Healthcare Delivery Reinvented | Advanced Contracting, Direct Care Strategies, and Cost Control

Speaker A: Today on, um, the Benefits Breakdown, the team's joined by Katie Wendorf, who helps lead the Brown and Brown Advanced Contracting Strategies team. What a great conversation as we look into this great upcoming market that looks at how to rethink the delivery of care that could stretch from on site care to direct primary care, surgical bundles, high performance networks, and everything in between. So welcome to the Benefits Breakdown. Let's go.

Speaker B: Hello.

Speaker C: Hello.

Speaker D: Welcome to another episode of the Benefits Breakdown. It's Vanessa Longnecker here with Jared and Adam. We are excited to have fun with you all today.

Speaker A: Good to see you both.

Speaker B: How's everyone doing?

Speaker A: It's a party.

Speaker B: It is a party.

Speaker D: Katie. Katie, we have on the line with us today. How are you doing?

Speaker C: I'm doing well. I'm excited. Um, I just learned about this podcast last week actually when Adam shared it with me and I've binged it over the last week. So I'm excited to be here. This is a great, uh, forum and love the conversations you guys have. So thanks for having me.

Speaker B: We try to make benefits fun.

Speaker A: Yeah, I think we do. We try to. Well, I know you've, you've also, as you identify as Katie, you also have a last name, Katie Wendorf. And Katie, you are the, uh, practice leader for our Brown and Brown Advanced Contracting Strategies. So that's a lot like, there's a lot that we're going to talk about in there today. But before we get into there, who are you? Just tell us a little bit about what and who you are because that's in my opinion, as important as what we do day to day.

Speaker C: Yeah, absolutely. So I've actually been at Brown and Brown for two years, but I don't come from a benefits background. I actually have about 25 years of healthcare experience in product strategy and operations. Most recently, I spent a decade at a pearl and health solution company where I worked a lot of the time that I was there in onsite care delivery, around, um, biometrics, health promotion, uh, screening events, clinics, fitness centers. So, um, after I finished that stint, I wanted to explore other opportunities in the benefits world is kind of where I landed. And I'm excited to be in the space where I get to work with a lot of different employers who have complex problems and strategies that they're trying to execute. So it's a fascinating, fast paced world that I enjoy being a part of. And then personally, I live in Minnesota, which Vanessa, I know you can appreciate. We have very short summers, uh, so we're in the summer season. So right now my Focus is if I'm not out on the lake, floating in a boat, um, and enjoying the sunshine in the summer, I am on a baseball field watching baseball games and in that spot, really trying to maximize the three months of summer we have here.

Speaker B: I love it. Baseball fields in the spring and summer is some of the best days. That's awesome.

Speaker C: Yes. And usually in a really random city in Minnesota, I feel like I travel all over the four corners of the state. So it's fun though.

Speaker D: Well, when you're not on a baseball field or traveling across the state, I know you're traveling all over the country focused on helping employers solve.

Speaker A: Oh, that's a good transition there, Vanessa. That was really, that was really good.

Speaker D: I like that.

Speaker C: Like that.

Speaker D: Anyhow, um, from planes, trains or automobiles, work owners in states to across the country, you've done tremendous work in helping employers, uh, solve for pretty significant pain points with very creative strategies. That said, I don't know that the average listener probably understands what is truly advanced contracting. Right. And how does that. Can you give us a simplified version of what that is and what you do?

Speaker C: Absolutely. Um, well, the simple answer, when you just break down the name, I would say is we really work on strategies that happen outside of the health plan that are advanced strategies around driving cost containment and access to care. Um, but if you truly take a step back and think about it from the employer perspective, mental health, many employers today face this continue, and you hear it in every conversation. Healthcare costs continue to rise and employees are still having struggles accessing the right care. It's fragmented, there's poor health outcomes. And so for many, many years, as you guys know, the focus of employers has been on plan design changes, um, and those different levers to drive, uh, cost containment. But those aren't solving the underlying problem. And so our role is to really help employers think differently about health care by helping them create a strategy that improves access to the right care in the right setting at the right time. So whether we're helping design a new clinic or optimize an existing on site clinic program, implementing a direct contract, uh, managing a vendor, or helping improve accountability or our goal is always the same. Um, how do we drive better employee outcomes, a better healthcare experience, and a lower total cost of care. Um, so advanced contracting strategies is really that healthcare consulting practice that comes up along employers to help them optimize how healthcare is delivered to their employees and families. And we work across advanced primary care, on site nearsight clinics, occupational health, direct contracting, healthcare navigation, and overall healthcare delivery strategy.

Speaker A: So why does it matter? I mean, I mean this from a financial perspective. We talked about the employee experience, but it's here because something's not really working. Well, what's the thing that we're answering from the industry perspective that is causing these things to boom and keep your travel schedule absolutely nuts?

Speaker C: Yeah, yeah, absolutely. I think, um, access is the biggest issue, uh, with rural employers. How do I get my employees access to care so that they can engage with their care earlier and more often? Uh, cost is an issue. Uh, how do I get them access to lower cost options so that they'll seek care earlier so that they are getting the full treatment that they should be getting so that down the road they don't progress and have worse outcomes and cost the employer more? Um, I would say those are probably the two biggest things is access and the cost. Those are the two primary goals that we're trying to achieve.

Speaker B: When those things are talked about, Katie, I feel like they're in our industry or the trend is to talk about them together.

Speaker C: Mhm.

Speaker B: And focus on access to care

Speaker A: outcomes,

Speaker B: um, and total cost. But I want to take a step back and talk about access specifically. Why are we having problems to access to care? What are some of those barriers to care? What are some of those things that uh, the average person out there is struggling, um, to get access or why probably said better.

Speaker C: Um, that's a really good question. I think that access is usually the starting point for everything. And when employees can't get access to primary care, preventative care, or even chronic condition management, it leads to a delay in treatment until problems become more serious and more expensive. And what you're seeing, I think a lot of times in the primary care space is it's a long wait time to get in. There's not enough primary care providers. You get seven minutes when you go into that appointment to go through all the things that you need to go through. Usually that problem isn't solved in those seven minutes and you get referred to a specialist. And so it gets really hard for the average person to just navigate those challenges. Uh, it's not, I can't get in for six months. I'm just going to ignore it and keep moving on. Or man, they just referred me to a specialist. My plan is really expensive. I can't afford to do that. So I'm just going to not worry about it. And so that leads to things progressing. Higher emergency room utilization, unnecessary specialty care at some point, avoidable hospitalization, that worse health outcomes. And I think employer, that's where employers are Seeing this increased cost of care. And so um, they're turning to strategies like advanced primary care, on site clinics, care navigation, direct contracting so that they're actually starting to control healthcare delivery and engaging in healthcare delivery so that their employees can get care earlier and more consistently, um, which can lead to better outcomes clinically as well as from a

Speaker B: cost ah, perspective what you just shared, I am living right now as I'm making the transition away to a new primary care physician or trying to find a new primary care physician.

Speaker A: Phi alert.

Speaker B: I live in a very phi alert. I won't share phi. I'm just sharing. I'm searching for a new primary care physician. I decided I needed to find an internist. As I'm a little more seasoned in my life, I want to have someone that's a little more special.

Speaker D: We're seasoned, aren't we?

Speaker B: And the reality is I live in a major metro area where you would think there would be a lot of access to care. And it's more difficult than I thought to find a highly rated internist that's accepting new patients right now. And so I think the average health, and I think maybe not the most savvy, but I'm a decent savvy person when it comes to navigating the healthcare system and it was difficult, it was a challenge. So um, the average healthcare consumer, what you described I think is a real journey that they're on and a real struggle the average American is finding to create that access to care, to create that initial entryway point into our healthcare ecosystem through their primary care. And if I'm struggling and I'm someone that lives and breathes this every day, I can't imagine that average person out there trying to navigate the system and the struggles that they're having. And so I think your point is so well taken that access to care is such a jump off point that if employers are not paying attention to it, you're exactly right, their employees are just punting that ball down the field and hoping for the best.

Speaker C: Yes, I would totally agree, which is unfortunate because um, if people were able to more easily navigate and get access to care, you would see probably a lot of different outcomes for people. Um, and I think, ah, in retrospect people often say, gosh, I wish I had done something earlier. And so I think that's what's really interesting about this space and why I'm passionate about it because it really does impact the patient and getting the patient to engage in their health earlier and in an easier way that's um, higher quality and lower cost.

Speaker D: Well, Jared, you bring up such an important metric, right? Like, this isn't just rural access to care, which is on steroids relative to the experience you've just said. It is everywhere. The dynamics of navigating the healthcare space has changed that access to care and specialty and the likes has changed. Right. So I don't think there's any market that's exempt. Right. It's, it's something that has growing frustrations from a member experience perspective. That's precisely why you're flying around the country and your team is so valued in the day to day conversations in solving for these pain points with employers of all shapes and sizes. Right. So, uh, you know, it's, it's an interesting dynamic and it's adding to, um, the creativity and the innovation in our worlds. Right?

Speaker C: Absolutely.

Speaker D: To solve that.

Speaker C: Yeah. To add on to that. I do think that's something really interesting because we have a lot of clients that are in rural spaces that are like, I need a clinic. And we're working through that process of evaluating it. But there's also a lot of employers, just even here in Minneapolis, where I am, we have a lot of different health system options. But I think that, uh, at first blush, they don't think they need a clinic or they need a direct contracting strategy because their patient or their employees have tons of access. And that's where partnering with them to take a step back to really understand their population and identify where their health care dollars are really being spent. I think it can be enlightening for them to see. Wow. A lot of my spend is in specialty care. And if I could move that patient earlier into their healthcare continuum and get them into preventative care and being proactive, I could be saving a lot of money. And, and so kind of bringing that to life for clients and getting them to think about things a little bit differently is something that we're doing very commonly right now and encouraging them to look at their data and their strategy. What are the biggest cost drivers, where are people going today and what health conditions are driving spend, and then that's where we can really step in and partner.

Speaker B: So, Katie, I want to dive in just a tiny bit deeper in this, um, and I won't be a side hustle like Adam and Vanessa love when I create my side hustles.

Speaker C: I like all your side hustles. I've been hearing all of them as I've been listening to the podcast.

Speaker B: So you probably got like 50 jobs. I know, but if I am that middle Market employer. And I'm trying to figure out how to create that better access. What are some of the things that I should be talking about or thinking about to, to help bring that to life? I mean maybe I don't feel like I'm large enough to have an on site clinic because I might have a few hundred employees or close with that, whatever that number is, but they're dispersed around. I don't have it really centrally located. What are some things that I can maybe be thinking about or talking about to help create that better access to care?

Speaker C: Yeah, I think um, taking a step back, like I said kind of before, just understanding your population, using data to help you understand where your dollars are being spent, how are people utilizing healthcare today and then looking at the trends there to understand where is the low hanging fruit and where can I make an impact. And so it might be something where you're trying to move specialty care into primary care and get people accessing care earlier. It could be that your MSK spend is really high and just even providing access to physical therapy and a PT first strategy is something that's going to drive savings for you. And that's where we really um, start to engage with employers is when they're trying to put this together and they're trying to wrap their minds around care delivery and access to care. We will partner to do long term partnerships with clients to walk them through that whole end to end process from a feasibility study to making strategic recommendations. And then we don't just stop at here's uh, our recommendations, we like to come alongside and help execute on that strategy to make sure that they're achieving their goals and getting the outcomes that they're looking for. But it starts with the data first and then really taking a goal oriented and strategic approach to it.

Speaker A: So if we're gonna not side hustle it, but maybe lean in a bit to some of your experience, uh, bringing this all together. I think that curiosity of what success looks like is something that design that you've built and uh, I think another layer of that is how you execute it. I'm sure you've learned things even sometimes where we've underestimated maybe the complexity or maybe lack of like what are some, if you can think of one or blend a couple of scenarios of case studies. What are some things that you've seen work really well and just some things that you've learned over your time?

Speaker C: Yeah, I think uh, organizations tend to underestimate probably what happens after implementation. I think they think the hard part is the strategy definition and maybe going through an RFP and implementing. But I think that um, the complexity comes after implementation and the real work starts when the strategy goes live. So that requires ongoing governance, vendor accountability, reporting, um, driving employee engagement, performance management, continually trying to optimize that clinic, um, or that those access points that you've established. And so without those elements, um, even a well designed strategy can underperform. And you see that often it's, you implement it and you forget it. And so um, this is a process. It takes time, it takes um, uh, just being patient as well. I think people think I want that ROI right away. And you have to be patient and get people engaging in it, utilizing the care the way that you've designed the care to be delivered. And then you'll start to see sort of the snowball effect of the roi. And um, I think for HR teams especially, who can be spread across a lot of different benefit categories, that's where the complexity comes in. They start to get overwhelmed and then they're like okay, I just want to shut this down because it's too much. And I think that's where our team really can come in and help navigate some of that complexity and build partnerships to drive that ROI.

Speaker D: Obviously KPIs ROI, all of those things you have to be really mindful of up front. What are our goals? Uh, obviously what I'm trying to solve for with the data. And I think if I'm a listener right now, and this is a very new concept to me, right. This isn't just about an on site clinic. Right. Direct contracting, certain centers of influence, different types of occupational health integration, um, you know, PT first strategies, high performance networks, how that ecosystem might be very foreign to me. So you're also learning right as you're going and that's where your team just shine and understanding how do all these puzzle pieces fit together with what we're trying to solve for and how can I potentially steer, incent and write, promote uh, new way of thinking and behaviors with our customers, journey into the members journey to drive those results. And you're right, happen overnight. But man, have we seen some tremendous early, early results. Maybe there's a case study or two, an example, right. That you could speak to for that new listener that this listener that is, it's a new concept to them.

Speaker C: Yeah, absolutely. There's kind of two examples at a high level of case studies um, that I think I can share. The first one is uh, working with a lot of public entities that want a clinic, but they don't know how to achieve a clinic or um, and so I'll start with that. And they don't know how to evaluate if a clinic uh, is right for them. They're thinking that they want it to be maybe advanced primary care. They might be integrating a health into it as well. And when they think about socializing it through all of their required approval processes, that's where it gets daunting and intimidating. And so um, a lot of our success stories have been where we've been able to take them all the way through that. Is this the right strategy with data to show you could achieve an roi? Looking at historical claims and demonstrating what a clinic could absorb and projecting that out to socializing that story to the city council and to procurement and to other groups to get it approved, to uh, actually take them through the RFP and implementation process. And we're starting to see this be very successful in the public entity space where we're seeing health sitting next to primary care. As patients come in and engage and continue to engage about 18 to 24 months, we're seeing a positive return on investment. And I think that's the most important measurement um, that we talk about is that value that the employer is getting and then taking it a step further and looking at what clinical gaps in care are we closing and um, are we seeing the patient improve over time? Secondarily, I think the second example is somebody who has a clinic but their gut is telling them that they're not getting the full value of their clinic and they're maybe lagging in utilization. It just kind of feels like it's flat. And that's where we've come in several times with employers who are just overwhelmed by the clinic and it's assessing with data where they're at, looking at opportunities to pull levers to increase engagement. Maybe it might be going after a, ah, chronic condition that in particular is driving a lot of cost and moving the needle there by getting heart failure or um, cardiovascular disease into the clinic to do blood pressure checks, to do medication adherence and driving a really measurable um, improvement in those populations. And we have had some m, um clinic clients that have seen that value an increase of like $1,000,000 ROI over a course of a year. And that gets them to take a step back and say, oh my gosh, okay, I'm going to invest in another clinic at a different location. Let's take this a step further and establish a direct contract around physical therapy or imaging. Some of those high cost areas where it's, they, they believe in it and they've started to expand their strategy. So those are kind of two very high level examples of, of case studies where we've seen a lot of success.

Speaker A: Industry is booming. Right. And so.

Speaker C: Mhm.

Speaker A: And let's be fair, this isn't you're saving, you're spending 100 bucks getting a dollar off. This is real tangible money. And there's not hundreds, could be thousands saved per member per year. Depends on who you are. But I think if you're looking at this, this long term investment, if I'm looking at it from the financial engine is huge. But from the employee engagement, if we're really here to take care of our people and our culture supports that, we're getting people a better member experience and really driving something that shows that we care about people. So I think it's this beautiful blend of money in the bank plus smiling, happy people like Vanessa and Jared. So.

Speaker C: Absolutely. And I'd add to that that um, employers are becoming much more savvy in this space as well. And so they're demanding a lot more transparency and accountability from their point solutions. And so um, in the past utilization might have been great or patient satisfaction was okay, good, it's working. I think what I'm seeing is employers are wanting to see even more about the programs that they've invested in and how it's changing healthcare utilization patterns, how it's improving chronic condition, reducing avoidable costs, creating measurable value because that tells them that their employees from a health perspective are doing better. And they want to know that those that are participating in these care delivery programs are performing better than those that are maybe just participating in the traditional healthcare system fee for service world. Uh, because that's where the impact happens. Where you don't have people going to the emergency room or um, hospitalized for conditions that take them away from work, take them away from family, that type of thing.

Speaker B: I love this conversation so much because I feel like employers oftentimes will say, I don't know what else we can do, we've done this and done that and they're throwing their hands up and I think this is hopefully helping our friends out there listening realize that we can take more control. You can be more proactive, you can find ways to using the phrase, that's the buzz phrase in the industry, deliver care more effectively to your people. Um, from the jump off point to the delivery point to the way they're steering to specialists, to um, and just really be that proactive employer out there to take control. Stealing Vanessa's phrase letting things sit the bench. Going back to our baseball, right, Your son that you travel around with probably hates to sit the bench. These strategies are ready to get off the bench and get on the game and start playing. And I think that it's just up to that employer to take that proactive approach and have the right partner out there who's willing to push the envelope a little bit.

Speaker D: Love, love, love that. I know we could talk, talk about this very topic and all of the amazing work that your team has been doing to help employers move the needle and ensure right this opportunity and these opportunities don't sit the bench. Certainly. Katie, we want to thank you for joining us today on the Benefits breakdown.

Speaker C: First and foremost, thanks for having me.

Speaker D: It is amazing to collaborate with you both on the podcast, but every day right in serving valued customers down today.

Speaker C: Thank you.

Speaker D: In a meaningful way for our listeners. And at the end of the day, there's a lot to digest. This is a very complex and rapidly evolving landscape, but you clearly present significant opportunities for organizations to really take a strategic and disciplined approach. So, again, thank you and we hope to have you back on the show in the future as well. We march towards, uh, fun and innovative ideas on a perpetual basis. So thanks, Katie, and thank you all for listening in today. So of the Benefits Breakdown,