Allison De Paoli joins Craig Andrews to break down how employers can lead through one of the most neglected aspects of their business—health insurance. Drawing from decades of experience and her family’s entrepreneurial legacy, Allison shows how leaders can stop hemorrhaging money on bloated health plans and start using benefits as a tool for retention, loyalty, and long-term cost control.

She argues the system isn’t broken—it’s rigged. But with the right strategy, employers can bypass middlemen, reclaim fiduciary control, and offer high-quality care without budget blowouts. Allison walks through real-world examples of employers who’ve turned skyrocketing premiums into savings—without shifting the cost burden onto employees.

If you lead a team and think better healthcare is out of reach, this episode will challenge that belief—and give you a roadmap to lead differently.

Want to learn more about Allison De Paoli's work? Check out their website at https://www.altiqe.com.

Connect with Allison De Paoli on LinkedIn at https://www.linkedin.com/in/allison-de-paoli/.

Key Points & Timestamps

• [02:28] A Lesson from Allison’s Father
  A former employee thanks her dad decades later for covering a childbirth deductible—a moment that shaped her leadership philosophy.

• [04:08] Employers Now Run Healthcare Divisions
  At $10–$15K per employee annually, Allison argues every employer effectively manages a healthcare division—whether they realize it or not.

• [06:00] The Beast Isn’t Broken—It’s Rigged
  The system works for everyone except patients, doctors, and employers. Middlemen and hidden costs drain budgets.

• [08:05] Rewriting the Rules
  Allison breaks down how to restructure contracts to regain control: stop-loss insurance, pharmacy benefit managers, and third-party administrators.

• [11:20] Fiduciary Responsibility 101
  Post-2020 regulations hold employers accountable for managing employee healthcare dollars responsibly—even if they don’t know it yet.

• [16:00] The Cash Pay Shuffle
  Craig and Allison share frustrating but revealing stories about trying to pay cash for simple procedures—and what it says about the system.

• [21:00] Healthcare vs. Health Insurance
  Allison separates care from the payment system and reveals how chronic conditions, not basic care, drive most costs.

• [24:00] Direct Primary Care as a Loyalty Tool
  Subscription-based care gives employees frequent access and personal attention—building trust and cutting future costs.

• [30:03] Lip Service vs. Real Strategy
  Allison calls out brokers who repeat her words but don’t deliver results. Lowering costs starts with tackling the cost of care itself.

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 in 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 this show.

00;00;51;10 - 00;01;24;04
Craig Andrews
Today I want to welcome Allison De Paoli with Altiqe consulting. Allison is also the host of Raising the Bar podcast. It's designed to help CEOs and executive teams learn and leverage what their peers are doing successfully into their own businesses. Allison is the daughter and granddaughter of entrepreneurs, manufacturers, car and heavy equipment dealers, and insurance. And she's had a front row seat in what it takes to run a business and manage risk.

00;01;24;07 - 00;01;40;21
Craig Andrews
She routinely advises employers when controlling their health care budgets and turning their benefit plans into recruiting and retention magnets. Now, Allison is one of a series of guests that I've invited on.

00;01;40;21 - 00;01;42;28
Craig Andrews
Because I believe,

00;01;42;28 - 00;01;58;07
Craig Andrews
my my front row seat, my $2 million trip through the hospital showed me how incredibly broken things are. And health care is a double digit year on year increasing budget item for so many employers.

00;01;58;09 - 00;02;07;19
Craig Andrews
And there are people out there that are changing that curve. You don't need to feel hopeless. And Allison is one of those people. Allison, welcome.

00;02;07;22 - 00;02;10;28
Allison De Paoli
Thank you for having me. It's a pleasure to be in such good company.

00;02;11;01 - 00;02;13;05
Craig Andrews
Yeah. So,

00;02;13;05 - 00;02;14;05
Craig Andrews
Yeah, it's,

00;02;14;05 - 00;02;17;28
Craig Andrews
You were telling me a story about

00;02;17;28 - 00;02;22;16
Craig Andrews
your dad. Had an employee that contacted them.

00;02;22;16 - 00;02;28;21
Craig Andrews
And your dad had done something that he probably didn't remember, but it it meant the world to them.

00;02;28;24 - 00;02;29;27
Allison De Paoli
Did he?

00;02;29;27 - 00;02;50;28
Allison De Paoli
So my father was also in the health insurance business. That's where I cut my teeth on self-funding plans. And he sent me a screenshot of a Facebook message he had received from somebody that used to work for him. Probably in the late 60s or the early 70s. So a very long time ago. And it said, Mr. Cohen, nobody ever called my father Mr. Cohen.

00;02;51;01 - 00;03;00;18
Allison De Paoli
Mr. Cohen, I just wanted to thank you. I don't think I thank you properly. At the time, when I was young and newly married and working for you.

00;03;00;18 - 00;03;10;20
Allison De Paoli
We couldn't afford the $250 deductible to have our first child. And you paid that for us. And,

00;03;10;20 - 00;03;16;22
Allison De Paoli
my father did, in fact, not remember this, and but he was delighted that somebody else did.

00;03;16;24 - 00;03;37;26
Allison De Paoli
And it it what it brought home to me is that there are a lot of employers that do extraordinary things for their team, for for people that work for them. They try to do the best they can, and they try to take care of them as best they can. And in the health insurance arena, most of them are not.

00;03;37;28 - 00;04;08;01
Allison De Paoli
And by adjusting their health plans just a little bit, they can do things like offer 100% coverage if you go to a high quality provider, make it much easier for you to get to the doctor so that you can get small things taken care of before they become big things, or when big things are identified, they can be diagnosed early so that they are less expensive to treat with better outcome for the human involved, or pay less for medications or whatever it is.

00;04;08;04 - 00;04;35;23
Allison De Paoli
And you know, when my dad did that, you know, that was a very long time ago and health insurance was still almost a new kind of thing. And now every employer that offers a health insurance plan has a health care division. I mean, health care. The average is about $15,000 a year per employee. And I would tell you that in Texas, that's probably closer to 10 or 12, but at 10 or $12,000 a year per employee, that's a division.

00;04;35;23 - 00;04;38;17
Allison De Paoli
And it should be managed properly.

00;04;38;20 - 00;05;02;14
Craig Andrews
Yeah. Well, it's I mean, the thing I buy my own health insurance and the thing that I've been running into is I have double digit year on year increases. And it just I'm like, except for one brief period of time, I'm pretty healthy. I never I never use it. And,

00;05;02;14 - 00;05;12;12
Craig Andrews
I'm about to go through a rate increase next month here in two weeks and, and it's going to go up another 23%.

00;05;12;15 - 00;05;25;13
Allison De Paoli
So 23% is a pretty significant number. And you know, if you have 100 employees and your budget increases 23%, that's not sustainable.

00;05;25;15 - 00;05;27;12
Craig Andrews
No, no.

00;05;27;14 - 00;05;38;02
Allison De Paoli
And we've seen quite a lot of it. We saw the increases kind of level out for a while. But we're seeing this year 2437 32.

00;05;38;02 - 00;05;40;08
Allison De Paoli
We had somebody with a 64,

00;05;40;08 - 00;05;52;06
Allison De Paoli
it's the the the beast is is hungry is the best way I know to describe that, because it's certainly not going to patient care.

00;05;52;09 - 00;05;57;25
Craig Andrews
Yeah. So when you referred to the beast, what's the beast?

00;05;57;27 - 00;06;18;21
Allison De Paoli
I think the beast is the system. And I hear a lot of conversation about how the system is broken. The system is not broken. The system is working very well for the people that it's working for. Unfortunately, those people are not patients, doctors or employers.

00;06;18;23 - 00;06;21;07
Craig Andrews
Yeah.

00;06;21;09 - 00;06;59;24
Allison De Paoli
There's too many middlemen. There's too many entities taking a little piece, a little piece, a little piece, a little piece, and ultimately that many little pieces is a big piece. Yeah. And the the mathematical shenanigans that we see are completely and utterly astounding. And, you know, it's one thing if you know what you're spending your money on, but nine times out of ten, 99 times out of 100, an employer doesn't understand what things cost, why they cost, and how to not make it cost that much.

00;06;59;26 - 00;07;07;28
Allison De Paoli
The only thing that they know to do, or being told that to do, is to pass it, pass the increase on to their employees. We just,

00;07;07;28 - 00;07;25;06
Allison De Paoli
installed a new client and they have, over the last three years had a 25, a 40 and a 24% rate increase. And the 20 this past year, the broker advised the employer to pass 100% of that 24% on to the employee.

00;07;25;06 - 00;08;05;12
Allison De Paoli
And he's absolutely not and but didn't know what else to do. Right. So what what what the traditional advice is increase your your out-of-pocket costs, your co-pays, your deductible, your maximum out-of-pocket or increase and or increase your premium contribution. I would argue, and pretty successfully, that if you review your contracting and you make sure that your vendors are responsible to you, the employer, your costs will drop 20 or 30% and stay there because you control everything and you understand where the money is going and what it's paying for.

00;08;05;14 - 00;08;19;21
Craig Andrews
Okay, so that's a little bit confusing to me. Help me help me work through this because in my mind I'm just going off and I'm buying insurance. But you're talking about there being different vendors. And so break this down for me.

00;08;19;28 - 00;08;58;25
Allison De Paoli
Sure. So every insurance contract fully insured self-insured level funded doesn't matter. Every insurance contract has a third party administrator at their core. That is all that BlueCross United Cigna Aetna Humana one time. That is all they are is third party administrators. They process claims. They answer the phone. There is a network. Yes, those big entities have their own network, but almost all of them rent the network out to private employers if they wish.

00;08;58;28 - 00;09;28;11
Allison De Paoli
There is stop loss insurance. An insurance company is not taking 100% of your risk. They are passing some of that risk off, sometimes two and three times. Then there is a pharmacy benefit manager, and I know a lot more people than used to know what a pharmacy benefit manager is. Pharmacy benefit manager started to help an employer or an insurance company manage drug costs and manage payment.

00;09;28;13 - 00;09;49;17
Allison De Paoli
Well, now there are about 53 buckets of revenue that they take and that adds to your cost. And sometimes other people benefit from that. And let me give you an example. If I am fully insured, then my insurance company probably owns my PBM, or the PBM owns the insurance company.

00;09;49;20 - 00;09;51;07
Craig Andrews
And PBMs pharmacy benefit.

00;09;51;09 - 00;10;13;22
Allison De Paoli
Benefit manager and then the rebates go to the insurance company, but the employer pays the bill, right. So that's probably 40% of the cost of a drug will be rebated. Well, don't you want that to come back to you. You don't want that to go back to somebody else, right?

00;10;13;24 - 00;10;14;04
Craig Andrews
Yeah.

00;10;14;07 - 00;10;24;24
Allison De Paoli
So you change the contracting. You choose medical management. That will help guide to the highest quality care because there is no good price for bad care.

00;10;24;26 - 00;10;26;03
Craig Andrews
Yeah.

00;10;26;06 - 00;10;37;11
Allison De Paoli
So that's what I'm talking about is repurpose those pieces and make them work for an employer rather than against an employer.

00;10;37;14 - 00;10;46;15
Craig Andrews
That seems like a lot of work. And I'm thinking about all these employers that it's it's a competitive world. They're busy running their businesses.

00;10;46;17 - 00;11;12;25
Allison De Paoli
Yes. So I would argue that every employer has a health insurance division if they like it or not, and it is their responsibility to manage it. It is not necessarily their responsibility to execute it. So I am not the only person in the country that does what I do. You've had a number of very effective consultants on your program, and what we do is unbundle that and repackage it for you.

00;11;12;28 - 00;11;20;19
Craig Andrews
Okay. Now there's this term called fiduciary. What is that and how does that all fit into this.

00;11;20;21 - 00;11;56;15
Allison De Paoli
So every employer if they like it or not is a has fiduciary responsibility to their employees. If they accept employee dollars into their health plan. Now what that means in reality is that for many years there was no there were no teeth to that. Right. You could say the employer had fiduciary responsibility, but if the plan was fully insured or it was with a large carrier, they weren't going to get their data, they weren't going to understand what they were paying for.

00;11;56;15 - 00;12;32;27
Allison De Paoli
They were just paying this premium dollar right. The Consolidated Consolidated Appropriations Act of 2020 gave the employer teeth to understand what is going on in their plan. Those regulations were based on what happened in the 401 K industry about ten years ago, and I think most people are familiar with that, where there were a lot of excess fees and employees were not getting the growth that they should because it was being eaten up by fees and employers didn't necessarily have access.

00;12;32;29 - 00;12;58;12
Allison De Paoli
And then the federal government said, you all are going to get access. And if you have egregious fees, then you need to correct that. And there were a lot of class action lawsuits. There are still a lot of class action lawsuits against 401 K plans that don't have a proper fee structure. The regulations that now apply to a health and welfare plan were based on those.

00;12;58;12 - 00;13;37;00
Allison De Paoli
And basically what they say is that if you're taking employee money, you must use those dollars effectively and fiscally responsibly. So you need to know what you're buying and you need to know what you're paying for. Now, most insurance companies have made that very difficult. They still don't make it all that easy, but it's getting better. So you can see if you are paying the right price for services, and you can see what your increases are, and you can have a little bit more visibility into what's going on in the plan for our clients.

00;13;37;00 - 00;13;55;00
Allison De Paoli
They can see everything. They can see what claims, what's billed, what's paid, why it's paid that way, what they're paying for drugs. They're seeing all their third party revenue come back and you can peer it all together. And that's what you want to be able to do. An employer can't do that on their own. That

00;13;55;00 - 00;13;58;25
Allison De Paoli
is why you have a consultant and or a broker.

00;13;58;28 - 00;14;21;09
Allison De Paoli
They should be putting that together for you. And then you should at this in 2025. If you are an employer with more than 50 employees, you should have a fiduciary committee that sets standards for your plan so that your HR team who manages this or oversees it can meet those obligations. It's not really as terrible as it sounds.

00;14;21;11 - 00;14;41;07
Craig Andrews
So one of the things that you've said, I don't think I've heard this before, is that you have a fiduciary duty if your employees pay into the plan. Now, if you have a plan, if you have a plan that you fund, do you still have the fiduciary responsibility.

00;14;41;09 - 00;15;24;03
Allison De Paoli
If you are not accepting any employee dollars into the plan. Then your fiduciary fiduciary obligation is is much lower. However, I know of one employer that does that offers 100% care for the employee, coverage for the employee, and the dependents, and does not charge any premium dollars. Right. So that's both sides. One employer, if you have co-pays, if you have deductibles, if you have a premium contribution, you are accepting employee dollars into your plan.

00;15;24;05 - 00;15;28;24
Craig Andrews
Okay. So pretty much it's it's hard to avoid that.

00;15;28;26 - 00;15;31;10
Allison De Paoli
It is very hard to avoid that.

00;15;31;13 - 00;15;38;22
Craig Andrews
You know. Now I remember, you know, a number of years ago, I,

00;15;38;22 - 00;15;43;12
Craig Andrews
yeah, I'm susceptible to what's called chelation ons. It's where you get a little bump

00;15;43;12 - 00;15;50;23
Craig Andrews
in your your eyelid and the treatment for. It's pretty simple. They just peel back your eyelid, lands it, and drain it.

00;15;50;23 - 00;15;55;17
Craig Andrews
But because I'm on a high deductible plan, I was.

00;15;55;17 - 00;16;11;09
Craig Andrews
I knew I wouldn't hit my deductible for this simple chelation. I started calling around. I called one place and they're like, well, you have to come in for an evaluation and then we'll do it. I'm like, let's just knock it out one visit and they're like, oh no, no, no. And how I was like, how much is it going to be?

00;16;11;09 - 00;16;33;23
Craig Andrews
And they said, 350 bucks. I call someone else. Got this incredible run around. Never got a hard number from them. It was more complicated. My listening to what they said, I was like, I think I'm gonna end up spending $800 here. And then I called someone else and again they said, well we want you to come in for an evaluation.

00;16;33;23 - 00;16;40;01
Craig Andrews
And then I'm like come on, so lazy on. You're going to see it. You're going to say lay way back, let's lance it. And

00;16;40;01 - 00;16;55;28
Craig Andrews
and they finally said tell you what. Okay, we'll do all this in one visit. We'll charge you 240 bucks. That's good. And that will include a follow up visit. I was with the nurse for 30 minutes.

00;16;56;00 - 00;17;01;07
Craig Andrews
I was with the surgeon for about 45 minutes. And then I had a follow up,

00;17;01;07 - 00;17;03;06
Craig Andrews
visit with the surgeon.

00;17;03;06 - 00;17;16;02
Craig Andrews
Offered 240 bucks. And the care. I didn't see any rusty scalpels laying around. It seemed like good quality care. What was happening there with.

00;17;16;05 - 00;17;17;27
Allison De Paoli
So a couple things were happening.

00;17;17;27 - 00;17;45;14
Allison De Paoli
Front desk staff are overworked, underpaid and can never dig out from under the pile that they're in. So when you throw something like, can I just pay cash? A lot of front desk staff don't know what to do with that. Right. So so then they have to call somebody or go find somebody or get up and go to the billing manager and say, what do I do with this?

00;17;45;21 - 00;17;52;01
Allison De Paoli
Right. So then they're kind of doing that on the fly. That was some time ago, right?

00;17;52;04 - 00;17;52;13
Craig Andrews
Yeah.

00;17;52;20 - 00;18;03;04
Allison De Paoli
So there are more providers today who understand what cash pay is. I had a similar experience. It was a little less complicated than that.

00;18;03;04 - 00;18;13;19
Allison De Paoli
I went to the dermatologist. I've been going to the same dermatologist for years, and I had a plan with co-pays. And then I had a plan that didn't have a copay. I was in the same boat as you.

00;18;13;22 - 00;18;26;00
Allison De Paoli
So I called. I needed to go back to be seen. I said, okay. They said, do you still have your insurer? No, I'm a cash pay patient now. And the very lovely woman on the phone said.

00;18;26;00 - 00;18;28;02
Allison De Paoli
You want to pay cash? And I said,

00;18;28;02 - 00;18;32;18
Allison De Paoli
credit card, whatever. I'll pay you at the time of service. She said, hold on, please.

00;18;32;21 - 00;18;56;04
Allison De Paoli
And a couple of minutes later she came back and she said, well, apparently an office visit is $85 and you'll have to pay that when you arrive. Okay. Are you sure? Yeah. I'm sure. And so I arrive. They checked me in. I said, do you want me to pay you now? And they're like, oh, yes, we would like you to pay us now.

00;18;56;05 - 00;19;20;17
Allison De Paoli
Okay, here's my credit card. And then the doctor saw me, and then I left and the woman said, well, you have to check out and I said, okay, but I already paid. She said, you already paid. So I already paid. Oh, you're the one. Yes, I am the one. And they were lovely, but very confused by that. And there are a lot of doctors that are that way.

00;19;20;19 - 00;19;35;01
Allison De Paoli
So it's hard to just send somebody into the wild and say, go pay cash for a service, right? Like the doctor's staff doesn't know what to do. The member doesn't know what to do. So you need to be a little more artful than that.

00;19;35;01 - 00;19;40;07
Allison De Paoli
And you can do that in a number of ways, and it works differently for different employers, you know, may be zero copay.

00;19;40;07 - 00;19;59;24
Allison De Paoli
It may be a small copay. It may be a go to this, everybody goes to the clinic. Maybe we can build you an on site clinic, which we can do for employers as small as about 4 or 500 people, staff them with a physician, get people everything they need for no charge. It's really wonderful. But doctors are confused.

00;19;59;27 - 00;20;29;17
Craig Andrews
You know, I live here in Austin, and if we go all the way back to 2010, obviously there was a lot happening then in health care. And John Mackey, the founder of Whole Foods, published a letter in the Wall Street Journal talking about how he'd built a Army of competitive consumer shoppers of health care in Whole Foods and how he had, I forgot, part time employees had health care.

00;20;29;20 - 00;20;40;27
Craig Andrews
It was something wonderful. And employees loved it. But all these people were all doing competitive shopping, and they were getting good health care at lower prices.

00;20;40;29 - 00;20;49;10
Allison De Paoli
They probably had a little bit of help. You know that may be some concierge service or maybe some advocacy service.

00;20;49;10 - 00;20;59;09
Allison De Paoli
It may be somebody that helped them get to doctors. Like I know who the cash paid doctors are. I know who the good cash paid doctors are and who are the not so good cash paid doctors.

00;20;59;11 - 00;21;23;04
Allison De Paoli
But it took me a little time to figure that out. So it is a wonderful model, and it is a wonderful way to help people be responsible for their health. You know, we have done such a good job of conflict greeting health care and health insurance. Those are two very different things. Health care is health care, right? Get your eye lanced.

00;21;23;06 - 00;21;35;15
Allison De Paoli
Get get your Band-Aid and go home. Right. For lack of a better description and how to pay for that. Health insurance is only a finance mechanism.

00;21;35;17 - 00;21;36;15
Craig Andrews
Yeah.

00;21;36;17 - 00;22;03;26
Allison De Paoli
Right. So day to day care, I hate to say it's commodity care. It's very upsetting to people, but day to day care is not what drives those premium increases that you're seeing. What drives those premium increases is big stuff. It's stage three and four cancer diagnoses. It is metabolic syndrome that is not controlled. And you know that is a huge problem in South Texas, right.

00;22;03;28 - 00;22;14;05
Allison De Paoli
You know metabolic syndrome, pre-diabetes, diabetes, huge problems in South Texas. They're going bankrupt us all. End stage renal heart disease that's not caught.

00;22;14;05 - 00;22;35;02
Allison De Paoli
We have a client who. God bless these people. They not they're not big users of care. Their day to day claims are very low. And every 9 to 15 months, they have a 3 to $500,000 claim because somebody didn't go to the doctor and now they have diabetes that's out of control.

00;22;35;06 - 00;23;00;19
Allison De Paoli
They have lost a toe, then they've lost a foot, then they've lost a leg and then they die. It's horrible. So whatever we can do to prevent that, we do. And that means doing something that doesn't make any sense, which is make it as easy and inexpensive for people to get care right up front so that you don't have that later, because that is what's driving your cost.

00;23;00;21 - 00;23;17;01
Allison De Paoli
Let people go to the doctor, you know, help them go to the doctor. It takes 21 days on average now to get to the doctor. Now, if you have the flu, either you're recovered or you're dead, right? Yeah. One or the other.

00;23;17;03 - 00;23;38;29
Craig Andrews
Yeah. Yeah. Well, I went to the doctor. I spent $150 for them to tell me. Go home and drink fluids. Which I was dubious about going to the doctor, but because of my my history with Covid. And I have to admit, I was so sick, it had me a little bit nervous and have my wife nervous. She was asking me what you know.

00;23;39;00 - 00;23;43;16
Craig Andrews
She kept asking me, what's your oxygen level? What's your oxygen level? And,

00;23;43;16 - 00;23;55;13
Craig Andrews
but it was just so frustrating. I lose a couple hours out of my day and 150 bucks to be told to drink fluids and.

00;23;55;15 - 00;24;17;11
Allison De Paoli
You know, I am a huge fan, and I know you've had some other guests that are quite in my camp, but I am a huge fan of direct primary care and onsite clinics. I think direct primary care is a.

00;24;17;13 - 00;24;39;13
Allison De Paoli
It is direct access to care and it is a subscription model. So you're paying a fixed fee every month, almost like an insurance premium. And you access the doctor as much as you need to access the doctor. So that means if you need to call them every day, you call them every day. And if you need to call them once a year, they will have called you three times in between to make sure you're alive.

00;24;39;15 - 00;24;40;08
Allison De Paoli
And,

00;24;40;08 - 00;24;58;08
Allison De Paoli
I get regular bloodwork, I pay I in fact, I just got a text message this morning. It's time for your annual physical. Where ordering these tests, this is how much they cost. And you need to be here on this date. Can you imagine a fee for service, doctor doing that for you?

00;24;58;11 - 00;24;59;27
Craig Andrews
Yeah. No.

00;24;59;29 - 00;25;27;15
Allison De Paoli
So I know what the tests are. I've added to the tests, actually, and I know what's going to be tested. I go there, I do my blood draw. I have my appointment a few days later. My appointments always take an hour. It makes me crazy. But we go over all of my medications. I do have some bone issues, so we talk about bone issues and the last time I was there, we had a demonstration of squats because I was having some problem with my hip and my ankle.

00;25;27;17 - 00;25;54;03
Allison De Paoli
That's not what you see in eight minutes with the doctor, right? So that is a different that is caring for Alison the person. And the more that we can do that for people, we lower long term costs and we get people what they need. And if you don't think that buys you loyalty as an employer, it buys a ton of loyalty.

00;25;54;06 - 00;26;19;00
Craig Andrews
Yeah. Well, I mean, you know, I was in the Marines in the late 80s, in the early 90s and, you know, I wasn't married, but it was an absolute calculation for the guys that were, you know, here's the cost of having a baby in the Marine Corps versus having a baby outside it. And it was the health care, and the health care wasn't particularly great.

00;26;19;02 - 00;26;21;20
Craig Andrews
They, it was okay.

00;26;21;20 - 00;26;27;17
Craig Andrews
But it wasn't particularly great, but it was there and it was available.

00;26;27;19 - 00;26;29;06
Allison De Paoli
I think that,

00;26;29;06 - 00;26;37;18
Allison De Paoli
military health care is actually good quality. It is all the attendant things around it that are such a problem. Right?

00;26;37;21 - 00;26;50;24
Craig Andrews
Yeah. So the first one, well, actually the second time I had to have a lazy unbalanced was in the Marine Corps and they couldn't do it at my base. They had to I was at Cherry Point, North Carolina.

00;26;50;24 - 00;27;01;24
Craig Andrews
I had to go in, which was 45 miles or 45 minutes away down country roads. Yep. And they just sent me there like, oh, yeah, just go down there.

00;27;01;26 - 00;27;06;17
Craig Andrews
And this was before I realized that you needed two eyes for depth perception.

00;27;06;19 - 00;27;11;00
Allison De Paoli
And and so you stayed awhile.

00;27;11;02 - 00;27;17;27
Craig Andrews
Now I'm driving down these country roads with one eye. I'm a cyclops coming down these country roads

00;27;17;27 - 00;27;18;10
Craig Andrews
and,

00;27;18;10 - 00;27;27;17
Craig Andrews
I, I was so exhausted by the time I got back to my barracks. I was like, somebody should have probably told me that.

00;27;27;22 - 00;27;39;14
Allison De Paoli
Well, that's what I mean, right? Like, the care was probably fine. It's just everything around it was. Well, maybe we should have thought this person only has one eye while driving, right? Like that just didn't occur to anybody.

00;27;39;16 - 00;27;42;12
Craig Andrews
Yeah. So.

00;27;42;14 - 00;27;52;16
Allison De Paoli
You know, it's it's there's no perfect model of health care, but helping people access care, making sure that your contracts are correct.

00;27;52;16 - 00;28;08;15
Allison De Paoli
And, and that that the vendors have responsibility to the employer, not to each other. And let me give you an example. I looked at a I've looked at at a zillion stop loss asso agreements. Those are all insurance type of agreements.

00;28;08;17 - 00;28;38;26
Allison De Paoli
And I can't tell you how many times I have read an a, TPA or a Asso agreement and a PBM agreement, and the premium is responsible to the third party administrator. They do what they say, they give them their third party revenue that the employer paid for, and the employer has no idea what they're signing. I just it is it is astounding to me.

00;28;38;26 - 00;28;58;29
Allison De Paoli
I, I've looked at contracts where if there is a change of 10% of population in a PBM contract, there were there was a $350,000 penalty for a 10% change in census population. And the employer had no idea because they're not reading the contracts.

00;28;59;01 - 00;29;02;02
Craig Andrews
Yeah. And here's, here's,

00;29;02;02 - 00;29;24;10
Craig Andrews
yeah, maybe we just we kind of wrap up on this thing. My heart breaks for all the employers out there because this is so incredibly complicated. And I'm listening to you and I know because one because I know of how we were introduced. But two, I know through my conversation with you that you're different.

00;29;24;12 - 00;29;40;20
Craig Andrews
But I go talk to somebody else who's maybe a broker and they're like oh here's how we take care of people. And I know enough to know they're not doing what you're doing. But you guys are. It sounds like they're using the same words I.

00;29;40;20 - 00;30;03;14
Allison De Paoli
So we are both a broker and a consultant. So sometimes we just consult and provide strategy for an employer. Those tend to be larger employers. And sometimes we we manage the entire process for an employer. And I have a consulting client that I sat I helped them choose a broker because they felt that they needed a large national broker.

00;30;03;16 - 00;30;36;12
Allison De Paoli
Okay. So I helped them choose. I helped them draft their RFP, and I sat in on the finalist presentations, and I was amazed at my words. All of the things that you've heard me say repeated back. But none of them were executing on that. And I hear it all the time. Well, we're going to lower your costs. We're going to do this if you're not addressing the cost of care, you cannot lower the cost of health insurance.

00;30;36;15 - 00;31;02;08
Allison De Paoli
If you want to control your health insurance budget, you have to figure out a way to manage the day to day costs and then have protection for the big stuff. This is a different philosophy, and unless you're doing that, you're not going to reduce costs. You're just going to continue to be on the hamster wheel. Yeah. And I, I don't know how to.

00;31;02;11 - 00;31;08;16
Allison De Paoli
Help people understand that any more than to just provide examples of where we've done it.

00;31;08;19 - 00;31;16;12
Craig Andrews
And it's so critical is so critical. I mean, I look at how I've done individual purchases and brought down the cost of my health care.

00;31;16;14 - 00;31;27;23
Allison De Paoli
But you took action, right? Like you took action to find the right price. And for a midsize employer, they're not going to do that for everybody, nor should they. But their vendors should.

00;31;27;25 - 00;31;37;14
Craig Andrews
Yeah. And that's something you help with. Absolutely Alison that is so awesome. And so how can people reach you.

00;31;37;16 - 00;31;55;14
Allison De Paoli
So our website is alt eight alt iq.com. And I'm also pretty active on LinkedIn. And so you can find me at Alison Cohen to Pauli on LinkedIn. And if I can answer any questions or point anybody in the right direction, it would be my pleasure to do so.

00;31;55;17 - 00;31;58;06
Craig Andrews
Well, thanks for sharing that. And layers and legacies.

00;31;58;08 - 00;32;01;11
Allison De Paoli
Thank you for having me.

00;32;01;11 - 00;32;28;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 Ally's for me.com/guest and sign up there. If you got something out of this interview, we would love you to share this

00;32;28;05 - 00;32;30;00
Craig Andrews
episode on social media.

00;32;30;02 - 00;32;53;12
Craig Andrews
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00;32;53;14 - 00;33;01;21
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.

00;33;01;21 - 00;35;03;26
Craig Andrews
It means a lot to my team. If you want to know more, please go to Ally's for me.com. Or follow me on LinkedIn. Thanks for listening. We'll see you next time.