Healthcare Cost Control with Embedded Clinical Advocacy

Like I don't have to walk into a casino today and actually lose money, but all of us are walking through the health care scene. And so having that support for the employee to walk through those processes, in the end, me as a consultant, it gave me the better chance of the ideas that I put on the table of actually having the ROI in the end.

Hey, welcome back to the Broker's Voice. I am joined today by Matt McQuide, CE and founder of Synergy Healthcare. You may remember I had Matt on several months ago, but I thought it was worth a bringing him back on. A lot of good things going on Synergy or going on with Synergy. So Matt, welcome back.

Yeah, thanks Andy. I appreciate your time and interest.

Yeah, no, I'm excited to have you. Obviously we have done some work together for a while and very impressed with the, with what you've built. Anytime I see somebody who has taken a problem they had and actually built a solution to fix it and then take it and deliver it to anybody else, I have a high respect for. But for the folks who might be tuning in right now that have never heard of you or Synergy Healthcare, I mean, you've been in the business for, in the industry for over 20 years. Talk a little bit about advising career and what led you to ultimately building Synergy Healthcare.

Yeah, yeah. I mean, how most of us got in the insurance world 30 years ago was completely by accident. Of course they have colleges for these things, but they didn't 30 years ago. But I was a finance and economics major in college. But frankly, the funny thing about that, it probably had nothing to do with it. Most of it was my love for games, strategy. I played everything, man. I played every sport, every card game, anything you could think of. Anything that took strategy in order to win is what I did in my life. And then my first job out of college, so random happened to be with a TPA playing medical, paying medical claims, you know, and I didn't even know what health insurance was. I just was all of a sudden engulfed in self insurance. And I saw these brokers, like these people that did this job and I was like, wow, they got the greatest job in the world. Like they get paid to help people make bets. And that's how I saw it. And so that was my goal, was to be a benefits broker. And it took a few years and I finally got in the role.

That's awesome. Now you, you spent a good chunk of your career at usi, right?

Well, actually I first went to a regional consulting firm and then I Was there for probably 15 years before they sold to us. I. Yes.

Okay, so walk us through this a little bit. Up to that light bulb moment when you, when you actually built Synergy Healthcare as an advisor, I know you were doing a lot of work with on site nearsight clinics, things like that. What ultimately led you, and we'll get into the description and details of what you guys do at Synergy, but what led you to this place where you said, hey, I see a big problem here. As a employee benefits advisor, I'm actually, I want to commit to solving this problem.

Yeah. Actually, I think it was just sort of early on in the strategy part of it. So, you know, like, like my first step, I had lots of phases here, but my first step was self insure everyone. Right? That's because that's what I mean, it's good for everybody. Yeah, I mean that was my destination, I thought was find employers who are fully insured, talk them into a better way of financing healthcare and then moving them self insured. Right. And so that was what I thought was the destination. But then when I realized, when I had this pretty large book of clients at a young age was like, how could I increase the odds of having a good year? That was probably the first step.

Hence playing a game.

It was all playing a game. And I realized there was a couple steps here like that people weren't taking. And to me there was honestly, there's like three ways to reduce a claim. I thought, well, if I reduce claims, I increase my odds, right? So there's three ways to reduce a claim. First is, you know, get a better price for the same service, same place. And I did that. Like that's, you know, network discounts, PBM contract, you know, that's, you know, I went heavy into that, but then it goes way beyond that, right? Like, how do I get, how do I get, how do I redirect care to just a better place, a lower cost option? And then ultimately, what if the claim never happens right in the first place? And so like just take like a knee surgery. The first step of a knee surgery is, is Cigna, Blue Cross, Aetna, like who's going to give me the best price? How can I get my 60k surgery down to 50, 55. But then what if that surgery happened in an ambulatory surgery center, not the hospital? Like now we're talking big time money reduction, right? If my MRI wasn't, wasn't in the hospital, it was an outpatient place. That's big time savings. And then the final Step, of course, was what if that knee surgery never happened in the first place? And these things can all be done. And part of owning the on site medical clinic and sort of diving into healthcare was realizing like, if you take that knee surgery, there's a lot of time when someone's before pain and before loss of function that if they did a few steps, they may never needed the surgery in the first place. So I dove in deep with my clients and then our goal was how do we reduce cost without affecting employees enough in a negative way.

I actually love how you just said that because I don't know if I've even thought about that the way you said it. You know, I think a lot of people start at in our industry as well. What can we do about claims? Claims are the claims, right? Then you go, wait a second, we have an opportunity maybe to have the claim, but buy the service at a better price. And then the third layer is, well, what could we do to actually make sure the claim never happens?

Yeah.

And I actually love how you just explained that. I thought that was a great. Because I would say a lot of employee benefit advisors, unfortunately are probably still back at phase one, which is it's a claim. What can you do about it? Right. And so, you know, I mentioned earlier that your foray into this started with a lot of on site nearsight clinics, things like that. I'd be curious, like with your experience and this, this brings us to Synergy Healthcare, Personalized care.

What does that mean to you? Because I know you had a lot of success as an advisor and CEO of Synergy Healthcare, helping people get the personalized care they need. Why is that important?

Well, actually, this is actually a recent thought of mine that I've had on how to explain this in a better way. But let's go back to the three ways of reducing a claim real quick. What I realized as a consultant back in the day and I still do today, is that we, as a consultant, our job, if we're doing it really well, is to move think of a casino. I'm going to stick on the bet theme here because it's how I think, right. If you think of a, I'm going to go, let's call it Healthcare Casino here. So as a consultant, I'm going to make it really basic. The two outer ends of a casino, your odds of winning. The first is slots, right? Super simple, right. It takes no skill. I put the money in, I pull a lever, I lose money. Right. I mean, it's just really basic. And then every Once in a while, something rings in the casino and somebody wins big and you just keep putting money in because you hope it's you, right? But like that's employers, right? They're in a system that they're guaranteed to lose money. And as a consultant, you take them through this process and there's lots of games in the middle. But ultimately, if you can get someone to play blackjack and play it really well, you're not still going to win money, but you're going to lose a lot less money for the house. So like, my job as consultant was getting as many of my clients to play really good blackjack as I could. And that's how we won. But my light bulb moment for synergy ultimately was when I realized that all of us really smart people, like, we're all sitting in this boardroom, we're all high fiving each other because we think we have great ideas, right? But then our entire.

Like the odds of winning that year, we couldn't play the game for the employee, right? We couldn't do it for him. And so we were in this position where we hoped as many of them would play it as possible. But what you realize real quickly is as smart as you think you are, it's, it's. They're never going to do it. And so we had this great process. And it's not that we didn't save money, but I had people going through this casino, had no idea what we were doing. And back to my knee surgery. What are the odds they're going to do any of what I said? If we don't help them, they're going to go right back to playing slots. And so my new sort of way, I've been thinking about it really for the last 10 years, but very recent how I think about this is we have to help employees play that game too. And it increases all of our odds. And they are absolutely going to be in the health care casino, right? We like, I don't have to walk in a casino today and actually lose money, but all of us are walking through the health care scene. And so having that support for the employee to walk through those processes. In the end, me as a consultant, it gave me the better chance of the ideas that I put on the table of actually having the ROI in the end.

Yeah, I love that. There's, there's actually two what do I want to say? Premises that I think from which you have built synergy, which I really like. The one you just explained is if we think the employees are going to Take it upon themselves to go make the right health care decisions. We're crazy. Two, you, you said something early when you and I first met that I absolutely love. You know, when you think about a lot of the marketing in our industry, the carriers will have these pictures of, well, the woman on the yoga mat and these super healthy fit people. And you've said repeatedly, people don't want perfect health. They just want to be one step better. Talk about that a little bit because I think that's the mistake we make in this industry is people are actually striving for perfect health. They're not.

Absolutely. Most people are not. But then. But they don't want like sort of what you're saying is they also don't want to be a large claim.

Right.

People don't and they don't want that. And you know that. I know we discussed it last time on the podcast, but this, you know, the first large client that I had and we put in this on site medical care clinic with a nurse practitioner part time. Like all these people improve their health and you realize, whoa, like they just needed a little bit help is what they needed. And so from a health perspective, that worked really well for our clients that we could put in an on site medical clinic. But not everyone can do that.

Right.

And so that's where this care navigation piece came in, is like this care navigation piece. I'm going to help them through this casino of healthcare. I need someone that can walk with them through that process that gets super complicated. Right. And so that was a process of sort of the aha moment of like, hey, I need to help them get through that.

Yeah. And then we're going to dive in right now about that. We're going to go into details because I definitely want the audience to hear a couple real life case study examples of what kind of the work you guys do. So synergy Healthcare. You know, you use the phrase care navigation. Okay, we'll put you in that bucket. But I think you guys are doing something that's really effective, which is the one nurse, one client model. You know, a lot of these care navigations is, hey, you call this call center. You have no idea who you're going to get today. It's probably going to be somebody different than you get tomorrow. But in your case, you guys are embedding one nurse into one client. Talk about, like, why is that important and what impact does that have on an organization when they have the consistency of having the same point person?

Yeah. So, you know, back to the same story. A Little bit. So, you know, we have this idea someone's going to help them.

Right.

But then I tried all kinds of avenues like this company, that company, some app, some 800 number, some call out. They all seem pretty reasonable. And so I tried them all with our clients. And at the end of the day, what I found is that with healthcare, people also have to trust. They need a lot of trust in order to.

Let someone help them.

Right.

So there's really smart people on the other side of the 800 line, but no one took the call. No one gave them a chance. And so I took the theory of those on site medical clinics and said, why is my nurse practitioner, you know, kicking the butt of the community, MD on health outcomes? Well, it's not because my nurse practitioner is smarter than the doctor. It was that they had time, trust, access, it was free. All these things were there. And as I was thinking through how do we do care navigation. Well, well, then that's when the idea popped in my head like, well, what if we did it the same way the on site clinic does? What if we don't worry about an 800 line? What if we literally embed one nurse with an entire population, the same thought process as an on site clinic, but they don't have to be on site. They can work out of their house, they can show up to open enrollment. Everyone can know who's to who. Shelley is Nurse Shelley. And their first clients that we started with, we put them in. We didn't even know if it would work. It was literally like, no one is doing this in the country. Like we, I couldn't find anyone. So let's just do it ourselves. And I'm going to hire a nurse, I'm going to put them in and let's just see what happens. And our first couple of clients who started it a year later, they said it was the best thing we ever did. It was beyond even the on site medical clinics and the other things we were doing because HR had support, employees had support. It was real time. And this nurse became part of the employer family at the end of the day. Right. She's fighting for them. And it, it changed everything. So when you say, you know, the, our one nurse, one employer, it's that trust and that engagement that allows a really talented person to help a lot of people.

Yeah. And I, I think there's no area of, how do I say this. Relationships where trust is required more than probably in health care. Yeah, right. If you're making a decision about your health, that level of trust you have to have is paramount. It's why we say doctors will get off their pedestal when patients get off their knees. Right. It's they trust that doctor so much. And if we think calling a 1-800-call center where you talk to somebody, you never build a relationship is going to be the answer, I don't know if that's so effective now. One thing I'm impressed with, Matt, is it you guys start to see some measurable results in three to six months. And I think that's very impressive. You know, I sit here today, we, we, we've got some programs where I think we have clients looking for quicker roi, and we're trying to address that because I, so I under, I feel the, I understand the pressure of, of performing. But talk a little bit about when you guys embed that nurse into the employer. What are some of the metrics you're really looking at to see if what you're doing is effective?

Yeah. So the first step, even before metrics of, of utilization is you have, you know, did you actually engage people?

Right?

I mean, did they actually listen? Are they engaged? And you know, to the open enrollment time. Like the nurse is literally a walking open enrollment book. Right. I mean she's the first step. Like no one remembers anything at open enrollment, but if they can just remember Nurse Shelly.

Right.

And HR knows Nurse Shelley, and everyone knows Nurse Shelley. Like it's just this walking thing. And, and the, one of the things that's happened in the last 10 years is insurance has gotten so much more difficult. Like prior authorizations, like five times what they used to be. All these things are, there's. Insurance is its own barrier to care now that, that people are starving for, you know, so engagement. When we put one of these nurses in, they can line up at the door waiting for problems that she can solve. And so our, our, our, our engagement with employees is actually super simple because people actually want it if they know the person. So, so the first step in our process is, you know, we have to solve insurance and healthcare problems. And that's our first bucket that we do every single client. Every once in a while someone says, can you make outbound calls to our highest risk people and not take the other part? I was like, absolutely not is what I tell them, because I'll be the same as any other 800 line. Right. You know, so, so that's the first.

Is out there because it's so bad. And so they just flock to our nurses for help and that employer. And then, you know what you're Talking about here, ultimately is how do I bend the trend?

Right.

Like, how do I actually reduce costs? And once you get that engagement, like, what do you do with it? Right. And so our nurses, you know, we're working with, you know, how do I reduce inpatient stays? How do I reduce ER visits? We have reports that we have that we know who their frequent flyers are. Right. When they go to the er, you know, is it a serious condition? Could they have gone to the urgent care or Teladoc or, you know, what is this? And so, like, we make outbound calls on every ER visit because I need to move someone in a direction no matter what it is. Almost. Right. And so those are our engagement points, but that engagement point doesn't happen if I don't do the first part first.

Yeah, well, and I think a measure of success, you've had plenty of situations where the employer has either made a plan, design change, carrier change, heck, might even have changed brokers, but the employees are like, we better not lose our nurse. You can make any changes you want. We better not lose that.

We never lose. We. They never lose our nurses, that's for sure. But then even in that, in the open enrollment change, like, the funny thing is about us is like, we're making these outbound calls, trying to do certain things, but if you change your PBM or you change some major part of your insurance, the nurse is gonna completely revert to, like, I need to solve all the problems. Right. Because the most important thing is getting people through that, that transition process.

Talk to me a little bit. Let's go. Let's give a couple examples. You know, a couple years ago you had that example, and I'm sure you had plenty more since. Since we talked about it. But, you know, give us an example where one of your nurses has really come in. I don't want to call it. Call it in an urgent moment. I know you've given the example of the nurse being on the phone with the hospital when somebody is literally in the hospital bed. Yep. Talk about that real time. Give me an example that real time support your nurses are providing when people need care the most.

Well, I got one that popped in my head the other day, and I thought it'd be helpful for this. And this is why I was saying, Nurse Shelley, I was speaking at a conference about three weeks ago at a broker put on a half day seminar conference, and I was one of the speakers and I was speaking and we had a number of clients in the room, but one of them was relatively new. Maybe like six months and she was in the back. I just noticed her. And then at lunch I got my food and I went and sat next to her. I hadn't actually had met her in person yet because most of everything was on video. And sat down with her and just was talking and I was like, well, how's Shelly doing? And I had no idea what she'd say. She'd only been a client maybe five or six months. And she says she's had this look on her face like, oh my gosh, it's been amazing. I was like, I said, well, tell me, like, what, what is it like? And she says, well, we had this employee, hadn't been to the doctor in 15 years. No one even knew. Shelly outreaches and starts talking to him, realized he hasn't been to the doctor in 15 years. She talks him in to going to the doctor, like, listen, you need an annual physical, you need a doctor relationship. I'm going to make you an appointment. Like literally, she made the appointment for him. He goes in, they find out through a bunch of processes that he has an early stage cancer.

Wow.

And he was never going, like, he was never going to the doctor. They, they did all the things that they needed to do. He ended up being fine in the end. And she's telling me and they, this, this was one of our smaller clients. They probably have 100 employees or something like that. And, and she's like, everyone at the company knows Shelly saved his life.

Wow.

And I, I had no. Like, the funny thing about our nurses is like she didn't even ring the bell. Like, it's just what they do every day. And no, I mean, obviously that's one's a little more extreme. But I mean just the idea of it that she won't even like tout herself and this employer is telling me this at the table, one of our clients. And I was like, I had, I'm like, this is amazing. Right? So I get right out, I sent a company wide email, like, about Shelley, you know, and just like. But it happens all the time. And this is like the impact is like this kind of thing all the time that happens when you have this kind of engagement. You don't know where it's going to go. Right. Because we're all different. Everyone's different. And so the key of our nurses is to be at the right time with the right member to do the right work that needs to be done. But it all starts with the relationship. And then data, and I'll add data to be at the Right place as well.

Yeah. How about an example? You know, it's. You and I are recording on November 6, we have a lot of employers and brokers who are going to be dealing with open enrollment when, when I'm an employer and I have a nurse like Nurse Shelley in my organization, how is she also supporting or helping make our open enrollment season more effective?

Yeah. So let's say like if I go back to the casino, right. It takes lots of solutions in order to get to the end. Like, it's not like a one solution. So you know, employers, brokers, we all have like this point solution fatigue. And I promise you, whatever we think it is, the employees like way long gone, long time ago. Right. And so, but we need them, right? We need them to make a difference. And so part of what the nurse. I talked about, the open enrollment book, but it's not as much. It has to be like that through data. So we get data. So we know who that musculoskeletal person is. We know who the medicine, who the specialty drug person is. We know who is accessing care, what their diagnosis is. But the key is from a broker standpoint and an employer standpoint, what they spend money on, Right. What solutions they spend money on. That nurse gets the right person to the right solution. So not everyone has to know everything at all times. But nurse Shelly knows, right? Nurse Shelly knows. So when she's engaging people or she's making outbound calls, it could be a musculoskeletal solution, it could be an eap. Like people talk about diabetics, like, what's your diabetic program? Well, my diabetic program is whatever that diabetic needs today. That's my program. Right. And if you think about it, if your life's a wreck, what's the point of me calling you, telling you to exercise and eat better? Right. Nurse Shelley's job at that point is how do I get them to the right provider. And it may be a mental health provider as well. And so, so it's, it's all encompassing and all individual for that one member at that moment of what she can make an impact on. And that makes an impact on the whole plan because as they're putting in solutions, as they're spending money, they know it's going to be the most effective possible because they've got their nurse driving the right people in the right program.

Yeah. I think you have solved a problem that I have talked about forever, which is the second that open enrollment meeting is done, they forget everything you told them and they will not think about it again until they need it. And to expect them to go back and remember what was what they were educated on when they need it. It's not going to happen. But if they know. I have one person I need to call. When in doubt, give Shelley a shout.

There you go.

That might be a tagline for you guys, but that, that just makes the.

Experience with healthcare so much better.

I promise you that brokers and account managers, they know their, they know their clients benefit plan better than they know their own.

Yeah.

Right. And, and so if, if we don't know our own. Exactly. How do we expect an employee to know it? Yeah. So it makes. So I just. In my history as a consultant, that's why I started Synergy is now I've moved from a broker to helping our broker partners. Weird. We don't call the shots anymore. Right. But we're, you know, but I'm the support when they call the shots to make sure the odds are better that whatever they recommended will work.

So if I'm an advisor listening and I go, okay, this is actually really intriguing. What does it look like to, to get Synergy Healthcare involved with a health plan? What does that setup look like?

Yeah, I mean just DM us for one thing, but on LinkedIn, we're everywhere. Of course. But, but I mean the key though is it doesn'. Matter any carrier, any tpa, any pbm. Because this is a clinical person going into an employer, it's not about having to be an entire solution. So it's actually really easy. Most of our groups, we install a nurse in 30 to 60 days. With any, any carrier. It could be nationwide. They could be in one location. We have all of those. We, our clients range from 100 to about 4,500 employees. And it's. And if you think about this service, it's like they interview the nurse, right. I don't tell them about the program. They literally interview the nurse. She's the right one for their team. And the broker is part of the interview process too to make sure we have the right fit. Yep.

Love that. Well, Matt, thanks for joining. I, you know, we've had a chance to, to support you guys and it's been awesome to watch your growth over the last two years. If you're an employee benefit advisor or commercial advisor with employee benefits in your office.

The future of health insurance, if you want to have a chance to control the health insurance cost for a client, is controlling the cost of health care and believing that employees as consumers are going to take it upon themselves to do it is just nothing short of ludicrous. You need somebody like one of Matt's nurses to be able to guide that experience and journey for employees if we're going to get the results we want. So, Matt, I want to thank you again. Awesome. You guys are good. It's fun to see your growth and keep see you guys keep doing what you're doing. Is there any last thoughts, any advice? How about this? Let's wrap with any advice you would give to an employee benefits advisor right now who is trying to create a different result for their client. Feels a little stuck.

Yeah. I'll just say in the broker world, the hardest thing is that you sound like everyone else no matter what you do. Right. I mean, that's the hard part. And I just say that in this hotel casino, if you think one thing in your mind let's, you know, you're trying to play po. You're trying to play blackjack, not slots. Let's get employees to play blackjack, not slots. And it's going to make a difference in your consulting and it's going to make a difference in even your sales because that's what different is with synergy involved than not.

Yeah. That was awesome. Well, Matt McQuiet, everybody. Matt, thank you again. If you're an employee benefit advisor or have employee benefits in your office, give Matt a shout, connect with him on LinkedIn, check out his content and see if Synergy Healthcare can start helping your clients bend the trend on healthcare costs. Matt, thank you.

Awesome. Thanks, Andy. Appreciate it.