Former Corporate HR Exec Leading Grassroots Effort to Help Employers Save

From foot soldier to platoon leader, Matt Ohrt blazed a transformative path in the pitched battle waged against health care fraud, waste and abuse perpetrated by Big Insurance, hospitals and benefits brokerages. As VP of HR and medical services for Merrill Steel in Schofield, Wisconsin, he immersed himself in trench warfare over unsustainable annual increases in employee health benefit costs.

His success led to the creation of a health care best-practice group and co-founding Self Fund Health, for which he also serves as chief healthcare officer. He’s also the author of “Save Your Company: Don’t Feed the Beast: The Employer Healthcare Success Formula,” has appeared on dozens of podcasts and toured the U.S. with a message of hope to HR professionals and business executives that they, too, can slay the health care beast.

Matt Ohrt, co-founder of Self Fund Health.

In the following interview, edited for clarity and space considerations, Ohrt explains more about his prescribed remedies.

Please tell us about your professional journey and commitment to fixing the nation’s broken health care system, including the book you wrote and your transition from corporate HR to consultant.

OHRT: In my 25 years of HR, mostly in manufacturing, I always led the enrollment meetings but never really had much influence to fix the problems. At Merrill Steele, we had five years of 9% average increases on a $5.5 million spend and had been absorbing it. The owner asked if there was anything we could do about it. I started my research and concluded there was no way to win at that game for the buyer. The seller was winning wonderfully. But over the next five years, we completely transformed our health plan. We changed all of our untrustworthy partners to trustworthy partners and saved about $1 million a year, and we greatly improved our care and accessibility of care. That led to a health care best-practice group, which now has 17,000 members, and I co-founded a company that turned this concept into a health plan that was scalable for other employees, and that’s taking off. I’m now out there encouraging this grassroots free-market health care movement.

How would you define fair pricing for health care services that please not only employers and health plan members but also physicians? 

OHRT: I don’t know if you’re familiar with the Surgery Center of Oklahoma [which pioneered transparency in pricing and direct contracting]. We have providers that have been mentored by them: Solstice Health in Milwaukee, WellBridge in Indianapolis and so forth. Let’s say we get a hip replacement in Wisconsin. I can get that for $19,000 with a 90-day warranty and a hand-picked surgeon at Solstice Health or I can get it for $60,000 to $150,000 at one of the hospitals where it literally could be the same doctor who makes more on the $19,000 surgery than he does on the $100,000 surgery. There’s so much waste in that process. Where is all that money going? It’s certainly not a good value.

To what extent do you believe doctors and hospitals are fed up with Big Insurance and might be more willing to do direct contracting with self-insured employers that provide upfront, bundled and guaranteed prices for their services, as well as accept cash prices?

OHRT: Employers have been tricked, and I believe the BUCAHs [Blue Cross Blue Shield, UnitedHealthcare, Cigna, Aetna, Humana] are the biggest root cause of evil. They’re the common enemy that probably will never change. On each side of them are the big brokerage houses that have become dependent on all these additional payments of commissions and overrides – all the money that employers aren’t really aware of – which they’ve turned to the dark side of protecting the status quo. About 1% of brokers are coming to the good side, more and more each day, but the others are all complicit. We have more than 2,000 brokers in Wisconsin, and so far we’ve found fewer than 20 who are really willing to do things right and to transition. The hospitals are similar. Although they too have plenty of evils, they’re slaves to the BUCAHs. It’s my hope that more hospitals come to the free-market [direct-contracting] side, or that they’re forced to do so, or they won’t be around.

How do you identify third-party administrators (TPAs) and pharmacy benefit managers (PBMs) that are aligned to work in an employer’s best interest and reduce excessive administrative costs?

OHRT: It’s hard, especially on the broker front. I see employers changing brokers all the time, but they’re going from one to the next. They’re not getting better. There are definitely some good TPAs out there. There are definitely some good PBMs out there, but they’re certainly the exception. The Free Market Medical Association, for which I’m the chapter leader in Wisconsin, has been pretty stringent in their guidelines on who they allow in, but one of the trickiest parts is years from now they could somehow lose their way. Even if you’re ethical at the start, somehow we’ve got to hold those values and not be tempted by payments and different things.

How can primary care physicians and direct primary care (DPC) practices be deployed to reduce unnecessary referrals and increase the quality of care through more preventive screenings?

OHRT: I’ve encouraged and supported DPCs. I had a call this afternoon with one of them on how to get patient flow right because they’re out of network. But in Wisconsin now, we have 131 DPCs across the state. Three years ago, when I was at Merrill Steele, we had no brick-and-mortar imaging. We had to hire the same truck that was going to the hospitals and clinics, and we could get the MRI done for $600. But if you get the MRI at the hospital where that same truck is parked, it was $6,000 and the hospital would pocket $5,400. Today, we have brick-and-mortar surgery, imaging and infusion centers throughout the state of Wisconsin, as well as two non-ambulatory micro-hospitals that have just started. We’re literally building a new system next to the old. We’re saying you get a choice, but the new system is free because they play by the rules, telling you their price and all these amazing things.

Bruce Shutan is a freelance journalist in Portland, Oregon, who has written about employer-provided group health benefits for 36 years. He is the former managing editor of Employee Benefit News, a regular contributor to The Self-Insurer magazine published by the Self-Insurance Institute of America and has written for more than 130 other publications during his career.