About David Chase
Dave is the creator of the Health Rosetta and cofounder of the Health Rosetta ecosystem.
Chase’s TEDx talk entitled “Healthcare Stole the American Dream – Here’s How We Take it Back” sums up healthcare’s devastation of the middle class and the redemption coming via a bottom-up movement. Chase was named one of the most influential people in Digital Health due to his entrepreneurial success, speaking & writing. He delights in sharing how high-performing organizations have solved healthcare’s toughest challenges. Chase co-authored the healthcare Book of the Year in in 2014.
Chase was the CEO/Co-founder of Avado, acquired by & integrated into WebMD & Medscape (the most widely used healthcare professional site). Before Avado, Chase spent several years outside of healthcare in startups as founder or consulting roles with LiveRez.com, MarketLeader, & WhatCounts. He also played founding & leadership roles in launching two new $1B+ businesses within Microsoft including their $2 billion healthcare platform business.
Chase is a father of two great kids/athletes, husband & oxygen-fueled mountain athlete. His 2014 team placed 3rd in their division & 24th overall (of 500 teams) the US’ oldest adventure race where Dave tackled the Nordic ski leg. Dave was a former PAC-12 800 Meter competitor.
About Health Rosetta
The Health Rosetta is an ecosystem for replicating adoption of practical non-partisan fixes to our health care system. The Health Rosetta framework enables public and private employers and unions to reduce their health benefits spending by 20% or more while improving the quality of care for plan members. We’re building the LEED ecosystem for purchasing and delivering high performance health care benefits and services.
Medical Travel & Digital Health News (MTDHN): Tell how you got involved with this organization and your vision for it.
David Chase (DC): I’ve been in the healthcare industry and am certainly aware of some of its dysfunction, which set me on this journey of discovering why it is so flawed in this country.
Healthcare is both fixed and fixable – and expensive. And we’re already investing more than enough money to not only fund a world class healthcare system, but also fund what drives 80% health outcomes — what we call social determinants of health (SDOH).
Health Rosetta offers a community and technology platform that empowers health plan architects—the people who build new and exponentially more health plans that are purpose built for the chronic disease era and tailored to the unique requirements of their community.
The result is dramatically improved health outcomes and 20-50% lower per capita healthcare spending. This leads to $2,000 to $5,000 per person per year that can be reinvested into better pay (the #1 determinant of health) or education or healthy food—the factors that drive SDOH.
Our vision is community-owned health plans based on different governance models. For us, health is a dividend in that we waste one and a half trillion dollars every year.
Our purpose is to stop that waste and reinvest money into what actually drives health outcomes. Our mission is to empower community-owned health plans.
MTDHN: Do you market directly to communities or employers?
DC: Employers are ultimately paying for our community and technology platform, but primarily our focus is on benefits advisors.
I would argue that the most underestimated role in the entire U.S. economy is the benefits advisor role. If they’re aligned, brokers are worth their weight in gold because they stop the largest wealth transfer in American history from the working and middle class to an underperforming healthcare system. Just as important, they put in health plans that are far superior to old-line health plans. For example, they ensure health plans have proper primary care — sadly, a rarity in U.S. healthcare.
MTDHN: Can you give us an anecdote of a typical plan or program that you’ve helped?
DC: An example of a community-owned health plan is what’s going on in Northeast Ohio in the Rust Belt. It’s had a pretty rough go of it the last 20+ years.
One of the recent successes is a particular school district that had a levy that did not pass last year. Fortunately, they had implemented a Health Rosetta style plan for that school district and saved more money in the prior 12 months than the entire school levy. They didn’t have to lay off teachers, cut programs or eliminate benefits.
MTDHN: What did you cut and what did you put in?
DC: We cut profiteering, price-gouging, fraud and administrative bloat. We have a five-step process that spells out LOCAL. The first L is learning how to be liberated from the status quo. Most people think solving the healthcare problem is like bringing peace to the Middle East. That is, something that seems out of your control and perhaps even hopeless. That is what status quo protectors would like you to believe.
The O stands for optimized health plan infrastructure and working with the right benefits advisor. This is the master key that unlocks the door to high performance health plans. Let’s say an employer wants to do a direct contract with some surgical hospital but might be contractually banned from doing that. We also found that 95% of employers don’t even look at or negotiate these standard agreements. That can be toxic and further codifies this large wealth transfer that is happening.
C is for carve out PBM, which is a pharmacy benefit manager (PBM). There’s incredible shenanigans and profiteering going on there. The PBMs have literally created dozens of revenue streams for themselves. But this is easy to fix. You don’t have to change the formulary or where people pick up their medications.
The fourth step, A, is add value based primary care. This is the first thing that members notice. There is no well-functioned healthcare system in the world is not built on proper primary care. It sometimes takes weeks to get in and they’ll see you for 10 minutes. That’s not primary care in a well-functioning primary care model. Primary care can fully address between 80 and 90% of all medical issues depending on how comprehensive they are.
The fifth step is L for leave behind value-extracting PPO networks, which are the greatest heist in American history. It’s common to have provider network where the carrier agrees to pay five or 10 times Medicare rates because they make more money when an employer spends more money. Consider Pacific Steel and Recycling. Five years ago, they were spending over $8 million on their health plan. If they had stayed with their old carrier, they were expected to pay over $10 million in 2021. In the last couple of years they’ve spent $3.5 on benefits. How did they do that?
They got a lot smarter about procuring drugs—representing about one-quarter of the savings. The rest was in having over 5,000 direct contracts between the employer and the healthcare provider. This approach addresses multiple needs and challenges for providers. For the employees they had no cost sharing when they went to high performance healthcare providers.
MTDHN: Has medical travel been an option?
DC: Yes, that’s an option, especially for complex medical issues. Rather than just going to whatever hospital happens to be closest that may or may not be high value. Centers of excellence are pivotal particularly for complex medical issues. That may mean going to the Mayo Clinic for a second opinion for cancer, for example. Half the time there’s significant change to the care plan, and about 20% of the time we find that the diagnosis is completely wrong. For this reason, medical travel really matters.
MTDHN: Did you ever send or recommend sending people out of the country?
DC: Yes, Health City in the Cayman Islands is one destination that advisors send patients to. Some people have looked at other destinations in Central America and Mexico, especially for medications.
You can have an all-expenses-paid vacation and get the medication you need at a much lower price than in the United States.
MTDHN: On the digital health side, can you give me a perspective on the role of telemedicine, telehealth and other remote patient monitoring solutions?
DC: I started Microsoft’s healthcare business many years ago, which is essentially getting people to build around Microsoft’s healthcare platform. What I learned is don’t automate a broken process.
We strongly advocate for better primary care. We’ve all learned during the COVID pandemic that you don’t need to go to the doctor’s office for everything. Evidence supports the use of remote patient monitoring.
MTDHN: Your name Health Rosetta is obviously the Rosetta stone. How do you see that?
DC: I refer to myself as an archeologist on a dig in that health care today is as indecipherable as Egyptian hieroglyphics. We found the organizations who are cracking the code and sharing how they did it so everyone can benefit. I like that metaphor.
MTDHN: Is there anything else you’d like to tell our readers?
DC: The one thing I want to add regards a set of laws around transparency and the hospital-carrier agreement. These laws represent the largest change in employer health benefits since 1943. But most people haven’t connected the dots. For example, if you look at what happened around broker compensation, you see it reflects what happened in pension benefits a decade earlier, which fundamentally changed that landscape.
The Employee Retirement Income Security Act of 1974 (ERISA), a federal law that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans, transformed that landscape.
We combined that with the pricing and carrier agreement. Over the next five years this will be a big game-changer that we are excited about. Our community has played a significant role. For example, one of our Health Rosetta advisors was a former senior health policy advisor in the White House who worked on the pricing transparency issue. She saw that the benefit advisor is the most underestimated role in the entire U.S. economy so made the career switch once she was done in the White House.