My Interview with Scott Stevens: Expert Insight About Employee Healthcare
The U.S. healthcare and health insurance landscape is shifting rapidly. Many of the changes are either subtle, misunderstood, or not readily apparent. Fortunately, we have experts around who can help us make sense of it all.
Enter Scott M. Stevens, RHU, CDHC.
Scott is an employee benefits and consumer-directed healthcare (CDH) broker/consultant and trusted adviser. He helps organizations of all kinds reduce their health insurance and related employee benefits costs. For over 35 years, Scott and his company, SM Stevens & Associates, have worked with thousands of employers to implement alternative health insurance funding solutions, creative strategies, and employee educational tracts.
Scott recently spent some time with one of the Vistage groups I work with. I learned more about his area of expertise in those three hours than I did over the past twenty years. Still, I felt like we just barely scratched the surface, so I asked Scott to spend a little more time with me.
During our one-on-one discussion, Scott and I chatted about the No Surprises Act, a few key points from one of his popular articles “Top 10 Non-Insurance Healthcare Payment Options,” and more. Watch our talk now! And to learn more about Scott, visit the S.M. Stevens and Associates website.
Chad Harvey (00:00): Hey everybody. Chad Harvey here with Scott Stevens. Really happy to have Scott on. Scott is an employee benefits and consumer directed healthcare broker and consultant, and a trusted advisor. He helps employer organizations of all types reduce their health insurance and their related employee benefits costs. Scott and his company, SM Stevens and Associates, has worked with thousands of organizations to implement alternative health insurance funding solutions, creative strategies, and employee educational tracks over a 35+ year period. I had the great privilege of working with Scott last week. He spoke with one of the vested groups that I chair. Dropped a lot of knowledge bombs on him, surprised him with a couple things, and I wanted to have him back today to chat with him about his area of expertise because it is of great interest to employers everywhere. Scott, welcome. It’s great to have you.
Scott Stevens (00:55): Thank you Chad. It’s my pleasure truly to be here with you and your audience today.
Chad Harvey (01:00): Good. Thank you. I typically tee things up here by asking folks a version of what’s the one question or the one thing that you wish everybody would know, but there’s so much stuff in your domain. You and I were chatting a little bit before we went live here. I’m going to give you a very targeted question and it’s about the No Surprises Act. I know that came up during the conversation we had last week. Actually maybe I just turn it right over to you because the No Surprises Act was actually a surprise to me. I had not heard of it, so surprise, surprise. Why don’t we talk a little bit about that? Tell me about what is the No Surprises Act, first of all.
Scott Stevens (01:39): Yeah, you’re not alone. I did write a blog about this and actually I submitted that to a national trade journal that publicized it as an article, which just goes to show you that it’s relevant, it’s timely, and not a lot of other people are covering it. It’s a little confusing too because the No Surprises Act is actually fully embedded within a much larger coronavirus relief act called the Consolidated Appropriations Act, which on its surface is a $900 billion package of relief aid associated with the coronavirus and the pandemic. As legislation’s been compared to sausage making to me many times, as legislation crafting goes sometimes you end up doing just that, is you take one goal or one law and insert it or embed in another.
The No Surprises Act really has a three-part aim, first and foremost is to create at long last true, unfettered healthcare transparency. By that, I mean the ability to treat healthcare consumption and shopping like any other consumer product or good. Believe it or not, we’ve lacked that up until the passage of this law, which really, it has some time release components to it. Effective the beginning of this year, January 2022, gag clauses were removed and healthcare providers were compelled to now share, for the first time to the public, all of their pricing data. That’s the fundamental part of this No Surprises Act. With that, there’s some other pieces. The other two parts to it, the No Surprise Billing part, which is how the name No Surprises Act came to be. No doubt people that watch this video have maybe even incurred this terrible calamity, which is that you go to a doctor or a clinic or a hospital and somehow end up receiving care from a provider that’s not contracted by your plan.
You end up getting this bill for a so-called non-PPO or non-contracted provider, and it has this ridiculously inflated amount of charges for a service that would’ve cost a fraction had the provider not been out of network or non-contracted. That has been going on for the better part of the last 40, 50 years. With the passage of this law, it is now banned, the practice of providers doing that. In order to keep everybody on a level playing field, the bill requires, over time, both employers and insurance, I call them payers, but insurance companies, government plans, employer supplement plans, they will be required, and already are in some cases required, to make available to patients a, it’s called a machine readable file, but it’s a link to pricing data that will show people how much it costs for the care they’re seeking both from a contracted PPO provider and a non-contracted non-PPO provider.
Chad Harvey (05:04): Hmm.
Scott Stevens (05:06): That’s a pretty big deal, but again, it’s been really clumsily rolled out. Right now, if you click on it, I think I shared this with one of your groups, if you click on any of these pricing links, all you see is a bunch of garbled, meaningless fonts, so it’s got some work yet to do. I think by 2024, the healthcare systems and health insurance payers are going to have to have virtually every conceivable treatment and pharmaceutical, durable medical equipment therapy, everything under the sun will have to be on these public facing websites.
Chad Harvey (05:49): Wow. That is an incredible amount of disclosure that’s coming down the pipe here. I was really stunned.
Scott Stevens (05:58): It is, and some are concerned, and this is a valid concern that absent the ability for different payers, let me just pick on Cigna, Aetna, Blue Cross, United Healthcare, historically their approach to negotiating discounts for their customers has been to sit down with these various providers and try to set rates for two to three year periods of time. Cigna certainly didn’t know what kind of deal Blue Cross got or United or Aetna for that matter, because those were all protected under gag clauses and all protected under confidentiality agreements I’m sure, and a host of other protections. Well, as I mentioned at the outset, that’s no longer the case. Now that everybody’s going to know what everybody else is getting as a fee schedule or as a deal, it might inflate costs. You might end up seeing costs or fees for healthcare rise. We will see. That remains to be seen.
Chad Harvey (07:01): Is there anything in particular from the No Surprises Act that you are finding that either employers are ill prepared for, or that they could get prepared for to get out in front of anything or maybe even leverage some of the provisions of this?
Scott Stevens (07:17): Yes. Great question. As is often the case in my world of healthcare financing and delivery, there’s a real divide and a difference between employer health plans that are so called fully insured plans, meaning they send off a premium check to an insurance carrier and that’s the extent of their risk taking or administrative role, contrasted by partially self-funded or self-funded employer based plans, which involve a little bit more enhanced level of risk taking and administrative responsibilities and so forth. Well, compliance with this No Surprises Act differs greatly between those two. If you’re an employer with a fully insured plan, you really don’t have to take any action unless you want to communicate to your employees that, hey, this pricing tool’s available and here’s where it is. In that fully insured space, the insurance companies have the compliance responsibility to make available that link that I talked about before to the machine readable files.
To answer your question, the thing that I think a lot of employers that self fund or partially self fund their health plans are caught off guard by is they are required to put on their public facing website these links to this transparency data, and a lot of employers are not doing it. Probably even more are not aware that they’re supposed to be doing it. That would be my cautionary tale for this interview today.
Chad Harvey (08:53): I think that’s a good takeaway. That’s a two-minute programming fix there on the website. Easy to put in.
Scott Stevens (08:59): It really is.
Chad Harvey (09:00): Yeah. You just got to know to do it.
Scott Stevens (09:02): You do. I should add to that their payers, whether it’s Blue Cross, United, Cigna, or a third party administrator TPA, they are, at least for my clients, they are all providing the link. Literally they just need to grab the link from the company they’re already doing business with and get it onto their public facing website, and that’s it.
Chad Harvey (09:26): Probably something that was sent to the HR or the benefits coordinator, and they didn’t even know what to do with it.
Scott Stevens (09:33): That’s a very real possibility.
Chad Harvey (09:38): Let’s switch gears real quick with our remaining time. You had written a blog post within the last couple years, the Top 10 Non-insurance Healthcare Payment Options caught my eye. Yeah, I was scrolling through your site. It was really good. I think we could talk a lot about that, probably an hour or more. Maybe you want to pull just one nugget out of there, and I’ll provide the link to that post in the transcript of our conversation on the website article. What’s one thing you could pull out of there you’d want to share with the audience.
Scott Stevens (10:12): Yeah. I guess on a macro level or a general level, and this is hard for people to intuitively accept or understand, your health insurance is not always the best mechanism or source.
Chad Harvey (10:27): People are calling you already.
Scott Stevens (10:30): What’s that?
Chad Harvey (10:31): I said, people are calling you already. I hear the phone ringing.
Scott Stevens (10:34): I don’t even know how to turn that off, so I’m just hanging up on whoever is calling me. Anyway, your health insurance, as expensive as it is, and it is expensive, is not always the best source of payment or funding or planning for the healthcare that you need. I put together this list, borrowing from the old David Letterman show, the top 10 that I have found, non-insurance related healthcare payment options. These are things like spending accounts. A lot of people have these health savings accounts, flexible spending accounts, health reimbursement accounts. A lot of people have them, or maybe even multiple of them, and don’t really know what or how they can use those accounts, but they’re very powerful. They’re very beneficial both from a tax saving standpoint and providing funds for necessary healthcare.
My real favorite in this, and I did a whole separate blog, is just on pharmaceuticals, prescription drugs. I mean, there are now, I think I’m up to eight or 10 different options, alternatives to health insurance for prescription drugs. I know I shared these with your group. GoodRx is probably the one that’s getting the most attention now, but there’s now a new entrant that’s very similar to GoodRx. Mark Cuban has come out with something called costplusdrugs.com, which seeks to do the same thing, eliminate the middle man, try to get patients a better negotiated rate for their prescription drugs. These resources, and they’re all on my blog, these are resources free of charge that people, patients can access. They’ll do a couple things. They’ll locate the lowest cost pharmacy within their geographic region to purchase the drug. They’ll also provide any types of coupons or incentives or vouchers that the pharmaceutical manufacturer for the drug that they’re seeking is offering at that any particular point in time.
Some of them are maybe more easy to maneuver than others. GoodRx has been around the longest and is probably the most recognizable. They also have an app for your iPhone or Android device, which is pretty cool. The last one I really want to talk about is virtual care. I just got through with an hour webinar where I’m learning about. Virtual care goes by a lot of different names, Telehealth, Telehealthcare, Teledoc, but virtual care is the ability to engage a healthcare practitioner via a smartphone or a tablet for the treatment and prescribing, if necessary, of upwards of 40 different health elements. Things like cold, flu, bronchitis, pink eye, UTI, there’s this generally accepted list of ailments that people can seek, truly and realistically, care from a primary care or a nurse practitioner, a physician’s assistant. They can be seen, treated, diagnosed, and if necessary prescribed in the comfort of their own home or their office or wherever they happen to be.
I just learned in this session that, obviously with the coronavirus and the pandemic, there was a huge spike in reliance and use on virtual care. It is now settled back down and it is still at 40 times pre-pandemic utilization rates is virtual care. It’s a real thing. People, now that have had the experience of using it have seen how great it is, how easy it is to use, and how efficacious it is because you’re seeing a real provider and they’re prescribing and helping you get well. Those are just some of the non-insurance related types of healthcare payment options that I’m a big fan of.
Chad Harvey (14:43): I’m glad you threw that in there and decided to close out with that. I am far from even mildly educated on this space. I’m very far back and far afield, but my sense is that we’re at a really unique point in terms of healthcare and healthcare delivery in this country. We got a convergence of technology. We got a convergence of different types and different methodologies of insurance. We’ve got delivery changes. There’s a whole swarm of stuff going on, and it must absolutely be fascinating to be in your space, and probably a little maddening sometimes as well.
Scott Stevens (15:20): It is. I mean, the pace, not only of regulatory changes, but also innovation and disruption is dizzying. I mean, that’s why I started blogging. I don’t know that I ever said, well, I aspire to grow up one day and have a blog. It was truly back in 2010 when the Affordable Care Act was passed, I mean, compliance and regulations were flying off the shelf on a weekly basis, that I felt the best way for me to communicate these changes and mandates and fees and taxes was to blog. That’s what got me started in this whole blogging space.
Chad Harvey (15:57): Well, and that might be a good question for us to close it out and end on here. You said when you were a child, you didn’t want to grow up and have a blog. What did you want to grow up to be, or did you always envision that you were going to be the healthcare expert dejour?
Scott Stevens (16:10): No. I really appreciate you asking that question. Believe it or not, as young as the 10th grade, I wanted to be an eye doctor.
Chad Harvey (16:17): Okay.
Scott Stevens (16:17): I wanted to be an eye doctor and I ended up on a precollege, so in high school education track where I took three years of Latin, five years of math, and four years of science to prepare for med school. Obviously that didn’t happen.
Chad Harvey (16:39): Well, there’s often a twisted path and a detour or three between where we think we’re going to be and where we eventually end up.
Scott Stevens (16:45): No question. Yeah, no question about it.
Chad Harvey (16:48): Oh my gosh. Well, Scott, it was a pleasure chatting with you. I appreciate your time today. Thank you very much.
Scott Stevens (16:53): My pleasure. Thanks for having me.
Chad Harvey (16:55): Absolutely. We’re going to drop a couple links in the transcript and on the post for the website here. To learn more and to visit Scott’s blog, https://smstevensandassociates.com, and we’ll link in the transcript to that specific blog post that we were talking about as well. Scott, thank you very much.
Scott Stevens (17:14): My pleasure, Chad. Thank you.