Newsmaker Interview: Jeffrey Lewis

Jeffrey Lewis
Chief Operating Officer
Employment Health Insurance Management
Southfield, Mich.

You were with the Heinz family for 20 years. That’s a remarkable stretch with one company. Why did you decide to move?

I started with Sen. John Heinz (R-Pa.) in 1989 and served as the Republican Staff Director for the Senate Special Committee on Aging, where he served as the ranking Republican until the day of his death. He was flying to Philadelphia for two meetings – one of them was with me and my staff for an intense afternoon briefing for a Congressional investigative hearing the next day. Shortly after his death, Teresa Heinz asked me to join her staff. When you meet someone as extraordinary as Teresa, you seize the opportunity, and I did for 20 years. During that time, we created some of the most amazing healthcare solutions (and) assisted public and private sector employers and safety net providers in understanding how (and why) they could reduce and more effectively control their healthcare spending, particularly in the area of prescription drugs. As extraordinary as this experience has been, I quickly realized that if I could find an entrepreneurial organization that shared the same ideals and who believed that there was a window of opportunity to change the face of healthcare forever, I would jump at the opportunity. EHIM and its president are founded on these principles – it was like a gift from God.

Of all the programs you worked on while at Heinz, is there one in particular you are most proud of, and why?

There are two. First, helping state legislators and governors understand how they could save taxpayers millions of dollars by changing their purchasing and procurement strategies. Most recently, we undertook such an analysis for the chairman of the Florida State Senate Budget Committee and the Senate president (see www.ps2healthcare.org). We identified almost $200 million in savings. The legislature just finished their work and adopted many of our recommendations.

Second, creating a solution to ensure that any person with HIV/AIDS who is placed on a waiting list for their medications never has to wait. In working with Abbott Laboratories and a number of other pharmaceutical manufacturers and Welvista, a central-fill charitable pharmacy in South Carolina, today no one placed on an AIDS Drug Assistance Program (ADAP) has to wait. Their caseworker simply calls, e-mails or faxes the form to Welvista and the medications are sent next day delivery.

The wonderful piece here was our ability to convince pharmaceutical manufacturers starting with Abbott that if we did not create a solution, hospital emergency rooms would be filled, charity care would rise and people would hold them accountable, not the government. More important, the pharmaceutical industry has done these kinds of projects with Heinz for years because we have been able to create blueprints – solutions that work, demonstrate the return on investment and, most important, help keep people independent.

What attracted you to EHIM? What are your goals as the COO at EHIM?

The values on which EHIM was created and the person who created the company. The first and, I believe, only PBM that does not and has never accepted rebates from pharmaceutical manufacturers or sold their patients’ data – two areas that every other PBM uses to make more money – EHIM learned how to operate in this space without being influenced. The founder and CEO is simply an amazing and incredible healthcare professional. When you are offered the opportunity to work with her and her team of experts, saying no was not part of the discussion.

My first order of business is to learn about everything that EHIM has done and is doing. I strongly believe that before you can walk or run, you must crawl. Understanding the core businesses that are part of EHIM is part of that slow learning process. And since I will eat and sleep EHIM, I learn fast.

You've done quite a range of things since your days as a member of Sen. Pete Dominici’s staff, including participating in John Kerry¹s bid for president and serving as the Republican staff director for the U.S. Senate's Special Committee on Aging. How will that varied experience help you in your first "new" job in 20 years?

My skill set is vastly different from anyone serving as a COO for other PBMs and that gives me one advantage: I am first and foremost a great listener. To survive in the political arena you have to understand – you have to learn to listen to what people do and do not say, siphon through the "stuff" and decide quickly what is and is not useful and real. I could have 20 different ideas for EHIM, but to truly succeed for the next 20 years requires a great deal of listening and learning. The other skill learned from the many years in the political world is the willingness to create ideas that others take ownership of. My success in life is not built on creating great solutions or interesting op-ed pieces, it is finding people who want to adopt these ideas and call them their own. Having done that for 30+ years, helping other staff take a fledgling idea and make it real, helping an employer save thousands of dollars, is ultimately their idea. I just help them understand how to (sometimes) make it a little better. My satisfaction is their smile, their success, their two-word e-mail saying "thank you." That is real success.

You have a lot of experience working with the healthcare issues in this country and, in particular, the plight of the country's senior citizens. What do you think the healthcare system needs to do to ensure our seniors can afford quality care?

Congress has forgotten that access to primary care or specialty care for seniors is not the real problem. That has always been a solvable problem. The largest crisis that has and continues to face this nation is the absence of a long-term care system – a series of affordable services to keep people over 65 as independent for as long as possible, and to protect their families from going bankrupt while caring for aging parents. Since women are America's caregivers, those who leave the workplace typically lose $650,000 in lost wages, benefits, social security benefits, pensions, etc., and they never recover those dollars. The impact is this: As daughters or daughters-in-law are caring for mom, their mother-in-law or other family members, we need to worry that we are not creating a new population of bag ladies.

What do you think are the biggest challenges facing our healthcare system right now?

First, healthcare reform will encourage employers to stop private healthcare benefits because the penalties are not significant. Therefore, you will watch a parade of employers, large and small, cease providing benefits, pay the penalty, and also reduce their HR departments. Congress forgot if employers can shift coverage to the Obama Plan, then they can cut a large number of the HR jobs that are needed to administer those programs. The result – more unemployment.

Second, Congress is spending hundreds of millions or billions of dollars creating another level of bureaucracy called Accountable Care Organizations. In the rush to demonstrate political strength, Congress failed to create a healthcare solution that could be done incrementally. Nothing can be fixed tomorrow, but we can learn from today's mistakes to create a better health system for tomorrow.

Third, Congress threw hundreds of millions of dollars at creating new Federally Qualified Health Centers as America's medical homes. But what they failed to do is understand that many FQHCs need staff, their infrastructures are weak and some have bad business models. Money does not solve a bad business model. Moreover, Congress failed to marry community mental health centers and FQHCs into a seamless system of care. The value proposition is that mental health patients often do not have access to 340B pricing because of where they access medical care. The perpetuation of a fragmented system only puts more pressure on mental health professionals.

Fourth, taxing the heck out of the pharmaceutical industry does not create jobs in America. Pharmaceutical manufacturers have been creating direct and indirect jobs in states like Delaware, Pennsylvania, North Carolina and New Jersey. If Congress does not help pharma create a sustained economic policy and strategy, more of these medications will be researched and produced outside the U.S. The result – more unemployment in Pennsylvania and New Jersey, states that are already teetering on the edge economically. Moreover, these are also companies that are publicly traded with a fiduciary responsibility to their shareholders, some who hold shares through growing 401K plans, mutual funds, etc. My point: health reform in a vacuum hurts the American economy short- and long-term.

Fifth, the future of prescription drugs should not be built on cash incentives to take or prescribe a specific medication. We want people to have access to the best medications at the lowest price.

Finally, Congressionally passed health reform does not mean affordable care – it simply means access to an insurance plan. Americans have been and continue to struggle. For many, $50 a month is still a luxury.