From 1 Million Cups to $10 Billion Saved

Um, we have our next presenter, Paul H. Flowers Jr. He hails from Gary, Indiana, by way of Chicago, and is founder of Superior Insurance Advisors. He's here to share a story of where the state of the U.S. healthcare system is today and where it is going. So I want to hear more, don't you? Let's welcome Paul H. Flowers Jr.

Thank you so much. I'm used to saying Madam Toastmaster for the sake of being in front of Toastmasters groups, so shameless plug, toastmasters.org if you want to get up here with no fear. Thank you so much. I got from Small Business Development Center to Purdue to, of course, 1 Million Cups. Again, like stated, my name is Paul, like the saint. Last name is Flowers, like the plants with an S. And yes, I've been saying that for a decade and I can't stop. So I'm here to share a little bit of a story today. And first, prior to getting started, because we're in this 1 Million Cups setting, I'd love for everybody to take out their cell phones, right? Everybody who's got a phone with a camera on it, just take it out. It'll take you less than 15 seconds. This is so that we can actually stay connected, right? Because everybody says, well, let's connect, let's connect, let's connect. Well, this is the easiest way to do it. Most of us have LinkedIn profiles. This will take you directly to my LinkedIn profile where my media campaign will be launching in early April. Enough about me. I got a whole team of folks behind me. And needless to say, the Next Gen Benefits Advisors Mastermind Group, again, this is my A-team that works with and supports Superior Insurance Advisors and having these kinds of conversations across the country. There's just under 40 of us. So again, I come with a large network of individuals, not just here in the Northwest Indiana space, Illinois, Midwest, but nationwide. We're solving these problems for employers of anywhere from 5 to 500 and well into the thousands. So what's the problem? Before I start on the problem, huh, who likes spending money on health insurance? I never get a hand for that. Never, not once, right? Who has noticed that healthcare expenses have continuously gone up over the years? I usually get 100% hands for that one. Well, it's not a secret, ladies and gentlemen, that the costs of healthcare are increasing year after year after year. In fact, they've tripled as a country, right? So now we're into the trillions, and that's trillions with a T, like the market cap of Apple, right? It just keeps getting bigger. Now, what does that actually mean in dollars and cents? Well, for many of you who are employers in the room and/or have been employees at some point, that means your healthcare costs are going up. So they're going up not just a little bit, right? They're going up a lot of it, and then seemingly in a very small amount of time. From 1999 to 2023, that's 24 years. Who's been out of high school for at least 20 years, right? A lot of them have been out of high school that long, and in just that amount of time, the second largest expense for employers has quadrupled, right? In a really, really small amount of time. Now, Tylenol doesn't cost that much, okay? But for whatever reason, inside of hospitals and pharmacy plans, it can be anywhere from 300 to 3,000% markup when we actually have these medicines provided to us through our medical plan. Even the diagnoses that we receive. I'm gonna let this sit for a second. 1 in 20? Anybody ever heard of somebody with a misdiagnosis? Oh, and a hand shot right up, right? So this is a real thing that happens. But unfortunately, without the proper education for our C-suite professionals, typically, again, we're having this conversation with CEOs, CFOs, and CHROs— that's Chief Executive Officer, Chief Financial Officer, and Chief Human Resources Officer— without having these intelligent conversations where we're doing it together, meaning not just a silo of HR. This isn't just an HR thing. It's a company-wide issue. Again, because it's impacting every person in the company, especially the bottom line. So what's the issue, right? Most companies are on what's called a fully insured plan. Now I know many of you didn't come here planning to get an education about health insurance, I wanna make this really, really simple. Fully insured bundled plans, it has a bunch of stuff that's all put together in kind of like a black box. And I'm actually gonna go through that black box in just a little bit. Main point to note is that it's 100% cash in and no cash out. There are very small amounts of claims that come out, and usually the quality of, quality of care tends to be a little bit less as opposed to employers shifting over to what's called a self-funded model. And again, employers can do this whether they're as small as 5 or 10, or of course, well into the thousands. There is no, you're too small for self-funded, like the actual mantra has been. And I'll talk about who promotes that mantra in just a second. But this can be done and have significant amounts of savings anywhere from 20 to 30% first year to well into the 40% range. This is what that progression looks like. So again, most employers start— oh, the laser does not work on screen. Most employers start in that fully insured space with what's called a BUCA plan design. B-U-C-A is the acronym that we use internally. It's a little bit of jargon, but it just stands for Blue Cross, United, Cigna, and Aetna. Has anybody heard of those companies before? Has anybody seen their stock prices recently? They're going the other way, right? So here the cost is going down, but those stock prices are going up, up, up, namely because they're responsible not necessarily for increased quality of healthcare and increased quality of outcomes for health services, but they're responsible to their shareholders for increased, what's that word that starts with a P?

Close.

Profit. Exactly. Increased profit, right? And again, no offense if you guys love your carriers. I'm just here to give a little bit of truth today, if that's okay. So we're going to actually unveil what's inside of this black box where you see a lot of dollars going in but just a few of them coming out. So many people don't know that it's actually made up of a bunch of little things. So every Blue Cross United, Cigna, Aetna plan has a bunch of little things in them. We'll go through those things again relatively briefly for the sake of time. We've got a third-party administrator, and that's your ARCs, Maritaines, UMRs. They're all owned by the BUCAs, by the way. Your pharmacy benefit managers, CVS, Express Scripts, Optums, again, owned by the BUCAs, by the way. Medical management company, stop-loss reinsurance, which is just a fancy way of saying that somebody pays for really, really big claims, right? When it gets really big, they pass the risk over. You have your provider network, which is any of the, again, Blue Cross, United, Cigna, Aetna, any of the carriers have their own contracted network. And then last but not least, you've got your program manager. So these are the Aons, the Brown and Browns, the USIs, and the Gallaghers, companies of which I've known very well. Some of them I've had the unfortunate, you know, excuse me, it was a fortunate learning experience, but once I learned what was going on on the inside, I could no longer work corporately with said companies. And again, you've connected with me on LinkedIn, so you can see the Dun Bradstreet there. Now, the difference in the traditional fully insured plan and what our organization provides, which are next-gen health plans, is that we have an unbundled third-party administrator. So what that means is that the employer actually gets the ability to choose. Each one of these areas is basically like a little à la carte portion that you can take out see what works best, and then put it in. Again, with the goal of decreasing savings— excuse me, increasing savings, decreasing cost, and overall increasing the quality of care. We use transparent and pass-through pharmacy benefit managers. So these aren't people that have the contracts that pay additional dollars to the program managers down here for every prescription. They are actively working on providing the lowest possible cost for every single prescription that a person uses. Again, Tylenol shouldn't cost $264 a pill. It's 12 cents, okay, 12 cents. Medical management, medical utilization management specifically, companies like AIM are there to actually provide guidance in where you should go to get not just the care, but the quality of care that's gonna keep the rates low for you to actually be readmitted into the hospital or have to go back and see that doctor. Stop-loss reinsurance. Again, we've got contracts with tons of reinsurance providers. They're actually simply looking at the overall plan, how it's put together, and they provide much better rates than traditional. Provider repricing mechanisms. Again, we don't wanna go down the rabbit hole because it's not that type of discussion per se, but just note that a doctor's visit or an MRI, let's say, that's $3,000 can actually be done for $90. 90 bucks, okay? And this is what we pay for on a regular and consistent basis. And as opposed to having those big national carriers whose job it is to help promote backend bonuses and increase profits for their companies, we only work directly for the patient. So by wrapping around a communication strategy, which is entirely essential, having a plan sponsor, meaning an employer that truly understands and values this process, and the NextGen Benefits Advisor, that again supports and puts this all together. We have a patient-centered focus that is second to none. So it's not about the profits, it's about the person. And with that, couple of quick slides that are just showing case studies of thousands of dollars saved per employee per month, which adds up to millions of dollars saved per year for our clients. And again, this is in every industry all across the country. With that, ladies and gentlemen, I wanna say thank you. Again, I'll put a different QR code up here. This is a different QR code. So if you actually want to connect with me outside of LinkedIn, this has more information on Trustpilot reviews, kind of a brag folder that's up there so you can see some of the work that I've done in the last decade or so, as well as ways to directly book meetings on my calendar. With that, I wanna thank 1 Million Cups and turn it back over to our esteemed, oh, actually not esteemed host, we're gonna pause. For Q&A, I'm going to turn it over to you all for the— I called it grilling session, but we call it supportive Q&A. Thank you. I can hear an ant pass gas right now. It's that quiet. Ladies and gentlemen, I'm not that good. I know there are questions.

Um, first of all, I commend you for talking about— sorry, I have to leave for a moment— but, um, talking about we run into our biggest hurdle, head against the wall with what we do, is problems with insurance covering rehabilitative care. So, um, I commend you for that. I— we will definitely be connecting with you with our organization because that's— it's just imperative. Nobody wants wants to deal with messy insurance world. So thank you.

You're very welcome.

This is absolutely probably amazing. This is the best insurance presentation I've ever listened to because I'm not ashamed to say I have state insurance because every job insurance I've ever been offered is way too expensive. So I have state insurance and that doesn't pay for very much. And listening to this is just like, wow, I'm so glad somebody's talking Thank you.

Thank you.

I also just wanted to comment on your presentation style. We could tell that you're definitely professional at doing this.

Toastmasters. I don't take any credit for it.

That was so polished, confident, and allowing us to understand what you're presenting. But also feel intellectually, but also emotionally understanding the problems that you're describing.

Beautiful. Thank you. I do have a question that I'll pose. Does everyone have a slightly better understanding of how employer healthcare works at this point? Okay, then my job is actually done. Because that really is the goal. I come from a background of education, just a little bit more about myself. And I'd learned in doing direct-to-consumer health insurance that honestly, I don't have the right to ask for your business unless you know what you're buying. And quite frankly, when I made that move to corporate employee benefits, I found that there was very little true education about the options that are available to the employer as opposed to the steering to a particular plan. Again, because of backend bonuses, pharmacy bonuses, collective body bonuses, meaning the more bodies on the plan, the better your bonus is. Not what's best for the company, not what's best for the employer— excuse me, employee— but what's best for the broker and the carrier behind them. And once I saw that, I realized that I don't do business that way. So again, my tenure there was very short-lived, which again, check me out on LinkedIn, but it was for those exact reasons when I sat in the back room and I realized that a specific carrier, whom shall remain nameless for now, was brought in their entire book of business that this large company I worked with had with them. And when they went down the list of, okay, this company has this percent renewal, we all know renewals are right, the price goes up every year, basically is what that means. This company has this percent, this percent, this percent, this percent. And they said, well, they did really well financially, they can take a few more percent increase. Oh, this company said that if they have any more increase, they're going to go to another carrier. So we need to actually decrease them a few points. What I learned in that meeting is it had nothing to do with the health of the employees at all, at all. And it's a game. It's a game that a lot of people will not talk about and quite frankly are afraid to talk about. So I'm gonna reference one more story and then again, I'll turn it back over or I'll escort myself off. I had the pleasure of doing a sales conference on January 23rd of this year with NextGen Benefit Advisors where a gentleman by the name of Terry Shook, was on the panel with me. And myself, Terry, Allison, Rachel, we had a very enlightening conversation for the audience. But Terry's history was so much more impressive than mine, quite frankly, because he had 20 years as an insider with Blue Cross Blue Shield, company that I'm pretty sure we've all heard of. Well, the story that I'll share with you again, really brief, is that Terry told me that he had the power to increase or decrease renewals as he saw fit. So while he sat with one of his companies, one of his carrier reps, but one of the companies that they did business with, he gave them a 20% decrease that next year. Premiums here, we're bringing it down 20% the next year where it usually goes up because of the cost of doing business. He brought it down 20%, and I'll give all the dollars in my nonexistent pocket if somebody can guess why.

Close.

He liked their beer. So if you want to know how decisions are made with large national brokerages and carrier reps for, again, buca companies, I'm here not to bash them because for some people, for some companies, those are very much needed plans. But there's an ugly truth out there that somebody's got to talk about, and I'm not afraid to. Yes.

So you have the patient in the middle, and then you have all the services around.

Yes.

Large company, insurance company has the bundled black box thing. How do you— and you said they're all run by the same people. So how do you negotiate these individual services?

Gotcha. So we find companies that are not these companies.

OK.

Right? So CVS— I look at the pharmacy benefits specifically. That's 30% to 40%. Of the healthcare spend as it comes to actual costs and claims. CVS, Express Scripts, and Optum are owned by UnitedHealthcare, Aetna, and Blue Cross, right? And there are a ton, and when I say a ton, there are a ton of actual transparent, what's called pass-through pharmacy benefit managers in the marketplace. So instead of the profits being kicked back to another area of the company or the profits being kicked to the broker, they remove that and say, here's the cost of the medicine, here's our slight margin, which you can see in plain English, black and white, and this is what the employee actually pays when they go and get a medication.

So, and then the next question would be, okay, so you find this not—

this unbundled, basically.

Yeah, unbundled, um, program. However, you know how people are. Oh, you know, Blue Cross or this and that. Who's this company? I don't trust them. They're, you know— so how do you talk How do you talk somebody through that?

A couple of ways. One is that— let me get to that last slide of the— there we go. We talk facts, we talk figures, we talk dollars. So it's pretty tough to deny that over the last decade my partners and I have had these type of results. We've got more references than you can shake a stick at from CEOs, CFOs, and CHROs around the country. So we simply let the peers do the talking. We have an educated discussion to educate you first. But if you need somebody that's more like you, there's no problem opening up the Rolodex, finding that person that can have that conversation, and they'll again get you any other insights you need on how well the program runs for their company.

So then how does, um, when you're going to, when you're going to high school and they don't know your insurance company that you're using, gotcha. And then a lot of them will say, well, then if we don't know that, we're going to make you Pay 100% up front and then we'll see how reimbursement goes.

This is where that first circle communication strategy— communication is essential. Just like here, within a matter of 6 or 7 minutes, the entire room for the most part raised their hands saying— except for the young gentleman in the back, but you might have a better understanding when you're like 18, 20, okay? There's a child in the room for those who might be seeing this in virtual land. But just like the entire room had a slightly better understanding of how this works within less than 10 minutes, Our goal is to make the understanding of how to use your healthcare plan simple, right? Simple. Just as simple as you take out your Buca card and flip it over and there's one number to call. Same thing. And when you actually have the conversation and educate the employees on what they are to say, if there is any sort of rebuttal or comeback, then they know how to handle that. We also have, again, the medical management staff that does a lot of that for them. So it's typically like concierge-based services. Where they don't have to do the heavy lifting. They can again make one phone call, somebody else finds the most reasonable rate for that MRI, CT scan, what have you. Great question.

Yes. I have a question. Um, how does this healthcare work for small companies that are under 10 or even so long, if they weren't interested in getting insurance through this area?

So I actually came from the individual space And that had been my passion for like the first few years once I left corporate. Sad to say, and again, I just like transparency, that they've recently passed laws that disallow for programs like this on the very, very, like the individual onesie-twosie level. Though we can create something, price point-wise, it would be very comparable to a fully insured plan. And for that, unless you're just really for the cause as an employer, many employers say, oh, it may not be worth the hassle. Again, that's in this area. Now, a slight bit more education— I don't have it on slide because that wasn't the purpose of this presentation— but there are things called healthcare sharing ministries, whereas opposed to going with the Blue Cross Blue Shield, and for a 35-year-old woman with a $5,000 deductible, you're paying $450 a month. You can have that same, if not better, quality of care. Now, there is a screening process because with healthcare sharing ministries, they want to ask certain questions and make sure you're not out there just doing all sorts of things. So there are some guidelines, kind of like an underwritten health plan that we might have been used to from like 15 years ago. That type of coverage still exists on a yearly basis, and those programs are anywhere from, again, 40 to— I've seen some as large as 60% less than traditional Blue Cross Blue Shield plans. So there are options. Saying that to say, there are options for the individual also, but the— they typically are going to come through a healthcare sharing ministry because most recently the legal changes, even in Illinois, I'm assuming used to being in Illinois, in Indiana as of September of last year, whereas you can purchase an underwritten plan for 3 years, 3 years at 40% less than a Blue Cross Blue Shield fully insured plan. Again, it had medical questions. So if you had certain issues, you might not be able to get it, or there might be some concerns or addendums, that type of thing there. They recently changed that law at a federal level so that no state, no state could have that type of plan in place for more than 4 months.

Why?

Because it supports the— oh, I'm not going to go all the way back, but it supports the bookers, right? So you got people that lobby, you got large companies that lobby for the sake that, hey, we don't want people to have these underwritten plans because it takes away from our book of business. So unfortunate nature of politics in that regard. Yes.

I've been involved— I have my own business for many, many years, and for the last 4 years I've spent $40,000 a year for medical insurance for me and my wife and my child.

For 3 people?

3 people. And my wife has insulin-dependent diabetes, and so that's all the costs. So for pre-existing conditions, your plan really doesn't work for small businesses, right?

Depending—

medical sharing, obviously. Usually for small businesses that have, you know, ongoing conditions.

So first thing I would ask is the age of your wife, over 65 or under?

Well, if she's under 65, we wouldn't have to discuss something.

Okay, okay, okay.

For under 65, obviously that's, you know, that's a major concern for a lot of small businesses.

Absolutely.

Coming in contact with, they want to start their own business, but they have to be tethered to a companies so they can have health insurance to cover those pre-existing conditions. So absolutely, Obamacare is good, but it's very expensive too, right? It's not unusual for real estate policies there, you know, a couple thousand dollars a month too easily. Yeah, so it's kind of a—

in instances like that, we have had clients that have had certain pre-existing conditions, and with that we work on the medical utilization aspect in order to actually either A, help improve the condition within a shorter duration of time, B, find better doctors that can actually better manage. And I'm not saying that your doctor's not, so no disrespect to the physician. But again, there are— you see Google scores in the front, and then you have things like Quantix in the back that can actually show you the actual quality rating of certain physicians. Again, these are things that the general public will never see. And for that reason, utilizing tools that we use on the larger scale, you find out that same information about the doctors on the smaller scale in order to help find better quality of care. And then there are also patient assistance programs that can provide assistance for certain medications at a reduced cost. So instead of having to pay X, Y, and Z company $40,000 a year, I'm just still floored at that dollar amount for 3 people. That—

Yeah. But I needed that kind of coverage because that special condition I had, and certain doctors have had to admit treat that particular disease.

Gotcha. I, I'll give you a short story. Okay, okay, good. And when you have somebody to advocate for you— I'll just wrap it up because I see we're getting ready to get the hook, right? Uh, it, it does absolutely make a difference. So by all means, reach out, and if there's something we can do, I'd love to help. Absolutely.

That's a major concern for us.

Absolutely. And thank you for bringing that up.

I know you see it's closing up.

Yeah, I was going to say—

Just the final question before I let you go. What is something the 1 Million Cups community can do for you?

Absolutely. Share, share, share, and keep sharing. This is a huge message that needs to be broadcast on a larger basis. My goal is to go from 1 million cups, meaning this presentation, to over 10 billion saved by doing these types of plans and programs even just starting in the Midwest, a company with an average of 250 employees, takes 2,000 companies to do this with to save $10 billion. What could be done with another $10 billion in the Midwest economy just between Indiana, Illinois alone is the question. So if you know employers with anywhere between 5 and 500, or heck, even, even if it's into the thousands, send them my information, shoot me over a text. Again, that second QR code gets all of my information there for you.

Thank you.

Thank you.