Higher Healthcare Consumer Costs = More Corporate Profit. What’s Wrong with This Picture?

Health insurance was established to protect us from catastrophic financial loss, but David Contorno, CEO and founder of E-Powered Benefits, says, “medical debt is the number one cause of bankruptcy in the U.S., with the huge majority of them having had health insurance?”

David explains how the typical broker and carrier contracts are structured so that they benefit most when costs go up. His firm turns the usual system of incentives around so they’re paid on how much they lower costs. 

Learn about his firm’s approach to building benefit plans that are built specifically for a company’s culture and workforce … and discover why insurance carriers don’t like him much.

Have feedback, questions, or suggestions for show ideas? Send them to us at podcast@springbuk.com.

Please rate and review us on your favorite podcast platform, and share it with your friends and colleagues. We appreciate you and thank you for listening!

Theme music: "Overboard" by Stay Outside


Full Episode Transcript:

Mike Pattengale
Hello and welcome to Healthcare on the Rocks, Employee Benefits with a Twist. I'm Mike Pattengale, senior account executive for Channel Sales.

Jennifer Jones
And I'm Jennifer Jones, Population Health Practice Leader at Springbuk. In this podcast, we'll talk with employers benefit advisors, technology, innovators and other experts in wellness, human resources and healthcare. Today, we have a true innovator in the world of employee benefits. In fact, in 2016, he was named by Forbes as America's most innovative benefits leader. He has also been honored as broker of the year and outstanding benefit advisor by multiple organizations.

David Contorno began his career as a teenager while living in New York and, over the span of
more than 20 years, has become a leading expert in employee benefits for large employers
across the nation. With sights firmly set on enacting positive change, David created E-Powered Benefits; a benefit consulting firm with a clearly defined mission to deliver a different
benefit experience based on full transparency.

David Contorno
Thank you, guys. Happy to be here.

Yeah, absolutely. Glad we could make this work. So before we get too far into the world of benefits, you know, looking over your LinkedIn and just some of the conversations in the past, I know that in college, you had studied photographic technology. How the heck did you end up launching and leading a benefits firm out of out of that background?

Well, I didn't graduate from said college. I realized, in this very intense majors very intense that photography was more of a hobby than a career for me. So I left college and I went home, I worked for my dad for a few months in an unrelated industry, and couldn't do that anymore for familial reasons. And I just left – quit on a Friday with no prospects and moved in with my best friend and roommate at the time. His name is Jason who's still in the business today. He worked for his dad in Long Island, a little small shop, a couple of folks and his dad. And I just showed up Monday morning, “I'm like, Hi, I'm here,” and started doing group health insurance. It was literally that simple.

That is awesome. So your firm, E-Powered Benefits, likes to say that one word sets you apart, and that word is transparency. Can you share with our listeners a little bit more of what that means?

Well, the problem with our healthcare system and why we keep getting the outcomes and results we get are remarkably simple. Everyone overcomplicates it. They attribute it to the obesity problem in the US, which is a problem, but I argue that's not the cause of the healthcare crisis. I'd argue the healthcare crisis is the cause of the obesity crisis. And happy to share more on that in a bit. But the system is a direct result of the incentives at every level that are there. When you look at how doctors are paid, when you look at how hospitals make money, when you look at how carriers make money. PBMs make money. All of them are predicated on higher costs.

But if you look at how a broker makes money, they too are typically predicated on higher costs. For many, many years, I was paid commission plus bonus; the commission was a percentage of premium. So as premium went up, how much money I made went up, and then I got bonus from the carriers for piling business, renewing business, writing new business, whatever the case may be. So I was being paid to do what they wanted me to do. But in most cases that was contrary to what the employers actually wanted me to do. And to be frank, I mean, I would have said the same thing back in the day when I was a commission-based broker that they don't influence me, but I think – I know, in retrospect, they did. And I'm sick and tired of people denying that incentives work, when we keep getting the outcomes that the incentives align with every year for decades, when are we going to acknowledge not only do they work, but these very powerful, very wealthy entities wouldn't be putting those incentives out there to the tune of hundreds and hundreds of millions of dollars, if they didn't work. They're smart people, they know what works, and they're getting the exact results that they align the incentives to give.

You put such good content out on LinkedIn. And I think some of the stories you tell are so interesting, and there was one the other day where you were speaking about the Internal Revenue Code 501 R and the requirement for not for profit health systems to have this financial assistance policy in place. Can you explain a little bit more as far as how you're putting that into action with employers and and kind of how that's interconnected with all of this of you know, kind of fighting the system and really changing how we approach healthcare?

Sure, every not for profit healthcare system, and I think we really should start to call them what they are, which is not for taxes, because the only difference in a for profit versus a not for profit, at least in the healthcare space, is the not for profit doesn't pay taxes. If you think they're not profit motivated. If you think they're not money motivated, you're sadly mistaken. The difference though, is is that they don't have shareholders turn that money over to so let me tell you what they do. They use those earnings to either pay their administrators and or build more capacity. But one thing we don't have a shortage of in the US is capacity, at least in most areas. And so they throw in another MRI machine or they throw in another wing of a hospital with more beds when one wasn't needed to begin with. And then they incentivize the doctors to fill those up to write orders for MRIs to bring them inpatient, or outpatient for procedures. I mean, that's the way our system works. It's totally backwards, they build up the supply first, artificially not needed. And then they artificially supplant that the the demand behind it in how they pay.

And so what we've come to realize is that hospitals have a tremendous amount of bloat, and when they claim they're losing money. And this isn't true of all hospitals, if you look at some of the real rural safety net hospitals, they're really struggling. But why are they struggling? They're struggling because the large health systems are pulling patients away from them. And they're only leaving them with the indigent, unable to pay or Medicaid reimbursement rates. That's why they're failing, while the large hospital systems are creating sweetheart deals with the carriers, which by the way, for those of you that don't know, when a hospital CFO looks at all the different revenue channels, they have – commercial insurance, your plan most likely, is the highest price hospitals get and so they try and push as much into that revenue bucket as possible.

But when they get not for profit status, one of the caveat is they must follow this rule 501 R, which says that they must have a financial assistance policy. And what is easy about the financial systems policy is it's black and white, it doesn't matter if you have insurance, don't have insurance, you can use it for your deductible, you can use it for your out of pocket, you can use it for a non covered service by your health plan, or in our model, you can use it for a balanced bill.

But let me tell you what the hospitals have done. They don't like giving away this care for free. And so not only have they made it very hard to find these financial assistance programs on their website, but when you do go to their website, or if you call their financial assistance office, most of those counselors are typically incentivized to get you to agree to any other program. But that 501 R because that's the one that has to write off the full balance. Black and white, if you make a certain income level, you qualify. Period. But they offer you payment plans, they offer you a 25% discount all these things to make they think they're doing you a favor, but they're really trying to avoid the one that would really bring you the most amount of benefit.

And so I think if more and more people realize this, since most of healthcare is provided by a not for profit health system, I would say, let's get rid of health insurance altogether. Let's just use the money we're paying for these high cost ridiculous BlueCross and united and Cigna, Aetna plans. Let's use that to pay for the little things like sore throat, annual physical. And then let's do the big things with the financial assistance programs that would start to force the system to change a little bit.

Yeah, I like it.

I really enjoyed hearing Marshall Allen speak at the You-Powered Symposium a couple weeks back and sharing some of the kinds of use cases and testimonials that people shared. That was a really powerful session to sit in. And for those that might not be familiar with Marshall Allen, his book Never Pay the First Bill was a really great book for me. And David, you actually turned me on to this book. So appreciate you doing so. And, you know, just sitting in that session was so eye-opening. And in a weird way, inspiring.

It's amazing to me that America, most of America is deathly afraid to go without health insurance. And I think that that's even more amped up by COVID. But at the same time, they are being taken advantage of by those very insurance policies. How is it that medical debt is the number one cause of bankruptcy in the US with the huge majority of them having had health insurance?

When I first studied for my insurance exam, they went through the history of insurance, and they describe that insurance has been created by humans for one reason and one reason only:  to protect us from catastrophic financial loss. And if you think of every other type of insurance we buy, that's what we expect it to do.

Health insurance has been perverted. We want it to do that, but we also want it to cover the things that we do every day like our tires, and our brakes, and our windshield wipers, which we don't expect car insurance to pay for. And so this inflation and the way that the system makes money has led to this inflation so much so that now not only are employers spending a ton of money on this, not only our employees having a ton of money come into their paycheck, whether they use it or not. But then when they go to use it, their out-of-pocket liability is 10 times what they have in their savings account. It's insane, insane that we continue to allow this.

And that reminds me I saw a story on the news the other day where the major credit vendors are I think it's next year maybe they are actually they've rewritten how your credit score will be developed to eliminate essentially medical debt. Which if that doesn't say it all, as far as how ridiculous the system is and the fact that like you said, as far as with medical debt being you know what puts people into bankruptcy, it's just absolutely crazy.

But think about the leverage that gives consumers or patients. Iin this model, if I can say to a hospital, “Go ahead, send me collection notices. I don't care. You can't touch my credit,” then their leverage is gone. When we deal with these huge balance bills from these egregious hospitals. And it's technically on the member responsibility until we work it out and fix it.

That's their biggest fear: they're going to buy a house, they're going to buy a car, they've worked so hard to maintain their credit, and they don't want it ruined. And so sometimes, we make concessions just to make it go away. Because of that, well, when that goes away, I mean, this opens up Pandora's box.

The healthcare system, they have got to be afraid with some of the changes going on, even though we're still nipping around the edges. We could go right at the heart of it, but things are starting to change.

Yeah, exciting times, hopefully. When we think about, you know, your business as a whole that we know, you speak to building benefit plans that are really developed around a specific company's culture and their workforce. Can you provide some examples of what that can really look like and how creative you've been with some of your employers?

Well, so here, you know, I mentioned the incentives, right. So the way brokers are paid, is such that as costs go up, how much money they make goes up the way the carriers are paid – and for those of you that don't know, there's a provision of the Affordable Care Act called the medical loss ratio provision, and it says the carriers get to retain 15% of premium, the other 85% must go to healthcare costs. So as healthcare costs go up, premium goes up, as premium goes up, that 15% gets bigger. So they want costs to go up.

Now, a lot of you might be saying, well, why do carriers deny claims? What they deny? Are the high value low cost claims? Think about it. What is it toughest to get into now, like a outpatient mental health provider, or your primary care doctor? Why? Because that incentivizes you if your back hurts to go right to the back surgeon where the most likely outcome is . . . back surgery, or skip over that mental health provider. And then you wind up inpatient or intensive outpatient. That's what the carriers want. That's what benefits them. And if you're self funded, and you're thinking, well, the medical loss ratio doesn't apply, I'd be willing to bet you dollars to donuts that you put yourself on the same United Blue Cross, Cigna, Aetna contracts in which all those things do apply. And so if you think you're going to be immune to it, you're silly.

And so when you start to realize what all the incentives are, then you have to realize that you need to remove those incentives, or even better, turn them around. And so that started with me, and how I'm paid, we get paid with our clients a flat monthly fee. We're prohibited from our contract from receiving any other income. Guys, let me tell you, if you think you're – if you are paying a fee, I congratulate you, if you're an employer, that's a step in the right direction, but the chances of your broker getting both disclosed and undisclosed compensation on the back end is pretty high. We prohibit ourselves from that. And then we furthermore typically create a bonus structure where we get a bonus from the client for doing what the client wants us to do. And in most cases, that's lower costs.

So how much cost? Can we lower? Well, I often want to downplay it because people say to me, there's no way, but it's not uncommon for us to reduce total spend by 30 to 50%, at the end of the first year, with usually another 10 to 20% in year two and/or three, and a lot of employers like there's no way. And my response to them is if you knew what I know about the healthcare system, you'd be disappointed with that.

The statistics show that about 26 cents of every dollar goes to actual healthcare costs, the other 74 cents is going to administration profit and non-medical, non-clinical services. And we need some of those, don't get me wrong, but do we need 74% of every dollar going to that? That's just insane.

So you have to get out of a carrier model. Otherwise, the dynamics are too strong in the opposite. So we build partially self-funded health plans. Now I say that word very carefully, because a lot of employers think I'm too small to be self funded, or it's too risky to be self funded. Some are too small, but we've done it as small as nine employees. It doesn't always work out that small, and it's not riskier. I want to share you guys let you guys know that even within your fully insured plan, if that's what you have right now, the carrier has risk mitigation tools, they have pooling points, and they have essentially what amounts to stop loss, but they're setting the limits that impact your renewal, not you. When we design a self-funded health plan for you, we put in those limits at your cash flow, your risk tolerance. So we can actually and typically do design self funded health plans that are less risky than the fully insured platform they came off of.

And I'm sick and tired of people saying, well, the carrier has all the risk. Yeah. Well, when you had a bad year, which is probably eight or nine years out of 10, the carrier comes to you and says, “You had a bad year. Here's a 40% rate increase or a 20% rate increase.” Does it feel like they had all the risk when they're shoving that risk right back on you?

And here's my question to you folks, if they shoved the risk back on you because of a high cost claimant, and that high cost claimant gets better. Maybe they move to another job. Do you get a reduction of a similar amount in that year? Of course not. So it's all a game if you think you're protected by the carriers, you're not. The carriers are protecting their shareholders as they're legally obligated to do. And the way they do it is opposite what you want.

So how do we build our health plans? Well, here's the beautiful thing about healthcare. In the US, cost and quality are inversely related, we have access to quality at almost every doctor in every facility on almost every procedure around the US. And when you rank them by quality, highest to lowest, you're almost always ranking them from cost lowest to highest. And the reason behind that is frequency, the more frequently a doctor and hospital do a particular procedure, the better they do it, the more efficiently they do it, the lower the cost. And so what we've done over the last 10 years of doing these types of plans, is we've created relationships around the US. And we have about 6000-6500 direct contracts. Now, with high-quality, high-value providers. It's everything from X rays, and imaging, up to infusions for cancer, and even open heart surgery and back surgery. And we've been able to validate their quality and make sure that their pricing is really, really fair and transparent.

It's so much less in that environment that our health plans then pay 100% of the cost for that employee when they go to one of those providers. And let me give you the metrics, an MRI:  we typically get MRIs for between $400-$700. Now, the typical MRI at a hospital is going to be $3000 to $7000. What gravitates people, how does it happen that they keep getting pushed to the high-cost imaging? Well, I'll tell you, it's because of the way that doctors are paid. Doctors are paid on two metrics patient volume, the more patients they see the more money they make, and also something called an R, which is a measurement of how much money they're generating in other parts of the healthcare system. And so when they send you to that $4000 MRI, they make more money than if they sent you to the $400 MRI.

But we have a way to intercede and give the member a choice. And we say hey, if you go to that high-cost MRI, your deductible and coinsurance is going to apply like you'd expect. But if you go down the road to this other place, your employer is going to pay 100% of the cost. Because if you're an employer, would you rather your health plan, pay 50% of $7000, leave your employee on 3500 bucks, or 100% of $500 and leave your employee owing absolutely nothing. It's a true win-win scenario. It also not only benefits the employer and the employee, but these independent imaging centers that are struggling to compete even though they're 1/10 the price.

Can you imagine, for any business owner listening to this, can you imagine if you offered the same quality as a bigger company at 1/10 the price and you had no business? Or you were struggling for business? You'd be like, “What am I doing wrong?”

That's what these independent imaging centers, that's what these independent pharmacies are doing.

Yeah. And it's interesting, as far as when you mentioned about the physicians. Several years ago, I ended up having shoulder issues had surgery. Another story, but when I needed the MRI at the, you know, the physician, the specialist was saying, “Oh, well, you just go down the hall down the hall,” and I was “Can I go over to, you know, the outside one, you know, down the street?”

“Well, you could but the quality is usually not very good. And then you'll have to come to ours …”

“I won’t  get the records back.”

Ultimately, I went to the independent one:  beautiful experience. But it's it's all it's just a game. It's so crazy.

Yeah, no, it is. And again, the whole entire system is predicated on higher costs equal more money, which is backwards from most industries and businesses.

Yeah, my wife and I actually drive close to an hour to see her neurologist because he's a private doctor, they won't sell out to any major hospital systems. And when she had three seizures in two hours, which normally would end in, you know, probably a fatality. You know, thankfully, that was not the case here. Instead of immediately going to, you know, EEGs and all these other tests, he said,” I know exactly what's going on, you know, here's what we need to do. I don't need to, you know, have you spend 2000 $3,000 out of pocket on these tests, you know, I I have a plan.” And he was able to do that and it was so refreshing that you know, myself, my wife, her parents who, you know, work in the industry as well, we're just, you know, sitting there mind blown of like, “Wait, can you actually do that and help us out that way.”

So, it's, it's been really refreshing just working with them and, and getting to see what that looks like when they're actually able to practice medicine to truly cure their patients.

Yep, absolutely. And the fact that they even cared and knew about what the cost of the test was, is a huge step above most other physicians. You know, I'm sick and tired of physician saying, “I shouldn't have to think about the finances of it. I want to give the right medical advice.” Well, what good is the right medical advice when the person you're giving it to can't afford what it is you're telling them to do? Like it's silly.

And that brings me back to an earlier comment I saw I posted a few weeks ago, what might be my most viewed post ever, it's reached over 200,000 views at this point and still going. And it was a chart that showed on one access per capita spending of, you know, some of the biggest countries in the world. And on the other access, it was life expectancy and the US stood out as way higher per capita spending and way lower life expectancy. And I don't know if people really understand that, but for the first time in the history of humankind, and only in the US, life expectancy has been going down for some time, even pre COVID. COVID did affect that in most countries, to some extent. But it was a temporary thing. We're the only ones that had it before COVID, and continue to have it now.

And so a lot of people push back, and there's not a lot of people, but some people push back and said, Because I blame the carriers. I was like, they're the hub of this problem. They're not the only problem; there are spokes to that, but they're the hub of it. And some people pushed back and said, “Oh, well, what about the health of American obesity and diabetes?” And my question to them was, Is obesity and diabetes in the health of America, the cause of healthcare costs going up? Or are healthcare costs going up the cause of obesity and diabetes and other health issues? Because I know I've spoken to some of our members, and I'm like, you know, how do we get you to eat healthier? How do we get you to be healthy, we used to do some wellness programs as a way to lower costs, which by the way, don't work to lower costs. They'd be like, “Listen,  it's $30. For me to buy a whole chicken and fresh vegetables, it's 10 bucks for me to get a bucket of KFC and all the fixings for my family.”

And if you think of that $20 delta times, seven times a week, times, for weeks a month, you're at $600 a month delta, between eating Kentucky Fried Chicken and eating fresh chicken. That's a lot of frickin money for most of America. And, as a matter of fact, I asked people and we were rolling out something called direct primary care, which is something we love at a client recently. And it's where the plan pays a monthly membership fee to the doctor, there's no copay, there's no billing insurance, there's nothing. And I asked the audience a question that I never thought to ask anyone before. And these were blue collar guys. And I said, Have any of you been to your primary care doctor for your one severe physical, which is what most people use their primary care doctor for exclusively. And that the PA or the NP comes in and they draw the blood and they do the test. And then 15 or 20 minutes later, your doctor whisks in for your five or six minutes of face time. And they say to you, anything else you want to talk about? And you think to yourself, you know, I've had this rash or my shoulder hurts. But gosh, if I bring this up right now, I currently pay zero copay. Now I'm going to have a $30 copay, or even worse, you're on a crappy HSA compatible plan, and you're going to have an unknown cost subject to your doctor and coinsurance How many of you have withheld that information from your doctor because of that reason, and about half the room went up.

And I said, you know, what kind of testament is it to this country, when a patient is afraid to tell their doctor something as innocuous as my ear hurts, or I have a skin infection? Because their copay is going to be applied or their deductible is going to apply? Like what is health insurance good for?

If you're afraid to do the small things you're afraid to do the big things, and how much of this financial stress is adding to our poor health as well. I would argue that when someone's diagnosed with cancer, one quarter of their fear is holy crap, I have cancer, and three quarters of their fear is holy crap, what is this going to cost me?

That is just awful. And a position that I'm hard I'm horrified that patients are in, I'm horrified that doctors have to choose at every encounter to do what's right for them or do what's right for our patient. This needs to be exposed. And people need to understand this. So that a lot more people can be putting in things to fix this than just me. And the people that we work with.

Wholeheartedly agree we've done a lot of work around social determinants of health. And one example we've used pretty frequently is is around a diabetes example. So you know, fast food is much more cheaper, or cheaper than you know, like you said, going to the grocery store and getting a more fresh meal, let alone do you know how to cook it? And then let's say they're out on disability. So now they're only you know, taking in 60% of what they would have fun their regular paycheck. Well, now all the fast food and all that cheap food is even more enticing than it was before. But anyways, Patty, I know you've got a couple more questions.

Yeah, absolutely. David, I know I'd mentioned before just being in the You-Powered Symposium there in Scottsdale a couple weeks ago. I really enjoyed it. In my little over five years here. I think that is the best conference. I've been to i Marty Mc, is it Macquarie. Okay, incredible. Had a chance to get to meet him at the breakfast at the hotel, just a really genuine person. It was awesome. For our listeners that did not have the opportunity to attend. You know, what are your thoughts? Is there another one coming up? How can they keep an eye out for that? Would love to hear more?

Yeah, we're finalizing the venue now. It's looking like it's going to be Miami around February again of next year, 2023. We're just humbled and overwhelmed by the response. And, you know, I've tried to identify why do so many people give us such positive feedback? I mean, are they blowing smoke? Are they being genuine, but we've really heard it from so many people that I truly trust, tell me the truth. And the only thing I can think of is there are a lot of conferences out there with a lot of great material. But we're the only one that I know of where we're not just instructing you on what to do. We're instructing you on what we do every day.

And we were pulling back the curtain, and I felt like there was a show and I was young on Fox. And it was a magician that wore a mask. And he was showing the world how magic magicians do the magic tricks and he was outcast by the magician community. There was a time where I was outcast by the broker community because I was lifting the curtain – not so much anymore – still by the carriers, but I'm okay with that. But the country needs to understand this and know this so that really smart people, people smarter than me, people that own really successful businesses can make better decisions on that information. Right now, they're making bad decisions. And I think a lot of that is because of an absence or vacuum of information. We need to change that.

We'll keep an eye out. And you said Miami in February for the next one is what you're looking for?

Yep. And we'll push it online. We have tickets starting to go live in April, for alumni anyway.


Mike's already booking his hotel.

Oh, yeah. We love Miami. Literally, there's probably something on my computer right now that pulled up a tab ready to go.


David, we’ve got one more question for you related to your business. As far as we know you've created a mentorship program within your firm that allows you to mentor fellow advisors around the country? Can you tell us a little bit more about that?

Yeah, you know, this is a really hard path, and we're into it exclusively, we don't do any traditional business anymore. And I'm in a position where I can say no to business that it refuses to move in that direction. But not everyone is in that situation. And so it's kind of moving a boulder uphill to get employers to say yes, to then get employees educated and bought in and then deliver the things we say we're going to deliver.

And so when we partner with brokers and consultants, hopefully we bring enough credibility to give the employer a sense of comfort that we can actually do this enough experience to educate the employees and get buy in as well as deliver on the things we say we're going to deliver. So hopefully, we're doing that and and we get the broker educated and the consultant educated on how to do this. And our goal is to just work with them on 2, 5, 10, 20 plans – however many they need. And obviously we share in the revenue. But the goal is to get them self sufficient where they don't need us anymore. And they have the credibility and the and the confidence to continue to do this for others and hopefully even empower them to teach others to do it as well and really start to bring scale to these fixes around the country.

Before we let you go, we always ask our guests, what's the biggest twist you've seen an employee benefits during your career?

The biggest twist that I've seen in employee benefits is, for me anyway, and I know not a lot can say this. But I recognized about eight or 10 years ago, that every single employer that I met with, dreaded meeting with me because every year I was bringing in varying degrees of bad news. I didn't like that.

And so the twist is that when you do things differently, when you do things properly, when you look at how everyone is getting paid, and you align them to get paid in a way that's aligned with the goals that you're trying to achieve for your client, everything changes. And I have clients that have been in this model now for 789 years. And every single year, they're talking about how do we redeploy some of these savings to the benefit of our employees, instead of how do we offset some of these increasing costs to the detriment of our employees.

And when you go in with employees and saying, guess what, for the fifth year in a row, what's coming out of your paycheck is going down by 10 or 20%. And at the same time, we're adding in more benefits, more physical therapy at no cost to try to get them there instead of surgery. One of our clients gives every single member on the plan a no-cost massage every single month, every man woman and child on the plan. Because there's so much savings in there was a huge goodwill towards it.

So the biggest twist is when you do things, right, you can come in with good news eight or nine years out of 10 instead of good news one or two years out of 10. And that changes your career. It changes how you interact with your family. At least it did for me. It's made me more fulfilled. It's made me feel better about getting bonus checks because my clients know the bonus checks I'm giving – they're giving them to me for doing what they wanted me to do. And it's such a different conversation now with clients than it ever was. And so that's the biggest twist for me.

Yeah, well, I don't know about y'all, but I'm ready to run through a wall. So … David, thank you for coming on. We really enjoyed having you and all I always appreciate the content that you're putting out there on LinkedIn. So thanks again.

All right, and that's a wrap for another episode of Healthcare on the Rocks:  Employee Benefits with the Twist. Thanks for listening. If you enjoyed this episode, please take a moment to rate us or leave a review on your favorite podcast platform; that really does help other people find this show and lets us know what you like.

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