Neer Patel, founder of Virtuous Benefits, shares about his innovative approach to healthcare through direct primary care. Patel discusses the challenges within the traditional healthcare system and how his model offers a more affordable and effective solution. By eliminating insurance company interference and focusing on patient-centered care, direct primary care allows physicians to spend more time with patients and provide higher quality care. Patel also shares insights on how employers can integrate this model into their health plans to reduce costs and improve employee health outcomes. His vision is to transform the healthcare landscape, ensuring better access and care for all.

Want to learn more about Neer Patel's work? Check out their website at https://www.virtuousbenefits.care.

Connect with Neer Patel on LinkedIn at https://www.linkedin.com/in/neerp.

Key Points

• 00:00:00 - Craig Andrews introduces the podcast and shares his personal healthcare experience.
• 00:01:17 - Introduction of Neer Patel and his background in healthcare.
• 00:03:05 - Explanation of direct primary care and its benefits.
• 00:05:21 - Challenges faced by physicians in the traditional healthcare system.
• 00:09:44 - Differences between concierge medicine and direct primary care.
• 00:12:29 - Patient expectations and benefits of direct primary care.
• 00:17:18 - Handling frequent patient needs under direct primary care.
• 00:25:13 - Transition from supporting his wife's practice to addressing broader healthcare issues.
• 00:28:11 - Neer Patel discusses the flaws in the health insurance system.
• 00:34:46 - How Virtuous Benefits helps businesses manage healthcare costs.
• 00:39:02 - Craig Andrews and Neer Patel discuss the importance of sustainable healthcare models.

Transcript

00;00;00;00 - 00;00;30;20
Craig Andrews
I was in a coma for six weeks while the doctors told my wife I was going to die. When I woke up, she told me the most fantastic story. My team kept running the business without me. Freelancers reached out to my team and said, we will do whatever it takes. As long as Craig's in the hospital. I consider that the greatest accomplishment of my career.

00;00;30;23 - 00;00;51;10
Craig Andrews
My name is Craig Andrews and this is the Leaders and Legacies podcast where we talk to leaders creating an impact beyond themselves. At the end of today's interview, I'll tell you how you can be the next leader featured on the show.

00;00;51;10 - 00;01;17;02
Craig Andrews
Today I want welcome Neer Patel. He is the founder of Virtuous Benefits, which is in the health care space. And for those that know my story, you know that I almost checked out of this plan about three years ago and spent three months in the hospital. And. And during that time, I saw part of the health care system that really was really disappointing, very disappointing.

00;01;17;04 - 00;01;42;27
Craig Andrews
And so I've been looking to speak to people like Nir, who are making a difference in health care. So if you're an employer, he has a message for you. if you're an employer, you already know health care costs are going up. He has an answer to that. If you're an employee, when it comes to health care plan, you need to hear this as well, because it is impacting you.

00;01;43;00 - 00;02;00;08
Craig Andrews
Now, I would say even if you're someone like me who buys their own health insurance, I'm looking forward to what Nir has to say because he's one of the vanguard, the impacting, you know, starting with companies. But a lot of this stuff will eventually trickle down. We don't know how, but eventually it will trickle down to the individual buyer and so near.

00;02;00;12 - 00;02;20;21
Craig Andrews
He's actually an engineer by degree, and I love that. As a fellow engineer, I, I love the way engineers thinks because they just kind of break things down and solve things. And he got into it because his wife, Doctor Katrina Iqbal, is a direct primary care practice provider. And we're going to talk about what that means.

00;02;20;24 - 00;02;31;13
Craig Andrews
But I've met both Nir and his wife. They're amazing people. Listen, and this is going to be a great episode. And so welcome, Craig.

00;02;31;13 - 00;02;33;05
Neer Patel
Thanks so much for having me.

00;02;33;07 - 00;02;56;20
Craig Andrews
Yeah. So I mean, just to give some folks some contact context, you know, we both live in the BCC Lakeway area just outside of Austin, and we met at the BC Chamber of Commerce and, at the what at the time, Katrina was running this thing, home practice. And you, you were kind of running the business, and she was running the stethoscope.

00;02;56;20 - 00;03;05;20
Craig Andrews
You were running, the rest of it. And I guess the first question is, what is direct med?

00;03;05;23 - 00;03;43;13
Neer Patel
Sure. Yeah. So direct med is a direct primary care medical practice that we started, roughly ten years ago. mainly to, to, to try to help fix kind of the genuine, the problem of, you know, sort of genuine primary care not existing, in the health care system. My wife was working in urgent care facilities around Austin for several years after she finished her medical training and quickly realized, you know, there they're forcing me to see 30 or 40 patients a day there, bonus ING me on how many patients I can get in and out the door, not how healthy I make people.

00;03;43;16 - 00;04;18;14
Neer Patel
And this is just something that I'm not interested in doing for the next 40 years of my career and any, any practice that I work for. The bills insurances are all going to be like this, so I have to find a different way. And so we heard about direct primary care, which is a growing movement, I would say for the last 20 years or so of physicians breaking away from the traditional health insurance health care system and hanging their own independent shingles, again, like doctors used to do 50, 60 years ago, where there used to be independent, family owned family practices around the country.

00;04;18;17 - 00;04;50;29
Neer Patel
That's that's what direct primary care is. It's this movement of that coming back to where doctors can break away from insurance contracting, charge an affordable monthly fee, usually somewhere around $100 a month for adults and half that for kids. And now they can practice medicine on their own terms and not have to deal with, you know, the handcuffs that, third party payer like an insurance company puts on them, saying, you know, dictating how they practice medicine, how many patients they see, how long they spend with patients and that sort of thing.

00;04;51;01 - 00;05;21;07
Craig Andrews
You know, there's there's something you said that I think so important to understand. And I admittedly, I harbor some bad feelings, to doctors in general and some very specific doctors in my journey. But there's a moment of empathy and something you said that just really jumped out to me. You know, Katrina had finished med school, amounted to a huge amount of debt, I'm sure, to get through med school.

00;05;21;10 - 00;05;46;14
Craig Andrews
And she's in the system and she realizes this is not what I thought I was getting into. And I would imagine that that was kind of a terrifying moment where it's easy to feel stuck. I've got this. It's not like I can quit. And, you know, go work at McDonald's or, you know, or start up a restaurant. I've got these massive bills, this debt to pay off, and I've got unique skills.

00;05;46;16 - 00;06;15;19
Neer Patel
That's absolutely right. Yeah. She came out with half $1 million in loans. And, you know, you you feel very trapped in that sort of situation, especially when you're blindsided when you come out and work in, you know, the traditional system and very quickly realize all these years of education and mentors teaching me about spending time with patients and listening, to to be able to help them and heal them.

00;06;15;21 - 00;06;21;25
Neer Patel
I'm never going to be able to do that. It's very frustrating for physicians.

00;06;21;27 - 00;06;40;21
Craig Andrews
Well, I mean, that's just when I listen to that, that just gives me such a sinking feeling in my heart. I mean, I think about times in my life where I've felt trapped never to that degree, and how horrible that that would feel.

00;06;40;23 - 00;07;21;16
Neer Patel
Absolutely. Yeah. It's it's it's a real problem with, with medicine in this country and there are thousands and thousands and thousands of physicians all over the country that feel that way. thankfully, there is the direct primary care model that has taken off and is here to stay and is growing exponentially. And all the direct primary care physicians that have had the foresight and the opportunity to go off on their own and break away and do this independently, are now teaching all the rest of the physicians about this, and so that they're aware and that they know that there is a path to do something different, that is, helps you advocate

00;07;21;16 - 00;07;32;27
Neer Patel
for patients and yourself, rather than, you know, sort of conforming to the stock in a box, system that's been become created in this country.

00;07;32;29 - 00;07;55;16
Craig Andrews
You know, I, I was approaching 20 years ago that I first heard of something. I lived in Greensboro, North Carolina, and there was a doctor there that did, she called it concierge medicine. And I think one of the things that's been confusing for me is the difference between concierge medicine and direct medicine, direct med.

00;07;55;19 - 00;08;22;00
Neer Patel
Sure. Yeah. That's, that's a great question. It's a question that I get asked all the time. So these are all just words, right? Concierge direct. They're just words or, you know, models that physicians can adopt, and then they're still going to create their practice however they want to. So whether you adopt the word concierge or you adopt the word direct primary care, you can create your practice however you want to.

00;08;22;02 - 00;08;51;26
Neer Patel
That's the easiest way that I explain the difference from what I've seen and do. My research is concierge medicine is generally much more expensive. and direct primary care is generally much less expensive and affordable and more genuine in the respect that they're not going to bill insurances at all. So direct primary care practices generally do not bill any insurances at all, and they keep everything very affordable and very genuine to their patients, the relationships and the care.

00;08;51;28 - 00;09;21;01
Neer Patel
Whereas concierge doctors a lot of times will charge much higher retainer fees, you know, 5 or $10,000 a year, versus, you know, one, 1 or $2000 a year for a direct primary care practice. And they'll still bill insurances on top of that retainer fee. and so in my mind, when you're, when you're billing insurances in any capacity, you are working for them, you're not working for your patient.

00;09;21;03 - 00;09;44;03
Neer Patel
And so you're obligated to do a lot of the things that are, in my mind, nonsensical that they sort of forced you to do because they're going to pay you something. And so you you really can't be a genuine practice if you're billing insurances. So direct primary care is really just a much more affordable and genuine version of concierge medicine, in my opinion.

00;09;44;06 - 00;10;18;27
Craig Andrews
Interesting. You know, and when I saw this, this particular practitioner, I think she was charging like 1500 or a couple thousand a year to be one per patient. So it's in the ballpark of what you're talking about. Again, 20 years ago. But I just did kind of back the, you know, napkin calculation. And she capped at like 400 patients and and when I did the back of the napkin calculation, I figured out that she was working less than 40 hours a week.

00;10;19;00 - 00;10;43;02
Craig Andrews
And taking home over 400 K a year, and which doesn't upset me. I just thought, oh my goodness, that would be that would be amazing. Have reasonable hours, still get paid well for that expensive education and the patient's benefit because she had a patient cap and you know, you could get same day appointments and and all these sorts of things.

00;10;43;02 - 00;10;48;29
Craig Andrews
What the does that do those numbers at all resonate is that ballpark ish.

00;10;49;01 - 00;11;10;19
Neer Patel
It's a little bit higher than than what I've seen. generally direct primary care physicians, I think will be closer to the 2 to $300,000 range on what they take home. their lifestyle absolutely is much, more conducive to, you know, having a really good work life balance and having a family life and those sorts of things.

00;11;10;22 - 00;11;31;18
Neer Patel
When you work for an insurance company, you know, not only are they double, triple booking, you make, you see 40 patients a day, you're having to chart, you're having to type things into the chart and codes and do all the billing things. As a physician that allow you to get a reimbursement, if you don't chart properly, you don't get the reimbursement.

00;11;31;20 - 00;12;03;15
Neer Patel
And so physicians get very, very backed up in the charting process. And so they're basically taking their work home every single day and at night, after spending 12 hours seeing those 40 patients, now they're charting all the rest of the night. They don't really have the opportunity to have a good work life balance or family life. And that's what DPC offers to physicians, is this idea of there is nobody that's putting handcuffs on you and telling you you're you're only going to get paid if you do this, this or this.

00;12;03;17 - 00;12;18;12
Neer Patel
This is, a physician able to practice medicine genuinely, the way they were trained in medical school and residency without those handcuffs and without all that billing and coding that they have to do in the chart in order to get paid.

00;12;18;15 - 00;12;29;26
Craig Andrews
Yeah. Now, from the patient perspective, you know, what would be what would be my expectations if I went direct med for my primary care?

00;12;29;28 - 00;12;50;12
Neer Patel
So, you know, the first thing we say that I think surprises people is we can handle about 90% of all the care that you need for your health. People are usually shocked when we say that because they're like, how can you do that? When my family or every other family doctor I've ever seen, they can't even handle 5% of the things that I need for my health.

00;12;50;14 - 00;13;29;04
Neer Patel
And so the way that I kind of answer that is physicians, generally speaking, are trained very similarly. Right. And in medical schools around the United States and residency programs around the United States, if you specialize in family medicine, internal medicine, pediatrics, those are the three main primary care specialties. You're trained generally the same as your peers. And the way that you're trained is you're rotating through the hospital for three years straight, working 100 plus hours a week, and you're rotating through every single specialty in the hospital neurology, cardiology, emergency medicine.

00;13;29;04 - 00;14;02;19
Neer Patel
Right. Every single specialty. So you know a little bit about every single specialty in medicine. You're trained very broadly as a family physician, and you're trained broadly enough to be able to handle 90% of people's health care. The difference is when they come and work in the traditional system for for these third party payers or insurances, they quickly realize if they're forcing me to see 20, 30, even 40 patients a day, that means I can only spend 5 or 10 minutes with each patient.

00;14;02;21 - 00;14;28;17
Neer Patel
Medicine is an art. It's a practice. It's it requires a huge amount of mental work and in five minutes, it doesn't matter what. You know what, Ivy League training you have, or, you know, if you were at the top of your class and in all of your training, it doesn't matter. You cannot physically do something in five minutes to take care of somebody genuinely, and help them through 90% of their issues.

00;14;28;20 - 00;14;39;00
Neer Patel
You need time, and you need genuine relationships in order to be able to to do that, you know, to care for people the way you trained.

00;14;39;03 - 00;14;53;20
Craig Andrews
So direct med, 90% of the care I'll need is, is provided. How long is it? You know, so let's say I wake up tomorrow and I'm not feeling well. how long would it take me to get in the office?

00;14;53;22 - 00;15;12;28
Neer Patel
So as long as you're you're already established. Meaning you've had the first appointment with your doctor. you will you simply just shoot them a text, you'll explain what's going on, and they're going to respond back to you, and they're going to triage it. They're going to say, you know, I know exactly what that is. Let me call something in or, you know, try this, this and this.

00;15;12;28 - 00;15;29;12
Neer Patel
Let me know how you're feeling tomorrow or, you know, those symptoms that you're describing to me, they sound a little bit concerning. I'd really like to just have you come in, and I'd like to listen to your heart or your lungs. Can you come in? You know, this afternoon or tomorrow morning? So it's same or next day. Care?

00;15;29;14 - 00;15;35;26
Neer Patel
Yeah. When you reach out to your DPC physician after you've become established, you're going to get taken care of same or next day.

00;15;35;29 - 00;15;53;15
Craig Andrews
But, you know, and there's you know, you were talking about the insurance companies and coding and what have you. And right there I see a difference, or at least what seems like a difference, you know, for the, you know, for my primary care to be able to get paid by submitting a, you know, a claim to the insurance company.

00;15;53;17 - 00;16;10;23
Craig Andrews
A lot of times he needs to he needs to see me and put a stethoscope on my chest. And what I'm hearing you say is a lot of things don't really take that much. It's, oh, you got green stuff coming out of your nose. Why don't we do this?

00;16;10;25 - 00;16;33;22
Neer Patel
You're absolutely right. And that's the only reason why we physically have to go into our doctor's office and the insurance based system for every single thing we need is so that they can bill our insurance. There is no other reason other than that. And so in direct primary care, it's an affordable membership that's always being paid to the physician for them to be available to help.

00;16;33;22 - 00;16;56;01
Neer Patel
And so you're right, a lot of things can be handled virtually. where and especially when when the physician knows you very well, they know you like a family member, and they have a small number of patients on their panel. That's where the magic happens to where, you know, I know that you frequently get you know, these utilize on a regular basis.

00;16;56;01 - 00;17;18;20
Neer Patel
You don't have to come in. And, you know, I already know this is a part of just your life in general and how your body operates. And so let's just call it an antibiotic for this, because I know you and I know that your body, you know, experiences these things and gets better with these treatments. So, yeah, there's not a lot of unnecessary, visits and things like that that have to happen.

00;17;18;23 - 00;17;35;20
Craig Andrews
Now, let's say I like I just really come down with a whole series of things, and I'm, you know, I'm calling Katrina, you know, five, six times a month for 2 or 3 months. Does is is that extra or is that covered? How does that work?

00;17;35;23 - 00;17;57;17
Neer Patel
It's all included in the membership fee. So it's basically a gym membership. So you know, as much as you want to use the gym or not use the gym, you're paying your membership fee and you have the access. And that's that example is a great one, because that's where people really see the value in direct primary care is when something happens like that, where they do need to be followed closely for, you know, a certain period of time.

00;17;57;17 - 00;18;19;03
Neer Patel
That's when they're like, doc, I'm so glad I have you, because I don't know what I would have done in the the traditional system, you know, and I know I wouldn't have recovered or become, you know, this healthy from that situation that happened to me in that system. Whereas I can just shoot you a text. You've got appointments for me every three days and you're watching me closely.

00;18;19;03 - 00;18;22;06
Neer Patel
And and this got resolved really quickly.

00;18;22;08 - 00;18;48;26
Craig Andrews
Yeah. You know, something that happened in my own care when I, you know, when I, about one year after I got out of the hospital, I went for a physical and had blood work done, and my creatinine was high. And for those that don't know what that means, basically that can be an indication of poor kidney function.

00;18;48;28 - 00;19;10;02
Craig Andrews
And I was going to camp Gladiator at the time asked, they I was saying my pa, it was rare that I would actually see a doctor. I like my shoes very nice. But I asked her, I said, is there any chance that my chem gladiator is causing my elevated create? And she was like, absolutely not. And, she said, let's do more blood work.

00;19;10;02 - 00;19;28;19
Craig Andrews
And, you know, 2 or 3 weeks I do that comes back creatinine even higher. And for those that don't know, you know, you don't want your create a new diet, you want it lower. And, and she started getting really nervous. And I asked again, is it any chance it was my camp Gladiator. No no no no, you need to keep working at you need to keep working out.

00;19;28;22 - 00;19;47;09
Craig Andrews
And I had, I ran into somebody who knew what they were talking about, and they said, Craig, I think it's your camp Gladiator, because it was driving me hypoxic, which means, you know, low oxygen and turns out your kidneys like oxygen. When you deprive them of oxygen, they don't behave well. And so I went back with that and asked a third time she said, absolutely not.

00;19;47;09 - 00;20;10;21
Craig Andrews
Keep on going. And so I ended up having to self-diagnose, and I stopped camp Gladiator for 3 or 4 weeks, went back, did more blood work in my craft, and then came down. Well, the point of that whole story was and I changed doctors, at that point. And the point of that whole story is when I went to my new doctor, he said, Craig, your case is complex enough.

00;20;10;23 - 00;20;31;26
Craig Andrews
You shouldn't be seeing a PA, you should be seeing a doctor. You've got a unique medical history. And so, I guess, one of the things I'm wondering if I were to switch over to direct med, would I be shuffled off to another PA or do I have a doctor? How does all that work?

00;20;31;28 - 00;21;06;11
Neer Patel
Great question. Yeah. So we, we don't employ any what they call mid-level providers or advanced practice practitioners. which are generally nurse practitioners or physicians assistants. We don't employ any of those, those, providers in our practice, we only employ physicians. And it's really for the reason that you you just kind of mentioned with your story, you know, there's a reason why, there are different degrees, physician degrees versus, nurse practitioner degrees.

00;21;06;13 - 00;21;39;22
Neer Patel
The training is very different. The, the hours of, you know, residency. There is no residency in nurse practitioner or physician physician assistant school. The hours that physicians put in in residency, like I mentioned, working 100 hours a week for three years, rotating through every specialty in the hospital, that's really the difference, is having that residency experience and seeing, you know, the worst of the worst over and over and over again and, and learning how to treat and react and do all the things.

00;21;39;25 - 00;22;04;08
Neer Patel
it's just invaluable. And so that's the reason why, you know, it's it's it's much it's very important to have a physician following you and watching over you. there's absolutely a place for nurse practitioners and physicians assistants, but, but for that to be the only care that you ever receive without a physician even watching you or looking at the charts.

00;22;04;10 - 00;22;07;28
Neer Patel
I don't think any any physician would support that.

00;22;08;01 - 00;22;34;00
Craig Andrews
Well, if if I hadn't made a change, I would've done irreparable damage to my kidneys. that was really a wake up call for me. that was really a wake up call, you know? And the other thing, when I think about, I think about that medical practice, and someone. If I said it live on the air here, you would.

00;22;34;02 - 00;23;05;10
Craig Andrews
You would absolutely know who they are. they have multiple offices here in Austin, one at the Galleria, one near MD. And I remember, I remember, it was about six weeks after I got out of the hospital. I, you know, obviously I had Covid, and, and the doctor stops in a meeting with the PA, and the doctor stops in and he starts badgering me about getting a vaccine.

00;23;05;13 - 00;23;27;07
Craig Andrews
Well, my I was in a wheelchair at the time. I couldn't walk my body. I mean, my body completely atrophied and, you know, there were two questions that came to mind. Was one, do you really think I'm strong enough for that vaccine? It knocks people in there. But, you know, and the other thing is I just recovered from Covid.

00;23;27;07 - 00;23;54;14
Craig Andrews
Don't you think there's some immunity baked in to the fact that I just had the disease that you're asking me to get vaccinated from? And I heard something, and I've actually seen something with at least one health care, one insurance provider is the doctors were financially incentivized to get all of their patients vaccinated. They would get paid by the insurance companies for pushing that vaccine.

00;23;54;16 - 00;24;19;04
Neer Patel
Yep. That's that's definitely, something that I've heard as well. We're not you know, none of our doctors are actually working in the hospital. So I don't have personal experience from any of our physicians that have kind of had that, you know, personally happen to them. But I definitely heard during that time there were a lot of financial incentives that that drove physicians to do things that weren't necessarily what they would have done otherwise.

00;24;19;07 - 00;24;21;08
Neer Patel
Wow.

00;24;21;10 - 00;24;42;29
Craig Andrews
But it's back to that being trapped in that system. You've got a mountain of, college debt, you know, you know, med school debt that you're paying off and you're in the system. You probably have a family, you know, a mortgage, all the things. And I would imagine you feel very trapped.

00;24;43;01 - 00;24;45;06
Neer Patel
Absolutely.

00;24;45;09 - 00;25;13;23
Craig Andrews
So, now, what's really cool is, you know, when you started off, you were working with your wife, supporting her practice, but seems like at some point you caught a bigger vision and you said, you know, there's. We can take this beyond just individuals. We can take this to businesses. So what? What's involved there? What did you do and what what are you doing?

00;25;13;23 - 00;25;16;14
Craig Andrews
What's, virtuous benefits do?

00;25;16;17 - 00;25;34;02
Neer Patel
So when we started the practice ten years ago, both of us went out on a limb. You know, we rented a tiny little room here in Lakeway and started the practice with zero patients. We had no idea if it was going to be successful or, you know, what was going to happen. But we but we knew that we had to do something different, and we thought this was the right thing to do.

00;25;34;02 - 00;26;04;16
Neer Patel
And so we started the practice. We started taking amazing care of our patients. Word started to spread through word of mouth, that that there's a much different way to get medical care that's very high quality and very affordable. And so patients started coming to us. And that's when I quickly realized that we're not going to have a problem growing this practice with patients, what I call retail patients, just people off the street that are looking for better care, that are frustrated and, you know, and I also realized there's all these other physicians.

00;26;04;16 - 00;26;23;00
Neer Patel
There were hundreds at that time. Now there's thousands, you know, but back then there were hundreds of physicians wanting to do this. And I quickly realized, you know, if we're going to grow and scale our practice because my wife will only be able to take a few hundred patients. So I know we're going to have to try to hire more physicians because the patients aren't going to stop coming to this.

00;26;23;02 - 00;26;52;28
Neer Patel
And I know the rest of the physicians around the country that are doing DPC are also going to face that. So I started thinking from a bigger picture. You know, most people in this country get their health care from their employer. And so if we really want to propel this direct primary care movement that we know is the right thing for them, we have to figure out how to build it into employer sponsored health plans, because that's how people are going to become aware that this exists and even have the opportunity to try it.

00;26;53;00 - 00;27;13;10
Neer Patel
And so that's when I sort of dove headfirst into the health insurance industry to learn everything that I could about health insurance. Why do we operate the way that we do? Why are we sort of programed to think health insurance is health care when there are actually two separate things? And, and why are we sort of programed to think?

00;27;13;12 - 00;27;33;21
Neer Patel
Well, I just I just have to everything has my insurance. My health insurance has to cover everything. and so I started kind of learn, you know, researching and figuring out the answers to some questions that I had around all this. And then I really and then I and then I started realizing how much greed was actually filled into this health insurance system.

00;27;33;23 - 00;27;47;20
Neer Patel
And so then my objective became, well, we need to figure out how to remove the greed from health insurance plans and build direct primary care in. Yeah. And so that's that's really how virtuous benefits started was, was when I started doing that.

00;27;47;22 - 00;28;11;18
Craig Andrews
Well. And there's, there's something you just said about, you know digging into insurance and it's it's a discussion I've had with people and it's, it's interesting the way we consume health care. And in the United States, I think, has broken our brains. And what I mean by that, you know, people say, well, I want everything covered. I want everything covered by my health plan.

00;28;11;20 - 00;28;30;20
Craig Andrews
And I ask, well, why don't you just pay? You know, if you know that you're, you know, you're going to have a fiscal once a year, why don't you just pay directly for that? No, no, no, I want my health plan to cover it. And what's missing from that is if your for your insurer to be viable for them to be viable on the day that you need them.

00;28;30;20 - 00;28;52;24
Craig Andrews
And I, I mean, for me, I needed, I ran a couple million dollars in medical bills. of course that's goofy numbers. You know, that's the little games that they play. But, I don't know. Let's cut in half or let's cut by. You know, a third. Let's say that the real cost of, you know, my three months in the hospital was only, you know, half million, three quarters of a million.

00;28;52;24 - 00;29;20;26
Craig Andrews
That's half a million, three quarters of $1 million I don't have, you know, I can't write a check for that. And so I need that health insurance to be there for that day. But for them to do that, if, let's say, a physical just using round numbers, let's say a physical cost 100 bucks, if my health plan is going to cover that, then they need to charge me at least $130 to provide that $100 benefit.

00;29;20;28 - 00;29;38;08
Craig Andrews
And so it's cheaper for me if I just write that $100 check directly, instead of saying, I want a plan that will cover that $100 benefit. But I think as Americans, because the way we've consumed health care, I think we have trouble understanding that getting there mentally.

00;29;38;10 - 00;29;46;07
Neer Patel
You're absolutely right. And, and you're on the right track, except that $100 becomes $1,000 for them, right? That check.

00;29;46;10 - 00;29;48;25
Craig Andrews
Wow. Help me understand that.

00;29;48;28 - 00;30;09;18
Neer Patel
So there's, you know, when we when we're talking with employers, one main thing that we try to help them understand is, is this network that you're used to, that you've been told by your current advisor, this network, right. Blue Cross's network, United's network, you know, the big networks that are out there. Is it helping you or hurting you.

00;30;09;21 - 00;30;31;03
Neer Patel
And and what we mean by that is what happens behind the scenes. How does the insurance company actually make money. And so most people would say, well, they're charging me a premium and they probably make a percentage of that as their profit. That's just the baseline starting point where the insurance companies make their money. So the premiums are just the baseline starting point.

00;30;31;08 - 00;30;51;17
Neer Patel
They're not making. They're they're astronomical revenues. They're where they're making their astronomical revenues is through the network that when you really think about it, they're forcing us to use. Right. If you have out of network benefits in your Blue Cross or United plan, they will be greatly reduced. If you go out and network, your benefits will be greatly reduced.

00;30;51;17 - 00;31;14;25
Neer Patel
They'll generally double your deductible. They'll do things like that to where they're essentially forcing you to use their network. And so we have to think about why are they forcing us to use this network. And the reason is because that's how they gouge us in the health plan. And so they have pre negotiated contracts with doctors and hospitals around the country.

00;31;14;27 - 00;31;32;21
Neer Patel
If you as a consumer or a member of their insurance ask them. I'd like to see the contract you have with Doctor Jones, my cardiologist. They'll tell you that information is confidential. We don't share that. And we have no legal right to see those contracts. And the reason for that is because those contracts are in their favor. They're not in our favor.

00;31;32;23 - 00;31;53;05
Neer Patel
And so when you go to your doctor's office, where all you see is your $30 copay, the actual cost of that visit, let's just call it $200, right? For a doctor visit, you're paying a $30 copay and you're getting your visit done. So you have no idea what the true cost is. Let's say it's a $200 visit. If you were to walk in and say, I have no insurance, I'm a cash patient.

00;31;53;07 - 00;32;13;10
Neer Patel
So that bill, when you plop down your blue cross card, it gets sent to Blue Cross. Blue cross has five different people look at it. And so, you know, verify the codes, audit the bill, send it back and forth with the facility. And so then Blue Cross says we have to pay our five people office space, salary, benefits.

00;32;13;13 - 00;32;41;02
Neer Patel
So we're going to add $500 to the bill for that. And then Blue Cross says us as a corporation, we have to make money. So we're going to add another $500 to the bill for that. And so now your $200 doctor visit became $1,200 because of their administration that they added on to their bill. The other thing that they don't tell us is that they don't have to ask anybody's permission to pay themselves that thousand dollars.

00;32;41;04 - 00;33;04;15
Neer Patel
They are managing the plan. It's their plan. They are managing and administering the claims. It's their network. So all the money that gets paid in and premiums from all their policyholders, that's basically the plan's money. That's their their pot. And they can reach into it and pay themselves that thousand dollars willy nilly however they please, without having to ask anyone's permission.

00;33;04;20 - 00;33;26;01
Neer Patel
And that is what they do. Every single time we use our health insurance card for every single health care service. Now, when we're talking about a doctor visit, it's small in the grand scheme of things, even though it sounds like, yeah, $1,000 for something and cost 200 is crazy. Think about when you escalate that now to pre-planned surgeries and bigger things, right?

00;33;26;01 - 00;33;47;27
Neer Patel
A knee surgery or hip surgery. The numbers that I generally hear from people are. Yeah, that I could never afford that. That knee surgery was, you know, $150,000. What they don't realize is that $150,000 is it's a it's a made up number. Right. Let's just like you kind of talked about with your couple million dollars of, three months of hospitalization, these are made up numbers.

00;33;47;27 - 00;34;11;02
Neer Patel
These aren't true numbers of actual cost of what things cost. So out of that 150,000, it incentivizes Blue Cross to pay or to allow a claim to come through for a higher amount like that, $150,000 for a knee surgery, because Blue Cross is going to take half of that. Right. And then they're going to give the hospital the other half.

00;34;11;04 - 00;34;18;26
Neer Patel
Whereas if, if most people don't realize the true cost of a bundle knee surgery is $19,700.

00;34;18;29 - 00;34;46;13
Craig Andrews
Yeah. Wow. So. And you know there's so much detail here. I mean we we could go on for another hour, I have no doubt. but let's let's think about from the, from the perspective. So you're helping businesses. I wish you were helping individuals, but we're not there yet. And I accept that. How are you helping businesses? What does what does what you do mean, the businesses?

00;34;46;13 - 00;34;52;05
Craig Andrews
And why should somebody running a business start thinking about changing the model that they're doing?

00;34;52;07 - 00;35;14;20
Neer Patel
So as health care continues to get more and more and more expensive, which I think every business owner that's listening today would probably agree if they're offering health insurance to their business, they would probably agree that my health insurance cost went up this year, last year, and every other year before this, and it probably went up, I would say somewhere between 5 and 20%.

00;35;14;22 - 00;35;41;06
Neer Patel
every year it's we call it the health care dance. You your advisor, broker, whoever's handling your, your health plans or your benefits will call you, you know, nine, ten months after the plan started and say, we've got your renewal rate of what UnitedHealthCare is going to charge you next year. We'd like to have a meeting and discuss it with you 100% of the time, they're delivering bad news that we're getting another 10 or 15 or 20% increase next year.

00;35;41;09 - 00;36;05;13
Neer Patel
We we did all the negotiating we could do, but you just had way too many claims, which they don't tell you. UnitedHealthCare overinflated every single one of those claims. And now they're charging you more because you had them. They don't tell you that part. And the other part they don't tell you is they're getting a raise. Your advisor is getting a raise at the exact same time that they're delivering this bad news to you.

00;36;05;15 - 00;36;28;28
Neer Patel
And so the Blue Cross is the Uniteds of the world are paying all of the brokers and advisors out there, essentially to keep the money flowing, to keep the premiums going up and up and up. Their compensation is a percentage of your premium as the employer. So that's just a backwards incentivized model. The employer and the employees will never win in that situation.

00;36;28;28 - 00;36;58;05
Neer Patel
So you definitely need to understand as a business owner, how is your advisor being compensated when they're advising you on something? but we're, you know, we're essentially fixing that problem of our costs are going up. My cost as a business owner is going up. 1015, 20% every year. That's an unsustainable amount. My cost for my employees, even if we can afford it as a business, my costs for my employees, we share the cost of the benefits with them, their portion.

00;36;58;05 - 00;37;20;25
Neer Patel
It's going up ten, 15, 20 plus percent. They can't afford their premiums. And even if we could afford the whole thing, we can afford 100%. We're going to pay for all of our employees and their dependents. Health care, their out-of-pocket expenses are going up dramatically to where they can't afford those, so their insurance is 100% covered for them in their family.

00;37;20;28 - 00;37;46;27
Neer Patel
But then they go and use it. And now they get what we call surprise bills, right? There's a reason why they call them surprise bills. It's because, no, there is no transparency in medicine. Nobody has a price anywhere for anything. So you have no idea what something's going to cost you. It's like going to the grocery store and then just telling you just, you know, just take buy it, pick up whatever you want off all the shelves in here and just walk out.

00;37;46;29 - 00;38;10;12
Neer Patel
We'll build you later, you know, and then you end up getting a $50,000 bill later for your $500 groceries. So just, Yeah, it's it's that kind of situation. So that's really what we're helping resolve with, you know, our strategy and and it's really a long term strategy that shows an employer and employees. How do we how do we how do we rate premiums logically?

00;38;10;14 - 00;38;38;00
Neer Patel
How do we build in the right types of care, like direct primary care that's going to be affordable and also very high quality, catch things early, minimize claims. And how do we reduce or almost eliminate the out-of-pocket expenses for our employees? Those are the things that we're doing, which when you put them all together, it actually helps. Insurance costs go down year over year rather than up.

00;38;38;02 - 00;39;02;07
Craig Andrews
That's awesome. And, you know, I, I talk to people around the country that are tackling the same problem you're doing, but tackling it differently. And the one thing that I hear from them is they have so much respect for what you're doing. And, and that's encouraging. And what that means is bright minds are working on the same problem from different angles.

00;39;02;10 - 00;39;28;25
Craig Andrews
And, as you mentioned, you know, if you have a line item in your business that's going up double digits year on year, unless your top line revenue is going up much more than that. you're you're working your way out of business. This has to be addressed. So, for those that want to talk more, how do they reach you?

00;39;28;27 - 00;39;57;12
Neer Patel
Sure. Yeah. So they can, all of our contact information is on our website. Dot virtuous benefit square. they can call, text, email, live chat with us. all of our, you know, our phone numbers there, our email address is there info at Virtuous benefits dot care 512887 3011 is our phone number. we'd love to hear from any employers and just want to want a different perspective and want to be educated about, you know, what does that look like?

00;39;57;12 - 00;40;06;19
Neer Patel
How how how how can you lower the cost of insurance year over year, without just moving me from a PPO to an HMO or something like that?

00;40;06;21 - 00;40;27;25
Craig Andrews
Yeah. Well, there I, I applaud, what you and Katrina are doing, to fix us. you're getting ahead of the problem. This. Well, this is not sustainable. It has to be addressed. And so I'm so thankful that, you guys are working with it. I do hope people reach out to you. And, thanks for sharing them.

00;40;27;26 - 00;40;29;06
Craig Andrews
Leaders and legacies.

00;40;29;09 - 00;40;38;22
Neer Patel
Thanks so much for having me. This is great. Had a had a really enjoyable time chatting with you and and sharing some stories. So really appreciate the time.

00;40;38;22 - 00;41;07;20
Craig Andrews
This is Craig Andrews. I want to thank you for listening to the Leaders and Legacies podcast. We're looking for leaders to share how they're making the impact beyond themselves. If that's you, please go to Alize for me.com/guest and sign up there. If you got something out of this interview, we would love you to share this episode on social media.

00;41;07;22 - 00;41;31;02
Craig Andrews
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00;41;31;04 - 00;43;41;18
Craig Andrews
Please go ahead and subscribe your thumbs up! Ratings and reviews go a long way to help promote the show. It means a lot to me. It means a lot to my team. If you want to know more, please go to Alize for me.com. or follow me on LinkedIn. Thanks for listening. We'll see you next time.