In episode 18 of The Healthcare Hangover, David Contorno and Emma Fox discuss their recent trip to Dallas and a new project they've been working on. They also talk about the challenges of the healthcare system and the need for a holistic approach to fixing it.
Tune in to hear their insights and find out how you can get involved in making a difference in your own community.
TIMESTAMPS
[00:02:43] Lack of Access to Healthcare.
[00:08:14] Prescriptions and Financial Assistance.
[00:11:45] Financial Assistance Programs at Nonprofit Hospitals.
[00:15:02] Providing Healthcare to the Uninsured.
In this episode, David Contorno and Emma Fox delve into the pressing issue of individuals in certain communities who are unable to afford essential medications and healthcare. They even highlight that as individuals age, they often require maintenance prescriptions for common health issues like blood pressure. However, the cost of these medications can be exorbitant, leading many to forgo necessary treatments and appointments.
Overall, David and Emma emphasize the importance of understanding the various assistance programs available and the distinction between medical and prescription coverage. While some programs require individuals to be uninsured, others may still be accessible to those with insurance. Taking a holistic approach to healthcare is crucial, addressing the issue from all angles simultaneously to prevent the problem from resurfacing in more detrimental ways.
QUOTES
SOCIAL MEDIA LINKS
David Contorno
LinkedIn: https://www.linkedin.com/in/dcontorno/
Emma Fox
LinkedIn: https://www.linkedin.com/in/emmamariefox/
WEBSITE
E-Powered Benefits: https://www.epoweredbenefits.com/
Emma Fox: https://emmamariefox.com/
Welcome to the health care hangover.
I'm one of your hosts, David Contorno, and I'm your other host, Emma Fox. This is a podcast about the headaches we've been encountering in the health care system that are leaving us feeling a little hungover.
Let's dive in.
Okay. So we were in Dallas recently, and, um, I kind of want to talk a little bit about this, uh, new project that we've been working on. I guess I've been doing it a little more than you, but you came into Dallas with me for a day. Uh, and we did Spencer Smith's podcast. That was pretty cool.
It's a lot of fun.
Yeah. What did you like most about Spencer's setup?
Well, first of all, it was really a professional setup. I mean, we were in a real sound studio. He had a, experienced photographer and from what I've seen in his prior shots and prior videos, you know why they turn out so well. So I'm looking forward to seeing the final results.
Yeah, me too. It was a fun conversation. He's a very professional guy. And he was telling me actually, I think this was after your episode was done and you had to get your plane to New York, but he was telling me he has experience with acting. He actually was somewhat of an actor in his earlier life. And so he was very good at hosting. I was impressed. And then it was funny because he was like, Oh, how are you guys doing your podcast? We're like, Oh, we just do it in Zoom. And send it off completely unprofessional. But okay, so the Dallas Fort Worth project, I was contacted by a friend of mine, Ivan Hall, who is a fantastic guy. And he reached out to me months ago and said, Hey, I live kind of on this invisible line in Dallas and where I live is okay. But on the other side of the line, there's this population of people that can't access healthcare. it was really bothering him, you know, he knew all these people that were neighbors and friends of his that couldn't afford to just go to get primary care services. And it was really impacting their life. And he says to me, you know, is there anything you can do about this? Any ideas? And of course, I said, yeah, let's let's figure out what to do. And so we created this project called Direct Care Connect. And I've got a couple people backing me up completely volunteer project, by the way. But the goal is to bring direct primary care into these communities for short periods of time, kind of like pop-up DPC, to serve these folks who don't have access to health care.
What's the underrunning current as to why that group of people can't access health care?
You know, that's a good question. So the reason I went down to Dallas was to kind of do some community assessments. And so we drove around for most of the day visiting these different communities and They all kind of have commonality, but different reasons. So these pockets are certain ethnicities. They might be at a certain scale on the socioeconomic spectrum, I suppose. But there was one community that we went into that was really interesting and heartbreaking, actually, is called Forest Hills. And they used to have two grocery stores. in town. And over the last few years, both grocery stores got bought by gyms of all organizations. And now there's not a single grocery store in the town and the closest one is about nine or 10 miles away. And so it could be because it's a food desert and people are using their resources to buy whatever foods available and guess what food is available in the community? Fast food, fast food. All we saw were Wendy's, McDonald's, Burger King and like a convenience store. But other than that, they can't access groceries. And so I don't know, maybe spending their resources trying to get to where there's food. We visited other communities where neighbors are sharing cars in order to reach the essential resources that they need. But yeah, I think it's it's a number of reasons, but it comes down to wealth, I think, or lack of.
And so what is it that you plan on bringing to these people and how?
Well, we're doing a kind of a dual take. We're going to build out. I'm actually looking for fundraising or maybe even government grants, I don't know, to develop a mobile health care unit, walk on clinic. is a great resource for this. And they actually showed me some blueprints of a mobile clinic where you can have three, four mobile doctor's offices in one unit that goes into these communities and just sets up shop for a week and sees as many patients as possible. And the goal is to get them basic primary care, just baseline level of health. And some of these folks haven't been in primary care offices for years and years. And Ivan was telling me, you know, they're functionally uninsured. And I spoke to a few people in those areas, and many of them qualify for Medicaid. And get this, the process to qualify for Medicaid is so nightmarish that they remain uninsured instead.
That doesn't really surprise me.
I know, but shouldn't it be easier than this?
Of course, it should be. The problem is, in order to make it easier, you have to put money into it. And by putting money into making it easier, you spend more money, if you're a government perspective, right? Especially if you're in a Republican state who doesn't fully back those programs anyway.
I'm excited though. I mean, we've got a couple of clinicians working on this and I'm really into the whole clinician run everything lately when it comes to healthcare. So everything I do, I tend to lean on a clinician. My right hand on this project is a physician's associate. Her name is Tiffany Ryder. She's a fantastic person, really decorated background. And she's really been running the project and I was just fortunate enough to head down to Dallas to see what was going on. And it reminded me so much of where I grew up, except, you know, I grew up in universal healthcare. So my situation was a little different.
Yeah. I mean, I think there's a lot of access to care issues in this country, but I think time and cost are probably among the biggest and let's, you know, here's my mind says, okay, so they get this good primary care and then some of them are going to need more acute care.
Now, what do we do with them? Well, I'm so glad you asked because another resource we have in the Dallas area and you and I have known about North Texas team care for years now, but if you do happen to be down in Texas or in and around Dallas, there's an incredible surgical facility, independent surgical center run by Dr. Kikiri and we call him Dr. K. But I think he was kind of one of the first along with Dr. Keith Smith in Oklahoma to say, you know what, we can do this better. We can bundle the prices, we can make it more accessible and more affordable. And then, you know, we have resources like green imaging, Dr. Kristen Dickerson. So if somebody would need an imaging, something beyond the direct primary care capabilities, So we're putting all those pieces together, but something that got brought up and I would love to hear some audience feedback on this is, what about the other problems that are contributing to the lack of healthcare? Like, do they have the money to get on the bus to get to wherever the mobile healthcare unit is or wherever the pop-up is? Is it in, you know, forest hills where there's food deserts, do they need food as well? I mean, it's kind of like a multifaceted layered problem.
Well, I do have one suggestion before that you get to that point is what if on the bus, you had a little office and in that office was a navigator, someone who could help them determine if they apply for Medicaid, Medicare subsidies in the exchange, and then actually know it well enough to help get them on the path of getting coverage for that.
Yeah, I think that's a really good idea. We were talking about prescriptions specifically as it pertains to this project, because a lot of folks in those communities, they just need prescriptions, maintenance prescriptions, right? Like blood pressure and run-of-the-mill stuff as you get older in your life and just being able to connect them with resources. I was in an Uber in Dallas. I forget where I was going from and to, but The guy, the Uber driver said he had been diagnosed with a brain tumor and it doesn't have insurance. He drives for Uber. And there's a medication that he needs and he couldn't afford it. So he's just not taking the medication and he's not going to appointments since his diagnosis because they want payment upfront.
And I spent... He wanted to take the medication he can't afford.
Right. And, you know, I spent the entire Uber ride in the back with my laptop out trying to find, you know, where he could get this medication. And I actually did track it down and he can get it for a reasonably price. But I went through like, what is a manufacturer's assistance program and how do you qualify for it? And where do you go in order to get this medication to you for free? And this Uber driver, he was a very smart man, but he had no idea that any of those things existed. He just thought, there's nothing I can do because I can't afford it. And it is what it is.
Can you imagine that? I think one of the challenges, it just reminded me of a TikTok that I saw from Jared Walker at dollar four. He said that he hates the name charity care, but he nonetheless highly recommends that everybody call when calling the hospital and asking for charity care. Because when you ask for financial assistance, you can get a whole host of other things that are not charity care. You could get payment plans, you could get a discount off, but none of those are charity care. Charity care is where because of your income and because of the nonprofit status of the hospital, there's a black and white formula as to how much you get reduced or eliminated. And when you say charity care, then they know. And I think the same thing needs to apply for prescriptions because We talk about all this financial assistance, but we're really talking about the manufacturers program for uninsured people as being the most effective and getting to that program if you don't know otherwise and don't do it frequently can be very challenging.
And one thing I'll throw out too, which is probably the most common misconception around these programs when people find out about it, is that it doesn't matter if you have insurance. It is not for only the uninsured. It's also for the under insured. And if you have, if you're on an HSA plan, you have a massive deductible and that bill hits your floor and your income can't support payment of it, you could still qualify for the charity care programs at nonprofit hospitals. And I want to kind of really harp on that point, because so often we think charity care is just for people that are uninsured and poor. And even the latter is not true, because some of these charity care programs are four to six hundred percent of the federal poverty level, which I would argue is most of America.
Mm hmm. Huge part of it. Yeah. Some of them are if you're uninsured and you have to be whether and then others, you can be insured and still qualify. So it's important to understand the distinction and to know when it applies. Normally speaking, the medical side, it doesn't matter if you're insured or not. The really valuable programs on the prescription side typically mean you have to either be uninsured or that drug is specifically excluded from coverage. But even if neither one of those do exist, there are still plenty of ways to get the drug a lot less expensively.
Yeah. I just found out actually there's some updates on the new GLP ones. I guess they're not new anymore. And they haven't really ever been new. Ozempic's been around forever. But yeah, we were able to source some of those internationally now from Canada and New Zealand. And it's a You know, they're not free, but they definitely give us some cost savings. So I see it. I see it improving. I see the programs expanding. But I was on a call with Doug Aldean about 501R programs. And I posed the question, I'm curious what your feeling on this is. But as it relates to financial assistance programs at nonprofit hospitals, here's my question. They have to have these programs in place if they're nonprofit. And that's kind of like an exchange of value. Right. You say, well, we will be a nonprofit and we'll avoid the tax implications of not being nonprofit. And in exchange, we will turn around and spend those tax savings on our local communities by providing charity care where it's eligible. Right. That's that's the point for anyone who doesn't know that. At what point, since since some of these programs are becoming more widely known, we've got tech talk and social media that are kind of outing these hospitals for their charity care programs. Do you think there's going to come a point where the hospitals are going to say, you know what, we'll just take the taxes?
Yeah, I mean, it depends on how broad this becomes, because if it really becomes. broad enough to where it is outweighing the taxes. I think we're a long way from getting there though, but it would be nice for that to occur. Yeah.
I hope so too, but I always, you know, I think once they do realize that people become smart to it, I expect that they're going to be making changes. It's kind of like the cost transparency data. There's a little buzz going around that hospitals all of a sudden are raising their cash prices. now that people have figured out that the cash price is the lowest price with the data that they release. So I always suspect that they're going to be sneaky and figure out how to take more away from patients and still increase their benefit.
Well, and that's been, I think, part of the problem with healthcare for decades and trying to fix this. We keep trying to fix one point and it always bubbles out elsewhere. We need to look at it holistically. We need to push pressure down on it. from all angles simultaneously. I think that's the only way to avoid it from popping out somewhere else. And usually in a worse way than before.
Yeah. I don't know. I don't have a lot of hope to be honest with you. I'm pretty hung over. Hey, question for you. This is off the cuff, so I don't even know if you're going to have an answer, but talking about the Dallas project, this has really become something super near and dear to my heart. You know, everything I do is important to me. Don't get me wrong. But this one is, you know, I was driving through those communities and I, you know, I was tearing up and just. Gosh, what can I do? Like what tangible thing can I do? And it's become like really fun to work on, I think, because it's so important to me. Is there anything that you want to do or that you've thought about doing that would make you feel similarly? Like it's work, but it's like it's really philanthropic, rewarding, meaningful work.
I mean, I've done it in the past. I guess there's nothing other than what we do day to day, which I would consider as part of that I'm doing now. But I was for a long time on the board of a clinic that provided care. If you didn't have insurance and didn't have Medicare or Medicaid, it was totally free. You had to show your pay stub, but it really fit a need. And especially right after Obamacare rolled out and Medicaid didn't get expanded here, we had quite a need for that. And then we eventually built a dental bus. So we had a dental bus that went around just to do dental care in the area. Um, and that felt good. You know, I put a lot of time into that and we had fundraisers. We've got Dr. Oz to come one year and raise money because. Yeah, he's Armenian or Albanian. I forget what she is. And there's a famous family in town. The parental units have passed off, but they're called the Max. There's the Charles Max Citizen Center and all stuff down to them. It turns out they're from the same country. So they knew Dr. Oz and they were able to get him here for a fundraiser. And so we put a lot of time and effort into that. I haven't done it for a while, especially since our business is growing outside of just this local area. You know, for me, I feel like I have the opportunity and our plans do that every day when I can get someone who is does have a job who's clearly doing the right thing, but they still can't afford their medication or their surgery or their tests, and then I can get it done for them. that feels really good. And it doesn't feel like charity. It feels like getting them what they should have been entitled to anyway. I mean, that's what we promise, right? As a job, you have a job, you have a good job, you have a kid, you have a family, like you're gonna get healthcare. I know that's not in our constitution and I know there's no laws necessarily around that, but it feels like even if you're paying for it, it should be affordable and it should be a basic affordable right. And it feels like for so many, it's just not.
You know, I agree. What I would like to know from our audience, though, before we close up this episode is if they live in a community where I could help, where we could do similar things. Dallas Fort Worth is just our pilot project. I'm being spearheaded by Ivan and Tiffany right now, and I'm just kind of overseeing it. Tiffany's doing some incredible work. If you guys don't know Tiffany Ryder, you got to connect with her on LinkedIn. She's just fantastic, puts out brilliant content and has a great clinical perspective. But I'm curious if anybody thinks that we could do some good in their community. I think that's kind of the direction I want to take things. So I'm looking forward to people's feedback and getting this on the road in the beginning of 2024.
Or if you want to volunteer and or know of any funds or grants that might be put towards this, please let Emma know.
Yeah. Thank you. Thanks so much for tuning in. Be sure to subscribe and leave a review. And remember, there's always a hangover with healthcare.
Until next time.