The Reverse Mullet Healthcare Podcast

Designing a Value Ecosystem: Alex Sommers on Driving Real Health Outcomes

• BP2 Health

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Healthcare costs have doubled in the past decade, reaching a crushing $26,000 annually for families—with individual contributions now matching what the total premium used to be two decades ago. This financial reality is what gets Dr. Alex Sommers out of bed each morning.

Live from the American College of Lifestyle Medicine Conference in Orlando, we sit down with Dr. Sommers, a board-certified emergency physician who's now leading a healthcare revolution through direct primary care. His Wisconsin-based practice bypasses traditional insurance models to work directly with employers, creating what he calls a "value-based ecosystem" that integrates primary care, mental health services, and lifestyle medicine under one roof.

The results speak volumes: Dr. Sommers' approach is generating savings of $115-120 per member per month—nearly double the national average for direct primary care practices. By focusing on preventive care, measuring meaningful biomarkers, and addressing root causes rather than symptoms, his team is demonstrating that better healthcare doesn't have to mean higher costs.

We dive deep into the tension between our reactive "sick care" system and what actually works for preventing disease and optimizing health. Dr. Sommers shares his journey from healthcare executive to innovator, explaining how he's collaborating with the Health Rosetta community to redesign employer health plans from the ground up. As he puts it, "When you align personal stake, professional stake, and the finances for all stakeholders, you get better outcomes."

Whether you're an employer drowning in healthcare costs, a provider seeking more meaningful ways to practice, or simply someone concerned about the unsustainable trajectory of American healthcare, this conversation offers hopeful insights into what's possible when we're willing to reimagine the system. Connect with us to continue the conversation and discover how these principles might transform your approach to health and wellness.

Justin Politti:

Welcome to the Reverse Wallet Healthcare Podcast from BP2 Health. We are live at the ACLM Conference in Orlando, Florida. I'm your host, Justin Politti. I'm Dave Pavlik.

Ellen Brown:

And I am Ellen Brown and we're here with Dr Alex Sommers, who it's fun to actually meet live and in person. We've talked before virtually video. It's always different whenever you could see this 3D form of someone. But is it AI?

Dave Pavlik:

Yeah, yeah, yeah, it's always different whenever you see the 3D form of someone. But is it AI? Yeah, yeah, yeah, it's real.

Ellen Brown:

Yeah, is it real or are we in some?

Dave Pavlik:

sort of matrix, I don't know.

Ellen Brown:

So yeah, so thanks for joining us. So tell us about what you're working on, tell us about yourself.

Alex Sommers:

Yeah, thanks for having me. It's great to be here. This is a great conference, great to see you guys here and sort of democratizing lifestyle medicine. So I'm a board-certified emergency medicine physician and became board-certified in lifestyle medicine last year. We run a direct primary care practice in Wisconsin and also in Missouri and are growing that practice as in a value-based ecosystem. I know you guys talk about that a lot.

Alex Sommers:

So we've noticed a lot of traction in the space and direct-to-employer mainly Direct primary care can be direct to community and direct to employer, but we specifically target group health plans. As you know, ellen, I'm excited about trying to innovate that space. I think it all starts there, as we all know the payer, the true payer is the patient, the taxpayer and the employer, exactly, and some combination thereof.

Alex Sommers:

But employers are sort of I mean, their health plans are wrecked right. So the costs have gone up from $13,000 for a family of four for a premium and $13,000 to $26,000 plus this coming year without any access to service. So to me, that gets me up in the morning. That's the fulfillment piece. They talked about the Blue Zones. Talk with Dan Buechner is you know what's your purpose? So trying to develop a value-based ecosystem around that.

Alex Sommers:

So we developed a mental health practice it's integrative, collaborative model based on Washington's model 15 years ago into our practice to try to provide as much primary care and build the best experience that patients need to get health prevention, health maintenance, problem-based visits taken care of, really trying to encapsulate as much care as they possibly need 90% or so more in that ecosystem. And then bringing lifestyle medicine. And then we also have a lifestyle medicine in there. We also have a lifestyle medicine practice where we've done some diabetes prevention programs and some comprehensive health improvement programs with our partner Pivio.

Alex Sommers:

I've had some great successes.

Alex Sommers:

I know you've seen some of that on LinkedIn, and so now we're trying to grow that with other technologies and AI and build our tech stack out.

Alex Sommers:

So on the backside non-member facing we can optimize that whole value ecosystem to really sort of what we see is seeing the fruition like the best possible value per member per year cost an employer could see, which also is tied to value, quality over cost, and really develop that value-based ecosystem that I think we all want to see. You know that's the utopia. You know we hope we get there and, as you know as well, I've gotten involved with employer-sponsored health plan design and there's probably less than a handful of us that are physician health Rosetta advisors in the health Rosetta community, which is really sort of getting on the plan-facing side and designing health plans that really bring in transparency, data plan infrastructure, independent partners that are accountable to their own silo, and so everyone's doing their job, so everyone's rolling in the right direction, as PJ Fleck says. So I'll roll the boat together and hopefully we get to the outcome we're trying to get to.

Ellen Brown:

I know you guys have so many questions.

Ellen Brown:

Now I just want to make two quick comments and then let you guys weigh in on questions. Is one you know your statistic. You shared about the $26,000 for a family that's the total health insurance spend. But I think what really hit me about that study was 10 years ago right, when the statistic $13,000, even if you go back further it wasn't too much. Before that it was $6,000. And what's crazy is now just the personal portion of that, 24,000 is 6,000. So something that 20 years ago what we are responsible for right is at the personal level, not what the employer is paying for, is the same amount that the whole nut used to be right. So it's like this huge amount of burden, financial burden that's being put on us on top of the employer that's paying for it. It's pretty wild. And then the other piece is, as you know, I'm very intrigued and excited by the work of Rosetta. I think that has the potential to sort of help push us out of this benefit consultant HR space. That kind of keeps us from innovation, I think.

Dave Pavlik:

And collaborate together. I want to hear more about Rosetta, because I was thinking the same thing.

Alex Sommers:

I mean employee wellness programs are After listing, I'm trying to bring them here and bring these guys there.

Ellen Brown:

Yeah, well, I've been trying to connect with them too, so yeah, no because I mean you've taken it.

Dave Pavlik:

I mean applaud the work. Obviously, the employee wellness is one thing, but now taking it to the next level, writing it into the benefit plan, is a whole nother level. And the benefit plan is a whole nother level. And then what about beyond the employer groups, you know, non-employer sponsored Are you seeing any movement there? So I mean outside of employer sponsored health plans or like government payers or Medicare Medicaid. I haven't.

Alex Sommers:

I figured that if we figure it out ourselves, we'll externalize it to the government. That's the way I've seen other players that have gotten to that grand scale do it. So because the ecosystem is so ripe right now in the employer-sponsored space, I think you know, and the government kind of can reflect that. But you know, as I hate to say, as Keith Smith says, the government drives the getaway truck here. So you know, we have to sort of you know, reinvent things on our own and not wait for them to solve the problem for us. That's in front of us and so that's really. It's sort of like you know.

Alex Sommers:

You know this is about the person here and the clinician and lifestyle medicine conference and person to plan If you can optimize that ecosystem. Now we bring in blue zones to make the healthy choice, the easy choice, and it just becomes logical how you compound wins in from a personal level to a group in an employer space, whether it's, you know, a singular employer or captive, or or a captive or larger groups or coalitions. And I think if we start to work together, collaborating in those situations, we'll be more successful.

Justin Politti:

Can you speak to some of the financial savings that you've achieved thus far with the work you've been doing?

Alex Sommers:

Yeah, on the backside we're pretty data focused. I mean, I think everyone wants to see data, so that's really important for us, for our clients, so we externalize that to our clients in dashboarding and reporting. I work with a lot of good partners on the back side that allow us to really, on the channel, reach our clients to get high engagement for disease management, et cetera, et cetera. But we keep track of CPTs to the old trite and true AMA billing system and ICD-10s for multiple reasons. That's one of them is on the financial piece. In the ROI. Last year we achieved in our direct primary care model about $115, $120 per member per month savings just on the services we provided and procedures in our clinic office visits, labs, immunizations, imaging et cetera which far supersedes what was sort of promulgated by the Society of Actuaries when Milliman was commissioned in 2020 to do a DPC study where they saw an average across the nation in all flavors of DPC, about $60 per member per month savings. It's a double.

Justin Politti:

So yeah, yep, and also, can you speak to any of like unique, I guess, engagement approaches within the benefit plans themselves that you're, I guess, working with in order to, like I always viewed like wellness is like all right, is there a way that we can pay patients to, or members to, get healthier, right? So those not just hey, on an incentive of like a discount on the benefit plan, but other things that are, you know you're kind of thinking of?

Alex Sommers:

I think everyone wants to get healthier, you know at their core and we need that knowledge, and I think it's continuous learning.

Alex Sommers:

For clinicians and I know Ellen's really big into this too is the wellness space, and the wellness space by itself has a bad rap, and so I don't want to confuse wellness for lifestyle medicine. But you know, can we look at, you know, new biomarkers and things such as ApoB, LP, little a and other things that really sort of move the needle on health, prevent cardiovascular disease, lower the risk of cancer and dementia, cardiometabolic diseases and so on and so forth. So we typically have, we have a wellness program that we embed, and we believe that if it's in the continuum of the care and embedded in the clinic side, with the clinicians and the patients as sort of co-creating that environment, that wellness does become important when you measure the right things and you manage them. As we all know, measure what you manage, manage what you measure, and then you'll get the outcome you desire. So when you bring the continuum and build the ecosystem with wellness as part of that, I think you can achieve that.

Ellen Brown:

Yeah, so it's interesting you brought up the diagnostic component, because when Justin and I were out in health last week, we were with the team at Pranovo which a lot of people don't do or don't know about but full body scans and there's a lot of debate around that and we ended up in this really fun situation of we had Adam Carew, brendan Keeler and Graham Walker we were all together, justin and I were with them and we were just debriefing around health and then-.

Justin Politti:

Were they wearing mullets at the same time? They were, they were, and we were in a limo. I mean, it was really like-.

Dave Pavlik:

Hummer limo. Yeah, it really should have been there. They were in a Hummer wearing mullets.

Alex Sommers:

Yeah, it was pretty spectacular.

Ellen Brown:

Sorry, I let you down. Graham Disconnected, yeah, yeah, yeah. So, but we were having a really great conversation and it just ended up timing-wise that we all they just stayed and they were like we're going to jump in the conversation too. And so Dan Duran, who's the CMO of Pernuvo, we go way back with Dan, and so luckily he was like all right, I'm in, like we'll do it. But in that conversation what really struck me because obviously I wasn't saying much, which I know is odd, but Oddly quiet, which was-.

Justin Politti:

Yes, I was observing the whole thing unfold.

Ellen Brown:

But what I observed, which was really powerful to me, was the debate that was ensuing was actually stemming from kind of your point about wellness, about 3.0, which was we were debating the efficacy and necessity of those diagnostic tools like Pranova or like the level of testing that you're talking about you know, in blood markers Screening like Grail, Exactly Grail things like that and what was so fascinating, we were arguing against it.

Ellen Brown:

When we put the sick care, acute care system that we've built filter on it.

Ellen Brown:

It makes no sense. It's like why would I spend all this money to know that the system is designed to try and keep you alive and treat it when it happened, not the other. But when you took that away and said what's the best thing for the person? Is it better to know that you've got these things that are coming down the pike, that you know if we did something now it wouldn't be like that then, then the answer was totally different and it was so interesting to watch that like sort of ping pong. It's like, well, if I put my sick care hat on, then I have this answer. But if I step back and say, what if I didn't have to work in the construct that we've created? What's the best thing for the person? It really changes. And I guess I kind of do the economic parallel to DPC Say again, like if I just give democracy and you know and license for the person to for the treatment to happen the way it should, as opposed to on this RVU fee for service basis, it changes.

Alex Sommers:

For sure. Yeah, no, I think those are all valid points. I think you know, is it the personal level we're looking at which is part of that? Medicine 3.0, or the population health 40,000 view level? And that really is who's your audience, right, and that's I think you really have to resonate with when you make these decisions about the value of new technology or innovation and how it influences that sphere. But you know, of course, if we could predict the future in a crystal ball and knew we were going to get X, y or Z malignancy and those tests would have, you know, caught it at an earlier stage, we'd be all in. So I think you really have to look at the data.

Alex Sommers:

Unfortunately, medicine's a little slower than other industries and it's typically 17 years before we see adoption as standard of care in the industry. So that holds. I mean, that's good and bad, right. So we don't want to over-testing, unnecessary anxiety and things that will harm patients, but we certainly would love to find those things that make a difference and can really impact outcomes in a cost-effective manner. And then, really, as far as cost goes, I mean, what is it worth to you to save your life, a family member's life? So that's a very nuanced, complicated discussion, so that I don't have the answer to what was the answer.

Dave Pavlik:

Oh, there's not one, no there's consensus that there's the consensus differences of opinion. Yeah, okay, yeah. So no answer is the right answer?

Justin Politti:

No, but Alex is coming at it from a different viewpoint, but.

Ellen Brown:

I appreciate your perspective on it, like that's why I asked, like there's some people that just don't even think about healthcare 3.0. They don't even you know. It's like this is what, this is the lane.

Ellen Brown:

I'm in this is what we have, and but you're one of those people and that's why we connected was we're both, we both are really looking at how do we? You know, I think, like you said, like I've even moved from originally, I'm going to try and fix the system to really say like the system is the system and it's designed to do certain things, and, yes, we can make that system better in some ways, but we just really need a different parallel. You know we need another and it doesn't. I'm not. When I say parallel, I think people sometimes think I mean like these two completely separate silos, and I don't mean that, you know, it's just we don't have a function. That's why lifestyle medicine is so powerful, because it does address the root cause, which medicine doesn't do today.

Alex Sommers:

Yeah, it's complicated.

Alex Sommers:

I think you have to unwind and align the incentives so that everyone wins, and I think when you align personal stake, professional stake, the finances for all stakeholders, you get better outcomes right.

Alex Sommers:

And so a lot of people are trying to do the right thing in their wheelhouse, whether it's as an advisor, a brokerage, a health plan, a healthcare system but they only can play within the rules of the game, and I was there as an executive in the bureaucratic system. One of the reasons I left is hard to sleep at night knowing how we're making money and people aren't getting better and you're not seeing the outcomes you're hoping to achieve. And so I think you start moving in that value ecosystem, you can start to think of things in terms of how it affects ultimately the outcome of the audience you're working with, whether it's the individual patient at the bedside or it's the employer sponsored health plan. And then now we have the right conversation and can move the needle in the right direction for better health and better financial outcomes, which I think is what we're all want yeah, we all want to get.

Ellen Brown:

Yeah, so I will make a shout out. I think it's Dave with Rosetta, right, so we should have we. I'm going to, I'm going to make a plug right now that we need to have you and Dave Chase on the podcast. We'll do like a full episode. We'll really dive into this from all the way through. I think it'll be a super interesting conversation. It'll be exciting.

Alex Sommers:

I think they're doing great things and that's what drew me into that. We've been working in those types of plans in our business and you know I've done well, won some awards for some employers on innovation and transformational health plans, on costs and improved health metrics, et cetera. You know, and you know fun fact is my brother and I business have the only um two books written on employer sponsored health plan transformations in the country. You know. So, looking for more information and people want to learn more about Rosetta Dave wrote a book, the CEO's guide to the healthcare and um and restoring the American dream, and then um, the company that solved healthcare. John's arena is this book that was written on the serigraph model that my brother, um, helped them establish.

Ellen Brown:

And your books are the names of your books.

Alex Sommers:

And then the name of the book um the uh how to save your company.

Ellen Brown:

Okay.

Alex Sommers:

Um, don't feed the beast that matter road which the HR executive of Merrill steel, which is based on the Meryl Steele story that we helped design on the clinical side.

Ellen Brown:

Okay.

Alex Sommers:

Nice and we can get those books on Amazon. Amazon, if you reach out and connect to us, we can get you one.

Ellen Brown:

Okay, awesome.

Alex Sommers:

Autographed copy, I think.

Ellen Brown:

I really appreciate you coming on.

Dave Pavlik:

Yeah, it was great, thanks for being here.

Ellen Brown:

I look forward to trying to get that other conversation and just further conversation. I appreciate your thinking and thought leadership.

Alex Sommers:

I love the think tank and we need things like this to really move the needles. Thanks again, yeah yeah, yeah, awesome.

Ellen Brown:

Have a great day, all right, all right, see you.