[00:00:00] Nicole: Welcome back to Healthcare on the Rocks: Employee Benefits with a Twist. I'm Nicole Belles, the SVP of Product at Springbuk.
[00:00:09] David: And I'm David Pittman, Senior Director of Marketing at Springbuk. Our guest today is Tom Falvey, who is the co-founder and CEO of NewHealth. Tom has over 20 years of experience in employee benefits consulting, working with national firms before co-founding NewHealth. His company is the first patient experience platform in health insurance, aiming to transform how patients interact with their health plans.
He lives in beautiful Point Pleasant, New Jersey with his wife and two sons. So Tom, welcome to the show.
[00:00:42] Tom: Thanks for having me, David, Nicole. Very happy to be here.
[00:00:45] David: We'll have plenty of time later to talk about your work and NewHealth, so let's start with something that's a little bit more personal first. What do you like to do when you're not working? Yeah.
[00:00:56] Tom: When I'm not working? Uh, well, I have a four-year-old and a seven-month-old. So, when I'm not working, you know, figuring that dynamic out. In addition, you know, for myself, when I do have free time, at this point there's not a lot. Running and getting to the ocean as much as possible. And that's about it.
Account for all those things and that's it.
[00:01:20] David: Yeah. Yeah. I think when you say you have a four-year-old and a seven-month-old, um, we understand there is no downtime.
[00:01:28] Tom: There's no downtime. No.
[00:01:30] David: All right. So, how about your work background then? How did you get into this field and what got you into the health insurance industry and then eventually led to NewHealth?
[00:01:41] Tom: Sure, so actually my father was in the employee benefits space, so when I graduated college, I had a business degree with not really understanding what to do with it, so just started in insurance. You know, no one I think goes into college thinking it's gonna be health insurance, right? So I ended up like everyone else.
Someone told me that this is a good place to be and it was. You know, I've been 20 years experience as an employee benefits consultant. On that side of the business, I've done everything from when I was younger, a lot of account management, sales, marketing, underwriting, take the garbage out, you know, whatever has been needed to been done.
I've seen a little piece of, you know, every piece of that side of the business. So, and then NewHealth, we started about five years ago. So, we've been working on NewHealth for about five years. It's been exciting.
[00:02:36] Nicole: Where did the idea for NewHealth come from?
[00:02:40] Tom: Yeah, sure. You know, the general idea of NewHealth is pretty simple, right? It's like patient satisfaction after every health insurance claim. Like, you used your health insurance, you have a health insurance experience, you know, healthcare experience. How did it go? Tell us, tell us your story. The, the truth is there was two driving reasons.
You know, one is, kind of from an ethical standpoint, I felt, and still do, as if, if you're going to play this part between a patient and a doctor, and that's the health insurance ecosystem, I think ethically, we're really, should be in a position to share as much information as we possibly can, so, I'll give you a story.
My son, when he was just born, he, um, needed surgery on his belly button. He's fine and everything ended up being fine, but at the time it was pretty scary stuff. And we were faced with, okay, go find a pediatric surgeon. And I've been in this business for 20 years, operating in that space between the patient and the doctor. I said to my wife, I said, you know, I have no idea, no clue where to go. So, what most people do is they end up asking, you know, a friend, we went on a Google, searching all these third parties that operate all outside the health insurance ecosystem. So, to answer your question from the, you know, ethically, it just thought that if we're going to have this position, we need to do better.
And then on the other side, I saw a business opportunity from a brokerage standpoint. If you think about like how many claims are running through the health insurance system every year, billions and billions of claims. And, we're not asking, we're not engaging for, for patient satisfaction feedback, it's an opportunity.
And it's a, it's a decision making data point that we should be using as plan sponsors and brokers to build high performing plans.
[00:04:34] Nicole: So, can you tell our listeners how NewHealth's platform works? Like, how does an employee, um, whose employer has access to this great, how did they get the information to drive decision making?
[00:04:48] Tom: Sure. So let me start from the very beginning. So say that, uh, Tom Falvey is a patient. I go to see my doctor. My doctor, I, I give them my insurance card. My doctor files a claim with the insurance company to get paid. Now, the big difference between NewHealth and all the other patient satisfaction platforms that operate outside of the health insurance ecosystem is that we're embedded and ingrained in the claims processing platform.
So, as soon as the claim hits the system, NewHealth is triggered. We send a text message to Tom to say, "Hey Tom, we see that you've seen your doctor. Would you care to give us some feedback on your patient experience with the doctor, the care you received, and also the experience that you had with the insurance throughout this visit?"
If I decide to participate in the survey, the results of that survey automatically are populated into a dashboard. That dashboard is available to the plan sponsor, the HR team, the finance team, at the client, and the broker. So at any point in time, the broker and the plan, uh, the plan sponsor can go into NewHealth and in real time see patient satisfaction and member satisfaction on their health plan.
[00:06:14] David: That's pretty cool. So are there, are there different types of surveys or is it just, you know, one size fits all for everyone?
[00:06:19] Tom: Now there's, so there's, it's a good question. There's a number of different surveys and the survey is always specific to the type of care that was received. But I just want to asterisk here that we always also ask about the health insurance experience regardless of what survey went out. We have a survey that's specific to primary care visits, specialist visits, a survey that's available to, for like hospital visits, certain different places of service.
We also have surveys for certain diagnosis codes, so if we have identified the highest costing diagnosis for health plans, like cardiac care, diabetes, and um, like orthopedic and a few others, and our chief medical officer along with the rest of the team has developed questions that are specific to high performing attributes for those types of care. So those are questions that are specific to the claim. So they're all triggered by a claim. We also have a biannual survey that is just for the insurance plan. So, we actually sent one of our, our mid year survey out last week. So every member, at the same time, will receive a survey and they'll say, we'd like to hear your satisfaction with the health insurance platform. And those questions are specific to the health insurance. So, they ask questions like, what's your overall satisfaction with the health insurance platform? How about customer service? How about the prime, uh, the PBM? Access to care. Tell me, tell us about access to care with doctors. Tell us about access to care with, uh, providers, uh, sorry, um, facilities and, and hospitals.
Now, all that information, our goal, and again, most likely. What I'm about to say is from my experience of being a broker, but all of the data collection is centered around taking the data and making it actionable. So we're really preparing the plan sponsor and the broker for future decision making.
[00:08:32] David: Okay. And so are you with all the survey data that you're collecting, are you ranking, rating these providers in some way or what's happening there?
[00:08:42] Tom: Sure. So as the data comes in, the output always comes to one to five stars. However we're collecting it, the output is always one to five. So, we have a number of different, um, measuring points, so one would be the NewHealth Score. And if you were to sign into the NewHealth Dashboard, one of the first columns is the NewHealth Score for every different doctor and facility.
The NewHealth Score is the average patient experience score. You can click on the provider and get more data, like wait times, and uh, communication, nursing care if it's a hospital. But we kind of center the system around like, you know, identifying very quickly, but with large numbers and many, many providers, high performing providers.
So we use the NewHealth Score. Now, we also have a score that is just for the insurance. So if you wanted to sort by providers where the insurance is working really, really well, you can do that. If you can sort by, hey, where are the places where maybe the broker needs to pick up the phone or the plan sponsor needs to pick up the phone and say like, Hey, you know, we had a thousand people go here last year and the insurance score was 2. However, the patient satisfaction score was 5. So people love the doctors here, but something's wrong with the insurance. We need to fix that. What is that?
And then we also have the Medicare scores. So it's really interesting to see how they don't always correlate. Like patient satisfaction of 5, very often is not a Medicare score of 5. As we work towards collecting data, it certainly starts to show a really interesting data point to, to use.
[00:10:30] Nicole: You started to touch on it a little bit, Tom, but can you talk more about the action steps or some of the decisions that employers and brokers will then make based on the satisfaction data that they see in their dashboard?
[00:10:47] Tom: I like to talk about this as if I'm, I'm the broker, or at least in the room, because I've been in the room for this many times. So Whatever part you're playing in a solution for a health plan, if you're in the finalist meeting or the renewal meeting, you've likely seen this at least a few times.
Someone comes in with some solution, say it's years and years ago some type of HRA, but now it's like a reference based pricing, sourcing drugs, direct contracts, new TPA, it's just a new solution. And often, what everyone's talking about is reducing costs in the meeting. But there's always two sides to every conversation.
There's the finance side, and then there's the more human resource and patient experience side, member experience side, and satisfaction. So, very often, I mean I could say, like, 50-60 percent of the time, the savings is trumped. by a concern about patient experience with that change.
So as a broker, my suggestion would be start with NewHealth. Start with the conversation before you deliver any financial savings. Say, let's talk about patient experience and member experience. Where do you think you're at today? You know, what metrics are you using today to quantify your patient and member satisfaction? And likely the answer there is, at least as far as I know is really there's nothing available.
[00:12:23] Nicole: Not a lot. Yep.
[00:12:25] Tom: Yeah, or you can look at um, net promoter scores for some of the bigger companies. But for your actual, your population, likely it's, it's nothing. So if you start there and say, okay, so we don't have anything now. We're gonna give you NewHealth. And NewHealth is gonna give you real-time patient and member feedback on every single health insurance claim. So we're gonna know what's working now and then any changes that are made what were the repercussions of those changes?
And I, I gotta tell you, I was on the phone with a client on Friday and this client, client said to me, you know, I don't know if I want to know the scores because they had a hospital that was pushing back pretty hard and in one state and she was like, you know, I'm not sure we want to do the survey this year, because they get scores on every claim.
So I said, I opened up her portal and I said, well let me ask you something. What do you think your score is?
She says, uh, two, overall, like the insurance score, not the patient satisfaction, this is the patient satisfaction on the insurance only. And I said, it's 4.02 out of 5. I'm like, that's great. You know, I would be, I would be starting with that. I would put that on my open enrollment doc before we get started.
The other thing about this business that is that when there are problems, they trump everything because it's healthcare. I understand why. I mean, I had two calls today that if you knew the emotional attachment to these calls, yeah, they're big. And they, two calls could trump probably 200. Right, so you digest the information as you need to and, um, sometimes in those scores the, the actual text in the response or the review, so if someone were to actually give us text feedback specific to what's going on is the most actionable.
[00:14:28] Nicole: I bet. Yeah, I was going to ask, how often does specific feedback get back to the provider?
[00:14:37] Tom: Uh, right now, really not at all. Like we're not there. In the future, that might be the case. But now, um, we're not engaging with their providers. I mean,
[00:14:48] Nicole: Future.
[00:14:49] Tom: Yeah, in the future that could be because if the broker decides to pick up the phone and try to fix a solution, I'm sorry, fix an issue that has been, um, derived from the scores, then that's happening.
But, you know, our system, as it stands today does not do that.
[00:15:08] Nicole: I think sometimes there might be an opportunity if the broker and employer have a relationship with the plan and they pass it along, maybe the plan will eventually go, hmm, Dr. John Smith keeps coming up as an issue.
[00:15:22] Tom: Listen, I think transparency, you know, son, it works, right? Like, it's um, yeah, I agree with you, and maybe in the future.
[00:15:32] Nicole: Can you share with us a success story that highlights the impact maybe New Health has had on someone's healthcare experience?
[00:15:41] Tom: I have a story where we're working with an account that direly was in, like, financial, like, constraints with their health plan, and I think at the time they were spending about 16 million dollars, um, You know, 800, 900 people on claims. And we get this all the time, which is, they could not find a way to move to one of these progressive pricing models. They just could not find it. They just say, hey, you know what, half of their team had presented it, you know, five, six times, but it always kept getting pushed aside.
I mean, if you Google some of these programs, the first couple lines, like, are going to scare you, right? It's a very sophisticated marketplace, and as an HR person, sometimes I wonder, like, how they could possibly make these decisions.
So they were just kind of handcuffed to the traditional insurance model, but in using NewHealth, we went that direction with them, and, and gave them the, you know, the comfort of, hey, you know what? We know that there's a tremendous amount of savings down this road. And now we're going to have more, better access, for the first time really, access to what's going on with the patients. And if it goes haywire, if it just completely flips upside down, well then this will be a one-year deal. But over the next three years, we're seeing like 35 percent reductions in cost and it just gave them the ability to have the confidence to make the change. That is extremely common with the platform.
[00:17:21] David: Okay. Crystal ball time. Uh, you're a co founder, you're a CEO. You've got to have vision and clearly you do have vision or you wouldn't have come up with this idea. So where do you see NewHealth going over the next few years?
[00:17:38] Tom: Sure, so we're very, very lucky to have, you know, our first, it's called like early adopters, like that was probably two years ago, some TPAs, some brokers, and some employers. So, that's really like, got us to a place where we're adding TPAs, we're, we're getting much more, uh, membership and, uh, the data is starting to become more and more significant.
Where I want to get to, and this can happen very quickly, that because of the claim integration component of the system, and how many opportunities that we are getting, depending on our membership. So I want to be the number one, and I believe that we can be the number one patient satisfaction platform in the country.
And we're actually keeping tallies on who's leading, and we have a little ticker every day. We're getting a little bit closer.
And the one that, and I should have mentioned this earlier, but the big difference, and this might be obvious to people because I explained how the system works, but is that we're verified. Every one of our patient satisfaction scores is verified with a claim. It's specific to diagnosis code. We're not seeing that in the marketplace. So in addition to the sheer frequency, we want to provide a better solution to those people that are sick and need to find the best doctors and facilities.
[00:19:02] David: So are you a competitive guy?
[00:19:06] Tom: Ran college track and cross country. Yeah, I'm a betting man. Sure.
[00:19:12] David: Yeah. Yeah. Yeah. That's great.
Tom, it's been really great talking with you today and learning about how you formed NewHealth and what you're doing in the the patient satisfaction universe. It's exciting. I'm looking forward to seeing your ticker and seeing how long it takes you to overtake the leaders right now, but if people want to learn more about NewHealth or connect with you personally, how can they do that?
[00:19:41] Tom: Well thanks, David. I am on LinkedIn. Uh, Tom Falvey. You can also find NewHealth's page on LinkedIn. Uh, the NewHealth website is newhealthus.com, and I'm pretty easily reached through those vehicles.
[00:19:57] David: Tom, thanks very much. It's been delightful having you here. I'm glad you shared all that information on the insights with us. I certainly learned more about the ins and outs of the healthcare industry and, uh, looking, uh, looking forward to staying in touch with you through the Springbuk Activate platform.
[00:20:16] Tom: Well, thank you, David. Thank you, Nicole.
[00:20:18] David: Yep. Thank you. And thank you to our listeners for tuning in again to Healthcare on the Rocks: Employee Benefits with a Twist. Be sure to subscribe and leave us a nice five-star review or rating that helps other people find the show and helps us, um, justify our salaries, I guess. So until next time, stay healthy and stay informed.
