By Scott Wooldridge | Photography by Kevin Garrett
It isn’t unusual to hear stories of consultants coming into the industry after a difficult interaction with insurance or health care. Bryce Heinbaugh has one such story: As a young college student, he found himself in the hospital awaiting emergency heart surgery.
“I found out I had a hole in my heart the size of a half dollar, and that I needed emergency open heart surgery,” he says. “Post-op, I was quickly trying to find a health care plan that would cover me if my heart failed. This was before the ACA, so I was one of those uninsurable individuals.”
Through his ordeal, he developed a passion for learning about insurance, so he moved back home to start his own agency, one year to the month after the surgery. “I had zero social capital, but I realized that at least in my hometown, I had some knowledge of the people. So I went back to Ashtabula, Ohio, and started cold calling,” he says.
Ashtabula, a Rust Belt city about 60 miles east of Cleveland, was once a booming port town, and Heinbaugh notes that it has a rough-and-tumble, working class reputation. But the loss of many employers and industries over the years left the area with fewer opportunities. Reinvesting in the community is something that Heinbaugh is passionate about.
He has developed an innovative and successful system in Ashtabula based on partnerships with providers and employers. His company works with experienced nurses who help enrollees navigate the bureaucracies of health care and find the most cost-effective, high-quality solutions.
Early lessons
When Heinbaugh started his first brokerage at the age of 23, he admits he had a lot to learn. “For every no I received, I knew I’d be that much closer to a yes. I also realized I needed to be highly disciplined, I needed structure, I needed to set goals. Probably the biggest challenge for those entering the industry is that you’re going to be knocked down and knocked back, but you have to persist through it.”
Being a new face in the industry meant that Heinbaugh had something to prove. “For years, I was the youngest in the room. I wasn’t a country club member; I didn’t drive a sports car. I built up tenacity around that. I said, ‘I’m going to work harder than everyone else.’”
That tenacity paid off. Heinbaugh eventually became CEO of his current company, IEN Risk Management, when several agencies came together and partnered in the new venture. “My equity partners voted to have me as the CEO,” he notes. “They knew I was going to go pretty hard at things.”
“I wasn’t a country club member; I didn’t drive a sports car. I built up tenacity around that. I said, ‘I’m going to work harder than everyone else.’”
Changing community health care
The firm started out in part as a response to the ACA, but has evolved and adopted many of the innovations of the Health Rosetta movement. IEN refers to itself as a community-owned health plan, a term that was first used by Health Rosetta. “Instead of a health plan being owned and run by misaligned health care providers, such as insurers, giant health systems, or big pharma, we believe the future of health care is local, open and independent,” Heinbaugh says. “As advisors, we need to create community health plans in our hometowns, which brings local employers into a collaborative effort.”
Heinbaugh’s clients share the same template: using concierge nurse navigators, contracted care, and a system that waives copays for services and prescriptions if enrollees follow guidance that directs them to high-quality providers—usually local, but sometimes from larger regional clinics such as Cleveland Clinic.
Heinbaugh and co-founder Casey Billington created Concierge Nurse Navigators as part of IEN’s community-owned health plan model. Billington and other navigators are former nurses with direct experience in the provider side of the health care system. “Bryce originally had a couple of nurses working with him, and he realized that there was a big gap in care between the hospital systems and the insurance plans,” she says. “And unfortunately, the patients and employees were getting caught in the middle. They didn’t have someone to translate the medical and insurance lingo for them, so they struggled to navigate the complex health care system. They were often getting taken advantage of.”
The system not only brings in the experience and knowledge of providers, but partners with independent providers through direct contracting. “Bryce really tries to bring back that patient-centered and provider-centered relationship and remove the business aspect on the insurance side for the provider,” Billington says. “Providers don’t want to do additional paperwork, so if we can help build a system where they get paid faster, it helps reduce their out-of-pocket costs, so they don’t charge as much. When you take the insurance company out of the middle, that’s eye-opening to CEOs and CFOs who understand that there is a lot of waste in the current health care system.”
Rebuilding trust
The community-owned health plan model has many connected parts, Heinbaugh says, and it requires a degree of cooperation. He notes that Ashtabula is an example of a community that had lost some degree of trust in the health care system, and that affordability had become a major issue. The once-thriving port town is now part of the 8th-poorest county in the state.
“These folks were like sheep being led to slaughter when it came to health care,” he says. “You keep going in with an insurance card and just hoping you can pay the bills.”
Heinbaugh’s vision is one where unions, school systems, municipalities, and private businesses come together to create a better system. “I find encouragement and further grit in helping a community that I believe has been kicked in the teeth over the years,” he says. “We’ve had a lot of companies close and go overseas. Our greatest calling is to help middle class families overcome what has happened to them.”
Heinbaugh’s goal is to continue on the journey he began in that hospital bed many years ago. “The future for us is to remain humble and have a growth mindset. If we keep the right core values and stay on target with our mission, we can be a force for systemic change in health care and how it is provided for our families.”