EP535: When Patient Experience Means Parking and Pianos, Plan Sponsors Pay for Hotels, Not Outcomes—What to Measure Instead, With Robyn Leone

[00:00:00] [SPEAKER_02] On episode 532, a few weeks ago, Chris Klomp from HSS was talking about ER, emergency room usage, as a signal, not just a statistic. If too many folks show up in the ER, consider this a signal that there's something missing.

[00:00:23] [SPEAKER_02] It means a patient who doesn't have access to primary care, or maybe specialist care, or maybe doesn't know where to go to get the care, or is too sick to figure this out. Or maybe there's onerous prior auth requirements or long delays that you can avoid if you just go to the ER and or a clinical organization is requiring upfront payment that a patient doesn't have on hand to make an appointment.

[00:00:45] [SPEAKER_02] All of these things are things that are blazing red flags that patients, who are also members, are lost.

[00:00:55] [SPEAKER_02] If you consider a lost patient as a patient having a wildly poor patient experience, then it becomes, I don't know, kind of inarguable that true patient experience in healthcare is not like a superficial amenity, such as pianos in the lobby or espresso machines.

[00:01:20] [SPEAKER_02] Patient experience is instead a direct operational consequence of the architecture underpinning any given patient journey, or lack of architecture underpinning any given patient journey, as the case may be. And by the way, the irony of talking right now about underlying architecture for the patient journey being the solve for what patient experience really should be.

[00:01:48] [SPEAKER_02] Yeah, this irony is not lost on me. We currently have a healthcare industry slightly obsessed with architecture, but I'm talking the real estate kind with lots of marble and waterfalls and fancy art, of course. But yeah, instead of the real estate kind of architecture, in the show today, we concern ourselves with making sure that our patient's journey is architected.

[00:02:12] [SPEAKER_02] That there's true design thinking here for what we want our patient experiences to be and or member experiences to be, because same thing. Unequivocally, without this kind of architecture, the kind that holds together a solid patient journey, we're not going to get patients, i.e. members, the right diagnosis and the right treatment for that diagnosis.

[00:02:39] [SPEAKER_02] And we probably also won't get outcomes at an affordable price. We're just not. For all the reasons that we talk about endlessly in episode after episode on this podcast. Listen to the episodes with Preston Alexander, Vivian Ho, Shane Cerrone and Dr. Sam Flanders. Or go back and listen to the first episode with Dr. Suhas Gandhi for maybe places to start.

[00:03:03] [SPEAKER_02] I say all this to say, or more accurately for Robin Leone to say, coming up here, if we are talking about patient experience, this right here, getting the right diagnosis, right care, affordable price is what the measure of patient experience really should be. I mean, otherwise, what are we even doing here?

[00:03:25] [SPEAKER_02] It's supposed to be a healthcare industry, but in many respects, we often measure experience in ways that don't include how easy and affordable it is to walk out having been appropriately cared for. Bottom line and key takeaway from this conversation with my guest, Robin Leone today. Patient experience is a function of experience architecture. Good intentions, clinician empathy and customer service cannot overcome a bad structural design.

[00:03:55] [SPEAKER_02] And I say that in defense of clinicians as much as on behalf of patients and plan sponsors. True experience means organizational leadership, getting architecture right to enable the right diagnosis and the right treatment at a fair and affordable price. And plan sponsors, you get what you pay for intentionally or otherwise. So, yeah.

[00:04:18] [SPEAKER_02] Robin Leone talks about architecting the patient journey as building three buildings, metaphorical buildings now that we should be constructing so that patients can make it through their encounters with the healthcare industry having received the highest value possible care as the default.

[00:04:40] [SPEAKER_02] The three buildings in your member and or patient experience journey should be building one, access and navigation. So this is what happens prior to anybody needing care. That's the first building. The second building houses delivery and care coordination. So this is what happens during the care episodes. How well is the whole person treated?

[00:05:03] [SPEAKER_02] And then the third building is what happens after where there should be transparent and accountable billing. And right, a lot of this will only work if a provider is working with plan sponsors who get in there and probably have direct contracts, who are deliberately paying for the patient experience that the plan sponsor wants their members to receive and is actively involved in steering and tiering.

[00:05:30] [SPEAKER_02] And also with an underline is investing, I would say, in true, measurable, accountable, advanced primary care. Robin Leone, my guest today, is the chief experience officer over at Xero Health. This entails looking after Xero's three main customer bases, meaning the patient slash member, the employer, as well as the clinicians or provider organization.

[00:05:58] [SPEAKER_02] So therefore, she's the perfect person to have this illuminating, light-filled, open floor plan conversation with today. My name is Stacey Richter. This is Relentless Health Value. Thank you so much to Xero Health for providing some financial support to Relentless Health Value to cover the costs of producing the episode today. Also, thanks so much to our founding sponsor, Aventria Health Group. Robin Leone, welcome to Relentless Health Value. Thanks for having me, Stacey.

[00:06:28] [SPEAKER_02] So let's just jump in here.

[00:06:30] [SPEAKER_01] What is patient experience? Well, I think a high-performing system or organization, their experience must be judged on whether the patient obtains the right diagnosis at the right time, the right and appropriate treatment for that diagnosis, and can afford the treatment without any financial ruin. I think that's it in a nutshell.

[00:06:56] [SPEAKER_02] So patients have a great experience when they get the right diagnosis. They get the proper, appropriate treatment at the right time, and they can afford their care. I'm going to just interject here and say, that is not what I thought you were going to say. Most of the time, I don't know, maybe a piano in the lobby would come up.

[00:07:16] [SPEAKER_01] Oh, that, and we'll have espresso machines, and we'll have valet parking.

[00:07:21] [SPEAKER_02] What's the danger there, though? Like, what's the danger if somebody starts talking? You say patient experience. They say espresso and pianos.

[00:07:29] [SPEAKER_01] Then what do you measure, right? The only thing you can change are the things that you measure. So you measure how many lattes you give out. You measure how many people smile when they watch the piano play itself. Instead of measuring, what were the outcomes? Can people actually show up and get their treatments? Do they put off those treatments because they can't afford it?

[00:07:54] [SPEAKER_01] You lose sight of the actual delivery of healthcare and serving patients' best interests.

[00:08:03] [SPEAKER_02] So many things have come together for me right now because I see exactly what you're saying. What gets measured gets managed, and maybe we shouldn't be surprised by the vast number of atriums that are currently being built because that's what we inadvertently probably are measuring. And when I say inadvertently measuring, what I mean by that is probably a combination of what's

[00:08:31] [SPEAKER_02] getting measured and what is frankly not getting measured. For example, a clinical organization is likely not measuring the experience of patients who never show up because they fear how much it will cost or they are in the process of not getting needed care for other reasons. It's also tough to get a grasp of how many patients got outcomes-driven, appropriate, and affordable care

[00:08:57] [SPEAKER_02] when how you ace most patient satisfaction surveys is, yeah, get better parking. Liberally prescribe antibiotics or prescribe, I don't know what the latest trend is on TikTok, like prescribe anabolic steroids from dubious sources. Not sure if I'm joking or not. Just saying, we have patient experience measures that might be better suited to like a hotel, not a hospital.

[00:09:24] [SPEAKER_02] And then we wonder why all of us are paying for hospitals to look like hotels while they still have high hospital acquired infection rates or ER mortality. So if I'm thinking about the patient experience being, did the patient actually leave with appropriate affordable healthcare that resulted in good outcomes?

[00:09:52] [SPEAKER_02] How does that, how do I achieve that? What's my first step here? What do I start thinking about?

[00:09:57] [SPEAKER_01] Well, I think we have to think about it as architecture, right? Because if you don't build the right structure, you never get the right experience. So, you know, if we stick with that architecture analogy, I think we could think of it as a series of three buildings. And at the simplest level, those three buildings happen before the care, during the care, and after the care.

[00:10:23] [SPEAKER_02] The patient experience starts way before the patient even enters the premises. Let me dig in here. If I started circling the first building.

[00:10:34] [SPEAKER_01] Yeah.

[00:10:36] [SPEAKER_02] What is it? What do you mean exactly? Like from a patient experience perspective, what has to be identified and built or blueprinted before the patient even arrives at the care setting relative to patient experience?

[00:10:50] [SPEAKER_01] Yeah. So as we consider constructing these buildings, the patient doesn't exist in isolation, right? There's three parties. They all have to be on the same page. The patient, the clinician, the employer paying for most of it. Everybody has to be aligned on what is building this house or it's not going to work, right?

[00:11:14] [SPEAKER_01] So if we think about that very first building before the care takes place, you're really looking at access and navigation at its core. Because what tends to happen is a referral gets dropped onto the patient by a doctor, right? What happens next? Total confusing administrative void. So the doctor thinks they did their job. Hey, I want you to get this MRI.

[00:11:42] [SPEAKER_01] The patient just kind of walks out of the office thinking, well, where do I go? Is my insurance going to cover it? How much is this going to cost me? And we don't know like between that happening, whether or not they're going to show up, right? So it's to me from a patient perspective in that very first encounter, I mean, it has to be frictionless access.

[00:12:07] [SPEAKER_02] So we're thinking about patient experience. And if you listen to patients complain, you will see very clearly the complexity of our healthcare system that we're chucking people in the middle of to try to figure out who to go to from the beginning or where to go for some service. To your point, maybe there's an imaging director. Like there's so many different ways that a patient can get lost. And that's patient experience.

[00:12:36] [SPEAKER_02] Like that's more patient experience than like with someone nice to them when they called. Because by the time the patient's calling, they're probably at work, number one, trying to figure out how to make a phone call in their car. Um, but, but also they shouldn't have even had to figure out how to find the time to go out to their car to make a phone call. It's almost like a little bit too reactive at that point.

[00:13:00] [SPEAKER_01] So what do I do? If you're really focusing on experience, then the experience from the clinician's point of view that either their organization or people that are partnering with them, we have to get this freedom from these, you know, prior off burdens, check boxes, just all this nonsense that's driving burnout. Right?

[00:13:24] [SPEAKER_01] So you focus on that clinician experience in order to enable them to provide a better patient experience.

[00:13:33] [SPEAKER_02] So you're saying like as an employer here, so if I'm, I'm thinking like a plan sponsor, how do I construct, because I'm, I'm, I'm taking this as, as actionable for me, the employer here. Are you saying that it's possible for me to provide a better experience for the doctors that are serving my members? Like I should take that as my, my remit.

[00:13:55] [SPEAKER_01] Absolutely. There's, you know, you're looking at your benefit package to better understand what offerings are out there. We are way beyond having to stick within that traditional, well, I just have my carrier. I'm going to let, you know, patients spend for themselves. Employers can take a really active role in either partnering directly with provider groups,

[00:14:21] [SPEAKER_01] partnering with organizations that do direct bundled contracts, really holding navigation and advocacy vendors accountable to truly support and automating those high value steerage so that care starts literally at the right site, not the most expensive default place. So there's ownership on, on all three parties within that first, first area. Yeah.

[00:14:51] [SPEAKER_02] I always say like nobody's job description on a plan sponsor is transform the healthcare industry. So this is a little untoward to be talking about it like it's a plan sponsor's responsibility, but at least in the short term, it almost feels like it sort of has to be. Sadly. So, okay. So our first building that the plan sponsor really needs to be contemplative of is kind of exactly what we're talking about. Like think about what's happening before even the care and make sure that this is set up so

[00:15:17] [SPEAKER_02] that the patient can actually have a good experience once they need care is kind of how I'm taking it. Okay. So let's just say we've got building one constructed. Not necessarily saying we've got the landscaping figured out, but at least we've got, we have a good sense of, cause this is, this is big stuff that we're talking about now, but you got to start somewhere. And let's just say that a plan sponsor and a clinical organization too, like we have collaboration between parties. We've got some direct contracts set up.

[00:15:47] [SPEAKER_02] We figured out how we're engaging members, right? Like we've done all of the things that need to happen. We've thought through what we want the patient experience to be. Okay. So now someone needs care. Now we're walking into building two here, which is the, what needs to happen during the delivery, the actual care delivery. If we're thinking about patient experience, what is building two with the architecture there?

[00:16:15] [SPEAKER_01] Well, building two is really about from a patient perspective is being treated as a whole person, not a collection of all these separate body parts. You know, having to go to all these different clinicians, that fragmentation is really a result of kind of a degradation of our primary care system. You know, you've talked with many guests about the cost of it. Why is, you know, why is it not being funded?

[00:16:43] [SPEAKER_01] But really understanding that if patients can't get timely access, they're going to either go without care or they're going to turn to really expensive alternatives. So I think we start to frame this and looking at how do we reduce the downstream costs. And if I'm an employer, just looking at what I spend on primary care, you know, isn't necessarily going to tell me a solution.

[00:17:10] [SPEAKER_01] But when you look at advanced primary care solutions in place today and being able to have patients have a true relationship with a primary care doctor, we get this holistic into end care while solving building one, getting, you know, the right, the right diagnosis, the right treatment, and, you know, hopefully a transparent, affordable price.

[00:17:39] [SPEAKER_02] So what I'm hearing you say is that the big pillar in the architecture of building two is getting the primary care, advanced primary care, having a strong game there. But then also, if I'm thinking about this from the clinician side, there is just such angst right now for very good reason amongst primary care clinicians, just given the, you

[00:18:06] [SPEAKER_02] alluded to it, pretty much decimation of primary care in the fee-for-service ecosystem that we currently have exacerbated by the rock, all kinds of things, structural things that have been transpiring here. So if I'm thinking about how I want to get a patient the best experience while they're in the process of getting care, you know, either in one episode or a string of episodes, because now there's a thing that's going on with this patient's health, the best way

[00:18:35] [SPEAKER_02] to do that is to ensure that they have a primary care home base, that they have somebody who's helping them that they already trust, who can make sure that they're getting directed to the something that is in line with what is both most affordable, but also the highest quality, aligning with the direct contracts potentially that the employer has in place, but also making sure that the patient feels like their whole person is getting taken care of.

[00:19:01] [SPEAKER_02] So building two is really like, probably as a first step, but get your primary care house in order, it sounds like.

[00:19:07] [SPEAKER_01] Absolutely, because what you're doing is you're solving the problem at the front door instead of the fact that as you're meandering around building two, trying to get care delivery, trying to get all the doctors to talk to each other, costs have gone up, outcomes are out the window, nobody understands what's happening, and the patient suffers at their most vulnerable point too. So why not fix it at the front door instead of trying to fix it later or deal with the

[00:19:37] [SPEAKER_01] consequences, especially from the employer? Because what that means for the employer is high ER rates, really high specialist costs, duplicate services over and over again, less productive employees for sure, and obviously less healthy as well.

[00:19:55] [SPEAKER_02] Yeah, there's been a lot of conversation about what does the data show relative to leveling up primary care relative to downstream costs. One thing that is very, very clear though, is that the less primary care that is available, the higher ER costs are. That is very, very well established. Middle of last year, I think I did a show that is entitled something like less primary care is higher ER visits, so it probably is not very hard to find.

[00:20:22] [SPEAKER_02] Right. So house number two, from a patient experience perspective, is primary care, trusted relationships, this care coordination, and you start thinking about patient experience, like again, when you start thinking about when it goes horribly wrong, it is always some patient who's just kind of like lost, trying to figure out they're not sure where to go, they're not sure what to do, they're making phone calls. It's really scary, especially if

[00:20:47] [SPEAKER_02] you just got diagnosed with something and you have no idea what to do or where to go or who to make an appointment with.

[00:20:53] [SPEAKER_01] Right. Yeah. Or you're being asked to take the next step, but you're faced with this $1,500 bill from the first step. You're like, well, what's this step going to cost me? And who's, how is this going to make me better? Who's advocating for me? I think that causes a lot of unknowns and it causes patients to stop treatment before they truly finish. And many times the clinician doesn't get

[00:21:23] [SPEAKER_01] accountability into that.

[00:21:24] [SPEAKER_02] Which probably leads us to building number three here. So maybe we should take the path over there, which is what happens after. And a lot of times what happens after is the financial repercussions of earlier decisions. So let's just say somebody walks out of that first, I just got care.

[00:21:46] [SPEAKER_02] And now they're in the after zone. Talk about patient experience relative to billing, just to simplify this.

[00:21:56] [SPEAKER_01] Well, I think we have to focus on the fact that employers are still paying the majority of healthcare costs, 80%, right? But that 20... For their plan. For their plan. Right. For their plan. They're paying about 80%. But as you think about how much those costs are going up, you put that 20% onus onto a patient. And if, you know, we're getting better

[00:22:24] [SPEAKER_01] at transparency, but we're not there. And so what really needs to be in place to have the best patient experience is there's no surprise bills or unexpectedly large bills. You're expecting something to be around $50 and it's $900 or something. Getting better at real-time upfront pricing or programs that can offer it at much significantly lower cost or no cost is ideal.

[00:22:54] [SPEAKER_02] It definitely reminds me of a conversation that I had with Dr. Kristen Dickerson from Green Imaging, where you're just talking about fee for service. There's probably two different kinds. One of them is some fee for some service. We're not quite sure what the fee is. We're not quite sure what the service is, right? Which is exactly what you're talking about. What that's going to result in is a patient getting an unexpectedly, probably large bill. So I think what you're saying is that

[00:23:23] [SPEAKER_02] if we really want to improve patient experience on the back end, like smacking them with a surprise that's wildly higher than what they thought it was going to be, you know, and or they're in the midst of a fight, which I think sometimes we underestimate like, oh, well, the insurance will eventually pick it up. You're getting this EOB sitting on the kitchen counter that says you owe $57,000. Like you're gonna panic and it doesn't matter if a month later it gets straightened out, right? Like

[00:23:49] [SPEAKER_02] that is not a good experience trying to go to sleep every night wondering if you're going to lose your house. On the other hand, you've got a known fee for a specified service. And if that's the case, then everybody knows what it's going to cost. There's going to be nothing unexpected for either the plan sponsor paying 80% of the bill or the enrollee paying whatever's left over.

[00:24:15] [SPEAKER_01] Yeah. And a majority of people are not going to understand that something went awry with the billing. A personal example, just got my yearly mammogram and I had switched insurance and I gave them the insurance information. I get the bill from the radiologist says I owe $497. I'm like, no, it's a preventive screening. It's going to be $0. And then I read the fine print. They didn't

[00:24:41] [SPEAKER_01] submit it to insurance. But so many people are going to think, well, my insurance paid for part of it. So I must owe this $497 bill. And maybe they start the process of paying it. So really that real-time upfront knowledge, what is this going to cost me? Do I have other options? And I think,

[00:25:07] [SPEAKER_01] you know, making sure, I think many organizations do a great job of advocating and helping patients become better advocates to understand healthcare because our healthcare literacy is too high because it's too complicated for anyone to navigate successfully.

[00:25:26] [SPEAKER_02] Yeah. And if we're also thinking about this building number three, long conversation about this with Andrew Tsang about revenue cycle management a couple of months ago, but you do have, I mean, like 30% or something of the cost of healthcare is going to fighting over who's going to pay the bill. In the olden days, a clinical organization that got a network contract, you knew how much you were going to get paid and you could count on getting paid. Like,

[00:25:51] [SPEAKER_02] that's why you wanted to be in network. The longer the time goes by, the more it is not necessarily a given. And you got to spend a lot of money fighting over getting paid and dealing with the denials. And it's a long game and there's the float. There's all kinds of perverse incentives that are involved there. So even if we're thinking about this from the clinical organization's perspective, especially if it's an independent physician that doesn't have a floor filled with

[00:26:18] [SPEAKER_02] people doing rev cycle, helping to ensure that everybody knows what the price is and everybody knows what the payment is ultimately going to be could make a really big difference here.

[00:26:32] [SPEAKER_01] When I think of the clinician inside building three, right, which is, should be financial transparency and accountable settlement, right? After the care, the clinicians get put in this very tough position because they're waiting months, months for reimbursements, which is ludicrous. It's forcing

[00:26:54] [SPEAKER_01] them in that second building to require patients to pay upfront before care is given, before care will get scheduled, right? I mean, recent articles talking about, you know, before you'll even have a surgery scheduled. Oh, it looks like you owe $2,000 on your deductible. Soon as you pay that, we can get you scheduled. And that is the result of the clinicians being pulled in both directions in building three

[00:27:24] [SPEAKER_01] of saying, well, I can't, I can't float all this money that I'm trying to collect from members and waiting for carriers to pay me. So really being able, it should be designed to get a fair settlement quickly, submit the claims. I mean, we have all these, you know, timely billing laws in place now, but it's more

[00:27:49] [SPEAKER_01] on the submission side. So getting that accountability more on the payment side is absolutely where we need

[00:27:55] [SPEAKER_02] to go. So if we're thinking about the advice overall, like we've got our three buildings here, if I'm thinking about this from the standpoint of the plan sponsor, union, self-insured employer, what do I do? Like what is a really tactical what now?

[00:28:16] [SPEAKER_01] Yeah, what now? Well, I think if as a plan sponsor, I would ask four things and you will probably, they'd probably be asking this, you know, their broker partners for assistance. But I think starting off to say, what are we really spending on primary care? How much are our employees and their covered dependents with chronic conditions using the system? Really looking at this from a people perspective

[00:28:44] [SPEAKER_01] to say, when we look at our plan dollars, what's being spent? Are they being managed? Are they showing up in the ER? Really understanding that. And then I think the third question is, what are we paying for high volume stuff, right? MRI, CT scans, MSK procedures, you know, specialty infusions now are going berserk. And then lastly, where's the gap of what did we pay? What did the provider really

[00:29:12] [SPEAKER_01] receive? You know, and what's kind of happening in the middle to understand, do we need to look at solutions that don't force us to solely rely on this insurance carrier? So that's my key advice for

[00:29:29] [SPEAKER_02] plan sponsors. We're thinking about this relative to patient experience, but also that patient experience is echoing what the care journey should be. Because if the care journey is great, the architecture of that care journey, if they run through the process, like it was designed to be run through because it was designed, they should have a great experience. It should be the right diagnosis, the right care, the right time, right price, right? Like that's how it should be managed. So your first thing is,

[00:29:59] [SPEAKER_02] how many patients are actually doing it that way, right? Like if we've set up primary care, then what is the utilization of primary care? How much are they paying for high volume things? If we're talking about affordability and everybody's going to the most expensive place in town, you know, even a Krijinovich talked about how an infusion at one place was literally a million dollars more. That's going to not be affordable either this year or next year when premiums go up.

[00:30:25] [SPEAKER_02] And if you start thinking about it that way, then we can be really proactive about what the experience is that we want. That is actionable information that we can then take back and really proactively think about what we want our supply chain to be. And if it's a high value service, John Quinn called it a subassembly, we can set up a subassembly so that we're navigating patients over to what that subassembly looks like, it sounds like. So just being very thoughtful about what we're not leaving it up

[00:30:54] [SPEAKER_01] to chance. Yeah. And I think they can demand hard metrics tied to both clinical and financial accountability, not soft satisfaction surveys, right? I think, you know, we get too wrapped up. We talked about the satisfaction of something, but really understanding the metrics behind what's happening clinically, what's the financial impact of that. And as plan sponsors start to really look at

[00:31:23] [SPEAKER_01] it from that lens, I think there's a level of empowerment that when they start to put solutions in place and they see those metrics for the first time, it's inspiring. Like, oh my gosh, I actually feel like we have a little bit more control. And our employees and their family members are coming to us thanking us for, you know, improving the quality of their lives.

[00:31:49] [SPEAKER_02] Yeah. And another issue with these, with the satisfaction surveys that you start hearing more and more about is that because everyone has heard the stories about someone going bankrupt and losing their house, the bar is so low. Like sometimes the satisfaction surveys are like, wow, I didn't lose my house. So five stars. The benchmarks must be taken into consideration as they're reviewed. But again, what are we doing here? If we're trying to pay for healthcare,

[00:32:17] [SPEAKER_02] then what does good look like relative to the care, I think is a really interesting and kind of a banger of a point that it's just like, just get back to basics here. Like first principles, the care is supposed to be right care, right time, right price. Yeah. If I'm thinking about this from a clinical perspective, there are a number of clinicians that listen to this podcast. What advice do you have relative to the three buildings,

[00:32:47] [SPEAKER_02] patient experience conversation for them?

[00:32:49] [SPEAKER_01] Well, I think it also ties into similar advice for the employer is that the clinicians don't have to just rely on contracts with carriers. They can seek direct contracting partners, right? That are really going to value the clinical expertise over the coding volume or throughput because they're going to be

[00:33:12] [SPEAKER_01] measured on the patient experience. I think also really understanding different relationships and how they impact how much more quickly they could get paid.

[00:33:24] [SPEAKER_02] To be specific here, practices considering getting into direct contracting, which is what Robin is alluding to here as the different relationship. Definitely ask direct contracting vendors for their, for example, median days to payment, not their target days to payment, what their median is. You want to weigh lower reimbursement against reduced accounts receivable and less time doing prior auths and or fighting

[00:33:52] [SPEAKER_02] denials. Because yeah, if anyone is playing the float, meaning carriers, ASOs, TPAs, what they want to do is slow walk payment. This is how they keep money in their own bank accounts and earn interest on that money for as long as possible. Listen to the episode with Preston Alexander. This point is what underlies what Robin is going to say right now.

[00:34:18] [SPEAKER_01] I think there's an interesting financial state conversation for clinicians around what is the impact of this carrier float and what would it look like if they got paid, you know, two weeks after they submitted a claim and were able to navigate that, expand, not have so many people in the practice dedicated to tracking down denials, but really just said, gosh, we have this flow of, of patients.

[00:34:48] [SPEAKER_01] We get to see them. We submit our bills. We get paid. We get to, we get to do what we went to med

[00:34:54] [SPEAKER_02] school for. I think you're raising a point also that comes up a lot on the show. There's a lot of advantages in formally having the ultimate purchasers of care, working with the ultimate deliverers of care, especially physician-led, independent operations, right? Like having the buyer and the ultimate purveyor actually having conversations with each other, actually working together, putting

[00:35:23] [SPEAKER_02] a vice grip on the middle. It's just so illuminating at a minimum. Yes. And at a maximum, there is so much money that is possible just to ensure that the purchaser is actually paying for healthcare and not some intermediary to do something, which may be unnecessary. I mean, it's not, but maybe it's not necessary. You'll figure that out. Robin Leone, talk to me a little bit about Xero Health.

[00:35:51] [SPEAKER_01] Well, Zero is a direct contracting solution. We contract directly with all kinds of specialty providers, right? Labs, imaging, surgeries, infusions, really adding in direct primary care to the mix as well. And employers, self-funded employers partner with Zero for everything we talked about today, really ensuring that the experience across all those that are involved in

[00:36:18] [SPEAKER_01] the healthcare system works more smoothly. And as we like to say, that is healthcare simplified. So that's a little bit about Zero.

[00:36:28] [SPEAKER_02] Yeah. And I definitely would recommend if anyone has other questions, Dr. Stanley Schwartz, also one of the founders of Zero, was on the pod, maybe it was last year. So for more thoughts from thought leaders over at Zero, definitely go back and listen to that show. Robin Leone, thank you so much for being on Relentless Health Value today.

[00:36:49] [SPEAKER_00] My pleasure. Thanks, Stacey. Hi, I'm Dr. Stan Schwartz from Xero Health. Relentless Health Value has been a real source of insight and inspiration for me. Every episode feels like a thoughtful, informed conversation that really gets to the heart of what matters in healthcare. If you're committed to moving the needle in this space like I am, I strongly recommend subscribing to Relentless Health Value newsletter. For me, it's the best way to keep up with new episodes and stay connected. Thanks for listening.