Six Degrees Health - Risky Benefits S6E2

Employers are fighting rising healthcare costs, and this week’s guest breaks down three powerful tools that actually move the needle. We sit down with Heath Potter, Chief Growth Officer at Six Degrees Health, to unpack reference‑based pricing, payment integrity, and member advocacy in plain, practical language.

Heath shares how RBP replaces inflated PPO discounts with fair benchmarks—often around 140% of Medicare—helping plans cut medical spend by 25–40%. He also digs into the 18% claim error rate hiding in the system and why pre‑payment review on large claims is essential.

You’ll hear how self‑funded employers can structure their plans with TPAs and stop‑loss, how provider education and single case agreements smooth the process, and how balance bills are typically resolved through negotiation rather than escalation. Plus, why facility claims are where the biggest savings live.

A clear, actionable conversation for anyone looking to take control of healthcare spend.

To listen in and subscribe to more episodes, visit our website: fbmc.com/podcast.

Transcript

rick-farris_1_04-15-2026_120830 0:00

Hey, everyone. Thank you for listening to Risky Benefits, the show where we dig into the world of employee benefits, what's working, what's broken, and what's next. Today, we are thrilled to have Heath Potter, Chief Growth Officer at Six Degrees Health. They're helping employers take a smarter, more transparent approach to managing healthcare costs through reference-based pricing, payment integrity, and advocacy support. So without further ado, I'd like to welcome Heath. Heath, thanks for coming on today. And, maybe before we get started, why don't you just tell us and our listeners a little bit about yourself and then how you ended up on the cost containment side of healthcare?

heath_1_04-15-2026_090830 0:38

yeah, pleasure to be on. So I don't know how far back we wanna go here. I guess we can start with myself. Heath Potter, chief growth officer. Been in the cost containment space since, two thousand and three. I, actually came out of the dot-com bust or boom. I got to play both parts of that. But in the process, met a guy that, happened to be neighbors with somebody that was building a transplant centers of excellence company. And they had like a staff of five. They needed somebody to to sling transplants to the stop-loss community out there. I didn't know much about it, but he liked my ability to sell, and so they put me through the training process, and we grew that company you know, to pretty good size. And in the process hired a guy named Scott Ray. And Scott and I became friends. Uh, he was the chief legal counsel for that company. I ended up running sales. And in twenty twelve, uh, Scott kinda had the Jerry Maguire moment and asked me to help him with his fridge out of his office. He's-- We're gonna start our own company. And broke away saw an opportunity in the reference-based pricing area and I can get into kind of what we did with that, kind of changed the landscape. But that was back in twenty twelve. We started Six Degrees, and, uh, it's been a phenomenal story ever since. And that's where we are today. So I've been with two companies helped build both from a sales and revenue perspective, and that goes all the way back for twenty-three years now. I remember when I used to be the youngest kid in the conferences, and now I wish I could push pause. But it's it's been a good, good career.

rick-farris_1_04-15-2026_120830 2:07

Heath, I'm noticing you have a lot less gray in your beard than I do, so either you're just

heath_1_04-15-2026_090830 2:12

depends on, which direction of it. Yeah. Well, yeah, eat-- I eat a lot of salmon. I like my salmon fishing, so maybe it's the omega-3s are keeping me young.

rick-farris_1_04-15-2026_120830 2:22

That's cool. So I noticed you got three basketballs going on behind you. What's the story on those?

heath_1_04-15-2026_090830 2:28

so one of them I actually won at a college basketball game signed by the, like, what was it? '90, early '90s, the Drexler era of the Blazers. My mom helped coach with Clark College, and we were there, and there was a raffle, and I, I won that thing. So that, that one's legitimate. The other two are, uh, I will plead the Fifth on, but we used to have season tickets for the Blazers, Scott and I did, and we did them for the office. And then the year... last year, they were in the Western Conference finals. They we traded the four tickets that we had for the office for some courtside seats that Scott and I used for the playoffs, and it was a ton of fun. Short-- try and shorten the story up. So my wife went to go to the bathroom and, you know, down in those seats you're, you get mingled in with all kinds of people. And she didn't come back. And so finally, the game gets over. We were getting our butt kicked in that game. And I can hear all this giggling in the bathroom, and I was like, "Hey, is there a lady by the name of Afton Potter in there?" I'm like shouting through the door. Most of the s-stadium had cleared at this point. And you hear some more laughing, and it was my wife had made friends, like, with all the Blazer moms. So it's like the mothers of the Blazers, and they're all in the bathroom together. And so we get invited to, like, the post-game hangout, meet and greet the Blazers and a party, which they weren't very, in a very good mood because we'd lost. But we ended up going home with a couple basketballs, and so that's what the other two balls are up there. But

rick-farris_1_04-15-2026_120830 4:00

That's pretty cool. Okay.

heath_1_04-15-2026_090830 4:02

yeah. Yeah.

rick-farris_1_04-15-2026_120830 4:03

big Blazers fan it sounds like.

heath_1_04-15-2026_090830 4:05

Well, they finally got into the playoffs last night. It's been a tough road, but I've also got some-- My sons play travel baseball, so I've got a couple of their tournament balls and rings up there. Over here, I've got a football signed by the Oregon Ducks back in the 2000s. Our family's pretty close with some of the Ducks supporters and coaches, and my dad had an accident. Actually, this is kind of how I got into the healthcare space. Broke his neck, became a quadriplegic, and the whole team, the University of Oregon, if you know what was Pac-10 football. Remember Oregon signed that ball, and then another friend of ours was quarterback up at UW, and the University of Washington signed another ball. So my brother has that ball. I've got the Oregon ball. But that accident was really one of the motivating factors to get into the cost containment space and has really driven my fire to make this a success, Not just for, you know, the employees that I have, but for all the families that we can impact to, to keep medical costs down. 'Cause we are fortunate with my dad that my family was in a position to, to manage that financially. But you look back on the impact, the cost impact that just bankrupt families. And so I've kind of been on a mission to, to help alleviate some of that pain through the different programs that we've been involved with, whether it was transplant, payment integrity you know, and reference-based pricing is probably what most people on this podcast wanna hear about. But it is the single biggest thing you can do to lower your medical expenses, reference-based pricing.

rick-farris_1_04-15-2026_120830 5:36

Well, so I appreciate that, and thanks for the candor. Heath, it's always nice to know who you're dealing with. And as for the people who are listening, y- it's quite common actually that when you talk to people, there's some kind of an event or something that happened in their life w- when they got into healthcare. And then there are some who just kind of happened into it, but it is pretty common to hear stories like you know, something happened with a significant other, and then people wanted to make a difference. And I always find that those people have a tendency to just really care, really devote their life to it. And so I love hearing that about you. I'm sorry, obviously, for the event that caused it. But let's jump into it. I mean, you said it, referent-based price, reference-based pricing is one of the top ways to contain costs. And I think a lot of people hear reference-based pricing or, for example, payment integrity, and their eyes glaze over 'cause they're like, "I don't-- What are, what is he talking about?" And so today we've got the opportunity to kind of remedy that. Maybe if you don't mind, in plain English, what does Six Degrees Health do?

heath_1_04-15-2026_090830 6:37

Yeah. So a couple pieces to this puzzle. The reference-based pricing side of the business uses a different way of determining what the proper reimbursement would be. So, traditional health plans run on a PPO or carrier-based network, and those are flawed for many reasons, and I don't know how in-depth we wanna get today. But you're basically taking a percentage off of a billed charge based on a contracted rate to determine what should be paid. And that percent is gonna vary depending upon which network you're associated with. I've always attributed network discounts to like furniture sales. You know, you can-- anybody can give a big discount if you can determine the price that is, is paid and what is billed. So the hospital systems, without transparency, can set any price and thus make a fifty percent discount seem like a good deal on paper, but the reality of it is you're still way overpaying. Reference-based pricing uses a different benchmark to determine what that proper amount would be, and that's something that, you know, not just us or we have competitors out there that do this work too, but we'll determine through the use of Medicare if those rates are available or other benchmarks, and then pay a premium above that, typically a hundred and forty percent of Medicare. And we found that to be widely accepted around, you know, ninety-eight percent of the time. And then there's ways that we handle those that aren't accepted through negotiations. But in the end, that will reduce your overall medical spend by, depending on what state you're located in, anywhere from twenty-five to, you know, forty percent. So fairly significant. The other half of the company does Paymentegrity. That is a prepayment negotiation or not so much a negotiation, but determination of what the proper reimbursement would be. And most of that work is done in the regional healthcare space. We do a part of our RBP product includes that, but on average, there's about an eighteen percent error rate on every single claim that's out there. So we do that work on large claim, you know, think hundred and fifty thousand dollar claims or greater. But you know, you start getting up in those million-dollar claims, which are quite frequent today, eighteen percent's a pretty significant number, so.

rick-farris_1_04-15-2026_120830 8:53

Yeah it's interesting just-- And for the listeners out there, to elaborate a little bit more on what, Heath, what you're talking about. It's like, I don't think people realize, but like every hospital has what's called a ch- cost to charge ratio, and that cost to charge ratio fluctuates on how many beds are filled in, say, a given day. So one might say, "Well, like, why does the, why is the cost changing?" Well, it's changing because they're trying to get people to come in, just like any other person who's trying to attract people. But what's interesting about that is, is they have what's called a charge master, and that charge master is fluctuating, so it becomes like this black box that nobody can understand. So the relevance of what, Heath, like you're saying to producers out in the market, brokers out in the market, employers out in the market is Medicare is like a baseline. Like it d- like we know what it is, and it's not fluctuating. So for-- It's cost plus, in essence. What you're saying is you're gonna come in and you're gonna say, "Okay, it's 40% above baseline." And that makes it so that everybody knows apples and apples exactly what they're getting charged. Whereas in another place, you could pay $30,000 for a knee replacement at hospital A, and you could pay $60,000 for a hospital at-- or for a knee replacement at hospital B. And that's largely because the cost to charge ratio is different from one to the other and what they're trying to do to get more people to come in.

heath_1_04-15-2026_090830 10:13

Have, you could even have the same surgeon at both hospitals and have that variation. And it's not tied to quality or anything. In fact, you know, if you look at Medicare, it's supposed to be relatively cost-neutral for a hospital with about an eight percent margin in it. Now, that's if the business was run appropriately. And unfortunately you know, our current system does not incentivize appropriately run systems, you know, because the lack of transparency. Your consumers aren't, you know, going on a pick list or the internet and saying, "Hey, here's the best quality hospital. Here's the-- what they're gonna charge me." That, that information is not easily available. You know, whereas if you were buying a TV, you could go online and compare Sony and Samsung and everything else and see that at this store you can get it for this price. And you have a much more educated consumer, and that lack of transparency allows these systems to take advantage of people. And you're not picking where you're going when you just, you know, snapped your leg in the, you know, the middle of your vacation, right? You're forced to go where it's available. Yeah.

rick-farris_1_04-15-2026_120830 11:17

Right. Well, so talk to us a little bit-- that's great as far as setting an under- a general understanding for Six Degrees Health and the services you're providing. healthcare pricing is famously murky and based on the conversation we just had, somewhat inconsistent. W-why are the-- or what are the biggest problems you see in how claims get billed and paid today?

heath_1_04-15-2026_090830 11:41

A lot of times you don't have people looking at these things, so you're, you build this arbitrary price and a administrator will push that through because they don't wanna disrupt the network agreement that they have that doesn't allow them to audit it, and things just get paid. And that's where our programs, whether it be Payment Integrity, which puts a pause And reviews that claim to make sure it is actually billed correctly. If you were billed for five screws, that indeed that procedure requires five screws. And again, there's an eighteen percent error rate there. Or reference-based pricing applies a whole new methodology of determining what is the proper reimbursement, but it also gives you a pause button to determine, you know, is this an appropriate claim. And those are-- that's a big shift in how things are done. And going back to the typical billed versus paid, since Obamacare took place, although I think the intentions were, you know, I think they had good intentions when they set to do that. But what it did is it took away lifetime maximums, you know, for the benefit of the patient and benefit of the member. But when you take away lifetime maximums, if you look at the correlation, all of a sudden you see these huge billing practices, right? 'Cause hospitals recognize that they can no longer be capped for care, so you're-- they just keep driving the billing up. The other thing that took place was the ratios that were set for revenue. The only way to make more money was to allow hospitals to bill more because you can't have a ratio that's further apart from the billing practices. So those two things alone have really escalated what we see today, and reference-based pricing goes against all that. It allows us to use that Medicare rate or some other benchmark, not the fluctuating billed charge, to determine what the proper reimbursement is. And that's where we step in.

rick-farris_1_04-15-2026_120830 13:39

That's awesome. Eve, can you talk to us about how your model works in practice? I mean, the ecosystem that your model functions within as-- and I'll give you example here. So self-funded, I'm assuming there's a TPA that's operating, and that's what makes kind of an employer able to take advantage of this process, 'cause now you can pull apart the program, you can build out your network instead of using like a P-PHCS multi-plan or whatever and then you can kind of parse your pieces into the program. guess when an employer uses Six Degree Health, like what changes in the claims process, in the member experience, and in how everything's set up?

heath_1_04-15-2026_090830 14:23

Yeah. So let me-- I'll start from the ground level here. You can do reference-based pricing in a couple different fashions. I mean, you could replace the entire network and just reference-base everything. But more traditionally, what you will see is a form of a physician network used for the physician side of the claim and then reference-based pricing for the facility side of the claim. And that has become the primary practice that you see today. And, you know, for us, we have our own internal physician network that can be used. We call that Pro Plus. But we're fine using other alternatives, and you'll see some regional ones that are out there. PHCS, you mentioned they have a physician network. Traditionally that was open to everybody. It is a little more closed today where it's being used with just a single or a couple different RBP vendors. There's a couple other more nationally known carriers that are out there that have opened up their physician network. I don't know if I can use their name on air, but they're definitely something you would recognize on your card. And that's the biggest thing that, that people face is when you go reference-based pricing, you do lose those big network names like Blue Cross, United, Cigna, Aetna, for example. And you have a Six Degrees, although we're quite well known in our world nationally compared to a United Health you know, we're not as well known. And so when that person at the front desk has somebody show them that card they may not recognize it. And so there's a lot of education that we have to go through to help people understand how to explain this program or who to call. We will actually have that conversation with the person at the front desk to get them in. But and then the other thing that we're seeing with these are like a dual option. So on bigger health plans you can run a reference-based product for employees that select it, and you could run a PPO for employees that select that. You just set the benefits slightly different so that you incentivize to reference base because that's where your biggest savings are going to come. And you'll s- typically see about a seventy percent selection rate on RVP if it's done correctly. But going back to your initial introduction to this, you do have to have a TPA, so you're gonna be working with self-funded plans. That TPA, and you're gonna have stop-loss. You're gonna have either a Six Degrees component, like an RVP part into this, or you may have some other physician or full network as a part of the dual option slice. You've got your PBM. So you are creating in, in, in essence, your plan. You know, this plan is designed for you and your members. You're not having somebody tell you what that plan is, and that's part of the beautiful piece of this is it becomes yours, and it will grow with your plan. So as we are working with you from a reference-based standpoint we'll keep adding contracts or negotiations and things that help support your membership for the care that you're seeking for them. So it really is a nice customized approach that you take, and in the end you're saving those dollars. And if we wanna walk into what that member experience looks like, I can, or I can pause here if you have any other questions about what I touched on.

rick-farris_1_04-15-2026_120830 17:34

I mean, just a basic question, like how does the provider portal work?

heath_1_04-15-2026_090830 17:39

So, if you're using our Pro Plus program, which is the physician side it would look and feel much like you see today, where you could go through and select on an app or online, you know, your physician. You can see you could put in there the area that you live or the area you're in and the care you're looking for, and it will show who's contracted, who is RBP approved. You would also see in there if somebody's not actively working with us for reference-based pricing, you would see that warning as well. And it doesn't mean you can't get care there. It just means we probably are gonna have to pick up the phone and have a conversation with that facility before you walk in the door.

rick-farris_1_04-15-2026_120830 18:17

you do like a single patient agreement or something?

heath_1_04-15-2026_090830 18:20

We do a lot of what we call SCAs or single case agreements. Those are typically done on planned procedures. So ER and emergency care, they have to accept you. You go in, they're gonna take you, and we'll reprice the claim accordingly. On planned procedures or ongoing care, that's typically where you'll see us get involved with negotiating something in advance, and we call those SCAs or single case agreements.

rick-farris_1_04-15-2026_120830 18:45

Okay, that's cool. No, that was it. I mean, go ahead and move through. I-- That, that answers most of it for me.

heath_1_04-15-2026_090830 18:51

Yeah. So that member experience as I mentioned earlier, is gonna be a little bit different than, you know, what people are accustomed to. Now, many people like it. I'll use the example of my... Well, I guess I'll use my wife as a couple examples here, but she had gone-- she was a ph-- or is a physician. She'd gone to school with somebody that she deemed to be the only person acceptable to be our kids' pediatricians. And back then Six Degrees wasn't big enough to be self-funded, so we were using a regional network out in the Northwest, and that physician was not a part of that network. So that makes it out-of-network, which makes it expensive, right? And once we went reference-based, once we moved our whole plan to our own product that became an available option. So we were able to go in, our kids were able to see that physician and it's a huge win. You know, you have that expanded ability to have an open access model. And it, it just works really nice. So, the downside that you could run into from that Would be they could say, because you're not contracted they could say, "We don't take this insurance," right? It's usually because they don't understand it, not that they won't take your money or they won't take your care or give you care. It's because they don't understand it. So our member advocacy team engages with physicians and hospitals to make sure that can be explained appropriately so your members get in the door. So we have a whole team of people that do contracting and outreach prior to prior to the person going in to, to get their care to alleviate that.

rick-farris_1_04-15-2026_120830 20:23

Yeah. No, that makes sense. Do you have any-- Last question I have on this. Do you have any steerage components built into your provider directory or, you know, green, yellow, red? Are you building it, connecting it to plan design and copay structure?

heath_1_04-15-2026_090830 20:39

So we do we do indicate who is contracted. We do indicate who is RBP friendly. So we have a algorithm that calculates, you know, the, this number have been accepted with no issues. And we do indicate if they push back, you know, greater than five percent of the time. And those are all indicated in that, that MetaV app tool that allows members to, to look those things up. We do not require steerage. That would be something that would be built into the plan design that would be handled by an organization such as yourselves. And some of that comes in the form of concierge or medical management or, you know, all those things that can be built into a self-funded plan to get them to where care should occur. But we ourselves are not requiring that.

rick-farris_1_04-15-2026_120830 21:28

What about pre-negotiated terms with stop-loss carriers just based on your standard discounts?

heath_1_04-15-2026_090830 21:34

Yeah. So we'll see on a typical plan, you're probably you know, anywhere from... and I say the variability because each state you'll see different billing practices. You know, California, for example, bills at a much higher rate than Oregon. And so your savings that come from reference-based, because it's no longer tied to bill charges, it is tied to a Medicare reimbursement rate with a premium built into it. Because of that, you'll see big swings in what your t- what your savings would be from bill charges. So it can be anywhere from, you know, twenty-five percent to, you know, pushing the high forties. Stop loss loves reference-based pricing because of that component. Now, the other thing stop-loss is taking into consideration will be the fee structure of the RVP company that you're working with. We typically run a PEPM but we will do a percentage of claim for those that want that variable risk. A lot of our competition run a, what they call a percent of claim or a percent of build. So that works out well if you don't use the system, but it does not typically work in your favor if you're having a lot of care take place. And so we can run a full analysis for a plan if they're looking at us at how those fee structures would work out. But stop-loss looks at that because if you're doing a percent of claim on the larger claims, that gets absorbed by stop-loss. Now, that might sound sexy, but it's like crashing your car because you have insurance, right? You will pay for it. So, those are things that they're building into their underwriting. But as a whole, whether you're using us or one of our competitors, stop-loss is gonna be preferential to RVP over a traditional network. And you might see anything from twenty to, you know, twenty-five percent reduction in your stop-loss.

rick-farris_1_04-15-2026_120830 23:21

Okay. Let's address the elephant in the room with the-- with reference-based pricing, right? It's like employees, HR departments, there's always a perception that con- cost control means reduced access or member friction. you respond to that, and what safeguards are in place for members?

heath_1_04-15-2026_090830 23:40

So, i-it's funny, HR probably is the one that pushes back the most 'cause it-- i-in their mind, they see additional work that might need to be done, right?

rick-farris_1_04-15-2026_120830 23:51

Yeah.

heath_1_04-15-2026_090830 23:51

And the reality of it is they should also be the ones that love RVP because it's opening up opportunity for paychecks and putting people on plan and expanding the plan and all those things. So that's the upfront education that you have to do as a part of you know, the sales process. The CFOs, you know, they love the numbers, so they'll see this and be like, this is great." But helping find comfort at the HR and across the entire executive team that this is going to be something that helps with retention, this is gonna be something that allows them to create a more beneficial health plan that attracts employees is our job to do that or in, in conjunction with you and your team, right? And that can be done, but not everybody gets over that hump 'cause they see the-- they get scared about somebody, you know, having an access issue or a balance bill or something. But when you look at the national statistics, you know, there's about a seventeen percent balance bill rate on network plans. We're running anywhere from two and a half to five percent. on a 63 plan and you have somebody that's going to jump in and assist. You don't have anybody to help you on traditional plans. And so it's that education piece that you have to help people through. But typically it's the dollars that, that really make that difference, you know, where people can see that we're gonna, we're gonna be able to keep our health plan. We're gonna be able to avoid the eighteen percent increase every year. I mean, I had a plan last year that had a ninety percent increase not on the 63 plan, but they were coming from a traditional,

rick-farris_1_04-15-2026_120830 25:25

Right.

heath_1_04-15-2026_090830 25:25

network plan and they said, "We can't keep-- We can't afford to keep doing this." And when you start to save, you know, thirty percent over, over the year prior and you flatten that curve, you're not getting increases. You're not getting seventeen percent increase every year. You're seeing maybe a half percent, one percent each year over year. That is real money. You know, that's the second largest line item next to payroll on your expense sheet. So, you put that money back into your company, put that money back into your employees go from a single covered entity to a family covered entity. You know, things really impact people's view of your organization.

rick-farris_1_04-15-2026_120830 26:03

Heath, the-- one of the questions I wanted to ask you is when I think about provider conversations, it's like there's kind of two points that happens. It's at the beginning of the relationship, generally, there'd be like a geo access report or a disruption report which you're well aware of. And then later on there's, "Hey, I need this," and then we wanna contract them in. a general rule when somebody starts with you, how do you start with the base of the network? And then when you need modifications after the fact, kinda how do you navigate into that? And th-that was where I was gonna start.

heath_1_04-15-2026_090830 26:36

Yeah. I've always said that we have all the tools that is necessary to make a successful health plan, and you don't know necessarily which tool you're gonna have to use 'cause it, it varies from state to state, city to city, to employer, right? Everybody's risk tolerance is a little bit different and we have to approach each client as its own unique entity and get them what they're looking to accomplish. For some, that is access. For others, it is pure savings. And so our program is designed to provide that service for all. You know, if your intent is pure savings and you're less concerned about people having to go to the provider across the street because one doesn't accept and one does that's a different plan than somebody that comes into this and says, "I don't ever wanna have somebody not be able to go see the doctor that they wanna see." Right? Which I don't think is a great strategy to take, but we can come close to providing that by increasing the thresholds in which we can negotiate and/or reimburse a hospital system. And that's the beauty of reference-based pricing is it becomes your plan. You're not being told how that plan's gonna run, and you can give us permission to reimburse a little bit higher when needed to get somebody in the door.

rick-farris_1_04-15-2026_120830 27:54

Sounds good. Can you give some insight into how you guys handle just in general balance billing?

heath_1_04-15-2026_090830 28:01

Yeah. So balanced billing for us, and there's variability a- amongst the different vendors. And I would say that the biggest variabilities amongst the different vendors when you're evaluating them will be how do you handle access issues? Are you willing to contract? How do you handle balanced billing? What's your approach there? And then the other is the amount of services employer-employee touchpoints and contracting that come with all these things. So those are really the things to evaluate. Everybody's gonna save you money. It really comes down to member experience and how some of these friction points are resolved.

rick-farris_1_04-15-2026_120830 28:34

Okay.

heath_1_04-15-2026_090830 28:36

For us we try to use negotiation as much as possible to alleviate disruption. There's other models that are more legal focused and although they can be effective, that can be somewhat disruptive to a member just 'cause you're involved with lawyers. And it can be expensive 'cause you're using lawyers. We kinda do a hybrid where it's primarily handled through negotiations using analytic tools that allow us to see what the appropriate reimbursement amount should be and coming to a negotiation table with a provider to get that resolved. But if we run into a sticky spot, we can bring in a, our legal product that has a very strong success rate. But that's a backstop more than the primary go-to.

rick-farris_1_04-15-2026_120830 29:24

Okay. for the listeners out there, Heath what kinds of organizations are the best fit for Six Degrees?

heath_1_04-15-2026_090830 29:32

For the RBP product, it's gonna be a self-funded client. And one that doesn't like giving money away. You know, if you're somebody that would rather put medical dollars back into your products, solutions, and services in the organization your employees, then we're probably somebody to work with. I mean, the irony is we have physician groups practitioner groups, facilities that use us for their own employees. So the system is using, you know, Six Degrees for its own health plans. You know, traditionally, I would say it was probably more blue collar but that's completely changed over the last couple years. We have, you know, law firms, we have technology firms, we have service firms as I mentioned, physicians facilities you know, for healthcare you know, using these programs. And you see a lot of the people in our industry, you know, TPAs do this work. You know, medical management term-- you know, firms use this work. Stop loss companies, you know, use reference-based pricing because they know the impact and the the benefit that it can bring, so.

rick-farris_1_04-15-2026_120830 30:34

funny, I was just thinking about how like an analogy you could use, a-and it's almost like, Heath, if I saw a bunch of salmon, right, in Alaska just chilling in a pond, and you and I were standing there, we're looking at these salmon, and you looked at me and you're like, "Hey, which one of these salmon's gonna make it and actually like, you know, do the job?" kinda chuckle 'cause I'd look at you and I'm like, "Well, they're all gonna try," right? Like, and it's kinda like employers. They're all gonna swim upstream. They're all gonna try to save money and contain costs on their plan. But which ones are actually gonna make it all the way up the stream, right? it's almost like the ones that do are the ones who are gonna achieve the highest level of cost containment. But in order to do that, they have to be the ones that are willing to most aggressively swim, right? And so a lot of times the answer to that question truly is, does the CFO drive or does the HR director drive? 'Cause, the CEO's driving or the CFO's driving the CEO and they're like, "Hey, listen, we have to do this so that we can afford to grow the business over here," everyone has to be on board with the complexities that are-- or the frustrations. Like, for example, "Yeah, I get it. Everybody loves this doctor, but this doctor's gouging everybody on the prices. Like, we need people to go over here. And oh, by the way, the quality rating's just as high." that does create tension in the HR department, but it has to be w-- people have to be willing to override it to get up the stream, or you're gonna just be where everyone else is and complain about

heath_1_04-15-2026_090830 32:08

Yeah.

rick-farris_1_04-15-2026_120830 32:09

know it, it sounds a bit harsh, but it's somewhat true.

heath_1_04-15-2026_090830 32:13

Well, I think smart organizations provide a carrot to their employees as well, you know. Let there be a benefit for making those decisions or making changes in the, in their behaviors. You know, reduce your deductibles, whatever it is. Add additional family to the plan. Add money back into their paychecks. I mean, it's you see all different kinds of strategies. I think if you were just to pocket everything as a owner of a company you know, you might have a very transient population, and you don't care. But otherwise, I think if you're looking for retention, you gotta help share some of that, that winnings with your employees, and they'll very quickly follow behind. Because the plan, you know, the... If there's gonna be some rough spots, it's gonna be in the first six to twelve months as people learn how to navigate that conversation about why you don't have United on your card anymore. You know, you've got a third-party administrator and a Six Degrees Health logo on there, and who are they? And that is just a simple explanation a simple discussion that with the proper education, the member can have, and they will go forth with-without any issues. But if they don't know how to explain that, then there can be some confusion because the minimum wage person at the front desk probably doesn't understand it either. Now, we've created a kind of a concierge model that allows for your members to engage with us. And in fact, in our app, there's a button you can push that, you know, click to call, and we'll have the conversation through their phone through our app with the front desk and explain it all to them. And that can be very effective at getting people in the door. And once you're in the door, they know who you are, they know the plan, and, you know, we'll do outreach prior to a plan going live to alleviate a lot of that, but it's impossible to talk to everybody prior to somebody going in. And people are constantly changing, you know, who their physician is or who their specialist is or whatnot. So we're always working hard for the plan, but sometimes it takes a couple phone calls to make sure that everything's set and ready to go.

rick-farris_1_04-15-2026_120830 34:11

No, I appreciate the transparency on that. Heath, where do you guys see the biggest savings first? Hospital claims, specialty, outlier?

heath_1_04-15-2026_090830 34:19

Yeah. Hospital claims is the bulk of it. In fact, that's why, That physician network side even though you're contracted, we try to use Medicare multiple contracts, but it's not as important as the facility RVP because the physician side is not where the bulk of the savings are. You know, we wanna make sure physicians are reimbursed fairly. They're not typically upcharging significantly. It's the facility side where you see these outrageous upcharges. You know, you could look in our analytic tool, and I'll pick on Texas, for example. You know, you might be getting a spinal fusion in Dallas, and at one of the... I won't use any names 'cause I don't want any phone calls. But you might have that same procedure at one facility in the same zip code, and it's billed at, let's say, four hundred percent Medicare. That exact same procedure with the exact same number of stitches and hours might be twenty-five times Medicare at a different facility with the exact same outcome, right? And it's that lack of transparency that the average consumer, if they saw that, they'd be appalled, right?

rick-farris_1_04-15-2026_120830 35:28

W-

heath_1_04-15-2026_090830 35:28

But they don't see it.

rick-farris_1_04-15-2026_120830 35:30

by the way, Heath, and for all of you who have kids out there or don't, but go shopping, this is like my daughter coming home to me and being like, "Dad, I got a 68% discount." And I'm like, "Oh, great. What was the markup?" And they're like, "Oh, what do you mean?" And I'm like, "It was 300% markup. You got a

heath_1_04-15-2026_090830 35:47

No, exactly. If you can set the,

rick-farris_1_04-15-2026_120830 35:50

you have to be careful in the marketplace when a carrier or when you look at it and your broker, whoever, is like, "Oh, well, yeah, but your average discount's 68%." 68%

heath_1_04-15-2026_090830 35:58

you can set the price, you can give any discount. It won't matter what the discount is, so. Yeah, you-- we have the ability to see all that, and that's something, you know, that we provide these tools so that, you know, HR can have that conversation, or we can have that conversation with the member to explain to them, you know, why these things are going on, so.

rick-farris_1_04-15-2026_120830 36:20

All right, Heath, I'm rounding out the podcast, so I'm gonna give you five lightning round questions. So

heath_1_04-15-2026_090830 36:24

Whoo.

rick-farris_1_04-15-2026_120830 36:25

quick

heath_1_04-15-2026_090830 36:25

right. Yep.

rick-farris_1_04-15-2026_120830 36:27

All right, here we go. Biggest myth about reference-based pricing?

heath_1_04-15-2026_090830 36:32

Biggest myth that it's all balanced bills and access issues. It's not. That's a very small percentage of the overall success of reference-based pricing.

rick-farris_1_04-15-2026_120830 36:42

Perfect. One word use after they understand your model.

heath_1_04-15-2026_090830 36:49

Great.

rick-farris_1_04-15-2026_120830 36:50

Okay. Most common employer hesitation and what changes their mind.

heath_1_04-15-2026_090830 36:56

Education.

rick-farris_1_04-15-2026_120830 36:57

Perfect. A benefits trend that deserves more attention right now.

heath_1_04-15-2026_090830 37:05

Probably ICHRAs, but not in a positive sense. I'm a little concerned about some of those, but...

rick-farris_1_04-15-2026_120830 37:11

All right. Finish this sentence: The future of healthcare is...

heath_1_04-15-2026_090830 37:17

Hold on. I think you cut out there. What the...

rick-farris_1_04-15-2026_120830 37:19

the future of healthcare is... Finish the sentence.

heath_1_04-15-2026_090830 37:23

Always changing. It-- I've been in this for twenty-three years, and there's no constant. It... You gotta keep being adaptive.

rick-farris_1_04-15-2026_120830 37:31

Well, Heath, I really appreciate it, man. I- we always save one question for the guest. One last thing, you know, is there anything else you'd like our listeners to know?

heath_1_04-15-2026_090830 37:41

Yeah, I mean, these programs, whether it's with Six Degrees or one of our competitors, they do work. But make sure you understand it before you get into it. One of the common things people make a mistake on is an advisor will say, "Hey, I can save you forty percent. It's gonna be just like your current plan." Y-you will save forty percent, but it's not gonna be just like your current plan. It takes some work. It takes some work by all parties, and it will be successful if given an opportunity to succeed. But don't just jump in blindly and pick your partners wisely. It's not just the work that we do, but the TPA, the work they do medical management the broker, and the advisor involved. We all gotta push in the same direction along with the employer to make these things successful, but it will save you money.

rick-farris_1_04-15-2026_120830 38:22

That's cool. Well, I just wanna thank you a- again, Heath, for coming on. And thank you to all the listeners out there. If you have any questions, please contact us and look for information on our homepage at www.fbmc.com. And Heath, if they'd like to look up Six Degree Health or get any information is there a website address or somewhere you'd like to send them?

heath_1_04-15-2026_090830 38:44

Yeah, you can find me on LinkedIn Heath Potter Six Degrees Health. Their website is sixdegreeshealth.com. Number six, sixdegreeshealth.com.

rick-farris_1_04-15-2026_120830 38:53

Thank you very much, sir. And remember to the listeners, please subscribe on any podcast app. Thanks, and have a great day