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.
Heather, my podcast is about alignment and it's about impact.
And alignment and impact mean a lot of different things to a lot of different people.
And you know, our conversation today obviously is about employer healthcare and the self insured marketplace.
But I love beginning conversations with just understanding who you are. Where'd you grow up? Where are you from?
How did you get into the insurance business? Just like to learn a little bit more about you.
[00:01:10] Speaker B: Sure.
Where I live today is Reno, Nevada. I raised my family there, have lived there most of my adult life. Prior to that, lived outside of the U.S. my dad was in the Air Force, so lived all over the world, which didn't feel great as a child, but now I feel it was amazing. It was amazing to see the entire country, you know, the world and different countries. So how did I get into health insurance?
Well, I didn't plan on that. I stumbled into it and throughout my entire career I've done different things in healthcare health insurance, from provider office billing, to starting a medical credentialing company, to working in provider relations contracting. And then my last phase of my career outside of being a consultant, where I am today, was running the operations of a self funded TPA program for a regional carrier in Reno.
[00:02:10] Speaker A: Okay.
[00:02:11] Speaker B: Yeah.
[00:02:11] Speaker A: What, what is the tpa?
[00:02:13] Speaker B: The third party administrator for the self funded clients. So we manage all the claims, we did customer service, we did utilization review management, kind of the A to Z of the services.
We own the network. So we had the network side of it. So it was pretty comprehensive as far as the TPA goes.
[00:02:30] Speaker A: And how long were you there at the TPA for?
[00:02:32] Speaker B: All in about 15 years. The TPA specifically about six or seven.
[00:02:37] Speaker A: Okay.
[00:02:38] Speaker B: Yeah.
[00:02:38] Speaker A: What made you transition out of the TPA business into a retail consulting brokerage?
[00:02:44] Speaker B: Sure. I. An opportunity presented itself just like everything else. Like I've kind of walked into, walked through different doors that I've. That put me in the position. Position where I'm at today.
And I was approached to join the consulting side and I was ready.
A lot has happened, especially since COVID Right. In healthcare health insurance. And I really just want to make an impact on the consulting side and I thought my background related to the healthcare and health insurance programs that I had supported throughout my entire career would be a benefit for the employer groups.
[00:03:20] Speaker A: And where did you first land when you came out of that? Which, which organization?
[00:03:23] Speaker B: Shared Partners, which was recently acquired by Gallagher.
[00:03:27] Speaker A: Okay. And so now you're with Gallagher.
[00:03:28] Speaker B: Yes.
[00:03:29] Speaker A: And you're in the Reno?
[00:03:31] Speaker B: Yep, I'm in Reno. So I support primarily Nevada. So we have an office in Reno, office in Las Vegas, but I also can support groups and our other region offices. So I'm more of a strategic consultant, not a producer. So I'm not out there cold calling or selling. I'm really supporting the business coming in as it comes in the door and then when it's in house then supporting them with strategy.
[00:03:54] Speaker A: And are most of the clients self insured now, level funded captives, fully insured?
[00:04:01] Speaker B: Nope, they're A to Z. Different, you know, different funding mechanisms. But I would say Nevada's fairly slow to change. And so primarily the groups that come in are fully insured.
Part of that I would say is due to HPN Health Plan of Nevada which is owned by United they in Las Vegas. They have a very large fully insured market that they've. Even giant casinos have fully insured programs with hpn, right? Yes. The largest school district in Nevada has HPN fully insured. It seems wild and crazy, right?
So they have established contract types, more capitated arrangements where they can support at a more competitive rate. Think that's changing.
I also think consultants are driving that too. Right. If consultants aren't pushing out what's new in the market related to level funding or Captives or even HRAs or medical reimbursement programs, you know, things that we can partially self fund onto a fully insured. The employer groups are just going to keep doing what they're doing.
[00:05:09] Speaker A: And what's the, what's your typical customer look like? What, what's the size? What kind of industries? What are you typically dealing with?
[00:05:16] Speaker B: Yeah, all types of industries.
Nothing's off the limits there. I would say our typical size, I would say between 80 and 300 is really typical, especially in the Nevada market. Obviously we support some larger groups. Some of those are based outside of Nevada, but yeah, that. I would call that. We would call that mid market. I know that. Not, that's not necessarily mid market, but that's what we would call that. But prime for doing some other stuff than fully insured, right?
[00:05:47] Speaker A: Yeah, yeah, yeah. That probably leads me to my next questions. You know, we've had a relationship with Crumbdale Specialty and you and your firm quite some time and you know we've built and designed programs around level funded, self funded, high performing captives and kind of a crawl walk run strategy for customers.
What's your, you know, what's your experience been like with, with Chromedale?
[00:06:12] Speaker B: So let's start from how I met you all. It was with broker record change with a group that was already with you and quite frankly when that happens we get suspicious. Right. Or we want to. We're curious, I guess I'll say we're curious why the group is in this program.
And so we did a lot of due diligence and I actually had previously met Ben at a different third party administrator and so I, I was able to call him and really talk through with him. What, what is this Grumdale, right? What is this program and how's it benefiting the group? And so I learned a lot from him and we, after reviewing it we thought okay, well you know, this looks good. I felt like the program was working for the group really nicely. So we did a lot of investigation around that and analysis on their claims and you know, their admin cost everything. So we stayed and then we were, we just became all in with Crumbdale. We, we really looked closely at what you all were doing and it was so impressive and especially on the west coast and I think you'll say like you're slower to change out west, right? You guys started on the east coast and they're, it was really nothing like Crumbdale. And then when I learned that we could do carve out models right with your stop loss with your pbm, all the creative things you're doing, the culture, the support, everything, it was working and it's working today. And now you've launched the Captive and we're even more impressed with that.
[00:07:51] Speaker A: You're on our Captive advisory board.
[00:07:53] Speaker B: Yes.
[00:07:54] Speaker A: What is that felt like. What does it look like? How's that experience been for you?
[00:07:58] Speaker B: It's been great. So we've been able to kind of work alongside Tanya and your team as you've built out this captive and really understand the reasons why, you know, you're making decisions around the captive, the investment you're making in the captive and it's, it's pretty impressive. And your team is so tight, you know, it's a tight knit team and you can tell and even at this conference today, I have a client here and she said, you know what I'm most impressed about is the culture. And I can tell everybody here is working together. They're in sync. They're working together. This makes sense. And guess what? That's what that employer does in their business. And so they care about that partnership. Right. And that's, I think, from a consultant perspective, that's what we care about, too. I don't just want a partner or vendor that is calling on us once a month, like, hey, do you have any quotes for us? Or whatever. We want to be part of this. We want to be part of the change that you. You've been making.
[00:08:57] Speaker A: Yeah. And I think relationships matter. Yeah. Partnerships matter. We at Grumdale take them very seriously.
This whole podcast is about alignment and impact, and it starts with proper alignment with the broker and proper focus on proper impact with a customer. Not everybody looks at the world the same way. That's. Okay.
What's your experience been like around alignment and relationship?
You know, because I. No one's perfect.
[00:09:26] Speaker B: Yeah.
[00:09:26] Speaker A: You know, there are always issues, problems and challenges. Healthcare is a complicated thing to deliver.
How Your own words, your experience with Crumbdale. Partnership and relationship.
[00:09:40] Speaker B: Yeah. We don't expect perfect. We're not perfect. You know, our groups aren't perfect. We do not expect that. What we expect is a relationship where we can share our. Our ideas, our thoughts, maybe our complaints, maybe our criticism, our feedback and feel heard. And I would tell you, from the bottom to the top, the top to the bottom, we've. We. We are heard.
And if. If things can't happen at one level and it's really important to us, then it moves into another area of Crumdale. And I don't feel like you guys have ever really said no. Obviously you can say, like, that's not going to work and here's why, or that, you know, there's reasons why we can't do this or here's the method to our madness kind of thing.
But no, it's truly been a partnership, and I think that's why we lean into Crumdale for integrated level funding. We haven't talked about your advocacy. That's one of my favorite parts about that program. And we lean in when we want to carve out.
I've been so impressed with underwriting, the consistency of underwriting with your stop loss programs, and then the way you have designed and set up your pharmacy and the advocacy in the middle. You know, we have a Crumbdale partner kind of layered onto the pharmacy benefit management program.
Phenomenal.
That person is available. The second I call.
[00:11:14] Speaker A: It's. You know, for me, Heather, hearing all this is really quite special.
[00:11:19] Speaker B: Yeah.
[00:11:19] Speaker A: You know, because as the it's the truth.
[00:11:21] Speaker B: I want to tell you.
[00:11:22] Speaker A: I'm not just saying as the leader and as the entrepreneur and as the founder of the company, you know, you aspire to set different standards.
You know, reimagine how things could, could be done and should be done. And you know, you're only as good as the people you surround yourself with. The big mode around our business is our people, which is what you've been talking about 100% in our culture.
How important? You know, I would assume brokers like you and others get inundated with all kinds of point solutions, all kinds of new products and services and vendors.
How has Grumdale made it better, easier for you? Like more turnkey? When it comes to having flexibility, yeah. But bringing stuff to you and your clients, that makes it easy for you to implement and your customers to understand.
[00:12:15] Speaker B: I. I love that you use the word alignment, because that's truly what it is like.
And I. And it works both sides. I think I try to communicate as well as I can what our needs are, and you all get it, right.
I'm not talking to a national carrier that has these stipulations and all the things, and there's just no wiggle room at all. You all are designed to work with the consultants and their groups to provide solutions that have not been available out in the marketplace. And it's funny because I think, oh, gosh, am I too all in with Crumbdale?
Do I focus too much on your solutions and not looking around anywhere else? And so we do. We look at a widespread. But we. We typically come back.
And the other part of that and the reason why we come back.
So it's three, four renewal cycles now, at least that we've been placing business with Crumbdale and been in partnership with Crumbdale.
The renewals, the work you said you'll do, it's consistent.
[00:13:19] Speaker A: And that is, how important is that to you and your firm? When you think about the data, the transparency, the level of consistency in how we report, how critical is that to your success as a broker?
[00:13:34] Speaker B: It's number one, because we have to. We are agnostic, right? We don't favor or we're not getting paid more by someone you know, we're not like, driving to place solutions with our clients on a bribe. Nothing like that.
[00:13:51] Speaker A: Right?
[00:13:52] Speaker B: We're like, we have to find the solutions and we have to speak for you on your behalf. I mean, a lot of times you present with us, but we have to speak on what you're saying. You'll Provide and then we have to know that that's actually going to happen. And if it doesn't happen, we lose credibility and that leaves the door open for another consult to come in to say, oh, looks like you picked the wrong partner sort of thing. So it's everything.
[00:14:15] Speaker A: Yeah. So four renewal cycles, lots of consistency.
People talk about roi, lots of people show up point solution vendors, insurance carriers, over promise underdeliver and never report on anything.
How has your experience with Chromedale been on us saying what we're going to do, standing behind exactly what we say we're going to do and then delivering it in real error, like real roi?
[00:14:48] Speaker B: Yeah, it's. You haven't missed the mark yet, honestly. So it's the truth.
I have not delivered a difficult renewal yet and we, we do a lot of stop loss business together. We do integrated level funded, the level funded program together and yeah, it's predictable.
We, we feel comfortable. Your stewardship reports phenomenal.
[00:15:11] Speaker A: Yeah. And our stored trip report is, you know, the journey we love, we love capturing where a client was before they came to us in partnership with a, with a broker.
And then we love capturing the observations and recommendations that we came up with together with the broker.
And then we love capturing that data to say, hey, we said we were going to do certain things.
[00:15:34] Speaker B: Yeah.
[00:15:34] Speaker A: Now let's report on that in a transparent way to say that, you know, we either made it or missed it.
[00:15:40] Speaker B: Right.
[00:15:41] Speaker A: And here are some additional observations. How impactful are those stewardship reporting for you as a consultant and broker? How empowering is that when you get in front of one of your clients?
[00:15:53] Speaker B: I love it because normally I'm doing all the legwork on that. Right. Or my team and I are doing all the legwork on that. So we're building it, we're having to analyze that, we're having to summarize it and figure out, you know, what's next. And for you all to put that in front of us in a beautiful package and then help present it to the group.
I mean it, it takes all the guesswork out of everything. Great.
[00:16:16] Speaker A: What, what are you most excited about? When you think about employer health, like where the market was, where the market is and where it's going, what do you see evolving?
[00:16:28] Speaker B: So it's interesting this year, I think across the nation, but I'll just speak about Nevada because that's really what I'm most familiar with. We saw accelerated fully insured renewals, like 20, 30, 60% renewals. Employer groups cannot, cannot sustain that. They need another solution.
So I think that starts what you're, the work you're doing starts, you're starting to build that and, and you're able to build the confidence in with the consultant and with the group.
And so yeah, I think AI more data transparency.
I think there's going to be a lot more work that you all will do and the pharmacy benefit managers will do. I was talking to Dr. Eric Emerson yesterday and I said we need solutions. I have never seen the prices, the cost, not just the pricing but the total cost of specialty pharmacy or pharmacy in general as high as it is today.
It makes me so nervous because if we don't have solutions for it, where are we going to go? Where are the groups going to go?
And I want them to have other solutions. We have to have a competitive market and with just the national caries, we won't have that.
[00:17:50] Speaker A: Have any of your groups at Gallagher transitioned from our level funded solution into our high performing captive, not the high performing.
[00:18:01] Speaker B: And I'll tell you the reason why so far.
So we have, we have groups in your open captive.
[00:18:07] Speaker A: Okay.
[00:18:08] Speaker B: The reason why the high performing is a little bit challenging for us is the network access.
[00:18:13] Speaker A: Got it.
[00:18:13] Speaker B: Nevada again, more Las Vegas than the northern Nevada. So more southern Nevada is a united market that is the most competitive network down there. They also kind of have the control on the primary care. So it's a lot of disruption. So for us to start moving into the high performance captive, we'll need to work together on disruption solutions and, or kind of the crawl walk run out of the, you know, the network. Yes.
[00:18:46] Speaker A: And so on that open captive in your marketplace with Gallagher is it. We're helping design the plan document, we're helping provide PBM services around specialty drugs and then we're doing the captive risk financing program. But United is the administrator or.
[00:19:07] Speaker B: Yeah.
So I have two things going on. One is a united group.
They already adopted your stop loss, they already adopted your pharmacy benefit programs because we're able to carve that. So we have that going for us, which is great. Yep, great. The other group, it's their going into their second year being self funded. So they're brand new and we did a transition with Anthem and so crawl walk run, less disruption for the employees. We, we left them with Anthem. So first year into the captive, there'll be Anthem and then we'll see how next year looks.
[00:19:43] Speaker A: Yeah, it's great.
[00:19:43] Speaker B: Yeah, yeah.
[00:19:44] Speaker A: And the high performing captive I, you know that we've built at Chromedale I think is really super unique and special because it's Totally vertically integrated. It's totally optimized.
[00:19:53] Speaker B: Yep.
[00:19:54] Speaker A: You know, you're not picking a tpa, a pbm, case management, pre cert, disease management. It's just turnkey, it's a plug and play.
[00:20:02] Speaker B: But it's very.
Okay. There's other. Well, here's what I'll say. There are other captives out there that seem to have a similar option. What I'll say is yours has much more oversight management.
I know that because we work with you on the integrated side. So I already have a taste for what that looks like on the high performance side of the captive.
[00:20:22] Speaker A: Yeah. So much more integration around cost containment.
[00:20:24] Speaker B: Yeah. You're like actually driving solutions around cost containment, not saying we have solutions and then picking and choosing those, if that makes sense.
[00:20:35] Speaker A: What's the biggest challenge for you as a consultant in this market today? What.
What keeps you up at night? What are you worried about?
And what are you looking for in a real partnership?
[00:20:50] Speaker B: So for sure, the burden of cost. I mean, even just talking to Dr. Emerson, it really does keep me up at night because I understand what the employer groups themselves are going through related to budgeting and financing their employee benefit program. And I know they want to give their employees the best. They really do.
Passing costs on to employees.
That, I mean, that's, that's not changing anything, that's just moving it. Right. And what we need are solutions to make real solid changes to, I don't know if lowering costs, but shifting costs, but away from the employer and employee. Right. And so I think that burden keeps me up at night. The other challenge, I think, and I talked about this yesterday on your panel at the captive conferences, employer groups are busy. They're busy running their business.
And sometimes we can bring the most beautiful strategy to them.
And they have not allotted for enough time to adopt a new strategy. And so they sometimes push an easy button, but that sets them back.
What they're not seeing is that could potentially set them back from movement into, you know, a more optimized program.
And I just think every year you're taking an increase that just gets compounded the next year because the inflation of healthcare, as we all know, is just going up exponentially, especially in the pharmacy. So I think important for partnership is that you can move with us.
Right. Or even pull us, you know, be ahead of what we're even thinking and be flexible and nimble.
[00:22:40] Speaker A: What questions, Heather, did I not ask you that? You wanted me to ask you.
You know, one of the things I was going to ask, but I didn't ask Ask me anything. Well, you know, it's. What I think is such a great testament to our relationship. You know, I'm a.
I'm a real big.
I. When I started my podcast and, you know, the team and I worked really hard on thinking through it, alignment and impact is really at the center of everything I do.
And what I think is so cool about our relationship is your daughter works for our company.
[00:23:16] Speaker B: Yes.
[00:23:17] Speaker A: And it's a real testament to how I think you feel about our partnership. Yeah. But I think your daughter's also.
I don't know this, like, directly, because obviously, as a CEO and founder, I'm working on other work on other things.
But, you know, every time I interact with your daughter, I did this morning.
You know, it's an emotional intelligence thing. I can look at someone and I can look in their eyes and almost see into their soul a little bit, and I could see how happy she was and how excited she is about, you know, what she's doing on her journey. And I just think it's really cool that, you know, not only are you working with us as a partner, but your daughter's working for our company. How special has that been for you to see your daughter grow?
[00:24:06] Speaker B: It's been cool in a lot of different ways. So first and foremost, when she first started at Crumbdale, probably a couple weeks in. And by the way, you have a phenomenal, like, training mentorship program. Right. And I've seen that. Which is really, really important to me as her mom, because especially as raising a strong woman, which we all know she's a strong woman and very opinionated, but also, I think, emotionally intelligent.
She called and she said, mom, is this what you've done my whole life? Is this the work you've been doing? She had no idea. She was busy being a kid. Right. Busy, you know, cheerleading or whatever that is. And so, one. It was great to kind of get recognized by her that, like, I've done some cool things and for. With a purpose, because what's important to her is to do something with purpose.
And she does feel like she can really change lives in this industry, but I don't think she could do that anywhere. And the fact that she's able to do it at Crumbdale is really, really special.
And your culture's not perfect, but it's amazing, right?
It aligns with, I think, her own personality. It aligns with kind of that moral, ethical. You know, I don't know if that's the age group or whatever. Like, I was just happy to have A job at her age, she's like, no, I need the right job.
[00:25:28] Speaker A: Yeah. I think it's funny when we, when we interview people, part of my interview process is telling people why they may not want to come work at Crumb versus, You know, because look, it is. Crumbdill isn't for everybody.
[00:25:42] Speaker B: Right.
[00:25:42] Speaker A: You know, we really believe in working hard. We believe in doing the right thing. We believe in treating people the right way.
[00:25:47] Speaker B: Yeah.
[00:25:48] Speaker A: And we don't hide in the shadows.
[00:25:50] Speaker B: Right.
[00:25:51] Speaker A: You know, like when things aren't good or not going well and, you know, we step up and accept our responsibility. And it's not for the faint of heart. You know, we have high expectations, we have high standards.
[00:26:02] Speaker B: Yep.
[00:26:03] Speaker A: You know, you talk about being honest and ethical and professional. We're. We're in an industry where those words are used but actually not follow through with, you know, and so it isn't, it isn't for everybody. And we also are very entrepreneurial. It's a very fast paced, very dynamic organization that is intentionally being very disruptive.
[00:26:22] Speaker B: Yeah.
[00:26:22] Speaker A: And where people want to push the easy button and go, that's not what Crumble is about. So it's, it's cool to hear the things that your daughter likes and also the things that, you know, sometimes can be challenging for. For somebody.
[00:26:35] Speaker B: Yeah. But that's okay. You grow from that. Right?
[00:26:37] Speaker A: Yeah.
[00:26:37] Speaker B: And so. Yeah. I mean, I.
[00:26:40] Speaker A: You.
[00:26:40] Speaker B: Yeah. We raised a. I think we raised a great young woman who's making her way and yeah.
[00:26:47] Speaker A: The young woman part touches my heart too. So. I'm the father of five.
[00:26:50] Speaker B: Right.
[00:26:50] Speaker A: I have three amazing girls. And the insurance. I've been in the insurance business now for 30 years.
And you know, I say this kind of in a serious way. The insurance industry has been a little misogynistic.
You know, it's been dominated by a lot of, I would agree, you know, men.
[00:27:10] Speaker B: Yeah.
[00:27:10] Speaker A: And, you know, not to profile, but, you know, it hasn't, it's not very diversified.
[00:27:16] Speaker B: Right.
[00:27:16] Speaker A: And women, you know, haven't really been given the same opportunity.
And I've tried to as a leader, I've tried to really be a real ambassador and advocate for giving people all people, you know, but women like. I love seeing your daughter have an opportunity to like, thrive and grow in a business that's not necessarily set up for that. It's.
[00:27:42] Speaker B: Yeah.
[00:27:43] Speaker A: You know, I, I got into the business in the 90s and in back, I don't want to the wonderful business, but it's kind of like the good old boys club.
[00:27:51] Speaker B: Yep.
[00:27:52] Speaker A: And it's, you know, had to be tough for you.
[00:27:54] Speaker B: Yeah.
[00:27:55] Speaker A: You know, in your career. Yep. But I've tried to create a space at Crumbdale to make it really special and easy for people like your daughter.
[00:28:02] Speaker B: Yeah.
[00:28:02] Speaker A: That not only have the same opportunity, but even maybe potentially a better opportunity, for sure. You know, so that they. They can really, you know, have a positive impact. It's just. It's an interesting perspective. When you think about our. Our space in our industry, did that ever affect you in your career?
[00:28:21] Speaker B: I. I think in my age group, if a woman says it didn't, I think they're probably telling themselves a story. I think in most industries, you know, I think we're probably pretty close to the same age, I think. Yeah, I definitely felt that.
But you know what? It's. I think it made. Made me stronger, for sure. Made me try harder, maybe.
So. Yeah. I don't know. It's. It is what it is. And. And I. What I can say is I appreciate your leadership and your other leaders for building that culture, you know, for her. And I think, you know, we. After she kind of got, you know, some good understanding and experience about what you all were really doing and the impact it could make on the industry. And for our employer groups, we asked that she be our rep, which I think says a lot, because, you know, moms and daughters, that's a fun relationship. But I would tell you, she works so hard for us, and she doesn't take me being her mom and how I feel about, you know, your program and your products.
She doesn't take that lightly. She. She takes it very seriously, and I would assume probably works even a little bit harder to earn business and make sure she's.
Everyone takes her serious.
[00:29:47] Speaker A: Yeah. Well, I'm sure mom's got some certain standards that, you know, maybe she has to live up to.
[00:29:51] Speaker B: Yeah.
[00:29:52] Speaker A: You know, I've loved our relationship because Heather, I do think, you know, admire grit. I admire perseverance and determination. And, you know, healthcare and consulting specifically is in for the faint of art. You get told no a lot.
[00:30:07] Speaker B: Yeah.
[00:30:07] Speaker A: You know, and it's a. It's a. It's a. It's a very difficult job. And for you to, you know, persevere and get to where you are in your stage of your career at your level is. Has to be super rewarding for you personally.
[00:30:22] Speaker B: Yeah. And I would tell you there was. There's a man that's now a very, very good friend of mine that was a huge mentor for me, and he really opened some doors for me and taught me a lot. And again, back to that leadership thing, you know, just. I think one is showing him that I, you know, initiating, you know, that I wanted to be at a certain place in my life and do certain things, and him mentoring me was a big deal and really helped me in my career.
[00:30:56] Speaker A: Cool.
[00:30:56] Speaker B: Yeah.
[00:30:57] Speaker A: Well, I've enjoyed our conversation.
[00:30:59] Speaker B: This was fun.
[00:31:00] Speaker A: Thank you so much for doing this with us.
[00:31:01] Speaker B: Yeah, of course. Of course.
[00:31:04] Speaker A: This is Matthew Naylor. You've been listening to Aligned for Impact.
