Dr. John Duldner, known as "The Data Doc," brings his unique leadership perspective to healthcare. With a background as a Marine and a medical professional, Dr. Duldner combines rigorous data analysis with compassionate patient care to transform health outcomes. In this episode, he discusses the importance of evidence-based medicine, explaining how good data, physician expertise, and patient preferences must align to create effective treatment plans. Dr. Duldner also delves into his work with employers, helping them provide better healthcare options for their employees, while driving down costs. His approach is rooted in leadership that empowers both patients and organizations to make informed decisions. This episode showcases how Dr. Duldner’s leadership in healthcare is not just about treating symptoms but about crafting a system that prioritizes patient advocacy and long-term results.

Want to learn more about Dr. John Duldner's work? Check out his website at https://www.connect-and-care.com.

Connect with Dr. John Duldner on LinkedIn at www.linkedin.com/in/john-e-duldner-md-ms-a4170789.

Key Points and Timestamps

• [00:00:51] - Introduction to Dr. John Duldner, his Marine background, and his passion for data.
• [00:01:16] - Dr. Duldner’s approach to employer-provided healthcare and improving patient outcomes.
• [00:03:42] - Explanation of evidence-based medicine and its key components.
• [00:04:49] - Challenges of data accuracy in medicine and how Dr. Duldner addresses them.
• [00:12:05] - Dr. Duldner’s advocacy for patients in the complex healthcare system.
• [00:16:24] - How Dr. Duldner works with employers to optimize healthcare plans.
• [00:19:45] - The concept of fiduciary duty and why it matters in healthcare.
• [00:27:00] - Dr. Duldner’s mission to provide personalized and impactful healthcare solutions.

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;10;12
Craig Andrews
Today I want to welcome Doctor John Duldner. He is the data doc and the founder of Connect and Care. There are a few things that I love about John. One is he is a marine. Semper fi. John. And the other thing is he has a passion for data.

00;01;10;12 - 00;01;15;27
Craig Andrews
And I would say even a third thing is he has a passion for improving patient outcomes.

00;01;16;00 - 00;01;26;13
Craig Andrews
Now, we've had a number of guests on leaders and legacies who have been talking about employer provided health care and how to make that better for your employees. And John,

00;01;26;13 - 00;01;30;03
Craig Andrews
is a part of that, but he's he works, directly with,

00;01;30;03 - 00;01;44;09
Craig Andrews
patients and employees for better outcomes. To questions to realizations from May in 2021. My two biggest mistakes.

00;01;44;14 - 00;02;09;27
Craig Andrews
One, I realized I didn't ask enough questions. And the second is I didn't ask the right questions. And I wish I'd met Doctor John earlier in my journey. It would have helped me avoid a lot of headaches. And so tune in. I think this is going to be a very interesting episode. Doctor John, welcome in Semper Fi, Semper fi.

00;02;09;28 - 00;02;11;26
John Duldner
Greg, thanks for having me.

00;02;11;29 - 00;02;16;28
Craig Andrews
Yeah, it's. You know, it's always fun having Marines on the show.

00;02;16;28 - 00;02;19;05
Craig Andrews
We just get each other.

00;02;19;05 - 00;02;33;06
Craig Andrews
And even I was, I was on a podcast once that's hosted by somebody in the army. And there's just a different mentality of people that have been active duty. And he. He said he had people that were messaging him on the show.

00;02;33;07 - 00;02;42;26
Craig Andrews
It was a live showing, and they were saying, how long have you guys known each other? And we just met and, you know, and that's just kind of the kinship that we have as, as Marines. And I,

00;02;42;26 - 00;02;45;27
Craig Andrews
and so happy to have you on the show.

00;02;46;00 - 00;02;50;29
John Duldner
I'm honored to be here, particularly knowing, you know, what you went through back in 2021.

00;02;50;29 - 00;02;54;15
John Duldner
You know, from the story and then from the book is is fantastic.

00;02;54;15 - 00;02;56;12
John Duldner
And, frightening.

00;02;56;14 - 00;03;13;23
Craig Andrews
Yeah. Well, you know, and that's the thing I, one of the things that you talk about and let's because I think this is a great place to start, is the whole thing of evidence based medicine. When we met, you made some comment about evidence based medicine. And that triggered me because,

00;03;13;23 - 00;03;18;22
Craig Andrews
my stepson recorded conversations with the doctors,

00;03;18;22 - 00;03;21;12
Craig Andrews
while I was in the coma and dying.

00;03;21;12 - 00;03;37;05
Craig Andrews
And these doctors are like, well, evidence based medicine, evidence based medicine, and and what struck me was, I think there are three principles, three pillars of evidence based medicine. They hung on to one. There you go. And,

00;03;37;05 - 00;03;42;17
Craig Andrews
and abandoned the other two. So kind of in a nutshell, what is evidence based medicine?

00;03;42;19 - 00;03;49;20
John Duldner
I mean, to me, evidence based medicine really is using the best data, but it has to be good data.

00;03;49;20 - 00;04;03;12
John Duldner
And again, that's why, I mean, the best data to really look at how to treat people, how to screen people for diseases, how to, you know, alleviate pain, all those aspects using the most up to date information that they have.

00;04;03;12 - 00;04;12;09
John Duldner
And Covid presented a lot of issues won, not just the polarization, but the big thing about we didn't know what we were doing. I mean, I got Covid, you know, pretty much in March of,

00;04;12;09 - 00;04;14;02
John Duldner
you know, of 2020.

00;04;14;02 - 00;04;19;28
John Duldner
And about you know, not as bad as yours, but, you know, had some complications there with to and, you know, we didn't know what we were doing.

00;04;20;00 - 00;04;22;00
John Duldner
You know, there were people who were coming in the E.R.,

00;04;22;00 - 00;04;23;28
John Duldner
which is, you know, my, my training,

00;04;23;28 - 00;04;31;15
John Duldner
and within four hours, we're intubating them, right? Because we didn't know at first we were saying, well, we're going to beat these people early, and then later a change. Well, we're going to go through permissive,

00;04;31;15 - 00;04;38;19
John Duldner
ventilation. And then if they continue to deteriorate, then we'll go back and then and then, you know, put them on a, on a ventilator.

00;04;38;19 - 00;04;51;05
John Duldner
So in those cases, evidence based medicine really looks at what is that evolution of data that I can make the best decision now. And, and I can tell you that, you know, the evidence isn't always great, particularly for a lot of things.

00;04;51;05 - 00;04;56;12
John Duldner
Because there isn't enough data, if you will, to actually make a credible decision in there.

00;04;56;15 - 00;05;11;08
John Duldner
You know, physicians have to do what I still believe is a big thing is there's the art and the science of medicine. And it when science doesn't provide you with sufficient background, then it's to me it's appropriate to, to work with the art of medicine,

00;05;11;08 - 00;05;19;00
John Duldner
which means compassion, which means advocating for the for the patient and trying to do the best thing you can for them so that it's a shared decision making.

00;05;19;00 - 00;05;35;07
John Duldner
So in those cases, again, with your situation, you know, what would be the appropriate thing to try. Knowing that we have to try. Right. There's something we have to do. There should have been the art of medicine, not just hey, this doesn't work or or listen, we're going to stop here. So I think that's that to me is the biggest deal,

00;05;35;07 - 00;05;42;23
John Duldner
is evidence based medicine has to use the information, but it cannot be separated from the art of medicine as well.

00;05;42;25 - 00;06;06;13
Craig Andrews
Yeah. And if I understand, correct me if I've got this wrong. The three elements are the data, the evidence, the scientific data supporting it. The second is what you're calling the art of medicine. Basically, it's the it's the expertise of the physician and using some judgment and discretion there, which I call ego. But I think in reality, it's their expertise and their discretion.

00;06;06;16 - 00;06;11;18
Craig Andrews
And then the third, as I understand it, is patient preference. Did I get that right?

00;06;11;20 - 00;06;14;08
John Duldner
I think so, yeah.

00;06;14;10 - 00;06;37;26
Craig Andrews
So yeah, the and the thing that was so bizarre in my situation was they had me on a protocol that had killed 100% of the people that preceded me. And there was no willingness to try other protocols which, were showing up in peer reviewed journals as efficacious.

00;06;37;28 - 00;06;39;16
John Duldner
Yeah. And in those cases,

00;06;39;16 - 00;06;41;27
John Duldner
I don't know if it was,

00;06;41;27 - 00;06;45;07
John Duldner
again, my I don't make excuses for other people, but the,

00;06;45;07 - 00;06;58;08
John Duldner
you have to wonder what the rationale was. Right? And therein lies with what what I like to do. And that is provide that physician side to help the patient or the patient's family to make a better decision.

00;06;58;08 - 00;07;05;03
John Duldner
Right. So that, you know, you're not being bowled over by the system, the institution.

00;07;05;03 - 00;07;16;20
John Duldner
And it could just be the physician that was on that day. Right? So, you know, we look at physician types a lot like, you know, we talk about the military types, right? So there are physician types and some are better than others.

00;07;16;20 - 00;07;19;25
John Duldner
I mean, they all go with the intention of wanting to do what's best.

00;07;19;27 - 00;07;22;07
John Duldner
But a lot of it comes to speak to

00;07;22;07 - 00;07;45;09
John Duldner
how do I actually do not just what I think is best, but best overall. Right. And so what are you talking about, equipoise? Or you want to talk about other aspects? So how do I just make sure that that person is getting the ultimate and best care? And if something isn't working, then, you know, if it if it destroyed the lives of 100% of people, then that's evidence against that activity, right?

00;07;45;09 - 00;07;45;28
John Duldner
So,

00;07;45;28 - 00;07;55;22
John Duldner
so in that case, evidence based medicine could have been being applied because, you know, it said Einstein in theory. Right. Why you keep doing the same thing if you're going to get that same result. That's just insane.

00;07;55;22 - 00;08;01;05
John Duldner
And in those cases, then you have to start wondering, well, let's do something different or try something different.

00;08;01;06 - 00;08;08;28
John Duldner
I think that's one of the unique things that that I like to do is when I'm practicing, I say, we can try this, here's what the evidence says, but we can try this.

00;08;08;28 - 00;08;15;12
John Duldner
Particularly if, you know, we've tried the evidence and the evidence is an effective, then there has to be another approach. And again, that's where case reports start, right.

00;08;15;12 - 00;08;25;12
John Duldner
So they can look at how do I how do I treat this or this is what everyone's been doing. I decided to do something different. And it was a good good outcome. That doesn't mean it's evidence. It means it's a case report,

00;08;25;12 - 00;08;30;08
John Duldner
singular event. It could just be a one off, or there was something else that mitigated that outcome.

00;08;30;10 - 00;08;49;01
John Duldner
But that outcome should be looked at and say, well, maybe there was something valuable there. Right. And there's there's hundreds of examples in health care, where there was 1 to 1 proposed application, but the spinoff was actually more effective than the initial proposal. So and I think, again, that's where that art in the science of medicine continues.

00;08;49;01 - 00;09;03;11
John Duldner
And it has to evolve. It can't be static, right? So it has to continue to say, okay, this isn't working or I've got to go here right. And we do that a lot with the employee data to say, listen, you don't have this or you don't, you need this. And this is how we got to go ahead and get that.

00;09;03;11 - 00;09;15;16
John Duldner
And so it's really about providing when evidence doesn't exist, you have to create those data points so that then you can actually manage that outcome in the best way for the patient.

00;09;15;18 - 00;09;28;17
Craig Andrews
Yeah. You know, one of the drugs that was identified early in the pandemic as potential and I don't think they tried it except late in the pandemic, I do know it saved a nurse's life over in the UK was,

00;09;28;17 - 00;09;37;25
Craig Andrews
Viagra high doses of Viagra to treat Covid patients. And I told my wife, I said, hey, if they give me that, I'm sure what I would set straight up in bed.

00;09;39;17 - 00;09;42;28
John Duldner
Yes, you would have.

00;09;43;00 - 00;09;54;20
John Duldner
But again, you know, you look at the different things about, you know, how drugs work, really it was that it's that mechanism of action, right? I mean, what makes Viagra work right. The phosphodiesterase inhibitors, all these, whatever, they're right that, you know,

00;09;54;20 - 00;10;07;25
John Duldner
when we look at that virus and again, the different variants of the virus because of gain of function or whichever, what ends up happening is that, you know, it's biologically something that's occurring that we weren't looking at before.

00;10;07;25 - 00;10;11;04
John Duldner
But now we are. Right. And we see that with cancer therapy all the time.

00;10;11;04 - 00;10;23;08
John Duldner
You know what a great example is? Aspirin. Look at the development of aspirin. I mean, it was something that you know, people would use the bark and that it would help reduce fevers until someone actually came up with acetyl salicylic acid. We didn't know what it was, right.

00;10;23;08 - 00;10;44;15
John Duldner
We just thought it was bark. So in those cases, you know, that development of a known mechanism of action of a medication that is somewhere in the biological pathway that would disrupt the virus or the viral activity within the body or the cells. If we can do that, then we can deploy that, whether or not it's Viagra, whether or not it's,

00;10;44;15 - 00;10;46;05
John Duldner
you know, chicken soup or whatever.

00;10;46;05 - 00;11;04;06
John Duldner
But but again, the reality is that you have to study it and say, hey, if we know this is occurring again, you know, reverse transcriptase or some other kind of medication to see if we can affect that process, do we have a drug that's already a, you know, anti reverse transcriptase medication. Yes we do. Well then we can try that.

00;11;04;06 - 00;11;13;18
John Duldner
And again then it's about clinical trials and those things. But it's that again that evolution of trying to get the best data to answer those questions. So the patients do the best.

00;11;13;20 - 00;11;46;15
Craig Andrews
Yeah. Well something you said a few minutes ago that just really resonated, for me was, you know, that you're there to help patients through this, you know, help them make better choices. What their doctors. One of the things that happened to my wife was they drug her in a room with like 15 or 20 doctors, administrators, you know, people with big titles and, and she she felt all alone in that room.

00;11;46;15 - 00;12;05;27
Craig Andrews
They put a chart up on the wall saying prognosis multiple organ failure leading to death. And they were she just felt so alone in that room. And it sounds like some of what you do is take away some of that sense of aloneness. But by equipping them with information so they can ask better questions.

00;12;05;29 - 00;12;26;09
John Duldner
Absolutely. And so, you know, you envision what was going on in that room, right? You have your wife or family members on one side of the table and then the establishment on the other side. Right. So there's already this kind of antagonistic approach just from a visual perspective, right? You're staring down the gantlet of all these people who are wanting to tell you what to do,

00;12;26;09 - 00;12;32;23
John Duldner
when you're not either capable because, you know, you don't understand the medical side when they talk.

00;12;32;23 - 00;12;41;10
John Duldner
Multi-system organ failure. Okay, that sounds bad. We live through it all the time. You're an example. Do I have the right information?

00;12;41;10 - 00;12;55;25
John Duldner
Well, are we doing the right things? And so someone has to be behind the patient's family or the patient to provide them with that support so that, you know, I always think back about the old, you know, the talk about,

00;12;55;25 - 00;12;56;04
John Duldner
you know,

00;12;56;04 - 00;13;00;23
John Duldner
where.

00;13;00;25 - 00;13;05;11
John Duldner
Military leaders would do artificial things to make their, their, their,

00;13;05;11 - 00;13;15;27
John Duldner
their forces look larger, right? So they'd be dragging trees behind them, making just so it looks like there, you know, ten men is actually a thousand men. So those are the kinds of things that if a patient has,

00;13;15;27 - 00;13;25;02
John Duldner
physician on their side, that automatically sets the level even.

00;13;25;04 - 00;13;34;26
John Duldner
And so they're know that, hey, I'm going to ask questions. I'm here as an advocate for the patient so that we can actually do that. And so in those cases, you know, that's really the key.

00;13;34;26 - 00;13;43;21
John Duldner
You have to be able to take some of that weight of responsibility off of the person so that they can actually breathe and make the decision that's best for them

00;13;43;21 - 00;13;47;23
John Duldner
and best for the patient, and not just, hey, this is what we think you should do.

00;13;47;26 - 00;13;52;05
John Duldner
Because again, maybe, maybe that's not what they should do. And again, in your case, you know, your wife,

00;13;52;05 - 00;13;54;06
John Duldner
you know, you know, she did the right decision.

00;13;54;06 - 00;14;16;26
Craig Andrews
So, yeah. So help me connect the dots. How do you how do you fit in the whole system? I mean, we have doctors, we have insurance, we have hospitals, we have patients. We're who. Who write your checks, who do who calls you? And how does all that connect?

00;14;16;28 - 00;14;25;09
John Duldner
So for us, it's the employer. Right. So the employer is usually one that we would work with. And during that time

00;14;25;09 - 00;14;41;13
John Duldner
we then work with each individual. So the employer basically sponsors us to come in and provide complete oversight to their, to their health plan so that we're working with individuals. And we do that, you know, direct with outreaches, our nurses, our care coordinators.

00;14;41;20 - 00;14;49;05
John Duldner
And so when they have an issue or a question or, or need help with something, they have a one called for complete accountability,

00;14;49;05 - 00;14;51;18
John Duldner
about their health care and their health plan. So,

00;14;51;18 - 00;14;57;01
John Duldner
the employer brings us in and we basically do all the work from there.

00;14;57;01 - 00;15;01;03
John Duldner
Whether or not we're, you know, a number of our docs where they take call,

00;15;01;03 - 00;15;05;17
John Duldner
you know, if it's an oncology situation, then, you know, then we have our oncology, team working on that.

00;15;05;17 - 00;15;09;29
John Duldner
So in those cases, it's it's specifically directed towards the disease as well.

00;15;09;29 - 00;15;32;04
John Duldner
So that everything is custom and tailored and again, based on information that we have from the patient that we have from the claims that we have from pharmacy, everything about that, we want to have that data so that we can make, again, that best approach and evidence to what they need, whether or not something that, hey, you know, we've got a 52 year old male or female that hasn't had their colonoscopy.

00;15;32;06 - 00;15;37;14
John Duldner
Right. They have no other risk factors. But, you know, five years ago it was 50. Now it's gone down to 45.

00;15;37;14 - 00;15;42;05
John Duldner
So that we know we can get that. And then again, whether or not the person I don't want to call

00;15;42;05 - 00;15;51;02
John Duldner
week, well, that doesn't mean we don't test you. Maybe we can look at fit testing or other kind of opportunities to to try to survey whether or not cancer is, is there.

00;15;51;02 - 00;15;57;22
John Duldner
And so again, being able to use that information but still working with that individual to provide them. So

00;15;57;22 - 00;16;01;29
John Duldner
again, we can come in on a lot of different ways, whether or not it's from a third party administrator.

00;16;01;29 - 00;16;13;13
John Duldner
So there's a lot of ways that we can come in. But ultimately, you know, our goal and there's always been helping that individual employee, patient last consumer of health care.

00;16;13;13 - 00;16;21;25
John Duldner
So and that's really where it's at whether or not it's, you know, the husband, the wife, the children. You know we take that whole individual approach.

00;16;21;25 - 00;16;24;29
Craig Andrews
So so what's the

00;16;24;29 - 00;16;31;17
Craig Andrews
what's the incentive for organizations for for companies to, you know, attach it to their health plans?

00;16;31;20 - 00;16;37;00
John Duldner
So I think it's massive, actually. So, you know, the three big things are cost savings.

00;16;37;00 - 00;16;49;28
John Duldner
So, you know, if we look at a plan, we look at the data and say, hey, you're overpaying here or, or hey, you're you're paying way too much on this medication or listen, why there's no reason you should be paying $66,000 for a,

00;16;49;28 - 00;16;58;09
John Duldner
you know, for a knee replacement when those can be directly sourced through a contracting or otherwise, you know, for more than or less than less than half of that,

00;16;58;09 - 00;17;02;11
John Duldner
or cases that we just reviewed a plan and, and the plan actually pay.

00;17;02;11 - 00;17;09;13
John Duldner
This was actually already paid $9,464 for an EpiPen, actually paid it.

00;17;09;13 - 00;17;12;25
John Duldner
Knowing that, yeah, we can get that for 253 over at the over at the,

00;17;12;25 - 00;17;19;18
John Duldner
the local pharmacy. So those are the kind of cases where, you know, we use the data to, to save the plan money.

00;17;19;18 - 00;17;31;13
John Duldner
From the patient perspective, we provide care, navigation, advocacy, everything they need along that journey to make sure that, you know, the navigational boobies are narrow.

00;17;31;16 - 00;17;45;15
John Duldner
And we know the channel that we're that we're taking. So it's not. Hey, I'm taking a, you know, I'm, I'm setting sail on the ocean, and I don't know really where we're going. And and our compass is broken. So we provide that health care, navigation,

00;17;45;15 - 00;17;49;29
John Duldner
at that patient level, which is, again, what we've been talking about.

00;17;50;01 - 00;17;56;13
John Duldner
And the third, the third aspect is it it just looks in terms of being able to cover,

00;17;56;13 - 00;18;02;18
John Duldner
quality and outcomes. And so saving money, you see a lot of people, hey, I saved this plan $300,000.

00;18;02;18 - 00;18;08;07
John Duldner
Because you save the plan $300,000 doesn't mean the people got better care. Again, health insurance doesn't mean health care.

00;18;08;07 - 00;18;14;16
John Duldner
So in those situations, it is about saving money, but it's really about making sure that the quality and the outcomes are there.

00;18;14;16 - 00;18;37;19
John Duldner
Because if you're just doing something, not just the financial outcome now, that's good for the employer, but it's not good for the for the patient. If they're if you're spending that money, even if it's less and they're not optimizing the care they're getting. So, you know, managing the plan cost and reducing those helping the patients and then making sure that the outcomes really are data and evidence driven so that everyone is benefiting from this.

00;18;37;21 - 00;18;59;04
John Duldner
You know, and it helps year after year from costs and recovery and, and again, making sure that the patients are healthy, which then also makes it easier for to retain employees. Right. You talk about jobs and things like that that, you know, employee benefits are a massive consideration for Gen Z, Gen X every generation because, you know, when you start looking at, hey, what are my what are the potential health care costs?

00;18;59;06 - 00;19;01;28
John Duldner
You know, I have to have a way to cover those.

00;19;02;01 - 00;19;12;14
Craig Andrews
Yeah. And I think, you know, based on some data I've heard as we approach 2030, the number I've heard is in 2030, 70% of the US budget is going to be,

00;19;12;14 - 00;19;24;16
Craig Andrews
service on the debt, Medicare, Medicaid and Social Security, you know, 70%. And so at that point, we're going to have to do something different. Something will have to change.

00;19;24;19 - 00;19;33;13
Craig Andrews
It's the prices of health care just so inflated. And I don't believe they have to be. I don't believe they have to be as inflated as they are.

00;19;33;15 - 00;19;43;01
John Duldner
No they don't. There's a lot of opportunities. You know, there's the traditional kind of insurance. You know, it's the same way we've been buying cars the same way for a long time. And then we look at a Carvana that comes up,

00;19;43;01 - 00;19;48;20
John Duldner
we've been buying health care the same way since, you know, it feels like the dawn of civilization, or at least the dawn of health care.

00;19;48;23 - 00;20;04;24
John Duldner
There are opportunities to do a better a better job. But again, it's just not about that final cost that, hey, I can save X number of dollars. If the people still aren't getting better care, then the savings are great, but we're still missing the point of why are we even providing health insurance and coverage for patients.

00;20;04;26 - 00;20;18;14
Craig Andrews
You know, when, as you were describing what you did, there was a slice of it that sounded like what pharmacy benefit managers were supposed to do. And this is still sort of a new concept to me that,

00;20;18;14 - 00;20;27;06
Craig Andrews
pharmacy benefit managers were conceived to help make sure the patient gets better health care and doesn't overspend. Then get on, you know, doesn't get addicted to,

00;20;27;06 - 00;20;27;18
Craig Andrews
drugs.

00;20;27;18 - 00;20;40;24
Craig Andrews
But from what I can tell, it's they've just become a massive shell game for hiding profits. So the big insurance companies can meet their was it their, their profit ratios.

00;20;40;26 - 00;20;48;03
John Duldner
So you know, it's funny because, you know, the law was formally passed in 2021 with the Consolidated Appropriations Act,

00;20;48;03 - 00;20;53;27
John Duldner
ten years ago, 15 years ago, you know, the original laws on the,

00;20;53;27 - 00;21;06;20
John Duldner
the retirement products went through a massive overhaul. Well, that was kind of the intention with the the Consolidated Appropriations Act. And that's put a lot of responsibilities with the fiduciary duty on the employers.

00;21;06;20 - 00;21;30;26
John Duldner
The problem is, and I think the best way to describe this is that there's a fairy tail in health care right now, and it's it's the Emperor's new clothes. So you've got the employer who's the emperor, and you have everybody else who services and serves them to say, well, you know, I've got the broker, I've got an advisor, I've got a pharmacy benefit manager, I've got all these people, and they're all telling me employer, you are beautiful.

00;21;30;26 - 00;21;55;13
John Duldner
Your plan is perfect. We're doing this for you. We're looking out for all these other things. And then you have people like myself and some other people in the industry that are basically putting our hands up saying, hey, you're naked and you're overweight and and, you know, your knees look like they're buckled. There's all sorts of things that, that we're coming in and saying, listen, all these people who are telling you these things, it's completely inaccurate.

00;21;55;15 - 00;22;07;02
John Duldner
And again, we're using either data or other mechanisms to do it. The problem is the employer is the first one that has to take that step and recognize maybe there is a better way. And maybe I shouldn't actually believe in these people.

00;22;07;02 - 00;22;14;25
John Duldner
Because this is an I fight this on a day to day basis, you know, with, with the business because people say, oh, my broker says they're covered.

00;22;14;25 - 00;22;21;19
John Duldner
I said, well, why don't we put your money where your mouth is and we'll do, you know, and I like your your comment about an irresistible first,

00;22;21;19 - 00;22;29;29
John Duldner
you know, first offering. It's like we'll do a data analysis for free if we're wrong, we actually make a donation in a veterans based,

00;22;29;29 - 00;22;32;09
John Duldner
charity that we support. It's like in your name.

00;22;32;09 - 00;22;34;18
John Duldner
So $250 goes to a veteran,

00;22;34;18 - 00;22;35;04
John Duldner
supported,

00;22;35;04 - 00;22;40;12
John Duldner
agency or organization if we are wrong. And so and we haven't been wrong yet.

00;22;40;12 - 00;22;54;03
John Duldner
But we still make some donations anyway. But the important part is, is that employer has to recognize that someone is telling them or they're looking in the mirror and actually recognizing themselves that, hey, they're not covered with beautiful robes and all these, you know, adornments.

00;22;54;05 - 00;23;16;18
John Duldner
They really are naked and they're they're missing on their fiduciary duty. They're not compliance with their they have no compliance with gag clause. Their DC reporting is completely unused and it's being held against them. So they don't see some of the pharmacy rebates that they should be getting. And again, that it's ultimately their responsibility to look at some of the lawsuits that have come up for breach of fiduciary duty by the employer.

00;23;16;18 - 00;23;21;10
John Duldner
So and, you know, the prediction that these are all going to keep going up in 2025.

00;23;21;10 - 00;23;38;14
John Duldner
And I don't disagree because there are those kind of organizations that will eventually say, hey, I'm not doing what I'm supposed to. And we come in and we try to help with that because that allows us to say, listen, you're now in compliance because we're taking a look and we're taking care of all these things that you weren't doing before.

00;23;38;14 - 00;23;39;09
John Duldner
So.

00;23;39;11 - 00;23;46;22
Craig Andrews
So in simple speak, what was the fiduciary duty? What's that mean? That's a big phrase. What's that mean for them?

00;23;46;22 - 00;24;11;25
John Duldner
Yeah, yeah. And it means a lot in different things. So you know investing fiduciary. But in the health care fiduciary they're supposed to act in the best interest. The plan is of their members. So all their employees are supposed to receiving or possibly receiving the the best I guess, for lack of a better description, you know, the best outcomes,

00;24;11;25 - 00;24;14;27
John Duldner
and the best stewardship of those health care dollars.

00;24;15;01 - 00;24;34;13
John Duldner
So they shouldn't be paying $9,646 for an EpiPen, right? That right there is a breach of fiduciary duty because and is something that someone can file a suit against because, you know, not only is the it's a self-employed plan. So the the the the employer pays one component, but you have to remember that the patient still has a deductible.

00;24;34;13 - 00;24;47;20
John Duldner
And so until that deductible portion on that that's met, it's a it's not only for them as well. So any time where the plan is not acting in the best interest of its membership, there is a breach of the fiduciary duty. And this is happening all the time.

00;24;47;20 - 00;24;55;25
John Duldner
And all the brokers advisors and all these other organizations who are, who are, who are allegedly supporting the employer are not helping them.

00;24;55;25 - 00;24;59;06
John Duldner
They're actually hurting them in the in the fiduciary space.

00;24;59;08 - 00;25;04;02
Craig Andrews
Well, and from what I've read, it's it's a fairly easy mistake to make. I mean, my goodness,

00;25;04;02 - 00;25;12;15
Craig Andrews
Johnson and Johnson, a very sophisticated company, breached their fiduciary duty and they got more than $20 million lawsuit.

00;25;12;17 - 00;25;16;19
John Duldner
The and it was over the cost of one drug. And so,

00;25;16;19 - 00;25;24;08
John Duldner
you know, again, that's why he uses the example of the EpiPen because that plan is is at high risk if the employee would find an attorney and say, hey,

00;25;24;08 - 00;25;26;19
John Duldner
you know, I want to sue about this, and they would have a case.

00;25;26;19 - 00;25;35;19
John Duldner
So and even if they don't have the case or the case gets settled out, like a lot of them, it's still occurs.

00;25;35;21 - 00;25;44;19
John Duldner
We haven't seen a plan yet that that is functioning above. And again, we have what's called a clinical claims assessment score. We look at either 1015 or 20 metrics.

00;25;44;19 - 00;25;51;25
John Duldner
We haven't seen one hit above 37 out of 100. And again, that takes into consideration pharmacy contagion, medication therapy management,

00;25;51;25 - 00;25;53;14
John Duldner
screenings and all sorts of kind of things.

00;25;53;20 - 00;26;12;28
John Duldner
And so this is why when we look at and try to help an employer to say, here's the data and here's where, here's what is the problem. But at the same time, we're not just saying here, here's your problem, you know, see us, we'll see you next year. And we can we do this again. We actually come back and say, here's the problem, here's the solution.

00;26;13;01 - 00;26;13;22
John Duldner
And again, that's,

00;26;13;22 - 00;26;29;00
John Duldner
the Marine Corps way, right? We don't just say, hey, we recognize, hey, there's the enemy. You know, the mercy of the ring, a rifle squad, right? Locate close with and destroy the enemy by fire. Maneuver or repel the enemy's assault by fire in close combat. So, you know, you still look at. Yeah. 40 years later, right?

00;26;29;00 - 00;26;48;01
John Duldner
Still on the back of that. But there it goes. Right. So it we know what the problem is. We know the solution. We're going to implement the solution, and we will be victorious again for the plan in this case, because that's really the idea. So what we have to do for them because again, most people in the business world, they know their business.

00;26;48;06 - 00;26;56;22
John Duldner
They're not in the business of health care, which is the whole reason why they enlist the help of a broker and all these other kind of people that that are, again, all the people who are doing the, the emperor,

00;26;56;22 - 00;26;58;02
John Duldner
or the Empress that they're not,

00;26;58;02 - 00;27;00;27
John Duldner
that, you know, that they're beautiful and they're really not.

00;27;00;29 - 00;27;16;00
Craig Andrews
Well, I love your example about the, the Marine Corps because, in, in health care, it feels almost like Chesty Puller in the same razor wire way. You say, hey, the the enemy has simplified their problem. Our problem? They've surrounded this. We can shoot in any direction.

00;27;16;02 - 00;27;19;05
John Duldner
That's right. Yep.

00;27;19;08 - 00;27;29;25
Craig Andrews
So. Wow. Well, I heard something there says as we wrap up, I think there's something very actionable that just seems like a no brainer.

00;27;29;25 - 00;27;31;28
Craig Andrews
You have this assessment,

00;27;31;28 - 00;27;36;23
Craig Andrews
for $250, which is. I mean, that's nothing,

00;27;36;23 - 00;27;45;10
Craig Andrews
where you'll look at somebodies plan and see if there's a gap and if you don't find problems, a veteran gets a donation.

00;27;45;12 - 00;28;00;10
Craig Andrews
If you do find problems, they start working on the past. They they're meeting their fiduciary duty, their, you know, their gag order. You listed off a whole bunch of things that still make my head spin, but they're at least on that path to making things right.

00;28;00;12 - 00;28;01;16
John Duldner
Absolutely.

00;28;01;18 - 00;28;05;17
Craig Andrews
So how do they how do they get that? How do they reach you?

00;28;05;20 - 00;28;08;09
John Duldner
So, you know, they're obviously, you know, on LinkedIn,

00;28;08;09 - 00;28;18;14
John Duldner
you know, they can find me there, you know, connect can I can Caricom, you know, where to go or where they can actually call, you know, (440) 829-7562. So,

00;28;18;14 - 00;28;19;14
John Duldner
any of those ways,

00;28;19;14 - 00;28;21;12
John Duldner
you know, we'll be happy to help.

00;28;21;15 - 00;28;28;07
Craig Andrews
Excellent, excellent. Well, doctor John. Doctor donor. Sorry.

00;28;28;07 - 00;28;30;25
Craig Andrews
This has been outstanding. And,

00;28;30;25 - 00;28;44;19
Craig Andrews
you know, I think there's a lot of actionable information. I would. I wish my wife had known you in 2021, because she would have had a lot of questions, and you would helped her through a really tough situation.

00;28;44;21 - 00;28;48;28
John Duldner
Well, you know, I'm sorry she had to go through it and obviously what you had to go through.

00;28;48;28 - 00;28;58;12
John Duldner
But yeah, that is really, you know, one of the mantras we have with connecting care is it's like putting a doctor in the family, right? Not everyone is that lucky. And I look at the genesis of connecting care was the bad care.

00;28;58;12 - 00;29;06;05
John Duldner
My father got diagnosed with cancer. I couldn't get him in to see somebody. No one would call me back about test results, all sorts of things.

00;29;06;05 - 00;29;13;06
John Duldner
There were 17 errors in his care. And again, you know, as a marine, as a as an ear doc, I don't have a small personality. I mean, we we live life,

00;29;13;06 - 00;29;14;20
John Duldner
and that's why there's a lot of shows about E.R..

00;29;14;20 - 00;29;15;20
John Duldner
Right? So,

00;29;15;20 - 00;29;27;26
John Duldner
we have that ability and that need to be able to control situations. But if I get pulled over, then 9 or 9% of people are getting pulled over. And that's the mission, really is to avoid that happening

00;29;27;26 - 00;29;33;01
John Duldner
to people. So we try to put a doctor in the family so that, you know, even if you have a doctor, the family doesn't want to get involved.

00;29;33;01 - 00;29;43;28
John Duldner
Or again, we work with it's making those decisions easier for people based on evidence and based on, you know, what, what we think is best in those situations. We may not know. And again, there's the art in the science.

00;29;44;03 - 00;29;53;10
Craig Andrews
So yeah, well, I hope people reach out to you and take you up on your offer. That sounds like an incredible offer. Thank you for being on Leaders and Legacies.

00;29;53;13 - 00;29;54;20
John Duldner
Semper fi.

00;29;54;22 - 00;29;58;11
Craig Andrews
Semper fi.

00;29;58;11 - 00;30;25;05
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

00;30;25;05 - 00;30;27;00
Craig Andrews
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00;30;27;02 - 00;30;50;12
Craig Andrews
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00;30;50;14 - 00;30;58;19
Craig Andrews
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00;30;58;19 - 00;33;00;26
Craig Andrews
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