Episode Transcript
[00:00:02] Speaker A: Welcome to Align for Impact. I'm your host, Matthew Naylor. I started this podcast because healthcare and leadership both come down to the same thing. Alignment. When people, purpose and performance connect, real impact happens.
On this show, we'll talk with entrepreneurs, brokers, and change makers who are challenging what is broken in healthcare and in business and find new ways to make a difference for companies, communities, and the people they serve.
You know, Brett, my podcast is all about alignment, and it's all about impact.
And when I think about the Samaritan Fund and the business that you're building and you've built and the impact that it's having and the true alignment that it. That it has.
Loving this conversation to dig into that in a moment, but I'd love to just start by getting to know you a little bit. Where are you from? Where'd you grow up? Where'd you go to school? How'd you get into this business? And we can then talk about the business a little bit.
[00:01:09] Speaker B: Yeah. So born and raised in Harahan, Louisiana, which is right outside of New Orleans.
Went to college, played golf. In college at Southern Miss, I majored in financial planning, which is a double major in mathematics and economics. And I started as a financial advisor, which was kind of difficult as a, you know, young 20 is just, you know, they say, how, you know, how many people do, you know, have liquid million net worth? That's who you need to go after. And I said, look, my natural market is drunk and in debt in college. Like, not an easy thing to do. So I had to sell outside my.
My kind of natural market, like 30 years above.
And I had a.
Had an older guy come in and said, look, you know, he's like, you're smarter than me, but I got something you don't. I was like, what? What is that? He goes, see this gray hair?
He's like, how about I bring him in and. And you. You skin them. I kill it. You skin them. So I was like, all right. We started doing that.
Did pretty well with it, but my idea was, hey, I'm gonna write 401k plans. That's how I'm gonna meet people with some net worth that gravitated into. Well, can you do our medical as well?
And so gravitated into employee benefits.
And just because of my background, you know, I like to dig into the data. I didn't just want to, you know, spreadsheet, you know, okay, here, quote. Here are your options. I wanted to have a little control and have something unique.
And so that kind of pushed me into Self funding.
And so from there that's where I kind of built my career as a broker advisor doing self funded medical plans
[00:02:55] Speaker A: and tell me about the Samaritan Funds. Tell me about the foundation.
Tell me about your focus, your vision, your strategy, the value proposition.
[00:03:08] Speaker B: So the Samaritan Fund, there's two different entities, the Samaritan Fund program and the Samaritan Fund Foundation.
The Samaritan Fund program, what we do is we, we find individuals that are, have high cost disease, are struggling with high cost medical bills and disease and then we source them funds to pay for all of their medical cost share and medical bills, bring that down to zero.
It's a tremendous help and benefit to them at a time where they really need it.
And when they do, they come onto the program, they leave the group health plan which results in a lot of times tremendous amount of savings for the, the plan as well. So it's a, that's a win for everybody.
[00:03:58] Speaker A: How does it actually work? How do they actually get it funded? How do they come off the plan? How does like how does it Sounds really interesting. Yeah, sounds complicated.
[00:04:07] Speaker B: Yeah.
[00:04:07] Speaker A: How does it work?
[00:04:09] Speaker B: Well, the way it works is we roll the program out. The employer just rolls the program out to everybody. Simple message of hey, if you're struggling with high cost disease or medical bills, you could get everything paid for. And all you need to do is send in the short HIPAA form to Samaritan Fund program and they're going to reach out to you and see if you qualify.
They're, they're hands off and it's designed that way. We don't want employers engaging high dollar individuals. I mean it could be dangerous for them. And so they reach out to us. It's, it's no pressure, you know, and, and, and that's how we identify, we talk, that's how we identify these high cost individuals. And we, and get the information is where we source the funds for them and make them an offer. Say hey, we're able to source, on average we source about 25 to $30,000 for each participant that we find.
And if we're able to make them that offer, they move forward, they come off the plan and move forward with our program instead.
[00:05:09] Speaker A: And where are the funds coming from? How they getting the funds to do what you're doing?
[00:05:16] Speaker B: Yeah, that is an integral piece of our strategy and program because it has to be compliant. And as an employer you can't directly incentivize an employee to leave the plan. You also can't indirectly incentivize, meaning you couldn't give my company money, and then I turn around and give it to the employee. And so that's why it's very important we have to take the extra step, it's cumbersome and expensive step of making sure that all of the funds that go to our participants are from our third party Samaritan sponsors. None of it comes from the employer. None of it comes from my company.
And that's what makes it compliant and safe. It's other foundations and charities and the philanthropy industry calls what we're doing grant smithing. We take a person's situation and we may source funds because we have funds for children, cystic fibrosis. We have funds for people in Kansas. We have, depending on what situation they're in. And so that's where we accumulate the funds and we put it in a package that is easy for them to use. We have a Samaritan fund program debit card that they just get the card. They're able to pay their bills and premiums with it, and it makes it easy for them. Instead of dropping 20 grant applications in their lap and saying, hey, you gotta fill all these out. We're able to cut through all of that to where it's easy on the participant.
[00:06:51] Speaker A: That sounds transformational.
[00:06:54] Speaker B: It has been.
[00:06:56] Speaker A: It sounds totally transformational. Like you have a member that's on a employer health plan in a high deductible that doesn't have the ability to keep up with their high deductible or the bills associated with their disease state that they're in. And you have an employer that is spending a lot of money on care for that member. So it sounds like the member wins in a very significant way.
And it sounds like the employer wins too. Is that a fair way of looking at it?
[00:07:28] Speaker B: Yeah, absolutely.
I mean, we're able to move the needle in ways that, you know, I used to grind really hard as a advisor, you know, broker, to try to cut costs. But, you know, the Kaiser numbers are that 1% of the people hold 27% of all medical claims. Well, I see especially in the mid market, these groups come in where one or two people are 80 or 90% of all the claims. What would it do, their cost if they were to leave? It should have a tremendous impact.
I even had a recent one 62% increase.
And with our program as a success, they delivered a 15% decrease. The broker's like, how am I going to deliver this? They're not gonna. They're gonna think I messed up on the numbers. I said it's easy. 90% of the claims just walked out the door, and that's what was driving it. And so we're able to move the needle quite a bit by attacking that, that, that top one to half percent of individuals, which equate for most of the time, over half of the claim.
[00:08:38] Speaker A: How did you come up with the idea?
Like, I mean, I'm an entrepreneur, and I love these conversations. Like, how did you come up with this idea?
[00:08:47] Speaker B: You know, it was kind of a. A multitude of things, and I can kind of tell three quick stories of how it all kind of came together. One was I was dealing with a case.
Woman on one of my groups had the plan, had 20 rehab visits, and she needed 40, and it only paid for 20. And she racked up a bill of $26,000. And I said, well, let me see if I can negotiate it for you.
And I did. And I said, look, I negotiated down to $3,000 for you. All you got to do is pay it by Friday and you're good. I thought I was super, bro. So proud of myself. Of course. What does she say?
[00:09:28] Speaker A: She didn't have the cash.
[00:09:29] Speaker B: I don't have that. Yeah, this thing broke me already. Yeah, thanks for the offer. I'm like, well, this is going to expire.
And so I'm like, well, there's got to be of something as an age I can reach out to, you know, can the employer help? No, that's discrimination. Well, maybe I can help it. Nope, that's rebating. Don't get involved in that, Brett. So I was like, man, as an industry, where can we turn to? I've vetted this thing. I've worked this thing. This is a great deal. And so I felt our industry really needed something to kind of turn to, to help these people in those situations. I negotiate giant claims from 500,000 down to 200,000 and thought it did great. But guess what? The participants still hit their out of pocket maximum and are in debt, and it didn't affect their lives.
The next thing is doing renewals. And as an agent, I think everybody kind of comes across this. You have this one person that's a high dollar claim, and you're meeting with the CEO and, okay, here's your 60% increase because you have this hemophilia on there, and there's nothing you can do. And that's what it is. And.
And so what does the CFO or CEO do? Okay, everybody get out of the room. I want to. I want to just talk to Brett. I mean, Brett I'm a bonus. This guy, he's got a. He's got a. Waive my plan. I'm going to offer him some money, right? I mean, no, that's illegal. You can't do that. You know, but he's like, what are you going to do? I'm gonna get fined a million dollars because that's what I'm paying now.
It's kind of a logical thought for a CFO or a CEO, but ultimately legal. I was like, man, there's got to be a better way to handle these things.
And finally, as I was on the board of a foundation, and I would always talk to these other foundation kind of directors, and I'd always ask them the same thing. I'd say, look, well, you know, what do you do?
They said, well, we want to help kids with cystic fibrosis. I say, man, that's great. How do you find the kids?
And they'd all say, well, they all have some kind of story. One told me they buy a NASCAR sticker. I don't know how that helps you at 500 miles an hour, but I'm thinking to myself, I have several hundred thousand people's data at my fingertips. I know exactly where these kids are, and I know the ones that need the most help. Much better than your application. We got this stuff ready for an underwriter.
Would you like to know? Would you like me to make that connection?
And so it just kind of all came together where I can connect these people that want to help to the people that need help through the employee benefits industry. That's the only bottleneck and industry that controls that kind of information.
And, yeah, it just kind of woke me up at night.
[00:12:20] Speaker A: Sounds. Well, one, it sounds super impactful. I mean, you probably could tell story upon story upon story of how you have changed lives.
You know, I could just think of you being on the phone with a mother or father of a really sick child.
[00:12:37] Speaker B: Yeah.
[00:12:37] Speaker A: That's trying to figure out how to pay their bills, and you come in and you solve their problem. And that's what I'm hearing when you speak to me.
[00:12:47] Speaker B: Yeah, we collect all those stories. We get a lot of great testimonials. You can see that on all of our social media and website and stuff. But I mean, it is sad that we found and we track these statistics. When people are faced with a difficult disease, their first concern is, is the cost of the care.
And second is the actual disease comes second.
One case comes to mind at the end of the year when we have a ton of Business. Sometimes I get on the front line and I start calling on individuals and, and it's kind of funny. They're like, well, and I'll help our ICs out that normally work with the individuals directly. And I'm like, oh, well, I'm helping Linda out. You know, there's a lot of caseload. I just want to get some of this. I'm like, oh, what's your, what's your. What do you do for the company? Well, I'm the CEO, you know, and they're like, oh, you know, but yeah, but I work for her today. You know, we're trying to get these through. But I remember one where there was a guy had cancer and he and the kids were pleading with him to. But he wanted to fight the cancer and he had to put up all this money. He was a man's man. He's like, no, I saved this money. I earned this money for Yalls education and I'm not going to take it, I'm not going to touch it. I don't want to fight this disease. And he was, he was just hell bent on. That's the way it's going to go. And so we're able to raise him the funds and pay for that. And the kids are like, you saved our father's life. Like, he, he would have, he would have took that to the grave. And this for sure saved his life. He decided to fight the cancer because of our help with him. Because, I mean, he just had his principles and that's what he wanted to work for. And he was, he had pride in what he built for his kids and he wasn't going to touch it. And so we're able to convince him to do that.
[00:14:37] Speaker A: How, how many clients do you have? Like, how many people are you touching? How many people are you impacting?
[00:14:43] Speaker B: So we started it in 2021. It was just me. I did 13 cases.
Uh, now we have.
Now we're in over. We're in 49 states in over 2,200 employer groups.
[00:15:01] Speaker A: Wow.
Wow. How many people do you have on the team?
[00:15:06] Speaker B: Well, we're growing every day. Well, every day.
[00:15:09] Speaker A: But I know how this feels, by the way. Yeah.
[00:15:12] Speaker B: You know, we have about 22 on the team. We got about eight more spots open. So it's.
Scaling has been an issue.
I guess the struggles of building a business, one is scaling and we couldn't grow too fast. I mean, I loved my story. I could have blasted it out there, just trying to grow as quickly as possible. But if I went Too fast, and I couldn't raise the funds. Then I'd burn my credibility of like, oh, Samaritan fund, they never have any money. So I had to make sure that I grew organically and just at the right speed to where I could. I could raise the funds, you know, at the same time. So it's kind of been a juggling act, but it keeps us busy.
[00:15:57] Speaker A: Yeah. Well, it sounds like you're a great entrepreneur. And from one entrepreneur to another entrepreneur. I love hearing these stories. Sometimes it's hard for entrepreneurs. I call it go slow to go fast.
[00:16:07] Speaker B: Yeah.
[00:16:07] Speaker A: And sometimes entrepreneurs don't know what go slow to go fast means. But that's what you just described to me.
Protect your brand, build your reputation. Figure out how to scale and grow a business.
[00:16:18] Speaker B: Right.
[00:16:18] Speaker A: Be thoughtful, be intentional.
Go slow so that you can then ultimately go fast, which is super cool.
[00:16:27] Speaker B: And then make sure you don't sacrifice the quality of it. And so we've been careful with that.
[00:16:34] Speaker A: And the consulting business, you have a consulting business too?
[00:16:37] Speaker B: No, I left the consulting business. I walked away from my book to start this.
[00:16:42] Speaker A: Okay.
[00:16:43] Speaker B: And, you know, I didn't.
[00:16:46] Speaker A: You didn't want the.
[00:16:47] Speaker B: I didn't want the conflict of interest of the two.
[00:16:50] Speaker A: Yeah.
[00:16:51] Speaker B: Which was a, you know, a leap for me. But I. I believed in what I had and what I. I felt, look, if this doesn't work, I could always go back to, you know, what I was doing. I've built a book before.
[00:17:01] Speaker A: I could.
[00:17:01] Speaker B: I could probably do it again. So.
[00:17:03] Speaker A: Yeah.
[00:17:05] Speaker B: But, yeah, we're.
We felt. We felt that was a conflict interest. So we don't partake in that.
[00:17:10] Speaker A: How are you leveraging data and technology? How important is that to your process? And even for that matter, like, are you leveraging AI? Like, is there anything you're doing or thinking about doing that will help you scale and grow your business more effectively?
[00:17:28] Speaker B: Yeah. Great question.
If you find the answer, let me know.
[00:17:34] Speaker A: But you might be sitting in the right place.
[00:17:36] Speaker B: Yeah.
[00:17:36] Speaker A: You never know. So
[00:17:40] Speaker B: we.
Data is very important.
I mean, I have, you know, my degree in statistics, so, you know, I love looking at the data and the probability and the ratios and, you know, making the projections and. And.
And you can only work off of. You want good projections. Well, you need it. You need good data.
We had to build out our management system kind of from scratch because were unique. And so we had to come up with our own processes. It wasn't like, we can purchase like a. A benefits system because we have a benefits agency that's already built and so we had to massage that and program that, you know, along the way.
A couple of aspects of what we do, we collect all the information about our participants disease directly from them.
We don't get anything from the claims data or from the group or nothing like that on the historical data. We get the information we receive from them and that goes to our clinical team and they like underwrite it using that information.
Now the broker will see both and it's great that we come to the same conclusion. Oh, I was looking at the historical data and we think this, well, I got my data from somewhere else and we got to the same place.
Sometimes it doesn't. Which is kind of neat actually. When we say, well, we talked to the participant, they said they went to the doctor Tuesday and the cancer's gone, there's no treatment, everything's great. And the stop loss is freaking out about it because they didn't know that. And so a lot of times we come across information they didn't know about.
But we're using some high tech tools for that underwriting, some AI for that underwriting, you know, and we hear about the dangers of AI, you know, when using that. So we're certainly not eliminating the human aspect of it and, but we're training, we're also training our own to find solutions for our participants. You know, if you were to change plans, what kind of disruption would that cause? Does this plan accept this hospital, accept this plan?
Not easy information to find. Sometimes you can call the hospital directly, they won't even tell you.
They really need some rules and laws around that to make that easier. I mean, how we are experts in this and it is difficult to navigate or to get an answer, hey, if I buy this Blue Cross Blue Shield plan or if I buy this, you know, care source plan, can I continue my care? Am I going to be in network? They're like, oh, we don't know.
And even if we do, we're thinking about dropping it. If you drop it, are you gonna, can I just not go to this hospital? I mean, they're just like, maybe. What about continuity of care? I mean, yeah, it's a nice term, but in reality they may not let you in the door. We've seen it.
That's what's sad. But we're trying to train AI to dig and solve those problems. For me, it's struggling and seeing the kind of things that we struggle with. But, but it's helping kind of get us to a place where we can kind of take it from there. And I've dabbled in trying to train it and give it prompts and things, but then it's scary. I remember one time, I'm like. It's like, okay, I'm going to work on this and I'll have it ready for you tomorrow. Tuesday.
And I'm like, today's Thursday, tomorrow's Friday.
Oh, you're right. Yeah, yeah. Thanks for the corrections. I'm like, wait a minute.
If you can't live a day the week, what else do you not look? No, I'm sure y' all looked into everything. We assured me you knew the day of the week. And so now I'm like, freaking out. But it. Yeah, it's been an interesting ride dealing with AI.
[00:21:31] Speaker A: How. How, Brad, how has the Crumbdale Specialty partnership with you and your firm, the Samaritan Funds, evolved and how's it helped you with your business?
[00:21:51] Speaker B: Well, you know, Crumbdale, you know, y' all certainly on the cutting edge of innovation and technology.
And I think for an employer group or a broker, they gotta have the same mindset.
Some brokers are not there. They're stuck in their ways. I'm just going to quote you the top carriers, and this is it.
And Crumbdale is definitely willing to roll up their sleeves, get their hands dirty and attack the claims.
And you gotta have a broker and a group willing to do that to understand what's going on and where these costs are coming from to try and attack that. And so that's really the nature of our strategy. And so Crumbdale is just kind of a natural fit, you know, for our strategy and the people that y' all look for in. In working with.
And so it's been a great fit.
[00:22:53] Speaker A: How many cases have we worked on together as Crumbdale?
[00:22:58] Speaker B: Yeah, I can't. I couldn't tell you. We had several. We have several appointments. I couldn't give you the number offhand though. Yeah, my counterpart was here. That'd be her department.
[00:23:12] Speaker A: I don't know either. So you don't feel lost?
[00:23:14] Speaker B: Okay, we can be lost together.
[00:23:17] Speaker A: That's funny.
[00:23:18] Speaker B: But I think Buzz found us and he's been a great.
He's been a great advocate for what we do.
[00:23:24] Speaker A: Yeah, look, we love, you know, Crumbdale Specialty is all about innovation, disruption, being creative around. How do you underwrite better, how do you administer it better, how do you deliver it better? How do you create a better experience for a self insured, employer level, funded, employer, captive customer, you know, where you actually lower cost, you're producing a better outcome. And you're creating a better experience. And the experience part matters to us because there's a lot of people that want to do things that actually in order their benefit as a service provider, but don't in order the benefit of the person receiving the care.
[00:24:02] Speaker B: Right.
[00:24:02] Speaker A: And what I love hearing in this conversation and in our partnership is, you know, we're doing the right thing. You know, we're really having a real, real, real impact on people at a point where, you know, more often than not, you can speak to it better than I can, but they're at a low point in their life. You know, they're at a real low point in their life, and we're there and, you know, we're doing real, real that. It's what I love about our business and what we, as with you, in partnership, do for employers and more importantly, their members.
You know, it's just when you think about alignment and impact, it. It really, it encapsulates all of that together.
How meaningful is that for you as the founder of your business?
[00:24:51] Speaker B: It really is. And I tell my team, like, or on the front line that deal with the people that call in, like, I don't know if I can handle the emotional highs and lows and that. I mean, it's. Some people are really struggling. The only thing that, you know, kind of pull you out that is the gratification you get and calling them back and saying, I have $30,000 for you. Oh, and that debt you already have, we negotiated that down and. And that's gone, too. And we do that a lot as well. And I'm able to play a card that I didn't have as an agent or broker.
You know, the hospital's view is differently than, oh, you're an insurance company. We're a foundation, you know, and this, this person here has this bill, and you're never going to get paid on that. You know, However, I do have a. I can make a deal with you. I have some funds here that I can pay. Would you make this go away for that amount? And they're willing to work with that with us.
And you said something. Yeah, they're. They're dealing with a low point. I lost sight of that as an agent, as a broker. These were lines in my equations and factors on my renewals, and I lost sight that these are people. What are they going through? I had a personal experience with one of my groups that showed me, man, some of these people are really struggling. And it's in private, too. This is something that they're not open about it. I mean, they reach out to us. This is something that's over the kitchen table at night.
We're holding your anxiety right here. What am I going to do? I don't know.
Do we even fight this? Do we. We're not going to have the money. Do. Do we destroy it? And.
And the system is terrible to where, okay, you. You go, you get the service, and then the hospital just. Just sends them to creditors and just destroys every other aspect of their life. And anxiety has a physical effect on the body. Absolutely. Stress and cortisol and.
And if that's coming to you and you're feeling that in a time where you're supposed to be focusing on healing or fighting a disease, that's a horrible time.
And so that's why our. Our mission and our slogan is to give the peace of mind, to heal. If you didn't have to worry about any of that, you could focus on what's most important. That's your family and that. That's your health. And we want to remove that. That. That tightness and that anxiety. That's. That's what we're after to do.
[00:27:13] Speaker A: I love it.
I love it. It just gives me chills because it's everything that. It's the Crumbdale's mission, it's the Crumdale's vision, it's the Crumbdale's value proposition. We lean on trading partners a lot because the market's very complicated. It's very difficult to do what you do and what others do. And when you find great partners that have shared alignment on vision and values and strategy, you can really do great things together.
I've appreciated this conversation, Brett, immensely. It's, you know, it's been transformational for me. I didn't know all the good things that you and your firm were doing, and I'm looking forward to continuing a great, great relationship.
[00:27:56] Speaker B: Yeah. As am I. So thanks for having me. I appreciate it.
[00:27:59] Speaker A: Yeah.
This is Matthew Naylor. You've been listening to Aligned for Impact.
[00:28:06] Speaker B: Sam.
