Re-localizing Healthcare With Community-Owned Health Plans (with Niko Caparisos)

Hey.

Hey.

Welcome back to the Bullpen Sessions podcast. My name is Andy Neary and this is episode 303. I am excited today to have Nico Caparisos join me. Nico is the founder of Prosperity Benefits in Savannah, Georgia. Today we're talking about a very unique program he has built and is having a ton of success with. Community owned health plans, how you can build health insurance plans that bring collaborative ideas to your local communities and promote a lot of the local healthcare providers in your town. So a lot of good information there. But I also wanted to have Nico on because he is one, a good human, but two very driven advisors. So not only do we talk about the CoHP model, but we also talk about what makes Nico tick, why he built Prosperity Benefits, how he has built it around his lifestyle and his thoughts and beliefs about things like stoicism and taking care of yourself mentally, physically and nutritionally. So I think you're going to really love this episode, especially if you are a driven advisor looking to get better in all ways. Nico has some nuggets. He has proven it, but this is just one of those. Another one of those episodes where I wanted to give you an opportunity to meet somebody I think is doing good things in the industry and I wanted you to get a chance to see what makes them tick. So here we go. Episode 303, Nico Caparizos. All right, Nico Caparisos, welcome aboard to the Bullpen Sessions, my friend.

Hey, good morning. Nice to be here.

Yeah, no, I. You. You've been on the Broker's Voice before. I think it was a couple years ago, but I wanted to bring you on the Bullpen Sessions just because it's been a couple years and you're doing some fantastic work with your community owned health plans. So we're going to talk about the CoHP. I think a lot of people are going to want to hear about that, but we're also going to use this as a chance to let people get to know you because you also have some very strong beliefs about fitness, health, all that stuff. So. So I can't wait to dive in because I want. I want people to learn what makes Nico tick. You cool with that?

Oh, all right. I love it, my friend.

I know you. You have a lot of beliefs. You put them out on LinkedIn, which I love. So I do got to ask, though. It is. We're recording on August 16th. We're a couple weeks away from the start of the college football season. You told me offline Prosperity Benefits. Your agency is the. Is completely 100% UGA alumni owned, which is aw.

Yes.

What's your outlook for the Bulldogs this year, man? Is it, is it another national title?

Well, owned and staffed. So my ownership, but then my new employee, Georgia is obviously a UGA grad too, so totally cool. Yes. Always hoping for the best. You know, I'm always pleasantly delighted when, when we get that far. But I also as mentioned too, I'll out myself here. I'm not the hugest, you know, organized sports fan and follower. I know just enough to get by. But I definitely love my home team and whenever I can get to Athens, it's always a good time.

Been there once. Been there once. Yeah, I went, went to Georgia Ole Miss game years ago. Very cool. If I remember, I think Ole Miss won. It was, it was disappointing because the crowd was out of it. Anyways, I want everybody to hear you have an employee named Georgia in the state of Georgia. Let's not forget that.

Right?

So let's talk, man. It's been a couple years. You and I had done some work together in the past. Community owned health plans. You know, as a founder of Prosperity Benefits. So your agency's down in Savannah, Georgia. What led you on this path to really wanting to create almost, you know, again, an entire health plan unto itself, Community owned health plans. What was the mission behind that?

You know, honestly, it was in having had the chops as a retail broker and trying a lot of things for. At the time When I established Cohp, I had been at work for 12 years, right? So trying RBP, trying different vendors, different strategies, different sales tactics with clients. And the more I learned about self funding, the more I just found it fascinating. Right? And then as I continued to have conversations with the industry, I saw that there was a need for brokers that didn't know how to necessarily prop up health plans from the ground up, right. And work with said vendors to really coalesce things together in a way that made meaningful sense. And honestly, it wasn't just the fact that I wanted to help brokers, it's that I want to help more people, right? So I said, look, if I can do these things on the retail side and I can get fancy with plan design and vendor sets and I know kind of what's working and what's not just trial and error because I'm not an uber scientific guy. I'm more like, let's kick these tires and then let's pay very close attention and who is fulfilling promises as well and what kind of people are you working with? So all these things kind of culminated together. But honestly it was reading one of Dave Chase's books and it was relocalizing health. And I had already been in the health Rosetta ecosystem for a while and I said, you know, look, I need to have a company that really touts local, that helps the community. Part of it is just simply saving on premiums and relinquishing control. Right. That is otherwise just put out to the masses and national factions and backdoor deals and all the things we know about. But that was it. I just want to help more people. And so I created an entire company dedicated to just that. And I'm a broker's broker. Right. I'm there as a resource and still a retail broker where I live in Savannah, Georgia but everywhere else in the country I have people that are, you know, my buddies or my new acquaintances or folks that send me really hard cases or things like they want a high performance network but they don't know where how to begin. And so that's kind of where I fit within that rubric of being able to help brokers and their clients. There's a brand new solution that I you know, propped up.

Yeah, you, you know one thing I admire about it is you said I really just wanted to help more people. And I think it's easy for a lot of people to say that. You know, you're not the first advisor in the industry to come up with your own solution. You then have turned around and worked with other advisors on. However, I think a lot of those solutions unfortunately hit a point where it started with the right mission and then the, the, the, the, the desire for revenue growth became the number one priority and they kind of lost their way as to why they're doing what they're doing in the first place. And I think your mission has always been true that I just want to help more people with this and I really admire that. What are, you know, you talked about Dave Chase's book and the whole re localizing healthcare. What are some of the core tenets of a community honed health plan?

So the biggest, most obvious one would be to tap into a local high performance network so that you actually have the ability more easily to steer within the plan design and to you know, have people select high performance vendors that reduces their out of pocket cost so that nothing is new with respect to that. What is new is that you know, part of this community owned aspect is to again adopt into a community based health plan direct contract. So there's a lot of noise. Well, not really noise, but talk in the industry, right. Rental network versus having no network versus direct pay versus a combination thereof. Right. And you have to meet people where they are and. But really one of the gold standards that appears to be coming through the fray as something that is again, something everyone wants to see with their clients is local based contract RBP level pricing with a direct contract and with all the proper bolt on solutions to help manage the claims that they're after. So that's one of the things I can tap into on a national basis. One of about 75 high performance networks. So in a broker's mind, where they may know that there's a direct contract with uf, right. In Florida or Centura Health in Colorado or whatever the hospital system may be, Baylor in Texas. Right. So they can actually work with me to tap into that high performance network because I've already built the architecture and all those connections and it's turnkey instead of having to try to navigate that autonomously. So that's one of the features obviously on the pharmacy side that's a really low hanging fruit piece as well that a lot of folks talk about. One thing that my health plan enables, irrespective of network choice, is that independently owned pharmacies they award if a member chooses to go there with a lower co pay out of pocket. Right. With hsas it gets a little more dicey because you have to come out of pocket a little bit first, obviously. So a 50% reduction in the copay is not really going to be felt. But that said, if you have a copay style plan, it's $50 at a national chain and you go to, you know, Susie's Pharmacy, right. That you've known forever, been there 30 years, like local business.

Owner doing care people, your copay will be $25. Right. Independently speaking. So there's a few different ways that the community has helped, but it's also just very collaborative. Right. Like some of the guerrilla style marketing approaches that brokers that like to adopt this line and walk this line actually will do is to see if there's a local pharmacy that's interested in introductions. Right. Because knowing not only that they will be helping their local community, but the model also allows for them to get paid more. Right. As their dispensing fee. So instead of it being a quarter or a dollar, it's $8. Right. And that's a modifiable amount. But either way you look at it, it's multiples more than the national PBMs. So the pharmacy is getting paid more, the members paying less. Right. Due to the formulary and plan design and all the features that we baked in by way of sourcing and 340B optimization and the rest, it all comes together super nicely, right? Like any, anything that I could think of to make it community oriented is something that continues to be, you know, in process. Right. But there's a few things solidly that are already there. Save money, buy local, right? Go local for pharmacy benefits, keep people with local doctors. Right. I mean, these are all just tenets of the program and they come in through the product. Right?

Well, and I think what's important, you know, again, referencing Dave Chase, relocalizing healthcare is I think it's easy in the benefits industry, right, to, to, to say to have this us against them mentality when it comes to the healthcare system. And what you're doing is instead of trying to create the us versus them, it's the collaboration. You're actually trying to promote the local hospital. You're trying to promote the local pharmacy and reward employees when they keep things local.

And I think that's what I want advisors to hear. It's about collaborating with the system, not fighting with them.

Yeah, you're totally right. And that's what also makes it more fun, right? Because we go to these conferences and we see our friends and like I was talking to a good friend on his advisory board, right, Just yesterday and I was like, you guys are just my people. Like when I go to these conferences, it's just so fun. Like I just feel like we all have this deep current of connections. And I felt that Years ago, in 2020, I was like, I want to be able to work with these people, right? And to be part of the ecosyste and the thread and the fabric of connecting people and vendors and being a part of the solution. And you're right. Like it's, it's just, it's more fun. And you know, you don't, you can win without really many people losing. Right. And the losers, if you will, they're not really directly involved in the local community anyway. Right. So without pointing fingers, it just, it is what it is. Like we're just.

Yeah. And the local, local providers are winning because you're encouraging foot traffic and incentivizing local foot traffic via how you design the plan. I mean, that's, that's what's really effective. And I want people to hear, I think you said 75 access to 75 high performance networks around the country. This isn't just something you're doing in the Southeast. This is advisors all over the country, you know.

Yeah, it's, it's national and I'm glad you mentioned that because you know, there, there are pockets of Cindy cities where there's already just one hospital anyway. Right. So that's a no brainer. And then you can obviously put a rap network in for, for out of area access, which is again just baked into the plan design itself. But for those that don't have a narrow network, right. Or there's too many hospitals, the employer doesn't like that idea or that strategy, even though we know it's a tight wrench and it does tend to work. Right. By way of controlling costs and steerage and all the other things, they can still access the Cigna ppo, right. Or a variety of other different network options that are more widely known, commonly accepted. Walking that line, if you will.

Flexible.

What was your experience like, Nico, when you first created the model? And obviously you were, you were eating your own cooking by doing it in Georgia. What was your experience trying to get the local communities to buy into that when you first started pushing this model out to the public?

Yeah, it's, it's interesting. You know, in my market, it's actually kind of funny because I do wear both hats, right. Because I am known as like the retail broker. I mean, I have retail groups. I've been serving the community in that way for 12 years prior to starting to collaborate with people. It was funny. You know, it's easier for me to work with out of area brokers. Right. So I'll say that dynamically speaking, it's way easier for me to work with anybody outside of Savannah because they don't see me as a competitor. Right. So that's kind of a natural fit when it comes to, you know, the adoption of these high performance plans within the local community. It's slow coming and it seems like it wouldn't be the case that. But when you have to actively describe that a high performance network would pay someone faster or more directly or you know, less turnaround time, less claims edits, less of a discount. Right. Like what's the actual ultimate result? You just have to educate so many people on what's actually already going on so that they know that there's a problem to solve for. And that's the big challenge. Right. So I've struggled a little bit with that. But also if you just find people that want to listen and then they know where your heart is and where you're coming from. And you know, I worked with a local pharmacy to get introduced to a Local employer. And I was like, look, I have this plan, it rewards local you. Do you know of any companies that may want to benefit from that or take advantage of it? And if that works for me, in my little sleepy town of Savannah, Georgia, any broker can just go onto a map that I can provide them and say, hey, why don't you reach out to this pharmacy and see if they know any business owners? Because we've got a plan down to 10 lives that could pay them more. It's more equitably built, it's transparent, all the things. And no one's coming through with that message. Right. I like to think that I thought of that level of marketing approach, but that's just one creative thing that people can leverage and use. Right. They can talk to DPC providers and say, we've got a plan to offer that perfectly pairs with TPC via plan design. Right. So I've had fun with it and I think a lot of brokers can and it has been fruitful. Right. Like who, who wants to say no to a locally owned and controlled plan from a local consultant that brought it to their door? I mean, it just checks so many boxes.

But it also, it proves, it proves how much our industry has evolved. You know, the days of just being a broker who's slinging spreadsheets and quotes are over. Right. You can't, you have to bring something more valuable to the market. And I think what's the evolution you have seen is consultants, I'll call them consultants because they're not just brokers, consultants who are starting to integrate into how do we bring our health plans. I've been selling for years together with the healthcare system to create a better experience for the employee. Because at the end of the day, the end user is the employee.

Right.

And I think some brokers, some advisors have to be careful because you have people who are starting to say they may know more than the doctors. And I don't think that's a good idea. Yeah, but at the same time what you're doing is saying, hey guys, if we're going to fix this, it's not fighting, it's collaborating. And you are becoming, you're not becoming just an asset to your own clients. You're becoming an asset to the entire ecosystem and to the community locally because you're helping keep foot traffic in the city, you know, whether it's Savannah or anywhere else, which is benefiting the local hospital, which has been. I love the idea you're promoting the local pharmacies, the independent pharmacies that still exist. Like who loses in that equation? That's my question.

Yeah, I mean it's the entities that aren't willing to go down the road of customization or carving things up or you know, disclosing closing things preemptively. And we live in this ecosystem. It's just really kind of obvious to see. But it is so much more rewarding to get that consulting hat on. And when I work with brokers that are like look, the rates are this, I say well how can the carrier be profitable at that level? But the other plan can. It's like because there's more revenue involved or because they're not paying out as much in claims due to the edits and the clawbacks and the rest of the. And so it all ends up making sense. But it is again just so much more satisfying to be able to be a consultant and to say here's these various different programs, here's why they're priced differently. This one's built for stability and this one's built for a 12 month win. Right. Anyone can sell you this one. I'm probably the only person that's going to talk to you about a more refined in depth strategy to stabilize long term and to incorporate care within the model, which is also tremendous. Right. Which a lot of these solutions don't really address. It's not about, as you said, the member coming first, it's about what's the spreadsheet look like, what are the premiums where the deductible benefit levels and the members are kind of stuck twisting. It's like well what about my care? You know, so that, that's been addressed with the plan design too. So not only local, it's, it's actually, you know, metabolic health improving initiatives and I'm not a clinician, I'll be the first to say it. Right. But reading a lot of books that were authored by very, very intelligent, you know, storied career phys that, that choose to now tell the truth on what they know. That's been fascinating and it's just, it's taken me down a whole other, whole other tear of like if we can get people healthier via the plan design and just to enable the knowledge. Right. Aren't we doing more than a lot of plans out there? Right. Like proactive outreach, let's talk about nutrition, let's get you healthy. Right.

It's, yeah, that's also just, it goes back to your mission to help, want to help more people.

Right? That's it.

And one, one thing I Like I'd love to get you, I got two questions on this because I really love to get your hear your feedback on this. So yeah, you started this in journey roughly in 2020, right?

Right. Yep.

Taylor. And here we are four years later and you're still at it. Which tells me this is a mission for you. You didn't do this just for another revenue opportunity because if you had done it for just another revenue opportunity, you probably wouldn't be doing it anymore. And you, I can tell you're passionate about this. What, how have you seen the COHP model evolve over the last four years?

So down several different roads I had walked, right. Trying to find the right partners, trying to build something, trying to prop something up, trying to generate enough interest without having thousands of lives or hundreds of broker relationships to offer to a vendor to try to do something bespoke from the ground up, who also in turn believes in doing the right thing was a little bit of a challenge. I would approach this vendor set and this basically stack and see what I can customize. Where did I sit on the priority list? Maybe it was high, maybe it was low, maybe there was a competency that wasn't there on my side or the vendors or maybe they weren't ready for it yet. It's been a lot of trial and error, but I feel like that's just how you get things done in this industry. Especially when you're doing things like build a network as you go direct contracts via payment methods that are built into the plan design. So it's not something as easy as just saying hey, here are the plans, it's going to be Cigna, it's going to be underwritten by whomever and here's the set of vendors, right. So it's been a lot of honestly just trying this, trying that, placing groups in, seeing what the challenges have been, seeing what vendors have performed well. And so to this point now I have involved and requisitioned I guess on a retainer. Health Rosetta's advice, right. So I'm a Health Rosetta Excel based advisor and several other plan builders are. But it's been interesting to work with them to try to cement what the path actually looks like and to actually create the product itself. Right. With. With a little more direction than just saying well hey, let's do this and then you can unbundle a plan, but it's not a product, it's not a, it's not a portfolio, it's not something necessarily bespoke that you can go resell. So While it sounds simple in nature, I've learned over the past four years, like you just have to keep bobbing and weaving and figuring things out and changing things up. And now I'm to the point, selfishly, I can say, like, the price point's been hammered through and having so many different passes at underwriting with different entities. The plan designs are locked and loaded, the vendor set is effective. So it's been an interesting first few years, but again, it has been kind of more of a project than my primary day to day, which is still retail broker. So it's good because I know that lane really well. It's less good that I'm not as available as I want to be all the time, but I still try to get it all done.

You know, we're going to talk about that in a second because I think you've done something really well on the retail side that I want other people to hear. Last question though, with the CoHP, that's what you just said. You know, I want everybody to hear. You've, you've done the legwork now. You've vetted the partners. You've, you've gotten kicked in the face when as you're trying to grow this, you now have gotten to a point where you, you feel you've got a good partner stack and a model in place you can bring to other markets. If I'm an advisor listening to this and I'm like, okay, I'm in, I'm in Illinois or I'm in Oklahoma, wherever, and this is an idea I would love to bring to my market. What advice would you give an advisor to when it comes to starting this kind of conversation locally?

Yeah, I mean, I, I would say the newness of the dialogue is probably enough to get some doors open. Right. Just because it's so atypical. But I think that if they just have the messaging of like, this is a health plan built for our community and it's a new model, would you like to hear about it? I just feel as though the answer would probably more likely be yes. I mean, maybe I'm optimistic in my thinking. I know people get busy and it is cold calls that happen or it's a cold email or it's whatever it is or walking through the door, which incidentally is very effective. I found earlier in my career just grabbing a business card and being a friendly human be like, can I email this person? Yeah, it's not hard to do either. It's actually kind of fun. But I would just say to have those dialogues and lean into the.