PHM: Precision & Personalized Medicine – Transforming Cancer Treatment for Employers

In this engaging episode of "Healthcare on the Rocks: Employee Benefits with a Twist," hosts Jennifer and David invite two guests from PHM, Natalya Gertsik and Tommy Axford, to discuss innovative strategies for managing employee benefits, with a particular focus on cancer care. 

Natalya, specializing in population health risk management and biopharmaceuticals, sheds light on the actionable guidance PHM provides for optimizing cancer care. Tommy, with his actuarial background, emphasizes the importance of focusing on the small subset of cases that drive a significant portion of healthcare spending.

The conversation delves into the complexities of cancer treatment, including the challenges of adopting precision medicine and the necessity of personalized care plans that consider the unique needs and preferences of each patient.

Key takeaways from this discussion include:
  • The importance of striving for precision medicine in targeting cancer treatment
  • The vital role of personalized medicine, considering the patient's personal preferences, cultural background, and socioeconomic factors, highlighting the need for a more holistic treatment plan.
  • Innovative solutions like PHM's Clear Cancer Care Management Solution, part of the Springbuk Activate Marketplace, which offers employers and their advisors data-driven ways to connect with partners who can address specific healthcare needs, particularly in managing high-cost cancer treatments.
  • Real-life success stories that illustrate the life-changing impact of creative and personalized cancer treatment strategies, emphasizing the potential for significant improvements in patient outcomes.
Stay in Touch!


Episode Transcript

[00:00:00] David: Welcome once again to Healthcare on the Rocks, Employee Benefits with a Twist. We're doing something today that we've never done in our first three seasons – we're talking with two outside guests simultaneously, and one of them is making a return visit, and that's also a first for us. Natalya Gertsik is the Vice President of Clear Cancer Advisory and Solutions with PHM.

Natalya specializes in population health risk management and biopharmaceuticals, and she provides actionable guidance to optimize cancer care at both the organizational and individual levels. Welcome back, Natalya!

[00:00:42] Natalya: Thank you for having me back, David. Great to be here.

[00:00:46] Jennifer: And also joining us is Tommy Axford, PHM Senior VP of Business Development and Strategic Partnerships. That's quite the title, Tommy. 

Tommy is an actuary with extensive experience shaping healthcare solutions for both private and public sector employers. Welcome to the show, Tommy.

[00:01:04] Tommy: Thanks, Jenn. Glad to be here. And I'm just sad that it's only my first go around here.

[00:01:10] Jennifer: We love it when, oh, but is it your first podcast? That's what we always like to ask. 

[00:01:15] Tommy: Not my first podcast, but my first one with you. 

[00:01:17] Jennifer: Okay. Well, that's still exciting. We'll take that. Since you are new to our podcast, Tommy, we're going to start with you. Tell us more about your background and remind our listeners what PHM does.

[00:01:29] Tommy: Yeah, thanks, Jenn. So, I have been operating in healthcare, most frequently in consulting, for over 20 years at this point. And what I love about what we're doing at PHM is really focusing on a small subset of cases – we tend to think about that top 5 percent of the population that's driving 50 percent of spend – and our ability to make a profound impact on those cases that quite frankly are the most expensive and often the most consequential within a population. 

And if I really think about what we're doing with Springbuk, I love the idea that we get to bring data to clients and inform how they identify that population that we know we can address and impact.

[00:02:21] David: And Natalya, it's been about a year. We were talking right before the show since we had you on. So why don't you give us a little refresher on your background, your role at PHM, and what you've been up to in that last year. 

[00:02:36] Natalya: Yeah, at PHM, I advise our clients on population health issues, primarily related to managing serious and complex conditions in the workforce. So just to give you an example, we'll look at employer claims data and take a clinical lens to say, okay, you have all this great data that Springbuk has provided to you, but what do we do about it?

How do we improve clinical outcomes and reduce costs for your workforce? I'll help employers think through those issues and develop a program that is likely to have the biggest impact and maximize their budget dollars. Prior to joining PHM, I was a management consultant at McKinsey for a couple of years, and I have a Ph.D. in biochemistry from Cornell.

[00:03:20] David: Excellent. Thanks for that recap. 

Well, cancer often dominates the top conditions with the highest cost thresholds. Probably not shocking to any of us here. In our Employee Health Trends report this year, various cancers comprise seven out of the top 10 highest cost claimant conditions. For this report, the threshold that we used for those high-cost claims was $500,000 a year.

Natalya, you speak to employers every day. What are you hearing from them and some of the struggles that they're having containing costs, specifically around cancer?

[00:03:59] Natalya: Yeah, and you know, the EHT report that just came out from Springbuk really shows that cancer is a top leading indicator for cost, right? So, if you, as an employer, have a bunch of cancers in your health plan, that's a leading indicator that you're going to have a lot of high-cost claimants – I thought that was really interesting information that came out of the EHT report this year.

There are a couple of reasons employers are having difficulty containing costs. Specifically, I mean, in general, in healthcare, but specifically related to cancer. One is sort of the most obvious: the cost of specialty drugs is growing, and checkpoint inhibitor cell therapies are very expensive for employers.

And the key here is not that we're going to stop using these drugs, but we've got to be using them in the right patient at the right time. Because if employers and payers are going to be paying for these drugs, it's important that we maximize their therapeutic benefit. And then, of course, the industry as a whole needs to come together and figure out a way to make these drugs more affordable with value-based contracts. And, of course, that's not sort of the focus of our discussion today, but it's going to be a huge part of affordability.

And a second reason why it's hard to contain costs is innovation in cancer. And there's been a ton of innovation in cancer over the past couple of decades, but it's really a double-edged sword.

I mean, it sounds like a good thing, but actually, it really is a double-edged sword, because we've got all these great tests and drugs, but providers can't keep up, and so there's low adoption of effective therapies, leading to poor outcomes for patients. Ultimately, patients are failing to benefit from the care that is here and available today, often care that is FDA-approved and guideline-recommended, which is entirely unacceptable, right, that patients aren't getting the fundamentals.

And suboptimal care is expensive. We all sort of know that. The solution to that is to improve the quality of care. I mean, it's easier said than done, for sure, but making better clinical decisions that are data-backed and science-backed, practicing precision medicine, and enabling better clinical outcomes because we do know that better care costs less.

Another reason that employers are really struggling is that younger people are being diagnosed with cancer. So, as the incidence of cancer grows in younger populations, it's more and more directly hitting the workforce, the working-age population. And so employers really need to solve two things.

Screening to make sure that folks are keeping up with the changing guidelines and increasing adherence to screening in their populations. And also once people are diagnosed, making sure they're getting the right treatment at the right time. Because we really want to avoid progression or recurrence of cancer because stage four cancer is much more costly, both in years of life and financially, than stage one or two.

The difference is orders of magnitude. So, it's really important to keep cancers from progressing. And then, you know, cancer is many diseases. There's no one-size-fits-all drug or algorithm. And so employers really need a partner that can handle all cancer types, including rare cancers, because rare cancers may be showing up on your high-cost claimants reports.

So how do you solve the problem of containing costs across many different disease types? That's a big challenge, so employers really need to find partners who can help them with that. 

And then the last thing I'll say is employers are struggling with the inability to action their data, right? They've got all this data. Springbuk is providing them with some, you know, incredible insights from their own data. And they often know they have a cancer problem, but they don't know what to do about it. And so, applying a clinical lens to the data that Springbuk is providing them to help them figure out what the “so what is” and what kind of programs they need to put into place to address the issues that their members have.

[00:07:31] Jennifer: So many good tidbits there. 

I think what stood out to me most, Natalya, about your response there and thinking about innovation being a double-edged sword because I don't think many people in our industry around data think about it in that context, but you're absolutely right as far as there's so much coming to market around cancer treatment that providers just can't keep up with everything that's out there.

And also, your point around more younger people having cancer, I think is, extremely insightful as well, because again, I think we traditionally always think it is typically over 50, which are certainly still in the workforce, but you certainly see many, many more incidents of younger individuals.

I mean, you know, Princess Kate just announced she has cancer and, you know, she's in her early 40s, but there's so many more occurrences of that that we see. 

Then your last piece there around the more specialty type of cancers, I think what stood out personally for me when we did our analysis in EHT this year around cancers is seeing, and we did this last year too, around blood cancers being so much more expensive to care for as opposed to like colon cancer and breast cancer.

And to your point, employers oftentimes don't necessarily have a strategy around those types of cancers because there's no typical, easier type of screenings to do around that.

I know we'll get into a lot of those additional details, but I think excellent points that you made there as far as for our listeners to really take away from that.

But Tommy, you had mentioned in your intro as far as, you know, working with Springbuk and with the data that we have, and PHM’s Clear Cancer Care Management Solution is a part of our new Springbuk Activate Marketplace, and we're ecstatic to have you as a partner within that, given all the solutions and the services that you provide. 

We've talked on our last few episodes around the Activate marketplace, but as a quick reminder for anyone who may just be jumping in within this episode, Activate gives our employers and broker clients a way to take the recommendations that they're getting from within the Springbuk platform, as far as ways to reduce risks and save costs and connect them directly and immediately with partners who can address those specific needs. And it's all data-driven. I think that's really the underlying point here. 

So, Tommy, sadly, as David mentioned, you know, cancer is typically one of our top health conditions and really a primary cost driver for employers. Tell us about some of the issues and challenges that PHM's solution addresses and how it benefits employers and their advisors.

[00:10:09] Tommy: First. I, just to piggyback on what you said, I absolutely love what you all are doing with Springbuk Activate, because as an actuary, the data doesn't lie. So bringing data-driven insights and actions to clients is incredibly important. Unlike some of the more traditional methods, let's just throw point solutions up on the wall until we find something that sticks.

So if I'm already coming to an organization, Jenn, and telling you I only want to engage with the top two to 3 percent of the population, it is incredibly important that we identify the right subset of the population who can benefit from the care management and the support structures that we deliver and provide.

And so our partnership is incredibly valuable to us because you all are bringing some of those insights to your clients, to our clients, to really help inform and guide. To me, that is one of the first issues and challenges that exist when trying to manage a condition like cancer. 

As Natalya mentioned, cancer is complex. It is not just one disease. We can talk about solid tumors versus blood-based cancers, etc. But when we think about all of these nuances, what it creates is an incredibly complex disease that we're trying to manage inside an incredibly complex healthcare system. And so when you think about those two things, they generally don't lead to optimal outcomes for members who are not qualified to make the decisions and the trade-offs around the care that they receive, when they receive it, how they receive it, from whom they receive it. And so that's a lot of the work we do at PHM, which is to try and bridge the gap on behalf of members in an incredibly complex and fragmented healthcare system. 

We all know that's true, but in no place are the consequences more important than when we start talking about complex diseases like cancer, where moments matter. Where a referral matters. Where the order of operations around chemotherapy and surgical options matter. So our ability to bring clinical expertise coupled with really, really smart Ph.D. level scientists like Dr. Gertsik, who's joining me on this podcast,   , is really, really valuable to members, and ultimately bubbles up to employers as we think about leveraging some of the new emerging treatments, therapies, and technology that are very, very valuable, very, very useful, but knowing when and where and how to leverage them is a really, really big gap in the system today.

[00:13:00] Jennifer: Totally agree. So, let's have you put your actuarial hat on for a second. And in thinking about the rising costs from cancer treatments, how can employers really mitigate risk for themselves and their employees?

[00:13:15] Tommy: So for us, it starts with identifying the right subset of the population who could benefit from support. Contrary to many programs that exist in the market, not every member should be engaged in a program like ours. So the first is understanding your data and understanding the population who could benefit from a program.

And then, um, you know, I sort of have to take my actuarial hat off for a second, Jen, because it actually starts with clinical outcomes. So what we know is if we can get the right member, with the right care plan, with the right provider, we are going to deliver a profoundly improved clinical outcome. And when we do that, the financial results will follow, right? 

So if you think about putting on that sort of that clinical expertise, putting a clinical lens to everything that we do, everything that we touch, and when you think about the complexities and the nuances of cancer, um, it shouldn't be surprising that if we can get the clinical aspects of this right, if we can get the right support and the right outcome, the numbers will always work because we are mitigating a tremendous amount of wasteful spend.

 We are avoiding unnecessary procedures, unnecessary specialty medications, which are, incredibly expensive. And so, we think that is a very, very important cornerstone to how you think about managing a complex disease like that.

[00:14:49] David: Okay, Natalya, Tommy right then was just talking about getting the right provider, providing the right treatment to the right people, and targeting those populations. Now, I've heard you talk about precision medicine. So, help me understand and our listeners, are those two concepts the same, or is precision medicine different from the right provider, right treatment, and right person?

Um, just set the ground stage for us here a little more.

[00:15:20] Natalya: Yeah, they're very much linked. And Tommy suggested I don't get too technical on precision medicine because he knows how excited I get about this topic. So I won't get too technical, but it's important for people to understand what precision medicine is, because if you understand what precision medicine is, you understand how important it is.

I want to define precision medicine as medical care designed to optimize therapeutic benefits for patients based on molecular signatures. And those molecular signatures include DNA, RNA, protein, the immune environment, and more. It's really all about understanding the molecular disease drivers so that we can target them.

And there's no doubt that precision medicine improves clinical outcomes. But it's tough to achieve. It requires genomics expertise, which most oncologists still need to have. It requires infrastructure, which most healthcare systems still need to have. It requires time, resources, and the right incentives, all of which are lacking in our healthcare system.

And so it's not surprising that precision medicine, the best of precision medicine, is not widely adopted in our current healthcare system. So at PHM, we deliver precision medicine to our patients. And so we've built this team of Ph.D. scientists with expertise across genomics, molecular biology, biochemistry, immunology, and much more, who help to develop data-informed treatment plans for our patients so that they can live longer and better lives.

And so this is distinctive for us. It's a big differentiator. We think we do this incredibly well. But in addition to precision medicine, which I think every cancer patient in the U.S. should have access to, they don't, but they should, and certainly we at PHM make sure that our patients have access to it and receive it.

In addition to precision medicine, I want to talk about another term, personalized medicine. And the terms precision and personalized medicine are often used interchangeably. And I think when we do that, we miss an opportunity because personalized medicine is personal. It takes into account culture. It takes into account socioeconomics and psychological factors. And it focuses on what's most important to the patient. What does the patient really want? 

So let me give you some tangible examples. A young woman who wants to have children may want to delay chemotherapy to preserve fertility. Are there risks in doing that? Absolutely. But helping that person weigh those risks and quantify those risks against the benefits is something that patients really need and are lacking today. Another example is that a patient may favor a less aggressive chemotreatment course or just a general treatment regimen to avoid lengthy downtime so they can care for their young children.

There may be risks associated with that. A patient may prefer to stay close to home for treatment versus traveling to a COE. These are personal decisions. They have nothing to do with the biology of your tumor. But helping patients quantify the risks against their sort of what we know about their disease and how aggressive that disease is will help them make informed decisions.

And so, two patients with similar conditions may benefit from completely different treatment plans, and we take the time to figure that out. And when our patients know we're listening, they have peace of mind and the ability to retain some control of their lives, even while they find themselves in the swirl of a crushing cancer diagnosis.

So, you know, I just really wanted to describe those two concepts. Precision, which is precision medicine, which is the biochemistry of the tumor. It's driven by the biochemistry of the tumor, sort of can't change. It doesn't depend on your personality or your wants. And then the personalized medicine, which pertains to the human being you're treating and how we bring both of those things together for our members, is sort of really unique.

And Tommy will talk more about how we actually do that, how we make that possible. 

[00:19:08] Tommy: Yeah, and just to be clear, David, that was the non-technical answer. So I just want to make sure we're clear.

[00:19:15] Jennifer: So David, do you get it now? Do you need a clarifying question?

[00:19:19] David: I'm pretty good. Thanks. Thanks, Natalya. 

[00:19:22] Natalya: Anytime. 

[00:19:24] Jennifer: Quick question follow-up for you on when we think about personalized medicine: I think that's a really important point to emphasize. Do you see where I like more mainstream type of physicians and offices and like if you go to, you know, Mayo, Johns Hopkins, anything like that, do you feel that personalized medicine takes a priority at all?

[00:19:49] Natalya: I think we're very far away from personalized medicine. We haven't even gotten to precision medicine. I almost see like personalized medicine as being this broad umbrella and then precision medicine being like a part of it because you have to understand the biochemistry of the tumor to inform the patient on their risks and benefits and how, how they can make decisions with respect to their care and integrate their sort of wants and needs and, and emotions and all of that other psycho, um, psychosocial factors, et cetera.

But if we can't even get that sliver under the umbrella right, around precision medicine, which is the most objective part and probably that's sort of the easiest part to do because we have the tools today and we have the sort of the tests and diagnostics and the treatments to do that work. If we can't even do that, right, sort of how many years away are we from true personalized medicine?

I mean, we're nowhere near, right? We've got to change the whole incentive structure of our healthcare system to be able to make an impact on that. And I think that's where we at PHM come in. That part is broken. There's no easy way to fix it. It requires a complete overhaul of our healthcare system.

So we kind of come in and sort of, from the side, enable that to happen within sort of this broader broken ecosystem.

[00:20:56] Jennifer: That's a really interesting way to think about it because I think most people initially probably would have taken it away as precision that's been personalized, but I like how you describe that as far as really personalizes the overarching goal here that everything else falls under. So thank you for that. It was very helpful.

Good question, David. 

All right. So Tommy, next one for you here. What types of support and services does PHM offer to people who are facing cancer?

[00:21:25] Tommy: Yeah, Jen, for us, it really starts with people and processes. So we've got to align the right people with the right level of expertise. Peace. that then are following a pretty rigorous process when you think about a complex disease like cancer to ensure that we're getting the right outcome. So first, let's talk about people.

Um, we are very, very careful about the teams we align to an individual who's been diagnosed with cancer. It starts with an advanced practice clinician. Again, they are licensed, they have experience and expertise managing complex cancers that we're managing here, and that clinician is partnering with a Ph.D. level research scientist. And then we put a care coordination logistics specialist underneath that to really help support and execute all the blocking and tackling as we think about, um, leveraging appointments and, um, supporting research. So, having that personal team wrapped around that member for their entire care journey is incredibly valuable.

It serves as a resource, a sounding board. Um, as a level of expertise to really advocate and guide that member all the way through what we know is going to be a very, very complex and sometimes convoluted process. So our ability to help cut through a lot of that is very, very important. So that's the team.

And that team follows a very rigorous four-step process as we engage with that member. It starts with immersion. Immersion is where we are diving deep with that member. It's really something that our healthcare system lacks.   , you know, most providers are still paid on a more traditional fee-for-service basis, so they have limited amounts of time to spend with each patient and unfortunately they're not compensated to dig deep into medical records and all of the things that we know are incredibly valuable as we're really trying to take a step back and get to know that member, understand their health risks, understand where and how they've received care up to this point in time so that we can truly get immersed in their care journey with them.

After that, we move to step two, which we call diagnosis. Now, every member that comes to us has come to us with a diagnosis. But in many cases, in fact, in 30 percent of the cases we see, they've actually been misdiagnosed. Now, that doesn't mean that we're suggesting somebody who comes to us with breast cancer actually has prostate cancer, etc., but what it does mean is we want to further characterize that disease to further clarify their diagnosis, which is going, is which is where we start to influence and inform things like precision medicine, where we're looking at additional diagnostic testing, imaging, um, and things of that nature to really make sure that we have properly determined the diagnosis for the disease that we're trying to manage. 

The worst treatment that an individual can receive is a treatment for the wrong diagnosis. So very important that before we hit go, we actually know what we're managing and are helping that member evaluate the different ways that we can manage, which leads me to step three, which is treatment planning.

This is where our clinicians and our Ph.D. scientists collaborate closely to understand and determine all of the various options that may be available to treat and manage that specific disease. For most complex cancers, there may be three or four viable, appropriate, reasonable treatment paths that that member could evaluate.

First, that member is not capable or qualified to render that opinion on their own. But in many cases, our healthcare system is set up to require them to do that. We're all familiar with the concept of second opinions. And I have no issue with that at large. I think that is great for members who are dealing with more routine or rudimentary issues.

But when you think about a condition like cancer, a second opinion is just that. It's now just an alternative theory on an appropriate course of action that member could take. However, that member still ultimately has to decide what opinion is right. This is where our team is actually in the middle, helping support and guide and advocate for that member, taking into consideration all of their health history, and their personal preferences, to really guide them to the very best option that is going to deliver the very best outcome. 

But we don't just stop there. Step four is implementation and ongoing monitoring. So, the best-laid plans often change. So our ability to stay engaged with that member all the way through that treatment plan to ensure that we are supporting, that we are guiding, that we are helping with any handoffs and transitions as that member may be moving across multiple health systems.

They may be working with multiple providers. As we think about their oncologists, there may be a surgeon involved, and we may have a radiologist involved. So who is helping to source, navigate, and coordinate all of the various outputs, inputs, and care needs that that member may have heading into and coming out of those engagements?

So, our ability to stay engaged all the way through remission is where we can actually guide them to ensure that we are optimizing that treatment and catching recurrence should it happen down the line. So these are all parts of what we refer to as our people and processes that are vitally important to get the right clinical outcome, which is going to lead to the financial outcome that many of our clients are looking to achieve as we think about the explosion of cancer in terms of prevalence and cost.

[00:27:21] Jennifer: All right, Natalya, anything you would add to that? 

[00:27:24] Natalya: No, I thought that was great. 

[00:27:26] Tommy: Thanks, Natalya.

[00:27:27] Natalya: Anytime, my friend.

[00:27:30] David: All right, Natalya, earlier you gave us some examples of why a person might choose personalized care, so they might choose something that maybe was not the recommended path, but it's best for them they feel at that point in time. Do you have any other stories that you can tell us, or maybe some real-life stories of success with PHM clients? 

[00:27:54] Natalya: Yeah. And you know, we have so many. One of the beautiful aspects of the work that we do is just hearing the stories from the people that we help. We actually have many even peer-reviewed studies where we have case examples of ways in which we changed the outcomes and someone's trajectory substantially.

And I'll tell you about one today. Um, that really was, is just life-changing, and it's just incredible to hear. So, Ben was a husband, a father, and a grandfather, and he had stage 4B prostate cancer, which means his disease had metastasized beyond the prostate. And into the bone. His five-year chance of survival was 30%, and his oncologist had given him six months to one year to live. And that's when he came to PHM. 

Ben had an initial response to first-line treatment, but we knew that response wouldn't last, so we got to work on identifying additional treatment options for when they would be needed. That day came about a year later when Ben's PSA levels started to rise. PSA is a marker for prostate cancer progression. Initial sequencing of his tumor showed no targetable mutations. We had to think even more creatively about this problem. 

Our research team had been following the data from Germany, using a theranostics approach with a radioligand targeting PSMA. And that data was compelling. It was so compelling we believed it could be Ben's best chance of survival. The challenge was that the agent wasn't approved in the U.S., and it wasn't available in the U.S. What we could do, and did do, was enroll Ben in a clinical trial in the U.S. to evaluate whether he would be a good candidate for the drug. The trial results showed that he was. His tumor expressed PSMA. And Ben opted to travel abroad for treatment. 

His response was astounding. His PSA levels dropped, and the imaging showed that the disease had melted away. The man who was told he had less than one year to live is still playing with his grandchildren eight years later. Five years later, the FDA approved this drug in the U.S. so that other patients like Ben can now benefit from it. But Ben didn't have five years to wait. 

Now, not every case will be as triumphant as Ben's, but most cases will benefit from precision medicine, resulting in longer survival and improved quality of life. And in fact, that's what we've seen time and time again with our patients.

[00:30:41] David: Yeah. That's a wonderful story. So thank you for sharing that one with us and thank you for finding the creativity to get something, get him into the clinical trial that could ultimately lead to hope for other people. Well, it's about time for us to start wrapping up. So, Natalya, I'm going to turn to you first.

Give us maybe one thing that you want our audience to take away from today's discussion, and certainly feel free to tell Tommy not to go too technical on his aspect of this answer, either.

[00:31:17] Natalya: I'll kick the first one over to Tommy.

[00:31:21] Tommy: Yeah, I would just say this, David, in all the years that I spent on the consulting side as an actuary, right? I would look at a high-cost claimant report every month and every quarter, and we would oftentimes just sort of throw up our hands and go. Well, we will try to mitigate people from getting to this list. But once they're there, there's not a lot we can do. 

And so that is one of the things I love about the work that we do. If you think about our ability to engage with an incredibly small subset of the population and have a profound impact on both clinical outcome as well as financial outcomes. This gives brokers, consultants, and employers a tool in their toolkit that can help them make a dent in those high-cost claimants that they have struggled with for years and decades.

[00:32:13] Natalya: And I'll just add that, you know, most of the benefits that employers are putting in place work for 95 percent of their populations. And that's great. Sounds like a high number, right? 95%. Fantastic. Okay. Guess what? The 5 percent they don't work for, those are the ones leading to 50 percent of your costs.

Your most serious and complex cases aren't necessarily benefiting from some of the benefits you may be putting into place, right? They need something different. They need something different from their employers. And they really need a level of support that 95 percent of your workforce simply doesn't.

And so the one thing I would say, that I would like people to take away from this is to remember when you're creating a benefits strategy that, you really have to think about segments of your population. And if you're solving for the 95 percent fantastic, but when you're thinking about that 5 percent and how to help them, um, often you need to think differently about the solution and the partner you're choosing.

[00:33:14] Jennifer: I think those are both great takeaways there. You know, Tommy, as you mentioned, you know, thinking about not just the financial impact, but the clinical impact there. And I agree with you wholeheartedly that a lot of times, I know consultants in the past, they'll typically look at cancers and just expect and accept really that, oh, well, that's always going to happen. There's nothing we can do about that. The cost is what the cost is. But to your point, what you all are doing around that is so refreshing to know that yes, it's there, but there's still more that can be done once you see someone pop up with those types of claims. And really, you both have provided tremendous information about what you're doing in the success stories.

And Natalya, I think absolutely right that we're certainly seeing with a lot of our large and direct employers that there's a lot more customization around the benefit plan that's happening today than there was, you know, probably three, five years ago, where it's not necessarily just put in programs that will feed the masses.

There's so much individuality with programs that are out there today, like PHM, that is for a small slice of the population, but you know there can be such a huge impact from both the physical, emotional, clinical, and financial aspects of everything that goes into that. I really appreciate all the statements that you all shared with us today. Very, very interesting and certainly very insightful for all of us.

So Natalya and Tommy, thanks so much for joining us today. 

[00:34:45] Tommy: Thank you, Jenn, I really appreciate the opportunity.

[00:34:48] Natalya: Thanks for having us.

[00:34:49] Jennifer: And we are, again, so happy to have PHM as a Springbuk Activate partner. If you want to learn more about PHM in our Activate marketplace, visit

[00:35:02] David: And be sure to grab a copy of the Springbuk Employee Health Trends Report, which is, as we've said here and on a couple of previous episodes, just chock full of data on cancer and other high-cost conditions, as well as obesity, and there's a section on drug spending. So, you need to know everything along with some guided actions that you can take to reduce risk and mitigate costs. And you can get that report at

And finally, before you go, please take a second to give us a nice five-star review and rating. We really appreciate it. And leave a comment on what you thought of this episode. And what you'd like to hear more of in the future. So until next time, thanks for listening.