Risk & Resolve
The Risk & Resolve Podcast is your go-to resource for insightful conversations at the intersection of leadership, business ownership, and the insurance industry. Hosted by Ben Conner and Todd Hufford, this podcast dives deep into the challenges and opportunities that leaders face in an ever-changing world.
Each episode features candid discussions with business owners, industry experts, and thought leaders, exploring topics like innovation, risk management, and the strategies that drive success. Whether you’re an entrepreneur, executive, or insurance professional, you’ll gain actionable insights and inspiration to navigate today’s complex business landscape.
Tune in to Risk & Resolve—where leadership meets resilience.
Risk & Resolve
Fixing Healthcare’s Broken System with Deb Ault, Founder of Ault International Medical Management
In this episode of Risk and Resolve, hosts Ben and Todd sit down with the renowned Nurse Deb Ault, founder of AIMM – Ault International Medical Management, to discuss how she’s reshaping the broken U.S. healthcare system. Deb shares the pivotal moment that led her to leave bedside nursing, the shocking truth about how money often drives life-and-death decisions in hospitals, and her mission to provide patients with ethical, proactive medical management.
Listeners will learn:
• The life-changing story that inspired Deb to start AIM.
• Why healthcare costs and patient outcomes are often at odds.
• How AIM’s nurses and doctors advocate for patients and employers.
• Deb’s bold executive orders to fix U.S. healthcare if she were in charge.
• Why patient advocacy and “righteous indignation” are key to change.
You're listening to Risk and Resolve, and now for your hosts, ben Conner and Todd Hufford. Welcome back to another episode of Risk and Resolve with your co-host, ben and Todd. And today we have a very special guest, deb Alt, who has a wonderful brand around Nurse Deb nation, famous Nurse Deb. Thanks for being with us today.
Speaker 2:Thanks for having me Happy to be here.
Speaker 1:Yeah, deb is the founder of AIM, alt International Medical Management. It's a company focused on proactive medical management, and there's a key word in there, I feel like.
Speaker 2:Proactive, yeah, yeah there are three key words, but management is's a key word in there. I feel like Proactive, yeah. Yeah, there are three key words, but management is also another key word.
Speaker 1:Fair, fair, deb. Can you give our listeners, viewers, a sketch of AIM and what you guys do on a day in and day out basis?
Speaker 2:Yeah, absolutely Happy to do that. So my company is a team of nurses and doctors. We come alongside patients, primarily telephonically although we're expanding that out recently and we help guide them through the two most cumbersome ecosystems in the universe the health care delivery system. So what care is the gold standard of care? When should I be getting it? Where should I be going to get it? And the health plan system. Oh my golly, how do I avoid bankrupting my family, my employer, as I'm going through this health event? So we navigate those two pieces with them and get them as healthy as possible, as quickly as possible.
Speaker 1:God bless your team for doing it too. That's hard work. What was the genesis or the reason for you wanting to start AIM Like? What's the story behind that of like, hey, I just, I really want to start a company that deals with the two most difficult things on the planet.
Speaker 2:I did not want to start a company to do that.
Speaker 1:Let's hear it.
Speaker 2:So this magazine back here actually has the whole story if anybody cares enough to read it. But I was a bedside nurse. I was a ER ICU, predominantly night shift, predominantly weekend kind of nurse. Knew from the time I was born essentially, essentially that I wanted to be in medicine, discovered that being a doctor was probably not the right answer for me once I became a candy striper and saw what doctors actually had to do and I didn't want to live in a hospital. I wanted to go work at a hospital and go home and have a family and, you know, do some other things as well.
Speaker 2:The problem is, about 30 years ago now I was working in an ICU and we had a patient and we should not have admitted that patient to our ICU. We didn't have all the right equipment, we didn't have the right skillset. We reluctantly admitted him to stabilize him so he could be transferred, and the hospital chose not to transfer him. He actually ended up passing away and it became really apparent to me in a conversation with my unit manager when she finally I mean I was hysterical, I was sobbing, you know when she called me and said you don't have to come in tonight and I was like, oh good, you transferred him. She's like no, he passed away today and I lost it. And she finally, you know, in her attempts to settle me down, said probably the one thing that was more true than anything else she'd said. She said do you know how much money we would have lost if we would have transferred him? And that was kind of the pivotal moment for me that wait a minute, we're making life and death decisions based on money. That is not what I signed up for. That is not why I became a nurse. I'm not count me out right, but what am I going to do? This is, you know what I feel like I've been called to do.
Speaker 2:And so my husband, kind of once he dug me out from the couch cushions in my deep depression said you've got to apply for this job. I had a master's in business, minor in math and statistics, and he said you've got to go apply for this managed care position. And I was like no, no, no. Managed care is evil. It's all their fault. You know, they're the ones that are cutting the money and the funding so that hospitals can't afford equipment. And he's like we need an income, apply for this job.
Speaker 2:So that's how I wound up in managed care. And then, as you guys know, in our industry mergers and acquisitions are rampant, right. And so finally, it got to the point where wait a minute if somebody is going to do this the right way, we're going to have to do it ourselves, you know. We're going to have to take the leap. No TPA is going to let medical management be done the right way, because they have a vested interest in different things, right? So actually, it was very much to my chagrin that I started the company, you know, 20 plus years ago, but somebody had to do it and nobody was doing it, and so that's how I wound up here.
Speaker 1:So you stepped into a calling. It sounds like.
Speaker 2:I think so. Yeah, unbeknowing at the time, right, but what nurse? I had an associate's degree in nursing and when I was working at Ohio State University they offered free tuition. And so I'm like what's the class that weeds everybody out when they're trying to get their bachelor's in nursing Statistics? Let me take that class first.
Speaker 2:By the way, I hated math up to that point and a TA made it make sense for me. So every quarter I would look at what math class he was taking and I'd go take it because I was like actually enjoying and learning math. And then eventually it's like wait a minute, you have enough credits to graduate. We need to kick you off the tuition reimbursement. And so they graduated me out with a bachelor's in business and a minor in math and statistics. And then I was like, okay, business, that's it Right. And then, when this all happened with at the bedside, I was like okay, business, that's it right. And then, when this all happened at the bedside, I was like somebody's got to take control of the purse strings. Somebody with some ethics and some morals and who actually cares about patients has to take control of the money. That's the only way we're going to fix the business of healthcare.
Speaker 1:So you hang a shingle with AIM and register with the state of Ohio and you're like, okay, we're going to do this, we're going to solve healthcare. Now, where's all the clients? Like how did all that start right? Like there's a dream, and then there's a reality of like we have to fit ourselves into this healthcare ecosystem.
Speaker 2:Yeah, that is still the hard part, in reality. It's interesting because when my husband said, let's just do this for ourselves, right, the pivotal moment, we'll just build our own company. First I asked him if he had somehow gotten into some drugs or something, because he didn't know what he was talking about, about starting our own company. And then I asked him how much money do you have? Because it's going to take a quarter of a million dollars to start this company. He had 12 grand, by the way, and then I said, well, you know, we spend the 12 grand and we have to go to work for somebody else. We might as well try.
Speaker 2:So I called several people in the industry employers in the industry that I had known for a very long time, that were innovative, that were creative, that wanted to do better for their employees, that wanted to get out of traditional health insurance type arrangements, and I said, hey, listen, if I do this, if I build this company, would you hire me?
Speaker 2:And eight of them said, yeah, we would hire you. Two of them actually came on the first year. Four of them still have never become a client, right, but they kind of gave me the comfort that, okay, yes, there are people out there who see it the way I see it, who believe in what I believe in, who want to solve it, and so that's why I decided to kind of take the leap and try it. And it's really been all about that for us finding people of a like mindset on the same mission, who see things the way we do in terms of what's broken, and who are willing to say. It probably isn't going to be easy, it's definitely going to be uncomfortable, it's going to feel different, but we want to fix this, we want to take control of it.
Speaker 3:So, Deb, a lot of our listeners have heard the story now about how it came to be, but they're wondering how does her team save money? Because I have a doctor and I've got a local hospital I go to and I have an employer with a plan. I've never seen anybody get in the way of what I'm doing. Help us understand the mechanics of the vehicle that you built and how you do sort of, I guess, stop the car or at least slow it down to make some changes. Explain the technicals of how that works.
Speaker 2:Yeah, in any and every way that people will allow us to. So I mean we have an approach of meeting people where they're at. So we have a product for fully insured groups of meeting people where they're at. So we have a product for fully insured groups. We have a product for groups that are not fully insured but they still need a carrier logo on their card to have that comfort level right. So how much we can do depends on where that client is at, how their broker and consultant and advisor has walked them down the glide path toward these like unbundled, transparent, you know, vanishing, deductible guided plans, right, where are they at in that continuum? So our goal is really to find people who have the same mindset, mission goals, work ethic, you know, communication strategies with their employees and partner up with them and kind of come down that continuum with them. There's a ton of technology that goes into it.
Speaker 2:Todd, if you want to get to a total unbundled health plan and have maximum control and highest quality and lowest cost, then we have to take control of the pre-cert function and when we do that pre-cert function we incorporate navigation into that. So if somebody calls and wants to pre-certify an MRI and the place of service they're proposing is the hospital we're going to call a timeout technical foul. You should not be doing MRIs in a hospital setting the vast majority of the time. Now people will tell you that technology or a non-clinician could probably do that, except there are clinical reasons that you might want to do that imaging in a hospital setting. Right, somebody who weighs 700 pounds? They're probably not going to have the appropriate equipment in a non-hospital setting for that imaging. So that's why we bring nurses into it.
Speaker 2:But we had to build our own medical management software customization to incorporate the MCG evidence-based care guidelines, which is the science behind what's going to cure this person. Where do the benefits outweigh the risk? That was a key component and we had to, you know, had to build everything to accomplish it. And now we're licensing 40-plus different quality and cost transparency tools and my nurses can't get out of our system and go hunting. Do I look at this one for imaging or do I look at that one? This is a hospital in Indiana versus a hospital in California. Which tool do I use for that? So we had to build all of that into our systems and tools just for the nurses who do it every day, all day long to be able to navigate it, and now we're beginning, especially with AI and some of the other strategies that we're able to use, to get ready to turn that and start making that patient facing so I was going to say.
Speaker 3:I think about how that example of an imaging where you're really kind of talking to the employee, let's say the person trying to get service, directing them somewhere else I bet those conversations are a whole lot more easy than the ones where you're talking to the provider and maybe telling them that procedure is not necessary or we need to go about it a different way. How does that work? I mean, you're talking with not only doctors and nurses in the facility, but you know their office managers, who think their doctors walk on water and don't make any mistakes. What leverage do you have? What ultimate control do you have? And then, what soft tools do you use in order to sort of navigate the ultimate best decision that you feel and know that this injured or sick person needs?
Speaker 2:So all of our nurses that work in our call center go through training in Procheska method, motivational interviewing and basic Dale Carnegie strategy. The other thing that we do is we use a natural language processing artificial intelligence software do is we use a natural language processing artificial intelligence software and so it listens in to every single call as it's happening. We've programmed it to walk our call center nurses through the steps of the process. It listens for key words. So if, for example, someone is suicidal, homicidal, unsafe, if someone is cussing on the call, it will automatically pull one of the call center managers into that call so that they can intervene or they can take action.
Speaker 2:If somebody says a key word right, they're going to cancel my procedure it pops up and it tells that nurse procedure. It pops up and it tells that nurse here's what to say, here's the next step to take. So it guides them through that process of that interaction. I wouldn't necessarily say it's easier or harder based on provider versus patient. Some patients just want what they want when they want it, wherever they want it from, and they feel that they are entitled to that because they have a premium taken out of their paycheck.
Speaker 1:Yep.
Speaker 2:Others are very open and receptive. Oh my gosh, you're going to help me. Ooh, you can help me find the place that I can best afford. Oh, you know who the good doctors are. You know what the great facilities are. Others embrace it and love it. Right, it's almost impossible to predict which one's going to be which Same thing on the provider side. Lots of times we're talking to someone in a provider's office and they're like there's a way for this patient to get this procedure for free. How do we make that happen? Oh, you can help me figure out the place that's going to get the best coverage for the patient. Let me talk about that, right? So some will embrace it. Others will be like no, our practice is owned by XYZ Hospital and everything gets done at XYZ Hospital and we're not going to order it at the independent imaging center, no matter what you say. And we're not going to order at the independent imaging center, no matter what you say.
Speaker 2:The more expensive the medical procedure or service is and the more profit that is being made on that medical procedure or service, you often find a correlation to how aggressive they're going to be about it. So, chemotherapy we see markups 2, 3, 4, 5, 6,000% on those drugs. And we'll say to the business office, the physician you know, wait a minute, this patient's going to get stuck with that bill. That is an excessive charge. That is not reasonable and customary. You know that's not going to fly with a plan, because we know you're buying this drug for X right or even less, depending you might be a 340B. You might be getting an even better deal than what we think you're getting on it. And we'll say to them okay, if you won't negotiate that price to something reasonable, if you won't, let us have the drug drop shipped so that we can control the cost. If you won't do any of these things, then write a prescription for the patient and we'll have a home infusion company go out and give the drug and they'll refuse to write the prescription. No, if you're not going to let us administer it, we won't write the prescription. So then we have to go all the way back to okay, now we have to find a different doctor because that doctor's not willing to write the prescription.
Speaker 2:And even when you call the state medical board, here's the thing that really is abhorrent you call the state medical board and you walk. The thing that really is abhorrent. You call the state medical board and you walk them through that situation and they will say that's a billing issue. We don't get involved in billing issues. No, that's an ethics issue. We've already diagnosed this patient, he's already determined what the appropriate treatment is and now they're refusing to help this patient get that treatment in a way that the patient can afford. That's an ethics issue. That's a greed issue, but we're seeing it across the country and we're seeing providers that are demanding cash up front from patients who have 100% coverage. It makes no sense. The breed has gotten worse the last 30 years instead of better.
Speaker 1:As you've worked with health plans, and I think it's fascinating, even before we started this call, just in thinking about where you sit, and you mentioned it in your intro you sit right in between healthcare and a health plan, which is ridiculous. That I mean that's a hard place to sit, but your client really is the employer. What would your ask be for all employers as they're considering a health plan?
Speaker 2:I think that employers ultimately have to examine their heart and their gut and come to some sort of a conclusion about why are we offering health insurance as a benefit? Because, if we're doing it for the wrong reasons, right. If we're not willing to really examine it and make sure that it's delivering, then should we be doing it at all? And I know people probably think that I'm crazy saying that, but you're really making a life and death decision for your employees and their families when you pick the health plan. And so I understand that you want to focus on making widgets because that's your core business. I totally get and understand that.
Speaker 2:But if your employees don't have good health care, they're not going to help you accomplish your widget making mission, right? So if you don't want to focus on health care and making it work, right, you're in a really tough spot as an employer, right? So your competitors are offering health insurance and that's the reason you offer health insurance. Well, that's not a good reason, right you know. So I think they really have to get down to. What are our goals and objectives? What are we trying to accomplish by offering health insurance?
Speaker 1:When you say that's a life and death decision, what do you mean by that?
Speaker 2:So the problem with US health care right now is that there are major disparities in health care. We all know that in terms of quality of care, in terms of cost of care. You know we have people who are avoiding their medications because they need to put food on the table, right. So even you know, just offering a traditional status quo kind of carrier plan has implications. Right, you're paying for the care that those people get. If they get sub quality care, you're paying for them to be butchered, maimed and killed, and I hate to be overly blunt about it, but people come out of the health care system hurt by inadequate quality of care, inadequate quality of care, and so I don't think that people understand the seriousness of it. I'll tell you.
Speaker 2:I walk into employers and a question that I ask a lot is is there anybody in your population who has cancer? And always the answer is yes, right. What has your insurance done to help them through that? Has anybody from the insurance even called them and offered to help them? Have they talked to them about okay, if you're on chemotherapy, here's all the nutrition and hydration and you can do a cold cap to avoid losing your hair and has anybody even called them and said, hey, I might be able to help you. No, nobody's called them right.
Speaker 2:So to me, as an employer, when I have somebody who's going through a health issue, I want somebody to help them, and right now that's probably somebody in your HR department or your C-suite, if anybody is helping them right. And that's an even bigger liability for you to take on when you're trying to help them and you don't have the tools and you don't have the resources and you're not a clinician. But you love your employees and you want to take care of them and you're not taking good care of them by putting them into systems that don't give them any kind of advocacy or information or support into systems that don't give them any kind of advocacy or information or support.
Speaker 3:Deb, there's, you know we've seen a flurry of executive orders out of our executive branch, of our federal government. Let's put yourself as the chief executive of all healthcare in the country. That position doesn't quite exist.
Speaker 1:I would love that.
Speaker 3:Yeah, I know she would oh sign me up and let's assume you did not have to go through the legislative bartering process. Can you describe what two or three executive orders that you would write and sign? That would help turn the tide on this thing?
Speaker 2:Absolutely. I would say that everybody who scores above a certain level on the MCATs gets 100% scholarship into medical school and as long as they maintain a 3.0 GPA, they keep that scholarship so that when they graduate they have zero debt.
Speaker 3:Okay, go ahead Sorry.
Speaker 2:So that they can go into independent practice rather than becoming an employee of a hospital or a health system go into independent practice rather than becoming an employee of a hospital or a health system. And that medical schools are not allowed to admit anyone with a lower GPA or a lower MCAT score unless all of the available seats have been filled by people that are on scholarship.
Speaker 3:So let's break that down a little bit before we move to your next executive order. We are trying to get the best and brightest the first part right and the second part. We're trying to eliminate the indebtedness which then motivates these new doctors from getting basically encumbered in situations where they're solving the debt but they're not actually practicing the medicine.
Speaker 2:Yeah, they're an employee who has gag orders and who has RBRVU requirements that have to be met and who have to do it the way the employer says to do it. They're the nurse in the ICU admitting the patient that should have never been admitted because they don't have the equipment and the supplies to do it.
Speaker 3:Right, okay. So what's your next executive order?
Speaker 2:look like Well, I would add to the last one medical schools must teach evidence-based care pathways, because right now they don't, and they don't teach anything about the business of healthcare either. They don't teach anything about insurance, what it is, how healthcare gets paid for, what things cost. That is entirely missing from the medical curriculum. So, number one I would attack the physician and then, once I got the physician shortage solved, I would move on to nurses and therapies and I would move it on down the chain.
Speaker 3:In the same way.
Speaker 2:In the same way.
Speaker 3:Okay, how about a second executive order that looks a little different, attacks a different problem. What would it look like?
Speaker 2:So we're all old enough to have been forced to read the scarlet letter in high school, right? Yep? So you see this lab jacket Yep, a, b, c, d or F above my name. That tells you my objective case mix, adjusted severity, risk, indexed quality score, so that when I walk onto a hospital floor you can see, coming a mile away, whether I'm a great doctor, an okay doctor or a horrible doctor. And I want every facility to have to post at every instant entrance, just like across the country a lot of restaurants have to post whether they passed the health. I want them to have to post A, b, c, d or F, right. And if their maternity unit is an A plus, that's great. Put an A plus on the maternity unit door. If their cardiac surgery unit is an A+, that's great. Put an A-plus on the maternity unit door. If their cardiac surgery is an F put an F on the door to the cardiac surgery unit, right.
Speaker 2:I want that plastered everywhere and I want it available over the internet. So I want to know as a normal consumer does this doctor have medical malpractice lawsuits against them? Do they have sanctions against their license? Are they still board certified, right? I want all of that data in one place where I can go. Is Dr Ben Connor any good, yes or no? And I want it to look at all of those things right. And I want the A doctors reimbursed at 100%, the B doctors reimbursed at 90%, the C doctors reimbursed at 70%, because the way fee-for-service system is rigged the low-quality doctors make more money than the high-quality doctors.
Speaker 2:So, what is the motivation to become an A plus doctor? Because when you do that, you become an A plus doctor. You have fewer services being delivered to that patient, so you get less money. So now you have to do high volume in order to make the same amount of money that a lesser quality physician is making on fewer patients, because he's getting to treat the infections and the readmissions and the complications that you're not treating, because you solved it. Because you got them healthier, quicker and healthier people file fewer claims.
Speaker 3:Yeah, you got one last EO to sign here. What's it say?
Speaker 2:Oh man, I really wish I had five instead of three. My third one be, I get two more.
Speaker 3:Sure, I was just giving you a pass, thinking you might not have more, but it sounds like you've got plenty.
Speaker 2:Yeah, I think that I would get rid of two things. I would get rid of the reception area at every medical facility doctor's office and I would replace it with a kiosk and I would automate eligibility and benefit and coverage information being delivered real-time at point of service. And I would tell hospitals and health systems that you can't turn away someone who is quote unquote not participating. You can't say we only take XYZ health plan patients. If a patient walks in your door, you have to take them, you have to treat them. You have to treat them, figure out the money on the back end right, check their eligibility, check their benefits, but you can't turn somebody away because you don't like the kind of insurance they're on. That, to me, is ridiculous.
Speaker 1:Unencumbering the system of networks and the waste that that is.
Speaker 2:Absolutely, absolutely. If I had a fourth one, I would mandate that everyone who bills for any kind of medical procedure or service has to have a clear breakdown of what the actual cost of delivering that care is down, of what the actual cost of delivering that care is, and that what they charge can be based on two things the cost of care and the quality of care. So if you have a very low cost of care and a very high quality of care, that's great. I want to reward that financially. If you have a very low cost of care and a very low quality of care, I want to eliminate that right. No, no, no, we don't want that right. If you have a low quality and a high cost, we don't want that right.
Speaker 2:So, but the problem is healthcare providers and facilities. They don't even really understand what the actual cost of care is. When I call a facility and I talk about a knee replacement and I have gone to Smith and Nephew's website and I see what the prosthesis is going to cost they don't even know that number, right? I'm like, wait a minute. Why are you charging 30 grand for this when the prosthesis only cost eight grand? What do you mean? It only costs eight grand. Well, I'm sitting here looking at the website and their published price. Is this right? How come I can go to Amazon and find that back brace for $25, but you're wanting to charge 500 for it? I know you're buying it for 25 or less because Amazon isn't losing money when they sell it, right.
Speaker 2:But practitioners have no clue. Hospitals, health systems have no clue what the actual cost of care is and they want to wrap all kinds of fun stuff into their cost of care. Like you know, maintaining the fountain at the entrance and valet parking in the fine art collection and the piano player in the lobby, and all those things are wonderful and lovely and, as a patient, great If you are looking for the four seasons experience. But those are not cost of care. Right, we've kind of lost touch with what is necessary to deliver this care and what does it cost.
Speaker 1:How are insurance companies putting, how are they involved in the mix for, maybe influencing facility, bad behavior or even a drain on the system? Bad behavior or even a drain on the system. What's your take on insurance companies' connectivity to what you just mentioned or, just in general, other problems?
Speaker 2:Well, I think we all know that there's one insurance company that is the largest employer of physicians in the country. Right, we've all seen what happens when insurance companies buy the pharmacy benefit managers or get bought by the pharmacy benefit managers. I think if you, years and years and years ago, watched oh, it was a comedy skit I can't remember the name off the top of my head, but he gets shot with an arrow and he's talking about how much does it cost? And oh, doggone it, it'll come to me. But you almost have to think that they're in a back room somewhere winking and nodding and colluding right, and MLR ratios made that so much worse. So I don't know. I've never worked for an insurance company per se. I've always worked for third party administrators or on my own on behalf of self-funded employers. So I don't have a lot of insight there, but I just know that it's not working.
Speaker 2:The cost of care, and I would think if anybody could do something about it Blue Cross, united, cigna, aetna, to some extent Humana, would have done something about it. If they could, they would have. The only reason they wouldn't have is there is some motivation to not fix it, because if I can fix it and we're fixing it for companies across the country right, hundreds of employers who have found essentially, healthcare nirvana. It takes a while to get there right, it's painful, there's some noise, there's a lot of work to get there, but once you get one of these cutting edge plans in and it's working well, get one of these cutting edge plans in and it's working well, the solution exists. So I can't understand why the carriers haven't embraced the solution. There's something there that we can't see or uncover.
Speaker 1:Yeah, no profit in the cure? I don't think, unfortunately. But a question for you is there's a few books behind you with your picture on it and you've been really outspoken about the ethics of coming alongside someone for good health care and protecting them from danger and you mentioned that even earlier in the podcast protecting them from danger, and you mentioned that even earlier in the podcast.
Speaker 2:You've stepped out in courage and potentially even received a lot of flack for that. Why do you do that? I would want somebody to do it for me. I would want somebody to do it for my spouse, my children, my grandchildren.
Speaker 2:And the bigger problem is there comes a point in time where good enough is not good enough.
Speaker 2:Right and that's probably the biggest criticism that I get personally is constantly striving for perfection, and the noise and the inconvenience and the alarm that goes into calling a timeout right and saying whoa, whoa, whoa, pause. This is not the best care, this is not the best place, this is not the best provider. Some people are much happier burying their head in the sand, but I wouldn't be able to sleep at night if I let one of my patients that I'm working with or that I'm responsible for caring for be harmed by getting something less than the best. Now, if the patient makes a decision and often they do right our success rate in navigation is 84% across our book of business. That means 16% of the time I fail and the patient chooses to go someplace that's lower quality, or chooses to get care or a treatment that is not the A plus, it's the B minus. At that point, okay, the patient made a decision. They have free will and autonomy to do that, but at least I know they did it armed with the information.
Speaker 1:How has that percentage changed over time?
Speaker 2:It's gotten higher, right? The other thing that I will tell you is, as employers have begun to embrace this and have begun to understand it and have begun to offer incentives, that has helped quite a bit. But there are still some employers that we send out every two weeks we send out member-facing promo materials and we can track how often those are opened at the employer level. Like, did HR open them and send them out? Well, if 80% of the time they're not even opening the message it's not getting out to the employees. And then, because they haven't been prepped with these, nurses love you, they're here to help you, they can help in this way and that way and you know they haven't gotten the positive buzz going.
Speaker 2:And let's face it, the only thing that people hate more than insurance companies are cable companies, right? So if their insurance company is calling them saying let me help you, it's kind of like, you know, a Native American skepticism about the government coming to help, right, that doesn't go together. So there's a lot of work that has to go into preparing employers and the employees in these kinds of plans. They have to understand the motivation behind it. But if you went out today and surveyed your employees and said how many of you have heard a healthcare horror story? How many of you have been the victim of a healthcare horror story you or your family? You would be amazed at the hands that go up when you ask those questions and would you like a resource to help do something about that, to prevent that.
Speaker 2:Everybody in concept thinks that it's good when they're in the throes of a medical situation and they're emotional and they're upset and they're scared and they believe that time is of the essence. Calling a time out in the middle of that can be disconcerting and the only thing we can do is approach that empathetically and to feel confident that, listen, we have a responsibility to do this and to kind of protect you from the things that you don't even know you need protected from.
Speaker 3:A lot of people will say when a friend or family has a sickness, they'll say, well, you need a patient advocate, you need someone to go to the doctor with you, which is 100% true. But, as you and I know, there are some of our friends that would be better than others in that room. Some are just note-taking and they're not pushing, they're not asking clarifying questions, because when you're that sick person, you might be still on medication and not thinking clearly. You just don't feel well, you don't feel like asking questions, you just want to get better. What I think about what AIM does is you are that patient advocate. While you may not literally be the physical person in the room, you're probably better because you have more knowledge, more expertise. You know where to go to get the answers.
Speaker 3:I've seen you in action in a couple different settings One, of course, in the movie and then just as a client. We've worked with your team and whenever I think about you, the phrase righteous indignation comes to mind, and I mean that in the most positive way. And I feel like when you approach these things, you do have this righteous indignation that you want to fix it, you want to make it right. So a personal question for you Where's that come from? Was that mom or was that dad?
Speaker 2:Oh boy, probably a good combination of the two. It's interesting that you call it righteous indignation, because after my small group from Bible study saw the documentary, the first thing my pastor said to me was the documentary.
Speaker 3:The first thing my pastor said to me, was you cussed on a national television? I was mad.
Speaker 2:Yes, yes, I did. It wasn't my best moment, but I was really upset about it. And you know, just for clarity, that patient was in his 30s. He had lost his wife to COVID. He had been ignoring a massive were supposed to be caring for him and taking care of him and helping him and prolonging his life, wanted to leave his two children as bankrupt orphans, cause that's the path that whole scenario was heading down.
Speaker 2:Right now you tell me anybody who has any kind of wherewithal at all who would not be indignant about that and upset by it. Everybody but it happens every day, every day in our US healthcare system, those scenarios play out.
Speaker 3:Well, my encouragement to you is I know you are teaching your team the mechanics of how to work through the system, but if you can also impart on them just a little bit of that righteous thing, the indignation, we might actually have a fighting chance.
Speaker 2:There you go. That's the part that AI will never be able to capture.
Speaker 1:That's right. That's been a significant highs of highs. But also family business can be difficult. But since we're kind of at the end of our time, we'd like to ask our guests two questions. The first question is what is a risk that you have taken that has changed your life?
Speaker 2:Besides cussing on national documentary I think you know starting the business, all those things that we've been talking about but really, every day, we take risk for our patients. We know that a customer can fire us, an employer can fire us at any point in time.
Speaker 3:So, being committed to our moral compass, Committed to our moral compass, regardless of the risk that it might have, regardless of the money that we might lose by staying committed to. That is probably the biggest risk that I continue to take every day, and the second and final question what's unfinished?
Speaker 2:that you have the resolve to complete. That you have the resolve to complete. We definitely need a whole nother session, because AI and healthcare and getting into the hands of the patient the information about what the best care is, who the best providers for that care are, and reversing the mindset of how people purchase healthcare, especially in the fee-for-service system, and getting them to understand that higher quality is cheaper that is something that I really, really want to resolve.
Speaker 1:It's awesome. A lot of work to still be done, that is for sure. Nurse Deb famously Nurse Deb thanks for joining us today and thank you all for listening. Have a good one.
Speaker 3:Thanks for tuning in to Risk and Resolve. See you next time.
