Self-Funded w/ Spencer - Mike Kohl - Episode 36

This video provides an in-depth exploration of "next generation wellness" and "whole person healthcare" within the context of employer-sponsored health plans. Featuring Mike Kohl, VP of Sales for Vida Health, the discussion, hosted by Spencer, delves into the evolution of wellness programs and the critical need for integrated mental and physical health support to address chronic conditions and rising healthcare costs. Kohl, drawing from his 30 years of experience in the insurance industry, offers a seasoned perspective on the complexities of self-funding and the strategic shift towards more effective member engagement strategies.

A central theme of the conversation is Vida Health's "whole health perspective," which posits that physical chronic conditions, such as diabetes, are frequently intertwined with mental health issues like stress, anxiety, and depression in approximately 70% of cases. Kohl emphasizes that merely treating the physical aspect provides only "half a solution," as true and sustainable health improvement necessitates addressing the underlying behavioral and emotional drivers. This integrated approach aims to guide individuals from an unhealthy to a healthy lifestyle by tackling the root causes of their health challenges, rather than just managing symptoms.

Vida Health's methodology involves an app-based enrollment process where members undergo initial assessments using PHQ and GAD scores to establish a baseline for stress and depression levels. Following this, members are empowered to choose a personalized coach from a diverse pool, including health coaches, psychologists, pharmacists, or licensed clinical managers, and then engage in a structured cognitive behavioral therapy pathway. A crucial aspect of their strategy is "meeting the member where they are," offering flexible communication channels such as text and asynchronous discussions to overcome initial resistance and cater to individual preferences and schedules. The company also strategically leverages claims data and advanced analytics to proactively identify and outreach to high-priority members, ensuring timely and targeted interventions.

The discussion highlights the significant impact of this integrated approach, with Vida Health reporting substantial "15 or 16 claim savings" for employers by effectively managing both mental and physical health. A critical societal problem addressed is the severe shortage of mental health providers in the United States, with only about 27% capacity available, leading to lengthy wait times for care. Vida Health aims to bridge this accessibility gap by providing immediate access to support, often within 24 hours, thereby diminishing the timeframe for individuals to receive necessary care and achieve a better overall health state.

Key Takeaways:

• Evolution of Wellness Programs: Traditional wellness initiatives, such as providing pedometers or promoting healthy eating with superficial incentives, often lacked the deep member engagement required for long-term effectiveness, necessitating a shift towards more integrated and data-driven approaches.
• Interconnectedness of Health: Effective health management must recognize and treat the profound interconnectedness of physical and mental well-being; chronic physical conditions are frequently co-morbid with mental health issues, with approximately 70% of individuals with diabetes also experiencing related mental health challenges.
• Addressing Underlying Behavioral Drivers: Sustainable health improvement goes beyond symptom management, requiring a deeper understanding and intervention into the behavioral, emotional, and psychological factors that drive unhealthy choices and contribute to chronic conditions.
• Personalized Coaching and CBT: Tailoring support through member-chosen coaches (e.g., health coaches, psychologists) and structured cognitive behavioral therapy (CBT) pathways significantly enhances member engagement, adherence to treatment plans, and overall health outcomes.
• Flexible Engagement Models for Participation: Overcoming member resistance and increasing participation rates in wellness programs demands meeting individuals "where they are" through flexible communication channels like text and app-based interactions, allowing for asynchronous discussions and engagement at their own pace.
• Data-Driven Member Identification: Utilizing claims data and advanced analytics is crucial for proactively identifying high-priority members who would benefit most from early intervention, enabling targeted marketing and engagement strategies to optimize resource allocation.
• Immediacy of Mental Health Care: The severe shortage of mental health providers in the US (only 27% capacity) underscores the critical need for virtual solutions that offer immediate access to care, reducing prohibitive wait times and providing support during crucial emotional moments.
• Significant Financial Impact: An integrated approach to mental and physical health can lead to substantial cost savings for employer-sponsored health plans, with reported figures indicating "15 or 16 claim savings" by improving overall member health and reducing high-cost claims.
• Complexity of Self-Funded Plans: Self-funded health plans, while offering significant control and flexibility to employers, are inherently complex and require deep expertise from consultants and brokers to navigate effectively and maximize their financial and operational benefits.
• Importance of Continuous Professional Education: The dynamic healthcare and insurance industries necessitate continuous education and professional designations (like CEBS or CSFS) to maintain credibility, expand specialized knowledge, and differentiate expertise in a rapidly evolving landscape.
• Lifestyle as a Foundation for Health: Personal choices regarding exercise, diet, and stress management form the foundational elements of physical and emotional well-being, highlighting the importance of fostering healthier lifestyles to prevent the onset and progression of chronic diseases.
• Technology as a Healthcare Enabler: Technology, through app-based platforms and specialized "point solutions," is revolutionizing healthcare delivery by enabling personalized, accessible, and data-driven approaches to wellness and chronic disease management.

Key Concepts:

• Whole Person Healthcare: An integrated approach to health that recognizes and treats the interconnectedness of an individual's physical and mental well-being, addressing both simultaneously for comprehensive improvement.
• Cognitive Behavioral Therapy (CBT): A common type of talk therapy that helps people identify and change destructive or disturbing thought patterns that have a negative influence on behavior and emotions.
• PHQ (Patient Health Questionnaire) & GAD (Generalized Anxiety Disorder) Scores: Standardized screening tools used to assess the severity of depression (PHQ) and anxiety (GAD) symptoms, providing a baseline for mental health status.
• Self-Funded Health Plan: An employer-sponsored health plan where the employer directly pays for employees' medical claims rather than paying a fixed premium to an insurance carrier. This offers greater control and potential cost savings but also higher risk.
• Point Solutions: Specialized, often technology-driven, healthcare services or products designed to address a specific health condition or need (e.g., a diabetes management app, a mental health coaching platform).

Examples/Case Studies:

• Vida Health's Origin Story: The company was founded by Stephanie Telenius, whose personal struggle navigating the complex healthcare system for her father's chronic physical and mental conditions highlighted the critical need for a more integrated and user-friendly approach to care.
• Diabetes and Mental Health Co-morbidity: The statistic that approximately 70% of individuals with diabetes also experience co-occurring mental health issues (stress, anxiety, depression) serves as a compelling example of why a whole-person approach is essential for effective chronic disease management.
• Mental Health Provider Accessibility Crisis: The alarming statistic that only about 27% of the US population can access reasonable care from a psychologist, leading to significant wait times (e.g., 30 days), illustrates the critical accessibility challenge that virtual health solutions like Vida Health aim to solve by providing immediate support.