This week I am talking to Jennifer Danielson, Chief Growth Officer at Collective Health an integrated third-party administration and navigation company delivering health benefits.
Jennifer describes herself as a recovering attorney who has ‘followed the money in healthcare to understand the workings of healthcare and bring about some positive change. By now I think most of us have some sense that the healthcare system is not working and claims and insurance continue to challenge many. We discuss the claims administration process and the origin story of an untenable insurance bill after life-saving surgery for Collective Health. They are trying to bring order to chaos for self-funded employers trying to deliver a better health experience for their employees
We discuss the claims process, the challenge for individuals navigating a complex world full of unfamiliar and confusing terms, and some of the history of how we got there – which as I highlight from an earlier show is not as many believe attributable to the war but predates that (Ensuring the Health of Employees with Dr. Christy Ford Chapin, Ph.D.)
Listen in to hear our discussion on the solutions to the mess our discussions on PBMs and how they started in healthcare to consolidate buying power and how we can help employers and employees create better solutions and choices for delivering the healthcare we all want, but often are not getting. We discuss the importance of transparency and personalized connection points in healthcare and the impact of laws requiring information to be made publicly available to help people make informed decisions about their healthcare
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today, I’m delighted to be welcoming Jennifer Danielson. She is the chief growth officer for collective health. Jennifer, thanks for joining me.
Jennifer Danielson
Thank you very much for having me. It’s a delight to be here.
Nick van Terheyden
So if you would I always start with the same question, I think it’s important to set the stage. Tell us a little bit about your background and how you got here to this point in your career.
Jennifer Danielson
Absolutely. You know, similar story that I think so many healthcare has been in my blood for a very, very long time, I fell in love with the complexity of health policy considerations a long time ago, in undergrad, and it has led to a career in health care that’s been focused on trying to do what makes it work best for people overall, I started started as a lawyer, I’m a recovering attorney. So don’t do that anymore. But I’ve had the opportunity to do a lot of different things in terms of looking at an understanding the policy, understanding how the contracts work. And one of the things that I tell young people in who are earlier in their stages in their careers in health care, is really understand how the money works in healthcare, because that drives a lot of it. Maybe Maybe all of it, but we try not to be too jaded.
Nick van Terheyden
You know, we I think most people probably know that podcasts are not sort of entirely spontaneous. There’s some discussion, I don’t have too much. But one of the things that my family members will know, and some people will know that I have specifically told that whatever Memorial they have, on my gravestone, my urn, whatever it is, follow the money. And I’ll tell you why. Because it answers all the questions. I’m not saying money is the answer. I’m saying it answers all the questions as to behavior. And the fact that you say that just resonates just a little bit with me, I’m just gonna say
Jennifer Danielson
it’s true. It’s not just about healthcare, you’re right. It’s about so many other things, but especially in health care, because of the history of how it developed, why things are the way that they are today. A lot of people want to just sort of point fingers rather than call the question about why something works the way that it does. And it’s just so big and complex that if you don’t understand what those entrenched financial interests underlying and underpinning all of it are, then I don’t know, then you’re shooting for you know, for something that you’re not going to hit the target for.
Nick van Terheyden
Yeah, you never got to understand because you as you pull on the throat, if it’s pulling on the finances of somebody, they’re they’re champing at the bit to say no, oh, hold on their partner.
Jennifer Danielson
That’s right. That’s right.
Nick van Terheyden
So tell us a little bit about collective health and what you do.
Jennifer Danielson
So collective health is a company that like, again, so many others is founded from a very personal experience of our founder who had a horrible experience in healthcare, that just should never happen to anybody that has underpinnings to cost control and trying to impact you know, unit cost overall, but he really wanted to lean into it and do something to make it better. So collective health took on the tough work to create a claims administration system that empowers our health care advocates, and our and our navigation specialists, to be able to do something in a much different way, when we’re serving the employees of large self funded employers. In addition to that, we have the ability to, you know, from the kind of concert that are a conference that you and I are sitting here today, cut through the noise of so many of these different points, solutions that are out there and bring them to the table together and make the mean something in relation to both claims data in the pharmacy data that’s out there, too.
Nick van Terheyden
So let’s talk about claims for a second because I’m, I feel like I’m not going to be controversial in the slightest by saying that that is possibly one of the most complex decisions that I make on a annual basis. I’m forced to, I can’t sort of stick with a plan. It seems like the plan disappears in a puff of smoke every time I think, wow, I found something that works. And then I’m presented with a series of options that I’ve got to be honest, I don’t even understand I am in the healthcare industry, copay CO this is extra, I am completely and utterly lost. Why are we still stuck with all of this bizarre annotation? Is it deliberate?
Jennifer Danielson
I don’t think that there’s anything deliberate about the point that we’ve ended up in healthcare. I think that it’s just the reality of all of those things that you and I were talking about before about how things have translated and what the entry is. Holt is have lots of big and tough decisions over years and years and years of work. So I agree with you. I mean, no one should be in that in that position for people in health care, like you and me, I get the call from siblings from friends on an annual basis saying, Can you help me sort through this kind of stuff. And the same is true for employers, when they’re making that purchasing decision for them for their employee population as well. It’s just as confusing for them to, and they become quickly overwhelmed with the, you know, just tons of awkward options and, and potential solutions that are out there. It’s, it’s way too complex and much more complex than it should be.
Nick van Terheyden
So let’s talk a more fundamental point, before we dive into this, you’re probably familiar with the Rosetta Stone project and the concept that, you know, maybe the benefit system is essentially, to your follow the money not structured in a way that is ever going to reduce costs, because there’s no incentive within that program, should we be looking for an alternative to the whole benefits of approach in the first instance, I mean, I feel I want to throw out the bathwater.
Jennifer Danielson
I think that there are a lot of people that would agree with you, for the point that collective health is add in the work that we’re doing for the reality that employers have to make that decision and provide those benefits as a recruitment and retention and culture, building effort, et cetera, et cetera, et cetera. That’s where the point of impact is, for us in terms of helping empower those employers, when you think about the purchasing power in healthcare in the United States. Number one, because of the entrenched interests, I don’t think that we’re going to be able to just scrap it and start over again, as much as I think a lot of people would like to. So I think that employers, it’s really time for them to stand up and sort of claim that prize have, you know, thrown some elbows about getting a better result for the amount of money that they’re investing in providing the service for their employees overall.
Nick van Terheyden
So who does collective health work for is it for the employer, the employee, or some other party?
Jennifer Danielson
both? It’s both, you can’t, so our customers are employers, but you can’t have an employer as your customer. If you aren’t serving their employees and helping them do something truly meaningful, you go back to the history of why employers are even in the business of providing health care coverage to their employees. And it really is about recruitment and retention. And you know, we’re at the point in the United States that we are, so they want it to mean something, they need it to mean something they’re in that role, they can’t scrape it off the table. Not at this point anyway. So they need that help and figuring out how to make it have an ROI for them as an employer and do some important things for their employees along the way to
Nick van Terheyden
you know, it’s funny on this podcast, I I came at this, you know, when we talk a little bit of history, and we should I’m curious to know what your thoughts are. The original reason that we ended up in this mess, is because of
Jennifer Danielson
you want one answer to that
Nick van Terheyden
I do.
Jennifer Danielson
I think that through a lot of you know, historical events that we have disintermediated the end, the end consumer from that that purchasing decision,
Nick van Terheyden
but why did health care, insurance end up in tied to employment benefits.
Jennifer Danielson
From what I remember it was it came about as a result after war, World Wars, where employers were really looking for ways to actually create some kind of benefit structure that that allowed them to recruit and to hire as many people as they needed to in sort of those after the war boom years. So employers are there because it’s part and parcel of what an economic recovery process needs to look like, for the employers to be able to hire as many employees as they needed.
Nick van Terheyden
So little soldier and for the listeners, I think this is important, because, you know, most people know I came from the NHS system, the NHS was absolutely a direct result of World War Two, we essentially had all of these injured. military folks coming back home, there was no system to take care of the government took over the system paid all the doctors so that they could actually take care in the hospitals. And then at the end of the war, anybody goes well, that was working pretty well. Let’s have the NHS roughly speaking, and I’m I’m sure I’m gonna get some flames over that. But let’s just accept that and the general view Is that in the US it was a corresponding thing that took place in the, in the, during the war. In fact, when the government said you can’t increase your wages to attract people to you, because you were going to essentially create inflationary pressures, because there was too few people to satisfy the employment. So they found other ways. And it was, you know, healthcare benefits. And I believe that right up until I interviewed somebody on the show, who essentially wrote a book all about this and said, it actually dates back before that. And it was the physicians who essentially said, we are not going to get involved in delivering that care in a sort of concerted way. And they abdicated responsibility. And these insurers jumped in unsure, it was amplified by the the war effort and then continued on. So we’ve got all of that history. And, you know, to your point, I think it I think you’re right, you can’t throw this out. I mean, I keep hoping I keep asking people to throw out the bathwater, but they weren’t. So we’re still swimming in this this mess. How do we fix this? What is the process that allows us to get what everybody wants, I think, which is great healthcare delivered, we pay the most money, so we sure as hell ought to get it, but we’re not right and delivered at a point that doesn’t induce essentially medical debt, crippling, you know, challenges of interacting with this healthcare system. How do we do that?
Jennifer Danielson
There’s not a single solution answer to that. But I think that there are a lot of things that are trending in the right direction for us to be optimistic about and for us to be hopeful about. So we are in an economic environment now, where employers are being much more aggressive, and much more creative in thinking about how they do continue to provide these benefits to their employees that parallels along with all of the work being done at the federal government level as well, because they’re calling the same questions on what price are we paying? And what are we getting for it at the end of the day, that the employers are a couple that those two things with everything going on as it relates to pricing, transparency, and quality, transparency, and all of the innovation that continues to come to the forefront, about how you do help connect people to healthcare, that is higher quality and lower cost as much as possible. I think that there are really big cost considerations out there that this country still has to deal with at the end of the day, in relation to the pricing on pharmaceuticals and things like that along the way. But in the meantime, you continue to see a lot of things that are lining up that are helping us trend in the right direction overall, for bringing that point of optimism to the table.
Nick van Terheyden
So for those of you just joining I’m and Dr. Nick the incrementalist today, I’m joined by Jennifer Danielson. She’s the Chief growth officer for collective health, we were just opening the door to pharma pricing, just gonna say and then this match between benefits and drugs. And again, I anybody that tracks any of my content will know that this is a big bee in my bonnet, despite the fact that it’s part of that benefits program. Is that something that you take into account? You’re trying to address this area as well? And if if you are, how are you handling PBMs?
Jennifer Danielson
It’s, again, an extremely, extremely complex question to put on the table overall.
Nick van Terheyden
So one word answers only
Jennifer Danielson
one word answers only. I don’t know what a one word answer to that will result. I know that’s true. You can’t you can’t solve healthcare costs without calling into consideration the pharmacy question as well at the end of the day. And I think that in the same way that we’ve been calling the question on value, value based outcomes for clinical care, we’ve got to start calling that to the table for pharmaceuticals as well. So that is part of the picture overall. The question for PBMs always puzzles me a little bit PBMs are an artifact of something that was put in place like so many things in healthcare, to try and make things work better at the end of the day, and it turns into something that’s pretty opaque. And so that’s really common. I’m just gonna
Nick van Terheyden
say I’m gonna cut that and say turned into a monster but keep going.
Jennifer Danielson
But at the end of the day, we’re still all PBMs exist because you need purchasing power for scale. And because the prices themselves are too expensive for people to just afford on an individual basis, or in some cases for employers to even afford on, you know, per employee basis for a very small portion of the Have the employee. So if we’re not calling to table, the actual, the the actual price that we’re paying for for pharmaceutical drugs, then we’re not asking the right question.
Nick van Terheyden
Well, I mean, in fairness, I think we are calling it out on an international basis. I mean, it seems no equity there at all that I just, I can’t get my head around the idea that, Oh, innovation will stop if the US doesn’t continue to pay 5x 10x, whatever it happens to be. But, you know, separate issue. And I’m obviously being a little bit mean by jumping into that, because it it really is a complex problem. And ultimately, to your original point, and you know, my area of passion, follow the money, you can see where that trail of money and I think, I think it’s important there. So let’s go back to perhaps, in this case, more simpler issues of general coverage and the ability to deliver that. How are you doing that? And what are you delivering in terms of information, that is allowing people to make better, more economic decisions, but ones that are actually benefiting the patient’s ultimately in the kind of care that can be bought and delivered.
Jennifer Danielson
There’s a lot of talk about technology, and healthcare and technology powers, a lot of technology and data power, a lot of amazing things. But at the end of the day, you’re missing the point if you try and replace that human touch element with technology alone. So for the work that we do in helping people just take them sort of, you know, by the arm and lead them through the crazy confusing system that’s out there, it really does have to bring in that human component to it. So we call our customer service folks, our member advocates, and they truly are advocates for the people who are on the other end of the phone with them, and helping them understand what their options are, what information is available to them, making sure that they’re accessing all of the things that are at their fingertips to be able to navigate these times of healthcare crisis, often that they’re dealing with. And we couple that with the the navigation skill set of people from a clinical point of view, who are really looking at this person sitting with them, in relation to social determinants of health and a very holistic it from from a very holistic viewpoint as well meaning listening for the things that are unsaid, listening for the things that they need, that don’t exist in their life that are preventing them from getting the health care that they need at the end of the day, and just helping take the homework out of healthcare for them at the end of the day.
Nick van Terheyden
So I’m going to ask a hard question. Maybe there’s not an answer to this. But, you know, as individuals, and I know, you’re working for the employer, but ultimately for the the individual, making that selection each year is like I might as well be going to Vegas every time. I mean, that’s the reality is, you know, am I going to get some serious clinical condition arise? At which point I’d rather pay the higher premium for the better car. I mean, I, I just feel like that whole principle appears wrong. But we’re sort of stuck in this model. And I understand some of the underlying economic issues. But is there a better way?
Jennifer Danielson
A better way for making that that decision,
Nick van Terheyden
or taking that decision point out of just not requiring it? I mean, is there some way that maybe you can, we can’t change coverage at any specific, you know, so it’s fixed. And sometimes it’s fixed at bizarre times? It’s not always at the end of the year. Interestingly, I’ve had that experience. Can we change the system? Is there some way to sort of deal with that, that you start to offer something that is maybe not as artificially segmented into annual decisions and blocks of of cost?
Jennifer Danielson
Maybe, maybe there there are a lot of opportunities for touch points with people along the way through the year, I can’t, I can’t alone solve for the question of the timing on an annual benefit decision basis that runs you know, all of the finances behind it. But there are touch points with people all along the way during the course have an individual’s year that give you that opportunity to know them to understand them to provide them help and to help educate them for the things that they have going on in their lives on an ongoing basis. So for an employer, generally really large employers who are providing more than one benefit solution more than one option to their employees. There’s a ton that can be done in that moment, to help them understand what their choices are and what the different, you know, impacts interest points are going to be for them at that decision point, there’s a ton that can be done in that time and in that place, and then the things that follow for that relationship over the year, and helping people really understand what it means to have this benefit available to them and all of the other point solutions that the employer might have brought to the table. That’s where the real impact opportunity sets, I think over the year. Well,
Nick van Terheyden
I mean, back to my Vegas analogy, I’m just gonna say is collective health, the card counter in the background here that will be banned from the the tables, because you’re tipping the balance and allowing people to make a better decision based on the odds that they’re presented with? Is that part of the sort of thinking, from your perspective?
Jennifer Danielson
I think so. I’ve never thought of it in terms. I’m not enough of a Vegas expert to to draw out the right analogy. But yes, I mean, we’re the ones who help them make those choices. We’re the ones who can help them see and understand through that complexity to understand where the true connection point opportunities are for themselves.
Nick van Terheyden
So you’re tipping the tables, you’re obviously, you know, trying to influence this in a positive way for the individuals and obviously, for employers to reduce costs, deliver better benefits? What what’s next on the table? I mean, you’ve started this process, you’ve got, you know, obviously a foundation. Where are you going next.
Jennifer Danielson
So two ideas for that. Number one is helping more people have this personalized connection point to be able to leverage that technology. The second is really leaning into a lot of that transparency, information that’s out there that really isn’t working yet to bring us the kind of result that we need it to, both for quality and for cost overall.
Nick van Terheyden
So is transparency key in all this?
Jennifer Danielson
I think that it is you can’t call the question on what price you’re paying for something if you don’t know what the price is. So does collective
Nick van Terheyden
health have transparency to the prices? So you actually have availability of that info?
Jennifer Danielson
Yeah, as much as possible out there. Right now, there’s more coming along the way. But yes, absolutely. And that is a critical point of impact for that relationship and helping people make those judgment calls, rather than just taking the advice that’s given to them about where they might need to go for a service or what service they might actually need to have.
Nick van Terheyden
So how do you go about getting that transparency from the organization’s because I mean, ultimately, they’re all like, you know, the people I used to sit next to in school that never wanted to share the results of their particular test that screening it, you’re obviously managing to do that how?
Jennifer Danielson
Well that is one of the beautiful things about some of those bright spots happening in this country overall, as it relates to health care. There are laws now that require that information to be made publicly available. So it’s going to be coming more and more and more to the forefront. It’s already been powering a lot of what’s been going on out there when it relates to really big contracting and everything else that’s been working sort of in big healthcare behind the scenes, but it’s time for it to really empower the the customer and the healthcare consumer.
Nick van Terheyden
So here we are, we’re at a point in time where Transparency Regulations have actually reached, you know, and I remember when they first enacted I thought, oh, and in fact, it wasn’t because it was you’ve got like, 17 years to implement this. I think we’ve reached that. I’m extending it a little bit. I think it maybe it was a year or two. But we’ve reached that point we’ve delivered on the regulatory issue. I know, I’ve seen some, definitely some mal intent based on some research that was carried out by Johns Hopkins, that showed even people that had put the data up and then decided actually to pull it away and even bury it so that it’s maybe harder to get clearly a critical element. I think we’re on the right trajectory. You know, and folks are now coming in to start to benefit that. Any parting thoughts on what you think they ought to do next?
Jennifer Danielson
Call the question asked the question, demand that that information be available at the end of the day, their healthcare consumers, like you said, we’re all paying a heck of a lot more than other countries do for health care and not getting more for it at the end of the day. And that’s just wrong.
Nick van Terheyden
You heard it here. All be like Dr. Nick asked the question, fight those denials, fight everything that takes place. It is absolutely your right. And there are organizations here to help you. Unfortunately, as we do each and every week. We’ve run out of time. So it just remains for me to thank you, Jennifer, for joining me on the show. Thanks for joining me.
Jennifer Danielson
Thank you for having me.
