions of doctor groups because they are unwilling or don’t know how to make one of the biggest changes in history. Stay tuned. This series is going to be very exciting for all concerned with any aspect of healthcare.” via=”no”]

More than 80% of all men 65 years old have incomes under $4,000 a year. Only 7.6% of the incomes between $7,000 and $10,000 a year and only 3.7% have incomes of $10,000 a year or more. A man starts his working career in his 20’s, often earlier. He’s fortunate and that he lives in the free world. He has better than 40 years to make it great financially and the richest country on earth. Yet according to the statistics, only 10 out of 100 will be financially secured by the age of 65 rolls around, and only four men out of 100 will be financially comfortable. Why? Let me tell you how you can find out for yourself. Conduct your own surveys. Start down the street in the neighborhood on a Saturday and Sunday and asked the man of every house two questions. The first question is, “What are you doing at the present time to increase your income?” That is how much do you want to earn? When you’ve evaluated the blank stare you’ll get in response to that question, ask question number two, which goes, “How much money are you planning to be worth at age 65?”

When the silence becomes too unnerving, thank him and move on to the next house. Ask 50 men, 100 men or 1,000 men until you’re completely convinced that the reason men don’t make more money during their working lives and the reason more are not financially independent by the age of 65 is simple. That seldom, if ever, do any constructive thinking on either subject. It’s that simple, unfortunately. The reason it’s so easy to earn more money than the average man earns in this country is that very few are going about it the right way. This is the race without enough contestants to bother about. The few who are in the race can all be winners. Some will finish ahead of others, but even the man who finishes last in the race will be financially secured.

Most people, more than 90% aren’t even in the race. To prove it, ask yourself the two survey questions. Up until the time you started reading this message, what were you doing to plan to increase your income? How much do you want to earn or how much money have you decided to be worth at the age of 65? People who earn large incomes aren’t lucky and they’re not crooks, as those without money who are so fond of pretending. Nor are they endowed with more brains or talent necessarily than their friends or neighbors, nor are they privy to an occult secret and only a few were lucky enough to have rich fathers or grandfathers.

Most of the people earning big money start the same way you and I did and most other people. The only difference between the man who earns big income and those who earn a small income is that those earning big incomes decided to earn more. They’re the people who made it their business to earn more. You see, a woman who does not think about making an apple pie for dinner will never think of looking up a recipe for the apple pie. Without a decision for pie, there’s no motivation for checking out the recipe. A man who does not think about driving his car to St. Louis, Missouri or to Nacogdoches, Texas will never get a roadmap which shows how to get to St. Louis or Nacogdoches, Texas. A man who never decides to earn more money will never think of learning how to look up the rules for earning more money.

You see, people do with a make up their minds to do so. Get rid of the ancient superstition. Once and for all, the people who are earners of big money are special people or lucky or get the breaks or had money to begin with or knew someone or are smarter than anyone else. These are all alibis and they can all be disproved a thousand times. The reason there are so many of these alibis around is that men who fail to make great financially are seldom honest enough just to admit that they didn’t try and keep trying. In order to justify their failures, in order to remain seated, they dream up and pass along these old alibis. We’re all self-made, but only the successful will admit it.

Once I had an occasion to visit Charleston, South Carolina. I had never been there, so I hired a taxi to drive me around the historic town. I particularly wanted to see the battery where the famous shots were fired on Fort Sumter along this beautiful drive of Charleston’s oldest and finest homes. I looked over the bay. I commented to my cab driver on what lovely homes there were and he said, “Some of those homes have 40 rooms.” Then he thought for a moment and said, “Every one of them is owned by crooks.” This is how the have nots justify themselves for their lack in life. I didn’t say anything because I didn’t feel I was entitled to advise him or to straighten out his thinking. This is a free country where as long as he doesn’t hurt others, anyone has the inalienable right to be just as wrong as he wants to be.

JFS 21 | Changes In Healthcare
Changes In Healthcare: The secret to success is simply this – sit down and make a plan to save 10% of everything you earn.


As Thomas Lansbury, the American scholar and educator, put it, “We must view without profound respect the infinite capacity of the human mind to resist the inroads of useful knowledge.” My taxi driver and men and women just like him all over the world have been kidding themselves, holding themselves down and refusing the bounty and abundance of the world for centuries. Knowledge is available to everyone. We can either listen to those who are qualified to teach us or we can go along with the ancient stumbling blocks we get from people who don’t know any more than we do. The truth, incidentally, about those homes along the beautiful drive is that they were built by the men and women who made the largest contribution to the City of Charleston. In just a moment, I’m going to give you the formula for getting rich, but before I do, I want to remind you of something.

Before a jet pilot begins his takeoff from the airport, he carefully goes over a checklist item by item. He does this not only because it’s required by law, but because he cannot afford to trust so important a job to his memory alone. He has another checklist that he goes over just as carefully before he begins his letdown at his destination. He does this without fail every time he takes off and every time he lands. I think living successfully is as important as flying an airplane and because of this, I think each of us needs a checklist. That was a little bit from Earl Nightingale, one of the great American heroes.

In each of our segments, I will cover a little bit from each great American hero that has encouraged us for decades. Some of these great writings and some of this great history sometimes gets slid away out of our sight, but the principles are very valuable because these principles could truly change your life. The secret to success is simply this. Sit down and make a plan to save 10% of everything you earn. Most Americans have never had that idea before. Therefore, it’s not in their budget. They go along, as the hamster on the wheel, busy about their lives and make millions of dollars over their career and at age 65 have virtually nothing to show for it. It’s important for you to make contact with someone that can put such a plan together for you.

Procrastination is the mother for failure. People don’t plan to fail, they fail to plan and that’s why we have the society that we have now. They spend all their working years accumulating things that they don’t need to impress people they don’t like. It makes good sense for you to sit down and make a plan. If you’re unable to do this, find a financial planner that will sit down with you to make sure that you reach your goals for the most important time of your life, retirement. We have a great guest and we’re going to talk about the healthcare crisis, but don’t only talk about the crisis, but discover a solution that a lot of employers have a great deal of interest in knowing more about. With that, let’s get right into our episode.

Joseph Farley, it’s Fred Meijering.

Fred, how are you doing?

[bctt tweet=”Obamacare made congress the only large employer in the country that can make tax-free contributions towards its employees.” via=”no”]

I’m doing great, Joseph. How about you?

I am doing just fine. Let’s get into this.

I’ve been on both sides of employee benefits on the employer’s side and on the broker side. Lately, I’m in the consulting space on alternate risk financing, which we can talk a little bit more about, but it has to do with how to pay for that coverage in new and different ways.

Fred, let’s go back a little bit and explain to the audience what Obama did to the healthcare industry and how Congress exempted themselves from this and put this tax on the American worker. What’s moving forward with the new administration changing some things up?

The ACA, the Affordable Care Act was 1,440 pages. I just want to call out a few of the significant things that created the pain points. A chief among those was the subsidies available to the uninsured across the country. Although on its face that is a good thing to do to provide coverage to people who can’t get it, there were some consequences to that that said that wasn’t favorable for the rest of us. Number one from that list is who pays for those subsidies. The rest of us who pay for health insurance have got to bear that cost in the form of premium in our group plans and even their individual plans when we were not eligible for a subsidy. As that went on, there was a huge amount of pent up or deferred healthcare needs in the uninsured that all of a sudden exploded onto the utilization of medical coverage market that was somewhat anticipated but not as full impact. All of a sudden, all of these folks are paying little or nothing for health coverage are coming in and getting those services.

Although they were, in most cases, likely needed, it overwhelmed the system. Very quickly those subsidized plans and those carriers offering coverage in the health insurance market were overwhelmed. Even passing those premiums onto others who couldn’t keep up with that utilization and it made it completely unsustainable. Many of those carriers pulled out of the exchanges altogether. It’s shocking how many counties in the United States don’t even have one carrier option on the exchange. The vast majority of counties have very few carrier options and plan options. It didn’t work in the way that it was intended, although the high costs for the people who do pay for health coverage remain.

JFS 21 | Changes In Healthcare
Changes In Healthcare: The universe of captives is as broad as the universe itself. It’s hard to talk in a specific way about something so general.


The other item that was a huge challenge for the American employer was the employer mandate, which required companies of certain size to offer not only minimum essential coverage, but minimum value plans to their employees. Whether or not they could afford it or whether or not their business wanted to offer that, that choice was taken away. The threshold for that is 50 employees and up. If you’re in a business where you’re making it and trying to grow and trying to do the best you can, now all of a sudden you had this unfunded mandate of that you had to deal with. Joseph, I can’t tell you how many times I’ve heard companies say that they would rather cap their growth as a business than to go north of the employer mandate. You can think about that what you want, but it’s an unintended lid on the growth of American business in this country. It’s an unfortunate circumstance.

You talked a little bit about the exemption of Congress, which is a fascinating study that in as brief as I can do it. Back when President Obama was implementing Obamacare, he promised that members of Congress would not receive anything that’s not available to the public. The Obamacare explicitly requires Congress to live under the same rules as everyone else by kicking members and their staff out of the federal employee health benefits program and leaving them to enroll in health insurance to do the exchanges like everybody else. It was I think at that time and attempt at leadership, if it’s good enough for you, it’s good enough for me, kind of thing.

Contrary to those assurances. In violation of federal law, the Obama administration shielded lawmakers from the effective pay cut of around $12,000 per person with several types of special treatment unavailable to the public. For example, it deemed congress eligible to participate in Washington, DC’s small business exchange that both federal and DC law prohibited. That form of special treatment gave rise to another. It made congress the only large employer in the country that can make tax-free contributions towards its employee’s exchange plan premiums. I think it’s important to note that cut is against federal law. As I think about it, and here’s my little editorial on that topic, Joseph, if it wasn’t good enough for Congress, is it good enough for America? Anyway, those are the chief takeaways from the ACA and a little bit about that exemption.

Now they’ve discovered this and as a matter of fact, Gruber that had designed all this, there’s a lot of bad press out there about how he put this together, that the American people are stupid or not paying attention or so forth. I think it’s the American people that are keeping their heads down and plowing and hoping that a congress would do the right thing. It’s turned out that it gets back to, “If you want to keep your doctor, you can keep your doctor.” That’s not the way that this thing turned out. The spooky thing about this is the bureaucrats are getting ready to take another stab at this. That’s why it’s important for the employer to be ahead of the curve and know what’s getting ready to happen and what’s going on and how they need to get into a good position before they change this thing again.

I think that’s a good point, Joseph. The landscape of this thing changes every day. What’s interesting about healthcare is it’s been a political football for about as long as it’s been around. When each party gets into power, they try to do what they think is right and impacting that, and then sometime later the other party gets into office and they try to move it their way. What you end up with is a program that has remnants from both political affiliations on it that makes it totally dysfunctional and weird. If you think about covering any insured interest, for example, like for your car. If you acquire a new vehicle, you call your insurance company and give them the year, make and model the mileage, the VIN and then three minutes later you have a policy and an insurance card.

If you want to get health coverage, I can talk for the next several hours about how complicated that is for anybody, “Am I an individual looking for individual coverage that hardly exists? Can I join my group plan and when can I do that? What are the rules around open enrollment and do I have any options?” The answer to that question is you don’t. There are no options on the individual exchange and at work. You get the policies that the boss chooses to offer. There are many things that complicate that. We take that as what it is, but when you look at it in terms of how any other insurable risk is handled, it’s bizarre.

[bctt tweet=”Healthcare has been a political football for about as long as it’s been around.” via=”no”]

It’s very complicated and that’s why we put together at Farley and Associates the piece that our agents go out and explain the coverage and sit down with the individual employee and go through it. If need be, then the agent will be available to sit down with the family and make an appointment, go out to the house and show them the policy. Here are your cards. Here’s how this works. Here are the numbers that you need to call. For the most part, what we see in the marketplace is that the employee comes home, he has a packet that he has no clue of how it works, don’t know anything about it, throws it on the desk or the kitchen table and tells his wife or the husband, “That’s our insurance.” They don’t understand how it works. A lot of people can get in the situation of having an emergency, going to the wrong place, getting the wrong information. They don’t find that out for 90 days until after the bill hits and now they’re stuck with a medical bill because they didn’t understand how the program worked. I think that there’s a great deal of service that can be provided to the employer, as well as to the employees if it’s put together correctly. Let’s get into a little bit about the captive market and tell the readers what a captive is and the history and who set it up and why they set it up and bring that forward for us.

The captive insurance market is largely not known or understood, but it’s relatively simple once you lift the hood and look under it. It offers some salient and advantaged opportunities to take that road. First, the term captive, as it relates to insurance is synonymous with the insurance company. The difference between a captive insurance company and another company is that the captive is owned by private entities or individuals. The universe of captives is as broad as the universe itself. It’s hard to talk in a specific way about something so general.

You can have micro captives that are owned by one person. You can have group captives that are owned by multiple. I think the underlying premise is that it’s one or more people who make a conscious choice to own their own insurance company. It’s up to organizations like Echelon to make sure that they stay in compliance and everything is handled as it should be so that they can enjoy the benefits of it. As it relates to health, specifically in the captive insurance market, I think the primary hallmark is that in that space, we bring consumerism to healthcare spend. What does that mean to bring consumerism to healthcare spend?

If you think about it, Joseph, you as a business owner, if it came time for you to buy new furniture for your offices, then you, like me, would likely look at that as a consumer and say, “What are my options out there? Have I reviewed them all? What are the products made of? What is the warranty? What is the cost? What is the meantime to failure?” All of these kinds of things. The same thing is true if you buy a fleet of vehicles or even your personal vehicle. We’re all over the details of what we’re spending and what it’s for. In this country, in the fully insured health market, we’ve conditioned people to simply look at a spreadsheet and look at prices without regard for what that money covers. Year over year, those prices tend to be anywhere from 5%, if you’re lucky, to sometimes 30% and 40% increases from the previous year.

It’s been an unsustainable path largely because of ACA and largely because of the way that healthcare works in general. I say business owners, because that’s where most health insurance lives in this country. We try to do reasonable improvement things around our budget and manage the cost. The only thing that we can’t seem to get our heads around is what is that healthcare spends increase going to be this year? Is it on par with increases in my revenue? In most cases, it is not. Most companies aren’t growing at 30% a year, but that’s the kind of renewal that we see.

In the captive space, what we do is we identify the owners. Either they come in as a group or if they’re big enough, they can have their own captive and we de-bundle the health plan. What that means is we present the elements that make up your health and pharmacy coverage. We present those to the members of the cap as options where we have gotten competitive bids and set performance standards with each element that’s contained within. Let me give you an example. When we talk about network, claims fund, third-party administration, pharmacy benefit management, stop loss and reinsurance coverage. If one or more of those terms aren’t familiar to you, it’s because your health insurance provider hasn’t let you have optics into those elements. Those elements exist in any health insurance plan, whether it’s fully insured from a BUCA, the Blue Cross, United, Humana, Cigna, Aetna or a self-funded arrangement or a captive arrangement.

JFS 21 | Changes In Healthcare
Changes In Healthcare: There is a growing body of healthcare providers who are forward thinking that want to meet the market as it is emerging.


When you de-bundle, you can bring that consumerism to a balance by climbing all over those contracts and understanding what’s in the contracts, what do they do, what are the performance standards, what do I have to pay for that? You become informed about those elements and can make choices as the owner of that insurance company about that. You would want somebody like Echelon or somebody who understand this market to be able to consult with you and present those options and explain these things. Because for most groups, this is a new thing and understand how those things come together. I will tell you one of the chief ways where these plans tend to be 20% to 40% below market for the same health plan is the fact that we’re not publicly traded. On our priority sheet, nowhere does it say, “Meet stockholder expectation or dividend expectation.” We’re not chasing the profit.

I don’t say that because I’m anti-capitalist because I’m not. We have a different set of priorities for this approach. Our priorities in order are to provide the best possible healthcare for the members, number two, at the best possible price, nothing follows. That looks markedly different from the fully insured market. What’s interesting and I’ve seen these hundreds, if not thousands, of times when you’re consulting with a group about this approach, it’s new to them. There’s an education uphill that you take with them as you’re showing them and providing optics and analytics and insights into these things and helping them with their choices. That takes a little bit more time because they’re not used to it. They’re used to picking number three off the spreadsheets and then grimacing for a year.

There’s a little bit more time involved in understanding this and being informed. Once you get into it, you can take healthcare spend back under your control. Even when you think about things like annual renewal, in the BUCA space, in the fully-insured space, your broker comes in and says, “Here’s your 20% increase. Sign here.” What happens then is that the broker is on the opposite side of the table, almost a conflict of interest because if that employer signs that renewal, the broker just got a 20% increase. That’s not how we operate in the captive space. In the captive space, there’s a line item on the sheet of all costs that the employer gets to see and as the PEPM, Per Employee Per Month. What cost is increasing at renewal time? It’s the insurance cost. The stop loss and/or the reinsurance. Not necessarily the network charge or any charges associated with managing the claims fund or the administration costs or the PBM because they’re all separate.

When you get a fully insured renewal, it’s 20% over everything. When you get an increase of any kind in the captive space, it’s for the part of your premium that’s the stop loss and the reinsurance. If it’s thought that other elements deserve an increase, like the pharmacy benefits management or administration, it has to be separately called out. It’s very rare that that ever happens. An employer gets to see every penny of spend, every penny of revenue and how it flows in and out and who gets what, where. It’s totally enlightening for them and you can see the lights go off because now they can control those elements.

Healthcare is one-fifth of the US economy. This is a massive deal right now and probably will be for the next decade or so. Employers need to pay attention to this issue because their revenues may not be increasing by 20% or 30%, but their renewals in the open market are under a fully insured plan. As far as the captive piece, a decade ago, these things were set up for the larger employers and when I say larger employers, typically over 1,000 employees. The smaller employers, under 1,000 employees, were stuck with the open market. Since this Obamacare came in, we were curious about the silence from the insurance industry of, “Why aren’t these guys throwing a fit about this?” Can you answer that as far as why the companies were quiet?

I think it’s important, first of all, to understand that captive started in 1903 and preceded fully insured. Sometime later when the fully insured market started and they were able to pool back when the risk dynamics were preferable, they took a back seat to that until that risk pool became adverse. When you fast forward to now, 95% of Fortune 1,000 companies are in one or more captive in. Although those are primarily property and casualty and other risks, large companies are very familiar with it. If captives fit into their risk management philosophies and practices, then it’s a great fit and it is something that at least should be considered.

[bctt tweet=”Health insurance is highly regulated and so there’s a lot of alphabet agencies that have their tentacles in there.” via=”no”]

Health insurance is highly regulated and so there are a lot of alphabet agencies that have their tentacles in there. Group health is one that’s impacted by that. What’s happened since the early 2000s both in the fully insured marketplace in terms of premium and then in the self-insured and captive space is that it used not to make sense to self-insure a small group from an economic standpoint because you didn’t have a broad enough risk for it to make sense financially. When you do the math on it, the rates were higher for fully insured. As the fully insured health rates have climbed at these alarming rates, it surpassed the economic numbers in the self-funded space, making it possible for the smaller groups to take a look at that and have that make sense.

Happening at the same time is there are a lot of third-party companies and strategies emerging to help mitigate claims. What I mean by that is not make people go places they don’t want to go, but to understand more that there are options around where people can go. I’ll give you an example. We have an app that shows the price of procedures inside of a specific geo parameter that you put in. You might set it for twenty miles from your current location and then put in the procedure that you need to have addressed. If that’s a total knee or a tonsillectomy or whatever that is, you put it in there, it is shocking the variance in prices from any location. They can vary as much as 300% or 400%. That leaves the consumer wondering why is there such a difference and why didn’t I know about that?

If you’re buying a car, you jump around to the different dealerships wherever you’re at and you can see those prices and quickly know it. It’s not so easy to do that in healthcare and that’s one of the reasons for our app, is to provide optics in that. From a mitigation perspective, some of these third-party administrators in the captive space have made a forward progress by when that claim comes up through the administration system, reaching out to that employee and saying, “Your total knee is going to cost X here and here’s your co-pay and your deductible and here’s the quality rating for that provider. What we want to talk to you about is would you consider this other provider with the same or higher quality rating? The total cost is less than half and we’ll waive your co-pay and deductible.” Ultimately the consumer or the patient gets to make a choice, but it’s an informed choice. Somebody is doing their homework. When you take a $30,000 claim and you cut that in half to $15,000, that’s another $15,000 that sits in that claims fund for the next person’s healthcare need. It’s strategies like that that can begin to control that claim spend instead of just letting it be willy-nilly, whatever comes through, what price is it the highest and go forward.

There’s a tremendous shift, there’s a large dynamic that’s changing in the healthcare space, not only with the products that you guys have put together, but also there at the hospitals. I was talking to a buddy of mine that runs a hospital. He was telling me about the physicians and the RNs that they can’t keep the RNs. They’re in such high demand and the doctors are getting a 10% increase and it’s very hard to keep the doctors. Each year the doctors are expecting that 10% increase. Prices are getting driven up from the provider. If the employer wants to be able to bypass at 20% and 30% increase, they better get armed to be able to counteract this with an app that you guys have. I think that app is amazing because when you look at that and see the price difference in your own city, “Why does this hospital charge X and this hospital charge Y if for the same service?

The good news about the points that you made that are all reality is that there is a growing body of healthcare providers who are forward-thinking that want to meet the market as it is emerging. We see the rise of things like DPC, which stands for Direct Primary Care programs. We work with about three of those right now. It’s a cool program. In general, how that works is that the employer pays a fixed monthly cost for all of the enrolled members on the plan. It would be the employees and the dependents and they figure out who pays what part per company policy, but they pay a fixed cost every month.

For the vast majority of things that an enrolled member would need, they simply call and make their appointment and go get it done at no additional cost because it’s covered by the fixed monthly cost. If there’s something that surpasses the scope of the services offered by the direct primary care network, then that would fall to their normal health insurance, but managed more than the exception. This is a powerful strategy, Joseph, for employers to begin to transition their healthcare spend into more of a fixed cost without the huge annual increases.

That’s all we have for now. Thank you for joining us. Remember this, the secret to your successful future is in your daily routine. We’ll see you next time.

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