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The PACN Podcast helps independent physicians and medical practices navigate today’s healthcare landscape. Hosted by Dr. John Pagan of the Pennsylvania Clinical Network, each episode explores practice management, healthcare policy, physician leadership, insurance innovation, and strategies that help private practices thrive. Featuring conversations with doctors, healthcare innovators, and industry experts, the PACN Podcast provides practical insights for physicians who want to protect their independence while delivering high-quality patient care.
Introduction
Dr. John Pagan: Hi there. This is the Pennsylvania Clinical Network Podcast where we highlight our network's talent and resources that get our physicians positive outcomes at PACN. I'm Dr. John Pagan, chair of the PA Clinical Network and your host. It's my pleasure to welcome Dr. Michael Fang today and his innovative new company.
PACN has partnered with Michael and his team to meet one of the biggest challenges of independent physicians. Dr. Fang is a geriatrician and a passionate advocate for physicians and our profession. Hi, Dr. Fang. We are excited to have you here. Tell us a little bit about your story.
Dr. Michael Fang: Hey, Dr. Pagan, thank you for having me.
And uh, and yeah, similar. We're very excited here at RYZE in our partnership with an innovative organization like PACN. I think we're very married at the hips and our joint. Mission to really just [00:01:00] defend the independent physician or our ability at is a physician to choose to practice independently and be successful.
Um,
Dr. Fang's Background
Dr. Michael Fang: yeah, I, as you said, I am a internal medicine, geriatric medicine doctor. I tell folks that since the age of eight, I wanted to be a doctor by the age of 12, I knew I wanted to take care of elderly people, and that's exactly what I did. Right. Folks often ask. Did you go get an MBA? What did you major in in college?
Was it like I, computer science? No, I did cell molecular biology. I went premed route straight to med school, straight to residency, straight to fellowship. And, and when I graduated I thought I achieved my dream right to be a geriatrician and now I can really take care of my patients. And it was when I started practicing, when that facade of academic right protection of us, that that went away.
And you realize how broken healthcare really is when you're practicing in it. And that's. When I became very interested in, in data, uh, not so much software. Again, not a computer, computer programmer or science, that's a computer science guy, but I just felt that we need to leverage data better, um, as a way to help us take care of our patients.
And that's when I [00:02:00] started, uh, getting involved with the, the health systems EHR committee, started learning about the software, um, started talking to the software developers and learning from them. And through that, um, began to build software. Solutions that was focused on taking care of patients, like clinical decision support tools like population analytics, tools like, uh, social determinants of health tools.
And uh, for the first several years of my career, that's what I was doing using technology to help us as, as physicians take care of patients. But as we came out of the pandemic, um, that's when I realized that we, independent doctors also need a lot of help. That's when I shifted my focus as a doctor and my understanding of, of software solutions for healthcare towards helping us as the physician profession.
Dr. John Pagan: Well, that's a, that's a great background. Um, how, how did you parlay that background to your innovative new company, Ryze Health? What's the mission of Ryze and how'd you [00:03:00] come up with that?
The Problem: Healthcare for Independent Physicians
Dr. Michael Fang: Yeah, it was actually a very simple, uh, grassroots movement. So, as I said, when we came outta the pandemic, right, a lot of independent practices were decimated.
And, uh, I, I was in independent practice at that time, and now after coming outta the pandemic, we were just, I was just calling around to my colleagues, seeing how they're doing, see who's still practicing, who's around. And as we, as we started to chat, um, it became pretty obvious that we as physicians don't actually have great health plans.
You do if you work for a big hospital, right? That if you work for a big employer, sure they cover your health plan. But if you are trying to start your own practice or run your own practice, you don't really have a great health plan for yourself or for your employees. We tend to be in the marketplace and we end up buying those solutions, which are very, very expensive, right?
Um, so we realize that we need to, we need to have a different solution, um, so that it can help us take care of ourselves, our families, and our employees.
Dr. John Pagan: That's great. And, and how does Ryze actually [00:04:00] help doctors? Why is this tailored to physicians?
Dr. Michael Fang: So when Ryze was designed, we, we kind of looked at what is the current problem, right?
So let's step back a bit. As independent doctors who own our own practice, we are. For all sense of the word small businesses, right? Um, even for medical groups that got to 50 or a hundred plus employees, um, you're still considered a small business. Keep in mind, a lot of other businesses in America are hundreds if not thousands of employees, right?
Even when you're at a thousand employee RS still calls you small, medium sized business. So for most of us, uh, we were never gonna get to that size. We are small businesses. When you're a small business owner, you have very limited choices when you're trying to get a health plan to cover yourself or your employees.
Right? So what do most of us do? We talk to brokers. We go to the, the payers, blue Cross Blue Shield, or, or Cigna's websites, right? Or we use the marketplace of the state or the federal healthcare.gov marketplace to find our insurance, those type of [00:05:00] insurances. When you go through those type of channels, you're getting what's called a fully insured product.
I know that sounds great. It's like, ooh, fully insured, but it's a very expensive product. Right? So on top of the thousands of dollars that you have to pay as a, as a, as a covered person, right? And most of us may wanna talk, doctors pay anywhere from 2000, sometimes to $5,000 a month, right? In premium, monthly premium for a health plan.
On top of that, you have your deductibles and you have a out-of-pocket max, and then you have your copays for if you happen to land outside the network. So if you look at it on top of the tens of thousands of dollars, you pay monthly, right? For over the course of a year for the premium, you still are almost out of pocket for about $30,000 before the insurance actually kicks, kicks in to do anything, right?
That's a very expensive health plan. The other problem with that is when you are in these fully insured products, keep in mind we're doctors, right? We're the most medically educated, trained. Uh, professions in the population, right? [00:06:00] We are literally the stewards of health, so we have the resources and the knowledge to take better care of ourselves, but when you buy these fully insured products, you are pooled with the rest of the population.
Now, I'm not saying we're elitist guys, so I'm just saying like we are in a better position to take care of ourselves and our families, right? And so, so are our employees. They're medical professionals too, right? Nurses. PAs and so forth. So we are at a lower health risk compared to the rest of the population, meaning we are at a higher likely chance of having better health outcomes than the rest of the population.
So when you're pulled in with those population in a fully insured product, you are in fact subsidizing, right? Some, a lot of your, what you're paying for is subsidizing their care. Now that's what the current state is, right? And this is why we see as small inde, uh, independent doctors, that our premiums can go up.
And we are wondering why, 'cause how many of us have spent $30,000 last year seeing doctors or running to the er? None of us. And yet our premiums keep going up. Our deductibles keep going up, [00:07:00] right? So this is why we end up in a situation, a small business owner not being able to afford to cover our employees, right, to recruit good, uh, employees by offering them health benefits.
Now the rest of America is different. Okay, so a lot of other industry employers, we're talking manufacturing, construction, right? Agriculture, like a lot of those employers, I, I've talked to beer manufacturers, I've talked to trucking corporations, they have all moved to what's called self-funded insurance.
Meaning the employers themself had either. Created their own health plan or band together in some way to create their health plan or at least band together so that they have size and volume to negotiate for better health plans. We as the small independent doctors, and there's a lot of us, there's over 400,000 independent practices still in, in the United States.
We have not done anything like that, and there has been no solutions around that, and that's why we created Ryze Health, is that we wanted to create the same. [00:08:00] Tried intrude methodologies that other industry employers have used to lower their health insurance costs for themselves and their employees. We wanted to create the same avenue and, and, and alternatives for the independent doctor.
Dr. John Pagan: Yeah, I think, you know, what you're describing is actually what we see every day and one of the missions of the PA clinical network is to make the practice of medicine easier and, and better and ironically. Physicians themselves and their practices have the hardest time getting insurance
Dr. Michael Fang: that's
Dr. John Pagan: right for themselves and for their families showing that the system isn't working.
Great. Um, and, and you did a great job, you know, highlighting the status quo and what the current system is, is doing there. Um, why is, um, Ryze unique as an approach or a solution to these problems?
What Makes Ryze Health Unique
Dr. Michael Fang: So, um, like I said earlier, other, other professions in other industries have band together to create their own health plan.
Right? [00:09:00] And that's great because if you think about it, um, when for doctors we have our own, we are, we're human beings. We get sick too. But we have a different risk profile. We have different disease burdens right there. We, because we're more aware, we probably keep up with all of our screening. So we are at a lower risk of.
Of undetected cancers, we're at lower risk of untreated cardiovascular diseases, right? So we do have our own disease burden. So when RYZE was created, we said, let's take a look at us as physicians and our employees as a medical profession. What is our health risk and what are the frequencies of that? And that allowed us as an insurance solution to design disease programs that are more catered to our our risk factors, right?
We're not truckers, so we're not gonna be driving long distances trying to. Take everything from caffeine to sugar, to right nicotine to stay awake. That's not us, right? Uh, we're at a lower risk of obesity and diabetes, right? So we can design programs now that caters to physician and our health risk, which [00:10:00] brings our costs down.
The other thing too is that we also design Ryze so that it fits the career path of physicians, right? So not all of us are in. Big medical groups. Um, some of us are practicing independently, right? Uh, as a direct primary care or concierge service. Some of us in telehealth services, some of us are 10 99. We travel across different states, right?
So we need a more unique health plan that can cover for our mobility and the fact that we are again, um, not big businesses, right? So these are all the things that, that when we were creating Ryze and our particular insurance offers to. Take into account so that our health plans really fits the physician and our medical practice type of disease burden, uh, as well as the type of career path that we have as, as, as professionals.
And of course on top of that, because of my background in informatics, we, we leverage technology, right? So we said we do not wanna be a typical health insurance company with a big building and the whole department of people trying to do whatever it is, whether [00:11:00] it's from onboarding folks to reviewing claims, to dealing with, with payments and things like that.
So we used a lot of technology, um, and automation to help remove the. The type of middleman or or overhead that typical insurance companies have, and that, again, brings our costs down so that we can be a more affordable solution specific for doctors.
Dr. John Pagan: That's great to hear. And, and, uh, you know, as, as you highlighted, you know, um, practices are very different.
I mean, if you know one independent practice, you know, one independent practice, each one of them is set up differently. There's different sizes. There's different structures. Yep. The beauty of these independent practices is that they're in the communities serving their patients where the patients are.
And they are adapted to those patients and those communities, which is why they're so valuable in the whole ecosystem of, of healthcare providing. So
Dr. Michael Fang: that's right.
Dr. John Pagan: So, so given the uniqueness and, and even the PA clinical network has many different flavors or [00:12:00] varieties of independent practices in that.
How, how can Ryze, um, be a custom solution to all of those different sizes and structures?
Ryze Health Solutions: PEO and Self-Funded Plans
Dr. Michael Fang: Yeah. Um, and like I said, fortunately for us, right, we can look to other industries who have already had tried and true models and examples of doing this, right. So Ryze, we offer, uh, in general like two different.
Buckets of solutions, right? So the first one is what we call the PEO solution. Now, PEOs Professional Employer Organization, some of you guys have seen other, um, companies out there doing this again for other industries, but we created one that's more specific for independent practices. Um, in the PEO, basically we come in as your HR partner, and because of that, we're able to aggregate you and your employees into our pool, right?
So instead of just you by yourself or you with. 15, 20 other employees. We're aggregating you together in our PEO into something that's like a 30,000 person pool. And as a large pool, we can now [00:13:00] go to the likes of a payer like Cigna, uh, or Blue Cross and negotiate way better rates, right? So instead of us looking like little independent businesses, we look like one giant corporation, and that's when we get.
Fantastic rates. And that's something the PEO is an option for. Uh, I would say anybody who's like practicing by themselves, right? A, a a, a company of one to anywhere to 15, 20. Most of the practice that come to us for that solution are smaller practices. And in addition to the health benefit, remember as a PO we can offer other things.
We can help you with payroll, we can help you with hiring. We help you with all the HR stuff, right? So when you're a small business, I know when I had a small business, none of myself and my four other physicians are trying to pay attention to HR and what we're supposed to do for employees and keeping track with the workman comps of the state and regulation changes.
And that's what the PO does, right? So in addition to, uh, aggregating you and your employees into a large pool for a nice health plan, it also gives you additional support. For growing your business. Now, uh, we also have a lot of large clients. Some of our groups are [00:14:00] 400 employee medical groups. We have one that's about to sign on.
It's 800 employee medical groups. So some doctors would think like, Hey, if I got to that size, I already, I'm fine. Right? No, they, they're struggling too, right? So they come to ride. But when you get to that kind of size, when you're. Above a hundred plus employees, that's when it gets really fun. So remember I talked about earlier where these bigger corporations and other industries have their own health plan.
That's what you can do now. That's what Ryze can help you do. Now we can design your own health plan. And in that one, it's, it's very cool, right? So remember, if you're in a fully insured product, you pay your premium. If you didn't use it. It, it, it doesn't come back. Right? It's not like Blue Cross ever gave you a check and say, oh, you didn't really go see your doctor this year, or You didn't really have any emergencies here.
$10,000 back. They never give you back money, right? In a self-funded model, which we can help create for you when you're a larger medical group, this is when the money you set aside to help pay for yourself and your employee's medical bills. If you guys had a great [00:15:00] year, you none. Nobody got really sick, right?
Everybody did their regular checkup, though as always, promote that like preventive health is good. Once you've done that, and if there's still money left in the, in the, in your bank, you keep it. It's not like we take it right. This, it doesn't go away. You keep it and it just keeps growing for the next year.
And that's how other businesses and other industries have been able to keep their premiums from going up. Right? 'cause you have surplus. Some years, some years like the pandemic, nobody made anything. Right? But in a, in normal years, usually you have a little bit left over and you can then carry that forward to the next year and keep the.
Your, your cost, uh, of health insurance, lower right for yourself and your employees. So that's, those are the two plans, PEO and then your self-funded plan, which is like your own plan. We help businesses create that. Um, and we focus specifically on, uh, uh, medical practices. We don't do this for other professions, so we're getting very, very good.
Our teams very, very good at looking at your population, your employees, their risk, and designing great plans for you.
Dr. John Pagan: This is great and this is [00:16:00] really exciting. I know a lot of our doctors have, since the time we formed the PA Clinical Network, that was one of the things on their pain point list that, you know, really we can use some help getting insurance.
Um, there. And again, it's so ironic as, as medical providers that we can't get. Insurance ourselves. So this is very exciting to have this partnership with the PA Clinical Network and NRIs, and I think many of our doctors hearing this podcast and also hearing, you know, the, the other, um, uh, information that's coming out of the network will want to learn more.
And are eager to get a quote and to, to find out more about this unique collaboration with the PA Clinical Network and, and your company and how they can, how they can do that exclusively as a member of the PA Clinical Network. So what are the next steps for those docs that, that want to get a quote?
How to Get a Quote
Dr. Michael Fang: Yeah. Um, this is again, why we're so, so excited, uh, Dr. K to partner with you and, and PACN. They just have to go to the PACN website. If you are a member of PACN, go to [00:17:00] Ppac N'S website. We've worked with the PACN team to put information about Ryze about. The insurance and some simple FAQs directly there. Um, and from there you can also click, um, there's also a link where you can then come to, um, a, a portal.
It'll ask you some simple questions about you as a doctor. If you're asking for your practice, it will ask you questions. About your practice, but you know, pretty simple questions. Nothing, nothing that's too complicated. It takes you maybe about 15 minutes if it's a, if you're just looking for yourself as insurance, if it's about your practice may take a little longer, 20, 25 minutes for some information about your practice and your number of employees and so forth.
But once you go through that little questionnaire survey, our team can take that information. They'll reach out to you, understand you more while our underwriting team, um, so the underwriting team is the team that looks at the numbers, right for insurance. Um. And, and they'll start to put together a, a solution and different types of quotes for you, but go no further than PA N's own own website.
Dr. John Pagan: That, that's fantastic, Michael. I mean, we, we really [00:18:00] appreciate, um, your time and the strong work that you and your innovative company do for our PA physicians, PACN physicians and for all doctors. Thank you. Um, but that wrap, that about wraps it up for today's conversation. Uh, thank. Everyone for tuning into this latest installment, and there's gonna be a part two to this and probably a part three.
So look for that as well, as well as all the other podcasts in our series that help have helpful tips on optimizing the recognition your practice deserves for the great care that you provide your patients every day. Once again, I'm Dr. John Pagan and the host of the PACN podcast and your chair. Uh, thanks for tuning in and, uh, Michael, we'll see you the next podcast.
Dr. Michael Fang: Take care everybody. Thank you for having me.