Season 4, Ep. 5: Getting in the Healthcare Driver’s Seat

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Episode Transcript

(Transcript edited for clarity using AI)

Chris Fredericks: Joining me on this episode of Empowered Owners is Kim Dinwiddie, Vice President of Human Resources at Empowered Ventures. Welcome back to Empowered Owners, Kim.

Kim Dinwiddie: Thank you. Excited to be back.

Chris Fredericks: Yeah. So this is your third appearance on the podcast. One of the previous two was a discussion about healthcare as well, and that happened earlier this year. A lot has been going on within Empowered Ventures when it comes to the topic of healthcare and our theme, Healthcare for Us, and something we care a lot about because it’s such an important part of the employee experience and impacts on business and stuff. So I’ll just start this off kind of broadly—what’s been going on within Empowered Ventures when it comes to the topic of healthcare in the past year or so?

Kim Dinwiddie: Yeah. Well, Healthcare for Us has definitely been rolling along. This year, I’m really asking for people to lean into healthcare with us. I think what’s important for folks to know is what’s been happening kind of behind the scenes at the EV level—what have we been doing? And it’s been a year. We went through a benefit broker RFP, or request for proposal, to really find a strategic partner that was aligned with where we wanted to head. It’s not just all about cost savings. It’s also—we want to make sure all of our employee owners and their families have good care, quality care. Obviously, we want good quality with cost savings ideally, but finding that strategic partner—we went through a very lengthy process, talking with a lot of different groups out there and ended up sticking with our same broker that we’ve had for a number of years because they know us well.

They are a trusted partner and actually where they have been looking ahead at all the changes that are out there in the benefit world, they were on top of it. Having that comfort, I’ll say, with them, but knowing that they’re willing to step outside the box with us and to trust them in doing that, and for them to know who we are and again, to be aligned in our strategy was really exciting. So that was kind of step one.

And then from there, though, it was more about, “Okay, now let’s pick some other good partners with us. Is our current situation working, or are we moving away from different carriers, different pharmacy benefit managers? What does that look like?” So we interviewed a number of folks in those groups as well and narrowed that down to select the right ones. But again, LHD, the benefit broker, has been alongside us the whole time.

But in the meantime, a lot of education has been pushed out through Healthcare for Us. And so just starting small, chipping away—benefits is a big road. It’s a lot for people to know. So just trying to get people to be as educated as they can be on the world of benefits, which is—sometimes those of us who live it, we take it for granted, like, “Well, of course you should know that.” So taking a step back and being like, “How can we provide them all the tools to make the best choices that they can?”

Chris Fredericks: That’s awesome. That’s a lot. A lot has been happening with Empowered Ventures when it comes to healthcare. So renewal season is kind of coming up. Typically for most companies, including us, the policy is on the calendar year. So every year there’s kind of a new insurance policy for everybody to consider and benefit policies and stuff like that. So we’re about to head into that. What are companies in general experiencing currently when it comes to the renewal process this year?

Kim Dinwiddie: Yeah. So it’s been interesting. I’ve been really trying to keep up, not only looking at, “Okay, what are all the surveys saying out there that some of the professional organizations are doing,” but reaching out to my peer network just to see, “Okay, what are you all experiencing?” And it’s interesting because a lot of the information, the surveys, all the articles out there are saying that 2026, most groups are going to experience the highest increase they have in 15 years, which is startling to me—double-digit increases.

A few of the peers that I just talk with within the HR world, some of them got a 50% increase renewal notice, and some are in the 30s, 20s. I mean, it’s just interesting. But I think there’s a lot of reasons why it’s happening. I think it used to be people would just be like, “Well, that’s just the insurance. Those carriers are just raising the rates.” But when you take a step back now and look at things, utilization has gone up tremendously. And there are better treatments, but those better treatments cost more, which lead to better outcomes. So you want them. Prescription costs are rising. And also an interesting thing that’s happened—people delayed care during the pandemic. So yes, the pandemic is still coming up, but they delayed care. And so now it’s almost like that delayed effect of that is now hitting.

So it’s just very interesting—all the different fingers that are making all of these costs raise so dramatically. But there’s also a lot of smaller private physicians that probably those of us growing up knew—there were little physician offices. Now those are part of big groups, the major hospital groups. So it’s just an interesting environment and it’s really driving the costs up. But it’s not just us. And I think that’s important for everyone to understand.

A lot of employers are obviously trying to figure out, “How do we combat that? How do we deal with these rising costs?” Some of them are making plan design changes, which means they’re raising deductibles, they’re raising out-of-pocket maximums, raising co-pays. So that will really affect their employees directly, affecting their out-of-pocket costs. But employers are at a point where they just aren’t sure what else to do. And I say that because some employers just don’t know what else is out there. They just—we have always talked about healthcare happening to us, and the insurance world just happening to us. If you don’t get in that driver’s seat and start thinking creatively and branch out, which is part of what we’ve been doing this past year…

Chris Fredericks: So yeah. I love that. And maybe we can dig in a little more into that theme, that concept of part of the issue with the healthcare cost and the system is that companies and people, it’s very easy to just sit back and let it happen to you the way you just stated. And it’s complex and it’s sometimes hard to understand. Brokers sometimes end up in a role where they’re just kind of helping the company, just telling the company, “Here’s your renewal, here’s your new plan,” and companies just kind of take it and don’t know what else they even could do. And so for us, that’s been a big part of this initiative.

And in the last year especially, it’s just kind of starting to—I don’t want to say take charge, but to the best of our ability, lean in and find ways to impact our experience, our cost going forward, and not just be that passive consumer, quote-unquote. With that, this being a bit of a preview without specific details necessarily, but what do you see happening going forward with us with this upcoming renewal? Tools that people might have access to that might be new? Just what could you preview that’s coming out of all this effort for our folks?

Kim Dinwiddie: Yeah. And I will say, I think part of it also is—we talked about the driver’s seat, not just being a passenger, but also stepping out of your comfort zone, because when you think about doing things differently—I mean, we’re talking about folks’ health and their coverage and their care. You want to get that right. And so stepping out of the comfort zone to be like, “Are there other possibilities out there? Are there other options that maybe just aren’t something that everyone’s doing? But a small group is and it’s working and it’s impactful.” And so I think it’s surely asking around, talking to a lot of different folks and digging those out.

And one thing we do have some things already in place. I think that’s important to talk about too. Like we had one of our employee owners use the prescription comparison tool, and they were able to save $70 just on one prescription just by using a tool that is out there that we talked about during open enrollment. But if you don’t use it all the time, it’s not top of mind. So that’s part of Healthcare for Us—making sure that things are top of mind and they automatically think about that. But so there are tools in place, but an exciting tool that we’re going to be putting in place is something called Optavise, which essentially is an advocate navigator.

This is really trending—some groups are catching on to it. And essentially what it does is it’s a group that we will have—an independent, we’ll call it an account rep. That’s probably not the title, but that’s what we’re going to say. So you would have someone that you would reach out to and let’s say, you know what, my physician asked for me to get an X-ray or an MRI somewhere. Where would be the best place for me to go? And essentially they will share with you, “Okay, what’s in network and what will be the prices for that?” So what I would say—out-of-pocket cost for you, as the employee owner, but also the plan in general. But it could also be a pharmacy question. It could be a claim question. “I have this claim and they’re saying I owe this. That doesn’t quite look right.” So it’s someone that you can reach out to and have this conversation and they’ll know the plan, they’ll know all the designs, and they’ll be able to really navigate. I call them navigators for a reason. They will navigate the system for you.

And it’s not just about cost savings. I think that’s an important detail that people need to know. They do look at quality of care and that’s what we really want to push folks to—where is the highest quality of care that usually, believe it or not, is actually tied to cost savings, which is kind of counterintuitive to what we usually think.

Chris Fredericks: What’s an example of that? What’s an example of something someone might come across in that situation where the quality of care and the cost in some cases could be even better?

Kim Dinwiddie: Yeah. So sometimes it is a standalone imaging facility, for instance, that I have seen quite frequently rather than—sometimes we’re at the doctor’s office and they’ll be like, “Just go down the hall.” We’ve all heard it. But instead—and that is quite costly typically when that happens—if there are standalone imaging facilities that when you go there, they have very good imaging results, I’ll say. So sometimes we think quality of care is more physician-aligned, but it can also be imaging, modern technology around technology. And much, much lower cost. The interesting thing too is the standalone facilities give you an upfront cost, so you know right away what that cost will be.

Chris Fredericks: So it sounds to me—and that’s the example that comes to mind for me personally a lot, and even recently, I think I told you—I actually messaged you, Kim, and said I sprained my ankle and I think I might need to get it imaged, and how do I even do this cost comparison thing? Because we don’t have this tool yet in place. And so you kind of coached me on how to follow a similar process, but without Optavise in place. But if I’m imagining in the future I have this Optavise tool, I have this person, an advocate who I can reach out to, and their job is to help me get great care, but also not just take whatever the most expensive thing being suggested to me is. Because I wonder how much confidence—sometimes the doctor suggesting the care is looking out for you, but also they want you to go down the hall because it’s good for their group financially if you just go down the hall. So having confidence that like, “No, I actually want to do this other thing” is part of what maybe an Optavise advocate can help with. Am I getting that correct?

Kim Dinwiddie: Yeah, you are. And so a couple of different things on that. So Optavise—I’ll just use your example. So for you it was like, “If it’s bad enough, do I go to the ER? Do I wait?” So they would be able to kind of guide you through from the very beginning.

Chris Fredericks: They can start to inform and support you in your decision-making. Okay, great.

Kim Dinwiddie: Because the interesting thing is sometimes people in situations will think, “I’ll just go to urgent care.” Oftentimes what happens is the urgent care is like, “We can’t treat you here. We now need you to go to the ER.” Well, there’s two co-pays that you’ve hit and you didn’t really need to. So having someone to kind of walk you through would be like, “You know, if you do this, they’re probably going to send you. So let’s just go ahead and go there.” So someone to walk through that with you would be very important. But right now I can’t even think of the other part that I was going to say.

Chris Fredericks: Yeah. And then I imagine maybe on the treatment on the back end of like once you’ve gotten to the right place, then what do you do when they’re giving you advice?

Kim Dinwiddie: Yeah. And so I think that’s one of the things—most folks, I think it’s changing a little bit, but most folks kind of hold themselves back from questioning what their physicians say. That’s just not comfortable because, you know, white coat, they’re the expert. We’re not there to question them. But they don’t know what tools and resources you have available, and out-of-pocket cost is very important to folks. And so just to say, “You know what, I know you want this image done, but I need to reach out and figure out where’s the most cost-effective place for me to go.” Whenever I’ve talked to folks, I’ve never run across anyone that says, “Yeah, my doctor is really mad at me for asking.”

Chris Fredericks: Well, that’s good.

Kim Dinwiddie: I haven’t ever run across that. Usually they will pause because most people just do as they say and they never have a problem with it. Now I will backtrack a little bit and just say I have been with some orthopedic physician groups that are like, “No, we need our images because I know exactly what type of picture,” but that’s very specific and doesn’t really meet everyone’s needs, but…

Chris Fredericks: Which Optavise could still be that consultant then to validate that if needed and just give you that confidence. So it sounds really exciting to have. And if I remember correctly too, from what I’ve learned, the Optavise person would be the same person. It’s not like calling into a general helpline.

Kim Dinwiddie: Yeah. And they obviously will keep notes in their system. But yeah, you will be talking with the same person. So let’s say you do have a chronic condition that maybe you need ongoing care, but maybe the care changes. Maybe you need lab work done and then you need to see maybe another specialist. Your Optavise rep will know your situation each time you reach out to them. So there are some unfortunate situations where they may talk to the Optavise individual quite frequently, but it does help to know that they are local—not necessarily in Indiana, but they are local—and they will know each of our cases and know if you ever correct this.

Chris Fredericks: Yeah, the EV folks and get to know us and support us. So this won’t be rolling out until our 2026 renewal, right? So I think January 1st is when this will most likely be available. So I guess this would maybe fall under the question then of what are we looking to our folks for going forward for ways they can lean in and continue to help us and help themselves have great health outcomes and also help us manage costs?

Kim Dinwiddie: Yeah. And I think right now, perfect time leading up into open enrollment is just a time to pause, look back and be like, “Okay, what has my healthcare use looked like?” I usually say this year, but also last year too. How many times have you and your family gone to see a physician, a specialist? How many times have you had to get images done, lab work done? How many prescriptions are you filling? Are those going to continue on? Do you have new ones you think you’re going to get?

So really just sitting back and taking kind of a picture of, “Okay, here’s what my insurance needs have looked like this past year.” And then you’re in perfect position to decide on which plan is best for you in the renewal season, because a lot of times, I know the very first thing people look at is “What’s the premium?” And that’s what they look at. But if you have all that data with you, you’re going to know, “Okay, if I went with this plan, here’s what my out-of-pocket costs would look like versus this plan,” and including premium in that.

And last year during open enrollment, we did roll out some things like, “Okay, here’s how to think through it and here’s how to step through what your cost would be.” So some good tools to look at. But I think really knowing your history, looking back is the best way to look forward. And I think this is the perfect time to do that and use the tools that are available. The price comparison tools, Optavise once that tool’s out there—use what is available to you and never hesitate to ask questions and be curious, whether that’s of us at the EV level, your local groups, whether it’s them or your physician. Be curious and ask questions. If they say you need a test, “Well, why? Is there a cheaper alternative?” And just again, I haven’t found physicians that get offended by that. Now somebody is going to find one and be like…

Chris Fredericks: In general.

Kim Dinwiddie: Yeah, yeah.

Chris Fredericks: You have a right to ask questions. I think that’s absolutely the right thing for folks to take away from this. Another tip that I think is worth mentioning—I’m curious if you have any other tips after I share this little one—is if you haven’t gotten your annual physical, maybe now’s a good time of year to try to squeeze that in as well, because those are free, if I’m not mistaken. Is that right?

Kim Dinwiddie: Yeah, absolutely. Preventive care is one of the best things because oftentimes you can catch something before it heads down a path that you don’t necessarily want it to go to. But that is no cost. And that’s a great benefit. And that’s for many different screenings, all preventative care, including even flu shots. I mean, there’s a list. And if you don’t know, you can ask the question and we can make sure that you know. But preventative care is a big way to save yourself and the plan money.

Chris Fredericks: I’ve really enjoyed getting into a routine where every year I have it around the same time every year and get to know my doctor, because if you’re not a person who has a chronic issue that you’re dealing with a lot and maybe you go years without a major illness or something, it’s easy to lose track of who is my primary care physician and like, “Do they really know me essentially?” And so just me seeing them once a year and establishing that routine, I have found really helpful for me so that if I do need something urgent, I can give him a call. He knows who I am. It makes it a lot easier.

Kim Dinwiddie: Yeah, well, even establishing a primary care physician—some folks don’t have one. And oftentimes that happens, like, if you move and it’s on the list of things to do. But if you don’t have a primary care physician, I think that’s a great thing to do is get one. And yeah, get your annual checkups with them.

Chris Fredericks: Yeah. Good. Any other thoughts or tips you want to share as we wind down here?

Kim Dinwiddie: I think level of care was probably another thing to mention. Rather than just thinking through, “Okay, is it an ER situation, is it an urgent care,” there’s a lot of options out there. So just thinking about the level of care that you need. But again, Optavise will be a resource that will be able to help with that.

And I think just kind of wrapping up, it’s important to know that again, we’re all in this together. And everything is increasing, prices are increasing. But it’s not just happening to us—it’s happening to everyone and we’re not alone. But I think the exciting thing is to know that we truly can make a difference. Each person—even if you think, “Oh, I saved $10 on this prescription,” that adds up. We have a lot of folks in our group, and so again, we’re just thinking, “How can you personally save out-of-pocket expenses?” But you’re also saving the plan money as well, which is great for all of us as employee owners.

Chris Fredericks: Yeah, it sounds like what you’re saying is we’re truly seeking a triple-win outcome here where care is better, cost for the individual is better, and cost for the enterprise is better too, which benefits us all as employee owners. That’s really what we’re shooting for here. Ultimately.

Kim Dinwiddie: Yes. Yeah. And don’t think about healthcare one time of year during open enrollment season. When you see Healthcare for Us information come out, please look at it. Pay attention to it.

Chris Fredericks: And read it and try to understand it. And if they have any questions, I assume they can always reach out to you.

Kim Dinwiddie: Absolutely, yes. Yeah. That’s what I’m here for.

Chris Fredericks: Okay, great. Thank you so much for this update, Kim. This has been awesome.

Kim Dinwiddie: You’re welcome. Thank you.