The Future of Healthcare: “How our institutions can reduce the cost of healthcare” with Terry Rowinski, President of Health Payment Systems, Inc.

First and foremost, our country has fixated itself on taking care of sick people and building institutions and reward systems for how we care for the sick, not how we prevent people from getting sick. Some have suggested that the Western culture lifestyle of our work-life balance is a social impact to this and that the fact the we aren’t more European in our lifestyle choices then lead to unexpected (really, are they?) consequences such as a higher use of healthcare, psych services, etc.
Many practitioners of healthcare treat the symptoms and not the actual cause of health issues. I am personally a huge believer and advocate that you can’t cure the patient and you cannot really get into full prevention until you practice holistically around the social determinants of health — recognizing that conditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes.
While we see a fair amount of hospitals closing in rural communities and also even some major city systems collapsing, it is because they have not focused on revenue/expense parity in their delivery of healthcare coupled with the ways and means to bring the right talent pools into their midst to practice based upon what I have stated above. The government’s role in what it is or isn’t doing/supporting/defending in the ACA complicates all of this and we need to get a basis of stability in what the government’s position is and what it will be to allow the systems to calibrate and move forward — we can’t leave these folks flatfooted based upon the whims of a tweet or a sudden reversal of course — they are too big to be nimble and change at a whim

As a part of my interview series with leaders in healthcare, I had the pleasure to interview Terry Rowinski.


Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

I am the President of Health Payment Systems, Inc., a Milwaukee, WI based firm committed to enhancing the consumer’s health care payment experience via proprietary technology and business processes anchored in our product, the SuperEOB(r), which is presently experienced in Wisconsin’s largest independent provider healthcare (“HPS”) network for use by self and level-funded employers.

Our team fights for a better way to reduce the cost of healthcare for the consumer and the employer, while increasing provider reimbursement rates by engaging each party in making the consumer experience easy to understand and use.

Over the past 30 years of my career, I’ve been a part of organizations “fighting for a better way” in the business segment that they owned or participated in. From my own personal beginning, while earning my undergraduate degree as a finance and management computer system major, I started my career as a software engineer implementing custom electronic solutions for the supply chain logistics industry being on the leading edge of robotics and materials management. Doing this for 12+ years gave me a foundation in both technology and business process management. My various professional and philanthropic roles have taught both sides of my brain to use hard data and facts combined with learned emotional intelligence and finesse in both how to listen and learn, and lead — whether it be retail, e-tail, process manufacturing or other business industries, the application of working with and leading teams to achieve and solve significant business issues by finding and “fighting for”, a better way is what has personally motivated me.

Can you share the most interesting story that happened to you since you began leading your company?

As a leader in other companies prior to joining HPS, I understood the impact of healthcare expense to my companies bottom line and also, health and wellness activities to create countermeasures to social determinants of health. What I had not understood until joining and leading HPS is just how “broken” the American healthcare ecosystem is in terms of the numerous conflicts created around both principals, financial and health and wellness, amongst those charged with keeping us from becoming ill or caring for us once ill.

When I define brokenness in healthcare finances, you have at least four major parties all appearing to operate in conflict of the patient and its best results; providers of medical services who are either employed by heatlhcare systems or practice independent medicine, the insurance entities (companies, brokers, etc.) who create the health plan, employers who are charged with a fiduciary duty to give their employees the best benefit plan possible while not breaking their own company budget, and then the ultimate consumer/responsible party for payment of healthcare. In very few instances do all of these parties share risk or work towards the proverbial win-win financial and health outcome. In Wisconsin, this is even more exaggerated as our state shows itself to be consistently among the top 5 on a cost per capita ranking with great quality. How to push/pull levers to reduce cost while maintaining or increasing quality is the holy grail.

Can you tell our readers a bit about why you are an authority in the healthcare field?

Myself and my team at HPS are influencers in our present market (Wisconsin). Because our company sits in the middle of the parties discussed above, we often work outside our tradition hierarchy within our own company and therefore use numerous skills and relationships (i.e., networking) to bring constituents together around new ideas and projects.

I have surrounded myself with diversity within my company and outside of it that makes my own personal circle of influence in healthcare. Diversity removes hidden bias but confronting it and allowing me to take ownership of well vetted ideas and allowing me to present myself as a rounded leader.

I have owned complex healthcare and health and wellness plans within companies that I have past managed. I and my team members have “experienced the mess of healthcare and now, here at HPS, have the opportunity to craft and refine the solutions to that mess”.

What makes your company stand out? Can you share a story?

Our company believes in our “Why” and lives it each and every day. Simply put our mission is, “to enable those who wish to pay for their healthcare, a simpler and trusted way to do it”. Notice that we are NOT trying to say “to get everyone to pay for their healthcare” as we believe that the consumer must be educated and participate in understanding who they owe what and why. This is where the simplicity of the HPS ecosystem delivers on its promise.

For the past 10+ years, HPS has created and delivered products in the healthcare marketplace that can be used to balance the playing field and create a positive relationship between the provider/system, insurance company/broker, employer and employee by creating a shared vision of patient financial wellness to allow the medical community to concentrate on patient health and wellness.

In the past 10+ years, HPS has processed just more than $2B of medical claims through its ecosystem here in Wisconsin, with just over $235M of member (patient) responsibility through our SuperEOB experience. We have built a technical architecture chassis in which we exchange data and money between the constituents discussed above and in doing such have created an open ecosystem for many to participate in.

At present, we hold six federal patents and one continuous filing patent protecting the product concepts, technology, and business processes described above.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

We are stepping into the broken healthcare ecosystem that exists today that places providers/systems, insurer/payer, employer, employee and their dependents at odds with one another related to payment of medical bills. This alone is an inspiring task.

As we evolve, based upon the economic model that we run and how we engage the consumer and get them to pay much more than the average provider/system collects, we have shown the ability to drive the cost of healthcare down as providers are seeing savings (hard cost) and better cashflow (more and faster) which then allows them to be more profitable and share that with the employer and consumer. Imagine a day where we can do that on a massive scale, more than just what we do in Wisconsin — how great of a victory to actually bring a consumer financial wellness product to market that actually solves for a large issue such as this.

Are you working on any exciting new projects now? How do you think that will help people?

With this year, there are number of strategic focus points that our team is focused on. First, the continued growth of the value of our provider panel (network). We look to add in new providers of medical services, companies that can help the consumer see quality and cost (i.e., transparency), and also push value-based payment methods into our ecosystem.

Second, we are looking to launch HPS Consumer Experience 2.0 in a multi-year rollout bringing additional user interaction points (receiving of the SuperEOB document, viewing medical claims, viewing and paying for their monthly bill (via the SuperEOB), engaging with a consumer advocate, etc.) using new UX/UI initiatives that span traditional e-commerce interactions found in retail today as well as bringing our own AI initiatives into this space to tailor individual experiences.

What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)

  1. Healthcare is broken at its core and it can be fixed but it will be hard. Basically, our companies’ reason for existing and our Why.
  2. The road to success should have road signs on it stating “potholes are like failures, at times you can maneuver around them and avoid them entirely, at times you have no choice but to drive through but in the end, the worst that happens is that you need a realignment moment to regain your ‘center’ direction and move forward”. As a continuous startup we daily encounter the unknown in an industry that one would think is the most “together” in how it records what happens to people when undergoing medical diagnosis or treatment — people put that information into computers and as the adage goes, “garbage in, garbage out”. It’s the garbage that happens that does not allow us to deliver on our promise and we need to be more diligent about building intelligence into our solution sets to fortify our user experience to both keep garbage out but also get rid of it once it’s in.
  3. Rules truly are guidelines and if you don’t bend and brake them, you never truly will innovate and be able to create new rules. Certain aspects of our business are regulated in the data that we hold and how governmental authorities state it can be used — HIPAA, PCI, etc. When a company like ours is “all in” on helping those who are regulated by those rules improve what they do and how they do it, you occasionally need to figure out how to create new rules and then, get buyoff from those that are only interested in enforcing the old.
  4. People actually do want to pay for what they consume, healthcare is no different, the industry has just made it so. See #1 above.
  5. 85% of communication is listening. I’ve seen quotes with different percentages around this all over the web and in various “selling” courses that I have taken. My point of view is to be the best leader and best partner you need to listen to what your team members, your customers, your partners, the industry, etc. are saying. The next 10% is using wisdom and discernment to ascertain what it actually means, the last 5% is then taking action through communication outward in all mediums. Too many people these days are caught up in the “I need to be in the limelight, listen to me” mentality that while they may have a valid point to share, they miss delivering that point in a context that their audience can relate to and understand and in such, lose their effectiveness and just become “noise”.

Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

First and foremost, our country has fixated itself on taking care of sick people and building institutions and reward systems for how we care for the sick, not how we prevent people from getting sick. Some have suggested that the Western culture lifestyle of our work-life balance is a social impact to this and that the fact the we aren’t more European in our lifestyle choices then lead to unexpected (really, are they?) consequences such as a higher use of healthcare, psych services, etc.

Many practitioners of healthcare treat the symptoms and not the actual cause of health issues. I am personally a huge believer and advocate that you can’t cure the patient and you cannot really get into full prevention until you practice holistically around the social determinants of health — recognizing that cconditions in the places where people live, learn, work, and play affect a wide range of health risks and outcomes.

While we see a fair amount of hospitals closing in rural communities and also even some major city systems collapsing, it is because they have not focused on revenue/expense parity in their delivery of healthcare coupled with the ways and means to bring the right talent pools into their midst to practice based upon what I have stated above. The government’s role in what it is or isn’t doing/supporting/defending in the ACA complicates all of this and we need to get a basis of stability in what the government’s position is and what it will be to allow the systems to calibrate and move forward — we can’t leave these folks flatfooted based upon the whims of a tweet or a sudden reversal of course — they are too big to be nimble and change at a whim

Lastly, for me, the for profit and non-for-profit healthcare systems and the large insurance companies are too focused on their financial return to “investors” and as we have read all over the news, healthcare stocks are at record highs as the cost to the employer and consumer are also at record highs yet our total healthcare outcomes are not — what’s wrong with this picture? I don’t advocate more regulation or anything that harsh however, what if the market valued companies based upon healthcare outcomes versus membership or revenue, what if the non-for-profits were subsidized by the for-profits for addressing population health?

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

  1. Evolve quickly to a two-payer system; one supported by the government but run by private industry for the mass populous that moves us towards more of a single payer approach to truly care for the underserved and underprivileged focused on social determinants of health and wellness. The second payer is for companies and individuals that wish to differentiate their populations healthcare experience with more concierge services such as on-site work clinics, in-home care, etc. — not elitism care but different access channels that matter.
  2. Legislatively enact the national healthcare record/patient id. The above will obviously help in making this take place but to truly allow for coverage and access and advocacy for the patient, we need to be able to track and understand the patient at all facets of their life journey and make their patient records portable to take with them into the “world.”
  3. Require full cost disclosure laws in all 50 states that allows employers and individuals to understand the costs being borne to them as a part of servicing their health and wellness and healthcare needs — healthcare systems/providers, insurance companies, brokers/consultants, and even 3rd party providers that are “elemental” to the success of healthcare.
  4. Adopt Lean management as a method for process improvement, which is an example of disruptive innovation because it takes a new approach to improving care. Lean principles of process mapping, eliminating non-value-added steps and simplifying practices are based on the Toyota Production System and methods used in the manufacturing industry. By adapting this approach to healthcare, many should be able to, like other industries, make significant improvements in quality of care and cost.
  5. Enable the education of providers of healthcare to be done at nationally recognized centers of excellence (educational and health complexes) at a far reduced cost to the student; don’t burden them with so much debt to the point that it crushes them coming out of school or, dissuades them from ever seeking the vocation.

Thank you! It’s great to suggest changes, but what steps would need to be taken? What can the individuals, corporations, communities and leaders do to help?

In my opinion, the key is partisan focus outside of political affiliations to solve for the fact that our healthcare and educational systems are in need of a redo — to simply say that we must work better together is cliché and overwrought with emotional conflict however, it is just that which needs to happen. Each participant in this ecosystem needs to act with a fiduciary duty of focus and care to understand just how broken the present healthcare system in America is and realize that “the other person” is not going to be the ones to change it, that it takes all of us.

Individual leaders within companies, communities and the like need to start at the micro level, within their own backyard to begin the evolution that is needed by giving focus, money, and capital intellect to solving the issue. Take the learnings and expand outward from there with representatives at the local and state level charged to bring learning and wins of best practices and outcomes up to the federal level to then evaluate alternatives, model, and pursue alternatives to move us to solutions discuss earlier. A top down macro to micro implementation just won’t work — the problem is too big to do a “jam down”.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

https://thefutureishere.economist.com/healthcare/

I feel that this is a very objective non-political view of what is happening and what could be happening within healthcare across many different facets and disciplines of healthcare. Thought provoking and ideation.

Being Mortal: Medicine and What Matters in the End by Atul Gawande.

Having lived through the passing of all of my grandparents and now my own two parents, as well as having incidents of chronic conditions in my own family, I need this reminder almost annually on quality of life versus sustaining life for the sake of science as well as the higher calling of my faith believes that impacts all of this.

Modern Healthcare Blog via www.modernhealthcare.com

I believe that this is a great :60 review of what’s happening in a consolidated fashion that I can remain headline relevant and dig deeper on the topics that are of interest to me.

https://thehill.com/policy/healthcare

While not 100% non-partisan, it does have relevant insights and brings awareness of events within healthcare that are happening across all 50 states into a web experience. I often then go and use Google to search on the topics that are of interest to me to find other releases or articles from differing points of view.

Twitter #healthcare

I have this as one of my saved searches for relevance within Twitter and much like the above, a very large smattering of content (video and copy) that I can then drill deeper on if I wish. I access this from my phone when waiting for others during the day in meetings/appointments, to decompress, etc.

How can our readers follow you on social media?

Find me at:

LinkedIn: https://www.linkedin.com/in/terryrowinski/

Twitter: https://twitter.com/terryrowinski / @terryrowinski

Find my team at:

https://info.hps.md/blog

LinkedIn: https://www.linkedin.com/company/health-payment-systems-inc-

Twitter: https://twitter.com/HPSOneBill / @HPSOneBill

Thank you so much for these insights! This was so inspiring!