Navigating Healthcare Disruption: Consumerism, Shrinking Markets, and the Future of Member Engagement

Navigating and getting healthcare has probably never been more frustrating for just the consumer at large, right? And no one wants to talk about the dirty secrets. You know, this past week I've looked at markets where Aetna and Humana are pulling L, and this is a big deal. It's a pretty violent disruption, right? And they've always thought that they're, you know, a business selling to another business, or they're an insurer selling to an employer group, and that their job is not the final end user, but today more than ever it is.

When you're getting a little bit of a narrower benefit design, how do you really make good decisions? Number one, welcome to Redesigning Healthcare Unfiltered. I'm Rihanna Grossman, CEO of HealthWorks, and today we're talking about membership. Some people call it membership when you sit on the health plan side, some people call it consumers, some people call it patients. So we're going to explore all these different people-oriented discussions as we look at the regulations that are going on, as we look at what's happening in the marketplace with health plans. It's an area of shrinkage. And what that means is something completely different. Growth officers used to have this goal of grow, grow, grow. Now we see Medicare Advantage shrinking its service areas. We see Medicaid shrinking its coverage due to redetermination issues. We see ACA also shrinking. So now from the health plan side and from the physician side and from the health system side, we all have to figure out how do we keep that patient engaged? How do we keep that member engaged, even though we might not offer the exact same service in that particular market any longer? We need to think about how do we care for them consistently throughout their experience with us. So today, my guest is Michael Preme. I'm delighted to have him. We're gonna have so much fun, and we promise you will learn something and you'll learn a lot of stories about us also at the same time. So, Michael Priest, introduce yourself.

Good to see you, Ryan, as always. It's not just a podcast, but getting to chat with a friend. I am the CEO of a company called Modern Impact, and we are an advertising and ad tech firm. So not only do we have proprietary technologies for trafficking media, but we're also a creative firm as well. And we have built a specialized healthcare practice inside of our organization as well. And we have numerous healthcare customers, whether they be on the payer side, provider side, and many others in between. So yeah, we'll get to talk about some of our battle scars and some of the forward-looking things we see coming at us. Perfect.

Thank you so much. And just for disclosure sake, so Michael and I worked together several years ago. And I feel like what we did maybe three years ago, four years ago is exactly where the market sits today. So somehow we were Voyagers in this, we were frontier leaders in this. And before it became so popular, um, we were both part of Bright Health Plan. I was responsible as president of Medicare Advantage, and Michael was not just a board advisor, but he was actively kind of our chief marketing officer. So it was mostly during the time of COVID. So we didn't always get to meet each other, but we always got to share ideas. And I came from building other Medicare Advantage plans that were very traditional, very conservative, very how do we stick to the regulations and not move across that particular line? And when I met Michael, he was very entrepreneurial, very much embracing the growth perspective. And so he taught me a lot. And I'll I'll share the floor with him on this discussion. But I think we had some healthy arguments, some opportunities to learn from each other. And ultimately we were wildly successful upright. So we really did grow to Mike Micah's vision, to the organization's vision, and we really did care for the patients, the members in our communities. But we did, just like right now, we did have to shrink some areas to grow. And then we grew really quickly. So, Michael, I'll pass the ball to you to kind of share what you experienced in that time.

Those are some good memories, right? You know, it was therapy during the world of COVID. That was an interesting role because I was the chief consumer officer and chief experience officer, in addition to being a vendor, right? And it was a really fun and rewarding time. I wish I would have just had marketing, um, but also had product, right? And so we had to design the experiences for the consumer. So everywhere I went, I had to think like the consumer. And, you know, Bright Health was kind of ahead of its time. You know, our model back then was not just being the payer, but also the provider. So we had to think about how we were enabling not just the insurer or worrying about our medical loss ratios and what that meant, but also how were we designing the right kind of experience design? So it led to some kind of really critical thinking. And Rayanne, you were such an advocate, a pioneer around MA. You know, you're you've got the war stories and battles, wounds to prove it. And here I am, the guy, like, what do you know? Right. And I'm talking about like the consumer and audience. And so we had some really fun debates. And I I remember well. I remember you telling me, Michael, why are we using this creative? We're talking to T65. And I I laughed. And, you know, I still it still resonates today as I work with other payers and health plans that, you know, if you look back historically, you know, we always would talk to certain audiences in the way that we think they should communicate, but it's not always how they actually do communicate. And I knew that we had to to win at Bright show up different than the competitive set. I felt like if Bright could just be different, we had a chance to win. We couldn't argue about feature and benefit. We didn't have a legacy of a name like United, where in the past ran, you know, you could coast on everybody new United. And so, how do we resonate? Where do we take mind share when we didn't have like a unique selling proposition that was wildly better or different in many of our plan filing? But what we do know is that people are frustrated with healthcare. People don't always trust healthcare, right? And sometimes just to win, all you have to do is be a little different and not show up the same. And so, Ryan, you and I did that. It's like, how do we roll up different? How do we actually build the best product that we can? But how do we actually try to build and forge a different relationship with our customer? And we did. Our creative was daring, um, our messaging was daring, and we went all digital. When you were telling me, you know, this is not the format we should go, but they reacted. And today, if you look at consumer research, it shows, you know, like some of the biggest FaceTime users are, you know, people that we Greta Thurmberg would refer to as okay boomer, right? But they're FaceTiming with their grandkids. And just because someone is of a certain age, there we ran, you and I discuss our age, which I don't want to get into. We start getting close to these categories that, you know, we're not that far away. And if someone's gonna send us, you know, some infomercial type of product, we buy it. So I think that that's kind of interesting when we think about where we're where we are today in healthcare and where it needs to go or where it should go.

Yeah, I think we both have the ability to kind of look around the corner. But the other part fun part of what we did together was actually we got to kind of look at the science and the numbers and be part of the acquisition. So we didn't just, you know, here's here's what you got. And to your point, we got to develop the benefits, we got to understand how to bring people in, how to consider their holistic needs. And then you represented it really well in your creative and in engage engagement. That was our creative.

You got to dig into, and that was the fun thing too was like, you know, unfortunately, healthcare does not think that they need to be creative, you know, and that is such a systemic fault because healthcare more than ever is being impacted around consumerism. And they've always thought that they're, you know, a business selling to another business, or they're an insurer selling to an employer group, and that their job is not the final end user, but today more than ever it is. And that I think is where the fundamental flaw is and still continues to be in healthcare. And you and I boiled up together, baby. And we got to talk about like the consumer end of it and how we have to build and things that normally some of the business owners in healthcare are not saddled with that burden. They don't think that that's always necessarily part of their job. And yet, more than ever, you know, the consumerism claws are digging deep into this industry. And a very good friend of mine that I've known for many, many years. I'm not gonna name who this person is because many of us now know exactly who he is. And he's been a longtime friend. And I had lunch with him a couple months ago, and he basically admitted and said, you know, I'd always argue with you about consumerism, but I'm gonna admit something. And I was like, okay, this is gonna be interesting. He goes, I was wrong. You're right. And this is not in this person's nature at all. And I love him. I just he's a great guy. So I'm kind of laughing because I think slowly but surely this is starting to spread. And it's really uncomfortable for healthcare organizations, right? They don't think of themselves as needing to really own a person of market share. They're not thinking about things in a brand tracker, they're thinking about plan design and plan filing and benefits and their cost model for open enrollment. And it it's not at a level of really understanding the consumer. And if they just did, they'd control a lot more of their own destiny, which is what you and I dug deep into.

Yeah, I think it's amazing and also fun. And so we had this opportunity, right? So when I joined Wright, it was 13 states, but it was probably about this thick. And so it didn't have a lot of membership, it didn't have that market saturation to your point, it didn't have that brand recognition. So I think what we had to do was come to the table together and say, okay, where do we really need to focus? And how do we explain this as CMS? Because they don't love that retraction, just like right now. The health plans are all saying, hey, I can't support these particular service areas. And so we did get to look at it and we got to look at other states and other opportunities with other health plans to acquire them. So Michael and I got to be at the table when Wright acquired Brand New Day, when we acquired Central Health Plan. And then we also to what Michael was speaking about before is we actually had the opportunity to purchase metabo groups in Florida. So we really started to say, okay, these are the communities that we're going to serve. So Michael and his brilliance gets to look at the consumer, right? How do how does this market density now speak to this particular consumer? And we had very different profiles than we had when we when I joined, and probably when Michael first looked at this particular business line. And so we had to go from being a little bit of, you know, plain Jane vanilla, very national, to really deep in certain populations. We had a lot of Hispanic culture in California and then obviously Florida. And then we actually partnered in Chinese communities in New York. So as Michael got to help me hit our targets and growth, we really had to understand how do we embrace these different cultures? How do we speak to them? How do we make them comfortable with their onboarding and keep them engaged in their care journey? And that was a different skill set than I think health plans have at that time and now are still developing. And that's what you know, Michael and I do every day is how do we make sure that the member or the patient feels engaged in what they're experiencing and they own this, right? They have to showcase right now the accountability in a different way. So right now, as products are receding, you particularly, you know, members in different areas are gonna have to be a lot smarter about what they're purchasing. What do they need? And I think as we watch Medicare Advantage shrink, I as a health plan want to make sure that now that member moves into my supplemental clan and also keeps their ancillary services like their dental and their vision and their hearing, right? So I can't just kind of, you know, release them and not say goodbye. I have to say, you know what, we're no longer servicing you in this way, but let's think about servicing you in that way. Same with Medicaid, same with ACA, right? There's different products that maybe could hit the mark for them and create opportunities at price points if they can afford to keep that coverage just in a little different version of what they were used to. So, Michael, maybe you want to speak to that as to how do you take some of the science and some of the cultural things and how do you really start talking to the member before open enrollment to help them think about their accountabilities as they start talking to brokers or even from an employee standpoint, when you're getting a little bit of a narrower benefit design, how do you really make good decisions?

Number one, you're hitting on you said a lot that we could unpack. And we always end up in that when you and I have these conversations. First of all, navigating healthcare. It doesn't matter if you're on MA or if you are, you know, just got your first job and you're a brand new employer or you're qualified for credits and you're using ACA. Navigating and getting healthcare has probably never been more frustrating for just the consumer at large, right? And if you don't know how to advocate for yourself, you know, people end up with the layer of frustration, which is causing a lot of stress and burden on our on our delivery system across the country, right? And I think right now is really an interesting time because of that, right? We knew 2024 was highly disruptive with open enrollment AP because of the rollback and certain credits with the ACA. So we kind of all referenced 24 was 2024 was a year of blow-up on the ACA. And based on plan filings and what we see right now, which are all coming out as we speak and as you and I are talking, they're happening, probably even tomorrow. We'll see quite a bit more that we'll see come out. And I'm expecting this year to be highly volatile again. But how consumers interact and purchase or make their health care decisions is at the crux of a lot of the problem. And you started tapping into something that I think is really important that more both health plans and care delivery practices should be really digging deeper into. And you started talking about populations, you know, with the secret of Brand New Day before we had acquired them was their population-centric delivery model, right? So they had big Korean and Chinese and they had multiple, and they really focused heavily on trying to provide an experience design, not just around how to get them as a customer, but how to actually help them through navigating their care. And um I think that that is still something that's really a challenge in healthcare. And one of those things that you and I leaned heavily into, right? We didn't just study what are the right members that we want and how do we hit our goals, which by the way, you remember, you said we'll never hit these goals. These are crazy. No way, no way. And you know, leadership was was really pushing hard. And I said, Okay, well, let's try. Let's see what we can do here. And you're right, we actually did hit them and we exceeded them. And they were bombastic at that time. Really. And the way we did it was really thinking around data and science and who those users really were. But, you know, one thing I'm really proud of that we did together, Ryan, was we focused on it as a population basis and we went really population based. And uh I really get annoyed with cohorts. Everybody thinks it's like a trendy fun name to talk about cohorts and healthcare. And cohorts to me is like the analogy of a segment, right? You know, like if we're building a media plan, we're looking at audience segments, et cetera. And so cohorts can really be used so liberally in healthcare that I kind of get annoyed, but populations winds up being even another layer of specific. And populations can be, you know, obviously ethnographic details that are highly designed around how you actually help. And I think it's more systemic into how people need help navigating care, as you talked about. So one of those things that you and I leaned heavily into was the population-based plan, not just cohorts. It's not to say we didn't care about cohorts, we did, but population will end up being such a root of what it, and it didn't mean that we were worried just about, you know, how do we effectuate a certain number of new MA members? You and I were also highly focused on how do we provide the best possible clinical outcomes for them as well. How do we build experience design from a call center experience coming in to making sure we had translations with their explanation of benefits that actually allow them to remove some of those social determinants of health? And we quickly moved as fast as it was a celebration to hit our goal in numbers, if you remember Rand, it was about how do we remove the friction and the experience design? Because that's what will lead to retention. And honestly, at the end of the day, what made you and I, and we talked about this deeply, why we're passionate about it, isn't just because we wanted to hit a goal. It's fun to feel victorious and I'm super competitive, but it feels good at night knowing that you're helping others solve some of those social determinants of health. And a lot of our populations today in the US are feeling more and more disenchanted with healthcare because it's becoming more and more of a struggle. So share a little bit about that. I I want more of your take when we were in on unpacking a little bit of that. I think there's a lot that's magical in that story around our friction together at that time on where we were talking. Because I I do, I think that it's important. I think that that we talk so much about the victory and how we made our goal. I don't care. I like talking about where our conflict was and how that made us like wiser, smarter in you know, debating how do we how do we unpack this?

Yeah, I think it came from again my years of building MA plans, knowing the application process, knowing the network design, knowing, you know, who you have to partner with, and then thinking about how did everyone go to market. And so coming into Bright, it wasn't to your point, it wasn't the everyone kind of vanilla version of health plans. It was very focused on ACA and Medicare Advantage and really wanting to drive growth, but to your point, had this incredible consumer experience underly. I I'm not used to that, right? So I came in saying, hey, we need to look and feel more like everyone else. And so I think I was pretty clear on like we need, you know, that older population. We don't need to look fresh, we don't need to look interesting, we just need to speak in an engaging fashion in a in a like voice and in the same old kind of, you know, we're here for you, we're thoughtful on you. But really, you had a dramatic change. And so I remember the first time meeting you in person, because again, it was COVID. So I could be really, you know, perhaps argumentative or, you know, have healthy conflict on Zoom because it's super easy. All of a sudden you walked in the door and I was like, oh my gosh, he's so tall. I was like, all right, I better just mind my P's and Q's. And and so sitting across the table from you, I think is really where we actually began to bond and take best like best practices of both worlds, right? Best practices of what CMS is demanding of us and what CMS was designed, right? Take care of this population, move through this experience and get better outcomes. And so then as we designed that, it was easier for me to go to CMS and say, you know what, we're doing this so well in California, we're doing this so well in Florida, we're doing this so well in New York, or we might not do this in Memphis, Tech, Tennessee anymore. So I think I had two thoughts. One was, you know, how did we always do this? And then a little nervousness of, hey, sitting down with CMS saying, we're gonna retract, right? And that's not a comfortable conversation. And I don't know that some of the folks sitting around the table at that time knew why I'm why I was concerned, like, hey, if we look too outlandish, CMS is gonna have a little, you know, target on their wall of us. And so I want to kind of blend in for at least this first year and then retract, grow in certain areas and and think of this in a different way. But you taught me how to think of this differently and be bold enough to share that new vision with CMS. And that was a great experience.

And you've taught me tons too. You're gonna forget more than I'm ever gonna know about MA. So let's be clear about that. And for all of you that I haven't met Rayna in person, she's even prettier in person. So you're like just absolutely a blast to work with. So yeah, I mean, I think that this year we're gonna see a ton of retraction all the way around, right? Which I think healthcare needs to be different. So I definitely am not afraid to be different, right? You know, there is a big CSameness, and I think that it taps into the psyche if you were to really look at how we all are frustrated. You know, I think I can give personal experience and I should be more adept at navigating care, right? And I should know really how to go about it. And there's instances where I'm just like, this, it should not be like this, right? And the friction that is in there for us to just get the medical help we need at times that we need them. And so I I am not, I'm not afraid. I think that there needs to be radical change. However, we're at a time right now where the stress from the finances, right? You know, I mean, a lot of other insurance industries, like a property and casualty, have reinsure brokers. Well, in healthcare, we have CMS, right? And no one wants to talk about the dirty secrets. And if you look at the past year, some of the most stable entities that have always been around helping drive our healthcare industry as a whole from a United Healthcare, looking at what's happened to them in the past year, looking at what's happened with Centen. You know, this past week, I've looked at markets where Aetna and Humana are pulling L. And this is a big deal. This is going to cause additional friction with people that have now new challenges, you know, for how do I navigate my care? How do I get access? What should I be doing? Where should I be going? And There's going to be a lot of contraction because our payer system right now is financially stressed, right? And they can't have product and service and that they can't financially deliver on, right? And so we're seeing some of that. We're seeing new plan design. And I think that there's stress between the employer, what can the employer continue to carry? What can the individual carry? You know, and if you just look at ACA, it breaks my heart when you think that there is a, you know, a very big growing population making decisions around what they can afford to procure for a healthcare plan or what do I need to budget for groceries? You know, and that's tough. That's really tough when, you know, nationally our healthcare system was always viewed as one of the world's best, but yet we don't have an increasing longevity. We're we're slipping in perceptions that way with our our image as a global healthcare system in the US. That is super frustrating to me.

Yeah, I think, you know, in some of our earlier episodes, we did talk about, you know, we spend, you know, what, five trillion dollars and we're 37th or lower in quality of care and things like that. So, so we do have all these perfect storms. And right now, I think it is still very frustrating to your point for the consumer. And what I think you and I are trying to work together on with other entities like medical groups and health systems and health plans is let's create a little, you know, smoother track. So instead of just letting people say, oh, you know what, we're no longer in your service area. Good luck. I know a lot of different plans actually created a stronger, more robust supplemental plan. So, but they need to be guided to that. They don't have the sense of what the health plans might have done for them or what how to best, you know, continue the care with their provider if if there's not a dialogue. And I think this is the time where, again, maybe the provider needs to step up and help, you know, their patients make some choices. And then also, I don't know that the broker community is is engaged in this. And I, and sometimes that's a really unique community in and of itself. And we'll talk about that another day. But it's also how do you, because I think most health plans took a lot of sales in in-house, right? Now they need to lean on you from a consumer perspective and say, hey, this is what was designed for you because we couldn't serve you in this way. And I don't feel like people, health plans are really good at influencing and kind of coming out proactively, right? Usually health plans are very reactive, like, oh, we can't afford it. We're out, you know, next next thing on the agenda to discuss. We really need to think about, you know, what we could come back and service that area again in the next three years. So we need to be thoughtful on how we exit and we need to be thoughtful on the continuity of care issues that we're creating. And that's why I love the supplemental benefit. My parents are actually at that age and I'm all about it.

Yeah, I mean, you're so spot on. You're hitting into something, though, that I like I really want to bring up with you and get your take because we're talking about the silos in the industry for just a minute. And you start talking about, you know, this the payers and how the payers are worried about that, what's happening to those populations and where they go. However, the payers think in a payer mind, right? And they're their own industry and an industry. Then we have the providers, the providers are over here, and the payers can be the nemesis when it comes to contracting. But yet the reality is that we just keep going back and forth with the burden and shift back and forth, you know. And and so, you know, before Obamacare, I think we had almost like, I think the peak was like 17% of our US population was uninsured, like a really high number. And then I think, you know, about four years ago is when we reached the lowest. I don't know the numbers. You might know better than me what we got down to for insured. Do you happen to know? I don't. All right, we should look and figure that out. But I know that we reached a record low. And now the data is all showing that we're we're having a rapidly rising uninsured population again, which might reduce some of the payer risk profile, right? As they contract. But where does that population go then to get services? And you know, and they wind up going into scenarios where they'll use your county hospitals, emergency room like a primary care clinic, right? And so you're pushing the burden back into the care delivery network all over again. And sometimes it's the most vulnerable parts of our care delivery network in the US that wind up being disproportionately burdened by that cost. And so these are the brutal reality of what's happening when we go through this contracting market. You know, I'm gonna opine for just one minute. I'm very defensive over, even though you and I both work together and have wonderful memories at Bright, that that story hasn't been able to be curated exactly the way that I think it should. You know, if you look at that very big success we had, Ryan, a ton of our membership that we effectuated are either at Molina now today or they're they're with Oscar on our individual and family plan side. And we were a big success. And Bright still does. You know, if you look at the size that they are today as a care delivery, right? You know, I joined, they were about 350 million in annual sales and left and they were IPOing. I had to leave. I couldn't stay there while being a strategic vendor, and they're still my client today with Nuke. So, you know, on the care delivery side, we're focusing purely as a provider and we're thinking about those things having come directly out of the payer side of the world. And where does that consumerism live and where is this burden shift go? And I wish that we could break some of these silos down on where the risk bearance is because you know, if you were to talk to payers today, some of them think, well, Bright, that was a big failure. It really wasn't. If you look at today on the population under management and how they're doing with some of those same population that were members on the payer side, right, then unfortunately it was, you know, not financially successful having them on the payer side, but they're still now a patient on the patient side. And so I think, you know, the whole delivery system as a whole, if we can break some of these silos, knowing that we're both now struggling with a lot of the same problems on the care delivery, it's about how do I control these patients? How do I help them through what the right coverage is and how do I help them with their care navigation? And the payers are still sitting here and saying, okay, well, how do I how do I manage my medical loss ratios within these populations? Right. And so the more we can couple and and get closer with both data share and solve these problems collectively, that's what I get excited now today thinking about.

Yeah, I think we're gonna have to have a whole nother podcast on really what today is value-based care. And I think, you know what, we we missed the mark there too. So I think it would be interesting to take a broader view. And I think that's why this is actually called redesigning healthcare, because I think we have to look at that whole ecosystem, right? Where is the patient walking? Where are they walking when they're a member? And how do we continue them in a continuous coverage kind of feeling so that they don't break one of the partners of the ecosystem? Because as we see, you know, 25 million people fall out of Medicaid, as we see probably about 2 million people going from MA coverage to maybe traditional or something like that, um, we need them to flow through the system with the grace and elegance that you're designing from a consumer perspective. We can't afford them to be going into the ER. We can't afford them to not being getting that chronic care that we've designed. And the other interesting part, if we would actually think of it and take a step back, think about if we don't actually offboard these people well, they're gonna change how our caps and house scores are, which affects our STAR score. And so it does mean a monetary difference. So if we could actually think about that, oh, you know what, because STARS is retrospectively looked, they could be contacted and this could be a bummer for our bonus payment, right? So we do, we are aligning patient care and member engagement and the health plan experience. We don't always see that at the table when we're so siloed, right? So this is this is an interesting time to be a smarter, a smarter leader, right? Whether you're in the medical group or in the health plan, you're talking about the same dollars, like $45 PMPM. That's a lot to be shared, right? So this is a big deal. So that's why I'm thinking, you know, as you talk to your clients and I'm talking to my clients, and I'm bringing it into my clients, we need to create this landing pad for these people who are falling out of it, making sure they understand what's the next opportunity, because there is some coverage opportunity for them. How do we get them there? And then how do we keep them on navigating what they're absolutely either the preventative care or the chronic care that they have to have to have that outcome?

I mean, Ryan, you're crushing exactly the point. And I have this conversation. You talk about like the improvement for a payer on their HETA score, right? And their SARS rating. That in itself, I can't tell you the number of conversations I've had to have saying if you can impact and speak to them on a consumer level, that's how you can change that. This entire investment in a consumer is self-funded by helping the plan perform. And I'm doing that then on the provider side as well. You know, it's interesting in my world on the marketing side. You know, I think part of the consumer side that's really scary is it's by far and away the most regulated. So, you know, I'll make this comment to say, like, make that investment because we'll improve your HETA score. There's actually a financial benefit. These dollars you invest, you have a strong likelihood of getting back. But the reality is there's not a lot of muscle memory in how to do this and to do it right to communicate to the consumer. And that's the area I've spent a ton of time at Modern Impact on, which is building our infrastructure, you know, our core internal healthcare practice where, you know, what we have the compliance on SOC 2 type 2, you know, we have high trust, we have, you know, the ability to supply a BAA. I mean, healthcare is the only industry. Google and others will not give you a business associate agreement. So your ability as a healthcare organization to just procure services you critically need, you're immediately handicapped. Right. So to do the important, really good tactics that we know work in marketing, you have hands tied behind your back unless you know where to find the resources, the resources with the right tools. And I've spent a ton of time in the AI world rebuilding our same tech stack around, you know, the the large language models so I can supply a business associate agreement to these healthcare organizations as well as everybody's trying to figure out what's the impact of AI in the same, in the same way on this consumer side. So, you know, we start this dialogue about planned performance and he discores, but they all end up tying back into this consumerism. And so I spend my time trying to remove the fear from it and helping organizations have like, you know what, you don't have a choice. You're either going to do it when it's too late or you're gonna do it now and try to get in front of it. And I think honestly, the train's already left the station, right? And you can't put the toothpaste back in the tube when it comes to how consumers feel at this point. So I think understanding that and always understanding what that sentiment is is absolutely at the core of everything you're discussing, Rayan.

The other thing that, you know, we've been talking about here within my organization and on the podcast is now, you know, we opened up this podcast on this episode about the regs for sales went down. So you you can be a little more willy-nilly. And that's why I think consumer education and awareness is going to be really important during the sales process. So you can educate them and sell them at the same session, right? There's no more break in that action. But what didn't change and actually grew in constraints and regulations is your AI, is your consent, is your PHI. So now my team has to, you know, work with your team that wanted to create that elegant experience. But now my team is actually coming in to audit it too. So and because the federal government and the state government both are gonna be auditing because there's new rigs every day. So right now we have a lot of federal governments, but then like California's got big laws on on AI, New York, we just saw Illinois. And so that's what I love about your firm is when we come in together, I know you're gonna create this extraordinary experience. But also when I go back and have to audit you, it's gonna be A plus across the road, right? And so it's not just a security issue about PHI anymore. It's about did you communicate in the right fashion, even if it's new and and amazing, right? To make sure that that member, that patient understood what they're doing, that they did consent to it, that they that you have all the backups, right? In the governance. So that's why I love working with you, not just because you teach me every day, not just because you're wonderful and I love your energy, but because when I bring you in, I'm regulatorily sound, right? That's a big deal. And then when I come and talk to you about what we need to do next, you're already ahead of the game. As I said in the beginning, you know, we're both looking around the corner because there's so much coming towards us.

And we really need to listen to I'm not sure that I deserve all that, Ryan. But you know, I do think that there needs to be a lot more time spent around experience design. And, you know, it's funny because our non-healthcare clients or or all of us as consumers, you know, like think about tonight, Ryan, you're gonna need to shop, right? You're you're not gonna get in your car and drive to Fashion Square. For those of you who don't know, Ryan lives down in Scottsdale, so it's like her neighborhood mall. And you'll go online instead, right? But through your browser experience, how many times will you have a consent cookie pop up that you need to agree to? And, you know, other industries have learned how to self-regulate, and healthcare is trying to move through, but we don't self-regulate. So the idea of these things that are not innate with muscle memory inside of these organizations have to have discipline put into place when you talk about consent. Consent is every way through, right? You know, and you mentioned a few of the states. I would add Texas and Florida and Minnesota. I I mean, there's many, and unfortunately, they're not all consistent as we have DOI and state by state by state. So regulatory environments are are not standard across the board. So yeah, we're seeing a lot of different things start to happen with like when you're allowed to even phone and reach customers, how that happens, even on the provider side, not just on you know the payer side when you're when they're focused so heavily on OEP AP right now, but even OEP AP has so dramatically evolved. You know, it's not necessarily with these critical hard deadlines with SCP feeling, you know, that it's year-round. So, you know, I would say healthcare has never felt as amorphous as it kind of feels right now, at least to me. Meaning it used to be very regimented based on a calendar, and it was very now the dates kind of move a little bit, you know, where we buy moves a little bit. I had a really interesting meeting last week, Ryan, that you'll find interesting. Um, it's with a a payer, but not on medical payer. So an ancillary service offering of a big brand. You guys might be able to go figure it out by looking at our website, but they they started working with us about nine years ago on their individual and family plan, which represented less than 2% of their book of business. Today, as of their membership count right now, it represents over 30% of their annual gross, and it's 40% of their net contribution margin on individual and family plan. They have spent so much time and dollars building that book of business, and it's the most meaningful service line they now have today in their business. But they've had to learn how to act a lot more like a consumer-focused business. And they are definitely a payer, and they are definitely a household name we know. And so it's been very interesting to watch that growth, and it's very real, and it's happening all around us. My bigger fear is the organizations in our healthcare, both delivery and payer side, that are still worrying about what do I do here? And they're gonna move before it's too late. And they've got to be ready to evolve right now. We can't keep doing things the way we have. We are gonna have to do things like shrink to go. My bigger concern is, like you said, the shrink to grow. 27 is gonna be interesting. It's gonna be really interesting. And the hardest part that I'm most concerned about is not what it means for the payer, but what is it gonna mean for the pressure on the delivery system? And what's it gonna mean for these people trying to just get care?

Yeah, I think there's a lot of conundrums, both in in what was the goal of these regs and what was the goal of the health plan and what was the goal of the provider system. And how do we, again, try to look at this from a member-centric, from a patient-centric point of view so that we can handhold them through this? It's a pretty violent disruption, right? Whether you're sitting in the physician office or whether you're sitting in the health plan, there is a commitment, there is a mission-driven, purpose-driven sentiment across all of us that says, okay, even if, you know, we realize this member's gonna be ours again in a few years, or this member needs to continue their person their personal care journey. How do we do this together? So I think as I talk to my clients, and I know as you talk to your clients, we're asking them to be a little bit better, not just bolder, right? But be better, be thoughtful in how you're doing this and make it easy and make it something that's within your mission, within your organization, to look at them not as a number, right? Not as a dollar sign, but as a person. And how do we reflect on that as we go through this experience together? Because we are just kind of pushing the pressure of the balloon in different areas from the health plan to the health system, from the health system to the physician. And that's why in another podcast that we're gonna come together and probably do a value-based care, because that's all I see is it's just a shifting pressure. But I think we together can solve that pressure. And what we're asking for though is that the consumer does need to be more accountable and more aware, right? Come to the table, understanding their needs and make sure that their product actually hits that. And it might be more expensive, but hopefully it's more expensive short term while we solve some of these challenges.

I mean, I think the your comment about value-based care is something that deserves like book me, I'll come back, we'll have a whole another hour-long conversation about it. But the upcoming just dialogues around mandates for 2030, you know, I see it right now on the payer side, thinking about, okay, well, how do I build tighter relationships of where I can better manage and share in this capitated rate, which means I have to work more coordinated with my care delivery system, right? I need to make sure that as I'm empowering these doctors to make some of the payer decisions for me, I need to be more tightly coupled, right? So I think it's a very interesting way to tie these bonds that need to be closer. The challenge that gets me so worried and me talking about the consumer is that that puts a lot of pressure on the tip of the arrow of our care delivery system, which is still today the PCP. So our primary care physicians, are they ready for this? How will they manage this? And what are they doing to enact in the clinic, right? Which arguably today is one of those places that we still have really frustrating experiences, right? You know, like we don't even, our kids won't answer our phone, right? But yet we can't even we have to still call the clinic and wait on hold, right? We don't do that in any part of our life anymore, but we have to at the clinic or we sit in a lobby and wait for hours, right? And that still is a really big frustration of the friction, the administrative burden and the experience of being a patient when you already don't feel well, right? And these are the things that still have to still get unpacked. And I think those organizations that want to jump in front of it have a are gonna have a big advantage because this value-based thing, we're gonna blink. We're like with the plan filings coming out this week are for 27. That gives us 36 months and they're talking about these really pivotal changes. But my hope is in it is that we're gonna have to really draw these tight lines between the care delivery and the payer systems that haven't really existed in the way they're gonna have to. Um, and that's my hope.

Well, at that, I'm gonna cut this off. I really appreciate your time. I think what we've showcased to you all is that one, we really need to be member centric in this very disruptive time. We need to think about the person as a person, as a patient, and as a member in the same light, right? How do we create this consistent experience for them, whether from the health plan standpoint, whether from the health system standpoint or the medical group standpoint? And certainly, we didn't go into it to quite as deeply as I thought we were, but there's a tech experience that we can support. There's, you know, data layers and protocols that we can share. But it's gonna be a time where we're all bold and we're gonna all have to lean in and look around the corner because those members are gonna come back. We need to make sure that they're as well taken care of as possible on that little hiccup in their journey when we might not have them holistically. But we need to think about how do we do this well? How do we do this in a compliant fashion? And how do we plan for the next version of where the industry is growing? So I appreciate your time today. And you're gonna be seeing a lot more, Michael, because we just began this discussion. So appreciate your time. Thanks so much. Have a good time.

Thank you.