What the Health Just Happened?
How Curative Cracked the Code: Zero-Copays and Laughing All the Way to Better Healthcare
Ladies and gentlemen, welcome to this week's episode of what the health just happened when we talk about all things health care community, business, and life the goods, the bads, the ups, the downs, the lefts, the rights, and everything in between. We're lucky to bring on a variety of guests to bring their perspective on what they find to be healthy or not healthy in all the previous topics. Today's guest, I'm excited like I'm doing the radio voice now and I'm talking with my hands and doing all that stuff for those of you who can't see it on the camera. We chatted for what 15, 20 minutes earlier, CEO of Curative, I know what Curative is, trading know what Curative is, you do now. Fred Turner, welcome to what the health just happens. You ready? You ready to have a good time? Or at least educate some people and if we don't make you laugh here and there. Before we started the radio show, we talked about what brought you to the States. You were professionally milking cows, right? Yeah, DNA sequencing, by the way, that's a terrible version for each other. Pivoted multiple times. Let's pick up there. Curative was doing COVID. PCR testing specifically. That was after doing septic DNA sequencing tests that did not work out. Let me know if I'm butchering this. Tell me when did we pivot to PCR testing? Yeah, well, it was meant to be a temporary pivot. We thought we would come back to sepsis. We thought COVID will last a couple of weeks. It'll be over. We're just going to help out and then we'll go back to our sepsis testing. We thought it was going to be temporary. At the beginning, when we hired people, we told them, "This is a six-week gig. This is going to be over. We're hiring you to do this to support the pandemic effort and then it'll be done." Who are you hiring? Nurses to administer tests, people to read the tests. Mostly lab tests. You're hiring people six-week contracts. We're going to run these tests. We thought it would be over when we just go back to sepsis testing. It took a while before, I guess, whenever getting back to sepsis. Even, I think, by the summer of 2020, we were like, "Oh, this will be done soon. This is six more weeks. It's six more weeks. We're going to get the vaccine. We'll be done." How long did that? Let's talk about the scaling up component. You said you started with seven people, a curative. Seven people at the beginning, February 2020, and then over the first 12 months, we grew to 7,000 employees. You hear that, right? Seven employees in February 2020 to 7,000, 12 months later. That is madness. That is madness. What's your role in scaling this up? Are you getting new contracts to do the testing? Are you hiring? That's insane, everything. I mean, it's bringing in a lot of great talent, particularly on the recruiting side, building out the executive team to be able to manage that, bringing in the best scientists. We hired a lot of ex-military, so our COO was a colonel in the Army for about 30 years before curative. The great thing about what they teach in the military is how to do operations at scale across wide geographies very smoothly. So you get the best operators. You put them with the best scientists. We also hired a bunch of Silicon Valley tech people. You get everybody together and you get them all speaking the same language. That's where the magic comes from. The people from Silicon Valley were those previous relationships from the Y Combinator days. There were two guys who were in the same YC batch as me. They were doing another company at the time and they moved on to doing another company. Are they still with curative? No, they're not. Okay, so we won't give them a shout out. You guys sold us out of kidding. There were instrumental in -- Of course. That blows my mind. I don't even want to do the math. How many employees a month is that? What's 7,000 divided by 12? And you did that in the midst of COVID, too? That's wild, because I wouldn't imagine most companies growing like that during COVID. Well, they weren't all over as well. They were all over the U.S. How many states were you in? We operated by the end in 49 states, everywhere apart from Hawaii. So from day one, you started in California this time, right? Yes. Curative actually started in Menlo Park, but we ended up moving down to L.A. We acquired a lab in L.A. that became our first COVID testing lab, and then we built a lab in Washington, D.C., and then won in Austin, Texas. So as you're doing these tests, you're flying the test to those separate labs, getting the results that then are reported back to 49 states. Again, just logistically and mathematically, it blows my mind. So exploding in what could be considered one of the most unique times in the history of the world. How are we going to keep our lights on? Is our business going to survive? Restaurants are closed. What state are you in? Who's the governor of the state? Still got to turn and burn these tests. So I think at one point, you said you were essentially attached to 10% of all COVID testing in the United States. Is there a number on that? It's about 36 million tests. 30 tests. 36 million, the 6 million. PCR tests. I don't know this. How are you compensated for that? Is it insurance companies? You're negotiating with them to pay for the tests? Yeah, it's a whole mix. A lot of it was direct contracts with states, cities, counties, various government entities that wanted to set up testing sites, and they would just contract and buy them directly from us. Then there was a mix of insurance companies, public and private, and then there was a fund for uninsured people to be able to get tested. Are you negotiating these? Who's out there hunting and gathering contracts and adding a new state? Me in the early days, but it quickly became the team. How did you say it was you in the early days? How many trips did you start having to take to DC? Do you have to lobby for a lot of this stuff? Are lobbyists involved in this portion or no? There's some local lobbying, but not a whole lot of DC lobbying now. I didn't know if that was a roadblock to some of the stuff that you're trying to do. No, most of the policy decisions were made pretty early in March of 2020 when the first passed. We were pretty well-written bills. It wasn't a whole lot to kind of lobby for. Got you. Fair enough. We're going to talk about lobbying in a second, too. Hopefully you're going to end up being a political man or not. Run for the fences. Again, explosion in a time where other businesses are turning the lights off and cutting back. As you grow, you're negotiating with insurance carriers. You're finding frustrations with the American health care system, learning the bureaucracy and whoops, you've got to jump through. But you also have a massive company and you're probably looking for employee benefits for those people. We could never hand this here if we could never get benefits that we liked. Particularly, I'm British originally. I'm used to health care where it's a zero dollar out of pocket. You just go get carrots and cluster anything. We could never get health care. We thought it was good. We had a mix of Kaiser and Blue Shield of California. I'm a big fan of Kaiser. I think Kaiser is one of the best run health care systems in the US, but it doesn't work for everybody. We can't just offer Kaiser. Some people love the other. Some people hate it. They haven't solved that. How do we be a full replacement product? Then Blue Shield of California was just dreadful. What was dreadful? Very hard to work with. No flexibility. Insisted, it was impossible to have a deductible less than $500. Is this from an executive? Again, this is a rhetorical question. I've got my own thoughts and answers. Is this from an executive perspective where you're frustrated that the cost coming out of the business? Or are you frustrated on your employees' behalf? Both. I mean, we have things where it's like, "Oh, we're running at 72% loss ratio." And they're saying that we need a 35% renewal. And it's like, "Well, do you understand what that means?" I kind of do, but if you wanted to explain it because I imagine most of our lives have no idea. Yeah, it's nice sometimes to fill in the gaps. Yeah, so 72% loss ratio means we pay them $100 of premium. They spend $72 on medical bills. They keep the other $28. But they turn around at the end of the year and say, "Well, actually, now you need to pay me $135 next year." It's like, "Well, if you only have $72 of medical bills, what do you need an extra $35 for? It seems like you're making a lot of money out of it." You know, I have my own theory on the medical loss ratio, right? So let's say for every dollar spent for large carrier, I got to be careful what names I say. They keep $0.80 of that. So what's more money? $0.80 of a dollar or $0.80 of $100. Like they have to spend $80 of that, I'm sorry, $80 of that amount. I'm butchering this. I think you get what I'm saying, right? So why would they not raise the cost? Because that difference, that spread, is significantly higher when you raise the cost. Sometimes I try to explain things to trade and I'm butchering it. Yeah, it's one of the, I guess, the most backfiring provisions in the Affordable Care Act is that there's a cap on MLR. So if you, as a large group insurer, run below 85% medical loss ratio, so you don't spend at least 85% of your premium on claims, or it's 80% for a small group and the individual market, then you have to rebate it. You have to give it back to the group at the end of the year. Now, as to the aggregate level, it's not for an individual employer. It's across your entire business. But the incentive that drives is, well, if I can't make more than 15% by profit, by being efficient, the only way to make more money is to spend more on healthcare, which is just the wrong incentive structure. Look, this is gold to be. I don't know if you're going to say that. That's great. It's frustrating. If you don't, it's one of those ideas that sounds like a good idea, you can see why they thought, oh, if we cap insurance, it was a good intention. Then this will help with restricting healthcare costs, but it just, it's not the right incentive structure. How many times have you heard people say healthcare's broken in the U.S.? Just constantly. Let me tell you what, I don't like that saying because I don't think healthcare's broken. I think it's working exactly how it's designed. So how do you redesign something new? The smartest man in the room right here. So, yeah, you're dealing with these frustrations for your business personally, and then what happens? Light bulb goes off, or you're just sitting in a room, or you're going to get a coffee and saying, "I'm doing this." It was a bit more deliberate than that. We spent, so we, we had, we called it Curated 1.0. It's a testing business, and we're like, "Well, what do we, what happens next?" 'Cause remember, we thought it was going to end in six weeks, in six weeks. So we're thinking like, "Okay, well, do we go out to sepsis? What do we do?" We looked at a few other things in the lab testing space. We looked at this really interesting technology where you could, instead of ordering a lab test for this, a lab test for that, everything would be one test, and then one test would test for everything, and then you'd just pick out what you wanted. The science wasn't really there, so we didn't, didn't move forward with that. We briefly looked at buying a hospital and trying to see if we could make it better with tech. What area? We were looking in Texas primarily, but we looked at a few in Florida as well. This is basically what General Catalyst is trying to do now with their acquisition of Suma Health. Okay, we decided it was a bad idea, so I'm really curious to see how that goes. You're going to follow it closely. Oh, man. It's just very hard. If you buy one health system, you only impact the health in that one very specific area. There's probably another system that you're competing with. Most employers just have employee populations that are too spread out for that to really be impactful. And so we decided as my main wasn't going to work to drive the impact. And everything we looked at on a preventative healthcare side basically realized you're either chasing a billing code that already exists and just trying to do more of it, or maybe be more efficient. And is that really helping the system? Or if you have something genuinely new, you have basically a 10-year fight with insurance companies to get a CPT code, get it covered, get a national coverage determination. So you know what a CPT code is? I do not. Again, I love to sometimes just jump it in for whoever happens to hear this. You go to a doctor, you have your belly button hurts. You're going to put in a CPT code for that diagnosing belly button pain. It's more complicated than that. That CPT code will determine what your insurance reimburses and why. Interesting. Very simplified version. Everything. Gotcha. And if it's typed in wrong, you're going to get billed more. If it's not typed in at all, you're not your insurance is what you know it would prefer for CPT. So if you have a new thing, it doesn't have a CPT code. So you can't bill because there's nothing to bill. You don't. And what it is? What is the time frame you just said for that to start years? You can get a new CPT code, arguably within two years if you know what you're doing, but then no one's going to pay for it. So getting a code, getting the coverage determination, getting payers on board, actually getting paid, it's like five to ten years, generally. Are you learning this as you're starting, like growing curative and you're figuring this stuff out? Or you decided, we're right to curative 2.0. Similar with that, with like a brand new test at my last company, it's Shield. Okay. Could never get anywhere with, even though it was saving the insurance company's money, they just getting that coverage is very challenging. So we decided that the problem with like lack of preventative health is really that health plans are just not currently set up to actually drive engagement in prevention. And although there's a lot of talk about wellness, it's just talk. It's not real and the plans are not designed to actually drive any meaningful outcomes. They just talk about wellness because it sounds good. And so we want a shiny object. Yeah. We wanted to build a plan design that actually does it. That's why I kind of hate the word wellness. I'll openly talk about this with you too. I don't, I feel bad because we have some relationships in friends in our community that work in the wellness space. And I, they all have good intention, but it's, it doesn't move the needle, in my opinion. I'm sorry. So no deductibles, no co-pays, no really. I love that tagline. Yeah. What is, why, how, I mean, it's just saying I'm like, it's, it's, that doesn't sound like, that's, that's not a real thing. So as we dug in, one of the things that we really honed in on is like, what is stopping people from getting access to preventative care? Like, why don't people go and engage with health care early before their problems or problems and deal with it? Some of it's just human psychology, but some of it is like the barriers that we've put in place. Right? So there's an administrative barrier that we have prior authorization to make everything like more. Okay. That needs to be, but there's also this financial barrier where we've moved towards the system where we try to charge you every time you go do something. Even if that thing is like incredibly beneficial to the insurance company because it keeps you out of the hospital, we still try to charge you under the idea that maybe if you didn't really need it, you wouldn't bother, but it just, it just is like, it isn't real. It doesn't, it doesn't, it doesn't be as friction points. Right. I can fight like financially damaging friction points. Yeah. So all it tends to do is drives this pattern of care to furl, but it isn't like sensible care to furl. It isn't people pushing off the right things as people just pushing off everything. And there's a lot of data out there that shows actually the people who most need care are the ones who tend to defer it the most because of their out of pocket cost. The ones who didn't really need it find a way to still go and do it anyway. So you're not saving the right kind of care. There's a really good study that we talk about a lot that the National Bureau of Economic Research did in about 2015 and they, they followed this group of about 50,000 members that moved from no out of pocket cost to a high deductible plan and they follow what happens. And in the first year, you get about a 12% reduction in claims cost. And so it looks like, okay, we've given people this high deductible plan and it must be out their price shopping. They must be looking for the most affordable options, must be avoiding unnecessary care. The problem is when you like dig in and look at what's actually going on, the hospitalizations stay completely flat. The specialty drug expense actually goes up. All of that 12% saving comes from people. They don't go get their primary care visit, don't get their checkups, don't get their colonoscopy, don't get their mammogram. All the stuff you really want them to do is throw active care versus reactive downstream. They just stop. But you was that report? That was 2015, like we've known about this for a while, but you know, there hasn't been a whole lot of action. So people just kind of defer care and it's even like in kind of illogical ways. So in that study, colonoscopies would still have been free because it's a preventative service under ACA, even with the deductible, it would have still been $0 out of pocket. But they go down by a third in that first year because when you tell people, hey, you have a deductible that's going to cost you money to see care, they don't read the benefit booklet. They don't know the details. Hey, guilty. What is my actual, what is my EOB say? And that's great. So they just think, okay, I shouldn't get care. I should avoid it. I don't need the colonoscopy. I feel like I don't have colon cancer. And that's the behavior you get. And so by the second year, you like me on a Friday to colonoscopy, you're basically already back at baseline costs by the second year. And by the third year, your costs have gone way up above what you would have expected them to be on over a three year period, you're not spending about 8% more. So in this short and current saving, early on, you're taking it, you're seeing a 12% dip, right? But then for a variety of reasons, it's not, it's really not good news. And then over the longer of a three year, you get a seven more because all of that deferred care catches up with you, right? You actually can see a measurable increase in colon cancer by the third year because you're not doing colonoscopies. All of your primary care checkups that could have been your prediabetes, hypertension, getting it managed, getting people on medication, they skip it and then they end up in the emergency room with a diabetic ulcer or a hypertensive crisis. And now you've got a $100,000 hospital stay that you didn't need, that we're totally unnecessary. Would you say men are even more susceptible, like they're probably the ones that are falling into this category the most or are women just as guilty in regards to just avoiding the care? Yeah, we definitely see the, it's like men in their 40s and what? Yeah, worse because they're like getting out of that phase of like, oh, I, I don't need to see dogs. It's like, no, no, you really do need every year. There's some things you need to do and, and the just the deferral is, oh, I'm guilty of it. I'm about to be 40 up here. I'm still in my 20s that everywhere else I'm in my 41. Definitely see that. So, so back. And again, so, so curative. Would you call this now 2.0 or you're on version 3.0 2.0, we're on 2.0 now. So yeah, so I can talk a bit more about our model. Yes. I think we just hammer this in what groups is it for like the pharmacy say, yeah, go ahead. Yeah. So we have a very different approach to this. We think cost-sharing is, is the enemy. So the curative plan, no copane, no deductible, no coinsurance. Everybody has zero dollar out of pocket cost for any network care for the first 120 days. And during say one more time. So for the first 120 days, all in network care is completely free. You can go see your PCP. You can have a baby, you can get cancer care. Really? It'll be zero dollars. Have a baby? I had a zero dollar baby in January. You got it. It was funny. I don't like that. My wife listened. Yeah. We're gonna have a fourth. Oh man. Three is good. It was pretty great. And then you have a hundred and twenty day window. During that hundred and twenty days, you have to complete what we call a baseline visit. This is very important component to acknowledge. Yeah. It's basically, I think a one hour zoom call. With our staff, it's 30 minutes with your care navigator where they're looking to onboard you to the health plan. So they explained what is a copate, what is a deductible, what does a network mean? What is out of network? Like, let's check that your drugs are on the form of the rea. Are you going to an in-network pharmacy? They explain all of these complex health care words that most people just don't know what they mean. Yeah. So you actually understand how to use your health plan. And then the second 30 minutes is with a clinician really looking for gaps in care. So they're Lauren, physician, PA, what level clinic. It's either an MD or nurse practitioner. Okay. Yeah. So they have prescribing authorities. Yeah. They can, if you're, you know, you should be taking your medication. You haven't filled in a few years. They can write your approach prescription for it. Really looking for gaps in care, looking for people who sort of know that someone told them they're prediabetic, but I don't want to see a doctor because it will cost me $20 and then they'll prescribe me something that'll cost me $50. I feel fine. I'm just going to leave it like that. We see so much of that and we can get those people and say, look, we're going to get you into a PCP that will cost zero dollars, we'll even make the appointment for you, or you have to do a show up. They're going to prescribe this drug. It will cost zero dollars. And by the way, we'll deliver it to your house. All you have to do is take it and swell. Okay. And you get more of that engagement. So if you don't do the baseline visit within the first 120 days on 100 day 121, you revert back to a $5,000 deductible and 20% insurance. So this is, this is good because we had about two minutes of the commercial break and then we'll hit more about this, we're going to run out of time, so why? The model that most people are used to, right, high deductible, what was the co-insurance? 20%, 20%. If you do this baseline visit, zero copay, zero deductible. Yeah. So are you going to be incentivized to actually do that? I had to lose it. And that was my skepticism, like, wait, how many people are actually going to do this? Well, yeah, 98% of members complete the baseline visit. 98% of people complete the baseline visit and what do you say on our prep call? The 2% that don't? It's a good predictor for HR teams of who is interviewing at other companies. Oh, that is good. That is good. Yeah. And then one more thing or two, so for groups specifically, it has to be 50 employees or more and at least 25 enrolls. 51 eligible employees are more 25 minimum enrolls. 51 eligible employees, 25 enrolled. What I can guarantee happens is if you have 51 eligible and you only have 18 participants, that number is going to jump up to 30 or 40. Yeah. Man, great first half. I knew that would fly by. CEO, curative, friend, turner, congratulations on the newborn, by the way, and a really awesome business. And that's what the health just happened. Welcome back to the second half of what the health just happened. If you missed the first half here on the radio show, good news is it's available on your favorite podcast platform under what the health just happens. Today, we have a, again, great guests. I don't know how we fumbled upon this. We're actually filming this in Orlando versus Jacksonville normally. CEO of curative, Fred Turner, great story. How did it start? Where you came from? That was off the air, curative, man. We're going to get to that in a second. We got to talk about the zero card, zero deductibles, zero copay, no deductibles, no copay, no really. That's the tagline. Collectibles, no copay, no really. I love saying that. We like to play a game called health, they're not healthy, right? We got our cheesy hats here, which are going to get one of these. All right. And if you're feeling healthy, you just popped a bubble. Every time that's healthy, but it's, um, health or not healthy calling football soccer. Oh, no, I'll be healthy or not healthy American football. Oh, I, I think I'd have to say healthy. I've been here long enough now. Healthier enough. You, you can affect people. We all offend somebody. You're definitely offended large insurance carriers right now. Healthier not healthy prior authorizations. It depends on the, on the fence. Oh, if you were leaning towards one way, what would you say? They're like a necessary evil, unhealthy, but they are required and a kind of circumstance. Healthier not healthy CPT kids. No, healthy. Healthier not healthy. The first five months of sleep with a newborn. No, healthy. You got, do you want to throw in? No, that would be good. Kelly, you got any one to throw up this so we, my goal is when people leave, they start texting and saying randomly all the time, healthier not healthy. Um, seriously though, I got a half free, but also healthy or not healthy in this beer. Healthy. Definitely healthy. Okay. Well, you can, you can take that or not. We don't think that other way over here. Um, let's get back to business here. Oh, also, thank you to 12 for sponsoring the show. That's our company. We are very bullish on curative right now. Um, so no co-pays, no deductibles, no really talked about how it started. Let's talk, let's talk about the data, right? The information you had, how you can show it's successful and people like it. How is this possible? How can you sustain this? How are you making money? Yeah. Yeah. The biggest question we get is our don't people just go to the door for all the time? Aren't people just using all the health care? Uh, there's a couple of things that one thing we found is that like people actually have better things to do than go to the door for all day long. Like it's not actually what they're, you know, super excited to do. So you don't see that massive uptick in utilization, but the other thing we see is on the hospital side by getting our member starts to engage earlier, go and manage their conditions, take their medications. We have 95% uh, meta derrants for type two diabetes, 93% for hypertension. This is people with those conditions, 95 and 93% actually take their medications as they're supposed to. And national numbers are more like 70%. That's what we'll say. So the national average for those same diagnosis is set down to 75. Yeah. If you don't charge people $10 every time they pick up their prescription, they actually do it. We do same day deliveries, we drop it off at their house, we make it super easy for them. So people actually take their meds. This lets us keep people out of the hospital. So we see about a 30% lower rate of hospitalizations compared to a kind of best case national average data. How long has this existed? Are you a city of three years of information so far? About two years. So two years so far. Yeah. And you're taking what's arguably the best statistics nationwide and you're performing better than that. 30% better. And you have evidence to show people this, like for personally, so two 12 benefits, we talk to a 100 life group, they're sitting at 15 role employees, like, how are you presenting this to groups? Well, if you don't have a mic on, like we show them the data. We will show you the data of hospitalizations across our groups. Like within just six months on the plan, we can see this measurable decrease in inpatient hospitalization rate, getting people engaged in their health care early. And no, no, it's all like really basic stuff, right? It's like take your medication, see a doctor, do your screening test, do your blood work. But it's getting all of that stuff done across 98% of your population, like we know this stuff works. We know if you take your medication, you have a PCP, yes, like they're countless studies. It's not rocket science. We know what works to keep you healthy. It's just how do you get it done across your entire group. And so that's where the 98% engagement we get with the baseline visit, getting everybody in and through that, we're able to drive a lot more of these behaviors where for a traditional health plan, if you're getting 20% of your members to engage in any kind of like program, disease management program, that's considered a really good, and we're getting 98%. So the member, yeah, I mean, most difficult, we get them through. There's man, I have so many thoughts. I didn't think of one thing. Trey, what was the last time you saw a PCP, primary care physician 10 years ago, or the last time you got blood work, probably 10, I don't know, high school. I like like trees on it. That's it. Yes. I'm probably fine. I use it. It's because of it. I don't want to call like a little tiny noticed. I had also not seen a PCP in about six years before I did my curative baseline visit. You got me set up with the PCP. The other thing that I had never done is skin check, like a dermatology, because in England, it's like not really a thing. There's no sun. No sun. Yeah. So it's like, I probably don't have skin cancer because there's nothing, there's no UV. It's just rain. So I'd never had one because it just was not a thing that like we did go out play. You heard about people doing, and they were like, you live in Texas now, you got it. You know what I do that is you're like super pale. Yeah. You got to get this done like once a year, and so I went and had it done and they removed a little mole here and it fell out, it was precancerous. Oh, really? Yeah. So if I hadn't seen a dermatologist, hadn't had that done, I would have not, you know, you would have never had it, but my current advocate amid the appointment, I got it all set up. It didn't cost me at all. So you're actively using like, what was the, you remember the old Rogaine commercials or the hair loss commercials? Not only my doctor, but I'm also at my, but you have actual evidence of using this because you're using it yourself. Yeah. Which again, I think that was a really cool story. You had a baby that was, is there at all a baby? That sounds, I'm sure there's a lot of people that would be banging on the door for that. Yeah. I have to ask this why, like why hadn't the large carriers try to do this? So it's really hard because it only works if you're all in. So the zero, zero, it only works if you offer it across the board. If you try to offer a zero dollar plan alongside a high deductible plan, it doesn't work. Because all of your young, healthy people pick the high deductible plan, continue deferring care and never seeing a doctor. Yeah. And then they get sick. Now they want to come on the zero dollar plan. So you're, you're still not managing people. It only works if you go all in on everybody gets zero, zero. And the large carriers that spent the last 20 years telling people that high deductible plans of the solution just need more consumerism and it will all be fine. Like how's that going? Not good. Not very well. So it's kind of hard to pivot and say, Ashley, you know what? We were wrong for the last 20 years, deductibles might not be the solution. You should entirely throw them away. That's a pretty, that's a pretty drastic line for a large health insurance company. Do you get dirty looks or emails from large carriers? We definitely get dirty looks at, yeah, road shares in the industry, then what's the curative? Hey, you wouldn't get them if you weren't doing something right. Yeah. Do you know what I mean? Yeah. That's the truth. Okay. So current, current states that your curative is available. So we are available to employers that are headquartered in Texas or Florida. So it's headquartered in Texas or Florida. That's important. That's in Georgia. Soon to be Georgia. Look, if you're going to work with someone in Florida, I'd recommend two to all benefits or Georgia. We can work there too. I got some great agencies in Texas, by the way. I'm kidding. I'm kidding. We didn't cover people anywhere there. So we have members across all 50 states. We have people in Alaska. We have people in Hawaii, but the headquarters has to be in Texas. It's just typical. And again, forgive my shameless plug. I'm not serious. If you're a business and you want to consider this, it's good for your business than consider this, whoever you work with. Why are they typically based in Florida and Texas? That's just, you want to, you can ask, it's just how the insurance lies in the word. Fair enough. It's wherever the transaction happens. So we are licensed to transact insurance in Texas and Florida. Gotcha. As the deal has to happen there. Okay. We have a couple companies that are headquartered in Florida and 80% of their employees are in different states. However, the plan is based out of Florida. That's just how our, right? So that's where we're, that's probably why we picked Texas and Florida is our, but there's a lot of companies that have their headquarters set up here, move their headquarters here, particularly, you know, through COVID of the last few years, there's a lot of companies that have moved and it doesn't matter why their employees are. So we cover a lot of California members, we cover York members, but as long as they're one core for us here. Where are, that's Texas so far? Again, I, I laugh how many people have ended up in Texas and Florida and I, like this, I think this is a big reason just, right, there's a bunch of reasons we won't go down that road. This tree, tree, I'll get all fired up over there. Let's talk drugs. Do you like drugs? I'm kidding. Like pharmacy drugs that are always like to vote out in the other. How does the pharmacy side work? Again, a whole conversation about PBM is that whole system is just, will explode minds. How are you doing the pharmacy side? How are you guys dealing legal drugs? So we have it set up again, really focused on the zero dollar out of pocket cost. So for every disease you might have, there is an option available at zero dollars. So if you have a condition where the only drug available to treat it and you need it or you'll die is a super expensive brand name specialty medication that's $500,000 a year, it'll be zero dollar out of pocket because there's no point charging people $100 a month. It doesn't help pay for the $500,000 the medication costs. All it does is mean they're less likely to, "Oh, I want to bother taking it this month." And then you're going to be paying for a $100,000 hospital stay and the drug next month. So we want to avoid that. We want people to take their medications. However, if in a given category of drug, there's two options. One's a generic, one's a brand, or one's a biosimilar, and one's a brand. Biosimilar is kind of like a generic for biologic drugs. We will have picked the most cost effective option and that will be available as well. Love it. Yeah. Again, sometimes it's helpful for me to say this out a lot too because it's like, "Bannis, this just seems wild to me." So Company X has an employee that has access to two different medications. The one that's biosimilar or generic will be zero dollars if you want the name brand, which again, they're the same exact medication, just a different stamp on the outside label. You will have to pay an additional $50 or $50 copay. And so the key example here, I think, like Humira is a humira, that's a great, really good example. Very expensive medication, it's $6,500 a month, but it comes with a $2,000 a month rebate. So the PBM is making $2,000 a month every time they fill a humira script. Chiching. Guess what you see? Commercials were all the time. Yeah. It went off-passant last year in February. And so now there's a biosimilar and the biosimilars are priced as low as $500 a month, but they don't have a rebate. So the PBM doesn't make any money when you fill one of those. So most of the national plans are still pushing people towards Humira, or at least they're not preferentially driving them towards the biosimilar because even though it's $4,000 a month more for the employer, they'd rather get their $2,000 rebate. So February 1st last year, there were only two plans in the country that kicked. Humira are fully off-formulary. It's just not covered. We'll only cover the biosimilar. There was others and Kaiser Permanente. Me and Edna finally got around to it this year. Several of the other plans still cover both. So it's like, well, you can have the Humira or the biosimilar and are covered the same, but they're not driving people towards the biosimilar, which is really what they should be doing. I'm trying to think of there's some medications, every client or group we look at, Humira's on that list. I'm going to draw a blank on medications now. The card, the curative credit card I call, Heracard, zero card. So again, this is in our space, Trey's over there. I love when Trey joins, because he's like, I have no idea what these guys are talking about. But a lot of people listening will understand this. Incredible stuff going on, frequently asked questions, flaws. I go to a doctor, I walk in there and I say, I need to get my ear looked at. Yeah, well, we don't take this. We don't know what this is. We've never heard a curative. Yeah. What happens? Yeah. So this was definitely a challenge that we faced. We initially tried to tackle it by just like calling every provider in the country and trying to educate them. That's a little challenging. A lot of them and the friend desk people tend to turn over pretty quickly. So we captured in this problem the solution we built, we call it the curative zero card. It's a credit card, a visa credit card. It's issued in your name. I was going to show you the physical card. Bird2D, come and talk it. With all the microphone. Sorry. It's a little black visa card issued in your name, but funded by us. And if you're ever at the provider office and they say, oh, we don't take that. You just say, okay, I'll pay the cash price, tap the card, you're done. Yeah. Is it always active? The card? Yes. So it is always active. Is there ever foul word? Right. It'll only work in network providers. Okay. You won't be able to use it by your groceries. Yeah. I'm saying is that they're going to be someone out there like, I'm going to go buy a six pack and get us and no, it'll only work out providers and there are limits like there's dollar limits. Yeah. Given whatever the provider type is, if you try to extend some more than like if you have a $20,000 PCP visit, it'll decline. But again, this is to reinforce how good this is for employers and employees. Yeah. All these friction points that people are accustomed to dealing with and death by paper cut, $20 here, $50 there, gone. You go somewhere and they're not accepting it. Friction point eliminated. Again, it's just, I'm just reinforcing this because we want people to get care out. We want as much access to care early because that's what saves money on the hospital costs. So sometimes you have this problem where people want to bring their doctor into the network, but doctors are really busy. They might not have a legal person, they might not have somebody who can sign a contract with a health plant because they've got a lot going on. And so we can't always contract with any given provider, even if we want to, just because it's hard to get it done, but we can let you go there on the zero card and just accept their cash price. So we found that those are actually often better than the contract to break the only way. Yeah. And because it's easier for the provider, they don't have to bill an insurance company and they don't have to deal with audits. They just, they get the money up front. They know that they're getting paid and they're done. And so we can expand the access members have, let them go to providers that they want to go to on the zero card. Again, I'm the, look, I don't know what you're talking about. No, I mean, my wife would be happy having that. But I'll take a stress levels down when she's having to go to the doctor and this is, this is that fear you're always going to get seen because maybe they don't know that they take curative. Maybe they don't know that they take for us health. We definitely know that they take visa. Yeah. So that's it. There's another tax. Yeah. Again, I'm just, we're so excited about this because as an employer, this is great, but I always, like my concern is always in frustration is the end consumer, right? His wife, my wife, my, like my kids are too young, but, but the people who don't work in this industry and don't know how to play the game, and even we sometimes were like, how is, what game is this? It's like playing a three, a three level chessboard with, with water as your, as your piece is right. Let's go back to pharmacy for a second. I know in Florida, there's a relationship with Publix. Yes. Why Publix? And then if you don't use Publix, there's also a mailing option. Yeah. So at the curative pharmacy available, we had one in Tampa, one foot waterdale, we'll do free same day delivery within a 30 mile radius or next pre-neck day delivery anywhere in the state. We want to make it really easy to get your medications. However, we have found that we can get better rates for the same drug through either using a curative pharmacy or through Publix. So excluding CVS and Walgreens, we're able to save about eight and a half percent on the film costs. That's a lot. Same drug adds up quick. Eight and a half percent more if you buy it from CVS. We don't want to go to Publix either. Hey, I think there's, I think they're building a, a public's building a pharmacy distribution center in Northeast Florida. Have you heard about that? I got to look that up. I think in St. John's County, just south of Jacksonville. So again, if you're in the Fort Lauderdale area, Miami area, cover basically all of South Florida with that. And in Tampa area, and as you expand and see what markets look like, we're currently sitting in Orlando. We have to be in Jacksonville. Who knows what happens? The worst case scenario, you got Publix and then there are overnight deliveries. Yeah. In Texas, we have one in Austin that does Austin in San Antonio, one in Houston and one in DFW. So we will add the other metro areas and get harder in time. Any big things I'm missing is I got kind of two questions, loaded questions here. I want to make sure they're like, I got to, I got to talk about this. It's hard. It's hard to cram years of efforts and this is, this is a game changer. I guess we're in our street. We are. I am best and minus rated. Say that again. We were a minus rated by a best. Does, do you know what that means? I mean, imagine it's like four star. What was it? The last guy was Raiden star. Is it like you guys are four star or is it all of what, A minus? Sorry. Financial ratings. It's not really about like the plan and the quality of the plan. It's about the financial stability of the company. So. Hey, you have the money to keep going. Basically anything, A minus, the technical description is excellent for that. So most of the large carriers are A minus or B plus. It's a big deal. Yeah. It's hard to get. It hurtles. Like what are some things that concern you in the future? Like we're going to run into this barrier soon. Maybe there are not. But when you look down and you're like, this is going to be a problem coming up. I don't know that it's a problem, but I think, you know, the biggest thing we face is we work with employers who are fed up with the status quo and fed up with what they're getting, but they still want to keep buying Blue Cross and they expect it to, they expect a different result when they're just doing the same thing. But it sounds like politics. That's an issue I'm insanity at doing the same thing again and again and expecting a different result. You know, if you want to get a different result, if you want to not have a 15, 20% renewal every year, if you want to not have unhappy employees because they're getting thousands of dollars of bills every time they go see a doctor, you have to be willing to try a different approach. Yep. And it's just getting through, you know, to employers of like, Hey, try something new if you're, if you're looking for a better week, we deal with that every single week, right? If you look at this, this doesn't work. It's like, okay, here is a different solution, but you need, you need buy in from the top. I'm sure the bot, like everyone in the bottom would be like, yes, let's do this. Yep. And it takes, it takes effort, right? It takes, it binds a huge one, but somebody has to, to manage it, hold your employees accountable to make sure they're doing those initial assessments. Baseline, sorry, I keep calling them initial assessments. I don't know if that'll ever change unless like someone's pain point is just so much. It's starting the conversations now is great. Yeah. Okay. So one, three, five, 10 years, what do you look at? What are you excited for? Like this is going to be a healthy change for curative. Yeah. Oh, I mean, we, we want to grow into being a national plan, certainly on the five year time horizon, you know, being in most States nationally is the plan. We think this is just a better way of doing healthcare, that this is the direction things are going to go. We can't just keep having ever increasing deductibles, it's, it's not real health insurance. Yeah. What, I would say this too, like what industry or products can you get an 8% increase every single year and just be like, okay, well, no, I mean, people ask us like, oh, how is this sustainable? But you kind of have to turn that question around and be like, well, how is the current? Like, okay, your deductible went from 7,000 to 7,900 and your rates are also going up 10%. That's sustainable. Like, whereas I got out for the housing within $1,000 deductible soon, like, yeah, it's, it wasn't, it wasn't going to, um, what do you think else, the other thing else? No, I would, I just find it fascinating when you mentioned the way that this is able to work is everyone is all in correct. So everyone has skin in the game, which is the way it's able to succeed. But if you don't, it can't work. Correct. Yeah. I like that. It's equally likely to have a heart attack and end up in the hospital as the CEO. Sure. Have to make that investment. It's going to cost the same amount amount of time it is in the company. It also could be the dependence, right? You're looking at an employer. It's not just about getting your employees. It's also about getting their dependence to understand the health plan to be taking the right actions and engaging, get some money, got to get everybody in. And that's why all adults have to do the baseline visit. Even the dependents have to do that baseline visit because we need that level of engagement from everybody to make it work. Any shout out to anyone before we wrap it up, I was like, "Hi, Mom. I love you. Thanks for listening." Hi, Mom. Shout out to my wife, Dina and Lincoln. Dina and Lincoln, we love a new dad, too. We love dad banter, by the way. Congrats. Thank you. That's incredible. And you're traveling less. Yeah. Other than you flew into Florida, then you're flying back to Austin today. Yeah. What's the next trip? Next trip is our summer vacation. Good for you. Yeah. Good for you. Man, zero deductibles, zero copes, no deductibles, no really. I keep saying zero. No deductibles, no copes, no really. I love that. Companies with 51 or more employees, minimum 25 enrolled. You're tired of the status quo, you're frustrated with how it goes. I cannot recommend curative enough for a variety of reasons. I mean, it blows my mind. Thanks for joining us. Do you enjoy yourself? A little bit. Right. If you're back in Florida, you come back on. Next time, we'll do it at a bar. We'll crack a Guinness mid-epice while watching football, while not real football, out of America. His football area. That was great, man. Let me get a fistball. That's what the hell just happened. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball. I'm going to get a fistball.