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Aww Shift

Jan 21, 2022

Welcome back to the Aww Shift Podcast! Today, our guest is Mark Gaunya, the Founding Principal and CEO of Captivated Health. Benefits Pro recognizes him as a Top 5 Broker of the Year Finalist, Benefits Adviser nationally, and one of the top 30 Thought Leaders. Mark developed innovative solutions to complex challenges to save clients time and money. He's passionate about consumerism, health & well-being, and its exponentially positive cultural and financial impact on businesses and organizations. Mark is also the Principal of Borislow Insurance, which serves clients who invest $1m+ in their employee benefits program by developing innovative solutions to complex challenges, saving time and money. Today, Mark talks with us about the healthcare system issues that consumers face today.

[9:21] Why should I listen to you?

The first thing you'll notice is that I'll be paying attention to you because I'm naturally curious about other people and their stories. I'm curious about what makes people tick, what motivates them, what they care about, and what they are passionate about. We'll have a great conversation if we can discover areas of commonality. 

[9:55] What do you do better than other people?

I take complicated stuff and make it simple for people to understand.

[10:37] How can you bring the conversation of healthcare understandable to the ninth-grade level?

Like anything in life, you’ll first have to understand the language. If you are having a conversation while translating one word at a time, it’s nearly impossible to do. That is exactly what nine out of ten individuals in our country are doing with healthcare right now. It was purposefully designed to be overly complicated.

[12:14] If you look at the big rule makers; the government, health insurers, regulatory bodies, they’ve developed this system through an opaque process called “Coding” and “Billing.” A code is created and sent to an insurance company. The produced code or negotiated price is then discussed between the healthcare provider and the health insurance. 

[13:13] How did healthcare become what it is today? 

There’s a lot of money in healthcare. Looking at healthcare as an industry sector, it’s three and a half to four trillion dollars of our economy. In most areas in the country, healthcare is the largest employer.

[13:56] I know many people in all these areas, and they are all great people. But they are in a construct that doesn’t put you and me at the center of it. It puts the people who are making the rules at the center of it. Fortunately, there was a law that was passed. Healthcare is now pricing quality transparency. But the challenging news is how we implement that. The first step is, if you can’t see it, you can’t measure it. If you can’t measure it, you can’t improve it. As a healthcare consumer, the first thing you need to understand is the inverse correlation between price and quality.

[16:47] How money is affecting the Healthcare System 

Most individuals are unaware that many of our chronic pharmaceuticals are manufactured in tier one English-speaking countries like Canada, Ireland, the United Kingdom, Australia, South Africa, and New Zealand. By the time they get here, they're seven to eight times more expensive than they should be.

[17:19] An annual supply costs $17,000 in countries where medicine is manufactured. However, when it arrives through the FDA and drugstore chains in the United States, the same medicine costs $69,000 due to the layered fees throughout the system. The costs that consumers do not perceive are added on top of the profit margins.  Financially, you are ultimately assessed by the performance of whatever service you provide, but you are not measured on the value you provide.

[18:48] How does your company help? 

We work directly with employers who sponsor health insurance for their employees. When you look at this country, about 180 million people get their insurance from their employers. We focus on a particular area of the market with between 50 and 500 employees. Those employees or employers typically buy a “fully-insured plan” from a national carrier. They charge their employees a premium that they share for the plan they’re offering. We do something similar, except that it’s not fully insured called “Partial Self-Insurance.” The employer exits the blind market in which they have no idea what is going on with getting charged. They go into an environment where they are willing to accept the risk of covering their people's healthcare costs. They find themselves in a position where they can act as their own insurance business. What we do is act as their intelligence chip on the inside, operating that for them.

[22:23] How did this become something you’re passionate about? 

I started to tackle the problem of our healthcare system because of my mother, who was a nurse, and my father, who was an Orthopedic Sports Medicine Physical Therapist. They taught me the business of healthcare. They weren't only medical professionals. They were also business owners that were incredibly creative. They were entrepreneurial in the sense that they just believed that healthcare could be delivered more effectively. I went to work for my mom and dad when I got to school. I went to their work for a bunch of insurance companies. For the last 17 years, I’ve been on the consulting brokerage side of the business and representing employers and consumers.


Key Quotes 

[15:37 – 15:44] “When you provide information and transparency of information, there are a lot of things we see that people don’t want us to see necessarily.”

[17:50 – 18:00] “You are ultimately measured by the performance of whatever service you’re providing. But you’re not being measured on the value you’re providing relative to the price you’re providing.” 

[21:38 – 21:46] “The right call doesn’t necessarily mean the least expensive. The right call means the highest quality care you can receive at the lowest possible price point.”


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