1 00:00:00,080 --> 00:00:02,000 Hello, everyone. This is Jacob Emerson with the 2 00:00:02,000 --> 00:00:03,779 Becker's Payer Issues podcast. 3 00:00:04,160 --> 00:00:06,399 Thrilled today to be joined by Jeff Yuan, 4 00:00:06,399 --> 00:00:09,199 who is the cofounder of Mending. Jeff, thanks 5 00:00:09,199 --> 00:00:10,719 so much for taking the time to be 6 00:00:10,719 --> 00:00:12,684 with me on the podcast today. Jacob, great 7 00:00:12,684 --> 00:00:14,044 to be here. Big fan of the podcast. 8 00:00:14,044 --> 00:00:15,884 Thanks for having me. Thanks a lot, Jeff. 9 00:00:15,884 --> 00:00:17,644 Appreciate you taking the time to be here 10 00:00:17,644 --> 00:00:19,804 with me. So, Jeff, before we dive into 11 00:00:19,804 --> 00:00:21,484 everything we wanna talk with you about, can 12 00:00:21,484 --> 00:00:23,324 you tell us a little bit more about 13 00:00:23,324 --> 00:00:26,125 yourself, your background in health care, or career 14 00:00:26,125 --> 00:00:28,210 in general, and then what it is you're 15 00:00:28,210 --> 00:00:29,829 doing today at Mending. 16 00:00:30,609 --> 00:00:31,429 Yeah. Absolutely. 17 00:00:31,890 --> 00:00:33,649 So I've been in health care for the 18 00:00:33,649 --> 00:00:35,590 last twenty years, my career. 19 00:00:36,130 --> 00:00:38,310 Early days, I was actually more in academia. 20 00:00:38,450 --> 00:00:40,130 So I started off my career doing a 21 00:00:40,130 --> 00:00:43,774 lot of laboratory research, translational research, specifically in 22 00:00:43,774 --> 00:00:45,314 the IBD and Crohn's space. 23 00:00:45,934 --> 00:00:47,375 Like a lot of folks just trying to 24 00:00:47,375 --> 00:00:49,054 figure out kind of my career, I think 25 00:00:49,054 --> 00:00:50,814 early days I also made a pretty hard 26 00:00:50,814 --> 00:00:52,195 pivot and left academia, 27 00:00:52,910 --> 00:00:55,230 enjoyed a consulting firm called the Advisory Board 28 00:00:55,230 --> 00:00:55,730 Company, 29 00:00:56,109 --> 00:00:58,130 which I credit to really be 30 00:00:58,670 --> 00:01:01,710 my education introduction to US Healthcare Economics. So 31 00:01:01,710 --> 00:01:03,149 a lot of my clients were large payers 32 00:01:03,149 --> 00:01:05,390 in hospital systems. We worked on the physician 33 00:01:05,390 --> 00:01:08,284 enterprise and really under stood that relationship, 34 00:01:09,465 --> 00:01:11,465 and then really, frankly, fell in love with 35 00:01:11,465 --> 00:01:13,644 startups, specifically health technology startups. 36 00:01:14,105 --> 00:01:15,805 I had a great stint at Zocdoc 37 00:01:16,265 --> 00:01:18,364 helping it run its enterprise business, 38 00:01:18,745 --> 00:01:20,424 doing a lot of patient access work and 39 00:01:20,424 --> 00:01:23,245 with hospital systems and online physician scheduling. 40 00:01:23,840 --> 00:01:26,560 And then, joined another startup called Charles Park 41 00:01:26,560 --> 00:01:28,180 now today called Formation Bio, 42 00:01:28,879 --> 00:01:30,799 who's a full stack pharma company. And that's 43 00:01:30,799 --> 00:01:32,640 actually where I met my cofounder Frank. He 44 00:01:32,640 --> 00:01:34,500 was the first employee, first engineer. 45 00:01:35,200 --> 00:01:35,700 And, 46 00:01:36,635 --> 00:01:39,534 together we ended up leaving and starting Mending, 47 00:01:39,995 --> 00:01:41,614 just a few years ago. So 48 00:01:41,995 --> 00:01:43,034 for those of you, 49 00:01:43,355 --> 00:01:45,515 who don't know, Mending, we were formerly called 50 00:01:45,515 --> 00:01:47,435 Terra Health. We are an AI native health 51 00:01:47,435 --> 00:01:48,334 insurance company. 52 00:01:48,635 --> 00:01:51,090 So today we have three customers. 53 00:01:51,469 --> 00:01:54,030 We sell our health insurance products directly on 54 00:01:54,030 --> 00:01:56,670 the ACA marketplace, so on and off exchange 55 00:01:56,670 --> 00:01:58,290 products on healthcare.gov. 56 00:01:58,590 --> 00:02:00,590 We work with a lot of small groups, 57 00:02:00,829 --> 00:02:03,230 small businesses who can buy fully insured products, 58 00:02:03,230 --> 00:02:05,745 and we also sell in the ICRA space 59 00:02:05,825 --> 00:02:07,365 for those employers who 60 00:02:07,745 --> 00:02:09,425 give money to their employers to buy their 61 00:02:09,425 --> 00:02:11,504 own health insurance. A lot of employees will 62 00:02:11,504 --> 00:02:12,405 pick us directly. 63 00:02:13,025 --> 00:02:15,425 And so one of our core beliefs as 64 00:02:15,425 --> 00:02:17,264 a health insurance company is that payers should 65 00:02:17,264 --> 00:02:20,224 actually build technology to help providers' lives. And 66 00:02:20,224 --> 00:02:20,724 so 67 00:02:21,150 --> 00:02:22,669 a lot of how we got our start 68 00:02:22,669 --> 00:02:25,389 is figuring out how can we make the 69 00:02:25,389 --> 00:02:27,810 piping between payers and providers much more smoothly, 70 00:02:28,030 --> 00:02:30,030 try to get more providers outside of the 71 00:02:30,030 --> 00:02:32,189 business of practicing insurance and more into the 72 00:02:32,189 --> 00:02:33,490 business of practicing medicine. 73 00:02:34,485 --> 00:02:37,605 Fantastic. So really interesting background, and I appreciate 74 00:02:37,605 --> 00:02:40,485 that overview of of the rebrand from Tero 75 00:02:40,485 --> 00:02:41,544 Health to Mending. 76 00:02:42,165 --> 00:02:43,525 I I honestly think we could do an 77 00:02:43,525 --> 00:02:46,405 entire podcast just talking about ICRA alone. But 78 00:02:46,564 --> 00:02:47,064 Yeah. 79 00:02:47,400 --> 00:02:49,879 You know, before before we do dive into, 80 00:02:50,280 --> 00:02:52,460 Mending specifically and and what you all do, 81 00:02:52,520 --> 00:02:54,120 talk to us about the rebrand. You you 82 00:02:54,120 --> 00:02:55,419 announced that very recently. 83 00:02:56,040 --> 00:02:58,520 What is why? What what's behind this? What 84 00:02:58,520 --> 00:03:00,915 does this shift represent in terms of the 85 00:03:00,915 --> 00:03:04,055 company's evolving identity and and and strategy? 86 00:03:04,915 --> 00:03:07,235 Yeah. Absolutely. So we were TerraHealth for four 87 00:03:07,235 --> 00:03:09,555 years. We've recently rebranded to Mending as you 88 00:03:09,555 --> 00:03:10,375 pointed out. 89 00:03:10,754 --> 00:03:11,254 And, 90 00:03:11,555 --> 00:03:12,215 you know, 91 00:03:12,594 --> 00:03:13,094 transparently, 92 00:03:13,635 --> 00:03:15,635 we always felt like a rebrand was something 93 00:03:15,635 --> 00:03:17,469 that would happen later down in the future. 94 00:03:18,090 --> 00:03:18,750 The early, 95 00:03:19,609 --> 00:03:21,129 the early story of how we got to 96 00:03:21,129 --> 00:03:23,370 TeroHealth is not glorious like a lot of 97 00:03:23,370 --> 00:03:25,370 early startups. It it was me and Frank, 98 00:03:25,370 --> 00:03:26,650 just the two of us in a room 99 00:03:26,650 --> 00:03:28,250 sitting on his couch saying, oh, at some 100 00:03:28,250 --> 00:03:29,685 point we need to name this company. 101 00:03:30,084 --> 00:03:32,485 And literally we're finding, you know, cheap domain 102 00:03:32,485 --> 00:03:32,985 names, 103 00:03:33,364 --> 00:03:34,884 things that can just get us started. We 104 00:03:34,884 --> 00:03:37,685 always knew branding as a, you know, mattered 105 00:03:37,685 --> 00:03:39,604 as a company, but it was good enough 106 00:03:39,604 --> 00:03:41,205 to get started. And we really liked the 107 00:03:41,205 --> 00:03:42,805 name. It it kind of spoke to us 108 00:03:42,805 --> 00:03:44,745 in terms of Taro being a root vegetable 109 00:03:45,199 --> 00:03:46,959 and trying to get in fixing kind of 110 00:03:46,959 --> 00:03:48,099 the root of health care. 111 00:03:48,560 --> 00:03:50,000 You know, as we've evolved in the last 112 00:03:50,000 --> 00:03:51,680 couple years now that we're in market, we've 113 00:03:51,680 --> 00:03:54,400 been growing really quickly. We work with lots 114 00:03:54,400 --> 00:03:56,340 of different doctors and patients in the market. 115 00:03:56,799 --> 00:03:57,586 We felt like Mending more uniquely captured our 116 00:03:57,586 --> 00:03:58,080 mission and our momentum. And as I stated 117 00:03:58,080 --> 00:03:58,580 earlier, 118 00:04:00,125 --> 00:04:02,764 mission and our momentum. And as I stated 119 00:04:02,764 --> 00:04:03,264 earlier, 120 00:04:03,644 --> 00:04:05,164 a lot of how we got started is 121 00:04:05,164 --> 00:04:07,164 we feel like there's this health care system 122 00:04:07,164 --> 00:04:09,485 we that, you know, all of us depend 123 00:04:09,485 --> 00:04:12,205 on. We love it. There's ways to improve 124 00:04:12,205 --> 00:04:14,044 it and mend it. Mend the doctor patient 125 00:04:14,044 --> 00:04:15,104 relationship. Mend, 126 00:04:16,149 --> 00:04:17,990 you know, how really US health care works. 127 00:04:17,990 --> 00:04:18,490 And, 128 00:04:19,270 --> 00:04:21,209 we just, again, felt like it was thematically 129 00:04:21,270 --> 00:04:23,589 great. And before we get bigger, it's easier 130 00:04:23,589 --> 00:04:25,189 to rip the Band Aid off earlier. And 131 00:04:25,189 --> 00:04:26,949 so we did the rebrand just a few 132 00:04:26,949 --> 00:04:27,610 weeks ago. 133 00:04:28,305 --> 00:04:29,985 Got it. Got it. Very cool. And and 134 00:04:29,985 --> 00:04:31,264 it sounds like so this is something that 135 00:04:31,264 --> 00:04:32,004 was always, 136 00:04:32,785 --> 00:04:34,944 in your heads. You you you fully expected 137 00:04:34,944 --> 00:04:36,884 to have a rebrand come down the line. 138 00:04:37,185 --> 00:04:38,785 And it makes sense, the the mending word. 139 00:04:38,785 --> 00:04:41,264 That's that's that's a that's a great word 140 00:04:41,264 --> 00:04:43,860 to use, for what you all do. You 141 00:04:43,860 --> 00:04:46,180 know, the company is positioning itself as the 142 00:04:46,180 --> 00:04:49,939 first AI native health insurer, which, you know, 143 00:04:49,939 --> 00:04:51,000 that's a really interesting, 144 00:04:51,459 --> 00:04:53,779 way to phrase things, I think. And especially 145 00:04:53,779 --> 00:04:56,339 because we've heard so much, especially the last 146 00:04:56,339 --> 00:04:57,935 few years, in the headlines, 147 00:04:58,634 --> 00:05:00,095 usually negative, Jeff, 148 00:05:00,794 --> 00:05:03,055 about, you know, insurers' use of AI. 149 00:05:03,435 --> 00:05:03,935 So 150 00:05:04,714 --> 00:05:07,854 what's what's your perspective on on or Mending's 151 00:05:07,995 --> 00:05:09,960 position on this in terms of how you're 152 00:05:09,960 --> 00:05:13,259 using this technology to meaningfully reduce 153 00:05:13,639 --> 00:05:16,360 administrative burdens for the providers that you contract 154 00:05:16,360 --> 00:05:18,600 with, and then ultimately, of course, improve the 155 00:05:18,600 --> 00:05:19,100 outcomes, 156 00:05:19,480 --> 00:05:22,360 for your members in comparison to a more 157 00:05:22,360 --> 00:05:23,339 traditional insurer? 158 00:05:24,154 --> 00:05:26,014 Absolutely. I love this question because 159 00:05:26,314 --> 00:05:28,475 I think, Jacob, to your point, there is, 160 00:05:28,475 --> 00:05:30,714 you know, AI is omnipresent in all of 161 00:05:30,714 --> 00:05:32,794 our lives, and there's a lot of news 162 00:05:32,794 --> 00:05:33,935 happening quickly. 163 00:05:34,474 --> 00:05:35,914 And a lot of what you hear is 164 00:05:35,914 --> 00:05:37,615 provider organizations hiring, 165 00:05:38,500 --> 00:05:40,660 AI agents to go bill better and and 166 00:05:40,660 --> 00:05:42,839 help their rev cycle. And then what happens? 167 00:05:42,980 --> 00:05:45,220 Well, the payer organizations buy their own AI 168 00:05:45,220 --> 00:05:47,300 to potentially put up more walls or deny 169 00:05:47,300 --> 00:05:49,300 claims or make it even higher harder with 170 00:05:49,300 --> 00:05:50,040 prior authorization. 171 00:05:50,500 --> 00:05:52,600 And that's kind of the most more negative 172 00:05:52,660 --> 00:05:54,854 version of things. The way we think about 173 00:05:54,854 --> 00:05:56,454 it, you know, just stepping back for a 174 00:05:56,454 --> 00:05:56,954 second, 175 00:05:57,334 --> 00:05:58,935 we think there's no better time to be 176 00:05:58,935 --> 00:06:01,414 building a health insurance company than in 2025. 177 00:06:01,414 --> 00:06:03,654 Obviously, there's been a long history of Upstart 178 00:06:03,654 --> 00:06:06,074 payers who, to your point, has been largely 179 00:06:06,375 --> 00:06:07,675 a very challenging experience. 180 00:06:08,610 --> 00:06:10,449 But if you look under the hood of 181 00:06:10,449 --> 00:06:13,269 what health insurance truly is, it's 182 00:06:13,649 --> 00:06:14,149 people, 183 00:06:14,610 --> 00:06:17,009 it's processes, it's payments, it's a set of 184 00:06:17,009 --> 00:06:19,490 rules, it's data shifting around, it's a financial 185 00:06:19,490 --> 00:06:20,470 services company, 186 00:06:21,335 --> 00:06:23,814 And all of those things combined, we think, 187 00:06:23,814 --> 00:06:25,194 are uniquely great 188 00:06:25,975 --> 00:06:28,634 for AI today in a first principles way. 189 00:06:28,855 --> 00:06:30,535 And we just know the AI is gonna 190 00:06:30,535 --> 00:06:32,795 be a 100 x better in 2030. So 191 00:06:32,935 --> 00:06:35,415 how can we infuse AI truly from the 192 00:06:35,415 --> 00:06:35,915 start 193 00:06:36,660 --> 00:06:38,420 of everything we think about in terms of 194 00:06:38,420 --> 00:06:40,580 our operational processes and the way we think 195 00:06:40,580 --> 00:06:41,800 about delivering care. 196 00:06:42,180 --> 00:06:45,379 And so, you know, Mending's version, we we 197 00:06:45,460 --> 00:06:47,460 this is how it kind of manifests today 198 00:06:47,460 --> 00:06:49,939 for us. One, like I said earlier, we 199 00:06:49,939 --> 00:06:51,985 got our start and a deep part of 200 00:06:51,985 --> 00:06:53,204 our company DNA 201 00:06:53,745 --> 00:06:56,464 is that the philosophical belief is that preparer 202 00:06:56,464 --> 00:06:58,544 should be building technology to make providers' lives 203 00:06:58,544 --> 00:07:00,544 easier. So for a lot of the doctors 204 00:07:00,544 --> 00:07:02,865 that we work with, primary care doctors, some 205 00:07:02,865 --> 00:07:04,324 direct primary care doctors, 206 00:07:05,029 --> 00:07:07,189 From day one, we have a very unique 207 00:07:07,189 --> 00:07:09,270 relationship with them where we're embedded with them 208 00:07:09,270 --> 00:07:10,569 using AI and technology. 209 00:07:11,029 --> 00:07:12,250 For a lot of the doctors, 210 00:07:12,870 --> 00:07:15,110 they don't have to have staff or RCM 211 00:07:15,110 --> 00:07:18,090 processes to work with us. There's auto benefits 212 00:07:18,230 --> 00:07:18,970 and verification. 213 00:07:19,725 --> 00:07:22,205 We integrate directly their EHR so that we 214 00:07:22,205 --> 00:07:24,925 understand when our members are actually inter getting 215 00:07:24,925 --> 00:07:27,004 care from these doctors. They don't file any 216 00:07:27,004 --> 00:07:28,464 claims with us at all, 217 00:07:29,084 --> 00:07:31,324 and there's no denial of payments as we 218 00:07:31,324 --> 00:07:33,425 look at some of that clinical evidence. So, 219 00:07:33,860 --> 00:07:35,620 you know, again, going back to how AI 220 00:07:35,620 --> 00:07:37,560 is being positioned of two agents 221 00:07:38,259 --> 00:07:40,360 fighting with each other in a very calcified 222 00:07:40,500 --> 00:07:41,000 pipeline, 223 00:07:41,459 --> 00:07:42,919 we think there's ways to 224 00:07:43,220 --> 00:07:45,459 really, really reduce the friction between payers and 225 00:07:45,459 --> 00:07:47,634 providers and how payers like us can be 226 00:07:47,634 --> 00:07:49,495 a very provider friendly organization 227 00:07:49,955 --> 00:07:52,834 that ultimately translates to better patient care and 228 00:07:52,834 --> 00:07:54,055 and better patient experiences. 229 00:07:54,915 --> 00:07:57,714 The other thing, as I mentioned, is we 230 00:07:57,714 --> 00:08:00,509 think insurance companies doesn't need to be an 231 00:08:00,509 --> 00:08:02,449 army of people to run those processes. 232 00:08:02,990 --> 00:08:06,050 A lot of historical and large insurance companies 233 00:08:06,110 --> 00:08:08,509 had to build up decades of processes and 234 00:08:08,509 --> 00:08:10,990 people and admin to run their SG and 235 00:08:10,990 --> 00:08:12,290 A to run their operations. 236 00:08:12,750 --> 00:08:14,189 And I think one of the advantages in 237 00:08:14,189 --> 00:08:14,990 2025 238 00:08:14,990 --> 00:08:16,725 is you you don't have to scale on 239 00:08:16,725 --> 00:08:19,205 people that quickly. You can actually, from day 240 00:08:19,205 --> 00:08:23,845 one, embed automation, customer support, network contracting, even 241 00:08:23,845 --> 00:08:26,165 the broker appointment process. All of these things 242 00:08:26,165 --> 00:08:27,865 don't need a ton of humans, 243 00:08:28,470 --> 00:08:32,149 and we think that savings on operations can 244 00:08:32,149 --> 00:08:34,710 ultimately translate to a lot of value and 245 00:08:34,710 --> 00:08:36,950 savings when we think about premium prices and 246 00:08:36,950 --> 00:08:39,110 the way we, and the the overall cost 247 00:08:39,110 --> 00:08:40,250 of the health care system. 248 00:08:41,384 --> 00:08:44,264 Interesting. And and that's such a fascinating little 249 00:08:44,264 --> 00:08:45,945 tidbit you just ended with there with Jeff 250 00:08:45,945 --> 00:08:48,425 of the some of the more legacy players, 251 00:08:48,425 --> 00:08:50,825 the big ones we see today needing to 252 00:08:50,825 --> 00:08:52,365 really build up their staffs, 253 00:08:53,680 --> 00:08:55,200 because that's what you needed to run an 254 00:08:55,200 --> 00:08:57,519 insurance company, let's say, twenty, thirty, forty years 255 00:08:57,519 --> 00:09:00,639 ago. And that's really not necessarily the case 256 00:09:00,639 --> 00:09:03,440 anymore as technology has evolved. That's that's really 257 00:09:03,440 --> 00:09:05,965 fascinating you said that. And I think what's 258 00:09:05,965 --> 00:09:07,725 also really interesting is hearing you say that 259 00:09:07,725 --> 00:09:10,764 your providers don't don't need an RCM staff 260 00:09:10,764 --> 00:09:12,845 or or staff at all necessarily to work 261 00:09:12,845 --> 00:09:14,865 directly with you. I think any of providers 262 00:09:14,924 --> 00:09:17,105 listening in, that's quite the enticing 263 00:09:17,565 --> 00:09:20,179 message given, some of their relationships, I think, 264 00:09:20,179 --> 00:09:22,179 probably with other insurers and the staff that 265 00:09:22,179 --> 00:09:24,100 they do have to hire to work with 266 00:09:24,100 --> 00:09:24,600 them. 267 00:09:24,980 --> 00:09:26,419 Let let's talk about a little bit, you 268 00:09:26,419 --> 00:09:29,699 know, you're you have exclusive partnerships with direct 269 00:09:29,699 --> 00:09:30,919 primary care practices, 270 00:09:31,725 --> 00:09:33,404 And and that does stand out, or at 271 00:09:33,404 --> 00:09:35,345 least that's that stood out to me because 272 00:09:35,725 --> 00:09:37,264 when we hear about this kind of model, 273 00:09:37,325 --> 00:09:41,164 usually, direct primary care operates outside of of 274 00:09:41,164 --> 00:09:42,384 the insurance plan. 275 00:09:42,764 --> 00:09:43,264 So, 276 00:09:43,750 --> 00:09:45,129 you know, from your experience, 277 00:09:45,750 --> 00:09:48,070 the the least last few years, first with 278 00:09:48,070 --> 00:09:50,149 Taro, now with Mending, how do you think 279 00:09:50,149 --> 00:09:52,870 this model has has impacted cost for your 280 00:09:52,870 --> 00:09:54,490 members? How has it impacted, 281 00:09:55,070 --> 00:09:57,610 the the utilization trends you're seeing internally? 282 00:09:58,144 --> 00:09:59,585 And then what are you hearing on the 283 00:09:59,585 --> 00:10:01,764 ground and from providers in terms of, 284 00:10:02,144 --> 00:10:04,225 is this actually making a dent? Is this 285 00:10:04,225 --> 00:10:05,664 making a difference in how they feel in 286 00:10:05,664 --> 00:10:08,085 terms of interacting with the health plan? 287 00:10:08,705 --> 00:10:11,504 Yeah. Absolutely. So, for those of you who 288 00:10:11,504 --> 00:10:13,809 maybe are less familiar with direct primary care 289 00:10:13,809 --> 00:10:14,389 or DPC, 290 00:10:15,409 --> 00:10:17,329 these are a lot of, you know, typically 291 00:10:17,329 --> 00:10:19,570 independent physicians in the community who have started 292 00:10:19,570 --> 00:10:20,389 their own practices 293 00:10:20,929 --> 00:10:23,329 who effectively their entire revenue model is cash 294 00:10:23,329 --> 00:10:25,970 only outside of insurance to your point. Right? 295 00:10:26,855 --> 00:10:28,934 These are physicians who have kind of walked 296 00:10:28,934 --> 00:10:31,035 the walk in terms of leaving the system 297 00:10:31,495 --> 00:10:33,175 and part of, you know, not this is 298 00:10:33,175 --> 00:10:34,535 not the whole reason, but part of this 299 00:10:34,535 --> 00:10:36,615 is is precisely because they were in the 300 00:10:36,615 --> 00:10:39,175 business of practicing insurance, not medicine. And they 301 00:10:39,175 --> 00:10:41,100 hated the fact that they had to buy 302 00:10:41,100 --> 00:10:42,860 all these systems and hire all these people 303 00:10:42,860 --> 00:10:44,220 just to deal with how do we get 304 00:10:44,220 --> 00:10:45,519 paid by insurance companies. 305 00:10:46,299 --> 00:10:48,620 The irony is that to your point direct 306 00:10:48,620 --> 00:10:50,620 primary care is a really unique feature for 307 00:10:50,620 --> 00:10:51,120 us. 308 00:10:51,740 --> 00:10:53,899 As you can imagine if you approach these 309 00:10:53,899 --> 00:10:54,399 DPCs 310 00:10:54,700 --> 00:10:56,834 as an insurance company and say hey let's 311 00:10:56,834 --> 00:10:58,914 partner to a bunch of doctors who have 312 00:10:58,914 --> 00:11:02,695 literally left that system it's an awkward conversation. 313 00:11:03,394 --> 00:11:05,875 But from a mission perspective you know they're 314 00:11:05,875 --> 00:11:08,195 really aligned on figuring out how can we 315 00:11:08,195 --> 00:11:10,054 mend this healthcare system and 316 00:11:10,470 --> 00:11:12,629 the technology and AI product for them has 317 00:11:12,629 --> 00:11:14,070 to be a really high bar for them 318 00:11:14,070 --> 00:11:16,070 to say yes I'm actually going to become 319 00:11:16,070 --> 00:11:17,289 in network with Mending, 320 00:11:17,990 --> 00:11:20,809 I'm gonna accept these insurance insured members 321 00:11:21,350 --> 00:11:22,409 and my 322 00:11:23,075 --> 00:11:24,674 kind of my my day to day, the 323 00:11:24,674 --> 00:11:26,514 way I practice clinically is not going to 324 00:11:26,514 --> 00:11:27,254 change drastically 325 00:11:28,115 --> 00:11:29,575 and this has impacted 326 00:11:29,955 --> 00:11:33,475 cost utilization, member satisfaction in a huge way. 327 00:11:33,475 --> 00:11:35,394 One, for most of these direct primary care 328 00:11:35,394 --> 00:11:37,409 doctors, they're only in network with us 329 00:11:37,970 --> 00:11:41,649 and so they have way more time to 330 00:11:41,649 --> 00:11:43,409 be spending with their patients. A lot of 331 00:11:43,409 --> 00:11:45,409 the annual physicals are forty five minutes to 332 00:11:45,409 --> 00:11:46,389 an hour long. 333 00:11:47,009 --> 00:11:49,429 You know, patients can go on telemedicine, 334 00:11:50,209 --> 00:11:52,983 they can emails. A lot of doctor a 335 00:11:52,983 --> 00:11:55,287 lot of patients, excuse me, will actually text 336 00:11:55,287 --> 00:11:57,592 their doctors directly and so there's constant interaction 337 00:11:57,592 --> 00:11:59,896 between the two. The insurance company, us, we're 338 00:11:59,896 --> 00:12:02,201 not the middleman between the doctor and the 339 00:12:02,201 --> 00:12:04,505 patient and that's what they love about the 340 00:12:04,505 --> 00:12:06,029 model as well. We have 341 00:12:06,570 --> 00:12:09,210 seen early days in our markets of Maine 342 00:12:09,210 --> 00:12:09,789 and Oklahoma 343 00:12:10,330 --> 00:12:13,450 on a normalized basis per 1,000 members specific 344 00:12:13,450 --> 00:12:16,490 to the demographics and market, a 70% decrease 345 00:12:16,490 --> 00:12:17,629 in specialist utilization, 346 00:12:18,009 --> 00:12:20,350 a 50% decrease in urgent care, 347 00:12:20,884 --> 00:12:22,585 35% decrease in ER. 348 00:12:23,284 --> 00:12:25,524 And we think it's because these doctors are 349 00:12:25,524 --> 00:12:27,845 actually making themselves way more accessible to our 350 00:12:27,845 --> 00:12:29,625 members, managing that care effectively. 351 00:12:30,565 --> 00:12:32,664 And because of all these interactions, 352 00:12:33,125 --> 00:12:34,985 the doc the patients feel 353 00:12:35,549 --> 00:12:38,210 really satisfied. We have a ninety seven percent 354 00:12:38,669 --> 00:12:41,409 renewal rate for our members year over year, 355 00:12:42,029 --> 00:12:43,629 for for those who are attributed to one 356 00:12:43,629 --> 00:12:46,429 of these direct primary care practices. So again, 357 00:12:46,429 --> 00:12:48,610 we're looking for those win win win scenarios 358 00:12:48,669 --> 00:12:51,024 and going back to that core belief, if 359 00:12:51,024 --> 00:12:53,684 we can free the doctors from this administrative 360 00:12:53,745 --> 00:12:56,144 burden and focus on the doctor patient relationship, 361 00:12:56,144 --> 00:12:57,825 we think it's gonna be better for us 362 00:12:57,825 --> 00:13:00,625 in the overall system. Sure. Absolutely. No. It's 363 00:13:00,625 --> 00:13:02,465 an amazing renewal rate you just you just 364 00:13:02,465 --> 00:13:04,304 mentioned. But I also imagine, you know, from 365 00:13:04,304 --> 00:13:04,965 the physician's 366 00:13:05,490 --> 00:13:08,289 perspective, this is an amazing model because, you 367 00:13:08,289 --> 00:13:10,289 know, it's obviously not a very easy time 368 00:13:10,289 --> 00:13:12,610 to be an independent physician right now. And 369 00:13:12,610 --> 00:13:14,370 this just gives you it sounds like a 370 00:13:14,370 --> 00:13:14,870 broader, 371 00:13:15,490 --> 00:13:15,990 patient's 372 00:13:16,370 --> 00:13:18,529 base to access even from from their side 373 00:13:18,529 --> 00:13:20,315 of things. So it's really interesting. 374 00:13:21,735 --> 00:13:24,215 And you mentioned Maine and Oklahoma. I know 375 00:13:24,215 --> 00:13:26,634 that's the states you first got started in. 376 00:13:27,335 --> 00:13:29,595 Can you educate me, our audience, 377 00:13:30,535 --> 00:13:33,274 where do things stand today? Where are you 378 00:13:33,415 --> 00:13:34,955 looking for the future? 379 00:13:35,769 --> 00:13:37,610 Are you are you looking to expand into 380 00:13:37,610 --> 00:13:39,789 new markets? And, you know, 381 00:13:40,250 --> 00:13:42,009 what what have you learned from your initial 382 00:13:42,009 --> 00:13:43,789 growth in those two states? 383 00:13:44,330 --> 00:13:47,289 Yeah. Absolutely. So we started in Maine and 384 00:13:47,289 --> 00:13:50,165 Oklahoma really as a testing bed and to 385 00:13:50,165 --> 00:13:53,285 understand different populations within The US. Between those 386 00:13:53,285 --> 00:13:55,925 two states, you have urban settings, suburban settings, 387 00:13:55,925 --> 00:13:57,065 certainly rural settings 388 00:13:57,684 --> 00:13:59,785 where patient access is really challenging, 389 00:14:00,165 --> 00:14:02,085 access to primary care is really challenging. So 390 00:14:02,085 --> 00:14:04,024 we we felt like they were great environments 391 00:14:04,200 --> 00:14:06,200 for us to learn in. We will be 392 00:14:06,200 --> 00:14:08,360 expanding into Georgia this fall, which we're really 393 00:14:08,360 --> 00:14:09,259 excited about. 394 00:14:09,720 --> 00:14:11,179 And I think for us, 395 00:14:11,639 --> 00:14:14,120 you know, working in the fully insured commercial 396 00:14:14,120 --> 00:14:16,379 space on the exchange, it's a 397 00:14:16,794 --> 00:14:17,615 dynamic environment. 398 00:14:18,554 --> 00:14:19,674 You know, you have to look at the 399 00:14:19,674 --> 00:14:21,355 hospital landscape, you have to look at the 400 00:14:21,355 --> 00:14:24,254 other competitor payer landscape, the regulatory landscape, 401 00:14:24,634 --> 00:14:27,035 how many hospitals and direct primary care doctors 402 00:14:27,035 --> 00:14:28,815 are there available. And so, 403 00:14:29,355 --> 00:14:31,355 we've learned a lot over the last couple 404 00:14:31,355 --> 00:14:32,940 years of scaling 405 00:14:33,480 --> 00:14:35,320 but I think the common theme for us 406 00:14:35,320 --> 00:14:35,820 is 407 00:14:36,440 --> 00:14:37,740 as an upstart insurer, 408 00:14:38,360 --> 00:14:41,240 understanding the history of other insurers who've tried 409 00:14:41,240 --> 00:14:43,660 to compete against the large legacy players 410 00:14:44,120 --> 00:14:45,560 you know when they zig you have to 411 00:14:45,560 --> 00:14:47,054 zag a little bit and you have to 412 00:14:47,134 --> 00:14:49,554 truly truly find ways to differentiate. 413 00:14:50,575 --> 00:14:53,054 The network size is one, premium price is 414 00:14:53,054 --> 00:14:55,075 another, but you you have to really 415 00:14:55,534 --> 00:14:58,495 you can't use those old playbooks of let's 416 00:14:58,495 --> 00:15:00,975 just cut premium prices, grow really fast and 417 00:15:00,975 --> 00:15:02,470 big, lose a lot of money, and try 418 00:15:02,470 --> 00:15:03,930 to come back and fix our economics. 419 00:15:04,470 --> 00:15:06,870 And so for us, learnings is, you know, 420 00:15:06,870 --> 00:15:08,649 making sure that we scale responsibly, 421 00:15:09,269 --> 00:15:11,350 do it in a way that's sound unit 422 00:15:11,350 --> 00:15:11,850 economically, 423 00:15:12,550 --> 00:15:13,210 and then, 424 00:15:13,910 --> 00:15:15,450 you know, kinda go from there. 425 00:15:16,235 --> 00:15:18,475 Got it. Cool. So so you're expanding into 426 00:15:18,475 --> 00:15:19,615 Georgia this fall. 427 00:15:21,514 --> 00:15:23,034 How do you how do you think that 428 00:15:23,034 --> 00:15:24,634 could influence or how do you think other 429 00:15:24,634 --> 00:15:25,134 insurers, 430 00:15:25,514 --> 00:15:27,274 what do you think they could learn from 431 00:15:27,274 --> 00:15:28,894 from your scaling? 432 00:15:29,195 --> 00:15:31,019 And is there any advice that you would 433 00:15:31,019 --> 00:15:31,519 offer, 434 00:15:32,220 --> 00:15:34,620 those individuals listening in right now in terms 435 00:15:34,620 --> 00:15:36,379 of what you've learned up up till this 436 00:15:36,379 --> 00:15:36,879 point? 437 00:15:37,899 --> 00:15:38,959 Yeah. I guess, 438 00:15:39,659 --> 00:15:41,500 guess it depends on who's listening and if 439 00:15:41,500 --> 00:15:44,079 you're certain that sit sitting on the 440 00:15:44,384 --> 00:15:47,425 legacy insurer side versus the kind of you're 441 00:15:47,425 --> 00:15:49,184 with us in terms of being a a 442 00:15:49,184 --> 00:15:51,125 startup player here. Yeah. Yeah. 443 00:15:51,904 --> 00:15:53,665 But I I I I go back to 444 00:15:53,665 --> 00:15:54,165 that 445 00:15:54,785 --> 00:15:55,285 differentiation, 446 00:15:56,304 --> 00:15:58,625 where I would also encourage even the legacy 447 00:15:58,625 --> 00:15:59,764 players to rethink 448 00:16:00,279 --> 00:16:02,839 how they think about their provider network. And 449 00:16:02,839 --> 00:16:05,240 it's not just direct primary care, it's finding 450 00:16:05,240 --> 00:16:08,220 different ways to truly create personalized and differentiated 451 00:16:08,360 --> 00:16:09,899 products that the market demands. 452 00:16:11,080 --> 00:16:13,879 You know, even with ICRA now, you're seeing 453 00:16:13,879 --> 00:16:15,019 more and more employers, 454 00:16:16,014 --> 00:16:17,855 give that money to their employees and those 455 00:16:17,855 --> 00:16:19,394 employees are looking for 456 00:16:19,774 --> 00:16:22,495 very personalized plans that speak to them. But 457 00:16:22,495 --> 00:16:24,894 the, you know, the the the way provider 458 00:16:24,894 --> 00:16:26,815 networks have been built over the last couple 459 00:16:26,815 --> 00:16:29,214 of decades of fee for service contracting and 460 00:16:29,214 --> 00:16:31,450 just continuing to kind of build those reimbursement 461 00:16:31,450 --> 00:16:31,950 rates, 462 00:16:32,730 --> 00:16:33,709 we feel like 463 00:16:34,009 --> 00:16:36,909 there's gonna be room prop there's opportunity set, 464 00:16:37,370 --> 00:16:39,389 to really figure out how do you differentiate 465 00:16:39,690 --> 00:16:42,169 truly on network? How do you use AI 466 00:16:42,169 --> 00:16:43,950 to be able to augment your, 467 00:16:44,634 --> 00:16:45,694 your care navigation? 468 00:16:46,794 --> 00:16:48,235 What are some of these tools that are 469 00:16:48,235 --> 00:16:50,794 now available that weren't available even five years 470 00:16:50,794 --> 00:16:52,875 ago and and to kinda double down, triple 471 00:16:52,875 --> 00:16:53,934 down in those areas? 472 00:16:55,034 --> 00:16:57,534 Yeah. No. It's good advice. And I wonder 473 00:16:57,595 --> 00:16:59,660 anything else you wanna mention today? 474 00:17:00,120 --> 00:17:02,279 You obviously we've got a lot of health 475 00:17:02,279 --> 00:17:04,680 plan leaders listening in, I think, from both 476 00:17:04,680 --> 00:17:06,460 sides of the aisle in terms of nonconventional 477 00:17:06,680 --> 00:17:08,140 and some of the legacy players. 478 00:17:08,680 --> 00:17:10,859 Any final thoughts you wanna share? 479 00:17:11,305 --> 00:17:13,305 Yeah. I think, you know, especially at the 480 00:17:13,305 --> 00:17:14,365 time of this recording, 481 00:17:14,984 --> 00:17:17,144 there's a lot happening in health care and 482 00:17:17,224 --> 00:17:18,744 Yeah. You had mentioned too a lot of 483 00:17:18,744 --> 00:17:20,525 negativity and understandably 484 00:17:20,825 --> 00:17:21,305 so. 485 00:17:21,705 --> 00:17:24,205 I think no one can truly truly predict 486 00:17:24,580 --> 00:17:27,160 the outcome of the one big beautiful bill. 487 00:17:27,619 --> 00:17:29,559 Everyone is navigating the landscape. 488 00:17:30,180 --> 00:17:32,980 My overall advice to folks and we say 489 00:17:32,980 --> 00:17:35,539 this constantly to the internal team is amidst 490 00:17:35,539 --> 00:17:36,519 all this uncertainty, 491 00:17:36,820 --> 00:17:37,480 the challenges, 492 00:17:38,434 --> 00:17:39,335 even the chaos, 493 00:17:39,634 --> 00:17:41,335 like find the opportunities. 494 00:17:42,355 --> 00:17:44,595 There actually is a a a set of 495 00:17:44,595 --> 00:17:45,654 positive opportunities. 496 00:17:46,115 --> 00:17:47,714 It's gonna be tough. I'm not saying it 497 00:17:47,714 --> 00:17:48,214 won't. 498 00:17:49,154 --> 00:17:52,330 But, you know, in in uncertain times, there's 499 00:17:52,330 --> 00:17:54,090 also at the same time a way to 500 00:17:54,090 --> 00:17:56,090 radically change how we think about delivering health 501 00:17:56,090 --> 00:17:57,529 care, how we think about building some of 502 00:17:57,529 --> 00:17:58,190 these systems. 503 00:17:58,809 --> 00:18:02,090 And I'm personally very excited and optimistic even 504 00:18:02,090 --> 00:18:04,410 amidst everything. I think it's time to get 505 00:18:04,410 --> 00:18:05,630 creative and 506 00:18:06,545 --> 00:18:08,085 these these times of uncertainty, 507 00:18:08,464 --> 00:18:09,924 create these windows where, 508 00:18:10,464 --> 00:18:12,704 we we feel like we can offer truly 509 00:18:12,704 --> 00:18:14,305 novel products and see if we can break 510 00:18:14,305 --> 00:18:17,025 the paradigm of how an upstart insurer could 511 00:18:17,025 --> 00:18:18,644 succeed, in this space. 512 00:18:19,420 --> 00:18:20,940 Awesome. Well, I feel it's a great place 513 00:18:20,940 --> 00:18:23,019 to leave things, Jeff. So I wanna thank 514 00:18:23,019 --> 00:18:24,700 you for taking the time to sit down 515 00:18:24,700 --> 00:18:26,940 with us and for sharing your insights and 516 00:18:26,940 --> 00:18:29,740 and future growth plans at Mending with our 517 00:18:29,740 --> 00:18:31,971 audience. We really appreciate it. Thanks so much 518 00:18:31,971 --> 00:18:33,971 for having me. And to our audience, if 519 00:18:33,971 --> 00:18:35,571 you'd like to listen to more podcasts from 520 00:18:35,571 --> 00:18:39,351 Becker's Healthcare, you can visit beckershospitalreview.com.