America's Most Innovative Benefits Leaders: Jim Millaway

 I've been on a quest over the last seven years to find the “health reform" that few talk about--the do-it-yourself kind. Healthcare's dysfunction and out-of-control costs are well documented. A set of benefits leaders have not only tamed the healthcare cost beast, they are showing that the best way to slash healthcare costs is to improve health benefits.

Underlying political unrest that is in the headlines is the fact that the middle class has gone backwards in the last 20 years — this is a direct byproduct of healthcare's hyperinflation. Consequently, it paints the picture that healthcare is the single greatest immediate threat to America. As I've spoken around the country, it's clear that company executives are boiling mad and want to revolutionize health benefits purchasing and realize they’ve been passive for far too long. They are demanding that their benefits brokers step up their game. It's great to share stories about benefits leaders who didn't simply throw up their hands about healthcare's under-performance--they were committed to restoring the American Dream that has been taken away from many.

The C-suite and benefits leaders I present to are champing at the bit for proven models of success. The leaders highlighted in this series are gaining a great market advantage while far too many of their counterparts are asleep at the wheel as highlighted in Benefits Brokers Are Dead. Long Live Benefits Advisors. The forward-looking advisors came to the realization that they are either part of the problem or part of the solution. I have yet to meet the benefits consultant who consciously wants to contribute to the continued decimation of the middle class by delivering under-performing benefits packages -- many are just waking up to that reality. The recurring theme to the fixes are that they don't advise removing old (under-performing) benefits as that would be too disruptive. Rather, they make the old "Tier 2" and make the Health Rosetta-based approach Tier 1. Put simply, they make bad decisions expensive for the employee and good decisions free or near-free allowing both the employee and employer to win.

[Disclosure: As I've disclosed many times, the Health Rosetta is a non-commercial open-source project that provides a reference model for how purchasers of healthcare should procure health services. In my role as managing partner of Healthfundr, a seed stage venture fund, the Health Rosetta is the foundation of our investment thesis.]

It's inspiring to see employers who have delivered superior health benefits while spending 50% less per capita. Or, how a small manufacturer solved healthcare's most vexing problem--pricing failure--and were influential in leading the largest nonprofit health system in the country to go truly transparent on pricing. It’s not limited to the private sector. School leaders on both themanagement and union side in Pittsburgh acted like adults and worked together to slay the healthcare cost beast. Unfortunately, most labor-management disputes are stuck in the tired old approach of fighting over health benefits when they should be fighting in common cause against a healthcare system rigged to decimate their budgets.

This series will highlight the most innovative benefits leaders who are ensuring healthcare realizes its full potential. They don't accept we have to leave a disaster behind for the next generation--the largest generation in history is increasingly saddled with a colossal mess by their boomer parents. Time and again, they show it's possible to break the cycle of employers spending more than enough money to fund great health benefits and a comfortable retirement yet getting neither with the status quo. In this ongoing series, I focus on benefits consultants, benefits executives and innovators delivering high-performing health benefits. Some will come from the large benefits consulting firms such as such as Aon Hewitt, Mercer and Towers Watson but many are off the beaten path doing great work.

Fortunately, there are employers, school districts, unions and many others who are receptive to the open source Health Rosetta blueprint. I’m regularly asked to speak about how to thwart the heist at customer events for TPAs and benefits consultants, business coalitions, non-profit associations, and public sector organizations. The overriding sentiment is the C-suite and benefits leaders have reached their breaking point and are no longer going to accept that every year they’re obligated to get less and pay more when it comes to health benefits. Consequently, benefits consultants are increasingly following the lead of Jim Millaway, Keith Robertson and David Contorno who I highlighted previously.

Jim Millaway, President and Innovation Lead, The Zero Card; Benefits Consultant, HUB International 
Jim is the antithesis of the stockbroker-like behavior that was outlined in Benefits Brokers Are Dead. Long Live Benefits Advisors. In the hard-hitting Cracking Health Costs, Millaway was one of the relatively few players that authors Tom Emerick and Al Lewis gave rave reviews to. He has long recognized that the status quo of healthcare benefits is performing horribly and has enabled his clients to slay the healthcare cost beast that go well beyond half-measures that sound good but don’t produce real, sustainable results. 

Millaway had the good fortune to operate in Oklahoma where there has been a pioneering surgical hospital that went fully transparent on their prices. The great thing is he figured out a way to productize a one-off practice by a forward-looking healthcare provider. For several years, they have been a pioneer in deploying Transparent Medical Markets that have solved healthcare’s most vexing problem — pricing failure. Their offering—The Zero Card—led them to spin a company out of a benefits consultancy, HUB International, so they could make their transparent medical market offering available to any employer.  

What is your philosophy for how you approach benefits, and what kinds of results have you seen?
It's actually pretty simple, I borrowed the Triple Aim framework developed by the Institute for Healthcare Improvement to optimize health system performance. So everything I look at must meet 3 criteria; improve the patient experience, improve health outcomes and substantially lower cost. Direct Primary Care and Transparent Medical Networks can do all 3 of those exceptionally well while it's virtually impossible for any wellness vendor to achieve even one of those goals.

The scariest thing about the world of benefits is that most people are just meddling with things, throwing more and more layers on top of a fundamentally flawed design. Take 3rd-party disease management for example; how silly is to expect that some unknown person (that doesn't even work in the doctor's office), sitting in a call center 1,500 miles away from your employees could have an impact on their health?

So a few years ago we decided to try a novel approach. I was curious to see what would happen if we made things easy for employees, removed the financial barriers to high quality care and only let doctors play doctor.

QuikTrip is one example where a commercial ACO provided employees an improved benefits package (with way less out-of-pocket expense), the employer got access to quality data and the plan saved hundreds of thousands of dollars in the first year alone. All of that was accomplished with an employee satisfaction rating above 90%. That's a big number in world where, according to an Aflac survey, 25% of millennials would rather clean their toilets than talk about their benefits. 

Enovation Controls is another great example. Here the plan adopted a Transparent Medical Network, on top of Direct Primary Care, that allowed for significantly lower costs for the employer and a new benefit in the form of zero cost for employees and their families. The idea was let's just make it easy, and free, for plan members to get the care they need and let's work directly with providers who have fair prices that are often 50% less than what we had seen before. Enovation Controls has plan costs some 30% less than those of their peers and the Transparent Medical Network they use has a Net Promotor Score of 92 (compare that to the insurance industry average of just 12). 

How you plan to or expect to incorporate the Health Rosetta?

So the Health Rosetta actually presents a wonderful opportunity for employers, employees and even physicians. The physician piece is key because you need to have the people actually delivering care on-board. Thus the 4th and final aim of the previously mentioned Triple Aim.  We have to really re-imagine the entire health ecosystem but the good news is we don't have to invent any one piece. Everything already exists we just have to put the the pieces together in a logical way. 

When you think of what a benefits world built on top of the Health Rosetta would look like it is pretty tough to not get excited. PennWell Corp. is one employer really blazing a trail here. They are laying the foundation of value-based primary care by latching on to the CMS' Comprehensive Primary Care Initiative, they have employed a Transparent Medical Network and also offer a Centers of Excellence program for costly and complex care. 

If you had direct primary care through someone like CareATC or Vera Whole Health, a Transparent Medical Market and a Centers of Excellence program through someone like EdisonHealth you would be way ahead of the game.
If you keep doing the same old thing and you expect to see any change then, as my good friend Al Lewis would say, you better layer in a pretty heavy wishful thinking multiplier when you start measuring the outcomes. 

Here's what a client (Brice Habeck,Benefits Manager, QuikTrip) had to say about Millaway and the gameplan they deployed:
Working with Jim is awesome.  Jim works tirelessly to find every possible avenue to solve or improve our Health Plan.  He consistently delivers new and innovative ideas and has been a huge part of our success in our internal HMO.

QuikTrip has introduced an internally managed HMO Plan. The QT HMO Plan has been implemented in five of our nine Markets. Under the QT HMO Plan primary care is managed by CareATC.  When additional care is needed, CareATC will refer patients to specialists participating in the contract QuikTrip has negotiated with the hospital system. QuikTrip negotiates a per-member-per-month (“PMPM”) cost with the hospital systems and “hedges” the cost of specialty care. QuikTrip and the contracted hospital system share upside and downside risk.

The QT HMO Plan has reduced QuikTrip’s overall cost of care, this has allowed QuikTrip to share these savings with the health plan members. Health plan members see a reduction in overall cost, this includes lowering premiums and the members out of pocket expenses are significantly less. Before the implementation of the QT HMO members had a quarterly deductible and coinsurance, now members on the QT HMO Health Plan are only responsible for copays.  There is no cost to the member for CareATC visits or any of the medication dispensed at the Clinic. When a member obtains a referral from CareATC into the hospital system the copays are $15 for a specialist visit, $50 for urgent care, $100 for hospitals, and $250 for an ER visit. QuikTrip went a step further to remove the financial barrier to care by removing the upfront collection of the copay at the time of service.  The copay is actually collected by QuikTrip though payroll deduction after the claim has been received and processed.

Quarterly, Medical Directors from each party meet to discuss costs, processes, and review the quality of care delivered. These meetings have led to the development of standard quality care measurements and incentives were implemented if the hospital system delivers higher quality care.

In Tulsa, QuikTrip saved six hundred thousand dollars after one year of implementation with St. John Health System. QuikTrip members saved significantly by moving from a deductible and coinsurance to copays.

QuikTrip’s goal is for employees to understand and use their benefits. One of QuikTrip’s core values is to focus long term, by reducing the upfront cost of health care to our employees then employees will use their benefits and get the care they need.

This article was also published in Forbes

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