[S2E4] Nathan Baar: From Emergency Room to Healthcare Revolution

From ER Nurse to Healthcare Entrepreneur: Transforming Primary Care

What happens when a bedside ER nurse discovers the healthcare system is designed to keep people sick rather than make them well?

In this revealing episode of The CLEARly Beneficial Podcast, host Vincent Catalano sits down with Nathan Baar, RN, Founder and CEO of HealthBar, to unpack one of healthcare’s most troubling contradictions. Nathan shares his eye-opening journey from emergency room nursing to hospital administration, where he witnessed firsthand how health systems talk about population health and preventative care while actually planning for higher patient volumes and increased revenue from sickness.

This disconnect became the catalyst for HealthBar, Nathan’s revolutionary approach to primary care that brings relationship-based healthcare directly to employers through on-site and virtual services. By focusing on nurse practitioners, combining traditional and functional medicine, and operating as a true fiduciary for patients’ health, HealthBar is proving that better care at lower costs isn’t just possible—it’s already happening.

In This Episode You’ll Discover:

• Why healthcare education teaches population health while hospitals plan for more sick patients
• How HealthBar delivers primary care to employers with 200+ employees through a hybrid on-site/virtual model
• Why nurse practitioners are ideally suited for relationship-based primary care
• What fiduciary responsibility means in clinical decision-making and why it matters
• How capitated payment models align incentives with better patient outcomes
• The importance of care navigation in reducing waste and preventing readmissions
• Nathan's vision for separating catastrophic care from routine primary care through payer model reform

Whether you’re an insurance broker seeking better solutions for clients, an HR professional managing employee benefits, or simply someone who cares about fixing our broken healthcare system, this conversation offers both inspiration and practical insights into what’s possible when we put patients first.

ABOUT THE GUEST:

Nathan Baar is a registered nurse and the Founder and CEO of HealthBar, a business developing care delivery innovation and healthcare payment model disruption. He started his career as a bedside ER nurse, eventually becoming Director of Emergency Services for University of Michigan Health-West. During his 13 years in the health system, he gained valuable insights as a clinical provider and significant expertise in the corporate functions of the healthcare system. These formative experiences were the catalyst for HealthBar and his desire to fundamentally change how primary and preventative care are viewed in the US.

ABOUT THE HOST:

Vincent Catalano is the CEO of CLEAR Healthcare Solutions and host of The CLEARly Beneficial Podcast. With decades of experience in the insurance brokerage industry, Vinny brings straight talk and actionable insights to healthcare benefits, helping brokers, employers, and HR professionals navigate the complex world of employee health benefits.

Disclaimer: This content is for educational purposes only and should not be considered medical or financial advice. Please consult with your healthcare provider or benefits administrator for personalized guidance regarding your specific situation.

Transcript

(00:00:03):
Welcome to the Clearly Beneficial podcast,

(00:00:06):
the show where we rip off the Band-Aid and explore the future of healthcare,

(00:00:10):
benefits,

(00:00:10):
and the people driving innovation in the industry.

(00:00:16):
This episode is brought to you by Health Next,

(00:00:19):
the company leading the way in helping employers build enduring cultures of health

(00:00:22):
and wellbeing,

(00:00:23):
reducing medical cost trends,

(00:00:25):
and increasing organizational performance.

(00:00:28):
To learn more how they can help you, visit healthnext.com.

(00:00:33):
Nate, thanks so much for joining me today.

(00:00:35):
I'm so excited to have you on the Clearly Beneficial podcast.

(00:00:41):
Yeah, thank you, Vinny.

(00:00:42):
No, I'm super excited to be here.

(00:00:43):
I've appreciated our LinkedIn conversations, and it's great to have one over your podcast.

(00:00:49):
Well, no, that's excellent, Nate.

(00:00:51):
I feel like, you know, you're one of those standouts to me on LinkedIn.

(00:00:57):
Someone who brings to the fore, you know, interesting conversation, challenging posts.

(00:01:05):
I mean,

(00:01:05):
definitely you like to be a little bit provocative the way I like to be a little

(00:01:09):
bit provocative.

(00:01:10):
So I like that.

(00:01:12):
And I think it's super important to open up the forum of my audience,

(00:01:18):
whom I believe are health care people,

(00:01:21):
insurance people,

(00:01:23):
professionals,

(00:01:24):
anybody interested in health care.

(00:01:26):
Those are the people I'm reaching with this podcast.

(00:01:29):
And I think they're going to be interested in what you have to say about Health Bar

(00:01:35):
and you and your background.

(00:01:36):
So let's start there.

(00:01:38):
um you know your your background you started as a nurse or trained as a nurse was

(00:01:42):
it was it was a practicing nurse and and a nurse manager so start there i mean how

(00:01:48):
did that come about and then when did that light bulb come on to say i want to be

(00:01:52):
an entrepreneur yeah no i um actually started out at pre-med so i was a guy you

(00:01:58):
know trying to fit the typical stereotypes and so i was like oh i should be a

(00:02:02):
doctor and uh

(00:02:03):
found that my core value set and kind of who I was,

(00:02:06):
uh,

(00:02:06):
you know,

(00:02:07):
led me to a nursing profession,

(00:02:08):
which I'm super happy to have found,

(00:02:10):
but I started practicing the emergency department.

(00:02:13):
Um,

(00:02:13):
you talk about,

(00:02:14):
uh,

(00:02:15):
initial clinical experience in the ER and you definitely learn,

(00:02:19):
learn a ton and get exposed to a lot.

(00:02:21):
You grow up really fast.

(00:02:22):
And so, uh, got into that environment, knew I wanted to do more.

(00:02:26):
And,

(00:02:27):
um,

(00:02:28):
and so it took the administrative route,

(00:02:29):
got my master's in healthcare administration and,

(00:02:32):
uh,

(00:02:33):
got those coordinator,

(00:02:34):
manager roles,

(00:02:36):
eventually became a director of emergency services for a University of Michigan

(00:02:40):
hospital.

(00:02:41):
And I would say that role really opened my eyes to the business side of healthcare.

(00:02:47):
The other roles were more personnel management,

(00:02:50):
clinical operations,

(00:02:51):
you're still doing some patient care,

(00:02:53):
but becoming a director in a larger health system and seeing how healthcare is

(00:02:59):
reimbursed,

(00:03:00):
seeing how healthcare is incentivized.

(00:03:03):
strategically planning for certain service lines.

(00:03:06):
And we always talked about growing revenue and growing patient volumes.

(00:03:12):
It's like we're healthcare providers and we're banking on people getting sicker and

(00:03:16):
charging more and having that be our future.

(00:03:19):
And I was like, that seems completely opposite to the profession of healthcare.

(00:03:24):
We should be healing people and reducing dependencies and really empowering individuals.

(00:03:30):
And so

(00:03:31):
As I was having those conversations,

(00:03:32):
there was this really weird,

(00:03:33):
like dichotomy in my head of this is the business side,

(00:03:38):
but then this is the clinical side.

(00:03:39):
It's like, what are we really going for here as a health system?

(00:03:44):
And that's where some, you know, some things started firing and I started asking questions.

(00:03:49):
I think health systems really want people in them that just say yes.

(00:03:54):
Or it's like, of course, yeah, let's do that.

(00:03:56):
Let's go.

(00:03:57):
But when you start asking questions and really drilling down,

(00:04:01):
You start seeing where some of the motivations are within the system.

(00:04:04):
And so it was really the biggest surprise.

(00:04:07):
I want to jump in because I mean,

(00:04:09):
you talk about firing in the brain,

(00:04:11):
you know,

(00:04:11):
you fired off like a lot,

(00:04:13):
a lot,

(00:04:13):
a lot there.

(00:04:14):
And I love it.

(00:04:14):
Yeah.

(00:04:16):
What was first of all,

(00:04:17):
the biggest disconnect between the education and going to school and studying,

(00:04:23):
you know,

(00:04:23):
for your,

(00:04:24):
for your masters and then landing in,

(00:04:27):
in a system.

(00:04:28):
I mean, what, what was the first big sort of disconnect there?

(00:04:32):
Yeah,

(00:04:32):
I think when we talk about in my master's,

(00:04:34):
we talked a lot about population health and we talked about systems of care.

(00:04:38):
We talked about a lot of the things that I think were maybe altruistic and hopeful

(00:04:44):
and that we should be doing.

(00:04:45):
And then you go into the actual practice of that, you know, of that leadership role.

(00:04:51):
And those weren't the things we were doing.

(00:04:53):
And so there was a lot of things we said we should be doing.

(00:04:57):
Then you look at the actual actions of what we were doing.

(00:05:01):
Massive disconnect between those two things.

(00:05:03):
And that was like,

(00:05:04):
okay,

(00:05:05):
if we're talking about all these things that we should be doing,

(00:05:08):
but none of them are actually happening,

(00:05:11):
like what's going on here?

(00:05:13):
It was just, it was a very strange experience.

(00:05:15):
Yeah.

(00:05:16):
Yeah, no, no, that's amazing.

(00:05:19):
I mean, you know, I think the reality is so far detached from the theory of health care.

(00:05:27):
I mean,

(00:05:27):
and to your point,

(00:05:28):
I've thought about what you said many,

(00:05:30):
many times in my insurance brokerage career about,

(00:05:33):
you know,

(00:05:33):
looking at hospital systems going...

(00:05:35):
You know, how can they survive if they don't keep, you know, so to speak, butts in the seats?

(00:05:40):
You know,

(00:05:40):
the idea is,

(00:05:41):
and all the things everybody's,

(00:05:43):
you know,

(00:05:43):
through lip service at over the years was,

(00:05:45):
you know,

(00:05:45):
outpatient services,

(00:05:47):
outpatient surgery,

(00:05:48):
all the outpatient stuff,

(00:05:50):
yet you still better have a full ICU if you want to ring the register,

(00:05:55):
right?

(00:05:56):
Yeah.

(00:05:57):
No, you talk, and it's funny to see all the consolidation that's occurred across our industry.

(00:06:02):
in the strategy around consolidating health systems, right?

(00:06:05):
Economies of scale, better purchasing power.

(00:06:08):
You can negotiate with payers a lot better.

(00:06:11):
But then when they started gobbling up all of these outpatient facilities,

(00:06:15):
they started charging facility fees for inpatient units to these outpatient

(00:06:20):
services.

(00:06:20):
And now you have a thousand dollar bill here and a thousand dollar bill there,

(00:06:24):
and you see your revenues increase.

(00:06:27):
And so the premise that consolidation is better, that it'll be cheaper,

(00:06:32):
better access,

(00:06:33):
better quality,

(00:06:34):
all these things,

(00:06:35):
I think has proven out in spades that it does not happen that way.

(00:06:39):
No,

(00:06:39):
and then,

(00:06:40):
you know,

(00:06:40):
I look at the cost of even,

(00:06:43):
you know,

(00:06:43):
like I take my dog,

(00:06:45):
my wife and I take my dog for a walk and a large university health system here in

(00:06:50):
Sacramento,

(00:06:50):
California is building a brand new,

(00:06:53):
you know,

(00:06:53):
hospital tower.

(00:06:54):
And I watch the girders go up every morning

(00:06:57):
And I remember being at a conference about two years ago where the interim CEO

(00:07:03):
threw out a number of what the total cost of this thing was going to be.

(00:07:06):
But he boiled it down to the cost per bed, and it was $30 million a bed.

(00:07:11):
you know,

(00:07:12):
ultimately when this is up,

(00:07:13):
you know,

(00:07:14):
so,

(00:07:14):
so,

(00:07:14):
you know,

(00:07:15):
again,

(00:07:15):
it comes down to,

(00:07:16):
they got to pay for that thing somehow.

(00:07:19):
And they're only going to pay for it by keeping the beds full.

(00:07:21):
So, I mean, to your point, it's, it's, it's, it's a lot.

(00:07:24):
So,

(00:07:24):
so,

(00:07:25):
so at some point along the way,

(00:07:26):
you're,

(00:07:26):
you're working in a hospital university hospital system,

(00:07:29):
and you're,

(00:07:29):
you're saying to yourself,

(00:07:30):
there's got to be a better way.

(00:07:32):
You know, where do we go from there?

(00:07:35):
Yeah.

(00:07:36):
Yeah.

(00:07:36):
Yeah, there was that kind of mental realization.

(00:07:39):
And my whole career, I've been a problem solver.

(00:07:42):
It's how, it's why I thrive in the emergency department.

(00:07:44):
You have stuff come through you,

(00:07:46):
you know,

(00:07:46):
through those doors and you got to make a snap decision.

(00:07:48):
You got to know what your resources are.

(00:07:51):
You got to get in that problem solving mode.

(00:07:52):
And I thrived in that environment and then took that skill and you just apply it to

(00:07:56):
a larger systems level process.

(00:07:59):
And so as I was encountering these problems or,

(00:08:02):
maybe perceived problems in my mind,

(00:08:03):
but not for the health system,

(00:08:05):
I started thinking about what would be the way to solve this if we're dealing with

(00:08:08):
this and that and whatever else.

(00:08:11):
And so I started conceptualizing what Health Bar has become when I was in the health system.

(00:08:17):
And I actually tried to implement some of the changes that we're doing today at

(00:08:21):
Health Bar in the health system,

(00:08:23):
which was not responded too well.

(00:08:27):
And you can imagine you're in a system that wants, yes, people

(00:08:31):
And you're pushing against the walls with,

(00:08:34):
you know,

(00:08:34):
innovative thinking or different ways of thinking.

(00:08:37):
And I wasn't making many friends towards the end of my time.

(00:08:43):
And so, but yeah, it took a couple of years.

(00:08:46):
I mean,

(00:08:46):
it was a couple of years of seeing and understanding and living it and breathing it

(00:08:51):
and,

(00:08:51):
you know,

(00:08:52):
getting that pushback to really fully understand like,

(00:08:54):
okay,

(00:08:55):
this is an uphill battle,

(00:08:57):
but it's definitely something that's possible.

(00:08:58):
Yeah.

(00:09:00):
And so I noticed on your LinkedIn profile that there's a couple of companies listed

(00:09:09):
on there before Health Bar.

(00:09:11):
Are those things like are in parallel to Health Bar or are those things that have

(00:09:17):
been sort of iterations before Health Bar?

(00:09:20):
I mean, maybe just take a second on that.

(00:09:23):
Yeah,

(00:09:24):
the other business opportunities have really been offsuit of our primary work at

(00:09:28):
Health Bar,

(00:09:29):
and we can get into what that is.

(00:09:31):
But one of the things that I think you quickly realize in the world of healthcare

(00:09:34):
entrepreneurship is that the system is very broken and that there are a lot of

(00:09:38):
opportunities to solve problems within that.

(00:09:41):
And so trying to align Health Bar underneath a specific core focus and then

(00:09:46):
allowing these other business ventures to find their own identities outside of

(00:09:50):
Health Bar in those focuses

(00:09:52):
So whether it's related to healthcare staffing or staffing in the industry,

(00:09:56):
more efficient ways of doing that,

(00:09:58):
whether it's supply chain related in the healthcare industry,

(00:10:02):
there might be efficiencies from bed placements on post-discharge and assisted

(00:10:08):
living and skilled nursing bed placements.

(00:10:10):
So every almost linkage in that ecosystem is right for opportunity.

(00:10:17):
You see a ton of healthcare entrepreneurship occurring right now because

(00:10:21):
It's a lucrative industry that's wildly inefficient and you're seeing people come

(00:10:25):
with solutions to make it that much better.

(00:10:29):
Yeah.

(00:10:29):
I mean, and, and, you know, I, I look at, at that ecosystem, right.

(00:10:33):
And, and I say, you know, is it, the status quo isn't good.

(00:10:39):
Right.

(00:10:41):
But are all these.

(00:10:43):
how do we get these fresh ideas like Health Bar to market?

(00:10:46):
But let me, before I go down that road, why don't we talk about Health Bar?

(00:10:50):
Let's talk about the company.

(00:10:52):
You're the CEO, your founder.

(00:10:55):
Let's talk about the mission and what you are trying to do with Health Bar.

(00:11:01):
What's the mission?

(00:11:03):
Where are you doing it?

(00:11:04):
Who are your ideal clients?

(00:11:09):
you know, et cetera.

(00:11:10):
So let's tell the story.

(00:11:12):
Let's talk about the company a little bit.

(00:11:15):
Yeah,

(00:11:15):
the original ideas were coming from my time in emergency medicine,

(00:11:18):
where we would see patients come to us for chronic disease management.

(00:11:22):
I mean,

(00:11:22):
things like work notes and prescription refills and really using emergency care as

(00:11:27):
a source of primary care and seeing how inefficient that was and wondering why we

(00:11:34):
weren't doing anything else about it.

(00:11:35):
So

(00:11:36):
That's really where the industry segments of Health Bar came into play.

(00:11:40):
Also seeing our primary care providers being overburdened with patients where their

(00:11:44):
patient loads were,

(00:11:45):
you know,

(00:11:46):
two,

(00:11:46):
three,

(00:11:46):
4,000 patients that they had to manage knowing that was completely unsustainable.

(00:11:51):
And they were just turning into funnel mechanisms for the healthcare system, quite honestly.

(00:11:56):
And so looking at that and saying, you know, if we were able to tackle this

(00:12:01):
you know, how would we do that?

(00:12:02):
And that's where health bars idea came from.

(00:12:04):
So what we do is we provide,

(00:12:07):
and we've really gone to businesses,

(00:12:09):
to schools and different,

(00:12:11):
um,

(00:12:11):
population centers.

(00:12:12):
So what do we could provide them,

(00:12:14):
um,

(00:12:15):
a form of primary care that was relationship based,

(00:12:19):
you know,

(00:12:19):
value added from a prevention standpoint,

(00:12:22):
increased access,

(00:12:23):
um,

(00:12:24):
and really look to that longitudinal relationship of it.

(00:12:28):
And so what we'll do at Health Bar is we've found and developed a system that can

(00:12:33):
take on-site healthcare,

(00:12:35):
virtual healthcare,

(00:12:37):
look at nurse navigation,

(00:12:39):
look at all these different elements of really outpatient healthcare and bring them

(00:12:43):
to an employer,

(00:12:45):
a school,

(00:12:46):
those different populations,

(00:12:48):
and provide it in a value-based care approach.

(00:12:50):
So we say we're innovating in primary care delivery

(00:12:54):
With Health Bar, we're also innovating on payer model kind of mechanisms within Health Bar.

(00:13:01):
And then also on that medical philosophy,

(00:13:03):
you know,

(00:13:03):
we say we go to school and we're taught how to be clinicians.

(00:13:06):
We're really taught how to do procedures, how to treat illness.

(00:13:09):
We get almost no education on what actual health is.

(00:13:14):
So nutrition and,

(00:13:16):
you know,

(00:13:17):
more of these functional medicine,

(00:13:18):
almost behavioral medicine topics.

(00:13:21):
And so you got a lot of the influencers out there and people talking about

(00:13:24):
longevity medicine and health span and all that good stuff,

(00:13:28):
which is great.

(00:13:29):
How do you take those concepts and marry them with a traditional medical approach?

(00:13:33):
And we say take the best of both worlds, right?

(00:13:36):
There's a place for an antibiotic, most definitely.

(00:13:38):
But wouldn't it be great if in the beginning you optimized your health through

(00:13:43):
daily health practices that reduced your need for that or prevented the need

(00:13:48):
altogether?

(00:13:49):
And so we kind of take those different,

(00:13:51):
you know,

(00:13:51):
access innovation along with payer innovation and then medical philosophy

(00:13:55):
innovation,

(00:13:56):
smash them together in a delivery model that is very scalable.

(00:14:01):
So it kind of feels like direct primary care, concierge care.

(00:14:05):
Then we layer in this functional medicine approach and we deploy it via those

(00:14:09):
onsite and virtual options.

(00:14:11):
And I think I've created somewhat of an optimized system with the whole idea of how

(00:14:17):
can we use this

(00:14:19):
to change how primary care is delivered across the US,

(00:14:22):
not just in a geography or around a certain brick and mortar.

(00:14:28):
So so this is a very important point,

(00:14:30):
I think,

(00:14:31):
and one of the things that's come up in a lot of the conversations I've had around

(00:14:36):
primary care and to your point,

(00:14:38):
the overworked primary care system that we have in this country.

(00:14:42):
But really, it comes down to care navigation.

(00:14:44):
You know, it's it's those you're diagnosed with something and you're hoping.

(00:14:49):
your primary care doc has the bandwidth to be your advocate,

(00:14:57):
your guide,

(00:14:58):
the person,

(00:14:59):
you know,

(00:14:59):
making sure you've got the appointments or at least talking to the right people.

(00:15:05):
And within certain integrated systems,

(00:15:07):
like out here in California,

(00:15:08):
we have Kaiser Permanente,

(00:15:09):
which,

(00:15:10):
you know,

(00:15:10):
say what you will about it,

(00:15:11):
it is an integrated system.

(00:15:13):
But if you're in the Wild West, which is, you know, the rest of America,

(00:15:18):
You don't really have quality care navigation.

(00:15:23):
And so my reading between the lines to understand that what part of what you're doing is that.

(00:15:32):
Yeah,

(00:15:32):
it's it's almost if you look at this from a concept we talk about in financial

(00:15:35):
management,

(00:15:36):
we do series like I'm looking out for your best interest as my client and not my

(00:15:41):
own best interests.

(00:15:42):
And I think if you take that exact same concept and apply it to primary care where

(00:15:48):
Right now,

(00:15:48):
I would largely argue primary care providers and hospital-based providers are not

(00:15:55):
fiduciaries of your health.

(00:15:57):
What they're doing is they're providing care,

(00:15:59):
but then they're funneling that care into their own systems and networks,

(00:16:03):
right?

(00:16:03):
And so as you get engaged with a health system,

(00:16:06):
you enter that funnel and the mechanisms in place,

(00:16:09):
the business functions in place,

(00:16:12):
incentivize certain pathways for that individual.

(00:16:15):
That may not be in your best interest.

(00:16:17):
financially or even health-wise.

(00:16:20):
And so what we're trying to do is almost become that fiduciary of your health, right?

(00:16:25):
Where we're on your side, we're acting in your best interest.

(00:16:29):
How do we find alternative networks?

(00:16:31):
So we've curated direct contracting ourselves and we have preferred networks that

(00:16:36):
we work within.

(00:16:37):
We optimize certain providers within different networks that we're working within

(00:16:43):
with employers.

(00:16:44):
And so how do you really

(00:16:45):
look at the patient's best interest and that business's best interest in funneling

(00:16:50):
that individual to the best and highest quality services at the lowest cost.

(00:16:55):
I think that's what a true healthcare fiduciary looks like.

(00:16:59):
And so if you take the two industries,

(00:17:00):
compare them against each other,

(00:17:01):
I think that's probably one of the easier ways to look at it.

(00:17:04):
No, I mean, I think that's brilliant.

(00:17:06):
And I mean,

(00:17:07):
that word fiduciary is one that needs to be more ubiquitous within the world of

(00:17:16):
employee benefits,

(00:17:17):
right?

(00:17:17):
I mean, employers, CEOs, CFOs, VPs of HR, et cetera,

(00:17:23):
They themselves don't understand how to be a fiduciary of their own plans.

(00:17:27):
And that is a problem.

(00:17:30):
And we're starting to see lawsuits and things start to hit.

(00:17:35):
And you've probably seen some of the posts on LinkedIn saying,

(00:17:37):
where people are finding these lawsuits,

(00:17:40):
they're finding that people aren't being responsible for their own employees' money

(00:17:47):
in terms of claim dollars and cost and all these different things.

(00:17:50):
And I think we're just at the,

(00:17:52):
not even the tip of the iceberg,

(00:17:54):
we're the snowflake on top of the tip of the iceberg when it comes to looking at

(00:17:59):
what's gonna be happening with fiduciary responsibility over the next several

(00:18:04):
years.

(00:18:05):
And I think,

(00:18:05):
you know you're layering in and i'm talking mostly financial fiduciary

(00:18:09):
responsibility yeah you're layering in another thing called healthcare fiduciary

(00:18:14):
responsibility that's correct yep that's exactly right not not putting it on the

(00:18:19):
provider to just make a decision haphazardly uh because it's a protocol or an order

(00:18:25):
set or something else but to weave back in to the clinical interaction

(00:18:30):
what is best for my patient, right?

(00:18:32):
Not what's best for me as a provider or my health system.

(00:18:36):
It's what's best for my patient.

(00:18:37):
And if we start changing our thinking in that way,

(00:18:40):
I think clinical practice changes significantly.

(00:18:43):
And I also think system behavior changes significantly.

(00:18:48):
So, so your part, describe a little bit more, a couple of things, I guess.

(00:18:53):
First thing, describe the delivery side of what you're doing.

(00:18:57):
Are your, are your deliverers, I mean, are they physicians?

(00:19:00):
Are they nurse practitioners?

(00:19:02):
Are they nurses?

(00:19:02):
Are they all the above?

(00:19:03):
Yeah, we've tried, we've tried to find the ideal mix.

(00:19:08):
And if you look at

(00:19:09):
I,

(00:19:09):
you know,

(00:19:10):
I started the business and everybody knows if you're following healthcare staffing

(00:19:13):
trends,

(00:19:13):
we've talked about a physician shortage for forever.

(00:19:16):
Right.

(00:19:16):
It's like, we're going to burn out by 2030 burnout, all the things.

(00:19:20):
Right.

(00:19:20):
And so one of the things that I'd love about being a nurse is we're the largest

(00:19:24):
workforce in all of the U S healthcare.

(00:19:27):
Right.

(00:19:27):
And we've been talking about this provider shortage for a very long time.

(00:19:31):
And what's happening is, is you're getting an increase in mid-level providers, right?

(00:19:35):
PAs, nurse practitioners.

(00:19:37):
Now,

(00:19:37):
in some medical settings,

(00:19:38):
you know,

(00:19:39):
having a physician provide the care is warranted,

(00:19:42):
right?

(00:19:42):
Complex medical settings,

(00:19:44):
surgical settings,

(00:19:45):
things that require very intensive medical knowledge and complexity.

(00:19:49):
But when we're talking about primary care, sometimes we overcomplicate it.

(00:19:54):
And the beauty,

(00:19:55):
I think,

(00:19:55):
of what a nurse practitioners who we use provide,

(00:19:58):
you know,

(00:19:58):
mainly in our model,

(00:20:00):
is that a nurse practitioner can do a large majority of what a physician can do in

(00:20:05):
a primary care setting,

(00:20:06):
but they can do it for half the cost,

(00:20:08):
essentially.

(00:20:09):
And so again,

(00:20:10):
thinking about scalable models in a workforce,

(00:20:13):
nurse practitioners,

(00:20:14):
that is actually increasing significantly to meet the demand of primary care.

(00:20:18):
And so you put those things together and say,

(00:20:20):
we have a cost-effective way of delivering primary care with a workforce that's

(00:20:25):
growing to meet the demand.

(00:20:27):
How do we create an optimized model around this?

(00:20:29):
So nurse practitioners and nurses are our main care teams that we deploy for population care.

(00:20:36):
We do have physician oversight for medical practices and clinical pathways and all of that.

(00:20:42):
So we don't want to lose that.

(00:20:44):
But we also want to not use an overly complex, costly system to try to solve health care access.

(00:20:53):
And we think this mid-level provider team system

(00:20:57):
and do that.

(00:20:59):
Yeah.

(00:20:59):
So it's,

(00:21:00):
that's been more of the,

(00:21:01):
yeah,

(00:21:02):
the main reasoning why we've,

(00:21:04):
we've kind of fallen right in the middle of that licensure.

(00:21:07):
Right.

(00:21:08):
And so your,

(00:21:09):
your clients are,

(00:21:11):
let me,

(00:21:12):
let me ask the question this way,

(00:21:14):
you know,

(00:21:14):
who are the people you seek to be your clients?

(00:21:20):
When we're looking or talking with businesses,

(00:21:22):
we're looking at,

(00:21:23):
you know,

(00:21:23):
self funded employers,

(00:21:24):
two to 300 employees and above.

(00:21:27):
You go to those mega employers and they probably had onsite clinics before, right?

(00:21:32):
They're big enough.

(00:21:32):
They've been self-funded for a super long time.

(00:21:34):
And they're like,

(00:21:35):
yeah,

(00:21:36):
having onsite care is definitely makes sense,

(00:21:39):
but they're able to afford it.

(00:21:40):
A segment of the market that this is newer in hasn't been able to afford it is

(00:21:44):
really in that,

(00:21:45):
you know,

(00:21:46):
200 or 300 employee life group and above where maybe it hasn't been cost effective

(00:21:50):
to have an onsite solution.

(00:21:52):
And sometimes near site solutions just don't get the right amount of engagement

(00:21:55):
because we've heard employers say,

(00:21:57):
you know,

(00:21:57):
if they're five minutes away,

(00:21:58):
they might as well have been 50 minutes away because,

(00:22:01):
you know,

(00:22:01):
you get some people who are just like,

(00:22:03):
I don't care how close it is.

(00:22:04):
I'm not going right.

(00:22:05):
Unless it's smack dab in front of my face.

(00:22:08):
And so we've found a way with our model to deploy those clinical teams on site at

(00:22:15):
that manufacturer's

(00:22:16):
you know,

(00:22:17):
at that office to where that onsite presence can be there,

(00:22:22):
you know,

(00:22:22):
one,

(00:22:22):
two,

(00:22:23):
you know,

(00:22:23):
five days a week.

(00:22:25):
And so we can fractionalize that clinical resource.

(00:22:29):
The beauty is, is the consistency of that resource and engaging with that population.

(00:22:34):
And our primary metric of success is engagement.

(00:22:38):
There's a lot of things, as you're aware, in the benefit space from a solution standpoint that

(00:22:43):
It could be the best solution out there in concept.

(00:22:46):
But if nobody ever uses it, it's completely worthless.

(00:22:49):
Right.

(00:22:50):
And so our our metric of success has been engagement.

(00:22:54):
We're engaging with a population of people that gives us a front door to be working

(00:23:00):
with them on behaviors and lifestyle changes,

(00:23:02):
health coaching.

(00:23:02):
We're doing system navigation.

(00:23:04):
We're doing primary care, occupational health.

(00:23:08):
all the above.

(00:23:09):
So, but if I don't, if I'm not working with that person, I have no opportunity to do that.

(00:23:13):
So for us, everything starts with engagement and that relationship.

(00:23:17):
And that really centers around being face to face with that person.

(00:23:21):
Yeah, yeah, no, that's super, that's super important.

(00:23:23):
And once you've established a relationship with that with that patient,

(00:23:27):
you know,

(00:23:27):
you're able to go deeper than probably any primary normal primary care situation

(00:23:33):
would be right.

(00:23:34):
Exactly right.

(00:23:35):
Yeah, there's,

(00:23:36):
And a lot of people are really put off by the manufacturing model that healthcare

(00:23:41):
has become where you go into your doctor's office and you wait in a waiting room

(00:23:45):
for 30 minutes and then you see your provider for five minutes and then you're

(00:23:48):
discharged and you've been there for two hours and that's all you got.

(00:23:52):
You know, how do you take that and how do you change it over to a patient friendly model?

(00:23:57):
And so what we've done is yeah, allow for more time with your provider, easy access.

(00:24:02):
And because we don't bill insurance,

(00:24:04):
we aren't sitting there typing in that computer to generate a billable.

(00:24:08):
We're spending time actually listening and communicating.

(00:24:11):
And if you understand what somebody's needs and goals are,

(00:24:14):
you can really make some good progress.

(00:24:16):
So your comp model is more of a PEPM for the employer.

(00:24:24):
So they have 1,000 employees.

(00:24:25):
You're going to charge them something per month per employee to be in the health bar universe.

(00:24:32):
Yep.

(00:24:33):
Essentially that, you know, capitated payment where it's a fixed monthly amount.

(00:24:36):
They're buying a clinical resource essentially at the end of the day and saying,

(00:24:41):
hey,

(00:24:41):
we're going to cap our expense for this resource at this amount.

(00:24:45):
And then our goal,

(00:24:46):
and this is what I say,

(00:24:47):
we have to realign that payer provider relationship where me as the provider is not

(00:24:52):
incentivized by doing more to bill more.

(00:24:55):
I'm incentivized to shift as much utilization and claims from higher cost

(00:25:01):
you know, complex, uh, situations over to this capitated payment model.

(00:25:06):
So I can generate an ROI on overcharging.

(00:25:09):
Yep.

(00:25:10):
So,

(00:25:10):
so at some point along the way,

(00:25:11):
I mean,

(00:25:12):
this happens probably every day,

(00:25:13):
you know,

(00:25:13):
there's a patient whereby the work you're doing is now beyond the scope of your

(00:25:19):
ability to serve them.

(00:25:20):
Right.

(00:25:20):
They need a specialist.

(00:25:21):
They need,

(00:25:22):
they need,

(00:25:22):
they need something beyond what health bar is potentially able to,

(00:25:27):
to deliver.

(00:25:29):
What does that handoff look like to the network that their employer is contracted

(00:25:37):
with to do the insurance side of that situation?

(00:25:42):
Yeah,

(00:25:44):
when I first started the business,

(00:25:45):
we wanted to make sure that we positioned ourselves as we're working with local

(00:25:49):
health systems and providers and specialists,

(00:25:51):
not as antagonists and not as disruptors in that way,

(00:25:55):
but how do we

(00:25:56):
blend into the existing care ecosystem and use it appropriately.

(00:26:01):
And so as we're identifying clients with special needs that we need to make a

(00:26:05):
referral to,

(00:26:05):
we'll integrate into what their tier one network is and what are the higher quality

(00:26:10):
providers in that area,

(00:26:12):
make that referral,

(00:26:13):
make that handoff,

(00:26:15):
and really help that be a seamless event for that individual.

(00:26:18):
And then walk alongside of that individual along the way.

(00:26:21):
It's not like we disappear

(00:26:23):
After we've made that specialty referral.

(00:26:24):
That's the most important thing.

(00:26:25):
Literally what you just said there is probably the most important thing that a

(00:26:29):
patient needs to hear is,

(00:26:31):
you know,

(00:26:32):
we're not leaving you.

(00:26:33):
We're going to be right beside you as you begin to navigate whatever the treatment

(00:26:38):
might be for a chronic illness,

(00:26:40):
a surgery,

(00:26:41):
a cancer,

(00:26:41):
whatever it might be.

(00:26:44):
Yeah, there's people say like, oh, you guys can't treat cancer.

(00:26:46):
Of course not.

(00:26:47):
We're primary care, right?

(00:26:48):
That's not our intent.

(00:26:50):
But what is our intent is that as you're going through that cancer treatment,

(00:26:54):
there are a lot of precautions to maintain.

(00:26:56):
And when I was back in the emergency department,

(00:26:59):
how many complications we saw with cancer patients who are neutropenic,

(00:27:02):
who got septic,

(00:27:03):
who had certain complications because of their treatments that weren't managed well

(00:27:08):
because of bad education,

(00:27:09):
because of a lack of this or that.

(00:27:12):
And so if we can work with these individuals going through a complex therapies,

(00:27:15):
recovering from a surgery,

(00:27:17):
preparing for a surgery,

(00:27:18):
are going through something like cancer care.

(00:27:21):
There's so much surrounding those diseases and that treatment that we can provide

(00:27:27):
significant value add through that process.

(00:27:29):
But it's not the flashy work and it's not the sexy work.

(00:27:32):
Well, no, it's the important work, you know.

(00:27:35):
I mean,

(00:27:37):
especially as,

(00:27:38):
you know,

(00:27:40):
I think one of the biggest disconnects in healthcare is the discharge order.

(00:27:45):
You know,

(00:27:46):
someone is now leaving the hospital,

(00:27:47):
they've had their surgery,

(00:27:48):
or they spent some time in there for something,

(00:27:50):
and now they're out and they get scribbled some notes or,

(00:27:54):
you know,

(00:27:54):
a PDF or two,

(00:27:55):
and they're sent on their way with,

(00:27:58):
you know,

(00:27:59):
depending on the system that they're coming from,

(00:28:01):
may have limited follow-up.

(00:28:02):
So for them to be able to come back into your ecosystem to make sure that that

(00:28:09):
discharge is positive,

(00:28:10):
that they're following instructions,

(00:28:12):
That they're doing all the things.

(00:28:13):
I mean, that's got to be, that's money right there.

(00:28:17):
It's huge.

(00:28:18):
Yeah, it's huge.

(00:28:18):
We used to say, and terribly, I hate saying it, but we used to say treat and street, right?

(00:28:22):
It's like, I'm going to treat you, get you out of here, right?

(00:28:24):
Treat you, get you out of here.

(00:28:25):
Because that turn was more revenue.

(00:28:28):
And so it was treat, treat, treat, treat, right?

(00:28:31):
Get them in, get them out.

(00:28:32):
Yeah, no, for sure.

(00:28:34):
So obviously you mentioned self-funded employers.

(00:28:38):
I mean,

(00:28:39):
do you have a sales force going after conversations directly with employers or are

(00:28:47):
you talking to TPAs or are you talking to brokers?

(00:28:50):
I mean, who are you talking to to fill your funnel?

(00:28:55):
It's a combination of everyone you just mentioned.

(00:28:57):
So we've realized that through this process,

(00:29:00):
health benefits is extremely complicated and understanding who's providing that

(00:29:05):
advice to employers and how are they crafting those plan designs and what are the

(00:29:10):
networks involved,

(00:29:12):
right?

(00:29:12):
So going direct to employer,

(00:29:14):
there's a whole layer of complexity there that a healthcare provider may not be

(00:29:18):
aware of as they're just providing care.

(00:29:20):
So we quickly started forming relationships with health benefits agencies,

(00:29:25):
with TPAs,

(00:29:26):
with payers and said,

(00:29:28):
you know,

(00:29:28):
everybody's,

(00:29:29):
we're all working towards,

(00:29:31):
making healthcare cheaper and improving access and reducing utilization off of these plans.

(00:29:37):
Let's look at implementing a health bar strategy where we're working on a

(00:29:40):
population health level and really significant reducing utilization.

(00:29:44):
This should make everybody happy at the end of the day, right?

(00:29:46):
The insurance carrier is like, great, less utilization.

(00:29:49):
And the benefits agent's like,

(00:29:51):
awesome,

(00:29:51):
I have a high performing plan and I look like a genius for bringing health bar in,

(00:29:55):
right?

(00:29:56):
Then you have the employer who's saying,

(00:29:57):
my utilization's down and my claims are down,

(00:29:59):
I'm super happy.

(00:30:00):
Then you have their employee who's like,

(00:30:02):
hey,

(00:30:02):
I got better access to health care all of a sudden.

(00:30:04):
So there's not many like win, win, win situations.

(00:30:08):
And we really feel like we actually created one.

(00:30:11):
Yeah.

(00:30:11):
I mean,

(00:30:11):
I mean,

(00:30:11):
what I love about what you're doing,

(00:30:13):
Nate,

(00:30:13):
is,

(00:30:14):
you know,

(00:30:14):
there's so many people throwing tons of technology at health care in many ways.

(00:30:20):
And what you seem to be doing is is is.

(00:30:24):
is throwing humanity at healthcare.

(00:30:27):
I mean,

(00:30:27):
you're really trying to take people on a journey,

(00:30:30):
a health journey,

(00:30:32):
whether to avoid chronic things in the long run or when they get involved in an

(00:30:39):
acute situation that you're able to help them manage that journey as well.

(00:30:46):
And I like that.

(00:30:48):
And you and I can have a conversation beyond the scope of this podcast.

(00:30:53):
If you want some insights,

(00:30:54):
deeper insights into how brokers think and stuff like that,

(00:30:58):
I'm more than happy to,

(00:31:00):
if you want to pick my brain about those kind of things,

(00:31:04):
I'm happy to.

(00:31:05):
to help dig in with you on that,

(00:31:08):
because I mean,

(00:31:08):
different brokers will have different incentives in order to do what you,

(00:31:12):
they all say they wanna do what you're doing,

(00:31:16):
but it ain't so black and white,

(00:31:19):
right?

(00:31:19):
So, and there's ways to access data.

(00:31:23):
Anyway, we'll talk another time about that offline.

(00:31:28):
But at the same time, I feel like, you know,

(00:31:33):
what you're doing, how, how challenging is it to scale this, right?

(00:31:38):
I mean,

(00:31:39):
there's lots of people that need help in this country and there's a lot of people,

(00:31:44):
a lot of organizations that can use your solution.

(00:31:47):
And to your point,

(00:31:48):
The mid-market to me, and that is that 250 to 5,000 size group is the perfect.

(00:31:56):
I mean,

(00:31:56):
they're not enterprise level to your point,

(00:31:58):
so they may not have their own chief medical officer.

(00:32:00):
They may have some third-party solutions,

(00:32:03):
but you're coming to the table with a real thing that can help people save on their

(00:32:10):
long-term costs.

(00:32:11):
And so given that the market is there for you,

(00:32:16):
Um, how do you scale this?

(00:32:18):
You're located in Michigan.

(00:32:19):
I know.

(00:32:19):
I mean,

(00:32:19):
I looked at the map on your website,

(00:32:21):
so you've got,

(00:32:21):
you know,

(00:32:22):
uh,

(00:32:23):
clients look like in about 20 States ish.

(00:32:27):
Yeah.

(00:32:27):
Yeah.

(00:32:28):
Yeah.

(00:32:28):
We're,

(00:32:29):
you know,

(00:32:29):
if you look at it,

(00:32:30):
we're combining the onsite and in virtual table stakes,

(00:32:34):
right?

(00:32:34):
So you need a virtual element of anything you do nowadays, given the world we live in.

(00:32:39):
Our,

(00:32:39):
our tip of the spear is our onsite program onsite,

(00:32:42):
you know,

(00:32:42):
with,

(00:32:42):
uh,

(00:32:43):
in five States with a variety of employers.

(00:32:46):
We're headquartered in Michigan and we have a density here that we're continuing to expand.

(00:32:50):
But when I was originally creating the model, I thought that it might become a franchise.

(00:32:55):
Honestly, like how do we create a package or a system of care that can be replicated anywhere?

(00:33:01):
Health care is ubiquitous.

(00:33:03):
Primary care needs are everywhere, right?

(00:33:05):
There's really no corner that this couldn't exist in.

(00:33:09):
The economy of scale with the size of employers and the economics of it is really

(00:33:14):
what we're trying to fine tune and tweak.

(00:33:15):
So right now we're going after those, you know, yeah, 200 to 5,000 size employers.

(00:33:22):
We've been more opportunistic up to this point.

(00:33:24):
We have a sales team that's out there.

(00:33:25):
We have great benefits agencies and brokers and TPAs,

(00:33:28):
some captives who are starting to leverage our solution.

(00:33:31):
But really,

(00:33:32):
we've grown a lot just now,

(00:33:34):
you know,

(00:33:34):
just over the past,

(00:33:35):
you know,

(00:33:35):
four and a half,

(00:33:36):
five years out of word of mouth.

(00:33:38):
do good care, take good care of people, you know, and do that.

(00:33:41):
But we would love,

(00:33:43):
I think as we're building it,

(00:33:45):
we want this system of care to be available to every market,

(00:33:48):
to everybody using employers as that kind of central,

(00:33:53):
um access point um to individuals and uh and we think we can you know we think we

(00:33:58):
can do that um provider you know for us we we find the right provider teams um

(00:34:04):
those clinicians to plug into our system to make it go but as i said using that

(00:34:09):
nurse practitioner first model and supported by nursing uh we think that we can do

(00:34:13):
that and find a viable workforce in most communities

(00:34:17):
Are you finding your local providers that you're working with tend to be,

(00:34:22):
well,

(00:34:23):
if they're nurse practitioners,

(00:34:24):
PAs,

(00:34:24):
nurses,

(00:34:25):
and stuff,

(00:34:25):
it's probably a little less complex because that may be a more flexible ecosystem.

(00:34:30):
But docs these days, I mean, I was actually interviewing last week the

(00:34:38):
gentleman who is the new,

(00:34:39):
well,

(00:34:40):
he started actually,

(00:34:41):
it's called the California Physicians Association.

(00:34:45):
And it's an association which is representing all independent physicians,

(00:34:49):
well,

(00:34:50):
independent physicians in California.

(00:34:52):
And he was talking about the statistics about how now,

(00:34:55):
you know,

(00:34:56):
you're down to about 25%-ish of docs being

(00:35:01):
independent.

(00:35:02):
They're all getting gobbled up by systems.

(00:35:06):
They're getting gobbled up by private equity.

(00:35:08):
They're getting gobbled up by insurance companies.

(00:35:14):
Who are you bringing into the health bar fold?

(00:35:17):
We have our health bar services proper, which is our care team structure, that pop health side.

(00:35:23):
We're building referral networks around us.

(00:35:27):
Think of your physical therapists.

(00:35:28):
Think of your labs and radiology providers.

(00:35:31):
independence.

(00:35:31):
And that's really,

(00:35:32):
you know,

(00:35:33):
I think as we discussed before,

(00:35:34):
a little bit of that conference that we'll be putting on here in April of next year

(00:35:38):
is it's not going to start creating structure and a framework around this

(00:35:41):
independent ecosystem of healthcare delivery.

(00:35:43):
And very much a part of that is direct primary care or independent physician

(00:35:49):
practice as we are continuing to do our work.

(00:35:53):
We're definitely not against having independent practice.

(00:35:56):
It's actually fantastic to have because

(00:35:59):
We understand the limitations of our models where we're not building a brick and

(00:36:03):
mortar facility to go drive to.

(00:36:05):
We're embedding ourselves into physical infrastructure to enhance health care access.

(00:36:10):
But some people prefer to go to a traditional office to receive their medical care.

(00:36:15):
So I think as I look at it,

(00:36:17):
you know,

(00:36:17):
and some people be like,

(00:36:18):
oh,

(00:36:18):
this is a competitor of yours at Health Bar.

(00:36:20):
And I look at it and say,

(00:36:22):
no,

(00:36:23):
these are collaborators in the work that we're doing because we need all of us.

(00:36:28):
to be synergizing around these efforts and creating systems that work together.

(00:36:32):
Cause yeah,

(00:36:34):
if we keep,

(00:36:35):
if we look at each other's competition continuously,

(00:36:37):
the health systems is going to be over here laughing at us while we eat each other

(00:36:40):
up.

(00:36:41):
And it's like,

(00:36:42):
no guys,

(00:36:42):
like let's,

(00:36:43):
let's look at this from a more focused and hope filled lens of fixing the broader

(00:36:49):
problem and understanding people will access healthcare in very different ways.

(00:36:53):
And we should present them with those options.

(00:36:55):
No, for sure, for sure.

(00:36:57):
No, I really appreciate, you know, all that vision.

(00:37:02):
And so, you know, we're coming up on a little over half an hour here in our conversation.

(00:37:06):
So where I want to kind of end this is,

(00:37:09):
you know,

(00:37:10):
that question you and I discussed,

(00:37:11):
you know,

(00:37:11):
you're now building out something which is a piece of the overall health care

(00:37:20):
puzzle and the solution, right?

(00:37:22):
You're going after a specific piece of that and you're actually creating a piece of that.

(00:37:27):
You're, you're, you're bringing a novel idea.

(00:37:30):
which you would think it would,

(00:37:31):
wouldn't be so novel,

(00:37:32):
but it's kind of novel of what you're doing into the marketplace.

(00:37:36):
Um,

(00:37:37):
but you're also,

(00:37:38):
you're,

(00:37:38):
we're also having to live within the confines of the existing,

(00:37:43):
you know,

(00:37:44):
employer benefit program,

(00:37:46):
whether it's a fully insured contract with an insurer or a self-insured contract

(00:37:50):
with stop law,

(00:37:50):
all the mess that is employee benefits and insurance and all the things,

(00:37:56):
um,

(00:37:57):
But also,

(00:37:58):
you know,

(00:37:58):
the way I look at it as someone who is becoming of an age where I'll be eligible

(00:38:03):
for Medicare in the not too distant future,

(00:38:05):
where I look at that as an interesting solution out there because,

(00:38:09):
wow,

(00:38:10):
what we have in one sense is a solution that exists,

(00:38:14):
but we have all these other solutions that run in parallel or et cetera before you

(00:38:19):
get to that point.

(00:38:21):
You know,

(00:38:23):
Knowing what you know,

(00:38:24):
working on the hospital side,

(00:38:25):
knowing payer solutions,

(00:38:27):
knowing all the things you do,

(00:38:30):
here's a white piece of paper,

(00:38:31):
Nate.

(00:38:33):
If you had to redraw what healthcare looks like in America, what does that look like to you?

(00:38:42):
Yeah.

(00:38:44):
The most complex question to ever be asked.

(00:38:46):
Yeah.

(00:38:49):
No,

(00:38:49):
I,

(00:38:50):
you know,

(00:38:50):
really,

(00:38:51):
I think if I'm starting from the insurance side,

(00:38:52):
how do we fund healthcare,

(00:38:54):
right?

(00:38:54):
We use insurance as a primary payer model.

(00:38:57):
What I think a lot about is why don't we look at health insurance,

(00:39:00):
kind of like we do other insurance products,

(00:39:01):
like our car insurance or home insurance.

(00:39:04):
Let's insure against catastrophic and larger style events.

(00:39:08):
Let's look at everything else in the healthcare ecosystem as more of this transparent cash-based

(00:39:14):
ecosystem where we're creating some level of consumerism around keeping yourself healthy.

(00:39:18):
And that includes preventative care,

(00:39:19):
includes primary care,

(00:39:22):
acute,

(00:39:22):
you know,

(00:39:22):
some minor acute injury illness care,

(00:39:24):
you know,

(00:39:25):
things that I that should be consumable and transparent.

(00:39:29):
And then,

(00:39:29):
you know,

(00:39:30):
let's look at,

(00:39:30):
you know,

(00:39:30):
emergency care and above as more of this complex care side of things.

(00:39:35):
And so if I were to, you know, wipe the slate clean to start with a blank slate,

(00:39:40):
I'd first look at changing that payer model on that side and say,

(00:39:42):
let's ensure for the catastrophic,

(00:39:45):
let's create cash-based ecosystems that are transparent for more of this outpatient

(00:39:49):
consumable and empower our populations to take care of themselves on that end of

(00:39:55):
it.

(00:39:56):
Now I look at care delivery structures and say,

(00:39:59):
okay,

(00:39:59):
how do we almost swing the pendulum back to where it was to make healthcare more

(00:40:03):
localized and more accessible and relationship-based?

(00:40:07):
And so I look at really that,

(00:40:09):
you know,

(00:40:10):
the fragmentation of primary care almost out of the traditional health systems to

(00:40:15):
take that funnel mechanism away.

(00:40:17):
And so you have independent primary care that's dotted all around,

(00:40:20):
kind of like direct primary care and our model and different things like that,

(00:40:24):
that are working with the right incentive structure for a population.

(00:40:27):
It can provide that care to people.

(00:40:29):
So, you know, change that payer model, change the primary care delivery model.

(00:40:33):
Look at our health care institutions as complex care.

(00:40:36):
I mean,

(00:40:36):
if I ever get really sick or have to have a surgery,

(00:40:39):
like I want a really good hospital to go to.

(00:40:41):
Right.

(00:40:42):
So I don't want that to go away.

(00:40:43):
I just think the incentive models and structures that we have surrounding them need to change.

(00:40:49):
And then I think,

(00:40:50):
you know,

(00:40:51):
I do think that hospital consolidation is it has been a very negative thing.

(00:40:55):
It's created a lot of unfortunate capitalism and health care.

(00:41:00):
And so how do we look at more of this decentralized hospital structures where you

(00:41:04):
have local care embedded within communities that can,

(00:41:07):
you know,

(00:41:08):
have a lot of robustness.

(00:41:09):
So I think we solve for these things in a wide variety of ways,

(00:41:12):
you know,

(00:41:13):
with advanced technologies and remote patient monitoring and wearables,

(00:41:16):
you know,

(00:41:17):
innovative care delivery models like health bar.

(00:41:20):
You look at,

(00:41:21):
you know,

(00:41:21):
alternative pair systems like we're looking to create that also,

(00:41:24):
you know,

(00:41:24):
do that and,

(00:41:26):
And I think we create change in parallel to our existing health care system and

(00:41:31):
really force its hand to change versus trying to reform our current system.

(00:41:36):
Because I don't think there's enough incentive to do that.

(00:41:38):
Yeah,

(00:41:39):
and there's just too many forces at work to keep the status quo,

(00:41:43):
but I think we've hit a tipping point in this country,

(00:41:47):
and I saw it coming when,

(00:41:49):
you know,

(00:41:50):
I look back in my early career as an insurance broker when a reasonably,

(00:41:55):
or actually a very good health insurance plan in 2003 would cost an individual,

(00:42:01):
would cost an employer 150 bucks a month to insure an employee,

(00:42:05):
and $400 to insure a family.

(00:42:09):
We've now basically added a zero.

(00:42:12):
And it's gotten to the point where it's unsustainable.

(00:42:17):
So things have to start changing.

(00:42:19):
And unfortunately,

(00:42:20):
I jokingly call the health care world that we live in is the blind leading the

(00:42:24):
blind.

(00:42:25):
No one understands.

(00:42:29):
politicians certainly don't you know they're just looking for the next sound bite

(00:42:35):
and and people within even a a system or an insurer they're just sort of hyper

(00:42:42):
focused on the thing they do and and nobody ever takes the helicopter up to you

(00:42:47):
know 50 000 feet of the plane up to 50 000 feet and and tries to see this from a

(00:42:52):
systemic point of view so

(00:42:53):
I applaud what you're doing in trying to make a difference in a way that I think

(00:43:00):
gets people thinking about being better,

(00:43:04):
keeping care local,

(00:43:05):
and most importantly,

(00:43:09):
helping people navigate care.

(00:43:10):
Because if you're helping them navigate care well,

(00:43:14):
the cost will go down because there'll be less waste.

(00:43:17):
There'll be less people going back into the hospital.

(00:43:20):
There'll be people who will avoid even going

(00:43:23):
to the hospital to begin with because they've taken care of themselves,

(00:43:27):
you know,

(00:43:27):
properly even before they get to that point.

(00:43:29):
So, you know, good on you for, for doing the work you're doing.

(00:43:33):
No, yeah, appreciate that.

(00:43:35):
It's,

(00:43:35):
you know,

(00:43:36):
hopefully we,

(00:43:36):
we,

(00:43:37):
we can act as a beacon of hope or an example of it's possible really.

(00:43:42):
I mean, and we, we're going to continue to do our work in our populations and in our segments.

(00:43:47):
And we hope there are many more that come alongside of us and with us and behind us and,

(00:43:52):
And, uh, so there's, there's great work being done.

(00:43:54):
We need more of it.

(00:43:55):
I'd love to see more competition in the market and just really this,

(00:44:00):
this whole idea proliferate and,

(00:44:03):
uh,

(00:44:03):
and gain more traction.

(00:44:04):
Cause I think, uh, I think we're onto something.

(00:44:06):
We're making a good change and I think we can do it.

(00:44:09):
Yeah.

(00:44:09):
I mean, it's just one other question about health part.

(00:44:12):
Did you bootstrap this thing or did you get funding?

(00:44:15):
You know, I bootstrapped it.

(00:44:16):
So I'm, I'm like finishing, right?

(00:44:18):
So it's a services business.

(00:44:20):
You start doing it.

(00:44:21):
Um,

(00:44:21):
I started during the pandemic.

(00:44:24):
So I actually did a lot of pandemic services to start,

(00:44:27):
which was a quick end and then develop core systems and processes and,

(00:44:33):
and got into our next stage of the business.

(00:44:35):
But yeah, no, this is a bootstrap venture.

(00:44:38):
Definitely learned a lot of hard lessons.

(00:44:40):
That's all I bet.

(00:44:41):
Yeah, yeah, yeah.

(00:44:41):
Good for you.

(00:44:42):
Good for you.

(00:44:44):
Well,

(00:44:44):
my last question,

(00:44:45):
which I always ask my guests,

(00:44:46):
I don't know if you're,

(00:44:47):
are you much of a wine drinker?

(00:44:49):
I do love a good wine.

(00:44:51):
Yes.

(00:44:52):
So,

(00:44:52):
so,

(00:44:52):
so basically,

(00:44:53):
cause I,

(00:44:53):
I actually,

(00:44:54):
on the side,

(00:44:54):
I have this,

(00:44:55):
uh,

(00:44:56):
uh,

(00:44:56):
an Instagram called vines with Vinnie.

(00:44:58):
And, uh, I talk about wine and, um, always interested in, in what people like to drink.

(00:45:04):
So, uh, do you have a favorite, uh, grape region?

(00:45:07):
Uh, tell me about your favorite wine.

(00:45:09):
Yeah.

(00:45:10):
I mean, I, I really like a good Cabernet.

(00:45:13):
Um,

(00:45:13):
it's always a go-to,

(00:45:14):
but as I started to appreciate wines a little bit more,

(00:45:17):
I've gotten into,

(00:45:19):
uh,

(00:45:19):
more of a Bordeaux wine.

(00:45:21):
And so really like a good Bordeaux or really good Zinfandel is also good options.

(00:45:26):
But reds are preferable.

(00:45:28):
I like drier reds with some complexity to them.

(00:45:33):
I live in here in Michigan, right?

(00:45:34):
And a lot of people don't see Michigan as wine country,

(00:45:36):
but we actually have some very nice,

(00:45:39):
I would say,

(00:45:39):
white wine.

(00:45:40):
So Chardonnays or some Pinot Grigios that are grown alongside of our Lake Michigan lakeshore.

(00:45:47):
And so if you're ever into some really good white wine,

(00:45:51):
I would say come and try ours here in Michigan.

(00:45:54):
Our red wine sucks.

(00:45:55):
So don't come here.

(00:45:57):
Well, no, that's good to know.

(00:45:58):
I mean, I think there's a lot of wine regions.

(00:46:00):
I mean, I live an hour from Napa Valley.

(00:46:02):
So, you know, I mean, you need a Cabernet.

(00:46:04):
I'm your guy.

(00:46:05):
But when it comes to other wine regions,

(00:46:09):
I know about Michigan,

(00:46:11):
upstate New York,

(00:46:12):
Virginia,

(00:46:13):
I mean,

(00:46:13):
even Texas.

(00:46:14):
I mean, all around the country, they're growing, you know, grapes.

(00:46:17):
And so, but, you know, I appreciate that you sharing that.

(00:46:21):
Well, Nate, thank you.

(00:46:23):
I mean, this is a great, great conversation.

(00:46:25):
I appreciate your insights.

(00:46:26):
I appreciate what you're doing for the industry.

(00:46:30):
And thank you for being a guest.

(00:46:33):
Yeah, no, appreciate it.

(00:46:34):
Great conversation.

(00:46:35):
Looking forward to the next.

(00:46:36):
Okay, sounds good.

(00:46:44):
This podcast reflects the personal views of the host and guests,

(00:46:49):
not their employers or sponsors.

(00:46:51):
See you next time.