Join host Larry Stout as he introduces himself and his mission to explore innovative solutions in healthcare. This episode delves into the evolution of American healthcare, highlighting how traditional health insurance has acted as a gatekeeper, often complicating access to essential services. Larry breaks down the basics of the healthcare industry, focusing on the crucial roles of primary care and major medical services. He then explores how TeleHealth and Medical Cost Sharing offer alternative routes, bypassing traditional insurance to provide more affordable and accessible care. Finally, Larry shares tips on becoming a savvy healthcare consumer, helping listeners navigate the complexities of the healthcare market with greater confidence. Tune in to discover how you can take control of your healthcare journey in this rapidly changing landscape.
Chapters:
1:02 Meet Your Host, Larry Stout
4:29 American Healthcare Evolving
7:31 Gatekeeper of Healthcare: Traditional Health Insurance
9:56 Medical Industry 101: Primary Care & Major Medical Services
11:17 Bypassing Traditional Health Insurance with TeleHealth for Primary Care
14:32 Bypassing Traditional Health Insurance with Medical Cost Sharing for Major Medical Services
19:20 Becoming a Smart Shopper for Healthcare
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Welcome to Next Generation Healthcare, proudly presented by Optimal Telehealth, our soaring health insurance costs for your family or business causing you stress. tired of the long waits and high fees for a simple doctor's consultation? Then you've found your podcast. Next Generation Healthcare is here to empower you to take back control over your healthcare decisions, freeing you from the constraints set by insurance companies. In our episodes, you'll uncover the secrets to circumventing traditional insurance to access direct services from your preferred providers at savings of 40 to 50 percent. Stout, the visionary founder and CEO of Optimal Telehealth. Now, let's hear from Larry. Thanks for your gracious introduction, Mandy. You make me sound cooler than I am. Welcome to the first episode of the Next Generation Healthcare Podcast. I'm your host, Larry Stout, and during this maiden voyage of our podcast, I'll introduce you to what we refer to as next generation healthcare and provide some insight into what you'll learn from this episode. To begin with, it seems appropriate we should go over a little personal history so you'll know a little more about me. Let's begin with personal background. I'm basically a top performing sales professional. I'm a serial automateur. I'm a small business developer. I don't consider myself an expert on any particular subject, but I have an abundance of knowledge in numerous fields of endeavor. I've experienced both success and failure in business, and I've learned from both. The success I can contribute to pursuit of knowledge, my unwavering persistence, commitment to honesty and integrity, and just an abundance of common sense. I spent my childhood in a small farm town in Central Kansas and matured to manhood after relocated Kansas City where I completed high school and college. After completing college, I moved to North Texas. got involved in the automobile industry, which was my original intent. My initial years were spent at the corporate level with Chrysler Corporation and Nissan Motor Corporation. And then I transitioned into my sales career by joining a large international computer services company. And the division I worked for sold hardware and software systems into the retail automobile industry. It was a great experience, but I left the corporate world in 2004 to invest in Massage Envy franchising. That was not my first business venture, but it was my first significant endeavor into franchising. That time, therapeutic massage had never been consumerized, so people didn't really know what it was. and we had to create our own market for it. My first Dallas-based clinic was number 39 in the nation, so I was obviously an early adapter in the franchise. Massage Envy grew over the years to be the largest massage franchise in the country, with around 1,200 locations today, I believe. Several years later, we relocated to the Pacific Northwest where our son and his wife wanted to start their family, and my wife wanted to be a part of that process. So after we moved up there, I ran them remotely for a couple of years, commuting back and forth and then eventually sold my clinics and reinvested in another franchise in the Pacific Northwest. And that's where I had my first franchise failure experience and it was quite an education. The, one of the owners of the franchise actually embezzled all the money out of the company and left the country. So it kind of left everybody high and dry. Along the way after that period, I've been involved in development of various businesses leading to my current company, Optimal Telehealth. Since leaving the corporate world, my business ventures have primarily focused on endeavors that intended to or had some component in improving the human condition. This venture into Optimal Telehealth is the most significant of those where we are trying to introduce a new generation of healthcare nationwide. Let's transition over to talking about healthcare in general. The U.S. healthcare system is not without its shortcomings, but it's eminently capable of delivering quality services to consumers, to Americans. The reason the United States ranks so low in healthcare performance compared to other nations is because of access to healthcare, not because of the actual quality of the healthcare services we provide. As a result, Americans underutilize primary care medical services, which results in an increased need for medical, for major medical services. Obviously, if you're not going to see your doctor, you're not keeping up, you know, you're not allowing professionals to help you manage your health, you're going to develop more serious problems. And people do that when they try to self-prescribe or cure their illnesses with off-the-counter products. If you're wondering why it takes six weeks to get in to see your doctor, it's because there's a major shortage. Nationally, there's a major shortage of primary care physicians. We'll discuss that in more detail as we go forward. There's a segment of the population that thinks gove single-payer healthcare system is the solution, but that's a hotly contested subject, and personally, it scares the heck out of me. I don't like the idea of the government... taking control over our health care system. I can't think of anything that government does effectively, especially when it comes to managing money. By nationalizing health care, the cost is theoretically spread over the entire taxpayer base. In reality, the government and their inefficiency is not going to get as many of those dollars to actually delivering health care as we would like to see. I don't want to start a political debate on this subject. But I was in the nutritional health business for a number of years, and I'm actually aware the United States is near the top of the list of most obese countries in the world, which is a problem of our own creation. Providing free health care would not only serve to reduce any personal motivation to manage individual health, much like the war on poverty launched during the Lyndon Johnson administration pushed record numbers of Americans into poverty. For decades, we've been living in times where technological solutions are dominant. A lot of our problems are solved through technology. So many of our human needs were addressed through technology as a student of business development. I still strongly think that the capitalistic free market system is especially capable of solving problems such as healthcare access, And at the same time, these principles made our nation the most powerful country in the world and our government had little involvement in that. We did that on our own. Let's move over to what I consider to be the gatekeeper of our healthcare and that's the insurance industry. 50% of Americans get their health insurance through their employers. Only actually less than 9% purchase their own medical insurance. The rest... are primarily on Medicare, Medicaid, and other gove programs. If we can agree we have a good health care system, but the problem centers around getting affordable access to service, then it's logical to evaluate the expense associated with health care and determine what the source of the problem is. Let me ask you a question. Are you aware that if you ask a medical service provider to quote you both an insurance price and a cash price for medical services? the cash price would typically be 40 to 50 percent lower than the insurance price. Most people I say that to are not surprised. They're like, oh, yes, I get that. That's believable. But it's a fact that's well documented. It's also one of the primary reasons the Department of Health and Human Services, the Treasury issued what they call the Final Rule on Transparency and Coverage in October of 2020. Health insurance carriers and medical service providers are now required to publish their costs of services for both insurance and cash-pay patients. In future episodes, we'll get into more detail as to why the insurance industry has inflated health care pricing. They've inflated the price from 80 to 100 percent. And now it's clear the culprit is the inflated price created by the insurance industry. So what can we do about that? It would seem to be out of our control, but really it's not. Common Sense tells us if we can bypass the insurance industry, the cause of the higher pricing, then people need to bypass it and pay cash as a cash pay patient. That may seem a little scary, like a scary alternative since the average American is not wealthy enough to pay cash or medical services, but that's not how it works. In fact, there's a huge national movement underway to migrate to cash pay medicine. To understand how this works, it's not, there's plenty of resources out there to support people in moving to cash pay. But let's... First, we need to understand how the medical industry works, so I'm going to talk about what I call Medical Industry 101. In its simplest form, healthcare is broken into two segments, primary care medicine and major medical services. Primary care is your family physician, also referred to as your general practitioner. They're the first doctor you contact when you need professional help with an injury or an illness. diagnostic centers such as lab testing and imaging facilities, and it even includes the hospital emergency room that can fall under the category of primary care. Many medical conditions are diagnosed and treated within the primary care medical system, but when diagnosis calls for treatment outside the scope of primary care, patients move into what we call major medical. It's common for major medical services to involve hospital stays, surgery, and sophisticated diagnosis and treatment. The solution to this is nothing new. It's been around for a long time and that's what's really cool about this. It just hasn't come to the forefront. So if we understand what causes the problems, let's discuss how consumers get direct access to those services. The tools required to bypass insurance and go directly to the source of your medical care are not new. As a matter of fact, they've been around for decades in the form of telemedicine and what's called medical cost sharing or health share. It's also referred to as health share. The history of telemedicine can be traced back a hundred years, but during the past two decades, improvements in communications technology coupled with the relaxation of state regulations that allow doctors to diagnose and treat medical problems remotely. has resulted in telemedicine becoming a consumer product. So, it's no longer just talking to a doctor over the telephone, it's now a product that companies have commercialized and sell in the open market. Patients can now have their own dedicated physician that can diagnose and treat over 1500 conditions over the telephone, or in video conferences. Diagnosis and treatment of common medical conditions can be consulted with urgent care doctors on a 24-365 basis and get a response within a two-hour window, usually less than 30 minutes. Consultations with your dedicated physician, what they call virtual primary care services, can be scheduled within 48 hours. You don't have to wait two weeks or four weeks to see your doctor. You can be on the phone with your regular doctor within two days. With the addition of specialists, medical services, mental health consulting, and care navigation services, telemedicine has evolved into what we call telehealth because it provides a wide range of health care services. And you can eliminate up to 90% of those inconvenience and expensive trips to the doctor's office by using telehealth services, all very available at a low monthly fee. And it's also extremely convenient, obviously. When patients are referred to a medical specialist by your, when your telemedicine doctor refers you to a medical specialist for diagnosis and treatment or for imaging services or lab work, yes, you still have to go see a doctor in person, but pages are connected with those providers on a reduced cash pay price basis. you've got 24 to 365 access to a doctor. The government acceptance of telehealth services within the Medicare and Medicaid programs strengthen credibility. The strong recommendation during the COVID pandemic where the government was asking people, suggesting people go to see their doctor via telemedicine services to avoid contact with other people. An infection has given telehealth a tremendous credibility. So it's very rapidly working its way into the marketplace. Probably wondering what does major medical look like in next generation health care. Virtual primary care services solve the problems of access and cost control for primary care medicine. What can be done for major medical services? Again, the solution has been operating successfully for over 30 years. But most consumers didn't need it because they had insurance that was affordable and took care and met their basic needs. But affordable financial protection against unexpected cost of medical services has gone up dramatically as insurance companies eventually focused on profit taking. They passed that expense along to their corporate clients primarily and those corporate clients passed portion of that on to their employees. So over the decades, since the 1990s, more and more of this financial responsibility has been pushed right down to the consumer. When problems grew to crisis proportion, the government stepped in with the Affordable Care Act, and that was obviously highly controversial. It was what I consider a band-aid to provide more affordable health care. that was paid for by the consumers. As the government always does, they obtain all their money from consumers through taxes. So all they do is reallocate wealth. It was during this period of the Affordable Care Act that medical cost sharing communities began to attract more followers. There was a problem. Medical cost sharing communities only existed in the face-based communities. That's where it originated 30 years ago, and that's where it remained for so long. But as cost sharing, as the cost of health insurance escalated, our free market system went into action. And companies began emerging that brought health share out of the Christian community and into the open market and made it available to everyone. So earlier in this episode, I said health insurance companies inflate the cost of medical services by 80% to 100%. So if by bypassing the insurance industry and obtaining services at half the cost, then join a sharing community that can reimburse members for medical expenses, we have become smart consumers of medical services and we're in control of our own health care. If Americans were able to observe the evolution of health care over the past several decades, it would be easy to see how health insurance industry has taken control of health care away from the individual and now regulates access to medical services. So how do we become smart health care consumers? This damaged health care system is not going to fix itself. Change will happen when everyone begins to see health care as a consumer product and starts treating it as such. We're a nation of consumers. We shop for everything we have. All goods and services on the market are commodities. So we identify the goods and the services we need and acquire them at a fair market price. That's what we do. That's why we're shoppers. The health care industry is no different. We need to treat health care as a commodity. and it is a commodity, by becoming smarter shoppers and selecting the best services for the best price. As is the case with all consumer products, the industry has evolved to where it provides all the shopping tools necessary to support that transition, because the doctors and hospitals don't like dealing with health insurance companies either. We've all heard the stories about how health insurance companies dictate procedures to that control the amount of time they spend with patients, to say nothing about what they will and won't pay for. Primary care service providers are reliant upon the insurance industry for their income, and big insurance has been squeezing the profit out of these medical services to the point doctors no longer go into business for themselves. As I said early in the podcast, this is one of the primary reasons for the shortage of primary care. physicians in the market. Doctors aren't getting out of medical school and hanging out their own shingle. They are going to work for large medical organizations. Hospitals and major medical organizations are no different than the doctors. They do battle with insurance companies all the time. So making changes to accommodate cash-pay patients is a welcome alternative for them. so don't be concerned that you'll have any pushback from these organizations when you ask for cash pay prices. Consumers should understand all the resources necessary to become a smart shopper of health care are available in many places. In closing, let me assure everyone that there are excellent alternatives available to give everyone access to quality health care at an affordable cost. Americans simply need to embrace the consumer approach to healthcare and become smart shoppers. In future episodes, I'll be taking a deep dive into every aspect of next generation healthcare, providing an intimate understanding of how to manage your own healthcare. Thank you for tuning in to Next Generation Healthcare, brought to you by Optimal Telehealth. Your engagement means the world to us. If you find our content informative, Follow our podcasts on Apple, Spotify, or YouTube. We welcome your participation and will review listener input in future episodes. To leave your questions or comments, access additional episodes, or browse our blog post library, please visit the resources page at Opti You may also connect with us on LinkedIn, Facebook, or Instagram for the latest insights and updates. We look forward to welcoming you back soon. Your journey towards empowered healthcare continues with us.