Carepath Benefits & Edison Health Solutions: A Level-Funded Solution Like No Other

Hey. Hey. Welcome back to the Broker's Voice. I am excited today because we not only have one person on the episode today, we have two thought leaders. So I'm excited because these two are making an announcement right now that I think is going to be a very, very impactful announcement for any broker, any insurance, health insurance broker out there who has small to mid sized business, you know, groups with anywhere from five to 50 employees. And so if that's you, this is an episode you definitely want to listen into because this is a big, big announcement. So without further ado, Mike Rohmeyer from Care path benefits, Bob McCollins from Edison Health. Welcome aboard, my friends.

Thank you, Andy.

Good to see you, Andy.

So, well, let's just kick this thing off. Who wants to make the announcement?

Mike, let's go do it.

Let's do it. Well, Care Path, as of as many may have seen as of 9:1, Care Path has partnered with Edison Health Solutions to be their TPA of choice. It is a heck of a partnership. The way we see it, what Edison is going to offer for our members or for CarePath members is, you know, access to benefits that they don't have elsewhere. You know, something different in the market. Andy, to your point, small groups from, you know, 2 to 50 now have access to benefits that Fortune 500, even Fortune 100. Bob. Bob, might say down to, or that they have access to, you know, benefits similar to those of very large companies. So we're, we're pleased and excited to make the announcement.

Well, before we dive into more about what this is going to mean, let's actually take a step back and Bob, I'm going to throw it over to you first because Edison Health Solutions is going to be a big, big part of this, this solution that's going to be offered to the small to mid sized client employers out there. For the folks listening in who are like, okay, wait, hold on. Edison Health Solutions, not sure what that is. Why don't we start with what is. Tell us a little bit about the Edison Health. How has it started, what it, when was it found, who founded it and, and what are you guys doing today?

Thanks. It is a story that goes back many, many years and it actually goes back to 1992 when our founder of Edison Healthcare, Tom Emrick, was handpicked by Sam Walton of Walmart to come in and address Walmart's healthcare costs issues, risk management issues and health improvement issues. And Tom, as he is very well known for and Walmart is known for, built the first destination centers of excellence Meaning he went out and created direct contracts for care for cardiac and cancer and complex pediatric and musculoskeletal with entities like the Mayo Clinic, the Cleveland Clinic, Boston Children's, the Andrews Institute. So these are the best of the best. These are bringing the best of best healthcare solutions to the members of Walmart. That's what Tom's known for. When Tom retired from Walmart, he had several companies reaching out to him. So in 2012 Tom started Edison Healthcare. And that's probably the name most of the brokers and benefit advisors are aware of. Edison Healthcare Dental destination centers of excellence Tom Emrick and then in 2014 Tom brought in partners Jared Fry and Sean Rutledge to really build and grow Edison Healthcare. And that was the explosion. And you know, that's where we're working with people like Dillard's and Amazon about Valparaiso University and Kindred at Health, kindred at home healthcare. But they saw a gap in the delivery and the value of Edison Healthcare. So a little over a year ago they purchased the TPA that was the claims administrator for the Edison Healthcare claims. It's a TPA out of Tulsa, Oklahoma. We rebranded it Edison Health Solutions last July and now we're in the market as a full service healthcare plan replacement operation working with Benefit advisors. And what's really exciting for us with Mike and David of carepath is we are a solution for all size employers and that's something that often we got asked about and now we have a way to help the small to mid size employer with the partnership with Care Path.

That's awesome. I, I can remember in 2014 I was at a UBA conference in Chicago and I was that typical average broker at that point, not knowing a whole lot about self funding and all these other cost containment ideas that existed. Right. And I remember listening to Tom speak and I, in my head I'm going, I don't know who this guy is but wow, like talk about smart, like it, it almost overwhelmed you how much he knew about benefits and how to develop a, an effective health insurance ecosystem. So yeah, I remember the first time I met him is he's a game changing individual for sure. Mike, how about you? Care Path Benefits. You guys are probably a little newer on the scene than Edison, right? Tell us a little bit about who Care Path is and who you serve.

So yeah, we're working on just past our first year, about 14 months in. We serve small to mid sized businesses, we want to serve the broker that serves those groups as well. Two to 50 is really our Niche, but we certainly serve, you know, serve larger groups as well. We want to offer choices to those small groups. Right. A lot of times those small groups get overlooked because brokers either don't have time for them, they may not make the money that they're, you know, they expect to make or want to make. So, so they feel those small groups feel left out and the brokers that serve them feel like all they can do is hey, here's the Blue Cross, here's the Cigna and move on. Carepath wants to be the option that they go to, to give the small groups what they deserve, a choice in their, in their health benefits and you know, and give them quality benefits that they can afford.

Yeah, no, I, this is why I, I'm going to love this episode because I think a lot of brokers, our industry loves to commoditize things.

Right.

And so they hear Mike, you talk about Care path. Oh, okay, so you're another level funded solution. Right. And great. You're one of the dozens I know now but with this partnership, again we said it at the beginning of the episode, this is going to provide or bring a solution that small businesses just did not have access to. So let's talk about that a little bit and either one of you know, either one can, can chime in here. Let's just start diving into, okay, what are we talking about? What are some of these opportunities these companies are going to have that they didn't even have a choice to look at just a few years ago?

I can start with that. Well, first and foremost, again go back to the beginning of the story. You know, Walmart's destination centers of excellence. And then when Tom left there and started Edison Healthcare, so a two employee life group has access to the same centers of excellence. The same concept of the patient comes first, get the diagnosis correct and get them to the highest quality care provider quickly to optimize the outcome for the patient and for themselves as the employer now taking on the value of the risk and risk management. So the ability for a 2 to 50 life group that just doesn't exist out there for nobody really, I don't want to say nobody really cares, but that really is foundational part of the program. Then on top of that we also have over 200,000 contracted right now direct contracts with physicians to support the pre care for that patient and the post care back in their community again that faith favors nicely high quality providers. With a direct contract in place, 200,000 so far with more to come. We're going to continue to build that out, being able to take that and again, partner with Mike and David and the Care Path folks and deliver that value to the small to mid size employer. Again, I just don't know of any other level funded program out there that has that value added in from a robust organization like Edison Healthcare and Edison Health Solutions.

Yeah, and one thing I love about doing these episodes, guys, when I'm sitting on this side, I get to be the, I get to play the ignorant individual that's going to ask like the question that I need the basic answers for. So Bob, let's start here. What is a center of excellence? For somebody who's listening going, I don't even know what a center of excellence means. Define that.

Well, I'm going to use the word smart care center in defining Edison Healthcare because there's a number of centers of excellence. If you look at any national carrier ppo, you've got stars, you got different things that designate a center of excellence. But what Tom built and brought to Edison Healthcare was a certain profile of a health care delivery system. It's a multidisciplinary team. You have peer upon peer upon peer reviewing that individual's healthcare issue. What Tom found and what we still have today is an epidemic of misdiagnosis, over utilization and suboptimal care. And critical to what Tom built and what we believe today is we have to get the diagnosis correct. So that multidisciplinary team, for example, is going to address the fact that 3, 30% of all cancer diagnosis, initial diagnosis are either completely wrong or have the wrong care path. Treatment for the type of cancer that you have, 60% of all spine surgeries are unnecessary. You don't need to be cut. 40% of cardiac events, there's other forms of treatment or another diagnosis that would have been appropriate. So when you take Tom's approach of a multidisciplinary team, get the diagnosis correct and bring that together with getting them to the highest quality care provider quickly. That's what makes the smart care center different from a centers of excellence. These folks go through a two year vetting process and then annually they're audited to continue to meet the demands and the needs that we expect to see them deliver care for our patients.

All right, Mike, I'm going to throw the tough question over to you. You ready?

Absolutely.

I'm a small business owner listening in or an advisor who's got a book full of them great centers of excellence. You're going to, you're going to send employees to better health care facilities. What does that do for me? I'm staring at premiums that keep going up every year. How is that going to help me control my health insurance cost?

Absolutely. On top of the, you know, the choices that the Care Path Plan just inherently have built in just 12 different options that we have, the bolt on of the Centers of excellence that we are now able to access with Edison allows for negotiated pricing with those high end great performing service centers. It has an outcome percentage that is higher than most or better than most. So you're getting your employee healed quickly at a set price. You know what you're getting. And on top of all of that, we're working to get it so that it's a $0 cost to the member. So the member is getting healed quickly, they're getting healed by great doctors at a great facility and it's not costing them anything to go to these centers of excellence. So if you want to know what you're providing your employees, I mean, you can't do much better than that.

No, you're absolutely right. I think with level funding, the carrot's always been you get the opportunity to get money back from unused premium. Right. And Mike, you know this very well. Let's be honest, some level funded plans are what I would call rigged. Your opportunity to actually get money back are very, very low. And what you're doing with Centers of Excellence is the better care you give, the better outcomes, the lower cost they'll have, which gives that employer a better opportunity to get money back. Which is the whole point.

So Bob, talk a little bit about, I believe there's also direct contracting involved, right?

There is direct contracting with our smart care centers. But then we also have a network of, a growing network of ancillary service providers, MRIs, X rays, ambulatory surgical centers, direct contracts with physicians and specialists. That's our evolution network. Currently it's over 200,000 providers out there. We continue to look to grow and add to that and really strategically in markets where carepath is having success, but to grow that network out so we can continue to build on again, getting people to the highest quality care provider that's going to take care of them but also incent them with no out of pocket costs, you know, no copay, no deductible. That's the incentive for the person to go to that high quality care provider. But again, those direct contracts are also going to allow Mike and the Care Path team to deliver a very competitively priced product and maximize that opportunity to deliver that big old check at the end of the year.

Well, and so I'm going to ask the question some might be thinking again. Talk or walk us through. Briefly walk us through. What's a direct contract? What does that mean?

Well, it means that we have gone in.

Not unlike but similar to a Medicare plus type, a reference based pricing type, an agreement that says when our patients come to you to see you for these services, this is what we're going to pay you, this is what you're going to be reimbursed. And the providers like it because quite frankly, they're not chasing dollars, they're not chasing dollars from the patient. They know what they're going to get paid. We believe that if you're a high quality provider, you should be paid appropriately. We're not trying to nickel and dime you. We want to pay you reasonably, reasonably being the key. So we have a reasonable agreement to pay you what you're worth for the quality of care that you're going to deliver. And with that contract in place, when somebody goes to see you, boom, that's it. It's a no noise type of situation.

That's awesome. Yeah, no, I think that's really important with direct contracting for people to understand that because when you go to a healthcare facility and you agree to a certain price that is guaranteeing that employer who offers the plan, if an employee goes there, you know exactly what you are going to pay, which is what we have all asked for from the health care system. And Mike, you said it. If that employee does it, guess what? They don't pay anything. The employee does not pay anything. So Mike, I got a question for you. I'm listening in. I'm going, this is great, Mike, how my, how are my employees going to know how to use this? You guys have an added feature in the program that really helps make sure employees have an easy access to, let's call it a human, so that they can make the right decisions to go to the right places for care. Talk about that for a little bit.

Sure. So we have actually a couple of different programs but that actually talk to humans and work, you know, work with one on one patients, whether it be through benefit navigation, finding the right place of service, you know, that is one of the lowest cost, highest quality for and appropriate for what they need. Additionally they walk them through from, you know, from any episode of care, from the beginning through the end. So it's not just a wild goose chase, where do I go? How does this work? And we communicate that one with the member, we communicate that with the broker and with the group so the group can be aware the HR person at the group which sometimes when it's a two or three or four life group might be the same person that's having the service or might be the wife or husband of the person. So it's good to have everyone know how that works. So if there's questions, which is always going to be questions in that time of stress you're trying to get healed and something's wrong and things are just going on, there's always, it's always good to have somebody to fall back to, to talk to a real person and, and you get those, the next guidance, the next steps that you need to do.

So yeah, I, I wanted everybody to hear everything we just talked about because at the end of the day what you guys are now opening the door to is brokers who have smaller clients that forever have been shown the spreadsheet of fully insured carriers in their market. They've been told to pick one, pick the cheapest this year, next year we'll pick the other cheapest. Now we have an option to give them something different, an option to get, to control their cost, to get money back if they don't use all of their premium. But on top of that, there's an opportunity for these employers to give their employees access to the right health care at very affordable prices. Like you said, Bob, you're not penny pinching, you're not trying to nickel and dime them just an agreed upon affordable price. But you're also incenting employees by eliminating their out of pocket limits when they make these choices and giving them access to somebody to help them make those choices. Like this could not be easier. So the million dollar question, both of you either one can answer. I'm an advisor listening in. I got Q4 coming up, Ton of renewals, small group. How the heck do I get started with you guys?

Easy. So we are carepathbenefits.com and go to our website. There is all of there's a RFP page so you can drop information for find the information to submit to U.S. census current rates and an employer app. And we're off. So it can all be done through email. We're available on easy apps or Formfire or health apps are so we're out there easy to get another way just shoot me an email mikearepathbenefits.com and we'll get started.

So even for 10111 on renewals, Mike, we're good to go.

101 is pushing it but we can, we can certainly work it but yeah, 11, 12 and one. We're working, we're working 12 ones and one ones now. So we're, we're moving.

Bob, I'm giving you the mic to, to leave your last golden nugget. If, if you're out talking to advisors who this is a thing. Knowing they are about to head into their most stressful anxiety inducing season, what advice would you give them?

Certainly reach out and take a look at Care Path Benefits from the standpoint as, as Mike said, you need options. You kind of been doing the same old same old every year. This is a great option for the small to mid size employer. And I will say that, that what attracted me and Edison Health Solutions to work with Mike and David and Stephanie at Carepath Benefits. They're good people and the type of advisors we want to work with, I use the term plus are people like us. We're good people. We want to do the right thing. Mike and David and Stephanie really have a heart and passion to help the small to mid sized business owner and that really resonated with me. And so benefit advisors, if you want people who care to, to support you, be in your corner, have your back for your employer prospects and clients, you need to consider Care Path Benefits.

Couldn't have said it better myself. So guys, I want to thank you for your time. If you are listening in again, if you have a book of business that is made up of those groups 2 to 50 especially, this is the year you got to give them something different. Quit showing them the same stuff every single year. It's that stuff no longer works. You're putting a band aid on the real problem. So take a look at a program like Care Path. It is a completely different solution. Something your clients have never seen and it's giving them an option that they didn't even know was available. So guys, thank you one more time. This has been awesome. And for everybody else listening in, reach out to these guys. Look at what they're doing this fourth quarter season because you know what happens when you mix clarity with confidence. You do massive things. You need to do some special things for your clients this fourth quarter. Take care.