Dr. Gleb Tsipursky – The Office Whisperer
Nirit Cohen – WorkFutures
Angela Howard – Culture Expert
Drew Jones – Design & Innovation
Jonathan Price – CRE & Flex Expert
About This Episode
In this episode of The Future of Work® Podcast, we welcome expert Robert E. Andrews, CEO of the Health Transformation Alliance (HTA), former U.S. Congressman, and co-author of the Affordable Care Act. Robert shares hard-won insights from his leadership of a coalition of 70+ major corporations with over $40 billion in healthcare spend. Together with host Frank Cottle, they tackle why employer-sponsored healthcare must evolve to support distributed teams, how to balance cost containment with personalization, and why empathy, listening, and trust are essential for retention in today’s workplace. From AI-assisted diagnosis to mental health gaps, this conversation unpacks bold strategies to fix healthcare and future-proof your workforce.
Guest Bio
Robert E. Andrews is the CEO of the Health Transformation Alliance, a coalition of 70+ major U.S. corporations committed to transforming the healthcare system. An original co-author of the Affordable Care Act and a former member of Congress, Andrews oversees strategic initiatives that impact more than 4 million employees and $40 billion in annual healthcare spending. He leads the HTA in designing data-driven, cost-effective, and human-centered solutions for better patient outcomes, mental health access, and AI-enabled care.
What You’ll Learn
- Why “one-size-fits-all” healthcare fails in a distributed workforce
- How listening to employees drives retention and cost savings
- Where AI can empower (or endanger) patient care in your company
- What employers can do about the loneliness and obesity epidemics
- The radical metric that could define ROI in employer healthcare
Transcript
Robert E. Andrews [00:00:00] And something I talked about leading up to our time today, Frank, is that it costs about twice as much to replace someone as it does to keep them. So if you have a sales team leader that’s making $150,000 or a call center employees making $35,000, if they leave, you probably have to spend twice that amount to replace them, meaning you have to fill their gap for a while. You may have to pay overtime to other people who are doing their work. You have to spend the money on recruiting their replacement and training their replacement.
Frank Cottle [00:00:34] Thank you for joining us on the Future of Work podcast today. We’re really excited to have you. And gosh, what an amazing background you have. I won’t go through it right now, but I feel blessed to have here to share your knowledge and your information with us. So thank you for joing us.
Robert E. Andrews [00:00:51] Frank, it’s an honor, our culture kind of lacks thoughtful discussion. There’s a lot of knee-jerk reactions in our culture. I know what you do is the opposite of that, so I feel really privileged to be here.
Frank Cottle [00:01:04] Well thank you very much, you know. We’re talking about health care and we’re talking about benefits and the workplace and the future of work. You know, getting right into it as work becomes more digital and more distributed, more remote, how is employer-sponsored health care evolve? How should that evolve? Everybody’s not in the same building with the same thing. Censuses are harder to manage because of multiple states, things of that nature. That’s just a U.S. Problem, I know, but what are the impacts and changes in health care on a distributed workforce?
Robert E. Andrews [00:01:46] The impact is a positive one if you listen to the people you work with. It’s a risk and a negative one if you don’t.
Frank Cottle [00:01:54] And how, what would that mean listing?
Robert E. Andrews [00:01:56] People. Yeah, the phrase one size fits all is almost never true. It is never true with distributed workforce. So a person who lives in an urban neighborhood in New York has very different health needs and challenges than a person in a rural village in Iowa. So if you’re planning your primary care solution, you want to be sure that The maximum number of people can have access to a really good primary care doctor. You would do something very different in the east side of Manhattan, the upper east side, than you would be in that rural village in Iowa. But do corporations do that? Do they actually do that, because I’ve not seen that. Not enough. Yeah, not enough. I think the mistake that is being commonly made is, well, we have one health plan, it has one set of benefits, and everybody takes it. I think that’s an unwise approach. And the leading thinkers that we encounter in health benefits are thinking about tailoring and customizing their plan to help that person on the Upper East Side as well as her colleague in Iowa.
Frank Cottle [00:03:03] Well, you know, I’ve got a CFO in my company, and when we review our particular health care plan, and it covers about 125 people, maybe not including family elements, his first reaction is, wow, health care went up this year. How do we keep our health care costs in check? So can you keep health care cost in check. And still do effectively what you’re suggesting if you’re a midsize company.
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Robert E. Andrews [00:03:36] You can, and I think the goals are complementary. Health care costs go up when people get sick. True. People are less likely to get sick if you think about the ways you can keep them well. And back to my example that, you know, offering a essentially an easy pass to every primary care provider in Manhattan would probably works for the person. On the Upper East Side, because there’s a lot of great primary care practices that she could walk to. For her colleague in rural Iowa, that doesn’t work. You probably have to spend more time thinking about, well, are there primary care providers near her village? And if so, how do you get them there? Maybe she needs a greater emphasis on virtual care, because leaving the house and finding a doctor is harder to do. So I would argue that The best way to control costs is exactly to customize and think about the specifics of a healthcare plan and how it affects people.
Frank Cottle [00:04:38] The in the offerings that are made to us, we don’t get a lot of we are not offered a lot of those choices upfront. We if we were more knowledgeable, we might require them or demand them if we are more knowledgeable larger had more weight in our are against our providers. But we aren’t offered those choices generally. How does a company such as my size, your size, you know, a nice medium size organization. How do we really get providers to to listen to that and to do something of that?
Robert E. Andrews [00:05:18] There’s two ways, two steps you need to take. The first, again, is listen to your employees and what they need. Really important to do that. It also establishes a culture that you’re the kind of place where people want to work. Correct. People want to be listened to and valued. Once you’ve done that listening, employers have a lot of cloud in the marketplace with carriers, with hospital systems, with pharmacy benefit managers. They don’t always use it very adroitly. So to say to a UnitedHealthcare, you know, we want you to give us something different than you give the rest of the market sounds hard, and it is. But you’d be surprised at how responsible, responsive they will be, if they realize they might lose your business. And so an employer who’s a good shopper, an employer who’s good negotiator and can say to United or to Aetna. Yeah, we have employees on the Upper East Side and in rural Iowa. What are you willing to do to build networks that make you meaningful and valuable to both of those employees? If they’re not willing to that, there’s a lot of other places to go. There’s a lots of other ways you can spend your money. It’s like everything else. I think it’s a matter, I think about going to the grocery store, which I still do. We don’t have our groceries delivered. My wife and I talk about what we want, then we go find it. And if we don’t find what we’re looking for in the grocery store, we either do order from somewhere else or maybe switch grocery stores. Now, healthcare is a lot more complicated than your weekly grocery order, but the process isn’t. Listen, think, choose, and negotiate.
Frank Cottle [00:07:05] I think one of the issues there probably, and I’ll use, again, my company as an example, I’ve got a CFO with one set of demands, an HR department trying to listen to employees that are well distributed with another set of demand, and so the first place I need to make a correction is between those two parties, as opposed to in order to successfully accomplish what you’re suggesting.
Robert E. Andrews [00:07:34] You’re not always going to get the CFO and the HR lead to agree, but there is common ground between the two when you can make the case, which I think is credible, that a more tailored and valuable health plan is good for the P&O.
Frank Cottle [00:07:52] I agree completely.
Robert E. Andrews [00:07:53] One size fits all. You have to do this health plan. It’s bad. Here’s why. And it’s something you and I talked about leading up to our time today, Frank, is that it costs about twice as much to replace someone as it does to keep them. So if you have a sales team leader that’s making $150,000 or a call center employee who’s making 35,000 dollars, If they leave, you probably have to spend twice that amount. To replace them, meaning you have to fill their gap for a while. You may have to pay overtime to other people who are doing their work. You have to spend the money on recruiting their replacement and training their replacement. So, from the point of view of the CFO, if people feel fulfilled and happy at work, there’s more likely that they’re going to stay, they’re gonna be more productive, and then cost less to replace because they’re not leaving. And so I really do believe that that’s the common ground.
Frank Cottle [00:08:51] Yeah, I agree with you. I wish more CFOs saw it that way, but we work with a variety of large human resources companies as clients. And the data that they provide to us that we see certainly supports what you’re suggesting. And we understand it. CFOs are always saying cashflow, cashflow cashflow and so
Robert E. Andrews [00:09:21] And the answer would be, well, the cash flow we don’t have to put out to advertise, recruit, interview, retain a new person. We don’t put that money out. What we do is maybe we spend a bit more to diversify our primary care program, but you spend a dollar to diversified primary care, you get $5 back in retaining people.
Frank Cottle [00:09:46] People fully understanding those metrics, and then creating the program that actually delivers that value.
Robert E. Andrews [00:09:53] That’s smart.
Frank Cottle [00:09:54] Well, that’s hard.
Robert E. Andrews [00:09:56] That’s what we do at the HTA that we’re trying to do is we’re about 80 companies now, large and small. Our smallest has 4,000 lives, our largest has 300,000 lines. The company, our own company has 24 employees and probably 50 lives. So we understand the spectrum. But at the end of the day, every effective problem solving technique I’ve seen has in common. Listening to who your customer is, what they want, in this case, your employee is and what they want, and then figuring out how to do it. And, you know, your work and your firm, that’s what you’re all about, is being effective listeners. And that’s, what we try to be. Well, you
Frank Cottle [00:10:40] It’s funny as we talk about distributed work, I think we need to bring up mental health. The distributed work has brought its own, has highlighted I should say, a variety of issues, and I’m a lone wolf so I don’t identify with this necessarily, but the concept of the loneliness epidemic and how distributed work is impacting that and how that impacts mental health and health. Mental health really isn’t well addressed by an awful lot of the health care management systems that are out there today. What’s your view on how to correct and how to adjust that or some some ideas that that we can share?
Robert E. Andrews [00:11:28] What we’ve learned from our member companies is this. In cases where people have distributed or virtual work, you have to replace what I’ll call the office walk-by with another mode of communication. So someone’s working in the same office. And you notice that Mary, I don’t know, maybe has put on a lot of weight, that she’s not as talkative as she used to be. She looks worried. She used to go out to lunch with the other co-workers, but doesn’t anymore. Yeah, that’s a sign that you might drop by and say, how are you doing, Mary? What’s going on? We’re all in the same pit. Yeah, you just notice that she’s… So the first thing is, is Mary in a place where maybe she’s struggling with something? If Mary’s at the other end of a laptop, and you’re in New York and Iowa, you’re probably not going to figure that out. So the first challenge is to create ways that employees can communicate among each other and with their management that are not official, are not interrogations, are comfortable for people, so you can begin to notice those things. So some of our members have created almost like a buddy system where periodically employee number one checks in with employee number two, not for some grave agenda, but. Hey, I know your son plays baseball. How’s he doing this season? Did I tell you that my daughter’s getting married and we’re, in other words, have that sort of encouraged peer communication about life itself. And you can start to pick up some patterns if something’s changing for the worse. It’s kind of awkward, it’s a little artificial, but it’s really necessary that you don’t let someone float out there in the ether with a problem you don t see. So that’s point one. Point two is once you find out there’s a problem, you have to have the resources to address it. Most of our member companies have EAPs. And EAPs, I found to have employee assistance programs that there’s a spectrum of effectiveness. Some are really gifted and good, some not so much. But having one where someone who has a competence I do not have, which is that if I found out that one of my coworkers seemed troubled and distracted, I wouldn’t really know what to do. But people in an EAP program do. Yeah. On top of that, you then have to have resources for someone who needs help from a psychiatrist, a psychologist, a counselor. There is a crisis in this country of wait times. People have to wait three months, four months to get seen, and that’s intolerable. What we’ve done for our members is struck an agreement with a behavioral health provider. Where people can be seen within four or five days virtually, if need be, instead of four or five weeks. And the employer pays for that on a per case basis. Our employers are allergic to, you got to pay a lump sum for everybody, whether they use the service or not. They don’t like that. So again, it’s a broken record here. By the way, that phrase is quaint, Isn’t it? You and I understand what records were and what they saw that had broken. And when they actually broke. My daughters who are 30 and 32 would not understand. So to be redundant here, I’ll put it that way, listen and problem solve.
Frank Cottle [00:15:05] Well, you know, I think that certainly good advice and good counsel and like all these things always easier said than done. We actually have in our internal something we encourage and I’ve had video conferencing in my company since 1984, maybe three.
Robert E. Andrews [00:15:28] You’re applying your frame.
Frank Cottle [00:15:29] Pioneers and all that. You know what they say about pioneers, they get stuck full of arrows. So we’ve suffered with all sorts of oddities in the growth of our business model overall. But one of the things that we’ve gotten used to and we encourage and actually discuss this is we break meetings and agendas for meetings really into three parts. The first word of the meeting personal. How’s the dog? We have a saying that we picked up somewhere. It’s not original. You don’t know your colleague or your member or your customer well enough unless you know the name of their dog. So how’s your dog? What’s going on? Hey, how’s the family? What are the kids doing? We talk about personal things for the first third of a meeting. And then we talk about our industry for the next third of a meaning. Now, the actual things we need to… Decide on decision-making issues or reporting issues. I think we contain that within the last third of the meeting And that sounds like how do you get the stuff done? Well by doing the first two we’re so aligned by the time we get to the third one
Robert E. Andrews [00:16:43] things just happen naturally. I think that’s terrific and practical advice. We do something like that, we probably could do better. And that’s good advice. Because by the way, the answer to the question, how do you get stuff done? First of all, you build trust. Absolutely. Understanding and empathy and all that. Second, you create situational awareness. We’re not the only company selling widgets? How are the other company, widget companies? And then third, you’re right. The solutions to the business problems and challenges kind of flow naturally when you trust the person you’re working with and you’re both situationally aware. You should probably do this for a living, Frank. That’s a good idea.
Frank Cottle [00:17:23] Well, I do, you know, but but we have found that that thirds works out really, really well. And it works equally well with clients. I mean, this has nothing to this is just remote relationship development. You can do the same thing when you’re face to face. It doesn’t quite take as it’s not as as challenging.
Robert E. Andrews [00:17:45] You know, to that end about understanding your clients, we try to teach and understand this. Obviously, we’re interested in our member companies participating in our programs. That’s how we help them. That’s our we generate our revenue. But I always say to people, how would you feel if some really significant problem, you just, your mom just got taken to the emergency room and she’s really sick. And she’s eight states away, and your sister’s helping her with her. If the next phone call that you get is someone who says, what a great day this is to buy a widget. I mean, aren’t widgets a great thing? It’s going to be fingers on a chalkboard here. A real good way to open any meeting is, how are you today? And mean it. Yep. Don’t use it as a figure of said. I’ve had people say to me… One I’ll never forget. I talked to one of our members and said, how are you today? He said, well, I’m rattled. I said, what happened? Said, my wife and I got a phone call in the middle of the night that our daughter was in an emergency room, again, a thousand miles away, that she had been shitting outside of a restaurant. And I said oh my goodness, first of all, Would you like to get off this call so you can go deal? He said, no, I’m fine. My daughter’s all right. She’s being discharged from the hospital in an hour, as a matter of fact. She had superficial wounds. But it certainly rattled me. Now, I am really glad I asked that question, because if I had dived into that call and said, you know, you really should use our behavioral health solution that we do here at HTA, I would have been so oblivious to that person’s And I’m not just saying that, by the way, you have to do this in a genuine way. It can’t be, I’ve encountered politicians who look at an index card and they’re like, hi, Frank, how is your grandson who’s in the Naval Academy? And it’s clear they don’t know that, they don t understand it. You have to really know it. But if you do, it builds that empathy and trust in a way that’s really beneficial.
Frank Cottle [00:20:00] No, I would agree with that understanding others is the key to most success and having a certain amount of empathy. You know, if you were to take one radical idea to transform how companies measure ROI, how health care was managed, go crazy for a minute. One really radical idea, something maybe that hasn’t been discussed too much. That’s what makes it radical.
Robert E. Andrews [00:20:34] People who work here live longer than people who don’t. Life expectancy.
Frank Cottle [00:20:39] OK.
Robert E. Andrews [00:20:39] Now there has to be risk adjusted. I mean, if someone’s 81 years old and has liver cancer, it’s a different question if they’re 21 years old or run the Boston Marathon. But at the end of the day, if we could say that our company offers health benefits, that if you take advantage of them, you are more likely to live longer and better. I’d love to be able to say that.
Frank Cottle [00:21:03] And how would you back that up?
Robert E. Andrews [00:21:09] With data, first of all, you would show that people been in our plan are more likely to have an early cancer screening and survive instead of die. Pregnant women who are in our planning are more likely to understand that they’re at high risk of a preterm birth, so their babies are healthier and so are they when the baby’s born. People who live in our plan, who live under our plan manage their weight better so they’re not obese and they don’t suffer from diabetes and knee replaces and hip replacements, you know, show me the money as Jerry Maguire would say that show that people in fact achieve those results. The radical goal of healthcare in America should be longer and better life for everybody. And if you can, if you could be a contributor to that and show that your company’s contributing to that, that’s probably the kind of place people want to work.
Frank Cottle [00:22:00] You know, it’s funny, I asked for a radical idea, not a common sense idea, but what you’re suggesting is pretty straightforward. It’s the proof of it, and I’m going to go to the obesity issue. We are in an obesity epidemic as a nation. I’ve spent a lot of time in Europe, and have a lot friends back and forth, and It’s just one bellwether difference, but They come over here and they can’t believe how how fat people are. You know they go what what what’s happening? You know, they they just can’t believe it. As a company, we can do things to help people, but people also have to help themselves. Well, they do. And I think that’s probably harder than anything else. You can add education to it, but no matter how much we tell people about this and that, right now, what’s the most popular drugs that are being prescribed and used by 20% of the U.S. Adult population? Wake up. Because they’re too lazy to exercise.
Robert E. Andrews [00:23:14] So here’s two ideas that are corollaries to the point that you’re making. I think we always need to be mindful of genetic predispositions to weight and so forth. And we should also be mindful that some people live in food deserts and don’t have the chance to access healthy and good food. Having said that, if you take those things into account, I think people who take better care of themselves should pay lower premiums than people who don’t. Will we do that with automobile insurance? Yes, we do. We do it with worker’s comp. We do with a lot of different things. And I think there’s nothing wrong with that. And I that the person who makes that effort, takes advantage of those resources, should take home more pay than somebody who doesn’t.
Frank Cottle [00:24:01] Do you see that as an option within the programs that are available today? I see encouragement for things.
Robert E. Andrews [00:24:10] Only to a limited extent. There’s a cultural and a legal problem with that. The legal problem is you have to be very careful not to be accused of a violation of the Americans with Disabilities Act or the Genetic Non-Discrimination Act. You have to careful not punish someone for their genetics or their situation. And then there’s a culture problem where you don’t want to be seen as the that the company decides what you order for lunch and the company decides whether you smoke or not. That makes both employers and employees uncomfortable. But I think there is a balance here where an employer can say we’re not telling you you have to go on a Mediterranean diet and run the Boston Marathon. But we’re telling you if you do and you cost us less to take care of, you’re going to get more take-home pay. If you make a different choice, you’ll have lower take-ome I’m for that. I think that promotes a sense of personal responsibility that is quite justified.
Frank Cottle [00:25:16] Well, we work on an international basis, and in a couple of cases, health care insurance is provided by government. I’ve never seen anything even approaching that on any program provided by government in any shape or form, and yet it should be a national imperative.
Robert E. Andrews [00:25:44] Yeah, we have one reason I think that our results are skewed, and it’s a very political reason, but it’s very true. For decades, the food industry has successfully advocated for laws that reward them for loading up our food with fat, salt, and sugar. And there are federal subsidies for those products, the federal school lunch program sells these products. And a political change, I’m not suggesting Republican-Democrat, I am suggesting policy.
Frank Cottle [00:26:19] For politics.
Robert E. Andrews [00:26:20] Yeah. The will to say here that we’re no longer going to subsidize high fructose drinks would be a good thing. We don’t put them in the school lunch program to the extent that they are. They actually don’t in school lunch, but there’s a lot of cheeseburgers served in the school lunch programs to kids that are already juvenile obese. Again, I’m not in favor of a nanny state, but I am in favor of a a tax system, a regulatory system, an insurance premium system that rewards behavior that keeps people healthy.
Frank Cottle [00:26:57] I think that if that can be achieved equitably and understandably, because you know what, when you remove a subsidy for someone, somehow a subsidy from someone else seems to pop in. You know, it always seems to be that way with SESAD. I don’t care where you are.
Robert E. Andrews [00:27:18] We used the term obesity crisis quite accurately a few minutes ago. It’s decades long. Here’s a fact that struck me, that the Affordable Care Act, which expanded coverage through Medicaid and through private, the health exchanges, not private exchanges, cost a large sum of money. And that reduction in what health insurance companies got for Medicare Advantage and somewhat higher taxes on very high-income people. If the percentage of Americans that were morbidly obese had been the same in 2010 as it was in 2000, the savings, federal savings in Medicaid would have paid for the entire Affordable Care Act. In other words, we would have been able to achieve virtually universal coverage without raising taxes on anyone or reducing spending in either area if simply the percentage of people on Medicaid who are morbidly obese had stayed what it was 10 years earlier. That’s what an obesity crisis looks like.
Frank Cottle [00:28:28] It’s just a crisis of health, it’s a crisis.
Robert E. Andrews [00:28:31] It’s a crest of lifestyle and here’s the other pet theory I have about this and I don’t have data to back this up but I have instinct so let’s choose instinct over data. I think most of us make most decisions in our life including health care decisions based upon whether someone who loves us pushes us in that direction. A spouse, a child, a sibling, a friend. I think that people who feel lonely in life, who don’t feel like there’s anybody who necessarily cares about them, suffer very often from a lack of self-esteem, and the lack of self- esteem is very much tied to obesity, again, for people who are not genetically inclined. Substance abuse, behavioral health challenges, so I think we also have a loneliness crisis in the United States. And addressing it in a non-judgmental, non-mandated way, something we have to think about. One quick anecdote, I’m aware of a primary care doctor in Texas who noticed that a lot of her patients had the kind of lifestyle I just talked about, kind of lonely. And she started a Wednesday afternoon walking club where she invited those patients to go take a 45 minute walk with her after the business day was over on Wednesday. About 25 of them showed up and out of that 25 grew a community. And some of that group started playing pinnacle together or they went to the diner for dinner together afterward or visited each other’s homes. And the primary care doctor kept track of these patients and said they all got kind of healthier. Their BMI dropped, their med adherence went up, they were less sick. The tragedy of this is that she got paid zero for that achievement. Our system didn’t give her any money for that because she couldn’t bill for a visit for this walk-in club. We should triple her pay for doing something like that. So, the way the healthcare system needs to change… Is to reward innovative physicians like this woman I’m mentioning in Texas and pay her a lot more for doing that.
Frank Cottle [00:30:55] Well, you know, in Texas we got four seasons. Still summer, Christmas almost summer. So those afternoon walks, I guarantee you that that was one sweaty group you would be playing with.
Robert E. Andrews [00:31:12] Well, we have family in San Antonio and we’ve sweated that we’ve attended family things that we know what you’re talking about you you bet
Frank Cottle [00:31:18] So I empathize with those people overall. I don’t know how to ask this. I’m going to think for a second. I want to bring AI into the mix of the conversation. It is the next generation of technology that we will all live with, just like we all live with everything that’s digital today that has evolved. You’ve got enough gray hair, and I’ve got enough loss of mine to remember handwritten letters, carbon paper. Things before anything that video conferencing system that I was referencing in the early eighties was before PCs. You know, there are no PCs back then, a couple of Eagles and a few other things, but nothing that mattered. So when we look at AI and we look healthcare. I see two factors. One a company that says they’re going to reduce their staffing overall and replace some functions. I won’t say people necessarily, but functions, and that ultimately means people with AI. That will reduce their health care, on the one hand. On the other hand, how is AI being used in health care to reduce costs overall for everyone. With the same corporate efficiencies that their clients are trying to achieve.
Robert E. Andrews [00:32:59] The welcome change for AI in healthcare will be freeing up more time for doctors and nurses to spend with patients and less time doing record keeping. Right. This is a welcome change. So the physician, I went to my cardiologist yesterday, who’s great, just for normal checkup. And I thanked him for, I had had a stress test, a nuclear stress test. You get on the treadmill and run. I did really well. I stayed up all night studying for it as well. And he gave me a terrific report, which I read the day I’d done the test, and I thanked him for that. And so I really appreciated the fact I got the report right away and understood what was going on, and what wasn’t. It was good news. He said, yeah, at 10.30 at night, my wife sees me doing these reports and wonders why, and that’s why. I said, well, I really appreciate you doing it. AI could do that report instead of him. And that would mean that either he’s seeing more patients, spending more time with them, or watching a movie with his wife, which has value as well for him, his lifestyle. So that’s the good part of AI and healthcare. The concerning part would be where the bots take over the care. And there’s some litigation right now that United Healthcare is the defendant in where they’ve been accused of using AI to deny… Care when people need pre-authorization to get the care. Yep. Now if a smart compassionate human is Using AI as a tool. I think that’s appropriate But if the algorithm takes the place of the doctor or the nurse, I think it isn’t so where I think the principle we’ve got to be guided by in the use of AI and health care is Is it being used as an enhancing tool for compassionate skilled humans? Or is it being use to replace compassionate skilled human? I’m for the enhanced tool, but not the replacement.
Frank Cottle [00:34:58] Yeah, I think that’s an idealist perspective, honestly, because we know from experience that it will be both.
Robert E. Andrews [00:35:08] It’ll be both. Yeah, it shouldn’t be, but it will.
Frank Cottle [00:35:13] And I won’t get into regulatory issues and limitations on that at all if they’ll ever be considered or enacted, if they could be or would be. Uh, will always be both, um, uh, overall. And, uh. So that, that is, I won’t say concerning because honestly, I don’t think it’s, there are people denying claims now AI just going to be replacing those people because they were the same people go through a formula process.
Robert E. Andrews [00:35:48] This is idealistic, and let me give another example, the idealism to which we seek. My numbers are notionally right here, that when radiology studies are read by algorithms, they’re wrong maybe 4% of the time. When radiology studies are read by humans, they’re wrong maybe 3% of the time.
Frank Cottle [00:36:11] That’s 25% difference.
Robert E. Andrews [00:36:13] When the radiology study is read by the AI and a human, they’re wrong less than 1% of the time. That’s what we’re looking to do. Now, you’re right. The market will generate results different than that. In order to lower cost, you’ll have 100% reading by the the AI. This is where I think smart consumers have to vote with their wallets and ask the question Well, is my radiology study going to be looked at by a competent radiologist after she’s read what the algorithm thinks? If the answer is yes, we think people should vote with their wallet and go there. Cost might be slightly higher. If the answers no, then we think that people should go with their wallets and not go
Frank Cottle [00:37:05] Quite a challenge because generally your primary care physician sends you somewhere and that’s just where you go. Now the onus is on them to make that decision and your trust as you were saying that you’ve developed with that physician.
Robert E. Andrews [00:37:20] Very true.
Frank Cottle [00:37:21] You’re able to do so.
Robert E. Andrews [00:37:22] Almost no healthcare decisions are made by the patient alone, but what the role the employer can play is to try to build a network, build a health plan where it’s filled with providers who are sensitive to the principles that we’re talking about. Hard jobs for the employer, but think about this conversation that a young woman gets pregnant, she and her husband are nervous about the baby’s a little small and they’re worried about the child. Do you want to be the employer who says we’re using the very best technology available and the smartest people available to answer your question about your baby? Or we got the radiology study for half price, but it’s all AI. Which of those two stories you want to tell to your employee?
Frank Cottle [00:38:13] Well, that’s even beyond rhetorical, because of course, we know the answer to that. What we want to tell the employee in the goodness of the situation, but what we’re armed with the information to tell of the employee, the HR department probably wouldn’t use it.
Robert E. Andrews [00:38:34] That’s why the HTA is here. She probably wouldn’t and we want to make sure she does because she’s the one or he’s the one who is on the front lines with that family and is there to assure them that the company’s doing right by them in that kind of critical situation. And look at the end of the day none of the HR people with whom I work wants to say we got you the cheapest healthcare. They want to say we took care of you when you had a need. Look, thank God, 85% of us, 85% of the time don’t think about our health because we feel good today. Correct. But when you get the child, you know, the baby’s a little small in the first trimester or you, God forbid, get a malignancy diagnosis or you get a problem with your calcium test on your heart study, you know, then you need, then you’d need someone. I want the best and I want it now. Yeah, absolutely. There’s no reason why we can’t say you’ll get the best. Now, that doesn’t mean there’s a blank check for the provider of the best, but there’s no reason we can say we’re going to find a way to get you the best that is a combination, a synthesis of what technology can do and what smart humans can do. Well, you know, I’m going to…
Frank Cottle [00:39:53] We’re running long on time here, which I really appreciate, Rob, but I’m going to bring up one more point if I can do it. Well, we work, as I mentioned earlier, with a variety of human resources companies. And they do recruiting for everybody big, the Global Fortune 100, 1000, et cetera, and manage the recruitment processes. And in that process, the two numbers that I’ll share, if they use the word remote, remote work, remote work is available, remote option, et cetera, they get a five times response on a job description in terms of applicants. If they have a family offer within the description of benefits. Overall versus no mention of benefits, but they go beyond just benefits package, blah, blah blah. But they reference the word family included in that. They get another three times respondents. So the ability to be flexible in your work program, which is a life work life decision, combined with benefits that are inclusive of family. Two of the biggest response issues in all employment structures. So addressing that effectively, which we’re trying to do here, is critical to winning the battle for talent, which is critical, to winning whatever objectives you might have in business or government or the military or whatever employment structure happens to be. Those two things are elemental, and if don’t deal with them, you’re not going to succeed.
Robert E. Andrews [00:41:50] Everything you said confirms what I’ve learned in my 10 years running the HTA. It’s all about recruitment and retention, and recruitment and retention is increasingly tied to do I have to build my family around my work or can I build my work around my family?
Frank Cottle [00:42:13] Well, that’s why we started as a distributed company, by the way.
Robert E. Andrews [00:42:17] Yes.
Frank Cottle [00:42:18] The primary person that I wanted to hire for a position, this goes years and years and decades ago, lived on a farm in a different part of the country and had a very rural lifestyle. He was brilliant. He’s great. He’s now been with me for almost three decades. And my first decision is I can move this guy to work in my office and he can uproot his family and his wife’s job if she’d even. Leave it, or maybe it would break the family apart, this terrible dilemma, etc. And I said, no, no, that’s not best. Whatever is best for the family ultimately is best for the company because those are the people that you talk about that have loyalty, have trust, and they stay productive.
Robert E. Andrews [00:43:07] I assume that 30 years ago, one of your competitors said to that valued person, no, you have to move to Dallas. Connecticut. Connecticut, and that competitor isn’t here, and you are.
Frank Cottle [00:43:26] Well, that competitor still is here, and they’re still moving people to Connecticut. But the reality is they have a much lower life. Much higher turnover.
Robert E. Andrews [00:43:38] I just, I just just to conclude this, what I try to do to learn from you on this that we have an employee who started with us about three weeks ago. He’s great. And we started our, we do a one-on-one 30 minutes twice a week. We had our meeting yesterday. So I sort of followed your thirds a little bit. And I was talking to someone the previous meeting about baseball. And I said to my new employee, who I know loves baseball, we were just talking about baseball, who’s your team? Well, I’m a Yankees fan. I thought about dismissing him on the spot for that reason, but did not. But he said, I am a Yankee fan and I know he has two teenage sons. And I asked him, are you going to get to see any games this year? And he said well, my oldest last day of school was like June 15th. Yankee Savo. Day game the next day on the 16th and I was thinking about it puts a weekday a workday. I said Go to the baseball game. Yeah, this is not an order, but whatever meetings you have for us, take some time and go to the baseball game and it wasn’t I didn’t have to read the employee manual about it. You want you understand I I but it was just struck me that that’s what he ought to do. And so I think that he’ll he’s a great guy. I hope he’s with us for a long time, and if he is, I’ll bet it’s because… Our thought was, you got this chance to take your two teenagers to a baseball game. Go!
Frank Cottle [00:45:14] Yeah, we agree, we have two philosophies over in music is for guidance for 45 years now. One is members first, which members are customers, so we don’t make any decision that isn’t best for the member first. If it’s good for them, it’ll be good for us, number one. And then the second one is family first. That if you strengthen the family environment, if you do things such as you said, simple things. Or complicated things like we had to do during the pandemic, it comes back, in all reverence. So I have not lost a C-level executive in my company.
Robert E. Andrews [00:45:53] You know, not to take this to the religious or philosophical level, but the golden rule works in every aspect of life in my mind. And that’s the way I’d want to be treated. If I had the chance to do something with my daughters, my wife, I would want my employer to encourage me to do that within reason. And so that’s the way we try to treat the people we work with.
Frank Cottle [00:46:15] Yeah, no, I think that’s important. Well, Rob, I really appreciate your time. I know how busy your schedule is. I know the depth of your knowledge and I’m very grateful for that.
Robert E. Andrews [00:46:25] Well, you’ve been in an oasis in a busy day, believe me, that’s the way I look at this conversation.
Frank Cottle [00:46:27]Oasis full of dirty water, probably.
Robert E. Andrews [00:46:30]No, clean water.
Frank Cottle [00:46:33] But maybe I could grow dates. Who knows? That was a dated remark. All fiber, natural sugar, it’s going to be good for the obesity thing. But I really am grateful, appreciate it. Look forward to staying in touch in the next time. Let’s please do. Thank you very much. If it’s impacting the future of work, it’s in the Future of Work podcast by allwork.space.
