Mark Gaunya – Where is Health Care Headed

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Mark Gaunya Biography

BIO: Mark is a principal at Borislow Insurance (BI) and the Founder of Captivated Health located in Boston Massachusetts.  BI is highly regarded as a leading regional employee benefits brokerage and strategic advisory firm serving employers and individuals.  Captivated Health is an innovative solution designed to help middle market employers “Bend the Healthcare Trend” by joining a community of like-minded organizations who change the way they finance their health benefits to take control of their future through insightful, actionable data to make healthcare easier and more affordable for employees and their families.

 

Mark is an employee benefits advisor with over three decades of experience and a tireless, passionate advocate for transparency, consumerism, health and well-being.  He is a pioneer in the use of Consumer-Driven Health and Wellness Plans (CDHP) to lower healthcare costs and improve overall health.  He was named as a national Top 30 Benefits Advisor to Watch in 2017 by Employee Benefit News and Employee Benefit Adviser and was awarded Most Innovative Broker of the Year in 2014.  Mark is a Member of the Board of Directors for the Massachusetts Health Connector and a member of the Board of Trustees as the Legislative Council Chair (NAHU).  He earned his GBA from Wharton and is certified in the ACA and Self-funding by NAHU.

 

Mark is a graduate of the University of Rhode Island and he resides in Hopkinton, MA.

 

Email: mark@borislow.com or mark@captivatedhealth.com

 

Transcript of Mark Gaunya interview by Alan Olsen, Host of the American Dreams Show (Mark Gaunya – Where is Health Care Headed?):

Alan Olsen: Hi, this is Alan Olsen and welcome to American Dreams. My guest today is Mark Gaunya. Welcome to today’s show, Mark.

 

Mark Gaunya: Thank you, Alan, I appreciate being a guest on your show.

 

Alan Olsen: So Mark, for the listeners, can you give us your background of how you got to where you are today?

 

Mark Gaunya: Sure, I am the product of a mother and a father who were healthcare entrepreneurs. But they were clinicians. So my dad was a orthopedic sports medicine physical therapist, and my mom was a cardiac rehabilitation nurse. But they were not your traditional clinicians. In other words, not working in big hospital system. That’s where they started, but then ultimately went out and created their own outpatient physical therapy management business, starting from the ground up. And when I got out of school, I had a chance to go work for them. And so I started out in the accounting and finance function, learn how to actually run a provider, practice a clinical practice, not run it from the clinical perspective, but from a business perspective. And you can imagine almost every conversation I’ve ever had with my mom and dad around the dinner table, were about their business, and I wasn’t scientifically inclined. But I was mathematically in business inclined, and I liked the business of healthcare. So like I said, I went to work for them. I helped them actually retire, they sold their company, after about five years of working with them. And then I went to go work for a number of insurance carriers. Names, you’d be familiar with Blue Cross Blue Shield, Cigna Health Care, and Tufts health plan out here in the northeast, in the Boston area, I actually went and worked for a Consumer Driven Health Insurance Company startup, it was a company based out of Johannesburg, South Africa, they’re actually the founders. Most people don’t know this, but they’re the founders of what we now call health savings accounts. Managed Care didn’t work in the country of South Africa, but that the consumerism definitely did work. So I actually helped start a insurance company that was a fun ride. And then when I landed here in Boston, through a combination of a joint venture of the company I was working for for called Destiny health and Tufts health plan here in Boston, I met my now business partner, Jennifer Borislow, I don’t know if you’ve had a chance to meet her. But if not, you will, she’s recently joined the free zone. So Jennifer had founded an insurance agency 20 years before she and I became the best of friends. She tried very hard for three years to get me to leave the corporate structure and join her in the entrepreneurial world, which I really wanted to go back to Alan, because that’s where my roots were, I really wasn’t a corporate guy might last for a couple of years in a place then just have to move on. Because people don’t think like we do. So make a long story even longer, Jennifer and I became business partners in 2005. And for the last 18 years, we’ve almost 10 times the size of our our insurance and brokerage consulting firm called borislow insurance. And then about seven, almost eight years ago, I founded a program called “Captivated Health”, which gives middle market employers know most people may not know this, your listeners might not but roughly 180 million Americans get their insurance from their employer. And a big segment of that about 50 million people are in that employer market about 50 to 500 employees, they typically are overcharged for the health insurance that they buy in the marketplace. So we did is we help them create their own insurance company. And then in years in which they have good years, or when they educate their employees, they actually spend less money and everybody gets higher, higher health care quality, at a lower price point enables them to save for future years of, of healthcare expenses. So that’s the shortest way I can tell you my story about how I got to where I am. I’m not a traditional insurance broker. That’s what everybody you know, you have a broker box in your head. That’s where you put me, because that’s how I’m paid for what I do. But I really have a 360 degree of healthcare that gives me a unique perspective on how we can really make it better and more affordable for people.

 

Alan Olsen: So the healthcare industry as a whole has been transforming and where you started versus where it is today is much different. Where do you see things going?

 

Mark Gaunya: So the future of healthcare, I believe will aid already is being digitized. But to the extent that, you know, we can do more of that there is going to be more of that if you look at telehealth as an example, pre-pandemic, it was in the single digits relative to take up percentages across the industry. And now it’s hovering around the mid to high maybe even low 50s, mid to high 40s, low 50s In terms of engagement rate, so where people don’t actually even have to go to a physician’s office to get the care and many cases that they need. They can just do that. something remotely online, I see the advent of technology actually changing the way we treat, we moved from sick care, to health care, we’re actually can prevent things from happening in the future. And frankly, I think they’ll always be a place for insurance, but not the way it’s been designed today, where it’s almost like prepaid healthcare, as opposed to really doing something about the way in which we all feel from a health perspective, to reduce the need for health care services, and to prevent things that are otherwise preventable. Now, how long is it going to take us to get there, it’s hard for me to say that, but technology is going to continue to be an integral part of how we’re going to improve the quality of peep of health care people are getting. And now because of the transparency law from the last administration, that’s now coming into effect, you and I are actually going to have access to quality and price information to make informed choices. So I also think that’s a game changer. Because once we see it, we can measure it. And once we measure it, we can improve it. And once we have technologists apply technology, to the to all that data to make it actionable information, I think we actually have the beginnings of a true consumer market, where people will be able to get the things that they need for their health care for their family.

 

Alan Olsen: As the baby boomers retire from the workforce for losing the funding vehicle, the Medicare. In fact most recent tax act had a good portion of percentage of the funds in the act going to fund Medicare, what do you see as the future of that? And and for those people who have been paying all their life? Should they expect it to be there when they need it?

 

Mark Gaunya: For Medicare? I think the short answer to that is they have to depend on it. How we ultimately pay for it, I think has to change. And what I what do I mean by that. If you look at Medicare reimbursement as a clinician, it is the lowest reimbursement level that that that a provider can take for the care that they receive, on average, Medicare pays about 60 cents for $1 of health care. And in turn, the private market this fully the market that I talked about before the 100 and 80 million people, they are paying higher rates of reimbursement without even knowing it because they’re privately insured. And, you know, in many cases, providers are getting five and 10 times the amount that Medicare pays for the exact same procedure. So that’s a cost shift Alan. It’s a cost shift that benefits Medicare. But the reality is to your point, as more baby boomers continue to retire, there’s going to be less and less people on the private insurance ranks. And as they continue that is the federal government continues to provide subsidies, they get more people off of private insurance and into government insurance. People might think that’s a good thing. But at the end of the day, I don’t know any top 10 percenter that is a clinician that’s going to accept Medicare as a form of reimbursement for the services they provide. In fact, the top 10 or 10 percenters will not. So what does that mean? That means that there’s going to be a bigger gap between those who have, and those who don’t, and those who have access to the best and those who can’t simply afford it, because the best are not going to be reimbursed at the level that Medicare can pay. So I see Medicare continuing to ratchet down when it pays providers because it has to in order to financially sustain, I don’t think the government can feed it enough to pay providers what they believe they’re worth. And so to the extent we can use this transparency law to actually create competition, so that we have like every other industry, we can measure quality and price and we see quality go up in price come down. But the problem is, and this is probably the context, I should have given you the front end of the answer. When you look at how the healthcare system was designed, it was designed and governed by for rulemaking entities like structures to the federal government, which is an insurance half the people in our country. You’ve got big hospital systems and name any major major metropolitan area. You know, if you look at Boston, its partners used to be called Partners. You look at Chicago, it’s Evanston, Northwestern, you look at DC is the ANOVA healthcare system. I could go around the country and list out to you huge hospital systems that control 60% In most markets, or the supply of health care. Okay, I could also look at the the employment rates in that particular metropolitan area and you know who the top employers are? Hospital systems. Okay. So if you’re a politician, you’re a governor of a state. Are you going to really squeeze on the provider community? Probably not, but When I look at the rate of inflation that they put through in their contracts that you and I are ultimately paying in the form of premiums. It’s not sustainable. So you got hospitals, government hospital systems, he’s the third entity. You got prescription benefit companies PBMs. Right. And then ultimately, you have a combination of those factors coming together. Right? The government, you have health insurers, you have prescription drug companies and the health insurers, the four of them created this construct you and I live in, called healthcare. And I don’t believe that people inside those constructs are evil or ill intentioned. But I believe this system because the way it’s been designed, which is to prevent you and I from understanding, what’s the quality of the care I’m receiving before I buy it? And then what’s the price I’m paying for the care I’m receiving? Do you know that health care is the only thing as Americans we buy today that we tolerate not having access to quality and price before we make a buying decision? And it’s the most important thing.

 

Alan Olsen: So Mark, there’s quite a bit going on in this in this whole field and what I, what I feel we need to do is get your expertise directly to a one on one meeting with with the listeners, how would they go about contacting you for more information.

 

Mark Gaunya: So they could email me at Mark@Borislow.com or can even text me on my cell phone. I put that out there for anybody. Alan, it’s 978-302-8642 again, 978-302-8642.

 

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GROCO Staff Writer