Navigating the health care system: How health plans can help or hurt

September 15, 2021 SmartBrief Season 1 Episode 1
Navigating the health care system: How health plans can help or hurt
Show Notes Transcript

Navigating the health care system is hard: Too many choices, too much complexity and not enough user-friendly information to untangle it. Fortunately health care leaders have more tools at their disposal than ever before to clarify, streamline and coordinate on behalf of consumers. Innovation takes time and commitment, but a world when consumers and clinicians have the information at their fingertips when they need it -- wherever they are -- is potentially within reach. Jaja Okigwe, CEO of First Choice Health and Susan Beaton, vice president of health plan strategy with Wellframe share solutions and strategy to get there.

This episode is brought to you by Wellframe.  

Melissa Turner -- 0:03  

Hello and welcome to Touchpoints, a conversation about care connection and costs in US healthcare. I'm your host Melissa Turner. I'm content director for healthcare and life sciences at SmartBrief. SmartBrief is a publisher of digital newsletters for professionals and creator of this and other shows in our series of SmartPod podcasts. In addition to overseeing production of smart briefs, healthcare content, I'm of course also a consumer of healthcare, just like those of you listening. Together in each Touchpoints episode, we'll explore the issues that make healthcare hard for all of us, and we'll discuss how health plans healthcare providers and their partners in the healthcare ecosystem can make it easier. Thank you for joining us.


Melissa Turner -- 0:55  

TouchPoints is brought to you by Wellframe. Wellframe works with health plans to reimagine member relationships. Their team believes that health plans are in the best position to lead the charge into the world of digital health management. Let Wellframe be your partner in improving member engagement and outcomes. Learn more at 


Melissa Turner -- 1:15  

Today our topic is navigating the healthcare system. I'm pleased to welcome our two guests up first we have Jaja Okigwe, CEO of FirstChoice health. Jaja has more than 25 years of experience driving strategy and innovation in the healthcare industry including roles at Premera Blue Cross, McKesson and Deloitte. Jaja, welcome.


Jaja Okigwe -- 1:35  

It's great to be here.


Melissa Turner -- 1:36  

Glad to have you. Also, I'd like to welcome Susan Beaton, vice president of health plan strategy at Wellframe. Before moving to Wellframe, Susan worked for more than two decades in various roles at Blue Cross Blue Shield of Nebraska. She's also a registered nurse who practiced in pediatric critical care and trauma. Welcome, Susan.


Susan Beaton -- 1:54  

Thank you, Melissa. It's great to be here. I look forward to the conversation today.


Melissa Turner -- 1:58  

All right, well, let's go ahead and jump in. I want to start by just getting to know each other a bit. We're talking today about navigating the healthcare system. So I'd like to start there. Could I ask each of you to share a great or perhaps not so great experience that you or someone you know has had with the healthcare system? Jaja, let's start with you. 


Jaja Okigwe -- 2:17  

I'm happy to start. I was going to say that I don't know that I've ever had an experience that couldn't have been better. That's to say that almost every experience I have has some element of confusion, disagreement, discussion. Probably the most recent one I had is -- you see me wearing glasses today. These are my special computer glasses. I went just before the pandemic to the optometrist, who discovered a little bit of flecking on my retina. That sent me to two different ophthalmologists. Why two? Because the first one had no idea what that what it was. And so we needed a second opinion. Along the way, if you've ever been to an ophthalmologist, you wind up with this sort of weird form of light torture that takes about 45 minutes, and then they spend 10 minutes telling you all the things that are wrong with your eyes. Having done that twice, and then having a third one -- just because after the second visit, they couldn't confirm that anything was happening. They told me there was actually nothing going on. Very unsatisfying to be terrified that you're going to lose your eye or something is going to tear and you're going to have you know, major problems, and then only to realize at the end of it. Yeah, we really didn't need to do any of this. 


Jaja Okigwe -- 3:29  

And I should know better, right? Because I'm part of the healthcare system. I'm giving you the short version. And there's a lot of twists and turns to it. I skipped the part where the second doctor tried to reject me, because apparently I didn't apply the right way. That was even more interesting. But yeah, so that's I mean, you know, welcome to Healthcare.


Melissa Turner -- 3:47  

Well, yeah, absolutely. And maybe we can kind of troubleshoot that experience as we're, as we're talking today. I'll just ask you to comment briefly. Was there anything that you took from that, that you kind of brought back to the office and said, here's something we need to address


Jaja Okigwe -- 4:04  

all the time, obviously, I think my crew is sick of me using personal examples, you know, this can't continue. But the thing that I really that really stands out for me is how often the whole healthcare scavenger hunt kicks off. And it really is a scavenger hunt. And it often starts with this simple complaint or a visit. And then there's this, where do I go and what do I do? And each point along the way, you can take a wrong turn and wind up gaining extra expense or anxiety, or a misdiagnosis and mistreatment. 


Jaja Okigwe -- 4:35  

The example I gave of my eyes is, as I actually think I spent something close to $900, one year, which is a minimal amount of money, and a lot of wasted time for no reason. And so how could we have gotten there faster? I mean, I think that's the question we've asked. The first way would have been to go see the second doctor first. So how I wound up with that other person is something we've talked about how do we get people to the right place faster? That's sort of the message that we've been talking about.


Melissa Turner -- 5:02  

Absolutely. I think that will be a theme for this conversation. Susan, does this resonate with you? And do you have an experience you want to talk about? 


Susan Beaton -- 5:10  

I would say Jaja in the last statement that he kind of made of "where do I go?" is probably the common theme that I'm going to use. So being a nurse, and then having 20-plus years at health plans, I am the go-to person for my family and friends of "what's wrong with me?" And then if what's wrong with me, where do I go? And then where do I find the information. And so I think that's the most time that I spend helping people. And it's interesting to me, that when they have all the other assets within the healthcare system, whether it's their physician or a health plan, or their employer group, they still do not know how to navigate the healthcare system. And so I think that's the thing that I spend the most time in helping family and friends. And it's one that I'm going through right now -- I have a friend whose father-in-law is needing hospice care, and, you know, was in the hospital and then had to go to a skilled nursing facility, and then needs to figure out how long can I stay there? And then what do I need to go home, and you think about not only the member and the patient, but then the family. And they all have full time jobs, they're taking care of other loved ones, and they're trying to still help navigate the healthcare system and have no idea where to go. That's stressful in an already stressful time when they're they're already facing, you know, potentially a catastrophic result or illness. And so I think that's the thing that still amazes me, of all the information that's out there, it's still so complex, that a regular person, a consumer cannot figure out how to navigate that pathway. And there's so many rules and regulations behind it, to Jaja's point, you know, a misstep could cost you your $900, a misstep could cause you a second or third opinion and not getting the right diagnosis the first time. And so I think that's the piece that is still a little bit disheartening to me, right, is that everybody trying their best sometimes, to put things out there for the consumer, it's still almost impossible sometimes to understand.


Jaja Okigwe -- 7:19  

I think anybody in healthcare gets that we are the Ask the Expert for the entire family. So I thought it was kind of that that resonated with me. But once upon a time we took the benefit booklet that most employers have, and we ran it through a readability index. And this was in this case, it was 150 page booklet that absolutely nobody reads. But there's a reason why they don't read it. When we ran it through the readability index, it came out somewhere between PhD level required and purposely confusing. That's the manual that supposedly every employer hands out that says, hey, here's how to use your benefits. So it's kind of it's no wonder that the navigation is a difficult thing, when all the aids are the job aids are kind of confusing, right.


Susan Beaton -- 8:08  

And to your point, I think we're we still get it, they still deliver it that way today, right? And you put it aside, and then you think you'll use it, but then an illness may come up rapidly, you know, or it's unexpected. And you don't even know where that [document] went. And you don't even know what you have to know to apply it. So it's that interesting dynamic where we think we're sharing all this information and knowledge, but we still haven't given consumers the best way to utilize it understand it or an easy way to do that. So agree.


Jaja Okigwe -- 8:42  

So we can almost say save on publishing, if we just handed out a refrigerator magnet that said call this number because that's what they do anyway. Right?


Susan Beaton -- 8:50  

Exactly. Right. Yes. Absolutely.


Melissa Turner -- 8:53  

I just want to acknowledge to you know, Susan, you mentioned that when people really need answers about the healthcare system, it may be a situation like you were in Jaja, where you needed an eye exam. It may be a time of catastrophe, somebody had a cancer diagnosis, somebody has COVID, where there's simply no time and no wherewithal to just wade through something that is PhD level or higher in terms of its complexity. So clearly, healthcare is complicated. We could spend our entire conversation on the reasons for that. I certainly want to move beyond that conversation. But let's talk a little bit about how it got this way. Because maybe there are some answers in resolving it there. Susan, let's start with you. 


Susan Beaton -- 9:40  

In our conversation that we are having there are so many stakeholders in healthcare. It's really become over a period of time a collection of what I would say disconnected components -- and not on purpose. Right? Everybody tries to put in safeguards or pricing, you know, regulations. Or, you know, access issues or quality of care. So all of them an individual basis probably had a really good purpose. But when you put them all together, it's just disconnected. And each one of those stakeholders holds something different. And it could be a health plan, it could be a hospital system, it could be a pharmaceutical company, all of those together that system, then each one of them owns a piece. And then together, they almost become somewhat resistant, at times to working together, even though they have to. And so at the end of that is the consumer. And they're trying to figure out navigate, just like we were talking about that healthcare system. And then you add on top of different stakeholders' regulations, that the consumer to Jaja's point was given a benefits manual that nobody can understand because of their state regulations and federal regulations, and then you try to innovate around that without getting fined or without missing, you know, one of those regulations, standards. And at the end of it, all of those stakeholders and rules and regulations, there's money behind it. And so a lot of things that make up how somebody eventually utilizes the health care system that is so complicated, that, you know, it is shocking that we wonder why sometimes members or patients can't figure out what their benefits are, how to use the system. But we've kind of made it that way. I think we've done it to try to address waste, right? There's about 25% of healthcare spending can be categorized as waste, whether it's administrative complexities, or duplicate services or unnecessary treatments, but we haven't made it very easy for the consumer to engage with all of those stakeholders to help alleviate some of that. So over a period of time and years, we've kind of done it to ourselves.


Melissa Turner - 11:55  

Jaja, what would you say to that


Jaja Okigwe -- 11:58  

I think Susan's got it exactly right. I mean, I think there's a lot of people who try to look at healthcare, in the same way that you you read a mystery, you know, who did it who's the person that's responsible for this? And the reality is, if we lined up all of the cast of characters, and had that wonderful library moment, when we have the big reveal, the answer is everyone. The idea that there's one party who's most responsible is probably not true. The only other thing I really add is that most of the expense and sort of the anxiety that we have around cost has come in the last 50 years. In around 1968, most people were able to pay cash for service. The second, if you will pay or the second responsible party for payment, was actually the government and there was this teeny little bit that was private or insurance. Today, it's all flipped around. The government, weirdly enough, actually pays the majority of health care expenditures, the United States, but we only talk about that the next biggest portion is private insurers, and then the cash payment is just this teeny little sliver. You couldn't afford it on your own. And I think a lot of people, I mean, patients included, this is sad to say, as we all have some responsibility for our own health. And we could do more. I think doctors could do more, I think hospitals could do more, insurers could do more, employers could do more. I think everybody has some culpability here. 


Melissa Turner -- 13:23  

I want to dig into now some of those, those places where this complexity is apparent to patients and sort of zero in on places where we might talk about interventions. So let's talk really broadly about the health care journey. Obviously, this is different for everybody. But I'm hoping we can describe it in some broad strokes. What would you say are the most important kind of touch points along the healthcare journey where we might think about intervention? Jaja, let's start with you.


Jaja Okigwe --  13:49  

I like the idea that if we can set people up from the get go with the right provider, they're, they're set up for success. And so I worry a lot about how do we get people to make the first decision, the right decision? So what does that really mean? We do know that the choice of care for a particular condition can mean the difference between readmission, infection and all kinds of things. Yet, we seem to pretend that all providers are equal. So how do we figure out the ones that are more likely to be successful and actually offer them up or promote them, and then just not so much promote the others in some way or another and have that not be a takeaway? I think that's the thing that I'm probably most focused on. Just a really, really quick aside if I can do fast. When you think about food, and going into a restaurant, there are some restaurants that love to produce this gigantic book. It has pictures in it like a catalog, because you can't figure out everything that you need to in order to be able to order. That's paralyzing for most people, and the meal is sort of mediocre, generally. The best meals we tend to have are ones in which we've given away choice. And we only have a couple of options. Or maybe we don't have any, you know, if you think about great home cooked meals, you show up and what's for dinner? Healthcare, I think could benefit from that same kind of thinking of maybe too much choice, maybe simpler choices. And I know that sounds contrary to the way people believe having more choice somehow preserves freedom. But the reality is you have freedom to pick poorly. And that's, I don't know if that's the greatest thing.


Melissa Turner -- 15:29  

Can I ask a follow up? You're really talking about provider networks? 


Jaja Okigwe -- 15:33  

Yeah. I mean, I'm not quite sure how we serve it up. Because a network itself is a confusing thing to most people, like who's in network and that what's a network? I think about somebody having an issue, my throat hurts. Google does a great job of of answering questions really simply and getting a couple of the first three or four things right. How do we do that? When somebody gives you a symptom or question, and we just serve up a name or two without really thinking about all the mechanics behind there?


Melissa Turner -- 16:03  

Sure. Susan, what do you want to say about the health care journey as we continue this conversation,


Susan Beaton -- 16:08  

You know, I was just writing down a few things that to make sure to talk about today, and as Jaja was talking about it, I agree on the physician side, just being you know, a nurse by training and seeing all those years, you know, on the floor was that, and even now, even on the health plan side for consumers, their physician is their trusted resource. So those other stakeholders that we mentioned are really, you know, on the pathway to that end goal of that physician. 


Susan Beaton -- 16:36  

But there's so much that happens outside of the time that a member has or a patient has with their physician. They may only see them a couple times a year. And so I think about, you know, consumers in health care, they're still there, unlike typical consumers. And I say that for a variety of reasons is that their experience can be so varied and complex as they engage with all these multiple parties that we talked about. Plus you add on emotional and personal pieces to that as well. And so healthcare is not simple. It's not a one-time transaction. So you know, we used to talk about how do we make the healthcare journey more like somebody buying something on Amazon or Zappos, right? But healthcare is not like that. It's not just a one time transaction, and you're not just buying shoes. And so healthcare, consumers face a multitude of options for services, just like Jaja said, so how do you maybe streamline that option? Or how do you make sure at the intersection of all of that their physician's helping them make that decision. And so it's almost a forced use, right, of a very confusing system. But in the end, you still get really good results. And so I think we have to think about it in that way. And that, yes, we want people to have access to technology to get ahold of their doctors and health plans and how to use technology to get them the access and insights and direct communication directly with those health plan nurses or a physician, because the stakes are high. So you have to give consumers the ability now to access that information. And, and the way they want to do it, which is on their phone, or their tablet. And they want to easy to use, but they're not really expecting it to be where it's a one and done type situation. They are expected though, to be easy to get ahold of and easy to understand the information that we share with them. So I think that's the piece that's different as healthcare continues to evolve and technology becomes a huge piece of it. It is still complex. And so how do we use that technology to deliver that important information and change consumers attitudes and behaviors about health by using both their physician and their health plan, but using technology at the center?


Melissa Turner -- 18:53  

Jaja, do you want to comment on that?


Jaja Okigwe -- 18:54  

I can I think Susan has a lot of great things to add. The one thing I tend to think about is the fact that when we want to access the health care system, we've fragmented it so much that it almost needs to be pulled back together. When I was a kid, we could call my doctor, if I had an issue at any time. And they I even remember going to get an X ray on the weekend where I met somebody at the clinic to get an X ray. If I call the doctor for one of my children today saying hey, I think we might have a break. They'd say, well hang up and go to the emergency room because they don't have an X ray machine anymore. And if I try on the weekend, I might get a call back but they're gonna say the same thing. We can't help you. If I try after 5pm I'm going to get an answering machine. Like all these pieces that make it somewhat easier to sort of go to your trusted advisor and say, hey, this is what's going on. I think technology can help with but right now it's feels like it's all siloed. So the reality is it's still up to you to start the scavenger hunt. It's 5:30 my my son slipped, I think he might have twisted or broken his ankle, gosh, I hope there's a urgent care center that's still open, or I'm going to be in an emergency room all night. That's kind of the reality for most consumers. I wish there was a better way


Susan Beaton -- 20:12  

I go back to technology, I think there's huge opportunity in the way consumers engage in their health. Now, I think we're seeing some of it now. But even in the future, and I think about how you get that same information into, you know, a patient or a member's hands to Jaja's point without, without having to go search for it 5:30 at night, right? Or how we do that. It's twofold. One is technology, but also, you know, primary care and then sharing that same information that those other stakeholders have and making sure their physicians and consumers have that information. It's almost how do you how do you find that data convener, right? That aggregates all that information, because everybody owns a piece of it. And that's what the members having left to go do. And so, you know, we're all trying to eliminate that hassle and homework and headache for the consumer. So I think that's the piece that we really need to figure out and hide how to continue to solve. And there's ways to do it now, right? With science and data and insights that we haven't had before and platforms to really put that then at the consumers fingertips. So I think that's where we can learn from our other partners outside of healthcare, we mentioned, you know, like, Amazon or Zappos or someone else that does have best-in-class services, or know how to service what you need, based on how you've shopped before. And so people are also creatures of habit in healthcare, potentially, right, where they go where they use their services, is it closer to work? Or is it closer to home? Or how often do they use it? Or are they using the ER to Jaja's point more than their physician? So as we become collectors of that data, how do we then use to surface it to members, kind of at their fingertips and in real time, so that we can help them make smarter decisions without having to go search for it?


Jaja Okigwe -- 22:03  

I'm sorry, I know you're going to move on. But Microsoft did a video a number of years ago, sort of imagining the health system in the future. And in it, there's a, there's a woman who's jogging, who's tracking data exhaust from a wearable, that then sort of beams it up to the cloud, and then has an interaction with their doctor over information. And I kind of imagined that, you know, the practice of the future has doctors actually being able to see stuff that you're doing. And then in that actually asking you questions more real time or asynchronously, different than the way it is now where I have a complaint and I go find you. If that could be more seamless, I think we'd save a lot of people's time. It isn't exactly the way we're training new medical professionals yet, but it seems like we could in the future.


Susan Beaton -- 22:46  

You know, that's interesting, Jaja, we had spent some time a few years ago, and we've been brainstorming this with some of my staff, and even here as you say exhaust -- and I talked about it from the standpoint of a COVID digital exhaust, right? Like we use that in other ways on consumer behavior, and we're beginning to use it in healthcare. I really think that truly that convener of all of that information is kind of the winner at the end. And I'm hoping that the consumer, is it, whoever figures out how to put that all together, really then, provides the avenue for us as consumers to have that better experience and for physicians to make better decisions and to have easier access, you know, to health plans as well and the resources and information they have there. And we're all wanting to share that information. It's just the best way to do that as well and breaking down those silos. But there are ways to capture that digital exhaust and putting it out there for the future. So we're starting that but there's a lot of work to do as well, but it's exciting work.


Melissa Turner -- 23:54  

Touchpoints is sponsored by Wellframe. Wellframe works with health plans to reimagine member relationships. They believe health plans have the knowledge and resources to support more people across more touchpoints in their healthcare journey. Wellframe solutions for care management and advocacy empower members and health plan staff to achieve their best in the most wonderfully human way possible. Make sure your members feel confident, cared for and supported by their health plan. Don't miss this moment. See how a digital health management strategy would benefit your plan at 


Melissa Turner -- 24:30  

I wanted to ask both of you about specific pain points in our care journey. I think we've covered a lot of them. I don't know if either of you have additional points you want to make on that. Feel free or we can move forward and talk about health plans.


Jaja Okigwe -- 24:43  

I can't think of anything that comes to mind. I'll tell you I worry about the fact that people generally aren't open to guidance. It takes a while for them to get to that point. Kaiser did an analysis and not it's really funny but it's an interesting analysis, I understand, a number of years ago on heart attack patients and sort of their openness to changing behavior. And what they realized is that their openness to change in behavior is about zero until the point in which they start feeling the first symptoms. And then they are really open to changing a lot in their life until the point at which they're in the recovery room. And then they're almost back to zero. There's this element of, oh, I have an issue, I have a diagnosis and I have a course of treatment or care. How do I be more accepting of that? So that I actually change behavior faster, rather than going through the process saying, well, I really don't have a condition or I really don't think I want to think about this right now. I think it's a challenge. And I don't I don't have an answer for.


Susan Beaton -- 25:43  

No, I think, Jaja, your point is, we studied a lot the behaviors of our members, even when I was on the health planning side. And it wasn't just about using, for example, claims data on the end, right, like after the experience is done. But I think that's why today, you see so many organizations and players within the healthcare system, focusing on what I would think social determinants of health data, or looking at behaviors and insights. Because as you know more about members or patients as people, and why and how they use the healthcare system, how do you interject earlier into that process to your point, because they're only going to maybe change their behaviors for something they're experiencing right away. But you can insert things you know, beforehand to help teach or guide based off of what we know about them. So maybe they care about cost. So if your messages say things that if you would invest right now in health care, let's say you know, a $20 copay or a no copay benefit for smoking cessation, and we can deliver that content to you. And you didn't even know you had the benefit. But we know you care about costs and you're a smoker, here's all the things that are available to you. So how do we start utilizing some again, what outside the healthcare system uses to subliminally message people on whether they want to buy something new, right, that matches the outfit they just bought? How do you start matching those same type of things about healthcare earlier on, when we know people are in the right frame of mind maybe to adopt them? Or it's the right time to try something different. How do we interject earlier on into that timeframe? So, to your point, we're not just using it when they're having those experiences, and then go right back to the way things they were doing before.


Melissa Turner -- 25:45  

Jaja? Do you see that kind of personalization as a solution?


Jaja Okigwe -- 27:33  

I do, though, I recognize that all of us who work on the financing side of healthcare think we have a big S on our chest and that we're superheroes and the reality is the public thinks we're creepy. So as we start looking at more of the data, saying, Hey, I know you smoke, I can help you. I just I worry that that's, how do we do that and not freak people out? You know, another way to say it is nobody really questions. Well, we do at times, you know, what you enter into Amazon and what they see in the suggestions and where they come from. The same thing for Google. On the health plan side, everything we do, people are really worried about that. How to grow into that role as Susan describes, without becoming creepy.


Susan Beaton -- 28:16  

We go back to what we started with. Jaja, you mentioned early on is that physician relationship, right? So if health plans as I think about, you know, we've invested as health plans in my prior role in that relationship with physicians and value based care and patient centered medical homes and accountable care organizations, but what stands out to me is to give them that data and insights that health plans have. So that maybe it might be creepy coming from a health plan, but maybe not so much from a physician because they know all about you, and, for example, the smoking and all of that. So how do we start in that partnership, maybe providing some of that information, right, and sharing that responsibility and communication engagement together so that if it is a little off-putting from your health plan, maybe it's more acceptable from the insights that were shared on that physician site as well. 


Jaja Okigwe -- 29:05  

Now, full disclosure, I really favor that idea. But I'm also working in a company, it's 100% provider owned. So the idea of, of being an administrator of finance or of care and working more closely with provider really appeals to me, I think they are well positioned to be able to provide that advice.


Melissa Turner -- 29:21  

And I think this takes us back to one of the points that you both made early on, which is really that you know, the complexity of healthcare has deep and broad roots. And across the system, you mentioned every type of stakeholder has contributed in some way. Certainly nobody intended for it to unfold the way that it did. But clearly solutions, they're not all going to come from health plans, they're not going to come from the clinician side. It's really about an integrated set of solutions. 


Melissa Turner -- 29:48  

I want to talk a little more directly about the role of health plans now in addressing some of these issues. And maybe we can think about this from two sides how health plans can add and alleviate complexity. We've already talked about some potential solutions, but want to keep this conversation going. What would you say the role of health plans is in alleviating or contributing to complexity in the healthcare system? And what have we seen work or not work so far? Susan, you want to start us off?


Susan Beaton -- 30:16  

Sure, you know, health plans actually have a structural advantage right now, I think in the healthcare industry with the access that they have, they have literally 179 million Americans with health insurance. And they have all of that data. And so I think there's a huge opportunity that health plans have to help fix that healthcare system, right, by improving the patient and member experience, they have a huge opportunity in their partnership with providers to share that information with the employer groups in deciding what benefits to put in as well. And then working with the, you know, the regulators, they really have that relationship with all of them. And then you bring in is then how do you take all that information? How do you take all those relationships, use technology to help streamline those processes, reduce costs, maybe for patients and, and health plans and providers? You know, you try to help solve two of the biggest problems in healthcare, which is the patient experience and rising costs. And so those are things that, you know, we even focus on today and making sure how we connect all of that, and how do we bring all those parties together and put the member in the middle? So there's a huge opportunity for health plans. And they're trained to do that. Right? When I think about today, we spent a lot of time, even when I was at a health plan is, what did we want to focus on? What did we want? What was our aspiration? And making sure bringing together members and consumers and providers -- how are we going to do that? Where are we going to do that? You know, where was the delivery of the future going to be? It wasn't maybe just always in a hospital setting it was your outpatient or hospital at home now. So those are all reinventions of the way that they pay for care today. And then how do you make it personalized? How do you have offerings that are personalized to your members in that regard? And then how do you redesign benefits, so you think about even pharmacy or biometric-like devices, all of those things behind the scenes. So how plans have a huge opportunity to sit at the middle of that intersection, and then start bringing in technology and data and other relationships, to really to bring that to the forefront. And some of that is relationships with providers and reinventing how you give care right to consumers and members, and have joint ownership models in some of that care. So there's a lot of opportunities that the health plan can sit at the intersection of to get that done.


Melissa Turner -- 32:52  

Jaja, you're CEO of First Choice Health, as you mentioned, provider owned health plan. What's the role of health plans here?


Jaja Okigwe -- 32:58  

I think it's a lot more than it's been historically. My sense is most traditional health insurers in particular have been pretty passive around reducing complexity and more aggressive on chasing cost, that the net result is adding rules to try to help people or employers reduce their spend. And instead of actually making things simpler, it tends to make things a lot more confusing. Creating, what? Cost. So this machine that we've built is producing 6% to 8% increases in an average employers health benefit expense per year, which is substantially higher than inflation last time I checked, and yet, it doesn't seem like it's raining salary increases everywhere else inside the healthcare system. So I think we need to find ways to remove complexity, that means change rules. There's a lot of stuff that we write in, and we do that seems kind of odd. I had a venture capitalist came to me once and said, hey, why do you guys do prior authorization? If the real issue is that you want a second opinion, then why don't you just ask for a second opinion. And that's interesting idea, if that's what we're really looking for, it just so happens, the second opinion is our own folks internally, but maybe what we really want is, is a patient that consider the options before they actually move forward. I think we need to think about stuff like that and make it a little easier for people. I don't actually think most patients really want to consume healthcare, yet we inside of the insurance industry tend to think, wait a minute, they really want to spend dollars, we need to protect ourselves from them. I don't really want to get another ophthalmological exam in my life if I can avoid it. It's painful.


Melissa Turner -- 34:41  

Well as we think about putting these ideas into practice, surely there are some barriers. I think we've alluded to a number of them in our conversation already. What are some of the challenges that you face Jaja, as you think about decreasing complexity in the healthcare system, improving members' experiences, things like that?


Jaja Okigwe -- 35:00  

I think Susan's sort of alluded to it. But there are some people who are kind of happy with it the way it is. That's a challenge. Whenever you're upsetting somebody apple cart, or they like it the way they understand it, or, or sadly, in some cases, maybe they're making money as a result of it, it becomes very difficult. They fight tooth and nail to keep it the same. So I think that probably self interest would be one of those that I that I worry about in healthcare. And that comes and goes, but there are a lot of different people who are contributing to try and keep it roughly the same. 


Susan Beaton -- 35:33  

And it's hard to innovate right, around that then. And so where can you spend some time trying to find the right partners within that system that that if those other ones have those barriers? And they, they don't want to change? Right, and there are dollars behind it? Or what's the incentive for them to change? Or they haven't really good the way it is, is that then how do you spend time but you have to still think about their speed to market and speed to delivery? How do you find those other innovators that maybe will help you work around that? 


Susan Beaton  --36:03  

I think we sometimes focus on the rules and regulations. And we don't spend time looking at how can we innovate around it. Yes, there's rules and regulations, but it doesn't dictate maybe how we do it, or how we apply it. And so I think that's a huge opportunity is, how are we going to manage maybe that execution? Or what capabilities do we need? And how do we move faster? And so yes, there's those that won't change? And maybe how you think about how do you leave them behind, and then maybe they will have to change as you start decreasing their resources, right, or their revenue is that there's a climate now, right? There's a lot of us that are innovators that are thinking that way that can help. And we're finding it now maybe in the tech arena, and thinking about faster ways to do things that yes, you can still comply maybe with regulatory things that you have to, but there's opportunity now to innovate around it and remove some of those barriers that may not have been possible, if you're having to spend so much time doing them manually. But it's bringing those think tanks together of these people that are thinking about that and wanting to move the future of healthcare forward. And then that will become the norm and the rest of them will have to either catch up and come along, or maybe no longer participate the way that they did. So I think about that is, is how we look at engagement and outcomes and measurements, maybe aren't the old way that we did, and really start thinking about different ways to look at it, as well. 


Jaja Okigwe -- 37:35  

You know, Susan raises that point of about regulation, too. And I, I tend to think that regulation has its role. The one thing that I think everybody in healthcare agrees on is when there's too much, and it happens too fast, we can't adjust. So there's almost this idea of do something and then let us try to figure out how to work with it before you make another change. If we get too many changes at one time, then we can't figure out how the structure works. And we're not really sure what kind of an outcome we get. 


Melissa Turner -- 38:02  

I like to close out these conversations with some key takeaways for listeners, and you both have a health plan perspective. So let's put ourselves in the shoes of other health plan leaders now who really want to make this a priority. Could we make a list of action items, maybe things to tackle first and then talk a little bit about longer term strategy? Susan, let's start with you.


Susan Beaton -- 38:23  

That's a good list. Right. So I would say the first thing that I would take away, even as a health plan leader, is even though all of these things can be overwhelming, and there's a lot of rules and regulations, I don't want them to lose their excitement about healthcare, their excitement about innovation. I think the list that I would put together to tackle about is what we spent a lot of time on is their strategic choices they have. And then when you look at the choices that you have, not waiting, you know, years down the road to act on them, as you can start now. And you need to start now and reinvent and innovate continuously. It's a motto that we always had was how do you build how you measure? How do you learn and repeat and do it faster? In and amongst everything you have to comply with? And so I think that's the first thing is, what is their aspiration to put out there? What are they looking at to change to make it better for their consumers? And maybe it's starting on their provider side? Or maybe it's an engagement piece for the member or a new technology to deliver that's going to do that for them. And then really looking at is as to how they do that. And they do have to look at it still as a business, right? How do you know what's your aspiration? And we're where we do it at and with whom, and then still as a business. How will we win? right so how do we as a business to stay solvent and still meet employer demands and consumer demands and providers' demands and what capabilities are we going to need to get there? And so don't look at it just as their core, you know, system of processing claims or answering questions about benefits. You need to look at capabilities such as AI and technology and digital hardware, all of those things that are going to move some of those things that you can't change that are regulations faster, though, for you. So think about, you know, as a health plan leaders really making that list and then how can you innovate around it, you've got all of these other core things that you're working on that you have to do is, but there's ways to invest for the future. So that I think, again, finding those innovative partners so you don't have to build everything yourself. Like we did, you know, in the past is, as a health plan is there's partners we can work with in order to do that, and there's technology now in order to do some of those things. 


Melissa Turner -- 40:54  

Thank you, Susan, great start for us. Jaja, what would you add? 


Jaja Okigwe -- 40:57  

Well, thank you for the extra time for thinking, and also all the stimulus that, that was helpful. I would say use your use your experiences example, those stories that people tell you don't forget them, when you're sitting in the office, or you're working with your colleagues, because those can really guide you towards real new insight, that even the stories we were telling at the top of the conversation, those things, there are kernels in, and you can make yourself uncomfortable, when you are comfortable. By remembering those stories, I used to listen to complaints, as well as appeals, which is a great way to confront all the things that you're doing wrong. And it does tend to make you feel like you have a mission to make improvements when you're facing down somebody who is saying they need this surgery because of the following reason. And we're not giving it to them for some reason. I would do all of that. And then I think everything Susan said makes a ton of sense. You don't have to do it by yourself. There's a whole network and of groups that you can work with. I think if anything, you've tried to do it yourself, it'll take too long. So do some experimentation with other people. And don't forget the provider relationship is probably much stronger than then the health plan one. So how do you help get on their side, instead of working to work against them, so to speak.


Susan Beaton -- 42:14  

I agree with Jaja, it was interesting I as well, I had the appeals team. But we also then when you look at it, and to your point is listening to those customer phone calls when they come in, and you know, the challenges that the members are facing. And we spent so much time on member journeys, but when you listen to it when it's live voices, and you can hear the inflection in the tone, or you know, as you look at the chats that they send in those, to Jaja's point are all opportunities for change. They're telling you what's wrong with the healthcare system, because they're living it. And so how do you take some of those and start tackling them? Right? Take the most common ones. And how do you know, tackle those and solve for those and bring your consumers in? There's no harm in asking them how to make the system better. Bring them in, listen and have those conversations and interviews and ask for you know, those answers back and the truth back and real-life examples like we gave when we started. So I think there's huge opportunities with the consumers to bring them in, and have them be a part of that system.


Melissa Turner -- 43:23  

Well, that's a great note to end on. I do want to invite both of you to offer any final thoughts, you might want to share.


Jaja Okigwe  43:30  

We can and should expect more. I don't think we should be happy with the system we've constructed. And maybe we can spend the next 50 years sort of improving it. That'd be really cool.


Susan Beaton -- 43:41  

I would say yes to that, even though it's overwhelming. I don't want people to think that there isn't still excitement and innovation happening. It may be slower than we want but it is happening. And I always challenge people no matter where they are consumers, health plan, providers, is to be a part of it, and to have a voice and to join along in that excitement in innovation.


Melissa Turner -- 44:06  

I want to thank you both. Jaja Okigwe of First Choice Health. Susan Beaton of Wellframe. It's been a pleasure talking with you both.


Jaja Okigwe -- 44:14  

Thank you. Thanks for having us.


Susan Beaton -- 44:15  

Appreciate it. Thanks so much.


Melissa Turner -- 44:20  

Thank you for listening. I hope you enjoyed today's conversation and learned something too. You can check out SmartBrief's healthcare newsletters by going to and hitting the blue subscribe button. Be sure to spread the word and subscribe to the Touchpoints podcast. Finally, a huge shout out to our friends at the Shift.Health content network. 


Melissa Turner -- 44:45  

Touchpoints is sponsored by Wellframe. Wellframe works with health plans to reimagine member relationships. Their digital health management platform empowers members and health plans to achieve their best. Let Wellframe be your strategic partner in providing innovative solutions that improve the member experience. Learn more at