AH078 - More About Judi Health™ & the Unified Benefits Experience, with Dr. Sunil Budhrani and Mike Tate

Transcript

Lightly edited for clarity.‍

[00:27] Justin Venneri: Hello, and thank you for joining us for another episode of Astonishing Healthcare. This is Justin Venneri, Senior Director of Communications at Capital Rx, and this episode is focused on unified claims processing again, as there were so many good questions on our last webinar that we couldn't get through them all. Mike Tate and Dr. Sunil Budhrani have been on the road talking to everyone in the industry about what's going on, new developments, and there are several new observations that they can share their insights on. So welcome back to the show, Sunil and Mike.

[00:56] Dr. Sunil Budhrani: It's very much a pleasure to be here and have this conversation with you again.

[01:01] Mike Tate: Thanks, Justin. It's great to be here.

[01:03] Justin Venneri: So we're not going to get too salesy here, I promise, but we are going to be talking about the realities of discussing Judi Health™ again - that's unified pharmacy and medical benefits - with prospective clients. Sunil, you're Chief Innovation & Medical Officer. You've remained an active ER physician. I'm just going through your brief background for time's sake because I know you both are all over the country. And Mike, I think you've been in three states in the last 48 hours.

Your discussions with us on the podcast, Sunil, have been on value-based care, the role of pharmacy in getting to a value-based world, and more recently of course the launch of Judi Health. So, can you spend 30 seconds, a little more detail on your background for anybody that's new to the show?

[01:40] Dr. Sunil Budhrani: Thanks for the opportunity, Justin. I always say that Judi Health represents a convergence or confluence of my career, and so I divide my career kind of in thirds. The first third being primarily in the provider space. As you mentioned, I'm a board-certified ER physician. I've been practicing more than 25 years. Although I'm still always feeling 21. I still practice and spend at that early phase of my career in the health system world. I've led, managed, and worked in some of the largest provider groups in the country. And then kind of my second phase was in the digital health entrepreneurial world, expanded an urgent care system in the D.C., Maryland, Virginia market, and built that into an extension into telemedicine and remote patient monitoring. So early pioneer in the digital health space, very focused on delivering more streamlined care.

And then finally, the third is now in the payer space. So I have spent about seven plus years prior to coming here with one of the large health plan/PBMs in the United States, where I really got a great feeling for understanding how transactions occur in healthcare beyond the clinical world. So in many ways, you're gonna hear about in this conversation how Judi Health brings all those components together in a more streamlined, efficient way to deliver transparency and efficiency to the healthcare ecosystem.

[02:50] Justin Venneri: And Mike, you joined me recently too, and that was a great discussion about the evolving health benefits space, and you were pretty upbeat about the pace of progress out there, just the level of interest people have in pushing the envelope. Can you share a quick overview of your background, too, and then we'll jump into the Q&A?

[03:04] Mike Tate: Yeah, you know, mine's a little bit different than Sunil. I started as a consultant primarily in the self-funded space, and then have had the fortunate journey to be kind of through the healthcare industry in multiple different ways. And so I was at a national TPA and then was with two large payers in the Blues portfolio for a few years before coming to Capital Rx. So, I think between myself and Sunil, we have a very unique and broad view on where the market is today and how Judi Health - where our platform fits as a solution to employers, members, and clients.

[03:40] Justin Venneri: So you guys both know how this goes. I have a twist for the last question though and we'll start off with you, Sunil. You know, Judi Health is live for our team, and now we've got Judi Care live too. So that's exciting. We have a unified front end and unified back end. The front door that is. So tell me a bit about what the actual issues are or what can truly be improved upon. Are there a few main friction or pain points that you're observing being solved thus far that everybody has just been dealing with because we've all become comfortable enough with the status quo that we just kind of let things go?

[04:13] Dr. Sunil Budhrani: Yeah, good question. So I always say one of the fundamental problems of healthcare is the lack of integration, the lack of sharing of data, and the lack of coordination when it comes to delivering a patient more care. Providers, physicians, nurses, and so on work in an electronic medical record ecosystem where data and information about taking care of patients lie there. PBMs and health plans live in a claim system world where information about encounters are trapped in those systems. Laboratory diagnostics, pharmacy data, etc., lie in so many different settings that often what happens is patients are kind of stuck in this complicated, confused ecosystem.

And so mistakes happen, inefficiencies occur, waste occurs - it's both administrative and poor care is delivered. I've always said you can give better care at lower cost if you can kind of remove the silos in the broken healthcare system, and then we can have a meaningful conversation about outcomes-based care and value-based care.

So, it’s just very early on in the first six plus months that we have launched has demonstrated some interesting data about how we can remove those barriers, how we can start empowering the relationship between the patient and the provider, and deliver a greater opportunity for clinical care, care navigation, provider selection and deliver that at lower cost. And so we'll report on that shortly.

But I think we can have a triple win with patients, providers, and plan sponsors.

Related Content

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• Health Benefits 101: The Importance of a Transparent PBM Model

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[05:50] Justin Venneri: And then Mike, any more tactical or specific issues that you see plan sponsors dealing with as it relates to their health plan administration, given the disconnected nature of the ecosystem as it stands?

[06:02] Mike Tate: Yeah, I think, you know, employers are facing rapidly rising healthcare costs. Those rising healthcare costs are being driven by pharmacy and medical claims. Pharmacy claims are rising faster than any other sector within healthcare. And employers are struggling, especially those that move into a self-funded space, that want control of their data; they want to control their own finances, right? They are struggling with making a connection as to what is driving this rise in healthcare, what is driving this rise in expenses. How can I correlate that data to make better decisions?

And they are starving for a strategy that will allow them to see the full scope of what's happening within their healthcare plan and then be able to make strategic moves alongside of their broker, alongside of what their objectives are as a business, [and] to empower employees to make better decisions. Better decisions equate to better buying and, subsequently, I think a better control of cost. So, and I think tactically, as Sunil said, it does come down to integration. It does come down to bringing these pieces together that have historically been very fractured.

[07:14] Justin Venneri: Okay. And we had some good questions on the webinar - Replay – The Bridge to Better Healthcare: Uniting Medical and Pharmacy Services on One Platform to Achieve Value-Based Care - about the network and design and flexibility there. And with almost everything we do, we try to limit disruption when people are switching. Mike, what are your thoughts on that and the network and the design and the flexibility that offering an integrated solution brings to the table?

[07:32] Mike Tate: Yeah, I think most of us, when we think about our insurance, we think about Cigna, Aetna, UnitedHealthcare, the Blues, right? The network that's on our ID card. In a self-funded plan, the employer is the insurance company. The network is simply an avenue and pathway to access a provider like Sunil or others. And so I think the network is critical because of that reason. Yes. There are parts of the country that some networks are better than others. Access to providers is better through others, discounts and provider contracts, etc.

That's not really our job to determine what network is best for an employer. Our job, similar to what we do on the PBM side, is to enable our clients, you know, to choose the platform and the ecosystem of partners that they want to use. That may be Cigna or another network, if that's what they wanted to go with and for us to execute on that strategy. So is the network important? Absolutely, because that's the access to the providers. That's how you gain access to be able to go to get care.

[08:37] Dr. Sunil Budhrani: I really like the word Mike used - "empower." right? Like a true insurance company, a true health plan, a true PBM, should not get in the way between the provider and the patient. We should strengthen that relationship. I've always said as long as I've been in the provider world, we shouldn't be delivering care. That's not our job. Our job is to empower the relationship between the patient and provider and bring the best clinical tools, provider networks, and vendors to the table so that we can create an ecosystem that fosters the health of patients. So I do like the word Mike shared, which is empower.

Judi Health is here to empower that relationship between the patient and provider by giving access to a robust provider network. And we're network agnostic. And this is very important. We believe that by creating a system that allows you to plug in a Cigna, Aetna, United, or whatever network would like and tier it according to what you like: a tier 1, tier 2, 3... and then create plan designs that are unique and personalized to your employee and patient populations. We've done our job as an insurance company, as a TPA or as a PBM because we brought best in class services and providers to the table to allow you to deliver that promise of higher quality care at lower cost.

[09:55] Justin Venneri: Okay, what is the best question that you guys have gotten thus far in your discussions about Judi Health? And how'd you answer it? Sunil, you want to go first there?

[10:06] Dr. Sunil Budhrani: Sure. And this kind of dovetails on what Mike and I were just talking about, which is people ask us, "Are you an insurance company? Are you a PBM?" And so on. And the way I like answering that question is if you're an employer or you're a broker or you're an organization, it could be a health system or anything. And you are looking for a full-service experience where the expectation is Capital Rx and Judi Health are providing a full-service network solution, clinical vendor stack, administrative services, claims processing and so on. We are there to provide that full service to you. If that's something you need, we can and provide that in the way that I describe.

But if you are a health plan or more complex organization that wants to have visibility and control aspects of that process, we can provide you a platform that will let you plug and play what you choose is best in class from a network point of view. It could be mail order, it could be your specialty pharmacy, it could be your clinical vendor stack and programs. We will provide you the chassis and the tools to provide a transparent, efficient and cost effective solution for you to plug in your own choices and manage it with or without our help. So the question we always get asked, "Are you an insurance company?" We can be or we can help assist you in your insurance and payer needs in the way I just described.

[11:29] Justin Venneri: And Mike, how about you? Any question you've received just sticks out in your mind as a particularly good one?

[11:34] Mike Tate: Yeah, I mean outside of, "How long will it take to get me implemented?" [laughter] Because I want to make the move now. That's the best question I get asked. Well, yeah, you know, I think the second question I get asked that, you know, I think is a really insightful question and it ties into Sunil's comments. You know, "Why would a PBM that's been really successful in, you know, disrupting a very kind of murky opaque marketplace. Why would we move into the medical space?"

I think that's the question I get often and it's a question that I love. The easy answer is: why not?

The longer answer is because we're a healthcare company, we're a people business. And if we're going to be great in the pharmacy space and we built a platform that changes the way that a pharmacy plan, that a PBM plan can be administered, why can't we do it for the medical space? That usually leads to, "Help me understand why I need it." And when we start talking about that, I think that's where our broker partners have said I want to bring this to my clients or our current clients that have said help me understand what I need to do next. We are a healthcare company by moving into unified claims, by moving into the medical space that enables us to truly impact healthcare impact on members, experience impact with their healthcare plan and do so in an extremely positive way. I think that's what drives us on the Judi Health side and I think that's what drives us, you know, culturally at Capital Rx is we want to have a lasting impact on a member's experience within healthcare.

Healthcare comes with some disruption in life. And if we can make that easier and we can do so by driving better efficiency, driving better cost, better outcomes, that's pretty powerful for us. And the reason why we do what we do here.

[13:13] Justin Venneri: I think that's a good segue to next question of thinking about here is like, I just would regret not asking you two about waste and how things are going with our program. And obviously there's asterisks and caveats here that it's like you said, Sunil, a little over six months in, I guess eight months in. What sort of financial impact are we seeing so far?

[13:32] Dr. Sunil Budhrani: Yeah, good question. And you know, you have probably heard our CEO AJ mention that we are going after the $1 trillion of waste in the healthcare system. And I actually would even double down on that. I would say there's significantly more waste out there that we haven't accounted for. You only know what you know. And if we take all the waste that exists and the fat that exists between payers, providers, employers, and patients, you know that there's a lot of errors and mistakes that occur in that process.

So by bringing all of this under one chassis, which is the goal of us here at Cap Rx and Judi Health, we have, as you pointed out, demonstrated some early successes which are very early, but are important to realize. Some of the early data that we have demonstrated with the Capital Rx employee population utilizing the Judi Health medical plan - and bear in mind, this is the first example of a unified claims platform in use in the United States - when we went live with our employees January 1st of this year, it's known that we've had significant growth in our employee population year over year. So that needs to be accounted for as well when we look at this.

But our Rx, our pharmacy PEPM, has gone up a mere 2%. The standard book of business, as you look in the pharmacy space, we're seeing upwards of 10, 15% increases related to a number of reasons. One is infusion therapies, the other is also GLP-1s that nobody can ignore these days.

[15:01] Justin Venneri: You're talking like broadly… broad PBM costs, correct?

[15:05] Dr. Sunil Budhrani: Correct. So when we see a small increase in our pharmacy and interestingly enough, a decrease in our medical spend of PEPM year-over-year, so we have seen a nearly 10% reduction thus far in medical PEPM in our employee population as a result of going live with Judi Health in January 1, where we plugged in a national provider network that provided our employees a PPO access network throughout the United States.

But we also chose what we felt were best in class vendors for women's health, telemedicine, diabetes care and chronic disease management, and behavioral health as part of our clinical vendor stack. And being that we were able to choose our vendors in this fashion and our provider network, we're very encouraged by the fact that our platform has demonstrated early on that not only can we choose a higher level of clinical care, but we can reduce cost by having an integrated medical pharmacy claim system that provides end to end transactional support. So our total PEPM has reflected nearly a 5% reduction year-over-year from what we used - a major national carrier last year. This is very early data. It's very encouraging and it is something that we feel is extremely important for us to continue to demonstrate because that's the value we want to introduce into the market: lower cost, higher quality care.  

[16:27] Justin Venneri: Mike, anything you'd add on that?

[16:30] Mike Tate: Yeah, I think I would also look to our member satisfaction scores, right? We are capturing NPS scores from our own people. And I think our own employees and our own members are tough as critics. What is the experience that they're having? Right. They came from a national carrier and the experience that they had there, they know what the experience is that we deliver to our clients. And so the expectations are that we're going to meet or exceed that and what we're seeing and finding and you know, to Sunil’s point, our growth is significant and you know, that has a correlating impact on our ability to control costs and temper the trend that is out there. But I think the experience that our members are having has been extremely positive.

The feedback that our members are having when they are having a healthcare issue and need to engage with our team, the ability to access providers and find the right care is extremely high. I think that will translate to the market. It's consistent with our current clients and the experience they have with us. But I think more so it's something that we can really lean on and lean into when we're talking to new employers that maybe aren't clients of ours that are looking for us to deliver at a high level when it comes to engagement. And so I think that that's a very powerful data point for us to really look at and be proud of, quite frankly.

[17:49] Justin Venneri: All right, and here we are, last question. Thank you guys so much for taking the time to chat with us today, I know you're both busy and on the road. What is the most astonishing thing that you've heard during a discussion about Judi Health with a prospect or channel partner that's safe to share, of course (for compliance). Tell us a good story from your recent travels, Mike, we'll stick with you.

[18:07] Mike Tate: You know, I think the most astonishing, thing that has happened is one small comment ignites a conversation that's unexpected. And I was at a meeting recently in the Midwest, meeting with a company that works with a number of other companies, and we were talking about PBM and some of their challenges that they have. And they asked us, "What makes you different in two years versus today?" And I said, you know, we've moved into the medical space and this is how we've done it with Judi Health and integration of Judi Care. And that started a conversation that lasted far longer than what we were even there for.

And the reason was they immediately captured, wait, we're having that problem. That's an issue for us. And it's an issue we are constantly talking about. Not being able to make quality decisions, struggling with members toggling between pharmacy and medical, rising costs that we just can't seem to correlate because data never matches. And so I think for me, what's astonishing, and I think will continue to be astonishing, is Judi Health is resonating with the marketplace because it's our ability and our fortunate foresight to have looked forward 2, 3, 4 years and said, how can we fix this problem now? How can we be a catalyst of change and then how can we talk about it? And this podcast allows us to do that. And I think those meetings, you know, that are impromptu do certainly do as well. And so I think that's what I find to be most enjoyable.

[19:33] Justin Venneri: Cool. Sunil, close us out.

[19:34] Dr. Sunil Budhrani: Yeah. I would say in my 25+ years in healthcare, in different parts of the world, in this space, I believe we're in an inflection point in US Healthcare system. I agree with Mike. The feedback we're hearing from all parties, employers, patients, providers: everyone is unhappy with the current state of healthcare and it's not sustainable. The costs keep rising and our outcomes are some of the worst in the world. The feedback that I think is very interesting we get from employers is they're not happy, the costs are unsustainable and they're breaking companies to go bankrupt. And it's the number one cause of individual bankruptcy.

So I always say when I hear about this, it is astonishing to hear this, but this is a very special time for Judi Health to really make its mark. Our timing couldn't be more perfect. The fragmentation in health care that has occurred over the last several decades provides us here at Cap Rx and Judi Health to provide a solution that nobody has. I always say our not so secret sauce is our investment in technology and our people. As Mike mentioned, it's demonstrated in unprecedented NPS for us in health care. We have numbers that frankly exist outside of the healthcare industry where retail industries hold themselves to, so people are unhappy with their TPA. We set a bar for ourselves to meet the market demand and that's what we're here for. It's a work in progress. We're trying to fix a system that's been broken for decades and we look forward to keep moving through this and partnering with innovative companies and organizations to make our healthcare system the place that all of us deserve to have.

[21:06] Justin Venneri: Well, that's a solid goal and I thank you both for taking the time today and I hope you have a great rest of your day wherever your travels take you.

[21:12] Mike Tate: Thanks Justin. Appreciate you.

[21:13] Dr. Sunil Budhrani: Thank you much.

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