Hello, everyone. This is Jacob Emerson with the
Becker's payer issues podcast. Thrilled today to be
joined by a special guest. Patrick Quigley is
the CEO of Sidecar Health. Patrick, thanks so
much for taking the time to join me
on the podcast today. Well, thanks so much
for having me.
So, Patrick, before we dive into everything we
wanna talk with you about and about your
company, can you tell us a little bit
more about yourself
and your background in healthcare?
Yeah. Absolutely. Well, I don't have a traditional
healthcare background
as you, as you may know. So I'm
an engineer, a mechanical engineer,
and I'm a consumer guy. All my previous
companies that I've led have all been focused
on empowering consumers.
But more important than any of that for
for health care purposes is I'm also a
dad. And I think a lot of what
we built at Sidecar Health has to come
from my own experiences,
navigating the health care system for my family.
Fantastic. So what is sidecar health then, Patrick?
When did you all launch and what do
you offer today? Yeah. So sidecar health is
a major medical health insurance carrier that is
focused on large employers. We've been around,
I guess now we're in our 8th year.
Everything that we do is is unique. So
we've had to build everything from the ground
up all around this concept of empowering consumers
to take control of their health care and
being in control of their health care journey
to get to get access.
I think the biggest thing and we can
talk about it, as much as we've got
time. I think the biggest thing for us
is that we think the the root cause
to the troubles in the US health care
system is the lack of transparency and the
costs and then the lack of motivation to
make good decisions. And if you can solve
those two problems, you can provide better coverage,
better access, and better affordability in a sustainable
way, which is something we all want.
Absolutely. And and just to clarify with you,
Patrick,
how many states is Sidecar now operating in
and how many members do you have? Yeah.
As a large employer, like, for our self
funded options serving jumbos and other folks that
are self funded, we are no borders to,
to where we operate. Right? So we cover
people in 44 states today. In terms of
the the large clients that want to be
fully insured, we sell in 3 primary states
today.
Companies that are domiciled in Ohio with, again,
employees anywhere,
Georgia
and in Florida.
Fantastic.
Appreciate you giving us all those details.
So sidecar, you mentioned your consumer driven. That's
your background, Patrick. You're you're aiming to disrupt
the traditional insurance market with that model.
So what do you see as some of
the biggest challenges in or what have you
experienced as being some of the biggest challenges
in terms of convincing
both health care providers
and consumers to embrace
more transparent
pricing models?
Yeah. I mean, I think the biggest challenge
is in more facing on the US health
care system, right, is how do you go
ahead and provide
better coverage and better access in a world
where cost continues to go up? And I
think the real trouble is that, you know,
the traditional legacy providers, the BUKAs,
they control costs by controlling access. Right? How
do you introduce prior authorization to limit? Would
someone really need that care? And I think
that creates
a lot of friction and lack of incentives,
and no one really knows what their costs
are. And so it's it creates a version
to engage engaging the health care system. So
for us,
our view of the world is let's empower
consumers. Let's give them full control, full transparency,
and let's create motivations for them to be
engaged in the decision making. And that actually
opens up better coverage and better access. So
it's a different way of thinking about health
care, and it really matches everything
people do in their entire lives. So our
biggest challenge
is the entire
US healthcare system has been cobbled together over
decades
and it's hard. And it's it's complicated.
It's sometimes it feels like it's there's there's
too many obstacles to getting care for your
family.
So our challenge is by we remove all
those obstacles and we suddenly put our members
in,
in control of their entire healthcare journey with
complete transparency.
And so our challenge is actually getting people
to go, it's okay
to do things differently.
And I think that the the best kind
of analogy for us is if you think
back to the first time you took an
Uber ride. I remember when I when I
first took mine, you know, I some random
person came to my house, picked me up
and took me to the airport. I got
to the airport and I'm looking at my
app and I have my credit card in
my hand. I'm trying to figure out what
to do. And I asked the guy, how
do I pay you? He's like, you just
get out of my car.
And so that experience was very different than
a taxi ride.
And I think the challenge for us is
we're asking people
to
do something they've not done ever.
And so at the end of the day,
our biggest challenge is getting people to feel
comfortable and empowered so that they can actually
start start like they did today. People don't
take taxis as much. They call an Uber
if they need occasional transportation. And so that's
that's the challenge that we work with our
HR departments and and leadership teams at the
companies we work with, to manage through. Sure.
Sure. Absolutely. And you said, you know, it's
a hard it's a complicated
health care system. It's been cobbled together
over the decades.
And, you you know, obviously, at the end
of the of last year, of 2024, we
we saw,
that almost come to a head. We've seen
the public frustration,
online about this. We're we're seeing lawmakers talk
a lot more about this spurred,
of course, by the by the tragic murder
of of UnitedHealthcare
CEO Brian Thompson.
So so what's your what's your take on
this,
Patrick? We we we know the public is
frustrated with the health care system, with the
health insurance system, with denial rates, with claims
issues,
with accessing health care. So with everything that
your company does in terms of trying to
drive more transparent models, more consumer driven models,
can you give us your take on on
everything we're we're and how we're seeing the
country
respond to an event like this?
You know, first of all, it's a terrible
event, and we it's great that we're having
a conversation about how to improve the system,
but this is not how we should have
ended up here.
But you're right. There is a tremendous amount
of frustration that seems to be, bringing things
to light to have the right conversations right
now. And I think for me,
just like you called out the denial rates,
I think that's kind of a flashpoint.
There is more public discussion right now about
denial rates, I think, than there has really
ever been at a public level.
And I think that, again,
some of the data that you see published
I know I saw an interview with Oscar
CEO
on CNBC, where they were talking about 20
30% denial rates for,
you know, some of some of the blues.
And and United was specifically called out given
the context.
And, you know, Oscar CEO was was sharing
that, you know, they've got industry leading,
denial rates that I think he called out
12%.
And I sit back and I look at
that. My reaction is, why is this okay?
Like, if I think about my family,
I would not I would not be okay
with the health insurance
solution to support my kids and my wife,
where
industry leading view is 12%,
and the largest in, you know, insurance companies
are are talking about denial rates north of
20.
So for me, I I think that
the public is ready for a change.
And, you know, part of the motivation and
starting sidecar health is this problem is how
could I get my family access to care?
And so when we think about denial rates,
we think about our kind of view of
the world in our North Star. And our
view is that doctors should be making care
decisions and insurance companies should be paying for
it. And that is why, like, our denial
rates are less than 1%.
Right? And frankly, closer to 0 than they
are to 1. And that is based on
this this value proposition of creating
access, making sure that doctors are driving care
decisions. And so as I look at I
look at the the dialogue that are happening
now,
I I think it's about time that we're
having real dialogue around real numbers.
And we start figuring out how do we
facilitate a world
where we have more transparency, more control, more
access and better decision making, and frankly, better
accountability.
I I think the last thing I would
say here is that,
I think it was, the United CEO put
out,
an op ed
that kinda called this out and and and
expressly said
that that the health system we all agree
that the health system doesn't work as it
should. And it it was designed
and cobbled together over a long period of
time.
And no one I think it says something
to the effect of no one would design
a system like this if they were to
design it from the beginning. And and I
just think that that statement alone,
along with the frustration is like, why why
are we okay with this? Let's do something
different. And we believe
that what's different are health plans that are
modeled on what we're doing, on what side
for health can do. Yeah. Absolutely. And it's
a great last point that you brought up
to there, Patrick, that that UnitedHealth CEO has
addressed the the public frustrations in that op
ed.
And just, for our listeners, u UnitedHealth also
did put out a statement in December saying
that the company approves and pays about 90%
of medical claims upon submission. So just wanna
put that out there. Yeah. But but one
last thing I wanna ask you about on
on this specific event, Patrick, is we've seen
other insurance CEOs like doctor Sachin Jain, who
leads SCAM Group, a Medicare Advantage company Mhmm.
Say that the industry at large needs to
have some more,
inflection about this event and and even say
we're sorry,
to to Americans about how insurers have,
you know, allegedly active or or not over
the last few decades.
As as the CEO of of an insurance
company, what what do you what do you
make of a statement like that? Well, I
mean, I think it's great that they're being
accountable and that they're coming forward saying we
want to do better. I I personally believe
that anybody that's in healthcare, whether you're on
the payer side, provider side, you're in here
because you're mission driven. You're trying to make
a difference and that's awesome. Right? So if
we all acknowledge that there's problems, we just
need to solve it. Right? We need to
the world is clamoring for more transparency, more
control, better access. I mean, mental health parity
is a great policy statement. But if you
look at the actual
access people have to mental health, for example,
like it's not enough.
Right? And the fact that,
we have core parts of our system, like
prior authorization,
step therapy for drugs.
You know, I I think there was, you
know, a large employer at one point last
year, excuse me, a large health insurance company
at one point last year, introduced prior authorization
for colonoscopies.
That's very extreme in my mind. Right? In
my view of,
you know, I don't know how many recreational,
colonoscopies,
Jacob, you signed up for. But, like, people
aren't right there. People aren't going and doing
that unless there's a reason. And so I
guess it's great that there's some accountability.
It's great that that United has come out
and said, hey. Our denial rate is 10%.
I would just say that, like, that's not
good enough for my family. And we would
that it needs to be bad. Yeah. Absolutely.
And it certainly does not help when we
see other insurers,
doing things like anesthesia
policies with with Right. But we won't get
into all that in the details, but it
yeah. Sure. It's so much more we can
talk about. But in terms of where we
have seen more transparency,
injected into the system, Patrick, at the end
of 2024,
Sidecar announced an agreement with the Ohio State
University's Wexner Medical Center,
for a fixed price model with upfront pricing
and no prior authorization.
Can you walk us through how this model
is is gonna be working for patients and
providers on the ground
and why you believe this this this is
different? This is a different model.
Yeah. Absolutely. And thanks for bringing it up.
I we're really excited about this partnership,
with the Ohio State University. It's a fantastic
model of of what we do and how
we want to continue to provide to partner
with, the leading medical institutions in the United
States.
And it's what's really interesting is that it
matches what how to work with all providers,
even those that don't come to us proactively
and say, how do we how do we
integrate more into your model to get access
to more to your commercial members? And so
with with this, relationship is all about, just
like you called out for Ohio State, this
eliminates all prior authorization. There's no,
there's no paperwork that,
to to get, you know, psych our health
members in for whatever procedures,
or treatments that Ohio State doctors want. Right?
So this that's key. So doctors can focus
on care.
We also, eliminate revenue cycle, limits. Right? Like,
so our members will pay, you know, Ohio
State in the way they wanna be paid.
There's there's no collections
issues. A lot of times, you know, hospital
systems are chasing folks around for,
for payment,
with a traditional model with us. Like and
what's special about this OSU,
partnership is you you talked about a transparent
pricing. Right? So
OSU basically has chosen the prices they wanna
charge sidecar health members.
We make those prices available
completely transparently
to our members, and then our members choose
to go to OSU knowing those prices.
And so it's it's exactly how health insurance
or health care should work. Right? We should
be consumers of health care engaging with providers.
So in that way and so, like, providers
shouldn't worry about getting paid. Providers shouldn't be
asking some third party that doesn't know what's
going on with the care of an individual
for permission. And so this is a codification
of our overall model.
And what it gives to our members is
it gives a, you know, a a
a simple access to one of the the
the greatest
hospital systems in the US,
right through our app or knowing knowing what
pricing are, and it can go and kinda
engage directly with OSU. So we're thrilled about
that. There's been several of these, type of
hospital arrangements
we have announced where the hospitals are coming
to us
and and asking to effectively make their pricing
and make their availability available to our commercial
members so that our members select them.
And I think the last kind of note
here is is specifically with regards to OSU.
What's exciting here is you can kind of
juxtapose this announcement
with some of the very public kind of
back and forth that OSU had been going
through with Anthem, where those relationships seem like
at least in the what what you can
read about. Like, they seem a little bit
more,
kinda adversarial,
like a game of chicken. Whereas what ours
are is like we go and we say,
hey, what what do you wanna charge our
members? Let's just tell them, and then our
members will come to you knowing what the
prices are.
Wow. That's really cool stuff. And it's fascinating
to hear how the how the hospitals are
coming to you versus what, at least from
our perspective, what we're seeing constantly is what
what you said, Patrick. He's a very adversarial
relationships that the patients always end up getting
caught in the middle of. But before we
go, Patrick, what else are we missing? You
you've got the ears of a lot of
health plan leaders from all over the country,
including Buka leaders.
What do you wanna say? Well, what I
would say is that, like, I think there's
a lot of conversation about driving consumer driven
health care. There's a lot of conversations about
transparency,
and there's there's a lot of kind of
undercurrents about are we ready as a country
for this? And what I would encourage everyone
to think about is that consumers
are the most efficient
way to get to the best quality, best
price in any market. And it can work
the same in health care. And I think
that if you're if you're a hospital system
that is is nervous about transparency,
I think it creates an opportunity
for you to demonstrate your value that you're
delivering to your patients. And patients, I can
tell you from our data, will run to
you when you're transparent. And you're you can
you can go ahead and create a better
experience for
transparent, and you're you can you can go
ahead and create a better experience for your
doctors and better, results from your for from
your patients. At the same time, payers
payers actually if we could all embrace this
model of letting,
consumers know
what things cost, what their individual responsibilities are
and let them make choices, you can actually
remove
the restrictions to care that that are the
traditional model, the prior authorization, step therapies, formularies.
Economically, those do not deliver as much value
as just telling someone here is a budget
you have for care, spend it where you
want. And so I I I hope that
we can help empower
payers as well as providers to embrace a
model like ours because I think every health
plan in the future should be similar to
sidecar health.
Fantastic. Lots of exciting stuff on the horizon.
Patrick, thank you so much for taking the
time to sit down with us and for
sharing your insights with our listeners. We really
appreciate it. Jacob, thanks for having me. If
you'd like to listen to more podcasts from
Becker's Healthcare, you can visit beckershospitalreview.com.