About Bob McCollins, Chief Sales and Marketing Officer, Pulse Health Solutions (PHS)
Bob brings 35+ years of employee benefit consulting and sales experience to the leadership role of Chief Sales and Marketing Officer at Pulse Health Solutions. His experience in self-funding, agent relationships, consultative problem solving and innovative approaches to reducing risk and cost serves to benefit PHS as a resource of health and risk management savings solutions for our employers and their agent advisors. Bob was recently elected to serve as a member of The Board of Governors for the National Alliance of Healthcare Purchaser Coalitions. Bob shares Employers’ Advanced Cooperative on Healthcare mission: “We work for our employers of every size to maximize the human performance of their workforce by addressing the issues of worker health, risk, cost management, engagement and productivity. By attacking these issues through education, clinical evidence and value-based programs, we will improve the health and well-being of our members workforce and their families while positively impacting the costs associated with these same risks.”
About Pulse Health Solutions (PHS)
Pulse Health Solutions offers companies the solutions to lower their future increases in health costs by targeting preventable chronic diseases, such as cardiovascular and diabetes, while at the same time adding improvement to employee’s health and well-being. We have partnered with select companies to provide options for a program that will best fit your company’s culture and needs. We are also able to provide these tools and resources with little to no budget. Companies in our programs will also reduce health related absenteeism and worker’s comp claims which can lead to improved productivity and profitability.
Medical Travel & Digital Health News (MTDHN): What does your company do and how did you get interested in this kind of work?
Bob McCollins (BM): I’ve been in the employee benefits space since 1986, and it’s been a wonderful career for 35+ years. Our company, Pulse Health Solutions (PHS), was originally started as a wellness company. Our CEO came from the managed care workers’ compensation side. We saw the impact of an unhealthy worker on workers’ compensation and realized there were a number of wellness companies out there, but few wellness consultants. Based on that, we pivoted to become more of a wellness and risk management consultant firm.
Primarily, we work with self-funded employers and their benefit advisor or broker consultant. We pay attention to the claims data in medical and pharmacy to find trouble spots. We offer a number of solutions, from traditional wellness programs, disease management to onsite and near-site clinics.
We work with the employer and their advisor/consultant to build a program to address the challenges with risk management, managing healthcare and pharmacy cost and finding solutions that engage their people and help them live healthier, happier lives which ultimately leads to more productive employees.
MTDHN: Who are your clients?
BM: They are all self-funded in some form. Some of our clients have 45 employee lives while others have as many as 4,000 employee lives. No specific industry. If they’re self-funded and we can get access to their claims data, then we can work with them to solve their problems.
MTDHN: What are the top concerns that you hear throughout the market?
BM: One is diabetes management and the comorbidities that go along with addressing diabetes. That’s easy to identify. Many people with diabetes also may have heart issues, high blood pressure, behavioral health issues and the mental stress that goes along with all of this.
Other concerns are musculoskeletal issues, back surgery, knee or shoulder surgery. In aggregate, musculoskeletal claims are probably the second or third largest disease category, and it costs employers considerable money and lost productivity.
Also, prescription drug costs are a significant concern for employers. All of these concerns are a risk to the long-term sustainability of employer-sponsored health plans.
MTDHN: For diabetes, what kind of interventions would you recommend or programs that you would enroll employees in?
BM: Our Engage, Educate, and Enhance (E3) program first engages the diabetic patient within an employer workspace to provide no cost to the patient diabetic testing supplies. We know that many people don’t stay compliant in their testing because of cost. We can get them the diabetic testing supplies they need by contracting directly with one of the largest diabetic supply manufacturers and distributors in the United States. We pass this significant discount on to the employers.
We tell them that they need to eliminate the cost barrier so that people will stay compliant and that they can save about 40 to 60 cents on the dollar from what they typically pay under their pharmacy benefits. With free testing supplies, patients are paying more attention to their numbers on a daily basis.
After engagement, we educate them via a health coach, nutritionist, diabetic educator and, maybe, a personal trainer. This helps people learn to live better with their diabetes and improve or maintain their health. To access their testing supplies they have to talk with their health coach on a regular basis.
With this approach, we are able to enhance the person’s life and ability to effectively manage their diabetes.
MTDHN: With musculoskeletal, do you ever recommend surgical intervention?
BM: Yes. We know that 60% of patients are misdiagnosed or have a suboptimal treatment plan. So, the first phase of treating someone who has a musculoskeletal issue is to make sure the diagnosis is correct.
We bring in Edison Healthcare to our self-funded client who can use their multidisciplinary teams to review the case and make sure that the treatment for their issue is correct. If surgery is needed, they have a number of Smart Care Centers, which are similar to Centers of Excellence, that they can access.
These are the best surgical facilities and surgery teams, and they do it right the first time. They also coordinate the follow-up care in the patient’s local community. We’ve seen great success with this program, not just in musculoskeletal, but in other high-cost areas like cancer, transplant, cardiac, and complex diagnosis cases.
MTDHN: The last area that you mentioned was high-cost drugs. Can you go over that area as well?
BM: It’s a small percentage of the utilization for any self-funded employer. It might only be 1% or 2%, but it represents at least 50%, if not higher, of the total cost of the pharmacy spend for most employers.
It’s important to look at the misalignment of incentives for approving high-cost drugs. When we get involved with our clients, we recommend that they remove the prior authorization and medical necessity review away from the pharmacy benefit manager (PBM) that is also filling that specialty drug. We want to remove the rubber stamp mentality, especially for high-cost specialty drugs.
First, we review the drug for medical necessity and ensure that there’s no alternative treatments, step therapy or other prescriptions that could be filled to effectively treat the patient instead of that high-cost specialty drug.
From there, we develop the plan design that supports taking advantage of the many charitable organizations, patient assistance programs and, potentially, international pharmacy sourcing. There’s no reason not to take advantage of getting that $70,000-a-year Humira billed through a patient assistance program or charitable organization.
MTDHN: Do you send patients out of the country to get those drugs?
BM: COVID has halted international pharmacy tourism for now, but we do have employers that take advantage of international pharmacy sourcing from tier one companies, primarily Canada, where you can get that exact same drug at a savings of 20-80%.
Employers will use this for people who don’t qualify for patient assistance or maybe the drug doesn’t have a patient assistance program.
MTDHN: Do you sell through brokers? How do you connect with the employers?
BM: We’re a solutions provider to the benefit advisor/benefit broker world. We ONLY work with benefit agencies as our path to providing our solutions to their employer prospects and clients.
MTDHN: Do you ever work with PBMs or specialty pharmacy companies?
BM: We have our own pharmacy benefits solution called Star Rx that addresses the misalignment of incentives that exist in typical PBMs. We are a true pass-through, transparent, cost-plus pharmacy solution. We prefer to say we are a “see-through” pharmacy benefit solution. Our costs are very clear. Our only source of revenue is an administrative fee to process that claim. No conflict of interest. No spread pricing.
MTDHN: How about rebates?
BM: We pass through 100% of the rebate that we receive from our rebate administrator. This is often an area where there is misrepresentation of transparency and truth.
For example, let’s say the rebate aggregator charges a 10% administrative fee for the rebate management and collection. If there’s a $100 rebate that was received on a prescription, $10 of that is going to go towards administration; $90 is the amount of rebate that we receive; and we pass along 100% of that $90.
MTDHN: What do you see on the horizon with gene and cell therapy?
BM: Concern for patients and employers because these are significant high-cost drugs. We’re not questioning the value. These drugs can save lives. For an employer, however, it’s a big cost that impacts their stop loss. There needs to be a hard look at the efficacy of the outcome to warrant the investment and expense in high-cost drugs, they must deliver.
Is this going to help the patient? And then, how much can the employer absorb in the cost of that therapy?
With pharmacogenomic testing, which is a noninvasive swab of the inside of the mouth, the result will say how your body metabolizes a certain drug. Are you a fast metabolizer or a slow metabolizer, are their drug-to-drug interactions that could cause an adverse health event?
Again, if I’m an employer about to spend $500,000 on a drug, you would want to know that it’s going to work for the patient and not cause undue harm. You can’t play Russian roulette or trial by error when it’s a $500,000 drug impacting your work family member!
MTDHN: Do you see self-funding growing?
BM: I see self-funding continuing to grow. It’s an exciting time to be in this space, talking to CEOs and CFOs about how they can control the cost and better manage their second or third largest business expense.
For too long, employers have believed they can’t do anything to control their healthcare cost. In fact, IT IS a controllable cost like many other things that are involved in the supply chain of their business.
I’ve never been more excited about working with benefit advisors/brokers/consultants and their employer prospects and customers, and most importantly, their work families to gain resources, access and an easy path for using their healthcare coverage when they need it. We want to:
- Bring back the CARE in healthCARE.!
- Bring back the BENEFITS in employee BENEFITS!
- Bring back the LOWER in healthcare COSTS!