Play full audio podcast (above) or find it by clicking from the list below:

Spotify

iHeart

Spreaker

Soundcloud

TuneIn

Amazon

RSS

Pandora

Google

Overcast

Pocket Casts

Apple

YouTube Podcasts

Or search for "America's Healthcare Advocate" on your favorite podcast platform.

Episode 2118 Transcript:

00;00;01;14 - 00;00;05;25

Announcer

And now America's Healthcare Advocate, Cary Hall.

00;00;05;28 - 00;00;22;29

Cary Hall

Hello, America. Welcome to America's Healthcare Advocate show. We're broadcasting coast to coast across the USA here on the HIA Radio Network. You can find out more about us by going to the website AmericasHealthcareAdvocate.com. All of our shows are posted up there, as well as our podcast platform and YouTube platform.

00;00;23;02 - 00;00;49;03

Cary Hall

By the way, I want to thank everybody, the audience. We're up to 429,873 views on YouTube and 107,078 plays on our podcast platforms. Dave Thiessen provided me with all of that information the other day, and I was quite surprised to see the numbers up so HyVee. So we thank all of you out there, and those of you listening on terrestrial radio to our over 200 stations around the country in studio with me today.

00;00;49;08 - 00;00;57;29

Cary Hall

We have two guests from HyVee, the Exemplar Care doctor Jon Van Der Veer is here and Jaci Robson here from HyVee Exemplar Care. Welcome to the studio today.

00;00;58;01 - 00;00;58;26

Dr. Jon Van Der Veer

Thank you.

00;00;58;28 - 00;01;21;13

Cary Hall

We're going to have a fascinating show today. If you're an individual on an ACA or as I call it Obamacare health insurance policy, or even if you're a small employer or a large employer, you've probably dealt with what's going on in this marketplace in terms of high cost, high deductibles, not a lot of care for your employees, a lot of dissatisfaction with these plans as the years have gone on.

00;01;21;15 - 00;01;40;29

Cary Hall

We're going to talk about a model today that is significantly different. It's an opportunity for primary care, direct pay, membership in a program that we think is going to make a big difference here in the Kansas City metro. So with that, I want to go to Doctor John Van Veer. Doctor. So how did you come up with this model and this concept?

00;01;40;29 - 00;01;42;08

Cary Hall

This is your baby.

00;01;42;10 - 00;02;08;21

Dr. Jon Van Der Veer

It's a lot of people's babies. But yes, this version is mine. So the, the idea of direct primary care has kind of been out in the ether, for a while. And I basically was I, like you said, you are a recovering “broker”. I am a recovering “fee for service” doctor. And it took kind of a breaking point in burnout to really realize there's a better way to deliver care and then for the patients to receive care.

00;02;08;23 - 00;02;13;18

Dr. Jon Van Der Veer

So this model, just allows for that type of interaction to take place.

00;02;13;21 - 00;02;22;24

Cary Hall

So, Jaci, talk a little bit about the membership model and how this works and how this is significantly different to what we see in a typical primary care practice. Jaci.

00;02;22;25 - 00;02;37;19

Jaci Robson

So the membership model is that for a monthly membership, you can receive all services that we provide in our clinics, which is all services, primary care or urgent care. So 80% of what most people's health care needs are.

00;02;37;25 - 00;02;54;28

Cary Hall

One of the things that I when I was researching this and going through the website and looking at, you know, how this is offered and where it's different than what we see in typical primary care. The average time spent with the primary care doctor in this country is 7.5 minutes. One of the things which is not good, doctor.

00;02;55;01 - 00;03;12;20

Cary Hall

One of the things that's emphasized in your model is the time spent with the patient, the ability to listen to what the patient has to say, and then be able to translate that into a program that's going to make a difference in terms of their care, their ongoing care. Disease management and health care. So let's talk a little bit about that.

00;03;12;21 - 00;03;34;11

Dr. Jon Van Der Veer

You hit that exactly on the head. So everyone wants to practice evidence based medicine, but people don't often talk about the fact that the time spent with a patient often leads to more accurate diagnoses and thus better treatment plans. And our model, we have 30 minute follow up visits, 60 minute new patient visits. I've had new visits, as long as two hours.

00;03;34;13 - 00;03;56;07

Dr. Jon Van Der Veer

So it's not that rat race. Where how fast can you get someone through, to get on to the next person? Because in a traditional system, your job is to see them, triage them, and move them on to whatever specialist or other care piece is downstream in this par alignment of the better I take care of you, the better you feel, the less I have to see you.

00;03;56;07 - 00;03;58;23

Dr. Jon Van Der Veer

Which actually goes into a membership model.

00;03;58;25 - 00;04;06;13

Dr. Jon Van Der Veer

The better I'm doing, the less work I have to do. But at the same time, when you need me, I then have time and availability to actually spend with you.

00;04;06;16 - 00;04;27;21

Cary Hall

So, Jaci, talk a little bit about the convenience of this. I mean, these are in the Hy-Vee stores now. We have them here in Lee's Summit in Overland Park in the Kansas City Metro. You've been in Iowa and Nebraska for some time. So talk a little bit about that and how that model works again, differently than the primary care model, where you may wait two weeks or months to see your primary care doctor.

00;04;27;24 - 00;04;29;04

Cary Hall

This is significantly different.

00;04;29;05 - 00;04;52;09

Jaci Robson

It is significantly different. And they’re not actually in the Hy-Vee stores, thery’re near two are close to a Hy-Vee store so that we can work with Hy-Vee and help them to, take care for their employees. So they're actually close to it or near to a Hy-Vee. So yes, we now have one in Lee's Summit and here in Overland Park, it's at West 135th Street.

00;04;52;11 - 00;05;15;09

Jaci Robson

And the convenience of it is that people can come see the longer appointments. And then once they've actually established, they can connect with the doctor provider any way they need to from where they're at, so they can send messages, they can do virtual, they can have those, calls with them from whenever they need to, wherever they need to get the care that they want.

00;05;15;15 - 00;05;18;02

Jaci Robson

And it's all included in that membership.

00;05;18;04 - 00;05;36;23

Dr. Jon Van Der Veer

Can I share an example with me? So we were driving from, West Des Moines down to Kansas City Market today, and I received a phone call from a patient who said, hey, I've got a rash. This is what's been going on. I said, well, I'm not in Des Moines today, but somebody could see you. Or if you want to shoot me some pictures, you can.

00;05;36;24 - 00;05;52;15

Dr. Jon Van Der Veer

So he sends me pictures. I looked at it. He has shingles and his antibiotic or his antiviral has now been sent in across the state line, to his regular pharmacy. And he's getting the care he needs without having to even step foot in a clinic.

00;05;52;18 - 00;06;07;23

Cary Hall

So the and that's, that's remarkable because they were able to resolve that problem right away and not have to wait to get an appointment and come in. Can they connect when you're when you're members, your patients connect, do they come back to the same doctor each and every time if that doctor is available. How does that work?

00;06;07;26 - 00;06;30;20

Dr. Jon Van Der Veer

They do. They also we like to view Hy-Vee Health Exemplar care kind of as the provider. If you're a member in West Des Moines and you're watching a Chiefs game, you can go into the Overland Park clinic and be seen just like any other member. So yes, you can see the same person for continuity on the primary care side, but if you have a need that you just need, taking care of the entire system is built to take care of members.

00;06;30;27 - 00;06;42;17

Cary Hall

And so if they're if they're not in their particular metro, if they happen to be in Des Moines or I'm back and forth to Nebraska all the time, you would be able to go into any of the Hy-Vee Exemplar clinics and do this.

00;06;42;17 - 00;06;47;20

Dr. Jon Van Der Veer

And you get moved to the front of the line. You get treated like a member. It doesn't matter where you're at.

00;06;47;27 - 00;06;53;18

Cary Hall

So what what prompted Hy-Vee to do this partnership with you? Jaci, talk a little bit about that, because this is unusual.

00;06;53;19 - 00;06;54;22

Jaci Robson

I think that might be a better Jon question.

00;06;54;24 - 00;07;26;00

Dr. Jon Van Der Veer

Okay. Obviously Hy-Vee has assets in pharmacy, the PBM space, specialty pharmacy, dietary, dietitians, all sorts of different components. So, it made sense that they were moving towards primary care, and they'd been looking and we, met with Doctor Fick, who's their chief medical officer, introduced him to our model. And we walked through what benefits this could have for them, as an employer, both taking care of employees and then also serving the communities we’re in.

00;07;26;07 - 00;07;29;15

Cary Hall

Their employees or actually in this program? Yes.

00;07;29;17 - 00;07;30;18

Dr. Jon Van Der Veer

Absolutely.

00;07;30;21 - 00;07;39;18

Cary Hall

So HyVee’s, this is not just something they're doing in the community they're invested in this in the standpoint of they're putting their employees in the program for this care model.

00;07;39;18 - 00;07;49;06

Dr. Jon Van Der Veer

Yes. Wherever we are located, we get access to that set of employees or as we call them, patients, and start providing services directly to them.

00;07;49;08 - 00;07;50;19

Cary Hall

That's very unusual, Jaci.

00;07;50;24 - 00;08;13;07

Jaci Robson

It absolutely is. And what we're finding is once, companies are putting their employees into this care model, the engagement of those employees with their health is significantly increased. So people who may not have had their annual physical or that's all they're having, they're actually coming in and having that. And so they're seeing they're having their annual physical.

00;08;13;09 - 00;08;33;20

Jaci Robson

And then we're finding rather than somebody who sees adult to once a year, they're maybe coming in 3 or 4 times a year because they're using those doctors and providers as advocates and coaches to be proactive about their health going forward. Whether it's weight management or help with sleep or mental health, whereas prior to coming into these programs.

00;08;33;23 - 00;08;37;01

Jaci Robson

They were managing it themself and maybe talking to Doctor Google.

00;08;37;01 - 00;08;38;16

Dr. Jon Van Der Veer

And a lot of times they were done.

00;08;38;17 - 00;08;45;05

Cary Hall

I know Doctor Google. My wife talks to Dr Google a lot, so I understand that comment..

00;08;45;11 - 00;09;03;12

Dr. Jon Van Der Veer

From the financial standpoint, and employees are often gun shy. They don't know what something's going to cost. I mean, a a urine test could be $1.30 or it could be $200. That's the that's the issue. They don't know. And in this model, the employers covering their membership and they come in. And every service we provide in-house is included.

00;09;03;12 - 00;09;04;29

Dr. Jon Van Der Veer

So they know they're not going to pay anything.

00;09;05;00 - 00;09;18;06

Cary Hall

So I think you can see this is a very different model. We're going to go into more of the details regarding the model. We're going to talk about how if you're an employer, this could make a huge difference for you. Also, if you're on an ACA plan, get ready for some market disruption in the fourth quarter of this year.

00;09;18;06 - 00;09;35;03

Cary Hall

So we're going to talk more about that with our guests in studio here. Stay tuned. We'll be right back after the break. If you want information. The website is Exemplar.care. Exemplar.care. It's not.com. It's just exemplar.care. They've got a great website. All the information is up there. You can reach out to them.

00;09;35;10 - 00;09;52;21

Cary Hall

They'll be happy to chat with you. If you're an employer or an individual and you want to see what this model's all about, or even take a tour of one of their facilities. Stay right there. We'll be right back after the break. You're listening to America's Healthcare Advocate broadcasting here on the HIA Radio Network. Coast to coast across USA.

00;09;52;21 - 00;10;05;04

Cary Hall

We've got more.

00;10;05;06 - 00;10;25;13

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate show, broadcasting coast to coast across USA. Here on the HIA Radio Network. My producers today, Mr. Garner Cowdery behind the microphones and Mr. Dave Thiessen behind the cameras puts all these shows together, all those YouTube views, you see, and those podcast platforms, all 15 of them. Dave is the one that puts all that up there.

00;10;25;20 - 00;10;47;01

Cary Hall

Very happy to have them in studio with us today doing this obviously. And Doctor Jon Van Der Veer, he is the CEO of Hy-Vee Exemplar Health and Jaci Robson , he's the VP of Hy-Vee Exemplar Healthcare membership services, and we're happy to have him in studio talking about this very different model that's now available here in the Kansas City Metro, with two clinics in Overland Park at the summit.

00;10;47;08 - 00;11;08;29

Cary Hall

We'll talk more about that in a minute. A little bit about doctor. Doctor VanDerveer is a D.O. and MBA is a board certified internal medicine physician and the CEO and founder of Hy-Vee Health Exemplar Care, a membership based clinic focused on personalized, accessible health care. He's got 20 years of experience in hospital and internal medicine, and he brings this patient centered approach to this model.

00;11;09;01 - 00;11;27;13

Cary Hall

Jaci Robson is the vice president of member service at Hy-Vee Exemplar Health. She helps with most of the innovative models and direct care and primary care and urgent care. We're happy to have them in studio with us. So let's continue with this conversation and talk a little bit about all the services included for this one. Single membership fee.

00;11;27;13 - 00;11;40;01

Cary Hall

No more co-pays, no more deductibles. I made notes this morning: no more coinsurance, no more out-of-pocket maxes. All that goes away. So let's talk about what those services are, doctor.

00;11;40;01 - 00;12;06;03

Dr. Jon Van Der Veer

So, like you said, it's kind of one and done. There's the monthly membership fee and that includes your in-person visits, your annual visit, virtual care, texting portal messages, any way you choose to communicate to get your care provided. In addition to the actual care, there's then lab services included. Depending on states, there are generic medications dispensed out of the clinic.

00;12;06;05 - 00;12;26;28

Dr. Jon Van Der Veer

Additionally, we are set up for X-ray. So for plain films, as markets grow and mature, we'll have X-ray in all of those locations. And then additionally there is DME. So durable medical equipment. This is the slings or crutches or things you may need if you have an accident or need something. I think that hits just about all of them.

00;12;27;00 - 00;12;47;27

Cary Hall

So that's basically Jaci, everything that you would get in a primary care clinic and then more so you need a lab right now. Now I got to schedule my labs, a quest or wherever I have to go that I have to drive there and get that lab done. If I'm at the Hy-Vee Exemplar Care Health facility, I get the lab is done right there.

00;12;47;28 - 00;13;11;14

Jaci Robson

Absolutely. It's a complete one stop shop where you're coming in and you're meeting with your provider, and then you're leaving with whatever you're needing to manage that care that you need. I think you should also, at some points as well, speak about the types of membership costs, because the membership itself it sends when you're speaking about membership and people say this is a lot of services that I receive.

00;13;11;16 - 00;13;40;12

Jaci Robson

So the actual costs for an individual are $89 a month. So $89 a month for an individual, a $158 a month for a couple, or $216 a month for a family. And a family would be two adults and two or more children. So we are speaking affordable here as well, but it's much more not about the cost. It's about the quality and the quantity of the services that you're receiving for that cost.

00;13;40;12 - 00;13;47;24

Dr. Jon Van Der Veer

So you can get care how you want, when you want, for less than the price of a cup of Starbucks a day.

00;13;47;27 - 00;14;09;12

Cary Hall

That's the that's a, that's a really good comparison of less than a cup of Starbucks a day. When I look at that versus what I'm going to do on an ACA Obamacare policy or what I'm going to do on the small group health insurance policy where you've got copays for labs, you got the copay to see the primary care doc and you go into a primary care doctor and it says right on the desk at the receptionist.

00;14;09;18 - 00;14;14;11

Cary Hall

You're responsible for the copay before you go see the doctor. This is completely different.

00;14;14;14 - 00;14;26;02

Jaci Robson

It's absolutely, completely different. And what we find is it's also unlimited visits. We don't encourage it, but you can absolutely come and see us every day if you wanted to. But Jon has patients.

00;14;26;04 - 00;14;27;20

Cary Hall

You're going to get a lot.

00;14;27;22 - 00;14;32;27

Jaci Robson

Patients who do message him on a regular basis. He has patients who he speaks to.

00;14;33;00 - 00;14;33;22

Dr. Jon Van Der Veer

A different way to go.

00;14;33;28 - 00;14;35;00

Cary Hall

Like he was doing this today.

00;14;35;06 - 00;14;43;00

Jaci Robson

Like he was doing today. So we do have, people do like the model. This is the talk to their provider more regularly.

00;14;43;00 - 00;14;53;03

Dr. Jon Van Der Veer

With, with the model Cary, I think one of the most important things is if you change the financial model, you change the care model, and that's where everything gets stuck.

00;14;53;05 - 00;14;54;24

Cary Hall

The fee for service world.

00;14;54;24 - 00;15;10;03

Dr. Jon Van Der Veer

That exists right now, it is perfectly incentivized to give us what we all think of as “sick care”. That's right. It's built and it delivers exactly what it was designed to do and accidentally designed. And this is changing the model and it changes how the care's delivered.

00;15;10;05 - 00;15;31;02

Cary Hall

So you talked a little earlier about the fact that people are managing their, their disease, managing their wellness, their health. They're doing they're going in to see the doctor more often. They're doing the things they need to do. Obviously, not having these roadblocks in front of them with the co-pay every time they turn around. I've got to get a piece of durable medical equipment.

00;15;31;05 - 00;15;44;09

Cary Hall

I've got a full deductible and co-insurance I have to pay before I can access that equipment. I need a lab. Well, that's that's $150 or $800 depending on the... So that has to have a direct impact on this.

00;15;44;09 - 00;16;04;19

Dr. Jon Van Der Veer

Yes, absolutely. Can I follow? Sorry, Jaci, just to tell a quick DME story, we had a gal who came into, an urgent care facility of ours and said, I my daughter's here. She was hurt. She needed a sling. We said, we'll sell you the sling. This was she wasn't a member, but we still serve the public as well.

00;16;04;25 - 00;16;22;21

Dr. Jon Van Der Veer

Said we'll sell you the sling for $20. And she goes, I have the best insurance in the state. I want to I want to have it billed to my insurance. She got her bill for $197. It was our first and only, our first, one star Google review blasting us for her having to pay $197 for a sling.

00;16;22;28 - 00;16;40;17

Dr. Jon Van Der Veer

We offered to her for $20, and she said, well, I could have bought the same one for $15 at Walmart. Well they have better buying power than we do. So it shows that people don't even understand what their insurance does, how it's going to impact them financially. We're this we make it as clear and transparent as possible.

00;16;40;18 - 00;17;01;09

Cary Hall

Yeah, well, there's a reason that the big hospital systems that run these primary care practices don't publish their rates where you can see what the cost is to have this visit or that visit or another visit. There's a reason for that. Okay. And a lot of that has to do with the negotiated price they put in place with the primary carriers, the big carriers.

00;17;01;09 - 00;17;20;09

Cary Hall

The Blue Cross’s, the United’s, the Aetna’s, is the Cigna's, you know, the Ambetter’s, go on down the list, okay. And that's got a lot of impact on how this works. And that's why people are spending so much money on a lot of this. What you're doing is you're cutting through all of that saying here for $89 a month, you can come in here and get everything you need done.

00;17;20;16 - 00;17;29;28

Cary Hall

We'll talk about, in the next segment, what happens here to be referred out and all that, and how all that functions. But the point is, 90% of what people do is right there with their primary care. Doc, am I right or wrong?.

00;17;29;28 - 00;17;39;14

Jaci Robson

Absolutely. That's exactly it's. 100%. We're also finding the some of the primary care through the hospital systems are actually billing at hospital rates.

00;17;39;17 - 00;17;43;24

Dr. Jon Van Der Veer

Oh that depends on on their facilities where they're structured.

00;17;44;00 - 00;18;07;15

Cary Hall

And so and the problem with that is obviously all this comes back to the user in terms of premium. And that's why you see, and that's why you're gonna see this year in the fourth quarter, especially if you're on one of these ACA plans that I intend to talk about this in great detail in an upcoming broadcast, but you're going to see rate increases of 25% or better across the board on most of the ACA plans.

00;18;07;15 - 00;18;24;04

Cary Hall

Some of that has to do with Aetna constricting out of the moving out of the market. You know, all of these things that are going to happen out here. So this is a model that is here today to serve today that makes a huge difference in the way care is being delivered and an even greater difference in the cost.

00;18;24;04 - 00;18;43;17

Cary Hall

If you want information, it's Exemplar.care, Exemplar.care. That's that's the website. It's a beautiful website. Ton of information up there. You can go up there and find out about it. If you're an employer, I urge you to take a look at this. If you're an individual and you're paying these high premiums, this is a great way to get out of that hole and start getting a better form of care.

00;18;43;22 - 00;19;04;26

Cary Hall

You're listening to America's Healthcare Advocate Broadcasting here on the HIA Radio Network. Coast to coast across the USA. Stay right there. The doctor's in the house. We'll be right back.

00;19;04;29 - 00;19;27;16

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate Show, broadcasting coast to coast across the USA here on the HIA Radio Network. Want to give a shout out to KVGB 1590 Am 97.7 FM on Saturdays from 11 to 12 in Great Bend, Kansas. One of our best affiliates in the state of Kansas. Want to say hello to all those folks out there in that listening audience

00;19;27;19 - 00;19;42;05

Cary Hall

that listen to our broadcast every week. So we're going to shift gears now. There's a lot of disruption coming in the fourth quarter. I talked a little bit just a minute ago. Who went out of that segment of what we're going to see in the individual marketplace? Well, it's going to be similar to what we're going to see in the small group space next year.

00;19;42;06 - 00;20;07;08

Cary Hall

You're going to see significant increases across the board. You're also going to see a very narrowing of networks. This is one of the ways that carriers control costs is by controlling access. Well, we're going to look at that versus this model. But the HyVee Exemplar Care model and talk about what those differences are and how that works and how that impacts cost, to you as an employer.

00;20;07;12 - 00;20;29;14

Cary Hall

So instead of cost shifting, raising the deductibles, raising the co-pay, raising the out of pockets and putting that burden on your employees, you're going to have an opportunity to hear how this program does just the opposite of that. So let's just start right there, doctor. To me and David Hickman just walked in studio here, broker here in the Kansas City metro I've worked with for about 16 years.

00;20;29;14 - 00;20;52;16

Cary Hall

And we've talked about this extensively to me, this is a tremendous alternative for the small group employer out there that is really getting hammered with it. The benefits are going down. The cost is going up. As I said, there's a lot of cost shifting, pushing it more on to the employer, the employee. This is significantly different. Talk about that a little bit and how this model works for employers.

00;20;52;16 - 00;20;56;04

Cary Hall

And what are employers finding in the way of satisfaction with this.

00;20;56;04 - 00;21;23;15

Dr. Jon Van Der Veer

So employers are very satisfied with it. First off, because it's affordable to them and it helps them manage some of their costs. Secondly, it allows them to provide what we've had some employees define as the only true benefit my company offers me. And, they said it, we've got a written down the, the employee though is the one, like you said, who's been carrying more and more of the burden.

00;21;23;17 - 00;21;40;08

Dr. Jon Van Der Veer

And as we all know, the vast majority of people can't tolerate a $1,000 bill. But they have a $7,000 deductible. They can't afford the care that they need. And in this model, they have a benefit that they know it's paid for. It's covered, and all the care they get is going to be included. They're not going to have a surprise bill.

00;21;40;08 - 00;21;54;17

Dr. Jon Van Der Veer

There's not going to be a lab fee. There's not going to be, a visit, a copay, a co-insurance, a deductible. Nothing's going to show up. And that's why they view it as a true benefit. They can get care that they've avoided in the past because they didn't know what it was going to do to their own finances.

00;21;54;20 - 00;22;11;13

Cary Hall

How does that affect the overall health of the employees as a group and for the employer in terms of things like absenteeism and, you know, trying to get to a doctor's appointment but they can't get to because they can't get there in time, they get to take time off work. This all changes now, talk a little bit about that.

00;22;11;14 - 00;22;39;15

Jaci Robson

It absolutely changes. So we are much healthier, happier employees, more engaged employees, and from the employer's point of view, as the employees are able to get that same day or next day appointments, they get seen when they need to be seen. If they're not able to get into a clinic, they can connect with the provider and they can manage the care that they need, get that prescription that day and be back at work, or be getting healthier as they move forward.

00;22;39;15 - 00;22;45;23

Jaci Robson

If they've had some of those conversations with the provider regarding long term concerns.

00;22;45;26 - 00;23;14;04

Cary Hall

So, the employer can take a high deductible plan like an HSA or an HRA. They can wrap it around this model where the primary care is all handled by the HyVee Exemplar Care primary care model. And if an employee needs to go out to, a doctor for an orthopedic surgery or another type of procedure, talk about how you work within that particular network to help them coordinate that so they get this, the best level of care in that network, doctor.

00;23;14;04 - 00;23;43;06

Dr. Jon Van Der Veer

So again, because we have the time to go through people's medical information and you have their insurance plan, you understand where they can get care and where they can, afford care. First off, every clinician in every market knows where quality providers are. So assuming that the network has quality providers in it, you can direct those people directly to those providers as long as they're in network, you know, which ones are going to be more cost effective for those employees.

00;23;43;08 - 00;24;07;12

Dr. Jon Van Der Veer

And if it's, if it's a different funding model or a level funded, self-funded, you can actually get the most cost effective for the employer as well. But ultimately the employee will have choice. They're going to say this, this is who I recommend. Oh, I, my neighbors, this person. Okay. They're in-network too. So you have the time to actually evaluate and send people where they should go instead of just the oh, well, this is the one that's in their system.

00;24;07;12 - 00;24;14;06

Dr. Jon Van Der Veer

So you go up a system and you go from primary care to specialty care with no real regard to cost or quality.

00;24;14;08 - 00;24;26;24

Cary Hall

So Jaci, when this occurs now is the primary care doctor clinician at the HyVee Exemplar Care clinic. They're following along to see how the care is being delivered. If there's follow up, whatever the case may be.

00;24;26;27 - 00;24;41;21

Jaci Robson

Oh, absolutely. The providers at HyVee Health Examplar Care. They’re advocates, they’re coaches, they’re navigators. They will help people to understand the complexity of the health care system and make sure that their patients, their members, are receiving the care that they need.

00;24;41;21 - 00;24;44;05

Cary Hall

So that there's a coordination between the two groups.

00;24;44;05 - 00;25;05;11

Dr. Jon Van Der Veer

We are the quarterback. That's how I always view it. Is the the primary care team at HyVee Health Exemplar Care is responsible for getting you in and seen. And then if you do need to go somewhere out to get the care you need, and then to close the loop and bring you back in and move you forward with the appropriate recommendations you receive.

00;25;05;11 - 00;25;34;00

Cary Hall

So you said something at the beginning of this segment that was kind of interesting. It's some of the employees have said: “this is the only benefit my employer really provides”. Do you think that that that that kind of a testimonial to what you're doing, results from the fact that they are not coming in and getting blown out the door in 7.5 minutes and handed three prescription, and out the door they go, or how how impactful do you think it is that you said you've had people spend as much as an hour sitting and talking to you?

00;25;34;00 - 00;25;52;27

Cary Hall

You took a call today on the way in here from Iowa, talking to a man had shingles and got a prescription for him. So how that's a that's unheard of. If you try to call a primary care physician, you're first. You're going to get the nurse if you're lucky, and then she's going to call you back between the hours of so-and-so and 3:00, if you're lucky.

00;25;53;03 - 00;26;11;28

Cary Hall

And if you miss that or you don't get that call, you're not going to talk to him at all. No, but I look at that versus here you are, the CEO running this whole program and you're taking calls and talking. How much do you think that statement made by that employee or employees you've talked to has to do with the fact that they can access this care, and somebody really gives a damn?

00;26;12;00 - 00;26;32;28

Dr. Jon Van Der Veer

I think that's solely what it is. Their life matters more than how we want to run our clinic. So their convenience is their first priority, their health is their first priority, and we're a delivery mechanism to meet their need. Health care has quit being a service organization, and it's a widget producing factory where here it's all about relationships.

00;26;32;28 - 00;26;54;00

Dr. Jon Van Der Veer

The better you know, somebody, the easier they are to care for. If you know all their history, you can take a phone call on I-35 and and take care of somebody because you know everything about them. So those relationships are essential. And people feel that. I mean, nobody wants to be hurried through like their cattle.

00;26;54;03 - 00;26;56;02

Cary Hall

And unfortunately, this way the system is set up.

00;26;56;08 - 00;27;17;02

Jaci Robson

And I think, as Jon's exactly said it, it's an experience. It’s something you need to feel. You need to come in and feel the difference. It’s a different way of doing health care. And until you've actually experienced it, it isn't easy to explain it and understand how that feels. It's a little bit that like the Disney magic. How do you explain what that experience is?

00;27;17;03 - 00;27;17;17

Jaci Robson

People.

00;27;17;21 - 00;27;24;10

Dr. Jon Van Der Veer

People always say that they it's too good to be true. This can't be how you take care of people.

00;27;24;12 - 00;27;35;28

Jaci Robson

And I felt listened to, I felt heard. I've had this conversation with multiple people in the past. This is the first time somebody has actually heard what I was saying. Listen to what I said.

00;27;36;01 - 00;27;37;22

Cary Hall

Because they took the time.

00;27;37;23 - 00;27;39;28

Jaci Robson

All about time and access.

00;27;39;28 - 00;27;50;17

Cary Hall

Because as you talked about primary care doctors are taxed with seeing every how many hundreds of patients they have, moving them through the system as quickly as they can and getting to the next patient.

00;27;50;17 - 00;27;55;19

Dr. Jon Van Der Veer

Internal medicine 2500 patient panels, family medicine, 3 to 5000 patient panels.

00;27;55;21 - 00;27;56;16

Cary Hall

You're serious?

00;27;56;18 - 00;28;05;25

Dr. Jon Van Der Veer

Yeah, and I was at 1900 when I left the fee for service world on my way to 2500 as an internist. Average age 76. Not the easiest population to take care of.

00;28;05;25 - 00;28;07;17

Cary Hall

Yeah, I'm 77. There you.

00;28;07;17 - 00;28;08;07

Dr. Jon Van Der Veer

Go.

00;28;08;09 - 00;28;10;07

Jaci Robson

You’re a wonderful 76.

00;28;10;10 - 00;28;26;23

Dr. Jon Van Der Veer

And then now, panels in direct primary care, 500, 800, a thousand. If they're, if it's a healthy population, it's a fraction of the people. And we don't need to see a certain number to bill them. You just change the model.

00;28;26;26 - 00;28;43;21

Jaci Robson

Where they paid their membership. And I'd like to add to a story with that. I was talking to a cardiologist, and he advised me he sees ten patients a day. He works in a system where he gets referrals through the primary care, through the system. He said. Of those ten patients a day, he only needs to see three.

00;28;43;24 - 00;29;01;24

Jaci Robson

And of the other seven, they didn't need to be there. If the primary care provider had been able, not the primary care providers' fault, the system. If the primary care provider would spend the time with them, each of those ten patients is paying $3,000 each for that visit with him and seven of them a day. Do not need to meet with them.

00;29;01;24 - 00;29;17;14

Cary Hall

And what do you think has to do with why that? Why they're doing that? You know, that's one reason why United Health Care is under investigation right now by the DOJ, because of those kinds of referrals and charges that they are saying are unnecessary. So, yeah, there's a lot that needs to be fixed.

00;29;17;14 - 00;29;18;11

Dr. Jon Van Der Veer

Its a broken system.

00;29;18;12 - 00;29;37;12

Cary Hall

It is a broken system. But this is a great system, and it's a system that can work. And if it sounds like something you'd be interested in, you should go to the website Exemplar.care. You'll see everything up there. If you're an employer, you can send them a quick message. They'll be happy to have someone come out and talk with you. If you’re an individual the same thing.

00;29;37;14 - 00;29;57;08

Cary Hall

Or better yet, go to one of the clinics, walk around and see what you think of it. You'll probably be surprised by what you learn. We'll be right back after the break. You're listening to America's Healthcare Advocate. Broadcasting coast to coast across USA here on the HIA Radio Network. We're going to shift gears now and talk a little about what do big employers do when they're on this plan.

00;29;57;08 - 00;30;05;07

Cary Hall

Stay right there. We'll be right back with more.

00;30;05;10 - 00;30;26;17

Cary Hall

Welcome back. You're listening to America's Healthcare Advocate Show, broadcasting coast to coast across USA here on the HIA Radio Network. You can find out more about us by going to our website, America's Healthcare Advocate. Also 15 podcast platforms, YouTube. So here's the thing. Maybe your company is got a health insurance plan and nobody's happy. Maybe you might want to mention to them.

00;30;26;17 - 00;30;44;18

Cary Hall

Hey go up and listen to this broadcast that Cary Hall did with the doctor in studio and talked about this HyVee Exemplar Care model and how it works, and see what let them know that it's there. Because oftentimes when people refer other people to this podcast, we get a lot of feedback on this, the podcast and the YouTube.

00;30;44;20 - 00;30;59;17

Cary Hall

You don't have to be able to relate this whole broadcast back to someone. If you think there's someone that would be interested in this, maybe it's a family and you think you maybe it's your wife and you want to tell your wife to go listen to this podcast. This is a great way to do this. We're posted on 15 podcast platforms/channels.

00;30;59;22 - 00;31;17;26

Cary Hall

We're on the we have our own YouTube channel. We got almost a half million views up there. So this is a great way to disseminate this information. And this program is very, very different. And I think it's really going to come into focus as we get closer in to the fourth quarter. And the marketplace disruptions that we're going to see. Its HyVee Exemplar Care.

00;31;17;26 - 00;31;31;26

Cary Hall

The website is exemplar.care if you want information. So now we're going to talk about large employers because I'm focused a little bit on small employers. Quik Trip was one of your first clients okay. And now how many employees?

00;31;31;28 - 00;31;43;04

Dr. Jon Van Der Veer

They have a lot of employees. But on their on their benefit plan it's around 24,000. And and we're taking care of, folks who are in the clinic areas where we've built out clinics.

00;31;43;07 - 00;32;02;20

Cary Hall

That's remarkable. Obviously, just hearing that is an endorsement into your quality level, what you do. I shop at Hy-Vee at 151st in Olathe. I'm in there multiple times a week. Okay. Thank you. Great people. Great. But I've never been to a grocery store where they literally stop whatever they're doing and, I need to know where I can find this.

00;32;02;24 - 00;32;19;06

Cary Hall

And they walk you to the aisle and show it to you that's the way the employees work there is completely different for them to have that kind of faith in what you're doing, and to be able to take their employees, and send them to your facility. I think that speaks volumes for how this works.

00;32;19;06 - 00;32;41;13

Jaci Robson

Absolutely. And I think we are actually headquartered in Des Moines, Iowa, which is where Hy-Vee's also headquartered. And our first clinic in, West Des Moines headquarters clinic is also 24 seven urgent care. So with Hy-Vee and the types of employees and the demographics, and then we've got shift workers that absolutely works for them just as well.

00;32;41;17 - 00;32;58;08

Jaci Robson

That's, you know, outside of us, they can connect with the primary care provider, or they can come in to urgent care if they have those acute needs. We do offer fee for service as well in the urgent care. So we have nonmembers, but our members get priority so they can walk in and they're the next one to be roomed.

00;32;58;08 - 00;32;59;24

Jaci Robson

When a room becomes available.

00;32;59;24 - 00;33;05;01

Cary Hall

So when you say 24/7 you really mean 24/7 brick and mortar urgent care.

00;33;05;02 - 00;33;11;00

Jaci Robson

Absolutely. We opened our doors, nearly five years ago now, and we've never closed those doors since.

00;33;11;03 - 00;33;19;14

Dr. Jon Van Der Veer

I’ve never missed a shift. And as we grow out and the markets mature, we're going to have it in Omaha. And here in the Kansas City market as well.

00;33;19;16 - 00;33;39;27

Cary Hall

That's that's pretty remarkable because that's not something you typically see. And again, the employees are coming in. There's no copay for them. There's no out-of-pocket costs for them. Am I going to be able to afford the copay? Well, I'll wait a couple days. I'd rather see if I'm not going to have this problem, or the problem gets worse because they don't want to pay the 50 or 75 or $100 co-pay.

00;33;39;27 - 00;33;40;20

Cary Hall

This is completely different.

00;33;40;20 - 00;33;58;12

Dr. Jon Van Der Veer

And even more so at night. Those employees would often be going to an emergency room. So now you have hours of time lost, thousands of dollars spent out of their pockets, and even more out of the large employer level funded, self-funded folks who are paying the bill. However it comes in.

00;33;58;12 - 00;34;02;05

Cary Hall

And it is the least effective dollar for health care spent in this country.

00;34;02;05 - 00;34;03;01

Dr. Jon Van Der Veer

Absolutely.

00;34;03;01 - 00;34;06;17

Cary Hall

Yeah. And it's unfortunate, but that's what you said is absolutely correct. Yeah.

00;34;06;17 - 00;34;29;27

Jaci Robson

They all understand zero. So they all understand zero. And we all know that accidents never happen when we want them to happen. They're always going to be at night or at the weekend or during the holiday. You you know, you're at the barbecue with your friends on the 4th of July and something happens. Where do you go? Emergency room is usually your only option, but now we can do the virtual care if needed.

00;34;29;27 - 00;34;36;25

Jaci Robson

If virtual care will manage the situation, we can do virtual care or they can come into the clinic for that 24/7 treatment.

00;34;36;25 - 00;34;52;03

Cary Hall

So on the break you were talking a little bit about the experience for the employee and what you have learned over the years with how the employees feel about this program versus being on a standard ACA type health insurance program. Talk a little bit more about that, Jaci because it was fascinating.

00;34;52;09 - 00;35;09;28

Jaci Robson

Yeah. No. What we find is that a lot of these employees, they've not necessarily had regular checks. So what we actually say to them, some of them are unsure, and they feel that when they're coming to a doctor's office, maybe it's a little bit more judgmental. They come and they visit our clinic and people have got the time for them.

00;35;09;28 - 00;35;36;01

Jaci Robson

They build that personal relationship with them, and it just feels more real. They’re coming and talking to a friend. We also say “doctor in your pocket”, or “that small town doctor” who knows your family and knows who you are and what matters to you. We want people to live their healthiest lives, so if that's playing with your grandchildren, it's you want to continue to be golfing, or whether it's that you just want to go and sit and meditate and have coffee with your friends.

00;35;36;08 - 00;35;58;09

Jaci Robson

We will work with you on whatever health means to you. And what we do is during that welcome visit, we will take those baseline labs. We’ll have those initial conversations of what health means to you, and then we'll make sure that we keep your health where it is today or we'll help you to improve. This is all about proactive preventative health care rather than the “sick care” that we have across most of healthcare.

00;35;58;10 - 00;36;20;28

Dr. Jon Van Der Veer

Must have time to dig into it all. If you come in and you've got a couple things you want addressed, one of them, you might be tired. You're chronically tired. If you work shifts, the your sleep's not very good. You don't eat very well because you work at QuikTrip and a convenience store. Or you get off work at two in the morning and there's nothing available, and you can't cook.

00;36;21;00 - 00;36;39;14

Dr. Jon Van Der Veer

We have the time to sit and go. Okay, let's look at first off. Yes, we need to figure out your sleep schedule. Go through all of that. That can be a ten minute conversation. Then you move on to the diet and the exercise. The exercise is going to help, sleep. I remember in the fee for service world, I would get people who would come in and be like, yep, you need to work on your diet and exercise.

00;36;39;14 - 00;36;43;17

Dr. Jon Van Der Veer

You shouldn't become diabetic. That would be bad. Thanks. Have a nice day. Done. Visit over.

00;36;43;19 - 00;36;46;06

Cary Hall

7.5 minutes. 7.5 minutes and out the door.

00;36;46;08 - 00;37;07;29

Dr. Jon Van Der Veer

Now have you sit and have a conversation. You say okay, your A1C comes back at at 6.0. You're pre-diabetic. You could become a diabetic if you're A1C gets to 6.5, you're on that trend. I could give you metformin, a medication that treats diabetes. And we can relative risk reduction of about 16. Or you can make wholesale lifestyle changes.

00;37;08;04 - 00;37;27;17

Dr. Jon Van Der Veer

And now I can talk about intermittent fasting, low carb food options, the types of exercise that, decreases the likelihood of progressing to diabetes. And that's a 32 fold relative risk reduction, twice as effective as me giving you a medication. One of those takes time and effort to explain. The other one takes writing a prescription and moving on.

00;37;27;19 - 00;37;29;25

Cary Hall

And that's the 7.5 minute visit.

00;37;29;25 - 00;37;44;06

Dr. Jon Van Der Veer

And half the patients will say, I kind of like that pill idea, but this is where you get a chance to really show them that you care about them and educate them like your health matters. And if you make these changes, you can head off one of the most costly long term diseases that you can have.

00;37;44;13 - 00;38;01;01

Cary Hall

And that comes back in cost to the employer, and it comes back with satisfied employees, and it comes back with the overall health of his workforce and how they feel about that employer. Which goes back to that comment you made earlier in the show. This is the one thing my employer does that’s a real benefit.

00;38;01;06 - 00;38;18;09

Dr. Jon Van Der Veer

So you know what this is though Cary, this is alignment. So my goal is to make you healthy. Your goal is to be healthy. The employer's goal is to provide a good benefit and to save money. At the same time. All these things are in alignment where in a fee for service world, the more you come in, the more I get paid.

00;38;18;14 - 00;38;25;22

Dr. Jon Van Der Veer

You have. I do have disincentives and misalignment that cost people money over time. And this is a way to to remedy that.

00;38;25;28 - 00;38;42;17

Cary Hall

And, you know, I think that's a great way to wrap this up. You just heard it from doctor. It makes perfect sense. This is this is an alignment. It's a alignment that works. I urge you to take a moment to go to their website and take a look at this exemplar care Exemplar.care.

00;38;42;17 - 00;38;59;09

Cary Hall

It's is on the website. All the information is up there if you're an employer, if you're a human resource director and you're, you know, you're looking for an alternative or you know you're going to get a significant increase next year, or maybe you're just not happy. You're not happy with the program that you're on. You're not happy with the carrier.

00;38;59;09 - 00;39;16;06

Cary Hall

You're not happy your employees are not happy. You've been cost shifting. You're doing all these different things to try to make it work. It's just not working. This model works okay. Hy-Vee and QuikTrip wouldn't be doing this with thousands of employees if they didn't think it worked. That's why I asked these folks to come and do this show.

00;39;16;11 - 00;39;34;18

Cary Hall

We try to provide information here about things that are different. On the cutting edge of health care. This program is different. The website exemplar.care is the website. All the information is up there. And now I leave you with this thought from Albert Einstein. The one who follows the crowd, they usually get no further than the crowd.

00;39;34;24 - 00;39;56;01

Cary Hall

The one who walks alone is likely to find himself in places no one has ever been. Remember, friends, it's a funny thing about life. If you refuse to accept anything but the very best. You most often get it. Thank you for listening to America's Healthcare Advocate Show broadcasting coast to coast across the USA. Goodbye America.

00;39;56;04 - 00;40;03;08

Unknown

You and you.