1 00:00:00,399 --> 00:00:02,480 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,480 --> 00:00:05,200 Becker's payer issues podcast. Thrilled today to be 3 00:00:05,200 --> 00:00:08,000 joined by a special guest. Patrick Quigley is 4 00:00:08,000 --> 00:00:11,039 the CEO of Sidecar Health. Patrick, thanks so 5 00:00:11,039 --> 00:00:12,639 much for taking the time to join me 6 00:00:12,639 --> 00:00:14,480 on the podcast today. Well, thanks so much 7 00:00:14,480 --> 00:00:15,380 for having me. 8 00:00:15,875 --> 00:00:17,475 So, Patrick, before we dive into everything we 9 00:00:17,475 --> 00:00:19,234 wanna talk with you about and about your 10 00:00:19,234 --> 00:00:20,755 company, can you tell us a little bit 11 00:00:20,755 --> 00:00:22,054 more about yourself 12 00:00:22,434 --> 00:00:23,894 and your background in healthcare? 13 00:00:24,355 --> 00:00:26,135 Yeah. Absolutely. Well, I don't have a traditional 14 00:00:26,195 --> 00:00:27,095 healthcare background 15 00:00:27,475 --> 00:00:29,554 as you, as you may know. So I'm 16 00:00:29,554 --> 00:00:31,175 an engineer, a mechanical engineer, 17 00:00:31,690 --> 00:00:33,369 and I'm a consumer guy. All my previous 18 00:00:33,369 --> 00:00:34,969 companies that I've led have all been focused 19 00:00:34,969 --> 00:00:36,270 on empowering consumers. 20 00:00:36,890 --> 00:00:38,570 But more important than any of that for 21 00:00:38,570 --> 00:00:40,250 for health care purposes is I'm also a 22 00:00:40,250 --> 00:00:41,609 dad. And I think a lot of what 23 00:00:41,609 --> 00:00:43,710 we built at Sidecar Health has to come 24 00:00:43,770 --> 00:00:44,829 from my own experiences, 25 00:00:45,609 --> 00:00:47,804 navigating the health care system for my family. 26 00:00:48,905 --> 00:00:52,265 Fantastic. So what is sidecar health then, Patrick? 27 00:00:52,265 --> 00:00:54,265 When did you all launch and what do 28 00:00:54,265 --> 00:00:56,585 you offer today? Yeah. So sidecar health is 29 00:00:56,585 --> 00:00:58,744 a major medical health insurance carrier that is 30 00:00:58,744 --> 00:01:00,844 focused on large employers. We've been around, 31 00:01:01,170 --> 00:01:02,770 I guess now we're in our 8th year. 32 00:01:03,170 --> 00:01:05,650 Everything that we do is is unique. So 33 00:01:05,650 --> 00:01:07,489 we've had to build everything from the ground 34 00:01:07,489 --> 00:01:10,209 up all around this concept of empowering consumers 35 00:01:10,209 --> 00:01:12,129 to take control of their health care and 36 00:01:12,129 --> 00:01:13,729 being in control of their health care journey 37 00:01:13,729 --> 00:01:14,745 to get to get access. 38 00:01:15,204 --> 00:01:16,644 I think the biggest thing and we can 39 00:01:16,644 --> 00:01:19,045 talk about it, as much as we've got 40 00:01:19,045 --> 00:01:20,825 time. I think the biggest thing for us 41 00:01:21,284 --> 00:01:23,685 is that we think the the root cause 42 00:01:23,685 --> 00:01:25,364 to the troubles in the US health care 43 00:01:25,364 --> 00:01:27,364 system is the lack of transparency and the 44 00:01:27,364 --> 00:01:29,560 costs and then the lack of motivation to 45 00:01:29,560 --> 00:01:31,959 make good decisions. And if you can solve 46 00:01:31,959 --> 00:01:34,540 those two problems, you can provide better coverage, 47 00:01:34,920 --> 00:01:37,959 better access, and better affordability in a sustainable 48 00:01:37,959 --> 00:01:39,659 way, which is something we all want. 49 00:01:40,155 --> 00:01:42,075 Absolutely. And and just to clarify with you, 50 00:01:42,075 --> 00:01:42,575 Patrick, 51 00:01:43,034 --> 00:01:45,275 how many states is Sidecar now operating in 52 00:01:45,275 --> 00:01:47,194 and how many members do you have? Yeah. 53 00:01:47,194 --> 00:01:49,515 As a large employer, like, for our self 54 00:01:49,515 --> 00:01:51,594 funded options serving jumbos and other folks that 55 00:01:51,594 --> 00:01:54,200 are self funded, we are no borders to, 56 00:01:54,520 --> 00:01:56,120 to where we operate. Right? So we cover 57 00:01:56,120 --> 00:01:58,680 people in 44 states today. In terms of 58 00:01:58,680 --> 00:02:00,200 the the large clients that want to be 59 00:02:00,200 --> 00:02:02,439 fully insured, we sell in 3 primary states 60 00:02:02,439 --> 00:02:02,939 today. 61 00:02:03,480 --> 00:02:06,280 Companies that are domiciled in Ohio with, again, 62 00:02:06,280 --> 00:02:07,420 employees anywhere, 63 00:02:07,935 --> 00:02:08,435 Georgia 64 00:02:08,735 --> 00:02:10,115 and in Florida. 65 00:02:11,375 --> 00:02:11,875 Fantastic. 66 00:02:12,175 --> 00:02:14,594 Appreciate you giving us all those details. 67 00:02:15,134 --> 00:02:18,254 So sidecar, you mentioned your consumer driven. That's 68 00:02:18,254 --> 00:02:20,895 your background, Patrick. You're you're aiming to disrupt 69 00:02:20,895 --> 00:02:23,849 the traditional insurance market with that model. 70 00:02:24,550 --> 00:02:25,510 So what do you see as some of 71 00:02:25,510 --> 00:02:27,590 the biggest challenges in or what have you 72 00:02:27,590 --> 00:02:29,430 experienced as being some of the biggest challenges 73 00:02:29,430 --> 00:02:30,569 in terms of convincing 74 00:02:31,030 --> 00:02:32,330 both health care providers 75 00:02:32,870 --> 00:02:34,569 and consumers to embrace 76 00:02:35,189 --> 00:02:36,090 more transparent 77 00:02:36,469 --> 00:02:37,370 pricing models? 78 00:02:37,990 --> 00:02:39,334 Yeah. I mean, I think the biggest challenge 79 00:02:39,334 --> 00:02:41,014 is in more facing on the US health 80 00:02:41,014 --> 00:02:42,694 care system, right, is how do you go 81 00:02:42,694 --> 00:02:43,594 ahead and provide 82 00:02:43,974 --> 00:02:45,814 better coverage and better access in a world 83 00:02:45,814 --> 00:02:48,134 where cost continues to go up? And I 84 00:02:48,134 --> 00:02:49,974 think the real trouble is that, you know, 85 00:02:49,974 --> 00:02:52,474 the traditional legacy providers, the BUKAs, 86 00:02:52,849 --> 00:02:55,889 they control costs by controlling access. Right? How 87 00:02:55,889 --> 00:02:58,290 do you introduce prior authorization to limit? Would 88 00:02:58,290 --> 00:02:59,969 someone really need that care? And I think 89 00:02:59,969 --> 00:03:00,710 that creates 90 00:03:01,169 --> 00:03:03,349 a lot of friction and lack of incentives, 91 00:03:03,730 --> 00:03:05,569 and no one really knows what their costs 92 00:03:05,569 --> 00:03:08,025 are. And so it's it creates a version 93 00:03:08,025 --> 00:03:10,185 to engage engaging the health care system. So 94 00:03:10,185 --> 00:03:10,925 for us, 95 00:03:11,305 --> 00:03:13,064 our view of the world is let's empower 96 00:03:13,064 --> 00:03:16,044 consumers. Let's give them full control, full transparency, 97 00:03:16,905 --> 00:03:19,064 and let's create motivations for them to be 98 00:03:19,064 --> 00:03:21,510 engaged in the decision making. And that actually 99 00:03:21,510 --> 00:03:23,909 opens up better coverage and better access. So 100 00:03:23,909 --> 00:03:26,710 it's a different way of thinking about health 101 00:03:26,710 --> 00:03:28,490 care, and it really matches everything 102 00:03:28,949 --> 00:03:31,430 people do in their entire lives. So our 103 00:03:31,430 --> 00:03:32,409 biggest challenge 104 00:03:32,944 --> 00:03:34,245 is the entire 105 00:03:34,625 --> 00:03:37,025 US healthcare system has been cobbled together over 106 00:03:37,025 --> 00:03:37,525 decades 107 00:03:37,905 --> 00:03:40,405 and it's hard. And it's it's complicated. 108 00:03:41,025 --> 00:03:44,145 It's sometimes it feels like it's there's there's 109 00:03:44,145 --> 00:03:46,064 too many obstacles to getting care for your 110 00:03:46,064 --> 00:03:46,564 family. 111 00:03:47,120 --> 00:03:48,959 So our challenge is by we remove all 112 00:03:48,959 --> 00:03:51,299 those obstacles and we suddenly put our members 113 00:03:51,359 --> 00:03:51,859 in, 114 00:03:52,639 --> 00:03:54,879 in control of their entire healthcare journey with 115 00:03:54,879 --> 00:03:55,780 complete transparency. 116 00:03:56,319 --> 00:03:59,039 And so our challenge is actually getting people 117 00:03:59,039 --> 00:04:00,099 to go, it's okay 118 00:04:00,455 --> 00:04:01,675 to do things differently. 119 00:04:02,055 --> 00:04:04,395 And I think that the the best kind 120 00:04:04,694 --> 00:04:06,134 of analogy for us is if you think 121 00:04:06,134 --> 00:04:07,414 back to the first time you took an 122 00:04:07,414 --> 00:04:09,495 Uber ride. I remember when I when I 123 00:04:09,495 --> 00:04:11,414 first took mine, you know, I some random 124 00:04:11,414 --> 00:04:12,775 person came to my house, picked me up 125 00:04:12,775 --> 00:04:14,259 and took me to the airport. I got 126 00:04:14,259 --> 00:04:15,539 to the airport and I'm looking at my 127 00:04:15,539 --> 00:04:16,660 app and I have my credit card in 128 00:04:16,660 --> 00:04:17,540 my hand. I'm trying to figure out what 129 00:04:17,540 --> 00:04:18,420 to do. And I asked the guy, how 130 00:04:18,420 --> 00:04:19,779 do I pay you? He's like, you just 131 00:04:19,779 --> 00:04:20,920 get out of my car. 132 00:04:21,459 --> 00:04:24,180 And so that experience was very different than 133 00:04:24,180 --> 00:04:25,160 a taxi ride. 134 00:04:25,540 --> 00:04:27,300 And I think the challenge for us is 135 00:04:27,300 --> 00:04:28,519 we're asking people 136 00:04:28,899 --> 00:04:29,399 to 137 00:04:29,935 --> 00:04:32,514 do something they've not done ever. 138 00:04:32,894 --> 00:04:34,595 And so at the end of the day, 139 00:04:34,814 --> 00:04:37,134 our biggest challenge is getting people to feel 140 00:04:37,134 --> 00:04:39,535 comfortable and empowered so that they can actually 141 00:04:39,535 --> 00:04:41,694 start start like they did today. People don't 142 00:04:41,694 --> 00:04:43,214 take taxis as much. They call an Uber 143 00:04:43,214 --> 00:04:45,120 if they need occasional transportation. And so that's 144 00:04:45,120 --> 00:04:47,540 that's the challenge that we work with our 145 00:04:47,600 --> 00:04:50,000 HR departments and and leadership teams at the 146 00:04:50,000 --> 00:04:52,560 companies we work with, to manage through. Sure. 147 00:04:52,560 --> 00:04:54,959 Sure. Absolutely. And you said, you know, it's 148 00:04:54,959 --> 00:04:56,180 a hard it's a complicated 149 00:04:56,879 --> 00:04:58,899 health care system. It's been cobbled together 150 00:04:59,360 --> 00:05:00,100 over the decades. 151 00:05:00,639 --> 00:05:02,375 And, you you know, obviously, at the end 152 00:05:02,375 --> 00:05:05,014 of the of last year, of 2024, we 153 00:05:05,014 --> 00:05:05,754 we saw, 154 00:05:06,615 --> 00:05:08,694 that almost come to a head. We've seen 155 00:05:08,694 --> 00:05:09,675 the public frustration, 156 00:05:10,615 --> 00:05:14,134 online about this. We're we're seeing lawmakers talk 157 00:05:14,134 --> 00:05:15,595 a lot more about this spurred, 158 00:05:16,259 --> 00:05:18,100 of course, by the by the tragic murder 159 00:05:18,100 --> 00:05:19,000 of of UnitedHealthcare 160 00:05:19,459 --> 00:05:20,759 CEO Brian Thompson. 161 00:05:22,259 --> 00:05:24,180 So so what's your what's your take on 162 00:05:24,180 --> 00:05:24,680 this, 163 00:05:24,980 --> 00:05:26,819 Patrick? We we we know the public is 164 00:05:26,819 --> 00:05:28,500 frustrated with the health care system, with the 165 00:05:28,500 --> 00:05:31,944 health insurance system, with denial rates, with claims 166 00:05:31,944 --> 00:05:32,444 issues, 167 00:05:32,985 --> 00:05:35,865 with accessing health care. So with everything that 168 00:05:35,865 --> 00:05:37,545 your company does in terms of trying to 169 00:05:37,545 --> 00:05:40,925 drive more transparent models, more consumer driven models, 170 00:05:41,545 --> 00:05:42,904 can you give us your take on on 171 00:05:42,904 --> 00:05:44,745 everything we're we're and how we're seeing the 172 00:05:44,745 --> 00:05:45,245 country 173 00:05:45,545 --> 00:05:46,949 respond to an event like this? 174 00:05:47,830 --> 00:05:48,949 You know, first of all, it's a terrible 175 00:05:48,949 --> 00:05:51,270 event, and we it's great that we're having 176 00:05:51,270 --> 00:05:53,189 a conversation about how to improve the system, 177 00:05:53,189 --> 00:05:54,470 but this is not how we should have 178 00:05:54,470 --> 00:05:55,350 ended up here. 179 00:05:56,150 --> 00:05:57,590 But you're right. There is a tremendous amount 180 00:05:57,590 --> 00:06:00,214 of frustration that seems to be, bringing things 181 00:06:00,214 --> 00:06:02,134 to light to have the right conversations right 182 00:06:02,134 --> 00:06:04,235 now. And I think for me, 183 00:06:04,774 --> 00:06:06,375 just like you called out the denial rates, 184 00:06:06,375 --> 00:06:08,074 I think that's kind of a flashpoint. 185 00:06:09,254 --> 00:06:11,095 There is more public discussion right now about 186 00:06:11,095 --> 00:06:12,774 denial rates, I think, than there has really 187 00:06:12,774 --> 00:06:14,235 ever been at a public level. 188 00:06:14,879 --> 00:06:15,680 And I think that, again, 189 00:06:17,040 --> 00:06:18,479 some of the data that you see published 190 00:06:18,639 --> 00:06:20,319 I know I saw an interview with Oscar 191 00:06:20,319 --> 00:06:20,819 CEO 192 00:06:21,279 --> 00:06:23,439 on CNBC, where they were talking about 20 193 00:06:23,439 --> 00:06:25,139 30% denial rates for, 194 00:06:25,680 --> 00:06:27,360 you know, some of some of the blues. 195 00:06:27,360 --> 00:06:29,519 And and United was specifically called out given 196 00:06:29,519 --> 00:06:30,105 the context. 197 00:06:30,665 --> 00:06:32,904 And, you know, Oscar CEO was was sharing 198 00:06:32,904 --> 00:06:34,925 that, you know, they've got industry leading, 199 00:06:35,464 --> 00:06:36,985 denial rates that I think he called out 200 00:06:36,985 --> 00:06:37,485 12%. 201 00:06:38,585 --> 00:06:39,785 And I sit back and I look at 202 00:06:39,785 --> 00:06:42,045 that. My reaction is, why is this okay? 203 00:06:42,839 --> 00:06:44,699 Like, if I think about my family, 204 00:06:45,800 --> 00:06:47,879 I would not I would not be okay 205 00:06:47,879 --> 00:06:48,939 with the health insurance 206 00:06:49,800 --> 00:06:52,540 solution to support my kids and my wife, 207 00:06:53,399 --> 00:06:53,899 where 208 00:06:54,279 --> 00:06:56,220 industry leading view is 12%, 209 00:06:56,520 --> 00:06:59,525 and the largest in, you know, insurance companies 210 00:06:59,525 --> 00:07:01,685 are are talking about denial rates north of 211 00:07:01,685 --> 00:07:02,185 20. 212 00:07:03,925 --> 00:07:06,185 So for me, I I think that 213 00:07:07,045 --> 00:07:08,904 the public is ready for a change. 214 00:07:10,120 --> 00:07:12,039 And, you know, part of the motivation and 215 00:07:12,039 --> 00:07:14,039 starting sidecar health is this problem is how 216 00:07:14,039 --> 00:07:15,720 could I get my family access to care? 217 00:07:15,720 --> 00:07:18,220 And so when we think about denial rates, 218 00:07:18,680 --> 00:07:20,199 we think about our kind of view of 219 00:07:20,199 --> 00:07:21,634 the world in our North Star. And our 220 00:07:21,634 --> 00:07:23,314 view is that doctors should be making care 221 00:07:23,314 --> 00:07:25,634 decisions and insurance companies should be paying for 222 00:07:25,634 --> 00:07:27,714 it. And that is why, like, our denial 223 00:07:27,714 --> 00:07:29,495 rates are less than 1%. 224 00:07:30,194 --> 00:07:32,035 Right? And frankly, closer to 0 than they 225 00:07:32,035 --> 00:07:33,955 are to 1. And that is based on 226 00:07:33,955 --> 00:07:36,214 this this value proposition of creating 227 00:07:36,810 --> 00:07:38,970 access, making sure that doctors are driving care 228 00:07:38,970 --> 00:07:40,889 decisions. And so as I look at I 229 00:07:40,889 --> 00:07:43,849 look at the the dialogue that are happening 230 00:07:43,849 --> 00:07:44,349 now, 231 00:07:44,649 --> 00:07:46,089 I I think it's about time that we're 232 00:07:46,089 --> 00:07:48,189 having real dialogue around real numbers. 233 00:07:48,490 --> 00:07:50,409 And we start figuring out how do we 234 00:07:50,409 --> 00:07:51,709 facilitate a world 235 00:07:52,145 --> 00:07:54,465 where we have more transparency, more control, more 236 00:07:54,465 --> 00:07:57,105 access and better decision making, and frankly, better 237 00:07:57,105 --> 00:07:57,605 accountability. 238 00:07:58,305 --> 00:07:59,665 I I think the last thing I would 239 00:07:59,665 --> 00:08:01,045 say here is that, 240 00:08:02,145 --> 00:08:04,625 I think it was, the United CEO put 241 00:08:04,625 --> 00:08:05,125 out, 242 00:08:05,745 --> 00:08:06,689 an op ed 243 00:08:07,490 --> 00:08:09,089 that kinda called this out and and and 244 00:08:09,089 --> 00:08:10,069 expressly said 245 00:08:10,449 --> 00:08:12,610 that that the health system we all agree 246 00:08:12,610 --> 00:08:14,129 that the health system doesn't work as it 247 00:08:14,129 --> 00:08:15,830 should. And it it was designed 248 00:08:16,290 --> 00:08:18,449 and cobbled together over a long period of 249 00:08:18,449 --> 00:08:18,855 time. 250 00:08:19,415 --> 00:08:20,694 And no one I think it says something 251 00:08:20,694 --> 00:08:21,975 to the effect of no one would design 252 00:08:21,975 --> 00:08:23,254 a system like this if they were to 253 00:08:23,254 --> 00:08:25,175 design it from the beginning. And and I 254 00:08:25,175 --> 00:08:27,275 just think that that statement alone, 255 00:08:27,814 --> 00:08:29,895 along with the frustration is like, why why 256 00:08:29,895 --> 00:08:31,335 are we okay with this? Let's do something 257 00:08:31,335 --> 00:08:32,554 different. And we believe 258 00:08:32,929 --> 00:08:35,009 that what's different are health plans that are 259 00:08:35,009 --> 00:08:37,089 modeled on what we're doing, on what side 260 00:08:37,089 --> 00:08:39,649 for health can do. Yeah. Absolutely. And it's 261 00:08:39,649 --> 00:08:41,009 a great last point that you brought up 262 00:08:41,009 --> 00:08:44,209 to there, Patrick, that that UnitedHealth CEO has 263 00:08:44,209 --> 00:08:46,610 addressed the the public frustrations in that op 264 00:08:46,610 --> 00:08:47,110 ed. 265 00:08:47,995 --> 00:08:50,714 And just, for our listeners, u UnitedHealth also 266 00:08:50,714 --> 00:08:52,735 did put out a statement in December saying 267 00:08:52,955 --> 00:08:55,294 that the company approves and pays about 90% 268 00:08:55,434 --> 00:08:57,995 of medical claims upon submission. So just wanna 269 00:08:57,995 --> 00:09:00,394 put that out there. Yeah. But but one 270 00:09:00,394 --> 00:09:01,834 last thing I wanna ask you about on 271 00:09:01,834 --> 00:09:04,059 on this specific event, Patrick, is we've seen 272 00:09:04,059 --> 00:09:06,539 other insurance CEOs like doctor Sachin Jain, who 273 00:09:06,539 --> 00:09:09,299 leads SCAM Group, a Medicare Advantage company Mhmm. 274 00:09:09,500 --> 00:09:11,740 Say that the industry at large needs to 275 00:09:11,740 --> 00:09:12,620 have some more, 276 00:09:13,100 --> 00:09:15,500 inflection about this event and and even say 277 00:09:15,500 --> 00:09:16,240 we're sorry, 278 00:09:17,235 --> 00:09:20,535 to to Americans about how insurers have, 279 00:09:21,154 --> 00:09:23,715 you know, allegedly active or or not over 280 00:09:23,715 --> 00:09:24,934 the last few decades. 281 00:09:25,394 --> 00:09:27,235 As as the CEO of of an insurance 282 00:09:27,235 --> 00:09:28,434 company, what what do you what do you 283 00:09:28,434 --> 00:09:30,320 make of a statement like that? Well, I 284 00:09:30,320 --> 00:09:31,679 mean, I think it's great that they're being 285 00:09:31,679 --> 00:09:34,080 accountable and that they're coming forward saying we 286 00:09:34,080 --> 00:09:35,840 want to do better. I I personally believe 287 00:09:35,840 --> 00:09:37,840 that anybody that's in healthcare, whether you're on 288 00:09:37,840 --> 00:09:39,759 the payer side, provider side, you're in here 289 00:09:39,759 --> 00:09:41,360 because you're mission driven. You're trying to make 290 00:09:41,360 --> 00:09:44,514 a difference and that's awesome. Right? So if 291 00:09:44,514 --> 00:09:46,274 we all acknowledge that there's problems, we just 292 00:09:46,274 --> 00:09:48,534 need to solve it. Right? We need to 293 00:09:49,074 --> 00:09:51,554 the world is clamoring for more transparency, more 294 00:09:51,554 --> 00:09:54,115 control, better access. I mean, mental health parity 295 00:09:54,115 --> 00:09:56,434 is a great policy statement. But if you 296 00:09:56,434 --> 00:09:57,574 look at the actual 297 00:09:58,440 --> 00:10:00,200 access people have to mental health, for example, 298 00:10:00,200 --> 00:10:01,580 like it's not enough. 299 00:10:01,960 --> 00:10:03,240 Right? And the fact that, 300 00:10:03,799 --> 00:10:06,120 we have core parts of our system, like 301 00:10:06,120 --> 00:10:06,940 prior authorization, 302 00:10:07,320 --> 00:10:08,779 step therapy for drugs. 303 00:10:09,480 --> 00:10:12,021 You know, I I think there was, you 304 00:10:12,021 --> 00:10:14,433 know, a large employer at one point last 305 00:10:14,433 --> 00:10:16,815 year, excuse me, a large health insurance company 306 00:10:16,815 --> 00:10:19,315 at one point last year, introduced prior authorization 307 00:10:19,375 --> 00:10:20,035 for colonoscopies. 308 00:10:21,215 --> 00:10:23,615 That's very extreme in my mind. Right? In 309 00:10:23,615 --> 00:10:24,595 my view of, 310 00:10:25,089 --> 00:10:26,549 you know, I don't know how many recreational, 311 00:10:27,330 --> 00:10:27,830 colonoscopies, 312 00:10:28,210 --> 00:10:30,049 Jacob, you signed up for. But, like, people 313 00:10:30,049 --> 00:10:32,929 aren't right there. People aren't going and doing 314 00:10:32,929 --> 00:10:35,169 that unless there's a reason. And so I 315 00:10:35,169 --> 00:10:37,190 guess it's great that there's some accountability. 316 00:10:37,845 --> 00:10:39,524 It's great that that United has come out 317 00:10:39,524 --> 00:10:41,065 and said, hey. Our denial rate is 10%. 318 00:10:41,445 --> 00:10:42,804 I would just say that, like, that's not 319 00:10:42,804 --> 00:10:44,404 good enough for my family. And we would 320 00:10:44,485 --> 00:10:46,584 that it needs to be bad. Yeah. Absolutely. 321 00:10:46,644 --> 00:10:48,644 And it certainly does not help when we 322 00:10:48,644 --> 00:10:49,544 see other insurers, 323 00:10:50,419 --> 00:10:51,720 doing things like anesthesia 324 00:10:52,259 --> 00:10:54,259 policies with with Right. But we won't get 325 00:10:54,259 --> 00:10:55,620 into all that in the details, but it 326 00:10:55,700 --> 00:10:57,700 yeah. Sure. It's so much more we can 327 00:10:57,700 --> 00:10:59,539 talk about. But in terms of where we 328 00:10:59,539 --> 00:11:01,000 have seen more transparency, 329 00:11:01,539 --> 00:11:03,860 injected into the system, Patrick, at the end 330 00:11:03,860 --> 00:11:04,600 of 2024, 331 00:11:05,294 --> 00:11:08,414 Sidecar announced an agreement with the Ohio State 332 00:11:08,414 --> 00:11:10,595 University's Wexner Medical Center, 333 00:11:11,214 --> 00:11:13,634 for a fixed price model with upfront pricing 334 00:11:13,695 --> 00:11:15,154 and no prior authorization. 335 00:11:15,855 --> 00:11:17,934 Can you walk us through how this model 336 00:11:17,934 --> 00:11:20,059 is is gonna be working for patients and 337 00:11:20,059 --> 00:11:21,279 providers on the ground 338 00:11:21,899 --> 00:11:23,820 and why you believe this this this is 339 00:11:23,820 --> 00:11:25,360 different? This is a different model. 340 00:11:25,820 --> 00:11:27,500 Yeah. Absolutely. And thanks for bringing it up. 341 00:11:27,500 --> 00:11:29,279 I we're really excited about this partnership, 342 00:11:29,580 --> 00:11:32,240 with the Ohio State University. It's a fantastic 343 00:11:32,299 --> 00:11:34,304 model of of what we do and how 344 00:11:34,304 --> 00:11:36,705 we want to continue to provide to partner 345 00:11:36,705 --> 00:11:39,024 with, the leading medical institutions in the United 346 00:11:39,024 --> 00:11:39,524 States. 347 00:11:39,904 --> 00:11:41,904 And it's what's really interesting is that it 348 00:11:41,904 --> 00:11:43,665 matches what how to work with all providers, 349 00:11:43,665 --> 00:11:45,845 even those that don't come to us proactively 350 00:11:45,904 --> 00:11:47,470 and say, how do we how do we 351 00:11:47,470 --> 00:11:49,309 integrate more into your model to get access 352 00:11:49,309 --> 00:11:51,230 to more to your commercial members? And so 353 00:11:51,230 --> 00:11:53,230 with with this, relationship is all about, just 354 00:11:53,230 --> 00:11:55,629 like you called out for Ohio State, this 355 00:11:55,629 --> 00:11:58,450 eliminates all prior authorization. There's no, 356 00:11:59,149 --> 00:12:01,065 there's no paperwork that, 357 00:12:01,625 --> 00:12:04,424 to to get, you know, psych our health 358 00:12:04,424 --> 00:12:06,284 members in for whatever procedures, 359 00:12:07,225 --> 00:12:10,184 or treatments that Ohio State doctors want. Right? 360 00:12:10,184 --> 00:12:12,985 So this that's key. So doctors can focus 361 00:12:12,985 --> 00:12:13,804 on care. 362 00:12:14,290 --> 00:12:17,889 We also, eliminate revenue cycle, limits. Right? Like, 363 00:12:17,889 --> 00:12:20,769 so our members will pay, you know, Ohio 364 00:12:20,769 --> 00:12:22,690 State in the way they wanna be paid. 365 00:12:22,690 --> 00:12:24,230 There's there's no collections 366 00:12:24,769 --> 00:12:26,610 issues. A lot of times, you know, hospital 367 00:12:26,610 --> 00:12:28,664 systems are chasing folks around for, 368 00:12:29,144 --> 00:12:29,884 for payment, 369 00:12:30,584 --> 00:12:32,904 with a traditional model with us. Like and 370 00:12:32,904 --> 00:12:34,284 what's special about this OSU, 371 00:12:35,704 --> 00:12:37,964 partnership is you you talked about a transparent 372 00:12:38,024 --> 00:12:39,164 pricing. Right? So 373 00:12:39,704 --> 00:12:42,024 OSU basically has chosen the prices they wanna 374 00:12:42,024 --> 00:12:43,404 charge sidecar health members. 375 00:12:43,769 --> 00:12:45,470 We make those prices available 376 00:12:45,850 --> 00:12:47,070 completely transparently 377 00:12:47,370 --> 00:12:49,930 to our members, and then our members choose 378 00:12:49,930 --> 00:12:52,190 to go to OSU knowing those prices. 379 00:12:52,649 --> 00:12:55,149 And so it's it's exactly how health insurance 380 00:12:55,290 --> 00:12:57,129 or health care should work. Right? We should 381 00:12:57,129 --> 00:13:00,754 be consumers of health care engaging with providers. 382 00:13:00,815 --> 00:13:02,894 So in that way and so, like, providers 383 00:13:02,894 --> 00:13:04,495 shouldn't worry about getting paid. Providers shouldn't be 384 00:13:04,495 --> 00:13:06,335 asking some third party that doesn't know what's 385 00:13:06,335 --> 00:13:07,715 going on with the care of an individual 386 00:13:07,774 --> 00:13:09,955 for permission. And so this is a codification 387 00:13:10,095 --> 00:13:11,475 of our overall model. 388 00:13:11,840 --> 00:13:13,360 And what it gives to our members is 389 00:13:13,360 --> 00:13:15,460 it gives a, you know, a a 390 00:13:15,919 --> 00:13:18,240 a simple access to one of the the 391 00:13:18,240 --> 00:13:18,899 the greatest 392 00:13:19,279 --> 00:13:20,980 hospital systems in the US, 393 00:13:21,600 --> 00:13:23,519 right through our app or knowing knowing what 394 00:13:23,519 --> 00:13:25,120 pricing are, and it can go and kinda 395 00:13:25,120 --> 00:13:27,965 engage directly with OSU. So we're thrilled about 396 00:13:27,965 --> 00:13:30,365 that. There's been several of these, type of 397 00:13:30,365 --> 00:13:31,184 hospital arrangements 398 00:13:31,565 --> 00:13:34,125 we have announced where the hospitals are coming 399 00:13:34,125 --> 00:13:34,784 to us 400 00:13:35,485 --> 00:13:38,445 and and asking to effectively make their pricing 401 00:13:38,445 --> 00:13:40,365 and make their availability available to our commercial 402 00:13:40,365 --> 00:13:42,465 members so that our members select them. 403 00:13:42,889 --> 00:13:44,830 And I think the last kind of note 404 00:13:44,889 --> 00:13:46,730 here is is specifically with regards to OSU. 405 00:13:46,730 --> 00:13:48,410 What's exciting here is you can kind of 406 00:13:48,410 --> 00:13:49,789 juxtapose this announcement 407 00:13:50,250 --> 00:13:52,169 with some of the very public kind of 408 00:13:52,169 --> 00:13:53,929 back and forth that OSU had been going 409 00:13:53,929 --> 00:13:56,665 through with Anthem, where those relationships seem like 410 00:13:56,665 --> 00:13:58,105 at least in the what what you can 411 00:13:58,105 --> 00:13:59,545 read about. Like, they seem a little bit 412 00:13:59,545 --> 00:14:00,045 more, 413 00:14:00,665 --> 00:14:01,485 kinda adversarial, 414 00:14:02,024 --> 00:14:03,785 like a game of chicken. Whereas what ours 415 00:14:03,785 --> 00:14:05,144 are is like we go and we say, 416 00:14:05,144 --> 00:14:06,585 hey, what what do you wanna charge our 417 00:14:06,585 --> 00:14:08,425 members? Let's just tell them, and then our 418 00:14:08,425 --> 00:14:09,545 members will come to you knowing what the 419 00:14:09,545 --> 00:14:10,110 prices are. 420 00:14:10,750 --> 00:14:13,149 Wow. That's really cool stuff. And it's fascinating 421 00:14:13,149 --> 00:14:14,589 to hear how the how the hospitals are 422 00:14:14,589 --> 00:14:17,070 coming to you versus what, at least from 423 00:14:17,070 --> 00:14:19,389 our perspective, what we're seeing constantly is what 424 00:14:19,389 --> 00:14:21,490 what you said, Patrick. He's a very adversarial 425 00:14:22,269 --> 00:14:24,509 relationships that the patients always end up getting 426 00:14:24,509 --> 00:14:26,804 caught in the middle of. But before we 427 00:14:26,804 --> 00:14:28,564 go, Patrick, what else are we missing? You 428 00:14:28,644 --> 00:14:29,764 you've got the ears of a lot of 429 00:14:29,764 --> 00:14:31,764 health plan leaders from all over the country, 430 00:14:31,764 --> 00:14:33,384 including Buka leaders. 431 00:14:33,684 --> 00:14:35,444 What do you wanna say? Well, what I 432 00:14:35,444 --> 00:14:37,125 would say is that, like, I think there's 433 00:14:37,125 --> 00:14:39,365 a lot of conversation about driving consumer driven 434 00:14:39,365 --> 00:14:41,044 health care. There's a lot of conversations about 435 00:14:41,044 --> 00:14:41,544 transparency, 436 00:14:41,980 --> 00:14:43,259 and there's there's a lot of kind of 437 00:14:43,259 --> 00:14:45,500 undercurrents about are we ready as a country 438 00:14:45,500 --> 00:14:47,580 for this? And what I would encourage everyone 439 00:14:47,580 --> 00:14:49,519 to think about is that consumers 440 00:14:49,899 --> 00:14:51,440 are the most efficient 441 00:14:51,899 --> 00:14:54,220 way to get to the best quality, best 442 00:14:54,220 --> 00:14:56,634 price in any market. And it can work 443 00:14:56,634 --> 00:14:58,794 the same in health care. And I think 444 00:14:58,794 --> 00:15:00,715 that if you're if you're a hospital system 445 00:15:00,715 --> 00:15:02,575 that is is nervous about transparency, 446 00:15:02,955 --> 00:15:04,254 I think it creates an opportunity 447 00:15:04,794 --> 00:15:07,355 for you to demonstrate your value that you're 448 00:15:07,355 --> 00:15:09,195 delivering to your patients. And patients, I can 449 00:15:09,195 --> 00:15:10,563 tell you from our data, will run to 450 00:15:10,563 --> 00:15:10,601 you when you're transparent. And you're you can 451 00:15:10,601 --> 00:15:10,634 you can go ahead and create a better 452 00:15:10,634 --> 00:15:11,615 experience for 453 00:15:14,209 --> 00:15:15,129 transparent, and you're you can you can go 454 00:15:15,129 --> 00:15:16,156 ahead and create a better experience for your 455 00:15:16,156 --> 00:15:18,850 doctors and better, results from your for from 456 00:15:18,850 --> 00:15:20,949 your patients. At the same time, payers 457 00:15:21,809 --> 00:15:24,209 payers actually if we could all embrace this 458 00:15:24,209 --> 00:15:25,750 model of letting, 459 00:15:26,445 --> 00:15:27,504 consumers know 460 00:15:27,965 --> 00:15:30,764 what things cost, what their individual responsibilities are 461 00:15:30,764 --> 00:15:33,184 and let them make choices, you can actually 462 00:15:33,325 --> 00:15:33,825 remove 463 00:15:34,205 --> 00:15:36,684 the restrictions to care that that are the 464 00:15:36,684 --> 00:15:39,425 traditional model, the prior authorization, step therapies, formularies. 465 00:15:40,529 --> 00:15:42,929 Economically, those do not deliver as much value 466 00:15:42,929 --> 00:15:45,169 as just telling someone here is a budget 467 00:15:45,169 --> 00:15:46,610 you have for care, spend it where you 468 00:15:46,610 --> 00:15:49,250 want. And so I I I hope that 469 00:15:49,250 --> 00:15:50,389 we can help empower 470 00:15:51,330 --> 00:15:53,809 payers as well as providers to embrace a 471 00:15:53,809 --> 00:15:55,784 model like ours because I think every health 472 00:15:55,784 --> 00:15:57,144 plan in the future should be similar to 473 00:15:57,144 --> 00:15:58,044 sidecar health. 474 00:15:58,825 --> 00:16:01,644 Fantastic. Lots of exciting stuff on the horizon. 475 00:16:01,705 --> 00:16:03,945 Patrick, thank you so much for taking the 476 00:16:03,945 --> 00:16:05,464 time to sit down with us and for 477 00:16:05,464 --> 00:16:07,625 sharing your insights with our listeners. We really 478 00:16:07,625 --> 00:16:10,160 appreciate it. Jacob, thanks for having me. If 479 00:16:10,160 --> 00:16:11,920 you'd like to listen to more podcasts from 480 00:16:11,920 --> 00:16:13,860 Becker's Healthcare, you can visit beckershospitalreview.com.