Care Navigation Employees Actually Love (with Matt McQuide)

Hey. Hey. Welcome back to the bullpen sessions. My name is Andy Neary, and this is episode 301. I am excited. Today I sit down with founder and CEO of Synergy Healthcare, Matt McQuide. Listen, when it comes to health insurance, we all would like to bend the trend, right? That is a common theme in the industry. What are you doing to help employers lower their overall health care and health insurance costs? And for years, we've expected employees to take care of themselves. We've expected employees to engage with their benefits, and we've expected employees to want to live an optimal life of health. But let's face it, that's just not the case. And what Matt's doing with his solution at Synergy Healthcare is second to none by with his program of embedding nurses into an organization. So an entire team of employees just works with one nurse. And he and his team of nurses are getting absolutely fantastic results because we have learned employees are not going to engage on their own. They need somebody to hold their hand and help them engage for them. So I'm excited for you to listen to Matt's story. What led him to build Synergy Healthcare and what he is doing to help organizations do what we are all trying to do, bend the trend on health insurance. So tune in, sit down, you're going to love this episode. And by the end, heck, I'm willing to bet you're going to want to reach out to Matt to learn how he can help with some of your clients. All right, tune in. Here we go. Episode 301 with Matt McQuide. Hey. All right. I am joined by Matt McQuide, founder of Synergy Healthcare. Matt, I'm excited to have you on because, you know, we operate in an industry where a lot of outsiders come in to disrupt the industry. You know, a tech person comes in with a tech solution. Somebody from the healthcare industry comes in with some kind of healthcare solution. But whenever I see an advisor who actually sees a problem and then sets out to fix the problem by creating their own product, I really love to talk about that. You've done that with Synergy Healthcare. But before we dive into what it is and how it works, talk a little bit. You've been in the industry for quite a while. What led you to wanting to fix the problem of care Navigation? So take us back maybe 20 years when you were advising, what were some of the problems you were seeing?

Yeah, sure. So I appreciate you having me on. Appreciate that a lot. So, yeah, I entered the as a consultant in 1999. And you know, I think we all have sort of that first big client that made a difference in our career. And I remember it like yesterday in 2003, a large textile manufacturer hired us and they brought us in, went through an RFP process. They brought us in, big table, conference room and, and the CEO looks at us and says, the reason I fired the last person was because they stopped bringing me new ideas. We have to stay in business. I don't want to put more on my employees. I don't want a cost shift. We need ideas that will make us innovative and help our plan and our costs and our people. And that'll open your eyes, right? So your largest client says that and you start looking around for solutions and what can happen and you realize that you personally are tied to the outcome of how this plan runs. And so we looked and for things that would help pricing and various things in the health plan that most people would look at. But the number one thing we realized was the lack of employee engagement in their health. Like literally we could improve healthcare by just having people reduce health risks, actually follow treatment plans, engage in the solutions that we had. And the surprising thing was that it wasn't actually that hard to do. You just needed to look past the solutions that had the same efficiency to effectiveness problem that healthcare has in its first place. Like everyone's trying to get off on the cheap and the easy. And the reality is people need real help, real people that care about them and can work through a very complex situation. And so that was the start of it. And the first thing I ever did was put in an on site medical clinic. And we've moved to care navigation from that. But what I learned from the on site medical clinic was that a making something easy, free with a relationship actually moves people. They actually improve their health, they lower risks. They weren't just, they didn't just not care about their health, they needed help. And so it has expanded from that. Because of the complexities of the healthcare system.

We'Ve moved beyond on site care. And now care navigation is, is, is the key to that. But that's how I got into it was because I was actually tied to the result and keeping that client.

No, you, you bring up really relevant points that I was thinking as you were discussing. We talked about this offline. You know, the original model was the on site clinic, right. Nearsight on site clinic. And I, I kind of feel like that was the, if we build it, they will come. And yeah, there are some case studies where on site clinics have done some Amazing things. But let's be honest, overall, even with the cost of building out a clinic, the engagement has not been what it's supposed to be. And all we got to do is go back. We've been talking about employee engagement for years now. And as we do this, health insurance costs only continue to go one direction, and employee health in this country only continues to go in one direction. And so as costs get worse, so does employee health. And yet we've been talking about engagement for quite a while, quite a long time. In your opinion, why, despite all these solutions, why is employee engagement in their own health care still so terribly low?

The essence of it is that health and health care is really hard. And so people are trying to solve things with an easy solution for something that's really hard. Look, our health, all of us, almost all of us just say healthcare, our health is a long term problem and we all have short term issues. So almost all of us kick the can down the road because we have things going on in our life that we can't imagine addressing that now. And so that is really easy to do. And then when someone decides to address it, what they run into is a brick wall of problems and complexities. And that same textile firm that we had, the original on site clinic, one of the things that we noticed is we did improve health, but eventually costs started going up. And when we looked at it, what we realized is that's fantastic. We can lower health risks and we can, it's fantastic. We can get more people on medications, but when they're accessing the healthcare system, it was way beyond what an on site clinic can do. The actual going through prior authorizations, actually following up on an mri, understanding where to go next, what the solution is, why I could possibly be in the hospital in the next 12 months because of what's going on in my life. When we added the Care Navigation to the program, our trend lines went back down. And that organization, literally 20 years later averages 1.8% a year over 20, over 20 years. And their benefits today are zero. Different than they were in 2003. Same exact three health plans that they had back then. But the reason, so that was then. And in 2012, we created our own healthcare company because.

Frankly, the vendors that we were using weren't effective enough. And in 2022, I left being a consultant and run Synergy Healthcare full time. And the reality is Care Navigation has gone beyond something that's a nice to have to something that's fundamentally important to solve the healthcare system and program as it is the whole delivery system for you and your employees. And I did this because I was helping a pretty large book of clients. But there are so many employers and so many people that need this that we decided to start this and offer it to other employers and other advisors that are out there to handle this.

I like this. It speaks to my heart because I too was a benefit advisor and then I saw a problem marketing and I decided to build a company to help solve that. You've done the same thing in Care Navigation. You were selling health insurance, saw the problem, started with on site clinics, moved into Care Navigation which led you to ultimately building Synergy Healthcare and and full disclaimer, I've had a chance to work with you as a client. And one thing you know, when I look at what Synergy Healthcare is from a Care Navigation program, I would describe it as Care Navigation that actually improves healthcare trend because you actually get employees to engage in their healthcare. So let's talk about that for a second because there's a lot of companies out there that are going to tout their Care Navigation but there's a big difference between do it yourself navigation and done for you. Talk about what Synergy Healthcare is doing as far as done for you. Care Navigation.

Yeah. I think as we looked around at solutions and the reason we came up with the Care navigation was that the app first 800 line version though I think it's more helpful than just dealing with insurance. Customer service ultimately doesn't move the needle. And what moves the needle is.

Authentic connection. Let's say a person, an employee who's connected with someone who they know who cares and who's knowledgeable and is truly helpful in the end. And the only way we could figure out how to do this that would be meaningful if you take the model of sort of the on site version. But now for any employer, especially if they're self insured, is the idea of putting a clinician directly integrated with the employer, sort of in human resources that they go beyond who is Synergy Healthcare to it's Sarah, Nurse Sarah who works with us. And so our process with this is integrating one nurse, one employer. They will probably never remember who Synergy Healthcare is, but they remember who Nurse Sarah is. And let me give you an example here. So someone walks into HR and says I've got a problem.

This happens all the time, right? And they could give an 800 number to someone. They could even say did you call the nurse Sarah? And that's really helpful. Right? But it goes beyond that. I would say most of our HR people, if you walked in their office, they could certainly hand you the card that says, hey, did you call nurse Sarah? It's got her picture on it, it's got her QR code. But you know what most say, most say, do you want me to email nurse Sarah and have her call you? And the employee says, sure, that sounds great. And so the HR director, benefits manager, whoever it is, simply email Sarah and says, Bobby could use a help on a claim or he's having a hard time with an authorization. I think you know his information. Let me know if you don't. But he's expecting your call. And then we don't have like a 24 to 48 hour turnaround. Like Sarah gets off the phone with someone else, sees her email, calls Bobby, hey, Bobby, what's up? That's engagement. And when he realizes that was helpful, she solved this problem. Bobby is usually the same person who has a gap in care, who may be having a problem with medication, who may be one step away from a heart attack. These things are all out there because of the people that utilizing healthcare. When we have the data and information in our system that Nurse Sarah reaches back out to them about something that she sees as problematic. What are the odds Bobby's going to take her call?

Yeah. You shared some statistics with me I thought were absolutely phenomenal, talking about the proactive outreach that your nurses perform, which is the done for you versus do it yourself. So I think a lot of care navigation is. Well, did you, did you go to the app? We're expecting employees to do the work and it's not working in your case. Your nurses are proactively out, reaching out to these members. And you shared with me that, you know, a case with 500 employees, one of your nurses reached out some inbound and outbound to 217 of those 500 in one quarter and was able to engage with 146 of those members. That's unbelievable.

Yeah. That employer has only been with us since late summer last year. So basically in nine months, that's how many people she has engaged. And this on just this one quarter. Right. Because she, it's just an active. It's like how many people did human resources engage last quarter?

Right.

Probably the vast majority of the workforce. Right. And that's how this works. And my favorite thing, when I looked at this report for this employer, the number one communication item or item that she talked about was medical care. Follow up.

Is just, it's my number one thing because this is, this is someone that went to an mri, went to a specialist, was supposed to go to a specialist, was supposed to follow up with this person, was supposed to get this medication. And someone who cares calls them up and says, how did it go? What did they tell you? Did you actually go? And it could have gone a million different directions. And she may realize that, you know what, I'm going to set the appointment this time for to get them, to get them to go, you know, whatever needs to happen, you know, and medical care follow up. Is that differential in what happens in health care?

Yeah, I think, you know, when I look at what makes you so effective. Again, it's not a. You're not a logo behind some smartphone app. You're not even a team of nurses that I've never met that I get to talk to on a phone. No, you're not even Synergy Healthcare. You're Sarah, you're Stephanie. That's who the members know. They actually know the name of the nurse because the nurse is the part of the team. Because this is your one nurse, one client approach, which is what I think makes you so different. Talk to me quickly about you talked offline about the fact that your nurses are certified RNs and they can help with the continuum of care. What are some of. Some of the services nurses can assist members with on that continuum of healthcare?

Yeah. Great. So Our nurses average 30 years in nursing, 18 years in case management, understand healthcare and insurance altogether. And this is really critical because when you get that member on the phone or in a meeting or whatever is going on, you have to be able to go all kinds of directions at any moment and you can't say, hey, let me stop and refer you to some other random person they don't know when you have this kind of experience, we hire the best of the best. They can go all the way from. My spouse was diagnosed with stage four cancer. What do I do? Someone help me all the way to the ER billed me $1,000 for something that I thought was a $200 copay. I don't know what happened. I called, but they said this is accurate, could you help? And the entire thing in between diabetes management, did I take my medications. And you can only do this with someone that's actually licensed to do this kind of help and license in their state as well as has the experience to do that. And so that's what we hire. And the reason we can hire these people is because we have a great job. Think about it. Most nurses, especially at insurance companies, are behind an 800 line that they know what they're doing. These are the same people we're hiring that no one will talk to. But we take them from the back of the line to the front of the line. Part of the employer team, part of the process. And they love their job. And they love their job because they're actually have the opportunity to help people and feel the gratitude of an organization that they know they're helping to make a difference.

Well, in fact, I think if I heard you correctly, you've been running the care navigation with nurses for about six years and you have yet to have a nurse leave.

We have yet to have in our sleeve.

Wow.

It's a great job. They love the job. Now they have their own issues. Right. Because they have to work their tails off. This is not. They don't just simply dial and everyone just like, oh, thank you for talking to me about my diabetes. Right. It takes a process, it takes an approach. It takes understanding that when their life is a wreck that talking to them about how they're eating may not be the next best step. Right. Maybe they actually need an EAP referral. Maybe they need certain things in their life that needs to happen. Maybe they need how to figure out how to afford their medicine, but they haven't told anybody. And so it's that kind of work that's done real time with a member that makes a difference.

Well, and I think, you know, when I look at what you're doing for organizations, you're improving, you are improving the employee engagement, you're also improving the employees engagement with all the other solutions they have in their benefits. You talked about EAP and things like that. But most importantly, you are improving the employer's health care trend. And I think it's hard for most solutions to all three. Improve engagement with the employees, employee engagement with all the other solutions and benefits they have, all the while improving the employer's health care trend, which is absolutely phenomenal. If somebody's watching this Matt, and they want to reach out benefits advisor who's got a client that's a good fit for this. Talk to us quickly about what type of employers are great fits for the solution and then how can brokers reach out to you to learn more about how they can imp minute with their clients?

Yeah, well, we're certainly all over LinkedIn. Find us our information and ability to make a 30 minute sort of call is all out there. But who we're looking for is mostly self insured employers or level funded employers, potentially fully insured, going to level funded or self insured and the reason is data is critically important. 35% of what we do is incoming and 65% outreach. And having the data is important. So some kind of level funded or self insured employer. Our nurses work best in a model where we are working with 100 to 2000 employees. And so we have organizations larger than 2000 and maybe they have multiple nurses or what they do, but ultimately that ratio is perfect.

Our number one question people get is how will I know after one year whether this is working or not? And I tell them they'll know in three months that it's working. We had a brand new employer January 1st.

We do monthly calls right away and then we end up going to quarterly. But in some of our first ones, the HR director had a list of executives that they wanted to make sure their nurse reached out to and really connected. It was executives plus what they thought were sort of high cost people that they needed to go. They started going down the list. The nurse was already talking to almost all of them, like literally. And so that was within two months because she just reaches out, introduces herself. I'm someone that's going to help. And because we have data and know who's who, we're reaching out to the right people. And so someone will know in three months that the engagement's happening. And literally in six months to 12 months, they'll see lower inpatient stays, lower ER visits, lower cost of disease, lower prevalence of disease, though the prevalence is a little more complicated and takes a little longer. But the initial things of lower metrics that actually mean something in specialty care happen within the first year.

That's phenomenal. Well, hey, if you're a health insurance advisor listening into this, I wanted to have Matt on because whenever I see a solution that is creating amazing results and I feel that not enough people know about it yet, I want to make sure the knows about it. So Matt, thank you for your time. This has been absolutely phenomenal. If you have self funded clients who need better employee engagement to drive better trend, this is your solution. Synergy Healthcare. Matt McQuide, look him up on LinkedIn. He's got plenty of content. You'll learn about them, reach out and learn more. Matt, thank you again.

Yeah, thanks Andy.

That's all we got for today's episode of the Bullpen Sessions podcast. One thing that would really help us both and other new potential listeners is for you to rate this show and leave a comment in it, stitcher or wherever you tune in to listen to the show. Also make sure to link up with us@completegameconsulting.com on social media. And please share this podcast with anyone who you think might enjoy it. Until next time. Remember, clarity creates confidence. Confidence creates consistency. Consistency makes you unstoppable.