From "Sickcare" to "Healthcare": The Future Of This Industry (with John Butler)

This video provides an in-depth exploration of the future of the healthcare industry, emphasizing a paradigm shift from a "sickcare" to a "healthcare" system. John Butler, from JB Benefits Consulting, discusses innovative strategies for employer health benefits, the transformative role of technology and AI in sales and marketing, and the critical need for awareness regarding cost-saving solutions. The conversation highlights how traditional health insurance models are perceived as broken and explores alternative approaches that simultaneously enrich employee health and reduce costs for businesses.

The discussion progresses from the general inefficiencies of the current healthcare and insurance landscape to specific technological advancements and alternative benefit structures. Butler details how marketing and sales are evolving with 24/7 "Evergreen" systems and the advent of AI-generated voices for outreach, posing both threats and opportunities for human interaction. He passionately advocates for a proactive approach to health, citing examples like full-body scans and regenerative medicine, such as stem cell therapies, as crucial components of a true "healthcare" system. The video then delves into practical solutions for employers, including health sharing plans, Individual Coverage Health Reimbursement Arrangements (ICHRAs), and the strategic use of "Centers of Excellence" to provide high-quality, cost-effective care.

Specific examples and case studies illustrate the potential for significant savings and improved employee well-being. Butler shares his personal experience with health sharing plans, demonstrating substantial premium reductions and efficient claims processing. He references Walmart's success with Centers of Excellence, achieving billions in savings while offering employees top-tier care with zero out-of-pocket costs. The conversation also touches upon the Consolidated Appropriations Act (CAA) and the importance of regulatory compliance in benefit plan design, as well as the potential for customized ICHRA plans (dubbed "cafeteria plans") to dramatically lower costs for small to mid-sized employers, exemplified by a Minnesota company's potential savings. The overarching theme is that by leveraging technology, data, and innovative benefit structures, it is possible to create a more efficient, cost-effective, and health-focused system.

Key Takeaways:

• Challenging Misconceptions in Health Insurance: A core message is that saving money and enriching employee health are not mutually exclusive; in fact, they can be achieved simultaneously through innovative strategies, contrary to common belief.
• The Power of Awareness and Marketing: Many effective healthcare solutions and cost-saving strategies exist, but a lack of awareness among business owners and brokers prevents their widespread adoption. Effective marketing, including 24/7 "Evergreen" systems, is crucial for disseminating this knowledge.
• AI's Dual Impact on Sales and Marketing: AI is rapidly transforming sales and marketing, with capabilities like AI-generated voices for cold calls. This presents both a threat to traditional sales roles and an opportunity to enhance efficiency, while also highlighting the increased value of genuine human interaction.
• Shift from "Sickcare" to "Healthcare": The current system is largely reactive ("sickcare"). The future lies in proactive health management, leveraging technology for early detection (e.g., full-body scans) and advanced treatments like regenerative medicine (e.g., stem cells for burn victims), to improve overall population health and reduce long-term costs.
• Health Sharing as a Cost-Effective Alternative: Health sharing plans, now accessible to businesses, offer significant cost savings (50-70% of America could fit) compared to traditional fully insured plans, often with lower out-of-pocket maximums, though they require medical considerations for eligibility.
• Real-time Reimbursement and Data Integration: Companies like Savos are leveraging technology for real-time claim reimbursements in the business health sharing world, connecting with systems like IRS records to streamline processes and ensure income-related subsidies are applied, demonstrating advanced data engineering.
• Strategic Broker RFP Process: The traditional Request for Proposal (RFP) process for brokers is often inefficient. A more intelligent, systemized approach that asks the right questions (e.g., regarding CAA compliance, deductible waivers, Centers of Excellence) can match employers with specialized brokers and solutions.
• Regulatory Compliance is Paramount: The Consolidated Appropriations Act (CAA) imposes serious compliance requirements and penalties on employers, underscoring the need for benefit plans to be designed with regulatory adherence in mind.
• Centers of Excellence for Quality and Savings: Directing employees to "Centers of Excellence" (e.g., Cleveland Clinic, Mayo Clinic via Edison Healthcare) for major procedures offers the highest level of care with zero out-of-pocket costs, leading to substantial savings for employers (e.g., Walmart's $1.8 billion reduction).
• Transparent Pricing Models: Outpatient surgery centers like Surgery Center of Oklahoma offer transparent, menu-based pricing that has not increased in decades and has even decreased, demonstrating a model for significant cost reduction compared to traditional hospital pricing.
• ICHRA and Customized Cafeteria Plans: Individual Coverage Health Reimbursement Arrangements (ICHRAs), especially when customized into "cafeteria plans," allow employers to offer reimbursements for individual health insurance or health sharing, providing budget predictability, significant savings, and employee choice, while disconnecting the employer from direct risk management.
• Zero Deductible as the Future Standard: High-tech platforms are already enabling zero-deductible plans for large companies (e.g., Best Buy, Target, Medtronic), and this model is expected to become more widespread, making healthcare more accessible and affordable for employees.
• Employee Engagement through Co-creation: The principle that "people support what they create" suggests that involving employees in the design and understanding of their benefit plans (e.g., through customized cafeteria plans) fosters greater support and engagement.
• Potential for Industry Disruption: The rapid growth of health sharing communities, driven by their cost-effectiveness and innovation, has the potential to significantly disrupt the market dominance of large traditional insurers ("buas"), similar to how Netflix disrupted Blockbuster.

Tools/Resources Mentioned:

• Paro Health: Sponsor, dedicated to improving health benefits, reducing volatility, and making self-funding simple for mid-size employers.
• Claim.do: Sponsor, medical claim auditing and member advocacy company providing fiduciary services to employer-sponsored benefit plans.
• Plansight: Sponsor, end-to-end RFP solution for benefits agencies.
• Upper Hand and Creative: Company hired by John Butler for personal video production and social media distribution.
• Fountain Life: Tony Robbins' company offering full-body scans and advanced medical analysis, connected to a program for companies with 50+ employees.
• Savos: A company in the B2B health sharing world that provides real-time reimbursements and connects technology with IRS records for income-related subsidies.
• Edison Healthcare: Manages "Centers of Excellence" programs for employers, directing employees to high-performing healthcare facilities (e.g., Cleveland Clinic, Mayo Clinic) for specialized care with zero out-of-pocket costs.
• Surgery Center of Oklahoma (Dr. Keith Smith): An outpatient surgery center known for transparent, menu-based pricing that has consistently lowered costs.

Key Concepts:

• Sickcare vs. Healthcare: The distinction between a reactive system that treats illness (sickcare) and a proactive system focused on maintaining and improving health (healthcare).
• Evergreen Marketing: Marketing content or systems that continuously run and generate leads 24/7 without constant manual intervention.
• KLT (Know, Like, Trust): A marketing and sales acronym emphasizing the importance of building rapport and credibility with potential clients.
• Health Sharing: A model where members share medical expenses, often outside traditional insurance, typically requiring medical considerations for eligibility and offering significant cost savings.
• ICHRA (Individual Coverage Health Reimbursement Arrangement): A type of HRA that allows employers to reimburse employees for individual health insurance premiums or other medical expenses, offering flexibility and budget control.
• Cafeteria Plan (Customized ICHRA): A term used by John Butler to describe a customized ICHRA model that provides employers with options for offering retail health insurance or health sharing, with compliance at its core.
• CAA (Consolidated Appropriations Act): Legislation imposing specific compliance requirements on employer-sponsored health plans, carrying serious penalties for non-compliance.
• Centers of Excellence: A network of high-performing healthcare providers or facilities specializing in certain conditions or procedures, to which employers can direct employees for superior care and controlled costs.
• Zero Deductible: A benefit plan design where employees pay no deductible for medical services, often enabled by advanced technological platforms and strategic cost management.

Examples/Case Studies:

• John Butler's Personal Health Sharing Experience: Switched from a $2,000/month fully insured plan with a $4,000 deductible to a health sharing plan for $389/month with a $500 out-of-pocket maximum, saving over $1,600/month in premiums. A hospital bill of $6,750 was reduced to $3,125 as a cash payer.
• Walmart's Centers of Excellence: Managed by Tom Americh, this program directed employees to top facilities like Cleveland Clinic and Mayo Clinic for conditions like heart issues and cancer, resulting in a $1.8 billion reduction in healthcare spend from a $6 billion budget, while offering zero out-of-pocket costs for employees.
• Minnesota Company's Cafeteria Plan Potential: A company with 40 employees on a Blue Cross plan paying $28,000/month (approx. $350k-$400k annually) could potentially save $10,000/month by shifting to individual Blue Cross plans, with further savings through exchange subsidies, reducing the total to $12,000/month.
• "Dan" Case Study: An employee named Dan, earning $90,000/year with four kids, was paying $1,700/month for his portion of the company's Blue Cross plan (company paid $974). On the individual marketplace, with subsidies from the Affordable Care Act (due to the 8.5% income cap), Dan's premium for a better plan (lower deductible) could be $832/month, reducing his personal contribution to $32/month if the employer paid $800.